Two Cases of Cesarean Sections Performed with Combined Spinal-Epidural Anesthesia with Perioperative Asthma Attacks / 日本東洋医学雑誌

Asthma attack difficulty breathing rapidly worsens the condition over time. Especially when the condition worsens before surgery, general anesthesia (GA) may be indicated depending on the type of surgery. In Japan, there is a tendency to avoid GA in cesarean section (C/S) due to the risk of difficult intubation, adverse effects on the fetus, and concerns about resuscitation of the newborn. This time, foreign body sensation in the throat (baikakuki) was found in a case of asthma-like attack accompanied by difficulty breathing caused by disturbance symptoms on the day of C/S and in a case of difficulty breathing due to preoperative antibiotic intravenous drip. After oral administration of hangekobokuto to the patients, dyspnea disappeared in either case, and I was able to avoid GA and perform C/S with combined spinal-epidural anesthesia. Considering asthma in Kampo medicine, it is thought that psychoactive predispositions such as anxiety and impatience are the triggers that cause qi counter flow and qi stagnation, which causes phlegm to condense, resulting in baikakuki and symptoms. Therefore, it was thought that hangekobokuto, which remove phlegm, was adapted.

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.

An Effective Case of Keishikajutsubuto and Maobushisaishinto for Arthritis / 日本東洋医学雑誌

We report the case of a 60-years-old man who complained fever and left knee pain. Fever and arthralgia appear once a month, and these symptoms disappear spontaneously in 3 days. The patient came to our hospital to receive Kampo treatment, because the patient experienced improving these symptoms by Kampo medicine about 20 years ago. I judged the arthralgia as kanshippi, because the arthralgia improved when the patient warmed the joint. We prescribed keishikajutsubuto 7.5 g/day. Arthralgia improved after administration of keishikajutsubuto, but the attack appeared every month. We prescribed maobushisaishinto 5 g/day in addition to keishikajutsubuto 5 g/day for further improvement of arthralgia. The frequency of fever and arthralgia attack was dramatically decreased after we prescribed keishikajutsubuto 5 g/day and maobushisaishinto 5 g/day. We considered the possibility of palindromic rheumatism based on clinical symptoms, X-ray in other clinic and blood test results in our hospital. We report an effective case of keishikajutsubuto and maobushisaishinto on arthritis attacks with fever that resolved spontaneously in a short time.

The Effect of Mokuboito in the Puerperium Lung Edema / 日本東洋医学雑誌

Mokuboito is a Kampo formulation consisting of four flavors of Sinomeni Caulis Radix (防已), Gypsum Fi­brosum (石膏), Cinnamomi Cortex (桂皮) and Ginseng Radix (人参). From a modern medical interpretation of the source “Kinkiyoryaku” it can be indicated for pulmonary edema, and if administered early in the onset, respiratory management by tracheal intubation can be avoided, which may contribute to improving the pa­tient's QOL. We experienced 10 cases of pulmonary edema that occurred during the postpartum period and were able to avoid tracheal intubation with mokuboito already. All patients complained of dyspnea and moist rales were heard. Their chest X-­rays showed decreased permeability of the lung field and increased pulmonary vascular shadow, increased cardiothoracic ratio (CTR), costophrenic angle (CP angle) blunting, therefore, they were diagnosed as pulmonary edema. After X-­ray confirmation, mokuboito was administered, and in 6 cases,the subjective symptoms decreased from 7 to 4 in NRS (numerical rating scale), the CTR decreased from 60 to 40%, and CP angle, lung field findings, moist rales also improved. In 3 cases, mokuboito+choreito or mokuboito+choreito+choijokito were administered, and the X-­ray findings were similarly improved. Mokuboito was useful for respiratory management of pulmonary edema during puerperium.

A Case of Pseudoaldosteronism Caused by Tokakujokito During Receiving Insulin / 日本東洋医学雑誌

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.

<b>The Effectiveness of Mashiningan for Constipation in Parkinson's Disease</b> / 日本東洋医学雑誌

We conducted a study to evaluate the efficacy of mashiningan for constipation in Parkinson's disease. Twenty-three patients with constipation in Parkinson's disease were enrolled and were evaluated after 1 month in this study. The mashiningan efficacy endpoint in the study was bowel movement frequency. We categorized treatment effect as “effective”, “ineffective”, and “worsened” to calculate increased, unchanged, and decreased bowel movement frequencies, respectively. Previously administered laxative was also switched to mashiningan and subsequent effect was evaluated as well. Mashiningan was effective in 78.3% of patients, and there were no patients determined to have “worsened”. The only adverse effect was diarrhea which was noted in 13.0% of patients. Mashiningan was effective in 86.7% of the 15 patients without laxative administration history, and was effective in 62.5% of 8 patients who had taken laxative previously. Therefore, mashiningan showed a higher degree of efficacy in the patients off medication for constipation. Additionally, mashiningan could be safely switched to from other laxatives without worsening constipation. In conclusion, mashiningan is a useful medication for the treatment of constipation in Parkinson's disease.

