Just pulled this out from the Vault – from a TCM herbal academy forum I was on back in 2002. Maybe it will be interesting to some.
In terms of prescribing a Chinese herb formula, I’m always thinking – what is the standard, what is traditional? When is it true that ‘less is more’? And in what situation is dosage critical?
This situation I wrote about in these emails felt more on the ‘critical’ to me (though I don’t discount the possibility of simple, even folk cures helping as well – I often recommend congees and soup herbs).
I should add, that in cases like I describe here- people are often taking medicines from vastly different paradigms. I adjust to that and even recommend that. I often present it all from a Chinese medical viewpoint, and don’t naturally assume a standard medical, naturopathic, or eclectic view is a superior one. I’ve found that to be a good stance. I have been known to get out my ‘detector’ out for… scientificy-sounding mumbo jumbo. Am I sounding closed-minded now? 🙂
My intention is to be as clear as I can in prescribing as well as explaining how I go about it. In the end, I do the best with the modality I know the best. And…I think there are some standards in my profession.
Of course the final choice of what to take is always up to the client. They know more than anyone what they need.
– – – – – – – – – – – – –
Date: Fri, 28 Jun 2002 22:45:36 -0700
From: tcmguy <tcmguy@mind.net>
Subject: homeopathic herbology
Here goes my first posting to this group, I’ve been lurking for awhile…
My reading of the Year of the Horse informs this Rat that he should “avoid
your favorite sort of intellectual argument, as the losses will be great.
Instead, nourish yourself and wait”…..and so I have, until now….
I have a patient who I have been ‘sharing’ with another Chinese
herbalist/acupuncturist, although I didn’t really put it together until
today what that meant. The other herbalist came over to confer with me about
what she was doing, what herbs I had been giving, our diagnosis, etc.
We really had about the same diagnosis – the patient, in her late 60’s, has
advanced lung carcinoma and a TCM diagnosis of dual Lung and Kidney yin
vacuity and secondarily Spleen qi vacuity. But my post is more about
dosages..
I had been giving her 2 KPC granule formulas (with about 10% single herb
granule modification) for this, in the total range of at least 10 grams per
day, figuring that at 5:1 she was getting about 50 grams a day – or 100
grams every 2 days. I consider that a minimum acceptable dose considering
she was fully utilizing the formula – and that if I was making her a
decoction it would probably be at least 150+ grams for a 2 day supply.
What concerned me was the dosing range that the other practitioner used – 1
teaspoon, 2X a day of a prepared tincture. I asked her how she thought 2
tsps. per day would translate into using bulk herbals. She didn’t like that!
She defensively stated was all she used for all her clients for over 10
years (I’ve been practicing 15 btw) – and that was what worked best for her.
Her formula was similar to mine, and made up entirely of tinctured single
herbal concentrates from Australia, mixed to make up the formula (which was
also priced at about $60 for a 2 week supply). This was all that my patient
would have received with this woman as far as TCM herbology – and what many
of her clients nationally probably think is the cutting edge of using TCM to
treat their cancers.
The question for the academy – is this woman practicing below the
professional standards? Or is there a school of thought to be taken
seriously for giving 1 teaspoon of an herbal tincture twice a day – a form
of ‘homeopathic’ TCM herbology perhaps?
Ken Bendat
——————————
Date: Sat, 29 Jun 2002 17:39:48 -0000
From: “tluger1” <tluger@inetarena.com>
Subject: Re: homeopathic herbology
I have investigated this as much as humanly possible. No one
has ever provided me a single citation or even an anecdote from
a bonafide family tradition that supports this type of prescribing.
It also flies in the face of modern pharmacology. Tinctures at
this price have huge profit margins and little labor involved. If
she truly gets results using this method, she should put up or
shut up. Where are the documented lab results? Funny, how all
these people can cure anything under the sun, yet in the past 15
years, I haven’t seen a single case study written by an american
practitioner that had this type of documentation for a cancer
patient.
