Application of traditional medicine in emergency and critical care “1st International Symposium on Kampo Medicine”

In the medical environment which favors modern Western medicine, treatment with Oriental medicine is not common in emergency and critical-care medicine. Nevertheless, treatments for acute infection, poisoning, or resuscitation are described in Shanghan Lun (Zhang Zhongjing version), and these descriptions were regarded as “emergency manuals” in their times. We should apply such manuals as a gift of wisdom from our ancestors and use them as suitable for modern society. Herein, we would like to discuss that Oriental treatments such as traditional Japanese medicine, Kampo, and traditional Chinses medicine, TCM, including acupuncture are effective in emergency and critical care. The quality of acute treatment strategies may improve by utilizing every available medical resource and practice such as Western and Oriental medicines. The first presentation is “Two Cases of CommunityAcquired Pneumonia with Good Clinical Course Treated with Shosaikoto or Saireito.” Introduction: It has been suggested that shosaikoto is useful in combination therapy with antibiotics for bacterial pneumonia [1], but it is not mentioned in guidelines and is not incorporated into general practice, probably because of concerns about interstitial pneumonia caused by shosaikoto, despite its efficacy. We compared the clinical course of two patients with community-acquired pneumonia treated with shosaikoto and saireito, a fixeddose combination of shosaikoto and goreisan, with that of two patients not treated with Kampo medicines. Cases: All patients with pneumonia received antibiotics, were not on ventilators, and were able to leave the hospital by themselves. In contrast to the two patients in the non-Kampo group who received oxygen and were hospitalized for a slightly prolonged period, the two patients in the Kampo group were weaned from oxygen at an early stage and showed marked improvement in their imaging findings. Conclusion: It is suggested that shosaikoto or saireito can be used safely and effectively for respiratory failure in patients with pneumonia if the indication is met. The second presentation is “Treatment of Heart Failure.” Background: In the treatment of heart failure, diuretics improve symptoms by relieving the preload. However, some adverse events of diuretics such as electrolyte abnormalities and kidney injury are problems. Case 1: A 91-year-old female came to our clinic complaining of exacerbation of dyspnea on exertion for two months. We diagnosed congestive heart failure and administered intravenous isosorbide dinitrate and furosemide 20 mg. However, her serum creatinine level was elevated. Therefore, we added shimbuto and goreisan. Then her symptoms were resolved, and her renal function did not decrease. Case 2: A 64-year-old male presented to our clinic complaining of dyspnea and palpitations on exertion. His symptoms exacerbated when his blood pressure elevated; on the other hand, he was in presyncope if his blood pressure decreased. We added mokuboito, and his symptoms were resolved without adverse reaction. Discussion: In the treatment of congestive heart failure and edema accompanying chronic renal failure, it is possible to treat with Kampo medicine without impairing renal function. Goreisan normalizes the imbalance of body fluid. Shimbuto improves the circulation of body fluid in spleen–kidney yang deficiency. Mokuboito tonifies yang of the heart, spleen, and stomach, then sends heat and body fluid of the lung to the kidney, activating qi. Conclusion: Kampo medicine is useful for adjusting the balance by treatment of excessive volumes of water. The third presentation is “Supportive Care in Acute Management.” Background: Western medicine does not have adequate strategies for treating gastrointestinal dysfunction and frailty, which are problems in acute disease management. Kampo medicine, on the other hand, has developed various treatments for gastrointestinal dysfunction and frailty. Case 1: An 82-year-old male was hospitalized for paralytic ileus. He was treated with laxatives, gastrointestinal peristalsis stimulants, and daikenchuto for two weeks, but did not improve. After three days of treatment with bukuryoingohangekobokuto, he showed marked improvement. Case 2: A 64-year-old male presented with short bowel syndrome after intestinal resection due to Crohn’s disease. He was hospitalized for postoperative renal failure. He usually had diarrhea 5–6 Received: 22 May 2022 Revised: 12 June 2022 Accepted: 12 June 2022