Fourteen Cases of Appetite Loss Treated with Shoyogan / 日本東洋医学雑誌

Shoyogan is a Kampo prescription described in the <I>Junqui Yaolue</I>. Few cases have been reported using this medicine. This time, we prescribed shoyogan for 14 patients who suffered from severe appetite loss. We had positive outcomes as follows. We administered shoyogan to 8 patients with malignant disease. Six of them suffered from lung cancer. Shoyogan was effective in these patients. Shoyogan was not effective for the other 2 patients, with bile duct carcinoma and malignant lymphoma. The dietary intake was increased from 28 percent of meals supplied to 79 percent in the appetite-improved group. We also administered shoyogan to 6 patients with nonmalignant disease. It was effective for 3 patients: 1 with congestive heart failure and 2 with great trochanteric fractures of the femur. It was not effective for the other 3 patients, who suffered from anorexia, pneumonia and depression associated with diabetes mellitus. Shoyogan seems to be effective for patients with terminal lung cancer and maintains their quality of life.

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.

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.

How Should We Write Academic Dissertation in Kampo Medicine? / 日本東洋医学雑誌

Academic dissertations on Kampo medicine have a certain peculiarity about them, when they are drawn up by the rules of western medical writing. Compared to western medicine, oriental medicine tends to employ more subjective terms, because of its many humanistic elements.Study objectives, methods, results and discussions however, need to be stated objectively in a way that makes a paper easy to understand for both referees and readers. Although it would be ideal to use designated terms when making objective statements, there are in fact many terms that have multiple meanings, which need to be clarified in a paper. And when presenting new evidence, one must declare how far any problems have been resolved, as clearly as possible.We have explained the recent changes to our regulations for contributors, regarding Kampo formulae naming conventions, abstract word counts, and contributions by mail. Here we discuss how our editing work proceeds, and our thoughts on how papers are re-reviewed or rejected.

A Case of Patient with Lung Cancer in the Terminal Stage whose Appetite and General Condition had been Maintained Following the Oral Administration of \it{Shoyogan} / 日本東洋医学雑誌

Shoyogan is a Kampo prescription described in the Jinkuiyaolue text, but there have been no case reports regarding this medicine. We report a patient with terminal stage lung cancer, whose appetite and general well-being was maintained following oral administration of this medicine.A 62-year old woman had her main tumor in the left pulmonary lobe, which invaded to the bilateral peritoneum and the mediastinum. Metastasis was recognized in the left femoral bone which had been broken, the ilium, chest and lumbar vertebral bones, and the liver. Her general condition was very poor in spite of the administration of corticosteroids and narcotic medicines, when she began to take shoyogan 5 months after the onset of her symptoms. Cytological examination of her pleural effusion revealed adenocarcinoma. Following the administration of shoyogan, her appetite recovered, nutrition improved, and she was able to survive while maintaining her quality of life for another 2 months.In this paper we discuss the efficacy of shoyogan in improving the general well-being of patients having the above-mentioned conditions, or jueyinbing in Kampo parlance. Although preparing shoyogan is laborious, we believe this medicine should be used more frequently.

Insight into the cold/heat in greater yang disease period and the definition of yang/yin pattern / 日本東洋医学雑誌

I discuss the question of cold/heat in greater yang disease period and the definition of yang/yin pattern as written in the Nyumon Kampo Igaku, which was the first textbook on Kampo medicine published by the Japan Society for Oriental Medicine. The first question is ; “Is the indication for Kampo medicine in greater yang disease period not the heat, but the exterior cold of a patient?” It is considered that a chilly feeling shows not cold illness, but a process trend toward body fever and sweating as a recovery strategy. The second question is ; “Should we adopt Okuda's definition of yang/yin pattern when my definition is obscure?” Okuda's definition was written for acute illnesses based on the treatise Shanghanlun (On Cold Damage). Nevertheless, we can not adopt this definition because our textbook has to be applied for treating patients with chronic illness, and the use of Goseiho and traditional Chinese medicine. The discrimination of quantitative analyses in the21st century, and qualitative approaches to discussing Kampo medicine diagnostic standards are considered important in the21st Century.

