Course:
Prof:
Herb Drug Interactions
John K Chen, Ph.D, PharmD., OMD, L.Ac.
Date:
April 24-25, 2010
This is mostly about the safety of herbs and drugs. Isolation of practice – practitioners who only pay
attention to the stuff they give the patient – can breed dangerous interactions of substances, be they
drugs, herbs, vitamins, etc. Most patients taking supplements don’t report them to their health care
practitioners – the ratio is something like 60%.
Pharmacokinetics and Pharmacodynamics
Pharmacokinetics interactions refers to the physical substance and the physical movement of the
medicine that enters and exits the body. Pharmacodynamics refers to how the medicines work in the
body – do they work on central nervous system, respiratory, are they stimulants or receptors, do they
work on enzymes? Etc. Pharmacodynamics refers to the physiology and p-kinetics is the action upon
that physiology.
Pharmacokinetic Interactions include absorption, distribution, metabolism and elimination. These are the
4 phases that all substances entering the body go through.
 Absorption is the movement out of the gastric system into the body. Interactions between
combinations of substances can affect absorption and therefore effect.
 Distribution is moving these substances to the target tissues (and other parts of the
body….when medicine goes to the non-target tissues these are considered side effects).
 Metabolism occurs mostly in the liver – this is the breakdown of drugs from inactive to
active or active to inactive. Liver also destroys the stuff you don’t need in your system –
toxins, preservatives, pesticides, etc. The liver breaks these down to eliminable parts.
 Elimination is the exit of waste products from the other processes out of the body.
Pharmacokinetics
Absorption
This is one of the most common interactions between substances and body. In TCM (at least in
America), that’s mostly in oral form. Medicines can be oral, sublingual, inhaled, suppository, etc.
Regardless of delivery method these substances must still be absorbed into the body.
Binding in GI tract
Binding is what happens when 2 substances come in contact. There are certain drugs and herbs that are
literally sticky in nature and will glue themselves to other substances. They form a large molecule that
may be insoluble or just too large to pass through the gastric membranes. When this occurs they just get
flushed out of the system thru the GI tract. Some drugs, like cholesterol control and weight control drugs
are designed to do just exactly this.
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
o Questran (cholestryramine) and colestid (colestipol) treat cholesterol
o Xenical treats obesity
Both of these drugs are designed to be taken with meals to block absorption of fatty substances. 15-20
years ago these were commonly prescribed. But they have a lot of GI effects – n/v/d as well as pain in
the stomach/stomach cramps - caused by the huge molecules these produce. Now statin drugs are more
commonly prescribed (Lipitor et al) since they are stronger and work better. In a small number of pts, 1
– 3 %, these cause kidney and liver damage. Now treating cholesterol begins with statins. If the patient
is likely to get the kidney/liver damage, they get the 3 drugs cited above.
If your patient is on the questran/colestid/xenical type drugs you are likely to diagnose as spleen qi xu or
turbid phlegm. You might prescribe Er Chen Tang for them. What’s the likely interaction? If taken
together the drugs will bind to them upon contact and it will flush the drug right out of the system. These
drugs take about 2 hours to flush out, so you can’t take them with other drugs either.
Xenical by the way has a nasty side effect of involuntary projectile diarrhea. As a result it’s rather a last
case scenario and is only prescribed for morbidly obese patients. Xenical primarily binds to fatty/greasy
molecules, but will bind to other stuff. Since there are a lot of vitamins that are fat soluble it will impact
these two, which further deplete a patient from a nutritional standpoint.
As a general rule, have patients take their herbs 2 hours away from any other substances since that’s (as
a rule) how long it takes for the stomach to empty again.
Wu Bei Zi, Chi Shi Zhi, and Yu Yu Liang are all astringent herbs that help bind the lung qi, stop
coughing and to bind intestines to stop diarrhea. They also have an unusual use…poison control. The
binding action can be very strong in large doses. Accidental ingestion of poisons (including spoiled
food) is treated with binding agents which then bind to poisons, block absorption, and flush it out of the
GI tract. If you were to combine formulas with these 3 herbs you will disable most of the other
medicines a patient might be on. Use the 2 hour rule.
You could also induce vomiting and purging to keep poison from being absorbed. Vomiting only works
in the stomach. Once the poison passes to the rest of the GI you bind and purge to limit absorption.
Ciprofloxacin/Cipro is a very strong antibiotic for very strong infections (lung, kidney, etc.). You
definitely don’t want to block its absorption! Cipro chelates or binds with minerals. Once bound it is
flushed out of the system and is not absorbed. You take it on an empty stomach to keep this from
happening. Since herbs are plant and have minerals
 Xiao Hui Xiang or fennel seed is often given for liver qi stagnation. It has a large mineral
content that will bind with Cipro. It decreases
serum concentration by 83%!
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
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 Di Yu is used to stop bleeding. Binds even more strongly with Cipro, decreasing serum
levels by 94%.
Why is this important? You have to have a certain
serum level for it to work.
You aren’t supposed to take herbs with tea. Why?
Tea has a lot of caffeine with stimulant effect. Tea
also has a strong binding effect on the GI tract that
flushes out the tract – sort of detergent effect like
soap washing the outside of the body. The molecules
have a hydrophilic end and a lipophilic end –
hydrophilic attaches to water and lipophilic attaches
to fatty molecules. Ergo, if you eat a fatty greasy
meal and then drink strong tea it helps flush it away. Because of this binding effect the tea binds to the
herbs and makes the herbs far less effective. This only applies to green, oolong, and black tea (plus pu-er
tea), not to other herb teas like mint or chamomile.
Chuan Xiong Cha Tiao San is the only formula in which tea is used. The caffeine in the tea is the wanted
ingredient as this formula treats headache/migraine. There are drugs for migraines that also use caffeine
as an ingredient (fiorinal and fioricet). This formula is a powder that is supposed to be blended with tea
right before you ingest. The only kind of teas you use with this formula are green, oolong, black tea
(camelia sinensis) and pu-er tea.
