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The acupuncturist must also discuss any risks and/or contraindication, alternative treatment
options, including no treatment, with the patient.
5) Respect patients’ cultural and religious needs, and/or special dietary needs (e.g., vegetarian
diet) when recommending TCM herbology services.
6) Demonstrate and maintain competency in the diagnostic and therapeutic techniques related
to TCM herbology services.
Standards of Practice – Herbology Page 5 of 30
7) Participate in professional development activities and remain current on the knowledge and
skills of TCM herbology.
8) Provide accurate, factual, and sufficient information to the patient, regarding the potential
benefits and risks of TCM herbology.
9) Review and document the patient’s use of medications when conducting consultation and
assessment.
10) Select, recommend, and combine herbs and/or formulas based on TCM diagnosis, treatment
plan, and patient’s use of medications, and make modifications based on the patient’s
physical, medical and health history as necessary.
11) Take into consideration all precautions and contraindications of the TCM herbs and/or
formulas recommended to the patient.
12) Provide a written recommendation to patients of the herbs and/or formulas including the
following information:
Prescribing raw herbs:
• Date
• Patient’s name
• Name of each herb included in the prescription
• Part of the herb (when relevant to avoid confusion)
• Method of preparation as appropriate (e.g., whole, powdered, granule, tincture)
• Form of processing (when relevant to avoid confusion)
• Preparation instruction
• Quantity/weight of each herb including measurement unit
• Number of packets or dosage as applicable
• Directions for use with clear instructions including the route, frequency, duration and
any special instructions.
• Acupuncturist’s name, address, signature, registration number, and contact telephone
number.
Prescribing granulated or powdered herbs:
• Above guidelines are applicable. However, there will be directives that may no longer
be relevant (e.g., preparation instruction)
• Name of the formula, weight, and dosage (when prescribing a formula extract)
• Weight of each herb, the total weight of the prescription and the dosage (when
prescribing single herb extracts or adding single herb extracts to formulas)
• Manufacturer of the herbs and/or formulas
• Batch number of the herbs and/or formulas
13) Provide instructions to patients with information related to:
Standards of Practice – Herbology Page 6 of 30
• Expected factors or normal reactions related to the medication (e.g., unexpected taste,
likely aroma, common sensations that may be experienced after use)
• Possible adverse reactions, and specific guidance on what the patient is to do if
adverse effects are experienced
• When to stop taking the herbs and/or formulas (e.g., nausea, significant change in
bowel movements, having a menstrual period, in the event of pregnancy)
• What to do after completion of the medication (e.g., further consultation is required to
continue medication)
14) Document the herbs and/or formulas recommended in the patient record.
15) Make appropriate referrals when patient’s needs are better addressed in collaboration with/or
by other healthcare providers.
16) Monitor and document the patient’s response and adverse reactions.
17) Initiate emergency response measures as appropriate if a patient suffers any adverse reaction
to a treatment. Refer to physician or emergency care provider when necessary.
18) Re-evaluate patients’ conditions and responses when appropriate and adjust or discontinue
services that are no longer required or effective.
19) Encourage patients to consult with their healthcare providers about the interaction between
the medication prescribed by those healthcare providers and the herb and/or formulas
recommended.
20) Report adverse effects of natural health products to Health Canada and the supplier.
