Western Drugs Research Articles

Hypertension prevalence, awareness, treatment, and control in 115 rural and urban communities involving 47 000 people from China.

Identification and treatment of hypertension in China remain suboptimal despite high prevalence of hypertension and increasing incidence of stroke and myocardial infarction. This study reported blood pressure levels, prevalence, awareness, treatment, and control rates of hypertension, in addition to drug treatments in China. This is a country-specific analysis of 45 108 individuals, average age 51.4 (standard deviation 9.6) (35-70) years, enrolled between 2005 and 2009, from 70 rural and 45 urban communities in 12 provinces. Among 18 915 (41.9% overall population) hypertensive participants, 7866 (41.6%) were aware, 6503 (34.4%) treated but only 1545 (8.2%) controlled. Prevalence of hypertension was higher, but awareness, treatment, and control were lower in rural than urban residents. Prevalence of hypertension was highest in eastern (44.3%), intermediate in central (39.3%), and lowest in western regions (37.0%). Awareness was higher in central (44.3%) and eastern (42.4%) but lower in western regions (37.0%). Similar patterns were observed in treatment rates, 37.7% central, 35.2% eastern, and 26.7% in western regions with control rates of 8.3% in eastern, 7.6% central, and 5.3% west regions. Of 4744 participants receiving documented treatments, 37.5% received traditional combination drugs alone, 55.4% western drugs alone and 7.1% combination of traditional combination drug in addition to western drugs. In China, hypertension is common, and while recent studies suggest some improvements, more than half of affected individuals were unaware that they had hypertension. Rates of control remain low. National programs effective in preventing and controlling hypertension in China are urgently needed.

Metabolomics and its application to the evaluation of the efficacy and toxicity of traditional Chinese herb medicines.

Traditional Chinese herb medicines (TCHMs) have been used in the treatment of a variety of diseases for thousands of years in Asian countries. The active components of TCHMs usually exert combined synergistic therapeutic effects on multiple targets, but with less potential therapeutic effect based on routine indices than Western drugs. These complex effects make the assessment of the efficacy of TCHMs and the clarification of their underlying mechanisms very challenging, and therefore hinder their wider application and acceptance. Metabolomics is a crucial part of systems biology. It allows the quantitative measurement of large numbers of the low-molecular endogenous metabolites involved in metabolic pathways, and thus reflects the fundamental metabolism status of the body. Recently, dozens of metabolomic studies have been devoted to prove the efficacy/safety, explore the underlying mechanisms, and identify the potential biomarkers to access the action targets of TCHMs, with fruitful results. This article presents an overview of these studies, focusing on the progress made in exploring the pharmacology and toxicology of various herbal medicines.

Interactions between traditional Chinese medicine and western drugs in Taiwan: A population-based study

