Yen-Ying Kung

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.

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.

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.

Effect of acupuncture ‘dose’ on modulation of the default mode network of the brain

Objective Recent functional MRI (fMRI) studies show that brain activity, including the default mode network (DMN), can be modulated by acupuncture. Conventional means to enhance the neurophysiological ‘dose’ of acupuncture, including an increased number of needles and manual needle manipulation, are expected to enhance its physiological effects. The aim of this study was to compare the effects of both methods on brain activity. Methods 58 healthy volunteers were randomly assigned into four groups that received single needle acupuncture (SNA, n=15) or transcutaneous electrical nerve stimulation (TENS, n=13) as active controls, or enhanced acupuncture by way of three needle acupuncture (TNA, n=17) or SNA plus manual stimulation (SNA+MS, n=13). Treatment-associated sensations were evaluated using a visual analogue scale. Central responses were recorded before, during, and after treatment at LI4 on the left hand using resting state fMRI. Results TNA and SNA+MS induced DMN-insula activity and extensive DMN activity compared to SNA, despite comparable levels of de qi sensation. The TNA and SNA+MS groups exhibited a delayed and enhanced modulation of the DMN, which was not observed followed SNA and TENS. Furthermore, TNA increased precuneus activity and increased the DMN-related activity of the cuneus and left insula, while SNA+MS increased activity in the right insula. Conclusions The results showed that conventional methods to enhance the acupuncture dose induce different DMN modulatory effects. TNA induces the most extensive DMN modulation, compared with other methods. Conventional methods of enhancing the acupuncture dose could potentially be applied as a means of modulating brain activity.

Trends in global acupuncture publications: An analysis of the Web of Science database from 1988 to 2015

Background Acupuncture is a rapidly growing medical specialty worldwide. This study aimed to analyze the acupuncture publications from 1988 to 2015 by using the Web of Science (WoS) database. Familiarity with the trend of acupuncture publications will facilitate a better understanding of existing academic research in acupuncture and its applications. Methods Academic articles published focusing on acupuncture were retrieved and analyzed from the WoS database which included articles published in Science Citation Index‐Expanded and Social Science Citation Indexed journals from 1988 to 2015. Results A total of 7450 articles were published in the field of acupuncture during the period of 1988–2015. Annual article publications increased from 109 in 1988 to 670 in 2015. The Peoples Republic of China (published 2076 articles, 27.9%), USA (published 1638 articles, 22.0%) and South Korea (published 707 articles, 9.5%) were the most abundantly prolific countries. According to the WoS subject categories, 2591 articles (34.8%) were published in the category of Integrative and Complementary Medicine, followed by Neurosciences (1147 articles, 15.4%), and General Internal Medicine (918 articles, 12.3%). Kyung Hee University (South Korea) is the most prolific organization that is the source of acupuncture publications (365 articles, 4.9%). Fields within acupuncture with the most cited articles included mechanism, clinical trials, epidemiology, and a new research method of acupuncture. Conclusion Publications associated with acupuncture increased rapidly from 1988 to 2015. The different applications of acupuncture were extensive in multiple fields of medicine. It is important to maintain and even nourish a certain quantity and quality of published acupuncture papers, which can play an important role in developing a medical discipline for acupuncture.

H1N1 influenza: Is traditional Chinese medicine effective and safe?

Influenza is a viral respiratory infection that causes an acute febrile illness with myalgia, headache, and cough, and can result in substantially elevated morbidity and mortality rates during an epidemic. A novel influenza H1N1 infection began in March 2009, which rapidly spread and caused the World Health Organization to declare the first influenza pandemic outbreak. The antiviral medication oseltamivir has been approved for use against influenza H1N1 infections; however, careful use of anti-influenza drugs has been recommended due to the emergence of drug resistance and the side effects of these drugs. Chinese herbal medicine, the most important component of traditional Chinese medicine (TCM), has been recommended for preventing and treating influenza due to the limitations of healthcare resources in China. Shang-Han Lun (Treatise of Exogenous Febrile Diseases or Discourse on ColdDamage Disorders) and Wen-Bing-Tiao-Bian (Detailed Analysis of Epidemic Warm Diseases) were regarded as the seminal guidelines for treatment of influenza in TCM. In the study of TCM, influenza is differentiated into two types: (1) wind-cold syndrome and (2) wind-heat syndrome. Severe cold, slight fever, absence of sweat, headache, aching pain of the extremities, stuffy nose with nasal discharge, and cough with thin sputum are the primary symptoms of the wind-cold type. Alternatively, a high fever, slight aversion to cold, headache, sore throat with congestion, and expectoration of yellowish sputum are the main symptoms of the wind-heat type. Many studies have shown that Chinese herbal medicine applied to counter the effects of wind-cold or wind-heat types can inhibit influenza virus, with some studies even showing potential modulation of the cellular immune system in animals. For example, Scutellaria baicalensis inhibits influenza HIN1 by exerting cytotoxic activity against infected cells. Hypericum perforatum L. could reduce the influenza HIN1 viral titer of infected mice by modulation of inflammatory cytokines. However, evidence-based data regarding the therapeutic effects and safety of TCM for treatment of influenza H1N1 in humans remain unclear. In 2013, Jiang et al assessed the therapeutic effects and safety of Chinese herbal medicine as an alternative or adjunctive therapy to other commonly used drugs for influenza in 18 trials involving 2521 participants. They found in one Chinese herbal trial that TCM is more effective than antiviral