We studied a case of bronchial asthma associated with irritable bowel syndrome which responded to Bukuryo-Keishi-Kanzo-taiso-to. The 54-year-old woman was admitted to our hospital due to recurrent abdominal pain and paroxysmal coughing. The abdominal pain was diagnosed as irritable bowel syndrome, and paroxysmal coughing as bronchial asthma. Uzu-Keishi-to, Sekiganyo, Gekyu-shokuso-to were given for abdominal pain, and Ryo-kan-kyo-mi-shin-ge-nin-to and Soshi-koko-to were given for cough. None of these, however, were effective. We consider the condition at the time of attack to be hypochondriasis with palpitation attack, including coughing and abdominal pain, based on the fact that (1) abdominal pain and paroxysmal coughing were accompanied by marked perspiration, (2) the patient felt that something was being pushed upward from the epigastrium into the throat, (3) the patient complained of coldness in the abdomen concomitant with a feeling of warmth in the head, neck, and chest, and (4) subjective palpitations in the upper and lower abdomen were significant. We then used Bukuryo-keishi-kanzo-taiso-to, and both the abdominal pain and the coughing improved using this formulation alone. Although there seem to be two different diseases, they can sometimes be treated as one in kampo medicine.

Case 1 was a 70-year-old female patient who visited our Department mainly due to palpitations which had persisted for the previous four years. From about one year ago, paroxysmal palpitations have occurred frequently. The 24-hour Holter ECG monitoring and echocardiography indicated supraventricular arrhythmia, but there was no temporal association between the arrhythmia and the palpitations. She was very nervous and irritable. She felt fullness of the upper abdomen and palpitations in the lower abdomen. She was given Chugoho-honton-to-ka-bukuryo-byakujutsu. One week later, the palpitations became less frequent, and two weeks later they all but disappeared.
Case 2 was a 41-year-old male company employee. He visited our Department complaining of general malaise, abnormal perspiration of the upper body, and pain in the fingers. Six years previously, he had developed erythema both in the palms and in the soles of the feet and also pain in the fingers of both hands. Four years ago, swelling occurred in the tips of his fingers and toes, which then aggravated. He was diagnosed as having acromegaly accompanied by pituitary adenoma and subsequently underwent resection of the pituitary tumor. After the operation, he developed general malaise and abnormal perspiration in the upper body, which obliged him to take time off work. Based on marked feelings of heat in the upper body and cold in the lower body and also abnormal sweating attacks, he was considered to be suffering from hypochondriasis with palpitation attack. One week after he was started on Chugoho-honton-to-ka-bukuryo-byakujutsu, his legs no longer felt cold. Symptoms of the joints and abnormal sweating subsequently improved, which enabled him to return to work.
Case 3 was a 32-year-old housewife who visited our Department complaining of headache and pain in the right shoulder. She had had contusion in the scapula ten years previously and had been suffering from dull pain ever since. Seven years ago, when she had a baby, she developed severe pain in the paraspinal muscle facing the right scapula. This severe pain radiated along the dorsal muscle and was accompanied by headache. Because she felt hot in the upper body and cold in the lower body, subjective palpations in the upper abdomen, and a mass in the hypochondria and umbilical region, Chugoho-honton-to-ka-bukuryo-byakujutsu was given. This produced excellent results.
Based on the experience of these three cases together with what can be found in the literature, we believe that conditions where Chugoho-honton-to-ka-bukuryo-byakujutsu are indicated have the following features. (1) The conditions are often triggered by fright, fear, depression etc. (2) There exist paroxysmal palpitations, headache, and the sensation of hot flushes. (3) A feeling of anxiety ascends from the abdomen. (4) The disease is in the initial stage of the three Yin diseases. (5) There are signs and symptoms of a deficiency in Qi. (6) There are subjective palpitations in the upper abdomen and in the epigastrium. (7) There is fullness of the upper abdomen and epigastrium, often accompanied by a mass in the hypochondria or umbilical region.

