We describe two cases of cardiac failure in elderly patients successfully treated with shimbuto. Case 1 was that of an 84-year-old man with severe aortic stenosis and liver cancer. His cardiac failure led to repeated hospitalization. After taking shimbuto, his pleural effusion decreased and cardio thoracic ratio improved. Case 2 was that of an 84-year-old man who was hospitalized because of cardiac failure and aspiration pneumonia after undergoing an operation for lung cancer. After taking shimbuto, his urine volume increased and cardiac failure improved. No notable adverse events were observed in any of the abovementioned cases. It is important that kanzo is not included in shimbuto to demonstrate risui action, hence the use of other “ho” formulations should be avoided. These cases suggest that shimbuto is indicated for elderly patients with cardiac failure under terminal care.

We report three cases with somatoform disorder which were considered as “Hontonki” disease, successfully treated with keishikakeito. Case1 was a 34-year old male who was suffering from headache and palpitation. He said ‘Something pierces and it goes up from the chest to the head.' We considered his complaint as Hontonki disease and administered keishikakeito. After one week, the headache disappeared and four weeks later, palpitation and tinnitus were definitely improved. Case2 was a 22-year old male. His complaints were excessive strain and general fatigue. Because he had coldness of lower extremities and spasmodic headache, we interpreted these symptoms Hontonki disease and administered keishikakeito. After that these symptoms and his psychological test scores improved markedly. Case 3 was a 75-year old female. Severe headache and palpitations presented after remodeling her home. Three weeks later taking keishikakeito, her symptoms had disappeared dramatically. Recently, Hontonki disease are often compared with panic disorder, and it is possible that some somatoform disorder cases include Hontonki disease. It is important to consider the possibility of Hontonki disease behind the physical complaints such as headache and palpitation, when we use keishikakeito.

We surveyed side effect incidences with Kampo therapies in 2530 patients based on their Kampo diagnoses. The number of side effects seen, including taste disorder, was 569 in 503 patients. Side effects were noted in 64 (3.0%) of 2139 patients administered Glycyrrhizae radix. The average 63.4±13.8 age of these patients was statistically higher than the overall 54.9±18.1 year mean. Symptoms which led to diagnosis of side effects were high blood pressure in 45 patients, edema in 16 patients, and hypokalemia in only 5 patients. Glycyrrhizae radix dose as an extract was 2.0±1.0 (mean±SD) g/day in 34 patients, and as a decoction was 2.2±1.1 g/day in 29 patients. There was no difference in administration or recovery periods between these two groups. Liver dysfunction was noted in 13 (1.0%) of 1328 patients administered prescriptions containing Scutellaria radix. Scutellaria radix was administered as an extract at 2.3±0.5 g/day in 7 patients, and as a decoction at 2.8±0.8 g/day in 6 patients. Although there was no difference in administration periods, the 69.0±52.5 day recovery period from side effects in the extract group was longer than that of 22.7±16.0 days in the decoction group. Symptom improvement was had for a large portion of these side effects with the first visit, indicating that initial diagnoses were correct. Care should be exercised with regard to inducing side effects, with Kampo medicines, even when using traditional diagnostic standards.

Shoyogan is a Kampo prescription described in the Junqui Yaolue. Few cases have been reported using this medicine. This time, we prescribed shoyogan for 14 patients who suffered from severe appetite loss. We had positive outcomes as follows. We administered shoyogan to 8 patients with malignant disease. Six of them suffered from lung cancer. Shoyogan was effective in these patients. Shoyogan was not effective for the other 2 patients, with bile duct carcinoma and malignant lymphoma. The dietary intake was increased from 28 percent of meals supplied to 79 percent in the appetite-improved group. We also administered shoyogan to 6 patients with nonmalignant disease. It was effective for 3 patients: 1 with congestive heart failure and 2 with great trochanteric fractures of the femur. It was not effective for the other 3 patients, who suffered from anorexia, pneumonia and depression associated with diabetes mellitus. Shoyogan seems to be effective for patients with terminal lung cancer and maintains their quality of life.

We studied contemporary indication of daikankyoto and daikankyoganryo. We administered either of these Kampo prescriptions for thirty-three patients with intractable muscle stiffness of neck, shoulder and back.Twenty-four patients were able to take the prescriptions for more than four weeks (long term group), and nine patients stopped taking the prescriptions less than four weeks (interrupted group). In long term group, fourteen patients (58%) improved their chief compliant. The Kampo formulations of fourteen effective cases were daikankyoto (13 cases) and daikankyoganryo (1 case). Comparative analysis has been done between long term group and nine cases of interrupted group. The characteristics of long term group were higher body mass index, firmer abdomen and more positive cases of epigastric resistance sign. Kansui root dose was 0.81 gram a day in long term group and 0.57 gram a day in interrupted group, which showed statistically-significant difference. We found twenty-seven side-effects in twenty four patients (73%) including eighteen patients with nausea and six patients with diarrhea. In side effects, there was no statistically significant difference between two groups. These side effects were promptly improved after discontinuation or dose reduction of Kansui root. We report clinical courses of six improved cases in this paper, two severe stiff neck, shoulder and back cases, each one case of psychosomatic disorder, depression, spasmodic torticollis and gastroesophageal reflux. These prescriptions should be administered more commonly to the patients with severe stiff neck, shoulder and back.