Three Cases of Easy Fatigability and Tiredness Successfully Treated with Hangekobokuto / 日本東洋医学雑誌

We describe 3 cases of easy fatigability successfully treated with hangekobokuto. Case 1 was a 44-year-old woman who had been experiencing fatigue for a long time due to her busy work schedule. Juzentaihoto was ineffective, and she felt abdominal swelling and showed epigastric resistance upon abdominal examination. Case 2 was a 13-year-old woman who became easily tired, had palpitations, felt uneasy, and showed epigastric resistance upon abdominal examination, after moving from overseas to Japan. Case 3 was an 18-year-old woman who became easily tired under the pressure of her studies after entering university, felt uneasy, felt abdominal swelling, and showed epigastric resistance upon abdominal examination. Hangekobokuto relieved these symptoms. In Case 2 and Case 3, there were obvious stressors, and qi stagnation was strongly suspected. In Case 1, although the patient did not complain of obvious stress, she did not respond well to juzentaihoto, which compensates for qi deficiency, so we also considered qi stagnation. For symptoms such as “get tired easily,” qi-tonifying formulas are often used, but qi-regulating formulas including hangekobokuto may also be effective. It is also important to focus on the patient’s mental state and living environment.

The Induction of Acupuncture Curriculum for Kampo Medicine Doctors / 日本東洋医学雑誌

To help medical doctors practicing Kampo medicine suggest appropriate acupuncture treatments for individ­ual patients, a study group made up of 7 acupuncturists and 5 medical doctors developed an acupuncture cur­riculum. The group provided a learning program based on the curriculum for 16 medical doctors in charge of outpatient Kampo services in a research institute. The learning program consisted of a lecture and practical training, and a total of 4 sessions were held. At the end of each session, a test was conducted to examine the participants' level of understanding. After the completion of the learning program, a questionnaire survey was conducted to confirm the usefulness of the acupuncture curriculum for the practice of Kampo medicine. The mean number of participants per session was 10.8 ± 1.3. The mean test score was 9.3 ± 0.5 (full score : 10). In the questionnaire, 14 out of the 16 (88%) answered that the acupuncture curriculum was useful or relatively useful for the practice of Kampo medicine. On comparing the numbers of new acupuncture patients with a his­tory of outpatient Kampo service use before and after the acupuncture curriculum, there was a 1.8-fold increase after it. The results support the usefulness of the acupuncture curriculum to understand acupuncture and practice Kampo medicine. Further evaluation is necessary.

Three Cases of Dry Nose Successfully Treated with Hachimijiogan or Rokumigan / 日本東洋医学雑誌

Few reports currently exist demonstrating that Kampo medicine is effective for dry nose. Here, we describe three cases of dry nose that were successfully treated with hachimijiogan or rokumigan. The chief complaints of the three cases differed. Dry nose was the second or third most troublesome symptom. The three cases had kidney deficiency and its typical symptom of abdominal numbness in common. Upon administration of hachimijiogan or rokumigan, dry nose improved promptly, along with the improvement of kidney deficiency. In addition, it became easier for all three cases to breathe. According to “Pu ji fang”, dry nose is ascribed to wind-­heat or kidney deficiency. The kidney is considered to control the reception of qi inhaled by the lungs. Taken together, we speculate that dry nose of the three cases were due to kidney deficiency, because treatment with hachimijiogan or rokumigan improved their dry nose along with the improvement of their kidney defi­ciency as well as their breathing which suggests the improvement of the reception of qi inhaled by the lungs. Hachimijiogan or rokumigan is shown to be effective for dry nose in the patients with kidney deficiency.

