TCM causing hepatotoxicity in patients with chronic hepatitis B infection: a 1-year prospective study

[Guest guest]

Hi All, & Alon,

 

Alon wrote:

> What are we to make out of this

 

Alon was referring to the following paper, just published:

 

Yuen MF, Tam S, Fung J, Wong DK, Wong BC, Lai CL. Traditional Chinese

medicine causing hepatotoxicity in patients with chronic hepatitis B infection:

a 1-year prospective study. Aliment Pharmacol Ther. 2006 Oct

15;24(8):1179-86. Dept of Medicine, Univ of Hong Kong, Queen Mary

Hospital, Hong Kong. Background Safety of TCM in patients with chronic

hepatitis B is unknown. Aim To study the clinical outcome of TCM-induced

hepatotoxicity in chronic hepatitis B patients. Patients and methods All

chronic hepatitis B patients in 2004 with liver dysfunction requiring

hospitalization were screened prospectively for TCM intake. The

hepatotoxicity of individual TCM elements was determined by extensive

search of both English and Chinese publications. Results Of 45 chronic

hepatitis B patients, the liver dysfunction in seven (15.6%) was attributable

to TCM. All had liver dysfunction pattern resembling those of acute

exacerbation of chronic hepatitis B. Three patients had adverse outcomes

(two deaths, one liver transplantation). One patient had accelerated course

of cirrhosis now awaiting liver transplantation. The identified hepatotoxic

components were Polygonum multiflorum Thunb, Cassia obtusifolia L, Melia

toosendan Sieb., Rheum palmatum L., Scolopendra subspinipes mutilans L,

Alisma orientale Juzepe, Glycyrrhiza uralensis Fisch. and Mentha

haplocalyx Briq. One TCM formula was adulterated with a highly

hepatotoxic agent, N-nitrosofenfluramine. Conclusions TCM-related

hepatotoxicity resulted in high mortality in chronic hepatitis B patients.

Prospective randomized-controlled trials with the same stringent criteria as

western medicine clinical trials are required for Chinese medicines, to

document their efficacies and safety before they can be advocated for the

treatment of patients. PMID: 17014576 [PubMed - in process]

 

IMO, this is a body-blow to TCM herbalism in patients with chronic virus-B

hepatitis. It will be a major reference used by Quackbusters in support of

their attempts to have TCM banned in the west, pending massive research.

 

It is doubly damaging because it is reported by a CHINESE TEAM from

University of Hongkong.

 

Those who may wish to respond to that paper would need study the full text

carefully and dig deep to see what other medications were used in the

patients studied.

 

They also should examine in detail the rationale WHEREBY the named

herbs were shortlisted as the " identified hepatotoxic components " , whereas

other supplements, nutrients or western drugs were eliminated as

predisposing or triggering causes of hepatotoxicity.

 

In the past, similar papers, for example on Kava, conveniently neglected to

put equal blame for morbidity/mortality on alcoholism and a concurrent

medication with WMs that can hit liver hard.

 

If FDA and EU Drug Licensing Authorities accept the validity of the

conclusions, we can expect to see suggestions that warnings against the

use of the following herbs will be issued, at least for patients with chronic

liver disease:

 

Bohe-Mentha haplocalyx

Chuanlianzi-Melia toosendan

Dahuang-Rheum palmatum

Gancao-Glycyrrhiza uralensis

Heshouwu/Yejiaoteng-Polygonum multiflorum

Juemingzi-Cassia obtusifolia OR

Wugong-Scolopendra subspinipes mutilans

Zexie-Alisma orientale

 

In TCM, Bohe is used to Course LV & Rectify Qi [

http://www.itmonline.org/5organs/liver.htm and

http://www.herbasin.com/database/bohe.htm ] and has LV-protective effects

[

http://content.nhiondemand.com/moh/media/TCMH1.asp?objID=100717 & ct

ype=tcmh ];

 

Chuanlianzi is used to Course LV & Rectify Qi [

http://www.itmonline.org/5organs/liver.htm ] but has toxic alkaloid; Caution:

TOXIC; Effective dose is very close to TOXIC dose; 5-6 pieces of Fr can

kill; Children taking 0.3-0.4g had TOXIC reactions; 2-4g caused death;

avoid overdose/prolonged use; CI in KI/LV disease; CI in SJM-SP-ST Xu &

Cold

 

Dahuang: Bitter; Cold; LV; SJM-SP-ST; LI; Class: Purge~Drain Down;

Purge vigorously; Purge~Drain Down; Drain Heat; Clear Heat; Resolve

Toxin; Purge Fire; Purge SJU/LU Fire (Drain Fire through LI in SJL); Clear

Damp Heat; Purge Icterus; Clear ST-SI-LI Phlegm Heat; Purge

Accumulation; Purge Stas; Resolve Stas; Aid Defecation; Quicken Xue~Aid

Circulation; Disperse Xue Stas; Clear Head; Antivirus; Topical for burns,

carbuncles, suppurative skin diseases; Used in Heat/ST-SI-LI Heat

Accumulation w constipation; Xue Heat w bleeding; Fire Uprising w eyes-

red, headache, pharyngitis, swelling & pain of gums; Xue Stas, incl

amenorrhoea, abdomen mass/trauma; Damp Heat w icterus & Heat Lin;

