Overview | History of Chinese Herbal Medicine | Principles of Traditional Chinese Herbal Medicine | Types of Chinese Herbal Remedies | What Is Chinese Herbal Medicine Used for Today? | What Is the Scientific Evidence for Traditional Chinese Herbal Medicine? | Other Uses for Traditional Chinese Herbal Medicine | How to Choose a Practitioner of Traditional Chinese Herbal Medicine | Safety Issues | References
The system of herbal medicine that developed in China differs in several significant ways from European herbal medicine. The most obvious difference is that the Western herbal tradition focuses on “simples,” or herbs taken by themselves. In contrast, traditional Chinese herbal medicine (TCHM) makes almost exclusive use of herbal combinations. More importantly, these formulas are not designed to treat symptoms of a specific illness; rather, they are tailored specifically to the individual according to the complex principles of traditional Chinese medicine. For this reason, TCHM is potentially a deeply holistic healing approach. On the other hand, it is both more difficult to use and to study than its Western counterpart.
TCHM is widely used in Asian countries, both in its traditional holistic form and in a simplified disease-oriented version. There have been a few properly designed scientific trials of TCHM, but the evidence base remains highly inadequate. In addition to questions regarding effectiveness, there remain serious safety concerns to be resolved.
Chinese herbal medicine has a long historical tradition, although it is not quite as ancient as popularly believed. Ancient herbology in China focused on potions whose function was part medicinal and part magical, and it lacked a substantial theoretical base. Sometime between the second century B.C.E. and the second century A.D., the theoretical foundations of traditional Chinese medicine were laid, but the focus was more on acupuncture than on herbs.1 Only by about the 12th century A.D. were the deeper principles of Chinese medicine fully applied to herbal treatment, forming a method that can be called TCHM. This was further refined and elaborated during various periods of active theorizing in the 14th through the 19th centuries. Western disease concepts entered the picture in the 20th century, leading to further changes.
In China today, TCHM is used alongside conventional pharmaceutical treatment. Considerable attempts have been made to subject TCHM to scientific evaluation; however, most of the published Chinese studies on the subject fall far short of current scientific standards. (For example, they generally lack a placebo group.)
In neighboring Japan, a variation of the TCHM system known as Kampo has become popular, and the Japanese Health Ministry has approved many Kampo remedies for medical use. The scientific basis for these remedies remains incomplete, but several studies of minimally acceptable quality have been reported.
Even a basic introduction to the principles of TCHM exceeds the scope of this article. Consider the following nothing more than a taste of this vast medical system.
According to the principles of all Chinese medicine, health exists when the body is balanced and its energy is freely flowing. The term “energy” refers to Qi, the life energy that is said to animate the body. The term “balance” refers to the relative factors of yin and yang—the classic Taoist opposing forces of the universe. Yin and yang find their expression in various subsidiary antagonists such as cold vs. heat, dampness vs. dryness, descending vs. ascending, at rest vs. active, and full vs. empty.
In an ideal state, yin and yang in all their forms are perfectly balanced in every part of the body. However, external or internal factors can upset this balance, leading to disease. Chinese medical diagnosis and treatment involves identifying the factors that are out of balance and attempting to bring them back into harmony. Diagnosis is carried out by means of “listening” to the pulse (in other words, taking the pulse with extraordinary care and sensitivity), observing and palpating various parts of the body, and asking a long series of questions.
It is important to realize that diagnosis according to TCHM differs greatly from Western diagnosis. To understand this, consider two hypothetical patients with the single Western diagnosis of migraine headaches. The first might be said to have “dryness in the liver and ascending Qi,” while another might be diagnosed with “exogenous wind-cold.” Based on these differing diagnoses, entirely different remedies might be applied. In other words, there is no such thing as a TCHM remedy for migraines per se; rather, treatment must be individualized to the imbalance determined by traditional theory.
The herbal formulas used in TCHM consist of four categories of herbs: ministerial, deputy, assistant, and envoy. The ministerial herb addresses the principal pattern of the disease. Deputy herbs assist the ministerial herb or address coexisting conditions. Assistant herbs are designed to reduce the side effects of the first two classes of herbs, and envoy herbs direct the therapy to a particular part of the body. For example, in the case of “dryness in the liver and ascending Qi” described above, an herbalist might employ a ministerial herb to reverse ascending Qi, a deputy herb to exert a moistening effect, an assistant herb to prevent the stagnation of Qi (Qi stagnation is said to be a side effect of moistening herbs), and an envoy to carry these effects to the liver.
TCHM remedies can also be designed to fit all common causes of migraines simultaneously, mostly by multiplying the number of ingredients. Practitioners of TCHM frown upon this “one-size-fits-all” approach, but it is often popular among consumers and easier to test scientifically.
To use Chinese herbal medicine in the most traditional fashion, you must visit an herbalist’s shop. There, experienced herb preparers will chop, grind, fry, and slice dried herbs according to the prescription given by an experienced herbalist. You will walk home with a packet of dried herbs that need to be prepared according to the instructions, which typically involve adding water, boiling for several hours in a ceramic pot, pouring off the liquid, adding more water, and repeating the process twice more. Certain herbs are supposed to be added right at the end, while others require extra-long preparation.
If you don’t wish to carry out such a complex process, or if a classic herbal shop is not available, you may wish to move one step away from tradition and purchase an already-prepared Kampo formula. There are several hundred such formulas designed to match the most commonly seen forms of imbalance. Available in powder, capsule, or tablet form, they can be used much more conveniently than fully traditional herbs. Many Kampo combinations are licensed in Japan and are manufactured there on a large scale by reputable manufacturers.
The lowest level of TCHM, scarcely deserving the name at all, involves so-called Chinese Patent Remedies, which consist most commonly of tiny brown spheres in small brown bottles. They are marketed both for classical imbalances and western disease categories. Patent remedies are inexpensive and widely available. However, there have been so many scandals involving dangerous contaminants not listed on the label that we recommend avoiding this form of treatment entirely. (See Safety Issues.)
