[MUSIC] My name is Kenji Watanabe from Keio University in Japan. And my background is actually internal medical doctor at the beginning. But now I'm doing other traditional medicine, so that is called Kampo medicine in Japan. >> Kampo medicine? >> Kampo medicine. >> And I would like to ask you what is the prevalence of herbal use of Kampo herbal use among patients with cancer, during chemotherapy in Japan. >> So the target of the treatment by Kampo is a human itself. But in the western medicine, the target is the Or disease. So it's a big difference between western medicine and traditional medicine, and especially for the cancer patients in my clinic. So 10% of the patients are cancer patients and they came to my clinic for many many reasons. I want to enhance, augment the immunology, immunity, or reduce the side effects by chemotherapy or radiation. So when you consider about the treatment for the human body, so herbal medicine can apply in many, many cases. >> Can you give me examples of herbs of Kampo medicine herbs that are frequently used in cancer treatment in order to improve the quality of life like nausea, neuropathy and so on, fatigue. What do you use? >> So the fatigue, the many many Kampo formula, are merely including ginseng. >> Ginseng. >> Panax ginseng. And panax ginseng has a tonic action to the human body but at the same time to boost the immune system. So currently in Japan 147 formula available on the list of the national insurance coverage. >> It means that if cancer patients come to your clinic, you can prescribe ginseng or any other of these over 1,000 herbs and the patient gets it free. As part of the medical insurance? >> Yes. Actually they are not free, 30% self payment. >> Self payment. But 70% is covered? >> Yes. >> So, which other herbs are used in terms to alleviate, for example, nausea or vomiting? >> So, 40 side effects of the chemotherapy so some formular are proven to reduce the side effects. For example diarrhea induced by eating a Is so diminished by, I'm sorry this is a Japanese name. [FOREIGN] Is very effective to reduce the diarrhea. So not for the only so couple are experts, but also surgeons. So I prefer to use such Kampo medicine to reduce the side effects by. >> So who prescribe this medication? I know you're well-trained in Kampo medicine, but can an ordinary, let's say, oncologist prescribe ginseng or another Kampo formula? >> So we tried it before, and the result showed. So over 90% of the oncologist are prescribed Kampo medicine. So it's well used, but for the very complicated cases. So we experts are prescribed a very special formula. >> So do clinicians in Japan, are they trained to Kampo medicine as part of the medical conventional training? >> Yes, so we have 80 medical schools in Japan. And all 80 medical schools are also teaching Kampo in the undergraduate. >> So there is a course for Kampo medicine? >> Yes. >> Like introductory course or something like that? >> Not really introductory, it's a real course. >> A real course. >> It's mandatory. >> I see, and for complicated quality of life issues, that we don't have any convention treatment like neuropathy induced by toxins or by other chemotherapies. Do you have any Kampo formulas that can be used in order to alleviate tingling pain, all kinds of disruptive sensations. >> So do you know aconite? >> Yes. >> So aconite can be used in Japan, it's not so allowed to use in some of your countries or USA. But aconite has a strong effect to alleviate the pain of the foot and hands. So there are several Kampo formula, including aconite, so we prescribe. >> So how do you manage, for example, with aconite, it's an herb with well-known toxicity. And there is a lot of literature about side effects of herbs, during chemotherapy, about interactions, potential interactions with chemotherapy. How do you deal with these safety issues? >> So quality control on the safety control, is well done by the Japanese pharmaceutical companies. So when the Dr Keller of the EMEA, so visited Japan and he was so surprised to see the batch of the certain formula this year. It is almost identical to the batch ten years ago. So the point is well-preserved and the safety is well-checked by the pharmaceutical company in Japan. So that's why so more than 90% of health physicians, oncologists, are prescribe Kampo medicine to cancer patients. So it's a strong, strong feature in Japan. >> So can you estimate, I mean, what's the prevalence, how many people who undergo chemotherapy, patients with cancer that go into chemotherapy, what's the percentage of people that would eventually use herbal medicine during chemotherapy? >> I have never counted that but, so over all, from the physician's aspect, so about 90% of physicians, not limited to oncologists are prescribed Kampo medicine in daily practice. But from the patients side, only 1.4% of patients reach Kampo medicine. >> So maybe it's a little bit higher in cancer patients. But roughly, maybe so 5% of patients reach to Kampo doctors. >> And would you say that Kampo medicine in Japan is integrated within cancer care? I mean it's, or separate from cancer care? I mean oncology and herbal medicine are really integrated Well integrated so that's a good point. And so in Tokyo University Hospital. So I communicate with the oncologist to treat patients and still some physicians very conservative. And sometimes they refuse, so traditionally medicine. But in most cases Kampo medicine is well accepted. >> So for example a patient with gastric cancer, or colon cancer, comes to oncology department in Japan, would you expect the oncologist or nurse, or someone else from the team to suggest to the patient that he can receive a referral to someone like you? Is it really something that's happening in daily life? >> So in the many cases, the oncologist, himself or herself, prescribe some certain type of medicine. If it doesn't work really well, then, so they think about the referral to expert, like me. >> I see >> So it's really well-established in Japan. >> Yes. >> I mean, in the cancer care. And do you see any patients that would say, I want to get only Kampo medicine, no conventional medicine at all. I want to be healed only by Japanese herbal medicine. Do you find people like that, or most people want to combine the two agendas? >> So most patients want to combine, but in some cases, like palliative care, so they refuse the further chemotherapy and come to my clinic. And in that case, I prescribe only Kampo medicine. >> And do you integrate, in palliative care for example, is it only herbal medicine or you combine other sorts of Japanese acupuncture or other complementary medicine modalities within the integrative care? >> Yep, so acupuncture, herbal medicine and sometimes some morphine. So for the morphine side effect, so Kampo reduces for example constipation, nausea. So to reduce the morphine side effect, so Kampo useful too. So it's well integrated. >> So actually when you prescribe morphine, you also subscribe herbal medicine in order to reduce the side effects of morphine or to be able to give more if needed? >> Yeah, exactly. >> Yes, so in palliative care what are the main symptoms that you find helpful in terms of kampo medicine effect? >> So appetite loss. >> Appetite loss. >> Yeah and fatigue. So and also coldness. >> What's that? >> A cold sensation. >> Cold sensation, yeah. >> A cold sensation, I ask the patients to check the body temperature. And ideally it should be 36.5, but most of the cancer patients have the body temperature >> Are less then 36, so low body temperature means the decrease of the immunity. >> Okay. >> So that's why with Kampo medicine I try to increase the body temperature to enhance the immune system. >> Highly interesting. I thank you very much, really. Thank you for the interview and for knowing your work and your approach. >> So the final message? >> Yes. >> If you're interested in, so I'm very pleased to support the patients or clinic. >> In foreign countries but at the same time if you send your students or fellows to Japan you're welcome. >> Thank you very much. >> Thank you. [MUSIC]
