Volume 10, Number 3 | Fall 2015

Clinical Report 2 (Kampo Medicine)
Case Studies from Ehime Prefectural Central Hospital (2)– From the Rural Bedside to the Global Podium –Genki Shimizu, Hiroshi Kakuto, Den-ichiro Yamaoka
The Internal Departement of East Asian Traditional
Medicine of Ehime Prefectural Central Hospital

Type 2 Cases
Combined use with standard Western medical
treatment

rubefaction on the trunk of the body
No discharge liquid. Nodules are hard and raised.
(Photos 1, 2)
Tongue: Rose pink, light tongue fur, no fissures, novaricosis
Pulse: Moderate, thin, powerful
Abdomen: Weak abdominal strength, weakness of
the lower abdominal region, gas accumulation[Progress]
First visit: Orengedokuto (黄連解毒湯) extract 7.5g

[Case 6 (Dr. Kakuto’s case)]
Administrationof+ Tsudosan (通導散) extract 5g

Unseiin-go-tsudosan-basedprescription (温清飲合通導散加減) [ys1][mi2] forsomewhat. Feces is soft but is of no problem.

refractory prurigo nodularis in a 77-year-old

Nodules on the back have slightly flattened.

woman(Remark from the dermatology dept.)[Chief complaint]

Unseiin (温清飲) extract 7.5g + Tsudosan (通導General rash, itching散) extract 5g[Past medical history]
Type1diabetes

Third visit (39 days later): The redness has(useofinsulin),lumbarcompression fracture

improved, but the nodules are still hard.
Nodules on the back have slightly flattened. The[Regular medication]prescription appears to have an effect. (Remarks

Amlodipine,

telmisartan,

epalrestat,sennoside,

famotidine,

EPA,

aspirin,mecobalamin,from the dermatology dept.)
Unseiin-plus-juyaku (温清飲加十薬), Tsudosan

olopatadine, levocetirizine, strongest class of(通導散) extract 5g

steroid ointment

Unseijin ( 温 清 飲 ) consists of oren (Coptis[History of present illness]japonica 黄連) 1.5g, obaku (amur corktree 黄柏)

The patient became aware of an itching of skin

1.5g, ogon (Baikal skullcap 黄芩) 3g, sanshishi

around December of X-1. She consulted the(gardenia fruit 山 梔 子 ) 2g, toki (Japanesedermatology department in our hospital in Marchangelica root 当帰) 4g, shakuyaku (peony 芍薬)

X and was diagnosed with overall prurigo

4g, senkyu (cnidium rhizome 川芎) 4g, jukujiou

nodularis. She was prescribed an antihistamine(rehmannia root 熟地黄) 4g, juyaku (chameleon

drug and steroid ointment, but they failed to haveplant 十薬) 10g.

a sufficient effect, so she requested Kampo

Fourth visit (67 days later): An improvement istreatment and was introduced to our department

observed. The nodules have flattened out.

in September.

(Figure 3)[Observations]

18

Second visit (11 days later): The redness abatedSuccessful (Remark from the dermatology

Dry mouth (-), excessive thirst (-), constipation (+)

dept.)(use of a laxative)

Continuation of treatment in same manner.

Appetite (+), hot flashes (-), cold hands and feet (+)

Good progress continued thereafter, and the

Bitterness in mouth (-), susceptibility to colds (-)

prescription was stopped three months after theSkin:patient’s first visit.

Numerous

nodulesaccompanied

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

Volume 10, Number 3 | Fall 2015

(Figure 3)(Observation)
We diagnosed this case as wind as a result of blood deficiency. We also hypothesize that the epidermalacanthosis and hypodermal hyperplasy of collagenous fiber due to chronic inflammation results in blood
stagnation. Consequently, the combination of Unseiin (温清飲) and drugs for overcoming blood stagnation
was effective.
We have to research more cases with prurigo nodularis suitable for these crude drugs.

[Case 5 (Dr. Shimizu’s case)]
68-year-old man[Progress]
Steroid infusion and β-agonist inhalation improved[Chief complaint]

oxygenation, but white frothy sputum and diluted

Difficulty in breathingsaliva began spilling from the patient’s mouth, and[History of present illness]he could not stop coughing. After he was given 6g ofThe patient has been seeking regular medical

Shoseiryuto (小青竜湯) extract dissolved in warm

attention for bronchial asthma. Since Sept. 20, hewater, his frothy sputum, saliva and coughing

has experienced repeated asthma attacks, andstopped in about 5 minutes.

used an inhalant. Around 7 p.m. on October 1, he[Observation]

suffered another asthma attack that did not

In this case example, white frothy sputum wasimprove even after using the inhalant, so he madeinterpreted as edema from the epigastric region,an emergency visit to the hospital.

and the patient was thus successfully prescribed)[Present symptoms]

Shoseiryuto (小 青竜湯 ). Shoseiryuto (小青 竜湯)

Blood pressure 136/68mmHg, temperature 36.7℃,

contains crude drugs that have a warming effect,

SpO2 = 90% (ambient air)and lacks any alternative in Western medicine.

Pulmonary sound: Marked wheezing(The figure below shows that six out of eight crude
drugs that constitute Shoseiryuto (小青竜湯) havea warming effect.)

