Starting Your Herbal Pharmacy, Part 2

This blog is the second part in a series on starting your herbal pharmacy.  In this section I will cover some helpful tips to get started with your herbal pharmacy and the benefits associated as a licensed healthcare practitioner. – By Sherri Taylor

Why Should I Have An Herbal Pharmacy?

Herbal Medicine is a great way to treat your patients comprehensively.  In China, herbIMG_4267al medicine is the primary form of treatment, and acupuncture, cupping, gua sha, tui na, etc. are secondary solutions.  Herbal medicine is a natural form of internal and external medicine, and more and more people are turning to natural methods for their healthcare.  people are tired of the western pharmaceuticals that often have more side effects than benefits.  Drugs such as antibiotics, are over prescribed in situations that might not be appropriate.  As a result, the natural flora in the gut gets disrupted and weakens the immune system leading to other potential health problems.  Herbal medicine can help balance the body during times of illness and with recovery.  Herbs can be used alone or with other western medications depending on the person’s condition and meds.  They can also serve as a preventative medicine during times such as cold or allergy season.

Here are some thoughts on getting started:

  • As Chinese medicine practitioners, we have much to offer to the public in terms of quality healthcare. We have all the tools available to treat people in the many modalities of Eastern medicine while getting to the root of their problem by diagnosing and treating.  And if you have herbal medicine as one of your tools, not only can you offer comprehensive solutions to your patients but you are improving your revenue stream with what you sell in concert with your treatment expertise.
  • To begin stocking your pharmacy, you only need to select a few basic formulas and maybe a few single herbs. The herb and formula selection should be based on your unique patient population and the conditions that you see.  For example, think of the environment in which you live.  Do you live in the hot, dry desert where you might see lots of yin deficiency, and heat conditions? Or do you live near the coast where it is cold and damp?  Also, consider the season.  Is it cold and flu season? Perhaps have some Yin Qiao on hand for flu season and traveling.  If it’s allergy season maybe have some Yu Ping Feng San or Cang Er Zi San.  If you see a lot of women for fertility and regulating the cycle, you may want to have some Xiao Yao San, Si Wu Tang, Tao Hong Si Wu Tang, and Liu Wei Di Huang Wan.
  • Some single herbs that come in handy and that are versatile are Gan Cao, Fu Ling, Bai Zhu, Bai Shao, Gui Zhi, Dang Shen, Xiang Fu, Chai Hu, Huang Qi, Dan Shen and Dang Gui to name a few. This gives you some general ideas when stocking your pharmacy, but over time you will have to diagnose in Eastern medicine what your patterns are, making sure that those formulas and herbs are a good fit for the patterns that you are treating.  As your confidence builds with pattern identification and diagnosing, then you can start to expand more.  As your skills improve, your herbal pharmacy will grow, and so will your income and business.
  • If you are not a person that wants to stock your shelves right away and wants to wait to improve your diagnostic skills before having too much inventory, then an online herbal pharmacy may be the way for you to go. TCMzone has that available to practitioners and will drop ship formulas direct to your patient’s house (see herbal dispensary).
  • There are many forms of herbs to choose from: Pills, tinctures, packet granules or bottled granules, in which you can mix the appropriate amount of each herb into the patient’s formula. Personally, I enjoy making my own formulas because it is my art and my passion.  I started with the granules and still have the granule bottles, formula packets of granules, some single herb granule packets, and veggie capsules in my pharmacy, but mostly I make my own customized formulas. You have to choose what you are comfortable prescribing and what your patients are going to comply with.  A formula in capsules or packets may be easy to start with when building your pharmacy and your skills.

If you want to be a primary natural medicine provider that people go to for their healthcare, then improve your herbal skills as a practitioner in Chinese Medicine.  Herbs are extremely affordable as a strategy to improve a person’s overall health while being easy on their pocketbook.  Over time, herbal medicine can be used as a preventative medicine keeping your patients well, while leading to fewer doctor and urgent care visits as well as fewer expensive prescription medications.   Natural medicine is not meant to replace Western medicine but it will become an integral part of our healthcare system in providing the best that medicine has to offer.

