Dr. Clove is here to answer that question.

Are you, or a close family member or friend, taking herbal remedies? If so, please pay special attention to the following ingredients in the formulas you are using:

Guanmutong, Guangfengxian, Qingmuxiang, Aristolochia, Bone-seeking Fung, Xinxin, Nanmuxiang, Guannanxiang, Sanpangtongtong, Cinnabar Lotus, Tianxianteng, Tongchenghu, Vine Fragrance, Huaitong, Dorsal Snake Sang, Butterfly Dark Elimination, Forcing Blood to Thunder, White Golden Fruit Olive, False Large Potato.

The herbs mentioned above all contain a chemical called 'aristolochic acid'.

as soon asThe day before yesterday (October 18, 2017), Science Magazine's translational medicine subseries (）以封面故事的形式，发布一篇题为「Aristolochic acids and their derivatives are widely implicated in liver cancers in Taiwan and throughout Asia」的研究论文。

The paper demonstrates that in Asia (especially Taiwan and China), through sequencing of pathologic specimens, theHepatocellular carcinoma is strongly associated with mutations caused by aristolochic acid. In other words, the herbs mentioned above, which contribute to the risk of liver cancer, are cause for concern.

One,The 'black hand' behind kidney failure, tumors

In 1956, the Balkan regions of Bosnia, Bulgaria, and Croatia had an epidemic of "chronic interstitial" nephritis, which led to reduced kidney function. Many farmers in the region suffered from the disease, but no one knew where it started.

In 1964, two cases of "extreme renal failure" were reported in China. Wu Hansong, a Chinese scholar, found that these two patients had taken the decoction of the herb Guanmutong, but this report did not attract much attention in the Chinese medical community and was regarded as an isolated case.

It was not until the 1990s that the 'culprits' of these diseases were identified.

It happened in Hungary, when a group of young women taking herbs for weight loss suddenly suffered kidney failure in large numbers, a situation that attracted the attention of the local government and the health department, and was eventually confirmed to be due to the weight-loss pills, a kind of plant called "broad-proofing", which led to the incident.

During the same period of time in China, there was also the famous "Gentian Liver Pill" incident. According to the Xinhua News Agency, only one hospital, the China-Japan Friendship Hospital, had more than 100 patients suffering from uremia between 1999 and 2001.

Ultimately all fingers point to the aristolochic acid behind these herbs. Meanwhile, studies have shown that aristolochic acid can cause not only uremia, but also a host of tumors such as kidney cancer, bladder cancer, and urothelial tumors.

In 2001, the World Health Organization issued a drug alert for the drug aristolochic acid.

In 2002, the FDA (Food and Drug Administration) of the United States ordered a ban on the use of all herbal medicines containing aristolochic acid. Subsequently, Hong Kong and Taiwan also banned and announced the cessation of the import and sale of Chinese herbal medicines containing aristolochic acid.

In 2003, China's State Food and Drug Administration (SFDA) removed the drug standard for guanmutong; in 2004, SFDA removed the drug standards for guangpianzhi and qingmuxiang. At the same time, the Chinese Pharmacopoeia eliminated Chinese herbal medicines containing aristolochic acid from its records starting in 2005.

However, at present, there are still a large number of herbal medicines as well as proprietary Chinese medicines containing aristolochic acid on the market in China, and the consumption of these medicines will bring about a great potential risk of liver and kidney toxicity.

What's even more frightening is that the kidney and liver damage caused by aristolochic acid is irreversible and irreparable, and he causes damage to the body from the moment he takes it.

As the cover review of this issue of Science magazine puts it.The Dark Side of an Herbal Medicine (The Dark Side of an Herbal Medicine)。

Evaluation of the Journal of Science Translational Medicine

ii,The most powerful genetic poison

In 2008, the International Agency for Research on Cancer (IARC) classified aristolochic acid as a class 1 carcinogen; aristolochic acid analogs as class 2 carcinogs.

In 2012, all aristolochic acids (aristolochic acid, aristolochic acid-containing compounds, and jobs) were upgraded to Class 1 carcinogens because of their intense toxicity.

Why is aristolochic acid so harmful? It starts with the toxicology of aristolochic acid-based substances.

