Review Article

Systematic Review on Chinese Herbal Medicine Induced Liver Injury

Table 1

List of CHM with reported hepatotoxicity.

CHMPart used/ingredientsPotential toxicity mechanismApplicationRecommended dosageCasesReferences

He-Shou-WuRadixProbably associated with anthraquinone derivatives, lipid peroxidation, or an immune response [32, 33] Alopecia and grey hair3~6 g/d (unprocessed herb), 6~12 g/d (processed herb) Preparation unmentioned, 25Jung et al., 2011 [18]
4 unprocessed, 14 processedDong et al., 2014 [19]
1 unprocessedZhang et al., 2014 [27]
Preparation unmentioned, 2Yuan and Chen, 2014 [25]
Preparation unmentioned, 1Yang et al., 2014 [28]
Preparation unmentioned, 18Ren and Xu, 2015 [29]

Cang-Er-ZiFruitProbably kaurene glycosides induced liver injury via oxidative stress as lipid peroxidation in liver [34]To eliminate wind and dampness3~10 g/d1Wang et al., 2013 [24]

Huang-Yao-ZiRhizomaProbably oxidative stress injury caused by diosbulbin [35]Thyroid nodule4.5~9 g/d1Jiang and Yang, 2014 [26]

Lei-Gong-TengRadixProbably associated with triptolide, lipid peroxidation, and an immune response [36, 37]OsteoarthrosisNA4Ren and Xu, 2015 [29]

Yang Xue Sheng Fa Jiao Nang Shu-Di-Huang, Dang-Gui, Qiang-Huo (Notopterygium incisum Ting ex H. T. Chang), Mu-Gua (Chaenomeles sinensis (Thouin) Koehne), Chuan-Xiong, Bai-Shao (Paeonia lactiflora Pall.), Tu-Si-Zi (Cuscuta chinensis Lam.), Tian-Ma (Gastrodia elata Blume), Zhi-Shou-WuAlopecia4 granules, twice a day4Ren and Xu, 2015 [29]

Bai Dian Feng Jiao Nang Bu-Gu-Zhi 33.33 g, Huang-Qi (Astragalus propinquus Schischkin) 33.33 g, Hong-Hua 33.33 g, Chuan-Xiong 33.33 g, Dang-Gui 33.33 g, Xiang-Fu (Cyperus rotundus L.) 33.33 g, Tao-Ren (Prunus persica (L.) Batsch) 33.33 g, Dan-Shen (Salvia miltiorrhiza Bunge) 33.33 g, Wu-Shao-She (Zaocys) 33.33 g, Zi-Cao (Lithospermum erythrorhizon Siebold & Zucc.)
33.33 g, Bai-Xian-Pi 33.33 g, Shan-Yao (Dioscorea oppositifolia L.) 33.33 g, Gan-Jiang 33.33 g, Long-Dan (Gentiana scabra Bunge) 33.33 g, Yan-Ji-Li (Tribulus terrestris L.) 433.33 g
Leucoderma3~4 granules, twice a day4Ren and Xu, 2015 [29]

Xiao Yin PianDi-Huang, Dan-Pi (Paeonia officinalis L.), Chi-Shao, Dang-Gui, Ku-Shen (Sophora flavescens Aiton), Jin-Yin-Hua (Lonicera japonica Thunb.), Xuan-Shen (Scrophularia ningpoensis Hemsl.), Niu-Bang-Zi (Arctium lappa L.), Chan-Tui (Cicadae periostracum), Bai-Xian-Pi, Fang-Feng (Saposhnikovia divaricata (Trucz.) Schischk.), Da-Qing-Ye (Wrightia laevis Hook. f.), Hong-Hua Psoriasis5~7 tablets, three times a day3Ren and Xu, 2015 [29]

Qu Bai Ba Bu PianLeucodermaNA2Ren and Xu, 2015 [29]

Bu Shen Sheng Fa TangAlopeciaNA1Ren and Xu, 2015 [29]

Ze Qi Chong Ji PsoriasisNA1Ren and Xu, 2015 [29]

Xian Ling Gu Bao Jiao NangOsteoarthrosisNA3Ren and Xu, 2015 [29]

Gu Kang Jiao NangOsteoarthrosisNA2Ren and Xu, 2015 [29]

Zhuang Gu Jiao NangOsteoarthrosisNA1Ren and Xu, 2015 [29]

Ling Zhi Yi Shou Jiao NangHealth promotionNA2Ren and Xu, 2015 [29]

Ling Zhi Jiao NangHealth promotionNA1Ren and Xu, 2015 [29]

Hui Chun Ru Yi Jiao NangSymptoms like dizziness, a poor memory, fatigue, tinnitus, and soreness in the lower back and kneesNA1Ren and Xu, 2015 [29]

Ru Bi SanHyperplasia of mammary glandNA1Ren and Xu, 2015 [29]

ShuXiong Jiao NangSan-Qi (Panax pseudoginseng Wall. var. notoginseng (Burkill) Hoo et Tseng) 166.7 g, Hong-Hua 166.7 g, Chuan-Xiong 333.3 gHyperplasia of mammary gland3 granules, three times a day1Ren and Xu, 2015 [29]

