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Associations Between Prescribed Chinese Herbal Medicine and Risk of Hepatocellular Carcinoma in Patients with Chronic Hepatitis B: A Nationwide Population-Based Cohort Study
BMJ Open
  • Tzung-Yi Tsai, Buddhist Dalin Tzu Chi General Hospital
  • Hanoch Livneh, Portland State University
  • Tsung-Hsing Hung, Buddhist Dalin Tzu Chi General Hospital
  • I-Hsin Lin, Buddhist Dalin Tzu Chi General Hospital
  • Ming-Chi Lu, School of Medicine, Hualien, Taiwan
  • Chia-Chou Yeh, Tzu Chi University
Document Type
Publication Date
  • Chinese Medicine,
  • Medicinal plants -- China,
  • Herbs -- Therapeutic use

Objective: Patients with chronic hepatitis B (CHB) are reported to exhibit higher risk of subsequent hepatocellular carcinoma (HCC). However, it remains unclear if Chinese herbal medicine (CHM), an important category of traditional Chinese medicine (TCM), may lower HCC risk in this population. So this study aimed to investigate the effects of CHM on HCC risk among patients with CHB.

Methods: This cohort study used the Taiwanese National Health Insurance Research Database to identify 21,020 newly diagnosed patients with CHB from 1998 to 2007. Among them, 8640 received CHM products after CHB onset (CHM users), and the remaining 12,380 patients were designated as a control group (non-CHM users). All enrolees were followed until the end of 2012 to measure the incidence rate and HR of HCC.

Results: During 15 years of follow-up, 371 CHM users and 958 non-CHM users developed HCC, representing an incidence rate of 5.28% and 10.18% per 1000 person-years, respectively. CHM users had significantly lower HCC risk compared with non-CHM users (adjusted HR=0.63, 95% CI 0.56 to 0.72). The predominant effect was observed in those receiving CHM products for more than 180 days (adjusted HR=0.52). Some CHM products, such as Hedyotis diffusa, Scutellaria barbata, Rehmannia glutinosa, Isatis tinctoria, Yi Guan Jian, Xiao Chai Hu Tang, Wu Ling San and Gan Lu Yin, were significantly associated with lower risk of HCC.

Conclusions: The use of CHM was associated with a significantly reduced HCC risk in patients with CHB, which supports the integration of TCM with CHM into clinical practice to influence a favourable prognosis.


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Citation Information
Tsai, T.-Y., Livneh, H., Hung, T.-H., Lin, I.-H., Lu, M.-C., & Yeh, C.-C. (2017). Associations between prescribed Chinese herbal medicine and risk of hepatocellular carcinoma in patients with chronic hepatitis B: a nationwide population-based cohort study. BMJ Open, 7(1), e014571.