The patient was a 49-year-old woman. She developed retroperitonitis and retroperitoneal emphysema due to iatrogenic duodenal perforation. We inserted a nasogastric tube into her stomach in order to decompress the gastrointestinal tract, and cefoperazone and proton pump inhibitors were administered intravenously. Her symptoms of retroperitonitis were then reduced. However, she developed enteritis suspected due to MRSA infection complicated by acute respiratory distress syndrome, acute renal failure and shock. We administered vancomycin via nasogastric tube, but her symptoms did not improve, so we added shojokito. She relieved her bowels after the administration of shojokito, and an antipyretic tendency was observed. Her breathing status recovered to normal, her blood pressure was stable, and her general condition gradually improved.
In recent years, we have not had many opportunities to perform Kampo treatment for severe infection cases needing hospitalization, but Kampo application has the potential to enhance the efficacy of infection treatments. Thus we advocate the active carrying out of Kampo treatment for patients with intestinal infection.

Kyokatsushoshitsuto is a Kampo formulation used against cervix pain so severe that the neck cannot be turned. Of six patients we treated with this formula, it was effective in three cases but ineffective in the remaining three. From the viewpoint of traditional Chinese medicine (Kampo) regarding the in/effectiveness of this formula : in effective cases, palpitations in the area of the navel and tooth marks on the tongue are seen in patients in a weak state. As for subjective symptoms : in effective cases, “the waist area around the body sometimes feels cold”, “air conditioning is disliked”, and “an electric blanket etc. is needed in winter” were also indicative signs. On the other hand, symptoms such as “the skin becomes dry”, “water may accumulate in a joint”, and “symptoms of clicking/pain in the knee and having difficulty sitting straight” were not seen. In total, these may serve as useful indications for the application of kyokatsushoshitsuto, especially when palpitations in the navel area are considered a helpful new Kampo finding.

We report two cases of inchinkoto treatment for obstructive jaundice via autoimmune pancreatitis (AIP). Case 1 : A 38-year-old male. After completion of treatment for Mikulicz disease, obstructive jaundice developed. A diagnosis of AIP was based on a high IgG 4 blood level and image views. T-Bil stayed above 20 mg/dl and there was no improvement by oral administration of prednisolone (PSL), ursodeoxycholic acid, or bilirubin adsorption therapy. Upon inchinkoto administration, T-Bil promptly fell to 3 mg/dL. Case 2 : A 77-year-old male. He suffered from itching and constipation, and blood data showed a pattern of obstructive jaundice. Image views suggested AIP, but a duodenal papillary biopsy could not provide a definitive diagnosis. Inchinkoto was administered, and the itching and constipation had mostly disappeared within 1 week. However, these symptoms recurred after one month. A definitive diagnosis of AIP was then reached based on a pancreas biopsy, and a PSL regimen was initiated. From these two cases, we consider that inchinkoto is useful for improving the symptoms of obstructive jaundice induced by AIP.