Objectives: Up to now, limited cases with acute liver failure caused by traditional Chinese medicine have been reported, and thus this topic has been scarcely discussed. This study aims to report such cases from China. Design: A retrospective study. Setting: Clinical investigation among seven tertiary hospitals in different areas of China. Patients: From January 2007 to December 2012, patients with acute liver failure induced by traditional Chinese medicinal herbs were included. Interventions: None. Meaurements and Main Results: A total of 30 patients were finally identified, including six men and 24 women. The average age was 39.7 years. The median period from initial symptoms to the development of hepatic encephalopathy was 13 days. Nine patients (30%) had accepted herbal therapies due to their skin disorders before the onset of acute liver failure. Eighteen patients (60%) eventually died, 10 of whom died of heavy bleeding. No patients received liver transplantation. Conclusions: The model of safety monitoring for traditional Chinese materia medica should be established. For those critically ill patients with herb-induced acute liver failure, coagulopathy is a vital problem in critical care. Additionally, the rate of liver transplantation for acute liver failure in China needs to be improved.