Three Cases Demonstrating the Effectiveness of Boiogito Treatment Against Rapid Weight Gain and Edema: Women Suffering from Irregular Menstruation Without Obesity / 日本東洋医学雑誌

We encountered three patients with edema and menstrual disorder that was improved by boiogito. Case 1 was a 17-year-old woman with fatiguability and irritability, treated with kamishoyosan. After adding boiogito to kamishoyosan because of facial and foot edema, palmar sweating and weight gain, her menstrual period became regular. Case 2 was a 15-year-old woman with headache as well as facial and foot edema, who was receiving goreisan. She complained of knee discomfort and worried about weight gain even though she was thin. So we prescribed her boiogito, and her menstrual disorder improved. Case 3 was a 42-year-old woman with fluid retention, who suffered from general fatigue, coldness, and menstrual disorder. She was prescribed boiogito because of weight gain as well as foot edema and coldness, and her menstrual cycle gradually became regular. Boiogito appears to be effective in patients with menstrual disorder who show “exterior deficiency edema” that is maldistribution of fluid on the body surface, such as water retention, sweating, or edema. Boiogito resulted in a feeling of lightness. Even if water retention is not clearly observed, the symptoms of rapid weight gain, edema or edematous feeling, and subjective coldness may be indications for boiogito.

Clinical trial of Guige Shujing Decoction combined with acupuncture in the treatment of cervical spondylotic radiculopathy with coldness-blood stasis obstructing meridians / 国际中医中药杂志

Objective:To explore the clinical effect of Guige Shujing Decoction combined with acupuncture in the treatment of cervical spondylotic radiculopathy with coldness-blood stasis obstructing meridians.Methods:A total of 86 patients with coldness-blood stasis obstructing meridians of cervical spondylotic radiculopathy, who met the inclusion criteria from May 2019 to May 2021, were divided into two groups, with 43 cases in each group, according to the random number table method. The control group was treated with routine basic treatment and acupuncture, and the observation group was treated with routine basic treatment, acupuncture and Guige Shujing Decoction. Both groups were treated for 4 weeks and followed up for 6 months. The scores of TCM syndromes were performed before and after treatment, Clinical Assessment Scale for Cervical Spondylosis (CASCS) was used to evaluate cervical spine function, Visual Analogue Score (VAS) was used to evaluate the degree of pain, Neck Disability Index (NDI) was used to evaluate cervical spine function, and ELISA was used to detect levels of hypersensitive C-reactive protein (hs-CRP), interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α). The adverse reactions were observed during treatment and the recurrence rate was recorded during follow-up.Results:The total effective rate of the observation group was 95.35% (41/43), and that of the control group was 81.40% (35/43), the difference between the two groups was statistically significant ( χ2=4.07, P=0.043). After treatment, the scores and total scores of shoulder and neck pain, upper limb numbness, neck stiffness, head tenderness and heaviness in the observation group were significantly lower than those in the control group ( t values were 10.66, 12.89, 9.12, 12.27 and 8.75, respectively, P<0.001). After treatment, the CASCS score in the observation group was significantly higher than that of the control group ( t=2.64, P=0.010). After treatment, the VAS and NDI scores in the observation group were significantly lower than those in the control group ( t values were 5.62 and 7.00, respectively, P<0.001). After treatment, the levels of serum hs-CRP, IL-1β and TNF-α in the observation group were significantly lower than those in the control group ( t values were 6.65, 7.52 and 5.08, respectively, P<0.001). There was no significant difference in the incidence of adverse reactions between the two groups during treatment ( χ2=0.73, P=0.393). After 6 months of follow-up, the recurrence rate in the observation group was 2.44% (1/41) and that in the control group was 17.14% (6/35). There was a statistically significant difference in the recurrence rate between the two groups ( χ2=3.89, P=0.048). Conclusion:The Guige Shujing Decoction combined with acupuncture therapy can inhibit the neurogenic inflammatory reaction of patients with coldness-blood stasis obstructing meridians of cervical spondylotic radiculopathy, reduce pain, improve cervical spine function, reduce recurrence rate and improve curative effect.

