Herbal Medicines in Pregnancy June-Seek Choi MD PhD

Korean Motherisk Program Div of Maternal-Fetal Medicine Dept of OB amp GYN Cheil General Hospital amp Womenrsquos Healthcare Center School of Medicine Kwan-dong University Seoul Korea

Contents

bull Definition

bull Introduction

bull Herbal medicines relate to uterine contraction (in

animal study vs human)

bull Herbal medicines relate to spontaneous abortion

(in animal study vs human)

bull Data of pregnancy outcomes of herbal medicine

exposure in Korean Motherisk Program

bull Summary

Definition (1)

bull Herbal medicines include herbs herbal

materials herbal preparations and

finished herbal products that contain as

active ingredients part of plants or other

plant materials or combinations

WHO

Definition (2)

bull Herbs crude plant materials such as leaves

flowers fruit seed stems wood bark roots

rhizomes or other plant parts which may be

entire fragmented or powdered

bull Herbal materials in addition to herbs fresh

juices gums fixed oils essential oils resins and

dry powders of herbs

WHO

Definition (3)

bull Herbal preparations may include

comminuted or powdered herbal materials or

extracts tinctures and fatty oils of herbal

materials They are produced by extraction

fractionation purification concentration or

other physical or biological processes

bull Finished herbal products herbal

preparations made from one or more herbs

WHO

Introduction (1)

bull It is estimated that about 25 of all modern

medicines are directly or indirectly derived from

higher plants Farnsworth NR 1976 Shu YZ 1998

bull Anticancer and antimicrobial drugs about 60

of the medicines currently available on the

market and most of those in the late stages of

clinical trials are derived from natural products

mainly from higher plants Gragg GM et al 1997

Illicii Fructus

Contents

bull Definition

bull Introduction

bull Herbal medicines relate to uterine contraction (in

animal study vs human)

bull Herbal medicines relate to spontaneous abortion

(in animal study vs human)

bull Data of pregnancy outcomes of herbal medicine

exposure in Korean Motherisk Program

bull Summary

Definition (1)

bull Herbal medicines include herbs herbal

materials herbal preparations and

finished herbal products that contain as

active ingredients part of plants or other

plant materials or combinations

WHO

Definition (2)

bull Herbs crude plant materials such as leaves

flowers fruit seed stems wood bark roots

rhizomes or other plant parts which may be

entire fragmented or powdered

bull Herbal materials in addition to herbs fresh

juices gums fixed oils essential oils resins and

dry powders of herbs

WHO

Definition (3)

bull Herbal preparations may include

comminuted or powdered herbal materials or

extracts tinctures and fatty oils of herbal

materials They are produced by extraction

fractionation purification concentration or

other physical or biological processes

bull Finished herbal products herbal

preparations made from one or more herbs

WHO

Introduction (1)

bull It is estimated that about 25 of all modern

medicines are directly or indirectly derived from

higher plants Farnsworth NR 1976 Shu YZ 1998

bull Anticancer and antimicrobial drugs about 60

of the medicines currently available on the

market and most of those in the late stages of

clinical trials are derived from natural products

mainly from higher plants Gragg GM et al 1997

Illicii Fructus

Definition (1)

bull Herbal medicines include herbs herbal

materials herbal preparations and

finished herbal products that contain as

active ingredients part of plants or other

plant materials or combinations

WHO

Definition (2)

bull Herbs crude plant materials such as leaves

flowers fruit seed stems wood bark roots

rhizomes or other plant parts which may be

entire fragmented or powdered

bull Herbal materials in addition to herbs fresh

juices gums fixed oils essential oils resins and

dry powders of herbs

WHO

Definition (3)

bull Herbal preparations may include

comminuted or powdered herbal materials or

extracts tinctures and fatty oils of herbal

materials They are produced by extraction

fractionation purification concentration or

other physical or biological processes

bull Finished herbal products herbal

preparations made from one or more herbs

WHO

Introduction (1)

bull It is estimated that about 25 of all modern

medicines are directly or indirectly derived from

higher plants Farnsworth NR 1976 Shu YZ 1998

bull Anticancer and antimicrobial drugs about 60

of the medicines currently available on the

market and most of those in the late stages of

clinical trials are derived from natural products

mainly from higher plants Gragg GM et al 1997

Illicii Fructus

Definition (2)

bull Herbs crude plant materials such as leaves

flowers fruit seed stems wood bark roots

rhizomes or other plant parts which may be

entire fragmented or powdered

bull Herbal materials in addition to herbs fresh

juices gums fixed oils essential oils resins and

dry powders of herbs

WHO

Definition (3)

bull Herbal preparations may include

comminuted or powdered herbal materials or

extracts tinctures and fatty oils of herbal

materials They are produced by extraction

fractionation purification concentration or

other physical or biological processes

bull Finished herbal products herbal

preparations made from one or more herbs

WHO

Introduction (1)

bull It is estimated that about 25 of all modern

medicines are directly or indirectly derived from

higher plants Farnsworth NR 1976 Shu YZ 1998

bull Anticancer and antimicrobial drugs about 60

of the medicines currently available on the

market and most of those in the late stages of

clinical trials are derived from natural products

mainly from higher plants Gragg GM et al 1997

Illicii Fructus

Definition (3)

bull Herbal preparations may include

comminuted or powdered herbal materials or

extracts tinctures and fatty oils of herbal

materials They are produced by extraction

fractionation purification concentration or

other physical or biological processes

bull Finished herbal products herbal

preparations made from one or more herbs

WHO

Introduction (1)

bull It is estimated that about 25 of all modern

medicines are directly or indirectly derived from

higher plants Farnsworth NR 1976 Shu YZ 1998

bull Anticancer and antimicrobial drugs about 60

of the medicines currently available on the

market and most of those in the late stages of

clinical trials are derived from natural products

mainly from higher plants Gragg GM et al 1997

Illicii Fructus

Introduction (1)

bull It is estimated that about 25 of all modern

medicines are directly or indirectly derived from

higher plants Farnsworth NR 1976 Shu YZ 1998

bull Anticancer and antimicrobial drugs about 60

of the medicines currently available on the

market and most of those in the late stages of

clinical trials are derived from natural products

mainly from higher plants Gragg GM et al 1997

Illicii Fructus

Introduction (2) bull Representing an annual global market of US $60

billion every year herbal medicines account for

around 20 of the overall drug market

bull Africa- 80 of population

China- 30-50 of total medical consumption

Europe North America- over 50 of population

have used complementary or alternative medicine at

least once WHO news 2004

bull Fee for herbal medical treatment was increased 57

times in Korea [ US $ 19 million (1990) US $ 11 billion (2006)]

A study on the current status and prospect of CAM world market 2007

Introduction (3)

bull Preference of consumers for natural therapies

bull Concern regarding undesirable side effects of

modern medicines and the belief that herbal

drugs are free from side effects

bull Great interest in alternative medicines

bull Herbal medicines might be of effective benefit in

the treatment of certain diseases where

conventional therapies and medicines have

proven to be inadequate

bull High cost of synthetic medicines

Important factors to growth of this worldwide complementaryalternative medicine(CAM)

Gruumlnwald J 1995

Introduction (4)

bull Active principles are frequently unknown

bull Standardization stability and quality control are

feasible but not easy

bull Availability and quality of raw materials are

frequently problematic

bull Well-controlled double-blind clinical and

toxicological studies to prove their efficacy and

safety are rare

bull Wide range of therapeutic use and are suitable for

chronic treatments

bull Usually cost less than synthetic drugs

Compared with well-defined synthetic drugs herbal medicines exhibit some marked difference

Calixto JB 2000

Side effects by Korean herbal medicines-drug interactions Western Medicine Drug interaction and results

Angelicae Gigantis Radix(Dang gui) Ginseng Radix Extract of Ginkgonis Germen

Warfarin Aspirin Decreased International Normalized Ratio and anticoagulant effects

Glycyrrhizae Radix (Gam cho) Digoxin Furosemide Hydrochlorothiazide

Licorice and digoxin may result in increased risk of digoxin toxicity Licorice and diuretics may result in increased risk of hypokalemia andor reduced effectiveness of the diuretic

Ginseng Radix Ephedrae Herba (Ma hwang) Zinberis Rhizoma Recens (Saeng gang)

Glyburide Insulin Metformin Severe Hypoglycemia due to increase insulin

Glycyrrhizae Radix (Gam cho)

Metoprolol Verapamil Diltiazem Decrease drug effect and Hypertension

Allii Bulbus (Ma neul) Isoniazid Decrease serum concentration of isoniazid

Zinberis Rhizoma Recens (Saeng gang)

Nifedipine Verapamil Diltiazem Severe Hypotension

Extract of Ginkgonis Germen Thiazide Hypertension

Extract of Ginkgonis Germen Ephedrae Herba (Ma hwang)

Anticonvulsant Increase risk of seizure

Ginseng Radix Azathioprine Cyclosporine Corticosteroid

Decrease effect of immunosuppressant

Ephedrae Herba (Ma hwang) Pseudoephedrine MAO inhibitor Hypertension

Ephedrae Herba (Ma hwang) Amiodaron Procainamide Quinidine Prolongation of QT interval

Park YC et al 2011

Introduction (5)

bull Some Chinese medical (CM) natural herbs listed

in the official Chinese Pharmacopoeia (CP) CP

are considered poisonous or toxic due to the

presence of poisonous or toxic chemical

constituents in the herb

bull Of which about 50 of animal plant and mineral

natural materials are included in the CP

bull In the CP the words ldquotoxic non-toxic very-toxic

or slightly toxicrdquo are often used in describing

Chinese Materia Medica

Chan K 2003

Herbs Toxicity Herbs Toxicity

Artemisiae Argyi Folium (황해쑥) Slightly toxic 백화자 Toxic

초오두 Slightly toxic 경대극 Toxic

조휴 Slightly toxic Meliae Cortex (고련피) Toxic

Toosendan Fructus (천련자) Slightly toxic Sulphur (유황) Toxic

Carpesii Fructus (학슬) Slightly toxic Agkistrodon (살모사) Toxic

Euphorbiae Pekinesis Radix (대극) Slightly toxic Pharbitidis Semen (견우자) Toxic

Tribuli Fructus (백질려) Slightly toxic Calomelas (경분) Toxic

금성자 Slightly toxic Scorpio (전갈) Toxic

Picrasmae Lignum (고목) Slightly toxic Sophorae Subprostratae Radix (산두근) Toxic

Armeniacae Semen (고행인) Slightly toxic Phytolaccae Radix (상륙) Toxic

남학슬 Slightly toxic Hirudo (수질) Toxic

Cnidii Fructus (사상자) Slightly toxic Arisaematis Rhizoma (천남성) Toxic

Eupolyphaga (자충) Slightly toxic Scolopendra (오공) Toxic

Evodiae Fructus (오수유) Slightly toxic 선모 Toxic

소엽련 Slightly toxic 향가피 Toxic

아담자 Slightly toxic Realgar (웅황) Toxic

Gleditsiae Fructus (조협) Slightly toxic 앵속각 Toxic

Typhonii Rhizoma (백부자) Toxic Genkwa Flos (원화) Toxic

Ginkgo Semen (백과(은행)) Toxic Cinnabaris (주사) Toxic

Pinelliae Rhizoma (반하) Toxic Crotonis Semen (파두) Very toxic

Bufonis Venenum (섬수) Toxic 파두상 Very toxic

Dichroae Radix (상산) Toxic Mylabris (반묘) Very toxic

Aconiti Tuber Laterale (부자) Toxic Aconiti Ciliare Tuber (초오) Very toxic

Lacca Sinica Exsiccata (건칠) Toxic Aconiti Radix (천오) Very toxic

Kansui Radix (감수) Toxic Strychni Semen seu nux Vomicae Semen (마전자) Very toxic

Very Toxic Herbal Medicine Herbal name Common name Korean common

name Binominal name Toxicity

Crotonis Semen Croton seed Pa doo Croton tiglium L (Euphorbiaceae) Very toxic

Mylabris Mylabris Ban myo 1 Mylabris cichorii Fabricius (Meloidae)

2 Mylabris phalerata Pall (Meloidae)

3 Mylabris sidae Fabricius (Meloidae)

Very toxic

Aconiti Ciliare Tuber Wild aconite (tuber) Cho o Aconitum ciliare DC (Ranunculaceae)

Very toxic

Aconiti Kusnezoffii Radix

Wild aconite (tuber) Cho o Aconitum kusnezoffii Reichb (Ranunculaceae)

Very toxic

Aconiti Proliferum Radix

Wild aconite (tuber) Cho o Aconitum proliferum Nakai (Ranunculaceae)

Very toxic

Aconiti Radix Wild aconite (tuber) Cho o Aconitum triphyllum Nakai (Ranunculaceae)

Very toxic

Aconiti Radix Aconite main tuber Chun o 1 Aconitum carmichaeli Debx (Ranunculaceae)

2 Aconitum chinense Paxton (Ranunculaceae)

Very toxic

Strychni Semen seu nux Vomicae Semen

Nuxvomica Ma jun ja Strychnos nux-vomica L (Loganiaceae)

Very toxic

The Pharmacopoeia Commission of PRC 2000

Crotonis Semen (Pa Doo)

bull Indications Scabies Eczema Abscess

bull Pretreatment Croton seed without husk Croton seed plaster

Croton seed frost-like powder

bull Pharmacological action increase GI movement (inhalation

human) increase cell differentiation (in vitro)

Hanyak yangnihak 2001

bull Toxicity Croton oil has the ability to promote radiation

transformation It is very toxic and carcinogenic (animal study) Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Caution Not use in pregnancy

bull Formula in Korea 35 OTC in Korea1

wwwtradimedcokrwwwkimsonlinecokr

Constituents 4-alpha-Deoxy-5-hydroxy-20-acetoxy-12-O-(2-methyl-amino-benzoyl)phorbol 4-alpha-Deoxy-5-hydroxy-12-O-(N-deca-246-trienoyl)phorbol 4-alpha-Deoxy-12-O-(2-methylbutyryl)-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglyl-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglylphorbol-13-isobutyrate 4-alpha-Deoxy-phorbol-13-acetate 4-alpha-Phorbol Angelic acid Cocacinogen A1 Cocacinogen A2 Cocacinogen A3 Cocacinogen A4 Cocacinogen B1 Cocacinogen B2 Cocacinogen B3 Cocacinogen B4 Cocacinogen B6 Cocacinogen B7 Crotin I Crotin tiglium lectin Crotonoside 4-Deoxyphorbol tiglate acetate 4-Deoxy-51320-triacetoxy-12-O-(n-deca-246-trienoyl)phorol 420-Dideoxy-5-hydroxy-12-O-(n-deca-246-trienoyl)-phorbol-13-acetate 12-O-Acetylphorbol-13-acetate 12-O-(alpha-Methyl-butyryl)-phorbol-13-decanoate Octyl acetate 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-5-Hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-phorbol-51320-triacetate 12-O-[2-Methyl-amino-benzoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-5-hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-phorbol-513-diacetate 12-O-(2-Methyl-butyryl)-phorbol-13-acetate 12-O-(2-Methylbutyryl)-phorbol-13-isobutyrate 12-O-[n-Deca-246-trienoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[n-Tetradecanoyl]-420-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-Tigloylphorbol-13-(2-methyl)-butyrate 12-O-Tiglylphorbol 13-isobutyrate 12-O-Tiglylphorbol-13-acetate Phorbol Phorbol 13-butyrate 12-tiglate Phorbol 13-caprylate 12-acetate Phorbol 13-caprylate 12-tiglate Phorbol 13-linoleate 12-acetate Phorbol 13-myristate 12-acetate Phorbol-13-acetate Phorbol-12-tiglate

wwwtradimedcokr

Mylabris (Ban Myo)

bull Indications Rabies Scabies Mercury intoxication Hepatic

cirrhosis due to Clonorchiasis Tuberculosis Tuberculous

lymphadenitis Eczema Abscess Atopic dermatitis Fever and

chill

bull Pretreatment parched Mylabris with rice

bull Pharmacological action intoxication of snake venom

increase urination increase abortion Dong-Eui-Bo-Gam

bull Caution Not use in pregnancy

bull Formula in Korea 4 wwwtradimedcokr

Cantharidin bull Phytochemical group Monoterpenoid

bull Molecular weight 1962

bull Cantharidin may cause symptoms from dermal inflammation to

blisters If ingested it may cause irritation and burning of the

mouth severe vesication of the upper GI tract diarrhea and

kidney and cardiovascular damage

bull Ii is a weak experimental animal carcinogen

wwwthomsonhccom wwwtradimedcokr

Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)

bull Indications Beriberi edema Cold limbs Myalgia Cold type

dysentery Epigastric pain Child epilepsy Chronic osteomyelitis

Hemiparalysis Hemiplegia Migratory arthropathy

bull Pretreatment processed Wild aconite tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Toxicity Toxic symptoms include bradycardia and irregular

rhythm Nausea and vomiting may occur as well as spasm of

extremities and cardiac arrhythmias The intestinal absorption of

the alkaloids is relatively fast Because of this gastric lavage is

recommended in case of overdose Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Formula in Korea 16 OTC in Korea 10

wwwtradimedcokrwwwkimsonlinecokr

Aconiti Ciliare Tuber

Aconiti Kusnezoffii Radix

Constituents of Aconiti Ciliare Tuber amp Aconiti Porliferum Radix Aconitine Hypaconitine Mesaconitine

Constituents of Aconiti Kusnezoffii Radix 3-Acetylaconitine Aconitine Acontine Beiwutine Bullatine A(structure unknown)formula C(21)H(31)NO(2) Bullatine C Chasmanine 6-Epimer Denudatine Hypaconitine Lepenine Mesaconitine Neoline Pendulin Songorine

Aconitine bull Phytochemical group Alkaloid

bull Molecular weight 64575

bull Bioactivity bind to neurotoxin binding site 2 of α-subunit of

Na+ channel activation of Na+ channel increase intracellular

Ca2+ arrhythmia Hanbang Yangnihak 2010

bull Toxicity Very toxic if swallowed or by skin absorption Human

systemic effects by ingestion LD50 (mus orl) 1 mgkg LD50 (mus ivn)

0175 mgkg exp lethal doses by subcutaneous route reported LD50 in mice

(mgkg) 0166 iv 0328 ip approx 1 orally (Dybing) also reported as LD50 in

mice (mgkg) 18 orally 0270 sc 0380 ip 012 iv (Sato)

wwwtradimedcokr

Aconiti Radix (Chun O)

bull Indications Beriberi edema Myalgia Cold type dysentery

Paresthesia Child epilepsy Epigastric pain Chronic

osteomyelitis Vomiting and Diarrhea Testiculitis

bull Pretreatment processed Aconite main tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Caution not use in pregnancy

bull Toxicity headache paralysis of tongue paraplegia pain on upper extremity nausea vomiting respiration difficulty coma

Hanyak yangnihak 2001

bull Formula in Korea 1 OTC in Korea 5 wwwtradimedcokrwwwkimsonlinecokr

Constituents of Aconitum carmichaeli Debx 14-Acetyltalatizamine Aconine Aconitan A Aconitan B Aconitan C Aconitan D Aconitine Aldohypaconitine Beiwutine Benzoylaconine Benzoylhypaconine Benzoylmesaconine Chuanfumine Chuan-Wu base A (structure unknown)(Tertiary base with 20H 20Me and one N-Et groups) Chuan-Wu base B(structure unknown)formula C(32)H(35)NO(4) Coryeine Coryneine Fuzitine Hokbusine A Hokbusine B Hypaconitine Ignavine Isodelphinine Isotalatisamine Isotalatizamine Karakoline Lipoaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipodeoxyaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipohypaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipomesaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Mesaconitine Neojiangyouaconitine Neoline Salsolinol Senbusine A Senbusine B Senbusine C Songarine Songorine Talatizamine

wwwtradimedcokr

Constituents of Aconitum chinense Paxton Violdelphin

How to make herbal medicine in Korea

Introduction (3)

bull Preference of consumers for natural therapies

bull Concern regarding undesirable side effects of

modern medicines and the belief that herbal

drugs are free from side effects

bull Great interest in alternative medicines

bull Herbal medicines might be of effective benefit in

the treatment of certain diseases where

conventional therapies and medicines have

proven to be inadequate

bull High cost of synthetic medicines

Important factors to growth of this worldwide complementaryalternative medicine(CAM)

Gruumlnwald J 1995

Introduction (4)

bull Active principles are frequently unknown

bull Standardization stability and quality control are

feasible but not easy

bull Availability and quality of raw materials are

frequently problematic

bull Well-controlled double-blind clinical and

toxicological studies to prove their efficacy and

safety are rare

bull Wide range of therapeutic use and are suitable for

chronic treatments

bull Usually cost less than synthetic drugs

Compared with well-defined synthetic drugs herbal medicines exhibit some marked difference

Calixto JB 2000

Side effects by Korean herbal medicines-drug interactions Western Medicine Drug interaction and results

Angelicae Gigantis Radix(Dang gui) Ginseng Radix Extract of Ginkgonis Germen

Warfarin Aspirin Decreased International Normalized Ratio and anticoagulant effects

Glycyrrhizae Radix (Gam cho) Digoxin Furosemide Hydrochlorothiazide

Licorice and digoxin may result in increased risk of digoxin toxicity Licorice and diuretics may result in increased risk of hypokalemia andor reduced effectiveness of the diuretic

Ginseng Radix Ephedrae Herba (Ma hwang) Zinberis Rhizoma Recens (Saeng gang)

Glyburide Insulin Metformin Severe Hypoglycemia due to increase insulin

Glycyrrhizae Radix (Gam cho)

Metoprolol Verapamil Diltiazem Decrease drug effect and Hypertension

Allii Bulbus (Ma neul) Isoniazid Decrease serum concentration of isoniazid

Zinberis Rhizoma Recens (Saeng gang)

Nifedipine Verapamil Diltiazem Severe Hypotension

Extract of Ginkgonis Germen Thiazide Hypertension

Extract of Ginkgonis Germen Ephedrae Herba (Ma hwang)

Anticonvulsant Increase risk of seizure

Ginseng Radix Azathioprine Cyclosporine Corticosteroid

Decrease effect of immunosuppressant

Ephedrae Herba (Ma hwang) Pseudoephedrine MAO inhibitor Hypertension

Ephedrae Herba (Ma hwang) Amiodaron Procainamide Quinidine Prolongation of QT interval

Park YC et al 2011

Introduction (5)

bull Some Chinese medical (CM) natural herbs listed

in the official Chinese Pharmacopoeia (CP) CP

are considered poisonous or toxic due to the

presence of poisonous or toxic chemical

constituents in the herb

bull Of which about 50 of animal plant and mineral

natural materials are included in the CP

bull In the CP the words ldquotoxic non-toxic very-toxic

or slightly toxicrdquo are often used in describing

Chinese Materia Medica

Chan K 2003

Herbs Toxicity Herbs Toxicity

Artemisiae Argyi Folium (황해쑥) Slightly toxic 백화자 Toxic

초오두 Slightly toxic 경대극 Toxic

조휴 Slightly toxic Meliae Cortex (고련피) Toxic

Toosendan Fructus (천련자) Slightly toxic Sulphur (유황) Toxic

Carpesii Fructus (학슬) Slightly toxic Agkistrodon (살모사) Toxic

Euphorbiae Pekinesis Radix (대극) Slightly toxic Pharbitidis Semen (견우자) Toxic

Tribuli Fructus (백질려) Slightly toxic Calomelas (경분) Toxic

금성자 Slightly toxic Scorpio (전갈) Toxic

Picrasmae Lignum (고목) Slightly toxic Sophorae Subprostratae Radix (산두근) Toxic

Armeniacae Semen (고행인) Slightly toxic Phytolaccae Radix (상륙) Toxic

남학슬 Slightly toxic Hirudo (수질) Toxic

Cnidii Fructus (사상자) Slightly toxic Arisaematis Rhizoma (천남성) Toxic

Eupolyphaga (자충) Slightly toxic Scolopendra (오공) Toxic

Evodiae Fructus (오수유) Slightly toxic 선모 Toxic

소엽련 Slightly toxic 향가피 Toxic

아담자 Slightly toxic Realgar (웅황) Toxic

Gleditsiae Fructus (조협) Slightly toxic 앵속각 Toxic

Typhonii Rhizoma (백부자) Toxic Genkwa Flos (원화) Toxic

Ginkgo Semen (백과(은행)) Toxic Cinnabaris (주사) Toxic

Pinelliae Rhizoma (반하) Toxic Crotonis Semen (파두) Very toxic

Bufonis Venenum (섬수) Toxic 파두상 Very toxic

Dichroae Radix (상산) Toxic Mylabris (반묘) Very toxic

Aconiti Tuber Laterale (부자) Toxic Aconiti Ciliare Tuber (초오) Very toxic

Lacca Sinica Exsiccata (건칠) Toxic Aconiti Radix (천오) Very toxic

Kansui Radix (감수) Toxic Strychni Semen seu nux Vomicae Semen (마전자) Very toxic

Very Toxic Herbal Medicine Herbal name Common name Korean common

name Binominal name Toxicity

Crotonis Semen Croton seed Pa doo Croton tiglium L (Euphorbiaceae) Very toxic

Mylabris Mylabris Ban myo 1 Mylabris cichorii Fabricius (Meloidae)

