Role of Kampo medicine and integrative medicine in general internal medicine “1st International Symposium on Kampo Medicine”

Japan faces multifaceted challenges including a rapidly aging population, escalating healthcare costs, and economic decline. These situations require physicians who can adapt as well as provide comprehensive medical care. Therefore, primary care which includes general internal medicine (GIM) and family medicine, has become a vital component of a well-functioning health system. Both GIM doctors in Japan and family medicine physicians in the US offer medical services in the clinic and hospital settings; however, family medicine doctors see patient of all ages. The Japanese healthcare system also supports Kampo, hence doctors in Japan are allowed to prescribe Kampo medicine as well as modern medicine. Kampo has been integrated into the Japanese national health care system since 1967. Research shows that about 90%of doctors prescribe Kampo formulas on a daily basis. Evidence to show the effectiveness of Kampo therapies has been reported in both outpatient and inpatient settings (1). Here, we aim to introduce the role of Kampo therapies in GIM, in addition discussing research involving Kampo therapies against infectious diseases and its potential for incorporation into the field of integrativemedicine in theUS. In Japan, the first GIM department was established in 1976. Since then, the number of GIM departments has increased and the role of GIM has become important due to Japan’s aging population. GIM received official recognition from the JapanMedical Specialty Board as the 19th area in the new medical specialty training system in 2018. In outpatient care, physicians treat a wide variety of patients who have chronic and degenerative diseases, functional and psychosomatic disorders, medically unexplained symptoms, and elderly comorbidities. Application of Kampo therapies can have a positive effect on these conditions and offer additional treatment options for these complex patients (2). Kampo therapies are also useful for inpatient care. As Japan ages, more elderly will need inpatient care, placing increased demands on limited resources. Even the best modern therapy cannot stand without primary preventive care for sustainability. Kampo does not directly affect the illness itself but helps stimulate patients to heal alongside modern medical therapies. As modern medicine mostly focuses on symptom suppression or killing infective pathogens and sometimes leads to issues such as resistance, conditioning patients with Kampo medicine in combination with modern therapy will help stimulate patients’ own immune systems for symptom improvement and possible increased resilience to future disease processes. For example, maoto has been effective against influenzawith further uses for COVID-19 described below. Recently, many GIM physicians participate in the teams caring for patients with COVID-19. In addition, some studies reveal the effectiveness of Kampo medicines against infectious diseases. Maoto exerts anti-viral effects on influenza and respiratory syncytial virus (RSV) (3), in which the mechanisms are different. In influenza, maoto traps the viruses within endosomes, and in RSV the binding of Ephedrae Herba and Cinnamomi Cortex components to virus surface G proteins inhibits its infectivity. Maoto also has positive effects as post-exposure prophylaxis for COVID-19 in the inpatient setting (4). In the US, integrative medicine is becoming popular as patients seek medical care to address the root cause and heal the disease process from the source incorporating eastern medicine principles. Western doctors have grown adept at diagnosing conditions and treating the resulting symptoms. More often than not, therapy errs toward symptom suppression. Unfortunately, patients may remain on medication for the rest of their lives with gradually increasing doses. The American Academy of Family Physicians advocates for evidence-based evaluations of integrative medicine to facilitate education, treatment, and counseling of patients. Some evidence supports the effectiveness and safety of several complementary or integrative treatment approaches to common primary care problems such as low back pain, insomnia, and anxiety symptoms (5). Integrative medicine aims to treat the patient as a whole and aims to work with conventional medicine to give the body the tools it needs to recover and eventually require less medication. In the US, doctors can learn integrative medicine and become board-certified following a fellowship after medical residency with focused areas of concentration such as ayurveda or acupuncture, and even Kampo in the future. Some family medicine residency programs in the US include integrative medicine and acupuncture training, which lead to less opioid prescription. Received: 19 May 2022 Revised: 10 June 2022 Accepted: 12 June 2022