Policy Advisory Committee Report : Kampo Frailty Score / 日本東洋医学雑誌

“The Kampo Future Vision Study Group responsible for health and medical care of people” was established in 2016 with the aim of discussions to resolve various problems related to Kampo, and issued six proposals as important items. Among these proposals, the emphasized themes that are directly linked to clinical practice are “Kampo as a supportive treatment for cancer” and “Kampo as a countermeasure against frailty in the elderly.” The Japan Society of Oriental Medicine decided on a policy to be involved in these themes and established the Proposal-Discussing Committee (later absorbed into the Policy Advisory Committee). At first, the committee asked experts to present the research status of Kampo medicine as supportive care for cancer and as countermeasures against frailty. The committee, then, decided to lead clinical research by itself on frailty treatment with Kampo medicine. In such clinical research, evaluation criteria for judging therapeutic effects are necessary. Therefore, the existing well-defined diagnostic criteria were combined to create a Kampo frailty score. This article explains the Kampo frailty score, citing the supporting literature.

Two Cases of Compulsive Behavior Successfully Treated with Ryokeijutsukanto / 日本東洋医学雑誌

To date, there have been limited reports on the efficacy of Kampo medicine in treating obsessive compulsive behaviors. To the best of our knowledge, there have been no previous reports on the efficacy of ryokeijutsukanto for obsessive compulsive behaviors. Here, we describe 2 cases of obsessive-compulsive behavior successfully treated with ryokeijutsukanto. Case 1 involved a 30-year-old female patient who presented with vague anxiety. As a result, she spent significant time engaging in compulsive behavior related to checking and was frequently tardy to work. She met the diagnostic criteria for obsessive compulsive disorder. We prescribed ryokeijutsukanto. Her compulsive behavior then improved from 40 minutes to 5 minutes in 56 days. Case 2 involved 57-year-old female patient who complained of not feeling refreshed in the morning. In addition, she had a feeling of gloom, daytime sleepiness and compulsive behavior of checking about 5 times whether windows were locked. We prescribed ryokeijutsukanto. In 14 days, her checking behavior then improved from 5 times to once. Other troublesome symptoms also improved. Ryokeijutsukanto is usually utilized for patients with fluid retention, dizziness, and qi counterflow. However, these 2 cases have qi stagnation rather than qi counterflow. These results suggested that ryokeijutsukanto could also be utilized to treat compulsive behaviors when patients had fluid retention, dizziness and qi stagnation.

Three Cases Demonstrating the Effectiveness of Boiogito Treatment Against Rapid Weight Gain and Edema: Women Suffering from Irregular Menstruation Without Obesity / 日本東洋医学雑誌

We encountered three patients with edema and menstrual disorder that was improved by boiogito. Case 1 was a 17-year-old woman with fatiguability and irritability, treated with kamishoyosan. After adding boiogito to kamishoyosan because of facial and foot edema, palmar sweating and weight gain, her menstrual period became regular. Case 2 was a 15-year-old woman with headache as well as facial and foot edema, who was receiving goreisan. She complained of knee discomfort and worried about weight gain even though she was thin. So we prescribed her boiogito, and her menstrual disorder improved. Case 3 was a 42-year-old woman with fluid retention, who suffered from general fatigue, coldness, and menstrual disorder. She was prescribed boiogito because of weight gain as well as foot edema and coldness, and her menstrual cycle gradually became regular. Boiogito appears to be effective in patients with menstrual disorder who show “exterior deficiency edema” that is maldistribution of fluid on the body surface, such as water retention, sweating, or edema. Boiogito resulted in a feeling of lightness. Even if water retention is not clearly observed, the symptoms of rapid weight gain, edema or edematous feeling, and subjective coldness may be indications for boiogito.

