Pharmacokinetic herb–drug interactions with traditional Chinese medicine: progress, causes of conflicting results and suggestions for future research

Background: Traditional Chinese medicine (TCM) has been used for medical purposes since the ancient time and has gradually gained recognition worldwide. Nowadays, patients with thrombus presiding to anticoagulant/ antiplatelet drugs prefer taking TCM. However, an increasing number of studies on herb–drug interactions have been shown. Nevertheless, findings are frequently conflicting and vague. In this review, we discuss the herb–drug interactions between TCM and anticoagulant/antiplatelet drugs to provide guidance on concomitant ingestion with anticoagulant/antiplatelet drugs. Methods: We undertook a structured search of medicine and drug databases for peer-reviewed literature using focused review questions. Results: Danshen, Ginkgo, Ginger, H. Perforatum, SMY and Puerarin injection had directional regulation effects on the efficacy of anticoagulant drugs by altering the CYPs, pharmacokinetic indexs and hemorheological parameters. H. Perforatum inhibited the efficacy of Clopidogrel by enhancing the CYP3A4 activity and Ginkgo increased the efficacy of Ticlopidine. Additionally, Renshen, the formulae except SMY and injections except Puerarin injection could increase or decrease the efficacy of anticoagulant/antiplatelet drugs via regulating the CYPs, platelet aggregation, hemorheological parameters and others. Conclusion: Some cases have reported that TCMs may increase the bleeding risk or has no effect on coagulation when anticoagulant/antiplatelet drugs are concurrently used. However, pharmacokinetic studies have presented either consistent or slightly varying results. So it is difficult to ascertain whether the concurrent use of TCM may increase or reduce the pharmacologic effects of anticoagulant/antiplatelet drugs with adverse reactions. Therefore, herb–drug interactions of TCM and anticoagulant/antiplatelet drugs should be further explored and defined.

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Traditional Chinese medicine: herb-drug interactions with aspirin

Singapore Medical Journal ◽

10.11622/smedj.2018051 ◽

2018 ◽

Vol 59 (5) ◽

pp. 230-239 ◽

Cited By ~ 12

Author(s):

JW Lim ◽

SX Chee ◽

WJ Wong ◽

QL He ◽

TC Lau

Keyword(s):

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Drug Interactions

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An evidence mapping of systematic reviews and meta-analysis on traditional Chinese medicine for ulcerative colitis

BMC Complementary Medicine and Therapies ◽

10.1186/s12906-021-03387-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yu-Xin Sun ◽

Xiao Wang ◽

Xing Liao ◽

Jing Guo ◽

Wen-Bin Hou ◽

...

Keyword(s):

Ulcerative Colitis ◽

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Systematic Reviews ◽

Methodological Quality ◽

Route Of Administration ◽

Current Evidence ◽

Future Research ◽

Evidence Mapping

Abstract Background Traditional Chinese Medicine (TCM) has been a proposed treatment option for ulcerative colitis (UC), however it has been difficult to understand the breadth and depth of evidence as various Chinese medicine therapies may produce effects differently. The aim of this evidence mapping is to visually understand the available evidence in the use of TCM in the treatment of UC, and to identify gaps in evidence to inform priorities of future research. Methods A systematic electronic literature search of six databases were performed to identify systematic reviews (SRs) on different Chinese medicine therapies in the treatment in UC. Methodological quality of the included SRs was assessed using AMSTAR 2. Results The mapping was based on 73 SRs, which included nine interventions that met eligibility criteria. The quality of the included SRs was very low. The diseases stages of patients with UC varied greatly, from active to remission, to non-acute outbreak, to not reported. The results mostly favored the method of intervention. Oral administration combined with enema was the most widely used route of administration in secondary research. Conclusion Based on the current evidence, the treatment of UC with TCM can only be recommended cautiously. A majority of included SRs did not report the location of the disease, the disease classification, and the route of administration of the intervention. Further research is needed on the effectiveness of Chinese medicine alone in the treatment of UC. The effectiveness of combined Chinese and conventional medicine combined with different routes of administration cannot be confirmed. Attention should be paid to the methodological quality of the systematic review. Unifies the outcome indicators used in the evaluation of effectiveness.

