When female patients with skin disorders become pregnant, the treatments with the previously used antiallergic oral drugs are preferred to be switched to the treatments with external medicines alone, which often make patients experience unbearable itching and exacerbation of rashes. The use of tokishakuyakusan is known to be safe and improve various symptoms in the pregnancy period. In this report, the treatment of 4 patients with skin disorders were successfully switched to tokishakuyakusan alone from previously used antiallergic internal medicines and other traditional Japanese herbal medicines after pregnancy. Case 1 and 2 were patients with atopic dermatitis who had been treated only with the external medicine during a previous pregnancy but without amelioration. Case 3 was a patient with prurigo gestations who had rashes on the upper body trunk and complained of a strong itching sensation. Case 4 was a patient with acne vulgaris. In all cases, the rashes and itching sensation improved promptly with oral administration of tokishakuyakusan, followed by successful delivery. No side effects of gastrointestinal disorders were observed in any cases. Their skin disorders were speculated to be caused by the blood deficiency and stasis. Qi deficiency and fluid disturbance developed in association with pregnancy, which led to Yin deficiency and abundance of moisture. The positive responses of these conditions indicated that tokishakuyakusan was effective in the cases reported herein.

Chi-no-michi-sho involves neuropsychiatric and physical symptoms that appear with hormonal changes, such as those during pregnancy and menopause. Until now, there were many case reports, which were within 2 years from the start of treatment. We present a case of chi-no-michi-sho that was successfully treated with Kampo formulations for 7 years. A 43-­year-­old woman had complaints of candida eczema in the vulva, palpi­tations, and headache. Tokishakuyakusan and shakanzoto were then administered for kekkyo (blood defi­ciency), oketsu (blood stasis), and suidoku (fluid retention), and a topical antifungal agent was administered for candida eczema. The headache and palpitations were reduced. Subsequently, tokishigyakukagoshuyuto and keishibukuryogan were administered because of skin rash and deterioration of sensitivity to cold. However, various symptoms, such as weight loss amenorrhea due to self-­determination, eczema, feeling heavy in the head, and edema, remained. We prescribed tokishakuyakusan again in addition to Western medical treatment. Her menstruation then resumed ; her eczema, palpitations, and headache also improved. However, she developed hyperthyroidism. While paying attention to organic diseases such as thyroid dysfunction, prescription of tokishakuyakusan may be effective when chi-no-michi-sho is long­-lasting and there are blood deficiency and stasis with fluid retention.

Although the descriptions of shigyakukachotanto in “Waitaimiyaofang” and tsumyakushigyakukachotanjuto in “Songban Shanghanlun” are quite similar to each other, the specifications of the dosages of crude drugs and the water volume in the books were considerably different. Focused on the specified water volume to decoct these formulas, each reasonable decocting period was estimated, then the decoctions were prepared using hard water that was common in mainland China. The dosages of aconite root were 2­-fold different between these two formulas, but the contents of aconitine-­type diester alkaloids (ADA) in both decoctions were found in the range of 1.2—1.4­-fold. It was suggested that in order to control the efficacy and the safety of aconite, the decocting period was well regulated by the specification of water volume for decocting at this ancient era. Moreover, the dosages of aconite root and glycyrrhiza in bukuryoshigyakuto (BSGT) formula of “Songban Shanghanlun” are equal to those of shigyakuto (SGT) but the specified water volume to begin decocting is as about twice as that of SGT. When prepared using hard water, BSGT resulted to make the contents of ADA lower and those of non-­ester alkaloids higher compared with those of SGT decoction. It was suggested the spe­cific water volume for each formula prescribed in classical Chinese medicine had considerable significance to determine the dosages of chemical ingredients in the decoctions especially in the circumstances using hard water to prepare them.