Five Female Cases of Irritable Bowel Syndrome with Diarrhea after Taking Cold Food and Drink Under Stressful Conditions Successfully Treated with Ireito-Based Kampo Prescriptions / 日本東洋医学雑誌

We report five female patients (range 33-54 years) with irritable bowel syndrome (IBS) that were successfully treated with ireito-­based prescriptions. Showing yin deficiency and weak constitution, they maintained a good state of bowel movement with warming and invigorating prescriptions. However, when it became hot around March to June and these patients encountered stressful conditions, they became thirsty and tended to take a lot of cold food and drink. Then, they developed diarrhea, epigastric and/or abdominal fullness, anxiety and depressive feeling, which are regarded as due to qi stagnation. Stuck sensations in pit of stomach by abdominal examination were reported in all cases. Their symptoms were derived from water retention and qi stagnation, and therefore, we prescribed ireito for one patient, ireito with keishikashakuyakuto or kenchutobased prescriptions (ogikenchuto or shokenchuto) for 3 patients, and ireito with keishibukuryogan for one patient. Ireito is composed of heiisan and goreisan. The Chinese herbs Magnolia Bark and Citrus Unshiu Peel in heiisan not only help the digestive system, but also improve qi stagnation. These results suggest that ireito,containing Peony Root, is effective for patients with IBS, who show stuck sensations in the pit of stomach and suffer from diarrhea with abdominal pain after taking cold food and drink under stressful conditions.

Ten Patients with General Fatigue Associated with Blood Stagnation Successfully Treated with Kampo Formulae, Keishibukuryogan and/or Tokakujokito / 日本東洋医学雑誌

In Kampo medicine, general fatigue is categorized as a symptom caused by qi deficiency according to the qi-blood-­water criteria. However, in some patients with general fatigue, formulae for qi deficiency are not ef­fective, and this might be because their chronic symptoms are associated with blood stagnation. Recently, we encountered ten patients (M/F 1/9, mean age 46 years, range 23-55 years) with general fatigue that was im­proved by agents for treating blood stagnation, such as keishibukuryogan and/or tokakujokito. These patients, who were mostly of medium build, complained of neck or shoulder stiffness (9/10), consti­pation (5/10), and blushing or hot flushes (5/10). They had no problem with appetite, except that 5 patients tended to overeat. Remarkable sublingual collateral vessels (8/10), paraumbilical tenderness (9/10) and periorbital dark circles (5/10) were observed on physical examination. The tongue and abdominal signs improved or had disappeared after treatment for 3 to 8 months. Our results suggest that patients with general fatigue, but who present with symptoms associated with blood stagnation, could be treated with drugs for blood stagnation such as keishibukuryogan and/or tokakujokito.

A Case of Globus Pharyngis in Gastroesophageal Reflux Disease Successfully Treated with Seinetsuhoketsuto / 日本東洋医学雑誌

Gastroesophageal reflux disease (GERD) can cause not only esophageal symptoms, but also extraesophageal symptoms such as globus pharyngis. Here, we describe a case of globus pharyngis in GERD successfully treated with seinetsuhoketsuto. A 72-year-old female began to have tingling in her pharyngolarynx in February 20XX. Otolaryngologist did not point out abnormal findings. However, reflux esophagitis was detected by upper gastrointestinal endoscopy. Although treatment with rabeprazole relieved the tingling, she experienced a relapse in September 20XX and visited our clinic in November. We prescribed seinetsuhoketsuto because she exhibited numerous blood deficiency-related symptoms including dryness of the skin and eyes, shallow sleep, coldness in the feet, etc. The tingling then decreased rapidly and disappeared in two months. In addition, dryness of the skin and eyes and her sleep also improved markedly. Seinetsuhoketsuto has been regarded as a medication for inflammation in the mouth such as oral ulcers and erosions. However, this case indicated that seinetsuhoketsuto could also be utilized to treat symptoms in the pharyngolarynx due to GERD.

Nine Cases of Migraine During the Late Period of Menstruation Successfully Treated with Juzentaihoto / 日本東洋医学雑誌

