Teapills, granulars vs bulk

[Guest guest]

, " ALON MARCUS "

<alonmarcus@w...> wrote:

> I am concerned about the relative concentration ratio especially when

> attempted to use traditional formula which are often design on the

> ratio between 2 or more herbs to produce a very specific action.

> >>>>>>What do you want to know? I can only speak about ShengCheng or

quliherbs as they are the only factory I have Vistide and know

detailed information.

>

> Also, is it really possible to concentrate a mineral or shell????

> >>>Not really but you would probably andup with more active

ingredients in the powders than in Bolk herb teas, since you cant

relay cook it out as well.

> Alon

>

>

>

>

[Guest guest]

An interesting experiment I did a few weeks ago was take the KPC

granular of MULI and the ground up version and put them in a glass of

warm water. Interestingly the KPC form did not dissolve nearly as well

as the Bulk.

>>>>Starch can not dissolve

Alon

 

 

[Guest guest]

Just a few thoughts on the current thread:

 

1. Just because a formula name ends in san (powder) or wan (pills) does not mean

that in standard professional Chinese medicine

that is the common method of administration of that formula for the REMEDIAL

TREATMENT of disease. One sees many, many case

hisotries where the author says the formula prescribed was Liu Wei Di Huang Wan

Jia Jian (Six Flavors Rehmannia Pills with

Additions & Subtractions) and then goes on to describe typical decoction doses

per ingredient and to say that one packet of these

medicinals was administered per day as a water decoction. The traditional names

of standard formulas only reflect their original use,

not their current usage.

 

2. Yesterday, I read a case history involving Takayasu's arteritis (TA) where

the patient was pres cribed pills made from powdered

Chinese medicinals bound with honey. Each pill weighed 9 grams and the patient

took one of these each time three times per day. So

27 grams per day of powdered Chinese meds. The author did not say why he had

chosen this method of administration. Of the 12

case histories on TA I read yesterday, this was the only one to use pills

remedially.

 

3. In the vast majority of Chinese case histories where pills are mentioned at

all, they are mentioned only at the end after the active

remedial therapy has been concluded with bulk-dispensed, water decoctions. In

this case, the authors state that treatmwent was

continued with pills to secure and cosolidate the therapeutic effects, not to

achieve the therapeutic effects in the first place. This is

such a common refrain that there is pro forma language to state this in Chinese

case histories.

 

4. What Chinese laypeople do on their own recognizance at corner apothecaries

needs to be distinguished from what professional

practitioner of Chinese medicine do. As I have noted before on this forum, it is

common to see at the beginning of a Chinese case

history that the patient had first tried these or those pills on their own.

After these had not worked, they came in for a professional

consultation and the prescription of a water decoction. Not only can one read

this over and over again in the Chinese case history

literature, I heard it over and over again when I was an intern in China.

 

Please note, in sharing these four observations, I am not saying any " shoulds "

here. I am merely reporting what the Chinese literature

relects. What we chose to do here in North America is our business.

Nevertheless, in attempting to decide what's best for us to do, I

think it is reasonable to pay attention to what Chinese have done and

experienced over the last 2,000 years.

 

That being said, according to articles in the Chinese press and medical

journals, Chinese themselves recongize that the hassles of

water decoctions are a real problem for the continued survival and popularity of

Chinese medicine, both in its homeland and abroad.

Therefore, there is considerable research being done in China on new methods of

preparation and administration of Chinese

medicinals. I have reluctanly come to the conclusion that water decoctions will

never really make it here in the U.S. as SOC of

professional Chinese medicine. I say this after 20 some years of devoting myself

to creating a literature to teach and support this

modality. Realistically, I just don't see it happening on any kind of large

scale. In part, this is why I have shifted a large part of my

attention to the creation of better, more powerful ready-made Chinese medicines.

 

Bob

Bob

[Guest guest]

, " Bob Flaws " <

pemachophel2001> wrote:

> Just a few thoughts on the current thread:

 

Bob

 

Thanks for the evidence of what the chinese have actually been doing. I think

it makes sense to follow this line of reasoning about herb dosage. I have a

question for anyone on this list who uses forms and doses of herbs not

justified in the medical literature (like tinctures and patents) as to why you

feel comfortable doing that if you do not feel comfortable questioning other

assumptions. I think the case for using high doses decoctions is a lot more

solid than the case for restricting sexual activity.

