Wednesday, March 26, 2008

G6PD Deficiency & Chinese herbs

[Hundreds of forbidden drugs] Parents whose child with glucose-6-phosphate dehydrogenase (G6PD) deficiency have this nightmare of guarding against drugs or medicines which may cause contraindications of hemolytic anemia (breakup of red blood cells) to their child. There are indeed many drugs or medicines which are forbidden to be used for children with this genetic disease. A little search of the web will reveal hundreds of them. And it’s definitely a terrible nightmare for any parents.

[Confusion over unsafe Chinese herbs] Whenever I talk about children diseases the topic of G6PD deficiency will be touched by concerned parents asking about the safety of taking Chinese herbs for their children with the disease. Often time the parents are confused as there are plenty of different sayings and beliefs in the society; many of which, it comes to me, are misunderstandings and unsubstantiated conceptions.

[Sulfur vs. sulfa] There was once a woman who mistook sulfur (a substance commonly used to preserve dried Chinese herbs in a safely controlled quantity) for sulfa (also sulpha, a SO2-based medicine of Sulfonamides/Sulphonamides/Sulfones/Sulphones group which is known to be offending drug of G6PD deficiency) medicine refused all kinds of Chinese herbs treatment for her baby. I had to explain the differences between the two substances (and the fact that they are completely different except for close spelling and pronunciation) and clarify some other misunderstandings she had had.

I hope this writing can help shed some light on the issue.

[Unsafe Chinese herbs] After much search of medical literature and clinical findings I’ve concluded that there are six (6) Chinese herbs which should not be prescribed for babies/children with G6PD deficiency. And they are:

1) 黄连/川连; Huang Lian / HuangLian / Chuan Lian; Rhizoma Coptidis; Coptis Root / Golden Thread
Huang Lian, mainly yielded in the province of Si Chuan (四川), China. It's therefore also called Chuan Lian (川连). Bitter in flavour, cold in property. Acting on heart, stomach, liver & large intestine channels. It clears away heat, dries dampness, purges fire and clears toxins. Commonly used to treat diarrhea, high fever and suppurative infections of the damp-heat type. Dosage: 2-10g. Caution: Very bitter & cold; overdose or prolonged use may interrupt stomach function.

2) 牛黄; Niu Huang / NiuHuang; Calculus Bovis; Bezoar
Bitter in flavour, cold in property. Acting on the liver & heart channels. It relieves convulsion, resolves phlegm to induce resuscitation and clears heat and toxins. Commonly used to treat epidemic febrile diseases with high fever, spasm, convulsion & unconsciousness due to phlegm-heat in pericardium, and sore throat, throat ulcers, canker sores in mouth of toxic heat. Dosage: 0.2-0.5g. Caution: Cautious for pregnancy; Not suitable for non excess-heat type.

3) 金银花; Jin Yin Hua / JinYinHua; Flos Lonicerae; Honeysuckle Flower
Bitter in flavour, cold in property. Acting on the lung, stomach and large intestines channels. It clears heat and detoxifies, removes heat from the blood and arrests dysentery. Commonly used to treat epidemic febrile disease at the early stage, high fever, sores, carbuncles, furuncles, and diarrhea and dysentery with purulent and bloody stool. Dosage: 10-15g.

4) 腊梅花; La Mei Hua / LaMeiHua; Flos Chimonanthi Praecocis; Wintersweet Flower
Sweet & mild bitter in flavour, neutral in property. Acting on the lung, stomach and spleen channels. It relieves heat stroke, promotes body fluid, regulates qi flow. Commonly used to treat heat stroke, thirst, abdominal pain. Dosage: 5-10g.

5) 珍珠; Zhen Zhu / ZhenZhu; Margarita; Pearl
Sweet and salty in flavour, and cold in property. Acting on heart and liver channels. It tranquilizes the mind and arrests convulsion, improves acuity, removes nebula, removes toxin and promotes granulation. Commonly used for palpitation, insomnia, convulsion and epilepsy, nebula, throat ulcers, carbuncles, skin pigmentation. Dosage: 0.1-0.3g.

