Four Case Reports on Treatment of elevated aminotransferase levels with Herbal medicine containing Artemisia capillaris as Principal Component

Hongmin Chu; Cheol-Hyun Kim; Kwang-ho Kim; Young-ung Lee; Kang-keyng Sung; Sang-kwan Lee; Chu, Hongmin; Kim, Cheol-Hyun; Kim, Kwang-ho; Lee, Young-ung; Sung, Kang-keyng; Lee, Sang-kwan

doi:10.13048/jkm.21032

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

Case Report

The Journal of Korean Medicine 2021; 42(3): 165-175.

Published online: September 01, 2021

DOI: https://doi.org/10.13048/jkm.21032

Four Case Reports on Treatment of elevated aminotransferase levels with Herbal medicine containing Artemisia capillaris as Principal Component

Hongmin Chu¹^{, 2}^{, ‡}

, Cheol-Hyun Kim¹^{, 2}^{, ‡}

, Kwang-ho Kim¹^{, 2}

, Young-ung Lee¹^{, 2}

, Kang-keyng Sung¹

, Sang-kwan Lee¹^{, 2}^{, *}

¹Department of Internal Medicine and Neuroscience, College of Korean Medicine, Wonkwang University, Iksan city, Republic of Korea

²Department of Korean Internal Medicine, Wonkwang University Gwangju Medical Center, Gwangju city, Republic of Korea

Correspondence to: Sangkwan Lee, Department of Internal Medicine, College of Korean Medicine, Wonkwang University, Iksan, Jeonbuk, 54538, Republic of Korea, Tel: +82-62-670-6412, E-mail: sklee@wku.ac.kr

‡ Chu H and CH Kim are contributed equally.

Received April 22, 2021 Revised July 14, 2021 Accepted July 28, 2021

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.

Keywords: Herbal Medicine, Case Report, Liver disease, Aminotransferase levels, Artemisia capillaris

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;

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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