Treatment of two cases of musical hallucinations with Kampo medicine

To the editor, In this article, we report treatment of two cases of musical hallucinations with Kampo medicine. An 84-year-old man (Case 1) presented with Alzheimer disease and complained of musical hallucinations of military marching songs from 3:00 to 21:00 every day. Medication with goreisan (7.5 g/day) for 100 days completely relieved the symptoms. A 47-year-old woman (Case 2) was diagnosed with hypoacusis and complained of musical hallucinations of a popular ballad during treatment for depression and generalized anxiety disorder with escitalopram (20 mg/ day). Based on her symptoms of fear, anxiety, hypoacusis, remarkable renal deficiency in the pulse examination, and lack of dampness, goshajinkigan (7.5 g) was prescribed. As shown in Figure 1, treatment for two weeks relieved her symptoms to the point where their frequency decreased from daily to once every three days. On day 317 after the second tapering of goshajinkigan, the hallucinations relapsed. Resumption of goshajinkigan was effective immediately. Since goshajinkigan led to drowsiness as a side-effect, around day 350, its dosage was reduced to 2.5 g and hachimijiogan extract (5 g) was added. However, it was not effective and the hallucinations gradually relapsed. Therefore, goshajinkigan extract (7.5 g) was restarted for the third time on day 403. By day 462, the hallucinations disappeared Endolymphatic hydrops, Ménière’s disease, and tinnitus are reported to be associated with musical hallucinations [1]. These disorders are indications for dampnessresolving diuretic medicines. Goreisan was effective in Case 1 in this report. This formula is also recommended for endolymphatic hydrops since it contains Atractylodes lancea rhizome and Polyporus sclerotium, which inhibits aquaporin water channels in the inner ear. Since the heat pattern consists of excitatory psychiatric symptoms such as irritation, insomnia, and delirium, clearance of heat is also considered important when treating psychiatric disorders accompanied by hallucinations. Goshajinkigan, which was effective for Case 2, consists of Achyranthes root and Plantago seed in addition to hachimijiogan. Both Achyranthes root and Plantago seed are diuretic medicines. Plantago seed is also used to clear heat. Therefore,