Background : Shigyakusan, a 4-component Japanese herbal medicine (Paeoniae radix, Aurantii fructus immaturus, Glycyrrhizae radix and Bupleuri radix), is used not only for cholecystitis and gastritis as an antiinflammatory agent, but also for anxiety neurosis and insomnia as an anti-anxiety agent.
Methods : We investigated the effects of shigyakusan on alloimmune responses in fully MHC-mismatched murine cardiac allograft transplantation. CBA mice underwent transplantation of a C57BL/6 heart and received shigyakusan or one component of shigyakusan administered orally from the day of transplantation until 7 days afterward. Histologic studies, cytokine measurements, and flow cytometry assessments were performed.
Results : Untreated CBA recipients acutely rejected C57BL/6 cardiac grafts (median survival times [MST], 7 days). On the other hand, CBA transplant recipients given shigyakusan had significantly prolonged C57BL/6 allograft survival (MST, 22.5 days). MSTs for C57BL/6 transplant recipients given Paeoniae radix, Aurantii fructus immaturus, Glycyrrhizae radix and Bupleuri radix were 11, 9.5, 18.5 and 8 days, respectively. Additionally, flow cytometry studies showed that the percentage of CD25+Foxp3+ cell populations in CD4+ cells was increased in transplant recipients given shigyakusan.
Conclusion : Shigyakusan induced hyporesponsiveness to fully MHC-mismatched allogeneic cardiac allografts and may generate CD4+CD25+Foxp3+ cells in our model.

The aim of this study is to retrospectively examine the efficacy of rikkunshito in comparison with shohangekabukuryoto and metoclopramide, administered to patients with hyperemesis gravidarum, using with the emesis index (EI) proposed by Kitagawa, et al. Total EI score for all groups was decreased with the passage of time, although EI in the rikkunshito group at day 7 was significantly lower than that of the other shohangekabukuryoto and metoclopramide groups. All nausea, vomiting and anorexia, scores were significantly lower in the rikkunshito group. These results suggest that rikkunshito is as effective in hyperemesis gravidarum as shohangekabukuryoto and metoclopramide are, and more effective for the gastrointestinal symptoms of nausea and vomiting, anorexia. The group in which rikkunshito was ineffective tended have a higher qi counterflow score, thus treatment modifications with qi circulating medicine would be required in accordance with sho patterns.

Constipation is one of the most common symptoms seen in elderly people, and is sometimes difficult to treat. Daikenchuto is a well-known Kampo formulation for treating ileus. Here, we report a case in which daikenchuto was not effective and constipation was effectively treated with kobokushokyohangeninjinkanzoto. The patient was an 81-year-old woman who had been hospitalized for treatment of a thighbone fracture. She was originally constipated, and her constipation had worsened over the course of hospitalization. Colonoscopy examination and abdominal computerized tomography showed no structural lesions. Her constipation improved after the administration of daikenchuto, but the improvement was transient. Since the constipation and abdominal distension worsened after she began eating again, we administered kobokushokyohangeninjinkanzoto. Subsequently, her condition improved remarkably. Eight days later, we changed the initial kobokushokyohangeninjinkanzoto to ninjinto and hangekobokuto. Her complaint did not recur, and she was discharged 17 days later. In case of deficiency pattern ileus, kobokushokyohangeninjinkanzoto may be considered as an alternative to daikenchuto. Furthermore, we believe that the combination of ninjinto and hangekobokuto is an effective alternative to kobokushokyohangeninjinkanzoto.

We describe two cases of cardiac failure in elderly patients successfully treated with shimbuto. Case 1 was that of an 84-year-old man with severe aortic stenosis and liver cancer. His cardiac failure led to repeated hospitalization. After taking shimbuto, his pleural effusion decreased and cardio thoracic ratio improved. Case 2 was that of an 84-year-old man who was hospitalized because of cardiac failure and aspiration pneumonia after undergoing an operation for lung cancer. After taking shimbuto, his urine volume increased and cardiac failure improved. No notable adverse events were observed in any of the abovementioned cases. It is important that kanzo is not included in shimbuto to demonstrate risui action, hence the use of other “ho” formulations should be avoided. These cases suggest that shimbuto is indicated for elderly patients with cardiac failure under terminal care.

A 54-year-old female had cesarean sections at ages 26 and 29, a left salpingophrectomy for left ovarian cyst at age 31, and a total abdominal hysterectomy for fibroids at age 41. After total abdominal hysterectomy, she had repeated bouts of ileus and started taking daikenchuto (DKT), which is commonly used to prevent ileus. At age 54, she visited our hospital when DKT failed to relieve her constipation and lower abdominal pain and had occasional heat flash above her neck. Tongue examination revealed pale red tongue and fissured tongue signs with yellow fur and dilation of the sublingual collateral vessels. Kampo diagnosis was blood stasis and excess heat, for which keishibukuryogan was prescribed to be taken daily and with which her symptoms dissipated after 7 days. Despite the popular use of DKT, its potential to cause excess heat after long-term use is not as well known. It is extremely important to warn clinicians who prescribe Kampo not to focus solely on a disease-to-prescription model but also to be learned of the discipline and to take measures to prevent adverse long-term effects and complications.