2 Mylabris phalerata Pall (Meloidae)

3 Mylabris sidae Fabricius (Meloidae)

Very toxic

Aconiti Ciliare Tuber Wild aconite (tuber) Cho o Aconitum ciliare DC (Ranunculaceae)

Very toxic

Aconiti Kusnezoffii Radix

Wild aconite (tuber) Cho o Aconitum kusnezoffii Reichb (Ranunculaceae)

Very toxic

Aconiti Proliferum Radix

Wild aconite (tuber) Cho o Aconitum proliferum Nakai (Ranunculaceae)

Very toxic

Aconiti Radix Wild aconite (tuber) Cho o Aconitum triphyllum Nakai (Ranunculaceae)

Very toxic

Aconiti Radix Aconite main tuber Chun o 1 Aconitum carmichaeli Debx (Ranunculaceae)

2 Aconitum chinense Paxton (Ranunculaceae)

Very toxic

Strychni Semen seu nux Vomicae Semen

Nuxvomica Ma jun ja Strychnos nux-vomica L (Loganiaceae)

Very toxic

The Pharmacopoeia Commission of PRC 2000

Crotonis Semen (Pa Doo)

bull Indications Scabies Eczema Abscess

bull Pretreatment Croton seed without husk Croton seed plaster

Croton seed frost-like powder

bull Pharmacological action increase GI movement (inhalation

human) increase cell differentiation (in vitro)

Hanyak yangnihak 2001

bull Toxicity Croton oil has the ability to promote radiation

transformation It is very toxic and carcinogenic (animal study) Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Caution Not use in pregnancy

bull Formula in Korea 35 OTC in Korea1

wwwtradimedcokrwwwkimsonlinecokr

Constituents 4-alpha-Deoxy-5-hydroxy-20-acetoxy-12-O-(2-methyl-amino-benzoyl)phorbol 4-alpha-Deoxy-5-hydroxy-12-O-(N-deca-246-trienoyl)phorbol 4-alpha-Deoxy-12-O-(2-methylbutyryl)-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglyl-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglylphorbol-13-isobutyrate 4-alpha-Deoxy-phorbol-13-acetate 4-alpha-Phorbol Angelic acid Cocacinogen A1 Cocacinogen A2 Cocacinogen A3 Cocacinogen A4 Cocacinogen B1 Cocacinogen B2 Cocacinogen B3 Cocacinogen B4 Cocacinogen B6 Cocacinogen B7 Crotin I Crotin tiglium lectin Crotonoside 4-Deoxyphorbol tiglate acetate 4-Deoxy-51320-triacetoxy-12-O-(n-deca-246-trienoyl)phorol 420-Dideoxy-5-hydroxy-12-O-(n-deca-246-trienoyl)-phorbol-13-acetate 12-O-Acetylphorbol-13-acetate 12-O-(alpha-Methyl-butyryl)-phorbol-13-decanoate Octyl acetate 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-5-Hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-phorbol-51320-triacetate 12-O-[2-Methyl-amino-benzoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-5-hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-phorbol-513-diacetate 12-O-(2-Methyl-butyryl)-phorbol-13-acetate 12-O-(2-Methylbutyryl)-phorbol-13-isobutyrate 12-O-[n-Deca-246-trienoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[n-Tetradecanoyl]-420-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-Tigloylphorbol-13-(2-methyl)-butyrate 12-O-Tiglylphorbol 13-isobutyrate 12-O-Tiglylphorbol-13-acetate Phorbol Phorbol 13-butyrate 12-tiglate Phorbol 13-caprylate 12-acetate Phorbol 13-caprylate 12-tiglate Phorbol 13-linoleate 12-acetate Phorbol 13-myristate 12-acetate Phorbol-13-acetate Phorbol-12-tiglate

wwwtradimedcokr

Mylabris (Ban Myo)

bull Indications Rabies Scabies Mercury intoxication Hepatic

cirrhosis due to Clonorchiasis Tuberculosis Tuberculous

lymphadenitis Eczema Abscess Atopic dermatitis Fever and

chill

bull Pretreatment parched Mylabris with rice

bull Pharmacological action intoxication of snake venom

increase urination increase abortion Dong-Eui-Bo-Gam

bull Caution Not use in pregnancy

bull Formula in Korea 4 wwwtradimedcokr

Cantharidin bull Phytochemical group Monoterpenoid

bull Molecular weight 1962

bull Cantharidin may cause symptoms from dermal inflammation to

blisters If ingested it may cause irritation and burning of the

mouth severe vesication of the upper GI tract diarrhea and

kidney and cardiovascular damage

bull Ii is a weak experimental animal carcinogen

wwwthomsonhccom wwwtradimedcokr

Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)

bull Indications Beriberi edema Cold limbs Myalgia Cold type

dysentery Epigastric pain Child epilepsy Chronic osteomyelitis

Hemiparalysis Hemiplegia Migratory arthropathy

bull Pretreatment processed Wild aconite tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Toxicity Toxic symptoms include bradycardia and irregular

rhythm Nausea and vomiting may occur as well as spasm of

extremities and cardiac arrhythmias The intestinal absorption of

the alkaloids is relatively fast Because of this gastric lavage is

recommended in case of overdose Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Formula in Korea 16 OTC in Korea 10

wwwtradimedcokrwwwkimsonlinecokr

Aconiti Ciliare Tuber

Aconiti Kusnezoffii Radix

Constituents of Aconiti Ciliare Tuber amp Aconiti Porliferum Radix Aconitine Hypaconitine Mesaconitine

Constituents of Aconiti Kusnezoffii Radix 3-Acetylaconitine Aconitine Acontine Beiwutine Bullatine A(structure unknown)formula C(21)H(31)NO(2) Bullatine C Chasmanine 6-Epimer Denudatine Hypaconitine Lepenine Mesaconitine Neoline Pendulin Songorine

Aconitine bull Phytochemical group Alkaloid

bull Molecular weight 64575

bull Bioactivity bind to neurotoxin binding site 2 of α-subunit of

Na+ channel activation of Na+ channel increase intracellular

Ca2+ arrhythmia Hanbang Yangnihak 2010

bull Toxicity Very toxic if swallowed or by skin absorption Human

systemic effects by ingestion LD50 (mus orl) 1 mgkg LD50 (mus ivn)

0175 mgkg exp lethal doses by subcutaneous route reported LD50 in mice

(mgkg) 0166 iv 0328 ip approx 1 orally (Dybing) also reported as LD50 in

mice (mgkg) 18 orally 0270 sc 0380 ip 012 iv (Sato)

wwwtradimedcokr

Aconiti Radix (Chun O)

bull Indications Beriberi edema Myalgia Cold type dysentery

Paresthesia Child epilepsy Epigastric pain Chronic

osteomyelitis Vomiting and Diarrhea Testiculitis

bull Pretreatment processed Aconite main tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Caution not use in pregnancy

bull Toxicity headache paralysis of tongue paraplegia pain on upper extremity nausea vomiting respiration difficulty coma

Hanyak yangnihak 2001

bull Formula in Korea 1 OTC in Korea 5 wwwtradimedcokrwwwkimsonlinecokr

Constituents of Aconitum carmichaeli Debx 14-Acetyltalatizamine Aconine Aconitan A Aconitan B Aconitan C Aconitan D Aconitine Aldohypaconitine Beiwutine Benzoylaconine Benzoylhypaconine Benzoylmesaconine Chuanfumine Chuan-Wu base A (structure unknown)(Tertiary base with 20H 20Me and one N-Et groups) Chuan-Wu base B(structure unknown)formula C(32)H(35)NO(4) Coryeine Coryneine Fuzitine Hokbusine A Hokbusine B Hypaconitine Ignavine Isodelphinine Isotalatisamine Isotalatizamine Karakoline Lipoaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipodeoxyaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipohypaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipomesaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Mesaconitine Neojiangyouaconitine Neoline Salsolinol Senbusine A Senbusine B Senbusine C Songarine Songorine Talatizamine

wwwtradimedcokr

Constituents of Aconitum chinense Paxton Violdelphin

How to make herbal medicine in Korea

Introduction (4)

bull Active principles are frequently unknown

bull Standardization stability and quality control are

feasible but not easy

bull Availability and quality of raw materials are

frequently problematic

bull Well-controlled double-blind clinical and

toxicological studies to prove their efficacy and

safety are rare

bull Wide range of therapeutic use and are suitable for

chronic treatments

bull Usually cost less than synthetic drugs

Compared with well-defined synthetic drugs herbal medicines exhibit some marked difference

Calixto JB 2000

Side effects by Korean herbal medicines-drug interactions Western Medicine Drug interaction and results

Angelicae Gigantis Radix(Dang gui) Ginseng Radix Extract of Ginkgonis Germen

Warfarin Aspirin Decreased International Normalized Ratio and anticoagulant effects

Glycyrrhizae Radix (Gam cho) Digoxin Furosemide Hydrochlorothiazide

Licorice and digoxin may result in increased risk of digoxin toxicity Licorice and diuretics may result in increased risk of hypokalemia andor reduced effectiveness of the diuretic

Ginseng Radix Ephedrae Herba (Ma hwang) Zinberis Rhizoma Recens (Saeng gang)

Glyburide Insulin Metformin Severe Hypoglycemia due to increase insulin

Glycyrrhizae Radix (Gam cho)

Metoprolol Verapamil Diltiazem Decrease drug effect and Hypertension

Allii Bulbus (Ma neul) Isoniazid Decrease serum concentration of isoniazid

Zinberis Rhizoma Recens (Saeng gang)

Nifedipine Verapamil Diltiazem Severe Hypotension

Extract of Ginkgonis Germen Thiazide Hypertension

Extract of Ginkgonis Germen Ephedrae Herba (Ma hwang)

Anticonvulsant Increase risk of seizure

Ginseng Radix Azathioprine Cyclosporine Corticosteroid

Decrease effect of immunosuppressant

Ephedrae Herba (Ma hwang) Pseudoephedrine MAO inhibitor Hypertension

Ephedrae Herba (Ma hwang) Amiodaron Procainamide Quinidine Prolongation of QT interval

Park YC et al 2011

Introduction (5)

bull Some Chinese medical (CM) natural herbs listed

in the official Chinese Pharmacopoeia (CP) CP

are considered poisonous or toxic due to the

presence of poisonous or toxic chemical

constituents in the herb

bull Of which about 50 of animal plant and mineral

natural materials are included in the CP

bull In the CP the words ldquotoxic non-toxic very-toxic

or slightly toxicrdquo are often used in describing

Chinese Materia Medica

Chan K 2003

Herbs Toxicity Herbs Toxicity

Artemisiae Argyi Folium (황해쑥) Slightly toxic 백화자 Toxic

초오두 Slightly toxic 경대극 Toxic

조휴 Slightly toxic Meliae Cortex (고련피) Toxic

Toosendan Fructus (천련자) Slightly toxic Sulphur (유황) Toxic

Carpesii Fructus (학슬) Slightly toxic Agkistrodon (살모사) Toxic

Euphorbiae Pekinesis Radix (대극) Slightly toxic Pharbitidis Semen (견우자) Toxic

Tribuli Fructus (백질려) Slightly toxic Calomelas (경분) Toxic

금성자 Slightly toxic Scorpio (전갈) Toxic

Picrasmae Lignum (고목) Slightly toxic Sophorae Subprostratae Radix (산두근) Toxic

Armeniacae Semen (고행인) Slightly toxic Phytolaccae Radix (상륙) Toxic

남학슬 Slightly toxic Hirudo (수질) Toxic

Cnidii Fructus (사상자) Slightly toxic Arisaematis Rhizoma (천남성) Toxic

Eupolyphaga (자충) Slightly toxic Scolopendra (오공) Toxic

Evodiae Fructus (오수유) Slightly toxic 선모 Toxic

소엽련 Slightly toxic 향가피 Toxic

아담자 Slightly toxic Realgar (웅황) Toxic

Gleditsiae Fructus (조협) Slightly toxic 앵속각 Toxic

Typhonii Rhizoma (백부자) Toxic Genkwa Flos (원화) Toxic

Ginkgo Semen (백과(은행)) Toxic Cinnabaris (주사) Toxic

Pinelliae Rhizoma (반하) Toxic Crotonis Semen (파두) Very toxic

Bufonis Venenum (섬수) Toxic 파두상 Very toxic

Dichroae Radix (상산) Toxic Mylabris (반묘) Very toxic

Aconiti Tuber Laterale (부자) Toxic Aconiti Ciliare Tuber (초오) Very toxic

Lacca Sinica Exsiccata (건칠) Toxic Aconiti Radix (천오) Very toxic

Kansui Radix (감수) Toxic Strychni Semen seu nux Vomicae Semen (마전자) Very toxic

Very Toxic Herbal Medicine Herbal name Common name Korean common

name Binominal name Toxicity

Crotonis Semen Croton seed Pa doo Croton tiglium L (Euphorbiaceae) Very toxic

Mylabris Mylabris Ban myo 1 Mylabris cichorii Fabricius (Meloidae)

2 Mylabris phalerata Pall (Meloidae)

3 Mylabris sidae Fabricius (Meloidae)

Very toxic

Aconiti Ciliare Tuber Wild aconite (tuber) Cho o Aconitum ciliare DC (Ranunculaceae)

Very toxic

Aconiti Kusnezoffii Radix

Wild aconite (tuber) Cho o Aconitum kusnezoffii Reichb (Ranunculaceae)

Very toxic

Aconiti Proliferum Radix

Wild aconite (tuber) Cho o Aconitum proliferum Nakai (Ranunculaceae)

Very toxic

Aconiti Radix Wild aconite (tuber) Cho o Aconitum triphyllum Nakai (Ranunculaceae)

Very toxic

Aconiti Radix Aconite main tuber Chun o 1 Aconitum carmichaeli Debx (Ranunculaceae)

2 Aconitum chinense Paxton (Ranunculaceae)

Very toxic

Strychni Semen seu nux Vomicae Semen

Nuxvomica Ma jun ja Strychnos nux-vomica L (Loganiaceae)

Very toxic

The Pharmacopoeia Commission of PRC 2000

Crotonis Semen (Pa Doo)

bull Indications Scabies Eczema Abscess

bull Pretreatment Croton seed without husk Croton seed plaster

Croton seed frost-like powder

bull Pharmacological action increase GI movement (inhalation

human) increase cell differentiation (in vitro)

Hanyak yangnihak 2001

bull Toxicity Croton oil has the ability to promote radiation

transformation It is very toxic and carcinogenic (animal study) Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Caution Not use in pregnancy

bull Formula in Korea 35 OTC in Korea1

wwwtradimedcokrwwwkimsonlinecokr

Constituents 4-alpha-Deoxy-5-hydroxy-20-acetoxy-12-O-(2-methyl-amino-benzoyl)phorbol 4-alpha-Deoxy-5-hydroxy-12-O-(N-deca-246-trienoyl)phorbol 4-alpha-Deoxy-12-O-(2-methylbutyryl)-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglyl-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglylphorbol-13-isobutyrate 4-alpha-Deoxy-phorbol-13-acetate 4-alpha-Phorbol Angelic acid Cocacinogen A1 Cocacinogen A2 Cocacinogen A3 Cocacinogen A4 Cocacinogen B1 Cocacinogen B2 Cocacinogen B3 Cocacinogen B4 Cocacinogen B6 Cocacinogen B7 Crotin I Crotin tiglium lectin Crotonoside 4-Deoxyphorbol tiglate acetate 4-Deoxy-51320-triacetoxy-12-O-(n-deca-246-trienoyl)phorol 420-Dideoxy-5-hydroxy-12-O-(n-deca-246-trienoyl)-phorbol-13-acetate 12-O-Acetylphorbol-13-acetate 12-O-(alpha-Methyl-butyryl)-phorbol-13-decanoate Octyl acetate 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-5-Hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-phorbol-51320-triacetate 12-O-[2-Methyl-amino-benzoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-5-hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-phorbol-513-diacetate 12-O-(2-Methyl-butyryl)-phorbol-13-acetate 12-O-(2-Methylbutyryl)-phorbol-13-isobutyrate 12-O-[n-Deca-246-trienoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[n-Tetradecanoyl]-420-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-Tigloylphorbol-13-(2-methyl)-butyrate 12-O-Tiglylphorbol 13-isobutyrate 12-O-Tiglylphorbol-13-acetate Phorbol Phorbol 13-butyrate 12-tiglate Phorbol 13-caprylate 12-acetate Phorbol 13-caprylate 12-tiglate Phorbol 13-linoleate 12-acetate Phorbol 13-myristate 12-acetate Phorbol-13-acetate Phorbol-12-tiglate

wwwtradimedcokr

Mylabris (Ban Myo)

bull Indications Rabies Scabies Mercury intoxication Hepatic

cirrhosis due to Clonorchiasis Tuberculosis Tuberculous

lymphadenitis Eczema Abscess Atopic dermatitis Fever and

chill

bull Pretreatment parched Mylabris with rice

bull Pharmacological action intoxication of snake venom

increase urination increase abortion Dong-Eui-Bo-Gam

bull Caution Not use in pregnancy

bull Formula in Korea 4 wwwtradimedcokr

Cantharidin bull Phytochemical group Monoterpenoid

bull Molecular weight 1962

bull Cantharidin may cause symptoms from dermal inflammation to

blisters If ingested it may cause irritation and burning of the

mouth severe vesication of the upper GI tract diarrhea and

kidney and cardiovascular damage

bull Ii is a weak experimental animal carcinogen

wwwthomsonhccom wwwtradimedcokr

Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)

bull Indications Beriberi edema Cold limbs Myalgia Cold type

dysentery Epigastric pain Child epilepsy Chronic osteomyelitis

Hemiparalysis Hemiplegia Migratory arthropathy

bull Pretreatment processed Wild aconite tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Toxicity Toxic symptoms include bradycardia and irregular

rhythm Nausea and vomiting may occur as well as spasm of

extremities and cardiac arrhythmias The intestinal absorption of

the alkaloids is relatively fast Because of this gastric lavage is

recommended in case of overdose Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Formula in Korea 16 OTC in Korea 10

wwwtradimedcokrwwwkimsonlinecokr

Aconiti Ciliare Tuber

Aconiti Kusnezoffii Radix

Constituents of Aconiti Ciliare Tuber amp Aconiti Porliferum Radix Aconitine Hypaconitine Mesaconitine

Constituents of Aconiti Kusnezoffii Radix 3-Acetylaconitine Aconitine Acontine Beiwutine Bullatine A(structure unknown)formula C(21)H(31)NO(2) Bullatine C Chasmanine 6-Epimer Denudatine Hypaconitine Lepenine Mesaconitine Neoline Pendulin Songorine

Aconitine bull Phytochemical group Alkaloid

bull Molecular weight 64575

bull Bioactivity bind to neurotoxin binding site 2 of α-subunit of

Na+ channel activation of Na+ channel increase intracellular

Ca2+ arrhythmia Hanbang Yangnihak 2010

bull Toxicity Very toxic if swallowed or by skin absorption Human

systemic effects by ingestion LD50 (mus orl) 1 mgkg LD50 (mus ivn)

0175 mgkg exp lethal doses by subcutaneous route reported LD50 in mice

(mgkg) 0166 iv 0328 ip approx 1 orally (Dybing) also reported as LD50 in

mice (mgkg) 18 orally 0270 sc 0380 ip 012 iv (Sato)

wwwtradimedcokr

Aconiti Radix (Chun O)

bull Indications Beriberi edema Myalgia Cold type dysentery

Paresthesia Child epilepsy Epigastric pain Chronic

osteomyelitis Vomiting and Diarrhea Testiculitis

bull Pretreatment processed Aconite main tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Caution not use in pregnancy

bull Toxicity headache paralysis of tongue paraplegia pain on upper extremity nausea vomiting respiration difficulty coma

Hanyak yangnihak 2001

bull Formula in Korea 1 OTC in Korea 5 wwwtradimedcokrwwwkimsonlinecokr

Constituents of Aconitum carmichaeli Debx 14-Acetyltalatizamine Aconine Aconitan A Aconitan B Aconitan C Aconitan D Aconitine Aldohypaconitine Beiwutine Benzoylaconine Benzoylhypaconine Benzoylmesaconine Chuanfumine Chuan-Wu base A (structure unknown)(Tertiary base with 20H 20Me and one N-Et groups) Chuan-Wu base B(structure unknown)formula C(32)H(35)NO(4) Coryeine Coryneine Fuzitine Hokbusine A Hokbusine B Hypaconitine Ignavine Isodelphinine Isotalatisamine Isotalatizamine Karakoline Lipoaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipodeoxyaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipohypaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipomesaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Mesaconitine Neojiangyouaconitine Neoline Salsolinol Senbusine A Senbusine B Senbusine C Songarine Songorine Talatizamine

wwwtradimedcokr

Constituents of Aconitum chinense Paxton Violdelphin

How to make herbal medicine in Korea

Side effects by Korean herbal medicines-drug interactions Western Medicine Drug interaction and results

Angelicae Gigantis Radix(Dang gui) Ginseng Radix Extract of Ginkgonis Germen

Warfarin Aspirin Decreased International Normalized Ratio and anticoagulant effects

Glycyrrhizae Radix (Gam cho) Digoxin Furosemide Hydrochlorothiazide

Licorice and digoxin may result in increased risk of digoxin toxicity Licorice and diuretics may result in increased risk of hypokalemia andor reduced effectiveness of the diuretic

Ginseng Radix Ephedrae Herba (Ma hwang) Zinberis Rhizoma Recens (Saeng gang)

Glyburide Insulin Metformin Severe Hypoglycemia due to increase insulin

Glycyrrhizae Radix (Gam cho)

Metoprolol Verapamil Diltiazem Decrease drug effect and Hypertension

Allii Bulbus (Ma neul) Isoniazid Decrease serum concentration of isoniazid

Zinberis Rhizoma Recens (Saeng gang)

Nifedipine Verapamil Diltiazem Severe Hypotension

Extract of Ginkgonis Germen Thiazide Hypertension

Extract of Ginkgonis Germen Ephedrae Herba (Ma hwang)

Anticonvulsant Increase risk of seizure

Ginseng Radix Azathioprine Cyclosporine Corticosteroid

Decrease effect of immunosuppressant

Ephedrae Herba (Ma hwang) Pseudoephedrine MAO inhibitor Hypertension

Ephedrae Herba (Ma hwang) Amiodaron Procainamide Quinidine Prolongation of QT interval

Park YC et al 2011

Introduction (5)

bull Some Chinese medical (CM) natural herbs listed

in the official Chinese Pharmacopoeia (CP) CP

are considered poisonous or toxic due to the

presence of poisonous or toxic chemical

constituents in the herb

bull Of which about 50 of animal plant and mineral

natural materials are included in the CP

bull In the CP the words ldquotoxic non-toxic very-toxic

or slightly toxicrdquo are often used in describing

Chinese Materia Medica

Chan K 2003

Herbs Toxicity Herbs Toxicity

Artemisiae Argyi Folium (황해쑥) Slightly toxic 백화자 Toxic

초오두 Slightly toxic 경대극 Toxic

조휴 Slightly toxic Meliae Cortex (고련피) Toxic

Toosendan Fructus (천련자) Slightly toxic Sulphur (유황) Toxic

Carpesii Fructus (학슬) Slightly toxic Agkistrodon (살모사) Toxic

Euphorbiae Pekinesis Radix (대극) Slightly toxic Pharbitidis Semen (견우자) Toxic

Tribuli Fructus (백질려) Slightly toxic Calomelas (경분) Toxic

금성자 Slightly toxic Scorpio (전갈) Toxic

Picrasmae Lignum (고목) Slightly toxic Sophorae Subprostratae Radix (산두근) Toxic

Armeniacae Semen (고행인) Slightly toxic Phytolaccae Radix (상륙) Toxic

남학슬 Slightly toxic Hirudo (수질) Toxic

Cnidii Fructus (사상자) Slightly toxic Arisaematis Rhizoma (천남성) Toxic

Eupolyphaga (자충) Slightly toxic Scolopendra (오공) Toxic

Evodiae Fructus (오수유) Slightly toxic 선모 Toxic

소엽련 Slightly toxic 향가피 Toxic

아담자 Slightly toxic Realgar (웅황) Toxic

Gleditsiae Fructus (조협) Slightly toxic 앵속각 Toxic

Typhonii Rhizoma (백부자) Toxic Genkwa Flos (원화) Toxic

Ginkgo Semen (백과(은행)) Toxic Cinnabaris (주사) Toxic

Pinelliae Rhizoma (반하) Toxic Crotonis Semen (파두) Very toxic

Bufonis Venenum (섬수) Toxic 파두상 Very toxic

Dichroae Radix (상산) Toxic Mylabris (반묘) Very toxic

Aconiti Tuber Laterale (부자) Toxic Aconiti Ciliare Tuber (초오) Very toxic

Lacca Sinica Exsiccata (건칠) Toxic Aconiti Radix (천오) Very toxic

Kansui Radix (감수) Toxic Strychni Semen seu nux Vomicae Semen (마전자) Very toxic

Very Toxic Herbal Medicine Herbal name Common name Korean common

name Binominal name Toxicity

Crotonis Semen Croton seed Pa doo Croton tiglium L (Euphorbiaceae) Very toxic

Mylabris Mylabris Ban myo 1 Mylabris cichorii Fabricius (Meloidae)

2 Mylabris phalerata Pall (Meloidae)

3 Mylabris sidae Fabricius (Meloidae)

Very toxic

Aconiti Ciliare Tuber Wild aconite (tuber) Cho o Aconitum ciliare DC (Ranunculaceae)

