Effects of Kampo Therapy for Inpatient on Medical Economics / 日本東洋医学雑誌

We investigated prescriptions and drug costs at admission and discharge for 35 patients hospitalized in Department of Japanese Oriental (Kampo) Medicine, Chiba University Hospital from September 2006 to October 2008. They recovered after Kampo therapy from various non-acute diseases. The number of western drugs decreased from 3.7 at admission to 2.7 at discharge, thus their drug costs per day significantly decreased from302.1yen to 227.6 yen. The cost of Kampo medicines themselves, on the other hand, did not decrease significantly. Total drug costs, however, were significantly reduced from 437.8 yen at admission to 348.0 yen at discharge, so patients' overall costs were reduced by 20%. These results indicated that the proper use of Kampo medicine for various diseases would reduce drug costs and the impact of treatment expenses on medical economics, with improvement in disease outcomes.

A case of Post-operative Complication and Chronic Pain Successfully Treated with Kampo Medicine for Qi Disturbance / 日本東洋医学雑誌

We experienced a case of post-operative complication and chronic pain due to left pyeloplasty and uterine myomectomy successfully treated with Kampo medicine. A 55-year-old woman underwent pyeloplasty for ureteropelvic junction obstruction, and ureteral stent for ureteral stenosis caused by synechia after uterine myomectomy. She suffered from post-operative complication and chronic pain, which was becoming severe, and had a depressed mood. She visited our outpatient clinic for Kampo therapy. We prescribed bukuryoingohangekobokuto on the diagnoses such as qi deficiency, qi stagnation, and water retention. Her symptoms disappeared with this formulation. This case suggests the importance of considering qi disturbance when we treat patients with chronic pain using Kampo 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.

Questionnaire Survey on Kampo Medicines for Patients Under 19 Years Old / 日本東洋医学雑誌

To investigate the difficulties of taking Japanese traditional (Kampo) medicines, questionnaires were filled out by patients under 19 years old or their families.Forty-six questionnaires were valid for analysis. The mean age of the patients was 9.7 &qlusmn; 5.3 years old (2 to 19 years old) and the percentage of male patients was high (65%). They took extract granules (n = 40) or decoction (n = 6) and most of the patients (n = 38, 83%) took medicines twice a day. Though 69% of patients under 5 years old needed direct assistance from their family to take medicines, none of over 6 years of age needed any help except to dissolve medicines in hot water, while notably 77% of the patients over 13 years old took their medicines un-aided. It was found that patients' families gave them the concrete explanations on the necessity of their medicines regardless of patients' age, so it is important for pharmacist to guide not only families but also patients themselves. Furthermore, pharmacists should understand the taste and the constituent crude drugs of Kampo medicines to improve patients' adherence in taking medicines.

Regulation of Expression of Sprouty Isoforms by EGF, FGF7 or FGF10 in Fetal Mouse Submandibular Glands / Oral Science International

Branching morphogenesis of the fetal mouse submandibular gland (SMG) is regulated by signaling through the ErbB and FGF families of tyrosine kinase receptors, whose members activate the ERK-1/2 pathway. The four Sprouty (Spry) proteins are inhibitory modulators of ERK-1/2. There is little information on their expression during pre- and postnatal development of the SMG. Qualitative RT-PCR detected mRNAs for <i>Spry1, 2</i>, and <i>4</i> from embryonic day 13 (E13) through postnatal day 7 (P7), but only trace amounts of <i>Spry1</i> and <i>2</i> in adult SMGs. More sensitive quantitative RT-PCR revealed that transcripts for all four <i>Spry</i> isoforms are expressed, and each shows individual patterns of variation across fetal and early postnatal stages, and that there are very low levels of <i>Spry1</i> and <i>2</i>, but no <i>Spry3</i> and <i>4</i>, in adult glands. EGF, FGF7 and FGF10 upregulate expression of mRNA for <i>Spry1</i>, but only FGF7 upregulates <i>Spry2</i> mRNA. EGF strongly induces an activating phosphorylation of all four <i>Spry</i> isoforms, but both FGFs do so only minimally. Quantitative RT-PCR of samples collected by laser capture microdissection showed that transcripts for <i>Spry1</i> are confined to the epithelium of E13 SMG rudiments. The isoform-specific temporal variation in the patterns of expression of <i>Spry1, 2, 3</i> and <i>4</i> suggests a potentially important role for these negative modulators of growth-factor driven ras/ERK-1/2 signaling at stages when the SMG is most actively undergoing branching morphogenesis.

