Guest guest Posted September 8, 2008 Report Share Posted September 8, 2008 So this may seem like a silly question to some, but I have recently come across some variance in how people think about dosing for a raw herb decoction and I would love to hear how others approach this. My point being that when writing an Rx, lets say Bu Zhong Yi QI Tang with 30 g of Huang Qi. That Rx is cooked twice and then the two fluids are mixed together. Now here is where I see the conflict. Some people I have heard divide that tea into 2 doses for a one days herbal intake. Others divide that fluid into 4 doses to be taken over 2 days. So if the daily dose of Huang Qi is 30g and it takes a patient two days to drink it, then wouldn't their daily dose of huang qi now only be 15g?? And shouldn't the dosages be increased within the Rx if patients are going to do this style of cooking enough for 2 days, ie increase Huang Qi to 60g?? Obviously this is a way to save costs, but is it effective?? Some practitioners have argued with me that the patient is still getting the required dose. I would love to hears others feedback, ideas, clinical experiences. Cheers, Trevor Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 8, 2008 Report Share Posted September 8, 2008 Hi Trevor- My own experience and the experience of my students that I supervise in clinic is that it should be taken in one day. Obviously there is some variation in dosing due to weight, sensitivity, and whatnot, but boiling it once or twice does not change the number of days it should be taken. I really think dosing is something that needs to be talked about more in school. I have talked with many practitioners that think doses listed in Bensky are for two days, 6g of granules per day is sufficient, and that taking the dosage listed on the bottles of patents is going to work. I think part of the problem is as Bob Flaws has mentioned many times - most practitioners are not using only herbs, so the effects (or non-effects!) of the herbs are masked by acupuncture treatment. -Steve Stephen Bonzak, L.Ac., Dipl. C.H. http://www.health-traditions.com sbonzak 773-470-6994 On Sep 8, 2008, at 11:38 AM, Trevor Erikson wrote: > So this may seem like a silly question to some, but I have recently > come across some variance in how people think about dosing for a raw > herb decoction and I would love to hear how others approach this. > > My point being that when writing an Rx, lets say Bu Zhong Yi QI Tang > with 30 g of Huang Qi. That Rx is cooked twice and then the two fluids > are mixed together. Now here is where I see the conflict. Some people > I have heard divide that tea into 2 doses for a one days herbal > intake. Others divide that fluid into 4 doses to be taken over 2 days. > > So if the daily dose of Huang Qi is 30g and it takes a patient two > days to drink it, then wouldn't their daily dose of huang qi now only > be 15g?? And shouldn't the dosages be increased within the Rx if > patients are going to do this style of cooking enough for 2 days, ie > increase Huang Qi to 60g?? Obviously this is a way to save costs, but > is it effective?? > > Some practitioners have argued with me that the patient is still > getting the required dose. I would love to hears others feedback, > ideas, clinical experiences. > > Cheers, > Trevor > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 9, 2008 Report Share Posted September 9, 2008 Its interesting that in the 80s a bag was used for two days by everyone i studied with in US. In the hospital i worked at in china they used one bag per day but the herbs definitely did not look as good as the ones in the US 400 29th St. Suite 419 Oakland Ca 94609 alonmarcus Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 9, 2008 Report Share Posted September 9, 2008 I had heard that as an explanation (for the one bag a day in China) from my Chinese friends. They felt that the best herbs were exported and that what they had to work with was lesser quality. Doug , alon marcus <alonmarcus wrote: > > Its interesting that in the 80s a bag was used for two days by > everyone i studied with in US. In the hospital i worked at in china > they used one bag per day but the herbs definitely did not look as > good as the ones in the US > > > > 400 29th St. Suite 419 > Oakland Ca 94609 > > > > alonmarcus > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 9, 2008 Report Share Posted September 9, 2008 Although I agree that the herbs in many Chinese hospitals may be of lesser quality than what we can get here, I still think that it is important to dose appropriately. I think a standard dose of 30 g of Huang Qi per day is based on using good quality herbs. I also asked my teacher Mazin Al Khafaji this same question. He goes to China directly himself to buy only the best quality, shipping back to the UK an entire container full. He has done this for years and has paid very close attention to detail in terms of herb dose and quality in watching for clinical results. I will share part of the letter he wrote back to me: " A dose is a dose is a dose, and there is no getting round that. If you baked a single potato and cut it in half, the two halves will still add up to a single baked potato with the same calorific value; you wont magically end up with two potatoes with twice as much goodness, so why should it be any different with herbs. 30 g of Bai shao is 30g of Bai shao no matter how you divide it up. You might be able to stretch it out a little but it wont amount to much with extra cooking. (maybe a better analogy would be trying to get a single tea bag to give you two cups..well you'll get some flavour out of the second steeping, but not much, and anyway that would tell me that you haven't extracted the maximum amount from the tea bag in the first steeping... " Again, Mazin is writing the above statement based on using some of the best quality ingredients he can get his hands on. If the herbs are of lesser quality then I would assume that a larger dose would be needed. SO instead of 30g of Huang Qi, maybe use 45g. Trevor , " " wrote: > > I had heard that as an explanation (for the one bag a day in China) > from my Chinese friends. They felt that the best herbs were exported > and that what they had to work with was lesser quality. > Doug > > > > > , alon marcus > <alonmarcus@> wrote: > > > > Its