The Problem with Traditional Chinese Medicine

[Prester John]

Is that you've got no idea whats in it:

http://www.mhra.gov.uk/news/presschinese.pdf

Aristolochic acid has caused a number of deaths in Belgium and at least 2 cases of Kidney failure in the UK.

TCM doesn't seem to be too concerned about what they are actualy selling and don't mind adulterating their products with pharmaceuticals. There have been cases of "traditional herbal" remedies for impotence containing viagra!

Caveat emptor.

 

[Deetee]

TCM doesn't seem to be too concerned about what they are actualy selling and don't mind adulterating their products with pharmaceuticals. There have been cases of "traditional herbal" remedies for impotence containing viagra!

Caveat emptor.

Imitation is the sincerest form of flattery

Coined by Charles Caleb Colton in 1820 in his 'Lacon.' First attested in the United States in 'Malice' (1940) by E. Cameron. The adage is found in varying forms." From "Random House Dictionary of Popular Proverbs and Sayings" by Gregory Y. Titelman (Random House, New York, 1996).

 

[Aragorn]

Is that you've got no idea whats in it:

Who doesn't know?
A professionally trained herbalist is aware of what's in it, and how to balance a prescription so that it is not dangerous.

I think the problem in this case was with Anna Yang (not a member of the Register of Chinese Herbal Medicine) and indirectly with the regulation of herbal medicine in the UK that allows non-regulated people to practice.

This all changes in 2007.

 

[Prester John]

Re: Re: The Problem with Traditional Chinese Medicine

Who doesn't know?
A professionally trained herbalist is aware of what's in it, and how to balance a prescription so that it is not dangerous.

I think the problem in this case was with Anna Yang (not a member of the Register of Chinese Herbal Medicine) and indirectly with the regulation of herbal medicine in the UK that allows non-regulated people to practice.

This all changes in 2007.

No, if you're talking general herbals perhaps you could get me the list of active ingedients from St Johns Wort. I eargerly await a detailed list of active ingredients and the range of concentrations of those ingredients...................................




back to TCM the MHRA is not very impressed at all with the whole sector and issued this warning

http://medicines.mhra.gov.uk/ourwork/licensingmeds/herbalmeds/tradchinmed_pressrelease_sept04.pdf

There are similar problems with TCM across europe and the US.

 

[Aragorn]

Re: Re: Re: The Problem with Traditional Chinese Medicine

No, if you're talking general herbals perhaps you could get me the list of active ingedients from St Johns Wort. I eargerly await a detailed list of active ingredients and the range of concentrations of those ingredients...................................

Please, do your own research...
I hope you won't wait too eagerly for too long. Probably not good for the BP. There are more ingredients in St John's Wort than anyone can list.
(Sorry I wasn't specific - I was talking TCM, not herbals in general)

It is absolutley true that there are unscrupulous herbal suppliers, and the MHRA have been on the case for some time. They are fond of banning herbs that can be shown to contain harmful ingredients (regardless of how those herbs are balanced in a prescription) as well as herbs that appear not to have any harmful effect.

As I understand it, TCM practitioners have been able to work with the bans by using substitute herbs. But in some cases, it must be like trying to work with one hand tied behind your back.

 

[Prester John]

Actually we don't know is the answer to the ST Johns Wort Question. Thats the point.

Since you are refering to TCM, perhaps you can tell me the active ingredients in Fufang luhui jiaonang, together with their concentrations.

Maybe for bonus points you could tell me which toxic metal made up 11.7% by weight of a particular batch tested, and how many shops this particular batch was found in?

So now say again how the TCM herbalists know whats they are selling.

 

[Psi Baba]

The problem I have with traditional Chinese medicine is that the more endangered the animal species that must be slaughtered to produce it, the more desirable it seems to be, rhino horn, tiger and leopard bones, and turtle shells come to mind.

 

[Aragorn]

So now say again how the TCM herbalists know whats they are selling.

PJ - We're talking at cross purposes. My fault.

