2 day packs, boiling twice, double dosing

[Guest guest]

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

 

>

> My question is this:

> Does the twice boiling method that we use make a single day dose be

> able to be stretch out to 2 days, or is it a common practice to twice

> boil even a single-day pack of herbs in order to get the most out of it?

>

> Another way I could ask this is:

> Is the twice boiling method a normal method of decoction, regardless

> of for how many days the herbs are going to be used, or is the twice

> boiling method used in order to double the amount of time over which

> the herbs can be taken?

 

 

It is my understanding that the twice boiling method is the standard

throughout most of china. I believe Bensky also states this. the soak and

single boil method I prefer for conveninence is used is used in some parts of

china according to Bensky and was favored by my teacher. I hear it is also

prevalent in Korea. Since it is the standard method in china, it cannot have

been designed to compensate for lower doses used in the west. One pack per

one day is the standard in china and it is here where the discrepancy arises.

 

While some have raised the issue of herb quality as a factor, keep in mind that

chinese doses are often above 150-180 grams per day. My formulas hover

around 100-120/day, while the low dosers to whom Brian refers dose in the

range of 50-60g/day. If chinese doctors have been low dosing either by

mistake or in outright rejection of PRC practice, you will never get one to

admit it and change their approach. that would be a massive loss of face.

 

Sadly I have found most of my chinese teachers and colleagues to stick to

their guns regardless of any evidence to the contrary. It is not even worth

having the discussion on such issues most of the time. Try discussing the

herb ID thing and how most sheng ma and ban xia in the US are not pinellia and

cimicifuga and you will find no agreement. To admit that you are right about

these matters is to admit that they have made clinical errors in prescribing

and herb selection. I think the language barrier and american clinical

procedures were initially responsible for this situation. but by the time

anyone figured out what was going on, no one was about to take responsibility

or rectify the matter. So things have continued unabated despite

overwhelming evidence that this level of dosing is far below that used in the

PRC.

 

However it is in line with kanpo dosing. These low dose formulas are perhaps

effective over the long term for yin organ root disorders, but I reiterate my

position that they do not reliably relieve strong branch symptoms. Given that

very few people will maintain themselves on raw herbs over a long period, the

most important use of raw herbs is for short term effects, IMO. If you

underdose a raw herb formula designed to give rapid symptom relief, all you

do is damage the credibility of the medicine. CM's reputation developed

because of its ability to treat acute illness and symptoms. Read Liu's warm

disease for more about this. I think it is a radical rejection of mainstream

chinese practice throughout history to lopsidedly focus our herbal efforts on

the relief of underlying patterns and not pay enough attention to acute

symptoms. If you don't relieve the damage at the branch, the root will never

heal. How can the qi be restored while a person bleeds profusely; how can yin

be restored while heat ravages the body? I am not talking about solely

addressing he branch here, just addressing the branch properly and that does

not happen with low dose formulas or patents.

 

[Guest guest]

I think the language barrier and american clinical

procedures were initially responsible for this situation. but by the time

anyone figured out what was going on, no one was about to take responsibility

or rectify the matter. So things have continued unabated despite

overwhelming evidence that this level of dosing is far below that used in the

PRC.

>>>Todd i believe it is much deeper than that and goes to the whole

traditionalism and perfectionalism attitude in CM

Alon

 

 

[Guest guest]

 

 

> I think the language barrier and american clinical

> procedures were initially responsible for this situation. but by the time

> anyone figured out what was going on, no one was about to take

responsibility

> or rectify the matter. So things have continued unabated despite

> overwhelming evidence that this level of dosing is far below that used in

the

> PRC.

 

I don't understand something: since most of our Chinese teacher/doctors were

trained in the PRC, why would they not be teaching the higher dosages that

they are used to?

 

Julie Chambers

[Guest guest]

I don't think that one boiling gets at all what the herbs have to offer. I

understand the

second boiling as extracting more of the essence of the herb out. Of course, if

its a

" light " formula for wind cold then one bag a day will take advantage of the

fragrance

of the formula while a tonic may need more than one boiling to get the full

benefit.

