Chinese Medicinals & Side Effects
by Bob Flaws

Many Western practitioners think that Chinese medicinals are safe because they are "herbs" and, therefore, natural. This opinion is both naïve and potentially dangerous. Happily, recent publicity about Chinese herbs containing aristolochic acid has helped to raise the consciousness of many Western practitioners regarding the safety of Chinese medicinals. As I have been saying for years, Chinese medicinals are safe and effective only when they are prescribed correctly. This is one of the reasons why I always use the term "Chinese medicinals" (the actual translation of zhong yao) as opposed to "Chinese herbs" ( which is zhong cao). I believe Chinese medicinals need to be considered just as potentially dangerous as Western medicinals if they are prescribed erroneously. Recently, Chinese doctors in China have begun to show more interest in the issue of adverse reactions (or side effects) from Chinese medicinals. There have been a number of articles on this subject in recent issues of Chinese medical journals in all probability prompted by the "aristolochia issue." One such article was written by Chen De-xin and published in the August 2000 issue of Fu Jian Zhong Yi Yao (Fujian Chinese Medicine & Medicinals). Titled "A Brief Discussion of the Adverse Effects of Chinese Medicinals & How to Prevent Them," Chen describes seven ways Chinese medicinals may cause adverse reactions or side effects.
I believe that Western practitioners should pay more attention to these seven ways Chinese medicinals may cause unwanted side effects and adverse reactions.
1. In appropriate for the patient's pattern
As Chen says, the treatment methodology of Chinese medicine is to base treatment on pattern discrimination. This means that, "If there is cold, heat it; if there is heat, chill it; if there is repletion, drain it, and if there is vacuity, supplement it." This is the fundamental heteropathic principle beneath the professional prescription of Chinese medicinals. If a Chinese medicinal does not match the patient's pattern, it may cause adverse reactions. This is because anything that is strong enough to push a person towards health when truly needed must also be strong enough to push a person out of balance if not needed. In medicine there are no panaceas, and you cannot have it both ways. For instance, prescribing a warming medicinal to a patient with a heat pattern may adversely increase evil heat. Chen's example of this most basic and fundamental mistake is to prescribe Radix Panacis Ginseng (Ren Shen) or Cornu Parvum Cervi (Lu Rong), both supplementing and boosting medicinals, to someone with an evil repletion pattern. In that case, these medicinals may cause the adverse reactions of chest oppression and abdominal distention. Other examples from my own experience are prescribing yang supplements to a patient who is not yang vacuous and bitter, cold medicinals with a spleen vacuity. In the first case, such erroneous prescription may result in unwanted oral sores and sore throat, while in the second case, it may result in unwanted diarrhea.
2. Excessive dose
It is also possible for Chinese medicinals to cause adverse reactions if they are appropriately indicated but their dosage is simply too large. As an example of this, Chen says that Caulis Akebiae (Mu Tong) may cause acute kidney failure if its dosage is too high even when otherwise correctly selected. Chen also says that excessively large doses of Herba Asari Cum Radice (Xi Xin), Semen Gingkonis Bilobae (Ying Guo), Semen Pruni Armeniacae (Xing Ren), and Radix Aconiti (Wu Tou) may all cause poisoning.
3. Prolonged administration
Prolonged administration of certain Chinese medicinals may cause unwanted side effects or adverse reactions, again even if otherwise correctly chosen. For instance, prolonged administration of Cinnabar (Zhu Sha), Haemititum (Dai Zhe Shi), and the ready-made medicine Liu Shen Wan (Six Spirits Pills) may all cause damage to the liver and kidneys, while prolonged administration of Royal Jelly (Feng Wang Jiang) to children may cause premature sexual development.
4. Wrong combinations
Most Chinese medical practitioners are required to learn a list of traditionally "forbidden" medicinal combinations. These describe those medicinal combinations which are likely to cause adverse reactions. In general, the erroneous combination of such medicinals increases the toxicity inherent in one or both medicinals. As an example of this, Chen says that the combination of Thallus Algae (Kun Bu) and Herba Sargassii (Hai Zao) with Cinnabar (Zhu Sha) may cause iatrogenic colitis. However, Chen also goes on to point out that such wrong combinations may include a Chinese medicinal and a Western drug. For instance, Rhizoma Alismatis (Ze Xie) with antisterone, spironolactone, or other such diuretics may result in hyperkalemia (i.e., too much potassium in the blood). Unfortunately, there are not yet well-vetted traditional lists of such Chinese medicinal-Western drug reactions.
