As someone who has done 20 years of cutting-edge biomedical research and who runs this web site, I have witnessed the debate on whether the herbal medicine works or whether it is safe to use all the time.

Take a latest case report on this month's Lancet (July, 2006). A man who took a Chinese herbal medicine developed bladder cancer. The herbal formula he took is called Long Dan Xie Gan Wan, a formula in recent years already linked to kidney damage in numerous cases. The kidney damage is due to aristolochic acid, a natural compound of a herb used in the herbal preparation at the time. (The aristolochic acid containing herb has since been replaced or removed from most Long Dan Xie Gan Wan preparations. ActiveHerb has not sold this formula because of the safety concern until May 2007 when we obtain the clean product that DOES NOT contain aristolochic acid. Please see it here) The man took the formula for over 5 years. What can we conclude? According to the authors of the report, it "highlights the dangers of unregulated herbal therapy".

Fairly enough, also in the news of this month, is that a study finds acetaminophen, the active ingredient in Tylenol, damages liver. In the study published in JAMA (Journal of the American Medical Association), 40% healthy adults taking maximal doses of Tylenol for just two weeks showed abnormal liver test results. The adverse effect of acetaminophen on liver has been known for a long time but the scale of this damage still comes to the surprise. Now considering Tylenol is a nonprescription OTC medicine used by most, if not all, Americans in their life, what can we conclude here?

Obviously we cannot simply conclude whether herbal medicines or OTC medicines are safe. We need to look deeper into what might contribute to the adverse effects.

A common reason for drug side effects is the improper or wrong use of medicines. In the Long Dan Xie Gan Wan case, the man used it for enhancing the liver for over 5 years. However, the herbal formula is not used in Traditional Chinese Medicine (TCM) as tonics but rather used for purging the liver. In addition, the herbal remedy is not suitable for a long time use. However, he used the wrong product not only for months but for 5 years. This is a clear case of both wrong and improper use of herbal medicines. In the case of acetaminophen, its accidental overdose causes 100 death and 13000 emergency room visits a year in USA alone (more). The overdose occurs because acetaminophen is included in many OTC and prescription drugs and people unwittingly combine drugs or because misinformed belief that larger doses will give faster pain relief.

The well publicized side effect of ephedra belongs to its misuse as well. While ephedra is a Chinese herb, it has never been used in Traditional Chinese Medicine (TCM) as a single herb for weight loss. Instead, ephedra is used in TCM in combination with other herbs to deal with health concerns other than obesity and no toxic effect is observed.

Another reason for drug side effects relates to the poor product quality. While we can trust FDA in ensuring that every medicine on the market is made under the strict quality control procedures, bleach in quality control had previously happened in USA. Quality control of herbal medicines is certainly a major concern. One aspect of concern is the contamination of herbs by heavy metals (e. g., lead) and pesticides. There have been reports of toxicity caused by the excessive lead in herbal products. Another aspect of concern is that pharmaceuticals are mixed into herbs without being disclosed to consumers. For example, a claimed "all natural", "guaranteed to work", male enhancement product may contain the active ingredient of Viagra. It surely works. What you do not know is that really the Viagra ingredient works. This can easily get your health out of control. Here we would like to mention the herbal supplements ActiveHerb sells are strictly selected for their high quality.

Finally, side effects are intrinsic to many medicines and cannot be avoided. Their use depends on whether the benefits or the adverse effects outweigh. Why prescription drugs need to be prescribed by doctors? Because they all have side effects and the doctors' role is to direct their proper use. Remember Vioxx, the blockbuster painkiller withdrawn by Merck at the end of 2004? Vioxx is estimated to have caused 140,000 serious coronary heart disease! Multiple sclerosis drug Tysabri is a different story. After linked to several patient deaths, the drug was taken off the market in early 2005. But it now comes back with more restrictions on the use.

Some herbal medicines have intrinsic side effects too. However, many believe herbal medicines in general have much fewer side effects than pharmaceuticals. This notion seems to be supported by the occurrence of drug adverse reactions in China where TCM is widely used. A vast majority of drug adverse reactions reported in China are caused by chemical drugs. Most TCMs are classified as nonprescription drugs in China and have good safety profiles when used properly. Herbal medicines including TCM are regulated in USA as dietary supplements. This status of dietary supplements partly reflects their origin as food and their benign nature in action in most cases. From a historic perspective, herbal medicines have been developed on a trial and error process on human body over thousands of years, much like today we know what to eat as food and how we test drug safety in current clinical trials.

In the end, what can I conclude? No matter it is a mainstream medicine or herbal medicine, we have to use the right product, made in right quality and obtained from a reliable source, for the right application at the right dose and duration. Any compromise or omission may cause our health.

X. Li, Ph. D. (credentials)

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