From a Patient's Perspective: Herbs Work Better When You Take Them

I once visited an acupuncturist friend of mine in the South. His family and I went out for Southern food night after night - twice it was "fried this" and "gravy covered" that.

I learned that in the South, macaroni and cheese is considered a vegetable and green beans often are not deemed edible until cooked so soft anyone without teeth can easily manage them. The food was good, but my Southern California digestive system could not manage all the fat and lack of fresh vegetables.

By Sunday morning, I was locked in my friend's guest bathroom with him gently asking through the door, "Is there anything I can do for you?" Once I explained the problem and he gave my tongue and pulse a quick check, he offered up an assortment of pills. "Take these," he said. I looked dubiously at the first bottle, which housed pills that looked like large rat droppings. "Just take them," he said again, noting my caution.

This was my first experience using Chinese herbs. I must admit, that like many of your patients, I still balk when they are prescribed.

Issue with Taste and Smell

There are a lot of reasons why patients fail to take their herbal medications and supplements. The most common complaint I hear is taste and smell. I am not Chinese, did not grow up in Asia, and was not raised on Oriental medicine. On the rare occasion that I was sick as a child, I was given a small pill that could usually be hidden in something like peanut butter or a syrupy drink that likely had more sugar in it than medicine. I am not accustomed to taking medications that smell or taste like anything at all, other than perhaps sugar-soaked cherries. Chinese herbs, however, have all sorts of smells and flavors. Some are pleasant. I have been prescribed formulas that included cinnamon or ginger. Others, well, let's just say were less agreeable to smell or ingest.

My first Oriental medicine treatment was given to me four years or so ago by a very accomplished Chinese practitioner. She was a kind woman who received her medical training in China. Her reputation was excellent and she had a gentle bedside manner. I liked and respected her immediately. After her initial examination of me and one acupuncture treatment she had me go to the front desk to get a tea. She met me to tell me how to brew it. She warned that it was extremely pungent and would taste awful, but to take it anyway.

I took the tea home and brewed it as directed. In my cup was a thick mud-colored infusion with lots of things floating in it. It gave off an almost overpowering smell of Earth with a hint of decay. My nose wrinkled and jaw clamped tight. I wondered if this was a test, because surely something that smelled like this could not possibly be good for me. I stood over the sink and looked out at the trees in the front yard. "Drink it quick," I said to myself, and in a big gulp, took about a third of the tea down. It tasted worse than anything I could have imagined. A half second later, it came right back up. That was my first and last experience with Chinese herbs taken as tea.

Please let me be clear. I am not suggesting that there is anything at all wrong with prescribing Chinese herbs in general or teas in particular. What I am saying is that it is important for you to know your patient before making any prescription. Some patients are completely willing to use teas, even if those formulas have undesirable smells or tastes. Someone like me, however, is not going to take anything that tastes or smells bad. Period. Yes, some formulas, I have been told, are much more effective as teas. But if the patient will not ingest them, they completely lose their medicinal value. Talk with your patients about what they will and will not take. Help them to be successful by helping them to be compliant.

Too Many Pills

I currently divide my time between Texas and California. When I am in Texas, I see a practitioner who uses herbs in her practice. I told her about my aversion to medicinal tea, which she respects. She created an herbal formula for me, which she had encapsulated and sent to my home. A box with a gigantic bottle in it arrived.

The directions on the bottle read, "Please take 12 capsules three times daily." I opened the bottle to find enormous capsules half as long as my pinky finger in it. Evidently, at least one of the herbs in the formula was "voluminous." I removed 12 pills and put them in a small bowl along with the other medications and supplements that I take. I poured a glass of water and started to swallow small a handful of pills one after another. I did this three times a day for three of four days. Then suddenly, one afternoon, my throat closed up. I just couldn't swallow anymore pills. I was done.

I went back to my acupuncturist and told her what had happened. We discussed why I simply could not swallow the pills any longer. Part of the issue was decidedly psychological. Taking so many pills made me feel like a sick person; I didn't like that. My acupuncturist listened to me and switched me over to a patent formula. I now take three much smaller tablets twice daily and can take everything in two swallows. The formula isn't quite the same as what I was being given before, but the results are better with a formula that I will take than one I will not.

My experience is not average. Some of your patients will not mind taking pills at all. I have a friend who literally takes at least 40 capsules of supplements every morning and thinks nothing of it. I know another woman who enjoys taking a lot of pills because it makes her feel like she's taking care of herself. The key is to be in constant discourse with your patients, to find out whether or not they are taking their supplements; if not, to find out why not and adjust your course of action.

Be Clear about Ingredients

In school, practitioners are taught the Chinese names of herbs and herbal formulas. This seems reasonable, since most Oriental medicine herbal medications and supplements are imported from Asia. As a practitioner, you will need to be able to communicate with your herb suppliers in a common language.

Your common language with your patient is likely not going to be Chinese. I expect my practitioner to be able to tell me precisely what is in the herbs she prescribes for me using terms I can look up in a Materia Medica or online. This means using either Latin or English names. I am not going to take rou gui or gui zhi, but I will take cinnamon. I'm not at all sure about ingesting lingzhi, but taking reishi mushrooms (which happen to have efficacy studies associated with them) is perfectly acceptable. I'll even take "the weird stuff" like ants, if I know what it is. Not every patient feels this way, but it is our right to know in clear terms exactly what is being prescribed.

My medical doctor also expects that I will be able to provide her with a comprehensive list, in Latin or English, of the supplements I am taking. I cannot do this by giving her many bottles of herbs as they are given to me. It is the prescribing practitioner's responsibility to provide that information to the patient upon request.

Find What Works

After being unable to swallow (literally and figuratively) so many pills, my practitioner found a formula and form that works for me. This is certainly different than she would prescribe for another person with exactly the same symptoms/medical issues, but a different personality.

Once we found a form in which I could easily and consistently take the herbs prescribed, I began to be compliant and take my herbs regularly. A strange thing happened. They worked. Listening to me paid off for her, and more important, for me. When I had taken my pills as prescribed for a week, I called my practitioner. "You know what? Herbs work better when you take them," I said into her voice mail. I could almost feel her smile as she picked up her messages.