We report 5 patients with polymyalgia rheumatica (PMR) successfully treated with Kampo medicines. In total, we investigated 10 patients with PMR, including the 5 patients here treated in our department. Results showed that Kampo medicine was effective in 6 cases. One of the 6 refused steroid drug administration, and tapering dosage steroid was difficult in the other 5 patients due to myalgia or inflammation. Except for one case, C-reactive protein in most of the effective cases was below 3.0 mg/dl. On the other hand, the non-effective cases had severe inflammation levels and needed steroid therapy. The effective cases were treated with sokeikakketsuto, tokakujokito, keishibukuryogan, choyotokasyakuyaku, yokuibushihaishosan and tokishakuyakusan, which have the effect of improving oketsu states. Thus, it was considered that Kampo medicine has the potential for treatments in PMR patients who have difficulty tapering steroid dosage and mild inflammation. Moreover, this suggests Kampo medicines that improve oketsu state are useful for PMR treatment.

We report two cases of ankylosing spondylitis (AS) successfully treated with Kampo formulae including Uzu (aconiti tuber). The 1st case was a 33-year-old male. Since the age of 20, he had stiffness and pain in his back. At 26 years of age, he was diagnosed with AS by a nearby orthopedist. When he consulted our department in 1997, X-ray examination revealed a Bamboo spine appearance. Because coldness exacerbated the pain, we prescribed Uzu-to. Together with a decrease in inflammatory reaction, his pain and quality of life were improved. The 2nd case was a 24-year-old male. He had left hip joint pain since the age of 14, and at 16 was diagnosed with AS and treated with NSAIDs. Methotrexate (MTX) had also been prescribed from the age of 23, since the pain of other joints and back was gradually progressive with consistently positive inflammation. He did not, however, improve on MTX, and visited our department in 2002. His HLA-B27 was positive, while iliosacral arthritis was also noted. Uzukeishi-to was then prescribed, resulting in decreased pain, alleviation of restricted motion, and an improved inflammation reaction. This suggests that Kampo formulae which include Uzu may be useful in the treatment of AS.

Aconitum carmichaeli debeaux is an essential herbal medicine that possess anti-inflammatory, analgesic, and cardiotonic effects. Five hundred ninety-three subjects were treated with Shuchi-bushi (a powder type of this aconiti tuber that has been autoclaved) added to Kampo extract granules, between the years 1996 and 2002. The patient population consisted of 153 men and 440 women with an average age of 54.5 years. Four patients showed adverse reactions such as hypertension, nausea and hot flashes with Shuchi-bushi. There were no serious adverse effects, and the toxic symptoms disappeared quickly by reducing the Shuchi-bushi dosage, or cessation.
Shuchi-bushi has been used in small quantities because of its highly toxic alkaloids. However, this study indicates that Shuchi-bushi can be used more actively.

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 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.

A patient with systemic lupus erythematosus (SLE), complicated by severe thrombocytopenia was successfully treated with Juzen-taiho-to. The patient was a 38-year-old woman presenting thrombocytopenia in 1974. She was diagnosed as having SLE with the appearance of renal failure in 1975. In 1984, she began blood dialysis due to deterioration of renal function. In addition, she repeatedly suffered from severe bleeding episodes due to thrombocytopenia. In 1989, she visited our clinic to undergo Kampo therapy, with no significant results obtained with any of the formulas tried.
In September 1992, she suffered from duodenal ulcer bleeding and stopped Kampo therapy for some time. However, since she began taking Juzen-taiho-to in June 1993, her thrombocytopenia improved and her platelet count stabilized at 10-15×10⁴/mm³. This made it possible to taper the dosage of the steroids being administered. Since July 1994, the prednisolone (PSL) dosage has been 5mg on alternate days. Since July 1995, the anti-DNA antibody was negative. The platelet count has been maintained at 15-20×10⁴/mm³ (as of December, 1996).

Visceral fat obesity is closely associated with lifestyle-related diseases that include symptoms such as hypertension, diabetes mellitus, hyperlipidemia, etc. To examine the correlation between pulse, appearance of tongue, and abdominal palpation-diagnostic indicators according to Kampo medicine-and visceral fat obesity, we investigated 209 subjects who received health screenings, and obtained the following results. 1) The simply obese subjects, as determined by body mass index, showed symptoms of excess state, Kidepression, and stasis of body fluids according to the diagnostic techniques of Kampo medicine. 2) The visceral fat-rich subjects were diagnosed by means of abdominal ultrasonography and showed symptoms of pulsus maximum and Oketsu (blood stasis) state.

In all but a few cases, the treatment for elderly patients must be conservative owing to the unavoidably poor general condition of the patients.
We report on three cases of long-term bedridden patients with acute cholecystitis or cholangitis who were effectively treated with Kampo prescriptions. An 86-year-old male with choledecholithiasis and acute cholangitis responded to Inchin-ko-to. When he repeatedly relapsed after the discontinuance of Kampo treatment, Inchin-ko-to was effective, and Inchin-shingyaku-to successfully improved his general condition. In an 89-year-old male with acute cholecystitis, Dai-saiko-to extracts and Bukuryo-shigyaku-to were effective. An 88-year-old female with cholecystolithiasis and acute cholecystitis responded to Dai-saiko-to and Bukuryo-shigyaku-to.
Most elderly patients are Inkyo-sho (Yin-deficient). But, when they are suffering from acute sickness, it is important to treat them according to the principle of “Senkyukokan (treating acute symptoms before treating chronic internal symptoms).” The severe sickness is treated first, and then the mild phase of the disease is treated.

A Kampo formulation, Senkinho-Karo-to, is considered to be effective for chest pain or discomfort. However, there have been few case reports concerning this formulation. Here, we report four cases of patients suffering from chest pain or discomfort that were successfully treated with Senkinho-Karo-to. We compared the clinical features of these four cases where Senkinho-Karo-to was effective with those of four other cases where Senkinho-Karo-to was ineffective. The cases where Senkinho-Karo-to was effective had the following features: Deficiency, feeling of spasmodic uprising heat, shoulder stiffness, deficient pulse, impressions of teeth on the rim, palpitation of the abdominal aorta in the supra-umbilical region, reduced tension in the lower abdomen, tenderness in the para-umbilical region, and Ki-depression.

During a four-year period from 1994 to 1998, we treated 46 cases of rheumatoid arthritis (RA) with Kampo medicine. Clinical disease activity of RA was assessed using the Lansbury activity index (L. I.). After a year of treatment with Kampo medicine, 20 patients showed over 75% improvement by L. I Eleven cases were considered to be non-responders. Twenty-six cases out of 37 who had been treated with Western medicine were able to discontinue using, or reduce reliance upon, analgesic drugs and steroid hormones following Kampo treatment. Steinbrocker's functional classification of RA was improved from 2.3 to 1.8.
We used Aconiti Tuber for 40 patients, and 13 cases showed aconiti poisoning. Two cases represented adverse reactions to Astragali Radix.
In this study, Boi-ogi-to-ka-bushi was the most effective for RA, and Keishi-ka-ryo jutsubu-to was the second most effective. Efficacy of Boi-ogi-to was enhanced with large quantities of Sinomeni Caulis et Rhizoma and Astragali Radix. We mixed Boi-ogi-to with Keishi-ka-ryo jutsubu-to when Keishi-ka-ryo-jutsubu-to did not work well. RA is one of the representative diseases that respond to Kampo medicine.