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Orthostatic dysregulation often occurs during adolescence and presents with symptoms such as dizziness, difficulty waking up in the morning, nausea, anorexia, general malaise, and headache. Herein we describe a case of delayed sleep-phase syndrome in a 16-year-old female who had been treated with Kampo medicine since the age of 14 for orthostatic dysregulation. After taking renjuin, her condition improved and she was able to attend school. However, two winters later, her symptoms flared up and she was hospitalized. Electro-acupuncture test revealed her severe interior cold, and a simple sleep analysis showed that she was not getting deep sleep. We hypothesized that her interior cold contributed to her sleep disorder. After taking sekiganryo for the purpose of warming therapy, her waking time and sleep depth improved. This case showed that interior cold can cause sleep disorders and that warming therapy with sekiganryo may contribute to the improvement of sleep disorders.
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The persistent genital arousal disorder (PGAD) is a condition in which intense abnormal sensations and pain appear in the genital area without sexual stimulation. Here, we report two cases of PGAD successfully treated with tokishigyakukagoshuyushokyoto. Since dysfunction of nerves and blood vessels is thought to be involved in the cause of PGAD, we believed that tokishigyakukagoshuyushokyoto, which improves ischemia of the pelvic cavity organs, would be a good indication for this treatment. Tokishigyakukagoshuyushokyoto should be considered especially when tenderness in the inguinal region is observed.
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Kampo medicine containing Gardeniae Fractus is often used for agony of the chest, but there are few case reports about shishikankyoto. Here, we report a case of a 73-year-old woman with heat sensation in the chest and severe malaise successfully treated with shishikankyoto. She suffered from lung cancer five years previously, and received chemoradiation treatment. One year later, radiation pneumonitis developed, which was resolved naturally. After another year, she began to develop a slight fever, burning sensation and general malaise, which disappeared and recurred in cycles of about six months. She received Kampo medicine treatment for one year at another hospital, but lacked in improvement and was introduced to our hospital. We thought her symptoms were caused by deficiency heat pattern in the chest and cold in the epigastric region. By giving shishikankyoto in reference to a sentence in the Shang Hang Lun, her symptoms improved in about two weeks. Although, shishikankyoto is a prescription medicine with few reports, it is effective in a short period of time and is useful for similar symptoms.
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A 64 year-old female presented with fever and cough. She had suffered from a cough for one day and we treated her with saikokeishito. However, her symptoms got worse and she developed chest pain. She was diagnosed with bacterial pneumonia at another clinic and she was referred to our hospital 3 days after starting saikokeishito. Her X-ray showed right infiltration in her lung and her blood examination had signs of inflammation. Pneumonia with pleuritis was suspected, but she was allergic to antibacterial drugs and hoped to continue Kampo treatment. We switched saikokeishito to saikanto. Her chest pain decreased soon after taking saikanto and 4 days later only a slight cough remained. Eleven days later, her inflammatory reaction improved. Kampo formulas containing Bupleuri radix are usually selected for pneumonia or pleuritis according to a patient' s pattern identification. We gave her saikanto, a mixture of shosaikoto and shokankyoto, because she had chest pain. Saikanto was significantly effective. There have been few clinical reports about treatment for pneumonia with Kampo medicine alone without using antibacterial drugs. We believe this case shows that Kampo treatment is effective for pneumonia and pleuritis.
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Hangekobokuto is often used for globus sensation. We herein describe two cases in which ryokeijutsukanto was effective for globus sensation, for which hangekobokuto was ineffective. Case 1 was a 28-year-old woman. She had been suffering from postprandial belching, fullness and stuffy throat for a year. She underwent examination, but could not find the cause of her symptoms and visited our department. She was prescribed hangekobokuto, but the feeling of stuffiness in her throat did not improve. Case 2 was a 50-year-old woman. She had been afflicted with a feeling of fullness in the ears, tinnitus, and pain in the back of the eyes for two weeks. She visited the otolaryngology department, but no abnormalities were found so she visited our department. She was prescribed kamishoyosan, and although her ear fullness and tinnitus improved by about 60%, she began to complain of dizziness and throat stuffiness. This did not improve even though she used hangekobokuto with kamishoyosan. In both cases, after changing treatment to ryokeijutsukanto, the symptoms were improved. For globus sensation, it is necessary to select Kampo medicines while paying attention to qi deficiency, qi depression, qi counter flow, static blood, liver depression, lack of fluid, fluid toxicity, and gastrointestinal disorders. We thought that ryokeijutsukanto could be a candidate.
