Dose of herbs prescribed to Westerner in Beijing

April 11, 2009

Hi again Jason

Maybe an interesting read for you about Mazin treating atopic eczema and his

principles in doing so…..

http://www.jcm.co.uk/media/cms/File/77-80.pdf

BR

April 11, 2009

Carl,

I cannot complain about my results, otherwise I would change strategies.

However, I do not see nearly the volume of patients that my teacher does and

gets results in. I really just try to emulate his style, because of his time

and time again results.

-Jason

On Behalf Of Carl

Sunday, April 12, 2009 9:21 AM

Re: Dose of herbs prescribed to Westerner in Beijing

Well spoken Trevor!

Jason, do you treat Psoriasis with good results time after time with small

dosages?

BR

Carl

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Version: 8.0.238 / Virus Database: 270.11.52/2053 - Release 04/11/09

10:51:00

April 11, 2009

Thanks I will check it out soon, right now the article is unable to d/l

from my connection.

Here is a dermatology case to consider in the meantime:

A 9 year old boy that came in for a diagnosis, where his mother spoke for

him at the intake: She said, ever since he was a toddler he never sweat.

Often in the height of the summer months his whole body's skin would become

red, dry, and itchy where he frequently would scratch himself until there

were bloody scabs. There was great suffering that was hard to endure, on

many occasions in the past he would go to the local hospital seeking

treatment. The diagnosis was sympathetic / parasympathetic (autonomic

dystonia) nervous functional disorder and used antibiotics with no effect.

Upon examination his whole body (4 limbs, chest and abdomen) had red, dry,

skin with scratch marks, scabs, and scars. He had rough breathing,

occasionally there was vexation, mouth and nose was dry, tongue body was

pale-red, coat was thin and white, pulse was floating and rapid.

With this bit of information it is an interesting exercise to write what

formula, or at least treatment principle, you would use to treat this

patient? What would Trevor or Mazin do for this skin condition?

-Jason

On Behalf Of Carl

Sunday, April 12, 2009 5:52 AM

Dose of herbs prescribed to Westerner in Beijing

Hi again Jason

Maybe an interesting read for you about Mazin treating atopic eczema and his

principles in doing so...

http://www.jcm.co.uk/media/cms/File/77-80.pdf

BR

11.52/2053 - Release 04/11/09 10:51:00

April 11, 2009

Hi Jason

Thank you for your response. (as well as Trevor and Carl).

Jason, you are certainly correct in catching me carelessly using the word

'tradition'. There are many traditions, all coexisting. It is also obvious that

our 'lineages' are quite different, and that is the beauty of Chinese

medicine--such diversity has created the amazing tradition we all share.

However, I do disagree with your statement that high doses were the exception

not the norm with regard to 'tradition'. There is a 2000 year span that

antedates 'premodern' that can all be considered 'traditional'. In that time

quite a lot has happened.

Vast changes have been seen in dosaging over the centuries. The Shang Han Lun,

from which I clinically and theoretically draw from the most, has extremely high

dosages listed in the 'original' text. This 'tradition' is arguably the oldest.

Mahuang is listed at 3 liang in Mahuang Tang and 6 liang in Da Qinglong Tang.

Guizhi in guizhi Tang is 3 liang. According to historical weights and measures

scholarship, one liang in the Han dynasty is about double what it is now. So

converting it over time and into grams, we get 1 liang a little more than 15g (a

slight underestimate) x 4 or 6 comes to 45 to 90 grams for mahuang and 35g for

guizhi. Now, these formulas were meant to be fast acting, but of course more

dangerous. This is why there are so many formulas and counter-formulas within

the SHL to take care of mis-use or over use of certain formulas. This tradition

of high dosages is alive and flourishing in Taiwan and quite a few

practiotioners in China. (I cannot speak for Korea or japan). Most practitioners

who are ardent Shang Han Lun'ists don't use these classic doses, but do tend to

fall in the range of 3 to 5 liang on average (say 12 to 20 grams) per herb. And,

of course, few stick to the original formula, choosing instead to add in (for

better or worse) quite a few herbs.

