With the widespread use and further development of traditional Chinese medicine, the occurrence and monitoring of adverse reactions to traditional Chinese medicine have been paid more and more attention. The incidence of liver damage caused by herbal medicines has been found to account for 32.6% of pharmacogenic liver diseases. In the treatment of chronic liver disease, due to the presence of underlying liver diseases, there are more reports of inappropriate use of Chinese medicine which aggravates liver damage, thus even leading to the aversion to Chinese medicine by Western hepatologists. In contrast, TCM has great advantages in liver disease treatment, especially in anti-liver fibrosis and other aspects. It is worthwhile to discuss how to take advantage of the therapeutic advantages of traditional Chinese medicine in liver disease and avoid the herbal-derived liver damage caused during the use of Chinese medicine. Traditional Chinese medicine is considered to be “natural medicine, safe and non-toxic”, but this is actually very wrong. Some of the drugs in Chinese medicine are toxic in themselves, such as aconite, saposhnikovia, stigmaster, yellow medicinal herb, crow’s nest, toadstool, etc. All have a certain degree of toxicity. Modern toxicological studies have found that some of the chemical constituents of the species considered non-toxic or less toxic in traditional Chinese medicine books have some hepatotoxicity in clinical studies. Therefore, it is very important to further understand the toxic side effects of Chinese medicine to guide our clinical use. According to the classification of the main toxic components and chemical properties of Chinese medicines, the following categories are included: (1) alkaloids: including Chinese medicines containing hydroxybis-thick pyrrolizidine alkaloids such as millipede, wild lily, earth panax notoginseng, cat’s tail and so on. These alkaloids are converted into beep derivatives under the action of cellular P450 after ingestion, and this unstable metabolite can cause dose-related liver damage; the herbal medicines containing yanghusuo, yuan hu and jin bu zhi, which are commonly used as analgesics, have been found to have acute hepatitis in healthy people after 20 weeks of taking such drugs, so these alkaloids are directly toxic to liver cell metabolism; some other herbal medicines containing alkaloids Some other alkaloid-containing herbal medicines such as ephedra, leigongteng, aconite and changshan have been reported to cause toxic hepatitis or chronic liver damage. (2) Glycosides: Glycosides can be divided into saponins, flavonoid glycosides, cardiac glycosides, cyanogenic glycosides, etc. Chinese herbal medicines containing saponins and flavonoid glycosides such as Huang Yao Zi, Coriolus Versicolor, Scutellaria Baicalensis, Chai Hu and Guang Dou Ge have been reported to cause liver damage. Among them, Huang Yao Zi has been reported to damage the liver most often. Huang Yao Zi can both damage liver cells and affect bile excretion, and the degree of damage is dose dependent. Scutellaria baicalensis, Chai Hu, Atractylodes cantonensis, and Senna lanceolata damage the liver are associated with related glycosides, manifesting as toxic hepatitis or hepatic necrosis. (3) Terpene and lactone containing: representative drugs include Leigong vine, neem, mugwort, cassia seeds, guanzhong, etc., among which Leigong vine is reported in domestic literature (10) to be the first of single liver damaging herbs. (4) containing toxic plant proteins: such as Cang Er Zi, Wang Jiang Nan Zi, castor bean seeds, etc.. Such plant proteins, mostly present in the seeds, have the effect of cytoplasmic toxicity, which not only damages the liver, but also damages the gastrointestinal mucosa and kidneys. (5) drugs containing hydrolyzed tannins: such as five times the seeds, Kozi, pomegranate bark, thuja, Huang Cang leaves, sour date root bark, etc., hydrolyzed tannins have a serious toxic effect on the liver. (6) Animals and minerals: such as red maidenhair, fish bile, pig bile, toad, centipede, penetrating centipede, and minerals such as strophanthus and mitragynine can cause toxic hepatitis. (7) Other drugs with liver damage confirmed by animal experiments: such as clove, smallpox powder, nutmeg, white flowered salvia, earth thorn, big wind seed, wintergreen leaf, acacia bark, seven-leaved one flower, ergot, five-color plum, rhubarb, etc. In addition, some proprietary Chinese medicines have also been proven to have liver damage, such as Strong Bone Joint Pill, Lei Gong Tang Tablet, He Shou Wu Tablet, Liushen Pill, Xiao Chai Hu Punch, Compound Qing Dai Pill, Dan Shen Injection, etc. have been reported. 2, how to avoid liver disease treatment in Chinese medicine source of liver damage (1) identification and treatment, pay attention to the combination: clinically reported (12) Chinese medicine source of liver damage is mostly related to not pay attention to Chinese medicine identification, but the use of Western medicine theory to guide the use of Chinese medicine, not to distinguish the yin and Yang deficiency, to a party or a Chinese medicine to cure the Western medicine of a certain “disease”, such as Chinese medicine identification is Yang deficiency, but the use of drugs to nourish Yin. For example, if a Chinese medicine practitioner identifies Yang deficiency, but uses drugs to nourish Yin, it will definitely cause harm to the human body. In addition, the use of traditional Chinese medicine is based on the combination of the ruler and the minister, which can not only increase the effectiveness of the medicine, but also reduce the adverse reactions of each other, such as ginger to kill the poison of the half summer, licorice to reconcile all the drugs, etc. are the beauty of the combination. How can the thousands of years of Chinese medicine