ABSTRACT
We report a case of a 74-year-old woman who suffered from uncomfortable heat under her right shoulder blade and felt anxiety about general fatigue that had been worsening mainly in the summer. She visited our Kampo clinic because of insufficient effect of various types of drug that had been prescribed by 3 doctors for about a year. We made the diagnosis of somatic symptom disorder and suggested Kampo therapy with decoction. We thought this might be caused by liver qi depression, blood deficiency, and blood stasis because he had symptoms of dry skin, cold of feet, deeply located fine pulse, pale and purple tongue with yellow thick fur, fullness in the chest and hypochondrium. Therefore we administered keppuchikuoto modified formula. Her symptom improved within about a month after taking this formulation. There was no recurrence of the physical symptom and fatigue in the summer during taking medicine for about 20 months. Evidence-based treatment in somatic symptom disorder has not been established and some cases are resistant to treatments in modern Western medicine. Kampo medicine may be useful and hopeful.
ABSTRACT
We report a case of a 51-year-old male who suffered from chronic idiopathic urticaria on every part of his body. Urticaria appeared especially in the morning and evening. He visited our Kampo clinic because of insufficient effect of antihistamine drug and tokiinshi that had been prescribed by a dermatologist for about a half year. We thought this might be caused by blood deficiency, blood stasis and liver qi depression because he had symptoms of sensitiveness of heat, dry skin, purple tongue with yellow fur, a deeply located string-like pulse,and fullness in the chest and hypochondrium. Therefore, we administered keigairengyoto and ryutanshakanto but the effect was insufficient. During this treatment, we revealed his state of having thick fur in tonguediagnosis. Finally we prescribed him seijobofuto and inchingoreisan because we concluded that it might be necessary to remove dampness-heat in this case. His symptom improved within about a week after taking this formulation. Some cases of chronic urticaria are resistant to standard treatments in modern western medicine. Kampo medicine may be useful and hopeful in these cases.
ABSTRACT
Cough-variant asthma is the most common cause of chronic cough. It may progress to classic asthma and therefore requires adequate treatment intervention. We experienced two cases of cough-variant asthma that was refractory to standard drug therapy but improved after additional administration of kumibinroto. In Case 1, the patient was a 46-year-old woman receiving hormone therapy after breast cancer surgery. She developed cough-variant asthma 5 years ago, and though she has received drug therapy, the symptoms aggravated. Cough continued to appear at night without improvement of asthma symptoms. However, the symptoms improved with subsequent administration of kumibinroto. In Case 2, the patient was a 47-year-old woman who developed cough-variant asthma after childbirth, which repeatedly worsened and improved. The cough-variant asthma aggravated after change of workplace and did not improve with drug therapy. However, asthma symptoms improved with oral administration of kumibinroto and hangekobokuto, and subsequent administration of kumibinroto alone. In both patients, the asthma was seasonal. These cases suggest that kumibinroto administration may contribute to the improvement of cough-variant asthma.
ABSTRACT
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.
ABSTRACT
The management of influenza has dramatically changed since the introduction of the rapid influenza diagnostic test, or RIDT, and neuraminidase inhibitors (NI). However, it is still far from optimal due to low RIDT sensitivity and problems involving NI such as side effects and the potential emergence of resistant virus.Therefore, we developed a decision-making model for the management of influenza, which includes Kampo medicines in its strategies. First, the severity of patients is evaluated. If a patient is judged at severe or high-risk, intravenous NI would be the main component of treatment. If a patient has neither a severe condition nor is at high-risk, the patient would be asked to choose either NI or Kampo medicine. In the former, RIDT would be used if pretest probability was less than 50%, but it would not be used if it was more than 50%, based on the lack of influence on the post-test probability. For the latter, RIDT would be not used in general as Kampo targets “phenomena”, not the virus <i>per se</i>. This model enables us to optimize the use of RIDT by appropriately selecting patients based on the characteristics of RIDT, and by avoiding unnecessary tests and their misinterpretation.
ABSTRACT
<b>Background:</b> Gingyo-gedoku-san (GGGS) is an herbal medicine approved for upper respiratory infections in Japan. We conducted an open-label, multi-center, prospective trial, comparing GGGS with oseltamivir in patients with influenza and influenza-like illness (ILI) as a pilot study.<br><b>Methods:</b> Subjects were healthy persons aged between 16 and 40, and were enrolled from January 12, 2010 to March 24, 2011. Fifteen patients were enrolled in this trial (8 and 7 for GGGS and oseltamivir, respectively). RT-PCR was positive for pandemic influenza A (H1N1) in 10 patients. The patients were provided with either GGGS or oseltamivir for 5 days. The primary outcome was mortality and/or hospitalization 7 days after the initial diagnosis. Body temperature and other clinical characteristics were also evaluated.<br><b>Results:</b> All patients recovered from illness without complication or hospitalization. The mean time to resolve symptoms for the GGGS and oseltamivir groups was 3.9 days and 3.3 days, respectively (p=0.43). The GGGS group appeared to have a smaller symptom score AUC than the oseltamivir group, (p=0.26). Time to recover activity level appeared to be shorter in the GGGS group (p=0.10), with shorter time to recover health status (p=0.02). Sub-group analysis on patients with positive PCR showed similar results between the two groups.<br><b>Conclusion:</b> GGGS was associated with symptom improvements resembling oseltamivir for both influenza and ILI. Randomized controlled trials involving larger sample sizes are needed to confirm these results.
