General prescription pattern of insured herbal preparation in South Korea: A nationwide cohort study

Article information

J Korean Med. 2024;45(3):14-30
Publication date (electronic) : 2024 September 1
doi : https://doi.org/10.13048/jkm.24034
Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University
Correspondence to: Heekyung Kim, Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul 06355, Republic of Korea, Tel: +82-3432-8775, Fax: +82-0303-3442-8775, E-mail: yebon8@gmail.com
Received 2024 May 28; Revised 2024 August 7; Accepted 2024 August 19.

Abstract

Objectives

Research on the general prescription patterns of insured herbal preparations in Korea has been limited. This study aimed to analyze prescription patterns of insured herbal preparations, utilizing the National Health Insurance Service (NHIS) sample cohort 2.0 data from 2010 to 2019.

Methods

NHIS sample cohort 2.0 database, which represents a sample of 2.2% of the Korean population, was analyzed. We analyzed data related to prescriptions recognized as insured herbal preparations. Variables included patient demographics, diagnosis codes, prescription details, and healthcare institution characteristics. We examined trends over the decade, focusing on herbal formulae and single herb extracts.

Results

During the study period, 275,358 patients visited Korean traditional medicine clinics and received at least one prescription of herbal preparations, representing 27.5% of the total sample. The number of prescriptions increased by 209%, from 34,621 in 2010 to 72,553 in 2019. Females accounted for 67% of these prescriptions, and 77% were for patients aged 70 and older. The top ten herbal formulae (TTHF), including Ojeok-san and Gungha-tang, constituted 76% of all prescriptions. Herbal formulae were used more frequently than single herb extracts, with certain prescriptions being commonly utilized. There was a notable focus on musculoskeletal disorders, with low back pain being the most common diagnosis.

Conclusion

The study demonstrates a significant increase in the use of insured herbal preparations, primarily in small clinics and among the elderly. Prescription patterns showed a preference for specific single herb extracts and herbal formulae, with consistent trends over time. These findings provide valuable insights for future clinical research and policy development, particularly as herbal medicine's role in the national healthcare system continues to expand.

Fig. 1

Annual number of patients with prescriptions of insured herbal preparations

Fig. 2

Average number of insured herbal preparation prescriptions

The average number of prescriptions was calculated by year and stratified according to the patient's age and sex.

Fig. 3-a

Prescription trends of Herbal formula by year

OJS: Ojeok-san, HPS: Hyangsapyeongwi-san, SRT: Socheongryong-tang, SSE: Samso-eum, GMT: Gumiganghwal-tang, PWS: Pyeongwi-san, BWT: Bojungikgi-tang, IPT: Insampaedok-san, NSS: Naeso-san, GSS: Gamisoyo-san, GGT: Galgeun-tang, BBC: Banhabaekchulcheonma-tang, YPS: Yeongyopaedok-san, IJT: Ijin-tang, HYT: Hyeonggaeyeongo-tang, HST: Haengso-tang, BJS: Bulhwang-eumjeonggi-san, SOT: Sosiho-tang, CGT: Cheong-sanggyeontong-tang, SBT: Sigyeongbanha-tang, PMT: Palmul-tang, JGT: Ja-eumganghwa-tang, DGT: Daesiho-tang, GGH: Galgeunhaegi-tang, BHT: Boheo-tang, IUT: Ijung-tang, HHT: Hwangryeonhaedok-tang, DHE: Daehwajung-eum, GHT: Gungha-tang, HSS: Haengso-tang, SJT: Sihogyeji-tang, DRT: Daecheongryong-tang, SMT: Saengmaek-san, JST: Jowiseunggi-tang, SGT: Sihosogan-tang, ORS: Orim-san, SST: Samhwangsasim-tang, HYS: Hoechunyanggyeok-san, DMT: Daehwangmokdanpi-tang, IST: Igwiseungyang-tang, SCT: Sihocheonggan-tang, CIT: Cheongseoikgi-tang, BRT: Bokryeongbosim-tang, IHT: Injinho-tang, BCT: Baekchul-tang, SYT: Samhojagyak-tang, HJT: Hwanggeumjagyak-tang, GUS: Gungso-san, DYT: Danggwiyukhwang-tang, DYE: Danggwiyeongyo-eum, CWS: Cheongwi-san, ATE: Antae-eum, SWT: Seungyangbowi-tang