In 2013, the journal Science Translational Medicine published two heavyweight studies that demonstrated the toxicity of aristolochic acid mechanistically.

Researchers at Johns Hopkins University and the State University of New York at Stony Brook, among others, reported in a study that they sequenced the whole exome of 19 patients with upper urinary tract cancers who had been exposed to aristolochic acid, as well as seven others who had not been exposed to the toxin.

An average of 753 mutations per patient in the aristolochic acid-exposed group was found, compared with 91 mutations per patient in the non-aristolochic acid-exposed group.

Studies have shown that aristolochic acid can trigger a higher number of gene mutations than tobacco and ultraviolet light, making it the most potent genetic toxicant known to cause gene mutations.

Another study was conducted by a collaboration of researchers from various medical institutions in Singapore, the United States and Taiwan, China. Using whole genome and exome sequencing techniques, they confirmed that exposure to aristolochic acid may cause cancers that were previously thought to be caused by other carcinogenic factors.

And the follow up expansion of that study is this article posted the day before yesterday.

Researchers from the United States, Singapore, and Taiwan collected liver cancer specimens from Taiwan, China, Japan, Singapore, and Europe and the United States and tested them for gene mutations caused by aristolochic acid.

They collected more than 1,400 liver cancer specimens and categorized them according to the presence of aristolochic acid-induced mutations. The results showed that liver cancer and aristolochic acid-producing mutations were highly correlated in Asian populations, with the highest correlation in Taiwan and China.

Of the 98 hepatocellular carcinoma pathology samples from Taiwan, 78% were characterized by aristolochic acid mutagenesis, and 47% of the 89 hepatocellular carcinoma specimens from mainland China were consistent with aristolochic acid gene mutation.

In Europe and the United States, the figures are 1.7% and 4.8% respectively.

Rates of aristolochic acid mutations in hepatocellular carcinoma in different national regions

More red color means that liver cancer development is associated with aristolochic acid-induced mutations.

And this is the strongest evidence yet to prove that aristolochic acid induces hepatocarcinogenesis.

iii,What can we do about aristolochic acid?

China is a big country for kidney disease and kidney cancer, as well as for liver cancer.

In 2015, there were more than 400,000 new liver cancer patients in China, accounting for more than half of the world's patients. The average risk of liver cancer in China is 3 to 4 times higher than that in Europe and the United States.

In the past, we have mostly blamed the widespread spread of viral hepatitis in this country and improper grain storage (aflatoxin). But this latest research paper has led us to a direct cause that may be even more damaging.

What can we do?

Until the country has stricter regulations on aristolochic acid medications, all each of us can do is avoid those aristolochic-containing medications listed above.

At the same time, it is important to make as many people as possible aware of the knowledge related to the genotoxicity of aristolochic acid and to promote stricter national management of aristolochic acid-based drugs.

These are things we do not only for ourselves, but for the next generation. We, for one, deserve a safer medication environment.

Answer content reproduced from Dingxiangwang microblogging public number: dingxiangwang

Author／Yellowstone

Editor／lightningwing, Capricorn

References:

1. Poon S L, Pang S T, McPherson J R, et al. Genome-wide mutational signatures of aristolochic acid and its application as a screening tool[J]. Science translational medicine, 2013, 5(197): 197ra101-197ra101.

2.Gentian Liver Pills - Fire-clearing medicine or "disease-causing" root cause?

http://www.china.com.cn/chinese/2003/Feb/280896.htm

3. Poon S L, Pang S T, McPherson J R, et al. Genome-wide mutational signatures of aristolochic acid and its application as a screening tool[J]. Science translational medicine, 2013, 5(197): 197ra101-197ra101

4. Hoang M L, Chen C H, Sidorenko V S, et al. Mutational signature of aristolochic acid exposure as revealed by whole-exome sequencing[J]. Science translational medicine, 2013, 5(197): 197ra102-197ra102.

5. Chen W, Zheng R, Baade P D, et al. Cancer statistics in China, 2015[J]. CA: a cancer journal for clinicians, 2016, 66(2): 115-132.

