To treat the patient who developed post-dural puncture headache (PDPH) after the epidural anesthesia for painless delivery or spinal subarachnoid anesthesia for caesarean section, we provided a combination therapy with Kampo medicines goshuyuto and ryokeijutsukanto (39 patients), and a single therapy with goshuyuto (17 patients). We compared the patients based on the improvement rate and the average of the differences of Numerical Rating Scale (NRS) before and after taking Kampo medicines. Of 39 patients treated with combination therapy, 82.1% were effective in the improvement rate, and 74.4% were effective in NRS differences. Of 17 patients treated with goshuyuto alone, 58.8% was effective in the improvement rate, and 41.2% in NRS differences. In the improvement rate, it was insignificant (p=0.094). However, in the comparison of the average of the NRS differences, the combination therapy was significantly more effective than with from goshuyuto alone (p=0.032) (p<0.05). There was no significant difference depending on when the administration was started. It was suggested that a combination therapy with goshuyuto and ryokeijutsukanto is effective and convenient for PDPH.

This report describes a case of cluster headaches that was successfully treated with juzentaihoto. A 39-year-old male had been having attacks of cluster headaches for 7 years. During an attack, he took a triptan and nonsteroid anti-inflammatory drug (NSAID), but they were not effective and he had lost his good eyesight after the attack. Recently, as the attacks had become more frequently and stronger, he visited our hospital. Physical examination including dry skin suggested that he had kikyo and kekkyo. Therefore, we prescribed juzentaihoto. After 3 months of treatment, the frequency and strength of the attacks decreased. The underlying pathophysiology of cluster headaches incompletely solved. When the responsible localization of organic disease is not clear, Western medicine sometimes have difficulty in relieving pain. On the other hand, we can analyze the case through “yin-yang and xu-shi categorization,” “life force, blood and colorless bodily fluids (3 elements that constitute an organism)” and Gozo-roppu-setsu according to traditional Chinese medicine. Understanding the bodily functions from an Oriental medicine viewpoint, we can prescribe effective oriental medicine to relieve pain.

Six patients with psychiatric symptoms were successfully treated with shimotsuto-containing medication. Case 1 was a 13-year-old boy who complained of difficulty in getting up ; however, when he was treated with a focus on the decrease in his concentration, he was able to go to school after treatment. Case 2 was an 18-year-old girl who had also difficulty in getting up, but was able to go to school. Case 3 was a 10-year-old girl who was able to go to school partially after treatment. Case 4, a 42-year-old man with apprehension in socializing, showed improvement in socializing after taking medication containing shimotsuto. Case 5 had various complaints that were relieved after taking medication containing shimotsuto. Case 6 was a 56-year-old woman who had also multiple complaints ; however, the symptoms were alleviated with shimotsuto-containing medication. All patients experienced depression and anxiety. Four patients with decreased cortisol recovered after treatment with shimotsuto. From these results, shimotsuto is considered to improve concentration, judgment, and psychiatric symptoms by treating blood deficiency.

The main symptoms of fibromyalgia are systemic pain and fatigue. The pharmacological treatments are usually performed for fibromyalgia in Western medicine. However, in some cases, pain that impairs everyday life continues even after medical treatment. We herein report a case in which fibromyalgia was successfully treated using jumizasan. The patient was a 28-year-old woman. Prior to admission to the author's clinic, she had complained of dull pain in the left upper arm for 4 years, and the pain had spread throughout the body for 2 years. Various other symptoms including fatigue, headache, heart palpitation, and shortness of breath coexisted. The pain resolved within 3 months after the initiation of treatment with jumizasan (a Japanese herbal medicine decoction), which was given based on pallid complexion, skin drying, strong upper arm pain, and walking difficulty. We concluded that jumizasan may be considered to be used for patients with blood deficiency, upper arm pain, and walking difficulty in Kampo concept of treatment.

