We report a case of a 38-year-old woman who initially had pain in her entire left leg and then began to feel intense pain everywhere in her body. She visited our Kampo clinic because of a poor response to the various drugs prescribed by six doctors over two years. We made the diagnosis of fibromyalgia and suggested Kampo therapy with decoction. We focused on liver qi depression, blood deficiency, and blood stasis because she had symptoms of dry skin, cold feet, deeply located fine pulses, purple tongue with thick yellow fur, fullness in her chest and hypochondrium, and pain on palpation beside her umbilicus. Therefore, we prescribed a keppuchikuoto modified formula with poor effect. Finally, we thought this might be caused by a liver-kidney yin deficiency because she had long-term symptoms and administered a dokkatsukiseito modified formula. Her symptoms markedly improved after taking this formulation. Some cases of fibromyalgia are resistant to standard Western treatments. Kampo medicine may be useful and provide relief in such cases.

Orthostatic dysregulation arises primarily from venous pooling in the lower extremities due to abnormal regulation of the autonomic nervous system. This leads to altered central blood volume, which reduces cardiac output and circulating blood volume, resulting in difficulties in rising, dizziness, fatigue, nausea, and palpitations. The treatment of orthostatic dysregulation typically involves non-pharmacological measures such as salt and water supplementation, as well as pharmacological interventions including midodrine hydrochloride. Here, we present two cases of orthostatic dysregulation that were effectively treated with shakanzoto, a Kampo medicine. Case 1 was a 15-year-old boy who had been experiencing fatigue, difficulty in rising, and palpitations in the morning for two years, resulting in his inability to attend school for six months. He was diagnosed with orthostatic dysregulation in accordance with the Japan Clinical Guidelines on Psychosomatic Diseases in Childhood and was administered shakanzoto, after which his symptoms were resolved by day 14 of the follow-up visit, enabling him to attend school. Case 2 involved a 14-year-old girl who had been experiencing fatigue, nausea, dizziness, and palpitations in the morning for five years and was also diagnosed with orthostatic dysregulation in accordance with the aforementioned guidelines. She was administered shakanzoto and her symptoms resolved by the fourth day, allowing her to return to school. To date, the effectiveness of shakanzoto for the treatment of orthostatic dysregulation has not been reported. Nonetheless, shakanzoto may be considered as a potential addition to the treatment for orthostatic dysregulation.

We report a case of a 74-year-old woman who suffered from uncomfortable heat under her right shoulder blade and felt anxiety about general fatigue that had been worsening mainly in the summer. She visited our Kampo clinic because of insufficient effect of various types of drug that had been prescribed by 3 doctors for about a year. We made the diagnosis of somatic symptom disorder and suggested Kampo therapy with decoction. We thought this might be caused by liver qi depression, blood deficiency, and blood stasis because he had symptoms of dry skin, cold of feet, deeply located fine pulse, pale and purple tongue with yellow thick fur, fullness in the chest and hypochondrium. Therefore we administered keppuchikuoto modified formula. Her symptom improved within about a month after taking this formulation. There was no recurrence of the physical symptom and fatigue in the summer during taking medicine for about 20 months. Evidence-based treatment in somatic symptom disorder has not been established and some cases are resistant to treatments in modern Western medicine. Kampo medicine may be useful and hopeful.

We report a case of a 51-year-old male who suffered from chronic idiopathic urticaria on every part of his body. Urticaria appeared especially in the morning and evening. He visited our Kampo clinic because of insufficient effect of antihistamine drug and tokiinshi that had been prescribed by a dermatologist for about a half year. We thought this might be caused by blood deficiency, blood stasis and liver qi depression because he had symptoms of sensitiveness of heat, dry skin, purple tongue with yellow fur, a deeply located string-like pulse,and fullness in the chest and hypochondrium. Therefore, we administered keigairengyoto and ryutanshakanto but the effect was insufficient. During this treatment, we revealed his state of having thick fur in tonguediagnosis. Finally we prescribed him seijobofuto and inchingoreisan because we concluded that it might be necessary to remove dampness-heat in this case. His symptom improved within about a week after taking this formulation. Some cases of chronic urticaria are resistant to standard treatments in modern western medicine. Kampo medicine may be useful and hopeful in these cases.

Cough-variant asthma is the most common cause of chronic cough. It may progress to classic asthma and therefore requires adequate treatment intervention. We experienced two cases of cough-variant asthma that was refractory to standard drug therapy but improved after additional administration of kumibinroto. In Case 1, the patient was a 46-year-old woman receiving hormone therapy after breast cancer surgery. She developed cough-variant asthma 5 years ago, and though she has received drug therapy, the symptoms aggravated. Cough continued to appear at night without improvement of asthma symptoms. However, the symptoms improved with subsequent administration of kumibinroto. In Case 2, the patient was a 47-year-old woman who developed cough-variant asthma after childbirth, which repeatedly worsened and improved. The cough-variant asthma aggravated after change of workplace and did not improve with drug therapy. However, asthma symptoms improved with oral administration of kumibinroto and hangekobokuto, and subsequent administration of kumibinroto alone. In both patients, the asthma was seasonal. These cases suggest that kumibinroto administration may contribute to the improvement of cough-variant asthma.

