Potential usefulness of the kampo medicine yokukansan, containing uncaria hook, for paediatric emotional and behavioural disorders: a case series

A cross-sectional survey of clinical factors that influence the use of traditional Korean medicine among children with cerebral palsy

Background

Traditional Korean medicine (TKM) is widely used to treat children with cerebral palsy (CP) in Korea; however, studies investigating factors that influence the use of TKM are scarce. Thus, we investigated the clinical factors that might influence the use of TKM.

Methods

A population-based, cross-sectional, multicenter survey was performed from August 2014 to May 2016. The history of TKM use, type and severity of CP, current treatment characteristics, presence of accompanying disabilities or other health problems not directly related to CP, and monthly cost for the treatment of CP were surveyed.

Results

In total, 182 children were recruited, and 78 children (42.9%) had used TKM. Among these 78 children, 50 (64.1% of the TKM-use group) had used both acupuncture and herbal medication, 15 (19.2%) had used acupuncture only, and 13 (16.7%) had used herbal medication only. Children with non-typical CP, accompanying disabilities and general health problems tended to use TKM. The monthly cost of treatment for CP was significantly higher in the TKM-use group than that in the no-TKM-use group, suggesting that economically disadvantaged children may have difficulty in accessing TKM. Dietary supplements, conventional pharmacological treatments, and rehabilitation therapies did not affect TKM use.

Conclusion

Children with non-typical symptoms or those with poor overall health status are likely to use TKM. Additionally, TKM use leads to increased treatment costs. Studies investigating the motivation for starting or ceasing TKM therapy, socioeconomic factors and the attitude of parents towards complementary and alternative medicine should be performed.

Mice Behavioral Phenotype Changes after Administration of Anani (Symphonia globulifera, Clusiaceae), an Alternative Latin American and African Medicine

Background:

Anani, (Symphonia globulifera, Clusiaceae), known as chewstick, is a traditional plant occurring in Africa and in Central and South Americas that is used against parasites and microorganisms. Although its use is popular in some of these countries, there is a lack of information related to its influence over behavioral phenotype (BP).

Objective:

The objective of this study is to evaluate the influence of the administration of the extract obtained from the aerial organs of Anani (EB1257) to male Balb-c mice over BP.

Materials and Methods:

Open cage observation, open field, and elevated-plus maze apparatuses were used. Evaluations were done 15, 30, 60, 120, and 180 min after intraperitoneal administration of Anani extract.

Results:

Impairment of general behavior activity, response to touch, tail squeeze, defecation, locomotion and rearing frequency were observed although no signs of hemorrhage or macroscopical alterations of internal organs. Anani is harmful, but not toxic if used in the appropriate doses, yet to be determined to male mice. Impairment of locomotion and defecation was observed, indicating some degree of influence over locomotion, but no alterations in anxiety levels were assessed. Three compounds were previously found in the plant-lupeol (1), β-amyrin (2) and 3-β-hydroxyglutin-5-ene (3), and one is being described for the first time to occur in the species: oleanolic acid (4).

Conclusions:

The present work contributes in the support of the rational use of Anani, an important Latin American and African alternative medicine, presenting findings that are being reported for the first time.

SUMMARY

Symphonia globulifera impairs locomotion and defecatin in behavior analyses

No alterations in anxiety was observed

Oleanolic acid occurs in the species.

Abbreviations used: BP: Behavioral phenotype; OF: Open field, EPM: Elevated-plus maze, MMA/ICMBio/SISBIO: Ministério do Meio Ambiente/Instituto Chico Mendes de Conservação da Biodiversidade/Sistema de Autorização e Informação em Biodiversidade, IBAMA/MMA/CGen: Instituto Brasileiro do Meio Ambiente e dos Recursos Naturais Renováveis/Ministério do Meio Ambiente/Conselho de Gestão do Patrimônio Genético, AM: Amazonas State, UNIP: Universidade Paulista, mg: milligram, kg: kilogram, I.P: Intraperitoneal, CEUA/ICS/UNIP: Comissão de Ética no Uso de Animais/Instituto de Ciências da Saúde/Universidade Paulista, LD: Lethal dose, NLD: Nonlethal dose, GBA: General behavior activity, FCHCL₃: Fraction chloroform, FBuOH: Fraction buthanol, FH₂O: Fraction water, FrHEX: Fraction hexane, FrDCM: Fraction dichloromethane, FrMeOH: Fraction methanol, ¹³C NMR: Carbon nuclear magnetic resonance, EPA: United States Environmental Protection Agency.

