**3. Application of Kampo medicines**

of licorice was the root or stolon of Glycyrrhiza uralensis or G. glabra (Legminosae) [1]. Licorice con‐

To select the best Kampo medicine, the patient's condition will be first checked by the crite‐ ria of yin‐yang and xu‐shi categorization (activity and physical fitness) and then narrowed down by the life force, blood and colorless bodily fluids, (if necessary) followed by the five viscera theory and the pulse, tongue and belly (**Figure 2**). As compared with Western medi‐ cine, Kampo medicine is more empirical (rather than scientific), comprehensive (rather than analytical), global (rather than local) and personal (rather than general) and normalizes the

During the business sorting work in 2009, the then Japanese regime proposed the exemp‐ tion of insurance against Kampo medicines, fomentations and mouth washes, claiming that Kampo medicine is evidence less and it can be obtained very easily by anybody. However, the patients, herbalists and medical personnel moved against this proposal by means of collecting approximately one million signatures and made the proposal with‐ drawn. Now, in Japan, approximately 150 Kampo medicines and 200 herbal drugs used as decoctions are covered by health insurance. Among the 900 physicians who worked in the core cancer treatment hospitals, 92.4% reported having prescribed Kampo medications [3]. Nationwide, random‐sampled and population‐weighted telephone survey demonstrated that respondents who had used at least one complementary and alternative medicine (CAM) therapy (76.0%) were greater than those who had used orthodox Western medi‐ cine (65.6%) and that the expenditure for CAM was nearly half that of orthodox Western medicine [4]. The most common CAM practice was Kampo, which corresponded to 96.1%

tains three orders higher amounts of glycyrrhizin, as compared with other components [2].

**2. Difference of Kampo medicine and Western medicine**

4 Biological Activities and Action Mechanisms of Licorice Ingredients

patient's condition (rather than removing the cause of disease).

**Figure 2.** Process of grasping the patient's condition prior to the prescriptions of drugs.

Kampo medicines have been used to improve the symptoms of various diseases (**Table 1**). Bakumondoto, Hochuekkito and Kiyoshihaiyu, which contains licorice, have been reported to improve the symptoms of chronic obstructive pulmonary disease (COPD) [6, 7]. Daikenchuto (that contains hydroxy‐α‐sanshool and 6‐shogaol as major ingredients) improved the intesti‐ nal motor paralysis and Crohn's disease, by increasing the RAMP (receptor activity‐modify‐ ing membrane protein) 1, 2, 3, mobilizing the CGRP (calcitonin gene‐related peptide) and AMD (adrenomedullin) and inhibiting the expression of pro‐inflammatory cytokines (TNF‐α, IFN‐γ) [8]. Rikkunshito recovered the meal uptake by increasing the plasma des‐acyl ghrelin level, suggesting its possible application to dyspepsia [9].

Old people experience the decline of body strength and vital function, the continuous languor, the loss of appetite and the fatigability. This kind of aging‐associated characteristics cannot be remedied by Western medicines, but more easily alleviated by treating with co‐agents such as


**Table 1.** Application of Kampo medicines to various diseases.

Hochuekkito and Juzentaihoto. However, licorice present therein may induce hypokalemia (hypertension, edema, feeling of weakness, convulsions paralysis of the extremities, arrhyth‐ mia) [10]. Shosaikoto, which also contains licorice, is known to induce interstitial pneumonia (fever, dry cough, exertional dyspnea) [11]. The use of herbal medicines is increasing all over the world and when a patient with such risk factors is prescribed an herbal medicine containing licorice, careful follow‐up is required. The patient's symptoms should be carefully monitored and if no improvement in symptoms is observed, continuous treatment should be avoided.
