PURPOSE : To determine risk factors for excessive sensitivity to cold (ESC) in relation to physical features.
DESIGN : A prospective cohort study carried out between July 7 and November 14,2008.
PARTICIPANTS AND METHODS : Seventy female junior college students with no ESC at baseline, and a median age of 20 years, participated. We used a numerical rating scale (NRS) to classify each ESC sensation over the five days in this July-November period.
To confirm physical symptoms, we used Terasawa's diagnostic scores for ki, ketsu, and sui. We defined ESC as mean NRSgeq ≥ 5.
RESULTS : We documented 17 participants with ESC in November. The multivariate adjusted odds ratio for ESC was11.6 (95% CI 1.9 to 97.5) for the physical characteristic “edema”. Participants with ESC were shorter in stature than participants without ESC (-5.9cm ; 95% CI -8.6 to -3.1).CONCLUSION : Participants with edema and short stature have a high risk for ESC.

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Takushato is a Kampo formula used for the treatment of dizziness and vertigo. Signs and symptoms suggestive of fluid retention have been regarded as clinical indications for takushato administration, but it is not clear if improvement of these signs and symptoms is related to the clinical efficacy of takushato, so we analyzed the correlation among these factors. Twenty patients who suffered from dizziness and vertigo were treated with takushato for 4 weeks. Before and after treatment, subjective symptoms and objective data including vestibular function tests were assessed, and correlation among the factors was analyzed. Improvement of patients' total symptoms was significantly correlated with improvement of fluid retention scores. Furthermore, improvement in vestibular function tests showed a trend toward correlation with that of fluid retention scores.
These results suggest that improvement in the signs and symptoms of fluid retention is related to the clinical efficacy of takushato. We conclude that the presence of fluid retention is a reasonable clinical indication for takushato administration.

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The Great East Japan earthquake and tsunami disaster that occurred on March 11, 2011 seriously destroyed Japanese social activities the medical system included. We provided medical support to the damaged area, and mainly performed Oriental medicine. Traditional methods using physical diagnoses and the treatments with herbs, acupuncture, and massage were effective, where any infrastructure had suffered or any modern medical facilities had been destroyed. Acute phase infectious disease, common colds, and hypothermia were dominant. Allergies increased two weeks later, and there was much mental distress, and chronic pain symptoms one month later. We prescribed Kampo herbal medicines for common colds, hypothermia, allergies, and mental distress. Moreover, we also performed acupuncture and kneaded patients' body to reduce pain, stiffness, and edema. These treatments were effective for both physical and mental distress. Thus we believe that Oriental medicine is valuable in disaster situations.

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Headache is one of patients' major complaints at medical examination. And in Kampo medicine, we select prescriptions for them by taking not only headache, but also other symptoms into consideration.
We present five patients with headache, whose symptoms were improved with tokishakuyakusan. Four patients (cases 1 to 4) had a background of menopausal symptoms and one (case 5), menstrual pain. Besides headache, other symptoms, such as vertigo, edema, and numbness of the fingers, were improved with tokishakuyakusan. Goshuyuto was not effective for headache in case 4, though it was effective to some extent in case 5, except for headache during her menstrual period. Headache during the ovulatory phase and/or pre- and early menstrual period disappeared when tokishakuyakusan was added to goshuyuto.
Eleven cases of headache treated with toshakuyakusan, including these five cases, revealed that tokishakuyakusan was efficacious against migraine-type headache, which becomes worse during the menstrual period, and coldness. Although tokishakuyakusan should sometimes be distinguished from goreisan or hangebyakujyutsutenmato, it may be effective in patients with so-called “blood pattern” headache, associated with menstrual period and menopausal symptoms, and in patients with a heavy feeling of the head and vertigo.

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We evaluated the effect of Kampo (Japanese herbal) medicine for overactive bladder (OAB), exacerbated by coldness. There were 258 OAB patients who visited our clinic between October and November. Thirty-one percent (79 out of 258) of those patients began Kampo treatment with their OAB drugs. Furthermore Kampo medicines for 49% of cases (39 out of 79) were for coldness. The prognosis of coldnesses which were treated by Kampo medicine at the next spring were as follows. An “effective and continued” group accounted for 54%, and an “effective but discontinued” group for 25%. An “ineffective and discontinued” group accounted for21%. There was a significant difference in mean age between the “effective and continued” group (63 ± 7.3) and “effective but discontinued” group (44 ± 11) (p < 0.01). Thus, the QOL of OAB patients should improve with Kampo medicine co-administered with OAB drugs.

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The case was a 70-years-old man whose chief complaint was tinnitus. After the administration of chotosan, his tinnitus was improved in 10 months. In addition, his headache, which had not been his main complaint, also disappeared. However, hypertension, which had not been reported in his history, was newly observed, when his chotosan dosage was reduced. After the usual dosage of chotosan was prescribed again, his blood pressure promptly decreased from the day that the administration started. Chotosan can improve tinnitus, especially in elderly people. Furthermore, this case suggested that chotosan is potentially useful as a primary medication in mild hypertension, when there are no severe coexisting illnesses. And, it may exhibit its anti-hypertensive effects quite rapidly.

