The New England Journal of Medicine has published Yong Ming Li’s letter on the issue of the so-called “Chinese-herb nephropathy.” A detailed Chinese version was published in the World Journal, Weekend Edition (~8,000 Chinese characters, July 23, 2000).

The New England Journal of Medicine –

October 26, 2000 -- Vol. 343, No. 17

To the Editor:

The outbreak of Chinese-herb nephropathy in Belgium is an example of serious misuse and abuse of medicinal herbs. The toxic effects are not caused by the ingestion of herbs as they are commonly consumed but by the consumption of a toxic product for an extended period of time as a result of human error and perhaps inadequate training of the practitioners. The original formula for dietary treatment should contain fang ji (Stephania tetrandra) and huo pu (Magnolia officinalis). But the formula used for a mean period of more than 12 months by the patients with renal nephropathy contained guang fang ji (Aristolochia fangchi), as proved by chemical analysis. It is indeed the aristolochic acid in guang fang ji that had renal toxicity.

It is clear from the Chinese National Pharmacopoeia that fang ji is the root of the S. tetrandra plant, whereas guang fang ji is from a totally different plant, A. fangchi. (1) Since fang ji does not have a renal toxic component, the tragedy would never have occurred if the correct herbs had been used in the Belgian dietary clinic.

Guang fang ji and related herbs have antiarthritis and diuretic effects and are often used together with other herbs to optimize efficacy and reduce toxicity. None of these herbs have been used in traditional Chinese medicine for weight control. They have a low level of toxicity and should be used with caution; they should never be used during pregnancy. The proper dose is 3 to 9 g of the decocted herb per day, and the herbs should be used for only a short period of time. The patient's renal function should also be monitored regularly. In the Belgian cases, the physicians apparently did not follow these guidelines of traditional medicine.

Yong Ming Li, M.D., Ph.D., D.C.H.
North Shore University Hospital
Manhasset, NY 11030

References

1. Chinese national pharmacopoeia: color atlas of Chinese herbs. Hong Kong, China: Wang Wen, 1991.

For more information:

http://www.nejm.org/content/2000/0343/0017/1268.asp#tref-3-1