Very toxic

Aconiti Kusnezoffii Radix

Wild aconite (tuber) Cho o Aconitum kusnezoffii Reichb (Ranunculaceae)

Very toxic

Aconiti Proliferum Radix

Wild aconite (tuber) Cho o Aconitum proliferum Nakai (Ranunculaceae)

Very toxic

Aconiti Radix Wild aconite (tuber) Cho o Aconitum triphyllum Nakai (Ranunculaceae)

Very toxic

Aconiti Radix Aconite main tuber Chun o 1 Aconitum carmichaeli Debx (Ranunculaceae)

2 Aconitum chinense Paxton (Ranunculaceae)

Very toxic

Strychni Semen seu nux Vomicae Semen

Nuxvomica Ma jun ja Strychnos nux-vomica L (Loganiaceae)

Very toxic

The Pharmacopoeia Commission of PRC 2000

Crotonis Semen (Pa Doo)

bull Indications Scabies Eczema Abscess

bull Pretreatment Croton seed without husk Croton seed plaster

Croton seed frost-like powder

bull Pharmacological action increase GI movement (inhalation

human) increase cell differentiation (in vitro)

Hanyak yangnihak 2001

bull Toxicity Croton oil has the ability to promote radiation

transformation It is very toxic and carcinogenic (animal study) Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Caution Not use in pregnancy

bull Formula in Korea 35 OTC in Korea1

wwwtradimedcokrwwwkimsonlinecokr

Constituents 4-alpha-Deoxy-5-hydroxy-20-acetoxy-12-O-(2-methyl-amino-benzoyl)phorbol 4-alpha-Deoxy-5-hydroxy-12-O-(N-deca-246-trienoyl)phorbol 4-alpha-Deoxy-12-O-(2-methylbutyryl)-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglyl-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglylphorbol-13-isobutyrate 4-alpha-Deoxy-phorbol-13-acetate 4-alpha-Phorbol Angelic acid Cocacinogen A1 Cocacinogen A2 Cocacinogen A3 Cocacinogen A4 Cocacinogen B1 Cocacinogen B2 Cocacinogen B3 Cocacinogen B4 Cocacinogen B6 Cocacinogen B7 Crotin I Crotin tiglium lectin Crotonoside 4-Deoxyphorbol tiglate acetate 4-Deoxy-51320-triacetoxy-12-O-(n-deca-246-trienoyl)phorol 420-Dideoxy-5-hydroxy-12-O-(n-deca-246-trienoyl)-phorbol-13-acetate 12-O-Acetylphorbol-13-acetate 12-O-(alpha-Methyl-butyryl)-phorbol-13-decanoate Octyl acetate 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-5-Hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-phorbol-51320-triacetate 12-O-[2-Methyl-amino-benzoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-5-hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-phorbol-513-diacetate 12-O-(2-Methyl-butyryl)-phorbol-13-acetate 12-O-(2-Methylbutyryl)-phorbol-13-isobutyrate 12-O-[n-Deca-246-trienoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[n-Tetradecanoyl]-420-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-Tigloylphorbol-13-(2-methyl)-butyrate 12-O-Tiglylphorbol 13-isobutyrate 12-O-Tiglylphorbol-13-acetate Phorbol Phorbol 13-butyrate 12-tiglate Phorbol 13-caprylate 12-acetate Phorbol 13-caprylate 12-tiglate Phorbol 13-linoleate 12-acetate Phorbol 13-myristate 12-acetate Phorbol-13-acetate Phorbol-12-tiglate

wwwtradimedcokr

Mylabris (Ban Myo)

bull Indications Rabies Scabies Mercury intoxication Hepatic

cirrhosis due to Clonorchiasis Tuberculosis Tuberculous

lymphadenitis Eczema Abscess Atopic dermatitis Fever and

chill

bull Pretreatment parched Mylabris with rice

bull Pharmacological action intoxication of snake venom

increase urination increase abortion Dong-Eui-Bo-Gam

bull Caution Not use in pregnancy

bull Formula in Korea 4 wwwtradimedcokr

Cantharidin bull Phytochemical group Monoterpenoid

bull Molecular weight 1962

bull Cantharidin may cause symptoms from dermal inflammation to

blisters If ingested it may cause irritation and burning of the

mouth severe vesication of the upper GI tract diarrhea and

kidney and cardiovascular damage

bull Ii is a weak experimental animal carcinogen

wwwthomsonhccom wwwtradimedcokr

Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)

bull Indications Beriberi edema Cold limbs Myalgia Cold type

dysentery Epigastric pain Child epilepsy Chronic osteomyelitis

Hemiparalysis Hemiplegia Migratory arthropathy

bull Pretreatment processed Wild aconite tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Toxicity Toxic symptoms include bradycardia and irregular

rhythm Nausea and vomiting may occur as well as spasm of

extremities and cardiac arrhythmias The intestinal absorption of

the alkaloids is relatively fast Because of this gastric lavage is

recommended in case of overdose Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Formula in Korea 16 OTC in Korea 10

wwwtradimedcokrwwwkimsonlinecokr

Aconiti Ciliare Tuber

Aconiti Kusnezoffii Radix

Constituents of Aconiti Ciliare Tuber amp Aconiti Porliferum Radix Aconitine Hypaconitine Mesaconitine

Constituents of Aconiti Kusnezoffii Radix 3-Acetylaconitine Aconitine Acontine Beiwutine Bullatine A(structure unknown)formula C(21)H(31)NO(2) Bullatine C Chasmanine 6-Epimer Denudatine Hypaconitine Lepenine Mesaconitine Neoline Pendulin Songorine

Aconitine bull Phytochemical group Alkaloid

bull Molecular weight 64575

bull Bioactivity bind to neurotoxin binding site 2 of α-subunit of

Na+ channel activation of Na+ channel increase intracellular

Ca2+ arrhythmia Hanbang Yangnihak 2010

bull Toxicity Very toxic if swallowed or by skin absorption Human

systemic effects by ingestion LD50 (mus orl) 1 mgkg LD50 (mus ivn)

0175 mgkg exp lethal doses by subcutaneous route reported LD50 in mice

(mgkg) 0166 iv 0328 ip approx 1 orally (Dybing) also reported as LD50 in

mice (mgkg) 18 orally 0270 sc 0380 ip 012 iv (Sato)

wwwtradimedcokr

Aconiti Radix (Chun O)

bull Indications Beriberi edema Myalgia Cold type dysentery

Paresthesia Child epilepsy Epigastric pain Chronic

osteomyelitis Vomiting and Diarrhea Testiculitis

bull Pretreatment processed Aconite main tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Caution not use in pregnancy

bull Toxicity headache paralysis of tongue paraplegia pain on upper extremity nausea vomiting respiration difficulty coma

Hanyak yangnihak 2001

bull Formula in Korea 1 OTC in Korea 5 wwwtradimedcokrwwwkimsonlinecokr

Constituents of Aconitum carmichaeli Debx 14-Acetyltalatizamine Aconine Aconitan A Aconitan B Aconitan C Aconitan D Aconitine Aldohypaconitine Beiwutine Benzoylaconine Benzoylhypaconine Benzoylmesaconine Chuanfumine Chuan-Wu base A (structure unknown)(Tertiary base with 20H 20Me and one N-Et groups) Chuan-Wu base B(structure unknown)formula C(32)H(35)NO(4) Coryeine Coryneine Fuzitine Hokbusine A Hokbusine B Hypaconitine Ignavine Isodelphinine Isotalatisamine Isotalatizamine Karakoline Lipoaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipodeoxyaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipohypaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipomesaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Mesaconitine Neojiangyouaconitine Neoline Salsolinol Senbusine A Senbusine B Senbusine C Songarine Songorine Talatizamine

wwwtradimedcokr

Constituents of Aconitum chinense Paxton Violdelphin

How to make herbal medicine in Korea

Introduction (5)

bull Some Chinese medical (CM) natural herbs listed

in the official Chinese Pharmacopoeia (CP) CP

are considered poisonous or toxic due to the

presence of poisonous or toxic chemical

constituents in the herb

bull Of which about 50 of animal plant and mineral

natural materials are included in the CP

bull In the CP the words ldquotoxic non-toxic very-toxic

or slightly toxicrdquo are often used in describing

Chinese Materia Medica

Chan K 2003

Herbs Toxicity Herbs Toxicity

Artemisiae Argyi Folium (황해쑥) Slightly toxic 백화자 Toxic

초오두 Slightly toxic 경대극 Toxic

조휴 Slightly toxic Meliae Cortex (고련피) Toxic

Toosendan Fructus (천련자) Slightly toxic Sulphur (유황) Toxic

Carpesii Fructus (학슬) Slightly toxic Agkistrodon (살모사) Toxic

Euphorbiae Pekinesis Radix (대극) Slightly toxic Pharbitidis Semen (견우자) Toxic

Tribuli Fructus (백질려) Slightly toxic Calomelas (경분) Toxic

금성자 Slightly toxic Scorpio (전갈) Toxic

Picrasmae Lignum (고목) Slightly toxic Sophorae Subprostratae Radix (산두근) Toxic

Armeniacae Semen (고행인) Slightly toxic Phytolaccae Radix (상륙) Toxic

남학슬 Slightly toxic Hirudo (수질) Toxic

Cnidii Fructus (사상자) Slightly toxic Arisaematis Rhizoma (천남성) Toxic

Eupolyphaga (자충) Slightly toxic Scolopendra (오공) Toxic

Evodiae Fructus (오수유) Slightly toxic 선모 Toxic

소엽련 Slightly toxic 향가피 Toxic

아담자 Slightly toxic Realgar (웅황) Toxic

Gleditsiae Fructus (조협) Slightly toxic 앵속각 Toxic

Typhonii Rhizoma (백부자) Toxic Genkwa Flos (원화) Toxic

Ginkgo Semen (백과(은행)) Toxic Cinnabaris (주사) Toxic

Pinelliae Rhizoma (반하) Toxic Crotonis Semen (파두) Very toxic

Bufonis Venenum (섬수) Toxic 파두상 Very toxic

Dichroae Radix (상산) Toxic Mylabris (반묘) Very toxic

Aconiti Tuber Laterale (부자) Toxic Aconiti Ciliare Tuber (초오) Very toxic

Lacca Sinica Exsiccata (건칠) Toxic Aconiti Radix (천오) Very toxic

Kansui Radix (감수) Toxic Strychni Semen seu nux Vomicae Semen (마전자) Very toxic

Very Toxic Herbal Medicine Herbal name Common name Korean common

name Binominal name Toxicity

Crotonis Semen Croton seed Pa doo Croton tiglium L (Euphorbiaceae) Very toxic

Mylabris Mylabris Ban myo 1 Mylabris cichorii Fabricius (Meloidae)

2 Mylabris phalerata Pall (Meloidae)

3 Mylabris sidae Fabricius (Meloidae)

Very toxic

Aconiti Ciliare Tuber Wild aconite (tuber) Cho o Aconitum ciliare DC (Ranunculaceae)

Very toxic

Aconiti Kusnezoffii Radix

Wild aconite (tuber) Cho o Aconitum kusnezoffii Reichb (Ranunculaceae)

Very toxic

Aconiti Proliferum Radix

Wild aconite (tuber) Cho o Aconitum proliferum Nakai (Ranunculaceae)

Very toxic

Aconiti Radix Wild aconite (tuber) Cho o Aconitum triphyllum Nakai (Ranunculaceae)

Very toxic

Aconiti Radix Aconite main tuber Chun o 1 Aconitum carmichaeli Debx (Ranunculaceae)

2 Aconitum chinense Paxton (Ranunculaceae)

Very toxic

Strychni Semen seu nux Vomicae Semen

Nuxvomica Ma jun ja Strychnos nux-vomica L (Loganiaceae)

Very toxic

The Pharmacopoeia Commission of PRC 2000

Crotonis Semen (Pa Doo)

bull Indications Scabies Eczema Abscess

bull Pretreatment Croton seed without husk Croton seed plaster

Croton seed frost-like powder

bull Pharmacological action increase GI movement (inhalation

human) increase cell differentiation (in vitro)

Hanyak yangnihak 2001

bull Toxicity Croton oil has the ability to promote radiation

transformation It is very toxic and carcinogenic (animal study) Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Caution Not use in pregnancy

bull Formula in Korea 35 OTC in Korea1

wwwtradimedcokrwwwkimsonlinecokr

Constituents 4-alpha-Deoxy-5-hydroxy-20-acetoxy-12-O-(2-methyl-amino-benzoyl)phorbol 4-alpha-Deoxy-5-hydroxy-12-O-(N-deca-246-trienoyl)phorbol 4-alpha-Deoxy-12-O-(2-methylbutyryl)-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglyl-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglylphorbol-13-isobutyrate 4-alpha-Deoxy-phorbol-13-acetate 4-alpha-Phorbol Angelic acid Cocacinogen A1 Cocacinogen A2 Cocacinogen A3 Cocacinogen A4 Cocacinogen B1 Cocacinogen B2 Cocacinogen B3 Cocacinogen B4 Cocacinogen B6 Cocacinogen B7 Crotin I Crotin tiglium lectin Crotonoside 4-Deoxyphorbol tiglate acetate 4-Deoxy-51320-triacetoxy-12-O-(n-deca-246-trienoyl)phorol 420-Dideoxy-5-hydroxy-12-O-(n-deca-246-trienoyl)-phorbol-13-acetate 12-O-Acetylphorbol-13-acetate 12-O-(alpha-Methyl-butyryl)-phorbol-13-decanoate Octyl acetate 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-5-Hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-phorbol-51320-triacetate 12-O-[2-Methyl-amino-benzoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-5-hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-phorbol-513-diacetate 12-O-(2-Methyl-butyryl)-phorbol-13-acetate 12-O-(2-Methylbutyryl)-phorbol-13-isobutyrate 12-O-[n-Deca-246-trienoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[n-Tetradecanoyl]-420-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-Tigloylphorbol-13-(2-methyl)-butyrate 12-O-Tiglylphorbol 13-isobutyrate 12-O-Tiglylphorbol-13-acetate Phorbol Phorbol 13-butyrate 12-tiglate Phorbol 13-caprylate 12-acetate Phorbol 13-caprylate 12-tiglate Phorbol 13-linoleate 12-acetate Phorbol 13-myristate 12-acetate Phorbol-13-acetate Phorbol-12-tiglate

wwwtradimedcokr

Mylabris (Ban Myo)

bull Indications Rabies Scabies Mercury intoxication Hepatic

cirrhosis due to Clonorchiasis Tuberculosis Tuberculous

lymphadenitis Eczema Abscess Atopic dermatitis Fever and

chill

bull Pretreatment parched Mylabris with rice

bull Pharmacological action intoxication of snake venom

increase urination increase abortion Dong-Eui-Bo-Gam

bull Caution Not use in pregnancy

bull Formula in Korea 4 wwwtradimedcokr

Cantharidin bull Phytochemical group Monoterpenoid

bull Molecular weight 1962

bull Cantharidin may cause symptoms from dermal inflammation to

blisters If ingested it may cause irritation and burning of the

mouth severe vesication of the upper GI tract diarrhea and

kidney and cardiovascular damage

bull Ii is a weak experimental animal carcinogen

wwwthomsonhccom wwwtradimedcokr

Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)

bull Indications Beriberi edema Cold limbs Myalgia Cold type

dysentery Epigastric pain Child epilepsy Chronic osteomyelitis

Hemiparalysis Hemiplegia Migratory arthropathy

bull Pretreatment processed Wild aconite tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Toxicity Toxic symptoms include bradycardia and irregular

rhythm Nausea and vomiting may occur as well as spasm of

extremities and cardiac arrhythmias The intestinal absorption of

the alkaloids is relatively fast Because of this gastric lavage is

recommended in case of overdose Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Formula in Korea 16 OTC in Korea 10

wwwtradimedcokrwwwkimsonlinecokr

Aconiti Ciliare Tuber

Aconiti Kusnezoffii Radix

Constituents of Aconiti Ciliare Tuber amp Aconiti Porliferum Radix Aconitine Hypaconitine Mesaconitine

Constituents of Aconiti Kusnezoffii Radix 3-Acetylaconitine Aconitine Acontine Beiwutine Bullatine A(structure unknown)formula C(21)H(31)NO(2) Bullatine C Chasmanine 6-Epimer Denudatine Hypaconitine Lepenine Mesaconitine Neoline Pendulin Songorine

Aconitine bull Phytochemical group Alkaloid

bull Molecular weight 64575

bull Bioactivity bind to neurotoxin binding site 2 of α-subunit of

Na+ channel activation of Na+ channel increase intracellular

Ca2+ arrhythmia Hanbang Yangnihak 2010

bull Toxicity Very toxic if swallowed or by skin absorption Human

systemic effects by ingestion LD50 (mus orl) 1 mgkg LD50 (mus ivn)

0175 mgkg exp lethal doses by subcutaneous route reported LD50 in mice

(mgkg) 0166 iv 0328 ip approx 1 orally (Dybing) also reported as LD50 in

mice (mgkg) 18 orally 0270 sc 0380 ip 012 iv (Sato)

wwwtradimedcokr

Aconiti Radix (Chun O)

bull Indications Beriberi edema Myalgia Cold type dysentery

Paresthesia Child epilepsy Epigastric pain Chronic

osteomyelitis Vomiting and Diarrhea Testiculitis

bull Pretreatment processed Aconite main tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Caution not use in pregnancy

bull Toxicity headache paralysis of tongue paraplegia pain on upper extremity nausea vomiting respiration difficulty coma

Hanyak yangnihak 2001

bull Formula in Korea 1 OTC in Korea 5 wwwtradimedcokrwwwkimsonlinecokr

Constituents of Aconitum carmichaeli Debx 14-Acetyltalatizamine Aconine Aconitan A Aconitan B Aconitan C Aconitan D Aconitine Aldohypaconitine Beiwutine Benzoylaconine Benzoylhypaconine Benzoylmesaconine Chuanfumine Chuan-Wu base A (structure unknown)(Tertiary base with 20H 20Me and one N-Et groups) Chuan-Wu base B(structure unknown)formula C(32)H(35)NO(4) Coryeine Coryneine Fuzitine Hokbusine A Hokbusine B Hypaconitine Ignavine Isodelphinine Isotalatisamine Isotalatizamine Karakoline Lipoaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipodeoxyaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipohypaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipomesaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Mesaconitine Neojiangyouaconitine Neoline Salsolinol Senbusine A Senbusine B Senbusine C Songarine Songorine Talatizamine

wwwtradimedcokr

Constituents of Aconitum chinense Paxton Violdelphin

How to make herbal medicine in Korea

Herbs Toxicity Herbs Toxicity

Artemisiae Argyi Folium (황해쑥) Slightly toxic 백화자 Toxic

초오두 Slightly toxic 경대극 Toxic

조휴 Slightly toxic Meliae Cortex (고련피) Toxic

Toosendan Fructus (천련자) Slightly toxic Sulphur (유황) Toxic

Carpesii Fructus (학슬) Slightly toxic Agkistrodon (살모사) Toxic

Euphorbiae Pekinesis Radix (대극) Slightly toxic Pharbitidis Semen (견우자) Toxic

Tribuli Fructus (백질려) Slightly toxic Calomelas (경분) Toxic

금성자 Slightly toxic Scorpio (전갈) Toxic

Picrasmae Lignum (고목) Slightly toxic Sophorae Subprostratae Radix (산두근) Toxic

Armeniacae Semen (고행인) Slightly toxic Phytolaccae Radix (상륙) Toxic

남학슬 Slightly toxic Hirudo (수질) Toxic

Cnidii Fructus (사상자) Slightly toxic Arisaematis Rhizoma (천남성) Toxic

Eupolyphaga (자충) Slightly toxic Scolopendra (오공) Toxic

Evodiae Fructus (오수유) Slightly toxic 선모 Toxic

소엽련 Slightly toxic 향가피 Toxic

아담자 Slightly toxic Realgar (웅황) Toxic

Gleditsiae Fructus (조협) Slightly toxic 앵속각 Toxic

Typhonii Rhizoma (백부자) Toxic Genkwa Flos (원화) Toxic

Ginkgo Semen (백과(은행)) Toxic Cinnabaris (주사) Toxic

Pinelliae Rhizoma (반하) Toxic Crotonis Semen (파두) Very toxic

Bufonis Venenum (섬수) Toxic 파두상 Very toxic

Dichroae Radix (상산) Toxic Mylabris (반묘) Very toxic

Aconiti Tuber Laterale (부자) Toxic Aconiti Ciliare Tuber (초오) Very toxic

Lacca Sinica Exsiccata (건칠) Toxic Aconiti Radix (천오) Very toxic

Kansui Radix (감수) Toxic Strychni Semen seu nux Vomicae Semen (마전자) Very toxic

Very Toxic Herbal Medicine Herbal name Common name Korean common

name Binominal name Toxicity

Crotonis Semen Croton seed Pa doo Croton tiglium L (Euphorbiaceae) Very toxic

Mylabris Mylabris Ban myo 1 Mylabris cichorii Fabricius (Meloidae)

2 Mylabris phalerata Pall (Meloidae)

3 Mylabris sidae Fabricius (Meloidae)

Very toxic

Aconiti Ciliare Tuber Wild aconite (tuber) Cho o Aconitum ciliare DC (Ranunculaceae)

Very toxic

Aconiti Kusnezoffii Radix

Wild aconite (tuber) Cho o Aconitum kusnezoffii Reichb (Ranunculaceae)

Very toxic

Aconiti Proliferum Radix

Wild aconite (tuber) Cho o Aconitum proliferum Nakai (Ranunculaceae)

Very toxic

Aconiti Radix Wild aconite (tuber) Cho o Aconitum triphyllum Nakai (Ranunculaceae)

Very toxic

Aconiti Radix Aconite main tuber Chun o 1 Aconitum carmichaeli Debx (Ranunculaceae)

2 Aconitum chinense Paxton (Ranunculaceae)

Very toxic

Strychni Semen seu nux Vomicae Semen

Nuxvomica Ma jun ja Strychnos nux-vomica L (Loganiaceae)

Very toxic

The Pharmacopoeia Commission of PRC 2000

Crotonis Semen (Pa Doo)

bull Indications Scabies Eczema Abscess

bull Pretreatment Croton seed without husk Croton seed plaster

Croton seed frost-like powder

bull Pharmacological action increase GI movement (inhalation

human) increase cell differentiation (in vitro)

Hanyak yangnihak 2001

bull Toxicity Croton oil has the ability to promote radiation

transformation It is very toxic and carcinogenic (animal study) Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Caution Not use in pregnancy

bull Formula in Korea 35 OTC in Korea1

wwwtradimedcokrwwwkimsonlinecokr

Constituents 4-alpha-Deoxy-5-hydroxy-20-acetoxy-12-O-(2-methyl-amino-benzoyl)phorbol 4-alpha-Deoxy-5-hydroxy-12-O-(N-deca-246-trienoyl)phorbol 4-alpha-Deoxy-12-O-(2-methylbutyryl)-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglyl-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglylphorbol-13-isobutyrate 4-alpha-Deoxy-phorbol-13-acetate 4-alpha-Phorbol Angelic acid Cocacinogen A1 Cocacinogen A2 Cocacinogen A3 Cocacinogen A4 Cocacinogen B1 Cocacinogen B2 Cocacinogen B3 Cocacinogen B4 Cocacinogen B6 Cocacinogen B7 Crotin I Crotin tiglium lectin Crotonoside 4-Deoxyphorbol tiglate acetate 4-Deoxy-51320-triacetoxy-12-O-(n-deca-246-trienoyl)phorol 420-Dideoxy-5-hydroxy-12-O-(n-deca-246-trienoyl)-phorbol-13-acetate 12-O-Acetylphorbol-13-acetate 12-O-(alpha-Methyl-butyryl)-phorbol-13-decanoate Octyl acetate 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-5-Hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-phorbol-51320-triacetate 12-O-[2-Methyl-amino-benzoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-5-hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-phorbol-513-diacetate 12-O-(2-Methyl-butyryl)-phorbol-13-acetate 12-O-(2-Methylbutyryl)-phorbol-13-isobutyrate 12-O-[n-Deca-246-trienoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[n-Tetradecanoyl]-420-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-Tigloylphorbol-13-(2-methyl)-butyrate 12-O-Tiglylphorbol 13-isobutyrate 12-O-Tiglylphorbol-13-acetate Phorbol Phorbol 13-butyrate 12-tiglate Phorbol 13-caprylate 12-acetate Phorbol 13-caprylate 12-tiglate Phorbol 13-linoleate 12-acetate Phorbol 13-myristate 12-acetate Phorbol-13-acetate Phorbol-12-tiglate

wwwtradimedcokr

Mylabris (Ban Myo)

bull Indications Rabies Scabies Mercury intoxication Hepatic

cirrhosis due to Clonorchiasis Tuberculosis Tuberculous

lymphadenitis Eczema Abscess Atopic dermatitis Fever and

chill

bull Pretreatment parched Mylabris with rice

bull Pharmacological action intoxication of snake venom

increase urination increase abortion Dong-Eui-Bo-Gam

bull Caution Not use in pregnancy

bull Formula in Korea 4 wwwtradimedcokr

Cantharidin bull Phytochemical group Monoterpenoid

bull Molecular weight 1962

bull Cantharidin may cause symptoms from dermal inflammation to

blisters If ingested it may cause irritation and burning of the

mouth severe vesication of the upper GI tract diarrhea and

kidney and cardiovascular damage

bull Ii is a weak experimental animal carcinogen

wwwthomsonhccom wwwtradimedcokr

Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)

bull Indications Beriberi edema Cold limbs Myalgia Cold type

dysentery Epigastric pain Child epilepsy Chronic osteomyelitis

Hemiparalysis Hemiplegia Migratory arthropathy

bull Pretreatment processed Wild aconite tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Toxicity Toxic symptoms include bradycardia and irregular

rhythm Nausea and vomiting may occur as well as spasm of

extremities and cardiac arrhythmias The intestinal absorption of

the alkaloids is relatively fast Because of this gastric lavage is

recommended in case of overdose Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Formula in Korea 16 OTC in Korea 10

wwwtradimedcokrwwwkimsonlinecokr

Aconiti Ciliare Tuber

Aconiti Kusnezoffii Radix

Constituents of Aconiti Ciliare Tuber amp Aconiti Porliferum Radix Aconitine Hypaconitine Mesaconitine

