dosage standards

[Guest guest]

I have never meant a single person who reads chinese or who has studied

in China who would dispute exactly what is meant in internal medicine

texts and cases histories throughout all of chinese history. The

dosages listed for formulas dispensed in tea form are for one pack.

One pack was typically dispensed for one day. I really think there is

no possible refutation of this point. This does not speak to whether

cases and texts recommended high or low doses (you can find examples

across the board). And this argument does not apply to doses of pills

or powders. However most pills and powders have also been applied in

tea form when the goal is rapid relief of strong symptoms. You can see

evidence of this all the way back to zhu dan xi at least. And you can

see it widely through modern internal medicine texts. The only point

to determine in this narrow debate is what was intended in the original

text vis a vis daily dosage. One pack for one day at doses listed;

anything else would really be counterintuitive anyway. Now ye tian shi

was famous for his low doses, while others for famous for their high

doses. The point is how does one interpret a text in front of them

today. If you think the author intended his dose listing to be for one

pack for two days, I think you are wrong. I have contacted the authors

of numerous texts such as Giovanni, Sionneau, Flaws, Bensky. They all

assert that the intention of the source texts they derive their work

from was one pack for one day at doses listed. Steve Clavey uses packs

for about 1.5 days according to his CHA lecture last year, but his

reported dosages are about 50% higher than mine, so its a wash.

 

This does not mean that it is not OK to use lower doses than in the

text or to use a pack for 1.5-2 days. That is the herbalist's

prerogative. However it is also incumbent upon us to know what we are

doing. If you use formulas listed in modern internal med texts at one

pack for two days, no matter how you cook it, you are underdosing the

patient relative to the text's instructions. It is fine to purposely

choose to do this for whatever reason (age, infirmity, etc.), but I

would say it borders on malpractice if one believes that this is what

the texts are directing as standard practice (1 pack/2 days). You need

to first understand what is a standard daily dosage and then make

rational adjustments from there. We certainly don't want our MD's

playing fast and loose with our drug dosages. And don't even bother to

say that we can never get precision with herbs, so this point is moot.

For one thing, we can indeed get precision dose using modern

technology. Honso does. For another, I am not talking about

precision, just reasonable ranges. While herbs do vary from lot to

lot, if one batch is truly 100% more potent than another, we have a

problem. In any event, the herbalist still needs a reference range to

work from and needs to understand what that reference range means in

order to vary dosages based upon perceived qualitative differences in

herb batches. I assume the textbook dose is the based upon a sample of

typical quality. If you don't know that the daily dose of the typical

sample of herb X is 3-9 g/day, it does not matter if you can tell

whether a sample is more or less potent.

 

My only concern in this matter is that people make informed choices and

not think something they are doing is correct just because they think

so. Gather evidence and decide.

 

 

Chinese Herbs

 

 

FAX:

 

 

[Guest guest]

 

 

In PCOM's teaching clinic, and in your own private practice, is one pack of

bulk herbs given for one day? So, do patients walk out with 7 packs of tea

for a week? How much do they pay for this? Here, average cost is $8 per

pack. That would mean patients are paying $56 a week for herbs, or $240 a

month.

 

Julie Chambers

 

 

> I have never meant a single person who reads chinese or who has studied

> in China who would dispute exactly what is meant in internal medicine

> texts and cases histories throughout all of chinese history. The

> dosages listed for formulas dispensed in tea form are for one pack.

> One pack was typically dispensed for one day. I really think there is

> no possible refutation of this point.

[Guest guest]

, Julie Chambers <info@j...>

wrote:

>

>

> In PCOM's teaching clinic, and in your own private practice, is one

pack of

> bulk herbs given for one day? So, do patients walk out with 7 packs

of tea

> for a week? How much do they pay for this? Here, average cost is $8 per

> pack. That would mean patients are paying $56 a week for herbs, or

$240 a

> month.

>

> Julie Chambers

 

$8 is quite a cost per pack.

 

At PCOM, the packs are sold base on the number of herbs in a pack. If

there are 12 or less herbs, then it works out to $12 for 3 packs.

