ascites

April 19, 2000

I just got off a plane after a long ride where I spent time reading the latest issue of HerbalGram. John Chen has an article in it about nephropathy associated with the use of Aristolochia. As you probably know, in the Belgian case, A. westlandi was the herb which was substituted for Stephania tetrandra. In a 1999 Lancet report, two women died of renal failure after ingesting Chinese herbs for two and six years respectively. In both cases A. manshuriensis Kom. was the common ingredient in their herbal remedies. Chen goes on to report that according to the Pharmacopoeia of the People's Republic of China, "the herb mu tong may be derived from the following species of plants: Clematis armandii Franch. (Ranunculaceae) (chuan mu tong), C. montana Buch.-Ham Ex DC. (chuan mu tong), or A. manshuriensis." He says that because of the toxicity of the aristolochic acid in A. manshuriensis, the armandii or montana forms are the preferred sources of mu tong.

The other issue he brings up is the lack of understanding of whether or not there is a toxic dose of aristolochic acids, or if chronic use of low concentrations has a cumulative effect. This is apart from any potential herb/drug interactions which could increase toxicity.

All of this would lead me to suggest that if your herb supplier uses modern laboratory techniques in identifying each and every batch of herbs, you can at least be sure you are giving your patient what you intended to give him. Physical examination alone isn't necessarily enough to differentiate species. Secondly, it is certainly your ethical responsability to confer with his western doctors about your herbal prescriptions. If you can substantiate that you are not using herbs which contain aristolochic acid, you might have a better shot at their cooperation. I agree with Z'ev that your prescriptions (and probably your presence) have been helping him physically as well as spiritually. For that reason alone I would try to keep going with it. If, in the end, you cannot continue treating him with herbs, perhaps it's time you consider using your qi gong in the treatment room?

Good luck, and keep us posted.

Toni Narins