A Case of Anorexia and Drooling Improved by Targeting “Excessive Saliva Secretion” Using Bushirichuto / 日本東洋医学雑誌

A 65-year-old man, with a history of surgery for esophagogastric junction cancer in X-3, was admitted to the Department of Internal Medicine in our hospital in March for anorexia that had developed since January X. The patient was diagnosed with adhesive small bowel obstruction, and underwent surgery to relieve the obstruction in early May. However, his symptoms did not improve, and he was referred to our department in mid-June. His drooling was considered to be due to “excessive saliva secretion.” He started taking a decoction of bushirichuto for epigastric discomfort and resistance and coldness of the hands and feet. On the 5th day, he started to feel more energetic, and on the 8th day, his saliva production decreased. Furthermore, on the 12th day, his sense of taste and appetite improved. As the oral intake increased, tube feeding could be reduced and rehabilitation progressed ; from an almost bedridden state, he was able to walk continuously for 150 m with a cane. On the 29th day, he was transferred to a chronic care hospital. His weight increased from 34.1 kg, when he was referred to our department, to 39.7 kg at the discharge time. Anorexia and drooling, which had otherwise continued for 5 months, were improved within a short period of time by using bushirichuto.

Successful Treatment of an Adolescent Male with Periodic Fever Using Byakugokassekisanryo / 日本東洋医学雑誌

The patient was a 13-­year-­old male who had experienced periodic fever since he was in the 5th grade. After he moved into the 8th grade, he developed fever, abdominal pain, and vomiting continuously, which caused him to miss school or leave school early once every one to two weeks. Various Kampo extract preparations prescribed at a nearby clinic did not improve the symptoms, and the patient was referred to our hospital. Ad­ministration of bukuryoshigyakuto and shokenchuto reduced the fatigue, but the fever could not be controlled. Subsequently, a grasp of “the disease byakugobyo turned into fever” was made, and he was put on byaku­gokassekisanryo, which eliminated the fever. Therapeutic approaches for disease known as the disease ebyo that arises after treatment of cold damage diseases (shokan) are discussed in the On Pulse Syndrome Complex and Treatment of Bai He, Hu Huo, and Yin Yang Du Diseases section of the synopsis of prescriptions of the golden chamber “Kinkiyoryaku”. Children, especially adolescents, are prone to fall ill because of rapid changes of the body, including sexual maturation. Clinical manifestations of such illnesses further change with growth and maturation, and it can be difficult to find clues for treatment at first glance due to complicated states of yin­yang and deficiency-­excess. As seen in this case, illnesses of adolescence is likely to include un­diagnosed cases of byakugobyo that manifests clinical signs similar to those of ebyo.

A Report of a Support Program for Cancer Patients and Their Families “Cancer Salon Rainbow” at Jichi Medical University Hospital

<p>Objectives: A cancer salon was established at Jichi Medical University Hospital in April 2014 operated based on the plan-do-check-act (PDCA) cycle. This study aims to understand the actual situation of the cancer salon and outcomes of participants, and utilize the information for optimal administration. Methods: The cancer salon was open to the public and conducted in our hospital. The program consisted of mini-lectures, relaxation, and interaction with the participants. We conducted a questionnaire survey for the participants. Results: We held 11 sessions from April 2014 to March 2015. The total number of participants was 369, and the average number of participants per session was 34 (22-50). Participants mainly consisted of patients and families who received care in our hospital. A high percentage of participants were women in their 60’s, patients who were newly diagnosed cancer within 3 years, or patients with breast cancer. Participants’ satisfaction tended to be high in lectures and relaxation, and there was a tendency for anxiety to be alleviated in their psychological state. Discussion: We must challenge that we refine quantitative evaluation methods and develop the system of assessment of detailed needs and provide appropriate support. Furthermore, we would like to propagate this system to the area around our hospital, support the development of cancer salons at other medical institutions, collaborate with them, and contribute to the creation of an inclusive society.</p>

<b>Review of 33 Patients in Whom Sokeikakketsuto was Used to Treat Recurrent Cramps of the C</b><b>alf</b> / 日本東洋医学雑誌

