The purpose of this study is to investigate the efficacy of hormone replacement therapy (HRT) and the Kampo medicine saikokeishito before and after treatment in postmenopausal women having various complains followed by a comparison of their effects. From April 2002 to March 2012, thirty-five (35) cases of HRT and eighteen cases of saikokeishito were evaluated by follicle stimulating hormone (FSH), Kupperman index, the self-rating questionnaire for depression (SRQ-D) and also various respective climacteric complaints such as hot flush, sweating, cold sensation, excitation, palpitation, stiffness in the shoulders and insomnia. While HRT was significantly more effective than saikokeishito by Kupperman index, hot flush and sweating (p < 0.05), saikokeishito was more than HRT in excitation, stiffness in the shoulders, insomnia significantly (p < 0.05) and also palpitation (p < 0.01). Although Kupperman index and SRQ-D were decreased significantly by HRT (p < 0.01) and saikokeishito (p < 0.05) over three months, HRT was significantly (p < 0.01) more effective than saikokeishito by Kupperman index and SRQ-D. These results suggested that although HRT and saikokeishito were both effective for climacteric complains, they had many differentiated efficacies in each treatment. Therefore saikokeishito was favorable in women in whom HRT is contraindicated or undesirable. We posit that serious climacteric symptoms with somatic disorders should be treated with HRT. On the other hand, saikokeishito is indicated in psychological disorders.
It is well known that an abdominal sign of painful groin indicates an appropriate condition for choosing the Kampo formulation tokishigyakukagoshuyushokyoto (TSG). This evidence was found by Keisetsu Otsuka in 1963. He thought that this sign is correlated with the liver meridian. However, the pathophysiological background for this sign has been unknown. Recently, the author made clear that this sign disappears by acupunctural procedure at the Hikon (ExB4) meridian point. According to this clinical evidence, the author proposes a new hypothesis for this abdominal sign in that it closely relates to a homeostatic mechanism. In the cold environment, sympathetic drive to the femoral arteries occurs in order to guard from radiation heat loss in the lower extremities. This drive also causes a reduction of blood supply to the pelvic viscera. The acupunctural procedure at the Hikon (ExB4) meridian point may release both the induration of the iliocostal muscle and the contraction of IOM simultaneously. TGS disconnects the vicious cycle which exist between the pelvic viscera and sympathetic ganglion, and improves various signs that correlates with ischemia of the pelvic viscera.
Objective : To determine the effectiveness of acupuncture therapy on hiesho in maturate stage females. Design : Multicenter, randomized, prospective, open blind, waiting list-controlled trial. Setting : A clinical center attached to three universities and one vocational school. Participants : Twenty two females between 18-39 years of age and with a level of more than four points on the “hiesho sensation scale” proposed by Kusumi et al for hiesho. Interventions : Participants were randomly assigned to receive therapies of either acupuncture or no therapy (waiting list controls). Acupuncture therapy was provided by needle retention to SP 6 and electro-acupuncture therapy to BL 32 at a frequency of 1 Hz for 20 minutes. One session per week of this therapy was provided for a total of four sessions. Method of Measurement : The primary outcome of change in hiesho intensity was measured using the visual analogue scale (VAS). Secondary changes were measured by an eight heading score and three component summaries of the standard edition SF-36 v 2. Results : The statistical analyses used an intent-to-treat analysis that included two participants who dropped out, and the mixture of one participant targeted for exclusion who was censored from the analyses. As a result, 21 participants were classified as either in the acupuncture group (n = 12) or the control group (n = 9). Efficacy with acupuncture therapy was not found for effect size (Cohen d, point-biserial correlation r) for VAS and the scores of SF-36 between the two groups. Conclusions : Effectiveness of the acupuncture therapy was not found, which suggests that it may be due to the smaller sample size, frequency of intervention, and symptoms associated with autonomic dysfunction.
Nephrosclerosis is a chronic kidney disease that gradually aggravates. Many elderly patients eventually require dialysis due to nephrosclerosis, which is the third-greatest cause of dialysis initiation. Past studies have shown that Chinese herbal medicines such as shinbuto may be effective for treatment. We evaluated the effect of concomitant shinbuto and boiogito extract administration to slow the progression of renal failure in patients with chronic kidney disease suspected to have nephrosclerosis. Our study included 20 patients with nephrosclerosis (12 male ; 8 female ; mean age, 76.2 years) treated at the Nephrology Department of Kagawaken Saiseikai Hospital on an outpatient basis. Shinbuto extract granules 5 g and boiogito extract granules 5 g were divided into two doses and given to the patients before breakfast and dinner. Laboratory tests were performed at baseline, 3 months, and 6 months. Serum creatinine levels decreased from 2.04 mg/dL at baseline to 1.72 mg/dL at 3 months and 1.59 mg/dL at 6 months, while eGFR increased from 26.8 mL/min at baseline to 32.2 mL/min at 3 months and 35.3 mL/min at 6 months (p < 0.01). Other laboratory tests showed no change. Shinbuto-boiogito may improve the renal function in patients with chronic kidney disease suspected with nephrosclerosis based on these data.
