A Case of Kampo Medicine Treatment for Acute Antebrachial Compartment Syndrome in the Arm Caused with Percutaneous Coronary Intervention Via Radial Artery / 日本東洋医学雑誌

After percutaneous coronary intervention (PCI), the patient developed symptoms of pain, sensory impairment, paralysis, pallor of the skin, and pain during passive extension, and was diagnosed with PCI-induced antebrachial compartment syndrome. Since it was considered to be blood stasis and water stasis in Oriental medicine, we administered jidabokuippo and keishibukuryogan to the patient. Then the subjective and objective symptoms improved promptly, and the symptoms disappeared by the 10th day after the operation. The patient was able to discontinue jidabokuippo 14 days after the operation. It was suggested that the symptomatic treatment with Kampo medicine is effective for compartment syndrome.

The Effective of Keishibukuryogan on Uterine Subinvolution after Childbirth: NRCT / 日本東洋医学雑誌

The uterus starts shrinking after giving birth and returns to its size prior to pregnancy one month postpartum. However, absence of this natural shrinking is called uterine subinvolution. There are two types of subinvolution : organic and functional. Removal of the cause is the first option for organic subinvolution. Conversely, most cases of functional subinvolution require drug treatment. This study included patients with subinvolution caused by accumulation of lochia with a uterine cavity width of 15 mm or more during a 14-day postpartum checkup. These patients were categorized into the control, keishibukuryogan, and ergometrine maleate groups ; therapeutic intervention was performed. A comparative study was conducted to determine the presence of subinvolution during the 1-month medical screening. There was no difference in the rate of uterine cavity shrinkage between the ergometrine maleate group and the control group. However, the keishibukuryogan group had a significantly higher reduction rate than the ergometrine maleate group. Furthermore, the keishibukuryogan group showed a tendency of higher shrinking rate when compared with the control group (76.1 ± 17.1% vs 65.8 ± 25.4%, 68.3 ± 22.9%, p = 0.0101, p = 0.0709). Additionally, no difference in the reduction rate of the fundal height was noted among the groups. These results suggest that although keishibukuryogan has little effect on reducing the uterine size, however, it has the effect of lochia accumulated within the uterine cavity.

A Case of Palmoplantar Pustulosis Successfully Treated with Kampo Medicine Switched Between Fundamental Treatment and Local and Symptomatic Treatment / 日本東洋医学雑誌

We experienced a case of palmoplantar pustulosis in which the patient's dermatological symptoms im­proved after treatment with a combination of bofutsushosan and keishibukuryogan. The patient was a 42-year-old woman. She had been prescribed biotin and a steroid ointment, but her condition did not improve. At her first visit to our Kampo clinic, we observed impetigo, cracks, and scaling on both palms and plantar surfaces. We determined that the patient was of the poisoned organ (zodoku) and stagnant blood (oketsu) constitutions,as outlined in the Ikkando school of medical thought. We prescribed bofutsushosan and keishibukuryogan as fundamental treatment and then in a few days, the patient's dermatological symptoms resolved. The patient later developed hyperthyroidism, which caused her symptoms to worsen again, we therefore switched to shofusan and eppikajutsuto as local and symptomatic treatment, and then she once again improved. Soon after, we returned to keishibukuryogan and bofutsusho for her to maintain remission. Since poisoned organ and stagnant blood constitutions contribute greatly to the Kampo pathology of palmoplantar pustulosis, we believe bofutsushosan and keishibukuryogan are effective formulations for the treatment of this condition. As far as we searched, there were no papers that selected bofutsushosan or blood stasis agents as the main cure from the viewpoint of the poisoned organ constitution and the stagnant blood constitution. Therefore, this case was considered to be a valuable case.

