Kampo, A Japanese Traditional Medicinal System for Psychiatric Conditions: A Narrative Review

Laina Tatsumi; Takefumi Suzuki; Kazuo Yamada; Masaru Mimura; Hiroyuki Uchida

doi:10.1055/a-0637-9760

Pharmacopsychiatry, Table of Contents

Pharmacopsychiatry 2019; 52(06): 251-260
DOI: 10.1055/a-0637-9760

Review

Kampo, A Japanese Traditional Medicinal System for Psychiatric Conditions: A Narrative Review

Laina Tatsumi

¹Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan

,

Takefumi Suzuki

¹Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan

²Department of Neuropsychiatry and Clinical Ethics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan

,

Kazuo Yamada

³Department of Psychiatry, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan

,

Masaru Mimura

¹Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan

⁴Center for Kampo Medicine, Keio University School of Medicine, Tokyo, Japan

,

Hiroyuki Uchida

¹Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan

⁵Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada

› Author Affiliations

Abstract

Introduction Kampo is a Japanese traditional medicinal system and is represented by unity of mind and body. It is originally based upon Chinese traditional medicine but has uniquely developed in Japan.

Methods A narrative review on the use of Kampo for psychiatric conditions is provided.

Results Kampo formula is a combination of several crude ingredients; most derive from natural plants and some from animals and minerals. These Kampo formulae are widely prescribed in almost all medical disciplines, including psychiatry, in Japan; they have been used for various psychiatric disorders such as dementia, schizophrenia spectrum disorders, mood disorders, anxiety disorders, and personality disorders. Kampo is a versatile traditional medicine with a variety of positive effects on mental states with relatively benign side effect profiles. Kampo formulae can be adjunctively combined with or substituted for the Western psychotropic drugs, which will provide more treatment options to patients with psychiatric conditions.

Discussion This review summarizes the current knowledge on Kampo for psychiatric conditions, highlighting a paucity of data and a need for further good-quality evidence on these medications.

