MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Tiger Balm (TB) ointments are Chinese topical remedies, often used for pain relief available as over-the-counter medications. TB is clearly popular, but does it work? The aim of this systematic review was to find out by assessing the efficacy, safety and tolerability of TB ointments.

A total of 12 studies were included (five on TB ointments efficacy, whereas seven on their safety and tolerability). Two cases of dermatitis and one of cheilitis likely ascribable to the use of TB ointments have been reported. Based on available studies, it might be estimated that around 4% [95% CI, 3%-5%] of patients with history of contact skin allergy could be positive if patch tested with TB ointments, therefore caution is recommended in the use of TB among these subjects.

The authors concluded that, according to retrieved evidence, TB ointments might be useful for the management of pain due to tension headache, and they seem capable of increasing leg blood flow if combined with massage. Considering available evidence on topical products with camphor, TB ointments shouldn’t be used in children, as well as in pregnant or lactating women. Chronic use, large amounts of balm, and the application on damaged skin must be avoided too. Further studies are recommended.

I had to laugh out loud when reading these conclusions:

  1.  That TB MIGHT be useful is hardly worth writing home about. A systematic review should tell us whether there is any good evidence THAT it is useful.
  2.  That TB seems capable of increasing leg blood flow is also nonsense. Firstly, anything increases blood flow IF COMBINED WITH MASSAGE. Secondly, why would anyone want to increase leg blood flow? Ahh of course: if you have leg ischaemia, e. g. in intermittent claudication. But then increasing blood flow of the skin of the leg is likely to be counter-productive, as this would shunt blood away from the already oxygen-starved muscles.

So, what evidence is there that TB might be effective? It turns out that there is all of ONE small randomised clinical trial that is over 20 years old which delivers a positive result. In view of this, I find it hard to resist re-writing the conclusions as follows:

TB IS A CHINESE REMEDY THAT CAN CAUSE ADVERSE EFFECTS AND FOR WHICH THERE IS NO GOOD EVIDENCE OF EFFICACY. ITS RISK/BENEFIT BALANCE IS THEREFORE NOT DEMONSTRABLY POSITIVE.

12 Responses to Tiger balm: not free of adverse effects and not supported by convincing evidence

  • Tiger Balm

    Ingredients

    7g Beeswax
    22 ml Saint John’s Wort infused carrier oil
    65 drops (3.5 ml) Peppermint essential oil
    125 drops (6.5 ml) White Camphor essential oil
    80 drops (4 ml) Cajeput essential oil
    60 drops (3 ml) Clove essential oil
    60 drops (3 ml) Cassia or Cinnamon Leaf essential oil
    120 drops (6 ml) Cornmint essential oil

    Equipment

    a kitchen scale
    a glass stirrer
    a double boiler
    a glass jar for containing oils during weight process
    a label
    enough small containers with lids to store finished product

    Procedure

    Gather the ingredients along with the equipment in a clean, well lit, workspace.
    Pour the St. John’s Wort infused carrier oil into a double boiler and heat it over medium-low heat.
    When the oil is warm, carefully add the beeswax.
    After the beeswax has melted, remove the double boiler from heat and stir in the essential oil.
    Pour the mixture into a few salve containers and cap them securely.
    Label the containers with the name of the salve.

    • … Pour the mixture into a few salve containers and cap them securely.
      Label the containers with the name of the salve.
      AND THEN THROW AWAY THE LOT.

    • I don’t know about all of these ingredients, but many of them are pharmacologically active and an be absorbed through the skin, particularly if it is damaged, as well as being potential irritants and allergens. They can interact with prescription drugs and camphor is certainly known to be toxic to the liver. I don’t know the route of elimination of the various active substances contained in these essential oils, but I would imagine that any risks would be increased by poor liver or kidney function. I hope you are issuing adequate warnings if you are supplying your home-made drugs to other people. And also that you have liability insurance.

    • The only ‘essential’ oil is WD40

  • Dr. JMK

    Doc

    I’m amused by your post… really, I had to laugh.

    Here you are passing out warnings of the dangers of herbs and oils….. hilarious.

