In clinical practice, drug-related liver disease is a diagnosis of exclusion, which is aided by the hepatologist’s reliance on a database of adverse drug reactions, based on prior knowledge. There are more than 900 chemical drugs that are known to cause drug-related liver disease. The risk of liver injury is clearly communicated in the instructions for many chemical drugs, such as anti-tuberculosis drugs, antibiotics and many chemotherapy drugs. Once the association between liver disease and the drug is identified and diagnosed by the physician during the course of drug administration, discontinuation and adjunctive hepatoprotective therapy may be an option. Internationally, drug-related liver disease is attracting increasing attention from the pharmacy community, pharmaceutical companies, drug regulatory authorities and the public. However, due to the widespread use of traditional Chinese medicine and the lack of toxicological studies, China faces a more complex and serious problem of drug-induced liver disease than foreign countries. The ingredients of chemical drugs are determined, domestic and foreign data on liver damage of chemical drugs are complete, and the whole process of detection, diagnosis and discontinuation of treatment of chemical drug liver disease is relatively clear. “Knowing clearly its efficacy and risks, doctors and patients will also pay attention to liver function monitoring, be alert to possible liver disease caused by taking the drug, and make timely adjustments and treatment.” Due to the complex composition of herbal medicines, no one abroad has studied the hepatotoxicity of herbal medicines, and there is a lack of safety research data in China, which has led to the fact that the general public, including even the prescribing Chinese and Western medical doctors, are not aware of the risk of liver damage from herbal medicines during the use of herbal medicines. There is no shortage of people suffering from acute liver failure and other serious liver diseases, and even death. Dangerous He Shou Wu Some hepatologists have found that the claim that herbs are non-toxic has long circulated among the public, resulting in the misuse of herbs. Some extremely serious cases of liver disease and death were caused by herbal liver disease patients who believed in folk remedies, abused herbal medicine or took herbal medicine in excessive doses and over the course of treatment. How can a patient with liver disease still take herbs that damage the liver.” When they learned that the patient’s sister was also taking he shou wu, they suggested coming to the hospital for diagnosis, and the same liver damage was found. He Shou Wu is rumored to be used in folklore for hair augmentation, while earth panax pseudoginseng is used to make medicinal wine, and with both drugs, there have been clear cases of liver damage. Du Xiaoxi, who has a degree in traditional Chinese medicine, believes that pharmacological liver damage from herbs is not a new clinical topic, but some medication problems should be attributed to purely artificial risks. “There are health programs that encourage the public to stew chicken with 10 grams of He Shou Wu every day. But is He Shou Wu, a Chinese herb, really suitable for each person to take so much per day?” In the hospital’s database of drug liver damage cases, He Shou Wu ranked No. 1 among all herbal medicines in the number of cases causing liver damage. He and Du Xiaoxi have jointly written that “in recent years, the National Adverse Drug Reaction Monitoring Center has collected nearly 10,000 reports of adverse reactions to He Shou Wu and its preparations, of which serious adverse reactions are dominated by liver function damage. Only a small percentage of cases of liver damage from He Shou Wu are reported to the National Adverse Drug Reaction Monitoring Center’s ADR spontaneous reporting system, and the potential number of undetected or undiagnosed cases of liver damage is even larger.” The problem of liver damage from he shou wu has also been noted by the U.S. medical community, and in September 2012, he shou wu was included as a separate topic in the LiverTox database of drug-related liver damage released by the U.S. National Library of Medicine (USNLoM). Xiao Xiaohe is concerned that studies have shown that anthraquinone components contained in He Shou Wu, such as rhodopsin (emodin), can cause liver damage in experimental animals, and anthraquinone components are contained in many Chinese medicines such as rhubarb, thuja, cassia, aloe, senna, etc. Therefore, the problem of He Shou Wu hepatotoxicity has a very wide ripple effect. In 1992, a doctor in the Chinese Journal of Traditional Chinese Medicine counted that there were only 62 cases of adverse reactions to Chinese herbal medicines in the 1950s and before, 174 cases in the 1960s, 398 cases in the 1970s, and 2,217 cases in the 1980s, according to the results of domestic medical journals for more than half a century. The list of commonly used herbs clinically found to cause liver damage is