Allergies can also occur to TCM herbs. Finding out which herb in a mixture patients are allergic to is not always easy. It could also be that patients did not react to the TCM mixture at all, but to something they happened to be eating at the same time. Allergies occur more frequently with certain herbs, such as herbs that are related to celery, i.e. umbelliferous plants such as Angelicae dahuricae:

• Angelicae dahuricae, Radix (Bai Zhi)

• Angelicae pubescentis, Radix (Du Huo)

• Angelicae sinensis, Radix (Dang Gui)

• Angelicae sinensis, pars caudalis radicis (Dang Gui Wei)

• Bupleuri, radix (Chai Hu)

• Centellae, Herba

• Chuanxiong, Radix (Chuan Xiong)

• Cnidii, Fructus (She Chaung Zi)

• Foeniculi, Fructus (Xiao Hui Xiang)

• Ligustici sinensis, Radix (Gao Ben)

• Notopterygii, Radix et Rhizoma (Qiang Huo)

• Peucedani, Radix (Qian Hu)

• Saposhnikoviae, Radix (Fang Feng)

There are other herbs from other plant families that can also react to an allergy to celery. In our range these are

• Artemisia annua (Qing Hao)

• Artemisia argyi (Ai Ye)

• Artemisia scoparia (Yin Chen)

Allergies can also occur to herbs other than those mentioned above. If an allergy occurs, you should stop taking TCM remedies immediately and contact your therapist. An allergy can be proven by taking the suspected remedy again after the allergy has subsided. However, we do not recommend this because the reaction could be more severe the second time. This should be done under the supervision of a therapist.

Side effects can occur when taking TCM remedies. Most of the ones we hear about are not worrying. They subside spontaneously after stopping the medication. Serious side effects must be reported. Contact us and we will help you to assess whether a report needs to be made to Swissmedic. Make sure you have all the necessary information ready (personal details, medical history with Western and TCM diagnoses, formulation, dosage, duration of use, symptoms, conventional medicines, etc.).

Further reading:

• Integrated Phamacology - Combining Modern Pharmacology with Chinese Medicine (Greg Sperber and Bob Flaws)
• Drug interactions in phytotherapy (Sabine Ritter)
• Drug Interactions from the Perspective of Chinese Medicine (Sabine Ritter)
• - Interactions between Chinese Hebal Medicinal Products and Orthodox Drugs (Kelvin Chan and Lily Cheung)
• Herb Contraindications and Drug Interactions (Francis Brinker)

And this too: Online courses at www.compleducation.ch: Contributions by various people on pharmacology etc. (e.g. Sperber, Ritter)

The answers to these questions can usually only be vague. Much has not yet been sufficiently investigated or is not known. It will probably never be possible to judge most of it conclusively, because very often the prescriptions that are prepared in TCM are individually tailored to the patients to be treated, with the type and quantity of components varying from patient to patient. In addition, each patient is a unique individual with a particular constitution at the time of prescription. His genome and his current disorder influence the effect of the prescription and there are accompanying factors due to the way he eats, what he drinks and what mental state he is in and even the environmental conditions (weather, travelling, job, stress...) can influence a drug effect.

Even if individual components of a formulation, i.e. one herb or another, should interact in some way with the conventional medical remedies taken at the same time, it is quite possible that in the mixture under discussion this interaction is cancelled out or, on the contrary, even intensified by the added remedies.

The data on interactions is often based on a solid foundation. Reasons may be

• Insufficiently qualified starting material (were the herbs of the correct botanical type? Were they clean in terms of heavy metals, aflatoxins, pesticides, microbiology and other contaminants? (in my opinion the most common reason, but also the one that gets the least attention).
• Was the application done correctly (cooking process, quantities, intake)
• Does the data come from laboratory experiments (cell cultures, animal experiments...) or from clinical studies?
• Is the study methodologically correct and meaningful? Study designs, as they are designed for western conventional medical drugs, often cannot be applied to TCM. The study design hierarchy considers randomised, controlled, double-blind studies to be the measure of all things. The significance of studies using other approaches, such as individual case studies, is considered to be inferior.
• Are the authors of a statement or study independent and reputable? Rarely in the case of older data from China, as it was tantamount to a serious loss of face if the outcome did not meet expectations. Highly positive values with success rates of 80 to almost 100% were the rule rather than the exception.
• Is an interaction that occurs in Asians, who have slightly different genetic characteristics, transferable to European people?
• Toxicologists and experts (often self-appointed) work with tunnel vision, assessing individual herbs or even just individual substances from one, and often only from laboratory or animal studies. What is needed are systems biologists who would have to assess the entirety of the effects of a formula according to all criteria.

A western conventional medicine remedy usually consists of a single molecule. Whilst its effect can still be followed to some extent in a patient's body, this is difficult for a TCM formula (in laboratory chemistry thinking this is meant here. In the TCM way of thinking, the effect is easily 'measurable'). Even a single herb is a mixture of many substances and contains dozens of ingredients that do not always have the same composition. A TCM formulation has even more. TCM deliberately refrains from standardising on a specific quantity of a single ingredient.

What procedure is recommended after all that has been said? A proper TCM diagnosis and close patient monitoring and observation are the most reliable factors for recognising effects, side effects and interactions. The experience of the therapist is enormously important and therefore the best therapists are those who, in addition to a good knowledge of TCM and the ability to observe closely, work with great empathy and empathy and also treat many patients, preferably specialising in a few problems and a limited number of herbs or formulations.

