A Report on Three Cases of Infertility that Resulted in Pregnancy and Childbirth when Tokishakuyakusan was Administered Following Symptomatic Treatment Resolving Blood Stasis or Regulating qi / 日本東洋医学雑誌

Tokishakuyakusan is well-known to be useful in infertility. We report 3 cases of infertility that resulted in pregnancy and childbirth due to oral administration of tokishakuyakusan after being led to tokishakuyakusan pattern by symptomatic treatment resolving blood stasis or regulating qi. Case 1 was a 39-year-old woman with unexplained infertility. She visited our hospital because of irritability and was initially administered keishibukuryogankayokuinin and yokukansankachinpihange, and then tokishakuyakusan. After a month of treatment, she conceived. Case 2 was a 33-year-old woman who was diagnosed with ovarian dysfunction and received ovarian stimulation. To support infertility therapy she was administered keishibukuryogan, and subsequently, tokishakuyakusan based on her pattern. After 3 months of treatment, she conceived. Case 3 was a 37-year-old woman who was diagnosed with unexplained infertility and was administered kamishoyosan and hochuekkito for premenstrual syndrome at another hospital. She visited our hospital because of sensitivity to cold and fatigability. The previous treatment was discontinued, and she was administered tokishakuyakusan based on her pattern. After 2 months of treatment, she conceived. All 3 patients continued tokishakuyakusan treatment during pregnancy and successfully delivered live babies. These 3 cases initially received other Kampo medicines and then, tokishakuyakusan, according to the changed Kampo medical pattern. It is important to administer tokishakuyakusan to patients with infertility, following administration of appropriate Kampo medicine to correct their imbalance of qi, blood and fluid and after further confirming the abdominal signs suitable for tokishakuyakusan.

Significance of Combined Use of Kamishoyosan and Tokishakuyakusan for General Infertility Treatment / 日本東洋医学雑誌

We aimed to clarify the significance of using Kampo therapy centered on kamishoyosan and tokishakuyakusan together with general infertility treatment. The subjects were 41 women who visited a Kampo outpatient clinic for infertility and received general infertility treatment with Kampo therapy (Kampo group). The control group was 781 women who received only general infertility treatment at the same time (non-Kampo group). In comparing both groups, we conducted a retrospective survey on the pregnancy rate by cycle and the pregnancy rate by prescription. The pregnancy rate in the first cycle was 24.4% in the Kampo group and 8.5% in the non-Kampo group, and the pregnancy rate was higher in the Kampo group (P = 0.003). There was no difference in pregnancy rates after the second cycle. The pregnancy rate by prescription was 26.7% for kamishoyosan, 22.2% for tokishakuyakusan, and 8.5% for the non-Kampo group. In the comparison between the first cycle pregnant group and the non-pregnant group, the qi counter flow score was clearly higher in the first cycle pregnant group (P = 0.012). It is suggested that combined use of Kampo therapy including kamishoyosan and tokishakuyakusan may be effective from an early stage. Meanwhile, if pregnancy does not occur even after the combined use of Kamp therapy, it would be an opportunity to consider stepping up as Western medical therapy.

Four Cases of Patients with Skin Disorders (Atopic Dermatitis, Prurigo Gestationis, Acne Vulgaris) During Pregnancy Responded well to Tokishakuyakusan / 日本東洋医学雑誌

When female patients with skin disorders become pregnant, the treatments with the previously used antiallergic oral drugs are preferred to be switched to the treatments with external medicines alone, which often make patients experience unbearable itching and exacerbation of rashes. The use of tokishakuyakusan is known to be safe and improve various symptoms in the pregnancy period. In this report, the treatment of 4 patients with skin disorders were successfully switched to tokishakuyakusan alone from previously used antiallergic internal medicines and other traditional Japanese herbal medicines after pregnancy. Case 1 and 2 were patients with atopic dermatitis who had been treated only with the external medicine during a previous pregnancy but without amelioration. Case 3 was a patient with prurigo gestations who had rashes on the upper body trunk and complained of a strong itching sensation. Case 4 was a patient with acne vulgaris. In all cases, the rashes and itching sensation improved promptly with oral administration of tokishakuyakusan, followed by successful delivery. No side effects of gastrointestinal disorders were observed in any cases. Their skin disorders were speculated to be caused by the blood deficiency and stasis. Qi deficiency and fluid disturbance developed in association with pregnancy, which led to Yin deficiency and abundance of moisture. The positive responses of these conditions indicated that tokishakuyakusan was effective in the cases reported herein.

