Volume 5, Number 2 | Summer 2010

Clinical Report 2 (Japan)
A Case that Had More Effect from Less Crude Drugs

Masayuki Kashima

Department of Internal Medicine
Kumamoto Red Cross Hospital[Background]
In Kampo treatment with crude drugs,
practitioners apt to add one drug after another in
response to patients’ complaints. On the otherhand, it has often been pointed out that theformulae that have additional crude drugs do notseem to sufficiently yield expected benefits. The
author has modified the original formulation by
giving no major changes to the structure andcharacteristics but rather adjusting the number ofthe crude drugs and drug amounts of the original
formulation, reducing to an essential minimum
structure. Following is the report about theexperience of using this modified preparation:[Case] Female of 22 years old[Chief complaint] Pyrexia and general malaise[Current medical history] Complications of SLE
developed at the age of 17 and Sjogren’s syndrome.
Raynaud’s
symptoms,
feveronset,
joint
inflammation, depression symptoms, hypocytosis,
and core symptoms of inflamed pleura. The
patient had been receiving treatment withdecoctions to manage the symptoms, but she
became exhausted after unusually hectic and longsummer days. In early October, she began to havethe onset of fever with the body temperature of 3940 degrees Celsius with a loss of appetite, a senseof malaise, and polyarticular pains.
Prescriptions administered up until early October.
According to the text book of Bensho(syndrome/type identification) for spleen-kidney
deficiency, liver qi depression, disquieted heart
spirit, blood stasis, and internal heat, following
had been used.
Astragali Radix 14g, Bupleuri Radix 14g,
Cimicifugae Rhizoma 4g, Ginsing Radix 8g,
Atractylodis Rhizoma 8g, Poria 8g, Fossilia OssisMastodi

18g, Oysteae Tespa 18g, thinleaf
milkwort root 6g, Zizyphi Semen 10g,Rehmanniae Radix 8g, Amomi Semen 5g, Processi
Aconiti Radix 2g, Psoraleae Semen 8g, Cinnamomi
Cortex 8g, Paeoniae Radix 8g, Angelicae Actilobae
Radix 8g, Persicae Semen 8g, Moutan Cortex 8g,
Spatholobi Radix 8g, Salviae Miltiorrhizae Radix8g, Lycii Fructus 8g, Citrus Unshiu Pericarpium 6g,Ophiopogonis Tuber 6g, Schisandrae Fructus 6g,
Phellodendri Cortex 4g, Zizyphi Fructus 4g,
Zingiber Rhizoma 4g, Glyzirrhizae Radix 4g.
Prescription after modification:
Astragali Radix 20g, Bupleuri Radix 6g,
Cimicifugae Rhizoma 6g, Cinnamomi Cortex 6g,
Paeoniae Radix 6g, Fossilia Ossis Mastodi 9g,
Oysteae Tespa 9g, platycladus orientalis seed 8g,
Salviae Miltiorrhizae Radix 8g, Ginsing Radix 10g,
Atractylodis Rhizoma 8g, Anemarrhenae Rhizoma
9g, Corneri Fructus 10g, Eucommiae Cortex 8g,Amomi Semen 4g, Zizyphi Fructus 6g, Zingiber
Rhizoma 3g, Glyzirrhizae Radix 6g.
Only three days from switching to the newprescription, a decline of the fever was attained to
the first half of 37 degrees C. The feeling ofmalaise also improved. Ds-DNA antibodies
returned to the normal vale of 86 from 129.
[Discussion]
Both formulae of before and after themodification are similar to each other in majorparts and there are no major differences between
the two in the properties of the drugs contained. A
marked response was obtained after making
changes to form the structure having an increasein the drugs with the ability of qi tonification butwith a reduction in the drugs for activating bloodstasis and flowing qi downward. It may beconsidered that the improvements in clinicalconditions could be achieved by eliminating thedrugs that were considered to bring only

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 5, Number 2 | Summer 2010

ineffectual effects but by matching clinicalconditions with the treatment method. Even if acertain preparation is effective, We often haveobserved the patients who have not responded tosimilar ones containing the same structuralcomponents. This may be due to the samemechanisms. Although we tend to easily increase
the number of crude drugs according to symptoms,
it is suggested in this case that an accurate
diagnostic ability and understanding ofprescriptions that can enable to make simplified
formulations
appropriatefor
pathologicalconditions are of clinical significance.

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The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)