The patient was a 49-year-old woman. She developed retroperitonitis and retroperitoneal emphysema due to iatrogenic duodenal perforation. We inserted a nasogastric tube into her stomach in order to decompress the gastrointestinal tract, and cefoperazone and proton pump inhibitors were administered intravenously. Her symptoms of retroperitonitis were then reduced. However, she developed enteritis suspected due to MRSA infection complicated by acute respiratory distress syndrome, acute renal failure and shock. We administered vancomycin via nasogastric tube, but her symptoms did not improve, so we added shojokito. She relieved her bowels after the administration of shojokito, and an antipyretic tendency was observed. Her breathing status recovered to normal, her blood pressure was stable, and her general condition gradually improved.
In recent years, we have not had many opportunities to perform Kampo treatment for severe infection cases needing hospitalization, but Kampo application has the potential to enhance the efficacy of infection treatments. Thus we advocate the active carrying out of Kampo treatment for patients with intestinal infection.

Kyokatsushoshitsuto is a Kampo formulation used against cervix pain so severe that the neck cannot be turned. Of six patients we treated with this formula, it was effective in three cases but ineffective in the remaining three. From the viewpoint of traditional Chinese medicine (Kampo) regarding the in/effectiveness of this formula : in effective cases, palpitations in the area of the navel and tooth marks on the tongue are seen in patients in a weak state. As for subjective symptoms : in effective cases, “the waist area around the body sometimes feels cold”, “air conditioning is disliked”, and “an electric blanket etc. is needed in winter” were also indicative signs. On the other hand, symptoms such as “the skin becomes dry”, “water may accumulate in a joint”, and “symptoms of clicking/pain in the knee and having difficulty sitting straight” were not seen. In total, these may serve as useful indications for the application of kyokatsushoshitsuto, especially when palpitations in the navel area are considered a helpful new Kampo finding.

We report two cases of inchinkoto treatment for obstructive jaundice via autoimmune pancreatitis (AIP). Case 1 : A 38-year-old male. After completion of treatment for Mikulicz disease, obstructive jaundice developed. A diagnosis of AIP was based on a high IgG 4 blood level and image views. T-Bil stayed above 20 mg/dl and there was no improvement by oral administration of prednisolone (PSL), ursodeoxycholic acid, or bilirubin adsorption therapy. Upon inchinkoto administration, T-Bil promptly fell to 3 mg/dL. Case 2 : A 77-year-old male. He suffered from itching and constipation, and blood data showed a pattern of obstructive jaundice. Image views suggested AIP, but a duodenal papillary biopsy could not provide a definitive diagnosis. Inchinkoto was administered, and the itching and constipation had mostly disappeared within 1 week. However, these symptoms recurred after one month. A definitive diagnosis of AIP was then reached based on a pancreas biopsy, and a PSL regimen was initiated. From these two cases, we consider that inchinkoto is useful for improving the symptoms of obstructive jaundice induced by AIP.

A 66-year-old woman presented with a choking feeling in her throat. She was hospitalized three times and started nasogastric tube feeding one year before. She was diagnosed as somatic hallucination by a psychiatrist and started antipsychotic medication. She was admitted to our department in September due to worsening of choking sensation. Her body weight was 29 kg, and she was significantly lethargic and undernourished, and had difficulty in moving, parkinsonism, cognitive dysfunction, and apathy. She was considered to be in late yin stage pattern and started on tsumyakushigyakuto, which enabled her to walk with a walker, but her choking sensation did not improve. Two days after the conversion to yokukansankachimpihange, her speech and smile increased, and her motivation improved. After the switch to the extract of yokukansankachimpihange, the fullness and discomfort in left chest and hypochondrium disappeared, and she was able to take jelly and walk by herself. She was transferred to other hospital in January of the following year. Three months after the transfer, she was able to take enteral nutrition by herself and her weight increased to 37 kg. Eight months later after the transfer, she was able to take solid food orally and her weight increased to 41.5 kg. Yokukansankachimpihange may be useful for treating the patients with somatic hallucination and apathy.

Uzushakusekishigan is a Kampo formula described in ‘Jin Gui Yao Lue' for treatment of “heart pain that spreads out to the back, or back pain that spreads to the heart.” We successfully treated three patients with this formula. Patient 1 was a 53-year-old man suffering from precordial pain which occurred after amputation of the right forearm;patient 2 was a 46-year-old man with epigastralgia that occurred after taking cold meals;and patient 3 was a 28-year-old woman suffering from epigastralgia accompanied with panic disorder. Epigastric discomfort and resistance occurred in all three cases, prompting us to prescribe this formula. There are few reports of successful application of uzushakusekishigan, and it is not clear what symptoms and pathologies are relevant when prescribing this formula. However, our findings strongly suggest that uzushakusekishigan should be considered when treating severe chest or abdominal pain.

We report a case of panic disorder treated with keishikyokeikabukuryobyakujutsuto. The patient was a 42-year-old woman who had one or two episodes of panic attacks every month for 1 year accompanied by dyspnea, fear, rigidity of hands, etc. The episodes were more frequent with physical exertion and menstruation and did not improve with kamishoyosan or kanbakutaisoto. Then, after a car accident, she had a panic attack with a stronger intensity. Blood and imaging examinations revealed no special findings, and we diagnosed her with panic disorder. We considered her complaint as Honton disease and administered ryokeikansoto. After 2 weeks, her mental condition improved, and dyspnea and fear of attacks relieved. After 2 months, office work became more strenuous, and attacks recurred once or twice a week. An abnormal sensation of the posterior cervix occurred as a prodrome of an attack, and simultaneously, she noticed neck stiffness. After switching to keishikyokeikabukuryobyakujutsuto, the cervical sensation disappeared, neck pain and neck stiffness were relieved, and the attacks did not reappear. This case suggested that keishikyokeikabukuryobyakujutsuto was useful for the prevention of panic attacks associated with neck stiffness.

An eight-year-old girl was referred and admitted to our hospital with the chief complaint of purpura on her lower legs. Blood tests revealed pancytopenia, and bone marrow findings showed marrow hypoplasia. Refractory cytopenia of childhood (RCC) was diagnosed based on the central diagnostic system of the Myelodysplastic Syndrome Committee of the Japanese Society of Pediatric Hematology. Immunosuppressive therapy was performed with the administration of rabbit antithymocyte globulin, methylprednisolone and cyclosporin A,but it was not effective. Eight months after admission to our hospital, Kampo treatment was started based on traditional Kampo diagnosis. After treatment with oral administration of kamikihito and kyukikyogaito, her pancytopenia gradually improved. Erythrocyte transfusion was discontinued after 2 months, and concentrated platelet transfusion also became unnecessary after 3 months. As a result of improvement in pancytopenia, her white blood cell count, hemoglobin value, and platelet count reached almost normal levels after 16 months. The scheduled bone marrow transplantation was canceled. The action mechanisms of kamikihito and kyukikyogaito for RCC are not clear, and their effective rates are also unknown. However, Kampo treatments are less invasive, inexpensive, and have few side effects. We believe that Kampo medicine is a therapeutic method that should be actively attempted in cases of RCC with poor response to standard treatment.