Every now and then, in the middle of a consultation, a patient opens their phone to show us a photo. Sometimes it is a handwritten herbal prescription with the ink already smudged, sometimes a slip of paper folded in four and kept in a wallet. It comes with a question: “Someone I know took this formula and got completely better. Doctor, can I have exactly the same one?”
The question is easy to understand. The person has seen with their own eyes someone they know get better, and everyone wants to take a road that someone else has already walked. This article explains why the doctor usually does not copy that prescription.
Why a friend’s prescription may not suit you
An herbal decoction is a prescription of several traditional herbs combined according to traditional medicine theory and divided into daily doses. The doctor prescribes one only after examining you in person and doing pattern differentiation: looking, listening, asking and taking the pulse to work out which pattern the illness belongs to (cold or heat, deficiency or excess) and which organ system it sits in.
Two people with the same modern medical diagnosis can still belong to two different patterns. Take insomnia as an example. The first person worries a lot, eats poorly, feels tired, has a pale complexion and a thin, weak pulse; traditional medicine usually places this in the Heart–Spleen deficiency pattern (心脾虚 / 心脾虛, xīn pí xū), which needs nourishing. The second person is short-tempered, has a bitter taste in the mouth and a flushed face, and lies down with a mind that is still racing; this is often the Liver fire pattern (肝火, gān huǒ), which needs clearing heat and calming. Give the first person’s nourishing decoction to the second person, and sometimes it does not help, sometimes it even leaves them feeling hotter and more restless. The old texts call this principle “same illness, different treatments” (同病异治 / 同病異治, tóng bìng yì zhì): one illness, treated in different ways.
Beyond the pattern, there is your constitution: age, weight, whether your digestion is strong or weak, whether you are pregnant or breastfeeding, how healthy your liver and kidneys are, and what medicines you are taking. A friend’s prescription knows none of these things about you. Even for that friend, the prescription only fit at the time it was written.
After each follow-up visit, a few herbs change
At Tam Duc, there is no fixed formula for a given illness. The doctor usually starts from a base formula that fits the pattern, then modifies it: adding herbs for the symptom that stands out most, removing herbs that easily cause bloating when digestion is weak, and adjusting doses to your constitution.
The stage of treatment also changes the decoction. While symptoms are still strong, the decoction focuses on what is bothering you most. As symptoms ease, the doctor shifts toward regulating and nourishing the root. Traditional medicine sums this up in the saying “in urgent cases treat the branch, in calm times treat the root” (急则治标，缓则治本 / 急則治標，緩則治本, jí zé zhì biāo, huǎn zé zhì běn): when things are urgent, deal with the surface symptoms; when there is time, deal with the root.
That is why a follow-up visit is more than just picking up more herbs. The doctor asks again about your sleep, eating and bowel movements, looks at your tongue, takes your pulse and compares everything with the previous visit. The new decoction may be close to the old one, or a few herbs may change. If things are not progressing as expected, the doctor may suggest lab tests or an ultrasound before prescribing further.
Herbal decoctions also rarely stand alone. The clinic looks at each person from three sides, structural, chemical and mental, so depending on the person, the decoction may go together with acupuncture, moxibustion, changes in nutrition and micronutrients, or exercises to do at home.
A small amount of an herb, then the muscle is tested again
Alongside the four examinations and a modern clinical examination, the doctors at Tam Duc use Applied Kinesiology (AK) to help choose herbs. Walther (1981) describes the method in the chapter Chemical and Nutrition Testing (pp. 45–50): the patient tastes or holds in the mouth a small amount of the substance being checked, sometimes only smells it, and then the doctor retests a chosen muscle to see how its response changes.
For herbal decoctions, this kind of check helps the doctor weigh up several herbs with similar actions, or see how the body responds to an herb before adding it to the decoction. The clinic also uses muscle testing to check minerals and electrolytes when considering micronutrient supplements. Rosner and Cuthbert (2012) describe AK as a way of assessing structural, chemical and mental function through muscle testing, always combined with standard diagnostic methods. Tam Duc uses AK in exactly that spirit: it gives the doctor extra information and runs alongside lab tests, imaging and medical diagnosis, without replacing them. If you have never had muscle testing, the article Is Applied Kinesiology safe? Understanding muscle testing correctly explains how it works.
Bring a list of your conventional medicines
Herbs contain active compounds, so they can interact with conventional (Western) medicines. Ulbricht and colleagues (2008) reviewed the clinical evidence and found more than 80 herbs and plant products with significant drug interactions. The group of medicines most often involved was anticoagulants and antiplatelet drugs such as warfarin and aspirin, with more than 30 herbs. The authors also noted cases where herbs that affect the liver, taken together with drugs that can harm the liver, such as paracetamol (acetaminophen), may cause liver toxicity.
For warfarin alone, the review by Tan and Lee (2020) found 78 herbs, foods and dietary supplements with interactions. The two authors reach a fairly measured conclusion. Most of these are still safe in moderate amounts, as long as patients tell their health care provider when they start a new herb or dietary supplement.