 

 

I have reluctanly come to the conclusion that water decoctions will never

really make it here in the U.S. as SOC of

> professional Chinese medicine. I say this after 20 some years of devoting

myself to creating a literature to teach and support this

> modality. Realistically, I just don't see it happening on any kind of large

scale. In part, this is why I have shifted a large part of my

> attention to the creation of better, more powerful ready-made Chinese

medicines.

 

 

I agree 100% with Bob. I can't imagine why anyone would buy a raw herbal

pharmacy anymore. Its just a waste of money. However I still do not think

ready made pills are the answer. We need some way to make custom pills or

extracts on the spot or have local pharmacies that can do this.

 

[Guest guest]

 

 

As you perhaps know, in countries in Europe such as Germany, Austria, and

Switzerland, practitioners are not allowed to sell meds

out of their offices. They write prescriptions which are filled at local

drugstores or by national pharmacies which deliver overnight

(mostly powdered extracts). I visited a pharmacy last year in downtown Zurich

where they had an herb-extractor-cum-vacuum-packer.

They gave me a demo. While the idea is intriguing, the process seemed too

laborious and time-consuming to really be effective

large-scale. Just the clean-up after each Rx seemed daunting. Instead of

custom-filling individual Rxes, this pharmacy was mostly

using this equipment to make standard Rxes for particular conditions, such

colds, allergies, and sinusitis, and then selling these from

their shop downstairs.

 

It'll be interesting if Crane Herb can make a real go of being a national

supplier of custom-written and filled Rxes. I certainly wish them

luck and hope they can.

 

Bob

[Guest guest]

, " "

> I agree 100% with Bob. I can't imagine why anyone would buy a raw

herbal

> pharmacy anymore. Its just a waste of money.

 

I was under the impression that you recently switched your patients

to raw decotions. Was this a misunderstanding or did you change your

mind?

 

fernando

[Guest guest]

Last year in Beijing the vaccuum bags was an option for the out patients at the

hospital. But the cost was rather high I thought, fifty cents (american) per

bag. I

needed something for my cold and I really liked taking it that way though. (The

docs

were pretty amazed when the foreigner wrote his own prescription.)

The local herb shop in Santa Monica has an extractor but I know the workers are

not

happy about having to make using it. (they too I think charge fifty cents

(american) a

bag.)

Although the Standard of Care may not be raw herbs they still are essential. I

generally find two types of patients. Those that look at the bag of twigs and

go,

" Yechhh " and those that go " cool! " .

doug

 

 

.. I visited a pharmacy last year in downtown Zurich where they had an herb-

extractor-cum-vacuum-packer.

> They gave me a demo. While the idea is intriguing, the process seemed too

laborious and time-consuming to really be effective

> large-scale. Just the clean-up after each Rx seemed daunting. Instead of

custom-

filling individual Rxes, this pharmacy was mostly

> using this equipment to make standard Rxes for particular conditions, such

colds,

allergies, and sinusitis, and then selling these from

> their shop downstairs.

>

> It'll be interesting if Crane Herb can make a real go of being a national

supplier of

custom-written and filled Rxes. I certainly wish them

> luck and hope they can.

>

> Bob

[Guest guest]

Dave,

 

While I believe water-based decoctions of individually written, bulk-dispensed

Chinese medicinal prescriptions is the most

therapeutically effective method of administration and is my preferred method as

a clinician, I just don't see either the rank and file

practitioners of the AVERAGE North American patient going this route. When I

lived in Boulder, CO, most of my patients were

" bourgeois bohemians " or Bo-bos who mostly fell into your " cool " category. Now I

live in a less bohemian, more bourgeois community,

and I can't really see these people boiling up decoctions. Yet these are the

people who need to adopt Chinese medicine if we're going

to move beyond the fringe.

 

Bob

[Guest guest]

I just don't see either the rank and file

practitioners of the AVERAGE North American patient going this route.

>>>>After doing bulk herbs only for 10 years in Berkeley which very compliant

population i came to the same conclusion. Too often patients said they took the

herbs when they did not or just took one bag instead of 3 etc. When i started

using powders (and as i said i give on average between 10-20g per day, i have

not seen much difference in outcomes. I think this is because there is better

compliance.

