A 66-year-old woman presented with a choking feeling in her throat. She was hospitalized three times and started nasogastric tube feeding one year before. She was diagnosed as somatic hallucination by a psychiatrist and started antipsychotic medication. She was admitted to our department in September due to worsening of choking sensation. Her body weight was 29 kg, and she was significantly lethargic and undernourished, and had difficulty in moving, parkinsonism, cognitive dysfunction, and apathy. She was considered to be in late yin stage pattern and started on tsumyakushigyakuto, which enabled her to walk with a walker, but her choking sensation did not improve. Two days after the conversion to yokukansankachimpihange, her speech and smile increased, and her motivation improved. After the switch to the extract of yokukansankachimpihange, the fullness and discomfort in left chest and hypochondrium disappeared, and she was able to take jelly and walk by herself. She was transferred to other hospital in January of the following year. Three months after the transfer, she was able to take enteral nutrition by herself and her weight increased to 37 kg. Eight months later after the transfer, she was able to take solid food orally and her weight increased to 41.5 kg. Yokukansankachimpihange may be useful for treating the patients with somatic hallucination and apathy.

[Objective] The purpose of this study was to investigate the effects of acupuncture on exercise-induced prolongation of information processing and decrease in attentional resource allocation, excluding the placebo effect.[Design] Crossover, double-blind randomized controlled trial[Settings] Tokyo Ariake University[Subjects] Fifteen healthy men aged 21.1 ± 0.9 years[Methods] We used a handgrip exercise for exercise loading. The handgrip was maintained for six seconds at an intensity of 40% of the maximal voluntary contraction (MVC), followed by rest for four seconds. This was alternately repeated and continued until the subject was incapable of exerting a grip strength of 40% of the MVC. To induce P300, an auditory oddball paradigm was used, and P300 was measured before and after the handgrip exercise. In the same subjects, thumbtack needle (TN) intervention (TN group) and placebo thumbtack needle (PTN) intervention (PTN group) were performed in random order. TN or PTN was applied to ST36, HT7, and GV14 before the handgrip exercise. After the experiment, we asked the subjects and practitioner about the intervention (TN or PTN). The allocation was conducted by a third party who did not participate in the experiment, and the subjects, practitioner, and measurer completed a series of all the experiment procedures and were blinded to the results.[Outcomes] The indicators for measuring the main outcomes were P300 latency and amplitude. reaction time, and masking were indicators for secondary outcomes. [Results and Conclusion] In the PTN group, P300 latency was increased significantly and P300 amplitude was decreased significantly after the handgrip exercise. In the TN group, no significant changes were observed in P300 latency and amplitude after the handgrip exercise. In both groups, reaction time was considerably slower after the handgrip exercise. The k value indicating the degree of agreement between the actual (genuine or placebo) and guessed intervention assignment was k = -0.06 for the practitioner and k = 0.66 for the subjects. No adverse events were found in this study.[Conclusions] The index changes in the TN and PTN in this study were the same as in our previous studies, and acceptable reproducibility was observed. However, the k values indicated that subject masking was inadequate. In the future, the reliability and validity of PTN must be investigated further.

Uzushakusekishigan is a Kampo formula described in ‘Jin Gui Yao Lue' for treatment of “heart pain that spreads out to the back, or back pain that spreads to the heart.” We successfully treated three patients with this formula. Patient 1 was a 53-year-old man suffering from precordial pain which occurred after amputation of the right forearm;patient 2 was a 46-year-old man with epigastralgia that occurred after taking cold meals;and patient 3 was a 28-year-old woman suffering from epigastralgia accompanied with panic disorder. Epigastric discomfort and resistance occurred in all three cases, prompting us to prescribe this formula. There are few reports of successful application of uzushakusekishigan, and it is not clear what symptoms and pathologies are relevant when prescribing this formula. However, our findings strongly suggest that uzushakusekishigan should be considered when treating severe chest or abdominal pain.

