(Note: this blog post is meant to be a very light introduction to this topic. If you want a more robust and complete understanding you should get a copy of “Chinese Medical Herbology and Pharmacology” by John K. Chen and Tina T. Chen)
It is seldom that an herb is used by itself. Herbs are typically combined in a formula to enhance their strength and reduce unwanted side effects. Some herbs, when combined, strengthen their therapeutic effect, and likewise, some herbs weaken the effect of other herbs. The idea is to properly strengthen the therapeutic properties without overdoing it, while at the same time diminish the unwanted properties of the therapeutic herbs.
Formulas are often created specifically for a patient. This is the best way to take herbs. In their basic form, the patient will need to prepare the tea at home. In this manner of delivery, the formula you get from your Chinese Medicine provider will come in a bag of herbs which you will need to boil to create a tea. Unfortunately in the United States compliance with this form of herbal supplementation method is poor. The herbs tend to taste bad and smell worse. Fortunately, there are alternatives such as ready-made powder formulas or your practitioner can have some capsules, tinctures, granules or even lotions, made up for you. The formulation should take into consideration not only the problem you are complaining about, but your physical condition is also important in the selection of herbs. For example, you and your twin may have the exact same cold but the herbs that your practitioner formulates for the two of you could be quite different because your physical condition is different or the cold in your case has progressed deeper into the body than your twin’s cold. This is very different than Western Medicine where your personal situation is not considered important. You and your twin will take the same cold medicine from the pharmacy shelf.
Formulation of herbs can be quite complex; one area of concern is herb to herb incompatibilities. There is a long list of herbal incompatibilities that I will not go into in-depth here except to list some herbs which have known incompatibilities: Gan Cao, Fu Zi, Chuan Wu, Cao Wu, Li Lu, and Shi Jiu Wei. These are herbs that have significant therapeutic value, however, care must be taken with how they are formulated.
There are some foods that may interact with herbs. Certainly, you do not want to eat food that is difficult for you to digest when you are taking herbs. You will also want to eat high-quality, clean, healthy food. Beyond that, there are some foods such as onions or garlic that might react with herbs. Your practitioner will be able to tell you which foods to avoid with your herbal formula.
For women, there are some additional concepts to know. During pregnancy, there are herbs that should be avoided but also there are herbs that can help stabilize the pregnancy. During nursing there are also herbs to be avoided, while there are herbs to promote healthy lactation and others that will reduce lactation should that become necessary.
One very important topic about formulation is that sometimes there are herb-pharmaceutical interactions. In the United States, we consume a vast number of pharmaceutical medications. The interaction can occur at several stages.
Absorption is the first stage where interaction can occur. If a pharmaceutical or an herb inhibits your digestion, then you will not properly absorb your medication. Herbal formulations are typically designed to be easily digested as are pharmaceuticals; however, any medication which inhibits stomach acid will reduce your body’s ability to absorb either herbs or other medications, not to mention the lack of proper absorption of your food. So be mindful of any medication or herb which might slow or speed up your digestion. It can have a significant effect on your absorption.
Distribution is the next stage. Once a medication or herb is absorbed, it needs to get to its destination to have a therapeutic effect. This is typically not a problem, and John and Tina Chen have outlined only two Western medications that are currently areas of concern. The first is warfarin (Coumadin) and the second is phenytoin (Dilantin).
Metabolism is the next stage. Some medications or herbs can speed up or slow down metabolism in your liver. If your metabolism is running fast, then medication will be in your system in a shorter amount of time; and if it is running slow, it will be in your system longer and will have a more profound effect. Some pharmaceuticals which speed up hepatic metabolism are phenytoin (Dilantin), Carbamazepine (Tegretol), Phenobarbitals, and rifampin (Rifadin).
Some pharmaceuticals which slow down liver function include: Cimetidine (Tagamet), erythromycin, ethanol, fluconazole (Diflucan), itraconazole (Sporanox), and Ketoconazole (Nizoral). There are others.
Elimination is the last step, and it usually comes down to the kidneys. Some medications which can harm kidney function are Amphotericin B, Methotrexate, Tobramycin, and Gentamicin. If you are taking one of these, you need to make sure your Chinese Medicine provider knows. He or she may want to reduce the herbal dosage.
Herbal formulation can be very involved, and it is best to find a practitioner you trust to help you make the correct choices. Your practitioner will know what brands of herbs are “high quality” and run a very low risk of contamination. And, it is very important that your practitioner know all your medications to avoid possible unsatisfactory results or side effects.