Mengen is an acute symptom that sometimes occurs after administration of a Kampo formula. It is a shortterm phenomenon and its onset indicates that the patient's clinical course will improve rapidly. It is important to distinguish it from other adverse events, which are not temporary. However, to date, detailed analysis of mengen characteristics such as its frequency, time of onset after Kampo administration, and duration have not been reported. Therefore, we report a precise analysis of mengen characteristics through a literature review of case reports published between 1945 and 2009 in Japan, and retrospective analyses of the cases in our institute.
The literature review revealed that 42% patients developed symptoms of mengen within a day of administration, and 79% developed symptoms within 3 days. In terms of mengen duration, the symptoms persisted for 1 day in 35% cases and 3 days in 63% cases. A diagnosis of mengen proved difficult in 39% cases that presented with atypical symptoms.
Overall, the retrospective analysis of the cases in our institute revealed that 11 patients (7.7%) developed mengen, among 143 patients treated with Kampo between May 2010 and November 2011.

Orthopedic symptoms are not rare in palmoplantar pustulosis, but standardized treatments have not yet been established.Here we report a case of palmoplantar pustulosis followed by joint pain that was successfully treated with the Kampo formulation saikokeishito. The patient was a 44-year-old Japanese man. He was suffering from pustules on the soles of his feet due to palmoplantar pustulosis, and joint pain of the sternoclavicular area, hip and lumbo-sacral area, which had not been controlled with diclofenac sodium suppositories. We prescribed saikokeishito for 1 month, and he felt less joint pain and experienced less pustulosis. After that, he suffered from an upper respiratory tract infection, and he again developed plantar pustulosis. We added kikyo (Platycodon grandiflorum root) to treat the sore throat, and his symptoms almost disappeared following this treatment. No author has reported a patient with palmoplantar pustulosis accompanied by joint pain who was treated with saikokeishito. The results experienced in this case suggest that saikokeishito could be a useful formulation for the treatment of palmoplantar pustulosis accompanied by joint pain.

Kakkonkokato is a special formula used for the treatment of rosacea-like dermatitis lesions in the nasal region, but very few cases treated with this formulation have been reported so far. Here, we report three patients with refractory facial eruptions of rosacea-like dermatitis treated successfully with kakkonkokato. Case1was a 39-year-old man who presented with a 15-year history of rosacea-like dermatitis lesions in the nasal region. After 3 weeks' treatment with kakkonkokato, a marked improvement of his lesions was seen, with disappearance of the redness of his face. Case 2 was a 56-year-old woman who presented with a prolonged history of itchy eruptions around her mouth and nasal region. After 8 weeks' treatment with kakkonkokato, an almost complete disappearance of her eruptions was observed. Case 3 was a 26-year-old woman who presented with atopic dermatitis and intractable erythema under her nose, which was refractory to treatment with steroid ointments and antiallergic agents. After 2 months' treatment with kakkonkokato, her erythema completely resolved, along with improvement of the systemic lesions of atopic dermatitis. The observations in these three cases suggest that kakkonkokato may be a useful formula for the treatment of not only rosacea-like dermatitis in the nasal region, but also of refractory facial eruptions of other causes.
therapeutic aspects ; seconds ; Lesion, NOS ; Nasal ; Acne Rosacea

Reitakutsukito is a Kampo formulation that is applied for the treatment of olfaction disorder. There have been some reports that reitakutsukito improves nasal obstructions such as allergic rhinitis and chronic sinusitis, but none have reported a neurogenic olfaction disorder successfully treated with this formulation. We report a case of olfaction disorder that was neurogenic, successfully treated with reitakutsukito. The patient was a 43-year-old male. After being bruised on the head, he presented with olfaction disorder. He went to the otorhinolaryngology department at a university hospital and received a diagnosis of neurogenic olfaction disorder. However, he did not show any improvement. Fourteen months after the head trauma, he consulted our institution. We prescribed reitakutsukito for four weeks, and his subjective symptoms improved. Treatment with reitakutsukito for almost two years then resolved his symptoms. This case suggests that reitakutsukito could be a useful formulation for the treatment of not only respiratory olfaction disorder, but also neurogenic disorder.

A 75-year-old man was admitted with symptoms of unstable angina pectoris. The patient was initially treated with ticlopidine and aspirin after first undergoing percutaneous coronary intervention (PCI) by means of a drug eluting stent (DES). Coronary angiography thereafter showed re-stenosis in left main trunk and two-vessel disease. As a result, emergency off-pump coronary artery bypass grafting (OPCAB) was therefore performed. However, major bleeding (3, 245ml) occurred after OPCAB. Therefore, a re-thoracotomy operation had to be performed to stop the bleeding. Based on the above findings it is important for surgeons to keep in mind that pre-operative ticlopidine administration can increase the risk of re-operation for hemostasis, while also potentially increasing and the requirements for blood and blood product transfusion both during and after OPCAB surgery.