It is appalling that there are suppliers around who are introducing high levels of mercury into their products, such as in fufang luhui jiaonang. And that these products can disseminate into as many as 35 unregulated shops around the country. Steroid preparations have also been found in herbal ezcema creams supplied by unscrupulous herbal "doctors". This is clearly wrong and, this being your point, I entirely agree with you. The unregulated use of chinese herbal products is bad news.

The RHCM is much more scrupulous. As a professional body, its members are not going to be supplying these "off-the-shelf" preparations that could contain anything.
My point (misdirected as it turns out) was that a professional chinese herbalist, making up their own prescriptions from pure dried herbs to be used in a decoction, sourced from reputable suppliers who do not include additives, or rare/endangered animal parts etc, is far removed from the Anna Yang story that you posted this thread about.

So the point that I was trying to make was that the Anna Yang case doesn't illustrate a problem with traditional chinese medicine as a whole, but with the regulation of the products used, and the regulation of the practitioners using them. As I said - this all changes in 2007.
I fully accept I may be misunderstanding this, but the generalisation you have made seems to be the same as saying:
The problem with conventional western medicine ... is that you don't know whether you doctor is a serial killer.


Being new here, I hadn't realised it was forum etiquette to post a little quiz for each other, so here's yours:

• List the chinese herbs that make up the fufang luhui jiaonang formula.
  For bonus points, demonstrate how these ingredients have been seen to be dangerous as prescribed by a RCHM regulated practitioner.[/list=]

 

[Deetee]

Are you implying that an RHCM practitioner requiring to use a fufang luhui jiaonang remedy would NEVER use an off-the-shelf packaged compound, but would ALWAYS make it up from its pure original herbal ingredients?

(yes you are, but I want to hear you say it for the record)

 

[Rolfe]

So the point that I was trying to make was that the Anna Yang case doesn't illustrate a problem with traditional chinese medicine as a whole, but with the regulation of the products used, and the regulation of the practitioners using them. As I said - this all changes in 2007.

Do you really mean that after 2007 every TCM practitioner will be required to formulate every remedy by hand from the raw plant ingredients? I seriously doubt it, because all this "regulation" has only got the political go-ahead because of the influence of the big business interests selling prepared TCM remedies.

However, even assuming that this hand-formulation is best practice, how do you know that your supplier has supplied the herb you wanted? How do you know it isn't adulterated in some way (these things are great substrates for toxin-producing moulds)? Do you always insist on the exact botanical species you want, or do your recipes allow "look-alike" substitutions? How do you know that one batch of a herb from one source will have the same concentrations of the active ingredients as one from another source?

And best of all, what the heck is "balancing a prescription"? Are you seriously implying that genuinely toxic ingredients may be incorporated, but that these can be and are rendered non-toxic by something else included in the recipe?

This is scary stuff.

Rolfe.

 

[Aragorn]

Are you implying that an RHCM practitioner requiring to use a fufang luhui jiaonang remedy would NEVER use an off-the-shelf packaged compound, but would ALWAYS make it up from its pure original herbal ingredients?

(yes you are, but I want to hear you say it for the record)

How strange to ask me a question, then answer it yourself.
I'm sorry, but I don't know what your presuppositions are, and I don't understand your perceived implication based on what I've written.
And, what record? Am I missing something?

As for your question, I haven't heard of a RHCM practitioner requiring the use of fufang luhui jiaonang in the first place.
I am not sure why such a practitioner would opt for theis formula when they have the training and means to make up a forumla that is specifically suited to the patient at hand.
However, I am not a chinese herbalist and have rather limited knowledge of the subject. Could you tell me why you would prescribe fufang luhui jiaonang in preference to a bespoke formula?

 

[drkitten]

However, even assuming that this hand-formulation is best practice, how do you know that your supplier has supplied the herb you wanted? How do you know it isn't adulterated in some way (these things are great substrates for toxin-producing moulds)? Do you always insist on the exact botanical species you want, or do your recipes allow "look-alike" substitutions?

Let's be reasonable here, Rolfe. I'm no fonder of quackery than you are, but you're holding the TCM practitioners and suppliers to a much higher standard than you hold conventional medicine. I assume that you prescribe (and use in your practice) off-the-shelf compounds made by someone else, and you have no practical way of knowing whether or not Novartis screwed up and you have the batch of genericillin which has been contaminated by unobtanium sulphate.