Some TCM remedies are given for an unfulfilled desire to have children, but you don't always know immediately if a pregnancy has occurred. Some TCM remedies are given during pregnancy to prevent miscarriage. Some remedies should not be given during pregnancy, for example those that favour a miscarriage. Some remedies exist which, according to TCM textbooks, help against abortion, against wild labour, against a restless foetus or which serve to have a strong and vital child or to keep the mother strong. As you can see, there is no clear answer to the question of whether someone should avoid TCM remedies completely or temporarily during pregnancy, or whether they should take them all the more. It is up to the person who prescribes TCM remedies to answer this question. Medication is often avoided in the first three crucial months, when organ development begins. Sometimes this is done more for forensic (=legal) reasons and less from a truly TCM perspective.

Certain herbs should not be prescribed during pregnancy (and possibly also during breastfeeding). There are various reasons for not using these remedies, for example if they are herbs that affect blood clotting or favour abortion or have other toxic potential that is sometimes accepted for other diseases by weighing up the benefits against the risks. Every medical system makes such judgements, especially Western conventional medicine, where certain officially approved drugs (and therapies, e.g. surgical ones) even indicate that a certain percentage of patients will suffer harm or even die, but an even larger percentage can be saved. Some TCM herbs that were previously banned for use during pregnancy and breastfeeding are used today. The ban at that time can be traced back to the fact that people could not always be sure of the quality of the goods on offer and preferred to avoid them in such cases. It could happen that certain herbs were mistaken for poisonous ones or that the detoxification process, in which the poisonous components were removed from some herbs, was not carried out properly. With today's quality controls, such dangers can be avoided, so that a formerly banned herb is now fit for use. Some herbs contain substances that can be toxic on their own. For example, they can alter genetic material, which can lead to malformations, malignant tumours or other damage. Such processes can be demonstrated in animal experiments or in laboratory cell cultures. However, it is questionable whether the results of such experiments can be transferred 1:1 to humans. In addition, the following three facts must be taken into account: 1) TCM has known how to use its herbs for centuries and has learned to deal with their dangers by knowing how to neutralise the toxicity of a herb through appropriate treatment (cooking, roasting, fermenting, extracting in various ways (alcohol, water, etc.)) or by adding other herbs to the formulas which neutralise a toxic ingredient of a herb. 2. animal experiments and laboratory tests usually work with a single herb or even just a single active ingredient from it. However, the toxicity of an entire formulation cannot necessarily be deduced from this. 3. it is possible that a potentially toxic ingredient can have positive effects at low doses, but toxic effects at high doses.

At www.compleducat ion.ch you will find information on TCM remedies that interact with conventional medical remedies or are unsuitable or prohibited in themselves during pregnancy and breastfeeding. The authors of such articles include Sabine Ritter and Greg Sperber.

At www.compleweb.ch you will find our 'Compendium'. This contains information from the most popular TCM textbooks. When entering a remedy, you will find information on whether it is unsuitable or prohibited during pregnancy and/or breastfeeding.

TCM formulations may contain sugary components such as fruits and roots. In addition, granules are usually granulated with (corn) starch or maltodextrin. Both are sources of sugar and are not suitable for diabetics. A daily dose of TCM granules is often between 9 and 20 grams. Most of these quantities (estimated: 60-90%) should be considered as sugar equivalents in the diet of diabetics.

Herba Ephedrae (Ma Huang, sea dew) must not be used in doping samples. This remedy is often found in formulations for colds, coughs and asthma, as it contains the active ingredient ephedrine. Ephedrine has a similar effect to adrenaline and amphetamine is also produced from ephedrine. Pinellia (Ban Xia) also contains minimal amounts of ephedrine. Doping authorities set a limit of 10 micrograms/ml in urine. To detect ephedrine in blood or urine, this information can be found on the Internet:

"In blood, ephedrine is normally detectable for a maximum of 24 hours after consumption. If the presence of the substance is to be checked by means of a urine test, a period of between two and four days is usually decisive. Incidentally, the active substance can be detected for the longest time in the hair: even if several months have already passed, ephedrine can still be detected by a hair analysis. Please note that these figures are only intended as a guide. Depending on how much a person has consumed, the condition of the body or how much time has passed between the consumption of ephedrine and the drug test, the detection times can vary."

About Pinellia (BanXia): Our main supplier reports that they have not yet succeeded in detecting ephedrine in Pinellia. This is probably due to the fact that the ephedrine content in Pinellia is around the detection limit for this substance, i.e. the content is so low that it is probably only just detectable or not detectable at all with highly sensitive laboratory equipment. The laboratory manager at Brion, the analytical laboratory of our main supplier, has already expressed the suspicion that the reports about ephedrine in Pinellia could be a story that is being bandied about in the specialist literature but is not factual. Subhuti Dharmananda, a source of information that we always hold in high regard, reports that the ephedrine content in Ma Huang is 0.7-1.2%, in extracts (granules) 6-8%, whereas in Pinellia (BanXia) it is 0.002%.

Based on these reports, it can be assumed that athletes who have to submit doping samples do not have to refrain from taking TCM products containing pinellia.

A substance with a similar name is often mentioned in connection with ephedrine: Synephrine. Not only the name is similar, but also the chemical structure and the effect. However, the substance is not on the doping list. However, after ephedrine was banned in certain countries, clever businessmen switched to synephrine. Even more than for performance enhancement, ephedrine was used in slimming pills because it supposedly burns fat. Ephedrine was therefore replaced by synephrine. In high doses and taken with other, similar substances, such products can have undesirable effects. However, it is completely absurd to blacken plants that contain synephrine, among other things, because of this. Synephrine is contained in all citrus fruit peels (Chen Pi, Zhi Ke/Zhi Qiao, Zhi Shi, Qing Pi, Fo Shou...) and also in Evodia (Wu Zhu Yu). Athletes do not have to do without any of these substances and should not be deterred from using them extensively.