Kanzoshashinto consists of seven medicinal herbs including ginseng. The formula for kanzoshashinto in the Chinese medical text “Jinguiyaolue” consists of the seven herbs, but its formula in “Shanghanglun,” a second medical reference, lists only six herbs and does not include ginseng. We investigated if formulas for kanzoshashinto in traditional Chinese and Japanese medical books included ginseng.
We searched modern Japanese databases using the terms kanzoshashinto and ginseng. We also searched medical books written during the Song Dynasty in China and the Edo period in Japan.
We found one article in a modern Japanese database that discusses kanzoshashinto and ginseng. The article stated that kanzoshashinto formula included ginseng only described in the Song medical text Jinguiyaolue. Kanzoshashinto formula in other ancient Chinese medical references did not list ginseng as one of the components of the medicine. This research confirmed the statements written in ancient Chinese medical references : doctors could add ginseng to kanzoshashinto. During the Edo period in Japan, most doctors prescribed a kanzoshashinto formulation that included ginseng.
In the medical reference “Jinguiyaolue,” kanzoshashinto with ginseng is described as a treatment for kowaku, an unstable psychological state. In the medical reference “Shanghanglun,” kanzoshashinto without ginseng was used to treat severe diarrhea. Therefore, it is possible that kanzoshashinto without ginseng might be a more effective treatment for diarrhea. Further studies are required to examine the efficacy of kanzoshashinto without ginseng in treating severe diarrhea.

We report four cases of anxiety disorder where psychiatric symptoms were effectively treated with combination therapy utilizing keishikaryukotsuboreito and kanbakutaisoto, which are two herbal formulas. The patients had common symptoms and experienced episodes leading to emotional stress. Moreover, in all four cases aggravation of psychiatric symptoms due to emotional stress, re-experience and memory retrieval were commonly observed. Additional treatment with kanbakutaisoto was effective for such aggravation. On the objective assessment, rapid pulse, deficient pulse, weak abdominal strength and brisk pulsation in the supraumbilical region were present. Yawning was not necessarily present. There are many patients with anxiety disorder or mental disorder associated with emotional stress, and Kampo treatment is often considered to be effective for these cases. However, a single administration of Kampo extract formulae does not often provide adequate results. When a single Kampo administration is ineffective, the combination of keishikaryukotsuboreito and kanbakutaisoto may be useful.

The main drug therapy for chronic kidney disease (CKD) is Western medical treatment, and no recommended oriental medical approach has been described. In this report, we focused on the medical herb Radix Astragali of single component which has been reportedly effective in improving nephritis and renal function. We analyzed the experience of using Radix Astragali in our hospital and reviewed the clinical features. Twenty-two cases were enrolled in this study. Irrespective of gender, age, CKD duration, the decreasing speed of estimated GFR, proteinuria, or diabetes, eGFR improved in all the patients. Furthermore, clinic blood pressure fluctuation and qualitative urinary protein also showed improvement. Radix Astragali is effective for CKD regardless of clinical features, severity, causative disease, and may be useful and safe for CKD treatment.

Molecularly-targeted agents such as cetuximab, an anti-EGFR (epidermal growth factor receptor) monoclonal antibody have been used for the treatment of head and neck cancer. However, these agents frequently induce adverse skin reactions including acne-like rash and paronychia. For these problems, minocycline oral and heparinoid or steroid ointments, are commonly used. Some patients, however, cannot be controlled just by using these drugs. This case report shows a man in his 50s, who was treated for recurrence of nasal cancer. He received a long-term cetuximab therapy for 1 year and a half, and had severe paronychia and skin rash. Medication of unseiin and shiunko ointment decreased these adverse skin reactions, especially, paronychia on his first toes didn't need to be treated by steroid ointment anymore. When the common skin therapies are not effective, these Kampo therapies are possibly one of the options for the supportive care for the patients using cetuximab.

We present 16 cases effectively treated using the traditional Japanese herbal formulation tokishakuyakusan with the crude extract jio (tokishakuyakusan and shimotsuto). All patients were women with a median age of 35.5 years (range : 22-62 years). Cases included infertility (n = 5), dermatological disease (n = 5), gynecological disease (n = 2), excessive sensitivity to cold (n = 2), mental nerve paresthesia (n = 1), and general fatigue (n = 1). All patients had sho for tokishakuyakusan and high degree of ketsu deficiency. All patients with infertility became pregnant within one year. The symptom severity of other patients decreased to less than half compared with their initial visit.
Cases of palmoplantar pustulosis and chronic eczema improved without topical corticosteroids. Our results suggest that tokishakuyakusan with jio is a suitable treatment for patients who have sho for tokishakuyakusan and high degree of ketsu deficiency.

We report a case of refractory transient ischemic attack (TIA) successfully treated with chotosan. A 64-year-old woman with recurrent right hemiparesis and dysarthria was seen in our clinic. Twenty-three months before coming to our clinic, she had a history of right hemiparesis and dysarthria, which resolved soon after treatment. Magnetic resonance imaging (MRI) revealed an ischemic legion in the left corona radiata. Then 4 months before coming, she had repeated transient right hemiparesis and dysarthria, which lasted for 40 to 50 minutes and recurred 3 to 4 times a week. She was hospitalized and treated with an intensive TIA therapy including direct thrombin inhibitor, dual antiplatelet therapy, statin, calcium channel blocker and benzodiazepine. Though she continued the therapy for 4 months, it proved ineffective. She was referred to our clinic, and we started to administer chotosan 7.5 g per day for anxiety and dizziness during an attack. Chotosan attenuated TIA within a week, but aggravated after discontinuation on her own. The medication was resumed and TIA diminished within three months. Chotosan treatment has now been continued for 17 months without a single TIA for 14 months. Multiple studies have shown the protective effect of chotosan against cerebrovascular diseases including cerebral infarction and TIA. Therefore, chotosan may be an effective prescription for refractory TIA.

