HERBAL MEDICATIONS AND LIVER TOXICITY

Herbal medications are a part of standard eastern medicine and now part of treating many patients
in the US. Today, more patients and an increasing number of physicians are using single herbs and
combinations in western medicine through a variety of providers or selfmedication. Although
these preparations are believed to have some medicinal value, there is also a risk of liver and
systemic 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 disease1,2. 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. Additionally, you should discontinue taking any herb if
you experience a skin rash, substantial nausea, bloating, fatigue and/or aching in the area of the liver
yellowing of the skin (jaundice) or pale feces.
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
Sassafras albidum
Scutelleria
Scuterarie
Senecio longilobus (senecio species)
Serrenoa serrulata
1
2

Larrey, D: Seminars in Liver Disease. 1995. 15: 1183-1188.

Am J Gastro 1997: 703.

Western Names
Asfetida
Margosa Oil
Comfry
Gentian
Senna
Gordolobo yerba tea
Greater celandine
Groundsel
Ma Huang
Hops
Kava
Kava kava
Margosa oil
Mat tea
chapparal
Pennyroyal (squawmint) oil/Jin Bu Juan
Peppermint
Noni
Sassafras
Senna
Skullcap
Sassafras
Sophora
Valerian
Viscum alba
prostate

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Stephania
Stephaniae Sinica
Symphytum officinale
Teucrium chamaedrys /polium
Tussilago farfara
Valeriana officinalis
Viscum Album
Zingeberis rhizoma
Zipiphy fructus

Amanita
Lepiota helveola
Comfrey
Germander

Mistletoe

Black Cohosh
*It appears that St. Johns Wort and milk thistle (silymarin) do not have significant liver toxicity
potential but have many drug drug interactions.
Asian Herbal Preparations
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 that are dangerous or inappropriate in combination with other herbs are
sometimes mistakenly used in concoctions.
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
Aristolochia
Au Shu Ling
Bi Tong Pian
Bi Yan Pian (Chung Lian Brand)
Chaso ( Weight Loss Program )
Dai-saiko-to
Da Huo Luo Wan
Dendrobum Moniliforme
Farfunoeminkam Wan
Gan Mao Ling (Yang Chen)
High-Strengh Yin Cheng
Ho Shou Wu
Huang Lien Shang Ching Pian
Jin Bu Huan
Ma Hsing Zhe Ke Pian
Ma Huang
Marguerite Acne pills
Night Sight pills

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Niu Huang Chiang Ya Wan

OnShido ( Weight Loss )
Pe Min Kan Wan (Chu Kiang, Yan Jiang)
Shosaikoto
Shen Ling Bai Zhu Pian
Ta Huo Lo Tan
Tsai Tsao Wan
Xiaoichai-hu-tang
Yin Chiao Chieh Tu Pian (Yang Cheng, Plum Flower)
Ye Bai He
Zhi Suo Ding Chuam Wan
Zhong Gan Ling
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
Acorus
Borax
Borneal
Bufonis
Buthus
Calomel
Cinnabar
Litharge
Minium
Myiabris
Orpiment
Realgar
Scorpion
Semen strychni
Strychnos nux vomica
Toad secretion

Causes paralysis and death if not highly processed before use

Causes Convulsions and death
Triggers ssevere kidney damage
Triggers internal bleeding and death
Can paralyze heart muscle and lungs
Causes paralysis of the heart and death
A mercury compound
A mercury compound
Contains lead oxide
Contains lead oxide
Can trigger convulsions, vomiting and death
Contains arsenic
Contains arsenic
Causes paralysis of the heart and death
Strychnine-containing seeds cause respiratory failure and death
Strychnine-containing seeds cause respiratory failure and death
Can paralyze heart muscle and lungs

Special Cases

Licoricea 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 welldocumented 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.

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Skullcapalso 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.

Milk Thistlewhile milk thistle has been shown to have an anti-inflammatory effect, it has no
antiviral effect and will not cure viral hepatitis. The following is an excerpt from Milk Thistle
& Liver Function by Elizabeth Burch, ND, that details the impact of this herb on liver disease.
Q. Is milk thistle really helpful in helping the liver function better? As an ex-drinker, would
it be to my advantage to use milk thistle?
A. The seed of the milk thistle plant contains high levels of silymarin, a flavonoid complex
with very potent liver protective action. Silymarin can prevent liver damage from a variety
of toxins. It works by inhibiting factors that cause liver damage and stimulates the growth of
new liver cells. Silymarin is a potent antioxidant, protecting the liver from damage by free
radical molecules. It also increases glutathione levels in the liverglutathione acts to
detoxify hormones, drugs and chemicals. And silymarin inhibits the formation of liverdamaging leukotrienes, preventing inflammation and damage of the liver cells. Most
remarkable is silymarins ability to stimulate the production of new liver cells to replace
damaged ones. In experimental studies, silymarin has been shown to protect the liver from
damage by such toxic chemicals as carbon tetrachloride, alcohol and the Amanita mushroom
toxin.
Clinical studies with silymarin have shown it is ineffective in treating a number of liver
conditions, including cirrhosis, chronic hepatitis and fatty liver from alcohol intake
according to a Cochrane analysis. There is no conclusive evidence that damaged livers were
restored to normal cell structure with long-term use of silymarin.
Milk thistle is a very good supplement for an ex-drinker to help restore the normal structure
and function of the liver. The dose of milk thistle is based on silymarin content; 70-210 mg
of silymarin should be taken three times a day. Look for a product that has a standardized
amount of silymarin per capsule.
Studies have shown that milk thistle extracts are essentially non-toxic. Because silymarin
causes an increase in bile secretion, large doses may cause loose stools. This can be
prevented by the use of fiber, such as psyllium or pectin.

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Other herbal comments:

Liv.52: Liv.52 contains Capparis spinosa (capers), Cichorium intibus (wild chicory), Terminalia
arjuna (arjuna), Solanum nigrum (black nightshade), Achillea millefolium (yarrow), and others.
Liv.52 was reported to protect against experimental toxic liver damage [87], and suggested to be
useful for human alcohol-related liver cirrhosis by lowering acetaldehyde, the highly toxic first
metabolite of alcohol degradation [88]. This initiated a 2-year European randomized controlled
clinical trial in 188 patients with alcoholic liver cirrhosis [89]. While no effect of Liv.52 on survival
was noticed in cirrhotics with Child class A and B, increased liver-related mortality among those
with child class C was found leading to premature termination of the study. This emphasizes the
potential hazards of poorly defined and incompletely tested herbal medications.

Robert G Gish MD
Robertgish.com
rgish@robertgish.com
1 858 229 9865