A Case Report of Fever of Unknown Origin Successfully Treated with Saikatsugekito / 日本東洋医学雑誌

A42-year-old man presented with a history of tidal fever almost every evening to night with 10-year duration. We could not find out the cause of his fever, so we thought he was classified in fever of unknown origin. The patient suffered from an anhydrosis phase during the temperature rose, but his fever broke after perspiration occurred at the end. The lack of perspiration with fever is a typical symptom of excess pattern of tai yang stage, and fever at night is suggestive of shao yang stage. Saikatsugekito was thought to be best suited as it would address both stages. The formula promoted perspiration, and the body temperature remained stable thereafter. It is not unusual to encounter complicated symptoms due to combined or overlapped pattern in clinical setting. This case represented successful outcome by identifying and analyzing the concept of gobyo and heibyo and prescribing a formula accordingly.

A Case of Erythema Nodosum Successfully Treated with Seinetsuhokito and Byakkokakeishito / 日本東洋医学雑誌

We experienced a case of erythema nodosum of unknown etiology successfully treated with therapy based on Kampo diagnosis. The case was 44 year-old woman who had erythema nodosum over her bilateral leg extensors several times a month, became cold easily and had stomatitis. At first, we administered seinetsuhokito, which resulted in the disappearance of her stomatitis. However, she still had a recurrence of her erythema nodosum. Because of a condition of interior heat and qi counterflow, we considered her situation heibyo. We administered seinetsuhokito and byakkokakeishito every other day, which resulted in the disappearance of both her stomatitis and erythema nodosum. Therefore, we suggest that it is worthy to think about heibyo situations, when treating patients with complications.

A Case of Subacute Thyroiditis Satisfactorily Treated with Kampo-therapy / 日本東洋医学雑誌

We report the case of a 77-year-old female with subacute thyroiditis who was successfully treated with traditional herbal medicine (Kampo-therapy). On 18th December 2001, the patient was admitted to our hospital because of malaise and loss of appetite.<br>The patient complained of what she thought was a sore throat that began one month prior to admission, with a fever rising to 37.8°C 4 days before admission. Physical examination showed tenderness and swelling of the thyroid. Blood examination showed hyperthyroidism (TSH 0.02μIU/ml fT₃ 20.18ng/dl fT₄ 5.21ng/dl) and high inflammation (CRP 13.7 ESR 122mm/hr). We then diagnosed subacute thyroiditis and treated her with Kampo-therapy only. We arranged herbs according to the “Sho-kan-ron (_??__??__??_)” and gave her Keishi-ni-eppi-ichi-to (_??__??__??__??__??__??__??_) and Choi-joki-to (_??__??__??__??__??_). Four days after admission, her intermittent fever disappeared. After 10 days, her CRP became negative. After 13 days, almost all the symptoms had disappeared. Thyroid function (fT₃, fT₄) returned to normal after 17 days of Kampo-therapy. Subacute thyroiditis is a self limiting disease, but steroid therapy is often needed to reduce the symptoms and avoid thyrotoxicosis. In this case, the patient made a relatively quick recovery without steroid therapy. We suggest Kampo-therapy can be an effective treatment for subacute thyroiditis.

The Practical Use of Asada's Saikatsugekito from the Viewpoint of "Heibyo" / 日本東洋医学雑誌

Asada's Saikatsugekito, which is a mixture of ginseng-and jujube-free, but gypsumadded Shosaikoto-Kakkonto mixture, is thought to be used for the Heibyo of Taiyobyo and Ritekisyoyosho according to its composition and the contents of the description in its source. On the other hand, in the treatment of Heibyo, Senhyogori may be the therapeutical principle for such a pathological condition according to that for Taiyobyo and Yomeibyo, but the present treatment is thought to be exceptionally beneficial due to the effect of Hyorisokai. The present case of cold syndrome, which initially was supposed to be Maotosho, was diagnosed, on the day after its first examination, as transferred to Ritekisyoyosho, i. e. Heibyo of Taiyosho and Ritekisyoyosho. The present treatment caused its symptomatic remission in a short period of time. This may be indicative of the significance of the present treatment for such a state of Heibyo of Taiyobyo and Ritekisyoyosho. From the viewpoint of Heibyo treatment, we should bear in mind that some exceptional use, such as in the present treatment, may be practical in consideration of the therapeutical principle.