ERK1/2 ERK1/2

ications, such as oral contraceptives or HRT (hormone replacement therapy) that, if they ever decide to stop taking the Western meds in question, either because they don’t work or they have too many side effects, I would be happy to try to treat them with internally administered Chinese herbal medic-inals. While taking this route eliminates any worry about pos-sible herb-drug interactions, it may unacceptably limit one’s potential patient population.

Secondly, you can choose to prescribe Chinese medicinals at the same time as the patient is taking Western meds pre-scribed by one or more Western physicians. In that case:

1. Be sure to find out all of the Western medications the patient is taking and their doses. Then go to a Western medical source, such as The Essential Guide to Prescription Drugs, and read up about each medication. If possible, also attempt to work out provisional Chinese medical descrip-tions for these drugs. For example, does this drug function as a heat clearer, a surface resolver, a qi supplement, or what? This is knowable (at least to a large extent) by look-ing at both the intended therapeutic effect as well as the unwanted side effects.

2. Determine from the patient if the Western meds are A) achieving their intended therapeutic effect satisfactorily and B) whether they are causing any side effects.

A. If one or more Western meds are not achieving their intended effect, we have to consider whether each Western medication is appropriate for our patient’s personally pre-senting pattern based on that medication’s provisional Chinese medical prescription. For instance, Clomid®, a fertility drug which stimulates ovulation, is clearly a yang-invigorating, kidney-supplementing medicinal which can cause yin vacuity/vacuity heat in patient’s who are predis-posed to yin vacuity. In that case, I would not prescribe

any more yang supplements but rather yin supplements and vacuity heat-clearing medicinals to moderate or “har-monize” the effects of the Clomid^®for that particular patient.

B. If one or more Western meds are achieving their intend-ed therapeutic effect but are causing side effects in the process, then I would not prescribe duplicate Chinese meds to achieve that same intended therapeutic effect. Rather I would prescribe Chinese medicinals based on the patient’s presenting patterns including the side effects. In this case, the goal is to allow the Western medication(s) to continue doing their job while eliminating any side effects.

3. After determining what Chinese medicinals you would like to prescribe, go to one or more sources to research if there are any known drug interactions between the patient’s Western meds and those Chinese medicinals.

Blue Poppy Press’s Herb Toxicities & Drug Interactions, by Fred Jennes is just such a source. If there are any known drug interactions between what you would like to pre-scribe and what the patient is already taking, then you should consider either A) leaving that ingredient out of your formula, B) substituting another Chinese medicinal for that ingredient, C) reducing that ingredient’s dose, and/or D) adding one or more ingredients to prevent such a reaction. This last suggestion is possible only if we can work out the Chinese medical mechanisms for the interac-tion, and this may not be possible. Therefore, this last pos-sibility is the least likely of our choices.

4. Once I have decided on my Chinese herbal formula and feel reasonably sure that it is not likely to cause any drug-interactions, I begin by carefully starting the patient off with a small trial dose. By this, I mean to keep the dosages of the individual Chinese medicinals on the small side as well as to only give the patient a couple of days worth of

herbs. For instance, I routinely start my patients out on a four-day dose. At the end of that time, I tell them to call me to let me know how they did. If they have had any side effects, this allows me to immediately change their prescription before too much damage has been done. In some cases, I may ask patients to call me after only a sin-gle day or two days. If the prescription has not caused any problems or adverse reactions, I then prescribe a one week’s dose. At the end of that time, again the patient calls in to tell me how they are doing, and again I pre-scribe another week’s dose or, if they are doing really well, I may prescribe as much as two weeks’ dose at a time.

However, I make sure that the patient stays in touch with me on a regular basis so that, if any problems crop up, I can immediately solve those problems as necessary.

Further, I make sure the patient knows what I consider a problem. Depending on the herbs and their Western meds, that may mean sleep disturbances, digestive complaints, skin rashes, or whatever. At the time, I try to assure the patient that these reactions are not expected—that they are unlikely. However, in the unlikely event that one of them does occur, I want to know ASAP.

5. If possible, open a dialogue with the prescribing Western physician(s). Some will simply not want to talk.

Others will talk but not really listen. Some will forbid their patients to take any Chinese herbs while taking their Western meds for fear of some unknown herb-drug inter-action. In that case, there may not be much you can do. If possible, consider sending them a copy of Fred Jennes’s book Herb Toxicities & Drug Interactions to show them that you diligently study the available literature on this subject and act responsibly. If possible, also send the physician copies of any research reports or pages from Chinese med-ical books which show that, in general, the combination of Chinese and Western meds in the disease at hand are safe.

Bottom line, everything in the Chinese medical literature sug-gests that Chinese medicinals correctly prescribed on the basis of the patient’s personally presenting patterns are generally safe when taken in tandem with most Western drugs. In China today, most Chinese use Western medicine. Only 25% use Chinese medicine and even these do not necessarily use Chinese medicine exclusively. That means that many, many Chinese (potentially millions) are routinely treated with both Chinese and Western medications. I read the Chinese medical literature assiduously looking specifically for articles on herb-drug interactions since I know there is currently so much concern over this issue. However, reports of such interactions are almost nil, and I have to think that more articles would be published about this if such interactions were common.

Over the last five years, I have worked on a half-dozen big books having to do with the Chinese medical treatment of this or that Western medical specialty, such as diabetes, nephrology, psychiatry, and cardiology. In doing the research for those books, I have read and translated hundreds upon hundreds of Chinese journal articles, many of them dis-cussing case histories or clinical trials where patients were treated with a combination of Chinese and Western medicine, so-called integrated Chinese-Western medicine. What I can say from all this recent research is that the combination of Chinese and Western medicines appears to achieve better therapeutic effects at smaller dosages of the Western drugs and with less or no side effects. This means that, if anything, the combination of modern Western and traditional Chinese medicines is a good thing, not something to be feared, avoid-ed, or forbidden. Based on my 25 plus years of clinical experi-ence, I believe that, if one proceeds carefully and with due diligence, there is little danger of herb-drug interactions.

Most acupuncturists and practitioners of Chinese medicine in the West refer to ready-made Chinese medicines (cheng zhong yao) as “patent medicines.” That is the word most of us were taught in school. For years now I have been arguing against our use of this term. Not only is it factually inaccurate, it also stigmatizes our medicines in the eyes of those who actually know what patent medicines are. The following is a definition of patent medicines I found on the Web:

The words “patent medicine” refer to products that were market-ed, mostly in the 19th century, as medicines that would cure a host of diseases. Many of the diseases which these medicines were supposed to cure are still not curable today—cancer and diabetes, for example. Why did people buy these products? Well, given that the access to medical practitioners was limited, espe-cially in rural areas, and the state of medical technology in the 19th century, who wouldn’t buy these products? After all, going to your general store and purchasing a prepared medicine was a lot easier and a lot more pleasant than going to a doctor and having him perform bloodletting!¹

In other words, “patent medicines” refer to 19th century

APPENDIX I