Dose of herbs prescribed to Westerner in Beijing

April 12, 2009

Dear All -

My apologies for not being engaged in dialogues on CHA over the last few

years my job and study requirements have precluded that. Style of

communication, which I have regarded as rather challenging in this forum, is

something that we can all work on.

To the matters at hand. I must agree with Jason about dosing, to a point.

Small doses do have a strong body of support historically and in

contemporary times. Most of my studies during the 90s were in the Menghe

current, with Drs Shen and Hammer. I was on the East coast and sent many

patients to Dr. Shen, analyzing their formulas in detail. Hammer also had a

rather large collection of formulas from Dr. Shen. Every one of these

formulas and the ones that we managed to collect from Shen's lectures

throughout the world had small doses.

There is also Yang Tiande, Al Stone speaks of him occassionally here. Yang

is a genious practitioner in a Beijing family lineage and is arguably one of

the finest in the LA basin. His reading list over the seven years that I

observed his practice included Ye Tianshi, Li Dong Yuan, Zhang Zhongjing and

their commentators. Yang's prescribing style used small herbs. I asked him

one day about his refined adjustments to formulas (sometimes .5 grams). He

always would name Ye Tianshi under these circumstances. But - he also said

to me one day - " I just think about how they taste. Then I adjust the doses.

It is like cooking. "

I also followed Neiqiang Gu, from a famous Shanghai family external

speciality lineage. He and I developed a close relationship over a five year

period. His doses were usually medium. However, I also saw him push the

doseage for agents such as bai hua she she cao and hu zhang.

What I have noticed is that there is a regional trend in dosing style among

faculties providing services in US AOM institutions. Those from northern

areas and ethnic areas closer to Tibet seem to employ larger doses than

those practitioners who come from Beijing and Shanghai. This is a rather

broad generalization based upon a limited set. But the northern ethnic

practitioners do tend to be heavy handed in dosing style.

I say heavy handed because it was a constant syle. In my opinion, large

doses can be advantageous, just as small doses. The question is when and

where? The style that I learned from Wang Jinling who was my first clinical

instructor in the early 80s, was to treat the pattern based upon small and

moderate dosing, and to push the dose of a specific herb that had an

evidence basis for the condition under treatment. All in all, my preference

is small dosing.

Warmly,

Will

--

William R. Morris, PhD, DAOM, LAc

http://www.aoma.edu/

http://www.pulsediagnosis.com/

http://health.PulseDiagnosis/

April 12, 2009

Yes this whole SHL dosage debate is tricky to understand. Reading Arnauds

comments on his forum make it clear that he believes the dosages were high. He

talks about even Wu Zhu Yu being used at 45g doses!

Trevor

, " " wrote:

>

> 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

>

> -

>

> <%40>

> 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.

>

> -

>

> <%40>

> [

> <%40> ] On Behalf Of Daniel

> Altschuler

> Saturday, April 11, 2009 11:37 AM

>

> <%40>

> 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

Hi Jason,

I have a blood testing machine called the Reflotron. It tests liver enzymes and

a whack of other blood components. The results are very accurate. A sample of

one is here: http://www.diavant.com/diavant/CMSFront.html?pgid=3,1,9,0

If your are interested in the topic, I suggest that you read the article Mazin

published on his own research (if you haven't already).

http://www.jcm.co.uk/media/sample_articles/liverenzymes.pdf?fe=f00694ce82be57f20\

feb4c42bc23f00f

Best

Trevor

>

> 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

>

> --- In

>

April 12, 2009

Jason,

I would love for you to elaborate on what you said, " 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. " I find this

topic very interesting and we can start a knew thread if you wish.

Are talking about treating based on:

Disease name in general?

Western disease names in general?

One size fits all for western disease name?

Best

Trevor

April 12, 2009

This is an interesting exercise :-)

Although I agree with Carl that visuals are very important in diagnosing skin

disease, I will give it a shot based on the limited written info we have.

To me it seems clear that this child is suffering with some sort of eczema. My

Dx would be Blood heat with wind.

