<b>A Case of Somnambulism Successfully Treated with Sansoninto</b> / 日本東洋医学雑誌

We report a case of somnambulism successfully treated with sansoninto. A 55-year-old woman had an initial episode of somnambulism in childhood, which recurred in her early 20s along with development of psychotic manifestations. The patient was hospitalized in a psychiatric hospital with a diagnosis of schizoaffective disorder and coexisting Crohn's disease. At the age of 55, she began to show nocturnal wandering tendencies and we prescribed yokukansan at 2.5 g/day, though the symptoms only temporarily improved. Following a switch to sansoninto at 7.5 g/day, the symptoms disappeared. Based on our experience with this case, we speculate that the Heart component of the five viscera theory in traditional Chinese medicine plays a key role in somnambulism.

Association between Autonomic Nervous Activities of Climacteric Patients and Undefined Symptoms / 日本東洋医学雑誌

This study was designed to investigate the association between autonomic nervous activities and clinical symptoms of climacteric women with qi disturbance. Power spectral analysis of heart-rate variability (HRV) was performed in 55 climacteric patients with undefined symptoms (age;51.9±2.8). The total power of HRV in patients with hot flushes was significantly higher (529.6±529.9ms2) than that of patients without this symptom (295.4±260.8 ms2) (P<0.05). The sympathetic nerve system (SNS) index in patients with hot flushes and with jitters (2.81±2.93 and 3.16±2.78), was significantly higher than those of patients without them (1.03±0.78 and 0.87±0.72) (P<0.001 and P<0.0001, respectively). The parasympathetic nerve system (PNS) index of patients with hot flushes and patients with jitters (0.38±0.19 and 0.33±0.16) was significantly lower than those of patients without them (0.55±0.17 and 0.58±0.14) (P<0.001 and P<0.0001, respectively). These findings indicate that HRV-based assessment of the autonomic nervous system activity of climacteric women with hot flushes and jitters, which have been known as symptoms of qi counterflow in the Kampo medicine, is associated with an increase in sympathetic nerve system and a decrease in parasympathetic nerve system activity. It has been suggested that autonomic nervous activities be included in the part of pathological condition of qi in the Kampo medicine, and that evaluation of qi be used as one diagnostic tool in the practical Kampo medicine, or fusion of western and oriental medicine.

Clinical Efficacy of Hochuekkito on Uterine and Bladder Prolapse—Assessment with Numerical Rating Scale and Baden-Walker grading— / 日本東洋医学雑誌

Female organ ptosis, especially uterine prolapse, is a delibilitative, dysfunctional condition of the supporting pelvic floor system of ligaments, connective tissues and muscles which manifests during pregnancy, delivery, or post-menopause. The Japanese Kampo herbal formula “hochuekkito” has been reportedly applied to uterine prolapse based on its putative ability to rejuvenate body vitality (Qi) and raise declined Qi. We assessed the efficacy of hochuekkito for uterine prolapse based on observations of its effect on clinical and objective symptoms. We administered hochuekkito to 17 patients (62.6 ± 7.1years) diagnosed with modern techniques as having uterine prolapse. The results showed that it was very effective in 6 cases (35.7%), effective in 9 cases (52.9%), and ineffective in 2 cases (11.8%). 10 patients with pessaries were all found to have been treated effectively (very effective : 4, effective : 6). In 6 patients whose compliance was below 90%, the percentage of very effective cases was 75%. The effectiveness score of hochuekkito with pelvic exercise (1.5 ± 0.5) and with pessaries (1.4 ± 0.5) was significantly higher than that with hochuekkito alone (0.8 ± 0.8) (p < 0.05). Finally, for uterine prolapse and bladder prolapse, the addition of pelvic exercise and pessaries to hochuekkito brought about more prompt improvement than that with hochuekkito alone. The increased efficacy with the addition of pelvic exercise or a pessary also helped strengthen atonic pelvic muscles, thus synergistically working together with the effects of hochuekkito.

Efficacy and Mechanism of Action of Saireito Therapy for Autoimmune Recurrent Abortion Indexed by Antinuclear Antibody and Anticardioripine Antibody / 日本東洋医学雑誌

