Chinese herbal medicine

In herbal medicine the healing properties of plants are used to treat illness and maintain good health. It is one of the most ancient forms of treatment known and there are herbal medicine traditions in various parts of the world. In Britain today, the two main systems of herbal medicine practised are Chinese and Western. Other forms of herbal medicine practised include Ayurvedic (Indian) and Tibetan.

What is Chinese herbal medicine?

Chinese herbal medicine is part of traditional Chinese medicine (TCM), which includes acupuncture, massage, tai chi (exercise using controlled movement) and qi gong (breathing exercises). Some practitioners are trained in, and practise, both Chinese herbal medicine and acupuncture. Traditional Chinese medicine is based on the theory that energy (known as qi, pronounced chee) flows through pathways in the body. Qi consists of equal and opposite qualities - yin and yang - and when these become unbalanced, illness may result. Practitioners usually prescribe a particular mixture of herbs for each patient, aimed at putting the balance right and improving the patient’s health.

What happens during a visit to a practitioner?

At the first consultation the practitioner will ask about your current health, your history of illnesses, your diet and how you are feeling. They will also do a physical examination. Chinese herbal practitioners will usually feel your pulses and look at your tongue. The practitioner will then make up a prescription. Usually this is done during the consultation.

The herbs may come as a tincture (a concentrated solution of herbs extracted in water and alcohol) or in tablet form. For skin complaints, the preparation might be in the form of an ointment. Chinese medicine practitioners often use ‘raw herbs’, which have to be boiled in water and then drunk as a tea. This is time-consuming for the patient and practitioners may give the same prescription as a tincture or freeze dried powder instead.

Herbal medicine practitioners may also give advice about diet and exercise, if this is appropriate.

Your second appointment is likely to be between 2-4 weeks later and the length of your course of treatment will depend on the reason you are having herbal medicine treatment. The practitioner will probably adjust your herbal prescription at times during the course of treatment.

What precautions should I take?

Herbal medicines, like other medicines, have an effect on the body and should be used with care. Sometimes people mistakenly assume that simply because a product is natural it must be safe; there are many plants that are poisonous to humans. There are some safety issues to be aware of.

Some herbal medicines can interact with other prescribed medicines, so you should not take them at the same time. For example, St John’s Wort and antidepressants; St John’s Wort and drugs for high blood pressure and for heart conditions; St John’s Wort and anticoagulants such as warfarin; ginkgo biloba and anticoagulant drugs.

Herbal medicines made to poor standards may be a health risk. The Medicines and Healthcare products Regulatory Agency (MHRA) is the government body responsible for the safety of medicines in the UK. It collects information about any harmful effects (called adverse drug reactions) and it has warned the public that the standards of production of unlicensed traditional Chinese medicines can vary considerably. Some have been found to illegally contain pharmaceutical ingredients, heavy metals or toxic herbs. For example, some ‘herbal’ creams for skin complaints have been found to contain steroids that are not listed as ingredients.

Poor labelling of medicines can be a risk as this can lead to patients using the product incorrectly.

It is important that you discuss all your medical treatments with your herbal medicine practitioner and tell your doctor if you are taking or planning to take herbal remedies. This is particularly important if you are about to have an operation, or have had a liver complaint, or you are pregnant. Pharmacists can also give advice on safety.

If you feel worse or unwell in a different way while taking herbal medicines, you should tell your herbal medicine practitioner, your doctor or pharmacist straightaway. They can report any harmful effects of medicines, including herbal medicines, to the MHRA. To check whether the MHRA has issued advice about particular herbal products or ingredients, you can check Herbal Safety News on the MHRA’s website. In addition, Phytonet collects information about harmful effects of herbal medicines.

The Medical Toxicology Unit at St Guy’s and St Thomas’ NHS Trust suggests that patients ask for a list of the ingredients in any herbal product they buy or are given. If they later suffer any ill effects and need medical treatment, doctors will know what they have taken.

In some parts of the world, Chinese medicine practitioners use products that are made from endangered species of animals. This is illegal in the UK and the ban is strongly supported by the UK herbal medicine profession.

It has not been easy for members of the public to tell if an unlicensed herbal medicine (whether supplied over the counter in a shop or made up by the herbal practitioner) has been made to acceptable standards. The MHRA is planning changes in regulation and, from autumn 2005 onwards, will run a scheme for registering over-the-counter traditional herbal medicines. These products will have to meet assured standards of safety, quality and patient information. Advice will be available on the MHRA web site on how to identify these products.

There are some licensed herbal medicines on the market, which are made to assured standards and can be identified by the PL number on the product.

The MHRA also carried out a consultation in 2004 about possible changes to regulations governing unlicensed herbal medicines which are made up by practitioners to meet the needs of individual patients. The aim of these changes is to give the public greater assurance about standards. The MHRA is considering the results of the consultation and information about any further developments will be on its website.

Some herbal remedies should not be taken during pregnancy because if they are taken in large amounts there is a possible risk of miscarriage. These include feverfew; golden seal; juniper; mistletoe; nutmeg; rosemary and sage. It is also advisable not to take any herbal medicines in the first three months of pregnancy, unless you are going to see a registered herbal medicine practitioner about a specific problem.