how many herbs to use in custom formulas?

[Guest guest]

Kath, thank you for your response.

 

Concerning, creating a custom herbal formula, when you use 20+ herbs,

what is the protocol in your formulation?

 

There are several herb formulation systems:

1. select classical formula according to diagnosis, do not modify it

(kampo) (1-15 herbs total)

2. select traditional formula according to diagnosis and modify a few herbs

and dosages. (TCM standard)

(1-20 herbs)

 

3. create a formula from scratch using herbs in dui-yao combos and single

herbs according to

symptomatic/constitutional indications (1-20 herbs total)

 

4. combine two or more traditional formulas based on constitutional and

symptomatic presentation.

(this is used often with patent pill formulas) (10+)

 

I've heard that one prominent teacher believes most Americans have SP qi

deficiency and LV qi stagnation, along with some form of yin or yang

deficiencies. So, one should treat this constitutional picture along with

whatever else comes up. This adds up to a pretty large herbal script. Does

anyone else practice this way? Has this been more or less effective for

anyone?

Thanks for the feedback.

 

Kath wrote:

every herbalist has a different answer. begining herbalist are taught 12-15

herb/px, smaller for shan han lun style tx. i write large px (20+) and

get effective results for my patients without s/e. this is an ususual,

perhaps even renegade style, but i works for my patients. i tx many

complicated conditions presenting with multiple sx/patterns. patient base

demogr. is babyboom women. i find younger patients with less complicated

symptomology/patterns tend to get smaller px. peds get smaller px. they

has simple conditions and respond quickly.

 

On 1/19/07, wrote:

>

> see below, KB

>

> On 1/19/07, <johnkokko <johnkokko%40gmail.com>>

> wrote:

> >

> > Hi all,

> > I've been thinking about certain questions for a while now

> > and would like to see how others have been practicing and with what kind

> > of

> > effects.

> >

> > 1. *Laterality of needles* - What decides a bilateral needle treatment

> > from contralateral or unilateral placement?

> >

> > I usually go contralateral for channel / external pain tx from site of

> > pain

> > (Master Tung/ Young Wei-Chieh)

> > and bilateral for organic (zang/fu) d.o., however, I know that Master

> > Nagano

> > (Kiiko M.) often does unilateral, as well as contralateral, depending on

> > the

> > issue. Aside from that, are there other perspectives?

> > In TCM school it is almost always bilateral for a single point, no

> matter

> > what.

> > Any ideas?

> >

>

> I use ipsi lateral local/distal for pain, contralat needle combo in xu

> patients to reduce number of needles (eg: sp6/st36 contra lat) and bilat

> for

> zangfu. occ. i use contra lat for pain in a stubborn/diff. case when i'm

> trying outside the box tech. to get results.

>

> 2. *Length of needle treatment* - What makes you decide between a 20 min.

> > tx, 30 min and a 40 min tx?

> >

>

> this is done according to shi/xu condition/patient. shi=40min, xu=20min.

> shorter tx lengths are used for elderly, peds, and xu patients who have

> neg

> reactions (eg: fatigue, lightheaded) post-tx.

>

> 3. *Number of herbs in a single formula* - What are your thoughts on the

> > limit of how many herbs should be in any formula?

> > Even / odd #?

> > Tonifying / Dispersing?

> >

>

> every herbalist has a different answer. begining herbalist are taught

> 12-15

> herb/px, smaller for shan han lun style tx. i write large px (20+) and

> get effective results for my patients without s/e. this is an ususual,

> perhaps even renegade style, but i works for my patients. i tx many

> complicated conditions presenting with multiple sx/patterns. patient base

> demogr. is babyboom women. i find younger patients with less complicated

> symptomology/patterns tend to get smaller px. peds get smaller px. they

> has simple conditions and respond quickly.

>

> never heard about focusing on even or odd# of herb in px.

>

> tonic/dispersing: as per TP to tx pattern, tonics for xu conditions, etc.

>

> 4. *Dosages of each herb in a single formula* - Besides Bensky doses,

> > some

> > practitioners I've seen use 1.5 qian as the average single herb dose,

> > others

> > greater than 5 qian. Is there a classical or historical trend in dosage

> > amounts?

> > What kind of considerations would one have in giving small vs. larger

> > doses.

> > ie. LV metabolism issues, SP qi def. size of patient, etc.

> >

>

> herbs have basic dosage ranges, see bensky. its best to stay in the rec

> ranges. however, these ranges are for daily doses, as is practiced in

> china: 1 bag/day. in the US, most practitioners use 1bag/2days, partly due

> to expense, partly because patients often to acu in addition (in china its

> usually either/or), and mostly because that's the way its taught.

>

> it's ok to stray outside the est. ranges if: the herbalist is experienced,

> the herb is known to be safely prescribed in higher doses: eg. huang qi

> can

> go 30-60g or higher. you must have a reason to do this, and know what

> you're doing to go this high.

>

> actually, px should be dosed by the patients weight. if i recall correctly

> its 140g/70 kilos. therefore smaller patients/elderly/peds get lower

> doses,

> and larger, more robust adults get higher doses. liv metab, sp qi xu could

> also be taken into consideration when dosing herbs.

>

> hope this helps,

>

> kb

>

>

>

 

 

 

[Guest guest]

i see multiple/complex patterns and symptomology in my patient pop. i

generally combine 2 and possibly 3 classic px., subtract redundant herbs and

add any additionals to get symptoms/patterns not covered. that's why the

px. get so large. as i say, my style is unusual, but i get effective

results without s/e.

 

kb

 

 

On 1/24/07, <johnkokko wrote:

>

> Kath, thank you for your response.

