Studies found so far about traditional medicines

March 17, 2008

Hello,

I don't know any other way to get the information to everyone who

needs it. The references at the end list some of the hospital cases

and treatments. Most of the meds I have seen (through DFW

International) have been destined for DFW area, Oklahoma City and

Houston, but with western interest climbing anything is possible.

It is really fascinating!

Raina Dodson

________________________________________

http://home.caregroup.org/clinical/altmed/interactions/Herb_Groups/Ad

ulteration_an.htm

Adulteration and Contaminants in Chinese Patent Medicines

DFW Seizures

Summary

Chinese Patent Medicines

Adulteration and Contamination Issues: An Introduction

Chinese herbs are often consumed in what are called proprietary or

patent medicines. Patent medicines from China have many inherent

problems, some reminiscent of the patent medicines used in America

at the turn of the twentieth century. This summary will introduce

some of the important documented problems.

• patent medicines toxicity concern: The use of patent medicines

from mainland China is inadvisable under any circumstances, unless

one is trained in Chinese herbal product identification and the

products have clear indications of having been produced in

accordance with GMP quality control standards.

patent medicines toxicity concern: Heavy metal contamination.

• A number of products have been found to have heavy metal

contamination, including lead and mercury. The possible sources of

lead and mercury can be accidental contamination from processing

machinery used in China or accumulation during cultivation from soil

contamination. Some formulae actually contain lead or mercury

containing ingredients, such as minim or cinnabar. Finally, the

coating of traditional pills called " dan " is often made from

cinnabar, a mercury containing substance. Responsible modern

practitioners no longer use such ingredients in their

prescriptions. However, they still may appear as ingredients or

contaminants in illegal patent medicines from China. Several

instances of poisoning from heavy metals are noted in the medical

literature.

(Zhang ZW, et al. Sci Total Environ 1998 Sep 18;220(2-3):137-145;

Kang-Yum E, Oransky SH. Vet Hum Toxicol 1992 Jun;34(3):235-238; Tie

B, et al. Chung Kuo Chung Yao Tsa Chih 1990 Oct;15(10):602-604, 639;

Chan TY. Vet Hum Toxicol 1994 Jun;36(3):238-240; Fratkin J. Oriental

Medicine Journal. Vol. 6, No. 3-4, Fall/Winter 1997.)

patent medicines toxicity concern: Pharmaceutical adulterants.

• A number of products have been found to have been adulterated with

pharmaceutical drugs. According to a study by the Taiwanese FDA,

these products may include drugs such as acetaminophen, aminopyrine,

caffeine, chlormezanone, chloroxazone, diazepam, diclofenac,

ethoxybenzamide, hydrochlorothiazide, ibuprofen, indomethacin,

ketoprofen, mefenamic acid, papaverine, phenylbutazone, piroxicam,

prednisolone and salicylamide. 25-30% of herbal formulae sold in

East Asian herbal stores and Chinese medicine clinics for the

treatment of asthma, pain and arthritis were found to contain drugs.

• It has been suggested the situation in the U.S. is not much better

than that in Asia. The popular cold and sinus remedies Yin Chiao

Chieh Tu Pian, Bi Yan Pian, Pe Min Kan Wan, Gan Mao Ling, Zhong Gan

Ling contain decongestants, analgesics or antihistamines. The Black

Pills for Arthritis may contain phenylbutazone, hydrochlorothiazide,

indomethacin, aminopyrine and acetaminophen, depending on

manufacturer and batch. epam is present in most samples. Most of

these are prescription or discontinued drugs and have dangerous,

even fatal consequences. Other arthritis products of concern include

Vine Essence Pills and Ox Head Brand Tong Shui Wan. Some patent

medicines, reputedly beneficial for heart disease, contain drugs

such as toad venom (Seven Flower Pills). Quite a few creams for skin

complaints contain cortisone or antibiotics. Cortisone is often

labeled as " unguentum flourocortisoni acetatis. "

(Dharmananda 11/99; Huang WF, et al. J Clin Pharmacol 1997 Apr;37

(4):344-350; Fratkin JP. Oriental Medicine Journal. Vol. 6, No. 3-4,

1997; Ries CA, Sahud MA. JAMA 1975 Jan 27;231(4):352-355.)

• herbal toxicity concern: Most nontoxic herbs require substantial

dosages to exert any effect at all in pill form. If a patent

medicine exerts a strong effect of any kind from a small dosage, one

should immediately suspect drug adulteration.

patent medicines toxicity concern: Single active compound isolates.

A number of products are not herbs per se, but single isolated

constituents, effectively making them unapproved drugs, most notably

the now banned Jin Bu Huan. Others include Qi Ye Lian, Yan Hu Suo

Tong Zhi Pian and Saloton. Jin Bu Huan was the cause of a number of

serious problems. A single, acute ingestion in children rapidly

produced life-threatening neurologic and cardiovascular

manifestations, while long-term Jin Bu Huan use in adults was

associated with hepatitis. The active ingredient, levo-

tetrahydropalmatine, is potent and potentially dangerous, as it acts

directly on the central nervous system. Jin Bu Huan has been banned

in California and other jurisdictions.

(Dharmananda 11/93; Picciotto A, et al.J Hepatol 1998 Jan;28(1):165-

167; Horowitz RS, et al. Arch Intern Med 1996 Apr 22;156(8):899-903;

Woolf GM, et al.Ann Intern Med 1994 Nov 15;121(10):729-735; MMWR

Morb Mortal Wkly Rep 1993 Dec 3;42(47):920-922; MMWR Morb Mortal

Wkly Rep 1993 Aug 27;42(33):633-636.)

patent medicines toxicity concern: Toxic herbs.

A few products contain poisonous herbs and should not be consumed

under any circumstances. In almost all known cases of poisoning

from Chinese herbs, the toxic components came from preparations

containing aconitine, podophyllin or anticholinergics, except for

the preparations containing dangerous pharmaceutical drugs or heavy

metals, as mentioned above or isolated cases that are probably due

to allergic hypersensitivity.

(Chan TY, Critchley JA. Hum Exp Toxicol 1996 Jan;15(1):5-12; Chan

TY, et al. Hum Exp Toxicol 1995 May;14(5):434-436; Chan TY, et al.

Vet Hum Toxicol 1994 Oct;36(5):452-455; Chan TY, et al. Aust N Z J

Med 1993 Jun;23(3):268-271; But PP.J Trop Med Hyg 1994 Dec;97(6):371-

374; Ferguson JE, et al. Br J Dermatol 1997 Apr;136(4):592-593.)

Herbs

Contamination Data: Chinese Patent Medicines

The following medicines were found to contain toxic levels of

arsenic, mercury, or lead, or had the addition of western

pharmaceuticals. This list is not all-inclusive of The Compendium of

Asian Patent Medicines (California Department of Health Services,

Food and Drug Branch. 1997) compiled by Ko, Pharm.D., Ph.D.

and Alice Au, Ph.D. This list focuses on those products that are

commonly used by practitioners, and that pose a significant health

risk. The USP lists toxic levels of lead at >10 ppm, and mercury or

arsenic at > 3 ppm. Bear in mind that doctors of traditional Chinese

medicine in China can and will justify the inclusion of mercury or

arsenic as a necessary therapy for heat toxins, fever, or disturbed

shen when done in a supervised manner and for short periods of time.

