BANXIA / Pinellia as an hepatotoxin?

[Guest guest]

Hi All, & Aloha Ihor,

 

Aiba T,* Takahashi T,* Suzuki K,* Okoshi S,* Nomoto M,* Uno K + & Aoyagi

Y* (2007) CASE REPORT: Liver injury induced by a Japanese herbal

medicine, Sairei-to (TJ-114, Bupleurum and Hoelen Combination, Chai-Ling-

Tang). Journal of Gastroenterology and Hepatology 22(5):762-763. *Div of

Gastroenterology & Hepatology, Graduate School of Med & Dental Sci,

Niigata Univ, and + Dept of Pharmacy, Suibarago Hospital, Niigata, Japan.

Contact: Dr Toru Takahashi, Div of Gastroenterology & Hepatology,

Nagaoka Red Cross Hospital, 297-1, Terashimacho, Nagaoka 940-2085,

Niigata, Japan. torutoru A man showed acute hepatitis

with jaundice after taking a Japanese herbal medicine, Sairei-to (TJ-114,

Bupleurum and Hoelen Combination, Chai-Ling-Tang). Unusually, the

component thought to be responsible for the observed drug-induced liver

injury was identified. Lymphocyte migration inhibition testing indicated that

the tuber of the perennial herbage Pinellia ternate was the causative agent.

 

Apart from that paper, I can find no hits on Medline for BANXIA / Pinellia as

a hepatotoxin.

 

However, another paper (Hsu et al, below) reported acute hepatitis in 1

patient taking XIAOCHAIHU TANG (Japanese: Syo-Saiko-To).

 

Hsu L, Huang Y, Tsay S, Chang F & Lee S (2006) Acute Hepatitis Induced

by Chinese Hepatoprotective Herb, XIAOCHAIHU TANG. Journal of the

Chinese Medical Association 69(2): 86-88. XIAOCHAIHU TANG (Japanese:

Syo-Saiko-To) is a herbal remedy widely used in China to treat respiratory,

hepatobiliary, and gastrointestinal diseases, particularly among patients w

chronic liver disease. However, its safety has been challenged recently. We

report a Chinese patient w acute hepatitis induced by XCT. A 52-year-old

woman presented w weakness, fatigue, and tea-colored urine after continual

consumption of XCT for 1.5 months. Lab studies disclosed acute hepatitis

even though all of the viral hepatitis markers were negative. Liver biopsy

also revealed acute hepatocellular hepatitis. The symptoms improved after

discontinuing XCT, and liver biochemical tests normalized 2 months later.

The case report reminds us of the probable adverse drug reaction of herbs,

even in some that are claimed to have hepatoprotective effects.

 

Phil's Notes:

Note that CHAILING TANG + XIAOCHAIHU TANG contain BANXIA; they

also contain 6 other Meds in common: Chaihu, Dangshen / Renshen,

Dazao; Gancao / Zhigancao; Huangqin; Shengjiang.

IMO, none of the latter Meds would be hepatotoxic at normal doses.

 

IMO, because BANXIA is used widely in Chinese + Kampo Med, and

because there are so few reports in medical journals of BANXIA

hepatotoxicity, we can conclude that it is GRAS (generally regarded as

safe).

 

However, we might be wise to omit BANXIA (or reduce its inclusion rate) in

patients in which we suspect pre-existing LV damage. Also, we should

ensure that we AVOID using RAW BANXIA (viz, use ONLY the

PROCESSED form).

 

TCMAssistant [ www.tcmassistant.com/ ] says:

CHAILING TANG; Bupleurum + Poria / Hoelen Dec;

Class: Dispel Damp; Subclass: Diuretic;

 

Chaihu (Rx Bupleuri) 13.00 %

BANXIA (Rz Pinelliae Ternatae) 11.00 %

Shengjiang (Rz Zingiberis Officinalis Recens) 11.00 %

Zexie (Rz Alismatis Orientalis) 11.00 %

Fuling (Sclerotium Poriae Cocos) 7.00 %

Zhuling (Sclerotium Polypori Umbellati) 7.00 %

Baizhu (Rz Atractylodis Macrocephalae) 7.00 %

Guizhi (Rml Cinnamomi Cassiae) 7.00 %

Renshen (Rx Ginseng) 7.00 %

Huangqin (Rx Scutellariae Baicalensis) 7.00 %

Dazao (Fr Jujubae) 7.00 %

Zhigancao (Rx Glycyrrhizae Uralensis) 5.00 %

 

Dec: 60-70 g/L; simmer down to 400mL; take ??mL TID-QID;

Actions: Diuretic; Harmonise SJM

Indications: digestive disorders w injury to Body Fluids dt Exterior disorders~

persistent; SSs: acute gastroenteritis; diarrhoea; BL disorders; dysuria;

nephritis; oedema; thirst; LV disorders; infectious disease in summer;

 

Bob Flaws - http://tinyurl.com/yzb9tg8 - says:

XIAOCHAIHU TANG (Minor Bupleurum Dec) & Digestive Ulcers: 80 cases

of digestive ulcers, all diagnosed by gastroscopy + all positive for

Heliobacter pylori, were studied; patients had digestive ulcers for 0.5-1

years; main SSs included ST duct tension + pain, distension, oppression +

discomfort, burping/belching, acid eructation, HT Vexation, dry mouth w

bitter taste, torpid intake, depression + oppression w predilection to sighing;

