We report a patient who received pelvic reconstruction for unstable pelvic ring fracture with severe open-book deformity after 10 months of conservative therapy and regained the ability to walk. The present report indicates that patients with unstable pelvic ring fractures should undergo reduction and fixation in the early period. Unstable pelvic ring fracture is a result of high energy trauma. It is difficult to find the best time for intervention once it has been delayed. This AO Type C3 unstable pelvic ring fracture was examined by CT imaging for pelvic deformity. Independence in activities of daily living (ADL) was evaluated using the Functional Independence Measure (FIM). After pelvic ring deformity was reduced by an external fixation-traction system, anterior fixation was performed and contracture of short external rotators was released. The patient's hip function normalized after the procedures and he was able to walk again 6 months later. Concomitant nerve paralysis also recovered after the reduction and fixation of the pelvic deformity. Unstable pelvic ring fractures may progress to pelvic deformity and adversely affect the patient's ADL unless they are managed with reduction and fixation in the early period. Unstable pelvic ring injury should primarily be treated with reduction and fixation in the acute phase.

We describe four cases of menopausal symptoms with respiratory complaints successfully treated with saikokeishikankyoto. Case 1 was a 49-year-old female who became easily tired and often caught colds, as well as suffered from cough, hot flushes and insomnia. Case 2 was a 47-year-old female who became easily fatigued and irritated, and suffered from dry cough. Case 3 was a 51-year-old female, who became easily exhausted and suffered from nasal congestion and swelling of the gums. Case 4 was a 53-year-old female, who suffered from sensations of coldness and hot flushes, insomnia, sore throat and dry cough. Although saikokeishikankyoto has been classically applied for diverse symptoms, respiratory signs are associated with the most preferable outcome. Saikokeishikankyoto could be a suitable herbal medicine for menopausal patients with a weak constitution, who present with respiratory symptoms caused by coldness, qi deficiency and qi stagnation.

Eight family care providers with various disorders showed improvement of their symptoms when treated with yokukansan-based prescriptions. Case1complained of hot flushes, burning sensation and difficulty in concentration; Case 2 of insomnia and back pain; Case 3 of insomnia; Case 4 of irritation and palpitation; Case 5 of anxiety and insomnia; Case 6 of palm eruptions; Case 7 of a painful sensation in the eyes and headache; and Case 8 of neck pain, stiff shoulders, diarrhea, palpitation, insomnia, general fatigue, etc. These diverse symptoms were all considered to be related to “liver” dysfunction of emotions, muscles and eyes, caused by chronic and continuous stress due to their care burden. In Cases 5, 6, 7and 8 the persons whom the care providers were caring for also took the Yokukansan-based prescriptions at the same time as these said care providers did. Instructions for the traditional medicine Yokukansan indicate that “mother and child should take this medicine at the same time”. And since the relationship between a patient and a care provider in the family might be similar to that between child and mother, we applied yokukansan-based prescriptions to these care providers based on traditional instruction.
Sleeplessness ; symptoms <1> ; Prescriptions ; Palpitations ; Mothers

We present seven cases of insomnia successfully treated with hochuekkito. Two patients showed improvement of their insomnia after taking hochuekkito before going to bed, and three patients showed improvement after taking hochuekkito twice per day. The other two patients could sleep better after adding hochuekkito to other Kampo formulations. All these patients were light sleepers, and became easily tired, excessive sleepy after meals, and had daytime sleepiness. However, they had no gastrointestinal symptoms, such as appetite loss. Five of the seven patients reported waking up feeling better after taking hochuekkito. Two other Kampo formulations, sansoninto and kihito, were also given to patients with deficient constitution, who complained of insomnia. Sansoninto and kihito are formulae that compensate for qui and blood deficiency. Kihito contains more herbs with beneficial effects on “spleen and stomach”, and “heart” functions more than sansoninto, and therefore, kihito may be preferred for patients with a more deficient constitution. The reason why our patients were able to sleep more deeply and wake up smoothly with hochuekkito may be that they exhibited remarkable qui deficiency, showing general fatigue, excessive sleepiness after meals, and daytime sleepiness, but without the symptoms of blood deficiency, such as palpitations or uneasiness, being easily frightened or forgetful, or showing anemia or bleeding.