Chinese Herbal Medicine - Is it Safe? Is it Effective?

Li Zhong Herbs.JPG

The two most common questions I get when recommending herbal medicine as part of someone's treatment plan are "Is it going to fix me?" and "Is it safe/ are there side effects?". I love it when patients ask me these questions. First, because it shows me that they are engaged in their healthcare and want more information. Second, because it give me an opportunity highlight the strengths of herbal medicine and dispel some of the common misconceptions.

Now this post is a little bit longer so if you want the short and sweet answers.

Is it effective? - Yes
Is it safe? - Yes, as long as your are getting your herbal medicine from a qualified practitioner and take it as prescribed.

Is it Effective?

The question of efficacy is a big one as there are so many factors that play into it. One must first consider the goal against which effectiveness is being measured. Are we trying to completely resolve a condition or improve some of the symptoms? We also have to consider the time line over which we are expecting to see the results. If someone comes in with a cold or flu it is reasonable to measure efficacy in days. However, if someone is coming in with congestive heart failure it might be weeks before we start to see noticeable improvements and months before satisfactory result. Longer yet, something like a chronic Lyme infection where it could take a month to start seeing results and may take a year or more before the condition is fully resolved. The timing of accessing healthcare is also an important factor. Say in the case of a neurological condition like Bell's palsy, if treatment is started right after the paralysis starts presenting we can except to clear it up fairly quickly, if the condition is given time to settle in, it is going to be more difficult and take longer to resolve.

Shang Han Lun

Keeping all of that in mind, there is over 2000 years of clinical records for the treatment of everything from minor infections to debilitating and life threatening conditions all being resolved through Chinese herbal medicine. Even though I am fairly satisfied with thousands of years of clinical evidence, I've include some examples below along with the modern scientific evidence which give us some insight into just a few randomly selected conditions and how herbal medicine can be effective.

For acute bacterial and viral infections like colds, flues, UTIs, and the like, Chinese medicine can be an effective means to resolve the condition and cut down on the duration of the illness by a few days while helping to decrease the severity of the symptoms during the course of the illness (1,2,3,4). There are countless studies done on individual Chinese herbs that have shown them to contain various potent anti-bacterial and anti-viral compounds. While certain herbs work directly on the pathogenic agent others have been shown to directly relieve symptoms such as decreasing fever, settling nausea, reducing nasal congestion, reducing pain/headache, and reducing inflammation.

Huang Lian, Dang Shen, Hong Hua.JPG

In a study on congestive heart failure (Yi Shi-hong, et al, 1998) (5) a herbal prescription, Xin Li Shu Kang Wan, was able improve the condition of 93.33% of the study patients with 6.6% being completed cured, 60% having significant improvement in symptoms, 26.6% having some improvement, and 6.6% seeing no improvement. Compare that to the control group receiving standard pharmaceutical therapy which saw an improvement in a total of 85% of cases with a break down of 2.5% cured, 40.0% experienced significant improvement,  42.5% experienced some improvement, and 15.0% didn't get any benefit. More recent research has given us some insight into how other formulas have the ability to protect the heart by supporting the mitochondria, the part of our cell which supplies the energy, and improve heart function (6).

The treatment of neurological conditions can often be challenging, especially the chronic degenerative ones such as Parkinson's Disease and Alzheimer's Disease. While there is currently no cure for these we can certainly take measures to slow down the progression and relieve some of the symptoms. Several studies have shown that both single Chinese herbs as well as certain prescriptions, containing multiple herbs, have the ability to protect the brain cells from damage and decrease cell death (7, 8). Some studies have also shown the ability of Chinese herbs to improve motor function and decrease other non-motor related symptoms of Parkinson's disease while allowing patients to decrease their dosage of pharmaceuticals (9).

These are just a few conditions which I chose as I think the highlight the variety of conditions which Chinese herbal medicine can be an effective treatment option for. If you have questions about any particular condition do not hesitate to let me know and I will let you know what both the classical texts (those 2000 year old studies I was talking about) and the modern research is saying.

Is it Safe?

Rou Gui - Cinnamon Bark

There are several factors that may contribute to the safety of Chinese herbal medicine, the intrinsic toxicities of herbs (which also happen to be the therapeutic agents quite often), environmental contaminations (such as air pollution and soil contaminations), growing practices (such as pesticides, fungicides, heavy metals, and microorganisms), and manufacture processing and handling (including compounding, storage, additives, microorganisms, endotoxins, and human adulteration). Other safety concerns such as long-term toxicity, dose-dependent toxicity, treatment duration, herb–drug interactions, and herb–herb interactions also need to be carefully evaluated in the use of Chinese herbal medicine.

