title: Characteristics of traditional Chinese medicine usage in patients with stroke in Taiwan: A nationwide population-based study.
abstract: BACKGROUND
  Stroke has been the leading causes of death worldwide. Traditional Chinese medicine (TCM) has been used for stoke patients for thousands of years. This study aimed to investigate TCM usage and prescription patterns in stroke patients in Taiwan.
  
  
  METHODS
  We analyzed a random sample of one million individuals representing the 23 million enrollees selected from the National Health Insurance Research Database in Taiwan. Demographic characteristics, TCM usage, prescription patterns and mortality rate among stroke patients were analyzed.
  
  
  RESULTS
  We identified 23,816 patients who were newly diagnosed with stroke between 2001 and 2009 by their diagnostic codes (ICD-9-CM 430-438). Among them, 4302 patients had hemorrhagic stroke while 19,514 patients had ischemic stroke. Overall, 12% of the stroke patients (n=2862) were TCM users. The median interval between stroke onset to the first TCM consultation is 12.2 months. Among the TCM users, more than half (52.7%) of the patients received both Chinese herbal remedies and acupuncture/traumatology treatment. Bu-yang-huan-wu-tang and Dan-shen (Radix Salviae Miltiorrhizae; Salvia miltiorrhiza Bunge) was the most commonly prescribed Chinese herbal formula and single herb, respectively. TCM users had a higher incidence rate ratio in myalgia, myositis, fasciitis and insomnia than non-TCM users. Mental disorders such as anxiety and depression are common in both TCM and non-TCM users. Comparing with the non-TCM users, the TCM users had a lower mortality rate (adjusted hazard ratios were 0.44 in overall stroke, 0.50 in ischemic stroke and 0.25 in hemorrhagic stroke).
  
  
  CONCLUSIONS
  Adjunctive TCM use may reduce the risk of mortality rate among stroke patients. Bu-yang-huan-wu-tang and Dan-shen are the most common prescribed Chinese herbal formula and single herb for stroke patients, respectively. Future study investigating the anti-inflammatory and neuroprotective efficacy of Bu-yang-huan-wu-tang and Dan-shen in stroke is warranted.
authors.affiliation: Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan. Electronic address: cheerpachang@gmail.com.
authors.forename: Chia-Chi
authors.initials: CC
authors.lastname: Chang
authors.affiliation: Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 404, Taiwan; Graduate Institute of Acupuncture Science, China Medical University, Taichung 404, Taiwan. Electronic address: d5167@mail.cmuh.org.tw.
authors.forename: Yu-Chen
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Health Data Management Office, China Medical University Hospital, Taichung 404, Taiwan. Electronic address: a21745@mail.cmuh.org.tw.
authors.forename: Che-Chen
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Department of Traditional Chinese Medicine, En Chu Kong Hospital, New Taipei City 237, Taiwan; Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan. Electronic address: 01399@km.eck.org.tw.
authors.forename: Chin-Hsien
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, China Medical University Hospital, Taichung 404, Taiwan; School of Medicine, China Medical University, Taichung 404, Taiwan. Electronic address: cdchiu@yahoo.com.tw.
authors.forename: Cheng-Di
authors.initials: CD
authors.lastname: Chiu
authors.affiliation: Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 404, Taiwan; Graduate Institute of Acupuncture Science, China Medical University, Taichung 404, Taiwan; School of Chinese Medicine, China Medical University, Taichung 404, Taiwan; Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404, Taiwan. Electronic address: chouliwe@gmail.com.
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Chou
authors.affiliation: Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 404, Taiwan; School of Chinese Medicine, China Medical University, Taichung 404, Taiwan. Electronic address: maofeng@mail.cmuh.org.tw.
authors.forename: Mao-Feng
authors.initials: MF
authors.lastname: Sun
authors.affiliation: Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 404, Taiwan; School of Chinese Medicine, China Medical University, Taichung 404, Taiwan. Electronic address: hungrongyen@gmail.com.
authors.forename: Hung-Rong
authors.initials: HR
authors.lastname: Yen
mesh_terms: D000368:Aged; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008516:Medicine, Chinese Traditional / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D027561:Salvia miltiorrhiza; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D013624:Taiwan / Q000453:epidemiology
chemical_list: D004365:Drugs, Chinese Herbal; C587029:bu-yang-huan-wu-tang; C028972:dan-shen root extract
keywords: Bu-Yang-Huan-Wu-Tang; Cerebrovascular accident; National Health Insurance Research Database; Salvia miltiorrhiza Bunge; Stroke; Traditional Chinese medicine