Two Cases of Abdominal Distension Successfully Treated with Tokishigyakukagoshuyushokyoto / 日本東洋医学雑誌

Abdominal distension is one of the common symptoms and can cause abdominal pain and anorexia, which may raise adverse effect on general well-being and quality of life. In Western medicine, there are specialized treatments for structural lesions associated with abdominal distension, but functional abdominal distension is often difficult to treat. There have been some reports of Kampo medicine for treatment of abdominal distension, but no case reports on tokishigyakukagoshuyushokyoto. We experienced two cases of abdominal distension successfully treated with tokishigyakukagoshuyushokyoto. Case 1 was 86-year-old woman who developed abdominal distension with frequent belching. Case 2 was 59-year-old man who developed abdominal distension associated with opioid. Regulating qi medicine was not effective for abdominal distension in both cases. Both cases had reversal coldness of the extremities, tympanic sounds of abdomen, coldness of abdomen, and inguinal tenderness and resistance. Therefore, we diagnosed them as tokishigyakukagoshuyushokyoto sho. After administration of tokishigyakukagoshuyushokyoto, in Case 1, the frequency of belching decreased and the appetite increased with the improvement of abdominal distension. In Case 2, increasing the dose of goshuyu in tokishigyakukagoshuyushokyoto relieved abdominal distension. Tokishigyakukagoshuyushokyoto can be effective for abdominal distension with interior cold pattern.

Experience in Kanzobushito for Rheumatoid Arthritis and Headache with Hypersensitivity / 日本東洋医学雑誌

We report a case of a patient with rheumatoid arthritis who refused Western medical treatment and was able to improve concomitant symptoms including arthralgia and headache by using kanzobushito. The patient was a 35-year-old. Eight years previously, she was diagnosed with rheumatoid arthritis due to joint stiffness. Although receiving methotrexate therapy, she developed methotrexate-associated lymphoproliferative disorders and the treatment was discontinued. Due to a feeling of rejection for Western medical treatment, she visited our hospital and was hospitalized for Kampo therapy. We prescribed kanzobushito for qi imbalance, coldness, and severe pain. Her joint pain, headache, and secondary symptoms were improved.

Forty-Five Cases of Chronic Testicular Pain and Groin Pain Treated with Kampo Medicine / 日本東洋医学雑誌

We examined Kampo treatment given to 45 patients with chronic testicular pain and groin pain. Thirty-three of 45 cases were healed with anti-percussive agents including keishibukuryogan, tokishakuyakusan. In addition to testicular pain, when the pain and numbness in the femoral lesion appeared, hachimijiogan and goshajinkigan were effective. If coldness in the lower body is an aggravating factor, tokishakuyakusan is considered appropriate as the first choice. We should notice the sign of qi-blood-fluid, especially, static blood, to select medicine for chronic testicular pain and groin pain.

Use of Hachimijiogan in Treatment for Cold/Pain Allows Gradual Dose Reduction of Antihypertensives / 日本東洋医学雑誌

The indications of hachimijiogan formulation include lower limb pain, low back pain, edema, fatigue, coldness, and accompanying symptoms of hypertension. In this study, hachimijiogan was administered to patients who complained of symptoms of coldness, pain, etc., and the subsequent blood pressure was observed. Changes in hachimijiogan, a powder pill formulation of crude drugs, were observed in 12 patients aged 45 years or older, with an average age of 71 years. Various symptoms of jinkyo, blood pressure, and laboratory findings were examined. Coldness and pain improved significantly after 3 months. Of the 9 patients who wanted to take hachimijiogan for more than 9 months, 8 were treated with antihypertensive drugs. Among them, 4 underwent an antihypertensive dose reduction by 9 months, and 3 received angiotensin receptor antagonists, and 1 received a Ca antagonist. The systolic pressure before treatment with hachimijiogan averaged 127 mmHg, and after 9 months it was stable at 128 mmHg despite drug dose reduction. In patients with antihypertensive drugs, the long-term use of hachimijiogan may facilitate dose reduction and protection of the vascular endothelium protection. The usefulness of hachimijiogan in the aging society was suggested.

Effect of Kampo Medicine (Japanese Herbal Medicine) for Cold Stress Induced Lower Urinary Tract Symptoms / 日本東洋医学雑誌

We administered Kampo medicine to 40 patients whose lower urinary tract symptoms worsened in winter and examined the changes in their lower urinary tract symptoms and coldness symptoms. The effectiveness was evaluated by International Prostate Symptom Score (IPSS), Overactive Bladder Symptom score (OABSS),and the interview of coldness symptom. IPSS scores were significantly improved in 30 cases (75.0%), and OABSS scores were significantly improved in 26 cases (65.0%). The number of the night-time frequency of urination significantly decreased from 2.5 times to 2.0. The symptoms of coldness were improved in 21 of 29 cases (72.5%). Moreover, in the group of 21 cases whose coldness symptoms were improved total OABSS were significantly improved compared to the group of 8 cases with no change of coldness symptoms. Appropriate administration of Kampo medicine was considered to be one of the effective measures that could improve lower urinary tract symptoms due to cold stress as well as coldness symptoms.

