- Email: [email protected]
Treating Pediatric Psychogenic Dizziness with a Japanese Herbal Medicine
BRIEF REPORT
TREATING PEDIATRIC PSYCHOGENIC DIZZINESS WITH A JAPANESE HERBAL MEDICINE Fumiyuki Goto, MD, PhD,1-3,# Noriko Morimoto, MD, PhD,2 Hidenobu Taiji, MD, PhD,2 Tomoko Tsutumi, MD,1 and Kaoru Ogawa, MD, PhD3
Objective: No conventional pharmacotherapy is available for the treatment of psychogenic dizziness in pediatric patients. Adults with psychogenic dizziness are treated with psychiatric medicines as the standard treatment. In children, this treatment is not widely accepted because of the potential for adverse reactions. Instead, Kampo, an alternative medicine, is probably the best choice of treatment.
improvement was assessed by the Clinical Global impressionImprovement scale.
Design: We report herein three of four cases of pediatric psychogenic dizziness successfully treated with Yoku-kan-san-kachimpi-hange (YKCH), a traditional Japanese Kampo medicine known to ameliorate psychiatric symptoms.
Conclusions: This report is the first to describe the beneficial effects of YKCH in the treatment of pediatric psychogenic dizziness. We conclude that administration of YKCH may be a suitable complementary therapy for pediatric psychogenic dizziness.
Subjects: YKCH was prescribed to four patients (two boys and two girls) with psychiatric dizziness whose ages ranged from 11 to 15 years. Four weeks after the initiation of treatment, clinical
Key words: herbal medicine, human, Yoku-kan-san-ka-chimpihange, Japanese, Kampo, Yi-Gan San (Explore 2013; 9:41-43. © 2013 Elsevier Inc. All rights reserved.)
izziness in pediatric patients often is associated with benign paroxysmal vertigo of childhood, orthostatic dysfunction, and psychogenic dizziness.1 The treatment of dizziness in pediatric patients may be difficult because we do not frequently encounter such cases in daily practice. In addition, there is no conventional pharmacotherapy for psychogenic dizziness in pediatric patients. In adults, the treatment for psychogenic dizziness constitutes psychiatric medicines, including serotonin reuptake inhibitors.2 In children, these medicines are not widely used, and Kampo, an alternative medicine, could represents an alternative treatment choice. It may be difficult for physicians who are not familiar with Kampo medicine to accept the use of alternative medicine in children. However, the administration of Kampo medicine to children is generally accepted in Japan, although few articles in English have reported on this practice. Recently, the effects of a Japanese herbal medicine, Juzen-taiho-to, in otitis-prone children was described.3 The safety of and compliance with Yoku-kan-san-kachimpi-hange (YKCH) in pediatric patients with psychiatric disorders also have been reported in a few Japanese articles.4,5
YKCH and Yoku-kan san (YKS) are quite similar in their formulation, and both contain Bupleurum root extract. YKCH is a combination of YKS, Pinellia tuber, and Citrus peels. The formulation of YKCH is shown in Table 1. YKS originally was developed in the 16th century as a remedy for restlessness and agitation in children and has been used as an antianxiety agent for the treatment of neurosis and insomnia and to ease nocturnal crying in children. It is initially used to treat nervous symptoms such as impatience or frequent anger, tics, and muscular convulsion. In addition, recently, it has been used for the treatment of other physical and mental conditions. Because Pinellia tuber has been reported to have antistress effects6 and Citrus peels have been shown to exert antioxidant and anti-inflammatory effects,7 one can assume that YKCH, a combination of YKS, Pinellia tuber, and Citrus peels, can ameliorate psychiatric symptoms. We report herein four cases of pediatric psychogenic dizziness treated with YKCH. This is the first report of cases in which YKCH administration was effective for the alleviation of pediatric psychogenic dizziness.
