If a patient's perception of herbal therapies is that they are'' safe and natural,'' like eating fruits to obtain fiber for constipation, the patient may not recognize the importance of safety issues associated with some herbal products. Use of herbal remedies can thus be less discerning and more indiscriminate as compared to use of conventional medicine. It is important for consumers to appreciate the fact that though herbal medicines have been in use for a long time, they still bring with them risks of side effects. A good example is ma huang (ephedra), commonly marketed as a natural weight loss product. Ma huang is a Chinese healing herb that has been used for thousands of years. The ephedra plant is a short, bushy shrub. Its stems contain the active constituent from which the stimulant ephedrine is now synthesized. The ephedra plant also produces ephedrine's stereoisomer, pseudoephedrine. Pseudoephedrine is the favored active ingredient in nondrowsy cold and sinus decongestants (2,39,40). Ephedrine was used traditionally to treat a variety of conditions, including asthma, hypotension, and depression. More effective medications have largely replaced it for treatment of serious disorders, but it is still available as an over-the-counter bronchodilator and an energy-enhancer. This is not to be assumed that ma huang is thus a safe herbal remedy. It can have side effects too. These include tremors, nervousness, insomnia, headache, gastrointestinal distress, high blood pressure, irregular heartbeat, hyperglycemia, and kidney stones, as reported (2,41). The Ephedra plant has also been linked to substance abuse. This is so because ephedrine and pseudoephedrine are used to produce the popular illicit stimulant methamphetamine (42,43).
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