A 65-year-old woman had left should pain for two months. She felt moderate pain in the left shoulder and she could not raise her left hand. She was diagnosed with shoulder periarthritis by an orthopedist, but her pain had not improved with medication and rehabilitation. So she came to our hospital. She had left shoulder pain with arthrogryposis and muscle atrophy over the course of the next two months. She had a floating and relaxed pulse with spontaneous sweating, so she was diagnosed with greater yang wind strike per Kampo medicine. Her left shoulder pain was improved with keishito for two weeks, and three months later she could raise her left hand. Greater Yang is characterized by floating pulse, headache, pain in the nape of the neck, chills, fever, general pain, and joint pain. And Greater Yang Wind Strike is characterized by fever, spontaneous sweating, mild chill and relaxed pulse. Keishito is useful for in Greater Yang Wind Strike, and our patient improved with keishito. However, keishito is generally used for the early stage of a common cold, and there have been a few reports that keishito is effective for chronic disease. To our knowledge, this is the first report of keishito being effective for shoulder periarthritis, and we believe that keishito is a valid option for the treatment of chronic pain in Greater Yang Wind Strike.

Benzodiazepines are frequently used for the treatment of insomnia, although these drugs cause dose-related centrally mediated respiratory depression. Moreover, benzodiazepines are contraindicated in patients with my asthenia gravis, so treating myasthenia gravis patients with insomnia is difficult.
A 67-year-old woman developed myasthenia gravis on December 20XX. Her myasthenia gravis went into remission with oral high-dose prednisolone medication and plasma exchange, after which her oral predniso lone medication was continued. On January 20XX+2, she suffered from insomnia. She had poor sleep quality, nocturnal awakenings and middle-of-the-night insomnia. She had high abdominal resistance and fullness, ten derness, and discomfort of the hypochondrium. She was treated with saikokaryukotsuboreito and could then sleep comfortably soon afterwards.
According to the Shang Han Lun, saikokaryukotsuboreito is effective for susceptibility to fright and deliri ous speech. Although our patient had no psychological symptoms such as these, an abdominal palpation examination led to diagnosis of a Sho (indication) for saikokaryukotsuboreito. So we started therapy with saikokaryukotsuboreito and her insomnia began improving immediately. To our knowledge, this is the first report of an insomnia patient with myasthenia gravis successfully treated with saikokaryukotsuboreito. Saiko karyukotsuboreito is not contraindicated in patients with myasthenia gravis. Thus we conclude that saikoka ryukotsuboreito is effective and safe for insomnia patients with myasthenia gravis.

Dementia of the Alzheimer's type, in which cognitive impairment slowly progresses, accounts for more than half of dementia cases. Symptoms develop slowly and worsen over time, and there is no cure for Alzheimer's type dementia. We conducted a study on the efficacy of hangebyakujutsutemmato for cognitive impairment in dementia of the Alzheimer's type. Seventy-two patients with Alzheimer's type dementia were enrolled in our study. Hasegawa dementia scale-revised (HDS-R) was implemented for all patients, for whom hangebyakujutsutemmato medication was started at the initial visit. After 4-weeks' treatment the HDS-R was implemented again. Sixty-four patients were assessable and 8 patients dropped out from the study. In these 64 patients, mean age ± standard deviation was 79.9 ± 6.0, and 33 patients were male, and 31 patients were female. After 4 weeks of hangebyakujutsutemmato treatment, HDS-R scores were increased significantly compared with baseline (from 15.5 ± 5.2 to 16.9 ± 6.2, p < 0.01). In taking histories from families, clinical presentation was shown to have improved in 13 patients (20.3%). To our knowledge, this is the first report demonstrating that hangebyakujutsutemmato is effective for patients with dementia of the Alzheimer's type. In conclusion, hangebyakujutsutemmato is a useful option for the treatment of cognitive impairment in Alzheimer's type dementia.

