Four Case Reports on Treatment of elevated aminotransferase levels with Herbal medicine containing Artemisia capillaris as Principal Component

Article information

J Korean Med. 2021;42(3):165-175
Publication date (electronic) : 2021 September 01
doi :
1Department of Internal Medicine and Neuroscience, College of Korean Medicine, Wonkwang University, Iksan city, Republic of Korea
2Department of Korean Internal Medicine, Wonkwang University Gwangju Medical Center, Gwangju city, Republic of Korea
Correspondence to: Sangkwan Lee, Department of Internal Medicine, College of Korean Medicine, Wonkwang University, Iksan, Jeonbuk, 54538, Republic of Korea, Tel: +82-62-670-6412, E-mail:

Chu H and CH Kim are contributed equally.

Received 2021 April 22; Revised 2021 July 14; Accepted 2021 July 28.



Many herbal medications have been used to treat various liver diseases. But the concerns of herbal medicine induced liver injury also existed. In this respect, we would like to report several cases with imporved elevated liver aminotransferase after treating herbal medicine including Artemisia capillaris.

Case Reports

We report four patients with elevated aminotransferase levels (ATLs), which indicate hepatocellular damages. After receiving herbal medicines therapy containing Artemisia capillaris as principal component (HMA), the patients’ ATLs were improved. In the first case, the patient’s ATLs decreased into normal range after administration of HMA, although they have not been improved with hepatotonics for a long period. In the second case, the patient’s ATLs have been elevated after taking anticoagulants. The ATLs were improved with HMA without stopping anticoagulants. In the other two cases, the patients’ ATLs were also improved after taking HMA. In addition, there were no changes of previous drugs for treating the corresponding underlying diseases and no adverse events during HMA applications.

Result and Conclusion

The four patients received the herbal medicine containing Artemisia capillaris as principal component and showed improvement of ATLs. These cases suggest that HMA can be considered as alternative or complementary remedies to improve various liver diseases.

Fig. 1

The Patients’ ALTs decrease with taking HMA.

The numbers above cicles mean aminotransferase levels. Square boxes represent reference range. Upper and lower dotted line represent normal ALT and AST range. 0–44IU/L and 0–38IU/L respectively.

Abbreviations: HMA,Herbal Medicine containing Artemisia capillaris; SKT,Saeng-Kankunbi-Tang; CKT, Cheong-Kankunbi-Tang; IJORS, Injin-Oryongsan;

Components and 1time Dose of Herbal Medicine

Results of Laboratory Test. Comparisons of ATLs and Bilirubin between Administration and Follow Up

