• Tsumura and Company

• Rikkunshito
• cervical cancer
• chemotherapy-induced nausea and vomiting
• cisplatin
• herbal medicine
• uterine corpus cancer

• Humans
• Female
• Cisplatin/adverse effects
• Nausea/chemically induced
• Nausea/drug therapy
• Nausea/prevention & control
• Drugs, Chinese Herbal/therapeutic use
• Vomiting/chemically induced
• Vomiting/drug therapy
• Vomiting/prevention & control
• Uterine Cervical Neoplasms/drug therapy
• Double-Blind Method
• Middle Aged
• Antiemetics/therapeutic use
• Antiemetics/administration & dosage
• Adult
• Aged
• Antineoplastic Agents/adverse effects
• Uterine Neoplasms/drug therapy

• Japan Agency for Medical Research and Development

• Irritable Bowel Syndrome (IBS)
• Visceral sensation
• functional dyspepsia
• gastrointestinal diseases
• herbal medicines.
• non-erosive reflux disease (NERD)

• Humans
• Animals
• Gastrointestinal Diseases/drug therapy
• Plant Preparations/therapeutic use
• Plant Preparations/pharmacology
• Irritable Bowel Syndrome/drug therapy
• Hyperalgesia/drug therapy
• Anti-Inflammatory Agents/therapeutic use
• Anti-Inflammatory Agents/pharmacology
• Antioxidants/therapeutic use
• Antioxidants/pharmacology
• Visceral Pain/drug therapy
• TRPV Cation Channels/metabolism

• Cancer
• chemotherapy
• chemotherapy-induced toxicities
• oncogenes.
• phytopharmaceuticals
• proto-oncogenes

• Humans
• Neoplasms/drug therapy
• Antineoplastic Agents/adverse effects
• Antineoplastic Agents/therapeutic use
• Antineoplastic Agents/chemistry
• Phytochemicals/therapeutic use
• Phytochemicals/pharmacology
• Phytochemicals/chemistry
• Phytochemicals/adverse effects
• Animals
• Medicine, Traditional/methods
• Phytotherapy/methods
• Plant Extracts/therapeutic use
• Plant Extracts/chemistry
• Plant Extracts/pharmacology

• Botanical drug
• Gastroesophageal reflux disease
• Herbal medicine
• Liujunzi-tang
• Proton pump inhibitor
• Rabeprazole
• Rikkunshito
• Yukgunja-tang

• Humans
• Gastroesophageal Reflux/drug therapy
• Proton Pump Inhibitors/therapeutic use
• Proton Pump Inhibitors/adverse effects
• Quality of Life
• Rabeprazole/therapeutic use
• Randomized Controlled Trials as Topic
• Treatment Outcome
• Double-Blind Method

• HI20C0865 Korea Health Industry Development Institute

• 21AA2007 Ministry of Health, Labour and Welfare
• 22AA2003 Ministry of Health, Labour and Welfare
• 20H03907 Ministry of Education, Culture, Sports, Science and Technology, Japan
• Grant on Health Economics Research Japan Kampo Medicines Manufacturers Association
• 2023 Japan Kampo Medicines Manufacturers Association

Rikkunshito is a Japanese herbal medicine (Kampo) that has been attracting attention and researched by many researchers not only in Japan but also worldwide. There are 214 rikkunshito articles that can be searched on PubMed by August 2021. The reason why rikkunshito has attracted so much attention is due to an epoch-making report (Gastroenterology, 2008) discovered that rikkunshito promotes the secretion of the orexigenic peptide ghrelin. Since then, many researchers have discovered that rikkunshito has a direct effect on the ghrelin receptor, GHS-R1a, and an effect of enhancing the ghrelin signal to the brain. Additionally, a lot of evidence that rikkunshito is expected to be effective for various gastrointestinal diseases have also been demonstrated. Numerous basic and clinical studies have suggested that rikkunshito affects (i) various discomforts caused by anticancer drugs, gastroesophageal reflux disease, functional dyspepsia, (ii) various stress-induced anorexia, (iii) hypophagia in the elderly, and (iv) healthy lifespan. In this review, as one who discovered the ghrelin enhancer effect of rikkunshito, we will review the research of rikkunshito so far and report on the latest research results.

