Fang-Pey Chen

Use frequency of traditional Chinese medicine in Taiwan

BackgroundUse of Traditional Chinese medicine (TCM), an important category of complementary and alternative medicine (CAM), has increased substantially in Western countries during the past decade. Use of TCM is also widespread in the Chinese population. However, few informative data have been obtained to date by large-scale investigations of TCM use in the Chinese population. This study was aimed at elucidating the demographics and patterns of TCM use in Taiwan.MethodsWe employed the complete datasets of TCM outpatient reimbursement claims from 1996 to 2001, including the use of Chinese herbal remedies, acupuncture and traumatology manipulative therapy, to analyse use frequencies, the characteristics of TCM users, and the disease categories that were treated by TCM in Taiwan.ResultsAt the end of 2001, 6,142,829 (28.4%) among the 21,653,555 valid beneficiaries of the National Health Insurance in Taiwan had used TCM during the year. However, 13,536,266 subjects (62.5%) had used TCM at least once during the whole 6-year period from 1996 to 2001, with a total of 156,224,266 visits (mean 11.5 visits per user). The mean number of TCM users per annum was 5,733,602, with a mean increment of 1,671,476 (29.2%) of new users yearly. Among TCM users, female was higher than male (female:male = 1.13:1), and the age distribution displayed a peak at around the 30s, followed by the 20s and 40s. Chinese herbal remedies (85.9%) were the most common TCM modality used by this population, followed by acupuncture (11.0%) and traumatology manipulative therapies (3.1%). Private TCM clinics provided most of the TCM care (82.6%), followed by private TCM hospitals (12.0%). The top ten major disease categories for TCM visits were diseases of the respiratory system, musculoskeletal system and connective tissue; symptoms, signs and ill-defined conditions; injury and poisoning; diseases of the digestive system, genitourinary system, skin and subcutaneous tissue, nervous system and sense organs, circulatory and endocrine system; nutritional and metabolic diseases; and immunological disorders.ConclusionTCM was popular among the Chinese population in Taiwan during the period studied. More than 60% of all subjects had used TCM during the 6-year interval. TCM was widely used by the Chinese population to treat problems and diseases of major human organ systems recognised by western medicine. This study provides information about the use frequencies of TCM and the disease categories treated by TCM, which should be useful for health policy makers and for those considering the integration of TCM and Western medicine.

Activation of the hypothalamus characterizes the acupuncture stimulation at the analgesic point in human: a positron emission tomography study.

We performed a positron emission tomography study, using regional cerebral blood flow as the index of brain activity, to address the specificity of brain activation pattern by acupuncture stimulation of short duration at the classical analgesic point. Needling manipulation at 2 Hz was performed at a classical point of prominent analgesic efficacy (Li 4, Heku) and a near-by non-classical/non-analgesic point, respectively, in normal subjects. Regions activated by acupuncture stimulation at Li 4 included the hypothalamus with an extension to midbrain, the insula, the anterior cingulate cortex, and the cerebellum. Of note, it was only the stimulation at Li 4 that activated the hypothalamus under the similar psychophysical ratings of acupuncture sensation (deqi) as elicited by the stimulation at the two points, respectively. The data suggested that the hypothalamus might characterize the central expression of acupuncture stimulation at the classical analgesic point and serve as one key element in mediating analgesic efficacy of acupuncture stimulation.

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.

The prescriptions frequencies and patterns of Chinese herbal medicine for allergic rhinitis in Taiwan

Background:  The evaluation of Chinese herbal medicines (CHM) to allergic rhinitis (AR) by large‐scale pharmaco‐epidemiological study is not ease found, although CHM had been reported to have potential effect for AR in some clinical trials.

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.

The different immunomodulation of indirect moxibustion on normal subjects and patients with systemic lupus erythematosus.

Moxibustion has been thought to enhance immunity in healthy condition, but suppress abnormal immune response in disease status. We collected 12 patients with systemic lupus erythematosus (SLE) and 12 healthy women who received indirect moxibustion on acupuncture points ST-36 (Zusanli) and SP-6 (Sanyinjiao) 20 minutes per day for 1 week. During the course, there were no changes of their regular medications or intercurrent infections in normal subjects and SLE patients. We found that indirect moxibustion for 1 week could elevate CD3+ and CD4+ T-lymphocytes in normal subjects, whereas decrease relative proportions of CD8+ T-lymphocytes in patients with SLE. This result confirms that indirect moxibustion has different immunomodulation in normal condition and autoimmune status. However, whether immunomodulatory effects of indirect moxibustion are beneficial for normal subjects and patients with SLE require further confirmation.

Neuroprotection effects of retained acupuncture in neurotoxin-induced Parkinson’s disease mice

The aim of this study was to investigate the role of retained acupuncture (RA) in neurotoxin-induced Parkinsons disease (PD) mice. Male C57BL/6 mice were injected with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) to induce the PD model. The mice were divided into four groups, namely, (1) normal; (2) MPTP+retained acupuncture (RA); (3) MPTP+electroacupuncture (EA); (4) MPTP+sham acupuncture (SA). After mice being manipulated with/without acupuncture at acupoints (Daling, PC 7), groups 2-4 were injected with MPTP (15 mg/kg/d). The mice were evaluated for behavioral changes, in terms of time of landing, after acupuncture treatment. The animals were sacrificed and their brains assayed for dopamine and its metabolites and tyrosine hydroxylase (TH) expression by using HPLC and immunohistochemistry/Western blotting, respectively. [(123)I] IBZM-SPECT imaging between SA and RA groups were compared. The results showed that the time of landing of the three groups with treatment was significant longer than group 1 (normal) (4.33±0.15 s). Nonetheless, group 2 (RA) (7.13±0.20 s) had a shorter time of landing than group 4 (SA) (7.89±0.46 s). The number of TH (+) neurons and the expression of TH proteins were significantly higher in the RA group than in the SA/EA groups. RA also increased the uptake of [(123)I] IBZM into the triatum compared to the SA group. We conclude that RA possibly attenuates neuronal damage in MPTP-induced PD mice, which suggests RA may be useful as a complementary strategy when treating human PD.

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.

A Parkinson’s Disease Measurement System Using Laser Lines and a CMOS Image Sensor

This paper presents a non-invasive, non-contact system for the measurement of the arterial dorsum manus vibration waveforms of Parkinson disease patients. The laser line method is applied to detect the dorsum manus vibration in rest and postural situations. The proposed measurement system mainly consists of a laser diode and a low cost complementary metal-oxide semiconductor (CMOS) image sensor. Laser line and centroid methods are combined with the Fast Fourier Transform (FFT) in this study. The shape and frequency and relative frequency of the dorsum manus vibration waveforms can be detected rapidly using our Parkinson’s disease measurement system. A laser line near the wrist joint is used as the testing line. The experimental results show an obvious increase in the amplitude and frequency of dorsum manus variation in the measured region in patients suffering from Parkinson’s disease, indicating the obvious effects of the disease. Both in postural and rest state measurements, as the patient disease age increases the vibration frequency increases. The measurement system is well suited for evaluating and pre-diagnosing early stage Parkinson’s disease.