Repeated relapses of vomiting were treated with Bukuryo-takusha-to in a patient with resistant gastric ulcer. A 77-year-old woman, who had been admitted to our hospital due to manic disorder, presented tarry stool in February 1997. Gastrointestinal endscopy revealed an active gastric ulcer. The ulcer remained at the healing stage even after three years of treatment with H₂ receptor antagonist or proton pump inhibitor. She developed vomiting attacks in February 1998; thereafter, these vomiting episodes recurred repeatedly. During one three-day episode, she vomited the contents of breakfast every evening. Therefore, we regarded this attack as “ihon” from the view of Kampo diagnosis. After the administration of Bukuryo-takusha-to, the vomiting attacks disappeared within a day. The gastric ulcer then reached the scarring stage. In this patient, Bukuryo-takusha-to might have been effective in treating the resistant gastric ulcer as well as the recurring vomiting attacks.

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>

We report on two cases of relapsing aspiration pneumonia caused by dysphagia due to cerebrovascular disease. Sei-hai-to (Qing Fei tang) offered useful palliation in both cases. Case 1 was an 83-year-old-woman who was hospitalized for multiple lacunar infarction and lumbago in 1996. She gradually became bedridden within two years of the admission period. She was admitted to a long-term care hospital affiliated with our department in January 1998. Dysphagia and productive cough appeared in May, and enteral tube feeding was started after she developed pneumonia in August. Pneumonia persisted against some antibiotics, and feverish periods ranged from 8 to 18 days a month. CRP values were elevated to more than 5mg/dl. Administration of Sei-hai-to provided negative CRP values and decreased feverish periods to 0-2 days a month. Case 2 was a 93-year-old-man who suffered from cerebral bleeding in the right thalamus in 1984. He developed many attacks of aspiration pneumonia after starting oral feeding. He was admitted to a long-term care hospital affiliated with our department in April 1999. Sputum culture yielded P. aeruginosa and MRSA. Moreover, fluoroscopy showed aspiration into the lower airway. Aspiration pneumonia relapsed continually without antibiotics. Administration of both Sei-hai-to and clarithromycin decreased feverish periods and provided negative CRP values. Pneumonia relapsed easily either with Sei-hai-to therapy alone or Clarithromycin therapy alone.

We report a case of a patient with steroid-dependent nephrotic syndrome, who achieved complete remission with a combination of steroid therapy and Bunsho-to. The patient was a 27-year-old female who became aware of edema, and was diagnosed as suffering from focal glomerular sclerosis (glomerulosclerosis) with nephrotic syndrome in November 1992. She responded to steroid therapy, but nephrotic syndrome relapsed frequently after the repeated reduction of steroids. In July 1995, she came to our hospital, and was diagnosed as having a recurrence of nephrotic syndrome. Although the combination therapy of steroid and Kampo formulas, Shinbu-to or Shimotsu-to and/or Keigairengyo-to, was effective, an exacerbation of nephrotic syndrome occurred after steroid therapy was discontinued, in July 1997. The prescription was changed to Bunsho-to, and steroid therapy was re-initiated with 10mg of prednisolone daily. As a result, she achieved complete remission. The steroid therapy could be discontinued in July 1999, and now she has taken Bunsho-to only for 18 months. But the complete remission of nephrotic syndrome has been maintained.

Wells' syndrome (eosinophilic cellulitis), whose etiology is idiopathic, is clinically characterized by solitary or multiple cellulitis-like eruptions which occur on the extremities and trunk. Corticosteroids are usually used for palliative treatment, but relapses are often observed. We observed an 8 year-old patient with Wells' syndrome successfully treated with Kampo medicines. In 2001, skin eruptions appeared on his extremities. In 2002, a histopathologic examination determined his disease to be Wells' syndrome, and corticosteroids were subsequently used for treatment. In January 2007, his skin eruptions worsened, and he first visited our outpatient clinic in May. After oral administration with keigairengyoto, his skin eruptions were slightly improved, but afterwards, they again worsened. In June, jumihaidokuto was administered instead of the former prescription, and the skin conditions had begun to improve. Because dry skin appeared in November, keigairengyoto was again added. With these treatments, his skin eruptions stably improved. In previous reports, Kampo medicines had not been used for the treatment of Wells' syndrome. This case, however, suggests that Kampo medicines are a candidate for the treatment of Wells' syndrome.

This report illustrates a case of chronic inflammatory demyelinating polyneuropathy (CIDP) masquerading as neurofibromatosis caused by multifocal enlargements of spinal nerve roots. At age 73, the patient reported a 6-year history of numbness, weakness and pain in the hands and legs, but he could but he could walk independently with a cane. And although tremor was present, he could still draw. T2-weighted magnetic resonance imaging (MRI) through the cervical spine demonstrated spinal cord compression bilaterally at C 6-7, caused by neurofibroma-like cervical root tumors and enlargement of the spinal nerve roots and the brachial and lumbosacral nerve plexuses. Nerve conduction studies showed very little evoked response, with the exception of the median nerve which demonstrated prolonged distal latency and reduced compound muscle action potential with temporal dispersion, suggesting a diagnosis of demyelinating neuropathy. Somatosensory evoked potentials of the median nerve revealed prolonged latency, and motor evoked potentials obtained from the abductor pollicis brevis and abductor digiti minimi by transcranial magnetic stimulation demonstrated prolonged latency and temporal dispersion. Sural nerve biopsies showed segmental demyelination, remyelination (onion-bulb formation), axonal loss, and lymphocyte infiltration suggesting CIDP. The patient did not have a positive family history and declined further genetic studies. We could therefore not rule out the possibility of a hereditary hypertrophic neuropathy such as Charcot-Marie-Tooth disease.