한방건강보험 약제 투약 실태 및 활성화 방안 연구

권용찬 ( Yong Chan Kwon ),유왕근 ( Wang Keun Yoo ),서부일 ( Bu Il Seo ) 대한본초학회 2012 大韓本草學會誌 Vol.27 No.2

Objective:To investigate the current status of prescription drugs in Oriental medical institutes and to draw up a future plan for the revitalization of Oriental medical health insurance, this survey has been performed. Method:The survey has been made with 321 doctors working at Oriental medical institutes in Daegu and Kyungbuk areas for a period of 3 month from June 1, 2010 until September 1, 2010. Result:1. When it comes to the current status of the use of herbal drugs in Oriental Health insurance, most of doctors surveyed prescribe insurance drugs, and they prescribe insurance drugs to patients, who are less than 20% of total patients visiting their clinics. 2. The awareness of Herbal Health Care Drugs is investigated. When it comes to the understanding of the difference between insurance drugs(powder type drugs) and granular type drugs, doctors admit that they differ only in one aspect, whether or not their being covered by health insurance. Based on the survey results on the understanding of insurance coverage of granular type drugs, doctors, even though they long for granular type drugs to be accepted as insurance drugs, are worrying whether the number of outpatients might dwindle due to increased insurance co-payments. They also point out that the biggest obstacles in the expansion of the granular type drugs as insurance drugs are the lack of understanding of the government and the objection of the Health Insurance Review and Assesment service (HIRA) for fear of increased insurance claims. 3. Upon investigation on Oriental medicine doctors`` understandings of herbal pharmaceutical industry, it is found that doctors`` responses on pharmaceutical industry are not all positive ones (``new product development and neglect of R&D infrastructure`` and ``smallness of industry``). When it is investigated what area needs the greatest improvement in herbal pharmaceutical industry, ``securing sufficient capital, good manufacturing, and strengthening quality control``, is the highest. 4. When it is asked what are the most needed in order to improve herbal health insurance medicine, responses such as ``the increase in the accessibility to and the utilization of Oriental medical clinics through the diversification of the means of prescriptions``, ``the improvement of insurance benefits(cap adjustments)``, ``increase the proportion of high quality medicinal plants``, ``the ceiling of co-payments(deductible) at 20,000 won or more``, ``expansion of the choices of formulations``, ``formulational expansions of tablets and pills``, and finally ``admittance and expansion of granular type drug as insurance drug`` are the highest. 5. Upon investigating the general characteristics of the current status of the usage of Oriental health care herbal drugs, the followings are observed. First, the frequency of use of health insurance drugs by the doctors who use health insurance with general characteristics shows similar differences in case of total monthly sales amount (p<0.001), average number of daily patients (p<0.05). Secondly, as to the willingness of the expanded usage of insurance drugs, similar differences are observed in case of total monthly sales amount (p<0.05). 6. Upon investigating the general characteristics of the perception of Herbal health care drugs, the followings are observed. First, inspecting general characteristics and insurance claims due to increased co-payments(deductible amount) reveals similar differences in case of working period (p<0.01) and in case of total monthly sales amount (p <0.01). Secondly, inspecting general characteristics and the obstacles that hinder granular type drugs from being accepted as health care insurance drugs shows similar differences in case of working period (p<0.05). 7. Upon investigating the general characteristics of the understanding of Oriental Herbal pharmaceutical companies, the followings are observed. First, opinions on the general characteristics of pharmaceutical companies, when examined with variance analysis, shows similar differences in case of total monthly sales amount (p<0.05). Secondly, when opinions are examined on general characteristics and the problems of herbal pharmaceutical companies, similar differences are found in case of working period (p<0.01) and in case of total monthly sales amount (p<0.001). Lastly, opinions on the general characteristics and reforms of pharmaceutical companies, similar differences are observed in case of working period (p<0.001). 8. Upon investigating the general characteristics of the improvement of insurance Herbal drugs, the followings are observed. First, regarding general characteristics and insurance benefits, similar differences are observed in case of working period (p<0.05), in case of total monthly sales amount (p<0.05), and in case of average number of daily patients (p<0.01). Secondly, opinions on the general characteristics and the needs for the improvement of Herbal insurance drugs are examined in 5 different aspects, which are the approval of granular type drugs as insurance drugs, the expanded practices of the number of prescription insurance drugs, the needs of a variety of formulations, the needs of TFT of which numbers of Oriental medical doctors are members for the revision of the existing system, and the needs of adjusting the current ceiling of the fixed amount and the fixed rate. When processed by the analysis of variance, the results show similar differences in case of average number of daily patients (p<0.01). Conclusion:From the results of this study the first measures to take are, to reform overall insurance benefit system, including insurance co-payment system(fixed rate cap adjustment), to expand the number of the herbal drugs to be prescribed matching with insurance benefit accordingly, and to revitalize herbal medicine insurance system through the change of various formulations. In addition, it is recommended to improve the effectiveness of herbal medicine by making plans to enhance the efficacy of herbal medicine and by enabling small pharmaceutical companies to outgrow themselves.