BackgroundDrug–drug interactions have long been an active research area in clinical medicine. In Taiwan, however, the widespread use of traditional Chinese medicines (TCM) presents additional complexity to the topic. Therefore, it is important to see the interaction between traditional Chinese and western medicine. Objective(1) To create a comprehensive database of multi-herb/western drug interactions indexed according to the ways in which physicians actually practice and (2) to measure this database's impact on the detection of adverse effects between traditional Chinese medicine compounds and western medicines. MethodsFirst, a multi-herb/western medicine drug interactions database was created by separating each TCM compound into its constituent herbs. Each individual herb was then checked against an existing single-herb/western drug interactions database. The data source comes from the National Health Insurance research database, which spans the years 1998–2011. This study estimated the interaction prevalence rate and further separated the rates according to patient characteristics, distribution by county, and hospital accreditation levels. Finally, this new database was integrated into a computer order entry module of the electronic medical records system of a regional teaching hospital. The effects it had were measured for two months. ResultsThe most commonly interacting Chinese herbs were Ephedrae Herba and Angelicae Sinensis Radix/Angelicae Dahuricae Radix. Ephedrae Herba contains active ingredients similar to in ephedrine. 15 kinds of traditional Chinese medicine compounds contain Ephedrae Herba. Angelicae Sinensis Radix and Angelicae Dahuricae Radix contain ingredients similar to coumarin, a blood thinner. 9 kinds of traditional Chinese medicine compounds contained Angelicae Sinensis Radix/Angelicae Dahuricae Radix. In the period from 1998 to 2011, the prevalence of herb–drug interactions related to Ephedrae Herba was 0.18%. The most commonly prescribed traditional Chinese compounds were MA SHING GAN SHYR TANG (23.1%), followed by SHEAU CHING LONG TANG (15.5%) and DINQ CHUAN TANG (13.2%). The prevalence of herb–drug interactions related to Angelicae Sinensis Radix, Angelicae Dahuricae Radix was 4.59%. The most common traditional Chinese compound formula were TSANG EEL SAAN (32%), followed by HUOH SHIANG JENQ CHIH SAAN (31.4%) and SHY WUH TANG (10.7%).Once the multi-herb drug interaction database was deployed in a hospital system, there were 480 prescriptions that indicated a TCM–western drug interaction. Physicians were alerted 24 times during two months. These alerts resulted in a prescription change four times (16.7%). ConclusionDue to the unique cultural factors that have resulted in widespread acceptance of both western and traditional Chinese medicine, Taiwan stands well positioned to report on the prevalence of interactions between western drugs and traditional Chinese medicine and devise ways to reduce their incidence. This study built a multi-herb/western drug interactions database, embedded inside a hospital clinical information system, and then examined the effects that drug interaction alerts had on clinician prescribing behaviour. The results demonstrated that western drug/traditional Chinese medicine interactions are prevalent and that western-trained physicians tend to change their prescribing behaviour more than traditional Chinese medicine physicians in their response to medication interaction alerts.

Affordable health technology assessment in Taiwan: A model for middle-income countries.

Taiwan achieved the goal of providing universal health care coverage by launching the National Health Insurance (NHI) program in 1995. Covering 99.9% of the population, including prison inmates, the NHI provides patients access to health care ranging from Western drugs and procedures to traditional Chinese medicine. The initiative was ahead of its time, with the World Health Assembly (WHA), the decision-making body of the World Health Organization, passing resolution WHA58.33, which urges states to develop health financing systems as part of efforts to provide universal health coverage, in 2005. Among other things, WHA58.33 calls for universal health care systems to provide equal access to health resources. Treatment must be affordable to all, and this puts pressure on health care systems to control costs. Taiwan began conducting health technology assessments (HTAs) to determine the suitability of new drugs within the financial context of the NHI program in 2007 by launching an HTA working group in the Center for Drug Evaluation. HTAs were extended to medical devices in 2011 and to medical services in 2014. All these assessments are used to support the NHI Administration (NHIA) for reimbursement decisions.

Chinese herbal therapy and Western drug use, belief and adherence for hypertension management in the rural areas of Heilongjiang province, China.

BackgroundTraditional Chinese medicine (TCM) including Chinese herbal therapy has been widely practiced in China. However, little is known about Chinese herbal therapy use for hypertension management, which is one of the most prevalent chronic conditions in China. Thus we described Chinese herbal therapy and western drug users, beliefs, hypertension knowledge, and Chinese herbal and western drug adherence and determinants of Chinese herbal therapy use among patients with hypertension in rural areas of Heilongjiang Province, China.Methodology and Principal FindingsThis face-to-face cross sectional survey included 665 hypertensive respondents aged 30 years or older in rural areas of Heilongjiang Province, China. Of 665 respondents, 39.7% were male, 27.4% were aged 65 years or older. At the survey, 14.0% reported using Chinese herbal therapy and 71.3% reported using western drug for hypertension management. A majority of patients had low level of treatment adherence (80.6% for the Chinese herbal therapy users and 81.2% for the western drug users). When respondents felt that their blood pressure was under control, 72.0% of the Chinese herbal therapy users and 69.2% of the western drug users sometimes stopped taking their medicine. Hypertensive patients with high education level or better quality of life are more likely use Chinese herbal therapy.Conclusions and SignificanceMajority of patients diagnosed with hypertension use western drugs to control blood pressure. Chinese herbal therapy use was associated with education level and quality of life.

