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This article reviews the effectiveness of Kampo (traditional Japanese herbal medicine) in the treatment of functional gastrointestinal disorders, especially functional dyspepsia (FD) and irritable bowel syndrome (IBS). The results of four randomized, controlled trials (RCTs) suggested the usefulness of rikkunshito in relieving the subjective symptoms of patients with FD. Rikkunshito significantly improved not only gastric symptoms, such as epigastiric discomfort, but also extra-gastric symptoms, such as general fatigue, when compared with control drugs. The therapeutic effects of rikkunshito were more evident when it was prescribed to patients with "kyosho", i.e., low energy. Two RCTs suggested the efficacy of keishikashakuyakuto for IBS.Basic research studies have demonstrated that these Kampo medicines have multiple sites of action to improve subjective symptoms. For example, rikkunshito improves gastric motility dysfunction, including impaired adaptive relaxation and delayed gastric emptying, gastric hypersensitivity, and anorexia via facilitation of ghrelin secretion. It also exhibits anti-stress effects, i.e., it attenuates stress-induced exacerbation of gastric sensation and anorexia, as well as the hypothalamic-pituitary-adrenocortical axis and sympathetic activation. Keishikashakuyakuto exhibited not only an antispasmodic effect on intestinal smooth muscle, but also antidepressant-like effects. Case series suggest that other Kampo prescriptions are also effective for FD and IBS. However, further studies are necessary to evaluate their efficacy.

This article reviews the therapeutic role of psychotropic drugs in the treatment of functional gastrointestinal disorders based on the Japanese Diagnostic and Therapeutic Guidelines for Psychosomatic Disorders(2006). As an initial step, primary care physicians should establish a therapeutic relationship with their patients, provide instructions on diet or lifestyle modification, and treat them symptomatically. If these treatments are not satisfactory, as a next step, they should evaluate the patient's stressors, coping styles, and comorbid psychiatric disorders, especially anxiety disorders and depression, and prescribe psychotropic drugs such as antidepressants and anxiolytics. If these treatments are unsatisfactory, as a third step, physicians should refer their patients to psychosomatic medicine specialists to inquire about psychotherapy, hypnosis, fasting therapy, or relaxation training.

Fatigue is one of the most common complaints of patients with functional somatic syndrome (FSS), which includes chronic fatigue syndrome (CFS). Although the etiology of fatigue related to FSS remains unclear, accumulating evidence has shown that cognitive behavioral therapy and graded exercise therapy are effective for treating fatigue in patients with CFS. This suggests that psychosocial intervention and physical rehabilitation, as well as biomedical treatment, play an important role in treating fatigue in FSS patients. Here we provide an overview of the biomedical and psychosocial treatments for fatigue in cases of FSS.

Previous studies have disagreed about whether prostaglandin EP1 or EP3 receptors are critical for producing febrile responses. We therefore injected lipopolysaccharide (LPS) at a variety doses (1 microg kg(-1)-1 mg kg(-1)) intraperitoneally (i.p.) into wild-type (WT) mice and mice lacking the EP1 or the EP3 receptors and measured changes in core temperature (Tc) by using telemetry. In WT mice, i.p. injection of LPS at 10 microg kg(-1) increased Tc about 1 degrees C, peaking 2 h after injection. At 100 microg kg(-1), LPS increased Tc, peaking 5-8 h after injection. LPS at 1 mg kg(-1) decreased Tc, reaching a nadir at 5-8 h after injection. In EP1 receptor knockout (KO) mice injected with 10 microg kg(-1) LPS, only the initial (< 40 min) increase in Tc was lacking; with 100 microg kg(-1) LPS the mice showed no febrile response. In EP3 receptor KO mice, LPS decreased Tc in a dose- and time-dependent manner. Furthermore, in EP3 receptor KO mice subcutaneous injection of turpentine did not induce fever. Both EP1 and EP3 receptor KO mice showed a normal circadian cycle of Tc and brief hyperthermia following psychological stress (cage-exchange stress and buddy-removal stress). The present study suggests that both the EP1 and the EP3 receptors play a role in fever induced by systemic inflammation but neither EP receptor is involved in the circadian rise in Tc or psychological stress-induced hyperthermia in mice.