Post-dural puncture headache is a headache caused after lumbar puncture. We report two cases of post-dural puncture headache improved with goreisan. Case 1 was 37-year-old man, Case 2 was 36-year-old woman, and they both had orthostatic headache after lumbar puncture. We diagnosed them as having post-dural puncture headache, and their headaches were improved with goreisan. Based on the international classification of headache disorders, 2 nd edition (ICHD-II), post-dural puncture headache is classified as headache attributed to low cerebrospinal fluid pressure. We treated their cerebrospinal fluid as a “shin-eki” (a body fluid other than blood), and their low cerebrospinal pressure as “suidoku” (fluid retention or depletion, or mal-distribution of “shin-eki”). Goreisan is effective for “suidoku”, so we believe that goreisan was good for their low cerebrospinal pressure. These results suggest that goreisan is a useful option for the treatment of post-dural puncture headache.
Headache ; Cases ; Postdural Puncture Headache ; Spinal Tap ; Two

Dementia of the Alzheimer's type, in which cognitive impairment slowly progresses, accounts for more than half of dementia cases. Symptoms develop slowly and worsen over time, and there is no cure for Alzheimer's type dementia. We conducted a study on the efficacy of hangebyakujutsutemmato for cognitive impairment in dementia of the Alzheimer's type. Seventy-two patients with Alzheimer's type dementia were enrolled in our study. Hasegawa dementia scale-revised (HDS-R) was implemented for all patients, for whom hangebyakujutsutemmato medication was started at the initial visit. After 4-weeks' treatment the HDS-R was implemented again. Sixty-four patients were assessable and 8 patients dropped out from the study. In these 64 patients, mean age ± standard deviation was 79.9 ± 6.0, and 33 patients were male, and 31 patients were female. After 4 weeks of hangebyakujutsutemmato treatment, HDS-R scores were increased significantly compared with baseline (from 15.5 ± 5.2 to 16.9 ± 6.2, p < 0.01). In taking histories from families, clinical presentation was shown to have improved in 13 patients (20.3%). To our knowledge, this is the first report demonstrating that hangebyakujutsutemmato is effective for patients with dementia of the Alzheimer's type. In conclusion, hangebyakujutsutemmato is a useful option for the treatment of cognitive impairment in Alzheimer's type dementia.

Blepharospasm is classified as a focal dystonia, and involves involuntary contraction of muscles such as the orbicularis oculi muscle and the corrugator muscle, which are associated with eyelid movement. Thus blepharospasm involves difficulties to eyelid opening. A 61-year-old woman came to our hospital complaining of a sense of discomfort of the eyes since a half year earlier. Blepharospasm was diagnosed based on current medical history and neurological examination. Oral saikokaryukotsuboreito was started and the blepharospasm improved gradually. After a week, oral treatment with one-third of the amount of shakuyakukanzoto was added and the blepharospasm further improved. The patient wanted to increase the dose of shakuyakukanzoto and to stop the saikokaryukotsuboreito. Once oral shakuyakukanzoto monotherapy was started, however, the blepharospasm worsened. Oral saikokaryukotsuboreito and low dose shakuyakukanzoto was started again, and her blepharospasm improved again.
The mechanism behind a focal dystonia such as blepharospasm is explained as a disorder of the basal ganglia motor loop. Saikokaryukotsuboreito is used for the diseases of the central nervous system. Thus there is the possibility that, here, saikokaryukotsuboreito improved a central nervous system disorder, and the blepharospasm. To our knowledge, this is the first report demonstrating that saikokaryukotsuboreito is effective for blepharospasm. It suggests that saikokaryukotsuboreito is a useful option for the treatment of blepharospasm.

Benzodiazepines are frequently used for the treatment of insomnia, although these drugs cause dose-related centrally mediated respiratory depression. Moreover, benzodiazepines are contraindicated in patients with my asthenia gravis, so treating myasthenia gravis patients with insomnia is difficult.
A 67-year-old woman developed myasthenia gravis on December 20XX. Her myasthenia gravis went into remission with oral high-dose prednisolone medication and plasma exchange, after which her oral predniso lone medication was continued. On January 20XX+2, she suffered from insomnia. She had poor sleep quality, nocturnal awakenings and middle-of-the-night insomnia. She had high abdominal resistance and fullness, ten derness, and discomfort of the hypochondrium. She was treated with saikokaryukotsuboreito and could then sleep comfortably soon afterwards.
According to the Shang Han Lun, saikokaryukotsuboreito is effective for susceptibility to fright and deliri ous speech. Although our patient had no psychological symptoms such as these, an abdominal palpation examination led to diagnosis of a Sho (indication) for saikokaryukotsuboreito. So we started therapy with saikokaryukotsuboreito and her insomnia began improving immediately. To our knowledge, this is the first report of an insomnia patient with myasthenia gravis successfully treated with saikokaryukotsuboreito. Saiko karyukotsuboreito is not contraindicated in patients with myasthenia gravis. Thus we conclude that saikoka ryukotsuboreito is effective and safe for insomnia patients with myasthenia gravis.

A 65-year-old woman had left should pain for two months. She felt moderate pain in the left shoulder and she could not raise her left hand. She was diagnosed with shoulder periarthritis by an orthopedist, but her pain had not improved with medication and rehabilitation. So she came to our hospital. She had left shoulder pain with arthrogryposis and muscle atrophy over the course of the next two months. She had a floating and relaxed pulse with spontaneous sweating, so she was diagnosed with greater yang wind strike per Kampo medicine. Her left shoulder pain was improved with keishito for two weeks, and three months later she could raise her left hand. Greater Yang is characterized by floating pulse, headache, pain in the nape of the neck, chills, fever, general pain, and joint pain. And Greater Yang Wind Strike is characterized by fever, spontaneous sweating, mild chill and relaxed pulse. Keishito is useful for in Greater Yang Wind Strike, and our patient improved with keishito. However, keishito is generally used for the early stage of a common cold, and there have been a few reports that keishito is effective for chronic disease. To our knowledge, this is the first report of keishito being effective for shoulder periarthritis, and we believe that keishito is a valid option for the treatment of chronic pain in Greater Yang Wind Strike.

We conducted a study to evaluate the efficacy of mashiningan for constipation in Parkinson's disease. Twenty-three patients with constipation in Parkinson's disease were enrolled and were evaluated after 1 month in this study. The mashiningan efficacy endpoint in the study was bowel movement frequency. We categorized treatment effect as “effective”, “ineffective”, and “worsened” to calculate increased, unchanged, and decreased bowel movement frequencies, respectively. Previously administered laxative was also switched to mashiningan and subsequent effect was evaluated as well. Mashiningan was effective in 78.3% of patients, and there were no patients determined to have “worsened”. The only adverse effect was diarrhea which was noted in 13.0% of patients. Mashiningan was effective in 86.7% of the 15 patients without laxative administration history, and was effective in 62.5% of 8 patients who had taken laxative previously. Therefore, mashiningan showed a higher degree of efficacy in the patients off medication for constipation. Additionally, mashiningan could be safely switched to from other laxatives without worsening constipation. In conclusion, mashiningan is a useful medication for the treatment of constipation in Parkinson's disease.