Herbal Treatment - The Big Picture
"Make everything as simple as possible, but not simpler. "
- Albert Einstein -
The key thing Nai-shing and I do every day is to formulate treatment
protocols specific to the individual needs of the patients we see. In
this section I want to show you how we go about putting our knowledge
to use in the clinic. I want you to understand how herbalists
throughout the world can solve real medical problems with scientific
reliability. To do that, it was necessary for me to give you background
information and basic vocabulary. In the first sections of this
teaching website I covered the basic herbal traditions, herb growth
and preparation, safety issues, and some essential language tools. In
the second section I introduced you to about 100 of the most important
and trusted herbs my wife and I use in our practice. This section is a
little bit more technical, but now you are prepared to understand it.
Congratulations. Let's begin.
First of all, to treat real diseases, it is not enough to know what the
individual herbs do. You must also incorporate diagnostic information,
physiological knowledge, problem-solving skills and guiding
philosophical principles. We will explore a few of the main diagnostic
and conceptual tools used by the three different medical systems I work
with, all the while recognizing that we are navigating just the
smallest tributary of the herbal sea.
It took me quite a while to figure out how I could simplify the vast
amount of information required to deal with the complexities of medical
treatment. Then I recalled to story my
friend molecular biologist Jon Narita told me about how biochemists
learn. Rather than attempting the impossible task of learning
absolutely everything there is to know about the biochemical life
processes, they choose a few key areas of biochemisty to study in
depth. This gives them the essential background to understand other
areas as needed. We will do the same here, as we examine some facets of
our major herbal traditions.
• Our discussion of TCM will explore some of the concepts regarding
causative factors, which are clinically very useful, and are simple
enough to begin to apply right away
• Our discussion of Western medicine will examine blood testing, a
practice of great value in understanding your health that is often
confusing to patients.
• Our discussion of Ayurveda will explore some philosophical
issues to try to understand how these ancient truths still have
relevance and value in modern medicine. I will go out on a limb here,
and reveal some evidence that may shock you into seeing the world in a
• We will also examine some integrated concepts, including a
simplified tongue and pulse diagnosis system appropriate for beginning
and intermediate students.
How to Construct Herbal Solutions to Health Problems
When you are ready for herbal treatment, whether for yourself or for
others, the first step you must take is to objectively examine the
health and identify problem areas. Most people could stand to
make at least a few dietary and lifestyle changes to improve their
health. Once you have identified the areas that need improvement,
you can begin to develop a treatment protocol. Remember that you can
always make adjustments along the way as you figure out which therapies
and/or regimens are appropriate.
When it comes to the world of herbal therapy there are several levels
of knowledge and expertise, beginning with the novice and ending with
the skilled practitioner. It is important to identify your level
so you know how to proceed.
• Level 1: Rank beginner. If
you are completely clueless, but smart enough to know that you don't
know, the best thing you can do is find a good natural medicine
therapist and do as you are told. You should ask around and do
some research on your own before choosing a practitioner. It’s
always a good idea to explore your options, and it helps to get
recommendations from people you trust. After working with a good herbal
practitioner your understanding will mature. See the resource guide for
infomation on how to locate a practitioner.
• Level 2: Educated consumer.
If you have already educated yourself in the basics of holistic
medicine, you may want to get a good diagnosis from your doctor and
research over-the-counter treatments as well. Once you are
familiar with all the available options, you can make a choice whether
to see a professional or begin to develop your own herbal protocol
using the guidelines I’ve provided. If you have completed this
book you will be better equipped to sort through the wealth of
information out there. Don't fall into the trap of using everything
that is "good for the liver" or "good for diabetes."
Most of the herbs I list are readily available in the consumer
marketplace, but you may have difficulty tracking down a select
few. If you’re not sure how to obtain some of the herbs and
preparations I’ve discussed, refer to the resource guide at the end of
the book—you may find the answers there. If not, ask the manager
or owner of your local natural foods store.
I would suggest starting slowly, incorporating just a few well-chosen
single herbal or nutritional products along with the necessary and
appropriate lifestyle changes. Depending on the results you want to
achieve, it is possible that a combination product or formula already
exists for your particular needs. Write out a list of the herbs I have
recommended for your particular needs, and take it with you to the
store. You may find a pre-packaged formula (tincture or pills)
that contains at least some, if not all of the herbs you’re looking
for. Always remain aware of your limitations, and do not hesitate to
seek out professional help if the problem is more complicated.
• Level 3: Budding herbalist.
If you are a budding herbalist, you are not only self-educated, but may
also have amassed a solid base of experience using various herbal
medicine therapies. You may not feel limited to pills and capsules. You
may want to try combining a group of herbs in a formula after studying
each one carefully. This will require you to find sources for some of
the more exotic Chinese and Ayurvedic herbs. (Sources for most of the
herbs I use can be found at one of the locations listed in the resource
guide.) It is important to note that the herbs may not all be available
in the same form, so be creative. If you compile a list of ten herbs
you want to use, and find that seven are available as crude powders and
three as tinctures, it may be necessary to make a tea from the crude
herbs and add the tinctures to the tea before drinking. Also, recognize
that you will have to defer to qualified health care practitioners for
serious or difficult problems. Don't trick yourself into thinking you
can treat nephritis compounded by liver disease at home.
• Level 4: Skilled therapist or
physician. If you are a skilled therapist or physician looking for
solutions to health problems faced by your patients, you may recognize
the inherent difficulties in trying to match herbs with patients in the
real world. You probably already have good sources for herbal materials
and utilize a system of clinical and differential diagnosis. Either you
have already explored the patient’s health condition and understand the
underlying causative factors, or you’re in the process of working this
out. At this point you can read about my personal approach to each
specific disease process and take note of the herbs I recommend for
treatment. Then you can do your own supplemental research to
identify and utilize only those herbs that match your patient’s
particular needs. Additionally, skilled practitioners entering from a
scientific discipline background must recognize the philosophical
requirements of herbal medicine. You must be aware of and sensitive to
your patients’ emotional and spiritual needs in addition to their
physical and dietary requirements. Herbal medicine is more than herbs.
But, I'll bet you already knew that.
Please note that within the discussion of each disease, I have
identified important causative factors, as well as possible herb
choices if those factors are relevant in a particular case.
DIAGNOSIS - Signs, Symptoms & Specifics
Classification and Diagnosis
The general public is most accustomed to approaching health conditions
by diagnostic category or name, such as asthma, diabetes or arthritis.
This is often the standard approach of Western medicine, and it is
important. In fact, a specific and clear diagnosis based upon
physiology is very, very important. If someone has eye pain, for
example, it is important to make sure a hidden tumor or chemical
poisoning is not the cause.
