There are two opinions about the progression sequence of diseases in the yang stage pattern among the six stage patterns : one is in order of early yang stage pattern, middle yang stage pattern, and late yang stage pattern, and the other is in order of early yang stage pattern, late yang stage pattern, and middle yang stage pattern. Daijokito and byakkoto are often used to treat diseases of middle yang stage, whereas shosaikoto is staple formula for late yang stage pattern. In this article, the progression sequence of diseases in the yang stage pattern was analyzed based on the three common formulae used to treat yang stage pattern, focusing on the water content of living body. Daijokito and byakkoto are often used for the middle yang stage, and shosaikoto is a staple formula for the late yang stage. While the body fluid is relatively maintained in the pattern treated with byakkoto and shosaikoto, there is a significant fluid loss in the pattern treated with daijokito. The daijokito pattern is unlikely to progress into either pattern, while the opposite transition is possible. A transformation between the pattern treated byakkoto and shosaikoto is conceivable. Therefore, diseases could progress in either order ; early yang stage pattern, middle yang stage pattern, and late yang stage pattern, or early yang stage pattern, late yang stage pattern, and middle yang stage pattern.

A 20-year-old woman had a tendency of belching from a young age. She began to realize that she might have excessive belching compared to other people for the past two years. She was prescribed some medicines to improve gastrointestinal function by some physicians, but her symptoms did not resolve. Aerophagia was suspected as forceful belching tends to occur soon after eating or drinking. Incidentally, ihon is a condition in which one vomits food half a day after the ingestion due to the malfunction of the digestive system. I considered her symptoms as ihon and prescribed bukuryotakushato, and her symptoms improved. This case report indicated that ihon could be defined as a symptom of forceful regurgitation of food or air, regardless of the timing after meals.

Although saikanto has often been an effective Kampo medicine for chest pain accompanied by coughing or deep breathing, there are few reports on its usefulness in recent years. Here we report 3 cases of outpatients who visited the respiratory department of our hospital with the symptom of chest pain accompanied by coughing or deep breathing. They were successfully treated with saikanto. Case 1 was a 17-year-old woman who was diagnosed with pleuritis. Case 2 was a 57-year-old man who was suspiciously diagnosed with pleuritis. Case 3 was a 45-year-old woman who was diagnosed with upper respiratory tract inflammation. In Kampo medical examination before the treatment with saikanto, 3 patients had kyokyokuman (fullness and discomfort in chest and hypochondrium) and 2 patients had shinkahiko (epigastric stuffiness and resistance). All of the patients recovered from the chest pain early without analgesic drugs. This suggests that Kampo medicine of saikanto is effective for the early recovery without using analgesic drugs from chest pain caused by pleuritis or a severe cough, and that kyokyokuman and shinkahiko are useful indications for its effectiveness.

A 44-year-old woman became easily fatigued after her second childbirth. Her symptoms improved with shimbuto and ninjinto as a substitute for bukuryoshigyakuto, and the prescriptions were continued. Recently, she suffered from fever, pain around thyroid glands, palpitation, and tremor of hands. She was diagnosed with subacute thyroiditis and prescribed acetaminophen, but the symptoms did not resolve. Based on the clinical signs of inappetence and her thick yellow tongue coating, we suspect the late yang stage and administered shosaikoto. Her body temperature remained below 37 degrees Celsius thereafter, and the pain around thyroid glands disappeared. Out of all the Kampo formulae used in 310 cases of subacute thyroiditis including past reported cases and this case, we found that 53% of the effective formulae were what we call formulae of involving Bupleuri radix that contain both of Bupleuri radix and Scutellariae radix. It is considered that formulae of involving Bupleuri radix are often effective to control the inflammatory process in subacute thyroiditis.