High levels of mercury and arsenic, however, are unacceptable, and

the conscientious practitioner should become aware of products

posing a health risk.

(Reproduced, with permission, from Fratkin JP. Toxic Contaminants in

Chinese Patent Medicines. Oriental Medicine Journal. Vol. 6, No. 3-

4, Fall/Winter 1997.)

The problem of adulterants and contaminants in Chinese patent

products, as well as the rapid appearance of a significant number of

counterfeit products, has been exacerbated in recent years by the

emergence of increased entrepeneurial activity and non-governmental

manufacturing facilities in the Peoples Republic of China.

Please note the particular manufacturer of a contaminated product.

Other factories may use the same or similar English name for a

contaminated product listed below, when in fact they may be pure.

• An Gong Jiang Ya Wan, Beijing Tung Jen Tang, Beijing.

Application: High blood pressure.

Contaminants: Arsenic 192 ppm.

• An Kung Niu Huang (Niu Huang-bovine gallstone 1 listed company in

ad states it imports gallstones to U.S. from FMD countries) Wan,

Beijing Tung Jen Tang, Beijing.

Application: High fever.

Contaminants: Lead 184 ppm, Arsenic 46,400 ppm, Mercury 1450 ppm

Comment: An extremely toxic level of arsenic.

• Ansenpunaw, Chung Lien Drug Works, Hangzhou.

Application: Insomnia, palpitation.

Contaminants: Arsenic 60 ppm, Mercury 3590 ppm.

Comment: A very toxic level of mercury.

• Chin Koo Tieh Shang Wan, Tianjin Lerentang Pharmaceutical Factory,

Tianjin.

Application: Trauma.

Contaminants: Lead 11 ppm, Arsenic 35 ppm.

Comment: These are low levels of contamination, but they may cause a

problem if taken over a period of time. Plum Flower offers a non-

contaminated version.

• Ching Chun Bao: Recovery Of Youth Tablets, Hangzhou Chinese

Medicine Factory.

Application: Geriatric tonic.

Contaminants: Arsenic 20 ppm.

Comment: This is a low level of contamination. As a tonic, however,

long term usage can cause an accumulative affect.

• Compound Prescribed Water Melon Frost, Guilin Chinese Medicines

Pharmaceutical Factory, Guilin.

Application: Sore throat.

Contaminants: Arsenic 1360 ppm, Mercury 1230 ppm.

Comment: Arsenic and mercury levels are high. Please note that the

following versions are uncontaminated: Compound Watermelon Frost,

Guilin Chinese Medicine Factory; Water Melon Frost, Fei Shan United

Manufactory.

• Ding Xin Wan, Min-Kang Drug Manufactory, Yichang.

Application: Insomnia, palpitation.

Contaminants: Lead 77 ppm, Mercury 1750 ppm.

Comment: This is a high level of mercury.

• Du Huo Jisheng Wan, Min-Kang Drug Manufactory,Yichang.

Application: Lower back pain.

Contaminants: acetominophen*

Comment: Plum Flower offers the same product in a non-contaminated

version.

• Fargelin For Piles, United Pharmaceutical Manufactury, Guangzhou.

Application: Hemorrhoids.

Contaminants: Arsenic 20,200 ppm.

Comment: This is a very toxic level of arsenic.

It should not be confused with High Strength Fargelin For Piles,

United Pharmaceutical Manufactury; Guangzhou.

• Gan Mao Qing Capsules, Bai Yun Pharmaceutical Factory, Guangzhou.

Application: Common cold or flu.

Contaminants: Acetaminophen, chlorpheniramine*.

Comment: There are many similar formulas without western

pharmaceuticals.

• Ganmao Pien, Tianjin Drug Manufactory, Tianjin.

Application: Common cold or flu.

Contaminants: Lead 241 ppm.

Comment: This is a moderately toxic level of lead. Also, there are

many similar formulas without heavy metals.

• Guanxin Suhe Jiaonang, Jing Xi Tang Pharmacy, Guangzhou.

Application: Coronary heart disease, angina.

Contaminants: Arsenic 74 ppm.

Comment: This is a moderately toxic level of arsenic.

• Hong She Pills, Chung Lien Drug Works, Wuchang (Hubei).

Application: Bi syndrome, arthritis, rhuematism.

Contaminants: Mercury 181 ppm, strychnine, ephedrine.

Comment: This has a moderate level of mercury. Strychnine is found

in the Chinese herb Strychnos Ma Qian Zi, and ephedrine is found in

Ephedra (Ma Huang).

• Huang Lien Shang Ching Pien, Tientsin Drug Manufactory, Tianjin.

Application: Bacteriaol infections of the throat, gums or eyes.

Contaminants: Pugelone, phenacetin*.

Comment: Plum Flower offers the same product in a non-contaminated

version.

• Hui Chun Dan, Kwong Tong Fushan Pharmaceutical Manufactory,

Fushan.

Application: Pediatric fever.

Contaminants: Lead 56 ppm, Arsenic 32 ppm, Mercury 50 ppm.

Comment: Not commonly available.

• Kai Yeung Pill: Trisnake Itch-Removing Pill, Wuzhou People's

Pharmacy, Guangxi.

Application: Skin itching.

Contaminants: Lead 5 ppm, Arsenic 51 ppm.

Comment: Safer versions are available from Hanyang Pharmaceutical

Works; Hubei, and from Plum Flower.

• Kang Gu Zeng Sheng Pian, United Pharmaceutical Manufactory,

Foshan.

Application: Vertebral calcification.

Contaminants: Arsenic 21 ppm, Mercury 35 ppm.

Comment: These are low but significant levels of contamination.

• Lu-Shen-Wan, Shanghai Chinese Medicine Works, Shanghai.

Application: Sore throat.

Contaminants: Lead 40 ppm, Arsenic 82,000 ppm, Mercury 3850 ppm,

resibufogenin.

Comment: Very toxic level of arsenic and mercury.

• Nan Bao, Tianjin Li Sheng Pharmacy, Tianjin.

Application: Male impotence or poor sexual function.

Contaminants: Lead 68 ppm.

Comment: This is a moderate level of lead contamination.

• Niu Huang Chieh Tu Pien-Bezoar ( Bezoar –gallstone) Antipyretic

Pills, Peking Tung Jen Tang.

Application: High fever.

Contaminants: Arsenic 59 ppm.

Comment: Taiwan also found this product contaminated with mercury,

as well as a product by the same name manufacturered by Tientsin

Drug Manufactory, Tianjin.

• Niu Huang Ching Hsin Wan, Tientsin Drug Manufactory, Tianjin.

Application: High fever.

Contaminants: Arsenic 4520 ppm, Mercury 2080 ppm.

Comment: These are very toxic levels of arsenic and mercury.

• Pe Min Kan Wan, United Pharmaceutical Manufactory, Fushan.

Application: Sinus congestion.

Contaminants: Chlorpheniramine*.

