ABSTRACT
We report a case of 87-year-old female with somatoform autonomic dysfunction whose complaint of oppression ranging from the left chest to the epigastrium was successfully treated with shimbuto, in whom neither antidepressants nor anxiolytic drugs had been effective. Since weak abdominal power, bilateral kyokyokuman and pulsation in the upper navel region were observed, saikokeishikankyoto was initiated, but satisfactory effect was not obtained. Thus, we re-estimated her conditions and judged as the stage of Shao yin based on symptoms such as bedridden tendency, coldness of the limbs and indigestible diarrhea, although a weak and surface pulse was noted. Shimbuto was then administered, and various symptoms including chest oppression were improved rapidly and dramatically. We speculated that her chest oppression might occur due to kiutsu (depression of ki) secondary to suitai (accumulation of sui) rather than kigyaku (regurgitation of ki), and that the improvement of suitai by shimbuto might result in the disappearance of kiutsu. Although shimbuto is not popularly used for the treatment of somatoform disorder having chest symptoms, our case suggests that there should be a certain case in which shimbuto is so effective. Also it is suggested that shimbuto might be applicable even when deep pulse or excessive strain of abdominal muscles is not necessarily observed.