Guest guest Posted March 30, 2007 Report Share Posted March 30, 2007 To morph into a little different subject, it is my experience that (despite what some of my colleagues say) a small dosage of a readymade-bottled-prepared or granule formula can go a long way to change a person. My belief is that if a body is out-of-balance, given the proper corrective herbs can dramatically change the terrain very quickly. Some of students are surprised at the small dosages of the herbs I often give. Too big of a dosage will just play chaos. And of course it has to be the right formula. Large dosages play their role in many cases but I love it when a few pills or grams a couple times a day does the trick. doug Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 30, 2007 Report Share Posted March 30, 2007 Doug, I agree with you. When you can get the job done with 3 - 6 grams a day (granular) (or less) this is much more impressive then 18 grams a day. Now sometimes this low dosage is merely because the patient is just overly sensitive, but sometimes it is just a eloquent formula that hits the nail on the head. In general I strive for smaller doses and smaller formulas (ala SHL / Ye Tian-Shi). When I am less clear or going for a pharmacological approach I will many times use monster doses. I think this later idea (Pharmacological thinking) is one reason why large doses are popular now. But that is not the only way to look at things. In the end, I am quite convinced that you do not need 12-18 scoops a day all the time. One can find doctors is China, Taiwan, and the US that are successful in using lower doses and smaller formulas. To prescribe high doses (12-18 scoops) across the board may be following the industry standard in Taiwan, but is IMHO dogmatic and void of critical thinking. One should treat every case with precision and thought. -Jason _____ On Behalf Of Friday, March 30, 2007 12:01 AM morphing Granules To morph into a little different subject, it is my experience that (despite what some of my colleagues say) a small dosage of a readymade-bottled-prepared or granule formula can go a long way to change a person. My belief is that if a body is out-of-balance, given the proper corrective herbs can dramatically change the terrain very quickly. Some of students are surprised at the small dosages of the herbs I often give. Too big of a dosage will just play chaos. And of course it has to be the right formula. Large dosages play their role in many cases but I love it when a few pills or grams a couple times a day does the trick. doug Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 30, 2007 Report Share Posted March 30, 2007 Is there a type of case in which small dosages are more likely to be effective? Acute excess type issues, or chronic deficiencies? My experience is that those with the mental/emotionally induced disorders such as qi stagnation can do well with a smaller quantity of the herbs because of the effect that being proactive with their condition has on their self-induced stress. Ni ne? On 3/29/07, wrote: > Large dosages play their role in many cases but I love it when a few > pills or grams a couple times a day does the trick. > -- Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 30, 2007 Report Share Posted March 30, 2007 , " " wrote: > I agree with you. When you can get the job done with 3 - 6 grams a day > (granular) (or less) this is much more impressive then 18 grams a day. Now > sometimes this low dosage is merely because the patient is just overly > sensitive, but sometimes it is just a eloquent formula that hits the nail on > the head. In general I strive for smaller doses and smaller formulas (ala > SHL / Ye Tian-Shi). When I am less clear or going for a pharmacological > approach I will many times use monster doses. I think this later idea > (Pharmacological thinking) is one reason why large doses are popular now. > But that is not the only way to look at things. In the end, I am quite > convinced that you do not need 12-18 scoops a day all the time. One can find > doctors is China, Taiwan, and the US that are successful in using lower > doses and smaller formulas. To prescribe high doses (12-18 scoops) across > the board may be following the industry standard in Taiwan, but is IMHO > dogmatic and void of critical thinking. One should treat every case with > precision and thought. No one is being dogmatic or failing to think critically. There are many things that work and many different ways to prescribe and dose. All types of new acupuncture techniques with no historical basis have been shown to work, and many many applications of Chinese herbs have been shown to be effective in doses far lower than their textbook Chinese doses- just look at a major European work like the ESCOP Monographs by Theime. The current state of knowledge isn't the apex of all that is possible or effective, and there are many things that work. Dose is variable and needs to be determined flexibly based on the individual. Certainly there is no reason to use two aspirin tabs without first seeing whether one will do the trick, but everyone should know that the standard dose range is 1-2 (or more) tabs. If you want to split one tab into 9 pieces it may well work for your patients (and they probably won't get many adverse effects!), but don't criticize the PDR for providing the standard reference range for the drug. Dosage information is just like textbook TCM, it is not meant to limit the practitioner or say that this is the only valid or possible approach. It is just a baseline of knowledge that has been deemed useful by many