Dosing in Granulars.

[Guest guest]

Here is a question for Eric or others that have studied in Taiwan:

 

 

 

Fact: Extraction ratios are labeled on Taiwanese bottles.

 

Fact: Hospitals will routinely run out of a given brand of herbs and

suddenly start using another brand. Consequently products from day to day

could and would be drastically different (i.e. almost 2x the potency as in

the Eric's ma zi ren wan example.)

 

 

 

Question: Do doctor's check which company and hence what ratio of each herb

they are prescribing before they write the prescription?

 

 

 

I have never heard of this, therefore one would assume that Doctors are

getting formulas and singles from various companies. It seems like if the

ratios were that different then there would be a very wide variability in

the patient's final prescription. Are we supposed to imitate the way

Taiwanese Doctor's prescribe?

 

 

 

So it would then seem that even though these ratios (for whatever they are

worth) are available, the doctors don't really do anything with them, how

could they have the time or mathematical brainpower?

 

 

 

Is it possible that the ratios are bogus? Is it possible that all the

companies pretty much have the same technology and produce products that are

fairly similar? I have no idea.

 

 

 

Does this question make sense? Did I miss something big in my thinking?

 

 

 

Comments?

 

 

 

-Jason

 

 

 

 

 

 

 

 

 

 

 

 

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[Guest guest]

, " "

wrote:

>

> Here is a question for Eric or others that have studied in Taiwan:

> Fact: Extraction ratios are labeled on Taiwanese bottles.

 

True.

 

> Fact: Hospitals will routinely run out of a given brand of herbs and

> suddenly start using another brand. Consequently products from day

to day

> could and would be drastically different (i.e. almost 2x the potency

as in

> the Eric's ma zi ren wan example.)

 

Also true. In big hospitals, brokers from the 5-6 main granule

companies visit the hospital directly. Each company meets the same

standards and each sells quality products, but there is variance from

batch to batch (even within lot-to-lot of the same company, but

especially company-to-company). So it is true that there is a

variable amount of medicine that actually gets delivered to the patients.

 

In small clinics, this does not happen, because the doctor usually

buys consistently from the same companies. Sometimes they shop around

product to product, based on concentration ratios, fragrance,

perceived effect, etc. I know that my teacher Feng Ye used to buy

herbs X, Y, and Z from company 1, herbs A,B, and C from company 2,

etc. Anyway, doctors in small clinics have control of their inventory

and generally use products that are consistently the same.

 

Hospital doctors don't have the luxury of running the pharmacy side of

the equation, but they are generally dosing the products based on an

18g daily dosage rather than a raw herb equivalence in the first place.

 

> Question: Do doctor's check which company and hence what ratio of

each herb

> they are prescribing before they write the prescription?

 

No, they prescribe the same 18g no matter what, but no matter which

company makes it, it will generally be within the same range (and

generally significantly lower than the actual amount of raw herbs that

they'd normally use, efficiency of granule technology notwithstanding,

so it is uniformly safe if not crazy powerful). At any rate, hospital

doctors have to survive with this limitation while private clinics do

not, but hospital doctors have to make many such sacrifices when

working in a large institution. Even on the small scale, I prescribe

granules at PCOM that are made by several different companies, none of

whom provide their extraction ratios on the label, so we are in the

same boat at an institution here. In private practice, we stock

whatever we choose, just like Taiwanese doctors do.

 

Are we supposed to imitate the way

> Taiwanese Doctor's prescribe?

 

In Chinese medicine, always take the best whenever you have the chance

to learn something new, and leave the problems unique to a given

teacher or cultural scenario behind. Hospital docs there have

limitations, their insurance system has limitations, but all of it

generated a hell of a lot of clinical experience as well as good

granule technology. They have a unique method of using Chinese

medicine, a unique approach to dosage and formula combining. We may

not choose to imitate everything and put it on a pedestal, but it is

worth paying attention and learning from the experience of the tens of

millions of patient experiences with granules that Taiwan has generated.

