# Ayurvedic herbs linked to liver injury, and what the reports show Canonical version of this page: https://nighantu.ageayurveda.com/choosing/ayurvedic-herbs-and-liver-injury/ > The herbs with the most published reports of liver injury are Giloy (Tinospora cordifolia), ashwagandha, turmeric and curcumin supplements, and bakuchi (Psoralea corylifolia), followed by Garcinia cambogia, oral aloe vera and senna. NIH LiverTox rates Tinospora and turmeric A, and ashwagandha, Garcinia and aloe B. The reports show association, not proof, and most cases resolved after the product was stopped. Seven herbs on this site have published reports of liver injury in people who took them: [Giloy](/herb/guduchi/) (*Tinospora cordifolia*), [ashwagandha](/herb/ashwagandha/), [turmeric](/herb/turmeric/) and curcumin supplements, [bakuchi](/herb/bakuchi/) (*Psoralea corylifolia*), *Garcinia cambogia* (a relative of [vrikshamla](/herb/vrikshamla/), *Garcinia indica*), oral [aloe vera](/herb/aloe-vera/) and [senna](/herb/senna/). The NIH LiverTox database, which grades every substance it reviews from A (well established cause of liver injury) to E (unlikely cause), rates [Tinospora](https://www.ncbi.nlm.nih.gov/books/NBK608429/) and [turmeric](https://www.ncbi.nlm.nih.gov/books/NBK548561/) A, [ashwagandha](https://www.ncbi.nlm.nih.gov/books/NBK548536/), [Garcinia](https://www.ncbi.nlm.nih.gov/books/NBK548087/) and [aloe vera](https://www.ncbi.nlm.nih.gov/books/NBK548634/) B, and [senna](https://www.ncbi.nlm.nih.gov/books/NBK547922/) D. Two things have to be said together. Most people who take these herbs do not develop liver injury: LiverTox puts the frequency for Garcinia at under 1 in 10,000 users and gives no figure for the others, because nobody has one. And the injury, when it happens, can be serious: the published series include deaths and liver transplants, and in the Indian series these fell almost entirely on people who already had chronic liver disease. The reports below show association, assessed with causality tools such as RUCAM, not proof; many involved multi-ingredient products, other medicines or possible adulteration, and the authors say so. ## The herbs, and what was reported
| Herb | Our page | What was reported | Strength of evidence | Sources | |---|---|---|---|---| | Giloy, Guduchi (*Tinospora cordifolia*) | [Guduchi](/herb/guduchi/), [Giloy Satva](/herb/giloy-satva/) | A Mumbai series of 6 patients with acute hepatitis after a median 90 days of Giloy taken as COVID-19 prophylaxis, all with an autoimmune pattern on biopsy, 4 with silent pre-existing liver disease; 5 recovered after stopping. A 13-centre Indian study then reported 43 patients: median 46 days to symptoms, RUCAM probable in 67% and possible in 33%, 4 deaths (all with chronic liver disease) and 2 transplants; 37 recovered. LiverTox counts more than 50 cases since 2017. | Strong: LiverTox A, two independent series, autoimmune features reproduced across centres | [Nagral 2021](https://pubmed.ncbi.nlm.nih.gov/34230786/); [Kulkarni 2022](https://pubmed.ncbi.nlm.nih.gov/35037744/); [LiverTox: Tinospora](https://www.ncbi.nlm.nih.gov/books/NBK608429/) | | Ashwagandha (*Withania somnifera*) | [Ashwagandha](/herb/ashwagandha/) | 5 patients from Iceland and the US DILIN network: jaundice and itching after 2 to 12 weeks, cholestatic or mixed injury, no liver failure, tests normal within 1 to 5 months in 4; chemical analysis confirmed ashwagandha with no other toxic compound, but 4 took other supplements too. An Indian series reported 8 single-ingredient cases out of 23 identified; 5 had chronic liver disease and the 3 who presented with acute-on-chronic liver failure died; analysis found no adulteration. A 2026 scoping review counted 25 patients in 13 publications. | Moderate to strong: LiverTox B, two series on two continents, consistent cholestatic picture | [Björnsson 2020](https://pubmed.ncbi.nlm.nih.gov/31991029/); [Philips 2023](https://pubmed.ncbi.nlm.nih.gov/37756041/); [McIntyre 2026](https://pubmed.ncbi.nlm.nih.gov/42367407/); [LiverTox: Ashwagandha](https://www.ncbi.nlm.nih.gov/books/NBK548536/) | | Turmeric, curcumin supplements (*Curcuma longa*) | [Turmeric](/herb/turmeric/), [Haridra](/herb/haridra/) | US