Chronic fatigue is a common symptom in primary health care and caused by various organic and functional diseases. Although improvement is attained by controlling underlying organic disease, it is sometimes difficult to relieve fatigue in patients with chronic fatigue syndrome or dysthymia. We have encountered patients with idiopathic chronic fatigue (ICF) successfully treated with sansonintokagen. A 62-year-old female complained of chronic fatigue several years after menopause, and had normal status in routine blood and image analyses at a nearby hospital. Her condition was diagnosed as ICF with sleeplessness. Treatment with sansonintoaogibakumondo for 8 weeks improved her chronic fatigue and sleeplessness, and enabled her to continue housekeeping. This observation suggests that this kampo formula may be a useful agent for ICF.

Using textbooks of Western medicine and Kampo medicine in Japan, we examined descriptions in classification and laxative therapy of chronic functional constipation. In terms of the relationship between stool shape and patient's age, description in Kampo textbooks was contrary to that in the textbook of Western medicine. The opinions on the long-term use of rhubarb also divided between Western medicine and Kampo medicine, although in Kampo medicine there was some opinion that the long-term use should be discouraged.

A patient with systemic lupus erythematosus (SLE), complicated by severe thrombocytopenia was successfully treated with Juzen-taiho-to. The patient was a 38-year-old woman presenting thrombocytopenia in 1974. She was diagnosed as having SLE with the appearance of renal failure in 1975. In 1984, she began blood dialysis due to deterioration of renal function. In addition, she repeatedly suffered from severe bleeding episodes due to thrombocytopenia. In 1989, she visited our clinic to undergo Kampo therapy, with no significant results obtained with any of the formulas tried.
In September 1992, she suffered from duodenal ulcer bleeding and stopped Kampo therapy for some time. However, since she began taking Juzen-taiho-to in June 1993, her thrombocytopenia improved and her platelet count stabilized at 10-15×10⁴/mm³. This made it possible to taper the dosage of the steroids being administered. Since July 1994, the prednisolone (PSL) dosage has been 5mg on alternate days. Since July 1995, the anti-DNA antibody was negative. The platelet count has been maintained at 15-20×10⁴/mm³ (as of December, 1996).

Medicine, Kampo ; Names ; Disease ; Diagnosis

In 1989, a 17-year-old male patient had fever and was admitted to a hospital in his neighborhood. He was then diagnosed as having Crohn's disease of the colon and ileum. His condition improved when treated with parenteral hyperalimentation via the central vein, an elemental diet, and salazosulfapyridine. Every time a normal diet was introduced, it recurred, which required a second hospitalization. At the third recurrence in July 1992, he expressed the desire to have Kampo medicine and subsequently visited our department. The inflammatory reactions were severe, and he had fever and was losing weight. He was fasted and given parenteral hyperali-mentation via the central vein. He received Kyuki-kyogai-to and Hange-shasin-to concomitantly which were prescribed according to his kampo diagnosis. One month later, CRP was negative and an elemental diet was started. Two months later, he was able to take both elemental and normal diets. Remission is still being maintainned even after he started the normal diet again.
Kampo medicine achieved a prolonged remission in this case where Crohn's disease kept recurring when hyperalimentation therapy was given, This suggests that a combination of an elemental diet and Kampo medicine may play an important role in maintenance therapy for this disease.

The authors would like to report the successful treatment with Hochuekki-to and Keishibukuryo-gan of a case of chronic renal failure that had deteriorated rapidly in a short period of time.
The patient was a 29-year-old woman that had been diagnosed as having IgA renal syndrome in 1987 after a local physician had detected proteinuria and requested a renal biopsy. In November of the same year she came to the authors' clinic requesting Kampo therapy. After her kidney function was stabilized with such formulas as Gorei-san and Byakokaninjin-to, the patient stopped coming to the clinic. In February of 1992, she returned to the clinic with renal failure following an episode of acute pneumonia. She was admitted to the hospital due to hypertension (Cr 2.8mg/dl; BUN 20mg/dl). Dietary therapy and hypertension control were carried out, and administration of 40mg/day of prednisone (PSL) was commenced on the 10th day following admittance. Since the proteinuria remained unchanged, 1g/day of methyl-PSL was given for three days from the 18th day after admittance. However, by the 38th day (4 weeks after commencement of PSL administration) the Cr was 5.0mg/dl. At this point the Kampo formula was changed from Sairei-to to Hochuekki-to in conjunction with Keishibukuryo-gan-ka-kokadaio. Her kidney function began to improve, and by the 108th day the laboratory findings had decreased to Cr 2.7mg/dl and Bun 26mg/dl and the PSL dosage was reduced to 20mg/day. She was discharged from the hospital on the 110th day, and has been progressing well as an out-patient.

