By Thea Elijah
A student recently wrote to me:
I have two patients who are having a hard time swallowing their raw herb formula. It comes right back up. They say they cannot get past the taste. Any suggestions for these patients to help them take their formula and keep it down?
Understanding Patient Resistance to Herbal Treatments
When a client doesn’t want to take a raw formula that I’ve prescribed for them because it tastes too bad–and they either can’t get it down or it comes back up again–my first thought is that it’s my problem, not their problem, and that I gave them the wrong formula. I actually think that this is a very practical default position on client “resistance” to a treatment intervention, because 99% of the time that’s exactly what it is–and I become a much better (and humbler) practitioner by approaching the situation with this bias. We think we know exactly what the client needs, but if we are willing to listen, we may find out something different.
The Importance of Right Diagnosis in Herbal Prescription
If I were running a healing school, I would make this book required reading:
The Patient Who Cured His Therapist, by Stanley Seigel and Peter Stein.
It is a short book, very readable, that essentially demolishes the notion of patient “resistance” to treatment–and places the responsibility squarely back on the practitioner. We need to step out of the arrogance of our paradigm and really listen to the feedback we are getting from the client with true respect. Sometimes this feedback is not presented in the most clear and articulate manner, so we may have to tease out the details of the message, but the gist of the message is, “Practitioner, you’re not being helpful.” Usually we don’t like to hear that. But there it is, usually loud and clear–yet it is so tempting to choose the route that does not ask us to change or grow or take a deeper look and blame the patient instead.
Identifying the Root Cause: Digging Deeper into Patient Needs
To our credit, when we make a suggestion to a client (and I include acupuncture points and herbal prescriptions under the category of suggestion) and the client “resists” the suggestion, we as practitioners are usually seeing something–we’re probably doing very good work–but we are not seeing the whole picture. Usually what happens is that we see very clearly the direction that the client needs to move in, but we have not identified clearly the client’s Next Step. We make a suggestion, and what we are suggesting is actually Step 5 or 6 for this person, not Step 1 from where they stand. Progress is like climbing a ladder; we cannot begin at the 5th rung. In these cases the client may even agree to the suggestion because they, too, can feel that this is a good idea and a good direction, but for some reason they don’t do it–for some reason it seems out of reach, beyond possibility. At this point it is our job not to blame or shame the client, but to look deeper for root causes, and realize that our healing and focus must be on a deeper and more basic level—and that our intervention must be tailored to the client’s true needs and integrative capacities.
The Earth Element’s Role in Digesting Herbal Formulas
I have a client who has recently graduated from a professional training, but who is having a lot of trouble getting started with her professional life. Without the structure of her academic program, she is floundering. Most of us could probably do a great job of seeing this and saying what she “should do” and make suggestions—but the more interesting question is not what does she need to do, but what does she actually need in order to do what she needs to do? What skills from what Officials are weak (tonify deficiency) or hog-tied (disperse excess)? In developing these skills and abilities, what is her Next Step, the rung of the ladder that is within her reach? If I suggest anything but this, I will encounter “resistance”. When this happens–and in my practice it happens frequently–this is my cue to let go of my picture and take an honest look at her situation, from the inside, for a more helpful, more elementary suggestion.
This translates directly into acupuncture point choices and herbal prescriptions. Since the discussion here is primarily about herbs, I will respond in these terms, but the same principles apply to efficacy/ adverse reaction to point choices as well.
If a client is unable to keep down an herbal formula or even get it down at all, this is a clear statement from their Earth element that something is wrong. Maybe the formula chosen is a brilliant response to their high blood pressure, but for their digestive system it’s just a bunch of Twig-and-Rock Tea that feels and tastes like an outright assault on their digestive wellbeing. If your client is repeatedly hurling a formula, this is a likely sign that they can’t digest it. That’s what hurling is for, and it has kept our ancestors alive to eat again another day. ‘Change the formula’ would be my advice.
Many Americans have very weak digestive systems from eating nutrient-deficient high-fructose corn syrup over-processed and essentially denatured food. And yet, any formula we give them needs to pass through the gut in order to get wherever we intended its effects to go. Some of the feats we ask of a client’s Earth element when taking an herbal formula might be no big deal for a peasant eating straight from the land, but for most Americans it’s a lot to ask.
In other words, if a client can’t hold down a formula, then the formula was Step 5, and their digestion needs to be strengthened and/or clarified first. If, because of the severity of the client’s condition, you don’t have time to work on the Earth first and then move on to the more difficult formula, and you cannot figure out a graceful way to buffer the formula with appropriate digestive grace notes, then don’t use herbs–use needles.
Dealing with Taste Issues: Understanding the Earth Element
If it is a matter of taste, remember that taste is an intimate reflection of the state of a person’s Earth element. What tastes good to us speaks to our entire digestive history, from day one to the present (although many people are now finding evidence that what our mother ate while we were in utero also conditions our sense of taste). The presence of an excessive amount of Sweet and Salty in the average American diet distorts our taste buds’ ability to identify “this is something which will be good for me”, which is the proper role of taste buds. Because of the 3-day renewal rate of taste buds (we are updating our taste standards every 3 days, as our taste buds re-grow), I often tell clients that if they can hang with it for 4 days, on the 4th day very often, magically, the formula seems to taste better, because their body has made positive ID on it as a truly helpful substance, and this is reflected in their taste buds as oral welcoming committee and homeland security check.
I’ll also have them try drinking it very dilute for the first three days, so their body and taste buds have a chance to “check it out” without a sense of overwhelm. Some folks have very tight security at their digestive entry point. OK I can respect that.
If after 4 days the client is still gagging on the formula, I’m going to change the formula. First I’ll rethink my diagnosis as a whole, then my treatment priorities, with more attention to the client’s Earth element. It may be a simple matter of hedonism–that the client is incapable of ingesting something that does not provide a positive sensuous experience. Hedonism is in fact an Earth issue, and exactly why America has such a poor diet, but it still means that I need to begin right there: with “lessons” on the nature of pleasure, sweetness, and our capacity for deeper satisfaction in our lives and at our dinner table.