Chiron screwed up the flu vaccine pretty badly. There's nothing specifically Chinese about putting poisons in expensive little bottles.

 

[Rolfe]

Notice that these were questions I was asking, and to which I was hoping for a reply.

The reply I was hoping for was that the standards of manufacturing control to be imposed on the TCM suppliers are to be equivalent to the standards imposed on real medicine, in particular as regards toxicity and purity testing.

Of course I rely on manufactured pharmaceuticals, when did I ever say I thought it was better to start cooking up my own prednisolone in the garage? However, I have the security of knowing that those from whom I obtain the stuff are subject to mandatory regulation. Now, just how many people actually received a dose of the faulty Chiron vaccine? (Hint, it's a nice round number.) And why was this? Because the process of manufacture was regulated. The problem was a lack of supply, not one of patients being poisoned by adulterated product.

So no, I don't think this is double standards at all. In fact, precisely the opposite. I don't demand that everyone be infallible, but I do demand that everyone be held to the same regulatory standards. And I point out that these standards work.

As I said, nobody was dosed with the contaminated Chiron vaccine. Other things have been taken off the market after people had received them, and indeed been harmed by them, but again only because of the regulatory process. Thanks to proper procedure, we know that cox2 inhibitors can cause stroke and heart attack (if I've got that right). Because the epidemiological studies were done. If "fufang luhui jiaonang" produced the same effect at the same rate of occurrence, is there any possible way to tell? No, because there are no safety reporting systems and no long-term controlled safety trials of TCM of the sort that showed the problem with the cox2s.

I want single standards of proof of efficacy and proof and maintenance of safety/non-toxicity, the same for all branches of "medicine".

Rolfe.

 

[drkitten]

And best of all, what the heck is "balancing a prescription"? Are you seriously implying that genuinely toxic ingredients may be incorporated, but that these can be and are rendered non-toxic by something else included in the recipe?

Again, I think you may be overreacting here.

Are you familiar with the drug Lomotil? It's primary use, I believe, is to treat severe diarrhea. Chemically, it's a combination of two poisonous substances : diphenoxylate and atropine. Either alone are poisonous (as is almost anything except a placebo in sufficient dose, of course), but their effect in combination is much less so, because the effects counteract each other. Specifically, diphenoxylate is a CNS depressant (related to some narcotics), while atropine, of course, is a stimulant.

So while the combination is still not something I would pop for fun at a party, I understand that the combination is substantially less dangerous than either one alone.

Heck, for that matter, the most widely used antidote for atropine poisoning -- physostigmine -- is not exactly fun stuff either. And, for that matter, the standard antidote for physostigmine poisoining is atropine.

So the idea that one might be able to balance a set of nasty drugs to get something worthwhile isn't confined to Chinese medicine.

 

[Rolfe]

Chemically, it's a combination of two poisonous substances : diphenoxylate and atropine. Either alone are poisonous (as is almost anything except a placebo in sufficient dose, of course), but their effect in combination is much less so, because the effects counteract each other. Specifically, diphenoxylate is a CNS depressant (related to some narcotics), while atropine, of course, is a stimulant. ....

I know all that. I was sort of hoping for a similar rational explanation of his methods from Aragorn. Not hoping very seriously, but hoping nevertheless.

If Aragorn can actually explain and justify his use of potentially toxic ingredients in "balanced" prescriptions in a similar manner to the explanations of how toxic components in licensed medicines are rendered safe, I'll be very impressed.

Gobsmacked, but certainly impressed.

Rolfe.

 

[Aragorn]

Do you really mean that after 2007 every TCM practitioner will be required to formulate every remedy by hand from the raw plant ingredients?

God no! But hopefully, no-one who cannot meet the standards of training currently set out by the RCHM will be allowed to practice TCM at all. This would eliminate the plethora of unregulated high-street herbal shops that are selling the sort of stuff that PJ linked to.

