A Case Report of Persistent Tic Disorder Successfully Treated with Nyoshinsan and Shoyosan Modified Formula

Abstract

We report a case of a 53-year-old woman who suffered from persistent tic symptoms around her mouth and right eyelids. She visited our Kampo clinic because of a poor response to Western medicine. We focused on symptoms including palpitations, anxiety symptoms and fullness in the chest and hypochondrium, and prescribed Kampo formulas containing Bupleurum root, which had little effect. Finally, we thought this might be caused by liver qi depression, heart heat, blood stasis, liver blood and yin deficiency as well as liver yang transforming into wind, because she had symptoms of not only fullness in the chest and hypochondrium, but also nocturnal awakening, constipation, a pale red and purple tongue with yellow fur, pressure pain beside her umbilicus, calf pain and fine pulse. Therefore, we administered modified formula of nyoshinsan and shoyosan. Her symptoms have markedly improved after taking this formulation and have been stable for 18 months. In addition, the number of Western medications has been reduced. It is known that some cases of persistent tic disorder are resistant to standard Western treatments. Kampo medicine may be a useful alternative and provide relief in such cases.