We report two cases successfully treated with tsumyakushigyakuto containing aconite root (uzu), instead of processed aconite root (bushi). The first case was a 33-year-old female. She had suffered from itching rashes in spite of being prescribed tsumyakushigyakuto with processed aconite root. Because she was in an extreme cold state, we changed the processed aconite root in her tsumyakushigyakuto to aconite root. Her itching rashes subsequently improved. The second case was a 42-year-old male. He had suffered from watery diarrhea and general fatigue in spite of being prescribed tsumyakushigyakuto with processed aconite root. Because he was in an extreme cold state, we changed the processed aconite root in his tsumyakushigyakuto to aconite root, and his watery diarrhea and general fatigue improved.We consider that using tsumyakushigyakuto with aconite root may be more effective than using it with processed aconite root in an extreme cold state.

We report a situation involving Kampo therapies on an isolated island and three cases treated with Kampo medicine on the island. The first author received outpatient training at the department of Japanese Oriental Medicine in Iizuka Hospital and provided medical care on the island for 3 years, using Kampo therapies.
About one quarter of patients (total, 134) were prescribed Kampo therapies in April 2009, and we surveyed the number of patients who had taken each Kampo medicine for 2 years from April of 2008 to March of 2010. As to prescriptions of less than 4 weeks, Kampo medicines used for a cold ranked high. As to prescriptions exceeding 4 weeks, hachimijiogan, daiokanzoto and keishibukuryogan were the most prescribed medications, in descending order.
We consider Kampo therapies to have been effective on this isolated island where there are many elderly people, and patients who must be treated comprehensively while giving consideration to their familial states. We also presume the environment of an isolated island to cause certain clinical conditions, water imbalances included, such that Kampo medicines for water imbalances tended to be prescribed frequently.
Finally, learning Kampo therapies has highly motivated the first author to practice community medicine.

We report a case of hot flush successfully treated with formulations for yin-syndrome. A 56-year-old female patient experienced hot sensations and sweating on her face post menopause. Her hot flush was improved slightly with kamishoyosan and ryokeijutsukanto, but her symptoms were aggravated whenever she became tired. The patient was reevaluated and her prescription was changed to hachimigan, based on symptoms related to yin-syndrome and hypofunction, and a lack of resistance at the lower abdomen with the abdominal palpation. The patient appeared to respond favorably. However, the patient was easily fatigued and her symptoms returned when she felt tired. Ninjinto was added to the prescription based on the patient's “stuck feeling in pit of the stomach”. Her hot flush resolved and she no longer became tired easily. Although the use of formulations for yang-syndrome are known to be useful for the treatment of hot flush, formulations for yin-syndrome may be effective for the treatment of hot flush depending on the state of the patient.

We report two cases successfully treated with tsumyakushigyakuto containing aconite root (uzu), instead of processed aconite root (bushi). The first case was a 33-year-old female. She had suffered from itching rashes in spite of being prescribed tsumyakushigyakuto with processed aconite root. Because she was in an extreme cold state, we changed the processed aconite root in her tsumyakushigyakuto to aconite root. Her itching rashes subsequently improved. The second case was a 42-year-old male. He had suffered from watery diarrhea and general fatigue in spite of being prescribed tsumyakushigyakuto with processed aconite root. Because he was in an extreme cold state, we changed the processed aconite root in his tsumyakushigyakuto to aconite root, and his watery diarrhea and general fatigue improved.
We consider that using tsumyakushigyakuto with aconite root may be more effective than using it with processed aconite root in an extreme cold state.

Shohangekabukuryoto, an herbal mixture, was administered to 15 patients with postnasal drip. Ten patients responded to this therapy and 5 failed to respond to it. Subjective symptoms and objective findings were analyzed and compared between the responders and nonresponders. Nausea was not observed in any patient. In the responders, watery rhinorrhea and shinsuion was often noted. Patients showing viscous rhinorrhea without shinsuion were considered nonresponders. These results suggest that shohangekabukuryoto is an herbal mixture that may be used for treating patients with postnasal watery rhinorrhea accompanied by shinsuion, despite the absence of evident nausea.

