We evaluated retrospectively the effect of prevent for recurrence of postoperative chronic subdural hematoma and the side effects in Japanese Kampo medicine [Goreisan and Saireito]. The Kampo nonusers included 45 cases and the recurrence were indicated 12 patients (26.7%). In contrast, the Kampo users included 163 cases and the recurrences were less than non-users as 15 patients (9.2%). There were only 1 case [0.2%] of liver dysfunctions in 606 cases administered Goreisan. In Saireito, the side effects were observed in 5 [5.1%] out of 98 cases. In the prevention of recurrence after chronic subdural hematoma surgery, we concluded that the Japanese Kampo medicine [Goreisan, Saireito] was effective and had few side effects.

Although Kampo medicines such as goreisan and saireito are administered as a first medication in the treatment of chronic subdural hematoma (CSH), many effects have been reported but a clinical field experience is unclear. In this paper, we conducted a questionnaire survey of doctors at the Kumamoto University School of Neurosurgery regarding medical treatment for CSH. Among the respondents, 58% of neurosurgeons administered goreisan and 17% administered saireito as first medication for CSH. The effects of these two medications were considered to be almost equivalent, but limited. The use of saireito for intractable CSH has been increasing lately. Although the effects of goreisan and saireito were considered to be very similar, because serious side effects have been reported for the latter, it was considered that the former is preferable as a first-line drug in the treatment of CSH.

Background and purpose: Recently, chronic subdural hematoma (CSDH) is often treated by Kampo medicine, such as goreisan and saireito. We mainly use saireito for the treatment of CSDH and investigate the effect of saireito.

Methods: From August, 2007 to December, 2016, 146 subjects were included. Ninety-seven were male and 48 were over 85 years old. Ninety-two were symptomatic, and their symptoms were severe motor disturbance in 24, gait disturbance in 19, dementia in 12, mild elevation of intracranial pressure in 35 and so on. Saireito of 6.0 g/day was administered to the all subjects. Seventy-seven had anti-thrombotic drugs, and continued the taking of these drugs.

Results: One hundred thirty-four subjects (91.8%) had improvement of CT findings. The average period of saireito treatment were 5.7 weeks. In almost subjects, the reduction of CSDH was noticed within 2 or 3 weeks after the beginning of treatment. The therapeutic effect was not different between with and without symptoms or antithrombotic drugs. The adverse effects occurred in 4 who had interstitial pneumonitis, liver dysfunction, hypo-potassium and diarrhea respectively.

Conclusions: Saireito is useful for the treatment of CSDH. Occasionally, saireito causes interstitial pneumonitis and liver dysfunction. Because of protection of adverse effects, we use 6.0 g/day which is two thirds of the maximum permissible dosage of saireito, and try to finish the treatment as early as possible.

No large clinical scientific study of goshuyutou has yet been reported. We prescribed goshuyutou for 20 migraine patients (5 men and 15 women) whose headache was uncontrollable with typical Western medicines. The headache did not disappear after one month of goshuyutou medication in any patients. The intensity or frequency of the headache improved in 13 patients. No effect was observed in 4 patients. Therefore, the final effective rate was 65%. There were no marked differences in the age or sex between the effective and ineffective groups. Neck pain, shoulder stiffness, nausea, photo sensitivity, phono sensitivity, family history of migraine, medication overuse headache and coldness of extremities were observed in both groups. The effective group tended to have low migraine frequency and a long migraine history; however, because of the small number of patients, Mann Whitney test demonstrated no significant differences (p<0.05). Five patients in the effective group had aura; however, no patients in the ineffective group had aura. Menses-related migraine was observed in 1 of 3 female patients in the ineffective group and 6 of 10 female patients in the effective group. Goshuyutou was effective for the patients with aura and menses-related migraine.

One of the most important diseases that our neurosurgeon treats is subarachnoid hemorrhage caused by ruptured cerebral aneurysm. Its postoperative management is often assembled focusing on treatment for cerebral vasospasm. There are many reports such as drug therapy and intracerebral endovascular treatment. We combine these useful methods and treat them, and we have introduced Kampo therapy further. Kampo therapy may show effects beyond Western medicine in acute treatment and postoperative management and there is a possibility that it may be a more useful treatment method by using them in combination.

