The positional relation between the point Jingei and the bifurcation of the common carotid artery was investigated with dissection of the neck after inserting a needle into the bilateral Jingei, using nineteen Japanese cadavers. We determined first the position of the point Futotsu as a point in the sternocleidomastoid lying about 10cm lateral to the laryngeal prominence along the neck wrinkle, and defined the location of Jingei in the cadavers as the mid-point between the laryngeal prominence and Futotsu mentioned above. The common carotid artery shows a dilatation, termed the carotid sinus, at its point of division into the external and internal carotid arteries. The needle did not prick the carotid sinus in all of the thirty-eight cases of insertion; it pricked the common carotid artery at a lower level than the carotid sinus in four of these cases, and in the other cases the needle did not prick the vessel, but rather a portion of the neck medial to the vessel at the lower level, similarly as in the former cases. The points of division of the common carotid arteries of the cadavers dissected were all located at a considerably higher level than the laryngeal prominence; the average level was 32.8mm higher than the prominence on the left, with maximum and minimum values of 52 and 11mm, respectively, and 29.9mm upper on the right (maximum and minimum values: 45 and 8mm). Furthermore, it was suggested that the insertion of a needle at the level of the hyoid bone has a higher possibility of reaching the carotid sinus than that at the level of the laryngeal prominence in acupuncture of the sinus.

We report two cases of older heart failure (HF) patients who improved pulmonary congestion and maintained functional capacity with tokishakuyakusan. Case 1 was an 83-year-old woman who previously treated with percutaneous coronary intervention for angina and had multiple comorbidities such as chronic kidney disease and rheumatoid arthritis. Despite of multiple medications including 3 kinds of diuretics, general fatigue that interferes with her daily life, marked pulmonary congestion, and leg edema remained. After prescription of tokishakuyakusan, urine volume increased rapidly and HF symptoms were alleviated so that 2 diuretics were successfully discontinued. Case 2 was an 88-year-old man with chronic atrial fibrillation and severe mitral regurgitation with worsening dyspnea on effort, paroxysmal nocturnal dyspnea, and leg edema. Tokishakuyakusan was effective for improving these HF symptoms and he returned to normal life without additional HF treatment. For elderly HF patients, tokishakuyakusan is considered to be effective to improve blood deficiency/stasis pattern and fluid retention, which enables these patients to make their daily life without being disturbed by severe HF symptoms.