However, although diagnostic terms offer us important information about
the problem, oftentimes it is not enough to determine the proper herbal
treatment. In fact, although we do not usually see it, each of us is
bound by often-unexamined beliefs about the nature and meaning of
disease drawn from our culture and upbringing. For example, a
diagnosis of asthma seems to clearly tell us that the patient has
trouble breathing. We assume that this word means something
specific. In fact, it does not tell us the level of inflammation
in the lungs, the amount of mucus in the lungs, the amount of tension
in the surrounding muscles, the level of diaphragm use or disuse, or
anything about contributing causes such as exposure to toxins or
cigarette smoke. Therefore, you cannot simply take "asthma" herbs and
expect good results. To understand how an herbalist or trained holistic
doctor thinks, you must first recognize that diseases can be examined,
diagnosed and treated from different points of view. When a
practitioner draws ideas from a system of thought, whether Western,
Naturopathic, Ayurvedic or Chinese, we say the prescribed treatment is
based upon signs and symptoms.
We define a symptom as any departure from normal structure, function or
sensation experienced by the patient. The most important part of this
definition is the phrase, "experienced by the patient."
We define a sign as a change in the normal structure or function of the
body that can be discovered by examination. The focus of this
definition is the idea that a sign is "discoverable by examination."
Symptoms are subjective, while signs are objective and usually more
physiologically specific. Symptoms and signs do not quantify the
disease. Rather, they should lead to an accurate understanding of the
In Western medicine, causation is related to morbid changes in the
biochemical or physical structure and function of the body. Determining
the cause requires data collection (urine, stool, images, subjective
and objective findings etc.) and systematic comparison and contrast of
the findings until you can determine a specific diagnosis.
In TCM, causation (bing yin) is related to "patterns of imbalance"
which are discovered by the signs and symptoms as understood in this
system. Determining the pattern requires a questioning process along
with pulse and tongue observation to define the nature or mechanism of
the imbalance (i.e. deficient, excess, cold, hot, wind), and the
location (i.e. internal organs, blood, energy meridians) of the
In TAM, causation (hetu) is related to aggravating agents (foods,
behaviors, emotional changes, seasonal influences, physical injuries
etc.) that cause either direct physical damage, or an imbalance in
Vata, Pitta and/or Kapha which leads to the emergence of doshas
(pathogenic defects). Determining the imbalance requires questioning,
observation and testing to define the prognosis, symptoms and morbid
anatomy. Diseases are defined both by specific name (as in Western
medicine) and by the nature and location of the doshas.
Understanding the TCM Causative Factors
TCM doctors use several basic ideas beyond Yin, Yang and Qi (discussed
in Chapter 6) to assist in their diagnoses and herb choices. As I
mentioned earlier, these terms are effectively used to describe the
external world we live in, as well as conditions that can penetrate and
reside in the body.
Deficiency and excess are basic
TCM medical terms. In diseases of deficiency, there is a pre-existing
weakness in the tissues or immune system that creates a
hypersensitivity to normal conditions. In excess conditions, the
disease is due to causative factors like stress or toxins that congest
or overcome normal resistance. For example, a high cholesterol level is
a disease of deficiency if caused by a weak thyroid (which slows down
the metabolism). Conversely, the same condition is a disease of
excess if caused by a dietary excess of poor quality fats. One
well-known health problem that can help us understand how deficiency
can cause what appears to be a fever-like condition are the hot flashes
that often accompany menopause. Everyone recognizes that you
cannot effectively use anti-inflammatory Western medicines or strongly
cooling herbs to stop hot flashes. This is a deficiency problem—it is
actually the hormonal decreases occurring during menopause, which
creates this problem. Hence, it is necessary to use estrogen
replacements or herbs that supplement and nourish the deficiency.
The different way each person’s body responds to illness has important
implications for diagnosis and treatment. For example, just because two
patients suffer from hypertension doesn’t mean you can prescribe the
same herbs to treat both of them. If one is a 96-pound 80-year-old
grandmother, and the other looks like Arnold Schwarzenegger, you
obviously need to account for differences in their body size, strength
and general state of health before recommending a treatment.
• Diseases of deficiency are usually treated with nourishing tonics.
• Diseases of excess are usually treated with herbs that remove the excess or which stimulate the excretory organs to do so.
Note: Yang diseases tend to be
external, excessive, hot and dry in nature. Yin diseases tend to be
internal, deficient, cold and damp in nature.
Heat and cold have already been
described in terms of the herbal energetics, or the actions of herbs.
Some herbs are described as heating and some as cooling. Similarly,
diseases can be hot (inflammatory) and hypermetabolic in nature, or
cold and hypometabolic. TCM doctors explain the difference between
internal and external heat and cold. External heat results from an
influence outside of the body, as when the skin is inflamed by the sun.
Internal heat results from internal disturbance, fever or toxins.
External cold results from an outside influence, as when the body gets
chilled due to low air temperature. Internal cold results from a
metabolic weakness inside the body, as when the thyroid is underactive.
• Hot conditions are treated with cooling herbs
• Cold conditions are treated with warming herbs.
Dampness refers to an
accumulation of fluids in the body. When the dampness resides in the
outer muscles and tissues, you feel stiff and swollen, often with dull
pain and edema. If the dampness resides in the digestive system, you
might feel nausea and sluggish digestion. If the dampness resides in
the lungs, you will feel heaviness and air hunger. Dampness has three
basic levels in Chinese thinking, starting as simple fluid
accumulation, progressing to thicker partially congealed dampness, and
leading later to thicker viscous accumulations of mucus.
• Dampness is treated with herbs that remove dampness or break up
mucus, or herbs that increase metabolism to drive out the dampness. TCM
doctors also use herbs that stimulate Qi to drive out the dampness.
Dryness is the opposite of
dampness, and can be caused when heat and inflammation dry out the
bodily fluids, or when blood supply to the tissue(s) is poor.
• Dryness is treated with herbs that moisten, or herbs that nourish the blood.
Wind refers to disturbances of
the nervous system, which result in symptoms like spasms, paralysis,
dizziness, shaking, convulsions and nervous tension and/or irregular
functioning in individual organs or systems. Pains or tensions that
quickly move from one area to another are also attributed to wind by
TCM doctors, as well as certain skin and liver problems. TAM doctors
look for signs of gas or swelling in tissues or in the abdomen that
yield to external pressure and bounce back
These ideas show that the TCM, Western and TAM conceptualization of
"wind" are a bit different. I think the Ayurvedic way of approaching
this is the most clear, so I use it in my practice. However--and this
is important to grasp--if I am reading about or using TCM herbs, I have
to defer to their understanding to fully grasp how and why they would
choose a particular herb. The same is true when I am choosing Western
• Wind is treated in TAM with herbs that calm, warm and nourish, and
reduce Vata dosha and in TCM with herbs that nourish the blood, herbs
that remove heat from the liver, or herbs that nourish the Liver Yin.