D
1 Department of Otorhinolaryngology, Hino Municipal Hospital, Hino, Tokyo, Japan 2 Department of Otorhinolaryngology, National Center for Child Health and Development, Tokyo, Japan 3 Department of Otorhinolaryngology, Keio University, Tokyo, Japan # Corresponding author. Address: Fumiyuki Goto Department of Otolaryngology, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino-shi, Tokyo 191-0062, Japan e-mail: [email protected] http://net.ne.jp
© 2013 Elsevier Inc. All rights reserved ISSN 1550-8307/$36.00
Results: In three of the four patients, the drug showed some significant effects. The remaining patient could not continue the medication. It is reasonable to assume that YKCH was effective because of its serotonergic mechanism and the improvement of sleep in our patients.
METHODS The subjects were four patients with pediatric psychogenic dizziness (Table 2), whose ages ranged from 11 to 15 years and who were intractable to various conventional conservative treatments, including pharmacotherapy and lifestyle changes, for periods of 4 to 24 months. The definition of pediatric psychogenic dizziness1 is as follows: (1) normal radiographic images of the brain and normal or nondiagnostic findings in balance function tests; (2) dizziness symptoms that persist for longer than 3 months; (3) sensations of nonvertiginous dizziness, light-head-
EXPLORE January/February 2013, Vol. 9, No. 1 http://dx.doi.org/10.1016/j.explore.2012.10.005
41
Table 1. Patients and Results Case
Age
Gender
Duration, Months
Symptom
Comorbidity
CGI-I
1 2 3 4
11 13 14 15
Male Male Female Female
4 24 8 24
Gait disturbance Dizziness Dizziness Vertigo, dizziness
Psychogenic visual disturbance Otitis media effusion Migraine without aura Migraine without aura
2 1 3 NA
CGI-I, Clinical Global Impression-Improvement scale; NA, not applicable.
edness, heavy-headedness, or subjective imbalance that is present on most days; and (4) chronic (3 months or more) hypersensitivity to one’s own motion or to the movements of objects in the environment and the exacerbation of symptoms in settings with complex visual stimuli (eg, grocery stores) or when performing precise visual tasks (eg, reading, using a computer). After informed consent was obtained, YKCH (7.5 g/d, 3 times a day) was prescribed to all patients. YKCH is an approved drug by the Japanese Ministry of Health, Labour and Welfare. It is prepared by the Japanese pharmaceutical company Tsumura (Japan, Tokyo). Every 2 weeks, each patient’s condition was evaluated for improvement. The final evaluation was based on the Clinical Global Impression-Improvement scale (CGI-I; Table 2).8 The CGI-I is commonly used to measure symptom severity, treatment response, and the efficacy of treatments in treatment studies.8 It is a seven-point scale that requires the clinician to assess how much the patient’s illness has improved or worsened relative to a baseline state at the beginning of the intervention and is rated as follows: (1) very much improved; (2) much improved; (3) minimally improved; (4) no change; (5) minimally worse; (6) much worse; or (7) very much worse. In the present study, the first author assessed the CGI-I score 4 weeks after the initiation of YKCH.
RESULTS The results are shown in Table 1. One of the subjects could not continue treatment with YKCH because of its taste. Three of the 4 patients experienced some benefits from the medication (a CGI-I score of 1, 2, and 3, respectively). In these patients, no adverse effects were observed.
