There are several examples of the inclusion of illegal ingredients in
Chinese medicines over many years and pharmacists should be aware of this
possibility. In 1975, a herbal-based preparation called Toukuwan was
manufactured in Hong Kong and widely promoted in the USA for rheuma-
tism and arthritis. It was discovered that the product contained four
orthodox medicines, including the prescription drug diazepam, and its
continued import was swiftly banned by the FDA. More recently, the New
Zealand Director General of Health advised consumers against taking a
Chinese product known as cheng kumbecause it contained a pharmacy-
only antihistamine that could cause drowsiness.^174 The capsules have now
been withdrawn from sale. They were advertised for use in the treatment of
various conditions, including the promotion of joint mobility, healthy skin,
as a support during menopause and of benefit while consuming alcoholic
drinks. The Ministry of Health made the ruling following complaints from
doctors about the product.
Another example is the intentional inclusion of steroids in oral^175 and
topical preparations^176 used for the treatment of dermatological conditions.
Following reports of positive clinical effects in the treatment of eczema, 11
Chinese herbal creams were analysed. Eight were found to contain dexa-
methasone in varying amounts.^177 The mean value approximated to a propri-
etary brand of 0.05% betamethasone valerate, a commonly prescribed steroid
ointment in the UK. None of the patients was aware that the creams contained
a steroid. The authors concluded that the risk of adverse reactions with such
potent steroids is increased by their inappropriate use and application to areas
of thin skin and on the face.
It has been suggested that exported herbal remedies have been adulter-
ated with synthetic drugs to improve their activity, and their popularity, in
western countries. A dangerous evolution in the formulation of a Chinese
herbal arthritis cure, Chuifong Toukuwan, manufactured by a laboratory in
Hong Kong, has been dsecribed.^178 The undeclared presence of phenylbuta-
zone, indometacin, hydrochlorothiazide, chlordiazepoxide, diazepam and
corticosteroids was reported in the product, a mixture of 23 herbs.
Dangerously high levels of undeclared pharmaceuticals have been
discovered in a supposed ‘herbal Viagra’ being sold in many TCM stores in
the UK.^179 The product ‘Jia Yi Jian’was seized by the MHRA in 2009 and
claimed to contain only herbal ingredients. However, laboratory analysis
revealed the unlicensed product contained 68.1 mg sibutramine and 50.06 mg
tadalafil, four times the level found in prescribed medicinal products
licensed for the treatment of erectile dysfunction and obesity respectively.
Inclusion of adulterants
Major problems resulting from the presence of adulterants in CHM have
been experienced. It is therefore extremely important that TCM products
166 | Traditional medicine