>

> Concerning, creating a custom herbal formula, when you use 20+ herbs,

> what is the protocol in your formulation?

>

> There are several herb formulation systems:

> 1. select classical formula according to diagnosis, do not modify it

> (kampo) (1-15 herbs total)

> 2. select traditional formula according to diagnosis and modify a few

> herbs

> and dosages. (TCM standard)

> (1-20 herbs)

>

> 3. create a formula from scratch using herbs in dui-yao combos and single

> herbs according to

> symptomatic/constitutional indications (1-20 herbs total)

>

> 4. combine two or more traditional formulas based on constitutional and

> symptomatic presentation.

> (this is used often with patent pill formulas) (10+)

>

> I've heard that one prominent teacher believes most Americans have SP qi

> deficiency and LV qi stagnation, along with some form of yin or yang

> deficiencies. So, one should treat this constitutional picture along with

> whatever else comes up. This adds up to a pretty large herbal script. Does

> anyone else practice this way? Has this been more or less effective for

> anyone?

> Thanks for the feedback.

>

> Kath wrote:

> every herbalist has a different answer. begining herbalist are taught

> 12-15

> herb/px, smaller for shan han lun style tx. i write large px (20+) and

> get effective results for my patients without s/e. this is an ususual,

> perhaps even renegade style, but i works for my patients. i tx many

> complicated conditions presenting with multiple sx/patterns. patient base

> demogr. is babyboom women. i find younger patients with less complicated

> symptomology/patterns tend to get smaller px. peds get smaller px. they

> has simple conditions and respond quickly.

>

> On 1/19/07, <acukath<acukath%40gmail.com>>

> wrote:

> >

> > see below, KB

> >

> > On 1/19/07, <johnkokko

<johnkokko%40gmail.com><johnkokko%40gmail.com>>

> > wrote:

> > >

> > > Hi all,

> > > I've been thinking about certain questions for a while now

> > > and would like to see how others have been practicing and with what

> kind

> > > of

> > > effects.

> > >

> > > 1. *Laterality of needles* - What decides a bilateral needle treatment

> > > from contralateral or unilateral placement?

> > >

> > > I usually go contralateral for channel / external pain tx from site of

> > > pain

> > > (Master Tung/ Young Wei-Chieh)

> > > and bilateral for organic (zang/fu) d.o., however, I know that Master

> > > Nagano

> > > (Kiiko M.) often does unilateral, as well as contralateral, depending

> on

> > > the

> > > issue. Aside from that, are there other perspectives?

> > > In TCM school it is almost always bilateral for a single point, no

> > matter

> > > what.

> > > Any ideas?

> > >

> >

> > I use ipsi lateral local/distal for pain, contralat needle combo in xu

> > patients to reduce number of needles (eg: sp6/st36 contra lat) and bilat

> > for

> > zangfu. occ. i use contra lat for pain in a stubborn/diff. case when i'm

> > trying outside the box tech. to get results.

> >

> > 2. *Length of needle treatment* - What makes you decide between a 20

> min.

> > > tx, 30 min and a 40 min tx?

> > >

> >

> > this is done according to shi/xu condition/patient. shi=40min, xu=20min.

> > shorter tx lengths are used for elderly, peds, and xu patients who have

> > neg

> > reactions (eg: fatigue, lightheaded) post-tx.

> >

> > 3. *Number of herbs in a single formula* - What are your thoughts on the

> > > limit of how many herbs should be in any formula?

> > > Even / odd #?

> > > Tonifying / Dispersing?

> > >

> >

> > every herbalist has a different answer. begining herbalist are taught

> > 12-15

> > herb/px, smaller for shan han lun style tx. i write large px (20+) and

> > get effective results for my patients without s/e. this is an ususual,

> > perhaps even renegade style, but i works for my patients. i tx many

> > complicated conditions presenting with multiple sx/patterns. patient

> base

> > demogr. is babyboom women. i find younger patients with less complicated

> > symptomology/patterns tend to get smaller px. peds get smaller px. they

> > has simple conditions and respond quickly.

> >

> > never heard about focusing on even or odd# of herb in px.

> >

> > tonic/dispersing: as per TP to tx pattern, tonics for xu conditions,

> etc.

> >

> > 4. *Dosages of each herb in a single formula* - Besides Bensky doses,

> > > some

> > > practitioners I've seen use 1.5 qian as the average single herb dose,

> > > others

> > > greater than 5 qian. Is there a classical or historical trend in

> dosage

> > > amounts?

> > > What kind of considerations would one have in giving small vs. larger

> > > doses.

> > > ie. LV metabolism issues, SP qi def. size of patient, etc.

> > >

> >

> > herbs have basic dosage ranges, see bensky. its best to stay in the rec

> > ranges. however, these ranges are for daily doses, as is practiced in

> > china: 1 bag/day. in the US, most practitioners use 1bag/2days, partly

> due

> > to expense, partly because patients often to acu in addition (in china

> its

> > usually either/or), and mostly because that's the way its taught.

> >

> > it's ok to stray outside the est. ranges if: the herbalist is

> experienced,

> > the herb is known to be safely prescribed in higher doses: eg. huang qi

> > can

> > go 30-60g or higher. you must have a reason to do this, and know what

> > you're doing to go this high.

> >

> > actually, px should be dosed by the patients weight. if i recall

> correctly

> > its 140g/70 kilos. therefore smaller patients/elderly/peds get lower

> > doses,

> > and larger, more robust adults get higher doses. liv metab, sp qi xu

> could

> > also be taken into consideration when dosing herbs.

> >

> > hope this helps,

> >

> > kb

> >

> >

> >

>

>