Volume 5, Number 2 | Summer 2010

Kampo Medicine - Current Research
Situation on Use of Goreisan in Dialysis Patients－From the Goreisan Symposium 2010”－

Kazuhiro Muroga
Kurokouchi Hospital

It was in the Korean War’s casualties withacute renal failure that the effectiveness ofdialysis was first recognized. Since then, dialysis
has been applied widely from acute renal failure
to chronic renal failure. At present nearly 300,000
people receive dialysis in Japan1) and Japan has
the world-top level of dialysis technology. The
advanced technology of dialysis membranes hassignificantly increased the effectiveness ratio ofdialysis and thanks to the synthesis oferythropoietin by the genetic engineering,
nephrogenic anemia occurring in the dialysis
patients needs for mostly no blood transfusions in
the regular life. However, there are symptoms thatcannot be sufficiently handled or prevented byWestern medicine such as headache, cramps inthe lower limbs, hypotension occurring during a
dialysis session – these symptoms cause to lower
the QOL of the patients in combination with thedialysis three times a week.
Naturally there are no descriptions in classic
books of Chinese medicine about clinicalconditions of patients having the dialysis
treatment of modern medicine, but Kampo
preparations are widely used in everyday dialysis
treatment. A renal failure that has fallen into thecondition that needs dialysis because of Kampo
treatment cannot be improved by Kampo
medicines. However, various implications orunpleasant symptoms that arise during a dialysis
can be relieved by Kampo medicines.
Treatment of various symptoms in dialyzed
patients will be reported below from the viewpointof the method of using goreisan, together with theintroduction of published literatures.

Historical background of Kampo treatment in adialysis patient
The first case report about Kampo treatment of
a dialyzed patient was made in 1977 by Okada.
The patient was a physician with diabetic
nephropathy who was under treatment withdialysis. The author came to know from adocument that the physician suddenly died2) rightafter the conversation was carried out that as hisconditions became improved with the combination
use of Kampo medicines including bunshoto andhochuekkito, the frequency of routine dialysis
might be reduced. The document did not mention
the cause of the death, so details are not known.
However, a cardiac disease or a cerebrovasculardisorder might be the cause. In around ’76, thecost of dialysis was covered by the government
fund and presumably there were no financial
burdens to the patients for paying the medical cost.
Furthermore, as the patient was a physician, I do
not like to think that he received less frequent
dialysis. In these days, practitioners or physiciansin general did not have sufficient understandingof Kampo medicines and information of Kampo
was scarcely available. After that, Kampo
medicines in the form of extract became popularand Kampo preparations began to be used in theeveryday settings of dialysis from 90s onward.
Use status of goreisan in the sites of dialysis
Up until today, the use of goreisan for dialysis
patient has been confined for the following:
1. Prevention of dialysis hypotension
2. Imbalance symptoms such as headache,nausea, cramps in the lower limbs
3. Effect on hyperpotassemia

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

9Volume 5, Number 2 | Summer 2010

no significant differences between the values

1. Prevention of dialysis hypotension
From my experience, hypotension, which may

before and after the intake of the Kampo medicine,possibly be associated with the volume of thefour patients showed an improvement in blood

removed water, often occurs in the patients during

pressure fluctuations during a dialysis session

the latter half of a dialysis session. Especially in theandpatients who badly control their body weight, acorrelation between ΔBV and PRR4). This means

large amount of water is removed and hypotensionthat there should possibly be the patients who hadoften occurs in the latter half of a dialysis even if

the water moving, due to the oral administration

they have taken vasopressors beforehand. In theof goreisan, from the outside of the blood vessels

case, to maintain the patient’s blood pressure theinto the inside of the blood vessels.

there

existedasignificant

negative

solution of normal saline is often infused. Thus, theIt may be said that goreisan is a prescription

amount of the water removed with great pains

worth trying for the prevention of hypotension

becomes balanced out by the amount of the infused

during a dialysis treatment.

solution. Kawashima reported in 2000 about a caseof diabetic nephropathy. This female patient of 64

