Identification of anti-fibrotic and pro-apoptotic bioactive compounds from Ganoderma formosanum and their possible mechanisms in modulating TGF-ß1-induced lung fibrosis.

ETHNOPHARMACOLOGICAL RELEVANCE: The Compendium of Materia Medica and the Classic of Materia Medica, the two most prominent records of traditional Chinese medicine, documented the therapeutic benefits of Ganoderma sinense particularly in addressing pulmonary-related ailments. Ganoderma formosanum, an indigenous subspecies of G. sinense from Taiwan, has demonstrated the same therapeutic properties. AIM OF THE STUDY: The aim of this study is to identify bioactive compounds and evaluate the potential of G. formosanum extracts as a novel treatment to alleviate pulmonary fibrosis (PF). Using an in-house drug screening platform, two-stage screening was performed to determine their anti-fibrotic efficacy. METHODS AND MATERIALS: G. formosanum was fractionated into four partitions by solvents of different polarities. To determine their antifibrotic and pro-apoptotic properties, the fractions were analyzed using two TGF-ß1-induced pulmonary fibrosis cell models (NIH-3T3) and human pulmonary fibroblast cell lines, immunoblot, qRT-PCR, and annexin V assays. Subsequently, transcriptomic analysis was conducted to validate the findings and explore possible molecular pathways. The identification of potential bioactive compounds was achieved through UHPLC-MS/MS analysis, while molecular interaction study was investigated by multiple ligands docking and molecular dynamic simulations. RESULTS: The ethyl acetate fraction (EAF) extracted from G. formosanum demonstrated substantial anti-fibrotic and pro-apoptotic effects on TGF-ß1-induced fibrotic models. Moreover, the EAF exhibited no discernible cytotoxicity. Untargeted UHPLC-MS/MS analysis identified potential bioactive compounds in EAF, including stearic acid, palmitic acid, and pentadecanoic acid. Multiple ligands docking and molecular dynamic simulations further confirmed that those bioactive compounds possess the ability to inhibit TGF-ß receptor 1. CONCLUSION: Potential bioactive compounds in G. formosanum were successfully extracted and identified in the EAF, whose anti-fibrotic and pro-apoptotic properties could potentially modulate pulmonary fibrosis. This finding not only highlights the EAF's potential as a promising therapeutic candidate to treat pulmonary fibrosis, but it also elucidates how Ganoderma confers pulmonary health benefits as described in the ancient texts.

Evaluation of the amelioration effect of Ganoderma formosanum extract on delaying PM2.5 damage to lung macrophages.

SCOPE: Particulate matter (PM) contains toxic organic matter and heavy metals that enter the entire body through blood flow and may cause mortality. Ganoderma formosanum mycelium, a valuable traditional Chinese medicine that has been used since ancient times, contains various active ingredients that can effectively impede inflammatory responses on murine alveolar macrophages induced by PM particles. METHODS AND RESULTS: An experimental study assessing the effect of G. formosanum mycelium extract's water fraction (WA) on PM-exposed murine alveolar macrophages using ROS measurement shows that WA reduces intracellular ROS by 12% and increases cell viability by 16% when induced by PM particles. According to RNA-Sequencing, western blotting, and real-time qPCR are conducted to analyze the metabolic pathway. The WA reduces the protein ratio in p-NF-κB/NF-κB by 18% and decreases the expression of inflammatory genes, including IL-1ß by 38%, IL-6 by 29%, and TNF-α by 19%. Finally, the identification of seven types of anti-inflammatory compounds in the WA fraction is achieved through UHPLC-ESI-Orbitrap-Elite-MS/MS analysis. These compounds include anti-inflammatory compounds, namely thiamine, adenosine 5'-monophosphate, pipecolic acid, L-pyroglutamic acid, acetyl-L-carnitine, D-mannitol, and L-malic acid. CONCLUSIONS: The study suggests that the WA has the potential to alleviate the PM -induced damage in alveolar macrophages, demonstrating its anti-inflammatory properties.

Biocompatible and biodegradable copper-protocatechuic metal-organic frameworks as rifampicin carrier.