We retrospectively surveyed and analyzed medical records of 41 effective cases with shigyakusan including shigyakusan decoction and shigyakusan extract. In classics, fullness in chest and hypochondrium and rectus abdominis muscle stiffness along with coldness of the extremities is regarded as important clinical indication of shigyakusan. In this analysis, patients who present fullness in chest and hypochondrium are more than 90%, and patients presenting rectus abdominis muscle stiffness are more than 60%, confirming that these findings are important. On the other hand, although more than half of the patients feel excessive sensitivity to cold, only about 20% of the patients had coldness of the extremities as objective Kampo findings in their medical records. Until now, coldness of the extremities has been considered to be important because shigyaku means Japanese expression of it. But our obtained results show that shigyakusan is used for the patients who do not have cold extremities.

When female patients with skin disorders become pregnant, the treatments with the previously used antiallergic oral drugs are preferred to be switched to the treatments with external medicines alone, which often make patients experience unbearable itching and exacerbation of rashes. The use of tokishakuyakusan is known to be safe and improve various symptoms in the pregnancy period. In this report, the treatment of 4 patients with skin disorders were successfully switched to tokishakuyakusan alone from previously used antiallergic internal medicines and other traditional Japanese herbal medicines after pregnancy. Case 1 and 2 were patients with atopic dermatitis who had been treated only with the external medicine during a previous pregnancy but without amelioration. Case 3 was a patient with prurigo gestations who had rashes on the upper body trunk and complained of a strong itching sensation. Case 4 was a patient with acne vulgaris. In all cases, the rashes and itching sensation improved promptly with oral administration of tokishakuyakusan, followed by successful delivery. No side effects of gastrointestinal disorders were observed in any cases. Their skin disorders were speculated to be caused by the blood deficiency and stasis. Qi deficiency and fluid disturbance developed in association with pregnancy, which led to Yin deficiency and abundance of moisture. The positive responses of these conditions indicated that tokishakuyakusan was effective in the cases reported herein.

Nyoshinsan is one of the Kampo formulations for the treatment of hot flash or dizziness, which are typically seen in chi-no-michi syndrome (characterized by physical and/or mental symptoms related to female hormone variation). But nyoshinsan is less frequently prescribed than three major formulas in gynecological field including tokisyakuyakusan, kamishoyosan and keisibukuryogan. Furthermore, few case series study of nyoshinsan has been reported so far. To elucidate clinically useful indication sho of nyoshinsan, we retrospectively analyzed medical records of the patients prescribed nyoshinsan for past 5 years in our institute. In consequence, majority of patients prescribed nyoshinsan had both blood stasis and qi-abnormality including qi-deficiency, qi-stagnation and qi-counterflow due to physical or mental stresses. On the other hand, they rarely had signs of fluid retention. These findings may be useful for more effective clinical application of nyoshinsan.

As for the clinical condition to be called “cold stagnating in the liver vessel” (寒滞肝脈kantaikanmyaku),cold invades a liver-­meridian (肝経絡) and causes pain. We report a case of 7-­year-­old boy that reached the difficulty in walking for agreed pain of lower extremities in a liver-­meridian by cold house environment after the diarrhea. There was no abnormality in a blood test and the MR imaging in Western medicine. The treat­ment principle was to warm the meridian and reduce the pain. We chose the infusion of “dankanzen­-based prescription” (暖肝煎加味方) to warm the meridian and to remove the pain. The symptom improved. And the bathing therapy to warm a body relieved pain too. The case report of children of kantaikanmyaku was not found as far as we examined it. However, we believe that such cases are latent in Japan where air conditioners are widely used.

