A Case Report of Infant Alopecia Areata Successfully Treated with Rokumigan Modified Formula / 日本東洋医学雑誌

We report a case of a 3-year-old girl who suffered from alopecia areata and was successfully treated with rokumigan modified formula. Initially, alopecia areata appeared on her left temporal region at the age of 3. The hair loss range had spread rapidly over the whole head. She visited our Kampo clinic because of insufficient effect of antiallergic drug. We prescribed her yokukansan, shimotsuto and juzentaihoto but the effect was insufficient. Finally, we thought this might be caused by kidney yin deficiency and liver blood deficiency because she had symptoms of pale white complexion, fine pulse, pale tongue with thin fur, and night sweating. Therefore, we administered rokumigan modified formula : rokumigan, tokiinshi and lycium fruit. Her hair began to grow after administering this formulation. There was not the re-hair loss during taking medicine for about 4 months. According to the traditional Chinese medicine, alopecia areata can be classified into 4 types : blood heat type, blood stasis type, dual deficiency type of yin and blood, dual deficiency type of qi and blood. We diagnosed this case as a dual deficiency type of yin and blood and selected rokumigan modified formula. Rokumigan is effective for various symptoms of kidney yin deficiency, and rokumigan modified formula may be useful for the treatment of infant alopecia areata.

Embryological Consideration of Half-exterior Half-interior / 日本東洋医学雑誌

We sought a connection between the half-exterior half-interior symptoms (hanpyo hanri sho), mentioned in the classic Chinese Shang han lun text and used in Kampo medicine, and embryology. An agreement between these shao yang (lesser yang) symptoms, and embryonic brachial arch domains was found. A part of the brachial arches strongly agrees with the ruling domain from the trigeminal nerve to the vagal nerve, and a connection was also seen to the vestibulocochlear nerve and partly to the accessory nerve. Thus we believe that half-exterior half-interior symptoms are a condition which relate back to part of the brachial arches, and are a result of so-called Heat reaction. Shang han lun Chinese medicine and embryology are two completely different fields. However, we consider an embryological view of nerve pathways to be helpful in understanding half-exterior half-interior symptoms, at least to a certain degree.

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 Rheumatoid Arthritis with Malaise after Taking Methotrexate Treated with Toki-shakuyaku-san-ka-bushi / 日本東洋医学雑誌

We treated one rheumatoid arthritis (RA) patient with Toki-shakuyaku-san-ka-bushi. A 51-year-old woman was diagnosed as RA in another hospital and was treated with salazosulfapyridine (SASP) and methotrexate (MTX). She was living a restricted daily life while taking MTX. She had to lie down for almost 48 hours after taking MTX once a week because of general fatigue. She was also suffering from depression. After the administration of Toki-shakuyaku-san-ka-bushi, her malaise after taking MTX and her depressive-mood disappeared. Her quality of life improved measurably.

Two Elderly Cases of Deviant Sexual Behavior Successfully Treated with Keishi-ka-ryukotsu-borei-to / 日本東洋医学雑誌

We report on two elderly patients in the extended care unit who were successfully treated with Keishi-ka-ryukotsu-borei-to for sexually deviant behavior. Case 1 was a 71-year-old male hospitalized for rehabilitation after surgery for benign prostate hypertrophy. He began to masturbate soon after hospitalization, which made caregivers and other patients very uncomfortable. After the administration of Keishi-ka-ryukotsu-borei-to, his masturbation behavior disappeared. Case 2 was a 90-year-old male hospitalized for rehabilitation after cerebral infarction. He began using obscene expressions and trying to touch female patients about half a year after being hospitalized. His sexually deviant behavior decreased after the administration of Keishi-ka-ryukotsu-borei-to. This strongly suggests that Keishi-ka-ryukotsu-borei-to is useful in the treatment of dementia-related deviant sexual activity in senior citizens.