Tuberculosis (TB) is a disease caused by the M. tuberculosis bacteria infection and is listed as one of the deadliest diseases to date. Despite the development of antituberculosis drugs, the need for long-term drug consumption and low patient commitment are obstacles to the success of TB treatment. A continuous drug delivery system that has a long-term effect is needed to reduce routine drug consumption intervals, suppress infection, and prevent the emergence of drug-resistant strains of M. tuberculosis. For this reason, biomolecule metal-organic framework (BioMOF) with good biocompatibility, nontoxicity, bioactivity, and high stability are becoming potential drug carriers. This study used a bioactive protocatechuic acid (PCA) as organic linker to prepare copper-based BioMOF Cu-PCA under base-modulated conditions. Detailed crystal analysis by the powder X-ray diffraction demonstrated that the Cu-PCA, with a chemical formula of C14H16O13Cu3, crystalizes as triclinic in space group P1. Comprehensive physicochemical characterizations were provided using FTIR, SEM, XPS, TGA, EA, and N2 sorption. As a drug carrier, Cu-PCA showed a high maximum rifampicin (RIF) drug loading of 443.01 mg/g. Upon resuspension in PBS, the RIF and linkers release profile exhibited two-stage release kinetic profiles, which are well described by the Biphasic Dose Response (BiDoseResp) model. A complete release of these compounds (RIF and PCA) was achieved after ~9 h of mixing in PBS. Cu-PCA and RIF@Cu-PCA possessed antibacterial activity against Escherichia coli, and good biocompatibility is evidenced by the high viability of MH-S mice alveolar macrophage cells upon supplementations.

The Impact of Different Pretreatment Processes (Freezing, Ultrasound and High Pressure) on the Sensory and Functional Properties of Black Garlic (Allium sativum L.).

Black garlic (BG) is an emerging derivative of fresh garlic with enhanced nutritional properties. This study aimed to develop functional BG products with good consumer acceptance. To this end, BG was treated with freezing (F-BG), ultrasound (U-BG), and HHP (H-BG) to assess its sensory and functional properties. The results showed that F-BG and H-BG had higher S-allyl-cysteine (SAC), polyphenol, and flavonoid contents than BG. H-BG and F-BG displayed the best sensory quality after 18 days of aging, while 5-hydroxymethylfurfural (5-HMF), SAC, and polyphenols were identified as the most influential sensory parameters. Moreover, the F-BG and H-BG groups achieved optimal taste after 18 days, as opposed to untreated BG, which needed more than 24 days. Therefore, the proposed approaches significantly reduced the processing time while enhancing the physical, sensory, and functional properties of BG. In conclusion, freezing and HHP techniques may be considered promising pretreatments to develop BG products with good functional and sensory properties.

Production of Siamenoside I and Mogroside IV from Siraitia grosvenorii Using Immobilized ß-Glucosidase.

Siraitia grosvenorii is a type of fruit used in traditional Chinese medicine. Previous studies have shown that the conversion of saponins was often carried out by chemical hydrolysis, which can be problematic because of the environmental hazards it may cause and the low yield it produces. Therefore, the purpose of this study is to establish a continuous bioreactor with immobilized enzymes to produce siamenoside I and mogroside IV. The results show that the immobilization process of ß-glucosidase exhibited the best relative activity with a glutaraldehyde (GA) concentration of 1.5%, carrier activation time of 1 h and binding enzyme time of 12 h. After the immobilization through GA linkage, the highest relative activity of ß-glucosidase was recorded through the reaction with the substrate at 60 °C and pH 5. Subsequently, the glass microspheres with immobilized ß-glucosidase were filled into the reactor to maintain the optimal active environment, and the aqueous solution of Siraitia grosvenorii extract was introduced by controlling the flow rate. The highest concentration of siamenoside I and mogroside IV were obtained at a flow rate of 0.3 and 0.2 mL/min, respectively. By developing this immobilized enzyme system, siamenoside I and mogroside IV can be prepared in large quantities for industrial applications.

Reduction of 3-Deoxyglucosone by Epigallocatechin Gallate Results Partially from an Addition Reaction: The Possible Mechanism of Decreased 5-Hydroxymethylfurfural in Epigallocatechin Gallate-Treated Black Garlic.

