Small Dosing vs Large Dosing

[Guest guest]

Years ago, I think on ChineseMedicineNetwork Will Morris wrote " use small

doses to affect the nervous system and (he used) large doses to affect the

organs " . I think he was talking about his herbal teacher. I thought it was

interesting so I wrote it down.

 

Tim Sharpe

 

 

Al Stone

Friday, March 30, 2007 11:36 AM

 

Is there a type of case in which small dosages are more likely to be

effective? Acute excess type issues, or chronic deficiencies?

[Guest guest]

" Years ago, I think on ChineseMedicineNetwork Will Morris wrote " use

small doses to affect the nervous system and (he used) large doses to

affect the organs " . "

 

Sounds like Kaptchuk's old rap. I thought that hypothesis was a dead

letter. There is no support of this idea within the contemporary

Chinese medical literature. In contemporary TCM psychiatry, large

doses tend to be the rule. Further, there is no body/mind dichotomy in

CM. Thinking this way is thinking in a non-Chinese manner.

 

Bob

[Guest guest]

That was not Wills' idea but Dr Shens'

 

 

 

 

 

 

 

 

-

Tim Sharpe

Tuesday, April 10, 2007 7:28 AM

Small Dosing vs Large Dosing

 

 

Years ago, I think on ChineseMedicineNetwork Will Morris wrote " use small

doses to affect the nervous system and (he used) large doses to affect the

organs " . I think he was talking about his herbal teacher. I thought it was

interesting so I wrote it down.

 

Tim Sharpe

 

Al Stone

Friday, March 30, 2007 11:36 AM

 

Is there a type of case in which small dosages are more likely to be

effective? Acute excess type issues, or chronic deficiencies?

 

 

 

 

 

 

[Guest guest]

I have been confused about this issue of dosing since I began my

herbal clinic at NESA this semester. In our clinic we use 10g of

powder as the daily dose. I have asked a number of my teachers about

this, and it seems the consensus dosage range is 9-12g per day. Their

reasoning behind this is largely financial, ie it would be too

expensive for the patients in the long run to have higher daily doses.

I have also been asking whether they look at the herbs as acting

primarily energetically or pharmacologically, and too my surprise the

majority have said energetically. I was wondering what CHA members

thought?

[Guest guest]

Bob

 

This has been a serious matter for a long time. How can a profession have any

credibility if prominent spokespeople bandy around ideas like this. When asked

about where such an idea came from, it appears to be either:

 

1. speculation on nebulous things like the " energy " of the herbs

2. derived from homeopathy

3. claimed to be part of some oral tradition.

 

In any of these cases, there is no mainstream researcher or insurance company

who would even consider entertaining such ideas as the basis for either

controlled experiments or justification for reimbursement. The sad thing is that

the practice of grossly under-prescribing herbs is not some fringe occurrence.

It is the far and away the norm. When the vast majority of practitioners make

such clinical decisions on a daily basis, it bodes poorly for the profession. At

best, it is an embarrassment; at worst, it is unethical.

 

-------------- Original message ----------------------

" Bob Flaws " <pemachophel2001

> " Years ago, I think on ChineseMedicineNetwork Will Morris wrote " use

> small doses to affect the nervous system and (he used) large doses to

> affect the organs " . "

>

> Sounds like Kaptchuk's old rap. I thought that hypothesis was a dead

> letter. There is no support of this idea within the contemporary

> Chinese medical literature. In contemporary TCM psychiatry, large

> doses tend to be the rule. Further, there is no body/mind dichotomy in

> CM. Thinking this way is thinking in a non-Chinese manner.

>

> Bob

>

>

 

 

 

 

 

[Guest guest]

I think anyone who says this (about energy) has no basis for their statements.

When the chinese talked about the qi of an herb, they were clearly referring to

its potency, not some invisible energy that had no relationship to matter. If

so, why did they always use high doses themselves and never write about the

supposed ethereal energies of herbs? In addition, purposely underdosing patients

for any reason is a breach of ethics. If the patients cannot afford the

medicine, they should not be prescribed anything at all.