I have been to taught to discriminate between two main poles of manifestation

with Eczema. On the one side is damp heat and on the other is blood heat with

wind. The main way to tell the difference, besides a visual observation, is

through the ability to sweat(showing evidence of damp predominance) or not

(showing evidence that damp is not that extreme). Of course there is a lot of

various within this, but it is a good place to start.

With the rapid pulse, dry, red, itching, lack of sweating, and excoriated skin,

I am validating my Dx of blood heat with wind. The heat in the blood could also

explain the vexation and rough breathing.

I would probably base my Rx on Dao Chi San with modifications.

Sheng Di Huang 12

Mu dan Pi 6

Dan Zhu Ye 6

Deng Xin Cao 2

Fang Feng 6

Jing Jie 6

Lian Qiao 6

Jin Yin Hua 6

Bai Xian Pi 6

Sheng Gan Cao 2

I think I would start with this for a week and see how the little guy responds.

I would love to hear what the actual diagnosis, treatment method, and outcome

was :-)

Best

Trevor

April 12, 2009

Jason,

Just to be clear, I do not think, nor do I feel challenged, that you are trying

to " convert " me to any one style. I really am just motivated by styles that have

been shown to be effective. Again I am VERY interested in your style and look

forward to learning more about it, as more work is published on it.

The great thing about skin disease, which is the reason I decided to focus on

it, is that results are objective and obvious. A person's skin either gets

better or not. Everyone present can see this with their own eyes. Short and long

term results can be measured and the argument becomes very clear. Thus it

becomes a lot easier to present/ teach/ and increase the student practitioners

faith in any given style- as they can more easily grasp what it is they are

working with and what kind of realistic treatment expectations to expect.

Best

Trevor

,

April 12, 2009

Bill,

Is there any record or planned publishing of Dr. Shen's compiled

formulas? We need more texts of great physicians' case histories and

prescriptions, both herbal medicine and acupuncture.

On Apr 12, 2009, at 7:09 AM, William Morris wrote:

>

> Dear All -

>

> My apologies for not being engaged in dialogues on CHA over the last

> few

> years my job and study requirements have precluded that. Style of

> communication, which I have regarded as rather challenging in this

> forum, is

> something that we can all work on.

>

> To the matters at hand. I must agree with Jason about dosing, to a

> point.

> Small doses do have a strong body of support historically and in

> contemporary times. Most of my studies during the 90s were in the

> Menghe

> current, with Drs Shen and Hammer. I was on the East coast and sent

> many

> patients to Dr. Shen, analyzing their formulas in detail. Hammer

> also had a

> rather large collection of formulas from Dr. Shen. Every one of these

> formulas and the ones that we managed to collect from Shen's lectures

> throughout the world had small doses.

>

> There is also Yang Tiande, Al Stone speaks of him occassionally

> here. Yang

> is a genious practitioner in a Beijing family lineage and is

> arguably one of

> the finest in the LA basin. His reading list over the seven years

> that I

> observed his practice included Ye Tianshi, Li Dong Yuan, Zhang

> Zhongjing and

> their commentators. Yang's prescribing style used small herbs. I

> asked him

> one day about his refined adjustments to formulas (sometimes .5

> grams). He

> always would name Ye Tianshi under these circumstances. But - he

> also said

> to me one day - " I just think about how they taste. Then I adjust

> the doses.

> It is like cooking. "

>

> I also followed Neiqiang Gu, from a famous Shanghai family external

> speciality lineage. He and I developed a close relationship over a

> five year

> period. His doses were usually medium. However, I also saw him push

> the

> doseage for agents such as bai hua she she cao and hu zhang.

>

> What I have noticed is that there is a regional trend in dosing

> style among

> faculties providing services in US AOM institutions. Those from

> northern

> areas and ethnic areas closer to Tibet seem to employ larger doses

> than

> those practitioners who come from Beijing and Shanghai. This is a

> rather

> broad generalization based upon a limited set. But the northern ethnic

> practitioners do tend to be heavy handed in dosing style.

