A 72-year-old female who had been experiencing chest pain after slight exertion for over one month was admitted to our hospital. An electrocardiogram after exercise revealed a myocardial ischemic change. We diagnosed Ketsu-kyo on the basis of symptoms such as extreme tenderness in the epigastric region (Shinka-hiko) and also tenderness in the anterior chest wall. After prescribing Dai-kankyo-to, which was made by boiling with Daio, Bosyo and Kantsui, the expected diarrhea did not occur. We then made Dai-kankyo-to according to the original method of Sho-kan-ron and administered it. The chest pain disappeared and severe diarrhea occurred. A coronary angiogram did not reveal a stenotic lesion and the patient was diagnosed with microvascular angina pectoris. This suggests that Dai-kankyo-to may be an effective treatment of microvascular angina in its acute stage.

We report a case of an 84-year-old septic patient who was treated with Ogi-kenchu-to (Huang-qj-jian-zhong-tang). The patient had remained positive for Klebsiella pneumoniae. The focus of infection had not been detected, but bacterial translocation from the digestive tract was suspected from the clinical course. After two weeks of antibiotic therapy, he still had a high fever and positive blood culture. In addition, multiple cultures showed the destruction of normal flora and an increase of antibiotics-resistant bacteria.
Antibiotics were then suspended, and he was treated with Ogi-kenchu-to alone. His fever and inflammatory signs gradually disappeared, and his blood cultures became negative without restarting antibiotic treatment. He recovered completely. Ogi-kenchu-to is indicated for treating “generally weakened” patients or patients with intestinal problems. However, we could not find any reports of its application to septic patients. Although we still need to determine the mechanism for its efficacy, we consider that this case adds further evidence that Ogi-kenchu-to may be helpful for those suffering from severe infection, especially in elder patients and immuno-suppressed patients.

We gave Borei-takusya-san to six patients with intractable edema under the waist. This treatment cured three of the six. Two of the cured patients had Ki-deficiency or Yang-Ki-deficiency in the kidneys. In these cases, we first intensified Ki in the kidneys and improved their conditions to Yin-disease, first stage. We noticed improvement of their subjective symptoms and objective signs after we gave them Borei-takusya-san in combination with their prescriptions. All of the ineffective cases presented some conditions of hypo-tonus or hypo-reactivity.
With reference to many ancient medical books and our own experience we studied the use of Borei-takusyasan. It applies to patients (1) with oliguria, (2) with edema under the waist, (3) without Ki deficiency and Yang-Ki-deficiency in the kidneys and with (4) more reactive stage than Yang-disease, second stage and Ki between excess and deficiency. (5) If they had Ki-deficiency or Yang-Ki-deficiency in the kidneys, we should first replenish with Ki sufficiently, and make out prescriptions for the patients.
We consider that Borei-takusya-san is capable of wide application to the patients with edema under the waist, following our indications.

A 44-year-old male with cyclic neutropenia who had suffered from repeated general fatigue and severe abdominal pain over twenty-six years was admitted to our hospital. Various active treatments such as steroid, granulocyte colony-stimulating factor and immunosuppressive regimen had been attempted, but a lasting cure could not obtained. In addition, the cycle of neutropenia had gradually been disturbed and abdominal pain occurred even at the period of normal neutrocyte. The patient fell into severe asthenia and cold syndrome judging from Japanese traditional Kampo medicine. Tsumyaku-shigyaku-to and Dai-kenchu-to combined with Busi-koubei-to were administered alternately, and then abdominal pain was reduced, accompanied by improvement of his cold and strengthening of his constitution. Furthermore, several Kampo formulas such as modifications of Chu-kenchu-to were administered on the basis of abdominal symptom and the cycle of neutropenia was regularized. This suggests that the genus Kenchu-to may be an effective treatment for cyclic neutropenia.

We report two cases of ankylosing spondylitis (AS) successfully treated with Kampo formulae including Uzu (aconiti tuber). The 1st case was a 33-year-old male. Since the age of 20, he had stiffness and pain in his back. At 26 years of age, he was diagnosed with AS by a nearby orthopedist. When he consulted our department in 1997, X-ray examination revealed a Bamboo spine appearance. Because coldness exacerbated the pain, we prescribed Uzu-to. Together with a decrease in inflammatory reaction, his pain and quality of life were improved. The 2nd case was a 24-year-old male. He had left hip joint pain since the age of 14, and at 16 was diagnosed with AS and treated with NSAIDs. Methotrexate (MTX) had also been prescribed from the age of 23, since the pain of other joints and back was gradually progressive with consistently positive inflammation. He did not, however, improve on MTX, and visited our department in 2002. His HLA-B27 was positive, while iliosacral arthritis was also noted. Uzukeishi-to was then prescribed, resulting in decreased pain, alleviation of restricted motion, and an improved inflammation reaction. This suggests that Kampo formulae which include Uzu may be useful in the treatment of AS.

