Guest guest Posted May 10, 2005 Report Share Posted May 10, 2005 Hi All, I started this thread about granules (brand comparisons, experiences, etc.) awhile ago, and I meant to reply to this post specifically, because I was surprised at the dosages you give, Rich. Are other people using dosages this high on a regular basis? I learned a standard dose (for a whole formula) of 9g/day (usually 3g tid); this works out to about 54g/week, or about half what Rich is giving. Dosage seems to be one of those things that often a veil of mystery surrounding it. Anyone care to lift the veil? Nora P.S. I realized that my experience with KPC (which I mildly disparaged) was gathered in school (ACTCM), where we usually gave patients raw herbs (and they were usually compliant! - something I seem to have a harder time with now that I am in practice myself); so I realize I was bound to see them, at the time, in an unfavorable light compared to the vitality and efficacy of raw herb formulas. And I hardly ever remember having to give patients patents. richblit wrote: >I have been using KPC and Evergreen for a few years and I like them >both. The Evergreen granules dissolve more easily I find, but >Evergreen has stopped selling Ma Huang and Ban Xia so I still use >both companies. Evergreen's custmer service is also much better than >4 Seasons which sells KPC. >Has anyone done a thorough price comparison on the other brands? If >so I'd like to know since the cost can be prohibitive for some >patients. Also what markup are people using? I use an 80% and >normally give about 100-140g per week making the cost on average >between 20 and 25$. >Rich > > > > > > > >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 May 11, 2005 Report Share Posted May 11, 2005 > Dosage seems to be one of those things that often a veil of mystery > surrounding it. Anyone care to lift the veil? Taiwan produces most of the granules mentioned in this discussion, and the Taiwanese use granules more often than everyone else. Taiwanese hospital doctors generally dose between 5-6 g of powder TID. In other words, around 15-18 g a day, basically the same as Rich seems to indicate below. Taiwanese generally compound formulas and then add singles, which they regard as a more effective use of granules than building a formula from scratch. While we have the concept that herbs are standardized at a 5:1 extraction ratio, the actual ratio is much more varied. Some herbs have higher amounts of solutes that can be extracted, some require more starch to prevent clumping, etc. There is no across-the-board estimate that can be used to determine the exact concentration relative to crude drugs, although it can of course be done with isolated products. For research, companies cook an entire lot to order so that the source is identical. Natural products vary from batch to batch, since location, soil, harvesting time, and other factors influence the end product; this variance is not acceptable for studies so the factories cook special lots to order for research purposes. Eric , Nora <nora@h...> wrote: > Hi All, > > I started this thread about granules (brand comparisons, experiences, > etc.) awhile ago, and I meant to reply to this post specifically, > because I was surprised at the dosages you give, Rich. Are other people > using dosages this high on a regular basis? I learned a standard dose > (for a whole formula) of 9g/day (usually 3g tid); this works out to > about 54g/week, or about half what Rich is giving. > > Dosage seems to be one of those things that often a veil of mystery > surrounding it. Anyone care to lift the veil? > > Nora > > P.S. I realized that my experience with KPC (which I mildly disparaged) > was gathered in school (ACTCM), where we usually gave patients raw herbs > (and they were usually compliant! - something I seem to have a harder > time with now that I am in practice myself); so I realize I was bound to > see them, at the time, in an unfavorable light compared to the vitality > and efficacy of raw herb formulas. And I hardly ever remember having to > give patients patents. > > > richblit wrote: > > >I have been using KPC and Evergreen for a few years and I like them > >both. The Evergreen granules dissolve more easily I find, but > >Evergreen has stopped selling Ma Huang and Ban Xia so I still use > >both companies. Evergreen's custmer service is also much better than > >4 Seasons which sells KPC. > >Has anyone done a thorough price comparison on the other brands? If > >so I'd like to know since the cost can be prohibitive for some > >patients. Also what markup are people using? I use an 80% and > >normally give about 100-140g per week making the cost on average > >between 20 and 25$. > >Rich > > > > > > > > > > > > > > > >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 May 11, 2005 Report Share Posted May 11, 2005 > > > On Behalf Of Nora > Tuesday, May 10, 2005 10:05 PM > > Re: Granules - follow-up re: dosages > > Hi All, > > I started this thread about granules (brand comparisons, experiences, > etc.) awhile ago, and I meant to reply to this post specifically, > because I was surprised at the dosages you give, Rich. Are other people > using dosages this high on a regular basis? I learned a standard dose > (for a whole formula) of 9g/day (usually 3g tid); this works out to > about 54g/week, or about half what Rich is giving. > > Dosage seems to be one of those things that often a veil of mystery > surrounding it. Anyone care to lift the veil? [Jason] Hhhmmm.. lifting the veil... Unfortunately there is nothing underneath... Dosage is the magical question in CM and at least IMO there is no answer... For example I have 1 patient that I give 1 scoop every other day, and she does incredibly