TCM Safety Quick Reference
A one-page summary of the main safety points for Chinese herbs, acupuncture and hands-on practices, with links to the full guides on contamination, interactions and warning signs.
Content last updated . This page has not been medically reviewed.
If you feel seriously unwell
Call 911 in the US for an emergency. For a possible poisoning in the US, Poison Help is 1-800-222-1222; for other countries see Poison Help by Country. Stop any herbal product you suspect is causing a problem and tell a clinician what you took. See Warning Signs After Taking Herbs.The five points to remember
- Do not replace or delay conventional care. NCCIH advises discussing TCM with your health care providers and not using it to replace or delay conventional care. [1]
- Tell everyone involved in your care. Give all your providers a full picture of what you use. [1]
- Herbal products carry the bigger risks. Some have been contaminated with toxic compounds, heavy metals, pesticides and microorganisms, and manufacturing errors that swapped one herb for another have caused serious complications. [1]
- "Natural" is not a safety guarantee. NCCIH notes that natural does not always mean safe, and that supplements may interact with medicines. [2]
- Take extra care in pregnancy, breastfeeding and with children. Consult a health care provider first. [1]
Safety by type of practice
| Practice | Main safety points | Evidence-based source | Full guide |
|---|---|---|---|
| Chinese herbal products | Contamination with undeclared drugs (such as warfarin and diclofenac), heavy metals (arsenic, lead, cadmium), pesticides, sulfites, or incorrect herbs [1] | NCCIH | More about Chinese herbal products → |
| Acupuncture | Relatively few complications reported, but nonsterile needles or improper delivery can cause infections, punctured organs, collapsed lungs and nervous system injury [1] | NCCIH | More about Acupuncture → |
| Tai chi and qigong | Appear to be safe, with minor aches possible; people who are pregnant should talk with their provider first [1] | NCCIH | Tai Chi, Qigong |
| Moxibustion, cupping, gua sha | Hands-on practices that can mark or injure skin; not for self-treatment | See guides | Moxibustion and Cupping Risks, Who Should Avoid Them |
Herbs with documented harm
- Ephedra (Ma Huang). The FDA banned dietary supplements containing ephedrine alkaloids in 2004, and NCCIH says ephedra has been linked to high blood pressure, heart attack, seizure, stroke and psychosis. [3] See Ma Huang Tang and Ephedra.
- Aristolochia and related plants. The FDA describes aristolochic acid as a potent carcinogen and nephrotoxin, and its import alert cites outbreaks of renal failure attributed to Chinese herbal medicines; the alert was published 12/10/2020. [4] See Aristolochic Acid and Kidney Injury.
- Others. Chinese Herbs With Known Safety Concerns, Liver Injury From Chinese Herbs.
Product quality
Labels may not match contents, and the FDA has found prescription drugs in products sold as supplements. [2] In FDA lab testing, some products contained active drug ingredients not listed on the label, which may interact dangerously with nitrates. [5] Terms such as "standardized" or "verified" do not necessarily guarantee quality or consistency. [2] See Undeclared Drugs, Heavy Metals and Buying Chinese Herbs Safely.Medicines and surgery
Supplements can interact with medicines, and some may increase bleeding risk or affect anesthesia, so tell your providers well before an operation. [2] Never stop a prescribed medicine on the strength of anything you read here. See Chinese Herbs and Prescription Medicines and Chinese Herbs Before and After Surgery.Choosing a practitioner
Ask about training and experience. Most US states and the District of Columbia regulate acupuncture practice, and most require NCCAOM certification. [1] See How to Choose a TCM Practitioner and Red Flags in TCM Practice.Reporting a problem
See Reporting a Problem With a Chinese Herbal Product or Treatment.Frequently asked questions
Is TCM safe?
It depends on the practice. Relatively few acupuncture complications have been reported, while herbal products have had contamination and wrong-herb problems. [1]
What is the single most important safety step?
Tell your doctor and pharmacist about everything you use, and do not replace or delay conventional care. [1]
Can I give Chinese herbs to a child?
Talk to the child's health care provider first. [1] See TCM for Children.
How can I tell whether a product is contaminated?
You usually cannot tell by looking. Labels may not match contents. [2] Buy cautiously and ask a pharmacist; see Buying Chinese Herbs Safely.
When should I stop a herb and get help?
When you have unexpected or serious symptoms. Call 911 for emergencies and see Warning Signs After Taking Herbs.
References
- National Center for Complementary and Integrative Health (NCCIH), Traditional Chinese Medicine: What You Need To Know. Read 2026-10-22.
- NCCIH, Using Dietary Supplements Wisely. Read 2026-10-22.
- NCCIH, Ephedra: Usefulness and Safety. Read 2026-10-22.
- US Food and Drug Administration, Import Alert 54-10 (aristolochic acid-containing products). Published 12/10/2020. Read 2026-10-22.
- US Food and Drug Administration, Tainted Honey-based Products with Hidden Active Drug Ingredients. 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.