Recovery of an Elderly Kwashiorkor Patient by Korean Medicine: A Case Report

Article information

J Korean Med. 2021;42(1):129-135
Publication date (electronic) : 2021 March 01
doi :
1Department of Internal Korean Medicine, College of Korean Medicine, Daejeon University
2Liver and Immunology Research Center, Oriental Medical College in Daejeon University
Correspondence to: Chang-Gue Son, Liver and Immunology Research Center, Daejeon Oriental Hospital of Daejeon University, Daedeokdae-ro 176 beon-gil 75, Seo-gu, Daejeon, Republic of Korea, Tel: +82-42-484-6484, Fax: +82-42-470-9005, E-mail:
Received 2021 February 3; Revised 2021 February 16; Accepted 2021 February 18.



The present study reports case of an elderly kwashiorkor patient who was treated with Korean Medicine.


A 68-year-old female patient with weight loss, general weakness, chills, anorexia, and dizziness after over 100 episodes of diarrhea visited the hospital. Blood tests showed hypoalbuminemia and anemia, and ultrasonography revealed fatty liver disease. The patient was diagnosed with kwashiorkor, and her symptom differentiation was Yang deficiency followed by Both Qi-Blood deficiency. Sayeok-Tang, Soshiho-Tang, Insamyangyeong-Tang, and Gongjin-Dan, herbal drugs, were given to the patient during 40 days of hospitalization.


After 40 days of hospitalization, her symptoms were reduced, and the blood test results improved.


This case presents the therapeutic potential of Korean medicine in the treatment of kwashiorkor.

Fig. 1

Summary of clinical outcome and treatment course.

Composition of Drugs

Course of Laboratory Test Results


1. De Onis M, Monteiro C, Akré J, Glugston G. The worldwide magnitude of protein-energy malnutrition: an overview from the WHO Global Database on Child Growth. Bull World Health Organ 1993;71(6):703.
2. Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN guidelines on enteral nutrition: terminology, definitions and general topics. Clin Nutr 2006;25(2):180–186.
3. Cereda E, Pedrolli C, Klersy C, et al. Nutritional status in older persons according to healthcare setting: a systematic review and meta-analysis of prevalence data using MNA®. Clin Nutr 2016;35(6):1282–1290.
4. Healthcare Biagdata Hub. health insurance review & assessment service Published 2019. Accessed February 10, 2019.
5. Puntis JWL. Malnutrition in Developed Countries. Ann Nestlé (English ed) 2009;67(2):65–72.
6. Pennington CR. Disease-associated malnutrition in the year 2000. Postgrad Med J 1998;74(868):65–71.
7. Béhar M, Viteri F, Bressani R, et al. Principles of treatment and prevention of severe protein malnutrition in childeren (kwashiorkor). Ann N Y Acad Sci 1958;69(5):954–968.
8. Longo DL, Fauci AS, Kasper DL, et al. Harrison’s Principles of Internal Medicine 2012. Mcgraw-hill. New York: 2012.
9. Boirie Y, Morio B, Caumon E, et al. Nutrition and protein energy homeostasis in elderly. Mech Ageing Dev 2014;136:76–84.
10. Omran ML, Morley JE. Assessment of protein energy malnutrition in older persons, part I: History, examination, body composition, and screening tools. Nutrition 2000;16(1):50–63.
11. Norman K, Pichard C, Lochs H, et al. Prognostic impact of disease-related malnutrition. Clin Nutr 2008;27(1):5–15.
12. Kuniaki H, Akihiko T, Tetsuya H, et al. Improvement in Frailty in a Patient With Severe Chronic Obstructive Pulmonary Disease After Ninjin’yoeito Therapy: A Case Report. Front Nutr 2018;5(September):3–6.
13. Ogawa-Ochiai K, Kawasaki K. Panax ginseng for frailty-related disorders: a review. Front Nutr 2019;5:140.
14. Sasatani Y, Okauchi S, Ohara G, et al. Long-term maintenance of nutritional status with ninjinyoueito in terminal patients with chronic respiratory disease: Two case reports. Biomed Reports 2020;12(3):121–124.
15. May T, Klatt KC, Smith J, et al. Choline supplementation prevents a hallmark disturbance of Kwashiorkor in weanling mice fed a maize vegetable diet: hepatic steatosis of undernutrition. Nutrients 2018;10(5):653.
16. Fechner A, Böhme CC, Gromer S, et al. Antioxidant Status and Nitric Oxide in the Malnutrition Syndrome Kwashiorkor. Pediatr Res 2001;49(2):237–243.
17. van Zutphen T, Ciapaite J, Bloks VW, et al. Malnutrition-associated liver steatosis and ATP depletion is caused by peroxisomal and mitochondrial dysfunction. J Hepatol 2016;65(6):1198–1208.
18. Saunders J, Smith T. Malnutrition: causes and consequences. Clin Med (Northfield Il) 2010;10(6):624.
19. Frenk S. Metabolic adaptation in protein-energy malnutrition. J Am Coll Nutr 1986;5(4):371–381.
20. Coulthard GM. Oedema in kwashiorkor is caused by hypoalbuminaemia. Paediatr Int Child Health 2015;35(2):83–89.
21. Okada R, Nakachi S, Inokuma S. The severity of peripheral blood eosinophilia indicates an eosinophilia-associated disease corresponding to its level. Allergol Int 2016;65(1):112–114.
22. Walker C, Kägi MK, Ingold P, et al. Atopic dermatitis: correlation of peripheral blood T cell activation, eosinophilia and serum factors with clinical severity. Clin Exp Allergy 1993;23(2):145–153.
23. Trzeciak M, Gleń J, Bandurski T, et al. Relationship between serum levels of interleukin-18, IgE and disease severity in patients with atopic dermatitis. Clin Exp Dermatol 2011;36(7):728–732.
24. Lai F, Zhou G, Mai S, et al. Sini Decoction Improves Adrenal Function and the Short-Term Outcome of Septic Rats through Downregulation of Adrenal Toll-Like Receptor 4 Expression. Evid Based Complement Alternat Med 2018;20185186158.
25. Uto NS, Amitani H, Atobe Y, et al. Herbal Medicine Ninjin’yoeito in the Treatment of Sarcopenia and Frailty. Front Nutr 2018;5:126.
26. Hong SS, Lee J, Lee JS, et al. The traditional drug Gongjin-Dan ameliorates chronic fatigue in a forced-stress mouse exercise model. J Ethnopharmacol 2015;168:268–278.