Comment: There are many clean versions of this product by other

manufacturers, including Fo Shan Herbal and Yu Lam Medicine Factory.

Plum Flower also offers it in a non-contaminated version.

• Ren Shen Zai Zao Wan, Kwong Tong Fushan Pharmaceutical

Manufactory, Foshan.

Application: Wei syndromes, post-stroke, trembling of limbs.

Contaminants: Mercury 827 ppm.

Comment: This is a toxic level of mercury.

• San She Dan Chuan Bei Powder, United Pharmaceutical Manufactory,

Guangzhou.

Application: Cough.

Contaminants: Arsenic 148 ppm.

Comment: This is a significant level of arsenic contamination. Do

not confuse it with the glass vial liquid, San She Dan Chuan Bei Ye.

• Shu Kan Wan: Hepatico-Tonic Pills, Lanchow Chinese Medicine Works,

Lanzhou.

Application: Liver-stomach dysharmony.

Contaminants: Arsenic 49 ppm.

Comment: Plum Flower offers the same product in a non-contaminated

version.

• Tao Chih Pien (For Babies), Tientsin Drug Manufactory, Tianjin.

Application: Pediatric fever.

Contaminants: Arsenic 26 ppm.

• Ta Huo Lo Tan, Beijing Tung Jen Tang; Beijing.

Application: Bi and Wei syndromes, arthritis.

Contaminants: Arsenic 30,900 ppm.

Comment: This is an very toxic level of arsenic.

• Tian Wang Bu Xin Wan, Min-Kang Drug Manufactory, Yichang.

Application: Insomnia, Shen disturbance.

Contaminants: Lead 5 ppm, Mercury 1580 ppm

Comment: This is a high level of mercury contamination. Plum Flower

offers the same product in a non-contaminated version.

• Tien Wang Pu Hsin Tan, Lanchow Chinese Medicine Works, Lanzhou.

Application: Insomnia, Shen disturbance.

Contaminants: Mercury 2290 ppm.

Comment: A high level of mercury contamination. This is a confusing

entry, because an identical looking package, Tien Wang Pu Hsin Tan,

Lanzhou Foci Pharmaceutical Factory; Lanzhou, had no contaminants.

This product (above) may in fact be a countefeit. Plum Flower offers

the same product in a non-contaminated version.

• Tin Tzat To Chung Pills, Shan Sai Hang Lam Medicinal Manufactory.

Application: Bi syndrome, arthritis and rheumatism.

Contaminants: Lead 62 ppm.

Comment: This is a moderate level of lead contamination.

• Tsai Tsao Wan, Tientsin Drug Manufactory, Tianjin.

Application: Wei syndromes, flaccid paralysis, trembling of limbs.

Contaminants: Mercury 204 ppm.

• Tung Shueh Pills (Cow's Head Brand), Ta Ang Pharm Co; Kaohsiang,

Taiwan.

Application: Bi syndrome, arthritis and rheumatism.

Contaminants: apam, chlorzoxanone, caffeine, chlormezanone*.

• Yen Shun Zai Zao Wan, Fushan United Med. Fact. Guangzhou

Application: Wei syndromes, post-stroke, trembling of limbs.

Contaminants: Lead 51 ppm, Mercury 1500 ppm.

Comment: These are high levels of lead and mercury contamination.

• Zhong Gan Ling, Meizhou City Pharmaceutical; Guangdong

Application: Viral cold or flu.

Contaminants: Mercury 22 ppm; chlorpheniramine, dipyrone*.

Comment: This formula is available in a non-contaminated version by

Golden Flower.

In addition to the material published in The Compendium, the

American-based Chinese herbal product manufacturer and distributor,

Mayway USA sent patent medicines out for laboratory analysis, and

reports the following contaminants. Parts per million (ppm) of heavy

metals, or amounts of other additives, were not reported. The

information however, is important to practitioners and again,

caution is advised in using the following medicines.

• Bi Tong Pian, Guangzhou Medicine and Health.

Application: Sinus congestion.

Contaminants: Chlorpheniramine*

• Bi Yan Pian, Chung Lien Pharmaceutical Works.

Application: Sinus congestion.

Contaminants: Acetaminophen*.

Comment: Plum Flower offers the same product in a non-contaminated

version.

• Farfunpeiminkam Wan, Foshan United Pharmaceutical Co., Foshan.

Application: Sinus congestion.

Contaminants: Chlorpheniramine*.

• Gan Mao Ling, United Pharmaceutical, Guangzhou.

Application: Cold, flu, respiratory viral infection.

Contaminants: Acetaminophen, caffeine*.

Comment: Plum Flower offers the same product in a non-contaminated

version.

• High Strength Yin Chiao, United Pharmaceutical, Guangzhou.

Application: Cold, flu, respiratory viral infection.

Contaminants: Acetaminophen, pulegone*.

• Margarite Acne Pills, Foshan United Pharmaceutical Manufactory.

Application: Asthma.

Contaminants: Sophoridane*.

Comment: Plum Flower offers the same product in a non-contaminated

version.

• Niu Huang Chiang Ya Wan, Tianjin Pharmaceutical Manufactory.

Application: High blood pressure.

Contaminants: Mercury, Lead.

• Niu Huang Chiang Ya Wan, Peking Tung Jen Tang, Beijing.

Application: High blood pressure.

Contaminants: Mercury, Lead.

The following pharmaceutical drugs are prohibited for use in these

products by the FDA:

• Acetaminophen (analgesic, e.g., Tylenol®).

• Chlormezanone (tranquilizer).

• Chlorpheniramine (antihistamine).

• Chlorzoxanone (antispasmodic).

• apam (tranquilizer, trade name: Valium®).

• Dipyrone (analgesic).

• Phenacetin (analgesic and antipyretic).

• Pulegone (promotes menstrual flow).

• Resibufogenin (cardiotonic).

• Sophoridane.

The following list of products were reported in The Compendium as

being uncontaminated, or having heavy metals within USP acceptable

levels (specifically, lead below 10 ppm). This represents a test

done on a single sample of the medicine, and may not be true for all

batches. Also, even if the product is uncontaminated, it still may

be banned in California due to Category 3: " Making claims on the

labeling for the treatment or prevention of serious medical

conditions/diseases for which a person should seek professional

medical help. "

• Alopecia Areata Pill, China National Chemicals Import-Export Corp,

Guangdong.

• An Shen Bu Xin Wan, Shanghai Native Medicine Works, Shanghai; also

available as:

An Sheng Pu Shin Wan, Shanghai Native Medicine Works, Shanghai.

• Bu Shen Pill, Sing-Kyn Drug House; Guangzhou.

• Dendrobrium( CITES Issue) Moniliforme Night Sight Pills, Tientsin

Drug Manufactory, Tianjin.

• Eight Flavor Tea, Lanchow Chinese Medicine Works; Lanzhou; also

available as:

Chih Pai Di Huang Wan, Lanzhou Foci Pharmaceutical Manufactory,

Lanzhou

Zhi Bai Ba Wei Wan, Lanzhou Foci Pharmaceutical Manufactory, Lanzhou

Zhi Bai Di Huang Wan, Lanzhou Foci Pharmaceutical Manufactory,

Lanzhou.