Site-specific Study on Warming Using Disposable Warmer “Kairo” in Healthy Subjects / 日本温泉気候物理医学会雑誌

  [Purpose] Acral coldness is a condition in which the fingers and/or toes are cold despite normal central body temperature. Regardless of the presence or absence of disease, many people suffer from acral coldness, especially elderly people. One method of relieving acral coldness is to heat the hands with a disposable warmer called “Kairo,” but this method interferes with daily work. We investigated whether or not heating other upper-limb parts with a pair of warmers can relieve acral coldness.   [Methods] After obtaining informed consent, 30 people who usually had acral coldness without other diseases received the Kairo holders for their necks, elbows, and wrists. Eighteen participants used a pair of Kairo warmers for each area for one week, respectively. The remaining participants wore only the holder to know the heat retention effect of the holders. All participants separately evaluated their acral coldness of the upper limbs and the cumbersomeness of holders and/or Kairo by using a 10cm visual analog scale (VAS). To measure the therapeutic effect of the Kairo, the temperature and blood flow of the surface of both hands were examined by thermography and laser speckle contrast analysis (LASCA) at the day after finishing each warming period. These evaluations were conducted after a 20-minute adaptation at 24°C.  [Result] The VAS of acral coldness of upper limbs decreased during the periods of warming on the neck and elbows with Kairo compared to the period without Kairo. There was no difference in the VAS value of the cumbersomeness among the neck, elbows, and wrists areas. The hand temperature on the day after the end of warming decreased slightly after elbow warming.  [Conclusion] We found that the coldness of the hand was improved by warming other parts, even if the hand was not warmed, but the effect varied depending on the warming area. No therapeutic effect was detected, but this was considered to be a problem in setting the measurement conditions. We believe these results will lead to new ways to improve acral coldness.

Site-specific Study on Warming Using Disposable Warmer “Kairo” in Healthy Subjects / 日本温泉気候物理医学会雑誌

  [Purpose] Acral coldness is a condition in which the fingers and/or toes are cold despite normal central body temperature. Regardless of the presence or absence of disease, many people suffer from acral coldness, especially elderly people. One method of relieving acral coldness is to heat the hands with a disposable warmer called “Kairo,” but this method interferes with daily work. We investigated whether or not heating other upper-limb parts with a pair of warmers can relieve acral coldness.   [Methods] After obtaining informed consent, 30 people who usually had acral coldness without other diseases received the Kairo holders for their necks, elbows, and wrists. Eighteen participants used a pair of Kairo warmers for each area for one week, respectively. The remaining participants wore only the holder to know the heat retention effect of the holders. All participants separately evaluated their acral coldness of the upper limbs and the cumbersomeness of holders and/or Kairo by using a 10cm visual analog scale (VAS). To measure the therapeutic effect of the Kairo, the temperature and blood flow of the surface of both hands were examined by thermography and laser speckle contrast analysis (LASCA) at the day after finishing each warming period. These evaluations were conducted after a 20-minute adaptation at 24°C.  [Result] The VAS of acral coldness of upper limbs decreased during the periods of warming on the neck and elbows with Kairo compared to the period without Kairo. There was no difference in the VAS value of the cumbersomeness among the neck, elbows, and wrists areas. The hand temperature on the day after the end of warming decreased slightly after elbow warming.  [Conclusion] We found that the coldness of the hand was improved by warming other parts, even if the hand was not warmed, but the effect varied depending on the warming area. No therapeutic effect was detected, but this was considered to be a problem in setting the measurement conditions. We believe these results will lead to new ways to improve acral coldness.

