We report a case of chronic heart failure successfully treated with bukuryokyoninkanzotokaboiogi. The case was an 87-year-old woman whose chief complaint was chest oppression at rest. She had been diagnosed with chronic heart failure and treated at a university hospital for 6 years, including several episodes of hospitalization. The patient's chest oppression was so strong that she felt depressed. Therefore, she consulted our institute to receive a Kampo treatment in addition to the western medications she was taking. At the patient's first visit to our institute, her serum brain natriuretic peptide (BNP) value was 545pg/ml, and her cardiothoracic rate (CTR) on chest radiogram was 64.1. The severity of the patient's chest oppression was class IV, according to the classification system of the New York Heart Association (NYHA). After we prescribed bukuryokyoninkanzotokaboiogi, her chest oppression and depressive mood gradually improved. Approximately one year later, the patient's BNP value had lowered to 104pg/ml, and CTR was reduced to 57.5. Eventually, her chest oppression and depressive mood disappeared completely. At that time, the chest oppression was categorized as class I in NYHA classification. Treatment with western medicines was not changed over the total clinical course of this case. These results suggest that bukuryokyoninkanzotokaboiogi could be a useful formulation for the treatment of chronic heart failure.

We experienced 2 cases in which Kampo (Chinese medicine) treatment was effective for septic osteoarthritis. Case 1 : a 34-year-old female. Septic coxarthritis developed with no left hip joint abnormality being noted, while DIC (disseminated intravascular coagulation) from MRSA pneumonia was treated. Surgeries were carried out five times, but there was no wound closure, and exudate discharge continued. At first, she was treated with Hochuekkito, did not run a fever, and good granulation tissue was formed in the wound. After a change to Senkinnaitakusan, exudate quantity decreased. Moreover, after an external fixation operation and being treated with Juzentaihoto, epithelization progressed, and the wound eventually closed. Case 2 : a 79-year-old female. One year and 6 months after osteosynthesis with compression hip screw was carried out for a femoral neck fracture, operation scar complications and large quantities of exudate were seen, so we diagnosed her with late onset septic osteomyelitis. She gained weight with Juzentaihoto treatment, while a decrease in exudates and fistula closure with Astragali Radix and Ginseng Radix were confirmed by MRI, and her nutritional state improved. Generally speaking, septic arthritis and osteomyelitis are difficult to treat, but Kampo medicines were curatively effective for these diseases, particularly when increasing Astragali Radix and Ginseng Radix quantity.

Background and objective : Diet has been recognized as an important part of Kampo medicine, and various plants with which we often cook are included as components of many Kampo formulations. Accordingly, nutritional science is closely related to Kampo medicine. So there is a need for national registered dietitian and nutritional science students to learn Kampo medicine. Despite this, no survey has reported on the awareness of nutritional science students toward Kampo medicine in Japan. We conducted for the first time a survey on this awareness amongst nutritional science students about Kampo medicine.Methods : A 13-item anonymous questionnaire was distributed to the third-year students in a national registered dietitian training program in Japan.Results : We obtained answers from 509 students in 9 institutions. Of the respondents, 59.3% answered that they were interested in Kampo medicine, and 86.4% of the students who were not interested in Kampo medicine answered that the reason was they had no chance to learn it. However, 81.3% of the students answered that they would attend lectures on Kampo medicine if it was adopted as part of their curriculum.Conclusions : These results suggest that Kampo medicine should be included in educational programs for nutritional science students.

Case 1 was a 40-year-old woman who used a facial treatment machine and felt burning facial pain at night.She then felt unpleasantness in her facial skin all day long and was too uncomfortable to leave her home. We prescribed kamikihito. Ten days later, she felt the positive effects of treatment. Forty-five days later, she did not feel the unpleasantness on her facial skin, and she was able to go out again. Case 2 was a 36-year-old woman who had intense inflammation of her face, because she had stopped treatment with a steroid ointment.After 6 months, her face still felt hot and strange, which decreased her quality of life. We prescribed yokukan sankachinpihange. Four weeks later, she felt the positive effects of the treatment, and 14 weeks later, she was able to restart her part-time job. Because both of these cases had received various types of conventional medi cal therapy in the beginning that were not effective, their Kampo therapy was begun a long after the start of their abnormal facial sensation symptoms. Kampo therapy demonstrated a positive effect after approximately one month in both of these refractory cases. Thus we recommend Kampo medicines for the treatment of abnor mal facial sensations.

We report two cases of unexplained thoracodorsal pain, which were successfully treated with the Kampo formulations karogaihakuhakushuto and karogaihakuhangeto. In case 1, the patient was a 67-year-old man. Left thoracodorsal pain appeared in this patient two months after the administration of chemotherapy for transverse colon cancer with hepatic metastasis. Bone metastasis was ruled out by bone scintigraphy, but the cause of the pain was still unknown. The Kampo formulation karogaihakuhakushuto was prescribed and the pain was reduced after two weeks, and disappeared within three months. In case 2, the patient was a 40-year-old man. Right thoracodorsal pain appeared in the right hypochondriac region without an apparent cause. Examinations, such as computed tomography and upper gastrointestinal endoscopy, were conducted, but the cause of the pain remained undiagnosed. The pain was not improved with pain killers, karogaihakuhakushuto was prescribed, and the pain was then reduced in about a month. The authors considered thoracodorsalpain as already described in the great classic Kinkiyoryaku (Chin Keiu Yao Lueh). We then prescribed karogaihakuhakushuto and karogaihakuhangeto, which resulted in immediate clinical improvement. These clinical courses indicate that the formulae can be effective for the treatment of thoracodorsal pain of unknown origin. Furthermore, the effect of herbal medicines and herbal decoctions boiled with rice wine may make it possible to have a more imminent effect on thoracodorsal pain.

