TOC  |    Herbal Medicine    

Herbal Medicine                                            
Ma-huang/ Ephedra (Ephedra sinica), Ma-huang

Be aware that the U.S. Food and Drug Administration does not strictly regulate herbs and dietary supplements. There is no guarantee of strength, purity or safety of products containing or claiming to contain ephedra. Decisions to use herbs or supplements should be carefully considered. Individuals using prescription drugs should discuss taking herbs or supplements with their pharmacist and other health care providers before starting.


Ephedra is also known as Ma-huang. Ephedra and the chemicals ephedrine and pseudoephedrine in ephedra have been associated with many reports of serious toxicity, including death, and with numerous interactions with drugs, herbs and supplements.

Note: On February 6th, 2004, the U.S. Food and Drug Administration (FDA) issued a final rule prohibiting the sale of dietary supplements containing ephedrine alkaloids (ephedra) because such supplements present an unreasonable risk of illness or injury. The rule became effective 60 days from the date of publication. Sales of ephedra have also been banned in several European countries.

On April 14, 2005, a Federal District Court in Utah under Judge Tena Campbell struck down an FDA ban on ephedra. The ruling is specific only to Utah, although it calls into question the FDA ban in general. The suit in question was brought by the dietary supplement manufacturing company Nutraceutical Corporation. The decision specifically questioned the ability of the FDA to ban ephedra completely without conclusively demonstrating danger at low doses.

Although most evidence around the risks associated with ephedra use is based on higher doses or combination use with caffeine, a universal ban was implemented by the FDA, as it would be unethical to conduct human studies of lower doses in order to establish safety. Therefore, Judge Campbell felt there is inadequate safety data at lower doses. This places the FDA in a bind under current dietary supplement regulatory law — it suspects dangers at low doses, but cannot seek to prove these dangers.

It remains unclear whether ephedra will find its way back onto shelves, despite widespread acknowledgement of significant safety risks, including serious potential cardiovascular events or death.

Scientists have studied ephedra for the following health problems:

Weight loss
Ephedra contains the chemical ephedrine, which appears to cause weight loss when used in combination with caffeine. However, there are weaknesses with the design of most available studies. There are variable amounts of ephedrine in commercially available products, and thousands of adverse reactions have been reported to the FDA with ephedrine use, including heart attack, stroke, seizure, serious psychiatric symptoms, and death. Before the official ban, the FDA issued a policy that ephedrine products had to be labeled with possible adverse effects, contain no more than 8 milligrams of ephedrine per serving, and be used for no longer than seven days.
Bronchodilator (asthma)
Ephedra contains the chemicals ephedrine and pseudoephedrine. It was used for many years as a treatment for asthma and chronic obstructive pulmonary disease in both children and adults, before the development of more modern treatments. Although ephedrine is an effective bronchodilator, there are drugs that are considered to be safer with less risk of toxicity.
Low blood pressure
Chemicals in ephedra can stimulate the heart, increase heart rate and raise blood pressure. The chemical ephedrine in ephedra has been used in hospitals to control blood pressure during delivery in women receiving spinal anesthesia. However, these effects have not been evaluated for ephedra supplements taken by mouth.
Nasal allergies (used as a nose wash)
Preliminary study suggests possible benefits of ephedrine, a chemical in ephedra, when used as a nasal spray for treating symptoms of nasal allergies. Although results seem promising, further research is needed.
Sexual dysfunction
Preliminary study suggests that ephedra may increase sexual arousal in women. Further research is needed to confirm these results.

Unproven Uses     

Ephedra has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially very serious and even life-threatening. You should consult a health care provider before taking ephedra for any use.

Acute coryza (rhinitis)
Anaphylaxis (a severe allergic reaction)
Appetite suppressant
Athletic-performance enhancer
Body building
Congenital myasthenic syndrome
Dyspnea (shortness of breath)
Energy enhancer
Hay fever
Increased sweating
Joint pain
Kidney disease
Lack of perspiration
Metabolic enhancement
Myasthenia gravis
Performance enhancer
Runny nose
Shortness of breath
Upper respiratory tract infection
Uterine disorders
Water retention

Potential Dangers     


Side Effects

Pregnancy And Breast-Feeding


Interactions with drugs, supplements and other herbs have not been thoroughly studied. The interactions listed below have been reported in scientific publications. If you are taking prescription drugs, speak with your health care provider or pharmacist before using herbs or dietary supplements.