In female patients with migraine, the triggering or exacerbating factors for migraine including stress, menstruation and fatigue, should be treated intensively in addition to treatment for headache. Patients with coldness and weak constitution become a state of qi and blood deficiency in terms of Kampo medicine under the circumstances of severe fatigue, lack of sleep and menopausal symptoms. They tend to suffer from migraine at around the 4th or 5th day of menstrual period after rather heavy menstrual bleeding on the 2nd or 3rd day. We experienced 4 patients with headache during the late period of menstruation whose symptoms were successfully treated by juzentaihoto known to improve qi and blood. In Case 1, daily prescription was changed from unkeito to juzentaihoto. In Case 2, during the 7 days of menstrual period, juzentaihoto was added to tokishigyakukagoshuyushokyoto, while juzentaihoto was substituted for tokishakuyakusan in Case 3 and Case 4. In 9 cases of headache, including these 4 cases, juzentaihoto was efficacious against migraine headache during the late period of menstruation with coldness (9/9 cases), fatigability (9/9 cases) and dryness symptoms (7/ 9 cases). These results indicate that juzentaihoto is effective for migraine during the late period of menstruation, especially in patients with fatigue after menstrual bleeding. The administration period of juzentaihoto should be individualized for each patient depending on the severity of qi and blood deficiency.

Three Cases of Insomnia Due to Alternating Heat and Chill Successfully Treated with Saikokeishito / 日本東洋医学雑誌

We describe three cases of insomnia due to a feeling of heat in parts of the body, successfully treated with saikokeishito. Case 1 was a 50-year-old man who felt hot in his trunk and extremities at night. Case 2 was a 57-year-old women with osteoarthritis in the fingers who felt hot in her back at night. Their heat/pain was regarded as shisetsuhanto, or vexing pain in the extremities as described in “Shang Han Lun.” Case 3 was another 57-year-old woman who reported hot flushes both day and night. She did not have vexing pain in her extremities, but developed a rash. Although three patients felt hot, they all felt chill when they took off a blanket. Their heat vexation and intolerance of cold were considered as zokansonetsu, as seen in saikokeishito syndrome. They had kyokyokuman, or objective tenderness in the hypochondrium. However, they differed in shinkashiketsu, or tightness below the heart, another characteristic physical findings of saikokeishito : case 1 had stuffiness and rigidity below the heart and abdominal muscle contracture, case 2 had hardness and stiffness in zhong wan (middle segment of the stomach), and case 3 had mild stuffiness and rigidity below the heart, in terms of signs classically reported by Japanese doctors in the Edo period. These findings may suggest that saikokeishito has a wide range of indications. The three cases shared several characteristics, such as during menopause, without cold limbs, moderate or hypofunctional body energy, and alternating heat and chills. Saikokeishito could be a good medicine to treat patients suffering from insomnia with such symptoms, especially during menopause.

Safety of Retained Acupuncture With the Planar Electric Heater at Our Institute / 日本東洋医学雑誌

Our institute performs retained acupuncture for cold-related symptoms using planar electric heaters. After placing retained acupuncture needles at 8 points on the lower back, the site is covered with a planar electric heater and heated for 20 minutes, with the 6-channel dial of the device set at 5, the second highest temperature. Using this method, we treat and examine patients with cold-related symptoms. If patients feel discomfort during the heating process, the procedure is continued when heat is used for treatment and immediately terminated in the case of examination. On examining related adverse events in 75 cases (224 sessions) within the 8-month period between March and October 2016, there was soreness/irritation of the skin surface in 5 (2.2%), itching in 3 (1.3%), and physical deconditioning in 1 (0.4%). However, all of these events were mild and temporary, supporting the safety of the method. As a future challenge, it may be necessary to expand this study to clinical research on traditional Chinese medicine and acupuncture/moxibustion.

Cases of Allergic Rhinitis Successfully Treated with Tokishakuyakusan / 日本東洋医学雑誌

Allergic rhinitis is an allergic disease affecting the nasal mucous membrane, and is aggravated by many kinds of factors. Here we describe 4 cases of allergic rhinitis successfully treated with tokishakuyakusan. Case 1 was a 31-year-old woman who suffered from coldness and irregular menstruation. We administered tokishakuyakusan, and her allergic rhinitis improved. When she stopped taking tokishakuyakusan, her allergic rhinitis recurred. Case 2 was a 40-year-old woman who suffered from seasonal pollenosis every year. Her pollenosis did not respond to keishibukuryogankayokuinin, administered for uterine myoma, but when we switched to tokishakuyakusan, her pollenosis improved. Case 3 was a 49-year-old woman who suffered from allergic rhinitis. She had not responded to many herbal medicines, but when we administered tokishakuyakusan, her allergic rhinitis rapidly improved. Case 4 was a 65-year-old woman who suffered from allergic rhinitis. She did not respond to kakkontokasenkyushin'i, but when tokishakuyakusan was added, her allergic rhinitis improved. Efficacy of tokishakuyakusan for rhinitis is not described in the classic literature. Our results suggest that tokishakuyakusan could be a suitable herbal medicine for asthenic, cold constitution of patients with allergic rhinitis caused by blood stagnation and blood deficiency as well as water disturbance.

