Letter: herbal hepatotoxicity – an update on traditional Chinese medicine preparations; authors′ reply

Teschke, Rolf; Wolff, Albrecht; Frenzel, Christian; Schulze, Johannes

doi:10.1111/apt.12887

Cited by 8 publications

(9 citation statements)

References 11 publications

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“…Ancient herbal TCM and modern medicine have evolved under different empirical, theoretical, philosophical, and cultural conditions, each attempting to establish cornerstones of valid diagnostic and therapeutic principles and to provide efficient healthcare. However, the opinion prevailed that the situation of ancient herbal TCM is partially disappointing [10,55], requiring substantial improvements with the tentative aim to develop a pragmatic modern herbal TCM that meets the needs of modern medicine and possibly combines both medicinal cultures by bridging the gap between the herbal TCM and Western medicine [10]. …”

Section: Herbal Traditional Chinese Medicine Its History Philosomentioning

confidence: 99%

“…For some herbal medicines including herbal TCM products, safety concerns have been expressed regarding rare adverse reactions that were not always transient but occasionally resulted in a severe clinical course and fatality [2,7,12,28,29]; attempts to ignore severe adverse reactions should be resisted [55]. Under these conditions, manufacturers and regulatory agencies are obliged to provide good product quality of efficient herbal products including herbal TCM, ascertaining consumer safety [12,50,60,61].…”

Section: Herbal Traditional Chinese Medicine Its History Philosomentioning

confidence: 99%

“…Nomenclature variability of individual TCM herbs and herbal TCM products such as herbal mixtures consisting of multiple TCM herbs are considered as a specific problem [52,55], especially when scientific reports have to be interpreted in relation to a TCM herb [52]. Unlike Latin scientific names, CMM names, be they Chinese, pin yin, English, or according to pharmacopoeia, have not been standardized and their use, spelling and occasionally even the plant species to which they refer vary from publication to publication [52].…”

Section: Herbal Traditional Chinese Medicine Its History Philosomentioning

confidence: 99%

“…The CMM [69] is a reference book that also describes thousands of plant preparations [6], including some nonbotanical elements (animal parts and minerals) [6,53,55,67] incorrectly classified as herbal medicines [34]. Outside of China, only around 500 Chinese herbs are commonly used [67].…”

Section: Herbal Traditional Chinese Medicine Its History Philosomentioning

confidence: 99%

“…Herbs grow at various extents in most countries of the world and provide the basis of local traditional herbal medicine in their respective cultures [191], including China [12,69], a country rich in plants [6,12,28,41,55,57,67,68,69], where around 13,000 herbal preparations are used as TCM [67,68,69]. …”

Section: Pathogenetic Aspects Of Liver Injury From Herbal Tcmmentioning

confidence: 99%

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Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

et al. 2016

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Background: Traditional Chinese Medicine (TCM) with its focus on herbal use is popular and appreciated worldwide with increased tendency, although its therapeutic efficacy is poorly established for most herbal TCM products. Treatment was perceived as fairly safe but discussions emerged more recently as to whether herb induced liver injury (HILI) from herbal TCM is a major issue; Methods: To analyze clinical and case characteristics of HILI caused by herbal TCM, we undertook a selective literature search in the PubMed database with the search items Traditional Chinese Medicine, TCM, alone and combined with the terms herbal hepatotoxicity or herb induced liver injury; Results: HILI caused by herbal TCM is rare and similarly to drugs can be caused by an unpredictable idiosyncratic or a predictable intrinsic reaction. Clinical features of liver injury from herbal TCM products are variable, and specific diagnostic biomarkers such as microsomal epoxide hydrolase, pyrrole-protein adducts, metabolomics, and microRNAs are available for only a few TCM herbs. The diagnosis is ascertained if alternative causes are validly excluded and causality levels of probable or highly probable are achieved applying the liver specific RUCAM (Roussel Uclaf Causality Assessment Method) as the most commonly used diagnostic tool worldwide. Case evaluation may be confounded by inappropriate or lacking causality assessment, poor herbal product quality, insufficiently documented cases, and failing to exclude alternative causes such as infections by hepatotropic viruses including hepatitis E virus infections; Conclusion: Suspected cases of liver injury from herbal TCM represent major challenges that deserve special clinical and regulatory attention to improve the quality of case evaluations and ascertain patients’ safety and benefit.

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Section: Herbal Traditional Chinese Medicine Its History Philosomentioning

confidence: 99%