Korean Herbal Medicine Research Articles

Antiosteoarthritic Effects of ChondroT in a Rat Model of Monosodium Iodoacetate-Induced Osteoarthritis.

Ganghwaljetongyeum is a traditional Korean herbal medicine used to treat joint pain, limited motion, fever, and swelling; it also inhibits inflammatory processes associated with arthritis. ChondroT, a water extract of Ganghwaljetongyeum, is a new complex herbal medicine. This study investigated the effects of ChondroT using a rat model of monosodium iodoacetate- (MIA-) induced osteoarthritis. Thirty-six rats were randomly divided into three ChondroT groups and a normal, control, and positive control group. Changes in paw edema volume, histopathology, and plantar withdrawal response were analyzed. Further, inflammatory cytokines, arachidonic acids, liver and kidney function, and hematological features were measured. ChondroT significantly decreased paw edema by the 5th day and notably improved articular cartilage damage; it also significantly improved the plantar withdrawal response in terms of both reaction time and force intensity. Moreover, treatment with ChondroT significantly decreased the serum levels of tumor necrosis factor alpha, interleukin-1β, interleukin-6, and prostaglandin E2 and significantly increased serum aspartate aminotransferase and alanine aminotransferase levels. This study demonstrates that ChondroT has anti-inflammatory and analgesic effects in a MIA-induced osteoarthritis rat model. These results support the clinical relevance of ChondroT for future use in patients with osteoarthritis. However, further studies are required to elucidate the corresponding mechanisms.

The Effect of Korean Herbal Medicine that Function by Inducing Diuresis for Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objectives: The aim of this study was to review the clinical research on antihypertensive effects of Korean herbal medicines that function by inducing diuresis. Methods: Literature searches were performed using PubMed, Cochrane, CNKI, Wanfang, Cinii, Oasis, KISS, NDSL, RISS, DBPia, with the keywords...

Changes in Drosophila melanogaster Sleep-Wake Behavior Due to Lotus (Nelumbo nucifera) Seed and Hwang Jeong (Polygonatum sibiricum) Extracts.

We evaluated the sleep enhancement activity of the medicinal herbs valerian (Valeriana officinalis), jujube (Ziziphus jujube), lotus seed (Nelumbo nucifera), Gastrodia elata, Polygonatum sibiricum, and baekbokryung (Poria cocos), which can relieve insomnia in a Drosophila model. Locomotor activity was measured in the Drosophila model to evaluate the sleep activity of Korean medicinal herbs traditionally used as sleep aids. The group treated with lotus seed extract showed less nocturnal activity. Treatment with 10 or 20 mg/mL of P. sibiricum significantly reduced nocturnal activity compared to the control group (P<0.05). The activity and sleep bouts of fruit flies were significantly decreased by a high-dose treatment (10 mg/mL) of lotus or P. sibiricum extracts at night. Caffeine-treated Drosophila showed increased nocturnal activity and decreased total sleep time (P<0.05). Flies receiving the 10 mg-doses of lotus seed or P. sibiricum extract showed significantly different nocturnal locomotor activity and total sleep time compared to caffeine-treated Drosophila. Lotus seed and P. sibiricum extracts are attractive and valuable sleep-potentiating nutraceuticals.

Effects of the Obesity Therapy with Korean Herbal Medicine on Liver Function: Case Series

Many obesity patients were affected by depressed liver function including hepatosteatosis. The aim of this study was to investigate the clinical effect of the obesity therapy with Korean herbal medicine (KHM) on obese patient with abnormal liver function. This is a retrospective observational study performed on obesity patients with abnormal liver function. All subjects have taken serum liver function tests (LFTs) before treatment. Ten patients showed abnormal LFTs. They were treated with KHM at least 15 days. During this treatment, LFTs were evaluated afterwards. Body weight and body mass index of the patients were decreased during treatments. Five of 10 subjects recovered normal levels of LFTs. While other subjects remained at abnormal level but their levels were decreased. This study shows that the obesity therapy including KHM could be effective to improve liver function on obese patient. Additional large scale studies are necessary for more evidences.

