Monday, January 5, 2015

Traditional Chinese Medicine and herbal hepatotoxicity: a tabular compilation of reported cases.

Ann Hepatol. 2015 Jan-Feb;14(1):7-19.

Traditional Chinese Medicine and herbal hepatotoxicity: a tabular compilation of reported cases.

Teschke R1, Zhang L2, Long H3, Schwarzenboeck A1, Schmidt-Taenzer W1, Genthner A1, Wolff A4, Frenzel C5, Schulze J6, Eickhoff A1.

Author information
1Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/ Main, Germany. 2Center for Drug Reevaluation, China Food and Drug Administration, Beijing, China.
3Department of Internal Medicine, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China. 4Department of Internal Medicine II, Division of Gastroenterology, Hepatology and Infectious Diseases, Friedrich Schiller University Jena, Germany. 5Department of Medicine I, University Medical Center Hamburg Eppendorf, Germany. 6Institute of Industrial, Environmental and Social Medicine, Medical Faculty of the Goethe University Frankfurt/Main, Germany.

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Traditional Chinese Medicine (TCM) with its focus on herbal use became popular worldwide. Treatment was perceived as safe, with neglect of rare adverse reactions including liver injury. To compile worldwide cases of liver injury by herbal Traditional Chinese Medicine (TCM), we undertook a selective literature search in the PubMed database and searched for the items Traditional Chinese Medicine, TCM, Traditional Asian Medicine, and Traditional Oriental Medicine, also combined with the terms herbal hepatotoxicity or herb induced liver injury. 

The search focused primarily on English-language case reports, case series, and clinical reviews. We identified reported hepatotoxicity cases in 77 relevant publications with 57 different herbs and herbal mixtures of TCM, which were further analyzed for causality by the Council for International Organizations of Medical Sciences (CIOMS) scale, positive reexposure test results, or both. 

Causality was established for 28/57 different herbs or herbal mixtures, 
Bai Xian Pi, Bo He, Ci Wu Jia, Chuan Lian Zi, Da Huang, Gan Cao, Ge Gen, Ho Shou Wu, Huang Qin, Hwang Geun Cho, Ji Gu Cao, Ji Xue Cao, Jin Bu Huan, Jue Ming Zi, Jiguja, Kudzu, Ling Yang Qing Fei Keli, Lu Cha, Rhen Shen, Ma Huang, Shou Wu Pian, Shan Chi, Shen Min, Syo Saiko To, Xiao Chai Hu Tang, Yin Chen Hao, Zexie, and Zhen Chu Cao. 

In conclusion, this compilation of liver injury cases establishes causality for 28/57 different Traditional Chinese Medicine (TCM) herbs and herbal mixtures, aiding diagnosis for physicians who care for patients with liver disease possibly related to herbal Traditional Chinese Medicine (TCM).

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