Herbs and dosages

[Guest guest]

Hi, I am still getting my feet wet as a new practitioner prescribing

formulas outside of the school clinic, so please forgive me for this

seemingly simple question: I seem pretty comfortable with my ability

to diagnose, and relatively comfortable with my ability to choose

appropriate herbs, but lacking confidence in my ability to know what

dosages to use for each herb.

 

Let me give an example: Let's say that I was prescribing a formula

with Wu Yao in it. Let's say my main focus was to clear dampcold in

the lower jiao, but I wanted to add some Dang Gui to protect the

blood from the drying herbs. On the one hand I would think that I

should have a higher dose of Wu Yao than of Dang Gui because clearing

dampcold is my main focus. But on the other hand, when I look in my

herbal books I see that Dang Gui is given somewhere around 10 to 20

grams a day, whereas Wu Yao is prescribed at somewhere around 3 to 5

grams a day (this is a guess--I'm at home and my books are at my

clinic). So from that point of view I think that I should prescribe

a higher dose of Dang Gui. Which is the more accurate way to

prescribe?

 

Advice anyone?

 

Thanks a million, Laura

[Guest guest]

, " heylaurag " <heylaurag@h...> wrote:

But on the other hand, when I look in my

> herbal books I see that Dang Gui is given somewhere around 10 to 20

> grams a day, whereas Wu Yao is prescribed at somewhere around 3 to 5

> grams a day (this is a guess--I'm at home and my books are at my

> clinic). So from that point of view I think that I should prescribe

> a higher dose of Dang Gui. Which is the more accurate way to

> prescribe?

>

 

Laura

 

Dosage is relative to dose range. However glancing through Sionneau's works, I

find

entries for both dang gui and wu yao at 9 g per day. In Bensky, the dose range

of wu yao

is 3-9 and dang gui 3-15. Let that be your guide. I rarely use more than 9

grams per day

of DG. I rarely use wu yao, but if I used it for shan qi pain, I could easily

see going to 9.

But the point is that 9 grams of wu yao is full strength (according to Bensky)

and 9 grams

of dang gui is 60% of full strength (9 of 15 is 60%). That is a significant

difference despite

doses being the same. That is how you should think about herbs, with the dose

you are

using as a % of total potency of the maximum dose. Thus 9 grams of huang lian

is far

stronger at heat clearing than 9 grams of shu di huang is at blood building,

since 9 gra,ms

is the low end of the range for shu di and the upper for huang lian.

 

[Guest guest]

 

 

Nice way of putting this. I like it.

 

Bob

[Guest guest]

Hi Todd---I agree, you summed up the idea well. But...um....I'm

still a bit confused. If you are wanting to clear something like

dampheat or dampcold but preserve the yin and/or blood do you use a

higher dose of the clearing herbs even though they are generally

prescribed at a lower dose? I think that is the case. Maybe this is

a dumb question....

 

Laura

 

 

 

 

, " Bob Flaws "

<pemachophel2001> wrote:

>

>

> Nice way of putting this. I like it.

>

> Bob

[Guest guest]

Laura,

 

Prescribing herbs is a lot trickier than prescribing acupoints, because there is

a bit more to consider here. It is here that Eight Principles Diagnosis and

Zang Fu Diagnosis becomes more important in your herbal prescription, because

they determine which herb, among those with similar indications, is more

appropriate and the dosage of the herb. Once you have nailed the patient's

symptoms according to Eight Principle Diagnosis, you can determine whether you

should use herbs with hot or cold properties. Zang Fu Diagnosis points you to

herbs that's indicated for particular channel(s) thus eliminating a few more

herbs with similar functions. Let's say for lower jiao coldness. I would go

with Fu Zi rather than Wu Yao even though Wu Yao's ability to clear coldness is

better than Fu Zi, because Fu Zi is indicated for kidney channels which is

associated with the lower jiao and Wu Yao is not indicated for any of the

channels (heart, liver, and spleen) associated with the lower jiao.

Consideration of dosage is pointless if you do not have the right herb.

 

As for dosage, your best clues come from your observations of your patient's

biorhythm over the course of the treatment and your experiences in treating the

particular diseases or discomforts. There is one more thing to consider though.

