RE: Digest Number 2774 - 5:1 powder dose help needed

[Guest guest]

Hi all,

 

Sorry for the belated response. I was out of the office, but I wanted to

respond a bit to the questions on 5:1 extract powders, if anyone is still

interested. My name is Laura Stropes, and I am an herbal consultant with

Mayway.

 

1. Why is a standard dose suggested for 5:1 extract powder formulas, instead

of just dividing a raw herb dose by 5?

 

As it was mentioned previously, extract powders in Taiwan are usually given

in a dose of 18 grams per day, regardless of how many herbs are in the

formula. This is because creating formulas using concentrated extracts is

more like making pills or tinctures; instead of each herb having a daily

dosage, a ratio of herbs is used.

 

For example, when we prescribe a small raw formula like Er Chen Tang (4

herbs) using single raw herbs, we might use a total of 30 grams per day,

boiled down to a cup of liquid. When we prescribe a large raw formula like

Tian Wang Bu Xin Dan (14 herbs), we might prescribe 90 grams per day, boiled

down to a cup of liquid. With either formula, the patient will cook and

drink approximately the same amount of liquid per day. The ratio of herbs in

the liquid is not predetermined or measured, only a greater or smaller

number of herbs.

 

In a raw herb formula, no matter how many herbs you add, the patient will

probably end up drinking about the same amount of liquid decoction. If you

prescribed 4 herbs and had your patient drink 2 cups of decoction per day,

would it then follow that for a prescription of 20 herbs you would have them

drink 8 cups per day? This wouldn't make sense. With raw herb decoctions a

practitioner can add an almost unlimited number of herbs and end up with the

same amount of liquid that a patient has to drink per day. The practitioner

doesn't think about how much liquid they want to end up with, but rather

which herbs, and at what dosages.

 

Conversely, writing formulas using extract powders is like making pills,

which are prepared based on a ratio of herbs. Rather than determining the

dosage/weight of each herb first, as we would with single raw herbs, we

determine the total quantity of extract powder formula we want, and then

figure out what percentage of that total each single herb should be. I have

included an example at the bottom, for those who are interested.

 

Check out the labels on your KPC or QualiHerb or Mayway extract powder

formulas, because this is exactly how they are formulated. Just like

teapills.

 

2. What sort of fillers do extract powders have?

 

Many companies use pharmaceutical starch, sometimes as much as 40-60%.

Mayway does not use any starch, but does use up to 30% of carriers such as

dextrin or microcrystalline cellulose for difficult to extract mineral herbs

such as Shi Gao or Hua Shi. A Whole Foods description of dextrin and

microcrystalline cellulose:

http://www.wholefoodsmarket.com/healthinfo/excipients.html

In making an extract powder the herbal decoction is blended with a small

amount of raw herb powder and then spray dried by itself (no filler) or with

a carrier (0-30%) such as dextrin or microcrystalline cellulose (For more

info see here: http://www.mayway.com/general/qa_chinese_medicine_powder.htm)

 

Unfortunately, as someone mentioned previously, some herbs tend to harden

easily, making them less usable. Our CEO at Mayway insists that the 5:1

extract need to remain almost free of any fillers, but some herbs really do

need fillers in order to remain free-flowing powders. The answer? Not easy,

but I think we need to find an acceptable method of preserving the usability

of the herbs while keeping them as pure as possible. Obviously this is why

many companies use pharmaceutical starch.

 

I realize that I am not really addressing the issue of minerals and other

materials that are extremely difficult to extract, or pulpy fruits that

consistently create more than a 5:1 extract. I can discuss these questions

with the CEO of Mayway, and try to get some answers back to you if you are

still interested.

 

I can be reached by e-mail on Monday, Tuesday and Friday, and would be happy

to answer any other questions about extract powders to the best of my

ability.

 

Sincerely,

 

Mayway Corporation

1338 Mandela Parkway

Oakland, CA 94607

Tel. 510-208-3113, ext. 8138

Fax 510-208-3070

www.mayway.com

 

For example, in each Er Chen Wan pill each of the four ingredients would

make up close to 25% of the pill, whereas in each Tian Wang Bu Xin Dan pill

each of the fourteen ingredients would make up closer to 7% of the pill. (Of

course this is just a rough estimate, not taking into account the chief

herbs being dosed higher, etc.)

 

Determining the dosages within an extract powder formula requires

translation of the dosages from a raw herb formula into a ratio, to

determine the dosage/weight of each ingredient in the extract powder

formula. So with our Er Chen Wan example, we would start with the raw herb

formula:

Ban Xia 9g (3 qian)

Chen Pi 6g (2 qian)

Fu Ling 9g (3 qian)

Gan Cao 3g (1 qian)

= 27g (9 qian)

 

Then we would figure out how many days and at what dosage we want to

administer the formula for. Say we wanted to administer a dose of 18g/day

(higher than typical dosages used by most US practitioners) for 15 days. We

would need to end up with 270g total. So we divide the extract powder total

by the raw herb total (270 divided by 27) and get our ratio, 10. Then we

just multiply each of the herbs in the formula by that ratio:

 

Ban Xia = 9g in Raw Herb Rx times Ratio (10) = 90g

Chen Pi = 6g in Raw Herb Rx times Ratio (10) = 60g

Fu Ling = 9g in Bulk Herb Rx times Ratio (10) = 90g

Gan Cao = 3g in Bulk Herb Rx times Ratio (10) = 30g

= 270g

--

 

 

Version: 7.1.385 / Virus Database: 268.3.5/301 - Release 4/4/2006

[Guest guest]

, " Laura Stropes "

<laurastropes wrote:

>

> Hi all,

>

> Sorry for the belated response. I was out of the office, but I

wanted to

> respond a bit to the questions on 5:1 extract powders, if anyone

is still

> interested. My name is Laura Stropes, and I am an herbal

consultant with

> Mayway.

 

Thanks, Laura, for the information. I'm still not certain that I

understand / believe what you say about dosing.

 

A large formula, say 20 herbs totalling 250g, decocted down to 2

cups of liquid, should have far more solute (I think I have the

right word) in that liquid than a small formula would, say 4 herbs

totaling 30g. With so much more solute, wouldn't there be

more " stuff " with which to make the powder?

 

And then what about custom formulas where powders of single herbs

are combined. The single herbs are getting decocted relatively the

same way, so there shouldn't be that much difference.

 

So, if I use individual herb powders (rather than the ready made

formula powder) to make er chen tang, why would I give the same

exact dose as if I used individual herb powders to make liu jun zi

tang which contains er chen tang plus additional ingredients. The

same could be said for ban xia huo po tang and huo xiang zheng qi

tang.

 

Again, thanks for the information.

 

Brian C. Allen

[Guest guest]

>

>

> On Behalf Of Laura Stropes

> Tuesday, April 04, 2006 11:46 AM

>

> RE: Digest Number 2774 - 5:1 powder dose help needed

>

> Hi all,

>

> Sorry for the belated response. I was out of the office, but I wanted to

> respond a bit to the questions on 5:1 extract powders, if anyone is still

> interested. My name is Laura Stropes, and I am an herbal consultant with

> Mayway.

>

> 1. Why is a standard dose suggested for 5:1 extract powder formulas,

> instead

> of just dividing a raw herb dose by 5?

>

> As it was mentioned previously, extract powders in Taiwan are usually

> given

> in a dose of 18 grams per day, regardless of how many herbs are in the

> formula. This is because creating formulas using concentrated extracts is

> more like making pills or tinctures; instead of each herb having a daily

> dosage, a ratio of herbs is used.

>

> For example, when we prescribe a small raw formula like Er Chen Tang (4

> herbs) using single raw herbs, we might use a total of 30 grams per day,

> boiled down to a cup of liquid. When we prescribe a large raw formula like

> Tian Wang Bu Xin Dan (14 herbs), we might prescribe 90 grams per day,

> boiled

> down to a cup of liquid. With either formula, the patient will cook and

> drink approximately the same amount of liquid per day. The ratio of herbs

> in

> the liquid is not predetermined or measured, only a greater or smaller

> number of herbs.

>

> In a raw herb formula, no matter how many herbs you add, the patient will

> probably end up drinking about the same amount of liquid decoction. If you

> prescribed 4 herbs and had your patient drink 2 cups of decoction per day,

> would it then follow that for a prescription of 20 herbs you would have

> them

> drink 8 cups per day? This wouldn't make sense. With raw herb decoctions a

> practitioner can add an almost unlimited number of herbs and end up with

> the

> same amount of liquid that a patient has to drink per day. The

> practitioner

> doesn't think about how much liquid they want to end up with, but rather

> which herbs, and at what dosages.

