Sionneau on decoctions

[Guest guest]

, " Alon Marcus " <

alonmarcus@w...> wrote:

 

many Dr did prescribe pills. Some time only pills some time with

an herbal tea.

> Alon

 

were those pills made from raw herbs or extracts?

 

[Guest guest]

, " dallaskinguk " <

dallasking@b...> wrote:

> It would seem to me that, in the compromise that is medicine,

there

> are patients who will only ever take patents as well as others,

> particularly those needing long term management, for whom

patents are

> entirely appropriate.

 

 

Simon

 

Your points are well taken, but they must be considered

carefully. Certainly many patients will not take decoctions. We

cannot just deny them care. but if the international standard of

care in TCM for certain conditions demands a certain level of

dosage to address certain conditions, then it is clear that some

types of prepared medicines are not adequate. I think a little

math is always helpful.

 

decoctions in the PRC seem to average about 100-150 grams

per day or more. Perhaps they use lower quality herbs, but they

are are not 10X lower quality.

 

According to Andy Ellis, a modified base formula made from

powdered extracts is typically prescribed at 10 grams per day in

taiwan. since the concentration ratio is 5:1, this makes the

powders the equivalent of 50 grams of decocted herbs.

 

so the doses in the PRC are typically 2-3 times higher than in

taiwan and japan. Some of this may be related to the use of

higher grade herbs and the fact that laboratory extraction is far

more efficient than home decoction. So it possible that is one

measured the levels of active constituents in a standard daily

dose of powdered extract, it wouldn't be that much lower than in

decoctions made in the PRC. Lower, but not 50-70% lower.

 

Arguably, both of these styles of practice deliver adequate

dosage and have enough flexibility to accommodate complex

patients.

 

what about pills?

 

Well, the supercheap pills available in most chinese herb stores

(assuming they do not contain drugs) are made from ground

dried herbs. A bottle of 200 little black pills contains about 42

grams by weight, a third of which is probably binder. So 28

grams of unextracted herbs are made to last 8 days. so one

ingests about 3.5 grams of herb per day. Now this dosage is

over 93% lower than both PRC decoctions and taiwanese

powders.

 

At this point, we are no longer in the same ballpark. Now we are

comparing the effects of say, drinking an entire beer versus

drinking a mouthful of beer. Beer, an ancient herbal extract with

which most are familiar, is dose dependent like all herbs. There

is no way one of these low dose patents can sub for a decoction,

if indeed they do anything at all.

 

On the other hand, various companies make prepared

medicines in pills or caps that are concentrated from 5-15X. At a

5X concentration, you would increase the dose of your little black

pills to 17.5 grams per day, still kind of low. You could triple the

dose, but then the patient would take 24 pills TID. the 15X

products made under very rigorous extractions methods do

deliver an effective convenient affordable dose in my opinion. I

have used 3 caps TID with good results.

 

Notice I am not plugging any companies. But investigate your

own products. How are they made. What is their decoction

equivalent. Do the math yourself. If you use liquid extracts that

use a pound of herb for a given amount of alcohol, you can

easily figure out whats in a one day dose. If your supplier claims

that their products work despite the low dose because of their

superior extraction methods, ask them to prove it. One supplier

sent me his products to taste side by side with his competitor's

products. I was thinking more like how much pseudoephedrine

is in a one ounce tincture versus a 150 gram decoction. that

really wouldn't be too hard to figure out. In fact, given the use of

pseudoephedrine in modern drugs, I bet this information is out

there.

 

[Guest guest]

were those pills made from raw herbs or extracts

>>>Most were traditional honey pills which are a kind of past (not really concentrate but are cooked

Alon

[Guest guest]

Well, the supercheap pills available in most chinese herb stores (assuming they do not contain drugs) are made from ground dried herbs

>>>>Todd most of these are cooked into a past and then rolled into theses little pills. They are not just row powders. Also these are usually used when long term therapy is indicated. In china the dose is often quite high lets say more like 90 little pills per day if the patient is moderately sick less for mild cases and then usually only after a decoction was used first

Alon

[Guest guest]

, " " <@i...> wrote:

> , " dallaskinguk " <

> dallasking@b...> wrote:

> > It would seem to me that, in the compromise that is medicine,

> there

> > are patients who will only ever take patents as well as others,

> > particularly those needing long term management, for whom

> patents are

> > entirely appropriate.

>

>

> Simon

>

> Your points are well taken, but they must be considered

> carefully.