Todd
Date: Thu, 4 Jul 2002 08:58:41 -0700
From: “Z’ev Rosenberg” <zrosenbe@san.rr.com>
Subject: Re: homeopathic herbology
It seems to me that what the other practitioner is doing is giving a
nostrum. . .i.e., a weak dose of herbs below therapeutic range that
would have more placebo effect than anything else. It certainly is
‘safe’ for cancer patients. . . .it doesn’t do anything!
Homepathic remedies are made according to stringent criteria, of
trituration and potency, and are prescribed according to a rigorous
systematic approach that takes time and dedication to learn. It cannot
be practiced casually, in the same way Chinese medicine cannot.
Z’ev Rosenberg
Message: 1
Date: Sun, 30 Jun 2002 07:22:27 -0000
From: “jramholz” <jramholz@yahoo.com>
Subject: Re: homeopathic herbology
— In chineseherbacademy@y…, tcmguy <tcmguy@m…> wrote:
> We really had about the same diagnosis – the patient, in her late
60’s, has advanced lung carcinoma and a TCM diagnosis of dual Lung
and Kidney yin vacuity and secondarily Spleen qi vacuity. But my
post is more about dosages..
Based on what you describe—if the formula is for lung and kidney
yin and spleen qi vacuity—unless there are uniquely expensive
herbs or some sort of elaborate, special, or spagyric preparation to
her tincture, she is clearly and simply gouging the patient
financially. And, her dosage may only be justified if the formula
has some super concentration to it. Ask your patient what sort of
story or rationalization goes with that other formula.
But there is second problem here too, in terms of diagnosis. Where
does the “advanced cancer” play in this TCM diagnosis? Patients may
have dual Lung and Kidney yin vacuity with secondary spleen qi
vacuity simply from aging. Those problems don’t cause, are not
necessarily part of, nor may be uniquely identified with the
pathology of cancer.
Jim Ramholz
Date: Sun, 30 Jun 2002 03:49:14 EDT
From: WMorris116@AOL.COM
Subject: Re: Re: homeopathic herbology
Todd –
Have you read the works of Eli Jones, MD, He was an eclectic practitioner
from the turn of the century. Here is an example of a successful physician in
the area of cancer treatment using low doses as a matter of course. Dose
range is an area where people often disagree. Remember, the famous
practitioner Ye Tian-shi? He was known for minimal dosing.
While I agree with your dosing policies in general, there will be people who
respond better to low dose ranges. In addition I think there is a place for
moderate physiological dosing styles rather than the dramatic pharmacological
styles such as those that are being practiced in parts of China close to
Korea.
Will Morris
Date: Thu, 4 Jul 2002 20:20:21 -0700
From: “Z’ev Rosenberg” <zrosenbe@san.rr.com>
Subject: Re: Re: homeopathic herbology
I have Dr. Ye’s case history book, and while his dosages are
comparatively low in many cases, he is using much stronger preparations
(decoctions and powders) and higher dosages than what is described in
this case. I think there is a place for low-dose (as distinguished from
homeopathically prepared dose) medicine, but it takes a high level of
skill and as Jim points out, a very sophisticated diagnosis.
I agree about some patients needing low doses. I have a few patients
that do very well and react very strongly to less than 10% of the usual
dose of herbal medicines that I give other patients.
Z’ev Rosenberg
On Sunday, June 30, 2002, at 12:49 AM, WMorris116@AOL.COM wrote:
> Todd –
>
> Have you read the works of Eli Jones, MD, He was an eclectic
> practitioner from the turn of the century. Here is an example of a
> successful physician in the area of cancer treatment using low doses as
> a matter of course. Dose range is an area where people often disagree.
> Remember, the famous practitioner Ye Tian-shi? He was known for minimal
> dosing.
