Aim Severe tetanus can be fatal, even with the latest drug treatments and artificial respiration. Nevertheless, combining Western and Kampo medicine may be beneficial for tetanus treatment. Methods We summarise the benefits of applying Kampo medicine in tetanus, especially referring to using shakuyakukanzoto (SKT) from the aspect of controlling myospasms. SKT is a Kampo formula used for the treatment of pain associated with sudden myospasms. Results SKT, kakkonto, daisaikoto, and daijokito have been used to successfully treat patients with generalised convulsions caused by generalised tetanus, without the use of a muscle relaxant. However, hypokalaemia, oedema, and hypertension caused by pseudo‐aldosteronism, which may result from an adverse reaction to licorice, should be monitored when using SKT. Conclusion A large randomised controlled trial may be necessary to establish a treatment for tetanus using both Western and Kampo medicines.

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Dear Editor, According to the statistical data on food poisoning from the Ministry of Health, Labor, and Welfare, two cases of colchicine poisoning occurred in 2021, resulting in one death. Additionally, three more such cases occurred in 2022, resulting in two deaths, indicating that lethal cases of this type of poisoning still occur. 1,2 We encountered a fatal case of colchicine poisoning because of the accidental ingestion of Colchicum autumnale, and we describe it here.An 86-year-old man with a history of diabetes mellitus, chronic heart failure, atrial fibrillation, severe tricuspid regurgitation, postoperative gastric cancer status, and irondeficiency anemia had accidentally ingested Colchicum autumnale (including the stem at the base and 2 to 3 leaves, but no bulbs), which had grown in his garden in the form of tempura. The patient developed diarrhea the day after ingestion. However, he refused hospitalization and was observed at home. Three days after the ingestion, the patient experienced difficulty moving and was taken by ambulance to a nearby hospital.On admission, he had developed multiple organ failure, including circulatory shock, acute liver failure, acute kidney injury (AKI), and coagulation disorders. The patient was transferred to our hospital for critical care. He presented with a consciousness level corresponding to a score of 12 on the Glasgow Coma Scale (E4V2M6) and was administered noradrenaline. On physical examination, his blood pressure was 137/64 mm Hg, heart rate was 98 beats per minute, respiratory rate was 28 breaths per minute, and body temperature was 37.1°C. The results of his blood tests were as follows: white blood cell count of 9600/μL, hemoglobin of 13.7 g/dL, and platelet count of 11.8 × 10 4 / μL. The results of the coagulation tests were prothrombin time-international normalized ratio (PT-INR), 3.56; D-dimer, 177.0 μg/mL; fibrin degradation product (FDP), 433.0 μg/mL; and an acute disseminated intravascular coagulation (DIC) score of 6 points. Biochemical tests revealed: aspartate aminotransferase (AST), 635 U/L; alanine aminotransferase (ALT), 250 U/L; lactate dehydrogenase (LD IFCC), 2294 U/L; alkaline phosphatase (ALP IFCC), 404 U/L; creatine kinase (CK), 1216 U/L; blood urea nitrogen (BUN), 50.8 mg/dL; creatinine (CRE), 3.30 mg/ dL; C-reactive protein (CRP), 10.48 mg/dL; and blood

Case: A male patient in his 70s was brought to the hospital with as chief complaint fever and difficulty in moving. Abdominal computed tomography revealed early acute appendicitis with fecaliths, and conservative treatment with antibiotics was started. On day 4, the patient started taking choyoto. Outcome: Although his symptoms did not exacerbate, contrast-enhanced computed tomography showed that the lumen of the appendix remained slightly enlarged, suggesting an appendiceal tumor. The patient refused further examination and was discharged on day 34 while continuing as an outpatient. Conclusion: Conservative treatment without surgery for acute appendicitis is risky in the elderly because of the possibility of a malignancy and because the severity of the disease tends to be underestimated. On the other hand, the risk of postoperative complications is high due to comorbidities. Therefore, In order to solve this dilemma, the effectiveness of the combination of Kampo medicines with conservative antibiotic therapy in improving symptoms and preventing recurrence should be verified.