We describe three cases of calf cramps successfully treated with shimbuto. Case 1 was a 74-year-old female who suffered from calf cramps and knee pain caused by gonarthrosis. She was treated with boiohito, but did not respond. When she complained of diarrhea, shimbuto was substituted for boiohito. After taking shimbuto, her knee pain improved, and her cramps disappeared. Case 2 was a 77-year-old female who suffered from leg edema and calf cramps. Tokishakuyakusan was prescribed, but she complained of an upset stomach. Tokishakuyakusan was replaced with shimbuto, and her cramps improved together with a decrease in the coldness and edema in her legs. Case 3 was a 79-year-old female who took kososan for uneasiness and restlessness after the death of her husband. She had edema and coldness in her legs, and suffered from calf cramps during the daytime and early in the morning. Shimbuto was added to kososan, and her coldness improved ; subsequently the leg edema diminished, and finally her cramps disappeared.
These cases suggest that shimbuto is indicated for patients with calf cramps, who report internal coldness caused by kidney deficiency with gastrointestinal dysfunction.

Tokito is used to treat patients with an asthenic, cold constitution, who have symptoms of chronic pleuritic pain, epigastralgia, and backache. There is no previous report on treatment of pruritus cutaneus with tokito. However, here we report a case of combined cutaneus pruritus and coldness, successfully treated with tokito. Our patient was a 38-year-old female, who reported having had facial pruritus cutaneus for one year. She attended our clinic in May of the year, because she had taken a turn for the worse. She was sensitive to cold, had poor circulation, felt cold in the abdomen, and reported that sleeping was difficult due to a cold back. We prescribed tokito (5.0 g/day). Her symptoms improved within six days. However, her symptoms, especially cold abdomen and cold back, returned when she drank cold water or stopped taking tokito. She was quite informative in that she prepared detailed records of her symptoms on visiting our clinic.
Tokito contains herbal medicines common to daikenchuto and tokikenchuto and hangekobokuto. Therefore, tokito could be a suitable herbal medicine for patients with pruritus cutaneus caused by coldness and qi stagnation and spleen deficiency.

In Kampo, respiratory symptoms are treated with prescriptions related not only to “lung”, but also other parenchymatous viscera. We report 2 patients whose stress-induced chronic cough was ameliorated by hachimijiogan. Case 1 was a 25-year-old female who was working under stressful circumstances at her company and reported an oppressive feeling in the chest. She was initially prescribed hangekobokuto because of a feeling that something was stuck in the pit of her stomach on abdominal examination, but her cough did not get better. As she also noted a dull feeling in her back ; she was switched to hachimigan, and her cough disappeared. Case 2 was 42-year-old female who suffered from depression, sore throat and an obstructive feeling in the throat ; she had been receiving infertility treatment for several years. Hangekobokuto and bakumondoto showed insufficient effect on her persistent cough. Her coughing stopped when she was prescribed hachimigan for back pain. Neither of these patients showed lack of resistance of the lower abdomen on abdominal examination.
Chronic ki (qi) stagnation under stressful conditions may cause ki deficiency, especially kidney deficiency. The symptom of stress-induced cough in our cases was considered to be due to kidney deficiency, and therefore hachimijiogan, but not hangekobokuto, was effective. The short duration of the complaints and relatively young age (20-40's) of the patients may account for the absence of the typical abdominal sign of kidney deficiency. Back stiffness and pain may also be important signs for cough due to kidney deficiency.

We present a 35-year-old male with palpebral hemispasm, which often occurred while at work. Because there were no ophthalmological findings, he consulted our clinic to receive Kampo therapy. He easily became fatigued and he had subchondral resistance and discomfort (kyo-kyo-kuman), so we treated him with saikokeishito and shakuyakukanzoto. However, they were ineffective, and therefore we reconsidered his symptoms.
Although he complained of fatigue, he was well built and had been a heavy drinker until a few years before presenting. Furthermore, he easily blushed and sweated in the upper body during the daytime, and his palpebral hemispasm often occurred during this blushing and sweating, and was accompanied by headache. We considered that this represented an excess-heat pattern rather than a deficiency pattern, and prescribed orengedokuto. His symptoms improved, and disappeared after six months.
There has been no detailed report of orengedokuto for the treatment of palpebral hemispasm. Orengedokuto may be useful for palpebral hemispasm in the context of symptoms of excess-heat pattern, such as blushing, sweating in the upper body and headache.

  We have managed information on adverse drug reaction using the clinical records to obtain data from within our hospital and using Medicine-Pocketbooks to obtain data outside our hospital.  Our system for management of side effect information does not require the development of a separate specialized system.  Our method of collecting side effect information was changed in April 2007.  Therefore, we evaluated our present method of collecting information on side effects by comparing the method used before the change with the new method.  The amount of side effect information collected has clearly increased since April 2007.  Although the amount of data collected directly from doctors has increased eight-fold, the amount collected from other data sources has hardly changed.  Side effect symptoms have hardly changed, with skin symptoms being the most frequent side effect.  Suspected drugs have also hardly changed, with antibiotics being the most frequently suspected drugs.  In addition, we conducted questionnaire surveys on the use of Medicine-Pocketbooks by patients who registered side effect information at our hospital to determine whether Medicine-Pocketbooks were being used effectively as a tool for the management of side effect information.  Among patients who registered their side effect information at our hospital, 76% also presented their Medicine-Pocketbooks to other medical institutions.  In addition, all patients received a change in prescription or were questioned about their side effect information when they presented their Medicine-Pocketbooks.  Our present method of collecting side effect information is considered appropriate since there was an increase in the amount of side effect information collected from doctors.  Medicine-Pocketbooks have also been effectively used as a tool for managing side effect information.