6) 熊胆; Xiong Dan; XiongDan; Fel Ursi; Bear Gall
Bitter in flavour and cold in property. Acting on the liver, gall bladder and heart channels. It clears away heat and toxic materials, relieves convulsion and spasm, clears liver heat to improve vision. Commonly used to treat high fever, convulsion, epilepsy, mouth ulcers, sore throat, heaty and reddish eyes and nebula. Dosage: 0.25-0.5g. Caution: Not suitable for weak-cold type.

[Unknown mechanism] The mechanism of how these 6 Chinese herbs come to interact and cause hemolysis among G6PD deficient patients are pretty much unknown. There 6 herbs were shortlisted based mostly on clinical reports of unfortunate incidents than controlled laboratory experiments.

[Rather be safe than sorry] Commonly used Chinese herbs for me are about 400 types. A typical herbal prescription may have 8 to 16 herbs (or more or less, depending on the need), prescribed after proper TCM (traditional Chinese medicine) diagnosis including tongue reading and pulse taking methods. Subtracting 6 unsafe herbs from 400 doesn’t affect much the choice I have over herbs I prescribe remedies/prescriptions for my young patients. Without these six herbs, the selection of herbs combination to treat illnesses is still endless. If in doubt, I’ll always put safety at first criterion and choose other alternative herbs which share similar nature and functionality with that of G6PD deficiency offending herbs. After all, safety, always, comes first.

There are indeed a few other Chinese herbs which are listed in some websites as unsafe Chinese herbs in addition to the six I mention here. These other herbs are, to my findings, not substantiated and not clinically proven to be so.

[Parents’ responsibility] Parents with G6PD deficient child should always check if certain OTC (over-the-counter) prescriptions contain any one of these 6 ingredients and choose not to use them if found so. It’s everyone’s responsibility to know what they are taking by checking out the individual ingredients. They should bring their child to qualified physicians for proper prescription which suits the symptoms as well as the body syndromes; and which contains no such unsafe ingredients.

Links:
1) Associazione Italiana Favismo - Deficit di G6PD
http://www.G6PD.org/favism/english/index.mv?pgid=chineseherbs

65 comments:

rsc said...

You can read more about G6PD deficiency here:
http://bit.ly/Q1uqV

samson_tam said...
This comment has been removed by the author.
shmt said...

Thanks so much for the information on which Chinese herbs G6PD deficient individuals should avoid, like myself.

I'm disappointed to hear that Lonicera japonica flower/Honeysuckle is on the list as it is commonly used in Wu Hua Cha/Five Flower Tea.

John J. C. Lew said...

Hi Samson Tan, (The comment by Samson and shmt are the same, so I deleted one of them. Hope the two of you don't mind sharing one post)

You're welcome.

John Lew

Anonymous said...

I m a Malaysian staying in sweden. my new born son has prelong jauntice and was dignosed with G6PD. I read that you mentioned to avoid 6 types of chinese herbs
http://www.g6pd.org/favism/english/index.mv?pgid=chineseherbs.

I would like to know whether I should avoid other chinese herbs especially for confinement i.e. angelica archantelica 当归,党参, herbs for 活血破血as I m currently breastfeeding. How about the wine DOM? as it will help blood circulation? Appreciate your speedy reply, anxious mum

John J. C. Lew said...

Dear Anxious Mom,

I hope this message gets to you as you've not mentioned your contact email.

The herbs you mentioned for confinement are fine for you to take.

Breastfeeding is important as one of the advantages of it is to get rid of newborn jaundice more quickly.

If you're to take wine, do warm it up a little to vaporize the alcohol content. Otherwise you'll be a little drunk and so will your baby.

If you have questions, you can write to me at johnjclew at gmail dot com.

Happy breastfeeding!

