We sought a connection between the half-exterior half-interior symptoms (hanpyo hanri sho), mentioned in the classic Chinese Shang han lun text and used in Kampo medicine, and embryology. An agreement between these shao yang (lesser yang) symptoms, and embryonic brachial arch domains was found. A part of the brachial arches strongly agrees with the ruling domain from the trigeminal nerve to the vagal nerve, and a connection was also seen to the vestibulocochlear nerve and partly to the accessory nerve. Thus we believe that half-exterior half-interior symptoms are a condition which relate back to part of the brachial arches, and are a result of so-called Heat reaction. Shang han lun Chinese medicine and embryology are two completely different fields. However, we consider an embryological view of nerve pathways to be helpful in understanding half-exterior half-interior symptoms, at least to a certain degree.
symptoms <1> ; CONSIDERATION ; Chinese People ; Nerve ; Medicine

Two cases of hyperthyroidism were treated with Kampo therapy alone, without the use of antithyroid drugs. The first case was a 47-year-old female who had been experiencing palpitations, weight loss, nervousness, tinnitus and vertigo for two years. She was diagnosed as having Graves'disease because of serum thyroid stimulating hormone (TSH) and increases in free T3 (fT3), free T4 (fT4), TSH binding inhibiting immunoglobulin (TBII), and 24-hour thyroid radioactive iodine uptake (24-h RAIU). Shakanzo-to was given for palpitations and other symptoms. Saiko-ka-ryukotsu-borei-to was later added in accordance with the Kampo diagnosis. After about one year and ten months, serum levels of TSH and fT3, fT4, and TBII are normalized.
The second case was a 40-year-old female, in whom palpitations had appeared about 3 years previously. Three months ago she was diagnosed as having hyperthyroidism. Thiamazole had been administered for two months. Serum TSH was decreased and fT3, fT4, TBII were increased when she first came to our clinic. Shakanzo-to was given for palpitations and other symptoms. After three weeks she refused to take thiamazole of her own accord. Saiko-ka-ryukotsu-borei-to was given concomitantly in accordance with the Kampo diagnosis. The serum levels of fT3 and fT4 increased gradually, but the palpitations were reduced. After about 10 months, the fT3 and fT4 levels were observed to decrease. This suggests that some of the hyperthyroidism can be imprgved by Kampo therapy without antitnyroid drugs.

Satisfactory results were obtained when Daiou-kanzui-to was administered to a patient suffering from osteoarthritis with Graves' disease.
The patient was a 61-year-old female, whose chief complaint was bilateral knee joint pain and leg edema. She was admitted to our clinic in May, 1995. She was diagnosed with Graves' disease and thiamazole was administered for six months. After discharge, the knee joint pain and edema worsened and she was readmitted to our clinic **********. Abdominal examination revealed fullness and lenderness of the lower abdomen. After administration. of Daiou-kanzui-to, the knee joint pain and leg edema improved remarkably, and she was discharged on **********. Although hyperthyroidism was discovered during the second admission, it improved without anti-thyroid drugs after five months of treatment with Daiou-kanzui-to.
Despite the fact that Daiou-kanzui-to is a strong purgative, no side effects were observed even with longterm administration. There are only two reports on the use of Daiou-kanzui-to since the Meiji era. The authors investigated old texts concerning abdominal symptoms, such lower abdominal fullness, which characterizes Daiou-kanzui-to, to establish indications for its application.

We report three elderly patients in the extended care unit who were successfully treated orally with Chotosan. Case 1 was an 84-year-old male who was hospitalized for lowered volition after aspiration pneumonia in 1999. He received nutrition through a stomach fistula. Administration of Choto-san increased his volition, and he resumed eating normally after practicing swallowing. Case 2 was a 99-year-old woman who was hospitalized for lower volition after a thighbone fracture in 2000. She also could not eat orally, and received nutrition via nasal-tube feeding. After the administration of Choto-san, she developed a will to eat, and she could again have meals orally. Case 3 was an 84-year-old woman who was hospitalized for lowered volition after aspiration pneumonia in 1999. She had pressure ulcers and was often feverish, so she was fed by nasal tube. She was treated with Choto-san, and was able to eat normally again after practicing swallowing. Her pressure ulcers were cured. This suggests that the administration of Choto-san may be successfully utilized as part of a strategy for overcoming swallowing trouble in the elderly.

We report two elderly cases in the extended care unit who were successfully treated for emitting a strange squealing sound with Sansonin-to. Case 1 was a 97-year-old female who was hospitalized with a strange squeal after repeated aspiration pneumonia. She made this strange sound especially during the night. This sound disappeared with the administration of Sansonin-to (TJ-103: 7.5g/day) except at the times of position change and diaper change, and she also became able to eat after practicing swallowing. Case 2 was an 80-year-old female who was hospitalized after a cerebral hemorrhage. She also made a strange squealing sound during the night. After administration of Sansonin-to, this sound was decreased, and she became able to sleep well at night and live actively with rehabilitation training in the daytime. With an aging society, troublesome behaviors due to dementia will be an increasing problem. These cases suggest that there may be certain conditions of elderly nighttime delirium that are treatable with Sansonin-to.

