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Hi, does anyone know of a good place to order individual granules in

the US? Specifically I am looking for Lu Jiao Jiao. I usually go

through KPC or May Way, but neither have it. Its such a key herb in

several of my patients formulas...and I'm running out! Help!

 

May Way does have it in raw herbs, so if I have to I could figure out

a way to make it into a granule...but first I'd have to figure that

out...(any simple ideas?).

 

Thanks,

 

Laura

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Evergreen has a Lu Jiao Shuang.

 

On Dec 20, 2007 8:16 PM, heylaurag <heylaurag wrote:

 

> Hi, does anyone know of a good place to order individual granules in

> the US? Specifically I am looking for Lu Jiao Jiao. I usually go

> through KPC or May Way, but neither have it. Its such a key herb in

> several of my patients formulas...and I'm running out! Help!

>

 

 

--

, DAOM

Pain is inevitable, suffering is optional.

 

 

 

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As far as I can tell making a granule will be near impossible since it has to be

dissolved for it

to be effective. I remember trying to put E Jiao through a grinder. It melted

inside with the

heat of the grinding and it took several days to scrape the dried goop out.

Doug

 

 

, " heylaurag " <heylaurag wrote:

>unning out! Help!

>

> May Way does have it in raw herbs, so if I have to I could figure out

> a way to make it into a granule...but first I'd have to figure that

> out...(any simple ideas?).

>

> Thanks,

>

> Laura

>

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Have you tried Bioessence. That's where I've purchased it in the past.

 

_____

 

 

On Behalf Of Al Stone

Thursday, December 20, 2007 9:00 PM

 

Re: Granules--Help!

 

 

 

Evergreen has a Lu Jiao Shuang.

 

On Dec 20, 2007 8:16 PM, heylaurag <heylaurag (AT) hotmail (DOT)

<heylaurag%40hotmail.com> com> wrote:

 

> Hi, does anyone know of a good place to order individual granules in

> the US? Specifically I am looking for Lu Jiao Jiao. I usually go

> through KPC or May Way, but neither have it. Its such a key herb in

> several of my patients formulas...and I'm running out! Help!

>

 

--

, DAOM

Pain is inevitable, suffering is optional.

 

 

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Hi, does anyone know of a good place to order individual granules in

the US? Specifically I am looking for Lu Jiao Jiao. I usually go

through KPC or May Way, but neither have it. Its such a key herb in

several of my patients formulas...and I'm running out! Help!

 

May Way does have it in raw herbs, so if I have to I could figure out

a way to make it into a granule...but first I'd have to figure that

out...(any simple ideas?).

 

Thanks,

 

Laura

 

Hi Laura,

 

As far as I know, the granules of this you can purchase are just the

ground up gelatin and are not further processed anyway. What we do is

order the Gelatins powdered from Kamwo in New York:

 

http://www.kamwo.com/mambo/

 

We use this powder in our raw herb formulas as well as with our powder

(KPC) formulas. As for proportions, we use it as if it were an

extract. It works great.

 

Best

 

Sharon

 

 

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz

www.whitepinehealingarts.com

 

 

 

 

 

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Crane Herb Co. has Lu Jiao Jiao and Lu Jiao Shuang from KPC and Spring Wind.

It was not available (per FDA) for some time.

Happy Holidays,

Bill Egloff

 

 

On 12/20/07 11:16 PM, " heylaurag " <heylaurag wrote:

 

>

>

>

>

> Hi, does anyone know of a good place to order individual granules in

> the US? Specifically I am looking for Lu Jiao Jiao. I usually go

> through KPC or May Way, but neither have it. Its such a key herb in

> several of my patients formulas...and I'm running out! Help!

>

> May Way does have it in raw herbs, so if I have to I could figure out

> a way to make it into a granule...but first I'd have to figure that

> out...(any simple ideas?).

>

> Thanks,

>

> Laura

 

 

 

 

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, sharon weizenbaum

<sweiz wrote:

>

> Hi, does anyone know of a good place to order individual granules in

> the US? Specifically I am looking for Lu Jiao Jiao. I usually go

> through KPC or May Way, but neither have it. Its such a key herb in

> several of my patients formulas...and I'm running out! Help!

 

Actually, the gelatin products in granule form are not actually

concentrated extracts, they are just finely ground powders. As I

understand it (based on discussions with granule producers at some of

the major factories), the gelatins cannot be further concentrated, as

the gelatin itself is already the water-soluble extract of the crude

drug, and the gelatin will just turn into gunk that sticks to all of

the equipment if one tries to cook it again.

 

Consequently, gelatins are the same in the bulk and the granule form,

the only difference is in the consistency of the even, fine powder.

The same is true for mineral products. This issue has been discussed

on CHA in the past, and the discussion would be completely unnecessary

if the granule companies didn't obscure their concentration ratios

when they are re-labeled for the US market. Of course, the problem

lies more with the consumers than the pharmaceutical companies, since

it is lack of practitioner knowledge of dose and lack of practitioner

demand for transparency that is the problem, but these issues and the

myth of 5:1 have been discussed on CHA before and don't need to be

repeated here.

 

If you buy your lu jiao jiao from a bulk herb supplier and need to

powder it, the most common technique is to bake the gelatin with

clamshell powder or hai piao xiao powder. This causes the gelatin to

puff up (commonly seen with e jiao when making e jiao zhu), and the

resulting product is easy to grind and use.

 

To my mind, using lu jiao shuang (degelatinated deer horn) as a

substitute for lu jiao jiao (deer horn gelatin) wouldn't make sense.

