Volume 6, Number 2 | Summer 2011

Clinical Report 2 (Kampo Medicine)
Headache 2I do?" This gave the impression that she had started
to panic because of what was going on with her both

Mihoh Koga, M.D., Kampo Specialist

Research Assistant of Division of Clinical Pharmacology
and Therapeutics and Division of General Medicine
Jikei University School of Medicine

mentally and physically. There was a mild degree ofchilliness of both hands and feet, recently her visualacuity deteriorated and she had nocturnal urinationand dryness of the mouth during the night. One bowel< Tension headache; spleen and stomach deficiency

movement every three days. No feeling of exhaustion.

cold, deficiency of heart and spleen >The pulse was thin and slippery, the tongue had athick white fur and she had a bitter taste in the mouth.

Case (4): age 49, female, visited our clinic in

The abdomen showed chilliness and increased

February XY.

resistance of the epigastric region and a mild degree

Chief complaint: headache, anxiety, discomfort inof

the gastric region, arthralgia of multiple joints

hypochondrium, softness of the lower abdomen,

Present illness:tenderness

At the age of 27, triggered by a pregnancy, the patient

palpitation above the umbilicus were observed.

started to suffer from frequent headaches. She isPattern: deficiency of both heart and spleen,

regularly using commercial analgesics, but since half

deficiency cold (stagnation of liver qi)

a year ago their effects were declining. The headaches

Prescription: kamikihito, keishininjinto

were a sort of pinching pain from the back of the head

Course: The patient expressed strong anxiety regarding

down the back of the neck and at the same timediscontinuation of the saikokaryukotsuboreito she wasassociated with ocular pain, repeating cycles ofusing so far, so that the prescription was first changed

alleviation and aggravation almost daily. The anxiety

to keishikaryukotsuboreito, taking her feelings into

influenced the gastric discomfort, so that she could

account. This helped to overcome her anxiety andeat, but felt nauseated on an empty stomach andsettle down, but still left the symptoms incompletely

therefore constantly ate little portions. She had nocontrolled, with no changes in the incidence ofsense of satiety. Another doctor diagnosed reflux

headaches and gastric discomfort. After persuading

esophagitis and prescribed a protective agent for thethe patient to use a prescription with added

gastric mucosa, but its effect was obscure. Moreover,about 1 year earlier the patient had been diagnosed

keishininjinto the incidence of the headaches
decreased to once per week. Later, using kamikihito

with chronic rheumatoid arthritis and is currently

as the main formula and reducing the dose ofunder treatment. Three months ago development ofkeishikaryukotsuboreito to 1/3 both headaches andfrozen shoulder. Three years ago she worried about

gastric discomfort improved and after three weeks

family matters and this problem now got worse about

were almost completely alleviated. The arthralgia

half a year ago, so that saikokaryukotsuboreito wasand anxiety also improved and the patient now

recommended in a pharmacy, which she is currently

presents with a calm expression.

using.

< Tension headache; liver qi stagnation, transverse

fullness,

tendernessofbothor

discomfort

inguinal

regions,ofthemarked

invasion of the stomach >Findings upon first visit:
The facial complexion was yellowish-white and theCase (5): age 41, female, employee

patient had a leptosomatic habit, she was occupied

Chiefby worries about her symptoms and described theweakness

circumstances

Present illness:

of

their

development

withdissatisfaction. She repeatedly asked: "What should
16

complaint:

headache,gastrointestinal

From the time she became employed the patient

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

Volume 6, Number 2 | Summer 2011

repeatedly experienced stomach disorders, belching,

Chief complaint: headache

abdominal distention, a bitter taste in the mouth andAnamnesis: At the age of 21 onset of a collagen

reduced appetite, occasionally gastric pain. Afterdisease, that was treated over a period of one year

examination she was diagnosed with neurotic

with steroids and the therapy then terminated.

gastritis and was prescribed western medicine, but

Present illness:later visited our clinic, because the symptoms did not

Onset of repeatedly occurring headaches after theimprove. The headaches developed at the same timepatient started to work in an office at the age of 23.

and were characterized by a slowly progressive and

Her work requires that she uses a computer. The

continuous dull pain.

headaches

Findings upon first visit:

pulsating pain (1) in the occipital region and (2) theIntermediate build, the skin appeared slightly

temporal regions and occasionally she also felt likeyellowish brown and there was some edema. She had

she had be hit or (3) a pain as if a heavy stone weredifficulties waking up in the morning and felt

placed in the center of her head. The incidence

exhausted and headheavy from morning; usually did

fluctuated but was higher on hot days with fair

not have any appetite in the morning. Although she

weather so that summers were difficult for her. A

had one bowel movement a day, there was always aneurosurgeon diagnosed migraine and tension

sense of incomplete evacuation. The menstruation

headache. The use of acetaminophen during periods

was regular, but prior to the onset of theof pain became increasingly frequent. Currently, shemenstruation the headaches grew worse. She

uses analgesics on average 5 times per week.

complained about shoulder stiffness. The pulse wasthin and wiry, the tongue was faintly dark red andhad a thick white fur and teeth marks, the abdomen
showed a marked degree of fullness, tenderness or
discomfort of the hypochondrium.
Pattern: liver qi stagnation, transverse invasion of
the stomach

After about 2 months of treatment, the ease withwhich she could wake up in the morning improvedand both the sense of exhaustion and headheavinessdecreased. Her stomach felt comfortable too, but she
susceptibletostressatwork.

