Chronic fatigue is a common symptom in primary health care and caused by various organic and functional diseases. Although improvement is attained by controlling underlying organic disease, it is sometimes difficult to relieve fatigue in patients with chronic fatigue syndrome or dysthymia. We have encountered patients with idiopathic chronic fatigue (ICF) successfully treated with sansonintokagen. A 62-year-old female complained of chronic fatigue several years after menopause, and had normal status in routine blood and image analyses at a nearby hospital. Her condition was diagnosed as ICF with sleeplessness. Treatment with sansonintoaogibakumondo for 8 weeks improved her chronic fatigue and sleeplessness, and enabled her to continue housekeeping. This observation suggests that this kampo formula may be a useful agent for ICF.

We administered daisaikoto to 13 patients with traumatic cervical syndrome and observed complete responses in the following 2 patients. Patient 1 was a 40-year male. He was in the xiaoyang stage, and showed high abdominal tension and marked chest oppression. These findings were indications for daisaikoto. Patient 2 was a female in her 50 s. She was in the xiaoyang stage, showed moderate abdominal tension and chest oppression, and was aware of chest tension and constipation. Evaluation using the VAS in the 13 patients showed a complete response in 3 patients, partial response in 6, minor response in 1 and no response in 3. To clarify indications for daisaikoto in this disease, findings of Japanese Oriental Medicine in the 13 patients were evaluated. Of 9 patients with high abdominal tension, 8 showed partial or complete responses. Of 4 patients with moderate abdominal tension, a complete response, partial response, and no response were observed in 1, 1, and 2, respectively. In addition, objective abdominal coldness was present in both patients with moderate abdominal tension who showed no response but not in the patient showing a complete response.We confirmed the importance of therapy based on oriental medical syndromes when daisaikoto is used for traumatic cervical syndrome. However, patients with moderate abdominal tension without abdominal coldness can be differentiated from others for this therapy.

There have been few studies of the relationship between respiratory function, chest x-rays, electrocardiograms, and the abdominal palpation signs of Kampo medicine. This investigation was designed to elucidate the above points with 489 subjects who had undergone a full physical examination. As a result of this study, we make clear the following features:
1. Abdominal tension (traditionally referred to as “fukuryoku”) was related to vital capacity, lateral distance of the thorax, CTR, counter-clockwised axis deviation of QRS, and negatively related to the intra-vertical thoracic distance.
2. Sound of gurgling fluid in the abdomen (“Shinsuion”) was related to intravertical distance of the thorax, clockwise axis deviation of QRS, negatively related to the lateral distance of the thorax, width of the heart and CTR.
3. Tonus of the rectus abdominis muscles was related to vital capacity and intravertical distance of the thorax and negatively related to the lateral distance of the thorax.
4. Palpitation of the abdominal aorta (traditionally called “Shinkaki”, “seijouki”, and “saikaki”) revealed nega tive correlation to the lateral distance of the thorax and width of the heart.
5. Resistance or tenderness upon pressure in the epigastric resion (“shinkahiko”) was negatively related to the intrathoracic distance.
6. Resistance resembling a string of pearls in the midline of the lower abdomen (“seichushin”) was related to intravertical distance of the thorax, clockwise axis deviation of QRS, and negatively related to SV 1 electro cardiogram voltage.

There have been few studies on the relationship between the body mass index (BMI), complete blood cell count, blood chemistry, fatty liver evidence and Kampo abdominal palpation signs. This study was designed to clarify the above points. It involved 484 subjects who had undergone full physical examinations. The results of this study, can be summarized as follows:
1. Abdominal tension (traditionally referred to as “fukuryoku”) was related to BMI (males and females), TG, TCh/HDL, GPT, RBC, Hb and evidence of fatty liver (males) and corresponded negatively with HDL (males).
2. Tonus of the rectus abdominis muscle (“fukuhikokyu”) was negatively related to BMI (males).
3. The sound of gurgling liquid in the stomach (“shinsuion”) was negatively related to BMI (males and females).
4. Palpitations of the abdominal aorta in the upper abdomen (“shinkaki”) was related toHDL (males) and negatively related to BMI (males and females).
5. Palpitation of the abdominal aorta below the navel (“saikaki”) was negatively related to BMI (males).

