We employed vacuum-assisted closure (VAC) as a treatment modality for wound complications after cardiovasular surgery. Between March and December 2004, 9 patients were treated with VAC, 8 of whom were men, and the mean age was 69.6 years old. Seven patients underwent off-pump coronary artery bypass, and 2 underwent a valve replacement. Six of them had diabetes, 5 had renal dysfunction (4 were dialysis patients), and 2 had chronic obstructive lung disease. Six cases were classified as superficial sternal infection (Superficial) and 3 as a deep sternal infection (Deep). Superficial cases were healed with wound closure after a short period of VAC treatment. However, Deep cases required long duration of VAC treatment and wound closure with a myocutaneous flap in 2 cases, although all of them did not develop mediastinitis requiring closed irrigation and drainage. In 9 cases, with numerous risk factors for poor healing, we found that VAC treatment facilitated wound healing and reduced frequent painful wound care.

Although the descriptions of shigyakukachotanto in “Waitaimiyaofang” and tsumyakushigyakukachotanjuto in “Songban Shanghanlun” are quite similar to each other, the specifications of the dosages of crude drugs and the water volume in the books were considerably different. Focused on the specified water volume to decoct these formulas, each reasonable decocting period was estimated, then the decoctions were prepared using hard water that was common in mainland China. The dosages of aconite root were 2­-fold different between these two formulas, but the contents of aconitine-­type diester alkaloids (ADA) in both decoctions were found in the range of 1.2—1.4­-fold. It was suggested that in order to control the efficacy and the safety of aconite, the decocting period was well regulated by the specification of water volume for decocting at this ancient era. Moreover, the dosages of aconite root and glycyrrhiza in bukuryoshigyakuto (BSGT) formula of “Songban Shanghanlun” are equal to those of shigyakuto (SGT) but the specified water volume to begin decocting is as about twice as that of SGT. When prepared using hard water, BSGT resulted to make the contents of ADA lower and those of non-­ester alkaloids higher compared with those of SGT decoction. It was suggested the spe­cific water volume for each formula prescribed in classical Chinese medicine had considerable significance to determine the dosages of chemical ingredients in the decoctions especially in the circumstances using hard water to prepare them.