Shooting more than 1600 years later, the Wenbing school (warm disease school)

took a different approach. Their formulas tended to be weighted less, though

certainly not lightweights. However, they were looking at a different types

diseases (of course you could also say, in many cases, the same disease from a

different perspective), and there was a need for a milder yet more patient

therapy. For example, treating combined heat and damp diseases becomes quite

tricky. Or extremely high febrile, including hemorragic, diseases that quickly

move into the deeper regions of the body (chinese medicine speak). SHL doses of

guizhi tang or mahuang tang, etc. would not necessarily be wise for such

problems.

Then your tradition--often dubbed the Shanghai School--has quite a distinguished

lineage as well, with dosages not unlike the those found in the Pi-Wei Lun

(famine underscored Li Dong Yuan's patients). An interesting aspect with many of

the practitioners in this small-dose lineage is that instead of using a high

dose for one herb, two somewhat redundant herbs might be used but each at lower

doses. Thus 20 grams of cangzhu might be substituted for 10 grams each of

cangzhu and baizhu. (random example)

Then there is what is known as the Fire-God school. This is alive and well in

China today and doses of some herbs (chaihu, fuzi, etc.) are in the 100 -150g

range.

And, there is a whole lot of space to maneuver in between all these approaches,

depending on individual practitioners, patients, and disease types. Certainly,

there are numerous other reasons why a some practitioners alter dosages that

have nothing to do with medicine at all (moralists and idealists should stop

reading here). Doctors or patients who wish to cut costs lower doses. Doctors

who wish to make money by selling the herbs or attempt to evoke professional

respect with a big bag of weighty herbs increase doses--just as many

practitioners in the US keep their consultation fees somewhat high at a

'respectable' rate citing the business model that the more a client pays, the

more s/he will respect you. (Physicians in Taiwan make money off of the

treatment, not the consultation fee.) I know many physicians and patients who

fit into all of the above categories.

In any case, proper use of herbs should not cause liver toxicity, unless you are

treating a patient whose liver is already compromised (hepaititis, cirrhosis,

cancer, etc.) or there are herbs which are known to potentially damage the liver

(or kidney)--huangyaozi, di yu, fangji, etc. In all my years in Taiwan (15)

observing patients with seroius diseases taking high dosed formulas for months

and even years, I have yet to see any incuring liver or kidney problems.

Anyway, thanks Jason for keeping me in check. I think that it is important to

acknowledge all of the coexisting traditions. As long as the herbs are

prescribed with wisdom, experience and a little creativity, and not

halfhazardly, the patient should benefit.

I have written this rather quickly and hope I have not made too many errors.

Since I am relatively new here in the US, I welcome responses to this very

interesting topic and am interested to hear the attitudes and experiences of

other herbalists outside of Asia.

Happy Spring to all

Daniel Altschuler

Seattle, WA

-

Saturday, April 11, 2009 1:46 AM

RE: Dose of herbs prescribed to Westerner in Beijing

Daniel,

I actually believe the opposite, and would like to see some evidence that

larger dosage formulas are the norm for a 'traditional perspective.' I think

larger dosage formulas are a more modern approach, many times fueled by

pharmacological / Western style research. I cannot speak for Taiwan, for I

have only studied their once, but in the mainland there are plenty of famous

doctors, actually most of the one's I have studied with, that do not use

large dosages. It is also clear that one can get results with serious skin,

autoimmune, etc with small concise formulas. THIS is what I see as a

traditional approach, hence practiced usually only by the really old

doctors, with strong classical training.

Actually one just needs to look through case studies and see how small and

precise the formulas were by some of the best doctors in history - hence

what I call a traditional approach. Of course there are exceptions with

doctors using large dosages, but there are plenty of examples of small

dosage formulas. Check out Ye Tian-Shi, Ding Gan ren, Qin Bo-wei, Liu

Bao-yi, and the meng-he doctors to see this style in real clinical

practice.

