Guest guest Posted November 7, 2009 Report Share Posted November 7, 2009 Hi Karen Your question cuts to the heart of a dilemma I face daily, which is the occasional conflict of TCM and western medicine. Let me just mention that I live in both worlds. I am a western trained MD, board certified internist, and a fully licensed TCM practioner, NCAAOM certified (DOM in New Mexico). Especially when herbs are involved, there will be conflicts. A couple of points.... Coumadin is used in atrial fibrillation because there is a slight risk of stroke without it. I say slight, but the problem is that the stroke could be devastating if you are the unlucky one. Around 2-3% risk of stroke per year. In an 80 year old, thats not much risk. In a younger person....more years of life left, more stroke risk. There is no good research on herbs in this equation, so western MDs go with what we have....coumadin (which also has risk of events at around 0.5-1% per year, but many of these may be treatable). So from a western perspective, if you are diminishing the effect of coumadin, you increase the risk of stroke. Notice....the western use of coumadin has no bearing on the heart itself, only the risk of a problem caused by the heart ailment. I tend to be very reticent to use herbs in patients on coumadin, because they could alter the degree of anticoagulation and cause bleeding problems if it is too thin. But, I think herbs are safe if..... 1) An herbal formula is selected and stuck with, same dose, same herbs, over a long period of time. This generally means a fairly mild formula with minimal long term risks, like Liu Wei Di Huang Wan. 2) Western MDs then can adjust the coumadin dose accounting for the herbs. They may need more or less, but as long as the herbal dose is regular, coumadin doses can be adjusted to compensate. Its not a big deal, and can be done safely. Remember, many vegetables affect coumadin dosing, and we would tell patients to either avoid these or eat them regularly. 3) Whenever herbs are changed, just have the blood checked more frequently for a while. As for whether the coumadin and herbs are interfering with each other, remember that a blood test is not TCM. If the INR is returning to normal, this may in no way reflect the effect of the herbs. Our blood stasis is not their blood coagulability. Use what we're trained with, pulse, symptoms, disease patterns, and treat accordingly. This is very powerful medicine, and my guess is that from the patient's perspective, your treatment is more helpful than the western treatment. They are treating the branches (although stroke is a mighty big branch), you are treating the root. Don't give up, but you need to be careful with the herbs. If the INR is coming back to normal, it is more likely that the herbs are directly weakening the effect of coumadin (as would lettuce and many other plants). Many western MDs may give you trouble with this. However, even in the current western medical paradigms, the patient should have the last vote. If your medicines are helping, the patient can just tell the western MDs that he/she is not going to stop them, and western MDs can compensate. Safely. Easily. The only risk is if herbal doses change frequently or the patient doesn't take them regularly. Hope this helps chicoliv MD, DOM Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2009 Report Share Posted November 9, 2009 Hi Chico - thanks for this, it's clearly well thought out. Interesting to know that the risk is small statistically - and I get that if you fall into that percentile it won't be a good thing. Also interesting, perhaps: I don't use herbs. I've been building his blood and moving it. He says the only thing that's changed is having acupuncture... k Karen R. Adams, Lic Ac, Dipl Ac 25 - 27 Bank Row Greenfield, MA 01301 413-768-8333 All shall be well and all shall be well and all manner of thing shall be well Julian of Norwich, 14th century British mystic ________________________________ Chico Livingston <chicoliv Chinese Medicine Sat, November 7, 2009 2:23:21 AM Coumadin and Atrial Fibrillation Hi Karen Your question cuts to the heart of a dilemma I face daily, which is the occasional conflict of TCM and western medicine. Let me just mention that I live in both worlds. I am a western trained MD, board certified internist, and a fully licensed TCM practioner, NCAAOM certified (DOM in New Mexico). Especially when herbs are involved, there will be conflicts. A couple of points.... Coumadin is used in atrial fibrillation because there is a slight risk of stroke without it. I say slight, but the problem is that the stroke could be devastating if you are the unlucky one. Around 2-3% risk of stroke per year. In an 80 year old, thats not much risk. In a younger person....more years of life left, more stroke risk. There is no good research on herbs in this equation, so western MDs go with what we have....coumadin (which also has risk of events at around 0.5-1% per year, but many of these may be treatable). So from a western perspective, if you are diminishing the effect of coumadin, you increase the risk of stroke. Notice....the western use of coumadin has no bearing on the heart itself, only the risk of a problem caused by the heart ailment. I tend to be very reticent to use herbs in patients on coumadin, because they could alter the degree of anticoagulation and cause bleeding problems if it is too thin. But, I think herbs are safe if..... 1) An herbal formula is selected and stuck with, same dose, same herbs, over a long period of time. This generally means a fairly mild formula with minimal long term risks, like Liu Wei Di Huang Wan. 2) Western MDs then can adjust the coumadin dose accounting for the herbs. They may need more or less, but as long as the herbal dose is regular, coumadin doses can be adjusted to compensate. Its not a big deal, and can be done safely. Remember, many vegetables affect coumadin dosing, and we would tell patients to either avoid these or eat them regularly. 3) Whenever herbs are changed, just have the blood checked more frequently for a while. As for whether the coumadin and herbs are interfering with each other, remember that a blood test is not TCM. If the INR is returning to normal, this may in no way reflect the effect of the herbs. Our blood stasis is not their blood coagulability. Use what we're trained with, pulse, symptoms, disease patterns, and treat accordingly. This is very powerful medicine, and my guess is that from the patient's perspective, your treatment is more helpful than the western treatment. They are treating the branches (although stroke is a mighty big branch), you are treating the root. Don't give up, but you need to be careful with the herbs. If the INR is coming back to normal, it is more likely that the herbs are directly weakening the effect of coumadin (as would lettuce and many other plants). Many western MDs may give you trouble with this. However, even in the current western medical paradigms, the patient should have the last vote. If your medicines are helping, the patient can just tell the western MDs that he/she is not going to stop them, and western MDs can compensate. Safely. Easily. The only risk is if herbal doses change frequently or the patient doesn't take them regularly. Hope this helps chicoliv MD, DOM Quote Link to comment Share on other sites More sharing options...
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