We report two cases of unexplained thoracodorsal pain, which were successfully treated with the Kampo formulations karogaihakuhakushuto and karogaihakuhangeto. In case 1, the patient was a 67-year-old man. Left thoracodorsal pain appeared in this patient two months after the administration of chemotherapy for transverse colon cancer with hepatic metastasis. Bone metastasis was ruled out by bone scintigraphy, but the cause of the pain was still unknown. The Kampo formulation karogaihakuhakushuto was prescribed and the pain was reduced after two weeks, and disappeared within three months. In case 2, the patient was a 40-year-old man. Right thoracodorsal pain appeared in the right hypochondriac region without an apparent cause. Examinations, such as computed tomography and upper gastrointestinal endoscopy, were conducted, but the cause of the pain remained undiagnosed. The pain was not improved with pain killers, karogaihakuhakushuto was prescribed, and the pain was then reduced in about a month. The authors considered thoracodorsalpain as already described in the great classic Kinkiyoryaku (Chin Keiu Yao Lueh). We then prescribed karogaihakuhakushuto and karogaihakuhangeto, which resulted in immediate clinical improvement. These clinical courses indicate that the formulae can be effective for the treatment of thoracodorsal pain of unknown origin. Furthermore, the effect of herbal medicines and herbal decoctions boiled with rice wine may make it possible to have a more imminent effect on thoracodorsal pain.

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.

We report three closely watched cases of intractable Meniere's disease in the elderly that were successfully treated with Kampo medicine. Case 1 is a 75-year-old female. At the time of the 4th Meniere's attack, we gave her western medicines such as isosorbide, but she had a significant hearing loss. Then, we administered hachimijiogan extract granules, and her hearing level improved and she had been free of Meniere's attack for 23 months. Case 2 is a 78-year-old male. We diagnosed as bilateral Meniere's disease and treated him with western medicines such as isosorbide. In September of year X, his hearing level in the left ear worsened despite the treatment, so we prescribed hachimijiogan extract granules. After the treatment, we found the patient's hearing improved and nystagmus decreased gradually. He has also been free of Meniere's attack for 9 months. Case 3 is a 70-year-old male. He had repeated episodes of vertigo in spite of the administration of western medicines. After we prescribed shimbuto extract granules, vertigo attack and nystagmus disappeared. He has been relieved from Meniere's attack for 8 months. These cases indicate that Kampo therapy is one of the useful therapeutic options for intractable Meniere's disease in the elderly.

We are planning a study focused on the gathering of clinical data for the purpose of formalizing diagnostic logic at 6 institutions specialized in Kampo-based medical examinations. However, during the planning stage, it has been recognized that there are a large number of Kampo formulas to be studied, and differences among faculties and individuals exist regarding how to identify each Kampo formula, methods of gathering findings, and the evaluation of efficacy. Here we report the solution proposal reached after building consensus among all participating faculties on these issues. After raising the issues, conferences were held for each of them, until a unanimous consensus was obtained. As a result, the following conclusions were reached. Thirty-three Kampo formulas were selected as targets for the formalization of diagnostic logic. In addition, the range of dosage forms, crude drug ingredients, and permissible dosages for each Kampo formula were determined. Regarding clinical findings for these Kampo medicines, the items to be collected and evaluation criteria were also established. The criteria for evaluating the validity and safety of each Kampo medicine were decided, together with the grading and timing of evaluation. We hope that our solution proposal reached after building consensus becomes the basis for Kampo research in the future.