Lesson 3: Monitoring safety

Monitoring of the patient means keeping a watch for side effects in the course of a treatment. It can be done by both patient and practitioner. Frequent monitoring is adviseable for combinations including herbs with potential side effects, and is essential for combinations containing herbs with the potential of severe adverse reactions for a specific patient.

Herbs needing monitoring
Some of the combinations in this database contain herbs that have potential mild to moderate side effects, eg. Zanthoxylum bark may cause or aggravate heat sensations.

A few combinations have stronger herbs with stronger potential side effects, especially for susceptible patients, eg. Cinchona, Convallaria, Ephedra, Lobelia, and Sarothamnus.

Monitoring may also be appropriate for combinations containing alterative herbs, especially Arctium seeds and Taraxacum root.
 
Monitoring by practitioner 
Predicting possible side effects  Detailed knowledge of the patients Chinese syndromes, and/or of their previous reactions to medical drugs and to herbs, can help the practitioner predict possible side effects.

Minimizing side effects  The practitioner can then minimize side effects by reducing the dose, using the most suitable dose form, and by using appropriate modifications to the combination.

Informing the patient   The patient can be informed of specific potential side effects, and also how to minimize them.

Good communication   It is essential that the practitioner makes clear to the patient the importance of informing them of any side effects by phone or email.

Some patients are forgetful, or have difficulty following verbal instructions, and it can be very helpful to give them brief written instructions, get them to verbally repeat them, and then to remind them, eg. by phone call or email.

Monitoring by patient
The patient can be asked to keep a record of the following:

• any suspected herb side effects or adverse herb-drug interactions: noting such details as severity and the time and date the symptoms occurred
• any changes in prescribed or self-prescribed conventional medication, herbs, food supplements, or life stresses that may have been responsible for the symptoms

Re-challenge
If it is appropriate, and if the patient agrees, the herbs can be taken again, at a lower dose and/or in a different form if preferred, to determine if the symptoms recur.

The patient should be asked to keep in contact with the practitioner during this process and to stop the herbs immediately if the adverse effect recurs.

Re-challenge may not be appropriate for herbs with potentially severe adverse effects for that patient, even if the dose is greatly reduced.