I recently had an email exchange with Dr Subhuti Dharmananda from the Institute for Traditional Chinese Medicine in Portland Oregon about the topic of ‘performance enhancing’ herbs. The conversation was inspired by one of our practitioners who is treating athletes in her clinic.

I did some research and found the Australian Sports Anti-Doping Authority:  https://www.asada.gov.au/substances

On their website, you will find a list of common ingredients banned in sport and hence supplement ingredients that have come to ASADA’s attention through failed tests.

They include:

Prohibited substance Other known names WADA Prohibited List category
Higenamine Demethylcoclaurine/Norcoclaurine Tinospora crispa
Nandina domestica 
Nelumbo Nucifera
Argemone Mexicana 
Magnolia salicifolia 
Coptis japonica 
Aconitum japonicum
Gnetum Parvifolium
Asarum hetertropoides Aconitum carmichaelii
Galium divaricatum
Annona squamosa
S3: Beta 2 Agonist
1,3-dimethylbutylamine DMBA 1,3-dimethylbutylamine Amperall AMP Citrate Butylamine, 1,3-dimethyl- 2-amino-4-methylpentane 2-Pentanamine 4-methyl-, 4-methylpentan-2-amine S6: Stimulant
Octodrine Kigelia africiana (extract)
J. Regia (Extract) or Juglans Regia (Extract)
1,5-Dimethylhexylamine
2-Isooctyl amine
2-Methyl-6-aminoheptane
6-Amino-2-methylheptane 6-Methyl-2-heptanamine
a,e-Dimethylhexylamine
Amidrine
Dimethylhexylamine
Isoctaminum
Octodrin
Vaporpac
S6: Stimulant

This table heading ‘other known names’ might be misleading as it’s to broad and potentially inaccurate. If someone says “orange” (referring to the fruit), someone will say: that’s vitamin C, right?”  No, an orange isn’t vitamin C.  Ascorbic acid is another name for vitamin C, but orange isn’t. We are only mentioning this because the table is the official compilation from ASADA (Australian Sports Anti-Doping Authority).

It’s also worth noting that Xi Xin (Asarum) is a restricted herb in Australia due to its connection with Aristolochic acid, a potential renal toxin.

As you can see there are three categories of substances that are banned:

  • Higenamine

Higename is a chemical that works as a stimulant and seems to increase heart contractions and heart rate. It’s found in several plants, including aconite. There are also species on that first list that we use in Chinese medicine such as: Nelumbo (Lian Zi, Ou Jie, He Ye), Magnolia (Hou Po, Xin Yi Hua),  Aconite (Fu Zi), Coptis/Coptidis (Huang Lian) and Asarum (Xi Xin). .  The primary pressure on herbs (including animal materials used in TCM) that are found in the wild is habitat destruction that is usually due to encroaching human population. 

  • 1,3-dimethylbutylamine (DMBA)

DMBA is a synthetic stimulant and apparently was never tested in humans. Nevertheless, it was found in supplements (https://www.ncbi.nlm.nih.gov/pubmed/25293509). Please note that DMBA is not found in natural products such as herbs.

  • Octodrine

Octodrine is the trade name for Dimethylhexylamine (DMHA), a central nervous stimulant that increases the uptake of dopamine and noradrenaline (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836053/). Octodrine is mentioned in only two herbs; Kigelia which is not involved with Chinese herbalism, and Juglans (walnut) which should refer to the bark; the actual nut should be safe and is the part also (rarely) in Chinese herbalism. 

In summary and in focusing on Chinese herbs, the number of herbs is small, and the number of Chinese herbs is even smaller when considering that higenamine can cause potentially undesired effects in athletes. The quantities of higenamine likely to be consumed with Chinese herbs in formulas is trivial. When treating athletes with supplement, keep in mind that the only way to have zero risk is to use zero supplements. Athletes who choose to use dietary supplements do so at their own risk.

If you are a registered Chinese medicine practitioner or Acupuncturist in Australia, it’s important to check the database global database for substances that might be banned. The online tool, Global DRO as to check thousands of ingredients and their status in sport, including individual ingredients listed on supplement labels.

It maybe important to note that substances that we use in Chinese medicine that are a qi, a yang or a blood tonic are not necessarily deemed performance enhancing as know in sports, but given as part of treatment to counteract a disharmony pattern, they might be ‘system enhancing’ meaning that they might make the person/patient feeling a lot better and hence having more energy, inspiration or stamina. This doesn’t necessarily mean that they are banned substances.

None of the herbs used in normal Chinese medicine practice have anything to do with performance.  In order to direct them at performance enhancement, we would have to product an extract rich in the “desired” ingredient and make a supplement that is not related to Chinese medicine but to using chemical constituents. 

My conversation with Dr Dharmananda brought one point back home that I always come to realise again and that is, if a pattern is corrected with the right formula, the patient improves significantly, especially, if the imbalance is severe. But this doesn’t mean that ‘doping’ has taken place.

In our exchange, we talked about other herbs that have in recent years attracted attention to act as performance enhancing in the physical sense. At least one of them has been taken away from Chinese medicine practitioners and in Australia is only available in ‘limited amounts’ to medical practitioners, pharmacists or veterinary practitioners. The herb, I am talking about is Ma Huang (Ephedra).

There are several single herbs that have been used to enhance physical performance in the past, but none were thoroughly investigated by human trials. The strength of Chinese herbal medicines lies in the synergy of a formula to treat a pattern and not a symptom. The following herbs are only listed as a point to bring that message home.  

Ginseng (Ren Shen) does not show in the DRO (Drug Reference Online) database, even though from a Chinese medicine perspective, it could be considered as enhancer due to its properties:  The sweet flavor and slightly cold nature supplements qi and fluids. Its not listed, because there is no evidence of an effect on a particular type of activity. In other words, there is no chemical composition that leads to Ren Shen being at risk for performance enhancing activities (and it does also not have any of the ingredients in the table listed above). 

Tribulus (Bai Ji Li) is found in the category of substances that extinguish wind and stop tremors. In the past, it has been as herbal supplement to produce body strength and lean muscle mass due to it’s …. A study showed that it neither produced the large increase of mass nor a positive test according to the World’s Doping agency requirements with the dosage administered with the study (https://www.ncbi.nlm.nih.gov/pubmed/17530942). As with active ingredients, there must be enough extracted for the desired action and in the case of Bai Ji Li, it would be the substance of steroidal saponins.

Epimedium (Yin Yang Huo) is supposed to be used as a kidney yang tonic. It’s warming and has an acrid and sweet flavor. The sweet flavour takes care of the replenishing, the supplementing and the acrid flavour can transform cold and dampness, so it can be expelled through urination. 

Cordyceps (Dong Chong Xia Cao) has similar properties to Yin Yang Huo – it’s warming and has a sweet flavour. It also is part of the yang tonifying classification of Chinese herbs. There is pressure on herbs (including animal materials used in Chinese medicine) that are found or collected in the wild. In the spirit of sustainability and the longevity of Chinese herbalism, we have to act responsibly. We will dive into this topic with a separate essay.

I am sure that there are other herbs potentially qualifying as performance enhancing but really what does that mean? In my opinion, it means that addressing the disharmony with the application of the correct Chinese herbal formula, the physical system is optimized and performance improved which would be the best outcome for any patient.

Other references:

https://www.asada.gov.au/substances/supplements-sport

eMail correspondance with Dr Subhuti Dharmananda  from ITM http://www.itmonline.org/