Kamisyoyosan (KSS) is a traditional Japanese Kampo medicine that is Shoyosan (SS), which was listed in the classic Chinese medicine “Wazai pharmacopeia”, plus crude drugs such as Moutan Bark and Gardenia fruit.

It is suitable for women with moderate or poor physical strength who have shoul­der stiffness, get tired easily, have psychiatric symptoms such as irritability and anxiety.

Sometimes it is used for cold sensitivity, a weak constitution, irregular men­struation, dysmenorrhea, and menopause in women with constipation. For that reason, it is more likely to be prescribed in obstetrics and gynecology, general medicine department, and psychiatry. But the medicine was effective in all 16 cases even in our neurosurgery department and even 2 cases were men.

We retrospectively examined the successful cases from an oriental medical viewpoint, and we consider what kind of patients can be expected to be effective by KSS. Moreover, we report about the historical background in which the medicine was created, other successful cases of men and serious adverse reaction of IMP (idiopathic mesenteric phlebosclerosis) from long–term use with relevant literature.

Microvascular decompression (MVD) is an established radical treatment for trigeminal neuralgia. However, the pain persists or recurs in some cases. We investigated the effect of Kampo medicine on the residual trigeminal neuralgia after MVD. Fifty one patients, who had residual neuralgia after MVD, were included in this study. We administered Kampo medicine as the first–line therapy. Thirty–six of the 51 patients (70.6%) were taken Kampo medicines, goreisan in 21 cases and keishikajutsubutou 18 cases. Any side effects as­sociated with Kampo medicine was not observed in all cases. The pain was well controlled by only Kampo alone in 10 cases, of which goreisan in 5 cases, keishibukuryogan in 3 cases and both in 2 cases. Pain was controlled in 15 patients by administration with other drugs , and ineffective in 11 patients. Of the 12 cases in which pain was controlled in combination with Kampo medicine and carbamazepine (CBZ), the dosage of CBZ significantly decreased from 462.5 mg to 225 mg between before and after surgery (p<0.01). Kampo medicine might be safe and effective in the patients with persistent or recurrent pain after MVD surgery.

Jidabokuippo is considered to be administered for subcutaneous hematoma due to trauma and postoperative subcutaneous swelling in the field of neurosurgery. However, there are no unified dosing criteria such as guidelines, and it is thought that it depends on the judgment of the attending neurosurgeon. We investigated the current state of administration of jidabokuippo in our neurosurgery department and examined its effects. It was considered to be effective against subcutaneous hematoma due to trauma and postoperative subcutaneous swelling. As for pain caused by trauma, it was difficult to judge the effect because there was no objectivity. It is expected to be effective against organized chronic subdural hematoma.

I reviewed the mutual interaction between daikenchuto and calcitonin gene–related peptide (CGRP) based on the studies in the available literature. Daikenchuto does not aggravate migraine headaches. Moreover, it does not affect the therapeutic effects of anti–CGRP monoclonal antibodies. In contrast, anti–CGRP monoclonal antibodies may affect the therapeutic effects of daikenchuto. However, owing to the intermittent effects of daikenchuto, continuous blockage of CGRP may not be a major clinical problem. Daikenchuto is effective for improving constipation in patients treated with anti–CGRP monoclonal antibodies. I confirmed this effect in some patients.

Introduction; Allodynia occurs as a part of neuropathic pain and sometimes cannot be controlled by guideline–based treatments. Objective; We report a case in which Junchoto was effective in treating allodynia, which had failed to respond to administration of conventional drugs and nerve blocks after the surgery for intradural extramedullary tumor. Conclusion; When conventional treatments are ineffective for neuropathic pain or should be avoided in view of side effects, Kampo treatments may be useful.

An 80–year–old man was admitted to our hospital associated with impaired consciousness with untraumatic left acute subdural hematoma. The acute subdural hematoma was removed by craniotomy. After surgery, he became in a state of prolonged impaired consciousness and accompanied by persistent hiccups. While tube feeding was administered for nutritional management, sakuyakukanzoto (7.5 g/day) was administered for persistent hiccups. The fre­quency of hiccups immediately decreased by administration of shakuyaku­kanzoto, and on the third day of its administration, the hiccups disappeared, and the administration of shakuyakukanzoto was stopped. Even when the administration of shakuyakukanzoto was discontinued, recurrence of stut­tering was nothing. These findings suggest that sakuyakukanzoto should be effective for persistent hiccups after acute subdural hematoma surgery.

Hyperhidrosis is excessive sweating that goes beyond the range of body temperature regulation, and often interferes with daily life. In particular, primary focal hyperhidrosis, which occurs on the palms, soles, and face under stress, is often seen in young people from around puberty. This time, we experienced a case in which shigyakusan was effective in a young man who had a fear of going out due to excessive sweating, especially on the head, face, and palms, when he was out in a crowd. Shigyakusan relieves stress, stabilizes the sympathetic nerves, and seems to be able to control sweating. The use­fulness of shigyakusan in hepatodepressive hyperhidrosis was suggested.

An 80–year–old woman presented with sudden onset of dysarthria, neurological findings showed left lateral medullary syndrome, and head MRI demonstrated left medullary infarction, and she was admitted. Laryngoscopy revealed poor closure of the left pharyngeal cavity due to left recurrent nerve palsy, fluid retention in the left parietal fossa, impaired left laryngeal motility, and decreased perception and reflexes. One week after the onset, the patient complained general fatigue and insomnia due to suffocation caused by saliva retention in the throat at night. We prescribed hangekobokuto because we thought that abnormal sensation in the laryngopharynx was caused by retention of saliva and other secretions due to laryngeal abnormal movement. She had no insom­nia due to abnormal laryngopharyngeal sensitivities after the prescription and transferred to the rehabilitation hospital on the 14th day from the onset.

Pharmacological treatment for chronic subdural hematoma (CSDH) recurrence prevention after surgery is under debate. CSDH may be related to suidoku (fluid disturbance) from the Japanese herbal Kampo perspective. Goreisan (GRS) treats suidoku and is used to prevent a postoperative recurrence. However, not all CSDHs are liquid, and some have structures such as trabecula, hematoma, and clots, suggesting oketsu (blood stasis). Therefore, we prospectively investi­gated the keishibukuryogan (KBG) effectiveness, which treats oketsu, for CSDH recur­rence prevention and hematoma resolution compared to GRS. We pro­spec­tively prescribed KBG 7.5 g/day for 12 CSDH patients after burr–hole surgery. As a control cohort, we retrospectively collected 48 patients treated by GRS 7.5 g/day. The recurrence within 1 month and the hematoma thickness after 1 month were evaluated. The median age was 84 years old. All the patients’ symptoms improved after surgery. The median preoperative midline shift and mean hematoma thick­ness were 6.0 mm and 23.75 mm. Those at 1 month were 2.0 mm and 11.43 mm. The recurrence rate was not significantly different between the KBG cohort (1 of 12) and the GRS cohort (4 of 48) (P=0.999). The KBG’s noninferiority to GRS regarding the hematoma thickness at 1 month was statistically proven; KBG (12.26 mm) and GRS (11.20 mm). The recurrence rate at 1 month was not dif­ferent between the KBG and GRS cohorts. The hematoma thickness at 1 month in the KBG cohort was not statistically inferior to that in the GRS cohort.

A chronic daily headache (CDH) comprises a group of headaches occurring at least 15 days per month for three or more consecutive months. We retro­spectively investigated the effectiveness of the hybrid treatment strategy for CDH using Kampo medicine combined with Western medication. We retrospectively investigated 43 consecutive first–visit CDH patients. In addition to Western acute and prophylactic medications, we prescribed three types of Kampo medicines: goreisan, goshuyuto, and kakkonto depending on the patients’ symptoms. Headache impact test–6 (HIT–6), monthly headache days (MHD), monthly migraine days (MMD), and monthly acute medication intake days (AMD) before, 1– and 3–months after starting the hybrid medications were assessed as outcomes. Thirty–six women and seven men were included. The median age was 51 years old. Nine were chronic migraine (CM), 22 were episodic migraine and tension–type headaches (EM+TTH), and 12 were chronic TTH. Twenty–seven patients also had medication–overuse headaches (MOH). The medians of HIT–6 before, one and three months after treatment were 63, 48, and 40, respectively. Those of MHD were 20, 5, and 2. Those of MMD were 2, 0, and 0. Those of AMD were 15, 0, and 0. Significant reductions in HIT–6, MDH, MMD, and AMD were observed one and three months after starting Kampo treatment. Similar trends were observed in the EM+TTH and MOH patients as subgroup analyses. The hybrid medication strategy of Kampo and Western medicines for CDH is safe and effective in terms of both acute and prophylactic medications with rapid efficacy.