Improving Patient Compliance - Taking Herbs
One of the most under-discussed topics in clinical herbalism is patient compliance. We often assume that if we give someone herbs, they’ll take them. But that’s not always the case. At Root and Branch Medicinary, we hear about a wide range of patient behavior when it comes to herbal formulas—from those who are enthusiastic and compliant from day one to those who let the bag sit on their counter for a week before admitting they never opened it. This variability isn’t just a matter of personality. It’s often a reflection of how we, as practitioners, present and prioritize herbs in the overall treatment plan. So over the years of working with patients, we’ve developed some methods for improving the liklihood that patients will take their herbs.
The first and most important step in improving compliance is simple: we must stop being ambivalent about herbs. Too often, clinicians present formulas as optional or secondary. We say things like, “Would you be open to taking herbs?” or “How do you feel about trying a formula?” While these questions may feel respectful, they can also communicate uncertainty or lack of confidence. And if we don’t sound certain that herbs are important, why should the patient believe otherwise?
We need to be clearer: if you are writing an herbal formula, it’s because you believe it is necessary for this patient’s healing. It is not an optional add-on. It is part of the medicine. The patient is paying for your expertise—and part of that expertise is knowing which tools are most likely to help them. If herbs are one of those tools, we should say so plainly. That doesn’t mean we coerce patients or ignore practical constraints, but it does mean we stop hedging. A statement like, “This formula is an important part of the treatment plan. I recommend you take it twice daily, every day for the next week,” communicates authority, clarity, and care. Patients respond better to that kind of confident direction.
Once we’ve established herbs as essential, the next question is how to deliver them in a way the patient can realistically follow through on. Herbalists have a range of tools at their disposal—raw herbs, granules, powders (sǎn 散), tinctures, pills—and each has different implications for compliance.
Granules are the most common method in modern clinics, and for good reason. They’re shelf-stable, easy to dose, and dissolve quickly in hot water. For many patients, granules offer a good balance between therapeutic strength and convenience. But they’re not ideal in every case. Some patients find them unpalatable. Others take them inconsistently because they require a moment of attention—boiling water, dissolving powder, remembering to drink. Over time, especially in chronic conditions, some patients fall off track with granules because the habit doesn’t stick.
Decoctions—traditional cooked herb teas—remain the gold standard for acute conditions like cold, flu, digestive upset, or other short-term imbalances. They extract and make availble a broader range of effective qi from the herbs and are particularly effective when you need strong, fast-acting results. The downside is obvious: cooking herbs every day is a hassle. The smell can be off-putting to some. And in busy households or small apartments, making a daily pot of herbs may simply not be feasible.
That said, there are ways to modify the decoction process to make it more manageable. For example, rather than having patients cook daily, you can write the formula for seven days of herbs and have it packed into two larger bags. The patient then only has to cook twice—once every three or four days—and can store the finished decoction in the fridge. This method is especially useful for patients who need the effectiveness of a decoction but would be overwhelmed by the full process. It also signals that you’ve thought about their reality and are trying to make things easier.
Powdered bulk herbs (sǎn 散) are another underutilized format. They offer a middle path between raw decoctions and granules. These formulas consist of raw herbs ground into a fine powder, usually boilde briefly in water or soaked overnight in an insulated thermos to be strained before drinking. Some practitioners will even have the patient drink the powder dregs after boiling or soaking, though many patients find it hard to keep that up. While not as potent as decoctions, they maintain the full herb profile of a formula made from whole plants and are significantly less processed than granules, which maintains much of the lighter or more effervescent qi that is lost when granules are manufactured. For some chronic or constitutional formulas, a sǎn can be a great long-term option that’s both affordable and easy to integrate into daily life.
The key point here is that delivery method matters. If you want a patient to take herbs regularly, you need to select a format that fits their lifestyle, schedule, and preferences. That doesn’t mean we cater to every whim—but it does mean we ask the right questions and think strategically. For example:
Does this patient travel often or have a chaotic schedule? Granules might be best.
Is this an acute illness where strong and fast results are important? Consider a short course of decoction.
Is the patient sensitive to strong tastes or already taking multiple medications? A low-dose sǎn, or maybe even a hand-made wán (pill), might be more sustainable.
In other words, patient-centered care is not just about diagnosis. It’s about follow-through. The best formula in the world won’t help if it stays in the bag.
There are also small, practical things that help with compliance. Label your formulas clearly. Give dosing instructions in grams and check with your medicinary about the conversion from grams to a volume measure like teaspoons. Not all granules have the same density, so you don't want to assume a relationship like 1 level granule spoon is 1 gram of herbs. You can read more about that descrepancy here.
Offer reminders or follow-up messages a few days after dispensing to check how the patient is doing. Reinforce the importance of consistency. If a patient reports no change after a week, ask directly: "Have you been taking the herbs every day?" Normalize that it takes time to build the habit and offer support when needed.
Finally, make sure you’re working with a medicinary that supports these goals. At Root and Branch Medicinary, we make it easy to dispense formulas in the format that best suits your patient. We offer granules, bulk in bags for decoction, sǎn powders, and if your patient is in Portland, OR, we'll even decoct the herbs for them. Our staff is trained to pack formulas in a way that facilitates compliance—whether that means splitting decoction doses into a more manageable schedule, grinding herbs into custom powders, or providing easy to use conversions from gram dosage to volume dosage in granules.
We believe herbs work best when patients actually take them. And getting patients to take them isn’t about being persuasive—it’s about being clear, strategic, and responsive. If you treat herbs like they matter, your patients are far more likely to do the same.