Case 1 was a 70-year-old female patient who visited our Department mainly due to palpitations which had persisted for the previous four years. From about one year ago, paroxysmal palpitations have occurred frequently. The 24-hour Holter ECG monitoring and echocardiography indicated supraventricular arrhythmia, but there was no temporal association between the arrhythmia and the palpitations. She was very nervous and irritable. She felt fullness of the upper abdomen and palpitations in the lower abdomen. She was given Chugoho-honton-to-ka-bukuryo-byakujutsu. One week later, the palpitations became less frequent, and two weeks later they all but disappeared.
Case 2 was a 41-year-old male company employee. He visited our Department complaining of general malaise, abnormal perspiration of the upper body, and pain in the fingers. Six years previously, he had developed erythema both in the palms and in the soles of the feet and also pain in the fingers of both hands. Four years ago, swelling occurred in the tips of his fingers and toes, which then aggravated. He was diagnosed as having acromegaly accompanied by pituitary adenoma and subsequently underwent resection of the pituitary tumor. After the operation, he developed general malaise and abnormal perspiration in the upper body, which obliged him to take time off work. Based on marked feelings of heat in the upper body and cold in the lower body and also abnormal sweating attacks, he was considered to be suffering from hypochondriasis with palpitation attack. One week after he was started on Chugoho-honton-to-ka-bukuryo-byakujutsu, his legs no longer felt cold. Symptoms of the joints and abnormal sweating subsequently improved, which enabled him to return to work.
Case 3 was a 32-year-old housewife who visited our Department complaining of headache and pain in the right shoulder. She had had contusion in the scapula ten years previously and had been suffering from dull pain ever since. Seven years ago, when she had a baby, she developed severe pain in the paraspinal muscle facing the right scapula. This severe pain radiated along the dorsal muscle and was accompanied by headache. Because she felt hot in the upper body and cold in the lower body, subjective palpations in the upper abdomen, and a mass in the hypochondria and umbilical region, Chugoho-honton-to-ka-bukuryo-byakujutsu was given. This produced excellent results.
Based on the experience of these three cases together with what can be found in the literature, we believe that conditions where Chugoho-honton-to-ka-bukuryo-byakujutsu are indicated have the following features. (1) The conditions are often triggered by fright, fear, depression etc. (2) There exist paroxysmal palpitations, headache, and the sensation of hot flushes. (3) A feeling of anxiety ascends from the abdomen. (4) The disease is in the initial stage of the three Yin diseases. (5) There are signs and symptoms of a deficiency in Qi. (6) There are subjective palpitations in the upper abdomen and in the epigastrium. (7) There is fullness of the upper abdomen and epigastrium, often accompanied by a mass in the hypochondria or umbilical region.

The relationship between tongue coating and Pancreas exocrine function was investigated in 45 cases by pancreatic function diagnostant. These cases were classified into three groups, “slight, ” “moderate” and “marked” according to the degree of thickness of tongue coating. Among the three groups, the mean rate of PABA excretion in urine tended to decrease as the degree of thickness of the tongue coating increased. That in the marked group was lower than in the slight group with statistical significance. The results suggest that thickness of tongue coating is partially related to pancreas exocrine function.

We successfully treated two chronic hepatitis B patients with Hochuekkito-go-Keishibukuryogan. Case 1 was a 27-year-old male diagnosed with chronic hepatitis B in 1998, who had received interferon (IFN) therapy. Liver function tests did not improve with this therapy. He visited the department of Japanese Oriental Medicine at Yukiguni-Yamato Hospital, complaining of fatigue, on **********. We initiated treatment with Hochuekkito-go-Keishibukuryogan. At two months of treatment, marked improvement in liver function tests was noted, with normalization of ALT, seroconversion (SC) and negative HBV-DNA. Case 2 was a 26-year-old male diagnosed with chronic hepatitis B in 2001 who had received IFN therapy. Seven months after termination of this therapy, on **********, he visited our department for a flare-up of hepatitis. Treatment with Hochuekkito-go-Keishibukuryogan was begun. Almost immediately, marked improvements were observed in the form of ALT and SC normalizations, and only slightly positive HBV-DNA.

