News & Perspectives

Chinese Herbs: How Safe Are They?

Today, millions of Americans pop ginseng for an afternoon pick-me-up, ginkgo biloba as a memory booster, or dong quai as a natural alternative to estrogen. Hundreds of other herbs from China are gaining in popularity as well, used in everything from teas and sports bars to spa treatments and herbal Viagra. Many people swear by them, and rigorous trials point to possible benefits against irritable bowel syndrome, breech births, chronic hepatitis, and more.

Recent Scares

While use of herbs continues to grow, however, new reports are raising fresh concerns about just how safe these and other herbal remedies long used in Chinese medicine really are. Early in 2002, for instance, thousands of men taking a blend of eight Chinese herbs called PC-SPES to fight prostate cancer were forced to abandon the therapy after a prescription blood thinner and other medicines were discovered in the product. The capsules, made by a California company, had shown cancer-fighting promise in early trials. Many of the men had experienced dramatic drops in PSA levels, a marker for prostate cancer progression. Because of apparent adulteration of the raw ingredients from China, however, PC-SPES was pulled from the market.

In another case, several young women in Britain showed up at their local medical center complaining of palpitations. All, it turned out, had been seeing the same Chinese herbalist for weight loss. "Most had been taking multiple preparations--as many as nine--and described 'spectacular' results," reported consultant physician Karl Metcalfe of Southend Hospital, Westcliff-on-Sea in Essex. Unfortunately, their blood pressures were also going through the roof.

At first their doctors suspected ma huang, or ephedra, an herbal stimulant popular among dieters and body builders that had been under investigation for possible links to heart attacks and strokes. Lab analyses, however, revealed that the herbal preparations they were taking contained fenfluramine, part of the infamous and now banned fen-phen diet drug that was found to damage heart valves.

However, in December 2003, the US government banned the sale of ephedra in over the counter herbal products. This ban came after the accumulating evidence of serious side effects among users of ephedra-containing products gave the FDA the basis for taking action under a 1994 law regulating dietary supplements.

Old Remedies, New Dangers

Concern about the safety of Chinese herbs is nothing new. In the early 1990s, dozens of Belgian women attending a weight loss clinic developed kidney failure after doctors prescribed a veritable medicinal brew that contained, among other things, Chinese herbs. The outbreak appeared to be due to a manufacturing error that substituted one Chinese herb (Stephania tetrandra) for another (Aristolochia fangchi) that contained aristolochic acid, a potential kidney toxin. Years later, some developed cancers of the urinary tract. The Food and Drug Administration (FDA) has since asked all distributors of Chinese herbs to recall products containing the suspect ingredient. More recently, doctors in the U.K. traced two deaths from liver failure to the use of Chinese herbs for skin problems.

In addition, over the years, researchers have discovered a host of drugs and other potentially dangerous adulterants in Chinese herbs. Most involved ready-made, or patent, medicines imported from Asia. Skin creams for eczema have been laced with steroids and a strong antibiotic. Madam Pearl's Cough Syrup, sold in New York's Chinatown, contained codeine. Other formulas have been doped with aspirin, antihistamines, anticonvulsants, theophylline, and Viagra. Along with the herbs in one arthritis formula, Chui Fong Koo Wan, was the toxic anti-inflammatory phenylbutazone, along with Valium and lead.

The findings underline the importance of obtaining your herbs from a reputable source and using them under the guidance of a healthcare expert. As with other dietary supplements, the FDA does not regulate Chinese herbs for purity or safety, as it does for conventional medications. In some cases, Asian manufacturers deliberately add prescription drugs to their products to give them an extra "kick." Other contaminants are inadvertently introduced in factories with poor quality control, usually because they use the same equipment to make both herbal remedies and prescription medicines. Lead, arsenic, and other toxins may also leach into products from the soils in which the herbs are grown.

The drive to create potent, modern herbal "pharmaceuticals" has also led to problems. During 1993 to 1994, at least seven Americans developed nausea, itching, fatigue, and other symptoms of hepatitis after taking Jin Bu Huan herbal pain relief tablets. Follow-up investigation revealed that the medicines were mislabeled. Rather than containing a blend of herbs or even a whole single herb, they contained high concentrations of one chemical extracted from the herb, making it druglike in its potency.

Most Chinese Herbs Are Safe

These instances, it's important to note, are the exceptions. Chinese herbs have been used safely for thousands of years by millions of people, with few of the harsh and sometimes deadly side effects common to so many conventional drugs. Some, like ginkgo and ginseng, are sold as single ingredients and are among the most popular herbs sold in the West today. Many more are prescribed by practitioners of traditional Chinese medicine; usually they're blended, boiled, and then drunk in decoctions, or pounded and mixed into powders and pills.

