Rikkunshito

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Rikkunshito
  Evaluated for:
Effectiveness Rating Effectiveness Rating
GI distress in cancer patients
+1(Slight Evidence)
Treatment of anorexia in dementia patients
0 (Unclear Effectiveness)

PRO

  • In 20 published trials of rikkunshito, most evidence showed a beneficial effect in patients suffering from various kinds of gastrointestinal distress, including loss of appetite, constipation, and generalized discomfort. These resulted from 1) gastrectomy, 2) loss of appetite due to advanced cancer and ascites (abdominal fluid), 3) functional bowel syndromes like constipation, and 4) loss of appetite due to chemotherapy with cisplatin.
  • Though not useful for nausea and vomiting, rikkunshito does appear to improve appetite, gastric motility, and overall gut function.
  • Rikkunshito improved heartburn in patients in whom conventional proton pump inhibitor medications (e.g., omeprazole, pantoprazole) were not effective.

CON

  • The studies of rikkunshito were small and probably of insufficient power to find important benefits or harms. The ability to draw broad conclusions from the data were hampered by different supplement sources, testing of different populations, and inconsistent outcome measures.
  • There have been no large randomized controlled trials, and a publication bias is likely. Long-term safety and drug interactions have not been clarified.

DOSAGE:Physicians who are familiar with this supplement will provide eligible patients with specific dosage recommendations.

CONCLUSION: If you use it, remember to include it in your list of medications when you visit your doctor and other health care providers.

REFERENCES
Takeda H, Muto S, Nakagawa K, et al. Rikkunshito as a ghrelin enhancer. Methods in enzymology. 2012;514:333-351.
Takeda H, Sadakane C, Hattori T, et al. Rikkunshito, an herbal medicine, suppresses cisplatin-induced anorexia in rats via 5-HT2 receptor antagonism. Gastroenterology. Jun 2008;134(7):2004-2013.
Arai T, Maejima Y, Muroya S, Yada T. Rikkunshito and isoliquiritigenin counteract 5-HT-induced 2C receptor-mediated activation of pro-opiomelanocortin neurons in the hypothalamic arcuate nucleus. Neuropeptides. Aug 2013;47(4):225-230.
Yada T, Kohno D, Maejima Y, et al. Neurohormones, rikkunshito and hypothalamic neurons interactively control appetite and anorexia. Current pharmaceutical design. 2012;18(31):4854-4864.
Yakabi K, Kurosawa S, Tamai M, et al. Rikkunshito and 5-HT2C receptor antagonist improve cisplatin-induced anorexia via hypothalamic ghrelin interaction. Regulatory peptides. Apr 9 2010;161(1-3):97-105.
Fujitsuka N, Asakawa A, Uezono Y, et al. Potentiation of ghrelin signaling attenuates cancer anorexia-cachexia and prolongs survival. Translational psychiatry. 2011;1:e23.
Ohno T, Yanai M, Ando H, et al. Rikkunshito, a traditional Japanese medicine, suppresses cisplatin-induced anorexia in humans. Clinical and experimental gastroenterology. 2011;4:291-296.
Matsumura T, Arai M, Yonemitsu Y, et al. The traditional Japanese medicine Rikkunshito increases the plasma level of ghrelin in humans and mice. Journal of gastroenterology. Mar 2010;45(3):300-307.
Hattori T. Rikkunshito and ghrelin. International journal of peptides. 2010;2010.
Arai M, Matsumura T, Yoshikawa M, Imazeki F, Yokosuka O. [Analysis of the Rikkunshito efficacy on patients with functional dyspepsia]. Nihon yakurigaku zasshi. Folia pharmacologica Japonica. Jan 2011;137(1):18-21.
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. Hepato-gastroenterology. Jan-Feb 2012;59(113):62-66.
Takiguchi S, Hiura Y, Takahashi T, et al. Effect of rikkunshito, a Japanese herbal medicine, on gastrointestinal symptoms and ghrelin levels in gastric cancer patients after gastrectomy. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. Apr 2013;16(2):167-174.
Uehara R, Isomoto H, Minami H, et al. Characteristics of gastrointestinal symptoms and function following endoscopic submucosal dissection and treatment of the gastrointestinal symptoms using rikkunshito. Experimental and therapeutic medicine. Nov 2013;6(5):1083-1088.
Tokashiki R, Okamoto I, Funato N, Suzuki M. Rikkunshito improves globus sensation in patients with proton-pump inhibitor-refractory laryngopharyngeal reflux. World journal of gastroenterology : WJG. Aug 21 2013;19(31):5118-5124.
Gunji S, Ueda S, Yoshida M, Kanai M, Terajima H, Takabayashi A. Effects of rikkunshito, a kampo medicine, on quality of life after proximal gastrectomy. The Journal of surgical research. Dec 2013;185(2):575-580.
Takahashi T, Endo S, Nakajima K, Souma Y, Nishida T. Effect of rikkunshito, a chinese herbal medicine, on stasis in patients after pylorus-preserving gastrectomy. World journal of surgery. Feb 2009;33(2):296-302.
Kusunoki H, Haruma K, Hata J, et al. Efficacy of Rikkunshito, a traditional Japanese medicine (Kampo), in treating functional dyspepsia. Internal medicine. 2010;49(20):2195-2202.
Tanaka K, Urita Y, Nara K, Miura O, Sugimoto M. Effects of the traditional Japanese medicine Rikkunshito on postprandial glucose and lipid metabolism. Hepato-gastroenterology. Jul-Aug 2011;58(109):1112-1118.
Kawahara H, Kubota A, Hasegawa T, et al. Effects of rikkunshito on the clinical symptoms and esophageal acid exposure in children with symptomatic gastroesophageal reflux. Pediatric surgery international. Oct 2007;23(10):1001-1005.
Tominaga K, Iwakiri R, Fujimoto K, et al. Rikkunshito improves symptoms in PPI-refractory GERD patients: a prospective, randomized, multicenter trial in Japan. Journal of gastroenterology. Mar 2012;47(3):284-292.
Tatsuta M, Iishi H. Effect of treatment with liu-jun-zi-tang (TJ-43) on gastric emptying and gastrointestinal symptoms in dyspeptic patients. Alimentary pharmacology & therapeutics. Aug 1993;7(4):459-462.
Shiratori M, Shoji T, Kanazawa M, Hongo M, Fukudo S. Effect of rikkunshito on gastric sensorimotor function under distention. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society. Apr 2011;23(4):323-329, e155-326.
Yagi M, Homma S, Kubota M, et al. The herbal medicine Rikkunshi-to stimulates and coordinates the gastric myoelectric activity in post-operative dyspeptic children after gastrointestinal surgery. Pediatric surgery international. Jan 2004;19(12):760-765.
Okuno S, Hirayama K, Inoue J, et al. [Effects of rikkunshito on the postoperative nausea and vomiting (PONV) after laparoscopic gynecological surgery]. Masui. The Japanese journal of anesthesiology. Dec 2008;57(12):1502-1509.  


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