>

> I say heavy handed because it was a constant syle. In my opinion,

> large

> doses can be advantageous, just as small doses. The question is when

> and

> where? The style that I learned from Wang Jinling who was my first

> clinical

> instructor in the early 80s, was to treat the pattern based upon

> small and

> moderate dosing, and to push the dose of a specific herb that had an

> evidence basis for the condition under treatment. All in all, my

> preference

> is small dosing.

>

> Warmly,

>

> Will

>

> --

> William R. Morris, PhD, DAOM, LAc

>

> http://www.aoma.edu/

> http://www.pulsediagnosis.com/

> http://health.PulseDiagnosis/

>

April 12, 2009

I don't mean to get this thread off-topic, but I wonder if this issue of low

dosage formulas could have any correlation to powdered extracts visa vis

could explain/give support to why doses of 10-16g/day of powdered extract

formulas are still seen as having clinical benefit by those who dose in that

range...

Joy

________

Joy Keller, LAc, Dipl.OM

Board Certified in Acupuncture & Oriental Medicine

Ramona Acupuncture & Integrative Medicine Clinic

Phone: (760) 654-1040 Fax: (760) 654-4019

www.RamonaAcupuncture.com

April 13, 2009

Will, Jason, Daniel, all,

I have another take on this issue. I think dosing reflects the

basic foundational philosophies of different styles of practice. Many

of our patients have chronic, complex issues that are strongly

connected with their psychological/emotional states reflected as

physical symptoms (symptom patterns). They may have been treated for

specific diseases pharmacologically and otherwise, but either haven't

responded well or have developed what Zhang Ji called bian zheng/

transmuted patterns. These patients, in my opinion, need a greater

length of time of treatment, gradual, and process oriented. They are

usually too weak for sudden assaults with strong medicines. One can

choose prescriptions, for example, that are harmonizing to shao yang

(if appropriate) such as xiao chai hu tang or chai hu jia long gu mu

li tang in smaller doses and gradually open up the patient in ways

that will not cause 'revolt'.

In other patients, we have an acute attack or a clear disease

pattern that needs strong intervention, stronger prescriptions with

pharmacologically active substances to the fore. For example, in

exterior patterns I will greatly increase dosages of herbs to drive

out the exterior evils if appropriate. Also, strong patients with

acute conditions will not respond to relatively low dose therapy, they

may be 'desensitized'.

The same holds true for acumoxa therapy. We focus and strengthen

therapy or increase subtlety through the factors of

a) length of treatment

b) repetition of treatment (times per week)

c) strength of needle stimulus

d) depth of insertion

e) number of needles or moxas used.

In herbal medicine we have large and small prescriptions, strong or

mild ingredients, dosages, frequency and length of treatment. We need

to be prepared for a full spectrum of possibilities, which means a

large knowledge base, great flexibility, and the possibility that we

are biased in a certain direction that doesn't benefit our patient.

Then we need to refer out.

We should remember that the herbal tradition was based largely on

the triad of heaven, humanity, and earth, superior, middle and

inferior grade medicinals, with superior grade being supporting the

correct qi, and inferior the treatment of disease (in the Divine

Farmer's Materia Medica). While we have an obligation to treat

disease, don't we also have an obligation to support our patients'

health?

I am also a fan of the Menghe tradition. Although I have

relatively little exposure to it, what I've seen resonates with me

strongly. I like what Volker Scheid says about it in his " Currents of

Tradition " text and in the new " Formulas and Strategies " . I also know

that Chip, Bill Morris and Jason appreciate it as well. From what

Volker writes, it would seem that the Menghe physicians such as Fei

Boxiong had patients who suffered from 'exhaustion and fatigue', due

to 'damage by the qi shang/seven emotions'. They had 'weak

constitutions, were unaccustomed to exercise, stressed by too much

work and thinking, frequently were unable to express their personal

worries (openly). "

A majority of my patients fit this category, therefore the more

long-term, gentle treatment with formulas that harmonize qi

transformation fit the bill. . .most of the time. My style and

demeanor, the setting in which I practice, are copacetic with these

clinical concerns.

