Two Cases of Inflammatory Bowel Disease Successfully Maintained in Remission with Kampo Decoction rather than Extract Formulations

Abstract

Inflammatory bowel disease (IBD) is a chronic inflammatory condition of unknown etiology characterized by recurrent periods of remission and relapse. Despite standard treatments, several patients continue to experience symptoms, such as abdominal pain, diarrhea, bloody stools, and inflammation of the intestinal mucosa. This report presents two cases of patients with IBD who achieved remission using Kampo decoctions instead of extract formulations. Case 1 involved a man in his forties with Crohn’s disease. He remained in remission for four years after receiving treatment with aminosalicylic acid and a Kampo decoction following partial resection of the small intestine. However, when he switched to an extract formulation with the same content as the decoction, he experienced worsened diarrhea and bloody stool. The patient’s symptoms and inflammatory markers improved following a comprehensive Kampo medical evaluation and administration of a decoction of daikenchuto and hochuekkito. Case 2 involved a woman in her forties with ulcerative colitis who had been in remission for four years with infliximab and a Kampo decoction consisting of hochuekkito, shimotsuto, and keishibukuryogan. However, four months after changing to an extract formulation with the same ingredients as the decoction, the patient experienced erosion of the rectal mucosa and bloody stool. After returning to the decoction and adding mesalazine suppositories, her symptoms improved. These cases suggest that Kampo decoctions may be useful in maintaining IBD remission, particularly when extracts are not significantly effective.