Editing Traditional Chinese medicine (section)

==Herbal medicine==
{{Main|Chinese herbology}}
{{See also|List of traditional Chinese medicines}}
{{more medical citations needed|section|date=June 2020}}
[[File:Traditional Chinese medicine in Xi'an market.jpg|thumb|Assorted dried plant and animal parts used in traditional Chinese medicines, clockwise from top left corner: dried [[Lingzhi mushroom|Lingzhi]] ({{lit|spirit mushrooms}}), [[ginseng]], [[Siraitia grosvenorii|Luo Han Guo]], turtle shell underbelly ([[plastron]]), and dried curled snakes.]]
[[File:Red ginseng.JPG|thumb|right|Chinese red ginseng roots]]
[[File:Bile bear.jpg|thumb|left|A [[bile bear]] in a "crush cage" on Huizhou Farm, China<ref name="c555c">{{cite web | title = ENDANGERED AND ABUSED WILD ANIMALS & The USE OF HERBAL ALTERNATIVES TO REPLACE ANIMAL DERIVATIVES | url = http://aapn.org/article/endangered/#Bile%20Bears | publisher = Asian Animal Protection Network | date = 26 July 2012 | access-date = 29 April 2014 | archive-url = https://web.archive.org/web/20140430013227/http://aapn.org/article/endangered/#Bile%20Bears | archive-date = 30 April 2014 | url-status = live}}</ref>]]
[[File:Seahorse Skeleton Macro 8 - edit.jpg|thumb|left|upright|Dried [[seahorse]]s are extensively used in traditional medicine in China and elsewhere.<ref name="Vincent2011" />]]
The term "herbal medicine" is somewhat misleading in that, while plant elements are by far the most commonly used substances in TCM, other, non-botanic substances are used as well: animal, human, fungi, and mineral products are also used.<ref name="QSmNc">{{Cite web|url=http://www.china.org.cn/english/MATERIAL/185685.htm|title=The Essentials of Traditional Chinese Herbal Medicine|website=china.org.cn|access-date=26 January 2017|archive-url=https://web.archive.org/web/20160303202039/http://www.china.org.cn/english/MATERIAL/185685.htm|archive-date=3 March 2016|url-status=live}}</ref><ref name=Lu2023>{{cite book |author=Lu, D. |title=The Global Circulation of Chinese Materia Medica, 1700-1949: A Microhistory of the Caterpillar Fungus |series=Medicine and Biomedical Sciences in Modern History |year=2023 |publisher=Palgrave Macmillan |pages=1–294 |doi=10.1007/978-3-031-24723-1 |isbn=978-3-031-24722-4 |s2cid=256618310 |url=https://link.springer.com/book/10.1007/978-3-031-24723-1 |language=en |access-date=22 February 2023 |archive-date=20 November 2023 |archive-url=https://web.archive.org/web/20231120120321/https://link.springer.com/book/10.1007/978-3-031-24723-1 |url-status=live }}</ref> Thus, the term "medicinal" (instead of herb) may be used.<ref name="1zMoF">{{cite book |url=https://books.google.com/books?id=uRdIuISvjo4C&q=wiseman+chinese |title=Introduction to English Terminology of Chinese Medicine |vauthors=Wiseman N, Feng Y |access-date=10 June 2011 |isbn=978-0912111643 |date=2002 |publisher=Paradigm Publications |archive-date=31 January 2021 |archive-url=https://web.archive.org/web/20210131201906/https://books.google.com/books?id=uRdIuISvjo4C&q=wiseman+chinese |url-status=live }}</ref> A 2019 review of traditional herbal treatments found they are widely used but lacking in scientific evidence, and urged a more rigorous approach by which genuinely useful medicinals might be identified.<ref name="Eigenschink Dearing Dablander et al 2020"/>

===Raw materials===
There are roughly 13,000 compounds used in China and over 100,000 TCM recipes recorded in the ancient literature.<ref name="Certainprogress">{{cite journal |last1=Chen |first1=K |last2=Yu |first2=B |title=Certain progress of clinical research on Chinese integrative medicine |journal=Chinese Medical Journal |date=1999 |volume=112 |issue=10 |pages=934–937 |pmid=11717980 |url=https://medcentral.net/doi/abs/10.5555/cmj.0366-6999.112.10.p934.01 }}</ref> Plant elements and extracts are by far the most common elements used.<ref name="Foster 1992">Foster, S. & Yue, C. (1992): [https://books.google.com/books?id=y78zzxTN570C "Herbal emissaries: bringing Chinese herbs to the West"] {{Webarchive|url=https://web.archive.org/web/20170320172949/https://books.google.com/books?id=y78zzxTN570C&printsec=frontcover&dq=herbal+emissaries&hl=zh-CN |date=20 March 2017}}. Healing Arts Press. {{ISBN|978-0-89281-349-0}}</ref> In the classic ''Handbook of Traditional Drugs'' from 1941, 517 drugs were listed – out of these, 45 were animal parts, and 30 were minerals.<ref name="Foster 1992" />

====Animal substances====
Some animal parts used include cow gallstones,<ref name="Hesketh1997">{{cite journal | vauthors = Hesketh T, Zhu WX | title = Health in China. Traditional Chinese medicine: one country, two systems | journal = BMJ | volume = 315 | issue = 7100 | pages = 115–7 | date = July 1997 | pmid = 9240055 | pmc = 2127090 | doi = 10.1136/bmj.315.7100.115 }}</ref> hornet nests,<ref name="mnfl6">{{cite web| url = http://tcm.health-info.org/Herbology.Materia.Medica/lufengfangproperties.htm| title = Lu Feng Fang, Materia Metrica| archive-url = https://web.archive.org/web/20180614121358/http://tcm.health-info.org/Herbology.Materia.Medica/lufengfangproperties.htm| archive-date = 14 June 2018}}</ref> [[leech]]es,<ref name="LAT">{{Cite web |url=http://www.acupuncturetoday.com/herbcentral/leech.php |title=Leech, Acupuncture Today |access-date=6 March 2011 |archive-url=https://web.archive.org/web/20110105042335/http://www.acupuncturetoday.com/herbcentral/leech.php |archive-date=5 January 2011 |url-status=live}}</ref> and [[scorpion]].<ref name="SAT">{{Cite web |url=http://www.acupuncturetoday.com/herbcentral/scorpion.php |title=Scorpion, Acupuncture Todady |access-date=6 March 2011 |archive-url=https://web.archive.org/web/20110104235049/http://www.acupuncturetoday.com/herbcentral/scorpion.php |archive-date=4 January 2011 |url-status=live}}</ref> Other examples of animal parts include horn of the antelope or buffalo, deer antlers, testicles and [[penis bone]] of the dog, and snake bile.<ref name="Still 2003" /> Some TCM textbooks still recommend preparations containing animal tissues, but there has been little research to justify the claimed clinical efficacy of many TCM animal products.<ref name="Still 2003">{{cite journal | vauthors = Still J | title = Use of animal products in traditional Chinese medicine: environmental impact and health hazards | journal = Complementary Therapies in Medicine | volume = 11 | issue = 2 | pages = 118–22 | date = June 2003 | pmid = 12801499 | doi = 10.1016/S0965-2299(03)00055-4 }}</ref>

