13 March 2004
Dear Doctor,
Suspected Cases of Aristolochic Acid Poisoning
A case of suspected Aristolochic Acid (AA)「马兜铃酸」poisoning due to erroneous substitution of the herb Herba Solani Lyrati (白英) with Aristolochia mollissima Hance (寻骨风) was reported to the Department of Health in March 2004 by the Hospital Authority. Investigation revealed confusion in the terminology in 3 types of herbs, namely白英,寻骨风and白毛藤. Department of Health has called on the trade to suspend the sale of the above 3 herbs.
Inappropriate or long term use of AA-containing herbs or products is reported in the literature to be associated with Aristolochic Acid Nephropathy and urinary tract cancer. Examples of the more commonly used AA containing herbs include: Caulis Aristolochiae Manshuriensis (关木通), Radix Aristolochiae Fangchi (广防己), Fructus Aristolochiae (马兜铃), Radix Aristolochiae (青木香) and Herba Aristolochiae (天仙藤).
Please be aware and consider enquiring about the use of herbal medicines when patients present with nephropathy or urinary tract cancer of unknown origin. Please report highly suspected case to the Department of Health using the attached report form report form to facilitate further investigation.
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