We studied the effects of a supplement containing freeze-dried earthworm powder : “Protein Related compound Derived from Redworm (PR-DR)” for atherosclerosis in 19 patients (10 females, average age : 61.5 ± 6.9), whose vascular ages were estimated to be older than their actual ages based on the index of atherosclerosis ; Intima-Media Thickness (IMT) by carotid ultrasonography and Cardio-Ankle Vascular Index (CAVI). After we obtained informed consent, they took daily dose of 6 PR-DR capsules for 6 months. Each capsule contains 40 mg of powdered extract of Lumbricus rubellus, which is known to contain fibrin-degrading an enzyme and to increase the effect of t-PA.
Before and 6 months after intake, we found significant decrease in 3 indicators of atherosclerosis. The scores of difference between 2 time points (6 month-pre) were IMT-Cmax : -0.15 ± 0.16 mm, maxIMT : -0.22 ± 0.17 mm, plaque score : -1.57 ± 1.12 (all p < 0.01 by Wilcoxon signed-rank test). As statins and EPA also decrease atherosclerosis, we excluded 6 patients who were taking these medications. Even in the remaining 13 patients (7 females, average age : 61.2 ± 7.9), 3 indicators were still significantly lower (IMT-Cmax : -0.07 ± 0.07 mm, maxIMT : -0.19 ± 0.17 mm, plaque score : -1.39 ± 1.04 ; all p < 0.01) after 6 months of intake. Thus, the results showed that PR-DR has anti-atherosclerosis effect and can be used clinically for the prevention of atherosclerosis and diseases associated with it.

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In the daily practice of Kampo medicine, a small string in the midline of the abdominal wall called the seichushin can be recognized. This paper intends to clarify anatomical aspects of this string by means of MRI or CT imaging. As a result of this study, this string's position distal of umbilicus was detected as the urachal remnant, and the proximal position was detected as the Lig. teres hepatis. The relationship between signs of the shofukufujin and seichushin has been not clear in some textbooks. The result of this study indicated that seichushin was detectable under the prerequisite condition of shofukufujin. That is, seichushin was inclusive special sign of shofukufujin, as has been already reported. On the other hand, the proximal seichushin was detectable under the condition of very weak tonus of the abdominal wall.

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In Japanese traditional medicine, “ganmenshin” (facial diagnosis), which means assessment of a patient's health based on the color of his/her face, is frequently used in a clinical setting. However, little scientific evidence is available to substantiate such diagnoses. In the present study, we investigated the relationship between skin color and patient's health status to ascertain the clinical usefulness of the “ganmenshin” technique. We evaluated the color of the cheeks and forearms of 30 healthy study participants and also administered questionnaires to determine their health. A correlation was observed between skin color and work efficiency and the inkyo (yin-fluid deficiency) scores in all subjects. In male subjects, skin color was correlated with their bodymass index (BMI), self-rated health status, work efficiency, and suitai (fluid stagnation) scores. In female subjects, skin color was correlated with the patient's age, work efficiency, and inkyo scores. These results suggest that “ganmenshin” may be clinically useful because of the correlation between skin color and the health of patients.

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Hemodialysis patients suffer from constipation, which often refractory. And they often realize anxieties over defecation urge during dialysis, or control of their body weight. Here we administered junchoto in the treatment of chronic severe constipation, and consideration of its therapeutic efficacy for constipation and for anxiety (qi stagnation). We prescribed junchoto 5.0 g or 7.5 g/day for 14 dialysis patients with chronic severe constipation regarded as a “Deficiency,” and evaluated response to constipation treatment with a constipation scoring system instrument, and Bristol Stool Chart. With a “qi stagnation score,” we also assessed improvement in qi stagnation. Median constipation scores significantly decreased from 14 to 4 after medication. Average Bristol Stool Chart scores significantly improved from 1.4 to 4.3. Median qi stagnation scores were significantly improved from 38 to 6. We believe that the Junchoto may be effective for chronic severe constipation in hemodialysis patients, who feel the improvements in qi stagnation (anxiety) with constipation.