DILIN: 10 cases (2011 to 2022), 8 women, hepatocellular injury after 1 to 4 months, 5 hospitalised, 1 died of acute liver failure; all 7 products tested contained turmeric and 3 also piperine; 7 of 10 patients carried HLA-B*35:01. Italy: 7 Tuscan cases, all with high-bioavailability, high-dose curcumin products, plus 23 literature cases, most of them also taking another medicine. A pathology series of 11 patients: RUCAM probable in 8, possible in 3, all normalised after stopping. | Moderate to strong: LiverTox A, recently raised; three series and a genetic marker; the reports concern concentrated supplements, not the spice | [Halegoua-DeMarzio 2023](https://pubmed.ncbi.nlm.nih.gov/36252717/); [Lombardi 2021](https://pubmed.ncbi.nlm.nih.gov/32656820/); [Papke 2025](https://pubmed.ncbi.nlm.nih.gov/39381846/); [LiverTox: Turmeric](https://www.ncbi.nlm.nih.gov/books/NBK548561/) | | Bakuchi, Babchi seed (*Psoralea corylifolia*), taken by mouth | [Bakuchi](/herb/bakuchi/) (the oil, [Bakuchi Taila](/formulation/bakuchi-taila/), is for external use and is not the subject of these reports) | Acute cholestatic hepatitis in a Korean woman taking over ten times the usual seed dose. A German patient taking Ayurvedic Bakuchi tablets with other herbs for 9 months: CIOMS score probable, recovered on stopping. A Beijing cohort attributed 40 of 547 drug-induced liver injury cases (7.3%) to the herb (Bu Gu Zhi), 85% women, median latency 45 days, 27.5% severe. One fatal acute liver failure after 7 months of a multi-herb vitiligo tablet. One Indian case of acute-on-chronic liver failure, recovered. | Moderate: a 40-patient cohort and several independent case reports, one fatal; no LiverTox entry found | [Nam 2005](https://pubmed.ncbi.nlm.nih.gov/16255343/); [Teschke 2009](https://pubmed.ncbi.nlm.nih.gov/19841509/); [Wang 2020](https://pubmed.ncbi.nlm.nih.gov/31758650/); [Li 2019](https://pubmed.ncbi.nlm.nih.gov/30975110/); [Gandhi 2024](https://pubmed.ncbi.nlm.nih.gov/38076371/) | | *Garcinia cambogia* (*G. gummi-gutta*), weight-loss products | [Vrikshamla](/herb/vrikshamla/) (our page is *G. indica*, kokum; the reports concern *G. cambogia* supplements) | A 2025 review found more than 200 liver adverse events in databases and 34 published case reports, with 1 death and 9 liver transplants; 17 cases had RUCAM scores from possible to highly probable and 1 was confirmed by rechallenge. LiverTox notes that the early cases were multi-ingredient products such as Hydroxycut containing other suspected hepatotoxins, with later cases on products labelled Garcinia alone, and that mislabelling of other Garcinia species cannot be excluded. | Moderate: LiverTox B, many reports but a large share in multi-ingredient products | [van Breemen 2025](https://pubmed.ncbi.nlm.nih.gov/41262061/); [Lunsford 2016](https://pubmed.ncbi.nlm.nih.gov/28018115/); [LiverTox: Garcinia Cambogia](https://www.ncbi.nlm.nih.gov/books/NBK548087/) | | Aloe vera, oral preparations | [Aloe Vera](/herb/aloe-vera/) | A 73-year-old taking aloe capsules for constipation developed acute hepatitis that resolved on stopping (RUCAM assessed). Three Korean women taking aloe preparations for months met RUCAM criteria for toxic hepatitis, enzymes normal after stopping. LiverTox counts at least a dozen cases, hepatocellular, 3 to 24 weeks after starting, none fatal; all with oral products. | Limited to moderate: LiverTox B, "likely but rare", single-ingredient cases but small numbers | [Bottenberg 2007](https://pubmed.ncbi.nlm.nih.gov/17726067/); [Yang 2010](https://pubmed.ncbi.nlm.nih.gov/20191055/); [LiverTox: Aloe Vera](https://www.ncbi.nlm.nih.gov/books/NBK548634/) | | Senna (*Cassia angustifolia*), long-term high-dose use | [Senna](/herb/senna/) | A woman who drank a litre of tea from 70 g of senna fruit daily for over 3 years developed acute liver failure with kidney impairment and recovered. A woman who drank a senna decoction daily for 2 years developed portal vein thrombosis. A 3-year-old given senna preparations long term for constipation had severe acute hepatitis with pancytopenia. LiverTox describes "several cases", all after months of higher-than-recommended doses, usually mild and resolving on stopping. | Limited: LiverTox D, "possible rare cause", and every report involves prolonged heavy use | [Vanderperren 2005](https://pubmed.ncbi.nlm.nih.gov/15956233/); [Soyuncu 2008](https://pubmed.ncbi.nlm.nih.gov/19238740/); [Haoudar 2021](https://pubmed.ncbi.nlm.nih.gov/33552756/); [LiverTox: Senna](https://www.ncbi.nlm.nih.gov/books/NBK547922/) |