    Not to say that there are no hazards. It’s just that the hazards from consuming Pharma products are obvious. They alone should be enough for you to focus without looking under bushes.

    • the hazards from consuming Pharma products are obvious

      But the hazards from herbal medicines, home-made or otherwise, are not. I thought I had put this reasonably clearly, but you seem to have missed the point.

    • RG:
      Have you not been reading this blog long?
      Readers are bored stiff with comparisons being made re ‘Pharma’ products when they are not the subject of the post.
      (They certainly are considered in other postings.)

      Tu quoque is a logical fallacy and unworthy.
      Do try and keep up.
      Which is ad hominem and also a LF, but hey…
      Grrrr…!

  • Richard Rawlins

    Have you not been reading my post on this blog for long ?

    My purpose here is to continually point out the pitfalls of Pharma meds, and SMB. Also to point out the double standards in comparisons between SBM and CAM here at this blog.

    If you don’t like it, ignore my postings, I don’t think you make the rules here.
    Cheers

    • RG – you rather miss the point! Pharma approved meds have to go through a variety of hoops before being approved and
      we have evidence of their efficacy for specific indications (versus the total lack of efficacy for just about all of all SCAM treatments in the entire history of alt med)
      In addition there is advance knowledge of the most common side-effects and interactions and a properly approved method of reporting any further suspected issues via the yellow card scheme among others – cf SCAM remedies which prefer to deny/hide any and all side-effects and issues and for which there is NO system of recording adverse events – very convenient!

      Actual medicines may have actual side-effects but at least they produce actual predictable changes in biochemistry and bodily function – unlike the haphazard lottery that is SCAM which ranges from zero effect (homeopathy) – zero effect with the risk of a punctured organ (acupuncture) and zero benefit with the risk of being made worse or a broken neck or vertebrobasilar arterial rupture (chiropractic).
      When the benefit is zero but the potential risk is high then it is hard to justify your SCAM at any price!

      If you seek double standards then you will find them aplenty within SCAM, where 99.99% of all studies are done badly and fudged to make the SCAM look good and where all critical thinking is verboten. Alt med is a religion and no-one dare question the faith – all you can do is spout dogma.

      Perhaps you would like to provide “evidence” of how SBM (not “SMB” as you would have it) is in some way inferior to your exalted and holy SCAM – pray do enlighten us! I won’t be holding my breath.

      And at least Pharma meds have the advantage of being based on scientific principles rather than on magic and wishful thinking or on the ravings of “visionaries” from previous centuries who were granted miraculous revelations of “innate” or “like cures like” from out of the wisdom of their respective rectums.

      • mark thornton

        First of all, I don’t perpetuate any CAM claims here. If you find a post where I did…. you prove me wrong. I support CAM because I believe in “do no harm”. Beyond that I support CAM because there are available placebo effect benefits for some therapies and some patients.

        Evidently you haven’t been reading my post here for long enough to know that me, my family and my friends, we have all subjected ourselves to SBM enough to learn that much of it over promises and under delivers. In other much of SBM is a SCAM also.

        Me and mine have been a patient on the side of SBM that prescribes meds to patients that toxifies human organs. We’ve been on the side of SBM that does harm to the patient. We’ve been on the side of SBM that has no solutions…. no cures. Not even the highly exalted antibiotics are a guarantee, my brother has had a sinus infection for 13 years. You think surgery is a slam-dunk ? The same brother has had six inguinal hernia surgeries due to the mesh implant boondoggle. Everywhere I turn, to my mother, my son, my father, my wife…. nothing but failed SBM. Hey now, how bout all them sick women walking around sick to death for every type of illness due to breast implants ? Failed Failed Failed.

        Mark, Do you realize that Pharma meds can not even cure a couple percent of chronic illnesses ? Why is this ?? … could it be that curing patients is bad for business ? Or, is it because SBM just doesn’t have the solutions. True, there are a few recent drugs on the market, or coming to market that cure…. but they are in the $80K – $300K price range…. and they are the one percent.

        Mark, I was an investor in Pharma public companies for over 25 years. You think I didn’t do my due diligence to buy and hold ? I doubt there is anything you could school me on with regard to the Pharma Industry.

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