Qi Spot

Much has been made about the non-effect of Ginkgo Biloba on alzheimer’s disease.  Surprisingly for the critics I ‘d have to agree with them.  Gingko Biloba works in Chinese medical theory by increasing blood flow.

In the classical text of “Ben Cao Pin Hui Jing Yao” it states that the characteristics of the leaves of yin xing are bitter sweet, astringent, neutral. and belong to the lung meridian and can control the lungs and calm asthma, calm the mind and arrest pain, rid of water retention and stop diarrhea…

…The main usage of the ginkgo leave extract is in cardiovascular therapy (including dementia caused by circulation dysfunction.)

(http://alternativehealing.org/ginkgo.htm)

So in theory, it should work only in a limited subset of patients with dementia.  It won’t work for most dementia patients, actually.  Personally I find that memory in general is better improved by tonifying Blood through the Kidney or Spleen.

But how did this come to my attention?  This work of art:

Gingko (sic) Biloba and other ‘Natural’ Remedies May Be Dangerous

by Benjamin Radford

http://news.discovery.com/human/gingko-biloba-and-other-natural-remedies-may-be-dangerous.html

I can’t help but smirk at this one.  At the risk of some commenters saying that it’s obvious when something gets under my skin, I have to say that these headline crafters are geniuses.  Radford takes the studies that show Ginkgo biloba isn’t as effective as it is thought to be (which I myself believe, never having prescribed it for dementia and memory problems and instead focusing on diet) and uses it as a springboard.  He mentioned ephedra, which I will comment on later.

In the meantime, what’s my irk?  Firstly, I have to honestly say the headline is true.  Well, I’ll have to be more specific.  Ginkgo Biloba and other natural medicines not only MAY be dangerous, they are DEFINITELY dangerous if not used properly!  I mean, come on, if one believes that a substance is powerful enough to effect changes in physiology so as to create a tangible medical effect, surely it is pure idiocy to believe that it can be taken at uncontrolled doses by just anyone without any adverse reactions!  We do not expect such sheepishness when we take western medicines, why shouldn’t we take the same attitude towards natural herbs?

This is also the fault of unscrupulous marketers who only care about selling their product.  To my commentors, I have to say that yes, news bias irritates me, but one thing that irritates me more is hearing “alternative” healers go about with such bullcrap as “oh it’s natural, there’s no such thing as an overdose, it’s safe.”  Oh please, I’ve seen people get admitted to ICUs for renal failure due to herb overdose.  The worst thing about such real quackery is that it gets real practitioners who only want the best for their patients lumped into the same duck fraternity as the herb pushers.

So why is this headline ticking me off? It’s the intention.  It’s obviously designed to plant suspicion in the minds of readers: God/Mother Nature is a quack.  Natural products “may be” dangerous.  Weasel wording.  You could say the same thing in a different way: “Natural Medicines Must Be Used with Caution” would say the same thing but with obviously different intent.

But on to the article:

According to new study in the Journal of Natural Products “restrictions should be placed on the use of Ginkgo biloba because of growing scientific evidence that Ginkgo may increase the risk of seizures in people with epilepsy and could reduce the effectiveness of anti-seizure drugs.”

Agreed.

Herbal supplements and remedies are not marketed as drugs (note the paragraph of legal fine print on bottles starting with, “This product is not intended to diagnose, treat, cure, or prevent any disease.”) That’s because in many cases the drugs have not been scientifically tested for safety or efficacy. They have not been proven to work in carefully-controlled clinical trials.

Here in the Philippines, they are marketed as “food supplements.”  This is bad, not because the herbs haven’t been tested (some have been, some haven’t, with varying degrees of success/failure), but because such dichotomy will lead the public into polarization.  Either they will join the “all natural, all safe” bandwagon or the “all unscientific” bandwagon.  Neither wagons are worth getting hitched to.

But here comes the kicker:

The herbal supplement industry is a multi-billion dollar business, and has lobbied hard to keep their products from being regulated by the FDA. As a result, the FDA can only step in when something goes wrong, after people have been injured or killed by natural herbs.

