Volume 7, Number 2 | Summer 2012

Clinical Report 2 (Kampo Medicine)
A Case in of Continual Leg Cramps Successfully Treatedwith Shigyakusan

but they only reduce the incidence or severity of leg
cramps and are not for the acute therapy to reducethe cramps and the related pain themselves at theSatoshi Yamamoto1), Keiko Ogawa-Ochiai2) andTetsuo Akiba3)
1) Center for Kampo Medicine, School of Medicine,
Keio University
2) Clinic of Japanese-Oriental (Kampo) Medicine,
Department of Othorhiolarygology andHead and Neck Surgery,
Kanazawa University Hospital
3) AKIBA Clinic of Traditional Medicine

to offer relief, but the frequent occurrence ofhypotension makes use unpractical. Kampo isJapanese traditional herbal medicine based on theancient Chinese medicine. Kampo prescriptions arecovered under the National Health Insurance Planof Japan, and are easily available to clinicians.

Shakuyakukanzoto is the most common prescription
for the leg cramp which cures acute state of theAbstractcramp. Some study showed that shakuyakukanzoto

Objective:
The authors report a case of continual leg cramps
successfully

onset of cramps. Nifedipine likewise has been foundtreatedwith

shigyakusan—aprescription of Kampo (Japanese traditional herbalmedicine).

is effective on leg cramps seen in patients underhemodialysis.1,2 However, some of the patients are
sufferingfromrecurrent

cramps

even

after

shakuyakukanzoto administration. Shigyakusan(sinisan, in Chinese) is traditionally prescribed for
irritation, stress and spasm of the abdominal rectal

Subject:
A 31-year-old male with continual leg cramps
consulted our clinic. He has no past medical history
except pollen allergy and was normal in the physicaland blood examinations. His cramps temporarilyrelieved with shakuyakukanzoto — a common
Kampo prescription for leg cramps, but had beenrecurring soon after a while.

muscle, and possibly effects on chronic restraint
stress-related disorders.3 A case with continual leg
cramps effectively treated with shigyakusan isreported.
Case Report
A 31-year-old male with continual right leg
cramps was seen in our clinic. He has no past
medical history except pollen allergy. For several

Result:By 30 minutes after shigyakusan administration, hisleg cramp completely stopped, and no cramp
recurred.

months, he was in stressed condition because thedecision of his boss had been frequently changing.
Since several days before visit, frequent leg cramps
on his right leg began and he had difficulty inwalking due to remaining continuous pain. He

Conclusion:
It was found that shigyakusan might be an effective
prescription for idiopathic continual leg cramps.

complained of leg cramps, irritated condition, tightpressure on his chest, and nightmare almost everyday. Physical examination and blood examination
findings

Introduction
There were no reliable therapies to reduce muscle
cramps and pain immediately when muscle cramps
happened even in hospitals or clinics. It is reported
that some drugs such as quinine, vitamin E,werenormal.

Shakuyakukanzoto(TSUMURA Shakuyakukanzoto Extract Granules
for Ethical Use, Tsumura, Tokyo, Japan) 7.5g/day
was prescribed for his leg cramps. Leg cramp
temporarily relieved soon after administration, but

chloroquine phosphate, and L-carnitine are effective,
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

21

Volume 7, Number 2 | Summer 2012

recurs after a while. He visited our clinic for further

that shakuyakukanzoto has an inhibitory effect on

Kampo treatment.

excessive muscle contraction.

Shigyakusan (TSUMURA Shigyakusan Extract

As for shigyakusan, it contains Bupleuri radix andGranules for Ethical Use, Tsumura, Tokyo, Japan)
medicine. By 30 minutes after administration, hisAurantii
fructusbesidesof
shakuyakukanzoto (Table 1). From the concept of
Kampo medicine, Bupleuri radix, or saiko inleg pain ceased. He continued shigyakusan for one

Japanese, spreads Liver qi and relieves constraints,3week, and no cramp appeared in the period. Sinceand immature Aurantii fructus promotes the flow ofthen, he is taking the medicine as needed, when heqi. It has been said that stagnation of qi causes pain.

had the prospect of leg cramp.

