title: Traditional Chinese Medicine and herbal hepatotoxicity: a tabular compilation of reported cases.
abstract: 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 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 TCM herbs and herbal mixtures, aiding diagnosis for physicians who care for patients with liver disease possibly related to herbal TCM.
authors.affiliation: Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/ Main, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Teschke
authors.affiliation: Center for Drug Reevaluation, China Food and Drug Administration, Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Internal Medicine, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Hongzhu
authors.initials: H
authors.lastname: Long
authors.affiliation: Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/ Main, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Schwarzenboeck
authors.affiliation: Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/ Main, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schmidt-Taenzer
authors.affiliation: Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/ Main, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Genthner
authors.affiliation: Department of Internal Medicine II, Division of Gastroenterology, Hepatology and Infectious Diseases, Friedrich Schiller University Jena, Germany.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Wolff
authors.affiliation: Department of Medicine I, University Medical Center Hamburg Eppendorf, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Frenzel
authors.affiliation: Institute of Industrial, Environmental and Social Medicine, Medical Faculty of the Goethe University Frankfurt/Main, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Schulze
authors.affiliation: Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/ Main, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Eickhoff
mesh_terms: D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D006801:Humans; D008516:Medicine, Chinese Traditional; D008517:Phytotherapy / Q000009:adverse effects*
chemical_list: D004365:Drugs, Chinese Herbal