dosage, was restless leg syndrome

[Guest guest]

, Heiko Lade <heiko@l...> wrote:

 

>

> Diagnosis is of course the key to successfull treatment and I am still

undecided about the large dosage thing. For me I think it is establishing which

patients suit the large doses and which respond better to smaller doses. I am

finding that some of the grnule concentrates are

> much stronger than what they suggest in terms of dosage.

 

I did say, " adequate dosage " , not large. However, I also agree that

granules are stronger than their concentration ratios suggest, due to

scientifically controlled processing. I often get by with 12 grams per

day, which is about the equivalent of 75% of my bulk doses (about 90 g

per day). I think Heiko is right about PRC herb quality. I have heard

this from many sources over the years. So when you figure higher

potency and better quality, you can definitely get by with lower doses

than suggested by chinese research studies. But the traditional doses

ranges in books like Bensky are based on historical use. they are

generally lower than research studies use, too. But I think they are

valid ranges for clinical practice with granules. I also note that

many entires in Bensky use pills in large dose, around 25 g per day.

this is much lower than bulk doses, but much higher than typical

patents and liquids. So I think " adequate " dosage is well supported,

if not the extreme dosage in modern studies. I would also add that

assertions regarding effective use of minute dosages rely on theories

of herb action that are also MSU (making stuff up, Al). Neither Ted

Kapchuk nor any other source I am aware of has ever provided citations

(traditional or modern, anecdotal or research) to support the use of

doses less than 1-6 g per day, which is the amount delivered by many

patent medicines and liquids.

 

[Guest guest]

Todd.....

 

A lack of references containing small dosage is an insufficient argument

against small dose usage. Failure of court authorized publications to mention

small dosage has no reflection on the virtues of such a strategy. Two of the

most well respected senior practitioners (John Shen and Tiande Yang) make

regular use of small doses. They also use large dosage when appropriate. I

agree with you that many times insufficient dosage causes an otherwise good

diagnosis and treatment to fail.

 

Typical use of small dosage would be chronic case management in

environmentally sensitive individuals. Dr. Shen would also use small doses to

affect nervous system function rather than organic tissue (a senior Chinese

practitioner using non-TCM language patterns).

 

Will

 

In a message dated 3/18/01 8:54:41 PM Pacific Standard Time,

writes:

 

> Neither Ted

> Kapchuk nor any other source I am aware of has ever provided citations

> (traditional or modern, anecdotal or research) to support the use of

> doses less than 1-6 g per day, which is the amount delivered by many

> patent medicines and liquids.

[Guest guest]

In a message dated 3/19/01 8:42:27 PM Pacific Standard Time,

writes:

 

> Can John shen or others provide us

> with any historical evidence besides their personal claims of success?

:

 

You are arguing for anecdotal evidence in one case and against it in another.

Most of the canons you are citing rely on anecdotal evidence. As far as Dr.

Shen, I have my observation of his work, which has been profound compared to

many younger practitioners of 20-40 years experience, that is as far as I can

go with that. I also have my own clinical experience working the full range

of the dose response curve. So...that said, I still agree with you for most

cases, dosage is insufficient.

 

Will

[Guest guest]

, WMorris116@A... wrote:

.....

>

> A lack of references containing small dosage is an insufficient argument

> against small dose usage. Failure of court authorized publications to mention

> small dosage has no reflection on the virtues of such a strategy.

 

Will

 

I do not think the majority of the 10,000 extant premodern works were

court authorized, as you suggest. I think most were done by small

presses,so to speak. I may be wrong. Perhaps others can comment, like

Ken. the fact that some individuals claim anecdotal success with a low

dose methodology is not near as convincing to me as the utter lack of

evidence for this in the traditional literature, whoever authorized it.

One of my teachers, Heiner Fruehauf, who prided himself on

investigating non TCM sources including taoist texts is one of the most

ardent supporters of a moderate-high dose methodology even in the

subtlest of complaints. why? because even in his most arcane

wanderings thru the CM archives, he was not able to find any support

for this approach. No one I know with access to the literature besides

Ted Kapchuk has ever disputed this position and Ted's work is

conspicuously lacking in citations. Can John shen or others provide us

with any historical evidence besides their personal claims of success?

 

[Guest guest]

I do not think the majority of the 10,000 extant premodern works were court authorized, as you suggest.

>>>From what I understand the mojority are court authorized litrature

Alon

[Guest guest]

You are arguing for anecdotal evidence in one case and against it in another. Most of the canons you are citing rely on anecdotal evidence

>>>>This is one of the most important statement we have read so far. The classics are based on anecdotal theory and therefore I have been taking the stances that I have.

Alon

[Guest guest]

WMorris116 wrote:

 

> Typical use of small dosage would be chronic case management in

> environmentally sensitive individuals. Dr. Shen would also use small doses to

> affect nervous system function rather than organic tissue (a senior Chinese

> practitioner using non-TCM language patterns).