Regards,
John Lew

julia said...

hi,

my 2nd son had G6PD,my question is..does taking fenugreek seeds used for increasing breastmilk affect my child?

thank you
julia

John J. C. Lew said...

Hi Julia,

Good day. I'm not familiar with fenugreek seeds (葫芦巴子) and I've not come across any articles associating the two either.

Herbs have medicinal effects stronger than regular foods. Please always check out the effects for prolonged usage.

Do avoid the six mentioned Chinese herbs. And there are plenty of drugs and chemicals to stay away too.

Don't over worry but do necessary homework to understand what to and not to take. Always mention the case to any doctors you come across.

Regards,

John Lew

LH Ng said...

Hi,

Thanks for the information on your site. It’s very helpful.

I intend to bring my baby to see a Chinese physician, but I worry that he may not know what is G6PD. Can you advise on the name in Chinese please?

Thanks

John J. C. Lew said...

Hi LH Ng,

Good day to you. G6PD Deficiency is also commonly called 蠺豆症/蚕豆病 (Can Dou Zheng / Can Dou Bing) in Chinese language. Zheng or Bing mean diseases in Mandarin. The characters differ in complicated and simplified forms.

One of the chemical ingredients in Can Dou commonly causes hemolytic anemia, thus the name of the disease in Chinese language.

Good luck to you and your baby. We do the necessary homework and let others help us then.

Regards,
John Lew

Cher-Hong said...

Hi Dr. John,

My baby has G6PD deficiency. Can you kindly advice if the insect repellent below is safe for my baby? My baby is just one month old.

Product brand: Antimos
Ingredients: Citronella, Pine Oil, Garlic Oil, Dipentene, Comphor Powder, Camphene.

John J. C. Lew said...

Dear Cher-Hong,

Good day to you.

Camphor is a substance known to be conflicting with G6PD deficiency and thus is to be avoided.

Be alert on some of the common symptoms if anemia is to take place for your new born baby.

The internet has got great info about foods and medicines to avoid and signs and symptoms of hemolytic anemia. Check out a few websites and compare and contrast of what they say.

Take care,
John

Cher-Hong said...

Dear Dr. John,

Thank you very much for your valuable advice.

Rita Lim said...

Hi John,

My son was diagnosed to be G6PDD today. Seeing Ur blog has somewhat put my mind at rest.

I'd like to know if chicken essence (original or tand gui flavor) can be taken?

Appreciate your help greatly..!!

John J. C. Lew said...

Hi Rita Lim,

Chicken essence poses a few controversial problems about its complicated protein ingredients.

And the nature of chicken (regular) is warm and dry. It brings up the heat quite easily and unnecessarily.

Why are you giving chicken essence to your G6PD-D baby son?

Hear from you.

John

Rita Lim said...

Sorry Dr John,

I missed out the fact that I'm breastfeeding. Thus, I'm worried that my consumption would affect my G6PD baby.

Happy new year!

John J. C. Lew said...

I see, Rita.

Happy new year to you and your baby. Do the right things right and everything will be alright.

Good luck!

John

Rita Lim said...

Thank you very much... baby's 4 mths now..
All is well... :D

John J. C. Lew said...

Yes, Rita.

Happy for you and your family. And for our world.

All's well here too. :)

John

ConcernMum said...

Dear John,

TQ for such useful sharings. I'm in confinement but dare not use most of chinese confinement herbs because I am breasfeeding. Can I consume

1) Thong som
2) Tong kuai
3) Tong sen
4) Phau sam
5) Apply pearl powder on baby's skin (face)?

Appreciate your advise. TQ!

John J. C. Lew said...

Hi ConcernMum,

Good day to you. (1), (2) and (4) are fine. I don't recognise (3). (5) isn't recommended.

1) Thong som; 党参; Dang Shen;
2) Tong kuai; 当归; Dang Gui;
3) Tong sen; ???
4) Phau sam; 泡参; Pao Shen; (Mature American ginseng)
5) Apply pearl powder on baby's skin (face)?