clinicians. I'm just reporting the trends of our colleagues, not selling dogma. BTW, Shang Han Lun doses were " monster doses " by modern standards. Eric Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 30, 2007 Report Share Posted March 30, 2007 One thing that needs to be taken into account in this discussion is that, in the West, we typically administer acupuncture and not just the herbs. Therefore, we are doubling up on therapies. This is not typically the case in Asia. By doubling up on therapies, we may be able to use less of each than are usually used in Asia. However, this is all terra incognita. We're doing something new here. the only downside to practicing this way is that we never really know what did what. If that doesn't matter, no problem. However, if we are doing both herbs and acupuncture, then any discussion specifically of the herbal treatment cannot be categorical. Bob , " " wrote: > > To morph into a little different subject, it is my experience that > (despite what some of my colleagues say) a small dosage of a > readymade-bottled-prepared or granule formula can go a long way to > change a person. My belief is that if a body is out-of-balance, given > the proper corrective herbs can dramatically change the terrain very > quickly. Some of students are surprised at the small dosages of the > herbs I often give. Too big of a dosage will just play chaos. And of > course it has to be the right formula. > Large dosages play their role in many cases but I love it when a few > pills or grams a couple times a day does the trick. > doug > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 30, 2007 Report Share Posted March 30, 2007 Eric, Just to be clear I was not in any way saying you were " selling dogma. " But it did sound like you are saying that to get good results you should be prescribing 18 grams a day, or somewhere around there. I guess you are not saying that, just reporting what Taiwan does. Okay. I though, am merely stating the other side of the coin, so people don't just blindly prescribe 18 grams a day. I personally find 18 grams an unnecessary starting point, as does everyone in my clinic. I actually can't remember the last time someone dosed higher than 12 grams a day (except for myself on occasion). Many will start at 6 grams a day! Therefore, as we see with so many aspects, maybe Western patients are much different than your typical Chinese patient. There are many differences that must be considered. So maybe a better question than, " what are the Taiwanese doing? " is " what works best for Western patients. " Obviously they have much more experience, but since patients and treatment strategies are different here, a melding of information must occur. It is my experience many Chinese style therapies are just unsuitable for many westerns, but that is another topic. But I think we are saying the same thing overall, treat the individual. As far as SHL dosage goes, it is not clear, no one really knows. There are multiple opinions out there. But we do know that the SHL used much smaller formulas in comparison to modern formulas. - _____ On Behalf Of Eric Brand Friday, March 30, 2007 9:38 AM Re: morphing Granules @ <%40> , " " wrote: > I agree with you. When you can get the job done with 3 - 6 grams a day > (granular) (or less) this is much more impressive then 18 grams a day. Now > sometimes this low dosage is merely because the patient is just overly > sensitive, but sometimes it is just a eloquent formula that hits the nail on > the head. In general I strive for smaller doses and smaller formulas (ala > SHL / Ye Tian-Shi). When I am less clear or going for a pharmacological > approach I will many times use monster doses. I think this later idea > (Pharmacological thinking) is one reason why large doses are popular now. > But that is not the only way to look at things. In the end, I am quite > convinced that you do not need 12-18 scoops a day all the time. One can find > doctors is China, Taiwan, and the US that are successful in using lower > doses and smaller formulas. To prescribe high doses (12-18 scoops) across > the board may be following the industry standard in Taiwan, but is IMHO > dogmatic and void of critical thinking. One should treat every case with > precision and thought. No one is being dogmatic or failing to think critically. There are many things that work and many different ways to prescribe and dose. All types of new acupuncture techniques with no historical basis have been shown to work, and many many applications of Chinese herbs have been shown to be effective in doses far lower than their textbook Chinese doses- just look at a major European work like the ESCOP Monographs by Theime. The current state of knowledge isn't the apex of all that is possible or effective, and there are many things that work. Dose is variable and needs to be determined flexibly based on the individual. Certainly there is no reason to use two aspirin tabs without first seeing whether one will do the trick, but everyone should know that the standard dose range is 1-2 (or more) tabs. If you want to split one tab into 9 pieces it may well work for your patients (and they probably won't get many adverse effects!), but don't criticize the PDR for providing the standard reference range for the drug. Dosage information is just like textbook TCM, it is not meant to limit the practitioner or say that this is the only valid or possible approach. It is just a baseline of knowledge that has been deemed useful by many clinicians. I'm just reporting the trends of our colleagues, not selling