Standards of Practice – Herbology Page 7 of 30
Appendix 1: Most Commonly Prescribed TCM Formulas
B
Ba Zhen Wan 八珍丸 八珍丸
Ba Zheng San 八正散 八正散
Bai Du San 敗毒散 败毒散
Bai He Gu Jin Wan 百合固金丸 百合固金丸
Bai Hu Tang 白虎湯 白虎汤
Bao He Wan 保和丸 保和丸
Bu Yang Huan Wu Tang 補陽還五湯 补阳还五汤
Bu Zhong Yi Qi Wan 補中益氣丸 补中益气丸
C
Cang Er Zi San 蒼耳子散 苍耳子散
Chai Hu Shu Gan San 柴胡疏肝散 柴胡疏肝散
E
Er Chen Wan 二陳丸 二陈丸
F
Fang Ji Huang Qi Tang 防己黄芪汤 防己黄芪汤
G
Gan Mai Da Zao Tang 甘麥大棗湯 甘麦大枣汤
Gui Pi Wan 歸脾丸 归脾丸
Gui Zhi Fu Ling Wan 桂枝茯苓丸 桂枝茯苓丸
Gui Zhi Tang 桂枝湯 桂枝汤
H
Huang Lian Jie Du Tang 黃連解毒湯 黄连解毒汤
Huo Xiang Zheng Qi Wan 藿香正氣丸 藿香正气丸
J
Jia Wei Xiao Yao Wan 加味逍遙丸 加味逍遥丸
Jing Fang Bai Du San 荊防敗毒散 荆防败毒散
Juan Bi Tang 蠲痺湯 蠲痹汤
L
Liu Wei Di Huang Wan 六味地黃丸 六味地黄丸
Long Dan Xie Gan Wan 龍膽瀉肝丸 龙胆泻肝丸
P
Ping Wei San 平胃散 平胃散
Standards of Practice – Herbology Page 8 of 30
Q
Qi Ju Di Huang Wan 杞菊地黄丸 杞菊地黄丸
Qing Qi Hua Tan Wan 清氣化痰丸 清气化痰丸
Qing Wei San 清胃散 清胃散
S
Sang Ju Yin 桑菊飲 桑菊饮
Shao Fu Zhu Yu Wan 少腹逐瘀丸 少腹逐瘀丸
Shen Ling Bai Zhu San 參苓白術散 参苓白术散
Shen Tong Zhu Yu Tang 身痛逐瘀湯 身痛逐瘀汤
Sheng Mai San 生脈散 生脉散
Shi Quan Da Bu Wan 十全大補丸 十全大补丸
Si Jun Zi Tang 四君子湯 四君子汤
Si Ni San 四逆散 四逆散
Si Wu Tang 四物湯 四物汤
Suan Zao Ren Tang 酸棗仁湯 酸枣仁汤
T
Tao Hong Si Wu Tang 桃紅四物湯 桃红四物汤
Tian Ma Gou Teng Yin 天麻鉤藤飲 天麻钩藤饮
Tian Wang Bu Xin Dan 天王補心丹 天王补心丹
W
Wen Dan Tang 溫膽湯 温胆汤
Wen Jing Tang 溫經湯 温经汤
Wu Ling San 五苓散 五苓散
X
Xiang Sha Liu Jun Zi Tang 香砂六君子湯 香砂六君子汤
Xiao Chai Hu Tang 小柴胡湯 小柴胡汤
Xiao Feng San 消風散 消风散
Xiao Jian Zhong Tang 小建中湯 小建中汤
Xiao Yao Wan 逍遙丸 逍遥丸
Xue Fu Zhu Yu Tang 血府逐瘀湯 血府逐瘀汤
Y
Yi Guan Jian 一貫煎 一贯煎
Yin Qiao Jie Du Pian 銀翹解毒片 银翘解毒片
Standards of Practice – Herbology Page 9 of 30
Yu Ping Feng San 玉屏風散 玉屏风散
Z
Zhi Bai Di Huang Wan 知柏地黃丸 知柏地黄丸
Zuo Gui Wan 左歸丸 左归丸
References
1. Flaws, B. (1999). 160 Essential Chinese Herbal Patent Medicines. Blue Poppy Pr.
2. Maclean, W. (2003). The Clinical Manual of Chinese Herbal Patent Medicines (2nd ed.).
Pangolin Press.
Source: The list of the most commonly prescribed TCM formulas is compiled from information
obtained from patent formula texts, Alberta acupuncture schools, and Herbal companies in
Canada.
Standards of Practice – Herbology Page 10 of 30
Appendix 2: Entry-Level Occupational Competencies for the Practice of Advanced
Herbology in Alberta
1. Comply with legal requirements.
a) Apply to practice current, relevant federal and provincial / territorial legislation.
b) Apply to practice current requirements of regulatory body.
c) Apply to practice current, relevant requirements of municipal and other local
authorities.
2. Practice with professional integrity.
a) Practice within limits of expertise.
b) Remain current with developments in TCM herbology practice.
3. Apply knowledge of the properties and functions of TCM herbs in treatment planning.
a) Si qi (four properties)
b) Wu wei (five flavours)
c) Sheng jiang fu chen (ascending, descending, floating, sinking)
d) Gui jing (channel tropism)
e) Actions
f) Indications
g) Toxicity
h) Pao zhi (processing of herbs)
4. Apply knowledge of herbal formulating strategies.
a) Composition of formula
b) Modification of formula
c) Functions & classifications
d) Combinations & compatibility
e) Dosage form & methods of administration
f) Dosage
g) Potential adverse effects
h) Contraindications & precautions
5. Apply knowledge of the herb interactions in treatment planning, including:
a) Herb - drug interactions.
b) Herb - herb interactions.
c) Herb - food interactions.
d) Herb - natural health product interactions.