 

My Advanced Training in China

Having practiced Chinese Medicine for 13 years, I always had the goal to participate in an advanced training program in China.  In May 2016, I was able to realize this goal when I embarked on a trip to China organized by TCMzone and Shanghai TCM University for advanced herbal training with seasoned practitioners of Traditional Sherri-2Chinese Medicine.  Since my practice consists primarily of prescribing customized herbal formulas for patients with various conditions, this was the perfect training for me.

The trip began in Beijing where we did some sight-seeing, and I was able to immerse myself in the culture and history of China, touring the Great Wall; the Forbidden City known as the imperial palace from the Ming Dynasty (see picture with TCMzone’s Jennifer Knapp, she has a great article too); Tiananmen Square at the center square of Beijing known as “Gate of Heavenly Peace”; The Temple of Heaven known as the Taoist temple; and so much more.

After our short stay in Beijing we traveled to Shanghai on the bullet train where I could see first hand the countryside of China.  Once we arrived in Shanghai, it was mostly all business at the Longhua hospital doing inpatient and outpatient rounds with the doctors in the hospital.  In the morning, we would see approximately 30 cases in the outpatient clinic with an interpreter describing the case, the diagnosis and the herbal prescription.  People would line up outside the door to see the physician.  Each patient would have a copy of their chart that they would bring to the doctor to review.  On occasion a patient would walk in on another in the middle of their consult and they would be asked to leave.  There clearly is not any HIPPA compliance being enforced in this hospital environment.  The outpatient acupuncture clinic within the hospital was just as busy.  There were a many different acupuncture clinics all with a small amount of space that consisted of a divider to make 2-3 different rooms on each side with a curtain and approximately 4 chairs out in the open so they could see approximately 10-12 patients at once.  Some rooms were even smaller than this. There would be about 2 doctors along with some interns to assist with treatment.  There were many cases of Bells Palsy in China, so this was a condition that we witnessed being treated often.  Treatments would include acupuncture, electrical stimulation, cupping, facial cupping for the Bell’s Palsy and Moxibustion.

The inpatient experience later in the day was a much more in depth study, examining 3-4 patients in much greater detail, see picture on the right shows I was checking a patient’s pulseSherri-1.  The team discussed the patient’s history, symptoms, and a detailed plan of short term and long-term treatment including herbal medicine and lifestyle recommendations.  In Cardiology, we would see patients hooked up to an IV drip of Dan Shen instead of a western medication for their heart.  Huang Lian Wen Dan Tang was also a popular formula given to some of the Cardiac patients.  In Traumatology, pain patients had an area where they had steam beds made for an herbal steam for their pain.  The patient would lie in this metal bed with a grate plate for the steam to come through the body.  The bottom of the bed would have a concoction of herbs.  The left over dregs of the herbal concoctions were wrapped in towels to put locally.  One patient had the dregs wrapped in a towel on her neck to help treat her neck pain.   Another form of external pain management were herbal patches placed on the patient’s skin that were used for electrical stimulation with a TDP lamp every other day for 20 minutes for approximately 10 sessions.  In addition to taking the herbs topically, patients would also have a prescribed herbal tea to take internally.

In the basement of the hospital is where they kept all the herbal supply that included the raw herbs, machines to decoct the raw herbssherri-3 into liquid to make packets of tea, along with granules that are dispensed in the hospital pharmacies. There were bags and bags of raw herbs stacked in the supply room.  Definitely a different look than what we might find in storage room of a western medicine hospital.

Afternoons also included lectures given by MD’s and professors on various topics such as cardiology, gastroenterology, immunology, and much more.  Herbal prescriptions were presented for specific energetic patterns along with modifications of a formula depending on the case.

During my time in China, I had another equally valuable personal experience.  I had been taking Western medications for a flu like virus, and as an asthmatic, I had been advised by my pulmonologist to continue taking steroid inhalers while abroad due to the high pollution levels in China.  Initially, I was hesitant to keep taking them for the prescribed time, but as an asthmatic, you fear not being able to breathe.  After about a week in China, I developed an increased appetite, dizziness, weight loss, anxiety and nausea.  As the days progressed, my symptoms worsened resulting in jitteriness and shakiness in my hands.

