Efficacy of Kampo medicine in respiratory diseases “1st International Symposium on Kampo Medicine”

To the Editor The integration of Western and Kampo medicine is a characteristic and massive advantage of medical care in Japan. Kampo medicine complements the parts which Western medicine cannot deal with and sometimes contributes to the primary treatment. More than 90% of Japanese clinicians prescribe Kampomedicines daily, including for respiratory diseases. Kampo medicine treats not only symptoms such as cough or sputum but also the disease itself. Furthermore, Kampo medicines called “hozai” support the patients with the disease themselves by immunomodulating effects or improving frailty. Western and Kampo medicine are in a different position from a treatment perspective. In this session, the unique remedy perspective for chronic obstructive pulmonary disease (COPD) and non-tuberculous mycobacterial (NTM) pulmonary disease that Kampo treatment has, is introduced. Recently the basic science regarding the mechanisms of Kampo medicines has progressed, and the mechanical approach for seihaito is briefly described with original data. Through these topics, we will discuss the efficacy of Kampo medicine for respiratory diseases. The first presentation is “Stillness and Movement are Beautifully Harmonized in Japanese Kampo Medicine.” Japanese Kampo medicine complementarily fills in gaps of Western medicine based on coexisting with the latter. Understanding of Japanese Kampo medicine from both a Western and Kampo medical perspective is therefore required. What is the basis of medical care? The answer is how to capture the signals emitted by the living body. In Western medicine, diagnosis naming the disease is required for medical therapy to acquire a medical insurance reimbursement. In contrast, in Japanese Kampo medicine a pathophysiological diagnosis is required for Kampo therapy. Western medicine is the science of disease, while Japanese Kampo medicine is the science of indication. In other words, Western medicine is searching to find a drug that works, while Japanese Kampo medicine is pursuing how to make medicine work. Japanese Kampo medicine originally comes from classic Chinese medicine. This framework was introduced to Japan around the 5th–6th centuries, and since then, based on the heritage of past experience, and by repeating verification again and again and making progress in the search of new developments, Japanese Kampo medicine has continued to develop. Japanese Kampo medicine has become established by combining a perspective of modern Western medicine and looking for what appropriate therapy is in accordance with the Kampo medical syndromes [1, 2]. Japanese Kampo medicine is a harmonious medical practice. The second presentation is “Clinical Application and Consideration of Ninjin’yoeito for Frailty of COPD Patients.” From a clinical perspective, chronic obstructive pulmonary disease (COPD) is characterized by gradual chronic cough, phlegm, and/or dyspnea on exertion, often combined with malnutrition and reductions in muscle mass. COPD presents a high incidence and mortality rates and is one of the diseases in which further clinical research is needed both in Japan and abroad. Recently, since the introduction of frailty as a symptom of COPD, the co-occurrence of frailty and COPD is seen to be highly prevalent among elderly patients. As the progress of both functional declines indicates similarity, a common mechanism is suggested. Ninjin’yoeito is an herbal medicine used to treat the symptoms of frailty, including decreased strength and/or fatigue; a clinical trial for COPD is also reported. We examined the effect of ninjin’yoeito on COPD patients with frailty and/or prefrailty despite them receiving established outpatient treatment [3]. This was a randomized controlled trial where the primary endpoint is the basic checklist reflecting the condition of frailty. The secondary endpoint included appetite, quality of life, and psychological symptoms. The administration of ninjin’yoeito demonstrated an improved effect on frailty and indicates a statistically significant difference in the COPD assessment test score indicating exacerbation of severity, appetite loss, anxiety, and/or depression. This study demonstrated the multilateral effect of ninjin’yoeito in COPD patients with frailty and/or pre-frailty. The third presentation is “Kampo Medicine for NTM Pulmonary Disease (NTM-PD).” The increase of nontuberculous mycobacterial (NTM) patients has become a global problem. Although standard combination therapy for NTM-PD, such as macrolide antibiotics, rifampicin, ethambutol, and amikacin or streptomycin is generally standard, complications of the drugs prevent treatment completion. Many cases of relapse are also recognized. The management of NTM-PD is worldwide thought to Received: 23 May 2022 Revised: 6 July 2022 Accepted: 15 July 2022