Two Cases Orthostatic Dysregulation in which the Effectiveness of Ryokeijutsukanto was Confirmed by Multiple Clinical Indicators / 日本東洋医学雑誌

Ryokeijutsukanto is an herbal medicinal product that is often used for dizziness when standing up, that is, orthostatic dysregulation. This time, we encountered 2 patients with orthostatic dysregulation successfully treated with ryokeijutsukanto, and objectively evaluated the therapeutic effect of ryokeijutsukanto by using Visual Analog Scale (VAS), Vertigo Symptom Scale-short form (VSS-sf) Japanese version and Dizziness Handicap Inventory (DHI) Japanese version. Case 1 is a 17-year-old woman. Dizziness when standing up appeared from 2 month ago. Before treatment, VAS scored 71/100, VSS-sf scored 7 points, and DHI scored 42 points. After 4 weeks of administration of Ryokeijutsukanto, VAS improved to 22/100, VSS-sf improved to 6 points, and DHI improved to 26 points. Case 2 is a 38-year-old woman. Dizziness when standing up appeared from 3 month ago. Before treatment, VAS scored 48/100, VSS-sf scored 18 points, and DHI scored 32 points. After 4 weeks of administration of Ryokeijutsukanto, VAS improved to 9/100, VSS-sf improved to 3 points, and DHI improved to 20 points. In both cases, all the evaluation scales showed sharp improvement after 4 weeks, indicating that ryokeijutsukanto was certainly effective.

Two Cases with Foreign Body Sensation of the Throat Treated with Ryokeijutsukanto and Goshuyuto / 日本東洋医学雑誌

The patients with foreign body sensation in the throat often visit the hospital. However, they have no problem in Western medicine and may be prescribed with anxiolytics. In Kampo medicine, hangekobokuto is effective in most cases for the symptom of qi stagnation. This time, we report that 2 cases, in which hangekobokuto was ineffective, responded to the combination of ryokeijutsukanto and goshuyuto. The combination, which is a mixture of hontonto (Zhouhou fang), bukuryo, jutsu, and taiso, excluding hange, was effective in these 2 cases as running piglet.

Effectiveness of Combination Therapy with Goshuyuto and Ryokeijutsukanto for Post-Dural Puncture Headache after Epidural Anesthesia for Painless Delivery or Caesarean Section / 日本東洋医学雑誌

To treat the patient who developed post-dural puncture headache (PDPH) after the epidural anesthesia for painless delivery or spinal subarachnoid anesthesia for caesarean section, we provided a combination therapy with Kampo medicines goshuyuto and ryokeijutsukanto (39 patients), and a single therapy with goshuyuto (17 patients). We compared the patients based on the improvement rate and the average of the differences of Numerical Rating Scale (NRS) before and after taking Kampo medicines. Of 39 patients treated with combination therapy, 82.1% were effective in the improvement rate, and 74.4% were effective in NRS differences. Of 17 patients treated with goshuyuto alone, 58.8% was effective in the improvement rate, and 41.2% in NRS differences. In the improvement rate, it was insignificant (p=0.094). However, in the comparison of the average of the NRS differences, the combination therapy was significantly more effective than with from goshuyuto alone (p=0.032) (p<0.05). There was no significant difference depending on when the administration was started. It was suggested that a combination therapy with goshuyuto and ryokeijutsukanto is effective and convenient for PDPH.

Four Cases of Upper Gastrointestinal Symptoms Successfully Treated with Ryokeijutsukanto / 日本東洋医学雑誌

Case 1 was a 28-year-old female who had epigastric discomfort and epigastralgia for three months. These symptoms were accompanied with dizziness, faintness and hot flush. Right after taking ryokeijutsukanto, her dizziness, faintness and chillness of foot disappeared with improvement of gastrointestinal symptoms after two weeks. Case 2 was a 40-year-old female who presented prolonged nausea and epigastralgia for eight months. She also complained of dizziness and strong globus sensation when taking meals. After taking ryokeijutsukanto, her appetite improved in a week and gastrointestinal symptoms improved in 3 weeks. Case 3 was a 15-year-old female whose complaints were nausea, epigastric discomfort, palpitation, dizziness and globus sensation consequent to swaying feeling after riding a roller coaster. These symptoms including nausea improved after taking ryokeijutsukanto with 3g of magnolia bark for a week. Case 4 was a 28-year-old male who presented severe appetite loss and epigastric discomfort when he got tired. He also complained of faintness. His faintness disappeared after taking ryokeijutsukanto for 2 weeks. His appetite also improved after four weeks. Clinical courses of these cases suggest that ryokeijutsukanto may be useful for the treatment of upper gastrointestinal symptoms including functional dyspepsia, i.e. fluid retention with qi-counterflow.

