<b>A Study of Indications for the Application of Kyokatsushoshitsuto </b> / 日本東洋医学雑誌

Kyokatsushoshitsuto is a Kampo formulation used against cervix pain so severe that the neck cannot be turned. Of six patients we treated with this formula, it was effective in three cases but ineffective in the remaining three. From the viewpoint of traditional Chinese medicine (Kampo) regarding the in/effectiveness of this formula : in effective cases, palpitations in the area of the navel and tooth marks on the tongue are seen in patients in a weak state. As for subjective symptoms : in effective cases, “the waist area around the body sometimes feels cold”, “air conditioning is disliked”, and “an electric blanket etc. is needed in winter” were also indicative signs. On the other hand, symptoms such as “the skin becomes dry”, “water may accumulate in a joint”, and “symptoms of clicking/pain in the knee and having difficulty sitting straight” were not seen. In total, these may serve as useful indications for the application of kyokatsushoshitsuto, especially when palpitations in the navel area are considered a helpful new Kampo finding.

<b>Two Cases of Autoimmune Pancreatitis-Induced Obstructive Jaundice Treated with Inchinkoto</b> / 日本東洋医学雑誌

We report two cases of inchinkoto treatment for obstructive jaundice via autoimmune pancreatitis (AIP). Case 1 : A 38-year-old male. After completion of treatment for Mikulicz disease, obstructive jaundice developed. A diagnosis of AIP was based on a high IgG 4 blood level and image views. T-Bil stayed above 20 mg/dl and there was no improvement by oral administration of prednisolone (PSL), ursodeoxycholic acid, or bilirubin adsorption therapy. Upon inchinkoto administration, T-Bil promptly fell to 3 mg/dL. Case 2 : A 77-year-old male. He suffered from itching and constipation, and blood data showed a pattern of obstructive jaundice. Image views suggested AIP, but a duodenal papillary biopsy could not provide a definitive diagnosis. Inchinkoto was administered, and the itching and constipation had mostly disappeared within 1 week. However, these symptoms recurred after one month. A definitive diagnosis of AIP was then reached based on a pancreas biopsy, and a PSL regimen was initiated. From these two cases, we consider that inchinkoto is useful for improving the symptoms of obstructive jaundice induced by AIP.

<b>Kampo Treatment Experience in a Case of Suspected MRSA Infection Related Enteritis Complicated by ARDS and Shock</b> / 日本東洋医学雑誌

The patient was a 49-year-old woman. She developed retroperitonitis and retroperitoneal emphysema due to iatrogenic duodenal perforation. We inserted a nasogastric tube into her stomach in order to decompress the gastrointestinal tract, and cefoperazone and proton pump inhibitors were administered intravenously. Her symptoms of retroperitonitis were then reduced. However, she developed enteritis suspected due to MRSA infection complicated by acute respiratory distress syndrome, acute renal failure and shock. We administered vancomycin via nasogastric tube, but her symptoms did not improve, so we added shojokito. She relieved her bowels after the administration of shojokito, and an antipyretic tendency was observed. Her breathing status recovered to normal, her blood pressure was stable, and her general condition gradually improved.<br>In recent years, we have not had many opportunities to perform Kampo treatment for severe infection cases needing hospitalization, but Kampo application has the potential to enhance the efficacy of infection treatments. Thus we advocate the active carrying out of Kampo treatment for patients with intestinal infection.

A Consideration for the Indication of Daikankyoto or Daikankyoganryo / 日本東洋医学雑誌

We studied contemporary indication of daikankyoto and daikankyoganryo. We administered either of these Kampo prescriptions for thirty-three patients with intractable muscle stiffness of neck, shoulder and back.Twenty-four patients were able to take the prescriptions for more than four weeks (long term group), and nine patients stopped taking the prescriptions less than four weeks (interrupted group). In long term group, fourteen patients (58%) improved their chief compliant. The Kampo formulations of fourteen effective cases were daikankyoto (13 cases) and daikankyoganryo (1 case). Comparative analysis has been done between long term group and nine cases of interrupted group. The characteristics of long term group were higher body mass index, firmer abdomen and more positive cases of epigastric resistance sign. Kansui root dose was 0.81 gram a day in long term group and 0.57 gram a day in interrupted group, which showed statistically-significant difference. We found twenty-seven side-effects in twenty four patients (73%) including eighteen patients with nausea and six patients with diarrhea. In side effects, there was no statistically significant difference between two groups. These side effects were promptly improved after discontinuation or dose reduction of Kansui root. We report clinical courses of six improved cases in this paper, two severe stiff neck, shoulder and back cases, each one case of psychosomatic disorder, depression, spasmodic torticollis and gastroesophageal reflux. These prescriptions should be administered more commonly to the patients with severe stiff neck, shoulder and back.

