A 3-min bath in 47°C hot-spring water called ‘jikan-yu’ has been recommended for over 130 years at Kusatsu-spa. There is a traditional custom of pouring hot-spring water of the same temperature over the head before entering the bath to avert an afflux of blood to the brain. The medical significance of this custom was investigated in 8 healthy male volunteers (age 31±6 years and body mass index 22.4±1.6kg/m²). There were no significant differences in plasma levels of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), cortisol, and β-endorphin on a comparison of findings before and after the action of pouring 20 pails of 47°C hot-spring water over the parietal and occipital areas of the head. However, the direct effect of heat stress on the internal thermosensor in the anterior hypothalamus regulating heat loss and thermogenesis was not examined in this study. Thus, it is considered that the action does not provide a direct hyperthermal stimulus to the brain stem to release stress hormones but may dilate blood vessels of the head to prepare for the abrupt afflux into the cerebral circulation of blood heated by subsequent very hot hot-spring bathing.

From June 1990 to October 1998, 100 patients with adult-type atopic dermatitis (59 males and 41 females, 25±8 years) were admitted to our hospital to receive balneotherapy using Kusatsu hot-spring water. The atopic dermatitis in all but 9 cases occurred while the patients were still under 20 and had been refractory to various treatments including steroid ointment therapy over a long period of time. The patients took a 10-minute 40-42°C hot-spring bath followed by immediate application of white petrolatum 1-2 times daily for 75±46 days. The main components of the hot-spring water are aluminium, sulphates and chlorides, and its pH is 2.0. The skin symptoms of 79 of 100 cases (79%) were improved through the balneotherapy and furthermore pruritus was improved in 55 of the 79 cases (70%). The improvement of skin manifestations was supported by a significant decrease in serum LDH levels. In contrast, pruritus was not improved in the remaining 21 cases who showed no changes in skin symptoms and serum LDH levels. Moreover, changes in the number of Staphylococcus aureus on the skin surface were examined before and after balneotherapy. In the 69 cases examined whose skin symptoms were improved, many Staphylococci aureus were detected in 52 of the cases but not in the other 17 cases before starting balneotherapy. They disappeared in 24 cases and decreased in 18 cases of the 52 cases, but were not changed in the remaining 10 cases through the balneotherapy. On the other hand, the number of Staphylococcus aureus on the skin surface was not changed in 11 of the 14 cases examined whose skin symptoms were not improved. Our previous study reported that bactericidal activity against Staphylococcus aureus is expressed by the co-existence of manganese and iodide ions contained in the hot-spring water under an acidic (pH 2.0-3.0) condition. Thus, the mechanisms of the improvement of skin manifestations through the balneotherapy may be explained by considering bactericidal activity of Kusatsu hot-spring water against Staphylococcus aureus inducing acute flares of skin manifestations. Therefore, balneotherapy at Kusatsu can be useful for the treatment of refractory cases of adult-type atopic dermatitis as a suitable method of skin care.

The circumferences of chest, abdomen, thigh and calf during head-out water immersion up to chin level were measured in 8 healthy male subjects (age 35.4±1.6years old, body mass index 23.7±1.6kg/m²) in standing and sitting positions. The circumferences of chest, abdomen, thigh and calf decreased significantly during immersion in standing position. The circumferences of chest, abdmen and thigh decreased significantly in sitting position. The circumference of chest decreased from 90.6±3.4 to 90.1±3.1cm, that of abdomen decreased from 81.4±2.8 to 80.6±2.5cm, that of thigh decreased from 47.1±1.6 to 46.6±1.8cm, and that of calf decreased from 37.7±1.8 to 37.2±1.8cm during immersion in standing position. As the body surface area is about 1.6m², the decrease in the volume of human body is considered to be 730cm³ or less when the body shape change during immersion is not taken into considerarion.

