Keishi-kyokei-ka-bukuryo-byakujutsu-to has been traditionally used for acute infectious diseases, such as the common cold, accompanied by epigastric discomfort and tenderness. However, the specific dosage for chronic diseases has not been clearly set yet. This study involved 4 cases with headaches, dull headaches, stiff shoulders and lumbago, so called neck, shoulder and arm syndrome which responded to Keishi-kyokei-kabukuryo-byakujutsu-to. The experience of these cases suggests that conditions indicating Keishi-kyokei-kabukuryo-byakujutsu-to have the following features: (1) dry skin, (2) edema and impressions of teeth at the rim of the tongue, (3) tenderness upon pressure in the epigastric region and sound of fluctuating liquid in the stomach, (4) Ki-deficiency.

There are many indications for Ryo-kei-jutsu-kan-to, such as orthostatic hypotension, cardiac neurosis, migraine, congestive heart failure, benign paroxysmal positional vertigo and eye disease. Although in oriental medicine Ryo-kei-jutsu-kan-to is used as a hydragogue agent for sui-doku (disorders of the body's fluid metabolism), its actual effect on hydragogue action remains unclear. We previously carried out hemodynamics tests before and after administration of Ryo-kei-jutsu-kan-to for a patient with orthostatic hypotension due to peripheral autonomic disorder. The pathosis of the patient before administration of Ryo-kei-jutsu-kan-to was found to be sui-doku caused by the excessive increase of circulating blood volume. We reported that after administration of Ryo-kei-jutsu-kan-to the blood pressure of the patient in the standing position was elevated by increased peripheral vascular resistance, while excessively increased circulating blood volume decreased. This time we administered Ryo-kei-jutsu-kan-to for four cases, such as orthostatic hypotension with migraine, cardiac neurosis, congestive heart failure, and hypotension in dialysis. We again realized that it also increases peripheral vascular resistance. As one of the dimensions of so-called hydragogue action, it is important to understand that Ryo-kei-jutsu-kan-to has a hydragogue effect against the retention of excess fluids (sui-doku) in the body through increasing peripheral vascular resistance by vasoconstriction.

A patient with gas symptom-predominant irritable bowel syndrome (IBS) who complained of recurrent severe abdominal pain was successfully treated with Saiko-sokan-to.
The patient was a 31-year-old male. Beginning in November, 1994, he repeatedly visited the emergency clinic with severe abdominal pain and abdominal distension. He was hospitalized three times, but no organic disorder was found. He usually had alternating constipation and diarrhea. He was diagnosed as gas symptom-predominant IBS because he mainly complained of gas symptoms such as abdominal distension, borborygmus and flatus together with abdominal pain. He was also suspected of having splenic flexure syndrome because his abdominal roentgenography revealed apparent intestinal gas at the splenic flexure. After treatment with Igakutoshi Saiko-sokan-to was begun in June 1996, his abdominal pain disappeared. Furthermore, emotional instability, lightheadedness, and skin troubles were also alleviated.
Saiko-sokan-to is indicated for patients having Sigyaku-san syo with severe Ki-depression, and appears to be a useful agent for gas symptom-predominant IBS.

In Japan chronic constipation is divided into two groups: atonic constipation and spastic constipation. Stimulant laxatives are unsuitable for patients with spastic constipation, and routine use of stimulant laxatives over long periods of time should be discouraged. Nevertheless stimulant laxatives are often used continually among these patients because their stools are too hard and infrequent without stimulant laxatives.
In this report, we present 4 cases of chronic constipation treated with Kami-shoyo-san. Cases 1, 2 and 3 were patients with spastic constipation and case 1, 3 and 4 had used stimulant laxatives continually. In all cases both stimulant laxatives and Kampo medicines containing Rhei Rhizoma caused adverse effects such as abdominal discomfort and pollakisuria. Kami-shoyo-san improved bowel movement as well as other complaints: irritability, heat in the upper part of the body, painful tension of shoulder muscles, fatigue, dysmenorrhea and pollakisuria. Withdrawal from stimulant laxatives was achieved in the patients except for case 2. In drug treatment of chronic constipation, Kampo medicines such as Kami-shoyo-san seem to be useful in withdrawal from stimulant laxatives.

