Volume 7, Number 4 | Winter 2012

Kampo Medicine - Current Research
Kampo (Japanese Traditional) Medicine andGastrointestinal Symptoms in Pediatric Surgery
Keiko Ogawa-Ochiai
Associate Professor
Clinic of Japanese-Oriental (Kampo) Medicine,
Department of Otorhinolaryngology & Head and Neck Surgery
Kanazawa University Hospital

daikenchuto (Da Jian Zhong Tang), shokenchuto (Xiao
Jian Zhong Tang), inchinkoto (Yin Chen Hao Tang),
daiokanzoto (Da Huang Gan Cao Tang), hangekobokuto(Ban Xia Hou Po Tang), yokukansan (Yi Gan San),
juzentaihoto (Shi Quan Da Bu Tang) andhainosankyuto (Pai Nong San Ji Tang) with reference
to clinical trials.
[Overview of pediatric surgical diseases]

Summary
With the dramatic improvements in the prognosis ofpediatric surgical diseases indefinite symptoms related
to the digestive organs associated with prolonged
survival are now also frequently observed. For thesepatients Kampo medicines then become a powerfulchoice. Frequently used prescriptions in the field of

1) Gastroesophageal Reflux Disease (GERD)
Based on the anatomical characteristics a mild refluxfrom the stomach into the esophagus happens in all
infants. It occurs in 50% of newborn under three monthsof age and 67% of the 4-month old, but resolves often
spontaneously when the infants start to assume apediatric surgery for diseases of the digestive system

sitting position. The gastroesophageal reflux in 10% of

rikkunshito, daikenchuto, shokenchuto, inchinkoto,
daiokanzoto, hangekobokuto, yokukansan, juzentaihotoand hainosankyuto are outlined here. In order to meetcomplications.

the enthusiasm of pediatric surgeons, Kampo experts

infants under 1 year of age is said to be associated withThe

symptoms

associatedwithgastroesophageal reflux are called Gastroesophageal
Reflux Disease (GERD). A portion of these symptoms

must cooperate in efforts to search for new indications.

are due to hypoactivity of the sphincter of the lower[Introduction]

lower esophagus. Due to the still immature faculty of

The progress in medicine has dramatically improved theprognosis of pediatric surgical diseases. Associated withthis progress an increase in indefinite symptoms related
to the digestive organs due to the prolonged survival has
been

observed.

Yet,further

improvements

inpostoperative long-term quality of life (QOL) and ADL(Activities of Daily Living) still need to be achieved.
Under these circumstances the value of Kampo
medicines has received attention for their action in
adjusting the general condition of the patients.
Moreover, during daily clinical pediatric surgicalpractice, even if surgery is not required, many patientsare counseled regarding symptoms of the digestiveorgans and Kampo medicines are at that time apowerful choice. In this manuscript we will discuss first
mainly pediatric surgical diseases of the digestiveorgans and later would like to outline the frequently
used prescriptions in the field of pediatric digestivesystem diseases rikkunshito (Liu Jun Zi Tang),

10esophagus. Persistent reflux causes inflammation of the
speech of the infants, they cannot complain of heartburnand the condition may manifest as bad mood, frequentcrying, decreased appetite, abdominal pain, throat pain,
asthma, chronic cough, middle ear infection etc. Thisshows, that once these infant specific characteristics areunderstood, in cases of indefinite complaints of theupper abdomen or a variety of other symptoms, thepossibility of GERD should also be suspected. Also, since
experience has shown, that the use of Kampo medicines
in infants is comparatively safe, their application is
worth a try.
Actually, in addition to the clinically easy developmentof gastroesophageal reflux in infants, aerophagia,
constipation, frequent crying, excessive feeding of milk
and other factors may contribute to the condition.

Rikkunshito is used as the drug of choice for infants
with GERD, but when aerophagia is the main
aggravating

factor,hangekobokuto

andsimilarprescriptions can be effective. Even if the drug of choice

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 7, Number 4 | Winter 2012

is not effective, Kampo medicines may be advantageous3) Hypertrophic pyloric stenosis

if there is a next therapeutic choice.