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Research Advance on Qingfei Paidu Decoction in Prescription Principle, Mechanism Analysis and Clinical Application

Frontiers in Pharmacology ◽

10.3389/fphar.2020.589714 ◽

2021 ◽

Vol 11 ◽

Author(s):

Wei Ren ◽

Yue Ma ◽

Raoqiong Wang ◽

Pan Liang ◽

Qin Sun ◽

...

Keyword(s):

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Clinical Application ◽

Future Research ◽

Mechanism Analysis ◽

The Novel ◽

Global Epidemic ◽

State Administration ◽

Tcm Theory ◽

Novel Coronavirus

Since the sudden epidemic of coronavirus disease 2019 (COVID-19), the State Administration of Traditional Chinese Medicine immediately organized experts to formulate and screen the effective prescriptions of traditional Chinese medicine according to the characteristics of the novel coronavirus infection. Qingfei Paidu decoction (QFPDD) has been proven to be effective in multi-provincial clinical trials, and has been selected as a general prescription for the treatment of COVID-19 in different stages that was later promoted to be used nationwide. This review highlights the latest advances of QFPDD, focusing on the TCM theory, mechanism analysis, clinical application of QFPDD and its future perspectives. Moreover, an in-depth discussion of some valuable issues and possible development for future research on QFPDD is also discussed, aiming to provide a novel guide to combat the global epidemic COVID-19.

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Case Series: Refractory Cases of Hyper-serum IgE Achieve Transformative Decrease by TCM Therapy

10.21203/rs.3.rs-235076/v1 ◽

2021 ◽

Author(s):

Johnathan Neshiwat ◽

Tory Mcknight ◽

Serife Uzun ◽

Paul Ehrlich ◽

Danna Chung ◽

...

Keyword(s):

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Pediatric Population ◽

Case Series ◽

Food Allergies ◽

Future Research ◽

Hypersensitivity Reactions ◽

Safe Alternative ◽

Serum Ige ◽

Ige Mediated

Abstract Background:Chronic conditions from IgE-mediated hypersensitivity reactions affect over 150 million Americans, but affordable and effective treatment options remain largely unavailable to the pediatric population. Traditional Chinese medicine has been shown to reduce IgE levels in refractory cases of hyper-serum IgE and have transformative effects in pediatric patients with chronic allergic inflammation.Presentation:Here we present ten patients with chronic atopic conditions and refractory hyper-serum IgE who were treated with TCM therapy. The patients had at least two atopic conditions as well as multiple allergic sensitivities to foods and environmental allergens: all of the patients presented with food allergies (FA) and atopic dermatitis (AD), 60% of patients presented with an environmental allergy (EA), 40% of patients presented with asthma (AS), 10% had celiac disease (Celiac), and 10% had eosinophilic esophagitis (EoE). All of the affected patients had IgE levels greater than 5,000kIU/L (normal =300kIU/L) prior to treatment. None of the patients had an IgE of greater than 5,000kIUL after treatment. We treated 10 children with IgE-mediated hypersensitivity reactions using topical and oral TCM and found an average reduction of 3,723kIU/L IgE per patient (p=0.01) or 79%. Conclusion:We present a ten-patient case series on the effective lowering of hyper-serum IgE using Traditional Chinese Medicine in otherwise refractory pediatric cases of chronic atopic inflammation. TCM is an affordable and safe alternative for chronic atopic conditions compounded with hyper-serum IgE. Future research via random controlled trials should be used to test the efficacy of TCM.

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Acupuncture for Hot Flashes in Cancer Patients: Clinical Characteristics and Traditional Chinese Medicine Diagnosis as Predictors of Treatment Response

Integrative Cancer Therapies ◽

10.1177/1534735419848494 ◽

2019 ◽

Vol 18 ◽

pp. 153473541984849 ◽

Cited By ~ 6

Author(s):

Wenli Liu ◽

Aiham Qdaisat ◽

Gabriel Lopez ◽

Santhosshi Narayanan ◽

Susan Underwood ◽

...

