Pulsatile tinnitus results from turbulence that occurs in the vascular lumen of the neck, skull base, and temporal bone region. Here we report two cases in which hachimijiogan was effective for pulsatile tinnitus which was thought to be caused by carotid artery stenosis. Case 1 was a 77-year-old man. He had been aware of left pulsatile tinnitus for more than 10 years, and visited our department. Ultrasonography revealed a 56% stenosis in the left carotid artery, which was considered to be the cause of tinnitus. We administered him hachimijiogan because he had a pattern of kidney yang deficiency. After 12 weeks of administration, his symptom disappeared. Case 2 was an 86-year-old man. He had been aware of pulsatile tinnitus for a year, and visited our department. He was pointed out about 70% stenosis in the left carotid artery at another hospital, and we thought this was the cause of tinnitus. We administered him hachimijiogan because he had a pattern of kidney yang deficiency. After 16 weeks of administration, his symptom improved to about one quarter. It is considered that there are cases where pulsatile tinnitus due to carotid artery stenosis associated with arteriosclerosis can be treated as kidney deficiency, as well as age-related inner ear tinnitus.

We report a case of burning mouth syndrome (BMS) in a woman in her 70s whose pain was relieved by goshajinkigan alone. Five years ago, she became aware of tongue pain when she was under emotional stress. We diagnosed it as BMS. Since she had been taking antidepressants for depression for a long time and was more bothered by symptoms of kidney deficiency, such as back pain and numbness in the lower limbs, than tongue pain, we first prescribed goshajinkigan to improve her general condition. After that, not only her kidney deficiency but her BMS was relieved. The patient is currently under follow-up, but there is no tendency to relapse BMS. We presume that the correction of the patient’s general condition by Kampo medicine would lead to the improvement of her BMS.

A 66-year-old woman presented with a choking feeling in her throat. She was hospitalized three times and started nasogastric tube feeding one year before. She was diagnosed as somatic hallucination by a psychiatrist and started antipsychotic medication. She was admitted to our department in September due to worsening of choking sensation. Her body weight was 29 kg, and she was significantly lethargic and undernourished, and had difficulty in moving, parkinsonism, cognitive dysfunction, and apathy. She was considered to be in late yin stage pattern and started on tsumyakushigyakuto, which enabled her to walk with a walker, but her choking sensation did not improve. Two days after the conversion to yokukansankachimpihange, her speech and smile increased, and her motivation improved. After the switch to the extract of yokukansankachimpihange, the fullness and discomfort in left chest and hypochondrium disappeared, and she was able to take jelly and walk by herself. She was transferred to other hospital in January of the following year. Three months after the transfer, she was able to take enteral nutrition by herself and her weight increased to 37 kg. Eight months later after the transfer, she was able to take solid food orally and her weight increased to 41.5 kg. Yokukansankachimpihange may be useful for treating the patients with somatic hallucination and apathy.

Apical periodontitis is the inflammatory lesion of apical periodontal tissue caused by tooth decay, etc. The treatment requires infected root canal therapy that can get rid of infected pulpy, septic matter and bacteria inside the tooth. This report outlines the case of a 77-year-old male patient who was diagnosed as apical periodontitis on the lower right first molar. Dentist advised the patient to have a root canal treatment, but he strongly resisted the treatment and did not agree. So we treated him with Kampo medicine, hainosankyuto and rikkosan as a result his condition has been stable for more than 3 years without using antibiotics or analgesic. If apical periodontitis is left untreated, there would be a risk of tooth conditions gradually getting worse. In cases where standard dental treatment is difficult, Kampo medicine may be useful and hopeful.

Neuro-otologic disease (e.g. hearing loss, tinnitus, dizziness) are often difficult to treat because their mechanisms and causes are not fully understood and Western medical approaches are limited. This time, we report 3 cases with high-tone sensorineural hearing loss successfully treated with a Kampo formulation daisaikoto. When high-tone sensorineural hearing loss remains after treatment of acute sensorineural deafness, or for high-tone acute sensorineural deafness, a Kampo medicine approach including abdominal patterns has the potential to improve hearing as well as comorbid symptoms such as tinnitus.

Pain of yin pattern is difficult to treat with Western medicine. We report four cases of shoulder periarthritis of yin pattern, as defined in Kampo, successfully treated with Kampo medicine. All three of these patients were women, aged 59, 74, and 62, respectively, at the end of the treatment series. All of them were diagnosed with shoulder periarthritis of yin pattern through interviews and were administered a combination of kakkonto and sokeikakketsuto after dokkatsukakkonto based on the classic description; their pain was then relieved. According to the classical interpretation, jufu is a clinical state of pain in the four extremities of people with yin pattern, for which dokkatsukakkonto is effective. We discussed the prescription directions for dokkatsukakkonto.

