Effect of Japanese Kampo medicine, eppikajutsuto, in patients with lymphatic malformation

Abstract

Lymphatic malformations (LMs) are congenital malformations of the lymphatic system that cause considerable cosmetic and functional complications. In this study, we present 8 children with LM who were treated with the Kampo medicine eppikajutsuto (EKJT). Between 2001 and 2020, 8 children (male: 4, female: 4) with LMs who underwent magnetic resonance imaging (MRI) evaluation both before and after treatment or observation were selected for investigating the effect of EKJT. Two patients were observed without any treatment for 24 and 60 months. EKJT was evaluated based on percentage reduction, defined as the percentage of total lesions that decreased in size, confirmed by radiological examination after initiating treatment with EKJT or determined by observation alone. Volumetric analysis of LMs on MRI was performed using the Digital Imaging and Communications in Medicine viewer. Six patients were treated with EKJT. The mean observational period was 13.2 months (range: 6–24 months). The mean reduction in LM volume on MRI was 73.0% in treated patients and –66.3% in observed patients. Two of the 6 lesions exhibited complete reduction, 2 exhibited marked (>90%) reduction, 1 exhibited moderate reduction, and 1 exhibited a small response. The treatment was well-tolerated, with no severe adverse events. This preliminary study demonstrated the beneficial effects of EKJT. Prospective evaluations of this promising therapeutic modality are warranted based on the results of this study.

An analysis of the onset and clinical characteristics in cystic lymphatic malformations

“…Japanese herbal medicine is often used in children. Some studies have reported that treatment with Japanese herbal medicine has resulted in a marked reduction in cLM 13,14 . There is currently no consensus concerning the administration of Japanese herbal medicine to reduce cLM, as clear evidence is lacking in terms of evaluating its efficacy.…”

“…In this study, the treatment grade was defined as the highest grade of treatment during the treatment course. Herbal medicines used by the patients included "Eppikajyututo," "Ogikenchuto," and/or "Keishibukuryogankayokuinin," which are reportedly effective in reducing and eliminating excessive fluids in patients with inflammatory joint disorders and lymph edema 13,14 . Those have diuretic action.…”

“…Major treatment options include course observation [3][4][5] , sclerotherapy [6][7][8][9] , surgical resection and, more recently, sirolimus [10][11][12] or herbal medicine 13,14 . Spontaneous regression has also been observed [4][5][6][7] .…”