吉野 鉄大 (ヨシノ テツヒロ)

Yoshino, Tetsuhiro



医学部 全人的漢方診断共同研究講座 (信濃町)




学歴 【 表示 / 非表示

  • 2002年04月

    慶應義塾大学, 医学部

    大学, 卒業

学位 【 表示 / 非表示

  • 博士(医学), 慶應義塾大学, 論文, 2016年07月

    The Difference between the Two Representative Kampo Formulas for Treating Dysmenorrhea: An Observational Study

免許・資格 【 表示 / 非表示

  • 医師免許, 2008年04月

  • ECFMG certificate, 2021年09月

  • 日本内科学会総合内科専門医, 2015年12月

  • 日本東洋医学会漢方専門医, 2015年04月

  • 日本内科学会認定医

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研究分野 【 表示 / 非表示

  • ライフサイエンス / 内科学一般


著書 【 表示 / 非表示

論文 【 表示 / 非表示

  • Relationship Between Conventional Medicine Chapters in ICD-10 and Kampo Pattern Diagnosis: A Cross-Sectional Study

    Wu X., Le T.K., Maeda-Minami A., Yoshino T., Horiba Y., Mimura M., Watanabe K.

    Frontiers in Pharmacology (Frontiers in Pharmacology)  12 2021年12月


    Objectives: The newest revision to the International Classification of Diseases, the 11th edition (ICD-11) includes disease classifications from East Asian medicine, including traditional Japanese medicine (Kampo medicine). These disease classifications allow for comparisons between disease classifications from conventional medicine and Kampo medicine. Design/Location/Subjects/Interventions: This is an exploratory, cross-sectional study exploring the relationship between conventional medicine diagnoses and Kampo medicine diagnoses at a large Kampo clinic in Japan. Patients were seen from October 1st, 2014 to June 30th, 2019 and were 20 years of age or older. Outcome measures: Patients presented with one or more conventional medicine ICD-10 codes into the clinic and were given one descriptor from the ICD-11 within the heat-cold module, excess-deficiency module, and an optional body constituents module. The distribution of these Kampo medicine codes was examined in relation to conventional medicine chapters. Results: 1,209 patients were included in our final analysis. Patient number, ages, sex ratio, and BMI varied within conventional medicine ICD-10 chapters and Kampo medicine descriptor codes. Certain conventional medicine chapters are related to specific Kampo medicine descriptor codes, such as chapter IV (endocrine, nutritional, and metabolic diseases) with excess, heat, and kidney qi deficiency. Conclusion: The advent of the ICD-11 allows for systematic, standardized comparisons between Kampo medicine, and contemporary medicine. In this exploratory study, our findings support the independence of Kampo medicine pattern descriptors with ICD-10 conventional medicine chapters. Code overrepresentations in relation to conventional medicine diseases and by age and sex should be an area of future investigation to best understand how to synergize and improve patient care.

  • Clinical Risk Factors of Licorice-Induced Pseudoaldosteronism Based on Glycyrrhizin-Metabolite Concentrations: A Narrative Review

    Yoshino T., Shimada S., Homma M., Makino T., Mimura M., Watanabe K.

    Frontiers in Nutrition (Frontiers in Nutrition)  8 2021年09月


    Licorice, the dried root or stolon of Glycyrrhiza glabra or G. ularensis, is commonly used worldwide as a food sweetener or crude drug. Its major ingredient is glycyrrhizin. Hypokalemia or pseudoaldosteronism (PsA) is one of the most frequent side effects of licorice intake. Glycyrrhizin metabolites inhibit type 2 11β-hydroxysteroid dehydrogenase (11βHSD2), which decomposes cortisol into inactive cortisone in the distal nephron, thereby inducing mineralocorticoid receptor activity. Among the several reported glycyrrhizin-metabolites, 18β-glycyrrhetyl-3-O-sulfate is the major compound found in humans after licorice consumption, followed by glycyrrhetinic acid. These metabolites are highly bound to albumin in blood circulation and are predominantly excreted into bile via multidrug resistance-associated protein 2 (Mrp2). High dosage and long-term use of licorice are constitutional risk factors for PsA. Orally administered glycyrrhizin is effectively hydrolyzed to glycyrrhetinic acid by the intestinal bacteria in constipated patients, which enhances the bioavailability of glycyrrhizin metabolites. Under hypoalbuminemic conditions, the unbound metabolite fractions can reach 11βHSD2 at the distal nephron. Hyper direct-bilirubin could be a surrogate marker of Mrp2 dysfunction, which results in metabolite accumulation. Older age is associated with reduced 11βHSD2 function, and several concomitant medications, such as diuretics, have been reported to affect the phenotype. This review summarizes several factors related to licorice-induced PsA, including daily dosage, long-term use, constipation, hypoalbuminemia, hyper direct-bilirubin, older age, and concomitant medications.

