We report on two cases of patients with chronic pain treated with opioid analgesics. They did not continue their treatment with opioid because of side effects.
An 88 year-old female complained of low back and leg pain caused by lumbar spinal canal stenosis. She also complained of dizziness, nausea and appetite loss after a course of weak oral opioid was administered. We thought it necessary to improve her general condition and digestive sickness following treatment for pain, and administered 5 g/day of hangebyakujutsutemmato. After the administration of this hangebyakujutsutemmato, her general condition improved, and we could administer various analgesics.
A 62 year-old female complained of dull headache, right neck pain and stiffness of tear and mouth due to fibromyalgia and collagen disease dating back several years. Her pain was reduced by the combined administration of a strong opioid and an immunosuppressive agent. However, she complained of severe dizziness, nausea and appetite loss after the commencement of drug therapy. Her general condition improved markedly, through the administration of 5 g/day of hangebyakujutsutemmato, and she was able to continue her treatment of chronic pain without deleterious events.
In conclusion, in patients treated with opioids for chronic pain, dizziness, dull headache, nausea, vomiting and loss of appetite is often seen. Therefore, we emphasize that the combined administration of hangebyakujutsutemmato and opioids can be beneficial for the treatment of chronic pain patients.

We investigated the effectiveness of hangekobokuto in alleviating dysphagia and aspiration pneumonia attributed to late­stage neurosyphilis. Our study subject, a 67-year-old man treated for his leg pain in our department, hoped this treatment would relieve his severe cough and sore throat. According to a neurological investigation and the analysis of blood and cerebrospinal fluid, his symptoms (swallowing disturbance and aspiration pneumonia in the lower lobes of both lungs) led to the diagnosis of cerebral bulbar paralysis caused by latestage neurosyphilis. The patient requested drug therapy ; thus, we prescribed 7.5 g/day of hangekobokuto, to be administered orally, based on his medical findings of qi stagnation and tan yin. Dysphagia was relieved one week after oral administration of hangekobokuto, and after three weeks, the patient's discomfort had almost disappeared. Moreover, aspiration pneumonia was also improved in his chest CT image finding. Late-stage neurosyphilis symptoms usually develop within 20 to 30 years of contracting syphilis, an infection caused by the bacterium Treponema pallidum. Symptoms may include a loss of swallowing reflex and cough reflex due to the paralysis of cerebral basal ganglia. However, hangekobokuto was found to increase the concentration of substance P released in the pharyngeal head and tracheal mucosa, and thus improve swallowing function. We conclude that hangekobokuto is a useful agent for alleviating the swallowing abnormality of late-stage neurosyphilis.

The use of hearing aids may not be sufficiently helpful for elderly people with advanced bilateral hearing loss when conversing with others. The patient in this case was an 82-­year­-old man whose main complaint was difficulty in verbal communication with his family despite using hearing aids. He was diagnosed with ad­vanced bilateral sensorineural hearing loss using Western medicine techniques. He was first prescribed the Kampo formulation, ryokeijutsukanto, followed by goshajinkigan. Later, he took a combination of both of these Kampo formulations, and his hearing ability improved. Pure tone audiometry and speech audiometry demonstrated hearing loss ;however, speech audiometry better reflected his improvement in hearing speech sounds after he began taking the Kampo formulations. Thus, in this case, the patient's hearing and communica­tion abilities improved with Kampo formulations combined with the use of hearing aids. In the future, speech audiometry (maximum discrimination score) can be applied to evaluate the efficacy of Kampo treatment for hearing loss.

We assessed the efficacy of Kampo medicine for lower extremity symptoms caused by lumbar spinal diseases, such as lumbar spondylosis, spinal canal stenosis, and post-spinal surgery syndrome. In particular, we evaluated its usefulness for lower extremity pain, coldness, and numbness. In addition, the efficacy of antecedent drug selection and pain treatment was also assessed. In accordance with Japanese traditional herbal medical practice, keishikajutsubuto, shimbuto, ryokyojutsukanto, tokishigyakukagoshuyushokyoto, goshajinkigan, and shakuyakukanzoto were prescribed primarily for lower extremity symptoms caused by lumbar disease. Thirty-two of 60 (53%) cases with lower extremity pain, 17 of 34 (50%) cases of pain with coldness, and 4 of 19 cases (21%) of pain with numbness were improved by these drugs. We conclude that the addition of keishikajutsubuto, shimbuto, ryokyojutsukanto, tokishigyakukagoshuyushokyoto, goshajinkigan, and shakuyakukanzoto after antecedent pain therapy was effective in treating lower extremity symptoms caused by lumbar disease.