RE: Altitude Sickness-herbs and legal defense -for Bob

[Guest guest]

Bob,

 

I'm curious as to what you are specifically referring to in regards to

cautioning against using herbs that aren't specifically in our training. Would

you caution practitioners against using herbs that are in Ben Cao's produced in

China when they are not taught in a standard curriculum here? Is your issue that

there is not a clear rationale for inclusion in this prescription? Related to

this, I was surprised to see in one of your nutrition books that you provide

flavor and natures for common OTC vitamins and minerals and argue that the

development of TCM materia medica has been a dynamic process of inclusion. How

is this different and how do you suggest those of us who wish to stretch out

beyond the materia medica we may have been tested on for our license here do so

ethically and/or legally?

 

Respectfully,

 

Ben Zappin

 

 

 

 

bob

Fri, 10 Jul 2009 19:35:56 +0000

Re: Altitude Sickness

 

 

 

 

 

 

 

Brown's lily bulb appears to be Bai He, Bulbus Lilii.

 

Potentilla anserina is called droma in Tibetan and is used as a famine food in

place of barley with which it is nutritionally comparable. In English, this is

called gooseweed. I have not been able to find a Chinese name or Chinese medical

description.

 

While this formula may manifestly work as advertised, I would caution against

prescribing it. Because of the last ingredient, you would probably have trouble

defending yourself in a court of law if that ever became necessary. This is not

one of our CM materia medica we are trained to use. Further, looking at the

medicinal descriptions of this plant, it is hard to rationally understand why it

is in this formula other than it is commonly consumed in Tibet, a high altitude

country. Like the Potentilla we are trained to use (Bai Tou Weng), its main

medicinal use seems to be as an anti-diarrhetic.

 

As healers, we are all interested in what works clinically. However, we also

have to take into account the medico-ethical and medico-legal ramifications of

anything we prescribe.

 

, <johnkokko wrote:

>

> Any info on these herbs?

>

> Potentilla anserina

> Brown's lilly bulb

>

> Thanks,

> K

>

>

> On Fri, Jul 10, 2009 at 3:51 AM, cara <herbbabe wrote:

>

> > thanks for the input!

> >

> > Cara O. Frank, R. OM

> > Six Fishes

> > China Herb Company

> > Director Chinese Herb Department

> > Tai Sophia Institute

> > www.carafrank.com

> > 215-772-0770

> >

> > On Jul 9, 2009, at 10:56 PM, John Freeman wrote:

> >

> > >

> > >

> > > - Feedback on effective formula for altitude sickness

> > > - My wife and I just returned from 2 weeks in Peru

> > > - We were hiking at altitudes up to 12,000 feet

> > > - We had purchased a product called Altigen (www.getaltigen.com)

> > > - The ingredients as listed are:

> > > Rhodiola crenulata

> > > American ginseng

> > > Angelica sinensis

> > > Panax noto-ginseng

> > > Potentilla anserina

> > > Brown's lilly bulb

> > > - We were taking 2 tablet (500mg) up to 3 times per day and found

> > > it amazingly effective

> > > - If the pills are crunched and washed down with water, they provide

> > > immediate relief

> > > within a couple of minutes

> > > Best Regards John F.

> > >

> > > ________

> > > Canada Toolbar: Search from anywhere on the web, and bookmark

> > > your favourite sites. Download it now

> > > http://ca.toolbar..

> > >

> > >

[Guest guest]

Ben,

 

I think all Bob is really tying to say is that we should be very clear about the

reason's why we offer whatever treatment it is that we offer. That we should

have some background on the particular ingredients for which we decide to have

our patients use. Is the treatment within our scope of practice? Do and

prescribe whatever you like, but at least be able to back up your thinking.

 

Bob is only reminding us, that legal and ethical issues rule our profession.

 

If a problem came up with one of your formulas, as in a side effect that you

over looked, what sources are you going to use to defend yourself? Is it not

easier to be prepared in advance of a possible problem, rather than scrambling

to make something up when the heat is on?

 

If someone prescribes this altitude sickness pill and, just in theory, a problem

occurs, what are you going to say in defense?

a) A friend told me about the product, so I thought it was a good idea

b) I am well aware of all the ingredients in that product and the roles that

they play in treating my patient. I truly believe that the side effect that

they experienced was just a rare situation that was unforeseen.

 

It is really about being open and prepared, rather than paranoid and fearful.

 

My 2 cents,

T

 

, ben zappin <btz23 wrote:

>

>

> Bob,

>

> I'm curious as to what you are specifically referring to in regards to

cautioning against using herbs that aren't specifically in our training. Would

you caution practitioners against using herbs that are in Ben Cao's produced in

China when they are not taught in a standard curriculum here? Is your issue that

there is not a clear rationale for inclusion in this prescription? Related to

this, I was surprised to see in one of your nutrition books that you provide

flavor and natures for common OTC vitamins and minerals and argue that the

development of TCM materia medica has been a dynamic process of inclusion. How

is this different and how do you suggest those of us who wish to stretch out

beyond the materia medica we may have been tested on for our license here do so

ethically and/or legally?