Change in pH in Stomach.
This is a change in the acid balance of the stomach. Drugs and herbs that change the pH are antacids
such as Maalox, Mylanta, and Tums. Herbs include Hai Piao Xiao, Long Gu (dragon bone, which is
fossilized bones of large mammals), all of the shells. The shells have a rather rough effect on the
stomach, possibly creating more stomach problems. All of the above is calcium carbonate.
If you take herbs with antacids you may reduce absorption of herbs by 10-15%, but it won’t harm the
patient. Antacids don’t work more than 30 minutes max, so you can separate antacids and herbs by
about ½ hour with good effect.
The frequency of
dosage on the
package will tell you
how long the drug
will last in the
system.
Because antacids don’t work very long, many patients escalate to histamine 2
receptor antagonists such as Zantac, Tagamet, Pepcid, and Axid. All of these
are available over the counter (because their patents expired, so don’t have to
be prescribed). When stuff goes OTC they are often at ½ strength, so Zantac
prescription strength is 150mg, but OTC is 75. Zantac lasts about 12 hours.
The frequency of dosage on the package will tell you how long it will last in
the system. Bear in mind that these drugs are Band-Aids, treating only the
symptom, not the cause. Until the problem is fixed the patient will continue to
take these drugs.
In TCM this problem could be caused by stomach heat. Zuo Jin wan might be the formula of choice for
treating the stomach heat. You can also use Qing Wei San. You might determine that stress is the root
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
cause, thus Liver Qi stagnation. For this you could prescribe Xiao Yao San. This would treat the root
cause.
Now what about drug/herb interaction? When should the herbs be taken? When the dose of the drugs
have least influence upon the digestion (so, below therapeutic dose levels) so that the herbs are best
absorbed.
Huang Lian is a heat clearing herb which also reduces production of stomach acid, similar to zantac and
tagamet. It also kills bacteria with it’s antibiotic effect. Specifically it kills H. pylorii. It’s also very bitter
and cold – stomach ulcers is a combination of excess and xu. The excess is the over-production of acid
and the erosion of the lining is the deficiency. Huang lian is really bitter and cold and strong. You use
wu zhu yu which is cold and directs heat downward – the acid thus is reduced in production. The effect
between them is synergistic. It’s also antagonistic – the temperature of the herbs are held in check
minimizing the harshness of both. This combination is Zuo Jin Wan, a 6:1 ratio between the two.
Zuo jin wan will protect the stomach against aspirin damage and increases the stomach’s mucus
membrane. This is important for aspirin and NSAIDS which block prostaglandins, an anti-inflammatory
process agent. That’s good for pain, but prostaglandins are needed in the stomach lining to keep the
digestive juices from eating the stomach lining tissues. That’s why NSAIDs erode the lining of the
stomach and exaccerbate the possibility of ulcers. If a patient is on NSAIDs for chronic pain (like
arthritis), you add herbs to minimize the damage. This is a complementary treatment, using an herb to
treat drug side effects.
Proton Pump Inhibitors are the next class of drugs that physicians will prescribe if the histamine
inhibitors don’t work. These drugs are Prilosec, Nexium, Prevacid, Protonix. These are for bleeding
ulcers. They are stronger and last longer (usually 24 hours) than all others. Prilosec is now available
OTC since the patent as expired. Large doses and long term use causes atropic gastritis (atrophy of the
stomach muscle) and thus increases the risk of stomach cancer. This is the “little purple pill” that is
heavily advertised on television and in media.
Let’s say your patient escalates to these drugs because they are even more stressed out now. The xiao
yao san isn’t working and needs more….you go to jia wei xiao yao san (or dan zhi xiao yao san) to clear
heat and alleviate liver qi stagnation stress or chai hu shu gan tang. When is the best time to take the
herbs? Again, an hour before taking the proton pump inhibitor. If you can’t do that, strengthen the
dosage as the absorption is only impacted by 10-20%.
Change in intestinal motility/peristalsis
Now that the herb and drug have passed the stomach, it goes to the intestine. The longer the herb or drug
stays in the intestines, the longer it is absorbed.
Some drugs increase intestinal motility and can decrease absorption. Reglan/metoclopramide is one such
drug. Everything is passed out more quickly thus lowering absorption, though it’s hard to say by how
much. Compensate with higher doses.
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Some decrease peristalsis and increase absorption. Examples are haldol and thorazine which are
antipsychotics. Perstalsis can become so slow that the patient gets constipation. The longer substances
are in the intestinal tract the stronger the absorption and then the patient can absorb too much. This
increases the risk of side effects. Solution: treat the constipation!
Opiods cause constipation by drying intestinal fluids. Patient gets really constipated and again absorb
too much. These include morphine, Vicodin, hydrocodeine, Darvocet, Llorcet, Tylenol 3, etc. In TCM
morphine is ying su ke, the husk of the poppy. It is an astringent which stabilizes and binds the lung qi
and diarrhea. Did you know Immodium is an opiod? Interesting, no? The only difference is that it only
binds to the intestinal stuff, so no good highs from this. 
Da huang is a downward draining herb to promote bowel movements. Mang xiao is another. Both are
powerful drain-downwards. The action mechanisms are very different though. Mang xiao is poorly
absorbed, if at all. It is an osmotic agent, sucking fluids toward it and thus to the intestines which treats
constipation due to dryness. Can take ½ hour or so to work. Milk of Magnesia and epsom salts are the
same in action. Da huang is rhubarb. You absorb it, clear the liver, goes to serum, then to the intestines.
The peristalsis action increases and speeds expulsion of contents. Can take 2-3 hours to work. The action
is much like flushing a toilet – osmosis pulls while peristalsis pushes.
Take herbs and drugs separately by 3 – 4 hours.
1 hour minimum for people that don’t have this
kind of time.
Overdose of both will cause loss of electrolytes,
loss of fluids and extreme discomfort! Once the
bm starts, discontinue. Switch to the seeds.
