A Case of Refractory Recurrent Genital Herpes Successfully Treated with Juzentaihoto and Saikokeishikankyoto / 日本東洋医学雑誌

A 40-year-old woman had suffered from genital herpes twice a year since approximately age 25 years. A year and a half before her first visit to our department, the frequency of her genital herpes had increased from 2 to 5 times a month. Continuous suppressive antiviral medication had not worked, and the patient was referred to our department. We discontinued the anti-herpes medication, and started treatment with Kampo (Japanese herbal) medicine. Initially, the patient’s symptoms did not improve with tokishigyakukagoshuyushokyoto for coldness of the hands and feet or hochuekkito for general fatigue. Then, on the basis of her symptoms of irritability, nightmares, dry skin and hair loss, we changed her prescription to juzentaihoto before meals and saikokeishikankyoto after meals. The frequency of genital herpes thereafter gradually decreased, and finally no further recurrences of herpes were observed as long as the patient was taking these two medicines. This result showed that some patients with recurrent genital herpes who fail to respond to antiviral therapy could be managed with Kampo medicine alone.

Kampo Medicine Treatment for Coronavirus Disease 2019 (COVID-19) / 日本東洋医学雑誌

The Japan Society for Oriental Medicine (JSOM) has made various efforts against coronavirus disease (COVID-19) to build evidence. JSOM has launched an academic society-led clinical research project on COVID-19 based on the concept and characteristics of Kampo medicine, including (1) prevention of disease by activating the immune system to regulate body conditions (pre-symptomatic stage of illness), (2) symptom alleviation in the mild and moderate stage and prevention of aggravation (acute to subacute stage of illness), and (3) early recovery and improvement of prolonged symptoms (late stage of illness). Since the declaration of the pandemic, the special working group has conducted the following activities : enlightening academic members, lobbying other academic societies, preparing research protocols, establishing research groups, conducting ethical reviews, responding to the research disclosure system, preparing protocol papers and review articles as the basis for the research, reporting research progress, soliciting case reports, warning against Chinese medicine use, requesting for research support funding, and revising the JSOM website. We also discuss the interpretation of COVID-19 from the perspective of Kampo medicine and the direction of the selection of Kampo formulas in this report.

Two Cases of Intractable Upper Abdominal Pain with Ipsilateral Induration of Hikon (pigen, ExB4) and Past Histories of Injury or Surgery Successfully Treated with Tokishigyakukagoshuyushokyoto / 日本東洋医学雑誌

We report two cases of patients with intractable upper abdominal pain and histories of injury or surgery. The patients' pains were successfully treated with tokishigyakukagoshuyushokyoto (TSG). Case 1 involved a 59-year-old woman with left upper abdominal and thoracodorsal pain lasting 5 years. Kampo drugs such as tokito or prescriptions containing saiko were ineffective. Two years after her first visit, we noticed an injury scar from childhood that passed near the left hikon (pi-gen, ExB4) and induration and tenderness of the left hikon. TSG was administered, and the pain promptly improved. Case 2 involved a 66-year-old woman. She complained of epigastric, right­-upper-­quadrant abdominal and back pain lasting 7 years. Two years before presentation, the pain had worsened, but the cause was unclear. Although keishibukuryogan or Kampo drugs containing saiko were ineffective, her pain improved when TSG plus bushi was administered. A wound from a cholecystectomy was observed on her right abdomen. Induration and tenderness of the right hikon were demonstrated. The combination of past history of injury or surgery of the upper abdomen or back and induration of hikon can be associated with development of indications for TSG.

Cases of Taste Disorder and Halitosis Successfully Treated with Hochuekkito / 日本東洋医学雑誌

The number of patients with taste disorder and halitosis has recently increased in Japan. Some of these patients have no abnormalities identified in blood tests and no apparent dental problems, so they are diagnosed with unidentified complaints. In this paper, we report 2 patients who were diagnosed with psychogenic taste disorder and pseudohalitosis. Kampo medical examination found their symptoms to be related to qi deficiency. They were prescribed 5g of hochuekkito extract per day, and their symptoms were relieved. These results suggest that hochuekkito is effective against unidentified complaints such as psychogenic taste disorder and pseudohalitosis.