The efficacy of Saireito (a herbal preparation) against autoimmune recurrent abortion was evaluated clinically and immunologically. Saireito therapy was performed with 87 women having experienced 3 or more recurrent abortions in the early stages of pregnancy (less than 12 weeks gestation), and whose antinuclear antibody (ANA) and anti-cardiolipine antibody (ACA) test results were positive. The effects of this therapy on the percentage of women in whom abortion was successfully prevented (the abortion prevention rate), and on the antibody titer were investigated. Among the 49 women who became pregnant during the study period, the abortion prevention rate was 63.3%, the percentage of ANA positive cases was 65.6%(32/49), the percentage of ACA IgG and/or IgM positive cases (as evaluated by SRL methods) was 65.5%(29/49) and the percentage of both ANA and ACA IgG and /or IgM positive cases was 75.0%(12/49). Although the titer of ANA was not significantly reduced by this therapy, the titer of ACA IgM was reduced significantly.These results suggest that Saireito exerts its efficacy by suppressing humoral immunity through its adjustment of the Th1/Th 2 cytokine balance. This therapy is expected to be effective against ACA-positive recurrent abortion by reducing the effects of ACA. Furthermore, in 2 observed child birth cases whose ACA titer were not decreased by Saireito, different effective mechanisms were speculated; for example, suppression of platelet aggregation via saireito's component herbs (ninjin and bukuryou) similar to the effect seen with low-dose aspirin therapy, or its “risui” effect via its components (bukuryou, soujyutu, takusha and chorei).

Is Tokishakuyakusan Clinically Useful in Treatment of Immunologic Recurrent Abortion? / 日本東洋医学雑誌

Clinical efficacy of tokishakuyakusan against immunologic recurrent abortion was evaluated using methods of diagnostic statistics. The subjects of this study were 38 women with recurrent abortion who had experienced a spontaneous abortion during their first trimester (within 12 weeks of pregnancy) twice, and who took tokishakuyakusan (extract granules) after development of their third pregnancy, but experienced spontaneous abortion again during their first trimester, with the karyotype of the aborted fetus being rated as 46, XX or 46, XY. The control group consisted of 244 women who had experienced 3 or more spontaneous abortions during their first trimester of pregnancy. The detection rates of autoimmune disorders and alloimmune disorders were compared statistically between the two groups. Neither the detection rate of autoimmune recurrent abortion nor the detection rate of alloimmune recurrent abortion differed significantly between the two groups, suggesting that tokishakuyakusan is not clinically effective against immunologic recurrent abortion. Tokishakuyakusan is estimated to prevent abortion caused by compromised luteal insufficiency of the uterus. Thus, saireito seems to provide a more rational means of Kampo therapy for immunologic recurrent abortion.

Analysis of 100 Women with Infertility Due to Ovarian Dysfunction Who Succeeded in Delivering Live Children after Kampo Therapy Diagnosed by \lq\lqZheng\rq\rq / 日本東洋医学雑誌

To determine the Kampo therapy indications for global infertility treatment, and the criteria for objective and rational evaluation of its efficacy, we analyzed the sho (Zheng), type of ovarian dysfunction, types of Western drugs used concomitantly, length of treatment, age upon pregnancy, etc., in 100 women with infertility due to ovarian dysfunction as diagnosed by Western medicine who succeeded in becoming pregnant and giving live births, after Kampo therapies diagnosed by sho based on Hakko, Ki, Ketsu and Sui. The diagnosis of the sho in these women was compared with that in 2737 control women. Their types of sho by frequency were Kyo (51%), Shoyo (Hanhyo-Hanri) (69%), Jonetsu-Gekan (52%), Kigyaku (47%), Oketsu (71%) and Suidoku (67%). When compared to the control group, the percentage of women whose Sho was rated as Jitsu, Taiyo, Shoyo, Jonetsu-Gekan, Oketsu or Suidoku was significantly higher. The sho type Hyonetsu-Rikan was lower. The preparation sho, rated on the basis of a general assessment, was most frequently Kamishoyosan(55%). The predominant type of ovarian dysfunction was luteal dysfunction (73%), whose frequency was significantly higher than that in the control group. Of all women studied, 46% were treated with Kampo alone and 54% were treated with Kampo + Western medicine. In terms of the percentage of each type of ovarian dysfunction, there was no significant difference between the two groups. The Western drugs used in combination with Kampo therapy were hCG preparations (33%), terguride preparations (18%), clomiphene preparations (3%) and hMG preparations (6%). The period of treatment until pregnancy was significantly shorter in the Kampo alone group (5.0 ± 4.4months) than in the combined therapy group (9.5 ± 6.8months). These results allow us to make the following conclusions:1.The type of infertility indicated for Kampo medicine is infertility due to ovarian dysfunction as diagnosed by methods of Western medicine.2.Women who successfully became pregnant following Kampo medicine were often cases of Shoyo disease complicated by sho with Jonetsu-Gekan, accompanied by Kigyaku, Oketsu and Suidoku.3.Uncombined Kampo medicine may be effective in cases of severe infertility.4.If pregnancy does not occur within 5 or 6 months after the start of Kampo therapy, combined use of Western medicines should be considered.

