Volume 7, Number 1 | Spring 2012

Clinical Report 2 (Kampo Medicine)
One Case of Ulcerative Colitis Whose Symptoms after Total
Colectomy were Successfully Treated with Kampo Drugs

Takao Namiki
Department of Japanese-Oriental Kampo Medicine
Graduate School of Medicine and School of Medicine
Chiba University

patient who achieved improvement in QOL withconcomitant use of Kampo formulas.
Case: 44 years of age, male who had complete
removal of large intestine
Chief complaints: Diarrhea, abdominal pain, cold
hands and legs
Past history: At the age of 20, intractable ulcerativeIntroduction
Ulcerative colitis is a non-specific inflammatory
disease of the lining (wall) of the large intestinewhere ulcers/erosions are formed in most cases.
What causes the disease is not known. Once thedisease has developed, repeated remissions andrecurrences occur. According to a report by arelevant Japanese authority, 113,306 people areaffected with ulcerative colitis in Japan (equivalentto the number of Recipient Certificates issued forSpecific Disease Treatment in 2009) with nearly
8,000 new patients every year. Compared to the U.S.
where there are 1 million people affected with thisdisease, Japan has about one-tenth of the patients in
the U.S. １ ） . Ulcerative colitis treatment usually
involves medical therapy with drugs. In severe cases
or cases for which drugs are not effective, surgicalprocedures may become necessary, that is, for thecases of (1) heavy hemorrhage, (2) toxic megacolon(widening (dilation) of the large intestine with toxinstravelling through the body), (3) perforation (of thelarge intestine), (4) canceration or cancer suspect, (5)severe conditions unresponsive to medical therapy,and (6) drugs such as steroids cannot be usedbecause of the side-effects.

colitis, total extraction of the large intestine in year X
Present history: The patient had been having
frequent bowel movements after the removal
surgery of the large intestine in year X. Then,
pouchitis had occurred and antibiotics had been usedand endoscopy had proved disappearance andimprovement in pouchtitis. Diarrhea, however,
persisted (15 times a day). A ELENTAL containing
drug had been administered and even laudanum fordiarrhea had been used. The patient desiring
treatment
Department

forfrequentofdiarrhea

visitedJapanese-Oriental

our“Kampo”

Medicine of Chiba University with a letter of referral.
The patient had no medical history except ulcerative
colitis and his family members had no history of thisdisease. He did not drink alcohol. His conditions at
the time of hospital admission were height 168cm,weight 58.2kg, body temperature 36.5 degrees
Celsius, blood pressures 114/73 mmhg, and regularpulse at the rate of 73/min. The presence of anemia
and jaundice was not observed in pulpebralconjunctivas and lymph nodes were not palpated. No
abnormalities were found in the chest. The abdomen
had an operative scar and lower legs were notswollen. Surface body temperatures were measured:

As of late, the author had a patient who ever had
the entire large intestine removed was sufferingfrom abdominal pains and frequent diarrhea of
unknown causes. For the patient, treatment wasperformed using Kampo drugs together with drugs
prescribed by his physician according to thesymptoms (sho) with the results of improved
symptoms. Introduced hereunder is the report of theforehead 34.2 C and lower legs 28 C, lower than theforehead’s . This is the state of upper body heat andlower body cold. The results of blood examination
were WBC 9600/mL, Hb 12.5g/dL, Hct37.9%, Plt
32.5X104 /μl, AST11U/L , ALT 6U/L, LDH 115 U/L,
ALB 4.1 mg/dL, BUN 9 mg/dL, and CRE 0.67 mg/dL.
Findings by Kampo medical diagnosis were thepatient was fatigable, easily felt cold and lied in bed
all day. The number of bowel movements was 15

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

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Volume 7, Number 1 | Spring 2012

times a day, of which solid stools 5-6 times andHe claimed that the frequency of diarrhea did notwatery diarrhea for the rest of the times. He woke upchange. Further one months later, the third visit wasduring

wasmade and at the time stomachache dissipated. A

sometimes accompanied by abdominal pains. He

sense of incomplete evacuation also lessened. Slightclaimed of coldness in the four extremities and therumblings in the intestines were present. Theabdomen. Pulse was slightly sunken and slightly

frequency of diarrhea was 15-13 times a day, still

weak. Tongue diagnosis: pale red colored with slightfrequent, so that changing the formula wasteeth marks, and its dryness was moderate. And it

examined. Pulse diagnosis indicated pulse waswas covered with thin whitish yellow furs withintermediately floating and sunken and the pulse

swollen sublingual veins. The abdomen had strength

size was slightly fine. Tongue diagnosis showed the(5/V). The bloated chest and hypocondrium region

tongue body was pale red and its dryness and moist

showed a strong resistance and the region below theare intermediate. Tongue furs were thick and white.

heart with a feeling of stuffiness and rigidity showed

Abdominal diagnosis showed strength (5/V). Thea slight resistance. Abdominal rectus muscles onchest and hypochondrium region having a bloatedboth sides were tense with a bloated feeling in thefeeling showed a strong resistance and the below-

left chest and hypochondorium. The region besidethe-heart region with a feeling of stuffiness andthe umbilicus felt no pressure pain. The ileocecalrigidity also showed a slight resistance. Resonant

region felt pressure pain. However, there was no coldsound was heard over the abdomen. Because ofsensation in the abdomen. In short, although pulse

frequent diarrhea, kanzoshashinto was a possible

and systemic conditions exhibited the sho (pattern)

option. However, its extract form was not available.

of yin deficiency, the abdomen had strength, whichSo, first the Extract of orento was changed to

was the state of upper body heat and lower body cold.

hangeshashinto (2.5g) 3 times/day (before meals).

