Volume 12, Number 1 | Spring 2017

Clinical Report 2 (Kampo Medicine)
A Case of Recurrent Intestinal Bleeding due to Radiationinduced Enterocolitis Successfully Treated with
Kyukikyogaito

Takahito Saito1)2)

1) Medical Corporation Tomidahama Hospital2) Yokkaichi Medical Association,
Kampo Medicine Study GroupAn 88-year-old woman suffered from recurrent
intestinal bleeding because of radiation-induced
enterocolitis after radiation therapy for cervicalcancer of uterus about ten years ago. Recently, she
was diagnosed renal anemia and chronic heartandacceptediron,vitaminB

anderythropoietin therapy simultaneously.
On March 13th in 2015, she was admitted to thehospital due to exacerbation of anemia. On her
admission course, dark bloody stool was sometimes
detected. Blood transfusion was done three times
within about a month, but anemia was not recovered.
Judged that venous bleeding, “oozing”, repeatedly
continued and there are no indication to endoscopic
and surgical procedures, kyukikyogaito, Kampo
medicine, was started under this poor condition (“yindeficiency”) just after fourth blood transfusion. Afterthen, anemia was recovered sooner and bloody stool
was not detected. She was successfully treated withkyukikyogaito and discharged on April 22th. One
month after her discharge, anemia was recovery, sokyukikyogaito was stopped.
Radiation-induced enterocolitis is well-known tohematochezia. There are several strategies for thisdisease such as hemostatics, blood transfusion,
drug’s enema, endoscopic and surgical procedures.
According to experience of this case, kyukikyogaito
isLower gastrointestinal bleeding is commonly
known

to

be

causedbyradiation-induced

enterocolitis after radiation therapy for prostatic
cancer or cervical cancer. Generally if the bleeding is
not remarkable, and can be expected to stop
naturally by itself in most cases. However, in caseswith continuing bleeding, a hemostatic may be
administered, or blood transfusion may be given.

Abstract

failure,Introduction

effective

toradiation-induced

enterocolitis

repeating intestinal hemorrhage.
Keyword: radiation-induced enterocolitis, venous
bleeding, Kyukikyogaito

Endoscopic treatment and surgical resection are also
attempted, but resection may be difficult in somecases1).

Kyukikyogaito is made from seven types of crude
drugs: Rehmanniae Radix, Paeoniae Radix,
Angelicae Acutilobae Radix, Glycyrrhizae Radix,
Cnidii Rhizoma, Asini Corii Collas andArtemisiae Folium. It is known as a type ofhemostatic

that

is

effectiveforgynecological

bleeding, urologic bleeding, hemorrhoidal bleeding,and other venous bleeding in the lower body. It is aprescription that acts against yin deficiency (poorcomplexion,

pallidcomplexion,

ectomorphism,

sensitivity to cold), and has been used for female
genital bleeding, as written in the section on
gynecologicalandpregnancy

illnesses

intheKinkiyoryaku (Essential Prescriptions from theGolden Cabinet)2). It is said to be effective tosymptoms of anemia in patients who are sensitive tothe coldness and experienced longer bleeding, suchas hemorrhoidal bleeding, post-traumatic internal
bleeding, postpartum bleeding or anemia.
In this particular case, the patient’s anemia
advanced despite of receiving blood transfusions
three times. Though chronic, persisting venous
bleeding was suspected, and natural hemostasis was
judged to be difficult. Thus, kyukikyogaito waschosen as a hemostatic, and good progress wasachieved, as reported below, in reference to relevant
literatures.
Case study
Subject: 88-year-old woman

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Volume 12, Number 1 | Spring 2017

Chief complaint: General malaise and fatigue
Past medical history:Age 40: Appendectomy
Age 75: Cervical cancer (radiation therapy),
adhesive intestinal obstruction
Age 81: Cataract
Age 85: Lumbar compression fracture
Age 87: Gouty arthritis, adhesive intestinal
obstruction, lower-leg cellulitis
Family medical history: NA
Clinical course 1 (history of present illness):
The patient had been receiving medical care at a
hospital nearby for high blood pressure andhyperuricemia. In 2002, she received radiation
therapy for cervical cancer. Thereafter, sheoccasionallydeveloped
adhesive
intestinal
obstruction and venous intestinal bleeding caused bychronic ischemic entero colitis (radiation enteritis)
after irradiation. Each time she developed theseillnesses, she received therapy in hospital under agastroenterologist. In June 2011, she was diagnosed
with atrial fibrillation and chronic heart failure, andwas given anticoagulant therapy, but the therapy
was discontinued due to exacerbation ofgastrointestinal bleeding. Thereafter, she wasdiagnosed with chronic heart failure, chronic renal
failure and renal anemia, and was treated with anerythropoietin preparation in addition to an ironpreparation, on a continuous basis. From around
March 10th, 2015, she began to experience a sense ofmalaise and fatigue when walking. On March 13th,
she visited our clinic. She was found to be anemic(Hb 5.6g/dl), and was admitted for blood transfusion.
Because she was taking iron, she continued to pass
black stool intermittently.
Physical findings from the perspective of Western
medicine:
Normal body temperature; SpO2: 95%; pulse
45/minute, irregular, blood pressure 96/60mmHg;
body weight 42kg; anemia in palpebral conjunctiva;
cardiopulmonary functions: nothing abnormal
detected; abdomen: flat, soft
Examination findings from the Eastern medicine
perspective:
20