 

Eric Brand

[Guest guest]

Eric,

 

 

 

Thanks for the input. So we can say that the Taiwanese hospitals in general

are not practicing very precise medicine. Usually giving everyone the same

dosage and using a variable amount of herbs. Okay this is what I thought and

not dissimilar from Chinese hospitals, which have there own issues in regard

to precision, although these are usually based on level of expertise and

style of practice.

 

 

 

You also point out that the smaller clinics have a bit more control. When I

studied in Taiwan, the small clinic doctor used only bulk so I have no

experience with the setting you describe. Could you help us understand the

situation better?

 

 

 

1. How much variance in dosage have you seen in these more " free " settings?

6 grams a day? 25 grams a day? OR do they still hover around 18g / day? I

guess that insurance still place a part in the smaller clinics' decisions

also, is that correct?

 

 

 

2. It is my understanding that in these settings the doctors still do not

pay much attention to the " extraction ratios " of singles (i.e. when they add

singles to a formula). Is that true? OR will they say herb A is a 3:1 and

Herb B is 8:1, and therefore I must adjust the dosage accordingly. I would

think this would be odd.

 

 

 

Your input is much appreciated,

 

 

 

-Jason

 

 

 

 

 

_____

 

 

On Behalf Of Eric Brand

Saturday, May 24, 2008 7:46 PM

 

Re: Dosing in Granulars.

 

 

 

@ <%40>

, " "

wrote:

>

> Here is a question for Eric or others that have studied in Taiwan:

> Fact: Extraction ratios are labeled on Taiwanese bottles.

 

True.

 

> Fact: Hospitals will routinely run out of a given brand of herbs and

> suddenly start using another brand. Consequently products from day

to day

> could and would be drastically different (i.e. almost 2x the potency

as in

> the Eric's ma zi ren wan example.)

 

Also true. In big hospitals, brokers from the 5-6 main granule

companies visit the hospital directly. Each company meets the same

standards and each sells quality products, but there is variance from

batch to batch (even within lot-to-lot of the same company, but

especially company-to-company). So it is true that there is a

variable amount of medicine that actually gets delivered to the patients.

 

In small clinics, this does not happen, because the doctor usually

buys consistently from the same companies. Sometimes they shop around

product to product, based on concentration ratios, fragrance,

perceived effect, etc. I know that my teacher Feng Ye used to buy

herbs X, Y, and Z from company 1, herbs A,B, and C from company 2,

etc. Anyway, doctors in small clinics have control of their inventory

and generally use products that are consistently the same.

 

Hospital doctors don't have the luxury of running the pharmacy side of

the equation, but they are generally dosing the products based on an

18g daily dosage rather than a raw herb equivalence in the first place.

 

> Question: Do doctor's check which company and hence what ratio of

each herb

> they are prescribing before they write the prescription?

 

No, they prescribe the same 18g no matter what, but no matter which

company makes it, it will generally be within the same range (and

generally significantly lower than the actual amount of raw herbs that

they'd normally use, efficiency of granule technology notwithstanding,

so it is uniformly safe if not crazy powerful). At any rate, hospital

doctors have to survive with this limitation while private clinics do

not, but hospital doctors have to make many such sacrifices when

working in a large institution. Even on the small scale, I prescribe

granules at PCOM that are made by several different companies, none of

whom provide their extraction ratios on the label, so we are in the

same boat at an institution here. In private practice, we stock

whatever we choose, just like Taiwanese doctors do.

 

Are we supposed to imitate the way

> Taiwanese Doctor's prescribe?

 

In Chinese medicine, always take the best whenever you have the chance

to learn something new, and leave the problems unique to a given

teacher or cultural scenario behind. Hospital docs there have

limitations, their insurance system has limitations, but all of it

generated a hell of a lot of clinical experience as well as good

granule technology. They have a unique method of using Chinese

medicine, a unique approach to dosage and formula combining. We may

not choose to imitate everything and put it on a pedestal, but it is

worth paying attention and learning from the experience of the tens of

millions of patient experiences with granules that Taiwan has generated.

 

Eric Brand

 

 

 

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The message was checked by ESET NOD32 Antivirus.

