Yutaka Nagata

A Chinese Herbal Medicine, Tokishakuyakusan, Reduces the Worsening of Impairments and Independence after Stroke: A 1-Year Randomized, Controlled Trial

In post-stroke patients, the recurrence of stroke and progression of impairments lead to a bedridden state and dementia. As for their treatments, only anti-hypertension and anti-coagulation therapies to prevent the recurrence of stroke are available. In Asia, post-stroke patients with impairments are often treated with herbal medicine. The present study evaluated the effectiveness of tokishakuyakusan (TS) in improving the impairment and independence in post-stroke patients. Thirty-one post-stroke patients (mean age = 81.4 years) were recruited and enrolled. Participants were randomly assigned to the TS group (n = 16) or non-treatment (control) group (n = 15) and treated for 12 months. Impairments were assessed using the Stroke Impairment Assessment Set (SIAS). Independence was evaluated using the functional independence measure (FIM). For each outcome measure, mean change was calculated every 3 months. The results were that impairments according to SIAS did not significantly change in the TS group. In contrast, SIAS significantly worsened in the control group. There was a significant difference between the two groups. In each term of SIAS, affected lower extremity scores, abdominal muscle strength, function of visuospatial perception, and so forth. in the TS group were better than those in the control group. Independence according to FIM did not change significantly in the TS group. In contrast, FIM significantly worsened in the control group. There was also a significant difference between the two groups. In conclusion, TS was considered to suppress the impairments of lower limbs and to exert a favorable effect on cerebral function for post-stroke patients.

Effect of Keishibukuryogan on Endothelial Function in Patients with at Least One Component of the Diagnostic Criteria for Metabolic Syndrome: A Controlled Clinical Trial with Crossover Design

We evaluated the effect of keishibukuryogan (KBG; Guizhi-Fuling-Wan), a traditional Japanese (Kampo) formula, on endothelial function assessed by reactive hyperemia peripheral arterial tonometry (Endo-PAT2000) in patients with metabolic syndrome-related factors by controlled clinical trial with crossover design. Ninety-two patients were assigned to group A (first KBG-treatment period, then control period; each lasting 4 weeks, with about one-year interval) or group B (first control, then KBG-treatment). In forty-nine (27, group A; 22, group B) patients completing all tests, the mean value of the natural logarithmic-scaled reactive hyperemia index (L_RHI) increased and those of serum nonesterified fatty acid (NEFA), malondialdehyde, and soluble vascular cell adhesion molecule 1 decreased significantly during the KBG-treatment period, but not during the control period, and 4-week changes of L_RHI, NEFA, and malondialdehyde between the 2 periods showed significance. These results suggest that KBG has beneficial effect on endothelial function in patients with metabolic syndrome-related factors.

Total dosage of gardenia fruit used by patients with mesenteric phlebosclerosis.

BackgroundMesenteric phlebosclerosis (MP) is a disease characterized by fibrotic change or calcification of the mesenteric vein. Recently, there has been an increase in case reports of MP related to herbal medicine usage. Long-term intake of gardenia fruit (GF) is suspected as a possible cause. However, many GF users do not develop this disease and the association between GF and MP remains unclear. In this study, we investigated for the first time the dosage of GF used by patients with and without MP.MethodsWe used a medical chart review study design to assess the association between GF and MP. We reviewed patients with a history of intake of herbal medicines containing GF. Among these patients, we selected patients who were examined by colonoscopy and abdominal plain computed tomography (CT). We investigated the findings of colonoscopy, CT scan and histological examination. We assessed the total dosages of GF alongside the duration of ambulatory visit, the administration period of herbal medicine containing GF and pre-existing disease in order to compare MP cases and non-MP patients.ResultsTen MP cases and 42 non-MP patients were analyzed. We summarized clinical findings of MP cases. All MP cases used more GF than non-MP patients and were administered more than approximately 5,000 grams of GF in cumulative dosage.ConclusionsThis study indicated that excessive intake of GF contributes to and/or accelerates the development of MP suggesting that long-term usage of GF in excessive amounts increases the risk of MP.

Successful eradication of Helicobacter pylori with a herbal medicine, goshuyuto (Wu Zhu Yu Tang), plus rabeprazole after failure of triplet therapy with vonoprazan: a report of three cases

Vonoprazan, a potassium-competitive acid blocker, is used as a substitute drug for conventional proton pump inhibitors. Recently, vonoprazan has been applied for eradication of H. pylori (HP) infection, and the efficacies of vonoprazan-based triple therapy against HP infection have already been reported. However, treatment sometimes fails in the primary and/or secondary triplet eradication therapy, including with the use of vonoprazan for HP infection. We experienced three cases of refractory HP infection. They were treated with eradication therapy for HP infection with chronic gastritis. After primary triplet therapy with amoxicillin, clarithromycin, and rabeprazole (Case 1) or vonoprazan (Case 2, 3), their urea breath test were positive. Subsequently, patients received secondary eradication therapy with amoxicillin, metronidazole, and vonoprazan (Case 1, 2) or rabeprazole (Case 3), but their urea breath test was still positive. Thereafter, they consulted Kampo treatment. Kampo eradication therapy was given consisting of goshuyuto 2.5 g three-times daily plus rabeprazole 10 mg twice daily for 28 days. Finally, their urea breath test became negative. We successfully treated these cases with goshuyuto and rabeprazole. Goshuyuto treatment is worth trying as another therapeutic option.

Successful treatment of antibiotic-associated diarrhea with a herbal medicine, daiobotampito

We present the case of a 43‐year‐old woman diagnosed with antibiotic‐associated diarrhea. She had diarrheal and hemorrhagic stool after secondary eradication of Helicobacter pylori. On examination of feces, rapid test for Clostridium difficile was glutamate dehydrogenase (GDH) antigen positive/toxins negative. Vancomycin was initiated for the C. difficile infection due to intolerance (nausea) of metronidazole, but vancomycin treatment was a clinical failure. GDH screening test continued to be positive. Kampo treatment was requested and daiobotampito (DBT) was selected due to eligible right lower quadrant abdominal pain. Stool abnormality improved and the GDH test became negative after DBT treatment.