Two cases of functional abdominal bloating successfully treated with hangekobokuto

To the editor, Functional abdominal bloating is a clinical entity which is characterized by intractable and uncomfortable abdominal fullness due to aerophagia with bowel gas retention. Recently, we experienced two cases of functional abdominal bloating with complaints of abdominal fullness or flatulence; the symptoms were successfully treated with the Kampo medicine hangekobokuto (HKT). Case 1 was a 73-years-old male whose complaint was abdominal fullness since 10 years. His abdominal fullness occurred around 10 a.m. every morning, sometimes accompanied with belching. Abdominal fullness is sometimes also accompanied by a need to defecate, and he passed normal stool mixed with a huge amount of bowel gas, which dispersed by flatulence. He had a past history of diabetes mellitus, angina and hypertension. On tongue diagnosis, he showed light-red tongue with slight white fur. His pulse diagnosis was deep and somewhat weak. His abdominal diagnosis showed slightly weak abdominal strength accompanied by lower abdominal weakness. After taking HKT ethical granule, his abdominal fullness almost disappeared the following day. After that, he was not disturbed any more by abdominal fullness and other gas symptoms. Case 2 was a 48-years-old male whose complaint was a frequent urgency to defecate since three months. His abdominal discomfort and rumbling of the intestine, and the frequent need to defecate, occurred from evening to nighttime. He usually passed bowel gas only, but sometimes had normal stool mixed with bowel gas, which dispersed by flatulence. He had a past history of surgery for thymic tumor and somatoform disorder as well as adaptation disorder. On tongue diagnosis, he showed light-red tongue with moderate white fur. His pulse diagnosis was deep, and abdominal diagnosis showed moderate abdominal strength accompanied with tympanic sound, suggestive of abdominal gas retention. After taking HKT ethical granule, the rumbling of his intestines improved after four weeks. After eight weeks, all his symptoms related to bowel gas had disappeared. Various treatments including medical and mental therapy are now applied as therapeutic options for functional abdominal bloating, but no effective standard therapy has yet been reported [1]. From this standpoint, Kampo medicine can be a new option for medical treatment, because it is easy to use in Japanese medical practice. HKT consists of Pinelliae Tuber, Hoelen, Magnoliae Cortex, Perillae Herba and Zingiberis Rhizoma. HKT is frequently used to treat neurosis or globus, but is also applied for gastrointestinal diseases. Previously, we reported that HKT reduced bowel gas volume and improved gastrointestinal symptoms, along with improving the gastric emptying rate in patients with functional dyspepsia [2, 3]. The reduction of bowel gas seems to be due to the suppression of aerophagia, which might be a characteristic mechanism of action for HKT. Moreover, the anxiolytic effect of the crude drugs included in HKT has been also reported in animal models [4, 5], which should be considered for related action mechanisms in abdominal gas reduction. It is not rare for patients to complain of abdominal fullness due to aerophagia. Therefore, an effective mode of treatment for this bothersome symptom is needed in general practice including Kampo clinics. HKT can be a strong and feasible option for the treatment of functional abdominal bloating.