Tx method: XIAOCHAIHU TANG:

Chaihu (Rx Bupleuri) 15g,

Huangqin (Rx Scutellariae) 12g,

Shengjiang (raw Rz Zingiberis) 6g,

BANXIA (Rz Pinelliae) 12g,

Dangshen (Rx Codonopsis) 12g,

Dazao (Fr Jujubae) 12g,

Gancao (Rx Glycyrrhizae) 3g;

Chaihu + Huangqin: Course + Resolve LV-GB Yu Heat;

Shengjiang + BANXIA: Harmonise ST + Descend Counterflow;

Renshen, Gancao + Dazao: Boost SP + Tone Xu;

Dec 1 packet; divide into 2 parts + take 1 part orally on empty ST, BID, for

15d / Tx course, for 5 continuous courses;

Formula acts to Course LV, Free SP + Cholagogue (Free GB), Rectify +

Harmonise SJM-SP-ST; thus these Meds and the Pattern correspond; thus

Tx effects are good

 

Indications: digestive ulcers mostly present as SJM-SP-ST Xu Pattern dt

enduring disease w emotional stress, oppression + unhappiness. Thus, it

relates to LV-GB Qiyu + LV Qi Not Coursing; then Wood Yu attacks Earth

(SJM-SP-ST), SP loses its fortification + movement, while Earth loses its

harmony + downbearing;

 

Modifications (Additions + Subtractions):

for rib-side distension + pain~ bilateral / pain radiating to loin / back~

upper,

add Chuanlianzi (Fr Toosendan) 10g + Yanhusuo (Rz Corydalis) 10g;

for depression + oppression w predilection to sighing, add Xiangfu (Rz

Cyperi) 12g;

for bitter taste in mouth, dry throat + HT Vexation, omit BANXIA + add

Huanglian (Rz Coptidis) 10g;

for nausea + acid eructation, add Haipiaoxiao (Os Sepiae / Sepiellae) 20g;

for ST duct distension + oppression, add Houpo (Cx Magnoliae) 10g +

Sugeng (Caulis Perillae) 10g;

 

Best regards,

 

 

 

 

[Guest guest]

Although I read the " lymphocyte migration inhibition testing " showed Ban Xia

the culprit, I wonder if it is not Chai Hu causing these problems. In the one

hospital I studied they tended to stay away from Chai Hu in most liver issue

patients as being damaging.

Doug

 

 

, " " < wrote:

>

> Hi All, & Aloha Ihor,

>

> Aiba T,* Takahashi T,* Suzuki K,* Okoshi S,* Nomoto M,* Uno K + & Aoyagi

> Y* (2007) CASE REPORT: Liver injury induced by a Japanese herbal

> medicine, Sairei-to (TJ-114, Bupleurum and Hoelen Combination, Chai-Ling-

> Tang). Journal of Gastroenterology and Hepatology 22(5):762-763. *Div of

> Gastroenterology & Hepatology, Graduate School of Med & Dental Sci,

> Niigata Univ, and + Dept of Pharmacy, Suibarago Hospital, Niigata, Japan.

> Contact: Dr Toru Takahashi, Div of Gastroenterology & Hepatology,

> Nagaoka Red Cross Hospital, 297-1, Terashimacho, Nagaoka 940-2085,

> Niigata, Japan. torutoru A man showed acute hepatitis

> with jaundice after taking a Japanese herbal medicine, Sairei-to (TJ-114,

> Bupleurum and Hoelen Combination, Chai-Ling-Tang). Unusually, the

> component thought to be responsible for the observed drug-induced liver

> injury was identified. Lymphocyte migration inhibition testing indicated that

> the tuber of the perennial herbage Pinellia ternate was the causative agent.

>

> Apart from that paper, I can find no hits on Medline for BANXIA / Pinellia as

> a hepatotoxin.

>

> However, another paper (Hsu et al, below) reported acute hepatitis in 1

> patient taking XIAOCHAIHU TANG (Japanese: Syo-Saiko-To).

>

> Hsu L, Huang Y, Tsay S, Chang F & Lee S (2006) Acute Hepatitis Induced

> by Chinese Hepatoprotective Herb, XIAOCHAIHU TANG. Journal of the

> Chinese Medical Association 69(2): 86-88. XIAOCHAIHU TANG (Japanese:

> Syo-Saiko-To) is a herbal remedy widely used in China to treat respiratory,

> hepatobiliary, and gastrointestinal diseases, particularly among patients w

> chronic liver disease. However, its safety has been challenged recently. We

> report a Chinese patient w acute hepatitis induced by XCT. A 52-year-old

> woman presented w weakness, fatigue, and tea-colored urine after continual

> consumption of XCT for 1.5 months. Lab studies disclosed acute hepatitis

> even though all of the viral hepatitis markers were negative. Liver biopsy

> also revealed acute hepatocellular hepatitis. The symptoms improved after

> discontinuing XCT, and liver biochemical tests normalized 2 months later.

> The case report reminds us of the probable adverse drug reaction of herbs,

> even in some that are claimed to have hepatoprotective effects.

>

> Phil's Notes:

> Note that CHAILING TANG + XIAOCHAIHU TANG contain BANXIA; they

> also contain 6 other Meds in common: Chaihu, Dangshen / Renshen,

> Dazao; Gancao / Zhigancao; Huangqin; Shengjiang.

