Trends in the use of Japanese herbal Kampo medicine in inpatients with cancer: a 14-year nationwide analysis

Association between complementary use of Goreisan (a Japanese herbal Kampo medicine) and heart failure readmission: A nationwide propensity score-matched study

Shosaiko-to and other Kampo (Japanese herbal) medicines: a review of their immunomodulatory activities

Kampo (Japanese herbal) medicine is the complementary and alternative medicine that is most frequently used by Japanese doctors. We studied the perceptions and attitudes of Japanese gynecologic cancer patients to Kampo medicines and analyzed the characteristics of the backgrounds of Kampo users. A total of 476 patients with gynecologic cancer completed a self-reported questionnaire on Kampo medicine. State anxiety and trait anxiety were also assessed using the State-Trait Anxiety Inventory. It was confirmed that 22.9% of the women had used Kampo medicine. Kampo users were more likely to have had chemotherapy and were more likely to have experienced uncomfortable side effects of cancer treatment. Kampo users were more likely to believe that 'Kampo offers relief of symptoms,' 'fewer side effects than Western-style medicine,' and 'is not less effective than Western-style medicine' than nonusers. Kampo users expressed a stronger attitude of 'I want to take Kampo medicine.' Multiple risk ratio regression analysis revealed that chemotherapy (RR, 1.82; 95% CI, 1.14-2.91), lower state anxiety (RR, 0.76; 95% CI, 0.58-1.00), and higher trait anxiety (RR, 1.46; 95% CI, 1.11-1.92) were independently associated with Kampo use. This study showed that slightly less than one-fourth of Japanese gynecologic cancer patients take Kampo medicine. Kampo users made more favorable comments on Kampo medicine than nonusers. Our findings suggest that the psychological characteristics of individual patients is one of the factors that can influence the usage of Kampo.

Menopausal hot flash and calciotonin gene-related peptide; effect of Keishi-bukuryo-gan, a kampo medicine, related to plasma calciotonin gene-related peptide level

Current status of Kampo (Japanese herbal) medicines in Japanese clinical practice guidelines

Kampo, a Japanese herbal medicine, is approved for the treatment of various symptoms/conditions under national medical insurance coverage in Japan. However, the contemporary nationwide status of Kampo use among patients with acute cardiovascular diseases remains unknown.Methods and Results: Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified 2,547,559 patients hospitalized for acute cardiovascular disease (acute myocardial infarction, heart failure, pulmonary embolism, or aortic dissection) at 1,798 hospitals during the fiscal years 2010-2021. Kampo medicines were used in 227,008 (8.9%) patients, with a 3-fold increase from 2010 (4.3%) to 2021 (12.4%), regardless of age, sex, disease severity, and primary diagnosis. The top 5 medicines used were Daikenchuto (29.4%), Yokukansan (26.1%), Shakuyakukanzoto (15.8%), Rikkunshito (7.3%), and Goreisan (5.5%). From 2010 to 2021, Kampo medicines were initiated earlier during hospitalization (from a median of Day 7 to Day 3), and were used on a greater proportion of hospital days (median 16.7% vs. 21.4%). However, the percentage of patients continuing Kampo medicines after discharge declined from 57.9% in 2010 to 39.4% in 2021, indicating their temporary use. The frequency of Kampo use varied across hospitals, with the median percentage of patients prescribed Kampo medications increasing from 7.7% in 2010 to 11.5% in 2021. This nationwide study demonstrates increasing Kampo use in the management of acute cardiovascular diseases, warranting further pharmacoepidemiological studies on its effectiveness.