• GHS-R
• Kampo
• aging
• anorexia
• ghrelin
• rikkunshito
• stress

• Kampo
• Persian medicine
• functional dyspepsia
• herbal medicine
• traditional Chinese medicine

Cancer cachexia is an important concern in cancer patients in view of advanced stage at presentation. The treatment goal for cachexia is the reversal of the loss of body weight and muscle mass with a variety of pharmacological agents. Various treatment guidelines focus on patients with advanced cancer who are likely to suffer from refractory cachexia. There is a paucity of data on research directed to cancer cachexia on cancer patients. Complementary and alternative medicines (CAMs) are widely use at some or other point of time by the majority of cancer patients in spite of little or no evidence to support that. There are many CAM which have been tried in different set up for cancer cachexia. These medicines are well accepted in view of lesser side effects and easy to use. There is a need for more randomized controlled trials with larger sample size with longer follow-up to generate more evidence in support to the use of CAM in cancer and cancer cachexia.

• Complementary and alternative medicine
• cancer
• cancer cachexia
• herbal medicine
• weight loss

Prokinetics is one of the therapeutic agents for functional and motility disorders of the stomach. However, its efficacy is limited. Kampo medicine is a unique medical system that was developed in Japan. In Kampo medicine, herbal medicine is prescribed based on the patient’s condition. Therefore, even for functional and motility disorders of the stomach, some herbal medicines are considered as a therapeutic option. Recently, there has been an increase in evidence for the efficacy or the mechanism of herbal medicine for functional and motility disorders of the stomach. Among these, rikkunshito is a well-studied herbal medicine that could be used as an alternative to prokinetics. In this review, we discuss the possibilities of rikkunshito for functional dyspepsia with its prokinetic and non-prokinetic effects and provide an overview of their current use with a focus on their therapeutic mechanism.

• Kampo
• functional and motility disorders of the stomach
• functional dyspepsia
• non-prokinetic treatment
• rikkunshito

The purpose of this study is both to estimate the efficacy and the safety of Yukgunja-tang (YGJT) and to establish evidence for the use of herbal medicines in the management of patients with cancer-related anorexia.

We enrolled 40 patients with cancer-related anorexia. The enrolled participants were randomly allocated to 2 groups: the control group (n = 20), which received nutrition counseling, and the treatment group (n = 20), which received nutrition counseling and was administered YGJT at twice a day for 4 weeks (a total of 56 times @ 3.0 g each time). The primary outcome of this study was the score on the anorexia/cachexia subscale (ACS) of the Functional Assessment of Anorexia/Cachexia Therapy (FAACT). The secondary outcomes were the FAACT score with the ACS score excluded, the score on the Visual Analog Scale (VAS) for appetite, and the results on laboratory tests regarding appetite, such as leptin, tumor necrosis factors (TNF-α), interleukin-6 (IL-6), and ghrelin. All variables related to the safety assessment, such as vital signs, electrocardiography results, laboratory test results (complete blood cell count, chemistry, urine test), and adverse events, were documented on the case report form (CRF) at every visit.

The difference in the primary outcome, that is, the score on the anorexia/cachexia subscale (ACS) of the Functional Assessment of Anorexia/Cachexia Therapy (FAACT), between the control and the treatment groups was statistically significant (P = .023) as was the difference in the FAACT scores with the ACS score excluded, a secondary outcome, between the 2 groups; however, no statistically significant differences were noted in the scores on the VAS or the levels of leptin, TNF-α, IL-6, and ghrelin. In addition, no significant differences in the numbers and the types of adverse events or in the results on the laboratory tests between the control and the treatment groups were recorded.

These results obtained in this research confirmed the efficacy and the safety of using YGJT as a herb-medicine treatment option for patients with cancer-related anorexia.

