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Aristolochic Acid and Chinese Herbs

By John K. Chen, Ph.D., Pharm.D., O.M.D., L.Ac.

January 5, 2001, CNN reported that a potentially harmful adulterant has been discovered in some herbal medicines that originate in Taiwan.

1. Background Regarding Aristolochic Acid

In the early 1990's, a weight loss clinic in Belgium was dispensing a weight loss regimen that contained numerous drugs and two Chinese herbs. The drugs used were fenfluramine (stimulant and appetite suppressant), diethylpropion (stimulant), acetazolamide (urinary alkalizer), and belladonna (the deadly nightshade). The herbs used were Stephania tetrandra (han fang ji) and Magnolia officinalis (hou po). However, instead of using Stephania tetrandra (han fang ji), the incorrect herb Aristolochia westlandi (guang fang ji) was used. After ingesting this combination of drugs and herbs over a long period of time, several illnesses were reported.(1,2)

In 1998 in United Kingdom, two illnesses were reported following years of ingestion of herbs. Upon examination, it was found that there was a dispensing error. Instead of using Clematis armandii (chuan mu tong), the incorrect herb Aristolochia manshuriensis (guan mu tong) was used.(3)

Despite these errors, the exact cause of illness is still undetermined, according to numerous authoritative sources. American Journal of Kidney Diseases stated that "The exact nature of the nephrotoxin is still speculative. (4)" European Agency for the Evaluation of Medicinal Products stated that due to lack of data, "no final conclusion can be drawn concerning the subchronic and chronic as well as reproductive toxicity of its (aristolochia plants) ingredients.(5)" The New England Journal of Medicine stated "The role of Chinese herbs (specifically, aristolochia species) as a cause of renal failure and urothelial carcinoma is still a matter of debate.(6)" Nonetheless, Belgium and United Kingdom have banned "Mu Tong" and "Fang Ji," regardless of whether the correct species is used.

2. Current Regulatory Situation

While the FDA acknowledges that no illness has been reported in its Letter to the Health Care Professional,(7) it has begun to take regulatory actions against herbs that contain, may contain, or may be adulterated with aristolochic acid. The list of single herbs implicated includes, but is not limited to, aristolochia fangchi (guang fang ji), akebia (mu tong), asarum (xi xin), clematis (chuan mu tong), clematis chinensis (wei ling xian), and stephania (han fang ji). The list of herbal formulas implicated include any formula that may include the single herbs listed above, including but not limited to Ba Zheng San, Long Dan Xie Gan Tang, Dang Gui Si Ni Tang, and Xi Yi Wan. This action will undoubtedly impact our practice.

We will continue to keep you informed of any new development. Please address all questions and comments to Dr. John Chen at his email address: johnchen@lotusherbs.com.

Sincerely,

John K. Chen, Ph.D., Pharm.D., O.M.D., L.Ac.
President, Evergreen Herbs & Medical Supplies
17431 E Gale Ave.
City of Industry, CA 91748
Tel: 626-810-5530 Fax: 626-810-5534
Website: www.evherb.com Email: sales@evherb.com
 

References:

1. Depierreux M, Van-Damme B, Vanden-Houte K, Vanherweghem JL. Pathological aspects of a newly described nephropathy related to the prolonged use of Chinese herbs. American Journal of Kidney Diseases, (1994 Aug) vol. 24(2):172-80.
2. Vanherweghem JL, Depierreux M, Tielemans C, et al. Rapidly Progressive interstitial fibrosis in young women: association with slimming regimen including Chinese herbs. Lancet 1993; 341:387-91.
3. Lord GM, Tagore R, Cook T, Gower P, Pusey CD. Nephropathy caused by Chinese herbs in the UK. The Lancet August 7, 1999; 354:481-482,494
4. American Journal of Kidney Diseases, (1994 Aug) vol. 24 (2):172-80)
5. Aristolochia Summary Report published by the European Agency for the Evaluation of Medicinal Products Veterinary Medicines Evaluation Unit (October, 1997)
6. The New England Journal of Medicine, (Volume 342, June 8, 2000, Number 23)
7. Letter to the Health Care Professionals published by the FDA on May 31, 2000

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