>
> While I agree with your dosing policies in general, there will be
> people who respond better to low dose ranges. In addition I think there
> is a place for moderate physiological dosing styles rather than the
> dramatic pharmacological styles such as those that are being practiced
> in parts of China close to Korea.
>
> Will Morris
>
From: “Z’ev Rosenberg” <zrosenbe@san.rr.com>
Subject: Re: Re: homeopathic herbology
Will,
I am hardly suggesting that lower dosage ranges require a less
sophisticated or accurate diagnosis. In fact, I think the opposite,
more sophistication and accuracy are necessary. But as Jim points out,
the Chinese diagnosis listed in the e-mail hardly describes the probable
situation of late-stage lung cancer. In addition, how many of us have
advanced skills in diagnosing and treating cancer patients? The e-mail
also doesn’t state if the patient is using western medications. Adding
a small amount of supplementing herbal medicinals is not going to have
much effect in a terminal disease, especially if strong drugs are being
taken. Finally, in terminal situations like this, how does one know if
you are helping the patient’s medical condition if they are at death’s
door, as the unknown practitioner in the e-mail seems to claim?
It is clear that there is a very wide range of strategies and
treatments in Chinese medicine, including high and low dose ranges, and
food remedies, which Sun Si-miao and many others also supported. There
are other factors to consider, however, in books such as Ye’s case
histories, such as strength of the medicinals, sensitivity of patients,
and strength of disease factors. Xu Da-cun’s text, translated by Paul
Unschuld as” Forgotten Traditions of Ancient Chinese Medicine” discusses
several of these issues.
Z’ev Rosenberg
On Sunday, June 30, 2002, at 08:27 AM, WMorris116@AOL.COM wrote:
> Z’ev –
>
> You are right, Ye did not use homeopathic dosing ranges — he used
> physiological dose ranges and was not married to it. However, he was
> famous and respected even to this day for a low dose style. He was also
> famous for choosing food remedies as opposed to formulas.
>
> And – are you suggesting that larger dose ranges require a less
> sophisticated or accurate diagnosis? I would think that engaging
> pharmacological dose ranges would mandate a greater level of accuracy
> to prevent iatrogenic complications whereas the low dose requires
> accuracy to be effective.
>
> Will Morris
>
>——————————-
Date: Sun, 30 Jun 2002 17:53:55 EDT
From: WMorris116@AOL.COM
Subject: Re: Re: homeopathic herbology
Z’ev —
My comments are restricted to dosing policy and the usefulness of a wide
range of dosing strategies. I am not making commentary on this particular
case. Nor on the topic of homeopathy. I was responding to Todd’s statement on
a paucity of case records or research for low dose ranges. However, on the
homeopathic front, Murray and Pizzorno’s text cites effective homeopathic
research and one case on cancer in rats with cell salts.
Hunkering down into specific dose ranges out of personal opinion, comfort, or
habit — even if it is a collectively agreed upon habit — can interfere with
optimal case management based on real patient needs.
Will Morris
> But as Jim points out,
> the Chinese diagnosis listed in the e-mail hardly describes the probable
> situation of late-stage lung cancer. In addition, how many of us have
> advanced skills in diagnosing and treating cancer patients? The e-mail
> also doesn’t state if the patient is using western medications. Adding
> a small amount of supplementing herbal medicinals is not going to have
> much effect in a terminal disease, especially if strong drugs are being
> taken. Finally, in terminal situations like this, how does one know if
> you are helping the patient’s medical condition if they are at death’s
> door, as the unknown practitioner in the e-mail seems to claim?
>
>
From: “stephen” <stephen@botanica-bioscience.com>
Subject: RE: Re: homeopathic herbology
Todd: I have investigated this as much as humanly possible. (Re:
homeopathic herbology)
A Response: You’ve certainly demonstrated that your investigation of issues
is pretty thorough. And, I believe that, other than doing your own
extensive series of well designed studies, the best way to know if something
works is to use it, personally if you are willing. It is not practical to
obtain all of the information we need to know on safety and effectiveness of
medicinals by relying on clinical studies or the limited written
transmission and transmuted verbal teachings of someone else’s intelligent
experimentation on their patients. The history of medicine recounts one
long experimentation that we are perpetuating.
