A Kampo formulation: Byakko-ka-ninjin-to (Bai-Hu-Jia-Ren-Sheng-Tang) inhibits IgE-mediated triphasic skin reaction in mice: the role of its constituents in expression of the efficacy

Effect of glucoglycyrrhizin on IgE-mediated immediate hypersensitivity in mice

To evaluate the pharmacological property of glucoglycyrrhizin (GGL), a unique glycoside of glycyrrhetinic acid (GA), we investigated the anti-allergic effect of GGL on IgE-mediated immediate hypersensitivity in mice. GGL exhibited the antiallergic effect against IgE-mediated immediate hypersensitivity. At a dose of 100 mg/kg, GGL exhibited antiallergic activity equivalent to that of glycyrrhizin (GL). Furthermore, the pretreatment with anti-GA monoclonal antibody eliminated the antiallergic action of GGL. These results indicated that GGL may act in the same way as GL in the human body. Its safety should be verified for its use as a drug similar to GL.

Therapeutic Benefit in Allergic Dermatitis Derived from the Inhibitory Effect of Byakkokaninjinto on the Migration of Plasmacytoid Dendritic Cells

Dendritic cells (DCs) are well known to be essential immunocytes involved in innate and adaptive immunity. DCs are classified as conventional dendritic cells (cDCs) and plasmacytoid dendritic cells (pDCs). Recently, the accumulation of pDCs in inflamed tissues and lymphoid tissues has been considered to be a possible contributing factor in the development of immunological diseases, but little is known about the pathophysiological roles of pDCs in immunological diseases. To date, many studies have demonstrated that many kinds of Kampo formulas can regulate immunological reactions in human immune diseases. Thus, we screened Kampo formulas to identify an agent that inhibits pDC migration. Furthermore, we investigated the therapeutic effects of these formulas on a murine DNFB-induced allergic contact dermatitis model. Bone marrow-derived pDCs (BMpDCs) were derived from the bone marrow cells of BALB/c mice in a culture medium with Flt3 ligand. The effects of Kampo formulas on BMpDC migration were evaluated by assessing the number, velocity, and directionality of BMpDCs chemotaxing toward the more concentrated side of a chemokine (C-C motif) ligand 21 (CCL21) gradient. The Kampo formulas that exerted inhibitory effects on pDC migration were orally administered to DNFB-induced allergic contact dermatitis model mice. Byakkokaninjinto reduced the number of migrated BMpDCs and suppressed the velocity and directionality of BMpDC migration in a chemotaxis assay. Gypsum Fibrosum and Ginseng Radix, which are components of byakkokaninjinto, obviously suppressed the velocity of BMpDC migration. Furthermore, Gypsum Fibrosum significantly suppressed the directionality of BMpDC migration. In DNFB-induced allergic contact dermatitis model mice, byakkokaninjinto markedly abrogated ear swelling in late-phase allergic reactions. In conclusions, byakkokaninjinto, which has an inhibitory effect on pDC migration, was able to prevent the occurrence of allergic contact dermatitis, suggesting that pDCs were involved in the onset of allergic contact dermatitis in the mouse model. Therefore, byakkokaninjinto is anticipated to be a therapeutic agent for disorders related to pDC migration.

Counteractive effect of Paeonia lactiflora root constituent mudanpioside E against suppressive effect of Shoseiryuto-extract on passive cutaneous anaphylaxis reaction in mice

ETHNOPHARMACOLOGICAL RELEVANCE

Shoseiryuto-extract (SST) is a herbal formula of Japanese traditional kampo medicine used to treat perennial nasal allergy, rhinitis, and bronchial asthma. SST contains eight crude drugs, and is registered in the 16th Edition of Japanese Pharmacopoeia. Previous studies reported anti-allergic effects of SST, but the contribution of the eight crude drugs in SST on these effects has not been evaluated. In the present study, we evaluated the contribution of the eight crude drugs in SST on anti-allergic effect using passive cutaneous anaphylaxis (PCA) reaction in mice.

MATERIALS AND METHODS

The mixture of crude drugs was decocted in water and lyophilized to prepare SST. To evaluate the active ingredients, compositions of crude drugs were modified and decocted. The PCA reaction was induced by intravenous injection of ovalbumin (OVA) and Evans blue 48 h after intracutaneous injection of anti-OVA serum in mice ears. The crude drug extract was orally administered to overnight-fasted mice 2h before induction of the PCA reaction. Ears were removed 30 min after induction, and the amount of Evans blue present was measured.

