Treatments used in complementary and alternative medicine

Liver injury. Drug-induced liver injury (DILI) is always a challenging problem to health care professionals worldwide. Recent studies have demonstrated that DILI in Asia has etiologies different from those in Europe or United States. In a Chinese literature review that identified 279 studies including 24,112 patients with DILI, tuberculostatics complementary and alternative meclicines (CAMs) were found to be the most common cause of DILI in China. The top five proprietary Chinese medicines related to DILl are Xiao He Pian, Common threewingnut root, Polygoni Multiflori Radix (Heshouwu), Trichosanthis Radix (Tianhuafen) and Zhuanggu Guanjie Wan [1R]. In a prospective study of 371 cases of DILI from 17 referral university hospitals recorded from May 2005 to May 2007 in Korea, the causes of DILI included 'herbal medications' (102, 27.5%), 'prescription or non-prescription medications' (101, 27.3%), 'health foods or dietary supplements' (51, 13.7%), 'medicinal herbs or plants' (35, 9.4%), 'folk remedies' (32, 8.6%), 'combined' (30, 8.2%), 'herbal preparations' (12, 3.2%) and others (8, 2.2%) [2C]. The possible mechanisms mainly involve hepatotoxic ingredients and diosyncratic liver reactions [3R]. Other herbs that have been reported to be associated with DILl include air potato (yam), Gynura, Xanthii Fructus (Cang'erzi), Polygoni Multiflori Radix (Heshouwu), Tripterygium Wilfordii Radix (Common threewingnut root, Leigongteng), and Toosendan Fructus (Chuaniianzi) [4R].