The application of herbs, botanicals and their preparations, including nutraceuticals and recipes, for the treatment of disease is quite common and increasingly widespread both domestically and internationally. Recent studies show that 42% of Americans have taken some kind of proprietary Chinese medicine preparation. In the overall population, the application of herbal medicine has increased 3-5 times compared to the previous one, and about 20-30% of liver disease patients use herbal medicine for treatment. Although some herbal medicines have liver-protective effects, such as detoxification, anti-fibrosis, immunomodulation and possible anti-viral effects, human knowledge of herbal medicines is far from adequate, and people mostly one-sidedly recognize the effectiveness and safety of herbal medicines, but ignore their existence or potential toxicity. 1, liver-damaging herbs More and more herbs with potential hepatotoxicity are reported. Pyrrolizidine bilane alkaloids can cause direct, dose-dependent hepatotoxicity, leading to typical hepatic venous embolic disease, now called hepatic sinusoidal obstruction syndrome, and later liver fibrosis or cirrhosis can occur. Jin Bu Bu and Da Cai Hua can cause acute hepatitis of immune origin; Ephedra and Da Chai Hu Tang can induce autoimmune hepatitis. Staphylinia spp. and Phyllostachys spp. can cause mitochondrial damage through CYP3A4 oxidative conversion. In addition, there are some herbs such as Euphorbia, Euphorbia valeriana, European Berberis, Neem, Rehabilitated Simon’s Lungwort, Paraguayan Tea, Aconitum fruit, Celestial Mustard, Three Finger Larea, American Sassafras and Brahmana that can apparently induce liver disease. Recent reports in foreign literature suggest that Chinese herbs such as white moss bark, peony bark, scutellaria baicalensis, chai hu and xiao chai hu tang may have liver damaging effects, and the scutellaria baicalensis in xiao chai hu tang preparations may have hepatotoxic components. Reports of liver damage caused by long-term use of certain proprietary Chinese medicines are common, such as Strong Bone and Joint Pills, Ke-Yin Pills, Nucleus Elimination Tablets, and White Etching Pills, etc. The most easily ignored are herbal-containing health products, such as weight loss and hair growth supplements. A scholar conducted a 1-year prospective study of Chinese herbal medicine for chronic hepatitis B. The results found that 7 out of 45 patients developed liver insufficiency related to Chinese herbal medicine with hepatotoxic ingredients: heshouwu, cassia, neem bark, centipede, licorice, and peppermint. The author has recently seen 2 cases of patients who developed severe liver damage from taking health products containing he shou wu. In addition, some topical herbs can also cause liver damage to varying degrees when taken by mistake, such as fish guts, fish vine, sea hare, andrographis, peppermint oil, raw cottonseed oil, tung seeds and tung oil. In addition to drug species, the combination, dosage, route of administration and method of administration of herbal medicines are also related to liver damage. Generally speaking, acute liver damage is related to allergic reactions, excessive doses, intramuscular or intravenous administration, while chronic liver damage is mostly caused by drug accumulation poisoning caused by long-term use of drugs. 2, the pathogenesis of liver damage caused by herbal drugs The pathogenesis of liver damage caused by herbal drugs has not been fully elucidated, some drugs or their metabolites can directly damage the liver, the more in-depth research is the pyrrole bilane alkaloids. This alkaloid is present in many herbal medicines such as wild lily, millipedium, asparagus, ephedra, jinbuzi and the Chinese medicine Xiao Chai Hu Tang. The hepatotoxicity of pyrrolizidine alkaloids is mediated by cytochrome P450 and converts unsaturated alkaloids into unstable toxic metabolites that damage hepatic sinusoidal endothelial cells, cause impaired hepatic blood flow, and cause SOS, which is repeatedly induced and dose-dependent in experimental animals. For example, peppermint is widely used as an abortifacient and insecticide as well as other herbs. Carminatone is the main component of peppermint, which rapidly depletes the liver of reduced glutathione; peppermint furan, a metabolite of carminatone, also has direct hepatocytotoxicity, mainly metabolized by CYP2E1. Single herbs with direct toxicity to the liver include neem, mulberry, cranberry, guanzhong, millipede, mugwort, seasonal green, acacia bark, wintergreen leaf, wild lily, pig’s pea, hippophaeum, shui tian qi, stone garlic, poppy, nutmeg, strophanthus, vermilion, fish guts, centipede, etc. Long-term use may cause discomfort and pain in the liver area and abnormal liver function in some items. In addition, improperly prepared herbal medicines such as aconite contain aconitine, and if improperly prepared, aconitine is not yet hydrolyzed, and poisoning can occur after taking it. In addition to the direct toxic effects of herbs or their metabolites on the liver, liver damage is related to the specific reactivity and allergic reaction of the body to herbs or their metabolites, i.e., damage to the liver through immune-mediated mechanisms. Plygala chinensis (orthologically known as Da Jin Niu Cao) contains levoransoprolene, which has certain structures similar to those of the hepatotoxic pyrrolo-bis-alkane alkaloids. The direct hepatotoxicity has