We successfully treated 2 patients with ophthalmic symptoms due to post herpetic infection using chotosan. Case1was a 78-year-old woman who had been suffering from ophthalmic symptoms such as foreign body sensation and irritation pain due to post herpetic infection for almost 20 years, and had a history of hypertension. We treated her with stellate ganglion block every week and orally administered keishikajutsubuto, amitriptyline, and later mexiletine. Initially, stellate ganglion block was very effective, but its effect gradually decreased over about one month. Considering the same action of stellate ganglion block and chotosan, both of which might increase intracranial blood flow, we administered chotosan instead of keishikajutsubuto. Her ophthalmic symptoms subsided for 5 days, and had completely disappeared almost two and half months after initiating chotosan. Case 2 was a 65-year-old man who had also complained of foreign body sensation due to post herpetic infection for 11 months. He also had a history of hypertension. Initial stellate ganglion block was also effective for relieving his symptom, but the effect was transient as in Case 1. Taking into consideration of our experience in Case 1,we administered chotosan. His foreign body sensation gradually subsided for 2 weeks, and had almost disappeared 2 months after initiating chotosan. Our experiences suggest that chotosan may be an optimal formulation for the patients suffering from ophthalmic disorders due to post herpetic inflammation and hypertension.

The very first session of the symposium on ‘cancer and acupuncture’ was held at the 53^rd Annual Conference of the Japan Society of Acupuncture and Moxibustion (JSAM). It suggested the efficacy and potential of acupuncture and moxibustion not only for cancer but also for cancer patients. This is the second session for further discussion. In recent years, acupuncture and moxibustion treatment for cancer patients has come to the world's attention, and many reports about its expediency and beneficial effect have been conducted in Japan and in the world. However, the adaptation range of acupuncture and moxibustion treatment for cancer is still limited because there is not enough evidence, so compilations of more sufficient case reports or research for presentation and effects in preventing relapse of cancer are required to prove its reliability. Acupuncture and moxibustion are used as one of the medical treatments directed at relieving symptoms and life-sustaining treatment in hospitals today. Earlier, frequent acupuncture treatment led to significant efficacy for cancer patients, and it is also reported that the number of lymphocytes increases in sequential acupuncture treatment but the number tends to return in a short time after cessation of treatment. Sequential autonomic immune therapy over a long term revealed several significant effects as follows; lymphocyte activation while the lymphocyte count remained, increase of cytokine (IL 12, IFNγ, TNFα, etc.) production and Th 1, Th 1/Th 2, immunostimulatory activity effect, reduction of tumor markers down to or close to normal, reduction or resolve of malignant neoplasm and recurrence prevention for unoperated cancer patients, QOL improvement with symptoms relief and life prolongation. In this seminar, it suggested that acupuncture and moxibustion are potential and appropriate treatments for cancer and further research in this field is required.

This is the third symposium on 'cancer and acupuncture and moxibustion'. Many physicians and intellectuals are skeptical of the use of Western medicine for cancer patients, which often lead to serious adverse events. Acupuncture and moxibustion, which is capable of improving quality of life (QOL) and activating immunity with minimal side effects is also expected to have beneficial effects on various stages of cancer patients, such as prevention of development or recurrence of cancer and palliative care. In fact, evidence has recently accumulated in the field. Dr. Fukuda, Associate Professor of Meiji University of Integrative Medicine, who reported the usefulness of acupuncture and moxibustion in palliative care in the first symposium and bibliographical information in the second has reported this time on the topic of safety and effectiveness of acupuncture on chemotherapy-induced peripheral neuropathy. Dr. Kurokawa from the National Defense Medical College reported the effectiveness of acupuncture on physical and psychological symptoms, QOL, prevention of adverse events, and pre-and post-operative disorders in cancer patients. Dr. Kouchi from Saitama Medical School reported on the usefulness of acupuncture in the university hospital and factors which influence the effect. Dr. Nakamura from Morinomiya University presented a case with chemotherapy-related symptoms who had been cared for with a long-term application of moxibustion. In contrast to these reports on the efficacy of the acupuncture for chemotherapy-and radiotherapy-induced side effects, Dr. Magara from Somon Hachipuji Clinic, who had consistently reported a preventive effect of autonomic immune therapy that involves acupuncture without Western clinical treatment from the first symposium, this time presented topics regarding improvement in the immunity by increasing various cytokines, the possibility of reduction of a tumor even in a case of advanced cancer that cannot be treated with a surgical approach, reduction of the recurrence rate among cases who were treated with his approach as compared with those under conventional approaches. He insisted we should concentrate our efforts on research on preventing the recurrence of cancer with approaches that activates the natural healing process of human beings.
We concluded that clinical trials with a larger sample are needed to clearly identify the usefulness of acupuncture and moxibustion for cancer patients.

We successfully treated 2 patients with ophthalmic symptoms due to post herpetic infection using chotosan. Case1was a 78-year-old woman who had been suffering from ophthalmic symptoms such as foreign body sensation and irritation pain due to post herpetic infection for almost 20 years, and had a history of hypertension. We treated her with stellate ganglion block every week and orally administered keishikajutsubuto, amitriptyline, and later mexiletine. Initially, stellate ganglion block was very effective, but its effect gradually decreased over about one month. Considering the same action of stellate ganglion block and chotosan, both of which might increase intracranial blood flow, we administered chotosan instead of keishikajutsubuto. Her ophthalmic symptoms subsided for 5 days, and had completely disappeared almost two and half months after initiating chotosan. Case 2 was a 65-year-old man who had also complained of foreign body sensation due to post herpetic infection for 11 months. He also had a history of hypertension. Initial stellate ganglion block was also effective for relieving his symptom, but the effect was transient as in Case 1. Taking into consideration of our experience in Case 1,we administered chotosan. His foreign body sensation gradually subsided for 2 weeks, and had almost disappeared 2 months after initiating chotosan. Our experiences suggest that chotosan may be an optimal formulation for the patients suffering from ophthalmic disorders due to post herpetic inflammation and hypertension.