DISCUSSION We have observed some beneficial effects of YKCH in the treatment of pediatric psychogenic dizziness in the aforementioned patients. Recently, successful treatment of chronic urticaria with YKS was reported.9 YKS also has been reported to be useful in alleviating psychiatric symptoms after traumatic brain injury.10 YKCH is used in milder cases of YKS-respondent symptoms and for somatoform autonomic nerve dysfunction affecting the lower digestive tract.11 YKCH also is used to treat insomnia.12 In a double-blind, crossover study of 20 healthy adult men, investigators compared YKCH with Anchu-sun, an herbal drug used for gastrointestinal complaints. Polysomnography showed that the total sleep time was significantly increased (P ⫽ .04) with YKCH.12 It is generally known that the effects of Japanese traditional herbal medicine differ between patients, according to the sho of each individual. Sho is determined not only from psychic and somatic symptoms but also from signs identified by a traditional physical examination that focuses on the patient’s constitution, general physical condition, pulse, and abdominal signs and includes an examination of the tongue. Because most physicians are not trained to determine sho correctly, modern diagnostic techniques, including neuro-otologic evaluation using the caloric test with electronystagmography, vestibular myogenic potentials, and pure-tone audiometry, are also performed before a prescription is formulated. With the concept of sho in mind, we prescribed YKCH to four patients with pediatric psychogenic dizziness. The psychopharmacologic mechanisms of YKS remain to be established; however, studies in animals suggest that YKS may exert its effectiveness through the serotonergic and dopaminer-
Table 2. Crude Drug Composition of YKCH Crude Drug Name
Composition, g
Major Components
Clinical Effect
Pinellia tuber Atractylodis lanceae rhizoma Poria cocos Cnidii rhizoma Uncariae Uncis cum ramulus Citrus peel Radix Angelicae
5.0 4.0 4.0 3.0 3.0 3.0 3.0
Homogentisic acid Atractylodin,eudesmol Eburicoic acid,ergosterol Cnidilide, butylphthalide Rhynchophylline, geissoschizine ethyl ether D-limonene Ligustilide, falcarinol
2.0 1.5
Saikosaponin a,c,d, e Glycyrrhizin, liquiritin
Antistress Invigorating spleen and drying Anti-inflammatory properties Promoting healing and blood flow Clearing away heat and calming the liver Antioxidant, anti-inflammatory Promote blood circulation and modulate the immune system Sedative effect Antiulcer activity
Radix Bupleuri Radix Glycyrrhizae
Yoku-kan-san-ka-chimpi-hange (YKCH) is a combination of Yoku-kan san (YKS), Pinellia tuber, and citrus peels.
42
EXPLORE January/February 2013, Vol. 9, No. 1
Treating Pediatric Psychogenic Dizziness
gic systems in the brain.13 The effect of YKS in is created partially by its effects on serotonin 1A receptors and its antagonistic effects on serotonin 2A receptors.14,15 A strong relationship has been reported between the serotonin system and psychogenic dizziness.2 It is reasonable to assume that these serotoninergic mechanisms and improvements in sleep caused the improvement in psychogenic dizziness observed in our patients. This is the first report to describe the beneficial effects of YKCH in the treatment of pediatric psychogenic dizziness. Our case report, presenting the beneficial effects of YKCH in pediatric psychogenic dizziness, suggests that YKCH may be considered a potential complementary drug for pediatric psychogenic dizziness. The observed results suggest that randomized controlled trials could be performed to provide better evidence of the efficacy of YKCH in this indication. Administration of YKCH may be a suitable complementary therapy for pediatric psychogenic dizziness. Acknowledgments We thank Emiko Nasu for her technical assistance. REFERENCES 1. Erbek SH, Erbek SS, Yilmaz I, et al. Vertigo in childhood: a clinical experience. Int J Pediatr Otorhinolaryngol. 2006;70:1547-1554. 2. Staab JP, Ruckenstein MJ, Solomon D, et al. Serotonin reuptake inhibitors for dizziness with psychiatric symptoms. Arch Otolaryngol Head Neck Surg. 2002;128:554-560. 3. Maruyama Y, Hoshida S, Furukawa M, et al. Effects of Japanese herbal medicine, Juzen-taiho-to, in otitis-prone children—a preliminary study. Acta Otolaryngol. 2009;129:14-18. 4. Ujiie T. The effect of YKCH to the pediatric patients with psychiatric disorders [in Japanese]. Phil. 2010;32:18-19.