Four intractable decubitus ulcer patients who had not responded to any Western medicine were treated effectively with Kigi-kenchu-to-ka-bushi. Case 1 was a 82-year-old female patient who had been admitted due to multiple-cerebral infarction. She had been bedridden and suffered repeatedly from pressure ulcers. Her bed sores were controlled successfully with Kigi-kenchu-to-ka-bushi. After treatment by Kigi-kenchu to-ka-bushi, any decubitus ulcer was not recurrence. Case 2 was a 85-year-old female patient. The pressure ulcer was 2cm in diameter and extent of soft tissue fissure underlying it was about 10cm in diameter. Skin color around pressure sore changed to purple. After administration of Kigi-kenchu-to-ka-bushi, skin color returned to normal and decubitus ulcer recovered. Case 3 was a 59-year-old male patient who had undergone operation on an intractable decubitus ulcer with fistula, but he did not get well. Two weeks later, after treatment with Kigi-kenchu-to-ka-bushi, he felt pain when we sterilized his ulcer. It was thought to be a sign of improvement of the wound. Physical status became better as the ulcer healed. Case 4 was a 64-year-old female patient with brain death because of acute myocardial infarction. Her pressure ulcer was treated effectively with Kigi-kenchu-to-ka-bushi, too.

Visceral fat obesity is closely associated with lifestyle-related diseases that include symptoms such as hypertension, diabetes mellitus, hyperlipidemia, etc. To examine the correlation between pulse, appearance of tongue, and abdominal palpation-diagnostic indicators according to Kampo medicine-and visceral fat obesity, we investigated 209 subjects who received health screenings, and obtained the following results. 1) The simply obese subjects, as determined by body mass index, showed symptoms of excess state, Kidepression, and stasis of body fluids according to the diagnostic techniques of Kampo medicine. 2) The visceral fat-rich subjects were diagnosed by means of abdominal ultrasonography and showed symptoms of pulsus maximum and Oketsu (blood stasis) state.

In all but a few cases, the treatment for elderly patients must be conservative owing to the unavoidably poor general condition of the patients.
We report on three cases of long-term bedridden patients with acute cholecystitis or cholangitis who were effectively treated with Kampo prescriptions. An 86-year-old male with choledecholithiasis and acute cholangitis responded to Inchin-ko-to. When he repeatedly relapsed after the discontinuance of Kampo treatment, Inchin-ko-to was effective, and Inchin-shingyaku-to successfully improved his general condition. In an 89-year-old male with acute cholecystitis, Dai-saiko-to extracts and Bukuryo-shigyaku-to were effective. An 88-year-old female with cholecystolithiasis and acute cholecystitis responded to Dai-saiko-to and Bukuryo-shigyaku-to.
Most elderly patients are Inkyo-sho (Yin-deficient). But, when they are suffering from acute sickness, it is important to treat them according to the principle of “Senkyukokan (treating acute symptoms before treating chronic internal symptoms).” The severe sickness is treated first, and then the mild phase of the disease is treated.

During a four-year period from 1994 to 1998, we treated 46 cases of rheumatoid arthritis (RA) with Kampo medicine. Clinical disease activity of RA was assessed using the Lansbury activity index (L. I.). After a year of treatment with Kampo medicine, 20 patients showed over 75% improvement by L. I Eleven cases were considered to be non-responders. Twenty-six cases out of 37 who had been treated with Western medicine were able to discontinue using, or reduce reliance upon, analgesic drugs and steroid hormones following Kampo treatment. Steinbrocker's functional classification of RA was improved from 2.3 to 1.8.
We used Aconiti Tuber for 40 patients, and 13 cases showed aconiti poisoning. Two cases represented adverse reactions to Astragali Radix.
In this study, Boi-ogi-to-ka-bushi was the most effective for RA, and Keishi-ka-ryo jutsubu-to was the second most effective. Efficacy of Boi-ogi-to was enhanced with large quantities of Sinomeni Caulis et Rhizoma and Astragali Radix. We mixed Boi-ogi-to with Keishi-ka-ryo jutsubu-to when Keishi-ka-ryo-jutsubu-to did not work well. RA is one of the representative diseases that respond to Kampo medicine.

Aconitum carmichaeli debeaux is an essential herbal medicine that possess anti-inflammatory, analgesic, and cardiotonic effects. Five hundred ninety-three subjects were treated with Shuchi-bushi (a powder type of this aconiti tuber that has been autoclaved) added to Kampo extract granules, between the years 1996 and 2002. The patient population consisted of 153 men and 440 women with an average age of 54.5 years. Four patients showed adverse reactions such as hypertension, nausea and hot flashes with Shuchi-bushi. There were no serious adverse effects, and the toxic symptoms disappeared quickly by reducing the Shuchi-bushi dosage, or cessation.
Shuchi-bushi has been used in small quantities because of its highly toxic alkaloids. However, this study indicates that Shuchi-bushi can be used more actively.

We prescribed Hyakugokokinto for four patients suffering from dryness in the throat. Dry throat improvements were observed in all patients, while improvements in insomnia were observed as well. Thus, insomnia may be a further indication for the use of Hyakugokokinto.