Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 I don't think that anyone at PCOM invents new prescriptions in the clinic or in private practice. I find it hard to believe that this type of herb combination is happening with beginners. It is akin to experimenting on patients, a practice which violates standards of commonsense medical practice. On Oct 30, 2004, at 2:02 PM, Doc wrote: > > A thought for discussion; > > I often hear of students and new (5 years or less of > practice) practitioners creating new formulas or > adding herbs based not on traditional modifications > but on their own understanding of the properties of > the herbs. > > I was taught that this type of practice often disturbs > or negates the all important Synergy of these formulas > and creates a less effective or even harmful formula. > (This has indeed been my observation in terms of the > results on patients.) > IMHO this practice arises out of a European paradigm > being superimposed onto the Chinese paradigm based > system. > > I was also taught that until one has a wider > understanding of the herbs than is possible in the > beginnning one should in fact stay with either adding > in complete formulas (for instance adding Hsiao Chai > Hu Tang to Yin Chiao San) or using only the classical > modifications. > > I realize that this flies in the face of the current > way herbs are being taught in the schools. > > I would like some feedback - especialy from the > Herbalists on the list. > > Doc Rosen > > > > > > > Mail - You care about security. So do we. > > > > > > > > http://babel.altavista.com/ > > > and > adjust accordingly. > > If you , it takes a few days for the messages to stop > being delivered. > > Messages are the property of the author. Any duplication outside the > group requires prior permission from the author. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 A thought for discussion; I often hear of students and new (5 years or less of practice) practitioners creating new formulas or adding herbs based not on traditional modifications but on their own understanding of the properties of the herbs. [Jason] I am unsure what you mean by 'own understanding' but it is a common practice in asia and the states for a practitioner to base there formulas of herb functions (properties) especially dui yao's (herb combinations). Meaning no classical formula that they base it off of. I was taught that this type of practice often disturbs or negates the all important Synergy of these formulas and creates a less effective or even harmful formula. (This has indeed been my observation in terms of the results on patients.) [Jason] This is not true. But it takes, IMO, a much more skillful herbalist to make such formulas really work. It is much easier to keep with the classical formulas / modifications in the beginning. - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 Hi Doc, I am really glad that you are bringing this topic up for discussion. I have sooooooo many questions about this. As you know, I am a beginning practitioner. Creating your own formula and adding your own additions to classical formulas was very much encouraged at my school...and it was considered a very good school (one of the oldest). However, I am getting to the point where I don't think that it is a good idea. Over and over I see that when I stick to classic formulas things happen in a predictable way, but when I change the formulas things are more likely to go awry in a way that makes no sense. If I give a classic formula things still might go wrong, but it generally makes sense why and how. Maybe this is just due to my own lack of experience, but generally I make seemingly logical changes. Nothing too " out there " . I've been trying to decide whether this is because of my own inability, because of poor choices regarding dosages of the herbs I have added, or because of the kinds of issues you bring up (synergy etc.) I don't know if you saw my post asking about Yi Guan Jian, but it was this line of questioning that inspired me to write that post. I asked why Chuan Lian Zi was used in a formula for yin deficiency with liver qi stagnation. Why not a less drying herb like Fo Shou? I think there is a lot that most of us don't understand well enough to design our own formulas. Laura Chinese Medicine , Doc <Doc@s...> wrote: > > A thought for discussion; > > I often hear of students and new (5 years or less of > practice) practitioners creating new formulas or > adding herbs based not on traditional modifications > but on their own understanding of the properties of > the herbs. > > I was taught that this type of practice often disturbs > or negates the all important Synergy of these formulas > and creates a less effective or even harmful formula. > (This has indeed been my observation in terms of the > results on patients.) > IMHO this practice arises out of a European paradigm > being superimposed onto the Chinese paradigm based > system. > > I was also taught that until one has a wider > understanding of the herbs than is possible in the > beginnning one should in fact stay with either adding > in complete formulas (for instance adding Hsiao Chai > Hu Tang to Yin Chiao San) or using only the classical > modifications. > > I realize that this flies in the face of the current > way herbs are being taught in the schools. > > I would like some feedback - especialy from the > Herbalists on the list. > > Doc Rosen > > > > > > > Mail - You care about security. So do we. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 Hard to believe as it is and as much as it violates standards of commonsense medical practice it is at the least being learned that way at many schools. I get patients who have previously been to these practitioners and when i look at their formulas they are incomprehensible to mer. I have encountered this with students and graduates of a number of otherwise reputable schools. doc <zrosenbe wrote: I don't think that anyone at PCOM invents new prescriptions in the clinic or in private practice. I find it hard to believe that this type of herb combination is happening with beginners. It is akin to experimenting on patients, a practice which violates standards of commonsense medical practice. On Oct 30, 2004, at 2:02 PM, Doc wrote: > > A thought for discussion; > > I often hear of students and new (5 years or less of > practice) practitioners creating new formulas or > adding herbs based not on traditional modifications > but on their own understanding of the properties of > the ... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 Hi, On the other hand, contrary to the post I just wrote, let me say this: There have been times when I haven't been able to treat something with a classical formula and it was only when I came up with a formula on my own that I got results. I think that when you are doing one clear thing it is easier to craft your own formula than when you are trying to do many things at once. So maybe there isn't a clear answer, but it is important to proceed with caution when you are moving beyond the classic formulas and classical modifications. Laura Chinese Medicine , Doc <Doc@s...> wrote: > > A thought for discussion; > > I often hear of students and new (5 years or less of > practice) practitioners creating new formulas or > adding herbs based not on traditional modifications > but on their own understanding of the properties of > the herbs. > > I was taught that this type of practice often disturbs > or negates the all important Synergy of these formulas > and creates a less effective or even harmful formula. > (This has indeed been my observation in terms of the > results on patients.) > IMHO this practice arises out of a European paradigm > being superimposed onto the Chinese paradigm based > system. > > I was also taught that until one has a wider > understanding of the herbs than is possible in the > beginnning one should in fact stay with either adding > in complete formulas (for instance adding Hsiao Chai > Hu Tang to Yin Chiao San) or using only the classical > modifications. > > I realize that this flies in the face of the current > way herbs are being taught in the schools. > > I would like some feedback - especialy from the > Herbalists on the list. > > Doc Rosen > > > > > > > Mail - You care about security. So do we. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 European paradigm? I've never heard of this before and don't know where you got this from, because it is incorrect. Creating a new formula from scratch is very difficult and takes years of practice. It's not something for a beginner practitioner as achieving the herbal balance is an art. Having studied in Europe, we weren't taught this, rather to modify an existing formula. Perhaps you saw this from less reputable schools of TCM. Although the question is, how many times can you modify an existing formula from its original ingredients? Attilio Doc [Doc] 30 October 2004 22:03 aac-list Combining Herbs a question A thought for discussion; I often hear of students and new (5 years or less of practice) practitioners creating new formulas or adding herbs based not on traditional modifications but on their own understanding of the properties of the herbs. I was taught that this type of practice often disturbs or negates the all important Synergy of these formulas and creates a less effective or even harmful formula. (This has indeed been my observation in terms of the results on patients.) IMHO this practice arises out of a European paradigm being superimposed onto the Chinese paradigm based system. I was also taught that until one has a wider understanding of the herbs than is possible in the beginnning one should in fact stay with either adding in complete formulas (for instance adding Hsiao Chai Hu Tang to Yin Chiao San) or using only the classical modifications. I realize that this flies in the face of the current way herbs are being taught in the schools. I would like some feedback - especialy from the Herbalists on the list. Doc Rosen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 Hi Laura, While starting with classic formula's and modifying from these to suit the individual patient is the norm and is what I attempt to do.......it is not so simple; as you seem to find as well. Adding herbs to or subtracting herbs from an established formula will change the action of the original formula in some way. IMO it is not just a matter of adding more herbs equalling adding extra functions to the formula, or subtracting herbs from a formula reducing or taking away an action of a formula. The interactions between the individual herbs in a whole formula will change in complicated ways depending on the dosage, qi, wei, actions etc of any herb added or subtracted to that starting formula or any adjustment in the dosage ratio within a classic formula itself. The more I study herbs and the more details I remember about each individual herb, simple dui yao or pao zhi and gradually integrate these into my herbal practice in terms of herb and formula strategies the more I realise the subtleties involved and why it takes so long to become a master of this medicine. I know this doesn't help much. Perhaps all I am saying is that I here what you are saying; even if it does seem contrary at first glance. I also it is important to proceed with caution and perhaps above all, choose the classic formula which addresses your major treatment principle first and don't go overboard with additions until you have experience in what such adjustments are likely to do to the overall formula action. Best Wishes, Steve On 31/10/2004, at 5:30 PM, heylaurag wrote: > > > > Hi, On the other hand, contrary to the post I just wrote, let me say > this: > > There have been times when I haven't been able to treat something > with a classical formula and it was only when I came up with a > formula on my own that I got results. I think that when you are > doing one clear thing it is easier to craft your own formula than > when you are trying to do many things at once. > > So maybe there isn't a clear answer, but it is important to proceed > with caution when you are moving beyond the classic formulas and > classical modifications. > > Laura > > > Chinese Medicine , Doc <Doc@s...