“Mi-byo” (pre-disease) is a special concept in Chinese Medicine proposed about 2,200 years ago in the ancient text Ko-tei-nai-kei, which states that “a Saint-like Doctor” can cure “mi-byo”. However, no one has been saintly enough to explain an actual “mi-byo” status to date. In the 21 th century, as immunology has developed, the novel notion of “homeostatic inflammation” began to be postulated. Here, “homeostatic inflammation” means the self-repairing steps initiated by innate immune sensors when they encounter either PAMPs (pathogen-associated molecular patterns) or with DAMPs (danger signal-or damage-associated molecular patterns) composed of either lipids-or nucleic acids-related substances through their own TLRs (toll-like receptors) or NLRs (NOD-like receptors), respectively. If such “homeostatic inflammation” does correlate with the “mi-byo”, perhaps we can control it by using herbal medicines containing various saponins, essential oils, alkaroids, and flavonoids that may reinforce innate barriers by regulating the effect of lipids and nucleic acids.

From around 1990, it has been suggested that our internal defense system is composed of two distinct elements ; local innate immunity principally arranged on surface areas to establish barriers against various pathogens, and systemic acquired immunity mainly seen in systemic compartments to survey and control internal damage and disorders. The former innate surface barrier is chiefly regulated via species-restricted CD 1 antigen-presenting molecules, through lipid/glycolipid antigens presented mainly by dendritic cells (DCs) and lacking antigen-specific memory through gene-rearrangements, while the latter acquired barrier is controlled by individually restricted MHC molecules and gains antigen-specific memory through gene-rearrangements. Surprisingly, it had been revealed more than 2,000 years before in the ancient Chinese medicine textbook, Ko-tei-nai-kei, that our defense system is also classified into two categories, named “defense-qi” and “nutritional-qi”, and shown that the former “defense-qi” is arranged at the surface of skin to control our sweat and interact with “muddy” substances, while the latter “nutritional-qi” is situated on and within blood vessels and produces purified nutrients from food, drink and other exogenous substances. In this review, based on our recent understanding of immunological progress and the modern concepts of immunity, the possible relationship between “defense-qi” and innate immunity as well as “nutritional-qi” and acquired immunity are discussed.

In this report, we describe three hemodialysis patients with carpal tunnel syndrome (CTS) that were successfully treated with Goshakusan, one of the well-known traditional Japanese herbal (Kampo) medicines.
Case 1 was a 77-year-old woman suffering from sleep disorder due to night pain in the bilateral forearms. Case 2 was a 66-year-old woman complaining of sleep disorder due to lancinating pain in right upper and lower limb. They had undergone surgical decompression procedures for CTS several times in the bilateral forearms. However, they still needed a periodical injection of glucocorticoid into the region of carpal tunnel for the relief from pain. Case 3 was a 54-year-old man, who has been suffering from the recurrence of numbness of the left fingers since surgical treatment for CTS.
We diagnosed that the symptom of CTS in those three patients may be due to kan-shitsu (damp-cold or interior cold with dampness), because all of them were anuric hemodialysis patients, who tend to easily acquire phlegm and dampness, and their symptom was partially relieved by warming the forearm and fingers. Therefore, they were prescribed an oral goshakusan extract formula to remove kan-shitsu. Soon after they started taking the formula, the intensity of their pain or numbness markedly decreased. Taken together, our report suggests that it is worth trying to remove kan-shitsu by Kampo medicines for the conservative treatment of CTS.

In this report, we describe four hemodialysed patients with upper abdominal discomfort successfully treated with Heiisan, one of the known traditional oriental herbal medicine.Case 1 was a 61-year-old man suffering from upper abdominal discomfort after each meal even though daily taking some medicine for gastritis. Case 2 was a 45-year-old man, who has also been suffering from upper abdominal discomfort after breakfast and supper despite daily taking H₂-blocker. Case 3 was a 61-year-old man complaining of upper abdominal discomfort. He has had loss of appetite despite being treated with H₂-blocker and gastroprokinetic medication. Case 4 was a 69-year-old woman complaining of upper abdominal discomfort with dull pain before eating. She was diagnosed as chronic gastritis and healing stage of duodenal ulcer and prescribed H₂-blocker. However, this medicine did not work.We diagnosed that upper abdominal discomfort in all the patients came from shitsu-jya (pathogenic dampness) in hii (Spleen-Stomach functional unit), and treated them with Heiisan, which was popular to remove shitsu-jya in Hii. Their symptom disappeared soon after taking this medicine.It is also difficult for hemodialysed patients to control their weight due to anuria and they tend to easily gain the weight due to inappropriate eating and drinking, leading to shitsu-jya in such patients. Therefore, our reports suggested that Heiisan was good for hemodialysed patients to control various upper abdominal symptoms that might be caused by shitsu-jya in Hii.

We experienced a case of group mushroom poisoning. The victims were Chinese workers. They developed symptoms such as vomiting, diarrhea, and abdominal pain one hour after ingestion of wild mushrooms growing at a riverside. Generally, it is very difficult to identify quickly a species of wild mushroom. Therefore we were in trouble about the treatment because they might have taken deadly mushrooms, such as ‘Amanita versa’ and ‘Amanita virosa’. ‘Chlorophyllum molybdites’ looks like these mushrooms. In this case, the incubation period is different between Chlorophyllum molybdites and Amanita species, so we could know that the mushroom they had taken was not so dangerous. There are various folk believes about mushroom poisoning, but many of them are groundless. In this case, the Chinese workers also belived a wrong one. The problem is that a simple and easy method for distinguishing harmless mushrooms from poisonous one is yet to be established in society.

Traditional western medical diagnosis and treatment strategies for a patient with persistent anorexia and weight loss failed to yield any positive results, and thus we changed to an eastern treatment modality employ­ing the use of byakkokaninjinto, which resulted in successful treatment of the anorexia and its associated symptoms. An 83-­year-­old man presenting with phlegm and anorexia visited our hospital. Upon examination, we iden­tified subpleural ground-­glass and reticular opacities via chest CT. The patient was diagnosed with idiopathic interstitial pneumonia in the outpatient setting. Due to persistent anorexia and weight loss, we conducted thor­ough examinations of gastrointestinal system to supplement our overall workup ;however, the cause of the anorexia could not be identified. Meanwhile the patient lost 30 kg within a span of 6 months and was hospital­ized. He failed to present with any neurological disorders, collagen/endocrine disease or mental illnesses. A full systemic review was unable to identify the cause of the underlying anorexia but we focused on the pa­tient's complaint of coldness in the neck, upper limbs, ankles/feet and abnormal warmth in the forehead, which made him seek and ingest cold foods. Given these findings, we have established an eastern medical diagnosis for the anorexia as ketsugyaku, netsuketsu and initiated treatment using byakkokaninjinto. After starting a regimen of byakkokaninjinto, the patient noticed increased dietary intake and the various cold and heat sensa­tions distributed throughout his body dissipated. Assuming an open stance on adopting traditional Chinese medical practice into anorexia treatment could prove valuable in certain cases.