What exactly makes up a Chinese herbal formula? You don't have to be a math wizard to solve this equation

New Life Journal, May, 2008 by Jessica Godino

How does an herbalist or practitioner decide what herbs to give someone?

The most important thing to understand about Chinese medicine is that it only treats symptoms in the context of overall patterns of health and illness. A practitioner will evaluate all of the organ systems of the body, looking for states of relative excess and deficiency and areas of blockage. Information is gathered from many areas, including the signs and symptoms a patient experiences, findings on the tongue and pulse, palpation of the abdomen and other acupuncture points on the body, and observation of the patient's demeanor and emotions.

For example, two patients may come in with a chief complaint of insomnia. The first patient also has palpitations, forgetfulness and anxiety. He has a very hard time falling asleep but then sleeps fairly well, except when he has bad dreams. His complexion is pale, and he jumps when the door opens. His pulse has a thin and choppy quality, and his tongue is pale orange with a red tip. This could be diagnosed with insomnia due to "Heart Blood deficiency" and prescribed herbs to nourish the heart and root the spirit. Another has insomnia and palpitations. She wakes in the night feeling hot and thirsty. Her face is flushed, and she appears restless and agitated. Her pulse is rapid and irregular with a red tip and a midline crack. She has a western diagnosis of ADHD and bipolar disorder. This patient could be diagnosed with "Heart Fire blazing" and could be given herbs to clear the heat that is agitating her heart and disturbing her sleep.

Even though the main symptom in these two patients is the same, they would be given drastically different formulas that are based on their overall patterns of health.

In what forms can I find Chinese herbs, and what are the differences between these forms?

Chinese herbs come in a variety of shapes and sizes, all of which have their advantages and disadvantages. Pills, which can include tea pills (the little black bee-bees) and capsules, are the most affordable and convenient form for taking Chinese herbs. They are also the least potent. Raw herbs, which are simmered on the stovetop into teas, are considered to be the most medicinally potent form of ingesting Chinese herbs. But, raw herbs have some major disadvantages; they are expensive, often unpleasant tasting (the other day I had a patient ask me if I was mad at her after I gave her a new batch of herbs!), time consuming to make, and your whole house will smell like Chinese herbs while you are cooking them. Granules are basically teas that are cooked in a factory and then dehydrated into an instant tea powder, so all you need to do is add water, and voila, your tea is prepared. They are also relatively expensive but are almost as convenient as pills with a much greater potency. The most important advantage of both raw teas and granules is that your practitioner can customize your formula by adjusting the dosages of certain herbs, or even omitting or adding other herbs to the formula in order to tailor it to your exact condition. In the initial stages of treatment, it is often preferable, or even essential, to be able to customize a formula for a patient.

Do I need to be concerned with issues of quality and contamination of Chinese herbs?

Absolutely! The regulations in China are much looser, and, if you don't use quality sources, you can easily get herbs that are contaminated with pesticides or heavy metals. Some of the formulas made in China have even been found to have pharmaceuticals in them. As a rule of thumb, if you buy from a company that follows GMP (Good Manufacturing Practices) you should be safe, as they are required to test all batches of herbs for contaminants. Another source of contamination of Chinese herbs is sulphur, which is sprayed onto herbs as a preservative. Sources of high quality, contaminant-free herbs are readily available in the U.S., so it's worth asking your practitioner or checking with the company if you are buying your herbs at a health food store.

I felt strange after I took my formula, is that normal?

Most of the time, people feel really good after they take their herbs. If you have any uncomfortable symptoms, you should check in with your practitioner. Sometimes herbal formulas can cause mild gastrointestinal distress. This can often be moderated by adding some herbs to the formula that make it more digestible and/or lessening the amount of the offending herb. With mild side effects, you can often simply cut back the dosage to a third and then work up gradually. (I sometimes have people start with a fraction of the dose and work up anyway to allow a gender introduction of the herbs into their systems, especially for sensitive patients.) If you experience side effects, such as vertigo, dizziness or headache, you should stop taking the herbs and check in with your practitioner. It could be that you are reacting to one of the ingredients or that the formula is too strong for your constitution.

All of these symptoms are signs of wind in Chinese medicine, and wind is often considered a harbinger of change and transformation. In order to heal any chronic condition, we need to change. It's one of the ironies of healing that people become attached to their illnesses and resist the movement that will bring them from a painful and uncomfortable place into the uncharted territories of feeling well. So, it's always worth considering if "negative" reactions to your herbs (or any other form of treatment for that matter) may have some basis in a fundamental resistance to or fear of change, even for the better.