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Distribution
During distribution most of the drug will stay in the blood. Again,
you want to effect your target tissues more than the other tisues. Two
factors that contribute to distribution interactions:
 Safety index
 High protein binding ratio
Safety index is just that: the level of safety and the difference
between minimum and maximum concentration. The bigger this gap
the safer the substance. When this gap is narrower there isn’t much
wiggle room between therapy and side effects.
Chemotherapy is very toxic and will kill all it comes in contact with.
The idea is to kill the cancer cells before you kill the patient.
Chemotherapy has a very narrow safety range.
Protein binding means once a drug is absorbed it has a hard time
getting to the organs. The blood brain barrier keeps blood borne
anything from coming in. If a drug binds to a protein the drug is
then more readily carried into the organs.
Every drug has a different amount of binding. A drug might bind
to protein at a 99% rate with only 1% free. Once in an organ it
has a different binding ratio. The parts that are free will then do
their work. This gets very complex when you start combining
drugs. Sometimes drugs will compete for binding thus leaving
more free in the system. Now you have more free to work than you anticipated. This can push a drug
over the safety level to the OD level.
Now all that said, there are only 2 that have these extreme problems: coumadin/warfarin, and dilantin.
Coumadin is an anticoagulant and treats clotting disorders like heart attack, stroke, etc. Profuse bleeding
and bruising are signs of overdose. Dilantin treats seizure and epilepsy, nerve related pain (this is an ‘off
lable’ use such as neuropathy and neuralgia, possibly migraine). CNS (from dizziness and light headed
to passing out) and eye problems (blurry, double vision or irregular movements of the eyeballs) are
markers of OD level. Generally it isn’t the patient that notices the eye movement, but the family and
friends.
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Will your herbs interact with these two? You don’t know. Herbs have a ton of molecules. How many
look exactly the same and compete with coumadin and dilantin? Who knows? You also don’t know
what happens chemically in the cooking process. This is no longer a dosing and timing issue. You could
start with very small doses, gradually adding increases and watching for interactions until you get to
therapeutic dose.
(These drugs also have pharmacodynamic actions also. More on that later.)
Metabolism
Some drugs increase the rate that the liver metabolizes stuff. If liver
metabolic rate is fast, herbs are less effective than normal. If a formula
works for a while then tapers off in effect don’t doubt your dx, gradually
up the dose. This is the liver enzyme inducer. Drugs that do this
The opposite is liver enzyme inhibitors. These drugs will supress and
decrease the liver metabolic rate. The upshot of this is that the
bioavailability of drugs and herbs will be increased and more available in
the system. This increases the likelihood of side effects. Some drugs that
do this 
In the 70’s/80’s it was common to prescribe erythromycin with
seldane/histmanol. These were potentially lethal together since they
inhibited metabolism and caused very high concentrations which led to cardiac repercussions such as
arrhythmias and heart failure.
Huang Yao Zi is classically used to treat phlegm accumulations, esp in the neck (i.e., goiter). Also used
for hyperthyroid and sometimes for thyroid cancer. Why don’t’ we study it in school? Because it’s
freakin’ toxic! It’s used in China at no more than 5g and with no liver conditions. You must check liver
enzymes frequently and regularly. You never use it unless it’s pretty much last resort in TCM. After that
you refer to western medicine for surgery or radiation therapies.
Guan Ye Lian Qiao is also known as St. John’s Wort.
In Europe it’s used antivirally. In TCM it’s a heat
clearing herb treating at superficial levels (sores,
abscess, insect bite, etc.). Similar in heat clearing to
Lian Qiao (forsythia). It’s also used now to treat mild
depression, which is why most people take this herb.
Since it’s available over the counter, there are
potential serious side effects for drugs. See the inset
 here.
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
This herb causes the liver to metabolize faster which makes other drugs and herbs less effective.
Tylenol + St John’s Wort wouldn’t cause much of a problem, but something St. John’s Wort and
Cyclosporine, an antirejection drug, that’s potentially very very bad.
Heat clearing herbs such as huang qin, huang lian, zhi zi have strong antibiotic effects and could affect
birth control. Since you only give these short term, let the patient know and ask them to use back up
birth control methods.
Usually when you talk about liver actions and
herbs/drugs, it’s usually a bad thing. In western
medicine there aren’t any medicines that will help
the liver except for interferon (and that’s only used
with liver infection). Here’s where TCM comes in
really handy. Dang Gui is one such example. Dang gui is for blood xu and anemia but also effectively
treats acetaminophen induced liver damage.
Damp heat in the liver and gallbladder are more examples. Treated with formulas such as xiao chai hu
tang, da chai hu tang, yin chen hao tang. Single herbs would include huang qin, huang lian, hu zhang,
yin chen hao, dang gui, niu bang zi/niu bang gen, wu wei zi and more.
Prevention and maintenance is much better in TCM.
Niu Bang Zi is used for heat in the upper body such as sore throat, laryngitis, etc. This too will treat
tylenol induced liver damaged. This is a heat clearing herb – pharmacologically this elimiated the effects
of toxic metabolites from acetaminophen/carbon tetrachloride.
Wu wei zi is an astringent herb, but also helps with damp heat in the liver/gallbladder. It also lowers
liver enzymes. That’s weird because it’s not cited in any way as going to liver/gallbladder in the Divine
Husbandman. When the herb is processed some of the heat sensitive components – the molecules that
are destroyed are the things that affect the liver/gallbladder. Therefore, when the Divine Husbandman
was written, since no one could look at the herbal decoction to the degree we can.
Elimination
This is the last part of pharmacokinetics. If the patient has healthy Kidney/functions, fantastic. The only
people that you need to worry about are those with nephrotoxicity or less than 2 working kidneys.
You’re probably not going to see the drugs on the left.
These are the nuclear bomb of antibiotics. They are last
case scenario drugs.. They can cause irreversible ear
and ki damage. You might see methotrexate. That’s a
chemo drug supressing the growth/replication of
tissues. Used in China to induce abortion.