RESULTS

Oral administration of SST suppressed the PCA reaction in a dose-dependent manner. Among the eight crude drugs comprising SST, Asiasarum root, Pinellia tuber, and Glycyrrhiza contributed positively, and Peony root contributed negatively to the anti-allergic effects of SST. We isolated mudanpioside E from the extract of Peony root as the counteracting ingredient to exhibit the anti-allergic effects of Peony root-depleted SST.

CONCLUSIONS

When we used SST for the treatment of allergic diseases, removal of Peony root from the traditional formula could augment its effect.

Interaction of gypsum and the rhizome of Anemarrhena asphodeloides plays an important role in anti-allergic effects of byakkokakeishito in mice

Gypsum is a crude mineral drug used in the formulas of Japanese kampo medicine and traditional Chinese medicine. The present study aimed to evaluate the anti-allergic effect of byakkokakeishito extract (BKT), which consists of gypsum (natural hydrous calcium sulfate), Anemarrhena Rhizome (rhizome of Anemarrhena asphodeloides), Cinnamon Bark (bark of trunk of Cinnamomum cassia), Oriza Seed (seed of Oryza sativa), and Glycyrrhiza (root and stolon of Glycyrrhiza uralensis), and to clarify the role of gypsum in the formula. We prepared BKT by boiling a mixture of various quantities of gypsum and fixed amounts of the other four crude drugs in water. We evaluated the anti-allergic activity of the formulations using three different murine models of allergy: contact dermatitis induced by painting hapten onto skin; allergic dermatitis-like symptoms induced by cutaneous injection of mite-antigen; and skin passive cutaneous anaphylaxis (PCA) reaction using ovalbumin as antigen. The calcium content in the various BKT samples was dose-dependently increased up to 60 g/day of human dosage. BKT significantly suppressed the allergic symptoms in the three different experimental models. The effect of BKT was augmented by increasing the gypsum dosage only in the PCA reaction model. The extract prepared from a mixture of Anemarrhena Rhizome and gypsum exhibited an effect comparable to that of BKT. BKT exhibits an anti-allergic effect in several animal models, which may provide experimental evidence for the clinical use of BKT in allergic diseases. Gypsum may augment the anti-allergic activity of BKT, presumably through increasing intestinal absorption of Anemarrhena Rhizome-derived active constituents.

Ginseng in traditional herbal prescriptions

Panax ginseng Meyer has been widely used as a tonic in traditional Korean, Chinese, and Japanese herbal medicines and in Western herbal preparations for thousands of years. In the past, ginseng was very rare and was considered to have mysterious powers. Today, the efficacy of drugs must be tested through well-designed clinical trials or meta-analyses, and ginseng is no exception. In the present review, we discuss the functions of ginseng described in historical documents and describe how these functions are taken into account in herbal prescriptions. We also discuss the findings of experimental pharmacological research on the functions of ginseng in ginseng-containing prescriptions and how these prescriptions have been applied in modern therapeutic interventions. The present review on the functions of ginseng in traditional prescriptions helps to demystify ginseng and, as a result, may contribute to expanding the use of ginseng or ginseng-containing prescriptions.

Sho-saiko-to-ka-kikyo-sekko as an alternative treatment for chronic tonsillitis to avoid surgery

Sho-saiko-to-ka-kikyo-sekko (TJ-109) is composed of 9 herbs (gypsum, Bupleurum root, Pinellia tuber, Scutellaria root, Platycodon root, jujube fruit, ginseng root, Glycyrrhiza root, and ginger rhizome). It is a folk medicine that has been used to treat pharyngitis or acute tonsillitis. The efficacy of TJ-109 for treating patients with chronic tonsillitis was investigated. Ten outpatients who experienced chronic tonsillitis for more than 2 years were recruited. TJ-109 was prescribed, and after one year of daily treatment the incidence of acute tonsillitis before and after the treatment was compared. The incidence of acute tonsillitis due to chronic tonsillitis decreased in all 7 patients who were followed up. No adverse events were observed in any of the patients. In conclusion, the herbal medicine TJ-109 effectively reduced the incidence of acute tonsillitis. In some cases, planned tonsillectomy was avoided.

