A Case of Hepatotoxicity from Long-Term Use of Chuanlianzi (Fructus Toosendan)

A friend consulted me: a relative of his had chronic atrophic gastritis, and a TCM physician included Chuanlianzi (Fructus Toosendan) in the prescription for pain relief for two months, causing hepatotoxicity that landed the patient in the hospital as an emergency.

Chuanlianzi has slight toxicity. Many Chinese herbs are hepatotoxic or nephrotoxic, and some patients do not tolerate certain herbs. TCM physicians should pay special attention to herb selection and dosage during long-term prescribing. Patients taking herbs should also have their liver and kidney function checked regularly. Generally, after a week of taking toxic herbs, liver and kidney function should be tested; if liver function is abnormal, dosing should be stopped promptly.

This is a clinical lesson from another doctor. I myself am sensitive to many herbs—such as Zexie (Rhizoma Alismatis), which poisons me 100% of the time, though most people tolerate its toxicity.

I record this to remind fellow patients to watch for chronic poisoning from herbs, and to remind myself in future clinical practice to closely observe for adverse reactions. Such poisoning was common in ancient times; modern diagnostic instruments, used skillfully, can greatly reduce this risk.

Generally, poisoned patients feel bodily discomfort—nausea, vomiting and diarrhea, acute gastroenteritis, or discomfort in the liver or kidney region. Patients themselves should watch for these signs.