Key words

herbal medicine - Kampo - psychiatric disorder - traditional medicine

Full Text

References

References
1 Terasawa K. Evidence-based reconstruction of Kampo medicine: part I – Is Kampo CAM?. Evid Based Complement Alternat Med 2004; 1: 11-16
2 The Japan Society for Oriental Medicine. Introduction to Kampo: Japanese Traditional Medicine. Tokyo. Japan: Elsevier; 2005
3 Yamada K. Herbal medicine in the treatment and prevention of depression: risk or benefit?. In: Watson R, Preedy V. eds. Botanical Medicine in Clinical Practice. Wallingford: CAB International; 2008
4 Devshi R, Shaw S, Elliott-King J. et al. Prevalence of behavioural and psychological symptoms of dementia in individuals with learning disabilities. Diagnostics (Basel) 2015; 5: 564-576
5 McKeith I, Cummings J. Behavioural changes and psychological symptoms in dementia disorders. Lancet Neurol 2005; 4: 735-742
6 Gauthier S, Cummings J, Ballard C. et al. Management of behavioral problems in Alzheimer’s disease. Int Psychogeriatr 2010; 22: 346-372
7 Azermai M, Petrovic M, Elseviers MM. et al. Systematic appraisal of dementia guidelines for the management of behavioural and psychological symptoms. Ageing Res Rev 2012; 11: 78-86
8 Goeman D, Harvey K, Lee CY. et al. How prolific is psychotropic medicines use in people with dementia in Australia within the community setting? A retrospective analysis. Drugs Real World Outcomes 2015; 2: 289-298
9 Maust DT, Langa KM, Blow FC. et al. Psychotropic use and associated neuropsychiatric symptoms among patients with dementia in the USA. Int J Geriatr Psychiatry 2017; 32: 164-174
10 Uchida H, Mamo DC, Mulsant BH. et al. Increased antipsychotic sensitivity in elderly patients: evidence and mechanisms. J Clin Psychiatry 2009; 70: 397-405
11 Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA 2005; 294: 1934-1943
12 Teranishi M, Kurita M, Nishino S. et al. Efficacy and tolerability of risperidone, yokukansan, and fluvoxamine for the treatment of behavioral and psychological symptoms of dementia: a blinded, randomized trial. J Clin Psychopharmacol 2013; 33: 600-607
13 Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 2014; 13: 57-65
14 Matsuda Y, Kishi T, Shibayama H. et al. Yokukansan in the treatment of behavioral and psychological symptoms of dementia: a systematic review and meta-analysis of randomized controlled trials. Hum Psychopharmacol 2013; 28: 80-86
15 Furukawa K, Tomita N, Uematsu D. et al. Randomized double-blind placebo-controlled multicenter trial of Yokukansan for neuropsychiatric symptoms in Alzheimer’s disease. Geriatr Gerontol Int 2017; 17: 211-218
16 Iwasaki K, Maruyama M, Tomita N. et al. Effects of the traditional Chinese herbal medicine Yi-Gan San for cholinesterase inhibitor-resistant visual hallucinations and neuropsychiatric symptoms in patients with dementia with Lewy bodies. J Clin Psychiatry 2005; 66: 1612-1613
17 Iwasaki K, Kosaka K, Mori H. et al. Improvement in delusions and hallucinations in patients with dementia with Lewy bodies upon administration of yokukansan, a traditional Japanese medicine. Psychogeriatrics 2012; 12: 235-241
18 Japanese Society of Neurology. Treatment guidelines for dementia. Igaku Shoin; 2010 (in Japanese)
19 Mizukami K, Asada T, Kinoshita T. et al. A randomized cross-over study of a traditional Japanese medicine (kampo), yokukansan, in the treatment of the behavioural and psychological symptoms of dementia. Int J Neuropsychopharmacol 2009; 12: 191-199
20 Takase S, Yokoyama H. Using a Kampo medication in the perioperative period – the preventative effects of yokukansan on postoperative delirium after cardiovascular surgery in the elderly. Kampo to Saishin-chiryo (Kampo and the Newest Therapy) 2013; 22: 113-119 in Japanese
21 Terasawa K, Shimada Y, Kita T. et al. Choto-san in the treatment of vascular dementia: A double-blind, placebo-controlled study. Phytomedicine 1997; 4: 15-22