>

> Conversely, writing formulas using extract powders is like making pills,

> which are prepared based on a ratio of herbs. Rather than determining the

> dosage/weight of each herb first, as we would with single raw herbs, we

> determine the total quantity of extract powder formula we want, and then

> figure out what percentage of that total each single herb should be. I

> have

> included an example at the bottom, for those who are interested.

>

> Check out the labels on your KPC or QualiHerb or Mayway extract powder

> formulas, because this is exactly how they are formulated. Just like

> teapills.

>

 

Laura,

 

Thanx for chiming in and expounding on some of these difficult issues. But

I am having a bit of difficulty following your logic. It sounds like you

are saying that no matter what the granular formula is, one should prescribe

18g /day. This makes little sense when comparing it to raw formulas. But I

guess you are saying you prefer to think of them like tea pills (which have

limited therapeutic effect IMO). It seems to me that you basically saying

the dosage doesn't really matter and it all comes down to ratio. Again this

makes little sense... Let me explain further.

 

You compare this (your above) method of thinking to the supposed method of

making a raw decoction. Meaning no matter how many herbs you still boil the

herbs into the same amount of cups to drink over a day. If there are 4 herbs

you boil down to 2 cups (/ day) , and if you have 14 cups you boil to 2 cups

(/day) - That is correct! But what seems to be overlooked is that the amount

of constituents consumed from 150 grams of herbs versus 40 grams is

astronomically greater.

 

Simple example -

 

If one gives a raw decoction of si wu tang (40 grams) one is delivering i.e.

10 grams of dang gui (etc). {assuming an equal split among herbs}

 

If one gives a decoction xue fu zhu yu tang (75 grams) one is still

delivering 10 grams of dang gui.

SAME AMOUNT OF DANG GUI for the patient.

 

 

But if you give 18g granular of si wu tang and 18g granular of xue fu zhu yu

tang. You are delivering very different doses of dang gui.

 

1) In si wu tang - dang gui is 25% of the Rx. And with 18 grams you have

4.5 grams of granular dang gui. - (with a 5:1 ratio) we are talking about

22.5 grams of dang gui. This is then overdosing quite a bit as compared to

a decoction.

2) In xue fu zhu yu tang - dang gui makes up 12% of the Rx. -with 18g

(total) you then deliver 2.16g of dang gui - with a translation to 10.8

grams of dang gui - This is very close to the decoction.

 

Very different end results.

 

Therefore it is very clear that depending on the original formula's dosage

one should adjust their granular dosage accordingly. For example to equal a

siwutang decoction, one would prescribe about 8 grams of granular. Anything

otherwise it a very different medicine than prescribing raw herbs - and one

loses major control over dosage in general when one creates their own

granular formuals. Maybe that is your point. But with the above example.

Giving 18g of granular siwutang is like giving over 2 times the normal dose

(from a decoction perspective)... What if you have a small # of ingredient

formula with xixin?

 

I think 18g across the board for any formula is lazy and makes little sense

to me... Just because something is occurring in Taiwan does not make it

good medicine.

 

Could someone explain what I may have missed? Thanx,

 

-Jason

[Guest guest]

Jason

In Taiwan they basically mix formulas and that is why they can have a standard

dose. The entire formulae is cooked together to form a fixed unit.

 

 

 

 

Oakland, CA 94609

 

 

-

Tuesday, April 04, 2006 7:09 PM

RE: Digest Number 2774 - 5:1 powder dose help needed

 

 

 

 

>

>

> On Behalf Of Laura Stropes

> Tuesday, April 04, 2006 11:46 AM

>

> RE: Digest Number 2774 - 5:1 powder dose help needed

>

> Hi all,

>

> Sorry for the belated response. I was out of the office, but I wanted to

> respond a bit to the questions on 5:1 extract powders, if anyone is still

> interested. My name is Laura Stropes, and I am an herbal consultant with

> Mayway.

>

> 1. Why is a standard dose suggested for 5:1 extract powder formulas,

> instead

> of just dividing a raw herb dose by 5?

>

> As it was mentioned previously, extract powders in Taiwan are usually

> given

> in a dose of 18 grams per day, regardless of how many herbs are in the

> formula. This is because creating formulas using concentrated extracts is

> more like making pills or tinctures; instead of each herb having a daily

> dosage, a ratio of herbs is used.

>

> For example, when we prescribe a small raw formula like Er Chen Tang (4

> herbs) using single raw herbs, we might use a total of 30 grams per day,

> boiled down to a cup of liquid. When we prescribe a large raw formula like

> Tian Wang Bu Xin Dan (14 herbs), we might prescribe 90 grams per day,

> boiled

> down to a cup of liquid. With either formula, the patient will cook and

> drink approximately the same amount of liquid per day. The ratio of herbs

> in

> the liquid is not predetermined or measured, only a greater or smaller

> number of herbs.

>

> In a raw herb formula, no matter how many herbs you add, the patient will

> probably end up drinking about the same amount of liquid decoction. If you

> prescribed 4 herbs and had your patient drink 2 cups of decoction per day,

> would it then follow that for a prescription of 20 herbs you would have

> them

> drink 8 cups per day? This wouldn't make sense. With raw herb decoctions a

> practitioner can add an almost unlimited number of herbs and end up with

> the

> same amount of liquid that a patient has to drink per day. The

> practitioner

> doesn't think about how much liquid they want to end up with, but rather

> which herbs, and at what dosages.

>

> Conversely, writing formulas using extract powders is like making pills,

> which are prepared based on a ratio of herbs. Rather than determining the

> dosage/weight of each herb first, as we would with single raw herbs, we

> determine the total quantity of extract powder formula we want, and then

> figure out what percentage of that total each single herb should be. I

> have

> included an example at the bottom, for those who are interested.

>

> Check out the labels on your KPC or QualiHerb or Mayway extract powder

> formulas, because this is exactly how they are formulated. Just like

> teapills.

>

 

Laura,

 

Thanx for chiming in and expounding on some of these difficult issues. But

I am having a bit of difficulty following your logic. It sounds like you

are saying that no matter what the granular formula is, one should prescribe

18g /day. This makes little sense when comparing it to raw formulas. But I

guess you are saying you prefer to think of them like tea pills (which have

limited therapeutic effect IMO). It seems to me that you basically saying

the dosage doesn't really matter and it all comes down to ratio. Again this

makes little sense... Let me explain further.

 

You compare this (your above) method of thinking to the supposed method of

making a raw decoction. Meaning no matter how many herbs you still boil the

herbs into the same amount of cups to drink over a day. If there are 4 herbs

you boil down to 2 cups (/ day) , and if you have 14 cups you boil to 2 cups

(/day) - That is correct! But what seems to be overlooked is that the amount

of constituents consumed from 150 grams of herbs versus 40 grams is

astronomically greater.

 

Simple example -

 

If one gives a raw decoction of si wu tang (40 grams) one is delivering i.e.

10 grams of dang gui (etc). {assuming an equal split among herbs}

 

If one gives a decoction xue fu zhu yu tang (75 grams) one is still

delivering 10 grams of dang gui.

SAME AMOUNT OF DANG GUI for the patient.

 

 

But if you give 18g granular of si wu tang and 18g granular of xue fu zhu yu

tang. You are delivering very different doses of dang gui.

 

1) In si wu tang - dang gui is 25% of the Rx. And with 18 grams you have

4.5 grams of granular dang gui. - (with a 5:1 ratio) we are talking about

22.5 grams of dang gui. This is then overdosing quite a bit as compared to

a decoction.

2) In xue fu zhu yu tang - dang gui makes up 12% of the Rx. -with 18g

(total) you then deliver 2.16g of dang gui - with a translation to 10.8

grams of dang gui - This is very close to the decoction.

 

Very different end results.

 

Therefore it is very clear that depending on the original formula's dosage

one should adjust their granular dosage accordingly. For example to equal a

siwutang decoction, one would prescribe about 8 grams of granular. Anything

otherwise it a very different medicine than prescribing raw herbs - and one

loses major control over dosage in general when one creates their own

granular formuals. Maybe that is your point. But with the above example.

Giving 18g of granular siwutang is like giving over 2 times the normal dose

(from a decoction perspective)... What if you have a small # of ingredient

formula with xixin?

 

I think 18g across the board for any formula is lazy and makes little sense

to me... Just because something is occurring in Taiwan does not make it

good medicine.