Evaluation of Various Anti-oketsu Kampo Formulae—Tokakujokito,Keishibukuryogan and Tokishakuyakusan—for Microcirculation by Live Imaging / 日本東洋医学雑誌

Oketsu is a characteristic pathophysiology in Kampo and traditional East Asian medicine that includes mul­tiple aspects of hemodynamic disorder. Anti­-oketsu drugs or the Kampo formulation used for oketsu show sig­nificant clinical effects on various disorders; however, their underlying mechanisms still remain unclear. We aimed to clarify the characteristics of the pharmacological effects of anti-­oketsu drugs on the microcirculation using a microscopic live imaging technique. Three Kampo formulations, namely tokakujokito, keishibukuryo­gan, and tokishakuyakusan were orally administrated to C57BL/6 mice at a dose of 300 mg/kg diluted in dis­tilled water. Live imaging was performed on the subcutaneous vessels of the mice, including the arteries (di­ameter > 50 μm), arterioles (diameter 10-50 μm) and capillaries (diameter < 10 μm). Tokakujokito widely increased erythrocyte flow velocity and blood flow volume from arteries to capillaries within 60 min of ad­ministration. The effects of keishibukuryogan on the vasodilation of the arterioles were remarkable, and con­tinued up to 120 min after administration. The pharmacological target of tokishakuyakusan was the capillaries, increasing their erythrocyte velocity and blood flow volume;its effect was more slowly expressed than those of the other formulations. Our results clearly demonstrate the sequential and special effects of anti-­oketsu drugs on hemodynamics. These differences may provide pharmacological information on the clinical usage of traditional Kampo formulations.

A Case of Chi-no-michi-sho that was Successfully Treated with Traditional Japanese Herbal Medicine for Seven Years / 日本東洋医学雑誌

Chi-no-michi-sho involves neuropsychiatric and physical symptoms that appear with hormonal changes, such as those during pregnancy and menopause. Until now, there were many case reports, which were within 2 years from the start of treatment. We present a case of chi-no-michi-sho that was successfully treated with Kampo formulations for 7 years. A 43-­year-­old woman had complaints of candida eczema in the vulva, palpi­tations, and headache. Tokishakuyakusan and shakanzoto were then administered for kekkyo (blood defi­ciency), oketsu (blood stasis), and suidoku (fluid retention), and a topical antifungal agent was administered for candida eczema. The headache and palpitations were reduced. Subsequently, tokishigyakukagoshuyuto and keishibukuryogan were administered because of skin rash and deterioration of sensitivity to cold. However, various symptoms, such as weight loss amenorrhea due to self-­determination, eczema, feeling heavy in the head, and edema, remained. We prescribed tokishakuyakusan again in addition to Western medical treatment. Her menstruation then resumed ; her eczema, palpitations, and headache also improved. However, she developed hyperthyroidism. While paying attention to organic diseases such as thyroid dysfunction, prescription of tokishakuyakusan may be effective when chi-no-michi-sho is long­-lasting and there are blood deficiency and stasis with fluid retention.

Successful Treatment with Tokishakuyakusan for de Quervain Disease and Carpal Tunnel Syndrome after Delivery / 日本東洋医学雑誌

De Quervain disease and carpal tunnel syndrome are major problems that occur after delivery. During pregnancy, hormone confusion readily causes inflammation of tendons ;furthermore, overuse of hands during care of other children contributes to symptom onset. We report four cases of de Quervain and carpal tunnel syndrome occurred after delivery. All patients were women, aged 33-­39 years. All patients breast-­fed after birth. One patient was diagnosed with de Quervain disease, two were diagnosed with carpal tunnel syndrome, and one was diagnosed with de Quervain disease accompanied by carpal tunnel syndrome. All patients received tokishakuyakusan ;thereafter, their pain decreased, but slight numbness from the carpal tunnel syndrome remained. Drugs that can be used during breastfeeding are limited ;however, tokishakuyakusan can be prescribed safely and effectively.