The two substances have significantly different natures and uses. Lu

jiao shuang has a very weak supplementing effect because all of the lu

jiao jiao has been cooked out of it; lu jiao shuang is mostly used for

its astringent effect in gynecology. Lu jiao jiao is mostly used for

supplementing yin-blood with its rich nature, so to my mind a more

comparable substitute would be gui ban jiao (if using it for

yin-blood) or lu rong (if using it for yang, blood, and essence).

 

Eric

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Thanks for all the great ideas everyone. Eric, I agree with you about

Lu Jiao Jiao being completely different from Lu Jiao Shuang. And

because its milder than Lu Rong it doesn't seem to run the risk of

liver yang rising from it. I think its a great herb, so I'm hoping I

can find it. So, Eric, do you use the same amount of grams in a

formula that you would use if it was a concentrated granule?

 

 

 

 

, " Eric Brand "

<smilinglotus wrote:

>

> , sharon weizenbaum

> <sweiz@> wrote:

> >

> > Hi, does anyone know of a good place to order individual granules in

> > the US? Specifically I am looking for Lu Jiao Jiao. I usually go

> > through KPC or May Way, but neither have it. Its such a key herb in

> > several of my patients formulas...and I'm running out! Help!

>

> Actually, the gelatin products in granule form are not actually

> concentrated extracts, they are just finely ground powders. As I

> understand it (based on discussions with granule producers at some of

> the major factories), the gelatins cannot be further concentrated, as

> the gelatin itself is already the water-soluble extract of the crude

> drug, and the gelatin will just turn into gunk that sticks to all of

> the equipment if one tries to cook it again.

>

> Consequently, gelatins are the same in the bulk and the granule form,

> the only difference is in the consistency of the even, fine powder.

> The same is true for mineral products. This issue has been discussed

> on CHA in the past, and the discussion would be completely unnecessary

> if the granule companies didn't obscure their concentration ratios

> when they are re-labeled for the US market. Of course, the problem

> lies more with the consumers than the pharmaceutical companies, since

> it is lack of practitioner knowledge of dose and lack of practitioner

> demand for transparency that is the problem, but these issues and the

> myth of 5:1 have been discussed on CHA before and don't need to be

> repeated here.

>

> If you buy your lu jiao jiao from a bulk herb supplier and need to

> powder it, the most common technique is to bake the gelatin with

> clamshell powder or hai piao xiao powder. This causes the gelatin to

> puff up (commonly seen with e jiao when making e jiao zhu), and the

> resulting product is easy to grind and use.

>

> To my mind, using lu jiao shuang (degelatinated deer horn) as a

> substitute for lu jiao jiao (deer horn gelatin) wouldn't make sense.

> The two substances have significantly different natures and uses. Lu

> jiao shuang has a very weak supplementing effect because all of the lu

> jiao jiao has been cooked out of it; lu jiao shuang is mostly used for

> its astringent effect in gynecology. Lu jiao jiao is mostly used for

> supplementing yin-blood with its rich nature, so to my mind a more

> comparable substitute would be gui ban jiao (if using it for

> yin-blood) or lu rong (if using it for yang, blood, and essence).

>

> Eric

>

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Eric-

 

I read your article in the acupuncture almanac on this subject and really liked

it. How do you end up dosing granules of these medicinals that do not

concentrate? Also, have you a list of the concentrations of various herbs?

Thanks.

 

-Steve

 

 

" Eric Brand " <smilinglotus

 

12/21/2007 2:12 PM

Re:Granules--Help!

 

, sharon weizenbaum

<sweiz wrote:

>

> Hi, does anyone know of a good place to order individual granules in

> the US? Specifically I am looking for Lu Jiao Jiao. I usually go

> through KPC or May Way, but neither have it. Its such a key herb in

> several of my patients formulas...and I'm running out! Help!

 

Actually, the gelatin products in granule form are not actually

concentrated extracts, they are just finely ground powders. As I

understand it (based on discussions with granule producers at some of

the major factories), the gelatins cannot be further concentrated, as

the gelatin itself is already the water-soluble extract of the crude

drug, and the gelatin will just turn into gunk that sticks to all of

the equipment if one tries to cook it again.

 

Consequently, gelatins are the same in the bulk and the granule form,

the only difference is in the consistency of the even, fine powder.

The same is true for mineral products. This issue has been discussed

on CHA in the past, and the discussion would be completely unnecessary

if the granule companies didn't obscure their concentration ratios

when they are re-labeled for the US market. Of course, the problem

 

 

[truncated by sender]

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, " heylaurag " <heylaurag

wrote:

>

> Thanks for all the great ideas everyone. Eric, I agree with you about

> Lu Jiao Jiao being completely different from Lu Jiao Shuang. And

> because its milder than Lu Rong it doesn't seem to run the risk of

> liver yang rising from it. I think its a great herb, so I'm hoping I

> can find it. So, Eric, do you use the same amount of grams in a

> formula that you would use if it was a concentrated granule?

 

All of the deer antler products have unique advantages and drawbacks,

no doubt about it. As for dosage, it depends on the situation. If I

am using raw herbs by decoction, I use a standard dose of lu jiao

jiao, melted into the strained decoction. If I am using granules

instead of decoctions, I just use the granule form of lu jiao jiao,

mixed with the other granules in the prescription. Ideally, the

dosage of lu jiao jiao for the two forms should be basically the same,

but there are often other concerns that affect my decision.

 

Expense and ratios are the biggest factors that shape granule dosing

for me. With granule prescriptions containing lu jiao jiao, the

issues that arise are largely parallel to the challenges posed by

other products that are weak in medicinal strength by weight, such as

qian shi, yi yi ren, and shan yao.

