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Analysis of Chinese herbal creams prescribed for dermatological conditions

BMJ 1999; 318 doi: (Published 27 February 1999) Cite this as: BMJ 1999;318:563

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EDITOR, Keane et al reported the analysis of Chinese herbal creams
prescibed for dermatological conditions and the finding that many contain
dexamethasone at concentrations inappropriate for their site of use. All
patients treated with these creams were unaware of their ingredients.
Keane et al concluded that "greater regulation & restriction needs to
be imposed on herbalists" to prevent illegal and inappropriate

We support Keane et al in their call for greater regulation not only of
alternative practitioners but also of their unlicensed products.
On the 28/7/99 Prof. Breckenridge, Chairman of the Committee on Safety of
Medicines sent an urgent message to medical professionals via the Chief
Medical Officer and the Public Health link / EPINET system (a dedicated
electronic network linking the CMO to Health Authorities, Trusts and
GP's). The message warned medical professionals about renal failure
associated with 'aristolochoia,' found in some Chinese Herbal Medicines.

Recently a patient
was investigated following complaints of fatigue, loss of appetite,
constipation and myalgia. She was found to have severe anaemia caused by
lead poisoning. For several weeks she had been taking various "remedies"
given to her by an Ayurvedic Practitioner. These remedies were analysed at
the Medical Toxicology Unit, Guy's & St. Thomas' Hospital, and two
were found to contain high levels of lead, arsenic and mercury. These were
Mahayograj-Guggul (lead: 28,900ppm; mercury: 4,970ppm) and Pulsineuron
(lead: 10,200ppm; mercury: 5,840ppm; arsenic: 45,900ppm).

The cases documented here raise a number of issues concerning the safety
of alternative medicines.
The use and expenditure on alternative medicine has increased
substantially in the last decade, to an estimated $21.2 billion in the USA
in 1997. The fact that 'traditional' and 'herbal' remedies, particularly
from the Indian subcontinent, can lead to heavy metal poisoning is not

It is worrying that with increasing use of alternative medicines in the
UK, there is no established national mechanism for ensuring the safety of
these products, and also there is no rapid system to warn the public
against taking those remedies identified as dangerous.
Alternative medicines are not licensed, and therefore are not regulated or
tested as stringently as prescribed medicines. The public tend to regard
'traditional' and 'herbal' remedies as safe due to the fact that they are
natural plant-derived products. They pose a threat to health that many
people are unaware of.

Dr Sarah R. Anderson
Specialist Registrar in Public Health

Dr Claude Seng
Consultant in Communicable Disease Control

Brent and Harrow Health Authority, Bessborough Road, Harrow, Middlesex.
HA1 3EX.

1. Keane FM, Munn SE, Du Vivier AWP, Taylor NF, Higgins EM. Analysis
of Chinese herbal creams prescribed for dermatological conditions. BMJ

2. Breckenridge A. Renal Failure associated with Aristolochia in
some Chinese herbal medicines. CEM/CMO/99/8

3. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay
M, Kessler RC. Trends in alternative medicine use in the United States,
1990-1997: results of a follow-up national survey. JAMA 1998;280(18):1569-

4. Shaw D, Leon C, Kolev S, Murray V. Traditional remedies and food
supplements. A 5-year toxicological study (1991-1995). Drug Safety

5. Prpic-Majic D, Pizent A, Jurasovic J, Pongracic J, Restek-
Samarzija N. Lead poisoning associated with the use of Ayurvedic metal-
mineral tonics. J Toxicol Clin Toxicol 1996;34(4):417-23.

Competing interests: No competing interests

02 September 1999
Sarah Anderson