Western herbalists treat wind with antispasmodic and nervine herbs.
Making TCM Causative Factors Real and Useful
It is easiest to understand how causative factors "exist" during most
disease processes when we combine them to describe a problem. For
example, if you have a fever and a chest cold with thin green phlegm,
this is a heat and mucus condition. If you have a fever and a spasmodic
cough, this is a wind and heat condition. I use this simple system of
classification not only to help me prescribe herbs but also to aid in
selecting appropriate diets during illness.
• For a spasmodic cough with fever, a TCM doctor would use herbs that remove wind and heat from the lungs.
• For knee and ankle swelling which "bounces back" when pressed,
indicating trapped gas, the TAM doctor would use an appropriate
swelling treatment (Kapha-reducing diuretic herbs) along with herbs
that reduce Vata.
• For painful urination with a "funny smell," a Western holistic doctor
or a Naturopath would order a urinalysis to culture for infectious
organisms, do blood tests to check for metabolic problems, and
prescribe herbs or antibiotics based upon results.
The Importance of Scientific Diagnostics
As mystified as people are with Oriental medical concepts, I have seen
just as many if not more people mystified by Western diagnostic
concepts and tests. Blood tests, for example, are windows into your
health, because your blood interacts with just about every cell in your
body. Equally as important as Yin or Yang, these tests are
excellent ways to measure to benefits or failure of herbal treatment,
providing--in conjunction with symptom changes--guidance to your
Over the past seventy years, scientists have made tremendous progress
in disease diagnosis and in our understanding of pathological
processes. Good diagnostics are a vital part of holistic
medicine. At our clinic we see many patients after they have
received a diagnosed from Western-trained doctors, and we also send
patients out to Western specialists when we find a need for further
diagnosis. Oftentimes, using specific scientific diagnostics in
conjunction with herbal signs and symptoms can be critically useful for
choosing the correct treatment protocol, herbal or otherwise.
Today, as the study of herbs continues, we now know much more about the
specific biochemical actions of herbs. Therefore, if someone has, for
example, a deficiency of a particular blood component, such as
platelets or red blood cells, we can choose herbs that have been shown
to improve those blood parameters.
The following is a simplified explanation of the most common blood
tests that your doctor may run. Good physicians will explain these
tests to you, and as a patient you have the right to get copies for
your own edification. Normally you will find reference ranges next to
your test results in each category, so you can see if your numbers fall
within normal values.
• Complete Blood Count -(CBC)
This test measures the total number of red and white blood cells.
It works with percentages, and analyzes them in different ways. The CBC
includes a number of different tests, and measures your numbers against
average values in each area to determine if they are high or low.
1. RBC test - Measures the
number of red blood cells in a given volume of blood. Your red blood
cells carry oxygen to your tissues. A low count of red blood cells can
indicate blood loss, reduced RBC production (often due to nutritional
deficiencies), or increased RBC destruction.
2. WBC test - Measures the
number of white blood cells. A low white cell count can often be
attributed to the same general causes as RBC's, and may indicate immune
system deficiency. An increased white count may indicate that the body
is fighting an infection.
3. HGB test - Measures your RBC
hemoglobin, a protein that carries oxygen and carbon dioxide. A low
level of hemoglobin indicates a reduced ability to carry oxygen, which
can be caused by many chemical factors such as auto fumes, toxic gases,
cigarette smoke and blood loss. Elevated levels can indicate vitamin
4. HCT test - Measures
hematocrit, the proportion of RBC's in your blood. A low hematocrit
count indicates anemia, possibly due to nutritional deficiencies.
5. MCV test - Measures the
average size of your RBC's (mean corpuscular volume). The RBC's
can swell up in response to inflammation, liver disease or even
abnormal production problems in the bone marrow. This increased MCV
often causes them to die off faster, leading to anemia. When cells are
too small (low MCV), it is often indicative of nutritional deficiencies.
• Individual White Blood Cell Tests
- Segmented neutrophil test, lymphocyte test, monocyte test, eosinophil
test and basophil test are all different types of WBC tests. These
cells are easily depleted by infections or chemical stress, so if these
numbers are low, or imbalanced with too many of one type and not enough
of another, it usually indicates some type of physical or chemical
stress. This phenomenon is directly related to immune system
deficiency, which we will discuss in more detail in our discussion of
the immune system in chapter 19.
• Platelet test - Platelets are
small corpuscles that participate in the blood clotting process. Low
numbers may indicate bone marrow or autoimmune problems. High numbers
may indicate poor spleen function.
• Blood Chemistries - Blood chemistry tests look for different substances normally found in you blood serum.
Note on Cholesterol Tests (Lipid Profile): There are several different types of lipids (fats) in your blood.
According to current medical theory, elevated levels may increase your
risk of arteriosclerosis, stroke and heart attack. However, there are many reasons to be skeptical of these tests.
1. TC (Total cholesterol) test -This test measures the blood level of a particular lipid called cholesterol.
2. HDL (high-density
lipoprotein) test – The high-density lipoprotein is a good and
important fat. I tell people to remember this as "Happy DL." If levels
are low, it indicates a greater risk of cardiac artery disease. Things
that can lower HDL include lowered by lack of exercise, genetic
factors, and chemical drugs.
3. LDL (low-density
lipoprotein) test – LDL is a bad cholesterol, which I tell patients to
remember by calling it "Lousy DL." People with LDL levels that are too
high are at greater risk of developing heart disease.
4. Glucose test - This test measure the amount of sugar in your blood.
Elevated levels indicate poor glycemic control or diabetes, and low
levels can indicate the presence of hypoglycemia.
5. Triglyceride test - This test measures a type of blood fat that is usually elevated due to a dietary sugar excess.
6. Uric acid test - Uric acid is a waste product from nucleotide
metabolism. Uric acid is actually an antioxidant, produced by your body
in response to inflammation. High levels indicate the presence of gout
or arthritis, and occasionally kidney disease or leukemia.
7. Total Protein test - Proteins are manufactured and used by your body
for innumerable processes related to growth, repair and defense.
Elevated levels can indicate problems in the liver, kidneys or general
metabolism, while low levels often indicates nutritional deficiency
7a. Albumin test - Elevated levels of this protein relate to
dehydration, while lowered levels relate to malnutrition, poor
absorption, liver and kidney disease, and metastatic cancers.
7b. Globulin test - Elevated levels indicate lupus, melanoma, liver
disease and sarcoidosis. Lowered levels indicate immune system
7c. A/G ratio - This is the ratio between albumin and globulin. A
lowered ratio is indicated in severe inflammation or infection, liver
disease, colitis, kidney disease, diabetes, and metastatic cancers.