Alon

 

 

[Guest guest]

, " Fernando Bernall " <

fbernall> wrote:

 

> I was under the impression that you recently switched your patients

> to raw decotions. Was this a misunderstanding or did you change your

> mind?

>

> fernando

 

Fernando

 

that is true, but I do not have my own pharmacy. And even though I get about

20 patients per week to take raw herbs, I still don't think that is enought to

turnover a pharmacy fast enough for freshness. Also, I have a patient load

that is more hip than the average joe. But in beaverton, oregon, a posh suburb

of portland, it was granules all the way. No one would even consider taking

raw herbs, there.

 

[Guest guest]

, Steven Slater <dragonslive@i...>

wrote:

Thus, in a clinical

> situation, one gram of 6:1 herbal extract is equivalent to over 12

> grams of raw herbs when given by decoction.

 

excuse my french. no freakin way that is true. or if it is chemically and

mathematically correct, it certainly does not play out that way in practice.

 

[Guest guest]

, " Alon Marcus " <alonmarcus@w...>

wrote:

 

> >>>>>Todd you are wrong they do give this data but not outside Taiwan.

 

Actually, that makes me right because I still can't get the data. :-)

 

[Guest guest]

I do not have sufficient clinical experience to comment on this myself

as yet. This is one of my major concerns with the " advised " use of

extracts along with the " real " concentration ratios which are hidden

from us as practitioners.

 

I think what many of these companies say on this issue is just repeated

from each other to maintain respect and competition in the market. I

certainly have not seen any reference to a study to support these

claims.

 

Studying this issue as well as I can for the last few days has led me

to believe this is their claim.........

 

1) 5g of raw herbs go into producing 1g of powder.

 

2) The modern extraction process itself obtains 95% of the " active

ingredients " from that 5g.

 

3) In comparison, they claim that normal decoction methods only release

between 30% and 50% of the " active ingredients " .

 

4) Thus 5g of raw herb is used to produce 1g of extract powder that

contains 2 to 3 times the " active ingredients " that would be obtained

from a traditional 5g raw herb decoction.

 

I CAN understand how this COULD be true. But where is the evidence? And

why do they not prescribe like this in China? Why do you and others you

know not prescribe like this if it is clinical true? Are these

companies breaking a law with these claims?

 

I truly feel this needs to be addressed by our profession. Especially

if the " advised " dosages from companies are what is used in clinic

trials which will play a large role in determining the future use of

TCM in the West as part of a changing public health approach.

 

What can we do about it? I have still not succeeded in getting the true

concentration ratio's out of any company as yet either :-(

 

Steve

 

 

On 07/02/2004, at 7:09 AM, wrote:

 

> , Steven Slater

> <dragonslive@i...>

> wrote:

> Thus, in a clinical

>> situation, one gram of 6:1 herbal extract is equivalent to over 12

>> grams of raw herbs when given by decoction.

>

> excuse my french. no freakin way that is true. or if it is chemically

> and

> mathematically correct, it certainly does not play out that way in

> practice.

>

 

>

[Guest guest]

Another issue on my mind about this is .......since when have formula's

been based on total weight? How can anyone say 6g of a formula

containing 4 herbs has the same clinical effect as a 6g formula

containing 12 herbs?

 

Simple maths and logic says to me that the second formula will contain

1/3 the dose of a herb compared to the first. Yet extract companies

certainly feel this is not an issue. They obviously believe that the

dosage of a herb in a formula is irrelevant compared to the over dosage

of herbs.

 

I have never been taught anything like this apart from the general

statement that " a herb is used in greater dosage when used alone and at

a smaller dosage when part of a formula " . However I always assumed

either of these dosages would have to fall within the recommended

dosage range.

 

More food for thought I suppose.

 

 

Steve

 

 

 

On 07/02/2004, at 7:09 AM, wrote:

 

> , Steven Slater

> <dragonslive@i...>

> wrote:

> Thus, in a clinical

>> situation, one gram of 6:1 herbal extract is equivalent to over 12

>> grams of raw herbs when given by decoction.

