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

Footnote: Hi mates. I'm sorry I can't be answering questions about suitability of products (herbal or chemical) for G6PD Deficiency people. Like I wrote previously, check for yourselves for these 6 herbs and if in doubt, consult your Chinese medicine herbalists/physicians/doctors. Thank you. John, date: 29-Jan-2020