Herbal medicine is one of the great strengths of TCM and remains an integral part of
its practice. As with acupuncture, the art and science behind it boasts a history
of thousands of years of refinement and cultivation. Over the ages, countless
herbalists have dedicated their lives to researching and classifying thousands
of herbs, leaving us their extensive writings (our materia medica)
to work with. Thanks to their efforts, modern practitioners are able to
select herbs and traditional formulas that have proven safe and effective
for generations of patients and to then customize these traditional formulas
for our patients at each office visit, based on their most current symptoms.
As an example, a patient may seek treatment for the problem of menstrual cramps.
The common diagnosis of Liver Qi and Blood stagnation may well be deemed to be
the root cause of her problems, but rather than reach for Xiao Yao San, the most
common formula to treat that diagnosis, a good herbalist will refrain from making
judgments until a full health-history has been taken and a true diagnosis reached.
Even if Xiao Yao San turns out to be the proper base formula for the patient,
it will likely have to be modified (herbs added and/or removed) to be perfectly
suited for her condition at that time. And the next patients who walks through
the door, though she may complain of the "same" menstrual cramps, may well have
a different diagnosis entirely. One woman may have a robust constitution while
the other seems more fragile. One woman may be too hot (Yin deficient or excess
Heat), the other too cold (Yang deficient or excess Cold). Giving both women
the same prescription would not only be less than ideal, it may in fact be
counterproductive for one of them.
A custom herbal formula rarely remains the same from visit to visit. As a patient's
presentation changes, the prescription must also be modified accordingly. For example,
if a patient with menstrual cramps also complains of poor digestion, the first few bags
of herbs may treat both sets of symptoms but focus more on improving Spleen function
(to help the patient to better digest the formula). After digestive symptoms improve,
the emphasis of the formula can be shifted more to addressing her cramps. The prescription
will be modified again as the cramps cease to be a problem.
Thus, customizing a formula—the addition or subtraction of just a single herb can
have a significant impact—is essential to obtaining maximum therapeutic results.
This is one reason why there are very few prescriptions that are taken long-term without
In my clinic I dispense herbs in concentrated-granule (powder) and pill form.
While a decoction of raw herbs is thought by some to be stronger than the pills
and powders, patient compliance with this method is generally low and thus the
overall effect is compromised. For most situations, I have found powders and
pills to be just as effective as decoctions. If I think a patient would benefit
more from drinking a raw-herb decoction (and the patient will commit to the time
and labor involved in preparing their herbs), I work with several herbal pharmacies
in the Oakland and San Francisco "Chinatown" neighborhoods that stock a complete
line of raw herbs. These prescriptions can be picked up in person or mailed to
the patient directly.
Herbal medicines are extremely safe when prescribed by a knowledgeable herbalist.
There are circumstances wherein certain herbs should not be taken, for example
during pregnancy or when breast-feeding. Long-term use or large doses of some
herbs can also cause problems. For this reason, it is important to take herbs
only under the direction of an experienced licensed herbalist. Clearly, it's
equally important not to share your herbs with others unless under the supervision
of an herbalist.
Doctor John Chen (PhD, PharmD, OMD, LAc)—an authority on western pharmacology as well
as Chinese herbal medicine—has written on the subject of the rising awareness of
possible interactions between herbal medicine and pharmaceuticals. If you're curious,
the full text of his article can be found here.