Heat Toxin w sores & carbuncles; burns & scalds; Damp Heat w dysentery,

abdomen pain; Xue Heat w fever, constipation & abdomen fullness,

haematemesis & Epistaxis; dysmenorrhoea & amenorrhoea; icterus~acute,

appendicitis~acute, intestinal obstruction; Large dose/sensitive subjects

show faeces-loose/abdomen cramp w diarrhoea; long-term use of emodin-

containing Hbs can cause colon to darken; Caution in Exterior Patterns; Qi

& Xue Xu; Cold dt SJM-SP-ST Xu; CI in menstruation/postpartum; CI in

pregnancy

 

Gancao: sweet, neutral; all 12 Channels & organs, esp HT; LU; SJM-SP-

ST; Glycyrrhizin & other actives of Gancao influence paeoniflorin activity on

muscles; Gancao triterpenes are metabolized to molecules that have similar

structure to adrenal cortex hormones ( used in vitaligo); this may be basis of

its Antiinflammatory action; Class: Tonic~Tone Qi; Tonic~Tone Qi

(Zhigancao is stronger); Replenish Qi; Tone SP; Tone & Build SJM-SP-ST

Qi, esp SP Qi; Moderate Hb Actions; Harmonise/Neutralise strong

(purgative, TOXIC) Hbs; Moisten LU; demulcent; Ease Cough; Antitussive;

expectorant; Resolve Damp/Phlegm; Clear Fire; Resolve Toxin; Antipyretic;

Relax Spasm; Antispasmodic, laxative~mild; Ease Pain; Antiinflammatory;

Antistress~adrenal agent; Used in Shi Patterns; HT Qi Xu w pulse-knotted;

cramp discomfort; infertility, colic, bronchial catarrh, bronchitis, gastritis -

chronic, peptic ulcer, adrenocortical insufficiency, Addison's disease;

weakness (Qi Xu), sore throat, boils, asthma, Qi-Xue Xu; peptic ulcer,

empty SJM-SP-ST, colic acute abdomen pains; Prolonged overuse may

cause oedema; CI in Damp Shi w chest & abdomen distension & fullness

/emesis; Gancao counteracts Daji (Peking Spurge Rx), Yuanhua, Gansui &

Haizao

 

Heshouwu is used to Moisten LV & Tone Yin [

http://www.itmonline.org/5organs/liver.htm ]: May cause faeces-loose;

NOTE: there are two case reports of LV reaction when taking Shouwupian,

a preparation of this herb; CI in Diarrhoea & Accumulation of Phlegm Damp,

esp when dt SP Xu

 

Juemingzi: Sweet; Bitter; salty; Cold-slightly; LV; LI; Class: Calm LV; Calm

Yang; Calm Wind ~Interior; Purge Fire; Clear Heat; Clear LV Heat; Clear

Wind Heat; Ease Tremor; Brighten Eyes; laxative - safe natural-acting;

Moisten LI; Ease Defecation; Aid Defecation; Anticholesterol; Dose: 10-15g;

Yin Xu w vision weak; LV Heat/Wind Heat w eye congestion, swelling &

pain, photophobia & lacrimation-profuse; LV Heat/LV Yang Uprising w

headache, hypertension & dizziness, vision-blurred; eye problems, eye

soreness & photophobia, eye inflammation~acute & lacrimation; SI-LI Heat

Accumulation/SI-LI Dryness w constipation; Allergy; Large doses may cause

diarrhoea; Caution/CI: Diarrhoea; Hypotension

 

Wugong is used to (1) Calm LV; Calm Wind~Interior; Ease Spasm; Ease

Convulsion; Antispasm; Dispel Stas; Resolve Toxin; (2) Free Channels &

Collaterals; Ease Pain, esp headache-stubborn; Dispel Channel Wind

Phlegm; (3) Resolve Toxin & Disperse Nodules; Disperse concretions;

TOXIC; Avoid overdose; CI in pregnancy

 

Zexie: Sweet, Bland (No Taste); Cold; KI; BL; Diuretic; Expel Damp; Drain

Damp; Release Water; Transform Damp; Aid Water Metabolism; Clear

Heat; Drain Heat; Purge Fire; Disperse Swelling; Dose: 5-10g; Used in

Damp w Water Retention, urination-infrequent, oedema, limb-oedema,

dizziness; Phlegm & Fluids Retention w dizziness, vertigo, palpitation &

cough; Heat Lin w dysuria, urine~turbid, burning sensation +/- haematuria;

diarrhoea; Damp Heat in abdomen-lower, like diarrhoea &

leukorrhoea~profuse; KI Yin Xu w Fire Agitation; thirst, abdomen bloating,

urinary calculi, diabetic Pattern (Zexie + Fuling, Zhuling & Baizhu in Wuling

San) ; Prolonged use of large doses can irritate ST & SI-LI; CI in SJL Damp

/abdomen-lower Patterns dt KI Yang Xu/Damp Cold w

spermatorrhoea/leukorrhoea

 

Expect incoming missiles! It is time to grab our helmets and flak-jackets &

head for the bunker!

 

Best regards,