The usefulness of acupuncture and moxibustion as complementary and alternative medicine in the field of palliative care, in recent years. Since August 2021, acupuncture and moxibustion therapy was integrated into the palliative care team at Tokai University Hospital, an advanced acute care hospital. We present an overview and activities of the acupuncture and moxibustion therapy team at our hospital. Within approximately 1 year and 3 months, 35 patients (14 men and 21 women) presented for acupuncture and moxibustion therapy, which corresponds to 10% of the number of patients treated by the palliative care team. The most common reason for consultation was requests for physical pain, especially pain (55%), indicating a need for acupuncturists to relieve pain. The most common treatment method was warm moxibustion, suggesting the influence of painful or scary images of acupuncture. The majority of patients also wanted acupuncture intervention until discharge from hospital. The presence of a need for acupuncture for temporary relief of pain as well as temporary improvement of mental state, including relaxation, was suggested.

Uzushakusekishigan is a Kampo formula described in ‘Jin Gui Yao Lue' for treatment of “heart pain that spreads out to the back, or back pain that spreads to the heart.” We successfully treated three patients with this formula. Patient 1 was a 53-year-old man suffering from precordial pain which occurred after amputation of the right forearm;patient 2 was a 46-year-old man with epigastralgia that occurred after taking cold meals;and patient 3 was a 28-year-old woman suffering from epigastralgia accompanied with panic disorder. Epigastric discomfort and resistance occurred in all three cases, prompting us to prescribe this formula. There are few reports of successful application of uzushakusekishigan, and it is not clear what symptoms and pathologies are relevant when prescribing this formula. However, our findings strongly suggest that uzushakusekishigan should be considered when treating severe chest or abdominal pain.

We report a case of panic disorder treated with keishikyokeikabukuryobyakujutsuto. The patient was a 42-year-old woman who had one or two episodes of panic attacks every month for 1 year accompanied by dyspnea, fear, rigidity of hands, etc. The episodes were more frequent with physical exertion and menstruation and did not improve with kamishoyosan or kanbakutaisoto. Then, after a car accident, she had a panic attack with a stronger intensity. Blood and imaging examinations revealed no special findings, and we diagnosed her with panic disorder. We considered her complaint as Honton disease and administered ryokeikansoto. After 2 weeks, her mental condition improved, and dyspnea and fear of attacks relieved. After 2 months, office work became more strenuous, and attacks recurred once or twice a week. An abnormal sensation of the posterior cervix occurred as a prodrome of an attack, and simultaneously, she noticed neck stiffness. After switching to keishikyokeikabukuryobyakujutsuto, the cervical sensation disappeared, neck pain and neck stiffness were relieved, and the attacks did not reappear. This case suggested that keishikyokeikabukuryobyakujutsuto was useful for the prevention of panic attacks associated with neck stiffness.

An eight-year-old girl was referred and admitted to our hospital with the chief complaint of purpura on her lower legs. Blood tests revealed pancytopenia, and bone marrow findings showed marrow hypoplasia. Refractory cytopenia of childhood (RCC) was diagnosed based on the central diagnostic system of the Myelodysplastic Syndrome Committee of the Japanese Society of Pediatric Hematology. Immunosuppressive therapy was performed with the administration of rabbit antithymocyte globulin, methylprednisolone and cyclosporin A,but it was not effective. Eight months after admission to our hospital, Kampo treatment was started based on traditional Kampo diagnosis. After treatment with oral administration of kamikihito and kyukikyogaito, her pancytopenia gradually improved. Erythrocyte transfusion was discontinued after 2 months, and concentrated platelet transfusion also became unnecessary after 3 months. As a result of improvement in pancytopenia, her white blood cell count, hemoglobin value, and platelet count reached almost normal levels after 16 months. The scheduled bone marrow transplantation was canceled. The action mechanisms of kamikihito and kyukikyogaito for RCC are not clear, and their effective rates are also unknown. However, Kampo treatments are less invasive, inexpensive, and have few side effects. We believe that Kampo medicine is a therapeutic method that should be actively attempted in cases of RCC with poor response to standard treatment.

Kyokatsushoshitsuto is a Kampo formulation used against cervix pain so severe that the neck cannot be turned. Of six patients we treated with this formula, it was effective in three cases but ineffective in the remaining three. From the viewpoint of traditional Chinese medicine (Kampo) regarding the in/effectiveness of this formula : in effective cases, palpitations in the area of the navel and tooth marks on the tongue are seen in patients in a weak state. As for subjective symptoms : in effective cases, “the waist area around the body sometimes feels cold”, “air conditioning is disliked”, and “an electric blanket etc. is needed in winter” were also indicative signs. On the other hand, symptoms such as “the skin becomes dry”, “water may accumulate in a joint”, and “symptoms of clicking/pain in the knee and having difficulty sitting straight” were not seen. In total, these may serve as useful indications for the application of kyokatsushoshitsuto, especially when palpitations in the navel area are considered a helpful new Kampo finding.