Are adaptive randomised trials or non-randomised studies the best way to address the Ebola outbreak in west Africa?

The Ebola outbreak that has devastated parts of west Africa represents an unprecedented challenge for research and ethics. Estimates from the past three decades emphasise that the present effort to contain the epidemic in the three most affected countries (Guinea, Liberia, and Sierra Leone) has been insufficient, with more than 24 900 cases and about 10 300 deaths, as of March 25, 2015. Faced with such an exceptional event and the urgent response it demands, the use of randomised controlled trials (RCT) for Ebola-related research might be both unethical and infeasible and that potential interventions should be assessed in non-randomised studies on the basis of compassionate use. However, non-randomised studies might not yield valid conclusions, leading to large residual uncertainty about how to interpret the results, and can also waste scarce intervention-related resources, making them profoundly unethical. Scientifically sound and rigorous study designs, such as adaptive RCTs, could provide the best way to reduce the time needed to develop new interventions and to obtain valid results on their efficacy and safety while preserving the application of ethical precepts. We present an overview of clinical studies registered at present at the four main international trial registries and provide a simulation on how adaptive RCTs can behave in this context, when mortality varies simultaneously in either the control or the experimental group.

Reducing drug-herb interaction risk with a computerized reminder system.

BackgroundTraditional Chinese medicine (TCM) and Western medicine are both popular in Taiwan. Approximately 14.1% of Taiwanese residents use Western drugs and Chinese herbs concurrently; therefore, drug–herb interaction is critical to patient safety. This paper presents a new procedure for reducing the risk of drug interactions.MethodsHospital computer systems are modified to ensure that drug–herb interactions are automatically detected when a TCM practitioner is writing a prescription. A pop-up reminder appears, warning of interactions, and the practitioner may adjust doses, delete herbs, or leave the prescription unchanged. A pharmacist will receive interaction information through the system and provide health education to the patient.ResultsDuring the 2011–2013 study period, 256 patients received 891 herbal prescriptions with potential drug–herb interactions. Three of the 50 patients who concurrently used ginseng and antidiabetic drugs manifested hypoglycemia (fasting blood sugar level ≤70 mg/dL).ConclusionDrug–herb interactions can cause adverse reactions. A computerized reminder system can enable TCM practitioners to reduce the risk of drug–herb interactions. In addition, health education for patients is crucial in avoiding adverse reaction by the interactions.

Clinical Practice Guideline of Acupuncture for Bell’s Palsy

Backgroud: Acupuncture is common used for Bell’s palsy in clinic, however, recent systematic reviews all shows that there is no sufficient evidence to support the effectiveness of acupuncture for Bell’s palsy because ofthe poor quality and heterogeneity. It’s urgently necessary to develop a guideline of acupuncture for Bell’s palsy based on principles of evidence-based medicine to optimize acupuncture treating, standardize outcomes evaluating and to improve the quality of acupuncture for patients with Bell’s palsy under general circumstances. Objective: To improve the accuracy of diagnosing and managing Bell’s palsy, optimize acupuncture treating and outcomes evaluating for patients with Bell’s palsy, and to improve the quality of acupuncture for patients with Bell’s palsy in most instances. Methods: This guideline was developed using an explicit and transparent a priori protocol based on supporting evidences and experts’ consensus. The guideline developing Group followed the protocol through all stages of the development process: proposed clinical questions, searched clinical evidences, evaluated levels of evidences, developed recommendations, peer reviewed and consummated, and finally formed the draft of this guideline. Results: (1)The guideline development group made a Grade A recommendation that ①With a course of Bell’s palsy within 3 months, the patients with mild facial palsy may be treated with any one of acupuncture, western drugs, or acupuncture combing with western drugs, whereas the patients with severe facial palsy may be treated with acupuncture or acupuncture combing with western drugs. With a course of more than 3 months, acupuncture is more suitable. ②Acupuncture should be applied as early as possible for Bell’s palsy. ③The principle of selecting acupoints for Bell’s palsy is to select local points, points of corresponding meridians and those according to differentiation. Generally, the points of yangming meridians are the main ones. ④The various methods of acupuncture and moxibustion are adopted for Bell’s palsy, including filiform needling, moxibustion, electro-acupuncture, etc. Two or more methods are usually used together in clinical practice. (2) The development group formed expert consensus on the principles of acupuncture treatment for Bell’ palsy. Bell’s palsy is suitably treated according to the stages, differentiation and symptoms.

