Bao He Teapills [Discontinued] by Plum Flower

LIKELY EFFECTIVE

• Coronary heart disease (CHD). Consuming barley 3-3.6 grams daily as a source of dietary fiber appears to reduce the risk of CHD. Details: Clinical research shows that a diet containing foods high in soluble fiber, such as whole grain barley or dry milled barley, reduces the risk of heart disease (2737,4962,4963,4964,4965,4966,4967,4968). In 1993, the US Food and Drug Administration (FDA) approved a health claim stating that consuming at least 3 grams of soluble fiber per day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of CHD (5792,5797,102336). However, some clinical research shows that at least 3.6 grams of soluble fiber daily is needed to reduce the risk of CHD (5788,5795).
• Hypercholesterolemia. Consuming barley 3-12 grams daily seems to reduce total cholesterol and low-density lipoprotein (LDL) cholesterol levels in adults with hypercholesterolemia. Details: Clinical research shows that taking barley significantly reduces total cholesterol and low-density lipoprotein (LDL) cholesterol when used with a normal diet or added to the National Cholesterol Education Program's Step I diet (11134,11986,17129,33734,33748,33752). A meta-analysis of 11 clinical trials shows that consuming preparations containing barley 3-12 grams daily for at least 4-12 weeks reduces total cholesterol and LDL cholesterol levels by around 12 mg/dL and 10 mg/dL, respectively, with no change in triglyceride or high-density lipoprotein (HDL) cholesterol levels. These changes did not appear to be dose-dependent (17129). However, a small clinical study in males with hypercholesterolemia shows that the effect of barley on cholesterol is modestly dose-dependent. Taking 0.4 grams, 3 grams, or 6 grams of soluble fiber from barley daily for 5 weeks reduces total cholesterol by 14%, 17%, and 20%, respectively, and reduces LDL cholesterol by 17%, 17%, and 24%, respectively, when compared to baseline (11986). The form of barley used may alter its effect on cholesterol levels. Some research has shown that barley highly enriched (75% by weight) with beta-glucans does not seem to significantly affect cholesterol. This lack of effect seems to be the result of processing the barley into a highly enriched beta-glucans product (10166). Food processing seems to affect beta-glucans structure or solubility and therefore decreases the cholesterol lowering effects of barley.

POSSIBLY INEFFECTIVE

• Colorectal cancer. Increased consumption of barley as a source of fiber does not appear to be beneficial for primary or secondary prevention of colorectal cancer. Details: Clinical and observational research shows that consuming dietary cereal fiber, including barley fiber, does not reduce the risk of colorectal cancer or prevent colorectal cancer recurrence (160,4819,4820,4821,5104).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Coronavirus disease 2019 (COVID-19). It is unclear if oral barley is beneficial in patients with COVID-19. Details: A small clinical study in Iranian adults hospitalized with moderate COVID-19 shows that drinking 250 mL of Persian barley water daily for 2 weeks, along with conventional treatment, decreases length of hospital stay, body temperature, and markers of inflammation when compared with conventional treatment alone. However, Persian barley water does not appear to improve oxygen saturation or symptoms of COVID-19 (111148). The validity of these findings is limited by a lack of placebo control and concerns related to the statistical methods used.
• Diabetes. Although there has been interest in using oral barley for diabetes, there is insufficient reliable information about the clinical effects of barley for this purpose.
• Diarrhea. Although there has been interest in using oral barley for diarrhea, there is insufficient reliable information about the clinical effects of barley for this purpose.
• Gastric cancer. It is unclear if oral barley is effective for the prevention of gastric cancer. Details: Observational research suggests that increased consumption of dietary fiber, a component of barley, is associated with 70% lower odds of gastric cancer when compared with low consumption of dietary fiber (10435).
• Gastritis. Although there has been interest in using oral barley for gastritis, there is insufficient reliable information about the clinical effects of barley for this purpose.
• Hypertension. Although there has been interest in using oral barley for hypertension, there is insufficient reliable information about the clinical effects of barley for this purpose.
• Obesity. Although there has been interest in using oral barley for obesity, there is insufficient reliable information about the clinical effects of barley for this purpose.
• Ulcerative colitis. Small clinical studies suggest that oral barley might improve symptoms associated with ulcerative colitis. Details: Several small, open-label trials in patients with ulcerative colitis show that consuming food containing germinated barley 20-30 grams daily for 4-24 weeks reduces symptoms of ulcerative colitis when compared to baseline (33725,33729,33732,33777). However, the validity of these findings is limited by a lack of comparator groups. Barley has also been studied in combination with other ingredients. A small clinical study in adults with mild to moderate ulcerative colitis shows that taking a specific nutritional supplement (Profermin, Nordisk Rebalance) containing barley malt flour, oat flour, Lactobacillus plantarum, and lecithin twice daily for 8 weeks decreases symptom scores by at least 50% in an additional 26% of patients when compared with a control nutritional supplement. Disease remission occurred in 31% of patients taking this product compared with 15% of patients in the control group (92818). It is unclear if these findings are due to barley, other ingredients, or the combination. More evidence is needed to rate barley for these uses.