Evaluation of Various Anti-oketsu Kampo Formulae—Tokakujokito,Keishibukuryogan and Tokishakuyakusan—for Microcirculation by Live Imaging / 日本東洋医学雑誌

Oketsu is a characteristic pathophysiology in Kampo and traditional East Asian medicine that includes mul­tiple aspects of hemodynamic disorder. Anti­-oketsu drugs or the Kampo formulation used for oketsu show sig­nificant clinical effects on various disorders; however, their underlying mechanisms still remain unclear. We aimed to clarify the characteristics of the pharmacological effects of anti-­oketsu drugs on the microcirculation using a microscopic live imaging technique. Three Kampo formulations, namely tokakujokito, keishibukuryo­gan, and tokishakuyakusan were orally administrated to C57BL/6 mice at a dose of 300 mg/kg diluted in dis­tilled water. Live imaging was performed on the subcutaneous vessels of the mice, including the arteries (di­ameter > 50 μm), arterioles (diameter 10-50 μm) and capillaries (diameter < 10 μm). Tokakujokito widely increased erythrocyte flow velocity and blood flow volume from arteries to capillaries within 60 min of ad­ministration. The effects of keishibukuryogan on the vasodilation of the arterioles were remarkable, and con­tinued up to 120 min after administration. The pharmacological target of tokishakuyakusan was the capillaries, increasing their erythrocyte velocity and blood flow volume;its effect was more slowly expressed than those of the other formulations. Our results clearly demonstrate the sequential and special effects of anti-­oketsu drugs on hemodynamics. These differences may provide pharmacological information on the clinical usage of traditional Kampo formulations.

Prolapsed tongue papilloma cured by administration of the traditional Japanese (Kampo) herbal medicine, Keishibukuryogan-ka-yokuinin: A case report / 中西医结合学报

Squamous papilloma is a benign mass lesion of the oral mucosa. For papillomas of the tongue, surgery is recommended owing to their malignant potential; however, certain complications may be associated with surgery. A traditional Japanese (Kampo) herbal medicine, Keishibukuryogan-ka-yokuinin (KBGY), has been used to treat viral warts and various skin diseases in Japan. Therefore, the effect of KBGY on papillomas is promising. A 49-year-old Japanese man presented with a wart on his tongue that was about 3 months old. He smoked 5 cigarettes per day. He did not drink alcohol. He had no history of malignant illnesses. He was taking alprazolam for panic disorder. The patient was diagnosed with a suspected papilloma of the tongue at the Department of Otolaryngology and was advised to undergo an excision biopsy to exclude malignancy. However, he refused owing to the fear of an invasive procedure. After informed consent was obtained from the patient, KBGY was prescribed. Three months later, the wart on his tongue spontaneously prolapsed. The histopathological diagnosis was squamous papilloma. There was no indication of malignancy, and the patient discontinued Kampo treatment. He has had no recurrence in the past 3 years. KBGY is a combination of Keishibukuryogan and yokuinin (adlay seeds). Keishibukuryogan may be beneficial for skin or oral mucosal remodeling, and yokuinin may have antiviral properties. The present case report suggests the use of KBGY as an appropriate complementary therapy for squamous papilloma.

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.

Twenty Cases of 20 Women Treated with a Regimen of Herbal Medicine According to the Treatment Stage of in vitro Fertilization or Microinsemination / 日本東洋医学雑誌

This report describes 20 women who underwent in vitro fertilization or microinsemination while receiving a regimen of herbal medicine, of which contents varied according to the treatment stage. Until the ova were harvested, in order to promote maturation, patients were treated with hachimijiogan for reinforcing kidney yang, and keishibukuryogan for removing blood stasis. Following this, during the period between harvesting and implantation, they were treated either exclusively with unkeito for warming meridians, dissipates cold, and replenishes blood, or with unkeito in combination with keishibukuryogan. Following implantation, they were treated with tokishakuyakusan to induce uterine relaxation. The treatment regimen was determined based on traditional herbal evidence of infertile patient's blood stasis and kidney deficiency. We adjusted applied dose depending on the conditions of patients. Fourteen of the 20 women tested positive for pregnancy; 10 of them carried to term, whereas in 4 of them, the pregnancy ended in abortion or miscarriage. Anti-Müllerian hormone concentration, endometrial thickness, estimated follicle count, recovered ova count, fertilized ova count, and numbers of ova to reach the early-embryo stage and blastocyst stage were compared between the continuing pregnancy and the non-pregnancy groups. Improvements were observed in all values after combined use of traditional herbal medicines, except in the case of endometrial thickness, and significant differences appeared in recovered ova count and fertilized ova count. These observations suggest that a regimen of herbal medicine adapted to the various stages of in vitro fertilization may be a useful complementary therapy during pregnancy.

