Meta-analysis of randomized controlled trials on the efficacy of daikenchuto on improving intestinal dysfunction after abdominal surgery

PURPOSE: Intestinal dysfunction is one of the most common complications in patients after abdominal surgery. Daikenchuto (DKT), a traditional herbal medicine, is recently employed to improve postoperative intestinal dysfunction. The aim of this meta-analysis was to assess the efficacy of DKT in improving intestinal dysfunction after abdominal surgery. METHODS: PubMed, Embase, and the Cochrane library were systematically searched to identify randomized controlled trails (RCTs) in adult patients undergoing abdominal surgery, who were randomly distributed to administrate DKT and placebo. The primary outcomes included the time to first postoperative flatus or bowel movement. We used random-effects models to calculate summary mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: Nine RCTs totaling 1,212 patients (618 in DKT, 594 in control group) were included in our study. Compared with control group, DKT can effectively improve postoperative intestinal dysfunction by shortening the time to first postoperative flatus (MD, −0.41; 95% confidence interval [CI], −0.66 to −0.16; P = 0.001) with significant heterogeneity (I2 = 71%, P = 0.004), and bowel movement (MD, −0.65; 95% CI, −0.97 to −0.32; P < 0.001) without significant heterogeneity (I2 = 40%, P = 0.14). Sensitivity analyses by indication of surgery and type of surgery yielded similar results. CONCLUSION: These data provide limited evidence that DKT shows efficacy on improving intestinal dysfunction after abdominal surgery. However, the results should be interpreted cautiously, due to the heterogeneity of the studies included. Thus, the efficacy of DKT on improving postoperative intestinal dysfunction warrants further investigation.

Dai-Kenchu-To, a Herbal Medicine, Attenuates Colorectal Distention-induced Visceromotor Responses in Rats

BACKGROUND/AIMS: Dai-kenchu-to (DKT), a traditional Japanese herbal medicine, is known to increase gastrointestinal motility and improve ileal function. We tested our hypotheses that (1) pretreatment with DKT would block the colorectal distention-induced visceromotor response in rats, and (2) pretreatment with DKT would attenuate colorectal distention-induced adrenocorticotropic hormone (ACTH) release and anxiety-related behavior. METHODS: Rats were pretreated with vehicle or DKT (300 mg/kg/5 mL, per os). Visceromotor responses were analyzed using electromyography in response to colorectal distention (10, 20, 40, 60, and 80 mmHg for 20 seconds at 3-minutes intervals). Anxiety-related behavior was measured during exposure to an elevated-plus maze after colorectal distention. Plasma ACTH and serum corticosterone levels were measured after exposure to the elevated-plus maze. RESULTS: Colorectal distention produced robust contractions of the abdominal musculature, graded according to stimulus intensity, in vehicle-treated rats. At 40, 60, and 80 mmHg of colorectal distention, the visceromotor responses of DKT-treated rats was significantly lower than that of vehicle-treated rats. At 80 mmHg, the amplitude was suppressed to approximately one-third in DKT-treated rats, compared with that in vehicle-treated rats. Smooth muscle compliance and the velocity of accommodation to 60 mmHg of stretching did not significantly differ between the vehicle-treated and DKT-treated rats. Similarly, the DKT did not influence colorectal distention-induced ACTH release, corticosterone levels, or anxiety-related behavior in rats. CONCLUSIONS: Our results suggest that DKT attenuates the colorectal distention-induced visceromotor responses, without increasing smooth muscle compliance, ACTH release or anxiety-related behavior in rats.

Effects of Several Kampo Medicines on Postoperative Ileus Model / 日本東洋医学雑誌

The effects of four Kampo medicines, Ninjin-to, Hange-shashin-to, Rikkunshi-to and Sho-hange-ka-bukuryo-to, were investigated in a rat model of postoperative ileus. The postoperative ileus model was made by incising the abdomen and exposing the small intestine and caecum for five minutes under ether anesthesia. The gastrointestinal transit was estimated by the migration of a charcoal marker. In contrast to the animals anesthetized only, the gastrointestinal transit was markedly decreased in control animals. First, we studied the gastrointestinal prokinetic drugs (cisapride, mosapride and metoclopramide), the anti-inflammatory drug indomethacin, and the Kampo medicine Dai-kenchu-to in this model. They significantly increased the transit as compared with the control. Using the same method, Rikkunshi-to and Sho-hange-ka-bukuryo-to were demon-strated to be almost inactive. However, Ninjin-to and Hange-shashin-to not only significantly improved the gastrointestinal mobility compared to the control, but also showed stronger effects than those of Dai-kenchu-to. These results suggest that in addition to Dai-kenchu-to, Ninjin-to and Hange-shashin-to are also effective Kampo medicines for postoperative ileus.