>

> Respectfully,

>

> Ben Zappin

>

>

[Guest guest]

I'm guessing that as soon as Bob catches up with this thread, he'll weigh

in. However, I'm pretty sure that the reason he was asking about whether the

herb was listed in particular books is that any herb that was used in the US

prior to a certain date was grandfathered in by the FDA as " generally

recognized as safe " . There is a specific date at play heer that is used in

legal problems surrounding adverse events of herbs.

 

I'm guessing that I've got some of the particulars incorrect, but I do

recall Bob being involved (expert witness?) with some legal action in which

he was looking for references of use for a particular herb prior to a

particular date.

 

I'm hoping that he'll chime in with more information.

 

-al.

 

On Sun, Jul 12, 2009 at 12:09 PM, Trevor Erikson <trevor_eriksonwrote:

 

>

>

> Ben,

>

> I think all Bob is really tying to say is that we should be very clear

> about the reason's why we offer whatever treatment it is that we offer.

>

 

 

 

--

, DAOM

Pain is inevitable, suffering is optional.

 

 

 

[Guest guest]

Thanks Al and Trevor for the feedback.

 

Trevor, what you share is certainly sound reasoning, no disagreement here.

 

 

 

I am very interested in whether there is any legal codification of Chinese herbs

in the West and look forward to hearing the particulars.

 

I'm sure some of you have heard Bob bring up the same issue with Yunnan Bai Yao

with its inclusion of many local and possibly secret undisclosed herbs and am

wondering if that is something for which there is a legal precedent around.

 

 

 

In response to Kokko's addressing the difference between us and the Western

medical profession in that we can profit off of our herbal treatments while

physicians can't - I have been delighted to have moved my office close enough to

an Spring Wind Pharmacy as it feels a lot cleaner to send someone off to pick up

a prescription. I don't know if patients prefer this over the convenience of

getting it filled in the office or not.

 

Ben

 

 

 

 

trevor_erikson

Sun, 12 Jul 2009 19:09:09 +0000

Re: Altitude Sickness-herbs and legal defense -for Bob

 

 

 

 

 

 

 

Ben,

 

I think all Bob is really tying to say is that we should be very clear about the

reason's why we offer whatever treatment it is that we offer. That we should

have some background on the particular ingredients for which we decide to have

our patients use. Is the treatment within our scope of practice? Do and

prescribe whatever you like, but at least be able to back up your thinking.

 

Bob is only reminding us, that legal and ethical issues rule our profession.

 

If a problem came up with one of your formulas, as in a side effect that you

over looked, what sources are you going to use to defend yourself? Is it not

easier to be prepared in advance of a possible problem, rather than scrambling

to make something up when the heat is on?

 

If someone prescribes this altitude sickness pill and, just in theory, a problem

occurs, what are you going to say in defense?

a) A friend told me about the product, so I thought it was a good idea

b) I am well aware of all the ingredients in that product and the roles that

they play in treating my patient. I truly believe that the side effect that they

experienced was just a rare situation that was unforeseen.

 

It is really about being open and prepared, rather than paranoid and fearful.

 

My 2 cents,

T

 

, ben zappin <btz23 wrote:

>

>

> Bob,

>

> I'm curious as to what you are specifically referring to in regards to

cautioning against using herbs that aren't specifically in our training. Would

you caution practitioners against using herbs that are in Ben Cao's produced in

China when they are not taught in a standard curriculum here? Is your issue that

there is not a clear rationale for inclusion in this prescription? Related to

this, I was surprised to see in one of your nutrition books that you provide

flavor and natures for common OTC vitamins and minerals and argue that the

development of TCM materia medica has been a dynamic process of inclusion. How

is this different and how do you suggest those of us who wish to stretch out

beyond the materia medica we may have been tested on for our license here do so

ethically and/or legally?

