Arthritis of the carpometacarpal joint of the thumb is typically treated with oral anti-inflammatory drugs, external medicines, and temporary external fixation. We report 3 cases of arthritis of carpometacarpal joint of the thumb that were successfully treated with sokeikakketsuto. In cases 1 and 2, a 50-year-old woman and 68-year-old man, respectively, were diagnosed with arthritis of the carpometacarpal joint and were successfully treated with sokeikakketsuto. In case 3, a 66-year-old man complained of pain in the second carpometacarpal joint caused by gout, and was successfully treated with eppikajutsuto and daiobotampito. However, the pain in the carpometacarpal joint of the thumb due to arthritis remained, and was successfully treated with sokeikakketsuto. Eppikajutsuto and daiobotampito were effective for acute arthritis such as gout, and sokeikakketsuto was effective for osteoarthritis. Overall, patients with different diseases in the various local regions may have slightly different clinical presentations even in the same case.

Heberden's and Bouchard's nodes are clinical manifestations of osteoarthritis of the interphalangeal joints. Heberden's nodes typically affect the distal interphalangeal (DIP) and Bouchard's nodes, the proximal interphalangeal (PIP) joints of a fingers in patients with osteoarthritis. We describe osteoarthritis of the interpha­langeal joints in 3 women who were successfully treated with sokeikakketsuto. Case 1 : A 58-­year-­old woman presented with pain in the DIP joint of her left middle finger and was diagnosed with a Heberden's node. Case 2 : A 60­-year­-old woman presented with pain in the DIP joint of her left ring finger and was diagnosed with a Heberden's node. Case 3 : A 37­-year-­old woman presented with pain in PIP joint of her left ring finger and was diagnosed with a Bouchard's node. All women were successfully treated with sokeikakketsuto. In conclusion, sokeikakketsuto is a useful Kampo medication to treat mild-­to-­moderate pain secondary to bone, joint, or spinal conditions, as well as non-­steroidal anti­inflammatory drugs.

We present two cases of night sweats due to eiefuwa (deficiencies of nutrients and defenses) that were suc­cessfully treated with Kampo medicine. Case 1 was that of a 64-­year-­old man with perspiration during sleep and slight fever, and Case 2 was that of a 78­-year-­old man with perspiration during sleep and common cold­-like symptoms. Case 1 was administered with saikokeishito, and his symptoms quickly disappeared. Case 2 was administered with common cold drugs and saikokeishito initially, but the treatment was ineffective. Therefore, keishito was administered, and the patient's symptoms disappeared within 2 days. Sweating and common cold-­like symptoms were successfully treated with Kampo medicine for the diagnosis of eiefuwa. Further, we discuss the various descriptions of eiefuwa in the literature.

Poor eating is a life-threatening condition in senior citizens. Herein, we report a case of poor eating due to stomach yin deficiency (wei yin xu), which was successfully treated with bakumondoto. The patient was a 91-year-old woman who expected treatment for her poor food intake. She was diagnosed as poor eating with stomach yin deficiency and was administered with bakumondoto, which increased her food intake and weight. To treat poor eating with Kampo medicine, rikkunshito and various other Kampo drugs are commonly used. In this case, bakumondoto, which is usually used for respiratory diseases such as dry cough, was effective. Bakumondoto is useful for stomach yin deficiency of poor eating.

Carpal tunnel syndrome is a common condition caused by compression of the median nerve. Patients usually present with numbness and pain along the distribution of the median nerve in the hand. We report 2 cases of carpal tunnel syndrome successfully treated with kakkonto after their pattern diagnosis. We treated a 57-year-­old women and a 59-­year-­old man. Two patients presented with hand pain and numbness and were diagnosed with carpal tunnel syndrome. Kakkonto treatment was successfully in two cases. We observed that median nerve compression persisted in these patients even after disappearance of numbness and pain ; therefore, we recommended operative management. The 2 patients underwent an operation for carpal tunnel syndrome. Kakkonto can be considered useful palliative treatment before considering operative management for numbness and pain in the patients with carpal tunnel syndrome.