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Aristolochiae-containing herbs are banned for the most
part.
Pharmacodynamics
To understand pharmacodynamics you have to understand synergistic and antagonistic effects. You also
have to understand whether a substance has calcium channel blocking effects,
Synergistic effects can be expressed as 1+1=3. The effect is at least double the combined effect.
Antagonistic effects can be expressed as 1+1=1, with one cancelling the other out.
Synergy
These pairs are used together regularly because they work so well
together.
These herbs cancel each other out. But you’ll see them
together sometimes! If you overdose on ren shen the
best antidote is lai fu zi’s source or the daikon radish.
Gensing gives you energy and improves mental
function. If you overdose you have palpitations, loss of
mental function, etc. Use daikon radish to counteract
this.
The nineteen counteractions are basically good for classical purposes, but clinically speaking useless.
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Drug-drug interactions also are subject to synergy. The first pair below are antibiotics which were
derived to counter antibiotic resistance. Vicodin is a
combination of drugs targetting the peripheral and central
nervous system at the same time. Cocktails of drugs used to
treat HIV and cancer are common also because this lowers
drug resistance and viral mutation.
There are also antagonistic type examples in wetern medicine. The
combination of tetracycline and ciprofloxacin with iron and activated
charcoal counteracting poisons are some examples. In the former it’s a
binding reaction that lowers toxicity when tetracycline and/or cipro are
combined with iron.
Though chinese herbs are natural and more gentle for the most part they aren’t safe or tame! Some
serious poisoning episodes have occurred with Chinese medicine. An article published in China
examined herb toxic poisonings. It cited 61% toxicity caused by aconite root herbs, 15% by
anticholinergic properties (of datura and areca) and 24% others. Bear in mind that there are over 11,000
herbs documented! Note that aconite and datura and areca are the only 3 specifically cited out of all
those!
China has 5000+ years of history. Prior
to this China was a collection of
nomadic tribes that were not linked
together. Eventually the tribes united
under one leader to give some
protection - the Yellow Emperor. The
Divine Husbandman, Shen Nong, was
the guy who solved the food problem,
bringing agricultural knowledge to
China as well as herb knowledge. You
see Shen Nong with a plant in his hand
in portraits of him. Legend has it that he was traveling, tasted a plant,
knew it was poison, but could not get to the remedy and so died.
Prior to Shen Nong China was a hunter/gatherer culture. Aconite was
used on the tips of arrows causing death to large animals who were
hunted and shot. It paralyzes, causing the skeletal muscle to stiffen. It
took another 1000 years to convert it to medicine. Aconitine, the
active poison component in aconite, can be deactivated by cooking for
2-3 hours.
Allergic reactions to aconite are similar to the paralysis effect. Can happen due to poor processing,
overdose, accidental ingestion. Tetraplegia and cardiac arrest as well as ventricular tachycardia and
death. Cao wu, fu zi, and chuan wu are the individual herb names you will see that are derivatives of
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
aconite. If you use raw herbs, ask the patients to cook an additional
hour just in case. If you buy patents or powders, you need to buy from
reputable manufacturers due to the potential toxicity.
Numbness is the first sign that the aconitine is still active. This is why
Dr. Wu always suggested you take a chopstick, dip it in the decoction
and put a drop on the tongue to see if it goes numb.
Rou gui, one of the antidotes, causes vomiting. If the
herb hasn’t passed to the small intestine and lower this
should be a good fix. You can also use the decoction
cited to the right. Doses are the recommended range of
dosage for each herb cited.
Below are some specific antidotes:
Anticholinergic effects
Anti means against, cholinergic refers to the parasympathetic system. Anticholinergic therefore blocks
the parasympathetic system, causing hyper states and excitability (dry eyes, dry mouth, tachycardia,
irritability). Three herbs are referred to here, but mostly refers to the seed and husk of the betel nut.
 Man Tuo Luo
Datura metel, D. innoxia, D. stramonium, D. tabula, D. fastusa
Usually not impoted into the US.
 Bing Lang
This is the seed of betel nut.
 Da Fu Pi
This is the husk of the betel nut
Betel nuts are chewed in asia/pacific area kind of like we drink coffee. Basically, they’re used for the
anticholinergic effects!
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Pregnancy and nursing are difficult situations, primarily due to liability. There are a number of
substances to avoid during preggers. These herbs are either toxic or dramatic in effect.
Your liability basically never goes away if you treat women during preggers! There have been cases in
which ob/gyn doctors were sued for low SAT scores 17 years after the baby was delivered. Screw that
noise, ya’ll.
As far as nursing, assume the worst: assume that the herb will go to the breast milk and will be passed
on to a baby. Ask yourself if you’d give these herbs to a baby. If the answer is no, don’t give them for
the mother either. Lipophilic herbs are
more likely to go into breast milk –
animal and seed ingredients.
Hydrophilic substances are less likely
to transfer.
Most books give doses for an ‘average
adult’ which is an average Chinese
man about 5’5” and 130-150 lbs.
Here’s a better guideline 
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Common Adverse Reactions
Nausea and vomiting are the most common. Patient can add ginger to the decoction or can drink ginger
tea first. Constipation and diarrhea are also common as is headache. Headache is more likely for upward
going herbs. Allergic reactions are most commonly skin reactions such as rashes.
Gluten reactions are the new black in allergic and adverse reactions. Herbs to be aware of: xiao mai, fu
xiao mai, mai ya, and shen qu. All of these either are or contain wheat.
Regulatory Issues
Herbs are regulated by the FDA in the US and they are
regulated differently here than anywhere else. Here they are
treated as food. In China they are considered traditional
medicines and who can/can’t prescribe is more strongly
regulated. This is why so many herbs have been banned –
adverse reactions = not suitable as food.
