Guest guest Posted April 27, 2010 Report Share Posted April 27, 2010 Hi everyone, I have a patient who is on warfarin therapy for an increased risk of blood clot formation. The side effects and lifestyle guidelines associated with using the drug are too much for him and he'd like to try something else. Of course TCM has a huge collection of blood invigorating/stasis removing herbs to choose from, but I'm having a hard time finding data in English showing any of our popular remedies having specific anticoagulant effects that increase INR. There are plenty of studies showing Chinese herbs potentiating the anticoagulant effects of warfarin that result in an increased INR, but none that I can find using solely Chinese herbs. His wife is an MD and would like to be able to measure his INR as a method of proof that any remedy is working. I've checked the Chen books and PubMed but nothing so far. Any ideas? Thanks, Danny Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2010 Report Share Posted May 11, 2010 Hi Danny, Interesting question, did you find anything yet? Take a look at this study http://tiny.cc/hrk5r It's in Chinese with an English abstract. I can't cut and paste from the pdf. To summarize, 71 patients were split into groups A and B. Group A was given herbs (formula listed in Chinese with herbs in grams, prep and dosage) and warfarin. Group B was given herbs but no warfarin. Scroll down to Table 2 in the PDF (all the blood work values). The last row (酶原时间 (s)) is Prothrombin Time in seconds. Group A's PT increased from 9.5±3.8 to 18.2±4. Group B from 9.7±3.6 to 14±2.5. The authors didn't provide the lab's Mean PT or ISI which would have allowed us to calculate INR. But the change in PT in group B strongly suggests that these herbs will result in a favorable change in your patient's INR when used along side or in replacement of the warfarin. Let us know how it goes. Charlie , Danny Johnson <dj wrote:>> Hi everyone,> I have a patient who is on warfarin therapy for an increased risk of blood clot formation. The side effects and lifestyle guidelines associated with using the drug are too much for him and he'd like to try something else. Of course TCM has a huge collection of blood invigorating/stasis removing herbs to choose from, but I'm having a hard time finding data in English showing any of our popular remedies having specific anticoagulant effects that increase INR. There are plenty of studies showing Chinese herbs potentiating the anticoagulant effects of warfarin that result in an increased INR, but none that I can find using solely Chinese herbs. His wife is an MD and would like to be able to measure his INR as a method of proof that any remedy is working. I've checked the Chen books and PubMed but nothing so far. Any ideas?> > Thanks,> Danny Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2010 Report Share Posted May 11, 2010 Charlie or group, Can anyone out there easily translate the herbs and dosages and post them for us non-Chinese readers? Thanks, Neil Pregozen , " charlie_thomson_lac " <cthmsn wrote: > > Hi Danny, > Interesting question, did you find anything yet? > Take a look at this study http://tiny.cc/hrk5r > It's in Chinese with an English abstract. I can't cut and paste from the > pdf. To summarize, 71 patients were split into groups A and B. Group A > was given herbs (formula listed in Chinese with herbs in grams, prep and > dosage) and warfarin. Group B was given herbs but no warfarin. Scroll > down to Table 2 in the PDF (all the blood work values). The last row > (酶原时间 (s)) is Prothrombin Time in seconds. Group A's PT > increased from 9.5±3.8 to 18.2±4. Group B from 9.7±3.6 to > 14±2.5. > The authors didn't provide the lab's Mean PT or ISI which would have > allowed us to calculate INR. But the change in PT in group B strongly > suggests that these herbs will result in a favorable change in your > patient's INR when used along side or in replacement of the warfarin. > Let us know how it goes. > Charlie > > , Danny Johnson <dj@> > wrote:>> Hi everyone,> I have a patient who is on warfarin therapy for > an increased risk of blood clot formation. The side effects and > lifestyle guidelines associated with using the drug are too much for him > and he'd like to try something else. Of course TCM has a huge > collection of blood invigorating/stasis removing herbs to choose from, > but I'm having a hard time finding data in English showing any of our > popular remedies having specific anticoagulant effects that increase > INR. There are plenty of studies showing Chinese herbs potentiating the > anticoagulant effects of warfarin that result in an increased INR, but > none that I can find using solely Chinese herbs. His wife is an MD and > would like to be able to measure his INR as a method of proof that any > remedy is working. I've checked the Chen books and PubMed but nothing > so far. Any ideas?