 

I spent a long time in Taiwan observing doctors using granules, and

there are a few issues that are hard to resolve completely,

particularly when mild medicinals, minerals, and gelatins are

indicated. However, despite these challenges, granules are extremely

effective and convenient, and I feel that in many ways granules are

the most promising modern form of Chinese herbal medicine. Certainly

they offer the greatest flexibility and the highest potency per dollar

compared to everything except raw herbs.

 

For Taiwanese doctors, the issue is mostly an issue of ratios, because

the government insurance only covers granules up to 6 gram doses

(generally these 6 g doses are given 3 times a day). When the total

quantity of granules is limited by government regulations, cost, or

compliance in terms of how much powder the patient will ingest, the

ratio of potent to weak ingredients becomes important.

 

In the example of lu jiao jiao, if a Taiwanese doctor is giving a

prescription with 18 grams of total granules per day (their typical

standard for adults), they need to consider how much lu jiao jiao

should be included for the maximum overall therapeutic effect. If

they were prescribing raw herbs, perhaps they would use 9 grams of lu

jiao jiao, to be taken dissolved into the strained decoction. In this

situation, the 9 g of lu jiao jiao is maybe 10% of the total medicine

in the pack, assuming a standard pack with about 90 grams of total

crude medicinals. Now, if they are using granules, to get that same 9

grams of lu jiao jiao, they have to have 9 grams out of the total 18

grams representing just one ingredient (50% LJJ instead of 10% LJJ).

In most cases, doctors prefer to use a smaller amount of lu jiao jiao

so that it doesn't take up half of the total prescription, thus

diluting the other ingredients. If the LJJ is done at its ideal dose,

the other ingredients are pushed to a dose that is lower than their

ideal.

 

The same is true for something mild by weight like yi yi ren. If you

would normally use 30 grams of crude yi yi ren in a raw prescription,

and you achieve a 5:1 concentration with the granule extract, you

still require 6 grams of the yi yi ren concentrate to achieve the same

dose that you get with raw herbs. However, if 6 grams of the total 18

gram prescription is just yi yi ren, it takes up a third of the space,

giving you less room for more potent ingredients like ren shen, bai

zhu, etc.

 

I see patients at the PCOM clinic in San Diego, and our limitation

there tends to revolve around price rather than gov't insurance dosage

limits. However, the same issue applies. A 12 gram daily granule

dose at the PCOM clinic costs the patient about $3, and often the

doses that I use represent a balance between acceptable cost and

acceptable dose ranges from the medical perspective. If I am

prescribing a 12 g total dose, I usually don't want half of it to be

only yi yi ren or lu jiao jiao. If I was using raw herbs, adding 30

grams of yi yi ren wouldn't have any effect on the amount of ren shen

and bai zhu or whatever that can go into the same daily pack.

However, if I am using granules and the dosage is capped by outside

limitations such as the clinic's pricing structure, the amount of yi

yi ren that goes into the daily dose affects the amount of ren shen

and bai zhu that they consume. In these examples, I will tend to use

a smaller amount of yi yi ren or lu jiao jiao than I would if these

outside limitations did not exist. Does that make sense?

 

Interestingly, very few practitioners in a granule-heavy medical

environment like Taiwan mix their granule formulas from scratch based

on single herbs. Most doctors there use whole granule formulas that

have been cooked together, augmented with single herb extracts. This

is my preference also.

 

I hope that helps answer your question! Granules are a new ball game

for many of us, and most Western and mainland Chinese practitioners

don't have much training in their use. Granules are very effective

and I have very positive sentiments towards their use, but they do

pose a few unique challenges and it is best for us to be as aware of

these issues as possible.

 

Eric Brand

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Hi Eric, you said that all the deer antler products have draw backs,

I'm curious to hear what kind of problems you see with Lu Jiao Jiao?

Are you referring to the potential for liver yang rising?

 

I never felt like I have found a source for good information for how

to take a classical formula and make it into a granule formula with

the right dosages. So I've instead just watched responses and

learned. I sure wish I had a good source though because I don't like

having to learn from mistakes with patients! I only use granules, so

that's what I'm working with.

 

One thing I've learned is that herbs like Chen Pi and Ze Xie do not

seem to require as high of a dose. I generally use a very small dose

of both those herbs in a formula and it works, whereas if I used the

same proportion as I see in a classical formula it would be way too

much.

 

For these reasons I too prefer to start with a classic formula and

modify from there. But it sure would be nice to feel like I fully

understood how to make them myself. Anyone have a good source for

this information? Anyone have a basic set of rules that you go by

with granules that you could share?

 

 

 

 

 

, " Eric Brand "

<smilinglotus wrote:

>

> , " heylaurag " <heylaurag@>

> wrote:

> >

> > Thanks for all the great ideas everyone. Eric, I agree with you about

> > Lu Jiao Jiao being completely different from Lu Jiao Shuang. And

> > because its milder than Lu Rong it doesn't seem to run the risk of

> > liver yang rising from it. I think its a great herb, so I'm hoping I

> > can find it. So, Eric, do you use the same amount of grams in a

> > formula that you would use if it was a concentrated granule?

>

> All of the deer antler products have unique advantages and drawbacks,

> no doubt about it. As for dosage, it depends on the situation. If I

> am using raw herbs by decoction, I use a standard dose of lu jiao

> jiao, melted into the strained decoction. If I am using granules

> instead of decoctions, I just use the granule form of lu jiao jiao,

> mixed with the other granules in the prescription. Ideally, the

> dosage of lu jiao jiao for the two forms should be basically the same,

> but there are often other concerns that affect my decision.

>

> Expense and ratios are the biggest factors that shape granule dosing

> for me. With granule prescriptions containing lu jiao jiao, the

> issues that arise are largely parallel to the challenges posed by

> other products that are weak in medicinal strength by weight, such as

> qian shi, yi yi ren, and shan yao.