Figure 3-b

Prescription trends of Single herb by year

Glycyrrhizae Radix: 甘草, Paeoniae Radix: 芍藥, Angelicae Gigantis Radix: 當歸, Zingiberis Rhizoma: 生薑, Cinnamomi Ramulus: 桂枝, Angelicae Koreanae Radix: 姜活, Cnidii Rhizoma: 川芎 Magnoliae Cortex: 厚朴, Cyperi Rhizoma: 香附子, Pinelliae Rhizoma: 半夏, Puerariae Radix: 葛根, Aurantii Nobilis Pericarpium: 陳皮, Persicae Semen: 桃仁, Platycodi Radix: 桔梗, Atractylodis Rhizoma: 蒼朮, Scutellariae Radix: 黃芩, Rehmanniae Radix Preparata: 熟地黃, Araliae Cordatae Radix: 獨活, Zizyphi Fructus: 大棗, Angelicae Dahuricae Radix: 白芷 Ephedrae Herba: 麻黃, Forsythiae Fructus: 連翹, Ledebouriellae Radix: 防風, Aurantii Fructus: 枳殼, CinnamomiCortex Spissus: 肉桂, Armeniacae Semen: 杏仁, Schizonepetatenuifolia: 荊芥, Gingseng Radix: 人蔘, Astragali Radix: 黃耆, Atractylodis Rhizomaalba: 白朮, Rehmanniae Radix: 生地黃, Cimicifugae Rhizoma: 升麻, Lonicerae Flos: 金銀花, Saussureae Radix: 木香, Gypsum: 石膏, Liriopis Tuber: 麥門冬, Bupleuri Radix: 柴胡, Agastachis Herba: 藿香, Alimatis Rhizoma: 澤瀉, Menthae Herba: 薄荷, Perillae Herba: 紫蘇葉, MoutanRadicis Cortex: 牧丹皮, Schizandrae Fructus: 五味子, Gardeniae Fructus: 梔子, Hordei Fructus Germinatus: 麥芽, AsiasariRadix: 細辛, Anemarrhenae Rhizoma: 知母, PhellodendriCortex: 黃柏, Gastrodiae Rhizoma: 天麻, Chrysanthemi Flos: 菊花, Trichosanthis: 天花粉, Crataegi Fructus: 山査子, Rhei Rhizoma: 大黃, Zedoariae Rhizoma: 蓬朮, Massa Medicata Fermentata: 神麴, AurantiiImmaturi Pericarpium: 靑皮, Natrii Sulfas: 芒硝, Scirpi Rhizoma: 三稜, CoptidisRhizoma: 黃連, Asparagi Radix: 天門冬, Artemisiaecapillaris Herba: 茵蔯

Fig. 4

Heatmap presentation with Top Ten Herbal Formulae and ICD code

Fig 5

Dendrogram of Top Ten Herbal Formulae

Characteristics of the study population (N=275358)

A comprehensive distance matrix on Top Ten Herbal Formulae

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Article information Continued

Fig. 1

Annual number of patients with prescriptions of insured herbal preparations

Fig. 2

Average number of insured herbal preparation prescriptions

The average number of prescriptions was calculated by year and stratified according to the patient's age and sex.

