Guest guest Posted February 22, 2003 Report Share Posted February 22, 2003 , " Emmanuel Segmen " <susegmen@i...> wrote: > > I apologize for not being able to support a clear numerical comparison of product lines. Emmanuel Maybe we could just ballpark it a little bit. If one were trying to determine the correct dosage of a liquid extract like Kan or far east summit in comparison to a traditional decoction, there must be a reasonable range of possibilities to help guide us. Ted Kapchuk told me point blank at Pacific Symposium last year that he set the dosages for his kan products purely on a hunch. that there was no basis for his selection in chinese literature and that nobody really understands dosage anyway. Be that as it may, I am still curious if there are biochemical limits that could give me some parameters. So working with a simple math problem as follows, is there any way to make a comparison of any sort? 1. decoct 100 grams of herbs in 16 oz. water for 45 minutes 2. extract and concentrate 100 grams of herbs with alcohol and water into 4 oz. of final product. How much more concentrated with markers can the liquid extract be compared to the water decoction? Could it be 10 times more? 100 times more? Or are we talking about much smaller factors like 2 or 3 times or perhaps percentages like 10-25% more. Basically, are there recognized extraction limits in biochemistry that can at least give someone like me the slightest inkling of how to compare these products. To be honest, it has been several months since I have used anything besides raw herbs on my patients. I have tradition behind me regarding dosage and I have almost 20 years of organoleptic experience evaluating raw herbs, 16 of them will full access to a chinese pharmacy. Chinese Herbs " Great spirits have always found violent opposition from mediocre minds " -- Albert Einstein Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2003 Report Share Posted February 22, 2003 I love your Ted Kaptchuk story. I have enormous respect for him and feel that his hunch is probably a good one. My last comment might bear rereading for one thing that I will now emphasize: physiology versus pharmacology. I apologize in advance for the length of my discussion. One of the things that we look at in physiology and biochemistry with in vivo research is first what is a chemical's pharmacological effect? You check for LD-50 which is the lethal dose. Then you investigate other effects like changes in heart rate, breathing, G.I. motility and so on. Finally if you are a subtle and intrepid scientist you begin to assess the "physiological effect". Our tissues deliver miniscule amounts of various biochemicals to our blood and extracellular fluids every second in profoundly varying amounts. At night we have a cocktail of growth hormone and glucagon among an array of other chemicals dedicated to parasympathetic activity. During the day we have sympathetic tone which changes from moment to moment based on simple movements and varying activities including eating. Also during the day, the night-time neurotransmitter/hormone cocktail is absent. What I'm suggesting here is that Chinese herbal medicine is not pharmaceutical in nature. I've seen research from Taiwan and mainland China that shows Bu Zhong Yi Qi Tang causing sleep to be more effective for both healing as well as for strengthening. It was this formula's physiological effect that was noted during clinical trials. It was used at dosages in which there was very little measurable pharmacological effect. Are you picking up on this point? I believe that this is the essential key for dosage and also for Ted's comment to you. Over the centuries the combining principles for herbal formulas are in part supposed to mask any possible pharmacological side effect and to emphasize the intended physiological effect. If I were you, I would not sweat the level or comparative concentrations. I would make very sure that I was getting the physiological effect I wanted. Which means you could treat formulas like food. Double the dosage if you are not getting the effect you want. One of my customers had asked Dr. Ping Qi Kang, one of the owners of my company, to devise a formula for improved sexual function ... something like an herbal Viagra. We sent her a formula for her and her husband based on the parameters that she required. She called me one afternoon to say that she had ingested the formula one hour prior to the call, and wanted me to know that she didn't feel anything yet. I had to explain to her the above point: that we had not devised a pharmacological aphrodisiac. If she got together with her husband for an hour of amorous activity, they might discover in subtle ways that they enjoyed their time together and were not so tired from the activity ... perhaps even energized by it. My experience as a 54 year old distance runner using tonic formulas is similar to this. We have finished products from the Taibo Factory in Lanzhou that also produces dry dosage finished products for NuHerbs and BioEssence. My dosaging recommendation is that people get at least a gram (two capsules) for the effect that's desired whether it's a lower respiratory cough formula or it's a formula for dysmenorrhea associated with menopause, for hepatitis C or what ever. You could increase the dosage to six capsules (3 grams of dry dosage powder) to address a more acute presentation. You could later back off to a 4 or 3 capsule dosage as the acute presentation was arrested. The point here is that you are looking for the physiological effect of, for instance, stimulating immune function for fighting an infection. You are not presenting an antibiotic or some other pharmaceutical chemical that is supposed to be at some blood concentration in order to have it's effect. So Chinese medicine is like food ... the effects are indirect and so only indirectly measurable. If you are moderately hungry, you eat just one bowl soup. If you're ravenously hungry, you could safely move up to two bowls of soup and in some cases even two and one half or three. The ingested nutrients need to be adequate to support homeostatic balance. Pharmaceuticals interrupt homeostatic balance. Estrogen given to a woman will turn off her pituitary output of LH and FSH and that will interruption will turn off her own tissue's estrogen output. I generally defer to Dr. Liang, my president, to provide the clinically correct dosage recommendations. But her commentary is most often that Chinese medicine is like food. You start out with a moderate amount and keep raising the dosage until you get the effect you want. In my opinion and in the opinion