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.

A Case of Multiple Intractable Skin Ulcers of Bilateral Legs due to Arteriovenous Fistula Successfully Treated with Kampo Medicines / 日本東洋医学雑誌

Arteriovenous fistulae are known to be one of the causes of intractable leg skin ulcers. Because they raise peripheral venous pressure, decrease arterial blood flow to peripheral tissue, and cause venous blood congestion, symptoms of skin coldness, edema, pain, dermatitis and skin ulcers may appear in the legs. We observed a 32 year-old woman with multiple intractable bilateral leg skin ulcers due to arteriovenous fistulae successfully treated with Kampo medicines. In 1999, skin ulcers, edema, and pain presented in both her legs. She was diagnosed has having arteriovenous fistulae with various examinations in 2003. She had subsequently been treated with topical preparations on her legs, analgesics and other palliative treatments, but as symptoms had not improved, she first visited our outpatient clinic in August 2006. After an initial oral administration of tokishakuyakusan extract for 6 weeks, her pain improved. Afterwards, ogikenchuto was added for symptoms of qi deficiency. Moreover, bushi powder was added for the treatment of pain exacerbated in cold conditions. After 6 months, the size of her skin ulcers was fairly reduced, and she had no need of analgesic drugs. In past reports, Kampo medicines have not been used for the treatment of intractable skin ulcers due to arteriovenous fistulae. This case suggests that Kampo medicines are a treatment option in this condition.

One Case of Wells' Syndrome Successfully Treated with Kampo Medicines / 日本東洋医学雑誌

Wells' syndrome (eosinophilic cellulitis), whose etiology is idiopathic, is clinically characterized by solitary or multiple cellulitis-like eruptions which occur on the extremities and trunk. Corticosteroids are usually used for palliative treatment, but relapses are often observed. We observed an 8 year-old patient with Wells' syndrome successfully treated with Kampo medicines. In 2001, skin eruptions appeared on his extremities. In 2002, a histopathologic examination determined his disease to be Wells' syndrome, and corticosteroids were subsequently used for treatment. In January 2007, his skin eruptions worsened, and he first visited our outpatient clinic in May. After oral administration with keigairengyoto, his skin eruptions were slightly improved, but afterwards, they again worsened. In June, jumihaidokuto was administered instead of the former prescription, and the skin conditions had begun to improve. Because dry skin appeared in November, keigairengyoto was again added. With these treatments, his skin eruptions stably improved. In previous reports, Kampo medicines had not been used for the treatment of Wells' syndrome. This case, however, suggests that Kampo medicines are a candidate for the treatment of Wells' syndrome.

A Case of Neurogenic Bladder Successfully Treated with Hangebyakujutsutemmato / 日本東洋医学雑誌

We report a case of neurogenic bladder that was successfully treated with hangebyakujutsutemmato. A 71-year-old Japanese male had difficulty in micturition because of a neurogenic bladder. We utilized hangebyakujutsutemmato on the assumption that he was suffered from qi deficiency, water retention, and qi stagnation. His symptoms disappeared with this therapy. Although kidney tonifying formulae, dampness-draining formulae, and blood stasis-resolving formulae are popular prescriptions for nerurogenic bladder, hangebyakujutsutemmato may be also effective for cases with qi deficiency, water retention, and qi stagnation.

The Present Status and Problems of Dispensing Herbal Medicine by the Analysis of Questionnarie Survey to Insurance Pharmacies / 日本東洋医学雑誌

Background : This questionnaire survey was performed to clarify the present status and especially the problems with dispensing herbal medicines and counseling patients.Objectives : To survey 15 pharmacies approved under the National Health Insurance System to dispense herbal medicines prescribed by Department of Japanese Oriental (Kampo) Medicine, Chiba University Hospital.Results : Twelve pharmacies responded that 1,900, the present fee allowed for dispensing herbal medicines, was low. The time for dispensing herbal medicine via an automatic packaging machine was half of that dispensed by humans. Many pharmacies requested a re-evaluation of the fee based on the length of a prescription and the number of herbs in a formula, and requested a re-evaluation of the drug price standards. About half of the pharmacists surveyed also had a poor knowledge of herbal medicines.Conclusion : We suggest that economical aspects of dispensing herbal medicine should be improved to secure more insurance pharmacies which can dispense herbal medicines. There is also a need to construct education systems for pregraduate and postgraduate university students in order to train pharmacists who will have a thorough knowledge of Kampo Medicine.