Five Cases of Thalamic Pain Effectively Treated with Keishikaryukotsuboreito / 日本東洋医学雑誌

Thalamic pain is an intractable central pain caused by thalamic hemorrhage and infarction. Unfortunately, there is no established method for its treatment. We report five cases of thalamic pain effectively treated with keishikaryukotsuboreito. Case 1 was a 63-year-old man who complained of pain in the right side of his body for three years after thalamic infarction. Case 2 was a 68-year-old-man who complained of pain in the right side of his body for 13 years after left thalamic hemorrhage. Case 3 was a 74-year-old woman who complained of left limb pain for three years after right thalamic hemorrhage. Case 4 was a 67-year-old woman who complained of pain in the upper and lower right limbs for two years after right thalamic infarction. Case 5 was an 82-year-old man who complained of pain in the right lower limb for two months after left putaminal hemorrhage including left thalamus. All cases were treated with keishikaryukotsuboreito and their symptoms improved. However, in Case 5, thalamic pain recurred after three months and the effect was not sustained with keishikaryukotsuboreito alone, but it was effective when combined with keishibukuryogan. From the imaging findings, keishikaryukotsuboreito would be a useful option for the treatment of thalamic pain with localized lateral thalamic lesions.

Consideration of a New Category of Patients for Whom Ryokeijutsukanto is Effective at a Different Stage Then was Previously Reported / 日本東洋医学雑誌

Ryokeijutsukanto consists of four crude drugs, Hoelen, Cinnamonmi Cortex, Atractylodis Rhizoma, and Glycyrrhizae Radix. In Kampo medicine, it is used for the yang stage, fluid disturbances, and qi counterflow. It is also used for orthostatic disturbance, which does not change smoothly from parasympathetic nerve dominance to sympathetic nerve dominance. This time, we report that ryokeijutsukanto is also effective for disturbance with function regulation of autonomic nervous system. Case 1: a patient who had headache after exercise and working. Case 2: a patient who had dizziness and cold sweat that appeared in the evening. Case 3: a patient who had headache after working or on holidays. In these cases, ryokeijutsukanto was effective for symptoms that appeared when the patient could not change smoothly from sympathetic nerve dominance to parasympathetic nerve dominance. Furthermore, we found that ryokeijutsukanto was effective, even if there was no sign of fluid disturbance in conjunction with the yang stage and qi counterflow. We identified a new category of patients for whom ryokeijutsukanto is effective.

A Case of Uncontrolled Cancerous Ascites Reduced by Sekiganryo / 日本東洋医学雑誌

Abdominal pain and marked coldness were observed in a 56-year-old male with cancerous ascites associated with cancer of unknown primary, and the patient was treated with sekiganryo. The abdominal pain resolved from day 2 after the initiation of sekiganryo administration, and the ascites markedly decreased with an increase in the urine volume on day 3. Although the mechanism of the effect of sekiganryo on cancerous ascites was unclear, it was considered that the improvement of coldness promoted the metabolism and subsequently promoted diuresis. No case of the improvement of cancerous ascites by sekiganryo has been reported to date. We report this case along with a literature review.

