Kampo medicine is widely used in Japan for neuro-otologic disease (e.g. tinnitus, dizziness, hearing loss). Some patients with these diseases suffer from comorbidity of other non-otologic symptoms. We reviewed typical Kampo medicine formulations for neuro-otologic disease. Kampo extracts have indications not only the neuro-otologic but also other systemic diseases. Kampo medicine would facilitate the care of patients with both neuro-otologic diseases and comorbid symptoms.

A 28-year-old man had been experiencing occasional stomach upset and heartburn for 14 years. The symptoms started after he suffered from vomiting and diarrhea in the winter when he was fourteen. He had always suffered from loss of appetite during the last couple of years, and his symptoms got worse whatever he ate. In a terrible time, he had a palpitation and grew cold his limbs. He defecated once in one or two days with painful diarrhea. These symptoms were considered as functional gastrointestinal disorders with functional dyspepsia and irritable bowel syndrome. First, saishakurikkunshito was tried but it had no effect. Shokenchuto was prescribed next and had some effect. Chukenchuto, a combination of shokenchuto and daikenchuto, showed better effectiveness. The results of this case suggest that saishakurikkunshito was ineffective because qi deficiency was not the main cause, and that chukenchuto was effective because of qi depression.

We examined Kampo treatment given to 45 patients with chronic testicular pain and groin pain. Thirty-three of 45 cases were healed with anti-percussive agents including keishibukuryogan, tokishakuyakusan. In addition to testicular pain, when the pain and numbness in the femoral lesion appeared, hachimijiogan and goshajinkigan were effective. If coldness in the lower body is an aggravating factor, tokishakuyakusan is considered appropriate as the first choice. We should notice the sign of qi-blood-fluid, especially, static blood, to select medicine for chronic testicular pain and groin pain.

Persistent or intractable hiccups worsen the activity of daily life and the quality of life of patients, but are sometimes difficult to treat. There are no recommended therapies in Western medicine for hiccups, and Kampo medicine can often be used. However, there have been no case reports on keishininjinto for hiccups. We experienced two cases of hiccups successfully treated with keishininjinto. Case 1 was a 68-year-old man who continued intractable hiccups for 3 years. Case 2 was an 81-year-old man who developed persistent hiccups during mechanical ventilation. Both cases had spontaneous sweat, tendency of diarrhea, epigastric discomfort and resistance, and cold of epigastrium, so we diagnosed them as keishininjinto-sho. It took 6 months to improve hiccups after administration of keishininjinto in case 1 and 1 week in case 2. Keishininjinto can be effective for hiccups with interior and cold pattern.

Paroxysmal atrial fibrillation (pAf) is an arrhythmia that often occurs in the elderly. The quality of life often declines due to severe palpitations caused by pAf. We present a case of recurrent pAf that occurred on postoperative day 2 of coronary artery bypass grafting and pulmonary vein isolation for unstable angina pectoris and pAf. The patient was a 62-year-old man who complained of palpitations, which was consistent with pAf on the monitor ECG. During hospitalization, the patient was constantly wearing an ECG monitor. During pAf, the heart rate was around 120 bpm, and pAf could continue for up to and beyond 24 hours. Paroxysmal atrial fibrillation with strong palpitations was observed every day, even after starting beta-blockers and anticoagulants. After discharge, a Japanese Kampo medicine called shakanzoto was taken for a month, but there was no improvement. After that, it was changed to another Japanese Kampo medicine called saikokaryukotsuboreito, because abdominal examination revealed kyokyokuman (hypochondriac discomfort and distension (resistance)) and saiboki (brisk pulsation in the para-umbilical region). Palpitations quickly improved dramatically. It was speculated that not only palpitations but also pAf had been improved.

In daily medical examinations of orthopedic surgery, treatment for chronic pain is sometimes needed. We report a case of chronic pain developed after an open fracture 15 years ago and successfully treated with sokeikakketsuto. A 35­-year-­old man unfortunately sustained an open fracture in his right lower leg in a traffic accident at his age of 20 years. He underwent 12­-13 surgeries for osteosynthesis, post-­operative focal infection, and leg extension. Subsequently, he developed periodic pain in his right ankle joint. He consulted our clinic because of the severe pain; although non-­steroidal anti-­inflammatory drugs were ineffective, sokeikakketsuto was dramatically effective. To treat chronic pain after an old fracture, sokeikakketsuto may be considered as a choice of treatment.

Crowned dens syndrome (CDS) is a pseudogout of the cervical vertebra, which shows calcification around the dens of the axis. We report a case of CDS that was successfully treated with daiobotampito and shimotsuto. An 83-year-old woman visited our clinic because of neck pain. She was diagnosed with CDS and was initially administered daiobotampito and eppikajutsuto. Her neck pain improved slightly, but recurred. She was then administered daiobotampito and shimotsuto, after which her neck pain disappeared. We considered that daiobotampito and shimotsuto were effective for this prolonged illness based on persistent stasis and blood deficiency according to her treatment course and laboratory findings.

