The Therapeutic Effects of Goreisan, a Traditional Japanese Herbal Medicine, on Lower‐Limb Lymphedema after Lymphadenectomy in Gynecologic Malignancies: A Case Series Study

Abstract

Background. Lower-limb lymphedema (LLL) is a chronic and progressive complication of gynecologic cancer treatment, including pelvic lymphadenectomy. This study aims to investigate the therapeutic effect of goreisan, a traditional Japanese medicine, which has been used for hydrostatic modulation on patients with LLL. Methods. Patients diagnosed with LLL in our hospital in 2018 were included and principally treated with complex decongestive therapy (CDT), including elastic clothing and lymph drainage. The patients who received a combination therapy of CDT and goreisan (CDT-G group) were prescribed goreisan extract granules, with a dose of 7.5 g per os daily in three doses. Patients who were not prescribed goreisan received CDT alone (CDT group). The severity of lymphedema was evaluated by the estimated limb volume calculated by limb circumferences and the ratio of extracellular water (ECW) to total body water (TBW). Results. Nineteen women with LLL after pelvic lymphadenectomy were included in the study. The number of patients in the CDT and CDT-G groups was 8 and 11, respectively. There were no statistically significant differences between the CDT and CDT-G groups in terms of patient characteristics and severity of LLL before treatment. Reduction in ECW/TBW in the CDT-G group (in the whole body and the affected lower limb) after the intervention was significantly more remarkable than that in the CDT group. Conclusions. Goreisan-based Japanese herbal therapy may be effective in patients with LLL after retroperitoneal lymphadenectomy.

Acquired lymphedema: Molecular contributors and future directions for developing intervention strategies

“…This herb is available in China and Korea. LLL patients who received Goreisan showed a remarkable reduction in extracellular water (ECW)/total body water (TBW) ratio, suggesting that the herb ameliorated the excessive accumulation of extracellular fluid that restricted free physical movement of extremities proximal to the lymphadenectomy-affected sites ( Yoshikawa et al, 2020 ).…”

Impact of Goreisan components on rat mesenteric collecting lymphatic vessel pumping

“…Goreisan is described as a water balance modulator with mild diuretic properties that can relieve symptoms of edema 11,12 . While diuretics typically are not recommended for lymphedema treatment due to their negative impact on electrolyte balance, no adverse effects on electrolytes were found in the recent study utilizing Goreisan 7 . This may be due to the impact of Goreisan on aquaporin expression rather than ion transporters.…”

“…An additional approach that has been tested in Japan is Kampo medicines (traditional herbal medicines) for prevention of secondary lymphedema following surgical excision of lymph nodes. One Kampo medicine, Goreisan (also known as Wu Ling San in China and Oreongsan in Korea), has been tested to reduce symptoms of surgically induced lymphedema patients 6,7 . Goreisan is a formulation of five herbs: Alismatis Rhizoma, Polyporus, Poria, Cinnamomi Cortex, and Atractylodis Lanceae Rhizoma, and are widely used in Japan and other east Asian countries to treat edema, nausea, and headaches 8–10 .…”

“…One Kampo medicine, Goreisan (also known as Wu Ling San in China and Oreongsan in Korea), has been tested to reduce symptoms of surgically induced lymphedema patients. 6,7 Goreisan is a formulation of five herbs: Alismatis Rhizoma, Polyporus, Poria, Cinnamomi Cortex, and Atractylodis Lanceae Rhizoma, and are widely used in Japan and other east Asian countries to treat edema, nausea, and headaches. [8][9][10] Goreisan is described as a water balance modulator with mild diuretic properties that can relieve symptoms of edema.…”

“…6 In the second study, administration of Goreisan in addition to standard-of-care compression and manual therapies was found to improve lower-limb lymphedema after pelvic lymphadenectomy, with a decreased estimated ratio of lower limb water volume to total body water. 7 These studies suggest that Goreisan may be useful for reducing lymphedema symptoms, however the mechanisms remain unknown.…”