Disorder of venous circulation is a common cause of skin ulcers in the lower leg. Increased vascular permeability inhibits normal healing of the skin and often prolongs the course. We observed a 75 year-old woman who developed intractable leg ulcer caused by traumatic injury. In spite of the routine medical therapy of Western medicine, the ulcer got worse. She came to us when her doctor recommended surgical intervention. After initial treatment with boiogito extract with shiunko ointment for 2 weeks, no improvement was observed. Then the prescription was changed to eppikajutsuto extract and bushi powder with shiunko ointment, which resulted in increased urine volume and healing of the ulcer after 2 months. Although we usually use hozai such as ogikenchuto for the treatment of skin ulcers, eppikajutsuto might be a choice for the difficult cases like this caused by circulation disorder.

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.

Chukenchuto is often reported to be useful for constipation. We experienced patients with diarrhea or loose stool, successfully treated with chukenchuto. In this report, five cases are documented. Of these, four cases did not present with constipation. We emphasize that chukenchuto is also effective for diarrhea or loose stool. Other clinical manifestations such as gargling sound or abdominal distension, tension of abdominal rectus muscle, and feeling of cold are common in cases where chukenchuto is effective.

We report three cases of depression, which were effectively treated with oriental medicine. All three patients were employees at the same workplace, which had a total of 17 employees. Case 1 was a 46-year-old, who had worked at the company for 20 years and complained of depression and insomnia. Case 2 was a 28-year-old woman, who had worked at the company for 9 years and complained of nausea and mood disturbance. Case 3 was a 41-year-old man, who had worked at the company for 15 years and complained of restlessness, insomnia, and depression. The three patients were treated with yokukansan and yokukansankachimpihange, which are Kampo formulations, and subsequently showed improvements in symptoms. In choosing prescriptions for these patients, we considered the fact that all three patients worked in the same workplace. Yokukansan is traditionally co-administered to mother and her child. Furthermore, Hoffman (1984) proposed the system of sharing emotional contagion in the field of neuropsychiatry. When considered holistically, medication shared by mother and child is an empirical treatment taking into account emotional contagion. This treatment is also considered applicable within a single community, such as the one in the same workplace. Shared medication that takes into account emotional contagion within the same workplace, could be useful as it was for our patients.

We treated dry eyes and eyestrains successfully with electrothermo-acupuncture and Kampo medicine. The case was a 41-year-old woman who was treated with a few eye drops. She came to our hospital to receive Kampo medicine because her photophobia and eye pain got worse. After taking shimbuto, her complaint got better with improving physical fatigue. Electrothermo-acupuncture was effective for photophobia and eye pain promptly and remarkably. After we added kihito to her, she did not need to use eye drops with improving bloody urine and sleeplessness. Photophobia and eye-ache are thought to be related to the trigeminal nerve system. In this case, we consider that the point of application of electrothermo-acupuncture is the trigeminal nerve system. At the same time, “rikan” and “hikyo” might be involved in this case with the general malaise of eye.