Dr. Wen accompanied me to the ER in the Longhua hospital to be evaluated.  The ER doctor asked me some questions with Dr. Wen translating for me.  After he completed his examination, he advised me to stop taking all my western medications.  He sent my herbal prescription electronically to the pharmacy.  The herbal prescription was a modified version of Huang Lian Wen Dan Tang.sherri-4

Going to the hospital pharmacy was an experience in itself.  There are three different floors for the pharmacy with each dispensing a different type of herbal prescription and medication.   One is for granules, a second is for sealed bags of liquid tea, a third for pill forms of an herbal formula, and lastly, a separate wing for the western medicine dispensary.  Each patient receives a number to pick up prescriptions at the many windows they have on each floor to dispense herbal prescriptions.   After receiving my prescription of granules and stopping my western medications, I felt better each day.

My valuable lesson in China was, “Always question if you really need a western drug for long periods of time.”  I learned first hand that long-term use of western medications can have consequences for your health.  The Chinese primarily use herbs, occasionally prescribe western medicine for short periods of time, and then return to an herbal regimen as long as needed.

The experience I had in China was the opportunity of a lifetime, and I will always be grateful to have been able to experience the Chinese healthcare system as a patient.  It was unfortunate that I had to struggle with my health on that wonderful trip but what better way to experience their healthcare system than going through their system as a patient.  And I should mention that my ER visit, and herbal prescription cost a total of $130 US dollars. Now that is affordable health care!

Starting Your Herbal Pharmacy, Part One

Fo Ti Tieng Herb

This blog is part one in a series on starting your herbal pharmacy.  I will cover the important areas of consideration when starting to build your herbal pharmacy as a licensed healthcare practitioner. 

As a new practitioner it can be daunting to start an acupuncture practice in addition to building an herbal pharmacy.  You may consider some of the following questions when thinking about the kind of pharmacy you want to have in your practice.

  • What brand of herbs should I use and what are the differences between the companies?
  • What is my patient population and the conditions that I will be treating most?
  • What are patients most likely to comply with (pills, granules, raw herbs for tea)?
  • What are my options for prescribing herbs to patients if I can’t afford to keep the stock on the shelf?
  • How are the herbs processed and packaged?
  • What equipment will I need starting an herbal pharmacy?

One of the first things to determine are is what brand(s) of herbs you should use and the differences between companies to determine who you will use to stock your pharmacy. Doing a little research will give you peace of mind when deciding which companies are a trusted source to use for your patients.  What exactly are the things you need to look for when doing your research?  You want to make sure you are getting a good quality product that is free of pesticides, herbicides, fungicides, and other toxicities.  Consider how the company sources the herb, tests it, processes it, and packages it for use by the consumer.   What is their authentication protocol? What type of testing is essential to ensure the product is safe and of excellent quality?  Quality control testing usually includes some of the following equipment: High Performance Thin layer Chromatography (HPTLC), Gas Chromatography-Mass Spectrometry (GC-MS), High Performance Liquid Chromatography (HPLC) and Microscopy.  HPTLC detects contamination, incorrect parts of the plant, and correct identity.  GC-MS combines the feature of gas without decomposition of the substances to analyze the form. HPLC separates ions and molecules to quantify components and gives a chemical fingerprint to each herb.  Microscopy is another form of examination under the microscope to look for pattern of I was pictured (first one from the left) when we visited the state-of-the-art lab in Tianjiang Pharmaceutical.herbs any contamination.  Another thing that you want to make sure of is that the company complies with Good Manufacturing Practices (GMP).  Chinese medicine manufacturers in mainland China are all under China’s pharmaceutical GMP to ensure that products are produced and controlled according to CFDA. Manufacturers in the US need to be in compliance with current GMP (cGMP) under the FDA requirement.  If you want to know detailed information about a specific herb or formula manufactured by the company, ask for a Certificate of Analysis (COA).

Last year, I had the amazing opportunity to travel to China with TCMzone and do an advanced herbal training at the Longhua hospital in Shanghai, China.  During that trip, I also visited their manufacturer, Tianjiang Pharmaceutical Co., Ltd (I was pictured in the photo here, first on the left, when we visited Tianjiang QC lab).  I felt comforted in knowing how they sourced their herbs, examined, tested, processed and packaged their herbs.  Getting an education and tour of the facility was an amazing experience to me.  I was so impressed with their state of the art technology and felt comforted knowing that I was supplying my patients with one of the best quality products Chinese Medicine has to offer.  Tianjiang Pharmaceutical is known to be the world’s largest manufacturer of premium Chinese granule herbs.  It is the main supplier for the doctors and hospitals throughout China.

