Core prescription pattern of Chinese herbal medicine for depressive disorders in Taiwan: a nationwide population-based study.

BACKGROUND: Depressive disorders (DD) affect not only mood and behavior but also various physical functions. Traditional Chinese medicine (TCM) has been shown to have some benefits in treating DD. However, one formula or one single herb might be not show high efficacy when used to treat depression. Thus, this study aimed to examine the core prescription pattern of Chinese herbal medicine (CHM) among patients with DD in Taiwan as a reference for related research and clinical applications. METHODS: All patients, who had been diagnosed with major depressive disorder or minor depression or dysthymia without any other baseline diseases and had at least one CHM outpatient clinical visit from 2002 to 2011, were extracted from three randomly sampled cohorts, namely the 2000, 2005 and 2010 cohorts of the National Health Insurance Research Database (NHIRD) of Taiwan. The collected data was analyzed to explore the patterns of herbal products. RESULTS: There were 197,146 patients with a diagnosis of DD and of these 1806 subjects had only a diagnosis of DD and utilized CHM. The most common formula was Gan-Mai-Da-Zao-Tang (12.19%), while Suan-Zao-Ren (3.99%) was the most commonly prescribed single herb. The core pattern of prescriptions consisted of a combination of Gan-Mai-Da-Zao-Tang, Jia-Wei-Xiao-Yao-San, Chai-Hu-Jia-Long-Gu-Mu-Li-Tang, He-Huan-Pi, Yuan-Zhi and Shi-Chang-Pu. CONCLUSIONS: This study describes the CHM core prescription pattern used to treat patients in Taiwan with DD and it is a potential candidate for study in future pharmacological or clinical trials targeting DD.

The effects of a Chinese herbal medicine (VGHBPH0) on patients with benign prostatic hyperplasia: A pilot study.

BACKGROUND: The current Western medicine treatment options for benign prostatic hyperplasia (BPH) have various degrees of documented effectiveness. However, the uses of these interventions are limited to specific patient populations or have certain side effects that interfere with patient quality of life. This study evaluated the clinical effects of a Chinese herbal medicine (CHM) on patients with BPH. METHODS: This was a single-arm pilot study. Twenty BPH patients were enrolled, and they were required to take the investigated CHM three times a day for 8 weeks, along with their Western medicine. Patients returned to clinics as scheduled and completing international prostate symptoms scores (IPSS), aging male symptoms score, international index of erectile function, and body constitution questionnaire of traditional Chinese medicine. Uroflowmetry and sonography were also applied to evaluate the changes in urinary velocity and post-voiding residual urine volume from the baseline to the end of the study. RESULTS: The mean IPSS total score was significantly decreased by 2.5 points after 8 weeks of treatment with the CHM (from 17.5 to 15.0, p = 0.03). The mean IPSS voiding subscore was decreased by 1.7 points (from 10.1 to 8.4, p = 0.02), and the mean incomplete emptying subscore was decreased by 0.8 points (from 2.9 to 2.1, p = 0.02), with both decreases being statistically significant. A descending trend in the post-voiding residual urine volume was also observed (from 52.9 to 30.8 mL, p = 0.07). CONCLUSION: This trial indicated that the add-on CHM treatment (VGHBPH0) might be a potential treatment for improving the lower urinary tract symptoms of BPH patients.

A clinical study of integrating acupuncture and Western medicine in treating patients with Parkinson's disease.

