Volume 1, Number 3 | Fall 2006

Clinical Report 2 (Japan)

Patient: 63-year-old man

A Case in which Shakanzoto Proved Markedly
Effective in a Patient with Arrhythmia
Takao Namiki
Department of Frontier Japanese-Oriental (Kampo) Medicine
Graduate School of Medicine, Chiba University

Occupation: farmer
Past history: hyperlipidemia
Familial history: Unremarkable
Present history: In March 1993 the patient developed
chest pain unrelated to exertion. He came to thehospital for extensive cardiovascular examination. InIntroduction
Arrhythmia is a medical condition that manifests
as irregularities in the heart rhythm. It involves
abnormal pulse rate and abnormal or irregular signaltransmission. It is common for the patient to beaware of arrhythmia when it occurs, and for theirregular or intermittent beat to be detectable when
taking the pulse at the radial artery, etc. However,there are also cases in which this condition involves

addition to chest pain, the patient reported symptoms ofoccasional palpitations and of tiring rather easily.
Chest

x-rayandECG

findings

werenormal.

Echocardiogram showed slight calcification of the aortic
valve, but no other abnormal findings. Holter ECG
recordings showed supraventricular extrasystoles(Fig. 1) and ventricular extrasystoles (Fig. 2) occurring
primarily during the day (Fig. 3, Table).

other symptoms apparently unrelated to the pulse,such as chest pain or dizziness. When the patient issubjectively aware of palpitations, a characteristic
symptom of arrhythmia, this awareness is mostcommonly experienced at the heart, on the left side of
the chest, and sometimes in the abdomen. In somecases the condition is asymptomatic. On ECG,
tachycardiac

arrhythmia

tachycardia,

andbradycardiac

arrhythmia

atrialincludesshakanzotoextrasystole,fibrillation,includes

Fig. 1 Supraventricular extrasystole before treatment withsickwhilesinus

syndrome and atrioventricular block. Among theseconditions, treatment with Kampo medicine iscurrently used in cases in which there is symptomaticFig. 2 Ventricular extrasystole before treatment witharrhythmia and the patient is subjectively aware ofshakanzoto

palpitations.
In particular, Kampo medicine is the first choicefor the treatment of patients who are subjectively
aware of their heartbeat or complain of palpitations,and without abnormal ECG. Western medicine
generally receives priority if the ECG is abnormal.
Recently we had a case in which ECG findings
were abnormal and Western drug therapy wasinitiated, but treatment was discontinued because ofadverse drug reactions. The patient was thenswitched to a Kampo medication, and arrhythmia wasreduced. Our findings are reported below.

20Fig. 3 Holter ECG records for heart rate and number ofirregular beats (before taking shakanzoto )(Upper row: supraventricular extrasystole; Lower row:
ventricular extrasystole)
Horizontal axis: time; Vertical axis: heart rate or
number of irregular beats

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

Volume 1, Number 3 | Fall 2006
Table
Results of Holter ECG findings before and after
treatment with shakanzoto
Reduction
rate

BeforeAfter

Total heart beats

105600/day

110771/day

SVE

3382/day202/day94%

VE

12947/day

1228/day90%

couplets

145 episodes

49 episodesrun

103 episodes

0 episodehad vanished. Holter's ECG, performed 1 month later,
showed at least 90% reduction in both supraventricularand ventricular arrhythmia (Fig. 4, Table).

SVE: supraventricular extrasystole VE: ventricular extrasystole

Present status:
Height: 162 cm
Weight: 72 kg
Blood pressure: 164/80 mmHg
Heart rate: 72 beat /min irregular beatConjunctiva bulbi: No anemia, no jaundice
Cardiac sounds: Systolic murmur 2LSB Levine II/IV
Respiratory sounds: No rales
Abdomen: Liver and spleen not palpable
No edema of the lower limbs

Fig. 4 Holter ECG records for heart rate and number ofirregular beats (after taking shakanzoto )Upper row: supraventricular extrasystole
Lower row: ventricular extrasystole)(Horizontal axis: time; Vertical axis: heart rate or number ofirregular beats)

Discussion

Present Status from the perspective of Oriental
medicine
Pigment deposits on the face, dry skin
Pulse: Knotted, lanquidus relaxed, somewhat deep andweak, somewhat congested
Tongue: Somewhat dark red, no fur on tongue, no toothmarks, no fissures
Abdomen: No fullness of the hypochondrium, moderate
resistance and tenderness on the lower right abdomen,
soft lower abdomen below navel.