Three Cases of Easy Fatigability and Tiredness Successfully Treated with Hangekobokuto / 日本東洋医学雑誌

We describe 3 cases of easy fatigability successfully treated with hangekobokuto. Case 1 was a 44-year-old woman who had been experiencing fatigue for a long time due to her busy work schedule. Juzentaihoto was ineffective, and she felt abdominal swelling and showed epigastric resistance upon abdominal examination. Case 2 was a 13-year-old woman who became easily tired, had palpitations, felt uneasy, and showed epigastric resistance upon abdominal examination, after moving from overseas to Japan. Case 3 was an 18-year-old woman who became easily tired under the pressure of her studies after entering university, felt uneasy, felt abdominal swelling, and showed epigastric resistance upon abdominal examination. Hangekobokuto relieved these symptoms. In Case 2 and Case 3, there were obvious stressors, and qi stagnation was strongly suspected. In Case 1, although the patient did not complain of obvious stress, she did not respond well to juzentaihoto, which compensates for qi deficiency, so we also considered qi stagnation. For symptoms such as “get tired easily,” qi-tonifying formulas are often used, but qi-regulating formulas including hangekobokuto may also be effective. It is also important to focus on the patient’s mental state and living environment.

The Induction of Acupuncture Curriculum for Kampo Medicine Doctors / 日本東洋医学雑誌

To help medical doctors practicing Kampo medicine suggest appropriate acupuncture treatments for individ­ual patients, a study group made up of 7 acupuncturists and 5 medical doctors developed an acupuncture cur­riculum. The group provided a learning program based on the curriculum for 16 medical doctors in charge of outpatient Kampo services in a research institute. The learning program consisted of a lecture and practical training, and a total of 4 sessions were held. At the end of each session, a test was conducted to examine the participants' level of understanding. After the completion of the learning program, a questionnaire survey was conducted to confirm the usefulness of the acupuncture curriculum for the practice of Kampo medicine. The mean number of participants per session was 10.8 ± 1.3. The mean test score was 9.3 ± 0.5 (full score : 10). In the questionnaire, 14 out of the 16 (88%) answered that the acupuncture curriculum was useful or relatively useful for the practice of Kampo medicine. On comparing the numbers of new acupuncture patients with a his­tory of outpatient Kampo service use before and after the acupuncture curriculum, there was a 1.8-fold increase after it. The results support the usefulness of the acupuncture curriculum to understand acupuncture and practice Kampo medicine. Further evaluation is necessary.

Three Cases of Dry Nose Successfully Treated with Hachimijiogan or Rokumigan / 日本東洋医学雑誌

Few reports currently exist demonstrating that Kampo medicine is effective for dry nose. Here, we describe three cases of dry nose that were successfully treated with hachimijiogan or rokumigan. The chief complaints of the three cases differed. Dry nose was the second or third most troublesome symptom. The three cases had kidney deficiency and its typical symptom of abdominal numbness in common. Upon administration of hachimijiogan or rokumigan, dry nose improved promptly, along with the improvement of kidney deficiency. In addition, it became easier for all three cases to breathe. According to “Pu ji fang”, dry nose is ascribed to wind-­heat or kidney deficiency. The kidney is considered to control the reception of qi inhaled by the lungs. Taken together, we speculate that dry nose of the three cases were due to kidney deficiency, because treatment with hachimijiogan or rokumigan improved their dry nose along with the improvement of their kidney defi­ciency as well as their breathing which suggests the improvement of the reception of qi inhaled by the lungs. Hachimijiogan or rokumigan is shown to be effective for dry nose in the patients with kidney deficiency.

<b>Two Cases of Acne Vulgaris Successfully </b><b>Treated with Tokikenchuto </b> / 日本東洋医学雑誌

Kampo treatment is frequently effective for patients with acne vulgaris who are unresponsive to standard treatment with western medicine. We report two cases of acne vulgaris successfully treated with tokikenchuto. In the first case, a 32-year-old woman complained of mild acne, loose stool and menstrual pain. Her abdomen was soft and a pulsation above the navel was noted. These symptoms were considerably improved after taking tokikenchuto. In the second case, a 26-year-old woman presented with moderate acne, loose stool and menstrual pain with excessive strain of the abdominal muscles and objective tenderness on the sides of the abdomen. Kamishoyosan and tokishakuyakusan were first prescribed, although these caused bowel disturbances, and eventually tokikenchuto was prescribed, which improved the acne. We suggest tokikenchuto is effective for patients with mild to moderate acne who have bowel disturbance with soft abdomen or excessive strain of the abdominal muscles, which are considered indicators of gastrointestinal weakness. In addition, yokuinin has a synergistic effect in the treatment of acne.

