Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.
Department of Chinese Medicine pharmacy, China Medical University Hospital, Taichung, Taiwan.
Complement Ther Med. 2019 Feb;42:286-291. doi: 10.1016/j.ctim.2018.11.028. Epub 2018 Dec 6.
Species of Tinospora are used as herbal remedies for the treatment of various diseases with very few toxic effects having been reported. Tinospora cordifolia (TCF) has been reported to effectively prevent hepatotoxicity. However, there are an increasing number of cases revealing that Tinospora crispa (TCP) might have the negative effect of inducing hepatotoxicity. Because of the similar leaves, people may mistake TCP for TCF, and consume it with the purpose of protecting liver function.
Find out the misusing level of TCP and TCF and which chemical compound in TCP might induce hepatotoxicity.
We report two cases of acute fulminant hepatitis associated with chronic use of TCP. Given that the two herbs were misidentified in these two reports, we investigated the frequency of erroneous identification by using three keywords ("Guduchi", "Tinospora cordifolia", "Tinospora crispa") to search images from the Google Images database. To further clarify the influence of liver function between TCP and TCF, we searched PubMed (up to 29 July 2018) for relevant publications on clinical trials or case reports.
Based on web review, over 35 percent of websites failed to accurately identify these two herbs. The different effects on liver function between TCP and TCF were compared through literature review. It indicated that TCF exerted liver protection, TCP had a contrary effect, suggesting its cis-Clerodane-type furano-diterpenoids might be an important factor of inducing hepatotoxicity.
We concluded that people might cause hepatic injury or even death without correctly identifying these two Tinospora species.
藤属植物被用作草药治疗各种疾病，其毒性作用很少被报道。三叶苦（TCF）已被报道能有效预防肝毒性。然而，越来越多的病例表明，细圆藤（TCP）可能具有诱导肝毒性的负面作用。由于叶子相似，人们可能会将 TCP 误认为 TCF，并将其用于保护肝功能。
找出 TCP 和 TCF 的误用程度，以及 TCP 中的哪种化合物可能导致肝毒性。
我们报告了两例与慢性使用 TCP 相关的急性暴发性肝炎。鉴于这两种草药在这两例报告中被错误识别，我们使用了三个关键字（“Guduchi”、“Tinospora cordifolia”、“Tinospora crispa”）来搜索 Google 图片数据库中的图像，以调查错误识别的频率。为了进一步阐明 TCP 和 TCF 对肝功能的影响，我们在 PubMed 上搜索了（截至 2018 年 7 月 29 日）关于临床试验或病例报告的相关出版物。
根据网络评论，超过 35%的网站未能准确识别这两种草药。通过文献回顾比较了 TCP 和 TCF 对肝功能的不同影响。结果表明 TCF 具有肝脏保护作用，TCP 则有相反的作用，表明其顺式-Clerodane 型呋喃二萜类化合物可能是诱导肝毒性的一个重要因素。
我们得出结论，人们可能会因错误识别这两种藤本植物而导致肝损伤甚至死亡。
