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Although the product was labeled as containing the herb Stephania tetrandra, it is likely that Aristolochia fangchi had been substituted for it, thereby accounting for the presence of aristolochic acid in the product.
The manufacturer inadvertently replaced one of the herbs, Stephania tetrandra, with Aristolochia fangchi, which has a similar-sounding Chinese name.
It has been reported that AA would have a significant risk factor for urothelial carcinoma, probably associated with the highest risk when the cumulative level exceeds 200 g crude drug of Aristolochia fangchi (Nortier and Vanherweghem, 2002).
Presence and absence of aristolochic acids in species of Aristolochiaceae and species of their botanical name-related families Herb Plant part Aristolochiaceae (Madouling Ke [TEXT NOT REPRODUCIBLE IN ASCII]) Aristolochia fangchi Y.