<b>Five Cases of Acute Ventilation Attack Successfully Treated with Shigyakusan in the Emergency Department</b> / 日本東洋医学雑誌

We report five cases of acute hyperventilation attack, with bilateral fullness of the chest and hypochondrium, and bilateral rectus abdominis muscle strain, that were successfully treated with shigyakusan. Case 1 was a 47-year-old female ; case 2 was an 18-year-old female ; case 3 was a 23-year-old female ; case 4 was a 39-year-old male ; and case 5 was a 40-year-old male. All five patients visited the emergency department with complaints of severe dyspnea and tetany. Their abdominal signs were characteristic, with remarkable bilateral fullness of the chest and hypochondrium and bilateral rectus abdominis muscle strain. In cases 1 to 4, the patients were given 2.5 g of shigyakusan extract, and their symptoms promptly improved. In case 5, as the patient could not swallow the prescribed medication at presentation, intramuscular diazepam was given. Thereafter, he complained of continuous severe numbness ; we subsequently gave him shigyakusan, and his numbness promptly improved. In conclusion, shigyakusan seems to be a useful Kampo drug for the treatment of acute hyperventilation attack.

<b>A Case of Hyponatremia Complicated with </b><b>Small Cell Lung Cancer Successfully Treated with Goreisan </b> / 日本東洋医学雑誌

We report a case of a 74-year-old male with hyponatremia complicated with small cell lung cancer. His hyponatremia worsened even with water restriction. Oral administration of sodium was difficult because of nausea and vomiting. We recognized this patient as having illness caused by excessive water accumulation within the body, and so prescribed goreisan 7.5 g/day to treat his hyponatremia. His hyponatremia improved after the administration of goreisan. Later his hyponatremia deteriorated while being administered of meloxicam, a cyclooxygenase-2 inhibitor. This case suggests that goreisan might inhibit water reabsorption by antidiuretic hormone at the collecting duct of the kidneys via stimulation of prostaglandin synthesis.

<b>2 Cases of Children Successfully Administered Kampo Formulae that Included Bushi or Uzu </b> / 日本東洋医学雑誌

We administered a Kampo decoction containing bushi (prepared aconiti tuber) or uzu (un-prepared aconiti tuber) to two children in Aso Iizuka hospital. Case 1 was a thirteen year-old girl with atopic dermatitis that worsened after her topical steroid was stopped. When her itching sensation was reduced following a bath, we considered that she was suffering from coldness. Therefore we administered a half dose of bukuryoshigyakuto.The next morning her old skin flaked off and her skin appeared healthy. We administered bukuryoshigyakuto before every meal and there was rapid improvement in her dermatitis. Case 2 was a twelve year-old girl with orthostatic dysregulation who was unable to attend school. She had become aware of coldness the previous autumn and had not been able to go to school, nor even sit up, since the previous winter because of severe fatigue. We diagnosed her with severe coldness and so started sekiganryo administration, and included 2 g of uzu. We gradually increased the uzu. At a result, her severe fatigue improved to the extent that she could eat breakfast and go to school inside the hospital. Children may have severe coldness if they suffer from a long-term illness. Moreover, particular attention should be given to toxicity caused by aconiti tuber.

<b>A case of Refractory Bloody Sputum due to Pulmonary Atypical Mycobacteriosis Successfully Treated by Shakanzoto and Yokuinin </b> / 日本東洋医学雑誌

Pulmonary atypical mycobacteriosis is a refractory pulmonary disease that has become resistant to the commonly used medicines. Here we report a case in which shakanzoto with yokuinin was useful in the treatment of bloody sputum caused by pulmonary atypical mycobacteriosis through Mycobacterium avium complex infection. An 86-year-old woman was diagnosed with pulmonary atypical mycobacteriosis four years before hospital admission because of repeated incidents of bloody sputum that had been unsuccessfully treated with stypsis. We administered shakanzoto with yokuinin, after which the bloody sputum disappeared rapidly. Although shakanzoto is usually prescribed for arrhythmia and cardioneurosis, our results suggest that shakanzoto is also useful for pulmonary diseases in which the pulse rate is irregular.