8. Calcium test - Calcium in your blood is necessary to maintain bone
metabolism and numerous other metabolic processes. Deficiency can
relate to heart palpitations, muscle spasms, bone loss or bone
diseases, inflammation, vitamin D deficiency etc.
9. Inorganic phosphorus test. Elevates levels of phosphorus are found
in parathyroid problems, bone and calcium metabolism problems, diabetic
acidosis, and some forms of kidney disease.
10. Bilirubin total test - This test measures the ability of the liver
and spleen to break down and eliminate dead red blood cells. Elevated
levels indicate liver disease and certain types of anemia.
10a. Bilirubin direct - Elevated levels are related to obstructions, such as obstructive jaundice, gall stones, and tumors.
10b. Bilirubin indirect - Elevated levels indicate liver diseases, anemia, and gall bladder disease.
11. BUN (Blood urea nitrogen) test - Measures the ability of the liver
and kidney to eliminate the by-products of protein metabolism. Elevated
levels are seen in adrenal, liver, thyroid and anterior pituitary
dysfunction. Low levels are seen in posterior pituitary dysfunction.
12. Creatinine test - Measures the ability of your kidneys to excrete a
byproduct of muscle metabolism. Increased levels are seen in kidney
failure, urinary obstruction, dehydration, muscle diseases and
13. BUN/Creatinine ratio – A measure of kidney function. Elevated
levels can mean kidney disease, excess protein, insufficient fluid
intake, and prostate swelling (BPH).
14.Sodium test - Sodium is related to maintenance of calcium/phosphorus
ratios and acid-alkaline balance. Elevated levels are related to
dehydration, excess salt intake, and kidney diseases. Low levels are
related to low adrenal function, heart failure, and vomiting.
15. Potassium test - Potassium is essential to heart and kidney
function. Elevated levels are related to acidosis, adrenal
deficiency, pharmaceutical side effects, and kidney disease.
Decreased levels are found in liver cirrhosis, malnutrition, alkalosis,
diarrhea, fatigue, irregular heartbeat, and kidney diseases.
16. Carbon dioxide test - CO2 levels are related to blood acid
and alkaline balance. As levels rise, hemoglobin decreases leading to
oxygen starvation. Elevated levels are found in lung disease and
alkalosis and low levels are found acidosis, inflammation or
17. Magnesium test - Magnesium is an important mineral for many
metabolic processes. Low levels can indicate diarrhea, muscle or other
spasms, poor nutrition, diarrhea, heart irregularity, and diabetes
18. SED rate - The sedimentation rate test measures clumping of red
blood cells. It elevates when there is an infection or inflammation
anywhere in the body. It does not indicate where the inflammation is,
only its existence.
• Blood Enzymes - Enzyme levels in your blood act as markers for damage to various
tissues. Elevated levels indicate problems in specific areas,
especially with your liver.
1. LDH test - This test measures lactate dehydrogenase, an enzyme that
is widely distributed in the body. Elevated levels indicate heart
tissue destruction (heart attack), anemia, leukemia, malignancies,
brain or muscle damage, seizure activity, and liver damage.
2. ALT (SGPT) test - This enzyme (alanine aminotransferase) is
related to liver metabolism, and elevates in liver congestion,
hepatitis, cirrhosis, liver cancer, severe inflammation, chemical or
drug exposure, and pancreatitis.
3. AST (SGPT) test - This enzyme (aspartate aminotransferase) elevates
in heart inflammation, heart attack, liver diseases, trauma,
pericarditis, pancreatitis, seizures, and chemical or drug
4. Alk Phos test - This enzyme (alkaline phosphatase) measures
metabolism in bone, liver and tumor cells. It elevates in prostate
cancer, prostatitis, heart attack, excessive platelet destruction, and
liver or bone diseases.
In our practice we use these blood tests extensively to monitor the
progress of our patients. If someone has hepatitis, we monitor liver
enzymes. If a patient has an immune system deficiency, we
monitor the white blood cell counts. Because herbs are so
effective at lowering elevated liver enzymes and raising WBC counts,
this is a perfect example of the integration of systems.
Ayurveda Made Real
Vata, Pitta and Kapha in Diagnosis and Treatment
I remember attending a conference with a budding holistic MD many years
ago. As I talked to him about Vata, Pitta and Kapha, I could see him
growing impatient. Finally he said, "I'm trying to remain open-minded.
But, frankly, I'm fed up with ethers, auras, Yin, Yang, Kapha and Qi.
Let's get real."
I understand his dilemma. The modern mind finds these terms primitive.
We feel more comfortable calling confusion "cognitive dissonance." The
word “ulcer” sounds better to us than "fire in the stomach." However,
the meaning behind the terms is our primary concern. The job of a good
translator is to change the words without altering the underlying
meaning, and to find ways to make unfamiliar concepts clear. The
question I want to tackle here is, "Do the Ayurvedic conceptual
divisions have a basis in physical reality?" I think that they do, and
this becomes clear when we change the words a bit, and examine some
lesser-known areas of biology. When we examine large patterns,
necessity dictates that we lose a certain amount of detail.
However, it is a mistake to think that these simplified concepts can
somehow supercede the complexity of life. They cannot. They can, at the
clinical level, help us find order within the complexity, and see
relationships that are otherwise hidden.
In other words, we need some background before we can understand the
Ayurvedic divisions as more than folklore or contrived religious
concepts. My teacher, Dr. Mana, like all Ayurvedic physicians,
firmly believes that the ancient ideas are based in philosophy
(actually spiritual knowledge discovered by sages) but exist in harmony
with physical realities. Like TCM and Western herbology, the concepts
lead to successful prescriptions and cures. Essentially, Vata, Pitta
and Kapha, as well Yin, Yang and Qi are methods that allow us to
examine the status of whole system homeostasis.
However, to remain truly universal, and to avoid materializing these
ancient concepts, we have to consider a few more ideas. Can we
find Vata, Pitta and Kapha elsewhere in the world of biology? Can these
terms help us to see things that we could not see before? Remember
first that the concepts behind Vata, Pitta and Kapha describe three
elemental processes or energies understood since ancient times as
regulatory, destructive (transformation or energy) and creative
(growth), respectively. The organism is a whole that lives in dynamic
relationship to these processes, and thus itself is arguably a
regulated process, and not a “thing.” In time this translates as
processes of absorption, transformation and production. For example,
the eye can absorb a photon of light and transform it into a molecular
cascade of reactions, which result in the production of a neural
electrical impulse. The digestive system absorbs nutrients and
transforms them through a different cascade into our physical
The same three aspects can also be identified in the
spatial organization of an embryo. Consider that in the early
stages of embryonic development, human cells divide into three primary
germ layers, out of which develop the entire nervous system (Vata). The
metabolic heart, muscle, bone, urogenital, and vascular (blood and
lymph) systems (Pitta) arise from the ectoderm. The nutrient
absorbing digestive tract (Kapha) develops from the endoderm. All (and
I mean all) organs and cells in our body develop out of these three
layers. Is it not possible to consider these three primary germ cells
as progenitors of three large meta-systems that maintain a systemic
integrity throughout life? What we normally consider to be organs are
actually sub-systems within these three. In this way of thinking, might
we consider these germ layers to be our meta-organs? Further, might
they not maintain a systemic integrity throughout our life spans?
