The examination of endoscopic findings in 221 cases of rheumatoid arthritis treated with Japanese Oriental (Kampo) medicine

OBJECTIVES: To evaluate the efficacy of Japanese Oriental (Kampo) medicine on treatment of rheumatic arthritis (RA) patients from the point of view of preventing the complication of gastroduodenal ulcer. METHODS: We examined endoscopic findings and contents of treatment in 221 rheumatoid arthritis (RA) cases treated with Japanese Oriental (Kampo) medicine retrospectively. RESULTS: A gastroduodenal ulcer was found in 10 patients (4.5%), an ulcer scar was found in 21 patients (9.5%) and a cancer was found in 6 cases (2.7%). Next, we compared the incidence of gastroduodenal ulcers in the group of patients who were receiving nonsteroidal antiinflammtory drugs (NSAIDs) therapy with the group of patients treated with Kampo medicine alone. The incidence of gastroduodenal ulcers was 9.3 % in NSAIDs group and 2.1 % in the group of patients treated with Kampo medicine alone. CONCLUSIONS: The incidence of gastroduodenal ulcers in RA patients treated with Kampo medicine was lower than that in other studies carried out in patients with RA. These findings suggested that treatment with Kampo medicine for RA is beneficial from the point of view of preventing gastroduodenal complication. 和漢薬治療中の関節リウマチ(RA)患者の胃十二指腸病変を検討した。【方法】当科で和漢薬治療中のRA患者のうち,1980年1月から2000年10月までに上部消化管内視鏡検査を施行した221例について内視鏡所見とRAの活動度,治療内容との関連を検討した。【結果】対象221例中,活動性の消化性潰瘍は10例(4.5%)。内訳は胃潰瘍9例,十二指腸潰瘍3例であった。潰瘍瘢痕は21例(9.5%)。内訳は胃潰瘍瘢痕16例,十二指腸瘢痕5例であった。その他,びらん性変化が12例(5.4%),早期胃癌が4例(1.8%)に認められた。非ステロイド性消炎鎮痛剤(NSAIDs)またはステロイド剤(ス剤)併用治療群(107例)と和漢薬単独治療群(96例)で比較検討すると,前者の活動性胃十二指腸潰瘍合併例が10例(9.3%)であるのに対し,後者では2例(2.1%)とNSAIDsまたはス剤併用群に有意に多く活動性潰瘍が合併していた。【考察】1999年CheatumらはNSAIDs服用中のRA患者の胃十二指腸病変を内視鏡検査で検討し,1009例中239例(23.6%)に胃または十二指腸潰瘍があったことを報告している。RA患者の胃十二指腸潰瘍の合併頻度については,Farahらの185例中67例(1988年),塩川らの1008例中175例(1991年)などがあり,いずれもNSAIDs投与との関連性が指摘されている。今回の検討では,221例中10例とこれらの報告と比較して少ない傾向にあった。和漢薬を中心とした治療で,NSAIDs使用を最小限にとどめることにより,消化性潰瘍の合併を減らしうる可能性が示唆された

A Chinese Herbal Medicine, Tokishakuyakusan, Reduces the Worsening of Impairments and Independence after Stroke: A 1-Year Randomized, Controlled Trial

In post-stroke patients, the recurrence of stroke and progression of impairments lead to a bedridden state and dementia. As for their treatments, only anti-hypertension and anti-coagulation therapies to prevent the recurrence of stroke are available. In Asia, post-stroke patients with impairments are often treated with herbal medicine. The present study evaluated the effectiveness of tokishakuyakusan (TS) in improving the impairment and independence in post-stroke patients. Thirty-one post-stroke patients (mean age = 81.4 years) were recruited and enrolled. Participants were randomly assigned to the TS group (n = 16) or non-treatment (control) group (n = 15) and treated for 12 months. Impairments were assessed using the Stroke Impairment Assessment Set (SIAS). Independence was evaluated using the functional independence measure (FIM). For each outcome measure, mean change was calculated every 3 months. The results were that impairments according to SIAS did not significantly change in the TS group. In contrast, SIAS significantly worsened in the control group. There was a significant difference between the two groups. In each term of SIAS, affected lower extremity scores, abdominal muscle strength, function of visuospatial perception, and so forth. in the TS group were better than those in the control group. Independence according to FIM did not change significantly in the TS group. In contrast, FIM significantly worsened in the control group. There was also a significant difference between the two groups. In conclusion, TS was considered to suppress the impairments of lower limbs and to exert a favorable effect on cerebral function for post-stroke patients

A report of three cases of diabetic nephropathy satisfactorily treated with traditional herbal medicine

We reported that three cases of diabetic nephropathy, who had overt proteinuria, were treated satisfactorily not only for their symptoms but also renal nephropathy with traditional herbal medicine over the long term. In Case 1, the level of S-Cr had changed from 1.2 to 2.0 mg/dl over 98 months, in Case 2 from 0.9 to 1.9 mg/dl over 70 months, and in Case 3 from 1.1 to 2.9 mg/dl over 81 months, acceptably moderate increases, meaning that the progression of their renal insufficiency was controlled over the long term. At the same time, the symptoms of hotness, numbness and edema were improved. Diabetic nephropathy with overt proteinuria is known to develop into renal failure after several years. In these cases, traditional herbal medicine was considered responsible for improving their QOL and prolonging the pre-dialysis period of diabetic nephropathy. 顕性蛋白尿期にある糖尿病性腎症の患者に漢方治療を施行した。その結果,随伴する諸症状の改善のみならず長期問,腎機能低下の進行を抑制した3症例を経験したので報告した。症例lでは,98ケ月の観察でS-Cr値はl.2から2.0mg/dl,症例2では70ケ月の観察で,S-Cr値は0.9から1.9mg/dl,症例3では81ケ月の観察で,S-Cr値は1.1から2.9mg/dl,と長期間腎機能低下の進行を抑制した。同時に,手足の火照りやしぴれ感,下肢の浮腫などの症状の軽快も認めた。持続的に蛋白尿を認める顕牲腎症期に至った糖尿病性腎症は数年の経過で,末期腎不全から血液透析に至ると言われている。今回の症例から和漢薬は,糖尿病性腎症における腎機能障害に対して腎機能障害の進行抑制作用を有する可能性が示唆された。このことから,和漢薬は糖尿病に随伴する諸症状を緩和し,QOLを改善するのみでなく,血液透析導人までの期間を延長し,予後を改善したと考えられた