한약ㆍ생약제제 품목허가신고심사 규정 변화에 관한 고찰

엄석기(Seok Ki Eom) 한국의사학회 2014 한국의사학회지 Vol.27 No.2

Objectives : The purpose of this study was to analyze and identify the problems of the changes in regulations that are relevant to approval, notification, and review of herbal medicinal preparations and crude drug preparations. Methods : I collected the regulations of approval, notification, and review of medicinal products mostly from official gazettes, analyzed enactment and amendments regarding herbal medicinal preparations and crude drug preparations, and studied it from the view point of Korean medicine field. Results : Regulations in regards to approval, notification, and review of herbal medicinal preparations and crude drug preparations were first established in 1978. Herbal drugs started to be categorized as crude drug preparations in 1981 and the regulatory outlines were completed in 1999. From 2008 to 2012, the regulatory standards that let crude drug preparations be new drugs from natural products were established. Through those procedures, the followings became crude drug preparations: 1) wholly new prescriptions that are not recorded in Korean Medical Classics, 2) prescriptions that are recorded in Korean Medical classics but prepared with new standard, composition and efficacy, 3) prescriptions that are recorded in Korean Medical classics but prepared with new formulation, and 4) herbal drugs. In case of herbal medicinal preparations, however, only regulations that are related to 1) drugs prepared with new compositions that are not recorded in Korean Medical Classics, 2) drugs with same prescription and same formulation, and 3) drugs with new formulation were arranged. Conclusions : Actual circumstances on crude drug-oriented regulations regarding approval, notification and review and future forms of prescription and drug administration in Korean Medical Institutions can be expected due to expansion in range of herbal medicinal preparations and shrink in that of on-site preparations. Reasonable improvement in efficient usage of modernized herbal medicinal preparations in Korean medical institutions and prospective cooperation from related pharmaceutical industry are needed.

항암제와 한약재의 병용투여 시 암세포 증식억제 효과에 대한 국내 실험연구 문헌고찰

이지은,최진용,한창우,최준용,박성하,김소연,Lee, Ji Eun,Choi, Jin Yong,Han, Chang Woo,Choi, Jun Yong,Park, Seong Ha,Kim, So Yeon 대한한의학방제학회 2017 大韓韓醫學方劑學會誌 Vol.25 No.3

Objective : In this study, we searched the experimental research about combined treatment of anticancer drug and herbal medicine for killing or inhibiting proliferation of Cancer cells searched in OASIS and KISS. This study aimed to analyze the experimental research paper about anticancer drug combined treatment with herbal medicine. Methods : We collected the research paper including killing or inhibiting proliferation of Cancer cells in OASIS and KISS using keyword anticancer drug with herbal medicine, tumor suppressor with herbal medicine, inhibition of Cancer with herbal medicine and combined treatment with herbal medicine. Assorting by cancer cells, we analyzed experimental results cancer cell viability, anticancer drug dosage, tumor weight and survival rate. Also, we checked the effects of herbal medicine on cancer and additive effect reducing side effect of anticancer drug. Results : Total 45 studies were selected. 38 studies reported combined treatment of anticancer drug and herbal medicine was more effective than only anticancer drug. The death of cancer cells was synergistically induced by the cotreatment of anticancer drug and herb extracts. The studies suggest that the cotreatment of anticancer drug and herb extracts could reduce side effect of anticancer drug. In addition, some studies reported cotreatment mechanism like apoptotic death signal processes. In combined treatment of anticancer drug and herb extracts, The expression of Fas/Fas L, Bax, Bcl2, Caspase-3 etc.. was markedly increased in cancer cells. Conclusions : Our results suggest that anticancer drug combined treatment with herbal medicine could be efficient for killing or inhibiting proliferation of cancer cells. However, this paper had some limitation as follows: First, collected studies have been published only for korean journal. Second, results of research and effects of combined treatment are not collected objectively. To solve these problems, more objective and balanced studies should be performed.

