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Many practitioners and proprietors of herbal pharmacies are under the mistaken impression that the purchase, storage and prescription of the Chinese herb 麻黃 Mahuang (Ephedra) is illegal. This is simply not true.
I was reminded of this issue by a recent graduate of NCNM, my friend and colleague, Tim Rudowsky. This is the man recently featured in a Deepest Health podcast about prescribing bulk Chinese herbs, and the proprietor at Green Tea Apothecary.
He’s an enterprising fellow, always researching, and apparently this issue piqued his interest. See, at the NCNM school pharmacy, students have been typically unable to use Mahuang in their prescriptions. (Update 12/6 I believe that this has shifted recently – but the rest of the article is still important for most people in the US).
Students and professors who have a strong preference for Classical formulas often lament this fact. It’s an issue of particular concern during this time of the year in the cold, wet, windy Columbia River Gorge area. We need our Mahuang! To be denied this critical tool is simply intolerable.
I wrote a short, simple article about the qualities and uses of Mahuang a while back. I do not use it frequently, but do use it when it is necessary. What would Mahuang Xixin Fuzi Tang be without Mahuang? Has anyone ever had success replacing Mahuang in Gegen Tang or Mahuang Tang? I think not.
I thought I had already written on Deepest Health about this important issue. However, it appears that my post never made it out of draft stage. Instead, I had sent an email to my friends and colleagues through our student email list. I’ll post some of the information from that email here:
“I’ve been investigating Mahuang. As you know, there is simply no substitute for it in our materia medica or any other. It’s hard to find, although people in Portland have secured sources. My research indicates that the major herb companies don’t carry it because they are worried about getting into trouble from the FDA – but that research only involves two herb companies – anything but rigorous. Does anyone else have any information?
Anyway – I have not seen any compelling evidence to suggest that we, as licensed acupuncturists, could ever get in trouble for using Mahuang. Read this FDA document about Mahuang, check around page 28. It specifically states that licensed acupuncturists are exempt from the restrictions placed on the major herbal product distributors.
I have been searching for some time, and cannot find any evidence that the rule has been amended in any way, so this information would appear to be correct. The same holds for Xixin. You just have to FIND IT, and then you can use it. If you can, then you SHOULD use it – when it is indicated.
Here is a short excerpt of the email that my friend Tim sent me about his experience researching Mahuang access:
“After an incredible amount of leg-work, I got in contact with the NW FDA rep who sent me the most recent official ruling on the use of Mahuang. No one seems to understand how the herb is to be legally handled, and, in fact, our own medicinary manager is convinced the herb is illegal for prescription in the US. This Federal document explains that Mahuang is completely legal for use by licensed Chinese herbalists as long as it’s not being used, long term, to induce weight loss. (He references the same document that I link to above)”
The fact is that despite the fact that there’s no compelling reason for us to stop using Mahuang, it is getting harder and harder to purchase. Qualiherbs, an East coast distributor of Chinese herbs, used to carry it in granules but no longer does so (though I believe they still have some granulated formulas containing Mahuang). I don’t know of any major bulk herb distributors that carry it. What are we to do, as practitioners, to gain access to the herbs we need for the complete practice of our medicine?
AAAOM, our professional organization in the United States, claims to make herbal access one of their main legislative priorities. I don’t have a lot of contact with the organization, so don’t know what they are doing around this issue. However, it has been my experience that working on issues like this is usually made more successful by utilizing the power and legitimacy of a membership driven professional organization. Thinking about this issue makes me more inclined to consider being involved with the AAAOM.
I’m interested to hear from readers on this issue. Do you use Mahuang in your practice? If not, why not? Do you have any more information about Mahuang and its use in the United States? Have anything to say about the AAAOM and their handling of this issue? Have any thoughts about strategies to ensure our access to the herbs we need?
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We started having trouble finding it several years ago. My office mate did most of the herbal formula creations and took care of the pharmacy. I haven’t seen it from any of my suppliers but haven’t gone looking. Would love to have it back–you’re right there are no substitutes when it’s needed.
I covered this same subject back in August: http://lifegivingsword.net/2009/08/the-law-and-ma-huang/. Yet another issue where hearsay is ruling the industry rather than facts and sense. I use Ma Huang in granules (amongst other controversial substances) though I have to go through some small effort to get it. There are multiple OM organizations that need overhauls in the fact checking and initiative departments, hope we see it before long.
