We report the successful repair of left main coronary artery obstruction with aortitis syndrome. She was a 39-year-old woman and was admitted to Saiseikai Kumamoto Hospital because of angina pectoris. Her bilateral radial artery pulsation was not palpable. Total occlusion of the left main coronary artery (LMT) and bilateral subclavian artery was detected by angiography. Patch enlargement of the LMT was performed using a Distaflo (Impra Carbon PTFE) graft. Postoperative coronary angiography showed an adequate LMT diameter and sufficient blood flow.

A 68-year-old woman was referred to our hospital with arrhythmia and cardiomegaly. She lost consciousness in the waiting room. After urgent hospitalization, cardiac ultrasonography showed cardiac tamponade, and urgent pericardial drainage was performed. A ruptured coronary aneurysm with a fistulous communication was diagnosed by CT scan and coronary angiography. Under extracorporeal circulation, ligation of the unusual coronary vessels and resection of the aneurysm were performed. The postoperative course was uneventful and she was discharged on the 25th postoperative day. No ischemic signs were observed on treadmill test at one year after surgery. Most congenital coronary aneurysms are asymptomatic; however, once rupture occurs, it is important to diagnose this condition rapidly and treat surgically.

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.