and value for each patient. Most reliable scientific proofs are obtained by
re-evaluation of kampo extract preparations, objective clinical study and the
importance of universality. When looking at EBM for kampo medicines,
balance and harmonisation between both judgements are important for
practical medical care.
The Japanese Society for Oriental Medicine has selected 95 EBM reports
of kampo treatment, which were based on shodiagnosis and evaluation
items in modern medicine, from the peer-reviewed published papers of the
clinical studies of kampo medicines.^28 These EBM reports have been gathered
for a variety of formulae.
Safety
Side effects of kampo medicines
If the shodiagnosis was correct, and the correct formulation was given to
the patient, kampo medicines show relatively lower adverse reactions
compared with western medicines. However, kampo medicines are also
drugs, so they must be considered to have certain side effects depending on
how they are used.
Furthermore it is important to note that, after taking kampo medicines,
unexpected adverse drug reactions (ADRs) may happen before the symp-
toms improve. Some component herbs are known to cause ADRs depending
on inappropriate use as follows.
Ephedrae herba
Ephedrae herbacontains the adrenergic ephedrine, which activates both
the sympathetic and central nervous systems, and may produce unwanted
symptoms such as insomnia, palpitations, rapid pulse, excitement, elevation
of blood pressure, hyperhidrosis, and dysuria. Therefore E.herbamust not
be used in patients who have ischaemic heart disease or angina pectoris.
Kampo formulae containing E.herbaare also generally not suitable for
older people.
Glycyrrhizae radix
Glycyrrhizae radixcontains glycyrrhizin. G.radixis prescribed in 15% of
the 210 kampo formulations. Glycyrrhizin metabolises to the aglycone,
glycyrrhetic acid, after oral administration, and glycyrrhetic acid facilitates
potassium excretion and lowers total serum potassium.
Excess administration of G.radixcauses oedema, hypertension and
pseudoaldosteronism, so care must be taken if the plural kampo formula-
tions containing G.radixare given together.
246 | Traditional medicine