• Eight Treasure Tea, Lanchow Chinese Herb Works, Lanzhou; also

available as:

Ba Zhen Wan, Lanzhou Foci Pharmaceutical Factory, Lanzhou

Nu Ke Ba Zhen Wan, Lanzhou Foci Pharmaceutical Factory, Lanzhou

Women's Precious Pills, Lanzhou Foci Pharmaceutical Factory,

Lanzhou.

• Gui Pi Wan, Lanchow Foci Herb Factory; Lanzhou; also available as:

e Longana Tea, Lanchow Chinese Medicine Works, Lanzhou

Kwei Be Wan, Lanchow Chinese Medicine Works, Lanzhou.

• Gejie Nourishing Kidney Pills, Yulin Pharm. Factory; Yulin; also

available as:

Gejie Bu Shen Wan, Yulin Drugs Manufactory, Yulin

Gejie Bu Shing Wan, Yulin Drugs Manufactory, Yulin.

• Golden Book Teapills, Lanzhou Foci Herb Factory; Lanzhou; also

available as:

Sexotan, Lanchow Chinese Medicine Works, Lanzhou.

• Kai Kit Pill, Hanyang Pharmaceutical Works, Hanyang.

• Lien Chiao Pai Tu Pien, Tianjin Drug Manufactury; Tianjin

• Liu Wei Di Huang Wan, Lanzhou Fo Ci Pharmaceutical Manufactory;

also available as:

Six Flavor Tea, Lanzhou Foci Pharmaceutical Manufactory, Lanzhou

Six Flavor Teapills, Lanzhou Foci Herb Factory, Lanzhou.

• Prostate Gland Pills, Wai Yeung District Medicine Company,

Guangdong.

• Sea Horse (Cites II worldwide-check ingredients for hippocampus)

Genital Tonic Pills, Tianjin Drug Manufactory; also available as:

Sea Horse Herb Tea, Tianjin Drug Manufactory; Tianjin.

• Specific Drug Passwan, Mai Yun Shan Pharm. Manufactory, Guangzhou

• Tabellae Suan Zao Ren Tang, Sing-Kyn Drug House, Guangzhou.

• Tian Wang Bu Xin Dan, Lanchow Foci Pharm. Factory, Lanzhou; also

available as:

Emperor's Tea, Lanchow Foci Pharmaceutical Factory, Lanzhou

Tien Wang Pu Hsin Tan, Lanchow Foci Pharmaceutical Factory, Lanzhou.

• Tzepao Sanpien Pills, Yantai Pharmaceutical Works, Yantai.

• Wuchaseng Tablet, Harbin Chinese Medicine Factory; Harbin

• Yeuchung Pills, United Pharmaceutical Manufactory, Szechuan.

• Yu Quan Thirst Removing Pills, Xinkang Pharmaceutical Factory,

Beijing.

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Please read the disclaimer concerning the intent and limitations of

the information provided here.

Do not rely solely on the information in this article.

The information presented in Interactions™ is for informational and

educational purposes only. It is based on scientific studies (human,

animal, or in vitro), clinical experience, case reports, and/or

traditional usage with sources as cited in each topic. The results

reported may not necessarily occur in all individuals and different

individuals with the same medical conditions with the same symptoms

will often require differing treatments. For many of the conditions

discussed, treatment with conventional medical therapies, including

prescription drugs or over-the-counter medications, is also

available. Consult your physician, an appropriately trained

healthcare practitioner, and/or pharmacist for any health concern or

medical problem before using any herbal products or nutritional

supplements or before making any changes in prescribed medications

and/or before attempting to independently treat a medical condition

using supplements, herbs, remedies, or other forms of self-care.

________________________________________

References

[No authors listed] Chinese herbal creams may contain steroids. BMJ.

1999 Feb 27;318(7183):C.

[No authors listed] From the Centers for Disease Control and

Prevention. Jin bu huan toxicity in children--Colorado, 1993. JAMA.

1993 Sep 15;270(11):1298, 1302.

[No authors listed] From the Centers for Disease Control and

Prevention. Jin bu huan toxicity in adults--Los Angeles, 1993.JAMA.

1994 Feb 9;271(6):423-424.

LA. Concern regarding herbal toxicities: case reports and

counseling tips. Ann Pharmacother. 1996 Jan;30(1):79-80.

Atherton DJ, Rustin MH, Brostoff J. Need for correct identification

of herbs in herbal poisoning. Lancet. 1993 Mar 6;341(8845):637-638.

(Letter)

Azuno Y, Yaga K, Sasayama T, Kimoto K. Thrombocytopenia induced by

Jui, a traditional Chinese herbal medicine. Lancet. 1999 Jul 24;354

(9175):304-305. (Letter)

Bateman J, Chapman RD, Simpson D. Possible toxicity of herbal

remedies. Med J. 1998 Feb;43(1):7-15. (Review)

Blackwell R. Adverse Events Involving Certain Chinese Herbal

Medicines and the Response of the Profession. J Chinese Medicine.

Jan 1996, 50. (See http://www.acupuncture.com/Herbology/Toxic.htm.)

Bullock K. Herbal remedies. Am Fam Physician. 1999 Oct 15;60(6):1661-

1662, discussion 1665-1666.

But PP, Tomlinson B, Cheung KO, Yong SP, Szeto ML, Lee CK.

Adulterants of herbal products can cause poisoning. BMJ. 1996 Jul

13;313(7049):117. (Letter)

But PP. Herbal poisoning caused by adulterants or erroneous

substitutes. J Trop Med Hyg 1994 Dec;97(6):371-374.

Abstract: Six cases of herbal poisoning involving six patients in

Hong Kong, Taipei and Kuala Lumpur are reported. The sources of

poisoning were identified as adulterants (Podophyllum emodi) or

erroneous substitutes (Datura metel-datura is anticholinergic). In

cases of suspected herbal poisoning, it is recommended that the

prescriptions, herbal residues and herb samples should be collected

for pharmacognostical and chemical analysis to substantiate the

cause of poisoning. Insofar as it is possible, an estimate of the

amount of herbs consumed should also be obtained, to establish

whether the amount of toxin present is sufficient to account for the

symptoms.

But PP. Need for correct identification of herbs in herbal

poisoning. Lancet. 1993 Mar 6;341(8845):637. (Letter)

Chan TY, Tomlinson B, Critchley JA. Aconitine poisoning following

the ingestion of Chinese herbal medicines: a report of eight cases.

Aust N Z J Med 1993 Jun;23(3):268-271.

