TCM for Kidney and Liver Conditions: Why Extra Caution Is Needed

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If you have kidney disease, liver disease, a kidney transplant, or abnormal kidney or liver blood tests, talk to your kidney or liver team before taking any Chinese herbal product. This is not a page about treating these conditions with herbs. It is about why the kidneys and liver need extra caution. The National Kidney Foundation (US) says that for people with chronic kidney disease, herbal supplements can make kidney disease worse, interact with medicines, or raise the risk of complications; after a kidney transplant, interactions can raise the risk of losing the new kidney. [1] Never stop kidney or liver medicines because of a herbal product. Bring the actual bottle or package to your appointment. [1]

Why the kidneys and liver are different

The National Kidney Foundation notes that some herbal supplements leave the body through the kidneys, so toxic levels can build up in kidney disease, which is not always clear on the label. [1] In the US, it adds, herbal supplements are not regulated for dose, content or purity. [1] NCCIH notes that Chinese herbal products have been found contaminated with undeclared drugs, heavy metals, pesticides or incorrect herbs, some of which have caused organ damage. [2]

Kidney harms that are documented

A review in the Clinical Journal of the American Society of Nephrology says some herbal medicines are known to cause kidney toxicity, which can be missed because people believe herbs are harmless. The toxic components include aristolochic acids and other plant alkaloids. Kidney problems reported include acute kidney injury, chronic kidney disease, kidney stones, Fanconi syndrome and urothelial cancer. Contributing factors include a herb's intrinsic toxicity, incorrect processing or storage, adulteration, heavy metals, wrong dosing and drug interactions. [3] Exposure to aristolochic acid may increase the risk of later urinary tract cancers, so exposed people need follow-up screening. [3]

The National Kidney Foundation lists Aristolochia products as a high risk for people with kidney disease and says aristolochic acid is banned in many countries but still present in some traditional remedies. [1] Read the full story in aristolochic acid and kidney injury. It also advises avoiding teas and supplements marketed as "kidney detox" or "kidney cleanse", because evidence for them is limited and some ingredients can interact with medicines or harm the kidneys. [1] See also TCM "detox" claims checked.

Liver harms that are documented

• Case reports. A review of herbal TCM liver injury named many products in reports, including He Shou Wu (Polygonum multiflorum), and said liver injury from a few herbal products may rarely occur in susceptible people. In some patients the course was severe, with risks of acute liver failure, liver transplant and death. [4]
• Quality problems. The same review said case data were mixed, especially because of adulteration with synthetic drugs, heavy metals contamination and misidentified herbs. [4]
• He Shou Wu. A review found reports of liver injury from raw and prepared forms increasing; the harmful components are not yet identified, and quality control is a major safety problem. [5] See He Shou Wu and liver injury reports.
• Mainland China. A review of herb-induced liver injury in mainland China said China has the most extensive herb use and the most cases of this injury worldwide, and that risk factors are still unclear. [6]
• How common? Studies comparing TCM herbs and drugs reported liver injury from TCM herbs less often than drug-induced liver injury, but cases still occur. [7]
• Early liver disease often causes no symptoms; later signs include tiredness, loss of appetite, nausea, itchy skin and yellow skin or eyes (jaundice). [8] See warning signs after taking herbs and liver safety and supplements.

What trials found for benefit

See Astragalus in Chinese medicine. The Xiao Chai Hu Tang formula also appears among the products named in the liver injury case reports above. [4]

Where evidence is missing

Proper evidence not found that any Chinese herbal product is a safe replacement for dialysis, transplant care, hepatitis treatment or liver disease care, or that it protects the kidneys and liver from "toxins". I searched PubMed for Cochrane reviews and systematic reviews on kidney disease, hepatitis B and liver injury. For safe handling of everyday supplements, see existing conditions and heavy metals in Chinese medicines.