Ma Huang Tang and Ephedra (Ma Huang): Traditional Use and Safety
Ma Huang Tang is a four-herb classical formula built on ephedra (Ma Huang). Here is its traditional use, what trials found, and why ephedra supplements are banned in the US.
Content last updated . This page has not been medically reviewed.
Urgent first
Ephedra has been linked to high blood pressure, heart attack, seizure, stroke and psychosis, even at relatively low doses and with short-term use. [1] Chest pain, a racing or irregular heartbeat, sudden weakness on one side, trouble speaking, a seizure or severe confusion after taking any ephedra product is an emergency. In the United States, call 911. For a possible poisoning, US Poison Help is 1-800-222-1222; see Poison Help by Country for other places.What it is
Ma Huang Tang is a classical Chinese formula named for its chief herb, Ma Huang (ephedra). In Japan it is called Maoto and is a Kampo medicine; commercial granules there are made from four plants: ephedra herb, apricot kernel, cinnamon bark and licorice root. [2] The Chinese herb Ma Huang (Ephedrae herba) is the dried stem of Ephedra sinica and related species, and it was recorded in Sheng Nong's herbal classic. [3] This page gives no doses and no advice on using either the formula or the herb.Traditional use
A review describes Maoto as developed in ancient China and used to relieve flu symptoms. [4] Ephedra herb itself has a long history in China and India for colds, fever, headaches, congestion, coughing and wheezing. [1] These are traditional uses. They tell you how the formula has been used, not that it is safe or effective by modern standards.What research shows
| Question | What the source found | Strength of evidence |
|---|---|---|
| Influenza symptoms (Maoto) | A systematic review found 12 studies, two randomized trials (60 people) and ten non-randomized studies. Fever may be shorter, but the authors could not reach a definitive conclusion because of small studies and high risk of bias. [4] | Insufficient evidence |
| Maoto versus antiviral drugs | A small randomized trial of 28 adults compared Maoto with oseltamivir or zanamivir; the authors called it well tolerated with equivalent clinical and virological efficacy. [2] | Promising but limited (very small trial, no placebo) |
| Weight loss and sport (ephedra supplements, historical) | Before the ban, supplements with ephedrine alkaloids, usually with caffeine, had modest short-term effects on weight loss that were judged not to outweigh the risks; evidence for athletic performance was insufficient. [1] | Evidence of harm outweighing benefit |
NCCIH notes that almost no new research on ephedra in people has been done since the supplement ban. [1] Maoto studies come mostly from Japan, where it is a regulated Kampo product; see Kampo Medicine and Kampo and TCM: Shared Roots and Differences.
Why ephedra supplements are banned in the US
The FDA issued a final rule declaring dietary supplements containing ephedrine alkaloids adulterated because they present an unreasonable risk of illness or injury. It was based on the pharmacology of ephedrine alkaloids, the published literature and reported adverse events, and it took effect on April 12, 2004. [5] A review of 140 adverse-event reports to the FDA found 31 percent definitely or probably related to ephedra-alkaloid supplements, with hypertension, palpitations, stroke and seizures among the problems, and ten deaths among related cases. [6]What this means for a formula prescribed by a practitioner is a regulatory question this page does not answer. Rules differ by country and by how a product is sold, so ask the practitioner and your pharmacist where the product comes from and how it is regulated where you live. See How Chinese Herbal Products Are Regulated.
Safety points
- Heart and blood pressure. People with cardiovascular disease have been considered at higher risk for severe harm, and ephedra may interact with other stimulants such as caffeine. [1]
- Overuse. A review notes that overuse is associated with palpitations, sweating, irritability and insomnia. [3]
- Liver. Ma Huang is among the herbs for which liver injury has been established as causal in a compilation of reported cases. [7]
- Pregnancy, breastfeeding and children. NCCIH considers ephedra unsafe in pregnancy, while breastfeeding, and for children. [1]
- Licorice in the formula. Licorice can cause irregular heartbeat and has reported interactions with corticosteroids. [8]
Related pages
Chinese Herbs With Known Safety Concerns and Natural Does Not Mean Safe cover other herbs with documented harms.Frequently asked questions
What is Ma Huang Tang?
It is a classical four-herb formula built on ephedra (Ma Huang), apricot kernel, cinnamon bark and licorice, called Maoto in Japan. [2]
Is ephedra legal in the United States?
The FDA banned dietary supplements containing ephedrine alkaloids with a rule effective April 12, 2004. [5] Ask a pharmacist how a particular product is regulated.
Does Ma Huang Tang work for the flu?
Evidence is insufficient. A review found fever may be shorter, but the studies were small and at high risk of bias. [4]
What are the main risks of ephedra?
High blood pressure, heart attack, seizure, stroke and psychosis have been linked to it, and it can be life-threatening or disabling. [1]
Is it safe in pregnancy or for children?
No. NCCIH considers ephedra unsafe in pregnancy and for children. [1]
References
- NCCIH. Ephedra: Usefulness and Safety. Read 2026-10-22.
- J Infect Chemother 2012. Traditional herbal medicine and neuraminidase inhibitors in seasonal influenza: randomized trial. Read 2026-10-22.
- J Ethnopharmacol 2023. Ephedrae herba: traditional uses, phytochemistry, pharmacology, and toxicology. Read 2026-10-22.
- BMC Complement Altern Med 2019. Maoto (Ma-Huang-Tang) to alleviate flu symptoms: systematic review and meta-analysis. Read 2026-10-22.
- J Pain Palliat Care Pharmacother 2004. Dietary supplements containing ephedrine alkaloids adulterated because they present an unreasonable risk; final rule. Read 2026-10-22.
- N Engl J Med 2000. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. Read 2026-10-22.
- Ann Hepatol 2015. Traditional Chinese Medicine and herbal hepatotoxicity: a tabular compilation of reported cases. Read 2026-10-22.
- NCCIH. Licorice Root. Read 2026-10-22.