Atopic dermatitis in adolescents and adults has severe erythema and desquamation, particularly on the face and the neck, and is often resistant for various treatments. We previously reported the case of intractable erythematous dry-type atopic dermatitis where Kagen-ichiin-sen-ka-kiban-kyo was effect. Kagenichiin-sen-ka-kiban-kyo has an effect for nourishing Yin and Blood. Although its antiinflammatory effect is weak, we expected it would improve the deteriorated barrier function of the skin by moistening dry skin, and treat the atopic dermatitis more fundamentally. This time aiming broad application for the lesion of exudative eczema, we treated atopic dermatitis by using sekko-added Kagen-ichiin-sen-ka-kiban-kyo (Kagen-ichiin-sen-ka-kiban-kyo-sekko). The moisture content of the forehead and the extensor surface of forearm sequentially increased. And IgE-KIST and LDH, the markers of the state of a disease, were significantlly reduced. Good results were given; 68.8% of efficacy in men and 77.8% in women.
This Kampo formulation is assumed one of the effective formulations for the treatment of atopic dermatitis.

Acute autonomic neuropathy is a syndrome where the peripheral nervous system is damaged acutely, primarily, and diffusely. For refractory orthostatic hypotension, which persists in cases where the disorder has not been cured completely, hypertensors or mineralocorticoids are generally administered. We observed that patients who did not respond to such agents did, however, respond to Ryokei-jutsukan-to, although no one has reported previously on the use of this Kampo formulation for acute autonomic neuropathy. In order to define the mechanisms of action of this formulation, we conducted orthostatic tests and drug loading tests and also studied endocrinology and hemodynamics. Blood pressure rose with the treatment of Ryokei-jutsukan-to, and this proved to be due to an increase in peripheral vascular resistance. Furthermore, cardiac output was decreased, and the renin-angiotensin-aldosterone system, which had been slightly activated, was corrected. The increase in peripheral vascular resistance appears to be a result of direct action on the vascular wall, since the formulation inhibited the sympathetic activity and improved the denervation hypersensitivity of peripheral vascular receptors.

In order to determine the pharmacological effects of Crocus (traditionally classified as an herb helpful in eliminating Blood Stagnation), the 11-dehydro TXB₂, platelet aggregation, blood viscosity and laboratory data of 12 healthy sexually mature females were examined during the menstrual, follicle and corpus luteum phases before the test substance was administered. Compared with the follicle or corpus luteum phases, higher levels of 11-dehydro TXB₂ and increased mean cell volume (MCV) were found during the menstrual phases. This suggested that the increase in blood viscosity may be due to a lowering of erythrocyte deformation resulting from increased mean cell volume. From the fact that the highest endometrial PGE₂ value was exhibited during the menstrual Phase, PGE₂ was thought to be involved in the MCV increase. Next, plain hot water was administered to the six cases in the control group (for four weeks), and Crocus infusion administered to the other six cases (for four weeks), after which a comparative study was made of their indicators. The significant lowering of the MCV and blood viscosity during the menstrual phase upon Crocus administration suggested that an improvement in erythrocyte deformation brought about by decreased MCV played a role in the reduction of blood viscosity. Moreover, a decrease in 11-dehydro TXB₂ was observed during the low blood estrogen follicle phase. It has been reported that there is an overall increase in blood viscosity and acceleration of platelet and thrombin synthesis associated with the disease state known as “Blood Stagnation”. From the clear effects of Crocus upon these indicators, its effectiveness as an herb useful in eliminating Blood Stagnation in healthy sexually mature females was indicated.

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.

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.

There are many indications for Ryo-kei-jutsu-kan-to, such as orthostatic hypotension, cardiac neurosis, migraine, congestive heart failure, benign paroxysmal positional vertigo and eye disease. Although in oriental medicine Ryo-kei-jutsu-kan-to is used as a hydragogue agent for sui-doku (disorders of the body's fluid metabolism), its actual effect on hydragogue action remains unclear. We previously carried out hemodynamics tests before and after administration of Ryo-kei-jutsu-kan-to for a patient with orthostatic hypotension due to peripheral autonomic disorder. The pathosis of the patient before administration of Ryo-kei-jutsu-kan-to was found to be sui-doku caused by the excessive increase of circulating blood volume. We reported that after administration of Ryo-kei-jutsu-kan-to the blood pressure of the patient in the standing position was elevated by increased peripheral vascular resistance, while excessively increased circulating blood volume decreased. This time we administered Ryo-kei-jutsu-kan-to for four cases, such as orthostatic hypotension with migraine, cardiac neurosis, congestive heart failure, and hypotension in dialysis. We again realized that it also increases peripheral vascular resistance. As one of the dimensions of so-called hydragogue action, it is important to understand that Ryo-kei-jutsu-kan-to has a hydragogue effect against the retention of excess fluids (sui-doku) in the body through increasing peripheral vascular resistance by vasoconstriction.

Currently, Keishi-bukuryo-gan is widely used for overcoming blood stagnation, and is most frequently used for adult women with blood stagnation (Oketsu) presenting the cold and hot flush (rush in the bust and cold in the lower half of the body) such as menopausal disorder. This time, we carried out thermographic tests for two groups: the patients with subjective symptoms of the cold and hot flush (group 1:8 adult women) and patients with subjective symptoms of cold sensation only in the lower limbs (group 2:8 adult women).
In the first group the difference between the surface temperature of the skin of the upper abdomen and that of the lower abdomen was more significant as compared with the second group. We also observed both groups for 60 minutes after administration of Keishi-bukuryo-gan. In the second group the surface temperature of the skin of both upper and lower abdomen decreased. In the first group, however, the skin temperature of the upper abdomen decreased but that of the lower abdomen increased in reverse, and the difference of the temperature between the upper abdomen and lower abdomen was reduced. This means Keishi-bukuryo-gan worked for improving “the cold and hot flush, ” i. e., the imbalance of the endocrine system and autonomic nervous system.
The findings suggest that Keishi-bukuryo-gan treatments for hot flush, which is the increase of the skin temperature caused by telangiectasis of the skin of the upper body, may increase the blood flow in the lower abdomen and improve pelvic congestion, which is one of the conditions of blood stagnation, as well as decreasing the skin temperature by contracting peripheral vessels.

Zentai (Cicadae Periostracum) is classified by traditional Chinese medicine as one of the “pungent cool-natured” drugs, but its pharmacological action is not well known yet.
Zentai is used in Shofu-san as an expelling pathogenic wind component for relieving itchiness for patients with eczema, dermatitis, urticaria, etc.
We examined a number of patients with atopic dermatitis whose condition worsened after they were treated with Zentai to relieve itchiness.
In the current study, five male and ten female adolescent/adult patients were randomly selected to receive 2.5g of Zentai. These patients had been treated with Kagen-ichiin-sen-ka-kiban-kyo and their skin conditions had been stable so far.
In a follow-up two weeks later, the water content of the horny layer of skin at the forehead and the anterior side of the forearm decreased significantly (p<0.05). In terms of the level of itchiness, two patients (13.3%) improved, nine patients (60%) worsened, and the other four (26.7%) remained unchanged.
The current study indicates that Zentai worsens dry skin and exacerbates itchiness. Care will be required in the use of Zentai for the treatment of atopic dermatitis because of its drying pharmacological character.