5-Hydroxymethylfurfural (5-HMF) is a harmful substance generated during the processing of black garlic. Our previous research demonstrated that impregnation of black garlic with epigallocatechin gallate (EGCG) could reduce the formation of 5-HMF. However, there is still a lack of relevant research on the mechanism and structural identification of EGCG inhibiting the production of 5-HMF. In this study, an intermediate product of 5-HMF, 3-deoxyglucosone (3-DG), was found to be decreased in black garlic during the aging process, and impregnation with EGCG for 24 h further reduced the formation of 3-DG by approximately 60% in black garlic compared with that in the untreated control. The aging-mimicking reaction system of 3-DG + EGCG was employed to determine whether the reduction of 3-DG was the underlying mechanism of decreased 5-HMF formation in EGCG-treated black garlic. The results showed that EGCG accelerated the decrease of 3-DG and further attenuated 5-HMF formation, which may be caused by an additional reaction with 3-DG, as evidenced by LC-MS/MS analysis. In conclusion, this study provides new insights regarding the role of EGCG in blocking 5-HMF formation.

Thermal treatment enhances the α-glucosidase inhibitory activity of bitter melon (Momordica charantia) by increasing the free form of phenolic compounds and the contents of Maillard reaction products.

Inhibition of α-glucosidase can slow carbohydrate metabolism, which is known as an effective strategy for diabetes treatment. The aim of this study is to evaluate the effect of thermal treatment (50, 60, and 70℃) for 15 days on the α-glucosidase inhibitory activity of bitter melon. The results show that the bitter melon heated at 70℃ for 12 days had the best α-glucosidase inhibitory effect. However, the amount of free polyphenols, 5-hydroxymethyl-2-furfural (5-HMF), and the browning degree of bitter melon generally increased with the time (15 days) and temperature of the thermal treatment, which is positively related to their antioxidant and α-glucosidase inhibitory activities. In conclusion, aged bitter melon shows great α-glucosidase inhibitory activity, which may be related to the increased free form of the involved phenolic compounds and Maillard reaction products. This suggests that thermal processing may be a good way to enhance the application of bitter melon for diabetes treatment. PRACTICAL APPLICATION: The thermal processing of bitter melon provides an application for diabetes treatment. This study demonstrated that heat-treated bitter melon can lower the blood glucose level; therefore, it can be used as a potential anti-hyperglycemic and functional food.

Enzymatic degradation of ginkgolic acids by laccase immobilized on core/shell Fe3O4/nylon composite nanoparticles using novel coaxial electrospraying process.

Enzyme immobilization can increase enzyme reusability to reduce cost of industrial production. Ginkgo biloba leaf extract is commonly used for medical purposes, but it contains ginkgolic acid, which has negative effects on human health. Here, we report a novel approach to solve the problem by degrading the ginkgolic acid with immobilized-laccase, where core/shell composite nanoparticles prepared by coaxial electrospraying might be first applied to enzyme immobilization. The core/shell Fe3O4/nylon 6,6 composite nanoparticles (FNCNs) were prepared using one-step coaxial electrospraying and can be simply recovered by magnetic force. The glutaraldehyde-treated FNCNs (FNGCNs) were used to immobilize laccase. As a result, thermal stability of the free laccase was significantly improved in the range of 60-90 °C after immobilization. The laccase-immobilized FNGCNs (L-FNGCNs) were applied to degrade the ginkgolic acids, and the rate constants (k) and times (τ50) were ~0.02 min-1 and lower than 39 min, respectively, showing good catalytic performance. Furthermore, the L-FNGCNs exhibited a relative activity higher than 0.5 after being stored for 21 days or reused for 5 cycles, showing good storage stability and reusability. Therefore, the FNGCNs carrier was a promising enzyme immobilization system and its further development and applications were of interest.

Bioactive compounds with anti-oxidative and anti-inflammatory activities of hop extracts.

The aim of this study is to simultaneously evaluate anti-oxidative and anti-inflammatory activities of the hop extracts by different solvents. Hop water extract (HWE) and hop ethanol extracts (HEEs) were prepared by extracting hop pellets with hot water at 90 °C and ethanol solutions (55%, 75%, and 95%), respectively. Bioactive compound such as α-acid, ß-acid, total phenolic, and total flavonoid contents were determined. All the HEEs showed higher anti-oxidative activities than the HWEs. The HEEs showing the highest anti-oxidative activities are different in the experiments with different free radicals. For anti-inflammatory activities, both the HWE and HEEs decreased NO productions. HWE decreased TNF-α and IL-6 secretion but showed no effect on IL-1ß, while HEEs decreased IL-1ß and IL-6 secretion but increased TNF-α secretion. Except for TNF-α secretion, the HEEs showed higher anti-inflammatory activities than the HWE. Future work is to explore the possible mechanism to improve the ethanol extraction procedure.

