Background
Methods
Data source
Study subjects
Statistical analysis
Results
Demographic characteristics of the TCM users with HC
Variable | Non-TCM | TCM | p value | ||
---|---|---|---|---|---|
N = 2876 (33.57 %) | N = 5691 (66.43 %) | ||||
n
| % |
n
| % | ||
Sex | <0.0001 | ||||
Female | 1148 | 39.92 | 3081 | 54.14 | |
Male | 1728 | 60.08 | 2610 | 45.86 | |
Age at baseline | <0.0001 | ||||
18−39 | 364 | 12.66 | 945 | 16.61 | |
40−64 | 1451 | 50.45 | 3395 | 59.66 | |
≥ 65 | 1061 | 36.89 | 1351 | 23.74 | |
Mean (STD) | 58.34 | 14.85 | 53.92 | 13.97 | |
Urbanizationa | <0.0001 | ||||
1 (highest) | 574 | 19.96 | 1215 | 21.35 | |
2 | 731 | 25.42 | 1652 | 29.03 | |
3 | 447 | 15.54 | 939 | 16.50 | |
4+ (lowest) | 1124 | 39.08 | 1885 | 33.12 | |
Co-morbidity | |||||
Hepatitis B | 570 | 19.82 | 1356 | 23.83 | <0.0001 |
Liver cirrhosis | 989 | 34.39 | 1618 | 28.43 | <0.0001 |
hepatocellular carcinoma | 535 | 18.60 | 898 | 15.78 | 0.0009 |
Alcohol-related disease | 294 | 10.22 | 477 | 8.38 | 0.0049 |
Chronic obstructive pulmonary disease | 508 | 17.66 | 1402 | 24.64 | <0.0001 |
Diabetes Mellitus | 1046 | 36.37 | 2143 | 37.66 | 0.2449 |
Thyroid disorders | 145 | 5.04 | 631 | 11.09 | <0.0001 |
Rheumatoid arthritis | 89 | 3.09 | 400 | 7.03 | <0.0001 |
Osteoarthritis | 953 | 33.14 | 2922 | 51.34 | <0.0001 |
Depression | 174 | 6.05 | 650 | 11.42 | <0.0001 |
Sicca syndrome | 78 | 2.71 | 423 | 7.43 | <0.0001 |
Charlson comorbidity index score | <0.0001 | ||||
0 | 1203 | 41.83 | 3024 | 53.14 | |
1 | 377 | 13.11 | 769 | 13.51 | |
More than 2 | 1296 | 45.06 | 1898 | 33.35 | |
Anti-viral or hepatoprotective agents | |||||
Interferon alfa | 392 | 13.63 | 974 | 17.11 | <0.0001 |
Ribavirin | 391 | 13.60 | 973 | 17.10 | <0.0001 |
Silymarin | 1916 | 66.62 | 4204 | 73.87 | <0.0001 |
Times of visits (mean, SD) | 15.61 | 17.18 | 21.23 | 23.18 | <0.0001 |
Number of TCM visits (times/per year) | Only Chinese herbal remedies | Only Acupuncture or traumatology | Combination both treatment | Total of TCM (N = 5691) |
---|---|---|---|---|
N = 2984 (52.43 %) | N = 64 (1.12 %) | N = 2643 (46.44 %) | ||
1-3 | 2423 (81.20 %) | 64 (100 %) | 1725 (65.27 %) | 4212 (74.01 %) |
4-6 | 212 (7.10 %) | 0 | 320 (12.11 %) | 532 (9.35 %) |
>6 | 349 (11.70 %) | 0 | 598 (22.63 %) | 947 (16.64 %) |
The prevalence of hepatitis B, liver cirrhosis, alcohol-related disease, chronic obstructive pulmonary disease and diabetes mellitus was lower in TCM users than non-TCM users in Taiwanese HC patients
Age groups (year-old) | Non-TCM user | TCM user | IRR (95 % CI) | Adjusted HRb | ||||
---|---|---|---|---|---|---|---|---|
Disease (ICD-9-CM) | N (%) | Person-years | IRa | N (%) | Person-years | IRa | (95 % CI) | |
Hepatitis B (70.2, 070.3, V02.61) | ||||||||
All | 570(19.82) | 13085 | 43.56 | 1356(23.83) | 39350 | 34.46 | 0.79(0.72−0.87)*** | 0.55(0.46−0.66)*** |
18−39 | 88(24.18) | 1901 | 46.3 | 239(25.29) | 7189 | 33.24 | 0.72(0.56−0.92)** | 0.41(0.25−0.69)*** |