Five Female Cases of Irritable Bowel Syndrome with Diarrhea after Taking Cold Food and Drink Under Stressful Conditions Successfully Treated with Ireito-Based Kampo Prescriptions / 日本東洋医学雑誌

We report five female patients (range 33-54 years) with irritable bowel syndrome (IBS) that were successfully treated with ireito-­based prescriptions. Showing yin deficiency and weak constitution, they maintained a good state of bowel movement with warming and invigorating prescriptions. However, when it became hot around March to June and these patients encountered stressful conditions, they became thirsty and tended to take a lot of cold food and drink. Then, they developed diarrhea, epigastric and/or abdominal fullness, anxiety and depressive feeling, which are regarded as due to qi stagnation. Stuck sensations in pit of stomach by abdominal examination were reported in all cases. Their symptoms were derived from water retention and qi stagnation, and therefore, we prescribed ireito for one patient, ireito with keishikashakuyakuto or kenchutobased prescriptions (ogikenchuto or shokenchuto) for 3 patients, and ireito with keishibukuryogan for one patient. Ireito is composed of heiisan and goreisan. The Chinese herbs Magnolia Bark and Citrus Unshiu Peel in heiisan not only help the digestive system, but also improve qi stagnation. These results suggest that ireito,containing Peony Root, is effective for patients with IBS, who show stuck sensations in the pit of stomach and suffer from diarrhea with abdominal pain after taking cold food and drink under stressful conditions.

Ten Patients with General Fatigue Associated with Blood Stagnation Successfully Treated with Kampo Formulae, Keishibukuryogan and/or Tokakujokito / 日本東洋医学雑誌

In Kampo medicine, general fatigue is categorized as a symptom caused by qi deficiency according to the qi-blood-­water criteria. However, in some patients with general fatigue, formulae for qi deficiency are not ef­fective, and this might be because their chronic symptoms are associated with blood stagnation. Recently, we encountered ten patients (M/F 1/9, mean age 46 years, range 23-55 years) with general fatigue that was im­proved by agents for treating blood stagnation, such as keishibukuryogan and/or tokakujokito. These patients, who were mostly of medium build, complained of neck or shoulder stiffness (9/10), consti­pation (5/10), and blushing or hot flushes (5/10). They had no problem with appetite, except that 5 patients tended to overeat. Remarkable sublingual collateral vessels (8/10), paraumbilical tenderness (9/10) and periorbital dark circles (5/10) were observed on physical examination. The tongue and abdominal signs improved or had disappeared after treatment for 3 to 8 months. Our results suggest that patients with general fatigue, but who present with symptoms associated with blood stagnation, could be treated with drugs for blood stagnation such as keishibukuryogan and/or tokakujokito.

<b>Yokukansan Descriptions in the Original Texts</b> / 日本東洋医学雑誌

We investigated original texts for yokukansan, a familiar Kampo formula, focusing on the classical literature <i>Xue-shi yi-an</i> (薛氏医案) . Yokukansan was described in the <i>Bao-ying jin-jing-lu</i> (保嬰金鏡録) written by Xue ji (薛己) in 1550, the <i>Xiao-er yao-zheng zhi-jue</i> (小児薬証直訣) revised by Xue ji (薛己) in 1551,the <i>Bao-ying cuo-yao</i> (保嬰撮要) by Xue kai (薛鎧) in 1556, and the <i>Xiao-er dou-zhen fang-lun</i> (小児痘疹方論) in 1550. The phrase “one's own work” was used in “<i>Bao-ying jin-jing-lu</i> (保嬰金鏡録)” and in the <i>Xiao-er dou-zhen fang-lun</i> (小児痘疹方論) by Chen wen-zhong (陳文仲). However, there was no mention of “one's own work” in the same title, the <i>Xiao-er dou-zhen fang-lun</i> (小児痘疹方論), as summarized by Xiong zong-li (熊宗立).<br>Yokukansan was found only in the <i>Xiao-er yao-zheng zhi-jue</i> (小児薬証直訣) revised by Xue ji (薛己) in 1551, but not in the other copies of the same text. Therefore, it seems likely that yokukansan was created by Xue ji (薛己) himself.<br>Yokukansan was previously thought to have originated with the <i>Bao-ying cuo-yao</i> (保嬰撮要). However, based on use of the phrase “one's own work” in the classical literature, it appears that the original text for yokukansan should be the <i>Bao-ying jin-jing-lu</i> (保嬰金鏡録). Therefore, yokukansan seems to have been made by Xue ji (薛己), and not Xue kai (薛鎧), who was his father.

