Herbal Medications and Liver Disease
Herbal medications are a part of standard eastern medicine. Today, more patients and an increasing number of physicians are using single herbs and combinations in western medicine. Although these preparations are believed to have some medicinal value, there is also a risk of toxicity.
The following herbs have been described to cause a variety of liver problems ranging from hepatitis to liver failure and should not be consumed if you have liver disease (1,2). If you are being treated with interferon, herbs should not be taken unless under strict supervision. Make sure you discuss the potential reactions and interactions with both Western and Chinese medicine practitioners before taking any medication or herbal remedy. Although universally liver-toxic substances are identifiable in the laboratory, liver hypersensitivity problems are not predictable. One person may experience no negative side effect from a medicinal substance; another may have organ failure. Although you cannot predict hypersensitivity in all cases, some indicators may offer clues as to who is vulnerable and who is not. Risk factors include:
- You have multiple allergies and have had previous adverse reactions to drugs or herbs.
- You have a history of chronic skin rashes.
- You have liver disease -- although herbs that benefit the liver are not harmful, it is recommended that if you have another, unrelated medical condition in addition to liver disease and you are going to treat it with herbs, you exercise extreme caution and monitor all posible adverse reactions carefully.
- You should discontinue taking any herb if you experience a skin rash, substantial nausea, bloating, fatigue and/or aching in the area of your liver, yellowing of the skin or pale feces.
- Herbal Medications to Avoid (Latin Names)
- Herbal Medications and Mushrooms to Avoid (Western Names)
- Asian Herbal Preparations (Herbs to Avoid)
- Common Toxic Ingredients in Asian Herbal Preparations
- Special Cases
- References
Herbal Medications to Avoid (Latin Names)
- Atractylis Gunnifera
- Azadirachza indica
- Berberis vulgaris
- Calliepsis laureola
- Cassia angustifolia
- Chelidonium majus
- Corydalis
- Crotalaria
- Ephedra
- Eupatorium
- Ginseng radix
- Glycyrrhizae radix
- Hedeoma pulegoides
- Heliotropium
- Larrea tridentate
- Lycopodium serratum
- Mentha pulegium
- Morinda citrifolia
- Pinelliae tuber
- Piper methysticum
- Sassafras albidum
- Scutelleria
- Scuterarie
- Senecio longilobus (senecio species)
- Serrenoa serrulata
- Stephania
- Stephaniae Sinica
- Symphytum officinale
- Teucrium chamaedrys/polium
- Tussilago farfara
- Valeriana officinalis
- Viscum album
- Zingeberis rhizoma
- Zipiphy fructus
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Herbal Medications and Mushrooms to Avoid (Western Names)
- Amanita mushroom
- Chaparral (creosote bush, greasewood)
- Comfry - taken internally
- Eupatorium
- Germander (mint family) - this toxic herb is often substituted for skullcap, and skullcap is not toxic in well-formulated herbal remedies. However, always insist that any ingredient identified as skullcap be the genuine article and not germander.
- Groundsel (senecio longilobus)
- Heliotropium
- Jin Bu Huan (Lycopodium serratum)
- Mentha pulegium
- Mistletoe
- Pennyroyal (squawmint) oil or Hedeoma pulegoides
- Sassafras
- Senicio species
- Senna
- Sophora
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Asian Herbal Preparations (Herbs to Avoid)
Herbal patent medicines, tonics, elixirs and prepackaged solutions are particularly risky for anyone, whether they have liver disease or not. Far too often ingredient labels are incomplete or mistranslated. Herbs are mistakenly used in the concoctions that are dangerous or inappropriate in combination with other herbs. Toxic herbs are substituted for beneficial ones. And herbal ingredients that are generally harmless can cause liver damage in a very small group of allergic or intolerant individuals.
The best advice is to avoid all premixed preparations. Rely on the best-trained and most experienced herbalist available to individualize your herbal therapy and monitor your reactions.