Twenty Cases of 20 Women Treated with a Regimen of Herbal Medicine According to the Treatment Stage of in vitro Fertilization or Microinsemination / 日本東洋医学雑誌

This report describes 20 women who underwent in vitro fertilization or microinsemination while receiving a regimen of herbal medicine, of which contents varied according to the treatment stage. Until the ova were harvested, in order to promote maturation, patients were treated with hachimijiogan for reinforcing kidney yang, and keishibukuryogan for removing blood stasis. Following this, during the period between harvesting and implantation, they were treated either exclusively with unkeito for warming meridians, dissipates cold, and replenishes blood, or with unkeito in combination with keishibukuryogan. Following implantation, they were treated with tokishakuyakusan to induce uterine relaxation. The treatment regimen was determined based on traditional herbal evidence of infertile patient's blood stasis and kidney deficiency. We adjusted applied dose depending on the conditions of patients. Fourteen of the 20 women tested positive for pregnancy; 10 of them carried to term, whereas in 4 of them, the pregnancy ended in abortion or miscarriage. Anti-Müllerian hormone concentration, endometrial thickness, estimated follicle count, recovered ova count, fertilized ova count, and numbers of ova to reach the early-embryo stage and blastocyst stage were compared between the continuing pregnancy and the non-pregnancy groups. Improvements were observed in all values after combined use of traditional herbal medicines, except in the case of endometrial thickness, and significant differences appeared in recovered ova count and fertilized ova count. These observations suggest that a regimen of herbal medicine adapted to the various stages of in vitro fertilization may be a useful complementary therapy during pregnancy.

Kampo Treatment for Intractable Iron-Deficiency Anemia Due to Gastrointestinal Side Effects of Oral Iron Supplement / 日本東洋医学雑誌

Iron deficiency anemia is the most frequently experienced anemia in common daily practice. It is often difficult to treat due to gastrointestinal side effects of iron drugs. We report a difficult case of iron-deficiency anemia with intolerance to oral iron supplementation, which was resolved by concomitant use of Kampo. Thirty-five-year-old woman visited us because of menoxenia continuing since she was 17 years old. Although tokishakuyakusan with kakobushimatsu (processed aconite root powder) had been administered, remarkable anemia such a low hemoglobin (Hb) level (7.8 g/dL) was observed. After we added an oral iron agent for 5 months, the hemoglobin level increased to 12.8 g/dL, and epigastric discomfort appeared. Therefore, we discontinued iron agent and switched to Kampo monotherapy, but anemia gradually worsened again. Following intravenous iron infusions could not improve the iron deficiency state. Then we administered ryokeijutsukanto with kojinmatsu (ginseng powder) and lower dose of oral iron agent than before, with reference to sinshato described in “Sokeitei Ijishogen” written by Nan'yo Hara. After administration, Hb and serum ferritin level improved from 11.6 g/dL and 4.0 ng/mL to 12.3 g/dL and 32.0 ng/mL, respectively. After that, the iron metabolism marker kept stable, although the oral iron agent had been further reduced. The main indications of sinshato are palpitation, shortness of breath, dizziness and edema according to the original text. These symptoms can be interpreted as ones related to anemia. In our case, it was suggested that prescription composition of sinshato promoted iron absorption and improved anemia.