Diseases and Findings of the Shigyakusan Effective Cases in Our Institution / 日本東洋医学雑誌

We retrospectively surveyed and analyzed medical records of 41 effective cases with shigyakusan including shigyakusan decoction and shigyakusan extract. In classics, fullness in chest and hypochondrium and rectus abdominis muscle stiffness along with coldness of the extremities is regarded as important clinical indication of shigyakusan. In this analysis, patients who present fullness in chest and hypochondrium are more than 90%, and patients presenting rectus abdominis muscle stiffness are more than 60%, confirming that these findings are important. On the other hand, although more than half of the patients feel excessive sensitivity to cold, only about 20% of the patients had coldness of the extremities as objective Kampo findings in their medical records. Until now, coldness of the extremities has been considered to be important because shigyaku means Japanese expression of it. But our obtained results show that shigyakusan is used for the patients who do not have cold extremities.

A Case of Lower Back with Extremity Pain Successfully Treated with Kanzobushito / 日本東洋医学雑誌

We report a case of lower back with extremities pain, whose cause could not be established in the medical sense nor relieved by analgesic drugs, was successfully treated with kanzobushito. The patient was a 69-­year-old male. Because of extremity pain of his lower left back, he could not move by himself and was transported to our hospital by an ambulance. Having persistent pain, he could not turn over or stretch his left leg and anal­gesic drugs and sacral nerve blocks were ineffective. We administered kanzobushito referring to the phrase “pain that gets worse as someone approaches” in the Shokanron. After administering kanzobushito, his pain was reduced remarkably and he could sit down on the bed. And his activities of daily living improved immedi­ately. Thus, kanzobushito may be useful for severe pain and should be administered to neuropathic pain compli­cated with psychogenic factors referring to coldness, severe pain and abnormality of qi (irritable).

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.

A Retrospective Study Assessing Kampo Medicine for the Treatment of Lower Extremity Symptoms Caused by Lumbar Spinal Diseases / 日本東洋医学雑誌

We assessed the efficacy of Kampo medicine for lower extremity symptoms caused by lumbar spinal diseases, such as lumbar spondylosis, spinal canal stenosis, and post-spinal surgery syndrome. In particular, we evaluated its usefulness for lower extremity pain, coldness, and numbness. In addition, the efficacy of antecedent drug selection and pain treatment was also assessed. In accordance with Japanese traditional herbal medical practice, keishikajutsubuto, shimbuto, ryokyojutsukanto, tokishigyakukagoshuyushokyoto, goshajinkigan, and shakuyakukanzoto were prescribed primarily for lower extremity symptoms caused by lumbar disease. Thirty-two of 60 (53%) cases with lower extremity pain, 17 of 34 (50%) cases of pain with coldness, and 4 of 19 cases (21%) of pain with numbness were improved by these drugs. We conclude that the addition of keishikajutsubuto, shimbuto, ryokyojutsukanto, tokishigyakukagoshuyushokyoto, goshajinkigan, and shakuyakukanzoto after antecedent pain therapy was effective in treating lower extremity symptoms caused by lumbar disease.

<b>The Effectiveness of Tokishigyakukagoshuyushokyoto in Lower Back Pain Patients with C</b><b>oldness</b> / 日本東洋医学雑誌

<p>Although “coldness” exaggerates chronic pain in the lower back and extremities in patients who experience it, there is no western-style medicine focusing on “coldness” Therefore, we investigated the efficacy and safety of a Kampo medicine that improves “coldness”. In the present study, we retrospectively reviewed medical chart records on the prescription of <i>tokishigyakukagoshuyushokyoto </i>7.5 g/day (dry weight) to patients who had subjective coldness in their lower extremities. We performed pre- to 1 month post <i>tokishigyakukagoshuyushokyoto </i>treatment comparisons with regard to Visual Analogue Scale (VAS), axillary temperature, dorsal foot temperatures, Ankle-Brachial pressure Index (ABI), Pulse Wave Velocity (PWV) and patient satisfaction. The records of 21 patients with lower back pain and “coldness” were evaluated. VAS, and both axillary and dorsal foot temperatures were significantly improved, and satisfaction score was increased. Subjective coldness was alleviated in 7 patients ; however, objective temperatures were increased in all patients. In summary, we noted that <i>tokishigyakukagoshuyushokyoto </i>increased axillary and the dorsal foot temperatures, and objectively contributed to pain relief as well as patient satisfaction.</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>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>On Clinical Findings and Indications for Ryokeigomikanzoto </b> / 日本東洋医学雑誌

Ryoukeigomikanzoto is a Kampo formulation originally described in the text <i>Kinkiyouryaku</i>. This formulation has also been described as an indication for respiratory disease in some texts, because it was classified under respiratory diseases in the <i>Kinkiyouryaku</i>.<br>The authors, however, considered that indications for ryoukeigomikanzoto could be wider than previously thought. The composition of this formulation is very similar that of ryokeimikanto and ryokeijutsukanto. And we have prescribed ryokeigomikanzoto for patients with a reddish face and coldness of the legs, whose chief complaints were a reddish nose, coldness of the leg, dysuria, spioncerebellar degeneration and ringing of the ears. Moreover, we have obtained good results from the current trial. This report is intended to elucidate indications for this formulation by means of past clinical results and our own experience.

