Two Cases of Orthostatic Dysregulation Successfully Treated with Shakanzoto

Abstract

Orthostatic dysregulation arises primarily from venous pooling in the lower extremities due to abnormal regulation of the autonomic nervous system. This leads to altered central blood volume, which reduces cardiac output and circulating blood volume, resulting in difficulties in rising, dizziness, fatigue, nausea, and palpitations. The treatment of orthostatic dysregulation typically involves non-pharmacological measures such as salt and water supplementation, as well as pharmacological interventions including midodrine hydrochloride. Here, we present two cases of orthostatic dysregulation that were effectively treated with shakanzoto, a Kampo medicine. Case 1 was a 15-year-old boy who had been experiencing fatigue, difficulty in rising, and palpitations in the morning for two years, resulting in his inability to attend school for six months. He was diagnosed with orthostatic dysregulation in accordance with the Japan Clinical Guidelines on Psychosomatic Diseases in Childhood and was administered shakanzoto, after which his symptoms were resolved by day 14 of the follow-up visit, enabling him to attend school. Case 2 involved a 14-year-old girl who had been experiencing fatigue, nausea, dizziness, and palpitations in the morning for five years and was also diagnosed with orthostatic dysregulation in accordance with the aforementioned guidelines. She was administered shakanzoto and her symptoms resolved by the fourth day, allowing her to return to school. To date, the effectiveness of shakanzoto for the treatment of orthostatic dysregulation has not been reported. Nonetheless, shakanzoto may be considered as a potential addition to the treatment for orthostatic dysregulation.