  • Inter-Rater Reliability of Kampo Diagnosis for Chronic Diseases

    Maeda-Minami A., Yoshino T., Horiba Y., Nakamura T., Watanabe K.

    Journal of Alternative and Complementary Medicine (Journal of Alternative and Complementary Medicine)  27 ( 7 ) 613 - 616 2021年07月

    ISSN  10755535


    This single-center observational study aimed to assess the inter-rater reliability (IRR) of Kampo medicine pattern diagnosis, which is modularized into three modules for chronic diseases, using 64 participants' information documents. The linearly weighted percentage of agreement and Gwet's agreement coefficient (AC) 2 for the deficiency-excess module, among three specialists, were 85.9% and 0.708, respectively. The unweighted percentage of agreement and Gwet's AC1 were 64.6% and 0.542 for the cold-heat, and 35.9% and 0.254 for the qi-blood-fluid modules, respectively. Our findings suggest that our modularization method may improve the IRR of Kampo medicine pattern diagnosis.

  • Identification of an Alternative Glycyrrhizin Metabolite Causing Liquorice-Induced Pseudohyperaldosteronism and the Development of ELISA System to Detect the Predictive Biomarker

    Ishiuchi K., Morinaga O., Yoshino T., Mitamura M., Hirasawa A., Maki Y., Tashita Y., Kondo T., Ogawa K., Lian F., Ogawa-Ochiai K., Minamizawa K., Namiki T., Mimura M., Watanabe K., Makino T.

    Frontiers in Pharmacology (Frontiers in Pharmacology)  12 2021年05月


    Liquorice is usually used as crude drug in traditional Japanese Kampo medicine and traditional Chinese medicine. Liquorice-containing glycyrrhizin (GL) can cause pseudohyperaldosteronism as a side effect. Previously, we identified 18β-glycyrrhetyl-3-O-sulfate (3) as a GL metabolite in Eisai hyperbilirubinuria rats (EHBRs) with the dysfunction of multidrug resistance-related protein (Mrp2). We speculated that 3 was associated with the onset of liquorice-induced pseudohyperaldosteronism, because it was mainly detected in serum of patients with suspected to have this condition. However, it is predicted that other metabolites might exist in the urine of EHBRs orally treated with glycyrrhetinic acid (GA). We explored other metabolites in the urine of EHBRs, and investigated the pharmacokinetic profiles of the new metabolite in EHBRs and normal Sprague-Dawley rats. We further analyzed the serum concentrations of the new metabolite in the patients of pseudohyperaldosteronism. Finally, we developed the analyzing method of these metabolites as a preventive biomarker for the onset of pseudohyperaldosteronism using an enzyme-linked immunosorbent assay (ELISA). We isolated a new GL metabolite, 18β-glycyrrhetyl-3-O-sulfate-30-O-glucuronide (4). Compound 4 significantly inhibited rat type-2 11β-hydroxysteroid dehydrogenase (11β-HSD2) and was a substrate of both organic anion transporter (OAT) 1 and OAT3. Compound 4 was also detected in the serum of patients with suspected pseudohyperaldosteronism at an approximately 10-fold lower concentrations than 3, and these concentrations were positively correlated. Compound 4 showed a lower serum concentration and weaker inhibitory titer on 11β-HSD2 than 3. We developed an enzyme-linked immunosorbent assay system using an anti-18β-glycyrrhetyl-3-O-glucuronide (3MGA) monoclonal antibody to measure the serum concentration of 3 to facilitate the measurement of biomarkers to predict the onset of pseudohyperaldosteronism. Although we found 4 as the secondary candidate causative agent, 3 could be the main potent preventive biomarker of liquorice-induced pseudohyperaldosteronism. Compound 3 was detected in serum at a higher concentration than GA and 4, implying that 3 may be a pharmacologically active ingredient mediating not only the development of pseudohyperaldosteronism but anti-inflammatory effects in humans administered GL or other liquorice-containing preparations.

