Effects of Kampo Herbal Medicine on Plasma Melatonin Concentration in Patients

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1 The American Journal of Chinese Medicine, Vol. 30, No. 1, World Scientific Publishing Company & Institute for Advanced Research in Asian Science and Medicine Effects of Kampo Herbal Medicine on Plasma Melatonin Concentration in Patients Hareka Watanabe, * Takao Kobayashi, * Meibou Tomii, * Yuki Sekiguchi, + Kazuhide Uchida, Tadashi Aoki and Jong-Chol Cyong * * Department of Bioregulatory Function, University of Tokyo Graduate School of Medicine Hongo, Bunkyo-ku, Tokyo , Japan + Department of Urology, School of Medicine Yokohama City University, Japan Department of Anaesthesiology, St. Marianna University School of Medicine, Japan (Accepted October 1, 2001) Abstract: There are studies reporting that some natural products containing melatonin. Sleep disturbance and nocturnal polyuria are related to abnormal biorhythm. It is possible that Kampo medicine may influence biorhythm. We therefore examined the symptoms and plasma melatonin of patients treated with Rokumi-gan, Hachimi-jio-gan, Gosha-jinki-gan and Seishinrenshi-in. Furthermore, the concentration of four kampo medicines and crude drugs making up these formulations were investigated. Diurnal plasma melatonin was not affected by Rokumi-gan, but tended to be lowered by treatment with Hachimi-jio-gan, Gosha-jinkigan and Seishinrenshi-in. Melatonin was present in several extracts from crude drugs, namely Rehmanniae radix, Moutan cortex, Cinnamomi cortex, Aconiti tuber, Plantaginis semen, Scutellariae radix and Lycii radicis cortex. Keywords: Kampo; Herbal Medicine; Melatonin; Hachimi-jio-gan; Gosha-jinki-gan. Introduction Melatonin has a role in the regulation of circadian rhythms, mood and tumor growth (Amnon, 1997). Sleep disturbance, seasonal affective disorders and the nocturnal polyuria of diabetes are related to abnormal biorhythm. Kampo herbal medicine, a Japanese traditional medicine has been applied to relieve complaints, which may be related to dysfunction of circadian rhythm. Recently certain plants have shown to contain melatonin (Dubbels and Reiter, 1995; Hattori et al., 1995; Murch et al., 1997). Since Kampo formulations consist of a combination of herbs, it is possible that Kampo medicine may contain melatonin and have an effect on biorhythm. Rokumi-gan, Hachimi-jio-gan, Gosha-jinki-gan and Seishi-renshi-in are often prescribed in Japan for patients who have symptoms of the genitourinary tract or central nervous system, and are effective in relieving nocturia of sleep interruption due to frequency. In this study, we therefore examined the content of melatonin in these four Kampo formulations and their 17 components (Watanabe et al., 1999). Plasma melatonin concentration was measured before and after administration of the Kampo formulations (Watanabe et al., 1998). 65

2 66 H. WATANABE et al. Materials and Methods Materials Extract granules of Gosha-jinki-gan (Achyranthes and Plantago Formula in English, Pilulae renales plantaginis et achyranthis in Latin), Rokumi-gan (Rehmannia Six Formula, Pilulae sexmedicamentorum rehmanniae), Hachimi-jio-gan (Rehmannia Eight Formula, Pilulae octomedicamentorum rehmanniae) and Seishin-renshi-in (Lotus Seed Combination, Decoctum nelumbinis purificationis cordis) marketed for treatment of patients were provided by Tsumura & Co. (Tokyo, Japan). The following crude drugs provided by Uchida Wakanyaku Co. Ltd. (Tokyo, Japan) were prepared to measure melatonin activity: Rehmanniae radix, Hoelen, Alismatis rhizoma, Dioscoreae rhizoma, Corni fructus, Moutan cortex, Cinnamomi cortex, Aconiti tuber, Plantaginis semen, Achyranthis radix, Nelumbis semen, Astragali radix, Ginseng radix, Scutellariae radix, Ophiopgonis tuber, Lycii radicis cortex and Glycyrrhizae radix. Measurement of Plasma Melatonin Twelve patients (seven males, five females; average age 52 ± 17.5) with residual urine and pain on urination, and eight patients (five males and three females; average age 61 ± 10.8) with non-insulin dependent diabetes mellitus (NIDDM), not using insulin, were the subjects of the study. The eight patients with NIDDM were treated orally with Gosha-jinki-gan and Rokumi-gan for two weeks respectively. The 12 urology patients were treated with Hachimijio-gan and Seishin-renshi-in alternately for two weeks. The urology patients answered questions about their subjective symptoms before and after herbal medicine administration. Figure 1. The concentrations of melatonin in plasma from the patients with non-insulin dependent diabetes mellitus. The concentration of melatonin before (l) and after two weeks ( ) administration of Rokumi-gan and Gosha-jinki-gan was detected by ELISA.

