T Itoh

Traditional Chinese Medicine and Kampo: A Review from the Distant past for the Future

Traditional Chinese medicine (TCM) is a complete system of healing that developed in China about 3000 years ago, and includes herbal medicine, acupuncture, moxibustion and massage, etc. In recent decades the use of TCM has become more popular in China and throughout the world. Traditional Japanese medicine has been used for 1500 years and includes Kampo-yaku (herbal medicine), acupuncture and acupressure. Kampo is now widely practised in Japan and is fully integrated into the modern health-care system. Kampo is based on TCM but has been adapted to Japanese culture. In this paper we review the history and characteristics of TCM and traditional Japanese medicine, i.e. the selection of traditional Chinese herbal medicine treatments based on differential diagnosis, and treatment formulations specific for the ‘Sho’ (the patients symptoms at a given moment) of Japanese Kampo - and look at the prospects for these forms of medicine.

The Effect of the Herbal Medicine Dai-Kenchu-to on Post-Operative Ileus:

Post-operative ileus (PI) is an inevitable adverse consequence of abdominal surgical procedures. We performed a randomized study of the effects of the herbal medicine dai-kenchu-to (DKT) on 24 patients with PI. Patients received either 15 g of oral DKT or placebo daily for 14 days. The effects on upper gastrointestinal motility, frequency of secondary operation and recurrence of PI were investigated. The frequency of surgical operation was significantly lower in patients receiving DKT compared with placebo. Oral administration of DKT was clinically effective for PI in reducing both the need for further surgery and the recurrence of PI.

Plasma adiponectin levels in post-menopausal women receiving hormone replacement therapy.

This study aimed to evaluate the correlation between plasma adiponectin levels and plasma lipid and lipoprotein levels in post-menopausal women (PMW) receiving hormone replacement therapy (HRT). Various clinical and biochemical parameters, including plasma lipid and lipoprotein concentrations and adiponectin levels, were measured in 54 healthy PMW before and after 3 and 6 months of HRT. Control groups consisted of women aged < 40 years (n = 20) or > 60 years (n = 17). PMW had significantly lower baseline adiponectin levels compared with the younger or older control groups, but adiponectin concentrations were not significantly altered after 3 or 6 months of HRT. Adiponectin levels in PMW were positively correlated with plasma high-density lipoprotein-cholesterol levels and were negatively correlated with body mass index and triglyceride levels. Our data suggest that circulating adiponectin may contribute to lipid homeostasis in PMW. Further studies are needed to elucidate the effects of HRT and oestrogen on adiponectin levels.

Effect of the Serotonin Blocker Sarpogrelate on Circulating Interleukin-18 Levels in Patients with Diabetes and Arteriosclerosis Obliterans

We aimed to evaluate the effect of treatment with sarpogrelate, a serotonin 2A receptor antagonist, on circulating interleukin (IL)-18 levels in patients with diabetes and arteriosclerosis obliterans. Patients received sarpogrelate (100 mg 3 times daily) for 2 months. We evaluated the degree of cryaesthesia (a feeling of cold in the foot and toes) as the clinical outcome, and measured circulating IL-18, IL-6 and lipid protein concentrations. An improvement in clinical outcome occurred after initiation of sarpogrelate therapy;a significant decrease in IL-18 levels was observed after 2 months of therapy. Levels of IL-6 and lipid proteins, including triglyceride, total cholesterol and high-density lipoprotein cholesterol, were not significantly altered by treatment. Our data suggest that by reducing circulating IL-18 levels, sarpogrelate treatment may contribute to the inhibition of arteriosclerosis obliterans progression in patients with diabetes.

Panic attack symptoms in a patient with left temporal lobe epilepsy.

We describe a 56-year-old woman with left temporal lobe epilepsy who developed symptoms of a panic attack. Owing to normal electroencephalography and brain magnetic resonance imaging results, she was initially diagnosed as suffering from panic attacks and treated for anxiety neurosis. The symptoms persisted and she was re-examined in our department. An interictal electroencephalogram showed paroxysmal spike waves in the left mesial temporal lobe region and this was the basis for a diagnosis of left temporal lobe epilepsy. This report suggests that left temporal lobe epilepsy should be considered as the differential diagnosis when patients frequently complain of fear or anxiety.

Spontaneously Identified Gastric Sarcoidosis: A Report of Three Cases

Sarcoidosis is a systemic granulomatous disease, frequently involving the lungs, lymph nodes, eyes and skin. Gastric sarcoidosis is very rare. We report three patients diagnosed initially with gastric sarcoidosis. Two had no other identified involvement, and one had involvement of the lungs and hilar lymph nodes. Gastroscopy was performed because of abdominal discomfort or as a follow-up examination for partial gastrectomy. This revealed atrophic lesions with nodular mucosal changes in the antrum and granular mucosa, and residual gastritis was found at the site of gastroduodenal anastomosis. Non-caseating epitheloid-cell granulomas were found in all patients following histological analysis. Gastroscopy and histopathological findings in gastric mucosal biopsy samples from suspicious sites are essential in establishing an accurate diagnosis of gastric sarcoidosis.

