Chinese people who take Chinese medicine are prone to liver cancer? Don’t be fooled, it’s medicine is poisonous!

Hefei, Anhui Province, Ms. Wang never expected that she spent three hours carefully stewed He Shou Wu chicken soup, was actually dumped by her son – “My son told me that He Shou Wu will cause cancer.” Ms. Wang said with a bitter smile.

Shortly before that, a paper in the authoritative medical journal Science Translational Medicine claimed that the widespread presence of aristolochic acid in Chinese medicines was linked to liver cancer in Asians. The paper, which was published recently in the leading medical journal Science Translational Medicine, said that aristolochic acid, which is widely found in proprietary Chinese medicines, is associated with liver cancer in Asians.

This is the reason why Ms. Wang’s chicken soup with aristolochic acid was dumped by her son.

The controversial Chinese medicine was once again pushed to the forefront of public opinion. People can’t help but ask: Does aristolochic acid really cause liver cancer? Is Chinese medicine safe or not? How to view the toxic side effects of Chinese medicine?

1 “Aristolochic acid causes cancer” controversy

On October 18, the Journal of Science and Translational Medicine published a cover article entitled “The dark side of an herb – aristolochic acid and its derivatives associated with liver cancer in Taiwan and Asia”. According to the paper, genetic sequencing and other means have revealed that 78% and 47% of liver cancer cases in Taiwan and China have a specific mutation, far more than in other countries and regions, and the researchers believe that this mutation is caused by aristolochic acid, thus calling it the “aristolochic acid fingerprint.

Since aristolochic acid is one of the common ingredients in Chinese herbal medicine, this paper was reprinted in excerpts on the Internet and was even interpreted by many self-publishers as one of the reasons why “Chinese people are prone to liver cancer when taking Chinese medicine”. A list of Chinese medicines containing aristolochic acid, which has not been verified by authorities, has also started to circulate. Some people have even thrown away their home remedies for this reason.

This type of panic is certainly unnecessary. The industry believes that although aristolochic acid is nephrotoxic and carcinogenic, carcinogenicity is not the same as equating it with cancer.

In fact, this is not the first time aristolochic acid has caused concern.

As early as the 1990s, a study in Belgium found that herbal diet pills containing aristolochic acid caused kidney damage in women, causing worldwide concern.

In 2003, the media reported that kidney damage was caused by guanxi, the herb containing aristolochic acid, in gentian and liver pills

In an article in The Economist in September this year, it was also mentioned that Aristolochia, a plant used to treat arthritis, was found to be carcinogenic.

In 2008, the International Agency for Research on Cancer (IARC) officially classified aristolochic acid as a Group I carcinogen and aristolochic acid as a Group II carcinogen, and in 2012, all aristolochic acid substances (including aristolochic acid, compounds containing aristolochic acid, and plants) were upgraded to Group I carcinogen.

Returning to the aforementioned paper published in the Journal of Science and Translational Medicine, in response to its talk about the relationship between aristolochic acid and liver cancer, several experts from the Institute of Traditional Chinese Medicine of the Chinese Academy of Traditional Chinese Medicine said that the mutations described in the article were not necessarily caused by aristolochic acid. As early as 1994, the authoritative professional journal Carcinogenesis published a paper stating that vinyl chloride can cause such genetic mutations and can cause liver hemangioma and even liver cancer. In addition, hepatitis is internationally recognized as one of the major causes of liver cancer, and in a paper published in the Journal of Science – Translational Medicine, only 10 out of 98 samples of liver cancer cases in Taiwan were not infected with hepatitis virus.

Chen Jiannan, a professor at Guangzhou University of Traditional Chinese Medicine, and other industry insiders believe that many Western doctors currently study Chinese medicine, often following Western medical theories on only one of the components, which is not scientific. In the case of aristolochic acid, for example, all the current studies are correlation studies, and to prove the causal relationship between aristolochic acid and liver cancer, more test data is needed, for example, the paper did not collect information related to the lifestyle habits of the case patients, aflatoxin testing, whether there is hepatitis, cirrhosis of the liver, and so on, and thus its conclusions are not rigorous.

The State Food and Drug Administration also issued a response saying: According to epidemiological analysis of large samples and data, Chinese liver cancer patients are mainly caused by hepatitis B virus infection, whether there is a direct relationship with aristolochic acid, there is no direct and strong data to support. They also reminded patients that drugs should be used strictly in accordance with doctors’ prescriptions and medical advice, to pay attention to the nephrotoxicity and carcinogenicity risks of drugs containing aristolochic acid, and that no drug should be taken in large doses or for long periods of time.