Mengen is an acute symptom that sometimes occurs after administration of a Kampo formula. It is a shortterm phenomenon and its onset indicates that the patient's clinical course will improve rapidly. It is important to distinguish it from other adverse events, which are not temporary. However, to date, detailed analysis of mengen characteristics such as its frequency, time of onset after Kampo administration, and duration have not been reported. Therefore, we report a precise analysis of mengen characteristics through a literature review of case reports published between 1945 and 2009 in Japan, and retrospective analyses of the cases in our institute.
The literature review revealed that 42% patients developed symptoms of mengen within a day of administration, and 79% developed symptoms within 3 days. In terms of mengen duration, the symptoms persisted for 1 day in 35% cases and 3 days in 63% cases. A diagnosis of mengen proved difficult in 39% cases that presented with atypical symptoms.
Overall, the retrospective analysis of the cases in our institute revealed that 11 patients (7.7%) developed mengen, among 143 patients treated with Kampo between May 2010 and November 2011.

The patient was a 14 year-old female. She had been hospitalized repeatedly since infancy for suspected tonsillitis. During this time, she experienced high fever for about a week once a month. In her school years, she often had a recurrent fever with cervical adenitis, with only a mild inflammatory reaction. We diagnosed her symptom as one of a periodic fever syndrome, triggered by the frequent administered antipyretic drugs for fevers of unknown origin (FUO). We also suspected that there was liver tension, based on her abdominal and back examination, and we prescribed yokukansan. After a 3-month course of yokukansan, she no longer experienced these fevers. Most case reports of FUO describe the use of bupleurum root drugs and tonic formulas as treatment. Although yokukansan has traditionally been used for FUO in older texts, to our knowledge, there are no reports on such use clinically. In the present patient's case, the yokukansan may have reduced or eliminated some type of trigger for the fevers, or it may have affected the regulation of cytokines.

We report a patient with hemifacial spasm in whom daijokito was effective. The patient was a 57-year-old woman who visited our clinic for treatment of fatty liver and asthma. She had been suffering from left blepharospasm and paroxysmal twitching movement of the left lower jaw in stressful situations during the 2 years prior to her first visit to us. After we prescribed daijokito because of her pot belly, she had no more asthma attacks and her left facial spasm improved. Seven months later, we added inchinko to daijokito for her liver damage. When we followed the test results of her clinical survey for two years, we found that her weight had decreased and liver function was improved after starting this dosage. We diagnosed her paroxysmal involuntary twitching on the left side of the face as hemifacial spasm, because these symptoms were unilateral. We regard that her hemifacial spasm was improved with relaxation, anticonvulsants, and the antianxiety action of daijokito.

Case 1 was a 24-year-old female suffered from the feeling that her throat was obstructed ; this occurred after she had to talk loudly in front of many people. Case 2 was a 51-year-old female who complained of a palpitation attack ; this occurred after she underwent a hysterectomy. We diagnosed these symptoms as “hontonki.” Hontonki is a case of symptoms rising from the lower abdomen into the chest and throat with feelings of anxiety. When these symptoms appeared, the patients felt as if death were upon them, but when they disappeared, the patients soon felt healthy. There are certain medicines that can be used to treat hontonki. We administered Kinkiyoryaku hontonto (i.e. hontonto as described in Kinkiyoryaku) to them, and it was very effective.
We undertook a retrospective analysis of these two cases, along with 8 other cases successfully treated with Kinkiyoryaku hontonto at our hospital over the last 11 years. We found the common clinical characteristics of hontonki events were paroxysmal symptoms with feelings of anxiety. There are some differences between the clinical characteristics of Kinkiyoryaku hontonto from those of Chugobikyuho hontonto (hontonto as described in Chugobikyuho). The cases of Kinkiyoryaku hontonto are not kyosho (hypofunction) as those of Chugobikyuho hontonto are. Either they have heat symptoms or they do not have coldness, and they have shoulder stiffness or headache as some of the other oketsu symptoms.

The patient was a 45-year-old woman who began suffering from pain in her extremities 1 year and 6 months previously, and who received Oketsu-reducing Kampo. Her pain disappeared in a year. Six months after her treatment ended, she visited our hospital again complaining of the same symptom. Due to strong signs of Oketsu, we prescribed her a Kampo that reduces Oketsu, but her pain largely persisted. On re-examination, we noticed that her condition had occurred during the rainy season on both instances and speculated that high humidity and strong ‘wind' may be the reason. Therefore, Byakujutsubushito was prescribed for her, and her pain disappeared in 2 weeks. However, in the following rainy season, she visited us again complaining of the same pain, and Byakujutsubushito was again administered, and that relieved her from pain in 11 days. Although it is stated that Byakujutsubushito is useful for the treatment of pain resulting from dampness and ‘wind', there are very a few reports on this in the Kinkiyoryaku text. Nowadays, we live in air-conditioned spaces, and high humidity results in ‘cool wind’ and exterior dampness. Frequent movement in and out of such spaces worsens extremity pain, and we believe that the incidence of this condition is increasing. And we believe that Byakujutsubushito is one of the most useful formulations for the treatment of this condition that occurs during rainy season.