Will taking herbs affect my meds?

With the vast majority of our patients on an herbal formula, we're asked this question quite frequently. It's a legitimate concern considering how many prescription medications the average person takes daily. The truth is that yes, herbs may influence how meds interact with your body, but the reality is herbs will probably affect your meds about as much as your lunch will. The real question should be: "Is it safe to take herbs while on prescription medications?"

A Quick Look at How Drug-Herb Interaction is Studied 

When looking at drug-herb interaction, researchers tend to focus more on the drug side of things; this is because drugs are very specific lab-made synthetic compounds, whereas herbs are complex organisms (for the most part). Drugs are essentially a chemical equation with every action accounted for in their structures. Herbs are latticework of organic structures which have naturally evolved, so, frankly, it's too difficult to isolate specific properties to study.

With that in mind, the basic approach is to take any given drug and ask whether or not it's properties allow it to be safely combined with other things including herbs, supplements, foods, and other drugs. The main way of deciding this is looking at the drug's therapeutic index - the window in which a drug works both safely and effectively. If a drug has a wide therapeutic index, there's less of a concern that other things in the body can render it ineffective or dangerous. If a drug has a narrow therapeutic index, there is very little difference between a safe dosage and a toxic dosage, so there is a greater concern about interfering with its actions.

Prescribing Chinese Herbs Safely

There are several steps we take to make sure that it is safe for our patients to take an herbal formula whether they are taking prescription medications or not:

1) Extensive study and training of Chinese herbal medicine. We spend 4 years learning the herbs inside and out. We are trained to identify the herbs by sight, smell, and taste, must know their actions on the body and what parts of the body they act on, what symptoms and conditions they treat, how to combine them into formula, how to prepare and cook them, and all possible contraindications. As acupuncturists, we are often compared to doctors, but when it comes to herbal knowledge, we are more like pharmacists.

2) Detailed diagnosis. With any system of medicine, treatment is only safe and effective when you nail the diagnosis. This is the most emphasized aspect of Chinese medicine, and herbs are only ever prescribed in accordance with a Chinese medicine pattern diagnosis.

3) Dosing low. This is something we do at Meridian as an extra precaution. Because people are generally not used to drinking teas made from twigs and barks, and because people are used to supplements working very subtly over time, we always start with the lowest effective dosage and increase it as needed. This is how herbal medicine is practiced in Japan, as well. Like the Japanese, Americans seem to have more delicate systems than the Chinese. In China, patients regularly leave the hospital with their raw herbs for the week in dosages that fit in garbage bags. What we give patients as a weekly dose, Chinese herbalists prescribe and package for daily consumption. Keep in mind that this is in conjunction with pharmaceutical medications, as well!

Each one of these is one day's dose.

4) Constant monitoring. We prefer to prescribe herbs one week at a time and have patients report back to us before refilling their formulas. This allows us to make adjustments in ingredients and dosages based on changes in symptomology. This allows helps us determine when herbs are no longer needed. Most patients are on herbs temporarily, though it may be long-term. This is in stark contrast to drugs which many patients are on indefinitely.

5) Caution with herbs with similar actions as drugs. On one hand, a formula that supports and enhances the action of meds can be very useful. In fact, many patients, in consultation with their physicians, are able to reduce or come off their meds while taking herbs. It serves as a natural way to ween off of pharmaceuticals. Again, those decisions are made by patients and their doctors rather than us. On the other hand, increasing the action of specific drugs can be non-therapautic. For example, if someone is on blood thinners, we are careful about using herbs which also invigorate the Blood from a TCM perspective. While even that is usually safe, we always operate with an abundance of caution.

6) Avoiding harsh herbs in conjunction with hardcore drugs. This goes back to the idea of therapeutic index. Most of the drugs that have a narrow therapeutic index are very serious meds like lithium and certain type of chemotherapy drugs. It is very rare that these patients also present with a condition that would required our harsher herbs (things like aconite or scorpion, which in large enough dosages can be slightly toxic). We are extremely cautious when these things show up on the med lists, and sometimes the safest and most appropriate course is to forego herbs altogether.

Following these principles, we have never had a problem with bad reactions from herbal formulas. At this point we've prescribed formulas to thousands of patients, most of whom have been on some form of prescription drugs. Even when advising patients that they might get a bit of an upset stomach the first day (since roots and sticks aren't normally in their diet), fewer than 1% ever report experiencing that.

So, are herbs safe to take with prescription drugs? Yes, it can absolutely be done safely, and no patient for which it is not safe will receive herbs!

