We evaluated body constituents patterns of 74 consecutive patients with neurological degenerative disorders. They comprise Parkinson's disease (n = 38), amyotrophic lateral sclerosis (n = 19), and multiple system atrophy (n = 17). We compared body constituents patterns between them and 149 consecutive patients with other neurological diseases of the same age. We used ki-ketsu-sui scores to evaluate body constituents patterns in all cases. Ki-ketsu-sui scores measure six factors : qi deficiency (kikyo), qi stagnation (kiutsu), qi counterflow (kigyaku), blood deficiency (kekkyo), blood stasis (oketsu), and fluid retention (suitai). As a result of multivariate analysis, neurological degenerative disorders had large weight of blood deficiency, fluid retention and qi stagnation. Their adjusted odds ratios (95% confidence interval) were 3.02 (1.43-6.48), 2.37 (1.13-5.11), 2.33 (1.01-5.44), respectively. Most relevant factor to neurological degenerative disorders was a blood deficiency. Taking into consideration a prescription of “shimotsuto rui” may contribute to alleviate patient's suffering. In addition to subjective symptoms, we need an oriental medicine scale such as pulse, tongue, and abdominal examinations to judge a therapeutic effect of Kampo medicine.
The change in color tone of crude drugs during storage of decoctions is one of the factors leading to poor drug compliance of decoctions. We experienced a case of a decoction including Aluminum Silicate Hydrate with Silicon Dioxide (Kasseki) turned into bright blue color after it was combined with goreisan. We therefore examined to find out possible causative crude drugs using an airtight container and performed a component analysis by the TLC. As a result, we found the following: Kasseki under the coexistence of Cinnamon Bark (C. Bark) and Atractylodes Rhizome (A. Rhizome) turned into a bright blue color in several hours. In this coloration, aluminum silicate hydrate, cinnamaldehyde and atractylon, which derive from these 3 crude drugs, were involved. This coloration change of Kasseki under coexistence of C. Bark and A. Rhizome was a vivid and sharp reaction generated in several hours. From the perspective of maintaining medication compliance, it is important to provide a full explanation to patients about the change in coloration of Kasseki, when decocting crude drugs that contain C. Bark, A. Rhizome, and Kasseki. To avoid coloration, it is considered useful to put Kasseki in a separate sachet, isolated from other crude drugs in storage, and to mix in Kasseki just before decocting.
The background and course of Kampo treatment in 39 patients with uncontrollable otolaryngeal symptoms treated between April 2013 and March 2016, in the Department of Kampo Medicine at Tohoku University Hospital, were analyzed retrospectively. An improvement in overall symptoms was noted with Kampo treatment in 28 of 39 cases (71%). The commonly reported subjective symptoms included glossodynia (7 cases), postnasal drip (4 cases), oral discomfort (4 cases), dizziness (3 cases), and taste disorder (3 cases). Analysis using the classification of qi, blood, and fluid revealed that cases with qi stagnation pattern (15 of 18 cases) were effectively treated with Kampo treatment. Prior reports support our finding that smoothing qi with Kampo medicine is effective in alleviating some chronic symptoms. The symptoms improved within 6 weeks after the treatment was initiated. Therefore, a 6-week period can be considered sufficient to determine the effectiveness of Kampo medicine. Many of the patients for whom Kampo treatment was not effective had depression and domestic stress. In conclusion, Kampo treatment may be effectively used to treat uncontrollable, chronic otolaryngeal symptoms in selected cases that are unresponsive to Western medicine.