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

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Volume 10, Number 3 | Fall 2015

Ingredients of Shoseiryuto
Maou (ephedra 麻黄)

Shakuyaku (peony 芍薬) Relaxes tension in smooth muscles.

Keishi (cinnamon 桂枝)

Eliminates water and cures wheezing.

Saishin (wild ginger 細辛)

Stops coughs.

Kanzo (licorice)甘草 Harmonic action

Kankyo (zingiber siccatum 乾姜)

Warms the body and eliminates water.

Hange (pinellia tuber 半夏)

Antitussive expectorant action

Gomishi (schisandra fruit 五味子) Prevent water from leaking.

[Case 8 (Dr. Kakuto’s case)]
Administration of Inchinkoto-go-goreisan (茵蔯蒿湯 合 五 苓 散 ) for refractory ascites caused bydecompensated cirrhosis in a 58-year-old woman[Chief complaint]
Neck pain, sense of abdomen distension[Past medical history]
Diabetes, hepatitis B[History of present illness]
The patient was diagnosed with diabetes andchronic hepatitis B at a different hospital and hasreceived

treatment

fromaroundX-5,

but

terminated the treatment at her own discretionand neglected her condition. In late November X,
she had a fall at home and hit her temporal region,
so she made a visit to our hospital. The patient wassuspected of a cervical sprain and was set toreceive symptomatic treatment, but because she
also clearly displayed jaundice and ascites, as well
as a complication of hyperglycemi with an HbA1C(NGSP) of 8.6%, she was immediately admitted.
[Western medical observations]
Lucid,

nodisorientation.

Bloodpressure

155/75mmHg.
Overall jaundice, marked ascites. Normal heartsound, breathing sound.
Capillary dilatation observed on the face andtrunk of body, and red palms.
No edema of the extremities. Weight 50.4kg,abdominal girth 86.2cm.
After hospitalization, the patient’s blood glucose was20

controlled by insulin and entecavir was introduced.
She was also given antibiotic treatment, as she wasfound to have a complication of purulent spondylitis
caused by methicillin sensitive Staphylococcus
aureus (MSSA). For her complication of cirrhosis,
liquids and salts were restricted immediately upon
hospitalization, and she was given 60mg/day of
furosemide and 75mg/day of spironolactone in anattempt to gain a diuretic effect, but
hypoalbuminemia and hyponatremia progressed,
and no improvement was gained. Ascites puncturedrainage was attempted as necessary, and an
intravenous drip of two 50ml of albumin 25% andfurosemide 20mg1A was administered over threedays, but since no improvement was observed,
Kampo was considered.
[Kampo observations]
The patient is of medium height and build, but her
abdominal region is swollen like a frog belly. She
has overall jaundice, and the capillary veins in her
face stand out. Her tongue has no teeth marks, andis dark red and lightly coated. No varicosis is seen
on her tongue. Her pulse is sunken and powerful.
She has constipation.
Judgingbyherjaundiceandascites,Inchingoreisan ( 茵 蔯 五 苓 散 ) [infusion] wasadministered from January 21, X+1. The patient
thereafter requested an extract preparation, soshe was prescribed Goreisan ( 五 苓 散 ) extract(Tsumura, 7.5g/day) from January 28, but no
particular change was observed.

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

Volume 10, Number 3 | Fall 2015Because the patient had a complication ofconstipation, a prescription containing a laxativewas considered, and her prescription was changed
to Inchinkoto-go-goreisan(茵蔯蒿湯合五苓散)[infusion]from February 4. Thereafter, she was given
albumin IV and ascites puncture drainage wasperformed once each. Whereas ascites previously
recurred soon after administering albumin ordraining ascitic fluid, the patient’s abdominal
girth gradually decreased after commencing
Inchinkoto-go-goreisan (茵蔯蒿湯合五苓散).

Her weight also decreased, such that she weighed
43.4kg and had an abdominal girth of 69cm by April
18. From there, she reached a plateau and her
condition stabilized. (Figure 1)
Thereafter,herprescription

waschangedtoInchinkoto (茵蔯蒿湯) extract (Tsumura, 7.5g/day) +Goreisan (五苓散) extract (Tsumura, 7.5g/day) when
she was discharged from the hospital on May 15. She
stilltakes

theprescription

today,

but

hasexperienced no recurrence of ascites.

Weight (kg)

Abdominal girth (cm)Albumin 25% intravenous injection 12.5g/50ml × 2
Frosemide injection 20mg1A, 3 consecutive days

Inchin-go-goreisan (infusion)

Goreisan (extract)

Inchin-go-goreisan (infusion)

Frosemide 60mg + spironolactone 75mg
1/07

1/21

2/04

2/18

3/04
Abdominal
girth

3/18

4/01

4/15

WeightAscites puncture drainage

Figure 1 Change in abdominal birth and weight(Discussion)
We usually use Inchinkoto to treat the liver diseases, or Goreisan for asciteses in Japanese Kampo style.
In this case, we found that an inchinkoto-go-goreisan decoction was more effective than an Inchingoreisan
decoction or a goreisan extract. This suggests that the effects of Gardenia and Rheum they are made fromcan be significant.

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

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