Case 1 was a 70-year-old female patient who visited our Department mainly due to palpitations which had persisted for the previous four years. From about one year ago, paroxysmal palpitations have occurred frequently. The 24-hour Holter ECG monitoring and echocardiography indicated supraventricular arrhythmia, but there was no temporal association between the arrhythmia and the palpitations. She was very nervous and irritable. She felt fullness of the upper abdomen and palpitations in the lower abdomen. She was given Chugoho-honton-to-ka-bukuryo-byakujutsu. One week later, the palpitations became less frequent, and two weeks later they all but disappeared.
Case 2 was a 41-year-old male company employee. He visited our Department complaining of general malaise, abnormal perspiration of the upper body, and pain in the fingers. Six years previously, he had developed erythema both in the palms and in the soles of the feet and also pain in the fingers of both hands. Four years ago, swelling occurred in the tips of his fingers and toes, which then aggravated. He was diagnosed as having acromegaly accompanied by pituitary adenoma and subsequently underwent resection of the pituitary tumor. After the operation, he developed general malaise and abnormal perspiration in the upper body, which obliged him to take time off work. Based on marked feelings of heat in the upper body and cold in the lower body and also abnormal sweating attacks, he was considered to be suffering from hypochondriasis with palpitation attack. One week after he was started on Chugoho-honton-to-ka-bukuryo-byakujutsu, his legs no longer felt cold. Symptoms of the joints and abnormal sweating subsequently improved, which enabled him to return to work.
Case 3 was a 32-year-old housewife who visited our Department complaining of headache and pain in the right shoulder. She had had contusion in the scapula ten years previously and had been suffering from dull pain ever since. Seven years ago, when she had a baby, she developed severe pain in the paraspinal muscle facing the right scapula. This severe pain radiated along the dorsal muscle and was accompanied by headache. Because she felt hot in the upper body and cold in the lower body, subjective palpations in the upper abdomen, and a mass in the hypochondria and umbilical region, Chugoho-honton-to-ka-bukuryo-byakujutsu was given. This produced excellent results.
Based on the experience of these three cases together with what can be found in the literature, we believe that conditions where Chugoho-honton-to-ka-bukuryo-byakujutsu are indicated have the following features. (1) The conditions are often triggered by fright, fear, depression etc. (2) There exist paroxysmal palpitations, headache, and the sensation of hot flushes. (3) A feeling of anxiety ascends from the abdomen. (4) The disease is in the initial stage of the three Yin diseases. (5) There are signs and symptoms of a deficiency in Qi. (6) There are subjective palpitations in the upper abdomen and in the epigastrium. (7) There is fullness of the upper abdomen and epigastrium, often accompanied by a mass in the hypochondria or umbilical region.

The relationship between tongue coating and Pancreas exocrine function was investigated in 45 cases by pancreatic function diagnostant. These cases were classified into three groups, “slight, ” “moderate” and “marked” according to the degree of thickness of tongue coating. Among the three groups, the mean rate of PABA excretion in urine tended to decrease as the degree of thickness of the tongue coating increased. That in the marked group was lower than in the slight group with statistical significance. The results suggest that thickness of tongue coating is partially related to pancreas exocrine function.

We successfully treated two chronic hepatitis B patients with Hochuekkito-go-Keishibukuryogan. Case 1 was a 27-year-old male diagnosed with chronic hepatitis B in 1998, who had received interferon (IFN) therapy. Liver function tests did not improve with this therapy. He visited the department of Japanese Oriental Medicine at Yukiguni-Yamato Hospital, complaining of fatigue, on **********. We initiated treatment with Hochuekkito-go-Keishibukuryogan. At two months of treatment, marked improvement in liver function tests was noted, with normalization of ALT, seroconversion (SC) and negative HBV-DNA. Case 2 was a 26-year-old male diagnosed with chronic hepatitis B in 2001 who had received IFN therapy. Seven months after termination of this therapy, on **********, he visited our department for a flare-up of hepatitis. Treatment with Hochuekkito-go-Keishibukuryogan was begun. Almost immediately, marked improvements were observed in the form of ALT and SC normalizations, and only slightly positive HBV-DNA.