Painful orthopedic diseases are sometimes aggravated because of weather changes ; this is referred to as meteorological pain. We report two cases of great occipital neuralgia (GON) due to traffic accident in patients whose pain was aggravated by weather changes. Case 1 involved a 41-year-old woman who developed lumbago and cervical pain following a traffic accident. Two months after the accident, she had irregular occipital pain. Three months after the accident, a great typhoon occurred, and she suffered from severe occipital pain since that morning. She was diagnosed with GON as meteorological pain and was administered goreisan ; her occipital pain then improved. Case 2 involved a 31-year-old woman who developed cervical pain following a traffic accident. Three months after the accident, she experienced severe occipital pain due to weather changes. She was diagnosed with GON as meteorological pain and was administered goreisan ; her occipital pain then improved. Goreisan is dramatically effective for GON as meteorological pain caused by cervical sprain.

We report 4 cases of vulvodynia, vulval pain from unknown causes that showed symptomatic improvements by administrating Kampo medicines. Modern medicines, such as analgesics, treatments for endometriosis or hormone replacement therapy, can't always be effective for vulvodynia and not a few patients go to see different hospitals without improving their pain. We diagnosed these 4 cases of vulvodynia were originated in kekkyo. We administered Kampo medicines, mainly shimotsuto with supporting ones, and the symptoms of vulvodynia improved.

We report a case of severe headache associated with cerebellar infarction was successfully treated with Kampo therapy. The patient complained of severe headache and vertigo in spite of standard therapy after the decompression craniectomy. However, his symptoms were relieved immediately by administration of goreisan. The pharmacological effect of Kampo formulation i.e. goreisan is still unknown, but this formulation has been used for headache with edema, vertigo and vomiting. According to the classic textbook, this formulation has a potential to improve water imbalance in the body, including brain edema. This Kampo medicine is seemed to be an alternative to manage such patients.

Growing evidences indicate that the development of mesenteric phlebosclerosis (MP) is associated with long-­term gardenia fruit (GF) intake. Besides duration and total dosage of GF ingestion, other factors associated with the development of MP or the symptoms of MP have not been known. We searched for previous case reports of MP from Japan. MP patients were divided into two groups : asymptomatic group without abdominal symptoms or symptomatic group. Age, gender ratio, body size, and duration of GF ingestion of the both groups were statistically analyzed. We evaluated concomitant diseases that can cause elevated venous pressure in the both groups. Colectomy rate were compared between symptomatic men and symptomatic women. Severe symptoms including ileus, stenosis peritonitis, and perforation were also compared between men and women. Age and sex were analyzed in all 164 cases. The gender ratio of women to men in the symptomatic group was higher than that in the asymptomatic group. However, colectomy rate in the symptomatic group was similar between men and women. Ileus, stenosis, peritonitis, and perforation were similarly found in both men and women. We found 15 symptomatic MP patients with concomitant diseases that can cause phlebostasis. None of the asymptomatic had these diseases. Concomitant diseases that can cause elevated venous pressure might be associated with symptomatic MP. The severity of MP seems to be similar between men and women. Association of gender difference with the development of MP symptoms was uncertain.

There are multiple options for treating hyperhidrosis, including Kampo medicine. However, as for acquired idiopathic generalized anhidrosis, steroid therapy is the only way to treat the patients. There are few clinical reports including Kampo treatment for anhidrosis. We report a case in which keishikaogito based prescriptions were effective in treating symptoms caused by decreased sweating. A 69-­year-­old woman visited our institute in June 201X, complaining of reduced sweating and abnormal feelings about body temperature. Her physician prescribed various sorts of Kampo medicines, but no improvement had been shown. We considered that she was not able to sweat and had water accumulation under her skin. She was given Keishikaogito based prescrip­tions, and she came to sweat spontaneously and abnormal feeling about body temperature improved. Honzo-biyo says “Astragalus promotes sweating if there is no sweating, stops it if there is sweating.” Keisetsu Otsuka said in Kinki-yoryaku-kowa that Astragalus works in both cases with too much and too little water. Kampo treatment especially containing Astragalus can be effective for sweating disorders.

Although it is not yet common, certified Kampo (traditional Japanese medicine) doctors and acupuncturists are cooperating with each other to provide traditional medical treatment for patients in some general hospitals in Japan. In other hospitals, however, Kampo and acupuncture-moxibustion have not been introduced, and doctors only treat patients using modern Western medicine. Many doctors must already be aware that modern Western medicine is not the only approach for the treatment of patients, but they do not make any efforts to improve the situation by adopting traditional medicine. Here, we give some examples of hospitals in which acupuncture treatments are routinely provided, having a favorable effect on both patients as well as the hospitals themselves. We believe that these examples give us a good opportunity to consider the future of an ideal medical system in which modern Western medicine and traditional Japanese medicine are successfully integrated.