臨牀消化器内科 Vol.33 No.11(3-2)


特集名 消化器病漢方治療―理論と実践
題名 理論:漢方薬作用機序の科学的解明 (2) 大建中湯
発刊年月 2018年 10月
著者 河野 透 札幌東徳洲会病院先端外科センター/札幌東徳洲会病院臨床試験センター医学研究所
【 要旨 】 漢方薬は日本の伝統医薬として独自に発展してきたが,西洋薬的なエビデンスレベルに到達している漢方薬はきわめて少ない.日本でもっとも多く処方されている大建中湯は比較的歴史が浅く,500年前に登場した.30年前に初めて保険収載され,本稿では最近,明らかとなってきた腸管血流,腸管運動改善,とくに術後イレウス改善効果に関する基礎的エビデンス,とくに,カルシトニンファミリーペプチド,TRPチャネルやKチャネルを介した作用を中心に概説した.また,大建中湯の薬物動態試験から明らかとなってきた大建中湯の成分レベルでの相互作用を概説し,漢方薬がレジメン的薬理作用を有していることを提言した.
Theme Kampo Medicine for Gastrointestinal Diseases -- Theory and Practice
Title Scientific Evidence-based Action Mechanism of Daikenchuto
Author Toru Kono Advanced Surgery Center, Sapporo Higashi Tokushukai Hospital / Center for Clinical and Biomedical Research, Sapporo Higashi Tokushukai Hospital
[ Summary ] We reviewed accumulating scientific evidence of the physiological mechanism and clinical action of Daikenchuto. Use of traditional Japanese medicine, including Daikenchuto, has a relatively brief history of 500 years' clinical use. Since the past 30 years, the Japanese government officially has recognized herbal medicine as a valid form of treatment alongside typical Western medicines.
Recently, scientifically robust data have been accumulating on treatment with Daikenchuto through basic and clinical studies, including placebo-controlled double-blind studies for various gastrointestinal disorders, and absorption, distribution, metabolism and excretion studies, previously conducted or ongoing in both Japan and the US. Clinical studies suggested that Daikenchuto is beneficial for treatment of patients with postoperative ileus. Basic studies indicated that its effect comprises a composite of numerous actions mediated by multiple compounds via multiple routes. With regard to mechanisms of action through enteric/sensory nerve stimulation, novel mechanisms that involve the TRPA1 channel and two pore domain potassium channels were recently reported. Daikenchuto compounds target these channels with and without absorption, both before and after metabolic activation by enteric flora, at different time-points, and possibly with synergism.
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