  • Bilateral pneumothorax after acupuncture treatment

    Nishie M., Masaki K., Kayama Y., Yoshino T.

    BMJ Case Reports (BMJ Case Reports)  14 ( 3 )  2021年03月


    A 31-year-old female physician was diagnosed with bilateral pneumothorax a day after her acupuncture treatment. Her body mass index was 16.9 and she did not have a prior history of respiratory disease or smoking. Acupuncture needles may easily reach the pleura around the end of the suprascapular angle of the levator scapulae muscle where the subcutaneous tissue is anatomically thin. In our patient, the thickness between the epidermis and the visceral pleura in this area was only 22 mm as confirmed by an ultrasound scan. Although she felt chest discomfort 30 min after the procedure, she assumed the symptom to be a reaction to the acupuncture. In light of our case, we advise practitioners to select appropriate acupuncture needles for patients based on the site of insertion and counsel them regarding the appearance of symptoms such as chest pain and dyspnoea immediately after the procedure.

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KOARA(リポジトリ)収録論文等 【 表示 / 非表示

総説・解説等 【 表示 / 非表示

  • A structured summary of a study protocol for a multi-center, randomized controlled trial (RCT) of COVID-19 prevention with Kampo medicines (Integrative Management in Japan for Epidemic Disease by prophylactic study: IMJEDI P1 study)

    Namiki T., Takayama S., Arita R., Ishii T., Kainuma M., Makino T., Mimura M., Yoshino T., Nogami T., Arai M., Sato J., Tanaka K., Nakae H., Igari H., Ozawa Y., Shiko Y., Kawasaki Y., Nezu M., Ito T.

    Trials (Trials)  22 ( 1 )  2021年12月


    Objective: We aimed to test our hypothesis that traditional Japanese (Kampo) medicine, hochuekkito (Hochu-ekki-to: HET) has a preventive effect for the symptoms on COVID-19. Trial design: The study is designed as a multi-center, interventional, parallel-group, randomized (1:1 ratio), investigator sponsored, two-arm study. Participants: Six thousand participants will be recruited from healthy hospital workers in 7 Japanese University Hospitals. Inclusion criteria: 1. Age from 20 to 75 years old at the time of registration 2. Asymptomatic and body temperature below 37°C at the time of registration 3. Capable of eating orally Exclusion criteria: 1. Previous upper respiratory inflammation due to viral infection (including suspected COVID-19) 2. Taking immunosuppressants 3. Allergic to the Kampo medicines used in this study 4. History of hypokalaemia, severe hypertension, severe liver dysfunction, and interstitial pneumonia 5. Regularly taking other Kampo medicines 6. Pregnant or possibly pregnant 7. Participating in other research 8. Judged to be unsuitable for this study by the doctor in charge Intervention and comparator: Kampo group: participants receive HET in 9 tablets 2 times per day for 8 weeks. Control group: participants receive placebo in the same dosage as the Intervention group - 9 tablets 2 times per day for 8 weeks. Placebo tablets are identical in appearance and package to HET. Taste of placebo is different from that of HET. The Ohsugi Pharmaceutical Co. Ltd, Osaka, Japan manufactured the placebo and HET. Main outcomes: Primary outcome: Number of patients with a SARS-CoV-2 RNA by ploymerase chain reaction (PCR) positive result with at least one symptom (fever, cough, sputum, malaise, shortness of breath) during the 12-week study period (including the 4-week observation period after oral administration). Secondary outcomes: 1. Period from infection to onset 2. Period from the appearance of symptoms to the disappearance of PCR positive 3. Number of days until the appearance or improvement of symptoms 4. Severe stage: presence of hospitalization 5. Shock stage: ICU management required for mechanical ventilation, shock vitals or failure of organ(s) other than lungs Safety endpoints include numbness in the hands and/or feet, edema, skin rash or other allergic symptoms, and gastric discomfort. Randomisation: Patients are randomized (1:1 ratio) to each group using minimization implemented with the Electric data capture system (DATATRAK Enterprise Cloud), with balancing of the arms with age range (under 50 years of age or not) and having a history of risk factors for COVID-19 (cardiovascular disease, hypertension, diabetes, respiratory diseases). Blinding (masking): Only participants will be randomized. Numbers to be randomised (sample size): The main research hypothesis of this study is that Kampo medicines significantly prevent the onset of COVID-19. It is assumed that the infection rate before the administration of the drug under consideration will be 0% and that the incidence of COVID-19 thereafter will be 2- 3%, of which 70%-80% will show symptoms of COVID-19. Assuming that the pharmaceutical effect of the drug will be effective in 50% of patients and that the incidence rates in the placebo and drug groups will be 1.4%-2.4% and 0.7%-1.2%, respectively, the placebo is calculated at 2%, and the study drug at 1%. Since the frequency of verification is low and the number of cases will be large, we set a total of 10 analyses (9 interim analyses and a final analysis). Since the number of cases at the time of the final analysis will be 4,986 under the conditions of α = 0.05 and a power of 80% by the Peto method. We set at 600 cases in each interim analysis with an estimated dropout rate of 16.9%. Finally, the total number of cases is set to 6,000 with 3,000 in the placebo group and 3,000 in the HET group. Trial status: Protocol version 1.3 of October 23rd , 2020. Recruitment start (expected): December 1st, 2020. Recruitment finish (expected): December 31st, 2022. Trial registration: This trial is registered in the Japan Registry of Clinical Trials (jRCT) (jRCTs031200150) on 14 October 2020. Full protocol: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

