Introduction : We evaluated the efficacy of keishito and maobushisaishinto with reference to keikyososooshinbuto, for patients feeling cold, by means of multiple regression analysis.Case reports : We reported a patient with an upset stomach whose severe coldness was improved as the stomach condition was cured by adding keishito to maobushisaishinto. Moreover, the combination of keishito and maobushisaishinto was effective for a patient feeling cold, with appetite loss, general fatigue and stiffness of the joints (case 1), a patient feeling cold, with chill, general fatigue, heavy feeling in the stomach, and prone to catch colds (case 2), and a patient feeling extremely cold, with general fatigue and menstrual pain (case 3).Subjects and Methods : In this study, the subjects were 43 patients who reported feeling cold. They were treated with keishito and maobushisaishinto according to their Sho for more than one month. The relationships between the improvement of cold sensation and 52 other factors, such as symptoms noted at their first medical examination, were evaluated by means of multi-dimensional cross-sectional analysis. Results : The factors of chilly or unpleasant wind and coldness of the whole body were significant. Discussion : The factors of coldness in the whole body with chill, and headache without diarrhea were important for improvement of cold feeling with keishito and maobushisaishinto.

It is important to treat patients with spleen qi deficiency not only with formulations for their deficiency, but also with formulations to improve qi stagnation. Rikkunshito plus Cyperi Rhizoma, Amomi Semen and Agastache rugosa, which improve qi circulation, was effective in cases 1 and 2 herein. We examined when and how to prescribe kososan with formulations for spleen qi deficiency, with reference to kosharikkunshito. Kososan and rikkunshito were effective in cases 3 and 4. Based on rikkunshito indication, a patient with weaker constitution was prescribed shikunshito (case 8), a patient with diarrhea and vertigo was prescribed shinbuto (cases 5 and 6), and a patient with severe coldness was prescribed ninjinto (case 7). Kososan played a supplementary role in treatment, and can be prescribed with other medicines. Not only gastrointestinal symptoms, but also various other complaints were improved by adding kososan to prescriptions for spleen qi deficiency.

Teian Azai classically described that summer heat was caused by humidity in addition to hot weather. It may occur after becoming chilled while asleep, enjoying the evening cool, and taking cold foods and drinks. Humidity and high temperature prevent qi circulation in the stomach. Therefore, he insisted that goreisan, a formula improving water circulation, could be applied for diverse symptoms caused by summer heat. We present two cases of patients with epigastralgia caused by cold foods and drinks in air-conditioned environments, whose symptoms were improved by goreisan. In prior treatment, anchusan in case1, and rikkunshito in case 2 were not effective for their epigastralgia. Nineteen cases of epigastralgia after taking cold foods and drinks in summer, including these two cases, revealed that goreisan was efficacious against summer epigastralgia with white fur on the tongue and a stuck feeling in the pit of the stomach. Abdominal fluid congestion is a major abdominal sign for an indication of goreisan, but a stuck feeling in the pit of the stomach presented in some effective cases with goreisan. We concluded that epigastralgia caused by cold foods and drinks with white fur on the tongue and a stuck feeling in the pit of the stomach could be a target for the application for goreisan.

We report on five patients with menstrual pain and/or other disorders, whose symptoms improved when treated with Ki-related prescriptions. Hangekobokuto improved severe epigastralgia and menstrual pain in Case 1. Saibokuto showed improvement of menstrual disorders and pain in Case 2, while Hangekobokuto also ameliorated menstrual pain in Case 3. The treatments were based on patient Ki stagnation, although the symptoms of Ketsu stagnation were also observed in these cases. In Case 4, the patient's menstrual pain and disorders were improved by changing her prescription from Kamishoyosan, to Keishikaryukotsuboreito. In Case 5, a menstrual period of more than 40 days became a regular rhythm of 30 days, while treating the patient's chief complaint of urticaria, with Keishikaryukotsuboreito. Symptoms of Ketsu stagnation were not apparent in Cases 4 and 5. We prescribed Keishikaryukotsuboreito—a prescription for Ki regurgitation—because of suggestive symptoms of nightmare, as well as palpitation in the abdomen.
Menstrual problems are often related to Ketsu abnormalities according to Kampo medicine literature. However, symptoms related to Ki regurgitation and Ki stagnation are also observed in women with menstrual problems who are under stress. Therefore, it is important to know that there have been cases, such as ours, of menstrual problems successfully treated with Ki-related prescriptions.

