Herb company that carries Shang han/Jin gui pills

May 17, 2009

Dr. Sung,

Your argument puzzles me. You assume I have certain opinions and/

or points of view when I do not. I simply made some statements of

fact about xi xin, substitutions and their toxicity. Frankly, I am

grateful that Spring Wind provides AA-free xi xin because I feel safe

prescribing it to my patients. Perhaps you practice outside the U.S.,

but xi xin is very hard to obtain here because of the AA scare a few

years ago. I strictly practice Chinese medicine according to pattern

differentiation, I am not a pharmacologist.

On May 15, 2009, at 6:27 PM, sxm2649 wrote:

>

> Mr Rosenberg & all,

>

> Thanks for taking time to explain to us about Spring Wind¡¦s user-

> friendly option of aristolochic acid-free xi xin granule. I did a

> quick research of this herb and there are 3 kinds of xi xin: the

> whole grass of Asarum heternotropoides Fr. Varmandshuricum

> (Maxim.)Kitag, Asarum sieboldii Miq. Var. seoulesense Nakai, and

> Asarum sieboldii Miq. Their chief ingredients are methyl eugenol, £\-

> pinene,£]-pinene, safrole, wstragole, asarone, limonene. And the

> root contains norepinephrine aconitine.

>

> As far as its side effect, it indicates that it has ¡¥some toxic

> effect on the liver, especially for those with renal failure¡¦. For

> long-term animal lab test, 1% of the safrole within the volatile oil

> of xi xin can cause 28% of liver cancer in mice after 2 yrs. 0.1%

> can cause liver tumor especially when the dietaries in lack of Vit

> B2 and E.

>

> Here is my points.

>

> 1 As a clinician, I usually prescribe 10 to 12 ingredients and xi

> xin is just 1/10-18 ingredients. It seems the issue is not

> significant to me especially all tcm students are taught (there is a

> saying) do not use more than 3g of xi xin.

>

> 2 Deliberately single out some pharmaceutical ingredients from any

> particular of herbs are never heard by me. It may not make sense

> financially. Most important of all, it is not Chinese medicine. We

> have a colloquial saying in Cantonese dialogue ¡¥wanting the baby

> but abandon (dump) the mother¡¦.

>

> 3 For those with renal failure¡]I hope not serious), I guess we can

> complement and balance the prescriptions by prescribing other

> ingredients. It is called formulation. Are we going to treat renal

> failure patients? To what extent the kidney are damaged we identify

> as such patients. Where is the basic principle of 'pattern

> identification'?

>

> 4 Who will take xi xin for 2 yrs daily? Besides, human body needs a

> larger dosage to show the results. Taken all these into

> considerations, I really care less about which ingredients are

> singled out. My question for Mr Rosengberg is: have you compared the

> results of these two products in significant numbers of patients and

> making it ¡¥scientific¡¦. All members here will benefit from your

> genuine findings and makes this discussion worthwhile.

>

> Thanks Hugo for his suggestions. He always has some insightful

> questions. I guess WM are in driving seat and enforces regulations.

> The only thing that keep vivid and convincing is

> clinical efficacy.

>

> SUNG, Yuk-ming

>

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

May 17, 2009

Mr Rosenberg,

I must apologize because I also respond to Hugo¡¦s post discussing about the

toxicity of xi xin when I consider the response to yours. They are not your

opinions.

I just summarize and conclude that xi xin is not that scary. All tcm students

(in herbology class in China) learnt that no more than 3g of xi xin should be

used. If pattern differentiation indicates the patient needs it, red flag must

be raised. What possible harm can that do to patients?

About the alternate product: herbs should posses certain properties. Without

that, it may not fit the definition of that particular medicinal it claims. In

that case, may be finding another substitute is a better bet. I just wondering

if same effect can be achieved by the alternative product.

You are right I am ignorant of the CM environment in states. To me, xi xin is

very cheap (raw herb) and common. I actually avoid using it. Its taste is spicy

hot and patients complain about it. We also have plenty of inexpensive ma huang

unregulated and they are rarely are demanded.

SUNG, Yuk-ming

May 17, 2009

Hi Z'ev and YukMing and all:

This is my fault. I was too loose with the argument and went all over with it

and ended up misrepresenting Z'evs comment - sorry about that Z'ev.

Again, what I should have stated clearly at the beginning is that I am most

interested in knowing some numbers behind aristolochic acid damage when the

herbs are used accordingto pattern differentiation.

Again, sorry for the mix-up Z'ev, YukMing and everyone else!