> > Thanks,> Danny > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2010 Report Share Posted May 11, 2010 Dr. Chen was at the Great River Symposium in 2009, where he delivered a presentation on TCM alternatives to drugs. From his handouts regarding " blood thinners " he lists Dan Shen and Chi Shao as having anti-coagulant effects; Dan Shen, Hong Hua and Chuan Xiong for anti-platelet effects; shui zhi, san leng, e zhu for thrombolytic effects; and of course the standard formulas for moving blood, are also listed. Unfortunately, no studies are referenced. Amadea Shakti , Danny Johnson <dj wrote: > > Hi everyone, > I have a patient who is on warfarin therapy for an increased risk of blood clot formation. The side effects and lifestyle guidelines associated with using the drug are too much for him and he'd like to try something else. Of course TCM has a huge collection of blood invigorating/stasis removing herbs to choose from, but I'm having a hard time finding data in English showing any of our popular remedies having specific anticoagulant effects that increase INR. There are plenty of studies showing Chinese herbs potentiating the anticoagulant effects of warfarin that result in an increased INR, but none that I can find using solely Chinese herbs. His wife is an MD and would like to be able to measure his INR as a method of proof that any remedy is working. I've checked the Chen books and PubMed but nothing so far. Any ideas? > > Thanks, > Danny > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2010 Report Share Posted May 11, 2010 I personally think that trying to duplicate drug effects with Chinese herbs is barking up the wrong tree. .. .apples and oranges. Huo xue/quickening blood medicinals and formulas have very different effects than powerful drugs such as wayfarin. On May 11, 2010, at 8:03 AM, amadeashakti wrote: > Dr. Chen was at the Great River Symposium in 2009, where he delivered a presentation on TCM alternatives to drugs. From his handouts regarding " blood thinners " he lists Dan Shen and Chi Shao as having anti-coagulant effects; Dan Shen, Hong Hua and Chuan Xiong for anti-platelet effects; shui zhi, san leng, e zhu for thrombolytic effects; and of course the standard formulas for moving blood, are also listed. Unfortunately, no studies are referenced. > > Amadea Shakti Chair, Department of Herbal Medicine Pacific College of Oriental Medicine San Diego, Ca. 92122 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2010 Report Share Posted May 11, 2010 Z'ev: I personally think that trying to duplicate drug effects with Chinese herbs is barking up the wrong tree. .. . Stephen: I couldn't agree more Stephen Woodley LAc -- http://www.fastmail.fm - The way an email service should be Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2010 Report Share Posted May 11, 2010 I also agree that looking for herbal substitutes for warfarin is inherently a flawed stategy. The question, however is not an uncomplicated one. First, we practitioners of Chinese medicine for the most part are viewed, unfortunately, as utilitizing a medicine that is still experimental and without supportive studies. As such, the legal, Western biomedical, and to some degree, the general establishment lean toward viewing our intervention in issues such as hypertension, congestive heart disease, and hyperlipidemia, as overstepping our bounds, and so to engage them in dialogue so as to consider a different paradigm I feel, at this point at least, would be most likely futile and possible provocative. If our patients come to us and ask us to support or substitute therapies with what we do, that's, of course, a different story, and can be very effective in a very short amount of time. Yet, if we do take upon ourselves such patients, there must be full disclosure of what they are taking, and they must be told that if they decide to go back on Western meds, that they tell us! I had an elderly patient who I treated for hypertension and dementia, who was doing incredibly well. Unfortunately, she was overseas, and because I wasn't able to follow up on her, I found out afterwards,  her nurse decided independently to restart giving her " prophylactically " a half a baby aspirin twice daily, while continuing to also take a formula that contained Dang Gui and Dan Shen. She died of internal bleeding!    