Pinyin: Kun Bu  Chinese: 昆布
Pharmaceutical: Thallus Eckloniae seu Saccharinae
Taxonomy: Ecklonia kurome seu Saccharina spp.
English: Konbu / Kelp

Tastes: Salty, cold
Meridians Entered: Liver, Stomach and Kidney

Actions & Indications:

1. Resolves Phlegm and softens Phlegm nodules (areas of hardness)
   Phlegm Nodules in the neck (scrofula, goiter, sensation of fullness and obstruction in the chest)
   Thyroid tumors, tuberculosis, lymphadenitis, cirrhosis – with Blood movers
   Dysphagia
2. Promotes urination and reduces swelling
   Adjunct for oedema, fistula and Leg Qi

Standard Dosage: 6-12g in decoction.
Cautions: Although known for its use in iodine deficiency goiters, Miyai et al (2008) suggested that excessive iodine from seaweed consumption may actually suppress thyroid function.

Pinyin: Huang Bai  Chinese: 黄柏
Pharmaceutical: Cortex Phellodendri
Taxonomy: Phellodendron amurense seu chinense
English: Amur Corktree Bark

Tastes: Bitter, cold
Meridians Entered: Liver, Gallbladder, Large Intestine, Kidney and Bladder

Actions & Indications:

1. Drains Damp-Heat especially from the Lower Jiao
   Thick, yellow vaginal discharge, foul smelling diarrhoea or dysenteric disorder
   Damp-Heat in the Lower Jiao
   Hot Leg Qi with red, swollen, painful knees, legs or feet
   Damp-Heat jaundice
2. Drains Kidney Fire (False Heat, Deficiency Heat)
   Kidney Yin Deficiency with Empty Fire Rising (steaming bone disorder, night sweats, afternoon fevers and sweating, occasionally with nocturnal emissions and spermatorrhea)
3. Drains Fire and relieves Fire toxicity
   Toxic sores and Damp-skin lesions (internally and topically)

Standard Dosage: 6-10g in decoction.
Cautions: It is contraindicated for deficiency-cold syndrome. Overdosage and long-time taking will impair spleen and stomach.

Pinyin: Zhi Mu  Chinese: 知母
Pharmaceutical: Rhizoma Anemarrhenae
Taxonomy: Anemarrhena asphodeloides
English: Anemarrhena Rhizome

Tastes: Bitter, sweet, cold
Meridians Entered: Lung, Stomach and Kidney

Actions & Indications:

1. Clears Heat and drains Fire (Clears Heat from the Qi Stage, from the Lungs and from the Stomach)
   Heat in the Qi Stage with high fever, irritability, restlessness, thirst and a rapid, flooding pulse.
   Lung Heat and Dryness with cough and expectoration of thick, yellow Phlegm
   Yang Ming Heat
   Stomach Heat
2. Nourishes Yin and moistens Dryness
   Lung and Kidney Yin Deficiency with night sweats, steaming bone disorder, irritability, afternoon or low grade fever, Five Sole Heat and bleeding gums
   (Stomach Yin Deficiency)
   Kidney Heat with spermatorrhea, nocturnal emissions and an abnormally elevated sex drive
3. Generates Fluids, clears Deficiency Fire and quenches thirst
   Oral ulcers and inflammation, steaming bones and Xiao Ke (diabetes) due to Yin Deficiency
4. Ameliorates the Dryness of tonifying or warming herbs
   For use with herbs such as Rx. Astragali Huang Qi, Ram. Cinnamomi Gui Zhi, Rx. Aconiti Lateralis Preparata Zhi Fu Zi when there is concern that these herbs may be too drying

Standard Dosage: 5-15g in decoction.
Cautions: It is not suitable for deficiency cold syndrome. Being cold and moist in property, it is prohibited to be used for those who have a spleen-deficiency diarrhea.