As you know, some of the herbs in the TCM Materia Medica is extremely poisonous

like Fu Zi, Wu Yao, and Ban Xia. Incidently, assasins in the ancient times used

to kill their victims by using arrow dipped in Wu Yao extract to make sure the

job is done correctly. That is why the dosage for these poinsonous herbs are so

low. For Wu Yao it is 3 to 9 g and should be reduced to 1 to 2 g if you are

using it as ingredient for medicinal powder or medicinal wine. When using herbs

like these for treatment, always use the lowest dosage as indicated in the

dosage range and up the dosage ever so slightly ONLY if needed. A little bit of

them goes a long way for thses poison ones. So, Wu Yao can never be in a higher

dosage than Dang Gui. Be very careful.

 

Ming

 

heylaurag <heylaurag wrote:

Hi, I am still getting my feet wet as a new practitioner prescribing

formulas outside of the school clinic, so please forgive me for this

seemingly simple question: I seem pretty comfortable with my ability

to diagnose, and relatively comfortable with my ability to choose

appropriate herbs, but lacking confidence in my ability to know what

dosages to use for each herb.

 

Let me give an example: Let's say that I was prescribing a formula

with Wu Yao in it. Let's say my main focus was to clear dampcold in

the lower jiao, but I wanted to add some Dang Gui to protect the

blood from the drying herbs. On the one hand I would think that I

should have a higher dose of Wu Yao than of Dang Gui because clearing

dampcold is my main focus. But on the other hand, when I look in my

herbal books I see that Dang Gui is given somewhere around 10 to 20

grams a day, whereas Wu Yao is prescribed at somewhere around 3 to 5

grams a day (this is a guess--I'm at home and my books are at my

clinic). So from that point of view I think that I should prescribe

a higher dose of Dang Gui. Which is the more accurate way to

prescribe?

 

Advice anyone?

 

Thanks a million, Laura

[Guest guest]

, " heylaurag " <heylaurag@h...> wrote:

> Hi Todd---I agree, you summed up the idea well. But...um....I'm

> still a bit confused. If you are wanting to clear something like

> dampheat or dampcold but preserve the yin and/or blood do you use a

> higher dose of the clearing herbs even though they are generally

> prescribed at a lower dose? I think that is the case. Maybe this is

> a dumb question....

>

> Laura

 

Laura

 

The herbs that address your most important treatment principles will usually be

dosed

closer to the upper end of their dose range. In your example, I would use herbs

that clear

dampheat in stronger doses than those that preserve yin blood. You just want to

preserve

yin blood, not worsen dampness. This does not mean you go above or below the

normal

dose range of either herb.

 

For example, you could prescribe huang lian at 2 grams per day when a

dysmneorrhea patient with liver depression heat complains of insomnia, which

you

surmise to be due to harassing the heart. The base formula, say a modified jia

wei xiao

yao san, might also have 9 grams of dang gui since the patient's CC is

dysmenorrhea. But

if you have dampheat vaginitis or diarrhea as the CC, you might use 9 grams of

huang lian

and cut the dang gui to 3 or 6, if still indicated, due to concern over its

warming,

moistening nature.

 

[Guest guest]

Chinese Medicine , " Ming H. Lee "

<aceqihealer>

wrote:

> Let's say for lower jiao coldness. I would go with Fu Zi rather than Wu Yao

even though

Wu Yao's ability to clear coldness is better than Fu Zi, because Fu Zi is

indicated for kidney

channels which is associated with the lower jiao and Wu Yao is not indicated for

any of the

channels (heart, liver, and spleen) associated with the lower jiao.

> Consideration of dosage is pointless if you do not have the right herb.

>

> As you know, some of the herbs in the TCM Materia Medica is extremely

poisonous like

Fu Zi, Wu Yao, and Ban Xia.

>

 

 

are we talking about the same Wu Yao? Rx Lindera, the one that's in Suo Quan

Wan/Shut

the Sluice pill or Tian Tai Wu Yao San? AFAIK Wu Yao enters Lu, SP, K & UB and

is

commonly used for lower jiao problems like cold shan and frequent urination.

I've never

heard anything about it being particularly toxic... not saying you're wrong but

wondering if

you're thinking of a different herb.

