Helpful Tips on Using Mayway Herbs' Prescription Service

by Skye Sturgeon, DAOM, L.Ac.

Recently, we have experienced a significant increase in the use of our prescription service and inquiries to our herbal consultants. For those of you who may be new to our online dispensary, or who may be returning to prescribing whole herb formulas, this article is a review of some dispensary basics. You can read about our service and quality control on our About the Mayway Dispensary page of our site or to access the dispensary service, first login, then visit your My Prescriptions page. We are also excited to bring you the first of a series of video tutorials about the Prescription service and other special features on our site.

Cooking Whole Herb Formulas

Nearly every TCM school or herb teacher has their own methodology for cooking whole herb formulas. Rather than being prescriptive regarding instructions, we have developed a versatile, fillable pdf document, titled “Directions for making a Chinese Herbal Decoction” that you can customize for your patients about how to prepare the decoction of herbs. Simply fill in the form, save the copy on your computer, then email the completed form to your patient.

Along with cooking directions, the following information is also included:

1. How many days each bag of herbs is intended to be used. In Bensky’s text Formulas & Strategies, it is suggested that, in general, one bag of herbs is intended to be used for one day of treatment. For some formulas, such as Qing Fei Pai Du Tang, two bags per day is recommended. Please see the source information from the PRC Health Ministry.
2. Which herbs should be pre-cooked (cooked first) and which herbs should be added last and how long these herbs should be cooked.
3. When the herbs should be taken, especially relative to meals or other medications. For example, “after cooking, divide the formula into 2 or 3 doses. One dose should be taken three times per day and at least 45 minutes away from meals.”
4. Any other instructions the practitioner wants the patient to know.

Speaking of personal methodologies, based on a live demonstration and comparison of home decoction methods class I taught, a better alternative to cooking on the stovetop is a slow cooker (Crockpot) method. The resulting decoction was thicker and more palatable in taste.

1. Boil 3-4 cups of water.
2. Place the herbs in the slow cooker, turn the cooker onto “high”, and add sufficient boiled water to cover the herbs by approximately one inch and put the lid on the cooker.
3. When the decoction begins to boil, tuns the heat setting down to “low” and let simmer for 1-3 hours.
4. Strain the decoction and remove the dregs.
5. Divide to liquid into 2-4 doses and administer the same way as a boiled decoction.

Some have asked about the use of a pressure cooker or Instant Pot for preparing herbs. This is a fine idea, but use a reduced amount of liquid and reduced cooking times.

Special Instructions for Whole Herbs

Instructions regarding which herbs require special handling must be added by the practitioner in the section “Dispensary Instructions” at Step Three of the prescription process. Herbs that are to be pre-cooked will be placed in a bag marked “PC” and those that are to be added last will be placed in a bag marked “AL”. Please see Bensky’s  Formulas and Strategies Practical Aspects section on pages 21-22, where the special treatment of various herbs is discussed. With specific regard to the template formulas for whole herbs referenced in the article, “Novel Formulas for Releasing the Exterior”, the special instructions that are required for these formulas are:

• Shi Gao (Gypsum Fibrosum) -- decocted first
• Qing Hao (Herba Artemisiae Annuae) -- decocted later
• Huo Xiang (Herba Pogostemonis) -- decocted later
• Da Huang (Radix et Rhizoma Rhei) -- decocted later

Additionally, the formula template “Wuhan Damp Heat Obstructing the Lung Syndrome” requires the following instructions: Shen Qu (Massa Medicata Fermentata), Shan Zha (Fructus Crataegi), and Mai Ya (Fructus Hordei Germinatus) should be blended together and dry fried in a wok until the color changes slightly (do not scorch!) before being decocted.

Combining Extract Powders and Whole Herbs

Practitioners who prefer to use extract powders have asked how to add certain herbs, such as Ma Huang, which is available in limited quantity in whole or powdered form, to an extract powder formula. Although there is no simple algorithm for combining these two quite different forms of herbal therapy, the solution that we recommend is having single doses of whole or powdered Ma Huang (or other herbs not available in extract powder form) placed into separate teabags. Instruct the patient to steep the teabag into a separate cup of hot water for 10-20 minutes and add this “tea” to each dose of reconstituted extract powder.

Converting Whole Herb Formulas into Extract Powder Formulas

Since most of the formulas coming from Wuhan Union Hospital, Hubei Provincial Hospital, and the National Health Commission of the PRC are based on whole herbs, we suggest the use of our guide on creating and converting whole herb formulas into extract powder formulas. This guide is applicable for the conversion of any whole herb formula into extract powder. The importance of this conversion guide is that the extract powder formula maintains the correct proportions that are defined in the original whole herb formula.

Converting a Whole Herb Formula Template into an Extract Formula

As noted in the last Mayway Newsletter, Formula Templates have been created in our Prescription service based on source information from China. Whole Herb formula templates can be converted to Extract formulas by following these conversion steps, or by watching the following video:

1. Log in to Mayway’s website and click “Prescriptions”. This will bring you to a page titled “My Prescriptions”.
2. Click on the purple button “Mayway Templates”
3. Locate the herb formula (by Pin Yin name) of the template to be converted.
4. Notice to the right, there are two columns of icons. Select the green icon from the “Herb” column.
5. This will open the formula template. Go to the bottom right side of the template and select the blue button marked “Use This Template”.
6. This will open a new page titled “Edit Prescription”. Under Prescription Details, enter the Formula Name, Practitioner Name, Practitioner Phone and Patient Name. Now, select the yellow button, “Next Step”.
7. A new Edit Prescription page will open to reflect the Basic Prescription information that was just entered. Below that information is a section titled “Prescription Type”. Select “Extract Powder” (it will appear shaded).
8. A new window will open that says, “Prescription Conversion Success!” Here is where the daily dosage and the number of days the formula is to be administered is entered. Mayway’s standard dosing recommendation for extract powders is 3g, 3x/day or 4.5g, 2x/day. Of course, the dosage regimen is up to the practitioner’s discretion. You can read more about extract powder dosing in our article Are You Under-Prescribing Extract Powders.
9. Next, select the purple button titled “Convert”. A new “Edit Prescription” page will open, and the Quantity column will now reflect the number of grams of each herb in extract powder form for the number of days that was entered on the previous page. Notice the red Prescription Type icon for Extract Powder is now highlighted.
10. From here, you can add or delete herbs or change quantities to modify the template. (The prescription is now your own customized formula and no longer a “template”.) If there are modifications, select “Update Items and Quantities” or if satisfied, select the yellow button marked “Next Step”.
11. A new Edit Prescription page opens where you can enter Patient Instructions or Dispensary Instructions. After entering these instructions, select the yellow button “Save”.
12. This will open the “My Prescriptions” page where the information can be reviewed and added to the cart.

We will be adding more “How to” videos and instructions in the future. Visit our Howtos page for updates. You can also connect with our herbal consultants by email with any questions or suggestions on how we can improve your experience. Thank you!