The efficacy and safety of Danggui-Sayuk-Ga-Osuyu-Saenggang-tang on Korean patients with cold hypersensitivity in the hands: study protocol for a pilot, double-blind, randomized, placebo-controlled, parallel-group clinical trial

BackgroundIn recent years, cold hypersensitivity in the hands (CHH) has become a common ailment of women in Korea. It can lead to gynecological problems such as irregular menstruation, miscarriage, and infertility. Traditionally, Korean herbal medicine has been the primary treatment method used to balance thermoregulation in the human body; however, its effectiveness has not been confirmed through systematic study. Thus, in this trial, we will investigate the feasibility of a full randomized clinical trial, Danggui-Sayuk-Ga-Osuyu-Saenggang-tang (DSGOST) in Korean women with CHH.MethodsThis study will be a pilot, multicenter, double-blind, randomized, parallel-group, two-arm, placebo-controlled clinical trial. A total of 66 participants will be randomly divided into two groups, a DSGOST treatment group and a placebo control group, in a 1:1 ratio using a web-based randomization system. Each group will take DSGOST or placebo three times daily for 6 weeks. The primary outcome will be measured using Visual Analogue Scale (VAS) scores of CHH. Secondary outcomes will include changes in skin temperature of the hands, Clinical Global Impressions (CGI) scale scores, recovery rate of skin temperature of the hands after the cold stress test, and the Korean version of the WHO Quality of Life Scale, abbreviated version (WHOQOL-BREF).DiscussionThis trial will be the first trial to reflect the newly defined disease range of CHH which was compiled by Korean medicine expert consensus. This study will provide considerable evidence for further large-scale trials and general clinical guidelines for CHH in the Korean medical field.Trial registrationThis study is registered at ClinicalTrials.gov, ID: NCT02645916. Registered on 30 December 2015.

A Case Report of an Ischemic Heart Disease Patient with Chest Discomfort and a Headache

Objective This case study describes the use of traditional Korean medicine to relieve chest pain and headaches in a patient with ischemic heart disease. Methods The patient was treated with a range of traditional Korean medicine, including acupuncture, moxibustion, and herbal medicines (Gamiondam-tang and Cheonmabanhwa-tang-gagambang). The Numerical Rating Scale (NRS) was used to measure the patient’s status and improvements in the frequency of symptoms. Results After the treatment, the NRS score for chest pain and headaches decreased from 6 to 0. In addition, chest discomfort and palpitations almost subsided. Conclusion This clinical case study suggested that Gamiondam-tang and Cheonmabanhwa-tang-gagambang could be effective in relieving chest discomfort and headaches. Keywords: ischemic heart disease, chest discomfort, headache, Gamiondam-tang, Cheonmabanhwa-tang-gagambang

Anti-cancer effect of Atractylodes macrocephala extract by double induction of apoptotic and autophagic cell death in head and neck cancer cells

The apoptosis resistance restricts the efficacy of traditional therapies of head and neck squamous cell carcinoma (HNSCC). To overcome this problem, Atractylodes macrocephala, a traditional Korean and Chinese herbal medicine, has been used in clinical practice. In the present study, the anticancer effect of A. macrocephala extract was investigated and its underlying mechanisms using head and neck cancer KB cell line. The extract-induced cytotoxicity was mediated by autophagic cell death as well as apoptosis in HNSCC cells though extrinsic apoptotic pathway and the Akt/mTOR autophagic pathway. This study suggests that A. macrocephala extracts can be a potential drug to overcome side effects and susceptibility for head and neck carcinoma by double induction of apoptosis and autophagy.&#x0D; Video Clip of Methodology: 6 min 27 sec Full Screen Alternate

Development of User-Friendly Method to Distinguish Subspecies of the Korean Medicinal Herb Perilla frutescens Using Multiplex-PCR.