interesting that in the 80s a bag was used for two days by > > everyone i studied with in US. In the hospital i worked at in china > > they used one bag per day but the herbs definitely did not look as > > good as the ones in the US > > > > > > > > 400 29th St. Suite 419 > > Oakland Ca 94609 > > > > > > > > alonmarcus@ > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 9, 2008 Report Share Posted September 9, 2008 Trevor, This is an important question! It must be understood that China / Chinese medicine is vast and there are many different varieties in styles of practice. Currently the trend in many major Chinese hospitals / clinics / schools etc is the use of very high doses. Many times this stems from financial incentive (kick backs on herbs sold) as well as pharmacological research / data. However, by no means does everyone in China use large doses or even 1 bag a day. Many believe that this is overkill. For example, my main teacher in China, almost always doses 1 bag every 2 days. He hardly ever uses large doses, i.e. 30+ grams of something. However he was trained in a different era and essentially was trained in the MengHe tradition of prescribing (meaning a moderate style). He gets some of the best results I have ever seen. I have come to the conclusion that large doses are not needed if one can diagnosis very clearly and one knows how to precisely pick and choose the herbs. The sloppier one gets, the more herbs one needs, the more patterns one diagnoses, as well as the larger doses one may require. As always this is not to say these hammer style doesn't sometimes work. The real question is it necessary. 60 grams of huang qi??? seems like overkill. My 2 cents, - On Behalf Of Trevor Erikson Monday, September 08, 2008 10:39 AM Raw herb decoction- dosages So this may seem like a silly question to some, but I have recently come across some variance in how people think about dosing for a raw herb decoction and I would love to hear how others approach this. My point being that when writing an Rx, lets say Bu Zhong Yi QI Tang with 30 g of Huang Qi. That Rx is cooked twice and then the two fluids are mixed together. Now here is where I see the conflict. Some people I have heard divide that tea into 2 doses for a one days herbal intake. Others divide that fluid into 4 doses to be taken over 2 days. So if the daily dose of Huang Qi is 30g and it takes a patient two days to drink it, then wouldn't their daily dose of huang qi now only be 15g?? And shouldn't the dosages be increased within the Rx if patients are going to do this style of cooking enough for 2 days, ie increase Huang Qi to 60g?? Obviously this is a way to save costs, but is it effective?? Some practitioners have argued with me that the patient is still getting the required dose. I would love to hears others feedback, ideas, clinical experiences. Cheers, Trevor Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 10, 2008 Report Share Posted September 10, 2008 Trevor, I have to disagree with the dosage answer that makes Qi tonification analagous to the calories in a potato. Consider this: Many western herbalists use Astragalus in tincture form. 30mL of a tincture that includes 20% Astragalus is 6mL of Astragalus tincture. Most bulk herbs are tinctured at concentrations of 1:5, but for arguments sake let's say that someone made strong tinctures of 1:2 strength. That would mean that the 6mL of Astragalus tincture contains 3g of Astragalus by weight. A 30mL tincture bottle is often to be taken over a whole week. Each dropperful contains about 1mL and dosages range from one dropperful/day for, say, gentle tonification purposes, to 3 droppers full 4x/day for, say, acute conditions. Thus a high dose would be about 12mL/day of a formula. In this case 2.4 grams of astragalus. Western herbalists don't ever seem to complain about the weakness of their dosages. (Usually, when they complain about a lack of strength, it is a complaint about the quality of the original herb - sat on a shelf too long, not organic, or tincture menstruum not extracting all constituents) Of course, alcohol does extract a lot more than water decoctions, but still, I think there is more to it. (for the purposes of length, I'll continue in another post) Erico Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 10, 2008 Report Share Posted September 10, 2008 cont'd.... I think what is missing from the discussion of dosages is Qi. Herbs are not potatoes and they are not drugs. Doubling dosages does not double the effect in a direct ratio. Drugs work that way: you give twice as much of an antibiotic and it is more or less twice as effective at killing bacteria. But herbs are agents that are dependent for their success upon an interaction with the vital force, or Qi of the person. What if you keep doubling the dose of Huang Qi? If you give 1200 grams of Huang Qi to your patient, it is not 40 times more tonifying to the Qi, and you do not get a superman, you get a patient who feels sick. The Qi is not thought of as quantifyable for a reason, I think. Herbs induce changes in a person because of their ability to influence the person's vitality. Warm herbs that release the exterior do not go over themselves and open up the pores of the skin. They direct the qi and blood to the exterior, which warms up the skin and induces the pores to open and sweating to occur. Herbs that stimulate intestinal peristalsis would not work correctly if there was no tone to the intestinal smooth muscle. Even a predictable drug-like stimulant like coffee has vastly different effects on individuals depending upon what they are able to do with that kind of stimulation... (all the more so for herbs that in some cases have no proven pharmacological action). Yes, if you eat slightly spicy food, you might sweat a little, and if you eat very spicy food you will sweat more. But there is a limit: If you eat 20 more habaneros after you've already been sweating profusely, you don't sweat 20 times the volume of perspiration. Anyone who has treated an elderly person with kidney xu knows that you don't just keep doubling the success of your treatment by doubling the dose of your formula. There is only so much of the herbs' energies, or actions, that the person is able to make use of. In fact, dosages often have to be reduced for elders in order to get a better