 

Could someone explain what I may have missed? Thanx,

 

-Jason

 

 

 

 

 

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]

Are we sure 18g/day prescription is so set and concrete in Taiwan?

My late teacher, Dr. Ma, Guang-Ya, who passed away only seven months ago,

doesn't give a fixed weight dose, and in fact, according to my memory, most of

his prescriptions use less than that, when he uses powders. Why is his practice

relevant here? He was the chairman of the CM department of the CM university for

more than ten years and authored several books. Most of the CM institution

leaders in Taiwan today are his students. He was among the first batch of

doctors who used powder granules when the first granule producing company

started offering it.

When I followed him, he often reminded me to use use only needed amount.

 

Mike L.

<alonmarcus wrote:

Jason

In Taiwan they basically mix formulas and that is why they can have a standard

dose. The entire formulae is cooked together to form a fixed unit.

 

 

 

 

Oakland, CA 94609

 

 

-

Tuesday, April 04, 2006 7:09 PM

RE: Digest Number 2774 - 5:1 powder dose help needed

 

 

 

 

>

>

> On Behalf Of Laura Stropes

> Tuesday, April 04, 2006 11:46 AM

>

> RE: Digest Number 2774 - 5:1 powder dose help needed

>

> Hi all,

>

> Sorry for the belated response. I was out of the office, but I wanted to

> respond a bit to the questions on 5:1 extract powders, if anyone is still

> interested. My name is Laura Stropes, and I am an herbal consultant with

> Mayway.

>

> 1. Why is a standard dose suggested for 5:1 extract powder formulas,

> instead

> of just dividing a raw herb dose by 5?

>

> As it was mentioned previously, extract powders in Taiwan are usually

> given

> in a dose of 18 grams per day, regardless of how many herbs are in the

> formula. This is because creating formulas using concentrated extracts is

> more like making pills or tinctures; instead of each herb having a daily

> dosage, a ratio of herbs is used.

>

> For example, when we prescribe a small raw formula like Er Chen Tang (4

> herbs) using single raw herbs, we might use a total of 30 grams per day,

> boiled down to a cup of liquid. When we prescribe a large raw formula like

> Tian Wang Bu Xin Dan (14 herbs), we might prescribe 90 grams per day,

> boiled

> down to a cup of liquid. With either formula, the patient will cook and

> drink approximately the same amount of liquid per day. The ratio of herbs

> in

> the liquid is not predetermined or measured, only a greater or smaller

> number of herbs.

>

> In a raw herb formula, no matter how many herbs you add, the patient will

> probably end up drinking about the same amount of liquid decoction. If you

> prescribed 4 herbs and had your patient drink 2 cups of decoction per day,

> would it then follow that for a prescription of 20 herbs you would have

> them

> drink 8 cups per day? This wouldn't make sense. With raw herb decoctions a

> practitioner can add an almost unlimited number of herbs and end up with

> the

> same amount of liquid that a patient has to drink per day. The

> practitioner

> doesn't think about how much liquid they want to end up with, but rather

> which herbs, and at what dosages.

>

> Conversely, writing formulas using extract powders is like making pills,

> which are prepared based on a ratio of herbs. Rather than determining the

> dosage/weight of each herb first, as we would with single raw herbs, we

> determine the total quantity of extract powder formula we want, and then

> figure out what percentage of that total each single herb should be. I

> have

> included an example at the bottom, for those who are interested.

>

> Check out the labels on your KPC or QualiHerb or Mayway extract powder

> formulas, because this is exactly how they are formulated. Just like

> teapills.

>

 

Laura,

 

Thanx for chiming in and expounding on some of these difficult issues. But

I am having a bit of difficulty following your logic. It sounds like you

are saying that no matter what the granular formula is, one should prescribe

18g /day. This makes little sense when comparing it to raw formulas. But I

guess you are saying you prefer to think of them like tea pills (which have

limited therapeutic effect IMO). It seems to me that you basically saying

the dosage doesn't really matter and it all comes down to ratio. Again this

makes little sense... Let me explain further.

 

You compare this (your above) method of thinking to the supposed method of

making a raw decoction. Meaning no matter how many herbs you still boil the

herbs into the same amount of cups to drink over a day. If there are 4 herbs

you boil down to 2 cups (/ day) , and if you have 14 cups you boil to 2 cups

(/day) - That is correct! But what seems to be overlooked is that the amount

of constituents consumed from 150 grams of herbs versus 40 grams is

astronomically greater.

 

Simple example -

 

If one gives a raw decoction of si wu tang (40 grams) one is delivering i.e.

10 grams of dang gui (etc). {assuming an equal split among herbs}

 

If one gives a decoction xue fu zhu yu tang (75 grams) one is still

delivering 10 grams of dang gui.

SAME AMOUNT OF DANG GUI for the patient.

 

 

But if you give 18g granular of si wu tang and 18g granular of xue fu zhu yu

tang. You are delivering very different doses of dang gui.

 

1) In si wu tang - dang gui is 25% of the Rx. And with 18 grams you have

4.5 grams of granular dang gui. - (with a 5:1 ratio) we are talking about

22.5 grams of dang gui. This is then overdosing quite a bit as compared to

a decoction.

2) In xue fu zhu yu tang - dang gui makes up 12% of the Rx. -with 18g

(total) you then deliver 2.16g of dang gui - with a translation to 10.8

grams of dang gui - This is very close to the decoction.

 

Very different end results.

 

Therefore it is very clear that depending on the original formula's dosage

one should adjust their granular dosage accordingly. For example to equal a

siwutang decoction, one would prescribe about 8 grams of granular. Anything

otherwise it a very different medicine than prescribing raw herbs - and one

loses major control over dosage in general when one creates their own

granular formuals. Maybe that is your point. But with the above example.

Giving 18g of granular siwutang is like giving over 2 times the normal dose

(from a decoction perspective)... What if you have a small # of ingredient

formula with xixin?

 

I think 18g across the board for any formula is lazy and makes little sense

to me... Just because something is occurring in Taiwan does not make it

good medicine.

 

Could someone explain what I may have missed? Thanx,

 

-Jason

 

 

 

 

 

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]

12g/day & veriaty in Taiwan..

 

Yes, Dr, Ma was a well-known doctor in Taiwan

 

Thank Mike

 

Christine

 

--- Mike Liaw <mikeliaw wrote:

 

> Are we sure 18g/day prescription is so set and

> concrete in Taiwan?

> My late teacher, Dr. Ma, Guang-Ya, who passed away

> only seven months ago, doesn't give a fixed weight

> dose, and in fact, according to my memory, most of

> his prescriptions use less than that, when he uses

> powders. Why is his practice relevant here? He was

> the chairman of the CM department of the CM

> university for more than ten years and authored

> several books. Most of the CM institution leaders in

> Taiwan today are his students. He was among the

> first batch of doctors who used powder granules when

> the first granule producing company started offering

> it.

> When I followed him, he often reminded me to use

> use only needed amount.

>

> Mike L.

> <alonmarcus wrote:

> Jason

> In Taiwan they basically mix formulas and that is

> why they can have a standard dose. The entire

> formulae is cooked together to form a fixed unit.

>

>

>

>

> Oakland, CA 94609

>

>

> -

>

>

> Tuesday, April 04, 2006 7:09 PM

> RE: Digest Number 2774 - 5:1 powder

> dose help needed

>

>

>

>

> >

> >

> > On

> Behalf Of Laura Stropes

> > Tuesday, April 04, 2006 11:46 AM

> >

> > RE: Digest Number 2774 - 5:1

> powder dose help needed

> >

> > Hi all,

> >

> > Sorry for the belated response. I was out of the

> office, but I wanted to

> > respond a bit to the questions on 5:1 extract

> powders, if anyone is still

> > interested. My name is Laura Stropes, and I am

> an herbal consultant with

> > Mayway.

> >

> > 1. Why is a standard dose suggested for 5:1

> extract powder formulas,

> > instead

> > of just dividing a raw herb dose by 5?

> >

> > As it was mentioned previously, extract powders

> in Taiwan are usually

> > given

> > in a dose of 18 grams per day, regardless of how

> many herbs are in the

> > formula. This is because creating formulas using

> concentrated extracts is

> > more like making pills or tinctures; instead of

> each herb having a daily

> > dosage, a ratio of herbs is used.