Treating Pediatric Psychogenic Dizziness
5. Miyaoka T. The application of YKS to the patients with various psychiatric disorders [in Japanese]. Brain. 2009;12:460-466. 6. Katagiri F, Inoue S, Sato Y, et al. Comparison of the effects of Sho-hange-ka-bukuryo-to and Nichin-to on human plasma adrenocorticotropic hormone and cortisol levels with continual stress exposure. Biol Pharm Bull. 2004;27:1679-1682. 7. Sood S, Arora B, Bansal S, et al. Antioxidant, anti-inflammatory and analgesic potential of the citrus decumana L. peel extract. Inflammopharmacology. 2009;17:267-274. 8. Guy W. CGI clinical global impressions. In: EC-DEU Assessment Manual for Psychopharmacology, revised. Vol DHEW Publication no. ADM-76 –338. Rockville, MD: U.S Department of Health, Education, and Welfare; 1976:76-338. 9. Kato S, Kato TA, Nishie H, et al. Successful treatment of chronic urticaria with a Japanese herbal medicine, yokukansan. J Dermatol. 2010;37:1066-1067. 10. Saito S, Kobayashi T, Osawa T, et al. Effectiveness of Japanese herbal medicine yokukansan for alleviating psychiatric symptoms after traumatic brain injury. Psychogeriatrics. 2010;10:45-48. 11. Sato Y. Introduction to Kampo: Japanese Traditional Medicine/The Japan Society for Oriental Medicine. Tokyo: Elsevier; 2005. 12. Aizawa R, Kanbayashi T, Saito Y, et al. Effects of Yoku-kan-san-kachimpi-hange on the sleep of normal healthy adult subjects. Psychiatry Clin Neurosci. 2002;56:303-304. 13. Mizoguchi K, Tanaka Y, Tabira T. Anxiolytic effect of a herbal medicine, yokukansan, in aged rats: involvement of serotonergic and dopaminergic transmissions in the prefrontal cortex. J Ethnopharmacol. 2010;127:70-76. 14. Egashira N, Iwasaki K, Ishibashi A, et al. Repeated administration of Yokukansan inhibits DOI-induced head-twitch response and decreases expression of 5-hydroxytryptamine (5-HT)2A receptors in the prefrontal cortex. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32:1516-1520. 15. Igarashi Y. [Elucidation of the pharmacological mechanism of yokukansan] in Japanese. Geriatr Med. 2008;46:255-261.
EXPLORE January/February 2013, Vol. 9, No. 1
43
TREATING PEDIATRIC PSYCHOGENIC DIZZINESS WITH A JAPANESE HERBAL MEDICINE Fumiyuki Goto, MD, PhD,1-3,# Noriko Morimoto, MD, PhD,2 Hidenobu Taiji, MD, PhD,2 Tomoko Tsutumi, MD,1 and Kaoru Ogawa, MD, PhD3
Objective: No conventional pharmacotherapy is available for the treatment of psychogenic dizziness in pediatric patients. Adults with psychogenic dizziness are treated with psychiatric medicines as the standard treatment. In children, this treatment is not widely accepted because of the potential for adverse reactions. Instead, Kampo, an alternative medicine, is probably the best choice of treatment.
improvement was assessed by the Clinical Global impressionImprovement scale.
Design: We report herein three of four cases of pediatric psychogenic dizziness successfully treated with Yoku-kan-san-kachimpi-hange (YKCH), a traditional Japanese Kampo medicine known to ameliorate psychiatric symptoms.
Conclusions: This report is the first to describe the beneficial effects of YKCH in the treatment of pediatric psychogenic dizziness. We conclude that administration of YKCH may be a suitable complementary therapy for pediatric psychogenic dizziness.
Subjects: YKCH was prescribed to four patients (two boys and two girls) with psychiatric dizziness whose ages ranged from 11 to 15 years. Four weeks after the initiation of treatment, clinical
Key words: herbal medicine, human, Yoku-kan-san-ka-chimpihange, Japanese, Kampo, Yi-Gan San (Explore 2013; 9:41-43. © 2013 Elsevier Inc. All rights reserved.)
