Successfully Treated Psychogenic Non-Epileptic Seizure with Shigyakusan and Hangebyakujutsutemmato / 日本東洋医学雑誌

We report a case of loss of consciousness multiple times with and without focal to bilateral tonic-clonic seizure-like episodes that we diagnosed as psychogenic non-epileptic seizures, and successfully treated with shigyakusan and hangebyakujutsutemmato. The patient did not have fullness and discomfort in the chest and hypochondrium (kyokyokuman), nor spasmodic bilateral rectus abdominis in an interictal state. On the other hand, she had extremely cold limbs, especially feet and hands, with fingers being flexion and rigid under the status of loss of consciousness even without tonic-clonic seizure-like episodes in the ictal state. After being warmed and loosened, her consciousness level slowly recovered. She had headaches frequently in a non-ictal state, too. We identified that she had qi deficiency (kikyo), qi depression (kiutsu), fluid retention (suitai) and qi counter flow (kigyaku) in the interictal state, while kiutsu and kigyaku were extremely strong in the ictal state. In this case, the combined use of shigyakusan and hangebyakujutsutemmato was useful, considering that the patient had two different locations of disease (byoi) that required treatment.

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.

<b>A Japanese Herbal Medicine, Shigyakusan, Induces Prolonged Survival of Fully MHC-Mismatched Murine Cardiac A</b><b>llografts</b> / 日本東洋医学雑誌

<p><b>Background </b>: Shigyakusan, a 4-component Japanese herbal medicine (Paeoniae radix, Aurantii fructus immaturus, Glycyrrhizae radix and Bupleuri radix), is used not only for cholecystitis and gastritis as an antiinflammatory agent, but also for anxiety neurosis and insomnia as an anti-anxiety agent.<br><b>Methods </b>: We investigated the effects of shigyakusan on alloimmune responses in fully MHC-mismatched murine cardiac allograft transplantation. CBA mice underwent transplantation of a C57BL/6 heart and received shigyakusan or one component of shigyakusan administered orally from the day of transplantation until 7 days afterward. Histologic studies, cytokine measurements, and flow cytometry assessments were performed.<br><b>Results </b>: Untreated CBA recipients acutely rejected C57BL/6 cardiac grafts (median survival times [MST], 7 days). On the other hand, CBA transplant recipients given shigyakusan had significantly prolonged C57BL/6 allograft survival (MST, 22.5 days). MSTs for C57BL/6 transplant recipients given Paeoniae radix, Aurantii fructus immaturus, Glycyrrhizae radix and Bupleuri radix were 11, 9.5, 18.5 and 8 days, respectively. Additionally, flow cytometry studies showed that the percentage of CD25+Foxp3+ cell populations in CD4+ cells was increased in transplant recipients given shigyakusan.<br><b>Conclusion </b>: Shigyakusan induced hyporesponsiveness to fully MHC-mismatched allogeneic cardiac allografts and may generate CD4+CD25+Foxp3+ cells in our model.</p>

<b>Five Cases of Acute Ventilation Attack Successfully Treated with Shigyakusan in the Emergency Department</b> / 日本東洋医学雑誌

We report five cases of acute hyperventilation attack, with bilateral fullness of the chest and hypochondrium, and bilateral rectus abdominis muscle strain, that were successfully treated with shigyakusan. Case 1 was a 47-year-old female ; case 2 was an 18-year-old female ; case 3 was a 23-year-old female ; case 4 was a 39-year-old male ; and case 5 was a 40-year-old male. All five patients visited the emergency department with complaints of severe dyspnea and tetany. Their abdominal signs were characteristic, with remarkable bilateral fullness of the chest and hypochondrium and bilateral rectus abdominis muscle strain. In cases 1 to 4, the patients were given 2.5 g of shigyakusan extract, and their symptoms promptly improved. In case 5, as the patient could not swallow the prescribed medication at presentation, intramuscular diazepam was given. Thereafter, he complained of continuous severe numbness ; we subsequently gave him shigyakusan, and his numbness promptly improved. In conclusion, shigyakusan seems to be a useful Kampo drug for the treatment of acute hyperventilation attack.

<b>Two Cases of Vasospastic Angina Poorly Controlled with Western Medicine Successfully Treated with a Combination of Traditional Shigyakusan and Keishibukuryogan Japanese Herbals </b> / 日本東洋医学雑誌

Vasospastic angina (VSA) is a condition in which a relatively large coronary artery transiently exhibits abnormal vasoconstriction. Although an angina attack by VSA can usually be controlled with nitrates and calcium channel blockers (CCB), there are some patients whose VSA cannot be controlled even by combinations of these drugs. We report here two cases of VSA successfully treated with a combination of the traditional Japanese herbal (Kampo) medicines shigyakusan and keishibukuryogan. Case 1 was a 73-year-old male with chest discomfort during effort and at rest. A 24-h Holter monitoring showed a short period of marked ST segment elevation associated with his chest pain. Although nitrates and a CCB were administered, his symptoms persisted. We then prescribed shigyakusan and keishibukuryogan, and his chest pain improved. Case 2 was a 58-year-old male with chest discomfort at rest. Acetylcholine-provoked coronary spasm was observed. Although he was prescribed nitrates and a CCB, these medicines were not effective. After we prescribed shigyakusan and keishibukuryogan, his chest pain improved. The results experienced in these two cases suggest that shigyakusan and keishibukuryogan could be useful formulations for the treatment of VSA uncontrolled by conventional medical treatment.

<b>Therapeutic Experience with Shigyakusan, a Traditional Japanese (Kampo) Prescription, Against Intractable Pain</b> / 日本東洋医学雑誌

Shigyakusan, a traditional Japanese prescription, has been prescribed for chronic diseases including gastritis, upper respiratory tract infection, hepatitis, irritable colon and so on. The effectiveness of shigyakusan against pain, however, has only been rarely reported. Here we report that shigyakusan was effective on pain such as intractable chronic and acute pain in 26 patients. Shigyakusan is composed of 7.5 g (dry weight/day) : saiko, shakuyaku, kijitsu and kanzo. Shigyakusan and kososan mimic the composition of saikosokanto. Pain alleviation periods were 3-90 days (26 ± 19). Pains were recognized in various regions including side of the flank and the thorax, the back, the tongue, the perineum, the elbow joint, the head and plantar areas. Abdominal findings as tension of the rectus abdominis, kyokyokuman (discomfort of the hypochondrium area) and sinkahiko (tenderness of the hypochondrium area) were recognized 58%, 46% and 38%, respectively. All patients were recognized with depressive conditions. Shigyakusan alleviated acute and chronic pain that had not been improved with Western medicine. Therefore, shigyakusan may be considered for prescription in patients with incurable pain.

Atopic Dermatitis as a Psychosomatic Disorder / 日本東洋医学雑誌

As mental stress has a great impact on the symptoms of atopic dermatitis, we administered Qi-related prescriptions to 6 patients with atopic dermatitis. Not only were mental and autonomic imbalances, but also skin conditions were improved in all six. We examined changes in palmoplantar sweating and a self-rating depression scale to evaluate the effectiveness of the Qi-related prescriptions. The Qi-related prescriptions were used in combination with standard treatments as follows : keishikaryukotsuboreito in Case 1, shigyakusan in Cases 2 and 3, yokukansankachimpihange and keishikaryukotsuboreito in Case 4, shigyakusan and keishikaryukotsuboreito in Case 5, and saikokeisikankyoto in Case 6. It appears to be important to treat Qi-disorders, along with skin disorders, in patients with atopic dermatitis.

The Evaluation of Handy Objective Indicator of Skin Moisture and Its Clinical Usefulness in Kampo Medicine / 日本東洋医学雑誌

Objects : The purpose of this study is to evaluate objective measurements of skin moisture and its usefulness in the Kampo clinic.Methods : We measured the skin moisture of 6 male volunteers using a sensor twice, in a one to two week interval, and calculated the correlation of both data sets at 66 points. Secondly, we compared the skin moisture data at 10 regions in 81 patients without any skin disease, in a wide age range from 30 s to early 70 s. The ten regions measured were : face, chest, back, abdomen, leg and 4 forearm points, i.e. the inside and outside of the bilateral center forearm, and palm.Results : The correlation of two successively measured data sets showed excellent relation (r=0.716, p<0.0001). The sensor measurement of skin moisture was quite reliable. Measurements of the face, chest and back showed them to be significantly wetter than the abdomen, leg or any of the 4 forearm points. Palm measurements indicated a wetter tendency than for any forearm measurements. Back and abdomen measurements in males were significantly wetter than those in females. There were no significant differences among the data sets, with regards to age. Therefore, any forearm points are clinically useful for the standard measurement of skin moisture. We also demonstrated a case in which skin moisture measurements with a sensor were useful in prescribing and observing the effects of shigyakusan.Conclusion : Utilizing this method may be helpful in acquiring much more objective measurements for Kampo medicine.

Three Cases of Palindromic Rheumatism Effectively Treated with Kampo Medicine. Consideration of Kampo Treatment in Palindromic Rheumatism / 日本東洋医学雑誌

We examined three cases where Kampo medicine had effects on palindromic rheumatism. All the patients are men with arthralgia accompanied by redness, fever, and swelling. All cases are RF negative. Cases 2 and 3 are brothers. Case 1: A 58-year-old patient with recurrent arthralgia on shoulders, hands, and legs for 30 years. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) was noted, the administration of Sho-Saiko-to reduced the symptom.<br>Case 2: A 40-year-old patient with recurrent arthralgia on shoulders, hands and legs for nine years. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) and contraction of the abdominal muscles (Fukuhikokyu) was noted, the administration of Eppi-ka-jutsu-to-go-Shigyaku-san-ryo was replaced, which reduced the symptoms.<br>Case 3: A 46-year-old patient with recurrent arthralgia on knees and fingers, and pain in hip joints. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) and contraction of the abdominal muscles (Fukuhikokyu) were noted, the administration of Shigyaku-san reduced the symptoms.<br>All cases were typical palindromic rheumatism, and Eppi-ka-jutsu-to was effective to a certain degree. Kampo diagnosis of Saiko (Saiko-sho) was made and additional Saiko-drugs (Saiko-zai) reduced the frequency, the degree, and the length of the period of symptoms.