1. Pain Medications Sometimes herbs and acupuncture can neutralize effect of pain drugs. For example, patients on neurontin or morphine need to be treated differently. Acupuncture in these patients should be of shorter duration with less stimulation and subtler point selections (like eight extra points, e.g.). Moxibustion is a helpful alternative.

2. Chinese Licorice Gan cao (chinese licorice) is sometimes problematic… it is in many herb formulas, but in low dosages. Higher dosages can lead to fluid retention. Gan cao can also reduce absorption of oral tetracycline and some other meds, and can offset pharmacological effect of spironolactone. The rule of separating dosage times of herbs and drugs solves this problem.

3. Tannins Tannins are insoluble with antibiotics. A few herbs such as Da Huang (rhubarb), He Zi, and Mo Yao (Myrrh) contain tannins. Tannic acids may inhibit absorption of iron.

4. Glycosides Glycosides, which are active ingredients in many herbs, are neutralized by acidic drugs. That means that, for example, Vitamin C (ascorbic acid) and nicotinic acid could prevent your herbs from working.

5. Blood-thinners Patients on warfarin (coumadin) are most at risk for problems from drug-herb interactions. Warfarin is given to thin blood, thus preventing likelihood of clots blocking blood vessels in heart, lungs, or brain. Warfarin's dosage needs to be quite exact to work, so we don't want any herbs affecting it. Herbs and herbal formulas that contain blood movers must be avoided. This includes, among others, herbs dan shen (salvia), dang gui (angelica), and yan hu suo (corydalis), and herb formulas like xue fu zhu yu tang, di dan tang, and tao he cheng qi tang. Feverfew, garlic, Ginkgo, ginger, and ginseng may alter bleeding time, and so they also should be avoided by patients on warfarin.

6. Dan Shen (Salvia) Salvia (see #5) can also reduce effectiveness of anti-ulcer drugs.

7. Surgery and Herbs It's a good idea to stop taking herbs 5 days before surgery, and then after surgery take herbs only to rebuild body.

8. Drugs for Heart Ma Huang (ephedra) should not be taken (even in an herbal formula) if your are on digitalis or any other heart drugs. It also reduces effectiveness of anti-anxiety and sedative drugs, and increases cardiovascular effects of caffeine. Kyushin, gan cao (licorice), plantain, uzara root, shan zha (hawthorn), and ren shen (ginseng) may interfere with digoxin.

9. St. John's Wort Studies have shown that patients who take St. John's Wort while on a Selective Serotonin Re-uptake Inhibiting (SSRI) anti-depressant end up with varying blood levels of drugs. This means it interferes with effectiveness of your anti-depressant. Because its mode of action is not understood, it should be avoided with monoamine oxidase inhibitors and SSRI's.

It also appears to reduce blood levels of cyclosporin, a drug taken to prevent body's rejection of transplanted organs. And it reduces effectiveness of AIDS drug indinavir. It's not yet clear whether it interferes with metabolism of all drugs, or just some. It may be difficult for your medications to work effectively if you take St. John's Wort.

10. Ginseng Ginseng plus phenelzine sulfate may cause headache, tremulousness, and manic episodes. Ginseng should not be used with estrogens or corticosteroids.

Continued in Part 2!

What Happens Without Qi?

Another way to understand things is by their absence (darkness is defined as absence of light). Without sufficient qi,

* your digestive system cannot break down food or transport nutrients to rest of your body * you become easily fatigued and are always tired * you lose your appetite * your limbs are heavy * you might wake up frequently at night because you need to urinate * academic/organizing thought is difficult or impossible * everything is overwhelming (you cannot 'digest' what is going on) * you tend to worry (the emotional component - TCM is a holistic medicine that does not separate body and mind)

How Do I Get More Qi?

The proper diet goes a long way. TCM dietary principles are too complex to cover here (I must say though that it is surprising to many patients, perhaps because vegetarianism is thought to be synonymous with alternative medicine, that TCM advocates eating meat and mostly cooked foods).

Herbs that increase qi include ginseng, and codonopsis.

Avoid activities that drain qi - Be sensible about your energy expenditure by living a balanced life; don't be too sedentary or too active. If you are a couch potato, your qi can't flow without exercise. If you are a type-A personality, relax and don't use yourself up too early in life - you may live to regret it!