RE: Book Revw: CMHP and drug-herb interactions

[Guest guest]

The reason that " herb/drug interactions are a hot topic, there is scanty hard

data " , as you point out below, is that the people who report these interactions

often do not have an explicit mathematical concept of what an interaction is.

Linear addition of effects is not interaction in the strict sense. For example,

many of the so-called " synergistic " effects that people talk about are mostly

simple additive effects. A true synergistic effect is where the net effect of

two herbs is more than the sum of either taken separately. The magnitude of most

Chinese herbal formulas can be understood using a simple summation of effects,

without resorting to synergism or non-linear antagonisms, although I'm sure that

will disappoint marketing types who like to use the word synergy a lot because

it sounds impressive.

 

Before any study of synergies or adverse interactions can be done, these things

need to be defined mathematically, so that they can be measured and quantified,

as I've done in the following article:

 

http://www.rmhiherbal.org/review/2004-3.html

 

Anthing short of this will only prolong the confusion and allow people to scare

the public with the threats of unpredictable interactions, when I believe that

most of these incidents are not true interactions at all, but a simple failure

to apply the complete sets of TCM indications and contraindications to a given

situation.

 

Any practitioner or researcher who labels a drug-herb adverse effect as an

interaction, when in reality the mishap was due to simple ignorance and failure

to read and understand available information, is a disservice to the herbal

community.

 

There is a downside to herbalists using the word synergy too much, because it

implies myterious non-linear effects between two herbs that cannot be predicted

by ordinary additive effects. When these effects are desirable, then everyone

seems happy and impressed. However, if one exaggerates the importance of true

synergisms, then one should logically expect herbal critics to exaggerate the

importance of drug-herb interactions, because they are really the same

phenomenon.

 

In reality, I suspect both aspects are overblown for propaganda purposes.

 

 

 

> Sat, 1 May 2004 17:10:54 -0700

> Al Stone <alstone

>Book Review: Chinese Medical Herbology and Pharmacology

>

>Chinese Medical Herbology and Pharmacology

>By John K. Chen, Tina T. Chen, with Laraine Crampton

>Art of Medicine Press, Inc. City of Industry, CA USA. 1327 pp

>ISBN: 0-9740635-0-9

>

>Reviewed by

>

>INTRODUCTION

>

>Chinese Medical Herbology and Pharmacologyís (henceforth ìCMHPî)

>appears to be an amalgamation of author John Chen's background as an

>instructor of both TCM herbology and Western pharmacology. CMHPís

>greatest strength in real terms is likely its educational value. As a

>teaching text, its organization, introductions and summaries make this

>is a wonderful book for both teachers and students, but what makes CMHP

 

>unique is its focus on herb/drug interactions and biomedical mechanisms

>for the actions of the TCM herbs.

>

>HERB/DRUG INTERACTIONS

>

>When it comes to herb/drug interactions, CMHP has done an admirable job

>of introducing the subject and giving TCM practitioners plenty to think

>about, however hard evidence is lacking. This lack is not the fault of

>the CMHP authors, but it needs to be understood at the outset that

>although herb/drug interactions are a hot topic, there is scanty hard

>data. What we have here is an author who straddles both the world of

>TCM herbology and western pharmacology pointing us toward the most

>likely interaction issues and in some cases documented observations of

>adverse events.

>

 

 

 

 

---Roger Wicke, PhD, TCM Clinical Herbalist

contact: www.rmhiherbal.org/contact/

Rocky Mountain Herbal Institute, Hot Springs, Montana USA

Clinical herbology training programs - www.rmhiherbal.org

[Guest guest]

I suppose some day I'll buy the Chen book. One thing I don't like about it is

that too

many of the research reports are over 20 years old. I have a feeling that the

mid-80's

were that a great period of science in China.

As per Todd's synergistic comments, the one " interaction " I know of is indeed

Chai Hu

that is indeed the culprit in Xiao Chai Hu Tang interferon deaths. (see Al's

review)

Chai Hu has the same actions of raising natural interferon levels causing an

overdose

of interferon. It's as if the patient doubled or tripled (?) their daily dosage

of the drug.

