We describe three cases of calf cramps successfully treated with shimbuto. Case 1 was a 74-year-old female who suffered from calf cramps and knee pain caused by gonarthrosis. She was treated with boiohito, but did not respond. When she complained of diarrhea, shimbuto was substituted for boiohito. After taking shimbuto, her knee pain improved, and her cramps disappeared. Case 2 was a 77-year-old female who suffered from leg edema and calf cramps. Tokishakuyakusan was prescribed, but she complained of an upset stomach. Tokishakuyakusan was replaced with shimbuto, and her cramps improved together with a decrease in the coldness and edema in her legs. Case 3 was a 79-year-old female who took kososan for uneasiness and restlessness after the death of her husband. She had edema and coldness in her legs, and suffered from calf cramps during the daytime and early in the morning. Shimbuto was added to kososan, and her coldness improved ; subsequently the leg edema diminished, and finally her cramps disappeared.
These cases suggest that shimbuto is indicated for patients with calf cramps, who report internal coldness caused by kidney deficiency with gastrointestinal dysfunction.

Tokito is used to treat patients with an asthenic, cold constitution, who have symptoms of chronic pleuritic pain, epigastralgia, and backache. There is no previous report on treatment of pruritus cutaneus with tokito. However, here we report a case of combined cutaneus pruritus and coldness, successfully treated with tokito. Our patient was a 38-year-old female, who reported having had facial pruritus cutaneus for one year. She attended our clinic in May of the year, because she had taken a turn for the worse. She was sensitive to cold, had poor circulation, felt cold in the abdomen, and reported that sleeping was difficult due to a cold back. We prescribed tokito (5.0 g/day). Her symptoms improved within six days. However, her symptoms, especially cold abdomen and cold back, returned when she drank cold water or stopped taking tokito. She was quite informative in that she prepared detailed records of her symptoms on visiting our clinic.
Tokito contains herbal medicines common to daikenchuto and tokikenchuto and hangekobokuto. Therefore, tokito could be a suitable herbal medicine for patients with pruritus cutaneus caused by coldness and qi stagnation and spleen deficiency.

In Kampo, respiratory symptoms are treated with prescriptions related not only to “lung”, but also other parenchymatous viscera. We report 2 patients whose stress-induced chronic cough was ameliorated by hachimijiogan. Case 1 was a 25-year-old female who was working under stressful circumstances at her company and reported an oppressive feeling in the chest. She was initially prescribed hangekobokuto because of a feeling that something was stuck in the pit of her stomach on abdominal examination, but her cough did not get better. As she also noted a dull feeling in her back ; she was switched to hachimigan, and her cough disappeared. Case 2 was 42-year-old female who suffered from depression, sore throat and an obstructive feeling in the throat ; she had been receiving infertility treatment for several years. Hangekobokuto and bakumondoto showed insufficient effect on her persistent cough. Her coughing stopped when she was prescribed hachimigan for back pain. Neither of these patients showed lack of resistance of the lower abdomen on abdominal examination.
Chronic ki (qi) stagnation under stressful conditions may cause ki deficiency, especially kidney deficiency. The symptom of stress-induced cough in our cases was considered to be due to kidney deficiency, and therefore hachimijiogan, but not hangekobokuto, was effective. The short duration of the complaints and relatively young age (20-40's) of the patients may account for the absence of the typical abdominal sign of kidney deficiency. Back stiffness and pain may also be important signs for cough due to kidney deficiency.

We present a 35-year-old male with palpebral hemispasm, which often occurred while at work. Because there were no ophthalmological findings, he consulted our clinic to receive Kampo therapy. He easily became fatigued and he had subchondral resistance and discomfort (kyo-kyo-kuman), so we treated him with saikokeishito and shakuyakukanzoto. However, they were ineffective, and therefore we reconsidered his symptoms.
Although he complained of fatigue, he was well built and had been a heavy drinker until a few years before presenting. Furthermore, he easily blushed and sweated in the upper body during the daytime, and his palpebral hemispasm often occurred during this blushing and sweating, and was accompanied by headache. We considered that this represented an excess-heat pattern rather than a deficiency pattern, and prescribed orengedokuto. His symptoms improved, and disappeared after six months.
There has been no detailed report of orengedokuto for the treatment of palpebral hemispasm. Orengedokuto may be useful for palpebral hemispasm in the context of symptoms of excess-heat pattern, such as blushing, sweating in the upper body and headache.

