Aristolochiae fructusforme
Also known as: Aristolochia contorta, Aristolochia debilis, Aristolochiae Fructus, Madouling
Overview
Aristolochiae Fructus refers to the dried fruits of Aristolochia contorta and Aristolochia debilis, plants belonging to the Aristolochiaceae family. Traditionally, it has been used in Chinese medicine for various indications. However, these fruits contain aristolochic acids (AAs), a group of compounds that are well-documented for their nephrotoxic (kidney-damaging) and carcinogenic (cancer-causing) properties. While there is extensive research on the chemical characterization and toxicology of Aristolochiae Fructus, robust clinical efficacy data supporting its benefits in humans is lacking. The presence of these highly toxic compounds has led to significant safety concerns, with available evidence strongly highlighting severe risks, particularly kidney damage and an increased risk of various cancers, especially those of the urinary tract. Consequently, its use is widely discouraged or banned by regulatory agencies in many countries.
Benefits
There is no high-quality clinical evidence, such as from randomized controlled trials (RCTs), that supports any beneficial effects of Aristolochiae Fructus in humans. While traditional uses have included claims of anti-inflammatory and analgesic effects, these claims are not substantiated by modern, controlled clinical trials. The overwhelming scientific consensus, supported by systematic reviews and meta-analyses, points to significant health risks rather than benefits. Therefore, from a scientific and medical standpoint, no evidence-based benefits can be attributed to the use of Aristolochiae Fructus as a supplement.
How it works
The primary mechanism of action for the toxicity of Aristolochiae Fructus lies with aristolochic acids (AAs). Upon ingestion, AAs are bioactivated in the body into reactive intermediates. These intermediates then form covalent bonds with DNA, creating DNA adducts. The formation of these adducts leads to mutations, particularly in critical genes, which can initiate and promote carcinogenesis, especially in the urinary tract. In the kidneys, AAs induce direct tubular damage and interstitial fibrosis, leading to progressive kidney dysfunction and ultimately renal failure. The bioavailability of AAs is sufficient to cause systemic toxicity following oral exposure, affecting DNA integrity and cellular function in susceptible organs.
Side effects
The overall safety profile of Aristolochiae Fructus is poor due to the presence of aristolochic acids (AAs), which are classified as potent nephrotoxins and carcinogens. The most common and severe side effects include significant kidney damage, leading to chronic kidney disease and renal failure, and various urinary tract cancers, such as urothelial carcinoma of the kidney, ureter, and bladder. There is also potential for other organ toxicities, though data is more limited. Drug interactions are not well characterized, but there is a potential for additive nephrotoxicity if used concurrently with other nephrotoxic medications. Aristolochiae Fructus is strictly contraindicated in patients with pre-existing kidney disease or those with risk factors for urothelial carcinoma. Due to these severe and well-documented safety concerns, regulatory agencies in many countries have banned or severely restricted the use of Aristolochiae Fructus and products containing aristolochic acids.
Dosage
There are no established safe or effective dosing guidelines for Aristolochiae Fructus due to its significant toxicity risks. Its use is generally discouraged or banned in many regions worldwide because of the presence of nephrotoxic and carcinogenic aristolochic acids. Any exposure to aristolochic acids, even at low doses, carries a risk of kidney damage and cancer. Therefore, no recommended dosage can be provided, and its consumption as a supplement is strongly advised against. There are no known safe upper limits or thresholds for aristolochic acids, making any use inherently risky.
FAQs
Is Aristolochiae Fructus safe?
No, Aristolochiae Fructus is not safe. It contains aristolochic acids, which are well-known to cause severe kidney damage and are potent carcinogens, increasing the risk of various cancers, especially in the urinary tract.
Can it be used for kidney or urinary conditions?
Absolutely not. Despite some traditional uses, Aristolochiae Fructus should never be used for kidney or urinary conditions. Its consumption directly leads to kidney damage and significantly increases the risk of urinary tract cancers.
Are there safer alternatives?
Yes, there are many safer and evidence-based alternatives for various health concerns. It is crucial to consult with a healthcare professional to explore other herbal or pharmaceutical agents that do not contain aristolochic acids and have a proven safety and efficacy profile.
Research Sources
- https://pubmed.ncbi.nlm.nih.gov/22484602/ – This analytical study developed a high-performance liquid chromatography (HPLC) method to quantify aristolochic acids (AAs) in 59 batches of Aristolochia fruits. It found species-specific AA profiles and confirmed the presence of AAs in all commercial samples, highlighting the widespread contamination and potential for exposure.
- https://pubmed.ncbi.nlm.nih.gov/33815744/ – This systematic review and meta-analysis, encompassing 38 studies, demonstrated a significant association between aristolochic acid exposure and a 6-fold increased risk of urinary tract cancers. It also linked AA exposure to worsened postoperative survival and increased recurrence rates in cancer patients, providing high-quality evidence for its carcinogenic risk.