Despite this there are very few if anybody " overdosing " on Chai Hu alone.

Western

science has a lot of catching up to do.

doug

 

 

, rw2@r... wrote:

>

> The reason that " herb/drug interactions are a hot topic, there is scanty hard

> data " , as you point out below, is that the people who report these

interactions often

do not have an explicit mathematical concept of what an interaction is. Linear

addition of effects is not interaction in the strict sense. For example, many of

the so-

called " synergistic " effects that people talk about are mostly simple additive

effects. A

true synergistic effect is where the net effect of two herbs is more than the

sum of

either taken separately. The magnitude of most Chinese herbal formulas can be

understood using a simple summation of effects, without resorting to synergism

or

non-linear antagonisms, although I'm sure that will disappoint marketing types

who

like to use the word synergy a lot because it sounds impressive.

>

> Before any study of synergies or adverse interactions can be done, these

things

need to be defined mathematically, so that they can be measured and quantified,

as

I've done in the following article:

>

> http://www.rmhiherbal.org/review/2004-3.html

>

> Anthing short of this will only prolong the confusion and allow people to

scare the

public with the threats of unpredictable interactions, when I believe that most

of

these incidents are not true interactions at all, but a simple failure to apply

the

complete sets of TCM indications and contraindications to a given situation.

>

> Any practitioner or researcher who labels a drug-herb adverse effect as an

interaction, when in reality the mishap was due to simple ignorance and failure

to

read and understand available information, is a disservice to the herbal

community.

>

> Rocky Mountain Herbal Institute, Hot Springs, Montana USA

> Clinical herbology training programs - www.rmhiherbal.org

[Guest guest]

, " " wrote:

 

> As per Todd's synergistic comments,

>

>

> , rw2@r... wrote:

> >

For example, many of the so-

> called " synergistic " effects that people talk about are mostly simple

additive effects.

 

 

I think Roger said the above.

 

[Guest guest]

Roger

 

Your model proposes that summation of anticoagulant effects when

combining warfarin and dan shen are more correctly described as

overdosage than interaction. That interaction as a term should be

limited to unexpected effects. We can easily handle the dan

shen/warfarin situation with dosage and monitoring. A true interaction

would be one that caused bleeding where no effects on the blood were

expected. Its like combining two hi BP drugs and the pt. developing

hypotension. This would not be characterized as an interaction, per

se, but rather a dosage problem. However it still an adverse event.

And I wonder what makes us look worse, that we can't predict or prevent

true novel interactions or we don't understand the the very basic

concepts of dosage and additive effects. If this model is accurate,

then there have actually been zero drug herb interactions with chinese

herbs worldwide.

 

On Sunday, May 2, 2004, at 08:41 AM, rw2 wrote:

 

> The reason that " herb/drug interactions are a hot topic, there is

> scanty hard

> data " , as you point out below, is that the people who report these

> interactions often do not have an explicit mathematical concept of

> what an interaction is. Linear addition of effects is not interaction

> in the strict sense. For example, many of the so-called " synergistic "

> effects that people talk about are mostly simple additive effects. A

> true synergistic effect is where the net effect of two herbs is more

> than the sum of either taken separately.

 

 

Chinese Herbs

 

 

FAX:

 

 

 

[Guest guest]

Roger

 

On Sunday, May 2, 2004, at 08:41 AM, rw2 wrote:

 

>

> Before any study of synergies or adverse interactions can be done,

> these things need to be defined mathematically, so that they can be

> measured and quantified, as I've done in the following article:

>

>  

 

The only problem I see with your model is the complexity of the

mathematics are beyond the comprehension of just about everyone in the

field, including myself. while I am sure engineers would find what you

have laid out to be fairly straightforward, I have taken advanced math

classes and even do well in them and no amount of time would allow me

to follow your equations. However I think those making the decisions

in his area should be capable of just such understanding and clearly

they are not. I know accreditors, regulators and school administrators

do not have the skills to follow your modeling. I plan to run it past

my pharmacology professor. But this is just another example that the

main problem we have in lawmaking is evidence and rationale are not the

basis. It still all ass kissing and back room deals.

 

 

Chinese Herbs

 

 

FAX: