Ma Huang Appropriate vs. High-Risk Uses

One of the worst things about a cold is that feeling that I can’t breathe
through my nose at night. Invariably, my sinuses will be clear all day,
but as soon as I lie down, it’s as if someone stuffed a large cotton ball
up each nostril. I try blowing my nose just right, I try turning this way,
then that to get one nostril to drain and open up, but to no avail. Hours
later, with little sound sleep, I reach for an herbal formula with the Chinese
herb called ma huang, which I know will shortly open things up.



Of course, I could have gone to the drug store and bought one of the many
over-the counter (OTC) preparations like SudafedÆ or PrimatineÆ
that contain the same active ingredient as ma huang, ephedrine, but then
I would have gotten a few other things that I might have to lie awake and
worry about, like FD&C Blue dyes Nos. 1 and 2, Red No. 3 parabens and black
ink.



Ma huang (Ephedra sinensis) is an important medicinal herb from China
used for over 3,000 year in teas and other preparations to help with symptoms
of astma, colds and flus and allergies. It has also found world-wide acceptance
as an effective component of many herbal formulas, Over-The-Counter (OTC)
medications, and as a source for the purified drugs ephedrine and psuedoephedrine
used widely for upper respiratory tract ailments (such as allergies and
asthma).



The broom-like stems of the herb are harvested by the tons in China and
shipped to ports all over the world. Although there are several American
species (known as Mormon Tea and used traditionally as a blood purifier),
such as E. nevadensis, it is important to note that they contain
little or no ephedrine.



The most common use of ma huang in traditional medicine is to relieve symptoms
from the first stages of what we call “the common cold,” in western
countries, especially the type that is due to exposure to cold, damp, and
wind. It is also invaluable for helping to relieve the wheezing and breathing
difficulties associated with some types of asthma and allergies.



A TCM herbalist or acupuncturist will always prescribe ma huang in combination
with other herbs to help counteract possible side effects such as nervousness,
sleeplessness, heart palpitations, high blood pressure, and directing energy
away from the digestive organs.



The main active ingredient of ma huang, ephedrine, falls into a therapeutic
category of “Adrenergic bronchodilators.” (Opens up the bronchial
tree by stimulating the sympathetic nervous system) and is the only adrenergic
bronchodilator that is available without a doctor’s prescription. Ephedrine
can shrink congested mucous membranes, helping to dry up the watery discharge
and open the stuffed nasal passages which so often accompany the common
cold or some flu.



The alkaloid acts in similar ways to the body’s own stimulant, adrenaline,
but is milder and longer-lasting and, unlike adrenaline, works orally.



Pseudoephedrine, a natural variant of ephedrine from ma huang, is found
as a main ingredient in such well-known products as Sudafed, Actifed, Contac,
Robitussin-PE, Sinutab, and others, because it causes less of a blood-pressure
rise than ephedrine, while maintaining a similar strength for bronchodilation.




In current medical practice in the United States, ephedrine is approved
for the following conditions:




  • “Symptoms of bronchial asthma, chronic bronchitis, emphysema and
    other lung diseases”
  • cough, wheezing, shortness of breath, and troubled breathing (increases
    the flow of air through the bronchial tubes by dilating them).
  • Narcolepsy (“uncontrolled desire for sleep, or sudden attacks of
    sleep”).



Presently, there is a controversy “brewing” over ma huang. The
problem is that some herbal product manufacturers tend at times to disregard
the traditional use of ephedra. A number of popular weight-loss and energy
products include pure ephedra concentrates, which stimulate the nervous
system and metabolism (by stimulating the thyroid gland). There is evidence
that the herb works for these purposes, but there are possible dangers…
side effects such as a weakening of the digestion, blood pressure increases
with an extra demand on the heart, as well as sleep disturbances, nervousness
and anxiety. Some manufacturers do try to add tonic herbs to help counteract
these effects.



David Litell from Excell Products, a popular line of “human energy”
products containing ma huang said that some of the formulas blended with
tonic herbs “are good enough to use on an as needed basis” and
that “….ma huang formulas give many people what they want [in the
way of extra energy] without draining their reserves.”



He adds that when blended with tonic herbs, ma huang is safer to use than
other popular (and legal) stimulants like coffee, kola nut, or guarana,
all of which contain caffeine.



However, the uncontrolled and possibly uneducated sale of ma huang is concerning
many licensed practitioners of Traditional Chinese Medicine (TCM) that the
herb (and perhaps others) will become unavailable to them for use in their
clinics because of restrictions by the Food and Drug Administration (FDA).
Harvey Kaltsis, the President of the American Association of Acupuncture
and Oriental Medicine (AAAOM) told me that if ma huang is used in commercial
formulas for weight loss or energy products, the contraindications should
be on the bottle and it should be properly formulated with other herbs that
help counteract its possible side-effects.



“Ephedra should be determined by a TCM differential diagnosis to be
appropriate for the person who is using it. Because ephedra is warm in nature,
it is inappropriate for people with high blood pressure, spontaneous sweating,
and other heat conditions because it will aggravate them.”



Michael Tierra, author of The Way of Herbs is a licensed acupuncturist
and western herbalist who feels that ephedra should not be taken long-term.
He feels that it is also not appropriate for use in people who have “yin
deficiency,” or stress-related adrenal weakness disorders like chronic
fatigue.



Currently, the Food and Drug Administration (FDA) has an import alert on
ephedra extracts, and the herb was recently mentioned in testimony before
a House Sub-Committee hearing on dietary supplements (Proxmire hearings)
as a substance about which unsubstantiated claims and documented hazards
had occured in the marketplace. They state that serious side-effects have
been reported to them from products containing ma huang.



