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Based on its long history of traditional use, picrorhiza appears to be relatively safe. However, systematic, scientifically modern safety studies of picrorhiza are lacking.
Many herbs and other treatments considered safe based on traditional use have later turned out to present severe, previously unrecognized risks. Herbalists would be expected to notice immediate, dramatic reactions to herbal formulas, and one can assume with some confidence that treatments used for thousands of years are at least unlikely to cause such problems in very many people who take them. However, certain types of harm could be expected to easily elude the detection of traditional herbalists. These include safety problems that are delayed, occur relatively rarely, or are difficult to detect without scientific instruments.
Due to the lack of comprehensive safety evaluation, we strongly recommend against use of picrorhiza by pregnant or nursing women, young children, or people with severe liver or kidney disease.