It has been popular to group various renal disorders under chronic kidney disease (CKD). And, angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB) drugs are used as the first choice for treatment of CKD with hypertension. Here, however, I review some Kampo treatments. To begin with, shichimotsukokato is a promising formula for the treatment of CKD in combination with ACE inhibitors/ARBs. The effects of hachimijiogan show promise for the inhibition of diabetic nephropathy through basic studies using experimental models. And, recent evaluations have revealed the efficacy and usefulness of saireito, in reducing steroid dose for the treatment of glomerulonephritis and primary nephrotic syndrome. Moreover, when considering disease backgrounds, saibokuto is useful in the patients with IgA nephropathy accompanied by frequent episodes of upper respiratory infection, while saireito is occasionally effective for nephrotic syndrome with allergic disorder. Saireito has also been reported to be effective in childhood IgA nephropathy in a prospective controlled study. The effects of onpito, on the other hand, are reported to prevent or postpone the introduction of dialysis in pre-dialysis patients with chronic renal failure. And furthermore, for the treatment of hemodialysis patients, goreisan efficacy has been reported for the difficulty of fluid removal, while saireito is promising for the treatment of peritoneal fibrosis due to peritoneal dialysis.

In this article, the proposal to rename “Chinese herbs nephropathy” was reviewed. Prolonged use of Chinese herbs that contain aristolochic acid may induce tubulo-interstitial disorders. In our opinion, the “Chinese herbs nephropathy” nomenclature is equivocal, and should be changed to “aristolochic-acid nephropathy”. Professor Vanherweghem, who is the first author to write about this disease, also used the name “Aristolochia nephropathy.”

We report two cases of nephrotic syndrome successfully treated with saireito. The first patient developed massive proteinuria of 5.2 g/day, was diagnosed with minimal-change nephrotic syndrome upon renal biopsy, and rapidly improved with saireito treatment for 2 months to the reduced urinary protein level of 0.3 g/day. Urinary protein increased to 2.0 g/day just after discharge, then again decreased and was brought to remission soon thereafter. The second patient with biopsy-proven idiopathic membranous nephropathy maintained nephrotic syndrome remission for 8 years with the treatment of small-dose prednisolone, an immunosuppressant, and an angiotensin II receptor blocker, then relapsed with 4.4 g/day proteinuria. In this patient, proteinuria was reduced after 4 weeks with the above combination therapy plus saireito to 1.3 g/day, then remitted again soon thereafter. The former patient presented with mild discomfort and opposition when the subcostal region was pressed ; the latter patient presented with apparent discomfort and opposition together with moderate leg edema. Because rapid remission of massive urinary protein with saireito treatment was observed in these patients, we report here and discuss possible mechanisms.
g/d ; Patients ; Nephrotic Syndrome ; sairei-to ; Cancer Remission

A case of progressive systemic sclerosis (PSS) with peripheral circulation disturbance, pulmonary fibrosis and stenosis of esophagus-cardia (E-C) junction, was treated with acupuncture and traditional Chinese medicine. The patient had digital pitting scar due to the peripheral circulation disturbance. Effect of acupuncture was examined using laser Doppler velosimetry (LDV). Acupuncture treatment was operated 3 times a week and laser therapy, once a week. And Chinese medicine was administered. The LDV measurements were done before and after acupuncture. In the total 9 times of measurements, 8 were increased in peripheral blood flow. Two times from the measurements of peripheral blood flow after acupuncture reached in the normal flow level. After the treatment of 2 months, polyarthralgia was reducted, vomiting was disappeard, and the stenosis of the E-C junction was improved. Present data suggest that the acupuncture therapy to the PSS patient is effective.

Comparing the effects of low energy laser and acupuncture was conducted in 14 patients with gonarthrosis. Effectiveness on the pain on going up or down stairs, range of motion (ROM) of knee joint and tenderness were examined. After acupuncture treatment, the pain on going up or down stairs, and ROM of knee joint were significantly improved. Laser therapy showed the same significant effects both on the pain on going up or down stairs and ROM of knee joint. In addition, laser therapy showed a significant effect on tenderness. In the statistical evaluation, no remarkable difference was shown between acupuncture therapy and laser therapy. Present data suggest that the laser therapy is as effective as acupuncture therapy in gonarthrosis.