Pinyin: Tian Hua Fen  Chinese: 天花粉
Pharmaceutical: Radix Trichosanthis
English: Snakegourd Root

Tastes: Sweet, slightly bitter and slightly cold
Meridians Entered: Lung and Stomach

Actions & Indications:

1. Drains Heat and generates Fluids
   Lung Heat and Dryness with thirst and irritability
   Yin Deficiency thirst
   Wasting and thirsting disorder (Xiao Ke)
   Thick sputum, blood streaked sputum
2. Clears and drains Lung Heat, transforms Phlegm and moistens Lung Dryness
   Phlegm Heat above the diaphragm, especially when the Heat has led to Dryness
3. Relieves toxicity, expels pus and reduces swelling
   Chuang Yung (especially breast abscesses - internal and topical)

Standard Dosage: 10-15g in decoction.

Pinyin: Jie Geng  Chinese: 桔梗
Pharmaceutical: Radix Platycodi
English: Balloon Flower Root

Tastes: Bitter, pungent, neutral
Meridians Entered: Lung

Actions & Indications:

1. Opens the Lungs, spreads Lung Qi, expels Phlegm and benefits the throat
   Cough due to Wind-Cold or Wind-Heat (with profuse sputum, sore throat, loss of voice)
   Loss of voice or sore throat due to external Heat, Phlegm Heat or Yin Deficiency Heat
2. Expels pus
   Lung or throat abscess (Phlegm and Qi Stagnation) with fevers, chest pain, coughing of yellow sputum with a fishy smell and hemoptysis
3. Opens and raises Lung Qi, directing the effects of other herbs to the upper body
   Reinforces the actions of the other herbs and focuses the formula on the upper body
4. Expels Gu Toxins
   Vomiting blood due to Gu-Toxins (with Gan Cao; in the Soushen Ji, Record of Searching for Spirits; Wilcox, 2024).

Standard Dosage: 3-10g in decoction.
Cautions: Overdose can cause nausea and vomiting.

Pinyin: San Leng  Chinese: 三棱
Pharmaceutical: Rhizoma Sparganii
Taxonomy: Sparganium stoloniferum
English: Burr-Reed Rhizome

Tastes: Pungent, bitter, neutral
Meridians Entered: Liver and Spleen

Actions & Indications:

1. Forcefully breaks up Blood Stasis, regulates Qi and alleviates pain
   Blood Stasis with amenorrhea, dysmenorrhea, postpartum abdominal pain and abdominal masses
2. Dissolves accumulations
   Food Stagnation and Qi Stagnation with severe abdominal pain and distention
3. Regulates menstruation
   Menstrual irregularities
4. Promotes lactation
   Agalactia
5. Suppresses Gu parasites
   Gu Syndrome with Blood Stasis (Fruehauf, 1998)
   Chronic inflammatory disease (Fruehauf, 2015)

Standard Dosage: 3-10g in decoction.
Cautions: Same as E Zhu. This herb is drastic in property with the disadvantage of consuming qi and impairing blood. Do not overtake long. Prohibited for pregnant women and during menstrual periods.

Pinyin: E Zhu  Chinese: 莪朮
Pharmaceutical: Rhizoma Curcumae zedoariae
Taxonomy: Curcuma zedoaria
English: White Turmeric Root

Tastes: Pungent, bitter, warm
Meridians Entered: Liver and Spleen

Actions & Indications:

1. Invigorates Blood circulation, dispels Blood Stasis, regulates Qi and alleviates pain
   Blood Stasis with abdominal pain, dysmenorrhea, amenorrhea, abdominal masses and epigastric masses
2. Dissolves accumulations and alleviates pain
   Food Stagnation with pain, distention, fullness and constriction in the chest and abdomen
   Childhood nutritional impairment
3. Suppresses Gu parasites
   Gu Sydnrome with Blood Stasis (Fruehauf, 1998)
   Chronic inflammatory disease (Fruehauf, 2015)

Standard Dosage: 3-15g in decoction.
Cautions: This herb is drastic in property with the disadvantage of consuming qi and impairing blood. Do not overtake long. Prohibited for pregnant women and during menstrual periods.

Due to its ability to increase bile secretion, caution should be used in cases of gallstones and avoided in biliary tract obstruction.