And I advocate, just boiling enough for one day and then adding water to reboil

the

second day. I like that fact that you get two different qualities out of the

herbs.

doug

 

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

> At PCOM, when selling raw herbs, we generally sell packets that are to

> be used over the course of 2 days.

>

> The basic method of preparation is this:

> add 4 cups of water

> boil down to 2 cups

> drain off decoction and save

> add 4 cups of water to leftover herbs

> boild down to 2 cups

> drain off decoction, adding to first part

> This gives 4 cups of decoction to be taken as 1 cup, twice daily, for

> 2 days.

>

> Because the packs are to be used for 2 days, it seems to make sense

> that the dosage should be doubled from the textbook formulas doses,

> which are given as daily doses. At least one teacher at PCOM agrees

> with this notion.

>_______________________

> My question is this:

> Does the twice boiling method that we use make a single day dose be

> able to be stretch out to 2 days, or is it a common practice to twice

> boil even a single-day pack of herbs in order to get the most out of it?

>

> Another way I could ask this is:

> Is the twice boiling method a normal method of decoction, regardless

> of for how many days the herbs are going to be used, or is the twice

> boiling method used in order to double the amount of time over which

> the herbs can be taken?

>

> Thanks in advance for you input.

>

> Brian C. Allen

[Guest guest]

Doug, How do you know you get two different qualities out of the herbs?

I've heard this idea but I am completely flummoxed wondering how anyone

could know this?

 

Julie

 

 

 

-

" "

 

Sunday, April 04, 2004 7:23 PM

Re: 2 day packs, boiling twice, double dosing

 

 

> I don't think that one boiling gets at all what the herbs have to offer. I

understand the

> second boiling as extracting more of the essence of the herb out. Of

course, if its a

> " light " formula for wind cold then one bag a day will take advantage of

the fragrance

> of the formula while a tonic may need more than one boiling to get the

full benefit.

> And I advocate, just boiling enough for one day and then adding water to

reboil the

> second day. I like that fact that you get two different qualities out of

the herbs.

> doug

>

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

> > At PCOM, when selling raw herbs, we generally sell packets that are to

> > be used over the course of 2 days.

> >

> > The basic method of preparation is this:

> > add 4 cups of water

> > boil down to 2 cups

> > drain off decoction and save

> > add 4 cups of water to leftover herbs

> > boild down to 2 cups

> > drain off decoction, adding to first part

> > This gives 4 cups of decoction to be taken as 1 cup, twice daily, for

> > 2 days.

> >

> > Because the packs are to be used for 2 days, it seems to make sense

> > that the dosage should be doubled from the textbook formulas doses,

> > which are given as daily doses. At least one teacher at PCOM agrees

> > with this notion.

> >_______________________

> > My question is this:

> > Does the twice boiling method that we use make a single day dose be

> > able to be stretch out to 2 days, or is it a common practice to twice

> > boil even a single-day pack of herbs in order to get the most out of it?

> >

> > Another way I could ask this is:

> > Is the twice boiling method a normal method of decoction, regardless

> > of for how many days the herbs are going to be used, or is the twice

> > boiling method used in order to double the amount of time over which

> > the herbs can be taken?

> >

> > Thanks in advance for you input.

> >

> > Brian C. Allen

>

>

>

> 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]

Hi Brian-

 

 

>My question is this:

>Does the twice boiling method that we use make a single day dose be

>able to be stretch out to 2 days, or is it a common practice to twice

>boil even a single-day pack of herbs in order to get the most out of it?

 

Dosage has always been a question that, in my experience at PCOM

Chicago, has not been answered very well. Many students seem to have

questions here about dosing, but no one has really been willing to

take on that issue and say something definitive. It is usually

something like " It all depends on the patient, the disease, and the

style of the practitioner. " Maybe technically a good answer, but it

does not help people find their way very well.

 

I do not usually any problem at the PCOM Chicago clinic with

supervisors lowering my dosages. I always double the dosage listed

in Bensky, and often create my own formulas that approach 100g/day.

Supervisors do not usually have a problem with this, but maybe it's

because I push them on it?

