Although glycyrrhizin (SNMC), and ursodeoxycholic acid (UDCA), alone or in combination have been administered in patients with active HCV-associated chronic hepatitis (HCV-CH) or liver cirrhosis (HCV-LC), there are many patients who do not respond well to these anti-inflammatory treatments. In this study, we examined retrospectively the possibility for juzentaihoto to alleviate inflammation in such patients. We calculated average ALT levels every 6 months for all 67 patients. If we assume an improvement in average serum ALT levels of more than 25% after juzentaihoto administration to be significantly effective, as compared with average ALT levels before juzentaihoto administration, 23 out of 40 patients (57.5%) showed significant improvement within one year. In the 32 patients with HCV-associated liver disease who were treated with combination SNMC and UDCA therapy, and whose average ALT levels did not decline to less than 80 IU/L, 18 (56.3%) showed significant improvement when juzentaihoto was added. Juzentaihoto was effective in 62.5% of patients with CH, and 54.2% of those with LC. Moreover, juzentaihoto was effective in 41.2% of male, and 69.6% of female patients.
And in about 40% of patients, average ALT levels lowered increasingly over time, out to 2 years. Juzentaihoto may be an effective anti-inflammatory agent for intractable cases of active HCV-CH, or HCV-LC.

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Female organ ptosis, especially uterine prolapse, is a delibilitative, dysfunctional condition of the supporting pelvic floor system of ligaments, connective tissues and muscles which manifests during pregnancy, delivery, or post-menopause. The Japanese Kampo herbal formula “hochuekkito” has been reportedly applied to uterine prolapse based on its putative ability to rejuvenate body vitality (Qi) and raise declined Qi. We assessed the efficacy of hochuekkito for uterine prolapse based on observations of its effect on clinical and objective symptoms. We administered hochuekkito to 17 patients (62.6 ± 7.1years) diagnosed with modern techniques as having uterine prolapse. The results showed that it was very effective in 6 cases (35.7%), effective in 9 cases (52.9%), and ineffective in 2 cases (11.8%). 10 patients with pessaries were all found to have been treated effectively (very effective : 4, effective : 6). In 6 patients whose compliance was below 90%, the percentage of very effective cases was 75%. The effectiveness score of hochuekkito with pelvic exercise (1.5 ± 0.5) and with pessaries (1.4 ± 0.5) was significantly higher than that with hochuekkito alone (0.8 ± 0.8) (p < 0.05). Finally, for uterine prolapse and bladder prolapse, the addition of pelvic exercise and pessaries to hochuekkito brought about more prompt improvement than that with hochuekkito alone. The increased efficacy with the addition of pelvic exercise or a pessary also helped strengthen atonic pelvic muscles, thus synergistically working together with the effects of hochuekkito.

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‘Processed bushi powder for ethical dispensing’, or TJ-3022, is an Aconiti tuber (PAT) herbal drug, and TJ-3023 is newly-developed to contain a higher proportion of diester aconitine alkaloid. We measured reactive oxygen metabolite derivative levels (d-ROMs tests), and total antioxidant capacity (OXY-adsorbent tests) in healthy adult volunteers, to assess whether PAT affects the oxidative stress regulation system. Thirty-four subjects were assigned to one of two groups: a TJ-3022 group and a TJ-3023 group. No significant chronological differences were observed in the TJ-3022 group. No significant chronological differences were observed in the TJ-3023 group, either. These results indicate that PAT dose not affect the oxidative stress regulation system in humans.

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This study was conducted to assess the appropriateness of preparation fees for dispensing herbal medicines, which were revised in 2006. We investigated the amount of time needed to dispense herbal, and general medicines. For prescriptions of1to 15 days length, the average time needed for herbal prescriptions was 13.4 minutes, which was about 3 times longer than for other prescriptions, which took only 4.4 minutes. For prescriptions of over 30 days length, this was about 7 times longer. Next we comparatively investigated fees charged per minute to prepare herbal medicines, with those for other medicines. Fees for all prescriptions of 1 to 15 days length were nearly equal, while fees for herbal prescriptions of over 15 days length were approximately 1/3 to 1/5l ess. Finally, we investigated the number of prescriptions filled out at one university hospital. In 2003 the number of herbal prescriptions exceeding 30 days length was 2.7% overall, while in 2008 this had increased approximately 14 times, to 42%. We would like to recommend an increase in herbal medicine preparation fees, based on the number of days a prescription is for, as the number of long-term prescriptions is increasing.

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Livedo vasculitis is one of the most difficult dermatological diseases to cope with in routine clinical practice. We report the case of a 23-year-old woman, who was diagnosed with livedo vasculitis and was responsive to Kampo treatment. She had a rash-like bruise from the spring of X-2, being diagnosed with livedo vasculitis at another hospital. In April, X, painful multiple ulcers on both lower limbs were beginning to appear and were resistant to the western standard therapy. In May 6,X, we started Kampo therapy for her at our hospital. After 4 months, her painful ulcers disappeared. We used tokishigyakukagoshuyushokyoto as the main agent, along with kakobushimatsu, hainoto, senkinnaitakusan, hakushusan and tokishakuyakusan. Although her livedo symptoms still remain and may need long-term treatment to heal completely, she obtained relief from painful ulcers, returning to her normal daily life.