In the West, herbal medicine is part of folk medicine. However, in China there is a distinct tradition of Chinese folk medicine that is separate from the orthodox, rather academic TCHM approach. In this Chinese folk medicine, herbs are used more simply, somewhat in the manner of Western herbal medicine. Herbs most commonly used in this manner include astragalus, dong quai, ginger, kudzu ( Pueraria lobata), licorice, lycium, Panax ginseng, and schizandra. For more information on the use of these herbs, see the appropriate individual articles.
Besides herbs, substances that we might consider supplements are utilized in TCHM. These include extract of human placenta,76 glandular extracts, and a variety of minerals.
In the traditional system of Chinese herbal medicine, herbal formulas can be used to treat virtually any condition. Some of the most common uses in China include liver disease ( hepatitis and cirrhosis), sexual dysfunction in men, infertility in women, insomnia, colds and flus, menstrual pain, irregular menstruation, menopause, and cancer treatment support.
Acupuncture is often used along with herbs as a supplemental treatment; in addition, extraordinarily detailed lifestyle suggestions are common. It is not unusual for a traditional practitioner to “prescribe” dinner, as well as counsel changes in living situation (for example, move from the basement to the first floor or face the bed south rather than north). Exercise systems such as Tai Chi and Qigong may also be recommended.
To establish the effectiveness of a treatment, it must be put through a double-blind, placebo-controlled trial. For this reason, our database is organized around such studies. However, there are a few issues that make it a bit difficult to study TCHM in this way.
The first problem involves diagnosis. As described above, there is no such thing as a TCHM remedy for migraine headaches, for example. Each person with migraines receives individualized treatment. This introduces an extra wrinkle for experimenters.
The best way to address this issue is as follows. People are chosen to participate in a study based on a Western diagnosis. Next, all participants are diagnosed by a classic herbal practitioner and prescribed a formula specific to their individual constitutions according to the principles of TCHM. Finally, another party steps in and provides participants with either the real formula or a placebo formula, under conditions whereby neither practitioners nor participants know which is which.
Other studies utilize a fixed remedy for all participants, in hopes that it will still prove effective on average. Such an approach doesn’t really test the effectiveness of true TCHM; rather, it tests a much-simplified form of it. Still, trials of this type are valid as far as they go.
Numerous other studies simply involve enrolling people with a certain condition and giving each participant an herbal remedy. Researchers then record the extent of improvement. Such “open label” trials, however, prove virtually nothing because even phony treatments will appear to cause benefits. (For more information, see Why Does This Database Rely on Double-blind Trials?) We do not report open label trials here.
Finally, many of these studies were performed in China, and, up to the time of this writing, research on Chinese medicine conducted in China generally falls far short of modern scientific standards of rigor.74,75
Hepatitis is a serious problem in many Asian countries, and conventional care leaves much to be desired. For this reason, herbal remedies are widely used.
The herbal combination Shosaiko-to (Minor Bupleurum) has been approved as a treatment for chronic hepatitis by the Japanese Health Ministry, and it enjoys wide use in that country and elsewhere.2 However, a search of the literature uncovered only one large-scale, double-blind, placebo-controlled study supporting its effectiveness.3 In this 24-week trial, the efficacy of Shosaiko-to was tested in 222 people with chronic active hepatitis using a double-blind, placebo-controlled crossover design. Results showed that use of Shosaiko-to significantly improved liver function measurements compared to placebo. Although these results are promising, an absence of long-term evaluation limits their meaningfulness. (Researchers only followed participants for 3 months.)
Other Chinese herbal remedies have been tested as adjuncts to conventional interferon treatment with promising results.4 However, published trials are of generally poor quality.
Note: If you are on interferon therapy, you should not use Chinese herbal formulas (or any herbs or supplements) except under the supervision of a physician (see Safety Issues).
Combination Chinese herbal therapies have also shown a bit of promise for the treatment of chronic hepatitis; tested formulas include Bing Gan Tang, Yi Zhu decoction, Fuzheng Jiedu Tang, and Jianpi Wenshen recipe.5-7 However, the quality of most of these studies was again quite poor—the results are mixed and overall, the evidence for these remedies remains far too weak to rely upon. Two studies failed to find Chinese herbal treatment helpful for hepatitis C.46,65
Note: There have been numerous cases of hepatitis and other forms of liver injury caused by Chinese herbs. See Safety Issues for more information.
Shosaiko-to, mentioned in the previous section, has also shown some promise for preventing liver cancer and liver fibrosis in people with liver cirrhosis or chronic hepatitis.8,9 However, the evidence remains marginal. For example, in a double-blind, placebo-controlled study, 260 people with cirrhosis were randomly assigned to take Shosaiko-to or placebo, along with conventional treatment.10 Over 5 years of evaluation, people taking the herb appeared to be less likely to develop cancer or die, but the results just missed the ordinary cutoff for statistical significance. For the subgroup of participants without hepatitis B infection, the benefits were statistically significant at the usual cutoff point.
In a double-blind, placebo-controlled trial, 116 people with irritable bowel syndrome (IBS) were randomly assigned to receive individualized Chinese herbal formulations, a “one-size-fits-all” Chinese herbal formulation, or placebo.11 Treatment consisted of 5 capsules 3 times daily, taken for 16 weeks. The results showed that both forms of active treatment were superior to placebo, significantly reducing IBS symptoms. However, the individualized treatment was no more effective than the “generic” treatment. Similar results were seen in another study as well.67
The Kampo formula known as Daio-kanzo-to is a mixture of rhubarb and licorice. In a 2-week, double-blind, placebo-controlled trial, 132 people complaining of constipation were randomly assigned to one of three groups: placebo, low-dose Daio-kanzo-to, or high-dose Daio-kanzo-to.12 The results indicate that the higher-dose group, but not the lower-dose group, experienced statistically significant improvements in constipation compared to placebo.
In a double-blind, placebo-controlled trial, 220 people with allergic rhinitis were given either placebo or the Kampo remedy Sho-seiryu-to for a period of 2 weeks.13 The results showed that use of the herbal formula significantly relieved all major symptoms of allergic rhinitis compared to placebo. Based on this and other more preliminary studies, Sho-seiryu-to has been approved by the Japanese Health Ministry for the treatment of allergic rhinitis and allergic conjunctivitis.