Constituents of Aconiti Kusnezoffii Radix 3-Acetylaconitine Aconitine Acontine Beiwutine Bullatine A(structure unknown)formula C(21)H(31)NO(2) Bullatine C Chasmanine 6-Epimer Denudatine Hypaconitine Lepenine Mesaconitine Neoline Pendulin Songorine

Aconitine bull Phytochemical group Alkaloid

bull Molecular weight 64575

bull Bioactivity bind to neurotoxin binding site 2 of α-subunit of

Na+ channel activation of Na+ channel increase intracellular

Ca2+ arrhythmia Hanbang Yangnihak 2010

bull Toxicity Very toxic if swallowed or by skin absorption Human

systemic effects by ingestion LD50 (mus orl) 1 mgkg LD50 (mus ivn)

0175 mgkg exp lethal doses by subcutaneous route reported LD50 in mice

(mgkg) 0166 iv 0328 ip approx 1 orally (Dybing) also reported as LD50 in

mice (mgkg) 18 orally 0270 sc 0380 ip 012 iv (Sato)

wwwtradimedcokr

Aconiti Radix (Chun O)

bull Indications Beriberi edema Myalgia Cold type dysentery

Paresthesia Child epilepsy Epigastric pain Chronic

osteomyelitis Vomiting and Diarrhea Testiculitis

bull Pretreatment processed Aconite main tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Caution not use in pregnancy

bull Toxicity headache paralysis of tongue paraplegia pain on upper extremity nausea vomiting respiration difficulty coma

Hanyak yangnihak 2001

bull Formula in Korea 1 OTC in Korea 5 wwwtradimedcokrwwwkimsonlinecokr

Constituents of Aconitum carmichaeli Debx 14-Acetyltalatizamine Aconine Aconitan A Aconitan B Aconitan C Aconitan D Aconitine Aldohypaconitine Beiwutine Benzoylaconine Benzoylhypaconine Benzoylmesaconine Chuanfumine Chuan-Wu base A (structure unknown)(Tertiary base with 20H 20Me and one N-Et groups) Chuan-Wu base B(structure unknown)formula C(32)H(35)NO(4) Coryeine Coryneine Fuzitine Hokbusine A Hokbusine B Hypaconitine Ignavine Isodelphinine Isotalatisamine Isotalatizamine Karakoline Lipoaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipodeoxyaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipohypaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipomesaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Mesaconitine Neojiangyouaconitine Neoline Salsolinol Senbusine A Senbusine B Senbusine C Songarine Songorine Talatizamine

wwwtradimedcokr

Constituents of Aconitum chinense Paxton Violdelphin

How to make herbal medicine in Korea

Very Toxic Herbal Medicine Herbal name Common name Korean common

name Binominal name Toxicity

Crotonis Semen Croton seed Pa doo Croton tiglium L (Euphorbiaceae) Very toxic

Mylabris Mylabris Ban myo 1 Mylabris cichorii Fabricius (Meloidae)

2 Mylabris phalerata Pall (Meloidae)

3 Mylabris sidae Fabricius (Meloidae)

Very toxic

Aconiti Ciliare Tuber Wild aconite (tuber) Cho o Aconitum ciliare DC (Ranunculaceae)

Very toxic

Aconiti Kusnezoffii Radix

Wild aconite (tuber) Cho o Aconitum kusnezoffii Reichb (Ranunculaceae)

Very toxic

Aconiti Proliferum Radix

Wild aconite (tuber) Cho o Aconitum proliferum Nakai (Ranunculaceae)

Very toxic

Aconiti Radix Wild aconite (tuber) Cho o Aconitum triphyllum Nakai (Ranunculaceae)

Very toxic

Aconiti Radix Aconite main tuber Chun o 1 Aconitum carmichaeli Debx (Ranunculaceae)

2 Aconitum chinense Paxton (Ranunculaceae)

Very toxic

Strychni Semen seu nux Vomicae Semen

Nuxvomica Ma jun ja Strychnos nux-vomica L (Loganiaceae)

Very toxic

The Pharmacopoeia Commission of PRC 2000

Crotonis Semen (Pa Doo)

bull Indications Scabies Eczema Abscess

bull Pretreatment Croton seed without husk Croton seed plaster

Croton seed frost-like powder

bull Pharmacological action increase GI movement (inhalation

human) increase cell differentiation (in vitro)

Hanyak yangnihak 2001

bull Toxicity Croton oil has the ability to promote radiation

transformation It is very toxic and carcinogenic (animal study) Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Caution Not use in pregnancy

bull Formula in Korea 35 OTC in Korea1

wwwtradimedcokrwwwkimsonlinecokr

Constituents 4-alpha-Deoxy-5-hydroxy-20-acetoxy-12-O-(2-methyl-amino-benzoyl)phorbol 4-alpha-Deoxy-5-hydroxy-12-O-(N-deca-246-trienoyl)phorbol 4-alpha-Deoxy-12-O-(2-methylbutyryl)-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglyl-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglylphorbol-13-isobutyrate 4-alpha-Deoxy-phorbol-13-acetate 4-alpha-Phorbol Angelic acid Cocacinogen A1 Cocacinogen A2 Cocacinogen A3 Cocacinogen A4 Cocacinogen B1 Cocacinogen B2 Cocacinogen B3 Cocacinogen B4 Cocacinogen B6 Cocacinogen B7 Crotin I Crotin tiglium lectin Crotonoside 4-Deoxyphorbol tiglate acetate 4-Deoxy-51320-triacetoxy-12-O-(n-deca-246-trienoyl)phorol 420-Dideoxy-5-hydroxy-12-O-(n-deca-246-trienoyl)-phorbol-13-acetate 12-O-Acetylphorbol-13-acetate 12-O-(alpha-Methyl-butyryl)-phorbol-13-decanoate Octyl acetate 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-5-Hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-phorbol-51320-triacetate 12-O-[2-Methyl-amino-benzoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-5-hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-phorbol-513-diacetate 12-O-(2-Methyl-butyryl)-phorbol-13-acetate 12-O-(2-Methylbutyryl)-phorbol-13-isobutyrate 12-O-[n-Deca-246-trienoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[n-Tetradecanoyl]-420-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-Tigloylphorbol-13-(2-methyl)-butyrate 12-O-Tiglylphorbol 13-isobutyrate 12-O-Tiglylphorbol-13-acetate Phorbol Phorbol 13-butyrate 12-tiglate Phorbol 13-caprylate 12-acetate Phorbol 13-caprylate 12-tiglate Phorbol 13-linoleate 12-acetate Phorbol 13-myristate 12-acetate Phorbol-13-acetate Phorbol-12-tiglate

wwwtradimedcokr

Mylabris (Ban Myo)

bull Indications Rabies Scabies Mercury intoxication Hepatic

cirrhosis due to Clonorchiasis Tuberculosis Tuberculous

lymphadenitis Eczema Abscess Atopic dermatitis Fever and

chill

bull Pretreatment parched Mylabris with rice

bull Pharmacological action intoxication of snake venom

increase urination increase abortion Dong-Eui-Bo-Gam

bull Caution Not use in pregnancy

bull Formula in Korea 4 wwwtradimedcokr

Cantharidin bull Phytochemical group Monoterpenoid

bull Molecular weight 1962

bull Cantharidin may cause symptoms from dermal inflammation to

blisters If ingested it may cause irritation and burning of the

mouth severe vesication of the upper GI tract diarrhea and

kidney and cardiovascular damage

bull Ii is a weak experimental animal carcinogen

wwwthomsonhccom wwwtradimedcokr

Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)

bull Indications Beriberi edema Cold limbs Myalgia Cold type

dysentery Epigastric pain Child epilepsy Chronic osteomyelitis

Hemiparalysis Hemiplegia Migratory arthropathy

bull Pretreatment processed Wild aconite tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Toxicity Toxic symptoms include bradycardia and irregular

rhythm Nausea and vomiting may occur as well as spasm of

extremities and cardiac arrhythmias The intestinal absorption of

the alkaloids is relatively fast Because of this gastric lavage is

recommended in case of overdose Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Formula in Korea 16 OTC in Korea 10

wwwtradimedcokrwwwkimsonlinecokr

Aconiti Ciliare Tuber

Aconiti Kusnezoffii Radix

Constituents of Aconiti Ciliare Tuber amp Aconiti Porliferum Radix Aconitine Hypaconitine Mesaconitine

Constituents of Aconiti Kusnezoffii Radix 3-Acetylaconitine Aconitine Acontine Beiwutine Bullatine A(structure unknown)formula C(21)H(31)NO(2) Bullatine C Chasmanine 6-Epimer Denudatine Hypaconitine Lepenine Mesaconitine Neoline Pendulin Songorine

Aconitine bull Phytochemical group Alkaloid

bull Molecular weight 64575

bull Bioactivity bind to neurotoxin binding site 2 of α-subunit of

Na+ channel activation of Na+ channel increase intracellular

Ca2+ arrhythmia Hanbang Yangnihak 2010

bull Toxicity Very toxic if swallowed or by skin absorption Human

systemic effects by ingestion LD50 (mus orl) 1 mgkg LD50 (mus ivn)

0175 mgkg exp lethal doses by subcutaneous route reported LD50 in mice

(mgkg) 0166 iv 0328 ip approx 1 orally (Dybing) also reported as LD50 in

mice (mgkg) 18 orally 0270 sc 0380 ip 012 iv (Sato)

wwwtradimedcokr

Aconiti Radix (Chun O)

bull Indications Beriberi edema Myalgia Cold type dysentery

Paresthesia Child epilepsy Epigastric pain Chronic

osteomyelitis Vomiting and Diarrhea Testiculitis

bull Pretreatment processed Aconite main tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Caution not use in pregnancy

bull Toxicity headache paralysis of tongue paraplegia pain on upper extremity nausea vomiting respiration difficulty coma

Hanyak yangnihak 2001

bull Formula in Korea 1 OTC in Korea 5 wwwtradimedcokrwwwkimsonlinecokr

Constituents of Aconitum carmichaeli Debx 14-Acetyltalatizamine Aconine Aconitan A Aconitan B Aconitan C Aconitan D Aconitine Aldohypaconitine Beiwutine Benzoylaconine Benzoylhypaconine Benzoylmesaconine Chuanfumine Chuan-Wu base A (structure unknown)(Tertiary base with 20H 20Me and one N-Et groups) Chuan-Wu base B(structure unknown)formula C(32)H(35)NO(4) Coryeine Coryneine Fuzitine Hokbusine A Hokbusine B Hypaconitine Ignavine Isodelphinine Isotalatisamine Isotalatizamine Karakoline Lipoaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipodeoxyaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipohypaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipomesaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Mesaconitine Neojiangyouaconitine Neoline Salsolinol Senbusine A Senbusine B Senbusine C Songarine Songorine Talatizamine

wwwtradimedcokr

Constituents of Aconitum chinense Paxton Violdelphin

How to make herbal medicine in Korea

Crotonis Semen (Pa Doo)

bull Indications Scabies Eczema Abscess

bull Pretreatment Croton seed without husk Croton seed plaster

Croton seed frost-like powder

bull Pharmacological action increase GI movement (inhalation

human) increase cell differentiation (in vitro)

Hanyak yangnihak 2001

bull Toxicity Croton oil has the ability to promote radiation

transformation It is very toxic and carcinogenic (animal study) Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Caution Not use in pregnancy

bull Formula in Korea 35 OTC in Korea1

wwwtradimedcokrwwwkimsonlinecokr

Constituents 4-alpha-Deoxy-5-hydroxy-20-acetoxy-12-O-(2-methyl-amino-benzoyl)phorbol 4-alpha-Deoxy-5-hydroxy-12-O-(N-deca-246-trienoyl)phorbol 4-alpha-Deoxy-12-O-(2-methylbutyryl)-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglyl-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglylphorbol-13-isobutyrate 4-alpha-Deoxy-phorbol-13-acetate 4-alpha-Phorbol Angelic acid Cocacinogen A1 Cocacinogen A2 Cocacinogen A3 Cocacinogen A4 Cocacinogen B1 Cocacinogen B2 Cocacinogen B3 Cocacinogen B4 Cocacinogen B6 Cocacinogen B7 Crotin I Crotin tiglium lectin Crotonoside 4-Deoxyphorbol tiglate acetate 4-Deoxy-51320-triacetoxy-12-O-(n-deca-246-trienoyl)phorol 420-Dideoxy-5-hydroxy-12-O-(n-deca-246-trienoyl)-phorbol-13-acetate 12-O-Acetylphorbol-13-acetate 12-O-(alpha-Methyl-butyryl)-phorbol-13-decanoate Octyl acetate 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-5-Hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-phorbol-51320-triacetate 12-O-[2-Methyl-amino-benzoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-5-hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-420-dideoxy-phorbol-513-diacetate 12-O-(2-Methyl-butyryl)-phorbol-13-acetate 12-O-(2-Methylbutyryl)-phorbol-13-isobutyrate 12-O-[n-Deca-246-trienoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[n-Tetradecanoyl]-420-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-Tigloylphorbol-13-(2-methyl)-butyrate 12-O-Tiglylphorbol 13-isobutyrate 12-O-Tiglylphorbol-13-acetate Phorbol Phorbol 13-butyrate 12-tiglate Phorbol 13-caprylate 12-acetate Phorbol 13-caprylate 12-tiglate Phorbol 13-linoleate 12-acetate Phorbol 13-myristate 12-acetate Phorbol-13-acetate Phorbol-12-tiglate

wwwtradimedcokr

Mylabris (Ban Myo)

bull Indications Rabies Scabies Mercury intoxication Hepatic

cirrhosis due to Clonorchiasis Tuberculosis Tuberculous

lymphadenitis Eczema Abscess Atopic dermatitis Fever and

chill

bull Pretreatment parched Mylabris with rice

bull Pharmacological action intoxication of snake venom

increase urination increase abortion Dong-Eui-Bo-Gam

bull Caution Not use in pregnancy

bull Formula in Korea 4 wwwtradimedcokr

Cantharidin bull Phytochemical group Monoterpenoid

bull Molecular weight 1962

bull Cantharidin may cause symptoms from dermal inflammation to

blisters If ingested it may cause irritation and burning of the

mouth severe vesication of the upper GI tract diarrhea and

kidney and cardiovascular damage

bull Ii is a weak experimental animal carcinogen

wwwthomsonhccom wwwtradimedcokr

Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)

bull Indications Beriberi edema Cold limbs Myalgia Cold type

dysentery Epigastric pain Child epilepsy Chronic osteomyelitis

Hemiparalysis Hemiplegia Migratory arthropathy

bull Pretreatment processed Wild aconite tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Toxicity Toxic symptoms include bradycardia and irregular

rhythm Nausea and vomiting may occur as well as spasm of

extremities and cardiac arrhythmias The intestinal absorption of

the alkaloids is relatively fast Because of this gastric lavage is

recommended in case of overdose Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Formula in Korea 16 OTC in Korea 10

wwwtradimedcokrwwwkimsonlinecokr

Aconiti Ciliare Tuber

Aconiti Kusnezoffii Radix

Constituents of Aconiti Ciliare Tuber amp Aconiti Porliferum Radix Aconitine Hypaconitine Mesaconitine

Constituents of Aconiti Kusnezoffii Radix 3-Acetylaconitine Aconitine Acontine Beiwutine Bullatine A(structure unknown)formula C(21)H(31)NO(2) Bullatine C Chasmanine 6-Epimer Denudatine Hypaconitine Lepenine Mesaconitine Neoline Pendulin Songorine

Aconitine bull Phytochemical group Alkaloid

bull Molecular weight 64575

bull Bioactivity bind to neurotoxin binding site 2 of α-subunit of

Na+ channel activation of Na+ channel increase intracellular

Ca2+ arrhythmia Hanbang Yangnihak 2010

bull Toxicity Very toxic if swallowed or by skin absorption Human

systemic effects by ingestion LD50 (mus orl) 1 mgkg LD50 (mus ivn)

0175 mgkg exp lethal doses by subcutaneous route reported LD50 in mice

(mgkg) 0166 iv 0328 ip approx 1 orally (Dybing) also reported as LD50 in

mice (mgkg) 18 orally 0270 sc 0380 ip 012 iv (Sato)

wwwtradimedcokr

Aconiti Radix (Chun O)

bull Indications Beriberi edema Myalgia Cold type dysentery

Paresthesia Child epilepsy Epigastric pain Chronic

osteomyelitis Vomiting and Diarrhea Testiculitis

bull Pretreatment processed Aconite main tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Caution not use in pregnancy

bull Toxicity headache paralysis of tongue paraplegia pain on upper extremity nausea vomiting respiration difficulty coma

Hanyak yangnihak 2001

bull Formula in Korea 1 OTC in Korea 5 wwwtradimedcokrwwwkimsonlinecokr

Constituents of Aconitum carmichaeli Debx 14-Acetyltalatizamine Aconine Aconitan A Aconitan B Aconitan C Aconitan D Aconitine Aldohypaconitine Beiwutine Benzoylaconine Benzoylhypaconine Benzoylmesaconine Chuanfumine Chuan-Wu base A (structure unknown)(Tertiary base with 20H 20Me and one N-Et groups) Chuan-Wu base B(structure unknown)formula C(32)H(35)NO(4) Coryeine Coryneine Fuzitine Hokbusine A Hokbusine B Hypaconitine Ignavine Isodelphinine Isotalatisamine Isotalatizamine Karakoline Lipoaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipodeoxyaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipohypaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipomesaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Mesaconitine Neojiangyouaconitine Neoline Salsolinol Senbusine A Senbusine B Senbusine C Songarine Songorine Talatizamine

wwwtradimedcokr

Constituents of Aconitum chinense Paxton Violdelphin

How to make herbal medicine in Korea

Mylabris (Ban Myo)

bull Indications Rabies Scabies Mercury intoxication Hepatic

cirrhosis due to Clonorchiasis Tuberculosis Tuberculous

lymphadenitis Eczema Abscess Atopic dermatitis Fever and

chill

bull Pretreatment parched Mylabris with rice

bull Pharmacological action intoxication of snake venom

increase urination increase abortion Dong-Eui-Bo-Gam

bull Caution Not use in pregnancy

bull Formula in Korea 4 wwwtradimedcokr

Cantharidin bull Phytochemical group Monoterpenoid

bull Molecular weight 1962

bull Cantharidin may cause symptoms from dermal inflammation to

blisters If ingested it may cause irritation and burning of the

mouth severe vesication of the upper GI tract diarrhea and

kidney and cardiovascular damage

bull Ii is a weak experimental animal carcinogen

wwwthomsonhccom wwwtradimedcokr

Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)

bull Indications Beriberi edema Cold limbs Myalgia Cold type

dysentery Epigastric pain Child epilepsy Chronic osteomyelitis

Hemiparalysis Hemiplegia Migratory arthropathy

bull Pretreatment processed Wild aconite tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Toxicity Toxic symptoms include bradycardia and irregular

rhythm Nausea and vomiting may occur as well as spasm of

extremities and cardiac arrhythmias The intestinal absorption of

the alkaloids is relatively fast Because of this gastric lavage is

recommended in case of overdose Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Formula in Korea 16 OTC in Korea 10

wwwtradimedcokrwwwkimsonlinecokr

Aconiti Ciliare Tuber

Aconiti Kusnezoffii Radix

Constituents of Aconiti Ciliare Tuber amp Aconiti Porliferum Radix Aconitine Hypaconitine Mesaconitine

Constituents of Aconiti Kusnezoffii Radix 3-Acetylaconitine Aconitine Acontine Beiwutine Bullatine A(structure unknown)formula C(21)H(31)NO(2) Bullatine C Chasmanine 6-Epimer Denudatine Hypaconitine Lepenine Mesaconitine Neoline Pendulin Songorine

Aconitine bull Phytochemical group Alkaloid

bull Molecular weight 64575

bull Bioactivity bind to neurotoxin binding site 2 of α-subunit of

Na+ channel activation of Na+ channel increase intracellular

Ca2+ arrhythmia Hanbang Yangnihak 2010

bull Toxicity Very toxic if swallowed or by skin absorption Human

systemic effects by ingestion LD50 (mus orl) 1 mgkg LD50 (mus ivn)

0175 mgkg exp lethal doses by subcutaneous route reported LD50 in mice

(mgkg) 0166 iv 0328 ip approx 1 orally (Dybing) also reported as LD50 in

mice (mgkg) 18 orally 0270 sc 0380 ip 012 iv (Sato)

wwwtradimedcokr

Aconiti Radix (Chun O)

bull Indications Beriberi edema Myalgia Cold type dysentery

Paresthesia Child epilepsy Epigastric pain Chronic

osteomyelitis Vomiting and Diarrhea Testiculitis

bull Pretreatment processed Aconite main tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Caution not use in pregnancy

bull Toxicity headache paralysis of tongue paraplegia pain on upper extremity nausea vomiting respiration difficulty coma

Hanyak yangnihak 2001

bull Formula in Korea 1 OTC in Korea 5 wwwtradimedcokrwwwkimsonlinecokr

Constituents of Aconitum carmichaeli Debx 14-Acetyltalatizamine Aconine Aconitan A Aconitan B Aconitan C Aconitan D Aconitine Aldohypaconitine Beiwutine Benzoylaconine Benzoylhypaconine Benzoylmesaconine Chuanfumine Chuan-Wu base A (structure unknown)(Tertiary base with 20H 20Me and one N-Et groups) Chuan-Wu base B(structure unknown)formula C(32)H(35)NO(4) Coryeine Coryneine Fuzitine Hokbusine A Hokbusine B Hypaconitine Ignavine Isodelphinine Isotalatisamine Isotalatizamine Karakoline Lipoaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipodeoxyaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipohypaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipomesaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Mesaconitine Neojiangyouaconitine Neoline Salsolinol Senbusine A Senbusine B Senbusine C Songarine Songorine Talatizamine

wwwtradimedcokr

Constituents of Aconitum chinense Paxton Violdelphin

How to make herbal medicine in Korea

Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)

bull Indications Beriberi edema Cold limbs Myalgia Cold type

dysentery Epigastric pain Child epilepsy Chronic osteomyelitis

Hemiparalysis Hemiplegia Migratory arthropathy

bull Pretreatment processed Wild aconite tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Toxicity Toxic symptoms include bradycardia and irregular

rhythm Nausea and vomiting may occur as well as spasm of

extremities and cardiac arrhythmias The intestinal absorption of

the alkaloids is relatively fast Because of this gastric lavage is

recommended in case of overdose Huang KC The pharmacology of Chinese herbs II CRC press 1999

bull Formula in Korea 16 OTC in Korea 10

wwwtradimedcokrwwwkimsonlinecokr

Aconiti Ciliare Tuber

Aconiti Kusnezoffii Radix

Constituents of Aconiti Ciliare Tuber amp Aconiti Porliferum Radix Aconitine Hypaconitine Mesaconitine

Constituents of Aconiti Kusnezoffii Radix 3-Acetylaconitine Aconitine Acontine Beiwutine Bullatine A(structure unknown)formula C(21)H(31)NO(2) Bullatine C Chasmanine 6-Epimer Denudatine Hypaconitine Lepenine Mesaconitine Neoline Pendulin Songorine

Aconitine bull Phytochemical group Alkaloid

bull Molecular weight 64575

bull Bioactivity bind to neurotoxin binding site 2 of α-subunit of

Na+ channel activation of Na+ channel increase intracellular

Ca2+ arrhythmia Hanbang Yangnihak 2010

bull Toxicity Very toxic if swallowed or by skin absorption Human

systemic effects by ingestion LD50 (mus orl) 1 mgkg LD50 (mus ivn)

0175 mgkg exp lethal doses by subcutaneous route reported LD50 in mice

(mgkg) 0166 iv 0328 ip approx 1 orally (Dybing) also reported as LD50 in

mice (mgkg) 18 orally 0270 sc 0380 ip 012 iv (Sato)

wwwtradimedcokr

Aconiti Radix (Chun O)

bull Indications Beriberi edema Myalgia Cold type dysentery

Paresthesia Child epilepsy Epigastric pain Chronic

osteomyelitis Vomiting and Diarrhea Testiculitis

bull Pretreatment processed Aconite main tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Caution not use in pregnancy

bull Toxicity headache paralysis of tongue paraplegia pain on upper extremity nausea vomiting respiration difficulty coma

