Guest guest Posted June 11, 2000 Report Share Posted June 11, 2000 FYI. Anyone else get this post from Lotus Herbs? Catherine - <LotusHerbs Friday, June 09, 2000 2:53 PM Urgent! Chinese Herbs News > Dear Friends, > > There has been a lot of negative publicity about Chinese herbs that we need > to address now. The purposes of this e-mail is to address the issue of > nephropathy caused by incorrect substation of two Chinese herbs, and to > assure clients of Lotus Herbs that such incidences will not occur with our > herbal products. > > 1. Nephropathy: There have been several cases of nephropathy related to the > use of herbs over the past few years in Belgium, England, and other > countries. Though nephropathy has been documented, these incidences > occurred because the herbs were inappropriately-used and > incorrectly-substituted. On May 16, 2000, FDA released a formal letter > warning the general public that the use of herbs that contain aristolochic > acid may cause kidney damage. On June 8, 2000, New England Journal of > Medicine published an article that continuously use and address the term > " Chinese-herb nephropathy. " > > We firmly believe that a vast majority of articles published thus far > unfairly and unjustly evaluated the entire situation. This incidence is not > " Chinese-herb nephropathy, " but " inappropriate-use and incorrect substation > of herb " that cause nephropathy. In Belgium, instead of using the correct > herb Stephania tetrandra (han fang ji), the incorrect herb Aristolochia > westlandi (guan fang ji) was used. In England, instead of using the correct > herb Clematis armandii (chuan mu tong), the incorrect herb Aristolochia > manshuriensis was used. The other issue is inappropriate use. Why did the > doctors in Belgium use herbs in combination with drugs for weight loss? The > two Chinese herbs, Stephania tetrandra (fang ji) and Magnolia officinalis > (hou po), were never intended for weight-loss. Furthermore, why were they > allowed to be combined with drugs, and prescribed and dispensed by someone > without adequate training? Instead of blaming the incidence as " Chinese-herb > nephropathy, " we should examine the incidence by looking for solutions on how > herbs can be used more responsibly and only by someone who is properly > trained and educated. We should all take this opportunity to educate the > general publish that herbs is not just an dietary supplement, but a form of > medicine that require professional training for safe and effective use. > > For more information, please refer to the articles published by Dr. John Chen > in CJOM, Winter 2000, page 46; HerbalGram #48, 2000, page 44; and the article > listed below. > > 2. Quality control: We, at Lotus Herbs, want to assure you that we always > have and always will guarantee the herbal products we sell. We guarantee > the identity and purity of our herbs using such sophisticated techniques as > TLC (Thin Layer Chromatography) and HPLC (High-Performance Liquid > Chromatography). We performed these tests on each and every batch of herbs > so incorrect substitution will never occur. We strongly believe that the > safety of the herbs and the health of your patients are simply too important. > Attached please find certificates of analysis which document all the > laboratory exams performed. > > We believe incidences like this will make us stronger, not weaker. We wanted > to make sure practitioners of TCM are informed of all the facts. More > importantly, we wanted to make sure patients who use herbs are assured of > safety. Such incidences will not occur if herbs are manufactured properly. > > We thank you for your continuous support of Lotus Herbs. > > Sincerely, > > John K. Chen, Ph.D., Pharm.D., O.M.D., L.Ac. > President, Lotus Herbs. > > > Nephropathy associated with the use of Aristolochia westlandi (guan fang ji) > and Aristolochia manshuriensis (guan mu tong) > > by John K. Chen, Ph.D., Pharm.D., O.M.D., L.Ac. > > ABSTRACT > > As the use of herbal medicine becomes more prevalent in the United States, it > is becoming increasingly important that the practitioners understand the > botany and toxicology of herbs. With adequate training, the vast majority of > Chinese herbal medicine can be used safely and effectively. However, there > are some herbs which have demonstrated significant