Kampo medicine in modern cardiology “1st International Symposium on Kampo Medicine”

To the editor, In the field of modern medicine, the requirements and necessity of evidence-based medicine (EBM) are increasingly demanded. Cardiovascular medicine in Japan is no exception. To answer various clinical questions, we need to perform carefully planned clinical trials at a huge expense of various medical resources. These trials are providing statistically validated medical procedures including medical devices and usage medicines for clinical guidelines. To the contrary, various procedures provided by Kampo Medicine are not sufficiently validated by EBM. Traditionally, orally described clinical chips, called “Kuketsu”, for individual subjects are used and applied to treat and cure the patients. Such individual approaches are the strength and characteristics of Kampo treatments in modern medicine, including in cardiology. In the current symposium, we are going to share our experiences of the effectiveness and utility of Kampo medicine in subjects with cardiovascular symptoms and discuss potential applications of Kampo medicine in geriatric cardiology. In the conclusions, we suggest that effective modernization of Kampo medicine in cardiology will be promising to create future integrated medicine with sophisticated combinations of both Kampo and western medicine. The first presentation is “Nutritional Solution Aided by Kampo Medicine in Cardiology.” Currently, malnutrition, frailty, and sarcopenia are becoming major clinical concerns for elderly patients in Japan. In cardiology, these ultimately result in a severe, life-threatening condition, “cardiac cachexia,” which is poorly understood and has no effective medical solutions. Not only physically unhealthy conditions, but also psycho-sociological insufficiencies are causing these health problems that are characteristic for the elderly. Both medical and nursing burdens are growing and ruin social, medical, and individual resources which in Japan are called “Year 2025 Problems,” inducing the medical reconstruction of the community. In this symposium, we are going to propose solutions for geriatric cardiology aided by Kampo medicine in Japan. These might include rehabilitation and multidisciplinary collaboration, both aided by Kampo medicine. In Kampo medicine senescence is seen as the gradual processes of imperceptibly losing vitality, which is called congenital “Qi” in ICD-11, accompanied by impairment of digestive function, which is called “Hi-I-kyo” and is a major source of acquired “Qi” in humans [1]. In Kampo medicine, we have various solutions for treating these conditions such as rikkunshito, hochyuekkito, ninjinyoeito, and so on [2]. These solutions should be beneficial in cardiac malnutrition and might be used in modern medical procedures to settle unresolved conditions such as malnutrition, frailty, sarcopenia and ultimately cardiac cachexia aided by Kampo medicine. The second presentation is “Practice in Cardiology by Kampo Medicine in Japan.” According to the Japanese Society of Hypertension’s Guidelines for the Management of Hypertension, 43 million people in Japan are estimated to be hypertensive [3], edging it toward being endemic. According to the Japanese registry of all cardiac and vascular diseases, in 2012, approximately 210,000 patients presented with heart failure and about 260,000 people developed the disease in 2016, indicating an increase by approximately 10,000 people per year since 2012 [4]. In an aging society the progression of cardiovascular diseases is further accelerated. Western medicine is the main form of treatment of cardiovascular diseases because abundant evidence exists that supports its effectivity, and Kampo medicine is uncommon in clinical practice. However, some formulations of Kampo medicine seem effective in certain cases in which the standard treatments of western medicine fail to obtain satisfactory results, such as cardiac neurosis. It is reported that 90% of medical doctors in Japan have experience with prescribing Kampo medicines, indicating that Kampo medicine plays an important role in modern medicine in Japan. Therefore, it is essential to obtain evidence on Kampo medicines prescribed in medical practice for cardiovascular diseases. In this symposium, I will introduce some case reports of patients with cardiovascular diseases to help understand the construction of evidence. The third presentation is “Kampo Medicine, Ameliorating Patients’ Symptoms, Outperform Routine Cardiology Practices.” Symptoms related to or localized to the chest often cause us anxiety. As we all know, they should be thoroughly diagnosed and treated first by western medicine Received: 20 May 2022 Revised: 21 July 2022 Accepted: 27 July 2022