Pain and Kampo: The Use of Japanese Herbal Medicine in Management of Pain

194 Pages·1994·12.57 MB·English

by  Masamichi Satoh (auth.)

T. Oyama· G. Smith (Eds.)
Pain and Kampa
The Use of Japanese Herbal
Medicine in Management of Pain
With 86 Figures
Springer-Verlag
Tokyo Berlin Heidelberg
New York London Paris
Hong Kong Barcelona Budapest
TSUTOMU OYAMA, MD, PhD
Director, Research Institute for Pain, Tsumura Co. Ltd., 3586 Yoshiwara, Inashiki-gun,
Ibaraki, 300-11 Japan
GRAHAM SMITH, MD, MB, BS, FRCA
Professor of Anesthesia, University of Leicester, Leicester Royal Infirmary, Leicester
LEI5WW, UK
On the front cover: Aconiti Tuber/ilf1:r © Tsumura Co. Ltd.
ISBN-13: 978-4-431-68262-2 e-ISBN-13: 978-4-431-68260-8
DOl: 10.1 007/978-4-431-68260-8
Library of Congress Cataloging-in-Publication Data. Pain and kampo: the use of Japanese herbal
medicine in management of painrr. Oyama, G. Smith (eds.). p. cm. "The First International
Symposium on "Pain and Kampo (Japanese Herbal Medicine)" took place in Tokyo in October
1992" -Pref. Includes bibliographical references and index. 1. Pain-Treatment-
Congresses. 2. Herbs-Japan-Therapeutic use-Congresses. 1. Oyama, Tsutomu. II. Smith,
G. (Graham) III. International Symposium on "Pain and Kampo (Japanese Herbal Medicine)"
(1st: 1992: Tokyo, Japan). [DNLM: 1. Medicine, Chinese Traditional-Japan-congresses.
2. Drugs, Chinese Herbal-therapeutic use-congresses. 3. Pain-therapy-congresses.
QV 767 P144 1994]. RB127.P332143 1994. 615'.321'0952-dc20. DNLM/DLC. For Library of
Congress 93-47603
Printed on acid-free paper.
© Tsutomu Oyama 1994
Softcove reprint of the hardcover 1s t edition 1994
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Preface
The First International Symposium on "Pain and Kampo (Japanese Herbal
Medicine)" took place in Tokyo in October, 1992. More than 700 registrants
participated, with 12 registrants from seven overseas countries. This book
contains summaries of the presentations at this meeting and is published in
order to provide up-to-date information to a much wider audience.
In China, traditional herbal medicine has been used for more than 3000
years while in Japan, its use has been documented for more than 1000 years,
albeit with some changes to the original Chinese formulations. Recently there
has been a revival of interest in herbal medicines for several reasons. There is a
rapid growth in the number of senior citizens who frequently require the
attention of modern medicine. In particular, there has been an increase in the
number of patients who suffer from chronic diseases which are difficult to treat,
e.g., arteriosclerosis, Alzheimer's disease, chronic pain syndromes, etc. It has
become evident that traditional Oriental herbal medicines could playa role in
the management of these and other conditions.
The distinct features of Kampo, Japanese herbal medicine, are as follows:
Kampo medicines are the extracts of several unrefined herbal drugs taken
orally and never given parenterally. In using these medicines, we should take
into consideration a patient's "sho", which implies physical resistance to dis
ease and bodily responses to coldness or fever. The use of traditional Chinese
medicine is unfamiliar to physicians trained in Western countries. Although
herbal medicines are widely available in Western countries, it is unusual for
such agents to be prescribed by physicians, and their use is frequently confined
to medicines available without prescription from pharmacies or to practitioners
of homeopathic medicine. In Japan there are 131 Kampo drugs available for
ethical dispensation.
