Integrated evidence chain-based identificationof Chinese herbal medicine-induced hepatotoxicity and rational usage:Exemplification by Polygonum Multiflorum (He shouwu)

Toxicity and adverse drug reactions (events) related to Chinese herbal medicines (CHMs) have been reported increasingly and stirred discussion within the public, media, government and academia, of which hepatotoxicity has become prominent problems in recent years, especially for those CHMs not conventionally considered of toxicity, for instance, Polygonum Multiflorum Thunb. (He shou wu in Chinese). Nowadays, clinical diagnosis for drug-induced liver injury (DILI) mainly adopts the Roussel Uclaf Causality Assessment Method (RUCAM) and the structured expert opinion process (SEOP). However, the accurate diagnosis of DILI is still the international challenge due to a lack of specific diagnosis indicators. Herb-induced liver injury (HILI), nevertheless, is more difficult to diagnosis and sometimes exists misdiagnosis, by reason of the complexity of both the composition of CHMs and combinational prescription of CHMs and western medicines in clinic.