not been demonstrated, and the clinical manifestations of poisoned patients are more akin to a hypersensitivity reaction than to the typical SOS seen in pyrrolizidine alkaloid liver injury. tablets or teas from plants of the genus Staphylin, such as Borneo sodium, were widely used as cholagogues or antiseptics, and were later found to have a secondary effect on weight control in weight loss drugs. These hepatitis occur on an immunological basis. In the past 70 years, more than 350 plants worldwide have been found to contain hepatotoxic alkaloids. In recent years, herb-related liver damage has been clinically reported according to clinicopathological types: autoimmune hepatitis, chronic hepatitis, hepatic fibrosis, cirrhosis, cholestasis, bile duct injury, fulminant liver failure, giant cell hepatitis and small vein stenosis (often leading to mitochondrial damage). Clinically similar to all forms of acute and chronic liver disease, including acute hepatocellular damage, cholestasis, vascular damage, chronic hepatitis with fibrosis, cirrhosis, and fulminant liver failure. The common clinical symptoms of acute liver damage are malaise, poor appetite, anorexia, abdominal distension, nausea and vomiting, a few patients may have rash, fever, jaundice, etc. appearing to represent significant hepatocellular damage or intrahepatic cholestasis, and in severe cases, hepatic coma, gastrointestinal hemorrhage and concomitant renal failure or even death [11, 12]. Such as brahmi, three-finger larrea, akai mugo, senna, ephedra, jinbun, daphyllanthus and xiaochaihu tang. Cholestasis is a decrease in bile flow due to decreased bile secretion or obstruction of the biliary system. Its clinical manifestations include jaundice, pruritus, nausea, malaise and fatigue. Biochemical features are elevated alkaline phosphatase, γ-glutamyl transpeptidase, 5′ nucleotidase and other indicators of bile duct damage. Acute cholestasis has been reported to be caused by gibberellic acid. Glycopyrrolate has also been reported to cause bile duct disappearance syndrome. Chronic hepatitis may be similar in presentation to chronic viral hepatitis and chronic autoimmune hepatitis. Chronic liver damage can be produced by long-term use of herbs such as Brahmi, Xiao Chai Hu Tang and Jin Bu Xie. Herbs may damage the liver such as hepatic sinusoids, hepatic veins and hepatic arteries. More frequently reported is SOS, which refers to luminal narrowing or even occlusion of the central and inferior hepatic lobular veins due to injury, which can manifest itself in the form of acute, subacute or chronic liver damage. Acute forms of liver damage can occur if large amounts of herbs containing pyrrolizidine alkaloids such as wild lily, millipede, asparagus, healing power and Paraguayan tea are taken in a short period of time, with an acute onset, abdominal pain, bloating, liver enlargement, ascites and swelling of the limbs, which may improve but also occasionally lead to death. In contrast, chronic liver damage in the form of insidious onset, ascites and portal hypertension, and progression to cirrhosis occurs when these herbs are taken in small doses over a long period of time. Histopathological examination shows non-thrombotic occlusion of the lumen of the small terminal hepatic veins, dilated hepatic sinusoids, hepatic stasis, and central necrosis of the hemorrhagic lobules, with fibrosis, cirrhosis and portal hypertension at a later stage. I have encountered a case of long-term use of herbal supplements to the liver vein SOS. 4, the prevention and treatment of liver damage caused by herbal medicine First of all, to improve the understanding of adverse drug reactions, to eliminate the misconception that Chinese medicine does not have adverse reactions and is safe to use. The adverse effects of herbal medicines are still waiting for a lot of research work, but more difficult, because herbal medicines are often a compound preparation of multiple drugs, and the same drug, if the origin, planting, growth period, harvesting season, processing, preparation, transportation, storage and other links are different, not only the composition and efficacy of different, and adverse reactions are not the same. Regardless of whether it is a single herbal medicine, multiple herbal soup, Chinese patent medicine, or injection, all can cause liver damage. Some herbal health products often lack strict animal testing and clinical observation before they are marketed, and adverse reactions are often unpredictable. Second, is the rational use of drugs. Avoid taking drugs after drinking or starvation. Malnourished and elderly patients are more prone to drug-related liver damage because of their reduced detoxification ability, so the dosage should be reduced appropriately. Observe the symptoms of fatigue, poor appetite, jaundice, rash, fever and other allergic manifestations during the drug administration. If symptoms appear, stop the drug in time and give drugs that can increase the concentration of reduced glutathione in cells. Herbal drugs have dual pharmacological and toxicological effects, and even their active ingredients are their toxic components. In clinical practice, physicians and patients should be encouraged to report adverse reactions associated with the application of herbal medicines in order to study the incidence of hepatotoxicity of these herbal preparations, so that our national essence can flourish and better and safer serve the people.