Herb-drug interactions: systematic review, mechanisms, and therapies.

Since the use of herbs in daily life has become quite prevalent, issues of the safety of coadministration of such products together with Western medicines should be brought into attention. Although the pharmacokinetics and pharmacodynamics of Western medicines are well-known, the activities of any coadministered herbal products have not been well studied due to their complex components and variability. Most reports on drug-drug or herb-drug interactions focus more on pharmacokinetics than on the pharmacodynamics. However, both effects cannot be ignored in practice, especially for interactions that may occur between a single component Western medicine and a multicomponent herbal product. Herb-drug interactions are essential considerations that need to be addressed by undertaking high quality scientific research and conducting thorough systematic literature reviews. Since our call for submission in January 2014, this special issue on has attracted over forty papers worldwide, ranging from reviews and preclinical research studies to clinical investigations. The ten final accepted articles cover the topics of (1) systematic reviews on the herb-drug interactions of clinically well-known narrow therapeutic index drugs, (2) recent method development and mechanistic studies on herb-drug interactions, and (3) clinical outcomes for commonly seen combination use of herbs and drugs. The five review papers from S. Mogami and T. Hattori, B. Ge et al., Y. K. Fong et al., S. Chen et al., and D. S. Kiefer et al. provided comprehensive updates on the interactions between herbs and Western drugs in the therapeutic areas ranging from oncology, gastrointestinal, and cardiovascular to central nervous system, among which the article entitled “Interaction of carbamazepine with herbs, dietary supplement, and food: a systematic review” was featured on http://www.mdlinx.com/ and selected as number 2 on the nursing site at http://www.mdlinx.com/nursing/news-article.cfm/4784813. Other three articles from Q. Chang et al., A. C. Muller et al., and F. Qiu et al., demonstrated the current advanced approaches for the clinical investigations of herb-drug interactions with emphasis on simultaneous monitoring of both pharmacokinetic and pharmacodynamic changes. The two articles by G. Wu and L. Huang et al. illustrated the current innovative mechanistic approaches in studying herb-drug interactions. We are of the opinion that the current special issue not only highlights the most updated research tools available in the investigation of herb-drug interaction, but also provides some essential skills for the healthcare researchers and practitioners to solve some relevant issues they may encounter in this field. Zhong Zuo Min Huang Isadore Kanfer Moses S. S. Chow William C. S. Cho

Herb Network Analysis for a Famous TCM Doctor's Prescriptions on Treatment of Rheumatoid Arthritis.

