Ma Huang

What is Ma Huang?

Ma Huang is a stimulant herb that can damage the heart. In the United States it is banned as an ingredient in dietary supplements. The FDA made that rule in 2004, after reports of deaths, strokes and heart attacks linked to it.

The plant is Ephedra sinica. Its stems hold ephedrine and related drugs that speed up the heart and raise blood pressure. Those same drugs made it a popular add-in for diet pills and sports products.

Chinese medicine used it in the past for colds with chills, for wheezing, and for a blocked nose. A long history of use is not proof that a herb works, and it is not proof that it is safe. This page gives no dose and no way to prepare it.

How does Ma Huang work?

Ma Huang acts like adrenaline, the body's own "fight or flight" chemical. It tells the heart to beat faster and harder. It also opens the airways and shrinks swollen tissue inside the nose.

That is why it can ease wheezing and a stuffy nose for a short time. The same push on the heart is what makes it risky. Blood pressure climbs, the heart works harder, and the beat can turn uneven.

Ephedrine also acts on the brain. It can leave you wired, anxious or unable to sleep. In some people it has set off seizures (fits) or a stroke.

Two things make the danger hard to predict. First, people differ a lot in how strongly they react to the same small amount. Second, the amount of ephedrine in raw plant material changes from batch to batch, so no two products act the same.

There is no level known to be safe for self-use. Harm has been reported in young, fit adults with no known heart problem. Caffeine from coffee, energy drinks or pills pushes the risk higher still.

What forms does Ma Huang come in?

Ma Huang shows up as dried stems, cut or whole, and as a powder. It is also sold pressed into capsules and tablets in places where that is still allowed.

In Chinese medicine it appears as one named herb inside larger formulas. Outside the United States it is also sold in packaged teas.

The forms that cause the most harm are sports, "energy" and weight-loss products. Some hide the herb under other names, such as ephedra extract, ephedra herb, or Sida cordifolia, a different plant that also contains ephedrine.

Online sellers still ship these products into countries where they are banned. A product bought this way has had no safety check at all. If you find ephedra on a label, show it to a pharmacist rather than taking it.

Where it comes from:

Chinese medicine has used Ma Huang for around 2,000 years. It is named in the Shennong Bencao Jing, one of the oldest Chinese herbal texts.

Classical practice placed it in the group of herbs meant to push out "wind-cold", a pattern of chills, body ache and no sweating. Practitioners also used it for wheezing and for puffiness in the face.

It was always treated as a strong herb, not a gentle one. Old texts warned against using it in weak patients and told practitioners to keep courses short.

Western medicine took an interest in the early 1900s, when ephedrine was pulled out of the plant. Doctors then used pure ephedrine for asthma and for low blood pressure during surgery. Better and safer asthma drugs replaced it later.

In the 1990s the herb was repackaged as a diet and workout aid in the United States. Reports of serious harm followed, and the ban came in 2004.

What does Ma Huang help with?

• Colds with chills and no sweating: Chinese medicine used Ma Huang for a chill-type cold, to bring on a sweat. No good human study has tested the whole herb for colds. Ephedrine can clear a stuffy nose for a while, but it does not shorten a cold and it does not kill the virus.
• Wheezing and asthma-like breathing trouble: This is the one use with a clear reason behind it. Ephedrine does open the airways, and doctors used it for asthma before better drugs arrived. Today's inhalers work better, act right where they are needed, and are far kinder to the heart.
• A blocked or stuffy nose: Ephedrine shrinks swollen tissue inside the nose. The effect is real but short. Safer sprays and salt-water rinses do the same job, and a pharmacist can point you to one.
• Puffiness and fluid build-up: Tradition used the herb for a puffy face during a cold. No solid human study backs this. Fluid build-up can be a sign of heart or kidney trouble, so it needs a doctor, not a herb.
• Weight loss and sports performance: This modern use is where most of the harm happened. Pooled trials found only a small weight loss over a few months. The same trials found two to three times more heart flutter, stomach upset, anxiety and poor sleep. Nothing shows it is safe over the long run.

What are the side effects of Ma Huang?

• A fast or pounding heartbeat
• An uneven heartbeat (arrhythmia)
• High blood pressure
• Chest pain
• Heart attack
• Stroke
• Heart muscle damage
• Seizures (fits)
• Shaking hands (tremor)
• Feeling jittery, anxious or panicky
• Trouble sleeping
• Headache and dizziness
• Nausea and vomiting
• Trouble passing urine
• Losing touch with reality (psychosis)
• Death

Good to know:

Harm can start fast. Some people had chest pain, a racing heart or a stroke within hours of one use.

Others were hurt after taking it daily for weeks. Many of them were young adults with no known heart problem.

Some of these events left lasting damage. Some ended in death. The US ban in 2004 grew out of that record.

Mild effects can be an early sign of trouble. Shaking, a dry mouth, a thumping chest or a night with no sleep all mean too much. Do not treat them as something to push through.

Is Ma Huang legal where you live?

In the United States, the FDA banned ephedrine-alkaloid ephedra in dietary supplements in 2004, and a federal court upheld that ban in 2006. The rule covers supplements; it does not cover FDA-approved medicines that contain ephedrine, or herbal preparations used in traditional Asian medicine.

Canada, the United Kingdom, Australia and several other countries also ban or tightly limit sale to the public. Ephedrine is watched closely almost everywhere, because it can be used to make illegal street drugs.

Ephedrine itself is not banned in the United States, and it is not prescription-only there either. Single-ingredient ephedrine tablets are sold from behind the pharmacy counter under the Combat Methamphetamine Epidemic Act, which caps how much you may buy and logs the sale. In most other countries it is a prescription medicine. What the 2004 rule bans is the herb in dietary supplements.

Options to discuss with a clinician

There are better answers for every job people ask this herb to do. Each one belongs in a talk with a doctor or pharmacist.

For asthma and wheezing: prescribed inhalers. They work better than ephedrine and are far easier on the heart. Never swap a prescribed inhaler for a herb.

For a blocked nose: salt-water rinses, steam, or a short course of a pharmacy nose spray. A pharmacist can pick one that suits you.

For colds: rest, fluids, and simple pain or fever relief. Nothing cuts a cold short, so comfort is the goal.

For weight: a doctor can check your thyroid and other causes, and can talk you through food, movement and approved weight medicines with proper follow-up.

For low energy: ask for a check of your sleep, iron, thyroid and mood. Tiredness with a cause is far better treated than masked with a stimulant.

If you want to stay within Chinese medicine, ask a registered practitioner about gentler herbs for your pattern, and tell your doctor what you are taking.