Editing Traditional Chinese medicine (section)

===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>