<b>Indicators for Treatment of Coldness with Tokishakuyakusan and Kamishoyosan </b> / 日本東洋医学雑誌

<i><b>Objectives </b></i>: We evaluated the efficacy of tokishakuyakusan and kamishoyosan for patients who complained of feeling cold, and identified key symptoms that would predict positive treatment outcomes for coldness with these medicines.<br><i><b>Design </b></i>: A retrospective cohort study<br><i><b>Subjects and Methods </b></i>: The subjects were 188 patients who reported feeling cold. They were treated with tokishakuyakusan or kamishoyosan according to their <i>Sho </i>for more than one month. The relationships between improvement of cold sensation and 62 factors, including other symptoms noted at the first medical examination, were evaluated by means of cross-sectional analysis, followed by logistic regression.<br><i><b>Results </b></i>: The factors of coldness of the abdomen (odds ratio, 5.0), vertigo (7.7), dimness of sight (16) and blushing (5.6), without anger (0.11) or tinnitus (0.025), were found to be predictors of a positive effect with tokishakuyakusan treatment (p < 0.001). The factors of hot flushes (14), without coldness of the whole body (0.099), and faint feeling (0.21) were significant for kamishoyosan (p < 0.001). This suggests that kamishoyosan can improve subjective coldness of the extremities (AIC -8.64), especially of the legs (-2.23).<br><i><b>Conclusions </b></i>: Coldness in the abdomen was an important indicator for treatment with tokishakuyakusan, while coldness in the legs, but not in the whole body, was important in the case of kamishoyosan.

<b>Three Cases of Dizziness with Feelings of Coldness Effectively </b><b>Treated with Tokishigyakukagoshuyushokyoto </b> / 日本東洋医学雑誌

About half of Japanese women have feelings of coldness, but there is no drug for their treatment in modern medicine. Here, we report 3 cases of dizziness with feelings of coldness effectively treated with tokishigyakukagoshuyushokyoto. The first case was a 35-year-old female with benign paroxysmal positional vertigo,the second case was a 29-year-old female with dizziness of unknown cause, and the third case was an 80-year-old female with benign paroxysmal positional vertigo. All cases were physically thin and had feelings of coldness. On Kampo medical examination, their diagnosis was <i>Rikan-kyosho </i>and <i>Kekkyo</i>. To improve feelings of coldness, we administered tokishigyakukagoshuyushokyoto to all three cases, and it was very effective. Thus, being aware of patients' coldness and using tokoshigyakukagoshuyushokyoto may be advisable when doing Kampo examinations.

<b>2 Cases of Children Successfully Administered Kampo Formulae that Included Bushi or Uzu </b> / 日本東洋医学雑誌

We administered a Kampo decoction containing bushi (prepared aconiti tuber) or uzu (un-prepared aconiti tuber) to two children in Aso Iizuka hospital. Case 1 was a thirteen year-old girl with atopic dermatitis that worsened after her topical steroid was stopped. When her itching sensation was reduced following a bath, we considered that she was suffering from coldness. Therefore we administered a half dose of bukuryoshigyakuto.The next morning her old skin flaked off and her skin appeared healthy. We administered bukuryoshigyakuto before every meal and there was rapid improvement in her dermatitis. Case 2 was a twelve year-old girl with orthostatic dysregulation who was unable to attend school. She had become aware of coldness the previous autumn and had not been able to go to school, nor even sit up, since the previous winter because of severe fatigue. We diagnosed her with severe coldness and so started sekiganryo administration, and included 2 g of uzu. We gradually increased the uzu. At a result, her severe fatigue improved to the extent that she could eat breakfast and go to school inside the hospital. Children may have severe coldness if they suffer from a long-term illness. Moreover, particular attention should be given to toxicity caused by aconiti tuber.