> >

> > For example, when we prescribe a small raw

> formula like Er Chen Tang (4

> > herbs) using single raw herbs, we might use a

> total of 30 grams per day,

> > boiled down to a cup of liquid. When we

> prescribe a large raw formula like

> > Tian Wang Bu Xin Dan (14 herbs), we might

> prescribe 90 grams per day,

> > boiled

> > down to a cup of liquid. With either formula,

> the patient will cook and

> > drink approximately the same amount of liquid

> per day. The ratio of herbs

> > in

> > the liquid is not predetermined or measured,

> only a greater or smaller

> > number of herbs.

> >

> > In a raw herb formula, no matter how many herbs

> you add, the patient will

> > probably end up drinking about the same amount

> of liquid decoction. If you

> > prescribed 4 herbs and had your patient drink 2

> cups of decoction per day,

> > would it then follow that for a prescription of

> 20 herbs you would have

> > them

> > drink 8 cups per day? This wouldn't make sense.

> With raw herb decoctions a

> > practitioner can add an almost unlimited number

> of herbs and end up with

> > the

> > same amount of liquid that a patient has to

> drink per day. The

> > practitioner

> > doesn't think about how much liquid they want to

> end up with, but rather

> > which herbs, and at what dosages.

> >

> > Conversely, writing formulas using extract

> powders is like making pills,

> > which are prepared based on a ratio of herbs.

> Rather than determining the

> > dosage/weight of each herb first, as we would

> with single raw herbs, we

> > determine the total quantity of extract powder

> formula we want, and then

> > figure out what percentage of that total each

> single herb should be. I

> > have

> > included an example at the bottom, for those who

> are interested.

> >

> > Check out the labels on your KPC or QualiHerb or

> Mayway extract powder

> > formulas, because this is exactly how they are

> formulated. Just like

> > teapills.

> >

>

> Laura,

>

> Thanx for chiming in and expounding on some of

> these difficult issues. But

> I am having a bit of difficulty following your

> logic. It sounds like you

> are saying that no matter what the granular

> formula is, one should prescribe

> 18g /day. This makes little sense when comparing

> it to raw formulas. But I

> guess you are saying you prefer to think of them

> like tea pills (which have

> limited therapeutic effect IMO). It seems to me

> that you basically saying

> the dosage doesn't really matter and it all comes

> down to ratio. Again this

> makes little sense... Let me explain further.

>

> You compare this (your above) method of thinking

> to the supposed method of

> making a raw decoction. Meaning no matter how

> many herbs you still boil the

> herbs into the same amount of cups to drink over a

> day. If there are 4 herbs

> you boil down to 2 cups (/ day) , and if you have

> 14 cups you boil to 2 cups

> (/day) - That is correct! But what seems to be

> overlooked is that the amount

> of constituents consumed from 150 grams of herbs

> versus 40 grams is

> astronomically greater.

>

> Simple example -

>

> If one gives a raw decoction of si wu tang (40

> grams) one is delivering i.e.

> 10 grams of dang gui (etc). {assuming an equal

> split among herbs}

>

> If one gives a decoction xue fu zhu yu tang (75

> grams) one is still

> delivering 10 grams of dang gui.

> SAME AMOUNT OF DANG GUI for the patient.

>

>

> But if you give 18g granular of si wu tang and 18g

> granular of xue fu zhu yu

> tang. You are delivering very different doses of

> dang gui.

>

> 1) In si wu tang - dang gui is 25% of the Rx. And

> with 18 grams you have

> 4.5 grams of granular dang gui. - (with a 5:1

> ratio) we are talking about

> 22.5 grams of dang gui. This is then overdosing

> quite a bit as compared to

> a decoction.

> 2) In xue fu zhu yu tang - dang gui makes up 12%

> of the Rx. -with 18g

> (total) you then deliver 2.16g of dang gui - with

> a translation to 10.8

> grams of dang gui - This is very close to the

> decoction.

>

> Very different end results.

>

>

=== message truncated ===

 

 

 

 

Christine Wei Chang, LAc, MTOM

BOD & Herbal Medicine Committee

American Association of Oriental Medicine (AAOM)

310-951-8698 (cel)

panasiaintl

 

" I think, therefore I am. "

[Guest guest]

Mike

Its not that the 18g/day is fixed. Its more about that the dosage is more based

on formula dosing that the combination of single herbs. Obviously not every pt

get 18g per day

 

 

 

 

Oakland, CA 94609

 

 

-

Mike Liaw

Tuesday, April 04, 2006 10:55 PM

Re: Digest Number 2774 - 5:1 powder dose help needed

 

 

Are we sure 18g/day prescription is so set and concrete in Taiwan?

My late teacher, Dr. Ma, Guang-Ya, who passed away only seven months ago,

doesn't give a fixed weight dose, and in fact, according to my memory, most of

his prescriptions use less than that, when he uses powders. Why is his practice

relevant here? He was the chairman of the CM department of the CM university for

more than ten years and authored several books. Most of the CM institution

leaders in Taiwan today are his students. He was among the first batch of

doctors who used powder granules when the first granule producing company

started offering it.

When I followed him, he often reminded me to use use only needed amount.

 

Mike L.

<alonmarcus wrote:

Jason

In Taiwan they basically mix formulas and that is why they can have a standard

dose. The entire formulae is cooked together to form a fixed unit.

 

 

Oakland, CA 94609

-

Tuesday, April 04, 2006 7:09 PM

RE: Digest Number 2774 - 5:1 powder dose help needed

 

 

 

 

>

>

> On Behalf Of Laura Stropes

> Tuesday, April 04, 2006 11:46 AM

>

> RE: Digest Number 2774 - 5:1 powder dose help needed

>

> Hi all,

>

> Sorry for the belated response. I was out of the office, but I wanted to

> respond a bit to the questions on 5:1 extract powders, if anyone is still

> interested. My name is Laura Stropes, and I am an herbal consultant with

> Mayway.

>

> 1. Why is a standard dose suggested for 5:1 extract powder formulas,

> instead

> of just dividing a raw herb dose by 5?

>

> As it was mentioned previously, extract powders in Taiwan are usually

> given

> in a dose of 18 grams per day, regardless of how many herbs are in the

> formula. This is because creating formulas using concentrated extracts is

> more like making pills or tinctures; instead of each herb having a daily

> dosage, a ratio of herbs is used.

>

> For example, when we prescribe a small raw formula like Er Chen Tang (4

> herbs) using single raw herbs, we might use a total of 30 grams per day,

> boiled down to a cup of liquid. When we prescribe a large raw formula like

> Tian Wang Bu Xin Dan (14 herbs), we might prescribe 90 grams per day,

> boiled

> down to a cup of liquid. With either formula, the patient will cook and

> drink approximately the same amount of liquid per day. The ratio of herbs

> in

> the liquid is not predetermined or measured, only a greater or smaller

> number of herbs.

>

> In a raw herb formula, no matter how many herbs you add, the patient will

> probably end up drinking about the same amount of liquid decoction. If you

> prescribed 4 herbs and had your patient drink 2 cups of decoction per day,

> would it then follow that for a prescription of 20 herbs you would have

> them

> drink 8 cups per day? This wouldn't make sense. With raw herb decoctions a

> practitioner can add an almost unlimited number of herbs and end up with

> the

> same amount of liquid that a patient has to drink per day. The

> practitioner

> doesn't think about how much liquid they want to end up with, but rather

> which herbs, and at what dosages.

>

> Conversely, writing formulas using extract powders is like making pills,

> which are prepared based on a ratio of herbs. Rather than determining the

> dosage/weight of each herb first, as we would with single raw herbs, we

> determine the total quantity of extract powder formula we want, and then

> figure out what percentage of that total each single herb should be. I

> have

> included an example at the bottom, for those who are interested.

>

> Check out the labels on your KPC or QualiHerb or Mayway extract powder

> formulas, because this is exactly how they are formulated. Just like

> teapills.

>

 

Laura,

 

Thanx for chiming in and expounding on some of these difficult issues. But

I am having a bit of difficulty following your logic. It sounds like you

are saying that no matter what the granular formula is, one should prescribe

18g /day. This makes little sense when comparing it to raw formulas. But I

guess you are saying you prefer to think of them like tea pills (which have

limited therapeutic effect IMO). It seems to me that you basically saying

the dosage doesn't really matter and it all comes down to ratio. Again this

makes little sense... Let me explain further.

 

You compare this (your above) method of thinking to the supposed method of

making a raw decoction. Meaning no matter how many herbs you still boil the

herbs into the same amount of cups to drink over a day. If there are 4 herbs

you boil down to 2 cups (/ day) , and if you have 14 cups you boil to 2 cups

(/day) - That is correct! But what seems to be overlooked is that the amount

of constituents consumed from 150 grams of herbs versus 40 grams is

astronomically greater.