Aristolochic acid is a recent banned substance. The 5 drugs
and two herbs to the right were used as a weight loss
combination in Belgium. If was effective, but several ingredients are toxic to the kidney. Some
participants in the program had trouble pee’ing – either pain or inability. Upon further examination, it
was discovered that these participants had kidney failure. It was also noted that the doses are also too
high. Unfortunately the article published about it called it “chinese herb nephropathy” and so it suffered
from bad press.
Aristolochic acid is not water soluble. When you cook it in water the active ingredients are extracted
while the aristolochic acid is then discarded with the herbal dregs you toss out at the end of the
decoction process. In Belgium this didn’t happen: instead they ground up the herb and pressed it into
tablets thus causing the nephrotoxic effects.
All of these are banned due to aristolochic acid:
In the US fen fang ji is fine, but not guang fang ji. San
ye mu tong is fine too as is xi xin.
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Pyrrolizidine alkaloids includes comfrey, kuan don ghua, and zi cao. Comfrey is used a lot and has
been occasionally linked to hepatitis. The FDA’s conclusion published in their yearly report says
comfrey is banned, not other plants and herbs. Will they cause harm? Probably not. However, if the
patient develops liver problems a case could be made for these herbs.
Ephedrine alkaloids include ephedra/ma huang, and ban xia. Ma huang was used for weight loss,
improperly so by the way, and then the FDA banned it. Ban xia was originally banned, but is no longer
and is without restrictions. Ma huang, however, has been reclassed as a drug not an herb. Ma huang can
be reduced to methamphetamine which is probably the real reason it’s been banned and likely isn’t
coming back. Even pseudoephedrine is regulated rather heavily.
Since ma huang was banned, herb companies started
using Citri Aurantii for weight loss. This includes zhi
shi, zhi ke, chen pi, and qing pi. Loss of these herbs
would really impact the TCM industry. That’d be a
bummer. The TCM industry is thus trying to work
with the FDA and educating them in hopes that we
will be exempt from any restrictions. However, at
high concentrations, it could cause cardiac problems. Now the FDA has decided not to take regulatory
action….also you can’t make them into meth! (And if you start banning oranges you’re going to totally
piss off the citrus growers lobby.)
Human placenta and wu ling zi were
also chopped by the FDA.
Manufacturing Issues
These don’t happen as often as they used
to, but still good to know…
Mercury, lead, western drugs and more
weird things sometimes have been found
in herbs.
Look at the example to the right and
note the scary shit found upon lab
analysis. This is a high price to pay for
male enhancement!
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Some examples in the handout, Herb-Drug Interaction (1 of 2) 2010 v1 handout, were from the 70’s and
80’s, however, there have been examples from the recent decade too. Notice on page 19 of the handout
(Herb-Drug Interaction (1 of 2) 2010 v1 handout) that the phrase “chinese herbal nephropathy” raises
it’s ugly head again.
Some herbs get the bad reputation due to improper processing, fungal growth due to improper storage
and more. Doesn’t mean they are necessarily dangerous in their processed format.
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Pharmcodynamic Interactions
Pharmacodynamics refers to either synergy or
antagonism, covered previously.
Herbs are classed in TCM into mentally digestible
chunks, as are formulas.
Xterior Releasing Herbs
Da Hui Xiang (Chinese star anise) is the herb from which Tamiflu comes. Shortens the duration of flu
virus by hours, not days. Gets better press than it actually deserves perhaps, but is the only drug that
treats bird flus.
Exterior Releasing Herbs
Gui Zhi and Ma Huang are commonly used to
release the exterior. Ma Huang increases the
metabolism therefore causing sweating by
opening sweating pores. This is also why it has
side effects – blood vessels constrict causing
blood pressure to increase and heart rate to increase. Gui Zhi on the other hand causes sweating by
warming – warms the channels and collaterals by causing vasodilation so that blood flows better to
hands and feet.
These 2 herbs have a helpful antagonistic effect. The combination of the two will prevent all of the
cardiovascular effects one alone might produce.
When ma huang is processed you are supposed to
remove the joints, then when you cook you have to
remove the froth that bubbles up. This is where the
ephedrine alkaloids are located which target the
cardiovascular system. The water soluble ephedrine
alkaloids which target the lung are in the inbetween bits. When processed correctly the cardio side fx are
far less. But if you are going to have side fx from any herb, it’s probably going to be from ma huang.
Should not be combined with other sympathomimetic drugs or with beta blockers (usually prescribed for
hypertension).
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Chai Hu is used in Xiao Chai Hu Tang. This is most used herbal formula in Japan which harmonizes
exterior/interior to treat LV problems such as hepatitis and cirrhosis. Asians suffer from hepatitis quite a
lot. There’s a lot of food sharing and communal meals and a whole lot of drinking. Business and
socialization happens over heavy drinking…heavy frat boy kind of drinking! The treatments for liver
problems are interferon (western med) and xiao chai hu tang (tcm treatment). Use of either or both in
combination for chronic hep and cirrhosis can result in drug-induced pneumonitis. Never treat with both
at the same time – there’s a 0.5% chance with inteferon, 0.7% with xiao chai hu tang, but 4% when
given both. This can translate into big numbers. This is a well documented herb/drug interaction.
Interferon is not a magic bullet and has side effects. There are 2 formulas that work really well for
adverse reactions: da qing long tang and ma huang tang. Side fx can be discomfort, fever, gen malaise,
paresthesia and arthralgia. Use of these 2 formulas can reduce these effects, esp with Hep C.
Antihistamine Effect Herbs and Formulas
Xin Yi Hua, Cang Er Zi, Chan Tui, Fang Feng.
The first 2 are for nose problems and the 2nd two treat skin problems.
Classic Formulas
 Ma Haung Tang. Not often used…probably more often used for people in colder climates.
 Gui Zhi Tang. Very useful. These patients have aversion to wind and cold. Good formula for
stop sweating, frostbite, poor circulation (because of vasodilation effects).
 Xin Yi San treats wind cold type problems. (Wrap the fibrous bits in gauze to keep the little
hairs out of the finished decoction.)
