Herbs - part two

So here I am in Portland for a long weekend, looking forward to having a treatment at WCA in a couple of days, and attempting to fulfill my CAN blogger obligations. I thought I would continue with the herbs discussion I began last month and hopefully, stimulate some more discussion on the subject.

Brands I prefer and why:

I already said in my previous posting that I rarely prescribe raw herbs, and don’t know tinctures much. In terms of powders I strongly favor KPC concentrated extracts, and for tablets my favorite company is currently Golden Flower. Why? Well, several reasons. I have talked to a number of people whose herbal proficiency I trust (including Andy Ellis) who have visited the KPC factory in Taiwan and reported that their facility is top-notch. KPC have great quality control in terms of species identification, testing for metals, pesticides, etc. I also like knowing that the herbs are processed in Taiwan. With all the scary stuff going on around products from China lately, I feel safer with a company that has good testing and manufacturing practices. And I get results with them.

As far as I know Golden Flower currently contracts KPC to make their tablets from their powder extracts, so they are very high quality and potency, and they are pretty affordable. They really work too! I also like the GF formulas – they are mostly classic with good modifications and they don’t mix in Western herbs, etc, so they are more traditional.

Compliance discussion:

If the patient is new to herbs, I believe it is vital to have this discussion, and it doesn’t have to long or complex if you know what you want to convey. They need to understand that this is a daily commitment, that they will get better results that way. I usually clearly explain what each prescription format (raw, powder, tablets) will involve in terms of their effort / time, money, taste. I give my opinion of what their best, 2nd best, etc choices would be. I want to make sure they actually will make their best effort to get the herbs into them on a daily basis. Then they get to decide what they are up for. I usually do not prescribe the first time for longer that a week, occasionally two weeks, but not longer – I want to see how they do first, before they buy more herbs and spend more money.

Pricing:

This is sometimes a tricky one. I know some people feel that making money off something you yourself recommended is not ethical. I am still mulling all this stuff over and would love to see what other folks think. This is what I do right now: for powders I charge exactly what a local powder herbal pharmacy charges (by the gram), so as not to compete with them. It feels fair to me because it takes time to mix the formula, to package it, to clean up, and I had to invest in a scale and some other equipment to be able to dispense the powders. For tablets, I mark up about 40%, which is usually cheaper than the local health food store that carries Chinese herbal pills. For most Golden Flower tablets that winds up being about $15 per for a 10-day supply of herbs – not too bad at all.

References:

The two books I use the most in my office when I prescribe herbs are the Golden Flower formula guide and Andy Ellis’s book: Notes from South Mountain. Andy’s book, for those unfamiliar, is basically an alphabetical guide to KPC formulas with his suggestions for modification and a great section on prescribing and dosing at the beginning of the book. I think it is the most clear and helpful formula book I have ever used, whether or not you use KPC products. It’s really easy to look stuff up in it, because the index pages are well-done. It handily comes on CD-ROM too.

Herbs in CA clinic – how do I see it?

I am not willing to give up doing herbs, so as I plan my full-time CAP, I am figuring out a way to incorporate herbs into CA. Here’s are some structural ideas I have come up with so far:

- Offer herbal consultations in my CA clinic as a separate service from acupuncture with a similar (or same) fee structure as the acupuncture. I am thinking it would be a 20-30 minute appointment slot (depending on whether they get needled too on the same visit), so it can probably be easily incorporated into a slower acupuncture shift
- Have a small private room in the clinic set up as a consult room and herbal pharmacy.
- The herbal consult is not going to be necessary for every person wanting to take herbs and would be recommended when there is a need for more detailed health history, lab evaluation, nutritional help, etc. Many regular patients will be able to get their herbal prescription without a separate consult, because I will have gotten to know their case enough through their regular acupuncture visits ( I have already experienced this with the community model). If they need a powder formula, I can prepare it after the acupuncture shift (they can pick up another day) or I can have a staff / volunteer fill it. The patient only pays for the herbs in this case.
- I plan to carry tablets, powders and external application products from Spring Wind.

Well, I hope there is more helpful stuff here. I would love to get feedback on the above and to keep exploring this on CAN and learning about how others approach this part of practice.

Thanks a lot for reading,
Tatyana