Insight for Oketsu Syndrome / 日本東洋医学雑誌

The diagnostic criteria for oketsu syndrome which was proposed by K. Terasawa et al. High scores in paranavel resistance and tenderness was characteristic in it. It's evidence was obtained by that blood viscosities of oketsu patients increased than ones of non-oketsu patients. The numbness of seven patients with cerebrovascular accidents in fourteen patients were improved following the four weeks of administration of keishibukuryogan. In this study we could also recognize improvement of intra-vascular erythrocyte aggregation in their conjunctival microcirculation by using the video-microscopic system. These studies had been clarifying that oketsu state might be accompanied to microcirculatory distubance and kampo prescriptions treated for oketsu syndrome could improve it. Important point in using these prescriptions under the traditional standard is to check kyojitsu (robust or asthenia), face color (red or pale) and constipation/or not. I emphasized that role of checking kyojitsu might be bigger in prevention from the adverse effects than in searching drug to treat patient's illness.

The Effect of Bofutsushosan on Weight Reduction in Humans / 日本東洋医学雑誌

We administered Bofutsushosan (Bo) to 127 obese patients who consulted our clinic, and investigated the effect of this herbal formula on reducing body weight in 33 obese patients who received continuous adminis tration for more than six months. The abdominal muscle tension of these 33 patients was assessed mainly as “strong” (four) under the five-grade scale of Kampo diagnostics, which was higher than that of 9 other patients with side effects (including diarrhea and abdominal pain) assessed mainly as “middle” (three). Sixteen patients reported a decrease in appetite following administration of Bo. Weight before medication in the patients with decreased appetite was 67.1±2.5kg, and that in 17 patients with unchanged appetite was 75.9±2.4kg. There was a significant difference between the two. Weight change in the patients with decreased appetite was -4.8±1.0kg and was significantly lower than -1.4±0.7kg in the patients with unchanged appetite. Their blood triglycerides levels decreased significantly following administration of Bo. This decrease in appetite was considered to be due not only to activation of the adrenaline β₃ receptor, through the administration of Ephedrae Herba, Schizonepetae Spica, Rhei Rhizoma, Forsythiae Fructus and Glycyrrhizae Radix but also to the psychotropic actions of Ephedra Herba, Rhei Rhizoma and Gardeniae Fructus. Recently severe side effects of Bo have been reported. This study suggested that patients showing a grade of strong (four) or more in abdominal muscle tension, were indicated for this treatment and that the long-term administration of this herbal formula should be continued in patients whose appetite was identified as being suppressed.

Assessment of the Appropriate Fee for Dispensing Herbal Medicine / 日本東洋医学雑誌

This study was conducted to assess the proper fee for dispensing herbs prescribed under the national health insurance. We investigated the cost of dispensing a) general medicine and b) Kampo formulae in relation to the time needed in three pharmacies. One prescription of general medicine including packed extract of Kampo formulae, and one Kampo formula consisting of different kinds of herbs, were counted as one sample each. The former counted 125 samples, and 176 samples of the latter. The mean time for dispensing one sample of Kampo formulae was 9 minutes and 33 seconds, and it was 5.4 times longer than for the general medicine (1 minute and 46 seconds). The time for dispensing herbs grew longer as the days of the prescription increased; with a mean number of 9-12 herbs in the formulae about twice the time was needed for a prescription for 22-28 days than for one of 8-14 days. As the number of herbs in the formulae increased, the time for dispensing them also increased. The cost of pharmacist's work was calculated based upon the time expended and the pharmacist's hourly wage. It amounted to one fifth of the fee for dispensing general medicine, but it was nearly equal or higher when involving herbs. According to the <i>Regulation of Dispensary Awards</i> revised in 2004, the fee for dispensing herbal medicine is \1200 whatever the formulae. We would like to recommend that a re-evaluation of the fee should be made based on the number of days of the prescription, the number of herbs in the formulae, and the cost of preserving herbs in pharmaceutical facilities.