> IMO, none of the latter Meds would be hepatotoxic at normal doses.

>

> IMO, because BANXIA is used widely in Chinese + Kampo Med, and

> because there are so few reports in medical journals of BANXIA

> hepatotoxicity, we can conclude that it is GRAS (generally regarded as

> safe).

>

> However, we might be wise to omit BANXIA (or reduce its inclusion rate) in

> patients in which we suspect pre-existing LV damage. Also, we should

> ensure that we AVOID using RAW BANXIA (viz, use ONLY the

> PROCESSED form).

>

> TCMAssistant [ www.tcmassistant.com/ ] says:

> CHAILING TANG; Bupleurum + Poria / Hoelen Dec;

> Class: Dispel Damp; Subclass: Diuretic;

>

> Chaihu (Rx Bupleuri) 13.00 %

> BANXIA (Rz Pinelliae Ternatae) 11.00 %

> Shengjiang (Rz Zingiberis Officinalis Recens) 11.00 %

> Zexie (Rz Alismatis Orientalis) 11.00 %

> Fuling (Sclerotium Poriae Cocos) 7.00 %

> Zhuling (Sclerotium Polypori Umbellati) 7.00 %

> Baizhu (Rz Atractylodis Macrocephalae) 7.00 %

> Guizhi (Rml Cinnamomi Cassiae) 7.00 %

> Renshen (Rx Ginseng) 7.00 %

> Huangqin (Rx Scutellariae Baicalensis) 7.00 %

> Dazao (Fr Jujubae) 7.00 %

> Zhigancao (Rx Glycyrrhizae Uralensis) 5.00 %

>

> Dec: 60-70 g/L; simmer down to 400mL; take ??mL TID-QID;

> Actions: Diuretic; Harmonise SJM

> Indications: digestive disorders w injury to Body Fluids dt Exterior

disorders~

> persistent; SSs: acute gastroenteritis; diarrhoea; BL disorders; dysuria;

> nephritis; oedema; thirst; LV disorders; infectious disease in summer;

>

> Bob Flaws - http://tinyurl.com/yzb9tg8 - says:

> XIAOCHAIHU TANG (Minor Bupleurum Dec) & Digestive Ulcers: 80 cases

> of digestive ulcers, all diagnosed by gastroscopy + all positive for

> Heliobacter pylori, were studied; patients had digestive ulcers for 0.5-1

> years; main SSs included ST duct tension + pain, distension, oppression +

> discomfort, burping/belching, acid eructation, HT Vexation, dry mouth w

> bitter taste, torpid intake, depression + oppression w predilection to

sighing;

> Tx method: XIAOCHAIHU TANG:

> Chaihu (Rx Bupleuri) 15g,

> Huangqin (Rx Scutellariae) 12g,

> Shengjiang (raw Rz Zingiberis) 6g,

> BANXIA (Rz Pinelliae) 12g,

> Dangshen (Rx Codonopsis) 12g,

> Dazao (Fr Jujubae) 12g,

> Gancao (Rx Glycyrrhizae) 3g;

> Chaihu + Huangqin: Course + Resolve LV-GB Yu Heat;

> Shengjiang + BANXIA: Harmonise ST + Descend Counterflow;

> Renshen, Gancao + Dazao: Boost SP + Tone Xu;

> Dec 1 packet; divide into 2 parts + take 1 part orally on empty ST, BID, for

> 15d / Tx course, for 5 continuous courses;

> Formula acts to Course LV, Free SP + Cholagogue (Free GB), Rectify +

> Harmonise SJM-SP-ST; thus these Meds and the Pattern correspond; thus

> Tx effects are good

>

> Indications: digestive ulcers mostly present as SJM-SP-ST Xu Pattern dt

> enduring disease w emotional stress, oppression + unhappiness. Thus, it

> relates to LV-GB Qiyu + LV Qi Not Coursing; then Wood Yu attacks Earth

> (SJM-SP-ST), SP loses its fortification + movement, while Earth loses its

> harmony + downbearing;

>

> Modifications (Additions + Subtractions):

> for rib-side distension + pain~ bilateral / pain radiating to loin / back~

upper,

> add Chuanlianzi (Fr Toosendan) 10g + Yanhusuo (Rz Corydalis) 10g;

> for depression + oppression w predilection to sighing, add Xiangfu (Rz

> Cyperi) 12g;

> for bitter taste in mouth, dry throat + HT Vexation, omit BANXIA + add

> Huanglian (Rz Coptidis) 10g;

> for nausea + acid eructation, add Haipiaoxiao (Os Sepiae / Sepiellae) 20g;

> for ST duct distension + oppression, add Houpo (Cx Magnoliae) 10g +

> Sugeng (Caulis Perillae) 10g;

>

> Best regards,

>

>

>

>

[Guest guest]

Hi All, & Aloha Ihor,

 

Aiba T,* Takahashi T,* Suzuki K,* Okoshi S,* Nomoto M,* Uno K + & Aoyagi

Y* (2007) CASE REPORT: Liver injury induced by a Japanese herbal

medicine, Sairei-to (TJ-114, Bupleurum and Hoelen Combination, Chai-Ling-

Tang). Journal of Gastroenterology and Hepatology 22(5):762-763. *Div of

Gastroenterology & Hepatology, Graduate School of Med & Dental Sci,

Niigata Univ, and + Dept of Pharmacy, Suibarago Hospital, Niigata, Japan.

