Objectives : Persistent coldness is a common complaint for which Kampo, traditional Japanese herbal medicine, is often tried, because there is no definition or objective measure of subjective coldness in Western medicine. The aim of this study was to evaluate the efficacy of a common Kampo agent, tokishigyakukagoshuyushokyoto, and to identify key symptoms that would predict positive treatment outcomes for coldness.
Design : A retrospective cohort study.
Setting : 181 patients who complained of coldness without any organic abnormalities self-surveyed their health using a Kampo questionnaire database system on their first visit. Another 28 patients were assigned to verify the discriminatory predictability of treatment efficacy.
Interventions : Patients were treated with extract product, 7.5 grams a day for a month.
Outcome measures : Treatment efficacy as a binary response.
Results : Frequency and severity scales (0 to 4) for coldness decreased from 3.2 ± 0.7 to 2.1 ± 0.1 (p < 0.01)and from 3.1 ± 0.7 to 2.2 ± 0.9 (p < 0.01), respectively. Improvements in both frequency and severity of coldness were observed in 74.0% of patients. The status of tenderness in the iliac region, without upset stom ach or depression, was obtained as an appropriate model for the prediction of treatment effect, and its discrimi natory predictability was calculated as 84.4%. The predictive accuracy of the model was validated with 82.1% for the 28 new patients.
Conclusions : Coldness susceptible to tokishigyakukagoshuyushokyoto was very frequently accompanied by tenderness in iliac region, without upset stomach or depression.

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The crude drug Aconite Root (bushi in Japanese) contains toxic compounds called bushi diester alkaloids(BDA), and the raw material with high BDA content has been considered suitable for processing into prepared bushi. Moreover, processing methods and an upper BDA content limit are prescribed in the 16th edition of Japanese Pharmacopoeia. In this study, we closely examined descriptions of high quality bushi in ancient herbal literature, and elucidated the relationship between bushi forms and BDA contents. The results showed that large-sized bushi with enlarged rootlets called “horns” (tsuno in Japanese) were considered higher quality, and the horns and the root tops (hozo in Japanese) were cut off when used as bushi. Meanwhile, chemical studies have shown that larger bushi contains less BDA, and the root tops and the horns contain more BDA than the root body. These results suggest that selecting larger roots and cutting off the more potent parts were processes for reducing BDA. Therefore we conclude that consistently less toxic bushi was considered a higher quality product in ancient times.

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Decoctions of Ephedrae Herba were prepared using tap water sampled in Changping District, Beijing City(China), tap water sampled in Niigata City (Japan) and some mineral water samples sold in markets. Various dissimilarities were found between drug extracts prepared using tap water in Japan and China, and the extraction efficiency of the alkaloids with Beijing tap water was approximately 80% of that with Niigata tap water. It is suggested that these dissimilarities result from concentrations of temporally hard components, such as calcium and magnesium bicarbonate salts, in the water. In addition, when Zizyphi Fructus and Ephedrae Herba were decocted together in hard water, the state of the decoction, ephedra-alkaloid content included, was found to come close to that of single Ephedrae Herba decoctions prepared using soft water. It was suggested that Ziziphi Fructus might possibly play roles as a softening agent in decoctions prepared using hard water.

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I treated crocodile tears syndrome (gustatory-lacrimal reflex) after right facial nerve palsy with acupuncture. The patient was a 74-year-old female. Her right peripheral facial nerve palsy had started one and a half years earlier.
Most of her facial nerve palsy symptoms disappeared in about 5 months. Sixteen months after onset of the condition, her crocodile tear phenomenon occurred spontaneously. Three acupuncture points on the face were stimulated with fine needles for 10 minutes. Her crocodile tears disappeared completely with the first acupuncture session. This case suggests the possibility of acupuncture treatment for aberrant regeneration after facial nerve palsy.

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There have been some reports that keishikaryukotsuboreito improves climacteric symptoms such as palpita tion, but none have reported coldness successfully treated with this formulation. We report a case of palpita tion and coldness, successfully treated with keishikaryukotsuboreito.
The patient was a 48-year-old female. She complained of palpitation and coldness for 2 to 3 years. She had coldness of the hands and feet without hot flushes. She consulted our clinic on May 8, XXXX. We prescribed keishikaryukotsuboreito (7.5 g/day) because of suggestive symptoms of insomnia, as well as palpitation in the abdomen. Her symptoms improved in 2 weeks. Keishikaryukotsuboreito is usually prescribed for cold feet with hot flushes. The results experienced in this case suggest that keishikaryukotsuboreito may be effective for cold feet without hot flushes, especially with palpitation and pulsation at the navel, which are known symp toms of qi counterflow in Kampo medicine.

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In this report, the author describes a case of recurrent ileus (intestinal obstruction) successfully treated with shimbuto. The patient was a 58-year-old man having been undergoing maintenance hemodialysis (HD) for 8 years. He had a history of laparotomy in his childhood. He had been admitted to the hospital frequently for recurrent ileus over the past 2 years. Although he was prescribed pantothenic acid, dinoprost, daikenchuto, and hangeshashinto, these medicines did not work. Eventually, he was transferred to our hospital. On admission, he suffered from abdominal pain and vomiting. Abdominal radiographics showed small intestine gases. Ab dominal CT, PET-CT, gastrointestinal endoscopy, colonoscopy, enteroscopy, and enterography through an ileus tube were performed to examine the cause of obstruction, however, no mass nor volvulus was observed. He recovered from the nausea and pain subsequent to ileus after taking shimbuto. At present, he has been pre scribed shimbuto without any recurrence of ileus for over 10 months. Patients undergoing maintenance HD are generally in a state of chronic water metabolism abnormality (suitai), abnormal defecation, and coldness in the extremities. Thus, the use of shimbuto for ileus might be recommended in patients undergoing HD.

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Patulous Eustachian tube (patulous ET) is not a rare disease, for which the prevalence rate is considered to be higher than 5%. Autophonia and ear fullness are common symptoms of patulous ET. Various treatments in cluding drug therapies and surgical procedures are attempted, although they do not give satisfactory results.
In oriental medicine, patulous ET is considered a Qui deficiency and/or blood deficiency. And Kamikihito is known as a popular Kampo prescription for patulous ET. Here we report the effect of hochuekkito on Patulous ET. Hochuekkito was administered to 10 patients, and complete improvement was had in 4 cases, partial im provement in 1 case and 5 cases had no change. Elevated ET tonus, gains in fatty tissue surrounding the ET, and influence on psychogenic factors were speculated as mechanisms by which hochuekkito brought about its effect.
Through this report, we expect that hochuekkito can be an alternative treatment for patulous ET.

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At present numerous Kampo formulae are used in Japan, and how we classify Kampo formulae into groups has become an important issue. Nevertheless, in recent-year Kampo formularies or prescription manuals, there is almost no comprehensive classification of all Kampo formulae covered by the older Koho or Goseihou schools, or recent Chinese Medicine. Furthermore no research has been performed on Kampo formulae classi fications. From a historical point of view, however, many classifications were made in formularies and prescription manuals of the Edo period then the early Showa period.
Kenzo Okuda, who belonged to the Koho School, was a Kampo physician in the early Showa period who attempted to make classifications of Kampo formulae. In this review, we researched his classifications as based on Ruihou-classifications, in other words the systematic collecting Kampo formulae by points of similarity between herb formations. Then we also studied the history of Ruihou-classifications preceding Okuda’s, and considered problems lying ahead for classifications of Kampo formulations in Japan.

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