Some compounds can include the parts of endangered species, including tiger bones<ref name="ezyCZ">{{cite book| vauthors = Wiseman N, Feng Y |title=A Practical Dictionary of Chinese Medicine|publisher=Paradigm Publications|edition=2|year=1998|url=https://books.google.com/books?id=_FyGk5QnjhAC&pg=PA904|page=904|isbn=978-0912111544|access-date=18 February 2016|archive-url=https://web.archive.org/web/20170320195430/https://books.google.com/books?id=_FyGk5QnjhAC&pg=PA904|archive-date=20 March 2017|url-status=live}}</ref> and [[rhinoceros horn]]<ref name="FTCMRH">''Facts about traditional Chinese medicine (TCM): rhinoceros horn'', Encyclopædia Britannica, [http://www.britannica.com/facts/5/1035448/traditional-Chinese-medicine-TCM-as-discussed-in-rhinoceros-mammal Facts about traditional Chinese medicine (TCM): rhinoceros horn, as discussed in rhinoceros (mammal): – Britannica Online Encyclopedia] {{Webarchive|url=https://web.archive.org/web/20110629095329/http://www.britannica.com/facts/5/1035448/traditional-Chinese-medicine-TCM-as-discussed-in-rhinoceros-mammal |date=29 June 2011}}</ref>
which is used for many ailments (though not as an aphrodisiac as is commonly misunderstood in the West).<ref name="0luMq">{{cite web|title=Poaching for rhino horn|url=https://www.pbs.org/wnet/nature/rhinoceros-rhino-horn-use-fact-vs-fiction/1178/|website=Save The Rhino|access-date=25 March 2016|date=20 August 2010|archive-url=https://web.archive.org/web/20160321143824/http://www.pbs.org/wnet/nature/rhinoceros-rhino-horn-use-fact-vs-fiction/1178/|archive-date=21 March 2016|url-status=live}}</ref>
The black market in rhinoceros horns (driven not just by TCM but also unrelated status-seeking) has reduced the world's rhino population by more than 90 percent over the past 40 years.<ref name="RH">{{cite news |title=Rhino horn: All myth, no medicine |first1=Rhishja |last1=Larson |date=July 2010 |url=http://voices.nationalgeographic.com/2010/07/07/rhino_horn_and_traditional_chinese_medicine_facts/ |archive-url=https://web.archive.org/web/20150411123924/http://voices.nationalgeographic.com/2010/07/07/rhino_horn_and_traditional_chinese_medicine_facts/ |archive-date=11 April 2015 }}</ref>
Concerns have also arisen over the use of [[pangolin]] scales,<ref name="70aUc">{{cite news|url=https://www.bbc.co.uk/nature/26549963|title='Shocking' scale of pangolin smuggling revealed| vauthors = Davies E | date=13 March 2014|work=Nature News|publisher=BBC|access-date=1 October 2016|archive-url=https://web.archive.org/web/20161018062653/http://www.bbc.co.uk/nature/26549963|archive-date=18 October 2016|url-status=live}}</ref> turtle [[plastron]],<ref name="guiban">{{Cite journal | vauthors = Chen TH, Chang HC, Lue KY |journal= Chelonian Conservation and Biology|volume= 8|issue=1|pages=11–18|year= 2009|doi= 10.2744/CCB-0747.1 |title=Unregulated Trade in Turtle Shells for Chinese Traditional Medicine in East and Southeast Asia: The Case of Taiwan |s2cid= 86821249}}</ref> seahorses,<ref name="Pbs.org">{{cite web |url=https://www.pbs.org/wgbh/nova/seahorse/vincent.html |title=NOVA Online &#124; Amanda Vincent |publisher=PBS |access-date=7 December 2009 |archive-url=https://web.archive.org/web/20091209055422/http://www.pbs.org/wgbh/nova/seahorse/vincent.html |archive-date=9 December 2009 |url-status=live}}</ref> and the [[Gill plate trade|gill plates]] of [[mobula]] and [[manta ray]]s.<ref name="Rc0qN">{{cite news|url=http://www.aljazeera.com/programmes/101east/2013/03/201332715299451455.html|title=Diminishing ray of hope| vauthors = Chou CT |date=2 April 2013|work=101 East|publisher=Al Jazeera|access-date=6 May 2013|archive-url=https://web.archive.org/web/20130502175216/http://www.aljazeera.com/programmes/101east/2013/03/201332715299451455.html|archive-date=2 May 2013|url-status=live}}</ref>

Poachers hunt restricted or endangered species to supply the black market with TCM products.<ref name="Weirum">{{Cite web |vauthors = Weirum BK |url=http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/11/11/TR10T8RBN.DTL |title=Will traditional Chinese medicine mean the end of the wild tiger? |work=San Francisco Chronicle |date=11 November 2007 |access-date=3 June 2020 |archive-url=https://web.archive.org/web/20090201170930/http://www.sfgate.com/cgi-bin/article.cgi?f=%2Fc%2Fa%2F2007%2F11%2F11%2FTR10T8RBN.DTL |archive-date=1 February 2009 |url-status=live}}</ref><ref name="Newscientist.com">{{Cite web |url=https://www.newscientist.com/channel/life/endangered-species/dn3376 |title=Rhino rescue plan decimates Asian antelopes |work=New Scientist |access-date=17 September 2017 |archive-url=https://web.archive.org/web/20080517124015/http://www.newscientist.com/channel/life/endangered-species/dn3376 |archive-date=17 May 2008 |url-status=live}}</ref> There is no scientific evidence of efficacy for tiger medicines.<ref name="Weirum" /> Concern over China considering to legalize the trade in tiger parts prompted the 171-nation [[Convention on International Trade in Endangered Species]] (CITES) to endorse a decision opposing the resurgence of trade in tigers.<ref name="Weirum" /> Fewer than 30,000 [[saiga antelope]]s remain, which are exported to China for use in traditional fever therapies.<ref name="Newscientist.com" /> Organized gangs illegally export the horn of the antelopes to China.<ref name="Newscientist.com" /> The pressures on [[seahorse]]s (''Hippocampus'' spp.) used in traditional medicine is enormous; tens of millions of animals are unsustainably caught annually.<ref name="Vincent2011" /> Many species of [[syngnathid]] are currently part of the [[IUCN Red List of Threatened Species]] or national equivalents.<ref name="Vincent2011">{{cite journal | vauthors = Vincent AC, Foster SJ, Koldewey HJ | title = Conservation and management of seahorses and other Syngnathidae | journal = Journal of Fish Biology | volume = 78 | issue = 6 | pages = 1681–724 | date = June 2011 | pmid = 21651523 | doi = 10.1111/j.1095-8649.2011.03003.x | bibcode = 2011JFBio..78.1681V | s2cid = 37920910 }}</ref>

Since TCM recognizes [[bear bile]] as a treatment compound, more than 12,000 [[asiatic black bears]] are held in bear farms. The bile is extracted through a permanent hole in the abdomen leading to the [[gall bladder]], which can cause severe pain. This can lead to bears trying to kill themselves. As of 2012, approximately 10,000 bears are farmed in China for their bile.<ref name="Xia Sheng" /> This practice has spurred public outcry across the country.<ref name="Xia Sheng" /> The bile is collected from live bears via a surgical procedure.<ref name="Xia Sheng">{{cite journal | vauthors = Sheng X, Zhang H, Weng Q | title = Traditional Chinese medicine: China's bear farms prompt public outcry | journal = Nature | volume = 484 | issue = 7395 | pages = 455 | date = April 2012 | pmid = 22538598 | doi = 10.1038/484455c | doi-access = free | bibcode = 2012Natur.484R.455S }}</ref> As of March 2020 bear bile as ingredient of ''Tan Re Qing'' injection remains on the list of remedies recommended for treatment of "severe cases" of COVID-19 by National Health Commission of China and the National Administration of Traditional Chinese Medicine.<ref name="7CLiE">{{Cite web|title=We've been accused of peddling 'fake news' – so here are the facts about China's recommended use of bear bile - EIA|url=https://eia-international.org/news/weve-been-accused-of-peddling-fake-news-so-here-are-the-facts-about-chinas-recommended-use-of-bear-bile/|website=eia-international.org|date=25 March 2020 |language=en|access-date=2020-05-01|archive-url=https://web.archive.org/web/20200516155613/https://eia-international.org/news/weve-been-accused-of-peddling-fake-news-so-here-are-the-facts-about-chinas-recommended-use-of-bear-bile/|archive-date=16 May 2020|url-status=live}}</ref>