Unkei-to was used successfully to treat three patients with primary Sjögren's syndrome (pSjS). The first case was a 67-year-old woman. In April 1993, she visited Tonami General Hospital with the symptom of dry eyes. Her condition was diagnosed as pSjS from being antinuclear antibody (ANA) positive, dry eye, and decrease of saliva secretion. She used eye drops, but her dry eye did not improve, she visited our department in June 1995. Administration of Unkei-to improved her symptoms after 6 months of treatment.
The second case was a 73-year-old woman. In 1987, she was treated in our hospital for lumbago based on spondylosis. In 1991, she began to suffer from pain and swelling of the right sterno-clavicular joint (RSCJ) and was admitted. She was anti-SS-A/Ro ANA positive, schirmer's test was positive, lymphocyte infiltration was observed by lip biopsy, and thus pSjS was diagnosed. Treatment with Unkei-to resulted in the improvement of pain and swelling of RSCJ, as well as a decrease in serum C-reactive protein. But a favorable effect on dry mouth was not attained in this case.
The third case involved a 39-year-old woman who began to experience polyarthralgia and dry mouth in June 1991. She visited a neighborhood hospital and was diagnosed as pSjS from hyper γ-globulinemia, anti SS-A ANA positivity, and decrease of saliva secretion. She first visited our hospital in March 1994. We administered Keishikaryojutubu-to and improvement of polyarthralgia was observed. Subsequently, she suffered from symptoms of dry eye and dry mouth. We treated her with Unkei-to, which improved the symptoms of dryness, but not polyarthralgia in this case.
These observations suggest that Unkei-to might be a useful agent for the treatment of pSjS.

Keishi-kyokei-ka-bukuryo-byakujutsu-to has been traditionally used for acute infectious diseases, such as the common cold, accompanied by epigastric discomfort and tenderness. However, the specific dosage for chronic diseases has not been clearly set yet. This study involved 4 cases with headaches, dull headaches, stiff shoulders and lumbago, so called neck, shoulder and arm syndrome which responded to Keishi-kyokei-kabukuryo-byakujutsu-to. The experience of these cases suggests that conditions indicating Keishi-kyokei-kabukuryo-byakujutsu-to have the following features: (1) dry skin, (2) edema and impressions of teeth at the rim of the tongue, (3) tenderness upon pressure in the epigastric region and sound of fluctuating liquid in the stomach, (4) Ki-deficiency.

We present here two cases of rheumatoid arthritis (RA) treated with Shikunshi-to-ka-keishi-shakuyaku-yokuinin. Case 1 was a 71-year-old female who had been suffering from RA for two years and had been treated with western medicines. Keishi-ni-eppi-itto-ka-ryojutsubu-to offered some degree of palliation at first, but soon came to cause itchy eruptions and anorexia. On the other hand, treatment with Shikunshi-to-kami-ho (described above) for nine months achieved complete remission without any adverse reactions. Case 2 was a 52-year-old female who was diagnosed as RA in 1989 and had discontinued treatments with a variety of DMARDs (disease modifying anti-rheumatic drugs) because of adverse reactions such as eruptions, anorexia, and loss of hair. Moreover, many Kampo medicines with low-dose steroids were less effective. Shikunshi-to-kami-ho, which was administered after Kampo-medicine-induced liver damage, produced clinical effects to some degree. Shikunshi-to-kami-ho may be useful in the treatment of RA patients who have developed adverse reactions such as eruptions, liver damage, and anorexia.

We report a case of rheumatoid arthritis (RA) that showed improvement after treatment with Daiseiryu-to-kadaiou. The patient was a 77-year-old woman diagnosed with RA in 1988. She had been visiting our department regularly since 1994. Oral steroids were used for two weeks in May 1994, but were discontinued due to a bacterial infection of the artificial femoral head. Thereafter, treatment was continued with bucillamine, nonsteroidal anti-inflammatory drugs, and various Kampo medicines. Joint pain worsened in November 2001. She was hospitalized on **********, as the CRP level had elevated to 15.2mg/dl. She had been taking bucillamine for seven years, but it had already been assessed as ineffective. It was discontinued upon hospitalization, and treatment with Daiseiryu-to-kadaiou was immediately begun. By ******, the patient judged the pain in both knees to have improved by about 50 percent. Moreover, the CRP level decreased to 2.4mg/dl by *******. The Lansbury index also improved from 100 percent to 69 percent during her hospitalization, and she was discharged on *******. Based on this experience, it is suggested that the prescription of Daiseiryu-to-kadaiou be considered in the treatment of RA patients.