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Bei Psoraleae fructus (Buguzhi) an eine mögliche Hepatotoxizität denken!

Beware of possible hepatotoxicity in the use of Psoraleae Fructus (Buguzhi)!

  • Arzneimittel
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Chinesische Medizin / Chinese Medicine Aims and scope

Zusammenfassung

Psoraleae fructus (Buguzhi) ist ein wichtiges Mittel der Chinesischen Medizin aus der Gruppe der Yang-Tonika. Was die Sicherheit des Mittels betrifft, sind in den letzten 15 Jahren zunehmend Berichte über Leberreaktionen veröffentlicht worden, die mit Psoraleae-fructus-haltigen Zubereitungen assoziiert sind. Diese betreffen zumeist Kombinationen mit anderen Arzneien in Form von Patentmitteln, aber auch einige Dekokte, Granulatmischungen, Pulver und einige Einzelanwendungen des Mittels, diese überwiegend außerhalb der Chinesischen Medizin. Auch in kursorischen Fallzusammenstellungen von Leberreaktionen fällt die häufige Beteiligung von Psoraleae fructus (Buguzhi) auf.

Im Einzelfall sind diese Berichte für eine definitive Kausalitätszuweisung unzureichend. Bei sorgfältiger Analyse der Summe dieser Berichte kommt man nicht daran vorbei, eine kausale Beziehung als wahrscheinlich ansehen, auch wenn ein eindeutiger wissenschaftlicher Beweis bislang aussteht. Ein übliches Paozhi-Verfahren, wie das Rösten mit Salz, ändert die Toxizität nicht grundlegend. Ein optimiertes Verfahren zeigte im Tierversuch günstiger erscheinende Ergebnisse, doch liefert dieses Modell keine valide Aussage für die klinische Situation beim Menschen.

Absolut gesehen sind Leberreaktionen durch Psoraleae fructus (Buguzhi), die dem idiosynkratischen Typ zuzurechnen sind, ausgesprochen selten. Dennoch ist es wichtig, bei der Verschreibung dieses Mittels an die Möglichkeit einer Lebertoxizität zu denken und sensibel für deren Symptome zu sein, um bei Auftreten von Nebenwirkungen rechtzeitig und angemessen zu reagieren. Der Patient sollte über das Verhalten bei Auftreten entsprechender Symptome aufgeklärt werden.

Abstract

Psoraleae Fructus (Buguzhi) belongs to the group of yang tonics and is an important Chinese herb. With regard to its safety, there have been an increasing number of reports published over the last fifteen years about liver injury associated with preparations which contain Psoraleae Fructus. These mostly involve combinations with other drugs in the form of patent remedies, but also some decoctions, granular mixtures, powders, and some single applications of the herb–these predominantly outside the domain of Chinese Medicine. The frequent involvement of Psoraleae Fructus (Buguzhi) in cursory summaries of case studies of liver injury is also noticeable.

In individual cases, these reports are insufficient to establish a definitive causal relationship. Upon careful analysis of the sum of these reports, however, one cannot fail to conclude that a causal relationship is probable, even though unambiguous scientific proof remains to be presented. A common Paozhi process, such as roasting with salt, does not fundamentally change the toxicity. An optimised processing technique tried in animal experiments displayed results that appear to be better, but this model does not provide any valid evidence for clinical use with humans.

In absolute terms, liver injuries brought on by Psoraleae Fructus (Buguzhi), which can be assigned to the idiosyncratic type, are extremely rare. Nevertheless, it is important when prescribing this medicine to consider the possibility of liver toxicity and to be vigilant and alert to corresponding symptoms in order to react quickly and appropriately to any adverse reactions that may occur. The patient should be instructed how to behave if corresponding symptoms appear.

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    Axel Wiebrecht

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Wiebrecht, A. Bei Psoraleae fructus (Buguzhi) an eine mögliche Hepatotoxizität denken!. Chinese Medicine 37, 94–105 (2022). https://doi.org/10.1007/s00052-022-00052-6

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