<b>Three Hemodialysis Patients with Postoperative Amputation Wounds Due to Critical Limb Ischemia Successfully Treated with Juzentaihoto and </b><b>Keishibukuryogan</b> / 日本東洋医学雑誌

<p>Peripheral arterial disease is a serious complication that can arise in hemodialysis patients. Prognosis in critical limb ischemia (CLI) due to peripheral arterial disease is extremely poor. A dialysis patient may experience symptoms of both <i>qi </i>and <i>ketsu </i>deficiency and <i>ketsu </i>stagnation during the long-term treatment of CLI. Herein, we report three hemodialysis patients with refractory postoperative skin ulcers who were successfully treated with juzentaihoto and keishibukuryogan after limb amputation. Case 1 was a 68-year-old man who had skin ulcers of the right second, third, and fifth toes. After amputation of the third toe, juzentaihoto and keishibukuryogan were initiated. Case 2 was a 67-year-old man who had skin ulcers after amputation of the left fourth and fifth toes. Postoperatively, juzentaihoto and keishibukuryogan were initiated, and good granulation was observed. Case 3 was a 76-year-old man who had skin ulcers after left below-the-knee amputation. Because of the extremely poor tissue granulation, juzentaihoto and keishibukuryogan were initiated, and good granulation was gradually observed. After an operation for CLI, prompt return to activities of daily living is desirable. The appropriate addition of Kampo treatment to Western treatment may improve chronic refractory skin ulcers.</p>

<b>A Case of Pelvic Congestion Syndrome Successfully Managed with Keishibukuryogan</b> / 日本東洋医学雑誌

<p>Pelvic congestion syndrome is a condition in women caused by congestion or varicosity of the intrapelvic vein. We report a case of pelvic congestion syndrome managed with keishibukuryogan. The syndrome was diagnosed based on expansion of the left periuterine and ovarian veins.<br>A 61-year-old female presented to our clinic with left lower abdominal pain. NRS was 9 and Terasawa's oketsu score was 40, indicating marked blood stasis. A CT scan revealed vascular expansion (10 mm) of the left ovarian vein. Transvaginal ultrasonography also revealed vascular expansion (6.0 mm) of the left periuterine vein. Based on these findings, a diagnosis of pelvic congestion syndrome was established. She was treated with keishibukuryogan (7.5 g/day). NRS was improved to 1 and Terasawa's oketsu score was improved to 20. The symptoms were resolved within 6 months, and the medication was discontinued.<br>Three months after discontinuation, she presented to our clinic again with left lower abdominal pain. The medication was resumed and the symptom was improved. After 5 months, a contrast enhanced CT scan showed no change of vascular expansion of the left ovarian vein (from 10 to 9 mm). Keishibukuryogan treatment has now been continued for 10 months.</p>

<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>A Case of Diabetic Foot Syndrome Successfully Treated with </b><b>Combination Kampo Medicine </b> / 日本東洋医学雑誌