한약, 한약재, 생약과 천연물의 법규상 개념 및 정의의 문제점과 개선안

엄석기 ( Seok Ki Eom ) 대한한의학원전학회(구 대한원전의사학회) 2014 대한한의학원전학회지 Vol.27 No.2

Objectives : This study was to analyze the definitions of herbs, herbal drugs, crude drugs and natural products in the relevant laws and regulations, understand the related problems, and propose directions for improvement. Methods : I analyzed the legal definitions in respect of herbs, herbal drugs, crude drugs and natural products in relevant laws and regulations since 1945, explained the problems, and suggested the solution-considering the academic stance of Traditional Korean Medicine and the dualistic medical and pharmaceutical system. Results : Herbs are defined as “refined things that are cut and dried in their most original state.” The definition of crude drugs includes herbs and the “cell contents, secretion, extracts, minerals and other parts of animals and plants that are used medicinally.” The concept of natural products is expanded to adding tissue cultures to the definition of crude drugs. Conclusions : The definition of herbs should at least include all products that are “processed, extracted and prepared” as well as contents that consist of various forms of hospital-prepared herbs. The term “herbal drug” corresponds to a traditional term of “drug,” and this should be established as a concept to explain “drugs in raw materials that are used to prepare herbs and/or manufacture herbal medicine.” The legal definition of herbs should include the concept of crude drugs. Herbal drug preparations and crude drugs should be included in the definition of herbal drugs

Review for Herbal Drug and Drug-Induced Liver Injury

Bong-Ky Park,Chang-Gue Son 대한한의학회 2010 대한한의학회지 Vol.31 No.3

Review for Herbal Drug and Drug-Induced Liver Injury

Park, Bong-Ky,Son, Chang-Gue The Society of Korean Medicine 2010 대한한의학회지 Vol.31 No.3

Objectives: This study aimed to review the general features of drug induced liver injury (DILI) and the important factors in consideration of herbal drugs and DILI. Methods: We reviewed general aspects of DILI such as classification, inducible factors, diagnosis methods, prevention, and the status of herbal drug-associated DILI via literature. Results: Besides the drug itself, genetic and environmental factors affect hepatic toxicity. There is a lack of definitive diagnoses of DILI by drugs, including herbal remedies. The possibility of herbal drug-associated DILI is exaggerated, and majority of herbal drug-derived hepatic injury could be easily prevented if Oriental doctors pay attention to this issue. Conclusion: This study can provide Oriental doctors an overview and be helpful in minimizing the episodes of hepatotoxicity in use of herbal drugs.

단미 한약과 합성 혈압약의 상호작용

오유나 ( Yoona Oh ),이홍범 ( Hongbum Lee ),김형우 ( Hyungwoo Kim ) 대한본초학회 2018 大韓本草學會誌 Vol.33 No.6

Objective : Many patients take antihypertensive drugs as well as herbal medicines at the same time in order to treat other symptoms or to keep their well-being. In this study, interactions between herbal medicines and synthetic antihypertensive drugs were analyzed. Methods : To investigate the interaction between herbal medicines and synthetic antihypertensive drugs, three electronic databases, including OASIS, Mediline and Sciencedirect were searched. Experimental and clinical studies on the interaction between herbal medicines and antihypertensive drugs were independently reviewed and included. Results : Analyzing selected studies, twenty herbs were found to interact with antihypertensive drugs. Herbs found to increase the antihypertensive effect were Panax ginseng, Carthamus tinctorius, Magnolia officinalis, Silybum marianum, Scutellaria baicalensis, Schisandra chinensis, Sophora flavescens, Piper nigrum, Curcuma longa, Ginkgo biloba, Juncus effuses and Hydrastis canadensis . In contrast, Commiphora myrrha, Rhodiola rosea, Hypericum perforatum, Eurycoma longifolia, and Daturae metel were found to inhibit the antihypertensive effect. Stephania tetrandra could increase or decrease the effect depending on the type of antihypertensive drug. Epedria sínica was suspected of pharmacodynamic interaction with antihypertensive drug. Glycyrrhiza uralensis has been reported to have serious side effects in combination with antihypertensive drugs. Conclusion : These results imply that when used in combination with herbal medicines and synthetic antihypertensive drugs, proper doses and herbs which are to avoid need to be informed to the patients. Despite concerns about interactions between herbal medicines and synthetic drugs, related research is very limited. More systematic researches are needed to give information on patient safety as well as to guide clinical practice.

