review article liver damage associated with polygonum...

Review ArticleLiver Damage Associated with Polygonum multiflorum ThunbA Systematic Review of Case Reports and Case Series

Xiang Lei1 Jing Chen1 Jingtian Ren2 Yan Li1 Jingbo Zhai1 Wei Mu3 Li Zhang3

Wenke Zheng1 Guihua Tian4 and Hongcai Shang15

1Tianjin University of Traditional Chinese Medicine 88 Yuquan Road Tianjin 300193 China2Center for Drug Reevaluation State Food and Drug Administration Xicheng Beijing 100045 China3Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine 816 Zhenli Road Tianjin 300150 China4Dongzhimen Hospital Beijing University of Chinese Medicine Dongcheng Beijing 100007 China5Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing Dongzhimen HospitalBeijing University of Chinese Medicine Beijing 100700 China

Correspondence should be addressed to Hongcai Shang shanghongcaifoxmailcom

Received 15 September 2014 Revised 16 December 2014 Accepted 16 December 2014

Academic Editor Jie Yu

Copyright copy 2015 Xiang Lei et alThis is an open access article distributed under theCreative CommonsAttribution License whichpermits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Objective To summarize the characteristics and analysis of relevant factors and to give references for prevention and further studyof liver damage associated with Polygonum multiflorum Thunb (HSW) we provide a systematic review of case reports and caseseries about liver damage associated with HSW Methods An extensive search of 6 medical databases was performed up to June2014 Case reports and case series involving liver damage associated with HSW were included Results This review covers a totalof 450 cases in 76 articles HSW types included raw and processed HSW decoction pieces and many Chinese patent medicinesthat contain HSW Symptoms of liver damage occur mostly a month or so after taking the medicine mainly including jaundicefatigue anorexia and yellow or tawny urine Of the 450 patients two cases who received liver transplantation and seven who diedthe remaining 441 cases recovered or had liver function improvement after discontinuing HSW products and conservative careConclusion HSW causes liver toxicity and may cause liver damage in different degrees and even lead to death most of them aremuch related to long-term and overdose of drugs Liver damage associated with HSW is reversible and after active treatment themajority can be cured People should be alert to liver damage when taking HSW preparations

1 Introduction

Polygonum multiflorum Thunb (He Shou Wu in Chinesepinyin hereinafter referred to as HSW) is the root ofPolygonum multiflorum a member of Polygonaceae As aChinese herb it was recorded most early in ldquoKaibao Bencaordquopublished by the imperial court of the Song Dynasty (973-974 AD) [1] In the Chinese Pharmacopoeia (2010) thereare two forms of HSW decoction pieces raw state (naturalroot) (Figure 1) and processed form that is radix polygonimultiflori preparata (boiled in black-bean liquid according toa traditional process) (Figure 2)The two forms have differentproperties the raw HSW is used for detoxification elim-inating carbuncle preventing malaria and relaxing bowel

whereas the processed HSW is used for nourishing liver andkidney supplementing essence and blood blackening hairstrengthening bones andmuscles eliminating dampness andreducing lipid [2] Modern pharmacological studies haveshown that HSW have the effect of reducing blood lipid andantiarteriosclerosis [3ndash5] protecting liver [6 7] enhancingimmunologic [8 9] improving memory protecting nervecells and increasing intelligence [10 11] antioxidation anti-aging [12 13] and so forth

HSW is popular in many countries especially in ChinaTraditional Chinese herbal medicine ordinarily recommendsthe use of herbs in complex formulas but HSW is also oftentaken as a single herbWhile there aremanyHSW-containing

Hindawi Publishing CorporationEvidence-Based Complementary and Alternative MedicineVolume 2015 Article ID 459749 9 pageshttpdxdoiorg1011552015459749

2 Evidence-Based Complementary and Alternative Medicine

Figure 1 Raw HSW

Figure 2 Processed HSW

products the most well-known product is like Shou-Wu-Pian which is usually consumed as an antiaging productor as a tonic for dizziness with tinnitus and also appears tobe efficacious in the treatment of premature greying of hairlumbago spermatorrhea leucorrhea and constipation Withthe wide application liver damage associated with HSW hasbeen reported in China Korea Japan Britain Italy Australiaand other countries [14 15] To fully understand the charac-teristics and possible factors of hepatitis associatedwithHSWwe conduct a comprehensive review of the relevant publishedliteratures we hope that our findings can provide guidancefor clinical medication and scientific research and thus canhelp to avoid hepatitis induced by HSW in the future

2 Methods

21 Data Sources and Search Strategy In June 2014 wesearched the following Chinese-language electronic data-bases Chinese Biomedical Literature Database (CBM 1980ndash2014) Chinese Journal Full-Text Database (CNKI 1980ndash2014) Weipu Journal Database (VIP 1989ndash2014) and Wan-fang Data (1990ndash2014) and two English-language databasesPubMed and EMBASE (1989ndash2014) The search termsincluded Polygonum multiflorum radix polygoni multiflori

He ShouWu liver injury liver damage liver diseases hepati-tis and liver failure in English or Chinese These terms weresearched as free-text in the title or the abstractThe referencesof relevant reviews and the included literatures were checkedfor possible identification of additional studies

22 Study Selection Case reports and case series are includedin the review if they reported factual data on liver damagerelated to HSW Clinical trials reviews commentaries andother nonrelated literatures were excluded Some clinicaltrials of HSW that reported liver damage were excludedfor reasons originally given by Lao et al specifically thatthey were too small to provide convincing evidence ofrare complications [16] Two authors (Xiang Lei and JingChen) independently examined the titles and abstracts ofall papers found through the search to determine if theyfulfilled the inclusion criteria outlined above The full textsof potentially relevant articles were retrieved for detailedassessment Differences can be resolved through discussion

23 Data Extraction After screening articles were read infull and extracted by two independent reviewers (Xiang Leiand Jing Chen) Information on author year of publicationnumber of patients disease originally treated gender doseand dosage forms course of taking HSW clinical manifesta-tions length of hospitalization outcome and family historyand recurrence of hepatitis related to HSW were extractedaccording to the designeddata extraction table independentlyby two authors

3 Results

31 Search Process and Result The search identified 923database records which led to the retrieval of documentationon 103 studies for a full-text review One additional referencewas identified while searching reference lists of the includedpapers 76 articles (59 case reports and 17 case series) met theinclusion criteria In total 450 cases of hepatitis associatedwith HSW were reported The characteristics of the casereports and case series are shown in Tables 1 and 2 Becausecase series is summary report for multiple patients andbecause of the lack of description of the individual patientinformation the following is mainly an analysis of casereports

32 Gender and Age In 450 cases 224 (4978) were maleand 226 (5022) were female In 72 cases of case reportspatients ranged in age from 5 to 78 years with a medianof 365 The most commonly affected age group was 18ndash44(3772 514) followed by 45ndash59 (2472 333) lt18 (67283) and ⩾60 (572 69)

33 Reasons for Medication (Disease Originally Treated)In case series the causes of consuming HSW productsinclude grey hair hair loss hypertension coronary heartdisease hyperlipidemia osteoarthritis insomnia dizzinessand health care the top diseases were gray hair and hair loss

Evidence-Based Complementary and Alternative Medicine 3Ta

ble1Patie

ntdetails

recorded

from

publish

edcase

repo

rts

Reference

Agegender

Reason

sfor

medication

HSW

type

Administratio

nanddo

sage

Durationof

intake

day

Hospitalization

day

Outcome

Rechallenge

Liuetal[17]

20F

Greyhair

HSW

OAP15g

4210

Recovery

NA

MiaoandYu

n[18]

52F

Health

care

PHSW

OAP5g

2014

Recovery

NA

61F

Hyperlip

idem

iaR

HSW

SIW5

g180

12Re

covery

NA

Zhao

[19]

39M

Greyhair

Jing-Wu-Pian

Oral3times6tablets

6018

Recovery

NA

Tan[20]

48F

NA

PHSW

uNA10g

4030

Recovery

NA

Liuetal[21]

37M

Vitiligo

PHSW

OAP10g

3035

Recovery

NA

Gao

etal[22]

14F

Vitiligo

PHSW

Decoctio

nNA

3815

Recovery

NA

Banarova

etal[23]

33F

NA

SWW

OralNA

60NA

Recovery

NA

Gao

[24]

45M

Hairloss

PHSW

OAPNA

9021

Recovery

NA

Kuiand

Chen

[25]

43F

Greyhair

HSW

OAP8ndash10g

6030

Recovery

NA

Shao

andLi

[26]

50M

Greyhair

HSW

OAPNA

6030

Recovery

NA

40F

Health

care

RHSW

Decoctio

n10ndash20g

6050

Recovery

NA

Huetal[27]

36M

Chronicn

ephritis

PHSW

OAP15g

3037

Recovery

NA

Zhen

andZe

ng[28]

52F

Greyhair

PHSW

OAPNA

1430

Recovery

NA

LiandZh

ang[29]