A strategy for promoting γ-glutamyltransferase activity and enzymatic synthesis of S-allyl-(L)-cysteine in aged garlic via high hydrostatic pressure pretreatments.

S-allyl-(L)-cysteine (SAC) is a bioactive compound within garlic. Its level is low since SAC formation is impeded by the cellular structure of garlic. This study investigates the effect of high hydrostatic pressure (HHP) pretreatment on SAC formation in garlic aged at 40 °C for 10 days. Results showed that HHP could enhance γ-glutamyltransferase (γ-GTP) activity, damage the cellular structure of garlic and increase SAC content in aged garlic by about 7-10 times, depending on the processing parameters. HHP processing at 300 MPa for 15 min provided the optimal conditions for enhancing γ-GTP activity (45%) and promoting SAC formation (from 0.51 ± 0.01 to 5.60 ± 0.22 mg/g dry weight). It was also found that HHP could induce the greening and browning of aged garlic. As such, we consider that HHP technology is a promising technique to produce aged black garlic products with higher amounts of bioactive compounds.

Enzymatic degradation of ginkgolic acid by laccase immobilized on novel electrospun nanofiber mat.

BACKGROUND: Ginkgo biloba leaf extract contains many active ingredients that are beneficial for health. However, ginkgolic acid, one of the major components found in G. biloba extract, may cause serious allergic and toxic side effects. The purpose of this study is to immobilize the laccase system on the electrospun nylon fiber mat (NFM) to hydrolyze the ginkgolic acid in G. biloba leaf extract efficiently. RESULTS: Novel electrospinning technology successfully produced high-quality nanoscopic fiber mats made of a mixture of multi-walled carbon nanotube and nylon 6,6. Laccase that was immobilized onto the NFM exhibited much higher efficiency in the catalyzation of 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS) than nylon 6,6 pellets. After being immobilized onto the NFM, the pH and temperature stability of laccase were significantly improved. The NFM-immobilized laccase could maintain more than 50% of its original activity even after 40 days of storage or 10 operational cycles. The kinetic parameters, including rate constant (K), the time (τ50) in which 50% of ginkgolic acid hydrolysis was reached, the time (τcomplete) required to achieve complete ginkgolic acid hydrolysis, Km and Vmax were determined, and were 0.07 ± 0.01 min-1 , 8.97 ± 0.55 min, 45.45 ± 2.79 min, 0.51 ± 0.09 mM and 0.49 ± 0.03 mM min-1 mg-1 , respectively. CONCLUSION: The result successfully demonstrated the strong potential of using novel electrospun nanofiber mats as enzyme immobilization platforms, which could significantly enhance enzyme activity and stability. © 2020 Society of Chemical Industry.

Extracts from Fermented Black Garlic Exhibit a Hepatoprotective Effect on Acute Hepatic Injury.

The mechanism of hepatoprotective compounds is usually related to its antioxidant or anti-inflammatory effects. Black garlic is produced from garlic by heat treatment and its anti-inflammatory activity has been previously reported. Therefore, the aim of this study was to investigate the hepatoprotective effect of five different extracts of black garlic against carbon tetrachloride (CCl4)-induced acute hepatic injury (AHI). In this study, mice in the control, CCl4, silymarin, and black garlic groups were orally administered distilled water, silymarin, and different fraction extracts of black garlic, respectively, after CCl4 was injected intraperitoneally to induce AHI. The results revealed that the n-butanol layer extract (BA) and water layer extract (WS) demonstrated a hepatoprotective effect by reducing the levels of alanine aminotransferase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), and hepatic malondialdehyde (MDA). Furthermore, the BA and WS fractions of black garlic extract increased the activity of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), glutathione reductase (GSH-Rd), tumor necrosis factor alpha (TNF-α), and the interleukin-1 (IL-1ß) level in liver. It was concluded that black garlic exhibited significant protective effects on CCl4-induced acute hepatic injury.

From nutraceutical to clinical trial: frontiers in Ganoderma development.

