Herbs that often cause liver damage can be divided into the following categories: 1) Plants: Huang Yao Zi, Chuan Jiang Zi, Wang Jiang Nan Zi, Ya Tong Zi, Cang Er Zi, Castor Zi, Ya Gao Zi, Lei Gong Vine, Long Qi, Senna, Da Huang, Ze Di, Shan Dao Nian Artemisia, Red Fennel, Sang Sang Sang, Jiang Han Xia, Cotton Seed, Thin Yellow, Qian Li Guang, Zi Jin Niu, Nong Jili (Wild Lily), Bai Bian Xi, Yuan Hu, Fang Wei, Jin Bu Xie, Ai Ye, Tiger Stick, Pomegranate bark, date palm root bark, five-fold seed, croton, acacia, peppermint, Eurasian peppermint, ground elm, water field ginseng, earth panax ginseng, sorrel, rue, wintergreen leaf, four seasons green, mulberry, clove, acacia bark, earth thorn, big maple seed, smallpox powder, cat’s tail, nutmeg, wheat horn, shangluo, poppy, aconite, evergreen, garlic, ephedra, scutellaria, broad bean root, coriander, snake berry, white fruit, and has. 2) Animals: Red maiden, fish gall, green maiden, spotted centipede, centipede, pangolin, etc. 3) Minerals: Bile alum, yellow dane, sulfur, andrographis, arsenic, etc. 4) Traditional Chinese medicine: Bone and Joint Pills, Dahuoluo Wan, Liushen Wan (Toadstool), Shouwu Tablets, Compound Qingdian Wan, Xiao Chaihu Tang, Toadskin Capsules, Niuhuang Detoxification Tablets, Noma San, Baixie Dan, Nucleation Pills, etc. 5) Injections Ginseng and wheat, compound salvia injection, and Shuanghuanglian injection have been reported to cause liver damage. 6) Topical drugs Tiger wort, tiger’s knot, pomegranate bark, Huangcang leaf, pressed leaf, ground elm, sour date root bark, five times the seeds and other experiments have serious damage to the liver, there are reports of tiger’s knot causing severe liver 5 cases, so topical drugs should not be ignored. Why do Chinese herbs cause liver damage? I. Herbal factors (1) The chemical composition and pharmacological activity of herbs are very complex. Many plants possess a defense system that obtains its own protection by synthesizing chemicals such as alkaloids and periodic polypeptides that have toxic effects on animals that eat these plants. These chemicals may act directly on biochemical targets, be available for therapeutic use in a range of doses, or may cause cell death. The liver functions as a chemical processing plant, performing its role of scavenging and metabolizing lipophilic endogenous and exogenous chemicals, with the potential for exposure to reactive intermediate metabolites that could lead to injury. (2) Traditionally considered “non-toxic” herbal species have been found to be hepatotoxic in modern clinical practice, such as Huang Yao Zi, Smallpox Powder, Senna, He Shou Wu, etc. (3) There are many cases of herbal medicines with the same name or different names, which can lead to poisoning due to misidentification and misuse. For example, Fangqi has a wide range of Fangqi, powder Fangqi and other differences, wide Fangqi clinical reports have liver and kidney toxicity. (4) Drugs due to the origin, planting, harvesting season, processing and concoction, transportation and storage conditions, can also affect its efficacy and adverse reactions, such as taking large doses of unconcocted raw shouwu will lead to liver damage. (5) the herbal medicine causes the hepatotoxic damage also with the dosage form, the dose, the combination and the use method and so on, such as the traditional Chinese medicine gardenia conventional dose is 3～9g, if takes 30g or even the higher dose, may lead to the liver damage. (1) Because the patient self-take, misuse or superstition some toxic herbal medicine, Chinese medicine or secret recipe, partial prescription; or because the doctor or the patient lacks the understanding that some herbal medicine preparation has the potential hepatotoxicity, thus taking the herbal medicine dose is too big, or using the medicine time is too long and causes the liver damage. (2) Different age or health conditions, such as the elderly, children, frail, pregnant and maternal, and those with liver and kidney dysfunction, are more likely to cause toxic reactions. (3) A few people can have toxic reactions at regular doses due to individual differences; some people have hereditary liver metabolism defects, which can easily lead to drug-related liver damage; the body’s idiosyncratic and allergic reactions to herbal medicines or their metabolites, i.e., damage to the liver through immune-mediated mechanisms. (1) Liver damage is caused by the patient’s self-taking, mis-taking or superstitious belief in certain toxic herbal medicines, proprietary Chinese medicines or secret recipes or prescriptions; or by the lack of understanding of the potential hepatotoxicity of certain herbal preparations by doctors or patients, thus taking too large a dose of herbal medicines or using them for too long. (2) Different age or health conditions, such as the elderly, children, frail, pregnant and maternal, and those with liver and kidney dysfunction, are more likely to cause toxic reactions. (3) Toxic reactions can also occur in a few people at regular doses due to individual differences; the existence of hereditary liver metabolism defect diseases in some people, which can easily lead to pharmacological liver damage; idiosyncratic and allergic reactions of the organism to herbal medicines or their metabolites, i.e., damage to the liver through immune-mediated mechanisms. In addition, since there are few studies on the pharmacokinetics of herbal drugs, especially compounded ones, for technical reasons, we do not know what effect the administration of an herbal drug can have on the activity of the metabolizing enzymes of the drug in question, and this effect may lead to the accumulation or metabolic transformation of other drugs taken with it in the body, thus producing toxic effects on the liver.