 

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[Guest guest]

Group,

 

 

 

Here are some additional info and thoughts on the topic. I just finished

having tea with a colleague who lived and studied in Taiwan for many years.

He studied in a pretty famous private clinic that had 1 very well-known

doctor and a few others (about 9 total). They exclusively used granulars.

 

 

 

1. He said that almost every formula was 15 grams. They practiced the

typical Taiwanese style of combining multiple formulas and then maybe a

single or two. They did not, at least to anyone's knowledge, make

adjustments based on extraction ratios (singles or formulas).

 

 

 

2. In the US I am curious what others experience is with dosage. I find that

a group of people start to get digestive complaints with dosages above 15g.

Of course larger amounts of any herbs can cause this. However, it seems that

many times such complaints are granular specific, where bulk herbs do not

cause the same type of problems. There are a smaller amount of people that

get these same problems with any dose of granulars. I always assumed it was

the fillers, but I am unsure. Have others experienced this?

 

 

 

-

 

 

 

_____

 

 

On Behalf Of

Sunday, May 25, 2008 8:31 AM

 

RE: Re: Dosing in Granulars.

 

 

 

Eric,

 

Thanks for the input. So we can say that the Taiwanese hospitals in general

are not practicing very precise medicine. Usually giving everyone the same

dosage and using a variable amount of herbs. Okay this is what I thought and

not dissimilar from Chinese hospitals, which have there own issues in regard

to precision, although these are usually based on level of expertise and

style of practice.

 

You also point out that the smaller clinics have a bit more control. When I

studied in Taiwan, the small clinic doctor used only bulk so I have no

experience with the setting you describe. Could you help us understand the

situation better?

 

1. How much variance in dosage have you seen in these more " free " settings?

6 grams a day? 25 grams a day? OR do they still hover around 18g / day? I

guess that insurance still place a part in the smaller clinics' decisions

also, is that correct?

 

2. It is my understanding that in these settings the doctors still do not

pay much attention to the " extraction ratios " of singles (i.e. when they add

singles to a formula). Is that true? OR will they say herb A is a 3:1 and

Herb B is 8:1, and therefore I must adjust the dosage accordingly. I would

think this would be odd.

 

Your input is much appreciated,

 

-Jason

 

_____

 

 

 

 

[Guest guest]

On Sun, May 25, 2008 at 1:18 PM, <

> wrote:

 

>

> 2. In the US I am curious what others experience is with dosage. I find

> that

> a group of people start to get digestive complaints with dosages above 15g.

> Of course larger amounts of any herbs can cause this. However, it seems

> that

> many times such complaints are granular specific, where bulk herbs do not

> cause the same type of problems. There are a smaller amount of people that

> get these same problems with any dose of granulars. I always assumed it was

> the fillers, but I am unsure. Have others experienced this?

>

 

 

 

 

 

 

 

 

 

 

Most of the dosage problems that I run in to are associated with the use of

capsules, and I believe that it is mostly a perception issue.

 

If I give a patient 5 capsules, three times daily, they can usually accept

that. However, the quantity of extract powder that the patient ends up

taking at this dosage is something kind of small like 7 grams per day.

Doubling that quantity can get closer to a therapeutic dosage, but 30

capsules per day is tough for the patient to accept. Seems like a very high

dosage.

 

However, I can give a patient the powders, and prescribe 2 teaspoons full,

three times daily and I can get to that 18 daily grams per day dosage

without too much problems from the patient.

 

Then again, a lot of my really sensitive patients do just fine with smaller

dosages.

 

As for heartburn specifically, I haven't really found that to be a

consistent complaint with the extract powders. I would propose however that

if a patient has any trepidation about any medicine whether a drug or an

herb or whatever, heartburn is going to be the body's reaction to this

question in the patient's mind. Nausea would follow, I believe. Most, if not

all drugs list nausea or stomach ache as a potential side-effect for this

reason. There's always a portion of the patient population that will

generate this sort of " side-effect " .

 

-al.

