Regulation of herbal medicine use based on speculation? A case from Sri Lanka

Chronic Kidney Disease of Unknown aetiology is a significant public health problem in Sri Lanka. The final report by the WHO mission recommended regulation of herbal medicines containing aristolochic acid, which is an established nephrotoxin. The use of Complimentary and Alternative Medicine (CAM) has a history of more than 2500 years in Sri Lanka. Aristolochia species are rarely used in Ayurveda and traditional medicine in Sri Lanka. Before regulating the analysis of herbal preparations using Aristolochia, collecting data from CAM practitioners regarding the use of Aristolochia is necessary. Analysis of Ayurveda pharmacopeia shows the doses used are negligible and some preparations are used for external applications.