Chinese Herbal Medicine and Unresectable Hepatocellular Carcinoma

Chinese Herbal Medicine 
and Unresectable Hepatocellular Carcinoma

A study was conducted to investigate the effects of Chinese medicine (CM) herbal treatment based on syndrome differentiation on patients with unresectable hepatocellular carcinoma (HCC). A total of 94 patients with unresectable HCC were reviewed between June 2008 and June 2011. Survival analysis was performed between patients who received CM with/without non-curative antitumor treatments of Western medicine (WM) (CM group, 30 cases) and patients who were not treated with CM but with non-curative antitumor treatments of WM or supportive treatment alone (non-CM group, 64 cases). Then, survival analysis was performed between patients treated with CM combined with non-curative antitumor treatments of WM (combination therapy group, 25 cases) and patients with non-curative antitumor treatments of WM alone (non-curative antitumor treatments group of WM, 52 cases). The survival analysis was performed by Kaplan-Meier method and prognostic factors for overall survival (OS) were assessed by the Cox proportional hazards regression model. The median survival time (MST), 1- and 2-year survival rates of the CM group and the non-CM group were 36 months, 76.7%, 56.1% and 12 months, 48.4%, 26.6%, respectively. The Log-rank test revealed significant difference between the two groups in OS (P<0.01). Cox proportional multivariate analysis revealed that CM was an independent favorable prognostic factor for OS. The MST, 1- and 2-year survival rates of combination therapy group and non-curative antitumor treatments group of WM were 36 months, 76.0%, 55.5% and 13 months, 55.8%, 30.8%, respectively. There was significant difference in OS between the two groups (P=0.004). CM herbs based on syndrome differentiation have positive effects on survival of patients with unresectable HCC. Furthermore, combination therapy of CM and WM are recommended in HCC treatment.

Source: Man YN^, Liu XH, Wu XZ. Chinese medicine herbal treatment based on syndrome differentiation improves the overall survival of patients with unresectable hepatocellular carcinoma. Chin J Integr Med. 2015 Jan;21(1):49-57.

Chinese Medicine Utilization in Chinese Medicine Hospitals

Chinese Medicine Utilization in Chinese Medicine Hospitals

A study was conducted to document clinical use of Traditional Chinese Medicine (TCM) for chronic conditions in all TCM hospitals in a Chinese province and to recommend treatments most in need of evaluation for use in community health centers. Design: A cross-sectional survey was conducted in the summer of 2010. It included 119 of 132 TCM hospitals in Hubei Province, China. TCM physicians were asked to recommend specific TCM treatments for common chronic conditions. Nine types of chronic conditions recommended more than 3.7 times (mean of frequencies of chronic conditions) are included in this analysis. Frequency of each TCM treatment and the number of visits by type of chronic conditions were calculated. Results: The total number of recommendations by TCM physicians was 411. For seven types of treatments, six were recommended for musculoskeletal pain, five for soft tissue injuries, four for visceral pain and fractures, three for stroke and asthma, two for hemorrhoids, and one for hypertension. The most frequently recommended treatments for specific conditions include orally ingested herbs for visceral pain (n=3), type 2 diabetes (n=5), and hypertension (n=7); herbs for external use for soft tissue injuries (n=10), asthma (n=6), and hemorrhoids (n=8); acupuncture for musculoskeletal pains (n=43) and for stroke (n=10); and Chinese external fixation for fractures (n=24). The number of visits for recommended treatments per year of was 671,759. The most frequently recommended treatments for specific chronic conditions have most visits, except for chronic conditions such as musculoskeletal pains, visceral pains, soft tissue injuries, and asthma. Conclusions: Patients with musculoskeletal pain have more treatment options than other patients. Herbal medicine is the option most commonly used for chronic conditions. These treatments for these conditions should be targeted for further evaluation of effectiveness and, only if found effective, considered for use in primary care settings.

Source: Cai Y, Boyd DL, Coeytaux RR, Østbye T, Wu B, Mao Z. Treatment of Chronic Conditions with Traditional Chinese Medicine: Findings from Traditional Chinese Medicine Hospitals in Hubei, China. J Altern Complement Med. 2014 Dec 18.

A Study on Drug-Herb Interactions

A Study on Drug-Herb Interactions

In the 21st century, the public are more informed, mainly via the Internet, about health and medical products and have become more knowledgeable about matters relating to their health conditions and well-being in curing and preventing illnesses. They often self-medicate themselves with various health products and over-the-counter (OTC) medicines apart from prescribed pharmaceutical drugs (PD). Some of those non-prescribed products may have doubtful quality control and contain harmful additives or unchecked ingredients; thus their usefulness is in doubt. The increasing popularity world-wide of using Chinese medicines (CM) and related OTC functional products has raised concerns over their concomitant use with PD and the consequential adverse effects. In most cases the alleged causes of adverse effects are linked with herbal sources, although the authorized information on the interactions between CM-PD is not plentiful in the literature. There is an urgent need for such a data base. The future professionals in health and medical care should be knowledgeable or aware of what their patients have been taking or given. In actual practice the patients may receive both treatments intentionally or unintentionally, with or without the awareness of the practitioner. In these situations a reliable database for interactions between CM-PD will be extremely useful for consultation when treatment problems appear or during emergency situations. Their combining of medications may be involved with possible outcomes of adverse reactions or beneficial effects. Such a database will be welcomed by both practitioners of herbal medicines and orthodox medicine practitioners in the emerging trend of integrative medicine. The author has been involved in various research projects of basic and clinical aspects in mainly CM among other herbal and PD. Examples will be given largely on those related to these disciplines as illustrations in this overview.

