Guidelines for the Diagnosis and Management of Herb-Induced Liver Injury

Jia-bo Wang; Yun Zhu; Zhao-fang Bai; Fu-sheng Wang; Xiu-hui Li; Xiao-he Xiao

doi:10.1007/s11655-018-3000-8

Your Location：

Home >

Browse articles >

Guidelines for the Diagnosis and Management of Herb-Induced Liver Injury

Updated：2021-08-27

- Guidelines for the Diagnosis and Management of Herb-Induced Liver Injury
- Chinese Journal of Integrative Medicine Vol. 24, Issue 9, Pages: 696-706(2018)
- Affiliations：
  
  1. Integrative Medical Center, Military Hospital of China,Beijing,China,302
  2. Research Center for Biological Therapy, Military Hospital of China,Beijing,China,302
  3. Integrative Medical Center, Beijing YouAn Hospital, Capital Medical University,Beijing,China
- Author bio：
- Funds：
  
  Supported by the National Key Technology R&D Program (No. 2015ZX09501-004-001-008), the National Traditional Chinese Medicine Industry Science and Technology Program (No. 201507004-04), the National Natural Science Foundation of China (No. 81630100), and the Foundation for Innovative Research Groups of the National Natural Science Foundation of China (No. 81721002)
- DOI：10.1007/s11655-018-3000-8
  CLC：
- Published：2018，
  
  Published Online：15 March 2018，
Scan for full text
Wang, Jb., Zhu, Y., Bai, Zf. et al. Guidelines for the Diagnosis and Management of Herb-Induced Liver Injury., Chin. J. Integr. Med. 24, 696–706 (2018). https://doi.org/10.1007/s11655-018-3000-8

Jia-bo Wang, Yun Zhu, Zhao-fang Bai, et al. Guidelines for the Diagnosis and Management of Herb-Induced Liver Injury. [J]. Chinese Journal of Integrative Medicine 24(9):696-706(2018)
Wang, Jb., Zhu, Y., Bai, Zf. et al. Guidelines for the Diagnosis and Management of Herb-Induced Liver Injury., Chin. J. Integr. Med. 24, 696–706 (2018). https://doi.org/10.1007/s11655-018-3000-8 DOI：

Jia-bo Wang, Yun Zhu, Zhao-fang Bai, et al. Guidelines for the Diagnosis and Management of Herb-Induced Liver Injury. [J]. Chinese Journal of Integrative Medicine 24(9):696-706(2018) DOI： 10.1007/s11655-018-3000-8.

摘要

Herb-induced liver injury (HILI) is a type of adverse drug reactions related to using Chinese medicine (CM) or herbal medicine (HM)

and is now a growing segment of drug-induced liver injury (DILI) worldwide. Owing to the complicated compositions and miscellaneous risk factors associated with the clinical usage of CM or HM

it is more challenging to diagnose and manage HILI than DILI. In the present guideline issued by the China Association of Chinese Medicine (CACM)

the authors present an evidence chain-based workflow with 9 structured judgment criteria for diagnosing HILI. The 3 diagnostic ending points—suspected diagnosis

clinical diagnosis

and confirmed diagnosis—could be reached according to the length of the evidence chain acquired in the structured diagnostic workflow. Either identifying the species of CM or HM or excluding adulterations and toxin contaminants was strongly recommended to improve the level of evidence for a clinical diagnosis of HILI. In addition

the authors report that the improper use of CM

which violates the general law of CM theory

is one of the most important factors that contributes to HILI and should be avoided. By contrast

based on syndrome differentiation

some CM can also be used to treat HILI if used in accordance with the general law of CM theory. Therefore

9 recommendations are put forward in this guideline.

Abstract

Herb-induced liver injury (HILI) is a type of adverse drug reactions related to using Chinese medicine (CM) or herbal medicine (HM)

and is now a growing segment of drug-induced liver injury (DILI) worldwide. Owing to the complicated compositions and miscellaneous risk factors associated with the clinical usage of CM or HM

it is more challenging to diagnose and manage HILI than DILI. In the present guideline issued by the China Association of Chinese Medicine (CACM)

the authors present an evidence chain-based workflow with 9 structured judgment criteria for diagnosing HILI. The 3 diagnostic ending points—suspected diagnosis

clinical diagnosis

the authors report that the improper use of CM

which violates the general law of CM theory

is one of the most important factors that contributes to HILI and should be avoided. By contrast

based on syndrome differentiation

some CM can also be used to treat HILI if used in accordance with the general law of CM theory. Therefore

9 recommendations are put forward in this guideline.

