RESUMEN
Hansen's disease (HD) is a chronic infectious disease caused by the Mycobacterium leprae, which parasitizes skin macrophages and Schwann cells of peripheral nerves. Left untreated, leprosy can be progressive, causing permanent damage to the skin, nerves, limbs and eyes due to sensory disturbance and neuritis. Many HD patients suffer from refractory neuralgia for which neither painkillers nor other western medicine are usually effective. Here, we will report the case of an 85 year-old male, whose refractory neuralgia remarkably improved with goreisan. The mechanisms by which goreisan was effective may be as follows : (1) neuralgia pathology is an interstitial edema of peripheral nerves, and can explain as a local <I>Sui-doku</I>, a specific <I>Sho</I> for goreisan ; (2) peripheral nerve ischemia, caused by scar formation from chronic inflammation, leads to dysfunction of Na<SUP>+</SUP>/K<SUP>+</SUP> ATPase, and extracellular potassium concentration increases. This environmental change leads a neural hypersensitivity, and goreisan is known to decrease extracellular potassium concentrations. This case suggests goreisan might be worth considering for use in refractory neuralgia, not only in HD patients, but also in other neuropathies.
RESUMEN
Five patients in the acute stage of reflex sympathetic dystrophy (RSD) of the hand were treated with Sairei-to and Rikkunshi-to, and were evaluated for pain (visual analog scale: VAS), swelling and limitation of finger motion. Four of the five patients had good results, with a decrease in pain to less than 50% of initial pain on VAS within six weeks. Swelling and finger motion tended to improve earlier than pain. In general, symptoms of RSD are limited to those associated with local inflammation during the acute stage, but patients with RSD tend to have psychological factors that can trigger generalized complaints even before the onset of RSD and to feature ‘kikyo, ’ a loss of vitality, after RSD onset. RSD should therefore be recognized as one feature of a generalized disease. Oral Kampo therapy using Sairei-to and Rikkunshi-to appears to be a reasonable treatment for early RSD.