A Kampo medicine, Dai-kenchu-to, has been used clinically for treatments of various ailments such as vomiting, stomachache, and abnormal intestinal peristalsis caused by abdominal chill. Recently, it is often used to prevent intestinal obstruction after abdominal operations. We searched ancient Chinese and Japanese medical texts for the indications and pharmacological characteristics of Dai-kenchu-to and its constituent herbs (Zanthoxylum fruit, dried Ginger rhizome, Ginseng root, and Malt sugar). We clarified the applications and the cautions of Dai-kenchu-to in this paper. Dai-kenchu-to has rarely been used in China. However, it was often used for the remedy of severe abdominal pain caused by chilling, worm-ileus and hernia in the medieval period of the Edo era in Japan. For these reasons, evidence is considered as described below. i) Japanese people did not have the habit of eating meat in those days. ii) Japanese people used to drink a lot of water. iii) Severe abdominal pain occurred frequently due to wearing traditional Japanese clothing, which does not protect well against cold. iv) Abdominal diagnosis was advanced in Kampo medical methods. We found two precautions in the ancient Japanese medical texts. One is that a purgative should be avoided when used in an applicable case of Dai-kenchu-to. The other is that Dai-kenchu-to should not be given in the case of high fever. It is supposed that the botanical origins and processing of the four herbs used in the medieval period of the Edo era are the same as those of today. Our findings suggest that the pharmacological contribution of the four herbs in Dai-kenchu-to is mainly due to Zanthoxylum fruit and dried Ginger rhizome, and that Ginseng root and Malt sugar harmonize between the condition of patient and the pharmacological action of Zanthoxylum fruit and dried Ginger rhizome.

INTRODUCTION
There have been very few reports on the effects of acupuncture on abnormal eye movements often seen in patients with central vertigo. Recently we had the opportunity to apply acupuncture to a case of Wallenberg's syndrome, which displays a peculiar nystagmus and vertigo. This case is reported because the effectiveness of acupuncture in improving the eye movement was proved by the electronystagmography (ENG) in collaboration with the Nihon University School of Medicine.
CASE REPORT
Patient: A 47 year old man. Diagnosis: Wallenberg's syndrome. Chief Complaint: Vertigo. Present Illness: In Nov. 1980, the patient noticed a loss of pain and temperature sense in his right limb, followed by vertigo. He was admitted to the Nihon Univ. Hospital in Dec. 1980. CT-examination of the whole body, a vertebral arteriogram, etc. indicated a circulatory failure in the left lateral area of the medulla oblongata.
In Mar. 1981, the patient visited our clinic with the chief complaint of vertigo. Present Condition: He complained of rotary vertigo. The orthostatic test was positive with both opened and closed eyes. A decrease in the pain and temperature sense on the right side of the body, except for the head, was observed.
COURSE
Acupuncture was applied to the posterior region of the neck, the back, and the lateral of the lower extremity in order to relax the muscles of these parts. After acupuncture the patient reported a decrease in his vertigo. After the twentieth session of acupuncture the symptoms improved to the extent that he could go out alone. After the twenty-second session, he returned to work. Although his vertigo and nystagmus did not completely disappear, an obvious improvement in these symptoms was seen after each session, and this improved condition remained for two or three days. With the ENG recorded before, shortly after, and 30min. after a session of acupuncture therapy, a decrease in abnormal eye movement after the session was confirmed.
CONCLUSION
Acupuncture therapy was applied to a case of Wallenberg's syndrome.
Result:
1. A short-term decrease in vertigo was observed.
2. A decrease in abnormal eye movement after acupuncture therapy was confirmed by electronystagmography.

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The purpose of this study was to investigate the influence of a shoulder injury on rotator cuff muscle thickness and shoulder muscle strength in baseball players. Based on orthopedic medical checks performed by a doctor for 57 male collegiate baseball players, two groups, the pain-free normal group (NOR group, n=19) and the impingement test positive group (IMP group, n=17) volunteered to participate in the study. Muscle thickness of the supraspinatus, infraspinatus and posterior deltoid muscles was measured bilaterally using a B-mode ultrasound apparatus (SSD-500, Aloka) with a 5-MHz transducer. Isometric shoulder abduction strength was measured bilaterally with a hand-held dynamometer in the sitting position with the arm at 45 degrees abduction, and shoulder external and internal rotation strength were measured bilaterally with an isokinetic dynamometer in the sitting position with the upper arm at 90 degrees abduction.
When the two groups were compared, the NOR group showed significantly greater values on the dominant side than on the non-dominant side for muscle thickness of the posterior deltoid. However, the IMP group showed significantly greater values on the non-dominant side than on the dominant side of muscle thickness of the supraspinatus, the muscle strength with the abduction and external rotation (300 deg/sec) and external internal rotation strength ratio (180 deg/sec) .
Also, the IMP group had a significantly weaker dominant/non-dominant ratio of supraspinatus muscle thickness (p<0.05) and abduction strength than the NOR group (p<0.01) .
These results suggest that baseball players with positive impingement show both a morphological and functional decline in the supraspinatus muscle. The dominant side supraspinatus weakness observed in the IMP group of this study may reflect muscle atrophy and chronic fatigue.

