San qi and bleeding

[Guest guest]

Ok, I'll address this.

 

I don't remember if Todd posted the whole article- but there was more than

one-

http://pulsemed.org/yunnan-baiyao-chinese-patent-medicine.htm

and

http://pulsemed.org/ynbyps2.htm

 

If you read them, then you'll be able to respond to what I actually wrote.

This is the advantage of providing a hyperlink to the original text. To

their disservice, my writings have been taken partially and out of context

before.

 

I also am a 'fan' of YNBY, but only for post-surgical use. I would not

recommend it pre-surgery not because of what we DO know, but rather because

of the questions we have not answered, because of what we DO NOT know.

 

> So Brian's information is not

> definite... Where did he get his info?

 

Nowhere in those articles did I claim to have the ultimate truth about this

issue. I did interview a number of practitioners, however, since I couldn't

find any sources for this. I only see 6 studies on MEDLINE, mostly on the

constituents and not on clinical usage... and one on a contact dermatitis

reaction to it.

 

The quote from McLean's book:

> For now, I have Maclean's " Chinese Herbal Patent Medicines " book at hand

so

> I will quote the relevant section from it for you.........

>

> Under " Indications " section....

>

> " * Pre-surgical preparation to reduce keloid scarring and improve

> postoperative recovery "

 

In response to this, Jim (Ramholz) brought up a point that we covered in the

above linked articles:

 

> Doesn't this bring up an ethical question about whether we *should*

> prescribe something that a doctor will not be aware of, and which

> may have an influence, on the surgical procedure he does---

> especially when we have no direct communication with him?

>

> Practically speaking, it happens all the time and in a small percent

> of cases has created adverse consequences. In recent years, I've

> told my patients to stop taking herbs and supplements about a week

> before a procedure so that everything that happens during it will be

> a consequence of the doctor's understanding and control. It seems

> only fair that they see the results of their work and deal with any

> complications unencumbered.

 

In the second article, Bob Damone is quoted:

" There have been some unusual cases of unexplained bleeding that docs are

wondering about herb interactions on- particularly ginseng (has been shown

to have anticoag effects), but also Vitamin E. Who knows, but I usually

play it safe myself. "

 

Also in the second article, Francis Butler says, " Any one who is up on

their modern Chinese research will know that the concomitant use of herbs

that deal with blood stasis and drugs like blood thinners is potentially

dangerous. In my opinion, you are correct, stopping the use of all

supplements (herbal and otherwise) five days before the surgery is prudent.

How soon to restart depends on the kind of operation. I have treated many

patients with this kind of methodology and have always had good results. I

would be hard pressed to believe that doing treatment right up until the

surgery would produce better results. The minuscule theoretical benefit does

not out weigh the not insignificant risk. Do you remember the first rule? Do

no harm. "

 

The key fact is that we do not know if YNBY interacts with

medicines/anesthesia used during surgery, or if it creates situations that

are unfamiliar for the surgeons. If YNBY has a hemodynamic effect unlike

any known drugs, then we do not know its biochemical mechanism, and how it

interacts with other drugs. Any surgery carries some risk of harm or death,

so I think it would be wise for us to play it safe until we know more.

 

Anecdotal reports of successful use in patients don't tell us much. If you

had advised a pt to take it, and there were complications during the

surgery, would you be passing that on to the group? Plus, there are pts who

take it without the knowledge of a practitioner. More than half of

alternative med use in the U.S. is without the advice of any practitioner.

 

I would like to know what McLean's sources were. I don't have that book.

Was this from Chinese scientific studies, or from anecdotal use, or what?

and Jason have asked what my sources were... they were other

practitioners, the Fratkin book, and the rest of speculation and didn't

claim to be any more than that.

 

This is a perfect example of what medicine really is- making the best

decisions for real patients based on partial information.

 

Of course, I'd be all ears to hear any new info on this topic.

 

B

 

 

 

Brian Benjamin Carter, M.Sci., L.Ac.

http://www.pulsemed.org/briancarterbio.htm

Acupuncturist & Herbalist

Editor, The Pulse of Oriental Medicine

Columnist, Acupuncture Today

(619) 208-1432 San Diego

(866) 206-9069 x 5284 Tollfree Voicemail

 

The PULSE of Oriental Medicine

http://www.pulsemed.org/

The General Public's Guide to Chinese

Medicine since 1999... 9 Experts,

240+ Articles, 195,000+ readers....

 

Our free e-zine BEING WELL keeps you

up to date Sign up NOW. Send a blank email to:

beingwellnewsletter-

 

[Guest guest]

I agree, discourse is good- and so are opinions

that people disagree with, for that very reason.

 

Sorry for jumping in on the discussion late- if I hit on something already

covered, just slap me on the back of my head.

