To date, there have been limited reports on the efficacy of Kampo medicine in treating obsessive compulsive behaviors. To the best of our knowledge, there have been no previous reports on the efficacy of ryokeijutsukanto for obsessive compulsive behaviors. Here, we describe 2 cases of obsessive-compulsive behavior successfully treated with ryokeijutsukanto. Case 1 involved a 30-year-old female patient who presented with vague anxiety. As a result, she spent significant time engaging in compulsive behavior related to checking and was frequently tardy to work. She met the diagnostic criteria for obsessive compulsive disorder. We prescribed ryokeijutsukanto. Her compulsive behavior then improved from 40 minutes to 5 minutes in 56 days. Case 2 involved 57-year-old female patient who complained of not feeling refreshed in the morning. In addition, she had a feeling of gloom, daytime sleepiness and compulsive behavior of checking about 5 times whether windows were locked. We prescribed ryokeijutsukanto. In 14 days, her checking behavior then improved from 5 times to once. Other troublesome symptoms also improved. Ryokeijutsukanto is usually utilized for patients with fluid retention, dizziness, and qi counterflow. However, these 2 cases have qi stagnation rather than qi counterflow. These results suggested that ryokeijutsukanto could also be utilized to treat compulsive behaviors when patients had fluid retention, dizziness and qi stagnation.

We present seven cases of insomnia successfully treated with hochuekkito. Two patients showed improvement of their insomnia after taking hochuekkito before going to bed, and three patients showed improvement after taking hochuekkito twice per day. The other two patients could sleep better after adding hochuekkito to other Kampo formulations. All these patients were light sleepers, and became easily tired, excessive sleepy after meals, and had daytime sleepiness. However, they had no gastrointestinal symptoms, such as appetite loss. Five of the seven patients reported waking up feeling better after taking hochuekkito. Two other Kampo formulations, sansoninto and kihito, were also given to patients with deficient constitution, who complained of insomnia. Sansoninto and kihito are formulae that compensate for qui and blood deficiency. Kihito contains more herbs with beneficial effects on “spleen and stomach”, and “heart” functions more than sansoninto, and therefore, kihito may be preferred for patients with a more deficient constitution. The reason why our patients were able to sleep more deeply and wake up smoothly with hochuekkito may be that they exhibited remarkable qui deficiency, showing general fatigue, excessive sleepiness after meals, and daytime sleepiness, but without the symptoms of blood deficiency, such as palpitations or uneasiness, being easily frightened or forgetful, or showing anemia or bleeding.

We investigated original texts for yokukansan, a familiar Kampo formula, focusing on the classical literature Xue-shi yi-an (薛氏医案) . Yokukansan was described in the Bao-ying jin-jing-lu (保嬰金鏡録) written by Xue ji (薛己) in 1550, the Xiao-er yao-zheng zhi-jue (小児薬証直訣) revised by Xue ji (薛己) in 1551,the Bao-ying cuo-yao (保嬰撮要) by Xue kai (薛鎧) in 1556, and the Xiao-er dou-zhen fang-lun (小児痘疹方論) in 1550. The phrase “one's own work” was used in “Bao-ying jin-jing-lu (保嬰金鏡録)” and in the Xiao-er dou-zhen fang-lun (小児痘疹方論) by Chen wen-zhong (陳文仲). However, there was no mention of “one's own work” in the same title, the Xiao-er dou-zhen fang-lun (小児痘疹方論), as summarized by Xiong zong-li (熊宗立).
Yokukansan was found only in the Xiao-er yao-zheng zhi-jue (小児薬証直訣) revised by Xue ji (薛己) in 1551, but not in the other copies of the same text. Therefore, it seems likely that yokukansan was created by Xue ji (薛己) himself.
Yokukansan was previously thought to have originated with the Bao-ying cuo-yao (保嬰撮要). However, based on use of the phrase “one's own work” in the classical literature, it appears that the original text for yokukansan should be the Bao-ying jin-jing-lu (保嬰金鏡録). Therefore, yokukansan seems to have been made by Xue ji (薛己), and not Xue kai (薛鎧), who was his father.

Headache is one of patients' major complaints at medical examination. And in Kampo medicine, we select prescriptions for them by taking not only headache, but also other symptoms into consideration.We present five patients with headache, whose symptoms were improved with tokishakuyakusan. Four patients (cases 1 to 4) had a background of menopausal symptoms and one (case 5), menstrual pain. Besides headache, other symptoms, such as vertigo, edema, and numbness of the fingers, were improved with tokishakuyakusan. Goshuyuto was not effective for headache in case 4, though it was effective to some extent in case 5, except for headache during her menstrual period. Headache during the ovulatory phase and/or pre- and early menstrual period disappeared when tokishakuyakusan was added to goshuyuto.Eleven cases of headache treated with toshakuyakusan, including these five cases, revealed that tokishakuyakusan was efficacious against migraine-type headache, which becomes worse during the menstrual period, and coldness. Although tokishakuyakusan should sometimes be distinguished from goreisan or hangebyakujyutsutenmato, it may be effective in patients with so-called “blood pattern” headache, associated with menstrual period and menopausal symptoms, and in patients with a heavy feeling of the head and vertigo.