We report a case of a 3-year-old girl who suffered from alopecia areata and was successfully treated with rokumigan modified formula. Initially, alopecia areata appeared on her left temporal region at the age of 3. The hair loss range had spread rapidly over the whole head. She visited our Kampo clinic because of insufficient effect of antiallergic drug. We prescribed her yokukansan, shimotsuto and juzentaihoto but the effect was insufficient. Finally, we thought this might be caused by kidney yin deficiency and liver blood deficiency because she had symptoms of pale white complexion, fine pulse, pale tongue with thin fur, and night sweating. Therefore, we administered rokumigan modified formula : rokumigan, tokiinshi and lycium fruit. Her hair began to grow after administering this formulation. There was not the re-hair loss during taking medicine for about 4 months. According to the traditional Chinese medicine, alopecia areata can be classified into 4 types : blood heat type, blood stasis type, dual deficiency type of yin and blood, dual deficiency type of qi and blood. We diagnosed this case as a dual deficiency type of yin and blood and selected rokumigan modified formula. Rokumigan is effective for various symptoms of kidney yin deficiency, and rokumigan modified formula may be useful for the treatment of infant alopecia areata.

Intestinal spirochetosis is a rare gastrointestinal infection caused by Brachyspira. Clinical manifestations vary, ranging from asymptomatic infection to gastrointestinal bleeding, diarrhea, or abdominal pain. Antimicrobial medications such as metronidazole are routinely given, but their clinical efficacy has not determined with any precision. We report a case of intestinal spirochetosis treated with daikenchuto extract with literature reviews. Treatment of intestinal spirochetosis can be difficult, and use of daikenchuto extract may be an option especially for patients with symptoms such as chronic diarrhea, abdominal distention, or change in flatus.

Background: Gingyo-gedoku-san (GGGS) is an herbal medicine approved for upper respiratory infections in Japan. We conducted an open-label, multi-center, prospective trial, comparing GGGS with oseltamivir in patients with influenza and influenza-like illness (ILI) as a pilot study.
Methods: Subjects were healthy persons aged between 16 and 40, and were enrolled from January 12, 2010 to March 24, 2011. Fifteen patients were enrolled in this trial (8 and 7 for GGGS and oseltamivir, respectively). RT-PCR was positive for pandemic influenza A (H1N1) in 10 patients. The patients were provided with either GGGS or oseltamivir for 5 days. The primary outcome was mortality and/or hospitalization 7 days after the initial diagnosis. Body temperature and other clinical characteristics were also evaluated.
Results: All patients recovered from illness without complication or hospitalization. The mean time to resolve symptoms for the GGGS and oseltamivir groups was 3.9 days and 3.3 days, respectively (p=0.43). The GGGS group appeared to have a smaller symptom score AUC than the oseltamivir group, (p=0.26). Time to recover activity level appeared to be shorter in the GGGS group (p=0.10), with shorter time to recover health status (p=0.02). Sub-group analysis on patients with positive PCR showed similar results between the two groups.
Conclusion: GGGS was associated with symptom improvements resembling oseltamivir for both influenza and ILI. Randomized controlled trials involving larger sample sizes are needed to confirm these results.

The management of influenza has dramatically changed since the introduction of the rapid influenza diagnostic test, or RIDT, and neuraminidase inhibitors (NI). However, it is still far from optimal due to low RIDT sensitivity and problems involving NI such as side effects and the potential emergence of resistant virus.Therefore, we developed a decision-making model for the management of influenza, which includes Kampo medicines in its strategies. First, the severity of patients is evaluated. If a patient is judged at severe or high-risk, intravenous NI would be the main component of treatment. If a patient has neither a severe condition nor is at high-risk, the patient would be asked to choose either NI or Kampo medicine. In the former, RIDT would be used if pretest probability was less than 50%, but it would not be used if it was more than 50%, based on the lack of influence on the post-test probability. For the latter, RIDT would be not used in general as Kampo targets “phenomena”, not the virus per se. This model enables us to optimize the use of RIDT by appropriately selecting patients based on the characteristics of RIDT, and by avoiding unnecessary tests and their misinterpretation.

We report a case of refractory pleural effusion after mitral valve replacement (MVR) successfully treated by adding goreisan. A 60-year-old man had right pleural effusion with exertional dyspnea in spite of taking two diuretics (furosemide 60 mg and spironolactone 25 mg a day) for 2 years after MVR. He underwent drainage twice and spironolactone was increased to 50 mg, but his pleural effusion volume still increased. Then in addition, he received goreisan 7.5 g a day, and the pleural effusion was decreased and stabilized. This suggests that goreisan is a candidate drug for additional treatment, when pleural effusion is uncontrolled because of heart failure, despite taking diuretics.