 

Will, Can you translate some of Dr. Shen's concepts into TCM?

 

Nervous system is Liver Qi? Kidney Stuff?

 

 

--

Al Stone L.Ac.

<AlStone

http://www.BeyondWellBeing.com

 

Pain is inevitable, suffering is optional.

 

Attachment: vcard [not shown]

[Guest guest]

In a message dated 3/20/01 10:01:12 AM Pacific Standard Time, Al:

 

alstone writes:

 

 

 

Will, Can you translate some of Dr. Shen's concepts into TCM?

 

Nervous system is Liver Qi? Kidney Stuff?

 

 

The peripheral NS is related to Liver and the Central NS is related to Kidney. He would use small doses of disperse wind agents such as Jing Jie and Fang Feng (agents that eliminate ghosts in older texts). In my analysis, most disperse wind agents have a vasodilitory action. To accomplish this action, the herbs cause a relaxing of the peripheral vascular system and diminish the xian/string taut sensation.

 

Dr. Shen also identified a nervous system weak type person. These people often have a weak left Chi/Guan positions and demonstrate Kidney and/or Jing insufficiency. The Water is incapable of nourishing the Wood due to insufficiency. These people do very well with small doses. I had one patient who could sniff a desiccated extract and have a response. Dispersing Wind is not the best solution under these circumstances. The treatment would include Shan Yao, Ji Nei Jin (boost the Spleen to Generate Essence) -- eventually the doses must be built up to accomplish such a treatment plan.

 

So these are two uses of small dosage. My experience with the disperse wind strategy is with over 1500 cases in a busy practice in the Berkshires of MA during the '90s. Members of two-year herb courses in Massachusetts and Florida corroborated these findings. It works in cases where the nervous system tension (Qi stagnation) is not constitutional. The NS weak is far more difficult to treat and is not as common. I treated over 200 cases of this nature, because the protoplasm-is-poorly-put-together (JIng Xu), these cases are difficult to treat. However, over time (years) they improve.

 

Will

[Guest guest]

, WMorris116@A... wrote:

 

>

:

>

> You are arguing for anecdotal evidence in one case and against it in another.

> Most of the canons you are citing rely on anecdotal evidence.

 

Hmmm. I think the accepted canons have demonstrated the efficacy of

their once anecdotal MSU over the centuries, while many other ideas

have fallen by the wayside. I think I have already stipulated that CM

was all MSU at one time. But when an idea becomes so accepted by huge

numbers of clinicians, that lends a credence to it that transcends the

original anecdote. Granted, there have been widely accepted medical

ideas that have turned out to be erroneous, such as massive

bloodletting. But conversely, the introduction of a new idea, no

matter how intellectually attractive, is not enough to sway me. And if

I have to choose between new ideas, I lean towards those that have some

foundation I can grasp, such as modern biomedical or accepted canons.

Unless I am failing in my methodology, I have no interest in getting

too far afield. but thats me, conservative. One caveat to Alon,

though. I have no doubt that you have had to reach far afield to have

a dramatic impact on the musculoskeletal conditions you specialize in.

Because despite the displaced emphasis on these conditions placed by

modern american acus, CM has been overwhelmingly about the tx of

internal medicine over the centuries. that is its strong suit.

 

[Guest guest]

I think the accepted canons have demonstrated the efficacy of their once anecdotal MSU over the centuries, while many other ideas have fallen by the wayside. I think I have already stipulated that CM was all MSU at one time. But when an idea becomes so accepted by huge numbers of clinicians, that lends a credence to it that

>>>>>

For the most part it is probably true. But the fact that so many of the ideas had to be "expanded" shows the need to do this. I also think that this expectance because ideas have survived does not make it useful or certainly true. Just look at so many of the religions

 

I have no doubt that you have had to reach far afield to have a dramatic impact on the musculoskeletal conditions you specialize in. Because despite the displaced emphasis on these conditions placed by modern American acus, CM has been overwhelmingly about the tx of internal medicine over the centuries. that is its strong suit. >>>>>That is very true. And I much prefer to use OM ideas in internal med

Alon

 

-

 

Wednesday, March 21, 2001 9:59 AM

Re: dosage, was restless leg syndrome

, WMorris116@A... wrote:> :> > You are arguing for anecdotal evidence in one case and against it in another. > Most of the canons you are citing rely on anecdotal evidence. Hmmm. I think the accepted canons have demonstrated the efficacy of their once anecdotal MSU over the centuries, while many other ideas have fallen by the wayside. I think I have already stipulated that CM was all MSU at one time. But when an idea becomes so accepted by huge numbers of clinicians, that lends a credence to it that transcends the original anecdote. Granted, there have been widely accepted medical ideas that have turned out to be erroneous, such as massive bloodletting. But conversely, the introduction of a new idea, no matter how intellectually attractive, is not enough to sway me. And if I have to choose between new ideas, I lean towards those that have some foundation I can grasp, such as modern biomedical or accepted canons. Unless I am failing in my methodology, I have no interest in getting too far afield. but thats me, conservative. One caveat to Alon, though. I have no doubt that you have had to reach far afield to have a dramatic impact on the musculoskeletal conditions you specialize in. Because despite the displaced emphasis on these conditions placed by modern american acus, CM has been overwhelmingly about the tx of internal medicine over the centuries. that is its strong suit. Todd Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

