Three Cases Demonstrating the Effectiveness of Boiogito Treatment Against Rapid Weight Gain and Edema: Women Suffering from Irregular Menstruation Without Obesity / 日本東洋医学雑誌

We encountered three patients with edema and menstrual disorder that was improved by boiogito. Case 1 was a 17-year-old woman with fatiguability and irritability, treated with kamishoyosan. After adding boiogito to kamishoyosan because of facial and foot edema, palmar sweating and weight gain, her menstrual period became regular. Case 2 was a 15-year-old woman with headache as well as facial and foot edema, who was receiving goreisan. She complained of knee discomfort and worried about weight gain even though she was thin. So we prescribed her boiogito, and her menstrual disorder improved. Case 3 was a 42-year-old woman with fluid retention, who suffered from general fatigue, coldness, and menstrual disorder. She was prescribed boiogito because of weight gain as well as foot edema and coldness, and her menstrual cycle gradually became regular. Boiogito appears to be effective in patients with menstrual disorder who show “exterior deficiency edema” that is maldistribution of fluid on the body surface, such as water retention, sweating, or edema. Boiogito resulted in a feeling of lightness. Even if water retention is not clearly observed, the symptoms of rapid weight gain, edema or edematous feeling, and subjective coldness may be indications for boiogito.

Combined Administration of Shinbuto and Boiogito Prevents the Progression of Chronic Kidney Disease with Minimal Proteinuria in the Long-term (Part 2) / 日本東洋医学雑誌

We previously reported that combined administration of shinbuto and boiogito extracts prevented the pro­gression of chronic kidney disease (CKD) over an observation period of 6 months. In the current study, we ex­tended the observation period to 60 months to investigate the long­-term effect of combined drug treatment. The subjects were 24 outpatients with CKD (14 men and 10 women ; mean age, 75.9 years) at the Department of Nephrology of Kagawaken Saiseikai Hospital. Shinbuto extract granules 5 g and boiogito extract granules 5 g were prescribed in two divided doses daily (before breakfast and dinner). Laboratory tests were performed before and 12, 24, 36, 48, and 60 months after drug administration. Although the treatment was discontinued in 14 patients because of reasons including patients' own volition, transfer to other hospitals, and emergence of proteinuria, 10 patients completed 60 months of treatment. Both the mean serum creatinine level (1.78 mg/dL before treatment ; 1.75 mg/dL after 60 months of treatment) and estimated glomerular filtration rate level (30.20 mL/min before treatment ; 34.39 mL/min after 60 months of treatment) did not deteriorate during the study period. Kidney test results persistently and significantly improved compared to the pre-­treatment results in 7 patients in whom the activities of daily living was stabilized. Taken together, we believe that long­-term treatment with shinbuto and boiogito extracts is effective for preventing the progression of CKD, which may be associated with nephrosclerosis, to advanced kidney failure.

A Case of Rheumatic Arthritis Successfully Treated by Boiogito and Yokuininto with Bushi / 日本東洋医学雑誌

Here I report a case of chronic rheumatic arthritis, which was successfully treated with boiogito, yokuininto and bushi, leading to complete remission. A 38 year-old woman, null gravida, has been suffering from strong pain and frequent sense of numb in both hand joints. Previous orthopedic specialist diagnosed as rheumatic arthritis. Since she had a hope of getting pregnant, she came to our outpatient clinic, seeking Kampo treatment. Clinical examination revealed a positive test of anti-CCP antibody (>200) or rheumatoid factor as 32.4. Kampo treatment was started with keishikajutsubuto besides bushi, or eppikajutsuto with bushi, which were not effective sufficiently. Finally, combined agents with yokuininto and boiogito dramatically reduced pain, visual analogue scale score or CRP level, and relieved pain in bilateral hand joints, leading to complete remission. Yokuininto is applied to the cases with pains, chilliness or sense of numb in limb joints or muscles. Furthermore, boiogito is administered to the patients with edematous, painful and/or swollen joints. Both agents contain several herbal medicines with pain relieving spasmolytics, redistributing of tissue fluid or anti-inflammatory actions. From these findings, agents used in this case appear to work towards redistributing tissue fluid, easing local immune reaction or relieving pains powerfully. It is thought that combined agents with boiogito and yokuininto could be a reliable option for the treatment of rheumatic arthritis.