Second, though Professor Chen does list many herbs with anticoagulant properties in his very extensive herb book, I agree with Z'ev's comment that this approach is bark up the wrong tree. I believe that we need to educate both our patients as well as our Western Biomedical, and Naturapathic colleagues to think differently-- to not treat symptoms but rather patients according to their complex patterns, treating the whole patient from the root.  We shouldn't take the approach of thinning the blood, but rather strengthening and invigorating the blood, viewing herbs and medicinal substances (including phamaceuticals!) from that perspective. And we need to view these substances according to their properties, temperatures and Channels.  This is the essence of the idea to " first do no harm. "   Any substance which simply thins blood viscosity without strengthening and (to the appropriate degree) moving it, causes damage and bleeding and is frought with dangerous side effects, as my story above illustrates.  respectfully,   ________________________________ <zrosenbe Tue, May 11, 2010 10:36:02 AM Re: Re: Herbal substitute for warfarin  I personally think that trying to duplicate drug effects with Chinese herbs is barking up the wrong tree. .. .apples and oranges. Huo xue/quickening blood medicinals and formulas have very different effects than powerful drugs such as wayfarin. On May 11, 2010, at 8:03 AM, amadeashakti wrote: > Dr. Chen was at the Great River Symposium in 2009, where he delivered a presentation on TCM alternatives to drugs. From his handouts regarding " blood thinners " he lists Dan Shen and Chi Shao as having anti-coagulant effects; Dan Shen, Hong Hua and Chuan Xiong for anti-platelet effects; shui zhi, san leng, e zhu for thrombolytic effects; and of course the standard formulas for moving blood, are also listed. Unfortunately, no studies are referenced. > > Amadea Shakti Chair, Department of Herbal Medicine Pacific College of Oriental Medicine San Diego, Ca. 92122 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2010 Report Share Posted May 11, 2010 I agree Z'ev. Not only that, but warfarin does not cure blood stasis. One can be taking warfarin, plavix, etc and still have blood stasis s/s that do not resolve until blood stasis medicinals are used. -Steve On May 11, 2010, at 12:36 PM, wrote: > I personally think that trying to duplicate drug effects with Chinese herbs is barking up the wrong tree. .. .apples and oranges. Huo xue/quickening blood medicinals and formulas have very different effects than powerful drugs such as wayfarin. > > > On May 11, 2010, at 8:03 AM, amadeashakti wrote: > > > Dr. Chen was at the Great River Symposium in 2009, where he delivered a presentation on TCM alternatives to drugs. From his handouts regarding " blood thinners " he lists Dan Shen and Chi Shao as having anti-coagulant effects; Dan Shen, Hong Hua and Chuan Xiong for anti-platelet effects; shui zhi, san leng, e zhu for thrombolytic effects; and of course the standard formulas for moving blood, are also listed. Unfortunately, no studies are referenced. > > > > Amadea Shakti > > > Chair, Department of Herbal Medicine > Pacific College of Oriental Medicine > San Diego, Ca. 92122 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2010 Report Share Posted May 11, 2010 Hi Neil, base formula: dang gui 15 g chuan xiong 12 g tao ren 12 g hong hua 10 g wu shao she 20 g chai hu 12 g niu xi 15 g mu gua 20 g for blood stasis add: ji xue teng 30 g dang pi 15 g tu yuan 15 g for damp evil add: fang yi 12 g ze xie 12 g yi mu cao 15 g for tendency toward yin xu ( & #20559;pian1 yin1 xu1) add: sheng di 20 g xuan shen 15 g mai dong 15 g hua fen 20 g Put herbs into pot, add 500 to 800 mL water, bring to boil at high heat, then lower heat to simmer 30 mins, down to about 200 mL. 1 batch of herbs per day, each batch to be cooked twice, drink in 2 to 4 portions. [i take this to mean cook the herbs twice for a total of 400 mL. Then drink this 400 mL each day, either as as 200 mL BID or 100 mL QID, or in thirds.] 