of those clinicians of great merit that I trust, this is the procedure. Also, these same people note (at the expense of their own finished products) that cooking raw herbs from scratch will get you the best effect, liquid extracts are stronger than dry dosage extracts, and finally you give dry dosage extracts if it's the only way you can get your patient to adhere to your herbal formula recommendations. Regarding your numbers and orders of magnitude, I will say this. The most clinical research that I've seen has been on Bu Zhong Yi Qi Tang. When they attempted to give people overdoses to document the effect, people tended to simply go to sleep. The sleep they got was deep and very beneficial. Dr. Chiang of Min Tong Herbs showed me the research, so if you want to read it you should check with him. This research showed that there was no pharmacological effect from taking Bu Zhong Yi Qi Tang ... only a strong physiological effect. It made the body's physiology work harder. Note carefully that sleep is as hard as you can possibly work. That's why babies sleep so much during their growth. Growth hormone is only in the blood during deep sleep. The parasympathetic system is full on during sleep. That's when you do your heavy lifting. For all you students out there, sleep is when memory is consolidated. I tell my own physiology students that "Rumplestilskin only works at night". He spun straw into gold ... and only at night. So if you are asking me about numbers of grams regarding clinically effective dosage, I've got to say numbers are for measuring pharmacological effects ... not for Chinese medicine. As a physiologist, that's why I use Chinese medicine for myself. I know that its effects are not pharmacological ... so Chinese medicine will not interrupt physiological homeostasis. It will support homeostasis. When I make a formula, I note relative amounts of ingredients ... I don't use a scale. I'm a biochemist and my parents are research scientists before me. But when I cook, I tend not to measure. I'm with Ted Kaptchuk on this one ... playing my hunches and making it taste good. :-) In our clinic Dr. Kang and Dr. Liang only use scales to sell things, not to make formulas. I stand by my suggestion to call the company you are working with and ask a clinician who works there about dosaging to meet their specs. I also stand by my statement that it's not about numbers. Dr. Kang was the chief of TCM at Shanghai Hospital #1, and he's willing to double and triple doses to get physiological effects. So I stand by my statement that it's about physiological effect and not pharmacological effect. Emmanuel Segmen - cha Saturday, February 22, 2003 11:12 AM dosage comparisons , "Emmanuel Segmen" <susegmen@i...> wrote:> > I apologize for not being able to support a clear numerical comparison of product lines. EmmanuelMaybe we could just ballpark it a little bit.If one were trying to determine the correct dosage of a liquid extract like Kan or far east summit in comparison to a traditional decoction, there must be a reasonable range of possibilities to help guide us.Ted Kapchuk told me point blank at Pacific Symposium last year that he set the dosages for his kan products purely on a hunch. that there was no basis for his selection in chinese literature and that nobody really understands dosage anyway. Be that as it may, I am still curious if there are biochemical limits that could give me some parameters.So working with a simple math problem as follows, is there any way to make a comparison of any sort?1. decoct 100 grams of herbs in 16 oz. water for 45 minutes2. extract and concentrate 100 grams of herbs with alcohol and water into 4 oz. of final product.How much more concentrated with markers can the liquid extract be compared to the water decoction? Could it be 10 times more? 100 times more? Or are we talking about much smaller factors like 2 or 3 times or perhaps percentages like 10-25% more. Basically, are there recognized extraction limits in biochemistry that can at least give someone like me the slightest inkling of how to compare these products. To be honest, it has been several months since I have used anything besides raw herbs on my patients. I have tradition behind me regarding dosage and I have almost 20 years of organoleptic experience evaluating raw herbs, 16 of them will full access to a chinese pharmacy. ToddChinese Herbshttp://www..orgvoice: fax: "Great spirits have always found violent opposition from mediocre minds" -- Albert Einstein Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2003 Report Share Posted February 22, 2003 I want to respect your question a little bit better by also saying that I could answer it if it was a molarity problem in first year chemistry. The thing is, it's not. You can't calculate the molarity of a thousand interacting molecules. Emmanuel Segmen - cha Saturday, February 22, 2003 11:12 AM dosage comparisons , "Emmanuel Segmen" <susegmen@i...> wrote:> > I apologize for not being able to support a clear numerical comparison of product lines. EmmanuelMaybe we could just ballpark it a little bit.If one were trying to determine the correct dosage of a liquid extract like Kan or far east summit in comparison to a traditional decoction, there must be a reasonable range of possibilities to help guide us.Ted Kapchuk told me point blank at Pacific Symposium last year that he set the dosages for his kan products purely on a hunch. that there was no basis for his selection in chinese literature and that nobody really understands dosage anyway. Be that as it may, I am still curious if there are biochemical limits that could give me some parameters.So working with a simple math problem as follows, is there any way to make a comparison of any sort?1. decoct 100 grams of herbs in 16 oz. water for 45 minutes2. extract and concentrate 100 grams of herbs with alcohol and water into 4 oz. of final product.How much more concentrated with markers can the liquid extract be compared to the water decoction? Could it be 10 times more? 100 times more? Or are we talking about much smaller factors like 2 or 3 times or perhaps percentages like 10-25% more. Basically, are there recognized extraction limits in biochemistry that can at least give someone like me the slightest inkling of how to compare these products. To be honest, it has been several months since I have used anything besides raw herbs on my patients. I have tradition behind me regarding dosage and I have almost 20 years of organoleptic experience evaluating raw herbs, 16 of them will full access to a chinese pharmacy. ToddChinese Herbshttp://www..orgvoice: fax: "Great spirits have