The Significances of Water Volume to Decoct Formulas Described in Classical Chinese Medicine / 日本東洋医学雑誌

Although the descriptions of shigyakukachotanto in “Waitaimiyaofang” and tsumyakushigyakukachotanjuto in “Songban Shanghanlun” are quite similar to each other, the specifications of the dosages of crude drugs and the water volume in the books were considerably different. Focused on the specified water volume to decoct these formulas, each reasonable decocting period was estimated, then the decoctions were prepared using hard water that was common in mainland China. The dosages of aconite root were 2­-fold different between these two formulas, but the contents of aconitine-­type diester alkaloids (ADA) in both decoctions were found in the range of 1.2—1.4­-fold. It was suggested that in order to control the efficacy and the safety of aconite, the decocting period was well regulated by the specification of water volume for decocting at this ancient era. Moreover, the dosages of aconite root and glycyrrhiza in bukuryoshigyakuto (BSGT) formula of “Songban Shanghanlun” are equal to those of shigyakuto (SGT) but the specified water volume to begin decocting is as about twice as that of SGT. When prepared using hard water, BSGT resulted to make the contents of ADA lower and those of non-­ester alkaloids higher compared with those of SGT decoction. It was suggested the spe­cific water volume for each formula prescribed in classical Chinese medicine had considerable significance to determine the dosages of chemical ingredients in the decoctions especially in the circumstances using hard water to prepare them.

A Case with Short Bowel Syndrome Successfully Treated with Shigyakuto-kagen / 日本東洋医学雑誌

We present a patient with short bowel syndrome (SBS), successfully treated with the Kampo medicine, shigyakuto-kagen. The patient was a 74 year old female complaining of severe diarrhea, abdominal distention, and abdominal pain. She was diagnosed as having tuberculous peritonitis when she 23 years of age. A partial resection of the small bowel and colon was performed for ileus, secondary to her tuberculous peritonitis, eventually causing her short bowel syndrome (SBS). Severe abdominal distention and pain had persisted even after the resection surgery. She consulted our clinic at 60 years of age in order to receive Kampo therapy. Bukuryoshigyakuto was prescribed, and her condition markedly improved. Zanthoxylum piperitum was added to bukuryoshigyakuto, and the regimen had the reactivity of daikenchuto. She regained her pre-operation body weight. It is significant that this case was followed for 14 years with therapy based on Kampo diagnosis, without remarkable complications, although patients with SBS often tend to have poor prognosis.

The Role of Roasted Glycyrrhiza Root in the Main Prescriptions for Shoinbyo (shao yin bing) / 日本東洋医学雑誌

Patients suffering through a period of shoinbyo (shao yin bing) must essentially be treated for impaired renal function. Formulations commonly prescribed during this period can be divided into two categories: the Shigyakuto (si ni tang) group which includes Glycyrrhizae Radix, and the Hakutsuto (bai tong tang), Hakutsukachotanjuto, Shimbuto (zhen wu tang) and Bushito (fu zi tang) groups, which do not include roasted Glycyrrhizae Radix. In order to understand the significance of Glycyrrhizae Radix, we have examined symptomatic differences in life-threatening situations, by comparing Shigyakuto and Hakutsuto formulations, based on both previous cases, and our own clinical studies.<br>Shigyakuto is composed of roasted Glycyrrhizae Radix, Zingiberis Siccatum Rhizoma, and crude Aconiti Tuber, while Hakutsuto is composed of Allii Fistulosi Bullbus, Zingiberis Siccatum Rhizoma, and crude Aconite Tuber. These formulations activate renal function, as well as gastroenterological function (bu pi wei). Which function is affected dominantly, however, appears to be dependent on whether roasted Glycyrrhizae Radix is included. In the Shigyakuto group of formulations which include Glycyrrhizae Radix, the activation of gastroenterological function is greater than that of renal function, whereas in the other formulation groups which do not include Glycyrrhizae Radix, activation of renal function is greater. This treatment principle can be applied not only in the acute phase of shoinbyo, but in the chronic phase as well. Therefore we believe that roasted Glycyrrhizae Radix has an important role in the effective Kampo treatment of patients suffering through periods of shoinbyo.