I herein report a case of epidural and subdural hematoma associated with meningeal infiltration of acute leukemia, which was ineffective to platelet transfusion, successfully treated with kamikihito. A 44-year-old woman with mixed phenotype acute leukemia developed left-side facial palsy during bone marrow suppression phase of chemotherapy at first relapse, and was diagnosed as meningeal infiltration. Brain magnetic resonance imaging showed meningeal thickening and epidural and subdural hematoma. The laboratory data showed thrombocytopenia and no remarkable abnormalities in coagulation. She received frequent platelet transfusions, whole-brain irradiation, and intrathecal chemotherapy, with the exacerbation of intracranial hematoma, and whole-brain irradiation and intrathecal chemotherapy had to be discontinued. Intracranial hematoma was improved with additional Kampo therapy with kamikihito in accordance with traditional “sho” indications for the purpose of hemostasis, and restarted intrathecal chemotherapy improved her meningeal infiltration. Finally, she could receive cord blood transplantation because of good control of meningeal infiltration of leukemia and intracranial hematoma. Kampo therapy can be considered one of the treatments for transfusion-ineffective intracranial hematoma.

Abdominal distension is one of the common symptoms and can cause abdominal pain and anorexia, which may raise adverse effect on general well-being and quality of life. In Western medicine, there are specialized treatments for structural lesions associated with abdominal distension, but functional abdominal distension is often difficult to treat. There have been some reports of Kampo medicine for treatment of abdominal distension, but no case reports on tokishigyakukagoshuyushokyoto. We experienced two cases of abdominal distension successfully treated with tokishigyakukagoshuyushokyoto. Case 1 was 86-year-old woman who developed abdominal distension with frequent belching. Case 2 was 59-year-old man who developed abdominal distension associated with opioid. Regulating qi medicine was not effective for abdominal distension in both cases. Both cases had reversal coldness of the extremities, tympanic sounds of abdomen, coldness of abdomen, and inguinal tenderness and resistance. Therefore, we diagnosed them as tokishigyakukagoshuyushokyoto sho. After administration of tokishigyakukagoshuyushokyoto, in Case 1, the frequency of belching decreased and the appetite increased with the improvement of abdominal distension. In Case 2, increasing the dose of goshuyu in tokishigyakukagoshuyushokyoto relieved abdominal distension. Tokishigyakukagoshuyushokyoto can be effective for abdominal distension with interior cold pattern.

Persistent or intractable hiccups worsen the activity of daily life and the quality of life of patients, but are sometimes difficult to treat. There are no recommended therapies in Western medicine for hiccups, and Kampo medicine can often be used. However, there have been no case reports on keishininjinto for hiccups. We experienced two cases of hiccups successfully treated with keishininjinto. Case 1 was a 68-year-old man who continued intractable hiccups for 3 years. Case 2 was an 81-year-old man who developed persistent hiccups during mechanical ventilation. Both cases had spontaneous sweat, tendency of diarrhea, epigastric discomfort and resistance, and cold of epigastrium, so we diagnosed them as keishininjinto-sho. It took 6 months to improve hiccups after administration of keishininjinto in case 1 and 1 week in case 2. Keishininjinto can be effective for hiccups with interior and cold pattern.

We report a case of severe headache associated with cerebellar infarction was successfully treated with Kampo therapy. The patient complained of severe headache and vertigo in spite of standard therapy after the decompression craniectomy. However, his symptoms were relieved immediately by administration of goreisan. The pharmacological effect of Kampo formulation i.e. goreisan is still unknown, but this formulation has been used for headache with edema, vertigo and vomiting. According to the classic textbook, this formulation has a potential to improve water imbalance in the body, including brain edema. This Kampo medicine is seemed to be an alternative to manage such patients.

The authors experienced two cases of trigeminal neuralgia successfully treated by a Kampo formulation tokishigyakukagoshuyushokyoto (TSG). Case 1 is 70-year-old woman who complained of severe pain on the right side of her face. She was administered carbamazepine. It was effective for the facial pain but she could not take it continuously because of side effect, namely ataxia. Therefore, we tried to administer TSG. This Kampo formulation proved effective, and her pain was controlled without carbamazepine. Case 2 is 69-year-old woman who complained of localized pain on the right side of her face. In this case TSG alone was effective.

Although saikanto has often been used for infectious pleuritis, there are few reports on the usefulness of it in recent years. We experienced a patient successfully treated with saikanto, who was suffering from bacterial pleuritis with residual pleural effusion, which was difficult to drain and treat with antibacterial drugs. Kampo treatment including saikanto should be used for pleuritis that is not sufficiently improved by Western medical treatment alone.

Keishininjinto has been used for those who have both interior cold pattern of ninjinto and exterior pattern, but there were no reports on improvement of hypertension. We experienced two cases that treatment with keishininjinto was effective for hypertension. The complaint of one case was dizziness, and the other was diarrhea. Both cases had epigastric discomfort and resistance, cold of epigastrium, and upper heat and lower cold. Treatment with keishininjinto was effective not only for the complaints but also for improvement of hypertension. Hypertension can be managed by Kampo therapy with keishininjinto in accordance with traditional sho indications. We consider that there were interesting clinical cases treated with Kampo medicine based on the theory whereby sho correlates with a formulation.

As the elderly society grows, polypharmacy becomes a problem in clinical practice. Until now, some Kampo treatments have been reported to be useful for polypharmacy caused by western-­style medicines. But this report shows that Kampo medicines in themselves could be the cause of polypharmacy. In fact, multiple Kampo prescriptions from several medical agencies are given to one patient in Japan. From the view point of proper use of Kampo prescriptions, medical experts and entire business fields related to Kampo medicine should take measures rapidly for so­-called “Kampo polypharmacy” after analyzing the actual situation.

Hypertensive urgency is sometimes repeated and difficult to treat with anti-hypertensive agents or anxiolytics. There were few reports on treatment of hypertensive urgency with Kampo medicine. We experienced five cases of frequent hypertensive urgency, successfully treated with shichimotsukokato only. All cases had deficiency pattern and symptoms of blood deficiency. It took relatively short term to stabilize blood pressure after taking shichimotsukokato, and the efficacy of this drug had been continued. Shichimotsukokato can attribute to rapid and continuous stabilization of blood pressure for frequent hypertensive urgency of those who have deficiency pattern and blood deficiency.

We experienced 8 cases of children who presented with somatic complaints and found it difficult to attend school successfully treated with Kampo medicine. We evaluated them objectively by using the evaluation scale in the guideline for medical care of school refusal. Four cases were orthostatic dysregulation, 2 cases were migraine, 1 case was involuntary movement in upper abdomen and the other case was autonomic dysfunction. Kampo medicines were selected according to conventional method, so-called sho. Among 8 cases, 5 cases had a major response, 2 cases had a minor response and one case had no beneficial response. These results suggest that Kampo therapy can be effective therapeutic means. Kampo therapy is quite personalized and beneficial especially for children who find it difficult to attend school and need individualized care. This is the first report evaluating many cases objectively by using the evaluation scale and there have been no reports similar to ours. We have to continue to enlighten general pediatricians about the effectiveness of Kampo therapy.