Few published reports exist on shishishito (sanshishi and koshi) usage. Our study group comprised of six female patients presenting with anxiety, insomnia, or chest discomfort, with the common characteristic of speaking restlessly. They either had heat symptoms or they did not experience coldness. All six patients were prescribed shishishito. Case 1, a 64-year-old woman presenting with chest irritation and tightness, recovered on day 4 of shishishito administration. Case 2, a 63-year-old woman displaying restlessness, epigastric clogging, and daily nightmares recovered after 8 days of treatment. Case 3, a 36-year-old woman taking Kampo for another ailment, presented with throat clogging and glossodynia, recovered on day 5 after changing to shishishito administration. Similarly, Case 4, a 73-year-old woman already taking Kampo for neurotic anxiety, showed sudden signs of insomnia that improved after 2 days of shishishito administration. Case 5, an 83-year-old woman already on Kampo medication for anxiety and palpitations, was successfully treated with shishishito for severe anxiety and restless speech and recovered in 5 days. A separate Kampo formulation resolved her palpitations. However, another panic attack ensued, which was resolved after 7 days of shishishito treatment. Interestingly, shishishito was not successful in resolving the panic attacks of Case 6, a 48-year-old woman with depression owing to personal loss. Treatment with Western medicine in addition to 11 days of shishito administration was also ineffective for this patient.

There are multiple options for treating hyperhidrosis, including Kampo medicine. However, as for acquired idiopathic generalized anhidrosis, steroid therapy is the only way to treat the patients. There are few clinical reports including Kampo treatment for anhidrosis. We report a case in which keishikaogito based prescriptions were effective in treating symptoms caused by decreased sweating. A 69-­year-­old woman visited our institute in June 201X, complaining of reduced sweating and abnormal feelings about body temperature. Her physician prescribed various sorts of Kampo medicines, but no improvement had been shown. We considered that she was not able to sweat and had water accumulation under her skin. She was given Keishikaogito based prescrip­tions, and she came to sweat spontaneously and abnormal feeling about body temperature improved. Honzo-biyo says “Astragalus promotes sweating if there is no sweating, stops it if there is sweating.” Keisetsu Otsuka said in Kinki-yoryaku-kowa that Astragalus works in both cases with too much and too little water. Kampo treatment especially containing Astragalus can be effective for sweating disorders.

We retrospectively surveyed and analyzed medical records of 41 effective cases with shigyakusan including shigyakusan decoction and shigyakusan extract. In classics, fullness in chest and hypochondrium and rectus abdominis muscle stiffness along with coldness of the extremities is regarded as important clinical indication of shigyakusan. In this analysis, patients who present fullness in chest and hypochondrium are more than 90%, and patients presenting rectus abdominis muscle stiffness are more than 60%, confirming that these findings are important. On the other hand, although more than half of the patients feel excessive sensitivity to cold, only about 20% of the patients had coldness of the extremities as objective Kampo findings in their medical records. Until now, coldness of the extremities has been considered to be important because shigyaku means Japanese expression of it. But our obtained results show that shigyakusan is used for the patients who do not have cold extremities.

Nyoshinsan is one of the Kampo formulations for the treatment of hot flash or dizziness, which are typically seen in chi-no-michi syndrome (characterized by physical and/or mental symptoms related to female hormone variation). But nyoshinsan is less frequently prescribed than three major formulas in gynecological field including tokisyakuyakusan, kamishoyosan and keisibukuryogan. Furthermore, few case series study of nyoshinsan has been reported so far. To elucidate clinically useful indication sho of nyoshinsan, we retrospectively analyzed medical records of the patients prescribed nyoshinsan for past 5 years in our institute. In consequence, majority of patients prescribed nyoshinsan had both blood stasis and qi-abnormality including qi-deficiency, qi-stagnation and qi-counterflow due to physical or mental stresses. On the other hand, they rarely had signs of fluid retention. These findings may be useful for more effective clinical application of nyoshinsan.

Case 1 was a 28-year-old female who had epigastric discomfort and epigastralgia for three months. These symptoms were accompanied with dizziness, faintness and hot flush. Right after taking ryokeijutsukanto, her dizziness, faintness and chillness of foot disappeared with improvement of gastrointestinal symptoms after two weeks. Case 2 was a 40-year-old female who presented prolonged nausea and epigastralgia for eight months. She also complained of dizziness and strong globus sensation when taking meals. After taking ryokeijutsukanto, her appetite improved in a week and gastrointestinal symptoms improved in 3 weeks. Case 3 was a 15-year-old female whose complaints were nausea, epigastric discomfort, palpitation, dizziness and globus sensation consequent to swaying feeling after riding a roller coaster. These symptoms including nausea improved after taking ryokeijutsukanto with 3g of magnolia bark for a week. Case 4 was a 28-year-old male who presented severe appetite loss and epigastric discomfort when he got tired. He also complained of faintness. His faintness disappeared after taking ryokeijutsukanto for 2 weeks. His appetite also improved after four weeks. Clinical courses of these cases suggest that ryokeijutsukanto may be useful for the treatment of upper gastrointestinal symptoms including functional dyspepsia, i.e. fluid retention with qi-counterflow.

