In the previous article, the author reported on the relationship between shinkahiko and transport points. However, acupuncture manipulation to these points never diminished fullness in the chest and hypochondrium (kyokyokuman). Thus the author searched a new lump of back muscles and finally discovered that the infraspinatus muscle is a critical point which is closely rerated with kyokyokuman. The author also discovered that this point improves hiccup. It is well known that this lump is present in patients with shoulder stiffness and so on. Some patients with kyokyokuman present this lump simultaneously. This report intends to clarify a kyokyokuman that appears related tense condition of diaphragm, by means of both two concrete clinical cases and fifteen cases discussing to the pathophysiological background of this phenomenon.

[Background] Although we have demonstrated the clinical effect of acupuncture therapy with epidermal stimulation by needle penetration, its neurophysiological mechanisms are unclear. To investigate the clinical effects of epidermal stimulation by needle penetration on muscle tone, we tested the Hoffmann's reflex (Hreflex) of the soleus muscle during epidermal needle stimulation.
[Methods] Eighteen healthy participants were recruited. We tested the soleus H-reflex elicited by tibial nerve stimulation before and after epidermal stimulation by needle penetration. Epidermal stimulation was performed at several points on the Achilles tendon by needle penetration. We analyzed the amplitude ratio of H/M obtained from the waveforms of the soleus muscle before and after epidermal stimulation.
[Results] The amplitude ratio of H/M was significantly decreased during stimulation when compared with ratio during rest (p < 0.05). Each participant demonstrated a decrease in soleus muscle amplitude ratio of H/M during epidermal stimulation by needle penetration as compared with the ratio during rest.
[Discussion] Epidermal stimulation of the muscle by needle penetration activated the inhibitory interneurons of the dermatome at the stimulation site. Therefore, epidermal stimulation by needle penetration was considered as a possible method to induce muscle relaxation.
[Conclusion] It is suggested that epidermal stimulation by needle penetration for 2 minutes for the insertion of the Achilles tendon results in an inhibitory effect by stimulating the spinal cord neural mechanisms that correspond to the soleus muscle.

In this report, we describe three hemodialysis patients with carpal tunnel syndrome (CTS) that were successfully treated with Goshakusan, one of the well-known traditional Japanese herbal (Kampo) medicines.
Case 1 was a 77-year-old woman suffering from sleep disorder due to night pain in the bilateral forearms. Case 2 was a 66-year-old woman complaining of sleep disorder due to lancinating pain in right upper and lower limb. They had undergone surgical decompression procedures for CTS several times in the bilateral forearms. However, they still needed a periodical injection of glucocorticoid into the region of carpal tunnel for the relief from pain. Case 3 was a 54-year-old man, who has been suffering from the recurrence of numbness of the left fingers since surgical treatment for CTS.
We diagnosed that the symptom of CTS in those three patients may be due to kan-shitsu (damp-cold or interior cold with dampness), because all of them were anuric hemodialysis patients, who tend to easily acquire phlegm and dampness, and their symptom was partially relieved by warming the forearm and fingers. Therefore, they were prescribed an oral goshakusan extract formula to remove kan-shitsu. Soon after they started taking the formula, the intensity of their pain or numbness markedly decreased. Taken together, our report suggests that it is worth trying to remove kan-shitsu by Kampo medicines for the conservative treatment of CTS.

A 48-year-old woman started to have dizziness after experiencing an earthquake. Her clinical signs improved with the use of shimbuto that was prescribed based on her symptom of yin-syndrome and hypofunction. At the same time, there was a decrease in reading errors with her finger, in a vein authentication device. One of the common reading errors that the security system makes is due to a change in blood flow due to vasoconstriction caused by low temperature. It is speculated that the use of a warming formula increased peripheral blood circulation, which contributed to the improvement of vein authentication.

Shichimotsukokato is composed of shimotsuto with chotoko, ogi, obaku, and this formula has been frequently used for the treatment of hypertension, eye-fundal hemorrhage and headaches. Here we describe three cases of chronic dermatitis with hypertension and dry skin of legs, which were successfully treated with shichimotsukokato. Case 1 was a 67-year-old man whose chief complaint was pruritus and skin eruption on his chest. He also had dry skin accompanied with pruritus on his legs, and hypertension. Case 2 was a 59-year-old man who had skin eruption accompanied with pruritus on his trunk and extremities. He also showed diastolic hypertension and renal insufficiency due to the side effect of an immunosuppressant. Case 3 was a 64-year-old man who had dry skin with eruption on the upper trunk. Furthermore, his blood pressure fluctuated within the high normal range. After medication with shichimotsukokato, both the hypertension and dermatitis improved in all three cases.
According to these observations, shichimotsukokato may alleviate dermatitis along with dry skin of legs and hypertension, and it may be worth noting that shichimotsukokato is an option for the treatment of skin lesion.