• Liu-Jun-Zi-Tang
• Rikkunshito
• Yukgunja-Tang
• anorexia
• cancer
• clinical trials
• malnutrition

• ambulatory reflux monitoring
• bile acids
• esophageal motility
• pepsin
• potassium competitive acid blocker

With the continued growth of the aging population in Japan, geriatric syndrome (GS), which is associated with aging-related symptoms, has become a social problem. GS is caused by physiological and pathological aging and may manifest various symptoms. Physicians use multidisciplinary approaches to provide treatment for individual GS symptoms. Kampo medicine, a Japanese traditional medicine that uses multiple pharmacologically active substances, is useful for many syndromes, conditions, disorders, and diseases associated with GS. Evidence of the effectiveness of Kampo medicine for GS has accumulated in recent years. The effects of Kampo treatment for symptoms related to functional decline of the cardiovascular, respiratory, and digestive systems, cognitive impairment and related disorders, pain and other sensory issues, among others, support the use of Kampo medicine for the management of GS. The role of Kampo medicine for GS is summarized in this review.

• Kampo medicine
• aging
• elderly
• evidence
• geriatric syndrome

• STW 5
• functional dyspepsia
• herbal
• irritable bowel syndrome
• peppermint

• anorexia
• cancer
• clinical trials
• liu-jun-zi-tang
• malnutrition
• rikkunshito
• yukgunja-tang

• Adult
• Aged
• Aged, 80 and over
• Anorexia/drug therapy
• Anorexia/etiology
• Appetite
• Body Mass Index
• Body Weight
• Cachexia/drug therapy
• Cachexia/etiology
• Double-Blind Method
• Drugs, Chinese Herbal/administration & dosage
• Drugs, Chinese Herbal/adverse effects
• Drugs, Chinese Herbal/therapeutic use
• Female
• Hematologic Tests
• Humans
• Male
• Middle Aged
• Neoplasms/complications
• Pilot Projects
• Quality of Life
• Republic of Korea
• Research Design
• Young Adult
• Randomized Controlled Trials as Topic

• chinese traditional medicine
• functional dyspepsia
• meta-analysis

• Adult
• Drugs, Chinese Herbal/therapeutic use
• Dyspepsia/drug therapy
• Female
• Gastrointestinal Agents/therapeutic use
• Humans
• Male
• Middle Aged
• Randomized Controlled Trials as Topic
• Treatment Outcome

• Cancer; Cachexia; Herbal medicine; Traditional East Asian medicine systematic review

• Animals
• Cachexia/drug therapy
• Cachexia/etiology
• Herbal Medicine/methods
• Herbal Medicine/trends
• Medicine, East Asian Traditional/methods
• Medicine, East Asian Traditional/trends
• Neoplasms, Experimental/complications
• Neoplasms, Experimental/drug therapy
• Phytotherapy/methods
• Phytotherapy/trends

• Ghrelin
• Herbal medicine
• Rikkunshito
• Systematic review
• Upper gastrointestinal symptoms

• diagnostic criteria
• guidelines
• severity classification
• systemic sclerosis
• treatment

• Dermatologic Agents/therapeutic use
• Evidence-Based Medicine/methods
• Evidence-Based Medicine/standards
• Fingers
• Gastrointestinal Tract/diagnostic imaging
• Gastrointestinal Tract/pathology
• Heart/diagnostic imaging
• Humans
• Kidney/pathology
• Lung/diagnostic imaging
• Lung/pathology
• Myocardium/pathology
• Rheumatology/methods
• Rheumatology/standards
• Scleroderma, Systemic/classification
• Scleroderma, Systemic/diagnosis
• Scleroderma, Systemic/drug therapy
• Scleroderma, Systemic/pathology
• Severity of Illness Index
• Skin/pathology
• Time Factors
• Tomography, X-Ray Computed

• acid secretion inhibitors
• acotiamide
• functional dyspepsia
• gastritis
• mosapride

Only a few reports focused on esophageal motility in patients with proton pump inhibitor (PPI)-refractory nonerosive reflux disease (NERD) and there has been no established strategy for treatment.