A 51-year-old woman with a 10-year history of diabetes visited our clinic for treatment of stiff shoulder and constipation. She was 156 cm tall and weighed 68 kg. The blood pressure was normal. Physical examination revealed no significant abnormalities. After she took the usual amount of tokakujokito for 3 days, hypertension and facial edema, legs edema, weight gain, and headache were observed. Pseudoaldosteronism inhibits 11 β-hydroxysteroid dehydrogenase Type 2, which is an active glycyrrhizin (GL) and its metabolites glycyrrhizic acid, 3-monoglucuronyl-glycyrrhizic acid metabolize and inactivate cortisol to cortisone. As a result, excessive cortisol acts on the mineralocorticoid receptor and promotes sodium reabsorption and excretion of potassium (K+), resulting in water retention and hypokalemia in the body. Insulin also causes hypokalemia because it also takes K+ at the same time as it takes blood glucose in the cell. As a result of these two different processes, it was thought that pseudoaldosteronism developed in low dose licorice. Glycyrrhizin-containing preparation should be careful used in patients receiving insulin.
Case 1 was a 72-year-old man with a generalized pain after 6 months of heavy physical work. Kakkonto was prescribed based on his symptoms of severe shoulder stiffness and pain, and keishibukuryoganryo was added to treatoketsu. It caused dysuria because of ephedra herb, so the dosage was reduced. Atractylodes lancea rhizome and processed aconite root were added to enhance the effect of treatment. And then, his pain was alleviated. Case 2 was a 53-year-old man with a generalized pain. He had a previous history of whiplash and two surgical operations. Daisaikoto was prescribed based on his symptom of bilateral costal arch pain, and keishibukuryoganryo was added because of oketsu. It caused an increased frequency of bowel movement due to crude drug of rhuharb, so the dosage was reduced. Pueraria root was added for the purpose of relieving severe shoulder stiffness. And then, his pain went away. It is often difficult to treat fibromyalgia. The decoction can be effective with increase or decrease and deleting or adding of the dosage of crude drug. Decoctions become handy as it allows dosage adjustment of crude drug to minimize the side effects and improve the efficacy.
In our clinic, patients with relatively positive diseases, which form the orthopedic conditions with inflammation, were successfully treated with eppikajutsuto and daiobotampito after reisenjotsuin. Patients with pain due to orthopedic disorders where NSAIDs (non-steroidal anti-inflammatory drugs) were difficult to be used or ineffective were successfully treated with eppikajutsuto and daiobotampito. We present the representative cases and bibliographically discuss them.
The patient was a 13-year-old male who had experienced periodic fever since he was in the 5th grade. After he moved into the 8th grade, he developed fever, abdominal pain, and vomiting continuously, which caused him to miss school or leave school early once every one to two weeks. Various Kampo extract preparations prescribed at a nearby clinic did not improve the symptoms, and the patient was referred to our hospital. Administration of bukuryoshigyakuto and shokenchuto reduced the fatigue, but the fever could not be controlled. Subsequently, a grasp of “the disease byakugobyo turned into fever” was made, and he was put on byakugokassekisanryo, which eliminated the fever. Therapeutic approaches for disease known as the disease ebyo that arises after treatment of cold damage diseases (shokan) are discussed in the On Pulse Syndrome Complex and Treatment of Bai He, Hu Huo, and Yin Yang Du Diseases section of the synopsis of prescriptions of the golden chamber “Kinkiyoryaku”. Children, especially adolescents, are prone to fall ill because of rapid changes of the body, including sexual maturation. Clinical manifestations of such illnesses further change with growth and maturation, and it can be difficult to find clues for treatment at first glance due to complicated states of yinyang and deficiency-excess. As seen in this case, illnesses of adolescence is likely to include undiagnosed cases of byakugobyo that manifests clinical signs similar to those of ebyo.
We report a case of pyoderma chronica capillitii successfully treated with shokenchuto. The patient was a 20-year-old man, who had been suffering from an abscess and hair loss in the occipital region of his scalp for the past 6 months ; the lesion was gradually enlarging and was 3×3 cm in diameter at presentation. He was diagnosed with pyoderma chronica capillitii by a dermatologist and treated with puncture and drainage, multiple courses of oral antibiotics, and focal injections of tetracycline twice, with no beneficial response. Furthermore, another similar abscess with hair loss appeared on his occipital scalp and a new similar nodule appeared on his right cheek. He consulted my clinic to receive Kampo therapy. His abdominal examination revealed spasm of the bilateral rectus abdominis ; his abdomen was remarkably hypersensitive. He felt tickling intensely on abdominal palpation. Based on these findings, he was treated with shokenchuto, and hainosankyuto was added to relieve his symptoms. After a month of therapy, the nodule on his cheek disappeared, and several months later, the two occipital lesions improved and growth of new hair was noted. With continued treatment, his scalp and hair lesions healed completely and no recurrence was noted. To our knowledge, there is no previous report on the treatment of pyoderma chronica capillitii with shokenchuto. Based on the Kampo diagnostic pattern, Kampo medicine can be a beneficial therapeutic option for pyoderma chronica in cases where standard treatments are ineffective.
