• The Journal of Pediatrics of Korean Medicine
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• v.22 no.3
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• pp.83-94
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• 2008

Objectives : The purpose of this study is to confirm severe problem caused by using a modified RUCAM scale than that officially recognized to diagnose liver injury induced by herbal medicine. Materials and Methods : Cases with liver injury induced by herbal medicine received to a related institute from January 2004 to December 2007 were collected and evaluated by the original scale and modified scale. Results : 1. Based on this study, we couldn't clinicaly confirm that the case was not excluded by the relieved first item basis of modified RUCAM scale which has to be excluded by the first item basis of orginal RUCAM scale. 2. By modified 6th item, one score was added to the total score. 3. By adding 8th item, it gaind one point to the whole the total score. Conclusions : In this study, we can clinically confirm that the modified RUCAM　application to case with liver injury induced by herbal medicine is a severe problem.

• The Journal of Internal Korean Medicine
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• v.36 no.1
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• pp.69-75
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• 2015

Objectives : To investigate the clinical features of drug-induced liver injury (DILI) and traditional Korean medicine (TKM) -based management. Methods : A female patient diagnosed with DILI caused by Western drugs had been treated with Oriental therapies, then the subjective clinical outcome and biochemical parameters were monitored. Results : A 73-year-old female had taken Western drugs (nonsteroidal anti-inflammatory and skeletal muscle relaxants) for about 3 months, and complained of severe abdominal discomfort and tiredness. Her RUCAM score was 9, which met the criteria for DILI (AST 90 IU/L, ALT 100 IU/L, ALP 191 IU/L, and GGT 614 IU/L). She was treated with herbal drugs, moxibustion, and acupuncture, and her symptoms completely resolved, with normalized hepatic enzymes within two weeks. Conclusions : This case report provides a clinical characteristic for a typical DILI caused by Western medicine, and shows an example of a TKM-based application.

• The Journal of Internal Korean Medicine
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• v.40 no.6
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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.

• Journal of Physiology & Pathology in Korean Medicine
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• v.32 no.5
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• pp.347-353
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• 2018

There are some controversies about the safety of herbal medicine. In order to examine the safety of herbal medicine, this study investigated the level of liver function test(AST/ALT) in patients taking herbal medicine for more than 6 months We checked liver function in 121 patients who took herbal medicine for more than 6 months. AST/ALT were measured before treatment and every 3 months (from 3 month to 9 month). In 121 patients taking herbal medicine for more than 6 months, mean AST level after 6 months was lower than before treatment and mean ALT level after 6 months was lower than before treatment. In 20 patients with abnormal AST/ALT before herbal treatment, 18 patients's AST/ALT changed to normal after 6 month herbal treatment. 2 patients's AST/ALT was slightly higher than normal. One woman patient met the criteria for herb-induced liver injury(HILI) with RUCAM scores 4 after taking herbal medicine for 6 months. Although her RUCAM score decreased to zero after taking herbal medicine for 9 months. This study suggests that long-term herbal medicine for 6 months or longer is very unlikely to injury liver function. Individual-specific liver damage may occur, it can be recovered.

• Journal of Sasang Constitutional Medicine
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• v.21 no.3
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• pp.209-215
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• 2009

1. Objects: This case study reports a liver injury in treatment of constipation with Yeoldahanso-tang plus Rheum rhabarbarum. 2. Methods: The patient's subjective symptoms and the laboratory data including aspartate transaminase(AST), alanine transaminase(ALT), alkaline phosphatase(ALP), and gamma($\gamma$)-glutamyl transpeptidase(GGT) were observed before and after liver injury. We used the Roussel Uclaf Causality Assessment Method(RUCAM) scale in order to find out whether if Yeoldahanso-tang plus Rheum rhabarbarum was related with the liver injury. 3. Results: The patient's AST and ALT were elevated more than twice after a 3week administration period of herbal medicine. After discontinuation of the herbal medicine and administration of hepatic protective medication, AST and ALT decreased. The patient's general condition improved during hospitalization. The RUCAM score was estimated at 8. 4. Conclusions: This case is presented to bring more attention to the toxicity of herbal medicine.

