Medicine, Kampo ; Pulmonary evaluation ; Therapeutic procedure ; Geriatrics

Ryo-kei-jutsu-kan-to was used to successfully treat two cases of overtraining syndrome with anemia. The first case was an 18-year-old woman. Several years ago, she was diagnosed with iron deficiency anemia, and she took Fe pills intermittently. After university graduation in 1996, she began to experience lightheadedness and general malaise concurrently with increased training of long-distance running. In September of the same year, her anemia worsened, and she was introduced to our department. Administration of Ryo-kei-jutsu-kan-to improved her symptoms, anemia and maximal oxygen uptake. The second case was a 19-year-old woman. She was an office worker and a member of her company's athletic club. She became easily fatigued, and she came to our clinic in December of 1996. Hochu-ekki-to was administered and her fatigue improved. But in the following year she began to feel depressed and lightheaded, and she became anemic after increased increasing her training of long-distance running. Administration of Ryo-kei-jutsu-kan-to improved her symptoms and anemia.

Keishi-kyokei-ka-bukuryo-byakujutsu-to has been traditionally used for acute infectious diseases, such as the common cold, accompanied by epigastric discomfort and tenderness. However, the specific dosage for chronic diseases has not been clearly set yet. This study involved 4 cases with headaches, dull headaches, stiff shoulders and lumbago, so called neck, shoulder and arm syndrome which responded to Keishi-kyokei-kabukuryo-byakujutsu-to. The experience of these cases suggests that conditions indicating Keishi-kyokei-kabukuryo-byakujutsu-to have the following features: (1) dry skin, (2) edema and impressions of teeth at the rim of the tongue, (3) tenderness upon pressure in the epigastric region and sound of fluctuating liquid in the stomach, (4) Ki-deficiency.

It is reported that the administration of Seinetsu-hoketsu-to has been effective in four cases of recurrent aphthous stomatitis. The literature states that Seinetsu-hoketsu-to is indicated for “blood deficiency and the combination of pathogenic dryness and heat in blood which causes ulceration or erosion with scaling pain in the tongue and oral mucosa, and its healing is often prolonged.” All four cases the patients are female. Their aphthous stomatitis is often exacerbated during pregnancy, childbirth, and/or each menstruation. In one case aphthous stomatitis reoccurred after the remission of general symptoms due to high fever and inflammation in the acute phase of Beçhet disease. The conclusion is that Seinetsu-hoketsu-to would be useful to patients with recurrent aphthous stomatitis in conditions where blood deficiency is worsening.

In Japan chronic constipation is divided into two groups: atonic constipation and spastic constipation. Stimulant laxatives are unsuitable for patients with spastic constipation, and routine use of stimulant laxatives over long periods of time should be discouraged. Nevertheless stimulant laxatives are often used continually among these patients because their stools are too hard and infrequent without stimulant laxatives.
In this report, we present 4 cases of chronic constipation treated with Kami-shoyo-san. Cases 1, 2 and 3 were patients with spastic constipation and case 1, 3 and 4 had used stimulant laxatives continually. In all cases both stimulant laxatives and Kampo medicines containing Rhei Rhizoma caused adverse effects such as abdominal discomfort and pollakisuria. Kami-shoyo-san improved bowel movement as well as other complaints: irritability, heat in the upper part of the body, painful tension of shoulder muscles, fatigue, dysmenorrhea and pollakisuria. Withdrawal from stimulant laxatives was achieved in the patients except for case 2. In drug treatment of chronic constipation, Kampo medicines such as Kami-shoyo-san seem to be useful in withdrawal from stimulant laxatives.

We present here two cases of relapsing infection of the lower airway caused by the recurrent laryngeal nerve paralysis. Seihai-to offered useful palliation and symptom control in the two cases described below. Case 1 was a 50 year-old-man who received surgery and radiotherapy for a cervical tumor in 1970. Thereafter he suffered from cough reflex at meals and a hoarse voice. He has suffered from airway infection four or five times a year since 1992. In May 1995 he was hospitalized for pneumonia. Two more attacks of pneumonia followed in the next two months. Administration of Seihai-to provided a palliation period of 15 months at first and decreased frequency of recurrence to as few as three times during the follow-up period of 43 months; one was pneumonia and two were bronchitis. Case 2 was a 76-year-old man who received surgery and radiotherapy for lung cancer in the left upper lobe in 1984. Thereafter he suffered from cough, sputum, cough reflex at meals, and hoarse voice. Lower airway infection was exacerbated five or six times a year since 1984. He was hospitalized for pneumonia in May 1997 and March 1998, and came to our hospital asking for Kampo therapy in April 1998. Administration of Seihai-to improved his symptoms and achieved a palliation period of 8.5 months. The original text “Man-byo-kai-shun” mentioned that loss of voice is one of the indications of Seihai-to. We took notice of hoarse voice in the two cases at selection of formulae.