22 Suzuki T, Futami S, Igari Y. et al. A Chinese herbal medicine, choto-san, improves cognitive function and activities of daily living of patients with dementia: a double-blind, randomized, placebo-controlled study. J Am Geriatr Soc 2005; 53: 2238-2240
23 Yamaguchi S, Matsubara M, Kobayashi S. Event-related brain potential changes after Choto-san administration in stroke patients with mild cognitive impairments. Psychopharmacology (Berl) 2004; 171: 241-249
24 Yamada K, Yagi G, Kanba S. Effectiveness of herbal medicine (Rokumigan and Hachimijiogan) for fatigue or loss of energy in patients with partial remitted major depressive disorder. Psychiatry Clin Neurosci 2005; 59: 610-612
25 Takeda T, Tsuiji K, Li B. et al. Proliferative effect of Hachimijiogan, a Japanese herbal medicine, in C2C12 skeletal muscle cells. Clin Interv Aging 2015; 10: 445-451
26 Iwasaki K, Kobayashi S, Chimura Y. et al. A randomized, double-blind, placebo-controlled clinical trial of the Chinese herbal medicine “ba wei di huang wan” in the treatment of dementia. J Am Geriatr Soc 2004; 52: 1518-1521
27 Utumi Y, Iseki E, Murayama N. et al. Effect of Rikkunshi-to on appetite loss found in elderly dementia patients: a preliminary study. Psychogeriatrics 2011; 11: 34-39
28 Takeda H, Sadakane C, Hattori T. et al. Rikkunshito, an herbal medicine, suppresses cisplatin-induced anorexia in rats via 5-HT2 receptor antagonism. Gastroenterology 2008; 134: 2004-2013
29 Matsumura T, Arai M, Yonemitsu Y. et al. The traditional Japanese medicine Rikkunshito increases the plasma level of ghrelin in humans and mice. J Gastroenterol 2010; 45: 300-307
30 Takeda H, Muto S, Hattori T. et al. Rikkunshito ameliorates the aging-associated decrease in ghrelin receptor reactivity via phosphodiesterase III inhibition. Endocrinology 2010; 151: 244-252
31 Fujitsuka N, Asakawa A, Uezono Y. et al. Potentiation of ghrelin signaling attenuates cancer anorexia-cachexia and prolongs survival. Transl Psychiatry 2011; 1: e23
32 Arai M, Matsumura T, Tsuchiya N. et al. Rikkunshito improves the symptoms in patients with functional dyspepsia, accompanied by an increase in the level of plasma ghrelin. Hepatogastroenterology 2012; 59: 62-66
33 Satoh N, Sakai S, Kogure T. et al. A randomized double blind placebo-controlled clinical trial of Hochuekkito, a traditional herbal medicine, in the treatment of elderly patients with weakness N of one and responder restricted design. Phytomedicine 2005; 12: 549-554
34 American Psychiatric Association. Practice guideline for the treatment of patients with schizophrenia. second edition Am J Psychiatry 2010; 161 2 Suppl 1-56
35 National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management clinical guideline; 2014;
36 Miyaoka T, Furuya M, Horiguchi J. et al. Efficacy and safety of yokukansan in treatment-resistant schizophrenia: a randomized, multicenter, double-blind, placebo-controlled trial. Evid Based Complement Alternat Med 2015; 2015: 201592
37 Yamada K, Kanba S, Onishi K. et al. Clinical effectiveness of Oren-gedoku-to for insomnia associated with acute schizophrenia and other psychotic disorders. Nihon Toyo Igaku Zasshi (Japanese Journal of Oriental Medicine) 1997; 47: 827-831 in Japanese
38 Yamada K, Kanba S, Onishi K. et al. The clinical effectiveness of Oren-gedoku-to in the treatment of schizophrenia. Nihon Toyo Igaku Zasshi (Japanese Journal of Oriental Medicine) 1997; 47: 603-607 in Japanese
39 Iizuka N, Hamamoto Y. Constipation and herbal medicine. Front Pharmacol 2015; 6: 73
40 Cheng CW, Bian ZX, Zhu LX. et al. Efficacy of a Chinese herbal proprietary medicine (Hemp Seed Pill) for functional constipation. Am J Gastroenterol 2011; 106: 120-129
41 Hirose T, Shinoda Y, Yoshida A. et al. Efficacy of daiokanzoto in chronic constipation refractory to first-line laxatives. Biomed Rep 2016; 5: 497-500
42 Yanagi Y, Yasuda M, Hashida K. et al. Mechanism of salivary secretion enhancement by Byakkokaninjinto. Biol Pharm Bull 2008; 31: 431-435