Ryokito is a Kampo formulation which has been administered for right upper quadrant pain since the Edo Era in Japan. Yet there are but a few reported cases in multiple clinical exams at one institution, on the usage of this formulation. We undertook a precise retrospective analysis of ryokito-prescribed cases at our institute over ten years, and reported cases published in the past to illuminate the clinical characteristics of ryokito effective cases.
Among the 21 cases at our institute, ryokito was effective in 11 cases and 10 of these 11 cases had right upper quadrant pain. Additionally, 7 of them reported abdominal distention.
Overall, this retrospective analysis revealed that amongst those ryokito effective cases, not a few patients had the right upper quadrant pain. This fact suggests that right upper quadrant pain is a reasonable characteristic for a usage of ryokito.
Likewise, abdominal distention was also a common symptom among the effective cases. It is likely that abdominal distention could be a characteristic for a usage of ryokito as well.

Typically, Japanese Kampo doctors use formulas classified for treating blood stasis, to treat pain. However,there have been few reported cases where pain was treated with formulas classified for treating qi stagnation. Here, we report a case of right lateral epicondylitis in a 48-year-old woman who was treated with a focus on qi stagnation and with uyakujunkisan. She underwent conservative treatment at an orthopedic clinic for ten months, but her pain was not relieved. Hence, she opted for Kampo treatment. She was in a state of melancholy, felt heaviness throughout her body, and had irregular menstruation. These symptoms were mainly related to qi stagnation, and hence, we chose uyakujunkisan without white silkworm, but with aconite root. One month later, the stiffness in her shoulder improved and the pain was reduced. Magnetic resonance imaging taken 2 months later showed an improvement in the lesion. Nine months later, her menstruation became regular, and 11 months later, the pain had almost completely resolved and she could comfortably perform activities of daily living. Uyakujunkisan is introduced in the classical textbooks, and we interpret uyakujunkisan as a formula that can treat pain with qi stagnation. In Kampo treatment, effective pain treatment involves consideration of not only local blood stasis but also general qi stagnation.

A patient with intractable glossalgia was successfully treated with a combination of three Kampo medicines : orengedokuto, bukuryoin, and kososan extracts. Then, 3 more patients with glossalgia were administered similar treatment based on the experience of the first case. The clinical features of these four patients and the efficacy of the combination Kampo treatment are reported herein.
A 61-year-old man with a 3-year history of glossalgia had been treated with psychopharmaceuticals for 4 months at another hospital, without any relief from symptoms. Upon referral to this Kampo clinic, the patient was treated with goreisan extract, daisaikoto extract, or other Kampo medicines, but these medicines were not effective. The prescription was then changed to a combination of orengedokuto, nichinto, and kososan extracts, which ameliorated the glossalgia symptoms almost by half. Furthermore, the glossalgia improved completely after the nichinto extract in the Kampo combination was replaced with bukuryoin extract.
After successful treatment of the first patient, three other patients were treated with the same Kampo combination. Two patients showed improvement within 2 weeks, but the combination treatment was ineffective in the other patient, whose symptoms finally improved with a zinc supplementation from Polaprezinc. The clinical features of the patients with good outcome were generally characterized by a combination of symptoms such as glossalgia, tendency toward depression, and digestive symptoms.
The combination treatment was prescribed as a substitute for seinetsugeutsuto decoction, and it was effective in three of the four patients with glossalgia. These results indicate that the combination treatment could be a candidate medicine to treat glossalgia.

We report a case of somnambulism successfully treated with sansoninto. A 55-year-old woman had an initial episode of somnambulism in childhood, which recurred in her early 20s along with development of psychotic manifestations. The patient was hospitalized in a psychiatric hospital with a diagnosis of schizoaffective disorder and coexisting Crohn's disease. At the age of 55, she began to show nocturnal wandering tendencies and we prescribed yokukansan at 2.5 g/day, though the symptoms only temporarily improved. Following a switch to sansoninto at 7.5 g/day, the symptoms disappeared. Based on our experience with this case, we speculate that the Heart component of the five viscera theory in traditional Chinese medicine plays a key role in somnambulism.

Recently, basophil activation test (BAT) has been applied to the diagnosis of drug allergy. We performed BAT for various Kampo medicines taken by 12 cooperators to evaluate the concentration which arouse nonspecific reaction during incubation in BAT. When whole blood of each was incubated for 24 hours with each Kampo medicine, false positive results were frequently observed. After 1-hour incubation with Kampo medicine at high concentration (1/312.5), false positive results were sometimes observed. These results suggest that in the diagnosis of Kampo-medicine adverse reactions, BAT should be performed in the condition of 1-hour incubation with lower concentration (1/1250 or lower).