A Missouri woman has filed an unusual case of malpractice against a doctor of traditional Chinese medicine (TCM), alleging Zhengang Guo fell below the standard of care by prescribing Chinese herbs that caused her to suffer kidney failure.

Delores Drury's case challenges the notion that Chinese herbs are free of the harmful side effects often associated with prescription drugs. After being treated for a variety of ailments by Patrick Kennedy, a St. Louis-area chiropractor who ordered herbs from Guo, she allegedly developed a kidney condition known as “Chinese herb nephropathy” (CHN).

“Defendants knew, or by using ordinary care, should have known that said Chinese herbs caused unreasonably dangerous risks and serious side effects of which the general public would not be aware,” Drury alleges in a complaint filed Dec. 31 in Cook County (Ill.) Circuit Court.

Guo is a seventh-generation Chinese medicine doctor and the founder of Life Rising, which operates clinics in Chicago. According to Drury, the herbs he prescribed for her contained aristolochic acid, a naturally occuring toxin which some researchers have linked to CHN.

“Plaintiff's Chinese herb nephropathy, kidney disease, and renal failure occurred as a result of her ingestion of the Chinese herbs” prescribed by Guo, the suit says.

Alternative medicine practitioners have generally been insulated from malpractice suits, in part because there is no established standard of care in the field. In Charell v. Gonzales, 660 N.Y.S.2d 665 (1997), a New York judge upheld a malpractice verdict against a licensed physician who used hair analysis and nutritional care to treat a cancer patient.

“Since using a complementary and alternative therapy invariably deviates from the standard of care, physicians cannot undertake a responsible, measured integration of such therapies in clinical practice without risking malpractice exposure,” Michael H. Cohen, a Newport Beach, Calif., attorney who specializes in alternative medicine law, says on his blog.

But Guo is not a licensed physician so Drury alleges a duty “to exercise that degree of care and caution commonly exercised by other [Chinese medicine] practitioners in the community.” Prescribing herbs that contained aristolochic acid and failing to warn her of their alleged side effects, she argues, falls below that standard of care.

Drury's ailments included headaches, joint aches and bowel irritation. Kennedy -– who is not named as a defendant -– treated her between 2003 and 2007 and she also visited Guo at his office in May and August of 2005.

At the very least, the case faces a causation problem since there appears to be no definitive evidence that the amount of aristolochic acid present in a herbal formula is unsafe.

In the 1990s, researchers investigated cases of nephropathy at a Belgian weight loss clinic where dieters were given a mixture of drugs, including serotonin, and herbs. Samples of the mixture showed aristolochic acid but, according to one review of the scientific literature, the dosage was “much lower than would be expected to exert nephrotoxic effects.”

Several incidents of aristolochic acid-related nephropathy have been reported elsewhere in recent years, the review says, but “[i]n none of these cases were the herbs prescribed by a fully trained and licensed practitioner of traditional Chinese medicine.”

According to the Life Rising website, Guo trained as both a TCM practitioner and conventional physician and has taught herbal medicine at the University of Illinois.