Pien Tze Huang and An Gong Niu Huang Wan: Premium Patent Medicines and Their Safety Issues

Stroke, brain bleeding and any sudden collapse are emergencies. In the US, call 911 at once; do not wait on a herbal pill.

Two well-known patent medicines

Both are Chinese patent medicines, meaning ready-made products. They are not alike, and their safety issues differ.

Pien Tze Huang. A review says it was first formulated by a royal physician in the Ming Dynasty in 1555. [1] The same review says it is composed of four ingredients: notoginseng, musk (Moschus), Calculus Bovis (Niuhuang) and snake gall, in proportions it gives as 85%, 3%, 5% and 7%. [1]

An Gong Niu Huang Wan (Angong Niuhuang). This is a classic formula that contains the minerals cinnabar (a mercury sulfide) and realgar (an arsenic sulfide), which together make up 12.5% of the formula by weight in one published description. [2][3]

What research shows

In the pilot stroke trial, serum mercury and arsenic changes were comparable with placebo over a short course. [9] Pien Tze Huang's own reviewers note there is little information on its side effects and toxicity. [1]

Mercury and arsenic in An Gong Niu Huang Wan

This site does not recommend products containing cinnabar or realgar. Here is what the sources say, in plain terms.

• A review notes that in these medicines the metals are sulfides, which behave differently from environmental mercury or arsenic compounds, but that measuring total metal alone is not enough to judge risk and that patients using them should be monitored. [3]
• A toxicology review found cinnabar poorly absorbed with relatively low oral toxicity compared with other mercury forms. It also warned that heating cinnabar releases mercury vapor and that long-term use can lead to kidney dysfunction. [10]
• Liver injury from realgar and kidney toxicity from cinnabar have been reported, often with overdose or prolonged use. [2]
• A six-week mouse study found kidney damage milder with An Gong Niu Huang Wan than with other mercury and arsenic compounds. [11] Animal findings do not settle human safety.

Children, pregnancy, and kidney or liver disease are not covered by the sources I read, so treat the risk as unknown and ask a clinician. See animal and mineral ingredients in TCM and Ayurvedic products: heavy metals, which covers a similar issue.

Wildlife ingredients

Musk comes from the scent gland of male musk deer and appears in some 300 TCM prescriptions. [12] A TRAFFIC report from about 2005 said every musk deer species is at least in CITES Appendix II, meaning international trade is allowed but monitored, and some populations are in Appendix I. Listings change, so check the current CITES lists. [12] The Environmental Investigation Agency found sellers advertising a North Korean-made version of An Gong Niu Huang Wan that states it contains rhino horn and musk, unlike the Chinese version. [13] Avoid any product that lists endangered-species ingredients.

Buying and using more safely

• Ask a pharmacist or qualified clinician about interactions, especially if you take blood thinners or have kidney disease. See Chinese herbal products: quality and interactions.
• Do not replace cancer treatment, antiviral therapy or stroke care with either product.
• Read reading a Chinese patent medicine label and buying Chinese herbs safely.