 

Simple example -

 

If one gives a raw decoction of si wu tang (40 grams) one is delivering i.e.

10 grams of dang gui (etc). {assuming an equal split among herbs}

 

If one gives a decoction xue fu zhu yu tang (75 grams) one is still

delivering 10 grams of dang gui.

SAME AMOUNT OF DANG GUI for the patient.

 

 

But if you give 18g granular of si wu tang and 18g granular of xue fu zhu yu

tang. You are delivering very different doses of dang gui.

 

1) In si wu tang - dang gui is 25% of the Rx. And with 18 grams you have

4.5 grams of granular dang gui. - (with a 5:1 ratio) we are talking about

22.5 grams of dang gui. This is then overdosing quite a bit as compared to

a decoction.

2) In xue fu zhu yu tang - dang gui makes up 12% of the Rx. -with 18g

(total) you then deliver 2.16g of dang gui - with a translation to 10.8

grams of dang gui - This is very close to the decoction.

 

Very different end results.

 

Therefore it is very clear that depending on the original formula's dosage

one should adjust their granular dosage accordingly. For example to equal a

siwutang decoction, one would prescribe about 8 grams of granular. Anything

otherwise it a very different medicine than prescribing raw herbs - and one

loses major control over dosage in general when one creates their own

granular formuals. Maybe that is your point. But with the above example.

Giving 18g of granular siwutang is like giving over 2 times the normal dose

(from a decoction perspective)... What if you have a small # of ingredient

formula with xixin?

 

I think 18g across the board for any formula is lazy and makes little sense

to me... Just because something is occurring in Taiwan does not make it

good medicine.

 

Could someone explain what I may have missed? Thanx,

 

-Jason

 

 

 

 

 

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]

, " "

<alonmarcus wrote:

>

> Mike

> Its not that the 18g/day is fixed. Its more about that the dosage is

more based on formula dosing that the combination of single herbs.

Obviously not every pt get 18g per day

 

There is no fixed standard; there are not even any classes or books on

the subject at the present time. The dosing of granules in Taiwan is

generally derived from a practitioner's clinical experience and the

trends that they observed from their teachers. Feng Ye is teaching a

case-based class on granule dosing starting next week, so I can

hopefully gain more insights and have more comments about this topic

in the near future.

 

Many doctors use granules slightly differently, but there are general

trends that can be seen if one is studying in a large hospital and

observing many different doctors. Based on my experience, most

doctors use 6 g doses TID (18g/day), but some use less than this

(rarely have I seen doses below 4g TID, or 12g/day). National

insurance pays only up to 6g doses, so many doctors use 6 g doses,

which they increase to QID (24g/day) for acute or severe cases.

Singles are generally added at 0.3 g TID, but typically range between

0.1 and 0.5 g TID. Formulas are often done at 1.2 g TID, 2.4 g TID,

or 4.6 g TID, depending on whether the formula in question is a

principle or supportive component of the treatment.

 

Eric

[Guest guest]

, " "

<alonmarcus wrote:

>

> Eric

> These are usually mixed formulas with few additions, correct? they

are not single herbs made into formulas. I think there is a big

difference between the two. Since i use single herbs i tend to think

of them the same way i would if i use raw herbs. So its not uncommon

for me to give patients 12g TID.

 

Yes, they compound whole formulas and add in a few singles. Many

hospital doctors utilize the full insurance coverage and prescribe 6g

doses TID. Of this, perhaps 4.2 g will be formula A, 1.2 g will be

formula B, plus 0.3 g each of two single herb additions.

 

Eric

[Guest guest]

, " Eric Brand "

<smilinglotus wrote:

>

> , " "

> <alonmarcus@> wrote:

> >

> > Eric

> > These are usually mixed formulas with few additions, correct? they

> are not single herbs made into formulas. I think there is a big

> difference between the two. Since i use single herbs i tend to think

> of them the same way i would if i use raw herbs. So its not uncommon

> for me to give patients 12g TID.

>

> Yes, they compound whole formulas and add in a few singles. Many

> hospital doctors utilize the full insurance coverage and prescribe 6g

> doses TID. Of this, perhaps 4.2 g will be formula A, 1.2 g will be

> formula B, plus 0.3 g each of two single herb additions.

>

> Eric

>

 

Can anyone (Eric?) comment on the efficacy of dosing in this manner?

It seems to me (as was stated in an earlier post) that 18g/day (90g of

source material) would be low for some formulas and quite high for

others. Also, is using concentrated granules now the standard of care

in Taiwan?

 

On the subject of using concentrated singles to compound a formula vs.

using premade formula concentrates with some singles added: I

understand that decocting/extracting the herbs together may make some

difference in the outcome because the active ingredients may somehow

interact differently during the cooking process. But how significant

is this difference really? Has anyone noticed a difference in clinical

efficacy of the two methods?

 

Andrew Fisher, L.Ac.

Inner Balance Center of Health

3549 North University Ave., Suite 200

Provo, UT 84604

801.356.7600

www.innerbalancesolutions.com

[Guest guest]

I have seen analysis comparing formulas to combined single herbs. I do not know

if they used hot h2o with the single herbs, i tell my patients to let the herbs

steep in boiling h20, or not. But these analysis do show some small differences,

ie different peaks on analysis. I know of no formal clinical study that compared

the two. In Taiwan i was told by several Dr that formulas work better but non

could back it up with studies.

 

 

 

Oakland, CA 94609

 

 

-

taoenergetics

Thursday, April 06, 2006 9:19 AM

Re: Digest Number 2774 - 5:1 powder dose help needed

 

 

, " Eric Brand "

<smilinglotus wrote:

>

> , " "

> <alonmarcus@> wrote:

> >

> > Eric

> > These are usually mixed formulas with few additions, correct? they

> are not single herbs made into formulas. I think there is a big

> difference between the two. Since i use single herbs i tend to think

> of them the same way i would if i use raw herbs. So its not uncommon

> for me to give patients 12g TID.

>

> Yes, they compound whole formulas and add in a few singles. Many

> hospital doctors utilize the full insurance coverage and prescribe 6g

> doses TID. Of this, perhaps 4.2 g will be formula A, 1.2 g will be

> formula B, plus 0.3 g each of two single herb additions.

>

> Eric

>

 

Can anyone (Eric?) comment on the efficacy of dosing in this manner?

It seems to me (as was stated in an earlier post) that 18g/day (90g of

source material) would be low for some formulas and quite high for

others. Also, is using concentrated granules now the standard of care

in Taiwan?

 

On the subject of using concentrated singles to compound a formula vs.

using premade formula concentrates with some singles added: I

understand that decocting/extracting the herbs together may make some

difference in the outcome because the active ingredients may somehow

interact differently during the cooking process. But how significant

is this difference really? Has anyone noticed a difference in clinical

efficacy of the two methods?

 

Andrew Fisher, L.Ac.

Inner Balance Center of Health

3549 North University Ave., Suite 200

Provo, UT 84604

801.356.7600

www.innerbalancesolutions.com

 

 

 

 

 

 

 

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]

, " taoenergetics "

<afisher wrote:

 

> Can anyone (Eric?) comment on the efficacy of dosing in this

manner?

> It seems to me (as was stated in an earlier post) that 18g/day

(90g of

> source material) would be low for some formulas and quite high for

> others. Also, is using concentrated granules now the standard of

care

> in Taiwan?

 

Granules are the standard for insurance patients. National

insurance only covers granules. Self-pay patients still sometimes

opt for raw herbs, which may or may not be cooked on-site in Korean

extraction machines (vs. cooked at home). Raw is regarded as the

most effective but granules are convenient and available for a $1.50

co-pay to all citizens.

 

As for the former question, 18g/day would be high if one was just

taking er chen tang vs. gui pi tang, but this never happens in

practice. No one prescribes er chen tang or si ni san alone, they

are just building blocks of the total prescription. Typically whole

formulas are mixed together,with 1-3 formulas present and several

single additions.

 

> On the subject of using concentrated singles to compound a formula

vs.

> using premade formula concentrates with some singles added: I

> understand that decocting/extracting the herbs together may make

some

> difference in the outcome because the active ingredients may

somehow

> interact differently during the cooking process. But how

significant

> is this difference really? Has anyone noticed a difference in

clinical

> efficacy of the two methods?

