title: How do government regulations influence the ability to practice Chinese herbal medicine in western countries.
abstract: BACKGROUND
  The regulation policies of substances used in Chinese Herbal Medicine (CHM), have a direct influence on the ability of health providers to practice in the clinic.
  
  
  OBJECTIVE
  We set out to assess the truth behind the assumption that practice of CHM in the west is constrained by the regulations imposed by authorities in western countries.
  
  
  METHODS
  For the first part of our study we surveyed and compiled lists of banned and restricted Chinese Materia Medica (CMM) from six countries: USA, UK, Germany, Israel, Canada and Australia. Afterwards, we estimated the relevant importance of the 300 CMM most-commonly-prescribed to the practice of CHM according to prescriptions from 2,000,000 randomly selected patients, from the Taiwanese National Health Insurance Research Database (NHIRD). We then compared both lists and determined the clinical importance of the banned and restricted CMM.
  
  
  RESULTS
  Except for regulations from Canada, most of the information of banned CMM proved to be difficult to organize. The USA was found to have the least amount of banned herbs, with 9 substances. Canada had the highest amount, with 98. In Germany, Australia, the UK, and Israel 10, 29, 36, 68 banned CMM were found, respectively. Apart from aristolochic acid containing substances, ma huang (, Ephedra sinica) was the only CMM banned in all countries. Most of the banned CMM were not found to be among the most-commonly-prescribed according to the NHIRD.
  
  
  CONCLUSIONS
  Authorities should make this information more accessible. No clear relation exists between CHM regulations and any 'Western' common denominator, and the amount of banned CMM varied greatly among the surveyed countries. However, even among countries with a larger amount of banned CMM, the majority of these were in the bottom two-thirds in respect to the frequency of their use. Thus, regulations in some western countries surely influence the practice of CHM, however, the variability of CMM have been influenced by regulations only to a limited extent.
authors.affiliation: Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan.
authors.forename: Tom
authors.initials: T
authors.lastname: Fleischer
authors.affiliation: Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan.
authors.forename: Yi-Chang
authors.initials: YC
authors.lastname: Su
authors.affiliation: Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; Department of Chinese Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.
authors.forename: Sunny Jui-Shan
authors.initials: SJ
authors.lastname: Lin
mesh_terms: D001315:Australia; D005060:Europe; D033161:Government Regulation; D006801:Humans; D007557:Israel; D007880:Legislation, Drug; D008516:Medicine, Chinese Traditional / Q000706:statistics & numerical data*; D009656:North America; D008517:Phytotherapy / Q000706:statistics & numerical data*; D013624:Taiwan
keywords: Chinese herbal medicine; Commonly used Chinese herbs; Global regulation policies; National Health Insurance Research Database; Restricted herbs; Taiwan