Hanyak yangnihak 2001

bull Formula in Korea 1 OTC in Korea 5 wwwtradimedcokrwwwkimsonlinecokr

Constituents of Aconitum carmichaeli Debx 14-Acetyltalatizamine Aconine Aconitan A Aconitan B Aconitan C Aconitan D Aconitine Aldohypaconitine Beiwutine Benzoylaconine Benzoylhypaconine Benzoylmesaconine Chuanfumine Chuan-Wu base A (structure unknown)(Tertiary base with 20H 20Me and one N-Et groups) Chuan-Wu base B(structure unknown)formula C(32)H(35)NO(4) Coryeine Coryneine Fuzitine Hokbusine A Hokbusine B Hypaconitine Ignavine Isodelphinine Isotalatisamine Isotalatizamine Karakoline Lipoaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipodeoxyaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipohypaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipomesaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Mesaconitine Neojiangyouaconitine Neoline Salsolinol Senbusine A Senbusine B Senbusine C Songarine Songorine Talatizamine

wwwtradimedcokr

Constituents of Aconitum chinense Paxton Violdelphin

How to make herbal medicine in Korea

Aconiti Radix (Chun O)

bull Indications Beriberi edema Myalgia Cold type dysentery

Paresthesia Child epilepsy Epigastric pain Chronic

osteomyelitis Vomiting and Diarrhea Testiculitis

bull Pretreatment processed Aconite main tuber

bull Pharmacological action analgesics anti-inflammation

vasodilatation and local anesthetic action in animal study

bull Caution not use in pregnancy

bull Toxicity headache paralysis of tongue paraplegia pain on upper extremity nausea vomiting respiration difficulty coma

Hanyak yangnihak 2001

bull Formula in Korea 1 OTC in Korea 5 wwwtradimedcokrwwwkimsonlinecokr

Constituents of Aconitum carmichaeli Debx 14-Acetyltalatizamine Aconine Aconitan A Aconitan B Aconitan C Aconitan D Aconitine Aldohypaconitine Beiwutine Benzoylaconine Benzoylhypaconine Benzoylmesaconine Chuanfumine Chuan-Wu base A (structure unknown)(Tertiary base with 20H 20Me and one N-Et groups) Chuan-Wu base B(structure unknown)formula C(32)H(35)NO(4) Coryeine Coryneine Fuzitine Hokbusine A Hokbusine B Hypaconitine Ignavine Isodelphinine Isotalatisamine Isotalatizamine Karakoline Lipoaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipodeoxyaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipohypaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Lipomesaconitine (R = linoleoyl palmitoyl oleoyl stearoyl linolenoyl) Mesaconitine Neojiangyouaconitine Neoline Salsolinol Senbusine A Senbusine B Senbusine C Songarine Songorine Talatizamine

wwwtradimedcokr

Constituents of Aconitum chinense Paxton Violdelphin

How to make herbal medicine in Korea

How to make herbal medicine in Korea

Korean women have a chance to be exposed to herbal medicine from marriage to lactation

Promote Health

Increase pregnancy

chance

Decrease nausea amp vomiting

Decreased lochia

Increase breast milk

Herbal Medicines relate to Uterine Contraction

Animal study

Hanyak yangnihak 2001

Herbal name Common name Korean name Binominal name

Lycii Radicis Cortex Lycium root bark Ji gol pi 1 Lycium chinense Mill (Solanaceae) 2 Lycium barbarum L (Solanaceae)

Dianthi Herba Dianthus Gu mac 1 Dianthus chinensis L (Caryophyllaceae) 2 Dianthus superbus L (Caryophyllaceae)

Aurantii Fructus Immaturus Unripe bitter orange Ji gac Citrus aurantium var daidai Makino (Rutaceae)

Crataegi Fructus Crataegus fruit San sa yug Crataegus pinnatifida Bunge (Rosaceae)

Typhae Pollen Typha pollen Po hwang Typha angustifolia L (Typhaceae)

Cnidii Rhizoma Cnidium (root) Chun gung Cnidium officinale Makino (Umbelliferae)

Chuanxiong Rhizoma Cnidium rhizome Chun gung Ligusticum chuanxiong Hort (Umbelliferae)

Ligustici Rhizoma Ligusticum rhizome Chun gung Ligusticum wallichii var officinale Yook (Umbelliferae)

Corydalis Tuber Corydalis (tuber) Hyun ho sac 1 Corydalis ternata Nakai (Papaveraceae) 2 Corydalis ambigua Chamisso et Schlechtendal

(Papaveraceae) 3 Corydalis decumbens Pers (Papaveraceae) 4 Corydalis nakaii Ishidoya (Papaveraceae)

Leonuri Herba 1 Chinese motherwort 2 Motherwort

Ik mo cho 1 Leonurus sibiricus L (Labiatae) 2 Leonurus heterophyllus Sweet (Labiatae)

Carthami Flos Carthamus flower (safflower) Hong hwa Carthamus tinctorius L (Compositae)

Angelicae Gigantis Radix Dang gui root Dang gui Angelica gigas Nakai (Umbelliferae)

Angelicae Sinensis Radix Dang gui root Dang gui Angelica sinensis (Oliv) Diels (Umbelliferae)

Angelicae Acutilobae Radix Dang gui root Dang gui Angelica acutiloba Kitagawa (Umbelliferae)

Cassiae Semen Feotid cassia (seed) Gyul myoung ja 1 Cassia tora L (Leguminosae) 2 Cassia obtusifolia L (Leguminosae)

Cnidii Rhizoma (Chun gung) (1)

bull Indications Secondary amenorrhea Muscle spasm

Hemiplegia Seborrheic dermatitis Persistent headache

Metrorrhagia Thoracoabdominal pain Consumptive disease

Abnormal menstruation Syncope Confusion Pelvic mass

Gingival bleeding Gingivitis Paresthesia Pneumonia

bull Pharmacologic action vasodilatation analgesics anti

inflammation and uterine contraction in animal

Hanyak yangnihak 2001

bull Formula in Korea 25 wwwtradimedcokr

bull OTC in Korea 1186 wwwkimsonlinecokr

Constituents of Cnidii Rhizoma Adenosine Apiol Butylidenephthalide Butylphthalide Chlorogenic acid Cnidilide Coniferyl ferulate Ferulic acid Ligustilide Ligustilidiol Neocnidilide Pregnenolone Senkyunolide Senkyunolide B Senkyunolide C Senkyunolide D Senkyunolide F Senkyunolide G Senkyunolide H Senkyunolide I Senkyunolide J Umbelliferose Vanillin Vitamin C wwwtradimedcokr

Korean Motherisk Program unpublished

Cnidii Rhizoma (Chun gung) (2) (80cases)

Number Spontaneous abortion

280 25

IUFD 478 51 Preterm birth 878 103 LBW 378 38 Malformation 278 26 Mega-cysterna magna(11mm) Left ventriculomegaly of cerebrum (11mm)

Median (Min-Max)

Last exposure weeks 46 (06-124)

Duration of exposure (days) 20 (10-590)

Dosage (mgday) (4280) 1250 (93-9000)

Corydalis Tuber (Hyun ho sac) (1) bull Indications Metrorrhagia Nasal bleeding Postpartum faint

Chest pain Bruise Abnormal menstruation Back and knee pain Peptic ulcer Pancreatitis Hyperhidrosis Postpartum lochiorrhea Pelvic mass Spontaneous abortion Multiple arthritis Rheumatoid arthritis Dysentery and Diarrhea

bull Pretreatment processed Corydalis tuber with vinegar

bull Pharmacological action muscle relaxation hypotension

anti-inflammatory action decrease secretion of gastric acid

anti-ulcer action and increase contraction of extract uterus in

animal Hanyak yangnihak 2001

bull Toxicity Over dosage intoxication leads to CNS depression

and muscle relaxation

bull Caution Not recommend in pregnancy

bull Formula in Korea 10 OTC 77

wwwtradimedcokrwwwkimsonlinecokr

Tetrahydropalmatine bullPhytochemical group Alkaloid

bullMolecular weight 35544

bullBioactivity hypnotic activity exceeds that of

morphine wwwtredimedcokr

Korean Motherisk Program unpublished

Corydalis Tuber (Hyun ho sac) (2) (25 cases)

Number Spontaneous abortion

125 40

IUFD - 0 Preterm birth 124 42 LBW - 0 Malformation 124 40 Post axial polydactyly of left foot

Median (Min-Max)

Last exposure weeks 54 (04-130)

Duration of exposure (days) 30 (10-380)

Dosage (mgday) (1625) 180 (750-7200)

Angelicae Gigantis Radix (Dang gui) (1)

bull Indications Secondary amenorrhea Nausea Laceration Headache Abdominal pain Metrorrhagia Hyperventilation Severe palpitation Arrhythmia Carbuncle Influenza Abnormal menstruation Hemorrhage without trauma Nasal bleeding Syncope Confusion Acute pulpitis Toothache Multiple arthritis Skin tumor Skin ulcer or Skin abscess Cerebrovascular accident Dysentery and Diarrhea Fever and chill Tuberculosis Anemia Paresthesia

bull Pretreatment parched dang gui with soil charred dang gui

parched dang gui with liquor ginger processed dang gui

bull Pharmacologic action Increase blood flow to heart

hypotension anti ulcer effect analgesic anti-inflammatory

effect and uterine contraction (aqueous extracts) in animal Hanbang Yangnihak 2010

bull Formula in Korea 120 wwwtradimedcokr

bull OTC in Korea 1401 wwwkimsonlinecokr

Constituents of Angelicae Gigantis Radix Aegelinol

alpha-Pinene(+-)

Choline

Coumarin

Decursidin

Decursin

Decursinol

Decursinol angelate

Decusinol angelate

Gigasol

Imperatorin

Isoimperatorin

Marmesin

Nodakenetin

Nodakenin

p-Cymene

Prenyletin

Umbelliferone

wwwtradimedcokr

Korean Motherisk Program unpublished

Angelicae Gigantis Radix (Dang gui) (2) (74 cases)

Median (Min-Max)

Last exposure weeks 46 (06-126)

Duration of exposure (days) 30 (10-590)

Dosage (mgday) (3474) 1250 (135-9000)

Number

Spontaneous abortion

374 41

IUFD 271 28

Preterm birth 671 85

LBW 171 14

Malformation 171 14

Mega-cysterna magna(11mm)

Herbal Medicines relate to Spontaneous Abortion

Animal study

Hanyak yangnihak 2001

Herbal name Common name Korean name Binominal name

Menthae Herba Mint Bak ha 1 Mentha arvensis var piperascens Malinv (Labiatae) 2 Mentha haplocalyx Briq (Labiatae)

Trichosanthis Radix Trichosanthes root Chun Hwa Boon Trichosanthes kirilowii Maxim (Cucurbitaceae)

Moutan Radicis Cortex Moutan root bark Mok dan pi Paeonia suffruticosa Andr (Paeoniaceae)

Lonicerae Flos Lonicera flowers Geum un hwa 1 Lonicera japonica Thunb (Caprifoliaceae) 2 Lonicera confusa DC (Caprifoliaceae)

Kansui Radix Kansui root Gam su Euphorbia kansui Liou ex Wang (Euphorbiaceae)

Clematidis Radix Clematis (root) Wi ryung sun 1 Clematis mandshurica Rupr (Ranunculaceae) 2 Clematis chinensis Osbeck (Ranunculaceae) 3 Clematis hexapetala Pall (Ranunculaceae)

Sulphur Sulphur Yu hwang Sulphur

Curcumae Longae Tuber Common turmeric Gang hwang Curcuma longa L (Zingiberaceae)

Curcumae Rhizoma Zedoary A chool 1 Curcuma phaeocaulis Val (Zingiberaceae) 2 Curcuma kwangsiensis S G Lee et C F Liang

(Zingiberaceae)

Achyranthis Radix Achyranthes root Oo seol 1 Achyranthes japonica Nakai (Amaranthaceae) 2 Achyranthes bidentata Bl (Amaranthaceae) 3 Achyranthes fauriei Leville et Vaniot (Amaranthaceae)

Pinelliae Rhizoma Pinellia rhizome Ban ha Pinellia ternata (Thunb) Breit (Araceae)

Aristolochiae Fructus Aristolochia fruit Ma doo ryung 1 Aristolochia contorta Bunge (Aristolochiaceae) 2 Aristolochia debilis Siebet Zucc (Aristolochiaceae)

Albizziae Cortex Silk tree bark Hab han pi Albizia julibrissin Durazz (Leguminosae)

Moschus Musk Sa hyang 1 Moschus moschiferus L (Moschidae) 2 Moschus berezovskii Flerov (Moschidae) 3 Moschus sifanicus Przewalski (Moschidae)

Menthae Herba (Bak ha) (1)

bull Indications Common cold Frozen shoulder Fever accompanied with fear Cholera Acute gastric cramp Aphthous stomatitis Tuberculous lymphadenitis Persistent headache Measles Nasal bleeding Snake bite Liver cirrhosis Ascites Urticaria Palpebral conjunctivitis Laryngitis or Laryngeal abscess Suppurative otitis media Aphasia in Stroke Contact dermatitis Burn Headache Rubella Bloody dysentery Pharyngitis

bull Pharmacologic action anti-inflammatory effects anti-

pyretic vasodilatation decrease secretion of bronchus (high

conc) and necrosis of placenta in animal

Hanbang Yangnihak 2010 Hanyak yangnihak 2001

bull Formula in Korea 225 wwwtradimedcokr

bull OTC in Korea 311 wwwkimsonlinecokr

Menthae Herba (Bak ha) (2) (48 cases)

Median (Min-Max)

Last exposure weeks 43 (04-126)

Duration of exposure (days) 30 (10-460)

Dosage (mgday) (2548) 852 (200-2256)

Number

Spontaneous abortion

148 21

IUFD - 0

Preterm birth 347 64

LBW 247 43

Malformation - 0

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (1)

bull Indications Headache due to Brain tumor Bronchial asthma

Dizziness Stomach cancer Pyloric stenosis Gastric gaseous

distension

bull Pretreatment purified Pinellia tuber processed Pinellia

tuber processed Pinellia tuber with ginger

bull Pharmacologic action antitussive effect decrease

vomiting decrease gastric ulcer decrease ocular pressure and

increase abortion in animal Hanyak yangnihak 2001

bull Formula in Korea 90 wwwtradimedcokr

bull OTC in Korea 587 wwwkimsonlinecokr

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (2) (43 cases)

Median (Min-Max)

Last exposure weeks 45 (04-124)

Duration of exposure (days) 20 (10-530)

Dosage (mgday) (1843) 6255 (267-3340)

Number

Spontaneous abortion

- 0

IUFD 243 47

Preterm birth 443 93

LBW 343 71

Malformation 143 23

Mega cysterna magna (11mm)

Pregnancy Outcomes Korean Motherisk Program

Unpublished data

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Herbal Medicines relate to Uterine Contraction

Animal study

Hanyak yangnihak 2001

Herbal name Common name Korean name Binominal name

Lycii Radicis Cortex Lycium root bark Ji gol pi 1 Lycium chinense Mill (Solanaceae) 2 Lycium barbarum L (Solanaceae)

Dianthi Herba Dianthus Gu mac 1 Dianthus chinensis L (Caryophyllaceae) 2 Dianthus superbus L (Caryophyllaceae)

Aurantii Fructus Immaturus Unripe bitter orange Ji gac Citrus aurantium var daidai Makino (Rutaceae)

Crataegi Fructus Crataegus fruit San sa yug Crataegus pinnatifida Bunge (Rosaceae)

Typhae Pollen Typha pollen Po hwang Typha angustifolia L (Typhaceae)

Cnidii Rhizoma Cnidium (root) Chun gung Cnidium officinale Makino (Umbelliferae)

Chuanxiong Rhizoma Cnidium rhizome Chun gung Ligusticum chuanxiong Hort (Umbelliferae)

Ligustici Rhizoma Ligusticum rhizome Chun gung Ligusticum wallichii var officinale Yook (Umbelliferae)

Corydalis Tuber Corydalis (tuber) Hyun ho sac 1 Corydalis ternata Nakai (Papaveraceae) 2 Corydalis ambigua Chamisso et Schlechtendal

(Papaveraceae) 3 Corydalis decumbens Pers (Papaveraceae) 4 Corydalis nakaii Ishidoya (Papaveraceae)

Leonuri Herba 1 Chinese motherwort 2 Motherwort

Ik mo cho 1 Leonurus sibiricus L (Labiatae) 2 Leonurus heterophyllus Sweet (Labiatae)

Carthami Flos Carthamus flower (safflower) Hong hwa Carthamus tinctorius L (Compositae)

Angelicae Gigantis Radix Dang gui root Dang gui Angelica gigas Nakai (Umbelliferae)

Angelicae Sinensis Radix Dang gui root Dang gui Angelica sinensis (Oliv) Diels (Umbelliferae)

Angelicae Acutilobae Radix Dang gui root Dang gui Angelica acutiloba Kitagawa (Umbelliferae)

Cassiae Semen Feotid cassia (seed) Gyul myoung ja 1 Cassia tora L (Leguminosae) 2 Cassia obtusifolia L (Leguminosae)

Cnidii Rhizoma (Chun gung) (1)

bull Indications Secondary amenorrhea Muscle spasm

Hemiplegia Seborrheic dermatitis Persistent headache

Metrorrhagia Thoracoabdominal pain Consumptive disease

Abnormal menstruation Syncope Confusion Pelvic mass

Gingival bleeding Gingivitis Paresthesia Pneumonia

bull Pharmacologic action vasodilatation analgesics anti

inflammation and uterine contraction in animal

Hanyak yangnihak 2001

bull Formula in Korea 25 wwwtradimedcokr

bull OTC in Korea 1186 wwwkimsonlinecokr

Constituents of Cnidii Rhizoma Adenosine Apiol Butylidenephthalide Butylphthalide Chlorogenic acid Cnidilide Coniferyl ferulate Ferulic acid Ligustilide Ligustilidiol Neocnidilide Pregnenolone Senkyunolide Senkyunolide B Senkyunolide C Senkyunolide D Senkyunolide F Senkyunolide G Senkyunolide H Senkyunolide I Senkyunolide J Umbelliferose Vanillin Vitamin C wwwtradimedcokr

Korean Motherisk Program unpublished

Cnidii Rhizoma (Chun gung) (2) (80cases)

Number Spontaneous abortion

280 25

IUFD 478 51 Preterm birth 878 103 LBW 378 38 Malformation 278 26 Mega-cysterna magna(11mm) Left ventriculomegaly of cerebrum (11mm)

Median (Min-Max)

Last exposure weeks 46 (06-124)

Duration of exposure (days) 20 (10-590)

Dosage (mgday) (4280) 1250 (93-9000)

Corydalis Tuber (Hyun ho sac) (1) bull Indications Metrorrhagia Nasal bleeding Postpartum faint

Chest pain Bruise Abnormal menstruation Back and knee pain Peptic ulcer Pancreatitis Hyperhidrosis Postpartum lochiorrhea Pelvic mass Spontaneous abortion Multiple arthritis Rheumatoid arthritis Dysentery and Diarrhea

bull Pretreatment processed Corydalis tuber with vinegar

bull Pharmacological action muscle relaxation hypotension

anti-inflammatory action decrease secretion of gastric acid

anti-ulcer action and increase contraction of extract uterus in

animal Hanyak yangnihak 2001

bull Toxicity Over dosage intoxication leads to CNS depression

and muscle relaxation

bull Caution Not recommend in pregnancy

bull Formula in Korea 10 OTC 77

wwwtradimedcokrwwwkimsonlinecokr

Tetrahydropalmatine bullPhytochemical group Alkaloid

bullMolecular weight 35544

bullBioactivity hypnotic activity exceeds that of

morphine wwwtredimedcokr

Korean Motherisk Program unpublished

Corydalis Tuber (Hyun ho sac) (2) (25 cases)

Number Spontaneous abortion

125 40

IUFD - 0 Preterm birth 124 42 LBW - 0 Malformation 124 40 Post axial polydactyly of left foot

Median (Min-Max)

Last exposure weeks 54 (04-130)

Duration of exposure (days) 30 (10-380)

Dosage (mgday) (1625) 180 (750-7200)

Angelicae Gigantis Radix (Dang gui) (1)

bull Indications Secondary amenorrhea Nausea Laceration Headache Abdominal pain Metrorrhagia Hyperventilation Severe palpitation Arrhythmia Carbuncle Influenza Abnormal menstruation Hemorrhage without trauma Nasal bleeding Syncope Confusion Acute pulpitis Toothache Multiple arthritis Skin tumor Skin ulcer or Skin abscess Cerebrovascular accident Dysentery and Diarrhea Fever and chill Tuberculosis Anemia Paresthesia

bull Pretreatment parched dang gui with soil charred dang gui

parched dang gui with liquor ginger processed dang gui

bull Pharmacologic action Increase blood flow to heart

hypotension anti ulcer effect analgesic anti-inflammatory

effect and uterine contraction (aqueous extracts) in animal Hanbang Yangnihak 2010

bull Formula in Korea 120 wwwtradimedcokr

bull OTC in Korea 1401 wwwkimsonlinecokr

Constituents of Angelicae Gigantis Radix Aegelinol

alpha-Pinene(+-)

Choline

Coumarin

Decursidin

Decursin

Decursinol

Decursinol angelate

Decusinol angelate

Gigasol

Imperatorin

Isoimperatorin

Marmesin

Nodakenetin

Nodakenin

p-Cymene

Prenyletin

Umbelliferone

wwwtradimedcokr

Korean Motherisk Program unpublished

Angelicae Gigantis Radix (Dang gui) (2) (74 cases)

Median (Min-Max)

Last exposure weeks 46 (06-126)

Duration of exposure (days) 30 (10-590)

Dosage (mgday) (3474) 1250 (135-9000)

Number

Spontaneous abortion

374 41

IUFD 271 28

Preterm birth 671 85

LBW 171 14

Malformation 171 14

Mega-cysterna magna(11mm)

Herbal Medicines relate to Spontaneous Abortion

Animal study

Hanyak yangnihak 2001

Herbal name Common name Korean name Binominal name

Menthae Herba Mint Bak ha 1 Mentha arvensis var piperascens Malinv (Labiatae) 2 Mentha haplocalyx Briq (Labiatae)

Trichosanthis Radix Trichosanthes root Chun Hwa Boon Trichosanthes kirilowii Maxim (Cucurbitaceae)

Moutan Radicis Cortex Moutan root bark Mok dan pi Paeonia suffruticosa Andr (Paeoniaceae)

Lonicerae Flos Lonicera flowers Geum un hwa 1 Lonicera japonica Thunb (Caprifoliaceae) 2 Lonicera confusa DC (Caprifoliaceae)

Kansui Radix Kansui root Gam su Euphorbia kansui Liou ex Wang (Euphorbiaceae)

Clematidis Radix Clematis (root) Wi ryung sun 1 Clematis mandshurica Rupr (Ranunculaceae) 2 Clematis chinensis Osbeck (Ranunculaceae) 3 Clematis hexapetala Pall (Ranunculaceae)

Sulphur Sulphur Yu hwang Sulphur

Curcumae Longae Tuber Common turmeric Gang hwang Curcuma longa L (Zingiberaceae)

Curcumae Rhizoma Zedoary A chool 1 Curcuma phaeocaulis Val (Zingiberaceae) 2 Curcuma kwangsiensis S G Lee et C F Liang

(Zingiberaceae)

Achyranthis Radix Achyranthes root Oo seol 1 Achyranthes japonica Nakai (Amaranthaceae) 2 Achyranthes bidentata Bl (Amaranthaceae) 3 Achyranthes fauriei Leville et Vaniot (Amaranthaceae)

Pinelliae Rhizoma Pinellia rhizome Ban ha Pinellia ternata (Thunb) Breit (Araceae)

Aristolochiae Fructus Aristolochia fruit Ma doo ryung 1 Aristolochia contorta Bunge (Aristolochiaceae) 2 Aristolochia debilis Siebet Zucc (Aristolochiaceae)

Albizziae Cortex Silk tree bark Hab han pi Albizia julibrissin Durazz (Leguminosae)

Moschus Musk Sa hyang 1 Moschus moschiferus L (Moschidae) 2 Moschus berezovskii Flerov (Moschidae) 3 Moschus sifanicus Przewalski (Moschidae)

Menthae Herba (Bak ha) (1)

bull Indications Common cold Frozen shoulder Fever accompanied with fear Cholera Acute gastric cramp Aphthous stomatitis Tuberculous lymphadenitis Persistent headache Measles Nasal bleeding Snake bite Liver cirrhosis Ascites Urticaria Palpebral conjunctivitis Laryngitis or Laryngeal abscess Suppurative otitis media Aphasia in Stroke Contact dermatitis Burn Headache Rubella Bloody dysentery Pharyngitis

bull Pharmacologic action anti-inflammatory effects anti-

pyretic vasodilatation decrease secretion of bronchus (high

conc) and necrosis of placenta in animal

Hanbang Yangnihak 2010 Hanyak yangnihak 2001

bull Formula in Korea 225 wwwtradimedcokr

bull OTC in Korea 311 wwwkimsonlinecokr

Menthae Herba (Bak ha) (2) (48 cases)

Median (Min-Max)

Last exposure weeks 43 (04-126)

Duration of exposure (days) 30 (10-460)

Dosage (mgday) (2548) 852 (200-2256)

