Health products and traditional Chinese medicine are the main drugs that cause liver damage?

　　Recently, a research paper published in the top journal "Gastroenterology" in the field of digestive diseases caused heated discussion.

　　According to a previous report by The Paper (www.thepaper.cn), the paper entitled "The Incidence and Etiology of Drug-induced Liver Injury in Mainland China" stated that the most important drugs that cause liver injury in Mainland China are various dietary supplements. (Health care products) and traditional Chinese medicines (26.81%) anti-tuberculosis drugs (21.99%) anti-tumor drugs or immunomodulators (8.34%).

　　In this regard, Gao Yueqiu, deputy director of the Hepatobiliary Disease Branch of the Chinese Society of Chinese Medicine, raised questions: Currently, there is no “gold standard” for the diagnosis of drug-induced liver injury. The diagnosis is mainly based on the exclusion method, and the misdiagnosis rate is relatively high. High, and the misdiagnosis rate of traditional Chinese medicine liver injury is higher.

　　Mao Yimin, one of the co-corresponding authors of the paper, expressed his affirmation, “From the data of 26.81%, it can also be seen that in China, the remaining 70% are caused by various types of western medicines. Liver injury.” It hopes that the media and the public will not interpret it one-sidedly. This study is not to question Chinese medicine.

　　Gao Yueqiu said that the repeated emphasis on the safety and non-toxicity of Chinese medicine is one-sided, and it is inappropriate to exaggerate it too much. Some Chinese medicines contain toxic substances that can cause liver damage.

　　Why did the research put Chinese herbal medicine and health products into one category?

　　"The traditional Chinese medicine is in the same category as dietary supplements and health products, and lacks a basic understanding of the properties of traditional Chinese medicine as a medicine for treating diseases." Gao Yueqiu said that Chinese medicine is a kind of animal and plant for preventing and curing diseases under the guidance of Chinese medicine theory. The crystallization of people's experience in disease prevention and treatment for a long period of time. Although some Chinese medicines are homologous to food and medicine, they are not equivalent to food and health products.

　　In this regard, one of the co-corresponding authors of the paper, Mao Yimin, chief physician of the Department of Gastroenterology, Renji Hospital, Shanghai Jiaotong University School of Medicine, said that since this paper is published in international journals, it needs to be combined with international practices, and herbal medicines and dietary supplements are usually used internationally. Herbal and Dietary Supplement (HDS) is classified into a large category.

　　Health products and traditional Chinese medicine are the biggest cause of drug-induced liver damage?

　　The research results show that the most important drugs that cause liver damage in mainland China are various dietary supplements (health products) and traditional Chinese medicines (26.81%). Does this mean that this category is the largest drug that causes liver damage? the reason?

　　Mao Yimin said: “From the data of 26.81%, it can also be seen that in China, more than 70% of the remaining causes are drug-induced liver injury caused by various Western medicines. The public should respond to traditional Chinese medicine. Keep a rational attitude and don't interpret it one-sidedly."

　　Mao Yimin further explained that for more than 70% of drug-induced liver injury caused by various types of western medicine, there are few controversies in the media and the Internet, and few people have seen “black” western medicine. The awareness of injury is relatively high. Many people know that western medicine will have adverse reactions, and the instructions are clearly marked to remind users of the need to regularly monitor related adverse reactions.

　　The reason why traditional Chinese medicine has caused controversy is that he believes that this just shows that the public has a low awareness of the adverse reactions caused by it, "because most people think it is natural and non-toxic, but this is a misunderstanding."

　　"According to the epidemiological survey of this article, the proportion of traditional Chinese medicine and dietary supplements, including health products, causing liver damage is 26.81%, but the proportion of traditional Chinese medicine is lack of statistical data." Gao Yueqiu further stated.

　　Which health products can cause liver damage?

　　Mao Yimin said that in China, traditional Chinese medicine and health products must be treated differently. Chinese medicine, like western medicine, has clinical therapeutic value, but there is no evidence on the efficacy of health products.

　　Mao Yimin emphasized that the harm of overuse of health care products requires social attention. "Data in the United States shows that drug-induced liver damage caused by dietary supplements in the United States has increased significantly in the past ten years. Some health care products that claim to be able to lose weight and improve sexual function A large number of them have been reported to cause liver damage. In our study, there are also a wide variety of health-care products that cause liver damage, such as slimming tea grape seed capsule protein powder propolis collagen oral liquid, etc. These products are not a panacea and cannot be taken blindly. "

　　Which Chinese medicines can cause liver damage?

　　Whether it is Chinese medicine or Western medicine experts, everyone agrees that there is indeed liver damage caused by Chinese medicine, but it cannot be overstated, nor can it be questioned about the efficacy of all Chinese medicines.

　　Mao Yimin said that Chinese medicine belongs to Chinese traditional culture, has a history of thousands of years, and has played an important role in the long history of mankind. This is beyond doubt.