Another combination herbal therapy has shown promise for allergic rhinitis as well. In a 12-week, double-blind, placebo-controlled trial, 58 people with allergic rhinitis were given either placebo or an 11-herb combination remedy called Biminne.14 This combination therapy contains the following herbs:
Benefits have been seen in small studies of other formulations as well.47,84 However, one study failed to find that use of herbal treatments augmented the effectiveness of acupuncture for allergic rhinitis.48
A double-blind, placebo-controlled study of 96 people with osteoarthritis of the knee tested the effectiveness of a mixture of three Chinese herbs ( Clematis mandshurica, Trichosanthes kirilowii, and Prunella vulgaris).15 Participants were randomly assigned to placebo group or one of three other groups: 200 mg, 400 mg, or 600 mg of the herbal formula 3 times daily. After 4 weeks of treatment, significant improvement in arthritis symptoms was seen in all three treatment groups compared to placebo. No dose appeared conclusively superior to the others.
The Kampo remedy Shakuyaku-kanzo-to is a combination of peony root and licorice, commonly used for the treatment of muscle spasms in general. In a double-blind, placebo-controlled study, 101 people with liver cirrhosis who also suffered from severe muscular spasms at least twice per week were given either Shakuyaku-kanzo-to or placebo 3 times daily for 2 weeks.16 (The herb combination is not specifically aimed at liver cirrhosis. However, people with liver cirrhosis often have muscle spasms, so it made sense to try an anti-muscle-spasm formula on them.) The results showed significant reduction in frequency and severity of spasms among the participants using the herb compared to those taking placebo. However, some participants using the herb developed edema (swelling caused by excess fluid) and weight gain. Researchers attributed this side effect to the licorice constituent. (See Safety Issues for risks associated with the use of licorice.)
In a double-blind trial of 40 women complaining of menstrual pain, the Kampo formula Toki-shakuyaku-san was compared to placebo with good results.17 The design of this study was interesting because researchers preselected women who, according to the principles of traditional Chinese medicine, would be expected to respond to this Kampo treatment. Over six menstrual cycles, women using the real herbal formula experienced significantly less menstrual pain compared to those in the placebo group. Benefits took three menstrual cycles to develop.
In a 2008 review of 39 randomized controlled trials involving a total of 3,475 women, researchers concluded that the use of traditional Chinese herbs shows some promise in for the treatment of menstrual pain. However, firm conclusions were not possible due to the wide variability of study design and herbs used, as well as the poor quality of many of the studies.77
A double-blind study of more than 200 people evaluated the effectiveness of Coptis Formula (a traditional combination therapy) with or without the drug glibenclamide for the treatment of diabetes.18 Coptis Formula appeared to significantly enhance the effectiveness of the drug; however, the herbs produced marginal benefits at best when taken alone.
The Kampo remedy Saiboku-to has been approved by the Japanese Health Ministry for the treatment of asthma. However, meaningful supporting evidence appears to be limited to one small trial. In this double-blind, placebo-controlled crossover study, 33 people with mild to moderate asthma received Saiboku-to or placebo 3 times daily for 4 weeks.19 Treatment with the herbal remedy improved symptoms of asthma to a greater extent than placebo. Additional measurements suggested that Saiboku-to works by reducing asthmatic inflammation (technically, eosinophilia)
A Chinese study using a proprietary formulation reported benefits as well.61
A Chinese herbal mixture sold under the name Zemaphyte has shown promise as a treatment for eczema. This formula, based on herbs traditionally used for skin conditions, contains the following:
However, a subsequent study of similar design performed by a different research group failed to find significant benefit with Zemaphyte.22 The reason for this discrepancy is not clear.
In a 12-week, double-blind study, a different traditional Chinese herbal formula also failed to prove more effective than placebo for treatment of eczema.72
A topical ointment known as Tiger Balm is a popular treatment for headaches and other conditions. Tiger Balm contains camphor, menthol, cajaput, and clove oil. A double-blind study enrolling 57 people with acute tension headache compared the application of Tiger Balm to the forehead against placebo ointment, as well as against the drug acetaminophen (Tylenol).23 The placebo ointment contained mint essence to make it smell similar to Tiger Balm. Real Tiger Balm proved more effective than placebo, and just as effective and more rapid-acting than acetaminophen.
Chinese herbal therapies have been investigated for the treatment of HIV, but the results have not been very promising. In a 12-week, double-blind, placebo-controlled trial, 30 HIV-infected adults with CD4 counts of 200 to 500 were given a Chinese herbal formula containing 31 herbs.24 The results hint that use of the herbal combination might have improved various symptoms compared to placebo, but none of the differences were statistically significant. Interestingly, people who believed they were taking the real treatment showed significant benefit regardless of whether they were in the placebo group or the real treatment group.
In another double-blind, placebo-controlled trial, 68 HIV-infected adults were given either placebo or a preparation of 35 Chinese herbs for a period of 6 months.25 The results indicate that use of Chinese herbs did not improve symptoms or objective measurements of HIV severity. In fact, people using the herbs reported more digestive problems than those given placebo!
A double-blind study performed in Hong Kong evaluated the potential benefits in cancer chemotherapy of personalized herbal formulas designed according to the principles of Traditional Chinese herbal medicine.71 In this study, 120 people undergoing chemotherapy for early-stage breast or colon cancer were given either a personalized formula or placebo. Researchers evaluated numerous possible effects of the treatment, but found benefits in only one: reduction of nausea. Note that even this single result is less meaningful than it may seem; it is statistical questionable to use a multiplicity of outcome measures. A review of 15 mostly poor quality trials with 862 patients suggested that Chinese herbal medicine might improve quality of life in patients with non-small cell lung cancer undergoing chemotherapy.83
For several years, the Chinese herbal combination PC-SPES underwent significant investigation as a treatment for prostate cancer, with apparently impressive results. However, subsequent investigation revealed that PC-SPES contained undisclosed pharmaceutical ingredients (principally, a form of estrogen and the strong blood thinner Coumadin), and that these were probably responsible for its benefits.26 The treatment has since been withdrawn.