A case of ascites and pitting edema from hepatocellular carcinoma treated with Boi-shomoku-teireki-daio-gan-ryo was reported.
An 80-year-old female presented progressive gait disturbance and dysuria in April 2002. Neurological examination revealed paraparesis, hypesthesia inferior to lumber level and sphincter dysfunction. An MRI revealed a solid mass arising from lamina at the right Th 12, extending into the spinal canal. Surgery was performed, but paraparesis continued. In addition, the patient developed ascites and pitting edema of the legs. An abdominal CT suggested liver cirrhosis and hepatocellular carcinoma. Some Kampo formulas were not effective. Boi-shomoku-teireki-daio-gan-ryo was administered on the basis of symptoms such as ascites, dry mouth and constipation, and then the pitting edema improved rapidly. In addition, the abdominal CT revealed the decrement of ascites. Unfortunately the treatment was effective for only one month. Ascites with malignant tumor is very difficult to treat. However, Boi-shomoku-teireki-daio-gan-ryo is clearly useful for treatment of ascites and edema.

We report the case of a 77-year-old female with subacute thyroiditis who was successfully treated with traditional herbal medicine (Kampo-therapy). On 18th December 2001, the patient was admitted to our hospital because of malaise and loss of appetite.
The patient complained of what she thought was a sore throat that began one month prior to admission, with a fever rising to 37.8°C 4 days before admission. Physical examination showed tenderness and swelling of the thyroid. Blood examination showed hyperthyroidism (TSH 0.02μIU/ml fT₃ 20.18ng/dl fT₄ 5.21ng/dl) and high inflammation (CRP 13.7 ESR 122mm/hr). We then diagnosed subacute thyroiditis and treated her with Kampo-therapy only. We arranged herbs according to the “Sho-kan-ron (_??__??__??_)” and gave her Keishi-ni-eppi-ichi-to (_??__??__??__??__??__??__??_) and Choi-joki-to (_??__??__??__??__??_). Four days after admission, her intermittent fever disappeared. After 10 days, her CRP became negative. After 13 days, almost all the symptoms had disappeared. Thyroid function (fT₃, fT₄) returned to normal after 17 days of Kampo-therapy. Subacute thyroiditis is a self limiting disease, but steroid therapy is often needed to reduce the symptoms and avoid thyrotoxicosis. In this case, the patient made a relatively quick recovery without steroid therapy. We suggest Kampo-therapy can be an effective treatment for subacute thyroiditis.

We report on three patients suffering from diabetic foot successfully treated with. Kigi-kenchu-to with additional ingredients.
Case 1 was a 68-year-old female with diabetes mellitus and rheumatoid arthritis The bilateral foot sole ulcers present were diagnosed as diabetic gangrene. Her condition had not improved, in spite of Western medical treatment. The ulcers of bilateral foot improved, however, after administration of Kigi-kenchu-to-ka-bushi, while rheumatoid indices also became negative.
Case 2 was a 66-year-old male with diabetes mellitus and a history of subarachnoidal hemorrhage. Kigi-kenchu-to-ka-bushi medication, in this instance, caused recurring ulcers of the big toe to disappear.
Case 3 was a 72-year-old male. Gangrene of bilateral toes set in, during treatment of diabetic nephropathy. And even though the toes were amputated, recovery was delayed because of poor blood flow to the feet. After administration of Kigi-kenchu-to-ka-hanbi, granulation formation progressed and the patient's outlook improved.
We consider that Kigi-kenchu-to, with additional ingredients, may serve as an effective cure for diabetic foot.

We prescribed Seisho-ekki-to for three bronchial asthma patients, with poor control of their attacks. Markers used to assess the efficacy of this formulation were sensations in the throat, palpitation and spontaneous sweating. All these markers improved rapidly, with Seisho-ekki-to administration. All three patients and several factors in common, namely; being middle-aged, having attacks that arise throughout the year, epigastric discomfort, fullness of the upper abdomen and pulsation near the umbilicus. Furthermore, a cessation or significant decrease in numbers of asthma attacks seen was brought about with Seisho-ekki-to medication. Up until now, Seisho-ekki-to has usually been used to treat summer heat syndrome. It appears, however, that Seisho-ekki-to may also be applied in the control of bronchial asthma, in the middle-aged.

This study was conducted to assess the proper fee for dispensing herbs prescribed under the national health insurance. We investigated the cost of dispensing a) general medicine and b) Kampo formulae in relation to the time needed in three pharmacies. One prescription of general medicine including packed extract of Kampo formulae, and one Kampo formula consisting of different kinds of herbs, were counted as one sample each. The former counted 125 samples, and 176 samples of the latter. The mean time for dispensing one sample of Kampo formulae was 9 minutes and 33 seconds, and it was 5.4 times longer than for the general medicine (1 minute and 46 seconds). The time for dispensing herbs grew longer as the days of the prescription increased; with a mean number of 9-12 herbs in the formulae about twice the time was needed for a prescription for 22-28 days than for one of 8-14 days. As the number of herbs in the formulae increased, the time for dispensing them also increased. The cost of pharmacist's work was calculated based upon the time expended and the pharmacist's hourly wage. It amounted to one fifth of the fee for dispensing general medicine, but it was nearly equal or higher when involving herbs. According to the Regulation of Dispensary Awards revised in 2004, the fee for dispensing herbal medicine is \1200 whatever the formulae. We would like to recommend that a re-evaluation of the fee should be made based on the number of days of the prescription, the number of herbs in the formulae, and the cost of preserving herbs in pharmaceutical facilities.