Subclavian artery aneurysm (SCAA), a peripheral arterial aneurysm, is a rare entity. The surgical procedure and approach depend on the location of the aneurysm. We present a case of the endovascular therapy combined with cross axillary bypass. The patient was a 75-year-old man with a small abdominal aortic aneurysm. Multi-detector computed tomography (MDCT) revealed an intrathoracic right SCAA 38 mm in diameter. The operation was performed successfully under general anesthesia. After cross bypass of bilateral axillary artery, the orifice of the right subclavian artery was covered with a stent-graft inserted into the right common carotid artery-brachiocephalic artery and the right subclavian artery was occluded with coils distal to the aneurysm. Post operation angiogram showed complete exclusion of the SCAA and patency of the right common carotid and right vertebral artery. We thought this hybrid treatment for the intrathoracic SCAA could be a useful surgical strategy.

We report a case of successful anatomical reconstruction with omentopexy of an infected abdominal aortic aneurysm (AAA) in a patient with a previous history of coronary artery bypass grafting with the right gastroepiploic artery. A 60-year-old man was referred to our institute because of fever and abdominal pain during hemodialysis for chronic renal failure. Antibiotic therapy was started after computed tomography revealed an infected abdominal aortic aneurysm. After infection control, surgical treatment was scheduled. At surgery, left axillo-bifemoral bypass was performed first, because it was unclear whether the omentum was large enough for omentopexy. At laparotomy, adequate omentum and infective AAA were confirmed. AAA repair using a rifampicin-soaked graft, and omentopexy were performed. Enterobacter aerogenes was detected from the resected aortic wall. After the operation, intravenous antibiotic was used for 25 days until CRP was normalized. One year follow-up showed no sign of re-infection.

In recent years, we have been told that the western medicine has developed the techniques of treatments on cancer, but the truth is that very few practical accomplishments has been made, while death rate from cancer has been steadily increasing. Although acupuncture has been thought to be ineffective in the treatments of cancer, nowadays we find some reports concerning its effectiveness in palliative cares, improvements of quality of life (QOL) and cancer regressions. Thus, this symposium was planned to investigate this theme. There were reports from appointed speakers on the acupuncturists' feelings of swung back and forth between joy and despair when treating patients with cancer, the experiences in treating her parents who died of lung cancer, and the patients who failed or rejected to be treated in western medicine but successfully treated using acupuncture eventually.
A panelist who practices acupuncture treatments in a hospital reported the effectiveness and indications on combined application of acupuncture and standard treatments for the patients in the terminal stage of cancer. He also reported that no correlation had been found between effective rates and duration (frequency) of treatments neither between stages (duration) of disorders and efficacy. Furthermore, if the environment of acupuncture treatment is well organized, he mentioned that acupuncture can produce a good deal of effect even in patients with terminal stage. He also reported that acupuncture will be able to influence on the physiology in autonomic nervous system, leading to the hyperactivity of parasympathetic nerve.
A panelist who practices his acupuncture treatments based on the theory of Professor Abo reported the effectiveness of acupuncture in improving QOL and in prolonging one's life. He showed an actual situation of the patient with scirrhous carcinoma who had prolonged his life for a long period using acupuncture treatment. He also demonstrated that radiotherapy, one of the three major medical treatments for cancer, will deprive the resistance of the patients.
A panelist who advocates salutogenesis demonstrated the possibility of the direct effectiveness of acupuncture treatment on cancer because acupuncture has significant effects in alleviating pains and enhancing the power of restoring human energy in patients with cancer. He mentioned the limitation of the treatments using “a theory of pathogenesis (modern medicine)” and the importance of the treatments using “a theory of salutogenesis (traditional medicine)”, and emphasized the necessity of acupuncture treatments as well as supplemental agents, and the importance of psychological approaches toward the mind of patients.
In this symposium, the efficacy of acupuncture treatments as palliative cares was indicated. Although there are few convincing evidences, the efficacy of acupuncture treatments as one of treatment methods for cancer may be demonstrated. Further integrative researches on the efficacy of acupuncture in patients with cancer are needed.

Postsurgical persistent pain, once entrenched, may be resistant to western medical treatments. A 39-year-old man who underwent thoracic repair with blood vessel prosthesis for dissecting aneurysm was presented to our pain clinic due to postoperative persistent pain. He complained his pain mainly around the sternum on which skin became keloid scar and presented tactile allodynia. Initially, we treated the patient with pregabalin, duloxetine and tramadol/acetaminophen fixed-dose combination tablets, leading to no pain relief. Then, we started the treatments with Kampo medicine as well as Yamamoto New Scalp Acupuncture and Unblocking acupuncture. We initially treated him with keishibukuryogan (TJ-23 ; Tsumura ®, Japan) and saikokeishito (TJ-10 ;Tsumura ®, Japan) based on the signs of blood stasis, hypochondrial resistance and pain, but no relief of pain was obtained. Thus, we administered ogikeishigomotsuto in addition to the above Kampo formulas. His pain was gradually decreased with increasing doses of ogi from 3 to 10 g/day and aconite tuber from 1.5 to 6 g/day due to cold sensation, and finally disappeared at 20 months since the start of Kampo treatments. The duration of effectiveness for relieving his pain with acupuncture was gradually increased in proportion to his pain relief. Our experiences suggest that ogikeishigomotsuto with aconite tuber as well as acupuncture may be optimal treatments for the patients with cold sensation suffering from postsurgical persistent pain.