50F

Greyhair

RHSW

OAP2g

6015

Recovery

NA

28F

Hairloss

RHSW

OAP3g

7512

Recovery

NA

Chen

etal[30]

57M

Greyhair

RHSW

NA

120

Recovery

NA

Liuetal[31]

56F

Greyhair

Yishen

wufa

Oral2times10mL

120

21Re

covery

NA

Sun[32]

39F

Allergicrhinitis

RHSW

Decoctio

n15ndash20g

3028

Recovery

NA

72F

Health

care

RHSW

Decoctio

n10ndash20g

6042

Recovery

NA

Caoetal[33]

28M

Greyhair

PHSW

NA10pieces

9042

Recovery

NA

Liuetal[34]

26M

Hairloss

Yang

xues

heng

faOral2times4capsules

6030

Recovery

NA

Yan[35]

28M

Hairloss

HSW

Decoctio

n4g

9028

Recovery

NA

WuandNiu

[36]

47F

Hairloss

Yishen

wufa

Oral3times10ml

2014

Recovery

NA

Liuetal[37]

50F

Hairloss

SWW

OralNA

725

Recovery

NA

Chen

etal[38]

46F

Health

care

HSW

tea

Oral1-2

g60

25Re

covery

NA

57M

Health

care

HSW

tea

Oral1-2

g20

15Re

covery

NA

Yunetal[39]

51F

Greyhair

SWW

Oral2times6g

180

18Re

covery

NA

Furukawae

tal[40]

53F

NA

SWP

NA

240

60Re

covery

NA

Yanetal[41]

54F

Greyhair

HSW

OAP2times10g

6035

Recovery

NA

He[42]

31F

Con

stipatio

nHSW

OralNA

1510

Recovery

NA

Chen

[43]

38F

Greyhair

HSW

OAPNA

120

63Re

covery

NA

Choetal[44

]34M

NA

HSW

HSW

tea(

liquo

r)N

A30

(4)

34im

proved

NA

Wangetal[45]

34M

Health

care

RHSW

SIWN

A20

20Re

covery

NA

46M

Health

care

RHSW

SIWN

A10

27Re

covery

NA

49F

Health

care

RHSW

SIWN

A5

27Re

covery

NA

Zhu[46]

36M

Hairloss

RHSW

SIWN

A30

30Re

covery

NA

Yang

andLi

[47]

38M

Greyhair

HSW

Decoctio

n30

gOncea

week(3w)

NA

Recovery

NA

51M

Sequ

elae

ofstr

oke

HSW

Decoctio

n15g

15NA

Recovery

NA

Laird

etal[48]

35M

Thinning

hair

NuH

air

OralNA

NA

120

Recovery

NA

Yang

andDon

g[49]

54M

Hairloss

SWP

Oral3times6tablets

4017

Recovery

NA

26M

Greyhair

SWP

Oral3times6tablets

3059

Recovery

Yes


Table1Con

tinued

Reference

Agegender

Reason

sfor

medication

HSW

type

Administratio

nanddo

sage

Durationof

intake

day

Hospitalization

day

OutcomeRe

challenge

FuandYu

[50]

32F

Infertility

PHSW

Decoctio

nNA

18Untreated

Recovery

NA

Zhao

[51]

17M

Greyhair

SWW

Oral3times6tablets

4090

Recovery

Yes

Li[52]

65M

Dizzinesstinnitus

HSW

SIW30ndash

50ml

2030

Recovery

Yes

38M

Greyhair

SWP

Oral3times6tablets

3020

Recovery

NA

Cardenas

etal[53]

28F

Hairloss

Shen-M

inOral2tablets

566

Recovery

NA

Han

[54]

42F

Greyhair

HSW

OAP10g

9030

Recovery

Yes

Yang

[55]

35M

Greyhair

PHSW

Decoctio

n30

g45

50Re

covery

NA

Panise

tal[56]

5F

NA

SWP

Oral3tablets

120

30Re

covery

Yes

Chen

etal[57]

20F

Greyhair

HSW

OAPNA

2040

Recovery

NA

Huo

andLing

[58]

28M

Hairloss

SWP+Yang

xues

heng

faOral3times5tabletsa

nd2times4capsules

6018

Recovery

Yes

Mazzantietal[59]

78M

Chronicp

rosta

titis

SWP

OralRD

30NA

Recovery

NA

Shao

[60]

46F

Hairloss

RHSW

Decoctio

nNA

630

Recovery

Yes

45M

Greyhair

hairloss

RHSW

Decoctio

n100g

NA

30Re

covery

Yes

Leng

[61 ]

15F

Greyhair

HSW

Decoctio

n15g

30NA

Recovery

NA

DaiandLi

[62]

18F

Greyhair

SWP

OralNA

9090

Recovery

NA

Yuan

[63]

66F

Con

stipatio

nHSW

ointment

OralNA

730

Recovery

Yes

Sun[64]

20F

Neurasth

enia

SWP+Liuw

eiDihuang

Wan

Oral3times6tabletsa

nd2times9g

310

Recovery

Yes

Yang

[65]

17M

Greyhair

SWP

OralNA

1429

Recovery

Yes

Park

etal[66]

46F

Greyhair

SWP

OralRD

1430

Recovery

NA

Sheng[67]

38F

Greyhair

HSW

OralNA

6NA

Recovery

Yes

Lietal[68]

58F

Dizziness

HSW

Decoctio

n30

g7

15Re

covery

Yes

49M

Hypertension

HSW

SIW15g

1020

Recovery

Yes

FanandZh

ou[69]

26M

Greyhair

SWP

Oral3times6tablets

3059

Recovery

Yes

Li[70]

17M

Greyhair

SWP

Oral3times5tablets

2060

Recovery

Yes

Ye[71]

30M

Greyhair

HSW

Decoctio

n50

g2

94Re

covery

Yes

Zhang[72]

36F

NA

SWP

Oral10ml

1515

Recovery

Yes

Niu

[73]

28M

Greyhair

SWP

Oral3times5tablets

1060

Recovery

Yes

Hea

ndZh

en[74]

19F

Greyhair

SWP

OralNA

NA

30Re

covery

Yes

27F

Greyhair

SWP

OralNA

NA

NA

Recovery

Yes

Butetal[75]

31F

Dizziness

SWP

OralRD

Severalw

eeks

21Re

covery

Yes

SWP

Shou

-Wu-PianS

WWS

hou-Wu-WanO

AP

oral

administratio

nof

powderSIWsoakedin

water

todrink

PHSW

processed

HSW

RH

SWraw

HSW

HSW

unclear

whether

itwas

processed

RD

recommendeddo

sagesNAnot

available

Evidence-Based Complementary and Alternative Medicine 5

Table 2 Characteristics of included case series

Reference Number ofcases

Gender(FM) Age (a) Duration of

intake day Type of liver injury (number) Outcome

Dong et al [76] 18 513 18ndash63 1ndash120 H (18) 18 recoveriesLian et al [77] 52 2230 22ndash69 5ndash120 H (30) C (9) M (13) 52 recoveriesZhang et al [78] 13 112 35ndash66 4ndash15 H (6) C (4) M (3) 12 recoveries 1 LTZhang et al [79] 36 1323 24ndash73 NA H (21) C (2) M (13) 33 recoveries 1 cirrhosis 2 deathsDing [80] 65 4520 34ndash71 7ndash90 NA 64 recoveries 1 deathGuo [81] 15 87 18ndash57 7ndash56 H (8) C (3) M (4) 15 recoveriesXie et al [82] 10 37 461 plusmn 102 30ndash105 H (5) C (4) M (1) 9 recoveries 1 deathSong [83] 26 1214 38ndash71 9ndash93 NA 26 recoveriesWang [84] 20 713 34ndash67 NA NA 20 recoveriesJung et al [85] 25 718 24ndash65 1ndash180 H (18) M (7) 23 recoveries 1 LT 1 deathChen et al [86] 12 57 20ndash70 15ndash90 H (4) C (4) M (4) 12 recoveriesLiu and Li [87] 7 52 31ndash64 60ndash180 NA 7 recoveriesLiu [88] 9 36 34ndash68 NA NA 9 recoveriesXu et al [89] 40 2416 452 9ndash168 H (22) C (8) M (10) 38 recoveries 2 deathsYang et al [90] 13 85 32ndash68 7ndash30 NA 13 recoveriesZhou and Qiu [91] 11 56 34ndash58 NA NA 11 recoveriesZhang et al [92] 6 33 24ndash50 4ndash24w NA 6 recoveriesNA not available H hepatocellular C cholestatic M mixed LT liver transplantation

Table 3 Use reasons of case reports

Disease originally treated Patients (number)Gray hair hair loss 43 (597)Health care 8 (111)Dizziness 3 (42)Vitiligo 2 (28)Constipation 2 (28)Othersa 8 (111)Unknown 6 (83)Total 72 (100)aIncluding infertility hypertension allergic rhinitis hyperlipidemia cere-bral infarction sequelae chronic nephritis and neurasthenia and chronicprostatitis