Complementary therapy with acupuncture for Parkinson's disease (PD) has been studied for quite a long time, but the effectiveness of the treatment still remains unclear. The aim of this study is to evaluate the integrated effects of acupuncture treatment in PD patients who received western medicine. In the short-term acupuncture treatment study, 20 patients received acupuncture therapy twice a week in acupoints DU 20, GB 20, LI 11, LI 10, LI 4, GB 31, ST 32, GB 34 and GB 38 along with western medicine for 18 weeks, and 20 controlled patients received western medicine only. In the long-term acupuncture treatment, 13 patients received acupuncture treatment twice a week for 36 weeks. The outcome parameters include Unified Parkinson's disease rating scale (UPDRS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-Version 2 (BDI-II), and WHO quality of life (WHOQOL). In the short-term clinical trial, a higher percentage of patients in the acupuncture group had score improvement in UPDRS total scores (55% vs. 15%, p = 0.019), sub-score of mind, behavior and mood (85% vs. 25%, p < 0.001), activity of daily living (65% vs. 15%, p = 0.003), mobility (40% vs. 15%, p = 0.155) and complication of treatment (75% vs. 15%, p < 0.001), BDI-II score (85% vs. 35%, p = 0.003), and WHOQOL score (65% vs. 15%, p = 0.003) when compared to control group at the end of the 18 weeks' follow up. After 36 weeks of long-term acupuncture treatment, the mean UPDRS total scores and sub-score of mentation, behavior and mood, sub-score of complications of therapy and BDI-II score decreased significantly when compared to the pretreatment baseline. In conclusion, acupuncture treatment had integrated effects in reducing symptoms and signs of mind, behavior, mood, complications of therapy and depression in PD patients who received Western medicine.

Chinese herbal prescriptions for osteoarthritis in Taiwan: analysis of National Health Insurance dataset.

BACKGROUND: Chinese herbal medicine (CHM) has been commonly used for treating osteoarthritis in Asia for centuries. This study aimed to conduct a large-scale pharmaco-epidemiologic study and evaluate the frequency and patterns of CHM used in treating osteoarthritis in Taiwan. METHODS: A complete database (total 22,520,776 beneficiaries) of traditional Chinese medicine (TCM) outpatient claims offered by the National Health Insurance program in Taiwan for the year 2002 was employed for this research. Patients with osteoarthritis were identified according to the diagnostic code of the 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 for treating osteoarthritis. RESULTS: There were 20,059 subjects who visited TCM clinics for osteoarthritis and received a total of 32,050 CHM prescriptions. Subjects between 40 and 49 years of age comprised the largest number of those treated (19.2%), followed by 50-59 years (18.8%) and 60-69 years group (18.2%). In addition, female subjects used CHMs for osteoarthritis more frequently than male subjects (female: male = 1.89: l). There was an average of 5.2 items prescribed in the form of either an individual Chinese herb or formula in a single CHM prescription for osteoarthritis. Du-zhong (Eucommia bark) was the most commonly prescribed Chinese single herb, while Du-huo-ji-sheng-tang was the most commonly prescribed Chinese herbal formula for osteoarthritis. According to the association rule, the most commonly prescribed formula was Du-huo-ji-sheng-tang plus Shen-tong-zhu-yu-tang, and the most commonly prescribed triple-drug combination was Du-huo-ji-sheng-tang, Gu-sui-pu (Drynaria fortune (Kunze) J. Sm.), and Xu-Duan (Himalaya teasel). Nevertheless, further clinical trials are needed to evaluate the efficacy and safety of these CHMs for treating osteoarthritis. CONCLUSIONS: This study conducted a large scale pharmaco-epidemiology survey of Chinese herbal medicine use in OA patients by analyzing the NHIRD in Taiwan in year 2002.

Pulse analysis in bipolar disordered and nonpsychotic human subjects.

The research literature indicates that patients with bipolar disorder (BPD) differ from healthy individuals in various ways that are also recognized in traditional Chinese medicine. The purpose of the current study was to analyze the pulse spectra in BPD patients to determine any differences from nonpsychotic healthy individuals. Sphygmography was used to measure the radial arterial pulse waves in all subjects. We analyzed the original waveforms and then transformed them into frequency spectra via Fourier transformation. The relative strength of each harmonic, believed to be connected to meridians in Chinese medicine, was identified from the frequency, and we compared the differences among the harmonics. A total of sixty individuals, thirty with BPD and thirty nonpsychotic healthy controls, participated in the study. The harmonic values of C4 (Lung Meridian) on the right hand, 401.33 ± 50.10 vs. 762.44 ± 125.17, were significantly different (p < 0.05) between the BPD group and the nonpsychotic healthy group. The harmonic percentage of C3 (Spleen Meridian) on the right hand, 7.85 ± 0.59% vs. 10.79 ± 1.01%, and C4 (Lung Meridian), 1.80 ± 0.15 vs. 3.24 ± 0.43, was significantly different (p < 0.05) between the two groups. The results were similar for the right and left hands. In this study, we objectively detected constitutional differences between BPD patients and healthy controls through arterial pulse analysis. The pulse spectrum analyzer is a non-invasive diagnostic tool that can be used to integrate scientific technology with traditional Chinese medicine. We plan further study in this field to improve the accuracy of diagnosis in Chinese medicine.

