Current research and future directions in pattern identification: Results of an international symposium / 中国结合医学杂志

A symposium on pattern identification (PI) was held at the Korea Institute of Oriental Medicine (KIOM) on October 2, 2013, in Daejeon, South Korea. This symposium was convened to provide information on the current research in PI as well as suggest future research directions. The participants discussed the nature of PI, possible research questions, strategies and future international collaborations in pattern research. With eight presentations and an extensive panel discussion, the symposium allowed participants to discuss research methods in traditional medicine for PI. One speaker presented the topic, 'Clinical pattern differentiation and contemporary research in PI.' Two speakers presented current trends in research on blood stasis while the remaining five other delegates discussed the research methods and future directions of PI research. The participants engaged in in-depth discussions regarding the nature of PI, potential research questions, strategies and future international collaborations in pattern research.

Blood stasis syndrome in Japan and its molecular biological analysis / 中国结合医学杂志

Blood stasis syndrome is one of the pathological concepts of Oriental traditional medicine. In Oriental traditional medicine, blood is thought of as not only blood but also as a living component of the body. In fact, blood stasis syndrome is related to not just circulation disorders but dermatological and gynecological and other diseases. In Japan, the concept of blood stasis syndrome is based on the past literature, for instance, Synopsis of Golden Chamber (Jin Kui Yao Lue), etc. There are many signs of this syndrome, such as a dry mouth, fullness of the abdomen and rough skin. However, the levels of importance of these signs had been unclear. Therefore, in order to determine the levels of seriousness, a scoring system of blood stasis syndrome was made based on multivariate analysis by Dr. Terasawa (Terasawa's Blood Stasis Score). Using the scoring system, we have studied blood stasis syndrome mainly related to blood circulation using modern techniques of analysis. From the results, we found that patients with blood stasis syndrome showed hemorheological abnormalities, and an improvement in these abnormalities was shown after administration of removing-blood stasis formulae. Furthermore, we have studied blood stasis syndrome from the point of view of molecular biology. We searched for the specific protein expression in blood stasis syndrome by proteomic analysis, and found no specific protein expression. However, there may be a possibility of developing a diagnostic algorithm for blood stasis by construction of a decision tree. During the past few years, as one of the molecular biological factors affecting blood stasis syndrome, we have been studying hypoxia inducible factor, which is located in the upstream of many genes. Above all, blood stasis syndrome is more than just circulatory deficit but encompasses the pathological concept of constant multilateral change in the living body.

Keishikashakuyakuto Ameliorated Diverse Autonomic Symptoms such as Diarrhea, Abdominal Pain,Urinary Retention and Orthostatic Hypotension in a Case of Pure Autonomic Failure / 日本東洋医学雑誌

Pure autonomic failure (PAF) is a degenerative disorder with diverse autonomic nervous symptoms, but without somatic nervous symptoms. We encountered a patient with PAF who was successfully treated with keishikashakuyakuto. A 61-year-old man complained of diarrhea, abdominal pain, dysuria and orthostatic hypotension. PAF was strongly suspected, based on a low level of plasma noradrenalin at rest and a finding of severe diffuse sympathetic nerve injury on <SUP>123</SUP>I MIBG myocardial scintigraphy. Various Kampo formulas were not effective, or could not be administered continually. Urinary retention was treated with self-catheterization. After the extract of keishikashakuyakuto was administered, his complaints of diarrhea and abdominal pain gradually decreased, and he was able to eat various kinds of food. His daily living activities improved.Moreover, he could urinate by himself, so the self-catheterization was stopped. Five years later, the diagnosis of PAF was clinically confirmed, but his daily living activities did not deteriorate. This suggests that keishikashakuyakuto can be effective for diseases with diverse autonomic nervous symptoms, such as the present case.

Two Cases of Postherpetic Neuralgia Recurring after Withdrawal of Kampo Medicine Including Uzu / 日本東洋医学雑誌