The [[deer penis]] is believed to have therapeutic benefits according to traditional Chinese medicine. Tiger parts from poached animals include [[tiger penis]], believed to improve virility, and tiger eyes.<ref name="Harding">{{cite news | vauthors = Harding A  |url=http://news.bbc.co.uk/1/hi/programmes/from_our_own_correspondent/5371500.stm |title=Beijing's penis emporium |work=BBC News |date=23 September 2006 |access-date=16 March 2009 |archive-url=https://web.archive.org/web/20090420070528/http://news.bbc.co.uk/1/hi/programmes/from_our_own_correspondent/5371500.stm |archive-date=20 April 2009 |url-status=live}}</ref> The illegal trade for tiger parts in China has driven the species to near-extinction because of its popularity in traditional medicine.<ref name="JLrVS">{{cite book |vauthors=van Uhm DP |title=The Illegal Wildlife Trade: Inside the World of Poachers, Smugglers and Traders (Studies of Organized Crime) |date=2016 |volume=15 |publisher=New York: Springer |doi=10.1007/978-3-319-42129-2 |isbn=978-3-319-42128-5 |url=https://www.springer.com/gp/book/9783319421285 |access-date=16 May 2020 |archive-date=3 August 2020 |archive-url=https://web.archive.org/web/20200803101218/https://www.springer.com/gp/book/9783319421285 |url-status=live }}</ref><ref name="Harding" /> Laws protecting even [[critically endangered]] species such as the [[Sumatran tiger]] fail to stop the display and sale of these items in open markets.<ref name="2008 report from TRAFFIC">{{Cite web |url=http://www.traffic.org/home/2008/2/13/tiger-tiger-future-not-so-bright.html |title=2008 report from TRAFFIC |access-date=16 March 2009 |archive-url=https://web.archive.org/web/20090122105541/http://www.traffic.org/home/2008/2/13/tiger-tiger-future-not-so-bright.html |archive-date=22 January 2009 |url-status=live}}</ref> [[Shark fin soup]] is traditionally regarded in Chinese medicine as beneficial for health in East Asia, and its status as an elite dish has led to huge demand with the increase of affluence in China, devastating shark populations.<ref name="Sfgate.com">{{Cite web |url=http://www.sfgate.com/cgi-bin/article.cgi?file=/g/archive/2003/01/20/urbananimal.DTL |title=Shark Fin Soup: An Eco-Catastrophe? |work=San Francisco Chronicle |date=20 January 2003 |access-date=3 June 2020 |archive-url=https://web.archive.org/web/20120614142217/http://www.sfgate.com/cgi-bin/article.cgi?file=%2Fg%2Farchive%2F2003%2F01%2F20%2Furbananimal.DTL |archive-date=14 June 2012 |url-status=live}}</ref> The shark fins have been a part of traditional Chinese medicine for centuries.<ref name="VBTdV">{{Cite web|vauthors=Radford B|date=9 July 2011|title=Sharks Fin Soup Bans Don't Stop Strong Demand|url=https://www.livescience.com/14964-sharks-fin-soup-bans-stop-strong-demand.html|access-date=2020-09-07|website=livescience.com|language=en|archive-date=14 August 2020|archive-url=https://web.archive.org/web/20200814234452/https://www.livescience.com/14964-sharks-fin-soup-bans-stop-strong-demand.html|url-status=live}}</ref> Shark finning is banned in many countries, but the trade is thriving in Hong Kong and China, where the fins are part of shark fin soup, a dish considered a delicacy, and used in some types of traditional Chinese medicine.<ref name="NaomiNg2013">{{cite web | url=http://www.cnn.com/2013/12/09/world/asia/china-ban-shark-fin/index.html | title=China bans shark fin dishes at official banquets | website=[[CNN]] | date=9 December 2013 | access-date=27 March 2014 | archive-url=https://web.archive.org/web/20140501103823/http://www.cnn.com/2013/12/09/world/asia/china-ban-shark-fin/index.html | archive-date=1 May 2014 | url-status=live}}</ref>

The [[tortoise]] ([[freshwater turtle]], ''guiban'') and turtle ([[Chinese softshell turtle]], ''biejia'') species used in traditional Chinese medicine are raised on farms, while restrictions are made on the accumulation and export of other endangered species.<ref name="dharma4">{{Cite web|url=http://www.itmonline.org/arts/turtles.htm|title=Endangered Species Issues Affecting Turtles And Tortoises Used in Chinese Medicine| vauthors = Dharmananda S |access-date=10 February 2013|archive-url=https://web.archive.org/web/20121004124346/http://www.itmonline.org/arts/turtles.htm|archive-date=4 October 2012|url-status=live}}</ref> However, issues concerning the [[overexploitation]] of Asian turtles in China have not been completely solved.<ref name="dharma4" /> Australian scientists have developed methods to identify medicines containing DNA traces of endangered species.<ref name="REKkt">[http://www.abc.net.au/news/2012-04-13/dna-may-help-weed-out-toxic-chinese-medicine/3949356 DNA may weed out toxic Chinese medicine] {{Webarchive|url=https://web.archive.org/web/20120413211547/http://www.abc.net.au/news/2012-04-13/dna-may-help-weed-out-toxic-chinese-medicine/3949356 |date=13 April 2012}} – By Carolyn Herbert – Australian Broadcasting Corporation – Retrieved 14 April 2012.</ref> Finally, although not an endangered species, sharp rises in exports of donkeys and donkey hide from Africa to China to make the traditional remedy ''ejiao'' have prompted export restrictions by some African countries.<ref name="0VO1T">{{Cite web |url=https://www.independent.co.uk/news/world/asia/china-donkeys-buying-kill-africa-ejiao-medicine-hide-burkina-faso-niger-donkey-shortage-a7339181.html |title=China's quest to buy up global supply of donkeys halted by African nations |work=The Independent |date=30 September 2016 |access-date=17 September 2017 |archive-url=https://web.archive.org/web/20171003171037/http://www.independent.co.uk/news/world/asia/china-donkeys-buying-kill-africa-ejiao-medicine-hide-burkina-faso-niger-donkey-shortage-a7339181.html |archive-date=3 October 2017 |url-status=live}}</ref>

====Human body parts====
{{Main|Traditional Chinese medicines derived from the human body}}
[[File:Ziheche.jpg|thumb|right|Dried [[Placenta|human placenta]] (Ziheche ({{lang|zh|紫河车}}) is used in traditional Chinese medicine.<ref name="Tierra" />]]
Traditional Chinese medicine also includes some human parts: the classic ''[[Materia medica]]'' ([[Bencao Gangmu]]) describes (also criticizes) the use of 35 human body parts and [[excreta]] in medicines, including bones, fingernail, hairs, dandruff, earwax, impurities on the teeth, feces, urine, sweat, organs, but most are no longer in use.<ref name="HDCM">{{cite book |doi=10.1007/0-306-46867-0_7 |chapter='Human Drugs' in Chinese Medicine and the Confucian View: An Interpretive Study |title=Confucian Bioethics |year=1999 |last1=Nie |first1=Jing-Bao |pages=167–206 |isbn=978-0-7923-5723-0 }}</ref><ref name="HBNC">THE HUMAN BODY AS A NEW COMMODITY, Tsuyoshi Awaya, The Review of Tokuyama, June 1999</ref><ref name="CBSH">Commodifying bodies, Nancy Scheper-Hughes, Loïc J. D. Wacquant, 2002</ref>

Human placenta has been used an ingredient in certain traditional Chinese medicines,<ref name="News-Medical.Net">{{Cite news |url=http://www.news-medical.net/print_article.asp?id=1333 |title=Traditional Chinese medicine contains human placenta |publisher=News-Medical.Net |date=8 May 2004 |access-date=29 April 2014 |archive-url=https://web.archive.org/web/20090116073621/http://www.news-medical.net/print_article.asp?id=1333 |archive-date=16 January 2009 |url-status=live}}</ref> including using dried human placenta, known as "Ziheche", to treat infertility, impotence and other conditions.<ref name="Tierra">{{Cite book | vauthors = Tierra L, Tierra M |title=Chinese traditional herbal medicine |publisher=Lotus Light Pub |location=Twin Lakes, WI |year=1998 |isbn=978-0-914955-32-0 | pages = [https://books.google.com/books?id=Zm6QTqNt3JEC&pg=PT225 225]}}</ref> The consumption of the human placenta is a potential source of infection.<ref name="News-Medical.Net" />