2. Effect of goreisan on headaches, nausea, andyear-old repeatedly developed hypotension during

cramping lower limbs

the latter half of a dialysis and an adequate amount

Headaches and nausea in the introduction stageof fluid could not be removed. Kawashima gave herof dialysis are called disequilibrium syndrome andan oral administration of the Extract 2.5g ofthese symptoms increase pain and suffering of thegoreisan at the start of a dialysis. With thepatient who do not get used to dialysis. Their cause

administration, her blood pressure was controlled

is described as cerebral swelling secondarily

and the volume of the normal saline infusion

developed by changes in the osmotic pressure of thedecreased enabling the planned water volume to be

blood due to the removal of urea nitrogen and otherremoved. In this publication, it was further

elements from the blood. Headaches are often-

reported that changes in the circulating bloodobserved complaints even in maintenance dialysis

volume (ΔBV) were determined by the vascularpatients. And other than migraines, there is a

refilling monitor of

the hematocrit monitor

different type of headache associated with changes

measuring cells (CritLin Rof JMS Co.) for thein the body fluid, similarly in the introduction stage

andwasof dialysis. Some patients have the type ofconfirmed that the amount of the circulating blood

headache which may be caused by medication

plasma that had not been seen before theoveruse and coping with this type of headache is aadministration of the Kampo medicine wasdifficult task. Cramping lower limbs is also amaintained during the latter half of a dialysis3).

symptom that often occurs in dialysis patients.

The results were further tested and the report

They suffer the cramping during a dialysis andabout this additional testing was presented at thesometimes

2008 Japanese Society for Dialysis Therapy.

Shakuyakukanzoto often has marked effects on

extracorporeal

circulation

that

it

An oral dose of the Extract 2.5g of goreisan wasgiven to 10 patients on non-diabetic maintenanceduringthenighttime.

cramps as in healthy people, but it cannot beeffective at all times5)6).

dialysis at the start of a dialysis to measure ΔBVs

The author had once conducted a questionnaireand plasma refilling rates (PRR) before and aftersurvey with 180 maintenance dialysis outpatientsthe administration. Although the result showed

at Tsuchiura Kyodo Hospital, in which they were

10The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 5, Number 2 | Summer 2010

asked about the presence of headache, nausea, and3. Effect oflower legs cramps and confirmed their willingness

hyperkalemiaof taking a Kampo medicine; and 20 of them weregoreisan on hyperpotassemia /As kidney failure progresses, the levels of bloodadministered goreisan to verify its effectiveness.

potassium

The subjects were aged 41 to 76 with the dialysis

frequency. The author has often experienced cases

history of 7 to 223 months. Primary diseases were

where plasma K did not decline sufficiently

diabetes in 6 patients, chronic glomerulonephritis

sometimes even if the K concentration of thein 9, and connective tissue disease in 2, anddialysis solution was controlled. This is the result

polycystic kidney disease / pregnancy kidney / renal

from the weak ability to remove K in hemodialysis

sclerosis in 1 individually. Headache in 16, nausea

comparedin 2 (nausea and headache overlapping in 1), andinstructions are given to the patients to avoid

cramps in lower limbs in 5 (cramps and headachetaking K from articles of food as much as possible.

overlapping in 2), to all of which goreisan wasHowever, only a few patients can continue toorally administered twice / morning and night (forstrictly adhere to the die. On the other hand, somepartial cramps in the lower legs, the administration

patients die suddenly due to the blood K levels

was once in the morning of the dialysis day).

elevated by overeating of K-rich foods, especiallyImprovements in subjective symptoms after 8fruit. The patients with high levels of plasma K atweeks were compared against score 10 of before-

ordinary times take the oral administration ofthe-administration to see how the scores declined.

potassium absorbing agents, which are hard toThedrink and have the risk of solidification in theresults

showedheadachedisappeared

completely in 4 patients, 70%-90% improvement in

intestinal

7, 30%-40% improvement in 4, and no change at allobstruction.

(K)

tobecome

elevated

peritoneal

tract,dialysis.

leadingto

anwithhighTherefore,intestinal

in 1. As for nausea, 90% improvement in 2, and forTajima et al. reported that a patient with highlower limbs cramps, disappeared in 1, 70%

levels of blood K showed an improvement in theimprovement in 1, 50% improvement in 1, andlevels of plasma K after the administration of20%-30% improvement in 2. Physical conditions

goreisan. According to the report, the femalechanged by the administration were constipation

patient of 50s whose plasma K had once increased

in 5, and soft stools / increased blood pressure /to 7mEq/ml complained of pain in the shoulder

feeling legs light / joint pain relief / relief of cramps

joints and received the administration of thisin 1 individually. In one patient with nausea, theKampo medicine; the levels of K that had not

symptom disappeared but constipation developed,

fallen below 6mEq/ml declined to around 5mEq/ml.

so that the oral administration was discontinued

Later goreisan was replaced with shosaikoto, but

voluntarily but the symptom did not recur7). It has

the K levels were maintained9). Then, Muramatsu

been verified from these results that goreisan ismade a report with Tajima with an addition of one

effective for improving complaints of dialyzed

more patient10).

patients.

And Naito also reported that the level of

There is another document reporting thatplasma K decreased after the administration of

goreisan was used for maintenance dialysis

goreisan in patients with chronic renal failure inpatients who developed cerebrovascular disorders

theduring a dialysis with worsening disordered

comparison was made between the group of highconsciousness during the session8).

levelsmaintenanceofK(anThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

period.
average

InoftheCr

report,a4.5mg/dl,

11Volume 5, Number 2 | Summer 2010K≧6mEq/ml) and the group of relatively high

5. Yamashita J.: Touseki Kanjya no Touseki-chu,levels of K (an average of Cr 1.9mg/dl, 5≦K＜Touseki-go6mEq/ml). The results showed that in the group ofTSUMURA shakuyakukanzoto no Kouka nihigh levels, an average of 6.6mEq/ml declined toTsuite. Pain & Kampo Medicine 2 18 1992

anaverageof

5.6mEq/ml

duetonoKin-keiren-tsu

nitaisuru

the6. Muroga K., et al.: A Clinical Study of the Efficacy

administration of goreisan, whereas in the groupof shakuyakukanzoto for Muscle Cramps inof relatively high level of K, no changes wereDialysis Patients 46(3) 467-469 1995

observed in effect from an average of 5.2mEq/ml
to5.3mEq/ml.

Moreover,nochanges

wereobserved in the amount of potassium in urine
during the administration of this Kampo medicine.

7. Muroga K.: Iji-Touseki Kanjya ni okeru

Goreisan no Shiyou Keiken. Journal of Kampo
Medicine44 (12) 1574－1577 1997
8. Kawamura T., et al.: Jinkou Touseki-chu noThus, it may be possible that although goreisan

Ishikidoes not affect the levels of plasma K in blood K ofFusegieta Nounai-shukketu no 2-rei. Journalhigh levels but not high enough to the life-of Noushinkeigeka to Kampo 3 9-10 2008

threatening extent, the Kampo acts to correct the9. Tajima K., et al.: Kampo-yaku ni yoru

ShougaiAkkanowoChiryou

Goreisan nitehigh levels of blood K that exceeds 6mEq/ml11).

Kansetu-shouchuni

Kessei

However, the mechanisms are not known.

Kariumu-chi ga Seijyouka shita Touseki
Kanjya no 1-rei. Kampo & the Newest Therapy

The above is the report on the reality of various

12(4) 367-369

2003

applications of goreisan, together with reports by

10. Muramatsu T., et al.: Kampo-yaku de Kessei

great physicians. I hope that the application ofKariumu-chi ga Kyusokuni Seijyouka shita

this Kampo medicine will further expand in theTouseki Kanjya no 2-rei. 22-kai Hinyouki-ka

sites of maintenance dialysis.

Kampo Kenkyu-kai Gakujyutsu-shu 2004
11. Naitou

M.:

Goreisan-ekisu-seizainiyoruReferences

Mansei Jinfuzen Kanjya no Kou-Kariumu-

1. Nakai S., et al.: Current status of chronic

Kesshou Yokusei-kouka (Zokuhou) – Kessei K-dialysis therapy in Japan (as of December 31,chi ni oujita Kouka –2008) Journal of The Japanese Society forMed) 57(supple.) 262 2007

Dialysis Therapy 43(1)

1-35

2010

2. Okada M.: Jin-touseki Kanjya ni Kampo wa Ze
ka Hi ka, Journal of Kampo Medicine 24(12)755-758 1977
3. Kawashima A., et al.: Touseki Iryou niokeru
CURRENT TOPICS 2008 Iji-Touseki Kanjya
ni taisuru Kampo-yaku no Ouyou, Journal ofThe Japanese Society for Dialysis Therapy 23(2) 195 2008
4. Oshima R., et al.: Goreisan no Touseki-chuuJyunkan Doutai ni okeru Kouka no Kentou.
Journal of The Japanese Society for Dialysis
Therapy 41 supple

12739 2008

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

Nittou Ishi (Kampo