Bioelectrical Impedance Analysis (BIA) of the association of the Japanese Kampo concept "Suidoku" (fluid disturbance) and the body composition of women.

BACKGROUND: In Japanese Kampo medical practice, suidoku (fluid disturbance) is one of the most important concepts for selecting the proper medication. Suidoku is an excessive or uneven distribution of fluid that is indicated by splashing sounds and pitting edema. However, few objective reports about suidoku have been published. Bioelectrical impedance analysis (BIA) uses resistance values obtained from weak electrical currents to estimate body composition, including intracellular and extracellular water and muscle and fat mass. In this study, we used BIA to search for objective factors that can discriminate the various types of suidoku. METHODS: Two hundred twenty-nine patients who visited the Kampo Medicine Clinic of Kyushu University Hospital from June 2010 to August 2015 were divided into non-suidoku (n = 180, 80 male and 100 female), splashing sound (n = 32, 8 male and 24 female) and edema groups (n = 17, 5 male and 12 female). Body composition values were taken from the electronic medical records of InBody730 (a vertical, segmental, multi-frequency analyzer by InBody, Tokyo Japan) testing done at the initial visit. Various parameters of the body composition values of female in the non-suidoku and suidoku groups (splashing sound and edema groups) were compared: there were too few male patients to provide significance. RESULTS: The age and body weight were significantly lower in the splashing sound group than in the non-suidoku group (p < 0.05). In contrast, the body weight of the edema group was significantly heavier than that of the non-suidoku group (p < 0.05). In ROC analysis, the percent Body Fat ≤ 27.8 %, Muscle Mass Index of the Trunk ≤ 6.5 kg/m2, VFA (Visceral fat area) ≤ 5.4 and BMI ≤ 19.2 kg/m2 were associated with splashing sound, and Muscle Mass Index of Legs ≥ 4.8 kg/m2 and BMI ≥ 21.4 kg/m2 were associated with edema. CONCLUSION: Our data suggest that the use of this type of BIA to estimate body composition would be a useful tool for the diagnosis of suidoku for women.

Spontaneous Intracranial Hypotension Manifesting Orthostatic Headache Worsened by Playing the Saxophone and Treated by Japanese Herbal Kampo Medicine Goreisan.

We present a 15-year-old Japanese girl with no previous medical history who presented with a gradually worsening series of orthostatic headaches. We diagnosed spontaneous intracranial hypotension, worsened by playing the saxophone and its Valsalva maneuver effect. She was treated with Japanese herbal Kampo medicine Goreisan 7.5 g/day in three divided doses, and her symptoms gradually improved. Her headache has never recurred for a year when she played the saxophone. Our case's headache may have been further exacerbated by cerebrospinal fluid (CSF) leakage due to CSF pressure increase by Valsalva maneuvers while playing the saxophone. Our case suggested that the Japanese herbal Kampo medicine Goreisan can facilitate the glymphatic system and adjust the CSF pressure appropriately.

Analysis of 100 Women with Infertility Due to Ovarian Dysfunction Who Succeeded in Delivering Live Children after Kampo Therapy Diagnosed by \lq\lqZheng\rq\rq / 日本東洋医学雑誌

To determine the Kampo therapy indications for global infertility treatment, and the criteria for objective and rational evaluation of its efficacy, we analyzed the sho (Zheng), type of ovarian dysfunction, types of Western drugs used concomitantly, length of treatment, age upon pregnancy, etc., in 100 women with infertility due to ovarian dysfunction as diagnosed by Western medicine who succeeded in becoming pregnant and giving live births, after Kampo therapies diagnosed by sho based on Hakko, Ki, Ketsu and Sui. The diagnosis of the sho in these women was compared with that in 2737 control women. Their types of sho by frequency were Kyo (51%), Shoyo (Hanhyo-Hanri) (69%), Jonetsu-Gekan (52%), Kigyaku (47%), Oketsu (71%) and Suidoku (67%). When compared to the control group, the percentage of women whose Sho was rated as Jitsu, Taiyo, Shoyo, Jonetsu-Gekan, Oketsu or Suidoku was significantly higher. The sho type Hyonetsu-Rikan was lower. The preparation sho, rated on the basis of a general assessment, was most frequently Kamishoyosan(55%). The predominant type of ovarian dysfunction was luteal dysfunction (73%), whose frequency was significantly higher than that in the control group. Of all women studied, 46% were treated with Kampo alone and 54% were treated with Kampo + Western medicine. In terms of the percentage of each type of ovarian dysfunction, there was no significant difference between the two groups. The Western drugs used in combination with Kampo therapy were hCG preparations (33%), terguride preparations (18%), clomiphene preparations (3%) and hMG preparations (6%). The period of treatment until pregnancy was significantly shorter in the Kampo alone group (5.0 ± 4.4months) than in the combined therapy group (9.5 ± 6.8months). These results allow us to make the following conclusions:1.The type of infertility indicated for Kampo medicine is infertility due to ovarian dysfunction as diagnosed by methods of Western medicine.2.Women who successfully became pregnant following Kampo medicine were often cases of Shoyo disease complicated by sho with Jonetsu-Gekan, accompanied by Kigyaku, Oketsu and Suidoku.3.Uncombined Kampo medicine may be effective in cases of severe infertility.4.If pregnancy does not occur within 5 or 6 months after the start of Kampo therapy, combined use of Western medicines should be considered.