===Traditional categorization===
The traditional categorizations and classifications that can still be found today are:
* The classification according to the [[Chinese herbology#Four Natures|Four Natures]] ({{zh|labels=no|c=四气|p=sì qì}}): hot, warm, cool, or cold (or, neutral in terms of temperature)<ref name="Ergil 2009" /> and hot and warm herbs are used to treat [[#Eight principles of diagnosis|cold]] diseases, while cool and cold herbs are used to treat heat diseases.<ref name="Ergil 2009" />
* The classification according to the [[Chinese herbology#Five Flavors|Five Flavors]], ({{zh|labels=no|c=五味 |p=wǔ wèi}}, sometimes also translated as Five Tastes): acrid, sweet, bitter, sour, and salty.<ref name="Ergil 2009" /> Substances may also have more than one flavor, or none (i.e., a "bland" flavor).<ref name="Ergil 2009" /> Each of the Five Flavors corresponds to one of zàng organs, which in turn corresponds to one of the [[#Five Phases theory|Five Phases]].<ref name="Ergil 2009" /> A flavor implies certain properties and therapeutic actions of a substance; e.g., saltiness drains downward and softens hard masses, while sweetness is supplementing, harmonizing, and moistening.<ref name="Ergil 2009" />
* The classification according to the meridian – more precisely, the zàng-fu organ including its associated meridian – which can be expected to be primarily affected by a given compound.<ref name="Ergil 2009" />
* The categorization according to the specific function mainly include: exterior-releasing<ref name="Xu 2002" /> or exterior-resolving,<ref name="Ergil 2009" /> heat-clearing,<ref name="Ergil 2009" /><ref name="Xu 2002" /> downward-draining,<ref name="Xu 2002" /> or precipitating<ref name="Ergil 2009" /> wind-damp-dispelling,<ref name="Ergil 2009" /><ref name="Xu 2002" /> dampness-transforming,<ref name="Ergil 2009" /><ref name="Xu 2002" /> promoting the movement of water and percolating dampness<ref name="Xu 2002" /> or dampness-percolating,<ref name="Ergil 2009" /> interior-warming,<ref name="Ergil 2009" /><ref name="Xu 2002" /> qi-regulating<ref name="Xu 2002" /> or qi-rectifying,<ref name="Ergil 2009" /> dispersing food accumulation<ref name="Xu 2002" /> or food-dispersing,<ref name="Ergil 2009" /> worm-expelling,<ref name="Ergil 2009" /><ref name="Xu 2002" /> stopping bleeding<ref name="Xu 2002" /> or blood-[[wikt:stanching|stanching]],<ref name="Ergil 2009" /> quickening the Blood and dispelling [[stasis (medicine)|stasis]]<ref name="Xu 2002" /> or blood-quickening,<ref name="Ergil 2009" /> transforming phlegm, stopping coughing and calming wheezing<ref name="Xu 2002" /> or phlegm-transforming and cough- and panting-suppressing,<ref name="Ergil 2009" /> Spirit-quieting,<ref name="Ergil 2009" /><ref name="Xu 2002" /> calming the liver and expelling wind<ref name="Ergil 2009" /> or liver-calming and wind-extinguishing<ref name="Ergil 2009" /> orifice-opening<ref name="Ergil 2009" /><ref name="Xu 2002" /> supplementing<ref name="Ergil 2009" /><ref name="Xu 2002" /> which includes qi-supplementing, blood-nourishing, yin-enriching, and yang-fortifying,<ref name="Ergil 2009" /> astriction-promoting<ref name="Xu 2002" /> or securing and astringing,<ref name="Ergil 2009" /> vomiting-inducing,<ref name="Xu 2002" /> and substances for external application.<ref name="Ergil 2009" /><ref name="Xu 2002">Xu, L. & Wang, W. (2002) [https://books.google.com/books?id=36dhuXGm3OgC&q=traditional+chinese+medicine+herb&pg=PA1 "Chinese materia medica: combinations and applications"] {{Webarchive|url=https://web.archive.org/web/20221215092023/https://books.google.com/books?id=36dhuXGm3OgC&pg=PA1#v=onepage&q=traditional%20chinese%20medicine%20herb |date=15 December 2022 }} Donica Publishing Ltd. 1st edition. {{ISBN|978-1-901149-02-9}}</ref>