dogma. BTW, Shang Han Lun doses were " monster doses " by modern standards. Eric Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 30, 2007 Report Share Posted March 30, 2007 Bob, You make a couple good points. Bob posits that acupuncture may change the dose of herbs necessary. This makes sense, and if so, supports the idea that Western patients need different therapies / dosages (than Chinese ones). People many times make the assumption that the need for lower dosage is b/c of some physiological difference or difference in herb quality (bulk), I am not sure. But maybe Bob's point helps explain things. To expand on this a bit, most patients compared to the average Chinese person, are on many more supplements (sometimes self-treating) even before coming through the door. Some fish oil for this, black cohosh for that, Glucosamine for this, Cold snap for that. I think this is a nationwide phenomenon, evidenced by the supplement statistic sales as well as the marketing that is blasted everywhere. As a practitioner, we must deal with this. One can tell the patient to get off everything (sometimes necessary) or work with it with some intelligence. So yes, we are in somewhat unknown / new territory. I fortunately feel very comfortable in this terrain. IMHO, if you know how to think through such issues one can most of the time figure out what is doing what. Meaning learning how to understand i.e. how supplements look through a TCM lens, as well as how acupuncture and herbs work differently in the body. It is not like you are just shooting a machine gun at a deer and not knowing which bullet actually hit it. Each aspect (or bullet) can play a role that one can understand. There is a methodology that one can follow. Just because we don't utilize one single therapy (i.e. herbs) does not mean we can't figure out what is working. It is not that we don't care what works, even though in some cases I do not. Of course there are times where things get murky, but that is just par for the course. To further complicate things, at least in Boulder, many people are getting multiple therapies, some cranial sacral, Rolfing, or some energy work. To top things off, people complain about things and in different ways than most Chinese and Westerners have different needs and desires from treatments. I think this is precisely why 5 element (Worsley) style practice does so well here. I personally don't think it would last a minute in China. What do others think? So I agree, one cannot say for sure if this herb or that acupuncture treatment, in and of itself, cured (or helped) the patient. IMO just visiting a alternative doctor, especially Chinese Medical practitioner, with weird smells and strange art on the walls, dramatically increases the variables / placebo. Quite simply, it has been reported that traveling far distances will increase the placebo. So bob is right, with multiple therapies we will never know " exactly " what has worked. This is the Western medical Gold standard argument, and a valid one, to some extent. For us to correct this, we would have to eliminate all unknown factors and just give one therapy. Even with a single therapy do we know if it was something else that worked? Never for sure. Do we deny this? We should not. All of these potential placebos, though, if we are smart, we will take full advantage of. I have learned though that there is a more important terrain to learn to navigate, that is far removed from the stale (completely unrealistic) single therapy (research ) style that many clutch onto. Essentially, one cannot deny the myriad of variables in the real life clinic. Working in this murkiness may not result in you finding the latest and greatest treatment for X disease. It may not even result in you discovering a treatment that can be applied to another individual. It can though result in you learning how to treat the individual and becoming comfortable with the idea of not having to rely on some research report to tell you where to put a needle or what herb is currently best for insomnia. If you allow it, it will teach you how to think and become a expert practitioner! This IMO is the Chinese medicinal road and has been traveled by great doctors for a long time. Case studies surely support this and the idea that individuals are treated with individual therapies and that is that. Obviously others think otherwise, and I do think they have a valid point. But many medical doctors hide behind the illusion that they control these variables, yet for example, statistically the majority of their patients don't even report to them what alterative therapies / supplements they are taking! So of course we are in uncharted territory. This is nothing new historically either. IMO, every patient is a puzzle to figure out with multiple variables. This is precisely why we must be flexible with every patient, and not hold rigidity onto anything. While at the same time though, it seems wise to stay true to the medicine that has been developed over China's long medical history. Fine line to walk. Finally, since almost every patient does get acupuncture, and the exception to the rule are one's that just get herbs (at least in Boulder), then this becomes the category we MUST talk about. Dosage and herb usages therefore should be discussed within this category, not the average zhong guo ren. - _____ On Behalf Of Bob Flaws Friday, March 30, 2007 9:41 AM Re: morphing Granules One thing that needs to be taken into account in this discussion is that, in the West, we typically administer acupuncture and not just the herbs. Therefore, we are doubling