izziness in pediatric patients often is associated with benign paroxysmal vertigo of childhood, orthostatic dysfunction, and psychogenic dizziness.1 The treatment of dizziness in pediatric patients may be difficult because we do not frequently encounter such cases in daily practice. In addition, there is no conventional pharmacotherapy for psychogenic dizziness in pediatric patients. In adults, the treatment for psychogenic dizziness constitutes psychiatric medicines, including serotonin reuptake inhibitors.2 In children, these medicines are not widely used, and Kampo, an alternative medicine, could represents an alternative treatment choice. It may be difficult for physicians who are not familiar with Kampo medicine to accept the use of alternative medicine in children. However, the administration of Kampo medicine to children is generally accepted in Japan, although few articles in English have reported on this practice. Recently, the effects of a Japanese herbal medicine, Juzen-taiho-to, in otitis-prone children was described.3 The safety of and compliance with Yoku-kan-san-kachimpi-hange (YKCH) in pediatric patients with psychiatric disorders also have been reported in a few Japanese articles.4,5
YKCH and Yoku-kan san (YKS) are quite similar in their formulation, and both contain Bupleurum root extract. YKCH is a combination of YKS, Pinellia tuber, and Citrus peels. The formulation of YKCH is shown in Table 1. YKS originally was developed in the 16th century as a remedy for restlessness and agitation in children and has been used as an antianxiety agent for the treatment of neurosis and insomnia and to ease nocturnal crying in children. It is initially used to treat nervous symptoms such as impatience or frequent anger, tics, and muscular convulsion. In addition, recently, it has been used for the treatment of other physical and mental conditions. Because Pinellia tuber has been reported to have antistress effects6 and Citrus peels have been shown to exert antioxidant and anti-inflammatory effects,7 one can assume that YKCH, a combination of YKS, Pinellia tuber, and Citrus peels, can ameliorate psychiatric symptoms. We report herein four cases of pediatric psychogenic dizziness treated with YKCH. This is the first report of cases in which YKCH administration was effective for the alleviation of pediatric psychogenic dizziness.
D
1 Department of Otorhinolaryngology, Hino Municipal Hospital, Hino, Tokyo, Japan 2 Department of Otorhinolaryngology, National Center for Child Health and Development, Tokyo, Japan 3 Department of Otorhinolaryngology, Keio University, Tokyo, Japan # Corresponding author. Address: Fumiyuki Goto Department of Otolaryngology, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino-shi, Tokyo 191-0062, Japan e-mail: [email protected] http://net.ne.jp
© 2013 Elsevier Inc. All rights reserved ISSN 1550-8307/$36.00
Results: In three of the four patients, the drug showed some significant effects. The remaining patient could not continue the medication. It is reasonable to assume that YKCH was effective because of its serotonergic mechanism and the improvement of sleep in our patients.
METHODS The subjects were four patients with pediatric psychogenic dizziness (Table 2), whose ages ranged from 11 to 15 years and who were intractable to various conventional conservative treatments, including pharmacotherapy and lifestyle changes, for periods of 4 to 24 months. The definition of pediatric psychogenic dizziness1 is as follows: (1) normal radiographic images of the brain and normal or nondiagnostic findings in balance function tests; (2) dizziness symptoms that persist for longer than 3 months; (3) sensations of nonvertiginous dizziness, light-head-
EXPLORE January/February 2013, Vol. 9, No. 1 http://dx.doi.org/10.1016/j.explore.2012.10.005
41
Table 1. Patients and Results Case
Age
Gender
Duration, Months
Symptom
Comorbidity
CGI-I
1 2 3 4
11 13 14 15
Male Male Female Female
4 24 8 24
Gait disturbance Dizziness Dizziness Vertigo, dizziness
Psychogenic visual disturbance Otitis media effusion Migraine without aura Migraine without aura
2 1 3 NA
CGI-I, Clinical Global Impression-Improvement scale; NA, not applicable.
