The effectiveness of the Kampo medicine shakuyakukanzoto extract for patients with muscle cramp is well known, but recently side effects related to pseudoaldosteronism have also been reported. To avoid this issue, Kampo medicines without Glycyrrhizae Radix are needed for treatment of muscle cramp. We investigated the therapeutic effect of shimotsuto extract, which has traditionally been used to treat anemia, in 26 patients (mean age : 70.7 ± 12.1 years) with muscle cramp. Improvement of the symptom was noted in 18 patients (69%), with no change in 8 patients (31%). The abdominal muscle tension of the former patients was significantly lower than the latter. Here, the cases of four representative patients in whom muscle cramp was improved by shimotsuto are described. The response rate to shimotsuto was similar to that of shakuyakukanzoto. Our results suggest that shimotsuto extract is a suitable alternative to shakuyakukanzoto for treatment of muscle cramp in older non-robust type patients not in need of emergency care.

Constipation is one of the most common symptoms seen in elderly people, and is sometimes difficult to treat. Daikenchuto is a well-known Kampo formulation for treating ileus. Here, we report a case in which daikenchuto was not effective and constipation was effectively treated with kobokushokyohangeninjinkanzoto. The patient was an 81-year-old woman who had been hospitalized for treatment of a thighbone fracture. She was originally constipated, and her constipation had worsened over the course of hospitalization. Colonoscopy examination and abdominal computerized tomography showed no structural lesions. Her constipation improved after the administration of daikenchuto, but the improvement was transient. Since the constipation and abdominal distension worsened after she began eating again, we administered kobokushokyohangeninjinkanzoto. Subsequently, her condition improved remarkably. Eight days later, we changed the initial kobokushokyohangeninjinkanzoto to ninjinto and hangekobokuto. Her complaint did not recur, and she was discharged 17 days later. In case of deficiency pattern ileus, kobokushokyohangeninjinkanzoto may be considered as an alternative to daikenchuto. Furthermore, we believe that the combination of ninjinto and hangekobokuto is an effective alternative to kobokushokyohangeninjinkanzoto.

We describe two cases of cardiac failure in elderly patients successfully treated with shimbuto. Case 1 was that of an 84-year-old man with severe aortic stenosis and liver cancer. His cardiac failure led to repeated hospitalization. After taking shimbuto, his pleural effusion decreased and cardio thoracic ratio improved. Case 2 was that of an 84-year-old man who was hospitalized because of cardiac failure and aspiration pneumonia after undergoing an operation for lung cancer. After taking shimbuto, his urine volume increased and cardiac failure improved. No notable adverse events were observed in any of the abovementioned cases. It is important that kanzo is not included in shimbuto to demonstrate risui action, hence the use of other “ho” formulations should be avoided. These cases suggest that shimbuto is indicated for elderly patients with cardiac failure under terminal care.

Nowadays, it is rare to see Yang min disease in the acute fever phase. We report three cases of acute fever successfully treated with daijokito.
Case 1 : An 82-year-old male with suspected viral infection. He had a persistent fever of 38 °C. Because of abdominal fullness, constipation and wheeze, we administered daijokito. These symptoms disappeared, his hypoxemia improved, and his fever went down to 36 °C, accompanied by considerable defecation.
Case 2 : A 67-year-old female with suspected central hyperthermia. She had a persistent fever of 38 °C. Because of abdominal fullness and constipation, we administered daijokito. These symptoms disappeared and her fever went down to 36 °C with considerable defecation.
Case 3 : A 43-year-old male who was diagnosed with paralytic ileus accompanied by cyclic neutropenia. Three days after his temperature rose to 38 °C, and constipation, abdominal fullness and pain appeared. After administering daijokito, these symptoms disappeared and his fever went down to 36 °C with considerable defecation.
When abdominal fullness and constipation appear after a fever continues, we believe the administration of daijokito should be considered whether western medicine has been applied or not.

A 68-year-old female had been diagnosed with granuloma annulare a year earlier. She was prescribed tranilast and was recovering, but had to discontinue the tranilast because she suffered liver damage as a side effect.
She was also suffering from a worsening rash and so decided to try Kampo medicine. We prescribed orengedokuto because of thermal symptoms suggestive of hot flushes, the appearance of her tongue, and the character of her rash. Initially, the rash improved, but from the 3rd day following admission did not change greatly. We suspected the existence of interior cold and started combining maobushisaishinto. Five days later, the granulomas had rapidly shrunk. We believe she had overlapping diseases of a yin and yang pattern from the fact that she improved clinically.

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.