We experienced a case of paranoid schizophrenia whose negative symptoms such as fatigue and depression were successfully treated with kamishoyosan and hochuekkito. The combination of medical herbal extracts did not affect positive symptoms. Herbal medicine may play not only a supporting role in treating mental disorders in general but also an important role in improving negative symptoms of schizophrenia.

The patient was a 77-year-old man with chief complaints of left lower jaw pain and discomfort. He had pain centering on the left lower jaw and was diagnosed with trigeminal neuralgia involving the third branch of the trigeminal nerve by a local physician. The pain subsided temporarily by administering carbamazepine, but recurred in the same region. He was subsequently referred to our ambulatory pain clinic. Sudden bouts of pain occurring dozens of times a day were noted, with depression, anorexia, lack of motivation, dry mouth, cold extremities, and dry skin. A crimson colored and slightly enlarged tongue with teeth marks on the border, crimson color on the tip, and white moss, were noted in the tongue examination. Pulse examination revealed a sunken pulse and abdominal examination noted epigastric discomfort and weakness (2/5) of the lower abdominal region. Mandibular nerve block temporarily resolved the pain, but there were repeated cycles of exacerbations, between which the feeling of discomfort persisted. Yokukansan extract (7.5 g divided into 3 doses per day) was administered, 35 months after the first clinic visit to address the discomfort that persisted after resolution of pain. Discomfort resolved. Currently, the patient still does not require mandibular nerve block or analgesics. Here we report this case in which Yokukansan was effective against discomfort in trigeminal neuralgia.

We treated a pediatric patient suffered from anxiety disorder with ogikenchuto in combination with Western medicine. The case was a teenage girl with long-term neck pain. After entering junior high school, she had palpitations and was afraid while interacting with other students, experienced headaches, struggled to get out of bed in the morning, and developed anorexia and dizziness upon standing up. She was diagnosed with anxiety disorder and orthostatic dysregulation (OD) associated with autistic disorder at a pediatrics department. Pediatricians prescribed aripiprazole and midodrine hydrochloride. And she was referred to our department for treatment with Kampo medicine. Her condition was presumed to be various deficiencies with kikyo, kigyaku, suitai, and kankikyo. She was prescribed 9 g of ogikenchuto extract per day, and the symptoms improved. Kankikyo should be considered for OD patients with psychosomatic symptoms, and ogikenchuto may be one of the prescription drugs for such condition.

We assessed the efficacy of Kampo medicine for lower extremity symptoms caused by lumbar spinal diseases, such as lumbar spondylosis, spinal canal stenosis, and post-spinal surgery syndrome. In particular, we evaluated its usefulness for lower extremity pain, coldness, and numbness. In addition, the efficacy of antecedent drug selection and pain treatment was also assessed. In accordance with Japanese traditional herbal medical practice, keishikajutsubuto, shimbuto, ryokyojutsukanto, tokishigyakukagoshuyushokyoto, goshajinkigan, and shakuyakukanzoto were prescribed primarily for lower extremity symptoms caused by lumbar disease. Thirty-two of 60 (53%) cases with lower extremity pain, 17 of 34 (50%) cases of pain with coldness, and 4 of 19 cases (21%) of pain with numbness were improved by these drugs. We conclude that the addition of keishikajutsubuto, shimbuto, ryokyojutsukanto, tokishigyakukagoshuyushokyoto, goshajinkigan, and shakuyakukanzoto after antecedent pain therapy was effective in treating lower extremity symptoms caused by lumbar disease.

Crowned dens syndrome is a type of pseudogout that occurs in the elderly. It is associated with calcification around the dens of the atlas and can cause recurrent pain. We report successful treatment for crowned dens syndrome by using Kampo medicine.
An 85-year-old woman was seen in our clinic after 3 days of neck pain and active exercise pain without trigger. Physical examination revealed tenderness in the bilateral upper cervical spine. Computed tomography (CT) revealed calcifications around the dens of the atlas and blood test data showed inflammatory reaction. Thus, she was diagnosed with crowned dens syndrome. In view of her medical history of gastric ulcer treatment, we prescribed Kampo medicine eppikajutsuto and daiobotampito, instead of nonsteroidal antiinflammatory drugs. The cervical pain and tenderness in her bilateral upper cervical spine disappeared, and her laboratory data also improved 6 days after treatment without side effects. Thus, her medications were discontinued.

To estimate the incidence of liver injury related to Kampo medicine containing Scutellaria baicalensis, all medical records in our clinic were retrospectively examined. Among 2,430 patients who took Kampo medicine containing Scutellaria baicalensis, liver blood tests were performed in 1,547 cases (63.7%). The possibility of liver injury related to Kampo medicine containing Scutellaria baicalensis could not be denied in 19 cases (1.2%) among the 1,547 cases. The clinical features of liver injury in 19 cases were not different from those in previous reports. In agreement with the previous literature, this study also suggests that the incidence of liver injury related to Kampo medicine containing Scutellaria baicalensis is about 1%.