40−64 | 327(22.54) | 6923 | 47.23 | 842(24.80) | 23900 | 35.23 | 0.75(0.66−0.85)*** | 0.48(0.37−0.6)*** |
≥ 65 | 155(14.61) | 4261 | 36.37 | 275(20.36) | 8260 | 33.29 | 0.92(0.75−1.11) | 0.82(0.58−1.17) |
Liver cirrhosis (571.2, 571.5, 571.6, 572.2, 572.3, 572.4, 572.8, 573.0) | ||||||||
All | 989(34.39) | 13085 | 75.58 | 1618(28.43) | 39350 | 41.12 | 0.54(0.50−0.59)*** | 0.42(0.37−0.48)*** |
18−39 | 45(12.36) | 1901 | 23.68 | 108(11.43) | 7189 | 15.02 | 0.63(0.45−0.90)* | 0.43(0.25−0.73)** |
40−64 | 489(33.70) | 6923 | 70.63 | 951(28.01) | 23900 | 39.79 | 0.56(0.51−0.63)*** | 0.39(0.33−0.46)*** |
≥ 65 | 455(42.88) | 4261 | 106.77 | 559(41.38) | 8260 | 67.67 | 0.63(0.56−0.72)*** | 0.54(0.44−0.66)*** |
hepatocellular carcinoma (155) | ||||||||
All | 535(18.60) | 13085 | 40.89 | 898(15.78) | 39350 | 22.82 | 0.56(0.50−0.62)*** | 0.78(0.45−1.36) |
18−39 | 6(1.65) | 1901 | 3.16 | 33(3.49) | 7189 | 4.59 | 1.45(0.61−3.47) | 1.25(0.12−12.75) |
40−64 | 242(16.68) | 6923 | 34.96 | 514(15.14) | 23900 | 21.51 | 0.62(0.53−0.72)*** | 0.98(0.43−2.21) |
≥ 65 | 287(27.05) | 4261 | 67.35 | 351(25.98) | 8260 | 42.49 | 0.63(0.54−0.74)*** | 0.72(0.29−1.75) |
Alcohol-related disease (291, 303.0, 303.9, 305.0, 571.0, 571.1, 571.3) | ||||||||
All | 294(10.22) | 13085 | 22.47 | 477(8.38) | 39350 | 12.12 | 0.54(0.47−0.62)*** | 0.41(0.32−0.51)*** |
18−39 | 65(17.86) | 1901 | 34.2 | 124(13.12) | 7189 | 17.25 | 0.50(0.37−0.68)*** | 0.37(0.24−0.58)*** |
40−64 | 185(12.75) | 6923 | 26.72 | 290(8.54) | 23900 | 12.13 | 0.45(0.38−0.55)*** | 0.31(0.23−0.42)*** |
≥ 65 | 44(4.15) | 4261 | 10.33 | 63(4.66) | 8260 | 7.63 | 0.74(0.50−1.09) | 0.61(0.33−1.16) |
Chronic obstructive pulmonary disease (491, 492) | ||||||||
All | 508(17.66) | 13085 | 38.82 | 1402(24.64) | 39350 | 35.63 | 0.92(0.83−1.12) | 0.59(0.50−0.70)*** |
18−39 | 27(7.42) | 1901 | 14.21 | 120(12.70) | 7189 | 16.69 | 1.18(0.77−1.78) | 0.94(0.45−1.97) |
40−64 | 198(13.65) | 6923 | 28.6 | 786(23.15) | 23900 | 32.89 | 1.15(0.98−1.34) | 0.67(0.52−0.86)** |
≥ 65 | 283(26.67) | 4261 | 66.41 | 496(36.71) | 8260 | 60.05 | 0.90(0.78−1.05) | 0.69(0.53−0.89)** |
Diabetes Mellitus (250) | ||||||||
All | 1046(36.37) | 13085 | 79.94 | 2143(37.66) | 39350 | 54.46 | 0.68(0.63−0.73)*** | 0.48(0.42−0.55)*** |
18−39 | 55(15.11) | 1901 | 28.94 | 151(15.98) | 7189 | 21 | 0.73(0.53−0.99)* | 0.40(0.22−0.71)** |
40−64 | 572(39.42) | 6923 | 82.62 | 1358(40.00) | 23900 | 56.82 | 0.69(0.62−0.76)*** | 0.46(0.38−0.54)*** |
≥ 65 | 419(39.49) | 4261 | 98.32 | 634(46.93) | 8260 | 76.75 | 0.78(0.69−0.88)*** | 0.64(0.51−0.8)*** |
Thyroid disease (240, 241, 242, 244) | ||||||||
All | 145(5.04) | 13085 | 11.08 | 631(11.09) | 39350 | 16.04 | 1.44(1.21−1.73)*** | 0.90(0.67−1.21) |
18−39 | 21(5.77) | 1901 | 11.05 | 105(11.11) | 7189 | 14.6 | 1.32(0.83−2.11) | 1.33(0.54−3.28) |
40−64 | 79(5.44) | 6923 | 11.41 | 418(12.31) | 23900 | 17.49 | 1.53(1.21−1.95)*** | 0.9(0.6−1.36) |
≥ 65 | 45(4.24) | 4261 | 10.56 | 108(7.99) | 8260 | 13.07 | 1.24(0.87−1.75) | 0.92(0.53−1.58) |