Contact: Dr Toru Takahashi, Div of Gastroenterology & Hepatology,

Nagaoka Red Cross Hospital, 297-1, Terashimacho, Nagaoka 940-2085,

Niigata, Japan. torutoru A man showed acute hepatitis

with jaundice after taking a Japanese herbal medicine, Sairei-to (TJ-114,

Bupleurum and Hoelen Combination, Chai-Ling-Tang). Unusually, the

component thought to be responsible for the observed drug-induced liver

injury was identified. Lymphocyte migration inhibition testing indicated that

the tuber of the perennial herbage Pinellia ternate was the causative agent.

 

Apart from that paper, I can find no hits on Medline for BANXIA / Pinellia as

a hepatotoxin.

 

However, another paper (Hsu et al, below) reported acute hepatitis in 1

patient taking XIAOCHAIHU TANG (Japanese: Syo-Saiko-To).

 

Hsu L, Huang Y, Tsay S, Chang F & Lee S (2006) Acute Hepatitis Induced

by Chinese Hepatoprotective Herb, XIAOCHAIHU TANG. Journal of the

Chinese Medical Association 69(2): 86-88. XIAOCHAIHU TANG (Japanese:

Syo-Saiko-To) is a herbal remedy widely used in China to treat respiratory,

hepatobiliary, and gastrointestinal diseases, particularly among patients w

chronic liver disease. However, its safety has been challenged recently. We

report a Chinese patient w acute hepatitis induced by XCT. A 52-year-old

woman presented w weakness, fatigue, and tea-colored urine after continual

consumption of XCT for 1.5 months. Lab studies disclosed acute hepatitis

even though all of the viral hepatitis markers were negative. Liver biopsy

also revealed acute hepatocellular hepatitis. The symptoms improved after

discontinuing XCT, and liver biochemical tests normalized 2 months later.

The case report reminds us of the probable adverse drug reaction of herbs,

even in some that are claimed to have hepatoprotective effects.

 

Phil's Notes:

Note that CHAILING TANG + XIAOCHAIHU TANG contain BANXIA; they

also contain 6 other Meds in common: Chaihu, Dangshen / Renshen,

Dazao; Gancao / Zhigancao; Huangqin; Shengjiang.

IMO, none of the latter Meds would be hepatotoxic at normal doses.

 

IMO, because BANXIA is used widely in Chinese + Kampo Med, and

because there are so few reports in medical journals of BANXIA

hepatotoxicity, we can conclude that it is GRAS (generally regarded as

safe).

 

However, we might be wise to omit BANXIA (or reduce its inclusion rate) in

patients in which we suspect pre-existing LV damage. Also, we should

ensure that we AVOID using RAW BANXIA (viz, use ONLY the

PROCESSED form).

 

TCMAssistant [ www.tcmassistant.com/ ] says:

CHAILING TANG; Bupleurum + Poria / Hoelen Dec;

Class: Dispel Damp; Subclass: Diuretic;

 

Chaihu (Rx Bupleuri) 13.00 %

BANXIA (Rz Pinelliae Ternatae) 11.00 %

Shengjiang (Rz Zingiberis Officinalis Recens) 11.00 %

Zexie (Rz Alismatis Orientalis) 11.00 %

Fuling (Sclerotium Poriae Cocos) 7.00 %

Zhuling (Sclerotium Polypori Umbellati) 7.00 %

Baizhu (Rz Atractylodis Macrocephalae) 7.00 %

Guizhi (Rml Cinnamomi Cassiae) 7.00 %

Renshen (Rx Ginseng) 7.00 %

Huangqin (Rx Scutellariae Baicalensis) 7.00 %

Dazao (Fr Jujubae) 7.00 %

Zhigancao (Rx Glycyrrhizae Uralensis) 5.00 %

 

Dec: 60-70 g/L; simmer down to 400mL; take ??mL TID-QID;

Actions: Diuretic; Harmonise SJM

Indications: digestive disorders w injury to Body Fluids dt Exterior disorders~

persistent; SSs: acute gastroenteritis; diarrhoea; BL disorders; dysuria;

nephritis; oedema; thirst; LV disorders; infectious disease in summer;

 

Bob Flaws - http://tinyurl.com/yzb9tg8 - says:

XIAOCHAIHU TANG (Minor Bupleurum Dec) & Digestive Ulcers: 80 cases

of digestive ulcers, all diagnosed by gastroscopy + all positive for

Heliobacter pylori, were studied; patients had digestive ulcers for 0.5-1

years; main SSs included ST duct tension + pain, distension, oppression +

discomfort, burping/belching, acid eructation, HT Vexation, dry mouth w

bitter taste, torpid intake, depression + oppression w predilection to sighing;

Tx method: XIAOCHAIHU TANG:

Chaihu (Rx Bupleuri) 15g,

Huangqin (Rx Scutellariae) 12g,

Shengjiang (raw Rz Zingiberis) 6g,

BANXIA (Rz Pinelliae) 12g,

Dangshen (Rx Codonopsis) 12g,

Dazao (Fr Jujubae) 12g,

Gancao (Rx Glycyrrhizae) 3g;

Chaihu + Huangqin: Course + Resolve LV-GB Yu Heat;