Crowned dens syndrome is a type of pseudogout that occurs in the elderly. It is associated with calcification around the dens of the atlas and can cause recurrent pain. We report successful treatment for crowned dens syndrome by using Kampo medicine. An 85-year-old woman was seen in our clinic after 3 days of neck pain and active exercise pain without trigger. Physical examination revealed tenderness in the bilateral upper cervical spine. Computed tomography (CT) revealed calcifications around the dens of the atlas and blood test data showed inflammatory reaction. Thus, she was diagnosed with crowned dens syndrome. In view of her medical history of gastric ulcer treatment, we prescribed Kampo medicine eppikajutsuto and daiobotampito, instead of nonsteroidal antiinflammatory drugs. The cervical pain and tenderness in her bilateral upper cervical spine disappeared, and her laboratory data also improved 6 days after treatment without side effects. Thus, her medications were discontinued.

In daily medical examinations of orthopedic surgery, treatment for chronic pain is sometimes needed. We report a case of chronic pain developed after an open fracture 15 years ago and successfully treated with sokeikakketsuto. A 35­-year-­old man unfortunately sustained an open fracture in his right lower leg in a traffic accident at his age of 20 years. He underwent 12­-13 surgeries for osteosynthesis, post-­operative focal infection, and leg extension. Subsequently, he developed periodic pain in his right ankle joint. He consulted our clinic because of the severe pain; although non-­steroidal anti-­inflammatory drugs were ineffective, sokeikakketsuto was dramatically effective. To treat chronic pain after an old fracture, sokeikakketsuto may be considered as a choice of treatment.

Crowned dens syndrome (CDS) is a pseudogout of the cervical vertebra, which shows calcification around the dens of the axis. We report a case of CDS that was successfully treated with daiobotampito and shimotsuto. An 83-year-old woman visited our clinic because of neck pain. She was diagnosed with CDS and was initially administered daiobotampito and eppikajutsuto. Her neck pain improved slightly, but recurred. She was then administered daiobotampito and shimotsuto, after which her neck pain disappeared. We considered that daiobotampito and shimotsuto were effective for this prolonged illness based on persistent stasis and blood deficiency according to her treatment course and laboratory findings.

Eruption as a dermatological disease is often localized, which is not fully explained by Western medicine. However, localization of eruption is interpreted in Kampo medicine according to meridian and collateral theo­ries, and here, we report two cases of successful treatment with Kampo medicine. Case 1 was of a 32-year-old woman who visited our clinic because of localized eruption around her mouth and was diagnosed with acne vulgaris. She was administered rikkunshito effectively. Case 2 was of a 37-year-old man who visited our clinic because of localized eruption in the anterior portion of the neck and was diagnosed with atopic dermatitis. He was administered shin'iseihaito effectively. Rikkunshito and shin'iseihaito are generally not adapted for dermatological diseases but were effective. After treatment we considered meridian and collateral theories. These two cases are depended on stomach meridian of foot-yangming and large intestine meridians of hand­-yangming, rikkunshito and shin'iseihaito were consisted of herbs concerning with spleen and lung meridians. Two cases were successfully treated through spleen meridian of greater yin and hand great yin lung meridian, which make exterior and interior with stomach meridian of foot-yangming and large intestine meridians of hand-yangming. Kampo medicine was effective for treating these diseases based on meridian and collateral theories.

Tokishakuyakusan is well-known to be useful in infertility. We report 3 cases of infertility that resulted in pregnancy and childbirth due to oral administration of tokishakuyakusan after being led to tokishakuyakusan pattern by symptomatic treatment resolving blood stasis or regulating qi. Case 1 was a 39-year-old woman with unexplained infertility. She visited our hospital because of irritability and was initially administered keishibukuryogankayokuinin and yokukansankachinpihange, and then tokishakuyakusan. After a month of treatment, she conceived. Case 2 was a 33-year-old woman who was diagnosed with ovarian dysfunction and received ovarian stimulation. To support infertility therapy she was administered keishibukuryogan, and subsequently, tokishakuyakusan based on her pattern. After 3 months of treatment, she conceived. Case 3 was a 37-year-old woman who was diagnosed with unexplained infertility and was administered kamishoyosan and hochuekkito for premenstrual syndrome at another hospital. She visited our hospital because of sensitivity to cold and fatigability. The previous treatment was discontinued, and she was administered tokishakuyakusan based on her pattern. After 2 months of treatment, she conceived. All 3 patients continued tokishakuyakusan treatment during pregnancy and successfully delivered live babies. These 3 cases initially received other Kampo medicines and then, tokishakuyakusan, according to the changed Kampo medical pattern. It is important to administer tokishakuyakusan to patients with infertility, following administration of appropriate Kampo medicine to correct their imbalance of qi, blood and fluid and after further confirming the abdominal signs suitable for tokishakuyakusan.