I have personally used homeopathically potentized TCM herbal formulas for
over 10
years. I send the herbal formula to a homeopathic manufacturer and
have them prepare multiple potency tinctures of the TCM formulation.
I started this practice as an experiment with some of my very
environmentally sensitive patients who could not tolerate most herbal
preparations even in low dosages. There were two in particular, one
an MD and another an ex-corporate exec, both of whom were living out
of the back of their cars in remote areas outside the city. The
potentized formulas in some cases did help to control the
hypersensitivity of their very toxic systems, so I continued the
experiment. After having used them on many occasions now I can say
that the tonic formulas do not work well. The ones that work best are
those that are designed to reduce Excess/Fullness/Repletion(?). I
personally still use one formula designed to reduce damp heat that
seems to take the edge off nervous hyperactivity related to damp heat
induced insomnia. I find it particularly useful right before bed.
However most of the potentized formulas are way too mild in their
effect to reverse the pathogenic course of most chronic health
conditions. But that’s just one practitioner’s experience.
From: Al Stone <alstone@beyondwellbeing.com>
Subject: Re: Re: homeopathic herbology
stephen wrote
> I have personally used homeopathically potentized TCM herbal formulas for
> over 10
> years. I send the herbal formula to a homeopathic manufacturer and
> have them prepare multiple potency tinctures of the TCM formulation.
> I started this practice as an experiment with some of my very
> environmentally sensitive patients who could not tolerate most herbal
> preparations even in low dosages. There were two in particular, one
> an MD and another an ex-corporate exec, both of whom were living out
> of the back of their cars in remote areas outside the city.
Can’t argue with clinical success, but I’ve often wondered about these
really severe environmental sensitivities. I’ve always considered them a
somatization of some other pathology, likely of an emotional nature.
After all, the back seat of a car is a whole lot more toxic an
environment than most other suburban areas, at least in my estimation.
That “new car smell” ain’t something that grows on trees, you know. : )
> The ones that work best are
> those that are designed to reduce Excess/Fullness/Repletion(?). I
> personally still use one formula designed to reduce damp heat that
> seems to take the edge off nervous hyperactivity related to damp heat
> induced insomnia.
So is this formula a homeopathic dosage (extremely dilute) and yet
retains the TCM treatment principle of drying damp and clearing heat?
Date: Mon, 1 Jul 2002 22:27:06 -0600
From: “stephen” <stephen@botanica-bioscience.com>
Subject: RE: Re: homeopathic herbology
Al,
Al wrote: …I’ve often wondered about these
really severe environmental sensitivities. I’ve always considered them a
somatization of some other pathology, likely of an emotional nature.
After all, the back seat of a car is a whole lot more toxic an
environment than most other suburban areas…
Resp: I’m sure that emotional factors play into a fair percentage, but I
would be reluctant to lump all such cases into any single category. Yet I
agree with your perspective that the hypersensitivity is a consequence not
the cause. Other not un-common etiologies that I’ve seen involve
parasitic/anthelmintic infection, chemical and/or metals toxicity, or dental
material aggravations, any one of which, due to their effects on the liver,
spleen, nervous system, and mucosally based immune response system in the GI
and Respiratory areas, can result in a hyper-allergic state. BTW, they
drove old cars and slept outside on the ground as much as possible. Some
days that even sounds appealing!
one formula designed to reduce damp heat that
> seems to take the edge off nervous hyperactivity related to damp heat
> induced insomnia.
Al wrote: So is this formula a homeopathic dosage (extremely dilute) and
yet
retains the TCM treatment principle of drying damp and clearing heat?