The purpose of this study was to investigate the reappearance of the post-absorptive resting metabolic rate (PARM) during a prescribed diet. The subjects were 10 sedentary female college students (20.1±0.7yrs) . Thyroid function was judged in all of them to be within a normal range. Subjects stayed in a metabolic ward at the National Institute of Health and Nutrition for 18 days. The post-absorptive resting metabolic rate was measured 4 times during the experimental period. Moreover, blood was collected five times, and general health care including the measurement of thyroxin by blood biochemical examination was carried out. As for the actual metabolic measurements, a high reappearance was confirmed by the intra-individual coefficient of variation (CV) of the post-absorptive resting metabolic rate (3.5±1.8%) and the inter-individual CV (7.2%) . The smallest CV was the standard value of PARM/body surface area, followed by PARM/body weight, PARM/LBM, and PARM/urine creatinine. On the other hand, weight (50.8±4.9 vs 50.3±4.6 kg ; p<0.01), hemoglobin concentration (13.7 ± 0.5 vs 12.8±0.5g/dl ; p<0.05), serum total cholesterol level (194±41 vs 175 ± 37 mg/dl ; p<0.05) and post-absorptive resting oxygen uptake (0.149±0.01 vs 0.142±0.011/min ; p<0.01) decreased significantly during the experiment. According to the Japanese Recommended Dietary Allowances (RDAs) (1999), basal metabolic rate (BMR) was calculated at 1, 210 kcal/day or 23.6 kcal/kg body weight/day for women within the 18-29 year age group. But the results (the mean of all measurements) of this research suggested that this value was 1, 033 ± 79 kcal/day, or 20.7 ± 2.0 kcal/kg body weight/day based on the method of Weir ; and was approximately 10% lower than RDAs. Future investigation is required to explain the reasons for the difference in BMR between this study and that of previous ones.

Four cases of atopic dermatitis successfully treated with the Kampo formula Tokaku-joki-to are reported. Case 1 was a 25-year-old woman who had been suffering from atopic dermatitis since she was in lower elementary school. She came to our clinic in July of 1992. She complained of intense itching of the neck and area around the mouth. Her abdominal tension was moderate, and there was para-umbilical and caecal tenderness. The patient complained of constipation and dysmenorrhea. After four weeks of Tokaku-joki-to administration, the dermatitis improved markedly. After two years of treatment with this formula, she is progressing favorably.
Case 2 was a 14-year-old girl, who had suffered from atopic dermatitis since she was 3 months old. She first came to our clinic in January of 1993. The dermatitis was located in the upper extremities, face and neck. She also had experienced flushing, para-umbilical tenderness and constipation. After two weeks of administration of Tokaku-joki-to, her dermatitis improved remarkably, although she still experienced flushing. Ryokei-mikan-to was added to the formula for the flushing.
Case 3 was a 28-year-old woman who had suffered from atopic dermatitis since she was 3 years old. She consulted our clinic in October, 1993. The dermatitis was located on her face and elbow. She had tenderness around the paraumbilical, caecal and sigmoid regions. The patient is progressing favorably with Tokaku-joki-to administration.
Case 4 was a 26-year-old woman. She had had atopic dermatitis since she was young, and came to our clinic in October of 1993. The dermatitis was on the upper extremities, face and back. At first we prescribed Toki-inshi, but this formula was not effective. The formula was changed to Tokaku-joki-to and the dermatitis improved remarkably after about three months of treatment.
This is the first report of administering Tokaku-joki-to for atopic dermatitis. Based on the clinical study involving the four cases described above, we propose the following indications for use of Tokaku-joki-to for atopic dermatitis: 1) the dermatitis is located on the upper part of the body, 2) there is flushing, with a feeling of coldness in the lower extremities, 3) there is tenderness around the para-umbilical, caecal and sigmoid regions, and 4) there is a tendency towards constipation.

Saiko-sokan-to has been traditionally used for the amelioration of symptoms such as anxiety, insomnia, Shigyaku-san-sho (sho = pattern of symptoms determined by Kampo diagnosis) with left hypochondralgia and Shigyaku-san-sho with a feeling of obstruction in the costal region. However, there are still aspects that remain to be elucidated concerning the indications for this formula.
This study involved 7 cases with stiff shoulders, headaches, abdominal distension, meteorism and flushing which responded to Saiko-sokan-to. The experience of these cases suggests that conditions indicating Saiko-sokan-to have the following features: (1) there is resistance or tenderness upon pressure in the subcostal region (traditionally referred to as Kyokyokuman), (2) there is resistance or tenderness upon pressure in the epigastric region (traditionally referred to as Shinkahiko), (3) there are signs of Ki-depression, (4) for severe “blood stagnation” syndrome (traditionally called oketsu), Ikkando Saiko-sokan-to was found to be more effective than Igakutoshi Saiko-sokan-to.