<b>Shinbuto-Boiogito Prevents the Progression of Chronic Kidney </b><b>Disease</b> / 日本東洋医学雑誌

<p>Nephrosclerosis is a chronic kidney disease that gradually aggravates. Many elderly patients eventually require dialysis due to nephrosclerosis, which is the third-greatest cause of dialysis initiation. Past studies have shown that Chinese herbal medicines such as <i>shinbuto </i>may be effective for treatment. We evaluated the effect of concomitant <i>shinbuto </i>and <i>boiogito </i>extract administration to slow the progression of renal failure in patients with chronic kidney disease suspected to have nephrosclerosis. Our study included 20 patients with nephrosclerosis (12 male ; 8 female ; mean age, 76.2 years) treated at the Nephrology Department of Kagawaken Saiseikai Hospital on an outpatient basis. <i>Shinbuto </i>extract granules 5 g and <i>boiogito </i>extract granules 5 g were divided into two doses and given to the patients before breakfast and dinner. Laboratory tests were performed at baseline, 3 months, and 6 months. Serum creatinine levels decreased from 2.04 mg/dL at baseline to 1.72 mg/dL at 3 months and 1.59 mg/dL at 6 months, while eGFR increased from 26.8 mL/min at baseline to 32.2 mL/min at 3 months and 35.3 mL/min at 6 months (p < 0.01). Other laboratory tests showed no change. <i>Shinbuto-boiogito </i>may improve the renal function in patients with chronic kidney disease suspected with nephrosclerosis based on these data.</p>

BOIOGITO INCREASES FATTY ACID - METABOLISM IN PROXIMAL TUBULAR CELLS THROUGH THE PEROXISOME PROLIFERATORS-ACTIVATED RECEPTOR (PPAR) Α AGONISTIC ACTIVITY / Монголын эм зүй, эм судлал

The promotion of fatty acid metabolism, to which PPARα contributes, has been suggested that it would be participate to maintain the proximal tubular cell function in kidney. The loading on the proximal tubular cell of fatty acids could arise the inflammation and cell death in obesity. One of the “Kampo” medicines, Boiogito (BO) is used for the remedy of overweight women exhibiting chronic fatigues as well as edema in the lower extremities or knees. BO would exhibit the prevention of the proximal tubular cell damage and improvement of kidney function by reducing the portion of fatty acids. In this study, BO was orally administered high fatty acid combined with bovine serum albumin for mice to evaluate the mRNA expression of PPARα quantified by PCR. The increase of PPARα mRNA expression was observed BO administration, followed by reduce the volume of fatty acids in kidney.KEY WORDS: Boiogito, Fatty acid metabolism, PPARα, Proximal Tubular CellINTRODUCTIONObesity is a risk factor for incidence of albuminuria and chronic kidney disease 1, 2, and an accumulating visceral fat would be involved in the regulation of primary stage of nephropathy 3, microalbuminuria. Fatty acids are major contributor to these kidney disorders caused by obesity 4. The binding fatty acids with albumin represents in blood generally, taking up by proximal tubular cells after glomerular filtration from albumin. A peroxisome proliferator - activated receptor (PPARα) has been suggested that it would regulate the fatty acid metabolism. Because the glomerular filtration rate and renal blood flow would increase in overweight patients 5, a large quantity of free fatty acids should be loaded into proximal tubular cells. Therefore, the investigation concerning to PPARα stimulator can be regarded as the fatty acid metabolism - regulation. One of the “Kampo” medicines, Boiogito (BO) is used for the remedy of the inflammation and cell death in obesity, is composed of eight crude drugs: Aluminum Silicate Hydrate with Silicon Dioxide, Astragalus Root, Atractylodes Rhizome, Ginger, Glycyrrhiza, Jujube, Sinomenium Stem and Rhizome. In this study, to clarify the therapeutic mechanisms of BO, we focused on the up - regulating for fatty acid metabolism through the PPARα activation.METHODSKampo formulaeBO was prepared according to the prescription for a one-day dose 6: 3.0 g Aluminum Silicate Hydrate with Silicon Dioxide, 5.0 g Astragalus Root, 3.0 g Atractylodes Rhizome, 1.0 g Ginger, 2.0 g Glycyrrhiza, 4.0 g Jujube, 4.0 g Sinomeniumstem and Rhizome.

<b>Efficacy and Economic Benefit of Combination Therapy with Boiogito and Methotrexate for the Treatment of Rheumatoid Arthritis </b> / 日本東洋医学雑誌

The purpose of this 3-year retrospective study was to determine the efficacy and economic benefit of boiogito when administered concurrently with methotrexate (MTX) in patients with rheumatoid arthritis (RA). One hundred twenty-six patients who were treated at Ohno Clinic between May 2006 and November 2011 with either the MTX-boiogito combination (n = 59) or MTX alone (n = 67) were identified for the study. Eligible patients were selected on the basis of the 1987 American College of Rheumatology (ACR) criteria and their disease activity, while their remission rates and treatment outcomes were evaluated using the Disease Activity Score 28 Erythrocyte Sedimentation Rate (DAS 28-ESR). A total of 93 patients (MTX-boiogito group,n = 45 ; MTX alone group, n = 48) were included in the statistical analysis after excluding those who prematurely withdrew from the study due to adverse events or conditions that required treatment with biological agents.<br>Our results showed that the MTX-boiogito group had significantly lower disease activity (<i>p </i>= 0.0372),higher rates of remission (<i>p </i>= 0.0093), and greater improvement in overall DAS 28-ESR score (<i>p </i>= 0.0050) when compared to the MTX alone group. With the combination therapy group, fewer patients needed to add further disease-modifying anti-rheumatic drugs (DMARDs), and the total cost of medications over the 3 years was lower (2,145,470 JPY vs 2,301,690 JPY) with a resultant savings of 156,220 JPY per person. In conclusion, the use of boiogito 7.5 g/day represents a clinically and economically important addition to MTX therapy for the treatment of RA.