Shengjiang + BANXIA: Harmonise ST + Descend Counterflow;

Renshen, Gancao + Dazao: Boost SP + Tone Xu;

Dec 1 packet; divide into 2 parts + take 1 part orally on empty ST, BID, for

15d / Tx course, for 5 continuous courses;

Formula acts to Course LV, Free SP + Cholagogue (Free GB), Rectify +

Harmonise SJM-SP-ST; thus these Meds and the Pattern correspond; thus

Tx effects are good

 

Indications: digestive ulcers mostly present as SJM-SP-ST Xu Pattern dt

enduring disease w emotional stress, oppression + unhappiness. Thus, it

relates to LV-GB Qiyu + LV Qi Not Coursing; then Wood Yu attacks Earth

(SJM-SP-ST), SP loses its fortification + movement, while Earth loses its

harmony + downbearing;

 

Modifications (Additions + Subtractions):

for rib-side distension + pain~ bilateral / pain radiating to loin / back~

upper,

add Chuanlianzi (Fr Toosendan) 10g + Yanhusuo (Rz Corydalis) 10g;

for depression + oppression w predilection to sighing, add Xiangfu (Rz

Cyperi) 12g;

for bitter taste in mouth, dry throat + HT Vexation, omit BANXIA + add

Huanglian (Rz Coptidis) 10g;

for nausea + acid eructation, add Haipiaoxiao (Os Sepiae / Sepiellae) 20g;

for ST duct distension + oppression, add Houpo (Cx Magnoliae) 10g +

Sugeng (Caulis Perillae) 10g;

 

Best regards,

 

 

 

 

[Guest guest]

From having extensive discussions on the topic of Hepatoxicity with Mazin, it

seems that the majority of incidences where by a patients liver enzymes became

elevated after ingesting herbs, were mostly idiosyncratic. Meaning they were one

off, unforeseen, incidences. Mazin has over ten thousand patients in his data

bank whose livers were monitored during treatments at his clinic, obviously a

massive piece of work. From what I understand Ban Xia, particularly in the

processed forms that we use, has never been an issue, nor has chai hu.

 

Trevor

 

 

, " " wrote:

>

> Although I read the " lymphocyte migration inhibition testing " showed Ban Xia

the culprit, I wonder if it is not Chai Hu causing these problems. In the one

hospital I studied they tended to stay away from Chai Hu in most liver issue

patients as being damaging.

> Doug

>

>

> , " " <@> wrote:

> >

> > Hi All, & Aloha Ihor,

> >

> > Aiba T,* Takahashi T,* Suzuki K,* Okoshi S,* Nomoto M,* Uno K + & Aoyagi

> > Y* (2007) CASE REPORT: Liver injury induced by a Japanese herbal

> > medicine, Sairei-to (TJ-114, Bupleurum and Hoelen Combination, Chai-Ling-

> > Tang). Journal of Gastroenterology and Hepatology 22(5):762-763. *Div of

> > Gastroenterology & Hepatology, Graduate School of Med & Dental Sci,

> > Niigata Univ, and + Dept of Pharmacy, Suibarago Hospital, Niigata, Japan.

> > Contact: Dr Toru Takahashi, Div of Gastroenterology & Hepatology,

> > Nagaoka Red Cross Hospital, 297-1, Terashimacho, Nagaoka 940-2085,

> > Niigata, Japan. torutoru@ A man showed acute hepatitis

> > with jaundice after taking a Japanese herbal medicine, Sairei-to (TJ-114,

> > Bupleurum and Hoelen Combination, Chai-Ling-Tang). Unusually, the

> > component thought to be responsible for the observed drug-induced liver

> > injury was identified. Lymphocyte migration inhibition testing indicated

that

> > the tuber of the perennial herbage Pinellia ternate was the causative agent.

> >

> > Apart from that paper, I can find no hits on Medline for BANXIA / Pinellia

as

> > a hepatotoxin.

> >

> > However, another paper (Hsu et al, below) reported acute hepatitis in 1

> > patient taking XIAOCHAIHU TANG (Japanese: Syo-Saiko-To).

> >

> > Hsu L, Huang Y, Tsay S, Chang F & Lee S (2006) Acute Hepatitis Induced

> > by Chinese Hepatoprotective Herb, XIAOCHAIHU TANG. Journal of the

> > Chinese Medical Association 69(2): 86-88. XIAOCHAIHU TANG (Japanese:

> > Syo-Saiko-To) is a herbal remedy widely used in China to treat respiratory,

> > hepatobiliary, and gastrointestinal diseases, particularly among patients w

> > chronic liver disease. However, its safety has been challenged recently. We

> > report a Chinese patient w acute hepatitis induced by XCT. A 52-year-old

> > woman presented w weakness, fatigue, and tea-colored urine after continual

> > consumption of XCT for 1.5 months. Lab studies disclosed acute hepatitis

> > even though all of the viral hepatitis markers were negative. Liver biopsy

> > also revealed acute hepatocellular hepatitis. The symptoms improved after

> > discontinuing XCT, and liver biochemical tests normalized 2 months later.

> > The case report reminds us of the probable adverse drug reaction of herbs,

> > even in some that are claimed to have hepatoprotective effects.

> >

> > Phil's Notes:

> > Note that CHAILING TANG + XIAOCHAIHU TANG contain BANXIA; they

> > also contain 6 other Meds in common: Chaihu, Dangshen / Renshen,

> > Dazao; Gancao / Zhigancao; Huangqin; Shengjiang.