Choosing herbs that avoid those interactions is the doctor’s job, provided the doctor knows enough. Before a decoction is prescribed, please tell the doctor clearly about:
- The names and doses of the conventional medicines you take, including ones you bought yourself, especially anticoagulants and antiplatelet drugs;
- Dietary supplements, vitamins and herbal teas you use every day;
- Being pregnant, trying to conceive or breastfeeding;
- Liver or kidney disease, or any past abnormal liver or kidney test results;
- Any history of allergy to medicines or food.
Taking photos of the medicine labels is usually easier than trying to remember the names. You also should not stop your conventional medicines on your own to “make room” for the decoction; changing those medicines is up to the doctor who prescribed them.
From ready-made pouches to a pot of herbs at home
Cooking a decoction properly takes time and attention: which herbs go in first, which go in later, when the heat should be high and when it should be low. For people who work, that is a real obstacle. The clinic offers a decocting service. Each prescription is cooked and packed into pouches by dose, so you take them home and simply use them as instructed.
If you would like to cook the decoction at home, here are a few basics:
- Use a porcelain or ceramic pot, or an aluminum pot; avoid cast-iron or iron pots;
- Give the herbs a quick rinse and soak them in clean water for about 30 minutes before cooking;
- Follow the doctor’s separate instructions for herbs that need to be cooked first, added late, cooked separately, or dissolved into the decoction when you drink it.
Once the decoction is made, whether it is the clinic’s pouches or a pot you cooked yourself, store it as instructed when you receive the herbs. If the liquid smells strange, tastes sour, or a pouch has puffed up, do not drink it, and message the clinic. What time of day to drink it, before or after meals, and how long to space it from conventional medicines are things the doctor tells you for each prescription, because each one has its own character.
While you are taking it, let us know early if your belly feels bloated, your stools are loose, a skin rash appears or you feel much more tired than usual, if you are prescribed a new medicine elsewhere, or if you find out you are pregnant. There is no need to wait until the course is finished to say so.
Older generations in Vietnam like to encourage children with the saying “bitter medicine cures illness.” Still, how bitter it tastes says nothing about whether the decoction suits you.
Common questions
Can I take an herbal decoction together with conventional medicines?
In many cases, yes.
The condition is that the doctor knows exactly what you are taking, so they can choose suitable herbs and tell you specifically how far apart to take the two kinds of medicine during the day. Keep taking your conventional medicines as prescribed; if you want to stop them or change the dose, ask the doctor who prescribed them.
How long do I need to take the decoction?
There is no single number. It depends on the illness, the pattern, how well you respond and your own goals. At each follow-up visit, the doctor reassesses and decides whether to continue, change the decoction, taper it or stop.
Are there foods to avoid while taking the decoction?
It depends on the person. What to avoid, and for how long, depends on the pattern and the herbs in the decoction, so the doctor gives you specific advice when prescribing. A list of foods to avoid copied from someone else can easily make you cut out foods your body actually needs.
My old decoction suited me. Can I just buy it again?
It is better to come back for a check-up first. That decoction was modified for your body at a point in time that has passed, and when symptoms return or have changed, the doctor needs to see whether the old decoction can still be used, needs adjusting or needs replacing.
Worth keeping
- Before your visit, take photos of the labels of all the conventional medicines and dietary supplements you are using;
- Bring your old lab and ultrasound results, and allow about 30–45 minutes for the first visit;
- Say clearly if you are pregnant, trying to conceive or breastfeeding, or if you have liver or kidney disease;
- Do not use a friend’s prescription, even if you have the same diagnosis;
- Do not stop your conventional medicines on your own when you start a decoction;
- Message the clinic right away if you notice bloating, diarrhea, a rash or unusual tiredness;
- Come to your follow-up visits on time, so the decoction can be adjusted to how your body is at that point.
Back to the photo on your phone
If you have already tried a few batches based on that photo, just bring it with you to your visit so the doctor knows which herbs your body has recently taken in. Your own decoction will be prescribed based on this examination and adjusted step by step at later visits. Before a consultation that includes muscle testing, you can also read What to bring and how to prepare for an Applied Kinesiology examination.
References
- Ulbricht C et al. (2008). Clinical evidence of herb-drug interactions: a systematic review by the Natural Standard Research Collaboration. Curr Drug Metab 9(10):1063-120. https://doi.org/10.2174/138920008786927785;
- Tan CSS, Lee SWH (2020). Warfarin and food, herbal or dietary supplement interactions: A systematic review. Br J Clin Pharmacol 87(2):352-374. https://doi.org/10.1111/bcp.14404;
- Walther DS (1981). Applied Kinesiology, Volume I – Basic Procedures and Muscle Testing. Pueblo: Systems DC. Chương Chemical and Nutrition Testing, tr. 45–50;
- Rosner AL, Cuthbert SC (2012). Applied kinesiology: distinctions in its definition and interpretation. J Bodyw Mov Ther 16(4):464-87. https://doi.org/10.1016/j.jbmt.2012.04.008.
