herbal prescription patterns at an aom university teaching clinic

Herbal Prescription Patterns at an Acupuncture and Oriental Medicine University Teaching Clinic

According to the 2007 National Institute of Health (NIH) survey, 55.1 million U.S. adults reported use of herbal supplements; and this number has nearly doubled since 1999. In 2007, 25.4% of adults reported to have used herbs or supplements. Herbs are an integral component to the practice of traditional Chinese medicine (TCM). There is currently no known data on the usage patterns and frequency of Traditional Chinese Medicine (TCM) herbal formulas in the United States. The only data recorded in the United States regarding Chinese herb usage are limited to a few single herbs like dong quai (dang gui), ephedra (ma huang), ginger (gan jiang), ginkgo biloba (bai guo) ginseng (ren shen), licorice (gan cao) and peppermint (bo he). Recent NCCAM data has shown increased use in acupuncture, but did not provide information on the usage patterns of TCM herbal formulas. It is important to understand the frequency of herbal prescriptions, in order to understand the practitioner preferences and the characteristics of TCM patients.

Purpose To identify and provide preliminary data on the herbal prescription patterns and frequency of TCM formulas within a university clinic setting in the United States.

Judith Miller, BA, MAOM (c) S. Prasad Vinjamury, MD (Ayurveda), MAOM, MPH; Thales Ruela, MAOM, Physical Therapy (Brazil) Clifford Lee, MSAOM, DAOM (c), Dipl. OM

Background

Methods

Results

References 1.  Wu C-H, Wang C-C, Kennedy J. Changes in herb and dietary supplement use in

the U.S. adult population: a comparison of the 2002 and 2007 National Health Interview Surveys. Clin Ther. 2011;33(11):1749–1758.

2.  Kennedy J. Herb and supplement use in the US adult population. Clin Ther. 2005;27(11):1847–1858. 3. Wong LK, Jue P, Lam A, Yeung W, Cham-Wah Y, Birtwhistle R. Chinese herbal medicine and acupuncture. How do patients who consult family physicians use these therapies? Can Fam Physician. 1998;44:1009–1015.

3.  Yang Y-H, Chen P-C, Wang J-D, Lee C-H, Lai J-N. Prescription pattern of traditional Chinese medicine for climacteric women in Taiwan. Climacteric. 2009;12(6):541–547

4.  The Use of Complementary and Alternative Medicine in the United States. Available at: http://nccam.nih.gov/news/camstats/2007/camsurveyfs1.htm.

From January 2011 to September 2013, majority of the same granule and bottle formulas (n=25) were prescribed each year, but changed in ranking. The most common granule formula prescribed was Bi Yian Pian (TCM Zone® patented formula that is a modification of Cang Er San. Among capsuled form, Chai Hu Jia Long Gu Mu Li was the most prescribed formula from 2011 to present. The yearly percentage of total number of prescriptions compared to total number of visits at the University Health Center and the yearly percentage of the most frequently prescribed form of herbs are provided in Table 1 and 2.

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A retrospective data analysis was conducted by reviewing all the prescription logs from January 2011 to September 2013 at the Herbal Pharmacy in the University Health Center, Whittier, CA. The prescriptions logs included Chinese herbal formulas in three categories: 1. A single dose packet in granular form, 2. Multi-dose 100 herbal capsules in a sealed bottle form and 3. Raw customized herbal prescriptions. The frequency of prescriptions for each category were counted for each year and were reported using Descriptive Statistics. However, the top 25 formulas in each category are being reported here.

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Discussion and Conclusion The yearly herbal prescriptions at our university health center ranged from 21% to 26%.The granular form and the capsules are more frequently prescribed than the raw herbs. The variations in the herbal prescription frequency and the choice of dosage form may be explained by the number of clinicians in the clinic, their educational background, years of experience, and individual practicing preferences. Additionally, patient conditions, patient affordability and availability of herbs may all have an influence over the frequency of herbal prescriptions and the selection of specific dosage form. Our analysis has several limitations. All prescription orders were manually logged and are entered by student workers and are not double checked allowing a scope for human error. We also did not account for the dosage frequency and duration of each prescription to accurately determine the frequency of prescription of a specific herbal formula or dosage form. Herbal prescriptions are received by approximately one fourth of patients who visit SCU University Health Center. Pre-packed Chinese herbal capsules and granules are more commonly used than the customized raw herbal formulas. It is recommended that the diagnoses of the patients who receive the herbal prescriptions be recorded in future years to identify and correlate patient characteristics with herbal prescriptions.