> > IMO, none of the latter Meds would be hepatotoxic at normal doses.

> >

> > IMO, because BANXIA is used widely in Chinese + Kampo Med, and

> > because there are so few reports in medical journals of BANXIA

> > hepatotoxicity, we can conclude that it is GRAS (generally regarded as

> > safe).

> >

> > However, we might be wise to omit BANXIA (or reduce its inclusion rate) in

> > patients in which we suspect pre-existing LV damage. Also, we should

> > ensure that we AVOID using RAW BANXIA (viz, use ONLY the

> > PROCESSED form).

> >

> > TCMAssistant [ www.tcmassistant.com/ ] says:

> > CHAILING TANG; Bupleurum + Poria / Hoelen Dec;

> > Class: Dispel Damp; Subclass: Diuretic;

> >

> > Chaihu (Rx Bupleuri) 13.00 %

> > BANXIA (Rz Pinelliae Ternatae) 11.00 %

> > Shengjiang (Rz Zingiberis Officinalis Recens) 11.00 %

> > Zexie (Rz Alismatis Orientalis) 11.00 %

> > Fuling (Sclerotium Poriae Cocos) 7.00 %

> > Zhuling (Sclerotium Polypori Umbellati) 7.00 %

> > Baizhu (Rz Atractylodis Macrocephalae) 7.00 %

> > Guizhi (Rml Cinnamomi Cassiae) 7.00 %

> > Renshen (Rx Ginseng) 7.00 %

> > Huangqin (Rx Scutellariae Baicalensis) 7.00 %

> > Dazao (Fr Jujubae) 7.00 %

> > Zhigancao (Rx Glycyrrhizae Uralensis) 5.00 %

> >

> > Dec: 60-70 g/L; simmer down to 400mL; take ??mL TID-QID;

> > Actions: Diuretic; Harmonise SJM

> > Indications: digestive disorders w injury to Body Fluids dt Exterior

disorders~

> > persistent; SSs: acute gastroenteritis; diarrhoea; BL disorders; dysuria;

> > nephritis; oedema; thirst; LV disorders; infectious disease in summer;

> >

> > Bob Flaws - http://tinyurl.com/yzb9tg8 - says:

> > XIAOCHAIHU TANG (Minor Bupleurum Dec) & Digestive Ulcers: 80 cases

> > of digestive ulcers, all diagnosed by gastroscopy + all positive for

> > Heliobacter pylori, were studied; patients had digestive ulcers for 0.5-1

> > years; main SSs included ST duct tension + pain, distension, oppression +

> > discomfort, burping/belching, acid eructation, HT Vexation, dry mouth w

> > bitter taste, torpid intake, depression + oppression w predilection to

sighing;

> > Tx method: XIAOCHAIHU TANG:

> > Chaihu (Rx Bupleuri) 15g,

> > Huangqin (Rx Scutellariae) 12g,

> > Shengjiang (raw Rz Zingiberis) 6g,

> > BANXIA (Rz Pinelliae) 12g,

> > Dangshen (Rx Codonopsis) 12g,

> > Dazao (Fr Jujubae) 12g,

> > Gancao (Rx Glycyrrhizae) 3g;

> > Chaihu + Huangqin: Course + Resolve LV-GB Yu Heat;

> > Shengjiang + BANXIA: Harmonise ST + Descend Counterflow;

> > Renshen, Gancao + Dazao: Boost SP + Tone Xu;

> > Dec 1 packet; divide into 2 parts + take 1 part orally on empty ST, BID, for

> > 15d / Tx course, for 5 continuous courses;

> > Formula acts to Course LV, Free SP + Cholagogue (Free GB), Rectify +

> > Harmonise SJM-SP-ST; thus these Meds and the Pattern correspond; thus

> > Tx effects are good

> >

> > Indications: digestive ulcers mostly present as SJM-SP-ST Xu Pattern dt

> > enduring disease w emotional stress, oppression + unhappiness. Thus, it

> > relates to LV-GB Qiyu + LV Qi Not Coursing; then Wood Yu attacks Earth

> > (SJM-SP-ST), SP loses its fortification + movement, while Earth loses its

> > harmony + downbearing;

> >

> > Modifications (Additions + Subtractions):

> > for rib-side distension + pain~ bilateral / pain radiating to loin / back~

upper,

> > add Chuanlianzi (Fr Toosendan) 10g + Yanhusuo (Rz Corydalis) 10g;

> > for depression + oppression w predilection to sighing, add Xiangfu (Rz

> > Cyperi) 12g;

> > for bitter taste in mouth, dry throat + HT Vexation, omit BANXIA + add

> > Huanglian (Rz Coptidis) 10g;

> > for nausea + acid eructation, add Haipiaoxiao (Os Sepiae / Sepiellae) 20g;

> > for ST duct distension + oppression, add Houpo (Cx Magnoliae) 10g +

> > Sugeng (Caulis Perillae) 10g;

> >

> > Best regards,

> >

> >

> >

> >

[Guest guest]

Thanks for posting this Phil. One of the questions that I always want to know is

about concurent meds, preexisting conditions and even more important was the

herbal formula tested after that to ensure proper herbs. One of the risks of

herbs in every country is adulteration of herbs by pesticides, heavy metals and

substitutions. As a western herbalist, I still see reports of Plantain leaf

being  toxic because of a substitution by Rue back in the 70's (just poor

quality control from a large distributor back in the day).  Reports like these

are interesting to note but until decent investigation is performed generally

meaningless.