Comparison of New Electrothermo-acupuncture using a Curved Heating Plate with Old Electrothermo-acupuncture using a Miniature Bulb / 日本東洋医学雑誌

We developed a new electrothermo-acupuncture instrument which employs a curved heating plate, and we compared this new one and the old hitherto used electrothermo-acupuncture instrument in terms of radiation temperature, using two male volunteers. The results showed that the 2nd step in the old instrument equaled the fifth channel in the new one. The radiation temperature increase of 140°C seen in 10 minutes was the same, between the two instruments, but the old one continued to increase its temperature, whereas the new one held at a plateau of about 140°C. Therefore, we considered that the new electrothermo-acupuncture instrument is safer than old one.<br>Next, we investigated the relation between effective Kampo formulas and endurance time in the fifth channel of the new electrothermo-acupuncture instrument, in nineteen patients. We found that Kampo formulas used in the resistant phase of Yang-syndrome disease, is effective in less than 10 minutes of endurance time, and the Kampo formula containing Aconite Tuber is effective for over 30 minutes.<br>We considered, because of the relation between endurance time and Kampo diagnosis, that the new electrothermo-acupuncture instrument can be useful in a supplementary way in deciding Kampo diagnosis.

The Role of Kampo Medicine in the Age of Inhaled Steroids / 日本東洋医学雑誌

With the world standardization of inhaled steroids for bronchial asthma, the principle of Kampo medicine has changed from treatment for asthma attack to the prevention of it. The number of severe adult patient cases has decreased, and the number of <i>hojinzai</i> (kidney tonic) users has increased. The number of weaker children has increased, and the number of <i>hohizai</i> (spleen tonic) users has increased. Kampo medicine was not equal to inhaled steroids for the treatment of bronchial asthma, because the number of patients treated with Kampo medicine, having more than one year without an attack, was only 10% to 20%, and this figure would be lower, with inhaled steroids.<br>Nevertheless, Kampo medicine has had a great effect, on patients with milder symptoms, who do not require inhaled steroids, and well as those patients uncontrollable even with inhaled steroids. The Saiboku-to and Maozai groups, including Sho-sei-ryu-to and Ma-kyo-kan-seki-to, are good for milder patients. It is advisable to first check the immediate reaction of Maozai group users, following its administration in the clinic for treating attacks. The Hojinzai group, including Hachimi-jio-gan and Bakumi-jio-gan-ryo, are good for patients with the severe asthma or chronic obstructive pulmonary disease. An increase in the peak-flow rate of these patients with Hachimi-jio-gan might be related to activation of dehydroepiandrosterone, although the mechanism is unknown. Moku-boi-to is indicated for those patients with complicated heart failure.

Kampo Treatment for Respiratory Tract Diseases / 日本東洋医学雑誌

Kampo treatment for respiratory diseases on the traditional standard including some care reports lectured. To find adequate Kampo prescription for each patient, it need to discriminate what is the cause of the symptoms, throat, nose, chest or low respiratory function. Some patients whose obstructive feeling at throat was improved by the adiministration of Hange-koboku-to, was introduced. Anxiety at throat was an important sign for its indication in these patients. This prescription was also applicated to sleep-disordered breathing. On treatment for chronic rhinitis that caused respiratory symptoms the pulse diagnosis was an important technique for the diagnosis of stasis of body fluids. Kampo treatment for common cold, chronic bronchitis, bronchial asthma and interstitial pneumonia were told as chest diseases. Kampo prescriptions for chronic bronchitis were classified by the characteristics of cough (dry or wet) and Kyo-Jitsu (asthenia or robust). Pediatric asthma patients who respond to the prescriptions with tonic effect including Sho-kenchu-to, was considered to increase recently. A case with interstital pneumonia improved with Bukuryo-kyonin-kanzo-to, was introduced and adequate Kampo prescription for this disease was discussed with some previous reports. Hachimi jio-gan increased peak flow rate of asthmatic patients with low respiratory function and the difference of indication to Bakumi-jio-gan-ryo was discussed.

