However, the degree of HILI varies among different countries and regions ( Zhou et al., 2013 Navarro et al., 2014). Herb-induced liver injury (HILI) refers to liver damage caused by TCMs, natural medicines and related preparations, resulting in adverse reactions such as dermatitis, nausea, vomiting, diarrhea, thrombocytopenia, coagulopathy, mental state changes, hepatotoxicity, nephrotoxicity, and electrolyte imbalance ( Dag et al., 2014 Divya et al., 2016 Ming et al., 2017 Awortwe et al., 2018). Herbal medicines and other botanicals are often used as complementary and alternative medicines which are believed safe, also has no strict safety and effective standards, should be paid great attention ( Moreira et al., 2014 Lee et al., 2015 Wang et al., 2015 Alamgir, 2017 Cho et al., 2017 Cecilia and Orish, 2018 Jing and Teschke, 2018 Teschke et al., 2018). TCM relies on natural products, mainly of herbal origin, used either as raw materials for decoction, as prepared herbal medicines, or as formulated traditional medicines. Traditional Chinese Medicine (TCM), which plays a significant role in Chinese civilization, is widely used in western societies, Asia, Africa and the Middle East ( Huang et al., 2014 Kim et al., 2016 Kasote et al., 2017 Lin et al., 2017 Sumei et al., 2018). Measures should also be encouraged and implemented to promote healthy development of the TCM industry. Indeed, the characteristics and risk factors associated with PM require both proper understanding and control of the risk by strengthening standardization of clinical applications, basic science research, quality control in manufacturing, active monitoring methodology and enhancement of international communication and cooperation. The model of safety monitoring and risk management of PM drugs is not yet developed. In short, quality control is still one of the major safety problems in TCM drug safety concerns. This study was aimed at reviewing the status of research on liver injury due to PM, including clinical characteristics, risk factors, material basis research and mechanism of action, with a view to understanding PM-induced hepatotoxicity, and taking reasonable and effective measures to prevent it. Moreover, many of the reports are contradictory, while studies on the mechanism involved in PM-induced liver damage are not comprehensive. However, the components of PM responsible for the reported hepatotoxic effects have not yet been identified. Most liver injury cases had been assessed for causality using RUCAM (Roussel Uclaf Causality Assessment Method) in this paper. multiflorum Praeparata (PMP) have been on the increase, especially with respect to liver injury. In recent years, reports on clinical adverse reactions of Raw Radix P. Several clinical studies have been conducted to evaluate the traditional therapeutic claims and to study the potential therapeutic activity of PM in dyslipidemia and neurodegenerative diseases, highlighting available clinical evidence. (PM), called Heshouwu in China, is a popular Chinese medicine in clinical practice.
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