Pinyin: Long Dan Cao  Chinese: 龍膽草
Pharmaceutical: Radix Gentianae
Taxonomy: Gentiana scabra
English: Chinese Gentian Root

Tastes: Bitter and cold
Meridians Entered: Liver, Gallbladder, Stomach and Bladder

Actions & Indications:

1. Drains Damp-Heat from the Liver and Gallbladder channels
   Damp-Heat in the upper portion of the Gall Bladder Channel with red, swollen sore throat and eyes; swollen, painful ears or sudden deafness
   Damp-Heat in the Liver/Gallbladder with jaundice, pain, swelling or dampness in the genital area or foul-smelling vaginal discharge and itching
2. Drains and pacifies Excess Liver Fire
   Liver Fire Blazing Upward with headache or red eyes
   Liver Wind-Heat with fever, spasms, convulsions or flank pain
3. Settles the Five Zang and Kills Gu Toxins
   Stated in the Shen Nong Ben Cao Jing but not commonly used this way today
4. Aids fasting
   Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, sharpen the wits, improve memory, make the body light and slow ageing. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).

Standard Dosage: 2-6g in decoction.
Cautions: It is contraindicated for deficiency cold syndrome.

Pinyin: Huang Lian  Chinese: 黄连
Pharmaceutical: Rhizoma Coptidis
Taxonomy: Coptidis chinensis
English: Coptis Rhizome / Goldthread Rhizome

Tastes: Bitter, cold
Meridians Entered: Heart, Stomach, Large Intestine and Liver

Actions & Indications:

1. Clears Heat and drains Dampness
   Damp-Heat in the Stomach or Intestines with diarrhoea or dysenteric disorder
   Stomach Heat with vomiting and/or acid regurgitation
2. Drains Fire and resolves Fire toxicity
   Heat with Blazing Fire (Toxic Heat) with high fever. irritability, disorientation, delirium, a red tongue and a rapid, full pulse
   Heat from Excess with toxicity: painful, red eyes and a sore throat
   Boils, carbuncles and abscesses (Chuang Yung)
3. Clears Heat and stops bleeding
   Blood Heat with epistaxis, hematuria, hemafecia and hemoptysis
4. Clears Heat topically
   Infected wounds, red and painful eyes, ulcerations of the tongue and mouth (topical)
5. Clears Heart Fire (sedative)
   Heart Fire
   Lack of communication between the Heart and Kidneys
6. Drains Stomach Fire
   Stomach Fire
7. Aids fasting
   Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, improve memory. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).

Standard Dosage: 2-10g in decoction.
Cautions: It is contraindicated for deficiency-cold syndrome. Because its taste is extremly bitter and dryness, overdosage and long-time taking will impair spleen and stomach, yin and fluids.

Pinyin: Huang Qin  Chinese: 黄芩
Pharmaceutical: Radix Scutellariae baicalensis
Taxonomy: Scutellaria baicalensis
English: Baical Skullcap Root

Tastes: Bitter, cold
Meridians Entered: Lung, Stomach, Gallbladder, Large Intestine and Bladder

Actions & Indications:

1. Clears Heat and dries Dampness
   Damp-Heat in the Stomach or Intestines with diarrhoea or dysenteric disorder
   Damp-Warmth with fever, a stifling sensation in the chest and thirst with no desire to drink
   Damp-Heat in the Lower Jiao with painful urinary dysfunction
   Damp-Heat jaundice (auxiliary), infectious hepatitis
2. Drains Fire and detoxifies
   Heat and Fire especially in the Upper Jiao (Lung) with high fever, irritability, thirst, cough and expectoration of thick, yellow sputum
   Upper respiratory tract infection
   Hot sores and swellings (topical or internal)
3. Cools the Blood and stops bleeding
   Xue Stage Heat or Blood Heat causing bleeding with epistaxis, hemoptysis, hematemesis and hemafecia
4. Clears Heat and calms the fetus
   Fetal restlessness due to Heat
5. Calms ascending Liver Yang
   Liver Yang Rising with headache, irritability, red eyes, flushed face and bitter taste
   Hypertension (high blood pressure)
   Gallbladder Heat

Standard Dosage: 5-15g in decoction.

