We report a patient with Multiple system atrophy that was successfully treated with the herbal formulation Hachimijiougan.A 79-year-old man was hospitalized with Multiple system atrophy. He showed slow movement, frozen gait, finger tremor, dizziness on standing up with slowly progressive characteristics. Various medications had been administered for orthostatic hypotension, but the effect was insufficient.So we administered Hachimijiougan without changing the other oral medications. After administration, orthostatic hypotension was improved, and he became able to perform various activities of daily living.In this case, we thought that Hachimijiougan improved autonomic nervous system disorders such as the orthostatic hypotension in a patient with Multiple system atrophy.

Recently, allogeneic bone marrow transplantation (allo-BMT) has been established for the treatment of hematological disorders. Fifteen patients had recieved allo-BMT at Tsuchiura Kyodo General Hospital as of April 1999. In this paper, we analyzedthe results and the problems of allo-BMT at our institution. The mean age of patients was 29.2years. Seven patients had AML, 5 ALL, 1 CML, 1 non-Hodgkin's lymphoma and one had severe aplastic anemia. Bone marrow donors were all HLA-identical siblings. Most of the patients were conditioned with a combination of busulfan or totalbody irradiation, cyclophosphamide and etoposide. To prevent GVHD, cyclosporine A and methotrexate were mainly used. Patients with acute GVHD were 4 and patients with chronic GVHD were only two. Three grade I patients with acute GVHD and all with chronic GVHD did not require therapy. In spite of small numbers of transfused cells, no cases of transplant rejection were found. All these engrafted patients achieved a WBC≥1×10³μl after a median of 19.5days and a Plt≥5×10⁴/μEl after a median of 38.1days. Five of the 14 engrafted patient relapsed in a median of 6.7months and all died in a median of 9.6months. Eight are alive in complete remission for 0.2 to 39.4 months (median 21.7months). For the improvement of the disease-free survival rate after allo-BMT, the prevention of relapse and prophylaxis of GVHD and infection are important. At our institution, especially the former is important. The conditioning regimens were stronger than usual but acute and chronic GVHD was very mild, therefore GVL would be weak. If prophylaxis of GVHD is weaken and mild GVHD ans GVL occur frequently, relapse will be prevented and better results will be obtained.

We report a patient who was successfully treated with a herbal formulation of goreisan (Wu-ling-san) for recurrent vomiting associated with pyloric stenosis, with significant simultaneous improvement of congestive heart failure.
A 78-year-old woman was in a bedridden state after cerebral infarction and was being fed through a nasal tube. She often experience repeated vomiting and aspiration pneumonia. Cicatricial stenosis was found in the pyloric region and we performed an expansion operation with balloon endoscopy. However, symptoms did not improve and her heart failure worsened. Therefore, we administered goreisan. Urinary output volume increased, edematous changes gradually disappeared, and pleural effusion decreased. The stenosis-related lesion did not change, but the vomiting ceased, even after nasal tube feeding was resumed.
Goreisan is an herbal formula used to promote diuresis that is considered to correct water absorption in digestive organs. In this case, goreisan was effective for the improvement of many symptoms.

Ryoukeigomikanzoto is a Kampo formulation originally described in the text Kinkiyouryaku. This formulation has also been described as an indication for respiratory disease in some texts, because it was classified under respiratory diseases in the Kinkiyouryaku.
The authors, however, considered that indications for ryoukeigomikanzoto could be wider than previously thought. The composition of this formulation is very similar that of ryokeimikanto and ryokeijutsukanto. And we have prescribed ryokeigomikanzoto for patients with a reddish face and coldness of the legs, whose chief complaints were a reddish nose, coldness of the leg, dysuria, spioncerebellar degeneration and ringing of the ears. Moreover, we have obtained good results from the current trial. This report is intended to elucidate indications for this formulation by means of past clinical results and our own experience.

Previously, the authors reported that a painful point at the epigastrium may be closely related with the term “shinkashiketsu” for the Kampo formulation saikokeishito (SKT) which was described in the textbook, shoukanron. In order to find conclusive evidence for our hypothesis, we tried SKT in four patients, whose chief complaints were headache, epigastralgia with headache, irritable bowel syndrome, and anorexia due to Behcet's disease. In this trial, we obtained satisfactory clinical results, which strongly suggest that the symptom of a painful epigastral point correlates with the term shinkashiketsu in the shoukanron description.

Recently, the authors experienced five cases of chronic primary headache in children which were successfully treated with shokenchuto. This report describes the details of these five cases and results of references in past literature. The common physical findings in these five cases were soft abdominal walls with a spasmodic bilateral m. rectus abdominis. There was only one case report of headache which was successfully treated with shokenchuto. We believe that our case report sheds light on a new aspect of shokenchuto, which might be a useful formulation for chronic headache. In this paper, we also speculate about the mechanism of this formulation for headache from the view point of former research showing the relationship between brain orexin behavior, and ghrelin which is induced from the digestive system.

We report a case of chronic heart failure with hypotension, successfully treated with goreisan (Wu lin san).In this case, goreisan improved both the heart failure symptoms and water regulation. This 91-old woman had been receiving treatment for congestive heart failure, mitral regurgitation, aortic regurgitation and atrial fibril lation, and had undergone pacemaker implantation due to sick sinus syndrome. She underwent repeated hospi talization due to aggravation of her chronic heart failure. She was re-admitted because of systemic edema as well as exacerbation of heart failure symptoms which included pleural effusions. Blood pressure remained constant at about 80/50 mmHg. She was prescribed furosemide 40 mg. Thereafter, cerebral infarction compli cations arose. Therefore, it became difficult to increase the quantity of diuretics. We administered goreisan without change to the other oral medications. Many of her symptoms improved and the pleural effusion resolved without affecting blood pressure.
Goreisan is one representative herbal formula for promoting diuresis. In this case, it is thought that goreisan showed actions that influenced water regulation.

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.

We performed a physio-psychological research on the mental, physical relaxation and health-keeping effect of Shinrin-yoku (forest walking) in Kawaba village. Eleven male and 8 female healthy elderly residents in Kawaba village, whose average age was 74.0±3.5 years old for male and 74.9±2.9 years old for females volunteered for this experiment. All members walked for one hour in the Kawaba Forest on August 17 under cloudy skies, 30-32°C temperature, 58-60% humidity, and, 0-2m/sec wind condition and walked again for another one hour in a non-forest rural agricultural area on August 21 under almost the same weather conditions. Phytoncides in the air, Profile of Mood State (POMS) test, blood pressure (BP), heart rate (HR), fasting levels of serum natural killer cell activity (NK), plasma catecholamine (adrenaline, noradrenalin and dopamine), plasma cortisol, and serum adiponectin were measured before and after walking. Phytoncides were detected in the forest and non-forest, all members showed a decrease of POMS total scale, BP, adrenalin and serum cortisol. Six (3 male and 3 female subjects) of them expressed an increase of serum NK cell activity after the forest-walking. One female showed a high serum NK cell activity after both forest and non-forest rural walking.
Our experiment on the forest-walking in Kawaba village indicated that its relaxation and health-keeping effects, probably due to walking in the fresh forest air.

  We describe a prototype seminar, inspired by the problem-based learning tutorial system, on pediatric emergency practice for young physicians working in 7 pediatric emergency centers in Yokohama. The seminar was received favorably by the participants, especially as an opportunity for individual learning. We expect that the seminar will contribute to the standardization of emergency practice in these pediatric centers and the establishment of an interhospital network.