up on therapies. This is not typically the case in Asia. By doubling up on therapies, we may be able to use less of each than are usually used in Asia. However, this is all terra incognita. We're doing something new here. the only downside to practicing this way is that we never really know what did what. If that doesn't matter, no problem. However, if we are doing both herbs and acupuncture, then any discussion specifically of the herbal treatment cannot be categorical. Bob @ <%40> , " " wrote: > > To morph into a little different subject, it is my experience that > (despite what some of my colleagues say) a small dosage of a > readymade-bottled-prepared or granule formula can go a long way to > change a person. My belief is that if a body is out-of-balance, given > the proper corrective herbs can dramatically change the terrain very > quickly. Some of students are surprised at the small dosages of the > herbs I often give. Too big of a dosage will just play chaos. And of > course it has to be the right formula. > Large dosages play their role in many cases but I love it when a few > pills or grams a couple times a day does the trick. > doug > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 30, 2007 Report Share Posted March 30, 2007 You're not equating the SHL 'liang' for today's 'liang', are you? Geoff , " Eric Brand " <smilinglotus wrote: > BTW, Shang Han Lun doses were " monster doses " by modern standards. > > Eric > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 31, 2007 Report Share Posted March 31, 2007 , " G Hudson " <crudo20 wrote: > > You're not equating the SHL 'liang' for today's 'liang', are you? > Geoff One SHL liang is roughly equal to the modern 4 qian (int'l qian, 3.7 g, not PRC qian). Eric Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 31, 2007 Report Share Posted March 31, 2007 As mentioned before there are differing opinions on this subject, For example, stated in a specific discussion on the conversion of dosages in Han dynasty to modern day, it states that One liang (SHL) is equal to One qian (Modern) which is equal to roughly 3 grams. The source is : É˺®Àà֤̽Îö(sh ¨¡ngh¨¢n l¨¨i zh¨¨ng t¨¤n x¨©) (renminweisheng)¡ -Jason _____ On Behalf Of Eric Brand > You're not equating the SHL 'liang' for today's 'liang', are you? > Geoff One SHL liang is roughly equal to the modern 4 qian (int'l qian, 3.7 g, not PRC qian). Eric Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 31, 2007 Report Share Posted March 31, 2007 Jason, This is one of the most eloquent posts I've read on CHA, and I agree wholeheartedly with all of your sentiments. You should expand this into an article, the newer generation of practitioners in the West need this type of guidance, there is too much confusion on how to translate Chinese medicine into modern Western reality. On Mar 30, 2007, at 7:37 PM, wrote: > > So of course we are in uncharted territory. This is nothing new > historically > either. IMO, every patient is a puzzle to figure out with multiple > variables. This is precisely why we must be flexible with every > patient, and > not hold rigidity onto anything. While at the same time though, it > seems > wise to stay true to the medicine that has been developed over > China's long > medical history. Fine line to walk. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 2, 2007 Report Share Posted April 2, 2007 I bought the tapes from one of the CHA(maybe CHA tape on the SHL?) conferences where Dr. Bensky talked about the difference between tradition and tradionalisim. This included an analysis of ling huo (flexible) vs. inflexible (don't remember the pin yin)which stated that dead things are inflexible. I would recommend it if anyone is interested. You can see amazing Chinese artists on the streets from San Fran to Vancouver, BC who do the pencil life-like portrait sketches. When I was in China last summer, artists were doing traditional style landscapes painting with the side of their hand and a fingernail! Then you have 'artists' here who just throw crap (even literally!) on a paper and their followers (groupies?) laud it as high art. Now, if they actually had good classical skills, I might humbly apologize for dissing poop-on-a-stick. I could make the same conclusions to classmates who 'felt' everything, but thought the classics were just communist government propaganda. Now, if they actually knew the textbook location of Sp 6, and then they might squiggle a little here or there for the best spot, great, but when they 'feel' Sp6 and it's actually Ki7, then... well. I read Cara's post on 're-engineering' herbal training, but worry about too much flexibility so students will feel that memorizing 300 herbs isn't important. Like Confucious (?) said, when your father dies, don't change anything for 7 years (Sorry big guy if I slaughtered that). There is a great value in some traditions, just think very carefully about the long term impact of changing things too quickly/easily. Best rgds, Geoff ps - this group has become much more interesting than in years past where political stuff was rampant, and it's great to see. , " " <zrosenbe wrote: > > Jason, > This is one of the most eloquent posts I've read on CHA, and I > agree wholeheartedly with all of your sentiments. You should expand > this into an article, the newer generation of practitioners in the > West need this type of guidance, there is too much confusion on how > to translate Chinese medicine into modern Western reality. > > Quote Link to comment Share on other sites More sharing options...
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