Perilla (Perilla frutescens) is an economically and culturally important plant in East Asia. Plant breeding between cultivars has enhanced the genetic diversity of perilla overall, but means that functionally diverse subspecies are more difficult to identify and distinguish. In this study, we developed gene-based DNA markers to distinguish between the Korean herbal medicinal perilla varieties. We identified informative simple sequence repeat (SSR) regions on the promoter regions of the Myb-P1 and dihydroflavonol 4-reductase (DFR) genes, as well as a large insertion-deletion (indel) region in the limonene synthase (LS) gene, and developed markers to characterize the distinct subspecies differences (PfMyb-P1pro, PfDFRpro, and PfLS, respectively). Using the PfLS primers, a 430-bp region could be amplified from P. frutescens var. acuta, crispa, and f. viridis (known as Jasoyeop, Jureum-soyeop, and Chungsoyeop, respectively), but not from P. frutescens var. japonica (Dlggae). The PfMybpro primers resulted in PCR products of 314 or 316, 330, 322, and 315 bp from Dlggae, Jasoyeop, Jureum-soyeop, and Chungsoyeop, respectively, and the PfDFRpro primers resulted in products of 189 or 202, 187 or 189, 185 or 189, and 193bp, respectively, for the four perilla subspecies. Combining these three reactions into a single multiplex PCR approach resulted in subspecies-specific PCR band patterns for six common types of commercial perilla, distinguishing between three varieties of Dlggae (Cham-Dlggae, Ip-Dlggae, and Bora-Dlggae), as well as identifying Jasoyeop, Jureum-soyeop, and Chungsoyeop. These user-friendly markers will be valuable as a simple and efficient method for identifying the Korean medicinal herb Jasoyeop, as well as distinguishing between other functionally distinct subspecies, which may have broad applications in the Korean herbal industry.

Successful Spontaneous Conception and Live Birth in a Woman with an Extremely Low Level of Anti-Müllerian Hormone Who Received Korean Herbal Medicine (Bogungsamul-tang): A Case Report

Conventional treatments do not appreciably improve fecundity in women with extremely low-serum levels of anti-Müllerian hormone (AMH). In Korea, herbal medicine is widely used to treat female infertility. We report a case in which an infertile woman with a very low AMH level naturally conceived after two months of herbal treatment (Bogungsamul-tang), ultimately giving birth to a full-term baby. Although AMH levels were not measured immediately before and after treatment, our study suggests that Korean herbal remedies are a viable option for infertile women with negligible AMH levels. Further studies should be performed to fully assess the clinical effects of Bogungsamul-tang in such women.

Polyphenolic compounds from Korean Lonicera japonica Thunb. induces apoptosis via AKT and caspase cascade activation in A549 cells.

Lonicera japonica Thunb. (L. japonica T.) has historically been used in Korean herbal medicine due to its anticancer and protective effects on the respiratory system. In the present study, the polyphenolic compounds in L. japonica T. were investigated using high-performance liquid chromatography coupled with tandem mass spectrometry, and its anticancer effects on A549 non-small-cell lung cancer cells were studied. Polyphenolic compounds potentially inhibit A549 cells in a dose-dependent manner. Flow cytometry and western blot analysis demonstrated that polyphenolic compounds induce apoptosis by regulating the protein expression levels of caspases, poly-(ADP-ribose) polymerase and the B-cell lymphoma-2-associated X-protein/B-cell lymphoma-extra large ratio. Furthermore, polyphenolic compounds inhibited mitochondrial membrane potential activity. Caspase-3 activity was increased in a dose-dependent manner and polyphenolic compounds inhibited the activation of protein kinase B by dephosphorylation. These results suggest that polyphenolic compounds in A549 cells indicate the anticancer activity through the induction of apoptosis.

The traditional Korean herbal medicine Ga-Gam-Nai-Go-Hyan suppresses testosterone-induced benign prostatic hyperplasia by regulating inflammatory responses and apoptosis.

Benign prostatic hyperplasia (BPH) is a pathological condition that affects the majority of men above the age of 50 years. Pharmacological agents are typically used to treat BPH; however, there are currently no pharmacological agents that are able to completely cure BPH without causing adverse side effects. As a result of these side effects, there is a great interest in developing effective herbal medicines that are able to inhibit the progression of BPH and are safe for long-term use. Ga-Gam-Nai-Go-Hyan (GGN) is a traditional Korean herbal medicine that has been widely used to treat BPH; however, no biological studies have been performed to elucidate the efficacy of GGN. The aim of the present study was to evaluate the efficacy of GGN as a treatment for BPH. GGN administration was demonstrated to significantly decrease prostate weight (P<0.001), the relative prostate weight ratio (P<0.001) and the ratio of prostate weight to body weight (P<0.001). In addition, GGN treatment was revealed to suppress testosterone and dihydrotestosterone serum levels (P<0.001) and the growth of prostatic tissue. GGN also decreased the levels of the two inflammatory proteins (P<0.05), inducible nitric oxide synthase and cyclooxygenase-2, decreased the levels of the two apoptotic suppressors (P<0.05) B-cell lymphoma (Bcl)-2 and Bcl-xL and increased the levels of the pro-apoptotic factors (P<0.05) Bcl-2-associated X protein, caspase-3, caspase-8, Fas, Fas ligand and Fas-associated protein with death domain. The results of the present study suggested that GGN may have suppressive effects on the development of BPH and therefore have the potential to be used for treating BPH.