We experienced two cases of postherpetic neuralgia (PHN) improved with Kampo medicines that include uzu (i.e. uzu-zai).The pain from PHN was improved via the administration of an uzu-zai in these 2 cases, worsened by its discontinuation, and improved again by its re-introduction.Case 1 : A 76-year-old male suffering from PHN of the right L 2-3 area was administered uzukeishito and obtained pain reduction. After 12 months, his prescription was changed from uzukeishito to keishikaryoju-tsubuto. Then, after only 2 days his pain worsened again. Uzukeishito treatment was re-instated, and he again obtained pain reduction. Case 2 : An 82-year-old male suffering from PHN of the right C 4-5 area was given uzuto and obtained pain relief. After 3 months his prescription was changed from uzuto to keishikajutsubuto. Then, after only1week his pain worsened again. Uzuto was then re-introduced, and pain reduction was achieved again. These two cases led to two suggestions. First, that the uzu-zais were very effective against the PHN pain. Second, that this effect of an uzu-zai against PHN pain might be a symptomatic rather than a radical treatment.These two cases highlight the fact that the use of an uzu-zai was instrumental in reducing PHN-associated pain, but further studies will be needed to determine a dosage protocol, including when and at what pace uzu-zais might be reduced/discontinued.

Trial of the Treatment of Kampo Medicines for Thalamic Pain / 日本東洋医学雑誌

Thalamic pain is known as intractable central pain caused by thalamic bleeding and infarction. Although some physical and surgical therapies have been tried, there is no established method for its improvement. We attempted the treatment of 6 cases of thalamic pain, and 4 of them showed improvements in their symptoms. Our patients were aged 27-70 years, 4 men and 2 women. Their diagnoses were 3 cases of right thalamic bleedings, 1case of left thalamic bleeding, and 2 cases of right thalamic infarctions. The periods from onset to consulting our department were from6months to 12 years. In the 4 cases whose symptoms improved, the symptoms had almost disappeared or were decreased by at least 40%. These improved cases used formulas containing uzu or bushi. Yokukansankachimpihange was effective for two cases with mental disturbances. One case showing major improvement was treated by only the formula against oketsu. The cases whose symptoms had continued for a long time were more intractable, with the symptoms remaining to some degree in spite of their decreasing tendency. Finally, in intractable cases, their symptoms remained fixed and they had severe paralysis.

Case Reports of Polymyalgia Rheumatica Successfully Treated with Kampo Medicines / 日本東洋医学雑誌

We report 5 patients with polymyalgia rheumatica (PMR) successfully treated with Kampo medicines. In total, we investigated 10 patients with PMR, including the 5 patients here treated in our department. Results showed that Kampo medicine was effective in 6 cases. One of the 6 refused steroid drug administration, and tapering dosage steroid was difficult in the other 5 patients due to myalgia or inflammation. Except for one case, C-reactive protein in most of the effective cases was below 3.0 mg/dl. On the other hand, the non-effective cases had severe inflammation levels and needed steroid therapy. The effective cases were treated with sokeikakketsuto, tokakujokito, keishibukuryogan, choyotokasyakuyaku, yokuibushihaishosan and tokishakuyakusan, which have the effect of improving oketsu states. Thus, it was considered that Kampo medicine has the potential for treatments in PMR patients who have difficulty tapering steroid dosage and mild inflammation. Moreover, this suggests Kampo medicines that improve oketsu state are useful for PMR treatment.

Two Cases of Water Polo Athletes Successfully Treated with the Acupuncture and Moxibustion Therapy / 日本東洋医学雑誌

Recently, the number of athletes who receive acupuncture therapy is increasing. However, most of these athletes receive acupuncture therapy with single-acupuncture and/or electro-acupuncture to a local point, or a trigger point. We experienced two water polo athletes who were improved using acupuncture and moxibustion therapy with “zuisho” therapy. Case 1 was 16 year old man. He became aware of pain in his right thumb after training, which continued with extended training time, a numbness in his left hand appeared more, and he received acupuncture and moxibustion therapy. These symptoms disappeared immediately with acupuncture and moxibustion therapy using the standard traditional methods, such as contact needling to a yuan point, and in situ acupuncture to a back shu point, etc. Case 2 was 17 year old man. He received acupuncture and moxibustion therapy for lumbago and stiffness of the neck. These symptoms disappeared immediately after acupuncture and moxibustion therapy using the standard traditional methods such as contact needling to a yuan point, and inserting needles into a back shu point, an extra meridian, etc. In these two cases, symptoms were improved with “zuisho” therapy, and both could continue with longer and more strenuous training. This suggests that acupuncture and moxibustion therapy using the standard traditional methods are useful for athletes.