It is well known that a painful lump around para-naval, ileo-cecal and sigmoid regions are correlated with oketsu syndrome, although, the physiological mechanism for these signs is still unknown. Recently, the author made clear that these signs disappear by acupunctural procedure at the meridian points Hikon (ExB4), Kekkai (SP10) and/or the lump itself. And also the author found out that these abdominal lumps are located in the most peripheral position of the superior or inferior epigastric artery. This evidence may indicate that abdominal lumps are brought by diminished blood flow of the superior or inferior epigastric artery, and acupunctural input from a meridian point or lump itself inhibits not only the excited gamma and alpha motor-neuron in the thoracic 11 and 12 segment of spinal cord but also excites sympathetic neurons. The author speculates that the initial noxious stimuli occur with stagnation of the pelvic vein associated with homeostatic inflammation.
A dialysis patient may experience shoulder disorders that are not associated with a history of dialysis treatment. We reported regarding 6 dialysis patients with shoulder disorders who were successfully treated with goshakusan. The subjective symptom was cold in 3 of the 6 patients, and the objective symptom was interior cold in 3 patients. All patients had symptoms of ketsu (blood) deficiency with skin dryness and amyotrophy and of sui (body fluids) disturbance with decreased urine volume and water metabolism with renal dysfunction. Furthermore, they had symptoms of ki (Qi) deficiency with malaise and dry mouth after dialysis treatment. If these conditions continue, the dialysis patient will experience a decline in metabolism and decreases heat production, and “the cold” condition may occur. Four of the 6 patients complained of gastrointestinal dysfunction, and 1 experienced stomachache after receiving a painkiller, and they all had dietary symptoms. All symptoms improved after prescribing goshakusan. The conditions of the ki, ketsu, sui, cold, and dietary symptoms are recognized in dialysis patients, and goshakusan may be a suitable herbal medicine in cases with repeated shoulder disorders.
Kampo goshajinkigan is effective for the improvement of urinary tract function. Moreover, the origin of ganglion cysts is said to be varied and is not clear. We report a case of ganglion cyst disappearance, which was successfully achieved with goshajinkigan for urinary tract discomfort. The patient, a 35-year-old woman, who complained of nocturia, had difficulty in urinating, and a feeling of incomplete emptying. There were no findings of note in the urine or blood tests, and she was negative for cystitis. The patient did however show symptoms of kidney yang-ki deficiency. She was started on goshajinkigan 7.5 g/day for cold of the hands and feet, edema, and nocturia ; her feeling of incomplete emptying gradually reduced, and the nocturia, and feeling of incomplete emptying disappeared after 6 weeks. At the same time, her right wrist ganglion cyst also disappeared. This suggests that goshajinkigan is effective in alleviating ganglion cysts in cases with symptoms of kidney yang-ki deficiency.
In 2013, we prescribed daiuzusen for 3 patients with intractable pain; pain from complex regional pain syndrome, colic pain of unknown origin after an abdominal operation, and colic pain from advanced colon cancer and ileus. A dose of daiuzusen (containing uzu 0.5-2 g) quickly relieved their pain in several minutes. Another common symptom was “cold” in their bowel or extremities when they were feeling pain. Aconite levels in drugs and patients' serum after taking daiuzusen were analyzed by liquid chromatography tandem mass spectrometry. Daiuzusen per 1 g of uzu contained aconitine 1.28 μg, mesaconitine 2.31 μg, and hypaconitine 92.89 μg, while jesaconitine was not detected; this was about 5 to 35 times the level of tsumyakushigyakuto per 1 g of uzu. Serum concentrations of hypaconitine peaked in the study at 1.11 ng/mL after about an hour of taking daiuzusen (1 g of uzu). We posit that the immediate effect after taking daiuzusen was due to transmucosal absorption of uzu components. However serum hypaconitine, which we are now able to monitor, is at least one practical way of indicating the use of uzu or bushi containing prescriptions.
We report five cases of painful swelling caused by hymenoptera stings and centipede bites treated with ourengedokuto and inchingoreisan soon after the time of injury. The first case was a 70-year-old male. He was stung by a hornet on the left hand 30 minutes prior. The second case was a 45-year-old male. He was stung by a hornet on the left face 20 minutes prior. The third case was a 55-year-old male. He was stung by a hornet on the left lower thigh 10 minutes prior. The fourth case was a 39-year-old male. He was stung by a hornet on the right thigh 60 minutes prior. The fifth case was a 35-year-old male. He was bitten by a centipede on the right first toe 20 minutes prior. All cases received Kampo therapies immediately and continued them every few hours. In all cases, their pain, redness and swelling at the site of injury were relieved by the next day. We consider Kampo therapies can contribute to the healing of hymenoptera stings and centipede bites at an early stage.
