Sho-saiko-to, a prescription composed of seven crude drugs, is one of the most popular Kampo formulas in clinical use. Recently, the side effects of Sho-saiko-to have become an issue. To gain perspective on this problem, the authors searched the indications and pharmacological characteristics of the Sho-saiko-to as noted in ancient Chinese and Japanese medical texts.
Sho-saiko-to was first described in the ‘Shokanron’ (_??__??__??_); ‘Shang Han Lun’; ‘Treatise on Damaging Cold’), which contains are over ten references to this formula. It is recommended for a variety of conditions, but its most fundamental usage was for exogenous febrile diseases. The meaning of some of the indications are still somewhat vague.
In China, the crude drug composition and clinical use of Sho-saiko-to gradually changed over the years. In Japan, Sho-saiko-to has been in use since the Kamakura era. In the Edo era, it was mainly used for complaints of alternative spells of fever and chills, a feeling of fullness and discomfort in the chest and hypochondrium, lack of appetite and vomiting.
Sho-saiko-to has been in use for centuries and is still a very useful prescription. However, the classical medical texts also indicate that adverse reactions will result if this formula is not prescribed properly following accurate Kampo diagnosis.

Recently, there has been an increase in reports of allergic reactions to Kampo medicines. In order to elucidate the mechanisms of these so-called Kampo allergies, suitable methods are necessary to detect allergens in crude drugs and allergenspecific antibodies in sensitized individuals. In this study, methodology and sensitivity were studied using enzyme-linked immunosorbent assay and Western blot analysis. The antigens used were haptenized baicalin and high-molecular-weight components of Ginseng Radix, both derived from Shosaiko-to extract.
Attempts were also made to further identify antigens from Shosaiko-to and detect antigenspecific antibodies in immunized rabbits.

The authors investigated the activity of Kikyo-to on the intestinal hormones, cholecystokinin (CCK) and secretin, released in healthy humans. The clinical efficacy of Kikyo-to on the abdominal symptoms associated with chronic pancreatitis was also investigated. In healthy volunteers, Kikyo-to (5g) significantly increased plasma CCK and secretin concentrations 30 minutes after treatment. In chronic pancreatitis patients, abdominal pain, abdominal tenderness, nausea and diarrhea were decreased by treatment with Kikyo-to (7.5g/day; divided into three doses). In conclusion, Kikyo-to improved the complaints of chronic pancreatitis, especially abdominal pain. The presumed mechanism was that Kikyo-to stimulated pancreatic exocrine secretion by the release of intestinal hormones, CCK and secretin.

Risk factors for developing hemolytic uremic syndrome among patients with enterohemorrhagic Escherichia coli O157: H7 (EHEC) infection include age. The young, especially those under the age of five, face an increased risk, as do the elderly. In the present study, we evaluated the protective effects of Hochu-ekki-to (HET) on intraperitoneal infection with EHEC, using immunosuppressant, dexamethasone (Dex)-treated mice.
It was found that HET induced improvement of Dex-induced leukopenia. Similarly, the IgM-plaque forming cell responses to sheep red blood cell (SRBC) were restored by the administration of HET to the normal-mice level in Dex-treated mice. Consequently, HET was administered orally into the Dex-treated mice before infection with EHEC to observe the therapeutic effect. With the oral administration of 500mg/kg/head of HET into the Dex-treated mice, prolonged survival was shown: the 50% survival time in the HET-administered mice was four days, compared with one day in the non-administered controls. In addition, the number of bacteria in the liver was reduced by the administration of HET in the Dex-treated mice.
The results indicate that orally administered-HET protects against EHEC infection in Dex-treated mice, and such protective effects appear to be due to the restorative effects of HET against the Dex-induced immunosuppression.