Like I wrote in the blog, herbs other than the six described are ok. We base them on the ingredients. So long we don't find any of the six, things should be fine.

Oh, babies are such a good way to start adulthood. Enjoy your motherhood!

Regards,
John Lew

Sharon said...

Dear Dr. John,

My baby is 12 days old now and he is G6PD deficient. What can be use to reduce the jaundice? And what can we apply to reduce the wind in his stomach? Some ppl said "yu yi oil" can't be use due to the content have menthol or peppermint.

John J. C. Lew said...

Dear Sharon,

There are many types of jaundice. I suppose you are talking about the physiological one. Please read
http://lews-info.blogspot.com/2008/12/breastfeeding-infant-jaundice-herbs.html for some info.

Newborn tummy wind is usually caused by external cold and/or weak spleen and stomach functions. Some warming medicated oils can help relieve the symptoms.

If menthol is part of the ingredients, the product should be used in a small amount initially. Observe your baby for reactions. If things are fine gradually increase the dosage to normal practice.

Regards,
John Lew

Anonymous said...

hi..im a adult with g6pd..izit safe to take licorice(gan-cao)?

John J. C. Lew said...

Dear Anonymous,

Gan Cao is fine. Remember to use it according to traditional diagnosis of the body type.

Good luck.

John Lew

Kok Kheong Wong said...

Hi John,

Is Chinese Tea (Purr Er, etc) and Bak Kut Tea save to be consume by G6PD children? Thanks.

Jean said...

Hi am G6Pd adult and in Ghana, west Africa i would want to know if medicated oil wif ingedrients menthol, Camphor and clove oil is ok for me to apply. And how do i boost blood circulation. thanks

John J. C. Lew said...

Dear Kok Kheong Wong,

They are safe to be consumed by children with g6pd-d. Generally, however, we don't encourage children taking too much of the said foods and drinks.

Take care.
John Lew

John J. C. Lew said...

Dear Jean,

The first two are known to be problematic with g6pd-d newborns and young children. For adults, the body constituent is much stronger and therefore they should be able to be used sparingly and in lesser recommended dosages.

Not too sure about clove oil though. Still, adults are stronger and it's much less risky.

Good luck.

John Lew

Anonymous said...

Dear John,
My newborn baby is recently diagnosed with G6PD deficiency. He is now at day 7 of life and has very mild jaundice. He is being fully breastfed. My in law suggested using a herbal concoction that has Honeysuckle flower as bath. Is it safe for external use such as for bath? Thank you.

Steve Lew said...

Dear Dr John,

I would like to know if this product is fine to my G6PD deficiency baby- Egozite baby cream (Protective barrier cream for nappy rash). The ingredients stated for this product are: Aqua(water),zinc oxide,dimethicone,paraffinum liquidum,glycerin, cetearyl alcohol, ceteareth-25, panthenol, methylparaben, xanthan gum, propylparaben.
Appreciate on your prompt reply. Tq.

John J. C. Lew said...

Dear Anonymous,

I would stay away from Jin Yin Hua, the honeysuckle flowers even for external bathing. Sometimes some of the active ingredients are in the vapor or the smell itself. And it is one of the known prohibiting herbs.

Take care.

John Lew

John J. C. Lew said...

Dear Mr Steve Lew,

The product you mentioned has got plenty of chemicals or ingredients I am not familiar with. As my area of practice is in traditional medicine, I should only share my knowledge on traditional herbal products. The rest I'm not really qualified to comment on.

You may contact the company itself for enquiry. Many companies manufacturing products of baby and children know very well about their products' contraindications. They simply don't state too much of negative info on the labels for commercial reasons... I'm sure you know what I mean.

Good luck!

John Lew

wany autumn said...

Hai.are yu yee oil is fine for my 2 month old baby? He got g6 pd dificiency.and he always vomit even after burp.thanx

alastairpang said...

Can we give lin liang to kid with G6PD?

John J. C. Lew said...

