Chinese Medicine - Modern Practice (252 pages)

Risks of Traditional Chinese Herbal Medicine 11
Wu, 1996a and b; Wong et al., 1998a and b) TCHM intake had been
prolonged until a diagnosis of intoxication was made. Intoxications have
also been documented in the West (Lightfoote et al., 1997; Schaumburg
and Berger, 1992; Kang-yum and Oransky, 1992; Markowitz et al., 1994).
Other potential contaminants of TCHMs include toxic botanicals (see
above), micro-organisms, microbial toxins, pesticides and fumigation
agents (De Smet, 2002).
Numerous instances are on record where TCHMs have been adul-
terated with synthetic drugs. Table 2 lists such ingredients identified in a
recent systematic review of the subject (Ernst, 2002a). One fatality (Ries
and Sahud, 1975) and several potentially life-threatening events have
repeatedly been documented (Forster et al., 1979; Offerhaus and Dukes,
1979; Hughes et al., 1994; Stricht et al., 1994; Goudie and Kaye,
2001).
1.12 TCHM-Drug Interactions
Interaction can be either pharmacodynamic or pharmacokinetic by nature.
In the former case, both interacting medicines typically have the same
pharmacological effects; the result would be an exaggerated clinical
response. In the latter case, one medicine interferes with the absorption,
distribution, metabolism or excretion of the other; the result would be an
exaggeration or diminution of the clinical response.
A recent systematic review (Fugh-Berman and Ernst, 2001) of all
documented cases of herb-drug interactions comprised 11 instances of
clinical events (Tam, 1995; Izzat, 1998; Yu, 1997; Page, 1999; Ellis,
1999; Galluzi et al., 2000; Matthews, 1998; Rosenblatt and Mindel, 1997;
Janetzky and Morreale, 1997; Jones, 1987; Shader, 1985). Their details
are summarised in Table 3. Virtually all interactions concern the blood
coagulation system. The reason might be that anti-coagulated patients are
closely monitored. Thus interactions might affect other physiological
functions but remain unnoticed. In addition to these documented clinical
cases, numerous herbal medicines have the potential of interacting with
synthetic drugs (Ernst, 2000a).