Acute pancreatitis associated with indigo naturalis in pediatric severe Crohn’s disease

The incidence of inflammatory bowel disease (IBD) is rapidly increasing worldwide. Indigo naturalis is known to have an antiinflammatory effect. Indigo naturalis has been traditionally used in the treatment of IBD in China and Japan. Currently, it is used as a primary or adjunctive drug in patients with ulcerative colitis. There are some reports of the effects of indigo naturalis when used in patients with ulcerative colitis. However, its usage has been associated with adverse events, including liver dysfunction, headache, gastrointestinal disturbance, and pulmonary hypertension. Pancreatitis as an adverse event during treatment using indigo naturalis has not yet been reported. We report a case of recurrent events of pancreatitis that occurred briefly after starting medication with indigo naturalis in a child with severe Crohn’s disease. The pancreatitis improved after indigo naturalis was discontinued in 2 events. This is the first case to report the association between pancreatitis and indigo naturalis in the English literature.

Potential application of the Kampo medicine goshajinkigan for prevention of chemotherapy-induced peripheral neuropathy / 中西医结合学报

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most common and severe adverse effects related to cancer treatment. Unfortunately, although several agents and protocols have been proposed, no prophylactic strategies have yet to be proven useful. Therefore, new alternative therapies have been considered for CIPN prevention. Herbal medicine in Japan, called Kampo medicine, is derived from traditional Chinese medicine. Goshajinkigan (GJG) is a Kampo medicine, that is comprised of ten herbs. The aim of this work is to analyse the results of pre-clinical and clinical studies on the potential applications of GJG in CIPN prevention.

Effect of Saikokeishito, a Kampo medicine, on hydrogen peroxide-induced premature senescence of normal human dermal fibroblasts / 中西医结合学报

<p><b>OBJECTIVE</b>Saikokeishito (TJ-10) is a Kampo (traditional Japanese herbal) medicine, clinically used for hundreds of years in East Asia. Among its various mechanisms elucidated so far, TJ-10 inhibits the production of transforming growth factor-β1 (TGF-β1) and development of pancreatic fibrosis in vivo. Oxidative damage of normal human dermal fibroblasts (NHDFs) in the corium is a cause of human dermal senescence. Our aim was to determine whether TJ-10 protects NHDFs from premature senescence by hydrogen peroxide (H₂O₂).</p><p><b>METHODS</b>Premature senescence was induced in NHDFs by 200 μmol/L H₂O₂ for 4 h. Cell viability and the expressions of p53, AMP-activated protein kinase α1 (AMPKα1), AMPKα2, and 14-3-3 protein sigma (14-3-3 σ) were measured in NHDFs treated with TJ-10 for 48 h before exposure to H₂O₂for 4 h.</p><p><b>RESULTS</b>Cell viability after treatment with 200 μmol/L H₂O₂ for 4 h was similar (about 80%) to after pre-treatment with TJ-10. Ascorbic acid as a control did not protect NHDFs from damage by 200 μmol/L H₂O₂. Treatment with 200 μmol/L H₂O₂tended to up-regulate p53 and to down-regulate SIRT1 and AMPKα1, but had no effect on AMPKα2 and 14-3-3 σ expression. Pretreatment with TJ-10 inhibited H₂O₂-induced up-regulation of p53 and enhanced AMPKα1 expression.</p><p><b>CONCLUSION</b>It is suggested that Saikokeishito has a protective effect on oxidative stress-induced senescence of NHDFs.</p>

Pharmacological characteristics of Kampo medicine as a mixture of constituents and ingredients / 中西医结合学报