Background: ‘Oketsu’ means mal-circulation or stasis of blood flow. Intracerebral hemorrhage can be classified into‘oketsu’syndrome in Japanese traditional medi­cine. Keishibukuryogan is one of ku-oketsu medicines which improve ‘oketsu’ syndrome by facilitating blood flow. In addition, because absorbed hematoma is excreted out of the body via the bowel, we need to ensure smooth bowel move­ment in order to accelerate early reduction of the hematoma. Sennoside, a typical Daio medicine, is known to improve stagnated bowel movement which phe­nomenon is often seen in stroke patients.

Aims: We have administered keishibukuryogan in combination with sennoside to intracerebral hematoma patients in order to verify whether it can accelerate hematoma absorption and improve their prognosis.

Methods: Six intracerebral hematomas (ICHs) are included in this study. They are all administered with both keishibukuryogan and sennoside. Six ICHs without administration of these medicines are selected as a control group. Computed tomo­graphy is taken on the day of hemorrhage, and one week and two weeks after the hemorrhage in order to calculate volume of hematomas. Absorption rate of hematoma is shown by calculating residual volume of the hematoma (hematoma residual ratio).

Results: Hematoma residual ratio in ku-oketsu group (mean 66.7% ± 19.9%, median value 75.9%) is significantly smaller than that in control group (mean 101.4% ± 10.3%, median value 101.7%, Wilcoxon rank sum test, p=0.017). The earlier improvement of bowel movement tends to show the smaller hematoma residual ratio, although the difference is not statistically significant.

Conclusion: Administration of keishibukuryogan in combination with sennoside to ICH patients may accelerate hematoma absorption.

We investigated the effect of postoperative administration of goreisan to prevent recurrence in patients who underwent surgery for chronic subdural hematoma (CSDH) and their clinical characteristics. The 384 CSDHs in 279 patients were divided into three groups: 302 CSDHs who underwent burr hole irrigation surgery without postoperative administration of goreisan (no administration group), 51 in whom treatment with goreisan was initiated between postoperative days 0 and 10 (early administration group), and 31 in whom it was administered between postoperative days 11 and 56 (late administration group).

Goreisan tended to be administered to patients who had a high risk of recurrence, such as high density, high volume, and high residual volume hematoma. Recurrence rate was 11.7% (45 ⁄ 384 CSDHs) overall, 11.3% (34 ⁄ 302) in the no administration group, 19.6% (10 ⁄ 51) in the early administration group, and 3.2% (1 ⁄ 31) in the late administration group. There was no significant difference in the recurrence rate between these three groups. However, the recurrence rate in the late administration group tended to be lower than that in the early group.

In high-recurrence-risk patients, no effect of goreisan in preventing CSDH recurrence postoperatively was observed in this study. However, in the patients in whom the risk of recurrence was deemed not high just after surgery, goreisan administration may be indicated.

The patient was thirty-three years old man with right-sided Bell’s palsy. His paresis was severe and was 4 points on Yanagihara score. Oral prednisolone, valacyclovir, mecobalamin, keishikajutsubuto, and bushi were started and his paresis was improved nearly on day 33, and completely on day 46. In our case, paresis was severe but was improved early, so we think keishikajutsubuto effective for Bell’s palsy. In conclusion, there is a possibility that keishikajutsubuto is a useful option for the treatment of Bell’s palsy in addition to conventional therapy.

The elderly people with advanced dementia increased recently, are poor clinical prognosis and QOL by inadequate medical treatment. The three patients were hospitalized by worsening heart failure. They refused adequate medical treatment due to positive BPSD (irritability and delirium). Yokukansan calmed irritability and delirium of the three patients, so adequate heart failure treatment could be performed. The other three patients with appetite loss and depression (negative BPSD) were hospitalized by aspiration pneumonia and poor nutrition. Hochuekkitou restored their appetite level, improved the general condition and prevented their pneumonia recurrence. The results showed that advanced patients with dementia can improve QOL and life prognosis by taking the appropriate Kampo treatment.