However your definition of traditional might be different than mine. I think

of a traditional approach from doctors prior to 'Modern TCM " and who used a

traditional approach to diagnosis and based their formulas on classical

ideas and prescriptions. Just for the record there is too much debate for

the SHL's dosages to weigh in on this topic.

I also disagree that 'smaller dosages' has to do with the economic situation

of the patient. There are doctors that I study with that just use small

dosages because they find no need to blast people out of the water. The get

some of the best results around hence are the busiest doctors. These

doctors do say that overdosing is an issue and too many herbs can be

harmful.

I always wonder why one would opt for an approach where one has to

constantly monitor Liver enzymes. Of course safe is best if you choose such

an approach, but such a strong approach IMHO is just unnecessary.

-

On Behalf Of Daniel Altschuler

Saturday, April 11, 2009 11:37 AM

RE: Dose of herbs prescribed to Westerner in Beijing

180 gms is actually quite a moderate dose from a traditional perspective.

Dosages in Taiwan tend to average 4 to 6 liang (one bag per day). One liang

is, in taiwan, 37.5g. Small dosages on the mainland has a lot to do with the

economic situation of the average person than it does with concern for

'overdosing'. In taiwan, many clinics (not herbal shop) have a set price for

their formulas--they charge per bag not per gram. So they actually lose

money with large prescriptions. Of course, this does not necessarily speak

for what happened in Beijing, but there are quite a few well known

physicians in China who retain old style treatment methods and use large

doses.

Daniel Altschuler

irus Database: 270.11.48/2048 - Release 04/10/09 18:27:00

April 12, 2009

Just a follow up: I think we should be clear (which I neglected to do in my

previous post) that there are two somewhat separate issues taking place in this

discussion. One is the dosage range of each individual herb in a formula. The

second is the total amount of herbs in any given formula. The Shang Han Lun.,

for example have small but high dose formulas. Many later formulas often had

large but small dose formulas. (look at Yin Qiao San, or Wu Ji San for example).

And, of course, lots of mixes in between.

Cheers!

Daniel

April 12, 2009

Jason,

Thanks for your lengthy reply.

As I have mentioned in many previous posts, I do believe that smaller dosed

formulas can get good results, I personally have not had the luxury to see them.

I have heard many tout such cases, but many times the guts of their speech are

missing. Hence why I asked you to provide case studies, so as to help me develop

faith.

Perhaps you are able to stay in China long enough to see real changes occur, say

from start to finish of severe psoriasis (which in my mind may take several

months) but I have not that opportunity. When I trained in China I was only able

to see a little snap shot of a case in progress, not the start to finish. This

is what my training with Mazin provided me through his meticulous case studies

with photographs of all the stages of healing.

I took Mazin's diploma training program and for me he was able to back up his

clinical claims with sound evidence of photographed results. Not just a few, but

hundreds. He was also able to present proper long term evaluations on many of

his cases, as in 5 year follow ups, as he has practiced for so long. Thus it was

very easy to develop faith in his style. I have since put his style into

practice and have seen the results and, opposite to your claims, have not seen

hardly anyone become sick from these formulas. When the diagnosis is right, I

have found that the patient is able to suck up the herbs quite easily and get

better.

In terms of psoriasis, Mazin tried many different styles of prescribing until he

found one that worked well. From his very stringent style of keeping case

studies, at least 65% of people with psoriasis clear completely and within 3

years 60% of those people are still clear, and have not developed any kind of

other strange problem related to the larger dosing of herbs. Mazin found that

unless he dosed high right away with most psoriasis cases, the patient would not

recover well enough- ie cure, and they would struggle for months trying to see

an effect.

I myself am still a beginner and also have years of training ahead of me, thus

am ALWAYS curious to hear about other styles. I am just skeptical to claims of

perfection when I cannot see with my own eyes the results (perhaps I have wasted

too much money on theoretical seminars with fluffy presenters who left my head

spinning but did not provide anything clinically useful).