Cases of Allergic Rhinitis Successfully Treated with Tokishakuyakusan / 日本東洋医学雑誌

Allergic rhinitis is an allergic disease affecting the nasal mucous membrane, and is aggravated by many kinds of factors. Here we describe 4 cases of allergic rhinitis successfully treated with tokishakuyakusan. Case 1 was a 31-year-old woman who suffered from coldness and irregular menstruation. We administered tokishakuyakusan, and her allergic rhinitis improved. When she stopped taking tokishakuyakusan, her allergic rhinitis recurred. Case 2 was a 40-year-old woman who suffered from seasonal pollenosis every year. Her pollenosis did not respond to keishibukuryogankayokuinin, administered for uterine myoma, but when we switched to tokishakuyakusan, her pollenosis improved. Case 3 was a 49-year-old woman who suffered from allergic rhinitis. She had not responded to many herbal medicines, but when we administered tokishakuyakusan, her allergic rhinitis rapidly improved. Case 4 was a 65-year-old woman who suffered from allergic rhinitis. She did not respond to kakkontokasenkyushin'i, but when tokishakuyakusan was added, her allergic rhinitis improved. Efficacy of tokishakuyakusan for rhinitis is not described in the classic literature. Our results suggest that tokishakuyakusan could be a suitable herbal medicine for asthenic, cold constitution of patients with allergic rhinitis caused by blood stagnation and blood deficiency as well as water disturbance.

Sixteen Cases Effectively Treated with Tokishakuyakusan with Jio (Tokishakuyakusan and Shimotsuto) / 日本東洋医学雑誌

We present 16 cases effectively treated using the traditional Japanese herbal formulation tokishakuyakusan with the crude extract jio (tokishakuyakusan and shimotsuto). All patients were women with a median age of 35.5 years (range : 22-62 years). Cases included infertility (n = 5), dermatological disease (n = 5), gynecological disease (n = 2), excessive sensitivity to cold (n = 2), mental nerve paresthesia (n = 1), and general fatigue (n = 1). All patients had sho for tokishakuyakusan and high degree of ketsu deficiency. All patients with infertility became pregnant within one year. The symptom severity of other patients decreased to less than half compared with their initial visit. Cases of palmoplantar pustulosis and chronic eczema improved without topical corticosteroids. Our results suggest that tokishakuyakusan with jio is a suitable treatment for patients who have sho for tokishakuyakusan and high degree of ketsu deficiency.

<b>Indicators for Treatment of Coldness with Tokishakuyakusan and Kamishoyosan </b> / 日本東洋医学雑誌

<i><b>Objectives </b></i>: We evaluated the efficacy of tokishakuyakusan and kamishoyosan for patients who complained of feeling cold, and identified key symptoms that would predict positive treatment outcomes for coldness with these medicines.<br><i><b>Design </b></i>: A retrospective cohort study<br><i><b>Subjects and Methods </b></i>: The subjects were 188 patients who reported feeling cold. They were treated with tokishakuyakusan or kamishoyosan according to their <i>Sho </i>for more than one month. The relationships between improvement of cold sensation and 62 factors, including other symptoms noted at the first medical examination, were evaluated by means of cross-sectional analysis, followed by logistic regression.<br><i><b>Results </b></i>: The factors of coldness of the abdomen (odds ratio, 5.0), vertigo (7.7), dimness of sight (16) and blushing (5.6), without anger (0.11) or tinnitus (0.025), were found to be predictors of a positive effect with tokishakuyakusan treatment (p < 0.001). The factors of hot flushes (14), without coldness of the whole body (0.099), and faint feeling (0.21) were significant for kamishoyosan (p < 0.001). This suggests that kamishoyosan can improve subjective coldness of the extremities (AIC -8.64), especially of the legs (-2.23).<br><i><b>Conclusions </b></i>: Coldness in the abdomen was an important indicator for treatment with tokishakuyakusan, while coldness in the legs, but not in the whole body, was important in the case of kamishoyosan.

