ABSTRACT
We report two cases of older heart failure (HF) patients who improved pulmonary congestion and maintained functional capacity with tokishakuyakusan. Case 1 was an 83-year-old woman who previously treated with percutaneous coronary intervention for angina and had multiple comorbidities such as chronic kidney disease and rheumatoid arthritis. Despite of multiple medications including 3 kinds of diuretics, general fatigue that interferes with her daily life, marked pulmonary congestion, and leg edema remained. After prescription of tokishakuyakusan, urine volume increased rapidly and HF symptoms were alleviated so that 2 diuretics were successfully discontinued. Case 2 was an 88-year-old man with chronic atrial fibrillation and severe mitral regurgitation with worsening dyspnea on effort, paroxysmal nocturnal dyspnea, and leg edema. Tokishakuyakusan was effective for improving these HF symptoms and he returned to normal life without additional HF treatment. For elderly HF patients, tokishakuyakusan is considered to be effective to improve blood deficiency/stasis pattern and fluid retention, which enables these patients to make their daily life without being disturbed by severe HF symptoms.