The research, led by scientists at the Korea Research Institute of Bioscience and Biotechnology together with colleagues at Hanyang University ERICA and Dong-A University, set out to answer a deceptively simple question: how much of the plant’s nutritional and antioxidant value depends on when it is picked and where it is grown? To find out, the team cultivated G. affine under two different cultivation environments and sampled it at multiple growth stages, then subjected every sample to ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry, a technique abbreviated as UPLC-QTOF/MS. This platform allows researchers to detect and tentatively identify hundreds of small molecules in a single run, generating a chemical fingerprint of each sample that can be compared statistically across conditions.

In total, the team annotated fifty metabolites, and from that pool they isolated eight compounds through successive chromatographic separations, determining their structures using nuclear magnetic resonance spectroscopy and mass spectrometry. This is a crucial step that many metabolomics studies skip. Untargeted profiling can suggest what a compound might be, but only isolation and structural elucidation provide certainty about identity. By purifying these eight molecules, the researchers created their own reference standards, which they then used to build a targeted high-performance liquid chromatography method with diode-array detection, or HPLC-DAD, capable of precisely quantifying the most important constituents in any sample of the plant.

The analytical performance of that quantification method was rigorous. Calibration curves showed excellent linearity, with coefficients of determination of at least 0.999 across the tested ranges, and detection limits fell between 0.671 and 1.088 micrograms per milliliter. In practical terms, this means the method can reliably detect and measure even trace amounts of the key bioactive compounds, making it suitable for quality control in food and nutraceutical manufacturing, where batch-to-batch consistency is essential and regulatory standards demand validated analytical procedures.

To make sense of the enormous datasets generated by untargeted metabolomics, the researchers turned to chemometrics, the statistical analysis of chemical data. Principal component analysis, or PCA, provided an unbiased overview of the variation, and it revealed that the metabolite profiles of G. affine were shaped by both growth stage and cultivation environment. Samples clustered according to how mature the plants were and where they had been grown, indicating that these two factors leave distinct chemical signatures in the plant tissue. A second, supervised method, partial least squares discriminant analysis, or PLS-DA, sharpened the picture further, showing particularly clear separation between samples from the two cultivation environments. Supervised models like PLS-DA actively search for the variables that best distinguish predefined groups, so the strong discrimination confirmed that growing conditions exert a powerful and consistent influence on the plant’s secondary chemistry.

The compounds driving that discrimination belonged overwhelmingly to two chemical families: phenylpropanoids and flavonoids. Within these broad classes, three subgroups stood out as the main discriminatory metabolites. Caffeoylquinic acid derivatives, which arise when caffeic acid is esterified with quinic acid, are well-known phenolic compounds with documented antioxidant and anti-inflammatory activities in the food science literature. Quercetin glycosides and luteolin glycosides, meanwhile, are sugar-conjugated forms of two of the most studied plant flavonoids, molecules that plants typically produce as protective agents against ultraviolet radiation, herbivores, and oxidative stress. That these particular compounds dominated the statistical separation suggests that the plant’s defensive chemistry is highly sensitive to both its developmental program and its growing environment.

The functional consequences of these chemical shifts were confirmed by classical assays. The researchers measured total phenolic content and total flavonoid content across all samples, alongside antioxidant capacity tests. Both the phytochemical contents and the antioxidant activities varied significantly across growth stages and between the two cultivation environments, mirroring the metabolomic patterns. Most notably, samples grown in the open field showed increased phenolic contents and enhanced ABTS radical-scavenging activity at later growth stages under the conditions examined. The ABTS assay works by measuring a sample’s ability to neutralize a synthetic green-colored radical cation, providing a rapid proxy for antioxidant capacity. The finding that open-field plants became chemically richer as they matured is consistent with a well-established principle in plant physiology: environmental stresses such as full sunlight exposure tend to stimulate the phenylpropanoid and flavonoid pathways, prompting plants to accumulate protective phenolic compounds.