Numerous studies have evaluated traditional Chinese herbal medicine for treatment of liver cancer with generally positive results.62 However, study design and reporting were markedly substandard.
After a mastectomy, some women develop wound complications. Ninety women who had undergone a mastectomy were randomized to receive 1 of 3 treatments: routine wound care, the Chinese herb Salvia miltiorrhiza (given intravenously for 3 days), or another Chinese herb called anisodamine (also given intravenously for 3 days).86 The women who received the herbal treatments had fewer wound complications compared to those in the routine wound care group. But, the women who took anisodamine had more adverse effects related to the treatment, like painful urination.
A large, double-blind study conducted in China reported that use of the traditional remedy xue-zhi-kang by people with a previous history of a heart attack could reduce the risk that they would suffer a subsequent severe cardiovascular problem, such as a stroke or another heart attack.63 Chinese herbal medicine may also be helpful for people with angina. In a small, randomized trial of 66 adults with stable angina, Shenshao tablets (containing ginsenosides and white peony) reduced the frequency of angina attacks.85
In a small, double-blind, placebo-controlled trial, use of the herbal combination Banxia Houpo Tang (also called Hange Koboku-To or Magnolia and Pinelliae Formula) was tested for the treatment of impaired cough reflex in people who had suffered a stroke.27 The results indicated that the herbal combination was more effective than placebo treatment for improving the coughing response. In another study, 140 people who recently had a stroke were randomized to receive the herbal formula sanchitongshu (200 mg three times daily) plus aspirin (50 mg once daily) or aspirin plus placebo.88 After one month of treatment, those in the herbal formula group had a greater improvement in their neurological deficits and activities of daily living compared to the aspirin plus placebo group.
While traditional Chinese herbal medicine has a long history of use for infertility, there is not a lot of strong evidence to support its effectiveness. In a 2011 review of 14 randomized trials involving 1,316 women, the addition of Chinese herbal medicine to the prescription medication clomiphene (used to induce ovulation) was associated with increased pregnancy rates.89 The researchers pointed out, though, that the studies were of poor quality with low sample sizes. As with the earlier review, a 2012 analysis of 30 studies, including 8 randomized trials, also found evidence to support the use of Chinese herbal medicine for improving pregnancy rates.91 This review included trials that compared Chinese herbal medicine alone, with acupuncture, or with standard drug therapy to drug therapy alone. While the researchers concluded that Chinese herbal medicine may improve pregnancy rates , as with the previous review, the quality of the studies was questionable.
Various Chinese herbal formulas have been evaluated for the treatment of respiratory infections. The results of published studies appear to indicate that these formulas are more effective than standard antibiotics, but the poor design of most of these trials precludes placing much faith in their outcomes.28 One combination therapy called Shuang Huang Lian has better supporting evidence than most.
A review of 17 trials found that there is limited evidence to support the use of Traditional Chinese herbal preparations for the common cold.82 Although reliable evidence supporting the benefits of Traditional Chinese herbs alone for the treatment of influenza is lacking, a randomized trial involving 410 people with H1N1 influenza found that those who took a combination of 12 Chinese herbal medicines (maxingshigan-yinqiaosan, 200 mL, 4 times daily) along with the antiviral medication oseltamivir (75 mg twice daily) for five days experienced a more rapid resolution of fever compared to those taking oseltamivir alone.87 One double-blind, placebo-controlled study tested the remedy Hochu-ekki-to for enhancing immune response to influenza vaccine, but failed to find benefit.63
One study evaluated the effectiveness of an herbal combination containing herbs commonly used for the treatment of cough, but failed to find the treatment effective.66 ( Note: This study has been incorrectly reported as finding the tested treatment effective; indeed, use of the treatment did help suppress coughing, but so did the placebo treatment, and there was no significant differences between the groups.)
In one study, the herbal formula Duhuo Jisheng Wan, widely used for osteoarthritis, proved to be as effective as the standard anti-inflammatory drug diclofenac.54 However, the herb caused as many side effects as the drug, and was slower to act. (It was so slow, in fact, that its benefits could have been due solely to the placebo effect.) This study did not use a placebo control group.
The Kampo remedies Saiko-keishi-to and Shosaiko-to have been suggested for the treatment of epilepsy, but the supporting evidence is too preliminary to be relied upon.30-32 Both of these combination treatments consist of bupleurum, peony root, pinellia root, cassia bark, ginger root, jujube fruit, Asian ginseng root, Asian scullcap root, and licorice root, but the proportions are different.
In a review of 21 studies involving almost 3,000 subjects, researchers concluded that Chinese herbs were as effective as commonly prescribed medications for drug withdrawal symptoms in heroin addicts. They could not draw any conclusions, however, regarding which specific herbs were more most beneficial.80
Other traditional herbal combinations with some supporting evidence (often from studies of questionable quality) include Xiao-Yao-San (Free and Easy Wanderer) for depression and bipolar syndrome,69,81 Mai-Men-Dong-Tang for allergic asthma,49 Yi-Gan San for dementia,50 Bofu-tsusho-san for weight loss and diabetes,51 Chang Ji Tai for irritable bowel syndrome,52 and Ondamtanggamibang (a Korean formulation) for reducing symptoms of stress.53 Qinzhu Liangxue for psoriasis,78 and red peony root for acute pancreatitis.79
There is no general certification for the practice of TCHM. Many people who are certified in acupuncture, however, have significant training in herbal medicine as well. (In general, 500 hours of specific training is considered necessary.) Some states offer the license of OMD (Doctor of Oriental Medicine); licensed OMDs are generally well versed in TCHM.
There are several serious safety concerns with the use of TCHM.
One concern involves the use of multiple herbs typical in this approach. In general, conventional medicine makes a point of using as few medications as possible (in theory, at least) because the greater the number of medications, the greater the risk of harm. (Also, when medications are used together and harm does result, it’s hard to know which drug was at fault.) From this perspective, formulas consisting of 5, 10, or 30 herbs are quite worrisome.