Resp: In terms of being extremely dilute, I don’t see how the physical
presence of the chemical components in the homeopathic preparation could
have any significant direct physiological influence given that the residual
amounts are so miniscule. I don’t have a defendable scientific explanation
for the results obtained, but I would like to get that strong and consistent
of a placebo effect in other circumstances, yet don’t. My experience is
that these preparations have similar, though more limited, physiological
influences as you would expect from a TCM perspective using the herbal
materials. In the case of the Resolve damp heat formula, I believe that a
flare-up of the effects of damp heat on the nervous system, triggered by
physical activity, were being relieved, but that the damp heat was not being
resolved. However, in terms of this one symptomatic pattern, the effect of
the potentized preparation has repeatedly shown to provide more effective
relief of damp heat stimulated insomnia than the exact same herbal formula
in prepared granules. And, the palliative effects obtained in a condition
such as this are certainly not significant enough in most cases to alter the
course of a chronic disease state in such a way that it should be considered
a long-term treatment of choice.
Date: Tue, 02 Jul 2002 10:26:22 -0700
From: tcmguy <tcmguy@mind.net>
Subject: Teaspoon herbology (was homeopathic herbology)
In reply to the comments on my first post,
1. I should have titled my post “teaspoon (or microdose) herbology”, rather
than ‘homeopathic’ – certainly the practitioner didn’t have any sort of
homeopathic or potentizing principles in mind here – we’re talking about
mixing together 5:1 tinctures to make a variation of standard formulas…
2.I didn’t mean to imply that I had given a complete diagnosis by mentioning
her Lung and Kidney yin vacuity with Spleen Qi xu, – which of course are
common enough with aging. Actually, that was the diagnosis the other
practitioner gave when she showed me her formula, and not the totality of my
view of her condition – but it was close enough to being what we needed
most to keep our eyes on – since she has a very intense and dry cough as a
sequalae to radiation – and needs both strong and cool yin supplementation
and the means to assimilate it. I mention that aspect of her case because
it was along those lines that her formula and one of my formulas met.
3. The company in Australia is called “Herbalist & Alchemist”. Single herb
extracts, 5:1 it looks like
4. Perhaps she does follow somewhat in Eli Jones’ footsteps. The group she
works with, as I said, treats mostly patients with cancer, and they use an
eclectic model-meaning she is also integrating western herbs, various
supplements, and diet in the protocol. (Often ranges in the $800/month for
the ‘works’)
5. More clearly, I am interested in the ramifications of using
only 1 tsp. of TCM-diagnosed blended tincture (again presumably a
concentrate of 5:1) twice a day for all of her clients, the vast majority of
who have some kind of advanced cancer. Especially in a case like this where
a yin-tonic is called for, I just can’t see how that kind of dose can be
said to be worth anything. And again, we aren’t talking about homeopathy.
Does anyone in the group have experience with this being a positive
contribution of Chinese medicine to an eclectic mix?….
Ken Bendat
tcmguy@mind.net
Date: Tue, 02 Jul 2002 18:40:15 -0000
From: “tluger1” <tluger@inetarena.com>
Subject: Re: Teaspoon herbology (was homeopathic herbology)
— In chineseherbacademy@y…, tcmguy <tcmguy@m…> wrote:
> Does anyone in the group have experience with this being a
positive contribution of Chinese medicine to an eclectic mix?….
Ken
whether we can postulate the influence of Eli Jones or other 19th
century mavericks upon this doctor is besides the point. I know
plenty of chinese herbalists who prescribe low dose liquid
products and very few of them have ever even heard of Eli Jones
or the eclectics. Most are influenced by marketing, convenience,
profit. the question is whether this is the standard of care for our
profession. Even if we can provide idiosyncratic sources to
support this position (and those sources should not have vested
interests in a liquid product line!!!), it does not belong at the heart
of our profession. the whole thrust of both chinese antiquity and
modern practice in china has been towards pharmacological
prescribing, especially for chronic illness with organic structural
changes.