Traditional Chinese Medicine (TCM) doctors always prescribe various herbal formulae tailored to individual patients. However, there is still a lack of appropriate methods to study the rule and potential biological basis underlying the numerous prescriptions. Here we developed an Herb-Compound-Target-Disease coherent network approach to analyze 871 herbal prescriptions from a TCM master, Mr. Ji-Ren Li, in his clinical practice on treatment of rheumatoid arthritis (RA). The core herb networks were extracted from Mr. Li's prescriptions. Then, we predicted target profiles of compounds in core herb networks and calculated potential synergistic activities among them. We further found that the target sets of core herbs overlapped significantly with the RA related biological processes and pathways. Moreover, we detected a possible connection between the prescribed herbs with different properties such as Cold and Hot and the Western drugs with different actions such as immunomodulatory and hormone regulation on treatment of RA. In summary, we explored a new application of TCM network pharmacology on the analysis of TCM prescriptions and detected the networked core herbs, their potential synergistic and biological activities, and possible connections with drugs. This work offers a novel way to understand TCM prescriptions in clinical practice.

Drug Access Is Improved By The Essential Drug System And "Low-Priced Drug" Policy In China.

(1) Since 2009 China had implemented national essential drug system, and issued first and second edition of NEDL (National Essential Drugs List) respectively in 2009 and 2013, which respectively covered 307 drugs and 520 drugs. (2) With development of Chinese health care reform, planning low-priced drug policy and adjusted essential drug system will impact on drug access. To describe Chinese policies’ development for promoting drug access, analyze the policies’ impact and potential lacks. Through collecting relevant policies from national departments and 31 provinces, apply descriptive statistics and comparison to summarize these policies’ impact. (1) On May 2013 China NHFPC had released the second edition of NEDL, which increased to 520 drugs and allowed all provinces to implement after appropriate addition. Until the end of February 2014, nine provinces in China had supplemented average 251 drugs (average 121 western medicines and 130 TCM) on the basis of 520 drugs. The most was 535 in Xinjiang and the least is 57 in Gansu. (2) Meanwhile, China NDRC was planning to introduce low-priced drug list covering 890 drugs, the price control of which will be released if average daily cost is less than 3 RMB for western drugs or 5 RMB for TCM. (3) On February 27,2014 Guangdong province had released “low-priced drugs list of non-essential drugs” including 1103 drugs, then plus essential drugs in the province, relatively cheap drugs that patients could afford are theoretically up to 1902. (1) These two policies had provided quantitatively safeguard for patients access to relatively cheap drugs close to 2,000. (2) Chinese “parallel development” policy for TCM and Western Medicine will be insisted on for a long term. (3) It needs more scientific mechanism designed to avoid the lacks of“double envelop”tendering and distortion of doctors’ income.

Real-world analysis of concurrent diseases and medicine use among patients with insomnia

This study aims to explore and analyze the condition of concurrent diseases and medicine use of traditional Chinese medicine (TCM) and western medicine among the patients with insomnia. One thousand and sxity seven cases of data from 20 national hospitals' hospital information system (HIS) databases were collected. The frequent concurrent diseases included hypertension (26.9%), brain blood supply insufficiency (24.93%), cerebral infarction (19.49%), blood lipoprotein disturbance (15.28%), coronary heart disease (14.15%), headache (10.68%), chronic gastritis (8.81%), type 2 diabetes mellitus (7.87%), depressive disorder (7.4%) and anxiety disorder (6.65%). The 10 most frequently-used western drugs included alprazolam (35.99%), aspirin (25.4%), olanzapine (24.18%), cinepazide (23.06%), flupentixol & melitracen (18.74%), zolpidem (18.37%), oxiracetam (15.65%), estazolam (15%), aniracetam (13.4%) and piracetam (13.31%). The 10 most frequently-used TCM included Shuxuening injection (16.4%), Shuxuetong injection (15.18%), extract of ginkgo biloba leaf (14.71%), gastrodin (12.46%), Dengzanxixin injection (11.34%), Xueshuantong (8.53%), Danhong injection (6.37%), compound liquorice tablet (5.81%), Sanqi Tongshu capsule (5.72%) and sowthistle-leaf ixeridium injection (5.34%). Among all combined uses, the most frequent western drug use was alprazolam and olanzapine, while combined use of hypnotic drug and Huoxuehuayu formula is the most frequent. This study concludes that the concurrent diseases mainly include cardio-cerebrovascular diseases, metabolic disorders and anxiety-depression disorders, with increasing tendency of diseases types by ages, especially for cardio-cerebrovascular diseases. The most frequently-used hypnotic is alprazolam in the insomnia patients, and it is worth being concerned about the off-label use of olanzapine as an antipsychotic for the treatment of insomnia However, due to the fact that all cases data are from the inpatients, these findings have some limitations.