The purpose of this study was to investigate the reappearance of the post-absorptive resting metabolic rate (PARM) during a prescribed diet. The subjects were 10 sedentary female college students (20.1±0.7yrs) . Thyroid function was judged in all of them to be within a normal range. Subjects stayed in a metabolic ward at the National Institute of Health and Nutrition for 18 days. The post-absorptive resting metabolic rate was measured 4 times during the experimental period. Moreover, blood was collected five times, and general health care including the measurement of thyroxin by blood biochemical examination was carried out. As for the actual metabolic measurements, a high reappearance was confirmed by the intra-individual coefficient of variation (CV) of the post-absorptive resting metabolic rate (3.5±1.8%) and the inter-individual CV (7.2%) . The smallest CV was the standard value of PARM/body surface area, followed by PARM/body weight, PARM/LBM, and PARM/urine creatinine. On the other hand, weight (50.8±4.9 vs 50.3±4.6 kg ; p<0.01), hemoglobin concentration (13.7 ± 0.5 vs 12.8±0.5g/dl ; p<0.05), serum total cholesterol level (194±41 vs 175 ± 37 mg/dl ; p<0.05) and post-absorptive resting oxygen uptake (0.149±0.01 vs 0.142±0.011/min ; p<0.01) decreased significantly during the experiment. According to the Japanese Recommended Dietary Allowances (RDAs) (1999), basal metabolic rate (BMR) was calculated at 1, 210 kcal/day or 23.6 kcal/kg body weight/day for women within the 18-29 year age group. But the results (the mean of all measurements) of this research suggested that this value was 1, 033 ± 79 kcal/day, or 20.7 ± 2.0 kcal/kg body weight/day based on the method of Weir ; and was approximately 10% lower than RDAs. Future investigation is required to explain the reasons for the difference in BMR between this study and that of previous ones.

The purpose of this study was to investigate the effect of changes in post-absorptive resting metabolism (PARM) on plasma triiodothyronine (T3) levels under a prescribed diet. The subjects were 31 sedentary female college students (19.9±0.9 yrs). Subjects stayed in a metabolic ward at the National Institute of Health and Nutrition for 18 days. PARM was measured 4 times during the experimental period. Additionally, blood was collected 4 times during the experimental period, and general health care including the measurement of thyroxin by blood biochemical examination was carried out. Subjects were divided into three groups (n=26, n=4, n=1), two of which were analyzed for this study. The two groups were divided according to thyroid function: Group N (n=26) included subjects in which T3 was judged to be within the normal range during the experimental period; Group L (n=4) included subjects for whom T3 was not normal during the study period, and was judged to be under the normal range at least once. The remaining 1 subject had a T3 judged to be over the normal range.For Group N, several parameters decreased significantly during the course of the experiment: weight was 51.5±4.97 vs. 50.8±4.3 kg (p<0.01); T3 was 1.16±0.19 vs. 1.01±0.12 ng/ml (p<0.01); and PARM was 3.1±0.2 vs. 2.9±0.2 ml/min/kg (p<0.05). For Group L, several parameters also decreased significantly during the course of the experiment: weight was 53.6±4.9 vs. 52.6±4.5 kg (p<0.01); T3 was 0.94±0.15 vs. 0.75±0.07 ng/ml (p<0.01); and PARM was 2.9±0.2 vs. 2.7±0.1 ml/min/kg (p<0.05). The average PARM of Group N was significantly higher than that of Group L (7.0%). PARM during the luteal phase of the menstrual cycle was significantly higher than during the menstrual phase (3.5 %), in subjects for whom the phases of the menstrual cycle were distinguishable (n=13).According to the 2005 Dietary Reference Intakes (DRIs) for Japanese, the basal metabolic rate (BMR) is calculated at 23.6 kcal/kg body weight/day, or 3.27 ml/min/kg translated for VO₂ for women within the 18~29 year age group. However, the values calculated from the measurements of this research study were approximately 9.5% lower for Group N and 15.8% lower for Group L than that of the DRIs.Future investigation is required to explain the reasons for the difference in PARM between this study and that of previous ones.

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 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.

We studied a case of bronchial asthma associated with irritable bowel syndrome which responded to Bukuryo-Keishi-Kanzo-taiso-to. The 54-year-old woman was admitted to our hospital due to recurrent abdominal pain and paroxysmal coughing. The abdominal pain was diagnosed as irritable bowel syndrome, and paroxysmal coughing as bronchial asthma. Uzu-Keishi-to, Sekiganyo, Gekyu-shokuso-to were given for abdominal pain, and Ryo-kan-kyo-mi-shin-ge-nin-to and Soshi-koko-to were given for cough. None of these, however, were effective. We consider the condition at the time of attack to be hypochondriasis with palpitation attack, including coughing and abdominal pain, based on the fact that (1) abdominal pain and paroxysmal coughing were accompanied by marked perspiration, (2) the patient felt that something was being pushed upward from the epigastrium into the throat, (3) the patient complained of coldness in the abdomen concomitant with a feeling of warmth in the head, neck, and chest, and (4) subjective palpitations in the upper and lower abdomen were significant. We then used Bukuryo-keishi-kanzo-taiso-to, and both the abdominal pain and the coughing improved using this formulation alone. Although there seem to be two different diseases, they can sometimes be treated as one in kampo medicine.