Volume 5, Number 2 | Summer 2010

Clinical Report 3 (Japan)
A Case of Eating Disorder Accompanied by Anxiety(Yokukansan for Paroxysmal Vomiting)
Mihoh Koga, M.D. – Kampo Specialist
Division of Clinical Pharmacology and Therapeutics,
Division of General Medicine
Jikei University School of Medicine

3)
Case: K.H. female of 46 years old
Initial visit: June 16, 200X
Chief complaints:
1. Eating disorder
2. Anxiety/sleeplessness
3. Feeling of fatigue
Past medical history:
Bilateral sinusitis (since childhood), irritablebowel syndrome (enteritis), and anxiety neurosisa) As she worried about her husband’ssnoring and apnea, she could not sleep
continuously.
b) She had a fear of being separated from herhusband.
c) She was worried about the disease of theirfirst son.
3) Felt fatigue due to frequent overseas businesstrips.
She had a detailed checking by other hospitaland was told these are symptoms of neurogenic
origin.

Findings at the initial visit:a) 152cm, 50kg. No big changes in the BW.
b) Blood pressure 120/60, pulse count 72/min.
c) Irritation (+)d) Defecation 1-2 times/day, thin stools, a sense
Occupation: Running a jewelry store. As theof incomplete evacuation (+)
volume of business negotiations abroad increasede) Urine – no abnormality
to expand the business, stress increased.
Family environment: Her husband was an artist tof) Menstruation – no problem.

design jewelry. (He likes Kampo.)
Their first son was 21 years old (at age 5, he hadbrain tumor).
Their second son was 19 years old.
Origin and course:1) The patient often had regurgitated the soupdishes or noodles eaten from the stomachsince around three years of age. Vomiting
after meals began at the age of 24 when she
was pregnant with the first child. She said
that with more than half of the normal foodintake, (1) food was involuntarily spewed out,or (2) she had a stuffy sensation in thestomach and voluntarily vomited. The
symptom got worse at night compared to day
time, and especially it became severe during
the business meeting over a meal.
2) Sleeplessness caused by anxiety, difficulty
falling asleep, and woke in the middle of thenight.

Pulse: Sunken, thin, string-like, and weak wristpulse
Tongue: Slightly dark red (partially purplecolored), moist with pale white furs.
Abdomen: Contracture of the abdominal skin,rumbling of intestine by the intake of cold
drinks/splashing sound (+)
Bensho (pattern identification): Spleen deficiency/ liver-spleen-stomach disharmony / liver qi
depression
Prescription: One day dose of shokenchuto
One day dose of yokukansankachimpihange.
These two prescriptions were divided into 3 doses
and taken 3 times/day between meals.
CourseTwo weeks later, the chief complaints subsided.
Although the patient subsequently made overseas
business trips, the symptoms did not recur. She
did not have vomiting during the negotiations.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

19

Volume 5, Number 2 | Summer 2010

The prescriptions were continuously administered.
Now she feels fine.
Analysis of clinical conditions:
VomitSinusitis

Deficiency of liver-qi

Stomach qi
ascendingcounterflow

Heart spirit anxiety

Deficiency ofheart blood Sleeplessness
 Anxiety neurosis

Excessive worry

 Regurgitation after eating

Liver qi statis

Spleen deficiency Rumbling after drinking cold water Abnormal defecation

 Business responsibility
and full schedule Irritation
 Pulse(sunken, thin, string-like)

Disharmoney ofliver/spleen/stomach

 Worsen during business meeting Irritable bowel syndrome Contracture of the abdominal skin

Yokukansan [Hoeisatuyou]“cures deficiency heat in the liver meridian,development of convulsions, or heat and clenching ofteeth,

orfright

palpitations/

cold-heatorvomit/thinner saliva / feeling of swollen abdomen by
spleen-deficiency activate liver-qi, small appetite,cannot have a good sleep. Bupleuri Radix /Glyzirrhizae Radix / Cnidii Rhizoma / Angelicae

Actilobae Radix / Atractylodis Rhizoma / Poria /Uncariae Uncis cum Ramulus”

20The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)