Co-Management of herbs, pharmaceuticals

Safety Issues affecting Chinese herb Ma-Huang (Ephedra Sinica)

By: Dr. Tamara Ramirez

May, 2014

The limited understanding of the application of Ma-Huang has raise fears that affect reputation of Chinese herb.  Manufacturers have commercialized and misuse the herb giving it a application that has nothing to do with the traditional indication.

 Ma huang has been deleted from several Chinese herbal formulas and in some cases the entire formulation had to be changed thanks to apparent side effects and FDA regulations.  Ma-huang becomes available for use at high doses and companies combine it with stimulants, such as caffeine.  The two compounds (caffeine and ephedrine) put together are considered to have an interaction with a potentially dangerous effect in sensitive individuals.  The combination was done to increase an “energizing” effect, improve sports performance and muscle building or to promote weight loss by stimulating metabolism.  This leads to an especially powerful effect on the nervous system.  “Ginseng, caffeine, ma huang (also called 'Chinese ephedra'), ephedrine and a combination of both caffeine and ephedrine are the most popular herbs used in exercise and sports. It is believed that these herbs have an ergogenic effect and thus help to improve physical performance.” (Chen, 2012)

Chi Powder was a product that became popular claiming to help individuals with low energy.  Competitors with the manufacturer of Chi Powder worked on getting more ephedrine per capsule, until ephedrine doses became excessive.  Once energizing effects were maximized, companies turned more attention to the weight loss characteristic.  

New questions about ma-huang were raised when the FDA banned phenylpropanolamine (PPA), a chemically similar to ephedrine.   They recommend that people who have the drug in their possession immediately discontinue its use.  Problems of overdose should not be a reflection on normal dosing but people would worry about low dosage forms as well. 

In ancient text Ma-huang formulas were mentioned for treatment of taiyang disorders (stuffiness of the head, headache, shoulder/neck tension, cough, high fever, spontaneous bleeding, wheezing, and pain).  Even thou, ma huang is really effective treating common cold, other applications can be done.  Shennong Bencao Jing describe Ma-Huang: “Bitter and warm; non-toxic, treats mainly wind stroke cold damage, headache, and warm malaria.  It effuses the exterior through sweating, eliminates evil heat qi, suppresses cough and counter flow of qi, eliminates cold and heat, and breaks concretions and hardness, accumulations and gatherings.”

Ma-Huang can be use for short-term and long-term therapies.  It helps resolves problems of water metabolism and congested fluids (Xiao Qing Long Tang).  It has a modern use treating ovarian cysts with fluids accumulations in the interior (Yang He Tang).  Also used for treatment of arthralgia, particularly used when the joints are swollen.

It’s important to remember that Ma-Huang is not suited for everyone and the correct dosis and diagnosis is essential for its use.  It needs to be recommended by a license oriental medicine practitioner or herbalist.  Ma-Huang can cause a rise in blood pressure and increase in heart rate but is not observed in healthy persons with normal blood pressure taking one time 20mg of ephedrine.  Ephedrine in ma-huang may have interactions between Monoamine oxidase inhibitors (MAOIs) and prostaglandin synthesis inhibitors (which include many of the non-steroidal anti-inflammatory drugs).


  1. Barolet, Bensky, Ellis, Scheid (2009).  Chinese Herbal Medicine: Formulas and Strategies.  Seattle: Eastland Press 
  2. Chen, C. K. (2012, March). Herbs in exercise and sports. Journal of Physiological Anthropology, (), . Retrieved from 
  3. FDA. (2014). Retrieved from 
  4. Journal of Ethnopharmacology. (2013, November). Deciphering the combination principles of Traditional Chinese Medicine from a systems pharmacology perspective based on Ma-huang Decoction, 150(2), . Retrieved from 
  5. Macciocia (1994): The Practice of Chinese Medicine: The treatment of disease with Acupuncture and Chinese herbs.  New York: Churchill Livingstone
  6. Shang Han Lun (On Cold Damage), Translation & Commentaries by Zhongjing Zhang, Feng Ye, Nigel Wiseman, Craig Mitchell, Ye Feng. Paradigm Press 2000
  7.  Yang, Shou-zhong. The Divine Farmer's Materia Medica: A Translation of the Shen Nong Ben Cao Jing. USA, Blue Poppy Press, 2007