Chinese herbal medicine (hereafter referred to as TCM), as an important part of Chinese medicine, has made great contributions to human health. With the continuous development of health care reasons and the combination of Chinese and Western medicine in the treatment of diseases, the clinical applications of TCM and its preparations are increasing. In recent years, there has been an increase in the number of reports of adverse reactions caused by herbal medicines and their products, and it has been reported that “drug-related hepatitis” caused by herbal medicines accounts for 21.0%-51.4% of the total cases of drug-related liver disease in clinical practice. It is one-sided to blindly believe that Chinese medicine is a natural medicine and has no adverse effects, so we should pay attention to liver injury caused by Chinese medicine.
The causes of “drug-related hepatitis” caused by Chinese medicine are
1, Chinese medicine factors.
(1) misconceptions about Chinese medicine, “natural drugs are not toxic” is a misleading propaganda, medicine is three points of poison. Chinese medicine is not only toxic, a small number of drugs have a big poison! There are clear discussions in the herbs, medical books and modern textbooks, such as breaking blood stasis and dispersing knots, as well as insecticidal Chinese medicine should not be taken for a long time, and it is easy to hurt the righteousness.
(2) The chemical composition and pharmacological activity of herbal medicines are very complex, and many plants can synthesize chemicals such as alkaloids and periodic polypeptides, which have toxic effects on animals and gain their own protection. The liver, as a biological factory for processing chemicals in the body, may produce toxic intermediate metabolites while removing these toxic substances, leading to “drug hepatitis”.
(3) There are many cases of Chinese medicine with the same name or different names, which can lead to poisoning due to misidentification and misuse. For example, Fangqi has wide Fangqi, powder Fangqi, wide Fangqi clinical self reported to 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) Not to use Chinese medicine or proprietary Chinese medicine in accordance with the basic features of the diagnosis and treatment of Chinese medicine, and violate the principle of contraindication, such as avoiding the use of published medicine for surface deficiency spontaneous sweating and Yin deficiency night sweating, and avoiding the use of laxative medicine for women before and after delivery.
2. Patient factors.
(1) Patients who take, misuse or superstitiously believe in certain toxic Chinese medicine, Chinese patent medicine or secret recipes, prescriptions, or due to the lack of patient awareness of the hepatotoxicity of certain Chinese medicine preparations, thus taking too large a dose of Chinese medicine, or using the medicine for too long and cause “drug hepatitis”.
(2) Different age or health conditions, such as the elderly, children, infirmity, maternity and liver and kidney dysfunction, are more likely to cause toxic reactions.
(3) Toxic reactions can occur in a few people at regular doses due to individual differences.
In addition, since there is little research on Chinese medicine, especially compound Chinese medicine, for technical reasons, we do not know what kind of effect on the activity of drug metabolizing enzymes is caused by taking one kind of Chinese medicine, which may lead to the accumulation or metabolic transformation of other drugs in the body, thus producing toxic effects on the liver.
Commonly used herbs that can cause “drug-related hepatitis”.
Commonly used herbal medicines that have been found to cause “drug-related hepatitis” are.
Huang Yao Zi, Ju San Qi, Cang Er Zi, He Shou Wu, Lei Gong Vine, Ai Ye, Wang Jiang Nan, Atractylodes, Smallpox Powder, Sang Sang Sang, Guan Zong, Pu Huang, Ephedra, Chai Hu, Senna, Centipede, Acacia Bark, Clove, Neem, Crow’s Guts, Mao Dong Qing, Castor Seed, Li Lu, Dan Shen, Poppy, Sang Sang Sang, Jiang Han Xia, Ze Di, Rhubarb, Tiger Stick, Guan Zong, Ai Ye, Qian Li Guang, Fang Qi, Tu Jing Wu, Nutmeg, Shang Lu, Chang Shan, Zhu Zhu Zhu Zi, Chang Shan. The following are known to cause “drug-related” effects
The following herbal compound preparations are known to cause “drug-related hepatitis”.