Rheumatoid arthritis (714) | ||||||||
All | 89(3.09) | 13085 | 6.8 | 400(7.03) | 39350 | 10.17 | 1.49(1.19−1.88)*** | 1.18(0.82−1.69) |
18−39 | 11(3.02) | 1901 | 5.79 | 42(4.44) | 7189 | 5.84 | 1.01(0.52−1.96) | 0.88(0.28−2.78) |
40−64 | 45(3.10) | 6923 | 6.5 | 266(7.84) | 23900 | 11.13 | 1.71(1.25−2.35)*** | 1.38(0.81−2.36) |
≥ 65 | 33(3.11) | 4261 | 7.74 | 92(6.81) | 8260 | 11.14 | 1.44(0.97−2.14) | 1.24(0.69−2.22) |
Osteoarthritis (715) | ||||||||
All | 953(33.14) | 13085 | 72.83 | 2922(51.34) | 39350 | 74.26 | 1.02(0.95−1.10) | 0.75(0.66−0.86)*** |
18−39 | 46(12.64) | 1901 | 24.2 | 215(22.75) | 7189 | 29.91 | 1.24(0.90−1.70) | 1.2(0.64−2.27) |
40−64 | 427(29.43) | 6923 | 61.68 | 1777(52.34) | 23900 | 74.35 | 1.21(1.08−1.34)*** | 0.85(0.71−1.03) |
≥ 65 | 480(45.24) | 4261 | 112.64 | 930(68.84) | 8260 | 112.59 | 1.00(0.90−1.12) | 0.82(0.67−1) |
Depression (296.2, 296.3, 296.5, 296.6, 305.8, 311, v790, 290.13) | ||||||||
All | 174(6.05) | 13085 | 13.3 | 650(11.42) | 39350 | 16.52 | 1.24(1.05−1.47)* | 0.78(0.61−1.01) |
18−39 | 31(8.52) | 1901 | 16.31 | 128(13.54) | 7189 | 17.8 | 1.09(0.74−1.62) | 0.76(0.42−1.38) |
40−64 | 86(5.93) | 6923 | 12.42 | 382(11.25) | 23900 | 15.98 | 1.29(1.02−1.63)* | 0.73(0.52−1.04) |
≥ 65 | 57(5.37) | 4261 | 13.38 | 140(10.36) | 8260 | 16.95 | 1.27(0.93−1.72) | 0.89(0.54−1.48) |
Sicca syndrome (370.33, 710.2) | ||||||||
All | 78(2.71) | 13085 | 5.96 | 423(7.43) | 39350 | 10.75 | 1.80(1.42−2.30)*** | 1.27(0.86−1.89) |
18−39 | 4(1.10) | 1901 | 2.1 | 42(4.44) | 7189 | 5.84 | 2.78(1.00−7.74) | - |
40−64 | 40(2.76) | 6923 | 5.78 | 266(7.84) | 23900 | 11.13 | 1.93(1.38−2.69)*** | 1.14(0.67−1.94) |
≥ 65 | 34(3.20) | 4261 | 7.98 | 115(8.51) | 8260 | 13.92 | 1.75(1.19−2.56)** | 1.71(0.93−3.15) |
Frequency distribution of disease categories in TCM versus non-TCM visits
Disease (ICD-9-CM) | Non-TCM user (N = 2876) | TCM user (N = 5691) | p value | ||
---|---|---|---|---|---|
n
| % |
n
| % | ||
Infectious and parasitic disease (001−139) | 2862 | 99.51 | 5673 | 99.68 | 0.2218 |
Neoplasms (140−239) | 1289 | 44.82 | 3121 | 54.84 | <0.0001 |
Malignant(140−208) | 824 | 28.65 | 1491 | 26.20 | 0.0158 |
Benign (210−229) | 597 | 20.76 | 2152 | 37.81 | <0.0001 |
Endocrine, nutritional and metabolic disease and immunity disorder (240−279) | 1863 | 64.78 | 4133 | 72.62 | <0.0001 |
Blood and blood-forming organs (280−289) | 843 | 29.31 | 1876 | 32.96 | 0.0006 |
Mental disorder (290−319) | 1206 | 41.93 | 3360 | 59.04 | <0.0001 |
Nervous system (320−389) | 2087 | 72.57 | 5120 | 89.97 | <0.0001 |
Circulatory system (390−459) | 2123 | 73.82 | 4410 | 77.49 | 0.0002 |
Respiratory system (460−519) | 2548 | 88.60 | 5573 | 97.93 | <0.0001 |
Digestive system (520−579) | 2797 | 97.25 | 5669 | 99.61 | <0.0001 |
Genitourinary system (580−629) | 1760 | 61.20 | 4485 | 78.81 | <0.0001 |
Complications of pregnancy, childbirth and the puerperium (630−676) | 19 | 0.66 | 178 | 3.13 | <0.0001 |