>

> I spent a long time in Taiwan observing doctors using granules, and

> there are a few issues that are hard to resolve completely,

> particularly when mild medicinals, minerals, and gelatins are

> indicated. However, despite these challenges, granules are extremely

> effective and convenient, and I feel that in many ways granules are

> the most promising modern form of Chinese herbal medicine. Certainly

> they offer the greatest flexibility and the highest potency per dollar

> compared to everything except raw herbs.

>

> For Taiwanese doctors, the issue is mostly an issue of ratios, because

> the government insurance only covers granules up to 6 gram doses

> (generally these 6 g doses are given 3 times a day). When the total

> quantity of granules is limited by government regulations, cost, or

> compliance in terms of how much powder the patient will ingest, the

> ratio of potent to weak ingredients becomes important.

>

> In the example of lu jiao jiao, if a Taiwanese doctor is giving a

> prescription with 18 grams of total granules per day (their typical

> standard for adults), they need to consider how much lu jiao jiao

> should be included for the maximum overall therapeutic effect. If

> they were prescribing raw herbs, perhaps they would use 9 grams of lu

> jiao jiao, to be taken dissolved into the strained decoction. In this

> situation, the 9 g of lu jiao jiao is maybe 10% of the total medicine

> in the pack, assuming a standard pack with about 90 grams of total

> crude medicinals. Now, if they are using granules, to get that same 9

> grams of lu jiao jiao, they have to have 9 grams out of the total 18

> grams representing just one ingredient (50% LJJ instead of 10% LJJ).

> In most cases, doctors prefer to use a smaller amount of lu jiao jiao

> so that it doesn't take up half of the total prescription, thus

> diluting the other ingredients. If the LJJ is done at its ideal dose,

> the other ingredients are pushed to a dose that is lower than their

> ideal.

>

> The same is true for something mild by weight like yi yi ren. If you

> would normally use 30 grams of crude yi yi ren in a raw prescription,

> and you achieve a 5:1 concentration with the granule extract, you

> still require 6 grams of the yi yi ren concentrate to achieve the same

> dose that you get with raw herbs. However, if 6 grams of the total 18

> gram prescription is just yi yi ren, it takes up a third of the space,

> giving you less room for more potent ingredients like ren shen, bai

> zhu, etc.

>

> I see patients at the PCOM clinic in San Diego, and our limitation

> there tends to revolve around price rather than gov't insurance dosage

> limits. However, the same issue applies. A 12 gram daily granule

> dose at the PCOM clinic costs the patient about $3, and often the

> doses that I use represent a balance between acceptable cost and

> acceptable dose ranges from the medical perspective. If I am

> prescribing a 12 g total dose, I usually don't want half of it to be

> only yi yi ren or lu jiao jiao. If I was using raw herbs, adding 30

> grams of yi yi ren wouldn't have any effect on the amount of ren shen

> and bai zhu or whatever that can go into the same daily pack.

> However, if I am using granules and the dosage is capped by outside

> limitations such as the clinic's pricing structure, the amount of yi

> yi ren that goes into the daily dose affects the amount of ren shen

> and bai zhu that they consume. In these examples, I will tend to use

> a smaller amount of yi yi ren or lu jiao jiao than I would if these

> outside limitations did not exist. Does that make sense?

>

> Interestingly, very few practitioners in a granule-heavy medical

> environment like Taiwan mix their granule formulas from scratch based

> on single herbs. Most doctors there use whole granule formulas that

> have been cooked together, augmented with single herb extracts. This

> is my preference also.

>

> I hope that helps answer your question! Granules are a new ball game

> for many of us, and most Western and mainland Chinese practitioners

> don't have much training in their use. Granules are very effective

> and I have very positive sentiments towards their use, but they do

> pose a few unique challenges and it is best for us to be as aware of

> these issues as possible.

>

> Eric Brand

>

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, stephenbonzak wrote:

>

> Eric-

>

> I read your article in the acupuncture almanac on this subject and

really liked it. How do you end up dosing granules of these medicinals

that do not concentrate? Also, have you a list of the concentrations

of various herbs? Thanks.

 

Hi Stephen,

 

Whew! Big questions! Hopefully I just answered some elements of the

dosing question in my most recent post, but let me know if there are

more specific questions and I can try to give you a better answer. In

short, it depends on which medicinal is in question, how important it

is in the formula, how safe it is in a crude state, and how much

outside variables like cost and pricing structures intrude on my

decision.

 

Most of my teachers in Taiwan tended to use lower doses of weak

substances and minerals in granule form than they would if they were

prescribing raw herbs, so that more potent medicinals would not be

diluted and so that the unknowns of ingesting straight minerals in

large amounts are minimized. Nearly all preferred to use whole

formulas rather than singles whenever possible. Doctors there prefer

to give the whole formula ma xing shi gan tang vs. mixing ma huang,

xing ren, shi gao, and gan cao together as singles, for example.

 

As for a list of concentrations, that is a big task. With more than 5

main Taiwanese producers, each with about 500+ products, comparing the

concentration ratios would require data entry of 2500+ products. Just

buying the 2500 products in Taiwan so that you can type up their

labels is daunting, much less the data entry component itself. The

producers use different quantities of filler, and the concentration

ratio varies from product to product and company to company. Below is

a small comparison of a handful of products that I have posted on CHA

in the past.

 

If you have any specific requests, let me know and I can research the

individual products for you. I am not associated with any of the

companies, and I respect them all. Therefore, I will not name any

companies or their concentration ratios on the internet because I

don't want these discussions to involve commercial product comparisons

and the resulting praise or critiques of any companies involved.

