▍Source: Hebei Traditional Chinese Medicine Liver Disease Hospital Subscription Account
▍Compiled by: Li Xue
In daily life,
most people have had experiences with medication.
During medication, in addition to using the right medicine for the right symptoms,
it is also important to pay attention to the method of taking the medicine,
in order to improve clinical efficacy
and reduce adverse reactions.
In traditional Chinese medicine (TCM) formulations, decoctions are widely used due to their rapid absorption, quick efficacy, and the ability to adjust the ingredients based on syndrome differentiation, making them extremely flexible. This aligns with the TCM principle of treating based on syndrome differentiation, thus becoming the most commonly used form in TCM treatment and widely accepted by patients. However, unlike Western medicine, which often comes with instructions for use, there is no fixed guideline for taking TCM decoctions, and the method of taking these decoctions can directly affect their efficacy.Generally, TCM decoctions are taken once daily, divided into two doses in the morning and evening, with the frequency adjusted according to the condition.
Famous Qing Dynasty physician Xu Lingtai stated in “Medical Source Theory”: “The recovery from illness is not only dependent on the prescription but also on the method of taking the medicine. If the method is incorrect, it can be not only ineffective but also harmful; this is something that must be understood.” Therefore, the correct method of taking TCM decoctions should be given sufficient attention. So, when and how should TCM decoctions be taken for the best effect?
Reference Times for Taking TCM Decoctions
According to the “Shennong Bencao Jing”: “For diseases above the chest, take medicine after eating; for diseases below the heart and abdomen, take medicine before eating; for diseases in the limbs and blood vessels, take on an empty stomach in the morning; for diseases in the bone marrow, take after a full meal at night.” This indicates that the timing of taking medicine varies based on the location of the disease.
Before meals
Taking medicine before meals allows the stomach to be empty, preventing the medicine from mixing with food, enabling it to quickly enter the intestines and exert its effects. This is suitable for tonics, anthelmintics, purgatives, antacids, and some medications for gastrointestinal diseases. Since taking medicine before meals facilitates digestion and absorption, most medicines are recommended to be taken before meals, especially for conditions located below, such as liver and kidney deficiency or diseases below the waist, and intestinal diseases, which should be taken before meals for better absorption and efficacy.
After meals
Taking medicine after meals, when there is food in the stomach, can reduce irritation to the stomach. Therefore, medications that irritate the gastrointestinal tract should be taken after meals, such as digestive aids and anti-rheumatic drugs. Additionally, stomach tonics should also be taken after meals to maximize their efficacy. Especially for conditions located above, such as heart, lung, and chest diseases, medications that irritate the digestive tract should be taken after meals to allow the medicinal properties to rise; toxic medications should also be taken after meals to prevent rapid absorption that could lead to toxicity.It is important to note that whether taking medicine before or after meals, there should be a slight interval, about one hour, to avoid affecting the digestion and absorption of both food and medicine.Yuan Dynasty physician Wang Haogu stated in “Tangye Bencao”: “The medicinal qi and food qi should not meet; food qi should dissipate before taking medicine, and medicinal qi should dissipate before eating; this is the meaning behind taking medicine before or after meals.”
Between meals
Taking medicine between meals avoids the influence of food on the medicine, and medications for spleen and stomach diseases should be taken between meals.On an empty stomachFor tonics, it is best to take them on an empty stomach in the morning for optimal absorption.
Single dose
In urgent cases, medicine can be taken in a single dose. Strong-acting small doses of decoctions can also be taken all at once. This should be done to concentrate the medicinal power without harming the vital energy, maximizing its effects, such as for laxatives or blood-activating medicines.Every four hoursFor severe or acute illnesses, medicine can be taken every four hours to maintain efficacy.Frequent dosesFor throat diseases or vomiting, frequent doses are recommended, taken slowly to ensure the decoction fully contacts the affected area for quicker results.Before sleepFor sedative and tranquilizing medicines, they should be taken one hour before sleep.Every other nightAnthelmintics should be taken once before sleep, and again on an empty stomach the next morning to more effectively kill and expel intestinal worms. (Currently, TCM is rarely used for deworming, as Western medicine is more convenient and effective.)Before disease onset
a. Bronchodilators and antimalarial medicines for cough and malaria generally have a regular onset, and should be taken two to three hours before an expected attack to be effective at the time of onset.
b. Medicines for menstrual irregularities, especially for dysmenorrhea, should be taken three to seven days before menstruation to regulate the cycle.
