This large-scale survey aimed to evaluate frequencies and patterns of Chineseherbal medicine (CHM) used for Sjögren's syndrome (SS) in Taiwan by analyzing the National Health Insurance Research Database (NHIRD) for cases in which CHM was used as an alternative therapy to Western medicine for improving patients' discomforts. We analyzed cases of SS principal diagnosis (ICD-9:710.2) with a catastrophic illness certificate (CIC) in traditional Chinesemedicine (TCM) outpatient clinics from three cohorts of the Longitudinal Health Insurance Database (LHID) in the NHIRD between 2002 and 2011. CHM prescription patterns for SS were evaluated from claimed visitation files and corresponding prescription files. There were 15,914 SS patients with CIC (SS/CIC), and we found only 130 SS/CIC cases visiting TCM clinics in LHID2000, 133 in LHID2005, and 126 in LHID2010. After removing duplicate data, 366 SS/CIC and 4,867 visits were analyzed. The 50-59 year age group showed the highest ratio (29.51%) in both women and men. "Qi-Ju-Di-Huang-Wan" and "Xuan-Shen" (Scrophularia ningpoensis Hemsl.) was the most commonly used formula and single herb, respectively. "Qi-Ju-Di-Huang-Wan, Gan-Lu-Yin, Xuan-Shen, Mai-Men-Dong (Ophiopogon japonicus (L. f.) Ker-Gawl.), and Sheng-Di-Huang (raw Rehmannia glutinosa Libosch)" were the corepattern prescriptions in treating SS/CIC.
Figure 1: Flowchart of recruitment of patients with Sjögren's syndrome and a catastrophic illness certificate from the 3 million random samples.We identified Sjögren's syndrome in individuals with an ICD-9 code of “710.2” and a catastrophic illness certificate in Taiwan between 2002 and 2011, and they were matched with three cohorts of 1 million random samples from the LHID2000, LHID2005, and LHID2010. Subjects with a catastrophic illness certificate were included after duplicate data were removed.
Figure 2: The core pattern of Chinese formula and single herb usage for Sjögren's syndrome.The top 50 Chinese formulae and single herbs for Sjögren's syndrome patients with a catastrophic illness certificate were analyzed through open-sourced freeware NodeXL, and the core pattern of these CHMs showed that Qi-Ju-Di-Huang-Wan, Gan-Lu-Yin, Xuan-Shen, Mai-Men-Dong, and Sheng-Di-Huang are among the most frequently used combinations.