A Case of Unexplained Long-Term Thumb Onycholysis Successfully Treated with Shimotsuto / 日本東洋医学雑誌

This report outlines the case of a 51-year-old female patient who had suffered from onycholysis of the thumbs for eight years. The patient complained of experiencing pain when she works in contact with water, affecting her quality of life. Before coming to our clinic, the patient was diagnosed and treated at three dermatology clinics. However, treatment proved ineffective and the cause was not elucidated. As the patient experienced symptoms of onycholysis and dry skin, we diagnosed her with ketsu deficiency and treated her with shimotsuto. The symptoms gradually improved with continuous oral administration, and were no longer present at eight months following the start of treatment. This case suggests that shimotsuto may be effective in treating instances of onycholysis where the cause is unknown.

The Factors Associated with Chill Syndrome Using Terasawa's ki, ketsu and sui (qi, blood and fluid) Diagnostic Score / 日本東洋医学雑誌

To determine the physical symptoms and ki, ketsu and sui (qi, blood and fluid) factors associated with the presence of hie-sho (chill syndrome). Total 118 healthy university students (66 males and 52 females, median age 22 years, range 21­-29) were enrolled. A cross-­sectional study about the presence of chill syndrome in par­ticipants was performed. Terasawa's ki, ketsu and sui diagnostic score was used to identify the presence of physical symptoms. Number rating scale (NRS) was used to classify the chill and NRS more than 5 was de­fined as chill syndrome based on Furuya's report. Eighteen students (4 males and 14 females) were docu­mented as chill syndrome. The multivariate analysis of physical symptoms identified female (OR 4.65, p = 0.0427), heavy sensation of head (OR 2.98, p = 0.0190) and chill of extremities (OR 1.94, p = 0.0480) as sig­nificantly associated factors with chill syndrome. The score of ki-kyo (qi deficiency), ketsu-kyo (blood defi­ciency) and suitai (fluid retention) showed higher score in students with chill syndrome compared to students without chill syndrome in univariate analysis. Being female and two indicators of qi abnormalities including heavy sensation of head and chill of extremities were associated with the presence of chill syndrome in univer­sity students.

Relationship Between Neurological Degenerative Disorders and a Blood Deficiency Using ki-ketsu-sui Score / 日本東洋医学雑誌

We evaluated body constituents patterns of 74 consecutive patients with neurological degenerative disorders. They comprise Parkinson's disease (n = 38), amyotrophic lateral sclerosis (n = 19), and multiple system atro­phy (n = 17). We compared body constituents patterns between them and 149 consecutive patients with other neurological diseases of the same age. We used ki-ketsu-sui scores to evaluate body constituents patterns in all cases. Ki-ketsu-sui scores measure six factors : qi deficiency (kikyo), qi stagnation (kiutsu), qi counterflow (kigyaku), blood deficiency (kekkyo), blood stasis (oketsu), and fluid retention (suitai). As a result of multi­variate analysis, neurological degenerative disorders had large weight of blood deficiency, fluid retention and qi stagnation. Their adjusted odds ratios (95% confidence interval) were 3.02 (1.43-­6.48), 2.37 (1.13-­5.11), 2.33 (1.01-­5.44), respectively. Most relevant factor to neurological degenerative disorders was a blood defi­ciency. Taking into consideration a prescription of “shimotsuto rui” may contribute to alleviate patient's suf­fering. In addition to subjective symptoms, we need an oriental medicine scale such as pulse, tongue, and ab­dominal examinations to judge a therapeutic effect of Kampo medicine.

