In 1994 the FDA released a medical bulletin regarding ephedra and the adverse affects associated with its use in products marketed for weight loss, energy or performance enhancing purposes. These products are often marketed for their ability to enhance metabolism with weight loss as a by-product. Ephedra is used in traditional Chinese herbology to treat cold and flu. It is also used by the Chinese as a diaphoretic to help the body eliminate pathogens and regulate the proper function of the lungs. Initially the FDA was not involved with ephedra due to it being marketed as a dietary supplement, not a food or drug. However, as the FDA received more and more reports of adverse reactions associated with the use of ephedra they began to take notice. Reported reactions ranged from the typical side effects of stimulants such as nervousness, dizziness, tremor and increased heart rate to chest pain, myocardial infractions, hepatitis, stroke, seizures, psychosis and death. The adverse reactions were reported as occurring in young, otherwise healthy individuals using products containing ephedra. People with pre-existing conditions of hypertension have reported worsening conditions or even death. In April 2004, the FDA banned the sale of ephedra-containing supplements and had the ban upheld by the U.S. Court of Appeals for the Tenth Circuit upheld the ban.