Interestingly, such combinations are actually designed for the purpose of reducing risks. According to TCHM theory, the various herbs in a formula balance and moderate each other. Unfortunately, this theory has never been put to the test, and there are reasons not to trust it. Simply put, it is very difficult to get an accurate picture of the risks of a treatment if you don’t keep systematic records of adverse effects, and the ancient Chinese government had no such system in place. In any case, the individualized nature of treatment would make it almost impossible to track harm. Herbalists would be expected to notice immediate, dramatic reactions to herbal formulas, and one can assume with some confidence that treatments used for thousands of years are at least unlikely to cause such problems in very many people who take them. However, certain types of harm could be expected to easily elude the detection of traditional herbalists. These include safety problems that are delayed, occur relatively rarely, or are difficult to detect without scientific instruments. How would a traditional herbalist ever know, for example, if a treatment caused liver failure in one out of 100,000 people who used it, especially if such failure took 2 or more years to develop? If such a death did occur in the herbalist’s patient population, it would probably be attributed to hepatitis or some other common cause.
These factors may explain why Chinese herbal medicine traditionally uses treatments that are now recognized as potentially dangerous, such as mercury, arsenic, lead, licorice, coltsfoot, and Aristolochia.
Mercury, arsenic, and lead accumulate slowly in the body, and for many years their harm can only be detected by lab tests. Licorice (used in many herb formulas to “harmonize” the ingredients) can raise blood pressure and disturb blood chemistry.33,34 These effects were presumably undetectable to traditional practitioners unless they became quite severe. The herb Aristolochia can cause severe kidney damage and kidney cancer, but only rarely. Modern medical surveillance has uncovered quite a few such cases,35 but traditional herbology considered the herb worth using. Aristolochia contains aristolochic acid, a substance shown in animal studies to damage the kidney when taken in high enough doses. Chinese herbal products generally list Aristolochia on the label when it is present, but in some cases, Aristolochia was apparently added accidentally—it is similar in appearance to a much safer herb.
Coltsfoot ( Tussilago farfara), used in Chinese cough syrups and other formulations, contains pyrrolizidine alkaloids, substances that can over time damage the liver. This also does not appear to have been noticed by traditional herbalists. Under modern conditions of medical surveillance, many incidents have been reported in which use of Chinese herbs appears to have various forms of liver injury, including acute hepatitis, chronic hepatitis, hepatic fibrosis, and acute liver failure.44,55,56,68 Ancient herbal practitioners might not have been able to distinguish these herb-induced illnesses from the effects of infectious hepatitis, a widely prevalent condition, and thereby failed to make the connection; even today, in fact, it appears that many cases of liver failure attributed to hepatitis have in fact been caused by the Chinese herbs used to treat hepatitis! 68
Other reported complications of Chinese herbal treatments include movement disorders and ovarian failure.57,58
Another set of potential problems arises from the fact that Chinese herbal medicine does not restrict itself to plant products with subtle effects. Many traditional Chinese herbal remedies are, simply put, poisons. When taken in proper doses, they may be safe for use, but dosage miscalculation or use in a particularly susceptible person may lead to serious consequences, including death. For example, in Hong Kong, poisoning caused by the herb aconite (used in numerous Chinese herbal formulas) was sufficiently widespread that public health authorities felt it necessary to launch an information campaign to combat the problem.45
Besides toxicity caused by Chinese herbs, other problems have been caused by adulteration of herbal products with unlisted ingredients.36 For example, the Chinese herbal formula PC-SPES, used for prostate cancer, turned out to contain three pharmaceutical drugs—diethylstilbestrol (DES), warfarin (Coumadin), and indomethacin. This appears to have been an intentional adulteration designed somewhat along the lines of a traditional Chinese formula, with one pharmaceutical adulterant that treated prostate cancer balanced by two others to offset the side effects of the first. Unfortunately, the combination is dangerous and has caused at least one case of severe bleeding.37
In another episode, 8 out of 11 Chinese herbal creams sold in the United Kingdom for the treatment of eczema were found to contain strong pharmaceutical steroids.38 Other studies have also found steroids in eczema preparations.59 In addition, Chinese herbal weight loss aids have also been found to contain an unlisted chemical related to the appetite suppressant drug fenfluramine (of fen-phen fame).60
Herbal products approved by the Japanese government have undergone meaningful safety testing and are very unlikely to contain known toxins or unlisted drugs. However, this does not mean they are completely safe. For example, several case reports suggest that therapy for chronic hepatitis combining an approved herbal formula with the standard drug interferon can cause severe inflammation of the lungs.39-43
The herbal formulas Takeda Kampo Ichoyaku K-matsu, Taisho Kampo Ichoyaku, and Kanebo Kampo Ichoyaku Hused, all used to treat upset stomach, might reduce the effectiveness of the Parkinson's disease medication levodopa.70
The bottom line: TCHM is a potentially dangerous form of treatment that should only be used under the supervision of a physician.
1. Bensky D, Barolet R. Chinese Herbal Medicines Formulas and Strategies. Seattle, WA: Eastland Press;1990.
2. Japanese Health Ministry confirms effectiveness of Tsumura's top-selling kampo herbal prescription. Kampo Today [serial online]. 1995;1. Available at: http://www.tsumura.co.jp/english/. Accessed November 4, 2002.
3. Hirayama C, Okumura M, Tanikawa K, et al. A multicenter randomized controlled clinical trial of Shosaiko-to in chronic active hepatitis. Gastroenterol Jpn. 1989;24:715-719.
4. McCulloch M, Broffman M, Gao J, et al. Chinese herbal medicine and interferon in the treatment of chronic hepatitis B: a meta-analysis of randomized, controlled trials. Am J Public Health. 2002;92:1619-1628.
5. Liu JP, McIntosh H, Lin H. Chinese medicinal herbs for asymptomatic carriers of hepatitis B virus infection. Cochrane Database Syst Rev. 2001;CD002231.
6. Liu JP, Manheimer E, Tsutani K, et al. Medicinal herbs for hepatitis C virus infection. Cochrane Database Syst Rev. 2001;CD003183.