<b>The Efficacy of Yokukansan in Obesity Patients on Overeating due to Anger (a Retrospective S</b><b>tudy)</b> / 日本東洋医学雑誌

We previously reported that a case of yokukansan efficaciousness for weight gain due to overeating behavior following bariatric surgery. The reason is considered that yokukansan stabilized the patient's mental state. So, we proposed that administration of oriental medicines for mental state might be a new way of treating obesity. We investigated the efficacy of mazindol, bofutsushosan or yokukansan for obese patients. We retrospectively reviewed clinical data to identify patients administered mazindol, bofutsushosan or yokukansan for treatment of obesity. The inclusion criteria were patients tolerant to medicine for 3 months, and who could be administered yokukansan for anger. A total of 107 patients met these selection criteria. After 3 months of drug administration, significantly body weight reduction was observed in either the mazindol group or yokukansan group. We also selected and analyzed patients with diabetes mellitus to clarify the efficacy of these drugs for glucose metabolism. Reduction in HbA1c was not significant in the groups. These results suggest that mental health problems are very important for the treatment of obesity. And we suggest that oriental medicine is an effective treatment for mental health in obesity patients.

<b>Saikokaryukotsuboreito is Effective for </b><b>Blepharospasm : A Case Report </b> / 日本東洋医学雑誌

Blepharospasm is classified as a focal dystonia, and involves involuntary contraction of muscles such as the orbicularis oculi muscle and the corrugator muscle, which are associated with eyelid movement. Thus blepharospasm involves difficulties to eyelid opening. A 61-year-old woman came to our hospital complaining of a sense of discomfort of the eyes since a half year earlier. Blepharospasm was diagnosed based on current medical history and neurological examination. Oral saikokaryukotsuboreito was started and the blepharospasm improved gradually. After a week, oral treatment with one-third of the amount of shakuyakukanzoto was added and the blepharospasm further improved. The patient wanted to increase the dose of shakuyakukanzoto and to stop the saikokaryukotsuboreito. Once oral shakuyakukanzoto monotherapy was started, however, the blepharospasm worsened. Oral saikokaryukotsuboreito and low dose shakuyakukanzoto was started again, and her blepharospasm improved again.<br>The mechanism behind a focal dystonia such as blepharospasm is explained as a disorder of the basal ganglia motor loop. Saikokaryukotsuboreito is used for the diseases of the central nervous system. Thus there is the possibility that, here, saikokaryukotsuboreito improved a central nervous system disorder, and the blepharospasm. To our knowledge, this is the first report demonstrating that saikokaryukotsuboreito is effective for blepharospasm. It suggests that saikokaryukotsuboreito is a useful option for the treatment of blepharospasm.

<b>The Effectiveness of Hangebyakujutsutemmato </b><b>for Alzheimer's Type Dementia </b> / 日本東洋医学雑誌

Dementia of the Alzheimer's type, in which cognitive impairment slowly progresses, accounts for more than half of dementia cases. Symptoms develop slowly and worsen over time, and there is no cure for Alzheimer's type dementia. We conducted a study on the efficacy of hangebyakujutsutemmato for cognitive impairment in dementia of the Alzheimer's type. Seventy-two patients with Alzheimer's type dementia were enrolled in our study. Hasegawa dementia scale-revised (HDS-R) was implemented for all patients, for whom hangebyakujutsutemmato medication was started at the initial visit. After 4-weeks' treatment the HDS-R was implemented again. Sixty-four patients were assessable and 8 patients dropped out from the study. In these 64 patients, mean age ± standard deviation was 79.9 ± 6.0, and 33 patients were male, and 31 patients were female. After 4 weeks of hangebyakujutsutemmato treatment, HDS-R scores were increased significantly compared with baseline (from 15.5 ± 5.2 to 16.9 ± 6.2, p < 0.01). In taking histories from families, clinical presentation was shown to have improved in 13 patients (20.3%). To our knowledge, this is the first report demonstrating that hangebyakujutsutemmato is effective for patients with dementia of the Alzheimer's type. In conclusion, hangebyakujutsutemmato is a useful option for the treatment of cognitive impairment in Alzheimer's type dementia.

<b>An Insomniac Patient Case with Myasthenia Gravis under Treatment with Prednisolone Successfully Treated with Saikokaryukotsuboreito </b> / 日本東洋医学雑誌

Benzodiazepines are frequently used for the treatment of insomnia, although these drugs cause dose-related centrally mediated respiratory depression. Moreover, benzodiazepines are contraindicated in patients with my asthenia gravis, so treating myasthenia gravis patients with insomnia is difficult.<BR>A 67-year-old woman developed myasthenia gravis on December 20XX. Her myasthenia gravis went into remission with oral high-dose prednisolone medication and plasma exchange, after which her oral predniso lone medication was continued. On January 20XX+2, she suffered from insomnia. She had poor sleep quality, nocturnal awakenings and middle-of-the-night insomnia. She had high abdominal resistance and fullness, ten derness, and discomfort of the hypochondrium. She was treated with saikokaryukotsuboreito and could then sleep comfortably soon afterwards.<BR>According to the <i>Shang Han Lun</i>, saikokaryukotsuboreito is effective for susceptibility to fright and deliri ous speech. Although our patient had no psychological symptoms such as these, an abdominal palpation examination led to diagnosis of a <i>Sho </i>(indication) for saikokaryukotsuboreito. So we started therapy with saikokaryukotsuboreito and her insomnia began improving immediately. To our knowledge, this is the first report of an insomnia patient with myasthenia gravis successfully treated with saikokaryukotsuboreito. Saiko karyukotsuboreito is not contraindicated in patients with myasthenia gravis. Thus we conclude that saikoka ryukotsuboreito is effective and safe for insomnia patients with myasthenia gravis.

