Prescriptions of Chinese Herbal Medicines for Insomnia in Taiwan during 2002.

Chinese herbal medicine (CHM) has been commonly used for treating insomnia in Asian countries for centuries. The aim of this study was to conduct a large-scale pharmaco-epidemiologic study and evaluate the frequency and patterns of CHM use in treating insomnia. We obtained the traditional Chinese medicine (TCM) outpatient claims from the National Health Insurance in Taiwan for the year 2002. Patients with insomnia were identified from the diagnostic code of International Classification of Disease among claimed visiting files. Corresponding prescription files were analyzed, and an association rule was applied to evaluate the co-prescription of CHM. Results showed that there were 16 134 subjects who visited TCM clinics for insomnia in Taiwan during 2002 and received a total of 29 801 CHM prescriptions. Subjects between 40 and 49 years of age comprised the largest number of those treated (25.3%). In addition, female subjects used CHMs for insomnia more frequently than male subjects (female : male = 1.94 : 1). There was an average of 4.8 items prescribed in the form of either an individual Chinese herb or formula in a single CHM prescription for insomnia. Shou-wu-teng (Polygonum multiflorum) was the most commonly prescribed single Chinese herb, while Suan-zao-ren-tang was the most commonly prescribed Chinese herbal formula. According to the association rule, the most commonly prescribed CHM drug combination was Suan-zao-ren-tang plus Long-dan-xie-gan-tang, while the most commonly prescribed triple drug combination was Suan-zao-ren-tang, Albizia julibrissin, and P. multiflorum. Nevertheless, further clinical trials are needed to evaluate the efficacy and safety of these CHMs for treating insomnia.

Prescriptions of Chinese herbal medicine for constipation under the national health insurance in Taiwan.

BACKGROUND: Constipation is a common gastrointestinal problem worldwide. The aim of this study was to determine the frequency of use and prescriptive patterns of Chinese herbal medicine (CHM) in treating constipation by analyzing the claims data of traditional Chinese medicine (TCM) from the National Health Insurance (NHI) in Taiwan. METHODS: The computerized claims dataset of the TCM office visits and the corresponding prescription files in 2004 compiled by the NHI Research Institute in Taiwan were linked and processed. Visit files with the single diagnostic coding of constipation (ICD-9-CM code 564.0) were extracted to analyze the frequency and pattern of corresponding CHM prescriptions. The association rule was applied to analyze the co-prescription of CHM in treating constipation. RESULTS: There were 152,564 subjects who visited TCM clinics only for constipation in Taiwan during 2004 and received a total of 387,268 CHM prescriptions. Subjects between 20 and 29 years of age comprised the largest number of those treated (25.5%). Female subjects used CHM for constipation more frequently than male subjects (female:male = 3.31:1). There was an average of 4.6 items of single Chinese herbs or formula in a single prescription for constipation. Ma-zi-renwan was the most commonly prescribed herbal formula, while Da-huang (Rheum palmatum) was the most commonly used single Chinese herb. According to the association rule, the most common prescribed pattern of 2-drug combination of CHM for treating constipation was Ban-xia-xie-xin-tang plus Ma-zi-ren-wan, while the 3-drug combination of CHM was Fang-feng-tong-sheng-san, Rheum palmatum and Ma-zi-ren-wan. CONCLUSION: This study showed the pattern of single Chinese herbs or herbal formulae used in treating constipation in Taiwan. Further clinical trials are needed to evaluate the efficacy and safety of these CHMs in treating constipation.

Modern use of Chinese herbal formulae from Shang-Han Lun.

BACKGROUND: The Chinese medical archive, Shang-Han Lun, is said to be written by ZHANG Zhong-jing (150 - 219 A.D.). This great influential work introduced the specific symptoms of six-channel disorders (Tai-Yang, Yang-Ming, Shao-Yang, Tai-Yin, Shao-Yin, and Jue-Yin) and their corresponding treatments, the combined syndromes, deterioration due to malpractice, and the concept of six-channel transitions. The concept of Shang-Han Lun is widely accepted by Chinese herbal doctors. However, no clinical data about Shang-Han symptoms are described in oriental or western medical reports. METHODS: The clinical prescription data of traditional Chinese medicine visits were extracted under the National Health Insurance in Taiwan. The application rate of 42 Shang-Han formulae in clinical practice was analyzed in detail with the software SPSS. RESULTS: Between 1999 and 2002, the prescription rate of Shang-Han formula was only 5.22% among a total of 528 889 576 Chinese herbal formula prescriptions. The most frequently used formula was Tai-Yang formulae (71.31%), followed by Shao-Yang formulae (17.49%) and the most commonly prescribed individual Shang-Han formulae were Ge-Gen Tang (16.11%), Shao-Yao-Gan-Cao Tang (12.97%), Xiao-Qing-Long Tang (11.79%), Ban-Xia Xie-Xin Tang (10.24%), and Xiao-Chai-Hu Tang (9.11%), which comprised 60.22% of the utilization rate of total Shang-Han formulae. CONCLUSIONS: From the prescription patterns of Shang-Han formulae, there was no evidence of transitions among the six channels. Despite the fundamental role of Shang-Han Lun in traditional Chinese medicine, prescription of Shang-Han formulae was limited in clinical practice.