Year Total Number of Patient Visits

Total Number of Herbal Prescriptions

Percentage (SD)

2011 10339 2658 25.71 (6.02) 2012 10392 2211 21.36 (3.02) 2013* 6838* 1629* 23.82 (2.64)

Year Raw Herb % Capsule % Granule %

2011 29.48% (16.59) 38.17% (8.97) 32.35 (12.28)

2012 17.02% (3.91) 40.41% (5.59) 42.57 (6.47)

2013 13.42% (4.33) 38.21% (4.6) 48.38 (7.22)

0 500 1000 1500

Bi Yan Pian

Yin Qiao San

Jia Wei Xiao Yao San

Xiao Yao San

Xiao Feng San

Chuan Xiong Cha Tiao San

Huang Lian Jie Du Tang

Yu Ping Feng San

Gui Pi Tang

Ba Zhen Tang

Ba Zheng San

Zhi Sou San

Shen Ling Bai Zhu San

Jin Gui Shen Qi Wan

Kang Ning San

Geng Nian An

Xiang Sha Liu Jun Zi Tang

Bu Zhong Yi Qi Tang

Juan Bi Tang

Zhi Bai Di Huang Wan

Qi Ju Di Huang Wan

Gui Zhi Tang

Ban Xia Hou Pu Tang

Qing Xin Lian Zi Yin

Chai Hu Shu Gan Tang

Number of Prescriptions

Form

ula

2011 Most Prescribed Granules

0 500 1000 1500

Bi Yan Pian


Yin Qiao San


Xiao Feng San

Xiao Yao San




Gui Pi Tang

Ba Zheng San

Juan Bi Tang

Bu Zhong Yi Qi Tang

Gui Zhi Tang

Zhi Gan Cao Tang

Tian Wang Bu Xin Dan

Long Dan Xia Gan Tang

Zhi Sou San

Ban Xia Xie Xin Tang

Xue Fu Zhu Yu Tang

Yu Ping Feng San

Ma Zi Ren Wan

Tao Hong Si Wu Tang


Form

ula


0 200 400 600 800 1000

Bi Yan Pian


Yin Qiao San

Xiao Yao San

Xiao Feng San


Gui Pi Tang



Ban Xia Hou Pu Tang

Xiao Chai Hu Tang

Ba Zheng San


Chai Hu Shu Gan Tang

Chai Hu Qing Gan Tang


Tao Hong Si Wu Tang

Zhi Sou San

Gui Zhi Tang

Xue Fu Zhu Yu Tang

Yu Ping Feng San

Bu Zhong Yi Qi Tang

Xiang Su San

Ma Zi Ren Wan

Gan Mai Da Zao Tang


Form

ula


0 10 20 30 40 50

Chai Hu Jia Long Gu Mu Li Tang

Zhi Bao Di Huang Wan

Dang Gui Bu Xue Tang

Suan Zao Ren Tang

Du Huo Ji Sheng Tang


Liu Wei Di Huang Wan


Xiao Yao San

Juan Bi Tang


Long Dan Xie Gan Tang

Qi Ju Di Huang Wan

Tian Ma Gou Teng Yin

Ba Zheng San

Xiao Feng San

Ma Zi Ren Wan

Bu Zhong Yi Qi Tang

Gan Lu Xiao Du Dan

Gui Pi Tang

Tao Hong Si Wu Tang

Xue Fu Zhu Yu Tang

Fang Feng Tong Sheng San

You Gui Wan

Ban Xia Bai Zhu Tian Ma Tang


Form

ula

2011 Most Prescribed Bottles

0 10 20 30 40 50






Juan Bi Tang



Xiao Yao San

Qi Ju Di Huang Wan

Shen Tong Zhu Yu Tang

Dan Shen Yin



Gui Pi Tang


Yu Ping Feng San

Bu Zhong Yi Qi Tang

Long Dan Xie Gan Tang

Ren Shen Yang Rong Tang


Sheng Mai San

Shu Jing Huo Xue Tang

Suan Zao Ren Tang

Xiao Feng San


Form

ula


0 10 20 30 40 50




Suan Zao Ren Tang





Xiao Yao San


Gui Pi Tang

Qi Ju Di Huang Wan

Ba Zhen Tang

Juan Bi Tang

Shu Jing Huo Xue Tang



Xiao Feng San


Ban Xia Xie Xin Tang

Shao Fu Zhu Yu Tang

Qing Fei Tang

Shen Tong Zhu Yu Tang

Zhi Gan Cao Tang

Wen Dan Tang


Form

ula


Table 1: Yearly Percentage of Herbal Prescriptions to Total Number of Patient Visits

Table 2: Yearly Percentage of Raw Herbs, Bottles or Granules Prescribed

* 2013 data is until September only

herbal prescription patterns at an aom university teaching clinic

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