 

> I disagreed with your more general speculation that YNBY might cause

strokes

> and your suggestion that it was more appropriate for stopping bleeding

than

> moving stasis. However my words were also opinion, just counter to yours,

> with no greater weight. They were not meant to be construed as a

correction.

 

A few years ago, a skeptical MD jumped on one of my shoulders- since then, I

am less likely to give the benefit of the doubt to speculative thought along

Chinese medicine lines.

 

As I said before, if an agent is capable of clotting, AND thinning, then it

has multiple effects on the blood- and not just more than one at once, but

the capability to in one circumstance produce more clotting, and in another

circumstance produce more thinning. As the joke goes about the thermos,

" how does it know? " Someone else wrote to me months ago about that article,

sugesting that YNBY had its own intelligence- that it could figure out

whether to clot or not to clot. I think that would be great, but find it

hard to believe. I'd imagine there'd be a fascinating explanation for

" intelligent hemodynamics. " It's not all that far-fetched, really, if the

herbs' actions are activated based on different levels of various blood

constituents.

 

I'm just not aware of any scientific info that would help resolve this.

 

The first step would be to prove that it has that behavior. I've seen it

stop bleeding, but I have not seen or heard proof of blood thinning. People

have quoted anecdote about it causing healing that amazed the surgeon... I

don't know that that's evidence of blood thinning. It may be evidence of

blood moving... whether blood moving and blood thinning are equal

categories, or if they'd require a venn diagram is another discussion.

Perhaps Emmanuel has some ideas. I'd bet they overlap and require a venn.

 

B

 

 

 

Brian Benjamin Carter, M.Sci., L.Ac.

http://www.pulsemed.org/briancarterbio.htm

Acupuncturist & Herbalist

Editor, The Pulse of Oriental Medicine

Columnist, Acupuncture Today

(619) 208-1432 San Diego

(866) 206-9069 x 5284 Tollfree Voicemail

 

The PULSE of Oriental Medicine

http://www.pulsemed.org/

The General Public's Guide to Chinese

Medicine since 1999... 9 Experts,

240+ Articles, 195,000+ readers....

 

Our free e-zine BEING WELL keeps you

up to date Sign up NOW. Send a blank email to:

beingwellnewsletter-

 

[Guest guest]

> Brian said:

> As I said before, if an agent is capable of clotting, AND thinning,

then it

> has multiple effects on the blood- and not just more than one at

once, but

> the capability to in one circumstance produce more clotting, and in

another

> circumstance produce more thinning. As the joke goes about the

thermos,

> " how does it know? " Someone else wrote to me months ago about that

article,

> sugesting that YNBY had its own intelligence- that it could figure

out

> whether to clot or not to clot.

 

Brian and others,

 

Sorry, a little behind on MSG.'s… I wonder if reducing Chinese

medicine's understanding of 'stop bleeding' and 'moving blood'

SHOULD be completely reduced to just blood thinning or clotting.

Brian stated that YNBY is a strong coagulate… Do we know this for

sure? And HOW? I am not sure...

 

Granted it is unclear what exactly YNBY or SanQi are doing from a

western perspective, but if we make a TCM DX, then we have a greater

ability to predict what the effects are going to be. AS far as

playing it safe and not taking ANY herbs before surgery goes, that is

fine. This makes sense... But why single out YNBY?

Furthermore the article states, " So, post-op herbal programs may

include blood moving as well as re-strengthening the body and immune

system. However, it is unlikely that yunnan bai yao would be part of

even that program. "

 

WHy Not?

 

Also stated is the argument : " But has that been validated

scientifically? " Should we start putting all our herbal medicine to

this test! What does scientific mean and how do we test our herbal

Rxs. Has BZYQT been proven to help .... (fill in the blank) Butler

makes the argument that ma haung has been used for years for weight

loss , does this mean it is good? This is totally mixing apples and

oranges... i.e. this use is not traditional (meaning applying a TCM

DX)-. etc...

 

My original inquiry of sources was surrounding the claim, " It

actually would make you more likely to have clots and a stroke than

to prevent it. " - which I did not understand... Brian also stated,

 

" In all my training, I have never heard any Traditional Chinese

Medicine (TCM) doctor recommend this formula pre surgery. "

I found this puzzling, since your article definitely quotes Damone

saying that it HAS been used that way for a LONG time... which means

it still is being used that way.. Mclean also supports this, ... So

my take is this... It is not a crazy thing to consider and the door

should not be shut on pre or post use. TCM DX should be applied and

further information (prob in Chinese) should be gathered.. But of

course your point about playing it safe is important, especially hear

in the WEST (at least for PRE-OP) - But again that applies to all

herbs not just YNBY.

 

-

[Guest guest]

, " " wrote:

> Sorry, a little behind on MSG.'s… I wonder if reducing Chinese

> medicine's understanding of 'stop bleeding' and 'moving blood'

> SHOULD be completely reduced to just blood thinning or clotting.

> Brian stated that YNBY is a strong coagulate… Do we know this for

> sure? And HOW? I am not sure... >>>

 

 

Jason:

 

" The Pharmacology of Chinese Herbs " (CRC Press, 1999, 2e) by Kee

Chang Huang states (p.102) that San qi " has a direct effect on blood

as well. It can also accelerate blood clotting time and increase the

probability of blood coagulation. "

 

 

Jim Ramholz

[Guest guest]

This is starting to feel like some kind of congressional inquiry by members

of the opposing party. But perhaps that's how some of you normally operate.

Ok, I think my skin is thick enough to take it. ;-)

 

said:

> I wonder if reducing Chinese

> medicine's understanding of 'stop bleeding' and 'moving blood'

> SHOULD be completely reduced to just blood thinning or clotting.

 

I don't think we can completely reduce those CM treatment principles/actions

to those WM actions- as with most things, there is probably a venn diagram.

 

> Brian stated that YNBY is a strong coagulate. Do we know this for

> sure? And HOW? I am not sure...

 

Jim just answered this one (see below)- Yes we know this for sure. How? I

don't know.

 

> AS far as

> playing it safe and not taking ANY herbs before surgery goes, that is

> fine. This makes sense... But why single out YNBY?

 

It's not singled out. This all came from a question about that product.

I'd apply the same caution to any blood

mover or hemostatic. YNBY just happened to be the formula under discussion.

 

> Furthermore the article states, " So, post-op herbal programs may

> include blood moving as well as re-strengthening the body and immune

> system. However, it is unlikely that yunnan bai yao would be part of

> even that program. "

>

> WHy Not?

 

Well, now that I've heard from about 20 more practitioners, I'll have to

change that to say that many DO include it in their post-op program. I'd

never heard that before. We never studied the McLean book- we had

Fratkin's.

 

> Also stated is the argument : " But has that been validated

> scientifically? " Should we start putting all our herbal medicine to

> this test! What does scientific mean and how do we test our herbal

> Rxs. Has BZYQT been proven to help .... (fill in the blank)

 

The discussion was about whether it was appropriate to combine a CHM with a

WM surgery. Here we do have to discuss the intersection of the two

medicines. Do they have a common language? No. So, we have to either put

surgery in CM terms, or herbs in WM terms. And then we're treading on

uncertain ground. Two perspectives, but only one reality... My

understanding via Scheid and Sionneau is that there is a branch of

integrated CM/WM in China that might have already studied this- but to my

knowledge, no one has translated any of this. Since it's a gray area, and

surgery carries automatic risk, I think it's a no-brainer to err on the side

of caution.

 

> My original inquiry of sources was surrounding the claim, " It

> actually would make you more likely to have clots and a stroke than

> to prevent it. " - which I did not understand...

 

Said James Ramholz:

 

[Jason:

" The Pharmacology of Chinese Herbs " (CRC Press, 1999, 2e) by Kee Chang Huang

states (p.102) that San qi " has a direct effect on blood as well. It can

also accelerate blood clotting time and increase the probability of blood

coagulation. " ]

 

Logic. Clots are coagulated blood. Strokes are from clots blocking blood

flow to the brain. Is it such a leap of logic to say, then, that if san qi

has the above proven effects, that clots could not form? Is this a risk

worth taking? To prevent a clot, or break one up, we'd need blood thinning,

not coagulation. So doesn't it logically follow that a formula based

primarily on san qi PROBABLY is more like to lead to a stroke than prevent

one?

 

> Brian also stated, " In all my training, I have never heard any Traditional

Chinese

> Medicine (TCM) doctor recommend this formula pre surgery. "

> I found this puzzling, since your article definitely quotes Damone

> saying that it HAS been used that way for a LONG time... which means

> it still is being used that way.. Mclean also supports this,

 

The quote about my training is from the first article. The quote from

Damone is from the second article. The second article happened after the

first.

 

> .. So

> my take is this... It is not a crazy thing to consider and the door

> should not be shut on pre or post use. TCM DX should be applied and

> further information (prob in Chinese) should be gathered.. But of

> course your point about playing it safe is important, especially hear

> in the WEST (at least for PRE-OP) - But again that applies to all

> herbs not just YNBY.

 

That's the whole point of my articles. So we agree.

 

B

 

 

 

Brian Benjamin Carter, M.Sci., L.Ac.

http://www.pulsemed.org/briancarterbio.htm

Acupuncturist & Herbalist

Editor, The Pulse of Oriental Medicine

Columnist, Acupuncture Today

(619) 208-1432 San Diego

(866) 206-9069 x 5284 Tollfree Voicemail

 

The PULSE of Oriental Medicine

http://www.pulsemed.org/

The General Public's Guide to Chinese

Medicine since 1999... 9 Experts,

240+ Articles, 195,000+ readers....

 

Our free e-zine BEING WELL keeps you

up to date Sign up NOW. Send a blank email to:

beingwellnewsletter-

 

[Guest guest]

, " Brian Carter "

<bbcarter@p...> wrote:

> This is starting to feel like some kind of congressional inquiry by

members

> of the opposing party. But perhaps that's how some of you normally

operate.

> Ok, I think my skin is thick enough to take it. ;-)

 

Brian,

 

Sorry if I seem challenging to some of these issues, but they hit on

some fundamental concepts that I think need exploring, i.e.

classifying Chinese herbs within western terms for 1...

 

 

 

>

> > Brian stated that YNBY is a strong coagulate. Do we know this for

> > sure? And HOW? I am not sure...

>

> Jim just answered this one (see below)- Yes we know this for sure.

How? I

> don't know.

>

 

I actually don't think this is answered . a) YES san qi is said to

have a coagulate effect, although I think Bensky says that in vivo it

has no haemostatic properties in powdered form (from memory - someone

should re-check)... So yes san qi is in the FORMULA YNBY but is YNBY

a STRONG Coagulate??? This is not said anywhere to my knowledge.

Remember formulas are not individual herb properties... It has been

proven that many individual functions or (biochem constituents) are

changed when cooked or taken with other herbs. And again I think

Chinese medicine offers a very important differentiation for the

causes of bleeding that is important to understanding san qi and

YNBY. A) qi xu, b) STASIS, c) heat d) trauma.

 

 

 

 

>

> Said James Ramholz:

>

> [Jason:

> " The Pharmacology of Chinese Herbs " (CRC Press, 1999, 2e) by Kee

Chang Huang

> states (p.102) that San qi " has a direct effect on blood as well.

It can

> also accelerate blood clotting time and increase the probability of

blood

> coagulation. " ]

>

> Logic. Clots are coagulated blood. Strokes are from clots

blocking blood

> flow to the brain. Is it such a leap of logic to say, then, that

if san qi

> has the above proven effects, that clots could not form? Is this a

risk

> worth taking? To prevent a clot, or break one up, we'd need blood

thinning,

> not coagulation. So doesn't it logically follow that a formula

based

> primarily on san qi PROBABLY is more like to lead to a stroke than

prevent

> one?

 

No I do not agree! there is much more going on here then 1 idea about

1 herb (especially a western idea) - there is also a blood moving

component. I don't think it is that black & white. And again is there

source for that? Do we have any cases of strokes occurring with pre-

op surgery use? Or any other documented cases of other problems? The

article mentions generally herb problems but not specific YNBY, this

is why I said , why single YNBY out…

 

Also I.e. just san qi also increases blood flow in the coronary

artery, dilation of vessels, decrease arterial pressure, heart rate,

oxy consumption etc etc…

 

>

> > Brian also stated, " In all my training, I have never heard any

Traditional

> Chinese

> > Medicine (TCM) doctor recommend this formula pre surgery. "

> > I found this puzzling, since your article definitely quotes Damone

> > saying that it HAS been used that way for a LONG time... which

means

> > it still is being used that way.. Mclean also supports this,

>

> The quote about my training is from the first article. The quote

from

> Damone is from the second article. The second article happened

after the...

 

We never studied the McLean book- we had

> Fratkin's.

>

 

This brings an important point, I believe. First I think it is great

that you are going out there and helping educate people about CM.

But let us look at something. I think if you are going to do a piece

on YNBY (or any other topic), you should really check the sources out

there making sure that you have all the info. I think you are

putting yourself out as expert on the subject- especially with many

of the BOLD statements made. But what if I had a patient and I gave

them YNBY post/pre surgery (as I did 4 weeks ago) and they did an

internet search and saw this article. And saw how you had never heard

of such a practice and how crazy this was etc. This has the potential

of uncertainty in the eyes of my patient. Personally I researched

YNBY, 1st evaluated the literature, talked to other doctors,

evaluated my patients type of surgery, and gave the RX. I still

think it was a good move… It IS used like this. You can err on the

side of caution, and promote this stance, but taking it to the next

level it a slippery slope. Some err on the side of caution and don't

give Chinese herbs during preg. I personally do all the time. And

there are famous doctors that give heavy blood movers during

pregnancy, what does that mean?

 

Point being, if bold statements are going to be made, I think one

should be an expert (years of experience) or at least check all the

sources in the language. It goes along with the whole

discussion, " How are we going to present ourselves to the public "

etc... The internet as great as it is, can allow anyone to say

anything, including my own babble right here. But we should all be

careful…

 

-