Patients with cancer cachexia often suffer from psychiatric disorders, severe nausea and vomiting. In the present study, we investigated the changes in monoaminergic activities in the brain in tumor-bearing mice (cachectic clone 20). The dopamine turnover rate in clone-20 mice was decreased markedly, and in contrast, the serotonin and histamine turnover rates were significantly increased. It is concluded that some of the psychiatric disorders in cachectic patients might be ascribable to changes in monoaminergic activities in the brain. The serotonin content of the small intestine in clone-20 mice increased significantly; this was associated with an increase in tryptophan hydroxylase activity. In addition, the increase in histidine decarboxylase (HDC) activity in the spleen occurred in clone 20 mice, and this histamine metabolism might modify the immune status in cancer-burden patients. Serum levels of interleukin-6 (IL-6) and granulocyte-macrophage colony-stimulating factor (GM-CSF) were significantly elevated in clone 20 mice, and these increased inflammatory cytokines might be partly responsible for the changes of monoamine turnover in the brain, in the gut and in the spleen.

Orengedokuto, a Kampo formulation, has traditionally been used to treat various diseases, including hypertension with neuropsychiatric symptoms, gastritis, dermatitis, hematemesis and hemorrhagic stools. We report 8 cases of intractable hemorrhage that could not be controlled by Western medicine, but were successfully treated with orengedokuto. We elaborate on 3 cases, including 1 case treated by enema administration of orengedokuto, which was found to be a useful method. In a representative case, an 80-year-old man with aplastic anemia who was taking anticoagulants due to a history of mitral valve replacement presented with a chief complaint of black stool. Hemorrhagic gastritis was diagnosed. We repeatedly attempted endoscopic hemostatic therapy, but failed to achieve hemostasis. Oral administration of orengedokuto demonstrated hemostatic effects within a few days of starting treatment. In all 8 these cases, moreover, we observed quick clinical responses with no side effects. Although the hemostatic mechanism of orengedokuto remains unclear, we speculate that orengedokuto contains a short-acting component that affects primary hemostasis. As such, conventional orengedokuto may also have potential as a novel hemostatic agent.