How to get your patients to take bulk Chinese herbs

Many students and practitioners are under the impression that their patients will not take bulk herbs. They feel that their patients are too busy, too unwilling to cook, or too averse to the taste of herbs. Certainly there are people that fall into these categories but the vast majority of patients will take bulk herbs, even the very busiest of patients. Quite simply, patients come to Chinese Medicine professionals for our expertise, and for help.  If we can clearly present a path to relief from symptoms and better health, most will follow our recommendations. If we ourselves feel that bulk herbs are the best and most effective option and can clearly communicate this to patients, most patients will comply. On the other hand, if we fail to offer what we believe is the most effective medicinal delivery system, not only do we fail our patients, but lose a chance to grow and succeed as practitioners.

Below are some thoughts on factors that influence patients’ willingness to take bulk herbs, and tips on approaching common questions and obstacles. 

Attitude & Presentation: These may be the single most important factors in getting patients to take herbs.  The way we present the options, and our own knowledge of the various forms of medicine have tremendous influence. For example, compare “Well, we have a couple of options for herbs: we have these smelly herbs that take a long time to cook, and taste terrible. Or we have this pill you can swallow. Which one do you prefer?” vs. “Raw herbs are your best option for getting better most quickly. They are the gold standard, traditional and time-tested method for delivery of herbs in China. They do take some time to prepare and don’t usually taste great, but they are by far the most effective and fast acting delivery system for Chinese medicinals. We also have powdered herbs or pills if you are travelling or if cooking really isn’t an option.” With Red Pine herbs, you may also appeal to the features of superior quality, a high potency unprocessed product, excellent value, and minimized likelihood of allergic reaction due to fillers, excipients, etc. as opposed to granulars or patents.

Convenience - There is no question that taking pills, or even granulars, are much easier than boiling herbs. However we can make cooking bulk herbs also relatively easy. Consider these points to create a smooth herbal experience for your patients.

 1. Have the formula ready to go when the patient walks out the door. 

 2. Instructions should be clear and not overly complex. In our clinical experience, we have found a few points that dramatically increase compliance.

• Cooking instructions - Written instructions are imperative. On the back of each bag of Red Pine herbs there are instructions for cooking and consuming herbs that are specific for the medicinals in the formula.  In addition there is a place where practitioner instructions can be written in. Customers of Red Pine Chinese Herbs may request a copy of our cooking instructions at no charge. We will add your clinic / apothecary name to it if you like.

• Cook Time - We suggest a single 45-minute cook in contrast to 2 shorter cooks. We have found that this  only slightly compromises the strength of the decoction, with the tradeoff of greatly increasing compliance.  

Duration and amount of consumption - Traditionally in China one bag of herbs is consumed over one day. Most often in the West one bag is consumed over two days. We have found that having patients cook herbs once every 2-4 days greatly enhances compliance. There is no downside to this strategy if the herbs are refrigerated and sealed in a jar. Therefore, we have doubled our doses so that one single bag of Red Pine herbs will last about 4 days. In acute situations, this may be shortened to 2 days, or lengthened to approximately 6 days if the patient needs less than a normal dose. Compliance also seems to increase as the amount of decoction that must be consumed decreases. We recommend teaching patients to cook down their herbs to a  small amount of liquid, so that they need to only drink a few ounces per dose.  

The final amount of decocted liquid directly relates to how much water one starts with. Therefore one should start with just enough water to cover the herbs by an inch or so, instead of fixed amount.

Our general instructions for consumption are as follows.

If one bag should last four days, then the amount of liquid that must be consumed in one day is 1/4 of the final amount. Thus if the patient ends up with two cups, they must drink 1/2 cup each day, or something like 1/4 of a cup twice a day. 

A useful trick it have your patient split the final decoction equally into four jars. They must then drink one jar per day (whatever amount it may be). We suggest just leaving it out on the counter so as to be reminded. Many like to just sip it throughout the day. This usually is not problematic.

Of course if the concentrated taste is too strong, or the herbs upset their stomach, they can dilute the herbs, or start with more water.

Commonly asked questions:

1. Should patients cook each batch individually every day, or do they cook all of their herbs together (e.g. 3 bags of herbs) and then re-heat the decoction as needed?

The answer relates directly to how long one bag is intended to last. Because we have doubled traditional doses, one bag of Red Pine herbs will usually last 4 days. In acute situations, two bags of herbs may be cooked together and consumed over four to six days. Note that herbs will start to go bad, even if refrigerated, after about seven days. 

Cooked herbs are usually re-heated before drinking or consumed at room temperature. One useful strategy is to have the patient put out the amount of herbs they will drink during a day. They will then consume the herbs at room temperature whenever it is convenient or appropriate (as determined by the practitioner). The most important thing is for patients to get the herbs into their bodies.  If a patient is having difficulty, encourage them to get into the habit of drinking their herbs every day, and not worry about the details. 

2. Do you tell your patient to take the cooked herbs at certain times of the day? Are the herbs consumed with food or away from food? Are there other considerations?

We usually have patients take herbs 2-4 times throughout the day, generally away from food (30 minutes before eating or 1 hour after eating). For digestive disorders or difficulty digesting the herbs, we recommend taking herbs with food. Herbs for sleep may be taken before bed.

In general cases, it is more important that the patient take the herbs then get hung up on exact timing.  

3. Are the herbs taken away from medications and other supplements.... and how many hours away? 

This depends greatly on the type of herbs and type of medication. Appropriate instructions should be given by the prescribing practitioner. Generally, it is safest to take herbs at least an hour away from other supplements and medications.

4. If they hate the taste, is it OK to add honey, sugar etc... ?

This is usually the last resort. After the first week, most patients become tolerant of the taste. For those who don’t, we first recommend eating a raisin (or other dried fruit) right after drinking the herbs or rubbing the tongue with a fresh piece of ginger before drinking them. If this does not work, or with children, agave or other sweeteners such as honey may be used. This is usually only mildly alters the therapeutic effect.

5. Do you advise cooking in clay pots, glass, crockpots or stainless steel?

We generally recommend glass, clay or ceramic pots, and non-reactive stainless steel is an OK option as well. We don’t recommend cooking in aluminum, and crock pots usually take too long to heat up.  Again, it is usually fine for patients to use what they have on hand rather than getting caught up in details.