Three Cases of Urinary Incontinence Successfully Treated with Ryokyojutsukanto / 日本東洋医学雑誌

Recently, QOL has become an important consideration when giving medical treatment. The development of treatments for urinary incontinence, a condition which greatly affects QOL, however, has been late in coming, because there are few critical symptoms. We experienced three cases of urinary incontinence successfully treated with ryokyojutsukanto. Case 1 was a 63-year-old woman. She had developed stress urinary incontinence (SUI) from about 30 years of age. As she came to be aware of lumbago and numbness of legs, she sought Kampo treatment. Tokishakuyakusangoninjinto was ineffective, but her all symptoms were improved with ryokyojutsukanto. Case 2 was a 46-year-old woman. She had become aware of incontinence after delivery of her first child (at 27 years of age), and she received Kampo treatment for lumbago and her incontinence. Tokishakuyakusankabushi was slightly effective for her lumbago, but ineffective for her incontinence. These symptoms were improved after a change to ryokyojutsukanto. Case 3 was a 70-year-old woman. She developed a bladder/bowel disturbance, and mixed urinary incontinence (MUI) caused by conus syndrome with a compression fracture of Th12 vertebral body. With ryokyojutsukanto, her fecal incontinence disappeared, and her lumbago and urinary incontinence showed a tendency toward improvement.

Three Cases of Recurrent Respiratory Tract Infections in Tube-feeding Elderly Patients Treated with Acupuncture / 日本東洋医学雑誌

Case1was a 91-year old man diagnosed with multiple cerebral infarctions. He had undergone percutaneous endoscopic gastrostomy in the same year. One year later, we initiated acupuncture treatment because of recurrent respiratory tract infections. The acupuncture points selected were LU 5, Chize and KI 13, Taixi. Before acupuncture, the frequencies of antibiotics-use and feverish days were 6.3 days and 2.7 days per month on average. During acupuncture therapy, these frequencies were reduced to 1.2 days and 0.6 days per month, respectively.Case 2 was an 81-year old man diagnosed with right thalamic hemorrhage. He underwent percutaneous endoscopic gastrostomy in the same year. After 6 months, we began acupuncture treatment, also because of recurrent respiratory tract infections. The acupuncture points were the same as in Case 1.Prior to acupuncture, antibiotics-use and feverish days were 8 days and 4.5 days per month, which were then reduced to1and 0.6 days per month, respectively.Case 3 was a 93-year old man diagnosed with dementia. He was being fed via nasoenteric tubes. After 3 months, again because of recurrent respiratory tract infections, acupuncture treatment was begun. The acupuncture points were the same as in Cases 1 and 2.His use of antibiotics and feverish condition were 9 days and 10 days per month on average before acupuncture, but with acupuncture therapy these were improved to 2 days and 1.3 days per month.Based on this experience, it is suggested that acupuncture be considered for the treatment of recurrent respiratory tract infections in elderly, tube-fed patients.

Effect of Keishibukuryogan on Silent Brain Infarction over 3 Years / 日本東洋医学雑誌

The purpose of this study was to evaluate the effect of keishibukuryogan (KB) against the cognitive symptoms associated with silent brain infarction in a prospective cohort study. The subjects were 93 patients with silent brain infarcts who visited the Department of Japanese Oriental Medicine, University of Toyama, and its allied hospitals. They consisted of 24 males and 69 females, mean age (± S.E.) 70.0±0.8.Group SK (n=51) consisted of patients who used KB extract for more than6months per year. Group SC (n=42) consisted of patients who did not use Kampo formulas. The NS group (n=44) consisted of elderly subjects who had no silent brain infarction, 21 males and 23 females, with a mean age (± S.E.) of 70.7±0.7 years. Among the three groups, the revised version of Hasegawa's dementia scale, apathy scale and self-rating depression scale were compared between the study start and after three years. In the SK and SC groups, these scores, and the subjective symptom levels (head heaviness, headache, dizziness or vertigo, stiff shoulder) were also studied. The results showed that the self-rating depression scales at study start for the SK and SC groups were significantly higher compared to the NS group. In spite of the scores for the NS group increasing after three years, the SK group scores were significantly decreased compared to the SC and NS groups. KB was effective against head heaviness, which often complicates silent brain infarction. In the above mentioned, KB was effective in treating cognitive disorders and subjective symptoms related to silent brain infarction.

