correct use of patents

[Guest guest]

Will Maclean was at PCOM last week and I was able to see his lecture and

grab some lunch. We got to discuss regulatory and clinical issues. Will

contributes to CHA occasionally. Most of you are familiar with his

Clinical Handbook of Internal Medicine. Will reads and writes chinese,

which is the source of his materials. We mostly talked about patent

medicines and Will's new patent book. At first, I wondered what he might

have to say that would sway my mind on this issue. But I like his texts

and he is not shy about high dosages when using raw herbs. What follows

are some rambling thoughts. Feel free to reply to any thread of this.

 

Will talked about compliance issues, as well as quality issues with raw

herbs. But where he differed from the typical advocate of patents was in

his keen understanding of when and how to use them. He did not feel that

patents replaced raw, but he also did not feel that patents were always a

worse choice, either. For acute conditions, he used high doses of patents

like qing qi hua tan wan, 100 pills per day. I can accept that, but not at

8 or even 16 TID. On the other hand, he claimed that small doses of herbs

for chronic blood stagnation or yin and blood xu were actually better than

high dose decoctions except in the most acute cases. Now that is an

interesting proposition. I can see how it might be true. Building yin

takes a long time anyway, so pills are more appropriate. Yin tonics in tea

form are very cloying and upset many patients digestion, so only small

doses are absorbed anyway. but what about moving blood. Will was

referring to problems like hepatitis C or lupus in remission. Well, it

does make sense not to go to heavy on either of these cases as they often

are asymptomatic. On the other hand, research for treating such complaints

uses only high doses of such blood moving herbs.

 

I know Bob Flaws uses high potency extracts in his patents, but also

recommends combining said patents with lower potency chinese patents to

round out the treatment at times. Subhuti Dharmananda also has made the

case that patents work when one pushes the dosage high enough, as high as

20 grams per day of pills in chronic illness patients. this is far lower

than decoction, but still higher than most pill products deliver. the

rationale is also that the absence of cooking is good in many cases as the

whole pills have everything in them. Then there are absorption issues of

pills. As we know, many products were originally pills and powders anyway,

so the argument for the necessity of synergistic cooking (or even any

cooking or extraction at all) are not well grounded historically, either.

 

So if one can effectively supplement yin or move blood with low dose

chinese patents, how do we know? and despite names like liu wei di huang

WAN, what was actually the standard for administration in ancient china.

What is the standard now. And if low dose pills are effective for these

conditions, are they being used that way in china? Why or why not? Is

there research to support their efficacy?

 

Oh yeah. I will stipulate that some people think such statistical research

is without value or misguided. We will not debate that point any further

as we will not debate the value of oral traditions. I value both to some

degree. For those who don't, we will have to agree to disagree on that

point. anyone who finds research based data offensive can always delete

those posts. :-)

 

 

 

Chinese Herbs

 

 

" Great spirits have always found violent opposition from mediocre minds " --

Albert Einstein

 

 

 

[Guest guest]

Todd:

 

<<< Subhuti Dharmananda also has made the case that patents work

when one pushes the dosage high enough, as high as 20 grams per day

of pills in chronic illness patients. >>>

 

That's 40 (500mg) pills a day for someone who is chronicly ill! Can

they actually tolerate and absorb that many pills? I only get near

that amount for severe, acute or chronic flu---dosing 2-3 grams

every hour until improvement is felt; then 2-3 grams every 4 hours.

With severe or chronic muscular skeletal problems, 1.5 to 2 grams in

concentrates TID with an additional 1 gram of Bromelain TID.

 

Otherwise a typical dose for formulas in concentrate are 1-2 grams

TID. Only a few patients seem to need larger doses. That's for both

patents in concentrate and my own proprietary formulas.

 

My teacher did do higher doses with his very chronic or

catastrophically ill patients---3 or more grams TID each of several

formulas.

 

 

Jim Ramholz

[Guest guest]

P.S. The largest raw herb formula we did---when we did them back in

the 70s and early 80s---weighed in at 13 or so ounces (about 350

grams?); boiled down and taken in divided doses. The formula

contains 35 herbs. It is used for qi, blood, and jing depletions

(xu); as well as general longevity.

 

I now have it make up with herbal concentrates and encapsulized. A

typical dose is 1 gram TID.

 

 

Jim Ramholz

[Guest guest]

Will and Kathyrn were also at ECTOM last week. He made some of the same points

up

here. One thing I do often is give smaller doses of patents than recommended. My

logic that the American body is pointed in one direction. What we attempt to do

is

point the body in another path. Often a small dosage of herbs, pills or

whatever, will

so drastically reorient the body that anything larger than a small dosages

upsets the

body and causes " side effects " . So I often start out with half the recommended

dosage

and work up to the larger dosages. Sometimes these small dosages on new patients

work well very quickly.

 

 

, wrote:

> Will Maclean was at PCOM last week and I was able to see his lecture and

> grab some lunch. We got to discuss regulatory and clinical issues. Will

> contributes to CHA occasionally. Most of you are familiar with his

> Clinical Handbook of Internal Medicine. Will reads and writes chinese,

> which is the source of his materials. We mostly talked about patent

> medicines and Will's new patent book. At first, I wondered what he might

> have to say that would sway my mind on this issue. But I like his texts

> and he is not shy about high dosages when using raw herbs. What follows

> are some rambling thoughts. Feel free to reply to any thread of this.

>

> Will talked about compliance issues, as well as quality issues with raw

> herbs. But where he differed from the typical advocate of patents was in

> his keen understanding of when and how to use them. He did not feel that

> patents replaced raw, but he also did not feel that patents were always a

> worse choice, either. For acute conditions, he used high doses of patents

> like qing qi hua tan wan, 100 pills per day. I can accept that, but not at

> 8 or even 16 TID. On the other hand, he claimed that small doses of herbs

> for chronic blood stagnation or yin and blood xu were actually better than

> high dose decoctions except in the most acute cases. Now that is an

> interesting proposition. I can see how it might be true. Building yin

> takes a long time anyway, so pills are more appropriate. Yin tonics in tea

> form are very cloying and upset many patients digestion, so only small

> doses are absorbed anyway. but what about moving blood. Will was

> referring to problems like hepatitis C or lupus in remission. Well, it

> does make sense not to go to heavy on either of these cases as they often

> are asymptomatic. On the other hand, research for treating such complaints

> uses only high doses of such blood moving herbs.

>

> I know Bob Flaws uses high potency extracts in his patents, but also

> recommends combining said patents with lower potency chinese patents to

> round out the treatment at times. Subhuti Dharmananda also has made the

> case that patents work when one pushes the dosage high enough, as high as

> 20 grams per day of pills in chronic illness patients. this is far lower

> than decoction, but still higher than most pill products deliver. the

> rationale is also that the absence of cooking is good in many cases as the

> whole pills have everything in them. Then there are absorption issues of

> pills. As we know, many products were originally pills and powders anyway,

> so the argument for the necessity of synergistic cooking (or even any

> cooking or extraction at all) are not well grounded historically, either.

>

> So if one can effectively supplement yin or move blood with low dose

> chinese patents, how do we know? and despite names like liu wei di huang

> WAN, what was actually the standard for administration in ancient china.

> What is the standard now. And if low dose pills are effective for these

> conditions, are they being used that way in china? Why or why not? Is

> there research to support their efficacy?

>

> Oh yeah. I will stipulate that some people think such statistical research

> is without value or misguided. We will not debate that point any further

> as we will not debate the value of oral traditions. I value both to some

> degree. For those who don't, we will have to agree to disagree on that

> point. anyone who finds research based data offensive can always delete

> those posts. :-)

>

 

>

>

>

> Chinese Herbs

>

> voice:

> fax:

>

> " Great spirits have always found violent opposition from mediocre minds " --

> Albert Einstein

>

>

>

[Guest guest]

On the other hand, he claimed that small doses of herbs

for chronic blood stagnation or yin and blood xu were actually better than

high dose decoctions except in the most acute cases.

>>>>Todd this is not a unique position. I have heard this also for Qi tonics

when one needs to give a smaller dose. The idea is that if one is truly

deficient he/she can not really process or absorbed high doses. I am like you

and believe only real research can answer such questions

alon

 

 

[Guest guest]

I now have it make up with herbal concentrates and encapsulated. A

typical dose is 1 gram TID.

>>>that is low, do you mix formulas or singles?

alon

 

 

[Guest guest]

, " James Ramholz " <jramholz>

wrote:

 

>

> Otherwise a typical dose for formulas in concentrate are 1-2 grams

> TID. Only a few patients seem to need larger doses. That's for both

> patents in concentrate and my own proprietary formulas.

 

what is the historical basis for this? how does it work scientifically? and

are

you talking about changing objectively measurable variables such as blood

sugar, liver cirrhosis, etc?

 

If Will is right, we need to demonstrate this in some rational way before we

teach it as acceptable practice to our students. Have we discovered a new

mode of action for herbs based upon new needs, a different population, etc. or

have we just conveniently figured out how to sell effective, yet inoffensive

medicines to our patients for the first time in the hx of CM? Is it enough to

find a bunch of folks who will stand behind this idea. I mean that's all CM is

anyway. Ideas and consensus.

 

[Guest guest]

, " Alon Marcus " <

alonmarcus@w...> wrote:

The idea is that if one is truly deficient he/she can not really process or

absorbed high doses. I am like you and believe only real research can answer

such questions

> alon

 

 

but what is small? below the phamrmological threshold or at the threshold. I

believe low threshold doses work, but slowly and unreliably. If we say below

threshold doses work, we need a mechanism.

 

[Guest guest]

, " " wrote:

> what is the historical basis for this? how does it work

scientifically? and are you talking about changing objectively

measurable variables such as blood sugar, liver cirrhosis, etc? >>>

 

The historical basis doesn't go back longer than my own practice, my

friends, and my teacher. The doses described are adequate for

patients to notice their own improvement over the course of a week,

and for me to see it in their pulses. Sure there are improvements in

their scientific tests, but nothing other than WM tests (blood

sugar, biopsies, cancer markers, etc.) when they are done by their

MDs. Nothing has been tested outside of simple practicality.

 

 

> If Will is right, we need to demonstrate this in some rational way

before we teach it as acceptable practice to our students. >>>

 

That wasn't a major issue 30 years ago, but I can see how it could

be now that we are sometimes considered competition for WM. And as

CM expands and matures in it's host country, more demands for

evidence are required.

 

 

Jim Ramholz

[Guest guest]

At 3:04 PM -0800 11/23/03, wrote:

>So if one can effectively supplement yin or move blood with low dose

>chinese patents, how do we know? and despite names like liu wei di huang

>WAN, what was actually the standard for administration in ancient china.

>What is the standard now. And if low dose pills are effective for these

>conditions, are they being used that way in china? Why or why not? Is

>there research to support their efficacy?

>

>Oh yeah. I will stipulate that some people think such statistical research

>is without value or misguided. We will not debate that point any further

>as we will not debate the value of oral traditions. I value both to some

>degree. For those who don't, we will have to agree to disagree on that

>point. anyone who finds research based data offensive can always delete

>those posts.

--

Am I missing your point here?

 

The literature that I'm aware of shows that many formulas were

originally used at lower doses. In F & S liu wei di huang wan is

recommended as small pills at 9 gm tid. This is also current

practice, as F & S comments " for long term and constitutional use;

and I've seen this in hospital practice in China. There are many

other examples, including for the treatment of acute illnesses. Look

for example at the standard doses for ma huang tang and gui zhi tang.

I don't see it needs as a non-standard practice.

 

As for research into this, what is it that you would want to show

that is not already shown?

 

Rory

--