Résumé
We investigated the effectiveness of hangekobokuto in alleviating dysphagia and aspiration pneumonia attributed to latestage neurosyphilis. Our study subject, a 67-year-old man treated for his leg pain in our department, hoped this treatment would relieve his severe cough and sore throat. According to a neurological investigation and the analysis of blood and cerebrospinal fluid, his symptoms (swallowing disturbance and aspiration pneumonia in the lower lobes of both lungs) led to the diagnosis of cerebral bulbar paralysis caused by latestage neurosyphilis. The patient requested drug therapy ; thus, we prescribed 7.5 g/day of hangekobokuto, to be administered orally, based on his medical findings of qi stagnation and tan yin. Dysphagia was relieved one week after oral administration of hangekobokuto, and after three weeks, the patient's discomfort had almost disappeared. Moreover, aspiration pneumonia was also improved in his chest CT image finding. Late-stage neurosyphilis symptoms usually develop within 20 to 30 years of contracting syphilis, an infection caused by the bacterium Treponema pallidum. Symptoms may include a loss of swallowing reflex and cough reflex due to the paralysis of cerebral basal ganglia. However, hangekobokuto was found to increase the concentration of substance P released in the pharyngeal head and tracheal mucosa, and thus improve swallowing function. We conclude that hangekobokuto is a useful agent for alleviating the swallowing abnormality of late-stage neurosyphilis.
Résumé
<b>Background:</b> Kampo medicine is the traditional form of medicine practiced in Japan, based on ancient Chinese medicine. Kampo medicine includes acupuncture and moxibustion, as well as herbal medicine. Physicians are allowed to prescribe ethical Kampo extract granules used in various formulae and practice acupuncture and moxibustion as acupuncturists and moxibustionists. However, medical schools do not offer many classes in traditional medicine. This study aims to analyze the use of Kampo formulae and practice of acupuncture and moxibustion in contemporary community health care.<br><b>Methods:</b> The subjects (1538 clinicians) were graduates of Jichi Medical University on or after 1978, affiliated with a clinic or hospital with 300 beds or less on July 2010, and surveyed by postal questionnaire in October 2010.<br><b>Results:</b> The effective response rate across Japan was 44% (n=679). Of these responders, 30%, 45%, and 22% were found to prescribe Kampo formulae regularly, occasionally, and rarely, respectively, in daily clinical care. Frequently prescribed formulae included shakuyakukanzoto, daikenchuto, kakkonto, rikkunshito, and hochuekkito. The reasons for using Kampo formulae given by 61% and 58% of the responders were, respectively, applicability for common diseases and ease of use for unidentified complaints and psychosomatic disease. Among the reasons for unlikely use, unclear applicability was chosen by 34% of the responders; difficulty stocking many formulations by 33%; and insufficient evidence of efficacy by 30%. Practitioners of acupuncture and moxibustion accounted for 4% of the responders. The main indications for acupuncture and moxibustion included low back pain and shoulder stiffness.<br><b>Conclusions:</b> A large number of primary care physicians use Kampo formulae, implying their usefulness. However, one out of three physicians complains of unclear applicability and insufficient evidence of efficacy for Kampo formulae. In the future, appropriate education and research will be needed to clarify these issues.