Subjective symptoms: Sense of malaise and fatigue
when walking
Objective findings: Poor, sallow complexion uponinspection. Ectomorphic. Sunken, thin and weakpulse. Thin white coating on tongue. Sublingual
venous dilatation. Weak abdominal strength andweakness of the lower abdominal region.
Examination results:
Blood exam: White blood cell count 2800dl, red blood
cell count 1.67million, hemoglobin 5.6g/dl,
hematocrit 17.9%, urea nitrogen 51mg/dl, creatinine
3.14mg/dl, uric acid 12.1mg/dl
Abdominal CT: Change in pelvic (ileum and adnexa)
adhesions (Fig. 1)

Fig. 1 Abdominal CT findings
An adhesion is seen in the pelvic organs.

Admission

Fig. 2 Clinical Course Discharge

2015
3/13

3/23

3/16

3/27

4/7

4/14

Erythropoietin preparation

Hb(g/dl)
6.4
5.6

Erythropoietin prepara

Dark red stool
Black stool
Once/dayOnce/dayIron + vitamins (B2 B6 B12)

Dark red stool
3 times/day
Blood transfusion
2 units

2 units

2 units

5.6

Kyukikyogaito
9g/day2 units

6.9

6.8
5.6

4/18 4/22 5/15

7.1

7.3

5.9

Fig. 2 Clinical Course

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

7.1

7.5

Volume 12, Number 1 | Spring 2017

Clinical course 2 (course after hospital admission): Fig. 2

perforation, hyperbaric oxygen therapy or surgical

After being admitted to the hospital, the patienttherapy are chosen1). In this particular case, thereceived

blood

while

patient experienced both early and late effects, andreceiving an iron and vitamin B preparation, but

received inpatient treatment each time, such thatdark red stool occasionally appeared in addition to

the pattern of her daily life was sometimes disrupted.

black stool (due to the iron preparation), and her

Kyukikyogaito is regarded as an effective

anemia did not improve. Due to persistent venous

hemostatic for venous bleeding that does notintestinal bleeding caused by chronic ischemic

accompany febrile symptoms in the lower body. This

enterocolitis, natural hemostasis was consideredis understandable when considering that licorice isdifficult. Judging from signs of renal deficiency,

added to Shimotsuto, a representative prescription

blood deficiency and blood stasis, a prescription offor blood deficiency, in addition to the Artemisia

kyukikyogaito (9g/day) was begun after her fourthprinceps leaf and donkey hide gelatin, which also

blood transfusion. Thereafter, no advancement of

have a hemostatic effect2). Today, it is consideredanemia was seen, so the patient was discharged on

effective against hemorrhagic anemia in people with

April

after

a weak constitution, like the patient in this caseadministering kyukikyogaito, the prescription was

study. With regard to literature, there are reports

stopped, because the anemia was found to havemainly in reference to bleeding in the lower body,

improved.

such as radiation enteritis3), hemorrhoidal bleeding4),

22th.

The

iron,

transfusion

On

May

vitamin

three

15th,

B

a

and

times

month

erythropoietin

diverticular bleeding5), Crohn’s disease6), ulcerative

preparations were continued after the termination ofcolitis7), 8), uterine bleeding9), 10), and hematuria andkyukikyogaito, but no longer intestinal bleeding or

urinary

advancement of anemia were detected.

Kobayashi’s report5) indicates a hemostatic effecttract

bleeding11),

12).

Among

them,

against diverticular bleeding, but the subject had
Observations

been taking an anticoagulant and an antiplatelet

Radiation enterocolistis is well known as adrug, so it is difficult to clearly determine whether

disorder of the pelvic tissue and particularly thethe effect was a result of a cessation of medication or

gastrointestinal tract, caused by radiation therapy

the administration of kyukikyogaito. Other casefor prostate cancer or cervical cancer. There arereports also include the administration of Westernearly effects and late effects, and may take morehemostatics in addition to kyukikyogaito, and do notthan ten years for the effects to occur. It causes

distinctly present the sole effect of kyukikyogaito.

hemorrhagic transformations such as inflammation

However, it is worth noting that Iwabuchi’s report9)

and ulcers in the rectum, sigmoid colon, or small

compares kyukikyogaito with Western hemostatics,

intestine. Radiation enteritis can be classified byand discusses the efficacy of kyukikyogaito. Also, in

progress, severity and pathology, and requires an

Matsumoto’s report12), which focuses on bleeding

efficienttreatment

caused by bladder cancer, kyukikyogaito is used withguidelines have yet to be established. Normally, thethe expectation of temporarily stopping the bleeding,

bleeding is expected to stop on its own, and either aand certainly not as a fundamental treatment, but it

hemostatic drug is administered or conservative

is considered important for avoiding psychologicaltreatment through blood transfusion is chosen instress and blood transfusion.

treatment

strategy,butmost cases. At the same time, in cases of frequency

Meanwhile, there have also been experiential

bleeding, endoscopic hemostasis or drug infusioncases where kyukikyogaito was effectively used totherapy is chosen, and in cases of stenosis orstop venous bleeding in the upper body, such as

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

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Volume 12, Number 1 | Spring 2017

upper gastrointestinal bleeding (lower esophageal

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