Pinyin: Ge Gen  Chinese: 葛根
Pharmaceutical: Radix Puerariae
Taxonomy: Pueraria lobata
English: Kudzu Vine Root

Tastes: Sweet, pungent, cool
Meridians Entered: Lung, Spleen and Stomach

Actions & Indications:

1. Discharges Exterior conditions and releases the muscles, especially of the neck and upper back
   Wind-Heat or Wind-Cold lodged in the muscles of the upper back and neck
2. Relieves Heat and generates fluids (relieves thirst)
   Thirst due to Stomach Heat or Wind-Heat or Wasting and Thirsting
3. Vents and discharges measles
   Measles with incomplete expression of the rash
4. Raises Spleen Yang and stops diarrhoea
   Diarrhoea or dysentery due to Heat
   Diarrhoea due to Spleen Deficiency (with appropriate herbs)
5. Lowers blood pressure
   Hypertension symptoms such as headache, dizziness, tinnitus or paresthesia

Standard Dosage: 3-10g in decoction.

Pinyin: Bai Shao  Chinese: 白芍
Pharmaceutical: Radix Paeoniae Alba
Taxonomy: Paeonia lactiflora
English: White Peony Root

Tastes: Bitter, sour, sweet, slightly cold
Meridians Entered: Spleen and Liver

Actions & Indications:

1. Nourishes the Blood and regulates menstruation
   Liver Blood Deficiency with menstrual dysfunction, vaginal discharge and uterine bleeding accompanied by a pale face, a lusterless complexion and dull, lusterless nails
   Anemia
   Breast distention and premenstrual syndrome
2. Astringes Yin and adjusts the Ying and Wei
   Yin Deficiency sweating Sweating due to Yin Collapse
   Disharmony between the Liver and Spleen
   Disharmony between the Ying and Wei with non-productive sweating
3. Calms Liver Yang and Liver Wind and alleviates pain
   Liver Qi Stagnation with Liver Yang Rising
   Liver Wind with Yin and Blood Deficiency
   Bi syndrome due to Blood Deficiency with pain and spasms
4. Softens the Liver and relieves pain
   Diarrhoea, borborygmus and abdominal pain
   Dysenteric disorders with tenesmus
5. Eliminates Evil Qi, breaks up Blood Stasis, disperses accumulations and fortifies Qi
   The Shen Nong Ben Cao Jing places this in the middle class of herbs and says that "It mainly treats Evil Qi and abdominal pain, eliminates blood impediment, breaks hard gatherings and cold and heat mounting conglomeration, relieves pain, disinhibits urination, and boosts the qi.
6. Tonifies the Blood while suppressing Parasites
   Gu Sydnrome (Fruehauf, 1998)
   Chronic inflammatory disease (Fruehauf, 2015)

Standard Dosage: 10-30g in decoction.
Cautions: Caution with anticoagulants as it may slow clotting time. May also slow the absorption of phenytoin.

Pinyin: Lian Qiao  Chinese: 连翘
Pharmaceutical: Fructus Forsythiae
Taxonomy: Forsythia suspensa
English: Weeping Forsythia Capsule / Forsythia Fruit

Tastes: Bitter, slightly pungent, slightly cold
Meridians Entered: Lung, Heart and Gall Bladder or Small Intestine

Actions & Indications:

1. Clears Heat (especially in the Upper Jiao) and resolves Toxicity
   Wind-Heat with high fever, slight chills and sore throat
   Bound Heat
2. Reduces abscesses and dissipates clumps
   Toxic Heat sores and swellings (Chuang Yung), swollen welling abscesses, malign sores, scrofula, goiter and tumours of the neck
   Throat Bi
3. Clears Blood Heat
   Blood Heat
4. Promotes urination
   Lin syndrome (urinary stones), dysuria, haematuria
5. Releases the Exterior and Drives Out Snakes
   Mentioned in the Shen Nong Ben Cao Jing as an inferior herb that treats Gu Toxins
   Chronic inflammatory disease (Fruehauf, 1998; 2015)

Standard Dosage: 10-15g in decoction.