 

The Taiwanese maintain that cooking the herbs together as a formula

is essential. They can demonstrate chemical differences in the final

product, and almost all Taiwanese doctors believe that using whole

formula granules is important for their efficacy. When teachers

come from the mainland to teach at Chang Gung University, they will

combine single granules because they don't know how to use the

Taiwanese style of formula combinations. However, the local doctors

never combine singles together to make a formula from scratch, they

all build upon decocted-together granule formulas.

 

Eric

[Guest guest]

hello everyone... i'm new to this list (and i'm a new practitioner).

it's great to see this granules discussion right now as i've been

trying to figure out how to use granules as of late.

 

in fact, just yesterday i hosted a small group of fellow alumni over

for a taste-test of different manufacturers' granules. the subject of

dosing came up but we were largely at a loss. confusion abounds,

apparently you know.

 

so question for you: is it considered bad etiquette on this list to

cut, copy, forward information for others? i'd love to copy a bunch of

your discussion to help my fellow tasters see more of the complexity

involved in the questions we were asking.

 

in any event, i'd also like to add that i'm thankful this list

exists... it's very interesting indeed.

 

not wanting to step on toes,

sheilah

 

 

 

 

 

 

 

, " Eric Brand "

<smilinglotus wrote:

>

> , " "

> <alonmarcus@> wrote:

> >

> > Mike

> > Its not that the 18g/day is fixed. Its more about that the dosage is

> more based on formula dosing that the combination of single herbs.

> Obviously not every pt get 18g per day

>

> There is no fixed standard; there are not even any classes or books on

> the subject at the present time. The dosing of granules in Taiwan is

> generally derived from a practitioner's clinical experience and the

> trends that they observed from their teachers. Feng Ye is teaching a

> case-based class on granule dosing starting next week, so I can

> hopefully gain more insights and have more comments about this topic

> in the near future.

>

> Many doctors use granules slightly differently, but there are general

> trends that can be seen if one is studying in a large hospital and

> observing many different doctors. Based on my experience, most

> doctors use 6 g doses TID (18g/day), but some use less than this

> (rarely have I seen doses below 4g TID, or 12g/day). National

> insurance pays only up to 6g doses, so many doctors use 6 g doses,

> which they increase to QID (24g/day) for acute or severe cases.

> Singles are generally added at 0.3 g TID, but typically range between

> 0.1 and 0.5 g TID. Formulas are often done at 1.2 g TID, 2.4 g TID,

> or 4.6 g TID, depending on whether the formula in question is a

> principle or supportive component of the treatment.

>

> Eric

>

[Guest guest]

Sorry but quoting from these pages without permission from the writer is not

allowed. I

know in this case it's all for the greater good but it sets up a whole lot of

problems as a

policy issues. At the CHA home it says " Quotation from this list is prohibited

without the

express written consent of the author. "

If you want to ask for permission you can email the individual post numbers to

me: not the

digest and I can ask the authors either as a group or individually. This will

take me an hour

or two of my time. I would hope you can be persuaded to spend a few minutes of

your

own time and just write about, without quoting, the issues and therefore not

involving the

CHA.

thanks and sorry,

doug

 

, " sheilah rogers " <shadowboxed

wrote:

 

> so question for you: is it considered bad etiquette on this list to

> cut, copy, forward information for others? i'd love to copy a bunch of

> your discussion to help my fellow tasters see more of the complexity

> involved in the questions we were asking.

>

> in any event, i'd also like to add that i'm thankful this list

> exists... it's very interesting indeed.

>

> not wanting to step on toes,

> sheilah

>

>

[Guest guest]

ah yes, i see, it's no problem at all, that's why i asked.

 

greg, of course i wouldn't ask someone else to solicit consent for

me.... so i'll summarize what makes sense to summarize and -I- will

ask others individually where that makes sense. in any event, no

quotes, no problem.

 

....and sorry i didn't notice the front page, but thank you for the

clarification anyways.

 

s.

 

 

 

 

, " "

wrote:

>

> Sorry but quoting from these pages without permission from the

writer is not allowed. I

> know in this case it's all for the greater good but it sets up a

whole lot of problems as a

> policy issues. At the CHA home it says " Quotation from this list is

prohibited without the

> express written consent of the author. "

> If you want to ask for permission you can email the individual post

numbers to me: not the

> digest and I can ask the authors either as a group or individually.

This will take me an hour

> or two of my time. I would hope you can be persuaded to spend a few

minutes of your

> own time and just write about, without quoting, the issues and

therefore not involving the

> CHA.

> thanks and sorry,

> doug

>

> , " sheilah rogers "

<shadowboxed@>

> wrote:

>

> > so question for you: is it considered bad etiquette on this list to

> > cut, copy, forward information for others? i'd love to copy a bunch of

> > your discussion to help my fellow tasters see more of the complexity

> > involved in the questions we were asking.

> >

> > in any event, i'd also like to add that i'm thankful this list

> > exists... it's very interesting indeed.

> >

> > not wanting to step on toes,

> > sheilah

> >

> >

>

[Guest guest]

uhhh, it's doug by the way.

doug

 

 

, " sheilah rogers " <shadowboxed

wrote:

>

> ah yes, i see, it's no problem at all, that's why i asked.

>

> greg, of course i wouldn't ask someone else to solicit consent for

> me.... so i'll summarize what makes sense to summarize and -I- will

> ask others individually where that makes sense. in any event, no

> quotes, no problem.

>

> ...and sorry i didn't notice the front page, but thank you for the

> clarification anyways.

>

> s.

>

>

>

>

> , " " <taiqi@>

> wrote:

> >

> > Sorry but quoting from these pages without permission from the

> writer is not allowed. I

> > know in this case it's all for the greater good but it sets up a

> whole lot of problems as a

> > policy issues. At the CHA home it says " Quotation from this list is

> prohibited without the

> > express written consent of the author. "

> > If you want to ask for permission you can email the individual post

> numbers to me: not the

> > digest and I can ask the authors either as a group or individually.

> This will take me an hour

> > or two of my time. I would hope you can be persuaded to spend a few

> minutes of your

> > own time and just write about, without quoting, the issues and

> therefore not involving the

> > CHA.

> > thanks and sorry,

> > doug

> >

> > , " sheilah rogers "

> <shadowboxed@>

> > wrote:

> >

> > > so question for you: is it considered bad etiquette on this list to

> > > cut, copy, forward information for others? i'd love to copy a bunch of

> > > your discussion to help my fellow tasters see more of the complexity

> > > involved in the questions we were asking.

> > >

> > > in any event, i'd also like to add that i'm thankful this list

> > > exists... it's very interesting indeed.

> > >

> > > not wanting to step on toes,

> > > sheilah

> > >

> > >

> >

>

[Guest guest]

sheesh, how embarrassing. sorry about that, doug.

 

i've always found broadcasting to a group you don't know vaguely like

doing standing up for a speech.

 

toastmaster's for the online world? you'd think i'd lose the

discomfort after 10+ years of online publishing.

 

but again, my apologies...

 

back to herbal conversation everyone

 

s.

[Guest guest]

Dear Jason,

 

Yes, as far as I have seen, all prescriptions of extract powder formulas,

including those made from single herb concentrated extracts, have been made

to ratios, like teapills. I understand that it does not seem logical to you

when you relate it to the method of prescribing raw herb decoctions, and

that even when relating it to teapills it does not make sense to you. I

understand that you think that it is lazy method. I will attempt to explain

further, but it may come down to a simple difference of opinion.

 

What I am not saying, is that other ways of using the extract powders are

incorrect, or ineffective. What I am saying is that I believe that using

extract powders is not the same as using raw herbs, and that they work very

well as I have detailed. I understand your point of view entirely; you don't

believe that they are a different method with a different set of rules. You

think extract powders should be prescribed exactly the same as raw herbs.

You are entitled to your opinion, and you may find with experience that a

straight conversion from raw herb formula to 5:1 extract works quite well

for you and your patients.

 

You pointed out:

 

" You compare this (your above) method of thinking to the supposed method of

making a raw decoction. Meaning no matter how many herbs you still boil the

herbs into the same amount of cups to drink over a day. If there are 4 herbs

you boil down to 2 cups (/ day), and if you have 14 cups you boil to 2 cups

(/day) - That is correct! But what seems to be overlooked is that the amount

of constituents consumed from 150 grams of herbs versus 40 grams is

astronomically greater. "

 

True. I am not overlooking or denying the fact that there are more herbal

constituents in a larger raw herbal decoction (up to a certain saturation

point). I am simply stating that the extract powder formulas I have seen

work extremely well, were made using a ratio of herbs, as teapills are made.