Fig. 3-a

Prescription trends of Herbal formula by year

OJS: Ojeok-san, HPS: Hyangsapyeongwi-san, SRT: Socheongryong-tang, SSE: Samso-eum, GMT: Gumiganghwal-tang, PWS: Pyeongwi-san, BWT: Bojungikgi-tang, IPT: Insampaedok-san, NSS: Naeso-san, GSS: Gamisoyo-san, GGT: Galgeun-tang, BBC: Banhabaekchulcheonma-tang, YPS: Yeongyopaedok-san, IJT: Ijin-tang, HYT: Hyeonggaeyeongo-tang, HST: Haengso-tang, BJS: Bulhwang-eumjeonggi-san, SOT: Sosiho-tang, CGT: Cheong-sanggyeontong-tang, SBT: Sigyeongbanha-tang, PMT: Palmul-tang, JGT: Ja-eumganghwa-tang, DGT: Daesiho-tang, GGH: Galgeunhaegi-tang, BHT: Boheo-tang, IUT: Ijung-tang, HHT: Hwangryeonhaedok-tang, DHE: Daehwajung-eum, GHT: Gungha-tang, HSS: Haengso-tang, SJT: Sihogyeji-tang, DRT: Daecheongryong-tang, SMT: Saengmaek-san, JST: Jowiseunggi-tang, SGT: Sihosogan-tang, ORS: Orim-san, SST: Samhwangsasim-tang, HYS: Hoechunyanggyeok-san, DMT: Daehwangmokdanpi-tang, IST: Igwiseungyang-tang, SCT: Sihocheonggan-tang, CIT: Cheongseoikgi-tang, BRT: Bokryeongbosim-tang, IHT: Injinho-tang, BCT: Baekchul-tang, SYT: Samhojagyak-tang, HJT: Hwanggeumjagyak-tang, GUS: Gungso-san, DYT: Danggwiyukhwang-tang, DYE: Danggwiyeongyo-eum, CWS: Cheongwi-san, ATE: Antae-eum, SWT: Seungyangbowi-tang

Figure 3-b

Prescription trends of Single herb by year

Glycyrrhizae Radix: 甘草, Paeoniae Radix: 芍藥, Angelicae Gigantis Radix: 當歸, Zingiberis Rhizoma: 生薑, Cinnamomi Ramulus: 桂枝, Angelicae Koreanae Radix: 姜活, Cnidii Rhizoma: 川芎 Magnoliae Cortex: 厚朴, Cyperi Rhizoma: 香附子, Pinelliae Rhizoma: 半夏, Puerariae Radix: 葛根, Aurantii Nobilis Pericarpium: 陳皮, Persicae Semen: 桃仁, Platycodi Radix: 桔梗, Atractylodis Rhizoma: 蒼朮, Scutellariae Radix: 黃芩, Rehmanniae Radix Preparata: 熟地黃, Araliae Cordatae Radix: 獨活, Zizyphi Fructus: 大棗, Angelicae Dahuricae Radix: 白芷 Ephedrae Herba: 麻黃, Forsythiae Fructus: 連翹, Ledebouriellae Radix: 防風, Aurantii Fructus: 枳殼, CinnamomiCortex Spissus: 肉桂, Armeniacae Semen: 杏仁, Schizonepetatenuifolia: 荊芥, Gingseng Radix: 人蔘, Astragali Radix: 黃耆, Atractylodis Rhizomaalba: 白朮, Rehmanniae Radix: 生地黃, Cimicifugae Rhizoma: 升麻, Lonicerae Flos: 金銀花, Saussureae Radix: 木香, Gypsum: 石膏, Liriopis Tuber: 麥門冬, Bupleuri Radix: 柴胡, Agastachis Herba: 藿香, Alimatis Rhizoma: 澤瀉, Menthae Herba: 薄荷, Perillae Herba: 紫蘇葉, MoutanRadicis Cortex: 牧丹皮, Schizandrae Fructus: 五味子, Gardeniae Fructus: 梔子, Hordei Fructus Germinatus: 麥芽, AsiasariRadix: 細辛, Anemarrhenae Rhizoma: 知母, PhellodendriCortex: 黃柏, Gastrodiae Rhizoma: 天麻, Chrysanthemi Flos: 菊花, Trichosanthis: 天花粉, Crataegi Fructus: 山査子, Rhei Rhizoma: 大黃, Zedoariae Rhizoma: 蓬朮, Massa Medicata Fermentata: 神麴, AurantiiImmaturi Pericarpium: 靑皮, Natrii Sulfas: 芒硝, Scirpi Rhizoma: 三稜, CoptidisRhizoma: 黃連, Asparagi Radix: 天門冬, Artemisiaecapillaris Herba: 茵蔯