Target network differences between western drugs and Chinese herbal ingredients in treating cardiovascular disease.

BackgroundWestern drugs have achieved great successes in CVDs treatment. However, they may lead to some side effects and drug resistance. On the other hand, more and more studies found that Traditional Chinese herbs have efficient therapeutic effects for CVDs, while their therapeutic mechanism is still not very clear. It may be a good view towards molecules, targets and network to decipher whether difference exists between anti-CVD western drugs and Chinese herbal ingredients.ResultsAnti-CVD western drugs and Chinese herbal ingredients, as well as their targets were thoroughly collected in this work. The similarities and the differences between the herbal ingredients and the western drugs were deeply explored based on three target-based perspectives including biochemical property, regulated pathway and disease network. The biological function of herbal ingredients' targets is more complex than that of the western drugs' targets. The signal transduction and immune system associated signaling pathways, apoptosis associated pathways may be the most important pathway for herbal ingredients, however the western drugs incline to regulate vascular smooth muscle contraction associated pathways. Chinese herbal ingredients prefer to regulate the downstream proteins of apoptosis associated pathway; while the western drugs incline to regulate the upstream proteins of VECC (Vascular Epidermal Cells Contraction) related pathways.ConclusionIn summary, the characteristics identified in this study would be valuable for designing new network-based multi-target CVD drugs or vaccine adjuvants.

ICoVax 2013: the 3rd ISV Pre-conference Computational Vaccinology Workshop.

Following last year's computational vaccinology workshop in Shanghai, China, the third ISV Pre-conference Computational Vaccinology Workshop (ICoVax 2013) was held in Barcelona, Spain. ICoVax 2013 provided an international platform for the attendees to showcase their research and discuss problems and solutions in the development and application of computational vaccinology and vaccine informatics tools. The first of the three full-length papers presented at ICoVax discussed the discovery of viral "camouflage" through cross-conservation of T-cell epitopes using a tool called JanusMatrix. This important paper reports that viruses may camouflage their presence in the human body by incorporating sequences in their proteins that are highly cross-conserved at the T-cell receptor surface with human genome proteins, a discovery that has wide ranging implications for the development of vaccines against viruses that use the camouflage method. The other papers described a database for storing experimentally verified data on DNA vaccines and compared therapeutic targets of western drugs to Chinese herbal medicines for cardiovascular diseases. The short poster presentations covered various uses of informatics tools for processing the DNA and microRNA of pathogens to improve vaccine coverage, efficacy and development. A live (on-line) demonstration of the vaccine design toolkit, iVax, presented by Frances Terry of EpiVax, illustrated how computational vaccinology could be used in the design of next generation vaccines.

Beneficial effects of rikkunshito, a Japanese kampo medicine, on gastrointestinal dysfunction and anorexia in combination with Western drug: a systematic review.

Background. Kampo medicines are traditional herbal medicines which have been approved for medicinal use by the Japanese Ministry of Health and Welfare and are currently being used more and more, often in combination with Western drugs. Thus, the need for investigation of interactions between Kampo medicines and Western drugs is now widely recognized. Aim. To summarize the effects and drug interactions of rikkunshito, a Kampo medicine often prescribed for upper gastrointestinal disorders and anorexia. Methods. Animal and human studies were systematically reviewed to identify published data on rikkunshito. Results describing its effects were abstracted, with an emphasis on drug interactions. Results and Discussion. Rikkunshito ameliorates anorexia induced by anticancer drugs, improves quality of life scores, and can even prolong survival compared with monotherapy. Rikkunshito combined with proton pump inhibitor therapy is shown to be useful in the treatment of PPI-refractory gastroesophageal reflux disease patients and patients with gastrointestinal symptoms after endoscopic submucosal dissection. Rikkunshito reduces antidepressant-induced adverse events and improves quality of life without influencing antidepressant effects. Conclusions. Rikkunshito shows ameliorative effects on adverse reactions induced by various Western drugs and can achieve better results (e.g., anticancer drugs and proton pump inhibitor) without influencing the efficacy and bioavailability of Western drugs.