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We describe three cases of calf cramps successfully treated with shimbuto. Case 1 was a 74-year-old female who suffered from calf cramps and knee pain caused by gonarthrosis. She was treated with boiohito, but did not respond. When she complained of diarrhea, shimbuto was substituted for boiohito. After taking shimbuto, her knee pain improved, and her cramps disappeared. Case 2 was a 77-year-old female who suffered from leg edema and calf cramps. Tokishakuyakusan was prescribed, but she complained of an upset stomach. Tokishakuyakusan was replaced with shimbuto, and her cramps improved together with a decrease in the coldness and edema in her legs. Case 3 was a 79-year-old female who took kososan for uneasiness and restlessness after the death of her husband. She had edema and coldness in her legs, and suffered from calf cramps during the daytime and early in the morning. Shimbuto was added to kososan, and her coldness improved ; subsequently the leg edema diminished, and finally her cramps disappeared.
These cases suggest that shimbuto is indicated for patients with calf cramps, who report internal coldness caused by kidney deficiency with gastrointestinal dysfunction.

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Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the lower limbs. Symptoms of RLS occur mostly during the night and can cause sleep disturbance. Here, we report experience with two RLS cases successfully treated with Kampo. The case 1 was a 60 year-old man. While the standard treatment showed temporary efficacy, it caused exacerbation. After starting jiinkokato and keishibukuryogan, his lower limbs discomfort was improved, and quality of his sleep was improved in one week. The case 2 was a 30 year-old man. He had felt abnormal discomfort in lower limbs six months before. The condition was getting worse to disrupt his sleep. With the first administration of jiinkokato and saikokaryukotsuboreito, the lower limbs symptom almost disappeared and his insomnia was much more improved. Then Kampo treatment was ended in two weeks.
The effectiveness of the jiinkokato for RLS was suggested by the following two observations. The first,nighttime aggravation of RLS could be related to deficiency of in and ketsu. And second, seinetsu therapy for RLS may have efficacy in cases of refractory heat of the limbs.

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It is not a few cases that present with fever and fatigability of an unknown cause. We report a case of fever and fatigability treated effectively with hangeshashinto. The case was 47 year-old woman who had been having fever and fatigability for three years. Sometimes she could not go to work because of this malaise. She was diagnosed with patterns of qi deficiency, upper body heat and lower body cold, qi stagnation and stagnant blood. We carefully considered shinkahiko (epigastric tightness and resistance).
Hangeshashinto was prescribed, and her complaints improved remarkably. Hangeshashinto is a well-known Kampo formulation for treating disorders of digestion. But this suggested that hangeshasinto is effective for a variety of symptoms in patients with digestional disorders, who also have a shinkahiko condition.

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Kippikijitsushokyoto is described in the great classical text, the Kinkiyoryaku (Jinguiyaolue) as the formulation for treating kyohi. We report seven cases of cough successfully treated with kippikijitsushokyoto. Almost all of these cases had similar symptoms, i.e., an itchy feeling in the throat, sputum that could not be expectorated easily, no feeling of dry throat, and skin findings of lighter complexion and increased moisture. Our clinical experience suggests that kippikijitsushokyoto is an effective treatment for cough accompanied by an itchy feeling in the throat.

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The efficacy of gemcitabine (GEM) monotherapy for recurrent ovarian cancer has been confirmed. Although it induces adverse reactions due to bone marrow toxicity, such as thrombocytopenia, there are no other effective treatments other than blood transfusion. Kamikihito has been reported effective for thrombocytopenia in about 20% of idiopathic thrombocytopenic purpura (ITP) cases, but there has been no report on its efficacy for thrombocytopenia caused by GEM administration. We encountered a patient with grade-2 thrombocytopenia in whom concomitant kamikihito improved thrombocytopenia, and it was also effective in improving response to chemotherapy. A 59-year-old patient developed thrombocytopenia in the first cycle of GEM therapy, and the dose was reduced or the drug was withheld appropriately until the 8th cycle. When kamikihito was concomitantly administered in the 9th cycle, thrombocytopenia was improved. The patient is now being treated in a 17th cycle, and is in a stable disease (SD) state. This suggests that kamikihito improves GEM-induced thrombocytopenia, as well as mental symptoms.