  • Re: JACM Special Focus Issue on Challenges in Inter-Rater Reliability in Traditional Chinese Medicine": A Japanese Perspective

    Yoshino T., Watanabe K.

    Journal of Alternative and Complementary Medicine (Journal of Alternative and Complementary Medicine)  26 ( 5 ) 437 - 438 2020年05月

    ISSN  10755535

競争的研究費の研究課題 【 表示 / 非表示

  • 新機軸の鍼灸臨床研究モデル確立に向けた新規パラメータの検証


    国立研究開発法人日本医療研究開発機構, 「統合医療」に係る医療の質向上・科学的根拠収集研究事業, 三村 將, 補助金,  研究分担者


    本研究の目的は、鍼灸技法の重要な要素である筋硬結の触診情報(CORI-map)を、体表面の等高線情報に変換し、鍼灸効果のパラメータとして確立する事である。研究開発代表者の三村將は、精神神経科の主任教授として独創的な臨床研究を実施してきた実績があり、大学病院副院長として漢方医学センター長を兼任し、エビデンスレベルの低い伝承から医学的seedsを蒐集することに深い造詣を有する。本研究は研究開発代表者の包括的な指示とデータ評価の元、厳正な評価に耐える鍼灸研究の新たなパラメータ確立を実現する。現状では鍼灸治療で変化する体表等高線変化は施術者の感覚で捉えられているが、これを三次元画像技術によりデータ化し記録する。この記録データから鍼灸治療前後の変化差分を抽出し、パラメータとしての実用性を検証する。三次元画像技術は研究協力者の(株)スペースビジョンよりサポートを受け、側弯症診断装置に活用されているLED光源を使用した被検者背部の3次元(3D)撮影と、背部の対称性をモアレ様画像として視覚的に描出する技術を援用し、下記4期の計画を遂行する。■第1期(4月~6月) 計測機器の調整および計測準備:3DカメラのFocus位置決定、計測マーカの設置部位及び撮影画素及び撮影範囲を検討する。■第2期(7月~9月)コントロールデータ蒐集:健常者ボランティア20名を募集する。1回目の撮影後、治療相当時間(20分)安静臥位の後、2回目の撮影を行う。これら2画像データの差分解析を行う。■第3期(10月~12月)鍼灸治療効果観察データ集積:慶應義病院において観察研究として倫理委員会の承認を受けたプロトコールに則り、鍼灸外来の来院患者からボランティア40名を募集して通常診療に付帯して鍼灸治療前後のデータ取得を行う。■第4期(1月~3月)取得データの解析および評価:取得した3Dデータおよび差分解析が臨床医学的な意義を持ち得るか、将来的なビックデータ化に対応可能であるかについて多角的検討を加え、英文誌に論文投稿する。本研究の成果を起点とし、AMED統合医療に係る医療の質向上・科学的根拠収集研究事業に対し、新機軸のプロトコール作成研究・臨床研究を提案していく予定である。薬剤と併用する事で強力な効力を見込める鍼灸を、安心安全に利用可能な診療ツールとする戦略の第一歩である本研究の意義は、非常に大きい。