Diabetes Mellitus Treatment in TCM

25.8 million people in the United States, 8.3% of the total population, have diabetes. It's one of the most prevalent chronic diseases in the country, and it's also one of the most preventable causes for heart disease, high blood pressure, blindness, kidney disease, neuropathy, and amputations. We spent $245 billion on diabetes patients last year with most of that going directly towards treatment. Traditional Chinese Medicine offers an effective and much cheaper alternative to managing diabetes.


Diabetes in Chinese Medicine

Traditionally, diabetes is characterized as xiao ke, wasting and thirsting disorder, but because of the most common symptoms experienced, it is often called duo shi, profuse eating, duo yin, profusing drinking, and duo niao, profuse urination. Diabetes, like most conditions we treat, can stem from several possible causes, according to Chinese medicine. These include congenital essence deficiency, aging, unregulated eating and drinking, and internal damage by the seven affects (meaning lifestyle and emotional factors).

In juvenile-onset diabetes, the cause is attributed to an insufficiency of the essence naturally endowed to newborns from their parents during fertilization. Whenever there is a congenital deficiency of jing, the most primary essence which we store in the Kidney, the child has an inherent tendency towards disease. This can be anything from developmental delays to scoliosis to diabetes (type 1). The nature of the disorders that manifest depend on the quality of jing from the parents, and many, though not all, can be overcome with early treatment.

Adults who develop diabetes later in life typically have a pattern of long-standing heat in the Stomach coupled with Spleen deficiency. The heat may come from over-eating hot, spicy, greasy,

fatty, rich foods or alcohol or from depressive heat of the Liver affecting the Stomach; this causes a large appetite and rapid hungering after meals. The Spleen deficiency may be due to over-eating
sugars and sweets or fatty, rich food, as well. It could also be from over thinking, too little exercise, or over taxation of the body. Spleen deficiency allows for the accumulation of dampness in the body causing obesity. Long-standing Spleen deficiency also accounts for the emaciation and muscular atrophy later in the progression of the disease. Enduring heat eventually damages and consumes the yin fluids of the Stomach and Lung causing thirst. If Lung yin deficiency reaches the Kidney and is complicated by yin deficiency from aging, Kidney yin deficiency may develop. Spleen qi deficiency may develop into Kidney yang deficiency over time. Dual vacuity of Kidney yin and yang can lead to urinary problems and impotence. Chronic deficiency with damp accumulation gives rise to Blood stagnation and a lack of nourishment of organs and tissues, accounting for the neuropathy of the muscles and optic nerves.

Treatment

Treatment of diabetes, particularly type 2, will focus on strengthening the Spleen and Kidney and regulating and transforming dampness. These are the most common aspects of the disease pattern we see clinically, but variations may include: Lung and Stomach heat accumulation with damage to fluids, exuberant Stomach heat, dual deficiency of qi and yin, Kidney yin deficiency, Spleen-Stomach qi deficiency, damp heat obstructing the center, and Spleen-Kidney yang deficiency. Liver qi stagnation and Blood stasis often accompany the main pattern.

Acupuncture and moxibustion are very efficient at bolstering Spleen function, but due to the chronic nature of the disease, most patients choose herbal medicine as a more cost-effective treatment for diabetes. Taking an herbal formula also addresses the condition daily rather than intermittently as with acupuncture. A daily regiment of herbal medicinals helps to treat the condition from the inside on a molecular level and helps to manage blood sugar levels.

Our most commonly used formula for the treatment of diabetes is called Jiang Xue Yuan Jian. It contains Huang Qi, Shu Di Huang, Xuan Shen, Tu Si Zi, Cang Zhu, Nu Zhen Zi, Fu Ling, Zhu Ling, Huang Jing, and Shan Yao. The synergistic effect of the ingredients work to fortify the Spleen, nourish the Kidney, regulate body fluids and transform damp accumulation, quell fire, and redirect heat to warm the yang. It's a good balance of augmentation, dissipation, and harmonization. Patients are able to report normalized blood sugar levels, increased energy, and, in many cases, weight loss and better weight management (though the most significant results are seen in patients willing to make dietary and lifestyle changes).

Lastly, acupuncture and herbs are amazingly effective at healing diabetic ulcerated wounds. In addition to managing the diabetes, there are acupuncture and herbal techniques for healing and regenerating flesh. Getting an open sore to close, finally, and preventing a gangrenous infection can be the difference between a patient continuing to walk or losing a foot. Seems like an easy choice!