A Study on a Quantity of Imbibition of Natural Medicines at Boiling / 日本東洋医学雑誌

As many natural medicines absorb water at boiling, yields of the decoctions are affected by absorbed water. Therefore, we examined the quantity of imbibition of each crude drug at boiling. We used 75 kinds of crude drugs. After boiling 600ml of water, each natural medicine was boiled for 70 minutes. The medicine was left for 60 minutes, and then boiled again for 20 minutes. The quantity of imbibition of each natural medicine was measured at 10, 20, 30, 40, 60, 130, and 150 minutes. The maximum data among the quantity of imbibition at each point was labeled “maximum quantity of imbibition.” With regard to the maximum quantity of imbibition in natural medicines of plant origin, the range was from a maximum of 69.10g in Chrisanthemi Flos to a minimum of 3.26g in Persicae Semen. The average maximum quantity of imbibition was 22.51±13.00g, and there were large differences among each of the natural medicines. The quantity of imbibition at 10 minutes or 20 minutes was above 80% of each maximum quantity of imbibition on many crude drugs, but that gradually increased over the time course for some crude drugs.

A Case of Sleep Apnea Syndrome Improved after Administration of Hange-koboku-to / 日本東洋医学雑誌

We report a case of obstructive sleep apnea syndrome effectively treated with Hange-koboku-to. A 32-year-old male suffered from globus syndrome (globus hystericus), excessive daytime sleepiness and snoring. He underwent uvulopalatopharyngoplasty at the age of 27, but the symptoms did not improve after surgery. Nocturnal polysomnography, performed before administration of Hange-koboku-to, confirmed the diagnosis of obstructive sleep apnea syndrome. After 1-month-administration of Hange-koboku-to extract (Tsumura Co. Ltd., 7.5g/day), his complaints almost disappeared. After 5-month-administration of Hange-koboku-to, nocturnal polysomnography was performed again. As a result, the apnea index fell from 19.2 events/hour to 10.3 events/hour, and the apnea-hypopnea index also fell from 19.2 events/hour to 12.8 events/hour. He was not obese (body mass index: 23.0kg/m²), and no significant body weight change was observed after administration. No adverse effect was observed. To our knowledge, there is no other report on the treatment of sleep-related breathing disorders with Hange-koboku-to. We presume that Hange-koboku-to may decrease the upper airway resistance, especially at the lower part of the upper airway.

Questionnaire Assessment of Training in the Use of Kampo Medicine in an Outpatient Clinic / 医学教育

We used questionnaires to assess training in the use of Kampo medicine which took place mostly at our outpatient clinic. Most of the 18 trainees (6 medical doctors and 12 medical students) felt that the quantity and the quality of the lectures and the amount of time spent in the outpatient clinic were satisfactory. In addition, all trainees thought that attending the outpatient clinic was the most instructive activity and made the deepest impression, but 14 of the 18 trainees (78%) thought that it was a difficult learning strategy. Fifteen trainees (83%) rated this training curriculum as good or very good. Sixteen trainees (88%) were conscious of a change in their study or work attitudes 3 to 6 months after training; this result suggests that this curriculum has an educational effect.

A Case of Focal Glomerular Sclerosis (Glomeruloscrelosis) Treated with Bunsho-to / 日本東洋医学雑誌

We report a case of a patient with steroid-dependent nephrotic syndrome, who achieved complete remission with a combination of steroid therapy and Bunsho-to. The patient was a 27-year-old female who became aware of edema, and was diagnosed as suffering from focal glomerular sclerosis (glomerulosclerosis) with nephrotic syndrome in November 1992. She responded to steroid therapy, but nephrotic syndrome relapsed frequently after the repeated reduction of steroids. In July 1995, she came to our hospital, and was diagnosed as having a recurrence of nephrotic syndrome. Although the combination therapy of steroid and Kampo formulas, Shinbu-to or Shimotsu-to and/or Keigairengyo-to, was effective, an exacerbation of nephrotic syndrome occurred after steroid therapy was discontinued, in July 1997. The prescription was changed to Bunsho-to, and steroid therapy was re-initiated with 10mg of prednisolone daily. As a result, she achieved complete remission. The steroid therapy could be discontinued in July 1999, and now she has taken Bunsho-to only for 18 months. But the complete remission of nephrotic syndrome has been maintained.