关键词

herb-induced liver injurydiagnosistreatmentmanagementChinese Medicineguideline

Keywords

herb-induced liver injurydiagnosistreatmentmanagementChinese Medicineguideline

references

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck–Ytter V, Alonso–Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924–926.

Chalasani NP, Hayashi PH, Bonkovsky HL, Navarro VJ, Lee WM, Fontana RJ, et al. ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug–induced liver injury. Am J Gastroenterol 2014;109:950–966;quiz 967.

Teschke R, Wolff A, Frenzel C, Schulze J. Review article: Herbal hepatotoxicity—an update on traditional Chinese medicine preparations. Aliment Pharmacol Ther 2014;40:32–50.

Zhu Y, Niu M, Chen J, Zou ZS, Ma ZJ, Liu SH, et al. Comparison between Chinese herbal medicine and chemical medicine–induced liver injury of 1985 patients. J Gastroenterol Hepatol 2016;31:1476–1482.

Teschke R, Schwarzenboeck A, Eickhoff A, Frenzel C, Wolff A, Schulze J. Clinical and causality assessment in herbal hepatotoxicity. Expert Opin Drug Saf 2013;12:339–366.

Kwon H, Lee SH, Kim SE, Lee JH, Jee YK, Kang HR, et al. Spontaneously reported hepatic adverse drug events in Korea: multicenter study. J Korean Med Sci 2012;27:268–273.

Li B, Wang Z, Fang JJ. Evaluation of prognostic markers in severe drug–induced liver disease. World J Gastroenterol 2007;13:628–632.

Group of Hepatobiliary Disease of Digestive Disease Branch of Chinese Medical Association, Xu JM. A multicenter survey on hospital inpatients with drug–induced acute liver injury in China. Chin J Dig (Chin) 2007;27:439–442.

Chalasani N, Fontana RJ, Bonkovsky HL, Watkins PB, Davern T, Serrano J, et al. Causes, clinical features, and outcomes from a prospective study of drug–induced liver injury in the United States. Gastroenterology 2008;135:1924–1934.

Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, et al. Features and outcomes of 899 patients with drug–induced liver injury: the DILIN prospective study, Gastroenterology 2015;148:1340–1352.

Chen YF, Cai HD. Investigation of herb induced liver injury. Adver Drug React J 1999;27–31.

Wu XN, You H, Jia JD. Clinical features of drug–induced liver injury: a review of Chinese literature 2003–2007. Chin Hepat (Chin) 2008;13:463–466.

Navarro VJ, Barnhart H, Bonkovsky HL, Davern T, Fontana RJ, Grant L, et al. Liver injury from herbals and dietary supplements in the U.S. Drug–Induced Liver Injury Network. Hepatology 2014;60:1399–1408.

Zhu Y, Li YG, Wang Y, Wang LP, Wang JB, Wang RL, et al. Clinical analysis of 595 cases of herb induced liver injury. Chin J Integr Med 2016;36:38–42.

Pelkonen O, Turpeinen M, Honkakoski P, Hukkanen J, Raunio H. Inhibition and induction of human cytochrome P450 enzymes: current status. Arch Toxicol 2008;82:667–715.

Deng WL. Toxicological studies of Tripterigyum willfordii. Pharmacol Clin Chin Mate Med (Chin) 2001;17:42–47.

Xiao WL, Motley TJ, Unachukwu UJ, Sanlau CB, Jiang B, Hong F, et al. Chemical and genetic assessment of variability in commercial Radix Astragali (Astragalus spp) by ion trap LCMS and nuclear ribosomal DNA barcoding sequence analyses. J Agric Food Chem 2011;59:1548–1556.

Lin G, Wang JY, Li N, Li M, Gao H, Ji Y, et al. Hepatic sinusoidal obstruction syndrome associated with consumption of Gynura segetum. J Hepatol 2011;54:666–673.

Teschke R. Traditional Chinese Medicine induced liver injury. J Clin Translat Hepatol 2014;2:80–94.

Tu C, Jiang BQ, Zhao YL, Li CY, Li N, Li XF, et al. Comparison of processed and crude Polygoni Multiflori Radix induced rat liver injury and screening for sensitive indicators. Chin J Chin Mater Med (Chin) 2015;40:654–660.

Hu YY, Huang F. Chinese herb and drug–induced liver injury. Chin J Hepatol (Chin) 2012;20:173–175.

Grove JI, Aithal GP. Human leukocyte antigen genetic risk factors of drug–induced liver toxicology. Expert Opin Drug Metab Toxicol 2015;11:395–409.

Navarro VJ, Lucena MI. Hepatotoxicity induced by herbal and dietary supplements. Semin Liver Dis 2014;34:172–193.