The two review papers that collect this literature for Indian herbs are [Philips 2020](https://pubmed.ncbi.nlm.nih.gov/33033566/) in the *World Journal of Hepatology*, and [Philips and Theruvath 2024](https://pubmed.ncbi.nlm.nih.gov/38640296/) in *Medicine*, which names *Tinospora cordifolia*, *Withania somnifera*, *Curcuma longa* and *Psoralea corylifolia* as the herbs with the clearest signal and *Centella asiatica* ([Mandukparni](/herb/mandukparni/)), *Garcinia cambogia*, *Cassia angustifolia* and *Morinda citrifolia* as ones with an emerging profile. A systematic review of herb-induced liver injury across all traditions counted 936 published cases involving 79 herbs or products ([Ballotin 2021](https://pubmed.ncbi.nlm.nih.gov/34307603/)). ### Reports of poisoning rather than medicinal use Three further plants on this site appear in the literature through poisonings, not through use at any medicinal dose. Children in western Uttar Pradesh who ate the beans of [Kasamarda](/herb/kasamarda/) (*Cassia occidentalis*) developed a fatal hepatomyoencephalopathy; a case-control study found an odds ratio of 12.9 for bean eating ([Vashishtha 2007](https://pubmed.ncbi.nlm.nih.gov/17704552/); further cases in [Chhapola 2018](https://pubmed.ncbi.nlm.nih.gov/29962748/) and [Getsuwan 2021](https://pubmed.ncbi.nlm.nih.gov/33227120/)). Infants who swallowed 10 to 30 mL of clove oil ([Laung](/herb/laung/)) developed severe liver and kidney injury within a day, which LiverTox rates [C in overdose](https://www.ncbi.nlm.nih.gov/books/NBK551727/) while finding no injury at ordinary doses. Neem seed oil ([Neem](/herb/neem/)) given to infants has caused a Reye-like syndrome with encephalopathy and liver involvement ([Sinniah 1982](https://pubmed.ncbi.nlm.nih.gov/7081175/); [Lai 1990](https://pubmed.ncbi.nlm.nih.gov/2259944/)). ### Herbs LiverTox has reviewed and rates unlikely For balance: LiverTox has also reviewed several Ayurvedic herbs and rates them E, unlikely to cause clinically apparent liver injury, having found no convincing published case: [Bacopa](https://www.ncbi.nlm.nih.gov/books/NBK603563/) ([Brahmi](/herb/brahmi/)), [fenugreek](https://www.ncbi.nlm.nih.gov/books/NBK548826/) ([Methi](/herb/methi/)), [Boswellia serrata](https://www.ncbi.nlm.nih.gov/books/NBK563692/) ([Shallaki](/herb/shallaki/)), [licorice](https://www.ncbi.nlm.nih.gov/books/NBK590484/) ([Yashtimadhu](/herb/yashtimadhu/)) and [berberine](https://www.ncbi.nlm.nih.gov/books/NBK564659/), the main alkaloid of [Daruharidra](/herb/daruharidra/) though not the plant itself. [Tribulus](https://www.ncbi.nlm.nih.gov/books/NBK583201/) ([Gokshura](/herb/gokshura/)) is rated E with an asterisk: it poisons grazing animals, but human injury is unverified. ## How to read these reports **Association is not proof.** A case report records that a person took a product and then developed liver injury, after other causes were looked for. Causality scores such as RUCAM grade how well the timing, the recovery on stopping, and the exclusion of other causes fit. In the Giloy study, two-thirds of patients scored "probable" and one-third "possible" ([Kulkarni 2022](https://pubmed.ncbi.nlm.nih.gov/35037744/)); in the turmeric pathology series, eight of eleven were probable ([Papke 2025](https://pubmed.ncbi.nlm.nih.gov/39381846/)). No trial could settle the question, and none will be run. **The product is often not just the herb.