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Abstract

We thank Dr Hosbach and colleagues for their interest in our review article and for the opportunity to respond. It is clear from their comments that traditional Chinese herbal medicines (THCM) are widely used throughout the world. The aim of our article was to increase the awareness of anaesthetists to the adverse effects and the contaminants in THCM. The main problem is that the prescription and preparation of THCM is not controlled in many countries. Because of the absence of strict international and national regulations, patients have access to various traditional medicines that have not been evaluated for safety by good preclinical animal studies, controlled clinical studies and post marketing surveillance. This is compounded by the failure or reluctance of many patients to disclose the THCM they take, and frequently the exact herb (as a dried herb or as a tablet) that is dispensed by the traditional Chinese physician is not revealed to the patient. Although western literature on THCM is restricted to case reports, we suggest that the adverse effects of THCM are probably under-reported. So far, literature from the Peoples Republic of China that suggests impressive results from THCM are not evidence based and/or poorly controlled. Given that healthcare professionals and patients are ignorant of the possibility of interactions between Chinese herbal remedies and anaesthesia, and also the possibility of added contaminants, the most important step is to increase the awareness of these potential adverse effects to all concerned. We support the views of Drs A Sehgal and J E Hall that ‘questioning regarding any herbal medicines should be included in any pre-operative assessment’, and this includes traditional Chinese and Indian herbal medications [1]. We agree that THCM is linked to many theories as suggested in our paper, and not only to the 5-element theory. We hope that we have increased the awareness of anaesthetists to the potential drug interactions and adverse effects of traditional Chinese herbal medications, and call for international and national regulation of all herbal medications (natural remedies, and traditional Chinese, Indian (ayurvedic) and other cultural herbal medicines).