This study investigated the existence of platelet activation before the onset of cerebral infarction, and analyzed the association between the platelet activation and the degree of atherosclerosis. Furthermore, prediction of the risk of cerebral infarction by assessing platelet activation was attempted. Thirteen patients with cerebral infarction, 7 patients with atherosclerosis and 8 healthy subjects were enrolled in this study. Ultrastructural shape change, peroxidase reaction, and fibrinogen content in the platelets were observed and plasma levels of thrombin antithrombin complex, α₂-plasmin inhibitor plasmin complex, β-thromboglobulin and platelet factor-4 were measured in patients with atherosclerosis and cerebral infarction at the acute, subacute and chronic phases. The ultrastructural shape change, peroxidase reaction, and fibrinogen content did not differ among acute, subacute and chronic phases of cerebral infarction. The frequency of platelet shape changes were also increased in patients with atherosclerosis, compared with healthy subjects. Plasma levels of β-thromboglobulin, platelet factor-4, and thrombin antithrombin complex increased only during the acute phase of cerebral infarction. It is suggested that platelet activation occurs before the onset of cerebral infarction and that platelet shape change is associated with the degree of atherosclerosis, or plaque stability. Platelet activation would be derived not from thrombotic event itself but from endothelial damage or pre-existing atherosclerosis. Platelet shape change, therefore, could predict the risk of cerebral infarction. Taken together with our previous reports demonstrating increased blood viscosity, noctural hypotension, increased human atrial natriuretic peptide, decreased fibrinolytic activity, and platelet shape change were observed after very hot hot-spring bathing, cerebral infarction in spa-resort could be caused partly by very hot hot-spring bathing after traveling on a tight schedule and alcohol drinking by elderly patients with atherosclerosis.

We have pointed out that the incidence of cerebral and myocardial infarction that occur early in the morning is high and estimated its correlation with blood viscosity as a cause. To clarify the mechanism of onset of such diseases early in the morning in further details, we examined the effect of alcohol drinking and hot spring bathing on the circadian changes in blood viscosity on normotensive and nonsmoking young men. It was observed that both drinking a bottle or 633ml of beer containing 4.5% alcohol and taking a hot spring bath at 42°C for 10 minutes at 8p.m. tended to enhance the rate of increase in blood viscosity between 4a.m. and 8a.m. the next morning as compared with the control. In contrast, drinking 500ml of water at 0a.m. after either drinking a bottle of beer or having a hot spring bath mitigated the change in blood viscosity the next morning. These findings may suggest that both drinking alcohol and taking a hot spring bath around dinner time elevate the rate of increase in blood viscosity in the next morning, leading to possible onset of cerebral and myocardial infarction. Drinking two glasses of water at midnight is effective in preventing such change in blood viscosity in the morning.

Diagnosis is difficult in patients who complain of slight fever without objective abnormalities. It is not rare that patients without signs of typical Mycobacterium tuberculosis (TB) infection have a delayed TB diagnosis. It has been reported that the QuantiFERON TB-2G test is useful for diagnosing latent TB infection. We report a patient who suffered from sweating, body weight loss, and a fever of less than 37.5C without abnormalities in routine tests. Except for his complaints, only QuantiFERON TB-2G testing suggested his illness, after which he was successfully treated with isoniazid administration. QuantiFERON TB-2G testing might be useful to diagnose patients with slight fever when TB is suspected but a conventional workup is not diagnostic.

We present a case of prolonged post-herpetic neuralgia (PHN), successfully treated by Uyaku-junki-san-ryo. A 76-year-old woman was referred for PHN for 5 months. Her pain was confined to the area of the maxillary nerve, and waving smart pains trouble her greatly, all day long. The stellate block or the administration of carbamazepine did not avail against her pain at a nearby hospital. She visited our hospital on ******, the degree of her pain was expressed as 7.0cm/10.0cm in visual analogue scale (VAS). We utilized Uyaku-junki-san-ryo three times a day. The therapy of Uyaku junki-san-ryo resulted in the improvement of her pain, as well as the increase of her quality of life (QOL). Additionally, her VAS score was diminished from 7cm to 2cm, after two months.
This case demonstrates that Uyaku-junki-san-ryo may be a useful agent for the treatment of PHN.