[77 79 86 88 91] The reasons for medication of 72 cases ofcase reports are shown in Table 3

34 Dosage Forms and Usage In case series there is insuffi-cient information on HSW forms and usage of each patientbut it is worth noting that in two case series the ratio ofprocessed HSW to raw HSW is 5 13 and 25 11 respectively[76 79]TheHSW forms of case reports are shown in Table 4in terms of usage all involved Chinese patent medicines areof oral formulation the types of HSW decoction pieces usedincluded tea liquor powder and decoction

35 Dose andDuration of TakingHSW In case series there isinsufficient information on dose and duration of takingHSWof each patient but some articles indicate that the majorityof patients take Chinese patent medicine in accordance withthe instructions For the 28 cases who consumed Chinese

Table 4 The classification of the drug of case reports

Dosage forms Patients (number)Chinese patent medicineShou-Wu-Pian 17 (2361)Shou-Wu-Wan 4 (556)Yishen wufa 2 (278)Othersb 5 (694)

Decoction piecesR HSW 13 (1806)P HSW 10 (1389)Unknown 21 (2917)

Total 72 (100)bIncluding Huolisu Koufuye Jing-Wu-Pian NuHair Shen-Min andYangxue shengfa capsules

patentmedicines in case reports 17 (1728 607) cases are inaccordancewith the recommended dosage and the remainingare unknown Of the 44 cases who used HSW decoctionpieces 19 cases (1944 432) did not report the daily dosethe other 25 casesrsquo daily dose ranged from 1 to 100 g with amedian of 15 g when the daily dose was ⩽12 g (1125) themedian of duration is 30 d but if the daily dose is gt12 g(1425) the median of duration is 60 d For all the patients ofcase reports the duration from starting to take HSW to theonset of symptoms ranged from 1 to 240 days with a medianof 30 days (Table 5)

36 Clinical Manifestations and Outcome According to casereports and case series most of the patients had been hospi-talized with jaundice fatigue anorexia and yellow or tawny


Table 5 The duration of taking HSW of case reports

Duration (day) Patients (number)lt10 10 (1389)10ndash30 27 (3750)31ndash60 19 (2639)gt60 12 (1667)Unknown 4 (556)Total 72 (100)

Table 6 The length of hospitalization of case reports

Hospitalization (d) Patients (number)lt15 8 (111)15ndash30 37 (514)31ndash60 14 (194)gt60 5 (69)Unknown 8 (111)Total 72 (100)

urine A handful of patients were found with abdominaldistension abdominal pain diarrhea rash pruritus andother symptoms After admission examination a few caseswere foundwith epigastrium tenderness first percussion overthe liver hepatomegaly or splenomegaly and even ascites [7786 89] Nine case series reported liver damage types of 221patients including 132 (132221 597) cases of hepatocytestype 34 (34221 154) cases of cholestatic type and 55(55221 249) cases of mixed type

In addition to two (2450 04) cases who receivedliver transplantation [78 85] and seven (7450 16) whodied [79 80 82 85 89] the remaining 441 (441450 98)cases recovered or had liver function improvement afterdiscontinuing HSW products and conservative care In casereports the length of 64 patientsrsquo hospitalization ranged from6 to 120 d with amedian of 295 (Table 6)The case series thatreported the average length of hospitalization was about fourweeks [79 81 83 84 89 91 92]

37 Recurrence and Family History In case reports 23 (2372319) cases were reported with liver damage associated withHSW for many times and 3 (372 42) cases had familyhistory of HSW induced hepatitis [61 67 71] In case seriesseven articles reported 53 (53138 384) cases with liverdamage related to HSWmany times [77 82ndash84 91 92]

4 Discussion

Based on the above information we know that HSW associ-ated with liver injury can occur at any age group and withno gender orientation The main reason for using HSW isthat patients suffer from gray hair and hair loss this maybe associated with those patients who are more likely to useHSW products but whether patients suffering from gray hairor hair loss are prone to occurrence of liver damage associatedwith HSW remains to be further studied

Although many studies suggest that processing couldreduce the toxicity of HSW [15 93] all HSW products maylead to liver damage regardless of herbal processing In theChinese Pharmacopoeia (2010) predetermined daily dose ofraw HSW is 3ndash6 g and of processed HSW is 6ndash12 g [2]Although only 25 cases of case reports have the HSW dosageinformation 14 cases exceed maximum dosages (12 gd) Theresults show that when daily dose is less than 12 g fromthe beginning of consuming HSW to the occurrence of liverdamage the median time is 60 days while when daily dose ismore than 12 g the median time is 30 days this suggested thatHSW associated with liver damage has a ldquodose-time-toxicityrdquorelationship animal experiments also had proved it [93]

Because more than 30 of patients in case reports andcases series were reported liver damage occurred many timeswhich was induced by HSW and a few cases have a familyhistory of liver damage induced byHSW these suggested thatHSWassociated with liver damagemay be related to personalbody factors of patients

The mechanism of HSW induced liver damage is stillunclear and mainly toxic substances are also an uncertainty[15 94] even few animal experiments did not find hepato-toxicity of HSW [95 96] Some studies suggested that theadverse reactions of traditional Chinese medicine are closelyrelated to patient self-medication arbitrarily increase in thedose or long-term use [97ndash99] this systematic review andsome papers included in it also have the same standpoint

HSWcan cause different degrees of liver injury even needof liver transplantation (2450) and death (6450) Howevermost HSW induced liver injuries are reversible after with-drawal of HSW products and corresponding treatments thevast majority of patients can recover liver function

Because HSW induced liver injury is not a specificdiagnostic method and some cases included in this reviewalso take other drugs or herbal medicines so considering thedoctors experience medical technology and other limitingfactors may not show all liver injury is caused by HSW

5 Conclusion

Many cases of liver damage associated with HSW had beenreported worldwide HSW has liver toxicity and may causedifferent degrees of liver damage The liver damage in mostpatients is reversible after discontinuation of HSW productsand active treatment can restore liver function but there arealso a small number of patients with liver failure and evendeath We suggest that patients should take HSW productsunder the guidance of a physician or pharmacist and avoidusing them for long-term or in high-dose If fatigue anorexianausea yellowing of skin and sclera yellow urine and othersymptoms appear aftermedication patients should be alertedto the occurrence of liver damage and promptly stop themedicine and treatment

Conflict of Interests

The authors declare that they have no financial conflict ofinterests


Authorsrsquo Contribution

Xiang Lei and Jing Chen contributed equally to this workHongcai Shang and Guihua Tian contributed equally to thiswork

Acknowledgment

The review was supported financially by Tianjin UniversityInnovation Team Training Program (TD12-5032)

References

[1] Q T Chen L H Zhuo W Xu Z H Huang and X H QiuldquoContent changes of 5 components in Polygohum muhiflorumduring processingrdquo Chinese Journal of Experimental TraditionalMedical Formulae vol 18 no 5 pp 66ndash71 2012

[2] National Pharmacopoeia Committee Chinese PharmacopoeiaChina Medical Science Press Beijing China 2010

[3] X Han C AWuWWang S Liu and L YWang ldquoMechanismresearch of stilbene glucoside from Polygonum multiflovumthunb on hyperlipemiardquoChinese Archives of Traditional ChineseMedicine vol 26 no 8 pp 1687ndash1689 2008

[4] X Gao Y-J Hu and L-C Fu ldquoBlood lipid-regulation ofstilbene glycoside from Polygonum multiflorumrdquo ZhongguoZhongyao Zazhi vol 32 no 4 pp 323ndash326 2007

[5] H H Cui Y Tian and S Y Long ldquoThe effective mechanismof 2 3 5 41015840-tetrahy-droxystilbene-2-O-120573-D- glucoside in anti-atherosclerosisrdquo Progress in Modern Biomedicine vol 9 no 20pp 3968ndash3982 2009

[6] W J Jin Experimental Study on Concentrated Processed Fleece-Flower Root Decoction in the Treatment of Liver Fibrosis DalianMedical University Dalian China 2004

[7] Y Y Yang H S Wang and S B Yang ldquoThe clinical effectof treated nonalcoholic fatty liver diseaserdquo Chinese Journal ofModern Drug Application vol 7 no 5 pp 66ndash71 2012

[8] X Y Wei J K Zhang Y H Luo S B Chen and J L SunldquoAntagonistic effect of Astragalus mongholicus and Polygonummultiflorum on thymocytes apoptosis induced by cyclophos-phamiderdquo Journal of China Pharmaceutical University vol 31no 1 pp 35ndash38 2000

[9] C L Ge and Y Liu ldquoPolysaccharide from Polygonum mul-tiflorum Thunb potentiates the immunological function inimmunosuppressed micerdquo Chinese Journal of New Drugs vol16 no 24 pp 2040ndash2042 2007