(Read more about BARLEY)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Bronchiolitis. Preliminary clinical research suggests a combination of forsythia, honeysuckle, and Baikal skullcap given intravenously might decrease the duration of symptoms of bronchiolitis in children with respiratory syncytial virus infection (12613). More evidence is needed to rate forsythia for this use.

(Read more about FORSYTHIA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Angina. It is unclear if oral hawthorn is beneficial in patients with angina. Details: Preliminary clinical research in patients with angina taking chronic beta-adrenergic receptor blockers or ACE inhibitor therapy shows that taking a hawthorn (Crataegus pinnatifada) extract 100 mg orally three times daily for four weeks improves angina and electrocardiogram (ECG) findings and reduces nitroglycerin intake when compared with placebo (19242). Other preliminary clinical research in patients with unstable angina shows that taking hawthorn 10 grams and hu zang 15 grams orally daily for 4 weeks does not reduce the frequency of angina pectoris attacks when compared with control. However, taking hawthorn and hu zang improved some subjective symptom scores and quality of life scores (109610).
• Anxiety. Oral hawthorn has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A clinical study in adults with mild to moderate generalized anxiety shows that taking a specific product (Sympathyl, not available in the US) containing hawthorn, magnesium, and California poppy for 90 days modestly improves anxiety scores when compared with placebo (12583). Also, a clinical study in adults with adjustment disorder and anxious mood shows that hawthorn, in combination with black horehound, passion flower, valerian, kola nut, and guarana, modestly improves anxiety scores when compared with placebo (6250). It is unclear if these effects are due to hawthorn, other ingredients, or the combination. Another small clinical study in healthy adults shows that taking a combination of herbal extracts containing hawthorn, passionflower, ballota, and valerian root daily for 14 days reduces subjective anxiety and objective sympathetic and autonomic nervous system activation in response to a psychosocial stressor when compared with placebo (111222). It is unclear if these effects are due to hawthorn, other ingredients, or the combination.
• Arrhythmia. Although there has been interest in using oral hawthorn for arrhythmia, there is insufficient reliable information about the clinical effects of arrhythmia for this condition.
• Atherosclerosis. Although there has been interest in using oral hawthorn for atherosclerosis, there is insufficient reliable information about the clinical effects of arrhythmia for this condition.
• Cardiovascular disease (CVD). Although there has been interest in using oral hawthorn for CVD, there is insufficient reliable information about the clinical effects of arrhythmia for this condition.
• Cognitive function. Oral hawthorn has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: In a preliminary clinical trial, a single dose of 25 drops of a combination product of D-camphor and hawthorn berry extract (Korodin) was superior to placebo for increasing cognitive performance in elderly female patients as measured by visuomotor speed and information processing capacity. The active treatment group showed an improvement in attentional and mental performance (19240,91504).
• Congestive heart failure (CHF). The evidence on the effects of oral hawthorn in patients with CHF is conflicting. Although some older research suggests it may be beneficial, more recent, larger studies suggest it may actually increase the risk for complications. Details: There is contradictory evidence about the effects of hawthorn extract in heart failure patients. Several clinical studies show that taking specific hawthorn leaf and flower extracts (LI 132, Faros 300, Lichtwer Pharma; WS 1442, Crataegutt forte, Dr. Willmar Schwabe Pharmaceuticals; or HeartCare, Nature's Way) 240-600 mg daily improves ejection fraction and exercise tolerance, reduces subjective symptoms, and decreases the risk of death in patients with New York Heart Association (NYHA) stage II heart failure. In these studies, the maximum effect was usually seen after 