===Efficacy===
{{Asof|2007}} there were not enough good-quality trials of herbal therapies to allow their effectiveness to be determined.<ref name="Shang-2007">{{cite journal | vauthors = Shang A, Huwiler K, Nartey L, Jüni P, Egger M | title = Placebo-controlled trials of Chinese herbal medicine and conventional medicine comparative study | journal = International Journal of Epidemiology | volume = 36 | issue = 5 | pages = 1086–92 | date = October 2007 | pmid = 17602184 | doi = 10.1093/ije/dym119 | doi-access = free | url = https://boris.unibe.ch/22102/8/dym119.pdf }}</ref> A high percentage of relevant studies on traditional Chinese medicine are in Chinese databases. Fifty percent of systematic reviews on TCM did not search Chinese databases, which could lead to a bias in the results.<ref name="DhORr">{{cite journal | vauthors = Wu XY, Tang JL, Mao C, Yuan JQ, Qin Y, Chung VC | title = Systematic reviews and meta-analyses of traditional chinese medicine must search chinese databases to reduce language bias | journal = Evidence-Based Complementary and Alternative Medicine | volume = 2013 | pages = 812179 | year = 2013 | pmid = 24223063 | pmc = 3816048 | doi = 10.1155/2013/812179 | doi-access = free }}</ref> Many systematic reviews of TCM interventions published in Chinese journals are incomplete, some contained errors or were misleading.<ref name="TUZvn">{{cite journal | vauthors = Ma B, Guo J, Qi G, Li H, Peng J, Zhang Y, Ding Y, Yang K | display-authors = 6 | title = Epidemiology, quality and reporting characteristics of systematic reviews of traditional Chinese medicine interventions published in Chinese journals | journal = PLOS ONE | volume = 6 | issue = 5 | pages = e20185 | year = 2011 | pmid = 21633698 | pmc = 3102106 | doi = 10.1371/journal.pone.0020185 | veditors = Hartling L | bibcode = 2011PLoSO...620185M | doi-access = free }}</ref> The herbs recommended by traditional Chinese practitioners in the US are unregulated.<ref name="HumberAlmeder2013">{{cite book| vauthors = Humber JM, Almeder RF |title=Alternative Medicine and Ethics|url=https://books.google.com/books?id=ehWzBwAAQBAJ&pg=PA10|date=9 March 2013|publisher=Springer Science & Business Media|isbn=978-1-4757-2774-6|pages=10–|access-date=18 February 2016|archive-url=https://web.archive.org/web/20160821092847/https://books.google.com/books?id=ehWzBwAAQBAJ&pg=PA10|archive-date=21 August 2016|url-status=live}}</ref>
* A 2013 review found the data too weak to support use of Chinese herbal medicine (CHM) for [[benign prostatic hyperplasia]].<ref name="FyK0S">{{cite journal | vauthors = Ma CH, Lin WL, Lui SL, Cai XY, Wong VT, Ziea E, Zhang ZJ | title = Efficacy and safety of Chinese herbal medicine for benign prostatic hyperplasia: systematic review of randomized controlled trials | journal = Asian Journal of Andrology | volume = 15 | issue = 4 | pages = 471–82 | date = July 2013 | pmid = 23728585 | pmc = 3739225 | doi = 10.1038/aja.2012.173 }}</ref>
* A 2013 review found the research on the benefit and safety of CHM for idiopathic sudden sensorineural hearing loss is of poor quality and cannot be relied upon to support their use.<ref name="ztPPx">{{cite journal | vauthors = Su CX, Yan LJ, Lewith G, Liu JP | title = Chinese herbal medicine for idiopathic sudden sensorineural hearing loss: a systematic review of randomised clinical trials | journal = Clinical Otolaryngology | volume = 38 | issue = 6 | pages = 455–73 | date = December 2013 | pmid = 24209508 | doi = 10.1111/coa.12198 | s2cid = 35688209 }}</ref>
* A 2013 [[Cochrane review]] found inconclusive evidence that CHM reduces the severity of eczema.<ref name="PS71S">{{cite journal | vauthors = Gu S, Yang AW, Xue CC, Li CG, Pang C, Zhang W, Williams HC | title = Chinese herbal medicine for atopic eczema | journal = The Cochrane Database of Systematic Reviews | volume = 9 | issue = 9 | pages = CD008642 | date = September 2013 | pmid = 24018636 | doi = 10.1002/14651858.CD008642.pub2 | pmc = 10639001 | url = http://handle.uws.edu.au:8081/1959.7/530887 | veditors = Gu S | access-date = 30 August 2017 | archive-date = 1 August 2020 | archive-url = https://web.archive.org/web/20200801083306/https://researchdirect.westernsydney.edu.au/islandora/object/uws:17466 | url-status = live }}</ref>
* The traditional medicine ginger, which has shown anti-inflammatory properties in laboratory experiments, has been used to treat [[rheumatism]], headache and digestive and respiratory issues, though there is no firm evidence supporting these uses.<ref name="BvceJ">{{cite journal | vauthors = Leonti M, Casu L | title = Traditional medicines and globalization: current and future perspectives in ethnopharmacology | journal = Frontiers in Pharmacology | volume = 4 | pages = 92 | year = 2013 | pmid = 23898296 | pmc = 3722488 | doi = 10.3389/fphar.2013.00092 | doi-access = free }}</ref>
* A 2012 Cochrane review found no difference in [[mortality rate]] among 640 SARS patients when Chinese herbs were used alongside Western medicine versus Western medicine exclusively, although they concluded some herbs may have improved symptoms and decreased corticosteroid doses.<ref name="3ab7r">{{cite journal | vauthors = Liu X, Zhang M, He L, Li Y | title = Chinese herbs combined with Western medicine for severe acute respiratory syndrome (SARS) | journal = The Cochrane Database of Systematic Reviews | volume = 10 | pages = CD004882 | date = October 2012 | issue = 10 | pmid = 23076910 | pmc = 6993561 | doi = 10.1002/14651858.CD004882.pub3 | veditors = Li Y  }}</ref>
* A 2012 Cochrane review found insufficient evidence to support the use of TCM for people with adhesive small bowel obstruction.<ref name="BEEp3">{{cite journal | vauthors = Suo T, Gu X, Andersson R, Ma H, Zhang W, Deng W, Zhang B, Cai D, Qin X | display-authors = 6 | title = Oral traditional Chinese medication for adhesive small bowel obstruction | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | issue = 5 | pages = CD008836 | date = May 2012 | pmid = 22592734 | doi = 10.1002/14651858.CD008836.pub2 | veditors = Qin X | pmc = 11844736 }}</ref>
* A 2011 review found low quality evidence that suggests CHM improves the symptoms of [[Sjögren syndrome|Sjögren's syndrome]].<ref name="9SvbV">{{cite journal | vauthors = Luo H, Han M, Liu JP | title = [Systematic review and meta-analysis of randomized controlled trials of Chinese herbal medicine in the treatment of Sjogren's syndrome] | journal = Zhong Xi Yi Jie He Xue Bao = Journal of Chinese Integrative Medicine | volume = 9 | issue = 3 | pages = 257–74 | date = March 2011 | pmid = 21419078 | doi = 10.3736/jcim20110306 }}</ref>
* A 2011 Cochrane review found inconclusive evidence to support the use of TCM herbal medicines for treatment of [[hypercholesterolemia]].<ref name=":1">{{Cite journal|last1=Liu|first1=Zhao Lan|last2=Liu|first2=Jian Ping|last3=Zhang|first3=Anthony Lin|last4=Wu|first4=Qiong|last5=Ruan|first5=Yao|last6=Lewith|first6=George|last7=Visconte|first7=Denise|date=2011-07-05|editor-last=Cochrane Metabolic and Endocrine Disorders Group|title=Chinese herbal medicines for hypercholesterolemia|journal=Cochrane Database of Systematic Reviews|issue=7|pages=CD008305|language=en|doi=10.1002/14651858.CD008305.pub2|pmid=21735427|pmc=3402023}}</ref>
* A 2011 Cochrane review did not find improvement in fasting [[C-peptide]] when compared to [[insulin]] treatment for [[Latent autoimmune diabetes in adults|latent autoimmune diabetes]] in adults after 3 months. It is important to highlight that the studies available to be included in this review presented considerable flaws in quality and design.<ref>{{Cite journal |last1=Brophy |first1=Sinead |last2=Davies |first2=Helen |last3=Mannan |first3=Sopna |last4=Brunt |first4=Huw |last5=Williams |first5=Rhys |date=2011-09-07 |title=Interventions for latent autoimmune diabetes (LADA) in adults |url=https://doi.org/10.1002/14651858.CD006165.pub3 |journal=Cochrane Database of Systematic Reviews |volume=2011 |issue=9 |pages=CD006165 |doi=10.1002/14651858.cd006165.pub3 |issn=1465-1858 |pmc=6486159 |pmid=21901702}}</ref>
* A 2010 review found TCM seems to be effective for the treatment of fibromyalgia but the findings were of insufficient methodological rigor.<ref name="UqEpQ">{{cite journal | vauthors = Cao H, Liu J, Lewith GT | title = Traditional Chinese Medicine for treatment of fibromyalgia: a systematic review of randomized controlled trials | journal = Journal of Alternative and Complementary Medicine | volume = 16 | issue = 4 | pages = 397–409 | date = April 2010 | pmid = 20423209 | pmc = 3110829 | doi = 10.1089/acm.2009.0599 }}</ref>
* A 2008 Cochrane review found promising evidence for the use of Chinese herbal medicine in relieving [[dysmenorrhea|painful menstruation]], but the trials assessed were of such low methodological quality that no conclusion could be drawn about the remedies' suitability as a recommendable treatment option.<ref name="mTlKH">{{cite journal | vauthors = Zhu X, Proctor M, Bensoussan A, Wu E, Smith CA | title = Chinese herbal medicine for primary dysmenorrhoea | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD005288 | date = April 2008 | pmid = 18425916 | doi = 10.1002/14651858.CD005288.pub3 | veditors = Zhu X }}</ref>
* [[Turmeric]] has been used in traditional Chinese medicine for centuries to treat various conditions.<ref name="Gautam" /> This includes jaundice and hepatic disorders, rheumatism, anorexia, diabetic wounds, and menstrual complications.<ref name="Gautam" /> Most of its effects have been attributed to [[curcumin]].<ref name="Gautam" /> Research that curcumin shows strong anti-inflammatory and antioxidant activities have instigated mechanism of action studies on the possibility for cancer and inflammatory diseases prevention and treatment.<ref name="Gautam" /> It also exhibits [[immunomodulatory]] effects.<ref name="Gautam">{{cite book |doi=10.1007/978-0-387-46401-5_14 |chapter=Immunomodulation by Curcumin |title=The Molecular Targets and Therapeutic Uses of Curcumin in Health and Disease |series=Advances in Experimental Medicine and Biology |year=2007 |last1=Gautam |first1=Subhash C. |last2=Gao |first2=Xiaohua |last3=Dulchavsky |first3=Scott |volume=595 |pages=321–341 |pmid=17569218 |isbn=978-0-387-46400-8 }}</ref>
* A 2005 Cochrane review found insufficient evidence for the use of CHM in HIV-infected people and people with [[HIV/AIDS|AIDS]].<ref name="PNBAI">{{cite journal | vauthors = Liu JP, Manheimer E, Yang M | title = Herbal medicines for treating HIV infection and AIDS | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD003937 | date = July 2005 | volume = 2010 | pmid = 16034917 | doi = 10.1002/14651858.CD003937.pub2 | pmc = 8759069 | veditors = Liu JP }}</ref>
* A 2010 Cochrane review found insufficient evidence to support the use of Traditional Chinese Herbal Products (THCP) in the treatment of [[angina]].<ref name="vfVTP">{{cite journal | vauthors = Zhuo Q, Yuan Z, Chen H, Wu T | title = Traditional Chinese herbal products for stable angina | journal = The Cochrane Database of Systematic Reviews | issue = 5 | pages = CD004468 | date = May 2010 | volume = 2010 | pmid = 20464731 | pmc = 6718232 | doi = 10.1002/14651858.cd004468.pub2 }}</ref>
* A 2010 Cochrane review found no evidence supporting the use of TCHM for stopping bleeding from [[Hemorrhoid|haemorrhoids]]. There was some weak evidence of pain relief.<ref name="vkl5u">{{cite journal | vauthors = Gan T, Liu YD, Wang Y, Yang J | title = Traditional Chinese Medicine herbs for stopping bleeding from haemorrhoids | journal = The Cochrane Database of Systematic Reviews | issue = 10 | pages = CD006791 | date = October 2010 | pmid = 20927750 | doi = 10.1002/14651858.cd006791.pub2 }}</ref>

