Chinese Herbal Medicine (CHM) is an important part of Traditional Chinese Medicine (TCM), using natural substances to support health, restore vitality and promote overall wellbeing. However, when herbal formulas are prescribed inappropriately or without following the fundamental principles of TCM, they may pose risks to patients' health rather than provide the intended benefits.
Safe and responsible practice requires well-trained and qualified TCM practitioners with a sound understanding of TCM principles, accurate pattern differentiation, appropriate herbal selection, correct preparation and handling, careful consideration of contraindications and potential interactions, and strict quality control. The safety and effectiveness of Chinese Herbal Medicine depend not only on the properties of the herbs themselves, but also on the professional knowledge, clinical judgement and responsible practice of those who prescribe and prepare them.
In the UK, although TCM practitioners are not subject to statutory professional registration, herbal medicinal products and their ingredients are subject to legal controls. These restrictions vary according to the substance and how it is supplied, rather than constituting a blanket ban on all animal-derived, mineral-derived or toxic ingredients. Manufacturers, wholesalers and sellers must ensure that any herbal products they place on the UK market are free from prohibited ingredients and that any restricted ingredients comply with the applicable legal requirements. (1)
Examples include tiger bone (虎骨, Hu Gu) and bear bile (熊胆, Xiong Dan), commercial trade in which is prohibited under UK wildlife controls, subject to limited exceptions for tiger specimens. Mineral substances such as cinnabar (朱砂, Zhu Sha), which contains mercury sulphide, and realgar (雄黄, Xiong Huang) (2), which contains arsenic sulphide, illustrate the potential risks associated with metal-containing traditional remedies. Toxic plants such as Guan Mu Tong (关木通, Aristolochia manshuriensis) and Guang Fang Ji (广防己, Aristolochia fangchi) (3) contain aristolochic acids, which can cause severe kidney damage and cancer; these ingredients are prohibited in unlicensed medicines in the UK. (4)
This topic became particularly relevant when Dr Tang and I began supporting a nine year-old boy whose mother reported that he had been diagnosed with ADHD at four and subsequently with autism, described as Asperger’s syndrome, at seven.
For more than two years, he had been receiving treatment remotely from a practitioner based in Asia who claimed experience in treating children with neurodevelopmental conditions. However, from mid-August, he began exhibiting increasingly pronounced movements described by his mother as 'tics', prompting her to approach us for additional help and support.
Following seven weekly scalp acupuncture sessions, we observed a reduction in the frequency and severity of his involuntary head movements and eye-rolling episodes.
However, his mother was concerned that recent blood tests had shown elevated mercury (5) and lead levels, suggesting possible heavy-metal exposure. She explained that her son had been taking herbal preparations supplied by the practitioner for over two years. Although she did not know the ingredients, she continued giving them to him because she trusted the practitioner and had noticed improvements in his symptoms.
According to his mother, the boy had also been taking a preparation called 'DMPS' regularly for so-called 'detoxification', as recommended by the practitioner. However, I believe that the ingredients of the CHM formula should be a key priority when investigating the possible sources of heavy-metal exposure.
It is important to check whether the herbal preparations contained mercury, lead or other harmful substances, either as ingredients or through contamination during production. The ingredients and use of DMPs should also be investigated, alongside other possible sources of exposure, including food and the environment.
This case highlights the importance of checking the ingredients, sources and quality of herbal preparations, especially those given to children. The boy should receive prompt medical assessment, and the suspected preparations should not be given again until medical advice has been obtained. Any remaining products and packaging should be kept for further investigation.
At present, the source of the reported heavy-metal exposure remains unknown. There is no confirmed evidence that the preparations caused the elevated levels or the boy's involuntary movements.
As TCM practitioners, we have a responsibility to recognise potential risks and work alongside medical professionals. Safe CHM practice requires well-trained practitioners, accurate TCM diagnosis, appropriate prescribing, correct preparation and handling, and reliable quality control. Patient safety must always remain our priority.
References:
1) Guidance Banned or restricted herbal ingredients for medicinal use
2) Realgar and arsenic exposure
3) Urothelial carcinoma associated with the use of a Chinese herb (Aristolochia fangchi)
4) Guidance Banned and restricted herbal ingredients Published 18 December 2014
5) Mercury intoxication presenting with tics
NOTE: This clinical case is shared for educational and professional awareness purposes. Appropriate parental informed consent has been obtained prior to publication, and the child's personal information has been anonymised to protect their identity, privacy and confidentiality.