A 28-year-old man had been experiencing occasional stomach upset and heartburn for 14 years. The symptoms started after he suffered from vomiting and diarrhea in the winter when he was fourteen. He had always suffered from loss of appetite during the last couple of years, and his symptoms got worse whatever he ate. In a terrible time, he had a palpitation and grew cold his limbs. He defecated once in one or two days with painful diarrhea. These symptoms were considered as functional gastrointestinal disorders with functional dyspepsia and irritable bowel syndrome. First, saishakurikkunshito was tried but it had no effect. Shokenchuto was prescribed next and had some effect. Chukenchuto, a combination of shokenchuto and daikenchuto, showed better effectiveness. The results of this case suggest that saishakurikkunshito was ineffective because qi deficiency was not the main cause, and that chukenchuto was effective because of qi depression.

A42-year-old man presented with a history of tidal fever almost every evening to night with 10-year duration. We could not find out the cause of his fever, so we thought he was classified in fever of unknown origin. The patient suffered from an anhydrosis phase during the temperature rose, but his fever broke after perspiration occurred at the end. The lack of perspiration with fever is a typical symptom of excess pattern of tai yang stage, and fever at night is suggestive of shao yang stage. Saikatsugekito was thought to be best suited as it would address both stages. The formula promoted perspiration, and the body temperature remained stable thereafter. It is not unusual to encounter complicated symptoms due to combined or overlapped pattern in clinical setting. This case represented successful outcome by identifying and analyzing the concept of gobyo and heibyo and prescribing a formula accordingly.

Abdominal pain and marked coldness were observed in a 56-year-old male with cancerous ascites associated with cancer of unknown primary, and the patient was treated with sekiganryo. The abdominal pain resolved from day 2 after the initiation of sekiganryo administration, and the ascites markedly decreased with an increase in the urine volume on day 3. Although the mechanism of the effect of sekiganryo on cancerous ascites was unclear, it was considered that the improvement of coldness promoted the metabolism and subsequently promoted diuresis. No case of the improvement of cancerous ascites by sekiganryo has been reported to date. We report this case along with a literature review.

Case 1 was a 72-year-old man with a generalized pain after 6 months of heavy physical work. Kakkonto was prescribed based on his symptoms of severe shoulder stiffness and pain, and keishibukuryoganryo was added to treatoketsu. It caused dysuria because of ephedra herb, so the dosage was reduced. Atractylodes lancea rhizome and processed aconite root were added to enhance the effect of treatment. And then, his pain was alleviated. Case 2 was a 53-year-old man with a generalized pain. He had a previous history of whiplash and two surgical operations. Daisaikoto was prescribed based on his symptom of bilateral costal arch pain, and keishibukuryoganryo was added because of oketsu. It caused an increased frequency of bowel movement due to crude drug of rhuharb, so the dosage was reduced. Pueraria root was added for the purpose of relieving severe shoulder stiffness. And then, his pain went away. It is often difficult to treat fibromyalgia. The decoction can be effective with increase or decrease and deleting or adding of the dosage of crude drug. Decoctions become handy as it allows dosage adjustment of crude drug to minimize the side effects and improve the efficacy.

A 31-year-old woman started to have a yellowish-white scab with exfoliation on her lip after delivery. Her exfoliative cheilitis did not improve with kigikenchuto nor juzentaihoto for treating deficiency of vital energy and lack of blood. After she developed upset stomach, her prescription was changed to hochuekkito which supports the digestive system. Her symptom improved dramatically. The characteristic of exfoliative cheilitis consists of chronic inflammation of lips which is considered to be yang-syndrome, therefore hochuekkito was effective as it covers yang-syndrome as well as yin-syndrome. It is suggested that psychological factors play a role for a pathogenesis of exfoliative cheilitis. We consider that antistress effect of bupleurum root and sedative effect of citrus unshiu peel in hochuekkito might also be key factors.

A 48-year-old woman started to have dizziness after experiencing an earthquake. Her clinical signs improved with the use of shimbuto that was prescribed based on her symptom of yin-syndrome and hypofunction. At the same time, there was a decrease in reading errors with her finger, in a vein authentication device. One of the common reading errors that the security system makes is due to a change in blood flow due to vasoconstriction caused by low temperature. It is speculated that the use of a warming formula increased peripheral blood circulation, which contributed to the improvement of vein authentication.