well, where others need anywhere from 10-20 grams a day. Some just 4 grams a day... The same is true for patents and raw. Some need a bag a day (100 grams), and some need 1 bag over 3 days... If anyone could ever figure out what kind of person needs what dosage ahead of time they would be my (and many others) HERO! But paying attention to how the patient reacts in the beginning helps to determine proper dose. I always start middle of the road, usually based on weight, disease (CC), and constitution.... Furthermore one's sensitivity to acupuncture seems not to correlate to their sensitivity to herbs. I have heard senior Chinese say all of this also. Just last month a very strong Chinese herbalist was telling me that he gives his patient 2 patent pills a day and anything more is too much. {BTW - this herbalist is a big time raw-head} --> It is one big mystery, such is life. But I think the real lesson here is flexibility. CM is about being able to use different tools for different situations... I am always skeptical when I see a practitioner ONLY gives large formulas or ONLY do deep needling, or ONLY do shallow needling or whatever... Different people require different approaches and the best doctors can go with the flow... It is so common to get stuck in one way (because one's teacher did it that way, or whatever)... but I think we live in a unique time, where our exposure to so many systems and styles can make us incredibly flexible and effective doctors if we can let go of the easily obtained pedantic-boxy views that like to latch on to the human mind... My 2 cent rant... - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2005 Report Share Posted May 12, 2005 Thank you Jason. Well said and reflected in my experience as well. In the words of Dr. Yat Ki Lai, the great( imho) Cantonese herbalist who taught at ACTCM in the early years, " In the crinical practice must be frexible! " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2005 Report Share Posted May 19, 2005 Thanks everyone who responded to this question. I especially wanted to thank you, Jason, for your valuable 2 cents; I had to laugh to myself when I read it: " What! Consider the patient when deciding on dosage! That's so...holistic! " Thanks for the wake-up; it's hard to trust my intuition/analysis of such things when I don't have much experience behind me, and not want a pat answer - but of course the pat answer wouldn't be chinese medicine. I'm very grateful to folks on the list for sharing the wisdom of their experiences, the different perspectives they were taught, etc. cheers, Nora P.S. Speaking of different ways we obtain information, I'm reading (well, listening to) " Blink " by Malcolm Gladwell; I'm sure most folks are familiar with it but it's an interesting read, and is making me think quite a bit about how I do/do not " thin slice " patients...and about objectivity, measurement, knowledge in general, etc. Plus he has an interesting bit where he discusses the research about who gets sued for malpractice, and how that can inform physician/patient interactions. wrote: > > >> >> >> On Behalf Of Nora >>Tuesday, May 10, 2005 10:05 PM >> >>Re: Granules - follow-up re: dosages >> >>Hi All, >> >>I started this thread about granules (brand comparisons, experiences, >>etc.) awhile ago, and I meant to reply to this post specifically, >>because I was surprised at the dosages you give, Rich. Are other people >>using dosages this high on a regular basis? I learned a standard dose >>(for a whole formula) of 9g/day (usually 3g tid); this works out to >>about 54g/week, or about half what Rich is giving. >> >>Dosage seems to be one of those things that often a veil of mystery >>surrounding it. Anyone care to lift the veil? >> >> >[Jason] >Hhhmmm.. lifting the veil... Unfortunately there is nothing underneath... >Dosage is the magical question in CM and at least IMO there is no answer... >For example I have 1 patient that I give 1 scoop every other day, and she >does incredibly well, where others need anywhere from 10-20 grams a day. >Some just 4 grams a day... The same is true for patents and raw. Some need >a bag a day (100 grams), and some need 1 bag over 3 days... If anyone could >ever figure out what kind of person needs what dosage ahead of time they >would be my (and many others) HERO! But paying attention to how the patient >reacts in the beginning helps to determine proper dose. I always start >middle of the road, usually based on weight, disease (CC), and >constitution.... Furthermore one's sensitivity to acupuncture seems not to >correlate to their sensitivity to herbs. I have heard senior Chinese say >all of this also. Just last month a very strong Chinese herbalist was >telling me that he gives his patient 2 patent pills a day and anything more >is too much. {BTW - this herbalist is a big time raw-head} --> It is one >big mystery, such is life. But I think the real lesson here is flexibility. >CM is about being able to use different tools for different situations... I >am always skeptical when I see a practitioner ONLY gives large formulas or >ONLY do deep needling, or ONLY do shallow needling or whatever... Different >people require different approaches and the best doctors can go with the >flow... It is so common to get stuck in one way (because one's teacher did >it that way, or whatever)... but I think we live in a unique time, where our >exposure to so many systems and styles can make us incredibly flexible and >effective doctors if we can let go of the easily obtained pedantic-boxy >views that like to latch on to the human mind... My 2 cent rant... > >- > > > > > > > >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...
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