 

What I didn't consider carefully was that Sionneau wasn't talking

about not using patents per se but rather about using decoctions, a

logical mistake after the admonition, from Julie I think, to all calm

down, caused a rush of blood to the head.

 

Certainly many patients will not take decoctions. We

> cannot just deny them care. but if the international standard of

> care in TCM for certain conditions demands a certain level of

> dosage to address certain conditions, then it is clear that some

> types of prepared medicines are not adequate. I think a little

> math is always helpful.

 

I like nothing better than my patients to have 100g+ per day in

decoction but neither maths nor international standards of care can

compete with the experience of patients just about managing to take

16 paste pills a day and getting results; Zhi Bai Di Huang Wan and

menopausal hot flushes are a common example.

Its a strange business and I think that over the years in Chinese

medicine one hears alot of seeming authority without much clinical

evidence. My, mild, opinion on dose is that it is more specific to

disease and symptom than is generally taught. For instance,

psoriasis, no matter what the pattern, arguably responds best to

doses in the range 150-250 g/ day whilst diarrhoea might respond to a

few pills.

 

Simon King

[Guest guest]

Simon,

 

Did you mean to say that I CAUSED a rush of blood to the head by saying

" calm down " ? I didn't mean to...

 

I took Sionneau's words to mean just what he said: Decoctions are better

than pills. Where's that article again? Maybe I should re-read it.

 

Speaking of Zhi Bai Di Huang Wan, I have tried it myself in patent pill

form, in all kinds of dosages from 24 pills a day to qradruple that with no

results whatsoever.

 

Julie

>

> What I didn't consider carefully was that Sionneau wasn't talking

> about not using patents per se but rather about using decoctions, a

> logical mistake after the admonition, from Julie I think, to all calm

> down, caused a rush of blood to the head.

[Guest guest]

"In order to promote the practice of Chinese medicine, it would be much better to have a handful of well-trained, effective practitioners than thousands of superficially-trained, mediocre ones."

 

 

<<<what is elitist about it. perhaps you mean arrogant. SionneAu reflects the dominant practice of TCM worldwide, which is the use of decoctions or their equivalents (such as powders and high potency extracts).>>>

 

I was responding to the above quote about Chinese medicine as a whole, which goes beyond herbal practice. Where, in his depiction, 5-10 "well-trained" practitioners would treat the masses, or at least those who can afford it, out of what would surely be mostly urban centers. So, arrogant is nice word usage but in my mind his is an elitist view too, , granted something may have been lost in the translation,as Bob said.

 

Regarding herbs he may well be right in his opinion. Why not just say, "I think herbal decoctions are better, and wish I could see more practioners using them". Personally, I practice almost exclusively with powders at present, but I know there are people who do not and are succesful, i.e. their patients get better.

 

 

<<<I am disappointed you feel that way. You seem to think Philippe has exposed our profession as quacks while I think he has sounded a much needed alarm.>>>

 

I don't think he has exposed us as quacks, I believe he thinks the majority of us are quacks.

 

 

Sean Doherty

 

 

 

 

[Guest guest]

Speaking of Zhi Bai Di Huang Wan, I have tried it myself in patent pillform, in all kinds of dosages from 24 pills a day to qradruple that with noresults whatsoever

>>>Also only rarely truly effective in decoction

Alon

[Guest guest]

I believe he thinks the majority of us are quacks.

>>>and proud of it

[Guest guest]

I have great results with the Kan extract (temper fire). I've used it

with kidney yin xu fire patients in such conditions as side effects of

chemotherapy, chronic sore throats, and chronic recurrent urinary tract

infections.

 

 

On Wednesday, September 18, 2002, at 07:18 PM, Alon Marcus wrote:

 

> Speaking of Zhi Bai Di Huang Wan, I have tried it myself in patent pill

> form, in all kinds of dosages from 24 pills a day to qradruple that

> with no

> results whatsoever

> >>>Also only rarely truly effective in decoction

> Alon

>

<image.tiff>

>

>

> 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]

Z'ev,

 

Can you tell us the composition of the formula so I can consider making it in a decoction?

And Alon, why do you say Zhi Bai Di Huang Wan is rarely effective as a decoction for hot flashes? What do you think is?

 

I use all kinds of different things: long gu mu li formulas, zhi mu shi gao formulas, etc. depending on the patient.