Identification and early diagnosis for traditional Chinese medicine-induced liver injury based on translational toxicology

Recently traditional Chinese medicine (TCM)-induced liver injury has been an unresolved critical issue which impacts TCM clinical safety. The premise and key step to reduce or avoid drug-induced liver injury (DILI) is to identify the drug source of liver injury in early stage. Then the timely withdrawal of drug and treatment can be done. However, the current diagnosis of DILI is primarily governed by exclusive method relying on administering history supplied by patients and experience judgment from doctors, which lacks objective and reliable diagnostic indices. It is obvious that diagnosis of TCM-induced liver injury is especially difficult due to the complicated composition of TCM medication, as well the frequent combination of Chinese and Western drugs in clinic. In this paper, we proposed construction of research pattern and method for objective identification of TCM-related DILI based on translational toxicology, which utilizes clinical specimen to find specific biomarkers and characteristic blood-entering constituents, as well the clinical biochemistry and liver biopsy. With integration of diagnosis marker database, bibliographic database, medical record database and clinical specimen database, an integrative diagnosis database for TCM-related DILI can be established, which would make a transformation of clinical identification pattern for TCM-induced liver injury from subjective and exclusive to objective and index-supporting mode. This would be helpful to improve rational uses of TCM and promote sustainable development of TCM industry.

A review on the traditional Chinese medicinal herbs and formulae with hypolipidemic effect.

Hyperlipidemia, characterized by the abnormal blood lipid profiles, is one of the dominant factors of many chronic diseases such as diabetes, obesity, and cardiovascular diseases (CVD). For the low cost, effectiveness, and fewer side effects, the popularity of using traditional Chinese medicine (TCM) to handle hyperlipidemia is increasing and its role in health care has been recognized by the public at large. Despite the importance of TCM herbs and formulations, there is no comprehensive review summarizing their scientific findings on handling hyperlipidemia. This review summarizes the recent experimental and clinical results of nine representative single Chinese herbs and seven classic TCM formulae that could improve lipid profiles so as to help understand and compare their underlying mechanisms. Most of single herbs and formulae demonstrated the improvement of hyperlipidemic conditions with multiple and diverse mechanisms of actions similar to conventional Western drugs in spite of their mild side effects. Due to increasing popularity of TCM, more extensive, well-designed preclinical and clinical trials on the potential synergistic and adverse side effects of herb-drug interactions as well as their mechanisms are warranted. Hyperlipidemic patients should be warned about the potential risks of herb-drug interactions, particularly those taking anticoagulants and antiplatelet drugs.

한포열천(寒包熱喘)으로 진단된 천식환자 1례

Objectives : A 55-year-old male patient whose symptoms were not improved by western drugs(including steroids) was hospitalized in Korean medical hospital for 22 days. Methods : This patient was diagnosed as Han-po-yeol(寒包熱) and treated with herbal decoctions, acupuncture, and moxibustion. And he answered the quality of life questionnaire for adult Korean asthmatics (QLQAKA) at 1st, 15th, and 22th day of hospitalization. Results : After 2 weeks herbal medical treatment, score of QLQAKA was increased by 0.53 point. Conclusion : This result suggest that Korean medical treatment has the potential for asthma patients who did not responded to western drugs.