A Case of Erythema Nodosum Successfully Treated with Seinetsuhokito and Byakkokakeishito / 日本東洋医学雑誌

We experienced a case of erythema nodosum of unknown etiology successfully treated with therapy based on Kampo diagnosis. The case was 44 year-old woman who had erythema nodosum over her bilateral leg extensors several times a month, became cold easily and had stomatitis. At first, we administered seinetsuhokito, which resulted in the disappearance of her stomatitis. However, she still had a recurrence of her erythema nodosum. Because of a condition of interior heat and qi counterflow, we considered her situation heibyo. We administered seinetsuhokito and byakkokakeishito every other day, which resulted in the disappearance of both her stomatitis and erythema nodosum. Therefore, we suggest that it is worthy to think about heibyo situations, when treating patients with complications.

Six Cases with \lqHonton\rq Disease Successfully Treated with Combination of Goshuyuto Extract and Ryokeijutsukanto Extract / 日本東洋医学雑誌

We report six cases with honton disease successfully treated with a combination of goshuyuto extract and ryokeijutsukanto extract. Five of the cases were diagnosed as panic disorder, and the remaining case as generalized anxiety disorder. All six cases complained of palpitation, nausea, dizziness, headache and anxiety attacks. We diagnosed them as a hontonto (Zhouhou fang) indication. Their various complaints disappeared after combination therapy with those extracts. Furthermore, efficacy of the combination therapy was proven to be equal to hontonto. These cases suggest that the combination therapy with goshuyuto extract and ryokeijutsukanto extract is useful in place of hontonto.

Two Cases of Complaints after Abdominal Operation Successfully Treated with Kososanryo / 日本東洋医学雑誌

Although a laparotomy itself may be successful, various complaints, whose organic causes are not definite, occasionally arise afterwards. We report two cases of complaints after abdominal operations successfully treated with kososanryo. The chief complaints were anorexia in Case 1, and anxiety in Case 2. We treated the pathological states in these cases as qi stagnation, or qi obstruction in Japanese-oriental medicine sense. The symptoms in these cases improved soon after administration of kososanryo, which is traditionally used for qi stagnation. On closer investigation, we first report that kososanryo is useful for complaints after abdominal operations. Complaints after various operations lower quality of life and, what is even worse, may cause unreliability of medical treatment. The present cases suggest that Japanese-oriental medicine has therapeutic utility in the therapy of complaints after various operations.

Disappearance of Various Abdominal Symptoms with Kampo Treatment in a Postoperative Patient with Renal Cell Carcinoma / 日本東洋医学雑誌

We report a case with various postoperative abdominal symptoms that were successfully treated with Kampo medicine. A 58-year-old Japanese female had nausea, eructation, epigastric pain, lower abdominal pain and anorexia that appeared just after laparoscopic nephrectomy for renal cell carcinoma. No abnormal findings were discovered by gastroenterological examinations. Western medical therapy was not successful. We used bukuryoin under the interpretation that nausea and eructation represent phlegm-fluid retention in the chest. The bukuryoin therapy cleared up her nausea and eructation in about one week. Additionally, her epigastric pain, lower abdominal pain and anorexia were cured by use of anchusan.

A Case of Intermittent Claudication and Skin Ulcers of Lower Limb due to Arteriosclerosis Obliterans Successfully Treated with Prepared in the Hospital Keishibukuryogan and Daisaikoto / 日本東洋医学雑誌

Lower limb skin ulcers due to arteriosclerosis obliterans are severe ischemic lesions, and if preservation therapies such as antiplatelet and anticoagulant treatments are not effective, lower limb amputation may be necessary.We report the case of 73 year-old male patient suffering from intermittent claudication and skin ulcers on the heel of the left foot, who was successfully treated with keishibukuryogan and daisaikoto prepared in hospital. This case suggests that improvement of micro circulation with the addition of keishibukuryogan and daisaikoto to anticoagulant and antiplatelet therapies, safely promoted an improvement of ischemic lesions due to arteriosclerosis obliterans.