Four Cases of Chronic Cough Successfully Treated with Boiogitokamao / 日本東洋医学雑誌

Boiogito is mentioned in Synopsis of the Golden Chamber, in which it is written to add ephedra herb for patients with cough at the end of the chapter. We experienced 4 chronic cough cases of wind-wetness syndrome or edema caused by pathogenic Wind successfully treated with boiogitokamao. Subjective symptoms such as heaviness when moving, heavy sweating, and body chills, as well as objective findings such as pallor, and a weak pulse in the most distal region of the right wrist were common in these patients. Moreover, not only cough, but also accompanying symptoms such as obesity, dysmenorrhea, and eczema were improved. Observation of these four cases suggests that boiogitokamao can be effective for the treatment of the patients with chronic cough due to wind-wetness syndrome / edema caused by the pathogenic Wind.

Consideration to Clinical Indication of Boiogito / 日本東洋医学雑誌

Boiogito, which has been used for obesity, edema and arthritis by using flabby constitution as a clinical indication, is mentioned in Jin Kui Yao Lue (Synopsis of the Golden Chamber). We experienced five cases of wind-wetness syndrome or edema caused by the pathogen Wind successfully treated with boiogito. There were common findings in these cases, i.e., heavy sweating or perspiration while sleeping, chilly feelings and worsening of the evening subjective symptoms and pulse diagnoses, such as floating, string-like and congested pulse in objective findings. On the basis of these cases, we investigated the efficacy of boiogito extract in 10 patients having the all of common findings mentioned above. As a result, boiogito improved symptoms in 8 patients. This suggests that medical examination by interview and distinctive pulsation are important in deciding the Kampo diagnosis for boiogito.

The Effects of Boi-Ogi-To-ka-Mokutsu-Shazenshi on Gout / 日本東洋医学雑誌

Twelve male patients with gout in the remission stage were administered Boiogi-to extract (5.0g/day), Mokutsu (Akebia quinata) extract (0.5g/day) and Shazenshi (Plantago asiatica) extract (0.5g/day) twice a day, The efficacy of this combination was then evaluated. (Prior to commencement of this study, all patients carried both diet and exercise therapies and contniued them during this study).<br>After the 12-week administration period was completed, significant results were observed. Notably, there was a decrease of body weight, decrease in serum uric acid and serum glycerol, and an increase in serum HDL-cholesterol. By the 24th week after therapy commencement, the body weight did not increase and the serum uric acid did not elevate. No side effects and no gout attacks ware reported. The clinical symptoms of fatigue, hidrosis, oliguria, and edema also improved. In conclusion, this kampo formula was considered to be effective in the treatment of gout.

A Study of the Differences in the Clinical Use of Atractylodes Japonica and Atractylodes lancea in Kampo Formulas / 日本東洋医学雑誌

In the classical Oriental medical texts the “Shang Han Lun” and the “Jin Kui Yao Lue”, no clear distinction is made between Atractylodes japonica and Atractylodes lancea. Even today, no sharp critical distinction is made between the usage of these crude drugs in Kampo formulas. The authors have attempted to elucidate the differences in their clinical effect by investigating the way patients reacted when the two crude drugs were interchanged in Kampo formulas the patients were taking.<br>It was found that Atractylodes lancea was more effective than Atractylodes japonica for patients with arthralgia. Of the effective cases, 60% reported that the formula had a pleasant taste, while 9% reported it tasted bad. This suggested that taste may play a significant role in patient's responses to Kampo formulas.

Efficacy of Boi-ogi-to in the Treatment of Rheumatoid Arthritis / 日本東洋医学雑誌

In ten patients with Rheumatoid Arthritis (RA) who suffered from renal dysfunction or oedema of lower leg due to ineffectiveness or side effect of NSAIDs or DMARDs, we treated them with other anti-rheumatoid drugs and Boi-ogi-to which is one of Risui-zai at the dose of 2.5g three times daily. After the administration of 2-8 months, there is no statistically significant difference between the means of the pre-and post-labolatory findings by using paired t-test. However, clinical symptoms were improved in 80% of patients. It is concluded that Boi-ogi-to is effective for deriving from the side effects of anti-rheumatic drugs and useful for the pain control of gonarthritis.