6 days is one course of treatment. Stop one day, the take next course of treatment [another 6 days of herbs]. According to the patient's condition, can add low molecular dextran or " 706 blood plasma substitute " [hydroxyethyl starch] and chuan xiong qin injection or compound prescription of IV drip of dan shen. Before and after each course of therapy, measure and record limb circumference, reexamine blood viscosity, PT, FN. Charlie , " neil " <npregozen wrote: > > Charlie or group, > > Can anyone out there easily translate the herbs and dosages and post them for us non-Chinese readers? > > Thanks, > Neil Pregozen > > , " charlie_thomson_lac " <cthmsn@> wrote: > > > > Hi Danny, > > Interesting question, did you find anything yet? > > Take a look at this study http://tiny.cc/hrk5r > > It's in Chinese with an English abstract. I can't cut and paste from the > > pdf. To summarize, 71 patients were split into groups A and B. Group A > > was given herbs (formula listed in Chinese with herbs in grams, prep and > > dosage) and warfarin. Group B was given herbs but no warfarin. Scroll > > down to Table 2 in the PDF (all the blood work values). The last row > > (酶原时间 (s)) is Prothrombin Time in seconds. Group A's PT > > increased from 9.5±3.8 to 18.2±4. Group B from 9.7±3.6 to > > 14±2.5. > > The authors didn't provide the lab's Mean PT or ISI which would have > > allowed us to calculate INR. But the change in PT in group B strongly > > suggests that these herbs will result in a favorable change in your > > patient's INR when used along side or in replacement of the warfarin. > > Let us know how it goes. > > Charlie > > > > , Danny Johnson <dj@> > > wrote:>> Hi everyone,> I have a patient who is on warfarin therapy for > > an increased risk of blood clot formation. The side effects and > > lifestyle guidelines associated with using the drug are too much for him > > and he'd like to try something else. Of course TCM has a huge > > collection of blood invigorating/stasis removing herbs to choose from, > > but I'm having a hard time finding data in English showing any of our > > popular remedies having specific anticoagulant effects that increase > > INR. There are plenty of studies showing Chinese herbs potentiating the > > anticoagulant effects of warfarin that result in an increased INR, but > > none that I can find using solely Chinese herbs. His wife is an MD and > > would like to be able to measure his INR as a method of proof that any > > remedy is working. I've checked the Chen books and PubMed but nothing > > so far. Any ideas?> > Thanks,> Danny > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2010 Report Share Posted May 12, 2010 My Grandfather was on Warfarin when I was caring for him. The doctor's office supplied us with some literature on the drug and it actually listed quite a few herbs that one should be careful with. TCM herbs included Dang Gui and Gan Cao. I gave him some formulas at a fairly light dose that included both of these drugs and I noticed no adverse effects. Still, it is a very squirrely drug. He was going to a " Coagulation Clinic " weekly for a while to have his levels checked and they had a hard time keeping them stable. I would be very very careful when treating someone on Warfarin with herbs. On another note, when I was a student a Naturopath teacher mentioned natto extract as having very strong clot-busting/preventing effects. Natto is a fermented soy product eaten in Japan. I found several abstracts online. Here's one: http://www.ncbi.nlm.nih.gov/pubmed/12620531?dopt=Abstract It's great food if you can get used to the taste. Most Japanese supermarkets in the states sell frozen natto. I just had some for breakfast! Carl acupuncturecarl.blogspot.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2010 Report Share Posted May 12, 2010 On May 12, 2010, at 7:52 PM, carlstimson wrote: > > On another note, when I was a student a Naturopath teacher mentioned natto extract as having very strong clot-busting/preventing effects. Natto is a fermented soy product eaten in Japan. I found several abstracts online. Here's one: > http://www.ncbi.nlm.nih.gov/pubmed/12620531?dopt=Abstract > It's great food if you can get used to the taste. Most Japanese supermarkets in the states sell frozen natto. I just had some for breakfast! > > Carl > acupuncturecarl.blogspot.com > > __ > Ewww. I've had some Japanese friends who scramble natto w/ raw egg and eat it that way. Double ewww. Now why would you want to do that to yourself, when you can get nattokinase in pill form, not too expensive. Unless you're in training for a trip to Japan - you'll really impress 'em! ann Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2010 Report Share Posted May 12, 2010 Yes, our clinical supervisor in school prescribed a dan shen containing formula to a patient on