Investigation of Clinical Indications of Tokishakuyakusan in Patients with Headache / 日本東洋医学雑誌

Headache is one of patients' major complaints at medical examination. And in Kampo medicine, we select prescriptions for them by taking not only headache, but also other symptoms into consideration.We present five patients with headache, whose symptoms were improved with tokishakuyakusan. Four patients (cases 1 to 4) had a background of menopausal symptoms and one (case 5), menstrual pain. Besides headache, other symptoms, such as vertigo, edema, and numbness of the fingers, were improved with tokishakuyakusan. Goshuyuto was not effective for headache in case 4, though it was effective to some extent in case 5, except for headache during her menstrual period. Headache during the ovulatory phase and/or pre- and early menstrual period disappeared when tokishakuyakusan was added to goshuyuto.Eleven cases of headache treated with toshakuyakusan, including these five cases, revealed that tokishakuyakusan was efficacious against migraine-type headache, which becomes worse during the menstrual period, and coldness. Although tokishakuyakusan should sometimes be distinguished from goreisan or hangebyakujyutsutenmato, it may be effective in patients with so-called “blood pattern” headache, associated with menstrual period and menopausal symptoms, and in patients with a heavy feeling of the head and vertigo.

Four Cases of Male Patients Successfully Treated with Tokishakuyakusanryo / 日本東洋医学雑誌

Tokishakuyakusan has been used widely to treat various diseases including gynecological disorders. Currently, tokishakuyakusan is frequently used to treat female patients, while indications for use in male patients are unclear. Furthermore, there are few reports of male patients having been effectively treated with tokishakuyakusan or tokishakuyakusanryo. Here, we report four male patients successfully treated with tokishakuyakusanryo. Case 1 was an 84-year-old man who had uncontrolled nasal allergy, and treatment with tokishakuyakusanryo was effective in relieving the patient's allergy symptoms that were accompanied by chills and oketsu (blood stasis) findings. Case 2 was a 63-year-old man whose chief complaints were bronchial asthma, benign prostate hypertrophy, and nasal allergy. All his symptoms improved considerably with tokishakuyakusanryo and hangekobokuto, especially the symptoms of nasal allergy. Case 3 was a 70-year-old man whose chief complaint was persistent proteinuria. Tokishakuyakusanryo was prescribed, in consideration of his clinically observed condition, which included sensitivity to cold, blood stasis and fluid retention. His proteinuria disappeared four months later, along with his other complaints of chills, oketsu, and fluid retention. Case 4 was a 56-year-old man whose chief complaint was ulcerative colitis. He had responded well to treatment with ifuto, but he developed hypertension. His prescription was changed to tokishakuyakusanryo, a similar prescription that does not contain the Glycyrrhiza radix which can cause hypertension. Afterwards, his blood pressure decreased to normal levels and his abdominal symptoms remained stable. Nangai Yoshimasu published the opinion that tokishakuyakusan could be applied not only in female patients but also male patients. Additional reports on male cases would provide helpful information to clarify tokishakuyakusan indications in male patients.

Tokishakuyakusan Induces Prolonged Survival of Fully Mismatched Cardiac Allografts and Generates Regulatory Cells in Mice / 日本東洋医学雑誌

Tokishakuyakusan is a Japanese herbal medicine which is extracts from six herbal materials. The author investigated the effects of oral administration of Tokishakuyakusan in a murine model of cardiac transplantation with fully mismatched allografts. CBA mice (H 2k) underwent transplantation of C 57 BL/6 (H 2b) hearts and received oral administration of Tokishakuyakusan from day 0 to day 7 after grafting. Untreated CBA mice rejected C 57 BL/6 cardiac grafts acutely (median survival time [MST], 7 days). Mice given 2 g/kg/day of Tokishakuyakusan accepted their grafts (MST, 60 days). However, each herbal material alone and 0.2, 0.02 g/kg/day of Tokishakuyakusan did not prolong the allografts survival. Splenocytes from Tokishakuyakusan-treated recipients showed alloproliferative hyporesponsiveness and down-regulation of IFN-γ in mixed leukocyte culture with C 57 BL/6 stimulators. Secondary CBA recipients (naive) given whole splenocytes from primary Tokishakuyakusan-treated CBA recipients with C 57 BL/6 cardiac allografts 30 days after grafting had prolonged survival of C 57 BL/6 hearts (MST, 100 days) compared to that in the secondary recipients with adoptive transfer of naive splenocytes (MST, 12 days). In flow cytometry experiment, the population of CD 4+CD 25+cells, CD 4+FOXP 3+cells and CD 25+FOXP 3+cells were increased in the spleens of Tokishakuyaku-san-treated CBA recipients. Treatment with Tokishakuyakusan induced unresponsiveness to fully allogeneic cardiac allograft and generated regulatory cells. Traditional knowledge of Japanese herbal medicine may contribute to immunomodulation after modern transplantation surgery.