 

Eric Brand

 

Ma zi ren wan (Brand A) Two parts of 5.5:1 concentrate and one part

starch.

4.5g of the final powder contains the equivalent of 4g huo ma ren, 2g

bai shao, 2g zhi shi, 2g hou po, 2.5 xing ren, and 4g da huang.

 

Ma zi ren wan (Brand B) one part 4.25:1 concentrate and one part starch.

4.0g of the final powder contains the equivalent of 2.5g huo ma ren,

1g bai shao, 1g zhi shi, 2g da huang, 1g hou po, and 1g xing ren.

 

As you can see, these two formulas have very different concentrations.

One is nearly twice as strong as the other. Oddly enough, the

stronger one is cheaper at the store. Note that neither is 5:1 in

its final stage. Brand B is 2.15:1. Brand A is 3.66:1.

 

Now just a random survey of other formulas:

 

Yin qiao san= Two parts of 7.5g concentrate to one part filler. About

4.95:1 at the end, very close to 5:1.

6g of final product contains 5g jin yin hua, 5g lian qiao, 2g dan zhu

ye, 2g jing jie, 2g lu gen, 3g jie geng, 3g niu bang zi, 3g ze xie, 3g

bo he, 2.5 gan cao, 2.5g dan dou chi.

 

Yi guan jian= One part 4.33g extract mixed with one part filler.

About 2.17:1 at the end, close to only 2:1.

 

Xiao Feng San= One part 5:1 extract mixed with one part filler. About

2.5:1 at the end.

 

Huo Xiang Zheng Qi San= One part 6.7:1 extract mixed with one part

filler. About 3.35:1 at the end.

 

Xiao Yao San= 10.5g contains 5.9g of 4.7:1 concentrate mixed with 4.6g

starch. About 2.6:1 at the end.

 

Si Wu Tang= One part 5:1 extract mixed with one part filler. About

2.5:1 at the end.

 

Gui Pi Tang= One part 5.2:1 extract mixed with one part filler. About

2.6:1 at the end.

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, " heylaurag " <heylaurag

wrote:

>

> Hi Eric, you said that all the deer antler products have draw backs,

> I'm curious to hear what kind of problems you see with Lu Jiao Jiao?

> Are you referring to the potential for liver yang rising?

 

Dear Heylaurag (???),

 

I'm not referring to liver yang rising per se. Although all of the

deer antler products share a common source and general nature, each

has particular actions that are relatively distinct, and their

supplementing effect is dramatically different.

 

For example, lu rong is potent for supplementing yang, while lu jiao

jiao is weak for supplementing yang but stronger for supplementing

essence and blood. Lu jiao jiao has the drawback of being richer and

stickier; it is more of a " zi bu " type of substance ( " enriching, "

which has a connotation of being rich and nourishing but potentially

cloying, a quality seen in herbs like shu di). This is a drawback in

some ways but it is the same thing that allows it to be so good for

building essence and blood. It is a comparatively yin substance that

is used in relatively high quantities and it additionally has an

action of stopping bleeding. By contrast, lu rong is used in smaller

doses and it has a more yang nature; it is much more effective for

supplementing yang, but this same nature gives it the drawback of

causing upbearing of yang and stirring of blood when it is taken

inappropriately.

 

Lu jiao (mature antlers) has similar actions as lu rong, but it is

much weaker. Its distinct characteristic is that it also moves the

blood and disperses swelling, but lu jiao is generally used much less

than the other deer antler products. Lu jiao shuang is distinguished

by its weak supplementing effects but its additional astringent

action; its use for uterine bleeding and vaginal discharge makes it a

relatively common medicinal in gynecology.

 

Eric Brand

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FYI- I have been waiting for lu jiao jiao as well from Crane herb and

just finally was able to order it about 2 weeks ago!!!

 

 

 

, " Eric Brand "

<smilinglotus wrote:

>

> , " heylaurag " <heylaurag@>

> wrote:

> >

> > Hi Eric, you said that all the deer antler products have draw

backs,

> > I'm curious to hear what kind of problems you see with Lu Jiao

Jiao?

> > Are you referring to the potential for liver yang rising?

>

> Dear Heylaurag (???),

>

> I'm not referring to liver yang rising per se. Although all of the

> deer antler products share a common source and general nature, each

> has particular actions that are relatively distinct, and their

> supplementing effect is dramatically different.

>

> For example, lu rong is potent for supplementing yang, while lu jiao

> jiao is weak for supplementing yang but stronger for supplementing

> essence and blood. Lu jiao jiao has the drawback of being richer

and

> stickier; it is more of a " zi bu " type of substance ( " enriching, "

> which has a connotation of being rich and nourishing but potentially

> cloying, a quality seen in herbs like shu di). This is a drawback in

> some ways but it is the same thing that allows it to be so good for

> building essence and blood. It is a comparatively yin substance

that

> is used in relatively high quantities and it additionally has an

> action of stopping bleeding. By contrast, lu rong is used in

smaller

> doses and it has a more yang nature; it is much more effective for

> supplementing yang, but this same nature gives it the drawback of

> causing upbearing of yang and stirring of blood when it is taken

> inappropriately.

>

> Lu jiao (mature antlers) has similar actions as lu rong, but it is

> much weaker. Its distinct characteristic is that it also moves the

> blood and disperses swelling, but lu jiao is generally used much

less

> than the other deer antler products. Lu jiao shuang is

distinguished

> by its weak supplementing effects but its additional astringent

> action; its use for uterine bleeding and vaginal discharge makes it

a

> relatively common medicinal in gynecology.