Three Cases of Somatoform Disorder Considered as "Hontonki" Disease, Successfully Treated with Keishikakeito / 日本東洋医学雑誌

We report three cases with somatoform disorder which were considered as “Hontonki” disease, successfully treated with keishikakeito. Case1 was a 34-year old male who was suffering from headache and palpitation. He said ‘Something pierces and it goes up from the chest to the head.' We considered his complaint as Hontonki disease and administered keishikakeito. After one week, the headache disappeared and four weeks later, palpitation and tinnitus were definitely improved. Case2 was a 22-year old male. His complaints were excessive strain and general fatigue. Because he had coldness of lower extremities and spasmodic headache, we interpreted these symptoms Hontonki disease and administered keishikakeito. After that these symptoms and his psychological test scores improved markedly. Case 3 was a 75-year old female. Severe headache and palpitations presented after remodeling her home. Three weeks later taking keishikakeito, her symptoms had disappeared dramatically. Recently, Hontonki disease are often compared with panic disorder, and it is possible that some somatoform disorder cases include Hontonki disease. It is important to consider the possibility of Hontonki disease behind the physical complaints such as headache and palpitation, when we use keishikakeito.

Four Cases Treated by Daikenchuto to the Patients with Recurrent Aspiration Pneumonia in Tube Feeding / 日本東洋医学雑誌

We administered daikenchuto to the patients having recurrent aspiration pneumonia with tube feeding, who had good responses. Case 1 : A 94-year-old-man with congestive heart failure suffering from recurrent aspiration pneumonia even after percutaneous endoscopic gastrostomy (PEG) placement : following daikenchuto administration, he did not suffer from pneumonia, and his general condition became stable. Case 2 : An 80-year-old-man suffering from severe pneumonia after PEG placement, and experiencing recurrent pneumonias after treatment with antibiotics:following daikenchuto administration, we did not find gastric contents in his oral cavity as before, and his general condition became stable. Case 3 : An 85-year-old-man with congestive heart failure and cerebral infarction also suffering from aspiration pneumonia : a nasogastric tube was placed, but he suffered from recurring pneumonias with tube feeding. After administering daikenchuto, he did not suffer from pneumonia and was discharged from the hospital. Case 4 : An 81-year-old-man with recurrent pneumonia and congestive heart failure : after treatment with antibiotics, we placed a PEG tube because of his severe anorexia caused by oral feeding difficulties. In order to prevent aspiration pneumonia, we administered daikenchuto prophylactically. He subsequently developed very little fever until his discharge to a nursing home.

Clinical Characteristics of Side Effects Induced by Administration of Glycyrrhizae Radix and Scutellaria Radix under the Therapy Based on Kampo Diagnosis in Our Hospital / 日本東洋医学雑誌

We surveyed side effect incidences with Kampo therapies in 2530 patients based on their Kampo diagnoses. The number of side effects seen, including taste disorder, was 569 in 503 patients. Side effects were noted in 64 (3.0%) of 2139 patients administered Glycyrrhizae radix. The average 63.4±13.8 age of these patients was statistically higher than the overall 54.9±18.1 year mean. Symptoms which led to diagnosis of side effects were high blood pressure in 45 patients, edema in 16 patients, and hypokalemia in only 5 patients. Glycyrrhizae radix dose as an extract was 2.0±1.0 (mean±SD) g/day in 34 patients, and as a decoction was 2.2±1.1 g/day in 29 patients. There was no difference in administration or recovery periods between these two groups. Liver dysfunction was noted in 13 (1.0%) of 1328 patients administered prescriptions containing Scutellaria radix. Scutellaria radix was administered as an extract at 2.3±0.5 g/day in 7 patients, and as a decoction at 2.8±0.8 g/day in 6 patients. Although there was no difference in administration periods, the 69.0±52.5 day recovery period from side effects in the extract group was longer than that of 22.7±16.0 days in the decoction group. Symptom improvement was had for a large portion of these side effects with the first visit, indicating that initial diagnoses were correct. Care should be exercised with regard to inducing side effects, with Kampo medicines, even when using traditional diagnostic standards.