• Journal of Yeungnam Medical Science
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• 제37권1호
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• pp.2-12
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• 2020

Drug-induced liver injury (DILI), including herbal and dietary supplement hepatotoxicity, is often passed lightly; however, it can lead to the requirement of a liver transplant or may even cause death because of liver failure. Recently, the American College of Gastroenterology, Chinese Society of Hepatology and European Association for the Study of the Liver guidelines for the diagnosis and treatment of DILI have been established, and they will be helpful for guiding clinical treatment decisions. Roussel Uclaf Causality Assessment Method scoring is the most commonly used method to diagnose DILI; however, it has some limitations, such as poor validity and reproducibility. Recently, studies on new biomarkers have been actively carried out, which will help diagnose DILI and predict the prognosis of DILI. It is expected that the development of new therapies such as autophagy inducers and various other technologies of the fourth industrial revolution will be applicable to DILI research.

• 대한한의학회지
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• 제31권3호
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• pp.128-132
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• 2010

Objectives: This study aimed to review the general features of drug induced liver injury (DILI) and the important factors in consideration of herbal drugs and DILI. Methods: We reviewed general aspects of DILI such as classification, inducible factors, diagnosis methods, prevention, and the status of herbal drug-associated DILI via literature. Results: Besides the drug itself, genetic and environmental factors affect hepatic toxicity. There is a lack of definitive diagnoses of DILI by drugs, including herbal remedies. The possibility of herbal drug-associated DILI is exaggerated, and majority of herbal drug-derived hepatic injury could be easily prevented if Oriental doctors pay attention to this issue. Conclusion: This study can provide Oriental doctors an overview and be helpful in minimizing the episodes of hepatotoxicity in use of herbal drugs.

• 혜화의학회지
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• 제18권1호
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• pp.83-88
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• 2009

Recently, herbal drugs haver been used world wide. and generally regarded as safe with no serious adverse reaction. Drug-induced liver injury (DILI) is one of frequent cause of liver diseases. If DILI is not treated, it can be developed into liver cirrhosis, hepatoma, etc. Currently, DILI has been reported to be common cause of acute hepatitis, and oriental medicine and folk remedy are not exception. We encountered one case of DILI, cause by folk remedy. Patients complained chest discomfort, yellow skin and urine, nausea, vomiting. Lab test showed elevated level of aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transpeptidase (r-GTP), total bilirubin (TB). We estimated acute DILI and stopped taking folk medication made by himself. After 1 week of treatment, the clinical symptoms and liver function improved. Genetic and environmental factors as well as drug itself decide the hepatic toxicity, and the major DILI are belonged in acute type. So we need to get more attention to folk medication to help preventing the DILI cause by folk remedy.

• 대한한방내과학회지
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• 제33권4호
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• pp.609-614
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• 2012

Drug-induced liver injury (DILI) is a common cause of acute hepatitis. Regarding the risk of DILI from herbal preparations, there are controversial issues such as exaggerated reports straying far from the truth and lack of discrimination between herbal drugs and folk remedies or food supplements. This study reported one case of a patient with DILI caused by Smilacis Chinae Radix and cured in an Oriental hospital. Smilacis Chinae Radix has been used as an anti-inflammatory, anti-microbial, detoxification and anticancer compound, as a folk remedy. This report would provide helpful information for management of DILI by folk remedies or herbal drugs.

• 대한한방내과학회지
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• 제40권6호
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• pp.1035-1042
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• 2019

Background: Herbal medication is widely used in the Korean Medicine Hospital, and drug-induced liver injury (DILI) in Korea has increased proportionally. Herb-induced liver injury now accounts for approximately 40% of cases of hepatotoxicity in Korea, according to research data. Currently, however, the component responsible for the toxicity is usually unknown or can only be suspected. Objective: To study the hepatotoxicity of Cheongsimyeonja-tang in DILI. Methods: A retrospective review was conducted of 82 inpatients between April 2010 and March 2017 with suspected drug-induced liver injury (n=5). The standard criteria (RUCAM scale) for drug-induced liver injury (DILI) were applied. The electronic medical records (EMRs) were retrospectively reviewed to identify the relevant database. Aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin (T. Bili) were analyzed in blood samples before and after the administration of Cheongsimyeonja-tang. Results: Five cases out of 82 patients had a criterion-referenced probable (RUCAM) score ranging from 6 to 8 points DILI. However, statistical analysis of the liver function parameters results of the 82 patients did not show a statistically meaningful elevation after taking Cheongsimyeonja-tang. Conclusions: These data suggest a relationship between Cheongsimyeonja-tang and DILI. More studies are needed to validate these observations and to explore their implications.

