{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T13:07:34Z","timestamp":1740143254038,"version":"3.37.3"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T00:00:00Z","timestamp":1656028800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T00:00:00Z","timestamp":1656028800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001786","name":"The University of Adelaide","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001786","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Forensic Sci Med Pathol"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Unexpected hepatic failure with liver necrosis is sometimes encountered during a forensic autopsy. Determining the etiology may sometimes be difficult, although increasingly herbal medicines are being implicated. To determine whether such effects might also be caused by foodstuffs, the following in vitro study was undertaken. Four formulations of traditional herbal soup advertised as <jats:italic>bak kut teh<\/jats:italic>\u00a0were prepared and added to cultures of liver carcinoma cells (HepG2). Cell viability was assessed using an MTT colorimetric assay at 48\u00a0h demonstrating that all formulations had significant toxicity prior to dilution (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Formulation #1 showed 21% cell death (<jats:italic>p\u2009<\/jats:italic>=\u20090.023), Formulation #2 30% (<jats:italic>p\u2009<\/jats:italic>=\u20090.009), and Formulation #3 41% (<jats:italic>p\u2009<\/jats:italic>&lt;\u20090.0001). Formulations #1\u20133 showed no significant toxicity once diluted (<jats:italic>p\u2009<\/jats:italic>&gt;\u20090.05). Formulation 4 showed approximately 83% cell death before dilution (<jats:italic>p\u2009<\/jats:italic>&lt;\u20090.0001) and persistent toxicity even with dilutions at 1:10 (15% \u00b1 3.7, <jats:italic>p\u2009<\/jats:italic>=\u20090.023) and 1:1000 (14% \u00b1 3.8, <jats:italic>p<\/jats:italic>\u2009=\u20090.024). This study has shown that herbal foodstuffs such as <jats:italic>bak kut teh<\/jats:italic> may be responsible for variable degrees of in vitro hepatotoxicity, thus extending the range of herbal products that may be potentially injurious to the liver. If unexpected liver damage is encountered at autopsy, information on possible recent ingestion of herbal food preparations should be sought, as routine toxicology screening will not identify the active components. Liver damage may therefore be caused not only by herbal medicines but possibly by herbal products contained in food.<\/jats:p>","DOI":"10.1007\/s12024-022-00490-5","type":"journal-article","created":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T04:02:33Z","timestamp":1656043353000},"page":"403-406","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Could herbal soup be a potentially unrecognized cause of hepatotoxicity at autopsy?"],"prefix":"10.1007","volume":"18","author":[{"given":"Susan M.","family":"Britza","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachael","family":"Farrington","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian F.","family":"Musgrave","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig","family":"Aboltins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger W.","family":"Byard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,6,24]]},"reference":[{"key":"490_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13020-018-0167-z","volume":"13","author":"AX Lin","year":"2018","unstructured":"Lin AX, Chan G, Hu Y, Ouyang D, Ung COL, Shi L, Hu H. Internationalisation of traditional Chinese medicine: current international market, internationalisation challenges and prospective suggestions. Chin Med. 2018;13:1\u20139.","journal-title":"Chin Med"},{"key":"490_CR2","unstructured":"Cyranoski D. Why Chinese medicine is heading for clinics around the world. Nature. (Sept) 2018. https:\/\/www.nature.com\/articles\/d41586-018-06782-7 (Accessed: 25 Feb 2022)."},{"key":"490_CR3","doi-asserted-by":"publisher","first-page":"86","DOI":"10.5694\/mja16.00614","volume":"206","author":"RW Byard","year":"2017","unstructured":"Byard RW, Musgrave I, Maker G, Bunce M. What are the risks to the Australian community from herbal products? Med J Aust. 2017;206:86\u201390.","journal-title":"Med J Aust"},{"key":"490_CR4","doi-asserted-by":"publisher","first-page":"9639","DOI":"10.3390\/ijerph120809639","volume":"12","author":"MH Lin","year":"2015","unstructured":"Lin MH, Chang HT, Tu CY, Chen TJ, Hwang SJ. Prevalence of polyherbacy in ambulatory visits to traditional Chinese medicine clinics in Taiwan. Int J Environ Res Public Health. 2015;12:9639\u201357.","journal-title":"Int J Environ Res Public Health"},{"key":"490_CR5","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/j.forsciint.2014.05.021","volume":"241C","author":"JD Gilbert","year":"2014","unstructured":"Gilbert JD, Musgrave I, Hoban C, Byard RW. Lethal hepatocellular necrosis associated with herbal polypharmacy in a patient with chronic Hepatitis B infection. Forensic Sci Int. 2014;241\u00a0C:138\u201340.","journal-title":"Forensic Sci Int"},{"key":"490_CR6","doi-asserted-by":"publisher","first-page":"101740","DOI":"10.1016\/j.legalmed.2020.101740","volume":"47","author":"S Britza","year":"2020","unstructured":"Britza S, Musgrave I, Byard RW. Potential role of herbal traditional Chinese medicines in hepatotoxicity. Leg Med. 2020;47:101740.","journal-title":"Leg Med"},{"key":"490_CR7","doi-asserted-by":"publisher","first-page":"17475","DOI":"10.1038\/srep17475","volume":"5","author":"ML Coghlan","year":"2015","unstructured":"Coghlan ML, Maker G, Crighton E, Haile J, Murray DC, White NE, Byard RW, Bellgard M, Mullaney I, Trengove R, Allcock RJN, Nash C, Hoban C, Musgrave I, Bunce M. Combined toxicological and genetic auditing of traditional Chinese medicines provides a means of detecting adulterants and improving pharmacovigilance. Sci Rep. 2015;5:17475.","journal-title":"Sci Rep"},{"key":"490_CR8","doi-asserted-by":"publisher","first-page":"1583","DOI":"10.3390\/jcm9051583","volume":"9","author":"L Ang","year":"2020","unstructured":"Ang L, Song E, Lee HW, Lee MS. Herbal medicine for the treatment of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis of randomized controlled trials. J Clin Med. 2020;9:1583.","journal-title":"J Clin Med"},{"key":"490_CR9","doi-asserted-by":"publisher","first-page":"100465","DOI":"10.1016\/j.imr.2020.100465","volume":"9","author":"L Ang","year":"2020","unstructured":"Ang L, Lee HW, Kim A, Lee. Herbal medicine for the management of COVID-19 during the medical observation period: a review of guidelines. Integr Med Res. 2020;9:100465.","journal-title":"Integr Med Res"},{"key":"490_CR10","first-page":"30078","volume":"S2095-4964","author":"AY Fan","year":"2020","unstructured":"Fan AY, Gu S, Alemi SF, Research Group for Evidence-based Chinese Medicine. Chinese herbal medicine for COVID-19: current evidence with systematic review and meta-analysis. J Integr Med. 2020;S2095-4964:30078\u20139.","journal-title":"J Integr Med"},{"key":"490_CR11","doi-asserted-by":"publisher","unstructured":"Britza S, Farrington R, Musgrave I, Byard RW. Intestinal epithelial damage due to herbal compounds \u2013 an in vitro study. 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