Treatment for Eradication of Helicobacter pylori Infection among Chronic Hepatitis C Patients

BACKGROUND/AIMS: Helicobacter pylori infection causes gastritis, peptic ulcers and gastric malignancies, and its eradication has been advocated by many groups. We determined the H. pylori carrier status and eradication rates of patients with chronic hepatitis C virus (HCV) infection. METHODS: In total, 76 chronically HCV-infected patients were enrolled for comparison with 228 HCV-noninfected, age- and sex-matched controls. H. pylori infection was confirmed by H. pylori antibody and urea breath testing. RESULTS: The H. pylori infection rate was significantly higher for HCV-infected patients (67 of 76, 88.2%) than for HCV-noninfected controls (158 of 228, 69.3%). Endoscopic findings showed that the rates of gastric ulcers and gastritis were significantly higher for the 67 HCV-infected patients with H. pylori infection (34.3% and 77.6%) than for the 158 HCV-noninfected controls with H. pylori infection (15.2% and 57.6%). Treatment to eradicate H. pylori had a significantly higher success rate for HCV-infected patients (61 of 67, 91.0%) than for HCV-noninfected controls (115 of 158, 72.8%). CONCLUSIONS: The markedly high H. pylori eradication rate observed in this study shows that eradication of H. pylori holds promise for the improvement of the long-term health condition of patients with chronic HCV infection.

A Case Of Anemia and Thrombocytopenia with Myelodysplastic Syndrome Successfully Treated with Juzentaihoto and Malt Sugar / 日本東洋医学雑誌

We report the case of a 76-year-old woman diagnosed with refractory anemia arising from myelodysplastic syndrome. Vitamin K 2 was administered, but pancytopenia continued to progress. At the initial visit to our department, her white blood cell count was 2150/μL, hemoglobin (Hb) was 9.6 g/dL and platelet count was 2.3×10⁴/μL. Juzentaihoto was administered for <i>Qi</i> and blood deficiency. A dosage of shimotsuto was increased from 3 to 5 g, and juzentaihoto was changed to ogikenchuto go shimotsuto, but the anemia did not improve. Juzentaihoto was again administered, and the dosage of shimotsuto was increased to 6 g. Malt sugar, 10 g, was added to the decoction, after which her Hb and platelet count markedly increased. There was no significant difference between pre- and post-treatment bone marrow findings. It is possible that malt sugar enhances the hematopoietic function of juzentaihoto.

Two Cases Successfully Treated with Tsumyakushigyakuto of Aconite Root Instead of Processed Aconite Root / 日本東洋医学雑誌

We report two cases successfully treated with tsumyakushigyakuto containing aconite root (<I>uzu</I>), instead of processed aconite root (<I>bushi</I>). The first case was a 33-year-old female. She had suffered from itching rashes in spite of being prescribed tsumyakushigyakuto with processed aconite root. Because she was in an extreme cold state, we changed the processed aconite root in her tsumyakushigyakuto to aconite root. Her itching rashes subsequently improved. The second case was a 42-year-old male. He had suffered from watery diarrhea and general fatigue in spite of being prescribed tsumyakushigyakuto with processed aconite root. Because he was in an extreme cold state, we changed the processed aconite root in his tsumyakushigyakuto to aconite root, and his watery diarrhea and general fatigue improved.<BR>We consider that using tsumyakushigyakuto with aconite root may be more effective than using it with processed aconite root in an extreme cold state.

The Meaning of \lceilFukuchukan\rfloor in the Abdominal Symptom of Daikenchuto-syo / 日本東洋医学雑誌