Zeng Sheng PingTumorNA1Ren and Xu, 2015 [29]

Long Bi ShuBu-Gu-Zhi, Yi-Mu-Cao (Leonurus artemisia (Lour.) S. Y. Hu), Jin-Qian-Cao (Lysimachia christinae Hance), Hai-Jin-Sha (Lygodium japonicum (Thunb.) Sw.), Amber, Shan-Ci-Gu (Iphigenia indica Kunth)Hyperplasia of prostate gland3 granules, twice a day4Ren and Xu, 2015 [29]

Zhi Xue Jiao NangHemorrhoidsNA2Ren and Xu, 2015 [29]

Move FreeContaining glucosamine, chondroitin, methylsulfonylmethane, black catechu, maltodextrin, Huang-Qin (Scutellaria baicalensis Georgi)ArthritisNA1Yang et al., 2012 [21]
1Dhanasekaran et al., 2013 [17]

Ban Tu WanDi-Huang, Shu-Di-Huang, Zhi-Shou-Wu, Dang-Gui, Dan-Shen, Bai-Shao, Wu-Wei-Zi (Schisandra chinensis (Turcz.) Baill.), Qiang-Huo, Mu-GuaAlopecia5 g, three times a day1Cortez et al., 2012 [16]

KamishoyosanChai-Hu (Bupleurum chinense DC.), Dan-Pi, Bai-Zhu (Atractylodes macrocephala Koidz.), Ri-Ben-Dang-Gui (Angelica acutiloba (Sieb. et Zucc.) Kitagawa), Fu-Ling (Poria cocos (Schw.) Wolf.), Zhi-Zi (Gardenia jasminoides J. Ellis), Bai-Shao, Sheng-Jiang (Zingiber officinale Roscoe), Gan-Cao (Glycyrrhiza uralensis Fisch.), Bo-He (Mentha haplocalyx Briq.)Postmenopausal syndromeNA1Inoue et al., 2011 [23]

Qi Bao Mei Ran WanZhi-Shou-Wu, Dang-Gui, Bu-Gu-Zhi, Gou-Qi (Lycium chinense Mill.), Tu-Si-Zi, Fu-Ling, Niu-Xi (Achyranthes bidentata Blume)Grey hairNA1Li et al., 2015 [15]

Herbal extracts containing Hu-Ji-Sheng and Ye-GeHealth promotionNA1Kim et al., 2015 [22]

Herbal tea containing KelpType 2 diabetes mellitusNA1Viswanathan and Patel, 2013 [20]

Decoction: Lian-Qiao (Forsythia suspensa (Thunb.) Vahl) 10 g, Pu-Gong-Ying (Taraxacum mongolicum Hand.-Mazz.) 10 g, Zi-Hua-Di-Ding (Viola philippica Cav.) 10 g, Ye-Ju-Hua (Chrysanthemum indicum L.) 10 g, Bai-Zhi (Angelica dahurica (Fisch. ex Hoffm.) Benth. et Hook. f. ex Franch. et Sav.) 10 g, Huang-Qin 10 g, Xuan-Shen 10 g, Gan-Cao 10 g, Sheng-Shi-Gao (Gypsum fibrosum) 15 g, Dan-Pi 10 g, Bai-Xian-Pi 10 g, Bai-Mao-Gen (Imperata cylindrica (L.) Raeusch.) 10 g, Yan-Ji-Li 10 g, Tao-Ren 10 g, Hong-Hua 10 g, Dong-Gua-Pi (Benincasa hispida (Thunb.) Cogn.) 10 g, Di-Gu-Pi (Lycium chinense Mill.) 10 g, Di-Fu-Zi (Kochia scoparia (L.) Schrad.) 10 g, Sheng-Bai-Zhu 10 g, Chuan-Xiong 10 g, Fu-Ling-Pi 10 g, Fa-Ban-Xia (Pinellia ternata (Thunb.) Makino) 10 g, Chen-Pi (Citrus reticulata Blanco) 10 g, Tu-Fu-Ling (Smilax glabra Roxb.) 10 gEczemaNA1Mao et al., 2013 [30]

Pi Fu Bing Xue Du Wan and decoction: Chai-Hu, Dang-Gui, Bai-Zhu, Fu-Ling, Bo-He, Wu-Mei (Prunus mume (Siebold) Siebold & Zucc.), Fang-Feng, Yin-Chai-Hu (Stellaria dichotoma L. var. lanceolata Bge.), Wu-Wei-Zi, Pi-Pa-Ye (Eriobotrya japonica (Thunb.) Lindl.), Chuan-Shan-Jia (Manis squama), Ze-Xie (Alisma plantago-aquatica Linn.), He-Shou-Wu, Lu-Lu-Tong (Liquidambar formosana Hance), Xu-Duan (Dipsacus inermis Wall.), Nv-Zhen-Zi (Ligustrum lucidum Ait.), Han-Lian-Cao (Eclipta prostrata (L.) L.), Gui-Zhi (Cinnamomum cassia Presl) PsoriasisNA1Wei, 2011 [31]

NA = not available.