Introduction: Stainless steel needles are mainly used in acupuncture treatment, but material considerations are crucial for patients with metal allergies. This report presents a case of acupuncture treatment administered without inducing allergic symptoms in the patient, achieved through effective collaboration with medical specialists.  Case: The patient was a 35-year-old woman. Complaints were menstrual symptoms, neck and lumbar pain, the former appeared after the birth of her second child at the age of 24, and the latter was felt chronically. She visited our department because she wanted to receive kampo medicine and acupuncture treatment. It was also reported that she had metal allergy symptoms. Therefore, after consultation with the allergist of our department, a full examination was requested at the dermatology department. In the meantime, our department suspected PMS, PMDD, and muscular or joint pain. First, we started acupuncture treatment using titanium press tack needles and resin contact needles to address muscular or joint pain, taking metal allergies into consideration. The frequency was once every two weeks. One month later, a patch test result was positive for nickel. Nevertheless, she still requested acupuncture treatment, and we consulted with the allergist regarding her case. Then, with her consent, the silicone-coated stainless steel acupuncture needles were inserted into the distal part of the limbs and remained in place for 15 min. During this time, we observed her skin and instructed her to closely monitor it and report any changes at her next visit. From the fifth treatment onward, additional acupuncture needles were placed in the neck and lumbar region, all without any allergic symptoms being observed.  Discussion and Conclusion: In this case, acupuncture treatment was performed safely in the medical cooperation. In the future, we would like to further examine the establishment of acupuncture treatment with high safety for patients with metal allergy symptoms and collaboration with medical specialists.

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.

Painful orthopedic diseases are sometimes aggravated because of weather changes ; this is referred to as meteorological pain. We report two cases of great occipital neuralgia (GON) due to traffic accident in patients whose pain was aggravated by weather changes. Case 1 involved a 41-year-old woman who developed lumbago and cervical pain following a traffic accident. Two months after the accident, she had irregular occipital pain. Three months after the accident, a great typhoon occurred, and she suffered from severe occipital pain since that morning. She was diagnosed with GON as meteorological pain and was administered goreisan ; her occipital pain then improved. Case 2 involved a 31-year-old woman who developed cervical pain following a traffic accident. Three months after the accident, she experienced severe occipital pain due to weather changes. She was diagnosed with GON as meteorological pain and was administered goreisan ; her occipital pain then improved. Goreisan is dramatically effective for GON as meteorological pain caused by cervical sprain.

The tongue possesses a complex muscular structure, and its motor functions are also intricate. Therefore, it would be beneficial to use a computational physiological model of the tongue to examine its vital functions in normal and pathological conditions. Thus far, the studies of tongue models have focused on symmetric movements for normal speech. For clinical purposes, it is necessary to develop a physiological model to deal with daily vital activities such as mastication and swallowing. To do so, we constructed a full 3D physiological model of the tongue based on MRI data from a normal subject, and verified the basic functions of the model based on anatomic and physiological knowledge. In this study, the model was applied to clinical issues: prediction and verification of the changes in movements of the tongue with a tumor before and after partial glossectomy, respectively. Tongue protrusion and lateral bending motion were examined for the prediction and verification. The simulation results were consistent with the observations for a patient with a tumor in the tongue. Comparisons of the simulation and observation in the clinical case showed that the model could predict potential effects of the glossectomy on the tongue movements. It is suggested that the model is a useful tool for pre-operative planning of glossectomy.