The heated debate over aristolochic acid suggests that we should scientifically promote awareness of the toxic side effects of Chinese medicine.

2 Chinese medicine toxic side effects are neither smaller nor more serious than western drugs

Chinese medicine experts believe that Chinese medicine has never denied the toxic side effects of Chinese medicine, since ancient times there is “medicine three points of poison”, but this is not the same as Chinese medicine is not safe. The deputy director of the academic department of the Anhui Chinese Medicine Association, Li Ping, said that, on the whole, except for the medicinal herbs of the same origin, Chinese medicine has toxic side effects as well as western medicine, and the toxic side effects of Chinese medicine are neither less nor more serious than those of western medicine.

On the contrary, misleading statements such as “low toxicity and low side effects of Chinese medicine” that often appear in the propaganda of Chinese medicine have laid the groundwork for the misuse of Chinese medicine and even the credibility crisis of its safety – some people even treat Chinese medicine as a tonic or supplement instead of a medicine. Some people even treat Chinese medicine as a tonic or supplement and take it freely.

In fact, not only the general public, but also primary care doctors may not be fully aware of the toxic side effects of Chinese medicine. Li Ping found that a county Chinese hospital director in his department for further training often take the seeds and pine to drink wine – and medical books have long been recorded “pine but money, over money life connected”, which means that the pine herb can only be used in small amounts, short-term application of allopathic diseases.

In Li Ping’s opinion: “Chinese medicine poisonous side effects of the claim of small harm to Chinese medicine.” He explained that people have long underestimated the toxic side effects of Chinese medicine, to the point of over-range, over-dose and over-therapeutic use of Chinese medicine, which has planted hidden dangers for the rational use of Chinese medicine.

In interviews, TCM experts agreed that the first thing to do is to acknowledge that Chinese medicine has toxic side effects.

Li Ping said that the ancients were aware of the toxic side effects of traditional Chinese medicine and had strict criteria for its use, “It is a medicine that is poisonous, and chemical drugs also have toxic side effects, even allergies and death, but they have never been used for choking. Acknowledging that Chinese medicine has toxic side effects and paying enough attention to them is a kind of cultural self-confidence, which is the only way to truly inherit and develop Chinese medicine.”

Professor Zhang Zhongde, vice president of Guangdong Provincial Hospital of Traditional Chinese Medicine, said that like Western medicines, many Chinese medicines have certain toxic side effects.

In the long-term development and application of Chinese medicine, doctors gradually recognize the toxicity of Chinese medicine and regulate the toxicity of Chinese medicine by standardizing the methods of compounding, planting, collecting, concocting, treatment and decoction, and sometimes use the toxicity of Chinese medicine to treat diseases, so called “correcting bias with bias”.

The six methods to reduce the clinical toxicity of Chinese medicine are identification and treatment, selection criteria, concoction process, compounding and compounding, administration method and treatment course.

He explained that TCM treatment is based on evidence-based treatment, such as the identification of internal organs, qi, blood, yin and yang, and the eight syllabuses, and drugs are used according to the evidence. If the evidence is appropriate, it is good medicine, but if the evidence is not correct, it is poison. Secondly, there are strict standards for the selection and use of Chinese herbs, and those collected according to the standards may be good medicines, while the opposite may be poisonous. The concoction process of Chinese medicine also adds “insurance” to its clinical safety, and the use of compound prescriptions also has strict contraindications. Strict decoction methods and clear treatment procedures guarantee the safety of Chinese medicine.

In Zhang Zhongde’s opinion, Chinese medicine, like Western medicine, is used to treat diseases and has certain toxic side effects, so it is meaningless to talk about toxicity by analyzing the chemical composition in isolation from the specific situation; and Chinese medicine has a deep mass foundation and is widely recognized for its clinical efficacy. “

3 Three cases of Chinese medicine being abused

Despite the heated public opinion, the market performance of herbs containing aristolochic acid is quite calm in Anhui Bozhou Chinese herbal medicine trading center.

The person in charge of the center said that as the world’s largest distribution center and price formation center for Chinese herbs, the center trades more than 20 billion yuan of Chinese herbs and preliminary processed beverages each year, accounting for more than a quarter of the country’s total. Therefore, the price fluctuation of Bozhou market is the “barometer” of the national Chinese herbal medicine market. The current sales of herbs containing aristolochic acid are stable, and the price is not unusual. “These herbs are very small amounts of small categories of Chinese herbs, and the concoction and usage of Chinese medicine reduces the toxicity. The market is basically unaffected by these public opinions at the moment.”