Glossodynia is often refractory to conventional medicine, and there is only limited evidence to guide clinicians in its management. Patients with refractory glossodynia are often introduced to Japanese traditional herbal (Kampo) medicine experts under such circumstances because Kampo medicine has become known in Japan to be effective in treating a wide variety of symptoms refractory to conventional medicine. Herein, we report our single-institution 5-year experience treating patients with Kampo medicine for primary glossodynia that was refractory to conventional medicine. We found that 69.2% of patients reported a beneficial effect of Kampo medicine on glossodynia, and the average onset of improvement was 8.0 ± 7.7 weeks after starting Kampo treatment. The top two frequently used Kampo medicines for glossodynia were seinetsuhokito and mibakuekkito among high responders who showed a decrease of severity by 50% or more. The top four most overlapped herbs among effective Kampo medicines for glossodynia were Glycyrrhiza Root, Ginseng Root, Hoelen, and Atractylodes (lancea) Rhizome, which compose an essential Kampo prescription called shikunshito. Although more research is required to further clarify the effectiveness of Kampo medicine, it has valid efficacy even in cases of glossodynia that remain incurable by conventional treatments.

Herbal medicines originating in China have been used in East Asia for thousands of years, while taking root and evolving independently in countries like China, Korea, and Japan. In Japan, herbal medicines may be referred to as Chinese herbal medicine, Japanese herbal medicine, and traditional Japanese medicine or Kampo medicine. Until recently, the efficacy of Kampo medicines remained largely empirical and lacked rigorous scientific evaluations. However, more studies have begun to elucidate their basic mechanisms and pharmacological effects of some of the active ingredients using the latest biochemical and biomolecular methods. The number of clinical trials and epidemiological studies of Kampo medicines have exponentially increased as well. Here, we have reviewed the scientific and clinical evidence on Kampo medicines for gastric cancer into several categories, including effect in postoperative symptoms, effect against side effects of chemotherapy, direct or indirect effects against cancer, and the role in preventive medicine. In summary, several Kampo medicines appear to alleviate postoperative symptoms and side effects of chemotherapy, while others appear to exhibit potential antitumor and/or cancer-preventive activities. However, most data on their preventive effects against adverse effects of chemotherapy as well as on their antitumor activities are limited to in vitro or in vivo experiments. There are a few clinical studies on Kampo medicines for the treatment of postoperative symptoms, yet these studies are small and hard to draw any concrete conclusions. In the future, large randomized, controlled trials are required to establish clinical and scientific evidence of Kampo medicines in gastric cancer.

Introduction. In addition to hormone replacement therapy, non-hormonal therapy, particularly Japanese traditional herbal medicine (Kampo), has been used to alleviate the various symptoms of female menopause. The efficacy and safety of Japanese traditional herbal medicine for male late-onset hypogonadism (LOH) are investigated.Methods. One hundred fifty-one patients with LOH were treated via the administration of Japanese traditional herbal medicine. The most appropriate Japanese traditional herbal medicine was administered to patients according to their pathogenic alteration. After 4 weeks, the clinical efficacy was evaluated based on improvement of LOH symptoms and the score of the simplified menopausal index (SMI). Additionally, predictive factors of efficacy of Japanese traditional herbal medicine were analyzed.Results. Among 151 patients with LOH, 63 (41.8%) achieved both relief from LOH symptoms and normalized SMI score (Excellent response group), whereas 44 (29.1%) achieved either relief from LOH symptoms or normalized SMI score (Fair). However, 44 (29.1%) patients displayed neither relief from LOH symptoms nor normalized SMI score (Poor). Adverse reactions were observed only in four (2.6%) patients. Patients displaying excess conditions and mild LOH symptoms appeared to be superior candidates for Japanese traditional herbal medicine.Conclusion. Japanese traditional herbal medicine is an effective and safe treatment for LOH.

Herbal medicines are currently employed for the treatment of several types of diseases, and also employed for the improvement of Quality of Life (QOL) of patients over the world, in particular, in Asian countries. In Japan, a Japanese herbal medicine namely kampo medicine has been prescribed for the improvement of QOL of patients. Ninjinyoeito (NYT), composed of 12 herbal plants, is one of kampo medicines and used for helping recovery of diseases and improving several symptoms that suffer patients such as anemia, anorexia and fatigue. Recent scientific research approaches to kampo medicines with cells and animal models enable to prove that NYT has multiple functions for improvement of symptoms. Also, clinical studies using NYT support such actions to be widely used for the improvement of symptoms that reduce the QOL of patients.

