Kampo treatment for neurological diseases “1st International Symposium on Kampo Medicine”

To The Editor Although novel modalities including various antibodies are at the forefront of clinical practice, most neurological diseases are still intractable. In this symposium, we will present representative examples in which Kampo medicine is effective in treating conditions for which western drugs are ineffective or cannot be used due to adverse effects. Dr Tamada will present the application of keishikaryukotsuboreito (KSTRB) as the effective treatment of parasomnia and adult nocturnal enuresis. As a prodromal symptom of neurodegeneration, the number of elderly people with rapid eye movement (REM) sleep behavior disorders is increasing. KSTRB can be used for the disorders. Dr Harada demonstrates that goreisan (GRS) was most effective in a homogenous type of chronic subdural hematoma for preventing recurrence after operation. It is well known that GRS can regulate water balance. Dr Raimura shows keishibukuryogan (KBG) is effective for patients who have both menstruation-associated migraine and scintillating scotoma. He will also show a video that blood stasis of the conjunctiva was improved after treatment. Finally, Dr Kwon introduces the effective treatment of cerebrovascular diseases with traditional herb medicine in Korea. The first presentation, by Dr Tamada, is “KSTRB for the Treatment of Parasomnia and Adult Enuresis”. In Jin Gui Yao Lue, an ancient text of Chinese medicine, KSTRB was initially described as effective in treating decreased sexual desire, sexual malaise, rectus abdominis muscle hypertonia, genital coldness, diarrhea, anemia, dizziness, alopecia, and very weak pulse. KSTRB had been used for nocturnal emissions in men and sexually aroused dreams in women in traditional Japanese medicine. In this way, abnormal sexual nocturnal behaviors had been treated with KSTRB for many years. We expanded the application of KSTRB to more general symptoms of parasomnia, which is defined as undesirable behaviors or experiences during sleep. Seven elderly patients including four patients with Parkinson’s disease had parasomnias in non-REM or REM sleep. After they started to take KSTRB, symptoms such as dream-enacting behavior and nightmares disappeared within a few days. In one patient, the frequency and magnitude of spike–wave complexes induced by 3-Hz photic stimulation were reduced on electroencephalography, suggesting inhibitory effects of KSTRB on brain irritability. We also successfully treated a woman with nocturnal enuresis that persisted into adulthood by KSTRB. Adult cases of nocturnal enuresis are refractory and rarely heal spontaneously. We suggest that KSTRB is a safe treatment option for parasomnia and nocturnal enuresis. The second presentation, by Dr Harada, is “The Effect of GRS for Chronic Subdural Hematoma.” Chronic subdural hematoma (CSDH) has a reported postoperative recurrence rate of 3%–20% and the optimal therapeutic strategy remains controversial. Several pharmacological treatments have been used to treat patients with CSDH (e.g., tranexamic acid, atorvastatin, and dexamethasone). GRS was reported effective in reducing the hematoma volume of CSDH for the first time in 1995. Since then, several studies, including prevention of postoperative recurrence, have been reported from Japan. Recently, GRS became one of the Kampo medicines most frequently used by Japanese neurosurgeons for reducing hematoma volume and preventing postoperative CSDH recurrence. We will introduce our clinical research on GRS for CSDH. We found that homogeneous-type CSDH was the most responsive to GRS for preventing recurrence. The third presentation, by Dr Raimura, is “Efficacy of KBG for Scintillating Scotoma and MenstruationAssociated Migraine”. Recently, new drugs such as triptans, ditans, anti-calcitonin gene-related peptide (CGRP) antibodies, and anti-CGRP receptor antibodies have been approved, and the treatment of migraine has made remarkable progress. But the preventive medicine for scintillating scotoma and menstruationassociated migraine is not effective enough. It is known that KBG can adjust the menstrual cycle and improve dysmenorrhea. Decreased blood flow in the visual cortex of the occipital lobe is known to cause scintillating scotoma. Some reports claim that antiplatelet drugs are effective for scintillating scotoma, and other reports demonstrate that KBG has an antiplatelet effect. Therefore, we administered KBG to patients who have both menstruation-associated migraine and scintillating scotoma and evaluated the effect by using HIT(Headache Impact Test)-6. The patient background is six women Received: 22 May 2022 Revised: 23 June 2022 Accepted: 29 June 2022