The pulse spectrum analysis at three stages of pregnancy.

OBJECTIVES: This study is the first to detect the radial pulses of the three diagnosis positions (inch, bar, and cubit) in both wrists (six positions) by pulse spectrum analysis. The purpose of this study was to identify the difference among pulses of the six positions at three stages of pregnancy and to examine whether the results of this study agree with the theory of Traditional Chinese Medicine (TCM), which states that the cubit pulse shows unique changes for an expectant woman and that the pulse changes coincide with the progression of gestation. SUBJECTS AND METHODS: One hundred and fifty (150) healthy pregnant women were divided into three groups according to gestational age (9-14 weeks, 20-28 weeks, and 32-37 weeks of gestation) and 50 healthy nonpregnant women were used as controls. A pulse analyzer was used to detect the six positions of the radial pulses and to calculate the 10 relative energy values of the spectrum's harmonics of the six positions. RESULTS: Results show that most of the 10 relative spectral energy values of the right and left cubits are statistically (p<0.01) higher than those of the inch for the pregnant women as compared with the nonpregnant women. In addition, the 10 relative spectral energy values of the six positions are not identical at the three stages of pregnancy. CONCLUSIONS: The cubit pulse is unique for pregnant women, which is consistent with the theory of TCM. In addition, the pulse conditions at the three stages of pregnancy are dissimilar.

Radial pressure pulse and heart rate variability in normotensive and hypertensive subjects.

OBJECTIVES: The characteristics of the right/left radial pressure pulse (RPP) at the six diagnosis positions in Chinese medicine are not well documented. The purpose of this study is to investigate the spectral energy and augmentation index (AI) of bilateral RPP at the six diagnosis positions and heart rate variability (HRV) in the normotensives, hypertensives without heart dysfunction (HTN-N), and hypertensives with mild diastolic dysfunction (HTN-A). DESIGN: One hundred and thirty-eight (138) subjects were enrolled in this study. All subjects underwent measurements of brachial arterial blood pressure and RPP of both wrists while seated, and the supine measurement of HRV. AI and spectral energy of RPP as well as HRV were analyzed. RESULTS: The low-frequency component, the spectral HRV parameter, was significantly reduced in HTN-A compared with that in the normotensive group. Radial AI of the six diagnosis positions in HTN-N was significantly higher compared with that in the normotensive group or HTN-A. At the six diagnosis positions, the spectral energy of 0-10 Hz (SE(0-10 Hz)) in both hypertensive groups and 10-50 Hz (SE(10-50 Hz)) in the HTN-A group were significantly higher compared with those in the normotensive group. SE(10-50 Hz) at right Chy, left Chun, and left Guan in the HTN-N group were higher than those in the normotensive group. Within each group, there was a significant difference in the energy proportion, 10-50 Hz% (EP(10-50 Hz%)), between the six positions and a significant reduction only at the left Chun position in both hypertensive groups compared to that in the normotensive group. CONCLUSIONS: It is concluded that the EP(10-50 Hz%) revealed the specific characteristics of RPP and significantly varied at the six positions, and the left Chun position, the position to detect the heart diseases in Chinese medicine, is qualified to discriminate the differences between the normotensive and hypertensive patients.

Locating the Acupoint Baihui (GV20) Beneath the Cerebral Cortex with MRI Reconstructed 3D Neuroimages.

