Analysis of Related Factors that Make Daikenchuto Useful for Constipation During Pregnancy / 日本東洋医学雑誌

The purpose of this study is to clarify factors related to the effect of daikenchuto on constipation during pregnancy. The subjects were 21 patients who had constipation during pregnancy and received 15 g/day of daikenchuto. Based on the constipation score that was created independently, the score values before administration, 2 weeks and 4 weeks after administration were retrospectively investigated. Furthermore, from the outcome of the oral status at 4 weeks, we divided the patients into 2 groups (12 in the improvement group and 11 in the non-improvement group), and attempted to extract factors that were considered to be related to efficacy. The total constipation score decreased significantly before and after administration of daikenchuto, and the concomitant symptoms of constipation scores were low, especially such as abdominal distension and abdominal pain. A comparison of the backgrounds of the improved group and the non-improved group revealed that the proportion of the patients with a history of surgery (laparotomy or laparoscopic surgery) was significantly higher in the improvement group. In addition, there were no particular problems with the pregnancy and delivery course of the 23 patients. Daikenchuto was considered to be highly effective against constipation during pregnancy, especially in pregnant women with a history of surgery.

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.

A Respiratory Failure Patient with CO2 Narcosis Successfully Treated with Kampo Medicines / 日本東洋医学雑誌

We experienced a refractory case of respiratory failure with CO2 narcosis after respiratory tract infection successfully treated with daikenchuto, ninjinyoeito, and bushimatsu. The patient was an 88-year-old woman with pulmonary tuberculosis sequelae and chronic obstructive pulmonary disease for which she had been receiving tiotropium, a budesonide inhalation suspension, and tulobuterol patches. She developed a fever and persistent dyspnea and was taken to our hospital by ambulance. Initially, artificial respiration was recommended because she had CO2 narcosis, but this intervention was rejected because of her advanced age. She showed persistent dyspnea and mild consciousness disturbance. Therefore, treatments by daikenchuto, ninjinyoeito, and bushimatsu were gradually introduced. As a result, her dyspnea, constipation, anorexia, and decreased consciousness improved, and the CO2 concentrations in arterial blood decreased with normalization of pH level. Artificial respiration management is the first-choice treatment for aggravated chronic respiratory failure with CO2 narcosis. However, when such medical management is not feasible, as in the present case, Kampo medicines may contribute to alleviating symptoms of respiratory failure.

A Case of Radiation-Induced Enteritis Effectively Treated with Daikenchuto / 日本東洋医学雑誌

Radiation-induced enteritis can cause acute or chronic radiation damage to bowel tissues producing a variety of symptoms which can have a significant impact on patients' quality of life. The herbal medicine, daikenchuto has been noted for its usefulness in preventing postoperative ileus or abdominal dysfunction. Here, we present a case of radiation-induced enteritis ; a 59-year-old woman who underwent radical hysterectomy and subsequent chemoradiotherapy for cervical cancer. Daikenchuto (TJ-100, Tsumura, Japan, 15 g/day) was administered to the patient in hopes of controlling abdominal dysfunction, pain, and fullness that was considered as a series of symptoms of radiation-induced enteritis. This case was successfully treated with daikenchuto in an attempt to control and prevent these gastrointestinal symptoms associated with radiation-induced enteritis. An increase in bloodstream with daikenchuto to the intestinal tract in which a microcirculatory insufficiency was developed by radiation exposure, may contribute to the improvement of these abdominal symptoms of this disease.

<b>Patient Taking Daikenchuto for More than 10 years Suffers from Excess H</b><b>eat</b> / 日本東洋医学雑誌

<p>A 54-year-old female had cesarean sections at ages 26 and 29, a left salpingophrectomy for left ovarian cyst at age 31, and a total abdominal hysterectomy for fibroids at age 41. After total abdominal hysterectomy, she had repeated bouts of ileus and started taking daikenchuto (DKT), which is commonly used to prevent ileus. At age 54, she visited our hospital when DKT failed to relieve her constipation and lower abdominal pain and had occasional heat flash above her neck. Tongue examination revealed pale red tongue and fissured tongue signs with yellow fur and dilation of the sublingual collateral vessels. Kampo diagnosis was blood stasis and excess heat, for which keishibukuryogan was prescribed to be taken daily and with which her symptoms dissipated after 7 days. Despite the popular use of DKT, its potential to cause excess heat after long-term use is not as well known. It is extremely important to warn clinicians who prescribe Kampo not to focus solely on a disease-to-prescription model but also to be learned of the discipline and to take measures to prevent adverse long-term effects and complications.</p>

<b>A Case of Functional Constipation and Abdominal Distension Treated with K</b><b>obokushokyohangeninjinkanzoto</b> / 日本東洋医学雑誌

