The Experiential Dozen: 12 Formulas for In-Clinic Tea
Shellie Rosen, DOM, LAc
Author Ted Kaptchuk, wrote, "The Web That Has No Weaver" in 1983. On the cover is a drawing which represents an herbalist spoon feeding a patient an herbal formula. Kaptchuk went on to engage in research surrounding the role of a practitioner in healing, as well as the influence of a clinical relationship. Kaptchuk's work inspires the notion that traditional Chinese herb practitioners are potent agents in clinical outcomes. Treatments are opportunities to invite patients into the world of traditional Chinese medicine (TCM) by engaging in a sensory experience. However, are practitioners leaving significant aspects of TCM out of the big clinical picture?
The modern treatment setting has evolved to center around acupuncture modalities. This new Chinese medicine brand commonly features passively prone patients with carefully placed acupuncture needles in their skin. The time has come to welcome patients into an active role in their healing, by illustrating the whole picture of TCM, with herb therapy as a foundational aspect of the treatment setting.
Traditional Chinese herbal medicine (TCHM) practitioners explore herbal wisdom throughout university and clinical practice. Western patients; however, face an enormous cultural gap when they initially encounter Chinese herbs. These patients have likely not experienced Gou Qi Zi or Huang Qi in their mother's chicken stew. They are often not prepared for the elemental flavors and philosophical methods TCM brings to the healing process.
A patient deserves an invitation into the paradigm of TCM through guidance and collaboration. The beauty is, the practice of herbal medicine is an engaging one. A patient must be an active participant to receive the benefits of herbal therapy. Aristotle wrote, "For the things we have to learn before we can do them, we learn by doing them" in his book of virtue entitled, "Nicomachean Ethics."
Creating a learning environment where patients can learn formula actions, dosage, and preparation while tasting and ingesting herbs to address their pattern establishes a behavior of herbal therapy.
Clinical Benefits
Practitioners work in busy clinical settings, at times with limited resources. The time, space, and tools required to create a seamless experiential herbal medicine intervention will take a bit of effort. However, this intervention is not for a patient's benefit alone. Inviting post-treatment patients to the lobby for tea, allows recovery and reflection time, freeing up a treatment room for the next patient. Demonstrating herbal preparations impacts patient compliance positively. Patients connect with their TCM practitioner once a week at most, but they work with their Chinese herbal prescription daily. Emphasizing therapeutic goals sets the stage for awareness driven positive outcomes.
Practitioners may employ partners to provide herbal therapy visits for patients. Akin to the essential role nurses play in taking vitals, engaging in small talk, and clarifying medication directions, specialized partners can amplify a healing environment. The NCCAOM Chinese Herbal Compounding and Safety (CHCS) Certificate of Qualification (COQ) coming in 2020 will allow a certificate for those in the TCHM field (including partners) to learn about Chinese herb quality and how to administer herb-prescriptions safely. Discussing TCHM quality with new patients is necessary to address concerns that may interfere with compliance.
The Process
The model example here illustrates a TCHM inventory of 12 formulas (three syrups for children, see digital edition) that create single dose teas capable of addressing many differentiated patterns. During the visit, a patient will be introduced to their personalized formula while blending warm water with the herbal material (powder, granules, liquid extracts, or tinctures). The "Experiential Dozen" is similar to wine tasting. It offers a way for a patient to engage their senses with a formula designed to meet their particular pattern. Practitioners that prescribe pills, soups, or bulk herbs may choose a simpler route (such as a powder, granule, liquid extract, or tincture) for only the in-clinic tea experience, explaining to a patient the herbs they will take at home will be slightly different.
The 'Experiential Dozen' can include any formula a practitioner prefers. It is important to keep the collection simple and easy to administer. The list provided shares 12 formulas that alone or with one another in combination can provide a single dose herbal tea for nearly any clinical presentation. Patient engagement is an art-form. The goal of an herbal tea experience is to connect with a patient. A wise practitioner ends a treatment with a formula designed to target a patient's concerns mentioned in the initial encounter. In a world of fast food and fast medicine perhaps TCHM practitioners can say to patients, "I see you. I hear you. This medicine was prepared especially for you. You can do it! You can get better!"
Formulas for In-Clinic Tea
Wind
Yin Qiao San (Honeysuckle and Forsythia Powder); Release exterior wind-heat (heat toxins); Early onset: Fever (perhaps chills), headache, thirst, sore throat, muscle pain
Xiao Yao San (Free and Easy Wanderer); Soothe liver, Disperse qi, Invigorate spleen, Nourish blood; Depression, anxiety, stress, gynecological symptoms
Vacuity
Liu Wei Di Huang Wan (Rehmannia Six Decoction); Nourishes kidney/liver yin, stabilizes essence; Back/knee weakness, night sweats, menopause
Bu Zhong Yi Qi Tan (Decoction for Reinforcing Qi in the Middle Energizer); Invigorates the spleen yang, Replenishes qi; Cold limbs, spleen yang deficient diarrhea, prolapse, qi collapse
Ba Zhen Tang (Decoction of Eight Treasure Ingredients); Qi and blood vacuity (usually due to loss of blood or long-standing disease)
Gui Pi Tang (Ginseng and Longan Formula); Heart/Spleen qi and blood vacuity; Anxiety, insomnia, night-sweats, palpitations
Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet); Kidney-yang vacuity, Invigorates/warms the kidney, Reinforces the kidney and liver; Lethargy, frequent urination/incontinence, low sex-drive
Damp
Long Dan Xie Gan Tang (Gentian Purge Liver Formula); Purge liver/gallbladder (zang-fu organ heat), Lower warmer damp/heat; Irrita-bility, headache, dizziness, red eyes, swelling, painful/dark urine, yellow leukorrhea w/odor
Shen Ling Bai Zhu San (Ginseng, Poria and Atractylodes Powder); Spleen qi vacuity, Resolves stomach damp; Diarrhea, IBS, poor appetite, shortness of breath with cough, fatigue
Pain
Xue Fu Zhu Yu Tang (Decoction for Removing Blood Stasis in the Chest); Qi and Blood stagnation, Promote flow of qi and blood to relieve pain; Cardiovascular issues/chest pain, migraines, menstrual pain, ovarian cysts, polarizing emotions
Du Huo Ji Sheng Tang (Decoction of Pubescent Angelica and Loranthus); Vacuity of: liver and kidney, qi and blood, Chronic bi-syndrome; Lower body pain, back/knee weakness/pain, arthritis with cold/damp (related to weather)
Juan Bi Tang (Remove Painful Obstruction Decoction); Wind-Damp upper body, Move blood; Upper body joint pain, arthritis, neck/shoulder pain
Children (Syrups are a sweet introduction to herbal medicines)
The following formulas are refenced from Golden Flower Chinese herbs:
Yin Qiao Gan Mao Fang (Honeysuckle and Forsythia Common Cold Syrup); Clear heat/toxin, Expel wind; Sinus, throat, cough
Hai Er Fang (Children's Ear Formula); Clear heat/toxin Drain damp; Ear pain
Xiao Er Zi Yu Fang (Children's Jade Defense); Augments wei qi; Allergies
As modern medical standardization continues, the field of traditional Chinese medicine has the advantage of comprehensive personalization. For rare or complex cases, deeper consideration of constitution is invaluable. Proper constitutional assessment, especially with first-time clients, can guide desirable and predictable outcomes. This leads to a higher rate of return, and greater trust between you and your patient.
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.