This case involved a 58-year-old male with diabetic foot syndrome complicated with osteomyelitis. He had been diagnosed with diabetes mellitus type 2 twenty years previously, but had ignored it and developed diabetic foot syndrome and diabetic triopathy. His HbA 1 c (NGSP) was 11.2%. Twelve days after diabetic foot onset, he was transferred to our hospital to receive Kampo medicine. His whole right leg was edematous and there were two ulcers on the dorsum (5 × 4 cm in size) and between the fourth and fifth toes (7 × 4 cm in size).We used antibiotics, insulin, and prostaglandin formulation in combination with Kampo medicine, involving hachimijioganryo because of lower abdominal numbness. Simultaneously, we used keishibukuryogan at high dosage (personalized formula, 2 g × 24 pills) for 7 days to improve blood stasis. Seven days after hospitalization, we changed the initial hachimijioganryo to hachimijiogan (personalized formula, 2.3 g × 9 pills) and kigikenchuto (astragalus root, 20 g) to accelerate ulcer granulation. We also decreased the high dose keishibukuryogan gradually. Although the bone of the DIP joint in the fifth toe was exposed, the ulcer dimensions decreased and reached 2.5 × 1.8 cm at the time of discharge (50 days after onset). Two months after onset, the ulcer had epithelialized and medical dressings were unnecessary. Four months after onset, it had completely healed. We propose that Kampo medicine is effective for diabetic foot syndrome when combined with conventional therapy, and that healing occurs earlier than with conventional therapy alone.

A Case of Schamberg Disease Successfully Treated with Keishibukuryogan Prepared at Hospital Pharmacy / 日本東洋医学雑誌

Schamberg disease is a subtype of idiopathic pigmentary purpura, which manifests with petechiae. It is assumed to be caused by venous microcirculatory disturbance, or an immunological and allergic mechanism. We report a 55-year-old Japanese male with Schamberg disease successfully treated with keishibukuryogan prepared at a hospital pharmacy. The patient had purpuric eruptions in his both lower legs at first, and brownish pigmentation enlarged with purpura. A dermatologist had diagnosed this, from the clinical findings, as Schamberg disease. We administered keishibukuryogan to the patient because his pathological condition was considered as oketsu. In order to improve effectiveness, keishibukuryogan was manufactured according to our own modification. The eruptions have reduced gradually, and about four months later, have mostly resolved. A Kampo therapy utilizing unseiin has been reported to be effective against idiopathic pigmentary purpura in previous studies. We suggest that a Kampo treatment with keishibukuryogan seems to be effective against idiopathic pigmentary purpura through improvements of microcirculation and inflammation.

Case Reports of Polymyalgia Rheumatica Successfully Treated with Kampo Medicines / 日本東洋医学雑誌

We report 5 patients with polymyalgia rheumatica (PMR) successfully treated with Kampo medicines. In total, we investigated 10 patients with PMR, including the 5 patients here treated in our department. Results showed that Kampo medicine was effective in 6 cases. One of the 6 refused steroid drug administration, and tapering dosage steroid was difficult in the other 5 patients due to myalgia or inflammation. Except for one case, C-reactive protein in most of the effective cases was below 3.0 mg/dl. On the other hand, the non-effective cases had severe inflammation levels and needed steroid therapy. The effective cases were treated with sokeikakketsuto, tokakujokito, keishibukuryogan, choyotokasyakuyaku, yokuibushihaishosan and tokishakuyakusan, which have the effect of improving oketsu states. Thus, it was considered that Kampo medicine has the potential for treatments in PMR patients who have difficulty tapering steroid dosage and mild inflammation. Moreover, this suggests Kampo medicines that improve oketsu state are useful for PMR treatment.

A Case of Schamberg Disease Successfully Treated with Keishibukuryogan Prepared at Hospital Pharmacy / 日本東洋医学雑誌

Schamberg disease is a subtype of idiopathic pigmentary purpura, which manifests with petechiae. It is assumed to be caused by venous microcirculatory disturbance, or an immunological and allergic mechanism. We report a 55-year-old Japanese male with Schamberg disease successfully treated with keishibukuryogan prepared at a hospital pharmacy. The patient had purpuric eruptions in his both lower legs at first, and brownish pigmentation enlarged with purpura. A dermatologist had diagnosed this, from the clinical findings, as Schamberg disease. We administered keishibukuryogan to the patient because his pathological condition was considered as oketsu. In order to improve effectiveness, keishibukuryogan was manufactured according to our own modification. The eruptions have reduced gradually, and about four months later, have mostly resolved. A Kampo therapy utilizing unseiin has been reported to be effective against idiopathic pigmentary purpura in previous studies. We suggest that a Kampo treatment with keishibukuryogan seems to be effective against idiopathic pigmentary purpura through improvements of microcirculation and inflammation.