Otsujito is a well-known Kampo medicine for treatment of hemorrhoidal diseases. In the current report, we present end results for a case of enterocutaneous fistula treated with Kampo medicine in accordance with traditional “sho” indications.
An 81 year-old female developed abdominal wall-intestinal fistula right immediately following partial colectomy due to ischemic sigmoid colic perforation 12 years previously. Two years later, she had a fistulectomy and repair using intraperitoneal mesh for abdominal recruitment. Eight years after repair of the enterocutaneous fistula, she had peritonitis caused by the tardive intraperitoneal mesh infection. Since then, she has had frequent repeated ileus and received conservative treatment for two years. Several local operations and abdominal drainages were performed after transfer to Aizu Medical Center. Kigikenchuto was provided for wound healing for approximately 1 year, and one fistula was finally identified. Otsujito dramatically decreased the leakage of intestinal juice and closed her enterocutaneous fistula.
Angelicae Radix as an anti-inflammatory agent, and Cimicifugae Rhizoma as originally indicated, may have played pivotal roles in this case with Otsujito.

A 19-year-old man was referred to our clinic for frequent nausea and vomiting. At age 16, he started to have periodic bouts of nausea and vomiting. During an attack, he would experience vomiting more than ten times a day and was unable to eat, which resulted in hospitalization for a week. Inpatient investigations did not reveal any abnormalities except dehydration. Between attacks, he was asymptomatic. Initially, he had attacks a few times a year. However, beginning at age 19, the attacks occurred almost every month. At our clinic, routine physical examination and laboratory tests were unremarkable. On Kampo medical examination, he had qi stagnation and qi counter-flow. He was diagnosed with cyclic vomiting syndrome. Hangekobokuto was administered with improvement of his symptoms. Hangekobokuto may be effective for cyclic vomiting syndrome with qi stagnation and qi counter-flow as diagnosed with Kampo medicine. This suggests the effectiveness of Kampo medicine in functional gastrointestinal disorders.

Peripheral arterial disease is a serious complication that can arise in hemodialysis patients. Prognosis in critical limb ischemia (CLI) due to peripheral arterial disease is extremely poor. A dialysis patient may experience symptoms of both qi and ketsu deficiency and ketsu stagnation during the long-term treatment of CLI. Herein, we report three hemodialysis patients with refractory postoperative skin ulcers who were successfully treated with juzentaihoto and keishibukuryogan after limb amputation. Case 1 was a 68-year-old man who had skin ulcers of the right second, third, and fifth toes. After amputation of the third toe, juzentaihoto and keishibukuryogan were initiated. Case 2 was a 67-year-old man who had skin ulcers after amputation of the left fourth and fifth toes. Postoperatively, juzentaihoto and keishibukuryogan were initiated, and good granulation was observed. Case 3 was a 76-year-old man who had skin ulcers after left below-the-knee amputation. Because of the extremely poor tissue granulation, juzentaihoto and keishibukuryogan were initiated, and good granulation was gradually observed. After an operation for CLI, prompt return to activities of daily living is desirable. The appropriate addition of Kampo treatment to Western treatment may improve chronic refractory skin ulcers.

We reported a patient whose left hypochondrial pain disappeared after treatment with jidabokuippo and sokeikakketsuto. An 81-years-old woman developed pain after bruising for 2 months. Intercostal nerve block temporarily reduced the pain ; however, considerable pain subsequently remained. The patient received Jidabokuippo and Sokeikakketsuto. Seventeen days later, the patient was relieved from the prolonged pain and had melanotic defecation. This suggests that formulas classified for the treatment of potential blood stasis may relieve prolonged pain.

Chukenchuto is often reported to be useful for constipation. We experienced patients with diarrhea or loose stool, successfully treated with chukenchuto. In this report, five cases are documented. Of these, four cases did not present with constipation. We emphasize that chukenchuto is also effective for diarrhea or loose stool. Other clinical manifestations such as gargling sound or abdominal distension, tension of abdominal rectus muscle, and feeling of cold are common in cases where chukenchuto is effective.

Medical therapies, adapted to local requirements, are necessary in the field of community medicine. Generalized medical treatment is often all there is in Japan's Konsen Area, due to the large number of elderly people and a paucity of medical institutions. Kampo medical treatment is useful for elderly patients with plural diseases, and the demand for such treatment has been increasing. Therefore, we collected data on Kampo prescriptions prescribed by the doctors at the Nakashibetsu Municipal Hospital, which is the main local hospital in the Konsen Area, from 2010 to 2013. We conducted similar investigations at the Kushiro Red Cross Hospital in Kushiro city, which is centrally located in the Konsen Area, and at Asahikawa Medical University Hospital in Asahikawa, central Hokkaido. The aim of these investigations was to compare Kampo medicine use based on hospital location and size. The results can be used in community medicine to enhance the use of Kampo medicine with increase for its demand. Medical students and doctors should be educated in Kampo medicines, since their prescriptions have a significant impact on community health.

In Kampo medicine, abdominal palpation is essential procedure to make the diagnosis of Sho. We experienced two cases of abdominal aortic aneurysm which are diagnosed by means of abdominal palpation. The coexistence of aneurysm and the sign of abdominal palpitation is extremely rare, but every clinician should pay attention to this fact.

Emi Sampaku (1707-1781) is one of the great Koiho (old medical school) practitioners along with Yoshimasu Todo who is from the same province as Sampaku.In general, he was depicted as an “intensive medicine dozer” ; however it doesn't seem to be his factual depiction.
This kind of misapprehension is caused by a scarcity in exploration on him, especially his philosophy of medicine, nevertheless being such a great master in that field. Now in this paper I would look over the quintessence of his remedy and the theory of medicine to clarify his philosophy of medicine through investigations on his volumes such as Emikun Ijidan, Emineiko Sensei Igen, Emi Sensei Iho Ryakusetsu, Toho Shiron.
As a result of my survey, it has been clarified that Sampaku took his way of remedy on accordance with the curate diagnoses which were brought about through his Shinshi-jikken “Experience and Verification”. Put it in another way, Sampaku took intensive medicine for vomiting/purgative remedy merely under the necessity. He is one of “a man of discerning eyes”.