Safety in Chinese medicine: risks, precautions and warning signs

A therapy being traditional or natural does not mean it is free of risk. Traditional Chinese Medicine (TCM) includes very low-risk techniques, such as tai chi, and others that require training and precautions, such as acupuncture or the use of medicinal herbs. In this guide we explain how to choose a practitioner, what specific risks exist, which situations require more care and, above all, when you need to see a doctor. The golden rule is simple: Chinese medicine can, in some cases, be a complement, but never a substitute for medical diagnosis and treatment.

How to choose a Chinese medicine practitioner

Choosing the practitioner carefully is the most important safety measure. Before you start, it is worth checking several things:

• Training. Ask where and for how long they trained. It is a plus if they are a licensed health professional (physician, physical therapist, nurse) with verifiable additional training.
• Hygiene. They must use sterile single-use needles, open the package in front of you and dispose of them in a dedicated container after the session.
• Medical history. A good practitioner asks about your diagnoses, medications, allergies, pregnancy and bleeding disorders.
• Honesty. They should explain what you can realistically expect and refer you to a doctor when needed.

Red flags

Be wary of anyone who promises to cure serious diseases, advises you to stop a medical treatment, dismisses diagnostic tests, sells unlabeled products or products without a clear composition, or pressures you to pay for many sessions in advance.

Risks of acupuncture and other techniques

Acupuncture performed correctly is low risk. The usual adverse effects are mild: small bruises, local pain, tiredness or dizziness, especially in the first session. Serious complications are rare, but they do exist: infections from non-sterile equipment or poor hygiene, and organ injuries from deep insertions, such as pneumothorax when needling the chest.

Needles must be sterile and single-use. Reusing needles has been linked to the transmission of infections and is not acceptable.

Other techniques have their own risks. Moxibustion can cause burns, and the smoke can bother people with asthma. Cupping and gua sha leave temporary marks on the skin and should not be applied over damaged skin or varicose veins, or in people with bleeding disorders.

Medicinal herbs: toxicity, contamination and interactions

Chinese herbal medicine is the part of TCM that calls for the most caution, for three reasons.

Toxicity of certain herbs. Two cases are especially well known:

• Aristolochic acid. Found in plants of the genus Aristolochia, it causes so-called aristolochic acid nephropathy, kidney damage that can be irreversible, and is associated with urinary tract cancers. Poisonings have occurred through confusion or substitution between plants with similar Chinese names.
• Ephedra (ma huang, 麻黄, má huáng). It contains alkaloids such as ephedrine, with stimulant effects on the heart and blood pressure. The US FDA banned dietary supplements containing ephedra alkaloids in 2004 after linking them to serious cardiovascular problems.

Contamination and adulteration. Products have been found containing heavy metals, pesticides or undeclared drugs. Only buy products that are clearly labeled and from a reliable source.

Interactions with medications. Some herbs can alter the effect of drugs such as anticoagulants, antiepileptics, immunosuppressants or antidiabetic medications. Always tell your doctor and pharmacist what you are taking.

Situations that require special precautions

Warning signs: when to see a doctor

See a doctor, or go to the emergency room if it is serious, in any of these situations, before turning to Chinese medicine:

• Chest pain, difficulty breathing or intense palpitations.
• Sudden, severe headache, or weakness, tingling or difficulty speaking on one side of the body.
• Persistent high fever, especially in children, pregnant women or older adults.
• Unexplained weight loss, abnormal bleeding or new lumps.
• Yellowing of the skin or dark urine after taking herbs.
• Symptoms that get worse or do not improve despite treatment.

What does the scientific evidence say?

Studies indicate that acupuncture, when performed by trained practitioners, has a very low rate of serious adverse effects. By contrast, the safety of many herbs and formulas has been little studied, and the cases of aristolochic acid and ephedra show that the risks can be serious. To learn which benefits are supported and which are not, see our page on scientific evidence.

Safety and precautions

Here are the key points: choose a practitioner with verifiable training, insist on sterile single-use needles, always inform your doctor and pharmacist, do not take herbs of doubtful origin and, above all, never stop or change a medical treatment without consulting your doctor. Used with these precautions, and with realistic expectations, Chinese medicine can play a complementary role, but the decision should always be made with reliable information.