warfarin. The patient had to be admitted to the hospital a few days later due to severe internal bleeding. This is a risky drug to experiment with. What makes Danny's original question interesting to me is the idea of using the PT/INR test in conjunction with . It's not about finding an herbal substitute for warfarin. Do the standard diagnosis and treatment. A favorable change in INR is a positive " side effect " of the CM treatment, which shows that the therapy is " working " from a western medical perspective. It may not be replicable or may not even be a valid protocol for other patients, but it could improve the quality of life for this particular patient. And it's an ideal situation that the patient and his MD wife are willing to give it a try and to do the necessary monitoring for safety and effectiveness (from a WM perspective). I would otherwise not be experimenting with warfarin / herbs. Not from a philosophical perspective of not using herbs as substitutes for pharmaceuticals, but for safety and liability reasons. BTW, ITM has a relevant article on warfarin and mentions natto at the end. http://www.itmonline.org/arts/warfarin.htm " Unlike warfarin, which has the focus on preventing clotting, natto-kinase appears to have the primary effect of breaking up clots, via a fibrinolytic activity; it interacts with the plasminogen system, by reducing the PAI level and increasing the amount of plasmin. " I just had some yesterday for lunch as well , " carlstimson " <carlstimson wrote: > > My Grandfather was on Warfarin when I was caring for him. The doctor's office supplied us with some literature on the drug and it actually listed quite a few herbs that one should be careful with. TCM herbs included Dang Gui and Gan Cao. I gave him some formulas at a fairly light dose that included both of these drugs and I noticed no adverse effects. Still, it is a very squirrely drug. He was going to a " Coagulation Clinic " weekly for a while to have his levels checked and they had a hard time keeping them stable. I would be very very careful when treating someone on Warfarin with herbs. > > On another note, when I was a student a Naturopath teacher mentioned natto extract as having very strong clot-busting/preventing effects. Natto is a fermented soy product eaten in Japan. I found several abstracts online. Here's one: > http://www.ncbi.nlm.nih.gov/pubmed/12620531?dopt=Abstract > It's great food if you can get used to the taste. Most Japanese supermarkets in the states sell frozen natto. I just had some for breakfast! > > Carl > acupuncturecarl.blogspot.com > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2010 Report Share Posted May 13, 2010 John Chen says in his seminars to be very cautious about mixing coumadin derivatives ie Warfarin, Heparin etc. with blood moving medicinals, since people have lost their license over this and people have had serious complications due to negligence. Dang gui is also something to be careful with, since it naturally contains coumarins. Any other herbs that aren't in the " Blood moving " category, we should also be cautious about? K On Wed, May 12, 2010 at 8:17 PM, charlie_thomson_lac <cthmsnwrote: > > > Yes, our clinical supervisor in school prescribed a dan shen containing > formula to a patient on warfarin. The patient had to be admitted to the > hospital a few days later due to severe internal bleeding. This is a risky > drug to experiment with. > > What makes Danny's original question interesting to me is the idea of using > the PT/INR test in conjunction with . It's not about finding > an herbal substitute for warfarin. Do the standard > diagnosis and treatment. A favorable change in INR is a positive " side > effect " of the CM treatment, which shows that the therapy is " working " from > a western medical perspective. It may not be replicable or may not even be a > valid protocol for other patients, but it could improve the quality of life > for this particular patient. And it's an ideal situation that the patient > and his MD wife are willing to give it a try and to do the necessary > monitoring for safety and effectiveness (from a WM perspective). I would > otherwise not be experimenting with warfarin / herbs. Not from a > philosophical perspective of not using herbs as substitutes for > pharmaceuticals, but for safety and liability reasons. > > BTW, ITM has a relevant article on warfarin and mentions natto at the end. > http://www.itmonline.org/arts/warfarin.htm " Unlike warfarin, which has the > focus on preventing