Dear Wany Autumn,

There are many brands of Yu Yi Oil / Yu Yee Oil / 如意油 / Ruyi You / Ru Yi You in the market and the compositions differ considerably from one to another. Some of them have menthol in them. If it's so the product should be used in a small amount first. Observe your baby for any known reactions. If things are okay then gradually increase the dosage to normal usage.

The vomiting after burping may have to do with stomach wind. Stomach energy is supposed to move down. In the case of babies, however, due to weak stomach function the energy may not move down that well and thus the case of vomiting.

Good luck to you and your baby!

John Lew

John J. C. Lew said...

Dear Alastairpang,

I'm sorry but I don't recognise what Lin Liang is. Can you give the name in Chinese or proper Latin name?

Thank you.

John

alastairpang said...

翔羊水 sorry for the wrong English translation. Can G6PD kid drink this ?

Hope you can help to clarify. Thank you

alastairpang said...

Does it mean that it is safe to use if we do not see any adverse reaction ? My kid has been using Ru Yi You since he was a baby. He has G6PD and when I read this post, I got worried. Do we continue to use or stop using or use moderately ? Can you advise. Thank you.

Anonymous said...

Hi Dr John,

My son has g6pd since baby. He is 8yrs old now.
Can he consume herbs Arsenicum iod, hypscyamus, tuberculinum, veratrum alb, gingko biloba, german chamomile,skullcap,gotu kola,wild oats,stinging nettle and rooibos leaves ?

John J. C. Lew said...

Dear Alastairpang,

羚羊角水(Ling Yang Jiao shui / Solution of antelope horn) is fine for babies with G6PD-D. Do make sure the body type is needed or necessary to take it.

As I mentioned before, the ingredients of the oil depend on different brands; and that the percentage of the prohibiting substance, if any, differs too. Babies grow stronger everyday and may be able to withstand certain amount of prohibiting substances.

If your son has used it for a while and he has been fine with it then it's usually safe to say he's strong enough to withstand the amount. To be safe, it should be used more moderately and sparingly.

John

John J. C. Lew said...

Hi Anonymous,

Your list of herbs:

"Arsenicum iod, hypscyamus, tuberculinum, veratrum alb, gingko biloba, german chamomile, skullcap, gotu kola, wild oats, stinging nettle and rooibos leaves"

are the ones I'm not familiar with. I run my clinical practise mostly with Chinese herbs and acupuncture. I'm sorry to say I can't comment on them in terms of suitability with G6PD-D babies and children.

Good luck!
John

Anonymous said...

Dear Dr John,

I would like to know if the following is safe for my G6PD deficient boy

1) Chuan kiong
2) Yu zhu

Thanks & regards,
Mrs Lim

John J. C. Lew said...

Dear Mrs Lim,

川芎(Chuan Xiong) and 玉竹(Yu Zhu) are fine for babies and children of G6PD-D.

Chuan Xiong is rarely used for babies and children. May I know how and why you're using it for your boy? How old is he please?

Regards,
John Lew

Anonymous said...

Dear Dr John,

Thanks for your reply. My boy is only 13days old.

Chuan Xiong and Yu zhu is not meant for my baby but was added to my confinement soup. Thus I would like to clarify if these will affect him as im breastfeeding him currently.

By the way, could you recommend some herbs that can be used for my confinement food/soup?

Thanks & Regards,
Mrs Lim

John J. C. Lew said...

Dear Mrs Lim,

The two herbs are fine for you to consume during breastfeeding period too. They have nothing to do with G6PD-D.

For herbal soups for confinement ladies, just use the regular ones for confinement. Make sure to avoid any of the 6 mentioned herbs. These traditional soups for confinement which are available as Over-The-Counter usually don't contain the 6 mentioned herbs.

Good luck to you and your baby!

Regards,
John

Jo Liew said...

Dear John,
I would like to know can I feed DOM to 16th years old?
Will the alcohol effect the growing of her brain?
she's been suffering very bad pms.
Thanks,
Jo

John J. C. Lew said...