• The Journal of Korean Medicine
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• v.37 no.2
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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.

• The Journal of Internal Korean Medicine
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• v.44 no.4
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• pp.751-756
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• 2023

Objective: This study attempts to increase awareness of hepatotoxicity caused by antipsychotic drugs and to provide updated information on drug-induced liver injury (DILI) to physicians in Korean medicine (KM) clinics. Methods: This study presents a detailed case of a female patient diagnosed with DILI attributed to antipsychotic drugs, highlighting the improvement observed through laboratory findings. Results: A 56-year-old female patient with underlying disorders, including mixed connective tissue disease and depression, was under medical care. One day, she reported experiencing intense fatigue and distressing sensations, prompting the author to order blood tests. The levels of AST and ALT were significantly elevated by more than 2.5-fold, indicating hepatocellular DILI. The RUCAM score for antipsychotic drugs was 9, as no other medications, including herbal medicine, were being taken. Upon discontinuation of the antipsychotic drugs, the patient's laboratory findings returned to normal levels within 2 weeks, accompanied by a recovery of subjective symptoms. Conclusion: This study presents a noteworthy case of hepatotoxicity caused by antipsychotic drugs, serving as an illustrative example that highlights the crucial need for awareness among doctors of KM in clinical settings.

• The Journal of Internal Korean Medicine
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• v.40 no.6
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• pp.1219-1224
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• 2019

Objective: To investigate the possibility of hepatotoxicity by supplemental foods or folk herbs such as Salvia Plebeia R. Br. Methods: A hospitalized male patient with alcoholic liver disease and electrolyte imbalance had recovered, and then followed by rapid hepatic serum enzymes after taking S. Plebeia. This study monitored the clinical outcome and biochemical parameters. Result: A 58-year male had drunk frequently, which led to alcoholic steatohepatitis and hospitalization. Two weeks after his discharge from hospital, he felt nausea, dizziness, and mild difficulties in speech and walking, resulting in re-hospitalization at the Korean Medical Hospital. The symptoms disappeared on correction of the electrolyte imbalance suspected to have been caused by severe sweating while working in the outdoors, and the patient was discharged. During treatment and monitoring of his health as an outpatient, the serum hepatic enzyme rapidly elevated approximately 10-fold in hepatic enzymes; the enzyme levels fluctuated according to whether or not he was taking the boiled water of S. Plebeia. The RUCAM score was 12, which met the criteria for toxic hepatitis by S. Plebeia. His general condition and abnormal hepatic enzymes recovered with cessation of S. Plebeia and administration of Chungganplus syrup (CGX). Conclusion: This study reports the hepatotoxic risk of Salvia Plebeia, which is commonly used as a folk remedy in Korea.

• Journal of The Korean Society of Clinical Toxicology
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• v.6 no.2
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• pp.110-116
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• 2008

Purpose: Acute toxic hepatitis is a common cause of acute liver failure (ALF). We investigated the causes, clinical manifestation, and outcomes of ALF patients who underwent liver transplantation due to acute toxic hepatitis caused by herbal medicines and preparations. Methods: Between January 1992 and May 2008, we retrospectively reviewed the medical records of 24 patients who were transplanted due to acute toxic hepatitis caused by herbal medicines and preparations. We applied the RUCAM score to patients with acute toxic hepatitis and assessed the relationship between herbal preparations and liver injury. We studied the patients' medication history, liver function tests, and clinical outcomes. Results: The type of liver injury was divided into three groups: hepatocellular type, 14 patients (58.3%); cholestatic type, 4 patients (16.7%); and mixed type, 6 patients (25%). Polygonum multiflorum Thunberg (3 cases) was the most common cause of acute toxic hepatitis, followed by Acanthopanax senticosus (2 cases), pumpkin juice (2 cases), Dictamnus dasycarpus Turcz (2 cases), Hovenia dulcis (1 case), Phellinus linteus (1 case), and Artemisia capillaries (1 case). One year survival after liver transplantation was 76%. Conclusion: We identified the herbal preparations leading to acute liver failure. Many patients consider herbal remedies to be completely free of unwanted side effects. However, we found that many herbal products have biological activities that can lead to severe hepatotoxicity.