English

This study aimed to evaluate the clinical effects of YiShenTongMai decoction working with conventional Western drugs in patients with unstable angina complicated with glucose metabolism disorder. Seventy-six patients with unstable angina complicated with glucose metabolism disorder were randomly divided into two groups: 37 cases were allotted to the control group and were treated with conventional Western medicine; 39 cases were allotted to the experimental group treated with conventional Western medicine and YiShenTongMai decoction (Gold Theragran 20 g, Chinese yam 30 g, Milkvetch root 15 g, Bombyx mori 10 g, Allii macrostemi bulbus 10 g, Cassiac torae 30 g, huai Achyranthis radix 15 g, notoginseng powder 3 g, Pheretima asiatica 15g, Chinese hawthorn 10 g and water 370 ml). The effect of treatment was studied on the indices of electrocardiogram, traditional Chinese medicine (TCM) syndromes, fibrinogen (FIB), C-reactive protein (CRP) levels, standard deviation of Normal-Normal (SDNN), and left ventricular diastolic function (E/A) ratio. There was a significant difference with regards to clinical manifestation improvement in angina control between the experimental group and the control group (94.9% versus 75.7%, P < 0.05), as well as in the electrocardiogram profile (84.6% versus 59.5%, P < 0.05) and syndrome integral (94.9% versus 70.3%, P < 0.05). FIB and CRP decreased while SDNN and E/A increased in both groups but was much higher in the experimental group (P < 0.05). The curative effect of combined YiShenTongMai decoction and Western medicine was better than Western medicine alone in patients with unstable angina complicated with glucose metabolism disorder patients. Key words: Unstable angina, glucose metabolism disorder, YiShenTongMai decoction.

Differential immunomodulatory effects by Tripterygium wilfordii Hook f-derived refined extract PG27 and its purified component PG490 (triptolide) in human peripheral blood T cells: potential therapeutics for arthritis and possible mechanisms explaining in part Chinese herbal theory “Junn-Chenn-Zuou-SS”

BackgroundFor thousands of years, it remains unclear why Chinese prefer complex herbal remedy and seldom try to purify it. One of the reasons is that they believe Chinese herbs compared to Western drugs are relatively less toxic and better tolerated. The so called “Junn-Chenn-Zuou-SS” theory illustrates a concept of coordinated effects from a combination of different Chinese herbs. PG27, a refined extract from a well-known Chinese antirheumatic herb Tripterygium wilfordii Hook f (TwHf), is effective in attenuating transplantation rejection and extending survival of cardiac xenografts.MethodsExperiments were conducted in human primary T lymphocytes isolated from buffy coat. The activities of the inhibitor of kappaB alpha kinase-inhibitor of kappaB alpha-nuclear factor kappaB (IKK-IκBα-NF-κB) and mitogen activated protein kinase-activator protein-1 (MAPK-AP-1) signaling pathways were determined via electrophoretic mobility shift assays, immunoprecipitation kinase assays, Western blots, and transfection assays.ResultsWe showed that PG27 inhibited IKKα-IκBα-NF-κB and MAPK-AP-1 signaling pathways; however, IKKβ activity was less susceptible to inhibition by PG27. In contrast, the purified component of TwHf, PG490 (triptolide), reduced both MAPK-AP-1 and IKK-IκBα-NF-κB signaling pathways, including both IKKα and IKKβ, with similar potency. By means of high performance liquid chromatography analysis, it was estimated that PG490 constituted 1.27 ± 0.06% of the total PG27 content. Further analysis demonstrated that compared to PG490 alone, PG27 that contained an equal amount of PG490 was less toxic and less immunosuppressive, suggesting the presence of cytoprotective ingredient(s) in the non-PG490 components of PG27.ConclusionsIn addition to demonstrating the immunomodulatory capacity of PG27 as the potential therapeutics for arthritis and prevention of transplantation rejection, the differential regulatory effects and mechanisms by PG27 and PG490 further support in part a possibly-existing Chinese herbal theory “Junn-Chenn-Zuou-SS”.