6-12 weeks of treatment (8279,8280,11449,19221,19223,19225,19226,19227,19228). Another clinical trial shows that hawthorn extract (WS 1442, Crataegutt forte, Dr. Willmar Schwabe Pharmaceuticals or HeartCare, Nature's Way) 1800 mg daily, combined with diuretic therapy, improves exercise tolerance and reduces subjective symptoms in NYHA stage III heart failure. In this study, maximum effect was usually seen after 16 weeks of treatment (8281). In another trial, patients with NYHA II heart failure taking either hawthorn (LI 132, Faros) 300 mg three times daily or captopril 12.5 mg three times daily experienced similar improvements in cardiac performance and symptoms (19230). However, other clinical research suggests no benefit and possible harm with hawthorn. A large-scale clinical trial (SPICE) in patients with NYHA stage II or III heart failure shows that taking specific hawthorn extracts (WS 1442, Crataegutt forte, Dr. Willmar Schwabe Pharmaceuticals; HeartCare, Nature's Way) 900 mg daily for 24 months, in combination with conventional treatment, does not decrease hospitalization due to progressive heart failure, non-fatal myocardial infarction, or cardiac death (17203). Another clinical trial in patients with NYHA stage II or III heart failure shows that taking these same specific hawthorn extracts at the same dose for up to 6 months does not slow the progression of heart failure when compared with placebo (19222). In a retrospective analysis of this study, it was shown that heart failure progression was significantly increased in patients taking hawthorn when compared with placebo. The rate of death was also increased by 1.7% over placebo, and heart failure-related hospitalizations increased by 8% over placebo in patients treated with hawthorn (16824).
• Hyperlipidemia. Although there has been interest in using oral hawthorn for hyperlipidemia, there is insufficient reliable information about the clinical effects of arrhythmia for this condition.
• Hypertension. It is unclear if oral hawthorn is beneficial for lowering blood pressure. Details: One preliminary clinical trial showed that taking hawthorn standardized extract 1,000-2,500 mg daily for three days does not significantly reduce blood pressure in hypertensive or prehypertensive patients when compared with placebo (19244). However, another study in patients with diabetes and hypertension shows that taking a specific hawthorn extract (LI 132) 1,200mg daily for 16 weeks significantly decreased diastolic, but not systolic, blood pressure when compared with placebo (19245).
• Orthostatic hypotension. Oral hawthorn has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in older adults with orthostatic hypotension shows that taking a specific combination product containing hawthorn and camphor (Korodin Herz-Kreislauf-Tropfen) 25 drops orally three times daily for 7 days attenuates the blood pressure reduction upon standing when compared with placebo. Signs and symptoms of orthostatic hypotension such as dizziness, blurry vision, and falls also seem to be reduced when compared with baseline (39614,39617). A meta-analysis of 4 studies shows that giving single doses of 20-25 drops of the same combination product increases systolic and diastolic blood pressure when compared with placebo (103620). However, the studies have methodologic problems and, while 2 were conducted in females with orthostatic hypotension, the others involved health young adults or normotensive elderly subjects. The effect of hawthorn alone for treatment of orthostatic hypotension has not been determined. The combination product used in these studies is not available in the US. More evidence is needed to rate hawthorn for these uses.

(Read more about HAWTHORN)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Insomnia. A meta-analysis in adults with insomnia shows that taking traditional Chinese medicines that contain Pinellia ternata improves the total effective rate for the treatment of insomnia by 23% when compared with conventional Western medicines (106544). It is unclear if these effects are due to Pinellia ternata, other ingredients, or the combination. Poor methodology in some of the included studies and publication bias limit the validity of these findings. More evidence is needed to rate Pinellia ternata for this use.