>

> Eric Brand

>

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Thanks Eric-

 

Great info. How have you seen single mineral substances dosed in granule

combinations? I usually use minerals decocted with the granule formula, not as

an addition. Aside from cost considerations, how much should you give of mu li,

let's say, if you want to get a similar effect in a granule combo of a 30 g raw

dose? Thanks.

 

-Steve

 

 

" Eric Brand " <smilinglotus

 

12/21/2007 10:23 PM

Re:Granules--Help!

 

, stephenbonzak wrote:

>

> Eric-

>

> I read your article in the acupuncture almanac on this subject and

really liked it. How do you end up dosing granules of these medicinals

that do not concentrate? Also, have you a list of the concentrations

of various herbs? Thanks.

 

Hi Stephen,

 

Whew! Big questions! Hopefully I just answered some elements of the

dosing question in my most recent post, but let me know if there are

more specific questions and I can try to give you a better answer. In

short, it depends on which medicinal is in question, how important it

is in the formula, how safe it is in a crude state, and how much

outside variables like cost and pricing structures intrude on my

decision.

 

Most of my teachers in Taiwan tended to use lower doses of weak

substances and minerals in granule form than they would if they were

prescribing raw herbs, so that more potent medicinals would not be

diluted and so that the unknowns of ingesting straight minerals in

large amounts are minimized. Nearly all preferred to use whole

formulas rather than singles whenever possible. Doctors there prefer

to give the whole formula ma xing shi gan tang vs. mixing ma huang,

xing ren, shi gao, and gan cao together as singles, for example.

 

As for a list of concentrations, that is a big task. With more than 5

main Taiwanese producers, each with about 500+ products, comparing the

concentration ratios would require data entry of 2500+ products. Just

buying the 2500 products in Taiwan so that you can type up their

labels is daunting, much less the data entry component itself. The

producers use different quantities of filler, and the concentration

ratio varies from product to product and company to company. Below is

a small comparison of a handful of products that I have posted on CHA

in the past.

 

If you have any specific requests, let me know and I can research the

individual products for you. I am not associated with any of the

companies, and I respect them all. Therefore, I will not name any

companies or their concentration ratios on the internet because I

don't want these discussions to involve commercial product comparisons

and the resulting praise or critiques of any companies involved.

 

Eric Brand

 

Ma zi ren wan (Brand A) Two parts of 5.5:1 concentrate and one part

starch.

4.5g of the final powder contains the equivalent of 4g huo ma ren, 2g

bai shao, 2g zhi shi, 2g hou po, 2.5 xing ren, and 4g da huang.

 

Ma zi ren wan (Brand B) one part 4.25:1 concentrate and one part starch.

4.0g of the final powder contains the equivalent of 2.5g huo ma ren,

1g bai shao, 1g zhi shi, 2g da huang, 1g hou po, and 1g xing ren.

 

As you can see, these two formulas have very different concentrations.

One is nearly twice as strong as the other. Oddly enough, the

stronger one is cheaper at the store. Note that neither is 5:1 in

its final stage. Brand B is 2.15:1. Brand A is 3.66:1.

 

Now just a random survey of other formulas:

 

Yin qiao san= Two parts of 7.5g concentrate to one part filler. About

4.95:1 at the end, very close to 5:1.

6g of final product contains 5g jin yin hua, 5g lian qiao, 2g dan zhu

ye, 2g jing jie, 2g lu gen, 3g jie geng, 3g niu bang zi, 3g ze xie, 3g

bo he, 2.5 gan cao, 2.5g dan dou chi.

 

Yi guan jian= One part 4.33g extract mixed with one part filler.

About 2.17:1 at the end, close to only 2:1.

 

Xiao Feng San= One part 5:1 extract mixed with one part filler. About

2.5:1 at the end.

 

Huo Xiang Zheng Qi San= One part 6.7:1 extract mixed with one part

filler. About 3.35:1 at the end.

 

Xiao Yao San= 10.5g contains 5.9g of 4.7:1 concentrate mixed with 4.6g

starch. About 2.6:1 at the end.

 

Si Wu Tang= One part 5:1 extract mixed with one part filler. About

2.5:1 at the end.

 

Gui Pi Tang= One part 5.2:1 extract mixed with one part filler. About

2.6:1 at the end.

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, stephenbonzak wrote:

>

> Thanks Eric-

>

> Great info. How have you seen single mineral substances dosed in

granule combinations? I usually use minerals decocted with the

granule formula, not as an addition. Aside from cost considerations,

how much should you give of mu li, let's say, if you want to get a

similar effect in a granule combo of a 30 g raw dose? Thanks.

 

Hi Steve,

 

That's the million-dollar question right there! There is no one

answer, and there is no source text that elucidates it, even in

Chinese. I've talked to several doctors in the top of the field, and

none of them have any final answer, though they all love to discuss

the issue and the challenge it poses.

 

The truth of the matter is that people watch their teachers and

imitate what their teachers do. In parallel CHA discussions, we see

people debating the merits of new delivery methods of herbal medicine

that are largely unique to the West- like the granules, they are a new

field with no past history of use. Granules do attempt to replicate

traditional methods and formulas, and granules do have a longer track

record of patient use than the other " new " forms of Chinese medicine

that we have on the US market, easily surpassing other new methods by

at least 10-20 million patients, I'd estimate. However, at the end of

the day, the phenomenon is the same- new delivery method appears, some

attempt to use it, some users are satisfied with their results,

students see teachers they trust get satisfying results, and students

imitate the teachers for the next generation of patients. Really this

process is just the history of Chinese medicine overall, the variables

are only a question of how long each method has been in use and how

many millions of patients have been used to test it.