>

> Respectfully,

>

> Ben Zappin

>

>

 

 

 

 

 

 

 

 

_______________

Windows Live™: Keep your life in sync.

http://windowslive.com/explore?ocid=TXT_TAGLM_WL_BR_life_in_synch_062009

 

 

[Guest guest]

Paranoid? Maybe. However, on average, professional health care providers (such

as MDs, DOs, DCs, LAcs, etc.) testify in court once every seven years. To be

fair, we LAcs testify less often than this national average because we spend so

much time with our patients. Nevertheless, I've been in practice 30 years and

have been deposed under oath three times. One time was when the Colorado State's

Attorney General was prosecuting me for practicing medicine without a license

because I had prescribed vitamins to one of my patients. At the time, our scope

of practice in Colorado as acupuncturists did not include this. (Because of this

legal action, I became Prez of the AAC and did get our scope rewritten to

include Chinese meds, nutritional supplements, dietary counseling, etc.) In any

case, I can tell you that being deposed is serious stuff and, whether you are

for the defense or the prosecution, the other side is going to treat you

aggressively. Prescribing something we are not trained to prescribe, that is not

part of our standard of care, and/or that we do not know about could get you in

trouble, certainly undermines one's credibility as a medical professional, and

is professionally irresponsible (not to mention unethical). It may also

invalidate your malpractice insurance, thus leaving you twisting in the wind

financially as well.

 

As for my CM descriptions of Western herbs, Western drugs, vitamins, minerals,

amino acids, etc., all of these are only my personal provisional hypotheses.

Until or unless these descriptions are reviewed, tested empirically, and

accepted by broad consensus within our profession, they should all be taken with

a large grain of salt. One person's opinion is relatively meaningless. To date,

I know of no published responses to any of my hypotheses in this matter. As a

profession, I don't think we've yet reached that level of maturity. Far too many

of us simply are not demanding evidence for new ideas and practices. Similarly,

Michael Tierra and Peter Holmes' CM descriptions of Western herbs should also be

taken as their personal opinions as yet not verified and accepted as standard

within our profession by clinical research and broad consensus. That does not

mean that I necessarily reject Michael or Peter's opinions. However, it does

mean I would not suggest acting upon those opinions in terms of prescribing in

clinic. One simply never ever knows what's going to come back and bite you in

the ass.

 

In terms of Potentilla anserina, I don't know this plant's Chinese name. So I

don't know if it is in the Zhong Yao Da Ci Dian (Great Dictionary of Chinese

Medicinals). It may very well be. My guess is that, if it is, its functions and

uses are going to be similar to Bai Tou Weng. Therefore, it's going to be tough

making a CM argument for its inclusion in an altitude sickness formula unless

diarrhea is a symptom of altitude sickness. Having had altitude sickness myself,

I don't remember that.

 

Bottom line, my response to this thread (and numerous others) was prompted by my

desire to see members of our profession really act like doctors with all the

professional ethics and legal responsibilities that involves. In general,

responsibility means giving up some freedoms. It means accepting some voluntary

restraints on one's behavior. It's the difference between Mozart and a monkey

sitting at a piano. I suppose that's the real meta-issue which prompted me to

chime in.

 

Goin' to the East Coast tomorrow to visit NESA and NYCC. So off-line for a few

days.

[Guest guest]

Potentilla anserina is jue2 ma2 (ÏÏËã) -

 

CM: enters Sp/St, tonifies qi and blood, builds up the Spleen and Stomach,

generates fluids and alleviates thirst.

 

WM: strengthens cardiac function (among other things).

 

Consequently, this is potentially suitable for altitude sickness.

 

 

 

 

 

I would though be surprised if someone put this herb in such a formula

without some justification. Are we suggesting that there is a random herb in

this formula that has no ability to treat altitude sickness nor the pattern

that commonly causes it? This is hard to believe. However, Bob¡Çs point is

WELL taken. We should only prescribe things we understand!

 

 

 

However more importantly, with all herbs, including this one, there is an

immense amount of Western style research done in China, that can explain

such usages. If the basic CM info in e.g. MMIII, does not mention a usage,

does this mean we cannot use it for things that have been researched

(elsewhere)? For example, we can use 30g of bai jiang cao for many types of

insomnia. Many such things are not even in the zhong yao da ci dian, and are

not ¡Èstandard¡É CM, but many CM doctors use it in this manner, and

is

written about in Chinese literature. BTW - I have no idea if this usage of

BTW is in the ZYDCD.

 

 

 

However, I am no expert on the law, so are we saying that we can only

prescribe if our usage is inline with e.g. our MMIII says it can be used

for. IS there any legal documentation someone can present? What about if

chen and chen mentions it? What if the Chinese literature clearly discusses

it? I do not think language is a legal barrier. What if doctors in China are

using it in such a manner, based on cutting edge research, journal articles.

What if it just fits the CM pattern? I often use herbs that are based on

classical or pre-modern usages that are not listed in basic modern text

books. I also use some modern western research on Chinese herbs, although

rarely. Am I liable for either of these usages?

 

 

 

Bob brings up a interesting thread which I think should be explored more.

However, clearly Bob and others have translated articles that discuss

Western usage for herbs and formulas. Why should this herb or any other be

any different, especially in this situation where it fits the pattern.

 

 

 

Others¡Ç thoughts?

