An Effective Case of Keishikajutsubuto and Maobushisaishinto for Arthritis / 日本東洋医学雑誌

We report the case of a 60-years-old man who complained fever and left knee pain. Fever and arthralgia appear once a month, and these symptoms disappear spontaneously in 3 days. The patient came to our hospital to receive Kampo treatment, because the patient experienced improving these symptoms by Kampo medicine about 20 years ago. I judged the arthralgia as kanshippi, because the arthralgia improved when the patient warmed the joint. We prescribed keishikajutsubuto 7.5 g/day. Arthralgia improved after administration of keishikajutsubuto, but the attack appeared every month. We prescribed maobushisaishinto 5 g/day in addition to keishikajutsubuto 5 g/day for further improvement of arthralgia. The frequency of fever and arthralgia attack was dramatically decreased after we prescribed keishikajutsubuto 5 g/day and maobushisaishinto 5 g/day. We considered the possibility of palindromic rheumatism based on clinical symptoms, X-ray in other clinic and blood test results in our hospital. We report an effective case of keishikajutsubuto and maobushisaishinto on arthritis attacks with fever that resolved spontaneously in a short time.

<b>The Efficacy of Yokukansan in Obesity Patients on Overeating due to Anger (a Retrospective S</b><b>tudy)</b> / 日本東洋医学雑誌

We previously reported that a case of yokukansan efficaciousness for weight gain due to overeating behavior following bariatric surgery. The reason is considered that yokukansan stabilized the patient's mental state. So, we proposed that administration of oriental medicines for mental state might be a new way of treating obesity. We investigated the efficacy of mazindol, bofutsushosan or yokukansan for obese patients. We retrospectively reviewed clinical data to identify patients administered mazindol, bofutsushosan or yokukansan for treatment of obesity. The inclusion criteria were patients tolerant to medicine for 3 months, and who could be administered yokukansan for anger. A total of 107 patients met these selection criteria. After 3 months of drug administration, significantly body weight reduction was observed in either the mazindol group or yokukansan group. We also selected and analyzed patients with diabetes mellitus to clarify the efficacy of these drugs for glucose metabolism. Reduction in HbA1c was not significant in the groups. These results suggest that mental health problems are very important for the treatment of obesity. And we suggest that oriental medicine is an effective treatment for mental health in obesity patients.

<b>A Case of Intractable Vomiting After Distal Gastrectomy Treated with Bakumondoto</b> / 日本東洋医学雑誌

There have been few reports on an antiemetic effect of bakumondoto. An 84 year old man was referred to the department of internal medicine for Kampo treatment of intractable vomiting since having a gastrectomy 6 years previously. He had experienced persistent regurgitation of gastric fluids at dawn and antiemetic and antiacid drugs were of little help. He had had a gastrojejunostomy 4 years previously for an intestinal obstruction. After the gastrojejunostomy, vomiting persisted despite of the administration of antiacids, rikkunshito or daikenchuto. Physical examination revealed only slight edema of the legs. An upper gastrointestinal series, blood tests and head CT scan revealed no specific vomiting cause. After referral to our department, we tried hangeshashinto, and shinbuto in vain. Then we prescribed bakumondoto. He reported that the frequency of his vomiting reduced in 3 weeks, and that the vomiting disappeared in 2 more weeks. Thus we consider that not only cough but also vomiting can be treated with bakumondoto.

<b>Case of Yokukansan Efficaciousness for Weight Gain Due to </b><b>Overeating Behavior Following Bariatric Surgery </b> / 日本東洋医学雑誌

We report the case of a 51-year-old woman whose body weight was increased after bariatric surgery. She has been obese from a young age. When she was 30 years old, she developed type 2 diabetes mellitus. She was hospitalized for diabetic ketoacidosis at 45 years of age. She was diagnosed bulimic at 48 years of age, and body weight reduction with diet and exercise therapy became difficult because she was bulimic. Then, she underwent bariatric surgery and her body weight had reduced by 11 kg, 6 months after the surgery. However, her body weight began to increase again 7 months post surgery. At this time, her mental status had become unstable and she ate constantly in the afternoons. We administered yokukansan 5 g/day to treat her unstable mental status. Her body weight then decreased in accord with decreasing energy intake after the administration of yokukansan. She also became aware that her mental status was improving. Furthermore, her HbA1c (JDS) decreased from 8.7% to 7.1% after yokukansan treatment. In this case, it is possible that yokukansan suppressed the overeating by stabilizing her mental status, with the parallel decreases in body weight and HbA1c.