A 27-year-old female had swelling, hotness and pain on her right clavicle. She was diagnosed as having chronic osteomyelitis and received bone curettement. However, even after this therapy, she occasionally suffered from recurrence of osteomyelitis. In the middle of July 1992, she was pregnant and had a low grade fever and pain from the right clavicle to the right upper arm. On **********, she visited our department and was diagnosed as having deterioration of the chronic osteomyelitis with pregnancy, based on the symptoms and laboratory data. In Kampo diagnosis, she was in the initial stage of Yang diseases with ectodermal symptoms, since she had headache and fever with slight chills and her pulse was floating. She received Keishi-mao-kakuhan-to and acupuncture therapy. The therapy gradually improved the symptoms and laboratory data. The present case suggests that Oriental medicine is one approach to the treatment of chronic osteomyelitis. Furthermore, the fact that the present therapy was effective during pregnancy without any adverse effects supports the clinical usefulness of Oriental medicine, especially since administration of massive amounts of antibiotics or surgery is often not advisable for pregnant women.

The authors examined the ralationship between ‘Oketsu’ syndrome and multiple cerebral infarction. In the 59 patients (62.8±9.5 years of age; 43 male and 16 female) with multiple cerebral infarction who had undergone MRI examinations, the authors evaluated the ‘Oketsu’ score, DEA (maximum diameter of the column of intravasclar erythrocyte aggregation) and erythrocyte aggregability.
The control group, 18 subjects (61.2±9.3 years of age; 11 male and 7 female) had no findings of cerebral infaction upon MRI examination.
In the patient group, the ‘Oketsu’ score was higher than the control group (P<0.0001) and microcirculation was significantly impaired (P<0.01).
According to localization of foci in the MRI study, the microcircuation was particularly impaired when infarctions occurred in areas controlled by the cortical branches (P<0.05).
Both symptomatic and asymptomatic infarctions presented high ‘Oketsu’ scores and impairment of microcirculation.
Erythrocyte aggregability significantly increased in patients in the multiple infarction symptomatic group (P<0.05). Particulaly, patients suffering from cerebral infarctions in the cortical branches had more severe erythrocyte aggregation.

The ‘Kenjuroku’ is a book of 54 case reports written by Yoshimasu Todo in 1763. The cases studies of four Buddhist monks (Gyokutan, Soboku, the director of Seikoji temple, and the son of the director of Shorakuji temple) from Toyama prefecture are described. Through an investigation of the biographies of these men, the authors attempted to determine the disease condition and symptoms present at the time of their meeting with Todo and inclusion in his book. These four cases were unique in that they appeared to have actively accepted Todo's new medical theories. This led to a discussion of the analogous aspects between his theories and the doctrine of Jodo-shinshu.

The authors would like to report the successful treatment with Hochuekki-to and Keishibukuryo-gan of a case of chronic renal failure that had deteriorated rapidly in a short period of time.
The patient was a 29-year-old woman that had been diagnosed as having IgA renal syndrome in 1987 after a local physician had detected proteinuria and requested a renal biopsy. In November of the same year she came to the authors' clinic requesting Kampo therapy. After her kidney function was stabilized with such formulas as Gorei-san and Byakokaninjin-to, the patient stopped coming to the clinic. In February of 1992, she returned to the clinic with renal failure following an episode of acute pneumonia. She was admitted to the hospital due to hypertension (Cr 2.8mg/dl; BUN 20mg/dl). Dietary therapy and hypertension control were carried out, and administration of 40mg/day of prednisone (PSL) was commenced on the 10th day following admittance. Since the proteinuria remained unchanged, 1g/day of methyl-PSL was given for three days from the 18th day after admittance. However, by the 38th day (4 weeks after commencement of PSL administration) the Cr was 5.0mg/dl. At this point the Kampo formula was changed from Sairei-to to Hochuekki-to in conjunction with Keishibukuryo-gan-ka-kokadaio. Her kidney function began to improve, and by the 108th day the laboratory findings had decreased to Cr 2.7mg/dl and Bun 26mg/dl and the PSL dosage was reduced to 20mg/day. She was discharged from the hospital on the 110th day, and has been progressing well as an out-patient.