Low anterior rectal resection was performed for lower rectal sm carcinoma. The patient had not complained of staining his underwear while hospitalized but only when he resumed work as a metal sheet worker. He then started to find his underwear stained with mucus.
The operation he had undergone was end to end anastomosis of the sigmoid colon and the rectum with EEA mechanical anastomosis. During the operation, there was an insecure site in one part of the doughnut ring, and therefore another three stitches for total layered suturing were made manually. An artificial anus was introduced temporarily. Since IVH was performed for two weeks after operation, no particular sutural insufficiency was noted.
It was assumed that underwear staining with mucus was due to some kind of persistent inflammation at the site of anastomosis. Based on Kampo medicine, the patient was diagnosed as “pathogenic dampness-heat combination”, and was given Oren-gedoku-to to clear away “heat-evil and dampness-evil”. This Kampo preparation proved to be very effective. The underwear staining was reduced considerably, though the anal sphincter remained hypotonic. Hochu-ekki-to was given to elevate and resume sphincteral tension. No report has previously been made concerning the use of a Kampo formulation in mucous staining of the underwear after low anterior rectal resection.

The source of Kami-shoyo-san varies in the literature. The current formula contains ten kinds of medicine. Only Shoyo-san is described in “He ji ju fang”. In “Nü ke cuo yao” and “Nei ke zhai yao”, a formula containing eight medicines without ginger and mentha was descrided. It was in “Wan bing hui chun” after Xue Ji that a formula containing ten kinds of medicine was first specified. The source of its combination with Shimotsu-to also varies in the literature. There is no mention of this combination in the “He ji ju fang”. In the “Nei ke zhai yao”, there is a case where eight-medicine formulations in combination with Shimotsu-to were used. Although ten-medicine plus Shimotsu-to are, in fact, described in “Futsugo-yakushitsu-houkan-kuketsu”, my investigation found that such a combination formula was used for general pruritus in “Ryo-chikeiken-hikki” about 90 years previously. I believe that if the process of establishing a formula is complicated, as in the case of Kami-shoyo-san, every activity contributing to each step in establishing the formula is generally included as a part of its source and that any activity, in which a combination of formulae was very effective, is regarded, in principle, as its source.

It has hitherto been believed that Kakkon-to plus Senkyu-shin'i was invented by Japanese. In his article entitled “On the Development of the Kampo formula, Kakkon-to-ka-Senkyu-shin'i”, Terasawa wrote that there is no literature available up to 1940's which specified the addition of Shin'i and that there is no definite data concerning the source of Shin'i. I studied the addition of Senkyu and Shin'i taking the above into consideration. I discovered how Magnolia kobus had been replaced by Shin'i, that it is described in “Ben cao gang mu”, and that there were schools, such as Yoshimasu Todo's which never prescribed Shin'i. I also found that Kakkon-to combined with other herbs was used in the treatment of syphilis in the Edo era, and that there are combinations containing Senkyu, Shin'i, or Senkyu plus Shin'i, which were used according to the status of syphilid and to reduce adverse reactions of mercurial agents. In my present investigation, the closest formulation to Kakkon-to plus Senkyu-shin'i is Kakkon-to-combined-gomotsu-gedoku-to plus Shin'i.

Coicis Semen was known in ancient times as a medicine promoting longevity. In the ‘Huang ti nei ching su wên’, there is a reference to Coicis Semen in a description of one of the pulses (cardiac pulse without stomachic energy), and it is contained in four formulas in the ‘Chin kuei yao lueh’. As for the effectiveness of Coicis Semen for the treatment of verrucae, there are no references in the ‘Ben cao gang mu’ or the ‘Nodoku’. In the Edo period, a common treatment for warts was moxibustion. The first text thought to mention Coicis Semen for the treatment of verrucae was the ‘Yamato Honzo. However, it is difficult to tell from the description of the condition whether it is in fact warts or not. Previously, the references contained in the later texts, ‘Matsukageidan’ and ‘Seinosatan’, containing a verruca formula (Chiyushimpo), have been considered to be theearliest notations of applying formulas containing Coicis Semen for the treatment of warts. However, independent investigation revealed the presence of a formula for verrucae in the text ‘Meikahosen’, compiled by Yamada Genrin twenty years before the ‘Seinosatan’. The description in the ‘Meikahosen’ says ‘Formula for warts: Coicis Semen-3 sen; Glycyrrhizae Radix-1 bu to beused not only internally but externally as well.
The realization of the ability of Coicis Semen to cure warts was thought to have occurred with the observation of many cases of remarkable effectiveness seen when large quantities were consumed in the form of rice and gruel containing Coicis Semen, rather than in the form of sweets made from what was called ‘Chosenmugi or Coix lacryma-jobi L. var. koreana.

