In this report, we describe three hemodialysis patients with carpal tunnel syndrome (CTS) that were successfully treated with Goshakusan, one of the well-known traditional Japanese herbal (Kampo) medicines.
Case 1 was a 77-year-old woman suffering from sleep disorder due to night pain in the bilateral forearms. Case 2 was a 66-year-old woman complaining of sleep disorder due to lancinating pain in right upper and lower limb. They had undergone surgical decompression procedures for CTS several times in the bilateral forearms. However, they still needed a periodical injection of glucocorticoid into the region of carpal tunnel for the relief from pain. Case 3 was a 54-year-old man, who has been suffering from the recurrence of numbness of the left fingers since surgical treatment for CTS.
We diagnosed that the symptom of CTS in those three patients may be due to kan-shitsu (damp-cold or interior cold with dampness), because all of them were anuric hemodialysis patients, who tend to easily acquire phlegm and dampness, and their symptom was partially relieved by warming the forearm and fingers. Therefore, they were prescribed an oral goshakusan extract formula to remove kan-shitsu. Soon after they started taking the formula, the intensity of their pain or numbness markedly decreased. Taken together, our report suggests that it is worth trying to remove kan-shitsu by Kampo medicines for the conservative treatment of CTS.

In this report, we describe four hemodialysed patients with upper abdominal discomfort successfully treated with Heiisan, one of the known traditional oriental herbal medicine.Case 1 was a 61-year-old man suffering from upper abdominal discomfort after each meal even though daily taking some medicine for gastritis. Case 2 was a 45-year-old man, who has also been suffering from upper abdominal discomfort after breakfast and supper despite daily taking H₂-blocker. Case 3 was a 61-year-old man complaining of upper abdominal discomfort. He has had loss of appetite despite being treated with H₂-blocker and gastroprokinetic medication. Case 4 was a 69-year-old woman complaining of upper abdominal discomfort with dull pain before eating. She was diagnosed as chronic gastritis and healing stage of duodenal ulcer and prescribed H₂-blocker. However, this medicine did not work.We diagnosed that upper abdominal discomfort in all the patients came from shitsu-jya (pathogenic dampness) in hii (Spleen-Stomach functional unit), and treated them with Heiisan, which was popular to remove shitsu-jya in Hii. Their symptom disappeared soon after taking this medicine.It is also difficult for hemodialysed patients to control their weight due to anuria and they tend to easily gain the weight due to inappropriate eating and drinking, leading to shitsu-jya in such patients. Therefore, our reports suggested that Heiisan was good for hemodialysed patients to control various upper abdominal symptoms that might be caused by shitsu-jya in Hii.

Traditional western medical diagnosis and treatment strategies for a patient with persistent anorexia and weight loss failed to yield any positive results, and thus we changed to an eastern treatment modality employ­ing the use of byakkokaninjinto, which resulted in successful treatment of the anorexia and its associated symptoms. An 83-­year-­old man presenting with phlegm and anorexia visited our hospital. Upon examination, we iden­tified subpleural ground-­glass and reticular opacities via chest CT. The patient was diagnosed with idiopathic interstitial pneumonia in the outpatient setting. Due to persistent anorexia and weight loss, we conducted thor­ough examinations of gastrointestinal system to supplement our overall workup ;however, the cause of the anorexia could not be identified. Meanwhile the patient lost 30 kg within a span of 6 months and was hospital­ized. He failed to present with any neurological disorders, collagen/endocrine disease or mental illnesses. A full systemic review was unable to identify the cause of the underlying anorexia but we focused on the pa­tient's complaint of coldness in the neck, upper limbs, ankles/feet and abnormal warmth in the forehead, which made him seek and ingest cold foods. Given these findings, we have established an eastern medical diagnosis for the anorexia as ketsugyaku, netsuketsu and initiated treatment using byakkokaninjinto. After starting a regimen of byakkokaninjinto, the patient noticed increased dietary intake and the various cold and heat sensa­tions distributed throughout his body dissipated. Assuming an open stance on adopting traditional Chinese medical practice into anorexia treatment could prove valuable in certain cases.