Parkinson's disease is a neurodegenerative disorder characterized by four major motor symptoms : resting tremor, rigidity, akinesia and postural instability. As the treatment period for Parkinson's disease is prolonged,psychological symptoms and motor complications occur frequently. Wearing-off fluctuations are the major motor complications caused by the shortening of levodopa efficacy time. They have serious influence on the quality of life (QOL) of patients with Parkinson's disease. There have been numerous reports on treatment of the behavioral and psychological symptoms of dementia (BPSD) with Kampo medicine. There have also been recent reports on treatment of the behavioral and psychological symptoms of Parkinson's with the Kampo medicine, yokukansan. On the other hand, there are few reports on treatment of the motor symptoms and motor complications of Parkinson's with yokukansan. We experienced two cases in which the levodopa-induced hallucinations and wearing-off fluctuations in Parkinson's sufferers were improved conspicuously with this Kampo medicine. These findings suggest that yokukansan improves both levodopa-induced psychological symptoms and motor complications by achieving curative effect with levodopa/carbidopa.

We report a patient with hemifacial spasm in whom daijokito was effective. The patient was a 57-year-old woman who visited our clinic for treatment of fatty liver and asthma. She had been suffering from left blepharospasm and paroxysmal twitching movement of the left lower jaw in stressful situations during the 2 years prior to her first visit to us. After we prescribed daijokito because of her pot belly, she had no more asthma attacks and her left facial spasm improved. Seven months later, we added inchinko to daijokito for her liver damage. When we followed the test results of her clinical survey for two years, we found that her weight had decreased and liver function was improved after starting this dosage. We diagnosed her paroxysmal involuntary twitching on the left side of the face as hemifacial spasm, because these symptoms were unilateral. We regard that her hemifacial spasm was improved with relaxation, anticonvulsants, and the antianxiety action of daijokito.

Case reports of drug-induced liver injury caused by Kampo medicines are on the rise, but most of them are noted for related symptoms such as jaundice. Usually, severe liver injury is detected by chance upon routine medical checkup. Recently, we noted 3 cases of suspected drug-induced liver injury caused by orengedokuto, saikokeishikankyoto and bofutsushosan. In these 3 cases, maximum ALT was under 100 IU/l and no symptoms related to liver injury were observed. Early detection by blood test was useful, and appropriate treatment quickly improved and normalized the abnormal values associated with liver injury. We should always be alert for drug-induced liver injury caused by Kampo medicines, especially when prescribing formulations that include Scutellariae Radix. We also emphasize the importance of scheduling blood tests when prescribing these formulations.