 

Julie

[Guest guest]

I have great results with the Kan extract (temper fire). I've used it with kidney yin xu fire patients in such conditions as side effects of chemotherapy, chronic sore throats, and chronic recurrent urinary tract infections.>>>>Zev I am talking about menopausal hot flashes. For the above conditions I have as well. I use Bioessence 5x1 tabs

Alon

[Guest guest]

Zhi Bai Di Huang Wan is rarely effective as a decoction for hot flashes? What do you think is?

 

I use all kinds of different things: long gu mu li formulas, zhi mu shi gao formulas, etc. depending on the patient.

>>>I am talking about Zhi Bai Di Huang without additions and subtractions. Also, I have seen and talked to several patients that did not respond to TCM. I have also seen many that did

Alon

[Guest guest]

What is in Bioessence again?

On Thursday, September 19, 2002, at 10:03 AM, Alon Marcus wrote:

 

> I have great results with the Kan extract (temper fire). I've used it

> with kidney yin xu fire patients in such conditions as side effects of

> chemotherapy, chronic sore throats, and chronic recurrent urinary

> tract infections.

> >>>>Zev I am talking about menopausal hot flashes. For the above

> conditions I have as well. I use Bioessence 5x1 tabs

> Alon

>

[Guest guest]

, " Alon Marcus " <alonmarcus@w...> wrote:

> Speaking of Zhi Bai Di Huang Wan, I have tried it myself in patent

pill

> form, in all kinds of dosages from 24 pills a day to qradruple that

with no

> results whatsoever

> >>>Also only rarely truly effective in decoction

> Alon

 

Julie and Alon,

I wrote a reply which I think got lost, so to summarise; I was going

to repeat how effective I find ZHI Bai.. for hot flushes but my wife

pointed out that she doesn't (though she used to). So back to the

initial issue, that of opinions. Jennie and I have 16 years each of

experience, different impressons and no self audits. Prehaps it is

only clinical data that is really going to advance Chinese medicine.

Simon King

[Guest guest]

Bioessence

>>Used to be Tashi the also sell Mintong

[Guest guest]

At 9:18 PM -0500 9/18/02, Alon Marcus

wrote:

Speaking of Zhi

Bai Di Huang Wan, I have tried it myself in patent pill

form, in all kinds of dosages from 24 pills a day to qradruple that

with no

results whatsoever

>>>Also

only rarely truly effective in decoction

Alon

--

I'm assuming you have a study to support that...

--

[Guest guest]

, " dallaskinguk " <

dallasking@b...> wrote:

 

Its a strange business and I think that over the years in Chinese

> medicine one hears alot of seeming authority without much

clinical

> evidence.

 

 

Actually this is not really about authority, which connotes

dictating downwards, but general consensus amongst most of

the world's TCM practitioners. We americans are the

exceptions, not the rule. As for clinical evidence, pretty much all

the modern research in China supports the use of high dose

decoctions and none that I am aware of supports the use of

paste pills in any condition. that is the opinion of every one I

know who has access to chinese language journals and I have

probably read thousands of abstracts myself over the past 15

years.

 

As to one's experience in clinic, well I am the first to admit that

in many conditions it is impossible to know what has caused a

change. Placebo effects run at 40% in controlled research and

up to 90% in private practice. In the absence of being able to

accurately evaluate the course of many conditions (such as

perimenopause), I feel I must rely on the bulk of the evidence in

both modern research and the premodern literary tradition, none

of which supports the use of low dose paste pills in serious

illnesses as the sole therapy. for while your patient may report

relief of hot flashes and nightsweats, I would be much more

suprised if you could demonstrate changes in protection against

heart disease and osteoporosis. which are far more important in

the long term than sweating. One of my goals for menopausal

women is not just symptom relief but an alternative to drugs for

healthy ageing. Not that I use decoctions for this, but I use pills

that deliver the goods.

 

[Guest guest]

As for clinical evidence, pretty much all the modern research in China supports the use of high dose decoctions and none that I am aware of supports the use of paste pills in any condition.

>>>Todd many authoritative TCM physicians also think that western patients need smaller doses that Chinese patients. But I think you are right as far as making this a very important issue which should be studied. Certainly if a high dose is needed to repeat a Chinese study result we should not expect lower dosages to be effective as well.

Alon

 

[Guest guest]

My herb instructor in school said that he found he needed to use smaller doses of herbs for American patients (especially with things like Shu Di Huang) to avoid reactions. We speculated that Chinese patients might be more used to the herbs from using a lot more of them in food, etc, and therefore need more to create a change in their system. Sort of like building up a resistance.