Interactions With Drugs

Interactions With Herbs And Dietary Supplements

Interactions With Food:  Ephedra and caffeine may curb appetite.


The doses listed below are based on scientific research, publications or traditional use. Because most herbs and supplements have not been thoroughly studied or monitored, safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients even within the same brand. Combination products often contain small amounts of each ingredient and may not be effective. Appropriate dosing should be discussed with a health care provider before starting therapy; always read the recommendations on a product's label. The dosing for unproven uses should be approached cautiously, because scientific information is limited in these areas.

Wide variations have been found in the amounts of the active chemicals ephedrine and pseudoephedrine in commercial ephedra products. Before the official ban, the FDA issued a policy that ephedrine products be labeled with possible adverse effects, contain no more than 8 milligrams of ephedrine per serving and be used for no longer than seven days. The FDA banned all sales of the product in 2004. Ephedrine or ephedra is often used in combination with caffeine, but this combination has been associated with significant adverse effects, including death.

Adults (Aged 18 Or Older)

Children (Younger Than 18):  There is not enough scientific data to recommend ephedra for use in children, and it is not recommended due to potential serious side effects. Purified ephedrine has been given to children in a controlled setting under direct medical supervision.


Ephedra has been suggested as a treatment for many conditions. Although there is evidence that ephedra is effective for weight loss, bronchodilation, and elevating blood pressure, ephedra has been associated with thousands of reports of adverse effects, including death. There is not enough scientific evidence to support the use of ephedra for any other medical condition. Ephedra may cause heart problems, including irregular heart rhythms and even death. It should be avoided in pregnant and breast-feeding women and in children. Ephedra may lower blood sugar. Use caution if you take insulin or drugs by mouth to control your blood sugar levels. Ephedra may interact with many other drugs, herbs, or supplements, and you should check with your health care provider or pharmacist to screen for dangerous interactions. Consult your health care provider immediately if you have any side effects.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.


  1. Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
  2. National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research
  3. FDA Press Release, HHS Acts to Reduce Potential Risks of Dietary Supplements Containing Ephedra.

Selected Scientific Studies: Ephedra

Some of the more recent studies are listed below:

