Basic Guidelines For Choosing An Appropriate Herbal Formula

One of the most common questions we get is what Chinese herbal formula is used to treat "insert any condition/symptom/western diagnosis".  There is a common assumption that herbal formulas are chosen and then used in the same way Western pharmaceuticals are.  That is largely misleading.  Herbal formulas are chosen based on what the underlying pattern or patterns are, not based on a specific symptom or a specific western medicine diagnosis (for a discussion of tcm patterns see "Treating the Cause and Not the Symptoms").  So in effect, the answer to what formula treats condition "x" is that there is no single formula that would universally apply.  The selection of herbal formulas is necessarily customized to each individual based on their overall health.  Incidentally this same principle applies to how we select acupuncture points.

So for example take a specific condition like insomnia.  We have over a dozen formulas listed on our store site that are used to treat insomnia.  The reason we have so many is that insomnia can be caused by a somewhat broad variety of underlying patterns.  In one case the insomnia could be due to what in TCM (Traditional Chinese Medicine) is a diagnosis of heart yin deficiency.  Usually in that case other symptoms might include palpitations, anxiety, restlessness, and vivid dreaming.  A formula like Tian Wan Bu Xin Dan would be appropriate for insomnia in that case.  Insomnia could also be the result of liver fire.  In that case other symptoms could include frequent outbursts of anger, bloodshot eyes or other manifestations of red coloring in the face, extreme irritability, dizziness, and constipation.  You would need to use a very different formula than Tian Wa Bu Xin Dan for someone with insomnia in this case (for example something like Long Dan Xie Gan Wan).

In Western medicine insomnia can be diagnosed as a stand alone disorder.  In TCM insomnia is never considered a stand alone disorder but rather as a symptom that is being manifest by an underlying disorder in the working of the body.  And according to the principles and theories of TCM there are several possible patterns that could present with insomnia as one of the symptoms.  So in the context of TCM, we are not treating the symptom of insomnia, we are looking to treat what underlying patterns are causing it.  This is why there is no one specific formula you can universally use for insomnia (or any other condition or western diagnosis).

To further complicate the selection of the appropriate formula, most people present with more than one underlying condition.  It takes a deep understanding of the principles and theories of Chinese and Oriental medicine to establish a proper diagnosis.  Once a diagnosis is established, appropriate herbal formula choices can be made from there.  And a diagnosis within the framework of oriental medicine does not (for the most part) have a corresponding diagnosis in the context of Western medicine.  For this reason we do not recommend that people take TCM formulas on their own based on information available online.  You will get better and safer results by consulting with a local acupuncturist or herbalist.

Types of Formula

It is common practice that the last character of each formula reflects the form it comes in.  Some herbal companies do not follow this which can be somewhat confusing.  But if the last part of a formula is slightly different or even missing it is very likely the same formula.  For example Bi Yan Wan is the same formula as Bi Yan Tang/Pian or even just Bi Yan.  

Tang is usually used to refer to the preparation of raw herbs and is also commonly used for capsules containing powder.  Pian are compressed herbal tablets without any coating.  Wan are small, usually black, balls of compressed herbs with a coating.  The wan form are also known as tea pills.  There are also some companies that offer herbal formulas in liquid drop form (usually alcohol based).  As far as I know there isn’t a separate name or designation for this.

I have a personal preference for formula in powdered or capsule format that I can make a tea from.  However from a clinical perspective there is very little, if any, clinical difference between the different formats.  My herbal teachers in school did say that the raw herb decoctions had a slightly faster absorption rate, but in most cases that doesn’t translate into a noticeable clinical effect.  Due to the smell, taste, and preparation time required the raw herbs are not commonly used.  Some of the capsules (tang) are larger and for some people may be more difficult to swallow than wan, which are usually smaller.  Other than simple practical considerations (like young children being unable to swallow large pills) the form the formula comes in doesn’t, except in rare cases, have any significant impact on the clinical effectiveness.

Dosage

Unlike Western pharmaceuticals the dosage of TCM herbal formulas is not as strict.  For example if you have the wan version of a formula taking 4 instead of 3 will not likely have any noticeable effect.  Young children usually require lower dosages.  Larger or heavy set people usually require a slightly larger dose.  In our clinical practice we tend to prescribe dosages that are less than what are printed on the bottle.  The different types of formula will also dictate dosage.  For example you'll generally take more pills in wan form versus capsule form for the same formula.  Your local practitioner will be the best source for the proper dosage of any herbal formula for you to take. 

Contraindications

If you develop acute cold or flu there are some formulas you should stop taking.  If you have liver or kidney disease you should only take herbal formula with the guidance of a licensed/trained practitioner.  There are also some formulas that should not be taken when pregnant or breastfeeding. There are also a very few formulas that cannot be taken with certain Western pharmaceuticals.  Your practitioner should be able to provide you with any possible contraindications.  

Side Effects

If you’re taking herbal formulas with the guidance of a licensed practitioner there are extremely low risks of any negative side effects.  This doesn't mean that herbal formulas are 100% safe for everyone.  It is possible that taking a formula that does not match the pattern(s) you are presenting could make some of your symptoms worse.  This is yet another reason why you should not take herbal formulas without the guidance of a licensed/trained practitioner.