Kampo treatment for respiratory diseases on the traditional standard including some care reports lectured. To find adequate Kampo prescription for each patient, it need to discriminate what is the cause of the symptoms, throat, nose, chest or low respiratory function. Some patients whose obstructive feeling at throat was improved by the adiministration of Hange-koboku-to, was introduced. Anxiety at throat was an important sign for its indication in these patients. This prescription was also applicated to sleep-disordered breathing. On treatment for chronic rhinitis that caused respiratory symptoms the pulse diagnosis was an important technique for the diagnosis of stasis of body fluids. Kampo treatment for common cold, chronic bronchitis, bronchial asthma and interstitial pneumonia were told as chest diseases. Kampo prescriptions for chronic bronchitis were classified by the characteristics of cough (dry or wet) and Kyo-Jitsu (asthenia or robust). Pediatric asthma patients who respond to the prescriptions with tonic effect including Sho-kenchu-to, was considered to increase recently. A case with interstital pneumonia improved with Bukuryo-kyonin-kanzo-to, was introduced and adequate Kampo prescription for this disease was discussed with some previous reports. Hachimi jio-gan increased peak flow rate of asthmatic patients with low respiratory function and the difference of indication to Bakumi-jio-gan-ryo was discussed.

With the world standardization of inhaled steroids for bronchial asthma, the principle of Kampo medicine has changed from treatment for asthma attack to the prevention of it. The number of severe adult patient cases has decreased, and the number of hojinzai (kidney tonic) users has increased. The number of weaker children has increased, and the number of hohizai (spleen tonic) users has increased. Kampo medicine was not equal to inhaled steroids for the treatment of bronchial asthma, because the number of patients treated with Kampo medicine, having more than one year without an attack, was only 10% to 20%, and this figure would be lower, with inhaled steroids.
Nevertheless, Kampo medicine has had a great effect, on patients with milder symptoms, who do not require inhaled steroids, and well as those patients uncontrollable even with inhaled steroids. The Saiboku-to and Maozai groups, including Sho-sei-ryu-to and Ma-kyo-kan-seki-to, are good for milder patients. It is advisable to first check the immediate reaction of Maozai group users, following its administration in the clinic for treating attacks. The Hojinzai group, including Hachimi-jio-gan and Bakumi-jio-gan-ryo, are good for patients with the severe asthma or chronic obstructive pulmonary disease. An increase in the peak-flow rate of these patients with Hachimi-jio-gan might be related to activation of dehydroepiandrosterone, although the mechanism is unknown. Moku-boi-to is indicated for those patients with complicated heart failure.

I discuss the question of cold/heat in greater yang disease period and the definition of yang/yin pattern as written in the Nyumon Kampo Igaku, which was the first textbook on Kampo medicine published by the Japan Society for Oriental Medicine. The first question is ; “Is the indication for Kampo medicine in greater yang disease period not the heat, but the exterior cold of a patient?” It is considered that a chilly feeling shows not cold illness, but a process trend toward body fever and sweating as a recovery strategy. The second question is ; “Should we adopt Okuda's definition of yang/yin pattern when my definition is obscure?” Okuda's definition was written for acute illnesses based on the treatise Shanghanlun (On Cold Damage). Nevertheless, we can not adopt this definition because our textbook has to be applied for treating patients with chronic illness, and the use of Goseiho and traditional Chinese medicine. The discrimination of quantitative analyses in the21st century, and qualitative approaches to discussing Kampo medicine diagnostic standards are considered important in the21st Century.
Medicine, Kampo ; Pattern ; Medicine ; Heat ; seconds

The diagnostic criteria for oketsu syndrome which was proposed by K. Terasawa et al. High scores in paranavel resistance and tenderness was characteristic in it. It's evidence was obtained by that blood viscosities of oketsu patients increased than ones of non-oketsu patients. The numbness of seven patients with cerebrovascular accidents in fourteen patients were improved following the four weeks of administration of keishibukuryogan. In this study we could also recognize improvement of intra-vascular erythrocyte aggregation in their conjunctival microcirculation by using the video-microscopic system. These studies had been clarifying that oketsu state might be accompanied to microcirculatory distubance and kampo prescriptions treated for oketsu syndrome could improve it. Important point in using these prescriptions under the traditional standard is to check kyojitsu (robust or asthenia), face color (red or pale) and constipation/or not. I emphasized that role of checking kyojitsu might be bigger in prevention from the adverse effects than in searching drug to treat patient's illness.
Syndrome ; seconds ; Insight, NOS ; Cancer resistance to treatment ; Prevention

We have previously reported that Bukuryo-shigyaku-to (BSG) has the effect of improving the asthmatic state of steroid dependent patients. Nevertheless, the standard indication for this drug in Kampo medicine was not established in these patients. In this paper, we report three such patients who improved by its administration. A 66 y. o. male diagnosed as having as asthma with pulmonary emphysema was treated daily with 30mg of oral prednisolone. A 45 y. o. female diagnosed as having asthma with autonomic disorder was treated daily with 7.5-15mg of oral prednisolone. A 61 y. o. female diagnosed as suffering from asthma with diabetes mellitus was treated daily with 10mg of oral prednisolone. The reason for the use of BSG was that their asthmatic state remained unchanged by other Kampo drugs which were indicated by the usual Kampo diagnosis, and in the second and third cases the duration until feeling heat from the applied electrical warm acupuncture apparatus was overly long. Weakness of radial pulse and cold in the extremities, the usual indications for the use of BSG by Kampo diagnosis, were absent in these three cases, but nevertheless its administration improved their asthmatic states. This apparent contradiction with Kampo diagnosis might be related to the effect of the steroid drugs used.

In this paper, we report four patients with chronic respiratory diseases who improved by administration of Bukuryo-kyonin-kanzo-to.
A 66-year-old female diagnosed as bronchial asthma could increase the peak flow rate and stopped western medicines by its administration. A 63-year-old female suspected to have cough variant asthma and an 08-year-old female diagnosed as having bronchiectasia with cough and dyspnea on exertion improved gradually after a few months of treatment. A 62-year-old female diagnosed as having interstitial pneumonia with systemic sclerosis showed improvement of cough and dyspnea. The erythrocyte sedimentaion rate and serum lactate dehydrogenase decreased and arterial oxygen pressure increased by its administration. This report and past reports seem to indicate that a patient profile which can be expected to be responsive to this formula is: elderly female, cough worse at night, chest dyspnea, and epigastric tenderness and muscle guarding. This drug was considered to have wider applications for chronic respiratory disease.

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.

The authors examined the ralationship between ‘Oketsu’ syndrome and multiple cerebral infarction. In the 59 patients (62.8±9.5 years of age; 43 male and 16 female) with multiple cerebral infarction who had undergone MRI examinations, the authors evaluated the ‘Oketsu’ score, DEA (maximum diameter of the column of intravasclar erythrocyte aggregation) and erythrocyte aggregability.
The control group, 18 subjects (61.2±9.3 years of age; 11 male and 7 female) had no findings of cerebral infaction upon MRI examination.
In the patient group, the ‘Oketsu’ score was higher than the control group (P<0.0001) and microcirculation was significantly impaired (P<0.01).
According to localization of foci in the MRI study, the microcircuation was particularly impaired when infarctions occurred in areas controlled by the cortical branches (P<0.05).
Both symptomatic and asymptomatic infarctions presented high ‘Oketsu’ scores and impairment of microcirculation.
Erythrocyte aggregability significantly increased in patients in the multiple infarction symptomatic group (P<0.05). Particulaly, patients suffering from cerebral infarctions in the cortical branches had more severe erythrocyte aggregation.

The ‘Kenjuroku’ is a book of 54 case reports written by Yoshimasu Todo in 1763. The cases studies of four Buddhist monks (Gyokutan, Soboku, the director of Seikoji temple, and the son of the director of Shorakuji temple) from Toyama prefecture are described. Through an investigation of the biographies of these men, the authors attempted to determine the disease condition and symptoms present at the time of their meeting with Todo and inclusion in his book. These four cases were unique in that they appeared to have actively accepted Todo's new medical theories. This led to a discussion of the analogous aspects between his theories and the doctrine of Jodo-shinshu.