Although Kampo medicine is regarded as an effective treatment for trigeminal neuralgia, the effect of Kampo on recurrent cases of trigeminal neuralgia is unclear. We examined 140 cases of trigeminal neuralgia patients who underwent surgery at our hospital. 30 out of 140 patients showed the recurrence of neuralgia postoperatively, and among these patients Kampo medicine was administered to 20 patients. There were 7 cases in which pain disappeared only by using Kampo medicine. In the cases with recurrent trigeminal neuralgia, Kampo was especially effective on the patients with veins as offending vessels. We showed the effect of Kampo on the recurrent cases with operated trigeminal neuralgia. Further studies are needed to reveal the impact of Kampo on the recurrence of trigeminal neuralgia.

There are no specific therapeutic drugs for the treatment of patients with tension–type headache. Chinese herbal medicine has been recommended for the treat­ment of tension–type headache. However, no large clinical studies have been reported. Thus, there is no established evidence to support the administration of Chinese herbal medicine for tension–type headache. The long–term use of analgesic agents may lead to medication overuse headache. Thus, we prefer to use kakkontou for the treatment of chronic tension–type headache. In the present study, we analyzed the clinical findings of patients to whom kakkontou was prescribed. The study population included 153 patients who were diagnosed with tension–type headache and who were prescribed kakkontou. The effect of kakkontou was evaluated after 1 month of treatment. Among the 121 evaluable patients, kakkontou was effective for 99 patients and ineffective for 22 patients; thus, the final efficacy rate was 81.8%. Side effects of kakkontou are very rare. Kakkontou was effective for both sexes and all age groups, and was also effective for the treatment of patients with coexisting diseases.

Transection of the occipital muscles is necessary during posterior fossa surgery in children. Postoperatively, the patients not only have headaches and wound pain, but also suffer from pain when rotating the neck. Pediatric pseudo torticollis may occur when patients attempt to assume an unnatural posture to tilt the neck in an effort to avoid pain. Shakuyakukanzoto has central and peripheral muscle relaxant effects. Based on its pharmacological activity, shakuyakukanzoto would be expected to relieve postoperative pain and improve cervical movement. In this study, 14 consecutive children that underwent posterior fossa surgery received shakuyakukanzoto and the development of pseudo torticollis and postoperative pain were evaluated. Our results suggest that shakuyakukanzoto may have im­proved pseudo torticollis and relieved postoperative pain after posterior fossa surgery.

Cerebrospinal fluid hypovolemia (CSFH) is a disease in which cerebrospinal fluid is reduced due to sustained or intermittent leakage of cerebrospinal fluid (cerebro­spinal fluid) from the cerebrospinal fluid cavity, and exhibits various symptoms. Epidural blood patch therapy (EBP) for cerebrospinal fluid leakage is recognized as an insurance indication, but there are still many problems in diagnosis and treatment. In this study, we examined patients who used Kampo medicine among 19 patients with CSFH who underwent laboratory hospitaliza­tion in our department in April 2017 to June 2018. EBP was administered to 17 out of 19 people. Twelve of them received Kampo medicine. As for the Kampo medicine used, there were 9 goreisan, 6 kakkonto, 3 keishikajyutubuto, 2 hochuekkito were administered. Representative cases are presented and discussed.

The aging society is accelerating in modern times. The number of dementia patients has increased dramatically, which is a social problem. Kampo medicine is frequently administered yokukansan with certain effects mainly on positive BPSD. This time, shinbuto was effective for the patient with dementia with extreme weakness and coldness (gastrointestinal frailty, loose tender diarrhea), decreased memory and general motivation. He had fallen into a vicious circle that cold, gastrointestinal symptoms worsened, motivation, physical activity further declined with progress of dementia. With the use of shinbuto, he improved gastrointestinal function, motivation, physical activity recovered, and it became possible to actively rehabilitate the community. In the elderly, it was suggested that selecting kampo medicine based on its constitution and leading the condition more moderately is more useful for restraining the progression of dementia and further restoring health.

Kampo therapy for trigeminal neuralgia is done by Kampo medicine expert, but it is not common in general neurosurgeon. We experienced a case of trigeminal neuralgia successfully treated with Kampo therapy, and that treatment is continued for some other cases. We think that Kampo therapy by using keishikajutubutou is useful for patient who has cold sensation. Combination therapy with yokukansan reduced frustration, headache and irritability other than neuralgia. Kampo therapy is effective for trigeminal neuralgia.

We report three cases that rikkunshito were prescribed for gastric reflux due to poor grade subarachnoid hemorrhage and had a good progress. In the case of a severe subarachnoid hemorrhage it is known as organ disorders associated with sympathetic tension. Among them, when there is gastric reflux or intestinal disorders by suppressing reflection of sympathetic nerve corresponding in consideration of the risk of vomiting and aspiration is required. Rikkunshito was useful when presenting a gastric reflux in a high stress state like the three cases.

Post–stroke shoulder–hand syndrome is a syndrome that causes pain, swelling, hotness and color change to the affected upper limb especially in the fingers and back of the hand for 2 weeks to 3 months after a stroke. This syndrome is an inhibitor to rehabilitation and is often a problem in convalescent reha­bilitation wards of hospitals at this time. It is important to take appropriate measures at an early stage, as this syndrome will not return to normal if it progresses. Although oral steroid treatment is a typical treatment for this syndrome, in some cases it is not effective after repeated recurrence and it cannot always be used because of side effects. This time, I tried the admin­istration of keishibukuryougan that can be used safely long term for this syndrome and I report 3 cases that showed improvement of symptoms. Case 1 and 2 are cases that recurrence did not occur after administration of keishibukuryougan despite recurrence occurring repeat­edly with oral steroid treatment. Case 3 is a case where only swelling is symptom and improvement of the condition is recognized by treatment with only keishibukuryougan.

A 69–year–old female was admitted to our hospital for advanced oculomotor nerve palsy associated with basilar artery–superior cerebellar artery aneurysm. The aneurysm underwent a stent–assisted coil embolization procedure with Bioactive coil. Steroid treatment was started due to perianeurysmal edema from the day after surgery. However, no therapeutic effect was observed three months after coil embolization. Hydrocephalus also developed from exacerbation of brain edema and occlusion of cerebral aqueduct. Brain edema and hydrocephalus were improved by additional administration of goreisan. It suggests that goreisan can be one of the effective treatment options for steroid intractable cases.

A 93–year–old man. He was judged right chronic subdural hematoma by head CT and underwent burr hole surgery. Because hematoma was organized, could not be removed sufficiently. From the 67th postoperative day, jidabokuippo oral administration started, so the hematoma decreased.

An 84–year–old man. He was judged right chronic subdural hematoma by head CT and underwent burr hole surgery. Because hematoma was organized, could not be removed sufficiently. After operation, jidabokuippo oral administration started, so the hematoma decreased.

There is a possibility of expecting a therapeutic effect on hematoma which is organized and hard to remove only by perforation.

Post–stroke headache may persist for a prolonged period and is often difficult to treat. Moreover, post–stoke headache influences the functional outcome and quality of life. The efficacy of Japanese Kampo medicines for chronic headache has recently been reported. We encountered 3 patients diagnosed with persistent headache attributed to past non–traumatic intracranial hemorrhage in whom the symptoms were improved by chotosan (7.5 g/day). Headache was improved by 12 weeks in all 3 patients and disappeared in 2 of the patients. These findings suggest that chotosan should be considered for this condition.