We describe three cases in which the same Kampo formulas were applied to a mother and daughter with different complaints. In cases 1 a, b, a mother with general fatigue after an operation for gastric and colon cancer, and her daughter with migraine and menopausal symptoms were effectively treated with kamishoyosan. In cases 2 a, b, a mother with menstrual disorder, and her daughter with palmar eruption were effectively treated with hangekobokuto. In cases 3 a, b, a mother with lumbago and her daughter with back pain were effectively treated with keishikaryukotsuboreito. These Kampo formulas are thought to improve qi circulation.
It is considered that improving qi disturbance is important for the Kampo treatment of female patients. Taking into account parent-child genetic similarities, it is possible that application of the same Kampo formula to familiarly related patients with different complaints could be effective. It is important to consider not only the patient's complaints, but also the patient's condition, from the Kampo viewpoint so-called “Sho”. Therefore,since our cases all involved a mother-daughter relationships, it may be reasonable to assume that Kampo formulas improving qi circulation were effective for their different complaints.

We would like to report on the treatment of 15 patients with floating sensation after the Great East Japan Earthquake (2011 Tohoku Earthquake) in 2011.Twelve cases were effectively treated with hangekobokuto, while two cases were effectively treated with hangebyakujutsutemmato, but not with hangekobokuto.One case was effectively treated with ryokeijutsukanto. We discuss how to treat this floating sensation, focusing on the usage of hangekobokuto.
Most patients who were successfully treated with hangekobokuto reported an uneasy feeling with a floating sensation. On the other hand, those who were successfully treated with hangebyakujutsutemmato or ryokeijutsukanto did not feel uneasy, but reported vertigo and upset stomach.Upon abdominal examination, epigastric resistance was frequently observed in the patients treated with hangekobokuto.This resistance decreased as the floating sensation was improved.
Our results indicate that hangekobokuto could be efficacious for patients with floating sensation after an earthquake, who also felt uneasy and showed epigastric resistance upon abdominal examination.

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.

The effect of Kampo therapy (Japanese traditional herbal medicine) on the second derivative of the photoplethysmogram (SDPTG) was investigated. The SDPTG is the second derivative of the fingertip photoplethysmogram (PTG), which expresses the characteristics of the vascular system, the properties of peripheral vessels, and the state of blood flow. The subjects comprised 13 normal volunteers, 101 patients (21 males and 80 females; mean age 53±11 years) with 1 month of Kampo therapy, and 19 patients (4 males and 15 females; mean age 60±9 years) with 3 months of medication. Control subjects showed no significant changes in their vascular age after 1 month. Patients with a higher vascular age than expected before therapy showed improvement of their vascular age, after treatment for 1 month and 3 months. The difference between the vascular age and calendar age decreased from about 10 to 7 years after 1 month of therapy (n=65. p<0.001), and from about 9 to 4 years, after 3 months (n=11, p<0.01). Vascular age not only reflects organic vessel wall sclerosis due to arteriosclerosis, but also a vascular wall tone that is closely related to the autonomic nervous system. The change of vascular age within a relatively short period suggested a functional change rather than an organic change of the vessels.

Kampo treatment is frequently effective for patients with acne vulgaris who are unresponsive to standard treatment with western medicine. We report two cases of acne vulgaris successfully treated with tokikenchuto. In the first case, a 32-year-old woman complained of mild acne, loose stool and menstrual pain. Her abdomen was soft and a pulsation above the navel was noted. These symptoms were considerably improved after taking tokikenchuto. In the second case, a 26-year-old woman presented with moderate acne, loose stool and menstrual pain with excessive strain of the abdominal muscles and objective tenderness on the sides of the abdomen. Kamishoyosan and tokishakuyakusan were first prescribed, although these caused bowel disturbances, and eventually tokikenchuto was prescribed, which improved the acne. We suggest tokikenchuto is effective for patients with mild to moderate acne who have bowel disturbance with soft abdomen or excessive strain of the abdominal muscles, which are considered indicators of gastrointestinal weakness. In addition, yokuinin has a synergistic effect in the treatment of acne.

Objectives : We evaluated the efficacy of tokishakuyakusan and kamishoyosan for patients who complained of feeling cold, and identified key symptoms that would predict positive treatment outcomes for coldness with these medicines.
Design : A retrospective cohort study
Subjects and Methods : The subjects were 188 patients who reported feeling cold. They were treated with tokishakuyakusan or kamishoyosan according to their Sho for more than one month. The relationships between improvement of cold sensation and 62 factors, including other symptoms noted at the first medical examination, were evaluated by means of cross-sectional analysis, followed by logistic regression.
Results : The factors of coldness of the abdomen (odds ratio, 5.0), vertigo (7.7), dimness of sight (16) and blushing (5.6), without anger (0.11) or tinnitus (0.025), were found to be predictors of a positive effect with tokishakuyakusan treatment (p < 0.001). The factors of hot flushes (14), without coldness of the whole body (0.099), and faint feeling (0.21) were significant for kamishoyosan (p < 0.001). This suggests that kamishoyosan can improve subjective coldness of the extremities (AIC -8.64), especially of the legs (-2.23).
Conclusions : Coldness in the abdomen was an important indicator for treatment with tokishakuyakusan, while coldness in the legs, but not in the whole body, was important in the case of kamishoyosan.