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Complementary and Alternative Medicine: Fair and Balanced

A bewildering array of Chinese herbal medicines

It is very difficult for the average consumer to make an informed decision when purchasing a Chinese herbal remedy.

By John Russo/Vicus.com

VICUS.COM (22 March 2000) -- Chinese herbology, along with acupuncture, is the best-known and most widely available branch of Chinese medicine. It is a holistic approach to medicine, meaning that treatment focuses on restoring balance in the body in a fundamentally individualized way rather than on the treatment of a specific disease. Presently, about one-quarter of the world's population uses some form of Chinese medicine. Of the estimated $14 billion a year that Americans spend on alternative medicine, Chinese medicine accounts for $1 billion, 75% of which is spent on acupuncture.  

Under the care of a qualified Chinese herbalist, Chinese medicine has been used to treat a variety of illnesses, from arthritis to infertility. However, when practiced by unqualified individuals, Chinese herbal medicine has been described as a recipe for grief. It is very difficult, if not impossible, for the average consumer to make an informed decision when purchasing a Chinese herbal remedy. There is a bewildering array of herbals complicated by inadequate labeling information, making it impossible to know for sure what is in the bottle or tea bag. 

The problem is compounded by a long history of products containing undeclared drugs, unlabeled drug/herb combinations and toxic ingredients. This review is not intended as a condemnation of Chinese herbal medicine. Rather, it is meant to guide consumers to carefully select a Chinese herbalist, and to update practitioners of recent warnings regarding the safety of herbal medicine products.

Self-treating is discouraged 

Chinese herbal medicines are not regulated as medicine in a Western sense, and they tend to be poorly (if at all) labeled with their contents. According to Adriane Fugh-Berman, M.D., of George Washington University School of Medicine, "It is not uncommon for medications prescribed in Asia to contain both herbs and drugs. This is standard practice. The problem occurs when a patient takes a preparation without knowing that it contains a potentially hazardous or addictive drug, or a drug to which the person is allergic."

More alarming is the fact that there is a long history of herbs being imported into the United States that have been contaminated with heavy metals and pollutants. 

Diagnosis and treatment are complex tasks 

The skills required to accurately assess (or diagnose) the imbalance between major body systems and then prescribe effective and safe treatment is a complex task that is best undertaken by a qualified professional. The process starts with inquiry to obtain a complete history and hands-on examination. Practitioners who treat only symptoms should be avoided.

Caution in choosing Chinese herbal medicines 

Chinese herbal medications have a history of containing prescription drugs. In 1974, there were four cases of agranulocytosis, a blood disorder resulting from an insult to the production of white blood cells, resulting in death of one person and extensive hospitalization of three others. Analysis by the Food and Drug Administration (FDA) of pills involved in the illnesses found phenylbutazone and aminopyrine, both of which have been associated with agranulocytosis. Analyses of other "herbal medications" found methyl testosterone, prednisolone, diazepam, chlorzoxazone and acetaminophen.

Six years later, several illnesses and another death were linked to use of Chinese herbal medications, particularly chuifong toukuwan. Analysis of chuifong toukuwan from various sources found indomethacin, hydrochlorothiazide, chlordiazepoxide, lead and cadmium, a human carcinogen.

More recently, in 1998, Californiaís Department of Health Services issued a warning to consumers not to use a Chinese medicine called An Shu Ling because it contains levo-tetrahydropalmatine, an ingredient that can cause chemical- induced hepatitis. An Alameda County woman was diagnosed with chemical-induced hepatitis in late May 1998 after using the product for insomnia. 

Retailers, distributors and acupuncturists were also told not to sell or provide An Shu Ling to their customers. In addition to hepatitis, levo- tetrahydropalmatine is associated with respiratory depression, slowing of the heart, sedation and fatigue.

Product review 

A list of products found by the FDA or the National Fish and Wildlife Service Forensics Laboratory to contain undeclared drug substances is presented in  Table 1.

Click here to view Table 1

Products identified by the California Department of Health Services as containing toxic ingredients, and the reported reactions to these products, are listed in Table 2.    

Click here to view Table 2

John Russo, Jr., PharmD, is senior vice president of medical communications at Vicus.com. He is a pharmacist and medical writer with 20 years of experience in medical education.

1. The list is based on a report issued by the FDA in August 1999. 

 

References:

Bratman S. The Alternative Medicine Ratings Guide: An Expert Panel Ranks the Best Treatments for Over 80 Conditions. Rocklin (CA): Prima Health; 1998.

Horstman J. The Arthritis Foundationís Guide to Alternative Therapies. Atlanta (GA): Arthritis Foundation; 1999.

Pelletier, K. The Best Alternative Medicine. What Works? What Does Not? (NY): Simon & Schuster; 2000.

U.S. Food and Drug Administration, Office of Regulatory Affairs. IA #66-10 - Revised 2/21/91, "Chinese Herbal Medicines," Attachment A - 08/11/99, Attachment B - 2/24/00. Automatic Detention Alert, Chinese Herbal Medicines. http://www.fda.gov/or%20a/fiars/ora_import_ia6610.html