For the food and nutraceutical industries, these results carry immediate practical weight. G. affine is already consumed as a food and medicinal plant valued for its nutritional and bioactive properties, but like many botanical raw materials, its chemical quality can fluctuate dramatically depending on agronomic choices. The study demonstrates that harvest timing and cultivation system are not minor variables but primary determinants of the plant’s functional value. A processor seeking maximum phenolic content and antioxidant activity, for example, now has evidence-based guidance pointing toward open-field cultivation and later growth stages under the conditions tested. Conversely, the detailed metabolite maps allow manufacturers to verify that incoming plant material meets expected chemical specifications, using the validated HPLC-DAD method as a quality gate.

Scientifically, the work also illustrates the power of combining untargeted and targeted approaches. Untargeted metabolomics excels at discovery, revealing unexpected patterns and flagging candidate biomarkers, but it produces tentative identifications that require confirmation. By following up with isolation, structural elucidation, and targeted quantification using purified reference standards, the Korean team closed the loop from pattern to proof. The fifty annotated metabolites and eight fully characterized compounds now constitute a chemical library for G. affine that future researchers can build upon, whether they are investigating the plant’s bioactivity, breeding improved cultivars, or optimizing cultivation protocols for industrial production.

The broader significance extends beyond a single species. As consumer demand for plant-based functional foods grows, the industry increasingly needs rigorous, systems-level data on how agricultural practices shape phytochemical quality. This study offers a template: profile broadly, discriminate statistically, isolate the key players, quantify them precisely, and connect the chemistry to measurable biological function. Applied to G. affine, that template transformed a traditional spring vegetable into a chemically characterized functional food candidate, and the authors conclude that their findings support the plant as a promising resource for future nutraceutical applications. For a plant that has quietly flavored festival rice cakes for centuries, modern metabolomics has finally revealed just how much its chemistry depends on the sun, the soil, and the season.

Subject of Research: Metabolomic profiling of secondary metabolites in Gnaphalium affine across growth stages and cultivation systems

Article Title: Comparative metabolomic characterization of secondary metabolites in Gnaphalium affine D. Don considering the influence of growth stages and cultivation systems

Article References: Hong, S., Lee, H. G., Oh, S. M., Kim, H.-G., An, Y. M., Lee, S.-Y., Kim, D.-Y., Oh, S.-R., Kim, C. Y., Lee, J. H., & Ryu, H. W. (2026). Comparative metabolomic characterization of secondary metabolites in Gnaphalium affine D. Don considering the influence of growth stages and cultivation systems. npj Science of Food. https://doi.org/10.1038/s41538-026-01194-8

Image Credits: AI Generated

DOI: 10.1038/s41538-026-01194-8

Keywords: Gnaphalium affine, metabolomics, secondary metabolites, flavonoids, phenylpropanoids, caffeoylquinic acid, quercetin glycosides, luteolin glycosides, antioxidant activity, cultivation systems, UPLC-QTOF/MS, functional food

The research, published as an open-access article in BMC Complementary Medicine and Therapies, was conducted by a team of Korean medicine researchers led by Ji-eun Yu of Pusan National University and Yohan Choi, Hanbit Jin, Eunji Ahn and corresponding author Dongsu Kim of Dongshin University. Rather than running a clinical trial, the investigators turned to one of the most powerful tools available in Korean health research: the National Health Insurance Service National Sample Cohort, a large, de-identified database drawn from the claims records of the country’s single-payer health system. Because virtually every medical encounter in South Korea generates an insurance claim, this cohort allows researchers to track diagnoses, prescriptions and healthcare visits across millions of citizens with a completeness that few other data sources can match.