Characterization of the Body Constituent Patterns for Symptomatic Acute Cerebral Infarction Using qi-ketsu-sui Score / 日本東洋医学雑誌

We evaluated body constituent patterns of 130 consecutive patients with symptomatic acute cerebral infarction. They comprise lacunar infarction (n = 47), atherothrombotic infarction (n = 70), cardiogenic embolism (n = 11), and other type of infarction (n = 2). We compared body constituent patterns between them and 93 consecutive patients with other neurological diseases of the same age. We used qi-ketsu-sui scores to evaluate body constituent patterns in all cases. Qi-ketsu-sui scores measure six factors : qi deficiency (kikyo), qi stagnation (kiutsu), qi counterflow (kigyaku), blood deficiency (kekkyo), blood stasis (oketsu), and fluid retention (suitai). As a result of multivariate model analysis, symptomatic acute cerebral infarction had the largest weight of blood stasis and an adjusted odds ratio (95% confidence interval) was 4.6 (2.45-8.91). Even when gender as a confounding factor was adjusted by stratified analysis, adjusted odds ratios of blood stasis (95% confidence interval) were 7.46 (3.02-20.25) for males and 2.63 (1.02-7.11) for females, and those were maximum. The point (median, interquartile range) of blood stasis was more severe in acute cerebral infarction (24 points, 18-33 points) than other neurological diseases (16 points, 9-23 points). We examined relationships between body constituent patterns and clinical disease type, severity at hospitalization, and sex in patients with symptomatic acute cerebral infarction. Ratio of blood stasis was the largest in any clinical disease type, severity and sex. Blood stasis seemed to be the most important factor in symptomatic acute cerebral infarction.

Two Cases of Sleep Disorder with Developmental Disorders Successfully Treated with Kampo Medicines / 日本東洋医学雑誌

We report two cases effectively treated with Kampo medicines for comorbid sleep disorder in developmental disorder. Case 1 was a 15-year-old woman diagnosed Asperger's syndrome, and her main complaints were difficulty in rising, difficulty in falling asleep and fatigability. We thought that the symptoms might be caused by in and ketsu deficiency, which lost control of kanki hyperactivity and evoked tension/excitement state easily. The difficulty in rising was improved with yokukansan and kambakutaisoto and she was able to go to school every day. Case 2 was a 17-year-old man diagnosed the attention-deficit/hyperactivity disorder. His symptoms were difficulty in rising, feeling of weariness, fatigability, and frequent tension/excitement state. The previous use of shokenchuto had improved the symptoms slightly. After shigyakusan was added to cure kanki dysregulation, he succeeded in going to school every day. In the oriental medicine, ketsu has important roles in mental stability and sleep, whereas qi and ketsu tend to be insufficient in childhood. Our results suggest that replacement of in and ketsu would be useful in treating comorbidities in developmental disorder.

The Notion of Qi and Disease States-An Outline Drawn Mainly from Modern Medical Texts- / 日本東洋医学雑誌

We re-examined <I>Qi</I>, a concept unique to oriental medicine, mainly from late century Chinese medical texts. <I>Qi</I> forms the basis of everything, and the phenomena of life arises from <I>Qi</I>. The integrated / holistic views characteristic of oriental medicine have their basis in this concept of <I>Qi</I>. Biological function is called <I>Qi</I>, and that which gives the body form, <I>Ketsu</I> (<I>Xue</I>). <I>Ketsu</I> is said to be sustenance, formed by <I>Qi</I>, and thus <I>Ketsu</I> and <I>Qi</I> can be regarded as two sides of the same coin. Through the concepts of <I>Qi</I> and <I>Ketsu</I>, is born an awareness that a whole body grasp of malady, the importance of synergistic relationships between organs as well as function and (bodily) substance cannot be separated. <I>Qi</I> is formed from the digestive tract and lungs (acquired <I>Qi</I>), and that which one is born with (innate <I>Qi</I>). It is theorized that “the heart” is expressed by <I>Qi</I>, and through the concept of <I>Qi</I> comes the association, and integration of “the heart” and body. <I>Qi</I> disorders can be classified into (1) those in which <I>Qi</I> function is lowered (<I>Qi</I> deficiency and Yang deficiency), or (2) those in which <I>Qi</I> circulation is impaired (<I>Qi</I> stagnation / <I>Qi</I> regurgitation). These conditions together, bring an overall feeling of fatigue and weakened physical condition. <I>Qi</I> is both a practical and useful view of physiological disease unique to oriental medicine.

