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This is a very interesting research proposal to evaluate a formula
originated from Chinese traditional medicine, Gan Mai Da Zao (GMDZ)
decoction. The protocol for a systematic review is generally well written;
however, there are several points that need to be addressed from the
standpoint of Japanese traditional Kampo medicine, which incorporated the
Gan Mai Da Zao decoction as kambakutaisoto.
Kampo medicine ori...
Kampo medicine originated from ancient Chinese traditional medicine,
but developed distinctively . Kampo medicine was the orthodox medicine
in Japan until the 19th century when modern Western medicine took over.
Nevertheless, some Kampo formulae are still officially registered in the
Japanese Pharmacopoeia . Since 1967, Kampo formulae have been covered
by National Health Insurance, and currently 148 Kampo formulae are
approved for ethical use . Although Kampo extracts are crude drugs
derived from plants, animals, and minerals, their quality is strictly
controlled in accordance with the Japanese Pharmacopoeia by quantitative
analysis of marker components using high-performance liquid
Unlike China and Korea, traditional medicine in Japan is used in a
Western-style medical system, and is prescribed by medical doctors,
educated in Western medicine , who are required to have a basic
knowledge of Kampo formulae. Reflecting the needs for establishing
evidence-based medicine in Kampo, the Japan Society for Oriental Medicine
has run a project from 2001 to gather comprehensive data on the randomized
controlled trials (RCTs) of Kampo formulae in Japan, and to compile
structured abstracts with critical appraisal. This report is published
annually as Evidence Reports of Kampo Treatment (EKAT) in Japanese and
English. In the current version EKAT 2013, 402 RCTs of Kampo formulae
The first point to be addressed is that the systematic review
protocol developed by Dr. Jun et al. lacks searches of articles written in
Japanese; thus, it may result in a biased review. The authors are
encouraged to search in Japanese database, Ichushi , although no RCTs
of kambakutaisoto (Japanese name for GMDZ decoction) seem to be reported
in EKAT 2013. Secondary, the authors mention that they include forms of
GMDZ such as extracts, tablets, capsules, pills, powders or injections.
However, unlike Japanese Kampo extracts, the quality and ingredients of
the formulae such as tablets, capsules, or crude powders are not strictly
controlled, especially in the older articles, which may result in a bias.
Thirdly, although the authors are planning to search the Kampo formula by
kambakutaisoto or kam baku tai soto, older articles seem to use the word
kanbaku-taiso-to to express the formula, and this word should be included
in the search. The structured notation of kambakutaisoto is not quite
correct; it should be Kambaku-taiso-To.
1. Matsumoto M, Inoue K, Kajii E. Integrating traditional medicine in
Japan: the case of Kampo medicines. Complement Ther Med 1999;7(4):254-5
2. Kawashima N, Deveaux TE, Yoshida N, et al. Choreito, a formula from
Japanese traditional medicine (Kampo medicine), for massive hemorrhagic
cystitis and clot retention in a pediatric patient with refractory acute
lymphoblastic leukemia. Phytomedicine 2012;19(12):1143-6.
3. Motoo Y, Arai I, Tsutani K. Use of Kampo diagnosis in randomized
controlled trials of kampo products in Japan: a systematic review. PLoS
4. Task Force for Evidence Reports/Clinical Practice Guidelines (ER/CPG-
TF) Special Committee for Evidence-based Medicine (EBM), The Japan Society
for Oriental Medicine (JSOM). Evidence Reports of Kampo Treatment (EKAT)
Appendix 2012. Retrieved September 4, 2014, from
5. Tomizawa Y. Ichushi, Japanese medical bibliography. Kyobu Geka
2010;63(7):585-9, in Japanese