Heavy metals in Chinese herb medicine

Dear Editor:
The November cover story” A History of Heavy Metals” reported on the role that heavy metals play in modern life. The use of heavy metals in Chinese herb medicine should not be overlooked.
According to reports by major hospitals in Taiwan, a large number of cases of heavy metals intoxication have occurred over the past years because older people have insisted that newborn infants be fed with “pa-pao-san”, or “ Eight Treasures Powder”.
( A Chinese herb medicine believed to relieve Tai-tu, or fetal toxin), leading to damage of their nervous system or even death. A joint study conducted in 1991 by the Consumer Foundation and The Medical Inspection Bureau of Drugs and Food in the Department of Health found that one fouth of the “pa-pao-san” used in Taiwan
Contains an excess amount of lead.
In August 1992, the pediatric intensive care unit of Tri-Service General Hospital received a seven-month-old male infant suffering from intractable seizure attack.
It turned out that he had been given a certain Chinese herb medicine that contained 430 ppm of lead for as long as one month. Four months after medication ceased he still has a high concentration of lead in his blood, enough to be diagnosed as lead poisoning under the criteria set by the U.S. Center of Disease Control and Prevention.
The concept of fetal toxin first became prevalent during the Sung Dynasty.
Medical experts at the time believed that it could be cured by hsiung-huang ( realgar ) and niu-huang( cow-bezoare), large amount of both drugs were used in medicine for infants. Cinnabar ( mercuric sulfide) believed to remove excess sputum and relieve Ching-feng (infant convulsion disease), was widely used in various kinds of medicine, as well. There are even records that shui-yin (metallic mercury) was taken directly by the patient during the Sung, Yuan, Ming and Ching Dynasties. Cinnabar, realgar, cow-bezoare and other minerals were subsequently used in large quantities in “pa-pao-san”.
Originally, no lead-containing ingredients were used in the preparation of pa-pao-san. large amount of cinnabar were, however, in short supply and because cinnabar was expensive, some Chinese pharmacists substituted other mineral in gredients, such as
Huang-tan(yellow lead) or chien-tan(red lead or minium—the scientific name is lead tetraoxide), which are similar to cinnabar in color. The result of this misuse was numerous cases of lead poisoning in newborn infants.
Toxicological studies revealed that heavy metal poisoning damages every system of the body. In acute poisoning, ingested heavy metals cause celar damage to the digestive system, producing nausea, vomiting, diarrhea, colic pain or tarry stool.

Inhaled in the lungs, they can cause necrotic bronchitis, pneumonia , pulmonary edema and pneumothorax. In chronic poisoning, the central nervous system and hematopoietic system are especially sensitive. Once they enter the body, heavy metals are difficult to be removed from the body. The half-life of lead in the bones, for instance, is estimated to be more than 20 years. Long term accumulation of heavy metals must not be ignored. The U.S. federal law maintains strict safety and limitation value of heavy metals contained in foods.
The concept of fetal toxin originated from ancient misunderstanding of infectious diseases with skin eruptions. Red lead and cinnabar are still used in Chinese herb medicine today, in spite of scientific evidence, resulting in heavy metal poisoning
cases in newborn period.
I hope that the health department of the government will extend regulation to Chinese herb medicine. Until its safety can be assured, the wide-spread use of Chinese herb medicine among the public is not appropriate.
Doctor Chi yun-wen.
December, 1992
編輯先生, 您好:
貴刊十一月封面故事[重金屬生活史] , 報導重金屬在現代生活中的角色,
事實上重金屬在中藥的使用情形, 也不容忽視。
根據國內各大醫院的報告, 歷年來因為老人家要求餵新生兒八寶散, 以 "解胎毒” "去胎火”, 造成新生兒重金屬中毒的案例, 時有所聞, 輕者神經系統受損,智能低下,重者不幸死亡。
去年 8 月,消費者文教基金會與衛生署藥檢局合作的調查中, 發現四分之一的市售八寶散,含鉛量過高。
民國81年 8 月, 三軍總醫院小兒部加護中心, 接獲一件七個月大男嬰
連續抽搐的病例, 病史中提到, 曾經連續服用某種中藥一個月之久, 經檢驗結果,發現所服中藥含鉛過量, 停止使用四個月之後,血中鉛濃度仍高, 據美國疾病管制中心所定的限值, 診斷為鉛中毒。
我國早在宋朝就有[胎毒]的說法, 當時醫學家認為雄黃、 牛黃、 天竺黃、 朱砂、 輕粉等物質, 可以解胎毒, 因此大量用於兒科方劑。 而朱砂廣泛使用於各種方劑, 甚至宋、元、明、清各代都有使用其前身水銀的紀錄, 因此八寶散開始大量採用朱砂、雄黃、牛黃、天竺黃、西黃等礦物藥。
朱砂是傳統中藥方劑用以 [袪痰] 與 [安神] 的藥物, 古代中醫認為 水銀及其化合物等比重極大的金石鎮墜藥可以壓制 [風] 和 [痰]. 因此[鎮驚]、[袪風]、[袪痰] 與 [安神 ] 的藥方, 幾乎都含有水銀、朱砂、輕粉, 但是大量使用之後, 造成傷身致命的悲劇。
八寶牛黃散是有千年歷史的傳統方劑，本來在歷代的八寶散配方中，並沒有含鉛的物質，但是因為朱砂的用量極大，來源稀少，因此價格昂貴，某些中藥店貪圖方便或為了節省成本，以另一種礦物藥材「黃丹」代替，黃丹就是鉛丹，化學名為四氧化三鉛，顏色與朱砂相近，濫用的結果，卻造成新生兒鉛中毒事件層出不窮。
重金屬中毒經毒物學之研究，其作用機轉為對細胞內硫氫基（ＳＨ基）之抑制，因此全身各系統都受害，急性中毒時，食入重金屬對腸胃道傷害明顯，造成噁心、嘔吐、口中金屬味、腹瀉、腹絞痛、黑便，吸入肺中可造成壞死性支氣管炎、肺炎、肺水腫、氣胸；慢性中毒時，中樞神經系統與造血系統尤其敏感，因此任何不明原因的痙攣、昏迷、神經系統病變、貧血、體重減輕、運動失調，都應注意重金屬中毒之可能性。
　　重金屬進入體內後，不易排除，例如鉛在骨中之半衰期，據估計在２０年以上，其長期累積性不容忽視。
　　「胎毒」的說法，源自古人對兒童出疹性傳染病的誤解，並無任何科學根據，解胎毒方劑大量採用金石鎮墜藥，使後世小兒受其毒害，更是傳統醫藥歷史上，令人痛心的悲劇。
　　現代化學家已經能夠詳細分析並且完全了解重金屬的劇毒性質，既然如此，現代中醫實不應繼續使用含混不明的傳統中藥方劑。
　　今日中醫藥界，有人不顧科學事實，濫用鉛丹、朱砂，使得臨床所見重金屬中毒案例不斷發生，如果中藥的安全性都無法保障，有效性也未做過科學的客觀評估，就不宜放任它在民間普遍應用。
　　而少數人堅持「遵古炮製」的落伍思想，不但不能救人，反因無知而害人，這是當前醫學界必須立刻解決的重大問題。
　　衛生主管機關有責任，依據現在毒物學上已知的重金屬毒性數據，將中藥製品納入管理。而社會上有影響力的團體或醫學會，也應該出面舉辦公開聽證會，釐清傳統醫學界許多謬誤觀念。
三軍總醫院小兒專科醫師
亓允文
1993年1月光華雜誌