(Read more about PINELLIA TERNATA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Cancer. Although there is interest in using oral poria mushroom for cancer, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
• Chronic fatigue syndrome (CFS). Although there is interest in using oral poria mushroom for CFS, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
• Chronic kidney disease (CKD). Although there is interest in using oral poria mushroom for CKD, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
• Coronavirus disease 2019 (COVID-19). Although there has been interest in using oral poria mushroom for COVID-19, there is insufficient reliable information about the clinical effects of poria mushroom for this purpose.
• Dementia. Although there is interest in using oral poria mushroom for dementia, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
• Diabetes. Oral poria mushroom has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A meta-analysis of generally small clinical trials in patients with type 2 diabetes shows that taking Chinese herbal medicine combinations containing poria mushroom for 2-24 weeks along with hypoglycemic medications modestly reduces fasting blood glucose and glycated hemoglobin levels when compared with control groups taking hypoglycemic agents only. There were also modest improvements in levels of triglycerides and low-density lipoprotein (LDL) cholesterol and in insulin sensitivity (111920). Given the large number of other ingredients in the available formulations, it is unclear if any beneficial effects are related to poria mushroom, other ingredients in the formulation, or their combination.
• Diarrhea. Although there is interest in using oral poria mushroom for diarrhea, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
• Endometriosis. Although there is interest in using oral poria mushroom for endometriosis, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
• Influenza. Oral poria mushroom has only been evaluated for influenza vaccine enhancement in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in healthy adults shows that taking a product containing poria mushroom extract, rosemary extract, and aloe gel powder twice daily for 28 days prior to and following an influenza vaccination does not affect upper respiratory tract illness symptoms, severity, duration, or medication-related use when compared with taking placebo (111921). It is unclear if this study was large enough to detect differences between groups. Also, the effect of poria mushroom itself on influenza vaccine enhancement is unclear.
• Tinnitus. Although there is interest in using oral poria mushroom for tinnitus, there is insufficient reliable information about the clinical effects of poria mushroom for this condition.
• Urinary tract infections (UTIs). Although there is interest in using oral poria mushroom for UTIs, there is insufficient reliable information about the clinical effects of poria mushroom for this use. More evidence is needed to rate poria mushroom for these uses.

(Read more about PORIA MUSHROOM)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Biliary disorders. Although there has been interest in using oral radish for biliary disorders, there is insufficient reliable information about the clinical effects of radish for this purpose.
• Diabetes. Although there has been interest in using oral radish for diabetes, there is insufficient reliable information about the clinical effects of radish for this purpose. More evidence is needed to rate radish for these uses.

(Read more about RADISH)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Cancer. Observational research has found that daily intake of oranges and/or tangerines is associated with a reduced odds of developing nasopharyngeal carcinoma when compared with consuming oranges and/or tangerines less than once a week (28608). More evidence is needed to rate tangerine for this use.

(Read more about TANGERINE)

LIKELY SAFE ...when used orally and appropriately in food amounts (4819,4820,4821,5104,10166,10435,11134,11463,11986,92818). There is insufficient reliable information available about the safety of barley when used orally in medicinal amounts or when applied topically.

PREGNANCY: LIKELY SAFE
when used orally in amounts commonly found in foods (19).

PREGNANCY: POSSIBLY UNSAFE
when barley sprouts are consumed in relatively high doses. Excessive amounts of barley sprouts should not be consumed during pregnancy (19).

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about BARLEY)

POSSIBLY SAFE ...when used orally and appropriately, short-term. Hawthorn preparations in doses of up to 1800 mg daily seem to be safe when used for up to 16 weeks. Although hawthorn might be safe for long-term use, current studies have not evaluated safety past 16 weeks (8279,8280,8281,10144,17203,104689). There is insufficient reliable information available about the safety of hawthorn when used topically.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about HAWTHORN)

POSSIBLY UNSAFE ...when used orally. Pinellia ternata contains ephedrine alkaloids and is banned in the US (12147). There is no reliable evidence available about the safety of Pinellia ternata in humans. Because it contains ephedrine alkaloids, it is likely that Pinellia ternata might potentially cause the adverse effects reported with ephedra, including heart attack, stroke, seizure, and other serious side effects.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about PINELLIA TERNATA)

There is insufficient reliable information available about the safety of poria mushroom.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about PORIA MUSHROOM)

LIKELY SAFE ...when used orally in moderate amounts (18). Large amounts may lead to gastrointestinal irritation (18).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid very large doses.