That lasts 6 full days. People often do not cook herbs as soon as

they go home, or on the day of their next appointment, so we generally

dish out 3 packs for a week.

 

I just got a 70g formula filled at a local herb shop here for $1.85

per pack. That's $5.55 for 3 packs. It had 11 herbs, so this is much

cheaper than the PCOM clinic. I intend on increasing the dose by 50%

if there are no problems with this first week's worth. Then, the 3

packs (about 105g per pack) will still be less than $9.00.

 

That is why I thought $8 per pack was really, really high because it

is even higher than the PCOM clinic, which is quite high compared to

local herbs shops which are still turning a profit and staying in

business.

 

Brian C. Allen

[Guest guest]

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

 

> That is why I thought $8 per pack was really, really high because it

> is even higher than the PCOM clinic, which is quite high compared to

> local herbs shops which are still turning a profit and staying in

> business.

 

When comparing PCOM's clinic to the local herb shop, it was for this

specific formula at 105g per pack. However, if the formula were 200g

per pack (100g per day), then if the formula had 12 or less herbs,

then the cost would be about the same between PCOM's clinic and the

local herb shop.

 

So, for formulas over 100g per day, PCOM's clinic is a good deal at

$12 for 1 week's worth.

 

Brian C. Allen

[Guest guest]

, Julie Chambers <info@j...>

wrote:

>

>

> In PCOM's teaching clinic, and in your own private practice, is one pack of

> bulk herbs given for one day? So, do patients walk out with 7 packs of tea

> for a week? How much do they pay for this? Here, average cost is $8 per

> pack. That would mean patients are paying $56 a week for herbs, or $240 a

> month.

 

 

 

No, I sell 2 day packs. And our 2 day packs of 12 herbs or less at PCOM are

$13 for three packs or $52 a month. But the real cost of goods sold versus the

price charged to patient should really have nothing to do with the number of

packs. It is determined from the total weight of the herbs. This idea of

selling by the pack is not smart business and I never did it inprivate practice

or at OCOM..

 

I recently saw an herb invoice from mayway for 300 herbs at 1 pound each.

Total cost was $1600 or about $5.35 per pound on average (about 1.2 cents per

gram). If you sell herbs for about $11 per pound on average (2.4 cents per

gram), you make a fair profit. At 600 grams for 6 days (typical weekly

dispensed amount by me), the patient cost would be $14.50.

 

But still this was not the point of my post. The herb supplier at PCOM, a nice

chinese woman, often complains about my high herb doses because she has to

resupply more often and it lowers overall profit margins because of the pack

pricing scheme. However when queried, she is admits that my style of dosing

is more in line with chinese tradition. She just thinks its too expensive for

americans with herb prices here. While the cost of herbs is a major concern

to me, I still maintain the crux of this argument is what is meant in standard

texts. One can't even make a rational decision about adjusting dosage to

control costs if one doesn't know what dosage was intended in the first place.

If we are going to use lower doses than recommended in our books becuase we

are concerned about cost, why not let the patient decide. I often give patients

options with different costs and different expected outcomes. Some are

willing to pay. Others not. But it would be inappropriate for me to deliver

other than standard care unless the fully informed patient has economic

hardship and thus has no choice.

 

[Guest guest]

Brian, I think $8 per pack is high too. We all know what our cost is from

Mayway, and $8 is certainly a healthy profit. I do not charge $8, but I know

private practitioners who do. The point is, even $6 per pack, if you give

one pack per day, is $42 per week for herbs. That's not affordable for most

people.

 

Julie

 

 

-

" bcataiji " <bcaom

 

Monday, April 05, 2004 1:18 PM

Re: dosage standards

 

 

> , Julie Chambers <info@j...>

> wrote:

> >

> >

> > In PCOM's teaching clinic, and in your own private practice, is one

> pack of

> > bulk herbs given for one day? So, do patients walk out with 7 packs

> of tea

> > for a week? How much do they pay for this? Here, average cost is $8 per

> > pack. That would mean patients are paying $56 a week for herbs, or

> $240 a

> > month.

