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Daihuang ©Erich Stöger

Since 1989, reports of various forms of interstitial pneumonia have appeared in medical literature, which were evidently ascribed to Kampo formulas. Over the years, the number of annually pub­lished cases has increased; the last of these was reported on recently – in Japanese (1). In 1997, a publication with a larger case series was released, and in 2017 a review, which contribute additio­nal information about the correlations. 

Cases during treatment with the formula Sho-saiko-to

The case series documented by Sato et al. (2) with 94 cases occurring between January 1988 and January 1990, relates exclusively to the formula Sho-saiko-to, which corresponds to the Chinese formula Xiao chai hu san. 72 of the cases were confirmed by a committee of experts to have been caused by this Kampo formula. Sho-saiko-to is very commonly used in Japan in cases of hepato­pathies of various types. 78% of patients in this series had chronic hepatitis or liver cirrhosis, a further 21 % had liver dysfunction, 76.5% tested positively for hepatitis-C antibodies. 

Treatment duration until the onset of interstitial pneumonia was on average 50 days. The symp­toms comprised cough, dyspnea and fever. C-reactive protein rose on average only slightly (5,7 mg/dl), and LDH rose significantly. The bronchoalveolar lavage contained high proportions of both neutrophils and lymphocytes with a low CD4/DC8 ratio. X-rays showed ground-glass shadows and/or ring-like shadows, infiltrations or combinations thereof. In 7 cases a re-exposition was carried out, which confirmed the diagnosis of Sho-saiko-to induced pneumonia. 8 patients died despite a high-dose therapy with steroids. Non-survival was associated with pre-existing lung disease and longer continued intake of the Kampo medicine after the onset of pneumonia.

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