effect. Why? Because the effect we really want has to do with how the person's vital force is able to make use of the influence of the herbs. (my appologies for long posts) Erico Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 10, 2008 Report Share Posted September 10, 2008 Erico, I think you are correct and this is where correct diagnosis comes in. You have to figure out what a patient can handle and make adjustments for dosages as well as herbs. Furthermore, a water decoction can only absorb so much herb. Some of these giant dosages / formulas cannot even get fully extracted. This is the same issue we discussed previously with extraction ratios. Water can only hold so much. -Jason On Behalf Of Center Way Wednesday, September 10, 2008 1:29 AM Re: Raw herb decoction- dosages cont'd.... I think what is missing from the discussion of dosages is Qi. Herbs are not potatoes and they are not drugs. Doubling dosages does not double the effect in a direct ratio. Drugs work that way: you give twice as much of an antibiotic and it is more or less twice as effective at killing bacteria. But herbs are agents that are dependent for their success upon an interaction with the vital force, or Qi of the person. What if you keep doubling the dose of Huang Qi? If you give 1200 grams of Huang Qi to your patient, it is not 40 times more tonifying to the Qi, and you do not get a superman, you get a patient who feels sick. The Qi is not thought of as quantifyable for a reason, I think. Herbs induce changes in a person because of their ability to influence the person's vitality. Warm herbs that release the exterior do not go over themselves and open up the pores of the skin. They direct the qi and blood to the exterior, which warms up the skin and induces the pores to open and sweating to occur. Herbs that stimulate intestinal peristalsis would not work correctly if there was no tone to the intestinal smooth muscle. Even a predictable drug-like stimulant like coffee has vastly different effects on individuals depending upon what they are able to do with that kind of stimulation... (all the more so for herbs that in some cases have no proven pharmacological action). Yes, if you eat slightly spicy food, you might sweat a little, and if you eat very spicy food you will sweat more. But there is a limit: If you eat 20 more habaneros after you've already been sweating profusely, you don't sweat 20 times the volume of perspiration. Anyone who has treated an elderly person with kidney xu knows that you don't just keep doubling the success of your treatment by doubling the dose of your formula. There is only so much of the herbs' energies, or actions, that the person is able to make use of. In fact, dosages often have to be reduced for elders in order to get a better effect. Why? Because the effect we really want has to do with how the person's vital force is able to make use of the influence of the herbs. (my appologies for long posts) Erico Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 10, 2008 Report Share Posted September 10, 2008 Eric, I agree with you completely about there being a limit to the particular dosage of herbs per particular individual. I have only referred to the dose of Huang Qi at 30g per day dose, which is in my opinion a very common and effective dose, as per my clinical experince and that of several teachers. When I say to double the dose of Hunag Qi to 60g I am meaning that based on the 30g dose per day, if one is going to save cooking time and only cook herbs for two days at a time then it would be good to double the dose of the herbs. I would have to disagree about herbs not being like potatoes. In my opinion any food is a medicine/ herb and has an effect on the human body. That effect is based on the individual make up of that herb, its quality, species, age,etc. Trevor , Center Way <paradoxrainbow wrote: > > cont'd.... > I think what is missing from the discussion of dosages is Qi. Herbs are not potatoes and they are not drugs. Doubling dosages does not double the effect in a direct ratio. Drugs work that way: you give twice as much of an antibiotic and it is more or less twice as effective at killing bacteria. But herbs are agents that are dependent for their success upon an interaction with the vital force, or Qi of the person. What if you keep doubling the dose of Huang Qi? If you give 1200 grams of Huang Qi to your patient, it is not 40 times more tonifying to the Qi, and you do not get a superman, you get a patient who feels sick. > The Qi is not thought of as quantifyable for a reason, I think. Herbs induce changes in a person because of their ability to influence the person's vitality. Warm herbs that release the exterior do not go over themselves and open up the pores of the skin. They direct the qi and blood to the exterior, which warms up the skin and induces the pores to open and sweating to occur. Herbs that stimulate intestinal peristalsis would not work correctly if there was no tone to the intestinal smooth muscle. Even a predictable drug-like stimulant like coffee has vastly different effects on individuals depending upon what they are able to do with that kind of stimulation... (all the more so for herbs that in some cases have no proven pharmacological action). Yes, if you eat slightly spicy food, you might sweat a little, and if you eat very spicy food you will sweat more. But there is a limit: If you eat 20 more habaneros after you've already been sweating profusely, > you don't sweat 20 times the volume of perspiration. Anyone who has treated an elderly person with kidney xu knows that you don't just keep doubling the success of your treatment by doubling the dose of your formula. There is only so much of the herbs' energies, or actions, that the person is able to make use of. In fact, dosages often have to be reduced for elders in order to get a better effect. Why? Because the effect we really want has to do with how the person's vital force is able to make use of the influence of the herbs. > > (my appologies for long posts) > Erico Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 10, 2008 Report Share Posted September 10, 2008 Jason, I have to disagree with your statement about large doses being used by practitioners who do not know their diagnosis very well and that they are " sloppy " formula writers. A