Kampo Treatment for Painful Multiple Ulcers of the Lower Limb Associated with Livedo Vasculitis : A Case Report / 日本東洋医学雑誌

Livedo vasculitis is one of the most difficult dermatological diseases to cope with in routine clinical practice. We report the case of a 23-year-old woman, who was diagnosed with livedo vasculitis and was responsive to Kampo treatment. She had a rash-like bruise from the spring of X-2, being diagnosed with livedo vasculitis at another hospital. In April, X, painful multiple ulcers on both lower limbs were beginning to appear and were resistant to the western standard therapy. In May 6,X, we started Kampo therapy for her at our hospital. After 4 months, her painful ulcers disappeared. We used tokishigyakukagoshuyushokyoto as the main agent, along with kakobushimatsu, hainoto, senkinnaitakusan, hakushusan and tokishakuyakusan. Although her livedo symptoms still remain and may need long-term treatment to heal completely, she obtained relief from painful ulcers, returning to her normal daily life.

Is Tokishakuyakusan Clinically Useful in Treatment of Immunologic Recurrent Abortion? / 日本東洋医学雑誌

Clinical efficacy of tokishakuyakusan against immunologic recurrent abortion was evaluated using methods of diagnostic statistics. The subjects of this study were 38 women with recurrent abortion who had experienced a spontaneous abortion during their first trimester (within 12 weeks of pregnancy) twice, and who took tokishakuyakusan (extract granules) after development of their third pregnancy, but experienced spontaneous abortion again during their first trimester, with the karyotype of the aborted fetus being rated as 46, XX or 46, XY. The control group consisted of 244 women who had experienced 3 or more spontaneous abortions during their first trimester of pregnancy. The detection rates of autoimmune disorders and alloimmune disorders were compared statistically between the two groups. Neither the detection rate of autoimmune recurrent abortion nor the detection rate of alloimmune recurrent abortion differed significantly between the two groups, suggesting that tokishakuyakusan is not clinically effective against immunologic recurrent abortion. Tokishakuyakusan is estimated to prevent abortion caused by compromised luteal insufficiency of the uterus. Thus, saireito seems to provide a more rational means of Kampo therapy for immunologic recurrent abortion.

Two Cases of Subchorionic Hematoma Successfully Treated with Tokishakuyakusan / 日本東洋医学雑誌

I report two cases of subchorionic hematoma successfully treated with Tokishakuyakusan. They had genital bleeding due to subchorionic hematoma in the second trimester of pregnancy. I prescribed Tokishakuyakusan, and their genital bleeding improved within a week after the administration. The hematoma disappeared in less than two weeks after the administration, and they delivered infants of 2470g and 3324g respectively at 39 weeks pregnant by vaginal delivery. I found Ketsu stagnation, Sui disturbance and coldness of extremities in two cases. Although several studies suggested that the presence of subchorionic hematoma might be associated with adverse pregnancy outcome, there is no effective treatment for subchorionic hematoma in western medicine. The present cases suggest that Tokishakuyakusan may be useful in the treatment of subchorionic hematoma.