3 KAMPO MEDICINE AND MELATONIN 67 Venous blood samples were collected at about 10 am before and after administration of Kampo formulations, using heparinized tubes. All samples obtained were centrifuged and stored at 80 C until assay. Plasma melatonin was determined at the same time with a commercially available enzyme linked immunosorbent assay (ELISA) kit (Buhlmann Laboratories AG, Allschwil, Switzerland). The analytical sensitivity of the assay was 3.6 pg/ml. All data presented as the mean ± SE. The significant difference between plasma melatonin concentrations (PCM) and symptoms was analyzed with the Mann-Whitney U test and the Student s t-test. The p value <0.05 was considered significant. Measurement of Melatonin Activity in Crude Drugs and Kampo Formulations The component herbs of each formulation, Gosha-jinki-gan, Rokumi-gan, Hachimi-jiogan, and Seishi-renshi-in are shown in Table 1. One day doses of four Kampo formulations and 15 g of 17 crude drugs, which consist of the above four Kampo medicines, were each decocted with 300 ml of distilled water to 150 ml for melatonin activity measurement. Each decoction was centrifuged at 3500 rpm for 10 minutes at 4 C. Polyphenol, which might interfere with the in vitro assay for melatonin, was excluded by adding polyclar SB-100 (Gokyo Trading Co. Ltd., Osaka, Japan). Addition and centrifugation were performed twice. Melatonin concentration was measured by an ELISA kit. Table 1. Melatonin Concentration in Kampo Formulation and Its Component Herbs Formula One Day Dose (g) Total Component Herbs pg per One Day Dose (600 ml) pg per 1 g Dry Herbs Rokumi-gan Rehmanniae Radix Corni Fructus 0 Dioscoreae Rhizoma 0 Alismatis Rhizoma 0 Hoelen 0 Moutan Cortex Hachimi-jio-gan Aconiti Tuber 11.0 Cinnamomi Cortex Gosha-jinki-gan Achyranthis Radix 3.2 Plantaginis Semen Seishin-renshi-in Nelumbis Semen 0 Ophiopgonis Ruber 13.3 Hoelen 0 Astragali Radix 0 Ginseng Radix 0 Scutellariae Radix 1690 Plantaginis Semen Lycii Radicis Cortex Glycyrrhizae Radix 730.7

4 68 H. WATANABE et al. Results Detection of Melatonin in Plasma The plasma melatonin concentrations (PMC) in patients with NIDDM before and after administration of Gosha-jinki-gan and Rokumi-gan are shown in Fig. 1. The PMC decreased in six of the eight patients in the Gosha-jinki-gan group and three of the eight patients in the Rokumi-gan group. Regarding the melatonin concentration before administration as 100, the degree of change after administration was determined. PMC increased to 154 after Rokumi-gan and decreased to 33 (p = 0.054) after Gosha-jinki-gan administration. Although most patients, except on with NIDDM, did not have any complications or subjective symptoms, the patient with paralysis of hand and foot was improved by Gosha-jinki-gan treatment. Figure 2 shows the PMC decreased in nine of the 12 urological patients treated with Hachimi-jio-gan and in eight of the 12 patients treated with Seishin-renshi-in. In comparison between these two groups, PMC in the Hachimi-jio-gan was significantly lower than the Seishin-renshi-in group (Fig. 2). The PMC in five patients who complained of sleepiness after a meal was reduced more by Hachimi-jio-gan than by Seishin-renshi-in. Patients with high PMC usually complained of sleepiness after a meal, stiff shoulders, and nervousness. Patients with low PMC complained that their hands were cold (Table 2). Seven out of 12 patients found that Hachimi-jio-gan was more effective than Seishin-renshiin. One out of 12 patients preferred Seishin-renshi-in, and both medicines were effective in one patient. Figure 2. The concentrations of melatonin in plasma from the patients with urodynia pollakiuria and residual urine. The concentration of melatonin before (Ž) and after two weeks ( ) administration of Hachimi-jio-gan and Seishin-renshi-in was detected by ELISA.