also expanding. In China’s Measures for the Administration of Toxic Medicines for Medical Use, the Chinese Pharmacopoeia, 2010 Edition I, the drug standards promulgated by the former Ministry of Health, and the local herbal standards of Shandong, Guangdong, Liaoning, Gansu and other provinces, a total of 182 kinds of toxic herbal medicines are collected, including 37 kinds of “major toxic herbal medicines” and 78 kinds of “toxic herbal medicines”. Toxic herbs” 78 kinds, “small toxic herbs” 67 kinds. However, many toxic herbs are still being discovered. Some of the traditionally recognized non-toxic herbs also have safety risks. “Even herbs for the liver and kidney have been found to be hepatotoxic in recent years.” At the 2013 National Hospital Pharmacy Academic Conference, it was noted that the literature reports that horse mulberry leaves, four seasons, ground elm, daylily root, heshouwu, nutmeg and clove can cause liver damage; herbs containing glycosides (diosgenin), toxic proteins (seeds), alkaloids (millipede, comfrey), heavy metals (lead, arsenic), and animal components (centipede, zebracho) have been associated with liver damage. However, liver damage is only known to the person taking the medicine when it reaches a severe level. If the patient only has general symptoms of liver damage such as elevated transaminases, he or she can recover after timely discontinuation of the drug. However, if the patient is unaware and does not get tested, he or she will not notice any changes in the liver. Minor cases of liver injury do not usually appear in the literature. Patients who are not hospitalized will not be included in hospital statistics of drug-related liver injury cases. They also have difficulty appearing in the system of adverse drug reaction monitoring reports. Therefore, hepatologists believe that the actual number of people with liver injury from taking herbal medicines is much higher than the hundreds of thousands or tens of thousands of people reported in the literature. Malevolent Chinese and Western medicine, pharmacogenic liver damage of herbal medicines has become a realistic proposition that seriously affects the safety of clinical use of herbal medicines and urgently needs to be addressed. The current prevalence of Chinese and Western drug combinations, coupled with the fact that Chinese medicine research is not as adequate as chemical drugs, makes it possible to misreport many drug-induced liver diseases as a result of Chinese medicine. In the view of some in the Chinese medicine industry, the combined application of Chinese herbal and chemical drugs in China allows Western doctors to prescribe Chinese medicine precisely also exacerbates the risk of herbal liver disease. An incomplete statistics shows that about 70% of Chinese proprietary medicines are prescribed by Western medical practitioners in general hospitals. However, according to the theories and traditions of TCM, doctors who prescribe TCM must understand the relevant theories of TCM, such as evidence-based treatment and concoction to remove toxins. “Different concoctions of a single medicine can have different effects on liver damage, as is the case with He Shou Wu. But Western medicine may not be clear about this.” He Shou Wu there are raw Shou Wu and system Shou Wu, the former is unprocessed concoction, the latter is processed. Although there is no uniform process standard for concoction, the nine steamed and nine sun-dried He Shou Wu concoction products may be less liver damage. Western medical doctors obviously have difficulty understanding this. This combination of Chinese and Western medicine leads to confusion not only in the process of use, but also in the manufacture of proprietary Chinese medicines, where there are serious problems. Dr. Xu believes that chemicals mixed in with Chinese herbal medicines are another major risk for liver disease from Chinese herbal medicines. “In the herbal medicines examined, the vast majority of proprietary Chinese medicines and health products were adulterated with chemicals.” Xu showed the report: including hypoglycemic drugs, anti-epileptic drugs, sedative-hypnotic drugs, anti-asthmatic drugs, diet pills and other proprietary Chinese medicines and health care products, dozens of Western pharmaceutical ingredients were checked. “This is when you can’t attribute liver disease caused by such herbal medicines to herbal liver disease. With a mix of proprietary Chinese and Western medicines, it’s not clear whether this is caused by Chinese herbs, Western medicines, or a mix. We are also confused as to which specific drug to study.” Only when the problem of chemicals is completely ruled out can we carry out toxicity studies on Chinese medicine. But whether it’s He Shou Wu or other herbal medicines, the traditional inertia of folk using herbal medicines, the green light of adverse reactions on herbal instructions, and the confusing prescription rights of Chinese and Western doctors have all put herbal liver disease in a long-term secret, but growing situation.