Traditional contraindications for ephedra include general weakness, poor
digestion, high blood pressure, nervousness, sleeping difficulties, cardiac
arrythmias, and heart disease. It may also contract the uterus, which means
it should not be used during pregnancy.



As an OTC and pharmaceutical drug, a number of cautions must be included
in labels and instructions for products containing ephedrine, including
tremors, nervousness, insomnia, hypertension, heart palpitations, diabetes,
hyperthyroidism and prostatic enlargement. Ephedrine is classified by the
FDA for pregancy in category C (no studies on adverse effects on the fetus
exist for humans or animals). passes through mother’s milk to the infant
and should not be taken during breast-feeding. It should not be taken with
monoamine oxidase (MAO) inhibitors (such as isocarboxazid, phenelzine or
tranylcypromine or possibly the herb St. John’s wort–Hypericum perforatum)
can potentiate the stimulating effects of ephedra.



Despite the number of side effects listed for purified ephedrine in therapeutic
doses, studies show that the whole herb ma huang has a very low toxicity
and potential for side effects, when used properly (Tang). Animal studies
also have failed to demonstrate carcinogenic or mutagenic potential for
ephedrine, and the alkaloid is rapidly eliminated from the human body (88%
of an oral dose is excreted in the urine within 24 hours, 97% after 48 hours).




Traditional Uses

Herbalists have been saying for years that ma huang should not be used
out of the context of a system of medicine that considers its possible side-effects
as well as clearly defining what kind of person can safely take the herb
and for what kind of conditions. Some herbalists feel like manufacturing
and advertising products containing ma huang for energy or weight loss is
irresponsible, and can do nothing but hurt the industry in the long run.
This may not have been an easy controversy to clear up without outside intervention,
because ephedra makes fantastic profits for manufacturers promising quick
energy and slimmer torsos.



Manufacturers of diet and energy products containing ma huang say that ephedra
really works to burn fat by stimulating the thyroid gland, a major player
in determining the rate of metabolism. They add that when blended with “tonic”
herbs that help to counteract its side-effects, ma huang is safer to use
than other popular (and legal) stimulants like coffee, kola nut or guarana,
all of which contain caffeine.



In TCM, it is known as “Ma Huang,” which means, literally, “hemp
yellow,” because of its color. Botanically, it is more closely related
to the conifers like pine and firs than to familiar flowering plants such
as the mints or dandelions.



The broom-like stems are harvested by the tons in China and shipped to ports
all over the world. Although there are several American species (known as
Mormon Tea and used traditionally as a blood purifier), such as E. nevadensis,
they contain little or no ephedrine or its natural variants.



In TCM, Ma huang is always used in combination with other herbs to help
counteract some of its possible side-effects such as nervousness, sleeplessness,
heart palpitations, high blood pressure and directing energy away from the
digestive organs.



For coughs and wheezing, it is often combined with apricot seed, for retention
of fluids (such as around the eyes) with symptoms of flu or colds, it is
combined with ginger, and to counteract its tendency to aggravate inflammation
or “heat” during colds and flu, combine with gypsum (Shi Gao)
and scullcap root (Huang Qin).



Traditionally, the contraindications (times when it is inappropriate to
take ma huang) are listed as


  • people who are weakened by excessive sweating (ma huang increases sweating
    to help “push out” the virus pathogen)
  • people who have colds in the summer during hot weather, or colds and
    flus with steady fever (no chills), or more-deeply seated ailments such
    as bronchitis accompanied by thick yellow mucus,
  • people with high blood pressure
  • people who are nervous or
  • people who have trouble sleeping
  • people with cardiac arrythmias.
  • people with heart disease



Medical Cautions



Additionally, western medicine gives these cautions for the use of ephedra:



  • tremor, nervousness, insomnia, transient hypertension and heart palpitations.
  • Allergic reactions are rare, but do occur
  • Ephedrine-containing products should be used cautiously with people
    with heart disease, diabetes, hypertension or hyperthyroidism.
  • Urinary retention can occur in men with prostatic enlargement.
  • Ephedrine is classified by the FDA for pregancy in category C (no studies
    on adverse effects on the fetus exist for humans or animals).
  • Ephedrine passes through mother’s milk to the infant, and should not
    be taken during breast-feeding.
  • Can trigger anxiety attacks
  • can cause tremors, and is be contraindicated for people with epilepsy
  • Monoamine oxidase (MAO) inhibitors (such as isocarboxazid, phenelzine
    or tranylcypromine or possibly the herb St. John’s wort–Hypericum perforatum)
    can potentiate the stimulating effects of ephedra.
  • Studies with animals show that ephedrine has a low toxic potential and
    is not carcinogenic or mutagenic (Tang).
  • In humans, 88% of an oral dose is excreted in the urine within 24 hours,
    97% after 48 hours



References



United States Pharmacopeial Convention. 1992. Complete Drug Reference.
Yonkers, NY: Consumer Reports Books.

American Medical Association. 1986. Drug Evaluations. Chicago: American
Medicial Association.

Bensky, D. and A. Gamble. 1986. Chinese Herbal Medicine. Seattle:
Eastland Press.

Hsu, H.-Y. 1986. Oriental Materia Medica. Long Beach: Oriental Healing
Arts Institute.

Barnhart, E.R. (pub.). 1989. Physicians’ Desk Reference. Oradell,
NJ: Medical Economics Co. Inc.

Chang, H.-M. & P.P.-H. But. 1986. Pharmacology and Applications of Chinese
Materia Medica.
Philadelphia: World Scientific.

Huang, K.C. 1993. The Pharmacology of Chinese Herbs. Boca Raton:
CRC Press.

Tang, W. & G. Eisenbrand. 1992. Chinese Drugs of Plant Origin. Berlin:
Springer-Verlag.

Christopher Hobbs LAc AHG Written by Christopher Hobbs LAc AHG

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