The

7.5g/day on the basis of the concept of Kampo

immatureeffectinqi

circulationisstrongerinshigyakusan than in syakuyakukanzoto.
Discussion

Shakuyakukanzoto is commonly prescribed for leg
cramps, but it is not enough effective in some

Table 1
Compositions of shigyakusan and shakuyakukanzoto extract

patients. When the patient is with mental stresses
which affect on the “liver”, shigyakusan is one of theConstituent herbs

Weight (g)Shigyakusan

Shakuyakukanzoto

5.0-

2.0-

Paeoniae radix

4.0

6.0

Glycyrrhizae radix

1.5

6.0

skeletal muscles. Shakuyakukanzoto is a hot water

Theof

shigyakusan

extract from a mixture of equal parts of Paeoniae

shakuyakukanzoto are listed. After drying, theradix and Glycyrrhizae radix. The main components

herbs (total amount, 12.5g and 12.0g) shown in theof the roots are paeoniflorin and glycyrrhizic acid.

Table were boiled in 10 times of their weight of water

shakuyakukanzoto in thefor one hour. The resultant extracts were spray-dried.

inhibition of muscular contraction remains to be

The daily dosages of shigyakusan (7.5g) andfully elucidated. Previous reports claimed that ashakuyakukanzoto (7.5g) contained 2.25g and 2.5g of

mixture of paeoniflorin and glycyrrhizic acid had no

the resultant extract, respectively.

candidates.
The

extract

shakuyakukanzotoof

inhibited

Bupleuri radix

contraction of skeletal muscles in rats.4,5 This

immature Aurantiiinhibition was observed in both the directly andfructus

indirectly stimulated contractions, and was notchanged by addition of neostigmine, an acetylcholine
esterase inhibitor. These findings of the experiments
indicate that shakuyakukanzoto acts directly on

Themechanismofcompositions

andeffect or no coordinative effect on skeletal muscles.4
One report, however, stated that paeoniflorigenone,Conclusions

a component of Paeoniae radix, indirectly blocked

It was found that shigyakusan might be an effective

stimulated

twitchprescription for idiopathic continual leg cramps.

confirmedthattheresponse.5

Anotherstudy

blendedpaeoniflorin

andglycyrrhizic acid indirectly blocks the stimulated

Disclosure Statement

twitching isolated sciatic nerve-sartorius muscle

No competing financial interests exist.

preparations in frogs (Rana nigromaculata), and inisolated or in situ phrenic nerve-diaphragm muscle
preparations in mice.6 Therefore, we also suggest

22

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

Volume 7, Number 2 | Summer 2012

References
1.

Hinoshita F, Ogura Y, Suzuki Y, et al. Effect ofOrally Administered Shao-Yao-Gan-Cao-Tang(Shakuyaku-kanzo-to) on Muscle Cramps in
Maintenance

Hemodialysis

PreliminaryStudy.

AmPatients:JChinAMed

2003;31:445–453.
2.

Hyodo T, Taira T, Takemura T, et al. Immediate
Effect of Shakuyaku-kanzo-to on Muscle Crampin Hemodialysis Patients. Nephron Clin Pract
2006;104:c28–c32.

3.

Wang UT, Tan QR, Sun LL, et al. Possible
therapeutic effect of a Traditional Chinese
Medicine, Sinisan, on chronic restraint stressrelated disorders, Neurosci Lett 2009;449:215–219.

4.

Kimura M, Kimura I, Takahashi K, et al.
Blocking effects of blended paeoniflorin or its
relatedcompounds

withglycyrrhizinonneuromuscular junctions in frog and mouse. Jpn
J Pharmacol 1984;36: 275–282.
5.

Kimura M, Kimura I, Takahashi K, et al.
Blockingeffectsofpaeoniflorigenone

ina

new
paeonycomponent,
root

on

neuromuscular junctions of frog and mouse. Jpn
J Pharmacol 1984;35: 61–66.
6.

Takagi K, Harada M. Pharmacological studies
on paeony root. III. Effects of paeoniflorin on
circulatory and respiratory systems and isolatedorgans.

YakugakuZasshi

1969;89:893–898[Japanese, abstract in English].

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