A 47-year-old woman, a native of Xuyi, discovered a small nodule in her thyroid gland by chance last year, and since her thyroid function was normal, the hospital doctor did not recommend further treatment, so she listened to the legend and took Chinese herbal medicine in a local private clinic for more than 5 months. After examination, he was found to be free of viral hepatitis, autoimmune hepatitis and other metabolic and genetic liver injury diseases, and liver puncture pathology examination was performed. The results were as follows: a typical pathological picture of drug-related liver injury, and very serious liver fibrosis, just one step away from cirrhosis. After our treatment, the patient has now recovered and will be discharged soon. Influenced by traditional culture, our people have a deep emotional dependence on herbal medicine and have some inaccurate notions, such as “Chinese medicine has no side effects” and “Chinese medicine cures all”. However, authoritative statistics show that the proportion of drug-related liver injury caused by herbal medicines in China has reached 20%-40%. The more commonly reported herbal medicines related to liver injury in China include He Shou Wu, Tu San Qi, and certain compound preparations for treating osteoporosis, arthritis, vitiligo, psoriasis, eczema, acne and other diseases. However, due to the complexity of the components, it is difficult to determine exactly which components cause liver damage. China’s proprietary Chinese medicines are required to complete pharmacological, pharmacological, toxicological and clinical studies in accordance with the “Drug Registration and Administration Measures” and be approved for marketing only after passing a strict review. The Pharmacopoeia stipulates that, with the exception of tablets used for both medicinal and food purposes, Chinese medicine beverages are managed in accordance with prescription drugs. Although proprietary Chinese medicines and Chinese herbal drinks are required to be manufactured and sold in accordance with the Good Manufacturing Practice (GMP) and the Good Manufacturing Practice (GSP), Chinese herbal tonics and creams, as prescription drugs, can be prescribed by doctors in different combinations without approval. In addition, many of the and folk Chinese herbal prescriptions that are non-prescription drugs are very commonly used. Commonly used herbs known to cause liver injury include: Huang Yao Zi, Ju San Qi, Cang Er Zi, He Shou Wu, Lei Gong Vine, Ai Ye, Wang Jiang Nan, Atractylodes Macrocephalae, Smallpox Powder, Mulberry, Guan Zong, Pu Huang, Ephedra, Chai Hu, Senna, Centipede, Acacia Bark, Clove, Neem, Crow’s Mantle, Mao Dong Qing, Ricinus communis, Li Lu, Salvia, Poppy, Jiang Han Xia, Ze Di, Rhubarb, Tiger’s Stick, Guan Zong, Qian Li Guang, Fang Ji, Dou Ji, Phyllanthus, Phyllanthus. FANGJI, Euphorbia, nutmeg, SHANGLU, CHANGSAN, DAIFENGZI
Cinnabar, Zanthoxylum, Andrographis paniculata, Scutellaria baicalensis, Valerian, Aconite, and Bacopa monniera. The compound preparations of Chinese medicine known to cause liver injury include: Strong Bone and Joint Pill, Xiao Chai Hu Tang, Da Chai Hu Tang, Compound Qing Dai Capsule (Pill), Ke Yin Pill, Dissipative Yin Tablet
(Pills), Dissipative Nucleus Tablets, Vitiligo Capsules, Bai Fu Kang Punch, Bai Etching Pills, Liushen Pills, Noma Pills, Ma Heng Shi Gan Tang, Ge Gen Tang, Da Huang Mudan Pi Tang, Fang Feng Tong Sheng San, Damp Poison Qing, Blood Poison Pills, Chasing Wind and Bone Pills, Anti-cough and Asthma, Strong Bone and Tendon Capsules, Bone Immortal Tablets, Zeng Sheng Ping, Niu Huang Detoxification Tablets, Tian Ma Pills, Compound Dan Shen Injection, Di Ao Xin He Kang, Kunming Shan Hai Tang Tablets, etc. It should be noted that even some topical herbal medicines can cause liver damage to varying degrees: such as fish gall bladder, fish vine, sea hare, staghorn, peppermint oil, raw cotton seed oil, tung seed and tung oil. Therefore, when taking the above-mentioned herbal medicines, one should be especially cautious. When it is not possible to replace them with other drugs and the above-mentioned herbal medicines must be chosen for treatment, one should pay attention to regular follow-up monitoring at the hospital in order to detect the signs of liver injury at an early stage.