Why Herbal Remedies Fail: 5 Things to Look For

Why People Choose the Wrong Remedy

Perceptual orientation is everything when it comes to choosing herbal remedies. If you choose a remedy based on what it’s “good for,” you’re likely to make mistakes because that’s an allopathic way of thinking rather than a vitalist one. Examples of allopathic thinking in herbalism include treating Feverfew (Tanacetum parthenium) as “the migraine remedy” and Turmeric (Curcuma longa) as “the inflammation remedy.” That type of thinking pigeonholes herbs, leading to a lack of precision and specificity in remedy selection.

When you choose the wrong herbal remedy for someone, the best-case scenario is that it does nothing. However, that mistake could actually worsen their condition. For example, a person’s headache could go from level 6 to level 9, or their irritated, dry cough could worsen rather than be soothed.​

If you want to be precise in your remedy selection, you must be specific in your assessment of your client during consultation. In order to do that, you’ll need to gather specific pieces of information in order to precisely select the herbs that will provide relief and healing. It is imperative to determine the tissue state of the person you’re working with. But how will you do this?

There are five main observations you can make to decipher the energetics of a condition you’re treating. In order to make use of the energetic properties of an herb, you’ll need to know the energetics of the person, which means you’ll need to be part investigative reporter and part healer. You need to know which questions to ask, how to ask them, and what to look and listen for to help you determine the root causes of a person’s issue.

Understanding Tissue State Energetics to Guide Remedy Choice

Let’s begin with energetics. In the context of herbal medicine, the word “energetics” does not refer to an esoteric concept. Energetics refers neither to the spirit of the plant nor to the spiritual life of the person. In this case, energetics is something very pragmatic, physical, and practical. What is the ecological state and the habitat of the tissue that gives rise to specific symptomatic patterns? This is one of the primary ways holistic physicians have understood the body, rather than through a biomedical, reductionist, chemically based model. In the energetic model, there is an understanding that the human being is a microcosm of the macrocosm, that nature is within us, and that there are layers to the ways in which nature is present in our bodies.

Each of us has a constitution and specific ecosystems within our bodies, composed of organs and tissues that exist in particular environmental contexts. We can distill the qualities and characteristics of natural habitats, weather, ecosystems, and the seasons into three major categories:

1. Temperature: hot or cold
2. Moisture: damp or dry
3. Tonal: tense or relaxed

Understanding this about your clients’ patterns helps you determine the right remedy to match their pattern antipathetically (using opposites to balance). If someone has dry lungs, you should give them moistening respiratory herbs. If they have cold digestion, give them herbs to warm their digestion. If they have uterine tension, give them herbs to relax the uterus. This is the principle of antipathy, and most herbal traditions, including Chinese medicine, Ayurveda, Tibetan medicine, Unani Tibb, and Galenic Greek medicine, use that model. The vast majority of folk traditions use opposites to balance.

When you’re working with a person, it isn’t enough to know that they have a headache, cough, or urinary tract infection. Knowing the general condition can be a useful starting point, but you must get much more detailed information. This is why I want to share the five main observations I use to decipher the energetics of tissue states.  

My professor at Bastyr University used to say, “The issue is in the tissue.” At the time, that seemed like a no-brainer. But after some reflection, I realized there’s something very profound about that statement: you need to assess the specific state of the tissue, organ, and system to determine the right remedy. If you don’t do that, you’re likely to choose the wrong remedy.

Determining Tissue State Energetics to Find the Best Remedy

The observations you need to make regarding tissue state sit within a broader framework of doing a thorough intake with clients. I originally learned the OPQRST intake method from Paul Bergner, though he didn’t invent it. I won’t go into the method in-depth in this post; just know that it stands for Onset, Provoke or Palliate, Quality, Radiate, Severity, and Timing. This framework provides the questions you need to ask about each client’s symptoms. The five observations or questions that help you gather the information you need should naturally arise during the intake process.

Observation #1: Quality of Symptoms

The first observation is ‘Q’, the quality of the symptom. It isn’t enough to know the symptom, the condition, and the name of the disease. You need to be much more specific about how the individual uniquely expresses that pathological pattern. There are some conditions and diseases that, by their nature, embody a specific tissue state pattern. For example, hyperthyroidism has a distinct pattern of heat and overstimulation, whereas hypothyroidism typically has a cold, depressed-tissue state pattern. Still, assessing symptom quality involves asking questions that guide the client in describing how their symptoms feel in their body. Though they may have hyperthyroidism, there may be some nuance to how they experience it.

