Diet Hanbang Medicine: Precautions You Must Know Before Taking It

It's the third day since you started taking the diet Hanbang medicine, and you wake up at two in the morning. Your heart is beating faster than usual, and your mouth is parched. Even after drinking water, the thirst doesn't subside, and during the day, your fingertips tremble slightly. If you search for these symptoms online, you'll find a mix of advice saying "you'll adapt in a few days" and "stop immediately."

These reactions are not coincidental. Many Hanbang prescriptions used for diet purposes contain Ma Huang (麻黃), and its main active components are ephedrine alkaloids. Palpitations, insomnia, dry mouth, and hand tremors are typical reactions that occur when these components stimulate the sympathetic nervous system. This should not be interpreted as the body getting used to the medicine, but rather as a signal that the components are active, and that the dosage or the individual may not be suitable.

Palpitations and Insomnia are Sympathetic Nervous System Hyperactivity Reactions

The Korea Institute of Oriental Medicine (한국한의약진흥원) explained Ma Huang in its webzine 「약재의 발견」(Discovery of Medicinal Herbs), stating that "ephedrine, one of the main components of Ma Huang, stimulates the sympathetic nervous system, activating heart rate and constricting peripheral blood vessels." When the heart rate increases and peripheral blood vessels narrow, blood pressure also rises. The same article states that "as it has the effect of raising blood pressure, people with high blood pressure should exercise caution when taking it."

「비만 치료에서 마황 및 에페드린의 유효성, 안전성에 대한 고찰」(A Review of the Efficacy and Safety of Ma Huang and Ephedrine in Obesity Treatment) published in 『대한한의학회지』 (The Journal of Korean Medicine) Vol. 38, No. 3 (2017), reviewed data from 16 randomized controlled trials involving approximately 1,000 people. Adverse reactions reported included sympathetic nervous system hyperactivity symptoms such as insomnia, anxiety, nervousness, hand tremors, palpitations, nausea, vomiting, constipation, dry mouth, headache, and dizziness. The daily usage range summarized by this paper is 20-90 mg based on ephedrine.

The 「비만치료 및 체중감량에서의 적절한 마황 사용에 대한 임상 진료지침 개발」(Development of Clinical Practice Guidelines for Appropriate Use of Ma Huang in Obesity Treatment and Weight Loss) in 『한방비만학회지』 (Journal of Korean Medicine for Obesity Research) in 2007 lists adverse reactions more broadly by system. Cardiovascular effects include palpitations, tachycardia, increased blood pressure, and arrhythmia; central nervous system effects include headache, dizziness, insomnia, and seizures; and psychiatric effects include excitement, instability, and hyperactivity.

The U.S. Prohibited Sales in 2004

The U.S. was the catalyst for the international recognition of Ma Huang's risks. On February 11, 2004, the U.S. FDA announced a final rule in the Federal Register prohibiting the sale of dietary supplements containing ephedrine alkaloids due to 'unreasonable risk', and the rule became effective on April 12 of the same year. The basis was the determination that increases in blood pressure and heart rate could lead to stroke, heart attack, and death, and that there was a risk of worsening heart failure and inducing arrhythmias.

The cited data reveals the scale. Reports of ephedrine-related adverse events increased from 211 in 1997 to 407 in 1999, and an analysis of consumer complaint records from one manufacturer by the U.S. Government Accountability Office (GAO) identified 92 serious adverse events, including heart attack, stroke, seizures, and death. A RAND report commissioned by the National Institutes of Health summarized an increased risk of palpitations, psychiatric symptoms, and gastrointestinal symptoms, and identified 21 sentinel events, including stroke, heart attack, and death.

However, the target of this measure was dietary supplements that consumers purchase and consume on their own. In Korea, Ma Huang is classified not as a raw material for health functional foods, but as a medicinal Hanbang ingredient prescribed by a Korean medicine doctor after diagnosis. The level of regulation is different, but the way the component acts in the body is not. It is more accurate to interpret it not as "it's safe because it's a prescription drug," but as "it's an herbal medicine that can only be used with prescription and management as a prerequisite."

These Individuals Are Not Candidates for Consumption

The Memorial Sloan Kettering Cancer Center (MSKCC) medicinal plant information lists the contraindications for ephedra (Ma Huang) as follows: anxiety disorders, hypertension, heart disease, glaucoma, benign prostatic hyperplasia, hyperthyroidism. Regarding pregnancy, it explicitly states that "ephedra should not be taken by pregnant women as it can stimulate uterine contractions," and adds that safety during pregnancy has not been established. If breastfeeding, the components can pass into breast milk, so it is also not suitable.

There are reasons for this list. Sympathetic nervous system stimulation raises blood pressure (hypertension), increases heart rate and myocardial oxygen demand (heart disease), increases bladder outlet resistance (benign prostatic hyperplasia), and can affect intraocular pressure (angle-closure glaucoma). Hyperthyroidism is already a state of elevated metabolism and heart rate, so adding stimulation in the same direction would be problematic.

The problem arises when individuals are unaware. This includes cases where someone was told they had "borderline hypertension" during a check-up and dismissed it, or experienced palpitations a few times but did not get tested. Do not leave the medical questionnaire blank, thinking there's nothing to write; you must accurately record your blood pressure readings, medications you are taking, and family history.