5. Wrong processing
Pao zhi is the Chinese medical term for the processing of medicinals. Such processing changes the nature and functions of medicinals, either eliminating or reducing something negative or enhancing and supplementing something positive about the medicinal being processed. For instance, uncooked Rhizoma Pinelliae Ternatae (Ban Xia) has toxins which can promote vomiting, whereas processing this medicinal removes these toxins. In that case, the processed medicinal is used to actually stop vomiting. Therefore, which form of Ban Xia one uses, uncooked or processed, is extremely important, and using the wrong one may result in unwanted vomiting. This is why Philippe Sionneau, the author of Pao Zhi: An Introduction to the Use of Processed Chinese Medicinals, regards differently processed forms of the same medicinal as different medicinals. Another example of adverse reactions from wrong processing is if the fine hairs on Folium Eriobotryae Japonicae (Pi Pa Ye) are not removed. After ingestion, Chen says that this may result in itchy throat and dry cough and, if severe, may cause edematous swelling of the throat.
6. Wrong decoction
The standard of care in terms of method of administration for most Chinese medicinal formulas in standard professional Chinese medicine is the water-based decoction. This means that the Chinese medicinals are boiled in water and that the resulting medicinal liquid is drunk. Different Chinese medicinals have different instructions in terms of how long they should be decocted prior to administration. In some cases, wrong cooking simply destroys the medicinal's therapeutic effect, such as overcooking Radix Ligustici Wallichii (Chuan Xiong) and Ramulus Uncariae Cum Uncis (Gou Teng). However, in other cases, wrong cooking may result in failure to eliminate toxicity and thus the causation of side effects or adverse reactions. For instance, if Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi) is not cooked long enough, its inherent toxicity may not be eliminated. Similarly, cooking Cinnabar (Zhu Sha) along with the other medicinals in a decoction may increase the absorption of Zhu Sha's inherent toxins.
7. Individual bodily differences
Individuals vary in terms of their age, sex, and constitutions. Therefore, the effects of a certain medicinal at a certain dose may not be the same from patient to patient. Some patients will be more sensitive to the constituents of a certain medicinal and other patients will be less sensitive. For instance, babies' and childrens' viscera and bowels are not completely developed and mature. Therefore the prolonged administration of otherwise nontoxic Chinese medicinals may cause poisoning reactions. This is why it is commonly said in Chinese medical pediatrics that one should stop administering medicinals when the baby's condition is cured by half. Similarly, the liver and kidney function in the elderly is typically decreased and, therefore, their bodies cannot breakdown and excrete medicinal constituents as easily as healthy middle-aged adults. This means that the effects of medicinals in the elderly are stronger and can easily lead to adverse reactions if those medicinals are overprescribed. Further, Chinese medicinals must also be adjusted and their use varied in women who are lactating, menstruating, or pregnant.
As we Western practitioners of Chinese medicine try to gain doctoral status for our profession, I believe it is also incumbent upon us to grant the full status of medicines to our so-called herbs. This means that we should recognize the full potential power of the ingredients we prescribe, both to do good and to do harm. Far too often I have heard from patients who have been told that an adverse reaction could not have been caused by the Chinese medicinals they were prescribed because those medicinals were "natural," "herbs," or "holistic." I believe we need to grow beyond such naïve, simplistic, and down-right wrong opinions. If we want increased respect from the public for our art, then I also think we need to pay increased respect to our medicinals. As Chen's article implies, Chinese medicinals are not safe because they are mostly made from herbal sources. They are not safe because they are natural. Water and salt are both natural, both are absolutely essential to human life, and both can kill you if taken inappropriately. And they are not safe because they are Chinese. They are only safe (and effective) when prescribed on the basis of a correct pattern discrimination in the right dose for the right length of time and processed and administered in the right way.
Copyright © Blue Poppy Press, 2001. All rights reserved.