A 56-year-old woman visited our hospital with a persistent fever of 38 °C. Chest radiography and plain computed tomography (CT) showed scattered infiltrative shadows in both lung fields. She was diagnosed as having pneumonia and received antimicrobial therapy. Subsequently, the pneumonia was improved and defervescence was observed. Although pneumonia appeared 1 and 5 months later, antimicrobial therapy again recovered the patient's condition. At that point, we noticed from the patient's medical history that she had developed pneumonia 2—3 times a year over the past 4 years. Therefore, we prescribed low-dose macrolide therapy and an expectorant as prophylactic treatment. However, she developed pneumonia again after 4 months, but recovered with antibiotics.
Jiinshihoto was administered, because the pneumonia repeated over short periods. Subsequently, no pneumonia developed during the 1.5 years following Jiinshihoto administration. In Japan's aging society, death due to pneumonia has increased and will increase. In many patients, antimicrobial therapy alone results in recurrent pneumonia despite of temporary improvement. Furthermore, because it is important to prevent the development of pneumonia, this case is considered of value in Japan, as Jiinshihoto proved effective in preventing recurrent pneumonia.

We report a case of acute chronic obstructive pulmonary disease (COPD) exacerbation caused by bacterial pneumonia infection, which was successfully resolved using saikokeishito. An 86-year-old woman with COPD presented with fever. Chest radiography and computed tomography (CT) confirmed bacterial pneumonia and she was admitted. Antibiotic therapy was started, but it had to be discontinued shortly thereafter because the patient developed drug rash. Oral saikokeishito was administered, as an alternative medicine, after which the patient showed dynamic improvements in pneumonia, and other general complaints such as respiratory dysfunction, fever, delirium, and appetite loss.
Saikokeishito is known to trigger various biomedical effects such as stimulation of anti-inflammatory and antipsychotic functions and autoimmune regulation.
Although antibiotic therapy is, without doubt, the most efficient treatment for acute bacterial pneumonia, in cases where antibiotic treatment is not possible, Kampo therapy may be used as an alternative treatment method for improving the condition and other complaints.
In future, more sequential case reports showing the use of Kampo therapy in acute respiratory medicine would be necessary to establish conclusive evidence for the use of this therapy as an alternative treatment method.

We experienced a refractory case of respiratory failure with CO2 narcosis after respiratory tract infection successfully treated with daikenchuto, ninjinyoeito, and bushimatsu. The patient was an 88-year-old woman with pulmonary tuberculosis sequelae and chronic obstructive pulmonary disease for which she had been receiving tiotropium, a budesonide inhalation suspension, and tulobuterol patches. She developed a fever and persistent dyspnea and was taken to our hospital by ambulance. Initially, artificial respiration was recommended because she had CO2 narcosis, but this intervention was rejected because of her advanced age. She showed persistent dyspnea and mild consciousness disturbance. Therefore, treatments by daikenchuto, ninjinyoeito, and bushimatsu were gradually introduced. As a result, her dyspnea, constipation, anorexia, and decreased consciousness improved, and the CO2 concentrations in arterial blood decreased with normalization of pH level. Artificial respiration management is the first-choice treatment for aggravated chronic respiratory failure with CO2 narcosis. However, when such medical management is not feasible, as in the present case, Kampo medicines may contribute to alleviating symptoms of respiratory failure.