Evaluation of the Effect of Kampo(herbal) Medicine to Diminish Climacteric Symptoms Induced by the GnRH Agonist / 日本東洋医学雑誌

In the hormonal treatment of uterine myomas, which are estrogen dependent, GnRH agonist (GnRHa) therapy has become widespread. However, GnRHa therapy causes uncomfortable or harmful side effects such as climacteric symptoms. The aim of this study is to evaluate the effect of Kampo (herbal) medicine to diminish climacteric symptoms induced by the GnRHa. Twenty-six patients with symptomatic uterine myoma were recruited, and informed consent was obtained from all subjects. Leuprolide acetate depot 3.75mg (LA) as GnRHa was given with subcutaneous injection every four weeks for six months. After LA therapy was initiated, Toki-shakuyaku-san, Kami-shoyo-san, or Keishi-bukuryo-gan was given from the second month of treatment. Climacteric symptoms were evaluated with Simplified Menopausal Index, which was improved for Japanese women. In the present study, we found all three Kampo medicines were useful. In particular, Kami-shoyo-san was useful for climacteric symptoms induced by LA. Also, LA therapy combined with Keishi-bukuryo-gan had beneficial effects in uterine myomas. However, the precise mechanism by which results were achieved remains unclear. Therefore, further research may be necessary to evaluate the ability of Kampo medicines to diminish climacteric symptoms induced by GnRHa.

A Analysis on Saiko-ka-ryukotsu-borei-to, Tokishakuyaku-san and Mokuboi-to for Size Limitation of Myocardial Infarction / 日本東洋医学雑誌

The size of myocardial infarct has been proposed as one of the important prognosis factors. In this study, we examined the effect of Kampo for the size limitation of myocardial infarct. Twenty male swine were used. A metal-coil was inserted in the left anterior descending coronary artery (LAD) of swine, in order to induce acute myocardial infarction (AMI). After occurrence of AMI, the swine were divided into four groups: Saiko-ka-ryukotsu-borei-to (TJ-12) group (n=5), Tokishakuyaku-san (TJ-23) group (n=5), Mokuboi to (TJ-36) group (n=5), and control group (n=5). Three kinds of Kampo formula were administrated via stomach tubes for four weeks. The control group received basal rations alone. The infarct size of the TJ-36 group was significantly smaller than that of the control (p<0.05). Each size of the TJ-12 and TJ-23 group had smaller tendency than that of the control, without significant difference. The histological character of the infarct in the control was numerous inflammatory cell infiltration and small foci of fresh coagulative necrosis in the border zone, which was not apparent in any Kampo administration group. We summarize that these Kampo, especially Moku-boi-to, inhibit the infarct size development. This inhibition is probably caused by suppression of harmful free radicals production from inflammatory cells, or by microcirculation improvement. This inhibitory effect by Kampo medicine led to rescue the border zone indicated as “jeopardized zone”.

The Effects of Tokishakuyaku-san and Mokuboi-to on Coronary Spasm in Swine / 日本東洋医学雑誌

Sixteen male swine were utilized to study the occurrence of acetylcholine (ACh) induced coronary spasm using catheters. The left anterior descending coronary arteries (LAD) of the swine were denudated by catheterization under anesthesia. The swine were divided into three groups and fed for four weeks. Group A received Tokishakuyaku-san (0.66g/kg/day; Tsumura Co. Ltd.; n=6) in addition to the basal rations; group B received Mokuboi-to (0.25g/kg/day; Tsumura Co. Ltd; n=5) in addition to the basal rations; and the control group were fed for four weeks on the basal rations alone. The Kampo formulas were administered via stomach tubes in groups A and B.<br>Coronary spasms induced by catheter administration of ACh (100-250μg) were evaluated by elevation of the ST segment as measured by electric cardiography, and vasoconstriction of the LAD as ascertained by cineangiography.<br>The ACh-induced coronary spasms were found to either be of the diffuse type or LAD segmental type. Coronary spasms were noted to occur at a frequency of 5/13 in group A, 5/12 in group B and 7/13 in the control group, without significant differences among the groups. Groups A and B, however, exhibited a tendency towards a decreased rate of coronary spasm (40%) when compared to the control group (53.8%).<br>The vasoconstriction rate (VCR) was also calculated, interpreted as a morphological index of spasms as proposed by Takeuchi (1974). The VCR was higher in the spastic segment of the LAD than in the non-spastic LAD. It was suggested that Tokishakuyaku-san and Mokuboi-to have antispasmodic effects and may reduce the occurrence rate of spasms in swine LAD.