Keyword(s):

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Treatment Response ◽

Cancer Patients ◽

Hot Flashes ◽

Final Analysis ◽

Symptom Assessment ◽

Patient Characteristics ◽

Future Research ◽

Edmonton Symptom Assessment Scale

Background: Acupuncture is a recognized integrative modality for managing hot flashes. However, data regarding predictors for response to acupuncture in cancer patients experiencing hot flashes are limited. We explored associations between patient characteristics, including traditional Chinese medicine (TCM) diagnosis, and treatment response among cancer patients who received acupuncture for management of hot flashes. Methods: We reviewed acupuncture records of cancer outpatients with the primary reason for referral listed as hot flashes who were treated from March 2016 to April 2018. Treatment response was assessed using the hot flashes score within a modified Edmonton Symptom Assessment Scale (0-10 scale) administered immediately before and after each acupuncture treatment. Correlations between TCM diagnosis, individual patient characteristics, and treatment response were analyzed. Results: The final analysis included 558 acupuncture records (151 patients). The majority of patients were female (90%), and 66% had breast cancer. The median treatment response was a 25% reduction in the hot flashes score. The most frequent TCM diagnosis was qi stagnation (80%) followed by blood stagnation (57%). Older age ( P = .018), patient self-reported anxiety level ( P = .056), and presence of damp accumulation in TCM diagnosis ( P = .047) were correlated with greater hot flashes score reduction. Conclusions: TCM diagnosis and other patient characteristics were predictors of treatment response to acupuncture for hot flashes in cancer patients. Future research is needed to further explore predictors that could help tailor acupuncture treatments for these patients.

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Association Between Acupoint Selection, Target Symptoms, and Traditional Chinese Medicine Diagnosis in Real-Time Clinical Practice in a Comprehensive Cancer Center

Integrative Cancer Therapies ◽

10.1177/1534735420928490 ◽

2020 ◽

Vol 19 ◽

pp. 153473542092849 ◽

Cited By ~ 1

Author(s):

Wenli Liu ◽

Aiham Qdaisat ◽

Gabriel Lopez ◽

Santhosshi Narayanan ◽

Susan Underwood ◽

...

Keyword(s):

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Symptom Control ◽

Hot Flashes ◽

Final Analysis ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Future Research ◽

Acupuncture Intervention ◽

Acupuncture Research

Background: Acupuncture intervention in actual practice is rarely reported and may be different from that applied in acupuncture research. Objectives: To review acupuncture practice in an integrative medicine clinic and characterize the association between targeted symptoms, traditional Chinese medicine (TCM) diagnosis, and acupoint selection. Methods: We reviewed outpatient acupuncture records from March 2016 to April 2018. Statistical analyses were applied to characterize referral symptoms and associated TCM diagnosis as well as acupoint selection. Results: The final analysis included 5393 acupuncture records (1264 patients). Twelve TCM diagnosis components were identified in the referral symptoms of pain, neuropathy, xerostomia, and hot flashes. Pain was associated with 78 different TCM diagnoses (combinations of TCM diagnosis components). Total of 217 different acupoints were used in the acupuncture treatments (1739) for neuropathy. The acupoint yintang was used in 73.8% of the visits for neuropathy, yet only in 26.5% ( P < .001) of the treatments when patients had a TCM diagnosis of qi deficiency, qi stagnation, and blood stagnation. Similarly, both consistencies and variations were seen in acupoint selection with each targeted symptom and its associated TCM diagnoses. Conclusions: TCM diagnosis was not homogeneous among acupuncture treatments for a single referral symptom. In contrast to most of the research on acupuncture for symptom control, there were considerable variations in acupoint selection among treatments for the same symptom in a clinical setting. Future research is needed to examine the clinical relevance of a fixed intervention structure in acupuncture research and the value of individualized acupuncture treatment.

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Unraveling the Molecular Mechanism of Traditional Chinese Medicine: Formulas Against Acute Airway Viral Infections as Examples

Molecules ◽

10.3390/molecules24193505 ◽

2019 ◽

Vol 24 (19) ◽

pp. 3505 ◽

Cited By ~ 9

Author(s):

Yi Shin Eng ◽

Chien Hsing Lee ◽

Wei Chang Lee ◽

Ching Chun Huang ◽

Jung San Chang

Keyword(s):