A Case of Paroxysmal Vomiting with Diarrhea Treated by Ryoukeijutsukanto / 日本東洋医学雑誌

The patient was an 80-year-old woman who had been suffering from paroxysmal vomiting with diarrhea about twice a month for 3 years. She had these symptoms at around 11:00 am every time and got over them after a rest for about 20 minutes. Though no abnormality was detected by the inspections in the gastroenterology and the cardiology, the interval of her attacks became short. These symptoms were treated with ryokeijutsukanto. We conclude that the pathogeneses of this case were excessive accumulation of fluids in epigastrium caused by the lack of stomach qi, and that these were ameliorated by the effect of ryokeijutsukanto mainly in nourishing stomach qi and cleaning away excessive accumulation of water. There is a report that the stuffiness and rigidity below the heart shows the presence of excessive accumulation of fluids in epigastrium, and this case suggests the possibility that this symptom of abdominal diagnosis by palpation is seen only during an attack.

Two Cases with Restless Legs Syndrome Successfully Treated with Kampo Medicine / 日本東洋医学雑誌

We report two cases with honton disease, also regarded as restless legs syndrome (RLS), successfully treated with a combination of goshuyuto and ryokeijutsukanto. Case 1 was an 88-year-old woman who started experiencing RLS after she received cardiac bypass graft when she was 76-years-old. Abdominal examination revealed stuck sensation in the pit of her stomach and aortic palpitation around the upper umbilical region. From these examination results as well as the deficiency pattern, cold pattern, qi deficiency, and qi stagnation, we diagnosed the case as a hontonto (Zhouhou fang) indication. A combination therapy of goshuyuto and ryokeijutsukanto was administered. Consequently, the stuck sensation and RLS disappeared. Meanwhile, Case 2 was a 62-year-old woman who experienced RLS upon going to bed after she underwent breast cancer surgery at the age of 54 years. Similarly, abdominal examination revealed stuck sensation in the pit of her stomach, aortic palpitation around the upper umbilical region, and lower abdominal numbness. These examination results as well as the slight deficiency pattern, upper heat and lower cold pattern, qi deficiency, and qi stagnation indicated hontonto (Zhouhou fang). The same combination therapy was given. Eventually, the stuck sensation disappeared, and the RLS was reduced. Therefore, for RLS that appears after a mental load with invasive therapy, the combination therapy of goshuyuto and ryokeijutsukanto may be an effective treatment choice.

A Patient with Hearing Loss Whose Hearing and Communication Ability Improved with Kampo Treatment Combined with Use of Hearing Aids / 日本東洋医学雑誌

The use of hearing aids may not be sufficiently helpful for elderly people with advanced bilateral hearing loss when conversing with others. The patient in this case was an 82-­year­-old man whose main complaint was difficulty in verbal communication with his family despite using hearing aids. He was diagnosed with ad­vanced bilateral sensorineural hearing loss using Western medicine techniques. He was first prescribed the Kampo formulation, ryokeijutsukanto, followed by goshajinkigan. Later, he took a combination of both of these Kampo formulations, and his hearing ability improved. Pure tone audiometry and speech audiometry demonstrated hearing loss ;however, speech audiometry better reflected his improvement in hearing speech sounds after he began taking the Kampo formulations. Thus, in this case, the patient's hearing and communica­tion abilities improved with Kampo formulations combined with the use of hearing aids. In the future, speech audiometry (maximum discrimination score) can be applied to evaluate the efficacy of Kampo treatment for hearing loss.