Abstract: BACKGROUND: Traditional Chinese medicines often

contain 'chuanwu' and 'caowu', the roots of certain Aconitum species

which are thought to have an anti-inflammatory effect in many

conditions. Excessive amounts of these materials, which contain

diterpene alkaloids particularly aconitine, can produce toxic

effects and occasional fatalities. AIMS: This study was conducted to

document the adverse effects related to these herbal medicines which

resulted in hospital admission and to determine the outcome in these

patients. METHODS: A retrospective survey was conducted of patients

admitted to the Prince of Wales Hospital, Hong Kong with suspected

adverse effects from Chinese herbal medicines containing chuanwu or

caowu over a two year period from 1989 to 1991. RESULTS: Eight

patients were identified with features of mild to moderate

intoxication including nausea and vomiting, paraesthesiae or

numbness in the mouth and extremities, hypotension and ventricular

extrasystoles. The management of aconitine poisoning is essentially

supportive and in-hospital observation with ECG monitoring should be

continued for at least 24 hours because of the risk of

cardiovascular collapse and ventricular arrhythmias. The medical

profession and general public should be alerted to the potential

toxicity of these herbs and their usage should be controlled by

legislation in Hong Kong as it is in some other countries.

Chan TY, Tomlinson B, Tse LK, Chan JC, Chan WW, Critchley JA.

Aconitine poisoning due to Chinese herbal medicines: a review. Vet

Hum Toxicol 1994 Oct;36(5):452-455.

Abstract: Both " chuanwu " , the main root of Aconitum carmichaeli,

and " caowu " , the root of A kusnezoffii, are believed to possess anti-

inflammatory, analgesic and cardiotonic effects and have been used

in Chinese materia medica mainly for the treatment of

musculoskeletal disorders. They contain the highly toxic C19

diterpenoid alkaloids of aconitine, mesaconitine and hypaconitine.

After ingestion, patients may present with signs and symptoms that

are typical of aconitine poisoning. Death may occur from ventricular

arrhythmias, which are most likely to occur within the first 24 h.

Management of aconitine poisoning is essentially supportive. There

are no adequate studies in humans to indicate the most effective

treatment of the ventricular arrhythmias. All clinicians should be

alerted to the potential toxicity of " chuanwu " and " caowu " .

Chan TY, Chan JC, Tomlinson B, Critchley JA. Chinese herbal

medicines revisited: a Hong Kong perspective Lancet 1993 Dec 18-

25;342(8886-8887):1532-1534.

Abstract: Chinese herbal medicines (CHM) and Chinese proprietary

medicines (CPM) are widely used by people of Chinese origin

throughout the world. Although the use of these medicinal materials

rarely causes significant toxic effects, cases of severe and even

fatal poisoning have occurred after medication with herbs containing

aconitine, podophyllin, and

anticholinergic (The most common plants containing anticholinergic

alkaloids are:

• Atropa belladonna (Deadly Nightshade)

• Mandragora officinarum (Mandrake)

• Hyoscamus niger (Henbane)

• Datura species (Datura) )

substances. Furthermore, CHM and CPM are often adulterated with

substituted herbs, heavy metals, and western medicines; such

contamination can have important clinical consequences. In Hong

Kong, surveillance and legislation are required to control the use

of some of these herbal preparations. In other countries, medical

practitioners should also be aware of the possibility that these

herbal-medicine-related remedies may cause significant clinical

problems in their Chinese patients.

Chan TY, Chan AY, Critchley JA. Hospital admissions due to adverse

reactions to Chinese herbal medicines. J Trop Med Hyg. 1992 Aug;95

(4):296-298.

Abstract: Chinese herbal medicines (CHM) are commonly used in Hong

Kong. To determine the importance of adverse reactions to CHM as a

cause of medical admissions in Hong Kong, all 1701 patients admitted

to two general medical wards at the Prince of Wales Hospital over an

eight-month period were prospectively studied. In only three

patients (0.2%) was the admission attributed to the adverse effects

of CHM. These were life-threatening in two cases ('dazao'-induced

angio-neurotic oedema and liquorice-induced hypokalaemic periodic

paralysis). Despite this low incidence of adverse reactions, in

communities where CHM are commonly used, it is important that there

is a continuing effort to collect new information on the safety of

these compounds.

Chan TY. Monitoring the safety of Chinese herbal medicines in Hong

Kong. Ann Pharmacother. 1996 Sep;30(9):1039-1040

Chan TY, Lee KK, Chan AY, Critchley JA. Poisoning due to Chinese

proprietary medicines. Hum Exp Toxicol 1995 May;14(5):434-436.

Abstract: 1. To determine the toxic potentials of those Chinese

proprietary medicines (CPM) which are commonly used for self-

poisoning by adults in Hong Kong, all patients admitted to four of

the eight general medical wards at the Prince of Wales Hospital

between January 1988 and December 1993 were retrospectively studied.

2. There were 54 women and 17 men with their age ranging from 15 to

86 years. Twenty-three subjects (32%) also took alcohol, chemicals

or drugs. Of the 51 subjects (72%) who had taken topical

medicaments, 22 had no symptoms while 28 had minor features of

gastrointestinal irritation (n = 26), mild (n = 2) or severe (n = 1)

salicylate poisoning. Of the 17 subjects (24%) who had taken CPM

tablets/capsules, nine had mild symptoms including nausea/vomiting

and drowsiness. The three remaining patients (4%) who had ingested

liquid CPM preparations were asymptomatic. Elevated plasma

salicylate or paracetamol concentrations (> 0.1 mmol l-1) were found

in some patients who had taken topical medicaments and CPM

tablets/capsules, respectively. All the 71 patients completely

recovered. 3. Most of the CPM used for self-poisoning in Hong Kong

were of low to moderate toxicity except for those containing

wintergreen oil (methyl salicylate).

Chan TY, Critchley JA. Usage and adverse effects of Chinese herbal

medicines. Hum Exp Toxicol 1996 Jan;15(1):5-12.

Abstract: The great majority of Chinese herbal preparations are

safe, and in the past, some useful Western drugs have been derived

from these herbs. Nearly all serious poisonings are due to the few

preparations containing aconitine, podophyllin or anticholinergics

or else proprietary preparations containing dangerous Western drugs

or heavy metals. Both medical professionals and the general public

should be alerted to the potential toxicity of herbal remedies.

There should be frequent monitoring of Chinese herbal medicines or

their derivatives, such as some Chinese proprietary medicines, for

undeclared Western drugs and heavy metals. Mothers should be

discouraged from treating their children with herbal or proprietary

medicines. There should be continuing efforts to collect safety

information on these widely used products.

Chan TY. The prevalence use and harmful potential of some Chinese

herbal medicines in babies and children. Vet Hum Toxicol 1994 Jun;36

(3):238-240.

Abstract: This article reviews the prevalence use of Chinese herbal

medicines (CHM) in Chinese pregnant women, babies and children

living in Hong Kong and the harmful potential of some CHM and

Chinese proprietary medicines (CPM) in babies and children. The use

of CHM appears to be common amongst Chinese pregnant women. The

possible effects of these herbs on the fetus and baby and their

overall safety are not known. This practice should be discouraged

since there is suggestion that maternal consumption of CHM might

increase the risk of neonatal jaundice. Both " chuen-lin " and " yin-

chen " can displace bilirubin from their serum protein binding and

increase the risk of hyperbilirubinaemia. These herbs should not be

given to the neonates. The use of CPM-containing undeclared drugs of

high toxicity or lead, arsenic and mercurial compounds should be

banned. The medical profession and the general public should be

alerted to the harmful potential of some of the CHM and CPM. There

should be continuing efforts to collect information on the safety of

these compounds.

