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.

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.

We examined three cases where Kampo medicine had effects on palindromic rheumatism. All the patients are men with arthralgia accompanied by redness, fever, and swelling. All cases are RF negative. Cases 2 and 3 are brothers. Case 1: A 58-year-old patient with recurrent arthralgia on shoulders, hands, and legs for 30 years. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) was noted, the administration of Sho-Saiko-to reduced the symptom.
Case 2: A 40-year-old patient with recurrent arthralgia on shoulders, hands and legs for nine years. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) and contraction of the abdominal muscles (Fukuhikokyu) was noted, the administration of Eppi-ka-jutsu-to-go-Shigyaku-san-ryo was replaced, which reduced the symptoms.
Case 3: A 46-year-old patient with recurrent arthralgia on knees and fingers, and pain in hip joints. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) and contraction of the abdominal muscles (Fukuhikokyu) were noted, the administration of Shigyaku-san reduced the symptoms.
All cases were typical palindromic rheumatism, and Eppi-ka-jutsu-to was effective to a certain degree. Kampo diagnosis of Saiko (Saiko-sho) was made and additional Saiko-drugs (Saiko-zai) reduced the frequency, the degree, and the length of the period of symptoms.

The purpose of this study was to examine the effects of short-term immobilization on the maximum voluntary contraction (MVC) force. The first dorsal interosseus (FDI) of 10 healthy male adults was immobilized for 1 week using casting tape. Atrophy of the muscle was estimated from a cross sectional view of magnetic resonance images (MRI) . To clarify the factors of a peripheral neuromuscular system contributing to the change in the MVC force, twitch force at rest was measured. The contribution of central factors was estimated from a voluntary activation (VA) index, which was obtained by the twitch interpolation method.
The MRI showed no significant changes in the cross sectional area. The MVC force declined after immobilization (p<0.01), and recovered after 1 week from the termination of immobilization (p<0.01) . Both the twitch force at rest and the VA at MVC declined after immobilization (p<0.01), and recovered after 1 week (p<0.05) .
The results indicate that the temporary decline of the MVC force was not accompanied by atrophy of the muscle. Furthermore the decline of the MVC was caused both by the deterioration of peripheral and central functions in the neuromuscular system. Possible factors in the peripheral and central neuromuscular systems affected by the immobilization were discussed.

A 76-years-old woman was admitted with a left ventricular tumor that was accidentally found by a transthoracic echocardiogram. The tumor was located in the papillary muscle near the apex, had an irregular surface, and was well mobile. The urgent operation was planned because the tumor might have caused of embolism. A cardiopulmonary bypass was established with distal ascending aortic cannulation and bicaval venous cannulations. The resection of the tumor was performed by a transaortic approach. Pathological examination confirmed the tumor as primary papillary fibroelastoma. During the operation, a thoracoscope was used to assist the resection of the tumor. It was useful for a good visualization in the left ventricle. In this case report we describe a rare case of primary papillary fibroelastoma in the left ventricle and a technique of resection using a transaortic approach with an assistance of a thoracoscope.

A man in his 60s, who was diagnosed as having postoperative recurrent gastric cancer with lymph node and spinal metastases, was admitted to our palliative care unit (PCU). He was unable to receive further aggressive chemotherapy for cancer because of bilateral hydronephrosis and chronic renal failure. He had chronic urethral infection and hence required continuous antibiotic administration. Although his infection was well controlled with antibiotics, his oral intake gradually declined. Seventeen days after admission, he developed systemic hemorrhage, including hematuria and oral bleeding. Coagulation tests revealed that the patient had markedly prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT) but no thrombocytopenia, fibrinogen consumption, or increased fibrin/fibrinogen degradation products (FDP) level. Serum level of protein induced by vitamin K absence or antagonist II (PIVKA-II) was markedly high, and vitamin K level was below the lower limit of the reference range. After he was administered intravenous vitamin K, his symptoms markedly improved. Many patients with advanced cancers tend to have malnutrition, anorexia, and chronic infection that require antibiotic administration. Prophylactic administration of vitamin K might be sometimes necessary for preventing catastrophic hemorrhage.