[10] H N Kim Y R Kim J Y Jang et al ldquoNeuroprotectiveeffects of Polygonum multiflorum extract against glutamate-induced oxidative toxicity in HT22 hippocampal cellsrdquo Journalof Ethnopharmacology vol 150 no 1 pp 108ndash115 2013

[11] L Liu L Li L Zhao L Zhang Y-L Li and C-F Ye ldquoEffects of23541015840-tetrahydroxystilbene-2-O-120573-D-glucoside on learningand memory abilities of rats with chronic cerebral ischemiardquoChinese Journal of Pharmacology and Toxicology vol 22 no 2pp 108ndash115 2008

[12] J Yu J Xie X-J Mao et al ldquoComparison of laxative andantioxidant activities of raw processed and fermented Polygonimultiflori Radixrdquo Chinese Journal of Natural Medicines vol 10no 1 pp 63ndash67 2012

[13] X X Zhou Study ofHigh Purity TetrahydroxystilbeneGlucosidersquosAnti-Aging Effect and the Possible Mechanism Fourth MilitaryMedical University Xirsquoan China 2013

[14] L Zhang X Yang and Y Deng ldquoEvaluation and considerationon safety information abroad of Polygonum multiflorum and itspreparationsrdquo Zhongguo Zhongyao Zazhi vol 34 no 18 pp2414ndash2418 2009

[15] G Q Shen L Jiang and C Y Gong ldquoPolygonum multiflorum-induced hepatic lesion retrospective analysis and clinical mon-itoringrdquo Evaluation and Analysis of Drug-Use in Hospitals ofChina vol 10 no 11 pp 1040ndash1042 2010

[16] L Lao G RHamilton J Fu andBM Berman ldquoIs acupuncturesafe A systematic review of case reportsrdquo Alternative Therapiesin Health and Medicine vol 9 no 1 pp 72ndash83 2003

[17] H P Liu X R Wu and J Yuan ldquoHepatic damage andagranulocytosis due to Polygonum multiflorumrdquo Adverse DrugReactions Journal vol 15 no 5 pp 298ndash300 2013

[18] Y J Miao and Y L Yun ldquoTwo cases of drug-induced hepatitiscaused by Polygonum multiflorumrdquo Chinese Journal of DrugApplication and Monitoring vol 10 no 1 pp 61ndash62 2013

[19] G X Zhao ldquoOne case of hepatitis caused by Jin-Wu-Pianrdquo InnerMongol Journal of Traditional Chinese Medicine vol 32 no 10pp 180ndash181 2013

[20] S Tan ldquoPharmaceutical care one case of drug-induced hepatitiscaused by Polygonum multiflorumrdquo in Proceedings of the 9thClinical Pharmacist Forum 2013

[21] Y Liu Z Z B Hu and X F Wang ldquoProcessed Polygonummultiflorum induced one case liver damage and literaturereviewrdquo Chinese Journal of Integrated Traditional and WesternMedicine on Liver Diseases vol 23 no 3 pp 176ndash177 2013

[22] Y Gao L Jia andK J Yu ldquoPolygonimultifloriRadix praeparataand Tribuli fructus induced acute liver failurerdquo Adverse DrugReactions Journal vol 15 no 5 pp 294ndash295 2013

[23] A Banarova T Koller and J Payer ldquoToxic hepatitis inducedby Polygonummultiflorumrdquo Vnitrnı lekarstvı vol 58 no 12 pp958ndash962 2012

[24] L S Gao ldquoOne case of drug-induced hepatitis caused byPolygonummultiflorumrdquoHealthMust Read vol 11 no 10 p 5762012

[25] X H Kui and X Q Chen ldquoOne case of drug-induced hepatitiscaused by Polygonummultiflorum combination a variety of coldmedicinerdquo Chinese Medicine vol 7 no 2 p 241 2012

[26] Y L Shao and Q Li ldquoTwo cases of drug-induced hepatitiscaused by Polygonummultiflorumrdquo Journal of Qilu Nursing vol18 no 22 p 111 2012

[27] Y C Hu H Z Li and R L Chen ldquoOne case of drug-inducedhepatitis caused byPolygonummultiflorumrdquoHerald ofMedicinevol 31 no 4 p 542 2012

[28] L X Zhen and C Z Zeng ldquoOne case of drug-inducedhepatitis caused by Polygonum multiflorumrdquo Chinese Joumal ofEthnomedieine and Ethnopharmacy no 21 p 50 2012

[29] Z X Li andZ Zhang ldquoTwo cases of icteric viral hepatitis causedby unprocessed Polygonum multiflorumrdquo Chinese Journal ofAesthetic Medicine vol 21 no 12 p 775 2012

[30] S P Chen FM Tan and Y Y Yang ldquoOne case of acute hepatitiscaused by PolygonummultiflorumrdquoChinese Hepatology vol 17no 1 p 68 2012

[31] S M Liu Y P Tang and Y X Gong ldquoOne case of acutehepatitis caused by Yishen wufardquo Chinese Journal of IntegratedTraditional andWestern Medicine on Digestion vol 20 no 4 p182 2012

[32] S M Sun ldquoTwo cases of liver damage caused by Polygonummultiflorumrdquo Guide of China Medicine vol 9 no 26 pp 136ndash137 2011


[33] M X Cao M Liu R R Wu F Q Liu and X Zhou ldquoOne caseof liver damage caused by processed Polygonum multiflorumrdquoChinese Journal of Pharmacovigilance vol 8 no 8 p 510 2011

[34] Y LiuW Y Chen Y Q Zhao andH Xiang ldquoOne case of drug-induced hepatitis caused by Shengfa Yangxue Capsulerdquo Journalof Military Surgeon in Southwest China vol 13 no 6 p 10112011

[35] Y Q Yan ldquoOne case of liver damage caused by long-termlow-dose administration of Polygonum multiflorumrdquo MedicalJournal of Beijing Military Region vol 23 no 5 p 41 2011

[36] Z Q Wu and H Y Niu ldquoOne case of severe liver damagecaused byPolygonummultiflorumrdquoWorldHealthDigestMedicalPeriodieal vol 8 no 12 pp 414ndash415 2011

[37] W Z Liu Y M Teng and L Lei ldquoOne case of acute liverinjury caused by Shou-Wu-Wanrdquo Journal of Shantou UniversityMedical College vol 23 no 3 p 172 2010

[38] M X Chen X Y Chen and W Tang ldquoTwo cases of drug-induced hepatitis caused by Polygonum multiflorumrdquo SichuanMedical Journal vol 31 no 9 pp 1390ndash1391 2010

[39] D W Yun X R Guo and X F Gao ldquoOne case of liver injurycaused by Shou-Wu-Wanrdquo Chinese Journal of Coal IndustryMedicine vol 13 no 7 p 1084 2010

[40] M Furukawa S Kasajima Y Nakamura et al ldquoToxic hepatitisinduced by Show-Wu-Pian a Chinese herbal preparationrdquoInternal Medicine vol 49 no 15 pp 1537ndash1540 2010

[41] X Y Yan Q C Meng and Z S Yan ldquoOne case of liver damagecaused by Polygonum multiflorumrdquo Chinese Journal of Difficultand Complicated Cases vol 8 no 7 p 399 2009

[42] R He ldquoOne case of liver damage caused by Polygonummultiflo-rum after postpartumrdquo Medical Journal of West China vol 21no 5 p 774 2009

[43] X Y Chen ldquoPlasmapheresis combined with hemofiltrationtreatment one case drug-induced hepatitis caused by Poly-gonum multiflorumrdquo Journal of Emergency in Traditional Chi-nese Medicine vol 18 no 5 pp 824ndash826 2009

[44] H C Cho H J Min C Y Ha et al ldquoReactivation of Pulmonarytuberculosis in a patient with Polygonum multiflorum Thunb-Induced hepatitisrdquo Gut and Liver vol 3 no 1 pp 52ndash56 2009

[45] F F Wang C H Jin and M Guan ldquoThree cases of hepatitiscaused by PolygonummultiflorumrdquoWest ChinaMedical Journalvol 23 no 3 p 631 2008

[46] B S Zhu ldquoOne case of drug-induced hepatitis caused byPolygonum multiflorumrdquo Journal of Huaihai Medicine vol 26no 4 p 320 2008

[47] J Yang and Z G Li ldquoTwo cases of drug-induced hepatitiscaused by Polygonummultiflorumrdquo Shanxi Medical Journal vol37 no 11 p 973 2008

[48] A R Laird N Ramchandani E M Degoma B Avula IA Khan and N Gesundheit ldquoAcute hepatitis associated withthe use of an herbal supplement (Polygonum multiflorum)mimicking iron-overload syndromerdquo Journal of Clinical Gas-troenterology vol 42 no 7 pp 861ndash862 2008

[49] J L Yang and Y J Dong ldquoTwo cases of liver damage causedby Shou-Wu-Pianrdquo Journal of the Fourth Military MedicalUniversity vol 28 no 2 p 162 2007