Hypertrophic pyloric stenosis is a disease characterizedby continuous vomiting in newborn and hypertrophy of2) Anal atresia (anorectal anomaly)

the pyloric ring. Fiberscopic surgery has developed as

Anal atresia is properly called anorectal anomaly. This

curative surgery for hypertrophic pyloric stenosis andanomaly is caused by incomplete development of thethe number of cases is increasing, but there is still nourorectal septum separating the urogenital sinus andagreement as to whether fiberscopic surgery is actually

the anorectal region, persisting cloacal duct or deficientthe optimal therapy for this condition. The continuous

opening of the anal membrane. There is no sex

vomiting is considered to be due to the hypertrophic

difference in incidence rate. The condition is classified

pyloric ring, but spasms of the pyloric muscles

into a high level type above rectum and coecum, anthemselves are also a conceivable cause for the vomiting

intermediate level and a low level type. Frequently

treated with atropine sulfate. If the treatment of thisfistulas develop between the lower end of the rectum

disease with atropine sulfate is done appropriately,

and urethra on one side and the perineum on the othermost of the cases are cured1). Prior to oral

side. Approximately 70% of anorectal anomalies areadministration 6 times/day, 0.01 mg/kg is administeredcomplicatedanomaly.

intravenously and when the vomiting has stopped, theComplication of anorectal anomaly with spinal

regimen is switched to 0.02 mg/kg per os 6 times/day. A

anomalies, cardiac anomalies, esophageal atresia, renal

gradual increase in the uptake of milk paralleled by amalformation and the like are called VATER (orgradual reduction of the atropine sulfate dose led in 45

VACTER, VACTERL) association.

out of 52 patients (87%) to a cure without complications.

Presentations made on academic conferences regarding

The average duration of the hospitalization was 13 days.

Kampo treatment following surgery for anorectal

In those patients in whom the administration of

anomalies are mainly reports dealing with the use of

atropine sulfate was not effective, rikkunshito was

Daikenchuto.

reportedly effective2). There is a possibility that aManagement of bowel movements following surgery for

combination

anorectal anomalies, in particular maintenance ofimprovement.

by

some

other

form

of

therapy

may

lead

to

an

earliernormal bowel movements and toilet training, isextremely important. Measures like enemas etc. are a4) Hirschsprung's disease

great burden on the guardians and meet at higher age

Hirschsprung's disease is a congenital functionalof the children with greater resistance. It is not an

obstructive disease of the intestines where theoverstatement, that toilet training towards independent

gangliocytes of the intestinal canal are lacking from theevacuation until a time when communal life like school

anal side extending towards the mouth, impairing thestarts, will affect the future of that particular child.

peristaltic movements of the intestinal canal. The range

Examination of the development of the rectal muscleof the aganglionosis varies widely, but the prognosis

group allows to assess, whether the constipation isworsens in proportion with the size of the aganglionic

mainly of organic origin, or whether training will likely

region. The condition is classified as follows.

lead to improvement. In cases of a high probability of(1) short segment aganglionosis: the aganglionic region

improvement through training, Kampo medicines playis restricted to the sigmoid colon, 70-80％

an important role as supportive treatment promoting in(2) long segment aganglionosis: the aganglionic region

particular independent evacuation.

extends past the descending colon towards the mouth,
20％

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

11

Volume 7, Number 4 | Winter 2012(3) total colon aganglionosis: the aganglionic region(MMIHS), Chronic Idiopathic Intestinal Pseudo-Obstruction

affects the entire colon, 1-2％

(CIIP) and hypoganglionosis.

(4) extensive aganglionosis: the aganglionic region

In these diseases the regions affected by the lesions areextends into the small intestines, 2％often very large and the distribution of gangliocytes(5) ultra-short segment aganglionosis: an aganglionicthroughout the intestinal tract is not uniform.

region is observed within the lower third of the anorectal

Prolonged central venous hyperalimentation is required

canal, 4-5％.

and bowel movement management extremely difficult,

Treatment consists of resection of the aganglionic region

rendering the long-term prognosis poor. Causes of deathof the intestines. When the region affected by the

include infection of the central venous catheter and aaganglionosis is limited, the condition often runs atransition towards bacterial translocation from enteritis

favorable course. However, in conditions like (3) and (4)can lead to sepsis. Recently, transplantation of the small

marked by extensive areas of aganglionosis postsurgicalintestine has also been attempted, but the choice of

diarrhea or colonitis may easily develop and progress

donors difficult because of the strong rejection.

