Mr. Steve Brabaw:
MT National Board Certified, Dunwoody Neuromuscular Clinic
stevebrabaw@yahoo.com

I do not think the FDA should ban all Ephedra containing products. There is a problem with people using Ephedra for the wrong reasons, in unbalanced formulas, and without proper knowledge of it's purpose. From the first article: "the functions (of Ephedra) are to induce sweat, soothe breathing, and promote the excretion of urine. It is traditionally prescribed for typhoid fever, bad colds, fevers without sweat, pain over the body, pain in the joints, coughing, shortness of breath, and swelling of the ankles." In the cases where people blamed Ephedra for having negative effects, they were using it as a pep pill or as a diet supplement. These are not the intended uses for Ephedra. It seems to me that Ephedra, like anything we eat, has the potential to be harmful. It also seems like, for thousands of years, it has helped people with asthma and other problems.
The mission statement of the FDA is: "The FDA is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation's food supply, cosmetics, and products that emit radiation. The FDA is also responsible for advancing the public health by helping to speed innovations that make medicines and foods more effective, safer, and more affordable; and helping the public to get the accurate, science-based information they need to use medicines and foods to improve their health."
My opinion is that the FDA should: (1) Require Ephedra only be sold by someone who has passed the national board for Chinese Herbs. Even a formula that is balanced such as Ephedra Decoction can be harmful if used too long, or not followed by a clearing formula such as the Four Gentlemen Decoction. Each patient is different, and many patients will need to have their formula altered to have the proper effect. Without the knowledge that comes from being properly educated in Chinese Herbal Medicine, more people will be hurt by Ephedra in the Unites States. (2) Limit the uses to the original uses, until more research can be done on using it for energy or weight loss. Any herb needs to be balanced in a formula using the Four Essentials (Principal, Assistant, Adjuvant, and Dispatcher). Only someone trained in Chinese herbs would know this. (3) Put warning labels for amount of time the herb should be taken. Any herb should only be taken for a certain amount of time. Only someone trained in Chinese herbs would know this. Allowing people to use Ephedra as a stimulant or diet pill in the form now available is dangerous. Outlawing Ephedra is not a good solution because it is an effective herb for many conditions when used properly. Regulating Ephedra so as to ensure that people get the proper dose in a balanced formula makes sense from a health perspective, and will help this society to accept Chinese Medicine quicker.