 Cang Er San are good to treat allergies (sinusitis, etc.). Cang er san is more for wind heat.
Make sure it’s properly processed.
 Qing Bi Tang treats chronic sinus problems, not just allergy related, but more year round –
perhaps damp heat in sinus cavity. Discharge is yellow and sticky, foul and smelly, even after
blowing feels like you’re congested.
Can be more irritating to the stomach – don’t take it empty, but take it with meals or client
could have nausea/vomiting Has da huang in it and will turn the urine darker and orange.
 Xiao Feng San is good for allergies affecting the skin whether it’s systemic or contact
dermatitis.
Allergies are a hot topic due to the overprocessed over chemicalled nature of our life. Look
for weird rash/itchy stuff – ask if patient came in contact with any allergens and the answer
will probably be no. This can be due to chronic exposure and sensitivity that develops – this
crap gets trapped in fatty tissues and organs. As allergens build up here they will eventually
flow out and cause allergy sx. This is now an allergy that comes out from within. Clears the
body from outside.
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
This is a symptomatic treatment. Use Dang Gui Yin Zi to treat the root. This is often used in
Taiwan and China, but you won’t find it in Bensky’s Formulas and Strategies. Clears the
body from within.
Don’t take these in caps/tablets – always take in liquid form. Think about the diseased area – caps have
to go a long way to get to the target tissues (stomach, Si, Liver via first pass, then distrib, then to nose,
etc.). If you use a decotion or powder, while it’s hot and steaming, breathe in the steam and essential oils
from the tea – cup your hands around the cup and inhale for about 5 minutes, then drink the decoction.
Much better immediate and long term effects.
If you want to be even more direct and aggressive, apply the herbs suspended in an essential oil form to
the nasal mucosa. Cook the formula down to decoction and discard the residue. Simmer until the water
evaporates into a thick herbal paste, put it on a qtip and apply it directly to the nasal mucosa. This is not
pleasant for 30 seconds to 1 minute, but after that all the gross junk comes out. Now use a neti pot and
wash that crap out. You’ll get 24-48 hours of very clear nasal breathing. Follow up with decoctions to
maintain the effect.
Xiao Qing Long Tang – cold fx the lung and cold type of asthma. Also when you feel you’re about to
get a cold. Take it in liquid form and try to inhale the essential oils in the steam. This formula is the
bomb. If you combine it with fluticasone it’s far more effective for cold asthma than xiao long tang or
fluticasone is alone.
Heat Conditions
There are a variety of heat and fire conditions:
 Heat and Fire disease is high fever, aversion to heat, thirst, restlessness, irritability, and
delirium. This is more systemic and global.
 Damp heat is more localized – can also be infection, inflammation but local. Ofte affects
lower jiao
 Heat in the blood is maybe sepsis, scarlet fever, meningitis or encephalitis. But it can also be
restlessness, irritability, delirium, semiconsc, purpura and bleeding
 Toxic heat is pus, discharge, solid mass, and cancer.
 Deficient heat is a perception of heat, but not necessarily a true heat.
Once you know which one you’re dealing with you can give effective prescriptions. You also need to
know if you’re dealing with infection and what kind.
Herbs with antibacterial effect for instance include huang qin, huang lian, huang bo, and zhi zi. Huang
qin basically goes to the upper jiao, huang lian to middle, zhi zi goes everywhere.
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Antiviral Effects
 Jin yin hua
 Lian qiao
These are generally for the upper body – common cold and flu in early stage and even when
they move to lung. Also good for viral herpes.
 Long dan
Better for damp heat in LJ – cystitis, vaginitis, bladder infections, genital herpes – very
effective for this last one.
 Dao di wu gong
Indiginous herb growing in SE China. Wasn’t described in detail in materia medicas. Treats
herpes zoster (shingles) really well – used orally and topically.
 Chuan xin lian
More badass than jin yin hua and lian qiao – hasn’t been used as much so there is less
resistance. Also has an anti-cancer effect.
Antineoplastic Effects
There are lots of these, but many too toxic to use.
 Ku shen zi
Extremely bitter. Never give in liquid! You hide it in longan fruit – like a pill pocket you use
for your pets!
 Ban zhi lian
 Bai hua she she cao
These last 2 are better.
Antipyretic Effects
These are heat clearing herbs that lower body temperature. Shi gao is one and has a fast onset with short
duration (about 4 hours). Zhi mu has slower onset with longer duration but isn’t powerful enough to
lower fever quickly. If you are treating a high fever you use a lot of shi gao, but you combine with zhi
mu for best effect. Bai hu tang combines these two for this reason.
Know that bai hu tang is only for reducing fever…like tylenol or ibuprofen. No antibacterial or antiviral
effect. If you are treating fever due to infection you need more – modify with some of the
antibac/antiviral effect herbs.
Antihypertensive Effect
Lower the metabolism and relieve HTN.
 Zhi zi
 Long dan
 Ye ju hua
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
 Xia ku cao
Immediate effect ot lower BP.
 Jue ming zi
Can use in a tea. Crack the seed open in mortar/pestel, drink that puppy all day long. It’s a bit
of an acquired taste, but you get past it fairly quickly.
 Zhen zhu mu
Hepatoprotective Effect
Hep is a damp heat in the liver. These clear the heat and flush.
 Huang qin
 Zhi zi
 Long dan
 Yin chen hao – best for jaundice
 Wu wei zi – not really heat clearing, but treats liver well if you don’t process at high temps.
Classic Formulas
Local effect
 Qing Fei San – Lung infections
 Qing Wei San – heat in ST
 Qing Chang Tang – travelers diarrhea – flushes out the digestive tract.

Systemic effect
 Long dan xie gan tang – damp heat in lower jiao, but also along LV and GB channels. Herpes
Zoster, sore throat, ear infections, etc.
 Huang lian jie du tang – infections fx trunk of body. Herbs to all jiao’s. Kkind of shotgun
therapy. 
