Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 764
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents 
CASE REPORT
Year : 2021  |  Volume : 10  |  Issue : 1  |  Page : 558-560  

Bukuryoingohangekobokuto may improve recurrent aspiration pneumonia in patients with brain damage and reduce the caregiver burden


Department of Education and Support for Regional Medicine, Department of Kampo Medicine, Tohoku University Hospital; Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine, Seiryo-machi 1-1, Aoba-ku, Sendai, Miyagi, Japan

Date of Submission11-Aug-2020
Date of Decision06-Oct-2020
Date of Acceptance28-Oct-2020
Date of Web Publication30-Jan-2021

Correspondence Address:
Prof. Shin Takayama
Department of Education and Support for Regional Medicine, Tohoku University Hospital, Seiryo-machi 1-1, Aoba-ku, Sendai, Miyagi 980-8574
Japan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_1627_20

Rights and Permissions
  Abstract 


A 17-year-old girl with hypoxic encephalopathy was hospitalized over four times in a year because of recurrent aspiration pneumonia (AP). She had dysphagia and reduced cough reflex as sequelae of brain damage. To prevent aspiration, a gastric tube was placed for feeding, but it did not reduce the frequency of AP because the gastroesophageal reflux caused backflow. However, after the Kampo medicine bukuryoingohangekobokuto (BRIHK) was added to the prescriptions, her sputum and gastroesophageal reflux was remarkably reduced. BRIHK is a Kampo medicine that confers multiple benefits such as improving swallowing and cough reflexes, reducing sputum, and improving gastric emptying. Subsequently, the frequency of sputum suction reduced from every 15 min to 30 min, thus reducing the burden on her mother. As a result, she has never been hospitalized for AP in the 7 years after treatment. Overall, BRIHK may be a treatment of choice for similar patients.

Keywords: Aspiration pneumonia, brain damage, bukuryoingohangekobokuto, hypoxic encephalopathy, Kampo medicine


How to cite this article:
Takayama S, Arita R, Kikuchi A, Ishii T. Bukuryoingohangekobokuto may improve recurrent aspiration pneumonia in patients with brain damage and reduce the caregiver burden. J Family Med Prim Care 2021;10:558-60

How to cite this URL:
Takayama S, Arita R, Kikuchi A, Ishii T. Bukuryoingohangekobokuto may improve recurrent aspiration pneumonia in patients with brain damage and reduce the caregiver burden. J Family Med Prim Care [serial online] 2021 [cited 2021 Feb 26];10:558-60. Available from: https://www.jfmpc.com/text.asp?2021/10/1/558/307939




  Introduction Top


Aspiration pneumonia (AP) is one of the causes of death in patients with brain damage. It is characterized by impaired swallowing and cough reflexes, and gastroesophageal reflux of stomach.[1] Swallowing and cough reflexes are mediated by endogenous substance P, which is regulated by dopaminergic neurons in the cerebral basal ganglia. Moreover, peristalsis of the stomach is regulated by the vagus nerve. Thus, damage to these brain structures frequently results in AP. Caregivers provide oral care and suction sputum to prevent AP, thereby increasing the burden of care. Herein, we report a patient with hypoxic encephalopathy with frequent AP who was successfully treated with Kampo medicine.


  Case History Top


A 17-year-old girl with hypoxic encephalopathy after drowning was hospitalized four times in a year because of recurrent aspiration pneumonia. [Figure 1] shows the chest X-ray of the patient when she admitted with AP. She had dysphagia and reduced cough reflex as sequelae of hypoxic encephalopathy, with a level of consciousness of E2V1M2 on the Glasgow Coma Scale 5. Her mother had been burdened with performing repeated suction every 15 min. Her oxygen saturation decreased, and fever elevated if the suction was delayed. To prevent aspiration, a gastric tube was placed for feeding. However, it did not reduce the frequency of pneumonia because regular peristalsis of the stomach was poor, and the gastroesophageal reflux caused backflow of the fed content, as evaluated by gastrostomy imaging. However, after the Kampo medicine Bukuryoingohangekobokuto (BRIHK) was added to her treatment regimen, her sputum and gastroesophageal reflux was remarkably reduced. [Figure 2] shows the constant agent gastrography; the contrast agent remains in the stomach [Figure 2]a and moved to the duodenum after the administration of BRIHK [Figure 2]b. Subsequently, the frequency of sputum suction was reduced from every 15 min to 30 min, thus reducing the burden on her mother. As a result, she has not been hospitalized for pneumonia in the 7 years since the treatment.
Figure 1: Chest X-ray of the patient with pneumonia at admission

Click here to view
Figure 2: (a): Gastrography through gastrostomy before the administration of BRIHK. The contrast agent remains in the stomach. (b): Gastrography through gastrostomy 10 months after the administration of BRIHK. The contrast agent smoothly moved to duodenum.