> > wrote: >> >> A thought for discussion; >> >> I often hear of students and new (5 years or less of >> practice) practitioners creating new formulas or >> adding herbs based not on traditional modifications >> but on their own understanding of the properties of >> the herbs. >> >> I was taught that this type of practice often disturbs >> or negates the all important Synergy of these formulas >> and creates a less effective or even harmful formula. >> (This has indeed been my observation in terms of the >> results on patients.) >> IMHO this practice arises out of a European paradigm >> being superimposed onto the Chinese paradigm based >> system. >> >> I was also taught that until one has a wider >> understanding of the herbs than is possible in the >> beginnning one should in fact stay with either adding >> in complete formulas (for instance adding Hsiao Chai >> Hu Tang to Yin Chiao San) or using only the classical >> modifications. >> >> I realize that this flies in the face of the current >> way herbs are being taught in the schools. >> >> I would like some feedback - especialy from the >> Herbalists on the list. >> >> Doc Rosen >> >> >> >> >> >> >> Mail - You care about security. So do we. >> > > > > http://babel.altavista.com/ > > > and > adjust accordingly. > > If you , it takes a few days for the messages to stop being > delivered. > > Messages are the property of the author. Any duplication outside the > group requires prior permission from the author. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 Hard to believe as it is and as much as it violates standards of commonsense medical practice it is at the least being learned that way at many schools. I get patients who have previously been to these practitioners and when i look at their formulas they are incomprehensible to mer. [Jason] Not really. it is a valid style of practice in CM. I would say that all 4 herbalists in my office, on a daily basis, create 'new' formulas for our patients. BUT they are based on sound TCM theory and known combinations (or building blocks) from classical formulas, and every once in awhile an empirical or *new* pharmacological usage will slip in. It is no big. - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 _____ heylaurag [heylaurag] Saturday, October 30, 2004 10:23 PM Chinese Medicine Re: Combining Herbs a question Hi Doc, I am really glad that you are bringing this topic up for discussion. I have sooooooo many questions about this. As you know, I am a beginning practitioner. Creating your own formula and adding your own additions to classical formulas was very much encouraged at my school...and it was considered a very good school (one of the oldest). However, I am getting to the point where I don't think that it is a good idea. Over and over I see that when I stick to classic formulas things happen in a predictable way, but when I change the formulas things are more likely to go awry in a way that makes no sense. If I give a classic formula things still might go wrong, but it generally makes sense why and how. Maybe this is just due to my own lack of experience, but generally I make seemingly logical changes. Nothing too " out there " . I've been trying to decide whether this is because of my own inability, because of poor choices regarding dosages of the herbs I have added, or because of the kinds of issues you bring up (synergy etc.) [Jason] I am pretty confident that just because of formula is 'classical' or written in a book it has any more synergy, or is any better, than a formula that is written from scratch (for an individual patient). But of course doing the latter is much easier to make a mistake (hence zero synergy) if you lack experience (IMO). Troubleshooting side-effects or 'things that go awry' is more about the level of understanding of the herbs and the patient's condition. - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 If you read Doc's original post, you will see that he is not discussing a prescription that is clearly modified from a classical script, but one that is entirely built on shotgun style, i.e., an herb for this, an herb for that, 'mix them together and shake them all about'. On Oct 31, 2004, at 6:37 AM, wrote: > > [Jason] Not really. it is a valid style of practice in CM. I would > say that > all 4 herbalists in my office, on a daily basis, create 'new' > formulas for > our patients. BUT they are based on sound TCM theory and known > combinations > (or building blocks) from classical formulas, and every once in > awhile an > empirical or *new* pharmacological usage will slip in. It is no big. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 Attilio, I use the term European Paradigm instead of Western Medicine or Western Paradigm because it is simply more correct. What a Lakota Wicasa Wakan practices is Western Medicine but Allopathic Medicine is using in fact a European Paradigm. AND the European Paraadigm denies the existance of synergy as a medical factor. This has nothing to do with the way TCM is taught in Europe today. Doc --- Attilio D'Alberto <attiliodalberto wrote: European paradigm? I've never heard of this before and don't know where you got this from, because it is incorrect. Creating a new formula from scratch is very difficult and takes years of practice. It's not something for a beginner practitioner as achieving the herbal balance is an art. Having studied in Europe, we weren't taught this, rather to modify an existing formula. Perhaps you saw this from less reputable schools of TCM. Although the question is, how many times can you modify an existing formula from its original ingredients? Attilio Doc [Doc] 30 October 2004 22:03 aac-list Combining Herbs a question A thought for discussion; I often hear of students and new (5 years or less of practice) practitioners creating new formulas or adding herbs based not on traditional modifications but on their own understanding of the properties of the herbs. I was taught that this type of practice often disturbs or negates the all important Synergy of these formulas and creates a less effective or even harmful formula. (This has indeed been my observation in terms of the results on patients.) IMHO this practice arises out of a European paradigm being superimposed onto the Chinese paradigm based system. I was also taught that until one has a wider understanding of the herbs than is possible in the beginnning one should in fact stay with either adding in complete formulas (for instance adding Hsiao Chai Hu Tang to Yin Chiao San) or using only the classical modifications. I realize that this flies in the face of the current way herbs are being taught in the schools. I would like some feedback - especialy from the Herbalists on the list. Doc Rosen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 _____ [zrosenbe] Sunday, October 31, 2004 8:52 AM Chinese Medicine Re: Combining Herbs a question If you read Doc's original post, you will see that he is not discussing a prescription that is clearly modified from a classical script, but one that is entirely built on shotgun style, i.e., an herb for this, an herb for that, 'mix them together and shake them all about'. [Jason] That is what I am talking about - I would not call it *always* a shot-gut approach, but a well-constructed Rx based on building blocks. IT is NOT a modified classical script. (the building blocks come from dui yao's which are many times from classical scripts. I.e. One might use a 2 herb combo from a 10 ingredient Rx, another 2 or 3 herb combo, etc etc. (and as you say mix it up). At the end one cannot say it is based on a single classical script but on theory, relationships, combos etc etc. - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 I agree with you, and have written scripts in this way myself, but how many people can use dui yao creatively in this manner? One has to have a deep knowledge of Chinese medical theory to do this. On Oct 31, 2004, at 8:19 AM, wrote: > > That is what I am talking about - I would not call it *always* a > shot-gut > approach, but a well-constructed Rx based on building blocks. IT is > NOT a > modified classical script. (the building blocks come from dui yao's > which > are many times from classical scripts. I.e. One might use a 2 herb > combo > from a 10 ingredient Rx, another 2 or 3 herb combo, etc etc. (and as > you say > mix it up). At the end one cannot say it is based on a single > classical > script but on theory, relationships, combos etc etc. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 _____ [zrosenbe] Sunday, October 31, 2004 9:57 AM Chinese Medicine Re: Combining Herbs a question I agree with you, and have written scripts in this way myself, but how many people can use dui yao creatively in this manner? One has to have a deep knowledge of Chinese medical theory to do this. [Jason] Yes. It is hard. And I always recommend people to start just with the base Rx. I also have to say, I only do this when I have the Disease Process down. If I am trying something obscure or just something I haven't had a lot of experience with I usually stick to the more standard formulas. It is interesting, just this AM I read an article in the JTCM about the author's experience in treating 'gastritis' with just herb combos. It was very interesting. " herbal pairs are one of the characteristics in formulating prescriptions in TCM. The author has for many years flexibly changed dosages of herbal pairs according to concrete conditions and treated 98 cases of chronic gastritis. " " .Herbs used in pairs are designed in accordance with such basic TCM theories as four natures and five flavors of the drugs; lifting, lowering, floating and sinking of pulse; reinforcing the xu and reducing the excess; zang & fu, superficiality and origin, and so on and so forth. It is under the guidance of these TCM basic theories that the author has used herbal pairs to treat chronic gastritis. " - On Oct 31, 2004, at 8:19 AM, wrote: > > That is what I am talking about - I would not call it *always* a > shot-gut > approach, but a well-constructed Rx based on building blocks. IT is > NOT a > modified classical script. (the building blocks come from dui yao's > which > are many times from classical scripts. I.e. One might use a 2 herb > combo > from a 10 ingredient Rx, another 2 or 3 herb combo, etc etc. (and as > you say > mix it up). At the end one cannot say it is based on a single > classical > script but on theory, relationships, combos etc etc. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 _____ Doc [Doc] Sunday, October 31, 2004 9:57 AM Chinese Medicine RE: Combining Herbs a question [Jason] >That is what I am talking about - I would not call it *always* a shot-gut approach, but a well-constructed Rx based on building blocks. IT is NOT a modified classical script. (the building blocks come from dui yao's which are many times from classical scripts. I.e. One might use a 2 herb combo from a 10 ingredient Rx, another 2 or 3 herb combo, etc etc. (and as you say mix it up). At the end one cannot say it is based on a single classical script but on theory, relationships, combos etc etc. < I Have in my 51 years of study seen numerous cases of patients helped in the short run but harmed in the longer term by this approach. Synergy is always present as a factor but when you experiment by using an unproven formula on patients it may not be the synergy you would wish for. Classical formulas becam CLASSICAL because they kept working and kept being used, not because " someone wrote it in a book " . They are proven rather than unproven and experimental which is by definition what you describe. Of course it was by experimenting on prisoners that the classical formulas were often proven to work...... [Jason] This is just 100% completely not true. Your stance is not supported by historical record nor modern Chinese clinical reality. Simple as that.. All that I can say is that maybe you (or whomever you were observing) were writing bad formulas. - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 Firstly Jason i must apologize because i misread what you wrote. You are still IMO following the classical guidelines. That said what I wrote was about creating formulas from scrastch and I fully stand by it. I Have in my 51 years of study seen numerous cases of patients helped in the short run but harmed in the longer term by this approach. Synergy is always present as a factor but when you experiment by using an unproven formula on patients it may not be the synergy you would wish for. Classical formulas became CLASSICAL because they kept working and kept being used, not because " someone wrote it in a book " . They are proven rather than unproven and experimental which is by definition what you describe. Of course it was by experimenting on prisoners that the classical formulas were often proven to work..... Doc Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2004 Report Share Posted October 31, 2004 No I don't think you misread what I said, but you seem to have said the exact same thing as your last post, so I will repeat: Your below idea is 100% completely not true. Your stance is not supported by historical record nor modern Chinese clinical reality. Simple as that.. All that I can say is that maybe you (or whomever you were observing) were writing bad formulas. Such blatant misinformation about TCM herbalism must not go unchecked. (Basically the only reason I bother to respond). I would like to see some evidence on your end (of such strong statements) before I will consider continuing with this discussion. - _____ Doc [Doc] Sunday, October 31, 2004 2:13 PM Chinese Medicine RE: Combining Herbs a question Firstly Jason i must apologize because i misread what you wrote. You are still IMO following the classical guidelines. That said what I wrote was about creating formulas from scrastch and I fully stand by it. I Have in my 51 years of study seen numerous cases of patients helped in the short run but harmed in the longer term by this approach. Synergy is always present as a factor but when you experiment by using an unproven formula on patients it may not be the synergy you would wish for. Classical formulas became CLASSICAL because they kept working and kept being used, not because " someone wrote it in a book " . They are proven rather than unproven and experimental which is by definition what you describe. Of course it was by experimenting on prisoners that the classical formulas were often proven to work..... Doc http://babel.altavista.com/ and adjust accordingly. If you , it takes a few days for the messages to stop being delivered. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 1, 2004 Report Share Posted November 1, 2004 > > I often hear of students and new (5 years or less of > > practice) practitioners creating new formulas or > > adding herbs based not on traditional modifications > > but on their own understanding of the properties of > > the herbs. > > In my schooling we were taught to start with a base formula and modify it appropriately (usually just a few herbs) to arrive at a tailored formula. I've talked to some of my colleagues who give out formulas with up to 30 herbs in varying doses which they say have worked, but that approach is a bit daunting to me at this point. Combing two formulas as different as xiao chai hu tang and yin qiao would be a little out of the box I learned. However when I've read some of the kampo formula combinations they seem all over the place - maybe four different patents a patitent takes all at once. But people who use this system get it to work. One of the difficulties with coming up with a formula on one's own is that it is difficult enough to understand the normally esoteric discussions in books such as bensky about why the formula works and is balanced. For some herb combinations there are at times totally different reasons why they work and why the combination is an exception here, and so on. It is possible to come up with a formula on your own using a feedback system such as muscle testing. Ingredients and relative dosages of them can be arrived at. If the person can get accurate radings I would trust this. > > I was taught that this type of practice often disturbs > > or negates the all important Synergy of these formulas > > and creates a less effective or even harmful formula. > > (This has indeed been my observation in terms of the > > results on patients.) > > IMHO this practice arises out of a European paradigm > > being superimposed onto the Chinese paradigm based > > system. > > I do however know senior chinese practitioners who do this quite effectively, but they've been doing it for 20 years and have gotten good at it. THey may only use two chief herbs from a formula with 15 ingredients and change all the rest of them. > > I was also taught that until one has a wider > > understanding of the herbs than is possible in the > > beginnning one should in fact stay with either adding > > in complete formulas (for instance adding Hsiao Chai > > Hu Tang to Yin Chiao San) or using only the classical > > modifications. > > I agree with this. Quote Link to comment Share on other sites More sharing options...
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