Because Tianjiang is TCMzone’s herbal manufacturer, they carry pharmaceutical grade herbs.   The herbs are harvested by good agricultural practices (GAP) by growers in areas where they traditionally grow in China and undergo quality assurance methods such as HPLC and GC-MS to certify safety and efficacy of the finished product.  They assess the appearance, moisture, solubility, microbiological, fungal, bacterial and heavy metals of the herbal specimen. TCMzone also complies with cGMP standards and provides a COA for each batch of product they carry. I have been using TCMzone herbs for over 7 years now, and I find TCMzone’s pharmaceutical grade herbs are a trusted source to use in my herbal dispensary.

How I became a Chinese Medicine Practitioner:

Often, I get asked the question: What made you get into this field of medicine? The answer might surprise you, but it’s actually pretty simple. It was in my self- interest to look for alternatives to my own physical health.

My journey to Chinese Medicine began in my late 20’s. At the time, I was working in Cardiac Rehab as an Exercise Physiologist in a hospital setting. I had been working there for about 4 years since graduating with my Bachelor of Science degree in Physical Education with a specialty in Exercise Science and a minor in Health. Like many late 20’s graduates, I was pondering my next step in my life and thinking about going back to school for an advanced degree, but in what field? Nursing? Physician assistant? Cardiologist? Not surprisingly, the answer came to me through my own physical health.

During this time, I became chronically ill with bronchitis, sinusitis, and reactive hypoglycemia. My doctors prescribed multiple rounds of antibiotics, to the point that when I stopped the drugs, my symptoms returned within 5 days and my recovery was stunted. After about a year of this, I needed sinus surgery for a deviated septum, blocked sinuses and a chronic cough, that had been persistent for the entire year. On and off of antibiotics, I was also prescribed inhalers such as flovent and serevent, which left me feeling slightly nauseous and dizzy most of the time.

I was getting tired of feeling tired and out of it so I decided to view my heart rhythm on the EKG monitor by placing some electrodes on myself. The EKG read that I was in a sinus tachycardia at rest of 110 bpm (beats per minute). Normally, my resting heart rate is about 60-65 bpm. It was clear that these powerful western medicines that were treating my symptoms were also making me more ill at the same time. My doctors were treating my medical symptoms and not my whole self. It was time to look for other solutions.

The first natural medicine practitioner prescribed herbal medicine as well as dietary recommendations that addressed my allergies along with my various medical conditions. In place of the powerful drugs, she prescribed herbal remedies for my sinuses and dietary changes such as eliminating sugar, white flour, pasta, yeast, and dairy from my diet. I ended up moving forward with sinus surgery since there was structural damage such as blocked sinuses and a deviated septum that needed treatment, but I had also discovered that I could treat my broader symptoms with the age-old reliance on herbal medicine and dietary adjustments.

Improving my diet and augmenting it with herbal medicines, I noticed immediate improvements in my overall health, and decided that the path of natural medicine was indeed the path for both my personal and professional future. I became passionate about helping people who were struggling with the same vicious cycle of stronger and stronger drugs that I had experienced. I wanted to learn more about how to treat the body naturally so that recovery would not be a temporary band-aid for 5-7 days but a permanent improvement.

If it worked for me, I knew that other people could get to the root of their problems and resolve the repetitive cycle of illness that plagues many of us. I learned that plants and natural cures can heal, and my field of advanced study would become natural medicine and its many uses — namely a graduate program in Oriental Medicine.

In my first interview at a graduate school I learned that Oriental Medicine is rooted in Acupuncture and Herbal Medicine, but I also found that studying hundreds of years of natural and alternative cures was much more challenging than I had ever anticipated. Most importantly, I learned that to become an Oriental Medicine practitioner you have to be an herbalist first because the first line of treatment in Oriental Medicine is herbal medicine, then acupuncture, cupping and other modalities. Herbal medicine has always been my love and passion and I continue to learn things about the medicine every day through my study and clinical experience.