clotting, natto-kinase appears to have the primary > effect of breaking up clots, via a fibrinolytic activity; it interacts with > the plasminogen system, by reducing the PAI level and increasing the amount > of plasmin. " I just had some yesterday for lunch as well > > > --- In <%40>, > " carlstimson " <carlstimson wrote: > > > > My Grandfather was on Warfarin when I was caring for him. The doctor's > office supplied us with some literature on the drug and it actually listed > quite a few herbs that one should be careful with. TCM herbs included Dang > Gui and Gan Cao. I gave him some formulas at a fairly light dose that > included both of these drugs and I noticed no adverse effects. Still, it is > a very squirrely drug. He was going to a " Coagulation Clinic " weekly for a > while to have his levels checked and they had a hard time keeping them > stable. I would be very very careful when treating someone on Warfarin with > herbs. > > > > On another note, when I was a student a Naturopath teacher mentioned > natto extract as having very strong clot-busting/preventing effects. Natto > is a fermented soy product eaten in Japan. I found several abstracts online. > Here's one: > > http://www.ncbi.nlm.nih.gov/pubmed/12620531?dopt=Abstract > > It's great food if you can get used to the taste. Most Japanese > supermarkets in the states sell frozen natto. I just had some for breakfast! > > > > Carl > > acupuncturecarl.blogspot.com > > > > > -- "" www.tcmreview.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2010 Report Share Posted May 13, 2010 Keep in mind that Western medicine warns about fluctuating the amount of intake of green vegetables. -Jason On Behalf Of Thursday, May 13, 2010 5:29 AM Re: Re: Herbal substitute for warfarin John Chen says in his seminars to be very cautious about mixing coumadin derivatives ie Warfarin, Heparin etc. with blood moving medicinals, since people have lost their license over this and people have had serious complications due to negligence. Dang gui is also something to be careful with, since it naturally contains coumarins. Any other herbs that aren't in the " Blood moving " category, we should also be cautious about? K Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2010 Report Share Posted May 13, 2010 On Thu, May 13, 2010 at 4:29 AM, <johnkokko wrote: > > Any other herbs that aren't in the " Blood moving " category, we should also > be cautious about? > > K > Many of the herbs that are described as hepato-protective can lower liver enzymes. At that point, the speed at which the liver metabolizes a drug is slowed potentially leading to a change in the amount of drug that is found in the blood stream. This process is identical to the affect that grapefruit has on the liver. Another issue, though I have yet to find any clinical examples of this, is herbs for either diarrhea or constipation. If herbs cause the intestinal peristalsis to speed up (to treat constipation) or slow down (to treat diarrhea), the amount of time in which a drug is available in the intestines to be absorbed can be shortened or lengthened leading to unforeseen changes in bloodstream concentrations of a given drug. -al. -- , DAOM Pain is inevitable, suffering is optional. http://twitter.com/algancao Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2010 Report Share Posted May 14, 2010 , <johnkokko wrote: > > John Chen says in his seminars to be very cautious about mixing coumadin > derivatives ie Warfarin, Heparin etc. with blood moving medicinals, since > people have lost their license over this and people have had serious > complications due to negligence. That's interesting because he used to say that he uses herbs with coumadin all the time and hasn't had a problem (that was a long time ago though) as long as you use careful monitoring. I followed that advice and just use a small dose until the patient gets their next INR / PT and then make sure it's playing nice. If I had a patient who did not have their clotting under control, I just follow common sense and avoid blood moving herbs or use very small doses and request they have their next blood test in a week. I haven't had a bad outcome yet and rarely seen large changes in clotting when we up the doses to normal levels that require much other than slightly lowering the coumadin (dictated by the PCP). Generally, now that Plavix is on the market you don't see as many patients on coumadin and I think plavix plays more 'nicely' with others. Geoff Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.