Aristolochic Acid side effects, danger, risks

May 20 2016 by Ray Sahelian, M.D. Visit this home page and find out about a natural healing newsletter


Aristolochic acid is present in at least 65 different kinds of plants, many of which are used as herbal folk remedies. It is considered one of the most potent plant carcinogens in humans and animals. It has been associated with the development of urothelial cancers in humans, and kidney and forestomach tumors in rats. Prolonged exposure to aristolochic acid was shown to pose rapid progressive renal fibrosis in Belgian women in a slimming regime in the early 1990s. Aristolochic acid has demonstrated to be a strong carcinogen in rats. The carcinogenicity of aristolochic acid is generally believed to be related to the nitro-reduction of aristolochic acid, in which the aristolactam-nitriumion ion with a delocalized positive charge is the ultimate carcinogen. Certain frequently used Chinese herbal medicines commonly used for weight control, may contain toxic Aristolochia species, which have been associated with severe nephropathy (kidney damage) and urothelial cancer in humans and animals. The toxic entities in Aristolochia species are aristolochic acid-I (AA-I) and aristolochic acid-II (AA-II).


Xi Xin formula

Aristolochic acid was present in a Chinese herbal formulation called Xi Xin which has been found to cause nephropathy.


Side effects, danger, caution, risks
The consumption of popular Chinese herbal products containing aristolochic acid is associated with an increased risk of urinary tract cancer. Aristolochic acid, known as Mu Tong in Chinese, is found naturally in some herbs that are used in Chinese herbal products to treat hepatitis, urinary tract infection, rhinitis, dysmenorrhea and eczema. Jung-Der Wang at the Institute of Occupational Medicine and Industrial Hygiene in National Taiwan University analyzed the medical history of patients with urinary tract cancer and compared the findings with those of other people without the disease. Those who consumed Mu Tong had a far higher risk of developing urinary tract cancer, and the level of risk rose the higher the dosages prescribed. Jung-Der Wang called for a ban on products containing Mu Tong. The Journal of the National Cancer Institute is published by Oxford University Press.


Occupational exposure to herbs containing aristolochic acids increases the risk of urothelial carcinoma in Chinese herbalists. Exposure to the Chinese herbal drug fangchi increases the risk of urothelial carcinoma in herbalists. Appropriate medical monitoring is warranted for workers who have similar exposure. J Urol. 2013.


Drug Saf. 2014 Dec 2.  Aristolochic Acid Nephropathy: Epidemiology, Clinical Presentation, and Treatment. Aristolochic acid (AA) is a compound extracted from the Aristolochia species of herbs. It has been used for centuries as a remedy for various illnesses and diseases. However, in the early 1990s in the setting of a weight loss herbal remedy, AA exposure was associated with a syndrome of kidney injury, termed aristolochic acid nephropathy (AAN). This entity is marked by elevated serum creatinine, significant anemia, and histopathologic changes demonstrating a hypocellular interstitial infiltrate with severe fibrosis. Progression towards end-stage renal disease (ESRD) is rapid, with most patients having chronic kidney disease for less than 2 years. In addition, AAN is associated with a 40-45 % prevalence of urothelial carcinomas. Treatment of AAN is limited to glucocorticoids that have been shown to delay progression in non-randomized trials. As most patients progress to ESRD, need for renal replacement therapy, as either dialysis or kidney transplant, usually ensues.

Longdan Xierganwan and bladder cancer

Longdan Xierganwan appears to have played a role in the development of bladder cancer and kidney disease in a 30-year-old Chinese man. In July 2003, the man presented to Whittington Hospital in London after referral from his family physician for blood in the urine. Further questioning revealed that the man had been taking Longdan Xierganwan for at least 5 years to "enhance" his liver. His tests confirmed bladder cancer. Although the patient stopped using Longdan Xierganwan, which, at the time, contained aristolochic acid, a chemical linked to kidney trouble and bladder cancer, he developed recurrent tumors. In April 2004, the patient had a kidney biopsy and was found to have interstitial fibrosis consistent with Chinese herbal nephropathy (kidney disease). Since then, he has progressed to end-stage renal failure and is now preparing for dialysis. Longdan Xierganwan no longer contains aristolochic acid. China Tong Ren Tang, the manufacturer of the product, changed the formula in 2002 after the US Food and Drug Administration issued a warning about the toxic effects on the kidneys.