 

Be well,

Bob

Robert Linde, AP, RH

Professional Herbalists Training Program

Acupuncture & Herbal Therapies

901 Central Ave

St. Petersburg, FL 33705

www.acuherbals.com

727-551-0857

 

--- On Wed, 12/2/09, < wrote:

 

 

<

Re: BANXIA / Pinellia as an hepatotoxin?

VBMA, traditional_Chinese_Medicine ,

 

Wednesday, December 2, 2009, 1:46 AM

 

 

 

 

 

 

Hi All, & Aloha Ihor,

 

Aiba T,* Takahashi T,* Suzuki K,* Okoshi S,* Nomoto M,* Uno K + & Aoyagi

Y* (2007) CASE REPORT: Liver injury induced by a Japanese herbal

medicine, Sairei-to (TJ-114, Bupleurum and Hoelen Combination, Chai-Ling-

Tang). Journal of Gastroenterology and Hepatology 22(5):762-763. *Div of

Gastroenterology & Hepatology, Graduate School of Med & Dental Sci,

Niigata Univ, and + Dept of Pharmacy, Suibarago Hospital, Niigata, Japan.

Contact: Dr Toru Takahashi, Div of Gastroenterology & Hepatology,

Nagaoka Red Cross Hospital, 297-1, Terashimacho, Nagaoka 940-2085,

Niigata, Japan. torutoru (AT) nagaoka (DOT) jrc.or.jp A man showed acute hepatitis

with jaundice after taking a Japanese herbal medicine, Sairei-to (TJ-114,

Bupleurum and Hoelen Combination, Chai-Ling-Tang) . Unusually, the

component thought to be responsible for the observed drug-induced liver

injury was identified. Lymphocyte migration inhibition testing indicated that

the tuber of the perennial herbage Pinellia ternate was the causative agent.

 

Apart from that paper, I can find no hits on Medline for BANXIA / Pinellia as

a hepatotoxin.

 

However, another paper (Hsu et al, below) reported acute hepatitis in 1

patient taking XIAOCHAIHU TANG (Japanese: Syo-Saiko-To) .

 

Hsu L, Huang Y, Tsay S, Chang F & Lee S (2006) Acute Hepatitis Induced

by Chinese Hepatoprotective Herb, XIAOCHAIHU TANG. Journal of the

Chinese Medical Association 69(2): 86-88. XIAOCHAIHU TANG (Japanese:

Syo-Saiko-To) is a herbal remedy widely used in China to treat respiratory,

hepatobiliary, and gastrointestinal diseases, particularly among patients w

chronic liver disease. However, its safety has been challenged recently. We

report a Chinese patient w acute hepatitis induced by XCT. A 52-year-old

woman presented w weakness, fatigue, and tea-colored urine after continual

consumption of XCT for 1.5 months. Lab studies disclosed acute hepatitis

even though all of the viral hepatitis markers were negative. Liver biopsy

also revealed acute hepatocellular hepatitis. The symptoms improved after

discontinuing XCT, and liver biochemical tests normalized 2 months later.

The case report reminds us of the probable adverse drug reaction of herbs,

even in some that are claimed to have hepatoprotective effects.

 

Phil's Notes:

Note that CHAILING TANG + XIAOCHAIHU TANG contain BANXIA; they

also contain 6 other Meds in common: Chaihu, Dangshen / Renshen,

Dazao; Gancao / Zhigancao; Huangqin; Shengjiang.

IMO, none of the latter Meds would be hepatotoxic at normal doses.

 

IMO, because BANXIA is used widely in Chinese + Kampo Med, and

because there are so few reports in medical journals of BANXIA

hepatotoxicity, we can conclude that it is GRAS (generally regarded as

safe).

 

However, we might be wise to omit BANXIA (or reduce its inclusion rate) in

patients in which we suspect pre-existing LV damage. Also, we should

ensure that we AVOID using RAW BANXIA (viz, use ONLY the

PROCESSED form).

 

TCMAssistant [ www.tcmassistant. com/ ] says:

CHAILING TANG; Bupleurum + Poria / Hoelen Dec;

Class: Dispel Damp; Subclass: Diuretic;

 

Chaihu (Rx Bupleuri) 13.00 %

BANXIA (Rz Pinelliae Ternatae) 11.00 %

Shengjiang (Rz Zingiberis Officinalis Recens) 11.00 %

Zexie (Rz Alismatis Orientalis) 11.00 %

Fuling (Sclerotium Poriae Cocos) 7.00 %

Zhuling (Sclerotium Polypori Umbellati) 7.00 %

Baizhu (Rz Atractylodis Macrocephalae) 7.00 %

Guizhi (Rml Cinnamomi Cassiae) 7.00 %

Renshen (Rx Ginseng) 7.00 %

Huangqin (Rx Scutellariae Baicalensis) 7.00 %

Dazao (Fr Jujubae) 7.00 %

Zhigancao (Rx Glycyrrhizae Uralensis) 5.00 %

 

Dec: 60-70 g/L; simmer down to 400mL; take ??mL TID-QID;