​To help guide your clients to find the words, you can ask clarifying questions. If all you know is that your client has a cough, giving them random expectorants won’t necessarily get to the root of their condition. You need to ask them, “What is the quality of the cough?” If someone comes to me with a cough, I’ll ask questions such as, “When you cough, are you able to expectorate anything?” If the answer is no, that gives me a lot of information. Usually, that is indicative of a dry cough. However, if they say, “Yes, I am able to expectorate some material,” I’ll dig into that a bit and ask clarifying questions. I’ll ask about the quality of that expectorated material: Is it thick and hardened or thin? Is it green, yellow, brown, or clear? Is it copious or scanty? What is the consistency? Is it ropey? How does it feel in your chest? Does your chest feel tight and constricted? When you take a deep breath, does it tickle in your throat and your lungs? Does it feel irritated? If you take a deep breath, does it make you cough a lot? Does it tend to get worse at night, say, when you lie down to sleep? Is it difficult to inhale or exhale? When you cough, what’s the sound of the cough? Is it hollow, echoey, wheezy-sounding, or does it sound gurgly, thick, and bubbly? These are the types of questions that help you determine if the condition leans toward heat or cold, and toward damp or dry.

​In this specific example, and I think this is true for any mucosal membrane organ system, such as the respiratory, urinary, and digestive systems, delineating damp from dry is very important. If someone has a dry cough and you give them drying herbs, it will make their cough worse. If someone has sharp, hot, scalding urine with a UTI, and you give them a pungent diuretic like Juniper (Juniperus communis), it will irritate that symptom. This is why the energetics are so important.

​Determining quality requires that you ask specific questions. This is also important when you’re assessing pain. Many practitioners make the mistake of focusing only on the S (severity) when addressing pain. The typical way to do this is on a scale of 1 to 10, with 1 being mildly annoying and 10 being debilitating, excruciating pain. They’ll say, “On a scale of 1 to 10, how bad is your pain?” This helps you track the case’s progression over time. If someone comes in and they’re at a level 8 with pain, and then upon reassessment a month later, they’re at a level 5, but they say, “I’m still in pain. Your herbs aren’t working,” you might ask them where they were on the pain scale a month ago. Many people won’t remember, but that may be a detail you can reflect back to them: “When you first came in, you said you were at a level eight on the pain scale, and now you’re at a level five. It seems like you have improved.” And then they’ll say, “I guess you’re right. Maybe it is a little better.” That’s why severity scoring is important. Timing scoring is also important because their pain may still be at level eight, but instead of two headaches each week, they’re down to one every two weeks. It’s still a level-eight headache, but the frequency has changed.

​To go back to quality, the quality of the pain is important to assess because it will indicate which herbs to use. It will also give you insight into what is causing the pain. Is the pain caused by inflammation? Is it caused by stagnant blood? Is it from swelling? Is it from spasm? Is it nerve pain? These are all important delineators that will impact which remedies you choose. If someone has severe, damp, stagnant pain and you give them St. John’s Wort (Hypericum perforatum), which is specific for nerve pain, it probably won’t help much. Conversely, if someone has nerve pain and you give them herbs that are anodyne because they drain dampness, that probably won’t work well either.

​Some questions to qualify the nature of the pain are as follows: Is it dull? Is it achy? Is it throbbing? Is it burning? Is it tingling? Is there numbness? Does it feel tense and tight, or does it feel like there’s a lack of tone? With headaches in particular, you should ask: Where is the pain? Is it occipital, temporal, frontal, or vertex? This is really important for any kind of pain, but especially for headache pain. If you get it wrong, for example, if someone has a hot headache and you give them Rosemary (Rosmarinus officinalis), they won’t be happy with you.

​To determine quality, you’re asking questions to better understand the qualities and characteristics of heat versus cold, damp versus dry, and tension versus relaxation. Often, there will be combinations, such as heat with dampness and relaxation, or heat with dryness and tension. There could be cold with dampness. There could be coldness, dryness, and tension. It isn’t simply one or the other; you have to sort out the particular combination of the variables of temperature, moisture, and tone.