Two Elderly Cases of Copious Sweating Successfully Treated with "Furidashi" Extract of Astragali Radix / 日本東洋医学雑誌

We report on two elderly patients in the extended care unit who were successfully treated with “Furidashi” extract (an extraction method of dipping in hot water) of Astragali Radix, for copious sweat. Case 1 was a 65-year-old male hospitalized for rehabilitation after cerebral hemorrhage. He needed a change of clothes three or four times a day because of copious sweat. After administration of Hochu-ekki-to and “Furidashi” extract of Astragali Radix, his sweat decreased. Case 2 was a 66-year-old female hospitalized for rehabilitation after cerebral contusion. She was dripping-wet with perspiration, and had itchy eczema and skin erosions on her trunk. After administration of the “Furidashi” extract of Astragali Radix, her sweat decreased and the erosions were cured. This strongly suggests that the “Furidashi” extract of Astragali Radix provides a convenient and inexpensive treatment against copious sweat accompanied by skin disorder in the elderly.

The Effect of the Kampo-Formula without Shakuyaku on the Palpitation at Rest Due to Imbalance of Ki-distribution / 日本東洋医学雑誌

We treated five patients with palpitation at rest due to imbalance of Ki-distribution, a concept of traditional Chinese medicine in which there is abnormal upward flowing of “Ki, ” who showed rapid improvement after Shakuyaku was excluded from their original regimen or after initiation of treatment with Shakuyaku-free regimens. All these patients shared in common two findings before the initiation of the Shakuyaku-free treatment: first, the absence of strain of the rectus abdominas muscle in the whole abdomen between the hypochondrium and the upper margin of the pubic bones, and secondly, the presence of abdominal pulsation diagnosed as pericardiac, infra-umbilical or sub-umbilical pulsation. We also treated patients who developed palpitation at rest only after Shakuyaku-free regimens were replaced with regimens including Shakuyaku. These findings suggest that there may be many patients in whom Shakuyaku-free regimens may improve palpitation when they have an imbalance of Ki-distribution as an underlying condition.

Preliminary Study on Unreliability of Lymphocyte Stimulating Test for Kampo Medicine / 日本東洋医学雑誌

We performed a preliminary study of the reliability of the lymphocyte stimulating test (LST) for Kampo medicine. LST for three kinds of Kampo medicines was performed in both a Kampo-administrated group and a non-administrated group. LST for each of the medicines was negative for seven of eight subjects in the non-administrated group, but was negative for four of 11 subjects in the Kampo-administrated group. The LST-positive participants had no allergic state, and some among them were negative in challenge test. This preliminary study suggests that LST for Kampo medicine is likely to be false-positive.

Sei-hai-to Therapy in Two Cases of Relapsing Aspiration Pneumonia Caused by Cerebrovascular Disease / 日本東洋医学雑誌

We report on two cases of relapsing aspiration pneumonia caused by dysphagia due to cerebrovascular disease. Sei-hai-to (Qing Fei tang) offered useful palliation in both cases. Case 1 was an 83-year-old-woman who was hospitalized for multiple lacunar infarction and lumbago in 1996. She gradually became bedridden within two years of the admission period. She was admitted to a long-term care hospital affiliated with our department in January 1998. Dysphagia and productive cough appeared in May, and enteral tube feeding was started after she developed pneumonia in August. Pneumonia persisted against some antibiotics, and feverish periods ranged from 8 to 18 days a month. CRP values were elevated to more than 5mg/dl. Administration of Sei-hai-to provided negative CRP values and decreased feverish periods to 0-2 days a month. Case 2 was a 93-year-old-man who suffered from cerebral bleeding in the right thalamus in 1984. He developed many attacks of aspiration pneumonia after starting oral feeding. He was admitted to a long-term care hospital affiliated with our department in April 1999. Sputum culture yielded <i>P. aeruginosa</i> and MRSA. Moreover, fluoroscopy showed aspiration into the lower airway. Aspiration pneumonia relapsed continually without antibiotics. Administration of both Sei-hai-to and clarithromycin decreased feverish periods and provided negative CRP values. Pneumonia relapsed easily either with Sei-hai-to therapy alone or Clarithromycin therapy alone.