6. Relate biomedical diagnostic and treatment approaches to TCM practice.
a) Diagnosis and treatment methods
b) Pharmacology
7. Establish treatment plan based on diagnosis.
a) Devise applicable TCM herbal formula.
b) Devise appropriate course of herbal treatment.
8. Implement herbal treatment plan.
a) Instruct patients on accessing TCM herbal formula.
b) Instruct patients on administration of TCM herbal formula.
9. Maintain herbal inventory.
a) Identify appropriate supply for herbs.
Standards of Practice – Herbology Page 11 of 30
b) Assess quality of herbs with reference to:
▪ Packaging
▪ Labeling
▪ Physical properties
▪ Available quality assurance information
c) Store herbs in appropriate conditions, including:
▪ Environment
▪ Security
▪ Monitoring
d) Maintain records with respect to inventory.
10. Prepare and dispense TCM formulas.
a) Verify formula information is clear, complete and accurate.
b) Verify availability of components and confirm substitution if required.
c) Confirm identity of components.
d) Compound formula.
e) Apply packaging.
f) Apply labeling.
g) Provide instructions for storage and use.
h) Maintain dispensing records.
11. Evaluate patient risk profile.
a) Determine the level of risk relative to TCM herbal treatment.
12. Manage risks to patients.
a) Include safety precautions in herbal treatment plan.
b) Manage adverse reactions and accidents resulting from treatment.
c) Respond appropriately to medical emergencies.
13. Ensure that equipment is safe and functional.
a) Select equipment that enhances patient safety.
b) Maintain equipment in good working order.
c) Clean equipment regularly and disinfect as appropriate.
Standards of Practice – Herbology Page 12 of 30
Appendix 3: Safety Requirements for Herbology
1. Requirements for Naming Herbs
In general, the name of the herb may initially be written in Chinese characters or in Chinese
using Pinyin but it is required that the botanical or Latin medicinal name will also be provided.
The guiding principle is that information be communicated in an effective and understandable
way so that patient safety is best ensured.
The use of the botanical name or the Latin medicinal name is required but may not be sufficient
for all situations. The Chinese characters (traditional or simplified) or Chinese using Pinyin name
should always be provided along with botanical name or the Latinate medicinal name in order to
meet the safety requirement. Care should be taken to accurately specify the herb required. In
cases where a number of species may share the same Chinese name, specific nomenclature is
needed to provide clarity. It is not sufficient to use only an English name if that could lead to
confusion.
To assist practitioners, Appendix 4 contains a reference table with Chinese, Pinyin, botanical
name and Latin medicinal name.
2. Contraindications and Precautions for Herbology
Herbs and/or formulas are contraindicated or used with great caution in specific situations. These
situations include but are not limited to:
• Patient is taking many different drugs
• After using herbs, liver-function test indicates abnormality
• Symptoms of liver or renal failure are clearly evident or patients are on medications to
treat the condition (cautionary use may be appropriate)
• Patient has suffered allergic reaction to herbs in the past
• During the first three months of pregnancy (used with great caution)
• Babies under one year of age (used with great caution).
3. Dosage and Toxicity
Health Canada has developed a monograph1 for TCM ingredients to serve as a guide to industry
for the preparation of Product Licence Applications (PLAs) and labels for natural health product
market authorization. The monograph excluded a number of herbs due to safety concerns.
Although the monograph is not intended for individual practitioners, the safety concern is still
valid. As such, acupuncturists are not permitted to recommend the following herbs (note that this
list is not all-inclusive):
1 Health Canada, H. (2007, May 08). Traditional Chinese Medicine Ingredients (TCMI). Retrieved November 19, 2020, from http://webprod.hc-sc.gc.ca/nhpid-bdipsn/atReq.do?atid=tcm
Standards of Practice – Herbology Page 13 of 30
• Chuan Wu (Aconitum carmichaelii) Radix Aconiti
• Ma Dou Ling (Aristolochia contorta) Fructus Aristolochiae
• Ma Dou Ling (Aristolochia debilis) Fructus Aristolochiae
• Tian Xian Teng (Aristolochia contorta) Herba Aristolochiae
• Tian Xian Teng (Aristolochia debilis) Herba Aristolochiae
• Qing Mu Xiang (Aristolochia contorta) RadixAristolochiae
• Qing Mu Xiang (Aristolochia debilis) RadixAristolochiae
• Guang Fang Ji (Aristolochia fangchi) Radix Aristolochiae Fangchi
• Da Ye Ma Dou Ling (Aristolochia kaempferi) Caulis Aristolochiae Kaempferi
• Guan Mu Tong (Aristolochia manshuriensis) Caulis Aristolochiae Manshuriensis