Department of Oriental Medicine, Doctoral Program of Medical Science, Kitasato University Graduate School, Sagamihara, Kanagawa, Japan.
J Altern Complement Med. 2010 Apr;16(4):501-5. doi: 10.1089/acm.2009.0183.
Saireito consists of components of shosaikoto and goreisan. There are several reports of liver injury caused by shosaikoto and saireito, whereas cases caused by goreisan are rarely seen.
A 70-year-old woman suffered from sicca of the eyes and oral cavity that arose in 2003. In June 2004, we diagnosed her as having Sjögren syndrome on the basis of Schirmer's test, salivary scintigraphy, presence of anti-SS-A/Ro antibody, and subjective symptoms. Although a muscarinic agonist was commenced, her sicca symptoms did not improve.
In February 2008, 7.5 g/day of shosaikoto extract granules (for ethical use, Tsumura & Co., Tokyo, Japan) was introduced. Her symptoms and laboratory data did not change. The next month, the treatment was replaced by 9.0 g/day of saireito extract granules (for ethical use, Tsumura & Co., Tokyo, Japan).
After 10 weeks, elevation of liver enzymes was observed. On suspicion of drug-induced liver injury (DILI), saireito was withdrawn, and the patient's liver enzymes returned to normal the next month. Drug-induced lymphocyte stimulation tests (DLSTs) for saireito, shosaikoto, and goreisan were all positive.
The clinical course suggested allergy to the goreisan component of saireito. It is important to be aware of the limitation of DLST as a diagnostic tool for DILI, especially for herbal medicines.
清上饮由小柴胡汤和芍药甘草汤组成。有几起因小柴胡汤和清上饮引起肝损伤的报告，而由芍药甘草汤引起的病例则很少见。
一位 70 岁女性于 2003 年出现眼干和口干。2004 年 6 月，根据 Schirmer 试验、唾液闪烁显像、抗 SS-A/Ro 抗体阳性和主观症状，我们诊断为干燥综合征。虽然开始使用拟副交感神经药，但她的干燥症状并未改善。
2008 年 2 月，开始每天服用 7.5 克清上饮提取物颗粒（出于伦理原因，Tsumura & Co.，东京，日本）。她的症状和实验室数据没有变化。下个月，将治疗药物更换为每天 9.0 克清上饮提取物颗粒（出于伦理原因，Tsumura & Co.，东京，日本）。
10 周后，观察到肝酶升高。怀疑药物性肝损伤（DILI），停用清上饮，患者的肝酶在接下来的一个月内恢复正常。清上饮、小柴胡汤和芍药甘草汤的药物诱导淋巴细胞刺激试验（DLST）均为阳性。
临床过程提示对清上饮中芍药甘草汤成分过敏。重要的是要意识到 DLST 作为 DILI 诊断工具的局限性，特别是对于草药。