lot of my training has been in the field of dermatology, where the results of ones treatment become very obvious. One sees what works and what doesn't. Teachers like Mazin have documented their work very thoroughly and over decades he has refined his style to one that works very well. His diagnosis is quick, precise, and accurate, being reflected in his formula writing which is clear, simple, with large doses, and most importantly, effective. I struggle to see how any one can claim to treat something like a severe and stubborn form of psoriasis without using large doses of herbals and see good results, if not a cure. I have seen this with my own eyes in clinic and from the work of my teachers. If you can get results with stubborn skin disease while using small formulas with small doses then I would love to fly down and train with you! The cost to my patients would be cheaper, for which they would be very happy. I have personally seen too many practitioners not prescribe large enough doses, have their patient take herbs for a lot longer than they need to, and end up paying more money and not have a good result. Chinese medicine is a vast and diverse system with many different styles, but when it comes to something like the treatment of skin disease, I have yet to see a practitioner, young or old, who can claim really good results without having used large doses. I have heard a lot of talk, but I have not seen anyone back this idea up for themselves. In terms of Huang Qi dosed at 60g, I was referring to a dose used over two days. Do you think that a 30g per day dose of Huang Qi is too big?? Trevor , " " wrote: > > Trevor, > > > > This is an important question! It must be understood that China / Chinese > medicine is vast and there are many different varieties in styles of > practice. Currently the trend in many major Chinese hospitals / clinics / > schools etc is the use of very high doses. Many times this stems from > financial incentive (kick backs on herbs sold) as well as pharmacological > research / data. However, by no means does everyone in China use large doses > or even 1 bag a day. > > > > Many believe that this is overkill. For example, my main teacher in China, > almost always doses 1 bag every 2 days. He hardly ever uses large doses, > i.e. 30+ grams of something. However he was trained in a different era and > essentially was trained in the MengHe tradition of prescribing (meaning a > moderate style). He gets some of the best results I have ever seen. > > > > I have come to the conclusion that large doses are not needed if one can > diagnosis very clearly and one knows how to precisely pick and choose the > herbs. The sloppier one gets, the more herbs one needs, the more patterns > one diagnoses, as well as the larger doses one may require. As always this > is not to say these hammer style doesn't sometimes work. The real question > is it necessary. 60 grams of huang qi??? seems like overkill. > > > > My 2 cents, > > > > - > > > > > On Behalf Of Trevor Erikson > Monday, September 08, 2008 10:39 AM > > Raw herb decoction- dosages > > > > So this may seem like a silly question to some, but I have recently > come across some variance in how people think about dosing for a raw > herb decoction and I would love to hear how others approach this. > > My point being that when writing an Rx, lets say Bu Zhong Yi QI Tang > with 30 g of Huang Qi. That Rx is cooked twice and then the two fluids > are mixed together. Now here is where I see the conflict. Some people > I have heard divide that tea into 2 doses for a one days herbal > intake. Others divide that fluid into 4 doses to be taken over 2 days. > > So if the daily dose of Huang Qi is 30g and it takes a patient two > days to drink it, then wouldn't their daily dose of huang qi now only > be 15g?? And shouldn't the dosages be increased within the Rx if > patients are going to do this style of cooking enough for 2 days, ie > increase Huang Qi to 60g?? Obviously this is a way to save costs, but > is it effective?? > > Some practitioners have argued with me that the patient is still > getting the required dose. I would love to hears others feedback, > ideas, clinical experiences. > > Cheers, > Trevor > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 10, 2008 Report Share Posted September 10, 2008 I asked the same question when I was back in school and heard exactly the same answer as Alon and Doug mentioned - my teachers said the Chinese market exported the best quality herbs as they could make much more money in our market and therefore the herbs were stronger here and they didn't need to use as much to achieve good results. As a side note, I've been buying various teas lately, and although tea comes from the same plant (Camellia sinensis) - qualities and processing make the difference between $50 / oz to $4 / oz - and usually (not always) a corresponding difference in flavor and effect. I wish I had more access to various qualities of herbs to compare the results on patients to see if this holds as true for herbs as well. Geoff Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 10, 2008 Report Share Posted September 10, 2008 Geoff, To expand on this issue a bit. Two times ago when I was in China I visited an lingzhi, tiepishihu and zanghonghua organic farm. They did not export at all to the US. I asked why. They smiled and without trying to offend me too much said, that the US did not care about quality, then just wanted the cheapest product. This company was the top tiepishihu farm in China. There processing plant was immaculate, state of the art, and the quality of their herb was unsurpassed. They exported to Japan and Korea. Really the US can't afford the best stuff (or chooses not too). The Chinese have a lot more money than they ever did in the past. They pay top dollar for top quality herbs. For example they sell plenty of the above mentioned products to Chinese. They (and Japan and Korea) will drop $500 (US) on a month supply of their tiepishihu + lingzhi gao. I have seen pristine herbs in China and have hard time buying that we in the West get the best. For example the renshen we get is bottom grade. We just don't know enough about the subject to invest money in it. (I assume that is the issue). Other'sexperiences..? - On Behalf Of G Hudson Wednesday, September 10, 2008 