The study design was a retrospective cohort analysis. The researchers identified patients diagnosed with gastric cancer and assigned each person an index date anchored to that diagnosis. They then looked backward one year to characterize each patient’s baseline healthcare utilization, including total outpatient visits, and forward one year to measure outcomes. Patients were classified as Korean medicine users if they received outpatient Korean medicine services during the defined exposure window; everyone else was treated as a non-user. This distinction matters because Korean medicine in South Korea is not a fringe practice. It encompasses herbal medicine prescriptions, acupuncture, moxibustion and other therapies delivered by licensed practitioners in dedicated clinics, and it occupies a formal, regulated place in the national health system.

The outcomes the team examined came in two distinct forms, and that distinction turned out to be the intellectual heart of the paper. The first outcome was binary: whether a patient used any analgesics, or any opioids, at all during the follow-up year, recorded simply as yes or no. The second outcome was a count: the number of analgesic prescriptions and the number of opioid prescriptions each patient received over the same period. Separating these two measures allowed the researchers to ask two different questions. Does Korean medicine change whether a cancer patient ends up on pain medication? And does it change how much pain medication that patient receives?

To answer those questions credibly, the investigators had to confront a stubborn methodological problem that plagues nearly all observational research on complementary therapies: confounding by indication and by healthcare behavior. Patients who seek out Korean medicine are, almost by definition, different from those who do not. They tend to be heavier users of healthcare in general, they may have different symptom profiles, and they may hold different attitudes toward medication. If those differences are not accounted for, any apparent association between Korean medicine and painkiller use could simply reflect the underlying characteristics of the patients rather than any effect of the treatment itself.

The team addressed this with multivariable regression analyses that adjusted for a broad set of demographic and clinical characteristics, including measures of healthcare utilization in the year before the index date. They went further, running sensitivity analyses with stricter definitions of what counted as Korean medicine use, to test whether the results depended on how liberally the exposure was defined. They also performed stratified analyses, dividing the cohort into quartiles of total outpatient visits during the exposure window and re-examining the association within each stratum. Supplementary tables in the published article document the ATC codes used to define analgesics and opioids, the distribution of annual prescription counts, and the model-based predicted outcomes for each group, giving readers an unusually transparent view of the analytical machinery behind the headline findings.

What emerged was a nuanced and, in some ways, counterintuitive result. Korean medicine use was not significantly associated with the likelihood that a gastric cancer patient would use analgesics or opioids at all during follow-up. In other words, patients who used Korean medicine were not meaningfully more or less likely than non-users to end up taking pain medication in the first place. But when the researchers turned to the intensity of medication use, a different picture appeared. In the adjusted analyses, Korean medicine use was associated with significantly lower prescription counts for both analgesics and opioids. The association was with the volume of prescribing, not the presence of prescribing.

The authors interpret this pattern as suggesting that Korean medicine may play a complementary role in medication-based pain management, one that operates on the medication burden rather than on whether medication is used. For patients living with cancer, that distinction could carry real clinical weight. Long-term analgesic and opioid use is associated with a cascade of concerns, including adverse drug events, drug interactions with chemotherapy agents, constipation, sedation and the risk of dependence. If a complementary therapy were to reduce the number of prescriptions a patient needs over a year of care, even without eliminating the need for pain drugs entirely, it could meaningfully lighten that pharmacological load. The stratified analyses, which examined the association within quartiles of prior outpatient visit intensity, were designed in part to check whether this signal simply reflected differences in how often patients see doctors, and the sensitivity analyses using stricter exposure definitions tested the robustness of the classification itself.

At the same time, the researchers are careful about what their study can and cannot show. As a retrospective analysis of insurance claims, it captures associations, not causal effects. It cannot reveal whether patients used Korean medicine because their pain was already better controlled, whether herbal prescriptions or acupuncture directly modulated pain, or whether unmeasured differences between user and non-user groups still shaped the results. Claims data also record prescriptions, not necessarily consumption, and they cannot capture over-the-counter medication use. The authors explicitly call for further studies to confirm the findings and to elucidate the underlying mechanisms, a caution that is standard in this field but particularly warranted given the complexity of cancer pain and the heterogeneity of Korean medicine practice itself.

