Adulteration by Synthetic Therapeutic Substances of Traditional Chinese Medicines in Taiwan

Huang, Weng Foung; Wen, Kuo‐Ching; Hsiao, Mei-Ling

doi:10.1002/j.1552-4604.1997.tb04312.x

Cited by 199 publications

(107 citation statements)

References 6 publications

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“…An average of 23.7% of samples was adulterated. [84] Adulterants present in several Chinese preparations included berberine, chlorphenamine, acetaminophen, theophylline, caff eine, ephedrine, dipyrone and fl uocinonide. [85] Another main problem related to botanical products is their possible contamination with toxic substances (heavy metals, pesticides, herbicides) or microorganisms and mycotoxins.…”

Section: Safety Implicationsmentioning

confidence: 99%

Raw materials: the importance of quality and safety. A review.

Salgueiro

Martins

Correia

2010

Flavour & Fragrance J

107

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Aromatic plants and spices are used throughout the world for fl avouring food and beverages, as well as for food supplements, novel foods and as a source of essential oils and aromatic extracts. The non-availability or inadequacy of standards for checking and assuring the quality of aromatic plants and spices is one of the main problems that arise for industry when using such raw materials. As many aromatic plants are harvested from the wild, standardization to assure their quality is important for their safe and eff ective utilization in food and beverage industries. On the other hand, there are numerous parameters that infl uence the chemical composition of plants, which play an important role in the fi nal quality of the product and possibly in any risk arising to the consumer. Also, from a safety point of view, aromatic plants and spices should be free of undeclared contaminants and adulterants, such as toxic botanicals, pathogenic microorganisms and excessive levels of microbial toxins, pesticides or fumigation agents. We focus on these aspects and examine ways to assure their appropriate utilization from the quality and safety standpoint. The regulatory situation of medicinal and aromatic plants (MAPs) is very complicated; several diff erences in standards and regulations between countries can be found, a situation that can result in more health risks arising for consumers. To clarify some of the existing problems, the major regulations of the USA and the European Union (EU) and the borderlines between food supplements and medicines and other international standards, are briefl y described and discussed.

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Section: Safety Implicationsmentioning

confidence: 99%

Raw materials: the importance of quality and safety. A review.

Salgueiro

Martins

Correia

2010

Flavour & Fragrance J

107

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“…In addition, herbal medicines may be adulterated with unidentified ingredients. In just Taiwan and Hong Kong, 23.7% and 2.6%, respectively, of herbal medicines may be illegally adulterated with undeclared pharmaceutical products such as heavy metals (Huang et al 1997;Lanzarotta et al 2012). We strongly suspect that the homemade TCM medicine taken by the patients in this report had been adulterated with lead.…”

Section: Discussionmentioning

confidence: 99%

Lead Poisoning Caused by Traditional Chinese Medicine: A Case Report and Literature Review

Tang

Feng

2017

Tohoku J. Exp. Med.

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Traditional Chinese herbal medicine is widely used for primary health care worldwide as it mostly consists of herbs or herbal extracts known to be safe. However, owing to the intentional or unintentional addition to herbs of lead-containing bases or pastes, lead poisoning from traditional Chinese medicine (TCM) remains a serious issue. We report here a case of lead poisoning caused by long-term use of homemade TCM. A 66-year-old man was admitted for periumbilical pain and constipation. A detailed medication history revealed that the patient had been using homemade TCM for the past 8 months. Screening for heavy metals showed that the patient had a blood lead level of 657 μg/L and his wife, who was asymptomatic, had a blood lead level of 488 μg/L. Chemical analysis confirmed a lead concentration of more than 4,000 mg/ kg in the TCM. Both individuals were advised to discontinue the medications and chelation treatment was immediately initiated for the husband. The patient's periumbilical pain was noticeably relieved after treatment, and blood lead levels returned to normal after three treatment rounds. We also review here the literature to summarize the usual reasons for taking TCM and common features of lead poisoning. Our findings suggest that potential exposure to lead from TCM treatment must be considered when diagnosing unexplained cases of abdominal colic in China. The Chinese health authority should speed up legislation to improve the regulatory framework of TCM, especially regarding small private clinics.

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“…Another point of interest focuses on solvents and solubilizers without regulatory advice [8,11,15,16] , as well as on adulterants, impurities, contaminants, or misidentified herbs [4,7,8,11] . These key issues of herbal product quality are rarely addressed in publications related to herbal hepatotoxicity [1,4,[8][9][10][11][12][13][14][15][16][17][20][21][22][23][24][25][26][27][28][29][30][31][32][33] .…”

Section: Herbal Product Essentialsmentioning

confidence: 99%

Herbal hepatotoxicity: Challenges and pitfalls of causality assessment methods

Teschke¹,

Frenzel²,

Schulze³

et al. 2013

WJG

156

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totoxicity cases, compared to numerous other causality assessment methods, which are inferior on various grounds. Among these disputed methods are the Maria and Victorino scale, an insufficiently qualified, shortened version of the CIOMS scale, as well as various liver unspecific methods such as the ad hoc causality approach, the Naranjo scale, the World Health Organization (WHO) method, and the Karch and Lasagna method. An expert panel is required for the Drug Induced Liver Injury Network method, the WHO method, and other approaches based on expert opinion, which provide retrospective analyses with a long delay and thereby prevent a timely assessment of the illness in question by the physician. In conclusion, HILI causality assessment is challenging and is best achieved by the liver specific CIOMS scale, avoiding pitfalls commonly observed with other approaches.© 2013 Baishideng. All rights reserved.Key words: Herbal hepatotoxicity; Herb induced liver injury; Herbs; Drug hepatotoxicity; Drug induced liver injury; Causality assessment Core tip: This review focuses on diagnostic causality assessment algorithms that have been used so far in herb induced liver injury (HILI) cases. Detailed information of the various methods with their strengths and weaknesses is provided including their challenges and pitfalls that emerged during the assessing course. For the physician caring for a patient with suspected HILI, the Council for International Organizations of Medical Sciences (CIOMS) scale is the preferred tool for assessing causality compared to numerous other causality assessment methods, which are inferior on various grounds. CIOMS based assessment should start at the day HILI is suspected to ensure completeness of clinical data. AbstractThe diagnosis of herbal hepatotoxicity or herb induced liver injury (HILI) represents a particular clinical and regulatory challenge with major pitfalls for the causality evaluation. At the day HILI is suspected in a patient, physicians should start assessing the quality of the used herbal product, optimizing the clinical data for completeness, and applying the Council for International Organizations of Medical Sciences (CIOMS) scale for initial causality assessment. This scale is structured, quantitative, liver specific, and validated for hepatotoxicity cases. Its items provide individual scores, which together yield causality levels of highly probable, probable, possible, unlikely, and excluded. After completion by additional information including raw data, this scale with all items should be reported to regulatory agencies and manufacturers for further evaluation. The CIOMS scale is preferred as tool for assessing causality in hepa-

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Adulteration by Synthetic Therapeutic Substances of Traditional Chinese Medicines in Taiwan

Cited by 199 publications

References 6 publications

Raw materials: the importance of quality and safety. A review.

Raw materials: the importance of quality and safety. A review.

Lead Poisoning Caused by Traditional Chinese Medicine: A Case Report and Literature Review

Herbal hepatotoxicity: Challenges and pitfalls of causality assessment methods

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