We report three cases of stroke in which rikkunshito was administered to improve the reflux of gastric fluid from a nasogastric tube in a short time.
Case 1 : a 63-year old female with right cerebellar hemorrhage who underwent surgical evacuation. Reflux of up to 650 ml gastric fluid from a nasogastric tube was observed after surgery. By the 4 th day of rikkunshito administration, the reflux decreased to 10 ml.
Case 2 : a 44-year old male whose consciousness had deteriorated before surgical treatment because of subarachnoid hemorrhage and re-rupture. Endovascular embolization and bilateral external ventricular drainage were performed for the anterior communicating artery aneurysm. Several days later, rikkunshito administration was initiated because of a reflux of 550 ml gastric fluid from the nasogastric tube. By the 3 rd day of rikkunshito administration, almost no episodes of reflux during tube feeding were observed.
Case 3 : a 72-year old male who suffered from intratumoral hemorrhage after undergoing surgery for metastatic brain tumor. The intratumoral hemorrhage was treated conservatively. Reflux of 200 ml gastric fluid from the nasogastric tube was observed. By the 3 rd day of rikkunshito administration, the reflux decreased to 10 ml.
These findings suggest that rikkunshito is useful in stroke cases with considerable reflux from a nasogastric tube.

We report our experience with two patients who had a previous history of cerebral hemorrhage and presented with persistent hiccups. Hangekobokuto was found to be effective in these patients. Case 1 was a 49-year-old man with a history of cerebral hemorrhage who experienced persistent hiccups as a result of pulmonary aspiration that occurred while he was admitted to the hospital for heat stroke. Abdominal palpation revealed epigastric resistance and tenderness. Metoclopramide and shakuyakukanzoto were administered without any amelioration of the symptoms, but the symptoms disappeared 1 hr after changing the drug regimen to hangekobokuto. Case 2 was a 64-year-old man who experienced persistent hiccups 28 days after suffering a cerebral hemorrhage. Abdominal palpation revealed epigastric resistance and tenderness and a lack of resistance at the lower abdomen. Because a regimen of metoclopramide and shakuyakukanzoto was similarly ineffective, we changed the drug regimen to hangekobokuto, and the symptoms subsequently disappeared 7 hr after administration. The symptoms did not recur in either patient following treatment. Hangekobokuto can be effective in cases of persistent hiccups is worth considering as a treatment option.

Gender differences were measured in the amount of intramyocellular triglyceride (IMCL) and extramyocellular triglyceride (EMCL) in skeletal muscles using¹H-MR spectroscopy and their relation to body fat and peak VO₂was studied. Fourteen apparently healthy subjects were separated into groups by gender. Both the male and female group subjects were selected according to similar ages and BMI (male: n=7, BMI=20.5±0.6 kg/m², age=21.1±0.7 years, female: n=7, BMI=20.6±0.5 kg/m², age=18.7±0.3 years) . We found a significant correlation between IMCL and EMCL in the soleus (SQL: p<0.01) and medial gastrocnemius (MG: p<0.01) muscles. IMCL values in SQL were significantly higher than IMCL values in MG and tibialis anterior muscle (TA) in both males and females in the order of SQL>MG>TA (p<0.01) .
IMCL and EMCL values in MG and SQL among females were significantly higher (p<0.01) than their corresponding values in males. However, a gender difference in IMCL and EMCL values for TA was not found. There was no correlation between IMCL and EMCL values for each muscle and BMI ; but IMCL (r=0.63 in SQL) and EMCL (r=0.88 and r=0.73 in SQL, and MG, respectively; p< 0.01) values correlated significantly with percent FAT. There was no correlation between IMCL values for each muscle and peak VO₂; but the EMCL values of SQL correlated quite negatively with peak VO₂ (r=-0.63, p<0.05) . These results suggest that there are gender differences in intramyocellular and extramyocellular triglyceride contents. Lipids were positively related to percent body fat in SQL and MG; EMCL values may have a negative effect on endurance capacity.