<p>Sokeikakketsuto was administered to 33 patients with recurrent cramps of the calf appearing once a week or more and persisting for 2 weeks or more. Treatment response was evaluated 1 month after the start of drug therapy. Patients whose cramps disappeared immediately after starting were regarded as showing a complete response, those with disappearance after 1 month as showing a partial response, those with a reduction to <50% after 1 month as showing a slight response, and those in whom 50% or more of cramps persisted after 1 month as showing no response. A complete response was achieved in 12 patients, a partial response in 11, a slight response in 9, and no response in 1. In 23 (69.6%) of the 33 patients, cramps disappeared within 1 month after the start of drug therapy. In 32 (96.9%), there was a reduction to <50%. In 29 (87.8%) of the 33 patients, cramps disappeared within 3 months, suggesting the efficacy of this drug. Two-package administration in the evening/at bedtime was more effective than 1-package administration for controlling cramps of the calf at night until early in the morning. The intensive pre-attack administration of 2 packages before sleep was the most effective. Sokeikakketsuto may be useful for treating recurrent cramps of the calf.</p>

<b>Five Cases of Hymenoptera Stings and Centipede Bites Treated with Ourengedokuto and </b><b>Inchingoreisan</b> / 日本東洋医学雑誌

<p>We report five cases of painful swelling caused by hymenoptera stings and centipede bites treated with <i>ourengedokuto </i>and <i>inchingoreisan </i>soon after the time of injury. The first case was a 70-year-old male. He was stung by a hornet on the left hand 30 minutes prior. The second case was a 45-year-old male. He was stung by a hornet on the left face 20 minutes prior. The third case was a 55-year-old male. He was stung by a hornet on the left lower thigh 10 minutes prior. The fourth case was a 39-year-old male. He was stung by a hornet on the right thigh 60 minutes prior. The fifth case was a 35-year-old male. He was bitten by a centipede on the right first toe 20 minutes prior. All cases received Kampo therapies immediately and continued them every few hours. In all cases, their pain, redness and swelling at the site of injury were relieved by the next day. We consider Kampo therapies can contribute to the healing of hymenoptera stings and centipede bites at an early stage.</p>

<b>Effective Treatment of Five Cases of Facial Erythema and Flushing Using </b><b>Orento</b> / 日本東洋医学雑誌

The use of orento for dermatosis is commonplace. We report herein the effective treatment of five cases of facial erythema and flushing using orento, based on the observation of heat symptom patterns in the upper part of the body and cold symptoms in the middle part of the body. Few reports have described specific symptoms of upper heat and middle cold ; however, interpreting ‘facial erythema and flushing exacerbated by warming',‘red face', ‘hot flashes', ‘hot sweats' and ‘yellow fur on the tongue' as “upper heat” , and ‘preference for warm drinks', ‘diarrhea exacerbated by cold drinks', and ‘objective coldness in the epigastric region' as “middle cold” enabled the application of orento for dermatosis in our experience.

<b>Three Cases of Trigger Finger which were Successfully Treated with U</b><b>nkeito</b> / 日本東洋医学雑誌

Trigger finger develops because of stenosis around the A1 annular ligament, which causes inhibition of smooth expansion and contraction of the finger. It is effectively treated by an anti-inflammatory analgesic and/or steroid infusion, and by Western style medical surgery. Here, we report 3 cases of trigger finger effectively treated with unkeito. The first case was a 71-year-old female who had been treated with Kampo medicine for an enlarged feeling in the abdomen. She complained of trigger finger, in the knuckle of her right third finger, dry lips, and hot flashes in her hands and feet. The second case was a 56-year-old female who had been treated with Kampo medicine for polyarticular pain in her fingers. She complained of trigger finger of the left fourth finger and hot flashes in her hands. The third case was a 71-year-old female who had been treated for chronic renal failure. She complained of trigger finger in the left first finger and dry skin but had neither hot flashes in the hands nor dry lips. One of the target symptoms of unkeito is hot flashes in the hands and dry lips. Unkeito is composed of herbs which improve <i>ketsu </i>deficiency, <i>oketsu</i>, inflammation, and dry skin. It is possible that these actions of unkeito are effective in trigger finger as well.