Ganoderma spp. are medical mushrooms with various pharmacological compounds which are regarded as a nutraceutical for improving health and treating diseases. This review summarizes current progress in the studies of Gamoderma ranging from bioactive metabolites, bioactivities, production techniques to clinical trials. Traditionally, polysaccharides and ganoderic acids have been reported as the major bioactive metabolites of Ganoderma possessing anti-tumor and immunomodulation functions. Moreover, recent studies indicate that Gandoerma also exerts other bioactivities such as skin lighting, gut microbiota regulation, and anti-virus effects. However, since these medical fungi are rare in natural environment, and that the cost of cultivation of fruiting bodies is high, industrial submerged fermentation of Ganoderma mycelia promotes the development of Ganoderma by dint of an increase of biomass and bioactive metabolites used for further application. In addition, various strategies for production of different metabolites are well developed, such as gene regulation, bi-stage pH, and oxygen control. To date, Ganoderma not only has become one of the most popular nutraceuticals worldwide but also has been applied to clinical trials for advanced diseases such as breast and non-small-cell lung cancer.

Extracts of black garlic exhibits gastrointestinal motility effect.

In this studied, extracts of black garlic on the improvement of gastrointestinal function, antioxidant activity, total polyphenols, total flavonoids and total polysaccharides were evaluated. Results showed that the black garlic n-butanol fraction extract (BA) had significantly increased effect within small intestine in vitro, while the ethyl acetate fractions had no significant effect on small intestine in vitro. Increase of 5-HT4 content effectively stimulated the gastrointestinal peristalsis, which enhanced its gastrointestinal tract emptying, and promoted defecation. As for antioxidant activity test, the water extract was more effective in SOD activity test, DPPH radical scavenging rates, ferric reducing antioxidant power and reducing power. In addition, the water fraction was simulated by gastric acid digestion and hydrolysis, and the small intestine was isolated after acid hydrolysis (AW). It was found that the water fraction extract after acid hydrolysis did significantly improve the intestinal contraction rate. In short, extract of black garlic could effectively promote gastrointestinal motility and promote defecation. The active compounds were highly polar ingredients since water extract of black garlic exhibits most significant effect on improving gastrointestinal function.

Protective and Detoxifying Effects Conferred by Dietary Selenium and Curcumin against AFB1-Mediated Toxicity in Livestock: A Review.

Aflatoxin B1 (AFB1), among other aflatoxins of the aflatoxin family, is the most carcinogenic and hazardous mycotoxin to animals and human beings with very high potency leading to aflatoxicosis. Selenium is an essential trace mineral possessing powerful antioxidant functions. Selenium is widely reported as an effective antioxidant against aflatoxicosis. By preventing oxidative liver damage, suppressing pro-apoptotic proteins and improving immune status in AFB1 affected animals; selenium confers specific protection against AFB1 toxicity. Meticulous supplementation of animal feed by elemental selenium in the organic and inorganic forms has proven to be effective to ameliorate AFB1 toxicity. Curcumin is another dietary agent of importance in tackling aflatoxicosis. Curcumin is one of the major active ingredients in the tubers of a spice Curcuma longa L., a widely reported antioxidant, anticarcinogenic agent with reported protective potential against aflatoxin-mediated liver damage. Curcumin restricts the aflatoxigenic potential of Aspergillusflavus. Curcumin inhibits cytochrome P450 isoenzymes, particularly CYP2A6 isoform; thereby reducing the formation of AFB1-8, 9-epoxide and other toxic metabolites causing aflatoxicosis. In this review, we have briefly reviewed important aflatoxicosis symptoms among animals. With the main focus on curcumin and selenium, we have reviewed their underlying protective mechanisms in different animals along with their extraction and production methods for feed applications.

Tyrosinase-based TLC Autography for anti-melanogenic drug screening.

Tyrosinase-based TLC (thin layer chromatography) was developed for screening of anti-melanogenic drugs. In particular, this technique enables researchers to identify melanogenic inhibitor(s) in tested mixtures with the naked eye. In comparison with traditional colorimetric screening assays for tyrosinase inhibitor(s), not only is tyrosinase-based TLC a more cost-effective option (nearly one-tenth the enzyme cost of colorimetric methods) but also is a more sensitive detection approach for kojic acid (KA), a standard anti-melanogenic drug. The detection limit of tyrosinase-based TLC and colorimetric tyrosinase assay for KA was 0.0125 and 1.25 µg, respectively, demonstrating that the former was 100-fold more sensitive than the latter to determine the tyrosinase inhibitory rate of KA. Furthermore, the results of this method have demonstrated excellent precision by Gage Repeatability and Reproducibility (Gage R&R), with the variation of total Gage R&R being 28.24%. To verify the applicability of tyrosinase-based TLC, this platform was employed to screen melanogenic inhibitor(s) from Ganoderma formosanum extracts and two of all fractions (GFE-EA F4, F5) obtained showed depigmenting activity. It is noteworthy that these two fractions also exerted anti-melanogenesis activity on zebrafish, therefore verifying the credibility of tyrosinase-based TLC. In sum, this technique provides new insight into the discovery of novel melanogenic inhibitor(s).