Blepharospasm is classified as a focal dystonia, and involves involuntary contraction of muscles such as the orbicularis oculi muscle and the corrugator muscle, which are associated with eyelid movement. Thus blepharospasm involves difficulties to eyelid opening. A 61-year-old woman came to our hospital complaining of a sense of discomfort of the eyes since a half year earlier. Blepharospasm was diagnosed based on current medical history and neurological examination. Oral saikokaryukotsuboreito was started and the blepharospasm improved gradually. After a week, oral treatment with one-third of the amount of shakuyakukanzoto was added and the blepharospasm further improved. The patient wanted to increase the dose of shakuyakukanzoto and to stop the saikokaryukotsuboreito. Once oral shakuyakukanzoto monotherapy was started, however, the blepharospasm worsened. Oral saikokaryukotsuboreito and low dose shakuyakukanzoto was started again, and her blepharospasm improved again.
The mechanism behind a focal dystonia such as blepharospasm is explained as a disorder of the basal ganglia motor loop. Saikokaryukotsuboreito is used for the diseases of the central nervous system. Thus there is the possibility that, here, saikokaryukotsuboreito improved a central nervous system disorder, and the blepharospasm. To our knowledge, this is the first report demonstrating that saikokaryukotsuboreito is effective for blepharospasm. It suggests that saikokaryukotsuboreito is a useful option for the treatment of blepharospasm.

We conducted a study to evaluate the efficacy of mashiningan for constipation in Parkinson's disease. Twenty-three patients with constipation in Parkinson's disease were enrolled and were evaluated after 1 month in this study. The mashiningan efficacy endpoint in the study was bowel movement frequency. We categorized treatment effect as “effective”, “ineffective”, and “worsened” to calculate increased, unchanged, and decreased bowel movement frequencies, respectively. Previously administered laxative was also switched to mashiningan and subsequent effect was evaluated as well. Mashiningan was effective in 78.3% of patients, and there were no patients determined to have “worsened”. The only adverse effect was diarrhea which was noted in 13.0% of patients. Mashiningan was effective in 86.7% of the 15 patients without laxative administration history, and was effective in 62.5% of 8 patients who had taken laxative previously. Therefore, mashiningan showed a higher degree of efficacy in the patients off medication for constipation. Additionally, mashiningan could be safely switched to from other laxatives without worsening constipation. In conclusion, mashiningan is a useful medication for the treatment of constipation in Parkinson's disease.

The purpose of this study is to develop a new system for measuring leg motions using a portable three-dimensional accelerometer. The measuring system is composed of acceleration sensors (Micro Stone, MA3-10Ac), a data logger, a data reader, and a personal computer. The personal computer draws a graph of the acceleration of movements (i.e., accelerogram) from the output signals of the acceleration sensors. We then calculated the average acceleration to evaluate leg motions. We drew the accelerograms from 19 young subjects and 36 elderly subjects during the performance of physical fitness activities and walking. Different accelerograms were obtained from two subjects for different walking styles. The average accelerations at the lumbar, ankle and toe points were higher at all axes during movements from the physical fitness activities in the elderly subjects. The accelerations of leg motion at the knee point were, however, lower in the up and down axis in the elderly subjects than in the young subjects, although they were higher in the back and forth and the right and left axes. The new instrument has enabled us to evaluate leg motions by measuring three-dimensional acceleration during the performance of physical fitness activities and walking. The average accelerations of leg motions showed age-related changes. Thus, the average acceleration of leg motions may be used as a new index for evaluating leg motions at the dynamic state.

Objectives: Among the many intervention programs for children with autism spectrum disorder (ASD), the Early Start Denver Model (ESDM) is one of the few approaches that has succeeded in demonstrating clinical efficacy in randomized control trials. Here, we investigate the clinical efficacy of ESDM intervention in young children with ASD in a community setting within Japan. Methods: All subjects were children with ASD who received ESDM intervention during the study period. Each ESDM session lasted 75 min and occurred once per week for at least 12 weeks. The outcome measures consisted of the Kyoto Scale of Psychological Development (K-test), Aberrant Behavior Checklist-Japanese version (ABC-J), and the Clinical Global Impression-Severity scale (CGI-S). Results: Twenty-seven subjects (29.4±6.4 months old) received ESDM intervention that lasted for 8.0±2.6 months on average. The score on Language and Social developmental quotient on the K-test increased significantly after the intervention. The total scores on the ABC-J and CGI-S significantly decreased after completion of the ESDM intervention. Conclusion Our results suggest that ESDM intervention could reduce the severity of distinct clinical features of ASD, such as impairments in social interaction and communication assessed by the K-test, and maladaptive behavior rated by the ABC-J and CGI-S. We believe that the ESDM adapted to each institution might become one of the standard options for children with ASD in Japan.