Cheng TJ, Wong RH, Lin YP, Hwang YH, Horng JJ, Wang JD. Chinese

herbal medicine, sibship, and blood lead in children. Occup Environ

Med 1998 Aug;55(8):573-576.

Abstract: OBJECTIVES: Risk factors for increased blood lead

concentration (BPb) has been investigated. However, the effect of

sibship and Chinese herbal medicine on BPb has not been

systematically studied. In this study BPb data from voluntary

testing was used to determine if Chinese herbal medicine and sibship

were associated with BPb. METHODS: 319 children aged 1-7 were tested

for BPb. Meanwhile, parents were interviewed to obtain information

including consumption of Chinese herbal medicine, living

environment, lifestyle, and sibship of the children tested. RESULTS:

The mean (SD) BPb of 319 preschool children was 4.4 (2.4)

micrograms/dl. The consumption of Ba-baw-san (a Chinese herbal

medicine) was significantly associated with increased BPb in

children (p = 0.038). Further multivariate regression analysis of

BPb in 50 pairs of siblings showed the factors of being brothers

explained 75% of variation for BPb, and being sisters and brother-

sister explained 51% and 41% of variation respectively. CONCLUSION:

Chinese herbal medicine and children's play patterns within the

family expressed in different types of sibship are the main

determinants of low concentrations of BPb in preschool children of

Taiwan.

Cheng TO. Herbal remedies. Am Fam Physician. 1999 Oct 15;60(6):1661;

discussion 1665-6.

D'Arcy PF. Traditional Chinese medicines: safety hazards. Adverse

Drug React Toxicol Rev 1999 Jun;18(2):53-57.

de Smet PA, Elferink F. [Chinese pills still contaminated]. Ned

Tijdschr Geneeskd. 1988 Feb 21;132(9):407-408. [Article in Dutch]

De Soriano G, Chase D. Safety of herbal remedies. J R Soc Med. 1998

Oct;91(10):561. (Letter)

Dharmananda S. ITM START : The Story of Jin Bu Huan. Portland, OR.:

Institute for Traditional Medicine, Nov 1993.

Dharmananda S. ITM START: Drugs in Imported Chinese Herb Products.

Portland, OR.: Institute for Traditional Medicine, Nov. 1996.

Du S, Cao F, Lei S. [A survey of adverse effects of Chinese herbal

drugs in China, 1915-1990]. Chung Kuo Chung Yao Tsa Chih. 1992 Jul;17

(7):435-8. Review) [Article in Chinese]

Ernst E. Harmless Herbs? A Review of the Recent Literature. Am J Med

1998 Feb104(2):170-178.

Ferguson JE, Chalmers RJ, Rowlands DJ. Reversible dilated

cardiomyopathy following treatment of atopic eczema with Chinese

herbal medicine. Br J Dermatol 1997 Apr;136(4):592-593.

Abstract: Chinese herbal medicines are increasingly being used as

an alternative treatment for chronic skin disease. Most patients and

many doctors remain insufficiently aware of their potential

toxicity. We report a patient with eczema who developed a severe

cardiomyopathy following a 2-week course of Chinese herbal medicine.

The connection between the two conditions was not made until 2 weeks

after presentation when the patient was specifically asked if she

had ingested any unusual substances. The belief that herbs, as

natural products available without prescription, are harmless, is

commonplace and patients may not consider them worthy of mention

during a standard medical history.

Fratkin JP. Chinese Herbal Patent Formulas. Portland, OR.: Institute

for Traditional Medicine, 1986.

Fratkin JP. Toxic Contaminants in Chinese Patent Medicines. Oriental

Medicine Journal. Vol. 6, No. 3-4, Fall/Winter 1997.

Graham-Brown RA, Bourke JF, Bumphrey G. Chinese herbal remedies may

contain steroids. BMJ. 1994 Feb 12;308(6926):473. (Letter)

Graham-Brown R. Toxicity of Chinese herbal remedies. Lancet. 1992

Sep 12;340(8820):673-674.

Gu Y, Yuan H. [A review of the adverse effects of Chinese herbal

drugs as published in Chinese journals in 1993 and 1994]. Chung Kuo

Chung Yao Tsa Chih. 1995 Aug;20(8):502-507. (Review) [Article in

Chinese]

Horowitz RS, Dart RC, et al. Jin bu huan toxicity in children--

Colorado. Morb Mortal Wkly Rep 1993 Aug 27;42(33):633-636.

Abstract: The consumption of traditional ethnic remedies can have

adverse health effects, especially among children. Life-threatening

bradycardia with rapid onset and central nervous system (CNS) and

respiratory depression developed in three unrelated children in

Colorado during 1993 following ingestion of Jin Bu Huan tablets, a

Chinese herbal medicine used for relieving pain. This report

summarizes the investigations of these cases.

Horowitz RS, Feldhaus K, Dart RC, Stermitz FR, Beck JJ. The

clinical spectrum of Jin Bu Huan toxicity. Arch Intern Med 1996 Apr

22;156(8):899-903.

Abstract: Herbal medications and other nontraditional medical

therapies are becoming increasingly popular in the United States. We

describe three children and three adults in whom severe toxic

effects developed after ingestion of a Chinese herbal medication,

jin bu huan, which is sold as Jin Bu Huan Anodyne Tablets. Jin bu

huan produced distinct clinical syndromes after acute ingestion in

children and long-term use in adults. A single, acute ingestion in

children rapidly produced life-threatening neurologic and

cardiovascular manifestations, while long-term jin bu huan use in

adults was associated with hepatitis. Jin bu huan contains levo-

tetrahydropalmatine, a potent neuroactive substance. The

constituents of jin bu huan are misidentified on the package,

resulting in significant delay in identifying the plant alkaloid

responsible for its toxicity. Although perceived as innocuous, jin

bu huan may produce major health effects. The highly concentrated

formulation, the lack of childproof packaging, and the product

insert listing indications for the treatment of serious medical

conditions may all contribute to the development of toxic reactions.

Huang WF, Wen KC, Hsiao ML. Adulteration by synthetic therapeutic

substances of traditional Chinese medicines in Taiwan. J Clin

Pharmacol 1997 Apr;37(4):344-350.

Abstract: The adulteration by synthetic therapeutic substances of

traditional Chinese medicines has been reported on various occasions

and has been a public health concern in Taiwan over the past several

years. A large-scale effort was initiated in 1992 to screen

traditional Chinese medicines that were suspected of adulteration

with synthetic therapeutic substances. The term " adulteration "

refers to traditional Chinese medicines that are tested and found to

contain chemical substances not prescribed or labeled as part of the

intended use. A total of 2,609 samples were collected by eight major

general hospitals in Taiwan. Samples were collected through

physicians' referrals during patients visits. The samples were

analyzed by hospital pharmacists following the established standard

procedures in comparison to references by thin-layer chromatography.