Following is a list of contaminated formulas containing heavy metals, poisons and other potentially liver-toxic substances identified by the Oriental Herbal Association:
Asian Names
- An Gong Niu Huang Wan - contains arsenic and mercury
- Bi Tong Pian - contains chlorpheniramine, an antihistamine
- Bi Yan Pian (Chung Lian Brand) - contains acetaminophen
- Da Huo Luo Wan - contains mercury
- Dendrobum Moniliforme
- Farfunoeminkam Wan - contains chlorpheniraminean antihistamine
- Gan Mao Ling (Yang Chen) - contains chlorpheniramine, caffeine, acetaminophen
- High-Strengh Yin Cheng - contains chlorpheniramine, acetaminophen, pulegone (it can trigger seizures, cerebral edema and liver failure)
- Huang Lien Shang Ching Pian - contains pulegone
- Ma Hsing Zhe Ke Pian - contains ephedrine which can cause heart irregularities and convulsion
- Marguerite Acne pills - contains sophoridane, an unknown medication
- Night Sight pills - contains mercury
- Niu Huang Chiang Ya Wan - contains mercury and/or lead in formlations from various companies
- Pe Min Kan Wan (Chu Kiang, Yan Jiang) - contains acetaminophen, chlorpheniramine and phenylpropanolamine hydrochloride (increases blood pressure)
- Shen Ling Bai Zhu Pian - contains isoborneol, a synthetic isomer of borneol, a camphor-related compound
- Ta Huo Lo Tan - contains mercury and lead
- Tsai Tsao Wan - contains mercury
- Yin Chiao Chieh Tu Pian (Yang Cheng, Plum Flower) - contains pulegone
- Zhi Suo Ding Chuam Wan - contains ephedrine and pseudophedrine (stimulants that can raise blood pressure and cause seizures)
- Zhong Gan Ling - contains aminopyrine and dipyrone that can lead to fatal bone marrow toxicity and agranulocytosis, an acute blood disease.
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Common Toxic Ingredients in Asian Herbal Preparations
The following list, provided by the Oriental Herbal Association, identifies harmful ingredients for which patients with liver disease should be on guard:
- Aconite or Aconitum - Causes paralysis and death if not highly processed before use
- Acorus - Causes convulsions and death
- Borax - Triggers severe kidney damage
- Borneal - Triggers internal bleeding and death
- Bufonis - can paralyze the heart muscle and lungs
- Buthus - Causes paralysis of the heart and death
- Calomel - A mercury compound
- Cinnabar - A mercury compound
- Litharge - Contains lead oxide
- Minium - Contains lead oxide
- Myiabris - Can trigger convulsions, vomiting and death
- Orpiment - Contains arsenic
- Realgar - Contains arsenic
- Scorpion - Causes paralysis of the heart and death
- Semen stychni - Strychnine-containing seeds cause respiratory failure and death
- Strychnos nux vomica - Strychnine-containing seeds cause respiratory failure and death
- Toad secretion - Can paralyze heart muscle and lungs
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Special Cases
Licorice - A mainstay of Chinese formulas, licorice is used in very small quantities to balance herbal action and often appears as glycyrrhizin (licorice root). However, licorice produces well-documented side effects such as hyperaldosteronism (an increase in levels of the adrenal hormone aldosteron, triggering imbalance of electrolytes) when taken in doses of more than 50 grams a day or for six weeks or longer. However, no side effects have been seen in smaller doses over 30 days or in higher doses for a very short period of time.
Skullcap - Also called scutelleria, this herb is used in many formulas to good effect. However, it appears that the toxic substance, germander, often is substituted for skullcap in formulas without being properly identified. As a result, skullcap looks like the offending substance. Whenever skullcap appears in a formula make sure that it, not germander, is in fact being used. If you cannot be sure, do not take the formula or herb.
There has been one mention of toxicity in the literature for the following herbs. Further research is needed.
- Calliepsis laureola
- Atractylis Gunnifera
- Margosa oil
- Valerian (Valerian officinalis)
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References
1) Larrey, D.: "Seminars in Liver Disease." 1995. 15: 1183-1188
2) Am J Gastro 1997: 703.
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