Clinical uses and Toxicity of Ephedra sinica: An Evidence-Based Comprehensive Retrospective Review (2004-2017)

Background: Ephedra sinica (ES) (Ma-huang) is a well-known plant due to its widespread therapeutic uses. However, many adverse effects such as hepatitis, nephritises, and cardiovascular toxicity have been reported for this plant. Few of these side effects are reversible whereas others are irreversible and may even lead to death. Aim of the Study: The aim of this study was to investigate the clinical uses and toxicity cases/consequences associated with the use of ES. The review will compare and evaluate the cases reported for ES and identify the causes which make the plant a poisonous one. Materials and Methods: An extensive literature review was conducted from 2004 to 2017, and research literature regarding the clinical cases were collected using databases and books such as Google Scholar, Science Direct, Research gate, PubMed, and Web of Science/Thomson Reuters whereas the keywords searched were “Ephedra sinica,” clinical cases of Ephedra sinica, “Ma-hung poisonous,” “Ma-hung toxicity reported cases and treatment,” and “Ephedra Sinica toxicity reported cases and treatment.” Results: eleven different cases were identified which met the eligibility criteria and were studied in detail to extract out the findings. It turned out that most of the patients and participants developed adverse side effects following the use of ES, and after a proper course of treatment or trail, some of the side effects were reversible, whereas others were found irreversible. The most common adverse effects and toxicity observed in patients were liver problems, renal failures, and cardiac toxicity which resulted in two mortalities whereas the other two got recovered. On an in-depth study, it was revealed that most of the toxicities in such cases were associated with the use of ES in combination with other conventional drugs, long-term use, or use in patients with cardiac and renal problems without a medical supervision. Conclusion: Hence, it is concluded that ES may have reversible as well as irreversible adverse effects and may even result in death; however, the use of a plant with the proper knowledge and under sound medical supervision may reduce such exaggerations