Toxic hepatitis associated with Polygoni multiflori

Abstract

Toxic hepatitis has been reported as a major cause of acute hepatitis, but its potential induction by herbal remedies and/or health foods is usually neglected. We experienced a case of toxic hepatitis associated with Polygoni multiflori, a Chinese herb commonly known as Ho-Shou-Wu. A 54-year-old woman consumed Ho-Shou-Wu for 1 month, after which she experienced fatigue and overall weakness. A diagnosis of toxic hepatitis was made based on her clinical history, the findings for viral markers and other laboratory data, and ultrasonography. Her condition improved considerably after she stopped taking Ho-Shou-Wu. However, she resumed taking Ho-Shou-Wu immediately after discharge from hospital, which aggravated her symptoms and liver function. She was immediately readmitted and stopped taking Ho-Shou-Wu. Her relapse into hepatitis immediate after resuming consumption of the herb is strongly indicative of the validity of Koch's postulate in this case.

Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

“…Assumed causality was mostly based on clinical judgment, rarely on the results of liver specific causality assessment methods [70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135…”

“…He Shou Wu, Shou Wu Wan, Fo Ti) and experienced acute liver injury [105]. Hepatotoxicity of Ho Shou Wu was also assumed in a 33-year old woman in Hong Kong with a chronic HBV infection, but comedication also consisted of the hepatotoxic Jue Ming Zi ( Cassia obtusifolia tora , Senna) and 10 additional and not further identified herbal products [82].…”

“…Kamishoyosan is a herbal mixture and contains several components like Angelica sinensis , Atractylodes racea , Bupleurum falcatum , Gardenia , Glycyrrhiza glabra , Mentha haplocalyx , Moutan , Paeonia alba , Sclerotium Poriae Cocos and Zingiber officinale , as described in the case report [92], or assessed by an additional internet search for a refined botanical description of the herbal components. The identification of the causative agents was difficult, but Scutellaria was definitively excluded as it was not an ingredient of this herbal product [105,130]. Some uncertainty exists around the Mentha species , declared as Mentha herb in the case report [92] and as mentha (pennyroyal) subsequently [130].…”

A Pediatric Case of Toxic Hepatitis Induced by Hovenia Dulcis

“…Not only do their side effects appear as toxic hepatitis but occur in various different forms. However, since most bioactive substances are metabolized in the liver, toxic hepatitis is a side effect that should always be examined for crude drugs or health medicine in addition to all other medicine [8,10]. Especially, children have different physiological characteristics from those of adults and are more sensitive to medicine.…”

“…In Korea, since people believe natural herb medicine has less side effects than commercialized medicine, the use of oriental medicine and health supplements is increasing, and the abuse of such product is more likely to increase the frequency of liver injury [8,9]. According to a recent retrospective research on 159 patients hospitalized for toxic hepatitis, 41.5% was caused by oriental medicine and 24.5% was by folk drugs such as Dictamnus, Perennial Artemisia, Ginseng, kudzu and Sanghwang Mushroom [3].…”