Acute autonomic neuropathy is a syndrome where the peripheral nervous system is damaged acutely, primarily, and diffusely. For refractory orthostatic hypotension, which persists in cases where the disorder has not been cured completely, hypertensors or mineralocorticoids are generally administered. We observed that patients who did not respond to such agents did, however, respond to Ryokei-jutsukan-to, although no one has reported previously on the use of this Kampo formulation for acute autonomic neuropathy. In order to define the mechanisms of action of this formulation, we conducted orthostatic tests and drug loading tests and also studied endocrinology and hemodynamics. Blood pressure rose with the treatment of Ryokei-jutsukan-to, and this proved to be due to an increase in peripheral vascular resistance. Furthermore, cardiac output was decreased, and the renin-angiotensin-aldosterone system, which had been slightly activated, was corrected. The increase in peripheral vascular resistance appears to be a result of direct action on the vascular wall, since the formulation inhibited the sympathetic activity and improved the denervation hypersensitivity of peripheral vascular receptors.

We studied a case of bronchial asthma associated with irritable bowel syndrome which responded to Bukuryo-Keishi-Kanzo-taiso-to. The 54-year-old woman was admitted to our hospital due to recurrent abdominal pain and paroxysmal coughing. The abdominal pain was diagnosed as irritable bowel syndrome, and paroxysmal coughing as bronchial asthma. Uzu-Keishi-to, Sekiganyo, Gekyu-shokuso-to were given for abdominal pain, and Ryo-kan-kyo-mi-shin-ge-nin-to and Soshi-koko-to were given for cough. None of these, however, were effective. We consider the condition at the time of attack to be hypochondriasis with palpitation attack, including coughing and abdominal pain, based on the fact that (1) abdominal pain and paroxysmal coughing were accompanied by marked perspiration, (2) the patient felt that something was being pushed upward from the epigastrium into the throat, (3) the patient complained of coldness in the abdomen concomitant with a feeling of warmth in the head, neck, and chest, and (4) subjective palpitations in the upper and lower abdomen were significant. We then used Bukuryo-keishi-kanzo-taiso-to, and both the abdominal pain and the coughing improved using this formulation alone. Although there seem to be two different diseases, they can sometimes be treated as one in kampo medicine.

Case 1 was a 70-year-old female patient who visited our Department mainly due to palpitations which had persisted for the previous four years. From about one year ago, paroxysmal palpitations have occurred frequently. The 24-hour Holter ECG monitoring and echocardiography indicated supraventricular arrhythmia, but there was no temporal association between the arrhythmia and the palpitations. She was very nervous and irritable. She felt fullness of the upper abdomen and palpitations in the lower abdomen. She was given Chugoho-honton-to-ka-bukuryo-byakujutsu. One week later, the palpitations became less frequent, and two weeks later they all but disappeared.
Case 2 was a 41-year-old male company employee. He visited our Department complaining of general malaise, abnormal perspiration of the upper body, and pain in the fingers. Six years previously, he had developed erythema both in the palms and in the soles of the feet and also pain in the fingers of both hands. Four years ago, swelling occurred in the tips of his fingers and toes, which then aggravated. He was diagnosed as having acromegaly accompanied by pituitary adenoma and subsequently underwent resection of the pituitary tumor. After the operation, he developed general malaise and abnormal perspiration in the upper body, which obliged him to take time off work. Based on marked feelings of heat in the upper body and cold in the lower body and also abnormal sweating attacks, he was considered to be suffering from hypochondriasis with palpitation attack. One week after he was started on Chugoho-honton-to-ka-bukuryo-byakujutsu, his legs no longer felt cold. Symptoms of the joints and abnormal sweating subsequently improved, which enabled him to return to work.
Case 3 was a 32-year-old housewife who visited our Department complaining of headache and pain in the right shoulder. She had had contusion in the scapula ten years previously and had been suffering from dull pain ever since. Seven years ago, when she had a baby, she developed severe pain in the paraspinal muscle facing the right scapula. This severe pain radiated along the dorsal muscle and was accompanied by headache. Because she felt hot in the upper body and cold in the lower body, subjective palpations in the upper abdomen, and a mass in the hypochondria and umbilical region, Chugoho-honton-to-ka-bukuryo-byakujutsu was given. This produced excellent results.
Based on the experience of these three cases together with what can be found in the literature, we believe that conditions where Chugoho-honton-to-ka-bukuryo-byakujutsu are indicated have the following features. (1) The conditions are often triggered by fright, fear, depression etc. (2) There exist paroxysmal palpitations, headache, and the sensation of hot flushes. (3) A feeling of anxiety ascends from the abdomen. (4) The disease is in the initial stage of the three Yin diseases. (5) There are signs and symptoms of a deficiency in Qi. (6) There are subjective palpitations in the upper abdomen and in the epigastrium. (7) There is fullness of the upper abdomen and epigastrium, often accompanied by a mass in the hypochondria or umbilical region.