toxicology profile and > should not be used unless the benefit outweighs the risks. This article > addresses the issue of nephropathy associated with the use of Aristolochia > westlandi (guan fang ji) and Aristolochia manshuriensis (guan mu tong). It > will discuss such issues as botanical identification, documentation of > toxicology, clinical application, and selection of herbs from manufacturers. > Most importantly, one must recognize that it is not Chinese herbs that are > toxic, but the incorrect use and substitution of Aristolochia westlandi (guan > fang ji) and Aristolochia manshuriensis (guan mu tong) that cause nephropathy. > > KEY WORDS > > Nephropathy, Aristolochia westlandi (guan fang ji), Aristolochia > manshuriensis (guan mu tong), Stephania tetrandra (han fang ji), Clematis > armandii (chuan mu tong), Clematis montana (chuan mu tong), Chinese herbal > medicine > > ARTICLE > > The issue of nephropathy associated with the use of Chinese herbal remedies > was first reported in Belgium in the early 1990's in a group of women taking > a slimming preparation which contained fenfluramine, diethylpropion, cascara > powder, belladonna extract, acetazolamide, Stephania tetrandra (han fang ji) > and Magnolia officinalis (hou po). Of all who ingested this preparation, 33 > cases of nephropathy were reported initially. To date, more than 100 cases > of nephropathy have been reported. The cause of nephropathy was attributed > to the substitution of Aristolochia westlandi (guan fang ji) for Stephania > tetrandra (han fang ji). Aristolochia westlandi (guan fang ji) contains a > substance called aristolochic acid, which is a known nephrotoxin . All cases > of nephropathy can be traced to the ingestion of the herbal preparation > prepared by the same clinic containing the incorrect herbal ingredient of > Aristolochia westlandi (guan fang ji). > > This unfortunate incidence of nephropathy occurred because there was a poor > handling of Chinese herbs. In this case, the prescribed herb was Stephania > tetrandra (han fang ji), but was incorrectly substituted with Aristolochia > westlandi (guan fang ji). These are two different herbs with distinct > physical appearances and laboratory presentations. Aristolochia westlandi > (guan fang ji) root is round, 8-15 cm in length, and 1.5-4.5 cm in diameter. > The root has a thick and rough outer layer that is grayish-brown in color. In > contrast, Stephania tetrandra (han fang ji) root is round or cylindrical, 3-5 > cm in length, and 3.5-5 cm in diameter. The outer layer of the root is > dirt-brown in color with numerous pores. > > In August 7, 1999, The Lancet reported two additional cases of end-stage > renal failure associated with the use of Chinese herbal remedies. Case one > was a 49 year-old white female who took a Chinese herbal remedy for her > eczema for 2 years. After complaining of headache and hypertension, she was > screened for renal function and was found to have acute renal failure. She > began dialysis immediately and subsequently received a cadaveric renal > transplant. Case two was a 57-year-old white woman who took a Chinese herbal > remedy for her eczema for 6 years. After a 6-month history of anorexia, > lethargy, nausea, and weight loss, she was admitted to the hospital with > end-stage renal failure. She began dialysis immediately and is currently on > the waiting list for renal transplant. In both cases, Aristolochia > manshuriensis (guan mu tong) was the common ingredient in the herbal > remedies. The Lancet reported that the investigation for other causes of > renal failure were negative. > > In this case, nephropathy occurred because there was a lack of verification > resulting in the inadvertent use of Aristolochia manshuriensis (guan mu > tong). 