This is from having seen prescriptions from master practitioners from around

the world in extract powder form through my work with Mayway and earlier

with another herbal pharmacy in Berkeley, as well as from my studies at

Meiji College and through my own clinical practice.

 

This is not a method I have created, but neither is it a method that I have

seen in any classic texts obviously, as extract powders are relatively new.

Perhaps we should look to the first use of extract powders - Japan and

Taiwan I believe. You said, " Just because something is occurring in Taiwan

does not make it good medicine. " I agree. However, we do not have recourse

to classic texts for advice about extract powders, but they do have at least

50 years of experience with extract powders in Japan and Taiwan. There may

be something to be learned. Take a look at Japanese dosaging regimens with

respect to different formulas. All prepared extract powder formulas are made

by ratio as I have described, and as far as I know the Japanese prescribe

formulas like teapills: with a standard dosage irrespective of how many

herbs are within each individual formula. Take a look at the Honso extract

granule formulas that all have the same dosage:

<http://honsousa.com/Products/defult_Kampo.htm>

 

Also, on a purely physical standpoint, there is an upper limit as to how

much extract powder patients can consume in a day. In your example above of

a 150 gram formula, a straight conversion would give you a daily dosage of

30 grams a day. That is a third of a 100g bottle of extract powder per day.

A larger formula, say a cancer formula of close to 300g, would bring it up

to a 60g daily dose.

 

In the example you gave (included just below) with Si Wu Tang and Xue Fu Zhu

Yu Tang, it is true that one would be delivering very different doses of

dang gui when you prescribe an extract powder. However, I would continue to

state that, like teapills, you would give more or less the same amount of

extract powder formula whether it was Si Wu Tang or Xue Fu Zu Yu Tang.

 

" But if you give 18g granular of si wu tang and 18g granular of xue fu zhu

yu tang. You are delivering very different doses of dang gui.

 

1) In si wu tang - dang gui is 25% of the Rx. And with 18 grams you have

4.5 grams of granular dang gui. - (with a 5:1 ratio) we are talking about

22.5 grams of dang gui. This is then overdosing quite a bit as compared to

a decoction.

2) In xue fu zhu yu tang - dang gui makes up 12% of the Rx. -with 18g

(total) you then deliver 2.16g of dang gui - with a translation to 10.8

grams of dang gui - This is very close to the decoction.

 

Very different end results. "

 

I see your point - 4.5 grams a day of dang gui extract powder would be a

high dose. Actually, I did not say that a standard dose should necessarily

be set at 18 grams a day. At Mayway we suggest a standard dose of 8-10

grams/day. And I personally use between 8-14 grams on average. I do not

suggest that the standard dosage be an absolute - nor is it in teapills.

Rather it is a standard from which we adjust up or down as usual - according

to the severity and duration of the condition, patient's age and weight,

their sensitivity to herbs, etc.

 

However, I do agree with your assertion that there are toxic herbs such as

Xi Xin, and other types of herbs that require a low dosage, and agree that a

low dose should be respected within the formula. In a manufactured formula

or when combining single herb extract powders that would be addressed by

assigning the herb a very small percentage.

 

In terms of your statement that teapills have limited therapeutic effect, my

experience is that when used correctly, they are extremely effective. This

is evident in both documented clinical trials and undocumented case studies.

Unlike raw herb prescriptions, teapills obviously cannot be modified.

Therefore, most of the time they are given in combination to cover all

aspects a practitioner would want to cover with an herbal decoction. Most

problems I have encountered with the effectiveness of teapills have been due

to insufficient dosing or improper combination of teapills. There are many

benefits to using teapills, including superior extraction of essential oils

that would be lost with a patient boiling them - even when given as a

post-add, superior extraction of minerals, some herbs are both alcohol and

water processed for greater extraction, and palatable versions of extremely

bitter or foul tasting herbs.

 

I realize that the method I have described sounds very strange to you, and

that you prefer to give a straight conversion from raw herb formulas. I do

not consider a ratio to be the penultimate truth of powdered extract

dosaging and would be very interested in hearing about practitioners'

experiences using a straight conversion.

 

Please let me know if you have further questions, or you can contact me

directly at: 1-800-262-9929 or laurastropes.

 

Thanks,

Laura

 

 

Website Project Manager

Mayway Corporation

1338 Mandela Parkway

Oakland, CA 94607

Tel. 510-208-3113

Fax 510-208-3070

www.mayway.com

 

 

 

 

Message: 4

Tue, 4 Apr 2006 20:09:04 -0600

" "

RE: Digest Number 2774 - 5:1 powder dose help needed

 

Laura,

 

Thanx for chiming in and expounding on some of these difficult issues. But

I am having a bit of difficulty following your logic. It sounds like you

are saying that no matter what the granular formula is, one should prescribe

18g /day. This makes little sense when comparing it to raw formulas. But I

guess you are saying you prefer to think of them like tea pills (which have

limited therapeutic effect IMO). It seems to me that you basically saying

the dosage doesn't really matter and it all comes down to ratio. Again this

makes little sense... Let me explain further.

 

You compare this (your above) method of thinking to the supposed method of

making a raw decoction. Meaning no matter how many herbs you still boil the

herbs into the same amount of cups to drink over a day. If there are 4 herbs

you boil down to 2 cups (/ day) , and if you have 14 cups you boil to 2 cups

(/day) - That is correct! But what seems to be overlooked is that the amount

of constituents consumed from 150 grams of herbs versus 40 grams is

astronomically greater.

 

Simple example -

 

If one gives a raw decoction of si wu tang (40 grams) one is delivering i.e.

10 grams of dang gui (etc). {assuming an equal split among herbs}

 

If one gives a decoction xue fu zhu yu tang (75 grams) one is still

delivering 10 grams of dang gui.

SAME AMOUNT OF DANG GUI for the patient.

 

 

But if you give 18g granular of si wu tang and 18g granular of xue fu zhu yu

tang. You are delivering very different doses of dang gui.

 

1) In si wu tang - dang gui is 25% of the Rx. And with 18 grams you have

4.5 grams of granular dang gui. - (with a 5:1 ratio) we are talking about

22.5 grams of dang gui. This is then overdosing quite a bit as compared to

a decoction.

2) In xue fu zhu yu tang - dang gui makes up 12% of the Rx. -with 18g

(total) you then deliver 2.16g of dang gui - with a translation to 10.8

grams of dang gui - This is very close to the decoction.

 

Very different end results.

 

Therefore it is very clear that depending on the original formula's dosage

one should adjust their granular dosage accordingly. For example to equal a

siwutang decoction, one would prescribe about 8 grams of granular. Anything

otherwise it a very different medicine than prescribing raw herbs - and one

loses major control over dosage in general when one creates their own

granular formuals. Maybe that is your point. But with the above example.

Giving 18g of granular siwutang is like giving over 2 times the normal dose

(from a decoction perspective)... What if you have a small # of ingredient

formula with xixin?

 

I think 18g across the board for any formula is lazy and makes little sense

to me... Just because something is occurring in Taiwan does not make it

good medicine.

 

Could someone explain what I may have missed? Thanx,

 

-Jason

 

 

--

 

 

Version: 7.1.385 / Virus Database: 268.4.1/307 - Release 4/10/2006

 

 

 

 

[Guest guest]

Laura,

 

Thanx for you detailed and patient explanation. It gives me much to

consider...

 

-

 

>

>

> On Behalf Of Laura Stropes

> Monday, April 10, 2006 12:01 PM

> Chinese Herbal Medicine

> RE: Digest Number 2774 - 5:1 powder dose help needed

>

> Dear Jason,

>

> Yes, as far as I have seen, all prescriptions of extract powder formulas,

> including those made from single herb concentrated extracts, have been

> made

> to ratios, like teapills. I understand that it does not seem logical to

> you

> when you relate it to the method of prescribing raw herb decoctions, and

> that even when relating it to teapills it does not make sense to you. I

> understand that you think that it is lazy method. I will attempt to

> explain

> further, but it may come down to a simple difference of opinion.

>

> What I am not saying, is that other ways of using the extract powders are

> incorrect, or ineffective. What I am saying is that I believe that using

> extract powders is not the same as using raw herbs, and that they work

> very

> well as I have detailed. I understand your point of view entirely; you

> don't

> believe that they are a different method with a different set of rules.

> You

> think extract powders should be prescribed exactly the same as raw herbs.

> You are entitled to your opinion, and you may find with experience that a

> straight conversion from raw herb formula to 5:1 extract works quite well

> for you and your patients.