(Read more about RADISH)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Tangerine has Generally Recognized as Safe (GRAS) status in the US (4912). There is insufficient reliable information available about the safety of tangerine when used orally or topically as a medicine.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about TANGERINE)

TRICLABENDAZOLE (Egaten) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, barley might decrease the clinical effects of triclabendazole.  Details Animal research suggests that a diet supplemented with barley can reduce the bioavailability of triclabendazole when taken concomitantly (23884). This effect has not been shown in humans.

(Read more about BARLEY)

(Read more about FORSYTHIA)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, hawthorn may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.  Details In vitro and animal research shows that hawthorn can inhibit platelet aggregation (95528,95529,95530,95531). However, its effect in humans is unclear. One observational study shows that patients taking hawthorn shortly before undergoing coronary artery bypass graft (CABG) surgery or valve replacement surgery have a 10% incidence of postoperative bleeding, compared with 1% in those who never consumed hawthorn extract (95527). However, clinical research shows that taking a specific preparation of dried hawthorn leaves and flowers (Crataesor, Soria Natural Lab) 800 mg three times daily for 15 days does not affect platelet aggregation or levels of thromboxane B2, the metabolite of thromboxane A2, in healthy humans (54664).

BETA-BLOCKERS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use might cause additive effects on blood pressure and heart rate.  Details Some evidence shows that hawthorn might lower blood pressure and heart rate (12595,19245).

CALCIUM CHANNEL BLOCKERS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use might cause additive coronary vasodilation and hypotensive effects.  Details Some evidence shows that hawthorn might lower blood pressure due to vasodilatory effects (12595,19245).

DIGOXIN (Lanoxin) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, hawthorn might potentiate the effects and adverse effects of digoxin.  Details Hawthorn appears to improve cardiac output (12595); however, hawthorn does not appear to affect digoxin pharmacokinetics (19249).

NITRATES Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Probable •  Level of Evidence = D Theoretically, concomitant use might cause additive coronary vasodilatory effects.  Details Some evidence shows that hawthorn might lower blood pressure due to vasodilatory effects (12595,19245).

PHOSPHODIESTERASE-5 INHIBITORS Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Probable •  Level of Evidence = D Theoretically, concomitant use might result in additive vasodilation and hypotension.  Details Hawthorn might inhibit PDE-5 and cause vasodilation (12595).

(Read more about HAWTHORN)

(Read more about PINELLIA TERNATA)

ANTICHOLINERGIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, poria mushroom might decrease the clinical effects of anticholinergic drugs.  Details In animal research, poria mushroom essential oil reduces acetylcholinesterase activity (111917). This interaction has not been shown in humans.

CHOLINERGIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, poria mushroom might have additive effects when used with cholinergic drugs.  Details In animal research, poria mushroom essential oil reduces acetylcholinesterase activity (111917). This interaction has not been shown in humans.

CNS DEPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking poria mushroom extract may enhance the therapeutic and adverse effects of sedatives.  Details Animal research shows that poria mushroom extract has sedative properties (111916). This interaction has not been shown in humans.

(Read more about PORIA MUSHROOM)

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, radish might increase the risk of hypoglycemia when taken with antidiabetes drugs.  Details Animal research shows that radish extract, juice, and sprouts can reduce glucose levels (96960). Animal research also shows that radish root juice 300 mg/kg reduces fasting and postprandial blood glucose in a rat model of diabetes, with effects similar to glibenclamide (98051).

(Read more about RADISH)

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Unlikely •  Level of Evidence = B In vitro, tangeretin, a constituent of tangerine, induces a 52% increase in the metabolism of midazolam by cytochrome P450 3A4 (CYP3A4) (28609). This suggests that tangeretin may stimulate CYP3A4 activity. However, in humans, drinking tangerine juice 200 mL slightly delayed the absorption, but did not affect the metabolism, of midazolam, a CYP3A4 substrate (28609). Theoretically, tangerine juice might increase CYP3A4 activity and decrease levels of drugs metabolized by this enzyme. However, this effect is unlikely.  Details Some drugs metabolized by CYP3A4 include amitriptyline (Elavil), amiodarone (Cordarone), citalopram (Celexa), felodipine (Plendil), lansoprazole (Prevacid), ondansetron (Zofran), prednisone (Deltasone, Orasone), sertraline (Zoloft), sibutramine (Meridia), and many others.