My comment about ethics was in regards to putting down a system that has clearly

well documented styles that work, when the style that one is comparing it to

does not have the same degree of weight (at least in the modern western, english

translated, world). That is why I asked for case studies to back your claims.

I have a liver enzyme tester and do plan to test everyone, for many reasons

other than dosing large. To say that even 9g of any given herb could not affect

someones liver is wrong. Most cases of documented liver toxicity to herbals,

that I know of, were due to idiosyncratic, one off, situations that could have

been prevented had the practitioner been monitoring them. That is truly the

reason why Mazin tests everyone. It is not that he sees peoples liver enzymes

going up all the time on the larger dosed formulas, it is that there are times

when someone will react that is not predicable, but is preventable with regular

measurements.

Short and long term results in the clinic are the most important to all of us. I

developed faith in a system that was shown to be effective and, from the

hundreds of cases presented to me, safe. I look forward to seeing the new

material coming out on the topics you mentioned. I hope that this will also be

able to be backed up with presenters sharing their wonderful experiences of this

system, so that we can all develop as much faith as you Jason.

Trevor

, " " wrote:

>

> Trevor,

>

April 12, 2009

There seemed to be some question about the dosage of this formula. IT is 1

bag over 2 days.

-Jason

On Behalf Of

Bi xie 9 Huang bai 5

Cang zhu 6 Can sha (wrap) 6

Yin chen hao 9 Ze xie 6

Xu chang qing 9 Feng fang 6

Ban xia 9 Bai xian pi 9

Ku shen 6 Chan tui 4

April 12, 2009

Daniel,

Thanks for the your below analysis. I am familiar with this argument in

regard to dosage of SHL. As mentioned in my previous email there are two

sides to this story, and the verdict is far from out. Some people believe

that the dosages are smaller and some larger. Hence I do not think it can be

used as proof that traditional styles were the majority of the time using

large dosages. Especially since most texts that I have seen side with the

smaller dosages.

However, how can one not disagree with your observation that there are many

styles in CM history all following various dosages as well as number of

ingredients. However, this conversation originally started with the BeiJing

doctor prescribing 180 grams a day. This was said to be a moderate dose in

regard to traditional standards. I still disagree. Besides this SHL / JGYL

possibility, I still find that bit high. Look through the F & S book and one

can get an overview of dosing through the centuries. I think it is clear

that 180 grams a day is a bit on the higher side for traditional standards.

I guess it comes down to preference. If you like giving 100 grams of fuzi a

day, then go for it. There are always going to be extremist on every end.

Some give 1-2 grams of granulars a day. Some 300grams of bulk. I think that

if I can find a way to prescribe that isn't extreme than all the better. I

like moderation. Hence one again, I am not trying to invalidate any school

of thought, one can learn something from them all, I just think some are bit

much once one studies a more harmonious system. I of course will keep my eye

out for that person who needs 100 grams of chai hu J..

So if these high dosages are modern or classical, does not really matter.

What I really think should be challenged are the high dose shotgun formulas

that many modern doctors are using based on Western disease etc. But that is

another topic.

-

On Behalf Of daltsch

Sunday, April 12, 2009 2:00 PM

Re: Dose of herbs prescribed to Westerner in Beijing

Hi Jason

Thank you for your response. (as well as Trevor and Carl).

Jason, you are certainly correct in catching me carelessly using the word

'tradition'. There are many traditions, all coexisting. It is also obvious

that our 'lineages' are quite different, and that is the beauty of Chinese

medicine--such diversity has created the amazing tradition we all share.

However, I do disagree with your statement that high doses were the

exception not the norm with regard to 'tradition'. There is a 2000 year span

that antedates 'premodern' that can all be considered 'traditional'. In that

time quite a lot has happened.

