It has been thought that the term “shukuben” does not mean a simple constipation but rather that a substance is stagnating in the digestive tract despite ordinary defecation. However, there has been no concrete evidence for this shukuben definition.
The authors have obtained evidence for what may be one type of shukuben, by means of X-ray photography after an upper digestive tract examination using a barium sulfate contrast medium, in a patient with irritable bowel syndrome. The X-rays showed the contrast medium adhering to the colon wall three days post-examination despite subsequent diarrhea, suggesting one type of shukuben. In this paper, the authors also reported the result of a historical search for the term shukuben in the past medical textbooks, which revealed that the first description of this term is found in hougizashi and was described by Yodo Odai. We also considered that this term is a derivation of shukushoku meaning a stagnation of digestive tract contents.

The practical use of abdominal examination is a major characteristic of Kampo medicine. Although most Kampo medical texts describe an abdominal examination for a Kampo formula, comparative studies between texts have not contributed to any standardized descriptions for such examinations. We investigated descriptions of 147 prescription Kampo extract formulations in Kampo texts written after the Showa Era, and obtained the following results. Abdominal examinations were described differently by authors, even for the same prescription. Additionally, we examined the descriptions for anchusan (安中散) and kososan (香蘇散), which are called the Gosei school formulae (後世方). Descriptions of abdominal examinations for these drugs were not quoted from an original Chinese medical text, but were empirically constituted in Japan. As knowledge was accumulated, these various descriptions were created through limited personal connections, and/or the opinions of particular authorities. We suggest that a consensus on abdominal examinations would further studies on the viability of traditional medicines, and better characterize Kampo medicine.

Enterovaginal fistula, which causes uncontrollable symptoms such as gas release, vaginal defecation, perineal erosion, and vaginitis, markedly reduces patients' quality of life. In this report, we present a case of successful treatment for enterovaginal fistula with Kampo medicine.
A 62 year-old female who had ileoanal canal anastomosis for ulcerative colitis developed symptoms of gas release and defecation from the vagina. Although these symptoms had disappeared with conventional medicine previously, they recurred 7 years later. There was no medical indication for surgery because the fistula could not be located by barium enema or endoscopic examination. She, therefore, visited our outpatient clinic 1 and a half years after all conventional management had ended in vain.
Her symptoms were slightly improved by the administration of ifutokaogi, a Kampo formula, although they persisted. Three months after switching her prescription to another Kampo formula, goreisan, her symptoms completely disappeared.
In recent years, there has been no report on goreisan for the successful treatment of enterovaginal fistulae. Our case suggests that Kampo medicine can be an option for the treatment of enterovaginal fistula refractory to conventional treatments.

We reported a case of a 69-year-old male who had been diagnosed with left eye glaucoma with surgical indication complicated by an eyesight view obstacle. His left intraocular pressure did not decrease regardless of the eye drop treatment he underwent at another hospital. At the initial visit to our hospital, his left intraocular pressure was 27 mmHg. As we noted marked tympanitic sounds in his abdomen, we prescribed hangekobokuto. After one month of his medication, his left eye intraocular pressure fell to 22 mmHg ; furthermore, the marked abdominal tympanitic sounds disappeared. Two years after his initial treatment, his left intraocular pressure still stayed generally within the normal range, and it did not require surgery. In this case, predominant sympathetic nervous system may have been the mechanism behind some cases of increased intraocular pressure ; therefore, the possibility that hangekobokuto reduces intraocular pressure by acting on this was suggested. As there have been no such reports that hangekobokuto itself has an effect on intraocular pressure decrease, this is considered as a novel case.

We investigated prescriptions and drug costs at admission and discharge for 35 patients hospitalized in Department of Japanese Oriental (Kampo) Medicine, Chiba University Hospital from September 2006 to October 2008. They recovered after Kampo therapy from various non-acute diseases. The number of western drugs decreased from 3.7 at admission to 2.7 at discharge, thus their drug costs per day significantly decreased from302.1yen to 227.6 yen. The cost of Kampo medicines themselves, on the other hand, did not decrease significantly. Total drug costs, however, were significantly reduced from 437.8 yen at admission to 348.0 yen at discharge, so patients' overall costs were reduced by 20%. These results indicated that the proper use of Kampo medicine for various diseases would reduce drug costs and the impact of treatment expenses on medical economics, with improvement in disease outcomes.

