R: BANXIA / Pinellia as an hepatotoxin?

[Guest guest]

Dear Phil, Ban Xia tosicity is due to Thuyone, one of the components of

thuya perennis; remember, too, that Sheng Jang, Zingiber rhiz. recens, fresh

ginger, is the most important antidote to Ban Xia; hence, MTC well knows its

toxicity; maybe some patient is more sensitive to it.

My best regards,

 

 

_____

 

Da: Chinese Medicine

Chinese Medicine Per conto di Phil

Rogers

Inviato: mercoledì 2 dicembre 2009 7.47

A: VBMA; traditional_Chinese_Medicine ;

 

Oggetto: Re: BANXIA / Pinellia as an hepatotoxin?

 

 

 

 

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) <torutoru%40nagaoka.jrc.or.jp>

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. <http://tinyurl.com/yzb9tg8> 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,