The Consideration of the Patients with Rheumatoid Arthritis Successfully Treated with Yokuinin-to-kami / 日本東洋医学雑誌

We report on three RA patients successfully treated with Yokuinin-to-ka-kyokatsu-dokkatsu-bofu (Yokuinin-to-kami). The first patient was a 47-year-old woman. In 1983, she visited a nearby hospital due to bilateral wrist joint pain. Her condition was diagnosed as RA. She was treated with gold sodium thiomalate (GST) and non-steroidal anti-inflammatory drugs (NSAIDs), but her symptoms did not improve. She visited our department in 1989. She was treated with Keishi-ka-ryojutsubu-to, Bushi-to which resulted in decreased arthralgia. However, in September 1995, her condition worsened. Administration of Yokuinin-to-kami improved her symptoms as well as her laboratory data after three months of treatment. The second patient was a 50-year-old woman. In 1986, she visited a nearby hospital with bilateral wrist joint pain. Several Kampo formulas were subsequently administered at a pharmacy. In 1991, she visited our hospital and her condition improved after treatment with Keishi-ka-ryojutsu-to-ka-boi-ogi-yokuinin. However, in May 1996, she complained of severe pain and swelling at the right shoulder joint. Treatment with Yokuinin-to-kami improved her symptoms, as well as decreased serum C-reactive protein (CRP). The third case involved a 42-year-old woman who exhibited polyarthralgia in June 1991. She visited a neighborhood hospital and was diagnosed as having RA. She was treated with NSAIDs and bucillamine. She first visited our hospital in1993. We treated her with Keishi-ni-eppi-itto-ka-ryojutsubu and Keishi-shakuyaku-timo-to, but the polyarthralgia worsened in May 1996. Subsequently, we treated her with Yokuinin-to-kami which resulted in improvement symptoms, as well as decreased serum CRP.<br>To identify the target group for Yokuinin-to-kami, we further analyzed the characteristics of the patients successfully treated with this formula. Yokuinin-to-kami was administered to nine patients with RA, and the symptoms in five patients improved, but the remaining patients did not respond. The score of stasis of body fluids and deficiency of blood was not considerably different between the two groups. Interestingly, there was a difference in the variation of joint symptoms throughout the day. Namely, the successfully treated patients complained of joint symptom in the evening more than in the morning. These observations suggest that Yokuinin-to-kami is a useful agent for the treatment of a subset of patients with RA, and that joint pain in the evening might be an indicator for this treatment.

A Case of Chronic Hepatitis C, in which Elimination of Hepatitis C Virus was Achieved by Kampo Treatment / 日本東洋医学雑誌

Chronic hepatitis C has a high incidence of proceeding to liver cirrhosis, and a natural healing from chronic hepatitis C is extremely rare. We observed a case of chronic hepatitis type C, in which the virus was eliminated after Kampo treatment. The patient was a 37-year-old female who underwent a blood transfusion following delivery of her first child in 1982. In January 1983, she became aware of general malaise, and was diagnosed as having chronic hepatitis. She was treated with Stronger Neo Minophagen C, but her symptoms and laboratory data were unchanged. A liver biopsy disclosed chronic active hepatitis in 1988, and she was transferred to our hospital for Kampo treatment in May. Although the symptoms rapidly disappeared after treatment with the Kampo formulas, Hochu-ekki-to and Keishi-bukuryo-gan, her transamilase values did not change. Her transamilase level decreased gradually after the prescription was changed to Saiko-keishi-to-go-Toki-shakuyaku-san-ryo, and returned to normal after her prescription was changed to Kami-shoyo-san-ryo in May 1996.<br>Concerning HCV-RNA in the serum, in March 1995, when Saiko-keishi-to-go-Toki-shakuyaku-san was administered, the amount of HCV-RNA in the serum was 10⁴ Kcopies/ml. But that was less than the detectable sensitivity in April 1998. We believe this to be a case in which elimination of HCV was achieved by Kampo treatment alone.

