Volume 7, Number 3 | Fall 2012

Clinical Report 2 (Kampo Medicine)
A Case in Which Keishikaryukotsuboreito Had a Marked
Effect on Postmenopausal Anxiety

Hisai Wada
Wada Clinic

58-year-old female
Past medical history & family history: Nothing
particular to mention. Entered menopause at 55
years of age.
Chief complaint: Anxiety, hot flashes, insomnia

Summary

Keishikaryukotsuboreito had a marked effect in acase where there was a hesitation to apply hormone
replacement therapy to a patient who enteredmenopause several years ago and whose chiefcomplaint was anxiety.

begins to decline toward the final cessation ofmenstruation to when it eventually falls andisunidentified

XXXX-3, the patient began to experience hot flashes,
but she ignored them, as they did not particularly
bother her. In the same year, she had a medical
checkup and was told her blood pressure was on thea doctor, but because her blood pressure had always

The period from when the gonadal function

stabilizes,

History of present illness: From around June ofhigh side. It was not so high that she needed to see

Introduction

calledmedical

menopause,
syndromethatandtheappears

during this period is called menopausal symptoms.
HormoneCase

replacement

therapyismarkedlyeffective against such vasomotor symptoms as
sweating and hot flashes, but it frequently fails tohave a sufficient effect on psychological symptoms

been low until then, the diagnosis shocked her, suchthat she was gripped by a sense of anxiety andexperienced palpitations whenever she measured
her blood pressure after that. No abnormality wasfound in subsequent medical checkups, but from thebeginning of XXXX, the patient’s anxiety mounted
for no reason, and she began to measure her bloodpressure at home. She also began to wake up in themiddle of the night, and tended to experience hot
flashes when she woke up. She would then think
about bad things and lose sleep out of anxiety. She

such as depression and anxiety. Additionally,created a stream of worries for herself to the point

applying hormone replacement therapy several

that she could not get any housework done, andyears after menopause increases the risk of side

thus made a first visit to my hospital on February

effects, so it is not a realistic first choice of22.

treatment.

Furthermore,prescribing

anAppetite: Not much appetite, although some foodantidepressant is met with strong resistance fromis consumed.

both gynecologists and patients who visit a

Bowel movement: Once a day

gynecologist with a chief complaint of general

Urination: 5 – 8 times/day; nighttime urination:

malaise.

1 – 2 times

This paper is a report on a case where Kampo

Sleep: Falls asleep, but tends to fall into a doze,

treatment had a marked effect on a patient whoandfrequently

experiences

nocturnalsought medical attention for a chief complaint ofawakening.

anxiety experienced several years after menopause.

Present condition: 155cm, 47kg, blood pressure
127/71mmHg
Overall findings: Hair is short, disheveled, andtangled. No makeup. Clothes are not worn
properly.

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

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Volume 7, Number 3 | Fall 2012

Abdominal findings: Weak (abdominal strength2/5). Tension in the rectus muscle on both sides,

Observations

Keishikaryukotsuboreitoaprescription

composed of cinnamon bark, keel bone and oyster

paraumbilical region. Slight painfulness in theshell. It works on deficiency patterns that call for therightsideofthechest.

Slightepigastricdiscomfort.

Progress: The patient was administered 7.5g ofkeishikaryukotsuboreito extract three times a day
and 1 tablet of an estrogen-progesterone compound
drug once a day, for a week.
When the patient made a visit the following week,
she was not wearing makeup, but she had brushed
her hair, and was wearing tidy clothes. She said she
became magically better from the following night
after she began taking her medicine. She reported
that sleeps well at night, and her feeling of anxiety,negative thoughts, hot flashes and palpitations alldisappeared. She did not want to take hormones, so
she was prescribed only Kampo medicine thereafter.
sometimes

thestrengthened

patient’s
afterakeishito or keishikashakuyakuto, andexcessive

anxietynocturnal

awakening or when there was an earthquake ortyphoon, but her condition improved on the wholeafter she was prescribed an additional 2.5g/day ofkambakutaisoto. By the time a year passed, thecloseattention

toherpalpitations,andIn the above case, keishikaryukotsuboreito wasused, based on palpation findings such as poor
abdominal strength, tension in the abdominal rectus
muscle and palpitations, accompanied by thepatient’s chief complaints of anxiety and insomnia.
Hot flashes and seating were observed since
immediately after menopause, so a female hormone
was initially prescribed, but the patient improved
solely with keishikaryukotsuboreito. The symptoms
were not due to hormonal decline, but rather, it wasthought that the kidney qi declined with age and theheart qi worsened on the whole, thereby causing a qi
counterflow mainly brought about the patient’sillness.
During menopause, patients are affected not only
by hormonal changes, but also changes in social
background and changes accompanying age. Kampo
treatment that corresponds to each condition isthought to be effective.

patient was seen wearing attractive makeup andgiving

dreaming,

nocturnal emissions.

｀treatment,ofsleep,Tongue: Red, swollen, light yellow coating

Duringuseimproves anxiety, tendency to be surprised, shallow

Pulse: Slightly floating and string-likeclothes.

Keishikaryukotsuboreito was gradually reduced in
response to her improvement, and when she came infor a consultation in February XXXX+2 “to makecertain, although she thinks she is alright now,” shewas prescribed 2.5g/day of keishikaryukotsuboreito
worth a month. This completed her treatment.

20

isand strong palpitations from the epigastric to theThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)