Background: It has been recently suggested that Japanese herbal (kampo) medicines, such as kami‐untan‐to, may improve cognitive function in elderly subjects with Alzheimer's disease. Polygalae radix is thought to be a useful component of kami‐untan‐to because it enhances the activity of choline acetyltransferase in cultured neuronal cells. The purpose of the present study was to investigate the safety and usefulness of kihito extract granules, a commercially available Japanese herbal medicine that contains P. radix, for elderly patients with senile dementia.Methods: Seventy‐five elderly subjects (84.4 ± 6.4 years) with senile dementia of Alzheimer type according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria were randomly assigned to the non‐treatment, goshajinkigan (control kampo medicine) or kihito groups. Each medicine was given three times a day for 3 months.Results: There was no severe adverse event in any of the groups. We examined the Mini‐Mental State Examination (MMSE), the activities of daily living (ADL) scale and cerebrovascular single photon emission computed tomography (SPECT) before and after treatment. MMSE scores were significantly improved only in the kihito group (+1.65 ± 0.53) but not in the non‐treatment (−0.3 ± 0.67) and goshajinkigan (−0.58 ± 0.49) groups. ADL scores remained unchanged in all groups. Treatment with kihito was not associated with an increase in cerebral blood flow.Conclusion: These results propose that kihito may be useful and has potential to be tested as a medicine for Alzheimer's‐type senile dementia, although further examination is required to clarify the mechanism of the improving effect of kihito on cognitive function.

We developed a rapid and simple HPLC method combined with solid-phase extraction (SPE) for quantitative analysis of (+)-pseudoephedrine (PEP) and (-)-ephedrine (EP) in Japanese herbal (Kampo) medicines such as Kakkon-to, Sho-seiryu-to, Goshaku-san and Bofu-tsusho-san. SPE was performed on TOYOPAK IC-SP M containing propylsulfonic groups. Determination of PEP and EP was carried out using ion-pair reversed-phase HPLC with sodium dodecyl sulfate. N-Benzyldiethylamine was used as an internal standard. The analytical procedure was validated with regard to specificity, linearity, accuracy, and precision. These data suggest that the analytical method developed in this study is useful for quantitative analysis of PEP and EP in various formulations of Kampo medicine containing Ephedra herb.

Persistent undifferentiated arthritis successfully treated with the Japanese herbal medicine “Eppikajutsuto”

