Guest guest Posted November 24, 2003 Report Share Posted November 24, 2003 <<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. :-) >> In his booklet on safety of herbs, Giovanni Maciocia cites research that the concentration of a drug in the blood can vary by a factor of about 20, depending on the person's metabolism. I have known very experienced oriental doctors prescribe decoctions at the 'full Chinese dose', to quarter this dose. Prof. Wu Bo Ping thought that accuracy of prescribing was a very importnat determinant, and that if one was off the mark, one needed more herbs, but if one had achieved an accurate diagnosis and prescribed accordingly, half the standard Chinese dose per day sufficed. In my own clinical experience, some people need larger doses, some less - it also depends on what one is treating. I can't see that finding suitable doses is much of a problem for an experienced practitioner. It's like how much needle stimulation to give in acupuncture - once one has enough experience, one will trust one's judgement. I would be very careful about waiting for research to 'answer' this sort of question - it's entirely possible that standardisation would be a mistake, for more than one of the reasons cited above. Wainwright Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 24, 2003 Report Share Posted November 24, 2003 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. >>>>I have seen some dr giving what would be considered the regular recommended doses for pills ie, small balls about 30-60 day aon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 24, 2003 Report Share Posted November 24, 2003 At 3:54 PM +0000 11/24/03, wainwrightchurchill wrote: >In my own clinical experience, some people need larger doses, some >less - it also depends on what one is treating. I can't see that >finding suitable doses is much of a problem for an experienced >practitioner. It's like how much needle stimulation to give in >acupuncture - once one has enough experience, one will trust one's >judgement. > >I would be very careful about waiting for research to 'answer' this >sort of question - it's entirely possible that standardisation would >be a mistake, for more than one of the reasons cited above. -- Wainwright, You've raised the issue of what is researchable, and if we were to do research, what sort of information would we be looking for. As you've pointed out, dosing is a matter of judgement, and so would be almost impossible to reduce to a set of fixed rules. Even in pharmaceutical medicine this is not possible, and specialists are always finessing dosage for individual patients. I think we can probably say that there is a rather wide range of doses that will have at least some effect in any given case, but to find the optimum dose for that patient at any given time is always going to require judgement. More experienced and well trained practitioners are more likely to get the optimum result more often, but most practitioners are going to get some result in most cases if they stay within a fairly broad range of dosing, and their treatment strategy is appropriate. Another factor to consider is that in Chinese herbal medicine, treatment strategies are often used to achieve a short term goal, within the context of a case that might take a long time to treat and involve many different formulas. I think this level of complexity does not lend itself to research studies, rather to well documented case studies. Rory -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 24, 2003 Report Share Posted November 24, 2003 <<Another factor to consider is that in Chinese herbal medicine, treatment strategies are often used to achieve a short term goal, within the context of a case that might take a long time to treat and involve many different formulas. I think this level of complexity does not lend itself to research studies, rather to well documented case studies. Rory>> Rory, That's a very good point. 'Many different formulas' probably should include variants of one formula - technically, a modified formula is a different formula. Wainwright Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 24, 2003 Report Share Posted November 24, 2003 Wainwright, Jiao Shu-De supports your statement and gives an example on Ten Lectures of changes in dosage of Da Huang, Hou Po and Zhi Shi creates three different formulas: Xia Cheng Qi Tang, Hou Po San Wu Tang and Hou Po Da Huang Tang. Fernando , " wainwrightchurchill " <w.churchill_1-@t...> wrote: 'Many different formulas' probably should > include variants of one formula - technically, a modified formula is > a different formula. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 24, 2003 Report Share Posted November 24, 2003 , " wainwrightchurchill " < w.churchill_1-@t...