Actions: Diuretic; Harmonise SJM

Indications: digestive disorders w injury to Body Fluids dt Exterior disorders~

persistent; SSs: acute gastroenteritis; diarrhoea; BL disorders; dysuria;

nephritis; oedema; thirst; LV disorders; infectious disease in summer;

 

Bob Flaws - http://tinyurl. com/yzb9tg8 - says:

XIAOCHAIHU TANG (Minor Bupleurum Dec) & Digestive Ulcers: 80 cases

of digestive ulcers, all diagnosed by gastroscopy + all positive for

Heliobacter pylori, were studied; patients had digestive ulcers for 0.5-1

years; main SSs included ST duct tension + pain, distension, oppression +

discomfort, burping/belching, acid eructation, HT Vexation, dry mouth w

bitter taste, torpid intake, depression + oppression w predilection to sighing;

Tx method: XIAOCHAIHU TANG:

Chaihu (Rx Bupleuri) 15g,

Huangqin (Rx Scutellariae) 12g,

Shengjiang (raw Rz Zingiberis) 6g,

BANXIA (Rz Pinelliae) 12g,

Dangshen (Rx Codonopsis) 12g,

Dazao (Fr Jujubae) 12g,

Gancao (Rx Glycyrrhizae) 3g;

Chaihu + Huangqin: Course + Resolve LV-GB Yu Heat;

Shengjiang + BANXIA: Harmonise ST + Descend Counterflow;

Renshen, Gancao + Dazao: Boost SP + Tone Xu;

Dec 1 packet; divide into 2 parts + take 1 part orally on empty ST, BID, for

15d / Tx course, for 5 continuous courses;

Formula acts to Course LV, Free SP + Cholagogue (Free GB), Rectify +

Harmonise SJM-SP-ST; thus these Meds and the Pattern correspond; thus

Tx effects are good

 

Indications: digestive ulcers mostly present as SJM-SP-ST Xu Pattern dt

enduring disease w emotional stress, oppression + unhappiness. Thus, it

relates to LV-GB Qiyu + LV Qi Not Coursing; then Wood Yu attacks Earth

(SJM-SP-ST), SP loses its fortification + movement, while Earth loses its

harmony + downbearing;

 

Modifications (Additions + Subtractions) :

for rib-side distension + pain~ bilateral / pain radiating to loin / back~

upper,

add Chuanlianzi (Fr Toosendan) 10g + Yanhusuo (Rz Corydalis) 10g;

for depression + oppression w predilection to sighing, add Xiangfu (Rz

Cyperi) 12g;

for bitter taste in mouth, dry throat + HT Vexation, omit BANXIA + add

Huanglian (Rz Coptidis) 10g;

for nausea + acid eructation, add Haipiaoxiao (Os Sepiae / Sepiellae) 20g;

for ST duct distension + oppression, add Houpo (Cx Magnoliae) 10g +

Sugeng (Caulis Perillae) 10g;

 

Best regards,

 

 

 

[Guest guest]

I know that ban xia is prepared by cooking it in ginger juice but I have no

idea of the exact process nor what actually happens biochemically as a

result of this. I have heard and seen a few individuals who

idiosyncratically, reacted to chai hu with extreme feelings of anger -

presumably this is from a sudden rise in live enzymes. I'm not sure it isn't

a constitutional predisposition rather than a 'damaged liver.' One of the

factors that is little emphasized and that is a foundation of Ayurvedic

medicine is constitutional typing according to the 'doshas'. Chinese

medicine tends to focus more on resolving the disease rather than the

constitution. Yes, if we all religiously adhered to pattern diagnosis in all

cases, I think much of the purported adverse reactions would be obviated but

at best this mode of practice is not always perfect.

 

 

 

I have chai hu in my commercial products and hear occasional reports of

individuals who experience exacerbations of anger after taking a formula -

and presumably they stop using it. I haven't heard of any long term damage.

The process of formulation should ameliorate against that.

[Guest guest]

Note that CHAILING TANG + XIAOCHAIHU TANG contain BANXIA; they

also contain 6 other Meds in common: Chaihu, Dangshen / Renshen,

Dazao; Gancao / Zhigancao; Huangqin; Shengjiang.

IMO, none of the latter Meds would be hepatotoxic at normal doses.

 

IMO, because BANXIA is used widely in Chinese + Kampo Med, and

because there are so few reports in medical journals of BANXIA

hepatotoxicity, we can conclude that it is GRAS (generally regarded as

safe).

 

However, we might be wise to omit BANXIA (or reduce its inclusion rate) in

patients in which we suspect pre-existing LV damage. Also, we should

ensure that we AVOID using RAW BANXIA (viz, use ONLY the

PROCESSED form).

 

 

Phil:

 

as i'm sure you're aware, xiao chai hu tang has long been c/i for hep

patients due to some problems occuring in japan some years ago with the

formula. it's been thought that the chai hu was the problem.

 

k

 

 

--

Kath Bartlett, LAc, MS, BA UCLA

Oriental Medicine

Experienced, Dedicated, Effective

 

 

Abstain from all that is evil.

Perform all that is good.

Purify your thoughts.

This is the teaching of the Buddhas.

 

 

Kath's Blog about , Healthy Living & Spirituality:

http://acukath.blogspot.com/

 

Flying Dragon Liniment: Effective pain relief for muscles & joints

Formulated by Kath Bartlett, Traditional Chinese Herbalist

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