  We have managed information on adverse drug reaction using the clinical records to obtain data from within our hospital and using Medicine-Pocketbooks to obtain data outside our hospital.  Our system for management of side effect information does not require the development of a separate specialized system.  Our method of collecting side effect information was changed in April 2007.  Therefore, we evaluated our present method of collecting information on side effects by comparing the method used before the change with the new method.  The amount of side effect information collected has clearly increased since April 2007.  Although the amount of data collected directly from doctors has increased eight-fold, the amount collected from other data sources has hardly changed.  Side effect symptoms have hardly changed, with skin symptoms being the most frequent side effect.  Suspected drugs have also hardly changed, with antibiotics being the most frequently suspected drugs.  In addition, we conducted questionnaire surveys on the use of Medicine-Pocketbooks by patients who registered side effect information at our hospital to determine whether Medicine-Pocketbooks were being used effectively as a tool for the management of side effect information.  Among patients who registered their side effect information at our hospital, 76% also presented their Medicine-Pocketbooks to other medical institutions.  In addition, all patients received a change in prescription or were questioned about their side effect information when they presented their Medicine-Pocketbooks.  Our present method of collecting side effect information is considered appropriate since there was an increase in the amount of side effect information collected from doctors.  Medicine-Pocketbooks have also been effectively used as a tool for managing side effect information.

This study reports the efforts of acupuncturists to promote multidisciplinary cooperation in our laboratory. We conducted a questionnaire survey involving all employees of our laboratory in December 2013 to investigate problems regarding multidisciplinary cooperation, and identified a lack of information and problems concerning treatment plans and costs. After implementing measures to tackle these problems between January and November 2014, we conducted the questionnaire survey again. As the results, 79% of the employees responded that they had gained more information about acupuncture compared to the previous year, and 72% of them responded that treatment plans and costs were appropriate. Compared to the number of new patients who sought acupuncture treatment between January and November 2013 (n = 273), there was an increase of 40% in the same period of 2014 (n = 385). These results showed that employees' understanding of acupuncture and multidisciplinary cooperation were promoted.

In Japan, controlled devices for medical professionals have been often purchased by people other than acupuncturists or doctors, using the Internet sales system. Press Tack Needle (PYONEX^®) allows easy handling by combining a plastic part with an adhesive tape. Since it has been reported to be relatively safe with limited adverse events such as adhesive-related dermatitis or similarly mild disorders, it is widely used. We report a case that when the patient removed a PYONEX^® which applied by himself, the needle tip was broken and remained in his body. It might lead to an accident such as injury due to a broken needle left in the body. The patient had purchased the PYONEX^® on his own judgments, storing it for a long period of time, applied it to his body 10 months after its expiration date and kept it attached for approximately 3 weeks. Plastics are characterized by deterioration and can be damaged by environmental factors including ultraviolet rays, water, and shocks. In this paper as an urgent issue, we note that when using these products, in addition to paying attention to their expiration dates, precautions should be considered since deterioration may also progress due to prolonged attachment.

We present two cases of aged males with cold-induced colic successfully treated with tokishigyakukagoshuyushokyoto. The first case is a 74-year-old male with bilateral sciatic neuralgia, who had a history of right leg amputation following a traffic accident. The second case is an 80-year-old male with chills of the lower body, who has undergone excision of biliary duct cancer. Their physical status appeared normal to excessive by traditional medical examination, whereas the pulse and abdominal patterns are usually deficient in female cases in whom tokishigyakukagoshuyushokyoto is effective. The common features in our cases are age and history of trauma by injury or surgery. Although males are more tolerant of cold than females, advancing age and history of injury or surgery tend to cause cold-induced colic in males. The number of male cases that can be effectively treated with tokishigyakukagoshuyushokyoto is likely to increase in our aging society, and we conclude that it is important to consider the presence of cold when we examine male cases.

Background : Menstrual migraine is more resistant to treatment than that of nonmenstrual episodes. Hormonal progesterone changes may cause sui (water/fluid) disturbance, in Kampo medicine terms. We therefore treated patients with menstrual migraine in which goshuyuto was ineffective, with the combination of goreisan and goshuyuto.
Subjects & Methods : Subjects were 37 female patients with coldness (mean age 37 years, age range 23-48 years), whose migraine during their intra-menstrual periods was successfully treated with goshuyuto for 3 months. In order to treat migraine in the menstrual period, goreisan was added to goshuyuto from 1 week before onset, until the end of their menstrual period. Results : Among 37 patients, the treatment was effective in 26 patients (70%). Significant variables were found to be dull headache (p = 0.003), edema (p = 0.006), vertigo (p = 0.014) and oliguria (p = 0.014) during attacks, as well as worsening before rain (p = 0.004). Conclusion : The periodical combination of goreisan and goshuyuto seems to be effective in patients with menstrual migraine who report symptoms of sui disturbance, such as dull headache and oliguria during their attacks.