耳鼻咽喉科臨床　補冊

漢方治療の基本的考え方

松田邦夫

1997 年 1997 巻 Supplement92 号 p. 1-8
発行日: 1997/06/27
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1997.Supplement92_1

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鼻粘膜における分泌機構と小青竜湯

池田勝久

1997 年 1997 巻 Supplement92 号 p. 9-11
発行日: 1997/06/27
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1997.Supplement92_9

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Sho-seiryu-to, a traditional Japanese herbal medicine, has been used extensively in the treatment of allergic rhinitis. The effects of Sho-seiryu-to on the electrical responses induced by acetylcholine in dissociated nasal gland acinar cells were investigated using a patch-clamp and microfluorimetric imaging technique. The application of Sho-seiryu-to inhibited both K+ and Clcurrents augmented by acetylcholine. The elevation in intracellular Ca²⁺ concentration was also inhibited by Sho-seiryu-to. These findings suggest that Sho-seiryu-to attenuated the secretion of water and electrolytes from the nasal glands through an anticholinergic effect.

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証に基づく方剤の選択 1.はじめに

水越鉄理

1997 年 1997 巻 Supplement92 号 p. 12
発行日: 1997/06/27
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1997.Supplement92_12

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証に基づく方剤の選択 2.私の行っている証の組み立て方

稲葉博司

1997 年 1997 巻 Supplement92 号 p. 13-17
発行日: 1997/06/27
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1997.Supplement92_13

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When incorporating Kampo therapy in otorhinolaryngological treatment, satisfactory results are not always obtained if the disease name is used as the only parameter. Kampo therapy, which is based on evidential medicine, refers to a method whereby medical professionals increase the number of parameters evaluated, beyond the disease name, and select drugs in conjunction with the signs that patients give out. I wish to explain, using actual examples, the ways in which otorhinolaryngologists can administer Kampo therapy based on evidential medicine using diagnostic methods made available to us.
The parameters used for evaluation include chief complaints, history of illness, patient's overall appearance such as physique, facial tone (and expressions), skin condition, local observations (nasal mucosa, nasal discharge, nature of otorrhea, observation of the pharyngeal mucosa, nature of liquid collected in the tympanic cavity), observation of the tongue, and sometimes stomach check-ups. These parameters are used in combination as required. Focusing on Kampo therapy to treat nasal allergy using these parameters, this paper introduces the use of evidential medicine in the selection of the most appropriate drugs, for treatment of individual patients.

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3.鼻腔,鼻咽腔の乾燥性病変への漢方エキスの効果-"証"をどう理解するか-

古和田勲

1997 年 1997 巻 Supplement92 号 p. 17-21
発行日: 1997/06/27
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1997.Supplement92_17

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o record the changes in objective observations of the nasal mucosa brought about by Kampo extract agents, the nasal mucosa in patients presenting with nasal allergies, nasal polyps, and dry lesions from the nasal cavity to the pharynx was videotaped, and the findings were reported at a general meeting of the Otorhinolaryngological Society of Japan. Atropic lesions, blood clots, and hemorrhagic lesions as well as other problems such as scabbing may also be evident, suggesting metaplasia of the mucosa in the upper respiratory tract. In addition, simple problems, most often seen among the elderly in an indoor environment, such as winter colds, may lead to complications, requiring caution with respect to drugs prescribed by other medical departments.
Videotapes illustrating the local changes in these patients before and after administration of extract agents, have been shown.
In the discussion, I w ould like to state my views on traditional medicine and outline my ideas on how this should be perceived, based on what I have learned. I hope this will become the first step for others in understanding the diagnostic methods which represents the degree and type of shift from a normal condition and differentiation of symptom complex.
Kampo, after all, is a culture different from our own. Many people are interested in the efficacy of Kampo drugs, but feel uneasy when dealing with evidential-based medicine. They often resist the idea, and are turn away from this treatment option. If they learn how to concentrate on information based on traditional concept, they may become more familiar with Kampo and its applications in symptomatology.

