A 28-year-old woman presented with persistent diarrhea, lower abdominal pain, low-grade fever and general fatigue in 1994. She was admitted to a hospital with suspected inflammatory colitis. Aphthoid mucosal changes were founded on colonoscopy, but the etiology was unknown. Salazosulfapyridine was administered for 3 months, but it was not effective for the abdominal symptoms. In November 1995, pyrexia, lymph node swelling and polyarthralgia appeared, and the patient was admitted to our hospital. Malar rash, photosensitivity, leukopenia, antinuclear antibody and anti-DNA antibody were found. She was diagnosed as having systemic lupus erythematosus and lupus colitis. Prednisolone (30mg/day) was administered, and pyrexia, polyarthralgia and leukopenia were improved, but the abdominal symptoms persisted for 5 weeks. Keisi-ka-syakuyaku-to was administered, and it was markedly effective for relieving persistent diarrhea and abdominal pain. Keisi-ka-syakuyaku-to was continued until February 1999 and the patient's clinical course was satisfactory.

The authors report a case of secondary renal amyloidosis associated with rheumatoid arthritis, which responded well to Kampo therapy. A 68-year-old woman was diagnosed as having rheumatoid arthritis in April 1992. Her disease activity was not controlled well with any anti-rheumatic drugs. In September 1996, proteinuria and hematuria were found, and a renal biopsy showed secondary amyloidosis. Proteinuria and hematuria were progressive. The patient was treated with Sairei-to, and by April 1998, proteinuria and hematuria nearly disappeared. This clinical course suggests that Sairei-to is an effective treatment for secondary renal amyloidosis.

A 62-year-old woman showed signs of liver dysfunction of unknown etiology in 1994. She was admitted to our hospital in July 1996 because the liver dysfunction, as well as general fatigue, worsened. Anti-mitochondrial antibodies were present, and a liver biopsy was performed. Pathological findings were compatible with primary biliary cirrhosis. Treatment with ursodeoxycholic acid (600mg/day) was initiated in August 1996, and liver dysfunction improved. However, ESR and IgM did not improve, and general fatigue persisted. In December 1996, Sairei-to was combined with ursodeoxycholic acid. One month later, ESR, IgM, and general fatigue improved. In May 1997, Sairei-to was replaced by Keishibukuryo-gan because of her symptoms (Hie-sho and varix pain), and liver dysfunction and general fatigue reappeared. Keishibukuryo-gan was later discontinued because of suspected drug-induced hepatitis. Two months later, liver dysfunction remained unimproved. Sairei-to was administered again and liver dysfunction and other symptoms disappeared. These results suggest that combined therapy with Sairei-to and ursodeoxycholic acid is effective in the treatment of primary biliary cirrhosis.

Twenty-two patients with chronic glomerulonephritis were treated with Sairei-to (7.5g/day), either alone or in combination with camostat mesilate (600mg/day), to determine the efficacy and adverse effects of these regimens. Although there was significant improvement in proteinuria (p<0.05) after 8 weeks of treatment with Sairei-to alone, this was not longlasting. Combination therapy resulted in sustained significant improvement (p<0.03; there were two dropouts). No adverse effects were seen with either regimen. The results suggest that combination therapy using Sairei-to and camostat mesilate may be a safe and efficacious method of treatment for patients with chronic glomerulonephritis.

We experienced a case of polymyalgia rheumatica (PMR) which responded to Kampo medicine. A 53-year-old female patient first complained of stiffness and pain in the neck. Myalgia was severe and gradually eypanded to both shoulders and both upper extremities. Body weight decreased, and the erythrocyte sedimentation rate (ESR) was greater than 100mm/hour. Because her condition tended to improve when treated with prednisolone 10mg/day, she was diagnosed as having PMR. Her condition was well controlled until the dose of prednisolone decreased. Myalgia then recurred, and the ESR increased to 83mm/hour. The patient visited our outpatient department for treatment with Kampo therapy. Two months after treatment with Sairei-to plus Yokuinin-to, all signs and symptoms disappeared other than the stiff neck. Her body weight showed a tendency to increase. Six months after she first visited us, prednisolone was decreased and then stopped. Her condition still remains well controlled with this Kampo therapy alone. She has no clinical signs and symptoms, and the ESR has improved to 16mm/hour.

In 1984 a 42-year-old female complaining of general malaise and loss of strength in the proximal muscles of the limbs came to the 2nd Department of Internal Medicine for an examination. From her high CPK value, electromyogram, muscle biopsy, etc., she was diagnosed as having polymyositis. Initially she responded well to steroids, but a year later the condition recurred. Treatment with various methods such as the immunosuppressants methotrexate and azathioprine, steroid pulse therapy and plasma replacement were tried without success. In September 1991, the patient's CPK value remained abnormal at about 800mU/ml. According to the Oriental Medical viewpoint, the condition was diagnosed as Kidney yin Deficiency. Rokumi-gan was therefore administered daily (7.5g/day) for a period of 80 days. The CPK value was brought down to the vicinity of 200mU/ml, and the feeling of general malaise and lack of strength in the proximal muscles of the limbs was improved. However, due to the persistence of edema in the lower limbs, the Kampo formula was changed from Rokumigan to Chorei-to, also administered at a dosage of 7.5g/day. This reduced the edema and normalized the CPK value to the 100mU/ml range. During this period, steroid administration was maintained with prednisolone (30mg/day). At present, with the improvement in the CPK value, steroid administration is gradually being reduced.

An attack of Raynaud's Phenomenon (RP) is characterized by blanching of the fingers in response to cold or emotional stimuli.
We analyzed the effect of ninjinyouei-to on RP in patients with MCTD. Subjects in this study comprised 19 patients, two males and 17 females, with a mean age of 38 years, and a mean duration of disease of 57.6 months. The study was performed at a time when RP occurred frequently in our country, that is in the period from November 1992 to March 1993.
We administered 9.0g of ninjinyouei-to to each case for four weeks and measured the surface skin temperature of the hands before and after medication with a thermograph using a Thermoviewer-JTG 3300.
There was a significantly higher temperature on the left first finger-tip after medication. Our thermographic findings in this study demonstrate a quantitative efficacy of ninjinyouei-to on RP in MCTD.