Improvement of the shoulder stiffness. Since after
about one year of treatment almost all symptoms
had healed, the dose was tapered, but since complete
interruptionofthebythrobbing,Findings upon first visit:
Obese physique, muscular, face was flushed red,
there was acne on the mandible, she disliked heatand there was no sense of coldness. She had a good
appetite, but since about one and a half years ago she
experienced almost daily heartburn and gastricdrinking water. There was a tendency toward easy

Course:easilycharacterized

discomfort. She had a dry mouth and preferred cool

Prescription: saikokeishito

wasweretreatment

resultedina

deterioration of her physical condition, she currently

development of edema of the face and extremities.
She had difficulties falling asleep and experienced
night sweats all over her body. She had 1 to 2 bowel
movements per day (in the morning). Her eyestended to tire easily and she was also easily irritated.
Her menstrual cycle ranged between 30 to 35 days,
lasted for 3 days, she had little menstrual flow andthe menstrual blood was dark red. Delayed
menstruation. The pulse was slippery and wiry, thetongue pale and the sublingual veins thin, there wascontinues on a low dose schedule.

distention of the lower abdomen and tenderness on< Migraine; tension headache; blood stasis >Pattern: exterior-interior evil repletion

Case (6): age 24 years, female, employee

Course:the right side next to the naval.
Prescription: bofutsushosan

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

17Volume 6, Number 2 | Summer 2011

Two weeks later she experienced comfortable bowel

use of cathartics. She used a cathartic from a Kampo

movements and lost about 1 kg in body weight. Bothpharmacy (content unknown) and had one bowel

frequency and intensity of the headaches decreased.

movement every 3 to 5 days. There was also cervical

Pulse was wiry and thin, tongue slightly red. Six

spondylosis (C7).

weeks later improvement of the sense of body heat.

Findings upon first visit:

Headaches and dizziness occurring during theFair-skinned large-built person, obese, light brownforenoon sometimes were alleviated when she hadcomplexion of the face with many freckles. In her

diarrhea. There was a strong sense of fullness,daily life she is working industriously. She has a bigtenderness or discomfort of the hypochondrium, theappetite, gets up twice for nocturnal urination,

entire lower abdomen was tender and even stroking

dreams a lot, is under stress relating to family

it hurt. Drugs for expelling blood stasis andmatters, her legs are prone to easy development ofrectifying qi were considered necessary and thus aedema, her face flushes and she sweats abnormally on

modified formula of tsudosan used. Ten weeks later

her head and back, dislikes summers, does not

the usage of analgesics had decreased to 1-2 times

complain of chilliness. The pulse was deep and wiry,

per week and without her really realizing since when,

the tongue deep red with a white fur and teeth marks,

she noticed that the gastric symptoms did not longer

engorged sublingual veins, the abdomen showed abother her. She continues to take the formula.

mild degree of fullness, tenderness or discomfort of< Migraine / tension headache; blood stasis >Case (7): age 62 years, female, housewife
Chief complaint: headache, dyshidrosis, constipation
Present illness:
Since 10 years, following her climacteric age, thepatient experienced hot flashes and abnormal
sweating, constipation and was prescribed atanother clinic unseiin + tokakujokito and similar
formulas, which improved these symptoms. Recently,
the same symptoms recurred and the patient visited
our clinic, also because of the headaches she hadsince her youth.
The headaches started at the age of 20, her eyesightdeteriorated and she experienced throbbing pain 2-3
times a month. On these occasions she usedcommercial analgesics and rested for 2-3 days, butsometimes these symptoms were also accompanied
by nausea and vomiting. Also, from her climacteric

the hypochondrium and there was a marked degree oftenderness on both sides of the naval.
Pattern: blood stasis, qi stagnation
Prescription: tsudosan
Course:
The administration of tsudosan led to a quick
alleviation of the headache and 2 months later theuse of analgesics had decreased to half its former
frequency. The frequency of the use of commerciallyavailable cathartic did not change, but upon
combination with daiobotanpito she experienced
from the following month onwards comfortablebowel movements and in association with this theuse of analgesics decreased to the range between one
and two tenth. Since the alleviation of the symptoms
was also associated with improvements in the bloodstasis findings of the tongue and abdomen, shecontinued to take this formula and gradually
improved. She stabilized mentally too.

age onward she experienced in the morning upongetting up a sense of headheavyness and felt as if shewore a hat. Formerly, she reported that the use of

kamishoyosan reduced the frequency of analgesic
use. She also had been constipated since her teensand could not have bowel movements without the18

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