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証に基づく方剤の選択 4.耳鼻科医による口内,鼻内所見からの証,漢方薬の選択性についての提案

金子達, 山内恵子, 久住武, 村田博明, 富樫香

1997 年 1997 巻 Supplement92 号 p. 21-31
発行日: 1997/06/27
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1997.Supplement92_21

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It is necessary to obtain pharyngeal and nasal specimens in daily otorhinological practice. In addition, doctors proficient in this field can take and assess these findings in more detail as compared to practictioners in other fields. In contrast, systemic findings such as those from an abdominal examination may often result in failure due to limited time or poor compliance from the patient. It is very important to check the patient's overall general condition for ascertaining adequate levels of medication, especially for Japanese Kampo medicine. Thus, findings from Japanese Kampo medicine obtained from pharyngeal and nasal specimens seem to be very useful to the otorhinologist.
Patients who had complained of an affected pharynx or allergic rhinitis, and who had visited the Otorhinolaryngology Department at the Showa University Hospital were used in this study. With respect to the methods, the patient's pharyngeal and nasal findings were recorded simultaneously with a questionnaire concerning their physique, KYOJITSU, and the possible contribution of KIKETSUSUI.
Tongue diagnosis has thus far been of importance in Chinese medicine. In this study, a possible relationship between congestion in the oral cavity, especially in the palate, and the sublingual region or ‘OTEN’ with ‘OKETSU’ drug administration and the diseased state were suggested to be of help in arriving at a diagnosis. In addition, the coloration such as pallor in the nasal mucosa as well as changes in the general condition and selectivity of Japanese Kampo medicine were taken into consideration. A weak correlation was observed between pallor and false-affecting trends. In conclusion, some positive tendency seems to exist, however, individual treatments are required, which may be of value in future treatments with Japanese Kampo medicine and its qualifications.

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スギ,カモガヤ花粉症に対する小青竜湯の効果

黒川泰資, 山浦香

1997 年 1997 巻 Supplement92 号 p. 32-37
発行日: 1997/06/27
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1997.Supplement92_32

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Cedar and orchard grass pollinosis are the typical form of Japanese pollinosis. The splash time, period and distribution varies from orchard grass pollens to cedar pollens. Orchard grass pollens are most common in the Hokuriku area. There were more patients suffering from orchard grass pollinosis than cedar pollinosis in this year. Sho-seiryu-to (Tsumura Co. Ltd) was prescribed against the cedar and orchard grass pollinosis. We therefore report the medication effects of Sho-seiryuto. The study included 38 pollinosis patients who had a medical examination at the Fukui General Hospital. Sho-seiryu-to (9 grams p. o. ) was given to each subject for 2-4 weeks. There were many cases that had an improvement in their nasal discharge and sneezing, but, nasal obstruction had not improved, as assessed by rhinomanometry. The eye and nasal symptoms improved more in orchard grass than cedar pollinosis. Sleepiness or other side effects were not seen in this study.

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小青竜湯(TJ-19)の鼻アレルギー患者の鼻閉塞に対する効果

山際幹和

1997 年 1997 巻 Supplement92 号 p. 38-42
発行日: 1997年
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1997.Supplement92_38

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The efficacy of Tsumura Sho-seiryu-to granules,3 g/day for 2 weeks, for the treatment of nasal obstruction was evaluated in 11 p atients (7 males and 4 f emales, aged 19-53 years with a me an age of 33.5 y ears) with perennial nasal a llergy symptoms. A 100 m m v isual analogue scale (VAS) was u sed for subjective measurement of nasal sensations of airflow, and acoustic rhinometry (AR) was used for objective measurement at one, two and three weeks after the start of medication. Parame tric and non-parametric statistical tests were used to evaluate the results and P< 0.05 was con sidered to be significant.
1) The mean ± standard error (SE) of the VAS score was 47.8 ± 6.3 before medication,32.0 ± 5.9 at one week,30.7 ± 6.7 at two weeks and 34.7 ± 7.5 at three weeks. The Friedman test showed signif icant variance in the VAS score (P=0.0395).
2) The mean ± SE of the right +left nasal cavity volume (NCV) was 12.08 ± 0.82 cm³ before medication,14.53 ± 0.79 cm³ at one week,14.37 ± 0.82 cm³ at two weeks and 13.77 ± 1.10 cm³ at three weeks. One-way repeated-mesaures ANOVA showed significant variance in the NCV (P=0.0049).
In conclusion, VAS and AR studies showed that Sho-seiryu-to appears to be effective in reducing allergy-induced nasal obstruction.