Anti-inflammatory Effects of KOTMIN13: A Mixed Herbal Medicine in LPS-stimulated RAW 264.7 Cells and Mouse Edema Models.

Background:A Korean herbal medicine, KOTMIN13, composed of Inula japonica Thunberg, Trichosanthes kirilowii Maximowicz var. japonica kitamura, Peucedanum praeruptorum Dunn, and Allium macrostemon Bge, has been used for anti-allergic and anti-asthmatic treatment in oriental clinics, but its activity has not been investigated.Materials and Methods:To evaluate the anti-inflammatory activity of KOTMIN13 for in vitro study, LPS-stimulated RAW 264.7 cells were used to induce the production and expression of inflammatory mediators and its mechanisms. 12-O-Tetradecanoylphorobol-13 aceate (TPA)-induced ear edema and carrageenan-induced paw edema models were also used to evaluate the effect of KOTMIN13 on acute inflammation in vivo.Results:KOTMIN13 reduced the release of inflammatory mediators [nitric oxide, prostaglandin E2, interleukin (IL)-1β, and IL-6] and the protein expression of inducible nitric oxide synthase and cyclooxygenase-2 in LPS-stimulated RAW 264.7 cells. Mechanism studies showed the attenuation of LPS-induced NF-κB activation by KOTMIN13 via IκBα degradation abrogation and a subsequent decrease in nuclear p65 levels. Activation of mitogen-activated protein kinases (ERK, JNK, and p38) was also suppressed. Furthermore, KOTMIN13 ameliorated the development of TPA-induced ear edema and carrageenan-induced paw edema in acute inflammatory edema mouse models.Conclusion:Our study demonstrates that KOTMIN13 inhibits inflammatory mediators through the inhibitions of NF-κB and MAPK activities in LPS-induced RAW 264.7 cells, as well as acute inflammation in edema models, indicating that KOTMIN13 is an effective suppressor for anti-inflammatory activities.SUMMARY KOTMIN13 decrease the production of No, PGE2, and proinflammatory cytokine (TNF-∝, IL-1β,IL-6).KOTMIN13 Suppressed the degradation of NF-kβ and IKβα and the phosorylation of MAP Kinases.Topical application of KOTMIN13 reduced mouse ear edema.Oral administration of KOTMIN13 decreased carrageenan-induced paw edema. Abbreviations used: NO: nitric oxide; PGE2: prostaglandin E2; iNOS: inducible NO synthase; COX-2: cyclooxygenase-2; TNF-α: tumor necrosis factor-α; IL: interleukin; NF-κB: nuclear factor kappaB; MAPK: mitogen-activated protein kinases; ERK: extracellular signal regulated kinase; JNK: c-jun N terminal kinase; TPA: 12-O-tetradecanoylphorbol-13-acetate

Attitudes among Elderly towards Complementary and Alternative Medicine use as a Suicide Prevention Program in Korea: A Preliminary Study

Introduction: Suicide among Korean elderly persons continues to be a major issue, with most suicides being in the over 65 years old demographic population. It has the highest suicide rate of all Organization for Economic Cooperation and Development (OECD) member countries and ranking 31st out of 38 member nations in terms of overall life satisfaction. It is well known that depression is the psychiatric diagnosis most strongly associated with suicide; therefore, the aim of this research was to explore how to address depression using Complementary and Alternative Medicine (CAM) among senior citizens. Methods: A cross-sectional study was conducted among 326 subjects aged 65 years and over, attending senior citizen halls located in Seoul, Korea. The survey instrument was designed to explore whether CAM is a good adjuvant in suicide prevention programs within senior citizen halls. Data entry was done by using Excel and exported to SPSS version 21.0 software package for analysis. Results: Among 326 participants, 93.3% reported using one or more CAM modalities for depression-related outcomes. Prayer, traditional Korean medicine, sports, diet, medicinal herbs and fungi were the leading complementary and alternative therapies used to improve mood disorders. Almost half of respondents, 49.7% used some complementary health therapy while receiving conventional depressive treatment. Conclusion: The findings support the urgent need to resolve the social problem of suicide among elderly population, especially isolated elders. CAM appears to be widely accepted and used by a high percentage of Korean elderly people to improve mood disorders. Most herbs were self-prescribed and undisclosed to health care providers. This result highlights the need of in-depth study into Complementary Health approaches and their potential effects as adjunctive treatment for elders at risk of suicide.