<b>On Ryokyu ARIMA, Tenmin NAMIKAWA's Mentor </b> / 日本東洋医学雑誌

Tenmin NAMIKAWA (並河天民) thought the <i>Shanghanlun</i> (傷寒論) was an important text. He also taught his pupils the importance of prescribing Zhongjing ZHANG's (張仲景) medicines. Ryokyu ARIMA (有馬凉及) was a physician-teacher, who prescribed Chengqitang (承気湯) for the emperor without conferring with other doctors. His chengqitang formulary was derived from medical texts by Zhongjing ZHANG. Kyugo GODA (合田求吾) on the other hand, was a pupil of Ikkannsai MATSUBARA (松原一閑斎), who wrote in the <i>Idokikigaki</i> (医道聞書) : the<i>Koho</i> (古方) school started by Ryokyu ARIMA. He was a hero who was punished by the Goseiin (後西院) emperor. He taught <i>Koho </i>to Tenmin. This therefore reveals that Ryokyu ARIMA was a teacher who taught the importance of the <i>Shanghanlun</i>.

Recovery from Recurrence of Post-operative Pouchitis Due to Ulcerative Colitis through Daitokato / 日本東洋医学雑誌

Pouchitis is the most common complication following ileal pouch-anal anastomosis in patients with ulcerative colitis and is strongly correlated with the risk of pouch failure and malignant mucosal transformation in the pouch. Here we report a case treated successfully with the Kampo decoction, daitokato. A 41-year-old male treated with ileal pouch-anal anastomosis due to severe ulcerative colitis suffered from repeated pouchitis and stenosis of the ileal pouch post-operatively. He complained of general fatigue, chills, continuous lower abdominal pain and discomfort, and severe pain with evacuation. Initial treatment with antibiotics and painkillers was ineffective, so the patient came to our hospital's Kampo clinic, where he was initially prescribed the decoction, shokenchuto. This proved ineffective at resolving his fatigue. Subsequent treatment with ogikenchuto improved physical strength but was ineffective for pouchitis. Antibiotic resistant pouchitis occurred afterwards and we attempted treatment with saikokeishito decoction and the extracts, hochuekkito and juzentaihoto, which similarly improved fatigue but not pouchitis. Following administration of daitokato, instances of pouchitis were reduced with no recurrence 6 months post-treatment. This case illustrates the therapeutic efficacy of daitokato in improving ileal pouch disorders resistant to treatment with Western medicine.

Efficacy of Kampo Medicine for Migraine in Children and Childhood Periodic Syndromes / 日本東洋医学雑誌

In the Guideline for treatment of chronic headache published by Japanese Headache Society, Ibuprofen and Acetaminophen are proposed for the acute treatment of migraine in children. But prophylactic treatment of pediatric migraine is not established. We report the efficacy of Kampo medicine for preventing migraine in children and childhood periodic syndromes. We use a variety of Kampo medicine for 9 pediatric migraine and periodic syndromes patients from 8 to 15 years old. All 9 patients improve their headache and associated symptoms including abdominal pain, vertigo, nausea and vomiting. After treatment the mean average of Headache Impact Test-6 (HIT-6) improve from 63.66 points to 45.77 points. Kampo medicines is effective for migraine in children and childhood periodic syndromes.