When we have these discussions, while we must define what has come

before us in tradition, and pay heed to the roadmaps and markers

placed before us, we must find our place in this great tradition in

the style that suits us best, otherwise our therapies will not be as

useful as they might be otherwise.

On Apr 12, 2009, at 7:09 AM, William Morris wrote:

>

> Dear All -

>

> My apologies for not being engaged in dialogues on CHA over the last

> few

> years my job and study requirements have precluded that. Style of

> communication, which I have regarded as rather challenging in this

> forum, is

> something that we can all work on.

>

> To the matters at hand. I must agree with Jason about dosing, to a

> point.

> Small doses do have a strong body of support historically and in

> contemporary times. Most of my studies during the 90s were in the

> Menghe

> current, with Drs Shen and Hammer. I was on the East coast and sent

> many

> patients to Dr. Shen, analyzing their formulas in detail. Hammer

> also had a

> rather large collection of formulas from Dr. Shen. Every one of these

> formulas and the ones that we managed to collect from Shen's lectures

> throughout the world had small doses.

>

> There is also Yang Tiande, Al Stone speaks of him occassionally

> here. Yang

> is a genious practitioner in a Beijing family lineage and is

> arguably one of

> the finest in the LA basin. His reading list over the seven years

> that I

> observed his practice included Ye Tianshi, Li Dong Yuan, Zhang

> Zhongjing and

> their commentators. Yang's prescribing style used small herbs. I

> asked him

> one day about his refined adjustments to formulas (sometimes .5

> grams). He

> always would name Ye Tianshi under these circumstances. But - he

> also said

> to me one day - " I just think about how they taste. Then I adjust

> the doses.

> It is like cooking. "

>

> I also followed Neiqiang Gu, from a famous Shanghai family external

> speciality lineage. He and I developed a close relationship over a

> five year

> period. His doses were usually medium. However, I also saw him push

> the

> doseage for agents such as bai hua she she cao and hu zhang.

>

> What I have noticed is that there is a regional trend in dosing

> style among

> faculties providing services in US AOM institutions. Those from

> northern

> areas and ethnic areas closer to Tibet seem to employ larger doses

> than

> those practitioners who come from Beijing and Shanghai. This is a

> rather

> broad generalization based upon a limited set. But the northern ethnic

> practitioners do tend to be heavy handed in dosing style.

>

> I say heavy handed because it was a constant syle. In my opinion,

> large

> doses can be advantageous, just as small doses. The question is when

> and

> where? The style that I learned from Wang Jinling who was my first

> clinical

> instructor in the early 80s, was to treat the pattern based upon

> small and

> moderate dosing, and to push the dose of a specific herb that had an

> evidence basis for the condition under treatment. All in all, my

> preference

> is small dosing.

>

> Warmly,

>

> Will

>

> --

> William R. Morris, PhD, DAOM, LAc

>

> http://www.aoma.edu/

> http://www.pulsediagnosis.com/

> http://health.PulseDiagnosis/

>

April 13, 2009

Carl,

Of course seeing the patient is helpful, however one should be able to use

written record to discuss cases.

For example it was asked from me to provide " proof " that such difficult

cases can be solved with smaller - more traditionally sized dosage formulas.

People for some reason just can't believe that it is possible. This proof,

though, was to via case studies. I would have to ask how would anyone

provide " proof " to people who a) do not believe such a feat is even

possible, and b) without seeing patients.

No information would ever be enough. No one will take my word for it nor why

should they. So I find the request a bit odd. Quite simply what would it

take to provide Trevor (or others) with proof that such conditions can be

treated in this manner. Can it be done through the internet? This is

precisely why I said wait for Greg's book or find a master doctor to follow.