Number

Spontaneous abortion

148 21

IUFD - 0

Preterm birth 347 64

LBW 247 43

Malformation - 0

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (1)

bull Indications Headache due to Brain tumor Bronchial asthma

Dizziness Stomach cancer Pyloric stenosis Gastric gaseous

distension

bull Pretreatment purified Pinellia tuber processed Pinellia

tuber processed Pinellia tuber with ginger

bull Pharmacologic action antitussive effect decrease

vomiting decrease gastric ulcer decrease ocular pressure and

increase abortion in animal Hanyak yangnihak 2001

bull Formula in Korea 90 wwwtradimedcokr

bull OTC in Korea 587 wwwkimsonlinecokr

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (2) (43 cases)

Median (Min-Max)

Last exposure weeks 45 (04-124)

Duration of exposure (days) 20 (10-530)

Dosage (mgday) (1843) 6255 (267-3340)

Number

Spontaneous abortion

- 0

IUFD 243 47

Preterm birth 443 93

LBW 343 71

Malformation 143 23

Mega cysterna magna (11mm)

Pregnancy Outcomes Korean Motherisk Program

Unpublished data

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Herbal name Common name Korean name Binominal name

Lycii Radicis Cortex Lycium root bark Ji gol pi 1 Lycium chinense Mill (Solanaceae) 2 Lycium barbarum L (Solanaceae)

Dianthi Herba Dianthus Gu mac 1 Dianthus chinensis L (Caryophyllaceae) 2 Dianthus superbus L (Caryophyllaceae)

Aurantii Fructus Immaturus Unripe bitter orange Ji gac Citrus aurantium var daidai Makino (Rutaceae)

Crataegi Fructus Crataegus fruit San sa yug Crataegus pinnatifida Bunge (Rosaceae)

Typhae Pollen Typha pollen Po hwang Typha angustifolia L (Typhaceae)

Cnidii Rhizoma Cnidium (root) Chun gung Cnidium officinale Makino (Umbelliferae)

Chuanxiong Rhizoma Cnidium rhizome Chun gung Ligusticum chuanxiong Hort (Umbelliferae)

Ligustici Rhizoma Ligusticum rhizome Chun gung Ligusticum wallichii var officinale Yook (Umbelliferae)

Corydalis Tuber Corydalis (tuber) Hyun ho sac 1 Corydalis ternata Nakai (Papaveraceae) 2 Corydalis ambigua Chamisso et Schlechtendal

(Papaveraceae) 3 Corydalis decumbens Pers (Papaveraceae) 4 Corydalis nakaii Ishidoya (Papaveraceae)

Leonuri Herba 1 Chinese motherwort 2 Motherwort

Ik mo cho 1 Leonurus sibiricus L (Labiatae) 2 Leonurus heterophyllus Sweet (Labiatae)

Carthami Flos Carthamus flower (safflower) Hong hwa Carthamus tinctorius L (Compositae)

Angelicae Gigantis Radix Dang gui root Dang gui Angelica gigas Nakai (Umbelliferae)

Angelicae Sinensis Radix Dang gui root Dang gui Angelica sinensis (Oliv) Diels (Umbelliferae)

Angelicae Acutilobae Radix Dang gui root Dang gui Angelica acutiloba Kitagawa (Umbelliferae)

Cassiae Semen Feotid cassia (seed) Gyul myoung ja 1 Cassia tora L (Leguminosae) 2 Cassia obtusifolia L (Leguminosae)

Cnidii Rhizoma (Chun gung) (1)

bull Indications Secondary amenorrhea Muscle spasm

Hemiplegia Seborrheic dermatitis Persistent headache

Metrorrhagia Thoracoabdominal pain Consumptive disease

Abnormal menstruation Syncope Confusion Pelvic mass

Gingival bleeding Gingivitis Paresthesia Pneumonia

bull Pharmacologic action vasodilatation analgesics anti

inflammation and uterine contraction in animal

Hanyak yangnihak 2001

bull Formula in Korea 25 wwwtradimedcokr

bull OTC in Korea 1186 wwwkimsonlinecokr

Constituents of Cnidii Rhizoma Adenosine Apiol Butylidenephthalide Butylphthalide Chlorogenic acid Cnidilide Coniferyl ferulate Ferulic acid Ligustilide Ligustilidiol Neocnidilide Pregnenolone Senkyunolide Senkyunolide B Senkyunolide C Senkyunolide D Senkyunolide F Senkyunolide G Senkyunolide H Senkyunolide I Senkyunolide J Umbelliferose Vanillin Vitamin C wwwtradimedcokr

Korean Motherisk Program unpublished

Cnidii Rhizoma (Chun gung) (2) (80cases)

Number Spontaneous abortion

280 25

IUFD 478 51 Preterm birth 878 103 LBW 378 38 Malformation 278 26 Mega-cysterna magna(11mm) Left ventriculomegaly of cerebrum (11mm)

Median (Min-Max)

Last exposure weeks 46 (06-124)

Duration of exposure (days) 20 (10-590)

Dosage (mgday) (4280) 1250 (93-9000)

Corydalis Tuber (Hyun ho sac) (1) bull Indications Metrorrhagia Nasal bleeding Postpartum faint

Chest pain Bruise Abnormal menstruation Back and knee pain Peptic ulcer Pancreatitis Hyperhidrosis Postpartum lochiorrhea Pelvic mass Spontaneous abortion Multiple arthritis Rheumatoid arthritis Dysentery and Diarrhea

bull Pretreatment processed Corydalis tuber with vinegar

bull Pharmacological action muscle relaxation hypotension

anti-inflammatory action decrease secretion of gastric acid

anti-ulcer action and increase contraction of extract uterus in

animal Hanyak yangnihak 2001

bull Toxicity Over dosage intoxication leads to CNS depression

and muscle relaxation

bull Caution Not recommend in pregnancy

bull Formula in Korea 10 OTC 77

wwwtradimedcokrwwwkimsonlinecokr

Tetrahydropalmatine bullPhytochemical group Alkaloid

bullMolecular weight 35544

bullBioactivity hypnotic activity exceeds that of

morphine wwwtredimedcokr

Korean Motherisk Program unpublished

Corydalis Tuber (Hyun ho sac) (2) (25 cases)

Number Spontaneous abortion

125 40

IUFD - 0 Preterm birth 124 42 LBW - 0 Malformation 124 40 Post axial polydactyly of left foot

Median (Min-Max)

Last exposure weeks 54 (04-130)

Duration of exposure (days) 30 (10-380)

Dosage (mgday) (1625) 180 (750-7200)

Angelicae Gigantis Radix (Dang gui) (1)

bull Indications Secondary amenorrhea Nausea Laceration Headache Abdominal pain Metrorrhagia Hyperventilation Severe palpitation Arrhythmia Carbuncle Influenza Abnormal menstruation Hemorrhage without trauma Nasal bleeding Syncope Confusion Acute pulpitis Toothache Multiple arthritis Skin tumor Skin ulcer or Skin abscess Cerebrovascular accident Dysentery and Diarrhea Fever and chill Tuberculosis Anemia Paresthesia

bull Pretreatment parched dang gui with soil charred dang gui

parched dang gui with liquor ginger processed dang gui

bull Pharmacologic action Increase blood flow to heart

hypotension anti ulcer effect analgesic anti-inflammatory

effect and uterine contraction (aqueous extracts) in animal Hanbang Yangnihak 2010

bull Formula in Korea 120 wwwtradimedcokr

bull OTC in Korea 1401 wwwkimsonlinecokr

Constituents of Angelicae Gigantis Radix Aegelinol

alpha-Pinene(+-)

Choline

Coumarin

Decursidin

Decursin

Decursinol

Decursinol angelate

Decusinol angelate

Gigasol

Imperatorin

Isoimperatorin

Marmesin

Nodakenetin

Nodakenin

p-Cymene

Prenyletin

Umbelliferone

wwwtradimedcokr

Korean Motherisk Program unpublished

Angelicae Gigantis Radix (Dang gui) (2) (74 cases)

Median (Min-Max)

Last exposure weeks 46 (06-126)

Duration of exposure (days) 30 (10-590)

Dosage (mgday) (3474) 1250 (135-9000)

Number

Spontaneous abortion

374 41

IUFD 271 28

Preterm birth 671 85

LBW 171 14

Malformation 171 14

Mega-cysterna magna(11mm)

Herbal Medicines relate to Spontaneous Abortion

Animal study

Hanyak yangnihak 2001

Herbal name Common name Korean name Binominal name

Menthae Herba Mint Bak ha 1 Mentha arvensis var piperascens Malinv (Labiatae) 2 Mentha haplocalyx Briq (Labiatae)

Trichosanthis Radix Trichosanthes root Chun Hwa Boon Trichosanthes kirilowii Maxim (Cucurbitaceae)

Moutan Radicis Cortex Moutan root bark Mok dan pi Paeonia suffruticosa Andr (Paeoniaceae)

Lonicerae Flos Lonicera flowers Geum un hwa 1 Lonicera japonica Thunb (Caprifoliaceae) 2 Lonicera confusa DC (Caprifoliaceae)

Kansui Radix Kansui root Gam su Euphorbia kansui Liou ex Wang (Euphorbiaceae)

Clematidis Radix Clematis (root) Wi ryung sun 1 Clematis mandshurica Rupr (Ranunculaceae) 2 Clematis chinensis Osbeck (Ranunculaceae) 3 Clematis hexapetala Pall (Ranunculaceae)

Sulphur Sulphur Yu hwang Sulphur

Curcumae Longae Tuber Common turmeric Gang hwang Curcuma longa L (Zingiberaceae)

Curcumae Rhizoma Zedoary A chool 1 Curcuma phaeocaulis Val (Zingiberaceae) 2 Curcuma kwangsiensis S G Lee et C F Liang

(Zingiberaceae)

Achyranthis Radix Achyranthes root Oo seol 1 Achyranthes japonica Nakai (Amaranthaceae) 2 Achyranthes bidentata Bl (Amaranthaceae) 3 Achyranthes fauriei Leville et Vaniot (Amaranthaceae)

Pinelliae Rhizoma Pinellia rhizome Ban ha Pinellia ternata (Thunb) Breit (Araceae)

Aristolochiae Fructus Aristolochia fruit Ma doo ryung 1 Aristolochia contorta Bunge (Aristolochiaceae) 2 Aristolochia debilis Siebet Zucc (Aristolochiaceae)

Albizziae Cortex Silk tree bark Hab han pi Albizia julibrissin Durazz (Leguminosae)

Moschus Musk Sa hyang 1 Moschus moschiferus L (Moschidae) 2 Moschus berezovskii Flerov (Moschidae) 3 Moschus sifanicus Przewalski (Moschidae)

Menthae Herba (Bak ha) (1)

bull Indications Common cold Frozen shoulder Fever accompanied with fear Cholera Acute gastric cramp Aphthous stomatitis Tuberculous lymphadenitis Persistent headache Measles Nasal bleeding Snake bite Liver cirrhosis Ascites Urticaria Palpebral conjunctivitis Laryngitis or Laryngeal abscess Suppurative otitis media Aphasia in Stroke Contact dermatitis Burn Headache Rubella Bloody dysentery Pharyngitis

bull Pharmacologic action anti-inflammatory effects anti-

pyretic vasodilatation decrease secretion of bronchus (high

conc) and necrosis of placenta in animal

Hanbang Yangnihak 2010 Hanyak yangnihak 2001

bull Formula in Korea 225 wwwtradimedcokr

bull OTC in Korea 311 wwwkimsonlinecokr

Menthae Herba (Bak ha) (2) (48 cases)

Median (Min-Max)

Last exposure weeks 43 (04-126)

Duration of exposure (days) 30 (10-460)

Dosage (mgday) (2548) 852 (200-2256)

Number

Spontaneous abortion

148 21

IUFD - 0

Preterm birth 347 64

LBW 247 43

Malformation - 0

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (1)

bull Indications Headache due to Brain tumor Bronchial asthma

Dizziness Stomach cancer Pyloric stenosis Gastric gaseous

distension

bull Pretreatment purified Pinellia tuber processed Pinellia

tuber processed Pinellia tuber with ginger

bull Pharmacologic action antitussive effect decrease

vomiting decrease gastric ulcer decrease ocular pressure and

increase abortion in animal Hanyak yangnihak 2001

bull Formula in Korea 90 wwwtradimedcokr

bull OTC in Korea 587 wwwkimsonlinecokr

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (2) (43 cases)

Median (Min-Max)

Last exposure weeks 45 (04-124)

Duration of exposure (days) 20 (10-530)

Dosage (mgday) (1843) 6255 (267-3340)

Number

Spontaneous abortion

- 0

IUFD 243 47

Preterm birth 443 93

LBW 343 71

Malformation 143 23

Mega cysterna magna (11mm)

Pregnancy Outcomes Korean Motherisk Program

Unpublished data

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Cnidii Rhizoma (Chun gung) (1)

bull Indications Secondary amenorrhea Muscle spasm

Hemiplegia Seborrheic dermatitis Persistent headache

Metrorrhagia Thoracoabdominal pain Consumptive disease

Abnormal menstruation Syncope Confusion Pelvic mass

Gingival bleeding Gingivitis Paresthesia Pneumonia

bull Pharmacologic action vasodilatation analgesics anti

inflammation and uterine contraction in animal

Hanyak yangnihak 2001

bull Formula in Korea 25 wwwtradimedcokr

bull OTC in Korea 1186 wwwkimsonlinecokr

Constituents of Cnidii Rhizoma Adenosine Apiol Butylidenephthalide Butylphthalide Chlorogenic acid Cnidilide Coniferyl ferulate Ferulic acid Ligustilide Ligustilidiol Neocnidilide Pregnenolone Senkyunolide Senkyunolide B Senkyunolide C Senkyunolide D Senkyunolide F Senkyunolide G Senkyunolide H Senkyunolide I Senkyunolide J Umbelliferose Vanillin Vitamin C wwwtradimedcokr

Korean Motherisk Program unpublished

Cnidii Rhizoma (Chun gung) (2) (80cases)

Number Spontaneous abortion

280 25

IUFD 478 51 Preterm birth 878 103 LBW 378 38 Malformation 278 26 Mega-cysterna magna(11mm) Left ventriculomegaly of cerebrum (11mm)

Median (Min-Max)

Last exposure weeks 46 (06-124)

Duration of exposure (days) 20 (10-590)

Dosage (mgday) (4280) 1250 (93-9000)

Corydalis Tuber (Hyun ho sac) (1) bull Indications Metrorrhagia Nasal bleeding Postpartum faint

Chest pain Bruise Abnormal menstruation Back and knee pain Peptic ulcer Pancreatitis Hyperhidrosis Postpartum lochiorrhea Pelvic mass Spontaneous abortion Multiple arthritis Rheumatoid arthritis Dysentery and Diarrhea

bull Pretreatment processed Corydalis tuber with vinegar

bull Pharmacological action muscle relaxation hypotension

anti-inflammatory action decrease secretion of gastric acid

anti-ulcer action and increase contraction of extract uterus in

animal Hanyak yangnihak 2001

bull Toxicity Over dosage intoxication leads to CNS depression

and muscle relaxation

bull Caution Not recommend in pregnancy

bull Formula in Korea 10 OTC 77

wwwtradimedcokrwwwkimsonlinecokr

Tetrahydropalmatine bullPhytochemical group Alkaloid

bullMolecular weight 35544

bullBioactivity hypnotic activity exceeds that of

morphine wwwtredimedcokr

Korean Motherisk Program unpublished

Corydalis Tuber (Hyun ho sac) (2) (25 cases)

Number Spontaneous abortion

125 40

IUFD - 0 Preterm birth 124 42 LBW - 0 Malformation 124 40 Post axial polydactyly of left foot

Median (Min-Max)

Last exposure weeks 54 (04-130)

Duration of exposure (days) 30 (10-380)

Dosage (mgday) (1625) 180 (750-7200)

Angelicae Gigantis Radix (Dang gui) (1)

bull Indications Secondary amenorrhea Nausea Laceration Headache Abdominal pain Metrorrhagia Hyperventilation Severe palpitation Arrhythmia Carbuncle Influenza Abnormal menstruation Hemorrhage without trauma Nasal bleeding Syncope Confusion Acute pulpitis Toothache Multiple arthritis Skin tumor Skin ulcer or Skin abscess Cerebrovascular accident Dysentery and Diarrhea Fever and chill Tuberculosis Anemia Paresthesia

bull Pretreatment parched dang gui with soil charred dang gui

parched dang gui with liquor ginger processed dang gui

bull Pharmacologic action Increase blood flow to heart

hypotension anti ulcer effect analgesic anti-inflammatory

effect and uterine contraction (aqueous extracts) in animal Hanbang Yangnihak 2010

bull Formula in Korea 120 wwwtradimedcokr

bull OTC in Korea 1401 wwwkimsonlinecokr

Constituents of Angelicae Gigantis Radix Aegelinol

alpha-Pinene(+-)

Choline

Coumarin

Decursidin

Decursin

Decursinol

Decursinol angelate

Decusinol angelate

Gigasol

Imperatorin

Isoimperatorin

Marmesin

Nodakenetin

Nodakenin

p-Cymene

Prenyletin

Umbelliferone

wwwtradimedcokr

Korean Motherisk Program unpublished

Angelicae Gigantis Radix (Dang gui) (2) (74 cases)

Median (Min-Max)

Last exposure weeks 46 (06-126)

Duration of exposure (days) 30 (10-590)

Dosage (mgday) (3474) 1250 (135-9000)

Number

Spontaneous abortion

374 41

IUFD 271 28

Preterm birth 671 85

LBW 171 14

Malformation 171 14

Mega-cysterna magna(11mm)

Herbal Medicines relate to Spontaneous Abortion

Animal study

Hanyak yangnihak 2001

Herbal name Common name Korean name Binominal name

Menthae Herba Mint Bak ha 1 Mentha arvensis var piperascens Malinv (Labiatae) 2 Mentha haplocalyx Briq (Labiatae)

Trichosanthis Radix Trichosanthes root Chun Hwa Boon Trichosanthes kirilowii Maxim (Cucurbitaceae)

Moutan Radicis Cortex Moutan root bark Mok dan pi Paeonia suffruticosa Andr (Paeoniaceae)

Lonicerae Flos Lonicera flowers Geum un hwa 1 Lonicera japonica Thunb (Caprifoliaceae) 2 Lonicera confusa DC (Caprifoliaceae)

Kansui Radix Kansui root Gam su Euphorbia kansui Liou ex Wang (Euphorbiaceae)

Clematidis Radix Clematis (root) Wi ryung sun 1 Clematis mandshurica Rupr (Ranunculaceae) 2 Clematis chinensis Osbeck (Ranunculaceae) 3 Clematis hexapetala Pall (Ranunculaceae)

Sulphur Sulphur Yu hwang Sulphur

Curcumae Longae Tuber Common turmeric Gang hwang Curcuma longa L (Zingiberaceae)

Curcumae Rhizoma Zedoary A chool 1 Curcuma phaeocaulis Val (Zingiberaceae) 2 Curcuma kwangsiensis S G Lee et C F Liang

(Zingiberaceae)

Achyranthis Radix Achyranthes root Oo seol 1 Achyranthes japonica Nakai (Amaranthaceae) 2 Achyranthes bidentata Bl (Amaranthaceae) 3 Achyranthes fauriei Leville et Vaniot (Amaranthaceae)

Pinelliae Rhizoma Pinellia rhizome Ban ha Pinellia ternata (Thunb) Breit (Araceae)

Aristolochiae Fructus Aristolochia fruit Ma doo ryung 1 Aristolochia contorta Bunge (Aristolochiaceae) 2 Aristolochia debilis Siebet Zucc (Aristolochiaceae)

Albizziae Cortex Silk tree bark Hab han pi Albizia julibrissin Durazz (Leguminosae)

Moschus Musk Sa hyang 1 Moschus moschiferus L (Moschidae) 2 Moschus berezovskii Flerov (Moschidae) 3 Moschus sifanicus Przewalski (Moschidae)

Menthae Herba (Bak ha) (1)

bull Indications Common cold Frozen shoulder Fever accompanied with fear Cholera Acute gastric cramp Aphthous stomatitis Tuberculous lymphadenitis Persistent headache Measles Nasal bleeding Snake bite Liver cirrhosis Ascites Urticaria Palpebral conjunctivitis Laryngitis or Laryngeal abscess Suppurative otitis media Aphasia in Stroke Contact dermatitis Burn Headache Rubella Bloody dysentery Pharyngitis

bull Pharmacologic action anti-inflammatory effects anti-

pyretic vasodilatation decrease secretion of bronchus (high

conc) and necrosis of placenta in animal

Hanbang Yangnihak 2010 Hanyak yangnihak 2001

bull Formula in Korea 225 wwwtradimedcokr

bull OTC in Korea 311 wwwkimsonlinecokr

Menthae Herba (Bak ha) (2) (48 cases)

Median (Min-Max)

Last exposure weeks 43 (04-126)

Duration of exposure (days) 30 (10-460)

Dosage (mgday) (2548) 852 (200-2256)

Number

Spontaneous abortion

148 21

IUFD - 0

Preterm birth 347 64

LBW 247 43

Malformation - 0

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (1)

bull Indications Headache due to Brain tumor Bronchial asthma

Dizziness Stomach cancer Pyloric stenosis Gastric gaseous

distension

bull Pretreatment purified Pinellia tuber processed Pinellia

tuber processed Pinellia tuber with ginger

bull Pharmacologic action antitussive effect decrease

vomiting decrease gastric ulcer decrease ocular pressure and

increase abortion in animal Hanyak yangnihak 2001

bull Formula in Korea 90 wwwtradimedcokr

bull OTC in Korea 587 wwwkimsonlinecokr

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (2) (43 cases)

Median (Min-Max)

Last exposure weeks 45 (04-124)

Duration of exposure (days) 20 (10-530)

Dosage (mgday) (1843) 6255 (267-3340)

Number

Spontaneous abortion

- 0

IUFD 243 47

Preterm birth 443 93

LBW 343 71

Malformation 143 23

Mega cysterna magna (11mm)

Pregnancy Outcomes Korean Motherisk Program

Unpublished data

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Korean Motherisk Program unpublished

Cnidii Rhizoma (Chun gung) (2) (80cases)

Number Spontaneous abortion

280 25

IUFD 478 51 Preterm birth 878 103 LBW 378 38 Malformation 278 26 Mega-cysterna magna(11mm) Left ventriculomegaly of cerebrum (11mm)

Median (Min-Max)

Last exposure weeks 46 (06-124)

Duration of exposure (days) 20 (10-590)

Dosage (mgday) (4280) 1250 (93-9000)

Corydalis Tuber (Hyun ho sac) (1) bull Indications Metrorrhagia Nasal bleeding Postpartum faint

Chest pain Bruise Abnormal menstruation Back and knee pain Peptic ulcer Pancreatitis Hyperhidrosis Postpartum lochiorrhea Pelvic mass Spontaneous abortion Multiple arthritis Rheumatoid arthritis Dysentery and Diarrhea

bull Pretreatment processed Corydalis tuber with vinegar

bull Pharmacological action muscle relaxation hypotension

anti-inflammatory action decrease secretion of gastric acid

anti-ulcer action and increase contraction of extract uterus in

animal Hanyak yangnihak 2001

bull Toxicity Over dosage intoxication leads to CNS depression

and muscle relaxation

bull Caution Not recommend in pregnancy

bull Formula in Korea 10 OTC 77

wwwtradimedcokrwwwkimsonlinecokr

Tetrahydropalmatine bullPhytochemical group Alkaloid

bullMolecular weight 35544

bullBioactivity hypnotic activity exceeds that of

morphine wwwtredimedcokr

Korean Motherisk Program unpublished

Corydalis Tuber (Hyun ho sac) (2) (25 cases)

Number Spontaneous abortion

125 40

IUFD - 0 Preterm birth 124 42 LBW - 0 Malformation 124 40 Post axial polydactyly of left foot

Median (Min-Max)

Last exposure weeks 54 (04-130)

Duration of exposure (days) 30 (10-380)

Dosage (mgday) (1625) 180 (750-7200)

Angelicae Gigantis Radix (Dang gui) (1)

bull Indications Secondary amenorrhea Nausea Laceration Headache Abdominal pain Metrorrhagia Hyperventilation Severe palpitation Arrhythmia Carbuncle Influenza Abnormal menstruation Hemorrhage without trauma Nasal bleeding Syncope Confusion Acute pulpitis Toothache Multiple arthritis Skin tumor Skin ulcer or Skin abscess Cerebrovascular accident Dysentery and Diarrhea Fever and chill Tuberculosis Anemia Paresthesia

bull Pretreatment parched dang gui with soil charred dang gui

parched dang gui with liquor ginger processed dang gui

bull Pharmacologic action Increase blood flow to heart

hypotension anti ulcer effect analgesic anti-inflammatory

effect and uterine contraction (aqueous extracts) in animal Hanbang Yangnihak 2010

bull Formula in Korea 120 wwwtradimedcokr

bull OTC in Korea 1401 wwwkimsonlinecokr

Constituents of Angelicae Gigantis Radix Aegelinol

alpha-Pinene(+-)

Choline

Coumarin

Decursidin

Decursin

Decursinol

Decursinol angelate

Decusinol angelate

Gigasol

Imperatorin

Isoimperatorin

Marmesin

Nodakenetin

Nodakenin

p-Cymene

Prenyletin

Umbelliferone

wwwtradimedcokr

Korean Motherisk Program unpublished

Angelicae Gigantis Radix (Dang gui) (2) (74 cases)

Median (Min-Max)

Last exposure weeks 46 (06-126)

