Research progress of traditional Chinese medicine in the treatment of endocrine metabolic diseases in 2023

This study aimed to provide a comprehensive review of the research progress in Chinese medicine in the treatment of endocrine metabolic diseases in 2023,covering traditional Chinese medicine(TCM)monomers,TCM extracts,and TCM combinations,including non-alcoholic fatty liver disease,type 2 diabetes mellitus and its complications,obesity,hyperuricaemia,and thyroid disorders.After systematic sorting and summary,we found that in 2023,the research focusing on the application of TCM for endocrine metabolic diseases was still on the mechanism of action at the cellular and molecular levels,which not only influenced the classical pathways of lipid metabolism,but also delved into the key mechanisms of anti-inflammation,anti-oxidation,anti-insulin resistance,and so on.Additionally,TCM has shown remarkable results in the treatment of endocrine metabolic diseases by improving intestinal flora disorders and abnormal cellular iron death.These research results provide valuable ideas,methods,and tools for TCM in the prevention and treatment of endocrine metabolic diseases,and provide important references and guidance for future research and practice.

Current Research Status of Traditional Chinese Medicine External Treatment for Diarrhea Type Irritable Bowel Syndrome

Irritable bowel syndrome(IBS-D)with diarrhea is a common gastrointestinal functional disease in clinical practice,which seriously affects the quality of life of patients.Cur‐rently,Western medicine has poor therapeutic effects,while traditional Chinese medi‐cine has unique advantages in relieving IBS-D symptoms and preventing recurrence.In recent years,especially with external treatment of traditional Chinese medicine,it has become a new treatment direction in clinical practice and has achieved good therapeutic effects.This article will provide a review of recent research on the treatment of IBS-D using traditional Chinese medicine external treatment methods.

Analysis of new therapeutic strategies for diabetes mellitus based on traditional Chinese medicine'xiaoke'formulae

Objective:To develop new therapeutic strategies for diabetes mellitus(DM)by analyzing the mechanisms of action of traditional Chinese medicine(TCM)'xiaoke'formulae(TCM prescriptions for remedying xiaoke).Methods:We characterized 291 xiaoke formulae,including the herbs contained,chemical composition,constituents'targets,and corresponding genes.Xiaoke-related genes were retrieved based on the relationships of constituents'targets and xiaoke formulae,and a threshold of over 95.88%occurrence of each constituent target in the 291 TCM formulae served as a definition for xiaoke-related genes.Upon comparison with DM-related genes in the DisGeNET database,the genes differing in expression between cases administered TCM and synthetic drugs were explored using a TCM grammar system.Results:The results showed that xiaoke formulae and 14 exclusively xiaoke-related genes were significantly associated with multiple biological processes closely related to DM and diabetic complications(P<.01).Moreover,intervention in the expression of these xiaoke-related genes would affect DM-related genes directly or indirectly.Conclusion:The 14 xiaoke-related genes APEX1,EHMT2,TSHR,CBX1,FEN1,GMNN,JUN,KMT2A,MAPT,POLl,USP1,PIN1,POLB,and POLK can serve as candidate genes for antidiabetic drug design.Compared with DM-related genes in DisGeNET,intervention in the expression of 14 xiaoke-related genes by TCM formulae has the potential to not only lower blood glucose,but also reduce the occurrence of some side effects and inhibit the development of diabetic complications.These findings will contribute to the discovery of new strategies for treating DM.

Analysis on the medication and methods of ancient traditional Chinese medicine in the prevention of plague