Miss. Winifred Lau:
ARCB National Board Certified
winifredlau@prodigy.net

The four essentials are principal herbs which are the main ingredients for the primary symptoms. Assistant herbs are to help the principal herbs. Adjuvant herbs are to help the principal and the assistant herbs and to tonify or counteract their toxic effects. Dispatcher herbs can be a mediator of all other herbs or be a vehicle to the meridians.
In western world, the modern high-tech made it easy to isolate single ingredients from plants to make it into pills. However, traditional Chinese medicine was not used to work in this a way. Our formulation consists of four parts, the principal herbs, the assistant herbs, the adjuvant herbs and the dispatcher herbs. Make it easier to understand, principal herbs are just like the Presidential Cabinet, assistant herb is the Republican Party, adjuvant herb is the Democratic Party and dispatcher herb is the Congressmen. As a whole group all work together to run the country to maintain balance of power. It is the same as our formulation. For example, ephedra decoction which contains ephedra, cassia twig, apricot kernel and roasted licorice. This classic formula is for relieving exterior cold. Ephedra is the main herb to disperse the lung for relieve. Cassia twig is the assistant to dispel the cold while warming the meridian and activate the defensive Qi. Apricot kernel is to sooth the lung and roasted licorice is to mediate the drastic effect of ephedra. This is the way the Asian use the herbs. Therefore if somebody taking the ephedra formula in pill form would not accumulate enough to harm.
The disputes of Mahuang (Ephedra) in the modern days actually happened in ancient China thousand years ago. The case was about a young man fell ill with profuse perspiration. A young herbalist prescribed Mahuang in large doses with the intention to produce quick results. Unexpectedly, the patient perspired even more that his arms and legs became as cold as ice. His entire body was shivering with cold. People brought him to his master. He gave him Mahuang again. This time, he was cure. Since then Mahuang had been under investigated. They found out that the leaves of Mahuang actually induce perspiration but the root produces opposing effect. The judgment is this herb would be known as "ask for trouble" to remind people this accident and the valuable findings should be included in all herbal scripts. From then onwards, all Chinese herb book had a mark on using the herbs intermittently, particularly in chronic asthma. In addition, it is marked that this herb can excite cerebral cortex which may lead to nervousness and insomnia. Ephedrine I believe is found in the leaves and pseudo-ephedrine is found in the root.
The cultural difference is another factor. The general public in the east understand the short term use of herbs to relieve symptoms and the long term use of herbs to tonify the body. In the west, people tend to relieve symptom fast without tonify the body. In order to get a rapid result, large doses should be administered. This would lead to harmful effects of the body like weakening the defensive Qi. As people do not have the concept of tonifying the body, the use of single herbs is very dangerous. In China, it is a common knowledge that ephedra is not for long term use even people only know a little bit about this herb. The culture trains them to know that to stop using the herbs if the body experience differently. However in the west, people is not train to tell low Qi level, too yin or yang. Without this background, they cannot aware the danger of long term use of single herbs.
Another difference in the culture is the consumption of coffee. Asian people do not drink as much coffee as westerner. The caffeine in coffee will boost up the effect of ephedra by 20%. Other medication that contains stimulant effect or recreational drug will add up to the danger of using any counter drugs or dietary supplement that contains ephedra. The problem of ephedra is from the weight loss products. These products contain a safe amount of ephedra. It is the long period use of the product that leads to the danger. In addition, the general public have no idea of intermittently use of herbs, of tonify the body and the huge consumption of other medication or drugs complicated the problem.
Ephedra is commonly use in the weight loss product. It is good because one can see the result in the first week because of the thermogenic effect. That is the reason why it is so popular. However, losing weight should be done through proper diet and exercise. There is no point of eating a lot and resting a lot, then take ephedra to burn the extra fat. When things go wrong, then ephedra is the criminal.
If we banned the use of ephedra, it would push it into the black market and became a new form of drug. This would bring more harm to the public than to protect the public. Besides, people who need the benefits cannot get it. Ephedra itself is not harmful. It is harmful only because people abuse the use of herbs. The banning of this herb will lead to another question, what will be the next? Sooner or later the legal herbs will be limited, and then illegal drug business will flourish.
What about the herbs only are dispensed by licensed people? It is unlikely to be only those herbalists or natural healers. It would probably the medical doctors. However they have limited training in herbs. I doubt whether they would even mentioned about it. Furthermore, it is not hard to get these products from other countries or through the Internet. So this is a fruitless act.
The law means to protect the public. In my opinion, I think the package of any product containing ephedra should have warning label just like the cigarette. It should have information on the side effect if combined with other stimulants. The advice on the rest period and to consult the doctor if there is any doubt. The manufacturer should be the one liable to the abusive use of the herbs.
As in modern language, if the presidential cabinet is in power and we only let the president to rule. Without his own party to help and the other party to counteract or help, the government will easily become a dictator. Even worse without the congressmen to mediate, the country is in chaos situation. A good president needs his party's support, the opposite part to watch out and the congressmen to deliver the order. Just like the formulation, it needs all other herbs to work together.
Traditional Chinese medicine is an art, and there is no one size fits all. The formulation varies with people, season, gender and the illness itself. The proper use of it will benefit us. Through this event I hope a fair judgment will pass down for ephedra.
I disagree to ban all ephedrine containing products. Our ancestor already handed down their wise judgment that lead to the use of this herb for thousand years.


Mr. A. J. Gardner:
Reiki Master
agard10158@aol.com

In my opinion the product Tylenol is more dangerous then Ephedra even when the Tylenol is used as instructed. Each and every argument that I read did not give enough clinical evidence for such strong action as a total ban on the use of this product. To date there has been one state legislature to ban the use of the drug state wide. I smell money; this herb is of to much value to the public to have is ban at the state or nationally government.
The company that was at the forefront of the Ephedra controversy Metabolite a multi level marketing company. Money is all this type of organization is concern with , how much research do you believe a company like that is going to perform before going public with the product and they prompted it as a weight lose product which is not what is should be used for.
Then the question of side effects, I have seen commercial on television for people who suffer for allergies that have side affect that or worst then Ephedra. An Example is Zola to lower cholesterol the side effect are, increase blood pressure, diarrhea, and in certain cases can cause heart problem. It is fine for the medical establishment to prescribe this form of death. It all about money and as soon as the big drug companies can package Ephedra it will be on back on he market without all this concern. Like the case where a high school football player use the herb and died that is sad but this is not the only drug that will kill you if not use properly. Certain street drugs can be produce using this herb, but this particular street drug is already being produce with the aid of Ephedra so that argument has no basis for a ban.
There is also the problem of nationalism the herb can be grown both in the United States and China and we are not talking about placing the ban on Ephedra shipped into this country from China. So if we go out west and gather the same plant and make the herb teas it will be legal, but if we use the Chinese's herb we are breaking the law.
Without thinking about the laws that may or may not be passes, the only active compounds in Ephedra are alkaloids ephedrine and pseudoephedrine. There are indications that this herb can help individuals with are cold and flu, headache, nasal congestion under Traditional Chinese Medicine and on the Western terms it is considered to have diuretic, central nervous system, stimulating and anti-asthmatic activity.
After reading the article and doing some research about Ephedra (Ma-Huang in Chinese) it is my opinion that the drug should not be banned by the FDA. But because of the potential danger of the use of Ephedra it should be controlled and dispenses only by professionally qualified individuals. Who have qualified by testing and have met other state or national requirements before being license to dispense the herb.
Therefore In my opinion the herb should be treated like certain medication only those who are so license can dispense eh herb.