** Four of the five ashwagandha patients in the Iceland and US series were taking other supplements, and in one case rhodiola was a possible cause alongside ashwagandha ([Björnsson 2020](https://pubmed.ncbi.nlm.nih.gov/31991029/)). Most of the turmeric cases in the literature involved another medicine too ([Lombardi 2021](https://pubmed.ncbi.nlm.nih.gov/32656820/)). The early Garcinia cases were multi-ingredient weight-loss products ([LiverTox](https://www.ncbi.nlm.nih.gov/books/NBK548087/)). In the Giloy study, two of six retrieved samples had mercury, arsenic or lead above prescribed limits and some contained industrial solvents ([Kulkarni 2022](https://pubmed.ncbi.nlm.nih.gov/35037744/)). A 2026 Brazilian series found a product labelled *Curcuma longa* with negligible turmeric constituents and a weight-loss product with undeclared synthetic drugs ([Góis 2026](https://pubmed.ncbi.nlm.nih.gov/42491527/)). The reverse also holds: in the Indian ashwagandha series and several of the US and Icelandic cases the product was tested and contained what the label said and nothing else ([Philips 2023](https://pubmed.ncbi.nlm.nih.gov/37756041/)). **Species disputes get settled by testing.** When the Giloy reports appeared, it was argued that patients had taken *Tinospora crispa*, a related species with its own published hepatitis cases ([Langrand 2014](https://pubmed.ncbi.nlm.nih.gov/24867504/); [Huang 2019](https://pubmed.ncbi.nlm.nih.gov/30670256/)). The Mumbai group retrieved the plant material its patients had used and identified it as *T. cordifolia* by morphology, chromatography and DNA barcoding ([Nagral 2023](https://pubmed.ncbi.nlm.nih.gov/36950495/)). This site's page on [why one herb has several botanical names](/choosing/one-herb-several-names/) explains why such disputes arise. **Existing liver disease changes the stakes.** All four deaths in the Giloy study, the three deaths in the Indian ashwagandha series, and most of the fatal Tinospora cases that LiverTox describes were in people with chronic liver disease, several of whom did not know they had it ([Kulkarni 2022](https://pubmed.ncbi.nlm.nih.gov/35037744/); [Philips 2023](https://pubmed.ncbi.nlm.nih.gov/37756041/)). LiverTox says plainly that ashwagandha should be avoided in cirrhosis or advanced chronic liver disease ([LiverTox: Ashwagandha](https://www.ncbi.nlm.nih.gov/books/NBK548536/)). **Some of it looks like autoimmunity.** Giloy injury came with autoantibodies and biopsy features of autoimmune hepatitis, and the authors suggest it can unmask silent autoimmune liver disease ([Nagral 2021](https://pubmed.ncbi.nlm.nih.gov/34230786/)). Seven of ten US turmeric patients carried HLA-B*35:01, an allele also linked to green tea extract and Garcinia injury, at an allele frequency of 0.45 against 0.06 in the population ([Halegoua-DeMarzio 2023](https://pubmed.ncbi.nlm.nih.gov/36252717/)). An idiosyncratic, immune-mediated injury in a susceptible minority fits what is seen better than a poison that harms everyone who takes enough. ## Multi-herb and heavy-metal products Rasa shastra preparations deliberately contain processed metals and minerals, and the [Ayurvedic Formulary of India sets no heavy-metal limits](/choosing/reading-a-formulation-label/). What has been published about them is mostly about lead, and mostly not about the liver. - **Content.** 14 of 70 Ayurvedic products bought in Boston shops contained lead, mercury or arsenic ([Saper 2004](https://pubmed.ncbi.nlm.nih.gov/15598918/)). Of 193 products bought online, 20.7% contained a detectable metal, with no difference between US-made and Indian-made; rasa shastra products were more likely to (40.6% against 17.1%) and carried far higher mercury, and every metal-containing product exceeded at least one daily-intake standard ([Saper 2008](https://pubmed.ncbi.nlm.nih.gov/18728265/)). In an Iowa poisoning cluster, lead was found in 65% of 252 product samples ([Mikulski 2017](https://pubmed.ncbi.nlm.nih.gov/29528276/)). - **Lead poisoning.** 12 adult cases across five US states, 2000 to 2003 ([CDC 2004](https://pubmed.ncbi.nlm.nih.gov/15241300/)); 6 pregnant women in New York with blood lead of 16 to 64 µg/dL from products containing up to 2.4% lead ([CDC 2012](https://pubmed.ncbi.nlm.nih.gov/22914225/)); 46 of 115 screened members of one Ayurveda community with elevated blood lead ([Breeher 2015](https://pubmed.ncbi.nlm.nih.gov/25843124/)); and, across ten years of New York City poisoning investigations, higher blood lead in rasa shastra users than in users of other remedies ([Hore 2022](https://pubmed.ncbi.nlm.nih.gov/36179284/)). Lead harms blood and the nervous system first; the anaemia in these patients was more severe than in occupational lead poisoning ([Kales 2007](https://pubmed.ncbi.nlm.nih.gov/17599022/)). - **Kidney.