The relationship between the fur of the tongue and dysfunctions of Ki, Blood, Body Fluids, Spleen and Stomach was investigated in 167 cases by analyzing both subjective and objective symptoms. The mean score of Ki-deficiency increased with the degree of both thickness and yellowness of the tongue fur. The mean score of upper gastrointestinal tract symptoms also increased with the degree of thickness of the tongue fur. These results suggest that when examining the tongue fur during Oriental Medical diagnosis, it is important to keep in mind its relationship with dysfunction of the Spleen and Stomach and Ki-deficiency.

Four cases of atopic dermatitis successfully treated with the Kampo formula Tokaku-joki-to are reported. Case 1 was a 25-year-old woman who had been suffering from atopic dermatitis since she was in lower elementary school. She came to our clinic in July of 1992. She complained of intense itching of the neck and area around the mouth. Her abdominal tension was moderate, and there was para-umbilical and caecal tenderness. The patient complained of constipation and dysmenorrhea. After four weeks of Tokaku-joki-to administration, the dermatitis improved markedly. After two years of treatment with this formula, she is progressing favorably.
Case 2 was a 14-year-old girl, who had suffered from atopic dermatitis since she was 3 months old. She first came to our clinic in January of 1993. The dermatitis was located in the upper extremities, face and neck. She also had experienced flushing, para-umbilical tenderness and constipation. After two weeks of administration of Tokaku-joki-to, her dermatitis improved remarkably, although she still experienced flushing. Ryokei-mikan-to was added to the formula for the flushing.
Case 3 was a 28-year-old woman who had suffered from atopic dermatitis since she was 3 years old. She consulted our clinic in October, 1993. The dermatitis was located on her face and elbow. She had tenderness around the paraumbilical, caecal and sigmoid regions. The patient is progressing favorably with Tokaku-joki-to administration.
Case 4 was a 26-year-old woman. She had had atopic dermatitis since she was young, and came to our clinic in October of 1993. The dermatitis was on the upper extremities, face and back. At first we prescribed Toki-inshi, but this formula was not effective. The formula was changed to Tokaku-joki-to and the dermatitis improved remarkably after about three months of treatment.
This is the first report of administering Tokaku-joki-to for atopic dermatitis. Based on the clinical study involving the four cases described above, we propose the following indications for use of Tokaku-joki-to for atopic dermatitis: 1) the dermatitis is located on the upper part of the body, 2) there is flushing, with a feeling of coldness in the lower extremities, 3) there is tenderness around the para-umbilical, caecal and sigmoid regions, and 4) there is a tendency towards constipation.

Saiko-sokan-to has been traditionally used for the amelioration of symptoms such as anxiety, insomnia, Shigyaku-san-sho (sho = pattern of symptoms determined by Kampo diagnosis) with left hypochondralgia and Shigyaku-san-sho with a feeling of obstruction in the costal region. However, there are still aspects that remain to be elucidated concerning the indications for this formula.
This study involved 7 cases with stiff shoulders, headaches, abdominal distension, meteorism and flushing which responded to Saiko-sokan-to. The experience of these cases suggests that conditions indicating Saiko-sokan-to have the following features: (1) there is resistance or tenderness upon pressure in the subcostal region (traditionally referred to as Kyokyokuman), (2) there is resistance or tenderness upon pressure in the epigastric region (traditionally referred to as Shinkahiko), (3) there are signs of Ki-depression, (4) for severe “blood stagnation” syndrome (traditionally called oketsu), Ikkando Saiko-sokan-to was found to be more effective than Igakutoshi Saiko-sokan-to.

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.