Craig G. Johnson, MD:
Northside Hospital, Atlanta
Johnson30033@yahoo.com

The Four Essentials are a way in which to think about herbal therapy formulations. Each herb or set of herbs would have a principal ingredient, otherwise nicknamed the "monarch". An herb assisting the principal herb's therapeutic action is nicknamed, the "minister". An herb assisting the principal herb and balancing the effects of the "minister" herb is nicknamed, the "Adjuvant". An herb in the formulation that makes the whole formulation move into action, so to speak, is nicknamed, the "Dispatcher".
An FDA ban on ALL ephedra products makes sense only in regard to protecting users from unscrupulous manufacturing and from improper use arising from ignorance or wishful thinking. A ban on ephedra would have the untoward effect of taking a therapeutic agent with a long history of relatively safe use out of the American formulary. Fundamentally, the question rests on whether the FDA has a statutory or moral obligation to protect citizens from predatory marketers and from their own ignorance. We know that caffeine is not banned, yet it too can cause hypertensive crisis or stroke when it is abused in the concentrated tablet form that is available at any truck stop. Similarly, ephedra products are also available at truck stops where they are promoted by predatory marketers making fantastically appealing claims. Medically speaking is ephedra abuse more likely to result in hypertension or stroke or cardiac arrhythmia than caffeine? Probably so, especially when the ephedra is improperly prepared. Are vulnerable citizens likely to abuse ephedra? Some no doubt have done so, which is why we have the black cloud hanging over this herb, although when used in a classic Chinese herb formulation it may be harmless, or in fact be one of the Four Essential portions for that formulation to be effective.
In an unregulated market where the buyer must beware, then any herb or pharmaceutical product is potentially just as harmful as ephedra to uneducated consumers. Antibiotics and heart medications are sold over the counter in countries without a central regulating body. Undoubtedly, some consumers have died as a result of improper use of those medications. Supposedly, the United States market is under FDA protection, which also relies on physicians to be gatekeepers and educators for the use of potentially harmful (and potentially helpful) medications. A new day is dawning. As a result of internet commerce, formerly regulated medications are now widely available to interested consumers. For example, vicodin, an addictive narcotice pain killer, can be ordered over the internet without physician, pharmacy or FDA scrutiny, just as addictive, illegal, non-pharmaceutical drugs continue to be bought and sold without regulation. If the buyer is now in charge, then with or without FDA action, that buyer must beware.
FDA regulation of manufacturing, quality control, truth in advertising, packaging and consumer warnings would make all herbal products more acceptable to an American public that is wary. Without knowledge of herbal products use and misuse, with no control over manufacturing processes, and with little knowledge of medication interactions, many Americans simply shy away from all Chinese herb formulations, much less from those containing ephedra. Abusive and predatory practices by some Chinese herb manufacturers, who have in some instances included prednisone or theophylline in their products, or have allowed pollutants and pesticides into them, makes Americans suspicious. They are used to some degree of protection afforded by FDA supervision. Although an FDA ban would be an extreme step, some cooperation between the FDA and herb formulae manufacturers would encourage more Americans to try Chinese herbs that may contribute significantly to illness prevention and treatment. A voluntary effort by herb manufacturers cooperating with the FDA may allow removal of predatory ephedra containing products from the market, and correspondingly permit a wider good perception of Chinese herbs in general. Doing so would also allow the continued use of ephedra when a formulation requires its presence to be effective.

Back