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 (chuan mu tong), Clematis montana (chuan mu tong), or Aristolochia > manshuriensis (guan mu tong). , Due to the toxicity associated with > aristolochic acid in Aristolochia manshuriensis (guan mu tong), Clematis > armandii (chuan mu tong) or Clematis montana (chuan mu tong) are now used as > the preferred sources of mu tong. In regards to visual inspection, > Aristolochia manshuriensis (guan mu tong) is long and round, approximately 1 > m in length and 1.5-3 cm in diameter. The outer layer is grayish-yellow or > light brown in color. It has enlarged joints in between parts of the plant > and a distinct camphor-like odor. In contrast, Clematis armandii (chuan mu > tong) or Clematis montana (chuan mu tong) long and round, 50-100 cm in > length, and 2-3.5 cm in diameter. The outer layer is light to dark > yellow/brown in color. It has no joints and no odor. > > Nephropathy associated with the use of Aristolochia westlandi (guan fang ji) > and Aristolochia manshuriensis (guan mu tong) is not an isolated incidence. > It has been documented in China, Belgium and England. Proper cautions must > be taken to avoid such adverse reactions. Correct identification of the herb > is imperative toward safe and effective use of the herbs. Physical > inspection is the most commonly used method of identification. It, however, > is not 100% accurate or reliable. In the Belgium incidence, an incorrect > substitution was used. In the England incidence, there was a lack of > verification for the safest herb used. Therefore, it can be concluded that > visual inspection is not sufficient for correct identification of the herbs > as physical appearance of the herbs are often indistinguishable. Laboratory > techniques such as High Performance Liquid Chromatography (HPLC), Thin-Layer > Chromatography (TLC), and Liquid-Column Chromatography (LCC) must be used to > confirm qualitative and quantitative analyses. Furthermore, such > examinations must be performed on each and every batch of the herbs as random > examinations will not ensure the safety of the herbs. It is the duty of the > herbal manufacturer to instill the most stringent quality control measures to > ensure the safety of the herbs, and it is the duty of the practitioners to > purchase and dispense herbs from manufacturers who meet such criteria. > > ABOUT THE AUTHOR > > Dr. John Chen is the president and founder of Lotus Herbs, Inc. He is a > recognized authority on western pharmacology and Chinese herbal medicine. He > graduated from the University of Southern California (USC) School of Pharmacy > and South Baylo University of Oriental Medicine. He also received extensive > post-graduate training in China specializing in herbology and internal > medicine. He currently teaches herbal medicine and pharmacology at USC > School of Pharmacy, South Baylo University, Yo San University and Emperor's > College. He is a member of the Herbal Medicine Committee for the American > Association of Oriental Medicine (AAOM) and a consultant for the California > Association of Acupuncture and Oriental Medicine (CAAOM). Dr. Chen > co-authored " Sixty-Five Herbal Formulas for the Stateboard Exam, " and > published many articles, and given numerous seminars at universities, state > and national organizations. In 1998, he was invited as a guest speaker by > USC to present the continuing education seminar " Where Do Herbal Remedies > Fit? Counseling the Patients on the Use of Herbal Remedies " at the Bergen > Brunswig annual convention where more than 400 pharmacists and medical > doctors attended. Lastly, Dr. Chen was the featured speaker of herbal > medicine at the First Annual Festival of Health in Los Angeles, an event > hosted by the Los Angeles Times and University of Southern California. Dr. > John Chen is the president and founder of Lotus Herbs, and is available for > medical consultations through the Lotus Herbal Consultation Line at > telephone: (626) 916-1070 and fax: (626) 917-7763. > > REFERENCE > > 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. > 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. > Vanherweghem JL. Misuse of herbal remedies: the case of an outbreak of > terminal renal failure in Belgium (Chinese herbs nephropathy). J Altern > Complement Med 1998; 4:9-13 > Chinese Herbal Botany, December 1974 > 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 > Goshi T, ed. Pharmacopoeia of the People's Republic of China 1992; 16-17 > and 304-05. > Zheng HZ, Dong ZH et al. Modern Study of . October 1997. > Vol 1. 936:954 > Zhejiang Journal of , 1965;12:32 > Zheng HZ, Dong ZH et al. Modern Study of . October 1997. > Vol 1. 936:954 > Zheng HZ, Dong ZH et al. Modern Study of . October 1997. > Vol 1. 936:954 > > Quote Link to comment Share on other sites More sharing options...
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