Ethical Herb Practices: Prescribing Custom Formulas
Shellie Rosen, DOM, LAc
The uniqueness of Traditional Chinese Herbal Medicine (TCHM) is the opportunity to design custom formulas for each patient's presenting and constitutional patterns. But is this our common practice in the modern pharmacy?
How Do You Prescribe?
Is your formula addressing your patient's condition, or are you prescribing pre-made general products from your clinic shelves to work for everyone? The ethical question might be, "Do TCHM practitioners choose Chinese herbal formulas for patients based on their inventory?"
Psychologist Abraham Maslow saw similar trends in the treatment of patients in his discipline as well. When doctors prescribed one of two pharmaceuticals for all their mentally ill patients he said, "… to a man with a hammer, everything looks like a nail."
How can we broaden our clinical tools and create more opportunities for practitioners to provide a more custom specific herbal solution? The most common TCHM prescription in the U.S. is the finished product (pre-formulated bottles).
If this is your method, you can aim even closer to your target by combining formulas to personalize your prescription. The products you select must list ingredients by weight so you can make appropriate assumptions.
Let's say your patient has Wu Ji San syndrome (accumulation syndrome with qi deficiency) presenting as colitis with occasional Bu Wei Fang symptoms (spleen/lung qi deficiency) like diarrhea.
Your prescription might look like this: "Take two pills of Wu Ji San (60 pills) and two pills of Bu Wei San (30 pills) three times per day until diarrhea subsides. Then reduce to only two pills of Wu Ji San three times per day. Your total amount of days taking Wu Ji San is ten."
Leave Your Options Open
Practitioners using finished products do best with access to pharmacies with many formula options, and various bottle sizes to offer flexibility in dosing. Example: Wu Ji San 1 = 6 pills per day for 10 days, 60 pill bottle. Bu Wei San 2 = 6 pills per day for 5 days, 30 pill bottle.
The multi-practitioner clinic where everyone shares inventory has some advantages. Others use online distributors and prescribe directly to their patient. Paired finished product prescriptions offer patients flexibility. If the above formulas were a single custom powder or granule prescription, the patient wouldn't have the option to add/remove the Bu Fei San daily as conditions (like diarrhea) come and go.
Concentrated granules can be prescribed in small or large quantities for changing or chronic patterns. Practitioners that enjoy granule custom blends find that it's an easy way to have flexibility with formula and single herb combinations. Again, access to an extensive inventory allows the practitioner to offer creative options for complex circumstances, but larger isn't always better. The main point is having the courage to study your patient's condition and design a formula that suits their needs.
Herb Formula Titans
Practitioner confidence is a big piece to the "custom" puzzle. Some practitioners rely on products in the market place because they don't feel "knowledgeable" enough to design a custom formula of their own. There are titans of herb formulation making amazing products, but some practitioners seem quick to jump on board with finished product lines without actually knowing the formulas or formulators.
Are you certain your formulator is a more skilled herbalist than you for this particular patient? Did they utilize a classical formula just like you would as a template? Did they add a little change, place a label on it and call it something special? My experience has been that not all Xiao Yao San (or any other formula for that matter) are created equally in the marketplace!
Practitioner Responsibility
It is my responsibility to understand finished product formula ingredients (by weight), quality and dosage information. If a formulator doesn't share that information, I don't contract with their products. How can a practitioner understand formula actions without full disclosure of ingredients?
The film The Matrix comes to mind. Through persistent effort and failure, the main character Neo begins to meld with the physical world, moving matter seamlessly into action with his every thought. When I spend time with herbal wisdom, I wish to be like Neo and find where connections are made naturally from experiences.
In listening to and noticing my patient, I attempt connections with the single herbs and formulas that most relate to their presentation and constitution. Mastery takes time (I'm far from it!), and it requires failure (of which I have many). It's painful to fail a patient, but we can invite them on the uncertain path towards seeing their true nature.
Finding a constitutional formula for a patient can be a moving experience! We can be one of the lucky people in the world to see them for who they are, and to find an herbal talisman unique to them that can offer a bit of peace. What an honor to have a profession that allows such opportunity!
Take a Refresher Course
To find some courses to supplement your online learning, check out these great teachers! Their methods of creating custom herb prescriptions differ from one another in various ways, but each has left me feeling inspired to create! Enjoy!
Bob Flaws — Blue Poppy Online
Sharon Weizenbaum — White Pine Institute ProD Seminars
Heiner Fruehauf — Classical Chinese medicine ProD Seminars
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Though the creation of a financially sustainable, health-promoting model feels far away today, we are casting a vision for a full return on health, believing that this compels us to keep one foot firmly rooted in caring for the sick and the other foot firmly founded in maintaining health. Shifting from a fee-for-service model to value-based care using a phased approach is paramount.
Traditional Chinese medicine and the Vedic traditions both offer rich frameworks for understanding human health, emphasizing the balance of physical, mental, and spiritual aspects. The concept of "souls" or spiritual components in TCM, namely Hun, Po, Shen, Yi, and Zhi, bears significant similarities to the yogic concept of koshas. Their similarities and differences provide insights into how these systems contribute to holistic health practices.
