In Kampo medicine, the emotion of fear is closely related to the kidney. Therefore, rokumigan medication for kidney malfunction can be expected to be effective for fear-related psychiatric symptoms. The author has experienced 7 cases with neurosis successfully treated with rokumigan. Three cases were diagnosed as adjustment disorder, two cases as social phobias, one case as generalized anxiety disorder, and one case as psychosomatic disease. Three cases were effective with a single administration of rokumigan, while four cases needed another medication such as etizolam and other Kampo medicines. All cases had symptoms for jinkyo such as weakening of the lower body, shofuku-fujin (weakness or numbness of the lower abdomen) and weak palpation at shakumyaku points. All cases had symptoms for hot state, and six cases had symptoms for deficiency of ki. Furthermore, these cases for rokumigan were effective not only for fear, anxiety, and insomnia, but also dysuria, simultaneous existing cold and hot state and menstrual disorder as atypical genital bleeding.

Psychotropic drug dependence, especially with benzodiazepines, is recognized as a growing problem. Several alternative agents such as selective serotonin reuptake inhibitors (SSRIs) have been suggested as benzodiazepine replacements. The author here reports two cases with neurosis in which psychotropic drugs were successfully replaced with Kampo medicines such as saikokeishito, saikokeishikankyoto, kihito, kamishoyosan, and saikokaryukotsuboreito. As two patients discontinued benzodiazepines, rebound symptoms arose in one, and the other exhibited withdrawal symptoms and relapsed. These symptoms gradually improved, however, and Kampo medicines were able to contribute toward their complete alleviation. This suggests that Kampo therapy can be an alternative to psychotropic drugs, especially benzodiazepines.

Huangdi Neijing has a disease concept named Yi ‘Wei' disease which is similar to ‘frailty'. Yi disease is characterized by physical and/or mental dysfunctions eventually being unable to stand up. Yi disease are classified into five types : the lung Yi ‘qi deficiency', the heart Yi ‘vascular disorders', the liver Yi ‘muscle weakness' like sarcopenia or ‘qi stagnation', the spleen Yi ‘spleen deficiency, weight loss or excess weight', and the kidney Yi ‘kidney deficiency'. Each condition can be treated by Kampo medicines. Therefore, frailty can be treated by Kampo medicines systematically and strategically. The author reports here two cases of frailty with weight loss successfully treated by Kampo medicines in giving priority to spleen Yi morbid state. One of 2 patients had a drug induced gastrointestinal disorder caused by probably previously taking Kampo hachimigan. After treating the spleen Yi, she became able to take hachimigan for the kidney Yi again. These cases suggest that high priority should be given to restoring spleen conditions, or digestive functions in treating frailty with weight loss caused by anorexia or digestive dysfunction.

Two different types, called “Yin-Yang Wu Tai” and “Yin-Yang Er Shi Wu Ren,” respectively, are described in the Huang Di Nei Jing, Ling Shu section. Each type can be divided into four closely interrelated sub-items: character, physique, constitution and therapy. These relations can be explained with the concept of the “unity of the physical and spiritual,” which is based on a holistic perspective with physical referring to the body and spiritual referring to mental activity.
If we regard these types as psychologic, we can compare them with present western psychological types. E. Kretschimer and L. Corman discussed this in relation to “character and physique” or “character and countenance.” Kampo examination of the physique and countenance are anthroposcopic. In contrast, the examination of character includes both anthroposcopy and medical interviews. Applying this knowledge, it may be possible to improve diagnostic techniques in Kampo medicine.

A 71-year-old man with double vessel disease (left anterior descending artery and right coronary artery) was surgically treated by off-pump coronary artery bypass grafting. He had undergone pre-sternal subcutaneous gastric tube reconstruction and mediastinal radiation therapy 19 years previously due to esophageal cancer. The gastric tube prevented the median sternotomy that is commonly necessary for cardiac surgery. In cases with difficulties of median sternotomy, left anterolateral thoracotomy and the use of the subclavian artery as inflow root for bypass grafting are available. Both radial arteries were harvested as graft conduit, because of prospective severe adhesion of left internal thoracic artery due to previous radiation. The radial artery was anastomosed on the back side of the left subclavian artery with side-to-end fashion. Y-shaped composite graft was made with the other arterial graft. Both ends were anastomosed to the left anterior descending artery and the right posterior descending branch on the beating heart status without cardiopulmonary bypass. Intra-operative SPY images showed good patency of both bypass grafts. The post-operative course was eventful. The catheter angiography revealed all graft patency 5 years after the surgery.

A 49-year-old man presented with subclavian steal phenomenon and severe stenosis of LMT. His SSP was composed of severe stenosis of the innominate artery, and the greater part of the blood supply to the right subclavian artery was through the collateral circuit of the vertebral arteries and the internal thoracic arteries. We performed replacement of the innominate artery with a prosthetic graft and coronary artery bypass using LITA in one-stage surgery.

Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by thrombocytosis and malfunction of platelets. Both thrombosis and bleeding due to thrombocytosis may occur. An 81-year-old female patient complicated with ET underwent mitral valve replacement using a bioprosthetic valve due to severe mitral regurgitation. She had been diagnosed and treated with the hydroxycarbamide for ET. The hydroxycarbamide had been interrupted 14 days before the surgery, to prevent infection and delayed wound healing. At hospitalization for surgery, her platelet count rose to 1,290,000/μl from 790,000/μl. Readministration of a half dose of the hydroxycarbamide lowered the platelets to her original level. During the operation, more heparin was necessary to control activated coagulation time for cardiopulmonary bypass. She was discharged unaffectedly on 25 POD.

Since the rectus femoris muscle is associated with trauma and disorders such as muscle strain, it is often a target for evaluation and treatment. However, in many studies, measurement results were obtained from only a part of the rectus femoris muscle and used as a representative value without considering the differences across the muscle. The rectus femoris muscle may change shape with knee flexion because the structure is complicated; it has an intramuscular tendon. The purpose of this study was to assess the changes in shape of the rectus femoris muscle during flexion of the knee joint in different directions. Twelve lower limbs of 12 male university students were analyzed. The rectus femoris muscle was divided into eight parts, and short-axis images were taken with an ultrasonic diagnostic imaging device at the knee joint; in extension; flexion at 30 °, 60 °, 90 °, and 120 °; muscle thickness; muscle width; and cross-sectional area. It was suggested that the thickness of the rectus femoris muscle increased from “A” to “F” due to knee flexion, and that this increase occurred because of stretching at the same site. In “G,” there was no difference between the angle conditions; conversely, in “H,” the muscle thickness decreased due to knee flexion. It should also be noted that D and E have the greatest muscle thickness when measuring in the knee flexion position.