(Read more about TANGERINE)

General ...Orally, barley is well tolerated.
Most Common Adverse Effects:
Orally: Abdominal distension, bloating, flatulence, unpleasant taste. Allergic reactions in sensitive individuals.
Topically: Allergic reactions in sensitive individuals.

Dermatologic ...Topically, barley malt contained in beer has been reported to cause contact dermatitis (33762). After occupational exposure, barley has been reported to cause contact dermatitis of the eyelids and extremities, as well as contact urticaria (33735,33770,33774).

Gastrointestinal ...When consumed orally, barley provides fiber. Increasing fiber in the diet can cause flatulence, bloating, abdominal distention, and unpleasant taste. To minimize side effects, doses should be slowly titrated to the desired level. Adverse effects usually subside with continued use (12514).
Barley contains gluten. In patients with biopsy-proven celiac disease, consuming barley can cause gastrointestinal upset and impairment of xylose excretion (33763,33772).

Immunologic ...Orally, consumption of beer has been reported to cause allergic reactions in sensitive individuals (33722,33724). Symptoms included tingling in the face, lip, and tongue, angioedema, generalized urticaria, chest tightness, dyspnea, cough, fainting, and rhinoconjunctivitis. It can also cause anaphylaxis in sensitive individuals (317). Topically and with occupational exposure, barley has been reported to cause contact dermatitis and rash (33762,33735,33770,33774).
"Bakers' asthma" is an allergic response resulting from the inhalation of cereal flours by workers in the baking and milling industries, and has been reported to occur after barley flour exposure (1300,33756,33760). Cross-allergenicity has been shown to exist between different cereals (33758).

Pulmonary/Respiratory ..."Bakers' asthma" is an allergic response resulting from the inhalation of cereal flours by workers in the baking and milling industries, and has been reported to occur after barley flour exposure (1300,33756,33760). Cross-allergenicity has been shown to exist between different cereals (33758).
By inhalation, barley flours may be a source of allergens in asthma (33764,33773). Inhalation of wild barley grass pollen may result in bronchial irritation or pneumonitis (33726,33755).

(Read more about BARLEY)

General ...Adverse effects of forsythia have not been reported. However, a thorough evaluation of safety outcomes has not been conducted.

(Read more about FORSYTHIA)

General ...Orally, hawthorn seems to be well tolerated when used appropriately. Topically, no adverse effects have been reported, although a thorough evaluation of safety outcomes has not been conducted.
Serious Adverse Effects (Rare):
Orally: Multiorgan hypersensitivity reactions resulting in acute renal failure have been reported rarely.

Cardiovascular ...Orally, tachycardia (with facial pains) of uncertain relationship to hawthorn was reported in a multicenter clinical trial (54640). Palpitations (19244) were reported in three patients in a large surveillance trial of 3,664 patients with cardiac failure (54692) and in 11 patients with congestive heart failure (CHF) in a literature review of 5,577 patients (19247). Circulation failure has been reported in two patients with CHF in a literature review of 5,577 patients (19247). Incidences of hospitalization, hospitalization due to CHF, worsening of CHF, angina, and atrial fibrillation have also been reported with the use of hawthorn extract WS 1442 (Crataegutt forte), although it is unclear if these events are related to hawthorn supplementation or existing CHF (19222). In clinical trials, chest pain (8281), short-term increases in blood pressure (19240), and other non-specific heart problems (17203) have also been reported following the use of various hawthorn preparations (e.g. WS 1442, Korodin).

Dermatologic ...Orally, erythematous rash has been reported in patients with CHF in a literature review of 5,577 patients (19247). Non-specific rashes and itching (19222,19243) as well as toxiderma from the fruits of hawthorn (54670) have also been reported.

