Liver injuries induced by herbal medicine, Syo-saiko-to (xiao-chai-hu-tang)

Abstract

Four patients treated with the herbal medicine syo-saiko-to (xiao-chai-hu-tang) exhibited acute drug-induced liver injury. The latent period was one and a half to three months. All of the patients showed a rise in aminotransferases after readministration or challenge test. The liver histology revealed centrilobular confluent necrosis or spotty necrosis, microvesicular fatty change, acidophilic degeneration, and a granuloma. Cholestasis was seen in two patients. The results of the [13C]aminopyrine breath test, performed in one patient, were low before the challenge test and even lower after the challenge. These findings suggest that the herbal medicine syo-saiko-to may induce acute injury or the hepatocellular pattern with variable cholestasis.

Estimation of bioaccessibility and potential human health risk of mercury in Chinese patent medicines

“…The concentrations of toxic heavy metals in 42 of 2080 TCMs were found to exceed Singapore's legal limits, including 28 for mercury, 6 for arsenic, and 8 for lead (Ernst, 2002;Koh and Woo, 2000). Such issues were also reported in Europe (Melchart et al, 1999;Zhang et al, 2012) and Japan (Itoh et al, 1995).…”

Hepatotoxicity of botanicals

“…In this area, reports referring to a herbal preparation named Sho-saiko-to are con¯icting. While Itoh et al attributed the observed hepatotoxicity of this herbal composition to Scutellaria (skullcap) 25 , others have even suggested bene®cial properties with regard to the liver. It has been shown lately in both human and animal studies that Sho-saiko-to is capable of preventing hepatocellular carcinoma and ®brosis in humans, an observation which was consecutively supported by experimental data from in vivo and in vitro studies 26±28 .…”

Herbalife hepatotoxicity: Evaluation of cases with positive reexposure tests

“…Retrospective assessment of unintentional reexposure tests is cumbersome, because clinical conditions are variable, as shown in the present report (Tables 1 and 4) [1][2][3][4][5] and in previous case analyses [14,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] . Specific criteria for reexposure tests are available since 1988 (Table 3) [31] and have been incorporated in the CIOMS scale (Table 4) [16,32,34] following successful use for validation purposes [33] .…”

“…Data problems of reexposure cases are not confined to Herbalife products (Table 4) but represent a general problem extending to liver injury by all herbal drugs, dietary supplements and herbal products [14,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] . Analysis of 30 cases within the last three decades claiming a positive reexposure test revealed that in many cases detailed descriptions of the reexposure test and actual ALT values were lacking.…”

“…In retrospect, a positive reexposure test has been confirmed in only 13/30 cases (43%) [16] , as ascertained by established criteria published previously [31] . Of note, none of these reports communicated criteria for the evaluation of the observed reexposure test [14,16,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] . The use of inappropriate causality assessment methods in the analyzed case reports is difficult to reconcile [1][2][3][4][5] .…”