The common treatment for chronic subdural hematoma (CSH) is surgical removal of the hematoma. Recently, Kampo is reported to have a beneficial effect for the management of CSH. Here, we examined the effect of saireito and the significance for the treatment of CSH. Thirty-seven patients of CSH, who had not undergone a surgical treatment, were given 6 g/day saireito and needed evacuation of the hematoma if they showed symptomatically worse. In the saireito effective group, the hematoma was disappeared in 28 ⁄ 37 (75.7%) patients. On the other hand, the factors including male, atypical symptom, and disagreement with the surgery were more frequent in the surgery group than in the saireito effective group. A complication of saireito was only one case. In this study, we suggest that saireito can be good candidate drugs for treatment of CSH.

Background. Cerebrospinal fluid (CSF) hypovolemia has become increasingly recog­nized, and the epidural blood patch (EBP) is the most effective treatment. However, EBP’s effectiveness is about 75% and other treatments such as the admin­istration of painkillers, tranquilizers are often necessary. Despite these treat­ments, several patients still suffer from intractable headache, vertigo, etc. This study investigates 18 cases of CSF hypovolemia treated with goreisan and analyzes outcomes.

Methods. The 18 patients (8 males, 10 females) who were diagnosed as CSF hypovolemia were treated with goreisan after EBP.

Results. Seven cases (38.9%) showed good recovery (relief ≥ 75%), 5 cases (27.8%) showed moderate recovery (relief ≥ 50%), and 6 cases (33.3%) showed no apparent improvement (relief < 50%) by the administration of goreisan.

Conclusion. Goreisan may be effective for treating CSF hypovolemia with EBP. If CSF hypovolemia patients are hard to cure, even after treated with EBPs, the administration of goreisan should be considered.

Elderly individuals may experience difficulty while eating because of facial swelling caused due to a contusion. Consequently, sputum accumulates in the mouth, thereby increasing the risk of pneumonia. Jidabokuippo is a herbal medicine, which has been in use for the past 300 years in Japan. In this study, 7.5 g/day jidabokuippo was administered for 3 – 5 days to 47 elderly individuals, aged 75 years or older, who had facial contusions due to a fall. The course of the swelling was evaluated using digital camera photography. Administration of jidabokuippo reduced the swelling in 42 subjects. Three patients experienced side effects such as mild diarrhea and rash. Jidabokuippo is thus considered to be a useful and safe treatment for swelling caused by facial contusions in elderly individuals.

Background and purpose. Chronic subdural hematoma (CSDH) is usually treated surgically, but we explained the patients who do not consent to surgical treatment. We investigate the efficacy of combined treatment dexamethasone and Saireito for severe CSDH.

Methods. Seven patients were included. Three were male and 6 were over 85 years old. Their symptoms were severe motor disturbance in all patients and unconsciousness in 4. Dexamethasone of 16.5 to 26.4 mg/day was administered intravenously during 7 to 10 days and Saireito of 6.0 g/day was administered to the all patients.

Results. All 7 patients had improvement of CT findings and symptoms. Total period of Saireito treatment were 4 to 10 weeks. The reduction of CSDH was noticed within 2 weeks after the beginning of treatment. In one patient, the adverse effect of interstitial pneumonitis was observed.

Conclusions. Combined treatment of dexamethasone and Saireito is useful for CSDH with unconsciousness and severe motor disturbance.

We evaluated the present conditions and problems in the Kampo education in school of medicine and pharmaceutical sciences by the questionnaire after the class and test result. We understood that we could not perform substantial classes even in Chiba University where Kampo education was relatively enough. Improvement of future curriculum and upbringing of the teacher of Kampo medicine are expected.

For the treatment of trigeminal neuralgia, various approaches including medical treatment and microvascular decompression have been applied. We examined the medication before and after the surgical in 60 cases that underwent microvascular decompression in our department. Before the operation, all cases applied medical treatment. Kampo medicine had been used in 29 cases (48%). After the operation, the neuralgia disappeared in 58 cases and remained in 2 cases. However, the neuralgia was recurred in 6 cases. Among these 8 cases with post­operative neuralgia, Kampo medicine was applied in 5 cases. The neuralgia was improved in 3 (60%) cases with postoperative Kampo medicine. In conclusion, Kampo medicine was common treatment for trigeminal neuralgia that was used in half of patients, and effective treatment for surgically resistant cases. Kampo medicine was thought to be an effective option for the treatment of trigeminal neuralgia.

The main conservative therapies for acute phase cerebral hemorrhage are administration of hemostatic agents, blood pressure control, and management of cerebral edema and intracranial pressure, which have all long been performed. In Kampo medical examinations, cerebral hemorrhage is recognized as the condition called oketsu, in which the blood (ketsu) leaks outside the blood vessels of the brain. We encountered a patient with cerebral hemorrhage in whom improvements were seen in early hematoma absorption and accompanying hemiplegia and aphasia follow­ing administration of tokishakuyakusan. Kuoketsu medicine is anticipated to be effective in the treatment of cerebral hemorrhage, which highlights the value of examining other Kampo medicine.

