We investigated the clinical efficacy of concomitant Kampo treatments, expected to have immediate effect in improving outcomes with western drug therapies for Japanese cedar pollinosis. Twenty cases using shoseiryuto, considered a first-line drug for allergic rhinitis, were studied. The resultant efficacy rate was 45%. The efficacy rate for 24 cases using eppikajutsuto, by contrast, was 64%. The latter cases demonstrated far better therapeutic result than the former. In 7 cases using maoto + eppikajutsuto (as simplified daiseiryuto), another prescription we often use for serious illness, the resultant efficacy rate was 72%. Of these, the most favorable effect resulted in 16 cases using shoseiryuto + gokoto, which resulted in an efficacy rate of 87%. We had originally developed this prescription in order to improve the effectiveness of mao and sekko as anti-inflammatories. There were no cases where patients needed to be dosed with an oral steroid. The only notable event was one patient who complained of stomachache as an adverse drug reaction. In conclusion, we can say that the overall therapeutic outcome with 11 different Kampo medicines was extremely satisfactory: an efficacy rate of 83%. These marked improvements in clinical efficacy were made by using Kampo medicines together with a western drug used for the treatment of Japanese cedar pollinosis.
Medicine, Kampo ; Japanese language ; Clinical ; Therapeutic procedure ; Western Herbs and Botanicals

Vasospastic angina (VSA) is a condition in which a relatively large coronary artery transiently exhibits abnormal vasoconstriction. Although an angina attack by VSA can usually be controlled with nitrates and calcium channel blockers (CCB), there are some patients whose VSA cannot be controlled even by combinations of these drugs. We report here two cases of VSA successfully treated with a combination of the traditional Japanese herbal (Kampo) medicines shigyakusan and keishibukuryogan. Case 1 was a 73-year-old male with chest discomfort during effort and at rest. A 24-h Holter monitoring showed a short period of marked ST segment elevation associated with his chest pain. Although nitrates and a CCB were administered, his symptoms persisted. We then prescribed shigyakusan and keishibukuryogan, and his chest pain improved. Case 2 was a 58-year-old male with chest discomfort at rest. Acetylcholine-provoked coronary spasm was observed. Although he was prescribed nitrates and a CCB, these medicines were not effective. After we prescribed shigyakusan and keishibukuryogan, his chest pain improved. The results experienced in these two cases suggest that shigyakusan and keishibukuryogan could be useful formulations for the treatment of VSA uncontrolled by conventional medical treatment.

The treatment of palpitation with a weak constitution through the use of modern western medicines is often difficult. We report here 4 cases of palpitation with weak constitution, which were successfully treated with shokenchuto. Case 1 was a 67-year-old female, who complained of palpitation, as well as anorexia and easy fatigability. An electrocardiogram (ECG) showed premature supraventricular contractions. Case 2 was an 83-year-old female, who also complained of palpitation and gastrointestinal dysfunction. ECG revealed premature ventricular contraction. Case 3 was a 34-year-old male, who complained of palpitation with gastrointestinal dysfunction and diarrhea. ECG findings were characteristic of Brugada syndrome. Case 4 was a 71-year-old female, who complained of palpitation and concomitant diarrhea and anorexia. All patients demonstrated tension of bilateral rectus abdominis muscles. After we prescribed shokenchuto, most of their symptoms improved. Thus, shokenchuto may be a suitable herbal medicine for patients with weak constitution presenting with palpitation.

Many patients with palpitation consult outpatient cardiology departments. They may present with cardiac tuning abnormality (arrhythmia), which manifests as morbid palpitations. Appropriate diagnosis and treatment of palpitation are crucial to prevent adverse cardiac events. However, palpitations, in addition to anxiety and dyspnea, are often not considered as significant factor for morbidity in Western medicine. Conversely, Kampo (traditional Japanese medicine) can be used to treat the constitution of the patients, including those with or without disease diagnosed by Western medicine. However, there are no reports on the efficacy of Kampo in many examples. In this study, we diagnosed and provided appropriate Western medicine treatment for 101 outpatients with palpitation who consulted our department. We give priority to it if we evaluate the treatment of the disease of Western medicine was required (group W : n = 19). When an appropriate diagnosis could not be made by Western medicine, or when no therapeutic effect was noted with Western medicine, we administered Kampo medicine alone (group K : n = 62) or combination therapy (Kampo and Western medicine ; group KW : n = 20). The treatment efficacy was evaluated in each of the three groups. We observed high efficacy in all 3 groups (group W = 100%, group K = 96%, and group KW = 100%). Therefore, for patient with palpitation, combined treatment with both Kampo and Western medicine could improve their symptoms.