A Case of Adhesive Ileus Successfully Treated with Shojokito / 日本東洋医学雑誌

We report a case of recurring adhesive ileus that was successfully treated with shojokito (decoction) without inserting a nasogastric tube. The patient was a 75-year-old male who had been treated for abdominal symptoms in our department after a laparotomy. He visited our hospital mainly for complaints of abdominal pain and distention, was diagnosed with adhesive ileus because of a niveau image upon abdominal X-ray, and was hospitalized the same day. We diagnosed him as Yang syndrome and excess syndrome because he had thick yellow fur of the tongue, and administered shojokito. He broke wind at 40 minutes after administration of shojokito, and had bowel movement two hours later. Furthermore, he had mass diarrhea after another administration of this formula, and the niveau image disappeared the next day. It is often considered that an ileus develops with Cold, for which daikenchuto is prescribed frequently. However, in some cases cold purgative formulas such as jokito group may be effective, if such cases are Yang syndrome and excess syndrome, and present with yellow fur of the tongue.

A Case Report of an Obstinate Belch Successfully Treated with Goshuyuto / 日本東洋医学雑誌

We report a case of an obstinate belch successfully treated with goshuyuto. The patient was a 74-year-old female. She had been hospitalized seven times in the past due to the belch, abdominal distention and anorexia, and had been prescribed various Kampo formulas. But her symptoms fluctuated up and down. The obstinate belch essentially disappeared after administering goshuyuto, and her appetite improved. Many of Kampo formulas that treat belchs are related to Shoyobyo (shao yang bing), but we consider that goshuyuto may be effective for a belch, which is yin-related and accompanied with stiffness and rigidity below the heart, and fullness in the chest and hypochondrium.

Two Cases of Numbness and Pain of Neuropathy due to ANCA-associated Vasculitis Successfully Treated with Ogikeishigomotsuto / 日本東洋医学雑誌

We report two cases of numbness and pain of neuropathy due to ANCA (antineutrophil cytoplasmic antibody)-associated vasculitis successfully treated with Ogikeishigomotsuto. The first case was a 57-year-old female who complained of high fever, painful skin eruptions of the lower limbs, and proteinuria. Although the severe pain was reduced with steroid therapy, neuropathy-related numbness and pain remained widespread in her lower limbs. After we prescribed Ogikeishigomotsuto, most of her pain disappeared while her degree of numbness diminished by almost half in two weeks. In addition, her steroid therapy could be tapered off without adverse effect. The second case was an 82-year-old female with fever and myalgia. Although myalgia of the upper arm disappeared with steroid treatment, walking became difficult due to numbness from the lower legs, to the soles of her feet. With Ogikeishigomotsuto administration, she became better able to walk because her legs had warmed up, and the range of her numbness had decreased. These cases suggest that Ogikeishigomotsuto may be effective against numbness and neuropathic pain due to ANCA-associated vasculitis.

Clinical Indications of Kumibinroto / 日本東洋医学雑誌

Kumibinroto is a Kampo formulation which was first produced by Sohaku Asada (1815-1894) and which has since been used for patients with stasis of body fluids presenting beriberi like symptoms. Previously, we reported that tympanic sounds on right side of the abdomen might be an indication for the use of kumibinroto. In this study, having both symptoms with stasis of body fluids, and tympanic sounds on right side of the abdomen were used as a target when prescribing kumibinroto. To the best our knowledge, the present study was the first to demonstrate that the effects of kumibinroto give significant improvement in dermatological disorders such as chronic prurigo, cutaneous pruritis and chronic urticaria, and susceptibility to chills. These findings suggest that tympanic sounds on right side of the abdomen may an extremely useful indicator for kumibinroto, and position it for practical use for various disorders, for which it has not been formerly used.

Four Cases of Panic Disorder Successfully Treated with Shishi-hakuhi-to / 日本東洋医学雑誌

Shishi-hakuhi-to was prescribed for four patients with panic disorder and sleep disturbance who requested the extract. As indications for the usage of this formulation, discomfort and restlessness of the chest for which Gardeniae Fructus has proved efficacious against, were used. Symptoms such as palpitation, chest discomfort, hot flash, anxiety and insomnia improved promptly with Shishi-hakuhi-to administration. The four patients had several common points, that is, menopause, hot flash and dysesthesia, but no agoraphobia. So far, Shishi-hakuhi-to had been used for liver dysfunction and dermatological diseases. Our results suggest that Shishi-hakuhi-to might be useful for cases with psychiatric diseases such as panic disorder.

