Are Chinese Herbs Safe?

If you’ve ever visited an acupuncturist, a Chinese herbal formula may have been suggested as part your treatment plan. Chinese herbal medicine is a sophisticated medical system that dates back thousands of years. Each formula is designed to treat the needs of the individual, as opposed to the specific complaint. In other words, it’s possible that if three different people came to you reporting chronic back pain, three completely different formulas may be prescribed.

If you simply don’t have the time to read this whole post on the safety of Chinese herbs, know this: There have been legitimate issues in the past with the quality of Chinese herbs, including issues around contamination, adulteration, and mislabeling.  However, if you’re getting your herbs from Wildwood, know that you are getting safe, high-quality herbs. At Wildwood, we use herbs from Spring WindKPC, Blue Poppy, Kan Herb CompanyEvergreen, Classical Pearls, and Seven Forests. All companies independently test for pesticides, fungus, mold, spores, and heavy metals to ensure that levels fall below minimum requirements.

Most importantly (if you ever wanted to do your own research), all of these companies will provide you with a Certificate of Analysis (COA) for any herb or formula. A COA is the laboratory documentation issued by an inspection firm attesting to the quality or purity of exported herbs.

In addition, all of our herbalists have completed a 4 year Master’s degree in Chinese Medicine, and have many years of clinical work under their belt.  And beyond that, we simply wouldn’t give you something that we wouldn’t take ourselves.

Of course, some people come with specific questions regarding specific issues. Below are some common concerns that I’ve heard.

Aristolochic acid: “Chinese Herbs Cause Kidney Failure”

This is probably the most common concern that I’ve heard, and unfortunately, this issue is the result of misuse of Chinese herbs combined with poor-quality, fear-based reporting. In short, yes, there have been documented cases of kidney failure due to aristolochic acid-containing Chinese herbs, BUT the herb in question was 1) misidentified,  2) used erroneously, and 3) used in addition with very potent pharmaceutical drugs in a dangerous weight loss formula.

In addition, in 2000 the FDA banned Chinese herbs that contained aristolochic acid (AA). Currently there are strict guidelines in place to make sure any herbs containing aristolochic acid are removed from circulation. China has been slower to remove these herbs from their domestic market (though export is restricted). Personally, I’d go so far as to recommend avoiding sourcing your herbs from small-scale Chinatown shops in the US,  especially if you are a relatively uninformed layperson with no experience with identifying or using Chinese herbs.

So, what happened, anyway? Why and when did Chinese herbs become vilified and associated with this kidney-damaging acid? The proliferation of misinformation happened fast and furiously in the early 1990s in Belgium, when toxic herbs containing aristolochic acid (AA) were wrongfully used in weight-loss formulas. 

The main cases involving toxic levels of AA herbs have occurred with improper substitution of AA herbs for non-AA herbs that have a similar name. For example, the initial situation in Belgium involved the substitution of guăng fáng jĭ (Radix Aristolochiae Fangchi) for fáng jĭ (Radix Stephaniae Tetrandrae). A medical doctor without knowledge or training in TCM made this substitution in his weight-loss clinic, obtaining the herb from unreliable sources. He used large amounts of guăng fáng jĭ for prolonged periods of time, certainly beyond what a traditional prescription would call for.

Presently, in the United States, it is virtually impossible to obtain raw herbs or products containing AA, with the possible exception of small Chinatown herb stores importing herbs and products from overseas relatives.  -Jake Paul Fratkin, OMD, LAc

For more information about this issue, see here and here.

Pesticides

Rapid industrialization has changed our natural environment, and when it comes to selecting the things that we will consume, we must consider issues such as industrial waste and chemical pesticides/fertilizers. All companies we use for Chinese herbs test for pesticides and will make available a Certificate of Analysis upon request (many have the COAs readily available on their website). Here is an example of a COA.

If you’re interested, a more detailed article about this topic can be found here and here.

On the whole, the issue of pesticides in Chinese herbs should not be blown out of proportion. For most herbs, vendors that do systematic testing on hundreds of products very rarely find pesticide residue levels that surpass safe limits and the majority of Chinese herbs have no detected pesticides at all. Pesticides require attention and remain a significant concern, but the problems are case-by-case and are primarily focused on specific crops. -Eric Brand, L.Ac.

Herb-Drug Interactions

It’s not uncommon for a patient to seek care from several health professionals. As a result, patient’s are often taking a variety of drugs, herbs, vitamins and supplements at once. If you’re a patient, it’s your job to communicate clearly with your practitioner. Provide them with a list of the medicines, including over-the-counter medicines, that you take regularly (or occasionally). Also provide them with a list of any herbs, vitamins, and supplements that you take.

There are two ways in which interactions can happen: pharmocokinetic (fluctuation in bioavailability of herb/drug molecules in the body due to changes in absorption, distribution, metabolism and elimination) and pharmacodynamic (fluctuations in the bioavailability of ingested substances as a result of synergistic or antagonistic interactions between herb and drug molecules). For a detailed piece on pharmacokinetic interactions, see here. For a detailed piece on pharmacodynamic interactions, see here.

For a list of drugs with a higher risk for interaction, see here. If you are taking a blood-thinner, most acupuncturists will not prescribe herbs, even if you ask for them.

If you are going to take something in addition to a pharmaceutical drug, it’s often recommended that you take the additional supplement or herb 2-3 hours away from your medication in order to lower risk of interaction. Remember, your job is to communicate clearly with your practitioner, so that the potential for negative herb-drugs interactions can be minimized.

Efficacy and Research Traditional chinese herbal medicine ingredients over bamboo background with mortar and pestle and chopsticks.

John and Tina Chen’s Chinese Herbal Formulas and Applications and well as Chinese Medical Herbology and Pharmacology are two indispensable resources for information on Chinese herbs. Monographs include pharmacological effects, clinical studies and research, and safety data (herb-drug interactions, safety index, toxicology, symptoms and treatments of overdosage).

The Society for Acupuncture Research is also a favorite.

To conclude, I’d recommend a few simple steps in regards to assuring the safety of Chinese herbs. See a qualified, experienced Chinese herbalist. If you’re curious, ask about the company (companies) they use for herbs (bulk, granule, and encapsulated). Avoid experimenting with Chinese herbs unless you have reliable guidance.

Now enjoy the wonderful, balancing effects of Chinese herbs – they’re truly a wonderful addition to treatment when used correctly!