10:52 AM Re: Raw herb decoction- dosages I asked the same question when I was back in school and heard exactly the same answer as Alon and Doug mentioned - my teachers said the Chinese market exported the best quality herbs as they could make much more money in our market and therefore the herbs were stronger here and they didn't need to use as much to achieve good results. As a side note, I've been buying various teas lately, and although tea comes from the same plant (Camellia sinensis) - qualities and processing make the difference between $50 / oz to $4 / oz - and usually (not always) a corresponding difference in flavor and effect. I wish I had more access to various qualities of herbs to compare the results on patients to see if this holds as true for herbs as well. Geoff Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 10, 2008 Report Share Posted September 10, 2008 Trevor, I respect your training and I know Mazin's style of prescribing gets good results. I used it for a long time. However, I am also very clear that you do not need to use these high doses to treat these conditions. I will try not to turn this into some " my teacher is better than your teacher " but J, the teacher I study with, specializes in very difficult dermatology and autoimmune cases. As mentioned he never uses these high doses and get bomber results. He is very classically oriented. So you can believe it or not, but I have seen the clinical results. I will tell you it has to do with diagnosis. I know that Mazin has a system, but IMHO his diagnosis is a bit simplified (very modern TCM) and I think this is why he relies on high dose herbs. There are many ways to skin a cat. I just like the simplest and less evasive approach. We should remember that herbs are toxic and high doses have the potential for damage. I think this is why Mazin routinely tests his patient's Liver enzymes. This IMO is very intelligent (when prescribing his style of medicine), but also demonstrates the strength that he is dealing out. Don't get me wrong I am happy to see you or anyone prescribing bulk herbs. I bet you get great results, and in no way discounting this. Everyone learns a certain way and this shapes their clinical lens. I just firmly disagree that higher dose formulas are necessary. If you fly to China you can find many doctors with different styles. I will be there for the whole month of October if you want to come over. - On Behalf Of Trevor Erikson Wednesday, September 10, 2008 10:16 AM Re: Raw herb decoction- dosages Jason, I have to disagree with your statement about large doses being used by practitioners who do not know their diagnosis very well and that they are " sloppy " formula writers. A lot of my training has been in the field of dermatology, where the results of ones treatment become very obvious. One sees what works and what doesn't. Teachers like Mazin have documented their work very thoroughly and over decades he has refined his style to one that works very well. His diagnosis is quick, precise, and accurate, being reflected in his formula writing which is clear, simple, with large doses, and most importantly, effective. I struggle to see how any one can claim to treat something like a severe and stubborn form of psoriasis without using large doses of herbals and see good results, if not a cure. I have seen this with my own eyes in clinic and from the work of my teachers. If you can get results with stubborn skin disease while using small formulas with small doses then I would love to fly down and train with you! The cost to my patients would be cheaper, for which they would be very happy. I have personally seen too many practitioners not prescribe large enough doses, have their patient take herbs for a lot longer than they need to, and end up paying more money and not have a good result. Chinese medicine is a vast and diverse system with many different styles, but when it comes to something like the treatment of skin disease, I have yet to see a practitioner, young or old, who can claim really good results without having used large doses. I have heard a lot of talk, but I have not seen anyone back this idea up for themselves. In terms of Huang Qi dosed at 60g, I was referring to a dose used over two days. Do you think that a 30g per day dose of Huang Qi is too big?? Trevor <%40> , " " wrote: > > Trevor, > > > > This is an important question! It must be understood that China / Chinese > medicine is vast and there are many different varieties in styles of > practice. Currently the trend in many major Chinese hospitals / clinics / > schools etc is the use of very high doses. Many times this stems from > financial incentive (kick backs on herbs sold) as well as pharmacological > research / data. However, by no means does everyone in China use large doses > or even 1 bag a day. > > > > Many believe that this is overkill. For example, my main teacher in China, > almost always doses 1 bag every 2 days. He hardly ever uses large doses, > i.e. 30+ grams of something. However he was trained in a different era and > essentially was trained in the MengHe tradition of prescribing (meaning a > moderate style). He gets some of the best results I have ever seen. > > > > I have come to the conclusion that large doses are not needed if one can > diagnosis very clearly and one knows how to precisely pick and choose the > herbs. The sloppier one gets, the more herbs one needs, the more patterns > one diagnoses, as well as the larger doses one may require. As always this > is not to say these hammer style doesn't sometimes work. The real question > is it necessary. 