Frequency and pattern of Chinese herbal medicine prescriptions for chronic hepatitis in Taiwan.

ETHNOPHARMACOLOGICAL RELEVANCE: Chinese herbal medicine (CHM) has been commonly used in treating liver diseases in Asian countries. AIM OF STUDY: To conduct a large-scale pharmacoepidemiological study and evaluate the frequency and pattern of CHM prescriptions in treating chronic hepatitis. MATERIALS AND METHODS: We obtained the database of traditional Chinese medicine outpatient claims from the national health insurance in Taiwan for the whole 2002. Patients with chronic hepatitis were identified by the corresponding diagnosis of International Classification of Disease among claimed visiting files. Corresponding prescription files were analyzed, and association rule were applied to evaluate the co-prescription of CHM in treating chronic hepatitis. RESULTS: Among the 91,080 subjects treated by CHM for chronic hepatitis, the peak age was in the 40 s, followed by 30 s and 50 s. Male/female ratio was 2.07:1. Long-dan-xie-gan-tang and Saliva miltiorrhiza (Dan-shen) were the most commonly prescribed Chinese herbal formula and single herbal drug, respectively. The most common two-drug prescription was Jia-wei-xia-yao-san plus Saliva miltiorrhiza, and the most common three-drug prescription was Jia-wei-xia-yao-san plus Saliva miltiorrhiza and Artemisia capillaries (Yin-chen-hao). CONCLUSIONS: This study showed the utilization pattern of Chinese herbal drugs or formulae in treating chronic hepatitis. Further researches and clinical trials are needed to evaluate the efficacy of these Chinese herbs or its ingredients in treating chronic hepatitis.

Effects of electro-acupuncture on serum cytokine level and peripheral blood lymphocyte subpopulation at immune-related and non-immune-related points.

The purpose of this study is to find out whether electro-acupuncture (EA) at acupoint LI.10 (Shou San Li), which has not been considered as an immune-related point, has a similar immune effect as LI.11 (Qu Chi). We recruited 24 male medical students for this study. They were randomized into 3 groups: control group (without acupuncture during the study period, n=7), LI.11 group (EA at LI.11 acupoint, n=9) and LI.10 group (EA at LI.10 acupoint, n=8). At the first day (Day 1), blood was taken from all subjects. But EA was applied to the LI.11 and LI.10 group immediately after blood drawing. On the second day (Day 2), EA was applied to the LI.11 and LI.10 group right before blood sample was taken. At the fourteenth day (Day 14), blood sample was taken for all subjects. The parameters of EA were 4 sec alternating intervals of 2 and 15 HZ (dense and disperse) and 1-4 mA in intensity for 20 min. The waveform of electrical impulse was bi-directional and pulse duration of 50 microsec. Blood analysis included flow cytometry for lymphocyte subpopulations (CD4 and CD8 positive cell percentages) and ELISA for cytokines [soluble interleukin-2 receptor (sIL-2R), interferon (INF)-gamma, IL-4, IL-6, and IL-10]. We treated the result of Day 1 as a baseline value. After EA at acupoint LI.11, CD4 positive cell percentage at Day 14 showed significant decrease compared to the baseline value (p = 0.011). CD8 positive cell percentage also decreased at Day 2 (p = 0.038) and Day 14 (p= 0.015). In the LI.10 group, CD4 and CD8 levels at Day 14 were decreased significantly (CD4, p = 0.012; CD8, p = 0.017). Results of all cytokines concentrations of the LI.11 group did not change during the study period. But the serum level of sIL-2R of the LI.10 group at Day 14 was higher than the baseline value (p = 0.018). The serum level of IL-6 at Day 14 was lower than the baseline value (p = 0.028). The serum level of IL-4 at Day 2 was lower than the baseline value (p = 0.025). Our results showed that LI.11 and LI.10 acupoints cause a similar decrease of CD4 and CD8 populations. Increase of serum sIL-2R and decrease of serum IL-4 and IL-6 were observed when EA was applied at LI.10 acupoint, but not at LI.11 acupoint. In this study, we can understand that EA may modulate the peripheral blood lymphocyte subpopulations and serum cytokine levels of the immune system.