To clarify the characteristics of esophageal motility in patients with PPI-refractory NERD, we evaluated esophageal function using combined multichannel intraluminal impedance and esophageal manometry (MII-EM). In addition, we evaluated the efficacy of rikkunshito (RKT), which is a gastrointestinal prokinetic agent.

Thirty patients with NERD were enrolled and underwent MII-EM. After 8 weeks of RKT (7.5 g/d) treatment, MII-EM was repeated on patients with PPI-refractory NERD. Symptoms were assessed by the Gastrointestinal Symptom Rating Scale.

In patients with PPI-refractory NERD, measures of complete bolus transit, peristaltic contractions, and residual pressure of the lower esophageal sphincter during swallowing deviated from the standard values and esophageal clearance was found to be deteriorated. RKT significantly improved the peristaltic contractions (P < 0.05), the complete bolus transit (P < 0.01), and the residual pressure of lower esophageal sphincter (P < 0.05) in these patients. The overall score (P < 0.01) and the subscale scores of acid reflux syndrome (P < 0.05), abdominal pain (P < 0.05), and indigestion syndrome (P < 0.01) in the Gastrointestinal Symptom Rating Scale were significantly improved by the 8-week RKT treatment.

In the pilot study, patients with PPI-refractory NERD had disorders of esophageal and lower esophageal sphincter motility that were improved by RKT. Further studies examining esophageal motor activity of RKT in PPI-refractory NERD are required. University hospital Medical Information Network (UMIN) Clinical Trial Registry identifier: UMIN000003092.

• esophageal motility
• high-resolution impedance manometry
• non-erosive reflux disease
• proton pump inhibitor
• rikkunshito

• gastroesophageal reflux disease
• proton pump inhibitor
• quality of life
• rikkunshito

• Anorexia
• Antiemetics
• Nausea
• Rikkunshito
• Vomiting

• epigastric pain syndrome
• functional dyspepsia
• itopride
• postprandial distress syndrome
• rabeprazole

Peripheral neuropathy is the major side effect caused by paclitaxel, a microtubule-binding antineoplastic drug. Paclitaxel-induced peripheral neuropathy causes a long-term negative impact on the patient's quality of life. However, the mechanism underlying paclitaxel-induced peripheral neuropathy is still unknown, and there is no established treatment. Ghrelin is known to attenuate thermal hyperalgesia and mechanical allodynia in chronic constriction injury of the sciatic nerve, and inhibit the activation of nuclear factor kappa B (NFκB) in the spinal dorsal horn. Rikkunshito (RKT), a kampo medicine, increases the secretion of ghrelin in rodents and humans. Thus, RKT may attenuate paclitaxel-induced peripheral neuropathy by inhibiting phosphorylated NFκB (pNFκB) in the spinal cord. We found that paclitaxel dose-dependently induced mechanical hyperalgesia in mice. Paclitaxel increased the protein levels of spinal pNFκB, but not those of spinal NFκB. NFκB inhibitor attenuated paclitaxel-induced mechanical hyperalgesia suggesting that the activation of NFκB mediates paclitaxel-induced hyperalgesia. RKT dose-dependently attenuated paclitaxel-induced mechanical hyperalgesia. Ghrelin receptor antagonist reversed the RKT-induced attenuation of paclitaxel-induced mechanical hyperalgesia. RKT inhibited the paclitaxel-induced increase in the protein levels of spinal pNFκB. Taken together, the present study indicates that RKT exerts an antihyperalgesic effect in paclitaxel-induced neuropathic pain by suppressing the activation of spinal NFκB.