History of Kampo Extracts for Medical Use / 日本東洋医学雑誌

In 1944, Dr Takeshi Itakura, director of the Eastern Therapeutics Institute, intended to perform controlled clinical trials with Kampo extracts, but gave up following the defeat in the Second World War. Japanese public insurance coverage of Kampo treatment started in 1961. Permission for medical use of six Kampo extracts was granted in 1967. This was increased to 848 products made with 148 formulas in 2000. The book, <i>Ippan-yo Kampo Shoho no Tebiki</i> (guide to general Kampo prescriptions) describing approval standards for Kampo extracts was published in 1975 and revised in 2008.The adverse effects of shosaikoto in 1996 forced the Japanese Society for Oriental medicine to establish the EBM Committee to prove that Kampo medicine was evidence-based. The first report on clinical evidence for Kampo was published in 2005. In 2001, the study of Japanese herbal medicine became compulsory in the medical education system. A petition against removing Kampo drugs from public insurance in 2009 showed that people hoped doctors would continue to be able to prescribe Kampo drugs under insurance systems.

Four Cases of Chronic Cough Successfully Treated with Boiogitokamao / 日本東洋医学雑誌

Boiogito is mentioned in Synopsis of the Golden Chamber, in which it is written to add ephedra herb for patients with cough at the end of the chapter. We experienced 4 chronic cough cases of wind-wetness syndrome or edema caused by pathogenic Wind successfully treated with boiogitokamao. Subjective symptoms such as heaviness when moving, heavy sweating, and body chills, as well as objective findings such as pallor, and a weak pulse in the most distal region of the right wrist were common in these patients. Moreover, not only cough, but also accompanying symptoms such as obesity, dysmenorrhea, and eczema were improved. Observation of these four cases suggests that boiogitokamao can be effective for the treatment of the patients with chronic cough due to wind-wetness syndrome / edema caused by the pathogenic Wind.

History of Kampo Extracts for Medical Use / 日本東洋医学雑誌

In 1944, Dr Takeshi Itakura, director of the Eastern Therapeutics Institute, intended to perform controlled clinical trials with Kampo extracts, but gave up following the defeat in the Second World War. Japanese public insurance coverage of Kampo treatment started in 1961. Permission for medical use of six Kampo extracts was granted in 1967. This was increased to 848 products made with 148 formulas in 2000. The book, <I>Ippan-yo Kampo Shoho no Tebiki</I> (guide to general Kampo prescriptions) describing approval standards for Kampo extracts was published in 1975 and revised in 2008.<BR>The adverse effects of shosaikoto in 1996 forced the Japanese Society for Oriental medicine to establish the EBM Committee to prove that Kampo medicine was evidence-based. The first report on clinical evidence for Kampo was published in 2005. In 2001, the study of Japanese herbal medicine became compulsory in the medical education system. A petition against removing Kampo drugs from public insurance in 2009 showed that people hoped doctors would continue to be able to prescribe Kampo drugs under insurance systems.

Survey of the Use of Kampo Medicine at the Kampo Clinic / 日本東洋医学雑誌

Kampo medicines have been used for treatment by an increasing number of doctors in recent years, and are becoming more frequently prescribed in combination with Western drugs. In the present study, we conducted a questionnaire of outpatients at the Kampo Clinic of Keio University Hospital in order to determine their perceptions and compliance regarding Kampo medicines.Ninety eight percent of patients used Kampo medicines in granular form, and approximately 30% of these patients reported difficulty in taking medicine due to reasons such as “bad taste”. Sixty percent of patients used Kampo medicines three times daily. Patients most often forgot to take afternoon doses, and so desired doses once daily. Furthermore, the same number of patients preferred Kampo medicines in tablet form as those who preferred Kampo medicines in granular form.The present findings clarified patients' perceptions toward Kampo medicines. Doctors and pharmacists must provide suitable treatment for patients by recognizing their perceptions of Kampo medicines.

A Case with Short Bowel Syndrome Successfully Treated with Shigyakuto-kagen / 日本東洋医学雑誌

We present a patient with short bowel syndrome (SBS), successfully treated with the Kampo medicine, shigyakuto-kagen. The patient was a 74 year old female complaining of severe diarrhea, abdominal distention, and abdominal pain. She was diagnosed as having tuberculous peritonitis when she 23 years of age. A partial resection of the small bowel and colon was performed for ileus, secondary to her tuberculous peritonitis, eventually causing her short bowel syndrome (SBS). Severe abdominal distention and pain had persisted even after the resection surgery. She consulted our clinic at 60 years of age in order to receive Kampo therapy. Bukuryoshigyakuto was prescribed, and her condition markedly improved. Zanthoxylum piperitum was added to bukuryoshigyakuto, and the regimen had the reactivity of daikenchuto. She regained her pre-operation body weight. It is significant that this case was followed for 14 years with therapy based on Kampo diagnosis, without remarkable complications, although patients with SBS often tend to have poor prognosis.