<b>Three Cases of the Same Kampo Treatment Applied to a Mother and Daughter with Different Complaints </b> / 日本東洋医学雑誌

We describe three cases in which the same Kampo formulas were applied to a mother and daughter with different complaints. In cases 1 a, b, a mother with general fatigue after an operation for gastric and colon cancer, and her daughter with migraine and menopausal symptoms were effectively treated with kamishoyosan. In cases 2 a, b, a mother with menstrual disorder, and her daughter with palmar eruption were effectively treated with hangekobokuto. In cases 3 a, b, a mother with lumbago and her daughter with back pain were effectively treated with keishikaryukotsuboreito. These Kampo formulas are thought to improve <i>qi </i>circulation.<br>It is considered that improving <i>qi </i>disturbance is important for the Kampo treatment of female patients. Taking into account parent-child genetic similarities, it is possible that application of the same Kampo formula to familiarly related patients with different complaints could be effective. It is important to consider not only the patient's complaints, but also the patient's condition, from the Kampo viewpoint so-called “Sho”. Therefore,since our cases all involved a mother-daughter relationships, it may be reasonable to assume that Kampo formulas improving <i>qi </i>circulation were effective for their different complaints.

A Case of Globus Pharyngis in Gastroesophageal Reflux Disease Successfully Treated with Seinetsuhoketsuto / 日本東洋医学雑誌

Gastroesophageal reflux disease (GERD) can cause not only esophageal symptoms, but also extraesophageal symptoms such as globus pharyngis. Here, we describe a case of globus pharyngis in GERD successfully treated with seinetsuhoketsuto. A 72-year-old female began to have tingling in her pharyngolarynx in February 20XX. Otolaryngologist did not point out abnormal findings. However, reflux esophagitis was detected by upper gastrointestinal endoscopy. Although treatment with rabeprazole relieved the tingling, she experienced a relapse in September 20XX and visited our clinic in November. We prescribed seinetsuhoketsuto because she exhibited numerous blood deficiency-related symptoms including dryness of the skin and eyes, shallow sleep, coldness in the feet, etc. The tingling then decreased rapidly and disappeared in two months. In addition, dryness of the skin and eyes and her sleep also improved markedly. Seinetsuhoketsuto has been regarded as a medication for inflammation in the mouth such as oral ulcers and erosions. However, this case indicated that seinetsuhoketsuto could also be utilized to treat symptoms in the pharyngolarynx due to GERD.

Three Cases of Insomnia Due to Alternating Heat and Chill Successfully Treated with Saikokeishito / 日本東洋医学雑誌

We describe three cases of insomnia due to a feeling of heat in parts of the body, successfully treated with saikokeishito. Case 1 was a 50-year-old man who felt hot in his trunk and extremities at night. Case 2 was a 57-year-old women with osteoarthritis in the fingers who felt hot in her back at night. Their heat/pain was regarded as shisetsuhanto, or vexing pain in the extremities as described in “Shang Han Lun.” Case 3 was another 57-year-old woman who reported hot flushes both day and night. She did not have vexing pain in her extremities, but developed a rash. Although three patients felt hot, they all felt chill when they took off a blanket. Their heat vexation and intolerance of cold were considered as zokansonetsu, as seen in saikokeishito syndrome. They had kyokyokuman, or objective tenderness in the hypochondrium. However, they differed in shinkashiketsu, or tightness below the heart, another characteristic physical findings of saikokeishito : case 1 had stuffiness and rigidity below the heart and abdominal muscle contracture, case 2 had hardness and stiffness in zhong wan (middle segment of the stomach), and case 3 had mild stuffiness and rigidity below the heart, in terms of signs classically reported by Japanese doctors in the Edo period. These findings may suggest that saikokeishito has a wide range of indications. The three cases shared several characteristics, such as during menopause, without cold limbs, moderate or hypofunctional body energy, and alternating heat and chills. Saikokeishito could be a good medicine to treat patients suffering from insomnia with such symptoms, especially during menopause.