 

I've had some great teachers that I respect a lot from the hospital in

Taiwan who use granules every day. My teacher Feng Ye sees about 3000

patients per month, and he uses granules for at least 2500 of them,

I'd estimate. His teacher, Vice Superintendent Chang Hen-Hong, has

the luxury of longer patient visits and lower patient numbers (good to

be the boss!), but he uses granules for dozens of cases every shift.

Xie Jia-Rong, the head of the GYN dept, sees about 120-140 patients

per shift, and she uses granules for 80% plus, at least. All of them

prefer to use raw herbs, but all feel that they also get consistent

(if slower) results with granules. Their patients largely receive

granules because they are virtually free with insurance, whereas raw

herbs are quite expensive, costing at least as much as in the US.

 

Having been fortunate to have some good teachers, I basically just

imitate their style because they all have far more experience than I

have. With regard to minerals, they prefer to use them integrated

into whole pre-cooked formulas (like chai hu jia long gu mu li tang,

ma xing shi gan tang, etc), but I have also seen them add minerals in

as single medicinals.

 

The limitation of the hospital environment is that the constant stream

of patients gives only small windows for questions on each individual

case- we'll be seeing 100+ patients in a four-hour slot and I am just

trying to keep up with the constant flood of doctor-patient

interaction in Mandarin, looking over the shoulder of the doctor to

watch the herbs that get entered into the computer. There will be a

brief pause and I will slip in as many good questions as possible, but

honestly I invariably feel as though I have more questions than

answers by the end of the shift. So please understand my limitations

and take my opinions with a grain of salt; I am no master by any

means, I just try to watch far smarter people than me practice their

art and I try to pay attention.

 

I've had some good chances to ask these doctors and many others about

their approach, but I always feel like there is so much more to learn.

In fact, I am planning another trip to Taiwan soon just so that I can

interview doctors about their granule styles; I want to tape the

interviews so that I can continue to learn more about it and compare

opinions. It's a fascinating topic, and hardly anyone in the US knows

much about it. Even in Taiwan, there are no books and no ultimate

authorities on the issue- the approach was pioneered about 30-40 years

ago, and the current generation largely follows the style that they

learned from watching their teachers. This produces Taiwan's distinct

approach of mixing whole formulas and adding singles, using about 18

grams per day, or about 9-15 grams or so for mild cases or kids.

 

Because 18 grams of granules is less total crude drug than a standard

pack of raw herbs, whole granule formulas are used together because

they are thought to get more mileage than just single herbs combined

together. This introduces another unknown variable, because no other

generations have tried mixing so many ingredients together before. So

there are a couple new variables and there is a general consensus that

there are a lot of unknowns in this evolving science. However, there

is one fact that is quite clear- practitioners continue to get great

results with the granule approach. Not as good as with the

traditional raw approach, but still acceptable, and the overall system

is far more convenient for accountability, research, patient

compliance, safety, and insurance purposes.

 

The doctors that I mentioned above all tend to use mineral products in

modest doses. For example, they add in about 1-1.5 g per day of

whichever given mineral they want to use. This does not necessarily

mean that they believe this dose to be correct, however. It just

means that they think it is the best choice for the patient under the

circumstances. If the patient is paying out of pocket and is willing

to cook raw herbs, raw herbs are always used, and the normal dose of

15 grams of mu li or whatever is used. However, if the patient is an

insurance patient or wants more convenient medicine, they have to

sacrifice the medical ideal to match the scenario so that they can

best help the patient. This often means retaining the theory or the

qi of the target medicinal (such as mu li) by including it in the

prescription, but they use it in a lower dose than it would be used in

a raw state. Remember also that the granule form is taken directly

and it is finely ground with a high surface area, so a smaller

quantity still represents more strength than the same small quantity

in a raw formula. But is 1.5 grams of straight mu li weaker or

stronger than 15 grams of decocted mu li? Now, that is the

million-dollar question.

 

My teachers don't have the answer to that question, although they know

enough to know that the question must be posed. They use the lower

dose of mu li in granule form because they are making a compromise to

give the patient a convenient and inexpensive form of medicine to

begin with, and they want to make sure that the overall granule

formula has its required potency- it wouldn't do to give a patient 12

grams of mu li and only 6 grams of everything else, and they are

operating with the 18 gram total limit or else they aren't using

granules at all. So their experience is based on different

limitations and considerations than we have in California. On the one

hand, you have the variable that giving 1.5 grams of mu li may not

have the strength of giving 15 grams of mu li in decoction, yet on the

flip side giving 15 grams of straight granule mu li introduces a new

variable because it would be more mu li than you'd get if you decocted

that same 15 gram dose. It's a quandary, and no matter who tries to

say they know the answer, no one does. There is no one answer, and we

can only make educated guesses based on 1000s of patients' experiences.

 

One thing is definitely true, and that is that the minerals should be

considered individually, based on their toxicity, solubility, and

traditional method of use. A mineral salt like mang xiao that is

highly water soluble (and taken in the strained decoction) should be

used in a high dose in the granule form, because the granule is not

very different from the use of the crude product. If we use 10 grams

of mang xiao as a crude drug, we probably should use a similar amount

as a granule, because in the case of mang xiao, the crude drug is

generally ingested completely. However, if the substance is not very

water soluble, the granule dose should be much lower because the

original water decoction wouldn't dissolve much of the mineral. If

the mineral has toxicity, the dose should be carefully considered,

especially for prolonged use (for example, dai zhe shi, hematite, has

traces of arsenic and poses a greater risk when ingested straight than

it would if it was decocted). By contrast, a mineral like mu li is

basically calcium, and is probably safe within a wider range of use.