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Fig. 1

Summary of clinical outcome and treatment course.

Table 1

Composition of Drugs

Drug Composition (g*)
Gongjin-Dan Cervi Parvum Cornu (0.8), Angelicae Gigantis Radix (0.8), Corni Fructus (0.8), Moschus berezovskii Flerove (0.08), Apis mellifera Linné (2)
Sayeok-Tang Glycyrrhizae Radix et Rhizoma (6), Zingiberis Rhizoma (5), Aconiti Lateralis Radix Preparata (4)
Insamyanyeong- Tang Paeoniae Radix (24), Zingiberis Rhizoma Recens (24), Angelicae Gigantis Radix (12), Cinnamomi Cortex (12), Citri Unshius Pericarpium (12), Zizyphi Fructus (12), Ginseng Radix (12), Atractylodis Rhizoma Alba (12), Astragali Radix (12), Glycyrrhizae Radix et Rhizoma (12), Anemarrhenae Rhizoma (12), Rehmanniae Radix Preparata (9), Schisandrae Fructus (9), Saposhnikoviae Radix (9), Polygalae Radix (6)

The indicated dose is weight of each herb for an adult during one day

Table 2

Course of Laboratory Test Results

Parameter Inpatient (week) Outpatient (week) Normal range

0 1 2 3 4 6 7 30
Total protein (g/dL) 5.6 5.7 6.1 6.2 6.7 6.5 - - 6.6–8.7
Albumin (g/dL) 1.9 1.8 2.5 2.7 2.7 2.8 - - 3.5–5.2
ALP (U/L) 149 123 99 78 81 83 - - 40–129
WBC (103/ul) 6.7 8.3 8.2 6.9 7.2 8.3 9.8 6.4 4.5–11.0
Eosinophil (%) 14.0 9.5 12.5 22.9 28.2 33.0 41.2 4.8 <5
Hemoglobin (g/dL) 10.5 9.6 8.7 8.8 9.7 9.9 10.4 11.7 12–16
IgE (IU/mL) 20955 - - - - 19376 - - <1000

ALP: alkaline phosphatase, WBC: white blood cell, IgE: Immunoglobulin E