Clinical course
Disopyramide 300 mg/day was initially used forthe treatment of arr. However, this treatment wasdiscontinued when the patient developed thirsty ofparasympathetic symptom. At that point the patient
was started on 9 g/day of shakanzoto , a formulationconsidered to be effective in the treatment ofconditions such as knotted pulse, palpitations, andfatigue. After taking the decoction, the patientreported that symptoms such as chest pain and fatigue

In this case shakanzoto was administered when
the patient developed an adverse drug reaction to theWestern drug treatment. The roasted licorice
formulation proved to be remarkably effective.
Pulse diagnosis is said to have originated in Asia,
spreading through the Islamic world to the West, andancient Chinese texts on pulse diagnosis have many
entries on the pulse. For example, there are entries on
Rapid Pulse, corresponding to tachycardia, and on
Slow Pulse, corresponding to bradycardia, as well as
entries on lost beat (Irregularly Intermittent Pulse
and Regularly Intermittent Pulse). The entries
regarding the pulse are more detailed than in Western
medicine, and possibly as a result of this detailed focus
on the pulse, Kampo medicines have been formula forthe treatment for the arrhythmias.
Shakanzoto was first documented in Shang Han
Lun (Discussion of Cold-induced Disorders)", which
offered a typical prescription for deficiencies of bothki and yin elements in the heart, including conditions
such as knotted pulse, palpitations, shortness ofbreath, and fatigue. This extract formulation contains

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

21

Volume 1, Number 3 | Fall 2006

the following ingredients(g):Glycyrrhizae Radix Praeparata
Zingiberis Rhizoma Processum
Cinnamomi CortexCannabis Fructus
Ziziphi Fructus
Ophiopogonis Radix
Ginseng Radix
Asini Corii Collas
Rehmanniae Radix

3.0g
3.0ｇ
3.0g
3.0g
3.0g
3.0g
3.0g
2.0ｇ
6.0g

This prescription, also known as the “shakanzoto”,
is considered to build up the blood and restore thepulse. In the Shang Han Lun (On Cold Damage), in thesecond volume on Greater Yang Disease, the text
states that, "After cold damage is relieved, knotted
pulse and palpitations are present," and the Jin Gui
Yao Lue (Synopsis of Prescriptions of the GoldenChamber), in the volume on Asthenic Disease, notes
that, "For deficiency and sweating, relieves knotted
pulse and palpitations, indicating treatment forarrhythmia.”

22

There are no definitive reports of anti-arrhythmic
effects of individual ingredients of herbal medicines.
From a Kampo perspective, Rehmanniae Radix,
Ophiopogonis Radix, and Asini Corii Collas have theeffects of moisturizing and cooling of the
body ,lubricating dry skin, improving nutrition,
relieving heat, and acting indirectly to strengthen theheart. Glycyrrhizae Radix and Cinnamomi Cortex are
known to reduce palpitations, and in combination withginseng, to show cardiotonic and stomachic effects.
These pharmacologic effects suggest that shakanzotoacts to regulate the autonomic nervous system. The
arrhythmia-improving effects noted in this caseindicate that the effects of this decoction may extend to
sympathetic nervous system activity. Further
investigation will be required.

Conclusion
When a patient who had experienced frequent
arrhythmia was treated with shakanzoto , Holter ECG
findings showed arrhythmia to be reduced to 10% orless. It is hoped that this mechanism can be clarified infurther research.

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