Hugo

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.chinesemedicaltherapies.org

________________________________

<zrosenbe

Chinese Medicine

Sunday, 17 May, 2009 3:04:38

Re: Re: Herb company that carries Shang han/Jin gui pills

Dr. Sung,

Your argument puzzles me. You assume I have certain opinions and/

or points of view when I do not. I simply made some statements of

fact about xi xin, substitutions and their toxicity. Frankly, I am

grateful that Spring Wind provides AA-free xi xin because I feel safe

prescribing it to my patients. Perhaps you practice outside the U.S.,

but xi xin is very hard to obtain here because of the AA scare a few

years ago. I strictly practice Chinese medicine according to pattern

differentiation, I am not a pharmacologist.

On May 15, 2009, at 6:27 PM, sxm2649 wrote:

>

> Mr Rosenberg & all,

>

> Thanks for taking time to explain to us about Spring Wind¡¦s user-

> friendly option of aristolochic acid-free xi xin granule. I did a

> quick research of this herb and there are 3 kinds of xi xin: the

> whole grass of Asarum heternotropoides Fr. Varmandshuricum

> (Maxim.)Kitag, Asarum sieboldii Miq. Var. seoulesense Nakai, and

> Asarum sieboldii Miq. Their chief ingredients are methyl eugenol, £\-

> pinene,£]-pinene, safrole, wstragole, asarone, limonene. And the

> root contains norepinephrine aconitine.

>

> As far as its side effect, it indicates that it has ¡¥some toxic

> effect on the liver, especially for those with renal failure¡¦. For

> long-term animal lab test, 1% of the safrole within the volatile oil

> of xi xin can cause 28% of liver cancer in mice after 2 yrs. 0.1%

> can cause liver tumor especially when the dietaries in lack of Vit

> B2 and E.

>

> Here is my points.

>

> 1 As a clinician, I usually prescribe 10 to 12 ingredients and xi

> xin is just 1/10-18 ingredients. It seems the issue is not

> significant to me especially all tcm students are taught (there is a

> saying) do not use more than 3g of xi xin.

>

> 2 Deliberately single out some pharmaceutical ingredients from any

> particular of herbs are never heard by me. It may not make sense

> financially. Most important of all, it is not Chinese medicine. We

> have a colloquial saying in Cantonese dialogue ¡¥wanting the baby

> but abandon (dump) the mother¡¦.

>

> 3 For those with renal failure¡]I hope not serious), I guess we can

> complement and balance the prescriptions by prescribing other

> ingredients. It is called formulation. Are we going to treat renal

> failure patients? To what extent the kidney are damaged we identify

> as such patients. Where is the basic principle of 'pattern

> identification' ?

>

> 4 Who will take xi xin for 2 yrs daily? Besides, human body needs a

> larger dosage to show the results. Taken all these into

> considerations, I really care less about which ingredients are

> singled out. My question for Mr Rosengberg is: have you compared the

> results of these two products in significant numbers of patients and

> making it ¡¥scientific¡¦. All members here will benefit from your

> genuine findings and makes this discussion worthwhile.

>

> Thanks Hugo for his suggestions. He always has some insightful

> questions. I guess WM are in driving seat and enforces regulations.

> The only thing that keep vivid and convincing is

> clinical efficacy.

>

> SUNG, Yuk-ming

>

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

May 17, 2009

Doug

how about dang gui si ni san

400 29th St. Suite 419

Oakland Ca 94609

alonmarcus

May 17, 2009

Hugo,

If you want to read about morbidity and mortality about the kidney damage

that occurred in Belgium in the early nineties, here are two links:

* Vanherweghem JL, Depierreux M, Tielemans C, Abramowicz D, Dratwa M,

Jadoul M, Richard C, Vandervelde D, Verbeelen D, Vanhaelen-Fastre R, et al.:

Rapidly progressive interstitial renal fibrosis in young women: association

with slimming regimen including Chinese herbs.

Lancet 1993, 341(8842):387-391. <http://www.cmjournal.org/pubmed/8094166>

PubMed Abstract | <http://dx.doi.org/10.1016/0140-6736%2893%2992984-2>

Publisher Full Text

<http://www.cmjournal.org/sfx_links.asp?ui=1749-8546-3-13 & bibl=B1> OpenURL

<javascript:turn();> Return to text

* Vanhaelen M, Vanhaelen-Fastre R, But P, Vanherweghem JL: Identification

of aristolochic acid in Chinese herbs.