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鼻アレルギーに対する苓甘姜味辛夏仁湯の臨床効果

前田稔彦, 松永喬

1997 年 1997 巻 Supplement92 号 p. 43-46
発行日: 1997/06/27
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1997.Supplement92_43

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Sho-seiryu-to is often used to treat allergic rhinitis. In this study, we evaluated the effects of Ryo-kan-kyo-mi-shin-ge-nin-to in patients whose symptoms were not improved following treatment with the former drug. The subjects included 22 patients diagnosed with nasal allergy, comprising 11 men and 11 women with a mean age of 46.3 years. The medicine was administered regardless of symptoms, and the patient's condition before administration was compared with that two weeks after administration. Overall,27% of the subjects reported a moderate or better improvement. Evaluation of specific symptoms revealed that paroxysmal sneezes improved in 72% of the patients, asal discharge in 65%, nasal obstruction in 58%; and dysosmia in 14%. A total of 53% ofn the subjects found that their daily life was impeded. No side effects were reported. The efficacy of the medicine appeared to be higher among patients whose the nasal mucosa was pink in color. Thus, the color of the nasal mucosa is thought to be an important factor in selecting the appropriate drug. It was deemed worthwhile to prescribe Ryo-kan-kyo-mi-shin-ge-nin-to to patients in whom Shoseiryuto had proven to be ineffective.

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小児慢性副鼻腔炎難治例に対する漢方治療

岡村由美子, 高野信也, 荒牧元

1997 年 1997 巻 Supplement92 号 p. 47-50
発行日: 1997/06/27
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1997.Supplement92_47

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Low-dose administration of macrolide antibiotics has been reported to be effective in the treatment of chronic sinusitis. This paper reports the effects of Shin'i-seihai-to in patients whose symptoms did not improve despite extended administration of low doses of erythromycin. The subjects included four male and six female patients with chronic sinusitis whose symptoms did not improve after an average of 7.5 months of extended administration of low-doseerythromycin. The ir mean age was 7 y ears. Two weeks after the administration of Shin'i-seihai-to, a slight or better imp rovement in nasal discharge was reported in approximately 70% of the subjects. Approximately 70%reported improvement in nasal o bstruction, and 20% in the frequency of nose b lowing. Changes in asal secretion were seen within 7 days. One patient suffered a mild gastric disorder. Althoug hn Shin'i-seihai-to was administered without assessing objective signs of improvement, s ubjective symptoms improved and X-rays of the paranasal sinuses in a high percentage of subjects. Kampo medicine was determined to be both easy to administer and useful in the treatment of chronic sinusitis.

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RIテストと牛車腎気丸

奥野秀次, 根岸達郎

1997 年 1997 巻 Supplement92 号 p. 51-52
発行日: 1997/06/27
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1997.Supplement92_51

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Of 20 patients with a sensorineural hearing loss chiefly complaining of tinnitus, eleven with a positive RI test score were given Gosha-jinki-gan. Subjects ranged in age from 40 to 64 years, and included 4 men and 5 women. Two patients dropped out in the middle of the trial. The medicine was administered for 8 weeks. The average time for the RI test was 54.1 seconds, and the following effects were seen after 8 weeks. Two patients had most of their symptoms disappear, three experienced remission, three experienced slight remission, and one reported no change. The correlation between RI test results and treatment effects using Spearman's rank correlation coefficient was 0.7637, with a 5% significance level. Gosha-jinki-gan was therefore determined to be effective in the treatment of RI-positive cases.