Angiotensin-II Receptor Antagonist Alleviates Non-alcoholic Fatty Liver in KKAy Obese Mice with Type 2 Diabetes

We examined the effects of the angiotensin-II receptor antagonist candesartan on non-alcoholic fatty liver (NAFL) and circulating adiponectin concentrations in KKAy obese mice with type 2 diabetes mellitus. The KKAy mice were randomly assigned to receive either candesartan at a once-daily dose of 10 mg/kg (n = 5) or placebo (n = 5). The differences in liver weight, histological evaluation of hepatic lipid infiltration, serum adiponectin concentration and hepatic adiponectin mRNA levels between the two groups were determined on day 7 after treatment was initiated. Candesartan-treated mice demonstrated significantly lower liver weights and reduced lipid droplets in hepatic cells compared with control mice. The circulating adiponectin levels and hepatic expression of adiponectin mRNA were significantly higher in candesartan-treated mice than control mice. These results suggest that candesartan might alleviate NAFL through elevation of circulating adiponectin levels in KKAy obese mice with type 2 diabetes mellitus.

Histochemical Study of Hyaluronate in Alcoholic Liver Disease

Recently, it has been reported that serum hyaluronate (hyaluronic acid; HA) concentrations increase in various liver diseases, especially in alcoholic liver disease (ALD), and serum HA concentration has been used as a marker for hepatic fibrosis. However, it is unknown whether hepatic HA contents in ALD increase by alcohol or not. In this study, we histochemically stained HA in liver biopsy specimens obtained from ALD patients while actively drinking and after abstinence to clarify the effects of alcohol on hepatic HA contents. Liver biopsy specimens were obtained from 13 patients with ALD and 10 patients with non-ALD. In ALD patients, liver biopsy was performed twice within 3 days, and 4 to 8 weeks after abstinence when serum levels of AST and ALT normalized. HA in biopsy specimens was stained histochemically with biotinylated HA binding protein. Staining intensity of HA in liver tissue was also determined by computer-assisted imaging analyzer. HA staining was clearly observed in sinusoidal wall and fibrous regions around the portal tract and central vein in liver diseases. HA staining intensities in patients actively drinking with ALD increased markedly, compared with those in patients with non-ALD, and these intensities decreased with abstinence. These results clearly suggest that hepatic HA contents in ALD may be increased by alcohol in addition to hepatic fibrosis, and, therefore, increased HA deposition in the liver may be reversible by abstinence of alcohol.

Chronotropic Effect of the Antithrombotic Agent Cilostazol in a Patient with Sick Sinus Syndrome and Syncope

In this case report we describe an 80-year-old man with sick sinus syndrome (SSS) who developed syncope attacks. The diagnosis of SSS was based on electrocardiographic evidence of markedly prolonged sinus arrests associated with syncope attacks while in hospital. The patient was given cilostazol, an anti-thrombotic agent that selectively inhibits cyclic nucleotide phosphodiesterase type 3, at a dose of 100 mg twice daily. The syncope attacks ceased, and an electrocardiogram obtained 1 week after the start of cilostazol administration showed no evidence of sinus arrest. The outcome of this case suggests that cilostazol may be useful in patients with syncope attacks due to SSS, although the long-term chronotropic effects of cilostazol need to be evaluated.

Effects of a new orally active dopamine prodrug, docarpamine, on refractory ascites: a pilot study

OBJECTIVE:Refractory ascites is a debilitating condition in patients with cirrhosis. Recently, docarpamine, an orally active dopamine prodrug, was reported to increase renal blood flow, glomerular filtration, and sodium excretion. This suggests docarpamine may be useful for the treatment of refractory ascites.METHODS:In this study, we investigated docarpamine metabolism in cirrhotic patients and its effect on refractory ascites.RESULTS:Blood samples were obtained from seven cirrhotic patients and six healthy subjects after administration of 750 mg docarpamine, and plasma levels of free dopamine were measured. In healthy subjects, maximum plasma concentration (Cmax), time taken to reach Cmax (Tmax), elimination half-life (T1/2), and area under the plasma concentration-time curve (AUC) of plasma free dopamine were 76.8 ± 24.1 ng/ml, 1.3 ± 0.2 h, 0.8 ± 0.1 h, and 97.5 ± 21.1 ng · h /ml, respectively. In patients with cirrhosis, Cmax (53.1 ± 24.9 ng/ml), T1/2 (0.8 ± 0.1 h), and AUC (100.6 ± 45.6 ng · h /ml) were no different from healthy subjects when comparing each parameter, whereas Tmax (2.7 ± 0.2) was significantly longer than that of healthy subjects. We treated 10 cirrhotic patients with refractory ascites with docarpamine or placebo and the same dose of diuretics used before hospitalization. After 8 wk of docarpamine treatment, ascites disappeared completely in three of the five patients and decreased in the remainder. However, in five patients treated with placebo, ascites was not changed or increased. Side effects were not observed in any case.CONCLUSIONS:Docarpamine was found to metabolize in cirrhotic patients as well as in normal subjects and may be an effective treatment for refractory ascites.