Daikenchuto is recorded in Kampo textbooks as a prescription for abdominal disorders. We considered fukuchukan (coldness in the abdomen) as equaling a sensation of coldness centering on the navel, and we examined the usefulness of using Daikenchuto as a medication for this symptom. We administered Daikenchuto to 90 patients who presented with coldness of the navel. The patients were divided into 2 groups:the first group had accompanying digestive symptoms, the second had no accompanying digestive symptoms. We then examined their response rates, and improvement rates for coldness centering on the navel. We also examined the abdominal strength and pulse strength for responders and non-responders, respectively.The Digestive Symptoms group consisted of 64 patients. In this group, the response rate was 81.3%.The improvement rate of coldness centering on the navel was 92.3% in responders and 41.7% in non-responders, and the difference was highly statistically significant (p<0.001). The Non-digestive Symptoms group consisted of 26 patients. In this group, the response rate was 38.5%. The improvement rate of coldness centering on the navel was 100% in responders and 43.8% in non-responders, and the difference was statistically significant (p=0.022).In a comparison of all 90 responder and non-responder cases, weak abdominal strength was 62.9% in responders and 42.9% in non-responders, intermediate abdominal strength or above was 37.1% in responders and 57.1% in non-responders, and the difference between abdominal strength and response rate (p=0.076) was non-significant. Weak pulse was 54.8% in responders and 40.7% in non-responders, intermediate pulse strength or above was 45.2% in responders and 59.3% in non-responders, and the difference between pulse strength and response rate (p=0.221) was non-significant. 13 of these cases were above intermediate, for both abdominal strength and pulse strength.We conclude that for patients presenting with a sensation of coldness centering on the navel, there is a strong possibility that the efficacy of Daikenchuto-syo is suggested, regardless of whether or not there are other digestive symptoms. Moreover, Daikenchuto proved effective in 13 cases where both abdominal strength and pulse strength were above an intermediate level, suggesting that a sensation of coldness centering on the navel can be the key to finding the sensho of Daikenchuto-sho.

The Meaning of "Fukuchukan" in the Abdominal Symptom of Daikenchuto-syo / 日本東洋医学雑誌

Daikenchuto is recorded in Kampo textbooks as a prescription for abdominal disorders. We considered <i>fukuchukan</i> (coldness in the abdomen) as equaling a sensation of coldness centering on the navel, and we examined the usefulness of using Daikenchuto as a medication for this symptom. We administered Daikenchuto to 90 patients who presented with coldness of the navel. The patients were divided into 2 groups:the first group had accompanying digestive symptoms, the second had no accompanying digestive symptoms. We then examined their response rates, and improvement rates for coldness centering on the navel. We also examined the abdominal strength and pulse strength for responders and non-responders, respectively.<br>The Digestive Symptoms group consisted of 64 patients. In this group, the response rate was 81.3%.The improvement rate of coldness centering on the navel was 92.3% in responders and 41.7% in non-responders, and the difference was highly statistically significant (p<0.001). The Non-digestive Symptoms group consisted of 26 patients. In this group, the response rate was 38.5%. The improvement rate of coldness centering on the navel was 100% in responders and 43.8% in non-responders, and the difference was statistically significant (p=0.022).<br>In a comparison of all 90 responder and non-responder cases, weak abdominal strength was 62.9% in responders and 42.9% in non-responders, intermediate abdominal strength or above was 37.1% in responders and 57.1% in non-responders, and the difference between abdominal strength and response rate (p=0.076) was non-significant. Weak pulse was 54.8% in responders and 40.7% in non-responders, intermediate pulse strength or above was 45.2% in responders and 59.3% in non-responders, and the difference between pulse strength and response rate(p=0.221) was non-significant. 13 of these cases were above intermediate, for both abdominal strength and pulse strength.<br>We conclude that for patients presenting with a sensation of coldness centering on the navel, there is a strong possibility that the efficacy of Daikenchuto-syo is suggested, regardless of whether or not there are other digestive symptoms. Moreover, Daikenchuto proved effective in 13 cases where both abdominal strength and pulse strength were above an intermediate level, suggesting that a sensation of coldness centering on the navel can be the key to finding the <i>sensho</i> of Daikenchuto-sho.