 

 

--

, DAOM

Pain is inevitable, suffering is optional.

 

 

 

[Guest guest]

I am using Mu Xiang and Sheng Jiang more and more for this issue.

Doug

 

 

, " Al Stone " <al wrote:

>

>

> As for heartburn specifically, I haven't really found that to be a

> consistent complaint with the extract powders. I would propose however that

> if a patient has any trepidation about any medicine whether a drug or an

> herb or whatever, heartburn is going to be the body's reaction to this

> question in the patient's mind. Nausea would follow, I believe. Most, if not

> all drugs list nausea or stomach ache as a potential side-effect for this

> reason. There's always a portion of the patient population that will

> generate this sort of " side-effect " .

>

> -al.

>

>

> --

> , DAOM

> Pain is inevitable, suffering is optional.

>

>

>

[Guest guest]

, " Al Stone " <al wrote:

>

> Most of the dosage problems that I run in to are associated with the

use of

> capsules, and I believe that it is mostly a perception issue.

 

IMO, applying a pharmacology filter to Chinese medicine can lead to

great debates and new way to think about dosages of medicine - but

still you have to judge by patient results. I don't think you need to

give a 5:1 equivalent to achieve decent results and most people are

going to balk at taking huge amounts of pills / granules.

 

> Then again, a lot of my really sensitive patients do just fine with

smaller

> dosages.

>

> As for heartburn specifically, I haven't really found that to be a

> consistent complaint with the extract powders. I would propose

however that

> if a patient has any trepidation about any medicine whether a drug or an

> herb or whatever, heartburn is going to be the body's reaction to this

> question in the patient's mind. Nausea would follow, I believe.

 

Great point, Al. I have also found this exact situation to be true

also. They are usually the ones who will tell you ahead of time that

they respond 'very strongly' to medications and will often take a lot

less than you will normally prescribe, no matter what dose you give them!

 

Geoff

[Guest guest]

Does anyone know of any case study books in which the herbs

administered were given in granular form? If there is, I would think

this would be extremely helpful in this conversation of dosing and

efficacy. Something tells me Taiwan might be a good place to find

such a book.

 

Be Well,

Akhil Kumar Kaplan L.Ac.

 

 

, " G Hudson "

<ozark.canuck wrote:

>

>

> , " Al Stone " <al@> wrote:

> >

> > Most of the dosage problems that I run in to are associated with

the

> use of

> > capsules, and I believe that it is mostly a perception issue.

>

> IMO, applying a pharmacology filter to Chinese medicine can lead to

> great debates and new way to think about dosages of medicine - but

> still you have to judge by patient results. I don't think you need

to

> give a 5:1 equivalent to achieve decent results and most people are

> going to balk at taking huge amounts of pills / granules.

>

> > Then again, a lot of my really sensitive patients do just fine

with

> smaller

> > dosages.

> >

> > As for heartburn specifically, I haven't really found that to be a

> > consistent complaint with the extract powders. I would propose

> however that

> > if a patient has any trepidation about any medicine whether a

drug or an

> > herb or whatever, heartburn is going to be the body's reaction to

this

> > question in the patient's mind. Nausea would follow, I believe.

>

> Great point, Al. I have also found this exact situation to be true

> also. They are usually the ones who will tell you ahead of time

that

> they respond 'very strongly' to medications and will often take a

lot

> less than you will normally prescribe, no matter what dose you give

them!

>

> Geoff

>

[Guest guest]

, " "

wrote:

> 1. He said that almost every formula was 15 grams. They practiced the

> typical Taiwanese style of combining multiple formulas and then maybe a

> single or two. They did not, at least to anyone's knowledge, make

> adjustments based on extraction ratios (singles or formulas).

 

Yes, the doctors in Taiwan generally prescribe a consistent total

weight of granule powder, but this is largely influenced by their

insurance system. Almost all patients using insurance get granules,

and almost all patients paying cash get raw herbs (nearly every

patient on the island has insurance, so the few self-pay patients are

generally choosing to pay out of pocket for raw because they believe

it is stronger/faster). Therefore, the dosage style in Taiwan is

connected more to a total daily dose, with people thinking in terms of

ratios of formulas and medicinals within that dose rather than basing

the total prescription on an extraction ratio and its raw-herb

equivalence.