From Todd: I have no doubt that you have had to reach far afield to have a dramatic impact on the musculoskeletal conditions you specialize in. Because despite the displaced emphasis on these conditions placed by modern American acus, CM has been overwhelmingly about the tx of internal medicine over the centuries. that is its strong suit. >>>>>That is very true. And I much prefer to use OM ideas in internal med

Alon

 

Alon and

I've observed that most new patient musculoskeletal conditions that arrive in the office of an acupuncturist are either chronic and have not responded to other treatments or have not healed on their own for at least a few weeks. Your established patients may come straight back to see you first, shi bu shi. My experience suggests that most musculoskeletal conditions are usually not just a channel phenomenon but in most cases are a branch of a chronic internal disorder that predisposed them to the musculoskeletal injury or at least has kept it from healing. My best results in these channel pathologies is to treat it as an internal medicine case and address the deeper pathology. I've been able to obtain excellent results in many musculoskeletal cases without using local points or linements. If there is not a relationship to an internal pathology then the acute injury or strain is much more likely to heal well on its own. The difficulty is when there are numerous interwoven internal problems (usually the case) and one has to decide which of them is most directly related to the channel pathology...cause and effect relationships. My observation is that digestive dysfunction is the most common internal/external relationship to the restricted healing of musculoskeletal pathology. Asking about a specific food that may be consumed in excess is often relevant...yummm, chocolate (only a little of course, but every day!?), ice cream and knee problems?...and the list goes on.

 

Stephen

 

 

 

 

-

 

Wednesday, March 21, 2001 9:59 AM

Re: dosage, was restless leg syndrome

, WMorris116@A... wrote:> :> > You are arguing for anecdotal evidence in one case and against it in another. > Most of the canons you are citing rely on anecdotal evidence. Hmmm. I think the accepted canons have demonstrated the efficacy of their once anecdotal MSU over the centuries, while many other ideas have fallen by the wayside. I think I have already stipulated that CM was all MSU at one time. But when an idea becomes so accepted by huge numbers of clinicians, that lends a credence to it that transcends the original anecdote. Granted, there have been widely accepted medical ideas that have turned out to be erroneous, such as massive bloodletting. But conversely, the introduction of a new idea, no matter how intellectually attractive, is not enough to sway me. And if I have to choose between new ideas, I lean towards those that have some foundation I can grasp, such as modern biomedical or accepted canons. Unless I am failing in my methodology, I have no interest in getting too far afield. but thats me, conservative. One caveat to Alon, though. I have no doubt that you have had to reach far afield to have a dramatic impact on the musculoskeletal conditions you specialize in. Because despite the displaced emphasis on these conditions placed by modern american acus, CM has been overwhelmingly about the tx of internal medicine over the centuries. that is its strong suit. Todd Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

I've observed that most new patient musculoskeletal conditions that arrive in the office of an acupuncturist are either chronic and have not responded to other treatments or have not healed on their own for at least a few weeks. Your established patients may come straight back to see you first, shi bu shi. My experience suggests that most musculoskeletal conditions are usually not just a channel phenomenon but in most cases are a branch of a chronic internal disorder that predisposed them to the musculoskeletal injury or at least has kept it from healing. My best results in these channel pathologies is to treat it as an internal medicine case and address the deeper pathology.

 

>>>>First, almost all patients with chronic musculoskeletal disorders have been totally mismanaged. Yes, when you look from an OM perspective they have internal med stuff. Yes taking care of their general health is often helpful. But, most patient with chronic pain have very specific pathology going on. The fact that most Dr. do such a poor job at diagnosis and usually relay on technology, does not mean that there is no specific pathology that can be fixed. If one can take care of such lesions then the results are quite superior to what you can get out of improving the patients healing ability. OM is quite inferior in many respects to well trained orthopedic medicine Dr. That is one that knows soft tissue disorders and one that usually uses manual therapies (manipulation), excersise and injection techniques. Unfortunately, or fortunately for us, there are very few of them around

Alon

 

-

Stephen Morrissey

Wednesday, March 21, 2001 2:28 PM

RE: Re: dosage, was restless leg syndrome

 

 