A bigger problem may be the use of these time-tested remedies among people who are also taking standard medications. In many cases in which serious troubles arose, including at the Belgian diet clinics, patients were also taking strong drugs and other herbs that may have compounded the problem. Little is known about the potential interactions of traditional Chinese herbs with conventional medications. There's no guarantee that an herb-drug interaction will not occur.

"So many people in China are taking Chinese herbal medicine and we just don't know whether it is effective or safe to use at the same time as conventional medicine," says Dr. Tony Mok of the Chinese University of Hong Kong. "We tend, therefore, to advise against it--but we should know for sure."

Rigorous Testing

Fortunately, well-designed studies that will tell us more about the safety of Chinese herbs are under way. Despite the setbacks with PC-SPES for prostate cancer, for example, the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, has resumed laboratory testing of this product. (Human trials, however, must await the production of contaminant-free herbs.) And in a gold-standard double-blind, placebo-controlled study in Hong Kong, a Chinese herbalist is prescribing individualized herbal blends to participants with cancer to prevent the nausea and vomiting of chemotherapy.

Additional studies are ongoing. In addition, the Chinese government has taken steps to ensure the safety of herbal medicines. The 1985 Drug Controls Regulation Act issued rules for the production and manufacturing of these medicines, and additional measures to regulate Chinese herb factories are being taken.

Simple Guidelines
In the meantime, some sensible precautions can help you to use your herbs safely.

·  Buy your herbs from a reputable manufacturer. Chinese herbs, like other dietary supplements, do not require the same strict manufacturing requirements or clinical trials required of prescription drugs. That makes it especially important to buy your herbs from a company you trust. One recent survey found that up to 7% of the Chinese herbal medicines sampled in the US were adulterated with standard medications, and rates approached 25% in Taiwan.

·  Seek a licensed and credentialed herbal practitioner. Many of the problems that do arise with herbs occur among practitioners who are not adequately trained. A doctor of oriental medicine (O.M.D.) undergoes extensive training in acupuncture, herbs, and other aspects of traditional Chinese medicine. Some M.D.s, osteopathic doctors (D.O.s), naturopathic physicians (N.D.s), and other personnel are well versed in Chinese herbs as well as Western medicine. As you would with any health provider, always check into your practitioner's credentials and background.

·  Avoid herbal "take out" shops and other outlets with which you are not familiar. The staff may not be qualified to dispense medical advice, and the herbs may have been imported through unlicensed channels.

·  Let your doctor know of any herbs and drugs you are taking, including over-the-counter preparations. Ginkgo, for example, has proven safe and may be effective for a number of conditions but must be discontinued a week or so prior to surgery to prevent excessive bleeding. In addition, although herbs have been safely used in traditional Chinese medicine for thousands of years, little is known about their potential interactions with conventional medications. Ephedra may interact with cold medicines; licorice with blood pressure drugs; ginseng with antidepressants; and PC-SPES with some cancer drugs. However, there are many additional interactions, and more are likely to emerge. Note: For information on interactions with specific generic drugs, see the WholeHealthMD Drug/Nutrient Interactions Chart under specific herbs.

·  If you feel ill, stop taking your herbal medicines and call your doctor immediately. Nausea, abdominal distress or tenderness, coughs, fever, or other symptoms could be signs of more serious problems. Tragically, one 32-year-old British man continued to take Chinese herbs to melt away fatty lumps despite weeks of persistent diarrhea, even though his doctor told him to call at once if he felt ill. He eventually died of liver failure.

·  Stick with recommended doses. Problems are more likely to arise with long-term use at excessive dosage levels--although as with conventional drugs, anyone can have a bad reaction. Let your doctor know if you have had hepatitis or any kidney or liver problems at any point in the past. It could increase your risk of adverse reactions.

·  Read labels carefully. Western drugs are sometimes added to Chinese patent medicines and often identified by the words "Fu Fang" or "Qiang Li" before the name of the product. Don't use an herb if you don't know what it does without checking with your doctor first.

·  Keep herbs away from children. In 1993, three Colorado children nearly died from overdoses of Jin Bu Huan, a traditional Chinese herbal pain reliever and sleep aid. Herbs, like drugs, can be potent medicine. Store in a safe place, away from pets and youngsters.

·  If you are pregnant, let your doctor know. As with most drugs, some Chinese herbs can be dangerous during pregnancy, and few have been tested in this group. If you are pregnant or considering becoming pregnant, let your practitioner know.

·  Finally, don't forego traditional therapies that may be an important part of your treatment plan. Chinese herbs can be helpful for some ailments, but don't let them lull you into skipping conventional treatments or ignoring symptoms that may indicate a serious underlying disease.

Date Published: 03/08/2003
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