It will be seen from the abstracts contained in this book that Kampo medicines
have been used predominantly for treatment of pain. Their application has
been based on traditional and empirical methods, and it is only recently that
scientific principles have been applied to the evaluation of Kampo medicines.
v
VI Preface
Many of the presentations at the First International Symposium emphasized
the use of rigorous scientific evaluation of Kampo medicines, and clearly this
is necessary if the use of such medicines is to extend widely into Western
countries.
The Symposium comprised presentations on both basic and clinical evaluation
of Kampo medicines, particularly in association with pain management. It is
hoped that the publication of these proceedings will both stimulate general
interest in the use of Kampo medicines and provide impetus to further rigorous
evaluation of the efficacy of these agents.
We are grateful to all those who participated in this symposium and parti
cularly to the 18 who presented an abstract of their work for publication
here. We are also particularly grateful to Mr. A. Tsumura, President, Mr. J.
Tsumura, Chairman, and Mr. S. Nakagami, Board Member of Tsumura & Co.
Ltd., without whose enthusiastic support it would not have been possible to
hold the Symposium or publish these proceedings.
T. OYAMA
President of the Symposium
G. SMITH
Co-Editor
Symposium Overview
Report on the First International Symposium
on Pain and Kampo*
October 3-4, 1992
Tokyo (Japan)
Kampo is the name given to Oriental herb medicine which has been used in
China and Japan to relieve acute and chronic pain for more than 2000 years.
Although Oriental herb medicines have been beneficial to patients, scientific
explanation of their benefit has lagged behind the widespread use of kampo in
clinical practice. The purpose of the symposium, therefore, was to lay the
foundation for an explanation of the mechanisms by which kampo works. The
First International Symposium on Pain and Kampo was organized by an inter
national committee headed by Dr. Tsutomu Oyama. Since retiring as chairman
of the Department of Anesthesia at the University of Hirosaki Medical School,
Dr. Oyama has focused his research efforts on understanding the scientific
basis for pain relief with kampo. Dr. Oyama is currently the director of the
Pain Research Laboratory, Research Institute for Pharmacology at Tsumura
Pharmaceuticals in Japan.
Opening remarks at the symposium were made by Dr. Haneda, former
president of the Japanese Medical Association, by Akira Tsumura, president
of Tsumura and Company, and by Dr. Oyama. In the first of three scheduled
didactic lectures, Dr. Oyama discussed the analgesic effects ofTJ-3021 (tsumura
shuchi-bushi-matsu), a traditional Oriental medicine derived from the aconite
tuber. The aconite tuber reduced pain through an effect on brainstem re
lay nuclei, especially the periaqueductal gray nucleus and the raphe magnus
nucleus. In the second lecture, Dr. Ishige suggested that aconite may be more
effective on the descending pain inhibitory pathways in the dorsal horn of the
spinal cord than on the cerebral sensation of pain. Finally, Dr. Hyodo, of the
Osaka Medical College, gave a comprehensive summary of the clinical benefits
of many kampo medicines, including some case summaries with details of the
way individual patients had benefited. He stated that one-third of all kampo
* This article has been reproduced in its entirety from the International Journal of Pain
Therapy, vol. 3, no. 1, pp. 49-50 with permission.
VII
VIII Symposium Overview
medicines approved for payment by the Health Service in Japan are used for
the relief of pain.
Dr. Satoh of Kyoto University then outlined the effects of kampo on sub
stance P and calcitonin gene-related peptide. He used the rat model to study
the analgesic action of shogaol, an agent contained in several kampo medi
cines. The effects of kampo in this model were much less striking than the
effects of kampo in descending pain pathways. Specific patient types who may
benefit from kampo were reviewed by Dr. Terasawa, Professor in the Depart
ment of Japanese Oriental Medicine, Toyama Medical and Pharmaceutical
University. Dr. Terasawa explained the theory underlying the efficacy of
kampo medicine: Analgesics are not directed to a specific anatomical or physio
logical target. Instead, the aim is to restore the balance of three basic elements:
ki, life energy; ketsu, red body fluid; and sui, colorless body fluid. Impairment
of circulation of any of these elements results in pain.