Fig. 4

Heatmap presentation with Top Ten Herbal Formulae and ICD code

Fig 5

Dendrogram of Top Ten Herbal Formulae

Table 1

Characteristics of the study population (N=275358)

Variables Overall

(N = 275358, %)
Sex
Male 90809 (32.98)
Female 184549 (67.02)
Age (Mean, yrs)
<20 29681 (10.8)
20~29 23593 ( 8.6)
30~39 34745 (12.6)
40~49 41856 (15.2)
50~59 43334 (15.7)
60~69 50290 (18.3)
70~79 39964 (14.5)
≥80 11895 ( 4.3)

BMI (Mean, kg/m2)

CCI
0 11314 (4.1)
1 39472 (14.3)
2 40177 (14.9)
3 39806 (14.5)
≥4 143684 (52.2)

Lab panel (mean, SD)
Fasting blood glucose 100.35 (24.55)
Total cholesterol 195.63 (40.92)
Triglyceride 130.98 (95.97)
High density lipoprotein 55.72 (26.26)
Low density lipoprotein 115.10 (49.00)
Creatinine 0.89 (0.68)
Aspartate aminotransferase (AST) 25.77 (17.80)
Alanine transaminase (ALT) 24.25 (24.18)
Gamma-Glutamyl Transferase (GGT) 33.33 (45.54)
Glomerular filtration rate (GFR) 87.99 (26.35)

Type of medical institution
Korean medical hospital 13804 ( 5.0)
Korean medical clinic 259968 (94.5)
Nursing hospital 1135 (0.4)
Public health center 183 ( 0.1)

Type of health insurance
National health insurance 265706 (96.5)
Medical aid 9613 ( 3.5)

Type of administration
Inpatient 4979 (1.8)
Outpatient 270379 (98.2)

Residence
Urban 245742 (89.2)
Rural 29577 (10.7)

Economic
Very Low 42062 (15.9)
Low 37842 (14.3)
Moderate 45556 (17.2)
High 60533 (22.9)
Very high 78595 (29.7)

Table 2

A comprehensive distance matrix on Top Ten Herbal Formulae

Galgeun-tang Gumiganghwal-tang Gungha-tang Banhasasim-tang Bojungikgi-tang Socheongryong-tang Ojeok-san Yijin-tang Pyeongwi-san Hyang sapyeongwi-san
Galgeun-tang 0 16.95 22.66 31.51 18.52 32.81 23.65 16.70 25.58 34.71
Gumiganghwal-tang 16.95 0 15.91 30.71 13.99 31.20 19.10 10.92 23.38 33.14
Gungha-tang 22.66 15.91 0 34.21 12.10 34.66 10.92 7.78 23.34 34.89
Banhasasim-tang 31.51 30.71 34.21 0 27.56 40.05 34.15 30.68 12.31 6.16
Bojungikgi-tang 18.52 13.99 12.10 27.56 0 30.53 11.76 8.07 17.62 28.60
Socheongryong-tang 32.81 31.20 34.66 40.05 30.53 0 34.26 31.28 35.96 41.96
Ojeok-san 23.65 19.10 10.92 34.15 11.76 34.26 0 11.44 23.30 34.73
Yijin-tang 16.69 10.92 7.79 30.68 8.07 31.28 11.44 0 20.80 32.41
Pyeongwi-san 25.58 23.38 23.34 12.31 17.62 35.96 23.30 20.80 0 12.42
Hyangsapyeongwi-san 34.71 33.14 34.89 6.16 28.60 41.96 34.73 32.41 12.42 0