paper on the
use in Japan of Dai-kenchu-to (DKT; Tsumura product TJ-100) to treat post-operative
ileus (paralysis of the intestinal tract) was presented at this year's meeting
of the American Gastroenterological Association, which took place in Washington,
D.C. May 11-14. Written by Professor T. Nakamura and his colleagues at Teikyo
University's Department of Internal and Digestive Tract Medicine, the paper
examined the mechanisms by which DKT and its constituent herbs - Ginseng
Root, Zanthoxylum Fruit and Dried Ginger Rhizome - work on paralytic ileus.
The Teikyo University study showed that the DKT presription had a close dose-dependent relaxing effect on the upper digestive tract (the smooth muscle of the fundus of the stomach) and that it also caused dose-dependent contraction of the lower digestive tract (the smooth muscle of the large intestine). One of DKT's constituent crude drugs, Zanthoxylum Fruit, also contracted the smooth muscle of the large intestine in a dose-dependent manner, but with less potency than did the whole DKT prescription.
In recent years, DKT has been prescribed in Japan for treating abdominal pain and fullness, as well as for ileus and its characteristics, i.e., abnormalities in bowel movement and difficulty in passing gas. Its utility for these conditions has been endorsed by gastrointestinal surgeons as well as gastroenterologists, obstetricians and urologists.
The spotlight was also on DKT at the 10th Symposium on Japanese Kampo Therapeutics, held in Tokyo in February of this year, where a session was devoted to "Impediments to Intestinal Peristalsis and Dai-kencho-to."
One of the major presentations at the session was made by Dr. Mitsugu Sugiyama, Director of the Lifesaving & Emergency Center at Yokohama Municipal University. According to Dr. Sugiyama's report, 5 grams of DKT dissolved in about 20 ml of lukewarm water was administered to 52 patients at 11 centers over a period of five days. Within two days after starting the medicine, 85% of the patients were able to pass gas. Moreover, after five days, abdominal fullness symptoms improved by 76.6%, abdominal pains by 78.2% and nausea and vomiting by 90.5%. When measured by x-ray, the rate of improvement was 76.1%, and diarrhea, which is considered beneficial in treatment of ileus, started in 66.7% of the patients. Based on these results, Dr. Sugiyama reported that the combined use of decompression therapy and DKT was effective for treatment of post-operative adhesive ileus.
Another paper, presented by Yoshiyuki Furukawa, a lecturer at Tokyo Jikei Medical College, reported on a study of the effectiveness of DKT for post-operative ileus patients. The 69 participating patients were divided into two groups, one receiving DKT and the other not. The results of the study confirmed that patients receiving DKT had a significant reduction in the number of days before oral ingestion could resume as well as in the number of days of hospitalization.
Good results were also reported in patients undergoing hysterectomy by Dr. Takashi Morita and his colleagues at Beppu National Hospital. A total of 58 patients were divided into one group of 28 receiving DKT and another of 30 who did not. Fourteen (50%) of the patients who received DKT passed gas within 36 hours of surgery as opposed to only eight (26%) of those not receiving DKT. In addition, the passage of gas occurred significantly sooner - about 10 hours - with those who received DKT.
Results in animal experiments help to explain some of these clinical observations. For example, it was observed in an experiment with four mixed-breed dogs that administration of DKT stimulated contraction of the stomach, duodenum and jejunum, whether the dogs had recently eaten or not. The administration of a physiological saline solution under these conditions served as a control and had no such effect. Since the stimulatory effect of DKT was eliminated by anesthetizing the mucous membrane with xylocaine, it was inferred that DKT acted directly on the mucous membrane to stimulate peristalsis.
In fiscal 1996, sales of DKT in Japan increased by 16% over the previous year to reach approximately 15 million, making it the 10th largest-selling Kampo prescription. The increase in Japan is particularly remarkable since it occurred at a time when overall drug sales have become static as a result of the government's attempts to reduce healthcare costs.
According to a survey conducted in fiscal 1996 by the Nikkei Medical Journal, ileus ranked as the number 10 condition for which doctors under 50 years of age most commonly prescribed Kampo medicine. The use of Kampo for post-operative patients indicates that Kampo can no longer be viewed simply as therapy for those with chronic illnesses.