Nevertheless, the study adds a genuinely useful data point to an international conversation about integrative oncology and opioid stewardship. Conducted under the Declaration of Helsinki with approval from the Institutional Review Board of Dongshin University, and funded by the Korea Health Industry Development Institute through grants from the Ministry of Health and Welfare, it exemplifies the kind of large-scale, claims-based evidence that health systems with integrated traditional medicine can generate. For the growing number of gastric cancer patients who already use Korean medicine alongside conventional care, the findings suggest that such use is associated with a lighter prescription burden rather than a change in whether painkillers are used at all. For policymakers weighing how complementary therapies fit into cancer care pathways, the message is subtler: the value of traditional medicine in this context may lie not in replacing conventional analgesia, but in reducing how much of it patients ultimately need. Confirming that promise will require prospective studies, but this analysis provides a rigorous starting point built on national-scale data.

Subject of Research: The association between traditional Korean medicine use and analgesic and opioid utilization in gastric cancer patients

Article Title: Association between Korean medicine use and analgesic and opioid utilization among patients with gastric cancer

Article References: Yu, J.-E., Choi, Y., Jin, H., Ahn, E., & Kim, D. (2026). Association between Korean medicine use and analgesic and opioid utilization among patients with gastric cancer. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05583-0

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05583-0

Keywords: Korean medicine, gastric cancer, analgesics, opioids, pain management, complementary and alternative medicine, National Health Insurance Service, retrospective cohort study, prescription counts, integrative oncology, healthcare utilization, South Korea

The retrospective descriptive study, conducted by Mikyung Kim and Dong-jun Choi of the Department of Internal Medicine and the Regional Pharmacovigilance Center for Korean Herbal Medicines, mined the shared adverse event reporting databases of the two hospitals. After removing duplicates, the researchers identified 454 reports in which an herbal medicine was recorded as the suspected agent. That figure represents just 1.2 percent of the 38,367 adverse event reports handled by the centers over the entire study period, a proportion that itself hints at how rarely herbal products are formally flagged as suspected causes of harm even in institutions where they are prescribed routinely.

The most striking finding concerns the regulatory status of the products involved. Non-licensed oral herbal medicines accounted for the largest share of suspected agents at 48.7 percent, narrowly exceeding the 47.0 percent share of oral herbal medicine products licensed by Korea’s Ministry of Food and Drug Safety. At the report level, 51.3 percent of cases involved at least one non-licensed formulation. These are preparations that fall outside the standard regulatory licensing pathway, including individualized herbal decoctions compounded for specific patients, and they are precisely the products that national databases built around licensed pharmaceuticals are least equipped to track.

The clinical profile of the reported events followed recognizable patterns. Gastrointestinal disorders were the most frequently reported system organ class, classified according to the Medical Dictionary for Regulatory Activities, followed by skin and subcutaneous tissue disorders. Among the 572 drug-event pairs with evaluable causality assessments, the overwhelming majority, 87.7 percent, were judged merely possible, while cases assessed as certain were vanishingly rare at 0.2 percent. That distribution reflects a familiar limitation of spontaneous reporting: without rechallenge or unambiguous temporal and biological evidence, causality in herbal medicine cases usually remains provisional, complicated by polypharmacy, delayed onset, and the multi-component nature of herbal formulas.

The surveillance gap emerges most clearly when the researchers compared reports that were forwarded to the national system with those that were not. Overall, 24.0 percent of the 454 reports were never submitted to national pharmacovigilance. The differences between the two groups were stark and statistically significant. Non-submitted reports far more frequently involved non-licensed herbal medicines, at 83.5 percent compared with 41.2 percent of submitted reports. They were far less likely to include documented clinical severity grading, at 7.3 percent versus 59.1 percent, and far less likely to contain a causality assessment, at 26.6 percent versus 98.8 percent, with p values below 0.001 across all three comparisons.