Observation #2: Aggravation and Palliation

The ‘P’ part of the OPQRST intake consists of a series of questions about what makes a person’s symptoms better or worse. Let’s continue with our headache example. Here’s a simple question that can be crucial, given the temperature differential in the headache: Does your headache feel better with an ice pack or a hot pad? Does your headache get worse when the weather is really hot, or when you’re in the sun, or when you eat spicy food? Is your headache worse when you go out in the cold, or when you eat cold food?

Usually, people who get headaches are clear about which factors affect their headaches. The same is true with musculoskeletal pain. People will say things like, “A hot pack really makes it feel better,” or, “No, hot makes it way worse. Only ice for me.” Determining what aggravates and what palliates can involve a variety of factors, and you’ll need to ask, “Have you noticed anything that makes it better or anything that makes it worse?” Sometimes, pressure can be an indicator, especially with pain: Does the pain feel better when you press on it? Do you want to push down on it, or avoid touching it? Sometimes people get headaches, and they want to hold them in. Other times, they want to give it space. This is usually a pattern of excess versus deficiency. So if they don’t want to touch the painful area, that’s more of an excess, whereas when pressing on it feels better, that’s often a sign of deficiency.​

Another way you can qualify a provocation or palliation is if a client has taken something that helps. Someone who has headaches might say, “If I drink Ginger tea, it makes my headaches feel better.” Ginger is a hot, dry, circulatory-stimulating remedy. If Ginger or Rosemary relieves someone’s headache, you can assume it’s a cold-deficient headache. In cold deficiency, we need to move blood up into the head. If I give that person a formula for their headaches, I’ll put it in their formula. That can also apply to over-the-counter remedies. For example, if someone has bad menstrual cramps, and she says, “When I have cramps, if I take an aspirin, it usually helps.” Aspirin is a nonsteroidal anti-inflammatory drug (NSAID). The fact that aspirin helps tells me that inflammation is a key component of her pain. I want to make sure I give herbs that will address the inflammatory side. I will also investigate why she is inflamed. Is she eating a food she’s intolerant of? Does she have other signs of inflammation systemically or in other organ systems?

​Observation #3: Timing – Seasons and Weather

The ‘T’ in our OPQRST intake method relates to timing. In this case, I’m referring to seasons, weather, and environmental exposure. Sometimes seasonal or weather issues also arise under the heading of palliate and provoke. People will say, “It gets worse when it’s really hot outside,” or, “It’s way better in the winter.” Environmental and seasonal influences are often overlooked, yet they can reveal constitutional tendencies and tissue-state patterns that might otherwise be missed.​

You should ask questions to determine whether their symptoms are better or worse in specific weather patterns, during certain seasons, or when they’re exposed to extremes of temperature, dryness, or moisture. For example, I occasionally spend time in the Southwest, and I’ve noticed certain issues start to arise for me in the desert’s dry heat, which I don’t experience here in the Pacific Northwest, where it’s cold and damp most of the time. I know now that when I go to the Southwest, I need to do some things to balance tissue energetics so those problems don’t arise.

The extremes of summer and winter are the temperature differential. In places with a rainy season, such as here in the Pacific Northwest, where it rains a lot, people with damp-type arthritis or joint pain often have a pain flare-up in the autumn when it’s especially rainy. Some people can predict when it’s going to rain because their joints start hurting. The body is a microcosm, and our environment affects our health, constitution, and tissue states. Sometimes nothing comes up in this category when you ask questions, and that’s okay. Other times important things do come up that can be key distinguishing factors for deciphering the tissue state of the afflicted organ system.

Observation #4: General Constitutional Patterns

The fourth observation to help you determine tissue state energetics is general constitutional patterns. Rather than zooming in on the tissue-state energetics of organs, we sometimes need to zoom out to look at the body as a whole and the person’s overall tendencies and dispositions based on their constitution. It is possible for someone to manifest symptoms that are directly opposed to their main constitution. Maybe they have a cold, dry, tense vāta constitution, but they have a damp heat condition, which is the exact opposite of vāta. Typically, a damp heat pattern in a cold, dry, tense vāta type person is much easier to treat than a cold, dry pattern would be in the same person. This is because the constitution reinforces the symptomatic pattern. It’s a little deeper and harder to treat. It’s important to understand that knowing someone’s constitution doesn’t necessarily mean all their problems will be of that constitutional nature. However, knowing the constitution gives you insights into a person’s tendency toward specific energetic patterns in the body.