The Study of Trigeminal Neuralgia, that Responded well to Kampo / 日本東洋医学雑誌

For many patients with trigeminal neuralgia, oral administration of carbamazepine is highly effective. Micro decompression surgery (Jannetta's operation) is also considered a fundamental treatment. However, there are patients who do not respond to carbamazepine and who hesitate to have surgery. Here, we report 14 cases whose pain was relieved solely by Kampo (7 cases) or by a combination of Kampo and carbamazepine (7 cases). The Kampo formulations used were Goshuyu-to (2 cases), Gorei-san (9 cases), Saiko-keishi-to (1 case), Toki-shigyaku-ka-goshuyu-shokyo-to (1 case) or Mao-bushi-saishin-to (1 case), depending on the “Zheng” of each patient. In trigeminal neuralgia, the nerve root is compressed or adhered to surrounding vessels, such as the superior cerebellar artery. It is highly possible that localized edema at the point of compression is responsible for the pain. The diuretic action of the Kampo may diminish the localized edema around the trigeminal nerve root.

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.

Effect of Kumi-binro-to on Chronic Headache / 日本東洋医学雑誌

A total of 20 chronic headache cases in which other Kampo medicines were ineffective or hardly effective were treated with Kumi-binro-to extract, and the effect of this medicine was investigated.<br>At the start of administration, we investigated the following items: any deficiency or excess, presence or absence of stagnation of vital energy (facial erythema, ophthalmologic injection, bitter taste in the mouth, etc.) and disease caused by contaminated water (tendency of edema, sound of fluctuating liquid in the region of the stomach, decreased urine volume) as well as the presence or absence of grasping pain (pressure pain) in the gastrocnemius muscle which is a characteristic symptom as a target of this drug. The efficacy of Kumi-binro-to was assessed by a pain score after weeks from the start of administration.<br>Kumi-binro-to was markedly effective in 5 cases, effective in 11 cases and ineffective in 4 cases, indicating that the ratio of markedly effective and effective cases accounted for 80% of the patients treated. There was no adverse reaction. When the characteristics of 16 cases assessed as markedly effective or effective were investigated, disease caused by contaminated water and stagnation of vital energy was observed in 13 and 14 of the 16 cases respectively. The grasping pain in the gastrocnemius muscle that is a characteristic target of this drug was noted in only one case.<br>The above result suggests that Kumi-binro-to promotes diuresis to eliminate wetness-evil and regulates vital energy, and is effective against chronic headache, especially when the disease caused by contaminated water is accompanied with stagnation of vital energy.

The Effects of Ryo-kei-jutsu-kan-to / 日本東洋医学雑誌

There are many indications for Ryo-kei-jutsu-kan-to, such as orthostatic hypotension, cardiac neurosis, migraine, congestive heart failure, benign paroxysmal positional vertigo and eye disease. Although in oriental medicine Ryo-kei-jutsu-kan-to is used as a hydragogue agent for sui-doku (disorders of the body's fluid metabolism), its actual effect on hydragogue action remains unclear. We previously carried out hemodynamics tests before and after administration of Ryo-kei-jutsu-kan-to for a patient with orthostatic hypotension due to peripheral autonomic disorder. The pathosis of the patient before administration of Ryo-kei-jutsu-kan-to was found to be sui-doku caused by the excessive increase of circulating blood volume. We reported that after administration of Ryo-kei-jutsu-kan-to the blood pressure of the patient in the standing position was elevated by increased peripheral vascular resistance, while excessively increased circulating blood volume decreased. This time we administered Ryo-kei-jutsu-kan-to for four cases, such as orthostatic hypotension with migraine, cardiac neurosis, congestive heart failure, and hypotension in dialysis. We again realized that it also increases peripheral vascular resistance. As one of the dimensions of so-called hydragogue action, it is important to understand that Ryo-kei-jutsu-kan-to has a hydragogue effect against the retention of excess fluids (sui-doku) in the body through increasing peripheral vascular resistance by vasoconstriction.