 

However, in Taiwan, they consistently use a dose that is higher than

what many American practitioners use, and they use a different

approach to prescribing altogether because they compound whole

formulas together. By far the largest confounding variable in

comparing US and Taiwanese granule approaches is an issue of formula

composition, not simply concentration ratios. However, few people in

the West have attempted to study this prescription style, and the

Taiwanese methods of dosage and formula combinations are rarely seen

in Western clinics.

 

Instead, we tend to prescribe based upon the normal way that we are

trained, and our use of granules is less about an alternative

prescription style than it is about replicating our raw prescriptions

in a concentrated form. Consequently, most of us are thinking of the

granules in terms of their equivalence to raw herbs, and the mainland

Chinese style of matching concentrated extracts to crude drug weights

may be more useful than the Taiwanese style for many of us. The

Taiwanese method works very reliably and thousands of doctors and

patients can attest to its merits, but unfortunately few of us in the

West have studied their style, so we are better off understanding how

much medicine we are giving to our patients by means of a mathematical

calculation.

 

Honestly, understanding extraction ratios and actually knowing how

much medicine we are giving to our patients should be a very basic

prerequisite, given that we like to present ourselves to the

mainstream medical community as informed, responsible practitioners.

And while sensory assessment of quality by means of taste, smell, etc

is ultimately very important, it is also important to know how much

crude medicine the powder corresponds to.

 

I agree with Andy's article in that there are many factors beyond

concentration ratios that must be considered. Jason, I am sorry if

you feel that I am somehow reading differently into Andy's article

than you are, but I honestly think I understand pretty well what he is

saying, and I agree with his points about the Taiwanese manufacturing

process as well as the many issues he brings up about different types

of extracts and ratio expressions. However, in the field of granules,

many of the people who are the most knowledgeable about the industry

do in fact have industry ties, and the fact that Andy's article is

fundamentally tied to a particular financial interest cannot be fully

ignored.

 

Andy is indeed one of the great experts in the field of herbal

pharmacy and granules. Andy's close relationship with the Tsai family

at KP, along with his language skills, medical knowledge, and his

friendly human warmth has allowed Andy to achieve a tremendous degree

of integration into one of the great Chinese herbal families. It is

quite an achievement for a Westerner to achieve the deep connections

that Andy has formed, and I have great respect for Andy both

personally and professionally. Andy helped KPC to pioneer issues in

botanical identity, raising awareness of substitute species and

correct identification both in Asia as well as the West. His input

allowed KP to be a leader in things like aristolochic acid testing and

non-gmo hypoallergenic fillers, and Andy's work with Spring Wind has

done wonders to educate Western practitioners on issues of herbal

identity and quality.

 

However, while I have great respect for Andy and KPC, it is important

to understand that this newsletter article was written with a

commercial interest. New GMP laws will apparently require granule

companies to write their extraction ratios, and an article like Andy's

is necessary so that people can understand the advantages and

limitations of extraction ratio information. If Andy was writing the

article with Taiwan instead of the US in mind, the article wouldn't

have needed to be written. The Taiwanese labels already have the

extraction ratios, and KP's extraction ratios already compare

favorably to other Taiwanese products. KP is well-established in

Taiwan, they have a reputation for quality, their extraction ratios

are good, and their products do not compete with mainland Chinese

products or Western-made products, such as liquid concentrates or

non-water based extract powders. The main reason that educating

people about the limitations of extraction ratios is necessary is

because they don't want to lose customers based on a number that looks

lower than a competitor's ratio. They need to assure their customers

that KPC is a leader in quality and technology, and that the product

is conscientiously made, so that consumers can look beyond things like

6:1 or 3:1 and know that the product has integrity.