<p>Constipation is one of the most common symptoms seen in elderly people, and is sometimes difficult to treat. Daikenchuto is a well-known Kampo formulation for treating ileus. Here, we report a case in which daikenchuto was not effective and constipation was effectively treated with kobokushokyohangeninjinkanzoto. The patient was an 81-year-old woman who had been hospitalized for treatment of a thighbone fracture. She was originally constipated, and her constipation had worsened over the course of hospitalization. Colonoscopy examination and abdominal computerized tomography showed no structural lesions. Her constipation improved after the administration of daikenchuto, but the improvement was transient. Since the constipation and abdominal distension worsened after she began eating again, we administered kobokushokyohangeninjinkanzoto. Subsequently, her condition improved remarkably. Eight days later, we changed the initial kobokushokyohangeninjinkanzoto to ninjinto and hangekobokuto. Her complaint did not recur, and she was discharged 17 days later. In case of deficiency pattern ileus, kobokushokyohangeninjinkanzoto may be considered as an alternative to daikenchuto. Furthermore, we believe that the combination of ninjinto and hangekobokuto is an effective alternative to kobokushokyohangeninjinkanzoto.</p>

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.

<b>A Case of Intestinal Spirochete Infection Treated with </b><b>Daikenchuto Extract</b> / 日本東洋医学雑誌

Intestinal spirochetosis is a rare gastrointestinal infection caused by <i>Brachyspira</i>. Clinical manifestations vary, ranging from asymptomatic infection to gastrointestinal bleeding, diarrhea, or abdominal pain. Antimicrobial medications such as metronidazole are routinely given, but their clinical efficacy has not determined with any precision. We report a case of intestinal spirochetosis treated with daikenchuto extract with literature reviews. Treatment of intestinal spirochetosis can be difficult, and use of daikenchuto extract may be an option especially for patients with symptoms such as chronic diarrhea, abdominal distention, or change in flatus.

Four Cases Treated by Daikenchuto to the Patients with Recurrent Aspiration Pneumonia in Tube Feeding / 日本東洋医学雑誌

We administered daikenchuto to the patients having recurrent aspiration pneumonia with tube feeding, who had good responses. Case 1 : A 94-year-old-man with congestive heart failure suffering from recurrent aspiration pneumonia even after percutaneous endoscopic gastrostomy (PEG) placement : following daikenchuto administration, he did not suffer from pneumonia, and his general condition became stable. Case 2 : An 80-year-old-man suffering from severe pneumonia after PEG placement, and experiencing recurrent pneumonias after treatment with antibiotics:following daikenchuto administration, we did not find gastric contents in his oral cavity as before, and his general condition became stable. Case 3 : An 85-year-old-man with congestive heart failure and cerebral infarction also suffering from aspiration pneumonia : a nasogastric tube was placed, but he suffered from recurring pneumonias with tube feeding. After administering daikenchuto, he did not suffer from pneumonia and was discharged from the hospital. Case 4 : An 81-year-old-man with recurrent pneumonia and congestive heart failure : after treatment with antibiotics, we placed a PEG tube because of his severe anorexia caused by oral feeding difficulties. In order to prevent aspiration pneumonia, we administered daikenchuto prophylactically. He subsequently developed very little fever until his discharge to a nursing home.

A Case Report of Intractable Diarrhea Successfully Treated with Daikenchuto / 日本東洋医学雑誌

We report a case of intractable diarrhea successfully treated with daikenchuto. The patient was a 60-year-old female. She had suffered from diarrhea in spite of being prescribed Shimbuto, Kanzoshashinto, Shigyakuto and so on. After daikenchuto was administered her intractable diarrhea improved. However, she had not symptoms such as abdominal pain, coldness in the abdomen and abdominal movement disorder that often appear in daikenchuto-syo. We consider daikenchuto may be effective not only for diarrhea but also constipation in yin-syndrome and hypofunction when intestinal juice and gas are stagnated.

A Case of Intestinal Adhesive Ileus, Successfully Treated with Daikenchuto during Pregnancy and Post Cesarean Section / 日本東洋医学雑誌

We report a clinical case of adhesive ileus that was treated with daikenchuto during pregnancy, and post cesarean section. A 29-year woman, who had undergone a laparotomy for small intestinal volvulus at the age of 15, was referred to our hospital for abdominal distention at11weeks gestation. Her severe abdominal distention led to the intestinal adhesive ileus finding. After treatment with daikenchuto, she had mass diarrhea while the abdominal symptoms disappeared. Afterwards, the prenatal course was uneventful. Spontaneous labor began at 36 weeks gestation. Under the indication of fetal distress, an emergent cesarean section was performed. There was widespread adhesion between the small intestine and abdominal wall. On post operative day 4, nausea and vomiting increased. Daikenchuto was orally administered with the diagnosis of recurrent adhesive ileus. On day 6, flatus and soft stool were passed. On day 9, oral food ingestion was begun. Her post operative course was uneventful beyond this, and she was discharged on day 25. Recently, clinical reports of adhesive ileus during pregnancy have been increasing as average maternal ages rise. Adhesive ileus during pregnancy tends to be critical for mothers and babies, so a surgical procedure is necessary in many cases. This report suggests the usefulness of daikenchuto for adhesive ileus during the perinatal period.