into septicemia and shock. Further, due to a reduction

Occasionally relevant case reports describe thatis the absorption intravenous nutrition is required overdaikenchuto was markedly effective for MMIHS ora prolonged period. The general condition and

CIIP3-5). This is highly significant. When the author

parameters including the nutritional state, electrolytes,

administered Shokenchuto to patients with CIIP in his

urinary volume etc. must therefore be carefullycare, septicemia and enteritis due to repeated central

observed.

venous hyperalimentation infections already led to the

In particular in cases of extensive resections destruction

loss of absorption from the intestinal tract and therefore,of the intestinal bacterial flora through the use ofso that the formula did not show any effects at all.

antibiotics is undesirable. However, because infants are

Through the early introduction of Kampo medicine,easily susceptible to infections, the use of antibiotics isprovided bowel movement management is possible, theoften necessary. For common cold or upper respiratory

vicious cycle of enteral infections or intestinal

infections the early use of Kampo medicine can avoid

dysfunction can be broken and there is a sufficient

the administration of antibiotics and is thus extremely

probability of improvement in the long-term prognosis.

important. The authors often use shoseiryuto or

Further investigations in this field are desirable.

kakkonto for sick children. Maoto was mostly
unsuitable following surgery of the gastrointestinal

6) Perianal abscesstract, because the condition is predominantly one ofPerianal abscesses are relatively common in outpatients"spleen deficiency". Usually administration of kenchuto

during infancy and the incidence is higher in boys. This

resembling formulas tends to result in a lower

suggests an immunological immaturity restricted to thesusceptibility to common colds. Although it is difficult toanorectal region that is characteristic of infancy6). Most

provide evidence to substantiate this claim, Kampo

cases heal spontaneously, but there may be repeated

medicine played definitely an important role in therecurrences and treatment periods often extend over

improvement of the individual conditions.

long periods. Ambulatory treatment for pain and care of
the wound etc. pose a great burden on the sick child and

5) Hirschsprung's disease related diseases

its family. In the past incision of the abscess andChronic and continuous intestinal obstruction caused byadministration

deficient or absent of normal peristaltic movements ofmainstream therapy, but the number of reports on thethe intestinal tract are refractory diseases. These include

value of using Juzentaihoto have increased7-10). It is not

Megacystis-Microcolon-Intestinal Hypoperistalsis Syndrome

an exaggeration to state, that it has already been

12of

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

antibiotics

constitutedtheVolume 7, Number 4 | Winter 2012

established as a therapeutic drug for the treatment of[Explanation of the individual formulas]perianal abscess. Juzentaihoto is compounded of

1) Rikkunshito

ginseng, cassia bark, Cnidium rhizome, Rehmanniae

For loss of appetite, early feeling of fullness during

Radix, hoelen, Atractylodes rhizome, Astragali Radix,

meals, gastric discomfort, stomach-upset and similar

glabra.

digestive symptoms found not only in adults, but also in

Examination of the composition reveals, that thisinfants. When in case of infants the food intake

formula is a combination of shimotsuto and shikunshito

continues to be low because of these symptoms, they

with the addition of cassia bark and Astragali Radix. In

may impair growth, making it necessary to achieve

addition of supplementing Qi and Blood it conceivably

improvements earlier than in adults.

also has exterior supplementing effects. In particular

The concept expressed by the general term Functional

Astragali Radix is said to have diuretic and swelling

Dyspepsia (FD), which is characterized by continuing

dispersing, internal expulsion and detoxifying actions,

epigastric digestive symptoms in adults, even if organic

which would explain the effectiveness of Juzentaihoto

diseases have been ruled out, has been proposed andfor perianal abscesses.

here too rikkunshito has received attention as one

Recently published reports describe hainosankyuto as

therapeutic

being effective during the acute phase of perianal

discharging capacity of the stomach and improves theabscesses. Also, while no clinical studies have been

adaptive relaxation of the stomach. This conceivably

published yet, there have been related reports on

results in improvement of the so-called early satiety

academic conferences. Hainosankyuto is comprised ofduring meals. The L-arginine content of this formula,

Zizyphi fructus, orange pease, peony, platycodon,
Glycyrrhiza glabra and ginger. Asada Sohaku too

providing the substrate for the nitric oxide (NO)mentioned that the effect of this formula is "due to theof the stomach, is probably related to this action11).