60 grams of huang qi??? seems like overkill. > > > > My 2 cents, > > > > - > > > > <%40> > [ <%40> ] On Behalf Of Trevor Erikson > Monday, September 08, 2008 10:39 AM > <%40> > Raw herb decoction- dosages > > > > So this may seem like a silly question to some, but I have recently > come across some variance in how people think about dosing for a raw > herb decoction and I would love to hear how others approach this. > > My point being that when writing an Rx, lets say Bu Zhong Yi QI Tang > with 30 g of Huang Qi. That Rx is cooked twice and then the two fluids > are mixed together. Now here is where I see the conflict. Some people > I have heard divide that tea into 2 doses for a one days herbal > intake. Others divide that fluid into 4 doses to be taken over 2 days. > > So if the daily dose of Huang Qi is 30g and it takes a patient two > days to drink it, then wouldn't their daily dose of huang qi now only > be 15g?? And shouldn't the dosages be increased within the Rx if > patients are going to do this style of cooking enough for 2 days, ie > increase Huang Qi to 60g?? Obviously this is a way to save costs, but > is it effective?? > > Some practitioners have argued with me that the patient is still > getting the required dose. I would love to hears others feedback, > ideas, clinical experiences. > > Cheers, > Trevor > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 10, 2008 Report Share Posted September 10, 2008 In terms of herb quality, I don't have much experience in understanding the american market, but I can speak for Mazin's experience in the UK. FOr years Mazin has gone to China himself to seek out the best quality herbs he can get his hands on. I believe he imports about 20 tonnes worth ever 8 months or so. Quality being very important to him he will pay whatever it takes. He has done this for a couple decades and so has contacts with local dealers/ farmers that others would not have access to. For years he has offered others to buy in with him, putting the message out to most of the herb shops throughout the UK. Every time he offers, every shop has always turned him down, saying that they would rather nickel and dime for lesser quality then pay the extra cost for better quality. SO if the same thing happens in the US, or Canada for that matter, I would agree with you Jason that most of the herbs available here are of lesser quality. Trevor , " " wrote: > > Geoff, > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 10, 2008 Report Share Posted September 10, 2008 Jason, I am not at all insulted or feel threatened by " a my teacher is better than your teacher " dialogue. For me it is truly about the learning and growing. You have obviously been exposed to some different styles than me and I really appreciate the sharing of your experiences. It sounds as if you have very similar interests to me in terms of dermatology and autoimmune problems. I am very curious to see the type of results you and your teacher achieve in these areas, especially if you are able to use smaller doses/ formulas. I must say that I am greatly intrigued!! I was so impressed by the results that I saw Mazin achieve, and then to be able to replicate them was very impressive to me. I also saw similar approaches in the derm ward in the Cheng Sha hospital, again using large doses. SO this became my trend as well. I have used smaller doses and was not happy with the results, so I tend to dose high for this reason. I also tend to be a skeptic to peoples claims unless they are backed up with clinical evidence. I guess I have seen too many practitioners with wonderful theories, but without actual results. From reading your previous threads it sounds as if you are a very results driven practitioner as well, which helps me to develop faith in your ideas. If you say there are different ways to approach the diagnosis of the different dermatological conditions and that that leads to the ability to use smaller doses, I am all for it! I would love to join you in China in October, even if only for a week. I will check my schedule to see if I may get this time off from clinic. If I cannot come this time, perhaps I could on a future date visit your clinic or else observe the work of your teacher when you visit another time. Thanks for the offer :-) Best Trevor , " " wrote: > > Trevor, > > > > I respect your training and I know Mazin's style of prescribing gets good > results. I used it for a long time. However, I am also very clear that you > do not need to use these high doses to treat these conditions. I will try > not to turn this into some " my teacher is better than your teacher " but J, > the teacher I study with, specializes in very difficult dermatology and > autoimmune cases. As mentioned he never uses these high doses and get bomber > results. He is very classically oriented. > > > > So you can believe it or not, but I have seen the clinical results. I will > tell you it has to do with diagnosis. I know that Mazin has a system, but > IMHO his diagnosis is a bit simplified (very modern TCM) and I think this is > why he relies on high dose herbs. There are many ways to skin a cat. I just > like the simplest and less evasive approach. We should remember that herbs > are toxic and high doses have the potential for damage. I think this is why > Mazin routinely tests his patient's Liver enzymes. This IMO is very > intelligent (when prescribing his style of medicine), but also demonstrates > the strength that he is dealing out. > > > > Don't get me wrong I am happy to see you or anyone prescribing bulk herbs. I > bet you get great results, and in no way discounting this. Everyone learns a > certain way and this shapes their clinical lens. I just firmly disagree that > higher dose formulas are necessary. > > > > If you fly to China you can find many doctors with different styles. I will > be there for the whole month of October if you want to come over. > > > > - > > > > > On Behalf Of Trevor Erikson > Wednesday, September 10, 2008 10:16 AM > > Re: Raw herb decoction- dosages > > > > Jason, > > I have to disagree with your statement about large doses being used by > practitioners who do not know their diagnosis very well and that they > are " sloppy " formula writers. A lot of my training has been in the > field of dermatology, where the results of ones treatment become very > obvious. One sees what works and what doesn't. Teachers like Mazin > have documented their work very thoroughly and over decades he has > refined his style to one that works very well. His diagnosis is quick, > precise, and accurate, being reflected in his formula writing which is > clear, simple, with large doses, and most importantly, effective. > > I struggle to see how any one can claim to treat something like a > severe and stubborn form of psoriasis without using large doses of > herbals and see good results, if not a cure. I have seen this with my > own eyes in clinic and from the work of my teachers. If you can get > results with stubborn skin disease while using small formulas with > small doses