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      Immediate Effect of Shakuyaku-kanzo-to on Muscle Cramp in Hemodialysis Patients

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          We administered 2.5 g of Shakuyaku-kanzo-to granule to 61 patients who had muscle cramp during hemodialysis (HD) sessions and examined its immediate effects. We selected 10 patients who wanted to take the drug at home, out of cases, for whom the drug was effective on the study described above and had them take the drug in the same way at the beginning of muscle cramp at home examined the effects. In the study during HD sessions, muscle cramp and its associated pain disappeared in 5.3 ± 3.9 min on average in 54 out of 61 cases. In the study of patients who took the drug at home, muscle cramp disappeared within 10 min in all cases. Shakuyaku-kanzo-to is thought to be very useful for muscle cramp during HD sessions of hemodialized patients because it has immediate effects by its oral administration on the occasion of cramp. With regard to the muscle cramp, which appears at home after HD sessions, the patients can cope with it by taking the drug by themselves. This is an epoch-making therapy, for it was impossible to cope with muscle cramp except in hospitals because the therapy of muscle cramp was limited to intravenous infusion of hypertonic solutions of dextrose, mannitol, and saline during HD sessions.

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          Effect of orally administered shao-yao-gan-cao-tang (Shakuyaku-kanzo-to) on muscle cramps in maintenance hemodialysis patients: a preliminary study.

          Muscle cramps are one of the most common complications of hemodialysis (HD), and often are a source of great pain in spite of various clinical measures. The traditional herbal medicine, shao-yao-gan-cao-tang (Japanese name: Shakuyaku-kanzo-to), consists of equal amounts of paeony and licorice roots, and has been used in Japan and China for muscle pain or skeletal muscle tremors. To determine whether this medicine is able to prevent frequent and unendurable muscle cramps in patients undergoing HD, Shakuyaku-kanzo-to at 6 g per day was prospectively administered for 4 weeks to five patients on HD who were suffering from frequent muscle cramps. The frequency and severity of cramping before and after the treatment treatment were carefully observed and compared. Skeletal muscle cramps completely disappeared in two of the treated patients after the start of oral administration of Shakuyaku-kanzo-to. Moreover, the frequency of cramping was significantly decreased in two of the remaining three patients after persistent administration. The severity of muscle cramps was also decreased by this treatment in the responsive patients. No serious side effects were detected during the treatment period. The inhibitory effect of Shakuyaku-kanzo-to on muscle contraction was also experimentally examined by using phrenic nerve-diaphragm preparations from male Wistar rats. Differences between the twitch responses were determined when the diaphragms and the nerves were stimulated in the presence and absence of the extract of Shakuyaku-kanzo-to. The results demonstrated that extracts of paeony and licorice roots inhibit contraction of skeletal muscles in rats. Taken together, we suggest that administration of Shakuyaku-kanzo-to is a safe, effective treatment for preventing muscle cramps in patients undergoing HD.
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            Blocking effects of blended paeoniflorin or its related compounds with glycyrrhizin on neuromuscular junctions in frog and mouse.

            The combined effects of paeoniflorin (PF), a main component of paeony roots, and glycyrrhizin (GLR), a main component of licorice roots, were investigated on isolated sciatic nerve-sartorius muscle preparations in frogs, or on isolated or in situ phrenic nerve-diaphragm muscle preparations in mice, intending to explain the effects of "Shakuyaku-Kanzô-Tô, composed of both these Chinese drugs, on clinical neuropathy. PF and GLR used together blocked indirectly stimulated twitchings at concentrations which when used alone induced no blocking effects. PF and GLR at a combining ratio of 1:2 (weight concentrations) corresponding to the amounts contained in "Shakuyaku-Kanzô-Tô, was more potent than when they were used at the ratio of 1:1 or 2:1. The synergistic effects induced by GLR were also confirmed for the other components, paeoniflorigenone or oxypaeoniflorin, which are contained in paeony roots, and for succinylcholine. The blocking effect of d-tubocurarine were not increased by GLR. Concludedly, PF and GLR were found to cause the pharmacological blend effect. The two combined compounds were mainly therapeutic components in "Shakuyaku-Kanzô-Tô".
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              The Immediate Effect of Shakuyaku-kanzo-to, Traditional Japanese Herbal Medicine, for Muscular Cramps during Maintenance Hemodialysis


                Author and article information

                Nephron Clin Pract
                Nephron Clinical Practice
                S. Karger AG
                August 2006
                26 May 2006
                : 104
                : 1
                : c28-c32
                aYokohama Dai-ichi Hospital, Yokohama City, bAtsugi Clinic, Atsugi City, cDepartment of Urology, Kitasato University School of Medicine, Sagamihara City, dDepartment of Urology, Tokai University Hachioji Hospital, Hachioji City, Japan
                93256 Nephron Clin Pract 2006;104:c28–c32
                © 2006 S. Karger AG, Basel

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