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 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.

Most obstetricians rarely encounter a case of placenta accrete, where the placenta does not detach after childbirth. If placenta accrete attachment is deep, it is likely to lead to poor prognoses such as massive bleeding and shock. With western medicine, it is currently accepted that the only medical intervention is doing a simple total hysterectomy. Our patient was a 27 year old, primiparous Japanese woman. Signs of placental separation were not seen after birth, and conservative medical management for also ended up failing. This was then diagnosed as placenta accrete via sonography and an MRI, and simple total hysterectomy was recommended. She hoped to keep her uterus, however, and she was prescribed tokakujokito Kampo therapy. Her postpartum period passed without abnormality, and the placenta, which had remained intact to the 50 th day after birth, was removed. There is not literature on Kampo therapy as it applies to placenta accrete, and we believe this case to be the first valuable report.

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.

Few reports have described the effect of phlegm-­fluid retention on the development of pain. We herein rep­ort two successful treatment cases of lower leg pain using chikujountanto in consideration of phlegm-­fluid re­tention. Case 1 (a 63-year-old woman) complained dull pain in the right calf. The pain persisted despite the ad­ministration of sokeikakketsuto for over two weeks. Case 2 (a 42-year-old woman) suffered from right buttock pain that had developed after a traffic accident. The pain persisted even at three months following the accident. The pain in both patients resolved within one week after treatment with chikujountanto, which was given on the basis of the patients' insomnia, thickened yellow fur on the tongue, and pain in the gallbladder meridian. We concluded that the concept of phlegm-­fluid retention should be considered for differential diagnosis when we treat pain.

There are cases of finger pain in which a definite diagnosis including rheumatoid arthritis cannot be made even after thorough examinations. We herein report the results of Kampo treatment in such cases with so called undifferentiated arthritis. Sixty­-two patients (male, n = 5 ; female, n = 57 ;average age, 49.7 years) were included in the present study. There is a tendency of the Kampo concept of a cold pattern (n = 39 ; 63%), static blood (oketsu, n = 47;76%), and qi stagnation (n = 44 ;71%). Among the 62 cases, excellent results were ob­tained in 29 cases (47%), good results were obtained in 10 cases (16%), and no effect was obtained in 23 cases (37%). Kamishoyosan, which was administered in 30 cases, was the most commonly used Kampo medicine. In most cases, Kampo treatment was given with a combination of two or more formulas. A paired formula of kamishoyosan and keishikaryojutsubuto was used in 9 cases, 8 of which showed good or excellent results (efficacy rate : 89%). Qi- and/or ketsu-­tonifying formulations and formulations with warming effects were often used for the treatment of undifferentiated finger arthritis.

The main symptoms of fibromyalgia are systemic pain and fatigue. The pharmacological treatments are usually performed for fibromyalgia in Western medicine. However, in some cases, pain that impairs everyday life continues even after medical treatment. We herein report a case in which fibromyalgia was successfully treated using jumizasan. The patient was a 28-year-old woman. Prior to admission to the author's clinic, she had complained of dull pain in the left upper arm for 4 years, and the pain had spread throughout the body for 2 years. Various other symptoms including fatigue, headache, heart palpitation, and shortness of breath coexisted. The pain resolved within 3 months after the initiation of treatment with jumizasan (a Japanese herbal medicine decoction), which was given based on pallid complexion, skin drying, strong upper arm pain, and walking difficulty. We concluded that jumizasan may be considered to be used for patients with blood deficiency, upper arm pain, and walking difficulty in Kampo concept of treatment.

We herein report the successful treatment of three elderly patients in an orthopedic clinic who were successfully treated using the Kampo formula of rokumigan and shimotsuto. The first patient was a 69-year-old woman with rheumatoid arthritis who complained of subjective coldness in her feet. The second patient was a 79-year-old man with lumbar spinal stenosis who presented with pain and paresthesia of his lower extremities, which aggravated by walking. The third patient was an 80-year-old man who complained of ambulatory pain in the body trunk and lower limbs, which had started more than ten years previously. The symptoms of these three patients resolved after the initiation of treatment with rokumigan and shimotsuto (a Japanese herbal medicine), which was given based on dry mouth, frequent urination, flushed face, insomnia, and skin drying. Tokaku Wada (a Kampo doctor in the Edo period) stated in the classical text “Shosohoikai” that the conditions of kekkyo (blood deficiency) and jinkyo (kidney deficiency) often exist together. We concluded that rokumigan and shimotsuto may be considered for patients presenting with the Kampo concept of kekkyo and jinkyo, even if they have different diagnoses under Western medicine.

It is thought that meirouin was created by Toukaku Wada, originally. Although prescriptions were applied for ophthalmologic disease at first, such case reports have decreased recently. Here, we report that meirouinkakikuka was successful for serous retinal detachment complicated with an abnormal visual field during postpartum.
We present the case of a 34 year old Japanese woman. Tinnitus had appeared from 35 weeks of pregnancy. Blood pressure rose to 140/100 mmHg at 36 weeks of pregnancy, the patient was diagnosed with preeclampsia,and hospitalized. After hospitalization, blood pressure was rose further to 190/120 mmHg, and an emergency cesarean section was performed. On the 2 nd postpartum (post operation) day her field of view became yellowed and eyesight failure arose. She was diagnosed as hypertensive retinopathy and serous retinal detachment by an ophthalmologist. She stopped applying her eyewash treatment herself because she was feeling unwell. One week afterward, she desired Kampo treatments. Meirouinkakikuka was prescribed, the tinnitus disappeared in 2 weeks, furthermore, her retinal detachment was recovered from 4 weeks later. Thus we believe that Kampo treatments can be a viable alternative, as suggested by this case where application of an eyewash treatment was difficult.