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Beyond adverse effects from the herb itself, "adulteration, inappropriate formulation, or lack of understanding of plant and drug interactions have led to adverse reactions that are sometimes life threatening or lethal." [3]
Herbal and traditional medicines also have side effects. A drug or procedure usually used for a specific effect may be used specifically because of a beneficial side-effect; this is termed "off-label use" until such use is approved. [1]
A 2011 review stated that although T. wilfordii has toxic potential, careful extraction gives an acceptable frequency of adverse reactions, which are largely related to the gastrointestinal tract and amenorrhea. The review found that T. wilfordii extract is a useful remedy for postmenopausal rheumatoid arthritis. [12]