Chinese Herbs Before and After Surgery
Why Chinese herbs and patent medicines matter to your surgeon and anesthesiologist, which herbs have bleeding or heart-rate reports, and what to tell your team before and after an operation.
Content last updated . This page has not been medically reviewed.
Quick answer
Tell your surgeon, anesthesiologist and pharmacist about every herb, tea, patent medicine and supplement you use, well before the date of surgery. Do not decide the stop date yourself, and do not stop prescribed medicines because of anything on this page. The American Society of Anesthesiologists (ASA) says supplements can prolong the effects of anesthesia, increase bleeding, raise blood pressure, interfere with other medicines and cause heart problems. [1] NCCIH adds that you should talk to your providers as far in advance of the operation as possible. [2]
Why this is a real issue
- Many people do not mention herbs. The ASA brochure says half of people who use herbal supplements do not tell their doctors before surgery. [1] A 2024 review put non-disclosure at 50 to 70% of surgical patients. [3]
- Herbs are not standardized the way anesthesia drugs are. A review of dietary supplements and coagulation concluded the effects on clotting and platelets are difficult to predict, so stopping before surgery is prudent. [4]
- Timing guidance differs by source. A 2024 review reports that the ASA and the American Association of Nurse Anesthetists recommend stopping herbal medicines 1 to 2 weeks before elective surgery. [3] The ASA's patient brochure says your anesthesiologist may recommend stopping at least two weeks before. [1] An older review suggested two to three weeks. [5] The right date depends on the product and the operation, so ask your team.
Which Chinese herbs come up in the reports
The sources below are mostly reviews of case reports and laboratory work, not controlled trials. They support caution, not a ranked list.| Herb (common name) | What the sources report | Strength of evidence |
|---|---|---|
| Danshen (Salvia miltiorrhiza) | Three published cases of over-anticoagulation and bleeding when people on long-term warfarin also took it; a review concluded it should be avoided with warfarin [6] | Case reports; limited, but a consistent warning |
| Dong quai (Angelica sinensis) | Can raise bleeding risk in people taking warfarin or antiplatelet drugs [7]; listed among herbs reported to over-anticoagulate with warfarin [8] | Case reports; limited |
| Ginseng (Panax) | May interfere with blood clotting [9]; cardiovascular instability observed [4] | Reviews; limited |
| Ephedra (ma huang) | Linked to high blood pressure, heart attack, seizure and stroke; banned in US supplements [10]; cardiovascular instability noted perioperatively [4] | Evidence of harm |
| Licorice (gan cao) | Glycyrrhizin can affect heart rhythm, especially in people with hypertension or heart or kidney conditions [11]; low potassium after licorice with blood pressure medicines [8] | Established concern at high or long-term intake |
Ginkgo and garlic, which are common in supplement cabinets, also have reported bleeding risks. [4] See Danshen and Ma Huang Tang and ephedra safety for single-herb detail.
Patent medicines and hidden drugs
A Chinese patent medicine with an unknown ingredient is a bigger unknown than a single herb. Products promoted for pain and other conditions have been found to contain undeclared drugs, such as steroids and painkillers, that can matter for anesthesia and healing. See undeclared drugs in Chinese patent medicines. Bring the actual package to your pre-surgery visit: the ASA brochure calls it a good idea to bring all medication and supplement bottles. [1]Herbs after surgery: what research shows
Some Chinese trials have tested herbal decoctions after joint replacement. A 2026 network meta-analysis of 64 studies in 5,603 patients reported that TCM decoctions improved clotting measures and lowered the rate of deep vein thrombosis after total hip replacement. [12] Only the abstract was read for this page; it does not say how reliable the individual trials were, and no source was found confirming that these decoctions are safe alongside blood thinners given after surgery. Label: promising but limited. In practice, anything affecting clotting should be agreed with the surgical team first.Questions to ask
- Which of my herbs or patent medicines should I stop before the operation, and on what date?
- When is it safe to restart anything, and is it safe with the pain medicines or blood thinners I will be given?
- Should I tell the anesthesiologist about teas and "tonics" too? (Yes: list everything.)
Related guides: supplements before surgery, Chinese herbal products: quality and interactions, TCM safety quick reference.
Frequently asked questions
How long before surgery should I stop Chinese herbs?
Ask your surgeon and anesthesiologist. Sources cite one to three weeks, and the ASA says your anesthesiologist may recommend at least two weeks. [1][3]
Should I stop my prescribed medicines too?
Do not stop any prescribed medicine without first talking to your doctor. [13]
Do herbal teas count?
Tell your team about them anyway. Some herbs used as teas, such as licorice and ginseng, appear in the safety reports above. [11][9]
Can acupuncture or tui na be used around surgery?
Those techniques are covered elsewhere. See acupuncture. This page covers herbs and patent medicines only.
What if I forgot to tell the team?
Tell them as soon as you remember, even on the day. Non-disclosure is common and the team can plan around what they know. [3]
References
- American Society of Anesthesiologists, Herbal and Dietary Supplements and Anesthesia (patient brochure, 2020). Read 2026-10-22.
- NCCIH, Using Dietary Supplements Wisely (US). Read 2026-10-22.
- Elvir Lazo OL et al. Use of herbal medication in the perioperative period: potential adverse drug interactions. J Clin Anesth 2024. Read 2026-10-22.
- Wang CZ, Moss J, Yuan CS. Commonly used dietary supplements on coagulation function during surgery. Medicines (Basel) 2015. Read 2026-10-22.
- Abe A et al. Perioperative analgesia and the effects of dietary supplements. Best Pract Res Clin Anaesthesiol 2014. Read 2026-10-22.
- Chan TY. Interaction between warfarin and danshen (Salvia miltiorrhiza). Ann Pharmacother 2001. Read 2026-10-22.
- Drugs and Lactation Database (LactMed): Dong Quai. National Institute of Child Health and Human Development (record revised 2026 Jun 15; read via PubMed record 30000896). Read 2026-10-22.
- Izzo AA et al. Cardiovascular pharmacotherapy and herbal medicines: the risk of drug interaction. Int J Cardiol 2005. Read 2026-10-22.
- NCCIH, Asian Ginseng (US). Read 2026-10-22.
- NCCIH, Ephedra (US). Read 2026-10-22.
- NCCIH, Licorice Root (US). Read 2026-10-22.
- Shi H et al. Effects of traditional Chinese medicine decoctions on coagulation and deep vein thrombosis after total hip arthroplasty: network meta-analysis. Explore (NY) 2026. Read 2026-10-22.
- NHS (England), Herbal medicines and complementary therapies (page last reviewed 1 May 2026). Read 2026-10-22.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.