Lancet 1994, 343(8890):174. <http://www.cmjournal.org/pubmed/7904018>

PubMed Abstract |

<http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed & cmd=prli

nks & retmode=ref & id=7904018> Publisher Full Text

<http://www.cmjournal.org/sfx_links.asp?ui=1749-8546-3-13 & bibl=B2> OpenURL

Tom Verhaeghe

Stationsplein 59

8770 Ingelmunster

www.chinese-geneeskunde.be

_____

Chinese Medicine

Chinese Medicine On Behalf Of Hugo

Ramiro

zaterdag 16 mei 2009 23:58

Chinese Medicine

Re: Re: Herb company that carries Shang han/Jin gui pills

Hi Tom, thank you for doing the legwork here. I've only read the first one

so far, which unfortuantely contains no information at all on " morbidity or

mortality " . One point regarding check ups and such with western mds. I

myself am in that habit, but it must also be said that they are no guarantee

of anything, and that much of the time it will be only to cover our butts.

See this:

Letter: Orthodox Medicine Isn't Infallible

BMJ 1993;307;624-625

Orthodox medicine isn't infallible

EDITOR,-In a letter about the Osteopaths Bill

E Ernst repeats the mistake of many orthodox

doctors-namely, that of resorting to a simplistic

stereotype of perfect orthodox medical diagnosticians

and their imperfect complementary

counterparts. Ernst asks whether osteopathic

treatment is to be prescribed after an orthodox

diagnosis by a " fully trained medical doctor " or

after direct access to a complementary practitioner

with only " non-optimal " knowledge and gives a

simple example of the dangers of the second

option: an osteopath being able to treat on the

NHS a patient with back pain caused by a spinal

malignancy. According to Ernst's conjecture, an

osteopath is much more likely to misdiagnose this

condition than a doctor.

I know of a real case similar to Ernst's conjecture,

but in which the roles are reversed. A colleague of

mine, who was eventually found to have a spinal

tumour, was misdiagnosed by two doctors, and it

was a subsequent visit to an osteopath that led to

the correct diagnosis. The osteopath concluded

that my colleague's lower limb neuromuscular

problems were caused not by an osteopathic lesion

but by a space occupying lesion in the spinal

canal pinching the nerves. A speedy referral to a

neurosurgeon was followed by the successful

removal of a benign tumour spanning three thoracic

vertebrae; the osteopath can take the credit for the

correct diagnosis.

This anecdote and others like it suggest that the

real world of health care in Britain is not as Ernst

suggests, for two reasons. Firstly, the open and

free access to general practitioners means that

the problems people take to complementary

practitioners have often been discussed with

an orthodox doctor beforehand. There is thus

ample opportunity for an initial orthodox medical

diagnosis (or misdiagnosis) of most problems.

Secondly, even though complementary practitioners

offer different diagnostic and therapeutic

approaches, this does not mean that they are blind

to the need to refer specific health problems to

orthodox doctors, nor that they are insufficiently

skilled to be able to detect the cases that require

this.

Obviously, there are perfect and imperfect

diagnosticians in all branches of health care, and it

is time for those of us who are in the orthodox

medical camp to refrain from defending our position

with simplistic, self righteous stereotypes.

DAVID ST GEORGE

Department of Public Health and Primary Care,

Royal Free Hospital School ofMedicine,

London NW3 2PF

I Emst E. Complementary medicine. BMJ

Hope you all enjoyed that!

Hugo

________________________________

Hugo Ramiro

http://middlemedici <http://middlemedicine.wordpress.com> ne.wordpress.com

http://www.chinesem <http://www.chinesemedicaltherapies.org>

edicaltherapies.org

May 17, 2009

Thanks Tom, I will be saving these documents.

I am more interested, though, in morbidity and mortality associated with

*correct usage* of Xi Xin / Asarum, including the varieties that have some

aristolochic acid present.

If you come across anythign like that, please shoot it my way as well!

Thanks,

Hugo

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.chinesemedicaltherapies.org

________________________________

Tom Verhaeghe <tom.verhaeghe

Chinese Medicine

Sunday, 17 May, 2009 15:35:25

RE: Re: Herb company that carries Shang han/Jin gui pills

Hugo,

If you want to read about morbidity and mortality about the kidney damage

that occurred in Belgium in the early nineties, here are two links:

* Vanherweghem JL, Depierreux M, Tielemans C, Abramowicz D, Dratwa M,

Jadoul M, Richard C, Vandervelde D, Verbeelen D, Vanhaelen-Fastre R, et al.:

Rapidly progressive interstitial renal fibrosis in young women: association

with slimming regimen including Chinese herbs.