 

 

 

-

 

 

 

 

On Behalf Of Bob Flaws

Monday, July 13, 2009 9:38 AM

 

Re: Altitude Sickness-herbs and legal defense -for Bob

 

going to come back and bite you in the ass.

 

In terms of Potentilla anserina, I don't know this plant's Chinese name. So

I don't know if it is in the Zhong Yao Da Ci Dian (Great Dictionary of

Chinese Medicinals). It may very well be. My guess is that, if it is, its

functions and uses are going to be similar to Bai Tou Weng. Therefore, it's

going to be tough making a CM argument for its inclusion in an altitude

sickness formula unless diarrhea is a symptom of altitude sickness. Having

had altitude sickness myself, I don't remember that.

 

 

 

 

/09 17:54:00

 

 

 

 

[Guest guest]

Jason,

 

Excellent. Now it makes sense. What was your source?

[Guest guest]

The trusty old internet. J

 

 

 

-Jason

 

 

 

 

On Behalf Of Bob Flaws

Monday, July 13, 2009 12:49 PM

 

Re: Altitude Sickness-herbs and legal defense -for Bob

 

 

 

 

 

 

 

 

Jason,

 

Excellent. Now it makes sense. What was your source?

 

 

 

 

 

 

[Guest guest]

Bob and all,

 

Bob:

As for my CM descriptions of Western herbs, Western drugs, vitamins,

minerals, amino acids, etc., all of these are only my personal provisional

hypotheses. Until or unless these descriptions are reviewed, tested

empirically, and accepted by broad consensus within our profession, they

should all be taken with a large grain of salt. One person's opinion is

relatively meaningless. To date, I know of no published responses to any of

my hypotheses in this matter. As a profession, I don't think we've yet

reached that level of maturity. Far too many of us simply are not demanding

evidence for new ideas and practices. Similarly, Michael Tierra and Peter

Holmes' CM descriptions of Western herbs should also be taken as their

personal opinions as yet not verified and accepted as standard within our

profession by clinical research and broad consensus. That does not mean that

I necessarily reject Michael or Peter's opinions. However, it does mean I

would not suggest acting upon those opinions in terms of prescribing in

clinic. One simply never ever knows what's going to come back and bite you

in the ass.

 

Thomas:

As an author of a work such as discussed above (with another volume in

production now) I would like to take issue with some of these comments.

First, all of the material found in my book was reviewed by a number of

other professionals and comments given. This greatly enhanced the final

product, which btw I would neither consider truly final, nor absolute. I

very much welcome this type of debate, which is the sign of professional

maturity, in fact if you read my opening statements they are, from page xi

(Preface): " Thus the expression of the work herein is, in part, an

integration or fusion of East and West. I prefer, however, to see it more as

an alternate way of looking at much of the same herbal healing information.

Please note that some of the clinical data comes from my own or colleagues'

personal experience. Our data may differ somewhat from the currently

available literature. " Further, in the Introduction of on page 1:

" Classifying Western herbs into the chinese medical system is not easy task,

and I offer this book as a stepping-stone toward a more complete

understanding of how Westerh herbs can be classified according to the

Chinese medical paradigm. "

 

I have tried to encourage more discussion on this topic, but there is simply

not a lot of folks out there doing the work. So, for the record, if anyone

has any comments on my book or would be interested in reviewing upcoming

work please contact me off list! I would also welcome any debate on list.

 

The fact is that there is a lot of disagreement about a lot of information

(period). Whether, herbal or in other fields, this is the nature of our

imperfect humanate writing/thought process. And, I would certianly not

consider the Chinese materia medica (CMM) to be absolute, no matter the

author(s). The fact is that there are a number of herbs used in the

" standard " CMM that are used in other cultures for different uses. Who is

" right " and who is wrong? Is there any such thing? The Chinese don't have

the market cornered on herbal knowledge.

 

To Bob: As I am living in China I don't have access to any of the literature

you have published on CM descriptions of Western herbs and although I

remember seeing something you wrote on Hypericum perforatum (St. John's

Wort) I don't recall seeing anything else. If you would be willing to send

me such material I would be more than happy to comment on it and even submit

that for publication to any journal or your choosing. As I don't use Western

drugs and don't feel like I have enough experiecne with vitamins/minerals,

etc. I do not feel qualified to write on those substances.

 

In Good Health,

Thomas

 

 

Beijing, China

Author of " Western Herbs According to Traditional : A

Practitioners Guide "

Check out my blog: sourcepointherbs.blogspot.com

 

 

 

[Guest guest]

What is unique about the Chinese materia medica, especially when it

comes to formulas, is the huge amount of consensus over many centuries

and by many physicians. It is certainly a sign of repeatability and

clinical success when such formulas as gui zhi tang and xiao chai hu

tang can be shown to have repetitive results for similar patterns over

such a long historical period, despite the expected variability and

complexity built into the form (Chinese medicine).