Three Cases of Bronchial Asthma Successfully Treated with Seisho-ekki-to / 日本東洋医学雑誌

We prescribed Seisho-ekki-to for three bronchial asthma patients, with poor control of their attacks. Markers used to assess the efficacy of this formulation were sensations in the throat, palpitation and spontaneous sweating. All these markers improved rapidly, with Seisho-ekki-to administration. All three patients and several factors in common, namely; being middle-aged, having attacks that arise throughout the year, epigastric discomfort, fullness of the upper abdomen and pulsation near the umbilicus. Furthermore, a cessation or significant decrease in numbers of asthma attacks seen was brought about with Seisho-ekki-to medication. Up until now, Seisho-ekki-to has usually been used to treat summer heat syndrome. It appears, however, that Seisho-ekki-to may also be applied in the control of bronchial asthma, in the middle-aged.

Rapid Effect of Kei-kyo-so-so-o-shinbu-to Recurrent Phase of Rheumatoid Arthritis / 日本東洋医学雑誌

We report a case of rheumatoid arthritis (RA) that was successfully treated with Kei-kyo-so-so-o-shinbu-to. A 56-year-old woman had been receiving treatment in our department for RA since 1992, and polyarthralgia and multi-joint swelling had become exacerbated from the beginning of April 2003. C-reactive protein and erythrocyte sedimentation rate were elevated. She was hospitalized on_??_, but even with some Kampo formulas, these levels did not improve. The epigastric region was extended and appeared to be in a state of “Hotori-senpai” from _??_, and the administration of Kei-kyo-so-so-o-shinbu-to was begun on _??_. From the next day, pain, swelling of joints, and the “Hotori-senpai” status began to improve, as did the inflammatory reactions. Thus, it was considered, when Kei-kyo-so-so-o-shinbu-to was prescribed, focusing on the “Hotori-senpai”, “Ki-bun” and “Sui-in” status of this patient, that this prescription exerted immediate favorable effects.

Experimental Application of Jiin-koka-to to Cases of Bronchial Asthma / 日本東洋医学雑誌

The source of the herbal mixture named Jiin-koka-to is Wan bing hui chun. Jiin-koka-to has been used mainly as a decoction for the treatment of bronchitis and tuberculosis. The cases of bronchial asthma treated with Jiin-koka-to in this report had similar symptoms: abnormal sensations in the throat and irritation. We investigated the efficacy of Jiin-koka-to in 11 asthma patients having both symptoms. Improvements were observed in all patients; these improvements included reduction of peripheral eosinophil count and serum IgE, loss in quantity of prednisolone, increment of peak expiratory flow rate, and cessation or decrease of asthma attacks. Thus, it is possible that Jiin-koka-to is a controller rather than a reliever in the treatment of bronchial asthma. Abnormal sensations in the throat and irritation might be one of the indications for Jiin-koka-to.

Cases Report of Kumi-binro-to / 日本東洋医学雑誌

Kumi-binro-to is a Kampo formulation produced by Sohaku Asada. It has been used for patients with stasis of body fluids presenting beriberi-like symptoms. The cases in this report where Kumi-binro-to was effective had symptoms similar to the cases where it was ineffective, but they had different distributions of tympanic sound in the abdomen.<br>We investigated the efficacy of four weeks of treatment with Kumi-binro-to in 30 cases having both symptoms of stasis of body fluids and tympanic sound in the abdomen. Kumi-binro-to was effective in 20 of 25 cases that had the tympanic sound in the right iliac, flank and subphrenic regions. However, Kumi-binro-to was not effective in 5 cases where the tympanic sound was restricted to the epigastrium, left iliac, flank and subphrenic regions. Tympanic sound on the right side of the abdomen might be one of the indications for Kumi-binro-to.

A Study on a Quantity of Imbibition of Natural Medicines at Boiling / 日本東洋医学雑誌

As many natural medicines absorb water at boiling, yields of the decoctions are affected by absorbed water. Therefore, we examined the quantity of imbibition of each crude drug at boiling. We used 75 kinds of crude drugs. After boiling 600ml of water, each natural medicine was boiled for 70 minutes. The medicine was left for 60 minutes, and then boiled again for 20 minutes. The quantity of imbibition of each natural medicine was measured at 10, 20, 30, 40, 60, 130, and 150 minutes. The maximum data among the quantity of imbibition at each point was labeled “maximum quantity of imbibition.” With regard to the maximum quantity of imbibition in natural medicines of plant origin, the range was from a maximum of 69.10g in Chrisanthemi Flos to a minimum of 3.26g in Persicae Semen. The average maximum quantity of imbibition was 22.51±13.00g, and there were large differences among each of the natural medicines. The quantity of imbibition at 10 minutes or 20 minutes was above 80% of each maximum quantity of imbibition on many crude drugs, but that gradually increased over the time course for some crude drugs.