Uzushakusekishigan is a Kampo formula described in ‘Jin Gui Yao Lue' for treatment of “heart pain that spreads out to the back, or back pain that spreads to the heart.” We successfully treated three patients with this formula. Patient 1 was a 53-year-old man suffering from precordial pain which occurred after amputation of the right forearm;patient 2 was a 46-year-old man with epigastralgia that occurred after taking cold meals;and patient 3 was a 28-year-old woman suffering from epigastralgia accompanied with panic disorder. Epigastric discomfort and resistance occurred in all three cases, prompting us to prescribe this formula. There are few reports of successful application of uzushakusekishigan, and it is not clear what symptoms and pathologies are relevant when prescribing this formula. However, our findings strongly suggest that uzushakusekishigan should be considered when treating severe chest or abdominal pain.

We report a case of panic disorder treated with keishikyokeikabukuryobyakujutsuto. The patient was a 42-year-old woman who had one or two episodes of panic attacks every month for 1 year accompanied by dyspnea, fear, rigidity of hands, etc. The episodes were more frequent with physical exertion and menstruation and did not improve with kamishoyosan or kanbakutaisoto. Then, after a car accident, she had a panic attack with a stronger intensity. Blood and imaging examinations revealed no special findings, and we diagnosed her with panic disorder. We considered her complaint as Honton disease and administered ryokeikansoto. After 2 weeks, her mental condition improved, and dyspnea and fear of attacks relieved. After 2 months, office work became more strenuous, and attacks recurred once or twice a week. An abnormal sensation of the posterior cervix occurred as a prodrome of an attack, and simultaneously, she noticed neck stiffness. After switching to keishikyokeikabukuryobyakujutsuto, the cervical sensation disappeared, neck pain and neck stiffness were relieved, and the attacks did not reappear. This case suggested that keishikyokeikabukuryobyakujutsuto was useful for the prevention of panic attacks associated with neck stiffness.

Diabetic foot lesions are internationally defined as infections, ulcers, or destructive lesions of the tissue of the lower extremities in patients with diabetes associated with neuropathy and peripheral artery disease. Early treatment is necessary for the three main causes of diabetic foot disease : neuropathy, peripheral artery disease, and infection. In this study, based on these associated factors, Kampo medicine was found to be effective for foot lesions in 50 to 100% of the 13 outpatients and 4 inpatients with diabetes. Kampo medicine treatment was effective for 50% or more patients with diabetes and neuropathy. In peripheral artery disease, Kampo medicine improved the circulation ; in particular, tokishigyakukagoshuyushokyoto improved the ankle-­brachial pressure index. In patients with diabetes and infection, hozai improved the general condition in combination with antibiotics of Western medicine.

It is written about daiobotampito in ‘Jin Gui Yao Lue' that the patients who should be treated with the for­mula urinated smoothly. On the other hand, Kampo doctors today tend to use daiobotampito for difficulty of urination. We investigated the feature of daiobotampito in old medical textbooks, especially about “urination,” “gonorrhea,” and “intestinal abscess.” We searched old medical textbooks for daiobotampito, which were writ­ten or published before or during the Song Dynasty. In the textbooks other than ‘Jin Gui Yao Lue,' it is written that the patients urinated frequently. In the textbooks other than ‘Jin Gui Yao Lue' and ‘Ishimpo,' it is written that the patients sometimes urinated difficultly. In the old medical textbooks before or during the Song Dynasty, urination of the patients who should be treated with daiobotampito was smooth but sometimes difficult.

The Japan Society for Oriental Medicine has established various committees, which are working every day to disseminate Japanese traditional herbal medicine (Kampo) and support the activities of academic members. As the members of the International Committee and the medical doctors who conduct research and clinical practice of Kampo at the university hospital, the authors participated in the 14th International Congress on Complementary Medicine Research held in Australia in May 2019. To improve the international recognition and international dissemination of Japanese Kampo, we held the Japanese Kampo Symposium on gastrointestinal diseases successfully. While it was realized that there was an international big interest in Japanese Kampo, it seemed that Kampo researchers in Japan lack the ability to dispatch of information at international conferences compared to neighboring countries such as Korea and China.