always found violent opposition from mediocre minds" -- Albert Einstein Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2003 Report Share Posted February 23, 2003 Emmanuel Segmen >>>Which company are working with. Is that the one that Dr Kang (formally from ACTCM) is associated with Thanks Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2003 Report Share Posted February 23, 2003 , " Emmanuel Segmen " > So if you are asking me about numbers of grams regarding clinically effective dosage, I've got to say numbers are for measuring pharmacological effects ... not for Chinese medicine. As a physiologist, that's why I use Chinese medicine for myself. I know that its effects are not pharmacological ... so Chinese medicine will not interrupt physiological homeostasis. It will support homeostasis. When I make a formula, I note relative amounts of ingredients ... I don't use a scale. I'm a biochemist and my parents are research scientists before me. But when I cook, I tend not to measure. I'm with Ted Kaptchuk on this one ... playing my hunches and making it taste good. > :-) In our clinic Dr. Kang and Dr. Liang only use scales to sell things, not to make formulas. Emmanual & Others, I have not been completely following this, but I have to say that dosage purely from a Chinese perspective albeit pharmacological, physiological, energetic or whatever, seemingly has always been of major importance. How many times just shifting an herb from 3 to 6 grams, completely changes the action or the direction of the Rx. And of course, this is usually in relation to decoctions. And IMHO, I believe cooking cannot be related to making herbal Rxs – in the above manner. When people (usually Chinese) do not use scales it is usually because they are so good at estimating the dosage that it is just not necessary. But overall, I have seen tremendous use of scales, to get the ‘proper dose’ . I don’t think one can just throw some herbs in a bag and there it is… what if you put 3 grams of dahuang vs. 1g. This could be huge…. I believe that dosage of the actually Rx (getting the right harmony and balance) and then dosage for the patient (i.e. how long are they going to take that bag and how often) is of utmost importance. But anyway my point… So if this is true, from a modern and historical perspective for decoctions, why would this not be important in granulars?? The only reason I can think of that kaptuck’s lackadaisical approach works is 1) he is dealing with complete formulas, and not having to custom make herb rx’s for his patients. 2) as we have hypothesized those extracts are at a considerable lower dose that decoctions – which is creating a whole new style of practice – maybe best liked to energetics, although I cannot imagine that a pharmacological change cannot be measured from even taken these. I guess we can never know, but for serious acute situations, I.e. pneumonia, or a sinus infection, or appendicitis, - I personally think dose is of the utmost important and would not even consider using the other mentioned alternatives, especially with such an imprecise attitude. This might be fine for someone who has chronic g.i. problems and you can play around till you get it right, but dosages have been established in Chinese history for a reason, precisely so we don’t have to play around. And this is Numbers. - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2003 Report Share Posted February 23, 2003 , " " wrote: > How many times just shifting an herb from 3 to 6 grams, completely > changes the action or the direction of the Rx. And of course, this is usually in relation to decoctions. >>> Jason: I have found this to be the case when working with concentrates too. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2003 Report Share Posted February 23, 2003 I strongly support the millennia old technique of proportions in preparing raw herb formulas. So I support your comments here. Dry dosage was invented as a factory technology several decades ago. They got chemistry departments in the 1980s and then became GMP companies. This is new. As a biochemist who worked in such a factory, I plead ignorance regarding your specific questions and gave you my best perspective. I don't know how to add dry dosage singles to dry dosage formulas in the clinical setting. I've seen it done in the hospital pharmacy, and no one got in a sweat about it. They certainly didn't ask for the help of a chemist. They based it on a hunch, not unlike Ted Kaptchuk, and went forward. My commentary was to suggest that you are not dealing with pharmaceutical ingredients that have a pharmacological effect. You are the generation of practitioners that will determine how to combine dry dosages from your clinical experience and outcomes. That's why I suggested you ask a clinician inside the company that you buy from. He or she will have had enough experience working with the dry dosage to have seen clinical outcomes one way or the other. They will be familiar with hospital pharmacy standards. On your behalf I will start exactly such an inquiry. I'll keep notes, and I'll get back to you. Who ever else wants to join the inquiry and add their notes, then feel free to join up. Fair enough? Emmanuel Segmen - James Ramholz <jramholz Sunday, February 23, 2003 12:35 PM Re: dosage comparisons , "" wrote:> How many times just shifting an herb from 3 to 6 grams, completely> changes the action or the direction of the Rx. And of course, this is usually in relation to decoctions. >>>Jason:I have found this to be the case when working with concentrates too.Jim RamholzChinese 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2003 Report Share Posted February 23, 2003 Greetings, I have only been able to skim through some of these postings of late but wanted to add a couple of cents to the discussion. I appreciate Emannuel’s interesting and knowledge and experience in the discussions. I think Todd’s questions regarding equivalence are important to both clinicians and researchers. My years of experience indicate that the varying qualities imparted by different processing methods definitely influence the degree to which it causes a physiological effect. I also support the use of chemical analysis as an additional factor with which to compare the quality of different plants and extracts. In one research project, which we have now repeated certain portions of on over 40 herbs, we evaluated the level of a single phytochemical in a Chinese herb every two weeks during an 8 week period leading up to what was traditionally considered the optimal time for harvesting that plant. The marker we chose showed statistically significant