The prefixes endo, ecto and meso refer to locations. Endo means inner,
ecto means outer, and meso means intermediate. As we move inwardly into
the organism we see the same divisions in the form of an almost
infinite hierarchy of nested compartments, all with insides, outsides
and middles. Thus, our individual cells have smaller organelles within
them, such as the nucleus and the mitochondria. Some physicists believe
(and offer mathematical proof) that this pattern of nesting is
necessary to maintain thermodynamic and biochemical equilibrium within
living organisms (Ho, 1998).
What happens if we move outward? Let's consider the work of Wolfgang
Schad, the brilliant German zoologist. (Allow the “Twilight Zone” theme
song to play through your head as you read this.) In his out-of-print book Man
and Mammals: Toward a Biology of Form, Schad describes how relative
differences in these three primary systems explain much about mammalian
physiology. Schad notes that not only are there three primary organic
systems operating within mammalian organisms, these "systems" can also
be seen without, in the three largest external groupings of Western
hemisphere mammals--the rodents (Vata), the carnivores (Pitta) and the
ungulates (Kapha), which together comprise more than 70% of mammals in
this area (Schad, 1971). (Schads work is based on the teaching of Goethe, and a brief review of how this works can be found here.)
• Vata animals - Rodent physiology (mice, squirrels, beavers etc.)
emphasizes nervous system development. Small in size, they are known to
have restless and highly sensitive natures.
• Kapha animals - Ungulate physiology (cows, horses, pigs, deer etc.)
emphasizes digestive processes. They are large in size, with passive
temperaments. The multiple stomachs of the cow constitute a
• Pitta animals - Carnivore physiology (lions, tigers, weasels
etc.) emphasizes metabolic and energetic processes. Predatory and
aggressive in nature, these animals epitomize energy and power.
Schad softened me up by pointing out that the horns on cows are
actually teeth that have moved up (note that canines are nowhere to be
found in cow dentation). He then essentially floored me when he
pointed out that the tripartate divisions within and without all
mammals could even be recognized within the subgroups. Thus, within the
large ungulates we have divisions into the super docile cows, the more
aggressive swine, and the relatively nervous high-strung horses. And
within the small nervous rodents, we have the more sensitive mice, the
more docile squirrels, and more aggressive porcupines. Finally, even
within the sensitive mouse group, we have the super sensitive harvest
and field mice (Vata), the larger more docile hamsters (Kapha), and the
obviously more aggressive rats (Pitta).
Ayurveda in Cell Biology
If my attempt to link ancient philosophy with modern science is to
survive, I am obligated to prove that these basic patterns occur in
other places, such as at the cellular level. It is easy to find Vata
(regulation), Pitta (energy release) and Kapha (growth) in the
individual cell. The nucleus, containing the master blueprint DNA, is
obviously a regulatory (Vata) center. The cell membrane regulates the
import and export of nutrient molecules--the raw materials for growth
(Kapha). And in the cytoplasm of each cell we see the many organelles
involved in a variety of energy and production processes, including
hundreds of mitochondria, our ultimate energy (Pitta) source, providing
cyclical energy to transform raw materials into useful ones.
When we look at cells from a structural point-of-view, we see that
fatty acids (Kapha) are the major building blocks of the membranes,
sugars called nucleosides are the building blocks of DNA and RNA
(Vata), and the building blocks of our worker bee proteins are amino
acids (Pitta). We will discuss the three main macronutrients, fats,
carbohydrates and proteins in the nutrition section.
One of the hottest areas in biology is the molecular cell signaling
systems. Molecules travel through the body until they reach receptor
sites on cells where they bind and initiate vital cell processes. The
vast majority of signaling molecules (like mammals) belong to one of
three large families. The first thing to remember is that, like the
sensitive mice group, all signaling molecules start off as Vata or
regulatory phenomena. The question is, what happens next?
• Ion channel-linked receptors (Vata) - Stimulation of these sites
alters the flow of ions, producing an electrical effect. They are the
receptors that control voltage changes related to neurotransmission.
• G-protein-linked receptors (Pitta) - Stimulation of these cell
membrane sites generally causes increases in energy activation,
including cyclic AMP (which energizes nerve cells as one function),
sugar breakdown (which increases energy production), accelerated
heartbeat, and activation of cellular response to light and smells.
• Enzyme-linked receptors (Kapha) - Stimulation of these receptor sites
causes activation of growth factors, proteins that regulate cell
growth, proliferation and differentiation in our tissues (Albert et
Ayurvedic Body Types
With the background information just provided, it should now be
torecognize and understand the existence of the three Ayurvedic body
types (Prakriti in Sanskrit) as one expression of the tripartate
patterns found throughout mammalian physiology. Whether this is a
physical reality or a "way of knowing" is irrelevant. My experience in
learning to distinguish these body types has helped me greatly in my
clinical practice. I recall that it was not easy at first. It took me
more than two years to develop the ability to identify a patient’s body
and energy type quickly at the time of first meeting. You can’t imagine
the effect it has on a new client when you describe their basic
personality traits since childhood to them in detail after knowing them
for only five minutes.
• Vata types are sensitive and restless in nature, generally high in
intelligence, thinner (due to weaker digestion), and prone to
nervousness and fatigue when ill.
• Pitta types are aggressive and strong-willed in nature, generally
hot, highly energized and physically strong (due to strong metabolism),
and prone to inflammatory conditions when ill.
• Kapha types are slow and stable in nature, generally heavy and solid
physically (due to strong digestion), and prone to mucus and "sluggish"
conditions when ill.
General Guidelines for Herb Use Based on Body Type
• Sensitive Vata types should use lower doses of herbs, and should use warming, calming and nourishing herbs.
• Strong-willed Pitta types should use higher doses of herbs and use more cooling and detoxifying herbs.
• Slow, stable Kapha types should use more warming, spicy, energizing and mucus-reducing herbs.
It is difficult to use this theory properly unless you realize that
everyone contains all three within themselves, and that many people are
Vata-Pitta, Vata-Kapha and Pitta-Kapha. If you are not sure of your
body type, usually you can easily pick one to eliminate, and what is
left is probably you.
