Thalamic pain is an intractable central pain caused by thalamic hemorrhage and infarction. Unfortunately, there is no established method for its treatment. We report five cases of thalamic pain effectively treated with keishikaryukotsuboreito. Case 1 was a 63-year-old man who complained of pain in the right side of his body for three years after thalamic infarction. Case 2 was a 68-year-old-man who complained of pain in the right side of his body for 13 years after left thalamic hemorrhage. Case 3 was a 74-year-old woman who complained of left limb pain for three years after right thalamic hemorrhage. Case 4 was a 67-year-old woman who complained of pain in the upper and lower right limbs for two years after right thalamic infarction. Case 5 was an 82-year-old man who complained of pain in the right lower limb for two months after left putaminal hemorrhage including left thalamus. All cases were treated with keishikaryukotsuboreito and their symptoms improved. However, in Case 5, thalamic pain recurred after three months and the effect was not sustained with keishikaryukotsuboreito alone, but it was effective when combined with keishibukuryogan. From the imaging findings, keishikaryukotsuboreito would be a useful option for the treatment of thalamic pain with localized lateral thalamic lesions.

Ryokeijutsukanto consists of four crude drugs, Hoelen, Cinnamonmi Cortex, Atractylodis Rhizoma, and Glycyrrhizae Radix. In Kampo medicine, it is used for the yang stage, fluid disturbances, and qi counterflow. It is also used for orthostatic disturbance, which does not change smoothly from parasympathetic nerve dominance to sympathetic nerve dominance. This time, we report that ryokeijutsukanto is also effective for disturbance with function regulation of autonomic nervous system. Case 1: a patient who had headache after exercise and working. Case 2: a patient who had dizziness and cold sweat that appeared in the evening. Case 3: a patient who had headache after working or on holidays. In these cases, ryokeijutsukanto was effective for symptoms that appeared when the patient could not change smoothly from sympathetic nerve dominance to parasympathetic nerve dominance. Furthermore, we found that ryokeijutsukanto was effective, even if there was no sign of fluid disturbance in conjunction with the yang stage and qi counterflow. We identified a new category of patients for whom ryokeijutsukanto is effective.