 

robert hayden

[Guest guest]

Thank you that was very helpful. What you said about using the

upper end of the dose for the herb that clears cold or heat and the

lower end of the dose of the herb that tonifies (if you are focusing

on clearing heat or cold) sealed it into my head.. That's just the

kind of clear advice I was looking for. Thank you!!!

 

Laura

 

 

 

, " "

wrote:

> , " heylaurag "

<heylaurag@h...> wrote:

> > Hi Todd---I agree, you summed up the idea well. But...um....I'm

> > still a bit confused. If you are wanting to clear something like

> > dampheat or dampcold but preserve the yin and/or blood do you use

a

> > higher dose of the clearing herbs even though they are generally

> > prescribed at a lower dose? I think that is the case. Maybe

this is

> > a dumb question....

> >

> > Laura

>

> Laura

>

> The herbs that address your most important treatment principles

will usually be dosed

> closer to the upper end of their dose range. In your example, I

would use herbs that clear

> dampheat in stronger doses than those that preserve yin blood. You

just want to preserve

> yin blood, not worsen dampness. This does not mean you go above or

below the normal

> dose range of either herb.

>

> For example, you could prescribe huang lian at 2 grams per day when

a

> dysmneorrhea patient with liver depression heat complains of

insomnia, which you

> surmise to be due to harassing the heart. The base formula, say a

modified jia wei xiao

> yao san, might also have 9 grams of dang gui since the patient's CC

is dysmenorrhea. But

> if you have dampheat vaginitis or diarrhea as the CC, you might use

9 grams of huang lian

> and cut the dang gui to 3 or 6, if still indicated, due to concern

over its warming,

> moistening nature.

>

 

[Guest guest]

Hi Ming,

 

Thanks so much for your response. I think I didn't make myself very

clear---I actually was just throwing those herbs out as an example,

not because I am actually using them. Let me try to say the question

in a more clear way:

 

If your focus is to clear out pathogens such as dampcold or dampheat

etc., but you also want to protect the blood or yin, do you prescribe

a higher dose of the clearing herbs even though the blood/yin tonics

are traditionally prescribed in higher daily doses?

 

I think that Long Dan Xie Gan Tang is a good example because it is

being used for dampheat but it has Sheng Di Huang and Dang Gui in

it.

 

Thanks!

 

Laura

 

 

 

 

Chinese Medicine , " Ming H. Lee "

<aceqihealer> wrote:

> Laura,

>

> Prescribing herbs is a lot trickier than prescribing acupoints,

because there is a bit more to consider here. It is here that Eight

Principles Diagnosis and Zang Fu Diagnosis becomes more important in

your herbal prescription, because they determine which herb, among

those with similar indications, is more appropriate and the dosage of

the herb. Once you have nailed the patient's symptoms according to

Eight Principle Diagnosis, you can determine whether you should use

herbs with hot or cold properties. Zang Fu Diagnosis points you to

herbs that's indicated for particular channel(s) thus eliminating a

few more herbs with similar functions. Let's say for lower jiao

coldness. I would go with Fu Zi rather than Wu Yao even though Wu

Yao's ability to clear coldness is better than Fu Zi, because Fu Zi

is indicated for kidney channels which is associated with the lower

jiao and Wu Yao is not indicated for any of the channels (heart,

liver, and spleen) associated with the lower jiao.

> Consideration of dosage is pointless if you do not have the right

herb.

>

> As for dosage, your best clues come from your observations of your

patient's biorhythm over the course of the treatment and your

experiences in treating the particular diseases or discomforts.

There is one more thing to consider though. As you know, some of the

herbs in the TCM Materia Medica is extremely poisonous like Fu Zi, Wu

Yao, and Ban Xia. Incidently, assasins in the ancient times used to

kill their victims by using arrow dipped in Wu Yao extract to make

sure the job is done correctly. That is why the dosage for these

poinsonous herbs are so low. For Wu Yao it is 3 to 9 g and should be

reduced to 1 to 2 g if you are using it as ingredient for medicinal

powder or medicinal wine. When using herbs like these for treatment,

always use the lowest dosage as indicated in the dosage range and up

the dosage ever so slightly ONLY if needed. A little bit of them

goes a long way for thses poison ones. So, Wu Yao can never be in a

higher dosage than Dang Gui. Be very careful.

