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JKM > Volume 42(3); 2021 > Article
Chu, Kim, Kim, Lee, Sung, and Lee: Four Case Reports on Treatment of elevated aminotransferase levels with Herbal medicine containing Artemisia capillaris as Principal Component

Abstract

Background

Many herbal medications have been used to treat various liver diseases. But the concerns of herbal medicine induced liver injury also existed. In this respect, we would like to report several cases with imporved elevated liver aminotransferase after treating herbal medicine including Artemisia capillaris.

Case Reports

We report four patients with elevated aminotransferase levels (ATLs), which indicate hepatocellular damages. After receiving herbal medicines therapy containing Artemisia capillaris as principal component (HMA), the patients’ ATLs were improved. In the first case, the patient’s ATLs decreased into normal range after administration of HMA, although they have not been improved with hepatotonics for a long period. In the second case, the patient’s ATLs have been elevated after taking anticoagulants. The ATLs were improved with HMA without stopping anticoagulants. In the other two cases, the patients’ ATLs were also improved after taking HMA. In addition, there were no changes of previous drugs for treating the corresponding underlying diseases and no adverse events during HMA applications.

Result and Conclusion

The four patients received the herbal medicine containing Artemisia capillaris as principal component and showed improvement of ATLs. These cases suggest that HMA can be considered as alternative or complementary remedies to improve various liver diseases.

Fig. 1
The Patients’ ALTs decrease with taking HMA.
The numbers above cicles mean aminotransferase levels. Square boxes represent reference range. Upper and lower dotted line represent normal ALT and AST range. 0–44IU/L and 0–38IU/L respectively.
Abbreviations: HMA,Herbal Medicine containing Artemisia capillaris; SKT,Saeng-Kankunbi-Tang; CKT, Cheong-Kankunbi-Tang; IJORS, Injin-Oryongsan;
jkm-42-3-165f1.gif
Table 1
Components and 1time Dose of Herbal Medicine
Medical plants Weight (g) per 1 time
HMA1(SKT)
Case 1, Case 4
Artemisiae Capillaris Herba (茵蔯蒿), Alismatis Rhizoma (澤瀉) 15g
Atractylodis Rhizoma Alba (白朮), Crataegi Fructus (山査), Hordeum vulgare (麥芽) 7.5g
Citrus unshiu (陳皮), Poria cocos (茯苓), Polyporus umbellatus (猪苓), Magnoliae Cortex (厚朴) 3.8g
Raphanus sativus (蘿葍子), Aurantii Immaturus Fructus(枳實), Sparganii Rhizoma (三稜), Zedoariae Rhizoma (蓬朮), Citri Unshius Pericarpium Immaturus (靑皮), Amomi Fructus (砂仁), Glycyrrhiza uralensis (甘草), Zingiber officinale (生薑), Agastachis Herba (藿香) 3g
HMA2(CKT)
Case 2
Artemisiae Capillaris Herba (茵蔯蒿) 12g
Puerariae Radix (葛根), Atractylodis Rhizoma Alba (白朮), Bupleurum falcatum (柴胡), Alismatis Rhizoma (澤瀉) 6g
Amomi Fructus (砂仁), Raphanus sativus (蘿葍子), Hordeum vulgare (麥芽), Paeonia lactiflora (芍藥), Crataegi Fructus (山査), Polyporus umbellatus(猪苓), Poria cocos (茯苓), Citrus unshiu (陳皮), Citri Unshius Pericarpium Immaturus (靑皮), Magnoliae Cortex (厚朴) 3g
Arecae Pericarpium (大腹皮), Pinellia ternata Breitenbach (半夏), Zedoariae Rhizoma (蓬朮), Sparganii Rhizoma (三稜), Agastachis Herba (藿香), Glycyrrhiza uralensis (甘草) 2g
HMA3(IJORS)
Case 3
Artemisiae Capillaris Herba (茵蔯蒿) 20g
Alismatis Rhizoma (澤瀉), Atractylodis Rhizoma Alba (白朮), Polyporus umbellatus(猪苓), Poria cocos (茯苓) 8g
Aurantii Immaturus Fructus(枳實) 6g
Lonicerae Flos (金銀花), Forsythiae Fructus (連翹) 4g
Coptidis Rhizoma(黃連) 2g

SKT;Saeng-Kankunbi-Tang, CKT;Cheong-Kankunbi-Tang, IJORS: Injinoryung-San-Gagambang

Table 2
Results of Laboratory Test. Comparisons of ATLs and Bilirubin between Administration and Follow Up
Case 1 Before SKT administration After 12 days administration After 34 days administration After 70 days administration Normal range
ALT (IU/L) 289 135 99 24 5–44
AST (IU/L) 106 51 51 34 5–44
ALP (IU/L) 200 166.6 162.3 160 40–129
Bilirubin(Total/Direct) mg/dl 2.15/0.75 0.84/0.58 1.79/0.74 0.84/0.31 0.22–1.2 / 0.05–0.3

