What to Consider While Prescribing Herbal Medicine

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To prescribe effectively, it’s important to choose the most appropriate formulation based on the patient’s biochemical individuality and energetics, preferences, and motivations. From an herbal perspective, select formulations based on what the treatment priorities are and what the best type of preparation will be for the patient and their treatment.

Choosing the Right Formulation

When choosing the most appropriate formulation, consider several points, including the patient’s age, preference, individual variability, tolerances, and sensitivities, acute or chronic conditions, medications and supplements, energetics, and likelihood of compliance.

Patient age: Although tinctures can be used with children in small doses, consider palatability and compliance. 

Patient preference: It’s advisable to ask the patient if they have restrictions around using alcohol-based tinctures. Tinctures should be avoided where there is a history of alcoholism, and if there are religious restrictions. It is easy to reduce the alcohol content by adding tincture to hot water and allowing the alcohol to evaporate.

Individual variability: Practitioners must not only consider individual variation in pharmacokinetics and pharmacodynamics, but also the intestinal microbiota, which play a role in mediating and potentially enhancing activity of plant medicine compounds. If the patient’s digestion or liver function isn’t optimal, practitioners should enhance their formula or herbal prescription with herbs that support detoxification function.

Differences in patient tolerance and sensitivity: Some patients experience strong effects at subtherapeutic doses, and others require extremely large doses to experience a positive benefit. Age, weight, build, and health history are some of the factors that may have an impact.

Speed of desired effect: Tinctures are the most effective route of administration for speed of achieving desired outcome, and as such are often preferred for acute conditions. Infusions and decoctions are faster than powders and capsules, which tend to work better for chronic conditions where the desired shift is slower, or the patient is more reactive, and the practitioner needs to start with a small dose and gradually increase.

Bioavailability of phytoconstituents in form used: Different phytoconstituents are better extracted in alcohol than in water. If a patient has cystitis, a cold infusion would be the preferred formulation, as the mucilaginous components are better extracted in water than alcohol.

Herbs must work directly on the affected area versus systemically: For example, a pain formula for a shoulder injury. A topical balm or oil would work well directly on the affected area. If the patient also wanted to work systemically on immune function and modulating the inflammatory response, the practitioner might also want to make a tincture to work synergistically alongside the topical product.

Medications, supplements, or other herbs: Consider the most appropriate formulation and how to time it effectively around medications, supplements, and other herbal products where there may be risk of potential interactions with medications, supplements or other herbs.

Energetics considerations: For example, different topical preparations would be used for red, inflamed, and cracking eczema over weeping and dry eczema.

Compliance and dosing frequency: How committed is the patient to their protocol? Will they do what it takes, even if it means taking something unpalatable? Are they good at following routine? Will work and travel commitments impede their ability to take their herbal medicine prescription and, if so, how can the practitioner mitigate that?

Editor's Note: This is an excerpt from the e-book, An Introductory Guide to Herbal Medicine. To read more, click here.