Ayurveda in the Clinic
Dr. Mana has taken the Ayurvedic concepts further, focusing on internal
regulation. He points out that each organ and system in the body has
arteries, nerves and veins that regulate its health. Vata, as the
regulator of movement, can be equated with nervous system
control. Kapha, as regulator of creative processes, can be
equated with (or seen in action within) the body's arterial supply of
nutrients. Pitta, as regulator of destructive processes, can be equated
with venous drainage of fiery metabolic wastes. These direct
associations help us gain a practical clinical understanding of
Ayurveda. Each organ can be discussed in terms of how well the nervous
system is doing its job (Vata), whether or not the organ or body system
has sufficient or excessive nutrient and fluid supply (Kapha), and
whether or not it is efficiently producing energy and draining away
inflammation and waste (Pitta).
Following Ayurvedic logic, destructive agents, such
as unhealthy foods, germs, viruses and toxins, enter the body or are
internally generated during metabolism, after which they mix with
normal gases, bile and mucus. These bodily components then act as
carriers for both pathogens (waste) and nutrients. When the effects of
pathogens exceed the body’s ability to detoxify and excrete (through
urine, feces, sweat, exhalation, etc.) they begin to overpower their
Ayurvedic doctors monitor the health of the body
through careful observation of these components. Any emergence of
physical symptoms or changes in the organism as a whole indicate that a
corruption, blockage or alteration has occurred. For example, if the
liver cannot sufficiently detoxify, then the bile becomes toxic, and
inflammation or heat increases. If the digestive system cannot fully
and completely excrete heavier substances, then dampness and/or mucus
begin to accumulate. If the body as a whole or individual cells cannot
fully, completely or properly respire, toxic gasses begin to
accumulate. It is through the physical manifestation of signs and
symptoms that the doctor can identify and correct the cause of the
The eyes may be the windows to your soul, but your tongue is the window
to your digestive system. When you eat, your teeth decimate food by
crunching it like giant hydraulic presses with jagged steel edges,
while your tongue darts around and wallows in the food like a greased
pig in mud. (Okay, okay. I was just giving you a visual to help
you remember.) During its immersion in the food bath, your tongue
sends signals to the digestive system about the tastes and other
qualities of the food. Think of the whole system, from the tongue to
the stomach, as one long, continuous membrane. As the digestive
tract undergoes various changes in its state of health, these changes
are physically reflected in the tongue.
The following simple observations can help you diagnose conditions that may exist in the digestive tract:
• A swollen tongue may indicate dampness.
• A dry tongue may indicate inflammation and/or dehydration.
• A redder-than-normal tongue may indicate heat and inflammation.
• A pale tongue may indicate blood deficiency or anemia.
A blue tongue may indicate thick stagnant blood, insufficient oxygen or
poor circulation. It can also be an indicator or intestinal infection.
• A small, thin tongue (as if it has shrunk) may indicate Yin (nutrient) deficiency.
• A thick white coating on the tongue may indicate mucus.
• A thin white coating may indicate cold and dampness.
• A thick, yellow greasy coating may indicate heat and dampness.
• A puffy and swollen tongue with visible tooth marks may indicate weak digestion.
• Redness around the edges of the tongue may indicate liver inflammation
• Swelling and a bluish tint of the large veins on the back of the
tongue (you can see this when you curl the tongue up) may indicate
• A withered and quivering tongue may indicate severe deficiency and nervous exhaustion.
Note: These signs should never be taken alone as definitive diagnoses. They
are pieces of information that, along with other signs and symptoms,
must corroborate to form a diagnosis and treatment protocol.
The pulse is another tool herbalists use to diagnose general health
conditions. The same cautions I offered about tongue diagnosis apply
here as well. TCM pulse diagnosis is a highly specialized skill,
and takes years to develop. In Ayurveda, doctors use pulse diagnosis to
assess the levels of imbalance in Vata, Pitta and Kapha. Western
doctors use pulse diagnosis primarily to determine the condition
of the heart.
The following simple rules may help simplify your understanding of the pulse and its diagnostic value:
• A fast pulse may indicate inflammation or fever if bounding (Pitta) or nervousness if weak (Vata).
• A slow, weak pulse may indicate Qi deficiency (energy depletion).
• A slow, strong pulse may indicate that the person has a strong heart, possibly an athlete.
• A tense or wiry pulse (like plucking a guitar string) may indicate nervous tension or energy restriction.
• A pulse floating close to the surface may indicate the early stages of an infection.
• A slow, soggy or slippery pulse (which tries to slip away from the doctor's touch) may indicate mucus and dampness.
• A thin pulse may indicate blood deficiency
• A deep pulse (you need to push down to feel) may indicate weakness and/or deficiency.
• An intermittent or irregular pulse may indicate congestion in the
heart, as well as potential hormonal or neurological imbalances.
Taste + Temperature = Action
In both TCM and TAM the combination of taste with temperature (warming
or cooling) can be used to create a simple basic description of the
action of an herb. For example sweet herbs are generally nourishing. A
sweet herb with a warming action would therefore probably benefit
conditions requiring warmth and nourishment, such as illnesses
involving nervous system weakness or weight-gain and tissue
Commonly Used Groups of Herbs
All systems of medicine group together their therapeutic agents with
similar actions. In Western medicine, for example, pharmaceuticals are
grouped into families, such a blood pressure lowering agents or
painkillers. More than 2,000 y ears ago, the ancient Charaka Samhita
divided herbs into 50 different groups. To avoid repetition, I have
placed several very important commonly used herbs into groups based
upon commonly needed actions. We will refer to these groups in Section
Three as we explore different body systems and the illnesses that
compromise them. Please note that these groups are representative and
cannot be wholly complete. Also note that some herbs fall into more
than one category.
Heat reducing group (herbs that reduce heat and inflammation)
Boswellia gum, bromelain, bupleurum root, burdock root, dandelion,
flaxseed oil, ginger root, guggul gum, heart-leaved moonseed, holy
basil, isatis root and leaves, licorice root, milk thistle seeds, neem
leaves, phellodendron root, raw rehmannia root, rhubarb root,
sarsaparilla, scute root, turmeric root.
• Blood moving group (herbs that move the blood and remove blood stasis)
Carthamus flower, dang gui root, myrrh gum, prickly ash bark, red
clover blossoms, salvia root, millettia stem, carthamus flower, tien
• Digestive group (herbs that strengthen weak digestion)
Black pepper, bromelain, garlic bulb, ginger root, ginseng root, trikatu (3 peppers), white atractylodes rhizome, cardamom.
• Immunity/Longevity group (herbs that increase vital force and strengthen the immune system)
American ginseng root, astragalus root, elderberry fruit, chaga
mushroom, cordyceps mushroom, ginseng root, guduchi stem, maitake
mushroom, reishi mushroom, shilajatu, Siberian ginseng root, amla
fruit, haritaki fruit, ganoderma mushroom, shou wu root.