That’s just what happened in 2004, when the FDA banned ephedra, an herbal remedy used in traditional Chinese medicine for thousands of years. Millions of consumers took the herb, on the belief that it was natural, safe, and effective. The herb was widely used for treating everything from the common cold to asthma to weight loss. Then the herb was linked to over 100 deaths; healthy people who took ephedra had a wide range of symptoms ranging from insomnia to heart attacks.

Now it seems another natural herbal remedy may pose a hidden danger. All drugs, whether pharmaceutical or “natural,” can have dangerous and unintended side effects. But when people are harmed or killed by an herbal supplement that has never been shown to work in the first place, the situation is all the more tragic.

While it is true that herbal supplements are a big cash cow, I’m not a big fan of the FDA, seeing as they’ve had a tendency to rush approval of drugs (remember bextra?) and are seemingly dominated by Big Pharma.   The story of Ephedra is appropriate for this.

I refer you to this article for more clarity: Safety Issues Affecting Chinese Herbs: The Case of Ma Huang <http://www.itmonline.org/arts/mahuang.htm>

Herba Ephedrae or Ma Huang is usually the first herb one would see in a typical textbook of Chinese herbal medicine.  It is usually used to clear early symptoms of flu, and not ALL kinds of flu.  ANY look at the texts will give SPECIFIC indications for it’s use.  However, western herb enthusiasts had, according to the article, “converted from an herbal treatment for diseases to an energy stimulant and a weight-loss product.”

What are it’s classic textbook uses?

Actions: induces diaphoresis, resolves surface, ventilates the lungs to relieve asthma, regulates water metabolism.

Applications: febrile diseases due to exterior-excess, fever, chillphobia [aversion to cold], anhidrosis [lack of perspiration], ostealgia [bone pain], arthralgia, cough with dyspnea, edema, edema due to wind.

From this, it becomes obvious that Herba ephedrae is meant to be used in actual illness, not in a healthy person just trying to get a kick or lose weight.  The weight loss aspect is gleaned from it’s strong diaphoretic effect.  However, a basic look at any  Chinese herbal textbook will show that administration of ma huang should stop WHEN PERSPIRATION BEGINS, whether or not the flu has dispersed.

Again, if the patient has external symptoms (chills, slight fever, arthralgia, muscle pain) with no sweating, ma huang may be given AS PART OF A FORMULA to mediate effects (see ma huang tang, among others) and should be STOPPED when sweating begins.

Also, it should not be used as a tonic.  Many of the early ma huang/ephedra “supplements” were mixtures of ephedra and other tonics (including caffeine!)  Disaster waiting to happen.

How does that compare with western enthusiasts taking the herb individually for what we MDs would term as “off label use” contrary to all warnings?

OF COURSE they’ll get sick.  A professor of mine in China warned against yin collapse (shock due to blood or fluid loss) after using too much sweat-inducing herbs.

So what’s the take home message?

1) ANY herbal medicine should be prescribed by a trained and qualified health professional.  That may depend on your country or state.  In the United States, there are licensed acupuncturists.  In Japan, only MDs can prescribed Chinese formulas.

2) Always research any herbs you may want to take.  Find out all about them.  If it’s a chinese formula, learn about why the herbs are combined together, at least in theory.

3) NEVER EVER believe the “all natural so all safe” argument.

4) We should regulate Chinese herbs to ensure quality (prevent fakes, etc) but at the same time, have them regulated by Chinese herbalists, not MDs or quack herbal “experts” like the ones who gave Ma Huang and Ginkgo a bad name.  Real Chinese herbalists would never mix Ma Huang with caffeine, knowing exactly how it works.

Tammy Cohen, in this article, talks about the impending ban on unregulated or unlicensed herbal medicines in the EU.  Now, many of my comrades in the “alternative” medicine field are up at arms regarding this.  It does indeed look like a big bad Pharmacorp conspiracy to drive natural remedies underground.  However, I am reminded of the fact that there is truly a need to regulate the “herbal medicine” industry.

