Volume 5, Number 3 | Fall 2010

Clinical Report 3 (Japan)

her husband’s agreement. It seemed her headache

One Case that had Effect of Modified Hochuekkito on Qi
Deficiency Headache
Hiromichi Yasui
Japan Institute of TCM Research

was agonizing and she looked deeply pained.
Pulse condition: Deep and slippery, 60/min.
Tongue condition: Slightly dark colored with furs(-), swollen sublingual veins (-), moist.

Case: Female of 75 years oldAbdominal condition:

Initial visit: May 15, 2006

Course: At the initial visit, Extract of hochuekkito

Chief complaint: Headache6.0ｇ＋Extract of chotosan 7.5g were given for 7

Present medical history: Headache developed

day doses. From the day after the start ofafter the patient gave a birth in her 30s. Ever

administration, headache became eased, but theafter headache had continued for long and she

condition was changeable and unstable, becoming

had regularly been using analgesic agents. She

good and then bad during a day. However, heroverused Norshin four years ago and optical

overall condition seemed good. On May 29 (2ndillusions appeared. So she was psychiatricallyvisit), she received the above prescription for 28

hospitalized in a nearby general hospital. After

day doses. Subsequently she visited to thethis, she received outpatient treatment at thehospital on June 26 when headache was eased

hospital.

“depressivebut a lassitude sensation still remained. InShe was depressed

compliance with her complaint, the extract form

with severe everyday headache. The pain was a

was changed to decoction - hochuekkito +dull ache type in the entire head and not achotosan. A month later, headache further

pulsating type. The onset of headache was not

improved. However, the sensations of lassitude

associated with weather changes. According toand fatigability remained unchanged. At the visit

her husband, she had mild dementia and wasof August 21, headache (pain in the temples) wasreceiving treatment.

present. The pain was the type of being

Drugs now being taken: Depas (1.5 g), Risperdalconstricted. She complained of feeling lassitude.

(1), Miradol (150), Marzutene-S (1.5), Tredomin

And a further modification to the prescription(25) 2 times/2 tablets, Gramalil (25) 1 tablet,

wasToledomin (25) 2 tablets, Silece (1), Artane (2),formulation, she mostly did not feel headache. In

Kyorinher subsequent visits to the examination room,

Thediagnosispsychosis” and “headache.”AP21.0wasdivided into 2 doses

Past medical history:

No special mention.

PresentAppetite;

insomnia.

symptoms:
Urination;

5made.

With

theswitchto

thisnew

she conversed with the author in a smiling tone ofgood.

Sleep;

voice and the agonizing symptoms exhibited attimes/day.

Nightthe initial visit disappeared.

urination; once. Defecation; once in 2 days.

Diagnosis: Qi Deficiency Headache

Normal stools. Dryness of the mouth. Feeling ofTreatment method: Nourishing qi to activate thesluggish.

flow of qi

Present condition: cm kg. Body temperature 35.6

Course: Resulstingly, following were decocted on

degrees C. Blood pressure 112/76mmHg

August 21 (modified hochuekkito)
Astragali Radix 8, Ginseng Radix 4, Atractylodis
Rhizoma 4, Angelicae Acutilobae Radix 3, Citri
Unshiu Pericarpium 2, Ziziphi Fructus 2,

She had a slightly dark expression on her faceand looked helpless. She did not talk first andwhen answering to questions, she always asked for

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

21

Volume 5, Number 3 | Fall 2010

Bupleuri Radix 2, Cimicifugae Rhizoma 1,Zingiberis Rhizoma 1, Glycyrrhizae Radix 2
Angelicae Dahuricae Radix 4, Cnidium Rhizome 4,
Chrysanthemi Flos 2 – for 28-day doses
At the visit of September 28, she claimed that
although slightly eased, headache appearedperiodically. So, the same prescription wasadministered for further 35 days. On November 7,
headache was relieved – far better than previouscondition. Since then, mostly no headache hasappeared.
Consideration:
The development of this headache was linked
with depression. Headaches associated withdepression are classified by The International
Classification of Headache Disorders 2nd Edition(ICHD-II) into the subcategory of “headaches
attributed to psychiatric disorders” under the
category of secondary headaches. Although
depression headaches are very common in our daily
life, there is no necessity in Kampo medicine to
specifically categorize this type of headache and theKampo treatment methods can be patterned to someextent.
In Western medicine, psychiatric disorders
presenting with depression are detailed into
varieties of groups, such as depression, of course,
psychoneurosis, schizophrenia, and organic
mental disorders including dementia. Psychiatricdisorders are usually treated with psychoactive
drugs
includinganti-depressantdrugs.
Meanwhile, there are quite a number of clinicalconditions that have benefits of Kampo drugs. In
the treatment of psychiatric disorders with
Kampo, clinical conditions are divided into a few
types and the most frequently used prescription ishochuekkito that has the action of supplementing
qi and enhancing the flow of qi. Some patientswith depression-associated headaches have hadrelief with this prescription. Moreover, there are
published data evidencing the usefulness ofsenkyuchachosan. And there is a case report in22

which chotosan was effective.
Hochuekkito is frequently used for thetreatment of depression. This prescription canalso be applied to depression-associatedheadaches. senkyuchachosan is a potential
candidate for depression-associated headaches.
Thus, for the treatment of depression, following
prescriptions should be taken into account:hochuekkito, or senkyuchachosan, or hochuekkito+ senkyuchachosan, or hochuekkito + chotosan. Ifblood deficiency is observed, either kihito orninjinyoeito is a good candidate. However, thefirst choice drug will be hochuekkito +senkyuchachosan.
In the case of this report, hochuekkito plus
Angelica Dahurica Radix, Cnidium Rhizoma, andChrysanthemum Flower were decocted andadministered. The final prescription was mostly
settled into this formulation. If the form of extract
is to be used, the Extract of hochuekkito + Extractof senkyuchachosan will produce similar effects.
References:Isoshima G., Isoshima T.: Seishin-shikkan ni
heihatsu-suru Zutsu eno Senkyuchachosan noKouka. Abstracts of 54th Gakujutu Sokai, The
Japan Society for Oriental Medicine, p190 2003
Extract of senkyuchachosan was administeredto 55 patients with the diagnosis of mooddisorders (depressive disorders). The prescription
was effective in 35 and headache disappeared in
20 within two weeks and the medication wassenkyuchachosan wasdiscontinued.
And,administered to 24 patients with the diagnosis ofschizophrenia; 19 patients were considered tohave had effects with the disappearance ofheadache and the medication was completed.
Most of the patients with schizophrenia
mentioned that “the use of senkyuchachosan
cleared the head,” or “the foggy head became clearwith the prescription.”

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