Volume 4, Number 4 | Winter 2009

Clinical Report 2 (Japan)
Kamishoyosan + Goshuyuto for Migraines before
Menstruation
Mitsuyuki Takamura
Mie University Occupational Health Research Project

Hiromichi Yasui
Japan Institute of TCM Research

Case: Female of 45 years old
Initial visit: October 11 of year X
Chief complaint: Migraine attacks
Current medical history: The patient had been
suffering from headaches with stiff shoulders forseveral years. Separately from the headache, athrobbing pain appeared sometimes in thetemples and became exacerbated especially before
the period. The pain was not associated with theweather. Analgesics hardly worked, and the use of
the medicine caused her stomach troubles.
Stiffness in the shoulders became worse
especially in recent days. Massages had effect tosome extent, but the effect lasted only for one day.
Menstruation became irregular 1-2 years ago. It
came earlier or late and the cycle was not stable.
She had menstrual cramps. Her limbs were cold.
She got hot and sweaty. She was irritable. The
lips became chapped.
Appetite: Ordinary
Sleep: GoodDefecation: twice/day
Urination: 15 times/dayPresent conditions: 158cm/58kg
Pulse: Deep
Tongue: Slightly red with small amounts offurs
Diagnosis: Qi stagnation and blood stasis/cold ofliver and stomach
Prescription: Extract of kamishoyosan 6.0g +Extract of goshuyuto 2.5g divided into 3 equal
doses
Course: The patient’s re-visit was 2 weeks later.
The frequency of headaches decreased and thelimbs became warm. Stiff shoulders were relieved
and a headache developed only once in a while. In

14 weeks, the headache disappeared completelyand she often forgot to take the medicine. As aprecautionary measure, however, the medication
was continued. On March 4 of year X+1, theheadache recurred and became worse. So theExtract of goshuyuto was increased to 5g,
resulting in a relief of the pain. On May 30 when
the patient made a hospital visit, she complainedof intense stiffness in the region from theshoulders to the back, involving the exacerbationof the headache. For these symptoms, kakkonto
7.5g was added, which relieved stiff shoulders
and the headache.
Consideration: In the patient’s case, tension-type
headache and migraine coexisted. Irregularmenstruation, or the unstable cycle of the periodcoming earlier or late, and irritability prompted
the author to assume liver Qi stagnation while it
was assumed that menstrual cramps caused
blood stasis. The conditions of cold limbs andsuddenly becoming hot and sweaty were causedby the simultaneous presence of heat in the upper
body and cold in the lower body. These symptoms
are indications of kamishoyosan, which is also
supported by her getting close to the age ofmenopause and similar signs and symptoms tothose of menopausal syndrome. The headache,however, was triggered by cold, so the applicationof goshuyuto was also possible. Thus, these two
formulations were administered at the same time.
After qi stagnation and blood stasis wereimproved, the reason the headache became
intense again was, I considered, because theseason was changing to the cold one and thereby
the conditions of cold of liver and stomach wereaggravated. And so, the volume of goshuyuto wasincreased and the symptoms were resolved.
Subsequently, as tension-type headaches became
noticeable, kakkonto was used in combination.
Then all problems were solved.
hen all problems were solved.

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

17