Blood nourishing group (herbs that nourish the blood and/or strengthen the tissues)
American ginseng root, alfalfa, dang gui root, deer antler, eclipta,
shou wu root, raw rehmannia, shilajatu, amla fruit, white peony root.
Poison removing group (herbs that remove and/or protect against poisons)
Amla fruit, beet root, burdock root, castor oil, licorice root,
triphala, arjuna bark, dandelion root, gotu kola, guduchi stem,
berries, schisandra berries, white sandalwood, turmeric root,
Nervine group (herbs that calm and/or strengthen the nerves)
Ashwaghanda root, bala, bupleurum root, ginkgo leaf, gotu kola, kava,
muira puama, reishi mushroom, schisandra berry, scullcap, St. John's
wort, valerian root, white peony root, wild asparagus root, milky
Vessel strengthening group (herbs that strengthen and detoxify the micro-vasculature)
Blueberry, gotu kola. hawthorn berry, raspberry, stoneroot, tien-chi.
Mucus reducing group (Herbs that remove thick mucus accumulations)
Black pepper, long pepper, bromelain, guggul gum, tangerine peel,
turmeric root, fritillaria bulb (chuan bei mu / F. cirrhosa), arisaema
(tian nan xing /A. species), trichosanthes fruit (gou lou / T.
kirilowii ), acorus rhizome.
Diuretic group (Herbs that promote urination and eliminate retention of watery fluids)
Dandelion leaf, Akebia (mu tong / A. trifoliata), plantain leaf (P.
ovata), capillaris (yin chen hao / Artemisia capillaris) ,
punarnava root (Boerhavia difusa), parsley, Grifola mushroom (zhu
ling / Polyporus umbellatus ), uva ursi leaf (Arctostaphylos
uva-ursi), barley water.
Dampness removing group (Herbs that remove thickened fluids from the digestive system and tissues)
Poria mushroom, tangerine peel, pinellia tuber, licorice root, prickly ash bark, oregano leaf.
Warming group (Herbs that warm the system)
Aconite, dry ginger, cinnamon bark, black pepper, long pepper, prickly ash bark.
Nutritive group (Herbs that promote weight gain)
Ashwaghanda root, dates, cashews, bala, cardamon, white atractylodes, ginseng root, dang gui root , cooked rehmannia root.
Wound healing group (herbs that promote healing of skin, vessels and tissue)
Gotu kola, tien chi root, aloe gel, turmeric root. dang gui root, astagalus root
Intestinal healing group (Herbs that soothe and heal the intestinal membranes)
Slippery elm bark, marshmallow root, licorice root, chlorophyll juice,
wild asparagus root, fennel seed, peppermint leaf, flaxseed oil, kava
Formulas: Addition, Subtraction and Multiplication
Dr. Duke, in his excellent (and free) online Medical Botany course, says that herbs generally
interact in formulas in three ways:
Antagonism occurs when herbs or herbal actions work in opposing ways.
For example, the coldness of neem would be antagonized or neutralized
by the warmth of prickly ash bark. The bitterness of coptis rhizome
would be antagonized by the sweetness of licorice root. Herbalist use
this idea to modify the actions of their formulas. There can of course
also be specific chemical antagonisms, but these are too complex to
deal with here, and there is much that we still do not know. (Some of
these properties are mentioned briefly in the safety chapter.) Because
individual herbs are complex mixtures of substances, antagonism that
occurs when you combine two herbs is much like the result of mixing two
groups of very different people. Imagine, for example, if a group of
birdwatchers and a group of biologists met at a park. Chances are they
would get along quite harmoniously, though individual members of each
group might have conflicts. The conflicts could be much greater in
number and severity in a meeting between a group of birdwatchers and a
group of longshoremen. (They actually did that on the old TV show
“Candid Camera.” Woody Allen went to the longshoreman’s union
hall in New York and tried to get them to join his bird-watching club).
Additivity occurs when herbs simply add to each other. Mixing a group
of herbs containing immune-stimulating polysaccharides (like maitake
mushroom with ganoderma mushroom) is additive, as is mixing herbs that
contain phytoestrogens. Mixing herbs with similar actions to get
additive effects is a common herbal strategy. Most of the herbs in the
groups mentioned below have additive effects.
Synergy is a result of the combination of two or more substances that
cannot be predicted by simply adding the sum of the parts. Following
this phenomenon, individual nutrients must work together for the body
to produces its immune response. For example, your body needs
less vitamin C if you are getting adequate levels of vitamin E, because
these two antioxidants support the regeneration of one another in the
body (Thomas et al., 1992). Herbs like shilajatu and American ginseng
root seem to generally increase and add to the actions of other herbs.
Dosage is as Dosage Does
It’s also important to know that the same nutrients can affect your
body in very different ways depending on the dose. It is well
known that individual herbs can act differently depending on dose. For
example, ginseng extracts cause vasoconstriction in small doses, and
vasodilation in large doses (Huang, 1999). The same thing is true of
individual nutrients, such as vitamin K. While low doses of this
vitamin assist blood clotting, high doses (above 1 mg/day) aid
calcification of the bone matrix (Seyama et al., 1996).
Another case in point is vitamin C. At low doses, vitamin C aids in the
generation of collagen and elastin, which help keep the body "glued
together." At higher doses, however, ascorbic acid becomes a potent
anti-viral and antioxidant compound. A final example is niacin, an
important B vitamin. At low doses, niacin provides the body with
adequate energy metabolism through the action of nicotinamide adenine
dinucleotide (NAD). At somewhat higher doses, niacin becomes a
valuable vasodilator. When the dosage is increased even more, this
vitamin is a potent hypocholesterolemic (cholesterol-lowering) agent.
Niacin was the first drug used in the treatment of high cholesterol
Most of what we know about how herbs interact with each other is based
on empirical knowledge. The understanding of how to combine herbs
together to improve, modify or potentiate their effects is part of all
mature herbal traditions. The TCM use of licorice root to "harmonize"
formulas, and the TAM combination of three fruits (triphala) to create
a balanced tonic effect are two obvious examples. In fact, because each
of the individual tonic fruits in triphala work a bit more on Vata,
Pitta and Kapha, this is an excellent example of a well-constructed
formula. The areas of antagonism, additivity, synergy and dosage
are exciting ones for the future of herbal medicine. Because this
research leads to a different direction than looking for single active
ingredients, it is more in harmony with the philosophy of herbal
In addition to the fact that herbs and nutrients can work together or
in opposition is the fact that all of us can react differently to just
about everything, a concept called biological or biochemical
individuality (Burgio, 1994, Rosenberg and Rosenberg, 1998). This means
that no matter how much we try to standardize treatments (one
size fits all), some of us simply will not respond. I think we can
never get rid of the need for good doctor-patient relationship with
frequent feedback leading to individualized treatments based upon
I Still Don't Get the Big Picture
Okay, I lied. Herbology is not that simple. Now that I've
confused you completely, let's see if I can sum it all up. The central
goal of herbal treatment is to restore the body to balance. At a global
level, the nervous system and the mind works in concert with digestive,
cardiovascular and circulatory systems to regulate bodily function and
health. As I view it, these systems derive from three primary germinal
layers, elemental tissues that form in the earliest stages of embryonic
development. The tissue layers are called ectoderm, mesoderm and
endoderm, and serve as the precursors to all tissue development.
