We describe four cases of menopausal symptoms with respiratory complaints successfully treated with saikokeishikankyoto. Case 1 was a 49-year-old female who became easily tired and often caught colds, as well as suffered from cough, hot flushes and insomnia. Case 2 was a 47-year-old female who became easily fatigued and irritated, and suffered from dry cough. Case 3 was a 51-year-old female, who became easily exhausted and suffered from nasal congestion and swelling of the gums. Case 4 was a 53-year-old female, who suffered from sensations of coldness and hot flushes, insomnia, sore throat and dry cough. Although saikokeishikankyoto has been classically applied for diverse symptoms, respiratory signs are associated with the most preferable outcome. Saikokeishikankyoto could be a suitable herbal medicine for menopausal patients with a weak constitution, who present with respiratory symptoms caused by coldness, qi deficiency and qi stagnation.

We present seven cases of insomnia successfully treated with hochuekkito. Two patients showed improvement of their insomnia after taking hochuekkito before going to bed, and three patients showed improvement after taking hochuekkito twice per day. The other two patients could sleep better after adding hochuekkito to other Kampo formulations. All these patients were light sleepers, and became easily tired, excessive sleepy after meals, and had daytime sleepiness. However, they had no gastrointestinal symptoms, such as appetite loss. Five of the seven patients reported waking up feeling better after taking hochuekkito. Two other Kampo formulations, sansoninto and kihito, were also given to patients with deficient constitution, who complained of insomnia. Sansoninto and kihito are formulae that compensate for qui and blood deficiency. Kihito contains more herbs with beneficial effects on “spleen and stomach”, and “heart” functions more than sansoninto, and therefore, kihito may be preferred for patients with a more deficient constitution. The reason why our patients were able to sleep more deeply and wake up smoothly with hochuekkito may be that they exhibited remarkable qui deficiency, showing general fatigue, excessive sleepiness after meals, and daytime sleepiness, but without the symptoms of blood deficiency, such as palpitations or uneasiness, being easily frightened or forgetful, or showing anemia or bleeding.

We investigated original texts for yokukansan, a familiar Kampo formula, focusing on the classical literature Xue-shi yi-an (薛氏医案) . Yokukansan was described in the Bao-ying jin-jing-lu (保嬰金鏡録) written by Xue ji (薛己) in 1550, the Xiao-er yao-zheng zhi-jue (小児薬証直訣) revised by Xue ji (薛己) in 1551,the Bao-ying cuo-yao (保嬰撮要) by Xue kai (薛鎧) in 1556, and the Xiao-er dou-zhen fang-lun (小児痘疹方論) in 1550. The phrase “one's own work” was used in “Bao-ying jin-jing-lu (保嬰金鏡録)” and in the Xiao-er dou-zhen fang-lun (小児痘疹方論) by Chen wen-zhong (陳文仲). However, there was no mention of “one's own work” in the same title, the Xiao-er dou-zhen fang-lun (小児痘疹方論), as summarized by Xiong zong-li (熊宗立).
Yokukansan was found only in the Xiao-er yao-zheng zhi-jue (小児薬証直訣) revised by Xue ji (薛己) in 1551, but not in the other copies of the same text. Therefore, it seems likely that yokukansan was created by Xue ji (薛己) himself.
Yokukansan was previously thought to have originated with the Bao-ying cuo-yao (保嬰撮要). However, based on use of the phrase “one's own work” in the classical literature, it appears that the original text for yokukansan should be the Bao-ying jin-jing-lu (保嬰金鏡録). Therefore, yokukansan seems to have been made by Xue ji (薛己), and not Xue kai (薛鎧), who was his father.