The main objective of this study was to describe the long-term results of left internal thoracic artery grafting of the left anterior descending artery with a sternotomy or anterior minithoracotomy without using extracorporeal circulation. From March 1997 to February 2000, a median sternotomy was performed in 8 patients and a minithoracotomy in 22 patients. We compared and analyzed the findings of these groups. An emergency operation was performed in 75% of the patients in the median sternotomy group and in 27.3% of those in the minithoracotomy group (p=0.03). The operation time was 2.1h in the median sternotomy group and 3.9h in the minithoracotomy group (p<0.01). The early graft patency rate was 100% in the median sternotomy group and 90.4% in the minithoracotomy group (NS). The five-year actuarial survival rate was 100% in the median sternotomy group and 86.4% in the minithoracotomy group. The five-year cardiac event free rate was 100% in the median sternotomy group and 86.4% in the minithoracotomy group. In conclusion, the results for the median sternotomy group were comparatively better than for minithoracotomy group. Minithoracotomy and median sternotomy have differences in operation time, early graft patency and early outcome. The median sternotomy technique therefore remains an invaluable operative modality for the treatment of one-vessel disease.

We have limited evidence as to the clinical indications for Kampo medicines, especially as they relate to gastrointestinal function. Thus, we investigated the efficacy of the Kampo medicine hangekobokuto (HKT) on patients with functional dyspepsia (FD), with special reference to its clinical indications for gastrointestinal function, including gastric emptying and bowel gas volume.Gastric emptying rate (GER) in FD patients was significantly facilitated by HKT. HKT also improved the gastrointestinal symptoms of the patients. Among these, patients who had inchuusharen, or a symptom of globus sensation, and a representative indication for HKT, showed significant improvement of both their GER and gastrointestinal symptoms compared with patients who did not have inchuusharen. As for bowel gas, the bowel gas volume calculated from a plain abdominal radiogram (gas volume score, GVS) in FD patients decreased significantly, after administration of HKT. Patients who had fukuman, or a feeling that one's stomach is full or bloated, and another representative indication for HKT, showed significant decrease of their GVS to normal levels, compared with patients who did not present with fukuman.These results suggest that the presence of clinical indications, such as inchuusharen or fukuman, are strongly related to HKT efficacy in patients with FD, and that these are useful, scientifically validated markers for the efficient use of HKT.
Clinical ; Final diagnosis (discharge) ; Gases ; seconds ; Volume

We encountered a patient with intractable panic disorder who responded extremely well to Ryukotsuto, a Kampo preparation. Beginning in March 2003, a 55-year-old female began to lose vigor and concentration, while developing palpitations and experiencing a rise in blood pressure (systolic pressure≥190mmHg) accompanied by sudden anxiety. When these symptoms became intense, she was brought to a hospital by ambulance. Although close examination revealed no abnormalities, on clinical diagnosis, however, autonomic imbalance was recognized. Despite treatment with antidepressants and minor tranquilizers, including selective serotonin reuptake inhibitors (SSRI), no improvement was observed. A series of medicinal Kampo preparations, prescribed one after another, also had no effect. For further treatment, she was referred to our hospital on July 22, 2005. At the first consultation, a diagnosis of panic disorder was made, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Hon-Ton disease was suspected based on clinical findings, and Ryokeikansoto was prescribed as a decoction. However, no positive effects were observed after 1 week, while marked incompetence, forgetfulness, and depression were noted. Therefore, based on the results of a self-rating depression scale (SDS), a profile of mood states (POMS), and autonomic function tests, such as pupillary dynamics at the first consultation, panic disorder accompanied by extreme tension with depression was diagnosed. Consequently, her Kampo preparation was changed to Ryukotsuto. As a result, symptoms virtually disappeared and all western drugs were discontinued. Psychological tests, autonomic function tests, and her diagnostic scores for conditions of Ki, Ketsu, and Sui also improved. We conclude that Ryukotsuto may be an effective treatment for panic disorder accompanied by depression.
Panic Disorder ; Cancer patients and suicide and depression ; Medicine, Kampo ; therapeutic aspects ; symptoms <1>

Standardizing Kampo medical findings is a significant challenge in Kampo medical circles. These findings are fundamental to Kampo diagnosis. This paper introduces our attempt to standardize these findings in a specialized Kampo medical service facility.
We started our project with verbal standardization. Nine medical doctors, all of whom were Kampo advisors or Kampo specialists, discussed issues such as subjective and objective findings, including those of the tongue, pulse, and abdomen, as well as the selection of target items, criteria for judgments on each item, and associated issues. When discussing the above issues, descriptions in prominent traditional Kampo texts were given most importance, and the wisdom of famous Kampo doctors since the Showa period was also given weight. In addition, we focused attention on clarifying the criteria for making judgments.
One hundred and twenty items were selected as subjective Kampo findings. We selected 12, 6 and 10 items as objective Kampo findings in the tongue, pulse, and abdomen, respectively, and provided criteria for judgments with each.
Our next challenge is to spread these standardizations in Kampo medical circles.

This paper reports the findings of off-pump coronary artery bypass grafting (OPCAB) for a 56-year-old man who had undergone a renal transplantation. Coronary angiography (CAG) revealed triple-vessel coronary disease. OPCAB was therefore performed. The patient was discharged 20 days after surgery without any subsequent rejection, infection or renal dysfunction. At two years after the operation the patient is doing well without any cardiac events. Cardiac disease, especially coronary artery disease is a common cause of death in renal transplant patients. Cardiac surgery in renal transplant patients is expected to increase. OPCAB for renal transplant patients with ischemic heart disease is therefore expected to reduce the incidence of myocardial infarction, thereby prolonging patient survival.