> wrote: > > In his booklet on safety of herbs, Giovanni Maciocia cites research > that the concentration of a drug in the blood can vary by a factor of > about 20, depending on the person's metabolism. source of that info, please. that seems very high. > > I have known very experienced oriental doctors prescribe decoctions > at the 'full Chinese dose', to quarter this dose. Prof. Wu Bo Ping > thought that accuracy of prescribing was a very importnat > determinant, and that if one was off the mark, one needed more herbs, > but if one had achieved an accurate diagnosis and prescribed > accordingly, half the standard Chinese dose per day sufficed. I think we agree here. I don't dispute giving herbs within their dose range to be effective. So a formula prescribed at 90 grams might be no more effective than another one at 30 grams and the latter might be better in some cases. Both meet the pharmacological threshold, though. I have made this point is my support for kanpo. The argument some are making is for much lower doses, well below accepted pharmacological thresholds, like 2 grams per day. this suggests another mode of action and I have never met a chinese doc who was comfortable or experienced at this level of prescribing, though Jim says otherwise. anyone else have chinese teachers who practiced this way? As for research, if one can determine drug dose ranges in large enough groups, one can do the same with herbs. If you test 1000 people and only 300 respond to low doses, that's a placebo. Once the group gets large enough, the individual variations can be factored out. Or at the very least, one should be able to prove whether low doses of herbs have ever effectively treated any complaint. give low doses to 1000 people with IBS and see how many get well. Try high doses. As for pattern taking precedence over potency, that's just another unproven bias. In fact, double research on IBS disproves this. In fact, most chinese research show excellent results practicing allopathically. Again, believe it when I see it and the only way I'll ever see enough is in research since I can't personally live 1000 years and treat all conditions. You are not suggesting that a modern healthcare system be based upon blind allegiance to the ancestors, are you? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 24, 2003 Report Share Posted November 24, 2003 , Rory Kerr <rory.kerr@w...> wrote: In F & S liu wei di huang wan is > recommended as small pills at 9 gm tid. that's my point. Will is suggesting not 9 g TID for yin xu (which would be 135 little black pills, BTW, but 8 pills TID, which is 1/2 g TID or 20 times less than the dose you mention). I know pills have historical and modern use, but at this low a dose? that is the claim I would like to see grounded in either history or research. I really do not think that question has been answered or even asked. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 24, 2003 Report Share Posted November 24, 2003 , " wainwrightchurchill " < w.churchill_1-@t...> wrote: > <<Another factor to consider is that in Chinese herbal medicine, > treatment strategies are often used to achieve a short term goal, > within the context of a case that might take a long time to treat and > involve many different formulas. I think this level of complexity > does not lend itself to research studies, rather to well documented > case studies. actually it lends itself to both, IMO. A controlled study that is designed to measure outcomes rather than micromanage therapies can demonstrate broad and valid comparisons. Such a study would also validate the very style of CM that we all practice and hold dear. Let me begin by saying that I believe Will may be correct in this matter and I am motivated to see him proved right as it would be of great benefit to our patients if he is. So, for example: Perimenopausal Nightsweating and hot flashes due to kidney yin and yang xu Group 1 - receives individualized raw herb formulas from senior herbalists with no restrictions on additional pattern diagnosis or herb selection or dosage group 2 - receives patent medicines in any combination and dosage with no restrictions on additional pattern diagnosis group 3 - receives patent medicines in low dose form (8 pills TID of lanzhou foci products or equivalent) with no restrictions on additional pattern diagnosis group 4 - receives patent medicines in low dose form (8 pills TID of lanzhou foci products or equivalent) with no additional pattern diagnosis group 5 - placebo group 6 - nothing and while we may have a broader definition of health and healing, the general public, insurers, medical doctors and regulators do not. So I do not agree that there is nothing to measure that would be of value here. We can evaluate symptom relief the same way they do for hormones (they still are thought to work for hot flashes, y'know). We can also measure hormone levels to see if any changes occur (reports from China are that they do). This type of data could be used to redirect HMOs to us as the try to figure out how to take care of their middle-aged female insurees. I guess it depends who you talk to. My father was a pharmacist and then at Merck. My step-grandfather was a medical doctor at Lincoln Hospital in the bronx. This is the type of data they want to see. My Dad is the age of many of the decisonmakers in the various groups referred to above, so I think those in power are definitely looking for this kind of old-fashioned stuff. Just imagine if it was shown that a 2 dollar per week supply of liu wei di huang wan or xue fu zhu yu tang could address many of the most devastating complaints of our era (in combination with good diet and exercise, of course). Or that even a $100 per month supply of herbs could do it. either way. This type of experiment would not tie the hands of practitioners (since groups 1-4 would probably all work well enough to justify insurance or MD referral - but who needs insurance for $8 a month of herbs - that's less than your co-pay - I am not being flippant here). And useful " data " could be easily collected. why would such a study be invalid or detrimental or useless? Such a study would probably cause a dramatic shift in use of CM overnight, much moreso than any goodwill and word of mouth. Currently, less than 1% of patients for acupuncture come for GYN complaints. We could turn that into 25% of all american females with a study like this. I think the point that may be missed is that politicians and medical doctors and HMO execs are busy people who want to be fed a big picture with solid numbers that is easy to understand. None of these folks are experts in research. If the numbers are simple and generally considered valid, they will make our case. No one will be prevented from doing any nuance they want in private tx. We don't need to use the long narrative case to make our point. In fact, no one wants to hear it. But we can certainly use individualized case studies to collect group data. I believe this is considered the cutting edge in medical research - outcomes studies. I think its a shame we cannot even agree on this basic point. I am actually shocked that there is a contingent of our profession that does not see the immense social and political value in such research. I would be lying if I thought the value was clinical. We do fine without it. But I think we limp along each day we continue to debate whether we should do research instead of just doing it. It is my goal that CHA will someday play a role in this. I know enough members feel the same as me. All we need is someone to write a grant. Anyone game? There's definitely some money in it for the lead clinician :-). Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 24, 2003 Report Share Posted November 24, 2003 , " " wrote: It is my goal that CHA will someday play a role in this. I know > enough members feel the same as me. All we need is someone to write a grant. Anyone game? There's definitely some money in it for the lead clinician :-). : Wouldn't any herb company, say Blue Poppy for instance, be willing to donate herbal formulas for this? Think of the publicity. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2003 Report Share Posted November 25, 2003 > In his booklet on safety of herbs, Giovanni Maciocia cites research > that the concentration of a drug in the blood can vary by a factor of > about 20, depending on the person's metabolism. source of that info, please. that seems very high. Todd>> Having read Giovanni's booklet 'Safety of Chinese Herbal Medicine' some years ago, I quoted this figure incorrectly. It seems that a 5- fold variation in plasma concentration is generally accepted, but some say that individual variations vary from 4-fold to 40-fold (Cohen JS, Preventing Adverse Drug Reactions before they occur, Medscape Pharmacology, Medscape.com, 1999.) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2003 Report Share Posted November 25, 2003 <<As for research, if one can determine drug dose ranges in large enough groups, one can do the same with herbs. If you test 1000 people and only 300 respond to low doses, that's a placebo. Once the group gets large enough, the individual variations can be factored out. Or at the very least, one should be able to prove whether low doses of herbs have ever effectively treated any complaint. give low doses to 1000 people with IBS and see how many get well. Try high doses. As for pattern taking precedence over potency, that's just another unproven bias. In fact, double research on IBS disproves this. In fact, most chinese research show excellent results practicing allopathically. Again, believe it when I see it and the only way I'll ever see enough is in research since I can't personally live 1000 years and treat all conditions. You are not suggesting that a modern healthcare system be based upon blind allegiance to the ancestors, are you? Todd>> It might be possible to conduct general research reducing the dosage of herbs to a point at which the overall rate of efficacy was equal or less than a placebo. While theoretically possible, it seems to me that such research is many steps away from where research is at the momunt, or is likely to be within the foreseeable future. It begs many issues, such as the theoretical principles for carrying out such research. As for small doses, I once saw a TV program about the pesticide Lindane, where a toxicologist argued that, 'if you want to get the most bangs for your bucks' (his expression), rather than give a person a relatively high dosage of a toxin for a short amount of time, more damage will be done if you give the same total amount in a lower dose over a greater period of time. Of course, this doesn't apply under certain circumstances, e.g. if the high dose kills the person outright. Wainwright Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2003 Report Share Posted November 25, 2003 This is the exact kind of thinking that IMO is needed from our profession. Now that the unwanted chatter from overly-expressive overly-anti-western member(s) have been chopped down, maybe we can come to some middle ground... Since research is necessary, and stats go along with any research, let's discuss the best way to utilize such information to best propel our profession. (BTW) I 100% agree that having some research, such as below, in no way binds our treatments in the real life clinic, this is just paranoia. - , " " wrote: > , " wainwrightchurchill " < > w.churchill_1-@t...> wrote: > > <<Another factor to consider is that in Chinese herbal medicine, > > treatment strategies are often used to achieve a short term goal, > > within the context of a case that might take a long time to treat and > > involve many different formulas. I think this level of complexity > > does not lend itself to research studies, rather to well documented > > case studies. > > actually it lends itself to both, IMO. A controlled study that is designed to > measure outcomes rather than micromanage therapies can demonstrate broad > and valid comparisons. Such a study would also validate the very style of CM > that we all practice and hold dear. Let me begin by saying that I believe Will > may be correct in this matter and I am motivated to see him proved right as it > would be of great benefit to our patients if he is. > > So, for example: > > Perimenopausal Nightsweating and hot flashes due to kidney yin and yang xu > > Group 1 - receives individualized raw herb formulas from senior herbalists > with no restrictions on additional pattern diagnosis or herb selection or dosage > > group 2 - receives patent medicines in any combination and dosage with no > restrictions on additional pattern diagnosis > > group 3 - receives patent medicines in low dose form (8 pills TID of lanzhou > foci products or equivalent) with no restrictions on additional pattern > diagnosis > > group 4 - receives patent medicines in low dose form (8 pills TID of lanzhou > foci products or equivalent) with no additional pattern diagnosis > > group 5 - placebo > > group 6 - nothing > > and while we may have a broader definition of health and healing, the general > public, insurers, medical doctors and regulators do not. So I do not agree that > there is nothing to measure that would be of value here. We can evaluate > symptom relief the same way they do for hormones (they still are thought to > work for hot flashes, y'know). We can also measure hormone levels to see if > any changes occur (reports from China are that they do). This type of data > could be used to redirect HMOs to us as the try to figure out how to take care > of their middle-aged female insurees. I guess it depends who you talk to. My > father was a pharmacist and then at Merck. My step-grandfather was a > medical doctor at Lincoln Hospital in the bronx. This is the type of data they > want to see. My Dad is the age of many of the decisonmakers in the various > groups referred to above, so I think those in power are definitely looking for > this kind of old-fashioned stuff. > > Just imagine if it was shown that a 2 dollar per week supply of liu wei di > huang wan or xue fu zhu yu tang could address many of the most devastating > complaints of our era (in combination with good diet and exercise, of course). > Or that even a $100 per month supply of herbs could do it. either way. This > type of experiment would not tie the hands of practitioners (since groups 1-4 > would probably all work well enough to justify insurance or MD referral - but > who needs insurance for $8 a month of herbs - that's less than your co-pay - I > am not being flippant here). And useful " data " could be easily collected. why > would such a study be invalid or detrimental or useless? Such a study would > probably cause a dramatic shift in use of CM overnight, much moreso than any > goodwill and word of mouth. Currently, less than 1% of patients for > acupuncture come for GYN complaints. We could turn that into 25% of all > american females with a study like this. > > I think the point that may be missed is that politicians and medical doctors > and HMO execs are busy people who want to be fed a big picture with solid > numbers that is easy to understand. None of these folks are experts in > research. If the numbers are simple and generally considered valid, they will > make our case. No one will be prevented from doing any nuance they want in > private tx. We don't need to use the long narrative case to make our point. In > fact, no one wants to hear it. But we can certainly use individualized case > studies to collect group data. I believe this is considered the cutting edge in > medical research - outcomes studies. > > I think its a shame we cannot even agree on this basic point. I am actually > shocked that there is a contingent of our profession that does not see the > immense social and political value in such research. I would be lying if I > thought the value was clinical. We do fine without it. But I think we limp > along each day we continue to debate whether we should do research instead > of just doing it. It is my goal that CHA will someday play a role in this. I know > enough members feel the same as me. All we need is someone to write a > grant. Anyone game? There's definitely some money in it for the lead clinician > :-). > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2003 Report Share Posted November 25, 2003 " Will is suggesting not 9 g TID for yin xu (which would be 135 little black pills, BTW, but 8 pills TID, which is 1/2 g TID or 20 times less than > the dose you mention). I know pills have historical and modern use, but at this low a dose? that is the claim I would like to see grounded in either history or research. I really do not think that question has been answered or even asked. " I think an important question to ask is if Will routinely prescribes this dose along with acupuncture. If so, then who's to say whether his outcomes are due to the herbs, to acupuncture, or to some combination of the two? Bob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2003 Report Share Posted November 25, 2003 I don't know anything about grant-writing. However, let me make a counter proposal. I would be willing to donate enough Ultimate Immortals to do a comparison study on dose-based efficacy. Six wings would be very unweildy and hard to accomplish. Having been involved in a large three wing RCT with the NIH, I can tell you you'd have problems enrolling enough patients to make the study valid. I would propose a two wing study. One wing with perimenopausal night sweats could receive Ultimate Immortals at a higher dose and another group could receive it at a much lower dose equivalent to the 8 pills TID recommended for Lanzhou Pai ready-made pills. Then there could be a third comparison (based on published literature) to the already established outcomes within Western medicine for this same complaint. This study would help solve the argument (within our profession) about the role of dosage in the use of rady-made Chinese herbal medicines, and it might help popularize Chinese medicine in the larger health care marketplace. Any takers? Bob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2003 Report Share Posted November 25, 2003 At 4:03 AM +0000 11/25/03, wrote: >Perimenopausal Nightsweating and hot flashes due to kidney yin and yang xu > >Group 1 - receives individualized raw herb formulas from senior herbalists >with no restrictions on additional pattern diagnosis or herb >selection or dosage > >group 2 - receives patent medicines in any combination and dosage with no >restrictions on additional pattern diagnosis > >group 3 - receives patent medicines in low dose form (8 pills TID of lanzhou >foci products or equivalent) with no restrictions on additional pattern >diagnosis > >group 4 - receives patent medicines in low dose form (8 pills TID of lanzhou >foci products or equivalent) with no additional pattern diagnosis > >group 5 - placebo > >group 6 - nothing == I'm interested in why you would do a study this way. If our objective is to show the rest of the world that CM has an effective treatment for menopausal hot flashes, it seems to me that we would want to study one treatment type, ie our professional standard, individual prescription, rather than four. Your method would tell us which methods of the four was more or less effective, whereas all we need to show is that one method is effective. No? Rory -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2003 Report Share Posted November 25, 2003 At 4:03 AM +0000 11/25/03, wrote: >I think its a shame we cannot even agree on this basic point. I am actually >shocked that there is a contingent of our profession that does not see the >immense social and political value in such research. -- I think it is an accurate generalization to say that on any give topic, any group of people is going to divide into at least two groups with differing if not opposing views. So don't be shocked! For myself, I'm persuaded that although I believe research should be an important activity in our profession, we definitely have an interest in controlling the type of research to avoid biomedicalization, and in speaking out when research is used to plunder or discredit our resources. I think we can do this by becoming well educated and engaged, not by rationalizing isolationism. Rory -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2003 Report Share Posted November 25, 2003 At 1:20 AM +0000 11/25/03, wrote: >Again, believe it when I see it and the only way I'll >ever see enough is in research since I can't personally live 1000 years and >treat all conditions. -- I don't know whether you have done this, but you can get a long way by spending six months in clinic in a Chinese teaching hospital. You would probably see at least 5000 patient visits during that time, and a very wide range of diseases conditions. Rory -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2003 Report Share Posted November 25, 2003 the role of dosage in the use of rady-made Chinese herbal medicines, and it might help popularize Chinese medicine in the larger health care marketplace. Any takers? >>>IT would be better if there is also a group receiving placebo, but if cannot find enough patients than a third party should dispense the herbs so that no one knows who is getting what alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2003 Report Share Posted November 25, 2003 You would probably see at least 5000 patient visits during that time, >>>You can see a lot more than this alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2003 Report Share Posted November 25, 2003 For myself, I'm persuaded that although I believe research should be an important activity in our profession, we definitely have an interest in controlling the type of research to avoid biomedicalization, and in speaking out when research is used to plunder or discredit our resources. I think we can do this by becoming well educated and engaged, not by rationalizing isolationism. >>>I totally agree alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2003 Report Share Posted November 25, 2003 Bob Flaws wrote: >This study would help solve the argument (within our profession) >about the role of dosage in the use of rady-made Chinese herbal >medicines, and it might help popularize Chinese medicine in the >larger health care marketplace. > >Any takers? -- Bob, At the risk of repeating myself, I think these two objectives should be kept apart, and that we should focus on one objective in any given study. If we want to convince the world, of the effectiveness of CM in a given condition, we should do a study of what we think is our optimal therapy, individual prescription. If we want to compare CM therapies, then design a study with that objective. When both studies are complete, they can be compared, assuming they have the same standards of randomization etc. Of course, there's no reason why two different groups could not be doing the two studies at the same time, in different places. BTW, I know you do a lot of Chinese journal reading. Has this ground not already been covered to some extent with respect to menopause and CM? Rory -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2003 Report Share Posted November 25, 2003 , Rory Kerr <rory.kerr@w...> wrote: > > > > I'm interested in why you would do a study this way. If our objective > is to show the rest of the world that CM has an effective treatment > for menopausal hot flashes, it seems to me that we would want to > study one treatment type, ie our professional standard, individual > prescription, rather than four. Your method would tell us which > methods of the four was more or less effective, whereas all we need > to show is that one method is effective. No? there is more than one goal here, one of which is to determine the most cost effective approach to CM. I think the issue of what form of CM works best is just as important as whether CM works at all. If it is easy enough to ascertain both, why not. Rember my original idea was merely to study patents vs. raw. It was only an afterthought that the implications would be beneficial for CM as a whole regardless of the outcome. However Bob Flaws's proposal is probably more reasonable and would settle the dosage issue in many people's minds (though many others would stubbornly cling to prior ideas anyway). Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2003 Report Share Posted November 25, 2003 > >>>IT would be better if there is also a group receiving placebo, but if cannot find enough patients than a third party should dispense the herbs so that no one knows who is getting what > alon Agreed. Bob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2003 Report Share Posted November 25, 2003 , Rory Kerr <rory.kerr@w...> wrote: > I don't know whether you have done this, but you can get a long way > by spending six months in clinic in a Chinese teaching hospital. You > would probably see at least 5000 patient visits during that time, and rory I've heard mixed reviews about such a rotation as it applies to my needs. Perhaps others who have worked in these hospitals can address these various issues that have been raised with me by many travelers to China over the years. As usual, I speak from my experiences and conversations here in the US and my words in no way reflect any actual knowledge of what goes on on the ground in china. 1. the patients are often not followed up over time and any reported cures may be transient 2. the time devoted to each patient is not adequate to learn very much about any given case. the thought process of the physician is usually not explained in any detail. 3. there is a tendency to focus on sx relief and detailed exploration of complaints is absent. 4. there is a tendency to type patients rather than fully pattern them (as Scheid explains it). Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 25, 2003 Report Share Posted November 25, 2003 BTW, I know you do a lot of Chinese journal reading. Has this ground not already been covered to some extent with respect to menopause and CM? >>>At this point there is no good and positive study done in US on menopause in any form of herbs Alon Quote Link to comment Share on other sites More sharing options...
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