Is ephedra safe and effective? - Ma Huang - Ask the Herbalist

Townsend Letter for Doctors and Patients, June, 2003 by Andrew Gaeddert

Andrew Gaeddert[C]

What is the difference between ephedra (Ma Huang) and ephedrine?

Ephedra (Ma Huang) refers to the whole branchlet which is traditionally used. It is typically made as a tea by cooking in water. Ephedrine and pseudophedrine refer to alkaloid constituents of the whole herb. Although chemically derived ephedrine is used in pharmaceutical medications, dietary supplement manufacturers are required by law to use the crude herb. Typically an extraction is made to bring out the alkaloids when selling stimulant products or products for weight loss. It is common in the weight loss industry to combine alkaloid rich extracts with caffeine or caffeine containing herbs such as cola and guarana, and even aspirin.

Typically, ephedra herb contains 0.5-2% alkaloids including ephedrine, pseudophedrine, norephedrine, norpseudoephedrine, and methylephedrine. The plant also contains flavonoids, proanthocyanidins, tannins, and volatile oils. It is likely that these other constituents are buffering agents which reduce the drug-like effects of the alkaloids. This supports the hypothesis that ephedra as a whole herb extract is safer than products formulated for their alkaloid content. One recommendation is to not use more than 8 mg of ephedra alkaloids per dosage, and to not exceed more than 24mg in one day. If an individual were to take a TCM formula in pill form, it would be very difficult to consume this amount of ephedra alkaloids. However, if one were to take a large dosage in tea form or a dietary supplement designed to contain the maximum alkaloid content, an individual would have to be careful not to exceed the recommended dosage.

When did you first hear of ephedra?

I first heard of Ma Huang (ephedra) in the early '80s in a health food store in Santa Cruz. Two teenagers were hanging out and said "Hey Andrew, have you tried this stuff, it works as well as speed (amphetamines). The label says to take two caps but you have to take six to get a buzz." I looked at the black capsules and said 'no thanks.' On another occasion when I had to stay up to study I took two capsules and felt pretty good, however I started sweating. Many years later when I was in herbal practice a friend told me he grew up in Utah and teenagers picked Mormon tea which contains ephedra and brewed it up when they wanted a drug-like experience.

What are the historical usages for Ma Huang?

Ephedra has a history of use in China for several thousand years. The written record goes back at least 1800 years. One Chinese herbal formula, Ma Huang Tang (ephedra decoction), traces its lineage back this long and is still used today for treating cold symptoms such as chills, headache, and general body aches. It is combined with cinnamon twig (gui zhi), apricot seed (xing ren), and baked licorice (zhi gan cao). It has been recognized since ancient times that ephedra is warming and should not be used when the body is running a high fever. In Traditional Chinese Medicine (TCM) it is not used as a long-term remedy. In addition it is contraindicated for weak patients and those prone to nosebleed.

Ephedra can also be found in prescriptions for respiratory complaints. One example of this is Minor Blue Dragon (xiao qing long tang). In this ancient formula Ma Huang is combined with cinnamon twig (gui zhi), dry ginger (gan giang), asarum (xi xin), schizandra (wu wei zi), peony (bai shao or chi shao, ancient texts did not discriminate), pinellia root (ban xia) and baked licorice (zhi gan cao). This formula is used for chills, coughing, wheezing, and sputum that is difficult to expectorate, and body aches.

In the late 1800's a Chinese scientist isolated ephedrine and pseudoephedrine, which are used in popular respiratory over-the-counter medicines and prescriptions today. It should be noted that it was not a popular weight loss ingredient until the 1980's. In other words, TCM practitioners do not use ephedra as a weight loss ingredient nor do ancient texts describe this use.

Is Ma Huang safe, are there benefits?

There are over 50 clinical studies on ephedra or ephedrine in which no medically serious adverse reports were reported. In fact, more than 20 studies have shown that ephedra preparations helped adults lose weight, if used as directed. Over ten million Americans safely take ephedra products each year. On the other hand, opponents of ephedra say that there have been thousands of adverse reports and a few deaths. Although this would be acceptable if ephedra was a drug, this is not considered an acceptable risk by regulatory authorities for herbs, which are regulated as food supplements. It is also important to acknowledge the intent. For example, Ma Huang probably is less safe for those using it for weight loss, as opposed to respiratory complaints. It is also less safe for individuals taking pharmaceutical and recreational drugs, pregnant women, and minors. Ephedra does have known side effects. They are dizziness, headache, rapid or irregular heartbeat, chest pain, shortness of breath, nausea, and mood swings, and although hallucinations have been reported, it is not clear if these effects were caused by ephedra itself, or in combination with pharmaceutical or recreational drugs. It is not recommended to be taken by those who have heart disease, high blood pressure, thyroid disease, seizures, mental or emotional disorders, glaucoma, or difficulty urinating. It may not be appropriate for diabetics.