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Shao SC, Lai ECC, Huang TH, Hung MJ, Tsai MS, Yang YH, Chan YY. The Chang Gung Research Database: Multi-institutional real-world data source for traditional Chinese medicine in Taiwan. Pharmacoepidemiol Drug Saf 2021; 30:652-660. [PMID: 33611792 DOI: 10.1002/pds.5208] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/16/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The Chang Gung Research Database (CGRD), the largest multi-institutional electronic medical records collection in Taiwan, has been used to establish real-world evidence related to traditional Chinese medicine (TCM). We aimed to evaluate patient characteristics and representativeness of TCM patients in CGRD. METHODS We identified a cohort of patients who had TCM records both from CGRD and from Taiwan's National Health Insurance Database (NHIRD) during 2010-2015 to investigate the representativeness of CGRD for TCM uses. The NHIRD was considered as reference because it covers all medical claims from 99.9% of the entire Taiwanese population. We investigated the coverage rates of TCM patients within CGRD compared to NHIRD, and compared the characteristics of patients between CGRD and NHIRD including age, sex, and 15 health conditions. RESULTS We identified 71 002 average annual patients within the CGRD, which accounted for 1.1% of the patients from the NHIRD. The patients from CGRD were older than those from NHIRD (≥65: 16.6% vs. 9.9% for CGRD vs. NHIRD). The ratios of female over male patients were 1.7 vs. 1.5 for CGRD vs. NHIRD. We found higher patient coverage rates for patients with major comorbidities in CGRD, specifically for neoplasm (9.2%) and mental disorders (6.0%). The most frequently prescribed Chinese herbal medicines in CGRD included Jia-Wei-Xiao-Yao-San, Xiang-Sha-Liu-Jun-Zi-Tang and Gui-Lu-Er-Xian-Jiao. CONCLUSION Higher patient coverage rates were found in CGRD for TCM patients with major comorbidities. Investigators should note possible selection bias since TCM patient disorders may be more severe in CGRD than in the NHIRD.
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Affiliation(s)
- Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Tse-Hung Huang
- Department of Traditional Chinese Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.,Research Center for Food and Cosmetic Safety and Research Center for Chinese Herbal Medicine, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Chang Gung University of Science and Technology, Graduate Institute of Health Industry Technology, Taoyuan, Taiwan.,School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Ming Chi University of Technology, Department & Graduate Institute of Chemical Engineering & Graduate Institute of Biochemical Engineering, New Taipei, Taiwan
| | - Ming-Jui Hung
- Section of Cardiology, Department of Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shao Tsai
- Department of Otolaryngology - Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Health Information and Epidemiology Laboratory of Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yuk-Ying Chan
- Department of Pharmaceutical Materials Management, Chang Gung Medical Foundation, Taoyuan, Taiwan
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Hsueh TP, Tsai TH. Preclinical Pharmacokinetics of Scoparone, Geniposide and Rhein in an Herbal Medicine Using a Validated LC-MS/MS Method. Molecules 2018; 23:molecules23102716. [PMID: 30360359 PMCID: PMC6222633 DOI: 10.3390/molecules23102716] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 02/07/2023] Open
Abstract
The herbal formula Yin-Chen-Hao-Tang has been reported to have anti-fibrosis properties. The aim of this study was to reveal the pharmacokinetic characteristics of bioactive compounds in this herbal formula. A new high-performance liquid chromatography-tandem mass spectrometry method was developed and validated for simultaneous determination of scoparone, geniposide and rhein in rat plasma. A pharmaceutical herbal powder was administered to rats at doses of 1 g/kg and 3 g/kg orally. The method showed excellent linearity (r2 > 0.999) and validation was successfully conducted for the pharmacokinetic study. The results show that the Cmax values and areas under the curve of scoparone, geniposide and rhein were higher and not proportional to the dose in rat plasma, while the Tmax and half-life values were consistent in the group that received 1 g/kg. The clearance of the higher dose (3 g/kg) did not decrease proportionally to that of the low dose. The results showed the nonlinear pharmacokinetic properties of scoparone, geniposide and rhein in Yin-Chen-Hao-Tang that suggested possible accumulation of bioactive compounds through oral administration. This pharmacokinetic study reveals that an increased dose of this herbal formula would largely increase the maximum concentration and bioavailability of scoparone, geniposide and rhein.
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Affiliation(s)
- Tun-Pin Hsueh
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Tung-Hu Tsai
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
- Graduate Institute of Acupuncture Science, China Medical University, Taichung 404, Taiwan.
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Department of Chemical Engineering, National United University, Miaoli 36063, Taiwan.