Investigations of Two Cases Initially Diagnosed as Having Absence of Competent Ovum at \it{in vitro} Fertilization but Having Succeeded in Obtaining Live Births after Short-Term Kampo-therapy Diagnosed by \lq\lq\it{Zheng}\rq\rq / 日本東洋医学雑誌

For two infertile couples with normal tubal function and spermatogenesis, who were diagnosed with infertility attributed to lack of competent ovum with poor grade embryo in spite of having received timing therapy and step-up therapy (artificial fertilization from husband ; AIH and in vitro fertilization and embryo transfer ; IVF-ET), Kampo-only therapies diagnosed according to their “Zheng” syndrome-type consisting of one cycle of tokishigyakukagoshuyushokyoto, and two cycles of kamishoyosan and anchusan was performed. As a result, both women became pregnant and gave live births. The causes of infertility in these two cases were analyzed, and problems with step-up therapy, commonly used in Western medicine and efficacy of Kampo-therapy diagnosed according to their Zheng were evaluated from the standpoint of Western medicine.Kampo-therapy diagnosed by Zheng was found to improve the follicular and luteal functions as well as related functions. The two cases presented were diagnosed as infertile due to ovarian dysfunction on the basis of therapeutic diagnosis. The indications of IVF-ET are tubal and male infertilities, not to be ovarian dysfunctional infertility.For infertility due to ovarian dysfunction, Kampo-therapy diagnosed by Zheng with Kuoketsu and Risui effects are drugs of first choice, rather than clomiphene, which has an anti-estrogen activity.

Practice of the Assimilation of Kampo and Western Medicine / 日本東洋医学雑誌

Chinese herbal remedy (KAMPO) is no longer an out-of-date medicine. It is now transforming into a new medical care system that attracts world-wide attention. The therapeutic system of Oriental Medicine is different in various aspects from that of Occidental Medicine. In this regard, appropriate harmonization of East and West (Oriental Medicine and Occidental Medicine) by comparison with merits and demerits in the understanding of diseases, methods of consultation, usage of drugs, etc. is expected to improve the quality of medical care. Considering that most of the drugs used in the Occidental Medicine are based on “single effective ingredient” that is artificially synthesized while herbal drugs are produced by combining crude drugs that contain various ingredients, the method of administration should naturally be changed.Such stance of Kampo medicine is based on the “respect for and understanding of individual constitution and disposition while paying attention to the gender difference and individuality” with the patient as the protagonist (treatment that is centered on client) and is also based on understanding and respecting the gender difference and individuality that are the basis of so-called “Science and Art” of practical medicine.

Rate of Identification of Eight-principle Pattern and Physiological Activity in Women with Climacteric Symptoms in Japanese Kampo Medicine / 日本東洋医学雑誌

Women with undefined climacteric period complaints often have multiple symptoms. To identify the characteristics of and to provide treatment tailored to each patient, Sho diagnosis based on an eight-principle pattern of identification is needed. Furthermore, identification of abnormalities in Ki, Ketsu and Sui, which are the basic elements of all physiological activity, are of great importance in clinical practice.<br>We determined identification rates of these principles in women with climacteric symptoms using Kampo medicine. Eight hundred and ninety-nine climacteric patients, aged 43-58 years: 52.1±2.4yr, were recruited for this study. We detected heat-or cold-syndrome, and hyper-or hypofunction patterns using the eight-principles with conventional, traditional Japanese Kampo medicine diagnostic procedures as well as disorders of Ki, Ketsu, and Sui metabolism according to the Terasawa score, in retrospective fashion. Ketsu stagnation (36.5%) was found to be the most frequent condition. Ki regurgitation (25.9%) and Ki stagnation (24.8%) were found to be relatively frequent pathological conditions. In women with headache, hot flushes, and dizziness as the principal menopausal symptom, disorders of the Sui metabolism (48.8%), Ketsu stagnation (48.1%), and disorders of the Sui metabolism (48.0%) were the most frequent conditions, respectively.<br>These results indicate that although climacteric symptoms are diverse in nature, identification of Ki-Ketsu-Sui patterns often makes it possible to obtain a coherent diagnostic picture, leading to a better understanding of the conditions seen in climacteric women. When dealing with climacteric women with undefined complaints, it seems particularly important for physicians to be able to prescribe Kampo preparations precisely for Ketsu stagnation (the most frequently observed) so that the health of these women can be restored. It is also important that physicians perform Sho diagnosis carefully, bearing in mind the finding that Ki-Ketsu-Sui patterns were complex in patients exhibiting hot flushes (one of the main symptoms), although half of these presented with Ketsu stagnation. Incorporating Kampo medicine into therapeutic approaches to the treatment of such patients therefore seems advisable.