In order to determine the pharmacological effects of Crocus (traditionally classified as an herb helpful in eliminating Blood Stagnation), the 11-dehydro TXB₂, platelet aggregation, blood viscosity and laboratory data of 12 healthy sexually mature females were examined during the menstrual, follicle and corpus luteum phases before the test substance was administered. Compared with the follicle or corpus luteum phases, higher levels of 11-dehydro TXB₂ and increased mean cell volume (MCV) were found during the menstrual phases. This suggested that the increase in blood viscosity may be due to a lowering of erythrocyte deformation resulting from increased mean cell volume. From the fact that the highest endometrial PGE₂ value was exhibited during the menstrual Phase, PGE₂ was thought to be involved in the MCV increase. Next, plain hot water was administered to the six cases in the control group (for four weeks), and Crocus infusion administered to the other six cases (for four weeks), after which a comparative study was made of their indicators. The significant lowering of the MCV and blood viscosity during the menstrual phase upon Crocus administration suggested that an improvement in erythrocyte deformation brought about by decreased MCV played a role in the reduction of blood viscosity. Moreover, a decrease in 11-dehydro TXB₂ was observed during the low blood estrogen follicle phase. It has been reported that there is an overall increase in blood viscosity and acceleration of platelet and thrombin synthesis associated with the disease state known as “Blood Stagnation”. From the clear effects of Crocus upon these indicators, its effectiveness as an herb useful in eliminating Blood Stagnation in healthy sexually mature females was indicated.

Saiko-sokan-to has been traditionally used for the amelioration of symptoms such as anxiety, insomnia, Shigyaku-san-sho (sho = pattern of symptoms determined by Kampo diagnosis) with left hypochondralgia and Shigyaku-san-sho with a feeling of obstruction in the costal region. However, there are still aspects that remain to be elucidated concerning the indications for this formula.
This study involved 7 cases with stiff shoulders, headaches, abdominal distension, meteorism and flushing which responded to Saiko-sokan-to. The experience of these cases suggests that conditions indicating Saiko-sokan-to have the following features: (1) there is resistance or tenderness upon pressure in the subcostal region (traditionally referred to as Kyokyokuman), (2) there is resistance or tenderness upon pressure in the epigastric region (traditionally referred to as Shinkahiko), (3) there are signs of Ki-depression, (4) for severe “blood stagnation” syndrome (traditionally called oketsu), Ikkando Saiko-sokan-to was found to be more effective than Igakutoshi Saiko-sokan-to.

We performed a preliminary study of the reliability of the lymphocyte stimulating test (LST) for Kampo medicine. LST for three kinds of Kampo medicines was performed in both a Kampo-administrated group and a non-administrated group. LST for each of the medicines was negative for seven of eight subjects in the non-administrated group, but was negative for four of 11 subjects in the Kampo-administrated group. The LST-positive participants had no allergic state, and some among them were negative in challenge test. This preliminary study suggests that LST for Kampo medicine is likely to be false-positive.