edness, heavy-headedness, or subjective imbalance that is present on most days; and (4) chronic (3 months or more) hypersensitivity to one’s own motion or to the movements of objects in the environment and the exacerbation of symptoms in settings with complex visual stimuli (eg, grocery stores) or when performing precise visual tasks (eg, reading, using a computer). After informed consent was obtained, YKCH (7.5 g/d, 3 times a day) was prescribed to all patients. YKCH is an approved drug by the Japanese Ministry of Health, Labour and Welfare. It is prepared by the Japanese pharmaceutical company Tsumura (Japan, Tokyo). Every 2 weeks, each patient’s condition was evaluated for improvement. The final evaluation was based on the Clinical Global Impression-Improvement scale (CGI-I; Table 2).8 The CGI-I is commonly used to measure symptom severity, treatment response, and the efficacy of treatments in treatment studies.8 It is a seven-point scale that requires the clinician to assess how much the patient’s illness has improved or worsened relative to a baseline state at the beginning of the intervention and is rated as follows: (1) very much improved; (2) much improved; (3) minimally improved; (4) no change; (5) minimally worse; (6) much worse; or (7) very much worse. In the present study, the first author assessed the CGI-I score 4 weeks after the initiation of YKCH.
RESULTS The results are shown in Table 1. One of the subjects could not continue treatment with YKCH because of its taste. Three of the 4 patients experienced some benefits from the medication (a CGI-I score of 1, 2, and 3, respectively). In these patients, no adverse effects were observed.
DISCUSSION We have observed some beneficial effects of YKCH in the treatment of pediatric psychogenic dizziness in the aforementioned patients. Recently, successful treatment of chronic urticaria with YKS was reported.9 YKS also has been reported to be useful in alleviating psychiatric symptoms after traumatic brain injury.10 YKCH is used in milder cases of YKS-respondent symptoms and for somatoform autonomic nerve dysfunction affecting the lower digestive tract.11 YKCH also is used to treat insomnia.12 In a double-blind, crossover study of 20 healthy adult men, investigators compared YKCH with Anchu-sun, an herbal drug used for gastrointestinal complaints. Polysomnography showed that the total sleep time was significantly increased (P ⫽ .04) with YKCH.12 It is generally known that the effects of Japanese traditional herbal medicine differ between patients, according to the sho of each individual. Sho is determined not only from psychic and somatic symptoms but also from signs identified by a traditional physical examination that focuses on the patient’s constitution, general physical condition, pulse, and abdominal signs and includes an examination of the tongue. Because most physicians are not trained to determine sho correctly, modern diagnostic techniques, including neuro-otologic evaluation using the caloric test with electronystagmography, vestibular myogenic potentials, and pure-tone audiometry, are also performed before a prescription is formulated. With the concept of sho in mind, we prescribed YKCH to four patients with pediatric psychogenic dizziness. The psychopharmacologic mechanisms of YKS remain to be established; however, studies in animals suggest that YKS may exert its effectiveness through the serotonergic and dopaminer-
Table 2. Crude Drug Composition of YKCH Crude Drug Name
Composition, g
Major Components
Clinical Effect
Pinellia tuber Atractylodis lanceae rhizoma Poria cocos Cnidii rhizoma Uncariae Uncis cum ramulus Citrus peel Radix Angelicae
5.0 4.0 4.0 3.0 3.0 3.0 3.0
Homogentisic acid Atractylodin,eudesmol Eburicoic acid,ergosterol Cnidilide, butylphthalide Rhynchophylline, geissoschizine ethyl ether D-limonene Ligustilide, falcarinol
2.0 1.5
Saikosaponin a,c,d, e Glycyrrhizin, liquiritin
Antistress Invigorating spleen and drying Anti-inflammatory properties Promoting healing and blood flow Clearing away heat and calming the liver Antioxidant, anti-inflammatory Promote blood circulation and modulate the immune system Sedative effect Antiulcer activity
Radix Bupleuri Radix Glycyrrhizae
Yoku-kan-san-ka-chimpi-hange (YKCH) is a combination of Yoku-kan san (YKS), Pinellia tuber, and citrus peels.