It is important to treat patients with spleen qi deficiency not only with formulations for their deficiency, but also with formulations to improve qi stagnation.Rikkunshito plus Cyperi Rhizoma, Amomi Semen and Agastache rugosa, which improve qi circulation, was effective in cases 1 and 2 herein.We examined when and how to prescribe kososan with formulations for spleen qi deficiency, with reference to kosharikkunshito. Kososan and rikkunshito were effective in cases 3 and 4.Based on rikkunshito indication, a patient with weaker constitution was prescribed shikunshito (case 8), a patient with diarrhea and vertigo was prescribed shinbuto (cases 5 and 6), and a patient with severe coldness was prescribed ninjinto (case 7).Kososan played a supplementary role in treatment, and can be prescribed with other medicines.Not only gastrointestinal symptoms, but also various other complaints were improved by adding kososan to prescriptions for spleen qi deficiency.

Teian Azai classically described that summer heat was caused by humidity in addition to hot weather. It may occur after becoming chilled while asleep, enjoying the evening cool, and taking cold foods and drinks. Humidity and high temperature prevent qi circulation in the stomach. Therefore, he insisted that goreisan, a formula improving water circulation, could be applied for diverse symptoms caused by summer heat. We present two cases of patients with epigastralgia caused by cold foods and drinks in air-conditioned environments, whose symptoms were improved by goreisan. In prior treatment, anchusan in case1, and rikkunshito in case 2 were not effective for their epigastralgia. Nineteen cases of epigastralgia after taking cold foods and drinks in summer, including these two cases, revealed that goreisan was efficacious against summer epigastralgia with white fur on the tongue and a stuck feeling in the pit of the stomach. Abdominal fluid congestion is a major abdominal sign for an indication of goreisan, but a stuck feeling in the pit of the stomach presented in some effective cases with goreisan. We concluded that epigastralgia caused by cold foods and drinks with white fur on the tongue and a stuck feeling in the pit of the stomach could be a target for the application for goreisan.

Introduction : We evaluated the efficacy of keishito and maobushisaishinto with reference to keikyososooshinbuto, for patients feeling cold, by means of multiple regression analysis.
Case reports : We reported a patient with an upset stomach whose severe coldness was improved as the stomach condition was cured by adding keishito to maobushisaishinto. Moreover, the combination of keishito and maobushisaishinto was effective for a patient feeling cold, with appetite loss, general fatigue and stiffness of the joints (case 1), a patient feeling cold, with chill, general fatigue, heavy feeling in the stomach, and prone to catch colds (case 2), and a patient feeling extremely cold, with general fatigue and menstrual pain (case 3).
Subjects and Methods : In this study, the subjects were 43 patients who reported feeling cold. They were treated with keishito and maobushisaishinto according to their Sho for more than one month. The relationships between the improvement of cold sensation and 52 other factors, such as symptoms noted at their first medical examination, were evaluated by means of multi-dimensional cross-sectional analysis.
Results : The factors of chilly or unpleasant wind and coldness of the whole body were significant.
Discussion : The factors of coldness in the whole body with chill, and headache without diarrhea were important for improvement of cold feeling with keishito and maobushisaishinto.

Introduction : We evaluated the efficacy of daisaikoto for patients with generalized fatigability or easy fatigability by multiple regression analysis.Subject and Methods : The subjects were fifty-three patients with generalized fatigability or easy fatigability, consisting of 6 males and 47 females, mean age 38 y/o (range 23-72), who were treated with daisaikoto according to Sho for more than one month. The relationships between the improvement of generalized fatigability or easy fatigability and 46 factors, including age, sex, height, body weight, hypertension and other symptoms noted at the first medical examination, were examined by multi-dimensional cross-sectional analysis.Results : The factors of sweating, hot flushes, sensation of something stuck in the throat, and feeling of fullness in the chest were significant. Improvement of objective tenderness on the sides of the abdomen and sweating formed the best subset of explanatory variables.Discussions : The sensation of something stuck in the throat and feeling of fullness of the chest often occur under Ki stagnation. The improvement rather than the existence of objective tenderness on the sides of the abdomen is assumed to be more important factor.

In Kampo, “lung medicines” are usually used to treat patients with bronchial asthma, according to the type of cough and sputum, and the degree of dyspnea which presents. However, it is also important to exclude exacerbating factors. In Kampo, the lungs and large intestine are thought to have a close relationship. We report three bronchial asthma patients whose cough and dyspnea were ameliorated by improving bowel movements. We discuss the types of bronchial asthma patients who might be effectively treated by controlling their defecation. We suggest that, when patients with mild bronchial asthma who have not previously had trouble with their bowel movements complain of respiratory distress with abnormal bowel movement, it might be effective to apply “large intestine medicines” to relieve their respiratory problems. (122 words)
Asthma ; Respiratory ; Bowel action ; Defecation ; Cases

We evaluated the efficacy of yokukansan-based prescriptions for patients with headache. Forty-five patients with headache (34 migraine, 6 tension-type, and 5 combined headaches), or 6 males and 39 females, mean age 38 (25 to 68) years were treated with yokukansan-based prescriptions according to their Sho diagnosis, for 1 to 24 months. Relationships between headache improvement, and 31 factors including age, sex, height, body weight and other symptoms at first examination, were qualified with multi-dimensional analysis. Factors such as painful eye sensation, back stiffness, eyestrain and irritability were significant indicators of headache improvement. Three of these factors (painful eye sensation, back stiffness and irritability) were the best subset of explanatory variables. Yokukansan-based prescriptions seemed to be effective for “liver-related” headache, and were thought to be useful to relieve a triggering or worsening of headache factors. And to our knowledge, this is the first paper to propose the importance of examinations of the back, when considering yokukansan-based prescriptions.
Headache ; Back ; Therapeutic procedure ; Esthesia ; Prescriptions