Click here to view



  Discussion Top


BRIHK is a Kampo medicine formulated using bukuryoin and hangekobokuto (HKT) with multifunction in brain and organs. HKT has been proven to improve swallowing and cough reflexes and reduce sputum.[2],[3],[4] HKT modulates cerebral levels of 5-hydroxytryptamine, noradrenaline, and dopamine resulting improving cough and swallowing reflexes.[5] HKT reduced pneumonia risk in older adults with dementia and it is recommended secondary prevention of aspiration pneumonia in clinical practice guidelines.[6],[7],[8],[9],[10] On the other hand, bukuryoin improves gastric emptying. BRIHK can inhibit corticotropin-releasing hormone receptor 2, dopamine receptors D2 and D3, neuropeptide Y receptor type 2, and acetylcholinesterase, which synergistically improve gastric emptying.[11] Recently, an exploratory study of the clinical effectiveness and safety of BRIHK has been in progress.[12] In conclusion, BRIHK can reduce the frequency of aspiration pneumonia by reducing dysphagia, cough reflex, and gastroesophageal reflux associated with brain damage. Many patients develop AP as a sequela of brain damage, and BRIHK may be a treatment of choice for these patients.

Key Messages

Primary care physicians have many treatment options for treating aspiration pneumonia in patients with brain damage. Multifunctional Kampo medicine BRIHK may be a treatment of choice for these patients.

Ethical and institutional permission

Informed consent was obtained from mother of patient.This case report was approved by the Institutional Review Board of Tohoku University School of Medicine (No. 19906).

Acknowledgement

None

Financial support and sponsorship

Nil.

Conflicts of interest

S. T., A. K., and T. I. belong to the Department of Kampo and Integrative Medicine, Tohoku University School of Medicine. The department received a grant from Tsumura & Co, a Japanese manufacturer of Kampo medicine which was used as per Tohoku University rules.



 
  References Top

1.
Yamaya M, Yanai M, Ohrui T, Arai H, Sasaki H. Interventions to prevent pneumonia among older adults. J Am Geriatr Soc 2001;49:85-90.  Back to cited text no. 1
    
2.
Iwasaki K, Wang Q, Nakagawa, T, Suzuki T, Sasaki H. The traditional Chinese medicine banxia houpo tang improves swallowing reflex. Phytomedicine 1999;6:103-6.  Back to cited text no. 2
    
3.
Iwasaki K, Cyong JC, Kitada S, Kitamura H, Ozeki J, Satoh Y, et al. A traditional Chinese herbal medicine, banxia houpo tang, improves cough reflex of patients with aspiration pneumonia. J Am Geriatr Soc 2002;50:1751-52.  Back to cited text no. 3
    
4.
Iwasaki K, Kato S, Monma Y, Niu K, Ohrui T, Okitsu R, et al. A pilot study of banxia houpu tang, a traditional Chinese medicine, for reducing pneumonia risk in older adults with dementia. J Am Geriatr Soc 2007;55:2035-40.  Back to cited text no. 4
    
5.
Kaneko A, Cho S, Hirai K, Okabe T, Iwasaki K, Nanba Y, et al. Hange-koboku-to, a Kampo medicine, modulates cerebral levels of 5-HT (5-hydroxytryptamine), NA (noradrenaline) and DA (dopamine) in mice. Phytother Res 2005;19:491-5.  Back to cited text no. 5
    
6.
Iwasaki K, Kurachi M, Nogami T, Takayama S. Traditional Chinese therapy initiates oral feeding in a stroked woman after three years of nasogastric tube feeding. J Family Med Prim Care 2019;8:3059-60.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Takayama S, Arita R, Kikuchi A, Ohsawa M, Kaneko S, Ishii T. Clinical practice guidelines and evidence for the efficacy of traditional Japanese herbal medicine (Kampo) in treating geriatric patients. Front Nutr 2018;5:66.  Back to cited text no. 7
    
8.
Kojima T, Mizukami K, Tomita N, Arai H, Ohrui T, Eto M, et al. Screening tool for older persons' appropriate prescriptions for Japanese: Report of the Japan Geriatrics Society Working Group on “Guidelines for medical treatment and its safety in the elderly“. Geriatr Gerontol Int 2016;16:983-1001.  Back to cited text no. 8
    
9.
Takayama S, Iwasaki K. Systematic review of traditional Chinese medicine for geriatrics. Geriatr Gerontol Int 2017;17:679-88.  Back to cited text no. 9
    
10.
Takayama S, Tomita N, Ryutaro A, Ono R, Kikuchi A, Ishii T. Kampo medicine for various aging-related symptoms: A review of geriatric syndrome. Front Nutr 2020;7:86.  Back to cited text no. 10
    
11.
Mogami S, Arita R, Nahata M, Fujitsuka N, Takayama S, Ishii T, et al. Usefulness of a Kampo medicine on stress-induced delayed gastric emptying in mice. Evid Based Complement Alternat Med 2020;2020:3797219. doi: 10.1155/2020/3797219.  Back to cited text no. 11
    
12.
Arita R, Takayama S, Okamoto H, Koseki K, Taniyama Y, Kaneko S, et al. Exploratory study of clinical effectiveness and safety of TJ-116 bukuryoingohangekobokuto for anxiety and postoperative water brash in esophageal cancer patients (TJ116E). Medicine (Baltimore) 2020;99:e20317.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]



 

Top
   
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   Abstract
  Introduction
  Case History
  Discussion
   References
   Article Figures

 Article Access Statistics
    Viewed156    
    Printed0    
    Emailed0    
    PDF Downloaded14    
    Comments [Add]    

Recommend this journal