Figure 2 Schematic mechanisms of Western medicine- and traditional Chinese medicine-induced DILI

After metabolism, both western drugs and traditional Chinese medicine can induce ROS accumulation and cellular stress (mitochondrial dysfunction, endoplasmic reticulum stress, and BSEP-related bile transport impairment), leading to cell swelling, membrane rupture, and DAMP release, which subsequently activates innate and adaptive immune responses and culminates in hepatocellular injury. Compared with traditional Chinese medicine, Western drugs more often involve gut-liver axis-related amplification of inflammation via circulating PAMP, while traditional Chinese medicine is chemically complex and more frequently presents as idiosyncratic injury associated with genetic susceptibility.