Case Reports of Polymyalgia Rheumatica Successfully Treated with Kampo Medicines / 日本東洋医学雑誌

We report 5 patients with polymyalgia rheumatica (PMR) successfully treated with Kampo medicines. In total, we investigated 10 patients with PMR, including the 5 patients here treated in our department. Results showed that Kampo medicine was effective in 6 cases. One of the 6 refused steroid drug administration, and tapering dosage steroid was difficult in the other 5 patients due to myalgia or inflammation. Except for one case, C-reactive protein in most of the effective cases was below 3.0 mg/dl. On the other hand, the non-effective cases had severe inflammation levels and needed steroid therapy. The effective cases were treated with sokeikakketsuto, tokakujokito, keishibukuryogan, choyotokasyakuyaku, yokuibushihaishosan and tokishakuyakusan, which have the effect of improving oketsu states. Thus, it was considered that Kampo medicine has the potential for treatments in PMR patients who have difficulty tapering steroid dosage and mild inflammation. Moreover, this suggests Kampo medicines that improve oketsu state are useful for PMR treatment.

A Case of Beh\ccet's Disease Successfully Treated with Keishibukuryogan, Whose Liver Damage Was Caused by Orengedokuto / 日本東洋医学雑誌

We present the case of 65 year-old male with Behçet's disease who was successfully treated with the Kampo medicine keishibukuryogan. The patient presented with hyperemic conjunctiva, ocular pain and uveitis at the age of 38, and was diagnosed with Behçet's disease. One year later he was affected with ulcerative glossitis, which was also diagnosed as a manifestation of Behçet's disease. At the age of 56 he was presented with acute arthritis of his ankle joint, followed by ulcerative stomatitis and glossitis. He was treated with colchicine and cyclophosphamide. Thereafter, he suffered from recurrent oral aphthous ulcers, and arthritis. Intractable oral ulcers, which did not respond to Western medicine, led him to seek Oriental herbal remedies. Keishibukuryogan was prescribed and, since then, his oral ulcers have completely subsided and his arthritis has not been a problem. He has been relieved from all manifestations of Behçet's disease.Thus, we believe that the Kampo medicine keishibukuryogan should be taken into consideration when treating Behçet's disease.Moreover, liver dysfunction caused by the Kampo medicine orengedokuto arose at an early stage of therapy, but immediately disappeared when its use was stopped. Pharmacoepidemiologically, Scutellariae radix, an ingredient of orengedokuto, was suspected of causing this liver dysfunction.

A Case of Intermittent Claudication and Skin Ulcers of Lower Limb due to Arteriosclerosis Obliterans Successfully Treated with Prepared in the Hospital Keishibukuryogan and Daisaikoto / 日本東洋医学雑誌

Lower limb skin ulcers due to arteriosclerosis obliterans are severe ischemic lesions, and if preservation therapies such as antiplatelet and anticoagulant treatments are not effective, lower limb amputation may be necessary.We report the case of 73 year-old male patient suffering from intermittent claudication and skin ulcers on the heel of the left foot, who was successfully treated with keishibukuryogan and daisaikoto prepared in hospital. This case suggests that improvement of micro circulation with the addition of keishibukuryogan and daisaikoto to anticoagulant and antiplatelet therapies, safely promoted an improvement of ischemic lesions due to arteriosclerosis obliterans.

