general information:
Chinese
medicine largely relies on formulae of eight to sixteen herbs, rather than single
herbs, nutrients or drugs, as in common in Naturopathic and conventional medicine.
While the number of total active constituents can thus be very high, the amount
of any individual constituent is generally low. This is generally thought to minimize
both side-effects and interactions in correctly prescribed formulae.
Chinese
herbal formulae are prescribed as teas, powders, extracts and pills. Teas may
have very large amounts of active ingredients, often beginning with raw material
of more than 100 grams for a daily dose of decocted herbs in mainland China. Japanese
Kampo practitioners often use much lower doses, with raw herb equivalents ranging
from 30-45 grams per day. Yet even these lower end dosages are relatively large
compared to about 0.5-10 grams per day used in typical practice of Naturopathic
medicine and medical herbalism. Thus, misprescribed formulae may have high potential
for side effects, independent of the inherent safety of the herbs they contain.
Chinese formulae of this size have been prescribed for 2000 years according to traditional Chinese parameters that match discrete symptom complexes or syndromes with specific herb combinations. The general rule of thumb is that an herb or formula will cause side effects if the disease is treated without consideration of the entire syndrome present.
Syndromes are basically just the
differences between patients in terms of appetite, energy level, sleep, physical
fitness and other general parameters. Many of the herbs in a large formulae for
chronic illness address such general parameters rather than the specific pathology
as defined by conventional biomedicine. Most of these general herbs are completely
nontoxic, such as mild tonics like Astragalus or digestives, like ginger.
the written tradition:
Because the Chinese had widespread distribution
of medical books by 800 C.E. (A.D.), they have had at least 1,200 years to vigorously
debate the effectiveness of various herbs and formulae, as well as the safety
and clinical validity of their diagnostic methods.
During the premodern
era, the misuse of herbs was a constant concern to literate scholar physicians.
Many important premodern medical texts have lengthy diatribes against prevailing
medical malpractices. In most cases, these diatribes are directed at overall misdiagnosis
or prescription without diagnosis. However, concerns have also been raised about
toxic herbs like aconite or those that are easily abused, like tea, poppy and
ginseng.
cultivation:
Many Chinese herbs are grown traditionally
without pesticides and herbicides. About half of the standard materia medica are
essentially weeds themselves. Another significant amount are wildcrafted. A smaller
amount, especially the more valuable herbs, may be sprayed as necessary. Since
Chinese herbs are exported to the U.S. as packaged food products, they are not
directly fumigated at customs, though their packaging may be. However, contamination
by such sources should remain a suspect in all future incidents, given China's
apparent laxity at enforcing environmental and public safety regulations.
A number of Chinese herbs were traditionally derived from what are now endangered
species. The endangered animals are not actually used in any legitimate clinics
of oriental medicine in America. However, they may be available in products in
Chinatown herb shops. Herbal medicines made from endangered plants are all sourced
through cultivation; they are not taken from their wild habitat.
patent
medicines:
Chinese herbs are frequently consumed in what are called patent
or proprietary medicines. There are considerable legal, ethical and scientific
problems with these prefabricated pill products and they should be avoided unless
one is a fully trained professional in Chinese herbal medicine. In response to
the apparent lack of quality control in Chinese patent medicines, several American
manufacturers have set up production facilities in China which abide by strict
quality control standards (GMP).
toxicity:
Most problems with Chinese
herbs appear to arise from drug interactions, contamination or misidentification
of herbal materials, drugs hidden in herbal products, heavy metal poisoning and
acute allergic hypersensitivity. This suggests the greatest problem with Chinese
herbs is lack of quality control and other regulations in production.
All incidents, except for one, described in this Herb Group involve the prescribing of Chinese herbs by untrained individuals or self-prescribing by consumers. That one appears to be an allergic reaction to a particular herb, which was probably unavoidable. This suggests the lack of training in the proper use of Chinese herbs to be a significant factor in the occurrence of adverse effects. The fact that fully trained practitioners of TCM are rarely, if ever, responsible for serious adverse herb reactions in their patients, suggests that traditional prescribing methods should be further investigated for their contribution to the safe use of Chinese Herbs.