However, even assuming that this hand-formulation is best practice, how do you know that your supplier has supplied the herb you wanted? How do you know it isn't adulterated in some way (these things are great substrates for toxin-producing moulds)? Do you always insist on the exact botanical species you want, or do your recipes allow "look-alike" substitutions? How do you know that one batch of a herb from one source will have the same concentrations of the active ingredients as one from another source?

Agreed. These are serious concerns, and I share them. There are UK suppliers who are commited to sourcing the herbs in there correct form. I see no reason why "look-a-like" herbs should be supplied instead, or why such a substitution wouldn't be noticed by such a distributer. I can't see why the highest standards shouldn't be applied to supply of herbs.
Do you know how the proposed regulation will affect quality control for imports? There must be measures in place to minimise the risk of contamination from moulds etc?

And best of all, what the heck is "balancing a prescription"? Are you seriously implying that genuinely toxic ingredients may be incorporated, but that these can be and are rendered non-toxic by something else included in the recipe?

This is scary stuff.

Your assumption is indeed scary, but, no I am not making this implication.
My apologises for the confusion: I was not refer to genuinely toxic ingredients such as mercury. I was referring to strong herbs that can cause a range of reactions such as vomiting, diarrhoea etc. These effects can be minimised through "balancing the prescription" i.e. include herbs that counteract these effects.

 

[Aragorn]

I know all that. I was sort of hoping for a similar rational explanation of his methods from Aragorn. Not hoping very seriously, but hoping nevertheless.

If Aragorn can actually explain and justify his use of potentially toxic ingredients in "balanced" prescriptions in a similar manner to the explanations of how toxic components in licensed medicines are rendered safe, I'll be very impressed.

Gobsmacked, but certainly impressed.

Rolfe.

Rolfe - has there been a mistake? I am not a herbalist! Why are you being aggressive towards me personally?

Our posts have crossed - here's hoping that my response above satisfies at least some of your curiosity.

 

[drkitten]

My apologises for the confusion: I was not refer to genuinely toxic ingredients such as mercury. I was referring to strong herbs that can cause a range of reactions such as vomiting, diarrhoea etc.

Excuse me? How do you draw the distinction between a "genuinely toxic ingredient" and one that can merely cause a range of reactions? Even water is toxic in sufficiently large doses, as well-documented by The Perfect Storm or Titanic.

 

[Rolfe]

Thank you Aragorn, those were reasonable replies. No doubt there will be some new problems in regulating things like herbal supplies, but I imagine they can be solved - testing for the presence of undesirable contaminants is probably the way to go.

Now, could you comment on what I was saying about a level playing field? The licensed pharmaceuticals I use have all had to prove not just safety but efficacy, to a pretty high standard, before they are permitted to be sold with any claim that they can cure or prevent or alleviate disease. How do you feel about you and your suppliers being held to the same standards?

I take your point about possibly being able to counteract a herb that causes vomiting by including a herb that with an opposite action. However, in order to be able to do that in conventional medicine, pharmacologists have to understand in a lot of detail exactly what the active ingredients in each category do within the body, and how they interact with each other. New drkitten gave a good outline of the sort of detail that is necessary.

Do you think that you ought to understand what you are doing with these herbal ingredients to the same level of detail, and be able to explain and justify your practices in molecular terms?

If not, why not?

Rolfe.

PS. But I also agree with new drkitten's latest post. Where do you draw the line between a very undesirable, unpleasant effect, and "real poison"? Many plants have pharmaceutically active components that are normally considered to be poisons - belladonna, digitalis, morphia and so on. The distinction seems a bit specious.

 

[Aragorn]

Even water is toxic in sufficiently large doses, as well-documented by The Perfect Storm or Titanic.

Very good! Too much of anything is fatal!

Excuse me? How do you draw the distinction between a "genuinely toxic ingredient" and one that can merely cause a range of reactions?

Indeed - this was in reference to mercury and other additives that are unscrupulously included in some TCM pills.
Of course some herbs contain toxic substances (i.e may have unpleasant effects if used in isolation), but used properly in a prescription (not in isolation) the effects are minimised, as I understand it.