We report a case of panic disorder treated with keishikyokeikabukuryobyakujutsuto. The patient was a 42-year-old woman who had one or two episodes of panic attacks every month for 1 year accompanied by dyspnea, fear, rigidity of hands, etc. The episodes were more frequent with physical exertion and menstruation and did not improve with kamishoyosan or kanbakutaisoto. Then, after a car accident, she had a panic attack with a stronger intensity. Blood and imaging examinations revealed no special findings, and we diagnosed her with panic disorder. We considered her complaint as Honton disease and administered ryokeikansoto. After 2 weeks, her mental condition improved, and dyspnea and fear of attacks relieved. After 2 months, office work became more strenuous, and attacks recurred once or twice a week. An abnormal sensation of the posterior cervix occurred as a prodrome of an attack, and simultaneously, she noticed neck stiffness. After switching to keishikyokeikabukuryobyakujutsuto, the cervical sensation disappeared, neck pain and neck stiffness were relieved, and the attacks did not reappear. This case suggested that keishikyokeikabukuryobyakujutsuto was useful for the prevention of panic attacks associated with neck stiffness.

Methods: A total of 105 subjects were included (48 men and 57 women; mean age, 63.2±2.7 years; range, 22–84 years). We analyzed five functional spinal unit levels (L1–S1) and evaluated the T2 values of the anterior annulus fibrosus (AF), nucleus pulposus, and posterior AF. We compared the low back pain (LBP) Visual Analog Scale (VAS) scores and the T2 values in each decade with or without SN. Results: There were no remarkable differences in SN prevalence rate regarding age decade or gender. SNs were more prevalent in the upper 2 levels (70.3%). LBP VAS scores with and without SN were 64.7±4.3 mm and 61.9±2.8 mm, respectively, with no significant differences between the groups (p =0.62). The T2 values of anterior AF with SN were significantly lower than those without SN in patients in their 50s, 60s, 70s, and 80s (p <0.01). Conclusions SN presence is not itself a risk factor for CLBP; however, it indicates IVDD of the anterior AF in subjects with SN who are ≥50 years old.

An eight-year-old girl was referred and admitted to our hospital with the chief complaint of purpura on her lower legs. Blood tests revealed pancytopenia, and bone marrow findings showed marrow hypoplasia. Refractory cytopenia of childhood (RCC) was diagnosed based on the central diagnostic system of the Myelodysplastic Syndrome Committee of the Japanese Society of Pediatric Hematology. Immunosuppressive therapy was performed with the administration of rabbit antithymocyte globulin, methylprednisolone and cyclosporin A,but it was not effective. Eight months after admission to our hospital, Kampo treatment was started based on traditional Kampo diagnosis. After treatment with oral administration of kamikihito and kyukikyogaito, her pancytopenia gradually improved. Erythrocyte transfusion was discontinued after 2 months, and concentrated platelet transfusion also became unnecessary after 3 months. As a result of improvement in pancytopenia, her white blood cell count, hemoglobin value, and platelet count reached almost normal levels after 16 months. The scheduled bone marrow transplantation was canceled. The action mechanisms of kamikihito and kyukikyogaito for RCC are not clear, and their effective rates are also unknown. However, Kampo treatments are less invasive, inexpensive, and have few side effects. We believe that Kampo medicine is a therapeutic method that should be actively attempted in cases of RCC with poor response to standard treatment.

Purpose：To explore a methodology for evaluating end-of-life （EOL） cancer care using diagnosis procedure combination （DPC） administrative data. Methods： We investigated care provided to inpatients whose deaths were attributed to cancer and occurred between August 2010 and December 2012. We measured the quality of palliative care by dividing the decedents into two groups： those who died in the palliative care unit （PCU） and those who died in the general wards（GW）. Results： A total of 311 inpatient deaths were identified as cancer deaths. Of these, 147 patients were included in the PCU group and 164 in the GW group. We calculated the DPC data as follows： the rates of chemotherapy administered within 30 days before death （PCU 0％, GW 27％） and within 14 days before death （PCU 0％, GW 10％）, admission to the intensive care unit （PCU 0％, GW 2％）, life-sustaining interventions （PCU 0％, GW 3％）, rehabilitation sessions （PCU 10％, GW 26％）, emergency admission （PCU 2％, GW 27％）, and antibiotics （PCU 32％, GW 28％）. In the PCU group, rates of chemotherapy and emergency admission were significantly lower（＜0.0001；＜0.0001, respectively）, and rehabilitation sessions were significantly higher （p＝0.0002） than in the GW group. Conclusion： EOL care in a university hospital can be easily investigated using DPC data. Some limitations are the single-site study design, the health insurance system, and secondary use of administrative data. However, this methodology may be adapted to investigate the entire Japanese claim database and to evaluate EOL cancer care.