[50] P Fu and Y Yu ldquoOne case of hepatitis caused by Polygonummultiflorumrdquo Chinarsquos Naturopathy vol 15 no 3 p 41 2007

[51] X D Zhao ldquoOne case of acute liver injury caused by Shou-Wu-Wanrdquo Zhongguo Zhongyao Zazhi vol 32 no 5 p 444 2007

[52] Z Li ldquoTwo cases of liver damage caused by Polygonum multi-florumrdquo Chinese Journal of Misdiagnostics vol 6 no 10 p 20332006

[53] A Cardenas J C Restrepo F Sierra and G Correa ldquoAcutehepatitis due to Shen-Min a herbal product derived fromPolygonum multiflorumrdquo Journal of Clinical Gastroenterologyvol 40 no 7 pp 629ndash632 2006

[54] J L Han ldquoHepatitis attributed to Radix Polygoni multiflorirdquoAdverse Drug Reactions Journal vol 8 no 5 p 390 2006

[55] D Q Yang ldquoPolygonum cause severe liver damagerdquo AdverseDrug Reactions Journal no 6 p 449 2005

[56] B Panis D R Wong P M Hooymans P A G M DeSmet and P P R Rosias ldquoRecurrent toxic hepatitis in aCaucasian girl related to the use of Shou-Wu-Pian a Chineseherbal preparationrdquo Journal of Pediatric Gastroenterology andNutrition vol 41 no 2 pp 256ndash258 2005

[57] C Chen C J Zhao and X Z Yu ldquoOne case of liver damagecaused byPolygonummultiflorumrdquoAnhuiMedical and Pharma-ceutical Journal vol 9 no 3 p 204 2005

[58] M Y Huo and S H Ling ldquoHepatitis due to the concomitantadministration of Shou-Wu-Pian and Yangxue Shengfa cap-sulesrdquoAdverse Drug Reactions Journal no 5 pp 335ndash336 2004

[59] G Mazzanti L Battinelli C Daniele et al ldquoNew case ofacute hepatitis following the consumption of Shou Wu Pian aChinese herbal product derived from Polygonum multiflorumrdquoAnnals of Internal Medicine vol 140 no 7 p 30 2004

[60] Z Y Shao ldquoTwo cases of liver damage caused by Polygonummultiflorumrdquo Zhejiang Journal of Integrated Traditional Chineseand Western Medicine vol 13 no 11 pp 716ndash718 2003

[61] M Leng ldquoOne case of acute severe liver injury caused byconventional dose Polygonum multiflorumrdquo Journal of HenanMedical College for Staff andWorkers vol 14 no 3 p 277 2002

[62] S Q Dai and Y M Li ldquoOne case of liver damage caused byPolygonum multiflorumrdquo Ningxia Medical Journal vol 24 no8 p 501 2002

[63] WD Yuan ldquoOne case of acute liver injury caused by Polygonummultiflorumrdquo Chinese Remedies amp Clinics vol 2 no 6 p 4162002

[64] J Sun ldquoOne case of severe liver damage caused byChinese drugsfor invigorationrdquo Chinese Journal of Integrated Traditional andWestern Medicine on Digestion vol 10 no 5 p 292 2002

[65] J Y Yang ldquoOne case of liver damage caused by Polygonummultiflorumrdquo Turpan Science and Technology no 4 pp 50ndash512002

[66] G J-H Park S P Mann and M C Ngu ldquoAcute hepatitisinduced by Shou-Wu-Pian a herbal product derived fromPolygonummultiflorumrdquo Journal of Gastroenterology and Hep-atology vol 16 no 1 pp 115ndash117 2001

[67] J Q Sheng ldquoFamilial acute liver injury caused by Polygonummultiflorumrdquo Chinese Journal of Hepatology vol 6 no 1 p 591998

[68] Z H Li D M Gai and X R Zhuang ldquoHepatitis attributedto Polygonum multiflorumrdquo Shandong Journal of TraditionalChinese Medicine vol 17 no 7 pp 23ndash24 1998

[69] D M Fan and Z L Zhou ldquoOne case of liver damage caused byPolygonummultiflorumrdquo Journal of Norman Bethune Universityof Medical Science vol 24 no 3 p 292 1998

[70] F X Li ldquoOne case of liver injury caused by Shou-Wu-WanrdquoJournal of New Chinese Medicine vol 29 no 12 pp 42ndash43 1997

[71] Q H Ye ldquoOne case of acute toxic liver disease caused by Poly-gonum multiflorumrdquo Chinese Journal of Integrated Traditionaland Western Medicine vol 16 no 12 p 732 1996

[72] W F Zhang ldquoOne case of liver injury caused by Huo-Li-SurdquoJournal of Practical Traditional Chinese Medicine vol 13 no 2p 41 1997


[73] J H Niu ldquoOne case of severe liver damage caused by Shou-Wu-Pianrdquo New Drugs and Clinical Remedies vol 15 no 6 p63 1996

[74] M H He and X J Zhen ldquoTwo cases of acute liver damagecaused by Polygonum multiflorumrdquo Shanxi Journal of Tradi-tional Chinese Medicine vol 17 no 5 p 230 1996

[75] P P-H But B Tomlinson and K-L Lee ldquoHepatitis relatedto the Chinese medicine Shou-Wu-Pian manufactured fromPolygonummultiflorumrdquoVeterinary andHumanToxicology vol38 no 4 pp 280ndash282 1996

[76] H Dong D Slain J Cheng W Ma and W Liang ldquoEighteencases of liver injury following ingestion of Polygonum multiflo-rumrdquo Complementary Therapies in Medicine vol 22 no 1 pp70ndash74 2014

[77] X Lian T T Ke and A R Hu ldquoClinical analysis of 52 casesof drug-induced liver injury caused by Polygonum multiflorumand its preparationsrdquo Chinese Archives of Traditional ChineseMedicine vol 31 no 5 pp 1133ndash1134 2013

[78] S G Zhang W Yi R J Hao J F Peng and G Zhao ldquoAnalysisof 13 cases of liver damage caused by Polygonum multiflorumand its preparationsrdquo Peoplersquos Military Surgeon vol 56 no 6pp 699ndash700 2013

[79] Y Zhang S Chen and L Lu ldquoClinical analysis of 36 cases ofdrug-induced liver injury by Polygonum multiflorum ThunbrdquoHainan Medical Journal vol 24 no 2 pp 235ndash237 2013

[80] E Ding ldquoClinical analysis on the treatment of drug-inducedliver injury by Polygonum multiflorumThunb with magnesiumisoglycyrrhizinaterdquo Inner Mongol Journal of Traditional ChineseMedicine vol 31 no 11 pp 15ndash16 2012

[81] X Q Guo ldquoClinical characteristics analysis of liver damagecaused by Polygonum multiflorumrdquo Chinese Community Doc-tors vol 14 no 4 p 416 2012

[82] X J Xie K F Ma and Y Liu ldquoAnalysis of liver injury inducedby Polygoni multiflori RadixrdquoDrug Evaluation vol 9 no 32 pp36ndash38 2012

[83] L Y Song ldquoCorrelation analysis of drug-induced liver injurycaused by Polygonum multiflorum Thunbrdquo Medical Journal ofWest China vol 23 no 7 pp 1300ndash1301 2011

[84] Y Wang ldquoClinical research of drug-induced liver injury causedby PolygonummultiflorumrdquoMedical Innovation of China vol 8no 30 pp 104ndash105 2011

[85] K A Jung H J Min S S Yoo et al ldquoDrug-induced liverinjury twenty five cases of acute hepatitis following ingestionof Polygonum multiflorum thunbrdquo Gut and Liver vol 5 no 4pp 493ndash499 2011

[86] S X Chen P Fan W X He J Jiang and Z Y Xiong ldquoClinicalAnalysis of drug-induced liver injury caused byPolygonummul-tiflorumrdquo Chinese Journal of Digestion and Medical Imageologyvol 2 no 5 pp 266ndash268 2012

[87] F Liu and Z Li ldquoAnalysis of 7 cases of drug-induced liver injuryby Polygonummultiflorumrdquo Inner Mongol Journal of TraditionalChinese Medicine vol 29 no 6 p 58 2010

[88] G Q Liu ldquoClinical analysis of 9 cases of drug-inducedliver injury by Polygonum multiflorum Thunbrdquo ContemporaryMedicine vol 15 no 30 p 149 2009

[89] J Xu M R Wang C L He Y H Sui and F Qiao ldquoLiver injuryby peroral Polygonum multiflorum an analysis of 40 casesrdquoMilitary Medical Journal of Southeast China vol 11 no 3 pp209ndash210 2009

[90] X X Yang N Jiang and J M Lin ldquoClinical analysis of13 patients with liver diease induced Polygonum multiflorum