====Drug research====
{{Further|Arsenic trioxide|Artemisinin|Huperzine A|Ephedrine}}
[[File:Artemisia annua(01).jpg|thumb|upright|''[[Artemisia annua]]'', traditionally used to treat fever, has been found to have [[malaria|antimalarial]] properties.<ref name="swallow" />]]
With an eye to the enormous Chinese market, pharmaceutical companies have explored creating new drugs from traditional remedies. The journal ''Nature'' commented that "claims made on behalf of an uncharted body of knowledge should be treated with the customary scepticism that is the bedrock of both science and medicine."<ref name="swallow">{{cite journal | vauthors =  | title = Hard to swallow | journal = Nature | volume = 448 | issue = 7150 | pages = 105–6 | date = July 2007 | pmid = 17625521 | doi = 10.1038/448106a | quote = Constructive approaches to divining the potential usefulness of traditional therapies are to be welcomed. But it seems problematic to apply a brand new technique, largely untested in the clinic, to test the veracity of traditional Chinese medicine, when the field is so fraught with pseudoscience. In the meantime, claims made on behalf of an uncharted body of knowledge should be treated with the customary scepticism that is the bedrock of both science and medicine. | doi-access = free | bibcode = 2007Natur.448S.105. }}</ref>

There was success in the 1970s, however, with the development of the antimalarial drug [[artemisinin]], which is a chemical compound isolated the herb ''[[Artemisia annua]]'' that has been used traditionally as a treatment for fever.<ref name="swallow" /><ref name="Su 2011">{{cite journal | vauthors = Miller LH, Su X | title = Artemisinin: discovery from the Chinese herbal garden | journal = Cell | volume = 146 | issue = 6 | pages = 855–8 | date = September 2011 | pmid = 21907397 | pmc = 3414217 | doi = 10.1016/j.cell.2011.08.024 }}</ref> ''Artemisia annua'' has been used by Chinese herbalists in traditional Chinese medicines for 2,000 years. In 1596, Li Shizhen recommended tea made from qinghao specifically to treat malaria symptoms in his ''[[Compendium of Materia Medica]]''. Researcher [[Tu Youyou]] discovered that a low-temperature extraction process could isolate an effective antimalarial substance from the plant.<ref name="scimag" /> Tu says she was influenced by a traditional Chinese herbal medicine source, ''The Handbook of Prescriptions for Emergency Treatments'', written in 340 by [[Ge Hong]], which states that this herb should be steeped in cold water.<ref name="scimag">{{cite web |url=https://www.science.org/content/article/lasker-award-rekindles-debate-over-artemisinins-discovery |title=Lasker Award Rekindles Debate Over Artemisinin's Discovery &#124; Science/AAAS |publisher=News.sciencemag.org |access-date=7 January 2014 |date=29 September 2011 |archive-url=https://web.archive.org/web/20140104214759/http://news.sciencemag.org/asia/2011/09/lasker-award-rekindles-debate-over-artemisinins-discovery |archive-date=4 January 2014 |url-status=live}}</ref> The extracted substance, once subject to detoxification and purification processes, is a usable antimalarial drug<ref name="Su 2011" /> – a 2012 review found that artemisinin-based remedies were the most effective drugs for the treatment of malaria.<ref name="h0dmr">{{cite journal | vauthors = Fairhurst RM, Nayyar GM, Breman JG, Hallett R, Vennerstrom JL, Duong S, Ringwald P, Wellems TE, Plowe CV, Dondorp AM | display-authors = 6 | title = Artemisinin-resistant malaria: research challenges, opportunities, and public health implications | journal = The American Journal of Tropical Medicine and Hygiene | volume = 87 | issue = 2 | pages = 231–241 | date = August 2012 | pmid = 22855752 | pmc = 3414557 | doi = 10.4269/ajtmh.2012.12-0025 }}</ref> For her work on malaria, Tu received the 2015 [[Nobel Prize in Physiology or Medicine]]. Despite global efforts in combating malaria, it remains a large burden for the population.<ref name="Chrubasik 2010" /> Although [[WHO]] recommends artemisinin-based remedies for treating uncomplicated malaria, resistance to the drug can no longer be ignored.<ref name="Chrubasik 2010">{{cite journal | vauthors = Chrubasik C, Jacobson RL | title = The development of artemisinin resistance in malaria: reasons and solutions | journal = Phytotherapy Research | volume = 24 | issue = 7 | pages = 1104–6 | date = July 2010 | pmid = 20578122 | doi = 10.1002/ptr.3133 | s2cid = 37901416 }}</ref><ref name="CtwCp">{{Cite web|title=The Nobel Prize in Physiology or Medicine 2015|url=https://www.nobelprize.org/prizes/medicine/2015/tu/facts/|website=NobelPrize.org|language=en-US|access-date=2020-05-21|archive-url=https://web.archive.org/web/20200422125851/https://www.nobelprize.org/prizes/medicine/2015/tu/facts/|archive-date=22 April 2020|url-status=live}}</ref>

Also in the 1970s Chinese researcher [[Zhang TingDong]] and colleagues investigated the potential use of the traditionally used substance [[arsenic trioxide]] to treat [[acute promyelocytic leukemia]] (APL).<ref name="dfp">{{cite journal | vauthors = Rao Y, Li R, Zhang D | title = A drug from poison: how the therapeutic effect of arsenic trioxide on acute promyelocytic leukemia was discovered | journal = Science China Life Sciences | volume = 56 | issue = 6 | pages = 495–502 | date = June 2013 | pmid = 23645104 | doi = 10.1007/s11427-013-4487-z | doi-access = free }}</ref> Building on his work, research both in China and the West eventually led to the development of the drug [[Trisenox]], which was approved for leukemia treatment by the FDA in 2000.<ref name="VonXd">{{cite journal | vauthors = Bian Z, Chen S, Cheng C, Wang J, Xiao H, Qin H |doi=10.1016/j.apsb.2011.12.007|title=Developing new drugs from annals of Chinese medicine|year=2012 |journal=Acta Pharmaceutica Sinica B|volume=2|pages=1–7|name-list-style=vanc|doi-access=free}}</ref>

[[Huperzine A]], an extract from the herb, ''[[Huperzia serrata]]'', is under preliminary research as a possible therapeutic for Alzheimer's disease, but poor methodological quality of the research restricts conclusions about its effectiveness.<ref name="SfkqU">{{cite journal | vauthors = Yang G, Wang Y, Tian J, Liu JP | title = Huperzine A for Alzheimer's disease: a systematic review and meta-analysis of randomized clinical trials | journal = PLOS ONE | volume = 8 | issue = 9 | pages = e74916 | year = 2013 | pmid = 24086396 | pmc = 3781107 | doi = 10.1371/journal.pone.0074916 | veditors = Scherer RW | bibcode = 2013PLoSO...874916Y | doi-access = free }}</ref>

[[Ephedrine]] in its natural form, known as ''má huáng'' ({{lang|zh|麻黄}}) in TCM, has been documented in China since the [[Han dynasty]] (206 BCE – 220 CE) as an [[Asthma|antiasthmatic]] and stimulant.<ref name="principles">{{cite book| vauthors= Levy WO, Kalidas K, Miller NS |title=Principles of Addictions and the Law: Applications in Forensic, Mental Health, and Medical Practice|date=26 February 2010|publisher=Academic Press|isbn=978-0-12-496736-6|pages=307–08}}</ref> In 1885, the chemical synthesis of ephedrine was first accomplished by Japanese [[organic chemist]] [[Nagai Nagayoshi]] based on his research on [[Japanese traditional medicine|Japanese]] and Chinese traditional herbal medicines<ref name="7Oug3">{{cite book| vauthors = Lock  |title=East Asian Medicine in Urban Japan: Varieties of Medical Experience|year=1984|publisher= University of California Press; Reprint edition|isbn=978-0-520-05231-4}}</ref>

[[Pien tze huang]] was first documented in the [[Ming dynasty]].