7. Liu JP, McIntosh H, Lin H. Chinese medicinal herbs for chronic hepatitis B. Cochrane Database Syst Rev. 2001;CD001940.
8. Oka H, Yamamoto S, Kuroki T, et al. Prospective study of chemoprevention of hepatocellular carcinoma with sho-saiko-to (TJ-9). Cancer. 1995;76:743-749.
9. Shimizu I. Sho-saiko-to: Japanese herbal medicine for protection against hepatic fibrosis and carcinoma. J Gastroenterol Hepatol. 2000;15(suppl):D84-D90.
10. Oka H, Yamamoto S, Kuroki T, et al. Prospective study of chemoprevention of hepatocellular carcinoma with sho-saiko-to (TJ-9). Cancer. 1995;76:743-749.
11. Bensoussan A, Talley NJ, Hing M, et al. Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial. JAMA. 1998;280:1585-1589.
14. Hu G, Walls RS, Bass D, et al. The Chinese herbal formulation biminne in management of perennial allergic rhinitis: a randomized, double-blind, placebo-controlled, 12-week clinical trial. Ann Allergy Asthma Immunol. 2002;88:478-487.
15. Jung YB, Roh KJ, Jung JA, et al. Effect of SKI 306X, a new herbal anti-arthritic agent, in patients with osteoarthritis of the knee: a double-blind placebo controlled study. Am J Chin Med. 2001;29:485-491.
16. Kumada T, et al. Effect of Shakuyaku-kanzo-to (Tsumura TJ-68) on muscle cramps accompanying cirrhosis in a placebo-controlled double-blind parallel study. Journal of Clinical Therapeutics Medicine. 1999;15:499-523.
17. Kotani N, Oyama T, Sakai I, et al. Analgesic effect of a herbal medicine for treatment of primary dysmenorrhea—a double-blind study. Am J Chin Med. 1997;25:205-212.
18. Vray M, Attali JR. Randomized study of glibenclamide versus traditional Chinese treatment in type 2 diabetic patients. Chinese-French Scientific Committee for the Study of Diabetes. Diabete Metab. 1995;21:433-439.
19. Urata Y, Yoshida S, Irie Y, et al. Treatment of asthma patients with herbal medicine TJ-96: a randomized controlled trial. Respir Med. 2002;96:469-474.
20. Sheehan MP, Rustin MH, Atherton DJ, et al. Efficacy of traditional Chinese herbal therapy in adult atopic dermatitis. Lancet. 1992;340:13-17.
21. Sheehan MP, Atherton DJ. A controlled trial of traditional Chinese medicinal plants in widespread non-exudative atopic eczema. Br J Dermatol. 1992;126:179-184.
22. Fung AY, Look PC, Chong LY, et al. A controlled trial of traditional Chinese herbal medicine in Chinese patients with recalcitrant atopic dermatitis. Int J Dermatol. 1999;38:387-392.
23. Schattner P, Randerson D. Tiger Balm as a treatment of tension headache. A clinical trial in general practice. Aust Fam Physician. 1996;25:216,218,220.
24. Burack JH, Cohen MR, Hahn JA, et al. Pilot randomized controlled trial of Chinese herbal treatment for HIV-associated symptoms. J Acquir Immune Defic Syndr Hum Retrovirol. 1996;12:386-393.
25. Weber R, Christen L, Loy M, et al. Randomized, placebo-controlled trial of Chinese herb therapy for HIV-1-infected individuals. J Acquir Immune Defic Syndr. 1999;22:56-64.
26. Sovak M, Seligson AL, Konas M, et al. PC-SPES in prostate cancer: an herbal mixture currently containing warfarin and previously diethylstilbestrol and indomethacin. Presented at: 93rd Annual Meeting of the American Association for Cancer Research; April 6-10, 2002; San Francisco, CA.
27. Iwasaki K, Cyong JC, Kitada S, et al. A traditional Chinese herbal medicine, banxia houpo tang, improves cough reflex of patients with aspiration pneumonia. J Am Geriatr Soc. 2002;50:1751-1752.
28. Liu C, Douglas RM. Chinese herbal medicines in the treatment of acute respiratory infections: a review of randomised and controlled clinical trials. Med J Aust. 1998;169:579-582.
29. Kuratsune, H. Effect of Kampo Medicine, “Hochu-ekki-to,” on chronic fatigue syndrome. Clinic and Research. 1997;74:1837-1845.
30. Yarnell EY, Abascal K. An herbal formula for treating intractable epilepsy: a review of the literature. Alt Compl Ther. 2000;6:203-206.
31. Narita Y, Satowa H, Kokubu T, et al. Treatment of epileptic patients with the Chinese herbal medicine “saiko-keishi-to” (SK). IRCS Med Sci. 1982;10:88-89.
32. Nagakubo S, Niwa S-I, Kumagai N, et al. Effects of TJ-960 on Sternberg’s paradigm results in epileptic patients. Jpn J Psych Neur. 1993;47:609-619.
33. Sigurjonsdottir HA, Franzson L, Manhem K, et al. Liquorice-induced rise in blood pressure: a linear dose-response relationship. J Hum Hypertens. 2001;15:549-552.
34. van Gelderen CE, Bijlsma JA, van Dokkum W, et al. Glycyrrhizic acid: the assessment of a no effect level. Hum Exp Toxicol. 2000;19:434-439.
35. Misidentified Herb Causes Serious Problems for Users of Imported Chinese Herbal Medicine. Kampo Today [serial online]. 1998;3. Available at: http://www.tsumura.co.jp/english/. Accessed November 20, 2002.
36. E Ernst. Adulteration of Chinese herbal medicines with synthetic drugs: a systematic review. J Intern Med. 2002;252:107-113.
37. Weinrobe MC, Montgomery B. Acquired bleeding diathesis in a patient taking PC-SPES. N Engl J Med. 2001;345:1213-1214.
38. Keane FM, Munn SE, du Vivier AWP, et al. Analysis of Chinese herbal creams prescribed for dermatological conditions. BMJ. 1999;318:563-564.