Herbal medicine in Japan is termed as Kampo medicine, which is derived from traditional Chinese medicine. Shakuyakukanzoto (Shao-Yao-Gan-Cao-Tang) as a kind of Kampo formulations is composed of just two components; Paeoniae Radix and Glycyrrhizae Radix, which produced marked relaxation of intestinal tract. Mokuboito (Mu-Fang-Ji-Tang) inhibited cardiac ionic channel currents, and as a mixture also produced great vasodilatation. Sinomenine (a main ingredient of Mokuboito) as a single compound also caused the vasodilatation, but decreased it along with ageing. Gypsum containing in Mokuboito and Chotosan (Diao-Teng-San) caused more marked effects, as compared with those without Gypsum. On the other hand, Rokumigan (Liu-Wei-Wan), Hachimijiogan (Ba-Wei-Di-Huang-Wan) and Goshajinkigan (Niu-Che-Shen-Qi-Wan) increase in order the number of contained ingredients. The formulations with more herbs (ingredients) produced much more effective actions on rat aorta, presumably due to compensation of the decline of pharmacological sensitivity with ageing. Thus, there are some important differences between single chemical drugs and mixture drugs with many ingredients. The effects of Kampo medicine (mixture) are never just a sum of each effect induced by a lot of ingredients. For elder persons, furthermore, Kampo medicine exerts more effective actions.

Traditional Japanese medicine, Kampo: its history and current status / 中国结合医学杂志

Traditional Japanese medicine, Kampo, is used by over 80% of medical doctors in Japan. Owing to its high quality and safety, Kampo has been integrated into modern medicine, and there are 345 randomized controlled trials using Kampo in Japan as of 2010. Although there are a number of articles in top journals about basic science research, we can find only small numbers of high-quality clinical evidence. Since undergraduate education on Kampo has been established, integrative approach with the balanced combination of modern medicine and Kampo is expected to generate good clinical evidence in the near future.

Use of traditional Chinese medicine in the management of urinary stone disease: [review]

Objective: To assess the evidence-based literature supporting the use of traditional Chinese medicine Kampo herbal and Acupuncture in stone disease management. Materials and Methods: Four of the most commonly used herbal components of Kampo medicine in the treatment of stone disease are described according to their in vitro and in vivo effects. We also reviewed the role of Acupuncture in urologic clinical setting as well as its proposed mechanisms of action and results. Medline database was assessed using isolated and conjugated key words (Chinese Medicine, Kampo, Chinese Herbal, Calculi, Stone Disease, Kidney, Acupuncture, Herbal Medicine). Articles were reviewed and summarized. Results: Herbal medicine has been proven to be free from side-effects and therefore suitable for long term use therapy. Its antilithic beneficial effects include increased urinary volume, increased magnesium excretion (Takusya), inhibitory activity on calcium oxalate aggregation (Takusya, Wulingsan and Desmodyum styracyfolium), inhibition of calcium oxalate nucleation and hydroxyapatite internalization (Wulingsan). In contrast, acupuncture, has shown to be effective as a pre-treatment anxiolytic and analgesic during colic pain and extracorporeal shock wave lithotripsy treatment, reducing the need for complementary sedative drugs. Conclusion: Chinese traditional medicine is promising as regards its role in stone prevention. An effort must be made in order to standardize study protocols to better assess acupuncture results since each procedure differs in regards to selected acupoints, electrostimulation technique and adjunct anesthetics. Similarly, standardization of Kampo formulations and acceptable clinical endpoints (imaging vs. symptomatic events) is needed.

The Clinical Efficacy of Combination Therapy with Kampo and Western Medicine to Japanese Cedar Pollinosis / 日本東洋医学雑誌

We investigated the clinical efficacy of concomitant Kampo treatments, expected to have immediate effect in improving outcomes with western drug therapies for Japanese cedar pollinosis. Twenty cases using shoseiryuto, considered a first-line drug for allergic rhinitis, were studied. The resultant efficacy rate was 45%. The efficacy rate for 24 cases using eppikajutsuto, by contrast, was 64%. The latter cases demonstrated far better therapeutic result than the former. In 7 cases using maoto + eppikajutsuto (as simplified daiseiryuto), another prescription we often use for serious illness, the resultant efficacy rate was 72%. Of these, the most favorable effect resulted in 16 cases using shoseiryuto + gokoto, which resulted in an efficacy rate of 87%. We had originally developed this prescription in order to improve the effectiveness of mao and sekko as anti-inflammatories. There were no cases where patients needed to be dosed with an oral steroid. The only notable event was one patient who complained of stomachache as an adverse drug reaction. In conclusion, we can say that the overall therapeutic outcome with 11 different Kampo medicines was extremely satisfactory: an efficacy rate of 83%. These marked improvements in clinical efficacy were made by using Kampo medicines together with a western drug used for the treatment of Japanese cedar pollinosis.

