RESUMEN
The patient was a 47-year-old woman. Four years previously, she began to suffer from left lower leg pain and numbness, and involuntary movements. She received further examination in the department of neurology at other hospitals, but had an uncertain etiology and was provisionally diagnosed with restless legs syndrome. She was treated with Western medicine such as gabapentin and gabapentin enacarbil, but they were ineffective. She subsequently visited our hospital and was hospitalized. She was diagnosed with painful legs and moving toes syndrome, and painful arms and moving fingers syndrome after further examination. We prescribed tokakujokito because she had severe blood stasis and panic disorder on Kamp medical findings. As a result, her left lower leg numbness disappeared and pain was reduced. We report a case of a patient who could not be effectively treated using Western medicine and was successfully treated with tokakujokito-based Kampo prescriptions.
RESUMEN
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.
RESUMEN
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.
RESUMEN
One case of peripheral vertigo disorder with sustained constipation was effectively treated with the application of a Kampo medicine proverb : “opening the north window to get the south wind (balmy summer breeze)”. The therapeutic strategy behind this proverb is to cure the superior (south) disease by unblocking the inferior (north) pathogenic stagnation, and thus activate internal qi movement, blood and body fluid circulation in the body. A 69-year-old female with postural vertigo episodes associated with the benign paroxysmal positional vertigo (BPPV) was effectively treated with tokakujokito, and her constipation discomfort was resolved at the same time. Based on these results, otolaryngologists should consider the inferior disease (the lower gastrointestinal tract disorder) when treating the superior disease (the inner ear-based disorder), and pay attention to the harmony and balance among qi, blood and body fluid throughout the body.
RESUMEN
A 51-year-old woman with a 10-year history of diabetes visited our clinic for treatment of stiff shoulder and constipation. She was 156 cm tall and weighed 68 kg. The blood pressure was normal. Physical examination revealed no significant abnormalities. After she took the usual amount of tokakujokito for 3 days, hypertension and facial edema, legs edema, weight gain, and headache were observed. Pseudoaldosteronism inhibits 11 β-hydroxysteroid dehydrogenase Type 2, which is an active glycyrrhizin (GL) and its metabolites glycyrrhizic acid, 3-monoglucuronyl-glycyrrhizic acid metabolize and inactivate cortisol to cortisone. As a result, excessive cortisol acts on the mineralocorticoid receptor and promotes sodium reabsorption and excretion of potassium (K+), resulting in water retention and hypokalemia in the body. Insulin also causes hypokalemia because it also takes K+ at the same time as it takes blood glucose in the cell. As a result of these two different processes, it was thought that pseudoaldosteronism developed in low dose licorice. Glycyrrhizin-containing preparation should be careful used in patients receiving insulin.
RESUMEN
Most obstetricians rarely encounter a case of placenta accrete, where the placenta does not detach after childbirth. If placenta accrete attachment is deep, it is likely to lead to poor prognoses such as massive bleeding and shock. With western medicine, it is currently accepted that the only medical intervention is doing a simple total hysterectomy. Our patient was a 27 year old, primiparous Japanese woman. Signs of placental separation were not seen after birth, and conservative medical management for also ended up failing. This was then diagnosed as placenta accrete via sonography and an MRI, and simple total hysterectomy was recommended. She hoped to keep her uterus, however, and she was prescribed tokakujokito Kampo therapy. Her postpartum period passed without abnormality, and the placenta, which had remained intact to the 50 th day after birth, was removed. There is not literature on Kampo therapy as it applies to placenta accrete, and we believe this case to be the first valuable report.
RESUMEN
Oketsu-night sweat was first mentioned in the “Yi lin gai cuo” by Wang Qing ren and the “Xue zheng lun” by? Tang Rong chuan, but there are few explanations of its disease condition. Thus we made pathological studies in Oriental medicine based on three cases (women), where Oketsu-sho was alleviated with Keppu-chikuo-to modification, and Teitou-gan and Tokaku-joki-to (Tao he cheng qi tang) modification. Common disease conditions were Netsu-sho or heat syndrome (summer incidences, redness, flushing during night sweat), and lower Oketsu symptoms (lower abdominal distention, distention and cramping of the lower abdomen, and increased urinary frequency). The theory of these disease conditions is as follows: During sleep, Wei-energy enters the blood. Because of this, Wei-energy of the body surface becomes asthenia making it easier to break out in sweat. The Wei-energy in the blood is depressed by Oketsu, and heat of Oketsu becomes stronger during the night. This fever heats and evaporates bodily fluids, and as a result fluids are pushed outward and cause night sweat. Therefore heat syndrome appears to be a pre-condition of Oketsu-night sweat. If the lower aspect of the body is taken to mean the liver, one would hypothesize that Oketsu-night sweat is more likely to emerge because blood accumulates in the lower area because it returns to the liver at night. Thus, it is thought to be necessary to consider Oketsu as one of the causes of night sweat.
