Pharmacological characteristics of Kampo medicine as a mixture of constituents and ingredients

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 in qredients. For elder persons, furthermore, Kampo medicine exerts more effective actions.

Effects of Kampo medicine hangebyakujutsutemmato on persistent postural-perceptual dizziness:A retrospective pilot study

BACKGROUND Persistent postural-perceptual dizziness(PPPD)is a functional disorder,typically preceded by acute vestibular disorders.It is characterized by a shift in processing spatial orientation information,to favor visual over vestibular and somatosensory inputs,and a failure of higher cortical mechanisms.To date,no therapies for PPPD have been approved.Kampo medicine hangebyakujutsutemmato(HBT)has been reported to alleviate disturbances of equilibrium.We hypothesized that HBT would be a beneficial treatment for PPPD.AIM To examine the efficacy of HBT for the treatment of PPPD.METHODS Patients with PPPD were enrolled and divided into two groups:The HBT group(n=24)and the non-HBT group(n=14).The participants completed questionnaire surveys[Niigata PPPD questionnaire(NPQ),dizziness handicap inventory,hospital anxiety and depression scale(HADS),orthostatic dysregulation questionnaire,pittsburg sleep quality index(PSQI),and motion sickness scores]before and after HBT treatment.Additionally,to identify HBT responders,multivariate regression analysis was performed using the results of the ques-tionnaire surveys and equilibrium tests;including stabilometry,and caloric,vestibular evoked myogenic response,and head-up tilt tests.RESULTS Thirty-eight outpatients were included in this study,of which 14 patients(3 men,11 women;mean age,63.5±15.9 years)received treatment without HBT,and 24(1 man,23 women;mean age,58.2±18.7 years)received combination treatment with HBT.Following HBT treatment,NPQ scores decreased significantly(baseline 40.1±10.0 vs 2 mo 24.6±17.7,P<0.001).No statistically significant changes were observed in the NPQ scores in the non-HBT group(baseline 38.6±12.2 vs 2 mo 39.4±14.4,P=0.92).Multivariable regression analysis revealed that the results of stabilometry(P=0.02)and the caloric(P=0.03),and head-up tilt tests(P<0.001),HADS(P=0.003),and PSQI(P=0.01)were associated with HBT responsiveness in PPPD patients.CONCLUSION HBT may be an effective adjunct therapy for PPPD.Patients with autonomic dysfunction,unstable balance,semicircular canal paresis,anxiety,and poor sleep quality may be high responders to HBT.

Modulation by anti-oketsu formulations in Kampo medicine of human arterial stiffness

Objective:In traditional herbal medicine(Kampo medicine in Japan),'sho'is diagnosed by the traditional assessments of clinical conditions.Among a variety of the shos,there is an'oketsu'syndrome,which is a stagnation and disturbance of microcirculation.The prompt effects of four anti-oketsu formulations in Kampo medicine on cardiovascular functions were compared in oketsu and non-oketsu persons.Methods:The arterial pulse wave from radial artery is formed by the combination with ejection and reflection pulses.An augmentation index(AI),a ration of the ejection and reflection pulses,indicates a degree of arteriosclerosis.For both seventy-six students with oketsu and thirty-seven students with non-oketsu,Kampo formulations overcoming oketsu of Tokishakuyakusan(TS,Dang-Gui-Shao-Yao-San),Kamishoyosan(KS,Jia-Wei-Xiao-Yao-San),Keisibukuryogan(KB,Gui-Zhi-Fu-Ling-Wan)and Tokakujokito(TJ,Tao-He-Cheng-Qi-Tang)were taken once,and then,the cardiovascular functions including blood pressure,heart rate,central arterial blood pressure(CBP)and AI were examined for 60 min.Results:At 40-60 min after an intake,these formulations decreased the AI almost by 6-18%(n=76),by 18.3±3.1%(P<0.01,n=15)with TJ.Simultaneously,the CBP was reduced by 9.0±1.8%(P<0.05,n=23)with KS and by 9.1±2.0%(P<0.05,n=15)with TJ.On the other hands,non-oketsu group had less or no effect by any kinds of the formulations.Conclusion:The anti-oketsu formulations can exert the ameliorative action for oketsu persons via decreasing AI and CBP.

Daikenchuto for postoperative adhesive small bowel obstruction:A systematic review and meta-analysis

AIMTo assess the effectiveness of Daikenchuto for patients with postoperative adhesive small bowel obstruction （ASBO）.METHODSA systematic search of PubMed （MEDLINE）, CINAHL, the Cochrane Library and Ichushi Web was conducted, and the reference lists of review articles were hand-searched. The outcomes of interest were the incidence rate of surgery, the length of hospital days and mortality. The quality of the included studies, publication bias and between-study heterogeneity were also assessed.RESULTS Three randomized controlled trials （RCTs） and three retrospective cohort studies were selected for analysis. In the three RCTs, Daikenchuto signifcantly reduced the incidence of surgery （pOR = 0.13; 95%CI： 0.03-0.50）. Similarly, Daikenchuto signifcantly reduced the incidence of surgery （pOR = 0.53; 95%CI： 0.32-0.87） in the three cohort studies. The length of hospital stay and mortality were not measured or described consistently.CONCLUSIONThe present meta-analysis demonstrates that admini-stering Daikenchuto is associated with a lower incidence of surgery for patients with postoperative ASBO in the Japanese population. In order to better generalize these results, additional studies will be needed.

