Volume 5, Number 3 | Fall 2010

Clinical Report 2 (Japan)
A Patient Who Feels Nauseous on Exposure to the Sun

Mihoh Koga, M.D., Kampo Specialist

Research Assistant of Division of Clinical Pharmacology
and Therapeutics and Division of General Medicine
Jikei University School of Medicine[Case]

Male of 52 year-old, working in thepainting industry.
[Chiefcomplaint]“Becomenauseouswhenexposed to the sun.”[Current medial history]
Since 26 years old, he had suffered a low-grade
fever and nausea. Detailed examinations had notdetected abnormalities and tranquilizing agents
had been administered for 10 years without
improvement.
When he was around 46 years old, he began todevelop

additional

symptoms

ofbecoming

nauseous, light headed and collapsing upon
exposure to the sun. On hot days,
fatigueinthelower

limbs,

hot flashes,
sleeplessness,

nocturnal sweating, and buzzing in the ears
appeared. These symptoms were exacerbatedduring summer and relieved during winter. He
poured water over his head to continue to work.
However, because of the chief complaint, he often
got off work.

Before visiting our hospital, he had received acomplete examination without any findings ofabnormalities.
August 3, he made the initial visit to us.
Findings at initial visit[Inspection] His physique was intermediary withpale complexion. He seemed to have too muchtrouble for sitting on a chair and almost fall down.
He became out of breath and words could not
be spoken continuously, giving the impression ofa negligent air.
His tongue was enlarged and purple coloredwith pale yellow furs.
[Inquiry] He had a dry mouth. His appetite
decreased during summer. Defecation was twotimes a day and normal. He seldom had
perspiration and when sweating occurred, he felt
good. Although he had no difficulty falling asleep,
he woke during the night. He easily got frustrated.
Four limbs were cold. He liked refrigerated air
conditioning and water of a cold spring.
[Palpation] The pulse was deep, thin, andslippery.
Abdominal examinations detected 3/5 of theabdominal strength and a light bloated feeling in
the chest and hypochondrium region andtenderness in the para-umbilical regions.

Analysis of clinical conditions
Spleen Deficiency

Blood Deficiency

Qi Deficiency

DroopingVisceraCold sensation inlimbs
Fatigue in lowerlimbs

Feel sickStagnant heat(low-degree fever, hotflashes)
Like air conditioning
and cold water

Heat evil

Defense Qi
Shortage

Short breath
Reducedperspiration
NocturnalsweatingThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Summer symptoms
worsenOn exposure to thesun …

19

Volume 5, Number 3 | Fall 2010

It can be thought from the low-grade fever andnausea for 20 years that the patient had anunderlying spleen qi deficiency which induced qideficiency and blood deficiency. Especially intense
symptoms of progressed spleen qi deficiency withthe drooping of viscera were observed. Because ofqi deficiency, a shortage of defense qi occurred
and thereby the role of sweating that normalizes
the body temperature did not work properly,
resulting in an internal accumulation of heat.
Thus he liked the air conditioning and water fromthe cold spring.
It can also be thought from the long-time low
fever and hot flashes and the general symptoms
including fatigue that there were underlying
deficiency fire and deficiency heat caused by ashortage of source qi. It is possible thatsummer-heat as a pathogenic factor madedeficiency fire and deficiency heat further burnCourse
Oneweeklater,administered.
Three weeks later, his physical condition wasgood. Fatigue in the lower limbs disappeared. The
feeling of heat trapped in the body disappeared
and he was able to do his job.
(Pulse) Deep and thin(Tongue) Enlarged, dark red, covered with thinwhite furs.
The patient had slight constipation.
The patient received the instruction to continue
to take the oral administration with adjustment
in small quantities.

symptom of spleen-qi deficiency with the drooping
viscera may have intensely appeared.
Prescription
LI Dong Yuan says in his book “Pi-wei-lun(Spleen-Stomach Theory)” that “fire and source qi
cannot stand side by side,” “If either one of themis dominant, the other loses,” and “if drugs withsweet taste and body warming characteristics,
such as Astragali Radix, Ginseng Radix, andGlycyrrhizae Radix are used, deficiency heatrecedes voluntarily.” He proposed the treatment
method of using drugs with a warming action toinvented

prescriptions

including hochuekkito.
The author selected hochuekkito that nourishes
the stomach-spleen and activates qi to nourish
chest qi.

20

anrelieved. hochuekkito only was continuously

exposure to the sun. In such process, theandfelt

continued longer. Fatigue in the lower limbs wasupsetting the patient’s health at a burst on

feverspatient

improvement in his physical condition. Sleep

up in conjunction with the internal cause,removetheThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)