ABSTRACT
Intestinal spirochetosis is a rare gastrointestinal infection caused by <i>Brachyspira</i>. Clinical manifestations vary, ranging from asymptomatic infection to gastrointestinal bleeding, diarrhea, or abdominal pain. Antimicrobial medications such as metronidazole are routinely given, but their clinical efficacy has not determined with any precision. We report a case of intestinal spirochetosis treated with daikenchuto extract with literature reviews. Treatment of intestinal spirochetosis can be difficult, and use of daikenchuto extract may be an option especially for patients with symptoms such as chronic diarrhea, abdominal distention, or change in flatus.
ABSTRACT
We report a case of refractory pleural effusion after mitral valve replacement (MVR) successfully treated by adding goreisan. A 60-year-old man had right pleural effusion with exertional dyspnea in spite of taking two diuretics (furosemide 60 mg and spironolactone 25 mg a day) for 2 years after MVR. He underwent drainage twice and spironolactone was increased to 50 mg, but his pleural effusion volume still increased. Then in addition, he received goreisan 7.5 g a day, and the pleural effusion was decreased and stabilized. This suggests that goreisan is a candidate drug for additional treatment, when pleural effusion is uncontrolled because of heart failure, despite taking diuretics.
ABSTRACT
Schamberg disease is a subtype of idiopathic pigmentary purpura, which manifests with petechiae. It is assumed to be caused by venous microcirculatory disturbance, or an immunological and allergic mechanism. We report a 55-year-old Japanese male with Schamberg disease successfully treated with keishibukuryogan prepared at a hospital pharmacy. The patient had purpuric eruptions in his both lower legs at first, and brownish pigmentation enlarged with purpura. A dermatologist had diagnosed this, from the clinical findings, as Schamberg disease. We administered keishibukuryogan to the patient because his pathological condition was considered as oketsu. In order to improve effectiveness, keishibukuryogan was manufactured according to our own modification. The eruptions have reduced gradually, and about four months later, have mostly resolved. A Kampo therapy utilizing unseiin has been reported to be effective against idiopathic pigmentary purpura in previous studies. We suggest that a Kampo treatment with keishibukuryogan seems to be effective against idiopathic pigmentary purpura through improvements of microcirculation and inflammation.
ABSTRACT
In this study, the author evaluated surgical results in 4 patients over 80 years old (3 males and one female) who were among 24 patients with ruptured abdominal aortic aneurysm (RAAA) who underwent operation at our medical center between November, 1985 and June, 1992. While three patients survived, one, who had preoperative profound shock, died due to mutiple organ failure. The post-operative course of two of the survivors was uneventful, and the other developed non-oliguric renal failure but recovered without hemodialysis. The Fitzgerald classification of the RAAA in the non-survivor was group 4 and that in the 3 survivors was group 2 or 3. The extent of preoperative shock and volume of blood loss were associated with increased operative risk. In conclusion, aggressive resection of RAAA should be performed not only in younger parients but also in elderly patients such as those over eighty years old.
ABSTRACT
A 22-year-old man was referred to our medical center with an impending rupture of an aneurysm of the descending thoracic aorta. Blood pressure was 180/110mmHg in the right arm but 110/60mmHg in the right foot. The diagnosis was confirmed by chest Xray, enchanced computed tomography and aortogram. Five days later, the chest Xray showed massive effusion in the left pleural cavity. Surgery was immediately performed via a left thoracotomy. Five hundred ml of bloody fluid was found in the pleural cavity but the site of bleeding could not be identified. The aneurysm was 7×10cm in size. Under percutaneous cardio pulmonary support, the aneurysm was replaced by a 22mm Gel-Seal Dacron vascular graft. The intima and the media of the aneurysm were lacerated longitudinally at the region receiving jet flow from isthmus, There was blood coagula between the media and adventitia. During replacement, activated clotting time was maintained at 200∼300sec. As a result, bleeding was limited to 200ml. The postoperative course was uneventful with little difference in pressure between the right arm and right foot.
ABSTRACT
Laser-Doppler velocimetry (LDV) was used to evaluate the effects of low energy laser irradiation on peripheral circulation disturbance in patients with collagen diseases, progressive systemic sclerosis (PSS) and systemic lupus erythematosus (SLE).<br>Using a commercially available LDV flometer (Periflux, Perimed KB, Sweden), the response to laser irradiation at the acupuncture points of Tian zhu, Feng chi, Jian jing, Shou san li, Jing qu, He gu, Stellate ganglion, was recorded in 4 patients with PSS and 6 with SLE. The digital pitting scars and Raynaud's phenomenon were observed in all the patients. The low energy of 10mW laser was irradiated for 1 minute at each acupuncture points, and LDV flow values ware recorded in fingertips at room temperature 25±0.5°C. Ten minutes after the laser irradiation, the LDV flow values increased significantly (p<0.5).<br>Present data suggest that the low energy laser irradiation to patients with PSS or SLE who suffered from circulation disturbance is effective.