Composition of Per Os Medication


1. Wegener T. 2017;Patterns and trends in the use of herbal products, herbal medicine and herbal medicinal products. International Journal of Complementary & Alternative Medicine 9(6):317–319. 10.15406/ijcam.2017.09.0031.
2. Barnes PM, Powell-Griner E, McFann K, Nahin RL. 2004;Complementary and alternative medicine use among adults: United States, 2002. Advance data (343):1–19.
3. Xu J, Yang Y. 2009. Traditional Chinese medicine in the Chinese health care system. Health policy (Amsterdam, Netherlands) 90(2–3)133–139. .
4. Yoo TW, Kim BI, Kim JB, Kim DJ, Kim JW, Baik SK. 2007;The survey for the actual condition of drug medication and development of health care cost associated with toxic liver injury in Korean: a multicenter study for the detection and the development of nationwide reporting system of toxic liver injry. Korean J Hepatol 13(1):34–43.
5. Ekor M. 2014. The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety. Frontiers in pharmacology 4177. .
6. Suk KT, Kim DJ, Kim CH, Park SH, Yoon JH, Kim YS, et al. 2012. A prospective nationwide study of drug-induced liver injury in Korea. The American journal of gastroenterology 107(9)1380–1387. .
7. Kim NH, Jung HY, Cho SY, Park SU, Park JM, Ko CN. 2011. Liver enzyme abnormalities during concurrent use of herbal and conventional medicines in Korea: a retrospective study. Phytomedicine: international journal of phytotherapy and phytopharmacology 18(14)1208–1213. .
8. Lee J, Shin JS, Lee YJ, Kim MR, Shin BC, Lee JH, et al. 2019. Battle Over Herb-Induced Liver Injury: Low Prevalence Confirmed through Secondary Evaluation and Research Team’s Clarifying Rebuttal to Unwarranted Public Claims. Journal of alternative and complementary medicine (New York, NY) 25(3)260–264. .
9. Cho JH, Oh DS, Hong SH, Ko H, Lee NH, Park SE, et al. 2017. A nationwide study of the incidence rate of herb-induced liver injury in Korea. Archives of toxicology 91(12)4009–4015. .
10. Chu H, Park C, Kim C, Sung K, Lee S. Effectiveness and safety of Injinoryung-San-Gagambang (Yinchen Wuling powder) decoctionon stroke patients with elevated serum liverenzymes. Medicine 2018;97(51):e13577.
11. Chu H, Park C, Kim C, Sung KK, Lee S. 2018. Effectiveness and safety of Injinoryung-San-Gagambang (Yinchen Wuling powder) decoction on stroke patients with elevated serum liver enzymes: Three case reports. Medicine 97(51)e13577. .
12. Stickel F, Schuppan D. 2007. Herbal medicine in the treatment of liver diseases. Digestive and liver disease: official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 39(4)293–304. .
13. Limdi JK, Hyde GM. 2003. Evaluation of abnormal liver function tests. Postgraduate medical journal 79(932)307–312. .
14. Kim HS, Lee SH, Kim H, Lee SH, Cho JH, Lee H, et al. 2016. Statin-related aminotransferase elevation according to baseline aminotransferases level in real practice in Korea. Journal of clinical pharmacy and therapeutics 41(3)266–272. .
15. Barnes PM, Bloom B, Nahin RL. 2008;Complementary and alternative medicine use among adults and children: United States, 2007. National health statistics reports (12):1–23.
16. Ye XF, He J. 2010. The bright future of Chinese herbal medicine: only after a twisty road. Contemporary clinical trials 31(6)508–509. .
17. Lee WJ, Kim HW, Lee HY, Son CG. 2015. Systematic review on herb-induced liver injury in Korea. Food and chemical toxicology: an international journal published for the British Industrial Biological Research Association 8447–54. .
18. Lee J, Shin JS, Kim MR, Byun JH, Lee SY, Shin YS, et al. 2015. Liver enzyme abnormalities in taking traditional herbal medicine in Korea: A retrospective large sample cohort study of musculoskeletal disorder patients. Journal of ethnopharmacology 169407–412. .
19. Chan K, Zhang H, Lin ZX. 2015. An overview on adverse drug reactions to traditional Chinese medicines. British journal of clinical pharmacology 80(4)834–843. .
20. Liang Z, Chen X, Shi J, Hu H, Xue Y, Ung COL. 2021. Efficacy and safety of traditional Chinese medicines for non-alcoholic fatty liver disease: a systematic literature review of randomized controlled trials. Chin Med 16(9)1–38. .
21. Zhao CQ, Zhou Y, Ping J, Xu LM. 2014. Traditional Chinese medicine for treatment of liver diseases: progress challenges and opportunities. Journal of integrative medicine 12(5)401–408. .
22. Takahashi H, Maruyama K. 1993;Clinical aspects of Kampo treatment for alcoholic liver disease. Igaku no Ayumi (J Clin Exp Med) 167:811–814. (in Japanese).
23. Higuchi K, Watanabe A. 2000;Study on liver cancer-preventive effect of juzentaihoto in patients with liver cirrhosis. Methods Kampo Pharmacol 5:29–33. (in Japanese).
24. Okabayashi T, Mimura H, Orita K. 1989;Usefulness of shosaikoto (TJ-9) inthe treatment of postoperative liver dysfunction. Prog Med 9:851–855. (in Japanese).
25. Chtourou Y, Garoui E, Boudawara T, Zeghal N. 2013. Therapeutic efficacy of silymarin from milk thistle in reducing manganese-induced hepatic damage and apoptosis in rats. Human & experimental toxicology 32(1)70–81. .
26. Lee IW, Choi HY, Lee JH, Park SD, Kim SM, Ku SK, et al. 2016. Saeng-Kankunbi-Tang (生肝健脾汤) protects liver against oxidative damage through activation of ERK/Nrf2 pathway. Chinese Journal of Integrative Medicine 22(8)619–28. .
27. Arora N, Goldhaber SZ. 2006. Anticoagulants and transaminase elevation. Circulation 113(15)e698–e702. .
28. Qamar A, Vaduganathan M, Greenberger NJ, Giugliano RP. 2018. Oral Anticoagulation in Patients With Liver Disease. Journal of the American College of Cardiology 71(19)2162–2175. .
29. Harrison MF. 2018. The Misunderstood Coagulopathy of Liver Disease: A Review for the Acute Setting. The western journal of emergency medicine 19(5)863–871. .
30. Jang E, Kim BJ, Lee KT, Inn KS, Lee JH. 2015. A Survey of Therapeutic Effects of Artemisia capillaris in Liver Diseases. Evidence-based complementary and alternative medicine: eCAM 2015. 728137. .
31. Heo J. 2009. Donguibogam Seoul: Bubin PUBLISHERS CO. p. 142.
32. Lee JM. 1964. Dongeuisusebowon Seoul: Shinil Publishing Co.
33. Kang WS, Lee JH, Wo HJ. 1999;The effect of Injin and Injinsaryungsangagambang on Liver Cell Viability, Liver Cell Cycle Progression and DNA Damage-induced Apoptosis. J Korean Med 20(1):91–105.
34. ANGP , GIMLAI D, WANG L, ZHANG S, YEZ , LIU J, et al. 2019;Survival Analysis of Yang Jaundice-Yin-Yang Jaundices-Yin Jaundice Syndrome Differentiation Combined with Western Medicine in the Treatment of Patients with HBV-related Acute-on-chronic Liver Failure. Journal of Traditional Chinese Medicine 60(7):582–586.