일제강점기 한의학술잡지에 실린 한약업자 광고 분석

정지훈(Ji-Hun Jung),김도훈(Do-Hoon Kim) 한국의사학회 2013 한국의사학회지 Vol.26 No.2

Korean medical journals were continuously published during the period of Japanese colonization of Korea. Various advertisements by herbal drugs manufacturers were in these journals, targeting Korean medical doctors or students who aspired to be Korean medical doctors. The advertisements varied from small ones to large-scale ads. At first these advertisements covered only dried herbs, but with time, they came to advertise various kinds of drugs. Advertisement of merchandise drugs brought many changes to the medical culture of Korea. Korean medical doctors who only prescribed dried herbs before began to prescribe merchandise drugs as well. When treating patients, they not only used Korean drugs but also actively prescribed merchandise drugs and western drugs, showing an advancement in treatment. As Korean medical doctors played the role of providers of merchandise drugs, herbal drugs manufacturers and Korean medical doctors seemed as sellers and consumers on the surface. However, they maintained a relationship where Korean medicine worked as the common denominator. Among merchandise drugs, Yoeng-so-hwan, Bi-jeon-go, and Myeol-dok-hwan were advertised often, and this shows that people at the time suffered mostly from digestive diseases, skin diseases, and sexually transmitted diseases. Herbal drugs manufacturers were business managers whose main objective was to make a good profit, but they consisted a part of Korean medical society. Like Korean medical doctors, they were anxious about the fall of Korean medicine. As a part of popularization of Korean medicine, they encouraged Korean medical doctors to treat patients using herbal drugs and merchandise drugs. This thought was reflected well in advertisements and Korean medical doctors made use of this thought well.

동의보감 탕액편에 기재된 식이본초의 독성유무에 대한 분류 연구

신호동(Ho-Dong Shin),정종운(Jong-Un Jeong) 대한한의학회 2011 대한한의학회지 Vol.32 No.1

1개 대학 한방병원에서 EMR을 통해 보고된 한약에 의한 약물유해반응의 현황

권영주,조우근,한창호,Kwon, Yeong-Ju,Cho, Woo-Keun,Han, Chang-Ho 대한한방내과학회 2012 大韓韓方內科學會誌 Vol.33 No.4

Objectives : The aim of this study was to systematically investigate herbal-drug-associated adverse drug reactions (herbal ADRs) reports submitted by a single oriental hospital and to analyze the general characteristics, causative agents, clinical manifestations, severity and types of herbal medicines which caused herbal ADRs. Methods : This study proceeded with IRB approval. The data on herbal ADR were collected prospectively from January 2008 to February 2012 by EMR of Dongguk University Ilsan Oriental Hospital. The World Health Organization (WHO)-Uppsala Monitoring Center (UMC) criteria was used to determinate causality for each herbal ADR. WHO-Adverse Reaction Terminology (WHO-ART) System Organ Class (SOC) code and WHO severity category were also used in this study. Results : A total of twenty eight cases were reported. Twenty two cases were assessed to have over possible relations with herbal medication. The gender ratio of these cases were 64.6 percent female and 36.4 percent male, demonstrating no statistical significance. Patients aged over 60 were 59.1%. Gastro-intestinal system was reported to be the most frequently affected organ (38.8%), and followed by psychiatric system (22.4%), and integumentary system (22.4%). The most common clinical symptom was headache (12.2%), followed by diarrhea (10.2%), and pruritus (10.2%). The severity of most cases was assessed to be mild (89.8%). The percentage of moderate ones was 10.2%, and there were no severe cases. Conclusions : Progressive study and further analysis on herbal ADRs are warranted for safety in the clinical use of herbal medicines.