I treated crocodile tears syndrome (gustatory-lacrimal reflex) after right facial nerve palsy with acupuncture. The patient was a 74-year-old female. Her right peripheral facial nerve palsy had started one and a half years earlier.
Most of her facial nerve palsy symptoms disappeared in about 5 months. Sixteen months after onset of the condition, her crocodile tear phenomenon occurred spontaneously. Three acupuncture points on the face were stimulated with fine needles for 10 minutes. Her crocodile tears disappeared completely with the first acupuncture session. This case suggests the possibility of acupuncture treatment for aberrant regeneration after facial nerve palsy.

This case involved an 86-year-old woman. She had suffered from vomiting, abdominal pain, distension and constipation, 3 times in 3 years.
Her constipation episodes were not complicated by ileus. There were no obstructive lesions on two colonoscopies.
She again suffered from same symptoms in March 2012. Abdominal radiography and CT scans showed significant gasses in her intestine along with a large volume of stool. The previous treatments had not been effective. So we switched to hachimigan with her. This Kampo medicine was very effective. Eight days after hachimigan administration start, all symptoms were relieved. Moreover, no constipation was observed in a 1 year course of hachimigan treatment. We thus conclude that hachimigan was very effective for this patient's constipation.

There are cases of intractable eye pain, which can be difficult to treat. The late Shogo Yamamoto treated un­explained eye pain with various Chinese herbal prescriptions. Among them, there were clinical trials of heating agents including orengedokuto and hangeshashinto, but no trials of orento are mentioned. Further, no trials of cases of eye pain treated with orento were found in several other collections of clinical trials ;however, here we report on two cases of intractable eye pain of unknown origin that showed significant effects when admin­istered orento. In case 1, unexplained eye pain appeared after cataract surgery and after various treatments were found to be ineffective, acupuncture treatment in our hospital showed a positive effect. In case 2, unex­plained eye pain developed without any obvious cause, and the pain was increased by acupuncture treatment at our hospital. A common finding in both cases was objective cooling of the upper abdomen. The eye pain was considered to be upper heat and the abdominal pain to be middle cold, thus a diagnosis of upper heat and mid­dle cold was made and orento administration begun. We therefore consider that orento could be listed as a treatment for unexplained eye pain.

The number of senile eye cataract cases increases year by year. Recent developments in new operation techniques have brought more safety and ease i.e. ultrasonic phacoemulsication and lens replacement. However, some complications of these techniques result in troublesome outcomes. In this paper the authors report a female patient aged 74 years old who suffered from severe photophobia after cataract surgery, which was successfully treated with the Kampo formulation, ryokeikansoto. Such troublesome cases tend to be neglected to in medical journal publications when the background of the complaint is unknown.

Nasolacrimal duct stenosis, which causes epiphora and eye mucus, is generally treated with probing and irrigation of the nasolacrimal duct. A 57-year-old woman was treated with probing and irrigation of the nasolacrimal duct three times, however, her symptoms of refractory nasolacrimal duct stenosis did not improve. Following 3 days administration of saisoin, her epiphora ameliorated. Based on this experience, we treated 11 adult patients with nasolacrimal duct stenosis using saisoin, and 10 (90.9%) achieved remission within a week. All the adult patients had received treatment by probing and irrigation of the nasolacrimal duct at an ophthalmological clinic, and their symptoms had not improved. Two such cases in infants, moreover, were cured with saisoin in a week. This is the first report on the efficacy of saisoin for the treatment of nasolacrimal duct stenosis in Japan.

In Kampo medicine, abdominal palpation is essential procedure to make the diagnosis of Sho. We experienced two cases of abdominal aortic aneurysm which are diagnosed by means of abdominal palpation. The coexistence of aneurysm and the sign of abdominal palpitation is extremely rare, but every clinician should pay attention to this fact.

A 55-year-old women with von Recklinghausen's disease was admitted to our hospital after sudden left-sided chest pain. She became shocked with a blood pressure of 50mmHg and pulse of 120per min. Chest radiography showed a massive left pleural effusion. Thoracentesis revealed bright blood. Emergency operation was perfomed. The source of bleeding was not clearly identified, but we suspected rupture of the intercostal artery. So we resected a part of descending aorta and implanted a Dacron graft. The bleeding was stopped. She discharged about five months later because of post-operative respiratory and hepatic failure. Histological examination of the aortic wall revealed extensive adventitial infiltration with neurofibromas. The turbulance of the aortic medial elastic fiber was also observed. We considered these histological change of the vessel caused spontaneous rupture of the intercostal artery.

A 34-year-old male with chest pain and shock was admitted as an emergency case to our unit. Ruptured acute aortic dissection with annuloaorticectasia was suspected and emergency operation was performed. Acute aortic dissection was localized at the aortic root. The right coronary orifice was involved with the dissection, and an intimal tear was found just above it. Aortic root replacement with composite graft was performed as follows. The aortic wall around the coronary orifice was incised in a circular manner like a button and the dissection of the aorta around the coronary orifice was repaired. Dacron tubes with xenopericardial skirts were interposed between the coronary orifices and the composite graft. Wrapping of the composite graft was completed using the aortic wall and xenopericardium. The postoperative course was uneventful with only slight bleeding. Our procedure is useful for acute aortic dissection around the coronary orifice.

A case of a 51-year old male with pulmonary valve endocarditis accompanied by aortic regurgitation, and ruptured aneurysm of Valsalva sinus was reported. Repeated blood cultures grew α-streptococcus on a single occasion. After medical treatment, resection of pulmonary valve vegetation, resection and patch closure of aneurysm, and aortic valve replacement were performed successfully. Twenty one cases of pulmonary valve endocarditis reported in Japan, including our case, were collected and reviewed. Causative organism was streptococcus in 93% of cases. No case of intravenous drug abuse was found in this series. A variety of preexisting heart diseses were found in 20 cases out of 21 (95%). All these diseases were congenital ones, such as ven-tricular septal defect, patent ductus arteriosus, pulmonary stenosis and ruptured aneurysm of Valsalva sinus. This fact means that jet lesion of pulmonary valve is a major predisposing factor of pulmonary valve endocarditis. Surgical procedures were reported in 12 cases: resection of vegetation in 4 cases, resection of pulmonary valve in 2, and pulmonary valve replacement in 5. Appropriate surgical procedures should be chosen, depending upon the activity of infective endocarditis, severity of destruction of the valve, and pulmonary vascular resistance.

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.