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Fig. 1

The Patients’ ALTs decrease with taking HMA.

The numbers above cicles mean aminotransferase levels. Square boxes represent reference range. Upper and lower dotted line represent normal ALT and AST range. 0–44IU/L and 0–38IU/L respectively.

Abbreviations: HMA,Herbal Medicine containing Artemisia capillaris; SKT,Saeng-Kankunbi-Tang; CKT, Cheong-Kankunbi-Tang; IJORS, Injin-Oryongsan;

Table 1

Components and 1time Dose of Herbal Medicine

Medical plants Weight (g) per 1 time
Case 1, Case 4
Artemisiae Capillaris Herba (茵蔯蒿), Alismatis Rhizoma (澤瀉) 15g
Atractylodis Rhizoma Alba (白朮), Crataegi Fructus (山査), Hordeum vulgare (麥芽) 7.5g
Citrus unshiu (陳皮), Poria cocos (茯苓), Polyporus umbellatus (猪苓), Magnoliae Cortex (厚朴) 3.8g
Raphanus sativus (蘿葍子), Aurantii Immaturus Fructus(枳實), Sparganii Rhizoma (三稜), Zedoariae Rhizoma (蓬朮), Citri Unshius Pericarpium Immaturus (靑皮), Amomi Fructus (砂仁), Glycyrrhiza uralensis (甘草), Zingiber officinale (生薑), Agastachis Herba (藿香) 3g
Case 2
Artemisiae Capillaris Herba (茵蔯蒿) 12g
Puerariae Radix (葛根), Atractylodis Rhizoma Alba (白朮), Bupleurum falcatum (柴胡), Alismatis Rhizoma (澤瀉) 6g
Amomi Fructus (砂仁), Raphanus sativus (蘿葍子), Hordeum vulgare (麥芽), Paeonia lactiflora (芍藥), Crataegi Fructus (山査), Polyporus umbellatus(猪苓), Poria cocos (茯苓), Citrus unshiu (陳皮), Citri Unshius Pericarpium Immaturus (靑皮), Magnoliae Cortex (厚朴) 3g
Arecae Pericarpium (大腹皮), Pinellia ternata Breitenbach (半夏), Zedoariae Rhizoma (蓬朮), Sparganii Rhizoma (三稜), Agastachis Herba (藿香), Glycyrrhiza uralensis (甘草) 2g
Case 3
Artemisiae Capillaris Herba (茵蔯蒿) 20g
Alismatis Rhizoma (澤瀉), Atractylodis Rhizoma Alba (白朮), Polyporus umbellatus(猪苓), Poria cocos (茯苓) 8g
Aurantii Immaturus Fructus(枳實) 6g
Lonicerae Flos (金銀花), Forsythiae Fructus (連翹) 4g
Coptidis Rhizoma(黃連) 2g

SKT;Saeng-Kankunbi-Tang, CKT;Cheong-Kankunbi-Tang, IJORS: Injinoryung-San-Gagambang

Table 2

Results of Laboratory Test. Comparisons of ATLs and Bilirubin between Administration and Follow Up

Case 1 Before SKT administration After 12 days administration After 34 days administration After 70 days administration Normal range
ALT (IU/L) 289 135 99 24 5–44
AST (IU/L) 106 51 51 34 5–44
ALP (IU/L) 200 166.6 162.3 160 40–129
Bilirubin(Total/Direct) mg/dl 2.15/0.75 0.84/0.58 1.79/0.74 0.84/0.31 0.22–1.2 / 0.05–0.3