You can use a variety of constitutional systems for this purpose, whether that’s the four humors of the Greek Galenic model, which is also used in Unani Tibb, or the Ayurvedic tridosha system, the five elements of Chinese medicine, or the planetary qualities of medical astrology. Any of these systems can work for your purposes; they are simply different languages, which give you varying levels of specificity. A seven-planet model is more specific than a three-dosha model because it has seven instead of three. Whichever system you like, you can simply use that. All of these constitutional systems have their specific manifestations of temperature, moisture, and tone. Pick your constitutional system, learn it, and use it.

As we already discussed, someone with a vāta constitution is more prone to cold, dryness, and tension. A pitta person is more likely to be hot and damp, oily, and stimulated. A kapha person will tend to be cold, moist, and relaxed. There are 20 main qualities in Ayurveda, such as light, heavy, mobile, and inert, but these are the main temperature, moisture, and tone qualities we see in the doshas. Just like our example with vāta, a person with a kapha constitution that is mainly damp, cold, and relaxed, with a phlegmatic tendency, can still get a hot, dry cough. Just like the vāta person with an imbalance that’s opposed to their basic constitution, the kapha person with the hot, dry cough will be easier to treat than if the cough were cold and phlegmy.

Clearing Up Constitutional Confusion

Here is a mistake many people make, and I get this question often: People think that if they have a kapha client with a hot, dry cough, they shouldn’t give them a cooling, moistening remedy because it could aggravate their constitution. That is a mistake. This differentiation is clearly outlined in Ayurvedic medicine: you have your prakruti, your core constitutional pattern, and your vikruti, your assumed constitutional pattern, or the constitution of the disease itself. You should always treat the vikruti, the imbalance. It doesn’t matter that kapha is cold, damp, and relaxed. If the person has a hot, dry cough, you should give them a cooling, moistening herb for their lungs. Correct the tissue state. That said, if you know the person has a kapha prakruti, it’s important to understand they might have a greater predisposition to cold, damp, relaxed patterns. That should make you careful not to overdo those cooling, moistening herbs.

How to Assess the Constitution

Look at the overall body composition, the shape of the body as a whole, the shape of the head, the limbs, the extremities, and the fingers. Look at the skin’s quality: Is it dry? Is it cold? Is it warm? Is it oily? Is it clammy? What’s the tone of their voice? What’s their hair like: is it thin and wiry or is it lush and oily and thick? Are their earlobes big? Is their nose bulbous? Do they have plump, thick lips? Is their chin pointed, or do they have a broad jawline? The nature of the eyebrows, the eyes, the nails — all of it points to the constitution. You can literally observe every minute detail about a person, and ultimately, all of that forms a general pattern.​

Another factor that helps reinforce understanding of the constitution is a person’s medical history. In my opinion, it is your duty as an herbalist to take an in-depth medical history from birth to the present moment. In my intakes, I want to know everything. I want to know their hospitalizations, how many antibiotics they’ve taken, and how many times they’ve been sick. I want to know how they get sick. I want to know the drugs they’ve taken, both illicit and medical. I want to hear about their lifestyle. All of that helps reinforce an understanding of the constitution.​

Observation #5: Tongue Assessment

Our fifth and final observation for determining the tissue state is one of my favorites: the tongue assessment. The tongue is a critically important area of assessment in a holistic evaluation. Because the tongue is a microcosm of the whole body, a simple tongue assessment is a straightforward way to clarify the body’s overall tissue state. Just as we humans are a microcosm of nature, we can scale that down to the tongue, which is a microcosm of the entire body. The body is mapped out on the tongue, starting at the top of the head (corresponding to the tip of the tongue) and ending at the kidneys at the back of the tongue. You can also observe the major organs on the tongue. Even without knowing the specifics of how the organs map onto the tongue, you can make some basic observations about the tongue that will give you a lot of information.