Thunbrdquo Sichuan Medical Journal vol 29 no 12 pp 1619ndash16202008

[91] X H Zhou and X Qiu ldquoClinical analysis of 11 cases of drug-induced liver injury by Polygonum multiflorumThunbrdquo Journalof North Sichuan Medical College vol 20 no 1 pp 107ndash1082005

[92] X Zhang X C Ding Y Yang P Zhang and F F Wu ldquoClinicalanalysis of 6 patients with liver diease induced PolygonummultiflorumThunbrdquo Journal of Ningxia Medical College vol 22no 2 pp 115ndash116 2000

[93] W Huang Y N Zhang and R Sun ldquoExperimental study onthe ldquoDose-Time-Toxicityrdquo relationship of acute hepatotoxicityinduced by different components from Polygonum multiflorumin micerdquo Chinese Journal of Pharmacovigilance vol 8 no 4 pp193ndash197 2011

[94] J Yu J Xie R-H Zhao S-Q Cai and Z Chen ldquoAdvancesin studies on liver adverse reaction of Polygonum multiflorumrdquoChinese Traditional and Herbal Drugs vol 41 no 7 pp 1206ndash1210 2010

[95] T Noda T Yamada T Ohkubo et al ldquoHot-water-extracts ofPolygonum multiflorum do not induce any toxicity but elicitlimited beneficial effects on the liver in micerdquo Journal of HealthScience vol 55 no 5 pp 720ndash725 2009

[96] Y D Liu X X Huang L S Wu D M Sun and D Y LuldquoExperimental study of liver toxicity of Polygonum multiflorumThunbrdquo Asia-Pacific Traditional Medicine vol 3 no 4 pp 71ndash72 2007

[97] S K Zhou and L D Wu ldquoAnalysis and preventive measures ofadverse reaction of Chinese herbal medicinerdquo Chinese Journalof Ethnomedicine and Ethnopharmacy no 12 pp 43ndash44 2013

[98] C J Guo ldquoAnalysis of the causes of adverse reaction of tra-ditional Chinese medicine decoction and recommendationsrdquoInformation on Traditional Chinese Medicine vol 20 no 3 pp168ndash170 2013

[99] X H Sun H S Ji J X Han and L P Wang ldquoFocus on theADR charicteristics of traditional Chinese herbal medicine andits preventmeasures from the liver damage byPoligonimultifloriradixrdquo Guide of China Medicine vol 18 no 34 pp 21ndash22 2010

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014


MEDIATORSINFLAMMATION

of


Behavioural Neurology

EndocrinologyInternational Journal of



Disease Markers


BioMed Research International

OncologyJournal of



Oxidative Medicine and Cellular Longevity


PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of



Computational and Mathematical Methods in Medicine

OphthalmologyJournal of


Diabetes ResearchJournal of



Research and TreatmentAIDS


Gastroenterology Research and Practice


Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom


Figure 1 Raw HSW

Figure 2 Processed HSW

products the most well-known product is like Shou-Wu-Pian which is usually consumed as an antiaging productor as a tonic for dizziness with tinnitus and also appears tobe efficacious in the treatment of premature greying of hairlumbago spermatorrhea leucorrhea and constipation Withthe wide application liver damage associated with HSW hasbeen reported in China Korea Japan Britain Italy Australiaand other countries [14 15] To fully understand the charac-teristics and possible factors of hepatitis associatedwithHSWwe conduct a comprehensive review of the relevant publishedliteratures we hope that our findings can provide guidancefor clinical medication and scientific research and thus canhelp to avoid hepatitis induced by HSW in the future

2 Methods

21 Data Sources and Search Strategy In June 2014 wesearched the following Chinese-language electronic data-bases Chinese Biomedical Literature Database (CBM 1980ndash2014) Chinese Journal Full-Text Database (CNKI 1980ndash2014) Weipu Journal Database (VIP 1989ndash2014) and Wan-fang Data (1990ndash2014) and two English-language databasesPubMed and EMBASE (1989ndash2014) The search termsincluded Polygonum multiflorum radix polygoni multiflori

He ShouWu liver injury liver damage liver diseases hepati-tis and liver failure in English or Chinese These terms weresearched as free-text in the title or the abstractThe referencesof relevant reviews and the included literatures were checkedfor possible identification of additional studies

22 Study Selection Case reports and case series are includedin the review if they reported factual data on liver damagerelated to HSW Clinical trials reviews commentaries andother nonrelated literatures were excluded Some clinicaltrials of HSW that reported liver damage were excludedfor reasons originally given by Lao et al specifically thatthey were too small to provide convincing evidence ofrare complications [16] Two authors (Xiang Lei and JingChen) independently examined the titles and abstracts ofall papers found through the search to determine if theyfulfilled the inclusion criteria outlined above The full textsof potentially relevant articles were retrieved for detailedassessment Differences can be resolved through discussion

23 Data Extraction After screening articles were read infull and extracted by two independent reviewers (Xiang Leiand Jing Chen) Information on author year of publicationnumber of patients disease originally treated gender doseand dosage forms course of taking HSW clinical manifesta-tions length of hospitalization outcome and family historyand recurrence of hepatitis related to HSW were extractedaccording to the designeddata extraction table independentlyby two authors

3 Results

31 Search Process and Result The search identified 923database records which led to the retrieval of documentationon 103 studies for a full-text review One additional referencewas identified while searching reference lists of the includedpapers 76 articles (59 case reports and 17 case series) met theinclusion criteria In total 450 cases of hepatitis associatedwith HSW were reported The characteristics of the casereports and case series are shown in Tables 1 and 2 Becausecase series is summary report for multiple patients andbecause of the lack of description of the individual patientinformation the following is mainly an analysis of casereports

32 Gender and Age In 450 cases 224 (4978) were maleand 226 (5022) were female In 72 cases of case reportspatients ranged in age from 5 to 78 years with a medianof 365 The most commonly affected age group was 18ndash44(3772 514) followed by 45ndash59 (2472 333) lt18 (67283) and ⩾60 (572 69)

33 Reasons for Medication (Disease Originally Treated)In case series the causes of consuming HSW productsinclude grey hair hair loss hypertension coronary heartdisease hyperlipidemia osteoarthritis insomnia dizzinessand health care the top diseases were gray hair and hair loss


ble1Patie

ntdetails

recorded

from

publish

edcase

repo

rts

Reference

Agegender

Reason

sfor

medication

HSW

type

Administratio

nanddo

sage

Durationof

intake

day

Hospitalization

day

Outcome

Rechallenge

Liuetal[17]

20F

Greyhair

HSW

OAP15g

4210

Recovery

NA

MiaoandYu

n[18]

52F

Health

care

PHSW

OAP5g

2014

Recovery

NA

61F

Hyperlip

idem

iaR

HSW

SIW5

g180

12Re

covery

NA

Zhao

[19]

39M

Greyhair

Jing-Wu-Pian

Oral3times6tablets

6018

Recovery

NA

Tan[20]

48F

NA

PHSW

uNA10g

4030

Recovery

NA

Liuetal[21]

37M

Vitiligo

PHSW

OAP10g

3035

Recovery

NA

Gao

etal[22]

14F

Vitiligo

PHSW

Decoctio

nNA

3815

Recovery

NA

Banarova

etal[23]

33F

NA

SWW

OralNA

60NA

Recovery

NA

Gao

[24]

45M

Hairloss

PHSW

OAPNA

9021

Recovery

NA

Kuiand

Chen

[25]

43F

Greyhair

HSW

OAP8ndash10g

6030

Recovery

NA

Shao

andLi

[26]

50M

Greyhair

HSW

OAPNA

6030

Recovery

NA

40F

Health

care

RHSW

Decoctio

n10ndash20g

6050

Recovery

NA

Huetal[27]

36M

Chronicn

ephritis

PHSW

OAP15g

3037

Recovery

NA

Zhen

andZe

ng[28]

52F

Greyhair

PHSW

OAPNA

1430

Recovery

NA

LiandZh

ang[29]

50F

Greyhair

RHSW

OAP2g

6015

Recovery

NA

28F

Hairloss

RHSW

OAP3g

7512

Recovery

NA

Chen

etal[30]

57M

Greyhair

RHSW

NA

120

Recovery

NA

Liuetal[31]

56F

Greyhair

Yishen

wufa

Oral2times10mL

120

21Re

covery

NA

Sun[32]

39F

Allergicrhinitis

RHSW

Decoctio

n15ndash20g

3028

Recovery

NA

72F

Health

care

RHSW

Decoctio

n10ndash20g

6042

Recovery

NA

Caoetal[33]

28M

Greyhair

PHSW

NA10pieces

9042

Recovery

NA

Liuetal[34]

26M

Hairloss

Yang

xues

heng


6030

Recovery

NA

Yan[35]

28M

Hairloss

HSW

Decoctio

n4g

9028

Recovery

NA

WuandNiu

[36]

47F

Hairloss

Yishen

wufa

Oral3times10ml

2014

Recovery

NA

Liuetal[37]

50F

Hairloss

SWW

OralNA

725

Recovery

NA

Chen

etal[38]

