title: Evidence-based toxicity evaluation and scheduling of Chinese herbal medicines.
abstract: BACKGROUND
  While there is an increasing number of toxicity report cases and toxicological studies on Chinese herbal medicines, the guidelines for toxicity evaluation and scheduling of Chinese herbal medicines are lacking.
  
  
  OBJECTIVE
  The aim of this study was to review the current literature on potentially toxic Chinese herbal medicines, and to develop a scheduling platform which will inform an evidence-based regulatory framework for these medicines in the community.
  
  
  METHODS
  The Australian and Chinese regulations were used as a starting point to compile a list of potentially toxic herbs. Systematic literature searches of botanical and pharmaceutical Latin name, English and Chinese names and suspected toxic chemicals were conducted on Medline, PubMed and Chinese CNKI databases.
  
  
  RESULTS
  Seventy-four Chinese herbal medicines were identified and five of them were selected for detailed study. Preclinical and clinical data were summarised at six levels. Based on the evaluation criteria, which included risk-benefit analysis, severity of toxic effects and clinical and preclinical data, four regulatory classes were proposed: Prohibited for medicinal usage, which are those with high toxicity and can lead to injury or death, e.g., aristolochia; Restricted for medicinal usage, e.g., aconite, asarum, and ephedra; Required warning label, e.g., coltsfoot; and Over-the-counter herbs for those herbs with a safe toxicity profile.
  
  
  CONCLUSIONS
  Chinese herbal medicines should be scheduled based on a set of evaluation criteria, to ensure their safe use and to satisfy the need for access to the herbs. The current Chinese and Australian regulation of Chinese herbal medicines should be updated to restrict the access of some potentially toxic herbs to Chinese medicine practitioners who are qualified through registration.
authors.affiliation: Faculty of Pharmacy, The University of Sydney, Sydney, NSW 2006, Australia.
authors.forename: Ellie J Y
authors.initials: EJ
authors.lastname: Kim
authors.forename: Yuling
authors.initials: Y
authors.lastname: Chen
authors.forename: Johnson Q
authors.initials: JQ
authors.lastname: Huang
authors.forename: Kong M
authors.initials: KM
authors.lastname: Li
authors.forename: Valentina
authors.initials: V
authors.lastname: Razmovski-Naumovski
authors.forename: Josiah
authors.initials: J
authors.lastname: Poon
authors.forename: Kelvin
authors.initials: K
authors.lastname: Chan
authors.forename: Basil D
authors.initials: BD
authors.lastname: Roufogalis
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: McLachlan
authors.forename: Sui-Lin
authors.initials: SL
authors.lastname: Mo
authors.forename: Depo
authors.initials: D
authors.lastname: Yang
authors.forename: Meicun
authors.initials: M
authors.lastname: Yao
authors.forename: Zhaolan
authors.initials: Z
authors.lastname: Liu
authors.forename: Jianping
authors.initials: J
authors.lastname: Liu
authors.forename: George Q
authors.initials: GQ
authors.lastname: Li
mesh_terms: D000818:Animals; D001315:Australia; D002681:China; D004348:Drug Labeling; D004365:Drugs, Chinese Herbal / Q000145:classification / Q000592:standards / Q000633:toxicity*; D006801:Humans; D007880:Legislation, Drug; D008516:Medicine, Chinese Traditional; D010946:Plants, Medicinal / Q000145:classification / Q000633:toxicity*; D018675:Toxicity Tests
chemical_list: D004365:Drugs, Chinese Herbal