Gastrointestinal ...Orally, rare abdominal discomfort of uncertain relationship to hawthorn has been reported in a large clinical trial, surveillance study, and a literature review (19247,54640,54692). Digestive intolerance (19241), diarrhea (19243), flatulence (8281), gastroenteritis (8281), increased bowel movements (19243), obstipation (8281), mild and rare nausea (10144,19247,19244), nutritional and metabolic problems (17203), and other non-specific gastrointestinal effects (19222), have also been reported. Furthermore, gastrointestinal hemorrhage has been reported in two patients with CHF in a literature review of 5,577 patients (19247).

Musculoskeletal ...In clinical trials, arthritis (8281), back pain (8281), weakness (19243), and other non-specific musculoskeletal effects (19222) have been reported following the use of various hawthorn preparations g. WS 1442, CKBM-A01).

Neurologic/CNS ...Orally, headache and dizziness/vertigo were reported in two patients in a large surveillance trial of 3,664 patients with cardiac failure (54692), in 15 patients with CHF as reported in a literature review of 5,577 patients (19247), and in a varying number of clinical trial participants (8281,19222,19244). Incidences of fainting (19222), fever (17203), and infrequent, mild and transient sleepiness have also been reported (19221,54692).

Psychiatric ...Orally, agitation was reported in a large surveillance trial of 3,664 patients with cardiac failure (54692).

Pulmonary/Respiratory ...Orally, bronchitis has been reported following the use of hawthorn extract WS 1442 (8281).

Renal ...A case of multiorgan hypersensitivity reaction and acute renal failure following the consumption of C. orientalis has been reported (54654).

Other ...Flu-like syndrome (8281) and other non-specific infections have been reported following the use of the hawthorn extract WS 1442 (17203,19222). Hawthorn has also been reported to cause nosebleeds (8281,10144).

(Read more about HAWTHORN)

General ...Orally, raw Pinellia ternata tuber can cause severe gastrointestinal irritation. Pinellia ternata is banned from use in dietary supplements in the US due to its ephedrine content. Ephedrine can cause serious cardiovascular and neurologic side effects (12147,98007).

Cardiovascular ...Pinellia ternata contains ephedrine alkaloids, which may potentially cause hypertension, tachycardia, and heart attack when used orally (12147).

Gastrointestinal ...Orally, raw, unprocessed Pinellia ternata tuber can cause severe irritation of the mouth, throat and gastrointestinal tract due to the presence of needle-like crystals of calcium oxalate (98007).

Neurologic/CNS ...Pinellia ternata contains ephedrine alkaloids, which may potentially cause stroke and seizures when used orally (12147).

Pulmonary/Respiratory ...If Pinellia ternata preparations are inhaled they can cause IgE-mediated occupational asthma (12145).

(Read more about PINELLIA TERNATA)

General ...Orally, poria mushroom seems to be well tolerated. However, a thorough evaluation of safety outcomes has not been conducted.

Immunologic ...Allergic reactions have been reported rarely, including allergic rhinitis and allergic asthma (12).

(Read more about PORIA MUSHROOM)

General ...Orally, radish seems to be well tolerated when used in moderate amounts.

Gastrointestinal ...Large amounts of radish may cause irritation of the gastrointestinal mucus membrane (18). Mild indigestion has also been associated with use of a specific product containing radish, camu camu, acerola, honey, and tapioca in clinical research. However, it is unclear if this adverse event is due to radish, other ingredients in the product, or the combination (94290).

Immunologic ...A case of allergy to oral intake of radish has been reported. Symptoms included throat tightness and generalized urticaria (94289).

(Read more about RADISH)

General ...Orally, very few adverse effects have been reported with the medicinal use of tangerine. However, a thorough evaluation of safety outcomes has not been conducted.
Topically, contact dermatitis has been associated with tangerine essential oil (28610).

Dermatologic ...According to one case report, the essential oil of tangerine in a fragrance has been associated with contact dermatitis (28610).

Gastrointestinal ...In a case report, a 5 year-old patient had a phytobezoar that included tangerine residues (28611). In another case report, orange and tangerine caused obstruction of the small intestine (28612).

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