Chinese medicine is one of the oldest medical systems. Its written history dates back 2,500 years, and there is strong evidence it has been practiced for over 5,000 years. In the U.S., the most familiar modality within Chinese medicine is acupuncture. But acupuncture is just one of many tools within the traditional Chinese medical system. Most acupuncturists in the U.S. have extensive training in the use of Chinese herbs—typically at least 450 hours dedicated specifically to this modality.

When an acupuncturist and herbalist makes a diagnosis, this informs not only which points should be used for acupuncture, but also which herbs would best treat a specific pain or illness. Herbal formulas are constructed with a hierarchy of ingredients, with dosages and herbs selected to target different aspects of the patient’s condition. The herbs work in conjunction with the acupuncture, reinforcing the treatment’s effects. Acupuncture sends an energetic message to impact physiology, while the herbs adjust the body’s biochemistry.

There are Chinese herbal formulations to treat a wide variety of conditions, ranging from pain in various regions of the body, to other medical issues including digestive disorders, cardiovascular problems, respiratory conditions, dermatology, gynecology, colds and flu and more. Any organ and physiological process can be addressed with Chinese herbs.

The most common traditional form of preparing Chinese herbs is an aqueous extraction called a decoction—a long, slow simmer of herbs in water, yielding a concentrated medicinal liquid. The Chinese word for this method of preparation is tang . Interestingly, this is the same word in Chinese as soup. Much as a good soup consists of multiple ingredients cooked together for a period of time, yielding a complex flavor profile, the same is true of Chinese herbs. Most Chinese herbal formulas consist of at least four ingredients, with many having 15 or more ingredients. With over 500 herbs in common use, the number of combinations possible is nearly limitless, with numerous formulations to treat varied medical conditions.

All reputable vendors of Chinese herbs in the U.S. carefully select their products from producers that adhere to Good Agricultural Practices (GAP), ensuring the safety and quality of the herbs. GAP standards include minimal use of pesticides, proper soil maintenance, crop rotation, clean irrigation and proper harvesting and storage. GAP also governs safe and humane treatment of livestock. All vendors refrain from using endangered or threatened species (animals and plants) as identified in the international treaty known as the Convention on International Trade in Endangered Species. While rhinoceros horn was used centuries ago to treat severe fevers, modern herbalists will choose other legal and ethical ingredients.

Unfortunately, there are very few certified organic Chinese herbs, as organic farming in China is a nascent industry. The few existing organic farms in China only produce food products. Several Chinese herbs are grown in the U.S. (some certified organic), but most Chinese herbs thrive in climates and soils specific to Asia. As organic farming gains prevalence in Asia, more organic herbal options will surely become available.

While a decoction of raw ingredients is the preferred traditional form of herb preparation (and raw Chinese herbs are widely available in the U.S.), most acupuncturists and herbalists in the U.S. use concentrated extracts of the herbs. This is primarily because cooking a decoction is time-consuming (typically 30-45 minutes), and can be logistically complex as different herbs require different preparation processes. Most herbal extracts are available in a 5:1 concentration (i.e. 1 gram of extract equals 5 grams of decocted raw herb). Extracts are commonly available in powder, tincture and pill form. There are also syrups, suppositories and topical liniments, ointments, balms and plasters made from herbal extracts. These extracts simplify use for the patient, eliminating the complex cooking and preparation methods, resulting in greater compliance.

When Chinese herbs are processed into extracts, the companies producing the products must also adhere to Good Manufacturing Practices (GMP). GMP require that the processing be done with pharmaceutical-grade equipment in a clean environment, and that product quality, potency and purity are consistent and trackable for each production batch. All major Chinese herb vendors in the U.S. test their products using mass spectrometry and liquid chromatography to ensure quality of their product. Both the FDA, and its Chinese equivalent, the National Medical Products Administration, have GMP standards, and most herb companies have to adhere to both sets of standards (and also other regions such as Europe, if their products are sold there as well). In short, Chinese herbal products in the U.S. are safe, pure and consistent—certified by multiple international governmental agencies.

While an herbal extract pill is certainly convenient, and culturally consistent with the American norm of taking medicine, it does have its limitations. Pills are not absorbed as efficiently as decoctions or loose powder extracts dissolved in hot water. Pills also do not allow for customized formulations that are specific to the unique presentations of an individual. But, as anyone who has consumed Chinese herbal liquids knows, the flavor can be unpleasant, and a pill bypasses this barrier to compliance.

An herbal pharmacy may stock dozens of formulas in pills and topical liniments—“off-the-shelf products for off-the-shelf conditions”. In many cases, the traditional prepared formulas match the clinical needs of the patient. Time-tested traditional formulas gained their status based on their common applicability, but complex or uncommon clinical cases require custom herbal formulations, which are compiled with powdered extracts of individual herbs. The patient dissolves these powders in hot water, and drinks them as a medicinal beverage. This allows the herbal pharmacist to adjust the ingredients, tailoring the formula as the clinical presentation evolves. Simple acute cases typically require only a few days or weeks of herbs, while complex and chronic cases may require months of herbal therapy.

For patients that balk at the flavor of herbal beverages, consider the analogy of coffee. Most people, when they first try coffee, find the flavor to be bitter and unpleasant—yet many develop a palate for it over time. The same concept applies to Chinese herbs, especially if the formula is appropriate for one’s condition. The body craves what’s good for it. Most people eventually accommodate to the flavor of Chinese herbs. In the interim, strategies to mask the flavor such as adding honey, or chasing the herbs with apple juice or a spoonful of peanut butter, can neutralize the flavor.

Whether it be to simply boost energy, improve sleep or treat a specific medical issue, seek an acupuncturist and herbalist who is trained and certified in Chinese herbal medicine. Inquire about their education and experience in treating a specific concern.