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A 65-year-old man, with a history of surgery for esophagogastric junction cancer in X-3, was admitted to the Department of Internal Medicine in our hospital in March for anorexia that had developed since January X. The patient was diagnosed with adhesive small bowel obstruction, and underwent surgery to relieve the obstruction in early May. However, his symptoms did not improve, and he was referred to our department in mid-June. His drooling was considered to be due to “excessive saliva secretion.” He started taking a decoction of bushirichuto for epigastric discomfort and resistance and coldness of the hands and feet. On the 5th day, he started to feel more energetic, and on the 8th day, his saliva production decreased. Furthermore, on the 12th day, his sense of taste and appetite improved. As the oral intake increased, tube feeding could be reduced and rehabilitation progressed ; from an almost bedridden state, he was able to walk continuously for 150 m with a cane. On the 29th day, he was transferred to a chronic care hospital. His weight increased from 34.1 kg, when he was referred to our department, to 39.7 kg at the discharge time. Anorexia and drooling, which had otherwise continued for 5 months, were improved within a short period of time by using bushirichuto.
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We report a case of post coronavirus disease 2019 (COVID-19) condition, in which the patient suffered from a severe sense of fatigue and brain fog that was successfully treated with Kampo therapy. The patient was a 21-year-old man. He had been diagnosed with COVID-19 and hospitalized for follow-up examinations. He recovered without any complications and was discharged from the hospital, but continued to suffer from a severe sense of fatigue, coldness, dizziness, and a loss of concentration. Because of these symptoms, he had to spend most of the day lying down. One month later, he was hospitalized to receive Kampo therapy. We administered bukuryoshigyakuto for 2 weeks referring to his severe coldness and fatigue and then changed to renjuin for his fluid disturbance and blood deficiency. After starting Kampo therapy, his fatigue and dizziness gradually improved. He was discharged after 3 weeks of hospitalization and received Kampo therapy as an outpatient. One month later, he reported a dull feeling in his stomach and depression. We switched to kamikihitogohangekobokuto and added hachimigan. His activities of daily living improved and he could take 4.5-kilometer walk. He could return to work 4 months later. Kampo therapy may be useful for post COVID-19 condition that causes a sense of fatigue and brain fog.
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The patient was a 47-year-old woman. Four years previously, she began to suffer from left lower leg pain and numbness, and involuntary movements. She received further examination in the department of neurology at other hospitals, but had an uncertain etiology and was provisionally diagnosed with restless legs syndrome. She was treated with Western medicine such as gabapentin and gabapentin enacarbil, but they were ineffective. She subsequently visited our hospital and was hospitalized. She was diagnosed with painful legs and moving toes syndrome, and painful arms and moving fingers syndrome after further examination. We prescribed tokakujokito because she had severe blood stasis and panic disorder on Kamp medical findings. As a result, her left lower leg numbness disappeared and pain was reduced. We report a case of a patient who could not be effectively treated using Western medicine and was successfully treated with tokakujokito-based Kampo prescriptions.
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We report a case of a patient with rheumatoid arthritis who refused Western medical treatment and was able to improve concomitant symptoms including arthralgia and headache by using kanzobushito. The patient was a 35-year-old. Eight years previously, she was diagnosed with rheumatoid arthritis due to joint stiffness. Although receiving methotrexate therapy, she developed methotrexate-associated lymphoproliferative disorders and the treatment was discontinued. Due to a feeling of rejection for Western medical treatment, she visited our hospital and was hospitalized for Kampo therapy. We prescribed kanzobushito for qi imbalance, coldness, and severe pain. Her joint pain, headache, and secondary symptoms were improved.