Among 62 patients who underwent hybrid arch TEVAR, which is a combination of supra-aortic bypass and TEVAR to treat arch aneurysm, 5 patients encountered postoperative cerebral infarction. In 2 patients, whose thoracic aorta were extremely shaggy, cerebral infarction were multiple and fatal. Other 3 patients, whose aorta were not shaggy, developed visual disturbance after TEVAR and minor cerebral infarction were detected in the area of vertebral artery. To prevent cerebral infarction after hybrid arch TEVAR, the blood flow from the left subclavian to vertebral artery is considered to be significant.

Objective
 We examined the effects of acupuncture electrotherapy in young women with hie symptoms (excessive sensitivity to cold), presented in conjunction with vasomotor dysfunction as determined by the postural change test.
Subjects and Methods
 Subjects comprised 20 women (mean age, 20.6 years; range, 18-26 years) who exhibited symptoms of hie, evaluated as toe skin temperature after standing for 5 mins or a temperature difference between the right and left toes as compared to before standing. A stainless steel acupuncture needle (length, 40 mm; diameter, 0.2 mm) was inserted approximately 15 mm in SP6 (Shangqui). Acupuncture electrotherapy connected an acupuncture electrode to SP6 and a non-feeling electrode to lateral of the tibial tuberosity, and was undertaken at a frequency of 1 Hz for 20 mins. Therapy was provided as a total of 5 sessions, with 1 session each week, and the postural change test was performed before and after therapy. Thermal images from the medial aspect of the foot to the tibial aspect of the lower leg were captured using a medical thermography device, and mean skin temperature was calculated in selected regions of the toes, metatarsals, ankle, and tibial aspect of the lower leg. Therapy was evaluated using a questionnaire with two originally designed scales: a categorical scale of 14 symptoms including hie; and degree of hie on a visual analogue scale (VAS). Subjects completed the questionnaire every day during a period from 1 week before therapy sessions began until 1 week after completion of all 5 sessions. Scores for hie symptoms were calculated as mean values from the total score of the 14 symptoms and VAS each week. Changes in health-related quality of life with acupuncture were evaluated using the SF-8 Standard Edition.
Results
 Toe skin temperature just after standing was not significantly increased by therapy as compared to before standing. Skin temperature on the tibial aspect of the lower leg 20 mins after standing was significantly increased as compared to the adaptation period. In terms of hie, VAS and SF-8, no significant changes were seen before and after therapy, but total score for the 14 symptoms decreased significantly.
Conclusions
 Acupuncture electrotherapy to SP 6 did not appear to exacerbate hie symptoms after reductions in air temperature, while normalizing the postural vascular reflex and improving hie-related symptoms.

It is well known that patients with abdominal aortic aneurysms (AAA) have a high incidence of coronary artery disease (CAD), and that the major cause of death in patients undergoing aneurysmectomy is acute myocardial infarction. A total of 53 patients (mean age, 71 years) underwent elective repair of AAA between January 1991 and November 1999. In an attempt to reduce early and late mortality caused by myocardial infarction, coronary angiography (CAG) was performed in all cases. Significant CAD was found in 23 patients (43%), with triple vessel disease in 1 patient (2%), double vessel disease in 5 patients (9%), single vessel disease in 16 patients (30%) and left main in 1 patient (2%). Ten patients (19%) in whom CAD was detected by CAG had no history of CAD and displayed no ischemic findings on ECG. In 4 patients (8%), AAA repair was performed 2 (mean) months after coronary artery bypass grafting (CABG). Percutaneous transluminal coronary angioplasty (PTCA) was performed in 8 patients (23%) 19 days (mean) prior to AAA surgery. No patient had a perioperative myocardial infarction either following coronary revascularization (CABG and PTCA) or AAA resection. Moreover, there was only one operative death after abdominal aneurysmectomy (2%), in a patient who was 70 years old with chronic hemodialysis and who died due to multiple organ failure caused by uncontrollable adhesional ileus. The results of this study emphasize the importance of preoperative routine coronary angiography following coronary artery revascularization to enhance the operative outcome of AAA repair.