Concerns about Traditional Chinese Medicine (TCM).
Compared with orthodox Western medicine, Chinese Medicine when practised by qualified and experienced individuals has an amazingly good safety record. Nevertheless, as time has gone by, and it becomes more popular, Governments are taking more interest and the medical profession is more concerned.

In 1986 the BMA produced a report which panned all forms of Alternative Medicine. In 1994 their next report reversed the findings of the first report, at least as regards acupuncture and homeopathy. In November 2000 the Select Committee of the House of Lords report on Complementary and Alternative Medicine in effect approved wholeheartedly of five therapies: acupuncture, chiropractic, herbal medicine, homeopathy, osteopathy. For a variety of reasons, probably based on the fact that they had an incomplete understanding of it, Chinese Herbal medicine was given a lower rating. Some of the original authors of the report, having seen more of it, are apparently now inclined to elevate Chinese Herbal Medicine to the same status as Acupuncture.

Acupuncture
Acupuncture is used throughout the world. Its benefits have been seen in treating acute and chronic illness, in assisting with addiction withdrawal, at childbirth, and in anaesthesia

Concerns about the Safety of Acupuncture
Professor Edzart Ernst of the Department of Complementary Medicine at Exeter University, Devon, England, has become something of an acupuncture 'killer'. But some of the claims he makes for the danger of acupuncture are unjustified. For example, 'acupuncture has killed 30 people': actually, this was during a period of thirty years, and was world-wide. Compare that with the numbers of people dying annually from surgery, or dying from prescribed medication….! In any case, one of the 30 people who died was a woman in Sweden who stabbed herself with a knitting needle: not acupuncture at all!

Any therapy that can do good can cause ill. There are concerns about unqualified practitioners using acupuncture needles, of course. Hygiene is an issue: nowadays, no needles are used more than once, although there is doubt as to whether this is really necessary. But in general, given the enormous number of treatments worldwide, acupuncture can be considered a remarkably safe therapy.

Currently, research is being conducted into the Safety of Acupuncture by the Medical Care Research Unit at Sheffield University, the Foundation for Traditional Chinese, and practitioner members of the British Acupuncture Council.

Herbalism
Concerning Herbal medicine, an article in the Journal of Traditional Chinese Medicine (TCM) in 1987 gave the following statistics:

• 480,000 practitioners of Chinese Herbal Medicine in People's Republic of China
• 1,500 Regional Hospitals for TCM, each covering around 500 acres.
• 8,000 County level hospitals for TCM
• 47,000 Township health centres using TCM mainly
• 1.29M Doctors in rural areas able to prescribe herbs
• Over 5,000 herbs recognised
• 660,000 acres under herbal cultivation

Since then, China's export of herbs has increased steadily to practitioners all over the world. Some practitioners prescribe many tons of herbs annually, with nothing but benefit for their patients. As in so many other areas of life, a very small number of cases have given it a bad name. If the same criteria were applied to Western Medicine, one might hazard a guess that nobody would ever visit a Western, orthodox, hospital again.

The difference is that we are unused to Chinese Medicine and suspicious of it. In addition, manufacturers of orthodox medication fear that their market is shrinking because of these competing medicines, and lobby for more control so that they can first patent and then profit from drugs equivalent in action to the herbs in question.

Dangers of Herbs
There are two main concerns. The first is that people without knowing much about herbal medicines will prescribe or take them, to their detriment. For example, wu wei zi - Schisandra fruit - is widely used in the West to maintain health and ward off disease. In Chinese medicine whilst considered a tonic for the Kidney, Schisandra's main action is to stabilise and bind. This means that if one has caught an illness, say a cold, from which your body is trying to clear itself by sweating, Schisandra may actually prevent this, prolonging the cold and potentially making it into a deeper, more chronic disease.

The second concern is that the herbs are mis-labelled, contaminated with heavy metals, steroids and other pharmaceuticals, or are just plain poisonous. For example, many people have heard that Chinese herbs can damage the liver. (Just to provide a small balance we will mention here two drugs that are widely available 'over the counter': one will kill you if overdosed: the other is merely lethal. Paracetemol has undoubted hepatotoxic effects, but controls over its sale were imposed only comparatively recently. Tobacco probably wouldn't get a licence if introduced nowadays. We are sure you will be able to think of other, apparently well-tested, drugs that have had to be withdrawn from the market.)

Adverse Symptoms
Our advice is as follows. If you experience adverse symptoms after taking Chinese herbs as prescribed, you should stop taking the herbs and consult your herbalist.
The symptoms we mean are: severe tiredness, loss of appetite, diarrhoea, headaches, nausea, upper abdominal pain, feeling generally unwell, jaundice.

Do not restart taking the herbs until instructed to do so.