The elderly people are complicated with dementia and diabetes frequently and have various complications because of hyperglycemia. We report that yokukansan was extremely effective for five cases of diabetes with dementia. By administration of Yokukansan, they could make sleep well and came to eat normal quantity slowly. As a result, hyperglycemia after a meal and HbA1c were improved significantly. Furthermore, they did not have to be hospitalized by complications and got improvement of the QOL. These results suggest that yokukansan is useful for diabetes complicated with dementia.

We experienced two cases of prolonged headaches after mild traumatic brain injury successfully treated with goreisan. One case is a 35 y/o male, suffered head injury during bicycle operation. The head CT showed no traumatic change, but his headache didn’t improve more than two weeks. We prescribed goreisan for the headache. He continued taking the medicine for two weeks, and the headache was improved to some extent. We continued prescription the medicine for four more weeks. The headache was abated. The other case is a 21 y/o female, suffered head injury during motorcycle operation. A headache developed three months after the injury, so we started prescription of goreisan seven months after the injury. After taking the medicine for eight weeks, her headache disappeared.

Intermittent claudication of lumbar canal stenosis is caused by microcirculartory disturbance of cauda equina, which means “blood stasis” or “bloos deficiency” in the concept of Kampo. A 59-year-old man had been presented with prolonged leg pain in walking, although the lumbar canal stenosis was improved after second surgery for the adjacent segment of the previous lumbar fixation. His intractable pain was relieved by sokeikakketsuto, which could be effective for the residual leg pain after lumbar surgery by improving the abnormality of “blood”.

We experienced a case of postoperative refractory headache associated with brain stem hemangioblastoma treated with goshuyuto. A case was 27-year-old woman. She underwent an operation for brain stem hemangioblastoma. She experienced refractory headache started three months after surgery. The headache was not improved by NSAIDs, Pregabalin and Eperisone. After goshuyuto was given to her, her headache was improved remarkably. When general analgesic does not work for a refractory headache, the Japanese traditional medicine can be one of the choices.

We experienced 2 cases of the subdural hematoma associated with left middle temporal fossa arachnoid cyst secondary to head injury. One case performed craniotomy, and the other case passed good course by conservative medical treatment with the hydragogue agent (goreisan). Both cases showed the regression of the hematoma and the disappearance of the cyst. Neurological deteriora­tion was thought as absolute indication of surgical treatment, however the hydragogue agent (goreisan) could be considered as a useful medication for the case with only minimal symptom of increased intracranial pressure like as our conservative treatment case.

This paper reports 2 cases of cerebral edema treated with the herbal medicine goreisan. While the treatment was successful in a 17-year-old male with cerebral infarction due to right internal carotid artery dissection, a 72-year-old male with acute subdural hematoma showed a poor response to it. To the present, various methods to evaluate the severity of cerebral edema, such as decompression, examina­tion to clarify the presence ⁄ absence of a midline shift, and visual analogue scales to assess symptoms, have been reported. Although their usefulness is not discussed in this report, it may be necessary to examine appropriate methods to evaluate cerebral edema, as its control is likely to influence the prognosis and ADL.

The efficacy of rikkunshito (TJ-43) is reported as antiemesis method of treatment to chemotherapy induced nausea and vomiting (CINV) associated with platinum based chemotherapy. We experienced 3 cases of rikkunshito use as antiemetic in the radiotherapy (RT) concominant with temozolomide (TMZ) for treatment of gliomas. [Methods] All patients had taken ramosetron 0.1 mg before taking TMZ for prevention of CINV. Metclopramide 5 mg had been administrated as needed. If patient had still complianed of continuous nausea, rikkunshito (2.5 g of rikkunshito three times a day before each meal) were added. The change of the nausea and dietary intake was evaluated retrospectively. [Result] The administration of rikkunshito suppressed the nausea in two of 3 cases, and their dietary intake rates were improved. [Conclusion] This is the first report that rikkunshito may alleviate the delayed emesis and loss of appetite associated with TMZ and RT.

Cerebral edema is one of the complications of BCNU wafer implantation for the patient with malignant glioma. We report a case that goreisan reduced cerebral edema due to BCNU wafer implantation during chemoradiotherapy.

The patient was 78 years old woman who was diagnosed with acute ischemic stroke and admitted to our hospital. Intravenous anticoagulant and oral anti­platelet agent were administered. MRI findings on admission showed asymptomatic chronic subdural hematoma in left parietal area, therefore, oral treatment by saireito was started. Chronic subdural hematoma was completely absorbed on day 12. She was discharged from our hospital without any recurrence of stroke. Our case suggests that saireito is safe and effective for the treatment of chronic subdural hematoma even under the anticoagulant and antiplatelet therapy.