 Pu ji xiao du yin – Chen’s favorite formula. Chinese culture started in Yellow River and
Beijing area. Zhang Zhongjing lived here. It’s a cold area, so he wrote a book based on those
conditions and the problems that arose from it. Hence the Shang Han Lun.
As Chinese culture and people migrated south the environment was found to be hot and
humid breeding a different disease profile. These formulas didn’t work so much any longer.
Chinese docs tend to respect the past and use the old formulas…which killed people off by
the droves. Finally the formulas changed – a doc carved the formulas that worked on stone
and set them into a public place. This is where this formula comes from.
Pu ji xiao du yin is also a shotgun kind of treatment – use as a last resort.
 Guan Ye Lian Qiao
St John’s Wort. Be aware that SSRI’s, which are really really common, in combination with
this herb can cause problems. Can cause Seratonin Syndrome
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Page 20 of 26
Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Cross Allergies
Two sets of drugs, sulfonylureas (or diabetes), sulfonamides (antibiotics) – all come from Isatis plant –
leaves and root. Da Qing Ye, Ban Lan Gen, and Qing Dai are from this plant too. Note that they are
sulfa based! If you have a patient allergic to sulfa-drugs, you can’t prescribe these!!
Watch for hives, rashes. Can also cause anaphylactic reactions!
MRSA (‘mersa’) is a huge problem and is a public
health freakout for good reason. Doesn’t respond to
individual herbs or drugs. Combine herb/drug and is
very effective. This is an herb drug interaction, but is
a good one with very positive effect.
Since bacteria mutate so quickly health practitioners
often carry The Sanford Guide to Antimicrobial
Therapy. This is called the “pocket bible” and is often
republished to keep current.
Downward Draining Herbs
Laxative/purgative effects mostly used for constipation, food stagnation, and intestinal obstructions.
Strong purgatives and moist laxatives are the common designations. Strong purgatives are for otherwise
healthy and strong patients. You might start here and when the BM begins again, switch to moist
laxatives. Moist laxatives are best for deficient, elderly, etc.
Downward draining herbs have to be used with caution esp when pts are taking pharm laxatives and
diuretics. Can also contrib to the elim of water and electrolytes. Could therefore cause or exaggerate
diarrhea, dehydration and electrolyte imbalance.
Another warning: Long term use and reliance on substances to treat constipation will also cause inability
to poop without it!
Strong purgatives
Da huang is stimulating and increases peristalsis while mang xiao draws water. You will find
both in formulas such as da cheng qi tang, xiao cheng qi tang, tiao wei cheng qi tang, and zeng
ye cheng qi tang. Severe constipation is best treated with liquid form for fastest relief. Use them
short term.
Xiao Cheng Qi Tang will treat opioid induced constipation and nausea. Zeng ye chang qi tang
treats phenothiazine induced constipation. Tiao wei cheng qi tang treats drug overdose
Moist laxatives
Run chang wan and ma zi ren wan. These are dosed in pills because they release slowly and are
thus better for chronic situations. Could and probably include other conditions.
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Sidebar: Honey is generally used to hold powders together in pill form – a good bowel lubricator
also and gives a sustained timed released pill. Honey in it’s raw form will do all of these things
plus have an antibacterial effect. If it’s pasteurized and cooked it won’t do any of these things.
Ma Zi Ren Wan will treat drug induced constipation.
Wind Damp Dispelling Herbs
Environmental factors affecting deeper levels of the body. Passes thru
the skin going to muscles and joints.
Anti-inflammatory effects
Many of them also work as antiinflammatory agents. Qiang hua for
instance works upon the upper body while du huo works on the lower
body. They will work individually as well as guide herbs to get others
to the target area.
Like treats like.
These are vines/
Synergistic Effect
branches which treat
Two herbs recently used to treat rheumatoid arthritis are a combination of fang ji
the ‘branches’ of a
and lei gong teng. Fang ji has an analgesic effect and is used for the wind-damp
human body (i.e. the
type of arthritis. Lei gong teng is anti-inflammatory. (We don’t often study this
extremities).
one.) Fang Ji treats the pain and lei gong teng supresses the immune response, so
in combination are supposed to work better than any of the medications on the
market (per the NIH and at least one rheumatoid arthritis target journal).
Lei gong teng means “thunder god vine” implying it’s really strong. This is it’s
TCM pharmaceutical name, but it’s commonly called Qi bu shi or Seven Steps to
Death! Pretty toxic shit, man. Accidental ingestion has been fatal. There are 2
antidotes traditionally: feng wei cao (pteris) and blood from rabbits and goats.
Rabbits and goats eat these on a regular basis and have natural antibodies to the
plant.
Diseases and cures
often coexist in the
same locale. That’s
why it’s a good idea
to experiment with
local herbal
medicine.
Bi Zheng
Painful obstruction syndrome. Bi syndrome is very
complex.
Juan Bi Tang removes painful obstructions. This is a
shotgun approach to treating pain. Once the pain is relieved
you can more easily do a good differential diagnosis.
Shang Zhong Xia Tong Yong Tong Feng Wan treats
painful obstructs adue to wind-pain everywhere also, but
the name is so damn long that it’s not commonly used here!
Drug companies know this trick – they make brand names
3 syllables or less. Drug lobbies make sure that generics are long and hard to remember. Fuckers.
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Potential herb-drug interactions to know for analgesics and anti-inflammatories
Herbs that dispel wind and damp have strong effect for both. But patients might need to use both for a
while to transition from one to the other. Should be no problem. Remind chronic pain patients that they
are supposed to take drugs as needed. With acu/herbs there will be less needed – so take less! Remind
patients not to take them habitually. That’s hard because taking opioids long term breeds addiction.
Physicians, no matter how you feel about them, as a rule do not like these patients – they will doctor
shop and pharmacy shop so they can keep that monkey on their back. You be might surprised to find
that you can work with doctors who treat pain and that they will refer patients to you for this reason.