We experienced a case of erythema nodosum of unknown etiology successfully treated with therapy based on Kampo diagnosis. The case was 44 year-old woman who had erythema nodosum over her bilateral leg extensors several times a month, became cold easily and had stomatitis. At first, we administered seinetsuhokito, which resulted in the disappearance of her stomatitis. However, she still had a recurrence of her erythema nodosum. Because of a condition of interior heat and qi counterflow, we considered her situation heibyo. We administered seinetsuhokito and byakkokakeishito every other day, which resulted in the disappearance of both her stomatitis and erythema nodosum. Therefore, we suggest that it is worthy to think about heibyo situations, when treating patients with complications.
Erythema Nodosum ; Stomatitis ; Treated with ; Medicine, Kampo ; month

Laryngeal granulomas which grow in the rear of the vocal cords can be a refractory and recurrent condition, because of various pathogeneses and a lack of established treatment guidelines. We experienced a laryngeal granuloma case which recurred repeatedly, and was resistant to modern medicinal treatment. The laryngeal granuloma recurred after microlaryngosurgery. And though a second microlaryngosurgery and laser cauterization was done, followed by prescription of lansoprazole, tranilast, chlarithromycin and inhalation of fluticasone propionate, the laryngeal granuloma recurred once more. Thus, we tried Kampo medicines at the this time. Hangekobokuto, saishakurikkunshito and keikyososooushimbuto were stopped due to lack of efficacy on the ganuloma, and the Kampo formulation was changed to kairosan. Three weeks after changing formulation, the granuloma was no longer seen with laryngeal fiberscopy. And to-date, recurrence of the granuloma has not been confirmed. This case suggests that fatigue, body weight loss, bilateral Kyokyo-kuman (discomfort of the hypochondrium), bilateral excessive strain of abdominal muscles, pulsation of both the upper and lower navel, and tympanitic sound in upper abdomen may be clinical indications for kairosan.
Granuloma ; recur ; Red color ; Granuloma, Laryngeal ; Medicine, Kampo

The source of reitakutsukito, which has been described in only one case, is the text “Ranshitsu-hizo.” We recently experienced a 65-year old male suffering from refractory chronic headache for forty years, and a 38-year old female suffering from bronchial asthma resistant to tokishigyakukagoshuyushokyoto, whose symptoms were successfully treated with reitakutsukito by adding shin'i which has the action of dispersing pathogenic wind factor and opening orifice. Although reduction of underlying disease was not obtained, we also experienced clear improvement of oxygen saturation peripherally, and the subjective symptoms of a 40-year old male suffering from bronchial amyloidosis with reitakutsukitokashin'i. We report these three cases including documented considerations.
Asthma ; Amyloidosis ; Cases ; Bronchial brand of guaifenesin-theophylline ; symptoms <1>

A case of ascites and pitting edema from hepatocellular carcinoma treated with Boi-shomoku-teireki-daio-gan-ryo was reported.
An 80-year-old female presented progressive gait disturbance and dysuria in April 2002. Neurological examination revealed paraparesis, hypesthesia inferior to lumber level and sphincter dysfunction. An MRI revealed a solid mass arising from lamina at the right Th 12, extending into the spinal canal. Surgery was performed, but paraparesis continued. In addition, the patient developed ascites and pitting edema of the legs. An abdominal CT suggested liver cirrhosis and hepatocellular carcinoma. Some Kampo formulas were not effective. Boi-shomoku-teireki-daio-gan-ryo was administered on the basis of symptoms such as ascites, dry mouth and constipation, and then the pitting edema improved rapidly. In addition, the abdominal CT revealed the decrement of ascites. Unfortunately the treatment was effective for only one month. Ascites with malignant tumor is very difficult to treat. However, Boi-shomoku-teireki-daio-gan-ryo is clearly useful for treatment of ascites and edema.

We report the case of a 77-year-old female with subacute thyroiditis who was successfully treated with traditional herbal medicine (Kampo-therapy). On 18th December 2001, the patient was admitted to our hospital because of malaise and loss of appetite.
The patient complained of what she thought was a sore throat that began one month prior to admission, with a fever rising to 37.8°C 4 days before admission. Physical examination showed tenderness and swelling of the thyroid. Blood examination showed hyperthyroidism (TSH 0.02μIU/ml fT₃ 20.18ng/dl fT₄ 5.21ng/dl) and high inflammation (CRP 13.7 ESR 122mm/hr). We then diagnosed subacute thyroiditis and treated her with Kampo-therapy only. We arranged herbs according to the “Sho-kan-ron (_??__??__??_)” and gave her Keishi-ni-eppi-ichi-to (_??__??__??__??__??__??__??_) and Choi-joki-to (_??__??__??__??__??_). Four days after admission, her intermittent fever disappeared. After 10 days, her CRP became negative. After 13 days, almost all the symptoms had disappeared. Thyroid function (fT₃, fT₄) returned to normal after 17 days of Kampo-therapy. Subacute thyroiditis is a self limiting disease, but steroid therapy is often needed to reduce the symptoms and avoid thyrotoxicosis. In this case, the patient made a relatively quick recovery without steroid therapy. We suggest Kampo-therapy can be an effective treatment for subacute thyroiditis.