RESUMEN
Four cases of atopic dermatitis successfully treated with the Kampo formula Tokaku-joki-to are reported. Case 1 was a 25-year-old woman who had been suffering from atopic dermatitis since she was in lower elementary school. She came to our clinic in July of 1992. She complained of intense itching of the neck and area around the mouth. Her abdominal tension was moderate, and there was para-umbilical and caecal tenderness. The patient complained of constipation and dysmenorrhea. After four weeks of Tokaku-joki-to administration, the dermatitis improved markedly. After two years of treatment with this formula, she is progressing favorably.<br>Case 2 was a 14-year-old girl, who had suffered from atopic dermatitis since she was 3 months old. She first came to our clinic in January of 1993. The dermatitis was located in the upper extremities, face and neck. She also had experienced flushing, para-umbilical tenderness and constipation. After two weeks of administration of Tokaku-joki-to, her dermatitis improved remarkably, although she still experienced flushing. Ryokei-mikan-to was added to the formula for the flushing.<br>Case 3 was a 28-year-old woman who had suffered from atopic dermatitis since she was 3 years old. She consulted our clinic in October, 1993. The dermatitis was located on her face and elbow. She had tenderness around the paraumbilical, caecal and sigmoid regions. The patient is progressing favorably with Tokaku-joki-to administration.<br>Case 4 was a 26-year-old woman. She had had atopic dermatitis since she was young, and came to our clinic in October of 1993. The dermatitis was on the upper extremities, face and back. At first we prescribed Toki-inshi, but this formula was not effective. The formula was changed to Tokaku-joki-to and the dermatitis improved remarkably after about three months of treatment.<br>This is the first report of administering Tokaku-joki-to for atopic dermatitis. Based on the clinical study involving the four cases described above, we propose the following indications for use of Tokaku-joki-to for atopic dermatitis: 1) the dermatitis is located on the upper part of the body, 2) there is flushing, with a feeling of coldness in the lower extremities, 3) there is tenderness around the para-umbilical, caecal and sigmoid regions, and 4) there is a tendency towards constipation.
RESUMEN
28 years-old male patient has felt dysesthesia as swelling of forehead, numbness of cheeks and pain of eyes. Dysesthesia has developed gradually.<br>“Fuku-myaku” means the pulse difficult to be palpable. This characteristic pulse and Oketsu symptoms suggested the indications of Tokaku-joki-to and Tokaku-joki-to-go-Daio-botampi-to. As we had found “Fuku-myaku” and oketsu syndrome in this patient, we treated with these kampo medicine according to “Sho” diagnosed by Kampo. The dysesthesia in the patient has been gradually disappeared. At the same time, attacks of asthma which had appeared after discontinuation of Saiboku-to administration have been also disappeared. It is easy to make a mistake that “Fuku-myaku” is for pulse of hypo-functioning condition. But we understand that “Fuku-myaku” is not always for pulse of hypo-functioning condition, but for hyper-functioning condition.
RESUMEN
With recent changes in the structure of society, the pathology of diseases is also changing, which includes an increase in Kampo diagnosis of Tokaku-joki-to. This formulation is now frequently used in my clinic too. I studied the clinical effect of the extract of this formulation in 125 evaluable patients (12 males and 113 females) out of 183 patients who received the extract of this formulation from January to October 1992 on an outpatient basis.<br>The success rates, when shown in the order of the number of patients, were 82% in dysmenorrhea, 74% in hypermenorrhea, 69% in signs and symptoms associated with hypertension, 72% in climacteric disorder, 59% in lumbago, 55% in hot flash with cold feeling of foot, 55% in irregular menstruation, 38% in chloasma, 60% in acne, 57% in hemorrhoid, and 60% in atopic dermatitis. Other disorders included vulvular contusion, prostatic hypertrophy, and sequela of cerebral thrombosis.<br>According to the instructions and the herb components described in the classics (Toueki, this formulation is considered to be effective for Kigyaku (rush of blood to the head) such as anxiety and feelings of heat on the upper body and cold on the lower body. I believe this formulation can be widely applied to disorders caused by problems in modern society, such as a stressful life-style, palatable food, lack of exercise and constipation.