Herbs as Pills and Patents

The most traditional form of Chinese herbal medicine is a concentrated tea or soup, but it isn’t the only form. Over the years, Chinese medicine has been made increasingly popular and accessible, available as raw herbs, tablets, plasters, syrups, and much more. I wanted to take some time to orient you to the many forms of herbal medicine and any associated advantages or disadvantages of each form.

Famous herbal formulas may also come in the form of patches, plasters, oils, liniments, and ointments to apply externally. I’ve written another blog entirely to help orient you to the differences between each one. You can see it here: Oils, and Ointments, and Liniments, Oh My!

Technically speaking, every herbal formula can be available in every form. The famous yin tonic Liu Wei Di Huang Wan can come in tablets, capsules, honey pills (large or small), and even syrups, wines, or granules. The forms are simply different ways to get the medicine into the body. Nonetheless, some formulas tend to be consumed in specific ways. I wanted to introduce you to just a few classics.

散 (San), Fen (粉) Powder
Powders are perhaps the simplest version of herbal formulas. After the individual herbs are all weighed out, the set is ground into a fine powder and used to apply. A few common examples would be Xi Gua Shuang San – 西瓜霜散 where a puf of herbal powder is sprayed on the back of the throat for inflammation or sores. Yunnan Bai Yao Fen – 云南白药粉 is another powdered formula applied externally to cuts or lesions to help stop bleeding.

片 (Pian) Tablets
Powders are incredibly useful when wanting to coat the throat, but can be troublesome to swallow. In that case, the powders can be pressed into tablets which are typically consumed 2-3 times per day. Yin Qiao Jie Du Pian – 银翘解毒片 is a household staple for fighting seasonal colds and allergies and almost always consumed as tablets.

胶囊 (Jiaonang) Capsules
Another option for swallowing the powdered herbs is capsules. There isn’t much difference between tablets, capsules, or honey pills in terms of advantages or disadvantages. Some people prefer capsules because they believe the capsules dissolve quicker and the medicinal effects are felt more rapidly. In light of the COVID epidemic, Lian Hua Qing Wen Jiaonang – 莲花清瘟胶囊 took the spotlight to fight symtoms of respiratory infection and weakness.

丸 (Wan) Honey Pills
Honey pills are my favorite form of herbal medicine if for no other reason than the addition of honey! To make these pills, the powdered formula is mixed with honey and rolled into pills. This style can often come in two sizes. The small variation is typically taken at a high dosage of 8-12 pills and swallowed with a glass of warm water. The large ones are chewed and washed down with warm water or mixed into congee. The famous yin-tonic, Liu Wei Di Huang Wan – 六味地黄丸, is most commonly seen in this form. At this point, it’s worth mentioning that in modern practice many of these words, Wan, Jiaonang, and Pian, are used interchangeably. Hu Gu Bai Tong Wan, for example, are actually jiaonang (capsules), not wan (honey pills). If you want a specific form, ask the herbal pharmacist before making a purchase.

露 (Lu), 膏 (Gao) Syrups
Traditionally, herbal formulas are boiled into a highly concerntrated decoction or soup (汤). During the boiling process, honey or molasses can be added to turn the formula into syrup instead. Two added benefits of this is that the medicine now carries the medicinal benefits of the added honey. But also, in a time before refridgerators, the sugar acts as a natural preservative to extend the life of the liquid decoction. Chuan Bei Pi Pa Gao – 川贝枇杷露 is a famous herbal cough syrup that you may just want to keep on hand in your medicine cabinet.

精 (Jing), 酒 (Jiu) Tincture
A tincture is made when the herbs are soaked in alcohol for at least a month instead of cooked in water. Typically either a rice wine (~12% ABV) or a stronger grain liquor (~60%) is used to soak which has the added benefits of the alcohol as well. Alcohol also acts as a natural preservative, and in TCM theory it warms the body and spreads stagnation. When grain liquor is used to make the concentrate, it is typically watered down with sumple syrup to consume. Two common examples are the daily ginseng bottles Ren Shen Jing – 人参精 or the strengthening qi tonic Shi Quan Da Bu Jiu – 十全大补酒.