Case 2 Before CKT administration After 14 day CKT administration Normal range

ALT (IU/L) 154 28 5–44
AST (IU/L) 77 20 5–44
ALP (IU/L) 132.7 155.6 40–129
Bilirubin(Total/Direct) mg/dl 0.6/0.24 0.52/0.19 0.22–1.2 / 0.05–0.3

Case 3 Before SKT administration After 13 day SKT administration Normal range

ALT (IU/L) 253 107 5–44
AST (IU/L) 116 62 5–44
ALP (IU/L) 790 764.3 40–129
Bilirubin(Total/Direct) mg/dl 1.4/0.65 1.7/0.94 0.22–1.2 / 0.05–0.3

Case 4 Before IJORS administration After 8 day IJORS administration Normal range

ALT (IU/L) 128 24 5–44
AST (IU/L) 46 15 5–44
ALP (IU/L) 145.5 160 40–129
Bilirubin(Total/Direct) mg/dl 1.72/0.31 1.19/0.22 0.22–1.2 / 0.05–0.3

ALT, alanine amino transferase; AST: aspartate aminotransferase; ALP: alkaline phosphatase; SKT, Saeng-Kankunbi-Tang; CKT, Cheong -Kankunbi-Tang; IJORS, Injinoryung-San-Gagambang

Table 3
Composition of Per Os Medication
Patient Product name (Ingredients label) Dosage
Case 1 Pletal SR Cap. (cilostazol 100mg) 2C qd
Atorva Tab. 20mg (atorvastatin calcium 20.73mg) 1T qd
Twynsta Tab. 40/5mg (telmisartan 40mg, amlodipine besylate 6.935mg) 1T qd
Alfoatirin soft cap. (choline alfoscerate 400mg) 2T bid
Sandoz escitalopram Tab. 15 mg (escitalopram oxalate 15mg) 1T SPC
Nexillen S Tab. (artemisia herb soft extract) 2T bid
Xanax Tab. 0.5mg (alprazolam 500μg) 0.5T SPC
Legalon Cap. 140 (milk thistle extract 339.4mg) 2T bid
Exonin CR Tab. (eperisone SR Tab. 75mg) 2T bid

Case 2 Aspirin Protect Tab. 100 mg (aspirin 100mg) 1T qd
Cuparin Tab. 2mg (warfarin Sodium 2mg) 0.75T hs
Conbloc Tab. 1.25mg (bisoprolol fumarate 1.25mg) 1T qd
Furix Tab (furosemide 40mg) 0.5T qd
Lipitor Tab. 20 mg (atorvastatin calcium trihydrate 21.7mg) 1T SPC
Trajenta Tab. (metformin HCl 1000mg, linagliptin 2.5mg) 2T bid
Diovan Film Coated Tab. 80mg (valsartan 80mg) 0.5T qd
Lanston LFDT Tab. 15mg (lansoprazole 15mg) 1T qd

Case 3 Talion Tab. 10mg (bepotastine besilate 10mg) 2T bid
Methylon Tab. 4mg (methylprednisolone 4mg) 3T qd, 1T
Ebastel Tab. Boryung (ebastine 10mg) SPC
1T qd

Case 4 Twynsta Tab. 40/10mg (telmisartan 40mg, amlodipine besylate 13.87mg) 1T qd
Duvie Tab. 0.5mg (Lobeglitazone sulfate 0.5mg) 0.5T qd
Trajenta-duo Tab. (metformin HCl 1000mg, linagliptin 2.5mg) 2T bid
Lipitor Tab. 40 mg (atorvastatin calcium trihydrate 43.4mg) 1T qd
Plavix Tab. 75 mg (clopidogrel Sulfate 97.875mg) 1T bid
Dichlozid Tab. (hydrochlorothiazide 25mg) 0.5T qd
Tanamin Tab. 80mg (ginkgo flavon Ext. 80mg) 2T bid
Mucosta Tab. (rebamipide 100mg) 2T bid
Bonaling-A Tab. (dimenhydrinate 50mg) 2T bid
Solondo Tab. (prednisolone 5mg) 6T qd(prn)
Lyrica Cap. 75mg (Pregabalin 75mg) 2T bid
Lacto Well Intestinal Cap. (Bacillus subtilis·streptococcus faecium 250mg) 2T bid

Per Os = through the mouth(Latin); BID= Bis in die, same as twice a day; Cap=Capsule; hs= Hora somni, same as before sleep; QD=Quaque die, same as once a day; SPC=supper post cibum, after meals; Tab=Tablet; TID=Ter in die, same as 3 times a day.

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