Kampo (Japanese herbal) medicine has been empirically prescribed as an acute treatment for primary headaches, but the evidence of its efficacy is insufficient. Therefore, we retrospectively investigated the effect of Kampo medicine on primary headaches at one week and discussed how Kampo medicine alleviates headaches, also considering previous articles. We prescribed, as needed, kakkonto (TJ–1) for 223 tension–type headaches, goshuyuto (TJ–31) for 93 migraines with or without aura and those associated with the menopausal disorder, goreisan (TJ–17) for 71 migraines with edema, dehydra­tion (Suidoku; unbalance of water distribution in Kampo medicine theory), or associated with weather conditions, and non–steroidal anti–inflammatory drugs (NSAIDs) for 162 primary headaches between 2015 and 2019 in Kesennuma City Hospital. In total, 92.0% of subjective symptoms improved after one week. The ratio of improvement was not significantly different between each Kampo medicine and NSAIDs. The follow–up period was as short as one week, and it was difficult to judge whether the improvement was due to the medication, placebo effect, or spontaneous remission. However, our results suggest that Kampo medicine could be an alternative medication for the acute treatment of primary headaches. Our strategy could be applied to the clinical practice of primary headaches.

It has been reported that about half of the patients with intracranial cystic lesion have headache, but the usefulness of Kampo treatment is still unknown. In this study, we retrospectively examined 33 cases treated with Kampo at the Iyemasa Neurosurgical Clinic for 9 years from January 2011 to October 2019. Twenty–seven cases (81.8%) showed improvement of symptoms. Among them, the headache diminished within 3 days in 8 cases (29.6%), and 14 days in 19 cases (70.4%). The therapeutic effect was observed within and early. Kampo treatment, especially goreisan which is hydrous drug, for headache with intra­cranial cystic kesion may be useful.

Treatment of organized chronic subdural hematoma is often difficult, and various methods have been reported so far. We retrospectively examined the organized chronic subdural hematoma that was administered jidabokuippo that we experienced at our hospital, and considered the treatment method. There were 9 target cases, and 6 cases were considered to be effective. As a result of the examination, it was considered that the reduction of the hematoma could be expected by administering jidabokuippo after the burr hole surgery to the organized chronic subdural hematoma at the usual dose for about 3 months. In the future, it is necessary to consider comparative studies including dosage.

Blood stasis–resolving formula is very effective for swelling and pain in the acute phase of head or face trauma and there are quite a few neurosurgeons who realize the clinical effect of the drug. But we have often experienced the patients complain about various health problems such as headache, neck pain, dizziness and so on a few days or a few weeks to a few months after head or face trauma in clinical practice. For patients with such after effects, we have provided treatment in accordance with the pattern and experienced the 12 cases. We retrospectively evaluated the body constituent pattern of these cases such as vital energy (qi), blood, and fluid. Although we recognized blood stasis in 9 patients, moreover we recognized sensitivity to cold in 7, fluid stasis in 8, abnormal of vital energy in 9 at a high rate. In the classification of successful formula, we prescribed fluid regulating formula to 6 patients, blood stasis–resolving formula to 2, harmonizing formula to 2, and releasing exterior formula to 2. Also in the treatment of head or face trauma, we recognized that we should not miss fluid stasis and abnormality of vital energy in addition to blood stasis.

The pathogenic mechanism of cluster headaches is currently unknown, and there is a critical unmet need for their treatment. We focused on points of view on “the five viscera” in the oriental medicine at this time, and reported effect of Japanese traditional medicine yokukansan which were given to three patients with cluster headaches.

In my personal experience, carbazochrome sodium sulfonate hydrate (Adona) and goreisan (TJ–17) had been used widely for the prevention to chronic sub­dural hematoma (cSDH) after minor head trauma, and the postoperative recurrence prevention. In this report, I tested the preventive effect to the reoperation of cSDH by using carbazochrome sodium sulfonate hydrate (Adona) and goreisan （TJ–17） in the recent decade. A total of 64 patients were included in this study. There were 43 males and 21 females, with an average age of 76.5 years. Eleven patients used antiplatelet agents, and 7 patients used warfarin potassium (Warfarin) before surgery. Only 2 patients needed the second surgery. There was no adverse effect by using carbazochrome sodium sulfonate hydrate (Adona) and goreisan (TJ–17). Average duration of carbazochrome sodium sul­fonate hydrate (Adona) and goreisan (TJ–17) usage was 60.1 days. Carbazochrome sodium sulfonate hydrate (Adona) and goreisan （TJ–17） therapy after the cSDH surgery has low reoperative rate (3.1%) and it has enough sufficient effect.