Efficacy of Hochuekkito on Genital Prolapse / 日本東洋医学雑誌

To evaluate the efficacy of hochuekkito on genital prolapse, 37 patients with genital prolapse or descending organs were studied. Hochuekkito (7.5g/day) was administered to all patients without confirming their Sho. Change of subjective symptoms, consequence of disease, relation between efficacy and grade of prolapse, and adverse effects were evaluated. The mean age of patients was 68.7 years. The mean number of parities was 2.5. No patient was nulliparious, or had over 5 parities. Total efficacy rate for subjective symptoms was 48.9%. The treatment was also effective for those who had suffered from vaginal prolapse after total hysterectomy. At endpoint, six of 37 patients continued taking hochuekkito. Six of 37 patients stopped taking Kampo after all their symptoms had disappeared. Ten of 37 patients received surgery. Nine of 37 patients were set with ring pessaries. Five of 37 patients discontinued their drugs beyond endpoint of their own accord. Adverse events were observed in only one patient. Hochuekkito was considered a useful Kampo drug for those who are suffering from genital prolapse, and do not want to be set with ring pessaries or receive surgery.

Expected to the Kampo Medicine / 日本東洋医学雑誌

Kampo medicine is more expected as the complementaly medicine than ever from the nation. It is important to make the evidence of the Kampo medicine for showing the efficacy and safety to the nation properly.

A Case of Erythema Nodosum Successfully Treated with Seinetsuhokito and Byakkokakeishito / 日本東洋医学雑誌

We experienced a case of erythema nodosum of unknown etiology successfully treated with therapy based on Kampo diagnosis. The case was 44 year-old woman who had erythema nodosum over her bilateral leg extensors several times a month, became cold easily and had stomatitis. At first, we administered seinetsuhokito, which resulted in the disappearance of her stomatitis. However, she still had a recurrence of her erythema nodosum. Because of a condition of interior heat and qi counterflow, we considered her situation heibyo. We administered seinetsuhokito and byakkokakeishito every other day, which resulted in the disappearance of both her stomatitis and erythema nodosum. Therefore, we suggest that it is worthy to think about heibyo situations, when treating patients with complications.

A Case of Beh\ccet's Disease Successfully Treated with Keishibukuryogan, Whose Liver Damage Was Caused by Orengedokuto / 日本東洋医学雑誌

We present the case of 65 year-old male with Behçet's disease who was successfully treated with the Kampo medicine keishibukuryogan. The patient presented with hyperemic conjunctiva, ocular pain and uveitis at the age of 38, and was diagnosed with Behçet's disease. One year later he was affected with ulcerative glossitis, which was also diagnosed as a manifestation of Behçet's disease. At the age of 56 he was presented with acute arthritis of his ankle joint, followed by ulcerative stomatitis and glossitis. He was treated with colchicine and cyclophosphamide. Thereafter, he suffered from recurrent oral aphthous ulcers, and arthritis. Intractable oral ulcers, which did not respond to Western medicine, led him to seek Oriental herbal remedies. Keishibukuryogan was prescribed and, since then, his oral ulcers have completely subsided and his arthritis has not been a problem. He has been relieved from all manifestations of Behçet's disease.Thus, we believe that the Kampo medicine keishibukuryogan should be taken into consideration when treating Behçet's disease.Moreover, liver dysfunction caused by the Kampo medicine orengedokuto arose at an early stage of therapy, but immediately disappeared when its use was stopped. Pharmacoepidemiologically, Scutellariae radix, an ingredient of orengedokuto, was suspected of causing this liver dysfunction.