The Revealing of Problems Concerning about Treatment of Kampo Formulae in Hospitalization / 日本東洋医学雑誌

Aims : To clarify any difficulties that pharmacists and nurses may have when prescribing Kampo medicines to newly-admitted patients with a survey questionnaire at a local hospital ward.Methods : Questions for pharmacists on the handling of Kampo herbs, any perceived risks in the preparation of Kampo formulae powder extracts/pills, or in explaining Kampo medicines, based on their experiences. Also questions for nurses on the handling of Kampo medicines, as compared to western medicines, and any perceived risks in their administration at their ward.Result : All 7 pharmacists and 14 out of the 16 nurses surveyed completed their questionnaires. The pharmacists pointed out that Kampo preparation takes more time, although none perceived an increased risk with Kampo medicines, as compared to western medicines. Only 1 pharmacist had ever had experience explaining Kampo medicines to patients. The nurses, on the other hand, felt that Kampo treatments were somewhat more difficult to use, and perceived similar risk in their administration to patients.Conclusion : Both the pharmacists and nurses surveyed believed that the handling of herb medicines was somewhat difficult, but that these difficulties could be overcome with risk management. This suggests that pharmacist, nurse and office personnel education would be useful before Kampo medicines are administered to newly-admitted hospital patients.

A Case of Generalized Pain from Fibromyalgia Successfully Treated with Byakkoto / 日本東洋医学雑誌

We report on a case of severe generalized pain due to fibromyalgia syndrome, which was successfully treated with a variation of byakkoto. A 65-year-old Japanese woman had severe generalized pain which grew worse in warm environments, such as during the summer or when bathing. She also had pollakidipsia. We utilized a variation of byakkoto on the assumption that she was suffered from high inner heat. Her severe generalized pain resolved with this therapy. Although bushi-zai and saiko-zai are common prescriptions for fibromyalgia syndrome, byakkoto-variations may also be effective in cases where conditions are worsened by heat effect.

A Case with Lumber Spinal Canal Stenosis Successfully Treated with Kigikenchutokauzu / 日本東洋医学雑誌

We report on a patient with residual complaints after an operation for lumber canal stenosis, successfully treated with the Kampo medicine, kigikenchutokauzu. The patient was 69 year-old woman complaining of severe coldness, numbness, and bilateral leg pain. She was diagnosed as having spinal canal stenosis when she was 67 years of age. Posterolateral fusion with laminectomy was performed at the age of 69, although severe coldness, numbness, and pain persisted even after her surgery. Also, her sutures had not healed. She was referred to our department 26 days after her surgery in order to receive Kampo therapy. Kigikenchutokauzu was prescribed, and her condition markedly improved. Her sutures healed completely 7 days after start of administration. This suggests that kigikenchutokauzu may be effective not only for the residual spinal canal stenosis symptoms, but also for the postoperative healing of sutures.

Cases Report of Bukuryoingohangekobokuto / 日本東洋医学雑誌

We report on 3 patients who presented with symptoms of Ki obstruction, Ki deficiency, and disorder of the body's fluid metabolism, successfully treated with bukuryoingohangekobokuto. In our experience, bukuryoingohangekobokuto has been effective in 25 of the 30 patients (6 men and 24 women) to whom is has been administered, who also presented with Ki obstructions, Ki deficiencies and disorders of the body's fluid metabolism as mentioned above. The most common subjective symptom in all these effectively-treated patients was hot flashes. Other signs were epigastric pain or discomfort accompanied by chest signs and symptoms, such as palpitations, heartburn, chest oppression or dyspnea. The most common objective findings in these effectively-treated patients were pulsation at the pit of the stomach and navel, and a fluid sound in the stomach upon palpation. Based on our experiences, we believe that prescription of bukuryoingohangekobokuto is best indicated when the presence of the above-mentioned symptoms and findings has been confirmed.

Six Cases with 'Honton' Disease Successfully Treated with Combination of Goshuyuto Extract and Ryokeijutsukanto Extract / 日本東洋医学雑誌

We report six cases with <I>honton</I> disease successfully treated with a combination of goshuyuto extract and ryokeijutsukanto extract. Five of the cases were diagnosed as panic disorder, and the remaining case as generalized anxiety disorder. All six cases complained of palpitation, nausea, dizziness, headache and anxiety attacks. We diagnosed them as a hontonto (<I>Zhouhou fang</I>) indication. Their various complaints disappeared after combination therapy with those extracts. Furthermore, efficacy of the combination therapy was proven to be equal to hontonto. These cases suggest that the combination therapy with goshuyuto extract and ryokeijutsukanto extract is useful in place of hontonto.