From Todd: I have no doubt that you have had to reach far afield to have a dramatic impact on the musculoskeletal conditions you specialize in. Because despite the displaced emphasis on these conditions placed by modern American acus, CM has been overwhelmingly about the tx of internal medicine over the centuries. that is its strong suit. >>>>>That is very true. And I much prefer to use OM ideas in internal med

Alon

 

Alon and

I've observed that most new patient musculoskeletal conditions that arrive in the office of an acupuncturist are either chronic and have not responded to other treatments or have not healed on their own for at least a few weeks. Your established patients may come straight back to see you first, shi bu shi. My experience suggests that most musculoskeletal conditions are usually not just a channel phenomenon but in most cases are a branch of a chronic internal disorder that predisposed them to the musculoskeletal injury or at least has kept it from healing. My best results in these channel pathologies is to treat it as an internal medicine case and address the deeper pathology. I've been able to obtain excellent results in many musculoskeletal cases without using local points or linements. If there is not a relationship to an internal pathology then the acute injury or strain is much more likely to heal well on its own. The difficulty is when there are numerous interwoven internal problems (usually the case) and one has to decide which of them is most directly related to the channel pathology...cause and effect relationships. My observation is that digestive dysfunction is the most common internal/external relationship to the restricted healing of musculoskeletal pathology. Asking about a specific food that may be consumed in excess is often relevant...yummm, chocolate (only a little of course, but every day!?), ice cream and knee problems?...and the list goes on.

 

Stephen

 

 

 

 

-

 

Wednesday, March 21, 2001 9:59 AM

Re: dosage, was restless leg syndrome

, WMorris116@A... wrote:> :> > You are arguing for anecdotal evidence in one case and against it in another. > Most of the canons you are citing rely on anecdotal evidence. Hmmm. I think the accepted canons have demonstrated the efficacy of their once anecdotal MSU over the centuries, while many other ideas have fallen by the wayside. I think I have already stipulated that CM was all MSU at one time. But when an idea becomes so accepted by huge numbers of clinicians, that lends a credence to it that transcends the original anecdote. Granted, there have been widely accepted medical ideas that have turned out to be erroneous, such as massive bloodletting. But conversely, the introduction of a new idea, no matter how intellectually attractive, is not enough to sway me. And if I have to choose between new ideas, I lean towards those that have some foundation I can grasp, such as modern biomedical or accepted canons. Unless I am failing in my methodology, I have no interest in getting too far afield. but thats me, conservative. One caveat to Alon, though. I have no doubt that you have had to reach far afield to have a dramatic impact on the musculoskeletal conditions you specialize in. Because despite the displaced emphasis on these conditions placed by modern american acus, CM has been overwhelmingly about the tx of internal medicine over the centuries. that is its strong suit. Todd Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

OM is quite inferior in many respects to well trained orthopedic medicine Dr. That is one that knows soft tissue disorders and one that usually uses manual therapies (manipulation), excersise and injection techniques. Unfortunately, or fortunately for us, there are very few of them around

Alon

Alon,

In a study I heard about on the news several years ago that was done at Boeing on back pain, it was indicated that roughly ninety percent of those suffering back pain could not identify a triggering mechanism, i.e. a specific injury. To me this clearly indicates the relationship of internal health to external conditions, especially chronic ones. I know many people that have gone to prolotherapy and other forms of injection treatments for everything from shoulder to low back problems. In fact I have personally had 6 prolo treatments and found that it strengthens weak links in the system. However if internal dysfunction or vacuity still exists after the injection treatment or manipulation, I believe that it will just find the next weak link in the system and then at some point of overuse, acute strain or exhaustion, it will manifest there. If OM diagnostic and treatment approaches are used concurrently then the short and long term outcomes will be better.

 

Stephen

 

 

Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

In a study I heard about on the news several years ago that was done at Boeing on back pain, it was indicated that roughly ninety percent of those suffering back pain could not identify a triggering mechanism, i.e. a specific injury. To me this clearly indicates the relationship of internal health to external conditions, especially chronic ones. I know many people that have gone to prolotherapy and other forms of injection treatments for everything from shoulder to low back problems. In fact I have personally had 6 prolo treatments and found that it strengthens weak links in the system. However if internal dysfunction or vacuity still exists after the injection treatment or manipulation, I believe that it will just find the next weak link in the system and then at some point of overuse, acute strain or exhaustion, it will manifest there. If OM diagnostic and treatment approaches are used concurrently then the short and long term outcomes will be better.

 

>>>>I totally agree and that is why I still practice TCM. As far as back pain the literature still states that 80% of chronic back pain idiopathic and I think that is bull. With good anesthetic techniques one can identify the exact source of 90% of back pain.

Where I see OM strength is in treating ones general strength and functional systems. But again, and both in internal medicine and orthopedics, my observations both here and china is that TCM often fails in non-functional disorders. And again this is looking at outcomes of very well trained Dr in China.

Alon