Aristolochia

(USAN)

💊 Chemical information

Serpentaria.

Pharmacopoeias.

Chin. allows various species of Aristolochia.

💊 Profile

Aristolochia spp. (birthworts) including A. clematitis and A. ringens (A. brasiliensis) have been used in herbal medicine. Serpentary (serpentaria) is the dried rhizome and roots of Aristolochia serpentaria (Virginian snakeroot) and of A. reticulata (Texan snakeroot) (Aristolochiaceae). Snakeroot is also used as a common name to describe poisonous Eupatorium spp. Preparations of serpentary have been used as bitters. The active ingredient is aristolochic acid, which has been tried in a number of inflammatory disorders, mainly in folk medicine; the sodium salt of aristolochic acid has also been used. However, there is concern over such use since aristolochic acid has been reported to be carcinogenic and nephrotoxic. Chinese medicine has employed various species of Aristolochia including A. contorta, A. debilis (but see under Adverse Effects, below), and A. manshuriensis. The terms Mu Tong and Fangji have been used for Aristolochia spp. in traditional medicine.

Adverse effects.

Progressive interstitial fibrosis of the kidney related to a slimming regimen containing Chinese herbs had been reported in 70 patients in Belgium by 1993; 30 of these patients had terminal renal failure.1 Renal failure has also been reported2 in 2 patients in the UK after ingestion of Chinese herbal medicines that were later found to contain aristolochic acid, a known nephrotoxin;3 one of these patients subsequently developed invasive urothelial carcinoma.4 Inadvertent ingestion of aristolochic acid can originate as a result of the substitution of Aristolochia spp. (probably A. manshuriensis) for other innocuous herbal substances;2,5 the Belgian cases were probably as a result of substitution of A. fangchi extracts for Stephania tetrandra.1 As a result of these cases, the UK MCA issued a permanent ban on Aristolochia preparations in 1999. Similar bans have been made in several other countries;3 in 2004, the Chinese regulatory authority also banned the use of A. fangchi and A. debilis in traditional medicine formulations. Examination of 39 patients in Belgium with nephropathy associated with A. fangchi ingestion had revealed 18 cases of urothelial carcinoma and evidence of mild to moderate dysplasia in 19 patients.6 There had appeared to be a higher risk of carcinoma with total doses of A. fangchi in excess of 200 g. Aristolochic acid has been proposed as the cause of endemic (Balkan) nephropathy,7 which is confined to a very specific rural geographical distribution and first described in the 1950s. Data supporting this hypothesis included findings of DNA damage linked to aristolochic acid in kidney samples from affected patients, as well as renal failure in horses who had grazed in the local fields. Aristolochia clematitis is endemic to the region and has been found in fields cultivated for wheat grain. It is possible that the local population could be exposed to toxic amounts of aristolochic acid over time from bread made with grain contaminated with A. clematitis seeds.
1. Vanhaelen M, et al. Identification of aristolochic acid in Chinese herbs. Lancet 1994; 343: 174
2. Lord GM, et al. Nephropathy caused by Chinese herbs in the UK. Lancet 1999; 354: 481–2
3. Cosyns JP. Aristolochic acid and ‘Chinese herbs nephropathy’: a review of the evidence to date. Drug Safety 2003; 26: 33–48
4. Lord GM, et al. Urothelial malignant disease and Chinese herbal nephropathy. Lancet 2001; 358: 1515–6
5. But PP, Ma S-c. Chinese-herb nephropathy. Lancet 1999; 354: 1731–2
6. Nortier JL, et al. Urothelial carcinoma associated with the use of a chinese herb (Aristolochia fangchi). N Engl J Med 2000; 342: 1686–92
7. Grollman AP, et al. Aristolochic acid and the etiology of endemic (Balkan) nephropathy. Proc Natl Acad Sci U S A 2007; 104: 12129–34.

💊 Preparations

Proprietary Preparations

Ital.: Euserpina Cellulite. Multi-ingredient: S.Afr.: Borstol Cough Remedy.
Published December 27, 2018.