Kampo therapy for pain of neurosurgery area was surveyed. Pain of trigeminal neuralgia and glossopharyngeal neuralgia are, often, untreatable with modern medical method, anticonvulsant, and neurosurgery. Some of Kampo medicines can reduce their stubborn pain. For migraine and tension headache, Kampo prescription should be constructed according to the condition of the patient, for example sympathetic tension, coldness, stagnation of blood and edematous state. Headache and orofacial pain from cervical abnormalities is well responsive to Kampo medicine. Kampo therapy today must be done on the basis of informations from modern medicine.

Objectives. Goreisan is a traditional Chinese medicine that is effective for the management of climate–related chronic headache. However, no large clinical scientific study of goreisan has yet been reported. The purpose of this study is to investigate the clinical characteristics of the chronic headache patients in whom goreisan is effective.

Patients and Methods. We prescribed goreisan for 45 patients who were diagnosed with primary headache at our headache clinic. The patients age was from 14 to 77 years–old. The study population included 8 men and 37 women. We evaluated the clinical effects of goreisan for 39 patients at one months after the prescription. Final diagnoses were migraine without aura for 21, migraine with aura for 5, tension type headache for 15, medication overuse headache for 6 patients, respectively.

Results. The intensity or frequency of the headache improved in 33 patients. No effect was observed in 6 patients. Three patients whose headache did not related with climate showed no effect of goreisan. Climate–related primary headache was patient’s self–reported diagnoses, however, this information was valuable to predict the effect of goreisan.

Conclusion. Goreisan was effective for the patients with climate–related primary headache. Goreisan may suppress primary headache by protecting glymphatic flow.

Temozolomide (TMZ) is used for postoperative standard chemoradiation regi­men against malignant glioma but we sometimes have no other choice but to intermit or withdraw the drug due to its hematological toxicity. One of the Kampo or traditional herbal medicine, juzentaihotou (JTT) is reported to be effective against cytopenia in combination with some anticancer drugs for solid cancers, but no report is available with regard to the effect of JTT in combination with TMZ. This study investigated the efficacy of JTT for bone marrow sup­pression during TMZ induction course. 3 cases were administered JTT when the trend of neutrophil, lymphocyte or platelet decreased to a certain level during TMZ induction course. As a result, the cell counts were generally increased to 132% in neutrophil, 130% in lymphocyte and 120% in platelet after the first week of JTT administration. All of 3 cases completed TMZ induction course without discontinuation. Conclusion: JTT reduces cytopenia caused by TMZ and it may contribute to complete induction course without discontinuation of TMZ.

Background: Intracranial hemorrhage (ICH) is classified into ‘oketsu’ syndrome in Japanese traditional medicine. Ku–oketsu medicines such as keishibukuryogan improve brain edema and accompanying symptoms. Tongue examination is useful for a diagnosis of ‘oketsu’ syndrome. We investigated the association between the residual hematoma and tongue findings in the patients with ICH who have administered ku–oketsu medicine.

Methods: We have administered keishibukuryogan and sennoside to seven ICH patients hospitalized from April to October, 2017. We have started to take tongue photographs at the time of oral health care every one week or two weeks. Computed tomography is taken on the day of hemorrhage, and one week and two weeks after the hemorrhage. We assessed the association between the residual ratio of hematoma and the tongue findings.

Results: In the un–operated cases, the residual ratio of hematoma of the patients with more tongue findings was higher than the one who had less tongue findings.

Conclusions: The tongue examination possibly evaluates the effect of ku–oketsu medicine in the patients with ICH.

A patient was 42–years–old woman with right–sided facial palsy caused by varicel­la–zoster virus (VZV). The facial palsy was severe and was 6 points on Yanagihara score on day 4. Oral prednisolone, valacyclovir, and mecobalamin were started and facial palsy was 12 points on Yanagihara score on day 13. Keishikajutsubuto was started and facial palsy was improved, was 32 points on Yanagihara score on day 20 and 40 points on day 41. There is no report that keishikajutsubuto effective for facial palsy caused by VZV. In conclusion, there is a possibility that keishikajutsubuto is a useful option for the treatment of facial palsy caused by VZV.

In a modern society with many elderly people, dementia patients are increasing dramatically. There are no effective medical treatments yet, and in terms of nursing care, facilities and human resources are in short supply. For that reason, the elderly themselves are increasingly taking care of other elderly people. Kampo medicine has a point of view of mind and body oneness and individualized medicine. This time, kamikihito was effective for dementia with advanced anxiety, insomnia (positive BPSD) and anorexia (negative BPSD). Kamikihito is rooted in improving vigor and digestive function. Therefore, the mental stabilization effect seems to have worked properly. Furthermore, the anti–dementia action of polygala root contained in it restrained the progress of core symptoms such as disorientation and performance dysfunction, and the burden of the family drastically decreased. It is expected that kamikihito will be useful for such dementia in future.

We report two cases that jidabokuippo were prescribed for subcutaneous hematoma due to puncture of arterial vessels for angiography and had a good progress. A 35–year–old male had strong pain due to right femoral subcutaneous hematoma after angiography. When prescribing jidabokuippo, his pain was reduced and he could walk the following day. A 53–year–old man with left elbow pain due to subcutaneous hematoma after endovascular treatment. The pain due to hematoma at the arterial puncture site of the large joint adds restrictions to daily activities. When prescribing jidabokuippo, his symptoms were relieved quickly in the next day. We experienced two cases could get the immediate effect of jidabokuippo for painful subcutaneous hematoma.

We have experienced 2 cases in each of which enlarging gadolinium–enhanced region after repeated gamma knife radiotherapy decreased its size after intro­duction of goreisan. Each of the regions was assumed as radiation necrosis, and it is not deniable about the effect of steroids or other drug used at the same time, but goreisan probably exerted the effect for treatment of radiation necrosis.

The subcutaneous swelling and hematoma inhibits the effect of external decompression after decompressive craniectomy for head trauma. Jidabokuippo is reported to be effective for swelling after trauma and surgery. We report that a case with massive subcutaneous swelling after decompressive craniectomy for head trauma showed rapid reduction of the swelling by jidabokuippo.

An antihypertensive effect of chotosan has been reported, but few clinical cases have been described. We encountered a patient with refractory hypertension in subarachnoid hemorrhage, for which chotosan was effective. A 39–year–old man presented subarachnoid hemorrhage due to rupture of an anterior communicating aneurysm and underwent coil embolization. Intravenous and oral administration of several antihypertensive drugs were concomitantly performed after surgery, but blood pressure control was poor. However, administration of chotosan markedly reduced blood pressure and enabled blood pressure control with oral antihypertensive drugs alone. This case suggests that concomitant administration of chotosan may be considered for a patient in whom the effect of antihypertensive drugs is insufficient.