Teschke Rolf, Zhang Li, Long Hongzhu, Schwarzenboeck Alexander, Schmidt-Taenzer Wolfgang, Genthner Alexander, Wolff Albrecht, Frenzel Christian, Schulze Johannes, Eickhoff Axel
Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/ Main, Germany.
Center for Drug Reevaluation, China Food and Drug Administration, Beijing, China.
Ann Hepatol. 2015 Jan-Feb;14(1):7-19.
Traditional Chinese Medicine (TCM) with its focus on herbal use became popular worldwide. Treatment was perceived as safe, with neglect of rare adverse reactions including liver injury. To compile worldwide cases of liver injury by herbal TCM, we undertook a selective literature search in the PubMed database and searched for the items Traditional Chinese Medicine, TCM, Traditional Asian Medicine, and Traditional Oriental Medicine, also combined with the terms herbal hepatotoxicity or herb induced liver injury. The search focused primarily on English-language case reports, case series, and clinical reviews. We identified reported hepatotoxicity cases in 77 relevant publications with 57 different herbs and herbal mixtures of TCM, which were further analyzed for causality by the Council for International Organizations of Medical Sciences (CIOMS) scale, positive reexposure test results, or both. Causality was established for 28/57 different herbs or herbal mixtures, Bai Xian Pi, Bo He, Ci Wu Jia, Chuan Lian Zi, Da Huang, Gan Cao, Ge Gen, Ho Shou Wu, Huang Qin, Hwang Geun Cho, Ji Gu Cao, Ji Xue Cao, Jin Bu Huan, Jue Ming Zi, Jiguja, Kudzu, Ling Yang Qing Fei Keli, Lu Cha, Rhen Shen, Ma Huang, Shou Wu Pian, Shan Chi, Shen Min, Syo Saiko To, Xiao Chai Hu Tang, Yin Chen Hao, Zexie, and Zhen Chu Cao. In conclusion, this compilation of liver injury cases establishes causality for 28/57 different TCM herbs and herbal mixtures, aiding diagnosis for physicians who care for patients with liver disease possibly related to herbal TCM.
以草药应用为重点的传统中医在全球范围内广受欢迎。人们认为其治疗方法安全，却忽视了包括肝损伤在内的罕见不良反应。为汇总全球范围内由中药引起的肝损伤病例，我们在PubMed数据库中进行了选择性文献检索，搜索了“传统中医”“中医”“传统亚洲医学”和“传统东方医学”等词条，并结合“草药肝毒性”或“草药引起的肝损伤”等术语。检索主要集中在英文病例报告、病例系列和临床综述。我们在77篇相关出版物中确定了报告的肝毒性病例，涉及57种不同的中药草药及草药混合物，并根据国际医学科学组织理事会（CIOMS）标准、阳性再暴露试验结果或两者对其因果关系进行了进一步分析。57种不同的草药或草药混合物中有28种确定了因果关系，包括白鲜皮、薄荷、刺五加、川楝子、大黄、甘草、葛根、何首乌、黄芩、黄根草、积雪草、积雪草、金不换、决明子、枳椇子、葛根、羚羊清肺颗粒、绿茶、人参、麻黄、首乌片、山慈菇、参麦、小柴胡汤、茵陈蒿、泽泻和珍珠草。总之，这份肝损伤病例汇编确定了57种不同的中药草药及草药混合物中的28种具有因果关系，有助于为诊治可能与中药相关肝病患者的医生提供诊断依据。
