fin soup is traditionally regarded in chinese medicine as beneficial for health in east asia, and its status as an elite dish has led to huge demand with the increase of affluence in china, devastating shark populations. the shark fins have been a part of traditional chinese medicine for centuries. shark finning is banned in many countries, but the trade is thriving in hong kong and china, where the fins are part of shark fin soup, a dish considered a delicacy, and used in some types of traditional chinese medicine. the tortoise (freshwater turtle, guiban) and turtle (chinese softshell turtle, biejia) species used in traditional chinese medicine are raised on farms, while restrictions are made on the accumulation and export of other endangered species. tortoise bile is used to treat swelling on the eyes with a later case of smallpox. turtle bile is used to treat those with hemorrhoids and soft-shell turtle bile is used to treat acute and chronic pharyngitis, which is taken orally with a mixture containing ginger juice and peppermint. however, issues concerning the overexploitation of asian turtles in china have not been completely solved. australian scientists have developed methods to identify medicines containing dna traces of endangered species. finally, although not an endangered species, sharp rises in exports of donkeys and donkey hide from africa to china to make the traditional remedy ejiao have prompted export restrictions by some african countries. human body parts main article: traditional chinese medicines derived from the human body dried human placenta (ziheche (紫河车) is used in traditional chinese medicine. traditional chinese medicine also includes some human parts: the classic materia medica (bencao gangmu) describes (also criticizes) the use of 35 human body parts and excreta in medicines, including bones, fingernail, hairs, dandruff, earwax, impurities on the teeth, feces, urine, sweat, organs, but most are no longer in use. human placenta has been used an ingredient in certain traditional chinese medicines, including using dried human placenta, known as "ziheche", to treat infertility, impotence and other conditions. the consumption of the human placenta is a potential source of infection. traditional categorization the traditional categorizations and classifications that can still be found today are: the classification according to the four natures (四气; sì qì): hot, warm, cool, or cold (or, neutral in terms of temperature) and hot and warm herbs are used to treat cold diseases, while cool and cold herbs are used to treat heat diseases. the classification according to the five flavors, (五味; wǔ wèi, sometimes also translated as five tastes): acrid, sweet, bitter, sour, and salty. substances may also have more than one flavor, or none (i.e., a "bland" flavor). each of the five flavors corresponds to one of zàng organs, which in turn corresponds to one of the five phases. a flavor implies certain properties and therapeutic actions of a substance; e.g., saltiness drains downward and softens hard masses, while sweetness is supplementing, harmonizing, and moistening. the classification according to the meridian – more precisely, the zàng-fu organ including its associated meridian – which can be expected to be primarily affected by a given compound. the categorization according to the specific function mainly include: exterior-releasing or exterior-resolving, heat-clearing, downward-draining, or precipitating wind-damp-dispelling, dampness-transforming, promoting the movement of water and percolating dampness or dampness-percolating, interior-warming, qi-regulating or qi-rectifying, dispersing food accumulation or food-dispersing, worm-expelling, stopping bleeding or blood-stanching, quickening the blood and dispelling stasis or blood-quickening, transforming phlegm, stopping coughing and calming wheezing or phlegm-transforming and cough- and panting-suppressing, spirit-quieting, calming the liver and expelling wind or liver-calming and wind-extinguishing orifice-opening supplementing which includes qi-supplementing, blood-nourishing, yin-enriching, and yang-fortifying, astriction-promoting or securing and astringing, vomiting-inducing, and substances for external application. efficacy as of 2007 there were not enough good-quality trials of herbal therapies to allow their effectiveness to be determined. a high percentage of relevant studies on traditional chinese medicine are in chinese databases. fifty percent of systematic reviews on tcm did not search chinese databases, which could lead to a bias in the results. many systematic reviews of tcm interventions published in chinese journals are incomplete, some contained errors or were misleading. the herbs recommended by traditional chinese practitioners in the us are unregulated. a 2013 review found the data too weak to support use of chinese herbal medicine (chm) for benign prostatic hyperplasia. a 2013 review found the research on the benefit and safety of chm for idiopathic sudden sensorineural hearing loss is of poor quality and cannot be relied upon to support their use. a 2013 cochrane review found inconclusive evidence that chm reduces the severity of eczema. the traditional medicine ginger, which has shown anti-inflammatory properties in laboratory experiments, has been used to treat rheumatism, headache and digestive and respiratory issues, though there is no firm evidence supporting these uses. a 2012 cochrane review found no difference in mortality rate among 640 sars patients when chinese herbs were used alongside western medicine versus western medicine exclusively, although they concluded some herbs may have improved symptoms and decreased corticosteroid doses. a 2012 cochrane review found insufficient evidence to support the use of tcm for people with adhesive small bowel obstruction. a 2011 review found low quality evidence that suggests chm improves the symptoms of sjogren's syndrome. a 2011 cochrane review found inconclusive evidence to support the use of tcm herbal medicines for treatment of hypercholesterolemia. a 2011 cochrane review did not find improvement in fasting c-peptide when compared to insulin treatment for latent autoimmune diabetes in adults after 3 months. it is important to highlight that the studies available to be included in this review presented considerable flaws in quality and design. a 2010 review found tcm seems to be effective for the treatment of fibromyalgia but the findings were of insufficient methodological rigor. a 2008 cochrane review found promising evidence for the use of chinese herbal medicine in relieving painful menstruation, but the trials assessed were of such low methodological quality that no conclusion could be drawn about the remedies' suitability as a recommendable treatment option. turmeric has been used in traditional chinese medicine for centuries to treat various conditions. this includes jaundice and hepatic disorders, rheumatism, anorexia, diabetic wounds, and