Cure or Cancer Culprit?The paper entitled "Aristolochic acid and its derivatives are associated with hepatocellular carcinoma in Taiwan and other parts of Asia" was published in a subseries of Science.(Note that it is about, not the cause)

First, let's understand a little bit about how this article proves that aristolochic acid is linked to the development of liver cancer.

Scientists, after many years of research, have discovered that aristolochic acid is able to bind tightly to DNA, leading to errors when cells are replicating, and tends to turn T into A and A into T (DNA encodes life with the four bases T, C, G, and A). Such changes - an average of 150 mutations for every 1 million DNA - can cause the entire life to be interpreted completely wrong, creating the possibility of cancer (in fact, urethral cancer is caused by aristolochic acid).

Therefore, aristolochic acid induces the above mentioned mutations in cells, which is called the "aristolochic acid mutational fingerprint". This is the so-called "aristolochic acid mutational fingerprint", and all (other) known mutagens do not produce this fingerprint.It is now possible to tell right away if there is a relationship between a certain tumor and aristolochic acid just by genetic testing (which is what the article uses).

The findings of this article are well known: 47% of liver cancer samples from mainland China, 78% from Taiwan, and 56% from Southeast Asia carried a clear "aristolochic acid mutation fingerprint".. This is a very high rate and could potentially contribute to liver cancer, which requires further research to confirm whether aristolochic acid exposure increases the risk of liver cancer.

And then, given the results of this study, there was a strong reaction from all sides.

Those who are "black on Chinese medicine" feel that they have obtained evidence that Chinese medicine is a "pseudo-science". Those who "support Chinese medicine" will feel that there is nothing to be afraid of when used under the guidance of Chinese medicine theories. Our State Food and Drug Administration, on the other hand, is of the view that: 1. Aristolochic acid has obvious nephrotoxicity, and there is a risk of causing kidney cancer; 2. As for the liver cancer patients in our country, which is mainly caused by Hepatitis B virus infection, there is no direct and strong data to support whether it has a direct relationship with aristolochic acid or not.

Finally, in Magician's opinion, there is something to be said for the following.

1.Whether the etiology of liver cancer patients in China is directly related to aristolochic acid needs to be confirmed by further data, I believe that a study will soon be available (the FDA has already organized a risk assessment of herbs and pCms containing aristolochic acid);

2. There is no doubt that aristolochic acid is a strong carcinogen (and actually causes kidney disease), and this article proves that it is linked to liver cancer, so it is best to avoid medications containing aristolochic acid and its derivatives;

3. Don't be gullibleThe so-called "compound detoxification."However, in the face of a super mutation inducer such as aristolochic acid, personal experience is useless, and unless it can be shown that the formulated product no longer induces mutations, it is just wishful thinking and conjecture.

We can't deny the usefulness of herbs in treating illnesses, but as this magazine says, "The Dark Side of Herbs," we need to take a critical look at everything in this age of science.Only with a scientific approach and methodology can we better understand the true nature of things and thus achieve the results we want. This study, at least, lets us know that the risks of using aristolochic acid are too high and the benefits are unclear at best. So "it would be prudent to suspend the use of traditional medicines known to contain aristolochic acid now and ensure that it does not contaminate traditional medicines through proper quality control procedures," as one scientist put it.

Note: Herbs containing aristolochic acid have been used in China for thousands of years. Currently, there are 24 herbs of the Aristolochiaceae family and 47 oral preparations of proprietary Chinese medicines containing herbs of the genus Aristolochia, all of which are available on the government website of the State Food and Drug Administration (link below).

List of listed proprietary Chinese medicine varieties containing herbs of the genus Aristolochia http://www.sda.gov.cn/WS01/CL1991/215893.html

List of Aristolochiaceae herbs that may contain aristolochic acid http://www.sda.gov.cn/WS01/CL1991/215894.html

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Cross-sectional studies can only illustrate the phenomenon, to be truly causal there must be cohort studies, as well as studies of quantitative and qualitative relationships. If the drug has been used for hundreds of years, and there has been no increase in market use in recent decades, but the incidence of hepatocellular carcinoma has risen, there is no relationship with this. Moreover, the mechanism of liver cancer is not clear. How to determine that the biological effect of this Chinese medicine is the pathogenesis of liver cancer?