Japanese traditional medicine

Moegi Tanaka et al. (2021) · PloS one

This randomized controlled trial with 77 analyzed women explored whether Yokukansan, a traditional Japanese Kampo herbal formula, can reduce anxiety around breast cancer surgery. Kampo is the Japanese adaptation of traditional herbal medicine, and Yokukansan combines seven herbal extracts that are traditionally prescribed for irritability, restlessness, and insomnia. Perioperative anxiety (anxiety in the period around an operation) matters because the authors link it to faster heart rate, higher blood pressure, longer postoperative pain, and a higher risk of postoperative delirium. Common anxiety medicines such as benzodiazepines can cause sedation, which is why a short-course herbal option was tested. Women aged 20 to 60 undergoing partial or total mastectomy at two Niigata hospitals in Japan were randomly assigned to a Yokukansan group or a control group. The Yokukansan group took two 2.5 g doses of a standardized extract granule, one at bedtime the night before surgery and one 2 hours before anesthesia; the control group received water. Anxiety was measured objectively with salivary alpha-amylase (an enzyme that rises with stress) and subjectively with two questionnaires, the Hospital Anxiety and Depression Scale and the State-Trait Anxiety Inventory. Pain was rated on a 100-mm scale the day after surgery. Salivary alpha-amylase just before surgery was lower in the Yokukansan group than in controls (0.88 versus 1.14 on a log scale, p = 0.03), meaning a smaller physiological stress signal at that moment. HADS-Anxiety scores dropped by 2.77 points with Yokukansan and 1.43 points in controls (both significant, though the difference between groups did not reach significance, p = 0.083), and the authors suggest part of the drop may reflect reassurance once surgery was complete. Trait anxiety on the STAI fell by 4.23 points with Yokukansan and did not change in controls (p = 0.92), with a significant group-by-time interaction (p = 0.009). On both questionnaires higher scores mean more anxiety, so falling scores indicate improvement. Pain scores were nearly identical (1.4 versus 1.36, p = 0.70), and no adverse events were observed. The authors suggest two preoperative doses may reduce perioperative anxiety and that further research is justified. Several limitations apply. Patients knew which group they were in because no matching placebo exists for Kampo medicines, so reassurance may explain some of the effect. Salivary alpha-amylase measures stress generally, and the analyzed groups fell short of the planned size, leaving statistical power at 0.708. Pain was low in both groups, so any pain effect remains untested. Larger double-blind, placebo-controlled trials, including more invasive surgeries, are called for.

John Kavanaugh et al. (2022) · International journal of environmental research and public health

This randomized controlled trial with 34 physicians and healthcare workers (24 in the forest-bathing group, 10 in a waitlist control group who took a day off instead) explored whether Shinrin-Yoku, Japanese for "forest bathing," a guided practice of mindfully sensing a forest environment rather than exercising through it, could ease professional burnout. Burnout was tracked with two validated tools: the Oldenburg Burnout Inventory (OLBI), which scores exhaustion and disengagement from work, and the Mini-Z, a shorter survey of job satisfaction and burnout risk. Physician burnout affects an estimated 33-50% of doctors and was worsened by the COVID-19 pandemic. Participants, health sciences faculty and medical residents at a New Mexico teaching hospital, were randomized through REDCap. The intervention group completed a 3-hour guided walk of under half a mile through a pinon-juniper forest, led by certified Association of Nature and Forest Therapy guides: a 15-minute grounding exercise, several sensory "invitations" to notice their surroundings, a 20-minute solo "sit spot," and a closing gratitude circle with shared tea. Both groups completed the OLBI and Mini-Z before and after their respective activity. Burnout scores stayed high in both groups throughout: median OLBI and Mini-Z scores never dropped below established burnout thresholds, before or after the walk. On the OLBI, there was no significant difference between the forest-bathing group's before-and-after scores, or between the two groups afterward (meaning the walk did not measurably shift standardized burnout scores). The Mini-Z initially showed a significant post-walk improvement in the intervention group versus control, but after adjusting for multiple comparisons (a standard statistical correction to avoid false positives), that difference was no longer significant. Separately, 34% of all participants said they had some burnout symptoms and 12% said those symptoms never let up. Yet the subjective side told a different story: of 20 participants who wrote in after their walk, 19 described feeling calmer, more relaxed, more appreciative, or less anxious; only one felt no different. This gap, unchanged scores next to strongly positive accounts, suggests one forest-bathing session may ease momentary stress without touching the deeper, cumulative syndrome burnout scales measure. The study was small (34 completers of 56 enrolled, notable dropout) and unblinded, testing only a one-time session; the authors and Shinrin-Yoku's founders note the practice is meant to be ongoing, not a single dose. Larger trials of repeated forest-bathing over months are needed before it can be recommended as a standalone burnout treatment, though it may help as a short-term stress reliever alongside other care.

Hestri Norhapifah et al. (2024) · International journal of community based nursing and midwifery

This randomized controlled trial with 80 first-time mothers tested whether shiatsu — the Japanese finger-pressure massage technique — can ease pain and anxiety during childbirth. Conducted across four low-risk maternity clinics in Samarinda, Indonesia, the study speaks directly to the many birth settings worldwide where epidurals and pain medications are scarce and midwives' hands are the main resource available. Women were randomized to receive shiatsu from certified midwives following standardized protocols, or standard care alone. Pain was scored on the 0–10 Numeric Rating Scale and anxiety on the Hamilton Anxiety Rating Scale at three moments: before the intervention, during early (latent) labour, and at the transition phase — the stage just before pushing, when contractions peak in intensity. What makes the results striking is the direction of travel. In the control group, pain did what labour pain does: it climbed, from 6.85 to 8.85 out of 10 by transition. In the shiatsu group, starting from the identical 6.85, pain fell — to 4.78 by transition (p<0.001). That is a four-point gap at labour''s hardest moment. Anxiety followed the same split: down from 28.5 to 20.7 on the Hamilton scale with shiatsu, up from 25.6 to 31.7 without it (p<0.001). No safety problems were reported for mothers or babies, and the intervention required nothing beyond trained hands and a repeatable protocol. For expectant mothers and midwives, this trial adds solid evidence that skilled pressure massage genuinely changes the experience of labour — not by numbing pain like a drug, but by reversing its expected escalation while calming the anxiety that amplifies it. The honest caveats: massage cannot be blinded, so comfort from focused human touch and attention is part of the package; the comparator was usual care rather than sham massage; and the participants were low-risk first-time mothers in one city, so high-risk pregnancies need separate study.