Near my house there’s an Asian grocery store. Occasionally I will drop in when I’m looking for ingredients for dishes that I can’t seem to find anywhere else. Walking through the store, I’m struck by how many foods are on the shelves that I’m totally unfamiliar with, and wonder how I might use them in a meal. I’m a label reader, and I can’t help but think about the ingredients and wonder about what kinds of additives, if any, are in these strange and different foods. Unfortunately in this store, most of the labels aren’t too helpful because most are written in Chinese.
It’s no secret that China has a history with issues regarding the quality and purity of some foods, drugs, and herbs being consumed there and imported to other countries. Recently, the Chinese government has been trying to remedy the situation through training, inspections, and the institution of good manufacturing practices, however there is still some mistrust and hesitation on the part of consumers.
As a result, when I prescribe Chinese herbs for my patients, some ask about the quality and ingredients in the herbs I’m using. Most people want to be reassured not only that they’re effective, but also that they’re safe. When it comes to Chinese herbs, there are a number of issues to take into consideration. Among them:
-Is what’s on the label actually what’s in the bottle? This is a valid concern, whether you are talking about supplements made in the United States or herbs that have been processed in China. How can you be sure of what you’re taking? The bottom line is that you can never be positive, but there are safeguards that you can take.
Most reputable herb companies will tell you in their catalogue or online about their manufacturing process. I only order herbs from companies that are willing to share that information. The herbs that I prescribe have been tested for composition, purity, and to screen for heavy metals and pesticides. In addition, the manufacturers can, if asked, provide proof of their procedures and controls for sanitation and hygiene. Also, reputable herb companies abide by current good manufacturing processes, which is indicated by cGMP on the label.
-What about toxicity? There are two issues with toxicity. The first is discussed above. It’s important to understand how the herbs you’re taking have been processed. Are they screened for heavy metals and pesticides? Are there any added preservatives? You can find this information out from any reputable manufacturer.
The second issue regarding toxicity is whether the herbs themselves are toxic when taken at a reasonable dosage or over time. The history of Chinese herbal medicine is over a thousand years old, and centuries ago toxic ingredients were used unknowingly. Over time, those substances have been completely removed from the Chinese formulary, or are used with extreme caution. It’s important to understand that Chinese herbs contain numerous compounds, and as with any medication or supplement, what is safe at the correct dose can be toxic at a high dose. For that reason, it’s imperative that you understand the credentials of the person who is prescribing your herbs. Acupuncturists who are adequately trained in Chinese herbal medicine must take years of coursework and pass a national exam. Don’t hesitate to ask your practitioner about their training in diagnosis and treatment with Chinese herbs.
-How about herb/drug interactions? In order to prescribe herbs safely, your practitioner needs to have a complete list of the medications—both prescription and over the counter—that you’re taking. A few notable examples of herb/drug interactions include the use of any herbs with anti-clotting Warfarin or Coumadin, as the herbs can decrease the effective of that medication. Taking an antacid medication can decrease the absorption of any herbs you’re taking, and licorice may affect your sodium/potassium balance, and shouldn’t be taken with diuretics. While I can decrease the herbal dosage, or prescribe a short course of herbs, in almost every case when a patient is taking several prescription medications, to be on the safe side, I won’t prescribe an herbal formula at all.
-Is Chinese herbal medicine effective? Treating patients with Chinese herbs for a wide variety of conditions has been a practice for over a thousand years. In fact, many modern hospitals in China today feature both a medical and herbal pharmacy. A great number of modern drugs—from aspirin to digitalis to malaria medications—have been developed from herbs, and research is ongoing to document the effectiveness of other herbs for a variety of illnesses. While many people think that because herbs are natural, they aren’t very strong. However, Chinese herbs can be a powerful and effective way to treat a great number of health conditions