then I would love to fly down and train with you! The cost > to my patients would be cheaper, for which they would be very happy. > > I have personally seen too many practitioners not prescribe large > enough doses, have their patient take herbs for a lot longer than they > need to, and end up paying more money and not have a good result. > > Chinese medicine is a vast and diverse system with many different > styles, but when it comes to something like the treatment of skin > disease, I have yet to see a practitioner, young or old, who can claim > really good results without having used large doses. I have heard a > lot of talk, but I have not seen anyone back this idea up for themselves. > > In terms of Huang Qi dosed at 60g, I was referring to a dose used over > two days. Do you think that a 30g per day dose of Huang Qi is too big?? > > Trevor > > > <%40> , " " > <@> wrote: > > > > Trevor, > > > > > > > > This is an important question! It must be understood that China / > Chinese > > medicine is vast and there are many different varieties in styles of > > practice. Currently the trend in many major Chinese hospitals / > clinics / > > schools etc is the use of very high doses. Many times this stems from > > financial incentive (kick backs on herbs sold) as well as > pharmacological > > research / data. However, by no means does everyone in China use > large doses > > or even 1 bag a day. > > > > > > > > Many believe that this is overkill. For example, my main teacher in > China, > > almost always doses 1 bag every 2 days. He hardly ever uses large doses, > > i.e. 30+ grams of something. However he was trained in a different > era and > > essentially was trained in the MengHe tradition of prescribing > (meaning a > > moderate style). He gets some of the best results I have ever seen. > > > > > > > > I have come to the conclusion that large doses are not needed if one can > > diagnosis very clearly and one knows how to precisely pick and > choose the > > herbs. The sloppier one gets, the more herbs one needs, the more > patterns > > one diagnoses, as well as the larger doses one may require. As > always this > > is not to say these hammer style doesn't sometimes work. The real > question > > is it necessary. 60 grams of huang qi??? seems like overkill. > > > > > > > > My 2 cents, > > > > > > > > - > > > > > > > > > <%40> > > [ > <%40> ] On Behalf Of Trevor Erikson > > Monday, September 08, 2008 10:39 AM > > > <%40> > > Raw herb decoction- dosages > > > > > > > > So this may seem like a silly question to some, but I have recently > > come across some variance in how people think about dosing for a raw > > herb decoction and I would love to hear how others approach this. > > > > My point being that when writing an Rx, lets say Bu Zhong Yi QI Tang > > with 30 g of Huang Qi. That Rx is cooked twice and then the two fluids > > are mixed together. Now here is where I see the conflict. Some people > > I have heard divide that tea into 2 doses for a one days herbal > > intake. Others divide that fluid into 4 doses to be taken over 2 days. > > > > So if the daily dose of Huang Qi is 30g and it takes a patient two > > days to drink it, then wouldn't their daily dose of huang qi now only > > be 15g?? And shouldn't the dosages be increased within the Rx if > > patients are going to do this style of cooking enough for 2 days, ie > > increase Huang Qi to 60g?? Obviously this is a way to save costs, but > > is it effective?? > > > > Some practitioners have argued with me that the patient is still > > getting the required dose. I would love to hears others feedback, > > ideas, clinical experiences. > > > > Cheers, > > Trevor > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 11, 2008 Report Share Posted September 11, 2008 Trevor, I am very impressed about what you have to say about Mazin's dedication to herb quality, going himself to get herbs from the source. It shows real dedication to the craft, and a real relationship to the tools of the trade. On Sep 10, 2008, at 5:40 PM, Trevor Erikson wrote: > > In terms of herb quality, I don't have much experience in > understanding the american market, but I can speak for Mazin's > experience in the UK. > > FOr years Mazin has gone to China himself to seek out the best quality > herbs he can get his hands on. I believe he imports about 20 tonnes > worth ever 8 months or so. Quality being very important to him he will > pay whatever it takes. He has done this for a couple decades and so > has contacts with local dealers/ farmers that others would not have > access to. > > For years he has offered others to buy in with him, putting the > message out to most of the herb shops throughout the UK. Every time he > offers, every shop has always turned him down, saying that they would > rather nickel and dime for lesser quality then pay the extra cost for > better quality. > > SO if the same thing happens in the US, or Canada for that matter, I > would agree with you Jason that most of the herbs available here are > of lesser quality. > > Trevor > > , " " > wrote: > > > > Geoff, > > > > Chair, Department of Herbal Medicine Pacific College of Oriental Medicine San Diego, Ca. 92122 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 11, 2008 Report Share Posted September 11, 2008 Jason, A very interesting discussion indeed. I've also been interested in the Menghe style of herbal medicine, through Volker Scheid's work (he is working on a prescription text right now), and have always had empathy for an approach that works with smaller doses and focuses on qi transformation, as Fei Boxiong's style does. I'd be interested in your experiences with your teacher and his/ her style, and the underlying philosophy of prescriptions. If too 'long-winded' for CHA, please contact me privately. On Sep 9, 2008, at 4:59 PM, wrote: > Trevor, > > This is an important question! It must be understood that China / > Chinese > medicine is vast and there are many different varieties in styles of > practice. Currently the trend in many major Chinese hospitals / > clinics / > schools etc is the use of very high doses. Many times this stems from > financial incentive (kick backs on herbs sold) as well as > pharmacological > research / data. However, by no means does everyone in China use > large doses > or even 1 bag a day. > > Many believe that this is overkill. For example, my main teacher in > China, > almost always doses 1 bag every 2 days. He hardly ever uses large > doses, > i.e. 30+ grams of something. However he was trained in a different > era and > essentially was trained in the MengHe tradition of prescribing > (meaning a > moderate style). He gets some of the best results I have ever seen. > > I have come to the conclusion that large doses are not needed if one > can > diagnosis very clearly and one knows how to precisely pick and > choose the > herbs. The sloppier one gets, the more herbs one needs, the more > patterns > one diagnoses, as well as the larger doses one may require. As > always this > is not to say these hammer style doesn't sometimes work. The real > question > is it necessary. 