The macro and micro aspects of granule concentration ratios

[Guest guest]

Dear groups,

 

Happy Lunar Chinese New Year.

I found the discussions on the granule concentration ratio

interesting, useful, and valuable. I was totally in the dark when

started using granule at the beginning. Gerry¡¦s advice (focusing on

one company product as different company products have different

ratios) reinforces my experiences.

 

As a granule user for past 13 years, (I use products from 4 different

granule companies, 1 from China and 3 from Taiwan), I mainly use the

products from China and from one particular Taiwanese product (the

rest 2 Taiwanese company products are used only when the individual

herbal that I need is out of stock or does not supply at all). Here

are my trial-and-error experiences to share with our members.

 

The granules made in China have ratio issue: they are four types

0.15g (granule) =3g (raw herbal)

0.2=3g

0.3=3g (most popular, majority)

0.6=3g

 

At the beginning, I had to do mathematics that seems bothersome. Once

experienced, it is not a drag.

 

On the other hand, the concentration ratio of the Taiwanese-made

granule is 1:1. That is easy to use except they are added lots of

starch powder as fixture.

 

As most other members here, I agree decoction from raw herbs have

better results. However, using granule is indispensable for its

convenience. I have no problems of using them but am skeptical about

them for the following reasons.

 

1 The fact that we cannot control over the quality (consistency) of

granules makes me care less about granule concentration ratios. The

quality of raw herbals used for granulation is unknown to us

(majority of them imported from China and we can never tell if they

are metal-free, pesticide-free, etc except to trust the producers)

 

2 Making granules is a specialty that we can never learn (and I don¡¦

t bother). Moreover, the technology know-how will always advance. I

notice the granule companies have tried very hard to perfect their

products over the years so we have to adjust to their change.

 

3 No matter how sophisticated the granule manufactured, it accounts

for only 10 to 15% of clinical efficacy (explain in the following).

 

In view of that, the following are my conclusion about using granules.

 

1. Stick to one major granule company only; so we can observe,

familiarize with, and master the density (dosage) most desirable for

patients.

 

2. Always use single granule to mix a formula; the patent one

always has the herbals that I do not want; or the ratio of individual

medicinal is not desired (e.g da huang is too much that tends to

produce unnecessary side effects). We may not have the benefit of

unknown molecules produced when a patent formula cooked together; it

is more important not to have the side effects. Remember, as long as

the selection of herbals is correct, efficacy will be seen.

 

3. Only use the basic formula such as si wu tang (Four Agents

Decoction) when a whole formula of granule is necessary. That saves

time and we gain the benefit of having the whole ingredients decocted

together (if they do). Add individual herbal separately.

 

One of the characteristics of Chinese medicine is its macro aspect.

Let us look at the flow of factors that affecting clinical efficacy.

We then may realize the issue of concentration ratio of granule is

really not that significant.

 

1Diagnosis---- 2 selection of herbals -----3 prompt dosage-------

4 quality of the herbals and processing-----5 preparation by patient

= efficacy

 

1. If the diagnosis is wrong, it is much likely that wrong

medicinals are given to the patient. We consider ourselves lucky if

the patient has no dizziness, vomiting, or diarrhea, no efficacy is

expected.

 

2. If diagnosis is correct, selection of herbals will be on

the right track. Experienced doctors will excel by 10 to 20% to those

mediocre. I will say as long as the herbals are not wrong, there are

70 to 80% will hit the target and we will see positive results;

 

3. If the dosage is appropriate (enough to see results), 70 to

80% chances remains to see positive results;

 

4. Quality of herbs in mainland China is usually inferior

(except Tung Ren Tong) than outside the country (the best are

exported). I would say one quality batch of herb is equivalent to two

inferior batches of herbs; if the processing method is appropriate

(to enhance or maximize ingredients), i.e. those should be stir-fried

such as bai zhu (ovate atractylodes); mu li (oyster shell) pre-decoct

for 20 minutes; da huang or aromatic herbs such as huo xiang, bai zhi

etc should not be decocted until the last 3 mintues; the positive

results remain 70 to 80%;

 

5. Preparation by patient refers to decocting method. Wrong

or indecent preparation of medicinals plus wrong timing to consume

the decoction will decrease efficacy by 5 to 10%.

 

Conclusion

 

If we fumble factor1 and factor2, the rest really does not matter at

all. In general, I would say factor 4, quality of the herbals and

processing (granulation), accounts for 10 to 15% of overall efficacy

only. Remember that this factor is totally in the hands of the

patients, either the technology of extracting the granules or

decocting raw herbals by patients, nothing a doctor can control.

 

The success of a TCM doctor is to make correct diagnosis and make

best selection of herbals. We should also look at the larger picture

and think more about why Steve Jobs is getting skinny and how to

tackle Mr Kennedy¡¦s brain issue; that is the future of road of TCM.

The future of TCM is in America.