Gender differences were measured in the amount of intramyocellular triglyceride (IMCL) and extramyocellular triglyceride (EMCL) in skeletal muscles using¹H-MR spectroscopy and their relation to body fat and peak VO₂was studied. Fourteen apparently healthy subjects were separated into groups by gender. Both the male and female group subjects were selected according to similar ages and BMI (male: n=7, BMI=20.5±0.6 kg/m², age=21.1±0.7 years, female: n=7, BMI=20.6±0.5 kg/m², age=18.7±0.3 years) . We found a significant correlation between IMCL and EMCL in the soleus (SQL: p<0.01) and medial gastrocnemius (MG: p<0.01) muscles. IMCL values in SQL were significantly higher than IMCL values in MG and tibialis anterior muscle (TA) in both males and females in the order of SQL>MG>TA (p<0.01) .
IMCL and EMCL values in MG and SQL among females were significantly higher (p<0.01) than their corresponding values in males. However, a gender difference in IMCL and EMCL values for TA was not found. There was no correlation between IMCL and EMCL values for each muscle and BMI ; but IMCL (r=0.63 in SQL) and EMCL (r=0.88 and r=0.73 in SQL, and MG, respectively; p< 0.01) values correlated significantly with percent FAT. There was no correlation between IMCL values for each muscle and peak VO₂; but the EMCL values of SQL correlated quite negatively with peak VO₂ (r=-0.63, p<0.05) . These results suggest that there are gender differences in intramyocellular and extramyocellular triglyceride contents. Lipids were positively related to percent body fat in SQL and MG; EMCL values may have a negative effect on endurance capacity.

This study used proton magnetic resonance spectroscopy (¹H-MRS) to investigate differences in muscle group specific intramyocellular lipid (IMCL) storage characteristics associated with elevated muscle lipid storage, and to determine whether IMCL content is associated with maximal aerobic capacity. Seven healthy men [untrained (UT)], four overweight (OW) and six endurance-trained (T) subjects volunteered for this study. Data were acquired, using ¹H-MRS, from the tibialis anterior (TA), medial gastrocnemius (MG) and soleus (SOL) muscles. The IMCL content in TA was approximately twice as high in T subjects than in UT and OW subjects. In MG, IMCL was higher in OW and T subjects compared with UT subjects. A linear relationship existed between the VO₂max and IMCL in TA and a curve of second-degree relationship between the VO₂max and IMCL in MG. These results suggest that elevated IMCL deposits in TA might reflect enhancement of aerobic capacity, whereas the IMCL accretion in MG might reflect not only aerobic capacity but also overweight and obese conditions in men.

The aim of this study is the evaluation of intramyocellular (IMCL) and extramyocellular lipids (EMCL) in skeletal muscle in elderly female endurance-trained individuals. The subjects comprised endurance-trained elderly persons (END : n=7, age=66.1±2.0) and healthy elderly control subjects (CON : n=7, age=70.1±3.0). All subjects were female and matched by age and lower BMI. We quantified differences in IMCL and EMCL concentrations in the tibialis anterior (TA), soleus (SOL), and medial gastrocnemius (MG) muscles using ¹H-MR spectroscopy. The IMCL and EMCL contents in SOL and MG in END were significantly lower than those in CON (p<0.01). Total lipid content in SOL and MG was lower in END. The IMCL and EMCL contents in TA in END were slightly lower than those in CON. Water contents of all types of muscle in END were higher than those in CON. These results suggest that stored IMCL and EMCL in END are less than in CON.

A 60-year-old female patient was treated with gamma knife on the left frontal lobe metastatic brain tumor. After 3 months, the tumor and peri-focal edema turned worse due to radiation necrosis. Despite increasing doses of steroid administration, the deterioration lasted for 6 months. The symptoms and brain edema did not improve for over a year, but we decided to observe the patient without bevacizumab. We performed Methionine-PET to diagnose radiation necrosis of the brain, and confirmed absence of hot spots. The steroid therapy continued and added saireito 9 g/day, because we thought brain edema was concerned with fluid retention. After 9 months, head MRI showed improvements of the brain edema. Saireito may help improve brain edema due to radiation necrosis.

Two cases of hair loss due to coronavirus disease 2019 (COVID-19) sequelae as known as Long COVID were successfully treated with ninjin’yoeito. Case 1 was a 45-year-old woman who complained of hair loss about 2 months after COVID-19 (moderate II in Japanese criteria). Case 2 was a 50-year-old woman who complained of hair loss about 2 months after COVID-19 (mild). In all cases, hair loss stopped next month after treatment with ninjin’yoeito. And their hair began to grow 2 months later administration, the depression caused by hair loss improved as the symptoms improved. Hair loss is one of the symptoms with blood [TM1] deficiency, and patients suffering from Long COVID are also with qi deficiency. We gave ninjinʼyoeito for pattern of both qi and blood [TM1] deficiency with reference to traditional key of treatment, and it contributed to the improvement of symptoms.