That is, it was considered that the patient was

On the revisit of 1 month later, stomachpain

intrinsically robust and full of vigor with physicaldisappeared. There were no rumblings of thestrength but frequent diarrhea rapidly weakened his

intestines heard and the frequency of diarrhea

physical strength inducing the state of deficiency sho.

decreased to 5 times a day.

Therefore, under the condition that there was theConsideration: According to the records of diagnosis

sho of yang deficiency with a reverse flow of qi andof the department of gastroenterological medicine,

abdominal pains, the Extract of orento (2.5g), which

frequent diarrhea of the patient was the state inis the formula for minor yang diseases, waswhich the function of the small intestine was unableadministered 3 times/day before meals. His revisit toto compensate for a loss in the function of the large

our department was scheduled 3 weeks later. Twointestine. This is considered to be the disease state

weeks after the start of the formula, however, heof a functional disorder and fixing and harmonizing

happenedof

disordered functions is the area of Kampo’s speciality.

gastroenterological medicine that had referred theFormula selection was dependent on whether topatient to our department. Their medical record

target at frequent diarrhea by using hangeshashinto

about him included the description of “no abdominal

or kanzoshashinto or whether to target at abdominal

pain for these several days and if pain appears, only

pain by using orento. From the past documents thatnear the anus.” Our department confirmed in theabdominal pains in the cases of ulcerative colitis had

second visit as scheduled that a sensation of cold legsoften been successful treated with orento, orento wasand feet dissipated as well as abdominal coldness.

a selective formula and it was administered for

The intensity of stomachache reduced to one-tenth.

abdominal pains of the patient with favorable results.

20

thenighttosometimes.

visit

theDiarrhea

department

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

Volume 7, Number 1 | Spring 2012

The frequency of diarrhea, however, did not

References:decrease;1) Japan Intractable Disease Information Center

theformulawaschangedtohangeshashinto, resulting in reduced frequency of

http://www.nanbyou.or.jp/entry/62

diarrhea. There are reports on Kampo treatment

2) Tsuneo MATSUO, et al.: Kaiyosei Daichouen ni(mostly classical formulations) for ulcerative colitis,

taisuru saireito no Koka. Journal of Traditional

illustrating cases of minor yang diseases with yang

Medicines 7(3), 270, 1990

sho for which shosaikoto or saireito2)3) was used, and3) Tsuneo MATSUO, et al.: Kaiyosei Daichuoen ni

whichokeru Kampo Ryouho,, 2nd Choukan Kinou

hangeshashinto was used. The reports also carried
the description that for yin sho, used were ninjinto4),
bushirichuto, keishikashakuyakuto5), kigikenchuto6)
bushikobeito7).
Andforhemorrhage,andorengedokuto3) and kyukikyogaito8) were usedKenkyukai Kirokushu (Geri to Kampo [Diarrheacasesofminoryang

diseases

forand Kampo], 1998
4) Shuichi MIZUNO: Daichouen no Kampo Ryouho(2nd Report), Journal of Traditional Medicines
7(3), 226,2990
5) Teturo GONOI: Kaiyosei Daichouen, Kaiyosei

concomitantly.

Daichouen no Kampo Chikenrei, Journal ofOrento is the formula that uses cinnamomi cortex inplace of saetellariae Radix contained inhangeshashinto. hangeshashinto is often used for5) Teturo GONOI: Kaiyosei Daichouen, Kaiyosei

targeting at stuffiness and rigidity below the heart

Daichouen no Kampo Chikenrei, Journal ofand rumblings of the intestines. Orento is often used

Traditionalfor targeting at abdominal pains9); this formula isEdition), 12(1), 109, 1991

Traditional

Sino-Japanese

Medicine(ExtraEdition), 12(1), 109, 1991

Sino-Japanese

Medicine(Extrasaid to be good for abdominal pains emerging from6) Makoto FUJIMOTO, et al.: Two Cases ofthe region between the epigastric fossa andUlcerative Colitis Successfully Treated with kigi-umbilicus (the place of acupressure point of thekenchu-to. Journal of The Japan Society foranterior midline CV12)10) and in many cases, pain on

Oriental MedicineJournal of Kampo Medicine,pressure was felt. In the case of the patient, diarrhea

55(5), 5, 655, 2004

and abdominal pains were co-existed. I thought it7) Kumiko TAKAHASHI, et al.: Bushikobeito ga

better to cure abdominal pains first, for which I used

Yukou de atta Kaiyosei Daichouen no Ichi-Rei,orento resulting in a rapid decrease in the intensity

Journal of Kampo Medicine, 59(2), 319, 2012of abdominal pains. However, diarrhea occurred8) Yoshiko TAKAGI: Kaiyosei Daichouen no Chiken,frequently as ever, so I changed the formula to

Journal of Kanpo Medicine and Herb, 7(3), 208,

hangeshashinto after confirming the improvement of2003

abdominal pains. As a result, the frequency ofdiarrhea decreased to less than half. If the frequency

9) Tetsuo AKIBA: Katuyo Jizai no Shohou-Kaisetsu,
Life Science, Tokyo, 2009of diarrhea is more than 10 times, kanzoshashinto10) Keisetsu OTSUKA: Shoko ni yoru Kampo Chiryo

which is made by adding Licorice to hangeshashinto

no Jissai (5th edition), Nankodo,Tokyo, 2000

was administered.

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

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