The Clinical Effect of Hochu-ekki-to on Patients with Chronic Hepatitis C. A Relationship Between Ki-deficiency State and the Clinical Effect / 日本東洋医学雑誌

We investigated the clinical effects of Hochu-ekki-to on symptoms, biological properties, quantities of hepatitis C virus, and fibrotic markers of 25 patients with chronic hepatitis C for six months. Results were analyzed by comparison of sex, age, and Ki-deficiency symptoms. Transaminase levels did not change in total, although decreases in scores of malaise and fatigability were statistically significant. Nevertheless, in patients 60 years old or older, GOT levels were elevated and total cholesterol levels decreased as compared to younger patients. Decreases in transaminases after administration of Hochu-ekki-to were statistically significant only in the 60+ age group. Decreases in transaminases were also statistically significant in patients who suffer from malaise, who are highly susceptible to colds, or who have reduced tension of the radial pulsation and faint red color or edema of tongue. Decreases were not observed in patients without these symptoms. These results suggest that the diagnosis of Ki-deficiency in Kampo medicine is very important in treating hepatitis C with Hochu-ekki-to.

On the Indication of Shishi-zai / 日本東洋医学雑誌

The authors investigated the clinical effects of Shishi-zai for neurosis with chest disturbance. There were 19 subjects in the study, 9 of which reported improvement with Shishi-zai. Three of the cases in particular showed marked improvement and will be discussed here.<br>The first case was 68-year-old female who had been suffering from pharyngolaryngial neurosis. She came to our clinic in March of 1994. Shishi-kanzoshi-to was given for a burning sensation in the throat. She reported relief after administration. The second case was 57-year-old female who had previously suffered from ethylene oxicide poisoning. She complained of chest discomfort and sleeplessness. Shishi-kanzoshi-to was administered and her complaint was improved. The third case was 25-year-old female who had been suffering from atopic dermatitis. She had a relapse when her relationship with her husband was strained, and was also experiencing headaches and anxiety when she came to our clinic in September of 1994. Her condition was reliened by administration of Shishi-kankyo-to.<br>The results suggest that Shishi formulas are effective for neurosis with chest discomfort when the indicators of sleeplessness, heat sensations, restlessness and flaccidity of the epigastrium are present.

Effects of Kami-shoyo-san on the Indefinite Complaints / 日本東洋医学雑誌

Physical and psychological symptoms were evaluated in 9 cases with unidentified clinical syndromes who were effectively treated with kami-shoyo-san (KS). Before and after administration, the patients were tested with the 43-question Abe questionnaire for vegetative syndrome and 51 questions (M-R) of the Cornell Medical Index. After administering KS for three months, the mean number of physical symptoms decreased from 19.9 to 9.1, and the psychological symptoms decreased from 16.7 to 9.3.<br>In order to clarify the clinical features for which KS is efficacious, the physical and psychological symptoms were divided into 7 and 6 categories, respectively. The average complaint rates responding to those categories before administration were evaluated. Physically, the average complaint rates related to locomotion and fatigue were high, and those related to digestion were low. Psychologically, the average complaint rates related to hypersensitivity and anger were high, and those relating to depression and tension were low.