>

> Ming

>

> heylaurag <heylaurag@h...> wrote:

> Hi, I am still getting my feet wet as a new practitioner

prescribing

> formulas outside of the school clinic, so please forgive me for

this

> seemingly simple question: I seem pretty comfortable with my

ability

> to diagnose, and relatively comfortable with my ability to choose

> appropriate herbs, but lacking confidence in my ability to know

what

> dosages to use for each herb.

>

> Let me give an example: Let's say that I was prescribing a formula

> with Wu Yao in it. Let's say my main focus was to clear dampcold

in

> the lower jiao, but I wanted to add some Dang Gui to protect the

> blood from the drying herbs. On the one hand I would think that I

> should have a higher dose of Wu Yao than of Dang Gui because

clearing

> dampcold is my main focus. But on the other hand, when I look in

my

> herbal books I see that Dang Gui is given somewhere around 10 to 20

> grams a day, whereas Wu Yao is prescribed at somewhere around 3 to

5

> grams a day (this is a guess--I'm at home and my books are at my

> clinic). So from that point of view I think that I should

prescribe

> a higher dose of Dang Gui. Which is the more accurate way to

> prescribe?

>

> Advice anyone?

>

> Thanks a million, Laura

[Guest guest]

Chinese Medicine , " heylaurag "

<heylaurag@h...>

wrote:

 

>

> If your focus is to clear out pathogens such as dampcold or dampheat

> etc., but you also want to protect the blood or yin, do you prescribe

> a higher dose of the clearing herbs even though the blood/yin tonics

> are traditionally prescribed in higher daily doses?

>

> I think that Long Dan Xie Gan Tang is a good example because it is

> being used for dampheat but it has Sheng Di Huang and Dang Gui in

> it.

>

 

IMHO this is a very complicated question and there's no simple answer. The

quick answer

is that the chief herbs generally get a relatively higher dosage and the

assistants and

envoys relatively lower. " Relatively " meaning lower in the dosage range; there

are all kinds

of reasons why standard dosages are written as they are -- minerals are denser

and

heavier than aerial parts of plants, for example, and some herbs are very toxic

and can

only be prescribed in small amounts. Some herbs have very different effects in

lower vs

higher dosages.

 

Also, to address your example, how much damp-heat is present vs how much are you

worried about protecting from damage to Yin in a given patient -- are they

already

somewhat Yin deficient or are you anticipating a protracted course of this

particular

formula, these are some things that would factor into it. IMHO the most basic

thing is to

keep in mind the relative strength of the Correct Qi vs the Pathogenic Qi.

 

You already sort of answered your own question in giving your LDXGT example.

The best

way is to study prescriptions, and if possible spend time with a more

experienced

herbalist. Prescription study is a lifetime endeavor if you really want to be

good at it (I for

one cannot claim that I am anything more than barely competent). Even assuming

your

diagnosis and tx principles are correct, you may still have to adjust the dosage

as you go

along. I started my TCM studies with an herbalist of 30+ years experience and I

saw times

when he had to tell the patient to come back with their remaining bags of herbs

so he

could pull stuff out and add other stuff.

 

The fact that you are asking this question, though, is a sign that you have the

prerequisite

to being a really good herbalist -- a strong desire to learn. Best of luck to

you in your

practice.

 

robert hayden

[Guest guest]

re: herbs and dosages - I'm still a student myself, so others obviously can

offer more than I can. But I thought I could pass along two recommendations

from my last herbal teacher. She said: 1) start with a classical formula and

then add and subtract (rather than just putting together a lot of single herbs

based on their properties) and 2) check standard dosages from more than one

source. This I took to mean don't only look in Bensky; check other sources as

well.

 

Hope this helps.

 

---RoseAnne

[Guest guest]

Hi Robert---Thanks for the thoughtful response. Makes sense, what you

say. I am trying to make a complex thing simple! But your ideas are

helpful. I find that sometimes I just need to ask questions like

this so that I can hear that I'm not the only one who finds this

aspect challenging. So I got what I wanted---some good ideas and

solace that I am not alone in feeling challenged. Thanks!