However I believe otherwise. I believe written record is valid and we should

be able to discuss such a case as presented in the previous email. One

should always be able to get into the ballpark with some idea on how to

treat a patient even if it is just an exercise on paper. If one needs a

specific skin manifestation to use a given herb or to confirm a diagnosis

that can be mentioned. However, just saying one must see the patient to

comment is a bit of a cop out. Really there is not a right answer, we just

try to learn from the answer.

There is a large tradition is CM that uses written record case studies

including dermatology to learn from. I find such exercises important because

they can show you that there are completely different ways to treat

conditions than one is used to. If one views a given case through a various

lens, but the doctor cures the case with something totally different than

bammm. One can see the possibility of something different. This is why there

are literally 1000's of case study book.

If one is trained that everyone needs fu zi or large dosages it will hard to

believe otherwise. The only issue I have with this discussion is the

potential toxicity that accompanies any form of extreme or high dose

treatment (albeit, Chinese medicine Western or otherwise). All herbs are

potentially toxic. The more we give, the more harm that can occur.

Without exposure to the vast options out there we can easily only see one

way. This also validates the idea that if we don't know that high dosages of

herbs like fuzi etc are possible, then we might miss an opportunity. Since I

have not studied with anyone that does this I personally am at a deficit

here. Are their people on the list that find that high dosages of fuzi are

the only thing that will help certain conditions?

Ultimately I guess all that any of us can do is get exposed to as much as

possible and find what works and then choose the safest treatments. Hence

why I am huge fan of eclectic (meng-he) medicine.

Thoughts?

-Jason

On Behalf Of Carl

Sunday, April 12, 2009 5:49 PM

SV: Dose of herbs prescribed to Westerner in Beijing

Jason

I can not speak for either Mazin or Trevor of course, both whom are a lot

more experienced in treating skin problems than me, but for me to treat any

skin problems I need to see the patient visually at least through one or

several photos.

Basically I admire any system of thought that can get good results

constantly, without jeopardizing the patient's health in the process. Being

able to write formulas with small dosages would be very nice, but as Trevor

said, I have not found anyone that could time after time show good results.

Mazins style is very convincing, since he can back it up with case after

case.

It seems to me that you are very lucky being able to follow such a good

teacher with all that experience.

Thanks to you and Trevor for an enlightening conversation, I am just sad I

can not keep up since my English is not the best.

Happy Eastern!

Carl

April 13, 2009

Z'ev,

I don't think anyone can argue with what you say (or at least I won't). I

also vary considerably my dosage dependant on the situation, patient etc.

However, I think there is a bit of a terminology issue here. I think when

one says small dosage we are thinking of some minute amount, actually I am

just contrasting it to the large heavy handed approach of modern Chinese

hospitals, e.g. as this BeiJing doctor prescribed 180grams a day for no real

disease. There is plenty of history with the dosage and methodology that I

describe.

This Beijing 180g is common though, and IMHO not representative of

traditional medicine. They often choose herbs at 30-60 grams because of

pharmacological actions based on disease or disease process etc. For better

or worse this really is a different medicine. But as we all know, there is a

lot of ideas out there and I would love someone to bring forth a

traditional lineage / famous doctor's case studies that routinely used high

dosages.

Also to elaborate, the meng-he current / tradition are really just

eclectics. The studied all the major traditions and used what was needed for

the situation. Qin Bo-Wei through influence of Ding Gan-Ren was the most

articulate and prolific at laying this out in a system of study.

Their thrust was not merely using small dosages, but really about using

precise diagnosis to nail the problem and hence just using a push instead of

a hammer. If one is only doing SHL and one encounters a wenbing problem

sometimes one might need the hammer to get results. Often (but of course not

always), IMO, the more off your diagnosis is the more heavy handed your

approach is needed to get results. This is one reason why modern Chinese

formulas are so large and what I consider " sloppy " , they have no clear

diagnosis. This is something to contemplate.

-

On Behalf Of

Monday, April 13, 2009 3:07 PM

Cc: Simcha Gottlieb

Re: Dose of herbs prescribed to Westerner in Beijing