We encountered a patient with chronic pain due to reflex sympathetic dystrophy (RSD) that was relieved by Uzu-keishi-to (Wu tou gui zhi tang) therapy. A 69-year-old man was diagnosed with RSD in 1995. Intractable pain of the extremities and trunk persisted despite several therapies such as spinal cord stimulation, local anesthetic blocks, and a variety of conventional medications. The patient was admitted to our hospital in June 2000, and was diagnosed as having stage II RSD. Thermography demonstrated that the left side of the back and the hand were lower in temperature than the corresponding areas of the right side. “Perfusion” images of three-phase bone scintigraphy showed a lower flow in the lower left extremity. Uzu-keishi-to was administered in addition to the Western medicines. After administration of Uzu-keishi-to, the pain was relieved and the value of the face scale decreased from 20 to 11. Moreover, after 16 weeks of Uzu-keishi-to therapy, the decreased blood flow on the left side of the body detected by thermography and three-phase bone scintigraphy increased to a level equal to that of the right side. Uzu-keishi-to is effective not only in reducing the intractable pain of RSD but also in preventing the development of “dystrophy.” Further evaluation of Uzu-keishi-to therapy for patients with RSD is warranted.

It has been demonstrated that excellent athletes usually have, not only a higher exercise capacity but also higher ability to maintain equilibrium which is important for assuming the various body postures required in different sports. It is thought that a method of training which enhances the sense of equilibrium will also increase the ability to perform certain of sports.
Many sensory organs and the central nervous system, which integrates these organs, are integrated to the maintenance of equilibrium. To maintain equilibrium, vestibular, visual and bathyesthetic inputs are integrated centrally (in the brainstem, cerebellum, etc.) and necessary commands are other tissues.
A series of studies which we performed demonstrated that the ability to maintain equilibrium was lower in individuals with imbalanced occlusion than in individuals with normal occlusion.
Imbalanced occlusion can be corrected by the appropriate use of rejin sprints. We recently examined the effects of such sprints on the equilibrium of athletes with imbalanced occlusion, using a gravity fluctuation analyzer. In this study, we raised the bite only within the amount of existing free way spce.
From these results, gravity fluctuation in athletes with imbalanced occlusion was greater than that in individuals with normal occlusion.However, when imbalanced occlusion was corrected by the use of rejin sprints, gravity fluctuation tended to decrease.
It these findings from the present study are combined with the knowledge that the exercise capacity of athletes has a positive correlation with their equilibrium maintenance ability. It appears that correction of imbalanced occlusion and the appropriate use of mouth protectors would contri-bute to improving the performance of athletes.

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.

We present here two cases of rheumatoid arthritis (RA) treated with Shikunshi-to-ka-keishi-shakuyaku-yokuinin. Case 1 was a 71-year-old female who had been suffering from RA for two years and had been treated with western medicines. Keishi-ni-eppi-itto-ka-ryojutsubu-to offered some degree of palliation at first, but soon came to cause itchy eruptions and anorexia. On the other hand, treatment with Shikunshi-to-kami-ho (described above) for nine months achieved complete remission without any adverse reactions. Case 2 was a 52-year-old female who was diagnosed as RA in 1989 and had discontinued treatments with a variety of DMARDs (disease modifying anti-rheumatic drugs) because of adverse reactions such as eruptions, anorexia, and loss of hair. Moreover, many Kampo medicines with low-dose steroids were less effective. Shikunshi-to-kami-ho, which was administered after Kampo-medicine-induced liver damage, produced clinical effects to some degree. Shikunshi-to-kami-ho may be useful in the treatment of RA patients who have developed adverse reactions such as eruptions, liver damage, and anorexia.

We treated two patients with rheumatoid arthritis (RA) who demonstrated different signs from the perspective of traditional medicine. The first case was a 73-year-old woman. In 1977, she consulted a nearby hospital due to bilateral knee joint pain. Her condition was diagnosed as RA. In 1984, she consulted our department for Stage IV and Class III disease. She was treated with Keishi-ni-eppi-itto-ka-ryojutsubu-kagen, and her condition stabilized. In 1994, she received total replacement of the bilateral knee joints. Her ADL increased, but pain at her bilateral wrist, elbow, shoulder and ankle joints persisted. Although she was treated with Yokuininto, as well as bucillamine and salazosulfapyridine, arthralgia persisted. In 1996, her condition was as follows: general malaise, pain at the bilateral shoulder and elbow joints, severe deformity at the wrist joints, dry skin and slender limbs. She walked with a cane. Therefore, we changed the formula from Keishi-shakuyaku-chimoto to Daibofu-to. Thereafter, her symptoms significantly decreased. The second case was a 50-year-old woman. In 1994, she suffered from pain in the right hand, bilateral feet and knee joints. Her condition was diagnosed as RA at a local hospital. In 1996, polyarthralgia increased and she consulted the department of orthopaedic surgery in our hospital. She was administrated bucillamine, but it was discontinued due to eruptions. Then she consulted our department. She was first treated with Keishi-ni-eppi-itto-ka-ryojutsubu, and then with Yokuininto, which did not change her symptoms. Therefore, we tried several DMARDs; however, her condition worsened. In June 2000, her laboratory data were as follows: RF 860U/ml, ESR 72mm/hr, CRP 4.0mg/dl. Although she complained of pain at the bilateral wrist, elbow and ankle joints, there was no deformity in the bilateral wrist or finger joints of either hand. She was a medium-sized person, and without dry skin or edema at the limbs. The administration of Daibofu-to improved her symptoms as well as laboratory data after 3 months of treatment.
The clinical signs of case 1 were in accordance with the traditional indications for Daibofu-to. In contrast, those of case 2 differed from these indications with regard to blood-deficiency, since there was no dry skin, change in the nail, dizziness or deformity of the joints. These observations suggest that a subset of patients with RA, who have poor deficiency of blood or Ki, may be another population that can be successfully treated with Daibofu-to.