Historical Evolution of Traditional Medicine in Japan

Traditional Japanese Medicine originated from traditional Chinese medicine and was first introduced to Japan directly from the mainland of China or the Korean Peninsula.After its dissemination,integration,adaption,and development in Japan for generations,it had evolved into Kampo medicine with Japanese characteristics and taken a leading role in Japanese medical practice.In history,there appeared successively schools such as Followers of Later Developments in Medicine,Followers of Classic Methods,Integrated School,and School of Textual Research.Alter Meiji Restoration,Kampo medicine experienced a tremendous impact by western medicine.However after World War II,with unremitting endeavors from learned scholars,traditional Japanese medicinje was revived again.

Standards of Reporting Kampo Products (STORK) in research articles

There had been no standardized rules for citing ethical Kampo products used in clinical trials in journal articles. Although the name of a Kampo manufacturer was described in 77.9% of research articles, the name and ratios of crude drug components of Kampo formulas were not described in 77.5% of these papers. Considering the importance of proper characterization of interventions in the Consolidated Standards of Reporting Trials （CONSORT） checklist, we hereby propose the use of the Standards of Reporting Kampo Products （STORK） website, http：//mpdb.nibiohn.go.jp/stork, as a reference for Kampo products. This will provide an official source on the internet for verified information on individual Kampo formulations for citation purposes in clinical research articles.

The Influence of Shanghanlun on Japanese Kampo Medicine

Shanghanlun is a classic work in traditional Chinese medicine(TCM),which systematically discusses diagnosis and treatment ideas based on syndrome differentiation and records a large number of highly practical prescriptions.When Shanghanlun was introduced into Japan along with the communication between China and Japan in the Sui and Tang Dynasties,it had a profound influence on the development of Kampo medicine in Japan.By sorting out the works related to Shanghanlun in the medical history literature of Kampo medicine before the Meiji Restoration,this paper discusses the relationship between Shanghanlun and the Koho school of Kampo medicine,as well as the influence of the thought“formula corresponding to pattern identification,”originating from the Koho school,on the development of modern Kampo medicine.The study of Shanghanlun by Kampo medicine nowadays not only attaches great importance to clinical practicality but also has theoretical discussions.It is expected that future medical exchanges between China and Japan will complement each other from the perspectives of both sides and promote the theoretical and clinical development of TCM.

Reflections on the Research Status of Kampo Medicine:A Most Rewarding Visit to Japan

Traditional medicine in Japan originated from Chinese medicine （CM）, on the basis of which the abdominal diagnosis and treatment by differentiation of diseases were developed. It was also called Kampo medicine （KM）, natural medicine or oriental medicine. KM had been on the verge of extinction by suffering from serious loss during the Meiji Restoration, and only started to revive in the beginning of the 1950s, and has had considerable progress up to now.

Discrimination of hie and hiesho using toe blood pressure in young women

OBJECTIVE： In Western medicine, hie （cold sensation） is thought as a subjective complaint. Consequently, despite women＇s complaints of health problems due to hie, such as distress and decreased quality of life, it is not diagnosed as a disease or given active treatment. However, hie sometimes requires emergency treatment or is a symptom of other disorders. Thus, diagnosing hie and eliminating distress due to hie are clinically significant. This research aimed to discriminate between hie and hiesho （cold disorder） and quantify hie by using objective assessments in addition to subjective assessments. METHODS： A questionnaire was administered to 159 healthy young women without any underlying disease that could cause hie, followed by assessment of vascular function. These data were examined through exploratory factor analysis, exploratory cluster analysis, and multivariate logistic analysis. Two- and three-group comparisons were made using the Mann-Whitney test and KruskaI-Wallis test, respectively, followed by multiple comparisons using Scheffe＇s method.RESULTS： The hie （including hiesho） and normal groups comprised 81 （51%） and 78 （49%） subjects, respectively. The questionnaire was a low reliability screening method for determining the severity of hie symptoms. As an index of discrimination of hie and hiesho, we determined the toe-brachial index （TBI） to be 0.81 and toe systolic blood pressure （SBP） to be 87.73 mmHg with a linear function （TBI=0.007 5xtoe SBP＋0.152, adjusted R2=0.829, F（1,79）=388.79, P〈0.001）. CONCLUSION： Toe SBP and TBI were suggested to be capable of discriminating and quantifying symptoms when used in combination with a questionnaire.

Effect of Juzentaihoto/Shi-Quan-Da-Bu-Tang on Malignant Progression and Metastasis of Tumor Cells

A Japanese herbal(Kampo,汉方)medicine,十全大补汤(juzentaihoto/Shi-Quan-Da-Bu-Tang),is one of the nourishing agents, a so-called"补剂(Hozai/Bu-Ji)," that is used for improving disturbance and imbalances in the homeostatic condition of the body. This formulation is orally administered to patients in various weakened states, including postsurgery patients and patients with chronic illness, where it can alleviate general symptoms such as extreme fatigue, pale complexion, loss of appetite, dry or scaly skin, night sweating, and dryness of the mouth.Recently, juzentaihoto/Shi-Quan-Da-Bu-Tang has been shown to have a variety of biological activities, including activation of natural killer cells and macrophages, cytokine induction, antibody production, antitumor effects in combination with surgical excision or other drugs, and protection against the adverse effects of anticancer drugs and radiation, including immunosuppression and bone marrow toxicity. This article focuses on the antitumor and antimetastatic properties of some Kampo medicines and mainly describes the effects of juzentaihoto and its related formulations on tumor development, progression, and metastasis in vivo. We also discuss the inhibitory mechanism of action and the importance of the prescription and constituent crude drugs in determining the efficacy.