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Table 3 Most commonly found herbal ingredients with limited or lack of documented reports of possible hepatotoxicity

From: Drug-induced liver injury associated with Complementary and Alternative Medicine: a review of adverse event reports in an Asian community from 2009 to 2014

Name of herbal ingredient No. of cases, n (%) Types of hepatotoxicity implicated (n) Mean TDD (g) (SD) Mechanisms of action (based on TCM system of therapeutics) a Recommended daily doses (g) a
Fu Ling (Sclerotium poriaecocos) 18 (31.6) Acute hepatic necrosis (3), Acute hepatitis (11), Cholestatic hepatitis (1), Mixed hepatocellular-cholestatic hepatitis (1), Enzyme elevations without jaundice (2) 8.3 (13.4) Promotes urination in order to drain dampness, strengthens the spleen and calms the heart. 10–15
Huang Qin (Radix scutellaria baicalensis) 15 (26.3) Acute hepatic necrosis (3), Acute hepatitis (10), Mixed hepatocellular-cholestatic hepatitis (1), Enzyme elevations without jaundice (1) 6.3 (12.1) Clears heat and dries dampness, purges fire to remove toxin, stops bleeding and prevents miscarriage. 3–10
Gan Cao (Radix glycyrrhizae) 15 (26.3) Acute hepatic necrosis (3), Acute hepatitis (8), Mixed hepatocellular-cholestatic hepatitis (1), Enzyme elevations without jaundice (3) 8.9 (10.6) Strengthens spleen and improves 'qi', clears heat and removes toxin, dispels phlegm in order to relieve cough, relax spasm and relieves pain and moderate drug actions. 2–10
Ze Xie (Alisma orientalis) 14 (24.6) Acute hepatic necrosis (2), Acute hepatitis (11), Mixed hepatocellular-cholestatic hepatitis (1) 5.9 (14.4) Promotes urination to drain dampness, discharge heat, revolves turbidity, and lowers lipid 6–10
Chuan Xiong (Rhizoma ligustici) 14 (24.6) Acute hepatic necrosis (1), Acute hepatitis (10), Mixed hepatocellular-cholestatic hepatitis (1), Enzyme elevations without jaundice (2) 6.3 (8.3) Activates blood and moves 'qi', and dispels wind in order to relief pain. 3–10
  1. Total number of reports included in data analysis, N = 57
  2. Abbreviations used: TCM Traditional Chinese Medicine, TDD total daily doses of raw herb (in grams)
  3. a Information is obtained from the Pharmacopoeia of the People’s Republic of China, 9th Ed, 2010 (English Ed)