 

I agree that the work needs to be done for herbal medicines in the

West, and that a local herbal culture of medicine needs to be

developed. However, we are just beginning, really, so we can make our

strokes in the sand and hope that others will follow in our generation

of herbalists' footsteps.

 

 

On Jul 13, 2009, at 11:27 PM, wrote:

 

> The fact is that there is a lot of disagreement about a lot of

> information

> (period). Whether, herbal or in other fields, this is the nature of

> our

> imperfect humanate writing/thought process. And, I would certianly not

> consider the Chinese materia medica (CMM) to be absolute, no matter

> the

> author(s). The fact is that there are a number of herbs used in the

> " standard " CMM that are used in other cultures for different uses.

> Who is

> " right " and who is wrong? Is there any such thing? The Chinese don't

> have

> the market cornered on herbal knowledge.

 

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

 

 

 

 

 

 

 

[Guest guest]

Thomas said:

The fact is that there is a lot of disagreement about a lot of information

(period). Whether, herbal or in other fields, this is the nature of our

imperfect humanate writing/thought process. And, I would certianly not

consider the Chinese materia medica (CMM) to be absolute, no matter the

author(s). The fact is that there are a number of herbs used in the

" standard " CMM that are used in other cultures for different uses. Who is

" right " and who is wrong? Is there any such thing? The Chinese don't have

the market cornered on herbal knowledge.

 

Trevor:

Yes there is a lot of various opinions that exist in the world about herbal use.

What it comes down to, really, is how we define ourselves to the public eye. If

we are assuming the name " Doctor " of Chinese herbal medicine, then we will want

to be sure that we are using the Chinese system of thought set up for the

medicinals that we prescribe. If you are labeling yourself as a western

herbalist, then use that system. Until there is a clear cut agreement between

the two, then there is going to be problems in mixing them, including legal

ones.

 

To practice Chinese herbal medicine here in British columbia, Canada, one must

be " Registered " with the College, which is Government appointed. Swaying too far

from what is defined by the registered title, opens up a lot of legal debate. I

personally do not think I would be protected in a court of law if I were to use

a text book, like your own, as a reference for a local herb I used in my

practice.

 

Perhaps a waiver from the patient declaring that they are aware that the mixing

of Chinese herbs with medicinals from other cultures is new and a work in

progress, but that they agree to this experiment...... Signed and dated.

 

Trevor

 

 

,

wrote:

>

> Bob and all,

>

> Bob:

> As for my CM descriptions of Western herbs, Western drugs, vitamins,

> minerals, amino acids, etc., all of these are only my personal provisional

> hypotheses. Until or unless these descriptions are reviewed, tested

> empirically, and accepted by broad consensus within our profession, they

> should all be taken with a large grain of salt. One person's opinion is

> relatively meaningless. To date, I know of no published responses to any of

> my hypotheses in this matter. As a profession, I don't think we've yet

> reached that level of maturity. Far too many of us simply are not demanding

> evidence for new ideas and practices. Similarly, Michael Tierra and Peter

> Holmes' CM descriptions of Western herbs should also be taken as their

> personal opinions as yet not verified and accepted as standard within our

> profession by clinical research and broad consensus. That does not mean that

> I necessarily reject Michael or Peter's opinions. However, it does mean I

> would not suggest acting upon those opinions in terms of prescribing in

> clinic. One simply never ever knows what's going to come back and bite you

> in the ass.

>

> Thomas:

> As an author of a work such as discussed above (with another volume in

> production now) I would like to take issue with some of these comments.

> First, all of the material found in my book was reviewed by a number of

> other professionals and comments given. This greatly enhanced the final

> product, which btw I would neither consider truly final, nor absolute. I

> very much welcome this type of debate, which is the sign of professional

> maturity, in fact if you read my opening statements they are, from page xi

> (Preface): " Thus the expression of the work herein is, in part, an

> integration or fusion of East and West. I prefer, however, to see it more as

> an alternate way of looking at much of the same herbal healing information.

> Please note that some of the clinical data comes from my own or colleagues'

> personal experience. Our data may differ somewhat from the currently

> available literature. " Further, in the Introduction of on page 1:

> " Classifying Western herbs into the chinese medical system is not easy task,

> and I offer this book as a stepping-stone toward a more complete

> understanding of how Westerh herbs can be classified according to the

> Chinese medical paradigm. "

>

> I have tried to encourage more discussion on this topic, but there is simply

> not a lot of folks out there doing the work. So, for the record, if anyone

> has any comments on my book or would be interested in reviewing upcoming

> work please contact me off list! I would also welcome any debate on list.