Yes, this is a great issue to discuss, as many people seemed to be misinformed on this topic. It seems as if when the ban started on supplements containing ephedrine after people died from misuse is when this whole issue came up. I don’t recall, but as far as I remember, I think only products with ephedrine, not ephedra were sited as dangerous. To me, this is even more reason as to why we should be promoting the use of whole herb plant parts being used in natural medicine instead of isolated chemical constituents that are standardized to promote “maximum therapeutic results”. The reason these kinds of standardized extracts of isolated chemical components from natural substances are dangerous is because they don’t contain all of the other chemical ingredients that are found naturally in the plant. It is the delicate balance (in the right ratios) of these chemicals that naturally occur in the plant that prevent side effects as well as help to achieve the desired therapeutic actions. Having said that, I am not implying that all whole herb products are completely void of side effects or toxicity. Let’s not forget that herbs where originally called du, or toxic in Chinese medicine.
For Portlanders, I believe you can obtain Mahuang from the Asian market on 65th and Powell.
As for substitutes, Dr. Jun Zhang says that Qianghuo can be susbstituted for Mahuang in some instances, but he hasn’t really made clear to me under what circumstances, or in which formulas this is acceptable.
I hope the future holds the expansion of the use of these Chinese herbs, rather than more and more limitations on what we can use and how we can use it. It is mostly up to practitioners and consumers to use these herbs appropriately to make sure that the FDA doesn’t have any further reason to ban herbs for safety reasons.
Hi Delli,
You made a great point here! I always say to my patients and colleagues that studying herbs by isolating the effective extracts and therapeutic ingredients is not the correct approach. TCM originally uses four Qi, five Wei (flavours) and meridian attribution (Gui Jing) to describe herbs’ function but not the ingredients such as ephedra or ephedine. Moreover, there are interactions between herbs in a formula decotion or other forms, which is exceptionally complicated and researching this by modern scientific ways are impracticable. It is like there is no way to find out what exactly meridians (Jing Luo) are by just “guessing” that they might be the communicative part of nervous system, circulatory system and lymph system. Therefore, it is completely wrong to regulate herbs under modern scientific standard. We should regulate the qualifications of practitioners instead of herbs. There is a Chinese term saying that every herb is more or less toxic (是藥三分毒shi yao san fen du). It’s very important that we should grasp what “toxin” means. First of all, the toxic effect is actually the therapeutic effect! Simply speaking, every herb has its yin or yang deviation, in another word, warm or cold nature, in order to correct the imbalance of yin and yang of the body. Hotter or colder means it is more toxic. Secondly, toxic effect is relative. Different people of different constitutions and syndrome differentiations have different response to the same “toxin”. To a person with yin deficiency and internal heat constitution, a piece of ginger is toxic for him or her. While a person suffering Bi syndrome with cold dampness and qi and blood deficiency, large amount of dried ginger and Fu zi are pleased for him or her. I used 20 grams of Ma huang (I usually use 2 to 4 grams in wind cold external syndromes and asthma) in a formula for a female patient who suffers dermatosclerosis for one year and she felt generally warm and significant released of joint pain and neck stiffness after taking the tea. Lastly, comparing to Chinese herbs, western drugs are more toxic. Ridiculously, people are willing to take them everyday! Nowadays, people don’t know yin and yang, don’t know balance, don’t know the rule of nature, don’t sleep until midnight, drink cold drinks and eat cold fruits everyday, they don’t know how to prevent hypertension, diabetes, high cholesteral and cancer, they are told and actually misled to take miscellaneous drugs AFTER they get those health problems. Aspirin is a drug and toxic. It causes uncontrollable bleeding and actually damages the function of Pi (spleen). Unfortunately, people nowadays are misled to take this “toxin” the rest of their lives because they are convinced that they won’t get cardiovascular diseases. And this is supposed to be legal! More and more cancer patients die of over-treating by chemo drugs. Unfortunately, they are threatened to die in a certain length of time without taking chemotherapy. And this is supposed to be legal! This is completely ridiculous!
Hope to listen to every Si Fu master’s point of view in here! And may all wish everybody have a successful, healthy and prosperous year of Dragon!
Kevin
Ephedra’s harmful effects are over rated. Unless your an athlete pushing himself to the limit in bball or football you aren’t going to have and problems. Been taking it for 6 years with great results.
If the mahuang herb can still be available Stateside, are there any directories that we can look up for suppliers for these? Can we then import this directly into the country?
One way for the FDA to limit the use of certain products is to make it illegal to sell them in the US, without limiting the physicians or others from using them. Although I have not used mahuang in my alternative medicine practice, it seems a shame that qualified individuals that know how to use herbs correctly, and recognize their power in the body, are inhibited from helping people get and remain healthy.
Stan Gardner, MD
stangardnermd.com
I used ephedra for years with zero problems. I actually used it mainly for my breathing problems associated with asthma. This crackdown on a truly useful and innocent herb is completely unwarranted. I hope y’all are able to make some progress on this issue.
Ephedra viridis grows wild and can be harvested in bulk where I live. I often make a simple tea that has surprisingly wonderful effects for the body and mind.
The ephedra species you mention doesn’t have the essential alkaloids the ma huang, therefore it is useless as a substitute in clinical practice.