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We report a case of a 49-year-old woman who presented with 6-month period menopausal syndrome including excessive sweating and hot flushes in her face, chest and back. She was also frustrated with her sons, but she reflected on her own anger and wondered why she got so irritated with them. We prescribed yokukansan to her and her all symptoms improved one month later. We need to differentiate between yokukansan and kamishoyosan in the treatment of menopausal syndrome and irritation, and it may be useful to evaluate the detail of irritation in selecting formula.
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Yang diseases of the Shanghanlun (shōkanron) list the Three Yangs in the order of early yang stage pattern (taiyōbyō), middle yang stage pattern (yōmeibyō) and late yang stage pattern (shōyōbyō). However, in Japan, the order is early yang stage pattern, late yang stage pattern, and middle yang stage pattern. A survey of Japanese disease history revealed that by the Edo period smallpox, measles, and influenza were infectious, febrile, and highly lethal. Furthermore, these diseases exhibited bimodal fever. We investigated and examined how Kampo doctors viewed the order of the Three Yangs in the Shōkanron from the literature of the Edo period, and found that the epidemic period of these three diseases coincided with the increase in the number of doctors advocating late yang stage pattern. It is thought that the Three Yangs in Japan came to be recognized in the order of early yang stage pattern, late yang stage pattern, and middle yang stage pattern through these three diseases that became prevalent from around 1700.
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In this report, we present three cases of lower limb cellulitis. The first case was an 88-year-old woman and the second case was a 36-year-old man. In addition to standard therapy, both of them received Kampo therapies with keishinieppiitto and jidabokuippo during the acute phase of cellulitis and were promptly cured. The third case was a 52-year-old woman with severe obesity suffering from repeated and intractable cellulitis. She received Kampo therapy including keishibukuryogan. The redness and swelling in her leg gradually disappeared. Administration of adequate antibiotics and elevation of affected areas are important for the treatment of cellulitis. Even with appropriate therapy, some patients are slow to respond and difficult to treat. The skin findings in cellulitis are swelling, redness, heat, and pain, which can be recognized and treated as water imbalance, heat, and blood stasis in Kampo medicine. This case report suggests that cellulitis during the acute phase can be treated with keishinieppiitto and the treatment of water imbalance and heat is important. After the acute phase, the treatment of blood stasis is important. Considering the time of onset and skin findings in cellulitis, Kampo therapy can contribute to the rapid recovery of cellulitis.
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We report a case in which goreisan with hoketsuzai (blood-tonifying formula) was successful in the treatment of a marked nutritional disorder. A 17-year-old woman was screened for prominent emaciation of unknown cause. After the administration of goreisan, edema was reduced and her body weight increased. Subsequently, anemia improved and muscle mass increased with a combination of shimotsuto or sokeikakketsuto. It is possible that goreisan with hoketsuzai improved the water balance of the whole body including the digestive tract, and restored the digestive and absorptive function.
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Mokuboito is usually used for the treatment of patients with dyspnea and edema due to chronic heart failure. We herein report two cases successfully treated with mokuboito on the basis of shinkahiken (epigastric stuffiness and strong resistance). Case 1 was a 28-year-old woman. She had been experiencing occasional bouts of epigastralgia for 12 years, but they had worsened two months before the first visit to our department. When she was examined, however, the cause of epigastralgia could not be determined and she was diagnosed with functional gastroenteropathy. After being introduced to our department, she was treated with various Kampo formulas, but the symptom was poorly improved. Case 2 was a 74-year-old man who was prescribed hachimijiogan and shoseiryuto for an overactive bladder and perennial allergic rhinitis. His symptoms were stable, but suddenly deteriorated after two months. In both cases, when changing treatment to mokuboito on the basis of shinkahiken, the symptoms were improved. These results suggest that mokuboito can be used in a wide range of cases with shinkahiken.
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Five cases of various diseases associated with breast cancer treatment including arthralgia, menopausal symptoms, chemotherapy-associated symptoms (nausea, vomiting, numbness, pain, general fatigue), and anxiety neuroses during follow-up were treated with Kampo medicine and a favorable course was obtained. Combined use of Kampo treatment can reduce the suffering caused by the side effects of breast cancer treatment, alleviate mental symptoms, prevent recurrence, and improve the patients' health. Kampo medicine plays a role in cancer supportive care for breast cancer.
