The patient is a 71-year-old man. After receiving chemoradiotherapy (CRTx) for an unresectable esophageal cancer, he developed sudden hematemesis during a follow-up examination. Subsequent imaging via contrast-enhanced computed tomography (CT) showed leakage of the contrast medium from the descending aorta into the esophagus. Consequently, an aortoesophageal fistula (AEF) was diagnosed and an emergency thoracic endovascular aortic stent graft repair (TEVAR) was scheduled. However, during the preparation for surgery, the patient vomited a large amount of blood and went into cardiopulmonary arrest. Following the administration of cardiopulmonary resuscitation, a Sengstaken-Blakemore tube (SB-tube) was inserted intranasally to control bleeding and TEVAR was performed to save his life. Although a gastrostomy was necessary after the surgery, the patient was transferred from the hospital on the 32nd day without any complications. Nonetheless, his general condition deteriorated as the cancer progressed and he died on the 103rd postoperative day. It is generally reported that the risk for esophageal perforation is 10-20% in CRTx for unresectable esophageal cancer. Although issues regarding the long-term prognosis of patients treated with TEVAR have been highlighted in recent years, there have also been reports of life-saving cases following its use; in this case, the patient was discharged home after SB-tube insertion and TEVAR with prompt treatment, resulting in his life being prolonged for an estimated 3 months.

We report a case of a 3-year-old girl who suffered from alopecia areata and was successfully treated with rokumigan modified formula. Initially, alopecia areata appeared on her left temporal region at the age of 3. The hair loss range had spread rapidly over the whole head. She visited our Kampo clinic because of insufficient effect of antiallergic drug. We prescribed her yokukansan, shimotsuto and juzentaihoto but the effect was insufficient. Finally, we thought this might be caused by kidney yin deficiency and liver blood deficiency because she had symptoms of pale white complexion, fine pulse, pale tongue with thin fur, and night sweating. Therefore, we administered rokumigan modified formula : rokumigan, tokiinshi and lycium fruit. Her hair began to grow after administering this formulation. There was not the re-hair loss during taking medicine for about 4 months. According to the traditional Chinese medicine, alopecia areata can be classified into 4 types : blood heat type, blood stasis type, dual deficiency type of yin and blood, dual deficiency type of qi and blood. We diagnosed this case as a dual deficiency type of yin and blood and selected rokumigan modified formula. Rokumigan is effective for various symptoms of kidney yin deficiency, and rokumigan modified formula may be useful for the treatment of infant alopecia areata.

The purpose of this study was to evaluate the effect of keishibukuryogan (KB) against the cognitive symptoms associated with silent brain infarction in a prospective cohort study. The subjects were 93 patients with silent brain infarcts who visited the Department of Japanese Oriental Medicine, University of Toyama, and its allied hospitals. They consisted of 24 males and 69 females, mean age (± S.E.) 70.0±0.8.Group SK (n=51) consisted of patients who used KB extract for more than6months per year. Group SC (n=42) consisted of patients who did not use Kampo formulas. The NS group (n=44) consisted of elderly subjects who had no silent brain infarction, 21 males and 23 females, with a mean age (± S.E.) of 70.7±0.7 years. Among the three groups, the revised version of Hasegawa's dementia scale, apathy scale and self-rating depression scale were compared between the study start and after three years. In the SK and SC groups, these scores, and the subjective symptom levels (head heaviness, headache, dizziness or vertigo, stiff shoulder) were also studied. The results showed that the self-rating depression scales at study start for the SK and SC groups were significantly higher compared to the NS group. In spite of the scores for the NS group increasing after three years, the SK group scores were significantly decreased compared to the SC and NS groups. KB was effective against head heaviness, which often complicates silent brain infarction. In the above mentioned, KB was effective in treating cognitive disorders and subjective symptoms related to silent brain infarction.
Infarction ; Brain ; seconds ; Ions ; symptoms <1>

