As is evident from the Oriental Medical phrase “the mind and body are one”, the body and mind are thought to mutually influence each other. Based on this assumption, the authors studied the psychotropic effects of Kampo formulas that are commonly used for physical disorders. The effects were rapid and remarkable. However, just as individual Kampo formulas are effective for specific organs, the effect of each formula was found to be limited to a certain mental state. Since each mental state was thought to correspond to one of the elements in the Five Element theory there were five mental states identified, i. e.: 1. Will, 2. Anxiety, 3. Irritation, 4. Manic mood, 5. Sociability. Tonifying Kampo formulas seemed to affect two states, one of which was suppressed. The Mutually Destructive Aspects (Sokoku) of the Five Element theory was useful in explaining this. Further studies were made of the psychotropic effects of one Kampo formula, Hachimi-jio-gan. The results indicated that Hachimi-jio-gan had the mutually opposing psychotropic effects of facilitating the will and suppressing the irritation. From these results and the study of various other Kampo formulas, it was suggested that the Mutually Destructive Aspects of the Five Element theory may be useful in gaining an understanding of their psychotropic effects.
In this study, since we were afraid that the psychotropic effects of Hachimi-jio-gan might be due to the presence of Aconiti Tuber, it was removed from the formula, along with the Cinnamomi Cortex. The effects of the remaining formula, Rokumi-gan, were then studied. Twelve patients suffering mainly from depressive neurosis were given Rokumi-gan, and the five mental states evaluated. The states affected were thought to be the loss of will and irritation. After two weeks (four weeks), the efficacy rates were 66.7% (91.7%) and 66.7% (83.3%), but after four weeks, slight mood deterioration (depression) was seen in five of the twelve cases.
Long administration of such tonifying formulas seemed to bring about another improvement without the two mental states. From these findings and a summary of the results obtained from this stuby, the Mutually Creative Aspects (Sosei) of the Five Element theory seems to be useful after the 2-4 week point. In addition, from the study of many formulas, the psychotropic effect of Aconiti Tuber was thought to be a tonifyer of the Five element. Some observations were also made concerning the mutual relationship between the Yin/Yang Deficient/Excessive table and the Five Element theory.
*1 The Five Element theory: In ancient China, the universe was thought to consist of five elements. Mental states were also considered to correspond to the five elements. The five elements are: Wood (Moku), Fire (Ka), Earth (Do), Metal (Kon) and Water (Sui).
*2 The Mutually Destructive Aspect of the Five Element theory: The five elements were thought to have a special relationship. Wood suppresses Earth, Fire suppresses Metal, Earth suppresses Water, Metal suppresses Wood and Water suppresses Fire. This relationship keeps the universe in balance.

BACKGROUND/AIMS: The pharmacokinetics of tacrolimus (TAC) is known to be largely influenced by single-nucleotide polymorphisms (SNPs) in CYP3A5. Patients starting TAC require careful dose adjustment, owing to the wide range of optimal dosages, depending on their CYP3A5 expression status. Here, we evaluated whether individualization of TAC dosages based on CYP3A5 SNPs would improve its therapeutic efficacy in ulcerative colitis. METHODS: Twenty-one patients were prospectively treated, with their initial dosage adjusted according to their CYP3A5 status (0.1, 0.15, and 0.2 mg/kg/day for CYP3A5*3/*3, CYP3A5*1/*3, and CYP3A5*1/*1, respectively). Their clinical outcomes were compared with those of patients treated with a fixed dose (0.1 mg/kg/day). RESULTS: The first blood trough level of CYP3A5 expressors, CYP3A5*1/*3 or CYP3A5*1/*1, and the overall rate in achieving the target blood trough level within a week in the individualized-dose group were significantly higher than those in the fixed-dose group (5.15±2.33 ng/mL vs. 9.63±0.79 ng/mL, P=0.035 and 12.5% vs. 66.7%, P=0.01). The remission rate at 2 weeks in the expressors was as high as that in the nonexpressors, CYP3A5*3/*3, in the individualized-dose group. CONCLUSIONS: Individualized TAC treatment is effective against ulcerative colitis regardless of the CYP3A5 genotype.
Colitis, Ulcerative ; Cytochrome P-450 CYP3A ; Genotype ; Humans ; Pharmacokinetics ; Polymorphism, Single Nucleotide ; Prospective Studies ; Tacrolimus ; Ulcer

Objective: In patients with specific backgrounds, comprehensive identification of health problems and proactive pharmacist intervention are crucial to providing safe and effective medical care. However, there are insufficient reports on chemotherapy regimen selection and supportive care management in patients taking immunosuppressants. In this study, to circumvent adverse events, pharmacists intervened with a patient administering tacrolimus (TAC) using known information, focusing on multiple factors attributable to the patient in addition to drug interactions.Methods: The patient was a male in their 70s who received palliative chemotherapy for gastric cancer during their dermatomyositis treatment with TAC. Pharmaceutical support for cancer chemotherapy was provided using the following four procedures: (1) Patient information was collected from interviews and electronic medical records to identify patient-specific problems; (2) Basic pharmacological information was collected from tertiary sources, focusing on the interaction between TAC and aprepitant (APR). Furthermore, clinical reports were collected, and the pharmacokinetic drug interaction significance classification system was used for quantitative predictions; (3) The information obtained in steps 1) and 2) was evaluated, and comprehensive proposals linked to the patient information were presented; (4) Adverse events, TAC blood level, and patient outcomes were monitored after treatment initiation.Results: A chemotherapy regimen consisting of S-1/oxaliplatin therapy without APR was selected. The adverse effects were controllable, and the treatment was completed without many adverse events. Meanwhile, TAC adherence was unaffected by cancer chemotherapy, and the TAC blood concentration or dose ratios were controlled within the same range as previously reported.Conclusion: In cancer chemotherapy, for cases with limited evidence or information, comprehensive pharmaceutical support was provided using known patient information, considering multiple patient factors. This report is beneficial as an example of supportive care management by a pharmacist and contributes to providing optimal service in cases with specific backgrounds.