The Notion of Qi and Disease States / 日本東洋医学雑誌

We re-examined <i>Qi</i>, a concept unique to oriental medicine, mainly from late century Chinese medical texts. <i>Qi</i> forms the basis of everything, and the phenomena of life arises from <i>Qi</i>. The integrated / holistic views characteristic of oriental medicine have their basis in this concept of <i>Qi</i>. Biological function is called <i>Qi</i>, and that which gives the body form, <i>Ketsu</i> (<i>Xue</i>). <i>Ketsu</i> is said to be sustenance, formed by <i>Qi</i>, and thus <i>Ketsu</i> and <i>Qi</i> can be regarded as two sides of the same coin. Through the concepts of <i>Qi</i> and <i>Ketsu</i>, is born an awareness that a whole body grasp of malady, the importance of synergistic relationships between organs as well as function and (bodily) substance cannot be separated. <i>Qi</i> is formed from the digestive tract and lungs (acquired <i>Qi</i>), and that which one is born with (innate <i>Qi</i>). It is theorized that “the heart” is expressed by <i>Qi</i>, and through the concept of <i>Qi</i> comes the association, and integration of “the heart” and body. <i>Qi</i> disorders can be classified into (1) those in which <i>Qi</i> function is lowered (<i>Qi</i> deficiency and Yang deficiency), or (2) those in which <i>Qi</i> circulation is impaired (<i>Qi</i> stagnation / <i>Qi</i> regurgitation). These conditions together, bring an overall feeling of fatigue and weakened physical condition. <i>Qi</i> is both a practical and useful view of physiological disease unique to oriental medicine.

Systemic Kampo Treatment for Dermatologic Diseases / 日本東洋医学雑誌

In Kampo medicine, chronic dermatitis is considered to be associated with unstable interaction among Ki, Ketsu and Sui. Urticaria is resistant to standard treatments in modern western medicine, so we applied a Kampo approach to improve imbalance among Ki, Ketsu and Sui. In this paper, we report three cases of chronic urticaria treated with Kampo medicines, i.e., main prescriptions with goshakusan for urticaria with anemia, keishikaryukotsuboreito for urticaria with stress, and bukuryoshigyakuto for cold urticaria with stress. We examined changes in palmoplantar sweating in response to the treatments to evaluate improvement in the circulation of Ki.The importance of Ki, Ketsu and Sui in chronic diseases was emphasized by Nangai Yoshimasu and Gonzan Goto as early as the Edo period. Urticaria is regarded as being due to disturbances of Ketsu and Sui that are often caused by systemic Ki disorders. Therefore, we consider that it is important to improve Ki stagnation in “spleen”, “lung” and “kidney” in the treatment of urticaria.

Analysis of Coldness of the Limbs by Measuring Surface Body Temperature Using an Infrared Thermometer / 日本東洋医学雑誌

Purpose : Cold sensation of the limbs is a common complaint for which patients seek treatment with Kampo medicine. However, some patients complain of coldness of the limbs despite maintaining normal skin temperature. We studied this condition and its association with ki (energy), ketsu (blood), and sui (body fluids) by measuring surface body temperatures.Methods : Using an infrared thermometer, we measured the surface body temperature of 98 female patients during their first examinations at our clinic. We classified the patients according to the season of their examination and the presence of the abnormalities of ki, ketsu, and sui ; subsequently, we statistically analyzed these findings.Results : No statistical difference was observed in the surface body temperature of the patients with complaints of coldness (Pw/C), and those without such complaints (Pw/oC). However, under particular conditions, the surface body temperature of Pw/C was observed to be higher than that of Pw/oC. In the presence of “ki deficiency” and “sui accumulation,” the surface body temperatures were lower than in the absence of the ki and sui abnormalities, respectively. In contrast, the surface body temperature was higher in patients with the “oketsu (blood stasis) syndrome” than in those without the “oketsu syndrome”.Discussion : Although the dissociation between the subjective cold sensation and actual skin temperature is present only in limited conditions, the presence of this dissociation indicates that factors other than the surface body temperature such as the abnormalities of ki, ketsu, and sui may also determine cold sensation.Conclusion : It is important to treat Pw/C by taking into account their state of coldness and the abnormalities of ki, ketsu, and sui. Measuring surface body temperature using an infrared thermometer appears to be an effective method for analyzing cold sensation of the limbs.

