Safety Issues of Chinese Medicine:A Review of Intoxication Cases in Hong Kong

Chinese medicine (CM) has been widely used in Hong Kong for centuries. In fact, CM practitioners currently provide over 20% of the medical consultations in Hong Kong and about 60% of the population has previously used CM. In 1999, the Legislative Council passed the Chinese Medicine Ordinance with aims to govern practice, use, trading, and manufacturing of CM in Hong Kong. While it is usually safe to use CM under proper application and guidance, there have been frequent reports on intoxication and fatalities. The misuse of potent/toxic CM, because of misidentification or overdose, can cause severe aconite, aristolochic acid, anticholinergic, podophyllin, grayanotoxin, pyrrolizidine alkaloids, matrine, gelsemine, teucvin, and strychnine poisoning. In this review, we summarized CM intoxication cases in Hong Kong, concentrating on the discussion of toxic and adverse effects as well as the quality control of CM. By increasing the awareness of CM toxicity, we hope to enhance the regulatory process and stimulate further research on their toxic dose, toxic ingredients, intoxication mechanisms, and quality control.