I see a patient who has a history of Celiac’s disease and GERD. I wanted to take a gentle and cost-effective approach to stimulating her digestion and protecting and repairing her gastrointestinal mucosa. I thought I would keep it simple and use a common digestive bitter namely Gentiana lutea (gentian) and a demulcent tea namely Althea officinalis (marshmallow). I made sure to reference the appropriate doses and methods of preparation and I was prepared to explain the benefits, mechanisms of action, and potential side effect of my simple and traditional prescription. In short, I was prepared.

When the appointment was finished I walked the patient to the herbal dispensary with my neatly written formula prescriptions for the herbalist to dispense. As it turned out, we didn't have Althea root, which I learned was the preferred form of the herb; instead we had Althea leaf. Also the loose herbs were sold by weight and not by volume, which of course is how they are dosed. As the leaf weighs considerably less than the root, the total amount I had prescribed to last her two weeks was far too much! Also the method for preparing the leaf is very different than the method for preparing the root and so my instructions had to be changed as well.

When it came to the Gentiana lutea I figured nothing could go wrong. It was a standardized tincture with a well referenced dose, I had explained it would taste bad, and it was inexpensive. At the last minute my patients asked “it doesn’t contain alcohol does it?” I explained that the dose I had recommended was very low and that if she put in hot water the alcohol would evaporate from the heat. Despite my reassurance she didn’t want to take any alcohol and so I frantically searched the dispensary for a glycerine based bitter. I never found one and eventually just told her to use apple cider vinegar which was not at all what I wanted to begin with.

There many lessons to be learned from this - not the least of which is my lack of practical experience in dispensing herbs. The larger issue though has to do with the way natural medicine is practiced. We are taught to value traditional therapies and simple natural remedies; however the reality is that often these remedies are a lot less simple for both the practitioner and the patient.

Throughout this ordeal I found myself idolizing the doctor’s prescription pad. One simply scribbles a barely legible word and a number on a piece of paper and the patient can take that to one of thousands of pharmacies where a professional with dispense the treatment in easy to swallow capsules with detailed instructions and cautions. 

The reality is that health care providers need standardized, ready-made treatments that are accessible and affordable for patients. Whether this means stocking a dispensary or recommending specific product brands, part of the role of any prescribing doctor is to make recommendations that patients can reasonably follow.