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.

Medicine, Kampo ; Names ; Disease ; Diagnosis

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.

In Kampo therapy for rheumatoid arthritis (RA), Keishi-ka-ryojutsubu-to, Keishini-eppi-itto and Keishi-shakuyaku-chimo-to are considered to be the primary formulas. However, it is often difficult to control arthritis with the primary formula alone. In this study, we administered 7.5g/day of Ji-daboku-ippo to 12 patients with RA, who had not responded sufficiently to the primary formula alone. Administration of the primary formula and other anti-rheumatoid drugs was also continued.
After three months of this supplemental administration of Ji-daboku-ippo, the mean±SE of the Lansbury's index significantly decreased from 45.3±5.8% to 33.3±3.8% (p<0. 01). After treatment for one year, a decrement in the Lensbury's index (of more than 20%) was seen in the four patients. These results suggest that supplemental administration of Ji-daboku-ippo is effective for patients who fail to respond sufficiently to the primary Kampo formulas used for RA.

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.

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.

In Oriental medicine, atopic dermatitis is referred to as Fu-shitsu-netsu (wind-wetness heat), Ketsu-netsu (blood heat), Ketsu-kyo (blood deficiency) and Oketsu (blood stagnation). Though formulations such as Unsei-in (Wen-qing-yin), Ji-zuso-ippo (Zhi-tou-chuang-yi-fang), Shofu-san (Xiao-feng-san), Jumihaidoku-to (Shi-wei-bai-du-tang), Eppi-ka-jutsu-to (Yue-bi-jia-shu-tang), Byakko-ka-ninjin-to (Bai-hu jia-ren-shen-tang), and ku-Oketsu-zai (drugs for overcoming blood stagnation) are widely used, actually the treatment of adult atopic dermatitis is not an easy matter. The failure to improve dry skin in conventional treatments of atopic dermatitis has been the subject of many clinical trials.
In this study when changing to a modified formulation of Kagen-ichiinsen-ka-kiban-kyo in five cases of dry erythema, which we had been having difficulties in treating, a therapeutic effect was achieved. As Kagenichiinsen-ka-kiban-kyo has the effects of moisturizing dryness by nourishing blood, nourishing Yin to promote the production of body fluid, and clearing away heat-evil by nourishing Yin, dry skin was improved as well as skin inflammation, and it was relatively easy to withdraw external steroids.
Because of dry skin, the barrier function of the epidermis of patients with atopic dermatitis is hindered, and it becomes sensitive to mechanical stimulation from such things as sweat, clothing, and abrasion, or to allergens in the environment like mites. Therefore, as well as anti-inflammation, dry skin must be improved in treatment of atopic dermatitis. The cause of dry skin is loss of moisture in the corneal layer of epidermis, and this is an important point which must be considered in treatment.

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.

Bronchial asthma is now considered to be caused by airway hyper-responsiveness due to airway inflammation. Accordingly, inhaled corticosteroids, which reduce inflammation, have become the main treatment for this disorder. However, airway hyper-responsiveness would not improve in spite of using inhaled corticosteroids.
Kampo medicines such as Sho-seiryu-to, Makyo-Kanseki-to, Eppi-ka-hange-to, Shimpi-to and Saiboku-to are reported to be effective for bronchial asthma. However, it is still difficult to treat adult asthmatic patients by with these Kampo formulae.
We reported that Hachimi-jio-gan or Bakumi-jio-gan improved airway hyper-responsiveness and could reduce the doses of corticosteroids, or discontinue corticosteroids in four asthmatic patients. Case 1 is a patient induced by cold weather, Case 2 is a patient with hoarseness, Case 3 is a patient whose attacks are induced with exercise, and Case 4 is an intractable patient with recurrent pulmonary infection. These formulae consist of Rokumi-jio-gan, which is considered a basic prescription for moisturizing the dryness of airway mucosa and improving pulmonary function in Kampo medicine. These results suggest that moisture in airway mucosa following oral administration of these formulae is important to improve airway hyper-responsiveness.