Lancet 1993, 341(8842):387- 391. <http://www.cmjourna l.org/pubmed/ 8094166>

PubMed Abstract | <http://dx.doi. org/10.1016/ 0140-6736% 2893%2992984- 2>

Publisher Full Text

<http://www.cmjourna l.org/sfx_ links.asp? ui=1749-8546- 3-13 & bibl= B1> OpenURL

<javascript: turn();> Return to text

* Vanhaelen M, Vanhaelen-Fastre R, But P, Vanherweghem JL: Identification

of aristolochic acid in Chinese herbs.

Lancet 1994, 343(8890):174. <http://www.cmjourna l.org/pubmed/ 7904018>

PubMed Abstract |

<http://www.ncbi. nlm.nih.gov/ entrez/eutils/ elink.fcgi? dbfrom=pubmed &

cmd=prli

nks & retmode= ref & id=7904018> Publisher Full Text

<http://www.cmjourna l.org/sfx_ links.asp? ui=1749-8546- 3-13 & bibl= B2> OpenURL

Tom Verhaeghe

Stationsplein 59

8770 Ingelmunster

www.chinese- geneeskunde. be

_____

Traditional_ Chinese_Medicine

[Traditional_ Chinese_Medicine ] On Behalf Of Hugo

Ramiro

zaterdag 16 mei 2009 23:58

Re: Re: Herb company that carries Shang han/Jin gui pills

Hi Tom, thank you for doing the legwork here. I've only read the first one

so far, which unfortuantely contains no information at all on " morbidity or

mortality " . One point regarding check ups and such with western mds. I

myself am in that habit, but it must also be said that they are no guarantee

of anything, and that much of the time it will be only to cover our butts.

See this:

Letter: Orthodox Medicine Isn't Infallible

BMJ 1993;307;624- 625

Orthodox medicine isn't infallible

EDITOR,-In a letter about the Osteopaths Bill

E Ernst repeats the mistake of many orthodox

doctors-namely, that of resorting to a simplistic

stereotype of perfect orthodox medical diagnosticians

and their imperfect complementary

counterparts. Ernst asks whether osteopathic

treatment is to be prescribed after an orthodox

diagnosis by a " fully trained medical doctor " or

after direct access to a complementary practitioner

with only " non-optimal " knowledge and gives a

simple example of the dangers of the second

option: an osteopath being able to treat on the

NHS a patient with back pain caused by a spinal

malignancy. According to Ernst's conjecture, an

osteopath is much more likely to misdiagnose this

condition than a doctor.

I know of a real case similar to Ernst's conjecture,

but in which the roles are reversed. A colleague of

mine, who was eventually found to have a spinal

tumour, was misdiagnosed by two doctors, and it

was a subsequent visit to an osteopath that led to

the correct diagnosis. The osteopath concluded

that my colleague's lower limb neuromuscular

problems were caused not by an osteopathic lesion

but by a space occupying lesion in the spinal

canal pinching the nerves. A speedy referral to a

neurosurgeon was followed by the successful

removal of a benign tumour spanning three thoracic

vertebrae; the osteopath can take the credit for the

correct diagnosis.

This anecdote and others like it suggest that the

real world of health care in Britain is not as Ernst

suggests, for two reasons. Firstly, the open and

free access to general practitioners means that

the problems people take to complementary

practitioners have often been discussed with

an orthodox doctor beforehand. There is thus

ample opportunity for an initial orthodox medical

diagnosis (or misdiagnosis) of most problems.

Secondly, even though complementary practitioners

offer different diagnostic and therapeutic

approaches, this does not mean that they are blind

to the need to refer specific health problems to

orthodox doctors, nor that they are insufficiently

skilled to be able to detect the cases that require

this.

Obviously, there are perfect and imperfect

diagnosticians in all branches of health care, and it

is time for those of us who are in the orthodox

medical camp to refrain from defending our position

with simplistic, self righteous stereotypes.

DAVID ST GEORGE

Department of Public Health and Primary Care,

Royal Free Hospital School ofMedicine,

London NW3 2PF

I Emst E. Complementary medicine. BMJ

Hope you all enjoyed that!

Hugo

____________ _________ _________ __

Hugo Ramiro

http://middlemedici <http://middlemedici ne.wordpress. com> ne.wordpress. com

http://www.chinesem <http://www.chinesem edicaltherapies. org>

edicaltherapies. org

May 18, 2009

Chinese Medicine , Hugo Ramiro <subincor

wrote:

>

> Thanks Tom, I will be saving these documents.

