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Integrated Therapy in the Management of IgG4-Related Disease:

Mechanisms, Evidence, and Clinical Perspectives

Ching-Mao Chang* ,1,2,3

1 Division of Integrative Medicine, Center for Traditional Medicine, Taipei Veterans General
Hospital, Taipei, Taiwan
2 School of Chinese Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
3 Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

* E-mail: magicbjp@gmail.com

Abstract
Immunoglobulin G4–related disease (IgG4-RD) is a systemic fibroinflammatory disorder
that can involve multiple organs, often requiring long-term corticosteroid therapy. Relapse,
treatment-related adverse effects, and the absence of curative options highlight the need for

complementary or alternative therapeutic strategies. Integrated therapy combining conventional
medicine with Chinese herbal medicine (CHM) may offer immunomodulatory benefits by
targeting cytokine pathways implicated in IgG4-RD pathogenesis. We reviewed current
literature on the mechanisms and clinical applications of CHM in immune-mediated diseases,

focusing on cytokine modulation, NF-κB pathway inhibition, and Th1/Th2 balance restoration.
A representative case of IgG4-related sclerosing mesenteritis treated with corticosteroids and
CHM at Taipei Veterans General Hospital was presented to illustrate clinical application.
Literature evidence suggests that CHM components such as berberine, tanshinone IIA,

paeoniflorin, and taraxacum extracts can downregulate IL-4, IL-6, IL-10, and IL-13, inhibit
NF-κB activation, and modulate Treg and Th2 responses. In the presented case, integrated
therapy led to a reduction in serum IgG4 from 1560 mg/dL to 180 mg/dL, accompanied by
marked clinical improvement. Continued CHM treatment further decreased the serum IgG4

concentration to 68 mg/dL, with sustained symptom remission, radiological resolution, and no
need for corticosteroid reintroduction. These findings suggest that integrated therapy may serve
as a viable adjunct in IgG4-RD management by modulating pathogenic immune pathways and
enabling corticosteroid tapering, and further mechanistic studies and controlled clinical trials

are warranted to confirm efficacy, define optimal CHM formulations, and assess long-term
safety.

Keywords: IgG4-related disease; Traditional Chinese Medicine; Chinese herbal medicine;
Berberine; Tanshinone IIA; Paeoniflorin; Taraxacum extracts

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