液 (Ye), 汁 (Zhi), 水 (Shui) Water-based solutions
Much like the tinctures or wines just mentioned, Shou Wu Zhi – 首乌汁 and Huo Xiang Zheng Qi Ye – 藿香正气液 are bottled decoctions, ready for consumption. Some come in a large bottle to be drunk over a week or two. Others come in a pack of 10-12 little bottles, typically consumed 3 bottles per day.

茶 (Cha) Teas
Teas, sometimes called infusions, are often used for 1-2 herb combinations such as chrysanthemum and rose buds, or Ku Ding Cha – 苦丁茶. Because the tea is simply steeped in boiled water for 30 minutes, not actively boiled for 60, the effects are more gentle on the body than a tincture or decoction. The benefit here is for people who are focused on maintainence or preventative care, rather than treating a full-blown disorder.

颗粒 (Keli),冲剂 (Chongji) Granules
Sometimes we get sick and don’t have time or energy to boil a decoction on the stove or even make an infusion of tea 3 times a day. We can take tablets or pills, but there’s something about holding a warm mug, and hot tea washing over the back of the throat that just makes you feel good. On these days, granules are a savior. Granules are produced from a highly concentrated decoction which is then dried out and crumbled into a water soluble powder, also called, granules. This retains the strength of a decoction while almost entirely eliminating prep time. Xiao Chai Hu Tang Keli – 小柴胡汤颗粒 or Qi Xing Cha Chongji – 七星茶冲剂 are popular examples.

So Many Pills, So Often: A Note on Dosage
At this point it seems worthwhile to note the high dosages of Chinese patent medicine. Most patent pills or tablets have a dosage of 8 pills, 3 times per day. That’s 24 pills every day. Even teas or syrups are intended to be consumed 2-3 times daily. It sounds like a lot, becuase it is a lot! There are two reasons for this.

The first is that herbal medicine is entirely natural, like food, so the body processes it much more quickly than chemically-based perscriptions. Think, for example, of breakfast, lunch, and dinner. About 4 hours after breakfast, you’ll be hungry for lunch. That’s not because something was lacking with breakfast; on the contrary, breakfast was great! But your body processed the meal and is now ready for lunch. The same is true for herbal medicine. After your morning’s dose, your body will be ready for a second dose about 4-5 hours later, simply because the first dose has been processed.

The second reason is culture. Different trends and practices developed in different places without much reason. It’s just the way it is. In China, it’s general practice to take multiple pills, 2-3 times a day when sick. This is even common for pharmaceutical drugs, where antiobiotics will be broken up into 2 pills, 3 times daily. In the West, we get intimidated by “too many pills!” But in the East, people become doubtful of the medicine’s efficacy if the dosage is too small. “One pill, daily? No way that could work!” Different cultures, different expectations.

This still begs the question: why so many pills? Why not one pill, three times daily? Why 5-8? Part of this is culture, as mentioned above. But one more reason is that it makes the medicine more easily adjustable. Younger or older patients may need only 2 pills, 3 times per day. Someone with really stubborn symptoms, may need to up the dosage to 10 pills, 3 times per day. With the help of your licensed herbal practitioner, the right dosage can be easily adjusted for each unique body and circumstance.

Listen: A Final Note
One benefit to taking more herbal pills more often, is that it demands we actively listen to our body and preemptively tend to it’s needs. Taking your medicine three times a day requires you to slow down and take the time to care for your body. The same goes for medicated oils, which need to be applied and reapplied to injuries 3-5 times daily. It sounds like a lot, but maybe that’s because our fast-paced society doesn’t like to be slowed down. When really…perhaps that’s what we need most. I think we would all benefit from taking the time to slow down, and listen.

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