A Case Report of Concurrent Korean Herbal Medicine Treatment, Cognitive Behavior Therapy, and Person-centered Counseling Therapy for Anorexia Nervosa

A Case Report of Concurrent Korean Herbal Medicine Treatment, Cognitive Behavior Therapy, and Person-centered Counseling Therapy for Anorexia Nervosa

Two Cases of Correlation between Improvement of General Weakness Symptoms and DHEAS Level through Korean Medical Treatment

Objectives This study reports on the efficacy of treating patients with general weakness symptoms with Korean medicine. Methods Two patients with general weakness symptoms were treated with Korean medical treatment modalities, including acupuncture, moxibustion, and herbal medicines. Blood tests, the visual analogue scale (VAS), and patients’ complaints were used to assess the treatment effects. Results and Conclusions dehydroepiandrosterone sulphate (DHEAS), DHEAS/cortisol index, VAS, and the patients’ complaints improved after treatment. Korean medical treatment is effective in improving DHEAS and the DHEAS/cortisol index according to the improvements in the patients’ conditions. However, more studies are required to validate its use with other patients. Keywords: generally weakening, DHEAS, DHEAS/Cortisol

Studies on Quality Control of Domestic Leonurus japonicus Houttuyn

Background: Leonurine is a the aerial part of Leonurus japonicus Houttuyn, which has been used as a traditional medicines and is registered in the Korean Pharmacopoeia. Methods and Results: In the present study we performed a heavy metals and thin layer chromatography and measured loss on drying, as well as the contents of total ash, acid-insoluble ash, ethanol soluble compounds, and leonurine, using 15 domestically collected L. japonicus samples. The methods were performed according to the ‘crude drugs test of the general test, processes and apparatus’, published by MFDS, Korea (2014). The purity test (heavy metals) indicated that levels of Pb and Hg were 0.35 - 3.64, and 0.001 ppm, respectively, whereas the levels of As and Cd were undetectable, and stachydrine was identified by thin layer chromatography (Rf : 0.15). We found that 5.93 - 10.62% (average: 8.58 ± 1.8%) of the sample mass was lost during drying, and the contents of total ash, acid-insoluble ash, ethanol soluble compounds, and leonurine were 7.87 - 10.84% (average: 9.62 ± 0.82%), 0.99 - 1.76% (average: 1.38 ± 0.24%), 16.70 - 23.11% (average: 19.49 ± 2.14%) and 0.04 - 0.17% (average: 0.11 ± 0.04%) respectively. In addition, HPLC profiling detected leonurine (5.94 min), rutin (16.43 min) and myricetin (26.78 min). Conclusions: We hope that this the rusult of the present study will contribute to the standardization and quality control of Korean herbal medicines.

Adverse drug reactions in Korean herbal medicine: A prospective cohort study

IntroductionA large proportion of herbal drugs (HM) are still excluded in the regular pharmacovigilance system in Korea, despite suspicions about their safety. This study aimed to estimate the prevalence and risk factors of adverse drug reactions (ADRs) in HM and establish a foundation for a comprehensive surveillance system that includes herbal drugs. MethodsThis is a prospective cohort study based on a registry of patients who had been prescribed herbal drugs in a Korean medicine hospital. The authors monitored the registered patients and detected ADRs from HM using the WHO-UMC Causality Scale. The prevalence and possible risk factors of ADRs in HM were investigated. ResultsFrom 341 registered patients, 28 cases of adverse events (AEs) were detected and they were categorized as certain (14.3%), probable (21.4%), possible (42.9%), and unlikely (21.4%). Out of 22 ADRs, 29 cases of drug-symptom pairs were extracted. The prevalence of ADRs in HM was 9.36%. Old age was a risk factor for ADRs (OR 4.4, 95% CI, from 1.76 to 11.00) in HM. The most frequently reported clinical manifestation of ADR was dyspepsia (20.7%), followed by nausea and diarrhoea (17.2%, each). The severity of the ADRs was mostly mild (89.7%) and no serious ADR was detected. ConclusionThis study shows the possibilities and limitations of reconstructing the current pharmacovigilance system to guarantee the safe use of HM.