The Meaning of \lceilFukuchukan\rfloor in the Abdominal Symptom of Daikenchuto-syo / 日本東洋医学雑誌

Daikenchuto is recorded in Kampo textbooks as a prescription for abdominal disorders. We considered fukuchukan (coldness in the abdomen) as equaling a sensation of coldness centering on the navel, and we examined the usefulness of using Daikenchuto as a medication for this symptom. We administered Daikenchuto to 90 patients who presented with coldness of the navel. The patients were divided into 2 groups:the first group had accompanying digestive symptoms, the second had no accompanying digestive symptoms. We then examined their response rates, and improvement rates for coldness centering on the navel. We also examined the abdominal strength and pulse strength for responders and non-responders, respectively.The Digestive Symptoms group consisted of 64 patients. In this group, the response rate was 81.3%.The improvement rate of coldness centering on the navel was 92.3% in responders and 41.7% in non-responders, and the difference was highly statistically significant (p<0.001). The Non-digestive Symptoms group consisted of 26 patients. In this group, the response rate was 38.5%. The improvement rate of coldness centering on the navel was 100% in responders and 43.8% in non-responders, and the difference was statistically significant (p=0.022).In a comparison of all 90 responder and non-responder cases, weak abdominal strength was 62.9% in responders and 42.9% in non-responders, intermediate abdominal strength or above was 37.1% in responders and 57.1% in non-responders, and the difference between abdominal strength and response rate (p=0.076) was non-significant. Weak pulse was 54.8% in responders and 40.7% in non-responders, intermediate pulse strength or above was 45.2% in responders and 59.3% in non-responders, and the difference between pulse strength and response rate (p=0.221) was non-significant. 13 of these cases were above intermediate, for both abdominal strength and pulse strength.We conclude that for patients presenting with a sensation of coldness centering on the navel, there is a strong possibility that the efficacy of Daikenchuto-syo is suggested, regardless of whether or not there are other digestive symptoms. Moreover, Daikenchuto proved effective in 13 cases where both abdominal strength and pulse strength were above an intermediate level, suggesting that a sensation of coldness centering on the navel can be the key to finding the sensho of Daikenchuto-sho.

Three Cases of Acute Abdomen Treated with Daikenchuto in Emergency Room / 日本東洋医学雑誌

Daikenchuto has been attracting nationwide attention in recent years, with its therapeutic efficacy on posto-perative complaints and complications. We treated three patients with acute abdomen using daikenchuto. They suffered from severe abdominal pains and abdominal radiographs showed small intestine gases. All three recovered from their pains or nausea after taking daikenchuto, and were discharged home without hospital admission. The use of daikenchuto against acute abdomen is recommended in emergency medicine.

The Meaning of "Fukuchukan" in the Abdominal Symptom of Daikenchuto-syo / 日本東洋医学雑誌

Daikenchuto is recorded in Kampo textbooks as a prescription for abdominal disorders. We considered <i>fukuchukan</i> (coldness in the abdomen) as equaling a sensation of coldness centering on the navel, and we examined the usefulness of using Daikenchuto as a medication for this symptom. We administered Daikenchuto to 90 patients who presented with coldness of the navel. The patients were divided into 2 groups:the first group had accompanying digestive symptoms, the second had no accompanying digestive symptoms. We then examined their response rates, and improvement rates for coldness centering on the navel. We also examined the abdominal strength and pulse strength for responders and non-responders, respectively.<br>The Digestive Symptoms group consisted of 64 patients. In this group, the response rate was 81.3%.The improvement rate of coldness centering on the navel was 92.3% in responders and 41.7% in non-responders, and the difference was highly statistically significant (p<0.001). The Non-digestive Symptoms group consisted of 26 patients. In this group, the response rate was 38.5%. The improvement rate of coldness centering on the navel was 100% in responders and 43.8% in non-responders, and the difference was statistically significant (p=0.022).<br>In a comparison of all 90 responder and non-responder cases, weak abdominal strength was 62.9% in responders and 42.9% in non-responders, intermediate abdominal strength or above was 37.1% in responders and 57.1% in non-responders, and the difference between abdominal strength and response rate (p=0.076) was non-significant. Weak pulse was 54.8% in responders and 40.7% in non-responders, intermediate pulse strength or above was 45.2% in responders and 59.3% in non-responders, and the difference between pulse strength and response rate(p=0.221) was non-significant. 13 of these cases were above intermediate, for both abdominal strength and pulse strength.<br>We conclude that for patients presenting with a sensation of coldness centering on the navel, there is a strong possibility that the efficacy of Daikenchuto-syo is suggested, regardless of whether or not there are other digestive symptoms. Moreover, Daikenchuto proved effective in 13 cases where both abdominal strength and pulse strength were above an intermediate level, suggesting that a sensation of coldness centering on the navel can be the key to finding the <i>sensho</i> of Daikenchuto-sho.

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.