Larrey D
Presse Med. 1994 Apr 16;23(15):691-3.
The development of herbal medicine has follow in line with increased popular interest in ecology. Emphasis has been placed on the safety of natural herbs in contrast with the risks involved with "classical" medicines. But recent publications have revealed that several herbal medicines are toxic for the liver. For example, in France we have observed cases of hepatitis after ingestion of germander (Teucrium chamaedrys). Clinicians should also be aware of other well documented toxic effects of herbs used in popular medicines in Africa, Asia or Central America. The toxicity of pyrrolizidine alkaloids was recognized over 40 years ago. More than 300 plant species, including Heliotropium, Crotalaria, Senecio and Symphytum, are implicated. In Africa or Central America, intoxication is sometimes endemic since these plants are often used for making tea. In Western countries, cases of herb-induced hepatitis have been observed after use of preparations containing Symphytum or Chinese herbs. Pyrrolizidine alkaloids cause obstruction of the hepatic venous system and can lead to hepatonecrosis. Clinical manifestations include abdominal pain, ascitis, hepatomegaly and raised serum transaminase levels. Prognosis is often poor with death rates of 20 to 30% being reported. Atractylis gummifera is another example of herbal toxicity. Twenty-six species of this plant are used for medicinal purposes or for chewing gum. Intoxication usually occurs in the spring and is related to chewing the roots of these plants. Severe hepatocellular lysis may occur less than 24 hours after ingestion. Clinical manifestations are related to the induced hypoglycemia and neurovegetative disorders or subsequent renal failure. These compounds have an inhibitor effect on the Krebs cycle and can lead to severe or fatal liver failure. Other similar cases of fatal liver accidents have been reported after ingesting Callilepis laureola, a herb used by the Zoulous in Natal for medicinal purposes or after use of products containing extracts of Teucrium chamaedrys, which was nevertheless authorized in France in 1986 for use in preparations for weight loss. These examples emphasize the importance of remembering that herbal medicine is not harmless. Faced with the extensive distribution of many herbal preparations and the risk of self-medication, consumers and clinicians alike should be increasingly vigilant with these potentially hepatotoxic products.
草药医学的发展与人们对生态学兴趣的增加相一致。与“传统”药物所涉及的风险相比，人们更强调天然草药的安全性。但最近的出版物显示，几种草药对肝脏有毒性。例如，在法国，我们观察到摄入夏至草（Teucrium chamaedrys）后出现肝炎病例。临床医生也应该了解在非洲、亚洲或中美洲的大众药物中使用的其他有充分文献记载的草药毒性作用。40多年前就认识到了吡咯里西啶生物碱的毒性。包括天芥菜属、猪屎豆属、千里光属和聚合草属在内的300多种植物都与之有关。在非洲或中美洲，中毒有时呈地方性流行，因为这些植物常被用来泡茶。在西方国家，使用含有聚合草或中草药的制剂后，也观察到了草药引起的肝炎病例。吡咯里西啶生物碱会导致肝静脉系统阻塞，并可导致肝坏死。临床表现包括腹痛、腹水、肝肿大和血清转氨酶水平升高。预后通常很差，据报道死亡率为20%至30%。胶苍术是草药毒性的另一个例子。这种植物的26个品种被用于药用或制作口香糖。中毒通常发生在春季，与咀嚼这些植物的根有关。摄入后不到24小时可能会发生严重的肝细胞溶解。临床表现与诱发的低血糖和植物神经紊乱或随后的肾衰竭有关。这些化合物对三羧酸循环有抑制作用，并可导致严重或致命的肝功能衰竭。在摄入纳塔尔祖鲁人用于药用的草药月桂卡利列皮斯（Callilepis laureola）后，或使用含有夏至草提取物的产品后（尽管该产品于1986年在法国被批准用于减肥制剂），也报告了其他类似的致命肝脏事故案例。这些例子强调了记住草药并非无害的重要性。面对许多草药制剂的广泛分销和自我用药的风险，消费者和临床医生都应该对这些潜在的肝毒性产品越来越警惕。