> I am more interested, though, in morbidity and mortality associated with

*correct usage* of Xi Xin / Asarum, including the varieties that have some

aristolochic acid present.

Tom Verhaeghe just shared some excellent articles with the group on data

associated with the correct (educated professional) usage of xi xin. Thanks for

sharing the awesome articles, Tom. The original article was:

http://www.cmjournal.org/content/3/1/13

It is discussed further at the Blue Poppy blog at:

http://www.bluepoppy.com/blog/blogs/blog1.php/2009/02/25/xi-xin-and-aristolochic\

-acid

and

http://www.bluepoppy.com/blog/blogs/blog1.php/2009/05/16/interesting-data-on-ari\

stolochic-acid-an

Eric Brand

May 19, 2009

Hugo Ramiro wrote:

Again, what I should have stated clearly at the beginning is that I am most

interested in knowing some numbers behind aristolochic acid damage when the

herbs are used according to pattern differentiation.

Again, sorry for the mix-up Z'ev, YukMing and everyone else!

Hugo

-----------

Dear Hugo,

At your service. See:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1312226

This open access paper at Pubmed Central entitle Chinese Herbal Nephropathy

gives you the essential details about the injury and it's origins in Western

medical diet regimens. It also notes that 80% of our current world population

relies on herbal medicine of some sort indigenous to their cultural home areas.

Back at the time of the " alert " in the late 1990s there were only two papers

written in reference to the Belgian diet regime that caused kidney injury along

with a similar episode in Japan. China had its episode prior to the major

national alerts across Europe, Canada, Japan and the U.S. The two papers were

from Japan and from Germany. They were well carried out to identify

aristolochic acid as the molecule of toxicity and the mechanism of nephropathy.

You'll see in the open text review paper than basement membrane and endothelial

matrix injury (thickening of the nephron's can capillaries' walls) was the

mechanism of injury.

Standard medical physiology texts that I teach with note that our bodies perform

upwards of 28 full dialysis filtration treatments of our blood per day. That's

a lot of work and accounts for 25% of the heat of the body while sleeping. The

proximal convoluted tubule thankfully " actively " transports essential nutrients

from the kidney's filtrate back into the blood. Active transport is the work.

What's left of the blood's filtrate is excreted as urine. Transformation and

thickening of the nephron's walls (especially proximal convoluted tubules) is

the mechanism of injury that was defined as CHN.

The nephropathy happens in as little as two months time in some of the women who

go on the dietary regime that includes not only strong herbs but in the Belgian

case included belladonna extracts, phen/fen (Phentermine/Fenfluramine), etc. I

gave you the " Matrix Pre-loaded " paper to allow you to see how this basement

membrane thickening happens in arteries as well as in the kidney's tubules due

to hyperglycemia and glycosylation (advanced glycosylated end products). Pure

AA used at high dosages on healthy mammalian species took 3 to 4 months to cause

tubular wall thickening. So obese humans have been working on this for awhile

without the help of toxic pharmaceuticals.

By the way, I expect my physiology students who graduate from my standard

undergraduate course in California to know this stuff cold before they apply for

their masters or doctorate programs in various allied health fields including

Chinese medicine. This is science every L.Ac. or physician in the U.S. should

know. These are the patho-physiological mechanisms of Metabolic Syndrome. The

U.S. Surgeon General as well as the Director of the Center for Disease Control

have been " throwing down the gauntlet " since year 2002. They've been saying

that Metabolic Syndrome is not the largest disease threat to children in

America.

The fasted cure is quick and easy: go out the door under the sky and play. (^;

-ing. Who would have thought that " bondage to the computer screen " would have

destroyed the Western world. At least that's the implication. The greatest

danger to American children is inactivity and eating processed foods to

fullness. Hopefully we can meet the challenge.

Gratefully ... cycling along the Bay Trail (^; -ing,

Emmanuel Segmen

May 19, 2009

Dear Hugo and All,

My appologies for the typo. Too many distractions while trying to write this.

I wrote: " The U.S. Surgeon General as well as the Director of the Center for

Disease Control have been 'throwing down the gauntlet' since year 2002. They've

been saying that Metabolic Syndrome is (not) the largest disease threat to

children in America. " I meant to write, " ... Metabolic Syndrome is the largest

disease threat to children in America. " That according to the above WM

authorities.

I've had a bit of exercise since I wrote that earlier. (^;

Gratefully,

Emmanuel Segmen

-

Emmanuel Segmen

Chinese Medicine ; Hugo Ramiro

Monday, May 18, 2009 5:18 PM

Re: Herb company that carries Shang han/Jin gui pills