 

This thread began with a discussion about two articles written by

commercial enterprises, Blue Poppy and Golden Flower. In many ways,

they are responding to each others presence in the marketplace. While

both Andy Ellis and Bob Flaws have written accurate and valuable

information on the topic, it is important to remember that each has

their own commercial agenda that will influence the points that they

emphasize. Similarly, in the spirit of open disclosure, I should

point out that I also have commercial ties to the industry, so you

should also take my own perspective with a grain of salt just like

Andy and Bob's perspectives. I personally feel that I am more neutral

than Blue Poppy or Golden Flower can be, because I work with both

Taiwanese and mainland factories, and I endorse both product types

without being bound to any one company. However, like anyone, I will

still have my own bias.

 

So some disclosure about me: I became interested in granules because

I studied in Taiwan and saw the unique granule style that they use

there. I had the chance to study with a variety of great doctors that

used lots of granules, and I got a nice glimpse into their system. At

the moment, I teach and supervise at the San Diego PCOM, but in the

fall I am moving to do a PhD in China; my topic is centered on the

comparative use of granules between mainland China, Macao, Hong Kong,

and Taiwan. Like I mentioned, I've recently found myself connected to

the top of the supply chain as well, so I also have some degree of

commercial ties in addition to a lot of general interest in the subject.

 

In clinical practice, I regularly prescribe KPC's granules,

Evergreen's granules, and Blue Poppy's capsules (in Taiwan I also used

SunTen and Quali). I've seen KPC's factory in Taiwan, I've been

impressed with their labs, their facilities, their crude herbs, and

the patient response. Like I said before, KP has been a leader in

herb identity, and they are one of the only companies that employ a

botanist as well as a chemical lab. I've also been to at least one of

the Taiwanese factories that Evergreen uses, and I have been similarly

impressed; the facility that I was at has a reputation for making

Taiwan's best exterior-resolving herbs, and their essential oil

capturing technology is very advanced. (Incidentally, my teacher Feng

Ye in Taiwan uses a lot of granules from the same mother company that

supplies a lot of Evergreen's products, he is really happy with them

and uses over $1 million US/year worth of granules from them.) I also

use Blue Poppy's capsules because I prefer the no-filler technology

when giving capsules. As people mentioned, capsules aren't very

efficient for giving powders with filler, as the patient needs to each

too many capsules. If you don't need to mix even-flowing powders,

there is no point having fillers.

 

In addition to using a variety of supplier's products in clinic, I

also use and import products directly from the factories. Over time,

I ended up having really great connections in the Asian world, so I

started working directly with the factories in Asia. I buy and sell

granules from one of Taiwan's main producers as well as one of China's

main producers, and I also arrange for OEM/private labeling for

clients that want to produce extract products under their own brand.

I speak Chinese, I've been to the factories of every company that I

work with, and I have respect for all of their products. Honestly,

the Taiwanese and mainland products are different and the technology

is different, and both have intrinsic value. Since I sell both and

value both, I think that I have a relatively neutral ability to assess

the advantages and disadvantages of each.

 

In Taiwan, the granule products are based upon Japanese Kampo

technology, and their prescription style probably also has some degree

of inspiration from Kampo in that Taiwanese doctors use a lot of

whole, unmodified classical prescriptions combined together. They mix

powders together and need to have more filler so that the granules can

be mixed evenly in their fine powder state. The fine powders from

Taiwan tend to have a stronger fragrance than the mainland products

when you open the bottle, but they tend to become a bit grainer if you

mix them with hot water. The Chinese granules tend to be larger

granules (ke li) rather than fine powders (xi fen) if they are diluted

to a 5:1 concentration, though they can be a fine powder in a

single-dose foil pack; they use less filler and tend to dissolve more

cleanly in the water.

 

Generally speaking, granules in China are packaged in single dose foil

packs, with no filler. The lack of filler makes the granules clump

when exposed to air, so they require either single-dose foil pack

packaging or some degree of filler to prevent clumping if they are to

be stored in open bottles. The stuff that I use from China is an even

5:1 extract- they take the full dried concentrate and dilute it with

filler so that it makes an even 5:1 final concentration. The main

reason I like the Chinese product is because the concentration ratio

is higher and more consistent, which makes dosage calculation easier.