Herbal medicine for management of the behavioural and psychological symptoms of dementia (BPSD): A systematic review and meta-analysis

Management of the behavioural and psychological symptoms of dementia remains a challenge worldwide. Herbal medicines may play a role in the development of new interventions. To determine effects of herbal medicines for management of the behavioural and psychological symptoms of dementia, meta-analysis was conducted of 31 controlled trials (3613 participants). Frequently tested herbal medicines were the Ginkgo biloba leaf extract EGb 761 (seven studies) and the multi-ingredient formula Yokukansan (eight studies). Sixteen studies tested other herbal medicines. Improvements were detected in Neuropsychiatric Inventory scores in EGb 761 groups compared to placebo (MD -3.46 [-5.94, -0.98]; I² = 93%; n = 1757) and Yokukansan groups compared to no treatment (SMD -0.53 [-0.86, -0.21]; I² = 0%; n = 150). Cognitive scores were improved in EGb 761 groups while Yokukansan did not appear to affect cognitive function. Of the other herbal medicines, there were improvements in the behavioural and psychological symptoms of dementia and cognitive outcomes in two of four placebo-controlled studies. EGb 761 and Yokukansan appeared safe and well tolerated. Adverse effects and dropouts were not reported consistently for the other herbal medicines. Weaknesses of these included short durations, small sample sizes, lack of blinding and other risks of bias. Well-designed studies are needed to further investigate the reported effects of these interventions on the behavioural and psychological symptoms of dementia.

The role of the seven crude drug components in the sleep-promoting effect of Yokukansan

ETHNOPHARMACOLOGICAL RELEVANCE

Yokukansan is a traditional Japanese "Kampo" medicine derived from Yi-Gan San in traditional Chinese medicine. Many studies have been published on its effects and mechanisms. In this study, we focused on the sleep-promoting effects of Yokukansan.

AIM OF THE STUDY

Yokukansan composes of seven crude drugs: Uncaria Hook, Bupleurm Root, Cnidium Rhizome, Japanese Angelica Root, Poria Sclerotium, Atractylodes Lancea Rhizome, and Glycyrrhiza. Although each has distinctive effects in isolation, they combine to work as a sleep aid in the Yokukansan formula. We examined the roles of the seven crude drug components in the sleep-promoting effect of Yokukansan.

MATERIAL AND METHODS

In this study, we used an easy in vivo assay method which we developed previously to screen sleeping substances using thermography. This assay method focuses on the decrease in skin temperature of mice during sleep inducement.

RESULTS

By administering the crude drug components of Yokukansan one at a time, it was possible to separate them into two groups: those that caused a decrease in body temperature (Uncaria Hook, Bupleurm Root, Cnidium rhizome, and Japanese Angelica root) and those that did not (Poria Sclerotium, Atractylodes Lancea Rhizome, and Glycyrrhiza). Accordingly, it was thought that the crude drugs causing a drop in body temperature were responsible for promoting sleep, while those in the other group would have no such effect in isolation. To investigate whether the crude drugs that did not cause a decrease in body temperature might be unnecessary for the sleep-promoting effect of Yokukansan, a number of decoctions were prepared using only six of the seven crude drug components, excluding a different crude drug in each case. Results showed that when any of the three components (Poria Sclerotium, Atractylodes Lancea Rhizome, or Glycyrrhiza) of Yokukansan that had no effect on body temperature in isolation were removed from Yokukansan, the resulting extract no longer had any of Yokukansan's sleep-promoting effects. This result suggested that these three crude drug components were involved indirectly in the activity of Yokukansan, by supporting other crude drugs. The interactions of the three supporting crude drugs were then examined further. As a result, a combination of Poria Sclerotium, Atractylodes Lancea Rhizome, and Glycyrrhiza was found to cause a decrease in body temperature, even though none of the three crude drugs had this effect in isolation. When an extract prepared by infusing the three crude drugs together was tested alongside extracts made by infusing the three crude drugs separately, the latter showed no effect and there were differences between the two in constituent analysis by HPLC. These results indicate that some reactions may occur during extraction.

CONCLUSIONS

Results of this study show that all crude drug components of Yokukansan contribute to its sleep-promoting effects. This is the first report to show the role of the seven clude drug components in the sleep-inducing effects of Yokukansan.