Skin and subcutaneous tissue (680−709) | 1958 | 68.08 | 4830 | 84.87 | <0.0001 |
Musculoskeletal system and connective tissue (710−739) | 2091 | 72.71 | 5343 | 93.89 | <0.0001 |
Congenital anomalies (740−759) | 126 | 4.38 | 511 | 8.98 | <0.0001 |
Certain conditions originating in the perinatal period (760−779) | 13 | 0.45 | 43 | 0.76 | 0.0997 |
Symptoms, signs and ill-defined conditions (780−799) | 2569 | 89.33 | 5575 | 97.96 | <0.0001 |
Injury and poisoning (800−999) | 1997 | 69.44 | 5166 | 90.77 | <0.0001 |
The most commonly used TCM prescriptions
Prescription name (in Chinese) | Ingredients | Therapeutic action and Indication | Number of person-days | Average daily dose (g) | Average duration for prescription (days) |
---|---|---|---|---|---|
Single herb | |||||
Dan-shen | Salvia miltiorrhiza Bunge | H & E: Activate blood and resolve stasis anti-fibrosis, antihepatocarcinoma, anti-diabetic, lipid-lowering | 59252 | 2.5 | 10.1 |
Yan-hu-suo |
Corydalis yanhusuo
| H & E: Activate blood, promote flow of qi, and alleviate pain Also used in peptic ulcer | 41875 | 3 | 7.1 |
Huang-qin | Scutellaria baicalensis Georgi | H: Clear heat and drain fire Anti-inflammation | 35273 | 2.2 | 8.1 |
Yin-chen-hao | Artemisia capillaris Thunb | H: Excrete dampness and alleviate jaundice Anti-fibrosis | 33357 | 2.4 | 10.1 |
Da-huang | Rheum officinale Baill | E: Clear heat and drain fire Anti-tumor | 32110 | 1.1 | 7.9 |
Huang-qi |
Astragalus membranaceus
| H&E: Qi-tonifying/ restore energy Anti-cancer | 30086 | 2.1 | 8.8 |
Bei-mu | Fritillariae thunbergii Bulbus | E: Clear heat and resolve phlegm Also used in peptic ulcer and asthma | 29404 | 2.7 | 7.1 |
Ge-gen | Pueraria thomsonii Benth | E: Release exterior and cure heat Also used in ischemic heart disease | 29143 | 2 | 7.4 |
Ye-jiao-teng | Polygonum multiflorum Thunb. | E: Nourish heart and induce tranquilization Also used in menopausal syndrome | 28559 | 3.3 | 8.7 |
Hai-piao-xiao | Sepiella maindronide Rochebrune | E: Restrain acidity and alleviate pain | 27940 | 2.5 | 8.4 |
Formulae | Also used in peptic ulcer | ||||
Jia-wei-xiao-yao-san | Glycyrrhiza uralensis Fisch. Angelica sinensis, Atractylodes macrocephala, Bupleurum chinense, Gardenia jasminoides, Mentha haplocalyx, Paeonia lactiflora, Paeonia suffruticosa, Poria cocos, Zingiber officinale | H & E: Harmonize liver and release spleen; Also used in thyroid disorders | 88124 | 7.5 | 9.3 |
Xiao-chai-hu-tang | Bupleurum chinense, Scutellaria baicalensis Georgi, Pinellia ternata (Thunb.) Makino, Panax ginseng C.A. Mey, Glycyrrhiza uralensis Fisch, Zingiber officinale, Zizyphus jujuba | H: Regulate exterior and interior Qi activity by balancing between yin and yang; Antihepatocarcinoma | 39837 | 6.7 | 7.9 |
Long-dan-xie-gan-tang | Gentiana scabra Bge, Scutellaria baicalensis Georgi, Gardenia jasminoides Ellis, Alisma orientalis, Akebia quinata (Houtt.) Decne., Plantago asiatica L., Angelica sinensis, Rehmannia glutinosa (Gaert.) Libosch., Bupleurum chinense, Glycyrrhiza uralensis Fisch. | H: Purge fire in the liver and gallbladder, clear away damp-heat in the lower burner; Antiinflammation | 36293 | 11.3 | 7.9 |
