Orthostatic dysregulation arises primarily from venous pooling in the lower extremities due to abnormal regulation of the autonomic nervous system. This leads to altered central blood volume, which reduces cardiac output and circulating blood volume, resulting in difficulties in rising, dizziness, fatigue, nausea, and palpitations. The treatment of orthostatic dysregulation typically involves non-pharmacological measures such as salt and water supplementation, as well as pharmacological interventions including midodrine hydrochloride. Here, we present two cases of orthostatic dysregulation that were effectively treated with shakanzoto, a Kampo medicine. Case 1 was a 15-year-old boy who had been experiencing fatigue, difficulty in rising, and palpitations in the morning for two years, resulting in his inability to attend school for six months. He was diagnosed with orthostatic dysregulation in accordance with the Japan Clinical Guidelines on Psychosomatic Diseases in Childhood and was administered shakanzoto, after which his symptoms were resolved by day 14 of the follow-up visit, enabling him to attend school. Case 2 involved a 14-year-old girl who had been experiencing fatigue, nausea, dizziness, and palpitations in the morning for five years and was also diagnosed with orthostatic dysregulation in accordance with the aforementioned guidelines. She was administered shakanzoto and her symptoms resolved by the fourth day, allowing her to return to school. To date, the effectiveness of shakanzoto for the treatment of orthostatic dysregulation has not been reported. Nonetheless, shakanzoto may be considered as a potential addition to the treatment for orthostatic dysregulation.

Saffron (Crocus sativus L.) is classified as a beneficial herb in the treatment of “Oketsu,” eliminating blood stagnation. The clinical symptoms of “Oketsu” include feeling cold and arthralgia. The pathological condition of “Oketsu” is considered to be increased blood viscosity and microvascular disorders.However, no useful biomarker has been reported for evaluation of the degree of “Oketsu.” Here, we investigated the clinical effect of saffron on the symptoms of “Oketsu” in patients with autoimmune diseases. At the same time, we measured the plasma levels of platelet factor 4 (PF-4) and beta-thromboglobulin (β-TG) as platelet activation markers. Seventy-one patients (66 women and 5 men, mean age 52.3 ± 16.1) were studied. They were administered saffron (300mg∼900mg) with traditional Kampo medicine. The clinical symptoms of “Oketsu” improved (80.9%, n=38/47) and we measured PF-4 and β-TG in pre-and post-saffron treatment periods. The plasma levels of PF-4 and β-TG significantly decreased after saffron therapy (PF-4 : before 49.6 ± 29.8, after 24.0 ± 19.6ng/ml, β-TG : before 117.5 ± 64.0, after 64.6 ± 47.1ng/ml;paired t-test, p < 0.0001, respectively). These results suggest that saffron is effective in treatment of the symptoms of “Oketsu” in allergy and collagen disease patients. Moreover, PF-4 and β-TG may be useful biomarkers of the degree of “Oketsu.”