Background:To analyze the medication and methods of ancient traditional Chinese medicine for the prevention of plague and seasonal pathogen in order to reduce the spread of infectious diseases such as flu and protect the susceptible people.Methods:Search the medication and the methods for preventing plague and seasonal pathogen in the Chinese Medical Code,classify and summarize the methods,perform frequency analysis and efficacy cluster analysis on Chinese medicines of involved medicines.Results:The methods of preventing ancient plague were as follows:burning and fumigating Chinese medicines,medicating nostrils,wearing bags filled with Chinese medicines,oral Chinese medicines and applying medicines to skin.The 3 main ways for drugs to work were external medication,nostril inhalation,and internal absorption.The Chinese medicines for preventing plague are mostly warm in nature and pungent in flavour,belonging to the spleen,stomach,liver,lung meridian.The 3 categories of drugs obtained by cluster analysis are C1:drugs for facilitating lung,relieving exterior and dissipating cold,such as Cangzhu(Atractylodis rhizoma)-Qianghuo(Notopterygh rhizoma et radix)-Xixin(Asari radix et rhizoma)-Baizhi(Angelicae dahuricae radix)-Fangfeng(Saposhnikoviae radix)-Zaojiao(Gleditsiae sinensis fructus);C2:drugs for promoting blood circulation and removing blood stasis,such as Xionghuang(Realgar)-Zhusha(Cinnabaris)-Dahuang(Rhei radix rhizoma)-Chuanxiong(Chuanxiong rhizoma)-Jiegeng(Platycodonis radix);C3:drugs for replenishing Qi(it is the most basic element that constitutes human body and maintains life activities in traditional Chinese medicine)and tonifying the spleen,such as Gancao(Glycyrrhizae radix et rhizoma)-Dazao(Jujubae fructus)-Ganjiang(Zingiberis rhizoma)-Rougui(Cinnamomi cortex)-Gansong(Nardostachyos radix et rhizoma)-Chenpi(Citri reticulatae pericarpium)-Baizhu(Atractylodis macrocephalae rhizoma).Conclusion:Through analysis the medication and methods of ancient traditional Chinese medicine for the prevention of plague,we can provide reference for modern research from the original plague prevention methods,and make an important contribution to the use of traditional Chinese medicine in the prevention and treatment of epidemic infectious diseases in modern clinic.

General Situation of Traditional Chinese Medicine Identification Methods

Traditional Chinese medicines are the material basis for the treatment of diseases under theoretical direction, as well as the raw materials of traditional Chinese medicine decoction pieces and Chinese patent medicines. The quality of traditional Chinese medicine directly influences clinical efficacy. Therefore, the identification of traditional Chinese medicine is the responsibility of medicinal workers. The identification method develops from observation, tasting, smelling and listening to firing method and testing with water, and the construction of fingerprints of traditional Chinese medicines and molecular biological techniques. The development and evolution of traditional Chinese medicine identification methods was reviewed in this paper.

Safety Research in Traditional Chinese Medicine: Methods, Applications, and Outlook

Traditional Chinese medicine (TCM) is a medical system that has collected and summarized abundant clinical experience over its long history of more than 2000 years. However, the frequent occurrence of TCM-induced adverse reactions has hindered the modernization and internationalization of TCM, while attracting increasing attention from around the world. Unlike chemical drugs and biological agents, the difficulties involved in research on the toxicity and safety of TCM mainly include the complexity of its components and the unpredictability of drug–body interactions. Much of TCM, which has overall therapeutic effects, has the typical mechanisms of multiple components, multiple pathways, and multiple targets. While considering the gradualness and unpredictability of TCM toxicity, the ambiguity of toxicants and safe dosage, and individual differences during long-term TCM administration, we have systematically established key techniques for the toxicity assessment of TCM. These techniques mainly include TCM toxicity discovery in an early phase, based on a combination of drug toxicology genomics and metabolomics;methods to identify dose–toxicity relationships in TCM;and integrated techniques for the exploration of TCM interactions, such as fast-screening tests based on drug-metabolizing enzymes and receptor pathways. In particular, we have developed a new technical system for TCM safety evaluation using molecular toxicology, which has been validated well in research on TCM compatibility contraindication, quality control, and allergen discovery. The application of this key technical platform is introduced here in detail. This application includes model organisms, toxicant biomarkers, a magnetic suspension technique, and the application of network toxicology and computational toxicology in research on the toxicity of Fructus toosendan, Semen cassiae, Polygonum multiflorum, and Fructus psoraleae.

Traditional Chinese medicine for prevention and treatment of hepatocarcinoma: From bench to bedside