>

> excuse my french. no freakin way that is true. or if it is chemically

> and

> mathematically correct, it certainly does not play out that way in

> practice.

>

 

>

>

>

>

[Guest guest]

Actually, that makes me right because I still can't get the data. :-)

>>>>I have some on quali formulas if you really want i can probably share i need

to check

Alon

 

 

[Guest guest]

, Steven Slater <dragonslive@i...>

wrote:

> Another issue on my mind about this is .......since when have formula's

> been based on total weight? How can anyone say 6g of a formula

> containing 4 herbs has the same clinical effect as a 6g formula

> containing 12 herbs?

 

min tong says formulas with more than 5 herbs are concentrated more than 5

times, often much more.

 

[Guest guest]

I see, but I was wondering about making formulae in clinic from singles.

 

Can they really concentrate formula's more? and if so why don't they do

this for singles?

 

As may be becoming more and more obvious.....I am really beginning to

doubt where to start with the proper clinic use of extracts.

 

Steve

 

On 07/02/2004, at 3:45 PM, wrote:

 

> , Steven Slater

> <dragonslive@i...>

> wrote:

>> Another issue on my mind about this is .......since when have

>> formula's

>> been based on total weight? How can anyone say 6g of a formula

>> containing 4 herbs has the same clinical effect as a 6g formula

>> containing 12 herbs?

>

> min tong says formulas with more than 5 herbs are concentrated more

> than 5

> times, often much more.

>

 

>

>

>

> Chinese Herbal Medicine offers various professional services,

> including board approved continuing education classes, an annual

> conference and a free discussion forum in Chinese Herbal Medicine.

>

>

>

>

[Guest guest]

min tong says formulas with more than 5 herbs are concentrated more than 5

times, often much more.

>>>>They often do and then when sprayed it is reduced to what ever the formula

ends up being per 1g.

Alon

 

 

[Guest guest]

I guess what bothers me about all this is that if it is possible to

concentrate all these herbs/formula's more than 5 times............why

do they produce singles in varying ratio's?

 

We all seem to be in consensus that the extracts of singles vary in

concentration. Why do they do this if it is possible to concentrate

them more than 5:1?

 

Clinically, wouldn't it makes sense, regardless of what they CAN

produce, that they should either make ALL singles the same

concentration ratio to allow accurate combining or ADVISE practitioners

of the actual concentration of each single to allow accurate combining.

 

Steve

 

On 07/02/2004, at 4:36 PM, Alon Marcus wrote:

 

> min tong says formulas with more than 5 herbs are concentrated more

> than 5

> times, often much more.

>>>>> They often do and then when sprayed it is reduced to what ever the

>>>>> formula ends up being per 1g.

> Alon

>

>

[Guest guest]

I guess what bothers me about all this is that if it is possible to

concentrate all these herbs/formula's more than 5 times............why

do they produce singles in varying ratio's?

>>>>Actually some herbs can not even get as high as 5:1. Some can but to prevent

clumping they must be sprayed onto a carrier to form lower final concentrate per

weight unit. This is quite common. There is no way to have a consistent

slandered for all formulas or singles.

There is a difference in the final product in terms of comparing to raw herb

decoction in that the granules or powders are fairly consistent. When doing home

cooking you probably have a large variance between batches etc. One day you cook

them 10 min, next day you forget and cook 30min etc. There may be more volatile

oil escaping during one cooking as compared to the next. Cooking in costal areas

as compared to high elevation is at different temp and would result in different

decoction. So there is some differences beyond the simple thinking of just

comparing ratios.

When extracts are mixed with cooked dried herb powder (or even just raw herb

powders) as a carrier you would probably get additional strength as well as some

active ingredients that may not have been extracted from a raw herb H2O

decoction, and this may also effect the total clinical strength.

Unfortunately we have to function clinically in some darkness and learn by

experience.

One thing that really bothers me is the lack of clinical studies comparing the

powders with raw herbs, comparing mixing single extracts to precooked formulas,

etc. Most of the evidence they talk about is from HPLC and other such

comparisons between all the above.

I think the profession needs to start demanding such information. Same with

funding for acupuncture studies. We need to start having some real pressure on

the commercial entities that make money from their products to fund studies done

by others. Schools are probably the place these need to occur.

Alon