The great thing is that most of the above concerns can be easily mitigated through product quality assurance and proper training. 

Fu Zi - Aconite

Possibly to best thing one can do to ensure safety while taking Chinese herbal medicine is to make sure that you are getting your prescription from a qualified practitioner. When you hear about people getting organ damage and going into multiple system failures due to Chinese herbal medicine I am willing to wager very few of those people are taking whatever they are taking under the direction of a qualified herbalist. A large part our training is focused on safety, and the safe administration of herbal products is going to be a bit different for every individual. The herbalist has to consider a variety of factors when making an appropriate prescription, including the general health of the person, weight, age, any other herbs/ pharmaceuticals they are taking, and other conditions, how is liver and kidney function, among other things. These pieces of information will inform the practitioner of appropriate dosage of each herb and appropriate dosage of the total formula, how long the the patient can safely take the formula, and any additional processing that may need to be done to herbs to modify their phytochemical profile to make it more appropriate to the individual. There is an old saying in Chinese medicine that "what may be medicine for one person could be toxic to another".

Packaged Herbs

Here at Pestle & Pins, we prepare & package all of our prescriptions in house so that we can ensure each herb is processed correctly. This in-house process also provides peace of mind that nothing has been unknowingly added to the herbal prescription. We then provide clear direction on dosage, when to take your herbs, and for how long to take them. Regular check-ins are important through-out the process of taking a herbal prescription to ensure any side-effects can be addressed and the prescription modified as your condition changes.

In order to mitigate factors such as environmental toxins and toxins from growing practices, we only buy top quality herbs that have been grown, harvested, and processed by companies certified under Good Manufacturing Processes. With every shipment of herbs we also inspect the herbs to ensure quality and verify herbal identity. 

Hua Jiao.jpg

I hope this section also got you thinking about side-effects of Chinese herbs. One of the most common myths that I hear about Chinese medicine is that it is natural and therefore side-effect free so I doesn't matter what you take, how much of it, or for how long. While is wish it was that simple, unfortunately it is not. While you might find some Chinese herbs in your grandma's spice cupboard, which are more or less side-effect free and are actually everyday food items in some cultures such as cinnamon, longan nuts, red dates, licorice root, and szechuan pepper to name a few, most of them are a lot more potent than those. If you over due it with these every day herbs you might get some loose stool, maybe some water retention, and an upset stomach - not the end of the world. On the other hand, there are some herbs that we have to be very careful with as they have very strong effects on the body and some of which act as central nervous system depressants and even in small doses can interfere with nerve signaling which can affect respiration and the heart. Other herbs may not have an immediate side affect but if dosed incorrectly over a long time or are even at the right dose but taken for too long can lead to build-ups of phytochemicals to levels which eventually negatively affect the body. 

But again, as mentioned above, a qualified practitioner will be able ensure you are getting the rights herbs, at the right dose, processed in the appropriate way, for the right period of time in order to mitigate potential side effects and deliver an effective prescription.

In BC, traditional Chinese medicine is regulated by the CTCMA and in order to prescribe herbs a practitioner must be a Registered Traditional Chinese Medicine Herbalist (R.TCM.H), Registered Traditional Chinese Medicine Practitioner (R.TCM.P), or Doctor of Traditional Chinese Medicine (DTCM). Practitioners with these designations have undergone the necessary training and safety examinations to ensure safe and effective administration of Chinese herbal medicine. A Registered Acupuncturist (R.Ac) does not have the necessary training and has not passed the appropriate exams to demonstrate knowledge of safe herbal practices. If you are unsure about your practitioner's qualification you can verify them in the CTCMA practitioner database. If you are outside of BC, check which organization regulates the traditional Chinese medicine profession in your region and see what the appropriate qualifications are.

Sources

1. https://www.ncbi.nlm.nih.gov/pubmed/29739459
2. https://www.ncbi.nlm.nih.gov/pubmed/29522425
3. https://www.ncbi.nlm.nih.gov/pubmed/29500549
4. https://www.ncbi.nlm.nih.gov/pubmed/20211234 
5. https://www.acupuncturetoday.com/mpacms/at/article.php?id=27899
6. https://www.ncbi.nlm.nih.gov/pubmed/29855363
7. https://www.ncbi.nlm.nih.gov/pubmed/24411708
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4649620/
9. https://www.ncbi.nlm.nih.gov/pubmed/28807165