Laser-Doppler velocimetry was used to evaluate the effects of acupuncture stimulation on peripheral circulation disturbance in patients with collagen disease, progressive systemic sclerosis (PSS) and systemic lupus erythematosus (SLE). The response to acupuncture stimulation to shou-san-li was recorded in 8 patients with PSS and 6 patients with SLE. The digital pitting scars and Raynaud's phenomenon were observed in all the patients. The mean of laser-Doppler flow values in fingertips at room temperature 23°C was 4.83 (V) in normals (n=11), 2.82 (V) in patients (n=14). Patient group showed significantly lower values than normals (p<0.01). Ten minutes after acupuncture stimulation to shou-san-li, the flow values increased in 7, and decreased in 1 out of 13 patients (p<0.05). In normals no significant change was observed after the same stimulation. Present data suggest that the acupuncture therapy to the patients with PSS or SLE who suffered from peripheral circulation disturbance is effective.

Laser-Doppler velocimetry (LDV) was used to evaluate the effects of low energy laser irradiation on peripheral circulation disturbance in patients with collagen diseases, progressive systemic sclerosis (PSS) and systemic lupus erythematosus (SLE).
Using a commercially available LDV flometer (Periflux, Perimed KB, Sweden), the response to laser irradiation at the acupuncture points of Tian zhu, Feng chi, Jian jing, Shou san li, Jing qu, He gu, Stellate ganglion, was recorded in 4 patients with PSS and 6 with SLE. The digital pitting scars and Raynaud's phenomenon were observed in all the patients. The low energy of 10mW laser was irradiated for 1 minute at each acupuncture points, and LDV flow values ware recorded in fingertips at room temperature 25±0.5°C. Ten minutes after the laser irradiation, the LDV flow values increased significantly (p<0.5).
Present data suggest that the low energy laser irradiation to patients with PSS or SLE who suffered from circulation disturbance is effective.

The indications of hachimijiogan formulation include lower limb pain, low back pain, edema, fatigue, coldness, and accompanying symptoms of hypertension. In this study, hachimijiogan was administered to patients who complained of symptoms of coldness, pain, etc., and the subsequent blood pressure was observed. Changes in hachimijiogan, a powder pill formulation of crude drugs, were observed in 12 patients aged 45 years or older, with an average age of 71 years. Various symptoms of jinkyo, blood pressure, and laboratory findings were examined. Coldness and pain improved significantly after 3 months. Of the 9 patients who wanted to take hachimijiogan for more than 9 months, 8 were treated with antihypertensive drugs. Among them, 4 underwent an antihypertensive dose reduction by 9 months, and 3 received angiotensin receptor antagonists, and 1 received a Ca antagonist. The systolic pressure before treatment with hachimijiogan averaged 127 mmHg, and after 9 months it was stable at 128 mmHg despite drug dose reduction. In patients with antihypertensive drugs, the long-term use of hachimijiogan may facilitate dose reduction and protection of the vascular endothelium protection. The usefulness of hachimijiogan in the aging society was suggested.

Hepatolithiasis is the presence of calculi within the intrahepatic bile duct and has various causes, including liver operations. In the presented case, intrahepatic stones were detected in the patient 30 years ago. Three years ago, before visiting our hospital, at the age of 68, a choledojejunal anastomotic operation was performed for the distention of the common bile duct. Intrahepatic calculi also occurred postoperatively. Percutaneous transhepatic biliary drainage and lithotripsy were conducted, but the intrahepatic stones reoccurred. This treatment was performed three times in total, last year. In the patient, hepatobiliary enzymes were elevated over the past year. To prevent hepatolithiasis recurrence, the patient visited the Kampo medicine outpatient department for inchingoreisan and shigyakusan treatment. Prior to treatment, the patient experienced abdominal discomfort in the hypochondrium. Upon treatment, a transient hepatic enzyme elevation occurred, which was assumed to be a paradoxical healing response, and drug administration was suspended. The prescription was resumed after 3 months, upon stabilization of elevated liver enzyme levels. Ten years after treatment, the patient’s condition was stable, without intrahepatic stone recurrence and apparent elevation of hepatobiliary enzymes. Inchingoreisan is reported to suppress calculi. Shigyakusan, free of the occasionally liver-damaging Scutellariae Radix, was also reported to be effective for hypochondrium discomfort. In conclusion, the combination of these treatments is suggested as a useful therapy in this case of hepatolithiasis.