> >

> > Julie Chambers

>

> $8 is quite a cost per pack.

>

> At PCOM, the packs are sold base on the number of herbs in a pack. If

> there are 12 or less herbs, then it works out to $12 for 3 packs.

> That lasts 6 full days. People often do not cook herbs as soon as

> they go home, or on the day of their next appointment, so we generally

> dish out 3 packs for a week.

>

> I just got a 70g formula filled at a local herb shop here for $1.85

> per pack. That's $5.55 for 3 packs. It had 11 herbs, so this is much

> cheaper than the PCOM clinic. I intend on increasing the dose by 50%

> if there are no problems with this first week's worth. Then, the 3

> packs (about 105g per pack) will still be less than $9.00.

>

> That is why I thought $8 per pack was really, really high because it

> is even higher than the PCOM clinic, which is quite high compared to

> local herbs shops which are still turning a profit and staying in

> business.

>

> 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]

Todd-

 

>I recently saw an herb invoice from mayway for 300 herbs at 1 pound each.

>Total cost was $1600 or about $5.35 per pound on average (about 1.2 cents per

>gram). If you sell herbs for about $11 per pound on average (2.4 cents per

>gram), you make a fair profit. At 600 grams for 6 days (typical weekly

>dispensed amount by me), the patient cost would be $14.50.

 

At the Chicago PCOM campus we charge $0.03 per gram in general for

our formulations with certain herbs (like ren shen) going for a

higher rate.

 

-Steve

--

Stephen Bonzak

<smb021169

[Guest guest]

 

 

What is a 2-day pack? Is it about 200 grams of herbs?

 

The only reason I price " per pack " is for my ease...I figured out that my

average cost is $6.00 per pound (based on my original order of over 300

herbs), and if my packs vary in weight and expense of ingredients, I still

feel that overall I am making out OK. Versus weighing each pack and charging

by weight? or, heaven help me, charging based on the cost of ingredients?

Speaking of which, does anyone know why Kuan Dong Hua is so expensive all of

a sudden? Almost $20/pound.

 

Back to the real issue, though, I still don't know if you are prescribing

based on the notion that dosages (in Bensky) are meant for a one-day supply?

If so, I assume your 2-day pack is, as I suggested, about 200 grams?

 

Julie

>

>

> No, I sell 2 day packs. And our 2 day packs of 12 herbs or less at PCOM

are

> $13 for three packs or $52 a month. But the real cost of goods sold

versus the

> price charged to patient should really have nothing to do with the number

of

> packs. It is determined from the total weight of the herbs. This idea of

> selling by the pack is not smart business and I never did it inprivate

practice

> or at OCOM..

>

> I recently saw an herb invoice from mayway for 300 herbs at 1 pound each.

> Total cost was $1600 or about $5.35 per pound on average (about 1.2 cents

per

> gram). If you sell herbs for about $11 per pound on average (2.4 cents

per

> gram), you make a fair profit. At 600 grams for 6 days (typical weekly

> dispensed amount by me), the patient cost would be $14.50.

>

> But still this was not the point of my post. The herb supplier at PCOM, a

nice

> chinese woman, often complains about my high herb doses because she has to

> resupply more often and it lowers overall profit margins because of the

pack

> pricing scheme. However when queried, she is admits that my style of

dosing

> is more in line with chinese tradition. She just thinks its too expensive

for

> americans with herb prices here. While the cost of herbs is a major

concern

> to me, I still maintain the crux of this argument is what is meant in

standard

> texts. One can't even make a rational decision about adjusting dosage to

> control costs if one doesn't know what dosage was intended in the first

place.

> If we are going to use lower doses than recommended in our books becuase

we

> are concerned about cost, why not let the patient decide. I often give

patients

> options with different costs and different expected outcomes. Some are

> willing to pay. Others not. But it would be inappropriate for me to

deliver

> other than standard care unless the fully informed patient has economic

> hardship and thus has no choice.

>