CARB-TCMPA TCM Herbalist cheat sheet

The eight principles are four paired categories: exterior/interior, cold/heat, deficiency/excess, and yin/yang; yin/yang summarize the other six and indicate overall polarity.

Yin-yang relationships include opposition, interdependence, mutual consumption, and transformation; neither aspect is absolute, and each contains the seed of its opposite.

Five Phase correspondences: Wood-Liver/Gallbladder, Fire-Heart/Small Intestine, Earth-Spleen/Stomach, Metal-Lung/Large Intestine, Water-Kidney/Bladder.

Zang organs store essence, blood, qi, and spirit; fu organs receive, transform, and transmit; the extraordinary fu include brain, marrow, bone, vessels, gallbladder, and uterus.

Qi functions include transforming, transporting, holding, raising, protecting, and warming; qi deficiency commonly shows fatigue, shortness of breath, spontaneous sweating, and weak pulse.

Blood nourishes and moistens and houses the shen; qi commands blood, blood nourishes qi, and deficiency or stagnation of either can produce both qi and blood signs.

Jin is thin, light, and dispersible; ye is thick, heavy, and joint-nourishing; fluid distribution depends on spleen transformation, lung dissemination, kidney regulation, and san jiao passage.

Six-stage differentiation proceeds Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin; four-level differentiation proceeds wei, qi, ying, xue.

The four examinations are inspection, listening/smelling, inquiry, and palpation; pulse and tongue findings are interpreted with the whole presentation, not in isolation.

Each herb is described by nature (cold, cool, neutral, warm, hot), flavor (sour, bitter, sweet, pungent, salty, bland, astringent), meridian entry, and direction of action.

Sour astringes and consolidates; bitter drains and dries; sweet tonifies, harmonizes, and moistens; pungent disperses and moves; salty softens and descends; bland leaches damp; astringent stabilizes.

Meridian entry identifies the channel or organ a herb preferentially affects and guides formula selection; it is a tendency, not an absolute restriction.

Processing (pao zhi) can reduce toxicity, alter thermal nature, enhance a target action, or improve storage; honey-frying tends to tonify, vinegar-frying to enter the liver, salt-frying to enter the kidney, and wine-frying to ascend.

Dosage is herb-specific and modified by age, weight, constitution, severity, preparation, and purpose; toxic or potent herbs require narrower ranges and closer monitoring.

Major categories include release exterior, clear heat, purge fire, drain damp, warm interior, regulate qi, invigorate blood, stop bleeding, transform phlegm, calm shen, and tonify.

Ma Huang (Ephedra) releases exterior, vents lung, and promotes urination; it is sympathomimetic and requires caution in hypertension, cardiac disease, insomnia, and thyroid disease.

Ren Shen tonifies qi and benefits spleen/lung; Huang Qi tonifies qi and raises yang; Dang Gui tonifies and moves blood; Bai Zhu tonifies spleen qi and dries damp; each has distinct indications.

Classical formula hierarchy: chief (jun) addresses the principal pattern, deputy (chen) assists or treats secondary pattern, assistant (zuo) modulates or treats accompanying signs, envoy (shi) harmonizes and guides.

The chief herb determines the formula's main direction; its dose is important but not always the largest, because assistants and envoys may require greater quantity for their roles.

Si Jun Zi Tang contains Ren Shen, Bai Zhu, Fu Ling, and Zhi Gan Cao; it tonifies spleen qi and is a baseline formula for fatigue, poor appetite, and loose stools.

Liu Wei Di Huang Wan contains Shu Di Huang, Shan Zhu Yu, Shan Yao, Ze Xie, Mu Dan Pi, and Fu Ling; it nourishes kidney yin and drains deficient heat.

Gui Zhi Tang contains Gui Zhi, Bai Shao, Sheng Jiang, Da Zao, and Zhi Gan Cao; it harmonizes ying and wei and treats Taiyang wind-cold with sweating.

Xiao Chai Hu Tang contains Chai Hu, Huang Qin, Ban Xia, Ren Shen, Zhi Gan Cao, Sheng Jiang, and Da Zao; it harmonizes Shaoyang.

Formula modification adds, removes, or adjusts ingredients to match the current pattern; substitutions require attention to property, meridian entry, dose ratio, and interactions.

Dose ratios and preparation methods change formula behavior; decoction, powder, pill, and granule forms can differ in absorption, onset, and duration.

A treatment principle (zhi fa) converts the pattern into a method, such as clear heat, drain damp, tonify qi, nourish blood, move qi, or invigorate blood; formula selection follows the method.

Root/branch decision rule: chronic, recurrent, or mild cases prioritize root; acute, severe, or life-threatening presentations prioritize branch; mixed stable cases may treat both.

Pattern differentiation identifies location (zang-fu, channel, level) and nature (cold/heat, deficiency/excess, qi/blood/fluid); treatment targets both dimensions.

Case intake documents chief complaint, history, medications, allergies, pregnancy/lactation, comorbidities, tongue, pulse, and red flags before herbal prescription.

Reassessment intervals depend on acuity, toxicity, and response; initial follow-up is often short, and toxic herbs or significant comorbidities require closer monitoring.

Patient education covers preparation, dose, timing, diet, expected effects, possible adverse effects, and when to stop and seek care; understanding is confirmed and documented.

