Guest guest Posted February 29, 2004 Report Share Posted February 29, 2004 I have a hep C case who has been through a course of treatment with Ribovarin and Pegasus. Strangely, she was clear of any viral load at 3 and 6 months but tested positive after she completed treatment recently. She will soon be biopsied and if she's still at stage 1 she wants to 'watch and wait' while making lifestyle changes and taking herbs/nutraceuticals. I encouraged her to see a CM specialist in hep for her herbs/nutrients but she wants to see me. I offered to come up with some basic nutraceuticals that would be important for her. Through the interferon treatments she was on a regimen (a la Misha Cohen, I believe) of alpha lipoic acid, selenium, B complex, Vit E and a couple other nutrients. She is premenopausal, in her 40's. For any of you who specialize in chronic hep patients, can you suggest what basic nutraceuticals might be appropriate for her? She is starting to eat better (oatmeal, brown rice and 4! vegetables) but, I think we have to assume her diet will be average. Her budget is quite limited. Perhaps a multi-vitamin should be the starting point? I also plan to give her herbs, based on her pattern--probably a variation of xiao chai hu tang. Marian --- Outgoing mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.434 / Virus Database: 243 - Release Date: 12/25/2002 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 29, 2004 Report Share Posted February 29, 2004 This is not uncommon to have a positive viral test after interferon/robovarin. The success rate hovers around 50% depending on the genotype. I only suggest milk thistle as a supplement. For ideas about herbs you can look at my website hepchealth.com. Xiao Chai hu Tang is not a bad place to start but it certainly can be refined based on other signs and symptoms. I'm not sure what lifestyle changes your patient needs to still make at this point. you can write me off list if you want. doug , " Marian Blum " <marianb@r...> wrote: > I have a hep C case who has been through a course of > treatment with Ribovarin and Pegasus. Strangely, she was > clear of any viral load at 3 and 6 months but tested > positive after she completed treatment recently. She will > soon be biopsied and if she's still at stage 1 she wants to > 'watch and wait' while making lifestyle changes and taking > herbs/nutraceuticals. I encouraged her to see a CM > specialist in hep for her herbs/nutrients but she wants to > see me. > > I offered to come up with some basic nutraceuticals that > would be important for her. Through the interferon > treatments she was on a regimen (a la Misha Cohen, I > believe) of alpha lipoic acid, selenium, B complex, Vit E > and a couple other nutrients. She is premenopausal, in her > 40's. For any of you who specialize in chronic hep patients, > can you suggest what basic nutraceuticals might be > appropriate for her? She is starting to eat better (oatmeal, > brown rice and 4! vegetables) but, I think we have to assume > her diet will be average. Her budget is quite limited. > Perhaps a multi-vitamin should be the starting point? I also > plan to give her herbs, based on her pattern--probably a > variation of xiao chai hu tang. > > Marian > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 1, 2004 Report Share Posted March 1, 2004 What is her pattern, plus symptoms, pulse and tongue? On Feb 29, 2004, at 6:25 PM, Marian Blum wrote: > I also > plan to give her herbs, based on her pattern--probably a > variation of xiao chai hu tang. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2004 Report Share Posted March 2, 2004 , " " <zrosenbe@s...> wrote: > What is her pattern, plus symptoms, pulse and tongue? of course, that would be my concern as well. but to play devil's advocate, XCHT is the most widely research hep rx in the world. So the question is begged, under what circumstances would a pattern dx lead to better results than allopathic use of XCHT? Only in circumstances where the pattern diagnosis is precisely correct. I can certainly envison a scenario where XCHT is right for 75% of patients with hep and a botched pattern dx would only lead to worse results. I wonder if this realization has played a role in making kanpo largely allopathic today. That would be a good study. Compare the results of allopathic herbal prescribing with the results of pattern based prescribing. but instead of comparing expert herbalists with allopaths, let's compare recent grads. I wonder if the allopathic approach works better than novice TCM.. I think we have all heard the expression that WM is hard to learn and easy to practice,CM is easy to learn and hard to practice. So this again raises the issue of what type of practice is most effective amongst those who get only 2000 hours of training in OM. We may be surprised to find out that some (many?) people do more damage practicing TCM than they would if they used the same formulas allopathically (such as XCHT for hep C - BTW, I am not suggesting Marian does this, just wanted to make a point). In fact, I have read a number of articles lately saying one is best off using unmodified classical formulas because they a re tried and true, while modification is basically a crapshoot. Actually, formula modification is a logical process and those who do not think so were just never taught the process. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2004 Report Share Posted March 2, 2004 Xiao chai hu tang, in my experience, doesn't address the vacuity of liver yin and/or blood that tends to accrue in long-term patients with chronic illness such as Hep C, as either latent heat or vacuity heat damages the yin. While there are cases that may respond to XCHT, in many cases this prescription completely misses the mark. Also, since chai hu raises the clear yang and can aggravate yin vacuity according to several Warm Disease authors, it may be contraindicated in several patients as well. Especially if there are signs of liver wind or rising liver yang. The issue of prescription modification is an important one, and I want to address it along with Nigel Dawe's comments in AT in a separate post. On Mar 2, 2004, at 8:32 AM, wrote: > , " " > <zrosenbe@s...> > wrote: >> What is her pattern, plus symptoms, pulse and tongue? > > > of course, that would be my concern as well. but to play devil's > advocate, > XCHT is the most widely research hep rx in the world. So the question > is > begged, under what circumstances would a pattern dx lead to better > results > than allopathic use of XCHT? Only in circumstances where the pattern > diagnosis is precisely correct. I can certainly envison a scenario > where XCHT > is right for 75% of patients with hep and a botched pattern dx would > only lead > to worse results. I wonder if this realization has played a role in > making > kanpo largely allopathic today. That would be a good study. Compare > the > results of allopathic herbal prescribing with the results of pattern > based > prescribing. but instead of comparing expert herbalists with > allopaths, let's > compare recent grads. I wonder if the allopathic approach works > better than > novice TCM.. I think we have all heard the expression that WM is > hard to learn > and easy to practice,CM is easy to learn and hard to practice. So > this again > raises the issue of what type of practice is most effective amongst > those who > get only 2000 hours of training in OM. We may be surprised to find > out that > some (many?) people do more damage practicing TCM than they would if > they > used the same formulas allopathically (such as XCHT for hep C - BTW, I > am not > suggesting Marian does this, just wanted to make a point). In fact, I > have read > a number of articles lately saying one is best off using unmodified > classical > formulas because they a re tried and true, while modification is > basically a > crapshoot. Actually, formula modification is a logical process and > those who > do not think so were just never taught the process. > > > > > 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. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2004 Report Share Posted March 2, 2004 , " " <zrosenbe@s...> wrote: > Xiao chai hu tang, in my experience, doesn't address the vacuity of > liver yin and/or blood that tends to accrue in long-term patients with > chronic illness such as Hep C, as either latent heat or vacuity heat > damages the yin. that's a good point. nor does it address the blood stasis I find even more common than yin vacuity in these cases. but it further begs the question of why this formula works so well anyway in the vast majority of hep cases according to japanese research? or why kanpo works at all since kanpo formulas are often prescribed without the typical TCM consideration of all the mutually engendering pathomechanisms at play. in other words, the japanese use of many formulas is reportedly very successful, yet the formulas chosen very frequently do not address the entire pattern complex. I am referring here to the dominant " old rx " style of kanpo, not the style that was influenced by li dong yuan. I know many " old rx " style practitioners are also often the same folks who advocate addressing only one or two patterns in a single rx. the idea being that if one pulls the crucial thread, the entire knot will unravel. While I am more influenced by Li dong yuan as interpeted by Bob Flaws, I can't help but notice that many of the most knowledgeable and skillful px practice in a more minimalist fashion. Such a practitioner might state that: 1. concerns about chai hu damaging the yin are overstated 2. it is not necessary to directly supplement the yin; in fact, this may be problematic in phlegm and damp and spleen vacuity. 