Chinese Medicine Poisoning – Pearls from ICEM 2014

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Chinese Medicine Poisoning

Chinese Medicine Toxicology (Dr Man Li Tse)

  • Toxicity associated with Chinese Medicine accounts for 8% of all calls to the poison centre in Hong Kong
  • 1 in 5 medical consultations are carried out by Chinese Medicine practitioners

Three Types of Chinese Medicine

  • Three Preparations are commonly used:
      • Traditional Chinese Medicine
          • Herbal Soups – often there is use of up to 20 herbs to make one medicine soup
      • Proprietary Chinese Medicine in the form of Granules
          • These are thought to be of better quality by patients as they are more experience
      • Modern Herbal Medicine
          • Usually come in the form of pills and liquids- no registration or safety trials – a factory process occurs to extract active ingredients
Chinese Medicine
Chinese Medicine

Common Acute Toxicities from Chinese Medicines

  • Cardiac Toxicities
      • (1) Sodium Blocking Effects
          • Aconite, Veratrum or Rhododendron
      • (2) Cardio Active Steroids
          • Toad Venom or Tupistra
  • Aconite poisoning
      • Very common – can cause severe toxicity
      • Comes from herb routes and are known as “Caowu” and “Chanwu”
      • People take it for virility and energising effects or for analgesic effects (depending on the part of the plant is used)
      • Tse et al published a recent review of 33 Aconite cases
      • In Aconite poisoning onset of Cardiac Toxicity is typically rapid
      • Aconite can be toxic as a result of contamination, too large a dose or errors with the preparation
      • Treatment includes good supportive care, atropine and antiarrhythmics (anecdotal evidence)
  • Natural Cardioactive Steroids
      • “Chen-su” (Toad Venom)
      • Problems occur when those preparing the medicine get confused about various ingredients
      • The effect of these substances is similar to a “Digitalis” (Digoxin Like) Effects
Digitalis ECG
Digitalis ECG
  • Neurological
      • Common herbs include:
        • (1) Gelsemine (Gelsemium Plant)
            • Commonly causes “brain stem” dysfunction and respiratory depression
            • Often present with Occular abnormalities mimicking oculogyric crisis
            • Treatment is supportive


        • (2) Brucine (a bit like Strychnine)
            • Spinal Glycine Inhibitor – causes severe toxicity – twitching followed by seizure like activity and respiratory failure with rapid death without intervention
Strychnine (Murray et al)
Strychnine Summary (Murray et al)
        • (3) Matrine
            • Vestibular Symptoms and QT prolongation
  • Systemic Effects
      • Anticholinergic Poisonings (Datura)
      • Mercury
      • Lead
      • Arsenic
  • Chronic Toxicity from Chinese Medicines
      • Includes Neuropathy – less likely to present to the Emergency Department (ED)

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Take Home Points

There are 3 main ‘types’ of Chinese Medicine (Traditional, Proprietary and Modern)

Different Toxicology Profiles (Cardiac, Neurological and Systemic)

Look of Toxidromes (anticholinergic is the most common)

Initiate Aggressive treatment early (most evidence is anecdotal)