increases at every two week interval and peaked at the chosen harvest time. We then took samples of that plant from 5 different growing areas, at the same time relative to harvest, and compared the level of that same phytochemical as an additional way of comparing the richness of the same plant growing in different areas. Next we undertook extraction processing research to determine the optimal amount of time, the number of extractions, the solvent percentages (i.e. etoh+h2o in varying percentages), and found a statistically significant difference in the amount of the phytochemical marker, as well as notable differences in the yield ratio, the transfer rate, and the organoleptic characteristics of the extract resulting from the various approaches. I personally feel that if you removed the alcohol from 1oz tincture bottles of many herbs that the remaining materials would often seem like a very small amount of product. If it were really concentrated in a liquid form you would often have something very thick. Stephen Morrissey Emmanuel Segmen [susegmen] Sunday, February 23, 2003 3:29 PM To: Re: Re: dosage comparisons I strongly support the millennia old technique of proportions in preparing raw herb formulas. So I support your comments here. Dry dosage was invented as a factory technology several decades ago. They got chemistry departments in the 1980s and then became GMP companies. This is new. As a biochemist who worked in such a factory, I plead ignorance regarding your specific questions and gave you my best perspective. I don't know how to add dry dosage singles to dry dosage formulas in the clinical setting. I've seen it done in the hospital pharmacy, and no one got in a sweat about it. They certainly didn't ask for the help of a chemist. They based it on a hunch, not unlike Ted Kaptchuk, and went forward. My commentary was to suggest that you are not dealing with pharmaceutical ingredients that have a pharmacological effect. You are the generation of practitioners that will determine how to combine dry dosages from your clinical experience and outcomes. That's why I suggested you ask a clinician inside the company that you buy from. He or she will have had enough experience working with the dry dosage to have seen clinical outcomes one way or the other. They will be familiar with hospital pharmacy standards. On your behalf I will start exactly such an inquiry. I'll keep notes, and I'll get back to you. Who ever else wants to join the inquiry and add their notes, then feel free to join up. Fair enough? Emmanuel Segmen - James Ramholz <jramholz Sunday, February 23, 2003 12:35 PM Subject: Re: dosage comparisons , " " wrote: > How many times just shifting an herb from 3 to 6 grams, completely > changes the action or the direction of the Rx. And of course, this is usually in relation to decoctions. >>> Jason: I have found this to be the case when working with concentrates too. Jim Ramholz The Chinese Herb Academy, 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. Your use of is subject to the Terms of Service. 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. Your use of is subject to the Terms of Service. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2003 Report Share Posted February 23, 2003 Stephen, You're doing the good work that may bring about the marriage of Western science empiricism with Chinese medical empiricism. Congratulations. I'm sure that you and your colleague Professor Tan Yuyuan could comment knowledgeably on Todd's more specific questions regarding dry dosage single herb additions to dry dosage and liquid dosage formulas. I apologize for my insistence on addressing a subtext of Todd's question. Many have written off list to me directly to indicate that my answer either helped them or was the one they already had in mind. However, lest I be considered lackadaisical, I will endeavor to find more authoritative answers to directly address the numerical aspects of Todd's question. Perhaps you and Dr. Tan can present your views on this. Meanwhile, it's my firm belief from observing this discussion group, that Todd is one of the least lackadaisical of people and is a man of discipline and equanimity. I bow deeply to Todd for his efforts to moderate this group. :-) Emmanuel Segmen - Stephen Morrissey Sunday, February 23, 2003 5:35 PM RE: Re: dosage comparisons Greetings, I have only been able to skim through some of these postings of late but wanted to add a couple of cents to the discussion. I appreciate Emannuel’s interesting and knowledge and experience in the discussions. I think Todd’s questions regarding equivalence are important to both clinicians and researchers. My years of experience indicate that the varying qualities imparted by different processing methods definitely influence the degree to which it causes a physiological effect. I also support the use of chemical analysis as an additional factor with which to compare the quality of different plants and extracts. In one research project, which we have now repeated certain portions of on over 40 herbs, we evaluated the level of a single phytochemical in a Chinese herb every two weeks during an 8 week period leading up to what was traditionally considered the optimal time for harvesting that plant. The marker we chose showed statistically significant increases at every two week interval and peaked at the chosen harvest time. We then took samples of that plant from 5 different growing areas, at the same time relative to harvest, and compared the level of that same phytochemical as an additional way of comparing the richness of the same plant growing in different areas. Next we undertook extraction processing research to determine the optimal amount of time, the number of extractions, the solvent percentages (i.e. etoh+h2o in varying percentages), and found a statistically significant difference in the amount of the phytochemical marker, as well as notable differences in the yield ratio, the transfer rate, and the organoleptic characteristics of the extract resulting from the various approaches. I personally feel that if you removed the alcohol from 1oz tincture bottles of many herbs that the remaining materials would often seem like a very small amount of product. If it were really concentrated in a liquid form you would often have something very thick. Stephen Morrissey Emmanuel Segmen [susegmen] Sunday, February 23, 2003 3:29 PM Subject: Re: Re: dosage comparisons I strongly support the millennia old technique of proportions in preparing raw herb formulas. So I support your comments here. Dry dosage was invented as a factory technology several decades ago. They got