 

>Another way I could ask this is:

>Is the twice boiling method a normal method of decoction, regardless

>of for how many days the herbs are going to be used, or is the twice

>boiling method used in order to double the amount of time over which

>the herbs can be taken?

 

I think double boiling is just to get as much out of the herbs as possible

 

-Steve

--

Stephen Bonzak

<smb021169

[Guest guest]

, " " wrote:

> I don't think that one boiling gets at all what the herbs have to offer. I

understand the

> second boiling as extracting more of the essence of the herb out.

 

pure speculation. It is standard procedure in some parts of asia to boil only

once. So here is my anecdotal experience. Except for certain herbs, I find the

second boil to be negligible in effects relative to the inconvenience for the

patient. I would say compliance literally triples when using a single cook.

that alone is worth it.

 

[Guest guest]

On Apr 4, 2004, at 3:22 PM, wrote:

 

> It is my understanding that the twice boiling method is the standard

> throughout most of china.

 

Yang, Tiende trained and later taught at the Beijing University of TCM.

He says that the during the first cooking you derive the Qi properties

from the herbs and during the second cooking you'll get more the Yin

properties.

 

In this context, Qi means the thermal properties and the Yin means the

taste.

 

Just a little tidbit that I've always found interesting.

 

 

-al.

 

--

 

Pain is inevitable, suffering is optional.

-Adlai Stevenson

[Guest guest]

Todd-

 

>pure speculation. It is standard procedure in some parts of asia to boil only

>once. So here is my anecdotal experience. Except for certain

>herbs, I find the

>second boil to be negligible in effects relative to the inconvenience for the

>patient. I would say compliance literally triples when using a single cook.

>that alone is worth it.

 

Which herbs would you include in your list that would do well with a

second boil? Minerals and certain precious herbs like renshen?

 

-Steve

--

Stephen Bonzak

<smb021169

[Guest guest]

,

> > pure speculation. It is standard procedure in some parts of asia

to boil

> only

> > once. So here is my anecdotal experience. Except for certain

herbs, I

> find the

> > second boil to be negligible in effects relative to the

inconvenience for

> the

> > patient. I would say compliance literally triples when using a

single

> cook.

> > that alone is worth it.

> >

>

>

 

 

 

What are the details of your one-cook method? Is it time dependent

(cook for 30 minutes, etc.) or based on reducing to a certain volume?

Also, does anyone have anything to say about the electric herb

cookers?

 

Brandt

[Guest guest]

I'll throw my hat in here... I thought the way we were taught to make decoctions

was commonplace, but judging from the replies, it's not. The 'add 4 C of water'

is ok if you always use the right amount of herbs for that amount of water - but

like in baking (just got finished putting together my first real sourdough..),

you have to look and judge. If 4 C of water doesn't cover the herbs, that's not

going to work too well. I also like this since you on'y cook every other day

rather than every day. Here's my office form; I think it may be useful for you:

 

INSTRUCTIONS FOR RAW HERB PREPARATION

1. Place dry herbs in pot & fill with water to a level that is 1-inch above the

herbs.

2. Soak for at least 20 minutes.

3. Bring to a boil, then simmer for 30 minutes or _____ min, while covered.

4. Strain the cooked tea into a container. Keep herbs in the pot.

5. Fill pot with water to a level that is 1-inch above the herbs.

6. Bring to a boil, then simmer for 20 minutes or _____ min, while covered.

7. Strain this second batch into the first batch. Discard the used herbs.

8. These two batches make up your 2-day herb supply.

9. Drink 2-3 times/day, at least 30 min Ú¤ after meals / Ú¤ before meals.

10. Refrigerate unused portions.

11. Heat tea to warm, unless otherwise directed.

 

Geoff

 

> __________

>

> Message: 1

> Sun, 04 Apr 2004 18:25:21 -0600

> Julie Chambers <info

> Re: Re: 2 day packs, boiling twice, double dosing

>

>

>

> > I think the language barrier and american clinical

> > procedures were initially responsible for this situation.

> but by the

> > time anyone figured out what was going on, no one was about to take

> responsibility

> > or rectify the matter. So things have continued unabated despite

> > overwhelming evidence that this level of dosing is far

> below that used

> > in

> the

> > PRC.