Duration of exposure (days) 30 (10-590)

Dosage (mgday) (3474) 1250 (135-9000)

Number

Spontaneous abortion

374 41

IUFD 271 28

Preterm birth 671 85

LBW 171 14

Malformation 171 14

Mega-cysterna magna(11mm)

Herbal Medicines relate to Spontaneous Abortion

Animal study

Hanyak yangnihak 2001

Herbal name Common name Korean name Binominal name

Menthae Herba Mint Bak ha 1 Mentha arvensis var piperascens Malinv (Labiatae) 2 Mentha haplocalyx Briq (Labiatae)

Trichosanthis Radix Trichosanthes root Chun Hwa Boon Trichosanthes kirilowii Maxim (Cucurbitaceae)

Moutan Radicis Cortex Moutan root bark Mok dan pi Paeonia suffruticosa Andr (Paeoniaceae)

Lonicerae Flos Lonicera flowers Geum un hwa 1 Lonicera japonica Thunb (Caprifoliaceae) 2 Lonicera confusa DC (Caprifoliaceae)

Kansui Radix Kansui root Gam su Euphorbia kansui Liou ex Wang (Euphorbiaceae)

Clematidis Radix Clematis (root) Wi ryung sun 1 Clematis mandshurica Rupr (Ranunculaceae) 2 Clematis chinensis Osbeck (Ranunculaceae) 3 Clematis hexapetala Pall (Ranunculaceae)

Sulphur Sulphur Yu hwang Sulphur

Curcumae Longae Tuber Common turmeric Gang hwang Curcuma longa L (Zingiberaceae)

Curcumae Rhizoma Zedoary A chool 1 Curcuma phaeocaulis Val (Zingiberaceae) 2 Curcuma kwangsiensis S G Lee et C F Liang

(Zingiberaceae)

Achyranthis Radix Achyranthes root Oo seol 1 Achyranthes japonica Nakai (Amaranthaceae) 2 Achyranthes bidentata Bl (Amaranthaceae) 3 Achyranthes fauriei Leville et Vaniot (Amaranthaceae)

Pinelliae Rhizoma Pinellia rhizome Ban ha Pinellia ternata (Thunb) Breit (Araceae)

Aristolochiae Fructus Aristolochia fruit Ma doo ryung 1 Aristolochia contorta Bunge (Aristolochiaceae) 2 Aristolochia debilis Siebet Zucc (Aristolochiaceae)

Albizziae Cortex Silk tree bark Hab han pi Albizia julibrissin Durazz (Leguminosae)

Moschus Musk Sa hyang 1 Moschus moschiferus L (Moschidae) 2 Moschus berezovskii Flerov (Moschidae) 3 Moschus sifanicus Przewalski (Moschidae)

Menthae Herba (Bak ha) (1)

bull Indications Common cold Frozen shoulder Fever accompanied with fear Cholera Acute gastric cramp Aphthous stomatitis Tuberculous lymphadenitis Persistent headache Measles Nasal bleeding Snake bite Liver cirrhosis Ascites Urticaria Palpebral conjunctivitis Laryngitis or Laryngeal abscess Suppurative otitis media Aphasia in Stroke Contact dermatitis Burn Headache Rubella Bloody dysentery Pharyngitis

bull Pharmacologic action anti-inflammatory effects anti-

pyretic vasodilatation decrease secretion of bronchus (high

conc) and necrosis of placenta in animal

Hanbang Yangnihak 2010 Hanyak yangnihak 2001

bull Formula in Korea 225 wwwtradimedcokr

bull OTC in Korea 311 wwwkimsonlinecokr

Menthae Herba (Bak ha) (2) (48 cases)

Median (Min-Max)

Last exposure weeks 43 (04-126)

Duration of exposure (days) 30 (10-460)

Dosage (mgday) (2548) 852 (200-2256)

Number

Spontaneous abortion

148 21

IUFD - 0

Preterm birth 347 64

LBW 247 43

Malformation - 0

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (1)

bull Indications Headache due to Brain tumor Bronchial asthma

Dizziness Stomach cancer Pyloric stenosis Gastric gaseous

distension

bull Pretreatment purified Pinellia tuber processed Pinellia

tuber processed Pinellia tuber with ginger

bull Pharmacologic action antitussive effect decrease

vomiting decrease gastric ulcer decrease ocular pressure and

increase abortion in animal Hanyak yangnihak 2001

bull Formula in Korea 90 wwwtradimedcokr

bull OTC in Korea 587 wwwkimsonlinecokr

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (2) (43 cases)

Median (Min-Max)

Last exposure weeks 45 (04-124)

Duration of exposure (days) 20 (10-530)

Dosage (mgday) (1843) 6255 (267-3340)

Number

Spontaneous abortion

- 0

IUFD 243 47

Preterm birth 443 93

LBW 343 71

Malformation 143 23

Mega cysterna magna (11mm)

Pregnancy Outcomes Korean Motherisk Program

Unpublished data

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Corydalis Tuber (Hyun ho sac) (1) bull Indications Metrorrhagia Nasal bleeding Postpartum faint

Chest pain Bruise Abnormal menstruation Back and knee pain Peptic ulcer Pancreatitis Hyperhidrosis Postpartum lochiorrhea Pelvic mass Spontaneous abortion Multiple arthritis Rheumatoid arthritis Dysentery and Diarrhea

bull Pretreatment processed Corydalis tuber with vinegar

bull Pharmacological action muscle relaxation hypotension

anti-inflammatory action decrease secretion of gastric acid

anti-ulcer action and increase contraction of extract uterus in

animal Hanyak yangnihak 2001

bull Toxicity Over dosage intoxication leads to CNS depression

and muscle relaxation

bull Caution Not recommend in pregnancy

bull Formula in Korea 10 OTC 77

wwwtradimedcokrwwwkimsonlinecokr

Tetrahydropalmatine bullPhytochemical group Alkaloid

bullMolecular weight 35544

bullBioactivity hypnotic activity exceeds that of

morphine wwwtredimedcokr

Korean Motherisk Program unpublished

Corydalis Tuber (Hyun ho sac) (2) (25 cases)

Number Spontaneous abortion

125 40

IUFD - 0 Preterm birth 124 42 LBW - 0 Malformation 124 40 Post axial polydactyly of left foot

Median (Min-Max)

Last exposure weeks 54 (04-130)

Duration of exposure (days) 30 (10-380)

Dosage (mgday) (1625) 180 (750-7200)

Angelicae Gigantis Radix (Dang gui) (1)

bull Indications Secondary amenorrhea Nausea Laceration Headache Abdominal pain Metrorrhagia Hyperventilation Severe palpitation Arrhythmia Carbuncle Influenza Abnormal menstruation Hemorrhage without trauma Nasal bleeding Syncope Confusion Acute pulpitis Toothache Multiple arthritis Skin tumor Skin ulcer or Skin abscess Cerebrovascular accident Dysentery and Diarrhea Fever and chill Tuberculosis Anemia Paresthesia

bull Pretreatment parched dang gui with soil charred dang gui

parched dang gui with liquor ginger processed dang gui

bull Pharmacologic action Increase blood flow to heart

hypotension anti ulcer effect analgesic anti-inflammatory

effect and uterine contraction (aqueous extracts) in animal Hanbang Yangnihak 2010

bull Formula in Korea 120 wwwtradimedcokr

bull OTC in Korea 1401 wwwkimsonlinecokr

Constituents of Angelicae Gigantis Radix Aegelinol

alpha-Pinene(+-)

Choline

Coumarin

Decursidin

Decursin

Decursinol

Decursinol angelate

Decusinol angelate

Gigasol

Imperatorin

Isoimperatorin

Marmesin

Nodakenetin

Nodakenin

p-Cymene

Prenyletin

Umbelliferone

wwwtradimedcokr

Korean Motherisk Program unpublished

Angelicae Gigantis Radix (Dang gui) (2) (74 cases)

Median (Min-Max)

Last exposure weeks 46 (06-126)

Duration of exposure (days) 30 (10-590)

Dosage (mgday) (3474) 1250 (135-9000)

Number

Spontaneous abortion

374 41

IUFD 271 28

Preterm birth 671 85

LBW 171 14

Malformation 171 14

Mega-cysterna magna(11mm)

Herbal Medicines relate to Spontaneous Abortion

Animal study

Hanyak yangnihak 2001

Herbal name Common name Korean name Binominal name

Menthae Herba Mint Bak ha 1 Mentha arvensis var piperascens Malinv (Labiatae) 2 Mentha haplocalyx Briq (Labiatae)

Trichosanthis Radix Trichosanthes root Chun Hwa Boon Trichosanthes kirilowii Maxim (Cucurbitaceae)

Moutan Radicis Cortex Moutan root bark Mok dan pi Paeonia suffruticosa Andr (Paeoniaceae)

Lonicerae Flos Lonicera flowers Geum un hwa 1 Lonicera japonica Thunb (Caprifoliaceae) 2 Lonicera confusa DC (Caprifoliaceae)

Kansui Radix Kansui root Gam su Euphorbia kansui Liou ex Wang (Euphorbiaceae)

Clematidis Radix Clematis (root) Wi ryung sun 1 Clematis mandshurica Rupr (Ranunculaceae) 2 Clematis chinensis Osbeck (Ranunculaceae) 3 Clematis hexapetala Pall (Ranunculaceae)

Sulphur Sulphur Yu hwang Sulphur

Curcumae Longae Tuber Common turmeric Gang hwang Curcuma longa L (Zingiberaceae)

Curcumae Rhizoma Zedoary A chool 1 Curcuma phaeocaulis Val (Zingiberaceae) 2 Curcuma kwangsiensis S G Lee et C F Liang

(Zingiberaceae)

Achyranthis Radix Achyranthes root Oo seol 1 Achyranthes japonica Nakai (Amaranthaceae) 2 Achyranthes bidentata Bl (Amaranthaceae) 3 Achyranthes fauriei Leville et Vaniot (Amaranthaceae)

Pinelliae Rhizoma Pinellia rhizome Ban ha Pinellia ternata (Thunb) Breit (Araceae)

Aristolochiae Fructus Aristolochia fruit Ma doo ryung 1 Aristolochia contorta Bunge (Aristolochiaceae) 2 Aristolochia debilis Siebet Zucc (Aristolochiaceae)

Albizziae Cortex Silk tree bark Hab han pi Albizia julibrissin Durazz (Leguminosae)

Moschus Musk Sa hyang 1 Moschus moschiferus L (Moschidae) 2 Moschus berezovskii Flerov (Moschidae) 3 Moschus sifanicus Przewalski (Moschidae)

Menthae Herba (Bak ha) (1)

bull Indications Common cold Frozen shoulder Fever accompanied with fear Cholera Acute gastric cramp Aphthous stomatitis Tuberculous lymphadenitis Persistent headache Measles Nasal bleeding Snake bite Liver cirrhosis Ascites Urticaria Palpebral conjunctivitis Laryngitis or Laryngeal abscess Suppurative otitis media Aphasia in Stroke Contact dermatitis Burn Headache Rubella Bloody dysentery Pharyngitis

bull Pharmacologic action anti-inflammatory effects anti-

pyretic vasodilatation decrease secretion of bronchus (high

conc) and necrosis of placenta in animal

Hanbang Yangnihak 2010 Hanyak yangnihak 2001

bull Formula in Korea 225 wwwtradimedcokr

bull OTC in Korea 311 wwwkimsonlinecokr

Menthae Herba (Bak ha) (2) (48 cases)

Median (Min-Max)

Last exposure weeks 43 (04-126)

Duration of exposure (days) 30 (10-460)

Dosage (mgday) (2548) 852 (200-2256)

Number

Spontaneous abortion

148 21

IUFD - 0

Preterm birth 347 64

LBW 247 43

Malformation - 0

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (1)

bull Indications Headache due to Brain tumor Bronchial asthma

Dizziness Stomach cancer Pyloric stenosis Gastric gaseous

distension

bull Pretreatment purified Pinellia tuber processed Pinellia

tuber processed Pinellia tuber with ginger

bull Pharmacologic action antitussive effect decrease

vomiting decrease gastric ulcer decrease ocular pressure and

increase abortion in animal Hanyak yangnihak 2001

bull Formula in Korea 90 wwwtradimedcokr

bull OTC in Korea 587 wwwkimsonlinecokr

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (2) (43 cases)

Median (Min-Max)

Last exposure weeks 45 (04-124)

Duration of exposure (days) 20 (10-530)

Dosage (mgday) (1843) 6255 (267-3340)

Number

Spontaneous abortion

- 0

IUFD 243 47

Preterm birth 443 93

LBW 343 71

Malformation 143 23

Mega cysterna magna (11mm)

Pregnancy Outcomes Korean Motherisk Program

Unpublished data

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Korean Motherisk Program unpublished

Corydalis Tuber (Hyun ho sac) (2) (25 cases)

Number Spontaneous abortion

125 40

IUFD - 0 Preterm birth 124 42 LBW - 0 Malformation 124 40 Post axial polydactyly of left foot

Median (Min-Max)

Last exposure weeks 54 (04-130)

Duration of exposure (days) 30 (10-380)

Dosage (mgday) (1625) 180 (750-7200)

Angelicae Gigantis Radix (Dang gui) (1)

bull Indications Secondary amenorrhea Nausea Laceration Headache Abdominal pain Metrorrhagia Hyperventilation Severe palpitation Arrhythmia Carbuncle Influenza Abnormal menstruation Hemorrhage without trauma Nasal bleeding Syncope Confusion Acute pulpitis Toothache Multiple arthritis Skin tumor Skin ulcer or Skin abscess Cerebrovascular accident Dysentery and Diarrhea Fever and chill Tuberculosis Anemia Paresthesia

bull Pretreatment parched dang gui with soil charred dang gui

parched dang gui with liquor ginger processed dang gui

bull Pharmacologic action Increase blood flow to heart

hypotension anti ulcer effect analgesic anti-inflammatory

effect and uterine contraction (aqueous extracts) in animal Hanbang Yangnihak 2010

bull Formula in Korea 120 wwwtradimedcokr

bull OTC in Korea 1401 wwwkimsonlinecokr

Constituents of Angelicae Gigantis Radix Aegelinol

alpha-Pinene(+-)

Choline

Coumarin

Decursidin

Decursin

Decursinol

Decursinol angelate

Decusinol angelate

Gigasol

Imperatorin

Isoimperatorin

Marmesin

Nodakenetin

Nodakenin

p-Cymene

Prenyletin

Umbelliferone

wwwtradimedcokr

Korean Motherisk Program unpublished

Angelicae Gigantis Radix (Dang gui) (2) (74 cases)

Median (Min-Max)

Last exposure weeks 46 (06-126)

Duration of exposure (days) 30 (10-590)

Dosage (mgday) (3474) 1250 (135-9000)

Number

Spontaneous abortion

374 41

IUFD 271 28

Preterm birth 671 85

LBW 171 14

Malformation 171 14

Mega-cysterna magna(11mm)

Herbal Medicines relate to Spontaneous Abortion

Animal study

Hanyak yangnihak 2001

Herbal name Common name Korean name Binominal name

Menthae Herba Mint Bak ha 1 Mentha arvensis var piperascens Malinv (Labiatae) 2 Mentha haplocalyx Briq (Labiatae)

Trichosanthis Radix Trichosanthes root Chun Hwa Boon Trichosanthes kirilowii Maxim (Cucurbitaceae)

Moutan Radicis Cortex Moutan root bark Mok dan pi Paeonia suffruticosa Andr (Paeoniaceae)

Lonicerae Flos Lonicera flowers Geum un hwa 1 Lonicera japonica Thunb (Caprifoliaceae) 2 Lonicera confusa DC (Caprifoliaceae)

Kansui Radix Kansui root Gam su Euphorbia kansui Liou ex Wang (Euphorbiaceae)

Clematidis Radix Clematis (root) Wi ryung sun 1 Clematis mandshurica Rupr (Ranunculaceae) 2 Clematis chinensis Osbeck (Ranunculaceae) 3 Clematis hexapetala Pall (Ranunculaceae)

Sulphur Sulphur Yu hwang Sulphur

Curcumae Longae Tuber Common turmeric Gang hwang Curcuma longa L (Zingiberaceae)

Curcumae Rhizoma Zedoary A chool 1 Curcuma phaeocaulis Val (Zingiberaceae) 2 Curcuma kwangsiensis S G Lee et C F Liang

(Zingiberaceae)

Achyranthis Radix Achyranthes root Oo seol 1 Achyranthes japonica Nakai (Amaranthaceae) 2 Achyranthes bidentata Bl (Amaranthaceae) 3 Achyranthes fauriei Leville et Vaniot (Amaranthaceae)

Pinelliae Rhizoma Pinellia rhizome Ban ha Pinellia ternata (Thunb) Breit (Araceae)

Aristolochiae Fructus Aristolochia fruit Ma doo ryung 1 Aristolochia contorta Bunge (Aristolochiaceae) 2 Aristolochia debilis Siebet Zucc (Aristolochiaceae)

Albizziae Cortex Silk tree bark Hab han pi Albizia julibrissin Durazz (Leguminosae)

Moschus Musk Sa hyang 1 Moschus moschiferus L (Moschidae) 2 Moschus berezovskii Flerov (Moschidae) 3 Moschus sifanicus Przewalski (Moschidae)

Menthae Herba (Bak ha) (1)

bull Indications Common cold Frozen shoulder Fever accompanied with fear Cholera Acute gastric cramp Aphthous stomatitis Tuberculous lymphadenitis Persistent headache Measles Nasal bleeding Snake bite Liver cirrhosis Ascites Urticaria Palpebral conjunctivitis Laryngitis or Laryngeal abscess Suppurative otitis media Aphasia in Stroke Contact dermatitis Burn Headache Rubella Bloody dysentery Pharyngitis

bull Pharmacologic action anti-inflammatory effects anti-

pyretic vasodilatation decrease secretion of bronchus (high

conc) and necrosis of placenta in animal

Hanbang Yangnihak 2010 Hanyak yangnihak 2001

bull Formula in Korea 225 wwwtradimedcokr

bull OTC in Korea 311 wwwkimsonlinecokr

Menthae Herba (Bak ha) (2) (48 cases)

Median (Min-Max)

Last exposure weeks 43 (04-126)

Duration of exposure (days) 30 (10-460)

Dosage (mgday) (2548) 852 (200-2256)

Number

Spontaneous abortion

148 21

IUFD - 0

Preterm birth 347 64

LBW 247 43

Malformation - 0

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (1)

bull Indications Headache due to Brain tumor Bronchial asthma

Dizziness Stomach cancer Pyloric stenosis Gastric gaseous

distension

bull Pretreatment purified Pinellia tuber processed Pinellia

tuber processed Pinellia tuber with ginger

bull Pharmacologic action antitussive effect decrease

vomiting decrease gastric ulcer decrease ocular pressure and

increase abortion in animal Hanyak yangnihak 2001

bull Formula in Korea 90 wwwtradimedcokr

bull OTC in Korea 587 wwwkimsonlinecokr

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (2) (43 cases)

Median (Min-Max)

Last exposure weeks 45 (04-124)

Duration of exposure (days) 20 (10-530)

Dosage (mgday) (1843) 6255 (267-3340)

Number

Spontaneous abortion

- 0

IUFD 243 47

Preterm birth 443 93

LBW 343 71

Malformation 143 23

Mega cysterna magna (11mm)

Pregnancy Outcomes Korean Motherisk Program

Unpublished data

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Angelicae Gigantis Radix (Dang gui) (1)

bull Indications Secondary amenorrhea Nausea Laceration Headache Abdominal pain Metrorrhagia Hyperventilation Severe palpitation Arrhythmia Carbuncle Influenza Abnormal menstruation Hemorrhage without trauma Nasal bleeding Syncope Confusion Acute pulpitis Toothache Multiple arthritis Skin tumor Skin ulcer or Skin abscess Cerebrovascular accident Dysentery and Diarrhea Fever and chill Tuberculosis Anemia Paresthesia

bull Pretreatment parched dang gui with soil charred dang gui

parched dang gui with liquor ginger processed dang gui

bull Pharmacologic action Increase blood flow to heart

hypotension anti ulcer effect analgesic anti-inflammatory

effect and uterine contraction (aqueous extracts) in animal Hanbang Yangnihak 2010

bull Formula in Korea 120 wwwtradimedcokr

bull OTC in Korea 1401 wwwkimsonlinecokr

Constituents of Angelicae Gigantis Radix Aegelinol

alpha-Pinene(+-)

Choline

Coumarin

Decursidin

Decursin

Decursinol

Decursinol angelate

Decusinol angelate

Gigasol

Imperatorin

Isoimperatorin

Marmesin

Nodakenetin

Nodakenin

p-Cymene

Prenyletin

Umbelliferone

wwwtradimedcokr

Korean Motherisk Program unpublished

Angelicae Gigantis Radix (Dang gui) (2) (74 cases)

Median (Min-Max)

Last exposure weeks 46 (06-126)

Duration of exposure (days) 30 (10-590)

Dosage (mgday) (3474) 1250 (135-9000)

Number

Spontaneous abortion

374 41

IUFD 271 28

Preterm birth 671 85

LBW 171 14

Malformation 171 14

Mega-cysterna magna(11mm)

Herbal Medicines relate to Spontaneous Abortion

Animal study

Hanyak yangnihak 2001

Herbal name Common name Korean name Binominal name

Menthae Herba Mint Bak ha 1 Mentha arvensis var piperascens Malinv (Labiatae) 2 Mentha haplocalyx Briq (Labiatae)

Trichosanthis Radix Trichosanthes root Chun Hwa Boon Trichosanthes kirilowii Maxim (Cucurbitaceae)

Moutan Radicis Cortex Moutan root bark Mok dan pi Paeonia suffruticosa Andr (Paeoniaceae)

Lonicerae Flos Lonicera flowers Geum un hwa 1 Lonicera japonica Thunb (Caprifoliaceae) 2 Lonicera confusa DC (Caprifoliaceae)

Kansui Radix Kansui root Gam su Euphorbia kansui Liou ex Wang (Euphorbiaceae)

Clematidis Radix Clematis (root) Wi ryung sun 1 Clematis mandshurica Rupr (Ranunculaceae) 2 Clematis chinensis Osbeck (Ranunculaceae) 3 Clematis hexapetala Pall (Ranunculaceae)

Sulphur Sulphur Yu hwang Sulphur

Curcumae Longae Tuber Common turmeric Gang hwang Curcuma longa L (Zingiberaceae)

Curcumae Rhizoma Zedoary A chool 1 Curcuma phaeocaulis Val (Zingiberaceae) 2 Curcuma kwangsiensis S G Lee et C F Liang

(Zingiberaceae)

Achyranthis Radix Achyranthes root Oo seol 1 Achyranthes japonica Nakai (Amaranthaceae) 2 Achyranthes bidentata Bl (Amaranthaceae) 3 Achyranthes fauriei Leville et Vaniot (Amaranthaceae)

Pinelliae Rhizoma Pinellia rhizome Ban ha Pinellia ternata (Thunb) Breit (Araceae)

Aristolochiae Fructus Aristolochia fruit Ma doo ryung 1 Aristolochia contorta Bunge (Aristolochiaceae) 2 Aristolochia debilis Siebet Zucc (Aristolochiaceae)

Albizziae Cortex Silk tree bark Hab han pi Albizia julibrissin Durazz (Leguminosae)

Moschus Musk Sa hyang 1 Moschus moschiferus L (Moschidae) 2 Moschus berezovskii Flerov (Moschidae) 3 Moschus sifanicus Przewalski (Moschidae)

Menthae Herba (Bak ha) (1)

bull Indications Common cold Frozen shoulder Fever accompanied with fear Cholera Acute gastric cramp Aphthous stomatitis Tuberculous lymphadenitis Persistent headache Measles Nasal bleeding Snake bite Liver cirrhosis Ascites Urticaria Palpebral conjunctivitis Laryngitis or Laryngeal abscess Suppurative otitis media Aphasia in Stroke Contact dermatitis Burn Headache Rubella Bloody dysentery Pharyngitis

bull Pharmacologic action anti-inflammatory effects anti-

pyretic vasodilatation decrease secretion of bronchus (high

conc) and necrosis of placenta in animal

Hanbang Yangnihak 2010 Hanyak yangnihak 2001

bull Formula in Korea 225 wwwtradimedcokr

bull OTC in Korea 311 wwwkimsonlinecokr

Menthae Herba (Bak ha) (2) (48 cases)

Median (Min-Max)

Last exposure weeks 43 (04-126)

Duration of exposure (days) 30 (10-460)

Dosage (mgday) (2548) 852 (200-2256)

Number

Spontaneous abortion

148 21

IUFD - 0

Preterm birth 347 64

LBW 247 43

Malformation - 0

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (1)

bull Indications Headache due to Brain tumor Bronchial asthma

Dizziness Stomach cancer Pyloric stenosis Gastric gaseous

distension

bull Pretreatment purified Pinellia tuber processed Pinellia

tuber processed Pinellia tuber with ginger

bull Pharmacologic action antitussive effect decrease

vomiting decrease gastric ulcer decrease ocular pressure and

increase abortion in animal Hanyak yangnihak 2001

bull Formula in Korea 90 wwwtradimedcokr

bull OTC in Korea 587 wwwkimsonlinecokr

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (2) (43 cases)

Median (Min-Max)

Last exposure weeks 45 (04-124)

Duration of exposure (days) 20 (10-530)

Dosage (mgday) (1843) 6255 (267-3340)

