Success with Sanqi, Failure with Sanqi: A Balanced Analysis of Panax notoginseng for Cancer Patients

If I had to rank Chinese herbal medicines by their fatality rate among cancer patients, I would put sanqi (Panax notoginseng) first. The harm it causes is far more serious than that of the aristolochiaceous plants recently publicized online. This is probably because sanqi is the most widely used herbal remedy among cancer patients. Huge numbers of cancer patients buy and take sanqi on their own, never consulting a TCM physician for diagnosis and prescription.

In fact, the statistics on aristolochic acid carcinogenicity are deeply flawed. The great majority of liver-cancer patients in mainland China do not develop liver cancer because of aristolochiaceous herbs; their liver cancer results from causes such as hepatitis B.

As a country heavily burdened by hepatitis B, China has the world's highest liver-cancer incidence. To lay this blame on aristolochic acid violates common sense and logic. I have written before that China's hepatitis B outbreak was caused chiefly by the reuse of needles for childhood vaccinations in the 1960s and 1970s. Even if orally taken Chinese herbs injured the liver, they could not transmit the hepatitis B virus.

Aristolochic acid is a toxic substance, and TCM physicians of every era have used it with great caution. After the medical accident involving Longdan Xiegan Wan, a whole range of aristolochiaceous herbs were banned. As for toxic herbs such as asarum (xixin), TCM practitioners have known their toxicity since ancient times, and the rule "xixin must not exceed one qian" was established; few physicians use it, and pharmacies dispense it with special care.

Under strict dose limits, I have seen patients take Chinese patent medicines containing asarum for more than six years—not only without developing cancer, but with their advanced cancer cured.

It is tonic, supposedly harmless herbs such as sanqi, ginseng and lingzhi (ganoderma) that, because their side effects are overlooked, have led patients to abuse them disastrously and caused greater harm.

Many patients and their families, after watching health-and-wellness TV shows or reading merchants' promotional copy, regard sanqi as a wonder anticancer herb with a hundred benefits and no harms, buy it on their own, and take it as food or medicine—causing many tragedies.

The first patient I met who died because of sanqi was a lung-cancer patient. Recommended by a relative who was himself a TCM doctor, he took sanqi powder to fight cancer, and at first achieved very encouraging results, quickly seeing the tumor shrink. But less than three months after starting the herb, he died of a tumor thrombus caused by sanqi.

Later I saw more and more cases of patients dying from tumor thrombi and internal bleeding caused by taking sanqi on their own. Most often, sanqi causes intracranial hemorrhage and gastric bleeding; some long-term users also develop liver rupture.

I myself use sanqi with great caution. Sanqi is an excellent herb—its alternate name jinbuhuan ("worth more than gold") shows its truly exceptional clinical efficacy, and it is extremely expensive. But using it in cancer patients still requires caution.

Sanqi and ginseng both belong to the Araliaceae. From antiquity to the present, sanqi's greatest action has been on the blood and the hematopoietic system. It is an herb that both stops bleeding and activates blood circulation, while also promoting hematopoiesis. TCM bencao books therefore generally record that sanqi tonifies blood and stops bleeding, and activates blood without leaving stasis behind.

Sanqi's anticancer action is also very clear. The saponins of sanqi inhibit cultured tumor cells by up to 92%, and few Chinese herbs can match its antitumor effect. Its efficacy is especially marked in liver cancer and melanoma.

But sanqi's side effects are also enormous. Many bencao works record its adverse effects. Bencao Congxin notes that sanqi "can damage stasis; do not use it when there is no stasis." Depei Bencao records that sanqi is "contraindicated in vomiting and nosebleed due to blood deficiency, and in reckless movement due to blood heat." Sanqi is also contraindicated in pregnancy.

At a certain dose, sanqi stops bleeding; but above that dose it can trigger massive hemorrhage. Generally, taken orally as powder, sanqi within 3 g has a clear hemostatic effect, and that effect is proportional to the dose: the larger the dose, the stronger the hemostasis.

But when the oral dose of sanqi powder exceeds 3 g, it acts as a thrombolytic. A large dose of sanqi can dissolve clots in the body, breaking them into smaller clots or even dissolving them entirely.

However, all thrombolytic treatment is essentially high-risk. In severe cerebral thrombosis patients receiving thrombolysis in neurology departments, a considerable proportion die during treatment.

Clots dissolved by sanqi shatter into many small fragments that travel through the blood vessels; once a small fragment blocks a blood vessel or capillary, the patient develops a critical condition.

TCM practitioners through the ages actually observed this phenomenon, leaving the warning that "activating blood injures blood, and supplementing yang injures yang." This was a lesson drawn after many clinicians, in applying strongly blood-activating, stasis-resolving herbs like sanqi, suffered serious medical mishaps.

Ordinary people, however, know none of this; they see only sanqi's good side and not its bad side. Add unscrupulous merchants who selectively publicize sanqi's benefits and ignore its harms, and many patients have been maimed or killed by sanqi abuse.

When I say here that sanqi has maiming side effects, some may feel I am exaggerating to scare people. Sanqi does indeed improve hardened blood vessels, but long-term use greatly raises the risk of internal bleeding.

I often meet middle-aged, elderly and even young people taking sanqi powder for health preservation; the reasons they give are sometimes absurd. To these wellness fanatics, sanqi is all benefit and no harm. In fact, many people have been left disabled by intracranial hemorrhage after taking sanqi.

Of course, having stated these drawbacks, we cannot deny that sanqi is an excellent anticancer, hemostatic, blood-activating and analgesic herb. Properly combined with other Chinese herbs, sanqi can bring patients great help in anticancer analgesia.

But when using sanqi, note the following two points:

First, sanqi must not be used for prolonged periods. The longer it is used, the greater the risk of vascular rupture. Once the treatment goal is reached, sanqi should be stopped or reduced, or used intermittently, to avoid unnecessary harm to the patient.

Second, sanqi must not be used in large doses. Sanqi's anticancer effect is proportional to the dose used. Some patients or doctors deliberately increase the dose to pursue faster results, only for the patient to die within a very short time from bleeding or tumor thrombus caused by overdose. It is truly regrettable.

Some people mistakenly believe that the "poisonous blood" in a tumor should be drained out, and that once it is drained the tumor will resolve. Such ignorance is truly frightening. When a tumor ulcerates and bleeds, the patient can die within one to three days; it is an extremely perilous event. How can it be treated so lightly?

Moreover, hematogenous metastasis is precisely one of the major routes by which cancer cells spread. While activating blood, resolving stasis, reducing swelling and relieving pain, sanqi also carries the risk of promoting cancer-cell metastasis. So for patients whose tumors have already grown to a certain size, sanqi must be used with the greatest caution.