We investigated the effects of rikkunshito, in combination with a proton pump inhibitor, on symptoms and quality of life in patients with proton pump inhibitor-refractory gastroesophageal reflux disease. The subjects were 47 patients with gastroesophageal reflux disease with residual symptoms such as heartburn following 8 weeks of proton pump inhibitor therapy. We administered these subjects rikkunshito in combination with a proton pump inhibitor for 6–8 weeks. We scored their symptoms of heartburn, fullness, abdominal discomfort, and abdominal pain, and surveyed their quality of life using the Reflux Esophagitis Symptom Questionnaire, comprising questions concerning daily activities, meals (changes in amount and favorite foods), and sleep (getting to sleep and early morning waking). Improvement was seen in all symptoms, and quality of life scores for meals and sleep also improved. These results indicate that combination therapy with rikkunshito and a proton pump inhibitor improves quality of life related to eating and sleep in patients with patients with proton pump inhibitor-refractory gastroesophageal reflux disease.

• gastroesophageal reflux disease
• proton pump inhibitor
• quality of life
• rikkunshito

• Evidence based trials
• Gastrointestinal disorders
• Herbal traditional Chinese medicine
• Traditional Chinese medicine

Abdominal surgery inhibits food intake and induces c-Fos expression in the hypothalamic and medullary nuclei in rats. Rikkunshito (RKT), a Kampo medicine improves anorexia. We assessed the alterations in meal microstructure and c-Fos expression in brain nuclei induced by abdominal surgery and the modulation by RKT in mice. RKT or vehicle was gavaged daily for 1 week. On day 8 mice had no access to food for 6–7 h and were treated twice with RKT or vehicle. Abdominal surgery (laparotomy-cecum palpation) was performed 1–2 h before the dark phase. The food intake and meal structures were monitored using an automated monitoring system for mice. Brain sections were processed for c-Fos immunoreactivity (ir) 2-h after abdominal surgery. Abdominal surgery significantly reduced bouts, meal frequency, size and duration, and time spent on meals, and increased inter-meal interval and satiety ratio resulting in 92–86% suppression of food intake at 2–24 h post-surgery compared with control group (no surgery). RKT significantly increased bouts, meal duration and the cumulative 12-h food intake by 11%. Abdominal surgery increased c-Fos in the prelimbic, cingulate and insular cortexes, and autonomic nuclei, such as the bed nucleus of the stria terminalis, central amygdala, hypothalamic supraoptic (SON), paraventricular and arcuate nuclei, Edinger-Westphal nucleus (E-W), lateral periaqueduct gray (PAG), lateral parabrachial nucleus, locus coeruleus, ventrolateral medulla and nucleus tractus solitarius (NTS). RKT induced a small increase in c-Fos-ir neurons in the SON and E-W of control mice, and in mice with surgery there was an increase in the lateral PAG and a decrease in the NTS. These findings indicate that abdominal surgery inhibits food intake by increasing both satiation (meal duration) and satiety (meal interval) and activates brain circuits involved in pain, feeding behavior and stress that may underlie the alterations of meal pattern and food intake inhibition. RKT improves food consumption post-surgically that may involve modulation of pain pathway.

• Abdomen/pathology
• Abdomen/surgery
• Administration, Oral
• Animals
• Anorexia/drug therapy
• Brain/cytology
• Brain/drug effects
• Brain/metabolism
• Drugs, Chinese Herbal/administration & dosage
• Eating/drug effects
• Eating/physiology
• Eating/psychology
• Ghrelin/metabolism
• Male
• Mice, Inbred C57BL
• Neurons/drug effects
• Neurons/metabolism
• Pain/drug therapy
• Plant Extracts/administration & dosage
• Plants, Medicinal
• Postoperative Complications/drug therapy
• Postoperative Complications/pathology
• Proto-Oncogene Proteins c-fos/immunology
• Proto-Oncogene Proteins c-fos/metabolism
• Satiation/drug effects
• Satiety Response/drug effects
• Tyrosine 3-Monooxygenase/metabolism