3. restoring liver coursing will lead to quickening of the blood, relief of depressive fire and disencumberment of the spleen. 4. clearing dampheat and phlegm will further disencumber the spleen and relieve the stoking of the ministerial fire 5. supplementing the spleen will lead to the generation of postnatal yin essences via diet 6. Only after dampheat and phlegm are cleared and spleen is fortified is it correct to supplement yin directly. The above do not wholly represent my personal view, but a distillation of a valid alternate view on this matter. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2004 Report Share Posted March 2, 2004 Such a practitioner might state that: >>>Todd i have to agree and this was always something that intrigued me, i.e., the question of being able to " diagnose " the pivotal pattern. Unfortunately it has been more of a rhetoric argument in my experience as I never seen a practitioner that can do this in a predictable fashion and often enough. I also have to agree with you that we need studies comparing allopathic use of CM herbs and so called pattern specific. In reviewing many cases from my experience in China, i have noticed that many practitioners while speaking of individual patterns in reality use a fairly fixed or allopathic formulation when confronted by specific diseases. i.e., they have their favorite formulas which they use (often with some individual changes) to treat certain diseases. Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2004 Report Share Posted March 2, 2004 On Mar 2, 2004, at 10:13 AM, wrote: > , " " > <zrosenbe@s...> > wrote: >> Xiao chai hu tang, in my experience, doesn't address the vacuity of >> liver yin and/or blood that tends to accrue in long-term patients >> with >> chronic illness such as Hep C, as either latent heat or vacuity heat >> damages the yin. > > > that's a good point. nor does it address the blood stasis I find even > more > common than yin vacuity in these cases. but it further begs the > question of > why this formula works so well anyway in the vast majority of hep cases > according to japanese research? or why kanpo works at all since kanpo > formulas are often prescribed without the typical TCM consideration > of all > the mutually engendering pathomechanisms at play. in other words, the > japanese use of many formulas is reportedly very successful, yet the > formulas > chosen very frequently do not address the entire pattern complex. We also know that one of the few 'iatrogenic reports' on Chinese herb prescriptions is on use of xiao chai hu tang with Hep C patients when combined with interferon. > I am > referring here to the dominant " old rx " style of kanpo, not the style > that was > influenced by li dong yuan. I know many " old rx " style practitioners > are also > often the same folks who advocate addressing only one or two patterns > in a > single rx. the idea being that if one pulls the crucial thread, the > entire knot > will unravel. While I am more influenced by Li dong yuan as > interpeted by Bob > Flaws, I can't help but notice that many of the most knowledgeable and > skillful px practice in a more minimalist fashion. I tend to hover somewhere in the middle on this. I think the Shang Han Lun 'style' of treatment can be applied to internal medicine, but perhaps the SHL scripts don't really cover all patterns, especially those that are more complex. Many texts arose over the years to modify and expand SHL scripts, in order to treat a wider variety of pathoconditions and complex patterns. For example, zeng ye cheng qi tang, which treats yang ming repletion disease with constipation, plus yin vacuity causing severe intestinal dessication. This prescription was designed by Wu Jutong, author of Wen bing tiao bian/Systematic Differentiation of Warm Disease. So, by looking at historical modifications of SHL scripts for more complex patterns, we can still use the essence of SHL teachings, and be more accurate in prescribing. > Such a practitioner might > state that: > > 1. concerns about chai hu damaging the yin are overstated It depends on the issues of yang rising more than actual yin vacuity. One can add yin supplementing medicinals to XCHT and address this issue, as in chai hu si wu tang. > > 2. it is not necessary to directly supplement the yin; in fact, this > may be > problematic in phlegm and damp and spleen vacuity. If this is the issue, than this point of view is correct. > > 3. restoring liver coursing will lead to quickening of the blood, > relief of > depressive fire and disencumberment of the spleen. This also may be correct. But this will depend on the degree of liver depression. Again, scripts such as chai hu si wu tang wouldn't have been developed if they weren't necessary. > > 4. clearing dampheat and phlegm will further disencumber the spleen > and > relieve the stoking of the