Michael H. Dong MPH, DrPA, PhD with Jennifer I. Dong

1. Chinese Herbal Medicines: The Good, the Bad, and the Ugly Michael H. Dong MPH, DrPA, PhD with Jennifer I. Dong readings

3. Learning Objectives 1. To understand how Chinese herbal medicines (CHM) are used worldwide. 2. To familiarize the students with some of the negative aspects of CHM. 3. To learn the additional beneficial effects of CHM. 4. To gain insight into the controversies surrounding the use of CHM.

4. Performance Objectives 1. Be able to characterize the basics of Chinese herbal medicines (CHM). 2. Be able to identify some of the adverse cases associated with the use of CHM. 3. Know the basic properties of the major class of Chinese herbs. 4. Know the factors that continue to make CHM unacceptable to many people. 5. Know how to use some of the resources for advancing CHM.

5. Contents of Lecture 1. A brief introduction of how Chinese herbal medicines (CHM) are used worldwide. 2. Toxicological or side effects of CHM. 3. Beneficial effects on health prevention and health maintenance. 4. Controversies over the use of CHM. 5. Resources for advancing CHM.

6. Traditional Chinese Medicine • Has been practiced for many centuries. • Uses holistic concepts and elements of natural energies to restore body homeo-stasis and hence to treat the disease. • Relies principally on acupuncture and herbal drugs to restore patients’ health. • Chinese herbs include plant, animal, and mineral substances. • Recently has increasingly found its way into Western medicine.

7. Use of Chinese Herbal Medicines (CHM) in the USA • Use of CHM has soared in the USA since the passage of a law in 1994. • Many CHM are now treated as dietary supplements, thus not subject to any stringent health regulation. • Millions of Americans are now taking Chinese herbal products. • Not enough Congressional support to overturn current regulations on CHM.

8. Use of Chinese Herbs in Europe and Australia • Europe takes half of the global market for herbal medicines (HM) in 1996. • Use in Europe largely based on rule of historical use as evidence of herb safety. • European governments are more pro- active in regulating the use of HM. • Australia requires registration of practitioners as a means to regulate the dispensing of Chinese herbs.

9. Use of Chinese Herbs in Hong Kong and China • Hong Kong has enacted an ordinance and established a council to regulate the use of Chinese medicines. • China revised the Pharmaceutical (Administration) Law requiring drug manufacturers to obtain good manufacturing practice certification. • China’s law exempts Chinese herbs from following the new standards.

10. Ways in Which Chinese Herbs Are Used • Countless numbers of remedies have been prepared from a small fraction of approximately 6,000 Chinese herbs. • Used to treat the whole body with a focus on one or more body organs, but based primarily on holistic concepts. • Herbal formulas are used to mitigate the toxic effects of some herbs.

11. Negative Aspects of Chinese Herbs (I) • Poisonings from misuse of Chinese herbs do occur from time to time. • Misuse can also lead to acute or long-term adverse effects. • Chinese herbal products can be contaminated with heavy metals. • Extensive clinical trials on (long-term) side effects are not well documented.

12. Negative Aspects of Chinese Herbs (II) • Drug adulterations or drug interactions are found in some Chinese herbal medicines (CHM). • Misleading labels can also be problems with CHM sold over the counter. • Unapproved ingredients and heavy metals can be introduced during the formulation or cultivation of herbs.

13. Negative Aspects of Chinese Herbs (III) • More than 50 cases of kidney damage have been linked to Chinese herbs added to slimming capsules. • Several cases of liver problems have been linked to Chinese herbs used for skin conditions. • Acute hepatitis has been linked to some Chinese herbal products used for eczema or psoriasis.

14. Negative Aspects of Chinese Herbs (IV) • Some Chinese herbs are found to have caused cardiac adverse reactions and pneumonitis. • At least one herb was considered to be carcinogenic; another one was reported to increase risk of bleeding when used concomitantly with the drug warfarin. • Some others are known to cause allergic reactions.

15. Positive Aspects of Chinese Herbs (I) • Many Chinese herbs contain a variety of vitamins or minerals and hence can be used as dietary supplements. • Those herbs that are antioxidants can alleviate or prevent various disorders. • Herbs cooked with food are highly digestible, assimilable, extremely nutritious, and sometimes delicious.

16. Positive Aspects of Chinese Herbs (II) • A majority of Chinese herbs are famous for providing body strength and energy. • These tonic herbs are super-nutrients with an ability to enhance body functions. • They have anti-aging functions with no known adverse effects when used properly; and are easily digestible.

17. Positive Aspects of Chinese Herbs (III) • As an example, ginseng is a classic tonic herb used to enhance endurance. • The plant contains chemicals capable of nourishing and regulating the nervous and endocrine (hormonal) systems. • Ginseng may arouse sexual desire, even though long-term use of this plant could lead to some adverse effects.

18. Positive Aspects of Chinese Herbs (IV) • Tang kuei is another classic tonic herb used for centuries to build blood. • The herb can be used to alleviate pre-menstrual symptoms, muscular aches, and bowel movements. • A number of Chinese athletes regularly consume tonic herbs to supplement their stringent training regimen.

19. The Ugly Side of Chinese Herbs (I) • Some herbs have an unpleasant smell and a very bitter taste. • Stories are rarely reported on positive experiences with use of Chinese herbal medicines (CHM). • Disbelievers of traditional Chinese medicine are skeptical about the merits of CHM and have no room for therapy based on holistic concepts.

20. The Ugly Side of Chinese Herbs (II) • There are controversies over the use of some Chinese herbs, adding greater discomfort for disbelievers. • As an example, ginseng is said to have many faces regarding its effects. • Adequate standards and processes are not in place to guarantee the claimed effects and quality of Chinese herbs.

21. Institutes for Advancing Chinese Herbal Medicine (I) • Over a hundred of traditional Chinese medicine (TCM) institutes are located worldwide, with > 50% in the USA. • Chinese herbal medicine (CHM) is a key branch of TCM; students thus may receive CHM training in these institutes. • These institutes often take a leadership role in advancing CHM through joint programs and scientific conferences.

22. Institutes for Advancing Chinese Herbal Medicine (II) • Institutes located in Asia are fewer than 50, with expectedly the majority in China. • One institute in Beijing has compiled the English-Chinese Textbook Series in traditional Chinese medicine (TCM). • The university in Shanghai is one of the leading institutions in the world for TCM. • The university in Nanjing is known as the birthplace of the earliest TCM scholars.

23. Institutes for Advancing Chinese Herbal Medicine (III) • In Hong Kong, research into the effects of Chinese herbs is an ongoing activity at several local universities. • Some of these local universities also offer degree programs in Chinese medicine. • These educational and research programs all point to the direction that Chinese medicine should be used as an alternative or a supplement to Western medicine.