We sought a connection between the half-exterior half-interior symptoms (hanpyo hanri sho), mentioned in the classic Chinese Shang han lun text and used in Kampo medicine, and embryology. An agreement between these shao yang (lesser yang) symptoms, and embryonic brachial arch domains was found. A part of the brachial arches strongly agrees with the ruling domain from the trigeminal nerve to the vagal nerve, and a connection was also seen to the vestibulocochlear nerve and partly to the accessory nerve. Thus we believe that half-exterior half-interior symptoms are a condition which relate back to part of the brachial arches, and are a result of so-called Heat reaction. Shang han lun Chinese medicine and embryology are two completely different fields. However, we consider an embryological view of nerve pathways to be helpful in understanding half-exterior half-interior symptoms, at least to a certain degree.
symptoms <1> ; CONSIDERATION ; Chinese People ; Nerve ; Medicine

We treated one rheumatoid arthritis (RA) patient with Toki-shakuyaku-san-ka-bushi. A 51-year-old woman was diagnosed as RA in another hospital and was treated with salazosulfapyridine (SASP) and methotrexate (MTX). She was living a restricted daily life while taking MTX. She had to lie down for almost 48 hours after taking MTX once a week because of general fatigue. She was also suffering from depression. After the administration of Toki-shakuyaku-san-ka-bushi, her malaise after taking MTX and her depressive-mood disappeared. Her quality of life improved measurably.

We report on two elderly patients in the extended care unit who were successfully treated with “Furidashi” extract (an extraction method of dipping in hot water) of Astragali Radix, for copious sweat. Case 1 was a 65-year-old male hospitalized for rehabilitation after cerebral hemorrhage. He needed a change of clothes three or four times a day because of copious sweat. After administration of Hochu-ekki-to and “Furidashi” extract of Astragali Radix, his sweat decreased. Case 2 was a 66-year-old female hospitalized for rehabilitation after cerebral contusion. She was dripping-wet with perspiration, and had itchy eczema and skin erosions on her trunk. After administration of the “Furidashi” extract of Astragali Radix, her sweat decreased and the erosions were cured. This strongly suggests that the “Furidashi” extract of Astragali Radix provides a convenient and inexpensive treatment against copious sweat accompanied by skin disorder in the elderly.

We report on two elderly patients in the extended care unit who were successfully treated with Keishi-ka-ryukotsu-borei-to for sexually deviant behavior. Case 1 was a 71-year-old male hospitalized for rehabilitation after surgery for benign prostate hypertrophy. He began to masturbate soon after hospitalization, which made caregivers and other patients very uncomfortable. After the administration of Keishi-ka-ryukotsu-borei-to, his masturbation behavior disappeared. Case 2 was a 90-year-old male hospitalized for rehabilitation after cerebral infarction. He began using obscene expressions and trying to touch female patients about half a year after being hospitalized. His sexually deviant behavior decreased after the administration of Keishi-ka-ryukotsu-borei-to. This strongly suggests that Keishi-ka-ryukotsu-borei-to is useful in the treatment of dementia-related deviant sexual activity in senior citizens.

We treated five patients with palpitation at rest due to imbalance of Ki-distribution, a concept of traditional Chinese medicine in which there is abnormal upward flowing of “Ki, ” who showed rapid improvement after Shakuyaku was excluded from their original regimen or after initiation of treatment with Shakuyaku-free regimens. All these patients shared in common two findings before the initiation of the Shakuyaku-free treatment: first, the absence of strain of the rectus abdominas muscle in the whole abdomen between the hypochondrium and the upper margin of the pubic bones, and secondly, the presence of abdominal pulsation diagnosed as pericardiac, infra-umbilical or sub-umbilical pulsation. We also treated patients who developed palpitation at rest only after Shakuyaku-free regimens were replaced with regimens including Shakuyaku. These findings suggest that there may be many patients in whom Shakuyaku-free regimens may improve palpitation when they have an imbalance of Ki-distribution as an underlying condition.

We performed a preliminary study of the reliability of the lymphocyte stimulating test (LST) for Kampo medicine. LST for three kinds of Kampo medicines was performed in both a Kampo-administrated group and a non-administrated group. LST for each of the medicines was negative for seven of eight subjects in the non-administrated group, but was negative for four of 11 subjects in the Kampo-administrated group. The LST-positive participants had no allergic state, and some among them were negative in challenge test. This preliminary study suggests that LST for Kampo medicine is likely to be false-positive.