Pharmaceutical evaluation of liquorice before and after roasting in mice

Liquorice has been used for allergic-inflammatory and liver disorders in both traditional Chinese and modern medicine. In traditional Chinese formulations, it is mainly roasted liquorice that has been used rather than un-roasted liquorice. We have compared the pharmaceutical characteristics of liquorice before and after roasting to clarify the pharmaceutical significance of the roasting. Although roasted liquorice contained less glycyrrhizin (an anti-allergic component) than un-roasted liquorice, the inhibitory potency of roasted liquorice extract (200 mg kg−1) on immunoglobulin E (IgE)-mediated triphasic ear swelling in mice was much greater compared with un-roasted liquorice. To search for additional active ingredients, roasted liquorice extract was subjected to gel-chromatography to give an anti-allergic fraction (Fa) of molecular weight ranging from 15000 to 200000 or more, in which glycyrrhizin was not detected. By testing the activity of the various fractions, it was proved that the anti-allergic effect of roasted liquorice was due to glycyrrhizin, its metabolite glycyrrhetic acid, and the Fa fraction. The inhibitory potency of the Fa fraction (15 and 75 mg kg−1) prepared from roasted liquorice was stronger than that prepared from un-roasted liquorice. Therefore, a pharmaceutical implication of roasting the liquorice seems to be associated with an increase in the anti-allergic property of the Fa fraction. It is notable that oral administration of the high molecular mass fraction (Fa) significantly inhibited IgE-mediated ear swelling six days after challenge at doses as low as 3, 15 or 75 mg kg−1.

An Alternative Approach to Atopic Dermatitis: Part I-Case-Series Presentation

Atopic dermatitis (AD) is a complex disease of obscure pathogenesis. A substantial portion of AD patients treated with conventional therapy become intractable after several cycles of recurrence. Over the last 20 years we have developed an alternative approach to treat many of these patients by diet and Kampo herbal medicine. However, as our approach is highly individualized and the Kampo formulae sometimes complicated, it is not easy to provide evidence to establish usefulness of this approach. In this Review, to demonstrate the effectiveness of the method of individualized Kampo therapy, results are presented for a series of patients who had failed with conventional therapy but were treated afterwards in our institution. Based on these data, we contend that there exist a definite subgroup of AD patients in whom conventional therapy fails, but the ‘Diet and Kampo’ approach succeeds, to heal. Therefore, this approach should be considered seriously as a second-line treatment for AD patients. In the Discussion, we review the evidential status of the current conventional strategies for AD treatment in general, and then specifically discuss the possibility of integrating Kampo regimens into it, taking our case-series presented here as evidential basis. We emphasize that Kampo therapy for AD is more ‘art’ than technology, for which expertise is an essential pre-requisite.

Pharmaceutical evaluation of Glycyrrhiza uralensis roots cultivated in eastern Nei-Meng-Gu of China

To clarify the feasibility of medicinal use of the cultivated Glycyrrhiza resources, the equivalency between the G. uralensis roots cultivated in eastern Nei-Meng-Gu of China and medicinal licorice (Glycyrrhizae Radix, Gancao in Chinese and Kanzo in Japanese) was examined. The HPLC fingerprint including glycyrrhizin (GL) of the cultivated roots was similar to that of medicinal Gancao, but different from that of non-medicinal Xinjiang-Gancao (Shinkyo Kanzo in Japanese). Similarity between the cultivated roots and two medicinal Gancao was confirmed quantitatively by hierarchical cluster analysis on the basis of HPLC-7-peak-area data. Moreover, the 4-year-old adventitious roots conformed to the five standards described in the Japanese Pharmacopoeia XIV (JP XIV). The 4-year-old adventitious roots had similar pharmaceutical properties to those of medicinal Dongbei-Gancao (Tohoku Kanzo in Japanese) as determined by examining IgE-mediated triphasic skin reaction in mice and pharmacokinetic profile of glycyrrhetic acid, an anti-allergic metabolite of GL. The present pharmaceutical study suggests that the 4-year-old adventitious roots of G. uralensis cultivated in eastern Nei-Meng-Gu of China are comparable to medicinal Gancao conforming to the JP XIV, and may be a potential medicinal source to compensate for the insufficiency of wild Glycyrrhiza plants caused by collection restriction in China.