Traditional Chinese medicine(TCM) has played a positive role in the management of hepatocarcinoma. Hepatocarcinoma patients may present Qi-stagnation, damp-heat, blood stasis, Qi-deficiency, Yin-deficiency and other TCM syndromes(Zheng). Modern treatments such as surgery, transarterial chemoembolization(TACE) and high intensity focus ultrasound treatment would influence the manifestation of TCM syndromes. Herbs with traditional efficacy of tonifying Qi, blood and Yin, soothing liver-Qi stagnation, clearing heat and detoxifying and dissolving stasis, have been demonstrated to be potent to prevent hepatocarcinogenesis. TCM has been widely used in all aspects of integrative therapy in hepatocarcinoma, including surgical resection, liver transplantation, TACE, local ablative therapies and even as monotherapy for middle-advanced stage hepatocarcinoma. Clinical practices have confirmed that TCM is effective to alleviate clinical symptoms, improve quality of life and immune function, prevent recurrence and metastasis, delay tumor progression, and prolong survival time in hepatocarcinoma patients. The effective mechanism of TCM against hepatocarcinoma is related to inducing apoptosis, autophagy, anoikis and cell senescence, arresting cell cycle, regulating immune function, inhibiting metastasis and angiogenesis, reversing drug resistance and enhancing effects of chemotherapy. Along with the progress of research in this field, TCM will contribute more to the prevention and treatment of hepatocarcinoma.

Effectiveness and safety of traditional Chinese medicine for diabetic retinopathy:A systematic review and network meta-analysis of randomized clinical trials

BACKGROUND Diabetic retinopathy(DR)is currently recognized as one of the most serious diabetic microangiopathies and a major cause of adult blindness.Commonly used clinical approaches include etiological control,microvascular improvement,and surgical intervention,but they are ineffective and have many side effects.Oral Chinese medicine(OCM)has been used for thousands of years to treat DR and is still widely used today,but it is unclear which OCM is more effective for DR.AIM To estimate relative effectiveness and safety profiles for different classes of OCMs for DR,and provide rankings of the available OCMs.METHODS The search time frame was from the creation of the database to January 2023.RevMan 5.3 and Stata 14.0 software were used to perform the systematic review and Network meta-analyses(NMA).RESULTS A total of 107 studies and 9710 patients were included,including 4767 cases in the test group and 4973 cases in the control group.Based on previous studies and clinical reports,and combined with the recommendations of Chinese guidelines for the prevention and treatment of DR,9 OCMs were finally included in this study,namely Compound Xueshuantong Capsules,Qiming Granules,Compound Danshen Dripping Pills,Hexue Mingmu Tablets(HXMM),Qiju Dihuang Pills(QJDH),Shuangdan Mingmu Capsules(SDMM),Danggui Buxue Decoction(DGBX),Xuefu Zhuyu Decoction and Buyang Huanwu Decoction.When these nine OCMs were analyzed in combination with conventional western medicine treatment(CT)compared with CT alone,the NMA results showed that HXMM+CT has better intervention effect on the overall efficacy of DR patients,HXMM+CT has better effect on improving patients'visual acuity,SDMM+CT has better effect on inhibiting vascular endothelial growth factor,DGBX+CT has better effect on reducing fundus hemorrhage area,HXMM+CT has better effect on reducing fasting blood glucose,and QJDH+CT has better effect on reducing glycated hemoglobin.When there are not enough clinical indicators for reference,SDMM+CT or HXMM+CT treatments can be chosen because they are effective for more indicators and demonstrate multidimensional efficacy.CONCLUSION This study provides evidence that combining OCMs with CT leads to better outcomes in all aspects of DR compared to using CT alone.Based on the findings,we highly recommend the use of SDMM or HXMM for the treatment of DR.These two OCMs have demonstrated outstanding efficacy across multiple indicators.

Methodological exploration on the construction of a traditional Chinese medicine nursing expert consensus based on evidence--taking stroke as an example

Objective: To explore the methodology of the evidence-based expert consensus formulation process of traditional Chinese medicine(TCM) nursing taking stroke as an example.Methods: First, preliminary and comprehensive presentation of all stroke-related symptoms and corresponding TCM nursing techniques involved were revealed through bibliometric analysis. Then, selection of stroke symptoms and TCM nursing techniques for inclusion in the consensus was performed using an expert consultation method. Next, we determined the search strategy for a precise evidence search;conducted an evaluation of evidence quality and the grade of the evidence;and completed evidence extraction, evidence analysis, and evidence synthesis based on the included symptoms and TCM nursing techniques. The Delphi method was then applied to determine the strength of each recommendation and the choice of nursing care points by referring to the Grading of Recommendations, Assessment, Development, and Evaluations grid. Finally, we conducted an external expert validation of the Delphi results to form an expert consensus guideline.Results: Through the bibliometric analysis, 22 stroke symptoms and 18 TCM nursing techniques were identified in the literature. Then, after expert consultation, 22 symptoms and 111 pairs of symptoms combined with TCM nursing techniques were selected for the evidence search. Evidence integration yielded 10 stroke symptoms corresponding to 29 bodies of evidence;these 10 symptoms were retained through the Delphi consultation, and recommendation strength results for 26 recommendations were obtained. A total of 9 symptoms were further retained for expert external validation to form 24 recommendations, with a recommendation process score range of 7.64-9.99 points and a more scientific and standardized recommendation-formation process.Conclusion: Owing to the current limited conditions of evidence-based resources for TCM nursing, the present consensus-building process represents only a preliminary exploration of an evidence-based expert consensus for TCM nursing to provide a reference for a more scientific and standardized methodology.