43 Inoue H, Muraoka H, Matsushita Y. et al. Kouseishinyaku de shoujiru koukatsu ni taisuru Byakkokaninjinto no rinshoteki kentou. Shinyaku to Rinsho 1993; 42: 174-182 in Japanese
44 Yamada K, Kanba S, Yagi G. et al. Effectiveness of herbal medicine (Shakuyaku-kanzo-to) for neuroleptic-induced hyperprolactinemia. J Clin Psychopharm 1997; 17: 234-235
45 Tsuboi T, Uchida H, Suzuki T. et al. Effectiveness of saikokaryukotsuboreito (herbal medicine) for antipsychotic-induced sexual dysfunction in male patients with schizophrenia: a description of two cases. Case Rep Psychiatry 2014; 2014: 784671
46 Miyaoka T, Furuya M, Yasuda H. et al. Yi-gan san for the treatment of neuroleptic-induced tardive dyskinesia: an open-label study. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32: 761-764
47 National Institute for Health and Care Excellence. Depression in adults: recognition and management clinical guideline; 2009; https://www.nice.org.uk/guidance/cg90 (accessed on 15.05.2018)
48 National Institute for Health and Care Excellence. Bipolar disorder: assessment and management clinical guideline; 2014; https://www.nice.org.uk/guidance/cg185 (accessed on 15.05/2018)
49 American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder. Third edition 2010; http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf (accessed on 15.05.2018)
50 American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder. Second edition 2002; http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar.pdf (accessed on 15.05.2018)
51 Mizoguchi K, Ikeda R, Shoji H. et al. Saikokaryukotsuboreito, a herbal medicine, prevents chronic stress-induced anxiety in rats: comparison with diazepam. J Nat Med 2009; 63: 69-74
52 Otake T, Ashihara M, Yamada E. et al. Hochu-ekki-to has effects on depression. Journal of Japanese Association of Oriental Psychosomatic Medicine 2005; 19: 31-36 in Japanese
53 Nakada T. Effect of Kami-kihi-to on mild depression. Nihon Toyo Igaku Zasshi (Japanese Journal of Oriental Medicine) 1997; 48: 205-210 in Japanese
54 Oka T, Tamagawa Y, Hayashida S. et al. Rikkunshi-to attenuates adverse gastrointestinal symptoms induced by fluvoxamine. Biopsychosoc Med 2007; 1: 21
55 Yamada K, Yagi G, Kanba S. Effectiveness of Gorei-san (TJ-17) for treatment of SSRI-induced nausea and dyspepsia: preliminary observations. Clin Neuropharmacol 2003; 26: 112-114
56 Kaneko A, Cho S, Hirai K. et al. Hange-koboku-to, a Kampo medicine, modulates cerebral levels of 5-HT (5-hydroxytryptamine), NA (noradrenaline) and DA (dopamine) in mice. Phytother Res 2005; 19: 491-495
57 Wakasugi A, Odaguchi H, Shoda H. et al. Differentiation between Hangekobokuto and Kososan based on pupillary dynamics. Evaluation of autonomic nerve function. Japanese Traditional Medicines 2006; 23: 132-140
58 Ito N, Nagai T, Yabe T. et al. Antidepressant-like activity of a Kampo (Japanese herbal) medicine, Koso-san (Xiang-Su-San), and its mode of action via the hypothalamic-pituitary-adrenal axis. Phytomedicine 2006; 13: 658-667
59 Ito N, Yabe T, Nagai T. et al. A possible mechanism underlying an antidepressive-like effect of Kososan, a Kampo medicine, via the hypothalamic orexinergic system in the stress-induced depression-like model mice. Biol Pharm Bull 2009; 32: 1716-1722
60 Ito N, Hori A, Yabe T. et al. Involvement of neuropeptide Y signaling in the antidepressant-like effect and hippocampal cell proliferation induced by kososan, a Kampo medicine, in the stress-induced depression-like model mice. Biol Pharm Bull 2012; 35: 1775-1783
61 The Japan Society for Menopause and Women’s Health. Treatment guidelines for gynecological illnesses – outpatient clinic; 2014 (in Japanese)
62 Yamada K, Kanba S. Effectiveness of kamishoyosan for premenstrual dysphoric disorder: open-labeled pilot study. Psychiatry Clin Neurosci 2007; 61: 323-325