5 KAMPO MEDICINE AND MELATONIN 69 Table 2. Symptoms and Plasma Melatonin Concentration of Patients Treated with Hachimi-jio-gan and Seishin-renshi-in Symptom Number of Patients Average Concentration of MLT Not easy to wake up * Stiff shoulders * Nervous disposition * Cold feeling in hands 5 9.3* *p < 0.02 (Mann-Whitney U Test). Detection of Melatonin Activity in Herbs and Formulations Melatonin activity was high in the crude drugs: Rehmanniae radix, Moutan cortex, Cinnamomi cortex, Aconiti tuber, Plantaginis semen, Achyranthis radix, Scutellariae radix, Ophiopgonis tuber, and Lycii radicis cortex. In the formulations, Hachimi-jio-gan and Goshajinki-gan showed more melatonin activity than Rokumi-gan. Seishin-renshi-in was shown to have the most melatonin activity (Table 1). The melatonin activity in the four formulations almost coincided with that in the extracts from the crude drugs. Discussion Melatonin is a hormonal product of the pineal gland, the circadian rhythm of its secretion reflecting signals originating in the suprachiasmatic nucleus (Amnon, 1997). Although the presence of melatonin receptors has been demonstrated in various regions such as the brain (Stankov et al., 1994), gut (Lee and Pang, 1993), ovaries (Yie et al., 1995) and blood vessels (Viswanathan et al., 1990; Uchida et al., 1997). Melatonin may also act directly at the intracellular level (Benitez-King and Anton-Tay, 1993). Thus, it plays a role in the biologic regulation of sleep, mood, antioxidant effect (Reiter, 1995), enhancement of immune function (Maestroni, 1993), etc. In Kampo medicine, Rokumi-gan is often used to treat patients with hot extremities. Gosha-jinki-gan and Hachimi-jio-gan are prescribed for patients with cold extremities and patients with diabetic or autonomic neuropathy (Ishigaki et al., 1986; Sakamoto and Sato, 1985). On the other hand, Seishi-renshi-in has been prescribed for patients who have chronic urogenital disorder. Our results show that diurnal melatonin was significantly higher in patients who often complained of central nervous symptoms like neck stiffness or difficulty in waking up in the morning. Rokumi-gan did not affect diurnal plasma melatonin, but Hachimi-jio-gan and Gosha-jinki-gan tended to decrease it. The decrease in plasma melatonin concentration may be related to the effects of these Kampo medicines. Abnormal circadian rhythm of melatonin has been observed in patients with NIDDM (O Brien et al., 1986). Gosha-jinki-gan and Hachimi-jio-gan were considered to affect the central nervous system through the action of melatonin. However, after the administration of the formulations for two weeks, plasma melatonin concentrations were decreased. It was