Vast changes have been seen in dosaging over the centuries. The Shang Han

Lun, from which I clinically and theoretically draw from the most, has

extremely high dosages listed in the 'original' text. This 'tradition' is

arguably the oldest. Mahuang is listed at 3 liang in Mahuang Tang and 6

liang in Da Qinglong Tang. Guizhi in guizhi Tang is 3 liang. According to

historical weights and measures scholarship, one liang in the Han dynasty is

about double what it is now. So converting it over time and into grams, we

get 1 liang a little more than 15g (a slight underestimate) x 4 or 6 comes

to 45 to 90 grams for mahuang and 35g for guizhi. Now, these formulas were

meant to be fast acting, but of course more dangerous. This is why there are

so many formulas and counter-formulas within the SHL to take care of mis-use

or over use of certain formulas. This tradition of high dosages is alive and

flourishing in Taiwan and quite a few practiotioners in China. (I cannot

speak for Korea or japan). Most practitioners who are ardent Shang Han

Lun'ists don't use these classic doses, but do tend to fall in the range of

3 to 5 liang on average (say 12 to 20 grams) per herb. And, of course, few

stick to the original formula, choosing instead to add in (for better or

worse) quite a few herbs.

Shooting more than 1600 years later, the Wenbing school (warm disease

school) took a different approach. Their formulas tended to be weighted

less, though certainly not lightweights. However, they were looking at a

different types diseases (of course you could also say, in many cases, the

same disease from a different perspective), and there was a need for a

milder yet more patient therapy. For example, treating combined heat and

damp diseases becomes quite tricky. Or extremely high febrile, including

hemorragic, diseases that quickly move into the deeper regions of the body

(chinese medicine speak). SHL doses of guizhi tang or mahuang tang, etc.

would not necessarily be wise for such problems.

Then your tradition--often dubbed the Shanghai School--has quite a

distinguished lineage as well, with dosages not unlike the those found in

the Pi-Wei Lun (famine underscored Li Dong Yuan's patients). An interesting

aspect with many of the practitioners in this small-dose lineage is that

instead of using a high dose for one herb, two somewhat redundant herbs

might be used but each at lower doses. Thus 20 grams of cangzhu might be

substituted for 10 grams each of cangzhu and baizhu. (random example)

Then there is what is known as the Fire-God school. This is alive and well

in China today and doses of some herbs (chaihu, fuzi, etc.) are in the 100

-150g range.

And, there is a whole lot of space to maneuver in between all these

approaches, depending on individual practitioners, patients, and disease

types. Certainly, there are numerous other reasons why a some practitioners

alter dosages that have nothing to do with medicine at all (moralists and

idealists should stop reading here). Doctors or patients who wish to cut

costs lower doses. Doctors who wish to make money by selling the herbs or

attempt to evoke professional respect with a big bag of weighty herbs

increase doses--just as many practitioners in the US keep their consultation

fees somewhat high at a 'respectable' rate citing the business model that

the more a client pays, the more s/he will respect you. (Physicians in

Taiwan make money off of the treatment, not the consultation fee.) I know

many physicians and patients who fit into all of the above categories.

In any case, proper use of herbs should not cause liver toxicity, unless you

are treating a patient whose liver is already compromised (hepaititis,

cirrhosis, cancer, etc.) or there are herbs which are known to potentially

damage the liver (or kidney)--huangyaozi, di yu, fangji, etc. In all my

years in Taiwan (15) observing patients with seroius diseases taking high

dosed formulas for months and even years, I have yet to see any incuring

liver or kidney problems.

Anyway, thanks Jason for keeping me in check. I think that it is important

to acknowledge all of the coexisting traditions. As long as the herbs are

prescribed with wisdom, experience and a little creativity, and not

halfhazardly, the patient should benefit.

I have written this rather quickly and hope I have not made too many errors.

Since I am relatively new here in the US, I welcome responses to this very

interesting topic and am interested to hear the attitudes and experiences of

other herbalists outside of Asia.

Happy Spring to all

Daniel Altschuler

Seattle, WA

-

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