Referral is indicated when red-flag symptoms, diagnostic uncertainty, or comorbidity exceeds herbal scope; continue coordinated care rather than delaying biomedical evaluation.

Case management includes adherence checks, outcome measures, formula adjustment, interaction review, and clear termination or referral plans.

High-risk herbs include Fu Zi, Chuan Wu, Cao Wu, Ban Xia, Ma Huang, Xi Xin, Zhu Sha, Xiong Huang, and Lei Gong Teng; each has specific processing, dose, and monitoring requirements.

Aconitum species contain cardiotoxic diester alkaloids; use processed forms, decoct longer, avoid arrhythmia and pregnancy, and recognize numbness, vomiting, palpitations, and arrhythmia as toxicity.

Aristolochic acid causes nephropathy and urothelial cancer; Aristolochia species and contaminated Fang Ji or Mu Tong products must be avoided, and botanical identity should be verified.

Ma Huang contains ephedrine/pseudoephedrine; caution with hypertension, cardiac disease, insomnia, thyroid disease, MAOIs, and sympathomimetics; dose and duration should be limited.

Gan Cao can cause hypertension, edema, and hypokalemia through mineralocorticoid effect; risk rises with high dose, prolonged use, diuretics, digoxin, corticosteroids, and antihypertensives.

Pregnancy restrictions include toxic, drastic purgative, strongly blood-breaking, and uterine-stimulating herbs; risk varies by herb, dose, trimester, and maternal condition.

Warfarin interactions are possible with blood-invigorating herbs such as Dan Shen and Dang Gui, plus Ginkgo, garlic, and other antiplatelet herbs; monitor INR and bleeding signs.

Herbal hepatotoxicity has been reported with Polygonum multiflorum (He Shou Wu) and some multi-herb products; baseline liver risk review and symptom monitoring are prudent.

Heavy metal contamination is a risk in unregulated mineral or imported products; use verified suppliers, certificates of analysis, and avoid products with unknown composition.

Red flags requiring urgent referral include chest pain, severe dyspnea, new neurological deficit, uncontrolled bleeding, systolic BP ≥180 or diastolic ≥120 with symptoms, and suspected anaphylaxis.

CYP450 induction or inhibition changes drug levels; St John's Wort induces CYP3A4, while grapefruit inhibits intestinal CYP3A4; many herbs have uncharacterized effects.

Warfarin management includes INR monitoring and review of herbs affecting platelets, coagulation, vitamin K, or CYP metabolism; changes should be communicated to the prescriber.

Digoxin toxicity risk rises with hypokalemia; licorice-induced potassium loss and some diuretics can potentiate arrhythmia, so electrolytes and digoxin levels may be needed.

Renal function is assessed with creatinine and eGFR; reduced eGFR increases risk from nephrotoxic herbs and dose-dependent accumulation, and dose adjustment or avoidance may be required.

Liver injury is assessed with ALT, AST, alkaline phosphatase, and bilirubin; new jaundice, dark urine, right upper quadrant pain, or fatigue warrants stopping herbs and medical evaluation.

Pharmacokinetics includes absorption, distribution, metabolism, and excretion; formulation, food, gut flora, age, liver, and kidney function alter herb and drug exposure.

Thyroid, CBC, and electrolyte tests are selected based on symptoms and herb risks; no single panel replaces history, examination, and adverse-effect monitoring.

Informed consent includes diagnosis, proposed herbs, expected benefits, material risks, alternatives, costs, confidentiality limits, and the right to refuse or withdraw; consent is documented.

A complete record includes date, identity, chief complaint, history, medications, allergies, examination, TCM assessment, formula, dose, instructions, consent, and follow-up.

SOAP format organizes subjective, objective, assessment, and plan data; records should be legible, dated, signed, and completed contemporaneously.

Privacy laws require secure storage, minimum necessary disclosure, and authorization for non-treatment disclosures; state and federal rules may both apply.

Adverse events require stopping the suspected herb, assessing severity, providing or referring for care, documenting, notifying required authorities, and follow-up.

Communication should use plain language, confirmed understanding, interpreter services when needed, and shared decision-making that respects patient values.

Professional boundaries prohibit sexual misconduct and exploitative dual relationships; gifts, bartering, and personal disclosures require careful risk assessment.

Record retention follows state and payer requirements; records must remain retrievable for the required period and protected from unauthorized access.

Scope of practice is defined by state statute and board regulations; herbal assessment, prescribing, dispensing, and counseling must fall within authorized modalities.

Licensure requires graduation, examination, background checks, fees, and renewal; practicing without a current license is unlawful.

Unlicensed personnel may perform only delegated tasks permitted by regulation and under required supervision; they may not independently diagnose or prescribe.

Advertising must be truthful and not misleading; guarantees, unsupported cure claims, and omitted material risks violate common regulatory standards.

Dispensing labels commonly require patient name, herb/formula name, quantity, dose, directions, date, and practitioner identification; records must match the label.

Infection control includes hand hygiene, clean storage, pest control, and safe handling of powders, granules, and decoctions; contaminated products must be discarded.

Mandatory reporting duties can include child abuse, elder abuse, and certain communicable diseases; practitioners should know their state-specific obligations.

Telehealth practice requires licensure in the patient's jurisdiction, identity verification, informed consent, privacy protection, and records comparable to in-person care.