  • 甘草の副作用、偽アルドステロン症発症予防のためのバイオマーカーの開発


    国立研究開発法人日本医療研究開発機構, 「統合医療」に係る医療の質向上・科学的根拠収集研究事業, 牧野 利明 , 補助金,  研究分担者






  • ICD-11での漢方医学分類の国際展開に向けた調査研究


    厚生労働省, 厚生労働科学研究費補助金, 渡辺 賢治, 補助金,  研究分担者


    以上より、1)本研究ではWHO主導のフィールドテストへの協力と漢方医学分類への反映、2)コーディング・ガイドの作成、3)国際伝統医学分類に関する国内外の評価の収集ならびに分析、4)漢方分類のエビデンスの収集、5)WHO国際伝統医学分類への理解促進のためのシンポジウム開催、6)WHO-FIC 会議での報告ならびに情報交換を行う。

  • 漢方の新たな科学的知見創出に向けた疾患および証の関係性の検討


    厚生労働省, 厚生労働科学研究費補助金, 渡辺 賢治, 補助金,  研究分担者


    本研究の必要性は、1)個別化治療、2)患者の主観的愁訴を重視した医療、3)全人医療でといった漢方の特性を考慮した場合、疾病をターゲットにした従来の研究手法では実臨床に役立つ漢方の科学的知見につながらないことは明らかである。漢方は証に基づいて処方されて初めて効果がある。現在医師の9割が日常診療に漢方治療を取り入れているとされている。しかしながら、実際には自分の診療科の中で2、3 の漢方薬を使い分けているのみである。その理由としては、漢方薬を使い分ける「証」の見極めが分かりにくいという声が大きい。一方65歳以上人口が25%を超え、膨張を続ける医療費の中で、漢方は、複数の疾患を抱えている高齢者でも一つの薬で対処することが原則であり、処方薬剤数を減らし、医療経済的にも期待が大きい。漢方が適正使われるためには、西洋医学的疾病のみならず、漢方医学的「証」を考慮した処方選択が求められる。

受賞 【 表示 / 非表示

  • American college of physician Japan chapter academic award

    2021年06月, American college of physician Japan chapter

    受賞区分: 国際学会・会議・シンポジウム等の賞

  • Trainee Poster Award

    2014年05月, International Society for Complementary Medicine Research

    受賞区分: 国際学会・会議・シンポジウム等の賞,  受賞国: アメリカ合衆国

  • 第38回「漢方研究」イスクラ奨励賞

    2014年02月, イスクラ財団

    受賞区分: 国内学会・会議・シンポジウム等の賞

  • 平成26年度優秀論文助成先端奨励論文賞

    2014年02月, 一般財団法人博慈会老人病研究所

    受賞区分: 学会誌・学術雑誌による顕彰

  • 自主学習賞

    2005年, 慶應義塾大学医学部

    受賞区分: 塾内表彰等


担当授業科目 【 表示 / 非表示

  • 症候学


  • 症候学


  • 臨床実習入門


  • 症候学


  • 臨床実習入門


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教育活動及び特記事項 【 表示 / 非表示

  • Post Clinical Clerkship-OSCE, ステーションリーダー


    , 実務の経験を有する者についての特記事項

  • 臨床推論勉強会KICKS


    , 学友会・同好会等の指導


所属学協会 【 表示 / 非表示

  • 米国内科学会, 

  • 国際代替医療研究会, 

  • 和漢医薬学会, 

  • 日本東洋医学会, 

  • 日本内科学会, 


委員歴 【 表示 / 非表示

  • 2021年07月

    Public Relations Committee, 米国内科学会日本支部

  • 2021年

    Research Advisory Committee, 国際代替医療研究会

  • 2020年12月

    地域医療研修について;参考人, 医道審議会 (医師分科会医師臨床研修部会)

  • 2020年

    若手研究者の会世話人, 和漢医薬学会

  • 2019年12月

    「アジア健康構想」実現に向けた東洋医学のエビデンス作成に向けた実証可能性等調査「漢方に関するサブワーキンググループ」構成員, 内閣官房

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