You have just seen a patient, they finally agreed to take herbs. You have researched, compared, and invested time and effort to come up with the right formula to help this person and you are now ready to order. But your favourite herb is not in stock.
A lot of practitioners ring us at exactly that time and ask for guidance. And of course, we are always happy to provide support in these situations. Unfortunately, out of stock items have become more numerous over the past couple of years. So, we started thinking about a mechanism – a sequence of steps to replace herbs. This is what we have come up with and here are some examples that might help explain our process:
- Let’s say you have an herbal formula such as Dang Gui Shao Yao San (a common formula in Women’s health) and you have just discovered that Bai Shao (Paeoniae Albae Radix) is out of stock. We would recommend checking if Chi Shao is available and then simply replace Bai Shao (Paeoniae Albae Radix), white peony root with Chi Shao (Paeoniae Rubrae Radix), red peony root. They have the same energetics and target both liver and spleen channels. Chi Shao (Paeoniae Rubrae Radix) is slightly more cooling which might be counteracted with another herb in the formula that is more warming. They are not in the same category (chapter in the Materia Medica) but they are the same species.
- Or let’s say, you wanted to use Sheng Di Huang (Rehmanniae Radix) but it’s not available, so you check if Shu Di Huang (steamed Sheng Di Huang) is available and use that instead. Again, these substances are not part of the same category – Sheng Di (Rehmanniae Radix) is heat clearing and blood cooling and the other one is blood tonifying. Consequently, Shu Di (Rehmanniae Praeparata Radix) is more warming where Sheng Di (Rehmanniae Radix) is more cooling. But as above, you might be able to still use this plant but accommodate for the heat reducing or warming action with an additional herb depending on your patient’s current situation.
- The same applies for Gan Cao (Glycyrrhizae Radix) and Zhi Gan Cao (Glycyrrhizae Praeparata Cum Melle Radix Et Rhizoma) which is honey-fried liquorice. They are most likely interchangeable as it’s not even clear in the classics in what situations they were used. Mostly we prescribe Zhi Gan Cao (Glycyrrhizae Praeparata Cum Melle Radix Et Rhizoma) perhaps because it targets the middle burner to consolidate more than Gan Cao (Glycyrrhizae Radix) does?
- Gua Lou Pi (Trichosanthis Pericarpium), Gua Lou Shi (Trichosanthis Fructus) or Gua Lou Ren (Trichosanthis Semen) – they are all different parts from the same plant but. We are not saying they can be interchanged constantly, but the same plant is high on our hierarchy when it comes to substitution. Nevertheless, one aspect that is highly important is what formula and treatment strategy are you using for your patient?
- If you don’t have parts from the same plant or different processing methods available, then, this is what we suggest: Let’s say Shi Chang Pu (Acori Tatarinowii Rhizoma) is out of stock (which it is right now in liquid extract). This herb belongs to the category of aromatic substances and is particularly unique because it also calms the mind. Not many other herbs in the same category are available at all. So, then you would look at the formula that it is used in for example Ku Shen Tang (Ku Shen – 60 g, She Chuang Zi – 30 g, Bai Zhi – 15 g, Jin Yin Hua – 30 g, Ju Hua – 30 g, Huang Bai – 15 g, Di Fu Zi – 15 g, Shi Chang Pu – 9 g), you could simply increase the dose of She Chuang Zi (Cnidii Fructus), Bai Zhi (Angelicae Dahuricae Radix) and Di Fu Zi (Kochiae Fructus). If calming the mind is an issue with your patient, we always recommend using minerals such as Long Gu (Draconis Os), Mu Li (Ostreae Concha) or Zhen Zhu Mu (Margaritifera Concha) or Wa Leng Zi (Arcae Concha) as they have a strongly calming effect.
- Here is an instance where you are trying to replace (Fa) Ban Xia (Pinelliae Praeparatum Rhizoma). Ban Xia is always processed, so you might be lucky that (Jiang) Ban Xia (Pinelliae Zingibere Tostum Rhizoma) is also available and then just use the ginger processed Ban Xia instead of the lime and liquorice processed version to get the main properties of this warming, phlegm clearing substance. So, in the same category we will find other herbs which might have toxicity issues or are too cold for the middle burner. Depending on the patient’s presentation and the where the phlegm sits, a couple of options come to mind. To replace Fa Ban Xia or Sheng Ban Xia to target the middle burner, we could use Hou Po (Magnoliae Officinalis Cortex) and Fu Ling (Poriae) or to target hot phlegm in the chest, Jie Geng (Platycodonis Radix) comes to mind. Other phlegm clearing herbs such as Chen Pi (Citri Reticulatae Pericarpium), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) or Zhe Bei Mu (Fritillariae Thunbergii Bulbus) could be suitable too. So, it’s not easy to just recommend individual herbs as straight replacements and once again, your overall treatment strategy will inform which options you choose.
Remember, it always depends on your patient’s situation to what strategy might work best. So, it requires certain knowledge and ways of thinking on how to use different herbs. Also, do you think the success of an herbal formula depends on one herb? No, it doesn’t, because formulas are ‘whole system’ based. The concept of holism in health is based on the theory that an intimate interconnection exists between the parts of a whole and the assumption that those parts cannot exist independently of the whole.
Especially since the pandemic, we have frequently encountered herbs not being available from our GMP suppliers. There are several reasons for this. Some of the raw materials are primarily used in Asia and so are already ‘assigned’ (sold, shipped, allocated) before our suppliers can get their hands onto them. Secondarily, as GMP manufacturers, not all raw herbs can be accepted to produce liquid extracts or granules because they are not ‘pure’ enough to be used. Purity is measured or assessed by the level of contamination such as mycotoxins (Aflatoxin B1, Ochratoxin A, Zearalenone), pesticide residues, heavy metals, and microbes. If raw herb batches are above any of the accepted levels, they will be rejected which very often causes a significant delay in production. And thirdly, we sometimes don’t anticipate the popularity of a certain herb and might not have purchased enough of stock to accommodate for those variations. With around 500 herbs in our assortment, it’s a massive balancing act.
We are happy to assist with your replacing process, either call (03) 5956 7011 or email us and we will guide you the best we can.