We report a 68 year-old woman being treated for anorexia. Despite our treatment, her body weight decreased to 22 kg and she was admitted to our hospital ER for Wernicke's encephalopathy and a hypoglycemic attack, which both occurred on January 21 st. She experienced respiratory failure and was placed on a respirator. On March 24 th she developed a fever due to a respiratory tract infection, and antibiotics and keishinieppiichito were administered.
On March 26 th she again developed a fever. One tenth of the normal daily dose of daisaikotokabosho was administered successfully. However, she had a fever again on March 31 st. The following day, one tenth of the normal daily dose of daiaikotokabosho was administered successfully. The formula was continued and the fever disappeared after April 3rd.
Whether the base formula of saikokaboshoto is daisaikoto or shosaikoto remains controversial. Our case was suspected of rinetsu, excessive pathogenic heating of the interior body, and her abdominal symptoms indicated daisaikoto. Therefore daisaikotokabosho, which is closely related to yomeibyo as a shoyobyo, was administered effectively.
This case suggests that a grossly underweight patient, in whom hypo function or yin condition would usually be seen, has the potential to change to hyper function or a yang condition. In such a case, dose adjustment for physical size and body energy is necessary.

We report 5 patients with polymyalgia rheumatica (PMR) successfully treated with Kampo medicines. In total, we investigated 10 patients with PMR, including the 5 patients here treated in our department. Results showed that Kampo medicine was effective in 6 cases. One of the 6 refused steroid drug administration, and tapering dosage steroid was difficult in the other 5 patients due to myalgia or inflammation. Except for one case, C-reactive protein in most of the effective cases was below 3.0 mg/dl. On the other hand, the non-effective cases had severe inflammation levels and needed steroid therapy. The effective cases were treated with sokeikakketsuto, tokakujokito, keishibukuryogan, choyotokasyakuyaku, yokuibushihaishosan and tokishakuyakusan, which have the effect of improving oketsu states. Thus, it was considered that Kampo medicine has the potential for treatments in PMR patients who have difficulty tapering steroid dosage and mild inflammation. Moreover, this suggests Kampo medicines that improve oketsu state are useful for PMR treatment.

We report a case of intractable diarrhea successfully treated with daikenchuto. The patient was a 60-year-old female. She had suffered from diarrhea in spite of being prescribed Shimbuto, Kanzoshashinto, Shigyakuto and so on. After daikenchuto was administered her intractable diarrhea improved. However, she had not symptoms such as abdominal pain, coldness in the abdomen and abdominal movement disorder that often appear in daikenchuto-syo. We consider daikenchuto may be effective not only for diarrhea but also constipation in yin-syndrome and hypofunction when intestinal juice and gas are stagnated.

We encountered 2 cases of vomiting that were successfully treated with daisaikoto. In case1, the patient was a 16-year-old girl. She was vomiting in the hospital with pneumonia. Referring to the vomiting and kyokyo-kuman (Subchondrial resistance and discomfort), vomiting gradually disappeared after administration of daisaikoto. In case 2, the patient was a 73-year-old woman. After aspiration pneumonia, she developed nausea and vomiting and experienced constipation and kyokyo-kuman. The nausea and vomiting gradually disappeared after the administration of daisaikoto. These findings suggested that daisaikoto, in combination with a large amount of Zingiberis Rhizoma on classic text, suppresses nausea.

We encountered 4 cases of calf cramps in which the herbal mixture shakuyakukanzoto was ineffective but another herbal mixture sokeikakketsuto was effective. In case 1, the patient was a 73-year-old man. He had a history of calf cramps, and started experiencing calf cramps more frequently about1month before he made his first visit to our department. Shakuyakukanzoto (7.5g/day) was initially prescribed, but the frequency of cramps did not change. Then, shakuyakukanzoto was replaced with sokeikakketsuto (7.5g/day), and this resulted in rapid alleviation of the symptom. In case 2, the patient was a 67-year-old woman undergoing outpatient care for shoulder stiffness, low back pain, etc. She started experiencing calf cramps at night and underwent shakuyakukanzoto (7.5g/day) treatment. The frequency of cramps did not change, and hence, shakuyakukanzoto was replaced with sokeikakketsuto (2.5g at bedtime). The symptom was alleviated in response to this therapy. In case 3, the patient was a 66-year-old woman undergoing treatment for low back pain at our department. She experienced calf cramps and was treated with shakuyakukanzobushito (3.0g/day). The response was poor, and the herbal mixture was replaced with sokeikakketsuto (7.5g/day), which resulted in the disappearance of her cramps. In case 4, the patient was a 75-year-old man undergoing treatment for a cold sensation in the left leg. He experienced calf cramps and was treated with shakuyakukanzobushito (1.5g/day). This therapy resulted in only temporary relief from the symptom. After the herbal mixture was replaced with sokeikakketsuto (2.5g/day), the cramps disappeared rapidly. Thus, sokeikakketsuto, which improves blood flow and is thought to manifest analgesic effects, may be used for treating patients with calf cramps who do not respond to shakuyakukanzoto.