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Research Institute of Chinese Herbal Formulas, Guo Dingding
When it comes to taking traditional Chinese medicine (TCM), most people immediately think of drinking bitter decoctions. Decoctions are the most commonly encountered and familiar form of TCM. In fact, there are many forms of TCM, with traditional forms including pills (wan), powders (san), pastes (gao), and elixirs (dan). Modern TCM has also introduced new forms such as tablets, granules, capsules, and injections. It is not enough to simply ingest the medicine; the different forms and preparation methods significantly affect the efficacy of the medicine. How should we choose among the different forms of the same medicine? Below, we will introduce some common forms of TCM.
Decoctions
The decoction made by boiling Chinese herbal pieces in water is the most commonly used form of TCM. The ancients believed: “Decoction is for expelling major illnesses.” Decoctions are easily absorbed and act quickly. Most importantly, they reflect the TCM principle of dialectical treatment, allowing for flexible adjustments of herbal ingredients based on the patient’s condition, suitable for both acute and chronic diseases.
Granules
Chinese herbal granules do not require boiling; they can be taken by simply dissolving them in hot water, making them very suitable for fast-paced lifestyles and easy to carry. Granules dissolve quickly after oral administration, have a pleasant taste, and are suitable for use by the elderly and children.
Tablets
Tablets are small in size, with accurate dosages, suitable for long-term storage. However, they take longer to disintegrate in the gastrointestinal tract, generally requiring 15-20 minutes, and can easily damage the gastric mucosa, so they are best taken after meals.
Capsules
Capsules disintegrate faster in the gastrointestinal tract than tablets, generally within 5-10 minutes, with less gastrointestinal irritation and less risk of damaging the gastric mucosa, making them suitable for pre-meal consumption.
Pills
Pills are made by mixing finely powdered herbs or herbal extracts with suitable binding agents. Water pills use aqueous liquids (water, alcohol, vinegar, or herbal juice) as binders, which dissolve easily after ingestion and have a mild, long-lasting effect, suitable for chronic patients who require long-term medication. Honey pills are made with finely powdered herbs bound with processed honey, characterized by their soft, moist texture, mild and lasting effects, and ability to nourish and improve taste, suitable for treating chronic diseases and for patients needing nourishment. Examples include Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill), Ren Shen Jian Pi Wan (Ginseng Strengthening the Spleen Pill), and Wu Ji Bai Feng Wan (Black-Boned Chicken and White Phoenix Pill). Additionally, traditional preparations often use honey pills for herbs with aromatic and volatile components that should not be boiled for long, or for potent herbs, such as An Gong Niu Huang Wan (Calm the Palace Pill with Cattle Gallstone), Niu Huang Qing Xin Wan (Cattle Gallstone Heart-Soothing Pill), and Su He Xiang Wan (Agastache Pill).
Powders
Powders are a form made by grinding and mixing Chinese herbs, one of the oldest traditional forms, with numerous records in ancient texts such as the “Treatise on Cold Damage,” “Records of Famous Physicians,” and “Shennong’s Materia Medica.” The ancients said: “Powder is for dispersing, used for urgent illnesses,” which succinctly summarizes the characteristics of powders. Powders can be divided into oral powders and topical powders. Oral powders are taken after being mixed with water, and their advantages include convenience when decocting or making pills is not feasible, and they are more effective for gastrointestinal dampness-related diseases than other forms, such as Shen Ling Bai Zhu San (Ginseng and Poria Powder) and Ping Wei San (Stomach-Soothing Powder).
Elixirs
Elixirs for internal use are often made from potent Chinese herbs that are refined and extracted, commonly used for acute disease treatment, such as Zi Xue Dan (Purple Snow Pill) and Xiao Er Qi Zhen Dan (Children’s Seven Treasures Pill).
Additionally, there are modern new forms of TCM such as syrups, oral liquids, and micro-pills, which have greatly improved in terms of taste, convenience of use, and speed of efficacy compared to traditional forms. However, they still need to be used according to TCM principles for optimal efficacy.
It is important to note that a single medicine often comes in multiple forms to cater to different medication needs. For example, there are corresponding formulations for different age groups; elderly and children may prefer liquid forms due to difficulty swallowing; diabetic patients should monitor their daily intake when using honey pills; concentrated forms are preferred to avoid affecting appetite after taking large amounts of medicine; and children may choose formulations with relatively higher sugar content. For instance, Huo Xiang Zheng Qi (Agastache Correcting Qi) is commonly available in forms such as Huo Xiang Zheng Qi Shui (Agastache Correcting Qi Water), Huo Xiang Zheng Qi Ye (Agastache Correcting Qi Liquid), and Huo Xiang Zheng Qi Ruan Jiao Nang (Agastache Correcting Qi Soft Capsules). Huo Xiang Zheng Qi Shui contains ethanol as an excipient, which acts faster, but care should be taken to avoid taking it with cephalosporins to prevent adverse reactions. Additionally, it is not recommended for those who need to drive.
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