combination of orange pease and platycodon". By

In the period following pediatric digestive organ surgery

combining hainosan and hainoto the pus discharging

electrogastrography

action is amplified.

effectiveness of rikkunshito for epigastric indefinite

Regarding the combination of orange pease and peony

symptoms in the absence of organic diseases. Following

the "Synopsis of the Golden Chamber" (Jin Kui Yao Lue)administration of Rikkunshito (0.2 g/kg/day (tid)) for analso stipulates in the section for Kijitushakuyakuto: "foraverage of 10 months improvement of the irregularities

abdominal pain after delivery, when a person cannot lie

in gastric myoelectric activity were observed12). For thedownpathologic condition a combination therapy with the H2angelicaroot,

because

peony

of

and

Glycyrrhiza

vexationandfullness,

choice.

Rikkunshito

increasestheinvolved in causing an appropriate adaptive relaxation

reportedly

verifiedthekijitushakuyakuto will control this … and at the same

blockertime controls abscesses". This shows, that it acts to

Rikkunshito (0.2 g/kg/day (tid)) was used and after

dispel some kind of swellings by relieving muscle

disappearance of the clinical symptoms improvements

tension. During the acute phase of perianal abscessesof the irregularities in gastric myoelectric activity weretumors are formed from pus, so that discharge of thisobserved. This suggests, that a combination therapy

pus leads to healing. That is why administration ofusing famotidine and Rikkunshito possibly contributes

Hainosankyuto during the acute phase has adequate

to improvements in gastric myoelectric activities andeffects. Further investigations in this field are desirable.

the coordination of the latter13). Also, according to recent

famotidine(0.8mg/kg/day(bid))

andreports based on improvements in symptoms andesophageal pH monitoring, a decrease in the duration ofesophageal acid exposure and acid clearance time havebeen observed in pediatric patients with GERD. This

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

13

Volume 7, Number 4 | Winter 2012suggests, that treatment of GERD with Rikkunshito

Pharmacologically this formula is said to havealone too seems to be possibly under certain

peristalsis adjusting actions and increases blood flow incircumstances14). Moreover, some reports describe thatthe intestinal tract. It has been clarified, that this action

this formula improved the delay in gastric emptying

is mediated by the calcitonin gene related peptide

time in GERD after cardioplasty in children with severe(CGRP). Daikenchuto promotes the release of CGRP bypsychosomatic disorders15).

peripheral nerves, induces RAMP1, initiates generation

In the field of pediatric surgery there is frequentof large amounts of CGRP1 receptors and thereby

counseling for pediatric patients presenting with upper

increases the blood flow in the intestinal tract17). In thegastrointestinal symptoms, but in whom surgery of the

field of adult surgery it is frequently used fordigestive organs is not indicated. In these cases too

postsurgical intestinal movement disorders (ileus),rikkunshito represents an important therapeutic choice.
Then again, rikkunshito probably promotes appetite by

where it shortens the time until the first postoperative

increasing the secretion of active ghrelin16). Thus, it is

the hospital stay18). The improvement of postsurgicalalso effective for loss appetite, even if there are noileus induced by this formula is presumably due to an

obvious upper gastrointestinal symptoms.

improvement in peristaltic movements of the intestinal

From the long-term perspective, after administering

tract, which in turn is brought about but the increased

rikkunshito some effects like improved appetite,blood flow in the intestines. This formula has been

alleviation of stomach upset and epigastric bloating,reported to be useful in pediatrics for the treatment of

improvement of growth impairment and fatigue are

postsurgical adhesive intestinal obstruction or early

often observed. Prognosis can be assumed to bepostsurgical recovery from dysperistalsis19,20). Thisfavorable, when rikkunshito is continued for several

applies in particular for the use as a conservative

months, in case effects have been observed at this point

treatment for postsurgical ileus infusion of the formulaof time. It is further important to instruct the patients

through an ileus tube19,20). Additionally, it has also been

to use single doses, if symptoms should recur.

reported to improve constipation or evacuation

flatus and thus reportedly contributes to a shortening ofdisorders following surgery for anorectal anomalies in2) Daikenchuto

infants20-24) as well as chronic constipation20,24).