chemistry departments in the 1980s and then became GMP companies. This is new. As a biochemist who worked in such a factory, I plead ignorance regarding your specific questions and gave you my best perspective. I don't know how to add dry dosage singles to dry dosage formulas in the clinical setting. I've seen it done in the hospital pharmacy, and no one got in a sweat about it. They certainly didn't ask for the help of a chemist. They based it on a hunch, not unlike Ted Kaptchuk, and went forward. My commentary was to suggest that you are not dealing with pharmaceutical ingredients that have a pharmacological effect. You are the generation of practitioners that will determine how to combine dry dosages from your clinical experience and outcomes. That's why I suggested you ask a clinician inside the company that you buy from. He or she will have had enough experience working with the dry dosage to have seen clinical outcomes one way or the other. They will be familiar with hospital pharmacy standards. On your behalf I will start exactly such an inquiry. I'll keep notes, and I'll get back to you. Who ever else wants to join the inquiry and add their notes, then feel free to join up. Fair enough? Emmanuel Segmen - James Ramholz <jramholz Sunday, February 23, 2003 12:35 PM Re: dosage comparisons , "" wrote:> How many times just shifting an herb from 3 to 6 grams, completely> changes the action or the direction of the Rx. And of course, this is usually in relation to decoctions. >>>Jason:I have found this to be the case when working with concentrates too.Jim RamholzChinese 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2003 Report Share Posted February 24, 2003 When people (usually Chinese) do not use scales it is usually because they are so good at estimating the dosage that it is just not necessary. >>>Correct Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2003 Report Share Posted February 24, 2003 1) he is dealing with complete formulas, and not having to custom make herb rx’s for his patients. 2) as we have hypothesized those extracts are at a considerable lower dose that decoctions – which is creating a whole new style of practice – maybe best liked to energetics, although I cannot imagine that a pharmacological change cannot be measured from even taken these. >>>How about he thinks its mostly placebo anyway since he is into placebo medicine. alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2003 Report Share Posted February 24, 2003 Emmanuel , " Emmanuel Segmen " < susegmen@i...> wrote: > My last comment might bear rereading for one thing that I will now emphasize: physiology versus pharmacology. Interesting discussion. I guess what I have been calling pharmacological is actually physiological since my interest is in the physiological changes that occur from herbs that can be measured in either the language of symptoms/ signs or lab tests. Either way, all we know day to day is that physiology has changed, not how or whether that was accomplished pharmacologically. So we can know that herbs have measurable physiological effects, such as lowering blood pressure in our patients. We just can't say that this was done by beta-blocking. Am I following you here? However, I agree with Jason that dosage is crucial and was very much emphasized by all my teachers. And if herbology is dose dependent, what is increasing when dose goes up? It must be the amount of constituents. If quantity is a factor in clinical efficacy, then something substantial that can be quantified must be present in the herbs and that something must have different effects in the bloodstream depending on concentration. What other mechanism are you suggesting for how herbs alter physiology in a dose dependent fashion? that herbs work by resonance. if that is the case, then is increasing dose more akin to turning up the volume or frequency then actually increasing quantity? I think that is an interesting idea, but it still means I must be able to determine the relative volume of different forms of herbs. Experimentation with novel forms of herbs on my patients does not satisfy me. I still think measuring marker constituents is the way to calibrate these different volumes. I would even offer that while we often speak of constituents as if they are stuff like rocks or trees, we could just as easily speak of them as if they were vibrations and energy. Molecules of nuclei held together by invisible forces with electrons spinning around them, bound together by electrical charges. why is that stuff? we don't actually SEE these biochemicals themselves. all we know of them is based upon observing their effects and the predictive power of the laws of chemistry. is this really different from qi? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2003 Report Share Posted February 24, 2003 Hi Todd and Jason, As indicated I do honor and respect properly proportioned formulations. They are in themselves like a new entity or herb. They need to be cooked together to meet the criteria of Chinese medical history. I'm scratching my head about building a formula from scratch with just dry dosage singles. The people at Min Tong, Taibo (in Lanzhou) and other such factories would not approve of such procedures. I can understand adding a dry dosage single to a dry dosage formula for a patient who won't cook their herbs. I'm getting feedback now that you would need to add the same proportion of dry dosage single to the formula that you would if you were building the formula from scratch. That goes for Mu Li as well as Bai Shao. Tai Bo and Min Tong extracts the singles as they would the formulas. I'm only at the beginning of my inquiries so I'll have more to report. Regarding adding dry dosage to liquid dosage or how they relate quantitatively, I haven't gotten feedback on that yet. Regarding Ted Kaptchuk's "attitude", there seems to be some disrespect out there. I can go to that place with regard to any of you or any one we discuss off list. I have a lot of respect for all of you. Regarding the rest of your question, there are admittedly some "pharmacological" actions from the herbs, but they are supposed to be mitigated or blocked by the properly proportioned formulation. The observations I have from reading research, seeing clinical outcomes and being taught (and sometimes scolded) by those of merit that I've studied is that Chinese herbal medicine is like delivering nutrients. It indirectly gets the body to do things. I don't want to call it energetics, but you can if you want to. I would like to be able to speak easily in a physiology classroom about what to me is clear to me when I look at