It is one thing to suggest that we use small doses to help a
patient self actualize or some such thing. this type of human
potential therapy has never been prevalent in mainstream
chinese medicine (perhaps in taoism, etc.), so there is no solid
written precedent. But when it comes to treating most diseases,
it seems either ignorant, egotistical or greedy to suggest that a
nonstandard approach to dosage is desirable. Fact is that
practitioners who don’t burden their patients with foul brews
generally do better in practice than those who do. If this
practitioner gets results, it is probably from the 20 other things
her patients are taking, not the chinese herbs, IMO.
Except for a few very iffy studies on homeopathy (which were
contradicted by other studies), there is no evidence in the
research literature I can find for effective treatment of any
disease using doses of herbs below the pharmacological
threshold. Stephen, were you suggesting otherwise?
Todd
Date: Tue, 02 Jul 2002 18:45:43 -0000
From: “tluger1” <tluger@inetarena.com>
Subject: Re: homeopathic herbology
— In chineseherbacademy@y…, “stephen” <stephen@b…>
wrote:
>
> I have personally used homeopathically potentized TCM herbal
formulas for
> over 10
> years.
though I am skeptical of homeopathy, it does appear to have
worked in my experience. However, a potentized remedy is
different than drop doses of an unsuccussed tinture. Right?
After having used them on many occasions now I can say
> that the tonic formulas do not work well. The ones that work
best are
> those that are designed to reduce Excess/Fullness/
Repletion(?).
that has seemed to be the case with all homeopathics, IMO. no
yin essence to them, so better at moving and regulating.
> However most of the potentized formulas are way too mild in
their
> effect to reverse the pathogenic course of most chronic health
> conditions.
thanks for the experience.
Todd
________________________________________________________________________
________________________________________________________________________
Message: 18
Date: Tue, 2 Jul 2002 12:10:34 -0600
From: “stephen” <stephen@botanica-bioscience.com>
Subject: RE: Re: Teaspoon herbology (was homeopathic herbology)
there is no evidence in the
research literature I can find for effective treatment of any
disease using doses of herbs below the pharmacological
threshold. Stephen, were you suggesting otherwise?
Todd, I was pointing out three things: One, that low dosing, even to the
homeopathic extreme, can have a measurable physiological effect; 2) In most
cases, from my experience using a very broad spectrum of dosages,
pharmacological dosing, generally in the range of 6 to 15 grams of extract
per day, will be required to change the pathogenic nature of chronic
disease, and 3) That some patients, depending on their level of sensitivity,
will require that you start on a lower dose with less frequent dose
consumption, and it can still be of therapeutic benefit.
though I am skeptical of homeopathy, it does appear to have
worked in my experience. However, a potentized remedy is
different than drop doses of an unsuccussed tinture. Right?
Resp: Very definitely. However I did not find a “like cures like” effect
when potentized.
Date: Tue, 02 Jul 2002 19:07:03 -0000
From: “tluger1” <tluger@inetarena.com>
Subject: Re: Teaspoon herbology (was homeopathic herbology)
— In chineseherbacademy@y…, “stephen” <stephen@b…>
wrote:
>
> there is no evidence in the
> research literature I can find for effective treatment of any
> disease using doses of herbs below the pharmacological
> threshold. Stephen, were you suggesting otherwise?
>
>
> Todd, I was pointing out three things: One, that low dosing,
even to the
> homeopathic extreme, can have a measurable physiological
effect;
measured how?
>
> Resp: Very definitely. However I did not find a “like cures like”
effect
> when potentized.
Interesting, because most of the remedies in Boericke clearly do
not operate on like cures like, either. Remedies like echinacea
and goldenseal are used the same homeopathically or
pharmacologically. I have speculated on this phenomena at
http://www.chineseherbacademy.org/homeo.html
Todd