Anchu-san is included in the ‘Tai Ping Hui Min He Ji Ju Fang’ (a Song dynasty pharmacopoeia), with the constituent crude drugs listed as Kanzo (Glycyrrhizae Radix), Gengosaku (Corydalis Tuber), Ryokyo (Alpiniae Officinarum Rhizoma), Kankyo (Zingiberis Siccatum Rhizoma), Uikyo (Foeniculi Fructus), Nikkei (Cinnamomi Cortex) and Borei (Ostreae Testa). However, in modern-day Japan, the same formula usually contains Keihi (Cinnamomi Cortex), Borei, Shukusha (Amomi Semen), Engosaku (Corydalis Tuber), Uikyo, Kanzo and Ryokyo. The ‘Futsugo-yakushitsu-hokan, ’ (late 19th century) lists the latter formula in the section on decoctions and the former formula in the section on powdered medicines. In the ‘Shochitekiyo’ of the late Edo period (1603-1867), it is said that Hara Nanyo added Shukusha to the pharmacopoeia prescription, for a total of eight ingredients, and tripled the amount of Borei as another device. In ‘Sokei-tei-iji-shogen, ’ (1820) the latter device is included with the note that it is effective for treating pyloric stenosis. The former device may well have been a secret formula of his family of physicians.
In many texts, uses of the formula, Anchu-san, were not limited to the directions given in the pharma copoeia, and decocting the formula was relatively common. For severe cases of stagnation, the addition of Bushi (Aconiti Tuber) was recommended, and Shinra (river snail) was also used inplace of the Borei.
Anchu-san appears primarily in texts from the late Edo period onwards. If copies of books with unclear dates are not considered, Anchu-san was not used significantly as a prescription until the 19th century.

A study of the classical references to the Kampo formulas Kihi-to and Kamikihi-to was conducted. The common constituents for Kihi-to today are Ginseng Radix, Atractylodis Rhizoma, Hoelen, Longanae Arillus, Zizyphi Spinosi Semen, Astragali Radix, Polygalae Radix, Angelicae Radix, Saussureae Radix, Glycyrrhizae Radix, Zingiberis Rhizoma and Zizyphi Fructus. The Kihi-to noted in the ‘Saiseiho’ (‘Ji Sheng Fang) did not contain Angelicae Radix and Polygalae Radix, and the Kihi-to in the ‘Gyokukibigi’ (‘Yu Ji Wei Yi’) adds Angelicae Radix to the formula found in the ‘Saiseiho, ’ The ‘Sesshi-ian’ (‘Xue Shi Yi An’) also adds Polygalae Radix. In the ‘Sesshi-ian’ there are three formulas given for Kamikihi-to: one with Bupleuri Radix and Gardeniae Fructus, one containing Bupleuri Radix, Moutan Radicis Cortex and Gardeniae Fructus, and one with Moutan Radicis Cortex and Gardeniae Fructus. Although all three variations can be found in the formula guidelines in circulation during the Edo period in Japan, at present, the formula containing Bupleuri Radix and Gardeniae Fructus is the most prevalent. This is most likely due to the influence of the ‘Futsugo-yakushitsu-hokan’ and ‘Futsugo-yakushitsu-hokan-kuketsu’.
In summary, the classical texts which included Kihi-to and Kamikihi-to were found to be the ‘Saiseiho’, ‘Gyokukibigi’, and the ‘Sesshi-ian’

A report by the author entitled “Kampo formulas containing Coicis Semen that are Effective in the Treatment of Verrucae” was published in Volume 47 Number 1 of the Japanese Journal of Oriental Medicine. In this paper, the author notes the finding of a reference that supplements the above report. In ‘Yojuin Yamawaki Sensei Hokan, ’ written by Yamawaki Toyo the author found the following: “To control verrucae, boil 5 sen of Coicis Semen in 3 go of water. Drink or wash the affected area with 1 go of this use.” (This text was originally written in classical Chinese.) It is clear from this statement that Yamawaki Toyo used Coicis Semen for verrucae in a manner resembling folk medicine. Although the date of compilation of the text is not known, this treatment method had obviously been in use before the death of Yamawaki Toyo (1762).
The description of the use containing Coicis Semen appearing in the above text is more accurate than that found in ‘Yamato Honzo.’
The first description of a formula for Coicis Semen for the treatment of verrucae is found in ‘Meika Hosen, ’ which was edited by Yamada Genrin in his late teens after stealing formulas from various famous doctors. According to various medical texts, the name of Yamada Genrin was Ikyo. In ‘Meika Hosen, ’ which Yamada edited, his name was written using different Chinese characters, but also pronounced ‘Ikyo’, this was probably his original first name. The name ‘Ikyo’ with the characters used later is associated with the text ‘Baiso Yakugen.’