One case of peripheral vertigo disorder with sustained constipation was effectively treated with the application of a Kampo medicine proverb : “opening the north window to get the south wind (balmy summer breeze)”. The therapeutic strategy behind this proverb is to cure the superior (south) disease by unblocking the inferior (north) pathogenic stagnation, and thus activate internal qi movement, blood and body fluid circulation in the body. A 69-year-old female with postural vertigo episodes associated with the benign paroxysmal positional vertigo (BPPV) was effectively treated with tokakujokito, and her constipation discomfort was resolved at the same time. Based on these results, otolaryngologists should consider the inferior disease (the lower gastrointestinal tract disorder) when treating the superior disease (the inner ear-based disorder), and pay attention to the harmony and balance among qi, blood and body fluid throughout the body.
Although evidence of Western therapy for heart failure has been established, evidence of treatment for heart failure with chronic kidney disease (CKD) has still not been established. The efficacy of additional Oriental medicine to standard therapy for heart failure with CKD is unclear. To address this issue, we retrospectively evaluated 20 consecutive heart failure patients with CKD (≧stage 3) who were orally administered goreisan (7.5 g/day) due to insufficient efficacy of standard therapy in our hospital from November 2015 to December 2017. We assessed symptoms, chest X-ray, BNP concentration, serum electrolytes, eGRF, plasma osmolality, and side effects. Goreisan improved heart failure in 11 of 20 patients, did not significantly deteriorate renal function, plasma osmolality, and did not clinically affect electrolytes. In conclusion, the present study suggested that additional use of goreisan to Western standard therapy is safe and useful for heart failure with CKD.
Vertigo and dizziness are common symptoms encountered in clinical settings. We had examined 40 cases with a chief complaint of vertigo and dizziness that were effectively treated with Kampo medicines for 5 years. Here, we present 4 typical cases and report on the outcomes of these cases. A majority of the patients reported here had dizziness as the main complaint and were female. About 35% of the cases improved in no more than 7 days, and 50% of the cases were cured within 14 days. Ryokeijutsukanto (45%) and shinbuto (55%) are the most commonly prescribed Kampo medicines. We had to treat the patients with not only a single, but also multiple Kampo medicines because of tangled yin and yang. Cases of dizziness without any specific neurological abnormality were difficult to treat with modern medicine ;however, Kampo medicine could treat such cases promptly.
As the elderly society grows, polypharmacy becomes a problem in clinical practice. Until now, some Kampo treatments have been reported to be useful for polypharmacy caused by western-style medicines. But this report shows that Kampo medicines in themselves could be the cause of polypharmacy. In fact, multiple Kampo prescriptions from several medical agencies are given to one patient in Japan. From the view point of proper use of Kampo prescriptions, medical experts and entire business fields related to Kampo medicine should take measures rapidly for so-called “Kampo polypharmacy” after analyzing the actual situation.
The term sansho is an element of six entrails in the Kampo medicine. From anatomical knowledge, Kazuo Ohtomo determined that sansho corresponds to visceral peritoneum and mesentery in the human body. Kazuo Ohtomo's doctrine was derived from the description of “Koteidaikei”. This report aims to reveal the concept of sansho by means of description of ancient textbook “Shokanron” and “Kinkiyoryaku”, and further intend to propose the three division of sansho are able to separate by modern anatomy especially abdominal arteries.