6 70 H. WATANABE et al. assumed that the prolonged action of melatonin in the gut might suppress its secretion in the brain. The detailed pathway of the melatonin effects in the body such as involvement of gastrointestinal receptors should be investigated. In our result, melatonin activity was seen especially in Scutellariae radix. In the ELISA kit, cross-reactivities of melatonin antiserum was found with its metabolites such as serotonin, N-acetylserotonin, 5-methoxytryptophol, etc. It is possible that certain substance in the extracts of crude drugs other than melatonin may bind enzyme conjugates. Murch et al. (1997) reported that the melatonin concentration in Scutellariae radix was 7110 pg per gram of dried herbs by HPLC or radioimmunoassay (RIA) after extraction with acetone. The efficiency and reproducibility of extraction were decreased by decomposition of indolamines like melatonin or serotonin due to photooxidation. A more efficient method of extraction and measurement is needed. It is suggested that herbal medicine might be effective for abnormal biorhythm because of the amounts of melatonin found in the crude drugs and Kampo medicines. Murch S. et al. reported that the melatonin concentration in Scutellariae radix was 7110 pg per gram of dried herbs by HPLC or radio immunoassay (RIA) after extraction with acetone (Murch et al., 1997). The efficiency and reproducibility of extraction were decreased by decomposition of indolamines like melatonin or serotonin due to photooxidation. A more efficient method of extraction and measurement is needed. Because of the amounts of melatonin found in crude drugs and Kampo medicines, it is suggested that Kampo medicines would be effective in the body. Acknowledgements This work was supported in part by a grant-an-aid for Scientific Research of Kampo Medicine from Tsumura and Co., Ltd. References Amnon, B. Melatonin in human. N. Engl. J. Med. 336: , Benitez-King, G. and F. Anton-Tay. Calmodulin mediates melatonin cytoskeletal effect. Experientia 49: , Dubbels, R. and R.J. Reiter. Melatonin in edible plants identified by radioimmunoassay and by high performance liquid chromatography-mass-spectrometry. J. Pineal Res. 18: 28 31, Hattori, A., H. Migitake, Y. Yigo, M. Itoh, K. Yamamoto, O.R. Kaneko, M. Hara and R. Reiter. Identification of melatonin in plants and its effects on plasma melatonin levels and binding to melatonin receptors in vertebrates. Biochem. Mol. Biol. Int. 35: , Ishigaki, K., J. Fukada, M. Imura, T. Simizu, K. Nagai, H. Kiyosawa, H. Yamada, T. Maeba, N. Uehara, S. Hirano, T. Sindoh and Y. Matsuyama. The efficiency of Gosha-jinki-gan for diabetic neuropathy (in Japanese). Diag. N. Med. 23: , Lee, P.P.N. and S.F. Pang. Melatonin and its receptors in the gastrointestinal tract. Biol. Signals. 2: , 1993.

7 KAMPO MEDICINE AND MELATONIN 71 Maestroni, G.J. The immunoneuroendocrine role of melatonin. J. Pineal Res. 14: 1 10, Murch, S.J., C.B. Simmons and P.K. Saxena. Melatonin in feverfew and other medical plants. Lancet 350: , O Brien, I.A.D., I.G. Lewin, J.P. O Hare, J. Arendt and R.J.M. Corrall. Abnormal circadian rhythm of melatonin in diabetic autonomic neuropathy. Clin. Endocrinol. 24: , Reiter, R.J. The role of the neurohormone melatonin as a buffer against macromolecular oxidative damage. Neurochem. Int. 27: , Sakamoto, N., and Y. Sato. The effect of No. 107 Gosha-jinki-gan for diabetic neuropathy (in Japanese). Kampo Igaku 9: 45 47, Stankov, B., F. Fraschini and R.J. Reiter. Melatonin binding sites in the central nervous system. Brain Res. Brain Rev. 16: , Uchida, E., T. Aoki and B. Ishizuka. Effects of melatonin on cardiovascular system (in Japanese). Resp. Circ. 45: , Viswanathan, M., J.T. Laitinen and J.M. Saavedra. Expression of melatonin receptors on arteries involved in thermoregulation. Proc. Natl. Acad. Sci. U.S.A. 87: , Watanabe, H., T. Kobayashi, M. Tomii, Y. Sekiguchi, K. Uchida, T. Aoki and J.C. Cyong. The effect of Kampo medicine on plasma melatonin. J. Trad. Med. 15: , Watanabe, H., T. Kobayashi, T. Hong, Q.H. Song, Y. Sekiguchi and J.C. Cyong. The melatonin activity of crude drugs and Kampo medicine. Proc. 10th Int. Congr. Oriental Med.128, Yie, S.M., L.P. Niles and E.V. Younglai. Melatonin receptors on human granulosa cell membranes. J. Clin. Endocrinol. Metab. 80: , 1995.

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