An average of 23.7% (n = 618) of the samples collected from the

eight hospitals were adulterated. Four samples with either a

rheumatoid or an antiinflammatory indication contained six different

kinds of adulterants. More than half (52.8%) of the adulterated

traditional Chinese medicines contained two or more adulterants. The

sources of adulterated samples and their claimed indications, as

well as the most frequently detected synthetic therapeutic

substances, are presented in this report. The controversies

regarding the combination of synthetic therapeutic substances and

traditional Chinese medicines without adequate labeling should be

resolved through regulatory actions for better safety of drug use.

JR, et al. Oral dexamethasone masquerading as a Chinese

herbal remedy. Br J Dermatol. 1994 Feb;130(2):261.

Huxtable RJ. The myth of beneficient nature: the risks of herbal

preparations. Ann Intern Med 1992;17 (2), 165-166.

Jadoul M, de Plaen JF, Cosyns JP, Van Ypersele de Strihou C. Adverse

effects from traditional Chinese medicine. Lancet. 1993 Apr 3;341

(8849):892-893. (Letter)

Kane JA, Kane SP, Jain S. Hepatitis induced by traditional Chinese

herbs; possible toxic components. Gut. 1995 Jan;36(1):146-147.

Abstract: Traditional Chinese herbal remedies are widely available

in the United Kingdom for the treatment of chronic skin disorders.

Their benefits are considerable, but their use is completely

unregulated. Two patients are described here who suffered an acute

hepatitic illness related to taking traditional Chinese herbs. Both

recovered fully. The mixtures that they took included two plant

components also contained within the mixture taken by a previously

reported patient who suffered fatal hepatic necrosis. These cases

high-light the need for greater awareness of both the therapeutic

and toxic potential of herbal remedies, as well as greater control

of their use.

Kang-Yum E, Oransky SH. Chinese patent medicine as a potential

source of mercury poisoning. Vet Hum Toxicol 1992 Jun;34(3):235-238.

Abstract: This research is an effort to create an awareness. of the

potential hazards of some Chinese patent medicines which contain

mercurial ingredients. This should be of consideration when

screening symptomatic patients who are of Asian ethnic background or

other users of these medicines. This research discusses reported

cases of mercury poisoning related to the use of Chinese patent

medicines and the potential toxicity of cinnabar (red mercuric

sulfide) and calomel (mercurous chloride), 2 mercurials commonly

used in these medicines. A list of mercurial-containing Chinese

patent medicines available on the open market in North America has

been compiled, together with their traditional uses and mercurial

contents and is presented as a quick reference for Specialists in

Poison Information. This class of medicine may not pose a problem

when used appropriately; however, its misuse, abuse, overdosage and

improper storage can lead to serious mercury poisoning.

Kaptchuk TJ. Acute hepatitis associated with jin bu huan. Ann Intern

Med. 1995 Apr 15;122(8):636.

Kiefer DS, Barrett B. Herbal remedies. Am Fam Physician. 1999 Oct

15;60(6):1662, 1665; discussion 1665-6.

Ko R, Au A. The Compendium of Asian Patent Medicines. California

Department of Health Services, Food and Drug Branch. 1997.

Kolev ST, Leman P, Kite GC, son PC, Shaw D, Murray VS.

Toxicity following accidental ingestion of Aconitum containing

Chinese remedy. Hum Exp Toxicol. 1996 Oct;15(10):839-842.

Abstract: Various species of Aconitum are commonly used in

traditional Chinese medicine. These plants are known to contain

highly potent cardiotoxins. A 22 year old Chinese male accidentally

ingested a herbal liniment prepared from Aconitum with near fatal

results. His ventricular tachyarrhythmias responded to standard

treatment including the use of i.v. magnesium.

Larrey D. Hepatotoxicity of herbal remedies. J Hepatol. 1997;26

Suppl 1:47-51. (Review)

Liu HN, Jaw SK, Wong CK. Chinese herbs and atopic dermatitis.

Lancet. 1993 Nov 6;342(8880):1175-1176. (Letter)

Lu W, Jiang H. [Consideration and reflection on the study of the

processing of Chinese herbal medicine]. Chung Kuo Chung Yao Tsa

Chih. 1990 Feb;15(2):89-92, 126. [Article in Chinese]

Markowitz SB, Nunez CM, Klitzman S, Munshi AA, Kim WS, Eisinger J,

Landrigan PJ. Lead poisoning due to Hai Ge Fen, the porphyrin

content of individual erythrocytes. JAMA. 1994;271(12), 932-934.

Abstract: A 45-year-old Korean man developed abdominal colic, muscle

pain, and fatigue. Following a 3-week hospitalization, acute

intermittent porphyria was diagnosed based on the symptoms and a

high level of urinary delta-aminolevulinic acid (378 mumol/L [4.95

mg/dL]). However, discovery of an elevated blood lead level (3.7

mumol/L [76 micrograms/dL]) subsequently led to the correct

diagnosis. No occupational source of lead exposure was identified.

The patient reported ingesting a Chinese herbal preparation for 4

weeks prior to becoming ill. A public health investigation revealed

that the source of lead exposure was hai ge fen (clamshell powder),

one of the 36 ingredients of the Chinese herbal medicine. We used

fluorescence image-based cytometry to determine the frequency

distribution of the zinc protoporphyrin content in circulating red

blood cells and found that 70% of the patient's cells contained

elevated levels of zinc protoporphyrin, consistent with the duration

of lead exposure and effect of lead on heme synthesis. Analysis of

zinc protoporphyrin content in circulating red blood cell

distributions may be useful in the diagnosis, therapy, and kinetic

modeling of lead poisoning. Environmental lead poisoning is best

addressed through the close collaboration of clinicians, public

health specialists, and laboratory scientists.

McIntyre M. Chinese herbs: risk, side effects, and poisoning: the

case for objective reporting and analysis reveals serious

misrepresentation. J Altern Complement Med. 1998 Spring;4(1):15-16.

Ng TH, Chan YW, Yu YL, Chang CM, Ho HC, Leung SY, But PP.

Encephalopathy and neuropathy following ingestion of a Chinese

herbal broth containing podophyllin. J Neurol Sci. 1991 Jan;101

(1):107-113.

Abstract: Two patients developed podophyllin intoxication following

ingestion of a broth of the Chinese herb guijiu. The neurological

manifestations are described and the pathology of the peripheral

neuropathy is fully documented with ultrastructural and quantitative

studies.

Perharic-Walton L, Murray V. Toxicity of Chinese herbal remedies.

Lancet. 1992 Sep 12;340(8820):674.

Picciotto A, Campo N, Brizzolara R, Giusto R, Guido G, Sinelli N,

Lapertosa G, Celle G. Chronic hepatitis induced by Jin Bu Huan. J

Hepatol 1998 Jan;28(1):165-167.

Abstract: BACKGROUND/AIMS: Jin Bu Huan and other Chinese herbal

products are widely taken remedies. They have been developed as a

natural alternative to traditional drugs in the treatment of various

ailments. Their ability to induce several side effects such as acute

hepatitis has already been described. We report a case of chronic

hepatic damage following administration of Jin Bu Huan Anodyne

tablets. METHODS: The patient, a 49-year-old man, developed

biochemical signs of liver damage 2 months after beginning Jin Bu

Huan intake (3 tablets/daily) including biopsy-proven chronic

hepatitis with moderate fibrosis. Virological, autoimmune, metabolic

or other hepatotoxic causes were excluded. Liver function impairment

was resolved by discontinuing Jin Bu Huan intake. CONCLUSIONS: This

case reinforces the already known hepatotoxicity of this product and

should make us think more about the uncontrolled use of alternative

products.

