Two Cases of Sleep Bruxism Successfully Treated with Yokukansan / 日本東洋医学雑誌

Bruxism is a common condition often seen in daily practice. Although interocclusal appliances are often used, there are no established treatments to eliminate bruxism. Here, we report two patients who complained of bruxism and insomnia. Based on the diagnosis of Kampo medicine, we thought that stress was involved in the background of both cases. Therefore, we prescribed them yokukansan, and their symptoms improved. These results suggest that yokukansan may be effective for sleep bruxism and insomnia.

A 9-year-old Cancer Patient with Rectal Irritative Symptoms Relieved by Yokukansan: A Case Report

Rectal irritative symptoms in cancer patients are often refractory to treat and exacerbate their quality of life. We experienced a peadiatric case of rectal irritative symptoms treated by Yokukansan. A 9 year-old boy developed rectal irritative symptoms as itching sensation in rectum caused by relapsed rhabdomyosarcoma in pelvis. Oral Yokukansan, which is common Japanese Kampo medicine for temper tantrum of children, was administered and relieved his symptoms. Yokukansan is known as adjuvant drug for neuropathic pain. It could be one of the adjuvant drugs for refractory symptoms in palliative care setting.

Involvement of “anger” in Effectiveness of Yokukansan/Yokukansankachimpihange / 日本東洋医学雑誌

There is a well-­known “kuketsu : traditional oral instruction for using Kampo formula”, for yokukansan and yokukansankachimpihange (yokukansan group) which mentioned about the importance of existence of “an­ger”. It says that responders to yokukansan group are likely to be irascible. However, no statistically analyzed report about the accuracy of this “kuketsu” is published to date. Therefore, we retrospectively analyzed the charts of patients at one institution who had been treated with yokukansan group by multivariate analysis. We selected amelioration of their chief complaints as dependent variable ; ten items from inquiry as independent variables. The number of patients was 32 (male 12, female 20), mean age was 47.3. “Gender” and “irascible” were statistically significant in logistic regression analysis. The adjusted odds ratio of male versus female was 21.7, while being “irascible” versus not being “irascible” was 8.2. Yokukansan group seemed to be more ef­fective if patients were male or irascible in this study.

A Case of Stomachache Successfully Treated with Yokukansankachinpihange / 日本東洋医学雑誌

We report the case of a 36-year-old male who presented with an abdominal complaint after straightening of irregular teeth. He was examined and treated, however, the cause of the abdominal complaint could not be determined and the treatment was ineffective. He was treated in our clinic with yokukansankachinpihange for obvious pulsation in the supraumbilical region following the oral tradition of Kampo medicine, and the symptom gradually disappeared. We discussed the mechanism of the stomachache in Kampo medicine. After treatment, this case was diagnosed as somatoform autonomic dysfunction in psychiatric medicine. Advanced treatment by a psychiatrist was necessary to treat this disease in psychiatric medicine. In this case it is suggested that treatment following the oral tradition of Kampo medicine was effective.

Three Cases of Depression sequentially Occurred at the Same Workplace; Effectively Treated with Yokukansankachimpihange that was Taken into Account Emotional Contagion / 日本東洋医学雑誌

We report three cases of depression, which were effectively treated with oriental medicine. All three patients were employees at the same workplace, which had a total of 17 employees. Case 1 was a 46-year-old, who had worked at the company for 20 years and complained of depression and insomnia. Case 2 was a 28-year-old woman, who had worked at the company for 9 years and complained of nausea and mood disturbance. Case 3 was a 41-year-old man, who had worked at the company for 15 years and complained of restlessness, insomnia, and depression. The three patients were treated with yokukansan and yokukansankachimpihange, which are Kampo formulations, and subsequently showed improvements in symptoms. In choosing prescriptions for these patients, we considered the fact that all three patients worked in the same workplace. Yokukansan is traditionally co-administered to mother and her child. Furthermore, Hoffman (1984) proposed the system of sharing emotional contagion in the field of neuropsychiatry. When considered holistically, medication shared by mother and child is an empirical treatment taking into account emotional contagion. This treatment is also considered applicable within a single community, such as the one in the same workplace. Shared medication that takes into account emotional contagion within the same workplace, could be useful as it was for our patients.

