Herbal Traditional Chinese Medicine and suspected liver injury: A prospective study

Table 3 Indication for treatment, maximum value of alanine aminotransferase, suspected Traditional Chinese Medicine herbs and Roussel Uclaf Causality Assessment Method-based causality grading in liver injury cases 1-26

Cases	Indication for TCM treatment	Maxi-mum ALT (U/L)	Suspected TCM herbs	RUCAM-based causality
Patient 1	Asthma Depression Lower back pain syndrome	341	Bupleuri radix Glycyrrhizae radix Scutellariae radix	Possible (score +4)
Patient 2	Posttraumatic paralysis of both legs	140	Bupleuri radix Glycyrrhizae radix Scutellariae radix	Possible (score +3)
Patient 3	Chronic bronchitis Emphysema Sleeping disorder	234	Bupleuri radix Ephedrae herba Glycyrrhizae radix Scutellariae radix	Probable (score +7)
Patient 4	Chronic migraine	168	Bupleuri radix Glycyrrhizae radix	Probable (score +6)
Patient 5	Post herpes zoster state Hypertension Diabetes mellitus	330	Bupleuri radix Dictamni radicis cortex Scutellariae radix	Excluded (score -1)
Patient 6	Chronic migraine Cervico-brachial pain syndrome Low back pain syndrome Diarrhoea	530	Bombyx batryticatus (t) Psoraleae fructus (semen) Scutellariae radix	Possible (score +3)
Patient 7	Lumbosacral plexus syndrome Cervicobrachial pain syndrome	132	Bupleuri radix Dictamni radices cortex Ephedrae herba Scutellariae radix	Possible (score +5)
Patient 8	Polyneuropathy	193	Decoction; none identified suspected herb	Possible (score +3)
Patient 9	Polymyalgia rheumatica Fibromyalgia	162	Bupleuri radix Scutellariae radix	Possible (score +4)
Patient 10	Chronic migraine Tension headache	195	Bombyx batryticatus (t) Bupleuri radix Meliae toosendan fructus Scutellariae radix	Possible (score +3)
Patient 11	Difficulty of walking Polyneuropathy Low back pain syndrome	325	Glycyrrhizae radix	Excluded (score -1)
Patient 12	Chronic fatigue Depressive episodes Gastrointestinal symptoms	751	Meliae toosendan fructus	Probable (score +7)
Patient 13	Low back pain syndrome Sleeping disorder	389	Cassiae semen	Possible (score +5)
Patient 14	Chronic osteomyelitis	1052	Meliae toosendan fructus Scutellariae radix	Probable (score +7)
Patient 15	Chronic fatigue Chronic cephalgia	290	Bupleuri radix Meliae toosendan fructus Scutellariae radix	Possible (score +4)
Patient 16	Lichen sclerosus Cervical spondylosis	715	Bombyx batryticatus (t) Bupleuri radix Scutellariae radix	Possible (score +5)
Patient 17	Chronic migraine Depression	252	Bombyx batryticatus (t) Bupleuri radix Cassiae semen Scutellariae radix	Probable (score +6)
Patient 18	Spondylosis cervicalis Depression Migraine	233	Bombyx batryticatus (t) Bupleuri radix Scutellariae radix	Probable (score +6)
Patient 19	Carcinophobia	249	Bombyx batryticatus (t)	Probable (score +6, 2011)
(2011)	Tinnitus		Bupleuri radix
(2014)	Allergic sensitivity syndrome	295	Ephedrae herba Puerariae radix Polygoni multiflora caulis Scutellariae radix	Probable (score +7, 2014)
Patient 20	Migraine Lower back pain syndrome Depressive episodes	207	Bupleuri radix Ephedrae herba Glycyrrhizae radix Polygoni cuspidate rhizoma Scutellariae radix	Possible (score +4)
Patient 21	Neurasthenia Fibromyalgia	221	Bupleuri radix Glycyrrhizae radix Rhei radix et rhizoma Scutellariae radix	Possible (score+5)
Patient 22	Tension headache Somatoform pain disorder Polyarthritis	361	Glycyrrhizae radix Scutellariae radix	Possible (score +3)
Patient 23	Alopecia cranialis totalis Hashimoto-Thyroiditis	268	Bupleuri radix Polygoni multiflori radix Psoraleae fructus (semen)	Possible (score +4)
Patient 24	Chronic migraine Depression	210	Bombyx batryticatus (t) Bupleuri radix Polygoni multiflori caulis Scutellariae radix	Probable (score +6)
Patient 25	Chronic pain syndrome	359	Bupleuri radix Scutellariae radix	Possible (score +5)
Patient 26	Somatization Gastrointestinal symptoms	182	Bupleuri radix Glycyrrhizae radix Meliae toosendan fructus Scutellariae radix	Possible (score +3)

For ALT until 2002, the normal range was ≤ 24 U/L for males and females, thereafter ≤ 35 U/L for females and ≤ 50 U/L males. Causality levels are as follows: ≤ 0 points, excluded causality; 1-2, unlikely; 3-5, possible; 6-8, probable; and ≥ 9, highly probable. TCM: Traditional Chinese Medicine; RUCAM: Roussel Uclaf Causality Assessment Method.