Application of Bukuryoingohangekobokuto and Hangekobokuto for Perniosis with Ki Obstruction / 日本東洋医学雑誌

We experienced four cases of perniosis successfully treated with bukuryoingohangekobokuto, or hangekobokuto. Swollen tongue, pulsation at the pit of the navel, and tympanitic abdominal sounds were taken as common objective findings in all four cases. In addition, decreased surface body temperature was diagnosed at the bilateral hands and feet, so as to be distal from the trunk in palpation. These four cases had both symptoms of an eminent Ki obstruction, and a disorder of body fluid metabolism. For the two cases administered bukuryoingohangekobokuto especially, a state of strong Ki deficiency was diagnosed. Efficacy in each case was prompt. Thus, we consider bukuryoingohangekobokuto and hangekobokuto to be prescriptions worth trying for perniosis that does not responding to the usual Western medicines, or Kampo treatment.

Survey of the Use of Kampo Medicine at the Kampo Clinic / 日本東洋医学雑誌

Kampo medicines have been used for treatment by an increasing number of doctors in recent years, and are becoming more frequently prescribed in combination with Western drugs. In the present study, we conducted a questionnaire of outpatients at the Kampo Clinic of Keio University Hospital in order to determine their perceptions and compliance regarding Kampo medicines.Ninety eight percent of patients used Kampo medicines in granular form, and approximately 30% of these patients reported difficulty in taking medicine due to reasons such as “bad taste”. Sixty percent of patients used Kampo medicines three times daily. Patients most often forgot to take afternoon doses, and so desired doses once daily. Furthermore, the same number of patients preferred Kampo medicines in tablet form as those who preferred Kampo medicines in granular form.The present findings clarified patients' perceptions toward Kampo medicines. Doctors and pharmacists must provide suitable treatment for patients by recognizing their perceptions of Kampo medicines.

Disappearance of Various Abdominal Symptoms with Kampo Treatment in a Postoperative Patient with Renal Cell Carcinoma / 日本東洋医学雑誌

We report a case with various postoperative abdominal symptoms that were successfully treated with Kampo medicine. A 58-year-old Japanese female had nausea, eructation, epigastric pain, lower abdominal pain and anorexia that appeared just after laparoscopic nephrectomy for renal cell carcinoma. No abnormal findings were discovered by gastroenterological examinations. Western medical therapy was not successful. We used bukuryoin under the interpretation that nausea and eructation represent phlegm-fluid retention in the chest. The bukuryoin therapy cleared up her nausea and eructation in about one week. Additionally, her epigastric pain, lower abdominal pain and anorexia were cured by use of anchusan.

How Should We Write Academic Dissertation in Kampo Medicine? / 日本東洋医学雑誌

Academic dissertations on Kampo medicine have a certain peculiarity about them, when they are drawn up by the rules of western medical writing. Compared to western medicine, oriental medicine tends to employ more subjective terms, because of its many humanistic elements.Study objectives, methods, results and discussions however, need to be stated objectively in a way that makes a paper easy to understand for both referees and readers. Although it would be ideal to use designated terms when making objective statements, there are in fact many terms that have multiple meanings, which need to be clarified in a paper. And when presenting new evidence, one must declare how far any problems have been resolved, as clearly as possible.We have explained the recent changes to our regulations for contributors, regarding Kampo formulae naming conventions, abstract word counts, and contributions by mail. Here we discuss how our editing work proceeds, and our thoughts on how papers are re-reviewed or rejected.

The Revealing of Problems Concerning about Treatment of Kampo Formulae in Hospitalization / 日本東洋医学雑誌

Aims : To clarify any difficulties that pharmacists and nurses may have when prescribing Kampo medicines to newly-admitted patients with a survey questionnaire at a local hospital ward.Methods : Questions for pharmacists on the handling of Kampo herbs, any perceived risks in the preparation of Kampo formulae powder extracts/pills, or in explaining Kampo medicines, based on their experiences. Also questions for nurses on the handling of Kampo medicines, as compared to western medicines, and any perceived risks in their administration at their ward.Result : All 7 pharmacists and 14 out of the 16 nurses surveyed completed their questionnaires. The pharmacists pointed out that Kampo preparation takes more time, although none perceived an increased risk with Kampo medicines, as compared to western medicines. Only 1 pharmacist had ever had experience explaining Kampo medicines to patients. The nurses, on the other hand, felt that Kampo treatments were somewhat more difficult to use, and perceived similar risk in their administration to patients.Conclusion : Both the pharmacists and nurses surveyed believed that the handling of herb medicines was somewhat difficult, but that these difficulties could be overcome with risk management. This suggests that pharmacist, nurse and office personnel education would be useful before Kampo medicines are administered to newly-admitted hospital patients.