 

Laura

 

 

 

Chinese Medicine , " kampo36 "

<kampo36> wrote:

> Chinese Medicine , " heylaurag "

<heylaurag@h...>

> wrote:

>

> >

> > If your focus is to clear out pathogens such as dampcold or

dampheat

> > etc., but you also want to protect the blood or yin, do you

prescribe

> > a higher dose of the clearing herbs even though the blood/yin

tonics

> > are traditionally prescribed in higher daily doses?

> >

> > I think that Long Dan Xie Gan Tang is a good example because it

is

> > being used for dampheat but it has Sheng Di Huang and Dang Gui in

> > it.

> >

>

> IMHO this is a very complicated question and there's no simple

answer. The quick answer

> is that the chief herbs generally get a relatively higher dosage

and the assistants and

> envoys relatively lower. " Relatively " meaning lower in the dosage

range; there are all kinds

> of reasons why standard dosages are written as they are -- minerals

are denser and

> heavier than aerial parts of plants, for example, and some herbs

are very toxic and can

> only be prescribed in small amounts. Some herbs have very

different effects in lower vs

> higher dosages.

>

> Also, to address your example, how much damp-heat is present vs how

much are you

> worried about protecting from damage to Yin in a given patient --

are they already

> somewhat Yin deficient or are you anticipating a protracted course

of this particular

> formula, these are some things that would factor into it. IMHO the

most basic thing is to

> keep in mind the relative strength of the Correct Qi vs the

Pathogenic Qi.

>

> You already sort of answered your own question in giving your LDXGT

example. The best

> way is to study prescriptions, and if possible spend time with a

more experienced

> herbalist. Prescription study is a lifetime endeavor if you really

want to be good at it (I for

> one cannot claim that I am anything more than barely competent).

Even assuming your

> diagnosis and tx principles are correct, you may still have to

adjust the dosage as you go

> along. I started my TCM studies with an herbalist of 30+ years

experience and I saw times

> when he had to tell the patient to come back with their remaining

bags of herbs so he

> could pull stuff out and add other stuff.

>

> The fact that you are asking this question, though, is a sign that

you have the prerequisite

> to being a really good herbalist -- a strong desire to learn. Best

of luck to you in your

> practice.

>

> robert hayden

[Guest guest]

I just wanted to point out that a patient'sweight is not necessarily

correlated with dosage. I have two large patients, one around 300 lbs and the

other

around 250 who are more sensitive to herbs than others of a more " normal' size.

I generally ask about sensitivity to herbs, medicine or anesthesia dosages

and muddle through, but haven't come up with any ways of telling diagnostically.

 

Has anyone found dosages correlating to Spleen xu, stomach fire or other

diagnostic features?

 

 

 

Karen S. Vaughan, L.Ac., MSTOM

Creation's Garden

Creationsgarden1

253 Garfield Place

Brooklyn, NY 11215

 

(718) 622-6755

 

 

 

[Guest guest]

, creationsgarden1@a... wrote:

>

>

> I just wanted to point out that a patient'sweight is not necessarily

> correlated with dosage.

but all else being equal, it is. there are always multiple variables including

the 15% or so

of the population who are sensitive reactors regardless of body weight.

 

I have two large patients, one around 300 lbs and the other

> around 250 who are more sensitive to herbs than others of a more " normal'

size.

> I generally ask about sensitivity to herbs, medicine or anesthesia dosages

> and muddle through, but haven't come up with any ways of telling

diagnostically.

>

[Guest guest]

Chinese Medicine , " kampo36 "

<kampo36> wrote:

 

> Also, to address your example, how much damp-heat is present vs how

much are you

> worried about protecting from damage to Yin in a given patient --

are they already

> somewhat Yin deficient or are you anticipating a protracted course

of this particular

> formula, these are some things that would factor into it. IMHO the

most basic thing is to

> keep in mind the relative strength of the Correct Qi vs the

Pathogenic Qi.

 

Excellent answer !!! TCM is human-oriented. I don't think I will

even consider LDXGT if my 70-year old grandma is diagnosed with damp-

heat in lower jiao. The old chinese saying " ¤Ö¦~§Ò¸É , ¦Ñ¦~§ÒÂm " . The

relative strenth of the correct qi v.s. the pathogenic qi in your

individual patient is the most important factor in selecting herbs

and its quantity.