The effects of Rikkunshi-to and Hochu-ekki-to on serum cortisol as well as on the coefficient of variation of R-R intervals of ECG (CV_R-R) were studied.
Each drug was administered 7.5g/day for 4 weeks to 23 patients with non-ulcer dyspepsia and 18 with psychovegetative syndrome, respectively.
1) In the Rikkunshi-to treated patients, the serum cortisol at 9a.m. in 7 patients with a high cortisol level decreased significantly (p<0.05), but increased in 2 of the low cortisol level patients and did not change in the 14 patients who were within the normal range. In the Hochu-ekki-to treated patients, it increased in both 3 patients of the low cortisol level group and 12 of the normal range group (p<0.05), but decreased in 3 of the high cortisol level group. This modulatory effect of serum cortisol was consideredto be due to ACTH secretion.
2) CV_R-R, which represents the parasympathetic nervous function, showed no change in the Rikkunshi-to-treated patients. However, in the Hochu-ekki-to treated patients, it increased significantly (p<0.05) in those in whom their pretreatment levels were lower than their ages.
These results suggest that the above drugs have modulatory effects on the adrenal cortex and autonomic nervous function. This effect is thus considered to be a beneficial one for stress-related disorders.

We experienced two cases of postherpetic neuralgia (PHN) improved with Kampo medicines that include uzu (i.e. uzu-zai).The pain from PHN was improved via the administration of an uzu-zai in these 2 cases, worsened by its discontinuation, and improved again by its re-introduction.Case 1 : A 76-year-old male suffering from PHN of the right L 2-3 area was administered uzukeishito and obtained pain reduction. After 12 months, his prescription was changed from uzukeishito to keishikaryoju-tsubuto. Then, after only 2 days his pain worsened again. Uzukeishito treatment was re-instated, and he again obtained pain reduction. Case 2 : An 82-year-old male suffering from PHN of the right C 4-5 area was given uzuto and obtained pain relief. After 3 months his prescription was changed from uzuto to keishikajutsubuto. Then, after only1week his pain worsened again. Uzuto was then re-introduced, and pain reduction was achieved again. These two cases led to two suggestions. First, that the uzu-zais were very effective against the PHN pain. Second, that this effect of an uzu-zai against PHN pain might be a symptomatic rather than a radical treatment.These two cases highlight the fact that the use of an uzu-zai was instrumental in reducing PHN-associated pain, but further studies will be needed to determine a dosage protocol, including when and at what pace uzu-zais might be reduced/discontinued.

We report two cases of numbness and pain of neuropathy due to ANCA (antineutrophil cytoplasmic antibody)-associated vasculitis successfully treated with Ogikeishigomotsuto. The first case was a 57-year-old female who complained of high fever, painful skin eruptions of the lower limbs, and proteinuria. Although the severe pain was reduced with steroid therapy, neuropathy-related numbness and pain remained widespread in her lower limbs. After we prescribed Ogikeishigomotsuto, most of her pain disappeared while her degree of numbness diminished by almost half in two weeks. In addition, her steroid therapy could be tapered off without adverse effect. The second case was an 82-year-old female with fever and myalgia. Although myalgia of the upper arm disappeared with steroid treatment, walking became difficult due to numbness from the lower legs, to the soles of her feet. With Ogikeishigomotsuto administration, she became better able to walk because her legs had warmed up, and the range of her numbness had decreased. These cases suggest that Ogikeishigomotsuto may be effective against numbness and neuropathic pain due to ANCA-associated vasculitis.
Numbness ; Pain ; Peripheral neuropathy ; Antineutrophil cytoplasmic antibody measurement ; Vasculitis

We report a case of an obstinate belch successfully treated with goshuyuto. The patient was a 74-year-old female. She had been hospitalized seven times in the past due to the belch, abdominal distention and anorexia, and had been prescribed various Kampo formulas. But her symptoms fluctuated up and down. The obstinate belch essentially disappeared after administering goshuyuto, and her appetite improved. Many of Kampo formulas that treat belchs are related to Shoyobyo (shao yang bing), but we consider that goshuyuto may be effective for a belch, which is yin-related and accompanied with stiffness and rigidity below the heart, and fullness in the chest and hypochondrium.
Medicine, Kampo ; Treated with ; Case Report ; plastic property - rigidity ; symptoms <1>

We report a case of recurring adhesive ileus that was successfully treated with shojokito (decoction) without inserting a nasogastric tube. The patient was a 75-year-old male who had been treated for abdominal symptoms in our department after a laparotomy. He visited our hospital mainly for complaints of abdominal pain and distention, was diagnosed with adhesive ileus because of a niveau image upon abdominal X-ray, and was hospitalized the same day. We diagnosed him as Yang syndrome and excess syndrome because he had thick yellow fur of the tongue, and administered shojokito. He broke wind at 40 minutes after administration of shojokito, and had bowel movement two hours later. Furthermore, he had mass diarrhea after another administration of this formula, and the niveau image disappeared the next day. It is often considered that an ileus develops with Cold, for which daikenchuto is prescribed frequently. However, in some cases cold purgative formulas such as jokito group may be effective, if such cases are Yang syndrome and excess syndrome, and present with yellow fur of the tongue.
Intestinal Obstruction ; Syndrome ; Treated with ; Yellow color ; Yang

OBJECTIVETo investigate the clinical efficacy of artery perforator-based flap in the repair of gluteal-sacral pressure sores.

METHODSGluteal artery perforator-based island flap and perforator-based flap were designed to repair the gluteal-sacral pressure sores of 26 patients according to the location and size of the wounds. The area of the biggest flap was 20 cm x 15 cm, the diameter of perforating vessel was above 1. 1 mm, with the length of free pedicle ranging from 2.0 - 3. 5 cm.

RESULTSAll the flaps healed soon after operation, with no flap necrosis and postoperative complications, such as flap necrosis, wound infection and or formation. The color and texture of the flaps were good and the configuration was satisfactory. There was no recurrence of local bedsore in the follow-up period from 6 to 24 months.

CONCLUSIONThe artery perforator-based flaps have the advantages of delicate texture, easy dissection, reliable blood flow, preservation of the gluteus maximus muscle and no need of skin grafting for the donor defects in most cases. It is an optimal method in surgical treatment of gluteal-sacral pressure sores.

Adult ; Aged ; Aged, 80 and over ; Arteries ; transplantation ; Female ; Humans ; Male ; Middle Aged ; Pressure Ulcer ; surgery ; Reconstructive Surgical Procedures ; Sacrococcygeal Region ; Surgical Flaps ; Wound Healing

Real-world data (RWD), such as a health insurance claim database and electronic medical record database, which records daily medical care information, is one of the most important data sources in pharmacoepidemiological studies. In Japan, a post-marketing database study has been added as a new category of post-marketing surveillance since April 2018. It is expected that the post-marketing database studies will be conducted in the actual risk management plan； however, at this point, few have reached the stage of publishing study results. On the other hand, overseas, many database research results using RWD have already been reported. Although it is necessary to keep in mind that there are differences in the characteristics of the databases (e.g., data contents, structures) and the differences in the medical environment between overseas and Japan, we think that critically reviewing these reports has a reference value for the planning, execution, and interpretation of the results in performing post-marketing database studies in Japan. The purpose of this report is to examine the characteristics and cautions of the database studies through a critical review of published articles of overseas RWD studies and to make recommendations that are useful for conducting post-marketing database studies in Japan. We hope this article will become a help in the planning and implementation of future post-marketing database studies.