A Case of Painful Legs and Moving Toes Syndrome Successfully Treated with Shimbuto and Processed Aconite Root

Abstract

The patient was a woman in her 70s. Eight years previously, she began experiencing unexplained pain and numbness in both lower legs, accompanied by involuntary toe movements. Despite evaluations at multiple medical institutions, the cause remained unclear. While diagnosed with restless legs syndrome at one facility and treated with conventional medications, her symptoms persisted. After visiting our hospital, she was diagnosed with painful legs and moving toes syndrome (PLMT) following further investigation. Treatment with mirogabalin and amitriptyline proved ineffective and caused significant side effects. Based on traditional Kampo medicine assessment, her condition was classified as “yin deficiency with fluid disturbance and interior cold.” She was treated with shimbuto, which alleviated her lower leg pain, numbness, and involuntary toe movements. The addition of bushi (processed aconite root) and gradual dosage increases led to further symptom improvement. This case suggests that Kampo medicine may serve as a therapeutic option for patients with PLMT unresponsive to conventional treatments.