Daikenchuto, first mentioned in the "Synopsis of theFor

Golden Chamber" (Jin Kui Yao Lue), is a formula

Syndrome (MMIHS), a functional anomaly of thecompounded of 2 parts of Zanthoxylum piperitum, 5intestinal tract or Chronic Idiopathic Intestinal Pseudo-parts of Zingiber siccatum and 3 parts of ginseng with

Obstruction (CIIP) the available western medical

added malt extract. The source text states: "severe cold

therapies are currently limited.

pain in chest and heart, vomiting and inability to eat or

Postsurgical constipation is frequent in infants, where

drink, chilling within the abdomen, rising of Qi from thechilling of the intestinal tract is one of the causes for

abdomen to the hypochondrium, it emerges from thedysperistalsis, so that daikenchuto is the drug of firstskin and flows up- and downwards to the head and feet;choice. This does not contradict the Kampo medicalthus daikenchuto cures people suffering from pain thatconcepts pertaining to daikenchuto. Moreover, thecannot be approached or touched." Thus this formula isformula is indicated in healthy infants too, when

considered to be beneficial for conditions abdominal

chilling

pain and vomiting due to chilling and where abnormal

However, in case it should be ineffective, other Kampo

peristaltic movements of the intestines are observed informulas need to be considered.

the abdominal region.

The dose of 6 packages of daikenchuto extract per day

Megacystis-Microcolon-Intestinal

adversely

affects

Hypoperistalsis

intestinal

movements.

for adults is rather large, but this dose serves only as a

14

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 7, Number 4 | Winter 2012

rough estimate and can be increased or decreased as

the vomiting." Thus, like opening a small window on theappropriate. Since daikenchuto is a warming formula, it

north to let in a southern breeze in order to guide theshould be dissolved in hot water and then allowed to cool

obstruction in the stomach towards the excrements will

beforedifficult,prevent the vomiting caused by upsurging. Regarding

commercially available jelly, wafers or a little honey canthis usage the formula has a wide range of application

also be added.

as a Kampo medicine.

Administered for the treatment of ileus 1 package of

Pharmacologically the sennoside content of the rhubarb

daikenchuto is dissolved in 50 ml of hot water, allowed

is broken down by intestinal bacteria and after

to cool and then infused through an ileus tube. After

reduction

application of an appropriate amount and clamping therheinanthrones stimulating the colonic submucosal

ileus tube for 30 to 60 minutes the contents is released.

neural plexi in the intestinal wall to promote the

Similarly dissolved material can also be applied in form

movements of the smooth muscles. Subsequently theofcolonic

ingesting,enemas.

but

The

above

if

ingestion

described

istreatment

ismetabolized

mucosalintoepithelial

potentcells

laxative

inhibittheadministered as required once to three times a day.

phosphodiesterase activity and thereby inhibit the

Zanthoxylum piperitum, Zingiber siccatum do provide asort of warming stimulus. Since Zanthoxylum
piperitum "disperses cold dampness, but people withlung and stomach heat avert it" daikenchuto may not be

absorption of water, salts, glucose, xylose etc.25-26). The

suited in cases of heat in the intestinal tract. In terms of

movements. Compared to an application of rhubarb

Kampo medical concepts infants are considered to havealone increased tenesmus at the onset of the laxative

a purely yang body, they tend to be hotter than adults

action can be significantly inhibited when using

and therefore daikenchuto is rarely indicated in healthy

daiokanzoto26,27). Moreover, renal function is also

infants. Accordingly, it happens that while daikenchuto

improved and without affecting urinary pH a marked

had been effective during postsurgical recovery, theincrease in urinary output and electrolyte (Na, Cl)

infants suddenly cannot tolerate it any longer. In thisexcretion has been observed. The tanine content ofcase it can be necessary to temporarily discontinue therhubarb increases renal blood flow and the glomerularadministration or switch to a different formula. It must

filtration rate, leading to an improvement in renal

not be forgotten, that the condition of the bodyfunction26-28).

constantly changes.

