Although the constituent in germander responsible for its hepatic toxicity has not been identified, germander contains several chemicals, including polyphenols, tannins, diterpenoids, and flavonoids. On the basis of the 27 French hepatitis cases, the French Ministry of Health has forbidden the use of germander in drugs. Its use has been restricted in other countries. Because it shares the same chemical properties and the same adverse effects as aspirin, this claim is highly misleading. Both willow bark and aspirin are salicylates, a class of compounds that work by virtue of their salicylic acid content.
All salicylates share substantially the same side effects.
Children with influenza or chickenpox should avoid salicylates because their use, even in small doses, is associated with development of Reye syndrome, which is characterized by severe, sometimes fatal, liver injury. Approximately 5 percent of the population is hypersensitive to salicylates. All three utlimately recovered following intensive medical care. THP is found, however, in high concentrations in plants of certain Stephania species. The symptoms of the three children are consistent with these effects.