Control of stress-induced depressive disorders by So-ochim-tang-gamibang, a Korean herbal medicine

Ethnopharmacological relevanceSo-ochim-tang-gamibang (SOCG) is a Korean herbal medicine formula that has been applied to treat depressive moods and depression associated somatoform pain. This decoction consists of Cyperus rotundus L. (Cyperi Rhizoma), Lindera aggregata (Sims) Kosterm. (Linderae Radix), Aquilaria agallochum (Lour.) Roxb. ex Finl. (Aquilariae Resinatum Lignum), Glycyrrhiza uralensis Fisch. (Glycyrrhizae Radix) Platycodon grandiflorum (Jacq.) A. DC. (Platycodi Radix), and Citrus aurantium L. (Aurantii Fructus). The aim of this study is to assess antidepressant-like effects of SOCG and to investigate its possible cellular and molecular mechanisms. Material and methodsUsing chronic restraint stress animal model, effects of SOCG on depressive-like behaviors, corticosterone, and hippocampal expressions of a neurotrophic factor and an apoptotic marker, were investigated. Mice were exposed to restraint stress 6h per day over a period of two weeks, and orally administrated either SOCG (30, 100, or 300mg/kg/day). The depressive-like behaviors were analyzed by forced swimming test and open field test. The serum levels of corticosterone were measured by enzyme-linked immunosorbent assay. Expressions of caspase-3 and BDNF in the hippocampus were analyzed by immunofluorescence. Further, effects of SOCG were examined in corticosterone-treated PC12 cells. Cellular toxicity was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and lactate dehydrogenase assays. Real-time PCR was applied to investigate the cellular expression levels of Bax, Bcl-2, and BDNF. The levels of caspase-3 and BDNF were examined by Western blotting. ResultsAdministration of SOCG not only reduced immobility time of restraint-stressed mice in a dose-dependent manner, but also significantly increased the distance mice moved and the number of crossings in the open field test. Further, SOCG significantly reduced the serum level of corticosterone and expression of caspase-3, while increased expression of BDNF in vivo. SOCG increased cell viability in corticosterone treated PC12 cells, which was accompanied by decreased caspase-3 expression and the ratio of Bax/Bcl-2 mRNA expression as well as increased BDNF expression in vitro. ConclusionsTaken together, our data suggested that SOCG may have potential as an antidepressant agent controlling depressive behaviors and corticosterone-induced neuronal damage caused by chronic stress.

A Clinical Report of Polyneuropathy Treated with Korean Medical Treatment

Objective: To describe the effects of Korean medical treatment on a 51-year-old male patient with polyneuropathy and chief complaints of lower limb paralysis and dysarthria. Methods: The Toronto Clinical Neuropathy Scoring System (TCNSS) was used to evaluate the function of the lower limb and the symptoms of the patient were observed daily. We applied herbal medication and acupuncture daily, depending on the patient’s symptoms. Results: After the treatment, the TCNSS score was improved. Conclusions: In this case, Korean medical therapy was effective in improving lower limb function. Keywords: polyneuropathy, Toronto clinical neuropathy scoring system, Korean herbal medicine

Case Reports of Idiopathic Thrombocytopenia Unresponsive to First-Line Therapies Treated With Traditional Herbal Medicines Based on Syndrome Differentiation

The objective of our study is to present two cases showing the effects of traditional Korean herbal medicines based on traditional Korean medicine (TKM) for the treatment of immune thrombocytopenic purpura (ITP). One patient showed no response to treatment with steroids and an immunosuppressive agent. Moreover, liver toxicity and side effects of steroids were evident. However, after he ceased conventional treatment and started to take an herbal medicine, his liver function normalized and the steroid side effects resolved. Ultimately, he achieved complete remission. Another patient with ITP had sustained remission after steroid therapy in childhood, but extensive uterine bleeding and thrombocytopenia recurred when she was 16 years old. She was managed with steroids again for 2 years, but severe side effects occurred, and eventually she ceased taking steroids. She refused a splenectomy, and was then treated with a herbal medicine for 7 months, ultimately leading to sustained remission again. Many patients with resistance to first-line treatments tend to be reluctant to undergo a splenectomy, considered a standard second-line treatment. In conclusion, herbal medicines, based on TKM, may offer alternative treatments for persistent or chronic ITP that is resistant to existing first-line treatments.