We report on two cases of relapsing aspiration pneumonia caused by dysphagia due to cerebrovascular disease. Sei-hai-to (Qing Fei tang) offered useful palliation in both cases. Case 1 was an 83-year-old-woman who was hospitalized for multiple lacunar infarction and lumbago in 1996. She gradually became bedridden within two years of the admission period. She was admitted to a long-term care hospital affiliated with our department in January 1998. Dysphagia and productive cough appeared in May, and enteral tube feeding was started after she developed pneumonia in August. Pneumonia persisted against some antibiotics, and feverish periods ranged from 8 to 18 days a month. CRP values were elevated to more than 5mg/dl. Administration of Sei-hai-to provided negative CRP values and decreased feverish periods to 0-2 days a month. Case 2 was a 93-year-old-man who suffered from cerebral bleeding in the right thalamus in 1984. He developed many attacks of aspiration pneumonia after starting oral feeding. He was admitted to a long-term care hospital affiliated with our department in April 1999. Sputum culture yielded P. aeruginosa and MRSA. Moreover, fluoroscopy showed aspiration into the lower airway. Aspiration pneumonia relapsed continually without antibiotics. Administration of both Sei-hai-to and clarithromycin decreased feverish periods and provided negative CRP values. Pneumonia relapsed easily either with Sei-hai-to therapy alone or Clarithromycin therapy alone.

The purpose of this study was to examine the association between the pedometer-determined steps per day and physical fitness in order to evaluate the usefulness of the pedometer-determined physical activity to help individuals meet the recommended exercise target level of the Ministry of Health, Labour and Welfare (MHLW). The subjects consisted of 222 men and 172 women aged 71 years in community-dwelling elderly. The subjects wore a pedometer for 7 consecutive days to measure daily steps. The functional capacity was assessed based on the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) and self-reported performance of tasks (stair-climbing and chair-rising). Physical fitness tests included handgrip strength, knee extensor strength, leg extensor power, stepping, one-leg standing time with eyes open and maximal walking speed at 10 m. The men and women took on average 6,561±2,907 and 6,329±2,451 steps/day, respectively. Our subjects seemed to be highly functioning elderly, because the total scores of TMIG-IC (maximum : 13 scores) were on average 12 for men and women. The average of steps/day was significantly correlated with stair-climbing, chair-rising and knee extensor strength in men and women, and with body weight, body mass index (BMI), percent body fat (%Fat) and leg extensor power in women. The BMI and %Fat levels were significantly lower while the handgrip strength and knee extensor strength were significantly higher in women who attained to the level of the pedometer-determined physical activity as recommended by the MHLW.The present study suggests that both men and women who take a lot of steps on a daily basis tend to demonstrate excellent leg strength and thus have a good ability to perform the tasks of daily living. In addition, the degree of obesity tends to be lower in women who regularly take a lot of steps. In addition, the number of daily steps taken has been recognized to be linked to gender, and such a link has also been suggested to be stronger in women than in men.

We performed a preliminary study of the reliability of the lymphocyte stimulating test (LST) for Kampo medicine. LST for three kinds of Kampo medicines was performed in both a Kampo-administrated group and a non-administrated group. LST for each of the medicines was negative for seven of eight subjects in the non-administrated group, but was negative for four of 11 subjects in the Kampo-administrated group. The LST-positive participants had no allergic state, and some among them were negative in challenge test. This preliminary study suggests that LST for Kampo medicine is likely to be false-positive.

Objective: Isolated abdominal aortic dissection (IAAD) co-occurring with an abdominal aortic aneurysm (AAA) is rather rare. The objective of this report was to discuss the adequate timing and method of surgery for this condition.Patients: We encountered two operative cases, for which we carefully considered the timing and method of surgery. One patient underwent open repair 1 month after the onset, and the other patient underwent endovascular aneurysm repair (EVAR) 3 years after the onset.Results: Both patients had a good postoperative recovery and are doing well 8 months after the surgery.Conclusion: The presence of symptoms or an increase in the diameter of an AAA is important in determining the timing of intervention.