We report a case of recrudescent cholangitis successfully treated with Kampo medicine. The patient was a 31-year-old female. She was diagnosed with congenital biliary dilatation, and underwent an operation for partial resection of the liver, and a choledocho-jejunostomy. However, the cholangitis returned two years ago, when she was 29 years old. She had repeated abdominal pain and fever, and at that time received treatment with antibiotics. She desired pregnancy, and was hoping that Kampo treatment would enable her to decrease the amount of antibiotic she was taking. We prescribed inchinkoto as a base treatment and added to daisaikoto or shosaikoto. We changed the prescription according to her symptoms. As a result, her antibiotic quantity was reduced markedly, she safely conceived, and kept taking Kampo medicine while she was pregnant. She remained in good condition throughout her pregnancy. Thus, we consider that Kampo medicine may be useful for treating recrudescent cholangitis after an operation for reconstruction of the biliary tract.

We report a situation involving Kampo therapies on an isolated island and three cases treated with Kampo medicine on the island. The first author received outpatient training at the department of Japanese Oriental Medicine in Iizuka Hospital and provided medical care on the island for 3 years, using Kampo therapies.
About one quarter of patients (total, 134) were prescribed Kampo therapies in April 2009, and we surveyed the number of patients who had taken each Kampo medicine for 2 years from April of 2008 to March of 2010. As to prescriptions of less than 4 weeks, Kampo medicines used for a cold ranked high. As to prescriptions exceeding 4 weeks, hachimijiogan, daiokanzoto and keishibukuryogan were the most prescribed medications, in descending order.
We consider Kampo therapies to have been effective on this isolated island where there are many elderly people, and patients who must be treated comprehensively while giving consideration to their familial states. We also presume the environment of an isolated island to cause certain clinical conditions, water imbalances included, such that Kampo medicines for water imbalances tended to be prescribed frequently.
Finally, learning Kampo therapies has highly motivated the first author to practice community medicine.

Norovirus infection is a common cause of epidemic winter vomiting and diarrhea. The symptoms that present, such as vomiting, diarrhea, fever and abdominal pain, normally disappear within 1 to 3 days, although some fatal cases are reported in the elderly.During the two months from December 1, 2005 to January 31, 2006, we prescribed ogonto to twenty patients who presented with vomiting or diarrhea in a nursing home, and examined prescription times and illness durations, other drugs used, and whether there were any transfusion or complications.The number of ogonto doses given was from 1 to 12. Fifteen cases (75%) were dosed 3 times or less, and four cases were only dosed once. In terms of illness duration: eleven cases were cured in less than 24 hours; six cases were cured from 24 hours to less than 48 hours; two cases were cured from 48 hours to less than 72 hours; and one case was cured from 72 hours to less than 96 hours. Overall, seventeen cases (85%) were cured in less than 48 hours.Regarding the other treatment and complications: domperidone was used in four cases; and a transfusion was given in six cases. Aspiration pneumonia occurred in one case, but no patient required hospital treatment. Norovirus infection is usually treated only with symptomatic therapy, so we think Kampo therapy should be available because when started at an early stage, it can prevent this disease from becoming severe.

Three cases of dermatosis successfully treated with modified Mao-rensho-shakushozu-to are reported. Case 1 was a 45-year-old male who had been suffering from atopic dermatitis since childhood. He came to our clinic for treatment with Kampo formulas for unchanging symptoms. At first we prescribed Mao-rensho-shakushozu-to-go-byakko-ka-keishi-to, but this formula was not effective. After prescribing Mao-rensho-shakushozu-to-go-eppi-ka-jutsu-to, the dermatitis improved. Case 2 was a 25-year-old male student who had been suffering from atopic dermatitis since he was 19 years old. He responded to steroid ointment, but relapsed frequently after the repeated reduction of steroids. Some Kampo formulas were not effective, but the dermatitis improved after the patient used Mao-rensho-shakushozu-to-go-eppi-ka jutsu-to. Case 3 was a 65-year-old male who had been suffering from psoriasis vulgaris since he was 57. Shakushozu-to-go-byakko-ka-ninjin-to was effective for his psoriasis.
We used modified Mao-rensho-shakushozu-to in the three cases described above be cause the patients had strong itching. It is possible to apply this Kampo formula for dermatitis with strong itching.

We report on two elderly patients in the extended care unit who were successfully treated with Keishi-ka-ryukotsu-borei-to for sexually deviant behavior. Case 1 was a 71-year-old male hospitalized for rehabilitation after surgery for benign prostate hypertrophy. He began to masturbate soon after hospitalization, which made caregivers and other patients very uncomfortable. After the administration of Keishi-ka-ryukotsu-borei-to, his masturbation behavior disappeared. Case 2 was a 90-year-old male hospitalized for rehabilitation after cerebral infarction. He began using obscene expressions and trying to touch female patients about half a year after being hospitalized. His sexually deviant behavior decreased after the administration of Keishi-ka-ryukotsu-borei-to. This strongly suggests that Keishi-ka-ryukotsu-borei-to is useful in the treatment of dementia-related deviant sexual activity in senior citizens.