Effect of Keishibukuryogan on Silent Brain Infarction over 3 Years / 日本東洋医学雑誌

The purpose of this study was to evaluate the effect of keishibukuryogan (KB) against the cognitive symptoms associated with silent brain infarction in a prospective cohort study. The subjects were 93 patients with silent brain infarcts who visited the Department of Japanese Oriental Medicine, University of Toyama, and its allied hospitals. They consisted of 24 males and 69 females, mean age (± S.E.) 70.0±0.8.Group SK (n=51) consisted of patients who used KB extract for more than6months per year. Group SC (n=42) consisted of patients who did not use Kampo formulas. The NS group (n=44) consisted of elderly subjects who had no silent brain infarction, 21 males and 23 females, with a mean age (± S.E.) of 70.7±0.7 years. Among the three groups, the revised version of Hasegawa's dementia scale, apathy scale and self-rating depression scale were compared between the study start and after three years. In the SK and SC groups, these scores, and the subjective symptom levels (head heaviness, headache, dizziness or vertigo, stiff shoulder) were also studied. The results showed that the self-rating depression scales at study start for the SK and SC groups were significantly higher compared to the NS group. In spite of the scores for the NS group increasing after three years, the SK group scores were significantly decreased compared to the SC and NS groups. KB was effective against head heaviness, which often complicates silent brain infarction. In the above mentioned, KB was effective in treating cognitive disorders and subjective symptoms related to silent brain infarction.

The Usefulness of the Kampo for the Improvements of the Athletes Performance \lq\lqA new Management of Athletes by Kampo Medicine\rq\rq / 日本東洋医学雑誌

From a point of stress, the competitive sports are totally different from exercises for the health promotion. It would be even harmful especially for middle-distance or long-distance women runner. It brings them paramenia, defatigation and other orthopedic troubles which makes them unable to exercise further more.We have investigated the possibility of the preventive use of Kampo Medicine for those athletes and found that it is useful. The nine women who belong to the Tohoku-Region women team of long-distance relay road race had received Kampo medical treatment for 7 months. Serum CPK and AST were elevated with training exercise. In the cases whose CPK level was above 500 IU/l, most of them suffered from fatigue, leg pain, low back pain, and lower abdominal pain, which is very important for Kampo diagnosis. Because these symptoms unable athletes to exercise as planned, we understand that for the improvement of physical capacity, it is important to prevent those symptoms. For the treatment and prevention of the symptoms, we prescribed Keishibukuryogan, Rikkunshito, and Shimotsuto. We defined preventive medication period as “Mibyou” and continued to use Kampo medicine for 7 months. During the period, they were free from any troubles that would make them unable to exercise. These medicines enabled them to improve their records drastically. This study shows that preventive use of Kampo Medicine is extremely effective for any athletes to maintain their good conditions.

Two Cases of Treatment with Keishibukuryogan as Saiseito / 日本東洋医学雑誌

[Case 1] At 37 weeks and 5 days, a 27-year old woman was admitted to our clinic due to spontaneous rupture of the membranes. Her first pregnancy had come to term in a cesarean section delivery, because of toxemia and the breech presentation. This time, she wanted to deliver spontaneously. She didn't go into spontaneous labor, however, 44 hours after rupture of her membranes. Past history included the cesarean section, so labor induction with oxytocin or prostaglandin was not attempted. Active labor was established after administered keishibukuryogan as a saiseito, and she delivered spontaneously at 38 weeks and 1 day.<br>[Case 2] At 39 weeks and 5 days, a 33-year old woman was admitted to our clinic, due to elective induction of labor. Her first pregnancy had come to term in a labor induction with oxytocin for the uterine inertia. In this pregnancy she wanted to deliver without the use of oxytocin. Active labor was established after administered Keishi-bukuryogan as a Saisei-to, and she delivered spontaneously at the same 39 weeks and 5 days.<br>The present cases suggest that keishibukuryogan may be effective for establishment of labor, not to say a labor inducer or stimulator such as oxytocin and prostaglandin.