Basically, if the herbs come from responsible importers who know their sources and check their products properly, then there should be no concerns with toxicity when the herbs are prescribed by someone appropriately qualified. Chinese herbs have been in use for thousands of years, and are inherently safe when prescribed as recommended. However, just as some individuals have reactions to Western medications, eg penicillin, so some people react idiosyncratically to individual Chinese herbs. It is therefore sensible to start with less than the recommended full dosage and work up gradually so that any adjustments can be made.

Sensitivity should not be confused with the fact that Chinese herbs do make changes in the body, and it is not uncommon to have digestive changes when adjusting to herbs. These should be noted and if in any doubt, ring your practitioner.

Further Information
The following is more technical, but may be useful. There is a test called the ALT test (Alanine AminoTransferase - previously known as the SGPT - Serum Glutmic Pyruvic Transaminase). This measures ALT which is usually present in high concentration in the liver. It is also present in heart and skeletal muscle, but in much lower concentrations, so the ALT test is fairly specific to the liver, and is raised only if liver disease is present. Normal levels are below 45: if the level exceeds this, it may be due to alcohol, drugs (such as paracetemol), thyroid disease, new diabetes or heart failure. It needs investigation if it exceeds 150.

However, many people have a naturally raised level, or because it is raised by harmless dietary factors or other, perhaps Western, herbs or supplements which they are taking. These people may react beneficially to Chinese herbs. A very few people have a sudden dramatic increase in ALT from taking Chinese herbs, leading to jaundice. Here, clearly one would stop the herbs, allowing the ALT level to fall naturally. Then perhaps retest with smaller quantities of the herbs, or with a different variety of herb.

If the ALT level rises, it has often been found to rise to a peak after twelve weeks, then reduce. However, the more common pattern is that the ALT level rises after the first week or two before settling back when the body becomes adjusted to it.

In general, the problem is very rare. The main considerations are whether there is continuing malaise, fatigue, nausea, bloating, diarrhoea, aching , 'flu like symptoms, photophobia, skin rash etc, all of which are signs of a liver trying to detoxify. When we give patients herbs, we explain what to look out for and when to get back to us. The problem comes mostly when people persist in taking herbs even when they are feeling very ill from them, or perhaps when they continue to take the herbs long after they are needed, or when their health pattern has changed.

Other issues
Other issues to consider, especially if importing herbs directly rather than through an approved importer, include the following.

• Contamination/Adulteration. For example, although most freeze-dried powders will have had HPLC tracings so are probably safe, some powders are contaminated. (HPLC tracings use light chromatography to recognise herbs and exclude wrong species.)
• Some plants contain Cadmium which is in the soil they are grown in - this applies to Asarum - or they are grown on polluted soil.
• Pesticides are widely used and not all Chinese production is good. Partly this is because many precious plants need very strong treatment by growers to control pests.
• Sulphur is often used as a preservative/fumigant.
• Herbs need to be properly treated. For example, untreated Ban Xia is dangerous because it burns the throat, thereby potentially asphyxiating, unless it has been heat treated to destroy the killer chemicals. Equally, some importers will sell other varieties unless specifically asked for Fa Ban xia. For example, Shui Ban Xia (Typhonium) is often sold as Ban Xia, but is different. You can be sure that we buy our herbs only from importers who have inspected their herbs carefully. In any case, we know what untreated Ban Xia looks like and wouldn't prescribe it.
• Alum may be present. Although this is not seen as a problem in many countries, Alum is banned here.

There is, however, another concern, caused by Government intervention. Some herbs are banned because either their use threatens the continued existence of animals or species, or cruelty is involved in production. There are other herbs that actually have produced no ill-effects except under very exceptional circumstances that would not normally occur. An example of this is Akebia Trifoliata, which has never been implicated in poisoning people but which shares its Chinese name mu tong with other herbs, some of which, when over-used, have caused problems. Banning the use of this herb deprives practitioners of a very useful, safe and vital herb.

Summary on Concerns about Chinese herbs
Many people are taking Chinese herbs that they have read or heard about, such as Astragalus (Huang Qi), or Ginseng (Ren Shen) or Chinese Angelica root (Dang Gui/Tang Kwei) with only a few problems. These can be bought in many UK shops.

(Long-term use of any herb, Western or Chinese, is not recommended unadvisedly because they have an effect on us which is usually only very gradual. The experience of herbalists and homeopaths is that any substance will, especially if taken regularly, ultimately affect us. Since its effects will only gradually infiltrate into our lives, we may not realise where they come from, or indeed that anything is amiss.)

In a small number of cases, herbs were prescribed by people who did not have the requisite experience or knowledge, with results that have given Chinese herbalism a bad name. Government intervention has banned useful herbs on the grounds of public safety. It is to be hoped that these herbs will be returned to use before long, with suitable controls over their distribution.