Comparative study on the anti-tuberculous effect and mechanism of the traditional Chinese medicines NiuBeiXiao He extract and JieHeWan

Background:The traditional Chinese medicine NiuBeiXiaoHe(NBXH)extract and Chinese medicine preparation JieHeWan(JHW)exhibit anti-tuberculosis(TB)effects.The anti-TB effect of NBXH was compared with that of JHW to elucidate the mechanism of action of NBXH.Methods:BALB/c mice aged 6-8 weeks were randomly divided into a normal control group,TB model group,JHW treatment group,and NBXH treatment group.After 3 and 13 weeks of treatment,the therapeutic effect in each group was evaluated by comparing lung histopathology,lung and liver colony counts,the number of spots representing effector T cells secreting IFN-γin an enzyme-linked immunospot assay(ELISPOT),and the levels of Th1,Th2,and Th17 cytokines,which were measured by a cytometric bead array(CBA).Mouse RNA samples were subjected to transcriptome sequencing.Results:After 13 weeks of treatment,the mean histopathological lesion area of the NBXH group was significantly smaller than that of the TB model group(P<0.05).Compared with those in the TB model group,the lung colony counts in the JHW and NBXH groups were significantly decreased(P<0.05),and the IL-2 and IL-4 levels in the NBXH group were significantly increased(P<0.05).NBXH partly restored significant changes in gene expression caused by Mycobacterium tuberculosis(M.tuberculosis)infection.According to GO and KEGG analyses,the changes in biological process(BP),cell composition(CC)and molecular function(MF)terms and in signaling pathways caused by NBXH and JHW treatment were not completely consistent,but they were mainly related to the immune response and inflammatory response in the mouse TB model.Conclusions:NBXH had therapeutic effects similar to those of JHW in improving lung histopathology,reducing lung colony counts,and regulating the levels of cytokines.NBXH restored significant changes in gene expression and repaired cell damage caused by M.tuberculosis infection by regulating immune-related pathways,which clarified the mechanism of action of NBXH.

Research progress of data mining in the treatment of hypertension by traditional Chinese medicine

With the gradual development of data mining technology,more and more data mining software emerges as the times require,and the data mining methods are diversified,which provides a strong support in the study of the treatment of hypertension by traditional Chinese medicine.This research systematically introduces the advantages,disadvantages and application examples of data mining software such as SPSS,TCM inheritance support platform,TCM clinical research information sharing system and data mining methods such as cluster analysis,bayesian network,system evaluation.It is expected to enhance the practical application of data mining in the study of prevention,diagnosis and medication rule of TCM treatment of hypertension,and provide reference for the development of new software and new technology.

Exploring the Application Effect of Flipped Classroom Combined with Problem-Based Learning Teaching Method in Clinical Skills Teaching of Standardized Training for Resident Doctors of Traditional Chinese Medicine

Objective: To explore the application effect of flipped classroom combined with problem-based learning teaching method in clinical skills teaching of standardized training for resident doctors of traditional Chinese Medicine. Methods: The study used the experimental control method. The study lasted from September to November 2022. The subjects of this study were 49 students of standardized training for resident doctors of traditional Chinese Medicine from grades 2020, 2021 and 2022 of Dazhou integrated TCM & Western Medicine Hospital. They were randomly divided into experiment group (25) and control group (24). The experiment group adopted flipped classroom combined with problem-based learning teaching method, and the control group adopted traditional teaching method. The teaching content was 4 basic clinical skill projects, including four diagnoses of traditional Chinese Medicine, cardiopulmonary resuscitation, dressing change procedure, acupuncture and massage. The evaluation method was carried out by comparing the students’ performance and a self-designed questionnaire was used to investigate the students’ evaluation of the teaching method. Results: The test scores of total scores in the experimental group (90.12 ± 5.89) were all higher than those in the control group (81.47 ± 7.96) (t = 4.53, P P Conclusions: The teaching process of the flipped classroom combined with problem-based learning teaching method is conducive to improving the efficiency of classroom teaching, cultivating students’ self-learning ability, and enhancing students’ willingness to learn.

