The results of three cases involving administration of “Shien”, a Kampo formula containing Crotonis Semen, are reported here. The first case was a 48-year-old female, in whom orthopnea had appeared two years previously. She was diagnosed as having congestive heart failure. During the treatment period, the above symptom reappeared when she was fatigued. Based on a lessening of the symptoms after diarrhea, Shien was administered. After over ten abouts of diarrhea, the difficult breathing was eased and the cardiothoracic ratio decreased, as confirmed by chest x-ray.
The second case was a 64-year-old female. After the appearance of hyposarca and inappetence a year ago, she had been diagnosed as having amyloidosis brought on by nephrotic syndrome. The edema was reduced with combined administration of the Kampo formulas Hokikenchu-to and Bukuryoshigyaku-to. However, due to the persistence of poor appetite, and the marked presence of the (Oriental Medical) indicator of upper abdominal fullness, Shien was administered. After frequent bouts of diarrhea and vomiting, an improvement in the appetite and a decrease in abdominal fullness were seen.
The third case involved a 71-year-old female. After undergoing surgery for breast cancer eight years ago, edema appeared in her upper left arm. Due to the presence of the edema and constipation, both indicators for Shien, administration of this Kampo formula was commenced. Diarrhea occurred every day Shien was administered. A decrease in the upper arm diameter and weight was reported.
The results achieved in these three cases suggest that Shien is an effective treatment formula that can be used in cases of “Suidoku” (water metabolism disorders) when indicators such as upper abdominal fullness and constipation are present. Careful distinction between the “deficient” and “excessive” manifestation types (standard in Kampo theory) did not seem necessary.

A 27-year-old female had swelling, hotness and pain on her right clavicle. She was diagnosed as having chronic osteomyelitis and received bone curettement. However, even after this therapy, she occasionally suffered from recurrence of osteomyelitis. In the middle of July 1992, she was pregnant and had a low grade fever and pain from the right clavicle to the right upper arm. On **********, she visited our department and was diagnosed as having deterioration of the chronic osteomyelitis with pregnancy, based on the symptoms and laboratory data. In Kampo diagnosis, she was in the initial stage of Yang diseases with ectodermal symptoms, since she had headache and fever with slight chills and her pulse was floating. She received Keishi-mao-kakuhan-to and acupuncture therapy. The therapy gradually improved the symptoms and laboratory data. The present case suggests that Oriental medicine is one approach to the treatment of chronic osteomyelitis. Furthermore, the fact that the present therapy was effective during pregnancy without any adverse effects supports the clinical usefulness of Oriental medicine, especially since administration of massive amounts of antibiotics or surgery is often not advisable for pregnant women.

The prognosis of rheumatoid arthritis (RA) worsens significantly when accompanied by renal disorders due to amyloidosis. Recently, satisfactory results have been obtained by the administration of Daibofu-to to a patient suffering from amyloidosis and renal failure with RA. The patient was a 64-year-old female, whose chief complaint was a polyarthralgia. Ten years ago she was diagnosed as having RA. Both gold compound and glucocorticoid had been administered. Renal dysfuntcion was discovered in February, 1993, and she was admitted to the Aso-Iizuka Hospital in **********. On admission she was evaluated as class II and stage IV. Deposits of amyloid was found in the mucosa of the stomach, duodenum, and the glomerular tissues of the kidney. Administration of Daibofu-to brought about a reduction in the Lansbury's index from 64% to 39% during a two week period.
After four weeks, the serum creatinine level fell from 1.7mg/dl to 1.5mg/dl, and the daily amount of urinary protein excreted dropped from 4g/day to 2.5g/day. At present, one year after discharge, the RA with amyloidosis and renal failure is being successfully controlled with Daibofu-to.

Isho-ho was used to successfully treat three cases of muscular weakness. The first case was a 59-year-old woman. In May of 1993, she began to suffer from a feeling of general lethargy. The condition was diagnosed as multiple myositis, and prednisolone was administered. However, since she still experienced loss of strength in the lower limbs, she was introduced to the authors' department for treatment in August of 1994. Administration of Isho-ho improved the loss of strength in the lower limbs and increased her grip strength.
The second case was a 42-year-old woman who complained of unusual sensations in the tips of her fingers and toes starting in mid-September, 1994. In November of the same year, she began to experience a loss of strength in the limbs. In February of 1995, the condition was diagnosed as chronic inflammatory demyelinatory multiple neuropathy by the same department, and large doses of steroids were administered. Although this treatment delayed the loss of strength in the lower back and legs, actual improvement in the condition did not occur until Isho-ho was given.
The third case involved a 63-year-old man who began to experience a loss of strength in the lower limbs in 1984. In 1988, the loss of strength became pronounced. In June of the same year, he sought treatment at the authors' department, and the condition was diagnosed as bulbar myelinic muscular atrophy. In October of 1993, he was unable to get out of bed unassisted, and was admitted to the authors' department. He was given Isho-ho, and reported a decrease in the feeling of a loss of strength in the lower limbs, and a disappearance of greater pectoral muscle spasms. These results suggest that Isho-ho is not only effective for loss of strength in the lower limbs, but may also be efficacious for loss of strength, numbness and muscle spasms in the upper limbs.

The authors investigated the clinical effects of Shishi-zai for neurosis with chest disturbance. There were 19 subjects in the study, 9 of which reported improvement with Shishi-zai. Three of the cases in particular showed marked improvement and will be discussed here.
The first case was 68-year-old female who had been suffering from pharyngolaryngial neurosis. She came to our clinic in March of 1994. Shishi-kanzoshi-to was given for a burning sensation in the throat. She reported relief after administration. The second case was 57-year-old female who had previously suffered from ethylene oxicide poisoning. She complained of chest discomfort and sleeplessness. Shishi-kanzoshi-to was administered and her complaint was improved. The third case was 25-year-old female who had been suffering from atopic dermatitis. She had a relapse when her relationship with her husband was strained, and was also experiencing headaches and anxiety when she came to our clinic in September of 1994. Her condition was reliened by administration of Shishi-kankyo-to.
The results suggest that Shishi formulas are effective for neurosis with chest discomfort when the indicators of sleeplessness, heat sensations, restlessness and flaccidity of the epigastrium are present.