Currently, Keishi-bukuryo-gan is widely used for overcoming blood stagnation, and is most frequently used for adult women with blood stagnation (Oketsu) presenting the cold and hot flush (rush in the bust and cold in the lower half of the body) such as menopausal disorder. This time, we carried out thermographic tests for two groups: the patients with subjective symptoms of the cold and hot flush (group 1:8 adult women) and patients with subjective symptoms of cold sensation only in the lower limbs (group 2:8 adult women).
In the first group the difference between the surface temperature of the skin of the upper abdomen and that of the lower abdomen was more significant as compared with the second group. We also observed both groups for 60 minutes after administration of Keishi-bukuryo-gan. In the second group the surface temperature of the skin of both upper and lower abdomen decreased. In the first group, however, the skin temperature of the upper abdomen decreased but that of the lower abdomen increased in reverse, and the difference of the temperature between the upper abdomen and lower abdomen was reduced. This means Keishi-bukuryo-gan worked for improving “the cold and hot flush, ” i. e., the imbalance of the endocrine system and autonomic nervous system.
The findings suggest that Keishi-bukuryo-gan treatments for hot flush, which is the increase of the skin temperature caused by telangiectasis of the skin of the upper body, may increase the blood flow in the lower abdomen and improve pelvic congestion, which is one of the conditions of blood stagnation, as well as decreasing the skin temperature by contracting peripheral vessels.

Zentai (Cicadae Periostracum) is classified by traditional Chinese medicine as one of the “pungent cool-natured” drugs, but its pharmacological action is not well known yet.
Zentai is used in Shofu-san as an expelling pathogenic wind component for relieving itchiness for patients with eczema, dermatitis, urticaria, etc.
We examined a number of patients with atopic dermatitis whose condition worsened after they were treated with Zentai to relieve itchiness.
In the current study, five male and ten female adolescent/adult patients were randomly selected to receive 2.5g of Zentai. These patients had been treated with Kagen-ichiin-sen-ka-kiban-kyo and their skin conditions had been stable so far.
In a follow-up two weeks later, the water content of the horny layer of skin at the forehead and the anterior side of the forearm decreased significantly (p<0.05). In terms of the level of itchiness, two patients (13.3%) improved, nine patients (60%) worsened, and the other four (26.7%) remained unchanged.
The current study indicates that Zentai worsens dry skin and exacerbates itchiness. Care will be required in the use of Zentai for the treatment of atopic dermatitis because of its drying pharmacological character.

Recently, QOL has become an important consideration when giving medical treatment. The development of treatments for urinary incontinence, a condition which greatly affects QOL, however, has been late in coming, because there are few critical symptoms. We experienced three cases of urinary incontinence successfully treated with ryokyojutsukanto. Case 1 was a 63-year-old woman. She had developed stress urinary incontinence (SUI) from about 30 years of age. As she came to be aware of lumbago and numbness of legs, she sought Kampo treatment. Tokishakuyakusangoninjinto was ineffective, but her all symptoms were improved with ryokyojutsukanto. Case 2 was a 46-year-old woman. She had become aware of incontinence after delivery of her first child (at 27 years of age), and she received Kampo treatment for lumbago and her incontinence. Tokishakuyakusankabushi was slightly effective for her lumbago, but ineffective for her incontinence. These symptoms were improved after a change to ryokyojutsukanto. Case 3 was a 70-year-old woman. She developed a bladder/bowel disturbance, and mixed urinary incontinence (MUI) caused by conus syndrome with a compression fracture of Th12 vertebral body. With ryokyojutsukanto, her fecal incontinence disappeared, and her lumbago and urinary incontinence showed a tendency toward improvement.
Urinary Incontinence ; Low Back Pain ; symptoms <1> ; Human Females ; therapeutic aspects

Case1was a 91-year old man diagnosed with multiple cerebral infarctions. He had undergone percutaneous endoscopic gastrostomy in the same year. One year later, we initiated acupuncture treatment because of recurrent respiratory tract infections. The acupuncture points selected were LU 5, Chize and KI 13, Taixi. Before acupuncture, the frequencies of antibiotics-use and feverish days were 6.3 days and 2.7 days per month on average. During acupuncture therapy, these frequencies were reduced to 1.2 days and 0.6 days per month, respectively.Case 2 was an 81-year old man diagnosed with right thalamic hemorrhage. He underwent percutaneous endoscopic gastrostomy in the same year. After 6 months, we began acupuncture treatment, also because of recurrent respiratory tract infections. The acupuncture points were the same as in Case 1.Prior to acupuncture, antibiotics-use and feverish days were 8 days and 4.5 days per month, which were then reduced to1and 0.6 days per month, respectively.Case 3 was a 93-year old man diagnosed with dementia. He was being fed via nasoenteric tubes. After 3 months, again because of recurrent respiratory tract infections, acupuncture treatment was begun. The acupuncture points were the same as in Cases 1 and 2.His use of antibiotics and feverish condition were 9 days and 10 days per month on average before acupuncture, but with acupuncture therapy these were improved to 2 days and 1.3 days per month.Based on this experience, it is suggested that acupuncture be considered for the treatment of recurrent respiratory tract infections in elderly, tube-fed patients.
Acupuncture ; days/month ; Respiratory ; therapeutic aspects ; Cases