The therapeutic efficacy of Hachimi jio-gan on pain, weakness, numbness and coldness of the limbs and lower back was investigated in 37 aged patients. After administration for 4 weeks, improvement in the global improvement rating was 55.9%, and improvement in pain, weakness, numbness and coldness were 44.8%, 39.3%, 59.1% and 31.8%, respectively. For the improvement of numbness, more significant improvement was seen in patients 60 years old or greater than in those 59 or less. Such symptoms as hair thinning or hair loss, dimming of the eyes, constipation, pain in the upper limbs, numbness in the lower limbs, coldness of the upper limbs and coldness of the lower limbs showed significant improvement. These results suggest that Hachimi jio-gan is effective in the treatment of pain, weakness, numbness and coldness in aged patients.

We report on three RA patients successfully treated with Yokuinin-to-ka-kyokatsu-dokkatsu-bofu (Yokuinin-to-kami). The first patient was a 47-year-old woman. In 1983, she visited a nearby hospital due to bilateral wrist joint pain. Her condition was diagnosed as RA. She was treated with gold sodium thiomalate (GST) and non-steroidal anti-inflammatory drugs (NSAIDs), but her symptoms did not improve. She visited our department in 1989. She was treated with Keishi-ka-ryojutsubu-to, Bushi-to which resulted in decreased arthralgia. However, in September 1995, her condition worsened. Administration of Yokuinin-to-kami improved her symptoms as well as her laboratory data after three months of treatment. The second patient was a 50-year-old woman. In 1986, she visited a nearby hospital with bilateral wrist joint pain. Several Kampo formulas were subsequently administered at a pharmacy. In 1991, she visited our hospital and her condition improved after treatment with Keishi-ka-ryojutsu-to-ka-boi-ogi-yokuinin. However, in May 1996, she complained of severe pain and swelling at the right shoulder joint. Treatment with Yokuinin-to-kami improved her symptoms, as well as decreased serum C-reactive protein (CRP). The third case involved a 42-year-old woman who exhibited polyarthralgia in June 1991. She visited a neighborhood hospital and was diagnosed as having RA. She was treated with NSAIDs and bucillamine. She first visited our hospital in1993. We treated her with Keishi-ni-eppi-itto-ka-ryojutsubu and Keishi-shakuyaku-timo-to, but the polyarthralgia worsened in May 1996. Subsequently, we treated her with Yokuinin-to-kami which resulted in improvement symptoms, as well as decreased serum CRP.
To identify the target group for Yokuinin-to-kami, we further analyzed the characteristics of the patients successfully treated with this formula. Yokuinin-to-kami was administered to nine patients with RA, and the symptoms in five patients improved, but the remaining patients did not respond. The score of stasis of body fluids and deficiency of blood was not considerably different between the two groups. Interestingly, there was a difference in the variation of joint symptoms throughout the day. Namely, the successfully treated patients complained of joint symptom in the evening more than in the morning. These observations suggest that Yokuinin-to-kami is a useful agent for the treatment of a subset of patients with RA, and that joint pain in the evening might be an indicator for this treatment.

We report two cases of inchinkoto treatment for obstructive jaundice via autoimmune pancreatitis (AIP). Case 1 : A 38-year-old male. After completion of treatment for Mikulicz disease, obstructive jaundice developed. A diagnosis of AIP was based on a high IgG 4 blood level and image views. T-Bil stayed above 20 mg/dl and there was no improvement by oral administration of prednisolone (PSL), ursodeoxycholic acid, or bilirubin adsorption therapy. Upon inchinkoto administration, T-Bil promptly fell to 3 mg/dL. Case 2 : A 77-year-old male. He suffered from itching and constipation, and blood data showed a pattern of obstructive jaundice. Image views suggested AIP, but a duodenal papillary biopsy could not provide a definitive diagnosis. Inchinkoto was administered, and the itching and constipation had mostly disappeared within 1 week. However, these symptoms recurred after one month. A definitive diagnosis of AIP was then reached based on a pancreas biopsy, and a PSL regimen was initiated. From these two cases, we consider that inchinkoto is useful for improving the symptoms of obstructive jaundice induced by AIP.