Louisville Clinic of TCM

ACUPUNCTURE - CHINESE HERBS - NUTRITION - FACIAL REJUVENATION

Home - FAQ - Links - Gallery - About Us - Location

Aristolochia and Your Health

Background

Recent events in which Chinese herbs were implicated in end-stage acute renal failure and urothelial dysplasia have been blown out of proportion by the media and even some medical professionals. The intent of this report is to describe in detail what has occurred, dispel myths surrounding the events, and to explain how they could have been avoided.

Recent Events

In the Belgian cases of nephropathy, Guang Fang Ji (Aristolochia fangji) was only one component of a "cocktail" which included a variety of Western drugs, amphetamines, laxatives, diuretics, and tranquilizers. Guang Fang Ji (Aristolochia fangji) was incorrectly substituted for Han Fang Ji (Stephania tetrandra), a different genus and species with different pharmacological characteristics. In England, the intended herb was Chuan Mu Tong (Clematis armandii), which was incorrectly substituted with Aristolochia manshuriensis, a different but related species to Guang Fang Ji (Aristolochia fangji). Furthermore, instead of an aqueous extract (water decoction), the whole herb was administered. Water decoction is the principle method of preparation in traditional Chinese herbal medicine because toxic constituents are so seldom water-soluble. Most importantly, Guang Fang Ji (Aristolochia fangji) is never a traditional nor an appropriate choice for purposes of weight loss. Without a differential diagnosis according to Chinese medical principles, it is impossible to correctly prescribe Chinese herbal medicines. In each case of nephropathy associated with Guang Fang Ji (Aristolochia fangji), the herb was administered outside of its traditional context by MD's or other personnel not trained in traditional Chinese herbal medicine. It was applied inappropriately, it was not decocted, it was blended with several Western drugs, which may have had potentially nephrotoxic effects individually or interactively, and it was not combined with moderating herbs, such as Gan Cao (Radix Glycyrrhizae uralensis), which could have mitigated toxic side effects. It cannot be emphasized enough that Han Fang Ji (Stephania tetrandra) and Chuan Mu Tong (Clematis Armandii) are not traditionally used, alone or in combination, for the purpose of weight loss. All of the herbs in question belong to the "Drain Dampness" category of Chinese herbs, which are traditionally contraindicated for long-term use. In the Belgian and English cases, the herbs were used for many months, and in some cases, years. Guang Fang Ji (Aristolochia fangji) is the only crude herb commonly encountered in the West containing aristolochic acid, and distributors have voluntarily removed this herb from their catalogs.

Also of interest, in one year of testing on Belgian laboratory rats, the hypothetical nephrotoxic effects of Guang Fang Ji (Aristolochia fangji) could not be confirmed. In a weight loss program in Germany following the same protocol as the Belgian program, minus the Chinese herbs, 7 out of 700 participants died from complications associated with treatment.

Standard practice in the People's Republic of China is to use Clematis and Stephania species and not Aristolochia species when substituting medicinals.

What Should Have Happened?

Had a formally trained practitioner of Chinese herbal medicine been consulted, tragedy could have been avoided in each of these cases. In a similar, hypothetical situation, no one would blame the drugs when a health practitioner, untrained in the use of Western drugs, incorporated them into a treatment protocol which caused adverse reactions in participants, even if the drugs were available over the counter. Ma Huang (Ephedra sinica) has also been blamed for adverse reactions, yet no one would consider taking over-the-counter cold and weight loss drugs off the market, despite the fact that some can be re-manufactured into illegal and potentially dangerous drugs. Blaming herbs or drugs for human error is both heavy-handed and short-sighted. What matters is that those administering herbs or drugs have a thorough understanding of and healthy respect for the medical traditions surrounding these substances.

Perspective

According to a research article in the Journal of the American Medical Association, Western-style drug therapy directly causes more than 100,000 deaths annually in hospitals in the United States alone, with more than two million non-lethal adverse reactions annually. These figures only include medically supervised use of legal drugs in a hospital setting. Tobacco, the world's most commonly used herbal product, kills more than 400,000 Americans annually, more than motor vehicle accidents, AIDS, alcoholism, suicide, fire, and illegal drugs combined. Worldwide, tobacco accounts for more than 3.5 million deaths each year. Surprisingly, the only notable restriction on the sale of tobacco is to minors.

Chinese herbal medicine as a whole has a comparatively excellent record of safety, spanning centuries. When prescribed by a trained professional, Chinese herbal medicine is safe, efficacious, and free of toxic and deleterious side effects. The recent FDA bulletin on aristolochic acid nephropathy and Chinese herbs supports the position of our profession, and accords Chinese herbal medicine respect in identifying the syndrome as aristolochic acid nephropathy, instead of "Chinese herb nephropathy," a term that was used in some journal articles which falsely associates all Chinese herbs with toxic nephropathy.

The Louisville Clinic of Traditional Chinese Medicine does not use or condone the use of Aristolochia species, nor the use of Chinese herbal medicine in general by individuals or clinics without proper training. We believe that the evidence surrounding aristolochic acid nephropathy is inconclusive, and that correct application of Chinese herbal medicine is free from deleterious side effects. Nevertheless, to be as safe as possible, we dispense only medicinals that have been water-decocted or otherwise appropriately prepared and are produced according to GMP standards. Our suppliers have tested all recent lots of suspect herbs and herbal products in their inventories, and continue to test each new lot, to ensure that none contain aristolochic acid. We take seriously the Hippocratic imperative to "help the patient, but do no harm." Questions or comments? Call us at 303.604.0919 or