Baihui (GV20) is one of the most important acupoints of the Du meridian (the government vessel) and is commonly used in neurology and psychiatry and as a distal point of anorectal disorders by general practitioners. The anatomical relationship between the scalp region of the acupoint and the underlying corresponding cortex remains obscure. In this study, we first prepared the indicator for MRI scanning on a GE 1.5 T excite machine in a mode suitable for 3D reconstruction. The 3D Avizo software system (version 6.0, Mercury Computer Systems, Inc., Germany) was then used for image processing and the resulting data subsequently analyzed using descriptive statistics and analysis of variance (ANOVA). The mean distance from the Baihui anterior to the central sulcus in the adult group was greater than that in the child group (22.7 ± 2.2 and 19.7 ± 2.2 mm, resp., P = .042), whereas in the child group the distance between the Baihui anterior and the precentral sulcus was greater than in the adult group (6.8 ± 0.8 and 3.8 ± 0.8 mm, resp., P < .001). This MRI presentation demonstrates that the location of Baihui (GV20) can be identified using the distance from the central or precentral sulcus.

Differences in pulse spectrum analysis between atopic dermatitis and nonatopic healthy children.

OBJECTIVES: Atopic dermatitis (AD) is a common allergy that causes the skin to be dry and itchy. It appears at an early age, and is closely associated with asthma and allergic rhinitis. Thus, AD is an indicator that other allergies may occur later. Literatures indicate that the molecular basis of patients with AD is different from that of healthy individuals. According to the classics of Traditional Chinese Medicine, the body constitution of patients with AD is also different. The purpose of this study is to determine the differences in pulse spectrum analysis between patients with AD and nonatopic healthy individuals. METHODS: A total of 60 children (30 AD and 30 non-AD) were recruited for this study. A pulse spectrum analyzer (SKYLARK PDS-2000 Pulse Analysis System) was used to measure radial arterial pulse waves of subjects. Original data were then transformed to frequency spectrum by Fourier transformation. The relative strength of each harmonic wave was calculated. Moreover, the differences of harmonic values between patients with AD and non-atopic healthy individuals were compared and contrasted. RESULTS: This study showed that harmonic values and harmonic percentage of C3 (Spleen Meridian, according to Wang's hypothesis) were significantly different. CONCLUSIONS: These results demonstrate that C3 (Spleen Meridian) is a good index for the determination of atopic dermatitis. Furthermore, this study demonstrates that the pulse spectrum analyzer is a valuable auxiliary tool to distinguish a patient who has probable tendency to have AD and/or other allergic diseases.

Radial pressure pulse and heart rate variability in heat- and cold-stressed humans.

This study aims to explore the effects of heat and cold stress on the radial pressure pulse (RPP) and heart rate variability (HRV). The subjects immersed their left hand into 45°C and 7°C water for 2 minutes. Sixty healthy subjects (age 25 ± 4 yr; 29 men and 31 women) were enrolled in this study. All subjects underwent the supine temperature measurements of the bilateral forearms, brachial arterial blood pressure, HRV and RPP with a pulse analyzer in normothermic conditions, and thermal stresses. The power spectral low-frequency (LF) and high-frequency (HF) components of HRV decreased in the heat test and increased in the cold test. The heat stress significantly reduced radial augmentation index (AIr) (P < .05), but the cold stress significantly increased AIr (P < .01). The spectral energy of RPP did not show any statistical difference in 0 ~ 10 Hz region under both conditions, but in the region of 10 ~ 50 Hz, there was a significant increase (P < .01) in the heat test and a significant decrease in the cold test (P < .01). The changes in AIr induced by heat and cold stress were significantly negatively correlated with the spectral energy in the region of 10 ~ 50 Hz (SE(10-50 Hz)) but not in the region of 0 ~ 10 Hz (SE(0-10 Hz)). The results demonstrated that the SE(10-50 Hz), which only possessed a small percentage in total pulse energy, presented more physiological characteristics than the SE(0-10 Hz) under the thermal stresses.

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.