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Lin TH, Yen HR, Chiang JH, Sun MF, Chang HH, Huang ST. The use of Chinese herbal medicine as an adjuvant therapy to reduce incidence of chronic hepatitis in colon cancer patients: A Taiwanese population-based cohort study. JOURNAL OF ETHNOPHARMACOLOGY 2017; 202:225-233. [PMID: 28330722 DOI: 10.1016/j.jep.2017.03.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 06/06/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE There is a decided lack of in-depth studies to evaluate the effectiveness of Chinese Herbal Medicine (CHM) as an adjuvant therapy on the incidence of chronic hepatitis in patients with colon cancer. AIM OF THE STUDY The aim of this study is to assess whether CHM treatment decreased the incidence of chronic hepatitis in colon cancer patients who received conventional Western medical treatment. MATERIALS AND METHODS A Taiwanese nationwide population-based study of colon cancer patients receiving Western medicine treatment in conjunction with CHM treatment, using data provided by the National Health Insurance (NHI) Research Database, was conducted. A total of 61676 patients were diagnosed with colon cancer in Taiwan within the defined study period, from 1997 to 2010. After randomly equal matching for age, sex, excluding patients younger than 18 years of age, chronic hepatitis before colon cancer diagnosis date, receiving acupuncture and/or moxibustion and taking CHM for less than 30 days, data from 155 patients were analyzed. Hazard ratios of incidence rate of chronic hepatitis were used to determine the influence of CHM and the therapeutic potential of herbal products in treating patients with colon cancer. RESULTS CHM used for patients with colon cancer exhibited significantly decreased incidence rates of chronic hepatitis [hazard ratio (HR)=0.53; 95% confidence interval (CI):0.38-0.74], with multivariate adjustment, compared to those without CHM use. The protective effect of CHM treatment with statistical significance across the stratification of age, gender, co-morbidity and treatment modality was noted. The cumulative incidence of chronic hepatitis was also reduced in patients with colon cancer receiving CHM treatment during a five-year period. In this study, we provide the ten most used single herbs and herbal formulas that were prescribed for patients with colon cancer; moreover, we identify the eight single herbs and five formulas used in CHM treatment which significantly decreased incidence of chronic hepatitis among colon cancer patients. CONCLUSIONS This nationwide retrospective cohort study determined that therapy using CHM as an adjuvant modality may have a significant impact on liver protection in patients with colon cancer.
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Affiliation(s)
- Tsai-Hui Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan ROC; School of Chinese Medicine, China Medical University, Taichung, Taiwan ROC
| | - Hung-Rong Yen
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan ROC; School of Chinese Medicine, China Medical University, Taichung, Taiwan ROC; Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan ROC
| | - Jen-Huai Chiang
- School of Chinese Medicine, China Medical University, Taichung, Taiwan ROC; Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan ROC; Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan ROC
| | - Mao-Feng Sun
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan ROC; School of Chinese Medicine, China Medical University, Taichung, Taiwan ROC
| | - Hen-Hong Chang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan ROC; School of Chinese Medicine, China Medical University, Taichung, Taiwan ROC
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan ROC; School of Chinese Medicine, China Medical University, Taichung, Taiwan ROC; Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan ROC.
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Pharmacokinetic interactions of herbal medicines for the treatment of chronic hepatitis. J Food Drug Anal 2016; 25:209-218. [PMID: 28911662 PMCID: PMC9332521 DOI: 10.1016/j.jfda.2016.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/05/2016] [Accepted: 11/07/2016] [Indexed: 12/26/2022] Open
Abstract
Chronic liver disease is a serious global health problem, and an increasing number of patients are seeking alternative medicines or complementary treatment. Herbal medicines account for 16.8% of patients with chronic liver disease who use complementary and alternative therapies. A survey of the National Health Insurance Research Database in Taiwan reported that Long-Dan-Xie-Gan-Tang, Jia-Wei-Xia-Yao-San, and Xiao-Chai-Hu-Tang (Sho-saiko-to) were the most frequent formula prescriptions for chronic hepatitis used by traditional Chinese medicine physicians. Bioanalytical methods of herbal medicines for the treatment of chronic hepatitis were developed to investigate pharmacokinetics properties, but multicomponent herbal formulas have been seldom discussed. The pharmacokinetics of herbal formulas is closely related to efficacy, efficiency, and patient safety of traditional herbal medicines. Potential herbal formula–drug interactions are another essential issue during herbal formula administration in chronic hepatitis patients. In a survey with the PubMed database, this review article evaluates the existing evidence-based data associated with the documented pharmacokinetics profiles and potential herbal–drug interactions of herbal formulas for the treatment of chronic hepatitis. In addition, the existing pharmacokinetic profiles were further linked with clinical practice to provide insight for the safety and specific use of traditional herbal medicines.
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