There are only few reports on the use of daiokanzoto fortransport capacity of the small intestine is not affected,
so that the amount of feces and its water content
increase dose independently and thereby promote bowel

infants, but it has been reported useful for severe
3) Daiokanzoto

constipation in school children29) and reportedly be

In the "Synopsis of the Golden Chamber" it says: "foreffective in 56% of patients with constipation following

people who immediately vomit on eating, daiokanzoto

treatment for Hirschsprung's disease30). As stated above,

controls the condition". It is used for a condition, wherein cases of constipation in infants after surgery or

people vomit immediately after meals due to poor flow

diseases daikenchuto is the drug of first choice. Thisin the intestines. Also, the entry pertaining tohappens often when in healthy infants changes in

Daiokanzoto"Butsugodietary habits led to a febrile syndrome of the viscera,

Yakushitsu Hokan" reads: "when there is no desire fori.e., separation of clear and turbid elements in the colon

the so-called 'southern fume' of this formula, you must

is not processing smoothly. In this case this rhubarb

first open the 'northern lights', meaning that thecontaining formula should be taken into consideration.

stomach content closed up in the stomach must be

Concretely, it is considered useful when patients

guided as stool to prevent it from upsurging and to stop

complain of accumulation of scatomas in the colon,

in

Asada

Sohaku'stext

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

15

Volume 7, Number 4 | Winter 2012

constipation due to hardened feces, abdominal pain due

Also, adult cases of delayed onset hyperbilirubinemia

to the accumulation of feces or vomiting or else

following liver transplantation with small-for-size grafts

decreased appetite. Moreover, even if daikenchuto isalso suggest the possibility, that Inchinkoto will lead touseful, occasionally combination with daiokanzoto

improvements. In the field of pediatric surgery too theallows the treatment form so eloquently described as

number of liver transplants for the treatment of biliary"when there is no desire for the so-called southern fumeatresia is increasing and applicability of this formula inof this formula, you must first open the northern lights".

infants seems conceivable.

4) Inchinkoto

Conclusions

Inchinkoto has first been mentioned in the "Treatise on

Kampo therapy too is about to develop into an

cold-induced diseases" (Shang Han Lun) and "Synopsis

established therapeutic choice in the field of pediatricof the Golden Chamber" and is compounded of threesurgery. This can also be interpreted as a manifestation

crude drugs, namely of 3 parts of Artemisiae capillarisof the enthusiasm with which pediatric surgeons use

flos, 1 part of rhubarb and 4 parts of gardenia.

those choices, as long as they lead to improvements in

Pharmacologically, the gardenia constituents iridoid

their patients. Kampo expert physicians should

glucoside geniposides and the intestinal metabolite

cooperate in order to investigate new indications andGenipin have a non-bile acid dependent cholagogic

thus respond to the aforementioned enthusiasm. Since

action, activate a bilirubin transporter (multidrug

individual differences are particularly marked inresistance-associatedtheinfants, the therapy for each individual patient must be

Artemisiae capillaris flos constituent dimethylesculetin

considered separately. If that is done, still greater

reportedly has a relaxing action for the sphincter ofdevelopments are expected to be accomplished for

Oddi31,32). Also, in rat models of hepatic fibrosis the

Kampo therapy in the field of pediatric surgery.

protein:Mrp2),

while

concentration of liver hydroxyproline, serum hyaluronic
acid increase, the expression and activation in hepatic

Referenceextracellular matrix (type III procollagen mRNA)

1)

Kawahara Hisayoshi, Takama Y, Yoshida H, etincreases while the proliferation of activated Kupfferal.: Medical treatment of infantile hypertrophic

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"olive"? J Pediatr Surg 40(12):1848-51,2005

Cases of clinically effective treatment of patients with

2)

Noboru Oyachi, Takano K, Hasuda N, et al.:delayed postsurgical biliary atresia, recurrent icterus,

fects of rikkunshito on infantile hypertrophic

liver function failure with Inchinkoto have been

pyloric stenosis, refractory to atropine. Pediatr

reported34-37). Following administration of Tsumura's

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Hirakawa Hiroshi, Ueno S, Matudara H, et al.:surgery for the treatment of pediatric postsurgical

Effect of the herbal medicine daikenchuto on

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gastrointestinal

GTP and hyaluronic acid levels were observed. While

megacystis-microcolon-intestinal

similar improvements of serum GOT and GPT over time

hypoperistalsis syndrome (MMIHS) and chronic

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GTP and hyaluronic acid levels did not improve overreport of two cases. Tokai J Exp Clin Med.

time. This confirmed liver protective and anti-liver

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fibrotic effects of Inchinkoto35).

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motilityinpatientswith

Tetsu Yamazaki, Masayuki Kuboto, Minoru Yagi:
Attempt at improving intestinal movements with

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The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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