====Cost-effectiveness====
A 2012 systematic review found there is a lack of available [[cost-effectiveness]] evidence in TCM.<ref name="Zhang2012">{{cite journal | vauthors = Zhang F, Kong LL, Zhang YY, Li SC | title = Evaluation of impact on health-related quality of life and cost effectiveness of Traditional Chinese Medicine: a systematic review of randomized clinical trials | journal = Journal of Alternative and Complementary Medicine | volume = 18 | issue = 12 | pages = 1108–20 | date = December 2012 | pmid = 22924383 | doi = 10.1089/acm.2011.0315 }}</ref>

===Safety===
[[File:Calcite-Galena-elm56c.jpg|thumb|right|upright|Galena (lead ore) is part of historical TCM.<ref name="galena" />
Standard American TCM practice considers lead-containing herbs obsolete.<ref name="futoV">{{cite book | vauthors = Bensky D | author-link = Dan Bensky | title = Chinese Herbal Medicine Materia Medica | publisher = [[Eastland Press Inc.]] | edition = 3 | location = Seattle | date = 2004 | page = 1042 | isbn = 978-0-939616-4-28}}</ref>]]
From the earliest records regarding the use of compounds to today, the toxicity of certain substances has been described in all Chinese materiae medicae.<ref name="Ergil 2009" /> Since TCM has become more popular in the Western world, there are increasing concerns about the potential toxicity of many traditional Chinese plants, animal parts and minerals.<ref name="Shaw-2012" /> Traditional Chinese herbal remedies are conveniently available from grocery stores in most Chinese neighborhoods; some of these items may contain toxic ingredients, are imported into the U.S. illegally, and are associated with claims of therapeutic benefit without evidence.<ref name="LICHT">{{cite journal | vauthors = Ko RJ, Greenwald MS, Loscutoff SM, Au AM, Appel BR, Kreutzer RA, Haddon WF, Jackson TY, Boo FO, Presicek G | display-authors = 6 | title = Lethal ingestion of Chinese herbal tea containing ch'an su | journal = The Western Journal of Medicine | volume = 164 | issue = 1 | pages = 71–5 | date = January 1996 | pmid = 8779214 | pmc = 1303306 }}</ref> For most compounds, efficacy and toxicity testing are based on traditional knowledge rather than laboratory analysis.<ref name="Shaw-2012">{{cite journal | vauthors = Shaw D | title = Toxicological risks of Chinese herbs | journal = Planta Medica | volume = 76 | issue = 17 | pages = 2012–8 | date = December 2010 | pmid = 21077025 | doi = 10.1055/s-0030-1250533 | doi-access = free | bibcode = 2010PlMed..76.2012S }}</ref> The toxicity in some cases could be confirmed by modern research (i.e., in scorpion); in some cases it could not (i.e., in ''[[Curculigo]]'').<ref name="Ergil 2009" /> Traditional herbal medicines can contain extremely toxic chemicals and heavy metals, and naturally occurring toxins, which can cause illness, exacerbate pre-existing poor health or result in death.<ref name="0tADw">{{cite journal | vauthors = Byard RW | title = A review of the potential forensic significance of traditional herbal medicines | journal = Journal of Forensic Sciences | volume = 55 | issue = 1 | pages = 89–92 | date = January 2010 | pmid = 20412155 | doi = 10.1111/j.1556-4029.2009.01252.x | url = http://www.adelaide.edu.au/news/binary5521/Journal.pdf | access-date = 24 October 2017 | url-status = live | s2cid = 205768581 | citeseerx = 10.1.1.627.5612 | archive-url = https://web.archive.org/web/20170809110132/http://www.adelaide.edu.au/news/binary5521/Journal.pdf | archive-date = 9 August 2017 }}</ref> Botanical misidentification of plants can cause toxic reactions in humans.<ref name="Efferth2011" /> The description of some plants used in TCM has changed, leading to unintended poisoning by using the wrong plants.<ref name="Efferth2011" /> A concern is also contaminated herbal medicines with microorganisms and fungal toxins, including [[aflatoxin]].<ref name="Efferth2011">{{cite journal | vauthors = Efferth T, Kaina B | title = Toxicities by herbal medicines with emphasis to traditional Chinese medicine | journal = Current Drug Metabolism | volume = 12 | issue = 10 | pages = 989–96 | date = December 2011 | pmid = 21892916 | doi = 10.2174/138920011798062328 }}</ref> Traditional herbal medicines are sometimes contaminated with toxic heavy metals, including lead, arsenic, mercury and cadmium, which inflict serious health risks to consumers.<ref name="zkc6B">{{cite journal | vauthors = Yuan X, Chapman RL, Wu Z | title = Analytical methods for heavy metals in herbal medicines | journal = Phytochemical Analysis | volume = 22 | issue = 3 | pages = 189–98 | year = 2011 | pmid = 21341339 | doi = 10.1002/pca.1287 | bibcode = 2011PChAn..22..189Y }}</ref> Also, adulteration of some herbal medicine preparations with conventional drugs which may cause serious adverse effects, such as [[corticosteroid]]s, [[phenylbutazone]], [[phenytoin]], and [[glibenclamide]], has been reported.<ref name="Efferth2011" /><ref name="Ernst2002">{{cite journal | vauthors = Ernst E | title = Adulteration of Chinese herbal medicines with synthetic drugs: a systematic review | journal = Journal of Internal Medicine | volume = 252 | issue = 2 | pages = 107–13 | date = August 2002 | pmid = 12190885 | doi = 10.1046/j.1365-2796.2002.00999.x | type = Systematic Review | s2cid = 29077682 | doi-access = free }}{{open access}}</ref>