The Clinical Usage and Dosage Form of Dai-kenchu-to Extract / 日本東洋医学雑誌

All prescriptions containing Dai-kenchu-to (DKT, Da-Jian-Zhong-Tang), one of the most commonly prescribed Kampo medicines (Sino-Japanese traditional herbal medicines) in Japan, that had been issued during a six-month period from September 1999 to February 2000 at Kitasato University Hospital, were analyzed. The DKT used at this hospital was in the form of ethical extract granules (Tsumura, Tokyo), and it was mainly prescribed to patients who were treated in the Departments of Gynecology and Surgery and who had undergone surgery. In order to clarify problems in the administration of DKT granules to post-operative patients, a questionnaire was distributed to nurses working in the wards of eight large hospitals (over 470 beds each). More than 80% of the nurses reported that they had observed problems with the taste and dosage of DKT administered to their patients. Hard granules do not readily dissolve in water, and the nurses observed difficulty in deglutition upon oral administration of DKT, and tube obstruction in patients who were administrated DKT through a gastric tube. These difficulties in the administration of DKT are thought to increase the workload of the care staff, and the development of a new route of administration of DKT, for example, a decocted solution packed into a stick, is expected.

The History of Dai-kenchu-to and the Component Crude Drugs / 日本東洋医学雑誌

A Kampo medicine, Dai-kenchu-to, has been used clinically for treatments of various ailments such as vomiting, stomachache, and abnormal intestinal peristalsis caused by abdominal chill. Recently, it is often used to prevent intestinal obstruction after abdominal operations. We searched ancient Chinese and Japanese medical texts for the indications and pharmacological characteristics of Dai-kenchu-to and its constituent herbs (<i>Zanthoxylum</i> fruit, dried Ginger rhizome, Ginseng root, and Malt sugar). We clarified the applications and the cautions of Dai-kenchu-to in this paper. Dai-kenchu-to has rarely been used in China. However, it was often used for the remedy of severe abdominal pain caused by chilling, worm-ileus and hernia in the medieval period of the Edo era in Japan. For these reasons, evidence is considered as described below. i) Japanese people did not have the habit of eating meat in those days. ii) Japanese people used to drink a lot of water. iii) Severe abdominal pain occurred frequently due to wearing traditional Japanese clothing, which does not protect well against cold. iv) Abdominal diagnosis was advanced in Kampo medical methods. We found two precautions in the ancient Japanese medical texts. One is that a purgative should be avoided when used in an applicable case of Dai-kenchu-to. The other is that Dai-kenchu-to should not be given in the case of high fever. It is supposed that the botanical origins and processing of the four herbs used in the medieval period of the Edo era are the same as those of today. Our findings suggest that the pharmacological contribution of the four herbs in Dai-kenchu-to is mainly due to <i>Zanthoxylum</i> fruit and dried Ginger rhizome, and that Ginseng root and Malt sugar harmonize between the condition of patient and the pharmacological action of <i>Zanthoxylum</i> fruit and dried Ginger rhizome.

A Case of Ascites Arising from Liver Cirrhosis Effectively Treated with Dai-kenchu-to / 日本東洋医学雑誌

We reported that a patient with ascites arising from liver cirrhosis was successfully treated with Dai-kentyu-to. The case was a 67-year-old woman who was diagnosed as having C-type chronic hepatitis. After the operation of gastric cancer, ascites appeared. She was treated by diureatics, but ascites increased. When she was operated on for an abdominal hernia, the liver was cirrhotic. She lost appetite and was fatigued. She visited our clinic to undergo Kampo therapy. Hochu-ekki-to, Gorei-san, Sho-kenchu-to were given for her symptoms, but had no effects. However, since she began taking Dai-kenchu-to for her cold and rumbling abdomen, her ascites decreased gradually, and diuretics were stopped.