Recently, the authors experienced five cases of chronic primary headache in children which were successfully treated with shokenchuto. This report describes the details of these five cases and results of references in past literature. The common physical findings in these five cases were soft abdominal walls with a spasmodic bilateral m. rectus abdominis. There was only one case report of headache which was successfully treated with shokenchuto. We believe that our case report sheds light on a new aspect of shokenchuto, which might be a useful formulation for chronic headache. In this paper, we also speculate about the mechanism of this formulation for headache from the view point of former research showing the relationship between brain orexin behavior, and ghrelin which is induced from the digestive system.

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.

Ryoukeigomikanzoto is a Kampo formulation originally described in the text Kinkiyouryaku. This formulation has also been described as an indication for respiratory disease in some texts, because it was classified under respiratory diseases in the Kinkiyouryaku.
The authors, however, considered that indications for ryoukeigomikanzoto could be wider than previously thought. The composition of this formulation is very similar that of ryokeimikanto and ryokeijutsukanto. And we have prescribed ryokeigomikanzoto for patients with a reddish face and coldness of the legs, whose chief complaints were a reddish nose, coldness of the leg, dysuria, spioncerebellar degeneration and ringing of the ears. Moreover, we have obtained good results from the current trial. This report is intended to elucidate indications for this formulation by means of past clinical results and our own experience.

Previously, the authors reported that a painful point at the epigastrium may be closely related with the term “shinkashiketsu” for the Kampo formulation saikokeishito (SKT) which was described in the textbook, shoukanron. In order to find conclusive evidence for our hypothesis, we tried SKT in four patients, whose chief complaints were headache, epigastralgia with headache, irritable bowel syndrome, and anorexia due to Behcet's disease. In this trial, we obtained satisfactory clinical results, which strongly suggest that the symptom of a painful epigastral point correlates with the term shinkashiketsu in the shoukanron description.

We administered daisaikoto to 13 patients with traumatic cervical syndrome and observed complete responses in the following 2 patients. Patient 1 was a 40-year male. He was in the xiaoyang stage, and showed high abdominal tension and marked chest oppression. These findings were indications for daisaikoto. Patient 2 was a female in her 50 s. She was in the xiaoyang stage, showed moderate abdominal tension and chest oppression, and was aware of chest tension and constipation. Evaluation using the VAS in the 13 patients showed a complete response in 3 patients, partial response in 6, minor response in 1 and no response in 3. To clarify indications for daisaikoto in this disease, findings of Japanese Oriental Medicine in the 13 patients were evaluated. Of 9 patients with high abdominal tension, 8 showed partial or complete responses. Of 4 patients with moderate abdominal tension, a complete response, partial response, and no response were observed in 1, 1, and 2, respectively. In addition, objective abdominal coldness was present in both patients with moderate abdominal tension who showed no response but not in the patient showing a complete response.We confirmed the importance of therapy based on oriental medical syndromes when daisaikoto is used for traumatic cervical syndrome. However, patients with moderate abdominal tension without abdominal coldness can be differentiated from others for this therapy.

It has been thought that the term “shukuben” does not mean a simple constipation but rather that a substance is stagnating in the digestive tract despite ordinary defecation. However, there has been no concrete evidence for this shukuben definition.
The authors have obtained evidence for what may be one type of shukuben, by means of X-ray photography after an upper digestive tract examination using a barium sulfate contrast medium, in a patient with irritable bowel syndrome. The X-rays showed the contrast medium adhering to the colon wall three days post-examination despite subsequent diarrhea, suggesting one type of shukuben. In this paper, the authors also reported the result of a historical search for the term shukuben in the past medical textbooks, which revealed that the first description of this term is found in hougizashi and was described by Yodo Odai. We also considered that this term is a derivation of shukushoku meaning a stagnation of digestive tract contents.

Background : This questionnaire survey was performed to clarify the present status and especially the problems with dispensing herbal medicines and counseling patients.Objectives : To survey 15 pharmacies approved under the National Health Insurance System to dispense herbal medicines prescribed by Department of Japanese Oriental (Kampo) Medicine, Chiba University Hospital.Results : Twelve pharmacies responded that 1,900, the present fee allowed for dispensing herbal medicines, was low. The time for dispensing herbal medicine via an automatic packaging machine was half of that dispensed by humans. Many pharmacies requested a re-evaluation of the fee based on the length of a prescription and the number of herbs in a formula, and requested a re-evaluation of the drug price standards. About half of the pharmacists surveyed also had a poor knowledge of herbal medicines.Conclusion : We suggest that economical aspects of dispensing herbal medicine should be improved to secure more insurance pharmacies which can dispense herbal medicines. There is also a need to construct education systems for pregraduate and postgraduate university students in order to train pharmacists who will have a thorough knowledge of Kampo Medicine.
Medicine, Herbal ; seconds ; Surveys ; Insurance ; Analysis

Arteriovenous fistulae are known to be one of the causes of intractable leg skin ulcers. Because they raise peripheral venous pressure, decrease arterial blood flow to peripheral tissue, and cause venous blood congestion, symptoms of skin coldness, edema, pain, dermatitis and skin ulcers may appear in the legs. We observed a 32 year-old woman with multiple intractable bilateral leg skin ulcers due to arteriovenous fistulae successfully treated with Kampo medicines. In 1999, skin ulcers, edema, and pain presented in both her legs. She was diagnosed has having arteriovenous fistulae with various examinations in 2003. She had subsequently been treated with topical preparations on her legs, analgesics and other palliative treatments, but as symptoms had not improved, she first visited our outpatient clinic in August 2006. After an initial oral administration of tokishakuyakusan extract for 6 weeks, her pain improved. Afterwards, ogikenchuto was added for symptoms of qi deficiency. Moreover, bushi powder was added for the treatment of pain exacerbated in cold conditions. After 6 months, the size of her skin ulcers was fairly reduced, and she had no need of analgesic drugs. In past reports, Kampo medicines have not been used for the treatment of intractable skin ulcers due to arteriovenous fistulae. This case suggests that Kampo medicines are a treatment option in this condition.

We investigated prescriptions and drug costs at admission and discharge for 35 patients hospitalized in Department of Japanese Oriental (Kampo) Medicine, Chiba University Hospital from September 2006 to October 2008. They recovered after Kampo therapy from various non-acute diseases. The number of western drugs decreased from 3.7 at admission to 2.7 at discharge, thus their drug costs per day significantly decreased from302.1yen to 227.6 yen. The cost of Kampo medicines themselves, on the other hand, did not decrease significantly. Total drug costs, however, were significantly reduced from 437.8 yen at admission to 348.0 yen at discharge, so patients' overall costs were reduced by 20%. These results indicated that the proper use of Kampo medicine for various diseases would reduce drug costs and the impact of treatment expenses on medical economics, with improvement in disease outcomes.

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.