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We report on two cases of patients with chronic pain treated with opioid analgesics. They did not continue their treatment with opioid because of side effects.
An 88 year-old female complained of low back and leg pain caused by lumbar spinal canal stenosis. She also complained of dizziness, nausea and appetite loss after a course of weak oral opioid was administered. We thought it necessary to improve her general condition and digestive sickness following treatment for pain, and administered 5 g/day of hangebyakujutsutemmato. After the administration of this hangebyakujutsutemmato, her general condition improved, and we could administer various analgesics.
A 62 year-old female complained of dull headache, right neck pain and stiffness of tear and mouth due to fibromyalgia and collagen disease dating back several years. Her pain was reduced by the combined administration of a strong opioid and an immunosuppressive agent. However, she complained of severe dizziness, nausea and appetite loss after the commencement of drug therapy. Her general condition improved markedly, through the administration of 5 g/day of hangebyakujutsutemmato, and she was able to continue her treatment of chronic pain without deleterious events.
In conclusion, in patients treated with opioids for chronic pain, dizziness, dull headache, nausea, vomiting and loss of appetite is often seen. Therefore, we emphasize that the combined administration of hangebyakujutsutemmato and opioids can be beneficial for the treatment of chronic pain patients.

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The treatment of palpitation with a weak constitution through the use of modern western medicines is often difficult. We report here 4 cases of palpitation with weak constitution, which were successfully treated with shokenchuto. Case 1 was a 67-year-old female, who complained of palpitation, as well as anorexia and easy fatigability. An electrocardiogram (ECG) showed premature supraventricular contractions. Case 2 was an 83-year-old female, who also complained of palpitation and gastrointestinal dysfunction. ECG revealed premature ventricular contraction. Case 3 was a 34-year-old male, who complained of palpitation with gastrointestinal dysfunction and diarrhea. ECG findings were characteristic of Brugada syndrome. Case 4 was a 71-year-old female, who complained of palpitation and concomitant diarrhea and anorexia. All patients demonstrated tension of bilateral rectus abdominis muscles. After we prescribed shokenchuto, most of their symptoms improved. Thus, shokenchuto may be a suitable herbal medicine for patients with weak constitution presenting with palpitation.

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We report on a case of ascites with liver cirrhosis due to hepatitis B virus (HBV) that was successfully treated with a combination of inchinkoto and goreisan (inchinkoto-go-goreisan). Our patient, a 58-year-old woman had neglected her chronic B hepatitis and diabetes mellitus, and had not been treated with medication. She was admitted to our hospital because of severe jaundice and the ascites, which were noted when she consulted us for traumatic neck pain. Though we administered human albumin with diuretics, e.g. the combination of furosemide and spironolactone, the ascites did not improve. After administering a combination of inchinkoto and goreisan decoction, however, the ascites decreased rapidly within a month. In this case, we found that an inchinkoto-go-goreisan decoction was more effective than an inchinkoto decoction or a goreisan extract. This suggests that the effects of Gardenia and Rheum they are made from can be significant.

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To diagnose liver injury related to Kampo medicine accurately is not easy. Lymphocyte transformation tests are likely to give a false positive for Kampo medicine. Diagnostic criteria with a scoring system provide low specificity for the diagnosis of Kampo-related liver injury. This article intends to outline the problems with diagnosing Kampo-induced hepatic injury, and to review previous studies to shed light on its incidence and clinical features. Kampo-related liver injury incidence was 0.1% or less, and that related to Scutellariae Radix was 0.5-1.0% in the literature. The symptoms, types, and recovery periods were similar to those for western drug-related liver injuries.

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