Nine Cases of Migraine During the Late Period of Menstruation Successfully Treated with Juzentaihoto / 日本東洋医学雑誌

In female patients with migraine, the triggering or exacerbating factors for migraine including stress, menstruation and fatigue, should be treated intensively in addition to treatment for headache. Patients with coldness and weak constitution become a state of qi and blood deficiency in terms of Kampo medicine under the circumstances of severe fatigue, lack of sleep and menopausal symptoms. They tend to suffer from migraine at around the 4th or 5th day of menstrual period after rather heavy menstrual bleeding on the 2nd or 3rd day. We experienced 4 patients with headache during the late period of menstruation whose symptoms were successfully treated by juzentaihoto known to improve qi and blood. In Case 1, daily prescription was changed from unkeito to juzentaihoto. In Case 2, during the 7 days of menstrual period, juzentaihoto was added to tokishigyakukagoshuyushokyoto, while juzentaihoto was substituted for tokishakuyakusan in Case 3 and Case 4. In 9 cases of headache, including these 4 cases, juzentaihoto was efficacious against migraine headache during the late period of menstruation with coldness (9/9 cases), fatigability (9/9 cases) and dryness symptoms (7/ 9 cases). These results indicate that juzentaihoto is effective for migraine during the late period of menstruation, especially in patients with fatigue after menstrual bleeding. The administration period of juzentaihoto should be individualized for each patient depending on the severity of qi and blood deficiency.

Cases of Allergic Rhinitis Successfully Treated with Tokishakuyakusan / 日本東洋医学雑誌

Allergic rhinitis is an allergic disease affecting the nasal mucous membrane, and is aggravated by many kinds of factors. Here we describe 4 cases of allergic rhinitis successfully treated with tokishakuyakusan. Case 1 was a 31-year-old woman who suffered from coldness and irregular menstruation. We administered tokishakuyakusan, and her allergic rhinitis improved. When she stopped taking tokishakuyakusan, her allergic rhinitis recurred. Case 2 was a 40-year-old woman who suffered from seasonal pollenosis every year. Her pollenosis did not respond to keishibukuryogankayokuinin, administered for uterine myoma, but when we switched to tokishakuyakusan, her pollenosis improved. Case 3 was a 49-year-old woman who suffered from allergic rhinitis. She had not responded to many herbal medicines, but when we administered tokishakuyakusan, her allergic rhinitis rapidly improved. Case 4 was a 65-year-old woman who suffered from allergic rhinitis. She did not respond to kakkontokasenkyushin'i, but when tokishakuyakusan was added, her allergic rhinitis improved. Efficacy of tokishakuyakusan for rhinitis is not described in the classic literature. Our results suggest that tokishakuyakusan could be a suitable herbal medicine for asthenic, cold constitution of patients with allergic rhinitis caused by blood stagnation and blood deficiency as well as water disturbance.

Safety of Retained Acupuncture With the Planar Electric Heater at Our Institute / 日本東洋医学雑誌

Our institute performs retained acupuncture for cold-related symptoms using planar electric heaters. After placing retained acupuncture needles at 8 points on the lower back, the site is covered with a planar electric heater and heated for 20 minutes, with the 6-channel dial of the device set at 5, the second highest temperature. Using this method, we treat and examine patients with cold-related symptoms. If patients feel discomfort during the heating process, the procedure is continued when heat is used for treatment and immediately terminated in the case of examination. On examining related adverse events in 75 cases (224 sessions) within the 8-month period between March and October 2016, there was soreness/irritation of the skin surface in 5 (2.2%), itching in 3 (1.3%), and physical deconditioning in 1 (0.4%). However, all of these events were mild and temporary, supporting the safety of the method. As a future challenge, it may be necessary to expand this study to clinical research on traditional Chinese medicine and acupuncture/moxibustion.

Treatment of Patients with Floating Sensation after the Great East Japan Earthquake / 日本東洋医学雑誌

We would like to report on the treatment of 15 patients with floating sensation after the Great East Japan Earthquake (2011 Tohoku Earthquake) in 2011.Twelve cases were effectively treated with hangekobokuto, while two cases were effectively treated with hangebyakujutsutemmato, but not with hangekobokuto.One case was effectively treated with ryokeijutsukanto. We discuss how to treat this floating sensation, focusing on the usage of hangekobokuto.<BR>Most patients who were successfully treated with hangekobokuto reported an uneasy feeling with a floating sensation. On the other hand, those who were successfully treated with hangebyakujutsutemmato or ryokeijutsukanto did not feel uneasy, but reported vertigo and upset stomach.Upon abdominal examination, epigastric resistance was frequently observed in the patients treated with hangekobokuto.This resistance decreased as the floating sensation was improved.<BR>Our results indicate that hangekobokuto could be efficacious for patients with floating sensation after an earthquake, who also felt uneasy and showed epigastric resistance upon abdominal examination.

