Introduction to Chinese Medicine

Reports in the early 90’s of the benefits of Chinese herbal medicine in treating childhood eczema stimulated interest in the use of these medicines in the UK. Popularity has continued to grow and there are now at least 200 clinics in London and an estimated 2000 practitioners in the country. Use has spread beyond the ethnic Chinese population to all population groups in the UK.

This page aims to provide some essential background information on Chinese herbal medicine – what it is, how it is used, and safety issues. Health professionals can contact the Chinese Medicine Advisory Service for more details or if you have specific query.

China has an integrated health system - western orthodox medicine is used alongside traditional Chinese medicine and doctors may have training in both traditions. Traditional Chinese medicine includes herbal medicine, acupuncture, moxibustion, meditation and exercise (Tai Chi, Qi Gong) and dietary components and treatment may consist of combinations of these therapies. Traditional Chinese medicine has its own system of diagnosis, though some of the terms are the same as used in orthodox medicine. However the meanings may differ and, for example, ‘blood’ deficiency is not the same as anaemia. Diagnosis is based on history and clinical signs, also using features of pulse and tongue diagnosis.

In the UK, Chinese herbal medicine is most commonly used for chronic conditions such as eczema, psoriasis, rheumatism and gynaecological conditions, or for non-specific ill health and tiredness. They may also be used to complement and reduce side effects of orthodox treatment for cancer and AIDS. Clinical trials in the UK and Australia have shown efficacy in eczema and irritable bowel syndrome. Although many trials have been carried out in China few of these meet contemporary medical criteria.

In Chinese medicine, ‘herbal’ is a general term and includes animal parts and minerals. About 8,000 natural substances have been described as ‘materia medica’ in China, but of these only around 500 are used in the UK. An herbal prescription is generally a compound formula made up of between 10-15 ingredients. The medicine can be dispensed as raw herbs (dried and sliced), or as patent medicine (pills or concentrated powders). Raw herbs have to be boiled in water first and the fluid is taken as a tea. Each prescription is tailor-made for a patient and can change every few weeks after consultation.

As with any medicine, Chinese herbal medicine may have side effects. Those most commonly reported are nausea, abdominal discomfort and diarrhoea. More serious effects include jaundice, renal failure and cardiac effects. Some of these are known to be associated with specific herbs but others are thought to be idiosyncratic reactions. Because complex herb formulations are used it is not always possible to associate an adverse effect with a specific medicinal herb.

Clinically relevant interactions between Chinese herbal medicine and orthodox drugs are possible, though there are few published studies. The actual chemical composition of the herbal decoction or pills is not known, so it is very difficult to predict interactions. Health care providers should be aware of this, as closer monitoring may be required.

At present in the UK there are no minimum training requirements for herbal practitioners. There are a number of registers of Chinese medicine, but as membership of these is not compulsory it is difficult to identify trained practitioners. A system of statutory registration has been proposed and it is hoped that this will be introduced in the next few years.

Most of the herbal products available in the UK are unlicensed, with no evidence of quality, safety or efficacy. There are limited requirements for labelling and product information so the public may not have enough information about the safe use of these products.

The EU Directive on Traditional Herbal Medicinal Products introduced a registration scheme for over-the-counter herbal medicines, suitable for use without the intervention of a medical practitioner. Registered products will meet standards of safety and quality and labelling will be improved.

Herbal medicines assessed by the Medicines & Healthcare products Regulatory Agency (MHRA) have a PL (product licence) or THR (Traditional Herbal Registration) number on the label. These products are accompanied by clear comprehensive information about the safe use of the product. However the quality of unlicensed herbal medicines is not assessed by the MHRA and information provided may be incomplete or unreliable.

The majority of Chinese patent medicines in the UK are manufactured and imported from China. Some products have full labels with details of all ingredients and instructions for use, but the labelling of many is inadequate.

Some have labels only in Chinese, others have been repackaged with no list of ingredients and some have been identified where illegal ingredients have not been declared on the label. Combination products containing herbs and pharmaceuticals are used in China, but are illegal in the UK. A number of safety issues resulting from such patent medicines have been identified.

There are many highly trained qualified practitioners of Chinese medicine in the UK, providing good quality herbs and products to their patients. Unfortunately there is no entirely reliable way of identifying reputable practitioners or safe, good quality products. Reports from patients and practitioners confirm that there are benefits from the use of Chinese and other herbal medicines. However, quality issues remain a safety concern.

The Medicines and Healthcare products Regulatory Agency (MHRA) issued press statements in 2001 and 2004 warning consumers about the poor quality of some Chinese medicines available on the UK market. This was as a result of concerns expressed by the Committee on Safety of Medicines. It included comments from the then Chairman of the CSM, Professor Breckenridge:

"We recognise that many people value herbal remedies, such as traditional Chinese medicines and are keen that people carry on having the choice to use them. However there is clear evidence that standards used in the production of some TCMs on the UK market are, at best, unreliable. While many individual remedies are unlikely to pose any threat to public health, I am concerned that we continue to find further examples of TCMs containing potentially dangerous and often illegal ingredients. There is no reliable way for the public to identify those TCMs which could be unsafe.

When buying TCMs people should always be aware of the possibility of low quality or illegal products. They should not take them if they are not labelled and include a list of ingredients in English. Even then, clear labelling is not in itself a guarantee of good quality standards. When seeing their doctor or pharmacist people should always inform them that they are taking a herbal remedy."