Patients suffering through a period of shoinbyo (shao yin bing) must essentially be treated for impaired renal function. Formulations commonly prescribed during this period can be divided into two categories: the Shigyakuto (si ni tang) group which includes Glycyrrhizae Radix, and the Hakutsuto (bai tong tang), Hakutsukachotanjuto, Shimbuto (zhen wu tang) and Bushito (fu zi tang) groups, which do not include roasted Glycyrrhizae Radix. In order to understand the significance of Glycyrrhizae Radix, we have examined symptomatic differences in life-threatening situations, by comparing Shigyakuto and Hakutsuto formulations, based on both previous cases, and our own clinical studies.
Shigyakuto is composed of roasted Glycyrrhizae Radix, Zingiberis Siccatum Rhizoma, and crude Aconiti Tuber, while Hakutsuto is composed of Allii Fistulosi Bullbus, Zingiberis Siccatum Rhizoma, and crude Aconite Tuber. These formulations activate renal function, as well as gastroenterological function (bu pi wei). Which function is affected dominantly, however, appears to be dependent on whether roasted Glycyrrhizae Radix is included. In the Shigyakuto group of formulations which include Glycyrrhizae Radix, the activation of gastroenterological function is greater than that of renal function, whereas in the other formulation groups which do not include Glycyrrhizae Radix, activation of renal function is greater. This treatment principle can be applied not only in the acute phase of shoinbyo, but in the chronic phase as well. Therefore we believe that roasted Glycyrrhizae Radix has an important role in the effective Kampo treatment of patients suffering through periods of shoinbyo.

I consider keikyososooushinbuto is compounded with Ephedra and Asarum to keishikyoshakuyakukabushito. I studied many successfully treated cases with keikyososooushinbuto to indicate the sho of it. Keishikyoshakuyakukabushito is formed from keishikyosyakuyakuto with coldness. In the text of keishikyoshakuyakuto of the “Shang Han Lun,” after treatment with the purgative, the stomach yang becomes weakened and the stomach yin reverses up to the chest pathologically. This critical condition deteriorates by the coldness into the debilitation of the heart yang, therefore the addition of Ephedra and Asarum is needed. I think this pathological state is the basis of the sho of keikyososooushinbuto. The symptoms of the clinical cases vary, and every part of the body can be affected. But I found the common physical signs of these cases, which have two points with tenderness ; one is located on the bilateral intercostal parts of the end of the sternum, and the other is on the muscle bedside the spines Th 12-L 1. These are the signs of the fullness in the chest described in the text of keishikyosyakuyakuto, which is the indispensable symptom when I use keikyososooushinbuto clinically.

Based on our own 35 cases treated with kobokushichimotsuto as well as our predecessors' experience and their opinions, we investigated the drug's mechanism of action and its background indications. Our predecessors' opinions seem to be divided into two groups. Group A : An external pattern/syndrome (a keishito indication) of external contraction, followed by an interior heat pattern/syndrome (a kobokusammotsuto indication) appear. Mechanism of disease wise, this means that both external and internal patterns/syndromes exist at the same time. Because an internal pattern/syndrome is heavier than an external one, both patterns/syndromes are simultaneously treated, by making both medicinals bound together. Group B : Internal heat due to yang exuberance with yin debilitation is the mechanism of disease here. In group A, cause of disease is classed as a true heat pattern/syndrome. In group B, depending whether the internal heat belongs to either true heat or false type, deficiency and excess of pulse/abdominal patterns/syndromes change, and appetite differs. In either group, no peony is used to cope with the chest pattern/syndrome induced by the progression of gastric heat into the chest. Our cases consisted of upper respiratory illnesses with appetite loss, gastrointestinal diseases with chest oppression, respiratory diseases and intestinal obstructions. Kobokushichimotsuto, however, can be applied to neuroses, mental disorders and low back pains.