>

> The fact is that there is a lot of disagreement about a lot of information

> (period). Whether, herbal or in other fields, this is the nature of our

> imperfect humanate writing/thought process. And, I would certianly not

> consider the Chinese materia medica (CMM) to be absolute, no matter the

> author(s). The fact is that there are a number of herbs used in the

> " standard " CMM that are used in other cultures for different uses. Who is

> " right " and who is wrong? Is there any such thing? The Chinese don't have

> the market cornered on herbal knowledge.

>

> To Bob: As I am living in China I don't have access to any of the literature

> you have published on CM descriptions of Western herbs and although I

> remember seeing something you wrote on Hypericum perforatum (St. John's

> Wort) I don't recall seeing anything else. If you would be willing to send

> me such material I would be more than happy to comment on it and even submit

> that for publication to any journal or your choosing. As I don't use Western

> drugs and don't feel like I have enough experiecne with vitamins/minerals,

> etc. I do not feel qualified to write on those substances.

>

> In Good Health,

> Thomas

>

>

> Beijing, China

> Author of " Western Herbs According to Traditional : A

> Practitioners Guide "

> Check out my blog: sourcepointherbs.blogspot.com

>

>

>

[Guest guest]

Jason,

 

Yes, but where on the Internet? That's not a citation. I went several pages deep

in my own Internet search on this medicinal and did not come across this

description.

 

Reason I ask is because that description, although it seems spot-on in terms of

the formula under question, also seems very, very odd to me given everything

else I've read on the medicinal properties of this species. So I'd like to know

exactly who has stated this CM description in order to judge its validity. Is

this one person's idea or is this in a peer-reviewed source which suggests that

it is based on a consensus? These are important things we need to constantly be

asking. As a group, I think we are way to gullible.

 

Thanks in advance for the citation.

[Guest guest]

Thomas,

 

Sorry, I'm not aware of your work in this area. Since you have sought broad

professional consensus on your hypotheses, your work is obviously NOT included

in the works I was talking about. So no need to take exception. You're the model

of what we should be doing. However, even so, it takes a generation or more to

finally come to a standard consensus on new medicinals in CM. See Eric Brand's

recent blog at www.bluepoppy.com on the CM descriptions of the natures

(temperatures) of mango and even Zhi Shi (Fructus Immaturus Aurantii). Actually,

I think the title of the blog was something about eating fruits in the summer.

There are a number of other " recent " herb imports to China whose natures vary

from one book to another because they are so " new. "

 

As for sending you my own putative descriptions of vitamins, amino acids,

minerals, Western drugs, etc., the former are in The Dao of Healthy Eating and

the latter are in Integrative Pharmacology (co-authored by Greg Sperber). I

suggest you write Lori (lori), one of our CS reps, and tell her

that I said to send you " warehouse nine " copies of these two books. My

descriptions of Western herbs are in books that are no longer in print and don't

exist as digital files. (If they do, I don't know where they are.) Sorry. I'd

love some high-level Chinese feedback on these descriptions.

[Guest guest]

Trevor,

 

Your point is well taken. Since the Nurenburg Convention of the late 1940s and

it's various evolutions in the world of bioethics, there is broad consensus in

the international medical community that patients need to CONSENT to any

experimental treatment about which they have been duly INFORMED. I believe this

is an extension of Universal Bioethical Principle #4, Independence. (Sorry for

the all-caps, but I don't know how to italicize on this forum. Just trying to

emphasize these words and their technical/professional implications.)

 

The ethics of clinical medicine are quite different from the ethics of research.

I think what you are saying is that it is important AS CLINICIANS that we stay

within our professional standards of care. Part of that for me is using

medicinals I have been specifically trained to use or which I can learn about

from trusted, authoritative CM sources.

 

Interesting that you are a Canadian. As you know, the Health Canada Act requires

all CM herb companies selling in Canada to submit citations for all ingredients

in all formulas that are not standard formulas within CM. These citations must

substantiate why a medicinal has been used in a particular formula. There's a

huge amount of paperwork involved, and this has discouraged many Gringo

companies from selling in Canada since this law was enacted. However, as the

person at Blue Poppy who has had to fill out all the technical side of this

paperwork, the process has been very salutary to the clarity of my own thinking

and practice. At first I saw it as a big pain in the ass. But, once involved in

the doing of the work, I found it very helpful for deepening my own

understanding.

 

This is all about working in a more mature professional arena (which has both

its up- and downsides).

[Guest guest]

Bob,

I am unsure why you feel ¡°we¡±(on the CHA?) are ¡°way to gullible¡±? I

actually find most of us on the other side. We question most things, and look

for solid sources. I would like to hear your thoughts on this, so as to help

better understand your perception of our group.