Barritt AS, Lee J, Hayashi PH. Detective work in drug–induced liver injury: sometimes it is all about interviewing the right witness. Clin Gastroenterol Hepatol 2010;8:635–637.

Drug–induced Liver Disease Study Group, Chinese. Guidelines for the management of drug–induced liver injury. J Clin Hepatol (Chin) 2015;31:1752–1769.

Li C, Liang XS, Li CZ. Sinusoidal obstruction syndrome associated with the ingestion of gynura root. Clin Toxicol (Phila) 2010;48:962–964.

Drug–induced Liver Disease Study Group, Chinese. Guideline interpretation on diagnosis and treatment of drug–induced liver injury. Shanghai: Shanghai Science and Technology Press, 2015:1–6.

World Federation of Chinese Medicine Societies. The International Standard Chinese–English Basic Nomenclature of Chinese Medicine (SCM0002–2007). Beijing: People’s Medical Publishing House; 2007.

Ernst E. Adulteration of Chinese herbal medicines with synthetic drugs: a systematic review. J Inter Med 2002;252:107–113.

Danan G, Benichon C. Causality assessment of adverse risks to drugs: a novel method based on the conclusions of international consensus meetings and applications to druginduced liver injuries. J Clin Epidemiol 1993;46:1323–1330.

Rochon J, Protiva P, Seeff LB, Fontana RJ, Liangpunsakul S, Watkins PB, et al. Reliability of the Roussel Uclaf Causality Assessment Method for assessing causality in drug–induced liver injury. Hepatology 2008;48:1175–1183.

Rockey DC, Seeff LB, Rochon J, Freston J, Chalasani N, Bonacini M, et al. Causality assessment in drug–induced liver injury using a structured expert opinion process: comparison to the Roussel–Uclaf causality assessment method. Hepatology 2010;51:2117–2126.

Wang JB, Ma ZJ, Niu M, Zhu Y, Liang Q, Zhao Y, et al. Evidence chain–based causality identification in herb–induced liver injury: exemplification of a well–known liver–restorative herb Polygonum multiflorum. Front Med 2015;9:457–467.

Wang JB, LI CY, Zhu Y, Song HB, Bai ZF, Xiao XH. Integrated evidence chain–based identification of Chinese herbal medicine-induced hepatotoxicity and rational usage: exemplification by Polygonum Multiflorum (He shou wu). Chin Sci Bull 2016;61:971–980.

Aithal GP, Watkins PB, Andrade RJ, Larrey D, Molokhia M, Takikawa H, et al. Case definition and phenotype standardization in drug–induced liver injury. Clin Pharmacol Ther 2011;89:806–815.

Blendon RJ, DesRoches CM, Benson JM, Brodie M, Altman DE. Americans’ views on the use and regulation of dietary supplements. Arch Intern Med 2001;161:805–810.

Liu FF, Duan XZ, Zang H. Comparative analysis of clinical and hepatic pathologic features in patients with acute drug–induced liver injury caused by traditional Chinese herbs and chemical medicines. J Clin Hepat 2013;16:317–319.

Efficacy and safety of glucocorticosteroid treatment in the patients with chronic recurrent DILI. NCT02651350.

Li CY, Niu M, Bai ZF, Zhang C, Zhao Y, Li R, et al. Screening for main components associated with the idiosyncratic hepatotoxicity of a tonic herb Polygonum multiflorum. Front Med 2017;11: 253–265.

FULL TEXT LINK

More>

Views

Downloads

CSCD

Alert me when the article has been cited

Submit

Tools

Publicity Resources

Herb-Induced Liver Injury: A Global Concern

Pulse waveform analysis as a bridge between pulse examination in Chinese medicine and cardiology

Effect of treatment based on syndrome differentiation by Chinese medicine on post-traumatic elbow arthritis

Clinical observation on treatment of 32 patients with measles by Qingzhen Decoction (清疹汤)

Evidence-based therapies of Chinese medicine for chronic urticaria: Where do we stand and where are we going?

Related Author

No data

Related Institution

USC Research Center for Liver Disease, USC Keck School of Medicine

Postgraduation Program of Rehabilitation Science, Augusto Motta University Center, Rio de Janeiro

Department of Physical Therapy, Salgado de Oliveira University, Niterói

Laboratory of Respiratory Physiology, University of the State of Rio de Janeiro, Rio de Janeiro

Department of Orthopaedics, Jiaxing Traditional Chinese Medicine Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine

Address：1 Caochang, xiyuan, Beijing, People's Republic of China Postal code：100091
Tel：010-62886827, 62877592 Fax：010-62874291
Technical support is provided by Beijing Founder electronics co., LTD 京ICP备05067934号-1 京公网安备11010802024621
It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.

⁰