We report a case of temporomandibular joint disorder (TMJD) in a patient diagnosed with a long-term illness accompanied by psychological symptoms. A 79-year-old woman presented with a 10-year history of pain around both TMJs. She was diagnosed with TMJD and received anti-inflammatory pain medications, as well as oral appliance therapy ; however, her symptoms persisted. Although psychosocial factors were considered to be contributors to her condition, the patient refused psychological therapy and sought treatment at a clinic that specialized in Kampo medicine. Considering her abdominal signs, which included upper abdominal muscle strain and middle epigastrium tenderness, the patient was prescribed saikokeishito (SAKT). Her TMJD and psychological symptoms improved rapidly following 2-week SAKT treatment (5.0 g/day). Individualized treatment using Kampo medicine may be potentially useful for rapid symptom improvement in patients with TMJD. This case report highlights that treatment by pattern (sho) identification may be effective for rapid improvement of TMJD symptoms.

We report four cases of post coronavirus disease 2019 (COVID-19) condition in which the patients suffered from a severe sense of fatigue that was successfully treated with warming-tonifying therapy using bukuryoshigyakuto, allowing them to return to normal social life. All four patients were unable to engage in social or school activities and had difficulty performing daily living tasks. Initially, they were treated with Kampo formulas corresponding to the yang pattern, which proved ineffective. However, their sense of fatigue was relieved after starting bukuryosigyakuto. Case 1 (36-year-old man) was a latent yin-deficiency pattern, in which an electro-acupuncture test revealed his interior cold. In Case 2 (53-year-old man), Case 3 (17-year-old woman) and Case 4 (11-year-old boy), the administration of bukuryoshigyakuto was based on the presence of severe sense of fatigue, characterized by the need to lie down almost all day and worsening symptoms after walking several dozen meters or taking a bath. There have been some case reports of tonifying therapies being effective in treating post COVID-19 conditions which are considered examples of qi deficiency or qi and blood deficiency following acute infectious disease. Kampo therapy with warming-tonifying formulas may be useful for post COVID-19 conditions that correspond to a late yin stage pattern in the six stage classification, particularly those presenting with severe sense of fatigue.

We report two cases of patients with intractable upper abdominal pain and histories of injury or surgery. The patients' pains were successfully treated with tokishigyakukagoshuyushokyoto (TSG). Case 1 involved a 59-year-old woman with left upper abdominal and thoracodorsal pain lasting 5 years. Kampo drugs such as tokito or prescriptions containing saiko were ineffective. Two years after her first visit, we noticed an injury scar from childhood that passed near the left hikon (pi-gen, ExB4) and induration and tenderness of the left hikon. TSG was administered, and the pain promptly improved. Case 2 involved a 66-year-old woman. She complained of epigastric, right­-upper-­quadrant abdominal and back pain lasting 7 years. Two years before presentation, the pain had worsened, but the cause was unclear. Although keishibukuryogan or Kampo drugs containing saiko were ineffective, her pain improved when TSG plus bushi was administered. A wound from a cholecystectomy was observed on her right abdomen. Induration and tenderness of the right hikon were demonstrated. The combination of past history of injury or surgery of the upper abdomen or back and induration of hikon can be associated with development of indications for TSG.

The present study aimed to investigate how nutritional status affected iron status, and how this knowledge might be used to prevent anemia in rhythmic gymnasts prior to a competition. We divided twenty-one subjects according to their iron status in just prior to competition into either an iron-deficiency group (n=12) and a non-iron-deficiency group (n=9), the latter of which represented the normal group. Iron-deficiency group was defined as a hemoglobin concentration below 12g/dl, a ferritin level below 12ng/ml and/or a transferrin saturation ratio under 16%. Physical, hematological, and nutritional assessments were made using a semi-quantitative food frequency questionnaire, once at 2 months before a competition, and once more just prior to the competition (‘pre-competition’).1) The iron-deficiency group had significantly lower body weight, body mass index and body fat at pre-competition compared to 2 months before the competition.2) Compared to the normal group, the iron-deficiency group had significantly lower serum iron and haptoglobin concentrations at the pre-competition.3) Intakes of energy, protein, iron, and vitamin C at the pre-competition were 1965±340kcal, 68.0±14.0g, 11.2±3.2mg, and 76±30mg in the normal group, and 1620±456kcal, 53.8±18.0g, 11.6±4.1mg, and 75±29mg in the iron-deficiency group, respectively. There was no significant difference in intakes of energy, protein, iron, and vitamin C between the groups, respectively.4) Pre-competition protein intakes per body weight (BW) were 1.46±0.33g and 1.08±0.31g in the normal group and the iron-deficiency group, respectively. Those levels were significantly lower in the iron-deficiency group than those in the normal group.5) Pre-competition protein energy ratio (13.9±1.6%) and animal protein ratio (56.0±6.7%) of the normal group were significantly higher than those measured 2 months before the competition. Conversely, those ratios remained constant for 2 months in the iron-deficiency group.6) Changes in the protein energy ratio and/or the animal protein ratio between the pre-competition and the 2 months before were significantly correlated with the pre-competition Hb levels.We conclude that the pre-competition iron status is closely associated with protein intakes in female collegiate rhythmic gymnasts.

Objectives : The present study investigates the effects of body iron stores upon indices of biosynthesis and destruction of red blood cells (RBC) induced by a single session of cycling exercise.
Design : Eight sedentary female students were divided into groups depending on their body iron stores : normal (C group, n=5) and iron deficient (D group, n=3) . Blood samples were collected at five time points of before (pre), immediately after (0 hours), then 1, 3 and 6 hours after exercise (248±31 kcal, 70% V0₂ peak level) . Osmotic fragility and serum haptoglobin (hp) concentration served as of for degradation, and δ-aminolevulinate dehydratase (ALAD) activity, erythropoietin concentration and number of reticulocytes served as indices of RBC biosynthesis.
Results : A single session of cycling exercise did not affect the level of RBC, hemoglobin, hematocrit, serum iron, ferritin, transferrin saturation, hp and osmotic fragility in either groups. The δ-ALAD activity increased at 3 (p<0.05) and 6 hours (p<0.01) after exercise compared with that at 0 hours in the C group. In contrast, δ -ALAD activity in the D group was significantly lower at 3 hours after exercise than that of C group (p<0.001) . Reticulocytes and erythropoietin concentration increased gradually in the C group after exercise, but not in the D group.
Conclusions : A single session of cycling exercise under our experimental conditions enhanced RBC biosynthesis indicated by δ -ALAD activity, whereas exercise-induced hemolysis was not evident. Body iron stores affect the δ -ALAD activity induced by a single bout of cycling exercise.