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We report a 74-year-old woman who developed right-sided Hunt syndrome on July 3, XXXX, and who received stellate ganglion block and an infusion of aciclovir while hospitalized. Steroids were not used due to her diabetes. After discharge, she continued taking vitamin B₁₂, and received stellate ganglion block three times a week, but the paralysis did not show a tendency toward recovery. Following a combination of acupuncture and rehabilitation starting on October 6 (post-onset day 95), the paralysis score, which was 4 points on day 95, showed a tendency toward recovery : 32 points on day 186, and 36 points or more (within the normal range) on day 246. No apparent synkinesis was seen one year after the onset. Although Hunt syndrome appeared to be refractory due to her advanced age, presence of diabetes, unused steroids, complete paralysis with a paralysis score of 8 points or less, and no tendency to recover for three months or more, the results suggested that she responded to the combination of acupuncture and rehabilitation.

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Based on our own 35 cases treated with kobokushichimotsuto as well as our predecessors' experience and their opinions, we investigated the drug's mechanism of action and its background indications. Our predecessors' opinions seem to be divided into two groups. Group A : An external pattern/syndrome (a keishito indication) of external contraction, followed by an interior heat pattern/syndrome (a kobokusammotsuto indication) appear. Mechanism of disease wise, this means that both external and internal patterns/syndromes exist at the same time. Because an internal pattern/syndrome is heavier than an external one, both patterns/syndromes are simultaneously treated, by making both medicinals bound together. Group B : Internal heat due to yang exuberance with yin debilitation is the mechanism of disease here. In group A, cause of disease is classed as a true heat pattern/syndrome. In group B, depending whether the internal heat belongs to either true heat or false type, deficiency and excess of pulse/abdominal patterns/syndromes change, and appetite differs. In either group, no peony is used to cope with the chest pattern/syndrome induced by the progression of gastric heat into the chest. Our cases consisted of upper respiratory illnesses with appetite loss, gastrointestinal diseases with chest oppression, respiratory diseases and intestinal obstructions. Kobokushichimotsuto, however, can be applied to neuroses, mental disorders and low back pains.

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We encountered 4 cases of calf cramps in which the herbal mixture shakuyakukanzoto was ineffective but another herbal mixture sokeikakketsuto was effective. In case 1, the patient was a 73-year-old man. He had a history of calf cramps, and started experiencing calf cramps more frequently about1month before he made his first visit to our department. Shakuyakukanzoto (7.5g/day) was initially prescribed, but the frequency of cramps did not change. Then, shakuyakukanzoto was replaced with sokeikakketsuto (7.5g/day), and this resulted in rapid alleviation of the symptom. In case 2, the patient was a 67-year-old woman undergoing outpatient care for shoulder stiffness, low back pain, etc. She started experiencing calf cramps at night and underwent shakuyakukanzoto (7.5g/day) treatment. The frequency of cramps did not change, and hence, shakuyakukanzoto was replaced with sokeikakketsuto (2.5g at bedtime). The symptom was alleviated in response to this therapy. In case 3, the patient was a 66-year-old woman undergoing treatment for low back pain at our department. She experienced calf cramps and was treated with shakuyakukanzobushito (3.0g/day). The response was poor, and the herbal mixture was replaced with sokeikakketsuto (7.5g/day), which resulted in the disappearance of her cramps. In case 4, the patient was a 75-year-old man undergoing treatment for a cold sensation in the left leg. He experienced calf cramps and was treated with shakuyakukanzobushito (1.5g/day). This therapy resulted in only temporary relief from the symptom. After the herbal mixture was replaced with sokeikakketsuto (2.5g/day), the cramps disappeared rapidly. Thus, sokeikakketsuto, which improves blood flow and is thought to manifest analgesic effects, may be used for treating patients with calf cramps who do not respond to shakuyakukanzoto.

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We report a patient with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL) in whom saikanto was effective against pleural effusion induced by dasatinib, which is a second-generation tyrosine kinase inhibitor. The patient was a 43-year-old female. After she was diagnosed with Ph+ALL, she received imatinib and other chemotherapy. One year later, she started to receive dasatinib because of imatinib intolerance (vomiting and diarrhea). After about seven months of taking dasatinib, she experienced chest/back pain and a cough; at that time her chest x-ray showed right-sided pleural effusion. She consulted our clinic three months later, for treatment of the hydrothorax that frequently recurred. We prescribed saikanto because she presented with epigastric tenderness diagnosed as shokekkyo, and the pleural effusion and clinical symptoms improved remarkably. Because of the good clinical course in this case, we consider that the decrease of pleural effusion was caused mainly by the immunoregulatory and anti-inflammatory activities of saikanto in addition to its activities to alleviate fluid retention.

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We report a case of recrudescent cholangitis successfully treated with Kampo medicine. The patient was a 31-year-old female. She was diagnosed with congenital biliary dilatation, and underwent an operation for partial resection of the liver, and a choledocho-jejunostomy. However, the cholangitis returned two years ago, when she was 29 years old. She had repeated abdominal pain and fever, and at that time received treatment with antibiotics. She desired pregnancy, and was hoping that Kampo treatment would enable her to decrease the amount of antibiotic she was taking. We prescribed inchinkoto as a base treatment and added to daisaikoto or shosaikoto. We changed the prescription according to her symptoms. As a result, her antibiotic quantity was reduced markedly, she safely conceived, and kept taking Kampo medicine while she was pregnant. She remained in good condition throughout her pregnancy. Thus, we consider that Kampo medicine may be useful for treating recrudescent cholangitis after an operation for reconstruction of the biliary tract.

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