Chinese Medicine ◽

Herbal Medicine ◽

Traditional Chinese Medicine ◽

Adverse Effects ◽

Drug Interactions ◽

Clinical Studies ◽

Molecular Mechanisms ◽

Viral Infections ◽

Herbal Medicines ◽

Clinical Effects

Herbal medicine, including traditional Chinese medicine (TCM), is widely used worldwide. Herbs and TCM formulas contain numerous active molecules. Basically, they are a kind of cocktail therapy. Herb-drug, herb-food, herb-herb, herb-microbiome, and herb-disease interactions are complex. There is potential for both benefit and harm, so only after understanding more of their mechanisms and clinical effects can herbal medicine and TCM be helpful to users. Many pharmacologic studies have been performed to unravel the molecular mechanisms; however, basic and clinical studies of good validity are still not enough to translate experimental results into clinical understanding and to provide tough evidence for better use of herbal medicines. There are still issues regarding the conflicting pharmacologic effects, pharmacokinetics, drug interactions, adverse and clinical effects of herbal medicine and TCM. Understanding study validation, pharmacologic effects, drug interactions, indications and clinical effects, adverse effects and limitations, can all help clinicians in providing adequate suggestions to patients. At present, it would be better to use herbs and TCM formulas according to their traditional indications matching the disease pathophysiology and their molecular mechanisms. To unravel the molecular mechanisms and understand the benefits and harms of herbal medicine and TCM, there is still much work to be done.

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Traditional Chinese Medicine in Neuroprotection after Brain Insults with Special Reference to Radioprotection

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2018/2767208 ◽

2018 ◽

Vol 2018 ◽

pp. 1-14 ◽

Cited By ~ 1

Author(s):

Xiao Chun Peng ◽

Jiang Rong Huang ◽

Si Wei Wang ◽

Lian Liu ◽

Zhen Zhen Liu ◽

...

Keyword(s):

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Radiation Exposure ◽

Power Plants ◽

Clinical Medicine ◽

Health Effect ◽

Radioprotective Effect ◽

Future Research ◽

Neuroprotective Effects ◽

Functional Changes

With rapidly increased construction of nuclear power plants worldwide to reduce energy shortage and subsequent environment contamination, routine use of radiotherapy and radiodiagnosis equipment in the clinical medicine, the research on the health effect of radiation exposure has become a very important area to explore. Traditional Chinese Medicine (TCM) may be an ideal candidate therapy as it usually produces fewer side effects even with long-term administration. In this paper, we reviewed current therapeutic approaches to prevent radiation-induced brain neuropathological and functional changes. Neuroprotective effects of TCM in different brain injury models have been briefly summarized. We then reviewed the neuroprotective and radioprotective effect of TCM in different radiation exposure models and discussed the potential molecular mechanism(s) of the neuroprotective and radioprotective effect of TCM. The conclusions and future research directions were made in the last part of the paper.

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Constructing a fine-grained entity recognition corpus based on clinical records of Traditional Chinese Medicine

10.21203/rs.2.16418/v1 ◽

2019 ◽

Author(s):

tingting zhang ◽

Yaqiang Wang ◽

Xiaofeng Wang ◽

Yafei Yang ◽

Ying Ye

Keyword(s):

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Entity Recognition ◽

Future Research ◽

Step Method ◽

High Quality ◽

Fine Grained ◽

Corpus Construction ◽

Annotation Guideline ◽

Clinical Records

Abstract Objective ： In this paper, we focused on building a fine-grained entity annotation corpus with corresponding annotation guideline of Traditional Chinese Medicine ( TCM ) clinical records, and to provide an effective way to build more corpora of TCM clinical records in the future. Methods: Instead of previous research methods, we proposed four steps approach which is suitable for TCM medical records in our corpus construction work. Firstly, determine the entity types included in this study through sample annotation method; secondly, draft our fine-grained annotation guideline by summarizing the characteristics of the dataset and referring to some existing guidelines; thirdly, update the guideline through iterative annotations way until the inter-annotator agreement (IAA) value exceed 0.9, kappa value was used to measure the IAA; fourthly, comprehensive annotations were performed, if IAA value exceeds 0.9 stably . After above four method steps, we succeeded to construct the fine-grained entity recognition corpus of TCM clinical records. Results: There are 4 entity categories involving 13 entity types being determined finally. The fine-grained annotated entity corpus consists of 1104 entities and 67799 tokens totally. The final IAAs are 0.93, 0.94, 0.94 respectively (between two of the three annotators), the IAA value show the fine-grained entity recognition corpus are of high quality. We constructed a fine-grained annotated guideline and entity recognition corpus of TCM clinical records. Conclusions: The four-step method was of high quality, the corpus constructed in this study was an encouraging example . Based on this approach, more comprehensive corpus about TCM clinical records will be built to support the TCM named entity recognition tasks in future research.

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