menstrual complications. most of its effects have been attributed to curcumin. research that curcumin shows strong anti-inflammatory and antioxidant activities have instigated mechanism of action studies on the possibility for cancer and inflammatory diseases prevention and treatment. it also exhibits immunomodulatory effects. a 2005 cochrane review found insufficient evidence for the use of chm in hiv-infected people and people with aids. a 2010 cochrane review found insufficient evidence to support the use of traditional chinese herbal products (thcp) in the treatment of angina. a 2010 cochrane review found no evidence supporting the use of tchm for stopping bleeding from haemorrhoids. there was some weak evidence of pain relief. drug research further information: arsenic trioxide, artemisinin, huperzine a, and ephedrine artemisia annua, traditionally used to treat fever, has been found to have antimalarial properties. with an eye to the enormous chinese market, pharmaceutical companies have explored creating new drugs from traditional remedies. the journal nature commented that "claims made on behalf of an uncharted body of knowledge should be treated with the customary skepticism that is the bedrock of both science and medicine." there had been success in the 1970s, however, with the development of the antimalarial drug artemisinin, which is a processed extract of artemisia annua, a herb traditionally used as a fever treatment. artemisia annua has been used by chinese herbalists in traditional chinese medicines for 2,000 years. in 1596, li shizhen recommended tea made from qinghao specifically to treat malaria symptoms in his compendium of materia medica. researcher tu youyou discovered that a low-temperature extraction process could isolate an effective antimalarial substance from the plant. tu says she was influenced by a traditional chinese herbal medicine source, the handbook of prescriptions for emergency treatments, written in 340 by ge hong, which states that this herb should be steeped in cold water. the extracted substance, once subject to detoxification and purification processes, is a usable antimalarial drug – a 2012 review found that artemisinin-based remedies were the most effective drugs for the treatment of malaria. for her work on malaria, tu received the 2015 nobel prize in physiology or medicine. despite global efforts in combating malaria, it remains a large burden for the population. although who recommends artemisinin-based remedies for treating uncomplicated malaria, resistance to the drug can no longer be ignored. also in the 1970s chinese researcher zhang tingdong and colleagues investigated the potential use of the traditionally used substance arsenic trioxide to treat acute promyelocytic leukemia (apl). building on his work, research both in china and the west eventually led to the development of the drug trisenox, which was approved for leukemia treatment by the fda in 2000. huperzine a, an extract from the herb, huperzia serrata, is under preliminary research as a possible therapeutic for alzheimer's disease, but poor methodological quality of the research restricts conclusions about its effectiveness. ephedrine in its natural form, known as má huáng (麻黄) in tcm, has been documented in china since the han dynasty (206 bce – 220 ce) as an antiasthmatic and stimulant. in 1885, the chemical synthesis of ephedrine was first accomplished by japanese organic chemist nagai nagayoshi based on his research on japanese and chinese traditional herbal medicines pien tze huang was first documented in the ming dynasty. cost-effectiveness a 2012 systematic review found there is a lack of available cost-effectiveness evidence in tcm. safety galena (lead ore) is part of historical tcm. standard american tcm practice considers lead-containing herbs obsolete. from the earliest records regarding the use of compounds to today, the toxicity of certain substances has been described in all chinese materiae medicae. since tcm has become more popular in the western world, there are increasing concerns about the potential toxicity of many traditional chinese plants, animal parts and minerals. traditional chinese herbal remedies are conveniently available from grocery stores in most chinese neighborhoods; some of these items may contain toxic ingredients, are imported into the u.s. illegally, and are associated with claims of therapeutic benefit without evidence. for most compounds, efficacy and toxicity testing are based on traditional knowledge rather than laboratory analysis. the toxicity in some cases could be confirmed by modern research (i.e., in scorpion); in some cases it could not (i.e., in curculigo). traditional herbal medicines can contain extremely toxic chemicals and heavy metals, and naturally occurring toxins, which can cause illness, exacerbate pre-existing poor health or result in death. botanical misidentification of plants can cause toxic reactions in humans. the description of some plants used in tcm has changed, leading to unintended poisoning by using the wrong plants. a concern is also contaminated herbal medicines with microorganisms and fungal toxins, including aflatoxin. traditional herbal medicines are sometimes contaminated with toxic heavy metals, including lead, arsenic, mercury and cadmium, which inflict serious health risks to consumers. also, adulteration of some herbal medicine preparations with conventional drugs which may cause serious adverse effects, such as corticosteroids, phenylbutazone, phenytoin, and glibenclamide, has been reported. substances known to be potentially dangerous include aconitum, secretions from the asiatic toad, powdered centipede, the chinese beetle (mylabris phalerata), certain fungi, aristolochia, arsenic sulfide (realgar), mercury sulfide, and cinnabar. asbestos ore (actinolite, yang qi shi, 阳起石) is used to treat impotence in tcm. due to galena's (litharge, lead(ii) oxide) high lead content, it is known to be toxic. lead, mercury, arsenic, copper, cadmium, and thallium have been detected in tcm products sold in the u.s. and china. to avoid its toxic adverse effects xanthium sibiricum must be processed. hepatotoxicity has been reported with products containing reynoutria multiflora (synonym polygonum multiflorum), glycyrrhizin, senecio and symphytum. the herbs indicated as being hepatotoxic included dictamnus dasycarpus, astragalus membranaceus, and paeonia lactiflora. contrary to popular belief, ganoderma lucidum mushroom extract, as an adjuvant for cancer immunotherapy, appears to have the potential for toxicity. a 2013 review suggested that although the antimalarial herb artemisia annua may not cause hepatotoxicity, haematotoxicity, or hyperlipidemia, it should be used cautiously during pregnancy due to a potential risk of embryotoxicity at a high dose. however, many adverse reactions are due to misuse or abuse of chinese medicine. for example, the misuse of the dietary supplement ephedra (containing ephedrine) can lead