The Effects of Hachimi-jio-gan on Chronic Asthma. The Second Report / 日本東洋医学雑誌

The authors investigated the clinical effects of Hachimi-jio-gan in the form of handmade pills containing the steamed root of Rehmaniae Radix. There were 11 subjects involved in the study (eight women and three men), with a patient age of 56.7±11.1 (mean±S. D.) years old. All of the subjects suffered from chronic asthma, and their attacks had begun in adulthood. The patients were classified into three grades of severity: mild—one patient; moderate—two patients; and severe—eight patients. Ten of the patients received this medication for eight to twelve weeks, but one patient discontinued administration due to epigastrial discomfort.<br>The clinical efficacy of this agent was judged by changes in asthmatic attacks. Treatment scores in seven patients improved, two were unchanged and one worsened. Of seven patients taking oral steroids in conjunction with the Hachimi-jio-gan, two were able to decrease the dosage and two were able to discontinue the oral steroids, The peak expiratory flow rates in improved patients increased about 20% compared to the preadministration rates.<br>The authors considered that this Kampo formula may act to increase the anti-inflammatory action of corticosteroids or theophylline, because the bronchial dilatory effect was remarkable when it was administered in conjunction with these drugs, but less pronounced when used alone. This study suggest that wider application of this Kampo formula in patients with chronic asthma may improve respiratory function.

A Case of Rheumatoid Arthritis with Amyloidosis and Renal Failure Successfully Controlled with Daibofu-to / 日本東洋医学雑誌

The prognosis of rheumatoid arthritis (RA) worsens significantly when accompanied by renal disorders due to amyloidosis. Recently, satisfactory results have been obtained by the administration of Daibofu-to to a patient suffering from amyloidosis and renal failure with RA. The patient was a 64-year-old female, whose chief complaint was a polyarthralgia. Ten years ago she was diagnosed as having RA. Both gold compound and glucocorticoid had been administered. Renal dysfuntcion was discovered in February, 1993, and she was admitted to the Aso-Iizuka Hospital in **********. On admission she was evaluated as class II and stage IV. Deposits of amyloid was found in the mucosa of the stomach, duodenum, and the glomerular tissues of the kidney. Administration of Daibofu-to brought about a reduction in the Lansbury's index from 64% to 39% during a two week period.<br>After four weeks, the serum creatinine level fell from 1.7mg/d<i>l</i> to 1.5mg/d<i>l</i>, and the daily amount of urinary protein excreted dropped from 4g/day to 2.5g/day. At present, one year after discharge, the RA with amyloidosis and renal failure is being successfully controlled with Daibofu-to.

A Three-Case Study on the Kampo-Formula "Shien" / 日本東洋医学雑誌

The results of three cases involving administration of “Shien”, a Kampo formula containing Crotonis Semen, are reported here. The first case was a 48-year-old female, in whom orthopnea had appeared two years previously. She was diagnosed as having congestive heart failure. During the treatment period, the above symptom reappeared when she was fatigued. Based on a lessening of the symptoms after diarrhea, Shien was administered. After over ten abouts of diarrhea, the difficult breathing was eased and the cardiothoracic ratio decreased, as confirmed by chest x-ray.<br>The second case was a 64-year-old female. After the appearance of hyposarca and inappetence a year ago, she had been diagnosed as having amyloidosis brought on by nephrotic syndrome. The edema was reduced with combined administration of the Kampo formulas Hokikenchu-to and Bukuryoshigyaku-to. However, due to the persistence of poor appetite, and the marked presence of the (Oriental Medical) indicator of upper abdominal fullness, Shien was administered. After frequent bouts of diarrhea and vomiting, an improvement in the appetite and a decrease in abdominal fullness were seen.<br>The third case involved a 71-year-old female. After undergoing surgery for breast cancer eight years ago, edema appeared in her upper left arm. Due to the presence of the edema and constipation, both indicators for Shien, administration of this Kampo formula was commenced. Diarrhea occurred every day Shien was administered. A decrease in the upper arm diameter and weight was reported.<br>The results achieved in these three cases suggest that Shien is an effective treatment formula that can be used in cases of “Suidoku” (water metabolism disorders) when indicators such as upper abdominal fullness and constipation are present. Careful distinction between the “deficient” and “excessive” manifestation types (standard in Kampo theory) did not seem necessary.