** Anuric kidney failure in a 2-year-old after chronic intake of a mercury-containing Ayurvedic medicine ([Sathe 2013](https://pubmed.ncbi.nlm.nih.gov/23960350/)); lead poisoning from an Ayurvedic product in a patient with chronic kidney disease ([Prakash 2009](https://pubmed.ncbi.nlm.nih.gov/19384331/)). - **Liver.** Of 33 south Indian patients with severe liver injury attributed to Ayurvedic and herbal medicines, five of the 27 followed with a biopsy died, and arsenic and mercury in the products they had taken were significantly associated with death ([Philips 2018](https://pubmed.ncbi.nlm.nih.gov/29476406/)). In 386 products retrieved from 91 patients at the same centre, mercury exceeded WHO limits in 34%, cadmium in 25%, arsenic in 21% and lead in 14%; 40% of patients had acute-on-chronic liver failure, with 39% mortality in that group ([Philips 2026](https://pubmed.ncbi.nlm.nih.gov/41890551/)). Chronic arsenic from Ayurvedic preparations has been reported with non-cirrhotic portal hypertension, in an 11-year-old on eight preparations containing 5 to 248 mg/L arsenic ([Khandpur 2008](https://pubmed.ncbi.nlm.nih.gov/18477160/)) and in a 1979 series where two patients had taken bhasmas ([Datta 1979](https://pubmed.ncbi.nlm.nih.gov/468068/)). The pages here for [Naga Bhasma](/herb/naga-bhasma/) (lead), [Haratala Bhasma](/herb/haratala-bhasma/) and [Rasamanikya](/herb/rasamanikya/) (arsenic), [Tamra Bhasma](/herb/tamra-bhasma/) (copper) and [Arogyavardhini Vati](/formulation/arogyavardhini-vati/) (mercury and copper) report animal studies in which correctly prepared material showed no toxicity at the usual dose. Those studies test a preparation made by the method; the surveys above tested what was actually on sale, and the two are not the same question. In the Giloy study, the authors could not separate the herb from the metals and solvents some retrieved products also contained, and said so ([Kulkarni 2022](https://pubmed.ncbi.nlm.nih.gov/35037744/)). ## If you suspect liver injury Stop the product and see a doctor promptly if you notice yellowing of the eyes or skin, dark urine, pale stools, itching, pain or tenderness under the right ribs, nausea, loss of appetite or tiredness out of proportion to anything else going on. In the published series the first signs came weeks to months after starting, so a product begun long ago is not cleared by the delay. Take the packaging with you, and name every product you have taken: herbs, supplements, powders from a practitioner, teas, and anything bought online. Several of the cases above were diagnosed late because the patient did not think of a herbal product as a medicine ([Bottenberg 2007](https://pubmed.ncbi.nlm.nih.gov/17726067/)). Most patients in these reports recovered once the product was stopped, and that is also the first thing the doctor will want to know you have done. Anyone who already has liver disease, or a diagnosed autoimmune condition, has the strongest reason to discuss any of these herbs with their doctor before taking them, because the serious outcomes in the Indian series were concentrated in those patients. ## What this page does not do It does not say that any herb is safe, or that any herb is dangerous. It reports what has been published, with the number of patients and the authors' own caveats, so that the strength of each link can be judged. It does not estimate how often injury happens, because the denominator, the number of people taking each herb, is unknown. It does not give doses or say what amount is safe; the reports do not support such a figure. It does not test products, so it cannot say whether a particular packet contains what its label says. And it is a reading of the literature on 26 October 2026, not medical advice for any one person: the FAQ and the section above say when to see a doctor, and the doctor, not this page, decides what to do next. --- Canonical version of this page: https://nighantu.ageayurveda.com/choosing/ayurvedic-herbs-and-liver-injury/ Published by Age Ayurveda in the Nighantu. Educational reference only, not medical advice. Incorporates material from the Amidha Ayurveda Herb Database under CC BY 4.0.