Two Cases of Subchorionic Hematoma Successfully Treated with Tokishakuyakusan / 日本東洋医学雑誌

I report two cases of subchorionic hematoma successfully treated with Tokishakuyakusan. They had genital bleeding due to subchorionic hematoma in the second trimester of pregnancy. I prescribed Tokishakuyakusan, and their genital bleeding improved within a week after the administration. The hematoma disappeared in less than two weeks after the administration, and they delivered infants of 2470g and 3324g respectively at 39 weeks pregnant by vaginal delivery. I found Ketsu stagnation, Sui disturbance and coldness of extremities in two cases. Although several studies suggested that the presence of subchorionic hematoma might be associated with adverse pregnancy outcome, there is no effective treatment for subchorionic hematoma in western medicine. The present cases suggest that Tokishakuyakusan may be useful in the treatment of subchorionic hematoma.

For Universal Understanding of Kampo Medicine in which Context is a Keyword / 日本東洋医学雑誌

In order to have a more “universal understanding” of Kampo medicine, it helps to explain the “fundamental concepts” and the “theoretical framework” of Kampo medicine, in latest life science knowledge with a key word “context.”Ki, Ketsu and Sui are the three elements which compose the cellular environment (context), and shoulder the maintenance of life's activities, which are dependent on metabolic changes and information flow. The function and structure of the living body are normally led by Ki, Ketsu and Sui.The five parenchymatous viscera (lungs, heart, liver, spleen, kidneys) are not only organs which maintain the cellular environment, they also act as higher control systems which control organ activities. These five viscera as higher control systems create conditions (context) throughout the body and control the life activities of each organ in an integrated manner.In a sick person, these organ life activities take on a kind of “fighting style” which can change from moment to moment, with natural disease progression and/or treatment intervention. The classic text Shokanron describes these changes in fighting style as the “six stages of disease”, and indicates formulation choices based on variations in the body's fighting style.From the viewpoint of a connection with Western medicine and a dialog with traditional Chinese medicine, explaining Kampo medicine in ways which anyone can understand by creating a universal understanding of its fundamental concepts and theoretical framework, is our mission for the 21st Century.

The Lecture for the Diagnosis of Kampo Medicine : Boshin ( ?? ), Especially for the Diagnosis of the Tongue / 日本東洋医学雑誌

Physical examination in Kampo medicine are Inspection, Listening, Interview, Palpitation, and examining it make the core of “Inspection” the diagnosis of tongue. A character of “Inspection” is hieroglyphic formation of the state that even a tiptoe watches the distance of a person. In other Words, not a viewpoint of “analysis”, you must perform it for an idea to “grasp the whole” to the last. Medical examination and treatment begins at the moment when a patient entered a consulting room, and it is it with a key whether, with that in mind, “grasping the whole” is possible. Laennec (1781-1826) created a stethoscope states that “all the medicine begins with observation”, but a meaning to have of “Inspection” is deep. Examining it divide it into “Shin, color, form and state” and observe it, but this “Shin” is “energy” and gathers up a whole body state of a patient generally, and a tongue is important when I guess convalescence of illness an importance. It is thought that a tongue reflects development of a condition, Yin and Yang/Kyo and Jitsu of the condition of a patient, balance of Qi, Ketsu and Sui, but there is not such a change for views, and even a physically unimpaired person can watch a native change though there is serious illness in one. In other words it is a premise to watch quality of tongue and a change of fur as a partial phenomenon and an accompanying symptom of the condition of a patient generally without being seized with only views of a part.

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.