42
EXPLORE January/February 2013, Vol. 9, No. 1
Treating Pediatric Psychogenic Dizziness
gic systems in the brain.13 The effect of YKS in is created partially by its effects on serotonin 1A receptors and its antagonistic effects on serotonin 2A receptors.14,15 A strong relationship has been reported between the serotonin system and psychogenic dizziness.2 It is reasonable to assume that these serotoninergic mechanisms and improvements in sleep caused the improvement in psychogenic dizziness observed in our patients. This is the first report to describe the beneficial effects of YKCH in the treatment of pediatric psychogenic dizziness. Our case report, presenting the beneficial effects of YKCH in pediatric psychogenic dizziness, suggests that YKCH may be considered a potential complementary drug for pediatric psychogenic dizziness. The observed results suggest that randomized controlled trials could be performed to provide better evidence of the efficacy of YKCH in this indication. Administration of YKCH may be a suitable complementary therapy for pediatric psychogenic dizziness. Acknowledgments We thank Emiko Nasu for her technical assistance. REFERENCES 1. Erbek SH, Erbek SS, Yilmaz I, et al. Vertigo in childhood: a clinical experience. Int J Pediatr Otorhinolaryngol. 2006;70:1547-1554. 2. Staab JP, Ruckenstein MJ, Solomon D, et al. Serotonin reuptake inhibitors for dizziness with psychiatric symptoms. Arch Otolaryngol Head Neck Surg. 2002;128:554-560. 3. Maruyama Y, Hoshida S, Furukawa M, et al. Effects of Japanese herbal medicine, Juzen-taiho-to, in otitis-prone children—a preliminary study. Acta Otolaryngol. 2009;129:14-18. 4. Ujiie T. The effect of YKCH to the pediatric patients with psychiatric disorders [in Japanese]. Phil. 2010;32:18-19.
Treating Pediatric Psychogenic Dizziness
5. Miyaoka T. The application of YKS to the patients with various psychiatric disorders [in Japanese]. Brain. 2009;12:460-466. 6. Katagiri F, Inoue S, Sato Y, et al. Comparison of the effects of Sho-hange-ka-bukuryo-to and Nichin-to on human plasma adrenocorticotropic hormone and cortisol levels with continual stress exposure. Biol Pharm Bull. 2004;27:1679-1682. 7. Sood S, Arora B, Bansal S, et al. Antioxidant, anti-inflammatory and analgesic potential of the citrus decumana L. peel extract. Inflammopharmacology. 2009;17:267-274. 8. Guy W. CGI clinical global impressions. In: EC-DEU Assessment Manual for Psychopharmacology, revised. Vol DHEW Publication no. ADM-76 –338. Rockville, MD: U.S Department of Health, Education, and Welfare; 1976:76-338. 9. Kato S, Kato TA, Nishie H, et al. Successful treatment of chronic urticaria with a Japanese herbal medicine, yokukansan. J Dermatol. 2010;37:1066-1067. 10. Saito S, Kobayashi T, Osawa T, et al. Effectiveness of Japanese herbal medicine yokukansan for alleviating psychiatric symptoms after traumatic brain injury. Psychogeriatrics. 2010;10:45-48. 11. Sato Y. Introduction to Kampo: Japanese Traditional Medicine/The Japan Society for Oriental Medicine. Tokyo: Elsevier; 2005. 12. Aizawa R, Kanbayashi T, Saito Y, et al. Effects of Yoku-kan-san-kachimpi-hange on the sleep of normal healthy adult subjects. Psychiatry Clin Neurosci. 2002;56:303-304. 13. Mizoguchi K, Tanaka Y, Tabira T. Anxiolytic effect of a herbal medicine, yokukansan, in aged rats: involvement of serotonergic and dopaminergic transmissions in the prefrontal cortex. J Ethnopharmacol. 2010;127:70-76. 14. Egashira N, Iwasaki K, Ishibashi A, et al. Repeated administration of Yokukansan inhibits DOI-induced head-twitch response and decreases expression of 5-hydroxytryptamine (5-HT)2A receptors in the prefrontal cortex. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32:1516-1520. 15. Igarashi Y. [Elucidation of the pharmacological mechanism of yokukansan] in Japanese. Geriatr Med. 2008;46:255-261.
EXPLORE January/February 2013, Vol. 9, No. 1
43