Shu-jing-huo-xue-tang | Angelica sinensis, Paeonia lactiflora Pall, Glycyrrhiza uralensis Fisch, Rehmannia glutinosa (Gaert.) Libosch, Atractylodes lancea, Achyranthes bidentata Blume, Citrus tangerina pericarpium, Citrus reticulata Blanco, Prunus persica (L.) Batsch, Clematis chinensis Osbeck, Ligusticum striatum DC., Stephania tetrandra S. Moore, Notopterygium incisum, Angelica dahurica (Fisch. ex Hoffm.) Benth, Gentiana scabra Bge, Poria cocos, Zingiber officinale Rosc., | E: Relax the channels and activate blood; Also used in osteoarthritis and rheumatoid arthritis | 32646 | 10.3 | 6.9 |
Xiang-sha-liu-jun-zi-tang | Aquilaria sinensis, Amomum villosum Lour, Citrus reticulata Blanco, Pinellia ternata (Thunb.), Panax ginseng C.A. Mey, Poria cocos, Atractylodes macrocephala Koidz., Glycyrrhiza uralensis Fisch. | E: Tonify and replenish qi Also used in functional dyspepsia and post-surgery colon cancer patients | 28381 | 7.1 | 8.3 |
Gan-lu-yin | Rehmannia glutinosa, Asparagus cochinchinensis (Lour.) Merr., Liriope spicata (Thunb.) Lour., Dendrobium nobile Lindl., Artemisia capillaris Thunb, Scutellaria baicalensis Georgi, Citrus aurantium L., Eriobotrya japonica (Thunb.) Lindl., Glycyrrhiza uralensis Fisch, | H& E: Clear heat and nourish yin; Also used in Sicca syndrome | 27563 | 6.1 | 7.6 |
Xue-fu-zhu-yu-tang | Angelica sinensis (Oliv.) Diels, Ligusticum chuanxiong hort, Paeonia anomala L., Prunus persica (L.), Batsch, Carthamus tinctorius L., Rehmannia glutinosa (Gaert.) Libosch, Citrus aurantium L., Bupleurum chinense DC., Glycyrrhiza uralensis Fisch, Platycodon grandiflorum (Jacq.) A. DC., Achyranthes bidentata Blume, | E: Promote blood circulation to remove blood stasis Also used in ischemic heart disease and hyperlipidemia. | 27493 | 6.6 | 8.1 |
Du-huo-ji-sheng-tang | Angelica pubescens Maxim, Taxillus chinensis (DC.) Danser, Eucommia ulmoides Oliver, Achyranthes bidentata Blume, Asarum heterotropoides F. Schmidt, Gentiana macrophylla Pall, Poria cocos, Cinnamomum cassia Presl, Saposhnikovia divaricata (Turcz.) Schischk, Ligusticum striatum DC., Panax ginseng C.A. Mey., Glycyrrhiza uralensis Fisch, Angelica sinensis, Paeonia lactiflora Pall. | E: Reinforce the liver and kidney and tonify qi and blood; Also used in fracture, osteoarthritis and rheumatoid arthritis | 27388 | 11.1 | 8.2 |
Suan- zao-ren-tang | Ligusticum striatum DC., Ziziphus jujuba Mill. Poria cocos, Glycyrrhiza uralensis Fisch, Anemarrhena asphodeloides Bge | E: Nourish blood to tranquilize the mind; Also used in insomnia and depression | 26417 | 8 | 7.5 |
Ping-wei-san | Citrus reticulata Blanco, Atractylodes lancea (Thunb.), Magnolia officinalis Rehd, Glycyrrhiza uralensis Fisch | E: Activate the flow of Qi and regulate the stomach Also used in leukemia patients | 26083 | 7.2 | 7.6 |