Part 6 of 6 in the "Chinese herbs and Western medication" series. All six are listed at the foot.

The first five parts covered how interactions happen, what a gap reaches, and which drug classes need extra care. The last thing is how the question is handled inside a consultation.

The short version

• The medication list comes before the prescription. The practitioner looks at every Western medication, supplement and herbal tea you take before deciding what to prescribe. The easiest way is to photograph the boxes.
• The prescription is written with your list in view. Where there is a concern, the practitioner takes a different direction, or asks you to confirm with the prescribing doctor first.
• The spacing is written down. When to take it and how far from your Western medication go in the prescription notes. You do not apply a rule of thumb yourself.
• Both sides are told. At your next Western appointment, mention the herbs.
• This series gives examples, not a "clash list" — a list gets read as a safe-list.
• In Malaysia: chronic-disease medication from a government clinic counts, so does what you buy at a pharmacy counter, and so do soup packs from a medical hall and the tonic soup made at home.

First, the one thing never to do

⚠️ A safety note: TCM and Western medicine complement each other. It is not a choice between them. Do not stop, reduce, or adjust any prescribed Western medication because you have started seeing a TCM practitioner — changes to a prescription are decided by the doctor who wrote it. Never stop on your own.

The full account is in part 1.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

I. What actually happens at the consultation

• The medication list comes before the prescription. The practitioner looks at every Western medication, supplement and herbal tea you take before deciding what to prescribe. The easiest way is to photograph the boxes and show them.
• The prescription is written with your list in view. If an ingredient raises a concern against one of your drug classes, the practitioner takes a different direction, or asks you to confirm with the prescribing doctor before starting.
• The spacing is written down. When to take it and how far from your Western medication go in the prescription notes. You do not apply a rule of thumb yourself.
• Both sides are told. At your next Western appointment, mention the herbs. If a doctor ever needs to work out where a reaction came from, that sentence can matter.
• Why the examples in this series are not a "clash list". The examples in parts 2 and 3, and every herb named in the part 4 and part 5 tables, come from the Hong Kong Hospital Authority's teaching material; the other three rows in part 5's table carry their own sources. All of them are there to show how an interaction happens. A list gets read as a safe-list, and every pair not on it gets treated as fine. Judging your combination needs your whole medication picture, so it belongs in the consultation, not in an article.

II. Fitting it into life in Malaysia

• Chronic-disease medication from a Klinik Kesihatan: counts. Photograph it for the practitioner like everything else.
• Over-the-counter medicine and supplements from a pharmacy counter (Guardian, Watsons and the like): count. The pharmacist there is also someone you can ask, especially about the Western side.
• Herbal soup packs from a traditional Chinese medical hall, the tonic soup an elder made, the 凉茶 from the herbal-tea shop, the supplement from a direct-sales friend: all inside the consideration. Describe what is in them.
• Seeing a Western doctor and a TCM practitioner on the same day: photograph the doctor's prescription and show the practitioner, and the other way round.

III. The six parts in summary

✅ Remember these:

1. Used properly, in most cases the two can be used together, which is the Hong Kong Hospital Authority's position; HansMed's condition is that both practitioners know. (Part 1)
2. Interactions happen by six routes: absorption, distribution, metabolism, excretion, additive, antagonistic — that is the Hospital Authority's sorting. (Parts 2 and 3)
3. At least one to two hours apart as a rule, but spacing only reaches the "together in the gut" part, not "in the body together". (Part 3)
4. Narrow-window drugs like warfarin and digoxin come first; the other classes in the part 4 and part 5 tables, and anything before surgery, all need stating clearly.
5. The prescription is written with your medication list in view and the spacing is written down. No rule of thumb needed. (This part)
6. Supplements, vitamins, herbal teas and tonics all count. (Part 1)

❌ Don't do this:

1. Don't stop, reduce or adjust any Western medication because you have started TCM.
2. Don't treat "two hours apart" as a safety guarantee.
3. Don't read the examples and classes in this series as a safe-list. Not listed is not cleared.
4. Don't combine a red yeast rice product with a statin on your own; the Hospital Authority's position is that they should not be taken together. (Part 5)

The words in this part

These are the words the series hopes you take away. Each has its full account in its own part.

• Pharmacodynamics (药效学) — the Hong Kong Hospital Authority's gloss: what a medicine does to the body. Additive and antagonistic belong here. (Parts 1 and 3)
• Pharmacokinetics (药动学) — from the same material: what the body does to a medicine, which is the four stations of absorption, distribution, metabolism and excretion. (Parts 1 and 2)
• Narrow therapeutic window (治疗窗窄) — the Authority names this class as needing particular care, and gives warfarin and digoxin as its examples. It means the gap between the amount that works and the amount that causes trouble is small. (Part 4)
• Lovastatin (洛伐他汀) — the history the Authority records: approved in the United States in 1987 as the first statin drug. It is in the tablet, and it is in 红曲 red yeast rice — made by fermenting steamed rice inoculated with Monascus fungi, and used as food, in brewing and as a Chinese medicine. (Part 5)
• 凉茶 (herbal tea) — the Authority's lecture material notes that 凉茶 has no clear unified standard and each shop's recipe may differ. Which is why, on a medication list, it needs its ingredients described. (Part 1)

Frequently asked

I forgot to mention my Western medication at the TCM consultation. What now? Contact the practitioner now and add it. Hold off starting the herbs until the practitioner has seen the list.