A Case of Trigeminal Neuralgia Successfully Treated with Yokukansan / 日本東洋医学雑誌

The patient was a 77-year-old man with chief complaints of left lower jaw pain and discomfort. He had pain centering on the left lower jaw and was diagnosed with trigeminal neuralgia involving the third branch of the trigeminal nerve by a local physician. The pain subsided temporarily by administering carbamazepine, but recurred in the same region. He was subsequently referred to our ambulatory pain clinic. Sudden bouts of pain occurring dozens of times a day were noted, with depression, anorexia, lack of motivation, dry mouth, cold extremities, and dry skin. A crimson colored and slightly enlarged tongue with teeth marks on the border, crimson color on the tip, and white moss, were noted in the tongue examination. Pulse examination revealed a sunken pulse and abdominal examination noted epigastric discomfort and weakness (2/5) of the lower abdominal region. Mandibular nerve block temporarily resolved the pain, but there were repeated cycles of exacerbations, between which the feeling of discomfort persisted. Yokukansan extract (7.5 g divided into 3 doses per day) was administered, 35 months after the first clinic visit to address the discomfort that persisted after resolution of pain. Discomfort resolved. Currently, the patient still does not require mandibular nerve block or analgesics. Here we report this case in which Yokukansan was effective against discomfort in trigeminal neuralgia.

<b>A Case of Involuntary Movements Treated with Yokukansankashakuyakukoboku</b> / 日本東洋医学雑誌

We report the case of a 17-year-old male who had involuntary movements treated with yokukansankashakuyakukoboku. He had first recognized the involuntary movement 6 years previously. His symptom could not be alleviated with neurological and psychological treatments, and he visited our clinic for treatment with Kampo medicine. His symptom gradually alleviated with yokukansankashakuyakukoboku. The ancient physician Sekki (薛已) created yokukansan in China's Ming Dynasty. Yokukansan and its various add-on combinations were used in the Edo Era of Japan. Keisetsu Ohtsuka then created yokukansankashakuyakukoboku, which is however now rarely used because there is no extract drug in Japan. There are markedly nervous patients however, who can be treated with this formula. Thus, the authors feel that more research needs to be done on the differences between yokukansan and yokukansankashakuyakukoboku.

<b>The Efficacy of Yokukansan in Obesity Patients on Overeating due to Anger (a Retrospective S</b><b>tudy)</b> / 日本東洋医学雑誌

We previously reported that a case of yokukansan efficaciousness for weight gain due to overeating behavior following bariatric surgery. The reason is considered that yokukansan stabilized the patient's mental state. So, we proposed that administration of oriental medicines for mental state might be a new way of treating obesity. We investigated the efficacy of mazindol, bofutsushosan or yokukansan for obese patients. We retrospectively reviewed clinical data to identify patients administered mazindol, bofutsushosan or yokukansan for treatment of obesity. The inclusion criteria were patients tolerant to medicine for 3 months, and who could be administered yokukansan for anger. A total of 107 patients met these selection criteria. After 3 months of drug administration, significantly body weight reduction was observed in either the mazindol group or yokukansan group. We also selected and analyzed patients with diabetes mellitus to clarify the efficacy of these drugs for glucose metabolism. Reduction in HbA1c was not significant in the groups. These results suggest that mental health problems are very important for the treatment of obesity. And we suggest that oriental medicine is an effective treatment for mental health in obesity patients.

<b>Yokukansan Descriptions in the Original Texts</b> / 日本東洋医学雑誌

We investigated original texts for yokukansan, a familiar Kampo formula, focusing on the classical literature <i>Xue-shi yi-an</i> (薛氏医案) . Yokukansan was described in the <i>Bao-ying jin-jing-lu</i> (保嬰金鏡録) written by Xue ji (薛己) in 1550, the <i>Xiao-er yao-zheng zhi-jue</i> (小児薬証直訣) revised by Xue ji (薛己) in 1551,the <i>Bao-ying cuo-yao</i> (保嬰撮要) by Xue kai (薛鎧) in 1556, and the <i>Xiao-er dou-zhen fang-lun</i> (小児痘疹方論) in 1550. The phrase “one's own work” was used in “<i>Bao-ying jin-jing-lu</i> (保嬰金鏡録)” and in the <i>Xiao-er dou-zhen fang-lun</i> (小児痘疹方論) by Chen wen-zhong (陳文仲). However, there was no mention of “one's own work” in the same title, the <i>Xiao-er dou-zhen fang-lun</i> (小児痘疹方論), as summarized by Xiong zong-li (熊宗立).<br>Yokukansan was found only in the <i>Xiao-er yao-zheng zhi-jue</i> (小児薬証直訣) revised by Xue ji (薛己) in 1551, but not in the other copies of the same text. Therefore, it seems likely that yokukansan was created by Xue ji (薛己) himself.<br>Yokukansan was previously thought to have originated with the <i>Bao-ying cuo-yao</i> (保嬰撮要). However, based on use of the phrase “one's own work” in the classical literature, it appears that the original text for yokukansan should be the <i>Bao-ying jin-jing-lu</i> (保嬰金鏡録). Therefore, yokukansan seems to have been made by Xue ji (薛己), and not Xue kai (薛鎧), who was his father.