 

Having said this, 10 g of powders is a standard dose in Taiwan and Japan, so

this is not the kind of underdosing I refer to. While this is far lower than the

doses used in China both historically and now, my concern is for those who use

low-dose pill products as their primary treatment modality. 10 g of a powder is

the equivalent of 50 g of raw herbs (assuming we are talking about formulas and

not mixtures of single herbs, for which the actual dosage is a mystery). OTOH, 8

pills 3X/day of even a 5:1 Mayway extract are equal to about 25 g of raw herbs,

probably less since 1/3 of each pill is filler (so maybe 18 g). You need to at

least double, if not quadruple, the dose for these pills to actually do anything

more than placebo.

 

-------------- Original message ----------------------

" jasonnesa " <jasonhenson

> I have been confused about this issue of dosing since I began my

> herbal clinic at NESA this semester. In our clinic we use 10g of

> powder as the daily dose. I have asked a number of my teachers about

> this, and it seems the consensus dosage range is 9-12g per day. Their

> reasoning behind this is largely financial, ie it would be too

> expensive for the patients in the long run to have higher daily doses.

> I have also been asking whether they look at the herbs as acting

> primarily energetically or pharmacologically, and too my surprise the

> majority have said energetically. I was wondering what CHA members

> thought?

>

>

 

 

 

 

 

[Guest guest]

Yet patients do get better with these small dosages of patents, IMHO.

I also wonder what is meant by the 1:5 ratio. If we have a 120 gram

raw formula we are not grinding up 120 grams and eating it all. We

take a 4-8 ounces of extracted liquid from the bottom of a pot. Do the

companies claim that their powder is 5 to 1 of that extraction or 5 to

1 of raw herbs? I'm not that concerned with not giving 25 grams of raw

powder to meet a 125 5 to 1 ratio. Yes, economics play a role but also

I find I can't tolerate more than 10 grams or so a day, and the

formulas I write for myself are excellent. :-)

 

doug

 

 

 

, wrote:

___________

> Having said this, 10 g of powders is a standard dose in Taiwan and

Japan, so this is not the kind of underdosing I refer to. While this

is far lower than the doses used in China both historically and now,

my concern is for those who use low-dose pill products as their

primary treatment modality. 10 g of a powder is the equivalent of 50 g

of raw herbs (assuming we are talking about formulas and not mixtures

of single herbs, for which the actual dosage is a mystery). OTOH, 8

pills 3X/day of even a 5:1 Mayway extract are equal to about 25 g of

raw herbs, probably less since 1/3 of each pill is filler (so maybe 18

g). You need to at least double, if not quadruple, the dose for these

pills to actually do anything more than placebo.

>

[Guest guest]

Dear all,

 

My experinece with the concentrated granules is limited to KPC and Yi Fang.

 

KPC granules are at a 5:1 ratio and I tend to give patients the equivilent as I

would the raw.

Ie. a 130 gram formula would equate to 13 grams 2 times a day. Usually I will

lessen this

by a couple grams each time, but I will still always try to keep the same dose

as i would

with the raw, other wise I can't tell if the formula is working properly or not.

I can't tell if

my Dx is off or if the herbs are off or what. At least when I use the proper

dose I can

usually tell fairly quickly if it is working or not. This is especially true, in

my eperience,

with the treatment of skin disease, ie psoriasis. I have a company mix my

perscriptions for

me and then the patient is given a little scoop that is supposed to equal a

gram. Of course

this is not that accurate because volume and mass don't always equate. Ie. one

scoop of

Shan Yao may not be 1 gram, but one scoop of Sheng Di may equal one gram.