Study on traditional Chinese medicine syndrome of esophageal cancer based on Delphi method

Esophageal cancer is one of the common malignant tumors in humans.Traditional Chinese medicine(TCM)has unique advantages in the treatment of esophageal cancer.However,the TCM syndrome classification of esophageal cancer is not standardized.This Delphi survey aimed to explore the TCM syndrome classification and symptom characteristics of esophageal cancer.Methods:Based on literature research,an expert consultation questionnaire was developed for the study of the TCM syndrome rules of esophageal cancer.Two rounds of questionnaire surveys were conducted among 62 experts across the country.Statistical description and statistical analysis of the mean,coefficient of variation,grade sum,and unimportant percentage of the retrieved data.TCM syndrome rules and diagnostic indicators for esophageal cancer after screening and sorting out the questionnaire items,convening experts to demonstrate.Results:62 valid questionnaires were collected,and the expert positive coefficient was 100%.The Kendall's coefficient of concordance W of the first and second rounds are 0.232 and 0.2334 respectively.In addition,the Kendall's coefficient of concordance W of the second round has been improved compared with the first round,suggesting that experts have a better degree of coordination on the importance of indicators.The common TCM syndromes of esophageal cancer are obtained:"liver-stomach disharmony,phlegm and qi obstruction syndrome","liver and spleen disorders,phlegm accumulating with stagnation syndrome","deficiency of liver and kidney yin,stubborn blood syndrome","deficiency of spleen and kidney yang,stubborn blood syndrome".Conclusion:The TCM syndrome indicators of esophageal cancer has been established.It provides a basis for the standardized research of TCM syndrome diagnosis of esophageal cancer,which is of positive significance for improving the level of clinical diagnosis and treatment.

A Review of Traditional Chinese Medicine for the Treatment of Depression

Depression is a common mental illness with symptoms such as loss of interest.At present,It is mainly treated with antidepressants,which are effective in a short time,but it is highly addictive and has a high probability of adverse reactions.Traditional Chinese medicine(TCM)treatment of depression has the advantages of high feasibility,good tolerance,obvious effect,and small side effects.In addition,TCM has great potential for the treatment of depression with the overall concept of the unity of nature and man as its guiding ideology and rich clinical experience.This review mainly expounds on the research progress of TCM treatment of depression from two aspects of TCM non-drug therapy and TCM drug therapy,to provide a reference for clinical treatment of depression.

Discussion on the Quality Evaluation Method of Traditional Chinese Medicine Compound Preparations

As an important representative of the modernization of the Chinese medicine industry,traditional Chinese medicine(TCM)compound preparations are an indispensable part of the development of TCM.The complex ingredients and unclear action mechanism of TCM compound preparations restrict the development of TCM.In line with this problem,the modern TCM research has made extensive remarkable achievements.From the single indicator in the past to multiple indicator,the research on the combination of TCM fingerprints and pharmacodynamics also has made great progress.The introduction of quality evaluation methods such as the"quantitative analysis of multi-components by a single marker","dose-effect"indicator,"Bioactive Equivalent Combinatorial Components"(BECCs)and TCM quality markers have brought new ideas for quality control of TCM compound preparations.

Construction of Complex Intervention in Traditional Chinese Medicine (TCM): A Preliminary Methodological Study Based on Text Mining and Interviewing Method

Aim: To explore and analyze the feasibility of establishing a program of complex intervention in Traditional Chinese Medicine (TCM) based on Text Mining and Interviewing method. Methods: According to MRC, Constructing the program of complex intervention in TCM by Text Mining and Interviewing method should include 4 steps: 1) establishment of interview framework via normalization of extraction of ancient documents and Effectiveness of collection of modern periodical literatures;2) materialization of interview outline based on Focus Group Interview;3) rudimentary construction of complex intervention program based on Semi-structured Interview;4) evaluation of curative effect of complex intervention. Conclusions: It is feasible and significative to establish a program of complex intervention in TCM based on Text Mining and Interviewing method.