<b>A Case of Palpebral Hemispasm Successfully Treated with </b><b>Orengedokuto</b> / 日本東洋医学雑誌

<p>We present a 35-year-old male with palpebral hemispasm, which often occurred while at work. Because there were no ophthalmological findings, he consulted our clinic to receive Kampo therapy. He easily became fatigued and he had subchondral resistance and discomfort (kyo-kyo-kuman), so we treated him with saikokeishito and shakuyakukanzoto. However, they were ineffective, and therefore we reconsidered his symptoms.<br>Although he complained of fatigue, he was well built and had been a heavy drinker until a few years before presenting. Furthermore, he easily blushed and sweated in the upper body during the daytime, and his palpebral hemispasm often occurred during this blushing and sweating, and was accompanied by headache. We considered that this represented an excess-heat pattern rather than a deficiency pattern, and prescribed orengedokuto. His symptoms improved, and disappeared after six months.<br>There has been no detailed report of orengedokuto for the treatment of palpebral hemispasm. Orengedokuto may be useful for palpebral hemispasm in the context of symptoms of excess-heat pattern, such as blushing, sweating in the upper body and headache.</p>

<b>Assessment of Types of Menstrual Migraine Treated with Periodical Application of Goreisan in Combination with G</b><b>oshuyuto</b> / 日本東洋医学雑誌

<p><b>Background </b>: Menstrual migraine is more resistant to treatment than that of nonmenstrual episodes. Hormonal progesterone changes may cause <i>sui </i>(water/fluid) disturbance, in Kampo medicine terms. We therefore treated patients with menstrual migraine in which goshuyuto was ineffective, with the combination of goreisan and goshuyuto.<br><b>Subjects & Methods </b>: Subjects were 37 female patients with coldness (mean age 37 years, age range 23-48 years), whose migraine during their intra-menstrual periods was successfully treated with goshuyuto for 3 months. In order to treat migraine in the menstrual period, goreisan was added to goshuyuto from 1 week before onset, until the end of their menstrual period. <b>Results </b>: Among 37 patients, the treatment was effective in 26 patients (70%). Significant variables were found to be dull headache (p = 0.003), edema (p = 0.006), vertigo (p = 0.014) and oliguria (p = 0.014) during attacks, as well as worsening before rain (p = 0.004). <b>Conclusion </b>: The periodical combination of goreisan and goshuyuto seems to be effective in patients with menstrual migraine who report symptoms of <i>sui </i>disturbance, such as dull headache and oliguria during their attacks.</p>

<b>Two Cases of Stress-induced Chronic Cough Successfully Treated with H</b><b>achimijiogan</b> / 日本東洋医学雑誌

<p>In Kampo, respiratory symptoms are treated with prescriptions related not only to “lung”, but also other parenchymatous viscera. We report 2 patients whose stress-induced chronic cough was ameliorated by <i>hachimijiogan</i>. Case 1 was a 25-year-old female who was working under stressful circumstances at her company and reported an oppressive feeling in the chest. She was initially prescribed <i>hangekobokuto </i>because of a feeling that something was stuck in the pit of her stomach on abdominal examination, but her cough did not get better. As she also noted a dull feeling in her back ; she was switched to <i>hachimigan</i>, and her cough disappeared. Case 2 was 42-year-old female who suffered from depression, sore throat and an obstructive feeling in the throat ; she had been receiving infertility treatment for several years. <i>Hangekobokuto </i>and <i>bakumondoto </i>showed insufficient effect on her persistent cough. Her coughing stopped when she was prescribed <i>hachimigan </i>for back pain. Neither of these patients showed lack of resistance of the lower abdomen on abdominal examination.<br>Chronic <i>ki </i>(qi) stagnation under stressful conditions may cause <i>ki </i>deficiency, especially kidney deficiency. The symptom of stress-induced cough in our cases was considered to be due to kidney deficiency, and therefore <i>hachimijiogan</i>, but not <i>hangekobokuto</i>, was effective. The short duration of the complaints and relatively young age (20-40's) of the patients may account for the absence of the typical abdominal sign of kidney deficiency. Back stiffness and pain may also be important signs for cough due to kidney deficiency.</p>

