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Chinese Herbal Medicine

John Montgomery7 min read

Chinese Herbal Medicine

Chinese herbal medicine (CHM) is one branch of Traditional Chinese Medicine, alongside acupuncture, diet and exercise. For Atopic Dermatitis it is given as an oral decoction, usually a mix of about ten herbs boiled into a daily tea, as capsules or granules, or as creams and washes (Schäfer). Researchers have proposed immune-modulating effects. In one study of the commercial product Zemaphyte, clinical response came with immunological changes (Latchman 1996, via Schäfer). CHM was the most popular complementary therapy among UK children with eczema at a Leicester clinic (43% of CAM users; Johnston 2003). It also appeals to parents with Steroid Phobia. The National Eczema Association lists traditional Chinese herbs among complementary options, without discussing toxicity.

Chinese Herbal Medicine [part-of] Herbal and Home Remedies for Eczema Chinese Herbal Medicine [treats] Atopic Dermatitis Steroid Phobia [relates] Chinese Herbal Medicine

The early UK trials. Interest in the West began with crossover RCTs in London by Sheehan, Atherton and colleagues (Lancet 1992; Br J Dermatol). Thirty-seven children and 31 adults with severe, treatment-resistant eczema took a standard ten-herb decoction or a placebo tea for 8 weeks each. In children, the skin area affected fell by 63.1% on the active herbs compared with 6.2% on placebo. In adults, the geometric mean for affected skin was 11.3 on herbs against 111 on placebo. After a year, the 23 children who kept taking the herbs were doing better than those who stopped (Sheehan & Atherton 1994), and adults who continued had more than a 90% fall in severity score (Sheehan 1995). The formula was then commercialised as Zemaphyte. A later 37-patient crossover trial of Zemaphyte in Hong Kong found both groups improved, with no difference between them (Fung 1999). In a 2007 Hong Kong trial of capsules in 85 children, SCORAD fell in both groups and slightly more on placebo, although only the herbal group improved in quality of life and needed less steroid (Hon 2007) (all via Schäfer).

Conflict: [Sheehan & Atherton, Br J Dermatol, 1992 (via Schäfer)] says a ten-herb decoction cut affected skin by 63% vs 6% on placebo in children with severe eczema. [Fung et al., Int J Dermatol, 1999; Hon et al., Br J Dermatol, 2007 (via Schäfer)] say Zemaphyte did no better than placebo, and that SCORAD fell at least as much on placebo as on CHM capsules in 85 children. Unresolved — add to open_questions.

Chinese Herbal Medicine [relates] SCORAD

Strength of evidence: weak. The Cochrane review by Gu et al. (2013) included 28 RCTs with 2,306 children and adults. Four compared CHM with placebo, 22 with conventional medicines, and 2 compared different CHM regimens. Most studies had a high risk of bias, the evidence was graded very low quality, and the review found “no conclusive evidence” that oral or topical CHM helps children or adults. The earlier 2004 Cochrane review had found possible benefit from four trials, but these were dropped because they tested a product taken off the market in 2004. Schäfer names the commercial product studied in those trials as Zemaphyte. The AAP calls oral or topical CHM “ineffective”. NICE CG57 tells parents that the effectiveness and safety of herbal medicine “have not yet adequately been assessed in clinical trials”. The British Association of Dermatologists says healthcare professionals “do not generally recommend” Chinese herbal treatment. NCCIH notes a 2016 review of 70 studies that found some real effects of herbal preparations but concluded there were too many unanswered questions to warrant routine clinical use.

Conflict: [Cochrane (Gu et al.), 2013] says there is no conclusive evidence of benefit from oral or topical CHM. [National Eczema Association, 2025] says research has shown traditional Chinese medicine “helped ease certain symptoms of eczema in adults”, and lists it as a complementary option. Unresolved — add to open_questions.

Cochrane [contradicts] Chinese Herbal Medicine NICE CG57 [opposes] Chinese Herbal Medicine British Association of Dermatologists [opposes] Chinese Herbal Medicine

Toddler safety: liver, kidney and hidden-steroid harms. The London trials recommended routine liver and kidney function tests and a blood count before treatment. Soon afterwards, independent reports described severe adverse effects, including one fatal hepatitis after a herbal tea (Mostefa-Kara 1992) and liver damage in people taking CHM for skin disease (Perharic 1995) (via Schäfer). In the Cochrane trials, three people had temporary rises in liver enzymes that settled after stopping, and one study reported a severe adverse event. NICE warns that “liver toxicity has been associated with the use of some Chinese herbal medicines intended to treat atopic eczema”, and the BAD warns of liver inflammation. The kidneys are also at risk. Herbs such as Aristolochia contain Aristolochic Acid, which causes kidney scarring and cancer, and they have been swapped in for similar-sounding herbs. In 1999, two UK women who took unlicensed Chinese remedies for eczema developed end-stage kidney failure after Aristolochia manshuriensis was used in place of Mu Tong. One needed a transplant, and over 40% of UK Fang ji and Mu Tong samples tested contained aristolochic acids (European Medicines Agency HMPC 2005). NCCIH also reports contamination with heavy metals.

Unregulated "natural" creams can contain undeclared steroids

Chinese herbal creams for eczema have repeatedly been found to contain potent steroids such as dexamethasone or clobetasol. In one London study, 8 of 11 creams contained dexamethasone, and the strongest was prescribed for a 4-month-old’s face (Keane, BMJ 1999). See Adulterated Herbal Creams. NICE says steroids are “deliberately added to some herbal products intended for use in children”, and advises caution with any product not labelled in English or without safe-use information. Tell your GP or pharmacist about any herbal product your child uses, and keep using emollients.

Chinese Herbal Medicine [relates] Adulterated Herbal Creams Chinese Herbal Medicine [relates] Aristolochic Acid Aristolochic Acid [part-of] Chinese Herbal Medicine European Medicines Agency [regulates] Chinese Herbal Medicine MHRA [regulates] Chinese Herbal Medicine Traditional Herbal Registration [regulates] Chinese Herbal Medicine

Practical guidance and what parents report (evidence: anecdotal). NICE asks parents to tell healthcare professionals if they use or plan to use complementary therapies. If they do, they should keep using Emollient Therapy alongside, and look for a registered product (in the UK, a Traditional Herbal Registration number). In the clinic studies behind Adulterated Herbal Creams, parents described Chinese and other “herbal” creams as working fast and “extremely well”. The eczema flared when the supply stopped, a pattern that fits a hidden steroid rather than a herbal effect (Keane 1999; Ramsay 2003). No published trial has focused on toddlers aged 1–4, so there is no age-specific evidence on dosing or safety for this group.

Chinese Herbal Medicine [relates] Emollient Therapy Chinese Herbal Medicine [relates] Topical Corticosteroids

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