Eco-pharmacovigilance in traditional Chinese medicine: a review of mechanisms, challenges, and a call for a “One Health” approach

Eco-pharmacovigilance (EPV) conventionally addresses the environmental impacts of pharmaceuticals. However, extending EPV to Traditional Chinese Medicine (TCM) necessitates evaluating a product life cycle that is deeply intertwined with natural ecosystems. This review investigates the environmental footprint of TCM through a ‘One Health’ lens. We systematically evaluated contamination pathways, including heavy metal accumulation in medicinal plants and pollutant mobilization facilitated by dissolved organic matter from extraction residues. Furthermore, we analyzed under-investigated risks, such as the environmental dissemination of antibiotic resistance genes, the endocrine-disrupting properties of specific herbal compounds, and the implications of climate change for the quality and safety of medicinal plants. To compile this evidence, a systematic literature search was conducted across multiple academic databases, primarily PubMed, Web of Science, Scopus, and the China National Knowledge Infrastructure (CNKI), covering publications up to May 2026. The search strategy utilized terms including ‘eco-pharmacovigilance’, ‘traditional Chinese medicine’, ‘One Health’, ‘heavy metals’, ‘medicinal plants’, ‘antibiotic resistance genes’, ‘endocrine-disrupting compounds’, ‘life cycle assessment’, ‘dissolved organic matter’, and ‘green manufacturing’, both individually and in combination. Following a rigorous screening process for relevance, methodological quality, and thematic scope, a total of 62 peer-reviewed references were included in this comprehensive analysis. Based on the synthesized data, this review identifies critical gaps in current EPV frameworks and proposes an integrated strategy combining mechanistic toxicology, climate resilience planning, green manufacturing technologies, and international regulatory cooperation to advance the ecological sustainability of TCM.