• P30 DK041301 NIDDK NIH HHS
• NIHDDK-41303 PHS HHS

• Rikkunshito
• adrenergic receptor
• gastric relaxation

Herbal traditional Chinese medicine (TCM) is used to treat several ailments, but its efficiency is poorly documented and hence debated, as opposed to modern medicine commonly providing effective therapies. The aim of this review article is to present a practical reference guide on the role of herbal TCM in managing gastrointestinal disorders, supported by systematic reviews and evidence based trials. A literature search using herbal TCM combined with terms for gastrointestinal disorders in PubMed and the Cochrane database identified publications of herbal TCM trials. Results were analyzed for study type, inclusion criteria, and outcome parameters. Quality of placebo controlled, randomized, double-blind clinical trials was poor, mostly neglecting stringent evidence based diagnostic and therapeutic criteria. Accordingly, appropriate Cochrane reviews and meta-analyses were limited and failed to support valid, clinically relevant evidence based efficiency of herbal TCM in gastrointestinal diseases, including gastroesophageal reflux disease, gastric or duodenal ulcer, dyspepsia, irritable bowel syndrome, ulcerative colitis, and Crohn’s disease. In conclusion, the use of herbal TCM to treat various diseases has an interesting philosophical background with a long history, but it received increasing skepticism due to the lack of evidence based efficiency as shown by high quality trials; this has now been summarized for gastrointestinal disorders, with TCM not recommended for most gastrointestinal diseases. Future studies should focus on placebo controlled, randomized, double-blind clinical trials, herbal product quality and standard criteria for diagnosis, treatment, outcome, and assessment of adverse herb reactions. This approach will provide figures of risk/benefit profiles that hopefully are positive for at least some treatment modalities of herbal TCM. Proponents of modern herbal TCM best face these promising challenges of pragmatic modern medicine by bridging the gap between the two medicinal cultures.

• Evidence based trials
• Traditional Chinese medicine
• Herbal traditional Chinese medicine
• Gastrointestinal disorders

• Drugs, Chinese Herbal/adverse effects
• Drugs, Chinese Herbal/therapeutic use
• Gastrointestinal Agents/adverse effects
• Gastrointestinal Agents/therapeutic use
• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Diseases/drug therapy
• Humans
• Treatment Outcome

Accumulating evidence suggests that Japanese herbal medicines, called Kampo, have beneficial effects on cancer chemotherapy-induced side effects. Rikkunshito ameliorates cisplatin-induced anorexia through an antagonistic effect on the 5-HT receptors and by increasing the serum ghrelin levels. Hangeshashinto improves irinotecan-induced diarrhea and chemotherapy-induced mucositis by inhibiting the activity of β-glucuronidase as well as the synthesis of prostaglandin E2. Goshajinkigan prevents oxaliplatin-induced neurotoxicity, possibly through suppressing functional alterations of the transient receptor potential channels. In this review, we will summarize the currently available literature regarding the clinical efficacy and potential mechanisms of Kampo medicines in the treatment of cancer chemotherapy-induced side effects.

• Kampo
• chemotherapy-induced side effects
• goshajinkigan
• hangeshashinto
• rikkunshito

Gastroenterological reflux disease and functional dyspepsia are usually treatable using Western medical practices. Nonetheless, some cases present with intractable symptoms that are not amenable to these therapies. Treatment with kampo, a traditional Japanese medicine, recently has been proposed as an alternative therapy for use in combination with the Western practices. In general, traditional Japanese medicines have been used empirically for intractable symptoms correctively designated as “general malaises.” Accumulating lines of evidence, including basic and clinical researches, have demonstrate detailed mechanisms where traditional Japanese medicines exert pharmacological action to improve symptoms. Therefore, traditional Japanese medicines have been gaining use by various medical doctors as the specific modes of pharmacological action are recognized. This review covers both the pharmacological functions and the clinical efficacies of rikkunshito for use in treating disorders of the gastrointestinal tract.