What does someone look like when they’re really hot? They tend to have redness, so if you see a red tongue, it indicates heat. What happens when you have a lot of dampness in the body? Things swell with fluids. If you look at the tongue and it’s really wet, with streamers down the sides, puffy and swollen, with scallops along the edges, you’re seeing dampness in the body. If the tongue is withered, dry, and cracked, with no moisture on it at all, there’s dryness in the system. There are some simple, intuitive ways to assess the tongue that help you understand the underlying tissue state. I think every herbal practitioner should look at tongues. You can learn a lot by looking at your own tongue every day. Before you scrape or brush it, just look at it.​

Energetics are Innate 

I want to reassure you that energetics are common sense. People can be overwhelmed and confused by energetics, but it’s important to understand that you’re already practicing energetics in your everyday life. When you go out on a cold, snowy day, what do you want when you come back inside? Do you want a salad or a hot bowl of soup? When you’re cold, you instinctively have a desire to warm up. When you’re warm, you want to cool off. You know what a hot person looks like, not in terms of attractiveness, but in terms of their actual temperature, which clearly looks hot. You know what someone who’s really cold looks like. You’re using your senses constantly, and there’s something hardwired into the human condition that allows us to sense and understand energetics. We intuitively sense how the outer world affects the inner world, and we observe it daily in the weather, the seasons, and our environment.

The best way to learn energetics isn’t necessarily by studying books. Simply be a student of nature! Go outside and observe the qualities of temperature, moisture, and tone in the natural world. Observe how environments, weather, ecosystems, and seasons affect your body and health. The energetic qualities emerge from the elements. 

Studying the elements can give you a lot of insight into the nature of energetics, how pathological patterns manifest energetically, and how you can directly observe them in the body. Studying the elements also teaches you how to observe the energetics of herbs. If an herb tastes hot, aromatic, pungent, warming, and it moves up and out, that’s a fiery quality. It will probably be hot and dry, because fire warms things up and dries them out. So I encourage you to become well acquainted with the elements of nature, your environment, and the turning of the seasons. Study energetics, read the Greeks, read the Ayurvedic texts. Take some herbs and experience these things for yourself. This way, you can balance your intellectual knowledge with an experiential understanding, and those two come together with discipline, consistency, and practice, blossoming into wisdom.

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FAQ About Determining Tissue State Energetics

What are tissue state energetics in herbal medicine?

Tissue-state energetics refer to the ecological conditions of tissues and organ systems in the body. They are commonly assessed through patterns of temperature (hot/cold), moisture (damp/dry), and tone (tense/relaxed).

Why is it important to assess tissue state before choosing herbs?

If you choose herbs that aggravate the existing tissue state, symptoms can worsen instead of improve. For example, giving drying herbs to someone with a dry cough may intensify irritation rather than soothe it.

Why is thinking in terms of “what herbs are good for” limiting?

This approach oversimplifies herbal medicine and often results in an imprecise selection of remedies. Two people with the same condition may require completely different herbs depending on their tissue states and constitutions.

What is the OPQRST intake method?

OPQRST is a clinical intake framework used to gather detailed information about symptoms. It stands for Onset, Provoke/Palliate, Quality, Radiate, Severity, and Timing.

Why is the quality of symptoms so important?

The quality of symptoms reveals the underlying energetic pattern. A dry, irritated cough requires different herbs than a wet, congested cough, even though both are technically “coughs.”

What kinds of questions help determine tissue state?

Questions about temperature, moisture, sensation, pain quality, aggravations, palliations, weather sensitivity, and timing all help reveal energetic patterns.

How do aggravation and palliation help with remedy selection?

What makes symptoms better or worse often reveals the state of the tissue. If heat aggravates a condition and cold relieves it, the condition likely contains a heat pattern.

Why do weather and seasons matter in assessment?

Environmental conditions influence tissue states and often aggravate constitutional tendencies. Damp weather may worsen damp arthritis, while dry heat may aggravate dryness in the respiratory tract.

What is the difference between constitution and tissue state?

Constitution describes a person’s long-term energetic tendencies, while tissue state describes the current imbalance or pathology. Herbal treatment focuses primarily on correcting the current imbalance.

Should you always treat the constitution first?

No. In traditional systems such as Ayurveda, you treat the current imbalance (vikruti) first, even if it differs from the person’s constitutional pattern (prakruti).

Why is tongue assessment important in herbal medicine?

The tongue provides a visible reflection of tissue states throughout the body. Color, moisture, swelling, cracks, coating, and shape can reveal patterns of heat, cold, dampness, dryness, and more.

Can energetics be learned intuitively?

Yes. Energetics are rooted in direct observation of nature, seasons, climate, food, herbs, and the body itself. Studying natural patterns helps develop a practical understanding of energetic medicine.