For critically ill patients,those in a coma, with tetanus, or unable to eat, should be given medicine via nasogastric feeding. Patients with vomiting can take medicine with ginger, and anti-wind and dampness medicines can also be taken with yellow wine.
Seasonal medication
Many diseases are seasonal, and TCM should be taken promptly during the season of onset, with proper guidance for patients. However, attention should be paid to the issue of taking medicine at opposite times of the season, such as treating winter diseases in summer and summer diseases in winter. This is because some diseases, if treated during their season of onset, may not be completely eradicated, while intentional care during the off-season can facilitate recovery. For example, coughs that are more prevalent in winter, often due to phlegm and dampness, may become more pronounced in cold weather, but at this time, the condition is more severe, requiring TCM to “treat the symptoms urgently” to temporarily alleviate the disease. If one consciously takes medicines to resolve dampness and phlegm in summer, appropriate care can reduce the chances of winter onset. Even if it occurs, the condition will not be as severe, allowing for a comprehensive treatment approach to eliminate stubborn diseases.
The Temperature of Bitter TCM and Sugar Addition Analysis
Practice has shown that when the temperature of TCM decoctions is below body temperature, their bitterness is less pronounced. The normal oral temperature is 36.2℃ to 37.4℃, with the temperature under the tongue being 0.5℃ higher than the tongue surface. The taste sensory nerves are mostly distributed on the tongue surface, and when the temperature of the decoction is close to the surrounding temperature of the tongue, the taste nerves are in optimal working condition, making them most sensitive, meaning the decoction tastes the most bitter. When the decoction temperature is above 38℃ or below 35℃, the taste nerves become less sensitive, reducing the bitterness. Therefore, when drinking bitter TCM decoctions, it is best to control the temperature of the liquid between 20℃ and 30℃.
Since most TCM decoctions are quite bitter, people often add sugar to improve the taste, which should be determined based on the properties of the medicine and the disease, and cannot be generalized.
White sugar is cool and cold in nature, while brown sugar is warm. Adding white sugar to warm medicines or brown sugar to cold medicines will weaken or alter their properties, hindering full absorption and affecting efficacy. Brown sugar contains more iron and calcium, and since the chemical components of TCM are generally complex, once the proteins and tannins in TCM interact with the iron and calcium in brown sugar, a chemical reaction may occur, affecting efficacy. Adding sugar to cough-relieving TCM decoctions can increase phlegm secretion;
Additionally, excessive sugar intake can “generate heat,” leading to abdominal distension, internal damp-heat, phlegm accumulation, and thick, greasy tongue coating, which should be strictly avoided.Therefore, it is generally not recommended to add sugar when taking TCM decoctions. If it is difficult to swallow, it is best to consult a physician or pharmacist in advance. Honey is also a TCM, with its main components being fructose and glucose, which are easily absorbed by the gastrointestinal tract and are rich in nutrients, having medicinal value such as moistening the lungs and intestines, but the various trace elements in honey may also alter the efficacy.
Special Preparation Methods for Decoctions
Issues with Taking TCM
Melting (Dissolving)
Gummy and viscous drugs that are easily soluble, when decocted with other herbs, can easily stick to the pot and burn. They may also adhere to other herbs, affecting their efficacy. They should be separately heated to dissolve or placed in freshly decocted strained liquid, gently boiled or stirred while hot to dissolve, such as Ejiao (Donkey-hide Gelatin), turtle shell glue, deer antler glue, honey, and maltose.