<b>A Case of Recurrent Fever Successfully Treated with Yokukansan</b> / 日本東洋医学雑誌

The patient was a 14 year-old female. She had been hospitalized repeatedly since infancy for suspected tonsillitis. During this time, she experienced high fever for about a week once a month. In her school years, she often had a recurrent fever with cervical adenitis, with only a mild inflammatory reaction. We diagnosed her symptom as one of a periodic fever syndrome, triggered by the frequent administered antipyretic drugs for fevers of unknown origin (FUO). We also suspected that there was liver tension, based on her abdominal and back examination, and we prescribed yokukansan. After a 3-month course of yokukansan, she no longer experienced these fevers. Most case reports of FUO describe the use of bupleurum root drugs and tonic formulas as treatment. Although yokukansan has traditionally been used for FUO in older texts, to our knowledge, there are no reports on such use clinically. In the present patient's case, the yokukansan may have reduced or eliminated some type of trigger for the fevers, or it may have affected the regulation of cytokines.

<b>Case of Yokukansan Efficaciousness for Weight Gain Due to </b><b>Overeating Behavior Following Bariatric Surgery </b> / 日本東洋医学雑誌

We report the case of a 51-year-old woman whose body weight was increased after bariatric surgery. She has been obese from a young age. When she was 30 years old, she developed type 2 diabetes mellitus. She was hospitalized for diabetic ketoacidosis at 45 years of age. She was diagnosed bulimic at 48 years of age, and body weight reduction with diet and exercise therapy became difficult because she was bulimic. Then, she underwent bariatric surgery and her body weight had reduced by 11 kg, 6 months after the surgery. However, her body weight began to increase again 7 months post surgery. At this time, her mental status had become unstable and she ate constantly in the afternoons. We administered yokukansan 5 g/day to treat her unstable mental status. Her body weight then decreased in accord with decreasing energy intake after the administration of yokukansan. She also became aware that her mental status was improving. Furthermore, her HbA1c (JDS) decreased from 8.7% to 7.1% after yokukansan treatment. In this case, it is possible that yokukansan suppressed the overeating by stabilizing her mental status, with the parallel decreases in body weight and HbA1c.

<b>Two Cases of Parkinson's Disease with Wearing-off Fluctuations Successfully Treated with Yokukansan </b> / 日本東洋医学雑誌

Parkinson's disease is a neurodegenerative disorder characterized by four major motor symptoms : resting tremor, rigidity, akinesia and postural instability. As the treatment period for Parkinson's disease is prolonged,psychological symptoms and motor complications occur frequently. Wearing-off fluctuations are the major motor complications caused by the shortening of levodopa efficacy time. They have serious influence on the quality of life (QOL) of patients with Parkinson's disease. There have been numerous reports on treatment of the behavioral and psychological symptoms of dementia (BPSD) with Kampo medicine. There have also been recent reports on treatment of the behavioral and psychological symptoms of Parkinson's with the Kampo medicine, yokukansan. On the other hand, there are few reports on treatment of the motor symptoms and motor complications of Parkinson's with yokukansan. We experienced two cases in which the levodopa-induced hallucinations and wearing-off fluctuations in Parkinson's sufferers were improved conspicuously with this Kampo medicine. These findings suggest that yokukansan improves both levodopa-induced psychological symptoms and motor complications by achieving curative effect with levodopa/carbidopa.

<b>Analgesic and Anti-stress Effects of Yokukansan in Rats with Adjuvant Arthritis</b> / 日本東洋医学雑誌

Yokukansan (YKS), one of the traditional Japanese “Kampo” medicines, is a mixture of extract powders from seven kinds of medicinal herbs (<i>Atractylodis Lanceae Rhizoma, Hoelen, Cnidii Rhizoma, Uncariae Uncis Cum Ramulus, Angelicae Radix, Bupleuri Radix, and Glycyrrhizae Radix</i>). YKS has been administered to fragile habitus patients who show symptoms such as emotional irritability, neurosis and insomnia, and to infants who suffer from night crying and convulsions. In recent years, YKS has been reported to be effective against pain disorders such as headache and chronic pain, but the mechanism underlying these beneficial effects is still unclear. In this study, the effect of YKS on chronic inflammatory pain and stress caused by pain were investigated using rats with adjuvant arthritis.<br>Male Wistar rats were injected with complete Freund's adjuvant into the plantar surface of the right hindpaw, and then pain thresholds and stress markers were measured. The thermal pain threshold measured with the plantar test significantly decreased, and the level of salivary chromogranin A (CgA), which is used as a mental stress marker, was significantly increased in this model. The administration of YKS controlled the activation of spinal microglia involved in the expression of chronic pain, and significantly reduced a decrease in the pain threshold. Moreover, an increase in the level of salivary CgA was significantly inhibited. The authors concluded that YKS has effects in reducing chronic inflammatory pain and the stress caused by pain.

