Clinical and Translational Hepatology, The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, India.
Department of Clinical Research, Division of Complementary and Alternative Medicine and the Liver, The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, India.
Medicine (Baltimore). 2024 Apr 19;103(16):e37903. doi: 10.1097/MD.0000000000037903.
Complementary and alternative medicine-related liver injuries are increasing globally. Alternative medicine, as an inclusive healthcare practice, is widely accepted in developing and underdeveloped countries. In this context, the traditional systems of medicine in India have been at the forefront, catering to the preventive and therapeutic spectrum in the absence of conclusive evidence for benefits and lack of data on safety. Contrary to popular belief, it is evident that apart from adverse events caused by contamination and adulteration of alternative medicines, certain commonly used herbal components have inherent hepatotoxicity. This narrative review updates our current understanding and increasing publications on the liver toxicity potential of commonly used herbs in traditional Indian systems of medicine (Ayush), such as Tinospora cordifolia (Willd.) Hook.f. & Thomson (Giloy/Guduchi), Withania somnifera (L.) Dunal (Ashwagandha), Curcuma longa L. (Turmeric), and Psoralea corylifolia L. (Bakuchi/Babchi). This review also highlights the importance of the upcoming liver toxicity profiles associated with other traditional herbs used as dietary supplements, such as Centella asiatica (L.) Urb., Garcinia cambogia Desr., Cassia angustifolia Vahl (Indian senna), and Morinda citrofolia L. (Noni fruit). Fortunately, most reported liver injuries due to these herbs are self-limiting, but can lead to progressive liver dysfunction, leading to acute liver failure or acute chronic liver failure with a high mortality rate. This review also aims to provide adequate knowledge regarding herbalism in traditional practices, pertinent for medical doctors to diagnose, treat, and prevent avoidable liver disease burdens within communities, and improve public health and education.
补充和替代医学相关的肝损伤在全球范围内呈上升趋势。替代医学作为一种综合性的医疗实践，在发展中国家和不发达国家得到了广泛的认可。在这种情况下，印度的传统医学体系一直处于领先地位，满足了预防性和治疗性的需求，尽管缺乏确切的益处证据，也缺乏安全性数据。与普遍看法相反，很明显，除了替代药物的污染和掺假引起的不良事件外，某些常用草药成分本身就具有肝毒性。本综述更新了我们目前对传统印度医学体系（阿育吠陀）中常用草药的肝毒性潜力的理解和日益增多的出版物，如 Tinospora cordifolia (Willd.) Hook.f. & Thomson (Giloy/Guduchi)、Withania somnifera (L.) Dunal (Ashwagandha)、Curcuma longa L. (Turmeric) 和 Psoralea corylifolia L. (Bakuchi/Babchi)。本综述还强调了即将出现的与其他作为膳食补充剂使用的传统草药相关的肝毒性特征的重要性，如 Centella asiatica (L.) Urb.、Garcinia cambogia Desr.、Cassia angustifolia Vahl（印度番泻叶）和 Morinda citrofolia L.（诺丽果）。幸运的是，大多数报告的这些草药引起的肝损伤是自限性的，但可能导致进行性肝功能障碍，导致急性肝衰竭或急性慢性肝衰竭，死亡率很高。本综述还旨在提供有关传统实践中草药学的足够知识，为医生在社区中诊断、治疗和预防可避免的肝病负担提供帮助，并改善公共卫生和教育。
