Six cases of overeating successfully treated with rikkunshito

Rikkunshito is used to treat patients with weak constitution who suffer from epigastric symptoms manifesting as appetite loss, stomach upset, and so on, caused by a wide variety of diseases, such as functional dyspepsia, gastroesophageal reflux disease (GERD), and nonerosive reflux disease (NERD) [1]. Rikkunshito improves gastric motility dysfunction, including impaired adaptive relaxation, delayed gastric emptying, and gastric hypersensitivity [2]. Rikkunshito also ameliorates hypophagia in the elderly and stress-induced anorexia [3]. The orexigenic effect of rikkunshito is considered to be related to promotion of ghrelin secretion [3]. However, there is little evidence regarding the efficacy of rikkunshito against overeating. We present six cases of overeating successfully treated with rikkunshito (Table 1). Two examples are described in detail below. Case 1 is a 38-year-old male (body mass index (BMI) 25.8 kg/m2) with an upset stomach. Although he had no problem with his appetite, he felt stickiness in his mouth with a stuck feeling in the pit of the stomach, and right hypochondriac discomfort and resistance on abdominal examination. He was under stress at work. Saikokeishito 2.5 g ter in die (TID, three times a day; TJ-10, Tsumura Co., Ltd., Tokyo) prescribed for 2 weeks improved his irritation and stress. However, he reported epigastric pain before meals, and therefore anchusan 2.5 g TID (TJ-5, Tsumura Co., Ltd., Tokyo) was added. One month later, epigastric pain seldom occurred. Since then, several prescriptions have been given according to his symptoms. For example, hangeshashinto was prescribed when he felt epigastric discomfort accompanied with stomatitis and diarrhea. Bukuryoin or bukuryoingohangekobokuto was applied for belching, and heiisan for a strong stuck feeling in the pit of the stomach. Each prescription was beneficial but not curative. After 1 year of treatment, he reported an upset stomach because of overeating during the year-end and New Year holidays. He confessed that he had a habit of speedy eating and overeating, which made him feel bloated with a heavy stomach. Therefore, rikkunshito 2.5 g TID (TJ-43, Tsumura Co., Ltd., Tokyo) was prescribed. One month after taking rikkunshito, the upset and bloated stomach was normalized, and after 2 months he noticed improvements of coldness in his feet and feeling of fatigue. Taking rikkunshito led him to stop overeating under work stress, which resulted in a decrease of his weight from 66 kg (BMI 25.8 kg/m2) to 63 kg (BMI 24.6 kg/m2) for 2 years. Case 2 is a 45-year-old female (BMI 19.6 kg/m2) with chronic gastritis on endoscopy. Although she had suffered from frequent upset stomach and nausea, she had a good appetite and no signs of Qi deficiency (general fatigue and sleepiness after meals, for example). Her abdominal strength was moderate with a stuck feeling in the pit of the stomach, and thus bukuryoin-gohangekobokuto 2.5 g bis in die (BID, twice a day; TJ-116, Tsumura Co., Ltd., Tokyo) was prescribed. One month later, she said that epigastric discomfort and nausea were relieved, but she had an upset stomach when she could not help eating sweets under the burden of caring. She suffered from a heavy stomach due to overeating caused by her mental condition, such as anxiety, depression, and irritation, under chronic and continuous caring stress. We changed the prescription to rikkunshito 3 g BID (KB-43, Kracie Holdings, Ltd., Tokyo), and after 1 month of treatment, her stomach condition was good. Six months later, she was not inclined to overeat and remained in good condition with rikkunshito. The efficacy of rikkunshito against overeating is considered to be mediated by anxiolytic effect in addition to the improvement of gastric motility function [2, 4], implying that stress-induced eating disorder is a good indication for rikkunshito. Indeed, all six cases showed mental symptoms including anxiety, depressive feeling, irritation, as well as specific symptoms, that is, appetite change and upper gastrointestinal complaints, accompanied with overeating that disappeared after taking rikkunshito. Moreover, since the ghrelin level of overweight subjects is low [5], the ghrelin orexigenic effect of rikkunshito is limited in obese patients. The fact that ghrelin also induces the growth hormone pathway [5], which facilitates metabolism, may have contributed to the weight loss in cases 1, 5, and 6. Arimochi [6], in the ‘Kosei hoyogei’, noted that patients with a palpable thin line of linea alba, which is the sign of spleen deficiency, should be treated with the prescription group of kenchuto, richuto, or rikkunshito. He also explained that they were susceptible to diarrhea, loss of appetite, and overeating. This literature indicates that the prescription group of rikkunshito has been applied to patients with both poor and excessive appetite since the Edo period. Although rikkunshito normally enhances appetite by promoting ghrelin secretion, patients with overeating and/or obesity whose ghrelin secretion is restricted, may have their overeating habit improved by taking rikkunshito. The fact that rikkunshito attenuates depressive symptoms and reduces anxiety may also contribute to the improvement of appetite disorder. We thank Dr. Uezono, Yasuhito, for advice about the effect of rikkunshito on excessive appetite and diet. Kimura Y. has received lecture fees from Kracie Pharma, Ltd. N/A. N/A. N/A. N/A.