In other words, the reports most likely to slip through the cracks were those describing the products least visible to regulators, and those least complete in the clinical detail that pharmacovigilance assessment depends on. Severity grading in the study followed the Common Terminology Criteria for Adverse Events, the standardized scale used in oncology and increasingly across drug safety work, while causality was evaluated within the framework of individual case safety reports submitted through Korea’s adverse event reporting infrastructure. A report lacking both a severity grade and a causality judgment offers national assessors little to work with, which may partly explain why incomplete cases were not prioritized for submission.

The structural reasons behind the gap are not difficult to infer from the Korean context. Traditional Korean medicine doctors routinely prescribe individualized multi-herb decoctions that are compounded fresh for each patient. These formulations do not carry product licenses in the way manufactured drugs do, so they sit awkwardly within a reporting system whose data structures, coding conventions, and regulatory workflows were designed around licensed medicinal products. A suspected reaction to a ten-herb decoction does not map neatly onto a single product code, and the paper’s authors argue that the current pharmacovigilance framework therefore does not fully capture the range of herbal medicines actually used in real-world Korean practice.

The study’s setting gives its findings particular weight. Dongguk University Ilsan Oriental Hospital hosts a regional pharmacovigilance center specifically dedicated to Korean herbal medicines, one of the institutional mechanisms Korea has built to strengthen reporting from the traditional medicine sector. If, even at a center with dedicated reporting infrastructure, a quarter of herbal adverse event reports failed to reach the national system and half involved non-licensed formulations, the authors suggest that the true blind spots in less specialized settings are likely to be larger. Fifteen years of data also lend temporal depth, spanning a period in which Korea expanded its pharmacovigilance networks and electronic reporting systems considerably.

The methodological caveats are worth noting. This was a single-center retrospective descriptive analysis, so the absolute numbers and proportions cannot be generalized to the whole country, and spontaneous reporting data inherently capture only a fraction of adverse events that actually occur, with underreporting the norm rather than the exception across all drug classes. The study was exempted from full ethical review because it used de-identified data from previously collected reports. Still, the internal comparison between submitted and non-submitted reports is the analytically powerful part of the design, because both groups came from the same institutions over the same period, isolating the characteristics that predict whether a case enters national surveillance.

The authors’ conclusions point toward concrete reforms: broader surveillance coverage that explicitly encompasses non-licensed formulations, improved documentation of clinical severity and causality assessments at the point of reporting, and stronger reporting support for traditional Korean medicine professionals, who are often the first and only clinicians positioned to recognize a herbal adverse event. As herbal medicine use grows globally and integrative care models spread, the Korean experience offers a cautionary lesson for any country attempting to fold traditional formulations into regulatory safety systems built for licensed pharmaceuticals. A safety net with holes in exactly the places where the most-used products fall through is, the study implies, a net that needs reweaving.

Subject of Research: Herbal medicine adverse event reporting and pharmacovigilance surveillance gaps in traditional Korean medicine

Article Title: Real-world patterns of herbal medicine-related adverse event reports and surveillance gaps in national pharmacovigilance: a 15-year retrospective analysis from a single integrative medical center in Korea

Article References: Kim, M., & Choi, D.-J. (2026). Real-world patterns of herbal medicine-related adverse event reports and surveillance gaps in national pharmacovigilance: a 15-year retrospective analysis from a single integrative medical center in Korea. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05532-x

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05532-x

Keywords: pharmacovigilance, herbal medicine, adverse event reporting, traditional Korean medicine, drug safety, non-licensed formulations, spontaneous reporting, causality assessment, real-world data, Korea, integrative medicine, surveillance gap

The study, led by Ju Hee Kim and Jungbin Song with colleagues at CHA University, Kyung Hee University, and Korea University Guro Hospital, examined three herbal formulations: Bojungikgitang, Ijintang, and Cheongsanggyeontongtang. All three have long histories of symptomatic use in East Asian traditional medicine for cardiovascular and cerebrovascular conditions—precisely the patient populations most likely to be taking anticoagulants. The research team designed a fixed-sequence, two-period clinical trial in which healthy volunteers received a single 60-milligram dose of edoxaban alone, and then received the same dose after repeated dosing with one of the three herbal formulations. The design allowed each participant to serve in part as their own control, isolating the effect of the herbal co-administration from natural interindividual variability in drug handling.