Characteristics of Keio University Hospital's Kampo Clinic Judging from the First Visit Patients / 日本東洋医学雑誌

Background : Since 2002, Keio University Hospital's Kampo Clinic has promoted itself actively through the media, public presentations, faculty outreach and an internet home page. However, the relative value of these promotions is unknown. Additionally, the range and prevalence of presenting concerns, and the ages and the gender ratio of the patients served at Keio is unknown.Objective and Methods : To better understand and better serve the patients, the medical charts of every new patient who presented to Keio University Hospital's Kampo Clinic from November 2004 to November 2005 (n=791) were retrospectively analyzed for 1) referral source, 2) age, 3) gender, and, 4) disease category.Results : The internet webpage was by far the best source of new patient referrals. The out-of-hospital referral rate to the clinic was remarkably low. Women exceeded men by a 3 : 1 ratio. Most women were in their thirties but male patients were fairly evenly distributed across the age spectrum. Patients under 16 and over 70 were gender-balanced. The vast majority of patients presented with general medicine/pediatric, dermatological or gynecological problems.Conclusion : A patient-oriented internet home page provides a good source of new patient referrals. Given the low rate of referrals from outside hospitals and physicians, additional outreach directed at internal medicine, dermatology or obstetrics/gynecology physicians appears warranted.

The Usefulness of the Kampo for the Improvements of the Athletes Performance \lq\lqA new Management of Athletes by Kampo Medicine\rq\rq / 日本東洋医学雑誌

From a point of stress, the competitive sports are totally different from exercises for the health promotion. It would be even harmful especially for middle-distance or long-distance women runner. It brings them paramenia, defatigation and other orthopedic troubles which makes them unable to exercise further more.We have investigated the possibility of the preventive use of Kampo Medicine for those athletes and found that it is useful. The nine women who belong to the Tohoku-Region women team of long-distance relay road race had received Kampo medical treatment for 7 months. Serum CPK and AST were elevated with training exercise. In the cases whose CPK level was above 500 IU/l, most of them suffered from fatigue, leg pain, low back pain, and lower abdominal pain, which is very important for Kampo diagnosis. Because these symptoms unable athletes to exercise as planned, we understand that for the improvement of physical capacity, it is important to prevent those symptoms. For the treatment and prevention of the symptoms, we prescribed Keishibukuryogan, Rikkunshito, and Shimotsuto. We defined preventive medication period as “Mibyou” and continued to use Kampo medicine for 7 months. During the period, they were free from any troubles that would make them unable to exercise. These medicines enabled them to improve their records drastically. This study shows that preventive use of Kampo Medicine is extremely effective for any athletes to maintain their good conditions.

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.

A Pharmacoepidemiological and Economic Study on the Medicinal Expenses for the Treatment of Colds. Comparison between Modern Drugs and Kampo Medicine / 日本東洋医学雑誌

From December 1997 to February 1998, prescriptions for 875 patients with colds at the three institutions listed were investigated. The prescriptions were divided into three groups according to the nature of the drugs; modern drugs, Kampo medicine and combined use of modern and Kampo medicine. Mean age, the number of prescribed drugs and the days of prescription were checked and the medicinal expenses were calculated. When using only modern drugs, daily expenses were 203.8yen in average. On the other hand, using only Kampo medicine they were 119.6yen. When using combination of modern and Kampo medicine, the expenses reached to 215.9yen. These results indicated that Kampo medicine was the most economical, because using only Kampo medicine made the expenses approximately 60% less than those using only modern drugs. Thus, at least 41.5 billion yen could be saved in 1998 calculating from the market share of the national medical supplies in each therapeutic category. In conclusion, treatment of colds with only Kampo medicine was considered to be the most cost-efficient way.