46F

Health

care

HSW

tea

Oral1-2

g60

25Re

covery

NA

57M

Health

care

HSW

tea

Oral1-2

g20

15Re

covery

NA

Yunetal[39]

51F

Greyhair

SWW

Oral2times6g

180

18Re

covery

NA

Furukawae

tal[40]

53F

NA

SWP

NA

240

60Re

covery

NA

Yanetal[41]

54F

Greyhair

HSW

OAP2times10g

6035

Recovery

NA

He[42]

31F

Con

stipatio

nHSW

OralNA

1510

Recovery

NA

Chen

[43]

38F

Greyhair

HSW

OAPNA

120

63Re

covery

NA

Choetal[44

]34M

NA

HSW

HSW

tea(

liquo

r)N

A30

(4)

34im

proved

NA

Wangetal[45]

34M

Health

care

RHSW

SIWN

A20

20Re

covery

NA

46M

Health

care

RHSW

SIWN

A10

27Re

covery

NA

49F

Health

care

RHSW

SIWN

A5

27Re

covery

NA

Zhu[46]

36M

Hairloss

RHSW

SIWN

A30

30Re

covery

NA

Yang

andLi

[47]

38M

Greyhair

HSW

Decoctio

n30

gOncea

week(3w)

NA

Recovery

NA

51M

Sequ

elae

ofstr

oke

HSW

Decoctio

n15g

15NA

Recovery

NA

Laird

etal[48]

35M

Thinning

hair

NuH

air

OralNA

NA

120

Recovery

NA

Yang

andDon

g[49]

54M

Hairloss

SWP

Oral3times6tablets

4017

Recovery

NA

26M

Greyhair

SWP

Oral3times6tablets

3059

Recovery

Yes


Table1Con

tinued

Reference

Agegender

Reason

sfor

medication

HSW

type

Administratio

nanddo

sage

Durationof

intake

day

Hospitalization

day

OutcomeRe

challenge

FuandYu

[50]

32F

Infertility

PHSW

Decoctio

nNA

18Untreated

Recovery

NA

Zhao

[51]

17M

Greyhair

SWW

Oral3times6tablets

4090

Recovery

Yes

Li[52]

65M

Dizzinesstinnitus

HSW

SIW30ndash

50ml

2030

Recovery

Yes

38M

Greyhair

SWP

Oral3times6tablets

3020

Recovery

NA

Cardenas

etal[53]

28F

Hairloss

Shen-M

inOral2tablets

566

Recovery

NA

Han

[54]

42F

Greyhair

HSW

OAP10g

9030

Recovery

Yes

Yang

[55]

35M

Greyhair

PHSW

Decoctio

n30

g45

50Re

covery

NA

Panise

tal[56]

5F

NA

SWP

Oral3tablets

120

30Re

covery

Yes

Chen

etal[57]

20F

Greyhair

HSW

OAPNA

2040

Recovery

NA

Huo

andLing

[58]

28M

Hairloss

SWP+Yang

xues

heng


nd2times4capsules

6018

Recovery

Yes

Mazzantietal[59]

78M

Chronicp

rosta

titis

SWP

OralRD

30NA

Recovery

NA

Shao

[60]

46F

Hairloss

RHSW

Decoctio

nNA

630

Recovery

Yes

45M

Greyhair

hairloss

RHSW

Decoctio

n100g

NA

30Re

covery

Yes

Leng

[61 ]

15F

Greyhair

HSW

Decoctio

n15g

30NA

Recovery

NA

DaiandLi

[62]

18F

Greyhair

SWP

OralNA

9090

Recovery

NA

Yuan

[63]

66F

Con

stipatio

nHSW

ointment

OralNA

730

Recovery

Yes

Sun[64]

20F

Neurasth

enia

SWP+Liuw

eiDihuang

Wan

Oral3times6tabletsa

nd2times9g

310

Recovery

Yes

Yang

[65]

17M

Greyhair

SWP

OralNA

1429

Recovery

Yes

Park

etal[66]

46F

Greyhair

SWP

OralRD

1430

Recovery

NA

Sheng[67]

38F

Greyhair

HSW

OralNA

6NA

Recovery

Yes

Lietal[68]

58F

Dizziness

HSW

Decoctio

n30

g7

15Re

covery

Yes

49M

Hypertension

HSW

SIW15g

1020

Recovery

Yes

FanandZh

ou[69]

26M

Greyhair

SWP

Oral3times6tablets

3059

Recovery

Yes

Li[70]

17M

Greyhair

SWP

Oral3times5tablets

2060

Recovery

Yes

Ye[71]

30M

Greyhair

HSW

Decoctio

n50

g2

94Re

covery

Yes

Zhang[72]

36F

NA

SWP

Oral10ml

1515

Recovery

Yes

Niu

[73]

28M

Greyhair

SWP

Oral3times5tablets

1060

Recovery

Yes

Hea

ndZh

en[74]

19F

Greyhair

SWP

OralNA

NA

30Re

covery

Yes

27F

Greyhair

SWP

OralNA

NA

NA

Recovery

Yes

Butetal[75]

31F

Dizziness

SWP

OralRD

Severalw

eeks

21Re

covery

Yes

SWP

Shou

-Wu-PianS

WWS

hou-Wu-WanO

AP

oral

administratio

nof

powderSIWsoakedin

water

todrink

PHSW

processed

HSW

RH

SWraw

HSW

HSW

unclear

whether

itwas

processed

RD

recommendeddo

sagesNAnot

available


























4 Discussion







5 Conclusion







Acknowledgment


References












































































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















ble1Patie

ntdetails

recorded

from

publish

edcase

repo

rts

Reference

Agegender

Reason

sfor

medication

HSW

type

Administratio

nanddo

sage

Durationof

intake

day

Hospitalization

day

Outcome

Rechallenge

Liuetal[17]

20F

Greyhair

HSW

OAP15g

4210

Recovery

NA

MiaoandYu

n[18]

52F

Health

care

PHSW

OAP5g

2014

Recovery

NA

61F

Hyperlip

idem

iaR

HSW

SIW5

g180

12Re

covery

NA

Zhao

[19]

39M

Greyhair

Jing-Wu-Pian

Oral3times6tablets

6018

Recovery

NA

Tan[20]

48F

NA

PHSW

uNA10g

4030

Recovery

NA

Liuetal[21]

37M

Vitiligo

PHSW

OAP10g

3035

Recovery

NA

Gao

etal[22]

14F

Vitiligo

PHSW

Decoctio

nNA

3815

Recovery

NA

Banarova

etal[23]

33F

NA

SWW

OralNA

60NA

Recovery

NA

Gao

[24]

45M

Hairloss

PHSW

OAPNA

9021

Recovery

NA

Kuiand

Chen

[25]

43F

Greyhair

HSW

OAP8ndash10g

6030

Recovery

NA

Shao

andLi

[26]

50M

Greyhair

HSW

OAPNA

6030

Recovery

NA

40F

Health

care

RHSW

Decoctio

n10ndash20g

6050

Recovery

NA

Huetal[27]

36M

Chronicn

ephritis

PHSW

OAP15g

3037

Recovery

NA

Zhen

andZe

ng[28]

52F

Greyhair

PHSW

OAPNA

1430

Recovery

NA

LiandZh

ang[29]

50F

Greyhair

RHSW

OAP2g

6015

Recovery

NA

28F

Hairloss

RHSW

OAP3g

7512

Recovery

NA

Chen

etal[30]

57M

Greyhair

RHSW

NA

120

Recovery

NA

Liuetal[31]

56F

Greyhair

Yishen

wufa

Oral2times10mL

120

21Re

covery

NA

Sun[32]

39F

Allergicrhinitis

RHSW

Decoctio

n15ndash20g

3028

Recovery

NA

72F

Health

care

RHSW

Decoctio

n10ndash20g

6042

Recovery

NA

Caoetal[33]

28M

Greyhair

PHSW

NA10pieces

9042

Recovery

NA

Liuetal[34]

26M

Hairloss

Yang

xues

heng


6030

Recovery

NA

Yan[35]

28M

Hairloss

HSW

Decoctio

n4g

9028

Recovery

NA

WuandNiu

[36]

47F

Hairloss

Yishen

wufa

Oral3times10ml

2014

Recovery

NA

Liuetal[37]

50F

Hairloss

SWW

OralNA

725

Recovery

NA

Chen

etal[38]

46F

Health

care

HSW

tea

Oral1-2

g60

25Re

covery

NA

57M

Health

care

HSW

tea

Oral1-2

g20

15Re

covery

NA

Yunetal[39]

51F

Greyhair

SWW

Oral2times6g

180

18Re

covery

NA

Furukawae

tal[40]

53F

NA

SWP

NA

240

60Re

covery

NA

Yanetal[41]

54F

Greyhair

HSW

OAP2times10g

6035

Recovery

NA

He[42]

31F

Con

stipatio

nHSW

OralNA

1510

Recovery

NA

Chen

[43]

