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Orengedoku-to augmentation in cases showing partial response to yokukan-san treatment: A case report and literature review of the evidence for use of these Kampo herbal formulae

Authors

Okamoto, Hideki, Chino, Atsushi, Hirasaki, Yoshiro, Ueda, Keigo, Iyo, Masaomi, Namiki, Takao

Journal

Neuropsychiatric Disease and Treatment, Volume: 9

Year of Publication

2013

Abstract

Background: Yokukan-san, a Japanese traditional herbal (Kampo) prescription, has recently gathered increasing attention due to accumulating reports showing its remarkable efficacy in treating a wide variety of diseases refractory to conventional medicine as well as the behavioral and psychological symptoms of dementia. As yokukan-san has become broadly integrated with conventional medicine, augmentation therapy with other Kampo prescriptions has become necessary when the yokukan-san has been only partially efficacious. In this paper, we report three cases in which the addition of orengedoku-to, another Kampo formula, to yokukan-san was remarkably effective. Cases: Case 1 was an 85-year-old man with Alzheimer-type dementia who had become aggressive during the past 2 years. Three milligrams of aripiprazole completely suppressed his problematic behaviors but had to be stopped because of extrapyramidal symptoms. In the second case, a 44-year-old man with methamphetamine-induced psychosis had suffered from serious tardive dystonia for 2 years. No conventional approach had improved his tardive dystonia. The third case was a 29-year-old engineer who often failed to resist aggressive impulses and was diagnosed with intermittent explosive disorder. He was prescribed 5 mg of olanzapine, which did not suppress his extraordinary anger and caused somnolence even though the dose was low. Interventions and outcomes: Yokukan-san was complementarily added to the patients’ regular medication and exerted a definitive but partial effect in all cases. The addition of orengedoku-to to yokukan-san exerted the same efficacy as aripiprazole in controlling aggressiveness in Case 1, improved the tardive dystonia by 80% in Case 2, and was completely effective in controlling the patient’s aggressive impulses in Case 3. Conclusion: Together with empirical evidence demonstrating the effectiveness of both yokukansan and orengedoku-to in reducing irritability, impulsivity, and aggression, these three cases suggest that orengedoku-to augmentation can be an effective option in cases that are partially responsive to yokukan-san treatment. (PsycINFO Database Record (c) 2013 APA, all rights reserved). (journal abstract)

Keywords

alzheimer’s disease, ariprazole, case, dementia, dystonia, formulae, herbal, herbal prescription, japanese, kampo, medicinal herbs and plants, muscular disorders, prescription, series, traditional, treatment effectiveness, treatment effectiveness evaluation

Countries of Study

Japan

Types of Dementia

Alzheimer’s Disease

Types of Study

Other

Type of Outcomes

Behaviour

Type of Interventions

Pharmaceutical Interventions

Pharmaceutical Interventions

Antipsychotics and antidepressants, Herbal remedies, vitamins, dietary supplements