The use of plants and herbals as medicines and foods in the West was the
topic of three presenters: Dr. Wells of the Pain Relief Research Foundation,
Walton Hospital, Liverpool, England; Dr. Chrubasik, Professor of Anesthesi
ology, University Hospital, Heidelberg, Germany; and Dr. Roizen, Professor
and Chairman, Department of Anesthesia and Critical Care, University of
Chicago. Dr. Wells traced the origins of digitalis, aspirin, morphine, and
codeine to folk medicines and herbs such as extracts of foxglove, willow bark,
and the opium poppy. Dr. Chrubasik reported that phytopharmacology is now
mandated in German medical schools. Questions about phytopharmacology
and components of pain therapy will appear on all medical examinations in
Germany beginning in 1993. Dr. Roizen discussed kampo in the context of the
burgeoning health foods and herbals industry in the U.S. and summarized the
process for approval of a compound as a medicine. Such approval is regulated
by the Food and Drug Administration after four phases of clinical trials.
The first day's symposium ended with a presentation by Dr. Weilian of the
Cancer Department, Second Central Hospital, Tianjin, China. In his study,
wutou injection in a purified form relieved pain and prolonged life by four
months in end-stage gastric cancer. After an elegant buffet sponsored by Dr.
Tsumura, the meetings was adjourned for the evening.
The meeting resumed the next morning when Dr. Sugaya, Professor of
Physiology at the Kanagawa Dental College, Yokosuka, Japan, presented data
showing that TJ-960 (sho-saiko-to-go-keishi-ka-shakuyaku-to) corrected many
of the neuronal budding and extension effects in cultured neurons of mice with
certain disease states. This model suggests that components of TJ-960 may be
effective for treatment of neuronal disturbances. TJ-960 demonstrated anti
convulsive action and an ability to optimize conditions for the function of
neurons and glia.
TJ-48 (juzen-taiho-ho) prepared from a mixture of ten plants was studied by
Dr. Kawamura of the Tsumura Research Institute for Pharmacology, Ibaraki,
Japan. Dr. Kawamura showed that TJ-48 improved antibody production and
immune function by improving mitogenic activity in B cells and interleukin-2
Symposium Overview IX
production. More than one of the components of TJ-48 was important in these
actions. Each kampo compound has many ingredients, and the effect of kampo
is not necessarily attributable to just one component. The use of a combination
of agents to treat diseases in the West is also typical. In anesthesia, for
instance, fentanyl is often given with isofturane; hypertension is often treated
with a diuretic and an angiotensin-converting, enzyme-inhibiting drug; tuber
culosis is treated with three antibiotics; and pain may be treated with salicylates
and opiates. There may be teleological reasons for a plant to develop with
roots protecting it in multiple ways, so the fact that TJ-48, TJ-960, and aconite
tubers have at least two active components is not surprising. In TJ-48, two of
the components act as "biologic response modifiers". These data presented
very important areas to continue to explore.
Dr. Tan, Professor of Anesthesiology and Critical Care Medicine, Asahikawa
Medical College, and his colleague Dr. Ogawa presented outcome studies of
geriatric patients in whom kampo was used to supplement nerve block therapy
for pain relief. No adverse reactions occurred in the kampo group in which
symptoms such as insomnia, anorexia, and depression were significantly im
proved. Dr. Mizuguchi, Professor of Anesthesiology, Chiba University, showed
a quality of life table depicting outcome and the effects of kampo on cancer
related pain. Juzen-taiho-to was effective for treatment of nausea and vomiting
and for appetite loss.
Dr. Kamiyama, Professor of Anesthesiology, Kyorin University School of
Medicine, has developed a computer program as a diagnostic aid for clinicians
who wish to practice Oriental medicine. After responding to questions about a
patient's health status, the clinician can receive assistance at any of three
levels: treatment for symptoms described in Western terms, diagnosis when the
physician can distinguish between deficiency and robustness in Oriental terms,
and diagnosis according to Oriental medicine.
