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then examined the minimum effective dose of Shakuyaku-kanzo-to in the remaining 28 patients

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Shakuyaku-kanzo-to (Shao-Yao-Gan-Cao-Tang) as Treatment of Painful Muscle Cramps in Patients with Lumbar Spinal Stenosis and Its Minimum Effective Dose

Our data show that Shakuyaku-kanzo-to is effective for painful muscle cramps associated with lumbar

then examined the minimum effective dose of Shakuyaku-kanzo-to in the remaining 28 patients.
Shakuyaku-kanzo-to reduced the frequency of painful muscle cramps to less than 50% in 13 of 16
patients. However, eperisone hydrochloride reduced it to the same level in 4 of 14 patients. The onset of
the maximum therapeutic effect of Shakuyaku-kanzo-to was less than 3 days from the start of treatment
in 11 of 15 patients. Regarding the minimum effective dose for painful muscle cramps, 2.5 g of
Shakuyaku-kanzo-to used as needed had a therapeutic effect that was equivalent to the regular use of 7.5
g/day (given in divided doses three times daily).
Our data show that Shakuyaku-kanzo-to is effective for painful muscle cramps associated with lumbar
spinal stenosis. The dosage of 2.5 g of Shakuyaku-kanzo-to as needed had a therapeutic effect that was
equal to the regular use of 7.5 g/day.
INTRODUCTION
Many patients visiting pain clinics with low back pain or leg pain actually suffer from lumbar spinal stenosis,
which often involves painful muscle cramps. Shakuyaku-kanzo-to (Shao-Yao-Gan-Cao-Tang), which is an
herbal medicine (Kampo medicine) that has been used for a very long time in traditional medicine in East Asia,
is known to be effective for painful muscle cramps as well as crampy pain in the gastrointestinal smooth muscle
and in skeletal muscle. Shakuyaku-kanzo-to consists of two herbs: P. lactiflora and Glycyrrhiza. These two
herbs contain paeoniflorin, a monoterpene glycoside, and glycyrrhizin, a triterpene glycoside, respectively. The
application of the combination of paeoniflorin and glycyrrhizin reportedly produced a muscle relaxant effect in
mouse phrenic nerve specimens as a result of the synergistic action of the two compounds (1). Indeed,
Shakuyaku-kanzo-to effectively relieves painful muscle cramps associated with lumbar spinal stenosis, which is
a common symptom occurring in outpatients in pain clinics, and is widely used in their treatment (2, 3, 10).
Glycyrrhizin, however, is known to cause hypokalemia, hypertension, and edema as pharmacological adverse
drug reactions (14). Administration of the minimum effective dose is thus preferable.
In this study, we compared the effectiveness of Shakuyaku-kanzo-to for painful muscle cramps associated
with lumbar spinal stenosis with that of eperisone hydrochloride, which is widely prescribed as muscle relaxant

PAINFUL MUSCLE CRAMPS TREATED BY SHAKUYAKU-KANZO-TO
E133
and is often administered in case of muscle cramps. Then we determined the minimum effective dose of
Shakuyaku-kanzo-to.

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