Does herbal tea (凉茶) count? I only drink 五花茶. Yes. The Hospital Authority notes that 凉茶 has no clear unified standard, and each herbal-tea shop's recipe may differ. Its own example is 五花茶, "five-flower tea": among the recipes on the market, some use 鸡蛋花 frangipani, some swap it for 葛花 kudzu flower, and some use 绵茵陈 and 夏枯草 instead. So say which shop, which tea, and how often.

Do supplements and vitamins need spacing too, and do I mention them? Yes. Supplements and vitamins have active constituents just as herbs do, and they count as "things you take" — part 1 sets that out.

The other five parts

• Part 1: Can you take Chinese herbs with Western medication? The answer first, and the one thing never to do
• Part 2: How it actually happens: the four stations a medicine passes in the body
• Part 3: How far apart is far enough — and the two routes a gap does not reach
• Part 4: Which Western drug classes need extra care: the two with a narrow window, plus blood-pressure and blood-glucose medication
• Part 5: Red yeast rice and statins: when the supplement contains the drug, and three more classes to mention

👉 If you are on Western medication and want to know how Chinese herbs should be arranged around it, you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 assesses it with your medication list in view. Make sure your doctor knows about the arrangement too; safety rests on both sides having the full picture.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

Sources

• Hospital Authority, Hong Kong, Smart Patient lecture deck, 《當中藥師遇見藥劑師——認識中西藥相互作用》, PDF created 9 July 2024 — https://www.smartpatient.ha.org.hk/smart-patient-web/useful-information/sp-series/sp-series-details/%E8%97%A5-%E5%AF%86-%E8%A7%A3%E9%8E%96%E8%AC%9B%E5%BA%A7
• Hospital Authority, Hong Kong, HASLink July 2024, "中西藥相互作用知多少" — https://www3.ha.org.hk/ehaslink/issue132/tc/feature-3.html

本文是「中药和西药」系列的第 6 篇，共 6 篇。六篇的清单在文末。

前五篇讲的是相互作用怎么发生、间隔管得到什么、哪几类药要特别小心。最后一件事是：这个问题在问诊里是怎么被处理的。

一分钟看完

• 开药之前先问药单。 医师会先看您正在服用的所有西药、保健品与凉茶，再决定开什么。最省事的做法是把药盒拍下来。
• 处方是「看着您的药单」开的。 有顾虑的话，医师会换一个方向开，或请您先向开西药的医生确认。
• 间隔会写清楚。 什么时候吃、与西药隔多久，会在处方说明里写明，不需要您自己套通则。
• 两边都要知道。 下次西医复诊，请提一句您在服用中药。
• 这个系列给的是例子，不是「相冲清单」——一份清单会被当成安全名单读。
• 大马生活里：政府诊所的慢性病药算、药剂行柜台买的算、传统药材铺的汤包与家里的补汤也算。

先说绝对不要做的一件事

⚠️ 安全提醒：中医与西医是互相补位的关系，不是二选一。不要因为开始看中医，就自行停用、减量或调整任何西医处方药——处方药的调整，只能由开立那个处方的医师决定。切勿自行停药。

完整说明见第 1 篇。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

一、看诊时实际会发生什么

• 开药之前先问药单。 医师会先看您正在服用的所有西药、保健品与凉茶，再决定开什么。最省事的做法是把药盒拍下来，问诊时出示。
• 处方是「看着您的药单」开的。 如果某味药材与您的西药类别有顾虑，医师会换一个方向开，或请您先向开西药的医生确认再开始。
• 间隔会写清楚。 什么时候吃、与西药隔多久，会在处方说明里写明，不需要您自己套通则。
• 两边都要知道。 下次西医复诊，请提一句您在服用中药。医生若需要判断某个反应的来源，这句话可能很关键。
• 为什么这个系列给的例子不是「相冲清单」。 第 2 篇、第 3 篇的例子，以及第 4 篇、第 5 篇表格里的药材名，全部来自香港医院管理局的教学材料；第 5 篇表里另外三行注明了各自的来源。它们都是用来说明相互作用怎么发生的例子。一份清单会被当成安全名单读，没列到的组合会被当成没问题。判断您的组合，需要看到您的全部用药，所以它属于问诊，不属于文章。