In this paper, the authors report four case studies of patients with chronic asthma who improved with the administration of Hachimijio-gan (in pill form). The patients involved were three women aged 63, 57 and 41, and one man, aged 42.
In all of the cases, asthma attacks began in adulthood and occurred perennially. They were classified into three grades of severity: patient 1-mild; patient 2-moderate; patients 3 and 4-severe. The standard indications for usage (Sho) in Kampo medicine were confirmed in all four cases. The asthmatic state of patient 1 improved with administration of Hachimi-jio-gan M (Uchida Wakanyaku Inc.), but produced no response in the other three patients. However, when Hachimi-jio-gan pills that were made by hand using the steamed root of Rehmaniae Radix were administered, improvement was seen in the asthmatic state of the other three patients as well. With improvement in the asthmatic state of all patients involved, attack scores decreased, treatment scores decreased and peak expiratory flow rates in the early morning increased. Patient 3 was able to discontinue use of oral corticosteroid drugs, and patient 4 was able to decrease the dosage.
The results suggest that Hachimi-jio-gan improves the respiratory function in patients with chronic asthma, and that the clinical effect was increased when the steamed root of Rehmaniae Radix is used in place of the dry root.

The authors investigated the clinical effects of Hachimi-jio-gan in the form of handmade pills containing the steamed root of Rehmaniae Radix. There were 11 subjects involved in the study (eight women and three men), with a patient age of 56.7±11.1 (mean±S. D.) years old. All of the subjects suffered from chronic asthma, and their attacks had begun in adulthood. The patients were classified into three grades of severity: mild—one patient; moderate—two patients; and severe—eight patients. Ten of the patients received this medication for eight to twelve weeks, but one patient discontinued administration due to epigastrial discomfort.
The clinical efficacy of this agent was judged by changes in asthmatic attacks. Treatment scores in seven patients improved, two were unchanged and one worsened. Of seven patients taking oral steroids in conjunction with the Hachimi-jio-gan, two were able to decrease the dosage and two were able to discontinue the oral steroids, The peak expiratory flow rates in improved patients increased about 20% compared to the preadministration rates.
The authors considered that this Kampo formula may act to increase the anti-inflammatory action of corticosteroids or theophylline, because the bronchial dilatory effect was remarkable when it was administered in conjunction with these drugs, but less pronounced when used alone. This study suggest that wider application of this Kampo formula in patients with chronic asthma may improve respiratory function.

Before the administration of conventional medicines, outpatients with indefinite complaints answered 51 questions (six mental categories) from the Cornell Medical Index (CMI) and 43 questions (seven physical categories) from the Abe questionnaire for vegetative syndrome. The subjects of this study were 18 cases with CMI III-IV scores who were effectively treated with Saiko-ka-ryukotsu-borei-to (n=9; SR group) or Kami-shoyo-san (n=9; KS group). In order to compare the clinical features of both groups, the average complaint rates responding to the mental and physical categories were evaluated in each group.
Psychologically, the average complaint rates related to depression and tension were high in the SR group, and the average complaint rates related to hyper-sensitivity and anger were high in the KS group. Discriminant analysis revealed that three categories —tension, hyper-sensitivity and depression— contributed to a difference between the SR and KS groups. Physically, the average complaint rates responding to all of 7 categories of the SR group were not significantly different from those of the KS group.

Ryo-kei-jutsu-kan-to was used to successfully treat two cases of overtraining syndrome with anemia. The first case was an 18-year-old woman. Several years ago, she was diagnosed with iron deficiency anemia, and she took Fe pills intermittently. After university graduation in 1996, she began to experience lightheadedness and general malaise concurrently with increased training of long-distance running. In September of the same year, her anemia worsened, and she was introduced to our department. Administration of Ryo-kei-jutsu-kan-to improved her symptoms, anemia and maximal oxygen uptake. The second case was a 19-year-old woman. She was an office worker and a member of her company's athletic club. She became easily fatigued, and she came to our clinic in December of 1996. Hochu-ekki-to was administered and her fatigue improved. But in the following year she began to feel depressed and lightheaded, and she became anemic after increased increasing her training of long-distance running. Administration of Ryo-kei-jutsu-kan-to improved her symptoms and anemia.