Herbal medicine in Japan

Japanese traditional medicines, Kampo medicines (KMs), are usually herbal medicine based on traditional Chinese herbal medicine but developed into a unique form in Japan. At present, 148 kinds of KMs have been approved and are enlisted on the “National Health Insurance Drug Tariff.” About 72% of Japanese physicians prescribe some KMs to their patients. Based on patients' symptoms, KMs are given alone or in combination with contemporary western medicines. KMs can manage urological problems including erectile dysfunction, male infertility, lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia, overactive bladder (OAB), urolithiasis as well as late-onset hypogonadism (LOH) in Japan. In men's health clinic, a number of patients is eugonadal with suspicious LOH-related symptoms. Some are not eligible for androgen replacement therapy (ART) while others have no response to ART. To manage these patients, KMs can be used to improve indefinite complaints, or LOH-related symptoms. For psychological symptoms, saikokaryukotsuboreito, keishikaryukotsuboreito and kamikihito are usually used. For somatovegetative symptoms, we can use KMs as follows: hachimijiogan for erectile dysfunction and LUTS; goshajinkigan for numbness and OAB; hochuekkito for general fatigue and appetite loss; and keishibukuryogan for hot flushes. In recent experiences of the treatment for patients who visited our men's health clinic, these medicines showed effective rates of 57% to 71 %, either with KMs alone or in combination with ART. Mechanisms of the efficacy are to be elucidated, and efforts to find evidence for Kampo formulae are being made according to not only patients' symptoms but also to disease entities.