>

> You pointed out:

>

> " You compare this (your above) method of thinking to the supposed method

> of

> making a raw decoction. Meaning no matter how many herbs you still boil

> the

> herbs into the same amount of cups to drink over a day. If there are 4

> herbs

> you boil down to 2 cups (/ day), and if you have 14 cups you boil to 2

> cups

> (/day) - That is correct! But what seems to be overlooked is that the

> amount

> of constituents consumed from 150 grams of herbs versus 40 grams is

> astronomically greater. "

>

> True. I am not overlooking or denying the fact that there are more herbal

> constituents in a larger raw herbal decoction (up to a certain saturation

> point). I am simply stating that the extract powder formulas I have seen

> work extremely well, were made using a ratio of herbs, as teapills are

> made.

> This is from having seen prescriptions from master practitioners from

> around

> the world in extract powder form through my work with Mayway and earlier

> with another herbal pharmacy in Berkeley, as well as from my studies at

> Meiji College and through my own clinical practice.

>

> This is not a method I have created, but neither is it a method that I

> have

> seen in any classic texts obviously, as extract powders are relatively

new.

> Perhaps we should look to the first use of extract powders - Japan and

> Taiwan I believe. You said, " Just because something is occurring in Taiwan

> does not make it good medicine. " I agree. However, we do not have recourse

> to classic texts for advice about extract powders, but they do have at

> least

> 50 years of experience with extract powders in Japan and Taiwan. There may

> be something to be learned. Take a look at Japanese dosaging regimens with

> respect to different formulas. All prepared extract powder formulas are

> made

> by ratio as I have described, and as far as I know the Japanese prescribe

> formulas like teapills: with a standard dosage irrespective of how many

> herbs are within each individual formula. Take a look at the Honso extract

> granule formulas that all have the same dosage:

> <http://honsousa.com/Products/defult_Kampo.htm>

>

> Also, on a purely physical standpoint, there is an upper limit as to how

> much extract powder patients can consume in a day. In your example above

> of

> a 150 gram formula, a straight conversion would give you a daily dosage of

> 30 grams a day. That is a third of a 100g bottle of extract powder per

day.

> A larger formula, say a cancer formula of close to 300g, would bring it up

> to a 60g daily dose.

>

> In the example you gave (included just below) with Si Wu Tang and Xue Fu

> Zhu

> Yu Tang, it is true that one would be delivering very different doses of

> dang gui when you prescribe an extract powder. However, I would continue

> to

> state that, like teapills, you would give more or less the same amount of

> extract powder formula whether it was Si Wu Tang or Xue Fu Zu Yu Tang.

>

> " But if you give 18g granular of si wu tang and 18g granular of xue fu zhu

> yu tang. You are delivering very different doses of dang gui.

>

> 1) In si wu tang - dang gui is 25% of the Rx. And with 18 grams you have

> 4.5 grams of granular dang gui. - (with a 5:1 ratio) we are talking about

> 22.5 grams of dang gui. This is then overdosing quite a bit as compared

> to

> a decoction.

> 2) In xue fu zhu yu tang - dang gui makes up 12% of the Rx. -with 18g

> (total) you then deliver 2.16g of dang gui - with a translation to 10.8

> grams of dang gui - This is very close to the decoction.

>

> Very different end results. "

>

> I see your point - 4.5 grams a day of dang gui extract powder would be a

> high dose. Actually, I did not say that a standard dose should necessarily

> be set at 18 grams a day. At Mayway we suggest a standard dose of 8-10

> grams/day. And I personally use between 8-14 grams on average. I do not

> suggest that the standard dosage be an absolute - nor is it in teapills.

> Rather it is a standard from which we adjust up or down as usual -

> according

> to the severity and duration of the condition, patient's age and weight,

> their sensitivity to herbs, etc.

>

> However, I do agree with your assertion that there are toxic herbs such as

> Xi Xin, and other types of herbs that require a low dosage, and agree that

> a

> low dose should be respected within the formula. In a manufactured formula

> or when combining single herb extract powders that would be addressed by

> assigning the herb a very small percentage.

>

> In terms of your statement that teapills have limited therapeutic effect,

> my

> experience is that when used correctly, they are extremely effective. This

> is evident in both documented clinical trials and undocumented case

> studies.

> Unlike raw herb prescriptions, teapills obviously cannot be modified.

> Therefore, most of the time they are given in combination to cover all

> aspects a practitioner would want to cover with an herbal decoction. Most

> problems I have encountered with the effectiveness of teapills have been

> due

> to insufficient dosing or improper combination of teapills. There are many

> benefits to using teapills, including superior extraction of essential

> oils

> that would be lost with a patient boiling them - even when given as a

> post-add, superior extraction of minerals, some herbs are both alcohol and

> water processed for greater extraction, and palatable versions of

> extremely

> bitter or foul tasting herbs.

>

> I realize that the method I have described sounds very strange to you, and

> that you prefer to give a straight conversion from raw herb formulas. I do

> not consider a ratio to be the penultimate truth of powdered extract

> dosaging and would be very interested in hearing about practitioners'

> experiences using a straight conversion.

>

> Please let me know if you have further questions, or you can contact me

> directly at: 1-800-262-9929 or laurastropes.

>

> Thanks,

> Laura

>

>

> Website Project Manager

> Mayway Corporation

> 1338 Mandela Parkway

> Oakland, CA 94607

> Tel. 510-208-3113

> Fax 510-208-3070

> www.mayway.com

>

>

>

>

> Message: 4

> Tue, 4 Apr 2006 20:09:04 -0600

> " "

> RE: Digest Number 2774 - 5:1 powder dose help needed

>

> Laura,

>

> Thanx for chiming in and expounding on some of these difficult issues.

> But

> I am having a bit of difficulty following your logic. It sounds like you

> are saying that no matter what the granular formula is, one should

> prescribe

> 18g /day. This makes little sense when comparing it to raw formulas. But

> I

> guess you are saying you prefer to think of them like tea pills (which

> have

> limited therapeutic effect IMO). It seems to me that you basically saying

> the dosage doesn't really matter and it all comes down to ratio. Again

> this

> makes little sense... Let me explain further.

>

> You compare this (your above) method of thinking to the supposed method of

> making a raw decoction. Meaning no matter how many herbs you still boil

> the

> herbs into the same amount of cups to drink over a day. If there are 4

> herbs

> you boil down to 2 cups (/ day) , and if you have 14 cups you boil to 2

> cups

> (/day) - That is correct! But what seems to be overlooked is that the

> amount

> of constituents consumed from 150 grams of herbs versus 40 grams is

> astronomically greater.

>

> Simple example -

>

> If one gives a raw decoction of si wu tang (40 grams) one is delivering

> i.e.

> 10 grams of dang gui (etc). {assuming an equal split among herbs}

>

> If one gives a decoction xue fu zhu yu tang (75 grams) one is still

> delivering 10 grams of dang gui.

> SAME AMOUNT OF DANG GUI for the patient.

>

>

> But if you give 18g granular of si wu tang and 18g granular of xue fu zhu

> yu

> tang. You are delivering very different doses of dang gui.

>

> 1) In si wu tang - dang gui is 25% of the Rx. And with 18 grams you have

> 4.5 grams of granular dang gui. - (with a 5:1 ratio) we are talking about

> 22.5 grams of dang gui. This is then overdosing quite a bit as compared

> to

> a decoction.

> 2) In xue fu zhu yu tang - dang gui makes up 12% of the Rx. -with 18g

> (total) you then deliver 2.16g of dang gui - with a translation to 10.8

> grams of dang gui - This is very close to the decoction.

>

> Very different end results.

>

> Therefore it is very clear that depending on the original formula's dosage

> one should adjust their granular dosage accordingly. For example to equal

> a

> siwutang decoction, one would prescribe about 8 grams of granular.

> Anything

> otherwise it a very different medicine than prescribing raw herbs - and

> one

> loses major control over dosage in general when one creates their own

> granular formuals. Maybe that is your point. But with the above example.

> Giving 18g of granular siwutang is like giving over 2 times the normal

> dose

> (from a decoction perspective)... What if you have a small # of ingredient

> formula with xixin?

>

> I think 18g across the board for any formula is lazy and makes little

> sense

> to me... Just because something is occurring in Taiwan does not make it

> good medicine.

>

> Could someone explain what I may have missed? Thanx,

>

> -Jason

>

>

> --

>

>

> Version: 7.1.385 / Virus Database: 268.4.1/307 - Release 4/10/2006

>

>

>

>