• 대한본초학회지
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• 제33권1호
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• pp.9-15
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• 2018

Objectives : The root bark of Dictamnus dasycarpus has been frequently used to treat patients with skin diseases in Korea. Recently, wild root of D. dasycarpus are reported to induce liver injury. Methods : Traditional uses of D. dasycarpus for skin diseases were analysed bibliographically. In addition, reported cases were collected and analysed using pubmed and national digital library. Results : In taiwan, D. dasycarpus revealed to be one of major herbs for skin diseases and many researchers in worldwide had reported its dermatological efficacies. Reported cases related in liver injury described that hepatocellular or cholestatic liver injury were seen in patients eating wild root of D. dasycarpus. In addition, 6 cases in worldwide and 1 case in Korea showed that patients with drug induced liver injury (DILI) ingested not root bark of D. dasycarpus but prescriptions containing root bark of D. dasycarpus. These mean that wild root of D. dasycarpus (Bongsam or Bongwhangsam) was estimated to be closely related in DILI. Whereas, it was difficult to confirm direct correlation between root bark of D. dasycarpus used as herbal medicine by doctor of Korean medicine and DILI. Conclusions : these results imply that wild root of D. dasycarpus is closely related in DILI and strong recommendation not to take it without consultation by experts is needed. In addition, although there are no evidences of direct correlation between root bark of D. dasycarpus and DILI, doctor of Korean medicines should pay attention to use root bark of D. dasycarpus in their clinics.

• 대한한의학회지
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• 제37권2호
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• pp.119-124
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• 2016

Objectives: To demonstrate a clinical course and feature of a female patient with a severe liver injury (DILI) during antituberculosis treatment for her intestinal tuberculosis, whom traditional Korean medicine completely recovered. Methods: A female patient with diagnosed as DILI by antituberculosis drugs had been treated with herbal drugs; and then the clinical outcome and biochemical parameters had been monitored. Result: A 45-year old female had taken antituberculosis drugs for about 2 months, and complained severe abdominal discomfort and dyspepsia. The RUCAM score was 10, which met the criteria for DILI (AST 584 IU/L, ALT 1212 IU/L, ALP 100 IU/L, and GGT 161 IU/L, total bilirubin 0.9 mg/dL). She had been treated with herbal drugs and acupuncture as inpatient and outpatient, and then her symptoms had been completely recovered with normalization of hepatic enzymes. Conclusion: This report provides a clinical characteristic for a severe hepatotoxicity induced by antituberculosis drugs, and showed an example of TKM-based application.

• 대한한의학회지
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• 제32권6호
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• pp.112-116
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• 2011

Objectives: To inform the clinical features of drug-induced liver injury (DILI), and study traditional Korean medicine (TKM)-based strategies or therapeutics. Methods: A female patient with hepatitis after long term use of medication for cold symptoms was treated with Oriental therapies, after which the clinical outcome was evaluated by serum biochemical parameters and ultrasonography. Results: Clinical and biochemical levels were fluctuating during administration of cold medicine, but the patient completely recovered her health with herbal medicines. Conclusion: This case report would provide information about a typical DILI by western medicine followed by treatment with traditional Korean medicine.

• 대한한방내과학회지
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• 제36권1호
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• pp.69-75
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• 2015

본 증례보고는 퇴행성 관절염으로 양방병원에서 치료를 받던 중에 발생한 약인성 간손상으로 한방병원에서 진단 및 치료 받은 73세의 여성 환자의 증례를 소개하고자 한다. 환자는 약 3개월 동안 양방병원에서 비스테로이드성 소염제와 근육이완제 등을 처방 받아 오던 중 점차적으로 피로감과 오심 구역감 등의 위장장애를 호소하였다. 양방 의원에서 수 차례 약물치료를 하였으나 호전되지 않고 점차 극심한 피로감과 무기력감 및 위장증상으로 한방병원을 찾게 되었다. 한방병원에서 혈액검사상에 급성감염(AST 90 IU/L, ALT 100 IU/L, ALP 191 IU/L, GGT 614 IU/L) 소견을 보였다. 초음파 검사상 정상적 소견과 다른 기저질환의 배제 및 RUCAM score가 9로서 약인성 간손상으로 진단이 되었다. 15일간의 뜸치료와 침치료 및 한약물 (청간플러스시럽)의 복용으로 주관적 증상은 완전히 소실되었으며 GGT를 제외한 간기능 검사도 정상으로 회복되었다. 그동안 한약물과 관련된 약인성 간손상에 대한 연구가 주로 양의학계에서 이루어지다보니 한약물의 안전성에 대한 부정적 평가가 많았었다. 그러한 의미에서 본 증례보고는 양약에 의한 약인성 간손상에 대한 전형적인 증상의 특성을 보여주고 약인성 간손상에 대한 한의학적 관리 및 치료의 향후 연구에 대한 의미있는 증례를 제시한다고 하겠다.

• 대한한방내과학회지
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• 제41권3호
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• pp.531-541
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• 2020

From January 2014 to December 2016, 38 out of 153 inpatients admitted to the Korean Medicine Hospital for more than one month underwent follow-up blood tests to evaluate their liver function levels, and one drug-induced liver injury (DILI) patient was observed. 1. At the time of admission, six (15.8%) of the 38 patients had abnormal alanine aminotransferase (ALT) levels and five of them recovered after hospitalization. 2. At follow-up, two (5.3%) patients had a Council for International Organizations of Medical Science (CIOMS)-based liver injury. One was identified as a liver injury accompanied by pneumonia, and one was judged as a liver injury caused by the drug. 3. The patient had a suspected DILI and completely recovered after 13 days while discontinuing the herbal medication and by using Sanggangunbi-tang (生肝健脾湯).