39. Nakagawa A, Yamaguchi I, Takao T, et al. Five cases of drug-induced pneumonitis due to sho-saiko-to or interferon alpha or both. Nippon Kyobu Shikkan Gakkai Zasshi. 1995;33:1361-1366.
40. Ishizaki T, Sasaki F, Ameshima S, et al. Pneumonitis during interferon and/or herbal drug therapy in patients with chronic active hepatitis. Eur Respir J. 1996;9:2691-2696.
41. Sugiyama H, Nagai M, Kotajima F, et al. A case of interstitial pneumonia with chronic hepatitis C following interferon-alpha and sho-saiko-to therapy. Arerugi. 1995;44:711-714.
42. Sato A, Toyoshima M, Kondo A, et al. Pneumonitis induced by the herbal medicine Sho-saiko-to in Japan. Nippon Kyobu Shikkan Gakkai Zasshi. 1997;35:391-395.
43. Miyazaki E, Ando M, Ih K, et al. Pulmonary edema associated with the Chinese medicine shosaikoto. Nihon Kokyuki Gakkai Zasshi. 1998;36:776-780.
44. Verucchi G, Calza L, Attard L, et al. Acute hepatitis induced by traditional Chinese herbs used in the treatment of psoriasis J Gastroenterol Hepatol. 2002;17:1342-1345.
45. Chan TY. Incidence of herb-induced aconitine poisoning in Hong Kong: impact of publicity measures to promote awareness among the herbalists and the public. Drug Saf. 2002;25:823-828.
46. Jakkula M, Boucher TA, Beyendorff U, et al. A randomized trial of Chinese herbal medicines for the treatment of symptomatic hepatitis C. Arch Intern Med. 2004;164:1341-1346.
47. Xue CC, Thien FC, Zhang JJ, et al. Treatment for seasonal allergic rhinitis by Chinese herbal medicine: a randomized placebo controlled trial. Altern Ther Health Med. 2003;9:80-87.
48. Xue CC, Thien FC, Zhang JJ, et al. Effect of adding a Chinese herbal preparation to acupuncture for seasonal allergic rhinitis: randomised double-blind controlled trial. Hong Kong Med J. 2003;9:427-434.
49. Hsu CH, Lu CM, Chang TT, et al. Efficacy and safety of modified Mai-Men-Dong-Tang for treatment of allergic asthma. Pediatr Allergy Immunol. 2005;16:76-81.
50. Iwasaki K, Satoh-Nakagawa T, Maruyama M, et al. A randomized, observer-blind, controlled trial of the Traditional Chinese Medicine Yi-Gan San for improvement of behavioral and psychological symptoms and activities of daily living in dementia patients. J Clin Psychiatry. 2005;66:248-252.
51. Hioki C, Yoshimoto K, Yoshida T, et al. Efficacy of Bofu-tsusho-san, an Oriental herbal medicine, in overweight Japanese women with impaired glucose tolerance. Clin Exp Pharmacol Physiol. 2004;31:614-619.
52. Shen Y, Cai G, Sun X. [Randomized controlled clinical study on effect of Chinese compound changjitai in treating diarrheic irritable bowel syndrome.] Zhongguo Zhong Xi Yi Jie He Za Zhi. 2003;23:823-825.
53. Lee MS, Park KW, Moon SR, et al. Effects of a Korean traditional herbal remedy on psychoneuroendocrine responses to examination stress in medical students: a randomized placebo-controlled trial. Hum Psychopharmacol. 2004 Sep 20. [Epub ahead of print]
54. Teekachunhatean S, Kunanusorn P, Rojanasthien N, et al. Chinese herbal recipe versus diclofenac in symptomatic treatment of osteoarthritis of the knee: a randomized controlled trial [ISRCTN70292892]. BMC Complement Altern Med. 2004 Dec 13. [Epub ahead of print].
55. Adachi M, Saito H, Kobayashi H, et al. Hepatic injury in 12 patients taking the herbal weight loss aids Chaso or Onshido. Ann Intern Med. 2003;139:488-492.
56. Mantani N, Kogure T, Tamura J, et al. Challenge tests and Kampo medicines: case report and review of the literature. Am J Chin Med. 2003;31:643-648.
57. Wang XP, Yang RM. Movement disorders possibly induced by traditional Chinese herbs. Eur Neurol. 2003;50:153-159.
58. Edmonds SE, Montgomery JC. Reversible ovarian failure induced by a Chinese herbal medicine: lei gong teng. BJOG. 2003;110:77-78.
59. Ramsay HM, Goddard W, Gill S, et al. Herbal creams used for atopic eczema in Birmingham, UK illegally contain potent corticosteroids. Arch Dis Child. 2003;88:1056-1057.
60. Adachi M, Saito H, Kobayashi H, et al. Hepatic injury in 12 patients taking the herbal weight loss aids Chaso or Onshido. Ann Intern Med. 2003;139:488-492.
61. Wen MC, Wei CH, Hu ZQ, et al. Efficacy and tolerability of antiasthma herbal medicine intervention in adult patients with moderate-severe allergic asthma. J Allergy Clin Immunol. 2005;116:517-524.
62. Shu X, McCulloch M, Xiao H, et al. Chinese herbal medicine and chemotherapy in the treatment of hepatocellular carcinoma: a meta-analysis of randomized controlled trials. Integr Cancer Ther. 2005;4:219-229.
63. Hamazaki K, Sawazaki S, Itomura M, et al. No effect of a traditional Chinese medicine, Hochu-ekki-to, on antibody titer after influenza vaccination in man: A randomized, placebo-controlled, double-blind trial. Phytomedicine. 2006 Apr 24. [Epub ahead of print]
64. Arakawa K, Saruta T, Abe K, et al. Improvement of accessory symptoms of hypertension by TSUMURA Orengedokuto Extract, a four herbal drugs containing Kampo-Medicine Granules for ethical use: A double-blind, placebo-controlled study. Phytomedicine. 2005;13:1-10.
65. Mollison L, Totten L, Flexman J, et al. Randomized double blind placebo-controlled trial of a Chinese herbal therapy (CH100) in chronic hepatitis C. J Gastroenterol Hepatol. 2006;21:1184-1188.