Examination of 40 Cases of Vertigo and Dizziness that were Effectively Treated with Kampo Medicines : A 5-year Patient Survey in my Clinic / 日本東洋医学雑誌

Vertigo and dizziness are common symptoms encountered in clinical settings. We had examined 40 cases with a chief complaint of vertigo and dizziness that were effectively treated with Kampo medicines for 5 years. Here, we present 4 typical cases and report on the outcomes of these cases. A majority of the patients reported here had dizziness as the main complaint and were female. About 35% of the cases improved in no more than 7 days, and 50% of the cases were cured within 14 days. Ryokeijutsukanto (45%) and shinbuto (55%) are the most commonly prescribed Kampo medicines. We had to treat the patients with not only a single, but also multiple Kampo medicines because of tangled yin and yang. Cases of dizziness without any specific neuro­logical abnormality were difficult to treat with modern medicine ;however, Kampo medicine could treat such cases promptly.

Consideration of a New Category of Patients for Whom Ryokeijutsukanto is Effective at a Different Stage Then was Previously Reported / 日本東洋医学雑誌

Ryokeijutsukanto consists of four crude drugs, Hoelen, Cinnamonmi Cortex, Atractylodis Rhizoma, and Glycyrrhizae Radix. In Kampo medicine, it is used for the yang stage, fluid disturbances, and qi counterflow. It is also used for orthostatic disturbance, which does not change smoothly from parasympathetic nerve dominance to sympathetic nerve dominance. This time, we report that ryokeijutsukanto is also effective for disturbance with function regulation of autonomic nervous system. Case 1: a patient who had headache after exercise and working. Case 2: a patient who had dizziness and cold sweat that appeared in the evening. Case 3: a patient who had headache after working or on holidays. In these cases, ryokeijutsukanto was effective for symptoms that appeared when the patient could not change smoothly from sympathetic nerve dominance to parasympathetic nerve dominance. Furthermore, we found that ryokeijutsukanto was effective, even if there was no sign of fluid disturbance in conjunction with the yang stage and qi counterflow. We identified a new category of patients for whom ryokeijutsukanto is effective.

<b>A Case of New-Onset Vogt-Koyanagi-Harada Disease Successfully Treated with the Ryutanshakanto Prepared </b><b>at Ikkando and Goreisan and no Corticosteroids </b> / 日本東洋医学雑誌

Vogt-Koyanagi-Harada (VKH) disease is the second most common uveitis in Japan. This is considered an autoimmune disease as the immune system attacks self-melanocytes, and it is characterized by neurological, auditory, and dermatological symptoms in addition to panuveitis. Standard treatment is systemic steroid mass therapy. Also, an inadequate amount of corticosteroid can cause the disease recur or become protracted.<br>Here, we report a case of new-onset VKH disease successfully treated with a combination of ryutanshakanto prepared at Ikkando and goreisan, without any corticosteroids, in a hepatitis B virus carrier.<br>The patient was a 40-year-old male. He visited an eye clinic with bilateral blurred vision, and was diagnosed with bilateral maculopathy at this clinic. He was then referred to our hospital. We diagnosed him with VKH disease and, in accordance with (traditional Japanese) Kampo medicine, also with dampness-heat (shitsunetsu) of the foot's liver meridian with reverting yin (<i>ashi-ketchin-kankei</i>), mild water retention (<i>suitai</i>) and blood stasis (<i>oketsu</i>). We then administered the ryutanshakanto prepared at Ikkando, plus goreisan. His visual acuity consequentially began to improve gradually from the next day, and the disease was finally cured without the administration of any corticosteroid. Thus we believe this suggests that Kampo therapy for VKH disease can be a viable alternative.

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.

Application of Keishikaryojutsubuto for Extraarticular Symptoms / 日本東洋医学雑誌

It is assumed that keishikaryojutsubuto was first described in the Ho-ki medical text, and it has been used to target neuralgia and the arthritic pain. We experienced cases of Crohn's disease, endometriosis, post-operative rectal carcinoma, acute gastroenteritis and Meniere's disease successfully treated with keishikaryojutsubuto. When this formulation is administered, it might be important to keep in mind the definition of prescriptions for keishikashakuyakuto and shimbuto, or ryokeijutsukanto, as described in the Kokan-igaku text. In addition, this formulation might be applicable to various other diseases.