The author's first paper entitled “The First Recipe for Amomi Semen to the Kampo Formula, Anchu-san” was published in Volume 47 Number 2 of the Japanese Journal of Oriental Medicine. In this paper, the first appearance of the crude drug Bukuryo (Hoelen) in the formula Anchu-san-ka-bukuryo, which is listed in the Standardized Drug Prices of Japan, is examined.
The only manufacturer of this product remarked that the ‘Explanation of Clinical Applications of Kampo Formulas, ’ by Yakazu Domei, is the source of the formula Anchu-san-ka-bukuryo, since it includes the statement, “In many cases, Hoelen 5.0 is added.” In the ‘Hoizokucho, ’ published by Murase Toshu in 1889 (Meiji 22), however, it is noted that the addition of Hoelen to Ju fang Anchu-san is most suitable. In the “‘Kokonhoi’ and its Clinical Applications, ” published in Volume 2 Number 9 of the Journal of Kampo Medicine, Yakazu states that the ‘Hoizokucho’ can supplement the ‘Kokonhoi’, and that these two books are the best reference texts. It seems clear that Yakazu must have known about the presence of Hoelen in the ‘Hoizokucho, ’ since the description of Hoelen in the ‘Explanation of Clinical Applications of Kampo Formulas’ appears to be based on the ‘Hoizokucho.’ Yakazu confirmend this to the author when asked about this point. These considerations suggest that the source of Hoelen in Anchu-san-ka-bukuryo is the ‘Hoizokucho.’

A report by the author entitled “Kampo formulas containing Coicis Semen that are Effective in the Treatment of Verrucae” was published in Volume 47 Number 1 of the Japanese Journal of Oriental Medicine. In this paper, the author notes the finding of a reference that supplements the above report. In ‘Yojuin Yamawaki Sensei Hokan, ’ written by Yamawaki Toyo the author found the following: “To control verrucae, boil 5 sen of Coicis Semen in 3 go of water. Drink or wash the affected area with 1 go of this use.” (This text was originally written in classical Chinese.) It is clear from this statement that Yamawaki Toyo used Coicis Semen for verrucae in a manner resembling folk medicine. Although the date of compilation of the text is not known, this treatment method had obviously been in use before the death of Yamawaki Toyo (1762).
The description of the use containing Coicis Semen appearing in the above text is more accurate than that found in ‘Yamato Honzo.’
The first description of a formula for Coicis Semen for the treatment of verrucae is found in ‘Meika Hosen, ’ which was edited by Yamada Genrin in his late teens after stealing formulas from various famous doctors. According to various medical texts, the name of Yamada Genrin was Ikyo. In ‘Meika Hosen, ’ which Yamada edited, his name was written using different Chinese characters, but also pronounced ‘Ikyo’, this was probably his original first name. The name ‘Ikyo’ with the characters used later is associated with the text ‘Baiso Yakugen.’

A report by the author entitled “Kampo formulas containing Coicis Semen that are Effective in the Treatment of Verrucae” was published in Volume 47 Number 1 of the Japanese Journal of Oriental Medicine. In this paper, the author notes the finding of a reference that supplements the above report. In ‘Yojuin Yamawaki Sensei Hokan, ’ written by Yamawaki Toyo the author found the following: “To control verrucae, boil 5 sen of Coicis Semen in 3 go of water. Drink or wash the affected area with 1 go of this use.” (This text was originally written in classical Chinese.) It is clear from this statement that Yamawaki Toyo used Coicis Semen for verrucae in a manner resembling folk medicine. Although the date of compilation of the text is not known, this treatment method had obviously been in use before the death of Yamawaki Toyo (1762).
The description of the use containing Coicis Semen appearing in the above text is more accurate than that found in ‘Yamato Honzo.’
The first description of a formula for Coicis Semen for the treatment of verrucae is found in ‘Meika Hosen, ’ which was edited by Yamada Genrin in his late teens after stealing formulas from various famous doctors. According to various medical texts, the name of Yamada Genrin was Ikyo. In ‘Meika Hosen, ’ which Yamada edited, his name was written using different Chinese characters, but also pronounced ‘Ikyo’, this was probably his original first name. The name ‘Ikyo’ with the characters used later is associated with the text ‘Baiso Yakugen.’