There are several Cochrane systematic reviews looking at postpartum haemorrhage (PPH) prophylaxis in the third stage of labour and another Cochrane review investigating the timing of prophylactic uterotonics in the third stage of labour (i.e. before or after delivery of the placenta). There are, however, no Cochrane reviews looking at the use of interventions given purely after delivery of the placenta. Ergometrine or methylergometrine are used for the prevention of PPH in the postpartum period (the period after delivery of the infant) after delivery of the placenta in some countries. There are, furthermore, no Cochrane reviews that have so far considered herbal therapies or homeopathic remedies for the prevention of PPH after delivery of the placenta. To assess the effectiveness of available prophylactic interventions for PPH including prophylactic use of ergotamine, ergometrine, methylergometrine, herbal therapies, and homeopathic remedies, administered after delivery of the placenta, compared with no uterotonic agents as well as with different routes of administration for prevention of PPH after delivery of the placenta. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2013), The Food and Drug Administration (FDA) (USA), Medicines and Healthcare Products Regulatory Agency (MHRA) (UK), European Medicines Agency (EMA) (EU), Pharmaceuticals and Medical Devices Agency (PMDA) (Japan), Therapeutic Goods Administration (TGA) (Australia), ClinicalTrials.gov, Current Controlled Trials, WHO International Clinical Trials Registry Platform (ICTRP), University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; Japan), Japan Pharmaceutical Information Center Clinical Trials Information (Japic-CTI; Japan), Japan Medical Association Clinical Trial Registration (JMACCT CTR; Japan) (all on 30 April 2013) and reference lists of retrieved studies All randomised or quasi-randomised controlled trials comparing prophylactic ergotamine, ergometrine, methylergometrine, herbal therapies, and homeopathic remedies (using any route and timing of administration) during the postpartum period after delivery of the placenta with no uterotonic agents or trials comparing different routes or timing of administration of ergotamine, ergometrine, methylergometrine, herbal therapies, and homeopathic remedies, during the postpartum period after delivery of the placenta. Two review authors independently assessed trial eligibility and the methodological quality of trials, extracted data using the agreed form. Data were checked for accuracy. Five randomised studies involving 1466 women met the inclusion criteria. All studies were classified as having an unclear risk of bias. Two studies (involving 1097 women) compared oral methylergometrine with a placebo, and one (involving 171 women) compared oral methylergometrine with Kyuki-chouketsu-in, a Japanese traditional herbal medicine. The remaining two studies (involving 198 women) did not report the outcomes of interest for this review. None of the included studies reported primary outcomes prespecified in the review protocol (blood loss of 1000 mL or more over the period of observation, maternal death or severe morbidity). Overall, there was no clear evidence of differences between groups in the following PPH outcomes: blood loss of 500 mL or more (risk ratio (RR) 1.45; 95% confidence interval (CI) 0.39 to 5.47, two studies), amount of lochia during the first 72 hours of the puerperium (mean difference (MD) -25.00 g; 95% CI -69.79 to 19.79, one study), or amount of lochia by four weeks postpartum (MD -7.00 g; 95% CI -23.99 to 9.99).The Japanese study with a relatively small sample size comparing oral methylergometrine with a Japanese traditional herbal medicine found that oral methylergometrine significantly increased the blood haemoglobin concentration at day one postpartum (MD 0.50 g/dL; 95% CI 0.11 to 0.89) compared to herbal medicine. Adverse events were not well-reported in the included studies. We did not find any studies comparing homeopathic remedies with either a placebo or no treatment. There was insufficient evidence to support the use of prophylactic oral methylergometrine given after delivery of the placenta for the prevention of PPH. Additionally, the effectiveness of prophylactic use of herbal medicine or homeopathic remedies for PPH is still unclear as we could not find any clear evidence. Trials to assess the effectiveness of herbal medicines and homeopathic remedies in preventing PPH are warranted.

Influenza virus infections are a serious public health concern throughout the world. Emergence of viral resistance to the currently approved anti-influenza drugs warrants the development of new antiviral agents. Japanese herbal medicines called Kampo are very commonly used as prescription medication in Japan, and Mao-to is known to be effective against influenza that is caused by oseltamivir-resistant viruses. However, influenza-related death occurs mainly among the elderly, and for patients with hypertension and diabetes, Mao-to may cause these diseases to worsen. Therefore, the exploration of more potent and safe Kampo medicines may be a good strategy for developing new influenza medicines. Here cell-based screening of anti-influenza virus activity for 42 approved Kampo medicines was performed using the drug-repositioning approach. As a result, four Kampo medicines were selected as potent anti-influenza agents against the A/WSN/33 strain. It was found that Daio-kanzo-to [50% inhibitory concentration (IC50) = 10.5 μg/mL; 50% cytotoxic concentration (CC50) = 71.6 μg/mL; selective index = 6.8] is more effective than Mao-to. Daio-kanzo-to and its constituent Japanese Pharmacopoeia (JP) Rhubarb were also effective against H3N2 and H1N1 subtypes of influenza viruses, including oseltamivir-insensitive-2009 pandemic clinical isolates. These data suggest the potential application of Daio-kanzo-to for influenza treatment.