Just to clarify, the information I presented is the standard herb info that can

be found on multiple free websites, at least 1 subscription peer reviewed

website (what I used), as well as the 2002 zhong yao da ci dian

(ÖÐÒ©´ó´Çµä£¬ÉϺ£¿Æѧ¼¼Êõ³ö°æÉçp.2606). I find all sources that I checked (over

4 now) to present the same basic info. However if we find some legitimate source

that contradicts what I presented, then we may have something to squawk about.

However, from what I can see, the information I presented is the mainstream

view.

Bob, I am curious though, what information you found from your internet search

that contradicts what was said, and the source where it was located. Do you

consider your source peer reviewed and a valid source?

-Jason

 

, " Bob Flaws " <bob wrote:

>

> Jason,

>

> Yes, but where on the Internet? That's not a citation. I went several pages

deep in my own Internet search on this medicinal and did not come across this

description.

>

> Reason I ask is because that description, although it seems spot-on in terms

of the formula under question, also seems very, very odd to me given everything

else I've read on the medicinal properties of this species. So I'd like to know

exactly who has stated this CM description in order to judge its validity. Is

this one person's idea or is this in a peer-reviewed source which suggests that

it is based on a consensus? These are important things we need to constantly be

asking. As a group, I think we are way to gullible.

>

> Thanks in advance for the citation.

>

[Guest guest]

I think the question comes down to who is going to finance this sort of process.

The profession, or those who the profession (via our patients) supports. We

don't have deep pockets to tap like the pharm industry because of intense

competition among our suppliers (vs pharm profits at 1000 %+), which is good at

keeping our prices low, but actually is problematic in the long term. 

We rely on volunteers, who always seem to be the same people, who are burned out

after 10 or more years, and we need suppliers (and colleges!) to support this

expansion. I hate to say it, but can you imagine old time OM folks saying that

they won't use vitamins, homeopathics, or whatever because they weren't Chinese?

The patients pattern that we are working with remains OM and the patients

themselves are in a Western country taking western drugs and supplements and

foods. We are stuck with that, but our medicine is made to maintain that level

of flexibility, probably due to the differences in Chinese food. It is all

observation. We need to develop some consensus as to how drugs actions and

supplements fit in our paradigm. Just because our tools and diagnostic processes

don't fit Western mindsets doesn't mean our field doesn't have the flexibility

to understand how their tools are utilized within our framework. We seriously

need to work on this.

David Molony

 

 

 

On Jul 13, 2009, at 11:37:32 AM, " Bob Flaws " <bob wrote:

 

As for my CM descriptions of Western herbs, Western drugs, vitamins, minerals,

amino acids, etc., all of these are only my personal provisional hypotheses.

Until or unless these descriptions are reviewed, tested empirically, and

accepted by broad consensus within our profession, they should all be taken with

a large grain of salt. One person's opinion is relatively meaningless. To date,

I know of no published responses to any of my hypotheses in this matter. As a

profession, I don't think we've yet reached that level of maturity. Far too many

of us simply are not demanding evidence for new ideas and practices. Similarly,

Michael Tierra and Peter Holmes' CM descriptions of Western herbs should also be

taken as their personal opinions as yet not verified and accepted as standard

within our profession by clinical research and broad consensus. That does not

mean that I necessarily reject Michael or Peter's opinions. However, it does

mean I would not suggest acting upon those opinions in terms of prescribing in

clinic. One simply never ever knows what's going to come back and bite you in

the ass.

 

 

 

[Guest guest]

In acknowledgement of Bob's statement " Michael Tierra and Peter Holmes' CM

descriptions of Western herbs should also be taken as their personal

opinions as yet not verified and accepted as standard within our profession

by clinical research and broad consensus. "

 

 

 

--- I agree with Bob. My book, Planetary Herbology, was intended to initiate

and point a direction which I see is now gathering momentum. Nor am I

deluded to think that I initiated this direction. I merely identified it as

a trend that must eventually transpire i.e. the integration of herbs from

around the world into the TCM model.

 

 

 

Such assignments of TCM energetics, meridians, actions, etc. Cannot and

should not be based on one person (me in this case) opinions. It needs to

evolve from the experience of many. While I consider Planetary Herbology a

seminal work on the subject. I believe that in the introduction I have

stated that it was intended to point a direction.

 

 

 

I've tried to initiate even a small forum of respected herbalists to form a

committee so to speak to discuss and mull over the issues of how non TCM

herbs fit into the TCM energetic model. So far this has not gone anywhere.

How I made the assignments: first I found that many of the more universally

available growing Western herbs are already at least partially classified -

at the time I drew on sources from the standard materia medica, Barefoot

doctor's manual and a wonderful series of books called Chinese Medical Herbs

of Hong Kong. I remember that one of the major breakthroughs for me was to

realize that the flavors or tastes in TCM are not all based on

organoleptical (sensory) experience but they are also used to further

describe the action of an herb. The most obvious example is the description

of ginseng as sweet. If you were to give ginseng to 20 average people on the

street, I hardly believe you would find one to identify it as sweet. It is

sweet primarily because of its properties. Of course, those of us used to

TCM concepts might identify sweetness in ginseng but based solely on sensory

experience it is a stretch. So the flavors are to a varying extent a further

elucidation of the properties and actions of an herb as much as they are a

sensory experience.