66. Wong WC, Wong EL, Lam AT, et al. Effectiveness of a Chinese herbal medicine preparation in the treatment of cough in uncomplicated upper respiratory tract infection: A randomised double-blind, placebo-controlled trial. Cough. 2006 Jun 22. [Epub ahead of print].
67. Leung WK, Wu JC, Liang SM, et al. Treatment of diarrhea-predominant irritable bowel syndrome with traditional Chinese herbal medicine: a randomized placebo-controlled trial. Am J Gastroenterol. 2006;101:1574-1580.
68. Yuen MF, Tam S, Fung J, et al. Traditional Chinese medicine causing hepatotoxicity in patients with chronic hepatitis B infection: a 1-year prospective study. Aliment Pharmacol Ther. 2006;24:1179-1186.
69. Zhang ZJ, Kang WH, Li Q, et al. The beneficial effects of the herbal medicine Free and Easy Wanderer Plus (FEWP) for mood disorders: Double-blind, placebo-controlled studies. J Psychiatr Res. 2006 Sep 28. [Epub ahead of print]
70. Sunagane N, Aikawa M, Ohta T, et al. Possibility of interactions between prescription drugs and OTC drugs (2nd report)-interaction between levodopa preparation and OTC kampo medicines for upset stomach. Yakugaku Zasshi. 2006;126:1191-1196.
71. Mok T, Yeo W, Johnson P, et al. A double-blind placebo-controlled randomized study of Chinese herbal medicine as complementary therapy for reduction of chemotherapy-induced toxicity. Ann Oncol. 2007 Jan 17. [Epub ahead of print].
72. Hon KL, Leung TF, Ng PC, et al. Efficacy and tolerability of a Chinese herbal medicine concoction for treatment of atopic dermatitis: a randomized, double-blind, placebo-controlled study. Br J Dermatol. 2007 May 14. [Epub ahead of print]
73. Ye P, Lu ZL, Du BM, et al. Effect of xuezhikang on cardiovascular events and mortality in elderly patients with a history of myocardial infarction: a subgroup analysis of elderly subjects from the china coronary secondary prevention study. J Am Geriatr Soc. 2007;55:1015-1022.
74. Wang G, Mao B, Xiong ZY, et al. The quality of reporting of randomized controlled trials of traditional Chinese medicine: a survey of 13 randomly selected journals from mainland China. Clin Ther. 2007;29:1456-1467.
75. Vickers A, Goyal N, Harland R, Rees R. Do certain countries produce only positive results? A systematic review of controlled trials. Control Clin Trials. 1998;19:159-166.
76. Kong MH, Lee EJ, Lee SY, et al. Effect of human placental extract on menopausal symptoms, fatigue, and risk factors for cardiovascular disease in middle-aged Korean women. Menopause. 2007 Oct 10. [Epub ahead of print]
77. Zhu X, Proctor M, Bensoussan A, Wu E, Smith CA. Chinese herbal medicine for primary dysmenorrhoea. Cochrane Database of Systematic Reviews. 2008;(2):CD005288.
78. Li FL, Li B, Xu R, et al. Qinzhu Liangxue decoction in treatment of blood-heat type psoriasis vulgaris: a randomized controlled trial. Zhong Xi Yi Jie He Xue Bao. 2008;6:586-590.
79. Zhang M, Zhu DZ, Li ZS, et al. Red peony root decoction in treatment of severe acute pancreatitis: a randomized controlled trial. Zhong Xi Yi Jie He Xue Bao. 2008;6:569-575.
80. Liu TT, Shi J, Epstein DH, et al. A meta-analysis of Chinese Herbal Medicine in treatment of managed withdrawal from heroin. Cell Mol Neurobiol. 2008 Jun 27.
81. Li LT, Wang SH, Ge HY, et al. The beneficial effects of the herbal medicine Free and Easy Wanderer Plus (FEWP) and fluoxetine on post-stroke depression. J Altern Complement Med. 2008 Aug 23.
82. Zhang X, Wu T, Zhang J, Yan Q, Xie L, Liu GJ. Chinese medicinal herbs for the common cold. Cochrane Database of Systematic Reviews. 2007 (1):CD004782
83. Chen S, Flower A, Ritchie A, et al. Oral Chinese herbal medicine (CHM) as an adjuvant treatment during chemotherapy for non-small cell lung cancer: A systematic review. Lung Cancer. 2010 May;68(2):137.
84. Matkovic Z, Zivkovic V, Korica M. Efficacy and safety of Astragalus membranaceus in the treatment of patients with seasonal allergic rhinitis. Phytother Res. 2010 Feb;24(2):175.
85. Wang J, He QY, Zhang YL. Effect of shenshao tablet on the quality of life for coronary heart disease patients with stable angina pectoris. Chin J Integr Med. 2009 Oct;15(5):328-332.
86. Chen J, Lv Q, Yu M, Zhang X, Gou J. Randomized clinical trial of Chinese herbal medications to reduce wound complications after mastectomy for breast carcinoma. Br J Surg. 2010;97(12):1798-804.
87. Wang C, Cao B, Liu QQ, et al. Oseltamivir compared with the Chinese Traditional Therapy maxingshigan-yinqiaosan in the treatment of H1N1 influenza: a randomized trial. Ann Intern Med. 2011;155(4):217-225.
88. He L, Chen X, Zhou M, et al. Radix/rhizoma notoginseng extract (sanchitongtshu) for ischemic stroke: a randomized controlled study. Phytomedicine. 2011;18(6):437-442.
89. See CJ, McCulloch M, Smikle C, Gao J. Chinese herbal medicine and clomiphene citrate for anovulation: a meta-analysis of randomized controlled trials. J Altern Complement Med. 2011;17(5):397-405.
90. Zhong J, Xian D, Xu Y, Liu J. Efficacy of Tripterygium hypoglaucum Hutch in adults with chronic urticaria. J Altern Complement Med. 2011;17(5):459-64.
91. Ried K, Stuart K. Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: a systematic review. Complement Ther Med. 2011;19(6):319-331.
Last reviewed August 2012 by EBSCO CAM Review Board
Last Updated: 8/29/2012