Two Cases Successfully Treated with SANO-TO (Senkin-Ho) / 日本東洋医学雑誌

We reported two cases successfully treated with sano-to (Senkin-Ho). Case 1 was a 63-year old female, who visited our department in December 2004 complaining of polyarthralgia, a burning sensation in the hands and feet, irritability and chilliness. We prescribed sano-to (Senkin-Ho). The visual analogue scale (VAS) decreased from 100 mm on the first visit to 23 mm 10 months later in October 2005. Case 2 was a 62-year old female, who came to our department complaining of whole body pain in August 2004. Various Kampo medicines were tried but proved ineffective, and in June 2005 she was hospitalized. At that time, in addition to whole body pain, she complained of a burning sensation in her feet, psychological anxiety, and chillness. We prescribed sano-to (Senkin-Ho). After 2 months, her VAS decreased from 80 mm to 20 mm. We consider that sano-to (Senkin-Ho) should be prescribed more actively when patients suffer from painful diseases accompanied with subjective symptoms such as a burning sensation in the hands and feet, psychological symptoms, and chilliness.

Three Cases of Pneumonia Successfully Treated by Kampo Therapy / 日本東洋医学雑誌

We report three cases of pneumonia successfully treated with Kampo therapy. Case 1 was a 69-year-old female who was hospitalized with a fever and cough. Administration of Keishinieppiitto led to an improvement in her cough and a rapid reduction of fever, and we continued her treatment using Kampo medicine only. By the 7th day of admission, the infiltration shadow had disappeared, and on the 11th day, laboratory data on WBC and CRP had decreased to a normal range. Case 2 was a 66-year-old female who was hospitalized with cough, sputum and fever. She received modern western medical treatment, including antibiotics for one month, but her symptoms showed little improvement. After we administered Saiko-keishi-kankyo-to-go-Hange-koboku-to, her symptoms gradually improved. By the 15 th day of admission, her CRP levels had decreased to 0.7mg/dL, and the infiltrative shadow had disappeared. Case 3 was a 78-year-old male who was hospitalized with cough, sputum, anorexia and general malaise. A multiple nodular lesion in the lung was also detected by chest CT. Consequent diagnostic examinations were conducted, while providing him with Saikokeishito. Although the final diagnosis was pneumonia, of unknown etiology, his fever decreased and on further examination his laboratory data had improved. If a Kampo formula is selected in accordance with the diagnosis of Kampo medicine, we consider that pneumonia can be treated with Kampo medicine without the use of antibiotics.

A case of Megacolon Successfully Treated by Re-dosage of Kobokusanmotsuto; After an Attack of Pseudoaldosterenism induced by Chukenchuto / 日本東洋医学雑誌

We present a case of megacolon successfully treated with Kampo medicine. A 65-year-old male diagnosed with megacolon in 1999, came to our department in July 2003 complaining of severe abdominal distention. We successively used different Kampo formulae, in accordance with the diagnostic standard known as “SHO” which were: Daikenchu-to, Koboku-sanmotsu-to, Chukenchu-to, and Koboku-sanmotsu-to again. Daikenchu-to was only partly effective. Koboku-sanmotsu-to made the abdominal distention worse, forcing a change of drug. Chukenchu-to relieved the symptoms for some time, but the patient had to be hospitalized because of pseudoaldosteronism caused by the drug. Koboku-sanmotsu-to, however, worked smoothly on the second occasion and the symptoms disappeared. The efficacy of Koboku-sanmotsu-to was completely different on the two occasions it was used. This suggests that the pathological conditions were in a state of change, and these changes were identical to changes of SHO. This case reinforces the importance of detecting changes of the SHO accurately.

Subjective Symptoms that can be indicators for Choosing Ogikeishigomotsuto / 日本東洋医学雑誌

Ogikeishigomotsuto is a Kampo formula used for numbness or body pains. We experienced 29 cases in which attending physicians believed the drug would be effective. In 18 cases the drug was effective and in 11 cases it was not. We analyzed the difference in subjective symptoms between the responder group and the non-responder group. We concluded that some symptoms could be indicators for choosing the formula. Hypersensitivity to cold and heaviness of the whole body has previously been reported in many articles. In our cases, we observed a high incidence and specificity of the symptoms reported above, as well as arthralgia, dry skin and irritability in the responder group compared to the non-responder group. We believe these newly detected subjective symptoms can also be indicators for choosing Ogikeishigomotsuto.