Since traditional Chinese medicine covers so many different therapies and modalities, the below information are only examples of safety concerns with selected herbs, supplements, and modalities. For more detailed information, please see Natural Standard monographs on individual therapies.

Studies of the Chinese herb ma huang, which is the main active ingredient in the weight-loss drug, ephedra, indicate that use of the substance is associated with serious health complications, including acute hepatitis and deaths.

Pregnant or lactating women should not use ma huang or other herbs such as ginseng where safety has not been clearly established. For more details on individual therapies please see Natural Standard monographs.

There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metals or not containing the listed ingredients. A qualified healthcare professional, including a pharmacist, should be consulted for recommendations of safe herbal products.

Chinese herbs can be powerful. Based on one study, Sang Ju Yin or Yu Ping Feng San formulas may cause headache or dizziness. There have been reports of adverse effects; a qualified healthcare practitioner, including a pharmacist, should be consulted on dosage.

Chinese herbs can interact with drugs, interfering with or exaggerating their effects. In particular, ma huang should not be taken with caffeine. Consumers should consult with a medical professional, including a pharmacist, before mixing herbs with any prescription drugs.

Acupuncture is generally reported as a safe procedure when performed by an experienced practitioner using standard sterile techniques. Needles must be sterile in order to avoid disease transmission (most practitioners now use disposable needles).

Rare serious and potentially lethal complications have been noted, including infection, and organ, nerve, or vascular injury, such as cardiac tamponade. There are several reports of fatalities in the available medical literature. Acupuncture may be unsafe in particular when performed on patients with emphysema or other pulmonary disease, due to multiple case reports of pneumothorax, elderly or medically compromised patients, diabetics (due to poor circulation), or patients with history of seizures.

Electrostimulation acupuncture should be avoided in pregnant women (theoretical), in patients with a cardiac history, including those persons with an arrhythmia or a pacemaker, due to risk of arrhythmia or interference with pacemaker functioning.

Acupuncture should be avoided in the following conditions: valvular heart disease, known bleeding disorders, use of anticoagulant drugs, unstable medical condition or infection, pregnancy (may induce unwanted labor and possible miscarriage), systemic or local infection, pain of unknown medical origin, medical condition of unknown origin such as dermatologic lesions, neurologic patients. Acupuncture should also be avoided on areas that have received radiation therapy.

Adverse events reported in the scientific literature from cupping and moxibustion are extremely rare.

Cupping commonly leaves a temporary bruising of the skin, which disappears on its own.

For both cupping and moxibustion, the following precautions and contraindications are based on tradition, clinical experience, and theory rather than controlled research.

Cupping: Avoid the abdomen/sacral area during pregnancy, contraindicated acupuncture points, during high fever, during convulsions or cramps, over allergic skin conditions or ulcerated sores, over an inflamed organ, over inflamed areas in general, in patients with cardiac disease and/or aneurysms, in patients with extreme fatigue and/or anemia, in patients who have just finished exercising or taking a hot bath or shower.

Avoid sliding cups over the spine, moles, or other skin abnormalities.

Moxibustion: Use caution with patients with neuropathy. Avoid face, head, nipples and genitals, skin adhesions, points where needling is contraindicated for the individual patient, in patients with any kind of "heat syndrome" according to acupuncture theory, in patients with strong heat signs--high fever, etc.--on or near inflamed and/or red areas of the body, or in patients with diabetic neuropathy or in any situation where the patient may not respond to the sensations of heat.

Patients are advised not to bathe or shower for up to 24 hours after a moxibustion treatment.

Pregnancy & lactation: The abdominal area and the lower back during pregnancy are traditionally avoided in both cupping and moxibustion practice out of concern for adversely impacting the uterus or fetus, although there are no published reports of related adverse effects.

More safety information can be found in the specific monographs on this site for related modalities that are sometimes used with TCM.

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Angina (Grade: C)
TCM herb formulas have been reported to reduce symptoms of stable and unstable angina. However, research designs have been weak and more studies of better design are needed before recommendations can be made.

Arrhythmia (Grade: C)
TCM herb combinations have been used to stabilize arrhythmia after viral myocarditis (inflammation of the heart). However, research designs have been weak and more studies of better design are needed before recommendations can be made.

Cancer (Grade: C)
TCM uses over 120 different herbs in cancer treatment, depending on the type of cancer and its cause according to Chinese medical theory. Studies have reported significant benefits include reducing tumors, reducing treatment side effects and improved response to treatment. More studies of stronger design are needed before TCM can be recommended with confidence as an adjunct to cancer treatment.

Chronic obstructive pulmonary disease (COPD) (Grade: C)
TCM herbs have been reported to improve symptoms and improve immune function in COPD patients. However, research designs have been weak and more studies of better design are needed before recommendations can be made.

Congestive heart failure (Grade: C)
Many studies of TCM herbs have focused on treatment of congestive heart failure. Further research of better design is needed before recommendations can be made.

Coronary heart disease (Grade: C)
TCM herb combinations have been found to improve some markers of coronary heart disease. More studies of better design are needed before recommendations can be made.

Dementia (Grade: C)
TCM herbal combinations have been used for treatment of dementia and reportedly improve cognitive function and activities of daily living. More studies of better design are needed before recommendations can be made.

Diabetic nephropathy (kidney disease) (Grade: C)
TCM herbs may augment conventional Western medicine for better outcomes in diabetic nephropathy. More studies of better design are needed before recommendations can be made.

HIV/AIDS (Grade: C)
TCM herbs are a popular complementary therapy in HIV/AIDS. However, study results conflict. More studies are needed before the potential benefits of TCM herbs in HIV/AIDS can be established.

Menopausal symptoms (Grade: C)
TCM herbs are commonly used for menopausal symptoms. Evidence is mixed. More studies are needed to explore the possible contributions of TCM herbs in menopausal symptoms.

Nephrotic syndrome (Grade: C)
TCM herbs have been reported to improve the therapeutic effectiveness and counteract adverse reactions to hormone therapy in treating nephrotic syndrome, and reduce the recurrence of symptoms. More studies are needed to explore the possible contributions of TCM herbs in menopausal symptoms.

Polycystic ovary syndrome (Grade: C)
TCM herbs have been reported to not reduce symptoms, but to increase pregnancy rates in women with polycystic ovary syndrome. More studies are needed to explore the possible contributions of TCM herbs in this condition.

SARS (severe acute respiratory syndrome) (Grade: C)
Currently study results conflict, but overall show promise for TCM in immunomodulation effects and decreasing depression associated with SARS.

Schizophrenia (Grade: C)
Based on early data, Chinese herbal medicines may be helpful when combined with prescription medications. Schizophrenia should be treated by a qualified healthcare practitioner including a psychiatrist and pharmacist.

Irritable bowel syndrome (IBS) (Grade: D)
TCM has been studied for diarrhea predominant irritable bowel syndrome but herbal formulations used in available studies have not led to global symptom improvement. Further studies may be necessary to characterize the role of TCM in the management of IBS.