二、大马生活里怎么安排

• 政府诊所（Klinik Kesihatan）拿的慢性病药：一样算，请一并拍给医师看。
• 药剂行（Guardian、Watsons 等）柜台买的非处方药与保健品：算。药剂师（pharmacist）也是可以问的人，尤其是关于西药那一边。
• 传统药材铺买的汤包、家里长辈煲的补汤、凉茶铺的凉茶、直销买的保健品：都在考量范围内，请说明成分。
• 同一天既看西医又看中医：把西医开的药单拍下来，直接给中医师；反过来也一样。

三、六篇的总结

✅ 记住这几点：

1. 只要使用得当，多数情况下可以一起用，这是香港医院管理局的说法；汉方的前提是两边的医师都知道。（第 1 篇）
2. 相互作用有六种方式：吸收、分布、代谢、排泄、叠加、抵消——这是医院管理局的归纳。（第 2 篇、第 3 篇）
3. 一般至少相隔一至两小时，但间隔只管得到「同时在胃肠道」那一部分，不解决「同时在身体里」。（第 3 篇）
4. 华法林、地高辛这类治疗窗窄的药排最前；第 4 篇与第 5 篇表里的其他几类，以及手术前，都要特别说清楚。
5. 处方是看着您的药单开的，间隔会写清楚，不需要自己套通则。（这一篇）
6. 保健品、维他命、凉茶、补汤，全部算。（第 1 篇）

❌ 不要这样做：

1. 不要因为开始看中医就自行停掉、减少或调整任何西药。
2. 不要把「隔了两小时」当成安全保证。
3. 不要把这个系列的例子和类别当成安全名单，没列到不等于没问题。
4. 不要自行把红曲产品和 statin 类药一起用；医院管理局的说法是不宜并服。（第 5 篇）

这篇出现的几个词

这几个词是整个系列希望您带走的。每一个都在它自己那一篇里有完整说明。

• 药效学（pharmacodynamics）——香港医院管理局的说法：药物对人体的作用。叠加与抵消属于这一类。（第 1 篇、第 3 篇）
• 药动学（pharmacokinetics）——同一份材料的说法：人体对药物的作用，也就是吸收、分布、代谢、排泄这四站。（第 1 篇、第 2 篇）
• 治疗窗窄——医院管理局点名要特别留意这一类药，并举了华法林与地高辛。意思是：有效的量与出问题的量之间，距离很小。（第 4 篇）
• 洛伐他汀（lovastatin）——医院管理局记下的那条历史：1987 年在美国获批准上市，成为第一个他汀类药物。它既在药片里，也在红曲（红曲米）里——红曲是红曲菌接种于蒸熟米发酵制成的，传统上用作食物、酿酒和中药。（第 5 篇）
• 凉茶——医院管理局讲座材料指出，凉茶没有明确统一的标准，每家凉茶铺的配方可能不完全相同。所以在用药清单里，它要按「说明成分」处理。（第 1 篇）

常见问题

看中医时忘了说自己在吃西药，怎么办？ 现在就联络医师补充。中药先不要开始，等医师看过药单再说。

凉茶算吗？我只是喝五花茶。 算。医院管理局指出，凉茶没有明确统一的标准，每家凉茶铺的配方可能不完全相同。它举的例子正是五花茶：市面上的配方，有的用鸡蛋花，有的换成葛花，有的用绵茵陈、夏枯草。所以请说清楚是哪一家、什么茶、多久喝一次。

保健品和维他命也要隔开、也要告诉医师吗？ 要。它们和中药一样有活性成分，同样属于「正在服用的东西」——第 1 篇说明了这一点。

这个系列的另外五篇

• 第 1 篇：中药和西药可以一起吃吗？先给答案，和绝对不要做的那一件事
• 第 2 篇：它是怎么发生的：一颗药在身体里经过的四站
• 第 3 篇：隔多久才够？以及间隔管不到的那两种方式
• 第 4 篇：哪几类西药要特别小心：治疗窗窄的两种，加上降血压药与降血糖药
• 第 5 篇：红曲与他汀：保健品里就有同一种成分，以及另外三类要说清楚的药

👉 如果您正在吃西药，想知道中药该怎么安排，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师看着您的药单为您评估。请同时让您的医生知道这个安排，两边都掌握资讯，才是安全的前提。

无论身在何处，与持证中医师对坐。

汉方现代中医

资料来源

• 香港医院管理局「智友站」讲座简报，《當中藥師遇見藥劑師——認識中西藥相互作用》，PDF 建档 2024 年 7 月 9 日 — https://www.smartpatient.ha.org.hk/smart-patient-web/useful-information/sp-series/sp-series-details/%E8%97%A5-%E5%AF%86-%E8%A7%A3%E9%8E%96%E8%AC%9B%E5%BA%A7
• 香港医院管理局，《协力》2024 年 7 月号〈中西药相互作用知多少〉— https://www3.ha.org.hk/ehaslink/issue132/tc/feature-3.html