 

These are my thoughts, which in turn are basically entirely shaped

from the experiences and thoughts of my teachers. I'd be fascinated

to learn more about the experiences of others, collectively we have

seen a lot of patient responses. Getting more of this information

into our educational system would help prepare the next generation for

the realities of modern clinical practice, but I find that so few

teachers know much about granule dosing that it is hard for students

to get a clear message during their clinical training at present.

 

Stephen, I love your method of decocting the minerals at home!

 

I apologize to the group for all the long posts of late.

 

Eric Brand

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Hi Eric,

 

I have been using granules since 1996 in my own practice and ran a small

pharmacy for local practitioners in Santa Cruz. I started using them in '95 when

I was doing my clinical apprenticeship with Michael Tierra. I mostly used

singles combined to create formulas, primarily because that is what Michael did.

I also liked the versatility of creating the formula as I wanted. I started

using more simple formulas, such as er chen tang, si wu tang, et al, mostly for

time saving reasons, but also because I recognized that when formulas are cooked

together there is a synergistically created new " product " that is different from

simply mixing the single herbs together. As I went on I started using more

formulas and modifying them but still the majority of the prescriptions were

made up of wholly or mostly individual herbs. I write the prescription as if I

were writing a raw prescription and use the proportions of the medicinals as the

guide to the formula to be filled with

granules. Thus, if I wanted to use 15g of muli that would be represented

proportionately in the formula given to the patient. My daily dosage right range

from 6 to 18g, depending on the patient, condition, compliance, etc. I have

always found this to be satisfying clinically, although I will admit I don't

like it nearly as much as giving raw formulas and I always recommend raw

formulas.

 

I say all that as a prelude to a some questions and observations about the use

of granules. First, I am wondering how the granules are dispensed in Taiwan. The

main reason I ask this question is this. There in the Sates I always gave the

patients a spoon and the dose was measured by volume, not weight, although the

spoon is supposed to approximate a gram. If you look at different herbs the

volume can be quite different, for instance the volume of muli is significantly

different than that of juhua or even renshen gram for gram (most easily seen in

the 100g bottles). So, this will of course have an effect on the dosage when

given by volume rather than weight, no matter how close the approximation is.

What I'm getting at here is that because of the density of the the minerals if

you reduce the weight in an attempt to make sure they don't dominate the formula

disproportionately then using the volume (spoon) method will actually give you

less of the mineral than what you

wanted to give.

 

What do yo think? If the way they dispense formula in Taiwan different? Is my

thinking non-sense or does it make sense?

 

Thomas

 

 

 

Beijing, China

 

www.sourcepointherbs.org

 

 

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The only way I can think my way out of the granule issue is to

prescribe based on a raw formula. We know the saying, dosage changes

everything, but I have to look at that as meaning percentages not

volume. I tell my patients that herbs are more like foods than drugs

and work through the digestive mechanisms. Taking that as a given then

I stop second guessing every aspect of the granule concentrations and

dosages.

Doug

 

 

 

,

wrote:

>

> Hi Eric,

>

> I have been using granules since 1996 in my own practice and ran a

small pharmacy for local practitioners in Santa Cruz. I started using

them in '95 when I was doing my clinical apprenticeship with Michael

Tierra. I mostly used singles combined to create formulas, primarily

because that is what Michael did. I also liked the versatility of

creating the formula as I wanted. I started using more simple

formulas, such as er chen tang, si wu tang, et al, mostly for time

saving reasons, but also because I recognized that when formulas are

cooked together there is a synergistically created new " product " that

is different from simply mixing the single herbs together. As I went

on I started using more formulas and modifying them but still the

majority of the prescriptions were made up of wholly or mostly

individual herbs. I write the prescription as if I were writing a raw

prescription and use the proportions of the medicinals as the guide to

the formula to be filled with

> granules. Thus, if I wanted to use 15g of muli that would be

represented proportionately in the formula given to the patient. My

daily dosage right range from 6 to 18g, depending on the patient,

condition, compliance, etc. I have always found this to be satisfying

clinically, although I will admit I don't like it nearly as much as

giving raw formulas and I always recommend raw formulas.

>

> I say all that as a prelude to a some questions and observations

about the use of granules. First, I am wondering how the granules are

dispensed in Taiwan. The main reason I ask this question is this.

There in the Sates I always gave the patients a spoon and the dose was

measured by volume, not weight, although the spoon is supposed to

approximate a gram. If you look at different herbs the volume can be

quite different, for instance the volume of muli is significantly

different than that of juhua or even renshen gram for gram (most

easily seen in the 100g bottles). So, this will of course have an

effect on the dosage when given by volume rather than weight, no

matter how close the approximation is. What I'm getting at here is

that because of the density of the the minerals if you reduce the

weight in an attempt to make sure they don't dominate the formula

disproportionately then using the volume (spoon) method will actually

give you less of the mineral than what you

> wanted to give.

>

> What do yo think? If the way they dispense formula in Taiwan

different? Is my thinking non-sense or does it make sense?

>

> Thomas

>

>

>

> Beijing, China

>

> www.sourcepointherbs.org

>

>

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A good way to get an idea of the potency of a dosage form is to taste

it in one cup of water and compare the taste to a decoction. Granules

generally compare favorably in flavor to a decoction. Fluid extracts

(1:1) aren't quite as strong tasting. An exception is resinous herbs

like ru xiang or mo yao, which actually taste stronger in an ethanolic

extract. Pills and tablets can also be ground and mixed in one cup of

water. The flavor is typically quite weak.

 

I think all the dosage forms have their time and place, but it's good

to have some idea of the comparative potencies. Aside from analytical

chemistry, tasting is a fairly reliable subjective method.

 

- Bill Schoenbart

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