A decline in the immunopotential of the host plays an essential role in the occurrence of infections with methicillin-resistant Staphylococcus aureus (MRSA) or other multi-drug resistant microorganisms. In the present study, mytomycin C (MMC)-treated mice with or without the infection of MRSA were used to examine the bacteriostatic action as well as the immunopotentiating action of the promising herbal medicine, Hochu-ekki-to (HET). Basic experimental data showed the drug to be effective in the treatment of MRSA infection. Eight to ten week old male C57BL mice were injected with MMC at a dosage of 5mg/kg/day to inhibit the bone marrow, thus creating a mouse model with reduced immunopotential. A powder extract of HET was administered orally at a dosage of 500mg/kg/day for seven consecutive days. For the infection of MRSA 1×10⁹ cell were injected intraperitoneally. Peritoneal macrophages were prepared by the adherence technique. Macrophage migration, phagocytic activity, and the bactericidal activity were examined by the Boyden chamber method, by the phagocytosis for fluorescent-activated latex beads, and by the nitroblue tetra zolium (NBT) reduction test, respectively.
After the administration of HET, the number of white blood cells in the MMC-treated mice recovered to 80% of the normal value. In addition, the phagocytic activity of macrophages increased to 50%, although that of the non-treated group was only 20%. The bactericidal activity also recovered to a level close to the normal value. The ratio of neutrophils in the HET administered MMC-treated group increased to 2.2% (normal mice, 2.6%) whereas that of the MMC-treated control group was 0.5%. Concerning the function of the immunological cells, IL-1beta and IFNgamma levels were recovered by treatment with HET, as observed by IL-1beta, IL-2 and IFNgamma monitoring. The bacterial count in the liver of the MRSA challenged mice, with or without HET administration peaked 6 hours after the challenge. The number of the group with HET administration was, however, much greater than that of the group without HET administration. The bacteria count in the blood showed an increase 12 and 24 hours after the challenge. Even 24 hours after the challenge, a significant number of bacterial cells existed in the blood of the group without HET administration, whereas only a small number of cells were detected 6 hours after the challenge. All of the control mice died 8 days after the MRSA challenge, whereas the survival rates were 60% for HET treatment, 40% for the vancomycin treatment, and 80% for the HET plus vancomycin treatment, respectively.
As we move towards a society with a high percentage of elderly people, the authors believe Chinese herbal medicine, which activates the immunopotential, will be very helpful in the treatment of opportunistic infections that are common among elderly patients.

Resistance to facultative intracellular bacterial pathogens depends on acquired cell-mediated immunity and activation of macrophages by T- lymphocytes. Gamma interferon (IFN-gamma) is believed to be an important mediator of acquired cell-mediated immunity. In the present study, we evaluated the effect of Hochu-ekki-to (HET) on the survival rate and cytokine production with Salmonella infection model by using EL-4-bearing C57BL/6 mice. 1) When HET was administered orally to the tumor-bearing mice, it extended the survival time compared with non-treated controls in experimental infection by virulent strain 116-54. 2) The effect of HET on production of IFN-gamma in cultured splenocytes was tested by using the tumorbearing mice immunized with attenuated live SER strain. Spleen cells prepared from the mice treated with HET produced high levels of IFN-gamma compared with non-treated controls.
The results indicated that orally administered-HET enhanced protective ability to primary Salmonella infection and production of IFN-gamma accompanied by vaccination in EL-4-bearing C57BL/6 mice.

Objectives: Infective endocarditis (IE) has an extremely poor prognosis unless appropriate treatment is received. Hemodialysis patients with IE show higher rates of morbidity and mortality in comparison with non-dialysis patients with IE. We focused on hemodialysis patients, as well as patients in other stages of chronic kidney disease. We sought to assess the relationship between renal function and mortality in patients with IE.
Methods: We carried out a retrospective cohort study on 45 consecutive patients with IE in an urban teaching hospital between November 2003 and August 2008. We collected demographic and clinical data as well as pre- and post-discharge outcomes. Patients were subdivided into four groups according to their eGFR level at admission: A: eGFR≧60 ml/min/1.73 m² (n=23); B: eGFR 30-59 ml/min/1.73 m² (n=15); C: eGFR<30 ml/min/1.73 m² (n=3); and, D: dialysis patients (n=3). It was not possible to determine the outcome status of one patient. The Trend Test was used to evaluate the association between renal function and mortality.
Results: There were 29 male and 16 female patients with IE and the mean age was 67.9+-17.6 (SD). There were 10 diabetic patients (22%). Thirty-nine patients (84%) were either discharged or transferred to another hospital. Seven patients (16%) died: two (9%) Group A patients; three (20%) Group B patients; no Group C patients; and, two (67%) Group D patients. Patients with lower eGFR had higher mortality rates (Trend Test, P=0.046).
Conclusion: We presume a trend towards a higher mortality rate in conjunction with advancing CKD stage.