Here we report 3 cases of advanced cancer using multidisciplinary treatment including reibaisan (WTMCGEP, a dry extract of Wisteria floribunda, Trapa natans, Myristica fragrans, Coix semen, Ganoderma lucidum, Elfvingia applanata, Punica granatum). Case 1 : 87-year-old man, suffering from stage IV esophageal squamous cell carcinoma (ESCC) with aortic and bronchial invasion, was referred to our clinic for palliative care. He had radiotherapy and chemotherapy. Only one course of chemotherapy was performed due to its intolerable side effects. The treatment with reibaisan started 11 months after the diagnosis. ESCC disappeared after 17 months of reibaisan treatment, and no relapse was observed for 66 months after the diagnosis. Case 2 : 79-year-old man, suffering from stage III ESCC, was initially scheduled for surgery after preoperative chemotherapy. Only one course of preoperative chemotherapy was performed because of its intolerable side effects. Therefore, radiotherapy combined with reibaisan followed. ESCC disappeared 6 months later, and no relapse was observed for 33 months after the diagnosis. Case 3 : 73-year-old woman, suffering from stage IV pancreatic cancer with systemic metastasis (brain, lung, and peritoneum). She initially showed Trousseau syndrome and was treated with low-molecular-weight heparin for multiple cerebral infarctions. One-month palliative chemotherapy and reibaisan resulted in a rapid reduction of ascites and improvement of neurological symptoms. Her progression-free survival period was 7 months. She lived 13 months thereafter. This suggests that reibaisan, which contains crude drugs that have been shown to have antitumor effects, may be another promising treatment for advanced cancers.

A 22-year-old woman was admitted to our hospital with high fever and lumbar pain. Echocardiography revealed mitral regurgitation due to prolapse of the anterior mitral leaflet. On admission, her white blood cell count was high and results for C-reactive protein were positive. The blood culture was positive for hemolytic streptococcus. After the white blood cell count and C-reactive protein level were normalized, and the blood culture had become negative following treatment by multiple antibiotics, she underwent valvular surgery. Because the infectious lesion was limited to the mitral leaflet and chordae, mitral valvuloplasty was performed with a satisfactory postoperative result. The operative technique consisted of resection of the infected valvular tissue, implantation of artificial chordae with e-PTFE, and suture annuloplasty. To conclude, mitral valvuloplasty should be the operative method of choice in patients with infective endocarditis, especially in young women with the potential of future pregnancy and labor.

We report a case of refractory transient ischemic attack (TIA) successfully treated with chotosan. A 64-year-old woman with recurrent right hemiparesis and dysarthria was seen in our clinic. Twenty-three months before coming to our clinic, she had a history of right hemiparesis and dysarthria, which resolved soon after treatment. Magnetic resonance imaging (MRI) revealed an ischemic legion in the left corona radiata. Then 4 months before coming, she had repeated transient right hemiparesis and dysarthria, which lasted for 40 to 50 minutes and recurred 3 to 4 times a week. She was hospitalized and treated with an intensive TIA therapy including direct thrombin inhibitor, dual antiplatelet therapy, statin, calcium channel blocker and benzodiazepine. Though she continued the therapy for 4 months, it proved ineffective. She was referred to our clinic, and we started to administer chotosan 7.5 g per day for anxiety and dizziness during an attack. Chotosan attenuated TIA within a week, but aggravated after discontinuation on her own. The medication was resumed and TIA diminished within three months. Chotosan treatment has now been continued for 17 months without a single TIA for 14 months. Multiple studies have shown the protective effect of chotosan against cerebrovascular diseases including cerebral infarction and TIA. Therefore, chotosan may be an effective prescription for refractory TIA.

Background/Aims: Intestinal fibrosis is a major complication of Crohn’s disease (CD). The profibrotic protein transforming growth factor-β (TGF-β) has been considered to be critical for the induction of the fibrotic program. TGF-β has the ability to induce not only the expression of extracellular matrix (ECM) including collagen, but also the production of plasminogen activator inhibitor-1 (PAI-1) that prevents enzymatic degradation of the ECM during the onset of fibrotic diseases. However, the significance of PAI-1 in the developing intestinal fibrosis has not been fully understood. In the present study, we examined the actual expression of PAI-1 in fibrotic legion of intestinal inflammation and its correlation with the abnormal ECM deposition. Methods: Chronic intestinal inflammation was induced in BALB/c mice using 8 repeated intrarectal injections of 2,4,6-trinitrobenzene sulfonic acid (TNBS). TM5275, a PAI-1 inhibitor, was orally administered as a carboxymethyl cellulose suspension each day for 2 weeks after the sixth TNBS injection. Results: Using a publicly available dataset (accession number, GSE75214) and TNBS-treated mice, we observed increases in PAI-1 transcripts at active fibrotic lesions in both patients with CD and mice with chronic intestinal inflammation. Oral administration of TM5275 immediately after the onset of intestinal fibrosis upregulated MMP-9 (matrix metalloproteinase 9) and decreased collagen accumulation, resulting in attenuation of the fibrogenesis in TNBS-treated mice. Conclusions PAI-1-mediated fibrinolytic system facilitates collagen degradation suppression. Hence, PAI-1 inhibitor could be applied as an anti-fibrotic drug in CD treatment.