Pinyin: Sheng Ma  Chinese: 升麻
Pharmaceutical: Rhizoma Actaeae
Taxonomy: Actaea cimicifuga, A. heracleifolia (Da San Ye Sheng Ma), A. dahurica (Xin Gan Sheng Ma), A. simplex (Ye Sheng Ma)
English: Chinese Cohosh

Tastes: Pungent, slightly bitter, slightly cold
Meridians Entered: Lung, Spleen, Stomach and Large Intestine

Actions & Indications:

1. Releases the Exterior and vents measles
   Headache due to Wind-Heat Early stages of measles
2. Clears Heat and relieves toxicity
   Fire toxins in the upper or superficial aspects of the body with sore teeth, swollen or painful gums, ulcerated lips or gums, canker sores, painful and swollen throat, sores or maculae from Warm-Heat pathogen diseases
3. Raises Yang and lifts sunken Qi
   Central Qi Sinking or Middle Qi Deficiency with shortness of breath, fatigue and prolapse
   Dai channel spasms
   Guides other herbs upwards
4. Kills Gu Parasites and Scatters Toxins by Releasing the Exterior
   Chronic inflammatory disease (Fruehauf, 1998; 2015)
5. Aids fasting
   Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, prevent premature death, make the body light and prolong life. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).

Standard Dosage: 3-10g in decoction.
Cautions: The patients whose measles have come out or have yin deficiency and heat excess, or yin deficiency and yang going upward adversely are forbidden to use this herb.

Pinyin: Chai Hu  Chinese: 柴胡
Pharmaceutical: Radix Bupleuri
Taxonomy: Bupleurum chinense (Nan Chai Hu) seu scorzoneraefolium (Bei Chai Hu)
English: Hare's Ear Root / Thorowax Root

Tastes: Bitter, pungent, slightly cold
Meridians Entered: Liver and Spleen

Actions & Indications:

1. Resolves Shaoyang disorders and reduces fever (harmonizes the Exterior and Interior)
   Shaoyang Stage with alternating chills and fever, a bitter taste,dizziness, tinnitus, flank pain, irritability, vomiting and a stifling sensation in the chest
   Deficiency Heat (auxiliary)
   Gallbladder Fire
   The Shen Nong Ben Cao Jing says "It weeds out the stale to bring forth the new."
2. Spreads Liver Qi and relieves Stagnation
   Liver Qi Stagnation with dizziness, vertigo, chest and flank pain, emotional instability and menstrual problems
   Disharmony between the Liver and Spleen with epigastric and flank pain, a stifling sensation in the chest, abdominal bloating, nausea and indigestion
   Liver/Gallbladder Disharmony
   The Shen Nong Ben Cao Jing says "It mainly treats bound qi in the heart, abdomen, intestines, and stomach, food stagnation, cold and heat, and evil qi."
3. Raises Yang Qi (specifically the Clear Qi of the Stomach and Gallbladder)
   Spleen and Stomach Yang Deficiency, Qi collapse (prolapse) with hemorrhoids, vaginal discharge, bleeding or exhaustion
4. Disperses Wind-Heat and resolves Phlegm and congestion
   Wind-Heat
5. Guides herbs to the Shaoyang aspects of the head
   Shaoyang headaches
6. Releases the Exterior and Drives Out Snakes
   Relieves the symptoms of Gu Sydnrome while suppressing parasites (Fruehauf, 1998)
   Chronic inflammatory disease (Fruehauf, 2015)
7. Aids fasting
   Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, make the body light, brighten the eyes and boost the Essence. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).

Standard Dosage: Up to 3g to raise sinking Qi, 6-9g to relieve Liver Qi stagnation, 12-24g to release the exterior.
Cautions: Anyone who has syndromes of yin deficiency with yang hyperactivity, stirring of liver wind, yin deficiency with effulgent fire and qi going upward adversely, this herb should be used with cautions.

Pinyin: Gan Cao  Chinese: 甘草
Pharmaceutical: Radix Glycyrrhizae
Taxonomy: Glycyrrhiza uralensis seu glabra seu inflata
English: Liquorice Root

Tastes: Sweet, slightly cold
Meridians Entered: Heart, Lung and Spleen (and all 12 meridians)

Actions & Indications:

