where most herbs would be purchased from central markets dotted around
the country.
Accidental contaminants may also include allergens, pollen, insect
parts, moulds and mould spores. Mycotoxins are contaminants in a wide
variety of natural products.^193
Future measures to improve safety
The problems of TCM are not unlike those of orthodox medicine. There are
both intrinsic adverse reactions resulting from the toxicity of the product
and extrinsic adverse reactions arising from ancillary procedures, e.g. inap-
propriate diagnosis and prescribing. Both groups of problems need to be
addressed. To minimise the chance of adverse reactions leading to a recur-
rence of the circumstances surrounding the use of Aristolochia with other
herbs, the following measures should be instigated:
- Quality assurance and quality control should be put in place to ensure
that unadulterated herbs are supplied to manufacturers and
practitioners. - Herbal practitioners should undergo a course of training to ensure that
they provide a safe and effective service. - Herbs with known potential to cause adverse reactions should not be
mixed with orthodox drugs unless careful monitoring is carried out. - Accurate records should be kept by all practitioners to monitor the
incidence of adverse reactions. Regular audits should also be carried
out. This is in any case a minimum requirement for the collection of
the evidence of successful outcomes required by purchasing authorities.
Effective use of the Yellow Card system by all disciplines of
complementary medicine is long overdue. Non-medically qualified
practitioners (‘professional practitioners’) should also be encouraged to
take part. This would make sense because there are many more
NMQPs than health professionals involved in TCM.
Yellow Card ADR reporting schemes
RCHM
The RCHM’s Yellow Card scheme was established in order to gather safety
data on CHMs, through identifying suspected adverse drug reactions
(ADRs) to herbs. Although Chinese herbs have a long established history of
use there is still relatively little present-day information on herbal safety. An
example of the card used to record the reactions is provided in Figure 6.12.
Traditional Chinese medicine | 171