 

Jody

 

-

Alon Marcus

Friday, September 20, 2002 5:07 PM

Re: Re: Sionneau on decoctions

 

As for clinical evidence, pretty much all the modern research in China supports the use of high dose decoctions and none that I am aware of supports the use of paste pills in any condition.

>>>Todd many authoritative TCM physicians also think that western patients need smaller doses that Chinese patients. But I think you are right as far as making this a very important issue which should be studied. Certainly if a high dose is needed to repeat a Chinese study result we should not expect lower dosages to be effective as well.

Alon

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...> wrote:

 

>

>

> Actually this is not really about authority, which connotes

> dictating downwards, but general consensus amongst most of

> the world's TCM practitioners. We americans are the

> exceptions, not the rule. As for clinical evidence, pretty much

all

> the modern research in China supports the use of high dose

> decoctions and none that I am aware of supports the use of

> paste pills in any condition. that is the opinion of every one I

> know who has access to chinese language journals and I have

> probably read thousands of abstracts myself over the past 15

> years.

 

 

I also in my practice prescribe decoctions, often in very large dose,

but, it seems , the precipitating comment from Philippe Sionneau that,

 

" All the good practitioners I've seen, without exception, prescribe

decoctions. All the " miracle cures " performed by Chinese medicine

I've witnessed were from decoctions. I have never seen any of my

Chinese teachers prescribe ready-made pills to a patient,... "

 

is overstated. Or at least if it is intended in a prescriptive manner

then " good practitioner " and " miracle cure " would need defining and

alot of clinical backup. I just feel that those practitioners who

prescribe low doses, including UK Western herbalists, shouldn't be

dismissed apriori.

 

Simon

[Guest guest]

Dear Colleagues,

 

This statement seems rather odd and causes me to question the nature of experience that leads to such a conclusion. I have seen 'miracle cures' from patents such as huo xiang zheng qi pian, xiao chai hu tang, bu zhong yi qi tang, tang kuei gin, various ching fei formulas, long dan xie gan pian, and piantouteng wan. Even sang ju yin can produce a 'miracle cure' when correctly prescribed and dosed.

 

 

"All the good practitioners I've seen, without exception, prescribe decoctions. All the "miracle cures" performed by Chinese medicine I've witnessed were from decoctions. I have never seen any of my Chinese teachers prescribe ready-made pills to a patient,..."

 

all > the modern research in China supports the use of high dose > decoctions and none that I am aware of supports the use of > paste pills in any condition. that is the opinion of every one I > know who has access to chinese language journals and I have > probably read thousands of abstracts myself over the past 15 > years.

 

These statements suggest professional bias when compared to my clinical experience and the huge volume of sales generated from the patent industry. Studies only reveal answers to the questions that investigators ask. In addition, the situation of the professional in China is driven by complex medical, personal, political, and social agenda as Scheid has demonstrated. And finally, the biases of a professional group are not necessarily the basis of truth, for example:

 

1. The sun revolves around the earth. 2. The earth is flat and we will fall off the edges. 3. The is no relationship between eating limes and the prevention of scurvy. 4. There is no relationship between handwashing before surgery [to remove germs] and the prevention of disease [from germs on the hands]. 5. There is no relationship between nutrition and disease. 6. There is no relationship between toxic chemical exposure and disease.

I will say that the patents based on shu di and xiao yao wan are seldom effective in my experience. But, I have seen them effective when used by others.

 

 

Will

[Guest guest]

Alon - I agree with you on this. However, individual doctor's experience was cited in part as the rational for decoction delivery - my experience is contrary to that. And - after all Chinese medicine is best practiced by those with experience as Scheid indicates.

 

Will

does make a good point on placebo. We really can not draw any conclusions from personal clinical experiences. All the dr i studied with for the most part used large dosages, except one that was strongly SHL trained and he used to say this was because of poor diagnosis.

[Guest guest]

We speculated that Chinese patients might be more used to the herbs from using a lot more of them in food, etc, and therefore need more to create a change in their system

>>>there may be genetic differences as they need much lower dosages of western meds

alon

[Guest guest]

I will say that the patents based on shu di and xiao yao wan are seldom effective in my experience. But, I have seen them effective when used by others

>>>>Will does make a good point on placebo. We really can not draw any conclusions from personal clinical experiences. All the dr i studied with for the most part used large dosages, except one that was strongly SHL trained and he used to say this was because of poor diagnosis.

Alon

Alon