The following herbal compound preparations are known to cause “drug-related hepatitis”: Strong Bone and Joint Pills, Xiao Chai Hu Tang, Da Chai Hu Tang, Compound Qing Dai Capsules (Pills), Ke Yin Pills, Dissipative Yin Tablets (Pills), Dissipative Nuclei Tablets, Vitiligo Capsules, Bai Fu Kang Punch, Bai Etching Pills, Liushen Pills, Noma Pills, Ma Heng Shi Gan Tang, Ge Gen Tang, Da Huang Peony Peel Tang, Fang Feng Tong Sheng San, Damp Poison Qing, Blood Poison Pills, Chasing Wind and Bone. The Chinese medicine is also used for the treatment of cough and asthma, Bone Stretching Capsules, Bone Immortal Tablets, Zeng Sheng Ping, Six Gods Pills, Niuhuang Detoxification Tablets, Tianma Pills, Compound Salvia Injection, Dior Heart and Blood, and Kunming Shanhaigang Tablets.
In addition, some topical Chinese medicines can also cause different degrees of “drug-related hepatitis” when taken by mistake.
Such as fish gall bladder, fish vine, sea hare, staghorn, peppermint oil, raw cotton seed oil, tung seed and tung oil, etc.
3, the clinical manifestations of “drug hepatitis” caused by Chinese medicine.
Over the past 70 years, more than 350 plants worldwide have been found to contain hepatotoxic alkaloids that clinically resemble all forms of acute and chronic liver disease, including acute hepatocellular damage, cholestasis, chronic hepatitis with fibrosis, cirrhosis, and fulminant liver failure.
The common clinical symptoms of acute “drug hepatitis” are malaise, poor appetite, anorexia, abdominal distension, nausea and vomiting, and in a few patients, rash, fever, jaundice, etc., indicating significant hepatocellular damage or intrahepatic cholestasis. For example, senna, ephedra, jinbao, brahmi, daphyllanthus and xiaochaihu tang.
Cholestasis, whose clinical manifestations include jaundice, itching, 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 the long-term use of traditional Chinese medicine such as Xiao Chai Hu Tang and Jin Bu Xie.
4. Prevention of “drug-related hepatitis” caused by traditional Chinese medicine.
(1) Correctly understand the hepatotoxicity of Chinese medicine. Improve the understanding of adverse drug reactions, eliminate the misconception that Chinese medicine has no adverse reactions and is safe to use. The adverse reactions of Chinese medicines are still waiting for a lot of research work, but there are more difficulties, because Chinese medicines are often compound preparations of multiple drugs, and the same drugs, if the origin, planting, growth period, harvesting season, processing, preparation, transportation, storage and other links are different, not only the composition and efficacy are different, and adverse reactions are also different. Whether it is a single medicine, multi-flavored Chinese medicine soup, Chinese patent medicine, or injection, all can cause liver damage.
(2) Strengthen publicity, education and guidance for patients, advise patients to take drugs under the guidance of doctors, prevent or correct their indiscriminate use of folk single prescriptions, Chinese and Western drugs or health products, especially certain Chinese health products are often lack of strict animal experiments and clinical observation before they are marketed, and adverse reactions are often unpredictable. This can not only reduce the metabolic burden on the liver, but also avoid the potential toxic damage to the liver from drugs.
(3) To use drugs rationally. In the course of treatment, doctors should try to avoid the application of drugs that have been reported in the literature to cause “drug hepatitis”, and prescribe drugs in accordance with the dose, method of administration and course of treatment as prescribed or recommended by the pharmacopoeia. The detoxification ability of drugs decreases in malnourished and elderly patients, and drug-related liver damage is more likely to occur, so the dosage of drugs should be reduced appropriately; avoid using too many drugs, and avoid the combined application of multiple Chinese medicines or with multiple western medicines.
(4) During the application of traditional Chinese medicine, once patients are found to have symptoms such as weakness, poor appetite, jaundice, or allergic manifestations such as rash and fever, liver function should be checked and the drug should be stopped in time.
Chinese medicines have dual pharmacological and toxicological effects, and even their active ingredients are their toxic ingredients. In clinical practice, physicians and patients should be encouraged to report adverse reactions related to TCM in order to study the incidence of hepatotoxicity of TCM preparations, so that our national essence can flourish and serve the people better and safer.