We sought a connection between the half-exterior half-interior symptoms (hanpyo hanri sho), mentioned in the classic Chinese Shang han lun text and used in Kampo medicine, and embryology. An agreement between these shao yang (lesser yang) symptoms, and embryonic brachial arch domains was found. A part of the brachial arches strongly agrees with the ruling domain from the trigeminal nerve to the vagal nerve, and a connection was also seen to the vestibulocochlear nerve and partly to the accessory nerve. Thus we believe that half-exterior half-interior symptoms are a condition which relate back to part of the brachial arches, and are a result of so-called Heat reaction. Shang han lun Chinese medicine and embryology are two completely different fields. However, we consider an embryological view of nerve pathways to be helpful in understanding half-exterior half-interior symptoms, at least to a certain degree.
symptoms <1> ; CONSIDERATION ; Chinese People ; Nerve ; Medicine

We treated one rheumatoid arthritis (RA) patient with Toki-shakuyaku-san-ka-bushi. A 51-year-old woman was diagnosed as RA in another hospital and was treated with salazosulfapyridine (SASP) and methotrexate (MTX). She was living a restricted daily life while taking MTX. She had to lie down for almost 48 hours after taking MTX once a week because of general fatigue. She was also suffering from depression. After the administration of Toki-shakuyaku-san-ka-bushi, her malaise after taking MTX and her depressive-mood disappeared. Her quality of life improved measurably.

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.

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.

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.

Physical and psychological symptoms were evaluated in 9 cases with unidentified clinical syndromes who were effectively treated with kami-shoyo-san (KS). Before and after administration, the patients were tested with the 43-question Abe questionnaire for vegetative syndrome and 51 questions (M-R) of the Cornell Medical Index. After administering KS for three months, the mean number of physical symptoms decreased from 19.9 to 9.1, and the psychological symptoms decreased from 16.7 to 9.3.
In order to clarify the clinical features for which KS is efficacious, the physical and psychological symptoms were divided into 7 and 6 categories, respectively. The average complaint rates responding to those categories before administration were evaluated. Physically, the average complaint rates related to locomotion and fatigue were high, and those related to digestion were low. Psychologically, the average complaint rates related to hypersensitivity and anger were high, and those relating to depression and tension were low.

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.