Substances known to be potentially dangerous include ''[[Aconitum]]'',<ref name="Ergil 2009" /><ref name="Shaw-2012" /> secretions from the [[Asiatic toad]],<ref name="LICHT"/> powdered centipede,<ref name="CAT">{{cite web |url=http://www.acupuncturetoday.com/herbcentral/centipede.php |title=Centipede, Acupuncture Today |publisher=Acupuncturetoday.com |access-date=17 May 2011 |archive-url=https://web.archive.org/web/20110707082229/http://www.acupuncturetoday.com/herbcentral/centipede.php |archive-date=7 July 2011 |url-status=live}}</ref> the Chinese beetle (''[[Mylabris phalerata]]''),<ref name="IDCD">{{cite journal | vauthors = Namba T, Ma YH, Inagaki K | title = Insect-derived crude drugs in the Chinese Song dynasty | journal = Journal of Ethnopharmacology | volume = 24 | issue = 2–3 | pages = 247–85 | date = December 1988 | pmid = 3075674 | doi = 10.1016/0378-8741(88)90157-2 }}</ref> certain fungi,<ref name="2RQlq">{{cite journal | vauthors = Wang XP, Yang RM | title = Movement disorders possibly induced by traditional chinese herbs | journal = European Neurology | volume = 50 | issue = 3 | pages = 153–9 | year = 2003 | pmid = 14530621 | doi = 10.1159/000073056 | s2cid = 43878555 }}</ref> ''[[Aristolochia]]'',<ref name="Shaw-2012" /> arsenic sulfide ([[realgar]]),<ref name="Genuis2012" /> mercury sulfide,<ref name="AsaNP">{{cite journal |last1=Wong |first1=H.C. George |title=Mercury and Chinese herbal medicine {{!}} British Columbia Medical Journal |journal=BCMJ |date=November 2004 |volume=46 |issue=9 |pages=442 |url=https://bcmj.org/letters/mercury-and-chinese-herbal-medicine |access-date=10 January 2022 |archive-date=10 January 2022 |archive-url=https://web.archive.org/web/20220110132851/https://bcmj.org/letters/mercury-and-chinese-herbal-medicine |url-status=live }}</ref> and [[cinnabar]].<ref name="F1lej">{{cite journal | vauthors = Huang CF, Hsu CJ, Liu SH, Lin-Shiau SY | title = Exposure to low dose of cinnabar (a naturally occurring mercuric sulfide (HgS)) caused neurotoxicological effects in offspring mice | journal = Journal of Biomedicine & Biotechnology | volume = 2012 | pages = 254582 | year = 2012 | pmid = 22888198 | pmc = 3408718 | doi = 10.1155/2012/254582 | doi-access = free }}</ref> Asbestos ore ([[Actinolite]], Yang Qi Shi, 阳起石) is used to treat impotence in TCM.<ref name="ERTCM">''Encyclopedic Reference of Traditional Chinese Medicine'', Xinrong Yang, p. 8, [https://books.google.com/books?id=mwol-baZYMEC&q=actinolite&pg=PA1] {{Webarchive|url=https://web.archive.org/web/20160302164242/https://books.google.com/books?hl=en&lr=&id=mwol-baZYMEC&oi=fnd&pg=PA1&dq=Actinolite+toxic+%22traditional+chinese+medicine%22&ots=l_SDqCIZiJ&sig=lkBNJXF4HINqXZg-GG0Sl5Rc6o0#v=onepage&q=actinolite&f=false|date=2 March 2016}}</ref> Due to [[galena]]'s ([[litharge]], [[lead(II) oxide]]) high lead content, it is known to be toxic.<ref name="galena">{{Cite web |url=http://www.acupuncturetoday.com/herbcentral/galena.php |title=Galena, Acupuncture Today |access-date=7 March 2011 |archive-url=https://web.archive.org/web/20110312051005/http://www.acupuncturetoday.com/herbcentral/galena.php |archive-date=12 March 2011 |url-status=live}}</ref> Lead, mercury, arsenic, copper, cadmium, and thallium have been detected in TCM products sold in the U.S. and China.<ref name="Genuis2012">{{cite journal | vauthors = Genuis SJ, Schwalfenberg G, Siy AK, Rodushkin I | title = Toxic element contamination of natural health products and pharmaceutical preparations | journal = PLOS ONE | volume = 7 | issue = 11 | pages = e49676 | year = 2012 | pmid = 23185404 | pmc = 3504157 | doi = 10.1371/journal.pone.0049676 | bibcode = 2012PLoSO...749676G | doi-access = free }}</ref>

To avoid its toxic adverse effects ''[[Xanthium sibiricum]]'' must be processed.<ref name="Shaw-2012" /> [[Hepatotoxicity]] has been reported with products containing ''[[Reynoutria multiflora]]'' ([[Synonym (taxonomy)|synonym]] ''Polygonum multiflorum''), [[glycyrrhizin]], ''[[Senecio]]'' and ''[[Symphytum]]''.<ref name="Shaw-2012" /> The herbs indicated as being hepatotoxic included ''[[Dictamnus dasycarpus]]'', ''[[Astragalus membranaceus]]'', and ''[[Paeonia lactiflora]]''.<ref name="Shaw-2012" /> Contrary to popular belief, ''[[Ganoderma lucidum]]'' mushroom extract, as an adjuvant for cancer immunotherapy, appears to have the potential for toxicity.<ref name="LloIl">{{cite journal | vauthors = Gill SK, Rieder MJ | title = Toxicity of a traditional Chinese medicine, Ganoderma lucidum, in children with cancer | journal = The Canadian Journal of Clinical Pharmacology | volume = 15 | issue = 2 | pages = e275-85 | year = 2008 | pmid = 18603664 }}</ref> A 2013 review suggested that although the [[Antimalarial medication|antimalarial]] herb ''[[Artemisia annua]]'' may not cause hepatotoxicity, haematotoxicity, or hyperlipidemia, it should be used cautiously during pregnancy due to a potential risk of embryotoxicity at a high dose.<ref name="oSYtW">{{cite journal | vauthors = Abolaji AO, Eteng MU, Ebong PE, Brisibe EA, Dar A, Kabir N, Choudhary MI | title = A safety assessment of the antimalarial herb Artemisia annua during pregnancy in Wistar rats | journal = Phytotherapy Research | volume = 27 | issue = 5 | pages = 647–54 | date = May 2013 | pmid = 22736625 | doi = 10.1002/ptr.4760 | s2cid = 22650085 }}</ref>

However, many adverse reactions are due to misuse or abuse of Chinese medicine.<ref name="Shaw-2012" /> For example, the misuse of the dietary supplement ''[[Ephedra (plant)|Ephedra]]'' (containing ephedrine) can lead to adverse events including gastrointestinal problems as well as sudden death from [[cardiomyopathy]].<ref name="Shaw-2012" /> Products adulterated with pharmaceuticals for weight loss or erectile dysfunction are one of the main concerns.<ref name="Shaw-2012" /> Chinese herbal medicine has been a major cause of [[acute liver failure]] in China.<ref name="nc1f3">{{cite journal | vauthors = Zhao P, Wang C, Liu W, Chen G, Liu X, Wang X, Wang B, Yu L, Sun Y, Liang X, Yang H, Zhang F | display-authors = 6 | title = Causes and outcomes of acute liver failure in China | journal = PLOS ONE | volume = 8 | issue = 11 | pages = e80991 | year = 2013 | pmid = 24278360 | pmc = 3838343 | doi = 10.1371/journal.pone.0080991 | veditors = Avila MA | bibcode = 2013PLoSO...880991Z | doi-access = free }}</ref>

The harvesting of [[guano]] from bat caves (''yemingsha'') brings workers into close contact with these animals, increasing the risk of [[zoonosis]].<ref>{{cite journal |last1=Wassenaar |first1=T.M. |last2=Zou |first2=Y. |title=2019_nCoV/SARS-CoV-2: rapid classification of betacoronaviruses and identification of Traditional Chinese Medicine as potential origin of zoonotic coronaviruses |journal=Letters in Applied Microbiology |date=May 2020 |volume=70 |issue=5 |pages=342–348 |doi=10.1111/lam.13285 |pmid=32060933 |pmc=7165814 }}</ref> The Chinese virologist [[Shi Zhengli]] has identified dozens of SARS-like [[coronavirus]]es in samples of bat droppings.<ref>{{cite journal |last1=Li |first1=Wendong |last2=Shi |first2=Zhengli |last3=Yu |first3=Meng |last4=Ren |first4=Wuze |last5=Smith |first5=Craig |last6=Epstein |first6=Jonathan H. |last7=Wang |first7=Hanzhong |last8=Crameri |first8=Gary |last9=Hu |first9=Zhihong |last10=Zhang |first10=Huajun |last11=Zhang |first11=Jianhong |last12=McEachern |first12=Jennifer |last13=Field |first13=Hume |last14=Daszak |first14=Peter |last15=Eaton |first15=Bryan T. |last16=Zhang |first16=Shuyi |last17=Wang |first17=Lin-Fa |title=Bats Are Natural Reservoirs of SARS-Like Coronaviruses |journal=Science |date=28 October 2005 |volume=310 |issue=5748 |pages=676–679 |doi=10.1126/science.1118391 |pmid=16195424 |bibcode=2005Sci...310..676L |s2cid=2971923 |url=https://zenodo.org/record/3949088 |doi-access=free |access-date=17 May 2022 |archive-date=11 November 2020 |archive-url=https://web.archive.org/web/20201111110805/https://zenodo.org/record/3949088 |url-status=live }}</ref>