Things That Increase Risk When Taken Together

Concomitant use is a separate item to consider. MSKCC data warns that a hypertensive crisis can occur if used with monoamine oxidase inhibitor (MAOI) antidepressants. It also states that concomitant use with central nervous system stimulants can increase the stimulatory effect, with digoxin can lead to arrhythmias, and with theophylline, the effect may be reduced.

The 2007 Journal of Korean Medicine for Obesity Research clinical guidelines are in the same vein. They list alcohol, central nervous system stimulants, caffeine, and sympathomimetics as substances to be cautious about when co-administering, and explicitly state that severe hypertension can occur if used with monoamine oxidase inhibitors. Caffeine is particularly easy to overlook. If two or three cups of coffee, energy drinks, and anhydrous caffeine in supplements are combined, the daily exposure can be greater than expected.

Cold medicines are also in the same category. Pseudoephedrine, commonly found in nasal congestion and runny nose medications, is a sympathomimetic with a structure similar to ephedrine. The Korea Pharmaceutical Information Center's pseudoephedrine data.pdf) states that it cannot be administered to patients with cardiovascular disease, and cannot be administered to patients who are currently taking MAO inhibitors or have stopped taking them within the last 2 weeks. If you take a multi-symptom cold medicine while taking diet Hanbang medicine, the same action occurs twice.

Dosage and Duration, and When Adverse Reactions Occur

The Korea Institute of Oriental Medicine (한국한의약진흥원) recommends a daily intake of Ma Huang between 4.5-7.5 g, with a consumption period of within 6 months. The 2007 clinical guidelines reported a broader range used in clinical practice, calculating that if 24 g per day is used, the total alkaloids would be 168 mg or more, and if ephedrine accounts for 75% of that, it would be 126 mg or more. This means that even with the same single packet, the exposure can vary several times depending on the Ma Huang content. This is why sharing someone else's medicine without a prescription is dangerous.

The principle when adverse reactions occur is simple: do not endure it, do not adjust the dosage yourself, and inform the prescribing Korean medicine clinic immediately. If you experience chest pain, weakness in one limb, slurred speech, fainting, or severe headache, the emergency room should be contacted before the Korean medicine clinic.

Jaimdang's Gongbihwan is also a Korean medicine doctor-prescribed medication, for which consumption is determined only after diagnosis and prescription by a Korean medicine doctor. Preparation takes place at an off-site herbal dispensary (원외탕전실) in Paju, Gyeonggi Province, where indicator components of standardized herbal medicines are quantified by HPLC, and self-inspections for heavy metals and residual pesticides are conducted. Quality inspections are performed for each batch, and products are tracked by lot number. However, quality control does not mean "anyone can take it." The first step in the process is always the medical questionnaire, and accurately disclosing underlying conditions and medications being taken comes first. The preparation process is summarized in [Off-site Herbal Dispensaries and Hanbang Medicine Quality](/en/journal/wonoe-tangjeon-quality), and the consultation procedure in [Non-face-to-face Hanbang Medicine Prescription Guide](/en/journal/bidaemyeon-hanyak-guide).

Four Things to Check Before Consultation

• Measure and record your blood pressure twice over two days — in the morning and evening, after sitting and resting for 5 minutes. Having these readings will improve the accuracy of the medical questionnaire.
• List all medications you are taking, including their active ingredients — especially do not omit antidepressants, cold medicines, thyroid medications, blood pressure medications, and asthma medications. Product names alone do not indicate overlapping ingredients.
• Calculate your daily caffeine intake — sum up anhydrous caffeine from coffee, energy drinks, and supplements. Also decide how much you will reduce it during the consumption period.
• Establish discontinuation criteria in advance — agree with your Korean medicine doctor at the time of prescription on how many consecutive days of sleeplessness or what level of palpitations would warrant contacting them.

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References

• Cho, G. W. et al., 「비만 치료에서 마황 및 에페드린의 유효성, 안전성에 대한 고찰 — RCT 연구를 중심으로」 (A Review of the Efficacy and Safety of Ma Huang and Ephedrine in Obesity Treatment — Focused on RCT Studies), 『대한한의학회지』 (The Journal of Korean Medicine) 38(3), 2017
• Kim, H. J. et al., 「비만치료 및 체중감량에서의 적절한 마황 사용에 대한 임상 진료지침 개발」 (Development of Clinical Practice Guidelines for Appropriate Use of Ma Huang in Obesity Treatment and Weight Loss), 『한방비만학회지』 (Journal of Korean Medicine for Obesity Research) 7(2), 2007
• U.S. FDA, Final Rule Declaring Dietary Supplements Containing Ephedrine Alkaloids Adulterated Because They Present an Unreasonable Risk, Federal Register, 2004
• Memorial Sloan Kettering Cancer Center, Ephedra — Integrative Medicine Herb Information
• Korea Institute of Oriental Medicine (한국한의약진흥원), 「약재의 발견 — 마황」 (Discovery of Medicinal Herbs — Ma Huang), Webzine February 2024 issue

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*This article aims to provide safety information about Ma Huang-containing Hanbang medicine and does not guarantee the diagnosis or treatment efficacy for specific diseases. Hanbang medicines, including Gongbihwan, are prescribed by Korean medicine doctors, and their consumption is determined through a Korean medicine doctor's diagnosis and prescription; reactions may vary by individual. If you experience chest pain, fainting, severe headache, or neurological symptoms while taking the medicine, seek medical attention immediately.*