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Some time back, over a dinner conversation, someone brought up the topic of Hongqu (红曲), also known as Red Yeast Rice Extract. Hongqu has now been popularized as a natural statin, useful for the prevention or treatment of high blood cholesterol (高血胆固醇). Almost immediately, the topic moved on to the danger of using Chinese medicinal herbs, citing the case where someone suffered liver damage eating Hongqu. So what really went wrong? Is Hongqu really that harmful?

The enzyme, high blood cholesterol and LDL:

In the liver exists this enzyme called HMG-CoA reductase. If left on its own, this enzyme is able to create cholesterol from HMG-CoA. In many older people, there is a tendency to see excess cholesterol clogging up the blood vessels.

High blood cholesterol levels is related to high blood LDL levels. LDLs carry cholesterol from the liver (where it is mainly produced) into the blood vessels for use in other parts of the body. Therefore, when there is high blood cholesterol, there is usually high blood LDL. Usually this is a sign that your blood vessels are clogged up by cholesterol.

Statins, their effect and side effects:

Different statins include fluvastatin, atorvastatin, lovastatin and simvastatin. Available commercially, pharmaceutical statins work by inhibiting the action of the enzyme HMG-CoA reductase. When the enzyme is inhibited, HMG-CoA can no longer become cholesterol. This reduces the amount of cholesterol produced by the body. LDL is also reduced as a result.

That said, statins are broken down in the liver, hence increasing its workload. Liver damage is a possible side effect.

Important Information:

Side effects include dizziness, heartburn and muscle weakness.

  • Statins increase the risk of heart attack, unstable angina, and stroke is you stop taking it suddenly.
  • Studies have found that grapefruit juice enhances level blood levels of these statins, with the associated side effects. Therefore, you should be careful when taking grapefruit juice with statins.
  • Statins may lower the production of Coenzyme Q10 in the body. Coenzyme Q10 provides energy for every cell, and is crucial especially for helping our heart beat. Therefore, levels of Coenzyme Q10 are usually supplemented when using statins.

Hongqu as a natural statin:

Hongqu contains monacolins, compounds that are similar in structure to statins. Monacolins inhibit the same enzyme inhibited by statins. Hongqu is also called a natural statin. You may ask, how could it have caused liver damage if it is a natural herb?

It could have been used together with prescription statins like simvastatin and lovastatin. It could also have been due to misuse by the patient. More likely, the patient was not aware that even Hongqu overworks the liver despite being a natural product.

The lesson to be learned:
Yes, even natural statins are able to damage your liver. This is because of the way statins work.


The person who blamed Hongqu for causing liver damage must be aware that prescription statins are just as harmful. In the end, it is more a matter of how you use the medicines you have. Medicine (药) is synonymous to poison (毒) in Chinese Medicine. The lesson to be learned is to respect medicine and to use it with care.

By the way, there is an ongoing debate now in the States on whether or not to give Hongqu the status of a prescription drug. Of course the drug companies don’t want that to happen, since synthetic drugs like lovastatin are already making them alot of money.

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