<b>A Successful Case of Pseudo-Obstruction After Femoral Hernia Radical Operation Treated with Chukenchutokatoki </b> / 日本東洋医学雑誌

A 54-year-old female had left femoral incarcerated hernia. One month later, she received a radical operation for it, but was admitted to our hospital twice because of ileus. Various tests showed no mechanical intestinal obstruction, but small-intestinal edema. She was transferred to our department to receive Kampo medicine. She could not eat any food and her weight decreased from 47 to 37.5 kg. We therefore administered intravenous hyperalimentation. She had a cold sweat on her face and was prone to bed rest because of severe abdominal pain as if in labor, and general fatigue. Her skin was dry, her radial pulse was weak and her abdominal tonus was weak. In addition, lower abdominal tension was more intense than upper and we could observe bowel movements from her skin. At first, we administered bushikobeito, but it had no effect. Referring to her abdominal findings, we considered that daikenchuto and tokikenchuto were compatible in her case, and after changing to chukenchutokatoki her abdominal pain disappeared in 5 days. Thus, Kampo medicine was effective for post-operative pseudo-obstruction.

<b>A Case Report on Skin Itching and Scleroderma due to Systemic </b><b>Sclerosis and Primary Biliary Cirrhosis Successfully Treated </b><b>with Orengedokuto (Wanbinghuichun) and Sekiganryo</b> / 日本東洋医学雑誌

We report a case of systemic sclerosis complicated with primary biliary cirrhosis successfully treated with orengedokuto (wanbinghuichun) and sekiganryo. The patient was a 68-year-old female. She had been diagnosed with systemic sclerosis 20 years previously, and primary biliary cirrhosis 17 years previously. She received modern Western medical treatment for skin itching and scleroderma, but her symptoms showed little improvement. Therefore, she consulted our clinic in order to receive Kampo therapy. We prescribed orengedokuto (wanbinghuichun), and the skin itching improved in 5 days. As a result of administering sekiganryo in addition to orengedokuto (wanbinghuichun) for severe coldness, the scleroderma was also ameliorated. We consider this to be a case of diseases overlapping between yin and yang syndrome.

<b>Two Cases of Chest and Abdominal Pain in Elderly Persons </b><b>Successfully Treated with Daisaikoto</b> / 日本東洋医学雑誌

We report two cases of chest and abdominal symptoms, the causes of which can not be established in a medical sense, successfully treated with daisaikoto. The first case was an 81-year-old male. He complained of tightness in his chest. Since the frequency of his symptom was increasing, he underwent further evaluation in hospital, but no abnormalities were found. We administered daisaikoto with reference to his constipation and <i>kyo-kyo-kuman </i>(subchondrial resistance and discomfort), the tightness in his chest disappeared and three months later his qi stagnation score and SDS score had improved.<br>The second case was an 83-year-old male. He had been suffering epigastric pain, tightness of chest and abdomen and a feeling of fullness in the abdomen since two years previously, when he suffered multiple traumatic injuries. We administered daisaikoto in light of his epigastric pain, constipation and <i>kyo-kyo-kuman</i>.The epigastric pain and tightness of the chest and abdomen gradually disappeared, and the number of his unscheduled visits to the clinic decreased.<br>Thus, daisaikoto may be used to treat patients with chest or abdominal symptoms and depression, the cause of which can not be established in any medical sense.