Although “coldness” exaggerates chronic pain in the lower back and extremities in patients who experience it, there is no western-style medicine focusing on “coldness” Therefore, we investigated the efficacy and safety of a Kampo medicine that improves “coldness”. In the present study, we retrospectively reviewed medical chart records on the prescription of tokishigyakukagoshuyushokyoto 7.5 g/day (dry weight) to patients who had subjective coldness in their lower extremities. We performed pre- to 1 month post tokishigyakukagoshuyushokyoto treatment comparisons with regard to Visual Analogue Scale (VAS), axillary temperature, dorsal foot temperatures, Ankle-Brachial pressure Index (ABI), Pulse Wave Velocity (PWV) and patient satisfaction. The records of 21 patients with lower back pain and “coldness” were evaluated. VAS, and both axillary and dorsal foot temperatures were significantly improved, and satisfaction score was increased. Subjective coldness was alleviated in 7 patients ; however, objective temperatures were increased in all patients. In summary, we noted that tokishigyakukagoshuyushokyoto increased axillary and the dorsal foot temperatures, and objectively contributed to pain relief as well as patient satisfaction.
In Kampo, respiratory symptoms are treated with prescriptions related not only to “lung”, but also other parenchymatous viscera. We report 2 patients whose stress-induced chronic cough was ameliorated by hachimijiogan. Case 1 was a 25-year-old female who was working under stressful circumstances at her company and reported an oppressive feeling in the chest. She was initially prescribed hangekobokuto because of a feeling that something was stuck in the pit of her stomach on abdominal examination, but her cough did not get better. As she also noted a dull feeling in her back ; she was switched to hachimigan, and her cough disappeared. Case 2 was 42-year-old female who suffered from depression, sore throat and an obstructive feeling in the throat ; she had been receiving infertility treatment for several years. Hangekobokuto and bakumondoto showed insufficient effect on her persistent cough. Her coughing stopped when she was prescribed hachimigan for back pain. Neither of these patients showed lack of resistance of the lower abdomen on abdominal examination. Chronic ki (qi) stagnation under stressful conditions may cause ki deficiency, especially kidney deficiency. The symptom of stress-induced cough in our cases was considered to be due to kidney deficiency, and therefore hachimijiogan, but not hangekobokuto, was effective. The short duration of the complaints and relatively young age (20-40's) of the patients may account for the absence of the typical abdominal sign of kidney deficiency. Back stiffness and pain may also be important signs for cough due to kidney deficiency.
Direct moxibustion has been a common used moxibustion method in Japan, has required moxa floss of high-quality, and has promoted the development of a moxa floss manufacturing method unique to Japan. At the same time in China, because indirect moxibustion and the stick moxibustion method has been commonplace, low moxa floss of a purified standard has been produced with a simple manufacturing method. However well-refined moxa has become available in China recently, and it is now more similar to that in Japan. In this study, we investigated the difference between highly-refined moxa made in Japan and China based on reports from Japanese clinicians on the usability of moxa in firsthand practice. We performed a questionnaire survey with the country of manufacture blinded in 265 moxibustion clinicians. The number of valid responses was 164 (61.9%). To the question asking what the difference between the two types of moxa was, 54.9% of clinicians responded there was “a little difference,” and more than half responded with “better usability” and “favorability” for the Japanese moxa. Of 119 clinicians who performed moxibustion, 85 (71.4%) selected “comfort” for the Japanese moxa. We therefore conclude that Japanese clinicians recognize moxa refined with the Japanese manufacturing method as more suitable for direct moxibustion treatment.
A sign of palpitation above the umbilicus is an important piece of information which means a disorder of Ki circulation in the Kampo medicine. This study revealed that the amplitude of this palpitation observed in the abdominal wall was about 4 mm. The author has been speculated for a long time that this sign should accompany significant change of the diameter of abdominal aorta. But this speculation was denied by MRA study, which showed at most 1.5 mm change of the diameter of abdominal aorta. The ultrasonic studies of abdominal aorta showed that the amplitude of diameter of the aorta changed about 1.5 mm. The discrepancy between the amplitude of abdominal wall (4 mm) and that of ultrasonic image (1.5 mm) could be explained by assuming the impulse force toward the abdominal aorta wall. Concerning the generated powerful impulse, the author considered three factors including increased pulse velocity, reaction force by the spine and the sound pressure generated in the heart.
Chilblains is one indication for the use of an ethical Kampo formulation, i.e. tokishigyakukagoshuyushokyoto. This disease is a very common disorder which occurs in cold circumstances. It has been noted that this disorder correlates with diminished peripheral blood flow. However, the inflammatory mechanism associated with this disorder are still unknown. The author's intention is to speculate on the mechanism behind this disorder from the view point of homeostatic inflammation, as proposed by recent immunology. To wit, chilblains may occur via cytokines which are released from ischemic vessels of the microcirculation and/or cells associated with micro-coagulation in the post-capillary venula.
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