was distributed to practitioners throughout Belgium but it was only one
particular clinic that reported problems. The intrinsic nephrotoxic effects of
the Aristolochia may have been potentiated in this case by the combination
of orthodox drugs administered concurrently. The British National Formu-
lary^186 states that the use of diuretics for weight loss is inappropriate; this
would seem to question the wisdom of including acetazolamide in the
product. The Belgian medical authorities have also warned doctors not to
prescribe slimming products composed of appetite inhibitors and diuretics.
The women may have been more vulnerable to adverse reactions due to a
weakening of general health caused by the calorie-controlled diet that they
were following.^187 In addition, the herbs were prescribed by untrained
doctors and not in accordance with Chinese medical theories.
Since 1994 a total of seven cases of Chinese herb nephropathy have been
reported in France. In 1998 a case of reversible acute hepatitis in a patient
using a Chinese herbal tea was reported in the Netherlands.^188 A. debilis was
identified in the tea mixture. Also around this time a case was reported in
Spain of a patient with renal failure resulting from chronic intake of an infu-
sion made with a mixture of herbs containing A. pistolochia. This species of
the herb is native to Catalonia.^189
The first two cases of a specific nephropathy caused by ingestion of an
unlicensed Chinese herbal remedy in the UK were reported in 1999.^190 The
first case was a 49-year-old woman who initially presented to her GP with
headache and hypertension. Her only existing medication was a herbal prepa-
ration that she had been taking for about 2 years to treat her eczema. Renal
function tests and a biopsy revealed substantial tubular atrophy and inter-
stitial fibrosis in the cortex. The patient rapidly progressed to renal failure
and dialysis was begun. Three years later she received a renal transplant.
The second patient was a 57-year-old woman who was admitted with
renal failure and a 6-month history of anorexia, lethargy, nausea and weight
loss. She had been taking Chinese herbal tea for eczema for 6 years. A renal
biopsy showed evidence of deterioration, as in the case above. The patient
was started on dialysis.
Subsequently, it was found that both patients had been exposed to aris-
tolochic acids as a result of ingesting A. manshuriensis used as a substitute
for mu tongin the herbal tea, in place of Clematis or Akebia spp.
An emergency ban was imposed on the import, sale and supply of
Aristolochiaby the UK Medicines Control Agency (MCA) in 1999. The ban
was made permanent 2 years later.
Following the two cases in the UK the Australian Office of Comple-
mentary Medicine initiated a survey of products containing Clematis to
determine whether inadvertent substitution with Aristolochia had
occurred.^191 Their concern was prompted by a realisation that the Chinese
name mu tongcould be used to describe three different herbs: Clematis
168 | Traditional medicine