The Analogous State of Hyper-functioning Condition in the Initial Stage of Yang Disease with Ectodermal Symptoms (Tai yang bing) Induced by Interferon, and its Pulse Diagnosis / 日本東洋医学雑誌

We reported that Interferon (IFN) induces the analogous state of the initial stage of Yang disease with ectodermal symptoms (tai yang bing). Flu-like symptoms from IFN treatment were reduced or disappeared with Mao-to and Dai-seiryu-to. We consider that flu-like symptoms induced by IFN can be a symptomatic model of hyper-functioning condition of tai yang bing. Pulse of sinking and deficiency was seen in all five patients with the symptoms of having caught a chill. These results suggest that there is the possibility that pulse of sinking and deficiency is seen in the very early stage of tai yang bing.

Sei-hai-to Therapy in Two Cases of Relapsing Aspiration Pneumonia Caused by Cerebrovascular Disease / 日本東洋医学雑誌

We report on two cases of relapsing aspiration pneumonia caused by dysphagia due to cerebrovascular disease. Sei-hai-to (Qing Fei tang) offered useful palliation in both cases. Case 1 was an 83-year-old-woman who was hospitalized for multiple lacunar infarction and lumbago in 1996. She gradually became bedridden within two years of the admission period. She was admitted to a long-term care hospital affiliated with our department in January 1998. Dysphagia and productive cough appeared in May, and enteral tube feeding was started after she developed pneumonia in August. Pneumonia persisted against some antibiotics, and feverish periods ranged from 8 to 18 days a month. CRP values were elevated to more than 5mg/dl. Administration of Sei-hai-to provided negative CRP values and decreased feverish periods to 0-2 days a month. Case 2 was a 93-year-old-man who suffered from cerebral bleeding in the right thalamus in 1984. He developed many attacks of aspiration pneumonia after starting oral feeding. He was admitted to a long-term care hospital affiliated with our department in April 1999. Sputum culture yielded <i>P. aeruginosa</i> and MRSA. Moreover, fluoroscopy showed aspiration into the lower airway. Aspiration pneumonia relapsed continually without antibiotics. Administration of both Sei-hai-to and clarithromycin decreased feverish periods and provided negative CRP values. Pneumonia relapsed easily either with Sei-hai-to therapy alone or Clarithromycin therapy alone.

A Case of Chronic Hepatitis C, in which Elimination of Hepatitis C Virus was Achieved by Kampo Treatment / 日本東洋医学雑誌

Chronic hepatitis C has a high incidence of proceeding to liver cirrhosis, and a natural healing from chronic hepatitis C is extremely rare. We observed a case of chronic hepatitis type C, in which the virus was eliminated after Kampo treatment. The patient was a 37-year-old female who underwent a blood transfusion following delivery of her first child in 1982. In January 1983, she became aware of general malaise, and was diagnosed as having chronic hepatitis. She was treated with Stronger Neo Minophagen C, but her symptoms and laboratory data were unchanged. A liver biopsy disclosed chronic active hepatitis in 1988, and she was transferred to our hospital for Kampo treatment in May. Although the symptoms rapidly disappeared after treatment with the Kampo formulas, Hochu-ekki-to and Keishi-bukuryo-gan, her transamilase values did not change. Her transamilase level decreased gradually after the prescription was changed to Saiko-keishi-to-go-Toki-shakuyaku-san-ryo, and returned to normal after her prescription was changed to Kami-shoyo-san-ryo in May 1996.<br>Concerning HCV-RNA in the serum, in March 1995, when Saiko-keishi-to-go-Toki-shakuyaku-san was administered, the amount of HCV-RNA in the serum was 10⁴ Kcopies/ml. But that was less than the detectable sensitivity in April 1998. We believe this to be a case in which elimination of HCV was achieved by Kampo treatment alone.