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In the pharmaceutical department of Iizuka Hospital, larvae of the cigarette beetle (Lasioderma serricorne) were found in Plantago seed for the first time since the Department of Japanese Kampo Medicine started in 1992. The larvae grew into pupae and then adults. The plastic-packaged Plantago seed was left for about 3 months, during which several larvae and adult cigarette beetles appeared. Cigarette beetles are very common insects in summer and it is important that we store crude drugs in hard closed containers in our refrigerators. The larvae can bite strongly and puncture plastic packaging, however they cannot live under 15 ℃. Education of crude drug storage for patients is very important.
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Six patients with psychiatric symptoms were successfully treated with shimotsuto-containing medication. Case 1 was a 13-year-old boy who complained of difficulty in getting up ; however, when he was treated with a focus on the decrease in his concentration, he was able to go to school after treatment. Case 2 was an 18-year-old girl who had also difficulty in getting up, but was able to go to school. Case 3 was a 10-year-old girl who was able to go to school partially after treatment. Case 4, a 42-year-old man with apprehension in socializing, showed improvement in socializing after taking medication containing shimotsuto. Case 5 had various complaints that were relieved after taking medication containing shimotsuto. Case 6 was a 56-year-old woman who had also multiple complaints ; however, the symptoms were alleviated with shimotsuto-containing medication. All patients experienced depression and anxiety. Four patients with decreased cortisol recovered after treatment with shimotsuto. From these results, shimotsuto is considered to improve concentration, judgment, and psychiatric symptoms by treating blood deficiency.
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Abdominal pain and marked coldness were observed in a 56-year-old male with cancerous ascites associated with cancer of unknown primary, and the patient was treated with sekiganryo. The abdominal pain resolved from day 2 after the initiation of sekiganryo administration, and the ascites markedly decreased with an increase in the urine volume on day 3. Although the mechanism of the effect of sekiganryo on cancerous ascites was unclear, it was considered that the improvement of coldness promoted the metabolism and subsequently promoted diuresis. No case of the improvement of cancerous ascites by sekiganryo has been reported to date. We report this case along with a literature review.
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We report a case of lower back with extremities pain, whose cause could not be established in the medical sense nor relieved by analgesic drugs, was successfully treated with kanzobushito. The patient was a 69-year-old male. Because of extremity pain of his lower left back, he could not move by himself and was transported to our hospital by an ambulance. Having persistent pain, he could not turn over or stretch his left leg and analgesic drugs and sacral nerve blocks were ineffective. We administered kanzobushito referring to the phrase “pain that gets worse as someone approaches” in the Shokanron. After administering kanzobushito, his pain was reduced remarkably and he could sit down on the bed. And his activities of daily living improved immediately. Thus, kanzobushito may be useful for severe pain and should be administered to neuropathic pain complicated with psychogenic factors referring to coldness, severe pain and abnormality of qi (irritable).
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Orento is generally used for upper gastrointestinal symptoms. We have used orento for various diseases based on “upper heat and middle cold”. As a result of the evaluation of 30 responders to orento, the most frequent sign of “upper heat” was “yellow tongue coating” (29/30 responders), while the most frequent sign of “middle cold” was “preference for warm foods and beverages” (27/30 responders). Compared with the non-responder group, the responder group showed significantly higher frequencies of “gastrointestinal cold”, which is the sum of “preference for warm foods and beverages” and “aggravation of gastrointestinal symptoms by cold foods and beverages” (29/30 responders, p = 0.047), and “upper/lower gastrointestinal symptoms” (29/30 responders, p = 0.014). These results suggest that “yellow tongue coating” is the most important sign for “upper heat” while “gastrointestinal cold” is the most important sign for “middle cold”. As Kampo patterns for orento, gastrointestinal symptoms often occur, but there is a possibility of upper or lower gastrointestinal symptoms, skin disorders, and sleep disorders.