be well applied to clinical practice without understanding the evidence of Chinese medicine, without asking the ruler and the minister? Many cases of liver damage are related to the deviation from the essence of TCM. (2) The prescription should be refined according to the individual: Chinese medicine is concerned with the “three causes of identification”, and the clinical use of drugs should be different according to the individual, in addition to the elderly, children, frail and other factors, liver disease patients themselves have abnormal liver function, detoxification function is weakened, we should pay attention to the dosage of drugs should be light, in the taste of drugs should be refined, avoid overdose of drugs, and should set the appropriate If long-term medication is needed, a certain interval should be given in the course of treatment. Remember to avoid the use of multiple drugs of the same kind with certain effects confirmed by Western pharmacology or unilaterally increase the dose in pursuit of efficacy. (3) Selection and use of drugs to avoid blind obedience: liver disease is a difficult disease, some unrealistic, and even wrong propaganda abound, in the clinic, special attention should be paid not to use unknown pharmacology, toxicology of herbs, mono-formulas, prescriptions. We should not only refrain from using them, but also let the patients pay attention not to “rush to the doctor” and blindly believe in some untrue propaganda. In addition, we should avoid using a variety of Chinese medicines or Chinese medicines and tonics at the same time, as this often does not improve the efficacy, but increases the possibility of liver damage. (4) Chinese and western medicine together, choose the medication: the so-called “Chinese and western medicine together” we think includes two aspects: First, understanding the pharmacology and toxicology of modern Chinese medicine to guide the clinical use of drugs. For example, some drugs commonly used in the treatment of liver disease, such as Chai Hu, Neem, Xuan Hu, Radix et Rhizoma, Radix et Rhizoma, Money Grass, Scutellaria, Gentian, Tiger Balm, and Zedoary have been proven to have certain hepatotoxicity (13), so we should pay attention to prevent the simultaneous or long-term use of these drugs when prescribing. Secondly, we should prevent the side effects caused by the simultaneous use of Chinese and Western medicines. Due to the variety and complexity of Chinese medicines, the interaction between Chinese and western medicines is not clear, and it is not clear whether their efficacy is additive, but their side effects are additive, so we should avoid the simultaneous use of many Chinese and western medicines, which will increase the burden on the liver. For example, the simultaneous use of lipid-lowering drugs and traditional Chinese medicine in the treatment of fatty liver can easily cause liver damage and secondary pharmacogenic liver damage. (5) Take advantage of the strengths and weaknesses: Chinese medicine has many advantages in the treatment of liver disease, we must not choke on the liver damage caused by some improper use, or even to abolish Chinese medicine. Chinese medicine has clear advantages in anti-liver fibrosis, liver protection, yellowing, and improving the quality of survival of patients with advanced liver disease, which should be further studied. In the antiviral aspects of how to learn Western medicine to master the indications and timing of antiviral and related mechanism research is particularly important, Western medicine antiviral is not the same as Chinese medicine use a large number of detoxification drugs, how to more scientific understanding of the pathogenesis of viral hepatitis is also the majority of Chinese medicine workers must study the subject, more scientific evaluation of the efficacy of Chinese medicine, standardization of Chinese medicine research is also a top priority. (6) Strengthen supervision and improve quality: The cultivation, origin and preparation of Chinese herbal medicines have high requirements, and the quality of herbal medicines is directly related to clinical efficacy. The use of pesticides in the cultivation process, improper processing and preparation, and even some counterfeit and shoddy products flooding the market are important factors that lead to the reduction of efficacy and increase of side effects of Chinese herbal medicines, such as fumigating white drugs with cowry, dyeing, and manufacturing cordyceps with chemical raw materials. In recent years, the increase in reports of liver damage of Chinese medicine origin is also inseparable from this, whether it is a “drug hazard” or a “man-made disaster”, so we need to pay attention to it, so we should strictly control the procurement process of Chinese medicine, and strengthen the supervision in planting, processing and sales. In recent years, people have embarked on studies such as fingerprinting of Chinese medicines, which can help improve the quality of Chinese medicines. (7) Timely detection and early treatment: Chinese medicine practitioners often do not pay much attention to the review of treatment in clinical practice, “even Chinese medicine has three toxins”, after realizing this, we should pay more attention to the monitoring of liver function when treating liver disease, timely detection and early treatment of some non-predictable herbal-derived liver damage, when the liver is in a pathological state as well as individual differences. Individual variation requires vigilance. When clinical findings of fever, rash, jaundice, malaise, significant loss of appetite, nausea, etc. occur, liver function should be reviewed promptly. If abnormalities are found, we should deal with them promptly, stop taking Chinese medicine and take strong liver protection measures to avoid serious consequences.