As symptom-differentiating factors for hot and cold diatheses, urinary PGF_1α level of cholelithiasis patients (lower than about 138ng/day represented cold diathesis and above, hot diathesis) and age of breast cancer patients (lower than about 50 represented hot diathesis and above, cold diathesis) were pointed out. In gastric and large bowel cancer patients, these factors were not indicative of hoot and cold diatheses.
These facts were considered to be attributed to the differences of the outside-inside situation of the diseases; namely breast cancer is of outside, gastric and large bowel cancer is of inside, and cholelithiasis is of intermediate (half outside-half inside) situation. Cholelithiasis representative of intermediate situation of illness proved to be one of the diseases showing delicate relationship between urinary PGF_1α level and pathophysiological state of the patients. When situation of illness was of outside or of inside, this relationship was not recognized, probably because it was concealed by stranger factors, for example, age, energy metabolism, water balance or visceral venous stagnation.

The subjects of this study were 13 patients who came to the Juridical Foundation of Oriental Medical Science Techniques Center from September 1986 to February 1987. We measured their blood pressure during one acupuncture therapysession by serial hemodynamometer.
(1) Blood pressures tended to fall duringtherapy.
(2) The highest blood pressures tended tofall after acupuncture, EAT and massage.
(3) After therapy, blood pressure slowly returned to the previous level.
We found that it is useful to use certain related therapies to promote the stability of blood pressure.

At the end of 1986, herb medicines were switched over to newly modified preparations, and at the same time the usual dosage was changed from 5g to 7.5g per day. Therapeutic results in our experiences on 1864 diseases seen in 1270 patients during fifteen years were nevertheless rather stable, attaining good and moderate effects in about 60%, fair effect in about 20% and unchanged in about 20% of the cases. This fact might mean that the dosage of 5g per day can be sufficient to obtain satisfactory results especially in the patients with good drug-“Sho” signs correspondence.
Better results than the average were obtained in the diseases of common cold, dysmenorrhea, headache, constipation, abdominal pain and piles. The incidence of adverse effects showed decreasing tendency from 2.0 or 2.8% to 1.4% in spite of the increase of usual dosage of herb medicines. Among apparent adverse effects there can be mixed some hyperreactive phenomenon infrequently seen in the cases with excellent drug-“Sho” signs correspondence. In such a case further reduction of dosage would be worthy of trial.
Positive treatment of in-patients with herb medicines proved to be of benefit not only to the patients, but also to doctors to attain proficiency in medical performance. Recent good retults obtained among younger patients and wider as well as deeper interest of younger doctors in traditional Oriental medicine could be interpreted as some signs of gradual maturity of social circumstances around Oriental medicine.

The regulatory effects of Gorei-san (Wu-Ling-San) on circulatory, metabolic and diuretic function were investigated analyzing the perioperative transition of serum sodium levels, peripheral platelet counts and urinary 6-keto-prostaglandin F₁α levels in fifty-eight female patients who underwent cholecystectomy because of cholelithiasis or gallbladder polyps.
The endothelial cells were considered to be activated by administration of Goreisan as shown by an increase of prostaglandin I₂ production, resulting in circulatory and metabolic stimulation and partly promotion of diuretic function by a dilatation of the renal vessels. The urinary 6-keto-prostaglandin F₁α, a metabolite of serum prostaglandin I₂ and also excreted by the interstitial cells in the renal medulla or by the epithelial cells of the renal collecting tubules, was considered to regulate diuretic function through suppressing the antidiuretic hormone.
The phenomena mentioned above were not recognized when Sho-saiko-to (Xiao-Chai-Hu-Tang) was administered instead of Gorei-san.

Female patients suffering from gallbladder stone disease were administered Sho-saiko-to (Xiao-Chai-Hu-Tang), Gorei-san (Wu-Ling-San) or Toki-shakuyaku-san (Dang-Gui-Shao-Yao-San) preoperatively, and were examined by cholangiomanometry during operation. Perfusion pressure was significantly elevated, when Sho-saiko-to or Gorei-san were administered, meaning that the pressure threshold of the sphincter of Oddi for volume load in the bile duct was lowered. This phenomenon tended to be more obvious in Gorei-san group, and will prevent duodenal fluid from transpapillary reflux. Parameters concerning the declining curve (T_1/2, T_1/4, T_1/5) showed a significantly rapid relaxation of the sphincter of Oddi only in Sho-saiko-to group, which will result in a prevention of stasis of bile. These modulating functions of Sho-saiko-to and Gorei-san for the sphincter of Oddi would be one of the main reasons why these formulas are used for hypochondriac fullness and distress or excessively accumulated intestinal fluid. Toki-shakuyaku-san showed no such effects on the sphincter of Oddi.

Objective : To evaluate the effect of beraprost sodium (beraprost) on the vascular events occurring in patients with peripheral arterial disease (PAD) in a meta-analysis of placebo-controlled, randomized trials.
Design : Meta-analysis
Methods : Among the clinical trials of beraprost in patients with intermittent claudication associated with PAD, placebo-controlled, randomized trials with vascular events as outcome measures were selected. Two trials met the criteria, each of which was a comparative trial of beraprost (40 μg t.i.d.) and placebo (t.i.d.), with a six-month follow-up period.
Results : With both trials combined, the analysis included 594 patients in the beraprost group and 590 in the placebo group. The risk ratio was 0.608 (95%CI : 0.41 to 0.90, p =0.012), demonstrating the efficacy of beraprost on all vascular events. The risk ratio for lower limb deterioration was 0.598 (95% CI : 0.34 to 1.06, p =0.079), which was similar to that for all vascular events. A statistically insignificant but similar result was also obtained for cardio/cerebrovascular events with a risk ratio of 0.619 (95%CI : 0.36 to 1.07, p = 0.085). Heterogeneity between the two studies was not found for any of the events.
Conclusion : The results demonstrated the efficacy of beraprost on the vascular events in patients with PAD. The potential benefit of beraprost on vascular events will require evaluation in a larger prospective investigation.

We report the case of a 59-year-old man who presented with classical-type fever of unknown origin (FUO) during observation of hypertension and polycystic kidney. The presence of malignancy was suspected based on elevation of tumor marker levels. We examined the patient carefully and attempted diagnostic imaging, but definitive diagnosis was difficult due to the presence of multiple hepatic cysts. Hepatic biopsy detected adenocarcinoma, but identifying whether lesions were primary cholangiocellular carcinoma or metastases was difficult, and we were ultimately unable to diagnose the tumors as cholangiocellular carcinoma until autopsy. Polycystic kidney with hepatic cysts and complicated by cholangiocellular carcinoma is rare, but should be considered among the differential diagnosis for FUO, which itself is frequently encountered.

Six cases without aortic reconstruction for 48 hours were encountered among 22 cases of Stanford type A acute aortic dissection from April, 1990 to July, 1996. They were one man and five women, with a mean age of 60.3 years old (from 52 to 82 years old). According to Hagiwara's definition, acute thrombotic aortic dissection (ATAD) was observed in four and acute opacified aortic dissection (AOAD) in two of six cases of Stanford type A acute aortic dissection without aortic reconstruction. One of the four ATAD cases was well-controlled by medical therapy, but the others could not be controlled and underwent aortic root reconstruction within 1 month. Two AOAD patients died due to rupture within 1 month. It is said in general that the patients with acute thrombotic aortic dissection can be treated medically, but we consider that they should be treated surgically because of the frequency of late rupture.