<b>Two Cases Successfully Treated with T</b><b>okishigyakukagoshuyushokyoto</b> / 日本東洋医学雑誌

<p>We present two cases of aged males with cold-induced colic successfully treated with tokishigyakukagoshuyushokyoto. The first case is a 74-year-old male with bilateral sciatic neuralgia, who had a history of right leg amputation following a traffic accident. The second case is an 80-year-old male with chills of the lower body, who has undergone excision of biliary duct cancer. Their physical status appeared normal to excessive by traditional medical examination, whereas the pulse and abdominal patterns are usually deficient in female cases in whom tokishigyakukagoshuyushokyoto is effective. The common features in our cases are age and history of trauma by injury or surgery. Although males are more tolerant of cold than females, advancing age and history of injury or surgery tend to cause cold-induced colic in males. The number of male cases that can be effectively treated with tokishigyakukagoshuyushokyoto is likely to increase in our aging society, and we conclude that it is important to consider the presence of cold when we examine male cases.</p>

<b>A Case of Cutaneus Pruritus Successfully Treated with Tokito</b> / 日本東洋医学雑誌

<p>Tokito is used to treat patients with an asthenic, cold constitution, who have symptoms of chronic pleuritic pain, epigastralgia, and backache. There is no previous report on treatment of pruritus cutaneus with tokito. However, here we report a case of combined cutaneus pruritus and coldness, successfully treated with tokito. Our patient was a 38-year-old female, who reported having had facial pruritus cutaneus for one year. She attended our clinic in May of the year, because she had taken a turn for the worse. She was sensitive to cold, had poor circulation, felt cold in the abdomen, and reported that sleeping was difficult due to a cold back. We prescribed tokito (5.0 g/day). Her symptoms improved within six days. However, her symptoms, especially cold abdomen and cold back, returned when she drank cold water or stopped taking tokito. She was quite informative in that she prepared detailed records of her symptoms on visiting our clinic.<br>Tokito contains herbal medicines common to daikenchuto and tokikenchuto and hangekobokuto. Therefore, tokito could be a suitable herbal medicine for patients with pruritus cutaneus caused by coldness and <i>qi </i>stagnation and spleen deficiency.</p>

<b>Necessity of Precautions Against Expired and Broken Press Tack Needle</b> / 日本東洋医学雑誌

In Japan, controlled devices for medical professionals have been often purchased by people other than acupuncturists or doctors, using the Internet sales system. Press Tack Needle (PYONEX^®) allows easy handling by combining a plastic part with an adhesive tape. Since it has been reported to be relatively safe with limited adverse events such as adhesive-related dermatitis or similarly mild disorders, it is widely used. We report a case that when the patient removed a PYONEX^® which applied by himself, the needle tip was broken and remained in his body. It might lead to an accident such as injury due to a broken needle left in the body. The patient had purchased the PYONEX^® on his own judgments, storing it for a long period of time, applied it to his body 10 months after its expiration date and kept it attached for approximately 3 weeks. Plastics are characterized by deterioration and can be damaged by environmental factors including ultraviolet rays, water, and shocks. In this paper as an urgent issue, we note that when using these products, in addition to paying attention to their expiration dates, precautions should be considered since deterioration may also progress due to prolonged attachment.

