It Matters That Patients Themselves Master the Right Way to Take Their Medicine

How to take medicine should be in the hands of the patient himself, not decided by the doctor—at least when it comes to the use of Chinese medicine, this principle should be followed. For the patient himself is the true guardian of his own life, and only the patient knows best the changes in his own body.

I have seen many patients who, after getting a prescription from some TCM physician, take the Chinese medicine without a break for a whole year. The result is terrible: some patients end up not only unable to eat but unable even to drink water. The formula may be a good one, but such a crude way of taking medicine will, with even the finest herbs, cause incalculable harm to the body.

So when I receive patients I often urge them that the dosage and frequency must be matched to what they can bear. Moreover, after taking medicine for 3-5 days, they should rest for 1-2 days. At all times, remember: preserving one's appetite is more important than taking medicine.

If you feel your appetite has been damaged, the dosage must be reduced. If a decoction upsets the stomach, a day's dose may be split over two or three days. If a patent medicine upsets the stomach, the single dose should be lowered. If you cannot tolerate decoctions, ask the doctor to prescribe patent medicines. If you cannot tolerate patent medicines, you may ask the doctor to prescribe a decoction, or to crush the patent medicine and take it mixed with warm water.

What if the doctor prescribes a great many medicines? You may take the different medicines on odd and even days separately. I myself prescribe a lot, but I often use this odd/even-day approach, so the patient's daily intake is not large and the damage to the stomach is small. Some medicines I have the patient take on odd days, others on even days. On the one hand this reduces the harm each medicine does to the patient's body; on the other it lightens the patient's financial burden.

As far as I know, some deceased famous TCM physicians also liked this odd/even-day method. For example, the late famous Shanxi TCM physician Men Chun-de often gave patients two prescriptions, A and B: prescription A on odd days, prescription B on even days. The late Professor Fang Mingqian of Beijing University of Chinese Medicine also liked to use this approach when prescribing for critically ill patients.

For critically ill patients, especially late-stage cancer patients, it is hard to solve the problem with a few simple formulas alone—though it is true that a small number of patients do solve their problem with simple formulas. But most of the time, more medicines are needed. Even Zhang Zhongjing, the medical sage, sometimes had to use a large number of herbs; Biejia Jian Wan among the classical formulas is a typical example.

These patients therefore must pay special attention to technique when taking medicine. If many herbs are prescribed in one formula, the single odd-day dose should be kept at a level the patient's body can tolerate. If they are different patent medicines, each may be taken on different days, and each dose may be used at the maximum level that is both sanctioned and tolerated by the patient's body.

Doctors should also be flexible when giving orders. When I prescribe patent medicines, I always give a range rather than a fixed dose, because everyone's constitution differs and tolerance to medicines differs. The patient may gradually increase the dose within the range; if there is no discomfort, he may go up to the maximum.

On the other hand, for patients who need long-term medication, we must consider the long-term cumulative toxicity of small doses of poisonous herbs on the body. Some patients have no side effects from certain medicines at first, but after long-term use side effects appear.

This requires the doctor to urge the patient to observe his own body's reactions, and to advise regular hospital check-ups of liver and kidney function. When liver or kidney function becomes abnormal, the regimen must be adjusted promptly, to avoid more serious damage to the patient's liver and kidneys.

Another ancient TCM medication experience is also well worth recommending. When using certain harsh pills, the patient starts from the smallest dose and gradually increases it; once loose stools appear, reduce back to the smallest dose, then gradually increase again. This cautious, stepwise increase both ensures efficacy and ensures safety, truly achieving the goal of safe and effective medical treatment.

Moreover, when Li Zhongzi treated accumulation-type diseases (similar to today's digestive-tract tumors), he had another method. After using toxin-attacking and purgative herbs for about half a month, he stopped them; for the next half month he used supplementing and boosting herbs to regulate the patient's body, and once the patient's righteous qi recovered, he again used toxin-attacking and purgative herbs for about half a month. With this method he could even treat critically ill, dying patients effectively.

Li Zhongzi's method is much like the approach of modern Western chemotherapy. Chemotherapy also generally uses chemo drugs for a few days, then lets the patient's body recover for a while before the next course. Li Zhongzi's approach shows the bearing of a true clinical master.

But in TCM cancer treatment today, few patients are hospitalized. The distance between patient and doctor is also great, so it is hard for the doctor to care for the patient as conveniently as in ancient times. In the past, most patients sought care nearby, and the doctor could observe the patient's bodily reactions at any time and adjust the regimen promptly. Now many patients come from afar for a famous doctor; some travel a long way just to see a doctor once, so they must themselves learn some medication techniques.

If the patient himself can learn Li Zhongzi's therapeutic logic, he can fully use the doctor's various righteous-qi-supporting and pathogen-expelling medicines at the right times, according to his own bodily condition.

I strongly oppose family members hiding the true condition from the patient, because only the patient himself is the true guardian of his own life. Once the patient knows his true condition, besides cooperating with the doctor's treatment, he can himself flexibly adjust the regimen at any time according to his bodily state; this benefits the patient and harms nothing.