 

 

 

I think nowadays to many this may be obvious but when I wrote PH it was not.

The organ meridians were relatively simple because these usually related to

the function of the Western herbal properties. So an herb that is a laxative

would effect the colon, liver and/or GB.

 

 

 

What can't be discerned is given that an herbs like echinacea, plantain, red

clover clears heat - to what relative strength do these compare with herbs

such as scutellaria, lonicera, forsythia. That is if you had to reach for an

herb to clear heat would you trust the western herbs to be as strong and

effective as the TCM counterpart. Dosage plays a big part in all of this

because in general most Western herb doses tend to be lower and

non-specific.

 

 

 

Michael Tierra

 

 

 

 

 

 

[Guest guest]

David,

 

Can you please clarify your post. I am unclear what, exactly, you are

saying, but I am very interested.

 

Thomas

 

 

Beijing, China

Author of " Western Herbs According to Traditional : A

Practitioners Guide "

Check out my blog: sourcepointherbs.blogspot.com

 

 

 

[Guest guest]

Michael -

 

Your portrayal is how I have always seen your work, to point a direction. I

think that Thomas is extending upon that vital dialog. While there is no

official government committee resolution on the subject, the " creolization " of

Chinese medicine has been and will continue to be a feature of globalization.

 

As far as I am concerned, evidence based and consensus based opinion are subject

to a grain of salt as well. These questions all go towards a politics of

evidence: that is, who determines the truth and how it gets applied.

 

I took a group of students to Taiwan in 2000. While there, we observed the

Taiwanese equivalent of the FDA make a ruling to allow the inclusion of kava

kava in chai hu long gu mu li tang.

 

Warmly,

 

Will Morris

 

 

, " Michael Tierra " <mtierra wrote:

>

> In acknowledgement of Bob's statement " Michael Tierra and Peter Holmes' CM

> descriptions of Western herbs should also be taken as their personal

> opinions as yet not verified and accepted as standard within our profession

> by clinical research and broad consensus. "

>

>

>

> --- I agree with Bob. My book, Planetary Herbology, was intended to initiate

> and point a direction which I see is now gathering momentum. Nor am I

> deluded to think that I initiated this direction. I merely identified it as

> a trend that must eventually transpire i.e. the integration of herbs from

> around the world into the TCM model.

>

>

>

> Such assignments of TCM energetics, meridians, actions, etc. Cannot and

> should not be based on one person (me in this case) opinions. It needs to

> evolve from the experience of many. While I consider Planetary Herbology a

> seminal work on the subject. I believe that in the introduction I have

> stated that it was intended to point a direction.

>

>

>

> I've tried to initiate even a small forum of respected herbalists to form a

> committee so to speak to discuss and mull over the issues of how non TCM

> herbs fit into the TCM energetic model. So far this has not gone anywhere.

> How I made the assignments: first I found that many of the more universally

> available growing Western herbs are already at least partially classified -

> at the time I drew on sources from the standard materia medica, Barefoot

> doctor's manual and a wonderful series of books called Chinese Medical Herbs

> of Hong Kong. I remember that one of the major breakthroughs for me was to

> realize that the flavors or tastes in TCM are not all based on

> organoleptical (sensory) experience but they are also used to further

> describe the action of an herb. The most obvious example is the description

> of ginseng as sweet. If you were to give ginseng to 20 average people on the

> street, I hardly believe you would find one to identify it as sweet. It is

> sweet primarily because of its properties. Of course, those of us used to

> TCM concepts might identify sweetness in ginseng but based solely on sensory

> experience it is a stretch. So the flavors are to a varying extent a further

> elucidation of the properties and actions of an herb as much as they are a

> sensory experience.

>

>

>

> I think nowadays to many this may be obvious but when I wrote PH it was not.

> The organ meridians were relatively simple because these usually related to

> the function of the Western herbal properties. So an herb that is a laxative

> would effect the colon, liver and/or GB.

>

>

>

> What can't be discerned is given that an herbs like echinacea, plantain, red

> clover clears heat - to what relative strength do these compare with herbs

> such as scutellaria, lonicera, forsythia. That is if you had to reach for an

> herb to clear heat would you trust the western herbs to be as strong and

> effective as the TCM counterpart. Dosage plays a big part in all of this

> because in general most Western herb doses tend to be lower and

> non-specific.

>

>

>

> Michael Tierra

>

>

>

>

>

>