<b>The Efforts of Acupuncturists to Promote Multidisciplinary Cooperation at our Institute</b> / 日本東洋医学雑誌

This study reports the efforts of acupuncturists to promote multidisciplinary cooperation in our laboratory. We conducted a questionnaire survey involving all employees of our laboratory in December 2013 to investigate problems regarding multidisciplinary cooperation, and identified a lack of information and problems concerning treatment plans and costs. After implementing measures to tackle these problems between January and November 2014, we conducted the questionnaire survey again. As the results, 79% of the employees responded that they had gained more information about acupuncture compared to the previous year, and 72% of them responded that treatment plans and costs were appropriate. Compared to the number of new patients who sought acupuncture treatment between January and November 2013 (n = 273), there was an increase of 40% in the same period of 2014 (n = 385). These results showed that employees' understanding of acupuncture and multidisciplinary cooperation were promoted.

<b>Three Cases of Calf Cramps with Internal Coldness Caused by Kidney Deficiency Presenting with Gastrointestinal Dysfunction Successfully Treated with Shimbuto</b> / 日本東洋医学雑誌

We describe three cases of calf cramps successfully treated with shimbuto. Case 1 was a 74-year-old female who suffered from calf cramps and knee pain caused by gonarthrosis. She was treated with boiohito, but did not respond. When she complained of diarrhea, shimbuto was substituted for boiohito. After taking shimbuto, her knee pain improved, and her cramps disappeared. Case 2 was a 77-year-old female who suffered from leg edema and calf cramps. Tokishakuyakusan was prescribed, but she complained of an upset stomach. Tokishakuyakusan was replaced with shimbuto, and her cramps improved together with a decrease in the coldness and edema in her legs. Case 3 was a 79-year-old female who took kososan for uneasiness and restlessness after the death of her husband. She had edema and coldness in her legs, and suffered from calf cramps during the daytime and early in the morning. Shimbuto was added to kososan, and her coldness improved ; subsequently the leg edema diminished, and finally her cramps disappeared.<br>These cases suggest that shimbuto is indicated for patients with calf cramps, who report internal coldness caused by kidney deficiency with gastrointestinal dysfunction.

<b>The Effectiveness of Shimotsuto Extract for Patients with Muscle C</b><b>ramp</b> / 日本東洋医学雑誌

The effectiveness of the Kampo medicine shakuyakukanzoto extract for patients with muscle cramp is well known, but recently side effects related to pseudoaldosteronism have also been reported. To avoid this issue, Kampo medicines without <i>Glycyrrhizae Radix </i>are needed for treatment of muscle cramp. We investigated the therapeutic effect of shimotsuto extract, which has traditionally been used to treat anemia, in 26 patients (mean age : 70.7 ± 12.1 years) with muscle cramp. Improvement of the symptom was noted in 18 patients (69%), with no change in 8 patients (31%). The abdominal muscle tension of the former patients was significantly lower than the latter. Here, the cases of four representative patients in whom muscle cramp was improved by shimotsuto are described. The response rate to shimotsuto was similar to that of shakuyakukanzoto. Our results suggest that shimotsuto extract is a suitable alternative to shakuyakukanzoto for treatment of muscle cramp in older non-robust type patients not in need of emergency care.

<b>Seven Cases of Insomnia Successfully Treated with H</b><b>ochuekkito</b> / 日本東洋医学雑誌

We present seven cases of insomnia successfully treated with hochuekkito. Two patients showed improvement of their insomnia after taking hochuekkito before going to bed, and three patients showed improvement after taking hochuekkito twice per day. The other two patients could sleep better after adding hochuekkito to other Kampo formulations. All these patients were light sleepers, and became easily tired, excessive sleepy after meals, and had daytime sleepiness. However, they had no gastrointestinal symptoms, such as appetite loss. Five of the seven patients reported waking up feeling better after taking hochuekkito. Two other Kampo formulations, sansoninto and kihito, were also given to patients with deficient constitution, who complained of insomnia. Sansoninto and kihito are formulae that compensate for qui and blood deficiency. Kihito contains more herbs with beneficial effects on “spleen and stomach”, and “heart” functions more than sansoninto, and therefore, kihito may be preferred for patients with a more deficient constitution. The reason why our patients were able to sleep more deeply and wake up smoothly with hochuekkito may be that they exhibited remarkable qui deficiency, showing general fatigue, excessive sleepiness after meals, and daytime sleepiness, but without the symptoms of blood deficiency, such as palpitations or uneasiness, being easily frightened or forgetful, or showing anemia or bleeding.