Edoxaban is a direct factor Xa inhibitor, a member of the direct oral anticoagulant family that has largely displaced warfarin in many markets because it requires no routine monitoring and has fewer dietary interactions. Its disposition in the body, however, depends heavily on the efflux transporter P-glycoprotein and, to a lesser extent, on cytochrome P450 3A4 (CYP3A4) metabolism, which produces an active metabolite known as M4. This pharmacological profile makes edoxaban particularly vulnerable to interactions with drugs—and potentially herbal phytochemicals—that inhibit or induce P-glycoprotein or CYP3A4. Strong P-glycoprotein inhibitors such as quinidine and cyclosporine are already known to raise edoxaban levels, while inducers such as rifampin can slash them, and the edoxaban label reflects those established interactions.

To measure what the herbal formulations did to edoxaban, the researchers quantified plasma concentrations of both the parent drug and its active M4 metabolite using liquid chromatography coupled with tandem mass spectrometry, a gold-standard bioanalytical technique aligned with international ICH M10 validation guidance. Pharmacokinetic parameters—the area under the concentration-time curve, peak concentrations, and clearance measures—were compared between treatment periods using linear mixed-effects models, a statistical framework well suited to repeated-measures crossover designs. In parallel, the team assessed pharmacodynamic effects using prothrombin time and activated partial thromboplastin time, the two coagulation assays most commonly used to gauge anticoagulant intensity at the bedside. Finally, in laboratory experiments, the formulations were tested for their capacity to inhibit CYP3A4 activity in vitro.

The pharmacokinetic results were striking in their divergence. Bojungikgitang approximately doubled systemic exposure to edoxaban, effectively reproducing the magnitude of interaction seen with known strong P-glycoprotein inhibitors. At the other extreme, Cheongsanggyeontongtang reduced edoxaban exposure by roughly 40 percent—a reduction in the range that regulators associate with inducers of the drug’s clearance pathways and one that could, in theory, erode the anticoagulant’s protective effect against stroke. Ijintang, by contrast, exerted only minimal effects on the drug’s pharmacokinetic profile. The active metabolite M4 followed the same directional pattern as the parent compound in each case, indicating that the herbal formulations were shifting edoxaban’s overall systemic disposition rather than selectively rerouting its metabolism.

Perhaps the most provocative—and most cautionary—finding came from the pharmacodynamic measurements. Despite the substantial pharmacokinetic shifts, the researchers detected no significant changes in prothrombin time or activated partial thromboplastin time in any of the herbal co-administration groups. In other words, a patient’s exposure to edoxaban could double, or fall by 40 percent, while the standard laboratory coagulation tests remained essentially silent. This dissociation matters because clinicians sometimes lean on coagulation assays when concerns arise about anticoagulant intensity, and the results suggest those assays are poor sentinels for herb-driven changes in edoxaban levels. The therapeutic window of a drug, not the laboratory value alone, ultimately determines whether exposure changes translate into bleeding or thrombotic risk.

