A comparison of prohibited Chinese Medicine Herbs from six Western countries with a list of the most commonly used Chinese medicine herbs in Taiwan according to the National Health Insurance Research Database

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Chinese Medicine (CM) is already widely used in the West, and is growingly popular amongst patients seeking treatment for various ailments. Although grouped under the same framework, acupuncture and Chinese Herbal Medicine (CHM) are two different modalities within this system. While in places like Taiwan, CHM is more commonly used than acupuncture, it seems that in the West things are reversed. Whether as a consequence, or as a contributing factor, the regulation of CHM in the West is different than in Asia, with several substances being prohibited. This study sought to assess the impact of the regulations on the range of substances CHM practitioners are allowed to prescribe. For this purpose, the regulatory systems of six countries were surveyed: USA, Germany, Canada, UK, Australia and Israel. A list of all the allowed and prohibited Chinese Materia Medicine (CMM) in each country was compiled, along with any relevant stipulations. In order to evaluate the impact of banning a certain CMM on the ability of practitioners to prescribe formulas, CMM were ranked through data from the Taiwanese National Health Insurance Research Database (NHIRD). As CM is reimbursed by the Taiwanese NHI since 1995, patients may therefore receive concentrated-herbal-granules as part of CHM therapy. The NHIRD data analyzed was that of 2,000,000 randomly selected patients CHM prescriptions, from the years 2000-2011. From these results, the top 300 most frequently used CMM in the NHIRD were then compared to the banned substances from each country. It was found that of the country with the least banned substances was the USA, with 6. The country with the most banned substances was Canada, with 90, followed by Israel with 64. The amount of prohibited CMM in the rest of the countries varied between these two margins. Ma huang (麻黃, Ephedra sinica) was the only CMM ranked within the top #25 most-frequently-used in Taiwan to be restricted in all six countries. The majority of prohibited substances in the various countries were ranked below #100 in their frequency of use. This study is the first to address regulations of CHM in this manner, and is the first clear accessible material to list CMM banned in these six countries. In addition, it is the first time the frequency of use of CMM has been ranked in an explicit manner from data of this scale. This paper might serve regulators as a reference in the process of regulating CHM in the various countries.