  1. Backer R, Tautman D, Lowry S, et al. Fatal ephedrine intoxication. J Forensic Sci 1997;42(1):157-159.
  2. Baker JI, Zhang X, Boucher TA, Keyler DE. Investigation of quality in ephedrine-containing dietary supplements. J Herb Pharmacother 2003;3(2):5-17.
  3. Bell DG, Jacobs I, Ellerington K. Effect of caffeine and ephedrine ingestion on anaerobic exercise performance. Med Sci Sports Exerc 2001;33(8):1399-1403.
  4. Bell DG, McLellan TM, Sabiston CM. Effect of ingesting caffeine and ephedrine on 10-km run performance. Med Sci Sports Exerc 2002;34(2):344-349.
  5. Boozer CN, Nasser JA, Heymsfield SB, et al. An herbal supplement containing Ma Huang-Guarana for weight loss: a randomized, double-blind trial. Int J Obes Relat Metab Disord 2001;25(3):316-324.
  6. Bouchard NC, Howland MA, Greller HA, et al. Ischemic stroke associated with use of an ephedra-free dietary supplement containing synephrine. Mayo Clin Proc 2005;Apr, 80(4):541-545.
  7. Breum L, Pedersen JK, Ahlstrom F, et al. Comparison of an ephedrine/caffeine combination and dexfenfluramine in the treatment of obesity: a double-blind multi-centre trial in general practice. Int J Obes Relat Metab Disord 1994;18(2):99-103.
  8. Coffey CS, Steiner D, Baker BA, Allison DB. A randomized double-blind placebo-controlled clinical trial of a product containing ephedrine, caffeine, and other ingredients from herbal sources for treatment of overweight and obesity in the absence of lifestyle treatment. Int J Obes Relat Metab Disord 2004;Nov, 28(11):1411-1419.
  9. Cohen SN. Five young patients with cryptogenic stroke who used an ephedra containing compound in a time window prior to suffering a stroke. J Neurol Sci 2004;Aug 30, 223(2):203-204 Author reply, 205-206. Comment in: J Neurol Sci 2004;Jan 15, 217(1):55-60.
  10. Corrigan FM, Jennett J. Ephedra alkaloids and brief relapse in EMDR-treated obsessive compulsive disorder. Acta Psychiatr Scand 2004;Aug, 110(2):158. Author reply, 159.
  11. Gardner SF, Franks AM, Gurley BJ, et al. Effect of a multicomponent, ephedra-containing dietary supplement (Metabolife Am J Cardiol 2003;91(12):1510-1513, A9.
  12. Greenway FL, De Jonge L, Blanchard D, et al. Effect of a dietary herbal supplement containing caffeine and ephedra on weight, metabolic rate, and body composition. Obes Res 2004;Jul, 12(7):1152-1157.
  13. Gurley BJ, Gardner SF, White LM, et al. Ephedrine pharmacokinetics after the ingestion of nutritional supplements containing Ephedra sinica (ma huang). Ther Drug Monit 1998;20(4):439-445.
  14. Haller CA, Jacob P 3rd, Benowitz NL. Pharmacology of ephedra alkaloids and caffeine after single-dose dietary supplement use. Clin Pharmacol Ther 2002 Jun;71(6):421-432.
  15. Kalman D, Incledon T, Gaunaurd I, et al. An acute clinical trial evaluating the cardiovascular effects of an herbal ephedra-caffeine weight loss product in healthy overweight adults. Int J Obes Relat Metab Disord 2002;26(10):1363-1366.
  16. Lee A, Ngan Kee WD, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg 2002;94(4):920-926.
  17. Long C, Kakiuchi N, Zhong G, Mikage M. Survey on resources of ephedra plants in Xinjiang. Biol Pharm Bull 2005;Feb, 28(2):285-288.
  18. Meersschaert K, Brun L, Gourdin M, et al. Terlipressin-ephedrine versus ephedrine to treat hypotension at the induction of anesthesia in patients chronically treated with angiotensin converting-enzyme inhibitors: a prospective, randomized, double-blinded, crossover study. Anesth Analg 2002;94(4):835-840.
  19. Meston CM, Heiman JR. Ephedrine-activated physiological sexual arousal in women. Arch Gen Psychiatry 1998;55(7):652-656.
  20. Molnar D, Torok K, Erhardt E, et al. Safety and efficacy of treatment with an ephedrine/caffeine mixture: the first double-blind placebo-controlled pilot study in adolescents. Int J Obes Relat Metab Disord 2000;24(12):1573-1578.
  21. Morgenstern LB, Viscoli CM, Kernan WN, et al. Use of ephedra-containing products and risk for hemorrhagic stroke. Neurology 2003;60(1):132-5.
  22. Ngan Kee WD, Lau TK, Khaw KS, et al. Comparison of metaraminol and ephedrine infusions for maintaining arterial pressure during spinal anesthesia for elective cesarean section. Anesthesiology 2001;95(2):307-313.
  23. Nyska A, Murphy E, Foley JF, et al. Acute hemorrhagic myocardial necrosis and sudden death of rats exposed to a combination of ephedrine and caffeine. Toxicol Sci 2005;Feb, 83(2):388-396.
  24. Perrotta DM. From the Centers for Disease Control and Prevention. Adverse events associated with ephedrine-containing products: Texas, December 1993--September 1995. JAMA 1996;276(21):1711-1712.
  25. Samenuk D, Link MS, Homoud MK, et al. Adverse cardiovascular events temporarily associated with ma huang, an herbal source of ephedrine. Mayo Clin Proc 2002;71:12-16.
  26. Shaikh WA. Ephedrine-saline nasal wash in allergic rhinitis. J Allergy Clin Immunol 1995;96(5 Pt 1):597-600.
  27. Shekelle P, Morton S, Maglione M, et al. Ephedra and ephedrine for weight loss and athletic performance enhancement: clinical efficacy and side effects. Evidence Report/Technology Assessment No. 76 (Prepared by Southern California Evidence-based Practice Center, RAND, under Contract No 290-97-0001, Task Order No. 9). AHRQ Publication No. 03-E022. Rockville, MD: Agency for Healthcare Research and Quality. February 2003.
  28. Sola S, Helmy T, Kacharava A. Coronary dissection and thrombosis after ingestion of ephedra. Am J Med 2004;May 1, 116(9):645-646.
  29. White LM, Gardner SF, Gurley BJ, et al. Pharmacokinetics and cardiovascular effects of ma-huang (Ephedra sinica) in normotensive adults. J Clin Pharmacol 1997;37(2):116-122.

Last updated June 17, 2005