Volume 6, Number 2 | Summer 2011

Clinical Report 3 (Kampo Medicine)
A Case in which Saireito was Effective for Irritable Bowel
Syndrome

Masayuki Kashima

Department of Internal Medicine
Kumamoto Red Cross Hospitaland stomach, causing diarrhea. When mainly thespleen is causing problems, a diarrhea type condition
develops, while with problems caused mainly by thestomach, nausea and vomiting develops. Also, qi
background of liver qi flow anomalies, the influence of[Background]
Daily clinical experience regularly shows that
irritable bowel syndrome is one of the diseases for
Kampo

else the stagnant liver qi excessively flows into spleen

stagnation often causes the abdominal pain. Before a< Summary >whichstomach qi is obstructed, resulting in constipation, ormedicine

iseffective.

Variousprescriptions are used, but there are few reports on
the use of saireito, so that I would like to introduce
this one here.

stress and emotions, or a deficiency of liver blood andyin can impede a smooth movement of the liver qi.
Again, if the liver problems are not particularlymarked, the presence of spleen and stomach problems
could appear as a relative uprising of liver qi. 2) In
these conditions marked by liver qi stagnation andliver blood deficiency and associated with diarrhea[Case and course]
Forty-six-year old female. She complained of stressinduced abdominal pain and diarrhea since she was ateenager. Being very busy at work aggravates thesymptoms. The results of detailed examinations inmedical facilities visited in the past led to the diagnosis
of irritable bowel syndrome. She had been treated overa period of about 5 years in another clinic, but visited
our department because lack of improvement of thesymptoms. I administered kamishoyosan, but switchedto saireito because the symptoms did not improve andthereby achieved some relief.

kamishoyosan is used, while daisaikotokyodaio is used
for constipation. If this occurs due to asthenia of spleenand stomach, formulas like keishikashakuyakuto areoften used. Saireito is a combination of shosaikoto +goreisan and frequently used for acute diarrhea orinflammatory diarrheal diseases, while it is not very
often given for irritable bowel syndrome. Here I reporta case where saireito proved to be effective for thetreatment of irritable bowel syndrome.
[Case] 46-year old female[Chief complaint] chronic diarrhea, abdominal pain

[Discussion]
Generally, saireito is often used for acute diarrhea or
diarrhea caused by inflammatory diseases, but
depending on the pathology and considering othersimultaneously used medications, it is also considered
to be effective for irritable bowel syndrome.

[Anamnesis] migraine[Present illness]
The patient developed diarrhea every time she wastense since she was a teenager. Being very busy atwork aggravates the symptoms. She may have 6-10
bowel movements per day of which the first two aresoft stools, while the remaining movements are< Text body >watery diarrhea. After passing diarrheal stools the[Background]Kampo medicines have also in clinical studies beenshown to be effective for irritable bowel syndrome1) andthis is one of the conditions, for which theireffectiveness can be experienced in daily clinicalpractice. Frequently the correlation to the liver andspleen as well as the stomach has been discussed. Theflow of spleen and stomach qi is controlled by the liver,abdominal pain tends to decrease, but endurance
leads to severe abdominal pain. There is a mild
degree of nausea. Based on the results of detailed
examinations an irritable bowel syndrome wasdiagnosed and the patient was treated by a local
physician, but later visited our clinic, because thesymptoms did not improve.

but if liver qi flow stagnates, the flow of spleen and
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

19

Volume 6, Number 2 | Summer 2011

Height: 155 cm; weight: 45 kg; talkative, has

Lancea Rhizome / Poria and spleen function
improving Zingiberis Rhizoma and Glycyrrhizae

appetite, is easily irritated, has a dry mouth andRadix. This shows that the components of thiswhile complains of chilly hands and feet, her faceformula improve the liver qi stagnation and theneasily flushes.

consequently affect the spleen. On the other hand,

Pulse diagnosis: bilateral wiry and slipperythe combination of shosaikoto and goreisan forms

Tongue diagnosis: thin white coat, tip was slightly red

the framework of saireito (Bupleuri Radix 7,

Abdominal diagnosis: right-sided fullness in theAlismatis Rhizome 5, Pinelliae Tuber 5, Scutellariae
Radix 3, Atractylodis Lanceae Rhizome 3, Poliporus
3, Poria 3, Ginseng 3, Zizyphi fructus 3, Cinnamomi
Cortex 2, Glycyrrhizae Radix 2, Zingiberis Rhizoma[Current condition]

chest and hypochondrium, epigastric stuffiness[Course]
Initially I administered kamishoyosan. However,after 4 weeks of administration I still could notobserve any changes in the symptoms. The patient
suffered from violent diarrhea and I thought it would
be difficult to achieve improvement of fluid
absorption from the small intestines mediated byspleen function with Atractylodis Lancea Rhizomeand Paria of kamishoyosan alone. Therefore I
switched to goreisan for its powerful strengtheningof fluid absorption combined with the improvementof liver qi flow provided by shosaikoto. After 4 weeks
of administration the frequency of soft stools had
decreased to 3 times per day. Yet, after 8 weeks oftreatment the frequency of watery stools increased
again to 4 times per day, so that I added

tokishakuyakusan. Following the start of thecombination treatment the frequency of soft stools
stabilized at 3 times per day.

to improve the flow of liver qi and contains thepowerful liver heat dissipating Scutellaria Radix,

Bupleuri Radix, the fluid metabolism of the spleenincreasing Atractylodis Lanceae Rhizome, Poria,Chuling, Alismatis Rhizome, Pinelliae Tuber, spleenfunction improving ginseng, Zizyphi Fructus, ginger
and Glycyrrhizae Radix. Compared to kamishoyosan
it is more powerful in improving liver qi stagnationand dissipating heat and activates the fluid
metabolism of the spleen. That is why I thought thisformula is more effective for treating stress-induced
liver qi stagnation, consequently leading to diarrhea
than kamishoyosan. However, since saireito does notcontain any liver blood tonifying drugs, the liver qi
stagnation developing before a background of liver
blood deficiency could not be improved and therefore
possibly led to the recurrence of the symptoms. The
addition of liver blood supplementing and spleen[Discussion]
The patient presented with stress-induced waterydiarrhea I considered to be an indication for

kamishoyosan, which was, however, ineffective.
Kamishoyosan (Bupleuri Radix3, Paeoniae Radix 3,Angelicae Radix 3, Atractylodis Lanceae Rhizome 3,Poria 3, Gardeniae Fructus 2, Moutan Cortex 2,Menthae Herba 1, Zingiberis Rhizoma 1,Glycyrrhizae Radix 1) is composed of the liver qi flow
improving Bupleuri Radix, Menthae Herba, liver fireeliminating Gardeniae Fructus, Moutan Cortex /Bupleuri Radix / Menthae Herba, liver blood
supplementing Japanese angelica root, PaeoniaeRadix, spleen metabolism activating Atractylodis201) in which the amount of Bupleuri radix is increased

fluid metabolism activating tokishakuyakusan isconsidered to have led to an effective treatment.
1) Alan Bensoussan etc. Treatment of Irritable Bowel
Syndrome With Chinese Herbal Medicine A Randomized
Controlled Trial JAMA. 1998; 280:1585-158
2) Hiromichi Yasui: Kampo Medicine for Medical
Students [Basics], Oriental Medical Publishing
Chiba 2008

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