Abstract
Polygonum multiflorum Thunb. (PM), called Heshouwu in China, is a popular Chinese medicine in clinical practice. Several clinical studies have been conducted to evaluate the traditional therapeutic claims and to study the potential therapeutic activity of PM in dyslipidemia and neurodegenerative diseases, highlighting available clinical evidence. In recent years, reports on clinical adverse reactions of Raw Radix P. multiflorum (RPM) and P. multiflorum Praeparata (PMP) have been on the increase, especially with respect to liver injury. Most liver injury cases had been assessed for causality using RUCAM (Roussel Uclaf Causality Assessment Method) in this paper. However, the components of PM responsible for the reported hepatotoxic effects have not yet been identified. Moreover, many of the reports are contradictory, while studies on the mechanism involved in PM-induced liver damage are not comprehensive. This study was aimed at reviewing the status of research on liver injury due to PM, including clinical characteristics, risk factors, material basis research and mechanism of action, with a view to understanding PM-induced hepatotoxicity, and taking reasonable and effective measures to prevent it. In short, quality control is still one of the major safety problems in TCM drug safety concerns. The model of safety monitoring and risk management of PM drugs is not yet developed. Indeed, the characteristics and risk factors associated with PM require both proper understanding and control of the risk by strengthening standardization of clinical applications, basic science research, quality control in manufacturing, active monitoring methodology and enhancement of international communication and cooperation. Measures should also be encouraged and implemented to promote healthy development of the TCM industry.
Highlights
Traditional Chinese Medicine (TCM), which plays a significant role in Chinese civilization, is widely used in western societies, Asia, Africa and the Middle East (Huang et al, 2014; Kim et al, 2016; Kasote et al, 2017; Lin et al, 2017; Sumei et al, 2018)
The results showed different degrees of liver damage such as inflammatory cell infiltration, hepatic sinus congestion, and kupffer cell proliferation (Hu et al, 2007; Yun et al, 2015)
The results revealed that inhibition of drug metabolizing enzymes increased liver injury induced by stilbene glycoside, indicating that Polygonum multiflorum Thunb. (PM) may exert liver damage in patients with different phase II metabolic enzyme gene polymorphisms or low function of these enzymes (Li et al, 2017)
Summary
Traditional Chinese Medicine (TCM), which plays a significant role in Chinese civilization, is widely used in western societies, Asia, Africa and the Middle East (Huang et al, 2014; Kim et al, 2016; Kasote et al, 2017; Lin et al, 2017; Sumei et al, 2018). Herb-induced liver injury (HILI) refers to liver damage caused by TCMs, natural medicines and related preparations, resulting in adverse reactions such as dermatitis, nausea, vomiting, diarrhea, thrombocytopenia, coagulopathy, mental state changes, hepatotoxicity, nephrotoxicity, and electrolyte imbalance (Dag et al, 2014; Divya et al, 2016; Ming et al, 2017; Awortwe et al, 2018). Most of the liver damage caused by Chinese herbal medicine is due to the components of herbal medicines. The first Chinese herbal medicine that produced liver damage is Teucrium chamaedrys L. Liver injury caused by other Chinese herbal medicines in recent years has been reported. TCM drug safety monitoring and risk management are becoming increasingly important tasks
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