• acotiamide
• functional dyspepsia
• gastroesophageal reflux diseases
• gastrointestinal motility
• general malaises

Anorexia–cachexia syndrome develops during the advanced stages of various chronic diseases in which patients exhibit a decreased food intake, weight loss, and muscle tissue wasting. For these patients, this syndrome is a critical problem leading to an increased rate of morbidity and mortality. The present pharmacological therapies for treating anorexia–cachexia have limited effectiveness. The Japanese herbal medicine rikkunshito is often prescribed for the treatment of anorexia and upper gastrointestinal (GI) disorders. Thus, rikkunshito is expected to be beneficial for the treatment of patients with anorexia–cachexia syndrome. In this review, we summarize the effects of rikkunshito and its mechanisms of action on anorexia–cachexia. Persistent loss of appetite leads to a progressive depletion of body energy stores, which is frequently associated with cachexia. Consequently, regulating appetite and energy homeostasis is critically important for treating cachexia. Ghrelin is mainly secreted from the stomach, and it plays an important role in initiating feeding, controlling GI motility, and regulating energy expenditure. Recent clinical and basic science studies have demonstrated that the critical mechanism of rikkunshito underlies endogenous ghrelin activity. Interestingly, several components of rikkunshito target multiple gastric and central sites, and regulate the secretion, receptor sensitization, and degradation of ghrelin. Rikkunshito is effective for the treatment of anorexia, body weight loss, muscle wasting, and anxiety-related behavior. Furthermore, treatment with rikkunshito was observed to prolong survival in an animal model of cachexia. The use of a potentiator of ghrelin signaling, such as rikkunshito, may represent a novel approach for the treatment of anorexia–cachexia syndrome.

• anorexia
• cachexia
• ghrelin
• rikkunshito
• weight loss

• Helicobacter pylori
• epigastric pain
• functional dyspepsia
• postprandial fullness
• rikkunshito

• dyspepsia
• herbal
• irritable bowel

• CGRP
• DRG
• ERK1/2
• Rikkunshito
• SP

• Gastric motility
• Ghrelin
• Parkinson's disease
• Rats
• Rikkunshito
• l-dopa

• Animals
• Carbidopa/pharmacology
• Drugs, Chinese Herbal/pharmacology
• Gastric Emptying/drug effects
• Ghrelin/blood
• Levodopa/pharmacology
• Male
• Oligopeptides/pharmacology
• Parkinson Disease, Secondary/blood
• Parkinson Disease, Secondary/drug therapy
• Parkinson Disease, Secondary/physiopathology
• Postprandial Period
• Rats, Sprague-Dawley
• Receptors, Ghrelin/antagonists & inhibitors

• I01 BX003951 BLRD VA
• P30 DK041301 NIDDK NIH HHS
• DK-41303 NIDDK NIH HHS

This article reviews the effectiveness of Kampo (traditional Japanese herbal medicine) in the treatment of functional gastrointestinal disorders, especially functional dyspepsia (FD) and irritable bowel syndrome (IBS). The results of four randomized, controlled trials (RCTs) suggested the usefulness of rikkunshito in relieving the subjective symptoms of patients with FD. Rikkunshito significantly improved not only gastric symptoms, such as epigastiric discomfort, but also extra-gastric symptoms, such as general fatigue, when compared with control drugs. The therapeutic effects of rikkunshito were more evident when it was prescribed to patients with “kyosho”, i.e., low energy. Two RCTs suggested the efficacy of keishikashakuyakuto for IBS.

Basic research studies have demonstrated that these Kampo medicines have multiple sites of action to improve subjective symptoms. For example, rikkunshito improves gastric motility dysfunction, including impaired adaptive relaxation and delayed gastric emptying, gastric hypersensitivity, and anorexia via facilitation of ghrelin secretion. It also exhibits anti-stress effects, i.e., it attenuates stress-induced exacerbation of gastric sensation and anorexia, as well as the hypothalamic-pituitary-adrenocortical axis and sympathetic activation. Keishikashakuyakuto exhibited not only an antispasmodic effect on intestinal smooth muscle, but also antidepressant-like effects. Case series suggest that other Kampo prescriptions are also effective for FD and IBS. However, further studies are necessary to evaluate their efficacy.

• Acetylcholine
• Acotiamide rikkunshito
• Itopride
• Tandospirone