 

Yi Fang comes in little vacumm sealed packs with the equivelant of an average

days

dosage of the raw. They tend to be anywhere between a 6-10;1 ratio (it says

right on the

package what the actual weight is, what the raw equivelant is, and what the

ratio is). So if

Huang Qi is dosed at an equivilent of 15grams of raw per package then I can

double or

triple the number of packages accordingly. I pefer this system, as I know that

the patient is

getting the proper amount of herbs for their formula each day.

 

If people get results with lower doses then that is great. It would definetly be

more

economical and easier for the patient to swallow. I personally want results,

quickly and

efficiently and IMHO we need to give the proper dose, as we would the raw, in

order to see

the best results. If they can't tollerate so much at once, I will first try to

get them to split

the day into three instead of two, so that they take less more often. If this

doesn't work for

them then I will let them take less, but I will watch what kind of results take

place. Usually

I don't see the results that I want and I will inform the patient of this. This

way they know

that it was their choice to slow down their treatment outcome.

 

 

Trevor

[Guest guest]

, " Trevor Erikson "

<trevor_erikson wrote:

>

> Dear all,

>

> My experinece with the concentrated granules is limited to KPC and

Yi Fang.

>

> KPC granules are at a 5:1 ratio

 

Actually, it is more varied than that. I'm in Taiwan at the moment,

so I'll pick up a few KPC, Quali, and Sun-Ten products and compare the

labels and ratios. The extraction ratio varies from product to

product, even within the same brand. The 5 to 1 estimate is useful

clinically but it isn't very precise in terms of what's actually in

the bottle.

 

I'll pick some stuff up and post the ratios. I won't put the company

names in the post because I don't want to be seen as endorsing one

over the other- actually I like most of them and have no vested

interest in any of them. Including the company names might skew the

sample, because one could selectively choose products to compare that

make one company appear better than another.

 

Eric

[Guest guest]

 

I think you might be a little too rigid in your thinking here. In

reading MOA (method of action) in drug monographs, you will very often

read '.... unknown, but is thought to...'. Right there you throw the

strict pharmaceutical science out of the boat. Electro convulsive

therapy is another example - can be covered by insurance, but nobody

knows why it works (As far as I know, reasons for why something works

isn't a criteria for insurance reimbursement). You would be treading

interesting ground to simply correlate TCM MOA with the therapeutic

curve - especially considering the herb combinations in various

formulas. In regards to your ethics comment, MD's prescribe

sub-standard dosages all the time to patients for various reasons or

use possibly less than absolute best Rx available due to a patient's

financial constraints. Has there been arguments that those doc's are

unethical?

 

That all said, I don't think pharmaceutical science is the

end-all-be-all you make it out to be. It is very new and changes

often - but still has many great ideas. I agree it is hard to

understand pharmaceutically where you can say 8tid of a mayway pill is

equivalent to 25gm (if that is correct) of raw herbs. That dosage

seems silly, where our raw formulas can easily be 100gm or more. But,

as they also do so in China, many formulas will work 8 tid. Herbs

were dispensed in 1,2,3 qian, not as a percentage of the total

formula. Now formulas are given in pills / standardized granules (ie

10gm / day etc). So we should think of why that is effective, rather

than dismissing it as 'placebo' because it isn't simply Western

pharmaceutical 'above-the-curve' thinking.

 

Geoff

 

 

, wrote:

>

> I think anyone who says this (about energy) has no basis for their

statements. When the chinese talked about the qi of an herb, they were

clearly referring to its potency, not some invisible energy that had

no relationship to matter. If so, why did they always use high doses

themselves and never write about the supposed ethereal energies of

herbs? In addition, purposely underdosing patients for any reason is a

breach of ethics. If the patients cannot afford the medicine, they

should not be prescribed anything at all.

>

> ...OTOH, 8 pills 3X/day of even a 5:1 Mayway extract are equal to

about 25 g of raw herbs, probably less since 1/3 of each pill is

filler (so maybe 18 g). You need to at least double, if not quadruple,

the dose for these pills to actually do anything more than placebo.

>