The animal model was used by Drs. Takasaki and Totoki of Saga Medical
School to analyze movement occuring with pain. The effect of kampo were
compared in mice with those of two Western medicines, carbamazepine and
amitriptyline.
The management of chronic pain and pain control research with kampo was
the topic considered by the remaining speakers in the symposium. Dr. Nagata,
Hamamatsu University School of Medicine, tried to integreate classic tradi
tional methodology with Western quality-of-life measures. Dr. Matsumoto,
Saitama Medical School, presented results showing that the aconite tuber
benefited three of eight patients with terminal lung cancer. Oriental medicine
as an adjunct to rehabilitation therapy was described by Dr. Ogata, School of
Medicine of the University of Occupational and Environmental Health.
The treatment of arthritic pain and rheumatoid arthritis with kampo was dis
cussed by Drs. Nakata, Isobe, and Matsuta. Drs. Isobe and Matsuta explained
the effects of boiogi-to on patients with painful knee joints; Dr. Nakata de
scribed the "sho", or special syndrome associated with arthritis and neuralgia,
that must be identified before an appropriate kampo formula can be selected
X Symposium Overview
for treatment. Certain kampo medications are called women's medicines, and
Dr. Murata reported on uncontrolled treatment with kampo for menstrual
pain, lower back pain, and other symptoms associated with pregnancy. Kampo
formulas were also used for the treatment of headache in 1000 patients in Dr.
Hiyama's study and in the treatment of postherpetic neuralgia by Dr. Kato at
the Nihon University Hospital. Dr. Ha then provided a brief historical over
view of pain control research in China for the past 20 years.
Much work still remains before Western patients can fully benefit from the
effects of various components of kampo medicines on pain syndromes. Mech
anisms of pain themselves are only beginning to be uncovered. The many
facets of these mechanisms and pain reduction with kampo medicines must be
better understood before Western medicine can benefit from the pioneering
work of Drs. Oyama and Tsumura. Such understanding requires a marathon of
effort. The 573 participants attending the International Symposium of Pain and
Kampo witnessed the progress of the first several miles.
MICHAEL F. ROIZEN, M.D.
Professor and Chairman
Department of Anesthesia and
Critical Care, University of Chicago,
Chicago, Illinois USA
Contents
Preface. . . .. . . . . . . .. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V
Symposium Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. VI
List of Contributors ............................................... XIII
1. Basic Research in Pain and Kampa Medicines
M. SATOH .................................................... 1
2. The Analgesic Effect and Mechanism of Action of Processed Aconiti
Tuber and Its Alkaloid
T. OYAMA, Y. SUZUKI, Y. IKEDA, A. ASAMI, Y. OMIYA,
M. NOGUCHI, A. ISHIGE, and T. ISONO . . . . . . . . . . . . . . . . . . . . . . . . . . .. 16
3. Effects of Tsumura-Shuchi-Bushi-Matsu (TJ-3021) on
Cerebro-Cortical Function
A. ISHIGE, K. SEKIGUCHI, S. IIZUKA, and T. OYAMA. . . . . . . . . . . . . . . .. 29
4. Ameliorative Effects of Japanese Herbal Medicine on Abnormalities
of the Nervous System: Mechanism of the "Reilly Syndrome
Due to Trigeminal Irritation" and Its Suppression by an
Herbal Mixture, TJ-960
E. SUGAYA, K. KAJIWARA, and N. YUYAMA . . . . . . . . . . . . . . . . . . . . . ... 35
5. Studies of the Immunological Effects of Juzen-Taiho-To (TJ-48)
H. KAWAMURA .............................................. " 58
6. Periodical and Fluctuational Analysis of the Effect of Kampo
Medicines on Mouse Motility
M. TAKASAKI, Y. TANIGUCHI, M. EGASHIRA, and T. TOTOKI . . . . .. . . .. 73
7. A Survey of Pharmacological Studies of Chinese Herbs with
Analgesic Effects
H. HA ....................................................... 79
XI