Why is this so?  This is because there are unscrupulous dealers and “healers” out there who are merely trying to make a quick buck.  They can be considered guilty of the very “crimes” we accuse Big Pharma of.  I for one have seen cases in our hospital (the Philippine General Hospital) of renal failure from an overdose of herbs like ginseng.  The whole renal-failure-due-to-ephedra in that weight loss clinic a few years back was not so much because the herb was bad, but because some wannabe herbalist was using it against it’s intended purpose.  He was using Ma Huang (Herba ephedrae)’s diaphoretic and diuretic properties to effect weight loss DESPITE the fact that any cursory glance at a Chinese herbal textbook would let one know to stop Ma Huang intake once perspiration occurs lest yin deficiency (excess fluid loss) occurs.  A toxic “off label” use, so to speak.

Chinese Herbs: Safe and Effective When Used Properly

Now for some commentary on the article:

Today, with the ease of the internet, you can self-diagnose, order next day delivery, and even learn how to make your own.

Sigh, if only it were that simple.  Chinese Medicine prides itself in customization of the treatment to an individual patient.  Two people with seemingly similar symptoms might get totally different treatments based on pattern discrimination.

But renewed debate about the safety of these remedies was sparked last week following the news of an EU crackdown on herbalists and Chinese medicine practitioners who operate unregulated at present. Under the new law, from 2011 sales of all herbal remedies except for a small number of products for minor ailments will also be banned. Regulators warn that many of us believe that “herbal” is synonymous with “safe”, whereas herbal remedies can be deadly.

Now this is not good.  The answer to unregulated herbal remedies should be obvious: regulation.  Yet the proposed solution is similar to the Ma Huang incident in America: do we censure the idiot herbalist wannabe or ban the misused herb? We ban the misused herb because it is easier, more convenient, and possibly more profitable for (fill in the blank).

“Research we conducted last year found a significant proportion of people believed ‘herbal’ means ‘benign’,” says Richard Woodfield, Head of Herbal Policy at the Medicines and Health care products Regulatory Agency (MHRA). “That means people are more liable to self-medicate, and to neglect to inform their doctors, even though there’s a risk that the herbal remedy will react with any prescription drugs. They’re also more vulnerable to fraudulent, even criminal operators who put products out which are heavily adulterated with dangerous pharmaceuticals.”

Unfortunately this paragraph rings true, as I mentioned before.  The last statement in particular can refer to unscrupulous Chinese patent medicine manufacturers who include steroids or valium in their so-called “Chinese medicines”.

The actress Sophie Winkleman is reported to have taken aconite, or monkshood, found in some ‘herbal Valium’ last month to calm her nerves prior to her wedding to Freddie Windsor….

The plant while relatively harmless in licensed homeopathic remedies in which it is rigorously diluted, can be extremely dangerous, in herbal remedies, even lethal.

Aconite, or fu zi in Chinese medicine, is known to be toxic which is why it is usually prepared first by stir-frying with fresh ginger.  Even then it is still used with other medicinals to reduce toxicity and enhance therapeutic effects.

The article describes many more instances, but I won’t mention them anymore here.  The next few paragraphs are important (because I obviously agree with them)

The MHRA believes regulating the herbal medicine industry is the best way to limit abuses and ensure consumers are aware of potential dangers. All herbal medicines sold over the counter in the UK should according to the law be licensed. The MHRA assesses them on safety, quality and patient information. By 2011 a new scheme, which is currently being rolled out, will be in place.

“Check for products which have the THR (Traditional Herbal Register) or Product Licence (PL) number on the label,” advises Richard Woodfield.

Many herbal practitioners want even further regulation.”We want to be registered,” says Dee Atkinson, spokesperson for the National Institute of Medical Herbalists and herself a qualified medical herbalist. “Herbs are not harmless, they are drugs, just as pharmaceuticals are drugs and as such they should be prescribed by a qualified, registered practitioner.

I wish I could emblazon that last paragraph in gold lettering, plug it to Christmas lights and put a mariachi band to announce it.  It is SO SO SO SO TRUE!!!  Especially for Chinese medicine.