it. If you get adequate nutrients, then you get to have the physiological functions that are normal for you. A normal response to infection is building an immune response with antibodies and T killer cells. That's the Western view. In this view we all have cancer right now in small amounts. Our T cytotoxic cells are in sufficient numbers to lyse many cancer cells per second. As long as our immune function works well and we are otherwise in balance, then a little bit of cancer is okay. We're evolved to have cancer and infections and other minor imbalances and injuries and come back into balance. So I'm suggesting that Western medicine would give prednisone for acute allergic responses like advanced poison oak or really nasty iritis of the eye. I've had functional (non-infective) iritis in the past several times. The formula devised by Dr. Kang brought it to a close in about 10 days on the second and third occasions. That was a couple of months faster than ophthalmologists had anticipated, and that I had experienced on the first occasion. The Chinese herbal formula balanced the local inflammatory reaction going on in my eye's ciliary body and iris. It did it faster than intervening with an adrenal cortex hormone which was what the doctors were wanting to deliver to the eye. In fact that's what my body did. The Chinese herbal formula caused the body to deliver in a far more effective manner what the Western doctors where going to administer. I will not pretend to know the mechanism of this. I only know with some certainty that the formula did not contain steroids. Nor was it delivered locally, but rather it was ingested. From what I've read (and I've taught college nutrition) is that we know so very little of all of the molecules that we could call "nutrients". I'm suggesting that the phytochemicals of Chinese herbal formulas are also "nutrients" that can act to bring about homeostatic processes. The further point is that it is not "forced" by quantities or amplitudes. What does not mean you can't overeat food or overdose with the formula and have serious imbalances as a consequence. I'm suggesting that the actions of the formulas are more like food nutrients, and it would be wise to measure them as such. To that end I will continue my inquiries into dosaging. I believe we fail our undergraduate students in physiology if we don't teach the difference between pharmacological effect and physiological effect as a basic tenet of that science. Researchers that I know and read all respect that issue. When we don't teach it properly in undergraduate school, we have problems communicating about it later. Todd and Jason, I have to run here. I'll try to address this again a bit better. I just noticed your second post, Todd. Yes, you've got my drift. Emmanuel Segmen - < Monday, February 24, 2003 9:30 AM Re: dosage comparisons Emmanuel , "Emmanuel Segmen" <susegmen@i...> wrote:> My last comment might bear rereading for one thing that I will now emphasize: physiology versus pharmacology. Interesting discussion. I guess what I have been calling pharmacological is actually physiological since my interest is in the physiological changes that occur from herbs that can be measured in either the language of symptoms/signs or lab tests. Either way, all we know day to day is that physiology has changed, not how or whether that was accomplished pharmacologically. So we can know that herbs have measurable physiological effects, such as lowering blood pressure in our patients. We just can't say that this was done by beta-blocking. Am I following you here? However, I agree with Jason that dosage is crucial and was very much emphasized by all my teachers. And if herbology is dose dependent, what is increasing when dose goes up? It must be the amount of constituents. If quantity is a factor in clinical efficacy, then something substantial that can be quantified must be present in the herbs and that something must have different effects in the bloodstream depending on concentration. What other mechanism are you suggesting for how herbs alter physiology in a dose dependent fashion? that herbs work by resonance. if that is the case, then is increasing dose more akin to turning up the volume or frequency then actually increasing quantity? I think that is an interesting idea, but it still means I must be able to determine the relative volume of different forms of herbs. Experimentation with novel forms of herbs on my patients does not satisfy me. I still think measuring marker constituents is the way to calibrate these different volumes. I would even offer that while we often speak of constituents as if they are stuff like rocks or trees, we could just as easily speak of them as if they were vibrations and energy. Molecules of nuclei held together by invisible forces with electrons spinning around them, bound together by electrical charges. why is that stuff? we don't actually SEE these biochemicals themselves. all we know of them is based upon observing their effects and the predictive power of the laws of chemistry. is this really different from qi?ToddToddChinese 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2003 Report Share Posted February 24, 2003 Emmanuel, I have been enjoying your posts. Your insights on the dynamics of complex herbal prescriptions is profound, and matches my experience. Question: isn't the difference between pharmacological effect and physiological effect the same as the difference between pharmacodynamics and pharmacokinetics? This is how it is expressed by Simon Mills in his excellent text, " The Principles and Practice of Phytotherapy " , a text we are requiring parts of in the PCOM herb program. On Monday, February 24, 2003, at 11:09 AM, Emmanuel Segmen wrote: 1) The observations I have from reading research, seeing clinical outcomes and being taught (and sometimes scolded) by those of merit that I've studied is that Chinese herbal medicine is like delivering nutrients. It indirectly gets the body to do things. > 2) To that end I will continue my inquiries into dosaging. I > believe we fail our undergraduate students in physiology if we don't > teach the difference between pharmacological effect and physiological > effect as a basic tenet of that science. Researchers that I know and > read all respect that issue. When we don't teach it properly in > undergraduate school, we have problems communicating about it later. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2003 Report Share Posted February 24, 2003 Emmanuel, While I agree with you in principle, and generally work the way you describe with herbal medicines, I am wondering about your view with such issues as acute infections or inflammation. For example, when we use such prescriptions as huang lian jie du tang for repletion fire in all three burners. I would think that clearing internal repletion fire would require somewhat of a 'pharmacological' dosage. Or, again, are we using bitter cold medicinals to stimulate physiological processes? On Saturday, February 22, 2003, at 08:40 PM, Emmanuel Segmen wrote: > Over the centuries the combining principles for herbal formulas are in > part supposed to mask any possible pharmacological side effect and to > emphasize the intended physiological effect. > If I were you, I would not sweat the level or comparative > concentrations. I would make very sure that I was getting the > physiological effect I wanted. Which means you could treat formulas > like food. Double the dosage if you are not getting the effect you > want. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2003 Report Share Posted February 24, 2003 some "pharmacological" actions from the herbs, but they are supposed to be mitigated or blocked by the properly proportioned formulation. >>>That does not make any sense. Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2003 Report Share Posted February 24, 2003 The Chinese herbal formula balanced the local inflammatory reaction going on in my eye's ciliary body and iris. It did it faster than intervening with an adrenal cortex hormone which was what the doctors were wanting to deliver to the eye. In fact that's what my body did. >>>Why do you say that? Maybe that is what the herbs did for, and with your body. such as drugs do? Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2003 Report Share Posted February 24, 2003 Hi Z'ev and all, Let me first correct a typo in my last post. I can't go to a place of disrespect with any of you. I feel enormous respect for all of you. Secondly, I'm not sure I'm going to be able to keep up with the number of postings on this subject, but it won't be for lack of trying. Mark Twain once wrote at the end of a long letter, "I would have written less, but I didn't have time." It's hard to write succinctly about such fundamental issues. The questions that are being asked here could easily generate entire textbooks. Really fabulous questions. Please note further than I'm a biochemist who went to medical school then on to graduate school in several areas: physiology, immunology and molecular biology. I'm trying hard to keep up with your thorough knowledge of Chinese medicine. Z'ev, I haven't read Simon Mills, so I can't answer specifically. Your second posting regarding "repletion fire in all three burners" I believe addresses the point pretty clearly. I'm sitting with my friend and practitioner Shereen Kanehisa discussing this point. My subtexts were more than one. One is really allopathic medicine (pharmacological effect) as compared with Chinese medicine (physiological effect). The formula you described works by physiological effect in my opinion. Dr. Kang's formula for my iritis (from a previous post) functioned by physiological effect. In that case, the allopathic doctors were attempting to introduce the chemical that they thought (in some ways correctly) was missing (cortisol) in order to remedy the inflammation in my eyes. Do you see the difference here? One is more subtle and actually far more powerful a medicine, while the other is gross and disruptive. Kind of like a martial arts master using little energy to accomplish much as compared to a beginner using great force to accomplish less. Dr. Kang got my internal physiology to deliver beautifully titered doses of my own cortisol with all of the necessary coenzymes (like Vitamin C derived from my adrenal cortex) to treat the imbalance at a distant location (my eyes) and induce recovery in less than one sixth the time that the allopaths were expecting. My strongest point in all of this is that in allopathy, the clinician is performing the dosaging. In Chinese medicine, the clinician is inducing the human physiology to perform the dosaging. I can't imagine a physiologist who would not see the profound beauty in this. A further subtext of this discussion is the power of the medicine. I personally find the power of Dr. Kang's formula to be immeasurably greater than the medicine of allopathic tradition even though the allopaths were delivering pharmacologically effective chemicals directly to the affected tissues. Or were they? Was that their precise problem? Do you suppose they completely overlooked the homeostasis of the tissues and the systems? When I teach negative feedback homeostasis, I present Lyle Alzado from the cover of Sports Illustrated saying dejectedly, "I lied". That was awhile back, and you might not recall that magazine cover. Lyle Alzado used anabolic steroids ... and he significantly lost the very tissues in his own body that supply homeostatic doses of this biochemical. In negative feedback homeostasis, testosterone or estrogen from the gonads would turn off pituitary output of LH and FSH when normal blood concentrations are reached. By introducing the molecules from the outside, you not only turn off the pituitary output of LH and FSH, you also cause atrophy (chemical castration) of the gonad's secretory tissues (after a period of time). The introduction exogenously (from the outside) of any molecule in a human biosynthetic pathway will completely unhinge (turn off) that pathway. It will ruin the homeostasis. So "nutrients" are not pharmacological in this disruptive way. They support the homeostasis and may be coenzymes in the homeostasis, or otherwise strengthen self-regulation. Nutrients delivered from Chinese medicine are quite powerful, yet not disruptive. In general, you also don't take a hypodermic syringe and deliver them to a local tissue or to the blood. Though external applications to local areas are common. As of 1994 when I studied a lot of research on Chinese medicine regarding phytochemicals (their "nutrients"), very little bioassay had been done. We still don't know how ginsenosides work. We also don't know why the leaf has more than the root, yet the root is the medicinally effective part. Most research uses the whole herbal broth in human clinical trials. I've seen some whole broth used in tissue culture experiments and with animal experiments. Merck and other pharmaceutical companies have derived molecules. But they use these in allopathic treatment protocols and not as intended in Chinese medicine. Chinese medicine is profoundly powerful in it's ability to get the body's physiology to increase, decrease or otherwise regulate it's own dosaging in minute and complex ways. Pharmacological effects in Chinese medicine are sometimes noted as well as intended, but that's really quite rare and limited to things like the acute treatment of cancer. Mostly I note that Chinese medicine works in more subtle and far more powerful ways than pharmaceutical drugs. I find that both ironic as well as quite beautiful. Again, please forgive the length of my discussion. In Gratitude, Emmanuel Segmen - Monday, February 24, 2003 11:22 AM Re: Re: dosage comparisons Emmanuel, I have been enjoying your posts. Your insights on the dynamics of complex herbal prescriptions is profound, and matches my experience.Question: isn't the difference between pharmacological effect and physiological effect the same as the difference between pharmacodynamics and pharmacokinetics? This is how it is expressed by Simon Mills in his excellent text, "The Principles and Practice of Phytotherapy", a text we are requiring parts of in the PCOM herb program. On Monday, February 24, 2003, at 11:09 AM, Emmanuel Segmen wrote:1) The observations I have from reading research, seeing clinical outcomes and being taught (and sometimes scolded) by those of merit that I've studied is that Chinese herbal medicine is like delivering nutrients. It indirectly gets the body to do things. 2) To that end I will continue my inquiries into dosaging. I believe we fail our undergraduate students in physiology if we don't teach the difference between pharmacological effect and physiological effect as a basic tenet of that science. Researchers that I know and read all respect that issue. When we don't teach it properly in undergraduate school, we have problems communicating about it later. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2003 Report Share Posted February 24, 2003 the allopathic doctors were attempting to introduce the chemical that they thought (in some ways correctly) was missing (cortisol) in order to remedy the inflammation in my eyes. >>> that is not a correct way at looking at steroid therapy. It is not about supplentation but about suppressing an activity i.e. inflammation in your case. Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2003 Report Share Posted February 24, 2003 It will ruin the homeostasis. So "nutrients" are not pharmacological in this disruptive way. They support the homeostasis and may be coenzymes in the homeostasis, or otherwise strengthen self-regulation. Nutrients delivered from Chinese medicine are quite powerful, yet not disruptive. In general, you also don't take a hypodermic syringe and deliver them to a local tissue or to the blood. Though external applications to local areas are common. So "nutrients" are not pharmacological in this disruptive way >>So why does gan cao do it? it can shut down the pathway and cause the same side-effects as other steroids. Are going to la la land here? While these concepts sound very comforting they do not agree with the science of herbal medicine. Pharmacological effects are evident and can be demonstrated in both animals and humans. We use pharmacological effects when we design formulas all the time. Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2003 Report Share Posted February 24, 2003 While these concepts sound very comforting they do not agree with the science of herbal medicine. Pharmacological effects are evident and can be demonstrated in both animals and humans. We use pharmacological effects when we design formulas all the time. Alon Right Alon, I'm only referencing my areas of Western science and appreciating the view of Chinese medicine from where I stand. You and your colleagues can tell me far more about the view from Chinese medicine. Please proceed. With all due respect, Emmanuel SegmenChinese 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2003 Report Share Posted February 24, 2003 I would even offer that while we often speak of constituents as if they are stuff like rocks or trees, we could just as easily speak of them as if they were vibrations and energy. Molecules of nuclei held together by invisible forces with electrons spinning around them, bound together by electrical charges. why is that stuff? we don't actually SEE these biochemicals themselves. all we know of them is based upon observing their effects and the predictive power of the laws of chemistry. is this really different from qi?Todd This works for me. As long as you can keep it organized. I'd prefer to write and speak in poetry. My friends in the art community are wondering why I slipped off into the sciences in 1981. I speak in biochemistry and physiology as languages not unlike English and Chinese. It's just a language. I'm told that in medical school we increase our vocabulary by 25,000 words. You become fluent in a new language after about 5,000 words. I don't take chemistry to have predictive powers. To me it's a statement of suchness like any other science. I appreciate chemistry to keep me straight regarding orders of magnitude. So I don't get too crazy worrying about something that's got safety when used by the gram as compared to something that's dangerous at one thousandth or millionth the dosage. Teaching nutrition after having taught chemistry put an edge on this detail. Then teaching anatomy and physiology helped me see this in the light of homeostasis. I really do love Chinese medicine despite the fact that I speak in the language of biochem and physio when speaking of it. Yes, I like your use of Qi. I'd also toss in the Taoist precepts of Balance, Synchronicity and add on the uninhibited flow of Qi. Thank you for your insights. Emmanuel SegmenChinese 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2003 Report Share Posted February 25, 2003 > However, I agree with Jason that dosage is crucial and was very much > emphasized by all my teachers. And if herbology is dose dependent, what is > increasing when dose goes up? It must be the amount of constituents. If > quantity is a factor in clinical efficacy, then something substantial that can be > quantified must be present in the herbs and that something must have > different effects in the bloodstream depending on concentration. Friday I happened to do an on-line literature search on Xiao Chai Hu Tang. It is interesting how much research has been done (mostly in Japan) on various constituents of that formula and how the physiological effects of those constituents is dose dependent. A number of studies found differing effects from a single constituent or from the Rx as a whole at different dosage concentrations. Bob Quote Link to comment Share on other sites More sharing options...
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