Source: Chan K. Understanding interactions between Chinese medicines and pharmaceutical drugs in integrative healthcare. Chin J Integr Med. 2014 Dec 19.

Qi Ju Di Huang Wan for Dementia

Qi Ju Di Huang Wan

is the Top Choice for Dementia Patients in Taiwan

Few studies have reported on the utilization of traditional Chinese medicine (TCM) among dementia patients. The aim of the present study is to analyze factors associated with TCM users in the dementia populations and to investigate the medical conditions related to TCM visits. A total of 18,141 dementia patients were screened from the one million sample of the National Health Insurance Research Database. The dementia patients were then divided into TCM users and non-TCM users according to their medical records between 1997 and 2008. Demographic characteristics included gender, age, insured amount, and geographic location and medical conditions including comorbidity diseases, behavioral and psychological symptoms, and anti-dementia medication were also investigated. Their tendency of TCM usage was investigated using a multivariate logistic regression. In Taiwan, 43.3% dementia patients had sought TCM treatments. The inclination of TCM usage was inversely proportional to age; the younger and early-onset dementia (age less than 55 years) patients constituted the high usage group. Female, living in central Taiwan, and higher insured amount were also associated with higher tendency of TCM use. Multilevel Poisson regression analysis showed that the odds ratios (OR) of TCM use were 1.80 (95% CI=1.68-1.94), 2.52 (95% CI=2.30-2.76), 3.41 (95% CI=3.01-3.86) for those with one, two, three or more behavioral and psychological symptoms of dementia (BPSD), respectively compared with dementia sufferers without BPSD. In additional, polypharmacy led to higher utilization of TCM (one type: Adjust OR=1.41, 95% CI=1.28-1.56, two types: Adjust OR=1.97, 95% CI=1.63-2.00; three or more types: Adjust OR =2.95, 95% CI=2.27-2.78). More than 70% TCM visits were treated with Chinese herbal remedies, while others use acupuncture and manipulative therapies. Qi-Ju-Di-Huang-Wan (9.7%) was the most frequently prescribed formula, followed by Jia-Wei-Xiao-Yao-San and Ban-Xia-Bai-Zhu-Tian-Ma-Tang. More than 40% of the dementia patients in Taiwan used TCM. Young-onset dementia, higher number of BPSD, multiple chronic diseases, and polypharmacy were independent predictors for dementia patients seeking TCM medical advice. On the basis of the current findings, additional clinical or epidemiologic study on the prescription patterns of TCM in dementia treatment, or the herb-drug interaction and safety issue can be conducted.

Source: Lin S, Tsai Y, Lai J, Wu C. Demographic and medication characteristics of traditional Chinese medicine users among dementia patients in Taiwan: A nationwide database study. J Ethnopharmacol. 2014 Dec 16.

Traditional Chinese Medicine and Herbal Hepatotoxicity

Traditional Chinese Medicine and Herbal Hepatotoxicity

Traditional Chinese Medicine (TCM) with its focus on herbal use became popular worldwide. Treatment was perceived as safe, with neglect of rare adverse reactions including liver injury. To compile worldwide cases of liver injury by herbal TCM, we undertook a selective literature search in the PubMed database and searched for the items Traditional Chinese Medicine, TCM, Traditional Asian Medicine, and Traditional Oriental Medicine, also combined with the terms herbal hepatotoxicity or herb induced liver injury. The search focused primarily on English-language case reports, case series, and clinical reviews. We identified reported hepatotoxicity cases in 77 relevant publications with 57 different herbs and herbal mixtures of TCM, which were further analyzed for causality by the Council for International Organizations of Medical Sciences (CIOMS) scale, positive reexposure test results, or both. Causality was established for 28/57 different herbs or herbal mixtures, Bai Xian Pi, Bo He, Ci Wu Jia, Chuan Lian Zi, Da Huang, Gan Cao, Ge Gen, Ho Shou Wu, Huang Qin, Hwang Geun Cho, Ji Gu Cao, Ji Xue Cao, Jin Bu Huan, Jue Ming Zi, Jiguja, Kudzu, Ling Yang Qing Fei Keli, Lu Cha, Rhen Shen, Ma Huang, Shou Wu Pian, Shan Chi, Shen Min, Syo Saiko To, Xiao Chai Hu Tang, Yin Chen Hao, Zexie, and Zhen Chu Cao. In conclusion, this compilation of liver injury cases establishes causality for 28/57 different TCM herbs and herbal mixtures, aiding diagnosis for physicians who care for patients with liver disease possibly related to herbal TCM. 

Source: Teschke R, Zhang L, Long H, Schwarzenboeck A, Schmidt-Taenzer W, Genthner A, Wolff A, Frenzel C, Schulze J, Eickhoff A. Traditional Chinese Medicine and herbal hepatotoxicity: a tabular compilation of reported cases. Ann Hepatol. 2015 Jan-Feb;14(1):7-19.