1. Tonifies the Spleen and augments Qi
   Spleen Qi Deficiency with shortness of breath, lassitude and loose stools
   Qi and Blood Deficiency with an irregular pulse and/or palpitations
   Heart Qi Deficiency or Heart Yang Deficiency
2. Moistens the Lungs, resolves Phlegm and stops coughing
   Lung Heat or Cold
   Productive or non-productive coughing
3. Moderates spasms and alleviates pain
   Painful muscle spasms of the abdomen and legs
4. Clears Heat and relieves Fire Toxicity
   Raw for Toxic Heat with sore throat or carbuncles and sores (Chuang Yung)
5. Antidote for many toxic substances (internal and topical)
   Poisoning
   Bites (after washing the wound, chew Gan Cao and apply a thick layer on the bite wound, changing whenever it dries out; Bao Xiang-Ao, 1846, New Compilation of Proven Formulas)
6. Moderates and harmonizes the harsh properties of other herbs and guides the herbs to all twelve channels
   Often added in small doses to harmonise formulas
7. Tonifies the Qi while suppressing Parasites
   Gu Sydnrome (Fruehauf, 1998)
   Chronic inflammatory disease (Fruehauf, 2015)
8. Aids fasting
   Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, make the body light and prolong life. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).

Standard Dosage: Typically 1.5-9g in decoction. Large doses can be up 30g.
Cautions: It is contraindicated for combining with Hai Zao, Da Ji, Gan Sui and Yuan Hua because of "eighteen antagonisms". It is also contraindicated in cases of dampness obstruction in middle energizer and edema because it can help dampness obstruct qi, and it is prohibited from long-term usage in large dosage (more than 20g/day) and should be avoided or used with extreme caution in patients with high blood pressure because it may raise aldosterone levels in the blood causing retention of sodium.

The NHS recommends avoiding during pregnancy.

Pinyin: Dang Gui  Chinese: 當歸
Pharmaceutical: Radix Angelicae sinensis
Taxonomy: Angelica sinensis
English: Chinese Angelica Root / Tang-Kuei / Dong Quai Root

Tastes: Sweet, Pungent, Warm
Meridians Entered: Heart and Liver

Actions & Indications:

1. Tonifies the Blood and regulates the menses
   Blood Deficiency, especially when affecting the Heart and Liver with pale, ashen complexion, lusterless nails, tinnitus, blurred vision and palpitations
   Blood Deficiency associated irregular menstruation, amenorrhea and dysmenorrhea
2. Invigorates and harmonizes the Blood and disperses Cold (stops pain due to Blood Stasis)
   Blood Stasis causing abdominal pain and carbuncles and pain due to Blood Stasis from traumatic injury, especially when accompanied by Deficiency Cold
   Postpartum menstruation
   Pregnancy (use with caution)
   Blood Deficiency with chronic Wind-Damp-Bi
3. Moistens the Intestines and unblocks the bowels
   Dry Intestines due to Blood Deficiency
4. Reduces swelling, expels pus, generates flesh and alleviates pain
   Sores and abscess (Chuang Yung), internally and topically
5. Stops coughing and treats dyspnea
   Used adjunctively for coughing
6. Tonifies the Blood while suppressing Parasites
   Gu Sydnrome (Fruehauf, 1998)
   Chronic inflammatory disease (Fruehauf, 2015)

Standard Dosage: 6-12g in decoction.
Cautions: It is contraindicated in cases of Damp-Heat stagnating in the Middle, Lung Heat with Phlegm Fire, and Yin deficiency with effulgent Yang because it is warm and sweet in properties. In addition, it should be used with caution in cases of loose stool because it can moisten intestines to smooth stool.

Many sources recommend using caution, avoiding or only taking under guidance of a TCM physician during pregnancy as it can cause uterine contractions. However, there are no studies supporting this and the only scientific literature seems to suggest that Z-Ligustilide has anti-spasmodic activities that alleviate dysmenorrhoea by inhibiting uterine contractions (Du et al., 2006; Dietz et al., 2016).

Caution is also advised in breast cancer patients due to its oestrogen stimulating activity. This based upon Lau et al (2005) who found it may stimulate breast cancer growth in vitro, however Yue et al, (2019) demonstrated that it is not that stimulatory in breast cancer both in vitro and in vivo through a series of tests, although they suggested it should still be used with caution in estrogen receptor-positive breast cancer. Conversely, a large population study in Taiwan by Wu et al (2014) found it reduced the subsequent risk of endometrial cancer in breast cancer survivors taking tamoxifen, especially in those of reproductive age.