Progress on Therapy of Infertility by Integrated Traditional Chinese and Western Medicine

Infertility is one of the difficult complicated diseases. Many couples suffer from it. The pathogenesis is very complicated. The imbalance or lesson of any link of the reproductive system can cause infertility. This paper summarizes the treatment of female infertility by integrated Traditional Chinese Medicine (TCM) and Western Medicine (WM) which can not only improve the ovulation rate and pregnancy rate, but also decrease the complications. The effects are better than that by TCM or WM only. Therefore, the coupling method is worth to be used widely in clinical practice.

Construction of nursing standard of integrated traditional Chinese and Western medicine for patients with COVID‑19 (mild and common) in Beijing based on Delphi method

Objective:The objective of this study is to establish a nursing standard of integrated traditional Chinese and Western medicine for patients with COVID‑19(mild and common)in Beijing,to provide reference for clinical nursing of patients with COVID‑19(mild and common).Methods:Through online communication meeting with nurses who are in the frontline of anti‑epidemic,clinical investigation,literature research,and expert demonstration meeting are carried out to prepare the draft of the standard,and the Delphi method is applied to determine the standard of integrated traditional Chinese and Western medicine care for patients with COVID‑19(mild and common)in Beijing.Results:The nursing standard of integrated traditional Chinese and Western medicine for patients with COVID‑19(mild and common)was established,which included 5 first‑level indicators,14 second-level indicators and 60 third‑level indicators.After two rounds of Delphi method,the positive coefficients of experts were 96%and 83%,the authoritative coefficients of experts were 0.89 and 0.91,and the Kendall’s coefficient of concordance(W)of experts were 0.12,0.09,0.10,0.13(P<0.05)and 0.44,0.43,0.37,0.39(P<0.05).Conclusion:The standard of integrated traditional Chinese and Western medicine nursing for patients with COVID‑19(mild and common)in Beijing constructed by the Delphi method is scientific and practical,which provides a reference for clinical application of integrated traditional Chinese and Western medicine nursing to fight against COVID‑19 infection.

A Skopos Theory-based Study of Translation Principles of Traditional Chinese Medicine Decoctions

English translations of Traditional Chinese medicine(TCM)terms and prescriptions need standardizing to minimize ambiguity as the popularity of TCM spreads globally.Herein an evaluation guide for translation of TCM decoctions in English into diverse social,cultural and medical systems,is proffered which integrates Skopos theory and Li Zhaoguo’s principles of English translation(conciseness of lexical composition,information accuracy,and similarity in lexical composition).Based on a case study of the traditional herbal medicine Mahuang Xingren Gancao Shigao Tang,direct translation methods with concise lexical composition are determined to most clearly convey the sophisticated and verbose original TCM prescription.

Herbal Traditional Chinese Medicine and suspected liver injury: A prospective study

AIM To analyze liver tests before and following treatment with herbal Traditional Chinese Medicine(TCM) in order to evaluate the frequency of newly detected liver injury.METHODS Patients with normal values of alanine aminotransferase(ALT) as a diagnostic marker for ruling out pre-existing liver disease were enrolled in a prospective study of a safety program carried out at the First German Hospital of TCM from 1994 to 2015. All patients received herbal products, and their ALT values were reassessed 1-3 d prior to discharge. To verify or exclude causality for suspected TCM herbs, the Roussel Uclaf Causality Assessment Method(RUCAM) was used.RESULTS This report presents for the first time liver injury data derived from a prospective, hospital-based and largescale study of 21470 patients who had no liver disease prior to treatment with herbal TCM. Among these, ALT ranged from 1 × to < 5 × upper limit normal(ULN) in 844 patients(3.93%) and suggested mild or moderate liver adaptive abnormalities. However, 26 patients(0.12%) experienced higher ALT values of ≥ 5 × ULN(300.0 ± 172.9 U/L, mean ± SD). Causality for TCM herbs was RUCAM-based probable in 8/26 patients, possible in 16/26, and excluded in 2/26 cases. Bupleuri radix and Scutellariae radix were the two TCM herbs most commonly implicated. CONCLUSION In 26(0.12%) of 21470 patients treated with herbal TCM, liver injury with ALT values of ≥ 5 × ULN was found, which normalized shortly following treatment cessation, also substantiating causality.