Successful treatment of swelling caused by a mamushi (Gloydius blomhoffii) bite with herbal medicine eppikajutsuto

A 65-year-old woman was bitten by a Japanese mamushi (Gloydius blomhoffii) on her right index finger. The swelling progressed to the right wrist, and she was referred to our hospital for additional treatment. She was obese, with a height of 151 cm and a weight of 86.2 kg. The swelling of her right hand had spread beyond the wrist to the forearm. She had rheumatoid arthritis and was taking multiple immunosuppressive drugs. Despite using multiple immunosuppressive medications, the swelling of the right hand had expanded toward the body, so we treated her in the hospital with mamushi antivenom. On the day after admission to our hospital, the swelling and redness began to extend beyond the shoulder joint to the trunk (Figure. 1a). The right palm was swollen and had no wrinkles (Figure. 1b). Due to severe pain, she desired additional treatment, and hence we used the Japanese herbal medicine eppikajutsuto (EPJT). Her Kampo medical findings were: upon examination, the patient showed a good appetite and had no mood disturbance. Her skin was not dry. She was edematous throughout the body. Her right arm was reddish and hot. The tongue showed no swelling. Sublingual veins were less prominent. Her pulse was intermediate floating and sunken. Abdominal strength was strong. There were no other abdominal signs and findings. Kampo medical diagnosis: the patient was diagnosed as having fluid disturbance, excess and heat pattern. On the day after the start of EPJT, there was marked improvement in both the swelling and redness in the right upper limb (Figure. 1c), and wrinkles appeared on the right palm (Figure. 1d). The swelling in the right palm almost disappeared on the third day after the start of EPJT. She was discharged on day 7 of admission. As there is yet no reliable treatment for mamushi bites, management of the general condition is the mainstay of treatment. It has been reported that the treatment of mamushi bites is based on the grade of associated symptoms [1]. In our patient, the swelling in the right hand rapidly spread to the upper arm. Hence, we decided to use antivenom and injected it within 6 h from the mamushi bite. However, on the day after admission, the swelling and redness in the right hand had spread to the trunk. To the best of our knowledge, there have been no new and effective methods to control disease progression in such cases. However, Japanese herbal medicine could provide an alternative.