How to Write Abstractor's Comments on Structured Abstract of RCT in Kampo / 日本東洋医学雑誌

The Japan Society for Oriental Medicine (JSOM) began its second Special Committee for EBM (evidence- based medicine) project in 2005. Evidence Report Task Force (ER-TF) of the furthered the project on Evidence Reporting in Kampo Treatment initiated by the previous committee in 2001. The second Committee once again collected randomized control trial (RCT) literature only, to produce structured abstracts (SA). ors were then asked to make comments in these SA, as would be found in international EBM medical journals. There was concern, however, that their comments were reviewed negatively by authors of original article. Therefore a workshop entitled “How to Write Appropriate Comments” was held at the 58th Annual Meeting of JSOM in Hiroshima, on June 17, 2007. This workshop proved educational, and demonstrated ways to write more positive comments, including the so-called “sandwich technique” of writing first positive, then negative, then positive comments (PNP).

A Case with Lumber Spinal Canal Stenosis Successfully Treated with Kigikenchutokauzu / 日本東洋医学雑誌

We report on a patient with residual complaints after an operation for lumber canal stenosis, successfully treated with the Kampo medicine, kigikenchutokauzu. The patient was 69 year-old woman complaining of severe coldness, numbness, and bilateral leg pain. She was diagnosed as having spinal canal stenosis when she was 67 years of age. Posterolateral fusion with laminectomy was performed at the age of 69, although severe coldness, numbness, and pain persisted even after her surgery. Also, her sutures had not healed. She was referred to our department 26 days after her surgery in order to receive Kampo therapy. Kigikenchutokauzu was prescribed, and her condition markedly improved. Her sutures healed completely 7 days after start of administration. This suggests that kigikenchutokauzu may be effective not only for the residual spinal canal stenosis symptoms, but also for the postoperative healing of sutures.

5 Cases of Seborrheic Dermatitis Successfully Treated with Kampo Medicine / 日本東洋医学雑誌

We successfully treated 5 patients with seborrheic dermatitis using Kampo medicine. Three of these patients presented with facial the lesions which had persisted for 1 to 2 years despite their having received treatment with steroid ointments or ketokonazol lotions. We treated these patients with jumihaidokuto and they recovered significantly within a few months. The two remaining patients presented with scalp lesions, which had persisted for10and 25 years respectively. We treated them with a combined formulation of keigairengyoto, makyoyokukanto and yokukansankachimpihange, and they improved remarkably after 2 and 8 months respectively.

Systemic Kampo Treatment for Dermatologic Diseases / 日本東洋医学雑誌

In Kampo medicine, chronic dermatitis is considered to be associated with unstable interaction among Ki, Ketsu and Sui. Urticaria is resistant to standard treatments in modern western medicine, so we applied a Kampo approach to improve imbalance among Ki, Ketsu and Sui. In this paper, we report three cases of chronic urticaria treated with Kampo medicines, i.e., main prescriptions with goshakusan for urticaria with anemia, keishikaryukotsuboreito for urticaria with stress, and bukuryoshigyakuto for cold urticaria with stress. We examined changes in palmoplantar sweating in response to the treatments to evaluate improvement in the circulation of Ki.The importance of Ki, Ketsu and Sui in chronic diseases was emphasized by Nangai Yoshimasu and Gonzan Goto as early as the Edo period. Urticaria is regarded as being due to disturbances of Ketsu and Sui that are often caused by systemic Ki disorders. Therefore, we consider that it is important to improve Ki stagnation in “spleen”, “lung” and “kidney” in the treatment of urticaria.