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It is essential to prolong the term as possible in the treatment of threatened premature delivery. We report a case of threatened abortion successfully treated with hochuekkito. The patient was 31 year-old pregnant woman with lower abdominal pain. She was diagnosed to be at the risk of premature delivery on 21 weeks and 5 days of gestation. Intravenous ritodrine hydrochloride was started and she had to stay in bed. Severe side effects of ritodrine hydrochloride such as palpitation, tachycardia, tremor, nausea, and loss of appetite were appeared and she was consulted to our department on 23 weeks and 1 day of gestation. Those symptoms were markedly improved after administration of hochuekkito extract. She delivered a male infant of 1230g birth weight on 28 weeks of gestation. Hochuekkito suppressed severe side effects, and enabled to continue the infusion of ritodrine hydrochloride, suggesting the usefulness of Kampo therapy in the treatment of threatened premature delivery.

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Muscle hypertonicity, excitability, and insomnia were observed after improvement of cough, appetite loss, and general fatigue in four cases of severe mental and physical disability, and three cases of developmental disorder, while being medicated with bupleurum root-containing formulations for bronchial asthma, or other physical symptoms. By comparison with three trouble-free cases medicated with saibokuto, these four index double handicap cases used to react better to others with voice, gesture, and non-verbal communicative facial expressions, and they also used to have muscle hypertonicity with involuntary movements. In two cases with yokukansan, behavioral problems such as hyperactivity, excitability, and impulsive action were also prominent, and we might give more consideration toward both unapparent hot flushes or netsu-sho (hot states) of the head, and insufficiency of liver yin. We discuss the pharmacological function of bupleurum root drugs on the central nervous system, and suppose that the events presented in this paper might be adverse physical reactions rather than formulation side effects. Moreover, this should remind us to evaluate sho (Kampo diagnoses) carefully, and consult with parents on both mental and physical conditions, when prescribing Kampo medicines for handicapped children.

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Wells' syndrome (eosinophilic cellulitis), whose etiology is idiopathic, is clinically characterized by solitary or multiple cellulitis-like eruptions which occur on the extremities and trunk. Corticosteroids are usually used for palliative treatment, but relapses are often observed. We observed an 8 year-old patient with Wells' syndrome successfully treated with Kampo medicines. In 2001, skin eruptions appeared on his extremities. In 2002, a histopathologic examination determined his disease to be Wells' syndrome, and corticosteroids were subsequently used for treatment. In January 2007, his skin eruptions worsened, and he first visited our outpatient clinic in May. After oral administration with keigairengyoto, his skin eruptions were slightly improved, but afterwards, they again worsened. In June, jumihaidokuto was administered instead of the former prescription, and the skin conditions had begun to improve. Because dry skin appeared in November, keigairengyoto was again added. With these treatments, his skin eruptions stably improved. In previous reports, Kampo medicines had not been used for the treatment of Wells' syndrome. This case, however, suggests that Kampo medicines are a candidate for the treatment of Wells' syndrome.

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A 59-year-old woman presented with a 2-month history of headache with left eyelid swelling, and erythema in her lower extremities. She also had persistent low-grade fever and weight loss of 3 kg over 2 months. Blood biochemistry tests performed elsewhere indicated an inflammatory reaction. One week before hospitalization, she was treated at our hospital using the Japanese herbal medicines, keishito and shosaikoto. On hospitalization, her headache and eyelid swelling had slightly decreased ; therefore, she was advised to continue the Japanese herbal medicine, shosaikoto. Contrast-enhanced brain MRI showed meningeal thickening extending from the right anterior cranial fossa to the left cavernous sinus, suggesting a diagnosis of hypertrophic pachymeningitis. Cerebrospinal fluid examination revealed mild pleocytosis with mononuclear leukocyte predominance. Biopsy of the erythematous lesion on her leg was carried out, and analysis of the obtained specimen led to the diagnosis of erythema nodosum. In this case, exhaustive efforts to identify the cause of the combined hypertrophic pachymeningitis and erythema nodosum were unsuccessful. However, the symptoms and signs were alleviated after treatment with the Japanese herbal medicine, shosaikoto. We did not administer steroid therapy, which is generally prescribed for such an immune-inflammatory disease, because of the possible presence of an infectious disease. The Japanese herbal medicine was found to be a candidate therapeutic agent in this case.

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For a long time, clinical effect of Kampo medicine has been well evaluated. However, mechanism of this Kampo medicine is still unclear. Therefore, mechanism of action of Kampo medicine is clarified by using analysis procedures of Western Medicine.

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