ministerial fire > Good point. But sometimes, XCHT won't be enough. > 5. supplementing the spleen will lead to the generation of postnatal > yin > essences via diet Also true. . ..but there are drying medicinals in this script, so if there is preexisting yin vacuity, XCHT may aggravate the yin vacuity. > > 6. Only after dampheat and phlegm are cleared and spleen is fortified > is it > correct to supplement yin directly. One can do this concurrently. But, perhaps, this is a 'world view' issue, depending if one holds that one can treat one aspect of a pattern or treat the 'whole enchilada', as Bob Flaws would say. I also favor the Li Dongyuan approach, but sometimes a 'layers of the onion' approach, as Chip Chace puts it, is appropriate, using the example of Liu Baoyi's approach to treatment of latent qi warm disease. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2004 Report Share Posted March 2, 2004 , " " wrote: > , " " <zrosenbe@s...> > wrote: > > Xiao chai hu tang, in my experience, doesn't address the vacuity of > > liver yin and/or blood that tends to accrue in long-term patients with > > chronic illness such as Hep C, as either latent heat or vacuity heat > > damages the yin. > > > that's a good point. nor does it address the blood stasis I find even more > common than yin vacuity in these cases. but it further begs the question of > why this formula works so well anyway in the vast majority of hep cases > according to japanese research? or why kanpo works at all since kanpo > formulas are often prescribed without the typical TCM consideration of all > the mutually engendering pathomechanisms at play. in other words, the > japanese use of many formulas is reportedly very successful, yet the formulas > chosen very frequently do not address the entire pattern complex. My question is this: Chinese studies are constantly bashed for exagerating results, and very often on this list it is said " we can't trust them " , if so, why do you trust these japanese results (more)? -Jason \ \ I am > referring here to the dominant " old rx " style of kanpo, not the style that was > influenced by li dong yuan. I know many " old rx " style practitioners are also > often the same folks who advocate addressing only one or two patterns in a > single rx. the idea being that if one pulls the crucial thread, the entire knot > will unravel. While I am more influenced by Li dong yuan as interpeted by Bob > Flaws, I can't help but notice that many of the most knowledgeable and > skillful px practice in a more minimalist fashion. Such a practitioner might > state that: > > 1. concerns about chai hu damaging the yin are overstated > > 2. it is not necessary to directly supplement the yin; in fact, this may be > problematic in phlegm and damp and spleen vacuity. > > 3. restoring liver coursing will lead to quickening of the blood, relief of > depressive fire and disencumberment of the spleen. > > 4. clearing dampheat and phlegm will further disencumber the spleen and > relieve the stoking of the ministerial fire > > 5. supplementing the spleen will lead to the generation of postnatal yin > essences via diet > > 6. Only after dampheat and phlegm are cleared and spleen is fortified is it > correct to supplement yin directly. > > The above do not wholly represent my personal view, but a distillation of a > valid alternate view on this matter. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2004 Report Share Posted March 2, 2004 I take each study on its own merits, Chinese, Japanese or American. I don't count myself among the " Chinese study bashers " , but I do take all studies with a grain of salt. However, the xiao chai hu tang situation wasn't a study per se, it was an investigation into the deaths of 16 patients, all of who were taking interferon and xiao chai hu tang at the same time. Sounds too overwhelming to be coincidental. On Mar 2, 2004, at 7:35 PM, wrote: > > My question is this: Chinese studies are constantly bashed for > exagerating results, and very often on this list it is said " we can't > trust them " , if so, why do you trust these japanese results (more)? > > -Jason Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2004 Report Share Posted March 2, 2004 There is no doubt about Xiao Chai Hu Tang can cause death when used with interferon. The mechanism is in Chai Hu which raises interferon levels naturally and with interferon to fatal toxic levels. There are no reports of death when Chai hu is used alone. doug , " " <zrosenbe@s...> wrote: > However, the xiao chai hu tang situation wasn't a study per se, it was > an investigation into the deaths of 16 patients, all of who were taking > interferon and xiao chai hu tang at the same time. Sounds too > overwhelming to be coincidental. > > Quote Link to comment Share on other sites More sharing options...
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