[Guest guest]

The cooking instructions I learned are:

 

First soak the herbs at least 1 hour, overnight when possible. Not soaking

results in primarily decocting only the outside of the herb. Longer soaks

are recommended for heavier herbs, & light aromatic herbs should be soaked

for not more than 1 hour. (In the summer the soak may need to take place in

the refrigerator to keep from spoiling (if no A/C).

 

To cook, use clean water, & fill a glass or clay pot about 1 inch above

herbs. If using a painted clay pot - use a test strip (before ever using

the pot) to verify no lead leeches into the decoction. Use high heat to

bring to boiling point, then reduce to a low simmer. Cook 15 minutes,

strain, repeat.

 

Of course lots of herbs have special cooking methods. Most aromatics: short

cook, thick rich herbs (ren shen): long cook, some toxic herbs (sheng fu

zi): long cook, etc. In clinic I see people put ginseng in our herb

grinder, which probably cuts the cook time considerably, but I've never been

" trained " to do that.

 

My herb teacher is a PhD from Beijing university. He doses like an American

(~80-100g, 1 bag for 2 days). He claims that his results are nearly as good

dosing this way, with the only exception being that results on occasion are

accomplished more slowly (but only occasionally, though admittedly it's hard

to say).

 

It's interesting that Todd sees such a huge compliance differential when

adding a second cook. I've never heard of such a thing. With 15 minute

cook times I'd be surprised if many of my patients abandoned ship. I appeal

to their American sensibilities " with a second cook it's like you're getting

extra medicine for FREE. " I guess I'd have to create a survey to determine

if they actually ran scared due to the second cook. I find that the

quitters are lost long before the first boil.

 

Tim Sharpe

[Guest guest]

I heard this method of preparation from one of my PCOM-SD teachers, while the

rest of the faculty promoted the double boil method with 4 cups reduced to 2

cups for each boil. I also heard that for heating the herbs, it is not

recommended to do this in a microwave.

 

 

 

Geoffrey Hudson <list wrote:

I'll throw my hat in here... I thought the way we were taught to make decoctions

was commonplace, but judging from the replies, it's not. The 'add 4 C of water'

is ok if you always use the right amount of herbs for that amount of water - but

like in baking (just got finished putting together my first real sourdough..),

you have to look and judge. If 4 C of water doesn't cover the herbs, that's not

going to work too well. I also like this since you on'y cook every other day

rather than every day. Here's my office form; I think it may be useful for you:

 

INSTRUCTIONS FOR RAW HERB PREPARATION

1. Place dry herbs in pot & fill with water to a level that is 1-inch above

the herbs.

2. Soak for at least 20 minutes.

3. Bring to a boil, then simmer for 30 minutes or _____ min, while covered.

4. Strain the cooked tea into a container. Keep herbs in the pot.

5. Fill pot with water to a level that is 1-inch above the herbs.

6. Bring to a boil, then simmer for 20 minutes or _____ min, while covered.

7. Strain this second batch into the first batch. Discard the used herbs.

8. These two batches make up your 2-day herb supply.

9. Drink 2-3 times/day, at least 30 min Ú¤ after meals / Ú¤ before

meals.

10. Refrigerate unused portions.

11. Heat tea to warm, unless otherwise directed.

 

Geoff

 

> __________

>

> Message: 1

> Sun, 04 Apr 2004 18:25:21 -0600

> Julie Chambers <info

> Re: Re: 2 day packs, boiling twice, double dosing

>

>

>

> > I think the language barrier and american clinical

> > procedures were initially responsible for this situation.

> but by the

> > time anyone figured out what was going on, no one was about to take

> responsibility

> > or rectify the matter. So things have continued unabated despite

> > overwhelming evidence that this level of dosing is far

> below that used

> > in

> the

> > PRC.

 

 

 

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]

Hey All-

 

Is it possible to cook herbs too long, and thereby reduce their efficacy? Is it

possible to make a decoction too strong by not using enough water, or boiling

out too much? This is an interesting thread!

 

 

 

 

 

 

 

 

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