38F

Greyhair

HSW

OAPNA

120

63Re

covery

NA

Choetal[44

]34M

NA

HSW

HSW

tea(

liquo

r)N

A30

(4)

34im

proved

NA

Wangetal[45]

34M

Health

care

RHSW

SIWN

A20

20Re

covery

NA

46M

Health

care

RHSW

SIWN

A10

27Re

covery

NA

49F

Health

care

RHSW

SIWN

A5

27Re

covery

NA

Zhu[46]

36M

Hairloss

RHSW

SIWN

A30

30Re

covery

NA

Yang

andLi

[47]

38M

Greyhair

HSW

Decoctio

n30

gOncea

week(3w)

NA

Recovery

NA

51M

Sequ

elae

ofstr

oke

HSW

Decoctio

n15g

15NA

Recovery

NA

Laird

etal[48]

35M

Thinning

hair

NuH

air

OralNA

NA

120

Recovery

NA

Yang

andDon

g[49]

54M

Hairloss

SWP

Oral3times6tablets

4017

Recovery

NA

26M

Greyhair

SWP

Oral3times6tablets

3059

Recovery

Yes


Table1Con

tinued

Reference

Agegender

Reason

sfor

medication

HSW

type

Administratio

nanddo

sage

Durationof

intake

day

Hospitalization

day

OutcomeRe

challenge

FuandYu

[50]

32F

Infertility

PHSW

Decoctio

nNA

18Untreated

Recovery

NA

Zhao

[51]

17M

Greyhair

SWW

Oral3times6tablets

4090

Recovery

Yes

Li[52]

65M

Dizzinesstinnitus

HSW

SIW30ndash

50ml

2030

Recovery

Yes

38M

Greyhair

SWP

Oral3times6tablets

3020

Recovery

NA

Cardenas

etal[53]

28F

Hairloss

Shen-M

inOral2tablets

566

Recovery

NA

Han

[54]

42F

Greyhair

HSW

OAP10g

9030

Recovery

Yes

Yang

[55]

35M

Greyhair

PHSW

Decoctio

n30

g45

50Re

covery

NA

Panise

tal[56]

5F

NA

SWP

Oral3tablets

120

30Re

covery

Yes

Chen

etal[57]

20F

Greyhair

HSW

OAPNA

2040

Recovery

NA

Huo

andLing

[58]

28M

Hairloss

SWP+Yang

xues

heng


nd2times4capsules

6018

Recovery

Yes

Mazzantietal[59]

78M

Chronicp

rosta

titis

SWP

OralRD

30NA

Recovery

NA

Shao

[60]

46F

Hairloss

RHSW

Decoctio

nNA

630

Recovery

Yes

45M

Greyhair

hairloss

RHSW

Decoctio

n100g

NA

30Re

covery

Yes

Leng

[61 ]

15F

Greyhair

HSW

Decoctio

n15g

30NA

Recovery

NA

DaiandLi

[62]

18F

Greyhair

SWP

OralNA

9090

Recovery

NA

Yuan

[63]

66F

Con

stipatio

nHSW

ointment

OralNA

730

Recovery

Yes

Sun[64]

20F

Neurasth

enia

SWP+Liuw

eiDihuang

Wan

Oral3times6tabletsa

nd2times9g

310

Recovery

Yes

Yang

[65]

17M

Greyhair

SWP

OralNA

1429

Recovery

Yes

Park

etal[66]

46F

Greyhair

SWP

OralRD

1430

Recovery

NA

Sheng[67]

38F

Greyhair

HSW

OralNA

6NA

Recovery

Yes

Lietal[68]

58F

Dizziness

HSW

Decoctio

n30

g7

15Re

covery

Yes

49M

Hypertension

HSW

SIW15g

1020

Recovery

Yes

FanandZh

ou[69]

26M

Greyhair

SWP

Oral3times6tablets

3059

Recovery

Yes

Li[70]

17M

Greyhair

SWP

Oral3times5tablets

2060

Recovery

Yes

Ye[71]

30M

Greyhair

HSW

Decoctio

n50

g2

94Re

covery

Yes

Zhang[72]

36F

NA

SWP

Oral10ml

1515

Recovery

Yes

Niu

[73]

28M

Greyhair

SWP

Oral3times5tablets

1060

Recovery

Yes

Hea

ndZh

en[74]

19F

Greyhair

SWP

OralNA

NA

30Re

covery

Yes

27F

Greyhair

SWP

OralNA

NA

NA

Recovery

Yes

Butetal[75]

31F

Dizziness

SWP

OralRD

Severalw

eeks

21Re

covery

Yes

SWP

Shou

-Wu-PianS

WWS

hou-Wu-WanO

AP

oral

administratio

nof

powderSIWsoakedin

water

todrink

PHSW

processed

HSW

RH

SWraw

HSW

HSW

unclear

whether

itwas

processed

RD

recommendeddo

sagesNAnot

available


























4 Discussion







5 Conclusion







Acknowledgment


References












































































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















Table1Con

tinued

Reference

Agegender

Reason

sfor

medication

HSW

type

Administratio

nanddo

sage

Durationof

intake

day

Hospitalization

day

OutcomeRe

challenge

FuandYu

[50]

32F

Infertility

PHSW

Decoctio

nNA

18Untreated

Recovery

NA

Zhao

[51]

17M

Greyhair

SWW

Oral3times6tablets

4090

Recovery

Yes

Li[52]

65M

Dizzinesstinnitus

HSW

SIW30ndash

50ml

2030

Recovery

Yes

38M

Greyhair

SWP

Oral3times6tablets

3020

Recovery

NA

Cardenas

etal[53]

28F

Hairloss

Shen-M

inOral2tablets

566

Recovery

NA

Han

[54]

42F

Greyhair

HSW

OAP10g

9030

Recovery

Yes

Yang

[55]

35M

Greyhair

PHSW

Decoctio

n30

g45

50Re

covery

NA

Panise

tal[56]

5F

NA

SWP

Oral3tablets

120

30Re

covery

Yes

Chen

etal[57]

20F

Greyhair

HSW

OAPNA

2040

Recovery

NA

Huo

andLing

[58]

28M

Hairloss

SWP+Yang

xues

heng


nd2times4capsules

6018

Recovery

Yes

Mazzantietal[59]

78M

Chronicp

rosta

titis

SWP

OralRD

30NA

Recovery

NA

Shao

[60]

46F

Hairloss

RHSW

Decoctio

nNA

630

Recovery

Yes

45M

Greyhair

hairloss

RHSW

Decoctio

n100g

NA

30Re

covery

Yes

Leng

[61 ]

15F

Greyhair

HSW

Decoctio

n15g

30NA

Recovery

NA

DaiandLi

[62]

18F

Greyhair

SWP

OralNA

9090

Recovery

NA

Yuan

[63]

66F

Con

stipatio

nHSW

ointment

OralNA

730

Recovery

Yes

Sun[64]

20F

Neurasth

enia

SWP+Liuw

eiDihuang

Wan

Oral3times6tabletsa

nd2times9g

310

Recovery

Yes

Yang

[65]

17M

Greyhair

SWP

OralNA

1429

Recovery

Yes

Park

etal[66]

46F

Greyhair

SWP

OralRD

1430

Recovery

NA

Sheng[67]

38F

Greyhair

HSW

OralNA

6NA

Recovery

Yes

Lietal[68]

58F

Dizziness

HSW

Decoctio

n30

g7

15Re

covery

Yes

49M

Hypertension

HSW

SIW15g

1020

Recovery

Yes

FanandZh

ou[69]

26M

Greyhair

SWP

Oral3times6tablets

3059

Recovery

Yes

Li[70]

17M

Greyhair

SWP

Oral3times5tablets

2060

Recovery

Yes

Ye[71]

30M

Greyhair

HSW

Decoctio

n50

g2

94Re

covery

Yes

Zhang[72]

36F

NA

SWP

Oral10ml

1515

Recovery

Yes

Niu

[73]

28M

Greyhair

SWP

Oral3times5tablets

1060

Recovery

Yes

Hea

ndZh

en[74]

19F

Greyhair

SWP

OralNA

NA

30Re

covery

Yes

27F

Greyhair

SWP

OralNA

NA

NA

Recovery

Yes

Butetal[75]

31F

Dizziness

SWP

OralRD

Severalw

eeks

21Re

covery

Yes

SWP

Shou

-Wu-PianS

WWS

hou-Wu-WanO

AP

oral

administratio

nof

powderSIWsoakedin

water

todrink

PHSW

processed

HSW

RH

SWraw

HSW

HSW

unclear

whether

itwas

processed

RD

recommendeddo

sagesNAnot

available


























4 Discussion







5 Conclusion







Acknowledgment


References












































































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of









































4 Discussion







5 Conclusion







Acknowledgment


References












































































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of



















Acknowledgment


References












































































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of



























































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of
















review article liver damage associated with polygonum...

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