Keishi-bukuryo-gan (Gui-Zhi-Fu-Ling-Wan) (KBG) is one of the prescriptions in Japanese traditional medicine for improving the "oketsu" syndrome, so-called blood stasis syndrome. "Oketsu" syndrome is an important pathological conception in Japanese traditional medicine and often accompanies cerebro-vascular disorders. Previously, we were able to reveal a deterioration of RBC (Red blood cell) deformability and viscoelasticity in patients with "oketsu" syndrome. The purpose of the present study was to evaluate whether KBG has an effect on RBC deformability in comparison with pentoxifylline (PXF). The subjects were 30 male patients with multiple lacunar infarctions. Eighteen patients (44-79 yrs, mean [+ or -] SD, 66.1 [+ or -] 10.7 yrs) were treated with 12 g of KBG daily for 4 weeks (KBG group). Twelve patients (59-78 yrs, 70.7 [+ or -] 6.4 yrs) were treated with 300 mg of PXF daily for 4 weeks (PXF group). Based on the "oketsu" score, the patients of each group were divided into two subgroups, a non-"oketsu" group ("oketsu" score 20 points or less) and an "oketsu" group ("oketsu" score 21 points or higher). KBG had significant effects on RBC deformability as evaluated by filtration method. KBG also significantly increased intracellular ATP content, as did PXF. Moreover, KBG was more effective for patients with a more severe "oketsu" state. However, PXF was effective only in patients with "oketsu" syndrome, who might have deteriorated RBC deformability. In conclusion, the effect of KBG on RBC deformability was by no means inferior to PXF.
Key words: Keishi-bukuryo-gan, Pentoxifylline, Kampo medicine, RBC deformability, hemorheology
"Oketsu", blood stasis syndrome, is one of the pathological concepts unique to Japanese traditional medicine. In Japanese traditional medicine, "ketsu" ("Xue" or blood), means human red body fluid containing life energy ("ki" or "Qi"), that circulates in the body. "Oketsu" is a pathological state induced by circulatory failure of this "ketsu". The "oketsu" state was evaluated by the criteria presented by Terasawa et al. (Terasawa et al., 1989) in Japan. We previously reported that most of the patients with multiple cerebral infarction were complicated with "oketsu" syndrome (Hikiami et al., 1996a). These diagnostic criteria are popularly called the "oketsu" score (Table 1). Patients with "oketsu" syndrome revealed impairment of microcirculation on the basis of observiation of the blood flow of their bulbar conjunctiva by means of a video-microscope system (Terasawa et al., 1988), and they presented with elevated blood viscosity. (Terasawa et al., 1986) and increased RBC aggregability (Kohta et al., 1992). Recently, we established that RBC deformability and viscoelasticity were impaired in patients with "oketsu" syndrome (Hikiami et al., 1996b).
Keishi-bukuryo-gan (KBG: Gui-Zhi-Fu-Ling-Wan), one of the prescriptions in Japanese traditional medicine for improving the "oketsu" syndrome, exerts some favorable pharmacological effects on improving a conjunctival microcirculation (Itoh et al., 1988), inhibiting a platelet aggregation, suppressing the production of Thromboxane A2 in platelets, and decreasing blood viscosity (Tosa et al., 1987) and RBC aggregability (Kohta et al., 1993). Clinically, KBG has a favorable effect on several symptoms of patients with cerebro-spinal vascular disorder (Tosa et al., 1989)....