Powdering
Certain precious medicines that are heat-sensitive and difficult to dissolve in water can be ground into powder and taken with boiling water or decocted liquid, such as Sanqi (Notoginseng), amber, rhinoceros horn, pearl, and antelope horn.
Post-Medication Observation and Care
And Precautions
After taking medicine, patients should rest for a while to facilitate better absorption; at the same time, they should closely observe any reactions after taking the medicine, especially for those taking toxic or strong-acting medicines, as they should be monitored for adverse reactions.
■Patients with stagnation or chest diseases should lie on their backs after taking medicine;
■Patients with head, brain, ear, or eye diseases should lie without a pillow after taking medicine;
■Patients with diseases on both sides of the ribs should lie on their sides after taking medicine.
Observing Normal Reactions After Taking Medicine (Normal Reactions)
Patients will inevitably experience certain pharmacological effects after taking medicine; otherwise, the expected effects have not been achieved. For example, after taking exterior-releasing medicines, patients may sweat; after taking diuretics, the frequency and volume of urination will increase, indicating that the medicine is exerting its normal effects in the body.
Observing Comprehensive Reactions After Taking Medicine (Systemic Reactions)
Once the medicine enters the body, it will inevitably have certain effects. Therefore, it is necessary to comprehensively observe various reactions after taking the medicine. For example, after taking laxatives, in addition to observing the frequency of bowel movements, one should also observe the nature, color, shape, and odor of the stool, as well as whether there is accompanying abdominal pain, the nature of the pain, the timing of onset, and its severity.
Observing Toxic and Adverse Reactions After Taking Medicine
It is important to have a clear understanding of the properties of herbal medicines and the possible adverse reactions. Before medication, the precautions should be clearly explained to the patient, and the properties and dosages of commonly used medicines should be strictly controlled to avoid misuse and correct the misconception that herbal medicines cannot be toxic.
Common Symptoms of Herbal Toxicity
Dry throat, numb tongue, redness of the face and body, dry skin with rashes, dizziness, irritability, vomiting, diarrhea, abdominal pain; in severe cases, there may be speech and motor disturbances, agitation, rapid breathing, followed by confusion and respiratory arrest. Cardiovascular symptoms may include low heart sounds, weak pulse, arrhythmia, and low blood pressure. If any of these symptoms occur clinically, the use of herbal medicine should be stopped immediately, and emergency treatment should be initiated.
In summary, to achieve the clinical efficacy of TCM decoctions, mastering the correct and reasonable methods of taking decoctions becomes an essential aspect that cannot be overlooked in the application of TCM. Correctly taking TCM and providing appropriate care before and after medication not only plays a timely role in treating diseases but also enhances long-term efficacy, allowing the medicine to exert its effects over a longer period. This can gradually or rapidly bring about the recovery of chronic diseases and timely control of acute diseases, followed by gradual treatment methods to eradicate diseases and overcome stubborn ailments. Therefore, emphasizing the correct and scientific use of TCM decoctions is an important aspect that cannot be ignored in the rational use of medicine and the treatment of diseases.
I guess you might want to see:
51 combinations of medications for inflammation!
So comprehensive, a memorization version of 300 commonly used TCM formulas!
A table to tell you the difference between practicing pharmacists and title pharmacists!
Complete collection of TCM songs!
New version of the difference between practicing pharmacists and title pharmacists (table version) for collection!
Commonly used 50 disease combination medication plans in pharmacies (recommended for collection).
Pharmacy needs to know about gynecological inflammatory disease combination medication plans, recommended for collection.
Essentials | Combination medication manual (classic table version summary) worth collecting.
Common disease combination medication manual in otorhinolaryngology (recommended for collection).
7 common disease combination medication plans in dermatology.
Latest summary of common disease combination medication plans (for yourself and your family to collect).
Knowledge points to master for practicing TCM pharmacists in TCM identification.
Every day, a little bit of “pharmacy” knowledge
Practicing Pharmacist Circle: (ID: CF2017C)
If you find it interesting, click on me