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Table 5 Suspected herbal ingredients with previous 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
Chai Hu (Radix bupleuri) 11 (19.3) Acute hepatitis (9), Acute hepatic necrosis (2) 18.0 (33.5) Disperses and reduces fever, soothes the liver in order to alleviate mood, increase ‘yang qi’ 3–10
Cang Zhu (Atractylodes lancea) 8 (14.0) Acute hepatitis (3), Acute hepatic necrosis (2), Cholestatic hepatitis (1), Enzyme elevations without jaundice (1), Mixed hepatocellular-cholestatic hepatitis (1) 7.9 (15.5) Reduces ‘dampness’, strengthens the spleen, dispels ‘wind’ and dissipates ‘cold’, and improves vision 3–9
Zhi Ban Xia (Rhizoma pinelliae ternatae preparata) 7 (12.3) Acute hepatitis (3), Acute hepatic necrosis (2), Enzyme elevations without jaundice (2) 5.7 (3.4) Reduces ‘dampness’ and phlegm, suppresses counteractive flow (e.g. vomiting), dissolves lumps and reduces masses 3–9
Xi Xin (Radix et rhizome asari) 7 (12.3) Acute hepatitis (4), Acute hepatic necrosis (1), Enzyme elevations without jaundice (2) 2.2 (1.6) Dispels ‘wind’ and dissipates ‘coldness’, dispels ‘wind’ and relieves pain, relieves blocked nose, warms the lungs and resolves fluid retention 1–3
Da Huang (Radix et rhizoma rhei) 6 (10.5) Acute hepatitis (3), Acute hepatic necrosis (1), Enzyme elevations without jaundice (1), Mixed hepatocellular-cholestatic hepatitis (1) 8.1 (15.2) Removes accumulation of waste materials through purging, clears ‘heat’ and purges ‘fire’, cools the blood and removes toxins, expel stasis in order to unblock the meridians, drains ‘dampness’ to reduce jaundice 3–15
Ma Huang (Ephedra sinica) 4 (7.0) Acute hepatitis (2), Acute hepatic necrosis (1), Enzyme elevations without jaundice (1) 3.7 (1.2) Promotes sweating and dissipates ‘cold’, diffuse the lungs to relieve panting, and promotes urination to alleviate edema 2–10
Tian Hua Fen (Radix trichosanthis) 3 (5.3) Acute hepatitis (2), Cholestatic hepatitis (1) 1.1 (1.3) Clears ‘heat’ and purges ‘fire’, gives rise to fluid to quench thirst, disperses swelling and expels pus 10–15
Bai Xian Pi (Dictamni cortex) 2 (3.5) Acute hepatic necrosis (1), Acute hepatitis (1) 0.7 (N/A b) Clears ‘heat’ and dry ‘dampness’, dispels ‘wind’ and removes toxins 5–10
Jue Ming Zi (Semen cassiae) 2 (3.5) Acute hepatitis (1), Enzyme elevations without jaundice (1) 0.7 (0.7) Clears ‘heat’ and improves vision, ‘moistens the intestines to promote bowel movement 9–15
Chuan Lian Zi (Fructus toosendan) 2 (3.5) Acute hepatitis (2) 1.2 (N/A b) Soothes the liver and discharges ‘heat’, move ‘qi’ to relieve pain, kill worms 5–10
Cang Er Zi (Fructus xanthii sibirici) 2 (3.5) Acute hepatitis (2) 4.7 (4.7) Disperses coldness caused by wind, relieves blocked nose, dispels ‘wind-dampness’ 3–10
Hu Zhang (Radix polygoni cuspidati) 2 (3.5) Acute hepatitis (2) 4.6 (4.8) Reduces ‘dampness’ to abate jaundice, clears heat and removes toxins, dissipates stasis and relieves pain, suppresses cough and resolves phlegm 9–15
Du Huo (Radix angelicae pubescentis) 2 (3.5) Acute hepatic necrosis (1), Acute hepatitis (1) 1.9 (1.6) Dispels ‘wind’ and removes ‘dampness’, relieves pain 3–10
He Shou Wu (Radix polygoni multiflori) 1 (1.8) Acute hepatitis (1) 1.0 (N/A) Removes toxins, disperses abscesses, manage malaria, and ‘moistens’ the intestines to promote bowel movement 3–6
Zhi He Shou Wu (Radix polygoni multiflori praeparata) 1 (1.8) Acute hepatitis (1) 1.8 (N/A) Strengthens the liver and kidney, replenishes essence and blood, darkens beard and hair, strengthens sinew and bone, and reduces lipid levels 6–12
  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)
  4. b Standard deviations for Bai Xian Pi (Dictamni cortex) and Chuan Lian Zi (Fructus toosendan) were not available due to insufficient dosing information