Although saikanto has often been an effective Kampo medicine for chest pain accompanied by coughing or deep breathing, there are few reports on its usefulness in recent years. Here we report 3 cases of outpatients who visited the respiratory department of our hospital with the symptom of chest pain accompanied by coughing or deep breathing. They were successfully treated with saikanto. Case 1 was a 17-year-old woman who was diagnosed with pleuritis. Case 2 was a 57-year-old man who was suspiciously diagnosed with pleuritis. Case 3 was a 45-year-old woman who was diagnosed with upper respiratory tract inflammation. In Kampo medical examination before the treatment with saikanto, 3 patients had kyokyokuman (fullness and discomfort in chest and hypochondrium) and 2 patients had shinkahiko (epigastric stuffiness and resistance). All of the patients recovered from the chest pain early without analgesic drugs. This suggests that Kampo medicine of saikanto is effective for the early recovery without using analgesic drugs from chest pain caused by pleuritis or a severe cough, and that kyokyokuman and shinkahiko are useful indications for its effectiveness.

Twenty patients with bilateral localized lower leg edema were treated with acupuncture alone followed by combination therapy with acupuncture and Kampo formulas. The effects of treatment were examined after the first acupuncture session. Lower limb circumference significantly decreased from 29.1 ± 6.8 cm to 28.1 ± 7.0 cm (mean ± SD) (p < 0.01). In addition, the area of ankle edema decreased from 22.6 ± 10.6 cm² to 14.2 ± 7.2 cm² (p < 0.05). Subcutaneous tissue thickness, as measured via ultrasound, significantly decreased at the lower limbs and ankles from 10.4 ± 3.8 mm to 7.8 ± 3.4 mm and 10.1 ± 2.9 mm to 8.2 ± 3.0 mm, respectively (p < 0.05). In contrast, there was no change in subcutaneous echogenicity observed in the lower limbs. Following acupuncture, patients underwent combination therapy with acupuncture and Kampo formulas. As a result, area of ankle edema significantly decreased from 24.1 ± 2.5 cm² to 3.0 ± 2.1 cm² (p < 0.01). Moreover, symptoms resolved with respect to edema and coldness (p < 0.05). However, no change was observed in laboratory parameters. This study highlights the efficacy of acupuncture in improving lower leg edema. In addition, combination therapy with acupuncture and Kampo formulas seemed to be effective in the treatment of leg edema.

Few published reports exist on shishishito (sanshishi and koshi) usage. Our study group comprised of six female patients presenting with anxiety, insomnia, or chest discomfort, with the common characteristic of speaking restlessly. They either had heat symptoms or they did not experience coldness. All six patients were prescribed shishishito. Case 1, a 64-year-old woman presenting with chest irritation and tightness, recovered on day 4 of shishishito administration. Case 2, a 63-year-old woman displaying restlessness, epigastric clogging, and daily nightmares recovered after 8 days of treatment. Case 3, a 36-year-old woman taking Kampo for another ailment, presented with throat clogging and glossodynia, recovered on day 5 after changing to shishishito administration. Similarly, Case 4, a 73-year-old woman already taking Kampo for neurotic anxiety, showed sudden signs of insomnia that improved after 2 days of shishishito administration. Case 5, an 83-year-old woman already on Kampo medication for anxiety and palpitations, was successfully treated with shishishito for severe anxiety and restless speech and recovered in 5 days. A separate Kampo formulation resolved her palpitations. However, another panic attack ensued, which was resolved after 7 days of shishishito treatment. Interestingly, shishishito was not successful in resolving the panic attacks of Case 6, a 48-year-old woman with depression owing to personal loss. Treatment with Western medicine in addition to 11 days of shishito administration was also ineffective for this patient.

At our institution, various herbal medicines have been prescribed under the supervision of a herbal medicine supervisor for a wide range of clinical conditions in children with pediatric surgical diseases. At present, we continue to prescribe herbal medicines even in the absence of a herbal medicine supervisor. The aim of study is to continue and improve herbal medicines in pediatric surgery. A questionnaire survey was conducted among doctors prescribing herbal medicines in our department, and 14 doctors responded. All doctors agreed on their realization of the efficacy of herbal medicines and their willingness to study herbal medicines. Almost doctors obtained information on herbal medicine from the literature and decided on prescriptions based on the name of the disease and the symptoms. This survey showed that many doctors are aware of the effectiveness of herbal medicines and they prescribe herbal medicines to some extent in their own departments. As a result of this survey, three doctors from our department have received training in outpatient herbal medicine. Investigation of current problems through a fixed-point questionnaire survey would help to recognize the need for herbal medicine treatment in each department.