60 grams of huang qi??? seems like overkill. > > My 2 cents, > > - Chair, Department of Herbal Medicine Pacific College of Oriental Medicine San Diego, Ca. 92122 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 11, 2008 Report Share Posted September 11, 2008 , alon marcus <alonmarcus wrote: > > Its interesting that in the 80s a bag was used for two days by > everyone i studied with in US. In the hospital i worked at in china > they used one bag per day but the herbs definitely did not look as > good as the ones in the US High quality and low quality herbs exist in both China and the US. It is true that some of the lowest grades remain on the Chinese domestic market, but it is a simplification to suggest that all the herbs used there are of poor quality. One pack of herbs per day has been used since ancient times. The thing that is a new phenomena is the use of one pack for two days. As far as I can tell, it is primarily a feature of economics in the US- some practitioners pay too much for their herbs and they charge too much, so they reduce the sticker shock for the patients by prescribing half the normal amount of medicine. All this is not to say that more is better, or that the one pack per two days is ineffective. Different cases require different doses and administration methods, a fact that has also been agreed upon since ancient times. Eric Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 12, 2008 Report Share Posted September 12, 2008 Z'ev, Volker's book sounds great I can't wait.I am also currently working on a book that exemplifies this approach, although a bit different. It is a translation (with my teacher's commentary) of one of Qin Bo-Wei's most famous books. FYI- Qin Bo-Wei's teacher was Ding Gan-Ren. This style of practice is a real eye opener and presents a stark contrast to the modern prescribing approach. As mentioned before, in the end it doesn't come down to anything fancy. One just has to diagnosis very clearly and understand the differentiations betweens herbs and herbal preparations (pao zhi). It also requires a non-simplified approach to theory. This usually means understanding classical Chinese medical ideas a little deeper than presented in many modern schools. This is becoming a lost art. The first step for me was believing it was possible. For years I heard people like Bob Flaws saying, the biggest problem is not enough dosage. I was using higher and higher dosages, larger formulas. Of course I had success, but I also made people sick. Then I started studying Ye Tian-Shi, I said 'wow he only has 5 herbs in that formula, how does that work?' Anyway, now I find no need to either use large doses or large prescriptions, at least when I am thinking clearly. J - On Behalf Of Thursday, September 11, 2008 8:50 AM Cc: Re: Raw herb decoction- dosages Jason, A very interesting discussion indeed. I've also been interested in the Menghe style of herbal medicine, through Volker Scheid's work (he is working on a prescription text right now), and have always had empathy for an approach that works with smaller doses and focuses on qi transformation, as Fei Boxiong's style does. I'd be interested in your experiences with your teacher and his/ her style, and the underlying philosophy of prescriptions. If too 'long-winded' for CHA, please contact me privately. On Sep 9, 2008, at 4:59 PM, wrote: > Trevor, > > This is an important question! It must be understood that China / > Chinese > medicine is vast and there are many different varieties in styles of > practice. Currently the trend in many major Chinese hospitals / > clinics / > schools etc is the use of very high doses. Many times this stems from > financial incentive (kick backs on herbs sold) as well as > pharmacological > research / data. However, by no means does everyone in China use > large doses > or even 1 bag a day. > > Many believe that this is overkill. For example, my main teacher in > China, > almost always doses 1 bag every 2 days. He hardly ever uses large > doses, > i.e. 30+ grams of something. However he was trained in a different > era and > essentially was trained in the MengHe tradition of prescribing > (meaning a > moderate style). He gets some of the best results I have ever seen. > > I have come to the conclusion that large doses are not needed if one > can > diagnosis very clearly and one knows how to precisely pick and > choose the > herbs. The sloppier one gets, the more herbs one needs, the more > patterns > one diagnoses, as well as the larger doses one may require. As > always this > is not to say these hammer style doesn't sometimes work. The real > question > is it necessary. 60 grams of huang qi??? seems like overkill. > > My 2 cents, > > - Chair, Department of Herbal Medicine Pacific College of Oriental Medicine San Diego, Ca. 92122 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 15, 2008 Report Share Posted September 15, 2008 About the use of one pack of herbs for several days: i have gotten to know this practice during internship in mainland China (mainly Chengdu). There doctors would decide according to the severity of the condition (as according to the financial situation of the patient) if the patient was supposed to take one pack a day, 2 packs per 3 days or one pack per 2 days. Nina Nina Zhao-Seiler Praxis für Traditionelle Chinesische Medizin Wilfriedstrasse 8 CH-8032 Zürich Tel: +41 44 251 1331 Fax: +41 43 243 6990 ninaseiler www.tcmherbs.org Quote Link to comment Share on other sites More sharing options...
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