<b>A Case of Irritable Bowel Syndrome Causing the Abdomen to feel Enlarged, Successfully Treated with Ryokito</b> / 日本東洋医学雑誌

We experienced a 56-year-old male who had suffered from diarrhea, epigastric discomfort and an enlarged abdomen feeling for 12 years, and who was diagnosed with irritable bowel syndrome. Although he had undergone treatment using Western medicine in many hospitals, his condition had not improved. He was therefore started on Kampo medicine 5 years ago. However, since the enlarged abdomen feeling worsened whenever he changed his prescription, it was difficult to treat him on an outpatient basis. Thus we tried hospitalization. His feeling of enlarged abdomen was near continuous, but the discomfort from a spasmodic enlarged abdomen feeling was greater. We recognized the spasmodic feeling to be hontonki disease and started ryokeikansoto. The spasmodic feeling disappeared promptly after hospitalization. On the 12 th day of hospitalization, we noticed that the circumference of his navel was cold. Therefore, we changed his prescription to ryokito, which is kind of ryokeikansoto, containing ryokyo, which dispels cold and stops pain, and then the near continuous feeling of enlarged abdomen also disappeared. He was discharged from hospital on the 24 th day. Although the original text for ryokito states that it cures a right fleshy tumor and pain, this suggests that ryokito is effective in cases of hontonki disease and cold, even when not necessarily accompanied by hypochondralgia.

<b>A Case of Granuloma Annulare Successfully Treated with a Combination of Orengedokuto and Maobushisaishinto </b> / 日本東洋医学雑誌

A 68-year-old female had been diagnosed with granuloma annulare a year earlier. She was prescribed tranilast and was recovering, but had to discontinue the tranilast because she suffered liver damage as a side effect.<br>She was also suffering from a worsening rash and so decided to try Kampo medicine. We prescribed orengedokuto because of thermal symptoms suggestive of hot flushes, the appearance of her tongue, and the character of her rash. Initially, the rash improved, but from the 3rd day following admission did not change greatly. We suspected the existence of interior cold and started combining maobushisaishinto. Five days later, the granulomas had rapidly shrunk. We believe she had overlapping diseases of a yin and yang pattern from the fact that she improved clinically.

<b>A Case of Inflammation of the Lips Successfully Treated </b><b>with Otsujito </b> / 日本東洋医学雑誌

Otsujito is a well-known herbal preparation used for treating hemorrhoidal disease. However, we considered the anatomical similarities between the lips and the anus, and here report a case of inflammation of the lips with blood stasis successfully treated with otsujito as well.<br>The case was a 59-year-old woman suffering from eczema on her face and neck. The eczema showed a tendency to improve with herbal treatment, but inflammation and pruritus of the lips continued. Taking into account the presence of blood stasis, we included otsujito in the treatment and her symptoms improved.<br>Otsujito contains bupleurum, cimicifuga, scutellaria, and rhubarb, which dissipates heat, and angelica,which resolves blood stasis. Therefore, we consider that inflammation of the lips with blood stasis can be treated with otsujito.

Pulmonary artery banding in early infants with complete atrioventricular canal / 日本心臓血管外科学会雑誌

Infants with complete atrioventricular canal (CAVC) and severe congestive heart failure, not responding to medical managements, presents a difficult management problem. Between December, 1980, and August, 1987, 16 infants with CAVC presenting severe congestive heart failure underwent pulmonary artery banding. Average age at operation was 1.7 months (0.5 to 4) and average weight was 3.5kg (2.5∼4.9). Only four patients were older than 3 months of age at operation. Pre-operative cardiac catheterization and echocardiogram demonstrated that seven patients had mild to severe left atrioventricular valve regurgitation. Hospital death occurred in one patient (6%) due to rupture of the pulmonary artery. Of three late deaths, one patient had congestive heart failure, and one patient complicated with partial obstruction of right pulmonary artery died suddenly of an upper respiratory infection 11 months after rebanding. Survivors have been followed 18 to 94 months and all patients are growing at an increased rate postoperatively. In five patients of 12 long-term survivors who have undergone cardiac catheterization 37 to 83 months after the operation, pulmonary/systemic systolic pressure ratio (<i>PP/PS</i>) were 0.2∼0.42 (average 0.28). It is concluded that the pulmonary artery banding in infants with CAVC can be performed with low operative and late mortality and can provide good relief of symptoms and allow normal growth and development. It should be emphasized that early surgical palliation is mandatory to prevent the development of pulmonary hypertension and pulmonary emphysematous change.