Number

Spontaneous abortion

- 0

IUFD 243 47

Preterm birth 443 93

LBW 343 71

Malformation 143 23

Mega cysterna magna (11mm)

Pregnancy Outcomes Korean Motherisk Program

Unpublished data

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Korean Motherisk Program unpublished

Angelicae Gigantis Radix (Dang gui) (2) (74 cases)

Median (Min-Max)

Last exposure weeks 46 (06-126)

Duration of exposure (days) 30 (10-590)

Dosage (mgday) (3474) 1250 (135-9000)

Number

Spontaneous abortion

374 41

IUFD 271 28

Preterm birth 671 85

LBW 171 14

Malformation 171 14

Mega-cysterna magna(11mm)

Herbal Medicines relate to Spontaneous Abortion

Animal study

Hanyak yangnihak 2001

Herbal name Common name Korean name Binominal name

Menthae Herba Mint Bak ha 1 Mentha arvensis var piperascens Malinv (Labiatae) 2 Mentha haplocalyx Briq (Labiatae)

Trichosanthis Radix Trichosanthes root Chun Hwa Boon Trichosanthes kirilowii Maxim (Cucurbitaceae)

Moutan Radicis Cortex Moutan root bark Mok dan pi Paeonia suffruticosa Andr (Paeoniaceae)

Lonicerae Flos Lonicera flowers Geum un hwa 1 Lonicera japonica Thunb (Caprifoliaceae) 2 Lonicera confusa DC (Caprifoliaceae)

Kansui Radix Kansui root Gam su Euphorbia kansui Liou ex Wang (Euphorbiaceae)

Clematidis Radix Clematis (root) Wi ryung sun 1 Clematis mandshurica Rupr (Ranunculaceae) 2 Clematis chinensis Osbeck (Ranunculaceae) 3 Clematis hexapetala Pall (Ranunculaceae)

Sulphur Sulphur Yu hwang Sulphur

Curcumae Longae Tuber Common turmeric Gang hwang Curcuma longa L (Zingiberaceae)

Curcumae Rhizoma Zedoary A chool 1 Curcuma phaeocaulis Val (Zingiberaceae) 2 Curcuma kwangsiensis S G Lee et C F Liang

(Zingiberaceae)

Achyranthis Radix Achyranthes root Oo seol 1 Achyranthes japonica Nakai (Amaranthaceae) 2 Achyranthes bidentata Bl (Amaranthaceae) 3 Achyranthes fauriei Leville et Vaniot (Amaranthaceae)

Pinelliae Rhizoma Pinellia rhizome Ban ha Pinellia ternata (Thunb) Breit (Araceae)

Aristolochiae Fructus Aristolochia fruit Ma doo ryung 1 Aristolochia contorta Bunge (Aristolochiaceae) 2 Aristolochia debilis Siebet Zucc (Aristolochiaceae)

Albizziae Cortex Silk tree bark Hab han pi Albizia julibrissin Durazz (Leguminosae)

Moschus Musk Sa hyang 1 Moschus moschiferus L (Moschidae) 2 Moschus berezovskii Flerov (Moschidae) 3 Moschus sifanicus Przewalski (Moschidae)

Menthae Herba (Bak ha) (1)

bull Indications Common cold Frozen shoulder Fever accompanied with fear Cholera Acute gastric cramp Aphthous stomatitis Tuberculous lymphadenitis Persistent headache Measles Nasal bleeding Snake bite Liver cirrhosis Ascites Urticaria Palpebral conjunctivitis Laryngitis or Laryngeal abscess Suppurative otitis media Aphasia in Stroke Contact dermatitis Burn Headache Rubella Bloody dysentery Pharyngitis

bull Pharmacologic action anti-inflammatory effects anti-

pyretic vasodilatation decrease secretion of bronchus (high

conc) and necrosis of placenta in animal

Hanbang Yangnihak 2010 Hanyak yangnihak 2001

bull Formula in Korea 225 wwwtradimedcokr

bull OTC in Korea 311 wwwkimsonlinecokr

Menthae Herba (Bak ha) (2) (48 cases)

Median (Min-Max)

Last exposure weeks 43 (04-126)

Duration of exposure (days) 30 (10-460)

Dosage (mgday) (2548) 852 (200-2256)

Number

Spontaneous abortion

148 21

IUFD - 0

Preterm birth 347 64

LBW 247 43

Malformation - 0

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (1)

bull Indications Headache due to Brain tumor Bronchial asthma

Dizziness Stomach cancer Pyloric stenosis Gastric gaseous

distension

bull Pretreatment purified Pinellia tuber processed Pinellia

tuber processed Pinellia tuber with ginger

bull Pharmacologic action antitussive effect decrease

vomiting decrease gastric ulcer decrease ocular pressure and

increase abortion in animal Hanyak yangnihak 2001

bull Formula in Korea 90 wwwtradimedcokr

bull OTC in Korea 587 wwwkimsonlinecokr

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (2) (43 cases)

Median (Min-Max)

Last exposure weeks 45 (04-124)

Duration of exposure (days) 20 (10-530)

Dosage (mgday) (1843) 6255 (267-3340)

Number

Spontaneous abortion

- 0

IUFD 243 47

Preterm birth 443 93

LBW 343 71

Malformation 143 23

Mega cysterna magna (11mm)

Pregnancy Outcomes Korean Motherisk Program

Unpublished data

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Herbal Medicines relate to Spontaneous Abortion

Animal study

Hanyak yangnihak 2001

Herbal name Common name Korean name Binominal name

Menthae Herba Mint Bak ha 1 Mentha arvensis var piperascens Malinv (Labiatae) 2 Mentha haplocalyx Briq (Labiatae)

Trichosanthis Radix Trichosanthes root Chun Hwa Boon Trichosanthes kirilowii Maxim (Cucurbitaceae)

Moutan Radicis Cortex Moutan root bark Mok dan pi Paeonia suffruticosa Andr (Paeoniaceae)

Lonicerae Flos Lonicera flowers Geum un hwa 1 Lonicera japonica Thunb (Caprifoliaceae) 2 Lonicera confusa DC (Caprifoliaceae)

Kansui Radix Kansui root Gam su Euphorbia kansui Liou ex Wang (Euphorbiaceae)

Clematidis Radix Clematis (root) Wi ryung sun 1 Clematis mandshurica Rupr (Ranunculaceae) 2 Clematis chinensis Osbeck (Ranunculaceae) 3 Clematis hexapetala Pall (Ranunculaceae)

Sulphur Sulphur Yu hwang Sulphur

Curcumae Longae Tuber Common turmeric Gang hwang Curcuma longa L (Zingiberaceae)

Curcumae Rhizoma Zedoary A chool 1 Curcuma phaeocaulis Val (Zingiberaceae) 2 Curcuma kwangsiensis S G Lee et C F Liang

(Zingiberaceae)

Achyranthis Radix Achyranthes root Oo seol 1 Achyranthes japonica Nakai (Amaranthaceae) 2 Achyranthes bidentata Bl (Amaranthaceae) 3 Achyranthes fauriei Leville et Vaniot (Amaranthaceae)

Pinelliae Rhizoma Pinellia rhizome Ban ha Pinellia ternata (Thunb) Breit (Araceae)

Aristolochiae Fructus Aristolochia fruit Ma doo ryung 1 Aristolochia contorta Bunge (Aristolochiaceae) 2 Aristolochia debilis Siebet Zucc (Aristolochiaceae)

Albizziae Cortex Silk tree bark Hab han pi Albizia julibrissin Durazz (Leguminosae)

Moschus Musk Sa hyang 1 Moschus moschiferus L (Moschidae) 2 Moschus berezovskii Flerov (Moschidae) 3 Moschus sifanicus Przewalski (Moschidae)

Menthae Herba (Bak ha) (1)

bull Indications Common cold Frozen shoulder Fever accompanied with fear Cholera Acute gastric cramp Aphthous stomatitis Tuberculous lymphadenitis Persistent headache Measles Nasal bleeding Snake bite Liver cirrhosis Ascites Urticaria Palpebral conjunctivitis Laryngitis or Laryngeal abscess Suppurative otitis media Aphasia in Stroke Contact dermatitis Burn Headache Rubella Bloody dysentery Pharyngitis

bull Pharmacologic action anti-inflammatory effects anti-

pyretic vasodilatation decrease secretion of bronchus (high

conc) and necrosis of placenta in animal

Hanbang Yangnihak 2010 Hanyak yangnihak 2001

bull Formula in Korea 225 wwwtradimedcokr

bull OTC in Korea 311 wwwkimsonlinecokr

Menthae Herba (Bak ha) (2) (48 cases)

Median (Min-Max)

Last exposure weeks 43 (04-126)

Duration of exposure (days) 30 (10-460)

Dosage (mgday) (2548) 852 (200-2256)

Number

Spontaneous abortion

148 21

IUFD - 0

Preterm birth 347 64

LBW 247 43

Malformation - 0

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (1)

bull Indications Headache due to Brain tumor Bronchial asthma

Dizziness Stomach cancer Pyloric stenosis Gastric gaseous

distension

bull Pretreatment purified Pinellia tuber processed Pinellia

tuber processed Pinellia tuber with ginger

bull Pharmacologic action antitussive effect decrease

vomiting decrease gastric ulcer decrease ocular pressure and

increase abortion in animal Hanyak yangnihak 2001

bull Formula in Korea 90 wwwtradimedcokr

bull OTC in Korea 587 wwwkimsonlinecokr

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (2) (43 cases)

Median (Min-Max)

Last exposure weeks 45 (04-124)

Duration of exposure (days) 20 (10-530)

Dosage (mgday) (1843) 6255 (267-3340)

Number

Spontaneous abortion

- 0

IUFD 243 47

Preterm birth 443 93

LBW 343 71

Malformation 143 23

Mega cysterna magna (11mm)

Pregnancy Outcomes Korean Motherisk Program

Unpublished data

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Herbal name Common name Korean name Binominal name

Menthae Herba Mint Bak ha 1 Mentha arvensis var piperascens Malinv (Labiatae) 2 Mentha haplocalyx Briq (Labiatae)

Trichosanthis Radix Trichosanthes root Chun Hwa Boon Trichosanthes kirilowii Maxim (Cucurbitaceae)

Moutan Radicis Cortex Moutan root bark Mok dan pi Paeonia suffruticosa Andr (Paeoniaceae)

Lonicerae Flos Lonicera flowers Geum un hwa 1 Lonicera japonica Thunb (Caprifoliaceae) 2 Lonicera confusa DC (Caprifoliaceae)

Kansui Radix Kansui root Gam su Euphorbia kansui Liou ex Wang (Euphorbiaceae)

Clematidis Radix Clematis (root) Wi ryung sun 1 Clematis mandshurica Rupr (Ranunculaceae) 2 Clematis chinensis Osbeck (Ranunculaceae) 3 Clematis hexapetala Pall (Ranunculaceae)

Sulphur Sulphur Yu hwang Sulphur

Curcumae Longae Tuber Common turmeric Gang hwang Curcuma longa L (Zingiberaceae)

Curcumae Rhizoma Zedoary A chool 1 Curcuma phaeocaulis Val (Zingiberaceae) 2 Curcuma kwangsiensis S G Lee et C F Liang

(Zingiberaceae)

Achyranthis Radix Achyranthes root Oo seol 1 Achyranthes japonica Nakai (Amaranthaceae) 2 Achyranthes bidentata Bl (Amaranthaceae) 3 Achyranthes fauriei Leville et Vaniot (Amaranthaceae)

Pinelliae Rhizoma Pinellia rhizome Ban ha Pinellia ternata (Thunb) Breit (Araceae)

Aristolochiae Fructus Aristolochia fruit Ma doo ryung 1 Aristolochia contorta Bunge (Aristolochiaceae) 2 Aristolochia debilis Siebet Zucc (Aristolochiaceae)

Albizziae Cortex Silk tree bark Hab han pi Albizia julibrissin Durazz (Leguminosae)

Moschus Musk Sa hyang 1 Moschus moschiferus L (Moschidae) 2 Moschus berezovskii Flerov (Moschidae) 3 Moschus sifanicus Przewalski (Moschidae)

Menthae Herba (Bak ha) (1)

bull Indications Common cold Frozen shoulder Fever accompanied with fear Cholera Acute gastric cramp Aphthous stomatitis Tuberculous lymphadenitis Persistent headache Measles Nasal bleeding Snake bite Liver cirrhosis Ascites Urticaria Palpebral conjunctivitis Laryngitis or Laryngeal abscess Suppurative otitis media Aphasia in Stroke Contact dermatitis Burn Headache Rubella Bloody dysentery Pharyngitis

bull Pharmacologic action anti-inflammatory effects anti-

pyretic vasodilatation decrease secretion of bronchus (high

conc) and necrosis of placenta in animal

Hanbang Yangnihak 2010 Hanyak yangnihak 2001

bull Formula in Korea 225 wwwtradimedcokr

bull OTC in Korea 311 wwwkimsonlinecokr

Menthae Herba (Bak ha) (2) (48 cases)

Median (Min-Max)

Last exposure weeks 43 (04-126)

Duration of exposure (days) 30 (10-460)

Dosage (mgday) (2548) 852 (200-2256)

Number

Spontaneous abortion

148 21

IUFD - 0

Preterm birth 347 64

LBW 247 43

Malformation - 0

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (1)

bull Indications Headache due to Brain tumor Bronchial asthma

Dizziness Stomach cancer Pyloric stenosis Gastric gaseous

distension

bull Pretreatment purified Pinellia tuber processed Pinellia

tuber processed Pinellia tuber with ginger

bull Pharmacologic action antitussive effect decrease

vomiting decrease gastric ulcer decrease ocular pressure and

increase abortion in animal Hanyak yangnihak 2001

bull Formula in Korea 90 wwwtradimedcokr

bull OTC in Korea 587 wwwkimsonlinecokr

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (2) (43 cases)

Median (Min-Max)

Last exposure weeks 45 (04-124)

Duration of exposure (days) 20 (10-530)

Dosage (mgday) (1843) 6255 (267-3340)

Number

Spontaneous abortion

- 0

IUFD 243 47

Preterm birth 443 93

LBW 343 71

Malformation 143 23

Mega cysterna magna (11mm)

Pregnancy Outcomes Korean Motherisk Program

Unpublished data

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Menthae Herba (Bak ha) (1)

bull Indications Common cold Frozen shoulder Fever accompanied with fear Cholera Acute gastric cramp Aphthous stomatitis Tuberculous lymphadenitis Persistent headache Measles Nasal bleeding Snake bite Liver cirrhosis Ascites Urticaria Palpebral conjunctivitis Laryngitis or Laryngeal abscess Suppurative otitis media Aphasia in Stroke Contact dermatitis Burn Headache Rubella Bloody dysentery Pharyngitis

bull Pharmacologic action anti-inflammatory effects anti-

pyretic vasodilatation decrease secretion of bronchus (high

conc) and necrosis of placenta in animal

Hanbang Yangnihak 2010 Hanyak yangnihak 2001

bull Formula in Korea 225 wwwtradimedcokr

bull OTC in Korea 311 wwwkimsonlinecokr

Menthae Herba (Bak ha) (2) (48 cases)

Median (Min-Max)

Last exposure weeks 43 (04-126)

Duration of exposure (days) 30 (10-460)

Dosage (mgday) (2548) 852 (200-2256)

Number

Spontaneous abortion

148 21

IUFD - 0

Preterm birth 347 64

LBW 247 43

Malformation - 0

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (1)

bull Indications Headache due to Brain tumor Bronchial asthma

Dizziness Stomach cancer Pyloric stenosis Gastric gaseous

distension

bull Pretreatment purified Pinellia tuber processed Pinellia

tuber processed Pinellia tuber with ginger

bull Pharmacologic action antitussive effect decrease

vomiting decrease gastric ulcer decrease ocular pressure and

increase abortion in animal Hanyak yangnihak 2001

bull Formula in Korea 90 wwwtradimedcokr

bull OTC in Korea 587 wwwkimsonlinecokr

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (2) (43 cases)

Median (Min-Max)

Last exposure weeks 45 (04-124)

Duration of exposure (days) 20 (10-530)

Dosage (mgday) (1843) 6255 (267-3340)

Number

Spontaneous abortion

- 0

IUFD 243 47

Preterm birth 443 93

LBW 343 71

Malformation 143 23

Mega cysterna magna (11mm)

Pregnancy Outcomes Korean Motherisk Program

Unpublished data

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Menthae Herba (Bak ha) (2) (48 cases)

Median (Min-Max)

Last exposure weeks 43 (04-126)

Duration of exposure (days) 30 (10-460)

Dosage (mgday) (2548) 852 (200-2256)

Number

Spontaneous abortion

148 21

IUFD - 0

Preterm birth 347 64

LBW 247 43

Malformation - 0

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (1)

bull Indications Headache due to Brain tumor Bronchial asthma

Dizziness Stomach cancer Pyloric stenosis Gastric gaseous

distension

bull Pretreatment purified Pinellia tuber processed Pinellia

tuber processed Pinellia tuber with ginger

bull Pharmacologic action antitussive effect decrease

vomiting decrease gastric ulcer decrease ocular pressure and

increase abortion in animal Hanyak yangnihak 2001

bull Formula in Korea 90 wwwtradimedcokr

bull OTC in Korea 587 wwwkimsonlinecokr

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (2) (43 cases)

Median (Min-Max)

Last exposure weeks 45 (04-124)

Duration of exposure (days) 20 (10-530)

Dosage (mgday) (1843) 6255 (267-3340)

Number

Spontaneous abortion

- 0

IUFD 243 47

Preterm birth 443 93

LBW 343 71

Malformation 143 23

Mega cysterna magna (11mm)

Pregnancy Outcomes Korean Motherisk Program

Unpublished data

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Pinelliae Rhizoma (Ban ha) (1)

bull Indications Headache due to Brain tumor Bronchial asthma

Dizziness Stomach cancer Pyloric stenosis Gastric gaseous

distension

bull Pretreatment purified Pinellia tuber processed Pinellia

tuber processed Pinellia tuber with ginger

bull Pharmacologic action antitussive effect decrease

vomiting decrease gastric ulcer decrease ocular pressure and

increase abortion in animal Hanyak yangnihak 2001

bull Formula in Korea 90 wwwtradimedcokr

bull OTC in Korea 587 wwwkimsonlinecokr

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (2) (43 cases)

Median (Min-Max)

Last exposure weeks 45 (04-124)

Duration of exposure (days) 20 (10-530)

Dosage (mgday) (1843) 6255 (267-3340)

Number

Spontaneous abortion

- 0

IUFD 243 47

Preterm birth 443 93

LBW 343 71

Malformation 143 23

Mega cysterna magna (11mm)

Pregnancy Outcomes Korean Motherisk Program

Unpublished data

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Korean Motherisk Program unpublished

Pinelliae Rhizoma (Ban ha) (2) (43 cases)

Median (Min-Max)

Last exposure weeks 45 (04-124)

Duration of exposure (days) 20 (10-530)

Dosage (mgday) (1843) 6255 (267-3340)

Number

Spontaneous abortion

- 0

IUFD 243 47

Preterm birth 443 93

LBW 343 71

Malformation 143 23

Mega cysterna magna (11mm)

Pregnancy Outcomes Korean Motherisk Program

Unpublished data

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Pregnancy Outcomes Korean Motherisk Program

Unpublished data

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Demographic characteristics of participants(n=321)

Age (years) 320 plusmn 36

Gravidity (n) 22 plusmn 13

Parity (n) 10 (0 30)

Body mass index (kgm2) 208 plusmn 32

Exposure to X-rays

a) n () 54 (168)

b) total dose (mSv) 0005 (00005 288)

c) gestational age at exposure (weeks) 48 plusmn 32

Exposure to alcohol ()

a) n () 128 (399)

b) total dose (oz) 16 plusmn 14

c) gestational age at exposure (weeks) 46 plusmn 23

Smoking ()

a) n () 23 (72)

b) cigarettesday 54 plusmn 44

c) gestational age at exposure (weeks) 63 plusmn 46

Comorbidities [n ()]

a) type 2 diabetes mellitus 1 (03)

b) hypertension 2 (06)

c) thyroid disease 2 (06)

d) cancer 1 (03)

e) renal disease 1 (03)

Education level [n ()]

a) post-secondary education 130 (405)

b) high school 20 (62)

c) not answered 171(533)

Occupation

a) professional technical and related occupatio

ns

54 (168)

b) executive administrative managerial and sal

es

occupations

136 (424)

c) construction workers 124 (386)

d) unemployed 7 (22)

Korean Motherisk Program unpublished

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Indications of herbal exposure (n=321) INDICATIONS a n ()

Analgesics 8 (25)

Anti-acne preparations 2 (06)

Anti-emetics amp anti-nauseants 1 (03)

Anti-inflammatory enzymes 8 (25)

Anti-inflammatory amp anti-rheumatic products 7 (22)

Anti-obesity preparations 21 (65)

Anti-thrombotic agents 2 (06)

Cough and cold preparations 129 (402)

Dermatological preparations 3 (09)

Drugs for acid related disorder 1 (03)

Functional gastrointestinal disorders 93 (290)

Gynecological anti infectives and antiseptics 11 (34)

Psycholeptics 2 (06)

Sex hormones amp modulators the genital system 7 (22)

Others 26 (81) aAccording to the pharmacologicaltherapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)

Korean Motherisk Program unpublished

21 cases Tonic medicine

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Exposure to herbal medicine in pregnant women (n=321)

Median (range)

Numbers of herbal medicine including

one prescription

70 (10 - 400)

Duration of exposure (days) 30 (10 ndash 3650)

Gestational age at last dose (weeks) 47 (01 - 250)

197 kinds of herbal medicines

Korean Motherisk Program unpublished

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Frequencies of Herbal medicine (gt10)

0 50

100 150 200 188

75 91 46

81 71 103

65 71 57 57 48 43 45 43 45 41 40 33

n

Korean Motherisk Program unpublished

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Fetal outcomes Cases (n= 307)

Gestational age at birth (weeks) 389 plusmn 24

Birth weight (g) 32942 plusmn 5118

Birth length (cm) 497 plusmn 22

Head circumference at birth (cm) 346 plusmn 14

Apgar score 1 min 83 plusmn 09

Apgar score 5 min 90 plusmn 07

IUFD () 6 (20)

Malformationsa () 7 (23)

NICU admission () 12 (39)

Duration of NICU admission (days) 125 plusmn 92

Neonatal jaundice () 10 (33)

a A baby born with megacisterna magna second one with dysplastic change of left kidney left ectopic ureteral

insertion third one with small pulmonary artery fourth one with polydactyly of 5th toe of left foot and cleft palate and

patent ductus arteriosus fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart sixth

one with borderline left ventriculomegaly of cerebrum and seventh one with patent ductus arteriosus Korean Motherisk Program unpublished

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Summary (1)

bull Although herbal medicines have been used in

clinical practice for thousands of years basic

research on herbal substances should be focused on

the toxicity and efficacy relationship for those potent

and poisonous herbal substances according to

composite formula

bull Most traditional medical herbs are used in the form

of an aqueous decoction Therefore research

projects should be centered on development of

analytical and biological procedures for use to give

quality assurance control and clinical assessment of

efficacy and safety of products

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Summary (2)

bull Herbal medications should be regulated for safety

quality and for appropriate evidence of efficacy

bull Dosage and indications for treatment should be

standardized And contraindications should be

clearly identified

bull Language problem is another aspect as herbal

ingredients are supplied with similarly names

substitutes that could be toxic

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention

Thank you for your attention

• Herbal Medicines in Pregnancy
• Contents
• Definition (1)
• Definition (2)
• Definition (3)
• Introduction (1)
• Introduction (2)
• Introduction (3)
• Introduction (4)
• Side effects by Korean herbal medicines-drug interactions
• Introduction (5)
• 슬라이드 번호 12
• Very Toxic Herbal Medicine
• Crotonis Semen (Pa Doo)
• Mylabris (Ban Myo)
• Aconiti Ciliare Tuber Aconiti Kusnezoffii Radix Aconiti Proliferum Radix Aconiti Radix (Cho O)
• Aconiti Radix (Chun O)
• How to make herbal medicine in Korea
• Korean women have a chance to be exposed to herbal medicine from marriage to lactation
• Herbal Medicines relate to Uterine Contraction Animal study
• 슬라이드 번호 21
• Cnidii Rhizoma (Chun gung) (1)
• Cnidii Rhizoma (Chun gung) (2) (80cases)
• Corydalis Tuber (Hyun ho sac) (1)
• Corydalis Tuber (Hyun ho sac) (2) (25 cases)
• Angelicae Gigantis Radix (Dang gui) (1)
• Angelicae Gigantis Radix (Dang gui) (2) (74 cases)
• Herbal Medicines relate to Spontaneous Abortion Animal study
• 슬라이드 번호 29
• Menthae Herba (Bak ha) (1)
• Menthae Herba (Bak ha) (2) (48 cases)
• Pinelliae Rhizoma (Ban ha) (1)
• Pinelliae Rhizoma (Ban ha) (2) (43 cases)
• Pregnancy Outcomes Korean Motherisk Program
• Demographic characteristics of participants(n=321)
• Indications of herbal exposure (n=321)
• Exposure to herbal medicine in pregnant women (n=321)
• Frequencies of Herbal medicine (gt10)
• Fetal outcomes
• Summary (1)
• Summary (2)
• Thank you for your attention