2.2 MEDICATIONS FOR AUTONOMIC NERVOOUS DISORDERS AND RECONSTRUCTION OF AWAKENING-SLEEP RHYTHM
When there were orthostatic hypotension, prolonged QT interval, or bradycardia with cardiomegaly or high brain natriuretic peptide, the autonomic nervous disorder of circulatory organ was considered. And we used a diuretic or Toki-Shakuyaku-San to reduce heart load. High blood pressure was treated mainly by angiotensin II receptor blocker (ARB).31 When pollakiuria was detected without the storage of urine during night, we used Hachimi-Jio-Gan. The diuretics in morning also contributed to construction of the urination rhythm. In the case with arthralgia at the same time, we used Gosha-Jin-Ki-Gan. When the need of improvement of gastrointestinal peristalsis was considered, we treated lansoprazole in morning and tried to make the circadian rhythm. Lansoprazole stabilizes the receptive relaxation of stomach in morning.32 When we diagnosed loss of appetite, low motivation, and muscle weakness of legs, so-called frail syndrome, we used Ninjin-Yoei-To. When electroencephalogram (EEG) pointed out fluctuating cognition, or the interview confirmed the change of the cognitive function in the day or week, we chose Japanese Kampo Medicines (JKMs), which contained Toki, Japanese Angelica Root, including ligustilide, for the stabilization of awakening to reconstruct awakening-sleep rhythm. When it was necessary to make the end of activity towards night, we chose Japanese Kampo Medicines (JKMs) containing Chotoko, Uncaria Hook, including rhynchophylline. In other words, the Yokkan-San is a representative reconstructing the awakening-sleep rhythm. With the combination of clonazepam, we made experiences of the dream fewer and we performed a stabilization of the sleep by nitrazepam.33,34