This study analyzed the effects of various body surface areas being cooled by water-perfused suits (WPS) on thermoregulatory response during exercise in a hot environment. Seven male subjects, dressed in clothing with low moisture permeability (rain coats) over WPS covering the whole body surface except for the face, hands, and feet, performed three sessions of 20-min cycling at low intensity (250w/m²) in a room maintained at 30℃ under six conditions of body surface cooling : whole body (WB), upper body (UB), lower body (LB), lower body except lower legs (LBEL), head and neck (HN), and no body cooling (NBC). The coolant temperature at the inlet was 20℃ for all conditions, and heat extraction (HE) was estimated by the difference between inlet and outlet water temperatures and water flow rate. Esophageal (Tes) and deep thigh temperatures (T-d.thigh) and heart rate (HR) during exercise were significantly (p＜0.01) higher for NBC and HN, and forearm skin blood flow (SkBF) and dehydration (DEH) were significantly (p＜0.01) lower for WB than for other conditions. There was a similar tendency concerning Tes and T-d.thigh among WB, LBEL, and LB ; however, T-d.thigh for UB was significantly (p＜0.01) higher than for WB, LBEL, and LB. In comparison with resting levels, the mean skin temperature (Tsk) and thermal sensation (TS) significantly (p＜0.01) increased for NBC and HN, and decreased for UB and WB, but remained constant for LBEL and LB during exercise. Under all conditions, increases in Tes (ΔTes) and T-d.thigh (ΔT-d.thigh) at the end of exercise were significantly (p＜0.01) increased when less than 40% of the body surface was cooled (Tsk : above 35.8℃, HE : less than 110W). Furthermore, ΔTes at the end of the exercise was related to ΔTsk×SkBF, while the slope of the regression line between those parameters was steeper when ΔTsk×SkBF values were negative, as opposed to positive values. These results suggest that during light exercise under different body surface cooling conditions : 1) UB leads to a high T-d.thigh while Tes, Tsk, and TS are as low as those for WB, 2) critical levels of body surface cooling area causing a decrease in core temperature elevation might exist, and 3) changes in blood circulation due to body cooling might be affecting temperature responses at the end of exercise.

A 67-year-old man was considered a candidtate for CABG because coronary angiogram showed obstruction segment 6 and stenoses of segments 9 and 12. He underwent emergency CABG due to acute myocardial infarction (AMI) with cardiogenic shock caused by hemorrhage from a gastric ulcer. Because of hypoxia due to pulmonary edema and acute renal failure an intraaortic baloon was inserted. He had a history of cerebrovascular stroke. Although coronary angiogram revealed multiple vessel disease, we performed off-pump coronary artery bypass (saphenous vein graft-left anterior descending artery) for salvage, because cardiopulmonary bypass was considered very risky and further systemic heparinization might be fatal. He has returned to his job, and is now free from angina. As AMI with cardiogenic shock is often caused by a lesion in the LAD, CABG without cardiopulmonary bypass may be an effective technique in certain selected patients.

Myocardial oxidative stress during retrograde continuous blood cardioplegia (RCBC) was evaluated in 35 patients undergoing elective aortocoronary bypass surgery. The patients were divided into three groups: Group C (n=12) received cold (20°C) RCBC, Group T (n=11) received tepid (30°C) RCBC, and Group W (n=12) received warm (36°C) RCBC. Myocardial oxidative stress was assessed by measuring the release of oxidized glutathione (GSSG), malondialdehyde (MDA), and myeloperoxidase (MPO) in the coronary sinus plasma before aortic clamping, at 1, 5, and 10min after unclamping. Myocardial oxygen uptake and lactate release were assessed at the same times. Both the hemodynamic recovery and the creatine kinase MB (CKMB) activity were measured perioperatively until 24h after unclamping. In Group C, a significant coronary sinus release of GSSG was found in the early reperfusion period in comparison to Groups T and W. However, the peak CK-MB activity was significantly lower in Group T than in Group W. No significant difference in the release of MDA or MPO was noted in the three groups. The recovery of oxygen uptake after unclamping was rapid in Group T. The recovery in the left and right ventricular functions and the myocardial lactate release were similar in the three groups. In conclusion, tepid RCBC is considered to protect the myocardium from ischemia-reperfusion injury better than cold or warm blood cardioplegia under retrograde continuous perfusion.

This study reports the efforts of acupuncturists to promote multidisciplinary cooperation in our laboratory. We conducted a questionnaire survey involving all employees of our laboratory in December 2013 to investigate problems regarding multidisciplinary cooperation, and identified a lack of information and problems concerning treatment plans and costs. After implementing measures to tackle these problems between January and November 2014, we conducted the questionnaire survey again. As the results, 79% of the employees responded that they had gained more information about acupuncture compared to the previous year, and 72% of them responded that treatment plans and costs were appropriate. Compared to the number of new patients who sought acupuncture treatment between January and November 2013 (n = 273), there was an increase of 40% in the same period of 2014 (n = 385). These results showed that employees' understanding of acupuncture and multidisciplinary cooperation were promoted.