The other advantage is that I have access to more processed forms of

the herbs when using the Chinese supplier, so that I can choose

stir-fried bai zhu vs. raw bai zhu, zhi huang qi vs. normal huang qi,

etc.

 

It is important to understand the differences in the Chinese and

Taiwanese technology, because it makes a big difference in the

concentration. Of course, China is more variable than Taiwan in terms

of quality control, so it is essential to find a company with good

research controls and good extraction technology. The company that I

buy from has the largest research lab in China, and they supply many

Chinese hospitals. I've seen their production facilities, and they

definitely have a sophisticated method of determining the ultimate

concentration ratio of each herb- they have a lab setup that allows

them to determine the appropriate amount of water, the best potential

temperature and extraction time, and the target amount of

water-soluble extract (which will determine how high the concentration

ratio can go). With something like vinegar-processed yan hu suo, the

concentration can reach 10:1, whereas with other things like pu gong

ying, the concentration cannot go higher than 7.5:1. Each product

must be individually determined.

 

When they export to the US, they form a coarse (ke li) granule that is

mixed with filler to bring it to an even 5:1 concentration. Before

buying the herbs, they test the constituents, both in terms of

quantity and profile (for example, huang qin grown in Shandong tends

to have higher levels of active ingredients, while the Korean species

of yin yang huo tends to have the most even distribution of its

several active ingredients. The soil and weather conditions can vary

the active ingredient profile, so the farm that they use this year may

not be as good next year, so they have to test the ingredients before

they buy, as well as after they extract). In fact, many granule

companies share similar technology for testing product identity and

potency with HPLC, as well as testing for heavy metals, etc, and all

the really big companies are equipped with a similar setup in this

regard because they must verify the quality of large lots before they

start making extracts.

 

At any rate, the simple fact of the matter is that multiple companies

make good products, and people should not blindly trust any given

individual without researching the choices available on the market.

The true test of granules is taste and effect (as well as value), and

several products work well. There is obviously a commercial element to

these discussions, as we see that suppliers are stepping in to defend

their products from perceived market threats. The important thing for

consumers to realize is that granules exist in both even concentration

ratios as well as variable concentration ratios. While I agree that

there are complex factors that are ultimately more important than

simple concentration ratios, I believe that there is no way to fully

downplay the issue of concentration ratios. The current status quo of

keeping the concentration ratios unlabeled primarily benefits the

commercial industry, not the practitioners. And ultimately, if we

want to be regarded as serious medical practitioners, we should

understand how much medicine we are prescribing.

 

Eric Brand

[Guest guest]

Eric

Can you tell us which mainland company you are talking about and were

can we buy these granules

thanks

 

 

 

400 29th St. Suite 419

Oakland Ca 94609

 

 

 

alonmarcus

 

 

 

 

 

 

 

 

[Guest guest]

, alon marcus

<alonmarcus wrote:

>

> Eric

> Can you tell us which mainland company you are talking about and were

> can we buy these granules

> thanks

 

The factory that makes them is Tian Jiang Pharmaceuticals. I sell

them, website will be up shortly (legendaryherbs.com). For now, you

can just contact me offline if you are interested, at ericbrand @

gmail.com (no spaces).

 

Eric

[Guest guest]

Tian Jiang is also distributed through Blue Light Herbs in Ithica New York.

http://www.treasureofeast.com/

-al.

 

On Thu, May 29, 2008 at 8:42 PM, Eric Brand <smilinglotus wrote:

 

> --- In

<%40>,

> alon marcus

>

> <alonmarcus wrote:

> >

> > Eric

> > Can you tell us which mainland company you are talking about and were

> > can we buy these granules

> > thanks

>

> The factory that makes them is Tian Jiang Pharmaceuticals. I sell

> them, website will be up shortly (legendaryherbs.com). For now, you

> can just contact me offline if you are interested, at ericbrand @

> gmail.com (no spaces).

>

> Eric

>

 

--

, DAOM

Pain is inevitable, suffering is optional.