The Action of Chinese Patent Medicines Does Not Fully Match the Indications on Their Package Inserts

Last summer, my own teacher developed shoulder and back pain after using the air conditioner, with cervical spondylosis and frozen shoulder flaring up. He came to me for a prescription, and I told him to use Gegen Tang granules (Kudzu Decoction granules).

After buying the medicine and reading the package insert, he asked me: "The insert for Gegen Tang granules says it treats colds, fever and headache; there is no mention of treating cervical spondylosis or frozen shoulder."

I told him not to worry about what the insert says. According to the Shanghan Lun (Treatise on Cold Damage), the indication for Gegen Tang is, after a person contracts wind-cold, "a stiff and rigid neck and back"—what we today call the stiffness and discomfort of the shoulder, neck and back. It matches his syndrome, so he should use it boldly.

My teacher took my advice and, after a few days of Gegen Tang granules, his cervical spondylosis and frozen shoulder improved greatly.

Earlier, a patient who had had hypertension for many years also had stiff, uncomfortable shoulders and neck with a floating, tight pulse. When he came to me for treatment, I also prescribed Gegen Tang granules. After taking it, not only did the stiffness of his shoulders and neck resolve, his years of hypertension also cleared, and he has since been free of antihypertensive medication.

Logically, Gegen Tang granules contain Mahuang (Ephedra). In modern medicine's terms, Ephedra raises blood pressure and should be contraindicated in hypertension. Yet this hypertensive patient's blood pressure did not rise but fell after taking Ephedra-containing Gegen Tang. This shows that treating the matching syndrome matters far more than reading the package insert.

I also often use Gegen Tang granules to treat wind-cold-binding-the-exterior type rhinitis, or colitis and gastric ulcer. This goes far beyond the indications on the insert.

I also often use Erzhi Wan (Two-Immortal Pill) for patients who lose their hair from chemotherapy, or patients with alopecia areata, or patients with insomnia. Many patients, after buying Erzhi Wan, are stunned when they read the insert, because it says Erzhi Wan treats excessive menstrual bleeding or early menstruation in women.

Of course, on my insistence, most patients took it as I required. After taking Erzhi Wan for a while, the fallen hair grew back, and the patients beamed. In at least two patients, after taking Erzhi Wan, not only did lost hair regrow, but white hair turned black as well.

The anti-cancer Chinese patent medicines are what I prescribe most. The indications written on the inserts of many anti-cancer patent medicines are far narrower than their actual indications.

Because most patients who come to me are acquaintances of patients I have treated, ordinary patients and families generally do not question the patent medicines I prescribe.

But occasionally some patients or family members, after reading the insert, suspect that I rashly prescribed the wrong medicine.

Not long ago, after a gastric-cancer patient's father had taken a certain patent medicine I prescribed for a while, his daughter could not help asking me. She said that, looking at the drug insert, this medicine seemed very wrong for her father's condition; according to the insert, this drug was supposed to treat gynecological tumors, so how could it be used for gastric cancer?

I asked her whether her father's body had improved after taking the medicine. The daughter said the improvement was obvious. I had to explain further that the package insert of a Chinese patent medicine does not match its actual use; she should ignore the insert and be guided by the actual efficacy.

My own relatives, when taking some of the patent medicines I prescribe, also habitually read the insert; as soon as they see that the insert does not cover their disease, they hesitate. Western doctors in hospitals also frequently prescribe patent medicines, and they prescribe them according to the insert.

Not long ago my wife developed gallstones. The hepatobiliary surgeon at the hospital prescribed the patent medicine Dahuang Lidan Pian (Rhubarb Gallbladder-Benefiting Tablet), while I prescribed Shugan Hewei Wan (Liver-Soothing Stomach-Harmonizing Pill). Because Shugan Hewei Wan's insert does not state that it treats gallstones, whereas Dahuang Lidan Pian is, per its insert, a patent medicine for gallstones.

So she chose to take Dahuang Lidan Pian. It did not relieve her pain, and only then did she give up Dahuang Lidan Pian and take Shugan Hewei Wan instead. In the end, Shugan Hewei Wan solved her problem.

The package inserts for today's Chinese patent medicines are written very perfunctorily and are completely divorced from TCM thinking. The effects of TCM proven formulas cannot be matched one-to-one to modern Western disease names.

A TCM formula can only be applied according to the patient's cluster of symptoms, following TCM logic; it cannot be used according to a Western disease name. Chinese patent medicines should in fact be prescribed by well-trained TCM physicians, not by Western doctors.

Nowadays many doctors prescribe patent medicines with a Western medical logic, and as a result the patients get no effect, and then conclude that patent medicines are useless and TCM is useless. In fact, if a person who is thoroughly versed in Chinese medicine prescribes them according to the effects of TCM proven formulas, the result is very different.

I hope readers will not, in future, get too hung up on the package inserts of Chinese patent medicines.