Yokukansan-based Prescriptions for Care Providers with Various Symptoms / 日本東洋医学雑誌

Eight family care providers with various disorders showed improvement of their symptoms when treated with yokukansan-based prescriptions. Case1complained of hot flushes, burning sensation and difficulty in concentration; Case 2 of insomnia and back pain; Case 3 of insomnia; Case 4 of irritation and palpitation; Case 5 of anxiety and insomnia; Case 6 of palm eruptions; Case 7 of a painful sensation in the eyes and headache; and Case 8 of neck pain, stiff shoulders, diarrhea, palpitation, insomnia, general fatigue, etc. These diverse symptoms were all considered to be related to “liver” dysfunction of emotions, muscles and eyes, caused by chronic and continuous stress due to their care burden. In Cases 5, 6, 7and 8 the persons whom the care providers were caring for also took the Yokukansan-based prescriptions at the same time as these said care providers did. Instructions for the traditional medicine Yokukansan indicate that “mother and child should take this medicine at the same time”. And since the relationship between a patient and a care provider in the family might be similar to that between child and mother, we applied yokukansan-based prescriptions to these care providers based on traditional instruction.

Efficacy of Yokukansan-based Prescriptions for the Treatment of Patients with Headache / 日本東洋医学雑誌

We evaluated the efficacy of yokukansan-based prescriptions for patients with headache. Forty-five patients with headache (34 migraine, 6 tension-type, and 5 combined headaches), or 6 males and 39 females, mean age 38 (25 to 68) years were treated with yokukansan-based prescriptions according to their Sho diagnosis, for 1 to 24 months. Relationships between headache improvement, and 31 factors including age, sex, height, body weight and other symptoms at first examination, were qualified with multi-dimensional analysis. Factors such as painful eye sensation, back stiffness, eyestrain and irritability were significant indicators of headache improvement. Three of these factors (painful eye sensation, back stiffness and irritability) were the best subset of explanatory variables. Yokukansan-based prescriptions seemed to be effective for “liver-related” headache, and were thought to be useful to relieve a triggering or worsening of headache factors. And to our knowledge, this is the first paper to propose the importance of examinations of the back, when considering yokukansan-based prescriptions.

Evaluation of Efficacy of Chotosan for the Treatment of Patients with Headache by Multiple Regression Analysis / 日本東洋医学雑誌

We evaluated the efficacy of chotosan for headache patients via multiple regression analysis. The subjects were 46 patients with headache (31 migraine, 14 tension-type, and1combination headache), consisting of 1 3males and 33 females, mean age 48 years (range 19-77 years), who were treated with chotosan according to their Sho (symptoms) for more than1month. The relationships between the improvement of headache and 38 factors, including age, sex, height, body weight, hypertension and other symptoms noted upon first medical examination, were examined through multi-dimensional cross-sectional analysis. Morning headache, dizziness, insomnia, body weight, tinnitus and vasodilatation of sublingual veins were significant factors. Morning headache is traditionally an indication for the use of chotosan, and our results support its efficacy for this purpose. Three factors, i.e. morning headache, vasodilatation of sublingual veins and stiff shoulder, were the best subset of explanatory variables. Stiff shoulder is a key symptom for the application of chotosan, while stiffness in the back is a key symptom for the application of yokukansan.

Five Cases of Alzheimer's Type Dementia Showing Behavioral and Psychological Symptoms of Dementia (BPSD) Successfully Treated with Yokukansan / 日本東洋医学雑誌

We described here five patients with Alzheimer's disease (AD) who have behavioral and psychological symptoms of dementia (BPSD), and who have shown a remarkable improvement as a result of Yokukansan treatment. All five patients exhibited irritability and excitement, four of the patients suffered from aggression and insomnia, and three suffered from wanderings. All of the patients started recovering from these symptoms within 1-2 weeks from the start of the treatment, without any adverse reaction. In conclusion, our case study suggests that Yokukansan is a safe and effective treatment for AD patients with BPSD. Our study further suggests that Yokukansan is especially useful for patients who are difficult to treat with neuroleptics, such as patients with insomnia and wandering, patients exhibiting a depressive state as well as irritability and excitement, and those with physical symptoms, including gait disturbances and urinary incontinence.