A Case of Hyperhydrosis Patient Treated with Combined Formulation of Hangekobokuto and Ryokeijutsukanto / 日本東洋医学雑誌

We report a case of a 65-year old man who suffered from hyperhydrosis for 15 years and was treated with the combined formulation of hangekobokuto and ryokeijutsukanto as determined by Kampo diagnosis according to traditional logic. Not only excessive sweating but also complications such as a feeling of obstruction in the throat, palpitation at rest, panting at times of light work, and a feeling of residual urine were diagnosed. We conclude that these symptoms were induced by a dysfunction of the qi (vital energy) and jin (nourishing fluids) circulation between the upper and the middle aspect of the body caused by the existence of wet phlegm, which were ameliorated by the effects of eliminating phlegm, and regulating stagnated or regurgitated qi with this combined formulation.

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.

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.

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 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.

The Effects of Ryo-kei-jutsu-kan-to / 日本東洋医学雑誌

There are many indications for Ryo-kei-jutsu-kan-to, such as orthostatic hypotension, cardiac neurosis, migraine, congestive heart failure, benign paroxysmal positional vertigo and eye disease. Although in oriental medicine Ryo-kei-jutsu-kan-to is used as a hydragogue agent for sui-doku (disorders of the body's fluid metabolism), its actual effect on hydragogue action remains unclear. We previously carried out hemodynamics tests before and after administration of Ryo-kei-jutsu-kan-to for a patient with orthostatic hypotension due to peripheral autonomic disorder. The pathosis of the patient before administration of Ryo-kei-jutsu-kan-to was found to be sui-doku caused by the excessive increase of circulating blood volume. We reported that after administration of Ryo-kei-jutsu-kan-to the blood pressure of the patient in the standing position was elevated by increased peripheral vascular resistance, while excessively increased circulating blood volume decreased. This time we administered Ryo-kei-jutsu-kan-to for four cases, such as orthostatic hypotension with migraine, cardiac neurosis, congestive heart failure, and hypotension in dialysis. We again realized that it also increases peripheral vascular resistance. As one of the dimensions of so-called hydragogue action, it is important to understand that Ryo-kei-jutsu-kan-to has a hydragogue effect against the retention of excess fluids (sui-doku) in the body through increasing peripheral vascular resistance by vasoconstriction.

Two Case Reports of Overtraining Syndrome with Anemia Successfully Treated with Ryo-kei-jutsu-kan-to / 日本東洋医学雑誌

Ryo-kei-jutsu-kan-to was used to successfully treat two cases of overtraining syndrome with anemia. The first case was an 18-year-old woman. Several years ago, she was diagnosed with iron deficiency anemia, and she took Fe pills intermittently. After university graduation in 1996, she began to experience lightheadedness and general malaise concurrently with increased training of long-distance running. In September of the same year, her anemia worsened, and she was introduced to our department. Administration of Ryo-kei-jutsu-kan-to improved her symptoms, anemia and maximal oxygen uptake. The second case was a 19-year-old woman. She was an office worker and a member of her company's athletic club. She became easily fatigued, and she came to our clinic in December of 1996. Hochu-ekki-to was administered and her fatigue improved. But in the following year she began to feel depressed and lightheaded, and she became anemic after increased increasing her training of long-distance running. Administration of Ryo-kei-jutsu-kan-to improved her symptoms and anemia.

A Trial of Kampo Therapy for Panic Disorder / 日本東洋医学雑誌

The patient involved in this study was a 28-year-old male who complained of panic attacks accompanied by palpitations, dyspnea, dizziness and nausea. This condition had been occurring for 18 months, despite treatment with various minor tranquilizers and antidepressants. He fulfilled the DSM-III-R criteria for panic disorder.<br>The panic attacks improved with treatment with Hangekoboku-to, and the dizziness which persisted even with Hangekoboku-to administration was greatly eased by Ryokeijutsukan-to.<br>This case exhibited the symptom known in Kampo medicine as ‘Honton’ (a feeling of palpitation spreading upwards from the hypogastrium to the heart, and palpable near the upper and/or lower part of the navel) and study of this case may be significant in elucidating the relationship between panic disorder and the Honton symptom.