Guest guest Posted April 8, 2006 Report Share Posted April 8, 2006 Hi everyone, I have a patient with early stage prostate cancer who is also taking Warfarin (Coumadin) for a genetic predisposition to blood clots. Some of our Chinese herbal medicinals have been shown to potentiate Warfarin, and many of these herbs have shown to have anti-coagulant, anti-platlet, and thrombolytic properties. Warfarin has such a low therapeutic effective margin and plasma levels can readily bind with proteins and herbal constituents which could have an undiserable affect on PTT. This limits our use of Chinese herbs in treating patients who take Warfarin for risk of causing either blood clots or bleeding. What if we used Chinese herbas to replace Warfarin, does anybody have any experience with this? Patient would like to have surgery instead of radiation but, is worried about clots. The side affects of radiation are highly undesirable. I can't use herbs as adjunctive therapy to treat tumor because of possible herb-drug interaction. Thanks for your support, Steve Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 8, 2006 Report Share Posted April 8, 2006 On 4/7/06, Steve Sterling <acusteve1 wrote: > > What if we used Chinese herbas to replace Warfarin, does anybody have any > experience with this? > I think that many of us have experience with this, not so much in replacing Warfarin, but in addressing blood stagnation and/or phlegm-blood stagnation. If you want to treat platelet aggregation, you'll probably need to seek out a text or database that favors western mechanisms, but if you can differentiate according to TCM, you'll likely see what is causing that familial history of blood clots. If you don't see any signs of blood stagnation, adding some herbs to activate the blood is likely fine (if he's gone off the Warfarin obviously). So assess the pattern and then add a few of the following, whichever seem to fit in to the pattern. For instance, the radiation therapy is likely going to look hot on the skin, perhaps increasing the heart rate. In such a case, leaning toward the herbs that follow that are cool or cold in nature would make sense. If there are no blood stagnation signs, consider herbs from the class of gentle activators such as: Dang Gui Dan Pi Dan Shen Sheng Di Huang Chi Shao Ji Xue Teng. Herbs that move blood with indications of stagnation, consider: Chuang Xiong Pu Huang Hong Hua Liu Ji Nu Wu Ling Zhi Yu Jin San Qi Chuan Shan Jia Da Huang Jiang Huang Yi Mu Cao Ze Lan Su Mu Niu Xi Yan Hu Suo Gui Jian Yu Ru Xiang Mo Yao Ji Cao Wang Bu Liu Xin Zi Wei If there are masses, lumps, etc. (enlarged prostate may fall into this category: add: Shui Zhi Mang Chong San Leng Er Zhu Xue Jie Tao Ren Gan Qi Tu Bian Chong. Yun Nan Bai Yao has been studied for hyperplasia of the prostate. I see it is listed as efficacious for this, but I don't really have any evidence numbers for you. With these therapies, of course you'll want to keep an eye out for any inappropriate bleeding or bruising. If you see that, lower dosages or make appropriate changes. The lists of herbs above include a few that I haven't heard of. It comes from notes that I took over the weekend on Xue Yu Zheng (blood stagnation patterns). -- Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 9, 2006 Report Share Posted April 9, 2006 Dear Steve and Al, I would add two more notes: first, confirm by differential diagnosis the specificity of the blood xu: ie. is it an excess or deficiency pattern, hot or cold, etc. Also determine which channels, organs and location are involved (perhaps you might use a guide herb if the excess clotting seems to occur in a specific location). Finally, in the back of Chen's book,Chinese Medical Herbology and Pharmacology, the following herbs are listed (pg 1096) as treating clotting disorders: 1.Bi Cheng Qie 2.Ci Wu Jia 3.Dang Gui 4.Di Long 5.Ge Gen 6.Hai FengTeng 7.Hai Shen 8.Hong Hua 9. Mao Dong Qing 10.Shui Zhi 11.Xuan Shen Hope I've been helpful, Yehuda Al Stone <al wrote: On 4/7/06, Steve Sterling <acusteve1 wrote: > > What if we used Chinese herbas to replace Warfarin, does anybody have any > experience with this? > I think that many of us have experience with this, not so much in replacing Warfarin, but in addressing blood stagnation and/or phlegm-blood stagnation. If you want to treat platelet aggregation, you'll probably need to seek out a text or database that favors western mechanisms, but if you can differentiate according to TCM, you'll likely see what is causing that familial history of blood clots. If you don't see any signs of blood stagnation, adding some herbs to activate the blood is likely fine (if he's gone off the Warfarin obviously). So assess the pattern and then add a few of the following, whichever seem to fit in to the pattern. For instance, the radiation therapy is likely going to look hot on the skin, perhaps increasing the heart rate. In such a case, leaning toward the herbs that follow that are cool or cold in nature would make sense. If there are no blood stagnation signs, consider herbs from the class of gentle activators such as: Dang Gui Dan Pi Dan Shen Sheng Di Huang Chi Shao Ji Xue Teng. Herbs that move blood with indications of stagnation, consider: Chuang Xiong Pu Huang Hong Hua Liu Ji Nu Wu Ling Zhi Yu Jin San Qi Chuan Shan Jia Da Huang Jiang Huang Yi Mu Cao Ze Lan Su Mu Niu Xi Yan Hu Suo Gui Jian Yu Ru Xiang Mo Yao Ji Cao Wang Bu Liu Xin Zi Wei If there are masses, lumps, etc. (enlarged prostate may fall into this category: add: Shui Zhi Mang Chong San Leng Er Zhu Xue Jie Tao Ren Gan Qi Tu Bian Chong. Yun Nan Bai Yao has been studied for hyperplasia of the prostate. I see it is listed as efficacious for this, but I don't really have any evidence numbers for you. With these therapies, of course you'll want to keep an eye out for any inappropriate bleeding or bruising. If you see that, lower dosages or make appropriate changes. The lists of herbs above include a few that I haven't heard of. It comes from notes that I took over the weekend on Xue Yu Zheng (blood stagnation patterns). -- Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
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