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高齢者難治性中耳炎の漢方治療-補中益気湯の使用経験-

真崎雅和, 工藤和夫

1997 年 1997 巻 Supplement92 号 p. 53-54
発行日: 1997/06/27
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1997.Supplement92_53

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Otitis media with effusion (OME) in middle-aged to elderly patients rarely becomes serious, but can recur frequently. In this study, three patients who were initially diagnosed as having OME, who had resisted treatment and went on to develop combined infections, in addition to three typical adult OME patients, were evaluated. In addition to paracentesis and short-term administration of antibiotics, the subjects also received Hochu-ekki-to. As a result, the period before OME recurrence was extended in all patients, and all subjects reported a reduced frequency in infectious complications. Therefore, using Hochu-ekki-to in combination with antibiotics was deemed useful in treating intractable OME in the elderly who tend to develop combined infections.

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鼓室形成術施行例における柴苓湯使用経験

秋定健, 折田洋造, 佐藤幸弘, 半田徹, 吉弘剛, 河合晃充, 卜部吉博, 粟飯原輝人, 森幸威

1997 年 1997 巻 Supplement92 号 p. 55-60
発行日: 1997/06/27
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1997.Supplement92_55

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To evaluate the clinical efficacy of Tsumura-Sairei-to for the treatment of chronic otitis media and cholesteatomas after tympanoplasty, an open, randomized control trial was performed on 12 patients. Four patients dropped out in the middle of the trial. Distinct differences in the ear drum, fascia and subjective symptoms were recognized between the Sairei-to group and the control group. No significant differences were found in the antrum, mastoid, or pure tone audiograms. Of the five patients in the Sairei-to group, significant effects were observed in one patient (20%), slight effects in two patients (40%), and no noticeable effect was observed in two patients (40%). The general efficacy rate for the five patients treated with Tsumura-Sairei-to was 60.0%. No side effects were noted in any of the patients, and thus the general usefulness rate was 60.0%. These results indicate that Tsumura-Sairei-to is clinically effective as an oral therapy for chronic otitis media and cholesteatomas after tympanoplasty.

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中国における成人声帯結節に対する漢方治療について

周莉新, 佃守, 古川政樹, 池間陽子, 澤木修二

1997 年 1997 巻 Supplement92 号 p. 61-63
発行日: 1997/06/27
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1997.Supplement92_61

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There are more patients with vocal cord nodules in China than in Japan. The occupation of these patients consists mainly of female singers or teachers. On the basis of the etiology and pathology of Chinese traditional medicine, there are three different treatment modalities for this disease. Shikunshi-to, Toninsibutsu-to and Zoueki-to. These Chinese traditional medicine treatment modalities have been characterized by the combined use of Chinese medical herbs according to each individual patient's status.

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耳鼻咽喉科領域の漢方支援システムの構築(予報)

渡辺行雄, 將積日出夫, 島岳彦, 稲葉博司, 安村佐都紀

1997 年 1997 巻 Supplement92 号 p. 64-67
発行日: 1997/06/27
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1997.Supplement92_64

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We have planned the construction of a computerized Kampo treatment support system whose aim is to select Kampo medicine used in otorhinolaryngological treatment on the basis of symptoms, evidence, and effective ingredients in the crude drugs. The essence of this system is the creation of a database on Kampo medicines and their clinical applications. Data relating to individual medicines were input, including the name of the medicine, its crude drug composition, symptoms or physical signs the medicine is suited for, and the pharmacological actions of each crude drug. This system is expected to deepen public understanding of Kampo medicine by providing information on the selection of Kampo medicine in daily medical activities as well as information on the medicine's efficacy and pharmacological actions in connection with the patients' symptoms and physical signs. The latter information may be provided as part of the manual on Kampo medicine.

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