Black garlic: A critical review of its production, bioactivity, and application.

Black garlic is obtained from fresh garlic (Allium sativum L.) that has been fermented for a period of time at a controlled high temperature (60-90°C) under controlled high humidity (80-90%). When compared with fresh garlic, black garlic does not release a strong offensive flavor owing to the reduced content of allicin. Enhanced bioactivity of black garlic compared with that of fresh garlic is attributed to its changes in physicochemical properties. Studies concerning the fundamental findings of black garlic, such as its production, bioactivity, and applications, have thus been conducted. Several types of black garlic products are also available in the market with a fair selling volume. In this article, we summarize the current knowledge of changes in the components, bioactivity, production, and applications of black garlic, as well as the proposed future prospects on their possible applications as a functional food product.

Complementary traditional Chinese medicine therapy improves survival in patients with metastatic prostate cancer.

More than 50% of prostate cancer patients have used traditional Chinese medicine (TCM) in Taiwan. However, the long-term clinical efficacy of TCM in prostate cancer patients remains unclear. Here, we investigated the relationship between TCM use and the survival of prostate cancer patients.A retrospective nationwide cohort study of prostate cancer patients was conducted between 1998 and 2003 using the Taiwan National Health Insurance Research Database. Patients were classified as TCM users or nonusers, and monitored from the day of prostate cancer diagnosis to death or end of 2012. The association between death risk and TCM use was determined using Cox proportional-hazards models and Kaplan-Meier curves.Of the 1132 selected prostate cancer patients, 730 (64.5%) and 402 (35.5%) were TCM users and nonusers, respectively. The mean follow-up period was 8.38 years, and 292 (25.8%) deaths were reported. TCM users had a decreased mortality rate (21.9%) compared with nonusers (32.8%). A lower death risk was observed with longer TCM use, especially in patients who used TCM for ≧200 days (adjusted hazard ratio [aHR] 0.61, 95% confidence interval [CI] 0.44-0.84). TCM users with metastatic prostate cancer had a significant lower HR than nonusers (aHR 0.70, 95% CI 0.51-0.95). Chai-Hu-Jia-Long-Gu-Mu-Li-Tang was the most significant TCM formulae for improving survival in metastatic prostate cancer (aHR 0.18, 95% CI 0.04-0.94).The result suggested that complementary TCM therapy might be associated with a reduced risk of death in metastatic prostate cancer patients.

The Use and the Prescription Pattern of Traditional Chinese Medicine Among Urolithiasis Patients in Taiwan: A Population-Based Study.

OBJECTIVES: To investigate the pattern of Traditional Chinese Medicine (TCM) usage for urolithiasis patients in Taiwan and to determine the most common Chinese herbal products used for urolithiasis. DESIGN: Retrospective review of urolithiasis patients treated with TCM treatment. SETTINGS/LOCATION: One million randomly selected samples in the Taiwanese National Health Insurance Research Database between 1997 and 2008. PATIENTS: Eighty-two thousand five hundred and fifty-one newly diagnosed urolithiasis patients. OUTCOME MEASURES: The correlation between TCM treatment, demographic factors, or medical conditions. RESULTS: A total of 62.6% of urolithiasis patients use TCM treatment. A younger age, female gender, polypharmacy, multiple comorbidities, and stone in the lower urinary tract result in a greater tendency to use TCM, after adjusting for demographic factors. Jia-Wei-Xiao-Yao-San Extract Powder and Ji-Sheng-Shen-Qi-Wan Extract Powder are the most frequently prescribed Chinese medicine formulae. CONCLUSION: This is the first study to examine the use of and the prescription pattern for TCM in urolithiasis patients using a random, national population-based sample. More than 62% of urolithiasis patients use TCM, and patients with polypharmacy, multiple comorbidities, and stone in the ureter are more likely to use TCM. The most frequently prescribed Chinese medicine formulae were Jia-Wei-Xiao-Yao-San Extract Powder and Ji-Sheng-Shen-Qi-Wan Extract Powder, which were reported to retard the progression of renal failure and alleviate flank pain or tenderness.