Water regulating and Damp resolving Herbs
Treat edema, urine problems, phlegm. Most have a marked
diuretic effect. This is a big deal. If you use them out of their
usual context you could see side fx. Chuan mu tong and ze xie
for instance can treat hypertension and cholesterol respectively.
The down-side is that htn and cholesterol treatment is long
term….when using these herbs this can cause electrolyte
imbalance because of dehydration (body fluid deficiency in
TCM speak). You would need to have the patient increase electrolyte consumption. Zhu ling is
classically cited as an herb which increases the excretion of water, sodium, chloride, and potassium. You
could have the patient drink juices and eat a banana per day to counter this.
If your patient is already on something diuretic like
lasix you need to make sure you’re not creating bad
synergistic effects.
Interior Warming Herbs
When you have excess cold the result is stagnation and inability of organs to function properly.
Cardiovascular effects
Cold here can cause CHF, arrhythmia, hypertrophy, etc. Fu zi is the classic example – very hot, has a
stimulant effect and increases force of contraction. When used properly increases strength and rhythm.
When overdosed or improperly processed the stimulant is too strong and paralyzes.
Gastrointestinal effects
Cold stops the digestive system function. Gan jiang and gao liang jiang are 2 examples: warming and
stimulating. You should be seeing hypofunction, cold before using them.
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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Analgesic/anesthetic effects
 Wu zhu yu directs liver heat down so treats migraine. Wu zhu yu tang, evodia decoction,
does just this – treating liver wind or liver excess migraines. Migraines can also have blood
xu pattern, so you’d need to also nourish the blood.
 Xi xin is good for pain, but has the aristolochic acid. Uh oh.
 Ding xiang is also cloves – used dentally to treat tooth/gum pain. Eugenol is the active
substance here.
 Aconite will also relieve pain – chuan wu and cao
wu work better than fu zi. Fu zi should be saved
for organ function like KI xu. Chuan wu and cao
wu will be better to unblock and stop pain due to
chronic cold type of pain, or pain increased in
damp/rainy weather. Don’t use with pre-existing
heart condition or with pace maker!
Qi Regulating Herbs
Similar to interior warming herbs. Their regulating effect helps restore normal circulation of qi. Where
the qi regulation needs to occur determines symptoms and treatment.
Gastrointestineal herbs such as zhi shi and zhi qiao
will help restore digestive fnx. Yue ju wan and ban
xia hou po tang are formulas used for this. Yue ju
wan is also being used to treat depression –
stagnation type of depression. Works within a week
or two. These patients interact and go to work, but
don’t have a network of friends, go home at the end
of the day, lock themselves in their houses and sit in
front of the TV and eat. They aren’t motivated to do
anything else much.
Neither of these formulas will negatively ineract with antidepressants. Bonus! Antidepression drugs are
known to be linked with suicide. Why? Because these drugs give energy, but it’s about 8 weeks before
you see the antidepression effects. The thinking now is that where the depressed patient was so fatigued
they couldn’t do anything about it, the energy that comes with starting the antidepressant gives patients
enough energy to get it together to off themselves. Nice.
Ban xia hou po tang is also very useful for swallowing problems and tendency to aspirate food as a
result.
Respiratory regulation includes chen pi, qing pi and fo shou. This isn’t for acute, but for quiescent
stages. Lung Qi problems can be addressed with su zi jiang qi tang and ding chuan tang. The former is
good for phlegm obstrx in the lung – opens and pushes qi downward. Without ma huang ding chuan
tang doesn’t work the same way.
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Page 24 of 26
Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Cardio regulation herbs are zhi shi, zhi qiao, and qing pi, all citrus based. There are some mild to
moderate reactions for the zhi shi and zhi qiao herbs.
Liver Qi stagnation is treated with xiao yao san, jia we xiao yao san, and chai hu jia long gu mu li tang.
Chai hu jia long gu mu li tang is rising in popularity as our lives increases in stress. . . since 9/11. Chai
hu shu gan tang is for lv overact on sp/st – stress ulcer. Ju he wan is another for lv qi stagnation – hernia
and testicular pain.
Potential interactions
Digestive Herbs
This is historically not a common problem in China…more common was a lack of food. Bao he wan is
the shotgun approach and covers any kind of digestive stagnation problem. Shan zha is the most
commonly used herb in china though in europe it is made into a cardio treatment. Warning: don’t use
with digoxin! Negative synergistic effect.
Hong qu, red rice yeast, is a fermented herb which treats digestion. Usually used in chinese food and not
so much as an herb. Also changes the color of food so everything is red…that’s how they get the ducks
and geese hanging in the windows of some restaurants to look red. (Is that true for tandoori chicken
too?) A happy coincidental is that treats high cholesterol also… As a matter of fact, a Japanese doctor
discovered that it could be used to treat high cholesterol and developed lovistatin or Mevacor (brand
name), the first –statin drug. Ironically the japanese scientist who discovered the connection and did all
of the toxicology tests was later dx’d with high cholesterol and refused treatment by statins!
Bao he wan treats chemo induced gastrointestinal side fx.
Shen calming herbs
Had to switch to taking notes on the slides. My wrists are hurting pretty bad.
www.CatsTCMNotes.com
Page 25 of 26
Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun
Assignment for Herb Drug Interaction
Due 5/31/10, e-mail to Dr. Chen.
SOAP note format case study from clinic. Do full assessment with western and tcm dx, then
plan to treat. List herbs, acu, herbal formula.
Ideally, find a patient taking both drugs and herbs and evaluate. Do you think they are safe?
will they interact?
DON'T USE ANY TCM TERMS! Pretend you are speaking to a doc or a pharmacist and use
*their* speak. You have to explain the same thing, but not in TCM terms.
Note any potential side fx and interactions. Add references.
Pick your most difficult clinic case and describe that. Everyone is going to pass, but challenge
yourself!
www.CatsTCMNotes.com
Page 26 of 26
Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is
available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material
contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it
as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun