patent (tea pill) dosing?

February 2, 2004

I have a few questions / comments about tea pill patent medicine

dosing that I would like to address.

I would like to preface the questions with a few comments first:

1. When I talk of tea pills, I am referring specifically to those by

reputable brands such as Plum Flower, Min Shan, Golden Flower, and

Blue Poppy. I am aware that many inferior brands of tea pills are out

there that include Western meds, substitute herbs, placebo, chemicals,

etc., and I specifically do not want to talk about dosing of these

types of brands as I have no confidence in their effectiveness.

2. I am aware that tea pills cannot be modified like a raw herb

decoction can, so if I ask for a comparison between the two, it will

only be in regards to a decoction of the same herbs in the same ratio

as the tea pills. I know the ability to modifify a decoction is a

strong point, but that is not the focus of this discussion.

3. This is a genuine attempt to learn something. I am not interested

in defending any particular position in this discussion. If it seems

like I am arguing with you about something, it is only to get you to

clarify your position due to perceived deficits or inconsistencies in

your comments.

4. I am hoping that Bob Flaws will participate in this thread. I

know he is associated with the Blue Poppy line of tea pills, so his

view is important to me in this matter.

OK - now to the questions / comments:

1. I have used tea pills at their standard doses with good success.

I have heard others say that they are not strong enough and the dose

must be increased, even doubled to be on par with a raw formula.

Is this true? Tea pills are made from raw herbs, as are decoctions.

Wouldn't a tea pill manufacturer want to make a product that is

effective as labeled? If a product does not work as labeled, wouldn't

that hurt sales? Isn't it in the best interest of the manufacturer to

make an effective product and to set an effective dose? If they

purposely set a lower dose, then what would be the motivation? Is it

for " public safety " ? If so, then should I believe that doses in raw

herb formula books are also lowered for public safety?

2. Are tea pills not as strong as the equivalent decoctions? What

does " strong " mean here when people speak of it? Does it refer only

to effectiveness? If " freshness " the concern? Is it because of the

many counterfeit and inferior products that tea pills have received

the reputation for not being as effective as the equivalent

decoctions? What about the reputable brands? Have there been studies

done that clearly show the inferiority of the reputable brands of tea

pills?

3. I know some may say that they have noted that tea pills were not

effective for a patient. While this may be interesting, it begs

several questions. Was the diagnosis even correct (leave ego out of

this one)? Was the choice of tea pills appropriate for the diagnosis?

Can it even be assessed whether or not an equivalent decoction would

have worked in place of the tea pills? If the equivalent decoction

was given later and it did work, is this considered good evidence

against tea pills? A patient's condition changes with time, and maybe

the tea pills could have put the patient in a more favorable

condition, priming them for the decoction.

4. I know some question the digestability of tea pills. Some have

noted tea pills in their stool. Is this a major issue or does it only

happen with the occasional patient? For those patients that this does

happen to, what can we actually know about the digestability of the

equivalent decoction? It is liquid, so we are not going to see it in

their stool, but did they digest / absorb it? Would the decoction

work as expected in this case?

I may have more questions / comments that I cannot remember right now,

so I will start with this.

I thank you all in advance for your input.

Brian C. Allen

February 2, 2004

, " bcataiji " <bcaom@c...> wrote:

> Wouldn't a tea pill manufacturer want to make a product that is

> effective as labeled? If a product does not work as labeled, wouldn't

> that hurt sales? Isn't it in the best interest of the manufacturer to

> make an effective product and to set an effective dose? If they

> purposely set a lower dose, then what would be the motivation? Is it

> for " public safety " ? If so, then should I believe that doses in raw

> herb formula books are also lowered for public safety?

label doses for products are required by the FDA. it is a well known fact of

the

supplement industry that label dosages are lower than than effective doses to

protect

themselves against liability claims. the exception are those items for which

research

has established a safe effective dose, like saw palmetto and st. john's wort or

when

the item is exceptionally safe, like most vitamins. However, based upon

phamacological activity, most OTC herbs are dosed well below the active level.

Herb

formula books are not for the general public, but for professionals. All such

books

have disclaimers in them shielding them from liability suits from the

self-medicating

public. comparing books and product labels is apples and oranges in the world

of

litigation. The label is on the product. There is just no way around this. In

fact, the

dosages reflected in formula books can be traced through history and have

nothing

to do with the publishers.

there is no historical basis for using low dose teapills to treat severe or

acute

symptoms (BP recommends upping the label dose on their own products, BTW, as

does seven forests, far east summit and golden flower - this really is a given

with

such products - talk to the technical advisers at any of these companies). A

few

observed reports in an uncontrolled setting such as the PCOM clinic plus one's

own

personal experiences really proves nothing at all. PCOM interns see only 250

patients

during internship, maybe follow the cases of another 500 as assistants. 250 per

year.

tops. As a supervisor, I work on about 2500 cases per year. 1/3 of these are

those

with self-limited complaints, such as other PCOM students. another 1/3 take no

herbs at all for various reasons. when you factor in placebo effects as

typically

accounting for up 75% of the relief of sx in an uncontrolled setting, I think

the

apparent success of using little black pills at 8 TID is exaggerated. In fact,

school

clinics dramatically exaggerate the placebo effects because students go so over

the

top in giving patiens TLC (probably because they are not very confident about

the

actual medicine yet - but for others, this is the main focus of their practice,

compassion, not pharmacological efficacy - whatever gets people well).

This does not mean patents do not work for longterm supplementation or even

relieving functional disorders over time. I feel that in order to properly

evaluate the

effectiveness of low dose patents, one has to look at conditions like bleeding,

cough,

spasms, pain, muscle tics, tremors, etc. When you have seen enough of these

conditions, I think you will find that the branch sx do not resolve well with

these

products unless one is doing substantial other things. As I am sure Bob Flaws

will

point out, using multiple modalities such as weekly acupuncture makes the use of

hi

potency herbs less necessary for many complaints. The question I would ask for

the

healthcare system as whole is whether this is cost effective. Acupuncture costs

60

per week, herbs only 15-20. If the condition can be resolved by full strength

herbs

w/o acu, that is best for everyone. IMO.

Bob has offered to test this hypothesis of yours. He will donate the herbs to

the

PCOM clinic and well give menopausal patients low and high doses. If you want

to

organize such a study, I would be glad to help make it happen.

February 2, 2004

, " "

wrote:

> relieving functional disorders over time. I feel that in order to

properly evaluate the

> effectiveness of low dose patents, one has to look at conditions

like bleeding, cough,

> spasms, pain, muscle tics, tremors, etc. When you have seen enough

of these

> conditions, I think you will find that the branch sx do not resolve

well with these

This is an interesting comment, pointing out that the tea pills would

be less effective for some conditions than others. Though I am not

questioning your experience / observations over time, do you have any

idea why this might be? - aside from the placebo effect and TLC given

by practitioners, which you already mentioned.

This also raises another question in my mind. You mentioned " low

dose " patents several times. Does anyone know how a tea pill is

made? What is equivalent " raw herb dose " of the standard 24 pills per

day tea pill dose?

> Bob has offered to test this hypothesis of yours. He will donate

the herbs to the

> PCOM clinic and well give menopausal patients low and high doses.

If you want to

> organize such a study, I would be glad to help make it happen.

>

I do have an interest in this. Last week, I was part of a focus group

at PCOM for the purpose of discussing the items that scored low on the

students surveys for re-accreditation purposes. The area of lack of

research was one of them. I mentioned Bob's offer to Stacey and she

seemed interested in the idea and said that she would follow up on it,

though I do not know exactly what she meant.

Brian C. Allen

February 2, 2004

, " "

wrote:

> label doses for products are required by the FDA. it is a well

known fact of the

> supplement industry that label dosages are lower than than effective

doses to protect

> themselves against liability claims. the exception are those items

You almost got me on this one, Todd. Remember, that tea pills were

originally Chinese products, and at least one reputable company Min

Shan is still Chinese (imported by Mayway). The dosing of tea pills

originated in China. So, the whole 8 pills, 3 times a day, is a

Chinese convention used in China where there is no FDA (and thus so

many counterfeit and inferior products). I assume that the American

companies models their tea pills (and dosing) after the Chinese model.

Brian C. Allen

February 2, 2004

I think the question should be whether resolving conditions with full

strength herbs without acupuncture is cost/expense effective for the

practitioner. I understand the importance of cost effectivness for

the patient. However, how many patients would you need to see per day

at 15-20 dollars per patient in order to mee the overhead? If the

overhead is being covered by the institution or center one works for

it may be doable. Otherwise, economical realities should be

considered.

How many diagnoses and writing of rx can one do in an hour? What if

you're a lone practitioner and you have to compound your own

formulas? If you hire someone for the pharmacy at say 8 bucks per

hour to fill your prescriptions, and you're also paying for whatever

holds the formula such as paper bags, gauze, butcher paper or

whatever one uses for wrapping the rx. If you have to take time to

crush huo ma ren or suan zao ren or whatever preparations are needed,

this runs into money and time.

In order for your scenario to work, one would have to be a very good

practitioner. Be able to come to an accurate Dx quickly, and be able

to fill the formula, answer the phone, collect the money and all the

issues that come with running a practice within a few minutes in

oreder to keep the lights on.

Fernando

, " "

The question I would ask for the

> healthcare system as whole is whether this is cost effective.

Acupuncture costs 60

> per week, herbs only 15-20. If the condition can be resolved by

full strength herbs

> w/o acu, that is best for everyone. IMO.

February 2, 2004

, " Fernando Bernall "

<fbernall> wrote:

> I think the question should be whether resolving conditions with full

> strength herbs without acupuncture is cost/expense effective for the

> practitioner. I understand the importance of cost effectivness for

I'd like to keep the questions / answers pertaining to those

originally asked so that I can learn something about the topic.

You raise an interesting question above, but if you are going to go

way off-topic like this, please change the subject line so that we can

keep track of the threads accordingly.

Brian C. Allen

February 2, 2004

Todd asked a question. I answered. If you consider this way off the

topic, talk with Todd about it. In the meantime, I hope you learned

something from my reply.

Fernando

, " "

The question I would ask for the

> healthcare system as whole is whether this is cost effective.

Acupuncture costs 60

> per week, herbs only 15-20. If the condition can be resolved by

full strength herbs

> w/o acu, that is best for everyone. IMO.

, " bcataiji " <bcaom@c...>

wrote:

> , " Fernando Bernall "

> <fbernall> wrote:

> > I think the question should be whether resolving conditions with

full

> > strength herbs without acupuncture is cost/expense effective for

the

> > practitioner. I understand the importance of cost effectivness

for

>

> I'd like to keep the questions / answers pertaining to those

> originally asked so that I can learn something about the topic.

>

> You raise an interesting question above, but if you are going to go

> way off-topic like this, please change the subject line so that we

can

> keep track of the threads accordingly.

>

> Brian C. Allen

February 2, 2004

Brian,

My experience using raw herbs and the same exact formula in capsule form is

that the capsule form is much less effective. I have done the switch to

capsules if the person had to travel, for example, so there is no issue of

the diagnosis possibly having changed. I know your questions were about

teapills, not concentrated capsules.

I also find that if I start a patient on capsules instead of raw herbs, it

takes me a lot longer to find out if I have diagnosed and prescribed

properly. For this reason, I almost always start with a raw herb formula,

make changes as needed, and once I am sure I have prescribed properly, I may

switch to custom capsules if needed. Of course, in these cases, I am talking

about treatments that are going to last several weeks or months.

I have also taken many kinds of teapills at double and even triple the

stated dosage, and I have never noticed any effect whatsoever in my body,

except for a few exceptions, such as Peach Kernel pills and Curing Pills,

which I think are very effective.

As for the stated dosage being low, this is because people self-prescribe,

and because people come in different sizes, and the dosing is made safe for

even the smallest adult. You'd have to double it routinely for some people.

Julie

> I'd like to keep the questions / answers pertaining to those

> originally asked so that I can learn something about the topic.

>

February 2, 2004

My experience using raw herbs and the same exact formula in capsule form is

that the capsule form is much less effective.

>>>>July what dosages of caps, as compared to raw herbs are you giving?

Alon

February 2, 2004

Alon, I am giving the recommended dosage of capsules on the bottle: 3-4

capsules, tid...if the person is large, I am recommending increased dosage.

By the way, these dosages are not designed for self-treating patients, but

are for practitioners who are trained.

I mainly use Evergreen, formerly Lotus Herbs, products.