Dear Jo Liew,

PMS is treated based on body types and different symptoms. The combination of herbs needed therefore depends on individual needs. It is advisable to go consult a physician face to face for better diagnosis.

Thank you, and good luck.

John Lew

Anonymous said...

hi John,

my son keep coughing and my mother suggested to give Hou Tsao San, so
can i check with you whether "Hou Tsao San" safe for G6pd?

thanks in advance

John J. C. Lew said...

Dear Anonymous,

Please check the ingredients of "Hou Tsao San" (猴枣散?) of your brand to see if it contains any of the G6PD-D offending herbs as listed on the blog.

Cough is a very complicated symptom; it's not a disease itself. Many illnesses come together with cough as primary or secondary symptom. Always consult a physician face to face for proper diagnosis and prescriptions.

Thank you, and good luck.

John Lew

John J. C. Lew said...

Hi Chee Yein,

Good day.

Hemolysis or anemia of G6PD Deficiency are usually more tolerated among adults as the red blood cells are more in terms of numbers as well as more established.

My writing is more in response to Favism, a condition quite similar to a form of G6PD-D variant. And that favism affects more prevalently in infants and children.

Thank you,

John Lew



On Wed, Jun 12, 2013 at 11:47 PM:

Hi John,

I have been reading your blogs on the subject of G6PD & TCM. However, I am not able to get any information as to whether the 6 types of herbs identified by you as a trigger of G6PB deficiency affect the adults?

Hope to hear from you soon.

Thank you and best regards,
Chee Yein

Sancherry Wong said...

Dear Dr Lew,

I would like to know if the following is safe to my frinend who has G6DP deficit.
~ American Ginseng
~ Chinese Wolfberries
~ Huang Qi
~ Ling Zhi

Thanks & regards,
Cherry

Anonymous said...

Hi,

May I know if Ba Zhen and Pak Foong Pills ok to consume. I'm exclusively breastfeeding a 3 month old G6PD baby.

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Worldofhappiness said...

Hi there,

Im 18 now. I have G6PD deficiency and skin problem (cracking and bleeding). My grandma decided to follow some alternative medicine to cure my skin problem.
I not very sure, what was it.
but wat i heard is she cooked some herb with seahorse. IS it okay for me to drink it?

Ann

Anonymous said...

Hi my breastfed baby has g6pd,can I drink D.O.M wine.

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BCeagle said...

Hi Dr. John!
My daughter was recently diagnosed with G6PD. Could you direct me to a site that lists the food to avoid? I have the MIMS guide to G6PD. I am now looking for the food list. IS Fenugreek bad for G6PD kids? I have been drinking this Sacred Nursing Tea and it's main ingredient is Fenugreek seeds and oil. Thank you and I look forward to hearing from you.
email is thosaka1298@yahoo.com

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Anonymous said...

Dear Dr.,

Is Fenugreek safe for G6PD baby? I plan to consume fenugreek capsule/choc drink with fenugreek as milk boosters.

Thank you.

Anonymous said...

Hi There,

If my baby got G6PD and she is doing breast feeding, is it safe for the baby if baby taking DOM benedictine wine? Appreciate your speedy reply to ymlee76@gmail.com

Thanks
Anxious Dad

atiqah said...

Dear Dr John,

I have a 16 days old baby, exclusively breastfed. I just learn that he has G6PD def. I had planned to take a product (LD venus) supp postnatally, but now im quite uncertain whether to take it. I am wondering if the ingredients below are safe?

LD venus main ingredients as written on the box:

Radix Angelicae Sinensis
Radix Codonopsis (codonopsis pilosulae)
Radix astragali (astragali seu hedysari)
Herba leonuri (leonurus japonicus)
Herba patriniae cum radice (patrinia scabiosaefolie/p.villosa)
Radix salviae miltiotthizae

Would appreciate your kind opinion. Thank you.