A 40-year-old female patient took Rukuaixiao granules 10 g thrice daily orally by herself due to breast pain and nodules. After about 1 and a half months of medication, the patient developed intermittent right upper abdominal distension and pain, dark yellow urine, accompanied by fatigue, aversion to greasy food, nausea, vomiting, etc. After 2 and a half months of medication, the above symptoms worsened. Laboratory tests showed total bilirubin (TBil) 98.8 mmol/L, direct bilirubin (DBil) 51.5 mmol/L, alanine aminotransferase(ALT) 962 U/L, aspartate aminotransferase (AST) 1 213 U/L, γ-Glutamyltransferase(GGT) 196 U/L, and alkaline phosphatase (ALP) 124 U/L. The liver injury caused by Rukuaixiao granules were considered. Then the drug was discontinued and treatments such as glutathione, hepatocyte growth-promoting factor, tiopronin, Jiangmeiling(降酶灵), silymarin, and ursodeoxycholic acid were given. After 10 days of treatments, the patient′s symptoms were gradually improved; after 13 days, the patient′s digestive symptoms disappeared. Laboratory tests showed TBil 20.5 mmol/L, DBil 6.2 mmol/L, ALT 43 U/L, AST 58 U/L, GGT 53 U/L, and ALP 60 U/L. Glutathione, hepatocyte growth-promoting factor, and tiopronin were discontinued, and Jiangmeiling, silymarin, and ursodeoxycholic acid were continued to be taken for 2 weeks. Six weeks later, the patient′s liver function returned to normal. The patient′s liver injury was most likely related to the Fructus toosendan in Rukuaixiao granules.

A 40-year-old female patient took Rukuaixiao granules 10 g thrice daily orally by herself due to breast pain and nodules. After about 1 and a half months of medication, the patient developed intermittent right upper abdominal distension and pain, dark yellow urine, accompanied by fatigue, aversion to greasy food, nausea, vomiting, etc. After 2 and a half months of medication, the above symptoms worsened. Laboratory tests showed total bilirubin (TBil) 98.8 mmol/L, direct bilirubin (DBil) 51.5 mmol/L, alanine aminotransferase(ALT) 962 U/L, aspartate aminotransferase (AST) 1 213 U/L, γ-Glutamyltransferase(GGT) 196 U/L, and alkaline phosphatase (ALP) 124 U/L. The liver injury caused by Rukuaixiao granules were considered. Then the drug was discontinued and treatments such as glutathione, hepatocyte growth-promoting factor, tiopronin, Jiangmeiling(降酶灵), silymarin, and ursodeoxycholic acid were given. After 10 days of treatments, the patient′s symptoms were gradually improved; after 13 days, the patient′s digestive symptoms disappeared. Laboratory tests showed TBil 20.5 mmol/L, DBil 6.2 mmol/L, ALT 43 U/L, AST 58 U/L, GGT 53 U/L, and ALP 60 U/L. Glutathione, hepatocyte growth-promoting factor, and tiopronin were discontinued, and Jiangmeiling, silymarin, and ursodeoxycholic acid were continued to be taken for 2 weeks. Six weeks later, the patient′s liver function returned to normal. The patient′s liver injury was most likely related to the Fructus toosendan in Rukuaixiao granules.