Herbs – Part One

I thought it would be helpful to share some of my thoughts on the subject of herbs and my ideas about incorporating herbal prescriptions into Community Acupuncture. This is turning out to be a pretty long narrative, and I have been sick with a cold for several days (yes, I am getting’ needled and taking herbs:)), so I am splitting it up into two parts.

Just to be clear, I am not yet doing Community-style treatments full time in my practice, but I plan to soon, and I want to keep doing herbal medicine because I love herbs and because they are very helpful for many of my clients. Also, I am going to be mentioning brands / herb companies and expressing preferences about them – please know they are just my opinions based on my experiences; I am not trying to market anything here, just “talk shop” a bit.

A little background: Right after acupuncture school I worked (part-time) for 3 years for Spring Wind Herbs in Berkeley, which is owned by Andy Ellis. Andy is a really wonderful herbs teacher and has been a pioneer of sorts in bringing up the quality standards in Chinese herbs by encouraging correct species selection, testing bulk herbs for specific pesticides / herbicides / fungicides, and recently collaborating on updating the Bensky’s Materia Medica and Formulas and Strategies books to include more details and more correct information about species, adulterants, etc. He also has worked very closely with a few herbal companies, consulting with them on herb quality and correct species identification. For two of the three years I worked at Spring Wind, I spend 95% of my time as an herbal pharmacist, filling herbal formulas ordered by other practitioners (if you ordered from them during 2004 – 2005, it is very likely I filled your formula). During the 3rd year, the pharmacy part of the business was sold to another person (a friend of Andy’s) and moved to San Francisco, so I spent more time doing warehouse work and helping make Spring Wind products.

I learned so much in this time and it really helped me to feel comfortable with herbs. Since last year, I have been teaching herbs at my alma mater, ACCHS in Oakland and I really enjoy this. I did not explain the above to be deemed as some kind of expert, I just want folks to know where I am coming from in writing this. I don’t generally think I know something others don’t until I talk to another practitioner and they start to point out that I know stuff they never heard before and start asking me more questions. So I thought it would help to share some of the stuff that works for me and see if a helpful discussion can happen, because I want CA clinics to have the option of doing herbs successfully, and I want to help figure this out for all of us, CANers. For reading ease, I separated the rest into sections.

Raw, Powder, Tinctures or Pills?

I think raw herbs are great, but I cannot stock them, because most people I treat do not have the time to cook them. There are a few clients that want raw herbs for their potency or because they are allergic to carriers / binders that may be present in powders / pills. I send them to a local herbal pharmacy I trust to carry good quality herbs for a reasonable price. If you can / have access where you live, I recommend having a relationship with a place like that that you have checked out and feel comfortable with. I have a pre-printed form for herbal prescription with my contact info at the top and I just fill it out and either hand it to the client with the pharmacy address and phone # or fax it to the pharmacy and have them call the client when it is ready.

If you don’t have a local place, there are a couple of good mail order sources: Spring Wind Dispensary on West Coast and Crane on East Coast come to mind. Of course the problem with having herbs mailed is that your patient has to pay for shipping (so it costs more) and that it takes them a few days to get the herbs.

This is why I love powders AKA concentrated water extracts. I know some of you know this already, but you will be surprised how many acupuncturists don’t - Concentrated powder extracts are cooked decoction sprayed onto a starchy (rice or potato usually) carrier in a vacuum container, so they are the next best thing to cooking your own raw herb decoction. They are cooked, so they are not the same as ground up raw herbs! Many people get confused about this and it is pretty important because most herbs are meant to be “cooked” or processed somehow. With powder extracts, you can customize the formula anyway you want, they take up less space, keep for a long time, and are much more “portable” and user-friendly for the patient than raw herbs. And they work!

Tinctures – I don’t actually have much experience with them, and so I really can’t share much. I know some tinctures are really wonderful and high quality, and I have also experienced them to be kind of pricey. I am generally partial to water extracts because I learned that the most traditional way to prepare most Chinese herbs is decoction – so I just trust that chemical process more. It would be great to hear from someone who uses tinctures regularly and see what they have to share about their experience.

I think that’s it for this time, but I will post again soon with part two and some thoughts on:
-Brands I prefer and why
-Good reference materials for easy prescribing
-Compliance discussion
-Pricing herbs
-Herbs in a Community Acupuncture setting – how would it work?

I really hope this is a helpful discussion… would love some feedback and/or questions.
Tatyana