Unlike the herbal market which is performing calmly, the toxic side effects of Chinese herbs due to abuse should receive more attention.

The easy availability of Chinese herbs and proprietary Chinese medicines is exacerbating the abuse of Chinese medicine. At present, most Chinese herbal drinks can be bought in herbal markets or pharmacies, and even prescription drugs are often available without a prescription, and some prescription Chinese medicines are even sought after as “miracle drugs” for family health care. Some businessmen take advantage of the people’s trust in Chinese medicine to hype it, touting it as a high-priced health product, exaggerating its efficacy and indications, but not mentioning the toxic side effects.

The most typical example is Angong Niuhuang Pill. This classic ancient prescription pill for the treatment of coma contains the poisonous ingredients xiong huang and vermilion, and has strict indications, and is therefore classified as a prescription drug. However, many pharmacies sell it openly, and some claim that Angong Niuhuang Pills can be used for health care, and even hype it as a first aid “miracle drug”, and many families collect it for a lot of money. Some people take them indiscriminately after having stroke symptoms, or even dizziness, chest tightness, or drunkenness, and some people are poisoned or suffocated by tracheal blockage as a result.

Overtreatment is another important reason for the abuse of Chinese medicine.

The ancients divided Chinese medicine into five levels: highly toxic, highly toxic, poisonous, less toxic, and non-toxic, and asked that “the disease be stopped”, that is, to use Chinese herbs to treat the disease, as long as the condition has improved to a certain extent to stop the medicine. But Li Ping said, “Nowadays, Chinese medicine practitioners are required to stop taking medicine only after the condition is completely cured, like Western medicine practitioners, and some even take medicine to ‘consolidate and consolidate’ after the disease is cured, which makes the toxicity and side effects of Chinese medicine more serious.”

The quality of Chinese herbs also worries clinical experts in Chinese medicine. On November 13 of this year, the State Food and Drug Administration notified that 31 batches of Chinese herbal tablets produced by 29 enterprises, including Anhui Jishun Chinese Medicine Beverage Co.

The industry said that due to the increasing market demand, the supply of local herbs exceeds the demand, prices soared, so there are some non-local herbs or even the name is similar to the “pseudo-herbs” to replace the local herbs.

The herbs are good, the medicine is good. But many experts say that “unreliable” herbs are dragging the leg of the clinical safety of Chinese medicine.

Behind the misuse of Chinese medicine, some clinical studies have shown that the toxic side effects of Chinese medicine can not be ignored.

In 2005, Xu Jianming, chief physician of the Department of Gastroenterology at the First Affiliated Hospital of Anhui Medical University, and his team selected more than 1,200 cases of drug-induced acute liver injury in 16 major hospitals nationwide, of which Chinese herbs accounted for 20.6% of the causative factors. As one of the few clinical surveys with a large sample, this data has been cited in the media several times.

Xu said, “The 20.6 percent may be an underestimate.” He explained that the sampling of these cases back then was in tertiary general hospitals, from which it can be inferred that the percentage should be higher in primary hospitals and primary Chinese hospitals due to improper use and other reasons.

What worries Xu even more is that the proportion of acute drug-induced liver injury from Chinese medicine is rising rapidly in the big tertiary hospitals. He and his team conducted a typing judgment and correlation evaluation of 305 cases of inpatient diagnosed acute drug-induced liver injury admitted to the First Affiliated Hospital of An Medical University from 2012 to 2015, and found that Chinese herbal medicines already topped the list of drugs suspected of liver injury, at 47.5%, followed by anti-tuberculosis drugs (7.5%), antibiotics (7.5%), anti-tumor drugs (4.3%) and other western drugs and health care products .

Nevertheless, Chinese medicine at the center of public opinion still shows great market value. During this year’s Double Eleven, Anhui Provincial Hospital of Integrative Medicine offered discounts on the purchase of Chinese plasters, and sales of plasters to prevent respiratory diseases and strengthen resistance were promising.

Ms. Wang said she won’t use He Shou Wu in soup anymore, but she has recently purchased several Chinese herbal poultices, saying, “I still believe in Chinese medicine. My family has been eating for seven or eight years, and I feel it is still quite effective.”