<b>Efficacy of Kampo Formula Tokishigyakukagoshuyushokyoto for Cold Syndrome Evaluated with a Novel Clinical Method using a Patient-based Questionnaire D</b><b>atabase </b> / 日本東洋医学雑誌

<b>Objectives</b> : Persistent coldness is a common complaint for which Kampo, traditional Japanese herbal medicine, is often tried, because there is no definition or objective measure of subjective coldness in Western medicine. The aim of this study was to evaluate the efficacy of a common Kampo agent, tokishigyakukagoshuyushokyoto, and to identify key symptoms that would predict positive treatment outcomes for coldness.<br><b>Design</b> : A retrospective cohort study.<br><b>Setting</b> : 181 patients who complained of coldness without any organic abnormalities self-surveyed their health using a Kampo questionnaire database system on their first visit. Another 28 patients were assigned to verify the discriminatory predictability of treatment efficacy.<br><b>Interventions</b> : Patients were treated with extract product, 7.5 grams a day for a month.<br><b>Outcome measures</b> : Treatment efficacy as a binary response.<br><b>Results</b> : Frequency and severity scales (0 to 4) for coldness decreased from 3.2 ± 0.7 to 2.1 ± 0.1 (<i>p </i>< 0.01)and from 3.1 ± 0.7 to 2.2 ± 0.9 (<i>p </i>< 0.01), respectively. Improvements in both frequency and severity of coldness were observed in 74.0% of patients. The status of tenderness in the iliac region, without upset stom ach or depression, was obtained as an appropriate model for the prediction of treatment effect, and its discrimi natory predictability was calculated as 84.4%. The predictive accuracy of the model was validated with 82.1% for the 28 new patients.<br><b>Conclusions</b> : Coldness susceptible to tokishigyakukagoshuyushokyoto was very frequently accompanied by tenderness in iliac region, without upset stomach or depression.

<b>A Case of Palpitation / Coldness Successfully Treated in a Climacteric Woman with Keishikaryukotsuboreito </b> / 日本東洋医学雑誌

There have been some reports that keishikaryukotsuboreito improves climacteric symptoms such as palpita tion, but none have reported coldness successfully treated with this formulation. We report a case of palpita tion and coldness, successfully treated with keishikaryukotsuboreito.<br>The patient was a 48-year-old female. She complained of palpitation and coldness for 2 to 3 years. She had coldness of the hands and feet without hot flushes. She consulted our clinic on May 8, XXXX. We prescribed keishikaryukotsuboreito (7.5 g/day) because of suggestive symptoms of insomnia, as well as palpitation in the abdomen. Her symptoms improved in 2 weeks. Keishikaryukotsuboreito is usually prescribed for cold feet with hot flushes. The results experienced in this case suggest that keishikaryukotsuboreito may be effective for cold feet without hot flushes, especially with palpitation and pulsation at the navel, which are known symp toms of <i>qi </i>counterflow in Kampo medicine.

<b>A Case of Palpebral Hemispasm Successfully Treated with </b><b>Orengedokuto</b> / 日本東洋医学雑誌

<p>We present a 35-year-old male with palpebral hemispasm, which often occurred while at work. Because there were no ophthalmological findings, he consulted our clinic to receive Kampo therapy. He easily became fatigued and he had subchondral resistance and discomfort (kyo-kyo-kuman), so we treated him with saikokeishito and shakuyakukanzoto. However, they were ineffective, and therefore we reconsidered his symptoms.<br>Although he complained of fatigue, he was well built and had been a heavy drinker until a few years before presenting. Furthermore, he easily blushed and sweated in the upper body during the daytime, and his palpebral hemispasm often occurred during this blushing and sweating, and was accompanied by headache. We considered that this represented an excess-heat pattern rather than a deficiency pattern, and prescribed orengedokuto. His symptoms improved, and disappeared after six months.<br>There has been no detailed report of orengedokuto for the treatment of palpebral hemispasm. Orengedokuto may be useful for palpebral hemispasm in the context of symptoms of excess-heat pattern, such as blushing, sweating in the upper body and headache.</p>