　　"However, liver injury caused by traditional Chinese medicine is a clinical problem that needs to be correctly understood. It is one-sided to repeatedly emphasize the safety and non-toxicity of traditional Chinese medicine, and it is inappropriate to exaggerate it." Gao Yueqiu also summarized several major causes of liver injury caused by traditional Chinese medicine. :

　　One is that Chinese medicine itself contains toxic substances, which can cause liver damage, such as the toxic alkaloids of Tripterygium wilfordii, Changshan pomegranate skin, mountain bean root, bitter beans, wild lily, Senecio chrysanthemum, Panax notoginseng, etc.; Wangjiang Nanzi Euphorbia Bruceae Polygoni Multiflori, etc.; Xanthium Croton Castor, etc. which contain toxic proteins; Cinnabar Realgar Light Powder Mituo Monk's Gallbladder and Lead Dan with heavy metal hepatotoxic components, etc. These poisonous Chinese medicines need to be in experienced Chinese medicine. It should be applied under the guidance of the teacher, and it is not allowed to take it blindly.

　　The second is mistaking and misuse. The quality of the traditional Chinese medicine used is "changing the crown and wearing the crown". For example, Jusanqi, which can cause severe hepatic vein obstruction, is very similar to Panax notoginseng. Unscrupulous drug dealers will pretend to be sold as Panax notoginseng. The preparation emphasizes nine steaming and nine drying, but unscrupulous pharmacies simplify the production process, resulting in liver damage from time to time. It is recommended that you do not blindly buy the medicine by yourself. When taking traditional Chinese medicine, you must go to regular hospitals and pharmacies to find an experienced Chinese medicine doctor to prescribe.

　　The third is to take traditional Chinese medicine blindly with large doses and long courses. The dose of Chinese medicine is a key factor in the efficacy of Chinese medicine. The so-called secret recipes are often “secret” doses. Some doctors often use large doses over the course of treatment in pursuit of curative effects.

　　Are there any relevant policies at the national level for the management of liver injury from traditional Chinese medicine?

　　Gao Yueqiu stated that in response to the current chaotic status of liver injury evaluation of traditional Chinese medicine, the National Medical Products Administration issued the "Technical Guidelines for Clinical Evaluation of Traditional Chinese Medicine Drug-induced Liver Injury" in June 2018. The Hepatobiliary Disease Branch of the Chinese Society of Chinese Medicine and the Chinese Patent Medicine Branch of the Chinese Society of Chinese Medicine have issued guidelines for the diagnosis and treatment of Chinese medicine-related liver injury.

　　"According to the guiding principles and diagnosis and treatment guidelines, under the guidance of TCM theories, and following the compatibility theories of TCM "Eighteen Anti-Nineteen Fears" and "Prince and Minister Adjudicators", rational use of TCM can reduce liver damage caused by TCM." Gao Yueqiu said.

　　How is drug liver injury diagnosed accurately?

　　Gao Yueqiu raised questions about how drug-induced liver injury is diagnosed.

　　He said that there is no “gold standard” for the diagnosis of drug-induced liver injury (DILI). It is mainly diagnosed by the exclusion method. The misdiagnosis rate is higher, while the misdiagnosis rate of traditional Chinese medicine liver injury is higher. The clinical combination of Chinese herbal medicine and western medicine is as high as 30%. Up to 80% in chronic diseases.

　　Mao Yimin affirmed the above point of view: “The diagnosis of drug-induced liver injury is indeed difficult, challenging, and a worldwide problem. Diagnosis needs to exclude other causes of liver injury. Sometimes, clinically, it does cause misdiagnosis and missed diagnosis. Happening."

　　He specifically introduced the research method of his thesis, "This study is a retrospective study carried out in hospitalized patients. The patients included in the study will be further screened from the cases with the diagnosis of'drug-induced liver injury' related to the diagnosis of discharge from the hospital. All cases with drug-related liver injury diagnoses in the discharge diagnosis need to be further used RUCAM scale (note: a professional scale for comprehensive assessment of the causal relationship between drugs and liver injury) and expert evaluation opinions to determine the cause and effect of drugs and liver injury Relationship assessment, and this is also an internationally recognized method for conducting drug-induced liver injury research."

　　Is the history of taking Chinese medicines, proprietary Chinese medicines, or health care products, whether combined with western medicines or not, are all due to liver damage caused by Chinese medicines?

　　Mao Yimin said frankly that it is sometimes difficult to distinguish between traditional Chinese medicine and western medicine, or liver damage caused by the common factors of the two in clinical practice. What's more, his paper is a retrospective study. The flaws and limitations of the research itself cannot be avoided. In this way, we encountered cases in which Chinese medicine and western medicine were used at the same time in our research. When analyzing, we will objectively calculate the two separately, and there is no way to directly attribute liver damage to Chinese medicine."

　　He further stated that the objective evidence of this study shows that both western medicine and traditional Chinese medicine health products can cause liver damage in China. The purpose of this study is to understand the overall epidemiology, etiology, and clinical characteristics of drug-induced liver injury in China. The status quo, so that follow-up can put forward practical measures to prevent drug-induced liver injury in China. I hope that the media and the public will not interpret it one-sidedly. This study is not meant to question Chinese medicine.

　　Mao Yimin said that in the next step, they will continue to carry out in-depth research based on existing research data. "For example, research and analysis of why some drugs cause chronic liver damage in certain populations, and patients with basic liver disease and cirrhosis. What are the clinical features of the injury? Which drugs rarely cause liver injury in people without a liver disease basis, but are at risk of causing liver injury in people with a liver disease basis. What is the difference between liver injury caused by traditional Chinese medicine and western medicine, etc. Better put forward corresponding preventive measures."