63 Hidaka T, Yonezawa R, Saito S. Kami-shoyo-san, Kampo (Japanese traditional medicine), is effective for climacteric syndrome, especially in hormone-replacement-therapy-resistant patients who strongly complain of psychological symptoms. J Obstet Gynaecol Res 2013; 39: 223-228
64 Hoehn-Saric R, McLeod DR, Funderburk F. et al. Somatic symptoms and physiologic responses in generalized anxiety disorder and panic disorder: an ambulatory monitor study. Arch Gen Psychiatry 2004; 61: 913-921
65 Mantani N, Hisanaga A, Kogure T. et al. Four cases of panic disorder successfully treated with Kampo (Japanese herbal) medicines: Kami-shoyo-san and Hange-koboku-to. Psychiatry Clin Neurosci 2002; 56: 617-620
66 Lee B, Yun HY, Shim I. et al. Bupleurum falcatum prevents depression and anxiety-like behaviors in rats exposed to repeated restraint stress. J Microbiol Biotechnol 2012; 22: 422-430
67 Watanabe K, Goto Y, Yoshitomi K. Central depressant effects of the extracts of magnolia cortex. Chem Pharm Bull (Tokyo) 1973; 21: 1700-1708
68 Watanabe K, Watanabe H, Goto Y. et al. Pharmacological properties of magnolol and honokiol extracted from Magnolia officinalis: central depressant effects. Planta Med 1983; 49: 103-108
69 Kuribara H, Kishi E, Hattori N. et al. The anxiolytic effect of two oriental herbal drugs in Japan attributed to honokiol from magnolia bark. J Pharm Pharmacol 2000; 52: 1425-1429
70 Alexeev M, Grosenbaugh DK, Mott DD. et al. The natural products magnolol and honokiol are positive allosteric modulators of both synaptic and extra-synaptic GABA(A) receptors. Neuropharmacology 2012; 62: 2507-2514
71 Fuchs A, Baur R, Schoeder C. et al. Structural analogues of the natural products magnolol and honokiol as potent allosteric potentiators of GABA(A) receptors. Bioorg Med Chem 2014; 22: 6908-6917
72 Kagohashi K, Tamura T, Ohara G. et al. Effect of a traditional herbal medicine, hangekobokuto, on the sensation of a lump in the throat in patients with respiratory diseases. Biomed Rep 2016; 4: 384-386
73 Naito T, Itoh H, Takeyama M. Effects of Hange-koboku-to (Banxia-houpo-tang) on neuropeptide levels in human plasma and saliva. Biol Pharm Bull 2003; 26: 1609-1613
74 Saitoh K, Kase Y, Ishige A. et al. Effects of Keishi-ka-shakuyaku-to (Gui-Zhi-Jia-Shao-Yao-Tang) on diarrhea and small intestinal movement. Biol Pharm Bull 1999; 22: 87-89
75 Nobe K, Momose K, Sakai Y. Effects of Kampo medicine, keishi-ka shakuyaku-to (TJ-60) on alteration of diacylglycerol metabolism in gastrointestinal smooth muscle of diabetic rats. Acta Pharmacol Sin 2002; 23: 1173-1180
76 Kito Y, Teramoto N. Effects of Hange-shashin-to (TJ-14) and Keishi-ka-shakuyaku-to (TJ-60) on contractile activity of circular smooth muscle of the rat distal colon. Am J Physiol Gastrointest Liver Physiol 2012; 303: G1059-G1066
77 Mizuno S, Nagata K, Yoshida K. et al. Kabinsei-cho-shoukougun ni taisuru keishikashakuyakuto ekisu no chiryo kouka – mepenzolate bromide tono hikaku shiken. Shindan to Chiryo 1985; 8: 1143-1152 in Japanese
78 Haruta M, Inoue F, Mizushima T. Four cases of psychoses suffering from akathisia and psychotic symptoms effectively treated with Sanou-shashin-to. Nihon Toyo Igaku Zasshi (Japanese Journal of Oriental Medicine) 2000; 50: 665-672 in Japanese
79 Miyaoka T, Furuya M, Yasuda H. et al. Yi-gan san for the treatment of borderline personality disorder: an open-label study. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32: 150-154
80 Trull TJ, Sher KJ, Minks-Brown C. et al. Borderline personality disorder and substance use disorders: a review and integration. Clin Psychol Rev 2000; 20: 235-253
81 Bornovalova MA, Daughters SB. How does dialectical behavior therapy facilitate treatment retention among individuals with comorbid borderline personality disorder and substance use disorders?. Clin Psychol Rev 2007; 27: 923-943
82 Uchida H, Watanabe K, Suzuki T. et al. Two case reports of successful prevention of overdosing in borderline patients. Psychiatry 2005; 68: 179-182