Pillans PI. Toxicity of herbal products. N Z Med J. 1995 Nov 24;108

(1012):469-471.

Register of Chinese Herbal Medicine (1992). Patent medicines

warning. RCHM Newsletter, October 1992.

Register of Chinese Herbal Medicine (1993). Steroids in skin creams.

RCHM Newsletter, May 1993.

Ries CA, Sahud MA.Agranulocytosis caused by Chinese herbal

medicines. Dangers of medications containing aminopyrine and

phenylbutazone. JAMA 1975 Jan 27;231(4):352-355.

Abstract: Four non-Chinese patients, middle-aged or older,

developed agranuloctyosis while taking Chinese herbal medicines for

relief of arthritis and back pain. All four developed life-

threatening infections with bacterial sepsis; one died. The herbal

medicines were shown to contain substantial amounts of undeclared

aminopyrine and phenylbutazone, drugs that are well-known causes of

agranulocytosis. These Chinese herbal medicines are widely available

over the counter throughout the United States.

Rustin MH, Atherton DJ. Chinese herbs and atopic dermatitis. Lancet.

1994 Feb 19;343(8895):489. (Letter)

D, Kennedy N, McKendrick MW. Monitoring the safety of herbal

remedies. Herbal remedies have a heterogeneous nature. BMJ. 1995 Dec

9;311(7019):1569.

Segasothy M, Samad S. Illicit herbal preparation containing

phenylbutazone causing analgesic nephropathy. Nephron. 1991;59, 166-

167.

Siegel RK. Kola, ginseng and mislabelled herbs. JAMA 1977;237, 25.

Tai YT, But PP, Young K, Lau CP. Cardiotoxicity after accidental

herb-induced aconite poisoning. Lancet. 1992 Nov 21;340(8830):1254-

1256.

Abstract: Aconitine and its related alkaloids are known cardiotoxins

with no therapeutic role in modern western medicine. The rootstocks

of Aconitum plants, which contain aconite alkaloids, have been

common components of Chinese herbal recipes. We have documented life-

threatening intoxication in 17 Chinese subjects after accidental

herb-induced aconite poisoning. All patients developed symptoms of

aconite toxicity within 2 h of herb ingestion. Most developed

tachyarrhythmias, including ventricular tachycardia and fibrillation

from which 2 patients died. Toxicological evaluation revealed that

aconites from the Aconitum rootstocks were the only plausible casual

factor for intoxication. These cases point to the need for strict

surveillance of herbal substances with low safety margins.

Tang Y. [Compatibility of toxic Chinese medicines]. Chung Kuo Chung

Yao Tsa Chih. 1996 Jul;21(7):438-41 inside backcover. [Artcile in

Chinese]

Tie B, Qi W, Chen G. Determination of soluble mercury contents in

Chinese traditional patent medicines for children. Chung Kuo Chung

Yao Tsa Chih 1990 Oct;15(10):602-604, 639.

Abstract: Soluble mercury contents in Baochi San, Xiaoer Zhibon

Ding and Xiaoer Baishou Dan have been determined using dithizone

method. This method has the advantages of short digestion time,

clear digestion end point, simple operation and reproducible

results. The recovery rate ranges from 98.4 to 103%. The data

obtained can be used as a reference for controlling soluble mercury

contents in Chinese traditional patent medicines containing

cinnabar.

Vautier G, Spiller RC. Safety of complementary medicines should be

monitored. BMJ. 1995;311, 633.

Wood B, Wishart J. Potent topical steroid in a Chinese herbal cream.

N Z Med J. 1997 Nov 14;110(1055):420-421.

Abstract: Steroids have been discovered previously in oral " herbal "

preparations. Using liquid chromatography, we have now confirmed the

presence of the potent topical steroid, clobetasol proprionate, in a

Chinese herbal cream.

Woolf GM, Petrovic LM, Rojter SE, Wainwright S, Villamil FG, Katkov

WN, Michieletti P, Wanless IR, Stermitz FR, Beck JJ, et al. Acute

hepatitis associated with the Chinese herbal product jin bu huan.

Ann Intern Med 1994 Nov 15;121(10):729-735.

Abstract: OBJECTIVE: To describe the hepatotoxicity associated with

ingestion of the Chinese herbal product Jin Bu Huan Anodyne Tablets

(Lycopodium, serratum) and to propose possible mechanisms of injury.

DESIGN: Retrospective analysis. SETTING: Academic hepatology units

and private practice facilities. PATIENTS: Seven previously healthy

patients. MEASUREMENTS: Clinical, laboratory, radiologic, and

histologic studies. RESULTS: Acute hepatitis occurred after a mean

of 20 weeks (range, 7 to 52 weeks) of Jin Bu Huan ingestion and

resolved in six patients within a mean of 8 weeks (range, 2 to 30

weeks); another patient is currently improving. Hepatitis was

associated with symptoms of fever, fatigue, nausea, pruritus, and

abdominal pain and with signs of jaundice and hepatomegaly. Biopsy

specimens showed that one patient had hepatitis with eosinophils

(consistent with a drug reaction) and the other had mild hepatitis,

moderate fibrosis, and microvesicular steatosis. Decreasing the Jin

Bu Huan dose in one patient improved liver test results. Reusing Jin

Bu Huan in two other patients caused abrupt recrudescence of

hepatitis. CONCLUSION: Jin Bu Huan can cause liver injury. Although

the hepatotoxic mechanisms are not defined, they may include

hypersensitive or idiosyncratic reactions or direct toxicity to

active metabolites. Hepatotoxicity caused by herbal products

underscores the toxicity caused by herbal products underscores the

importance of national surveillance programs and quality control of

the manufacture of these products.

Woolf GM, Rojter SE, et al . Jin Bu Huan toxicity in adults - Los

Angeles 1993. MMWR Morb Mortal Wkly Rep. 1993 Dec 3;42(47):920-922.

Abstract: Jin Bu Huan (JBH) is a traditional Chinese herbal product

used as a sedative and analgesic. During 1993, public health and

health-care providers in Colorado reported three children with

unintentional overdoses of JBH that caused central nervous system

and respiratory depression with rapid onset of life-threatening

bradycardia. Subsequently, the first cases of acute hepatitis

attributed to use of JBH were diagnosed in three women in Los

Angeles during July and August 1993. Patients 1 and 2 were referred

to a Los Angeles hepatology clinic by their physicians; patient 3

was identified by patient 2. All three patients had purchased JBH at

the same health-food store. This report summarizes the investigation

of these cases.

Woolf GM, Petrovic LM, Rojter SE, Wainwright S, Villamil FG, Katkov

WN, Michieletti P, Wanless IR, Stermitz FR, Beck JJ, et al. Acute

hepatitis associated with the Chinese herbal product Jin Bu Huan.

ls of Internal Medicine. 1994 Nov 15;121(10):729-735.