The mechanistic work offered clues about how the divergent effects arise. In vitro testing showed negligible inhibition of CYP3A4 by Bojungikgitang and Ijintang and only weak inhibition by Cheongsanggyeontongtang, indicating that direct CYP3A4 blockade is unlikely to explain the doubling of edoxaban exposure seen with Bojungikgitang. The more plausible culprit is interference with P-glycoprotein, the efflux pump that governs edoxaban’s intestinal absorption and biliary excretion. Many phytochemicals common in traditional formulas—including compounds found in ginseng, licorice, and astragalus, herbs represented in some of these formulations—have been shown in laboratory studies to modulate P-glycoprotein and CYP enzymes. The precise constituent responsible for the Bojungikgitang effect, however, remains to be pinned down, and the authors’ data do not permit attribution to a single botanical ingredient.

The clinical context amplifies the significance of the findings. Surveys of Korean medical hospital practice have documented frequent combination therapy between herbal extracts and antiplatelet or anticoagulant drugs in ischemic stroke patients, and Korean medicine clinical practice guidelines for stroke, developed under the National Institute for Korean Medicine Development, formalize herbal care pathways for the same patients who often need anticoagulation. Case reports from around the world have described increased bleeding in patients combining oral anticoagulants with herbal products ranging from saffron to Salvia miltiorrhiza, and St John’s wort has been shown to lower rivaroxaban exposure in controlled human studies. Meanwhile, cohort data have suggested that some concurrent Chinese herbal medicine use may even be associated with fewer major bleeding events, underscoring that the herb-drug interaction landscape is neither uniformly dangerous nor uniformly benign—it is formulation-specific, and largely unmapped.

That is precisely the gap this trial helps to fill. By testing three named, commercially supplied formulations under controlled conditions in healthy volunteers, and by measuring both drug levels and clotting outcomes with validated methods, the Korean team has converted a vague anxiety—herbs might interact with blood thinners—into concrete, quantifiable risk statements: Bojungikgitang approximately doubles edoxaban exposure, Cheongsanggyeontongtang cuts it by about 40 percent, Ijintang is relatively benign, and conventional coagulation tests will not warn you about any of it. The authors conclude that clinical consideration is warranted when edoxaban is combined with Bojungikgitang or Cheongsanggyeontongtang, and the magnitude of the observed changes supports that caution, situating both interactions on par with labeled drug-drug interactions of edoxaban.

Important caveats temper the translation to patient care. The study enrolled healthy volunteers, not the older, multimorbid patients with atrial fibrillation or venous thromboembolism who actually take edoxaban, and it could not assess hard clinical endpoints such as bleeding or stroke. Fixed-sequence designs and modest sample sizes, typical of exploratory interaction studies, also limit generalizability, and the duration of herbal pre-dosing may not capture longer-term induction or adaptation effects. Even so, the work delivers a clear, actionable message for prescribers, pharmacists, and practitioners of traditional medicine alike: herbal formulations are not pharmacologically inert companions to modern anticoagulants. Until larger outcome studies are done, patients taking edoxaban who also use Bojungikgitang or Cheongsanggyeontongtang deserve explicit attention, honest conversations about herbal supplement use, and a healthy skepticism toward coagulation tests that may not reveal what the body is actually doing.

Subject of Research: Herb-drug interactions between traditional Korean herbal formulations and the anticoagulant edoxaban

Article Title: Effects of Bojungikgitang, Ijintang, and Cheongsanggyeontongtang on the pharmacokinetics and pharmacodynamics of edoxaban

Article References: Kim, J. H., Song, J., Kim, M., Kim, H., Cho, H.-Y., & Chung, H. (2026). Effects of Bojungikgitang, Ijintang, and Cheongsanggyeontongtang on the pharmacokinetics and pharmacodynamics of edoxaban. Journal of Pharmaceutical Investigation. https://doi.org/10.1007/s40005-026-00828-z

Image Credits: AI Generated

DOI: 10.1007/s40005-026-00828-z

Keywords: edoxaban, herb-drug interaction, Bojungikgitang, Ijintang, Cheongsanggyeontongtang, pharmacokinetics, pharmacodynamics, direct oral anticoagulants, P-glycoprotein, CYP3A4, traditional Korean medicine, clinical trial