Goreisan has been shown to prevent the recurrence of chronic subdural hematoma (CSDH); however, its therapeutic effect has not been discussed from the viewpoint of Kampo medicine. In this case report, we present our experience with a patient in whom goreisan treatment effectively prevented the recurrence of CSDH; a discussion of the mechanism of action presented. An 81-year-old man was brought to our hospital with altered consciousness and right hemipasis. Head computed tomography (CT) revealed bilateral CSDH. Burrhole surgery was performed; postoperatively, goreisan therapy was administered to prevent the recurrence of symptoms. Head CT at 1 month postoperatively revealed no recurrence of left CSDH, and right CSDH was ameliorated. The pathogenesis of CSDH is attributed to the extravasation of blood components from the outer membrane of the hematoma owing to hyperfibrinolysis or the influx of cerebro­spinal fluid due to the osmotic pressure gradient across the hematoma membrane. In Kampo medicine, hematoma is regarded as blood stagnation. Moreover, the uneven distribution of cerebrospinal fluid, which is regarded as a fluid according to Kampo medicine, and the osmotic pressure gradient are both involved in fluid retention. Preoperative head CT showed the delineation of low- and high-density areas in the hematoma. In other words, imaging revealed the presence of both red fluids (ketsu) and transparent fluids (sui), which suggests fluid retention. The fluid-disinhibiting drug goreisan appears to be an effective remedy for the symptom of fluid retention.

In the treatment and management of severe head trauma, sedation is necessary to suppress restlessness and excitement state, but side effects such as excessive seda­tion, aspiration, circulation suppression, extrapyramidal symptoms may occur, so that it is difficult to adjust it. Dexmethodimidine was added to patients with restlessness and excitement complicated with traumatic intracranial hemor­rhage, and yokukansan was added to antipsychotic drugs, which was effective for early symptom improvement. Yokukansan was found to be promptly effective, and was considered useful for patients who need rest in the acute period of disease.

An inexplicable dizziness is considered to include a part of vertebrobasilar insufficiency (VBI). Although typical VBI has not only dizziness but also other symptoms, atypical VBI has only dizziness by a hemodynamic mechanism, whose concept is proposed as a Hemodynamic-VBI (h-VBI). This case report shows the h-VBI patient that was successfully treated with keishikaryojutsubuto. When a part of the inexplicable dizziness results from h-VBI, this Kampo therapy is possibly one of the treatment options.

A 69-year-old woman, who had a left pulmonary upper lobectomy with thoraco­scope, lymph nodes dissection, and corpectomy (Th3–5), had complained of in­trac­table wound pain. Daily administration of 15 mg of oxycodone hydro­chloride hydrate was not enough to resolve her pain. She visited our clinic 30 months after the surgery. She was prescribed with 7.5 g of goshyajinkigan (TJ-107), 2 g of the processing Aconite Tuber (TJ-3023), 7.5 g of kamikihito (TJ-137), and 5.0 g of tsudosan (TJ-105). Although these medicines improved the efficacy of oxycodone hydrochloride hydrate to a desired level, the side effect of REHMANNIAE RADIX, such as gastric discomfort was observed, resulting in her discontinuing goshyajinkigan. A new prescription consisting of the processing Aconite Tuber (TJ-3023) 1 g, kamikihito (TJ-137) 5.0 g, and tsudosan (TJ-105) 5.0 g was administered.

The intractable wound pain was relieved almost by 2 months, but, her left paravertebral wound pain returned 7 months later. Since she was reluctant to increase the medicine from the previous dose, acupuncture therapy was per­formed and it removed the pain to a satisfactory level．

Kampo medicine successfully reduced the pain in this case. However, a con­tinuous usage of goshyajinkigan became difficult, and it resulted in a poor control of pain. Since the paravertebral wound running along the bladder meridian of foot-taiyang, selecting and toning the acupuncture points in the above meridian in her legs led to a good pain control. A supplemental acupuncture treatment to Sanyinjiao (Saninko) improved the internal cold pattern. The combination of those acupuncture treatments to Kampo medicines resulted in controlling the pain further.

Selecting those points and applying the acupuncture technique performed is not complex. If used, they could contribute to controlling pain after spinal surgery.

Although detailed mechanism of the growth of chronic encapsulated hematoma has not been clear yet, it is known that the histological image of the capsule is similar to the outer membrane of the chronic subdural hematoma. We report that the use of tranexamic acid and goreisan for a case of chronic encapsulated hematoma with venous angioma which repeated hematoma growth led to a significant reduction of the hematoma. The effectiveness of goreisan for chronic subdural hematoma is well-known, and goreisan may be also effective for chronic encapsulated hematoma which pathological conditions are similar to chronic subdural hematoma.

Histopathology of the late cyst formation associated radiosurgery for arterio­venous malformation (AVM), showed proliferation of dilated vessels with fibrinoid degeneration associated with exudation of protein and bleeding. There were also the spontaneous regression cases. However, for the symptomatic cases were treated with surgery. We report a case that treated effectively with saireito for the inoperable late cyst.