We are planning a study focused on the gathering of clinical data for the purpose of formalizing diagnostic logic at 6 institutions specialized in Kampo-based medical examinations. However, during the planning stage, it has been recognized that there are a large number of Kampo formulas to be studied, and differences among faculties and individuals exist regarding how to identify each Kampo formula, methods of gathering findings, and the evaluation of efficacy. Here we report the solution proposal reached after building consensus among all participating faculties on these issues. After raising the issues, conferences were held for each of them, until a unanimous consensus was obtained. As a result, the following conclusions were reached. Thirty-three Kampo formulas were selected as targets for the formalization of diagnostic logic. In addition, the range of dosage forms, crude drug ingredients, and permissible dosages for each Kampo formula were determined. Regarding clinical findings for these Kampo medicines, the items to be collected and evaluation criteria were also established. The criteria for evaluating the validity and safety of each Kampo medicine were decided, together with the grading and timing of evaluation. We hope that our solution proposal reached after building consensus becomes the basis for Kampo research in the future.

We report three closely watched cases of intractable Meniere's disease in the elderly that were successfully treated with Kampo medicine. Case 1 is a 75-year-old female. At the time of the 4th Meniere's attack, we gave her western medicines such as isosorbide, but she had a significant hearing loss. Then, we administered hachimijiogan extract granules, and her hearing level improved and she had been free of Meniere's attack for 23 months. Case 2 is a 78-year-old male. We diagnosed as bilateral Meniere's disease and treated him with western medicines such as isosorbide. In September of year X, his hearing level in the left ear worsened despite the treatment, so we prescribed hachimijiogan extract granules. After the treatment, we found the patient's hearing improved and nystagmus decreased gradually. He has also been free of Meniere's attack for 9 months. Case 3 is a 70-year-old male. He had repeated episodes of vertigo in spite of the administration of western medicines. After we prescribed shimbuto extract granules, vertigo attack and nystagmus disappeared. He has been relieved from Meniere's attack for 8 months. These cases indicate that Kampo therapy is one of the useful therapeutic options for intractable Meniere's disease in the elderly.

Teikosan is an herbal medicine that was developed from the Japanese herbal (Kampo) medicine hochuekkito. Unlike hochuekkito, teikosan does not include Zizyphi fructus and Zingiberis rhizoma. Instead, Cnidii rhizoma, Scutellariae radix, Coptidis rhizoma, Angelicae dahuricae radix, and shakusekishi are included as constituents of teikosan. The clinical indication of teikosan is anal prolapse with pain that is more severe than that considered appropriate for hochuekkito treatment, but there have been few clinical reports before. Here, we describe a case of anal prolapse with anal pain, which was successfully treated with teikosan. A case was a 47-year-old woman whose chief complaint was anal prolapse of internal hemorrhoids with pain. She was considered as indication for hochuekkito, but her symptoms including anal pain were so severe that we prescribed teikosan, especially because Angelicae dahuricae radix, Scutellariae radix, Coptidis rhizome in teikosan were expected to improve her anal pain. After the administration of teikosan, her symptoms including anal pain have much improved. Teikosan should be considered as a therapeutic option for anal prolapse with severe anal pain or inflammation.

Shichimotsukokato is composed of shimotsuto with chotoko, ogi, obaku, and this formula has been frequently used for the treatment of hypertension, eye-fundal hemorrhage and headaches. Here we describe three cases of chronic dermatitis with hypertension and dry skin of legs, which were successfully treated with shichimotsukokato. Case 1 was a 67-year-old man whose chief complaint was pruritus and skin eruption on his chest. He also had dry skin accompanied with pruritus on his legs, and hypertension. Case 2 was a 59-year-old man who had skin eruption accompanied with pruritus on his trunk and extremities. He also showed diastolic hypertension and renal insufficiency due to the side effect of an immunosuppressant. Case 3 was a 64-year-old man who had dry skin with eruption on the upper trunk. Furthermore, his blood pressure fluctuated within the high normal range. After medication with shichimotsukokato, both the hypertension and dermatitis improved in all three cases.
According to these observations, shichimotsukokato may alleviate dermatitis along with dry skin of legs and hypertension, and it may be worth noting that shichimotsukokato is an option for the treatment of skin lesion.

Ryokito is a Kampo formulation which has been administered for right upper quadrant pain since the Edo Era in Japan. Yet there are but a few reported cases in multiple clinical exams at one institution, on the usage of this formulation. We undertook a precise retrospective analysis of ryokito-prescribed cases at our institute over ten years, and reported cases published in the past to illuminate the clinical characteristics of ryokito effective cases.
Among the 21 cases at our institute, ryokito was effective in 11 cases and 10 of these 11 cases had right upper quadrant pain. Additionally, 7 of them reported abdominal distention.
Overall, this retrospective analysis revealed that amongst those ryokito effective cases, not a few patients had the right upper quadrant pain. This fact suggests that right upper quadrant pain is a reasonable characteristic for a usage of ryokito.
Likewise, abdominal distention was also a common symptom among the effective cases. It is likely that abdominal distention could be a characteristic for a usage of ryokito as well.