The Historical Development of Theories on Night Sweat Pathophysiology / 日本東洋医学雑誌

Until the Sui Dynasty in China, night sweat and spontaneous perspiration had been thought to be caused by same pathophysiology, that is, lowered superficial resistance by deficiency of Qi.In the Tang Dynasty, these were considered to have different pathophysiologies and a new principle indicated that pathogenic heat caused night sweat.In the Song and Jing Dynasties, deficiency of blood and pathogenic heat by deficiency of Yin was also considered to cause night sweat.In the Jing Dynasty, exogenous pathogens, such as Cold were considered to cause night sweat, which indicated the principle that not only the deficiency syndrome but also the excess syndrome caused night sweat.In the beginning of the Yuan and Ming Dynasties, it was concluded that the deficiency of Yin caused night sweat and the deficiency of Yang caused spontaneous perspiration.In the middle of the Ming Dynasty, another new theory indicated that deficiency of Yang also possibly caused night sweat; therefore we should diagnose abnormal sweat depending on the pathophysiology in each case.In the Qing Dynasty, new theories were established stating that not only exogenous pathogens but also Damp-heat, undigested food and stagnation of blood, all of which are included in excess syndrome, cause night sweat, and that based on which part of the body sweats occurred we might understand pathophysiology of night sweat. The night sweat by Warm-heat, which is different from the one by Wind-cold, was considered to be caused with deficiency of Yin.Thus we conclude that the theories of night sweat developed over time, based on Chinese medical classics.

A Case of Keishito Effective for Shoulder Periarthritis / 日本東洋医学雑誌

A 65-year-old woman had left should pain for two months. She felt moderate pain in the left shoulder and she could not raise her left hand. She was diagnosed with shoulder periarthritis by an orthopedist, but her pain had not improved with medication and rehabilitation. So she came to our hospital. She had left shoulder pain with arthrogryposis and muscle atrophy over the course of the next two months. She had a floating and relaxed pulse with spontaneous sweating, so she was diagnosed with greater yang wind strike per Kampo medicine. Her left shoulder pain was improved with keishito for two weeks, and three months later she could raise her left hand. Greater Yang is characterized by floating pulse, headache, pain in the nape of the neck, chills, fever, general pain, and joint pain. And Greater Yang Wind Strike is characterized by fever, spontaneous sweating, mild chill and relaxed pulse. Keishito is useful for in Greater Yang Wind Strike, and our patient improved with keishito. However, keishito is generally used for the early stage of a common cold, and there have been a few reports that keishito is effective for chronic disease. To our knowledge, this is the first report of keishito being effective for shoulder periarthritis, and we believe that keishito is a valid option for the treatment of chronic pain in Greater Yang Wind Strike.

Tokirikuoto (Dang-Gui-Liu-Huang-Tang) :How it was formulated and its clinical indications seen in Chinese medical classics / 日本東洋医学雑誌

Dang Gui Liu Huang Tang (in the <I>Lan Shi Mi Cang</I> written by Li Dong-yuan) is a common medicine for treating night sweats. We describe its historical development and therapeutic uses. The use of Huan qi (Radix Astragali sen Hedysari) is based on the Han-Sui dynasty medical principle that night sweats are mainly caused by Deficiency of Yang. Herbs to enrich the lood and Yin, Dang gui (Radix Angelicae Sinesis), Seng di huang (Radix Remannia), Shu di huang Radix Rehmannia preparata) were later added because Son dynasty physicians mentioned that Yin deficiency caused night sweats. The addition of heat-reducing herbs, such as Huang lian (Rhizoma Coptidis), was based on the Song dynasty theory that night sweats are caused by pathologic heat in the body, which forces body fluid out of the skin. In the same period, the herbal medicine called Da Jin Hua Wan created by Liu Wansu, and this greatly influenced the principles for treating night sweats. The clearest explanation can be found in the medical treaties <I>Huang Di Nei Jing Su Wen</I>, and <I>Xuan Ming Lun</I>. This medical combination was based on medical theories from a number of historical periods, which may explain its effectiveness. Dang Gui Liu Huang Tang is not effective against types of weak heat (Dan xin xin fa), severe vital <I>Qi</I> Deficiency (Zhang shi yang), or serious deficiency of Yin (Yi xue xin wu). It sometimes hurts Pi and Wei (digestive system). It is useful in the treatment of spontaneous perspiration (Yi xue zheng zhuang, Jin xue quan shu). In summary, this medicine is most effective when the seriousness of heat and Yin deficiency are almost equal and a slight <I>Qi</I> Deficiency exists, or in cases of spontaneous perspiration.