We examined clinical effects of kamishoyosan for the patients with primary headache. Kamishoyosan were prescribed for total 85 patients with primary headache. Clinical effects were evaluated for 59 patients. The results were strongly effective for 3 patients, effective for 38 patients, and no effect for 18 patients. Mean age were 70 for the patients showed strong effect, 61.4 for the patients showed effective, 52.1 for the patients showed no effect. These dif­ference of age were statistically significant, so older patients showed significant effects. Two male patients showed no effect. Kamishoyosan were preferably prescribed for the patients with tension–type headache and cervical spondylosis, because there is no specific medicine for these diseases. Clinical effective rate of kamishoyosan for the patients with most primary headache were nearly 80%. Especially high effectiveness was observed for the patients with medication over–use headache and neurosis.

The aim of this study is to clarify effectiveness of hochuekkito and ninjin’yoeito for various symptoms after clipping of unruptured cerebral aneurysms. Patients who were treated with hochuekkito and/or ninjin’yoeito after clipping of un­ruptured cerebral aneurysms from August 2020 to June 2021 were included in this study. Effect for acute and chronic symptoms were retrospectively investigated. The results indicated that hochuekkito and ninjin’yoeito improve post–operative symptoms such as headache and fatigue.

We examined the effect of yokukansan on the psychiatric symptoms such as ir­ritation, impulsivity, and aggression due to administration of antiepileptic drugs (AEDs). Sixteen patients were included in this study, and all the patients were diagnosed as localization–related epilepsy. AEDs that caused psychiatric symp­toms were levetiracetam (LEV) in 11 cases and perampanel (PER) in 5 cases. Yokukansan 7.5 g/day was administered, and psychiatric symptoms im­proved in 11 ⁄ 16 patients (68.8%). In LEV cases, ten of eleven patients (90.9%) showed the improvement of irritability and continued the LEV. However, only one case of five patients could continue PER. Yokukansan was significantly more effec­tive against the side psychosis due to LEV than PER (p<0.01). In ten patients who were aware of the psychiatric symptoms, the effect of yokukansan was confirmed in all cases, and the NRS was significantly improved from 4.6 to 1.3 (p<0.05). Yokukansan was effective for psychological symptoms such as ir­ri­tabil­ity and aggression, which are side effects of antiepileptic drugs. Yokukansan might be an effective treatment option that could continue antiepileptic drugs without withdrawal. On the other hand, further investigation is required to clarify in what cases yokukansan is effective.

Jidabokuippo consists of seven herbal medicines and is reportedly effective for alleviating swelling and pain after trauma. In this study, we investigated the effectiveness of jidabokuippo after craniotomy of brain tumor surgery. To examine the effectiveness of jidabokuippo for brain tumor surgery patients, we　retrospectively studied 120 cases prescribed jidabokuippo after craniotomy in our hospital between 2016 and 2020. Background characteristics of 120 cases were: glioma (38 cases), meningioma (28 cases), metastatic brain tumor (22 cases), CP angle tumor (12 cases) and others (22 cases). In all cases, pain and swelling improved significantly after taking jidabokuippo (Wilcoxon signed rank test, p<0.001). After brain tumor surgery, jidabokuippo improved sub­jective symptoms of pain and swelling. Jidabokuippo represents a promising herbal medicine for the treatment of pain and swelling after brain tumor surgery.

Microvascular decompression (MVD) is widely accepted as a radical treatment for hemifacial spasm. However, in rare cases, hemifacial spasm may recur after successful MCD surgery. We report a case in which shakuyakukanzoto was effective for recurrence of hemifacial spasm 6 years after MVD.

In elderly people, physical activity and cognitive function deteriorate due to events such as cerebrocardiovascular disease, infectious diseases, and bone fractures, result­ing in decreased quality of life (QOL) and increased burden on caregivers. This time, hochuekkito was administered to 5 elderly patients who were at risk of worsening sarcopenia frail due to various events, and rehabilita­tion was used as appropriate, and the course was observed for about 3 years. In all cases, physical activity was improved, maintained, and cognitive decline was suppressed, and a healthy life was possible. From the viewpoint of improv­ing health and longevity, the usefulness of hochuekkito for the elderly was suggested in the future.

Hiccups is often developed after brainstem infarction. Although there have been reports that Kampo medicine is useful as a treatment for hiccups associated with brainstem infarction, there have been no reports of examining how long the medication will continue. In the case of the hiccups after the brainstem infarc­tion, shakuyakukanzoto was administered, and the hiccups disappeared in all cases. Shakuyakukanzoto was administered for 5 to 18 days, and there was no re­cur­rence of hiccups after discontinuation of the medication. Shakuyakukanzoto was effective for the hiccups after the brainstem infarction, and the admin­istra­tion could be stopped early after the hiccups disappearance.

Ramsay Hunt syndrome has a worse prognosis than Bell’s palsy. Rehabilitation includes facial massage, facial muscle training, and physical therapy, but is not always successful. In addition to rehabilitation, we used keishibukuryogan for the treatment of this case. Because of its ability to increase blood flow, it may be a treatment option for severe facial paralysis.