The patient was a 49-year-old woman. She developed retroperitonitis and retroperitoneal emphysema due to iatrogenic duodenal perforation. We inserted a nasogastric tube into her stomach in order to decompress the gastrointestinal tract, and cefoperazone and proton pump inhibitors were administered intravenously. Her symptoms of retroperitonitis were then reduced. However, she developed enteritis suspected due to MRSA infection complicated by acute respiratory distress syndrome, acute renal failure and shock. We administered vancomycin via nasogastric tube, but her symptoms did not improve, so we added shojokito. She relieved her bowels after the administration of shojokito, and an antipyretic tendency was observed. Her breathing status recovered to normal, her blood pressure was stable, and her general condition gradually improved.
In recent years, we have not had many opportunities to perform Kampo treatment for severe infection cases needing hospitalization, but Kampo application has the potential to enhance the efficacy of infection treatments. Thus we advocate the active carrying out of Kampo treatment for patients with intestinal infection.

We report two cases of inchinkoto treatment for obstructive jaundice via autoimmune pancreatitis (AIP). Case 1 : A 38-year-old male. After completion of treatment for Mikulicz disease, obstructive jaundice developed. A diagnosis of AIP was based on a high IgG 4 blood level and image views. T-Bil stayed above 20 mg/dl and there was no improvement by oral administration of prednisolone (PSL), ursodeoxycholic acid, or bilirubin adsorption therapy. Upon inchinkoto administration, T-Bil promptly fell to 3 mg/dL. Case 2 : A 77-year-old male. He suffered from itching and constipation, and blood data showed a pattern of obstructive jaundice. Image views suggested AIP, but a duodenal papillary biopsy could not provide a definitive diagnosis. Inchinkoto was administered, and the itching and constipation had mostly disappeared within 1 week. However, these symptoms recurred after one month. A definitive diagnosis of AIP was then reached based on a pancreas biopsy, and a PSL regimen was initiated. From these two cases, we consider that inchinkoto is useful for improving the symptoms of obstructive jaundice induced by AIP.

Norovirus infection is a common cause of epidemic winter vomiting and diarrhea. The symptoms that present, such as vomiting, diarrhea, fever and abdominal pain, normally disappear within 1 to 3 days, although some fatal cases are reported in the elderly.During the two months from December 1, 2005 to January 31, 2006, we prescribed ogonto to twenty patients who presented with vomiting or diarrhea in a nursing home, and examined prescription times and illness durations, other drugs used, and whether there were any transfusion or complications.The number of ogonto doses given was from 1 to 12. Fifteen cases (75%) were dosed 3 times or less, and four cases were only dosed once. In terms of illness duration: eleven cases were cured in less than 24 hours; six cases were cured from 24 hours to less than 48 hours; two cases were cured from 48 hours to less than 72 hours; and one case was cured from 72 hours to less than 96 hours. Overall, seventeen cases (85%) were cured in less than 48 hours.Regarding the other treatment and complications: domperidone was used in four cases; and a transfusion was given in six cases. Aspiration pneumonia occurred in one case, but no patient required hospital treatment. Norovirus infection is usually treated only with symptomatic therapy, so we think Kampo therapy should be available because when started at an early stage, it can prevent this disease from becoming severe.

We experienced two cases of postherpetic neuralgia (PHN) improved with Kampo medicines that include uzu (i.e. uzu-zai).The pain from PHN was improved via the administration of an uzu-zai in these 2 cases, worsened by its discontinuation, and improved again by its re-introduction.Case 1 : A 76-year-old male suffering from PHN of the right L 2-3 area was administered uzukeishito and obtained pain reduction. After 12 months, his prescription was changed from uzukeishito to keishikaryoju-tsubuto. Then, after only 2 days his pain worsened again. Uzukeishito treatment was re-instated, and he again obtained pain reduction. Case 2 : An 82-year-old male suffering from PHN of the right C 4-5 area was given uzuto and obtained pain relief. After 3 months his prescription was changed from uzuto to keishikajutsubuto. Then, after only1week his pain worsened again. Uzuto was then re-introduced, and pain reduction was achieved again. These two cases led to two suggestions. First, that the uzu-zais were very effective against the PHN pain. Second, that this effect of an uzu-zai against PHN pain might be a symptomatic rather than a radical treatment.These two cases highlight the fact that the use of an uzu-zai was instrumental in reducing PHN-associated pain, but further studies will be needed to determine a dosage protocol, including when and at what pace uzu-zais might be reduced/discontinued.

Pure autonomic failure (PAF) is a degenerative disorder with diverse autonomic nervous symptoms, but without somatic nervous symptoms. We encountered a patient with PAF who was successfully treated with keishikashakuyakuto. A 61-year-old man complained of diarrhea, abdominal pain, dysuria and orthostatic hypotension. PAF was strongly suspected, based on a low level of plasma noradrenalin at rest and a finding of severe diffuse sympathetic nerve injury on ¹²³I MIBG myocardial scintigraphy. Various Kampo formulas were not effective, or could not be administered continually. Urinary retention was treated with self-catheterization. After the extract of keishikashakuyakuto was administered, his complaints of diarrhea and abdominal pain gradually decreased, and he was able to eat various kinds of food. His daily living activities improved.Moreover, he could urinate by himself, so the self-catheterization was stopped. Five years later, the diagnosis of PAF was clinically confirmed, but his daily living activities did not deteriorate. This suggests that keishikashakuyakuto can be effective for diseases with diverse autonomic nervous symptoms, such as the present case.