The large tube that extends from mouth to anus, forming our digestive
tract and all its related organs, grows out of the endoderm tissue
layer. The heart, blood vessels, connective tissue, glandular system,
muscles and bones all derive from the mesoderm layer. Finally,
the brain and nervous system are composed of endoderm tissue.
These three primary germ layers have evolved together; they are neither
separate nor individual; they are entwined and inter-dependent, and
this complexity reaches all the way down to the cellular level.
For example, cell biologists have shown us that each cell in the body
has its own musculoskeletal system, consisting of a stiffened skeleton
composed of tubules, which are surrounded by a contractile fibrous
Each aspect of the living web-like matrix of energies and systems we
call the human body is designed to break down and absorb different
forms of energy, which it then converts and releases outward in a
never-ending flow as we move through the world.
For example, the
food that we eat contains:
• essential nutrients that it cannot produce itself from smaller building block
• energy trapped in chemical bonds the molecules that make up food
• building blocks (such as amino acids) that our bodies can use
Our digestive systems break down food into component molecules and
absorbs them. The blood takes these molecules to the cells where they
are used as raw materials to produce our own molecules and/or further
broken down to release the energy trapped in the chemical bonds. This
energy release can only be done in the presence of oxygen, and our
breathing changes to accommodate ever-changing metabolic needs. This
process creates waste products that are expelled from the body via
exhalation and our eliminative organs. As we move through the world,
our nervous system "hears" internal signals (like hunger) and
responds, perhaps by looking for food. Likewise, our cells are
constantly hearing and responding to messages from the outside as well as sending
signals outward. This same process (flow of energy) takes place on many
The goal of this energy flow is a constant movement toward balance
among all organs and systems. Health is optimal when the major
systems are individually and collectively in balance. When your
body is in a state of optimal health, you experience such feelings as
love, peace, harmony and appreciation. Conversely, imbalances in health
usually lead to emotional states of pain, fear, depression and anger.
When health breaks down, certain large causative factor can be seen,
including inflammation, nutritional deficiencies and regulatory
This is why as an herbalist, I am primarily concerned (at the physical
level) with a patient's digestive energy, circulatory and metabolic
efficiency, and nervous system function. Once these primary
regulators are brought back into balance, we can begin to restore a
patient to optimal health. One way to do this is to use herbs.
Formula Writing Made Simple
Once you have good diagnostic information and a clear picture of your
larger goals, you are ready to choose your herbs. We all understand
what a good recipe is with regards to taste, texture, aroma, nutrition
etc. Putting together an herbal formula is like writing a recipe.
However, there is an important intermediate step, which is stipulating
a strategy. A strategy includes what you want to do to the body,
the methods you choose to employ, and the order in which you want to
deploy your tools. You have seen in section two that herbs are
often described by "What they do" to the body, as well as their
effects on specific disease processes. This method of
understanding herbs allows us to understand how to employ herbs.
Examples of simple strategies are:
• To nourish the blood
• To calm spasms in the legs
• To reduce inflammation in the liver
• To improve white blood cell counts
The above strategies are the result of diagnostic work. We would only
choose herbs that nourish the blood, for example, if the person had
anemia or another blood deficiency problem. So, a more complete
description of the strategies mentioned above would be:
• My patient is fatigued and anemic, so I will nourish their blood.
• My patients is having painful leg spasms, to I will calm the spasms.
• My patient is fatigued and jaundiced, so I will reduce inflammation in their liver.
• My patient is undergoing chemotherapy, so I will improve white blood cell counts.
Most patients will have other secondary considerations. They may have
blood sugar problems, or poor digestion, nervousness or constipation.
In writing your formula, you would want to add some herbs to address
these important secondary elements. This would translate the above examples into complex strategies as follows:
• My patient is fatigued and anemic due to stress and overwork, so I
will nourish their blood and add some calming nervine herbs.
• My patient is having painful leg spasms due to poor absorption and
poor diet, so I will calm the spasms, increase their intake of mineral
rich vegetables, and add some digestive herbs.
• My patient is fatigued and jaundiced due to hepatitis, so I will
reduce inflammation in their liver, council them on the importance of
stopping alcohol abuse, flush the bile out with diuretics and an
increase in water intake, and add some anti-viral and
• My patient is undergoing chemotherapy, and white blood cell counts
have decreased, especially macrophages. The gastrointestinal system is
also severely inflamed. Therefore I will nourish the blood with
tonics, emphasizing herbs than increase macrophage counts, and I
will protect the gastrointestinal system with herbs that coat the
intestinal membrane and counteract inflammation.
If you can train your mind to formulate your medical ideas in this
manner, you can develop your own strategies and begin to think like an
herbalist. Once you have identified the appropriate herbs and strategy
for treating all aspects of the patient’s condition, you can construct
your starting formula.
It helps to know that it has been a principle of TCM since its earliest
classic text (Herbal Classic of the Divine Plowman, first recorded on
paper over 2,000 years ago) that most basic prescriptions contain one
or two major herbs, along with several supportive ones to improve
activity and reduce adverse effects (Huang, 1999).
Dosage & Process: Healing with Herbs is like Playing Football
I heard a group of NFL football players on TV discussing how they sized
up an opponent. I was surprised to learn that these professionals did
not only look for obvious qualities like strength, size, speed and
agility. They were equally concerned with knee flexibility, grip
strength and peripheral vision. As explained, the latter
information was necessary to determine when an opponent was coming at
you from behind. My point is that good diagnosis and treatment in
herbal medicine involves noticing things that others ignore.
The starting formula (and starting dosage) is like the first play in a
football game. The goal is total health. The symptoms and disease
states are like the opposing team. After you make your first play
(write your starting formula), you have to evaluate results, then
re-strategize and reformulate your secondary formula and dosages. This
is like the football huddle before the second play. In both China and
Nepal, formulas are usually changed every three to five days. As
the problems begin to resolve or stabilize there are longer periods of
time between formula changes. Thus, good herbal medicine is an ongoing
feedback process, requiring a willingness to continually change
tactics. We will discuss this more in the following sections.