Volume 2, Number 4 | Winter 2007

Clinical Report 3
A Case of Palpitation in which Hangeshashinto had been
Effective
Keigo Nakata
Hosono Clinic

Knotted pulse or palpitations belong to thesymptoms frequently treated with Kampo medicine.

Saikokaryukotsuboreito,

saikokeishikankyoto,teikiin, keishikanzoto, shakanzoto and similarprescriptions may be named as often prescribed
formulas. Yet, in rare cases, like in the present
patient, people visit the clinic seeking relieve fromarrhythmias that have their origin apparently inthe alimentary tract. Below I will describe one suchcase.

dental indentations (+), thick white fur
Pulse diagnosis: between floating and deep, wiry,intermediate, forceful, regular
Abdominal diagnosis: thick abdominal wall, strong,elastic, there was some fullness, tenderness or
discomfort of the hypochondrium and increased
resistance and tenderness of the epigastric region.
Palms reddened and moist
Urinary findings: no anomalies
Electrocardiogram: nothing warranting special
mentioning
Prescription and course
Prescription:The

condition

wasconsideredtobea

saikokaryukotsuboreito pattern and thus thisCase: age 55 years, male, employee
Chief complaint: arrhythmia, palpitation
Present illness:
Two years ago the patient noted that his pulse
was beating irregularly. This occurred particularly
often after meals or when he climbed stairs quickly,
or he noticed the occurrence of a knotted pulse
walking the streets and suddenly emerged onbrightly lit places. He consulted a local physician,
who told him based on his electrocardiogram that
there is nothing to worry, but the taking β-blockers
did not improve the condition. Later he consulted
the department of cardiovascular diseases at a
certain general hospital and underwent detailed
examination, but no anomalies were found, so he
was told there is nothing to worry and wasprescribed the same medication. He continued toconsult that hospital as an outpatient for morethan one year, but because the symptoms did not
improve sought consultation in this clinic.
Present status: height: 162 cm, weight: 64 kg,
slightly obese, blood pressure 120/70

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Tongue diagnosis: thick tongue body, dark red,

formulaprescribed,

butafteroneweekofmedication no changes at all were observed. Thus,
I re-assessed the pattern and switched theprescription to hangeshashinto plus Bupleuri
Radix, which then led to gradual improvements.
Discussion
Based on the observation of a wiry and forcefulpulse, a white fur on the tongue and fullness,tenderness or discomfort of the hypochondrium
during the first visit I diagnosed a lesser yangdiseasestage.

BasicallyIusesaikokaryukotsuboreito for excess patterns inpatients

withlesseryangofpalpitation

complaining

diseasestageandsaikokeishikankyoto in cases of deficiency patterns.
Naturally,inthiscaseIdiagnosed

asaikokaryukotsuboreito pattern and prescribed
this formula.
In cases for which saikokaryukotsuboreito is anindication irritability and restlessness arising fromfear are observed, but this patient was calm and did
not show any signs of restlessness arising from fear.
Yet, the reddening and moistness of the palms

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

Volume 2, Number 4 | Winter 2007

suggested a state of excessive heart consumption,intervals of approximately 2 weeks and showed atwhicheach visit gradual improvements of the symptoms.

ledmetotheconclusionthatsaikokaryukotsuboreito would be appropriate.

Three months later the knotted pulse attacks had

Yet, contrary to my expectations, on the second

disappeared completely.

visit one week later the symptoms had not improved

Hangeshashinto is frequently use for various

at all. My master taught me: "Once you havediseases of the digestive tract and can be said to beprescribedthat

almost never used for cardiovascular diseases.

prescription without good reason" so that it would

However, while complaining of knotted pulse

probably be in order to continue with that

attacksprescription for a little while longer, but myconsidered to be triggered in this patient by

personal

noabdominal factors. Under these circumstances

improvements at all have been achieved after one

hangeshashinto too can be considered to be a very

week when treating patients with palpitations,useful prescription.

something,experiences

donot

showed,changethat

ifcontinuing the same treatment usually will not lead

Thisandwaspalpitation,antheseinteresting

attacks

experience

werethatto improvements. For this reason I reconsidered thenaturally brought the expression: "All five organs

prescription.

and six viscera can cause palpitation. It is not

At that time I focused on the fact that the attacks

limited to Heart.

of knotted pulse occurred after meals. The presenceof increased resistance and tenderness of theepigastric region also led me to the conclusion thatin this patient not stress or mental tension, butrather stimulation of the stomach triggered theknotted pulse attacks. Thus, I judged that unlessthe stomach is treated, the patient's knotted pulse
attacks are unlikely to be cured and therefore
prescribed hangeshashinto plus Bupleuri Radix.
Occasionally I use hangeshashinto with added

Bupleuri Radix. This is an addition based mainlyontheabdominalpattern.

In

thiswayacombination of hangeshashinto and shosaikoto isachieved, extending the range of indications forhangeshashinto and enhancing its effects.
One week after switching the prescription tohangeshashinto plus Bupleuri Radix decoction thepatient visited the next time and reported "Thistime I have the feeling the medicine suits me. The
palpitation attacks also have markedly improved."
This gave me the confidence to continue with thatprescription. Later the patient visited my clinic in
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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