Case 2 Before CKT administration After 14 day CKT administration Normal range

ALT (IU/L) 154 28 5–44
AST (IU/L) 77 20 5–44
ALP (IU/L) 132.7 155.6 40–129
Bilirubin(Total/Direct) mg/dl 0.6/0.24 0.52/0.19 0.22–1.2 / 0.05–0.3

Case 3 Before SKT administration After 13 day SKT administration Normal range

ALT (IU/L) 253 107 5–44
AST (IU/L) 116 62 5–44
ALP (IU/L) 790 764.3 40–129
Bilirubin(Total/Direct) mg/dl 1.4/0.65 1.7/0.94 0.22–1.2 / 0.05–0.3

Case 4 Before IJORS administration After 8 day IJORS administration Normal range

ALT (IU/L) 128 24 5–44
AST (IU/L) 46 15 5–44
ALP (IU/L) 145.5 160 40–129
Bilirubin(Total/Direct) mg/dl 1.72/0.31 1.19/0.22 0.22–1.2 / 0.05–0.3

ALT, alanine amino transferase; AST: aspartate aminotransferase; ALP: alkaline phosphatase; SKT, Saeng-Kankunbi-Tang; CKT, Cheong -Kankunbi-Tang; IJORS, Injinoryung-San-Gagambang

Table 3

Composition of Per Os Medication

Patient Product name (Ingredients label) Dosage
Case 1 Pletal SR Cap. (cilostazol 100mg) 2C qd
Atorva Tab. 20mg (atorvastatin calcium 20.73mg) 1T qd
Twynsta Tab. 40/5mg (telmisartan 40mg, amlodipine besylate 6.935mg) 1T qd
Alfoatirin soft cap. (choline alfoscerate 400mg) 2T bid
Sandoz escitalopram Tab. 15 mg (escitalopram oxalate 15mg) 1T SPC
Nexillen S Tab. (artemisia herb soft extract) 2T bid
Xanax Tab. 0.5mg (alprazolam 500μg) 0.5T SPC
Legalon Cap. 140 (milk thistle extract 339.4mg) 2T bid
Exonin CR Tab. (eperisone SR Tab. 75mg) 2T bid

Case 2 Aspirin Protect Tab. 100 mg (aspirin 100mg) 1T qd
Cuparin Tab. 2mg (warfarin Sodium 2mg) 0.75T hs
Conbloc Tab. 1.25mg (bisoprolol fumarate 1.25mg) 1T qd
Furix Tab (furosemide 40mg) 0.5T qd
Lipitor Tab. 20 mg (atorvastatin calcium trihydrate 21.7mg) 1T SPC
Trajenta Tab. (metformin HCl 1000mg, linagliptin 2.5mg) 2T bid
Diovan Film Coated Tab. 80mg (valsartan 80mg) 0.5T qd
Lanston LFDT Tab. 15mg (lansoprazole 15mg) 1T qd

Case 3 Talion Tab. 10mg (bepotastine besilate 10mg) 2T bid
Methylon Tab. 4mg (methylprednisolone 4mg) 3T qd, 1T
Ebastel Tab. Boryung (ebastine 10mg) SPC
1T qd

Case 4 Twynsta Tab. 40/10mg (telmisartan 40mg, amlodipine besylate 13.87mg) 1T qd
Duvie Tab. 0.5mg (Lobeglitazone sulfate 0.5mg) 0.5T qd
Trajenta-duo Tab. (metformin HCl 1000mg, linagliptin 2.5mg) 2T bid
Lipitor Tab. 40 mg (atorvastatin calcium trihydrate 43.4mg) 1T qd
Plavix Tab. 75 mg (clopidogrel Sulfate 97.875mg) 1T bid
Dichlozid Tab. (hydrochlorothiazide 25mg) 0.5T qd
Tanamin Tab. 80mg (ginkgo flavon Ext. 80mg) 2T bid
Mucosta Tab. (rebamipide 100mg) 2T bid
Bonaling-A Tab. (dimenhydrinate 50mg) 2T bid
Solondo Tab. (prednisolone 5mg) 6T qd(prn)
Lyrica Cap. 75mg (Pregabalin 75mg) 2T bid
Lacto Well Intestinal Cap. (Bacillus subtilis·streptococcus faecium 250mg) 2T bid

Per Os = through the mouth(Latin); BID= Bis in die, same as twice a day; Cap=Capsule; hs= Hora somni, same as before sleep; QD=Quaque die, same as once a day; SPC=supper post cibum, after meals; Tab=Tablet; TID=Ter in die, same as 3 times a day.