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Dear All -

 

My apologies for not being engaged in dialogues on CHA over the last few

years my job and study requirements have precluded that. Style of

communication, which I have regarded as rather challenging in this forum, is

something that we can all work on.

 

To the matters at hand. I must agree with Jason about dosing, to a point.

Small doses do have a strong body of support historically and in

contemporary times. Most of my studies during the 90s were in the Menghe

current, with Drs Shen and Hammer. I was on the East coast and sent many

patients to Dr. Shen, analyzing their formulas in detail. Hammer also had a

rather large collection of formulas from Dr. Shen. Every one of these

formulas and the ones that we managed to collect from Shen's lectures

throughout the world had small doses.

 

There is also Yang Tiande, Al Stone speaks of him occassionally here. Yang

is a genious practitioner in a Beijing family lineage and is arguably one of

the finest in the LA basin. His reading list over the seven years that I

observed his practice included Ye Tianshi, Li Dong Yuan, Zhang Zhongjing and

their commentators. Yang's prescribing style used small herbs. I asked him

one day about his refined adjustments to formulas (sometimes .5 grams). He

always would name Ye Tianshi under these circumstances. But - he also said

to me one day - " I just think about how they taste. Then I adjust the doses.

It is like cooking. "

 

I also followed Neiqiang Gu, from a famous Shanghai family external

speciality lineage. He and I developed a close relationship over a five year

period. His doses were usually medium. However, I also saw him push the

doseage for agents such as bai hua she she cao and hu zhang.

 

What I have noticed is that there is a regional trend in dosing style among

faculties providing services in US AOM institutions. Those from northern

areas and ethnic areas closer to Tibet seem to employ larger doses than

those practitioners who come from Beijing and Shanghai. This is a rather

broad generalization based upon a limited set. But the northern ethnic

practitioners do tend to be heavy handed in dosing style.

 

I say heavy handed because it was a constant syle. In my opinion, large

doses can be advantageous, just as small doses. The question is when and

where? The style that I learned from Wang Jinling who was my first clinical

instructor in the early 80s, was to treat the pattern based upon small and

moderate dosing, and to push the dose of a specific herb that had an

evidence basis for the condition under treatment. All in all, my preference

is small dosing.

 

 

Warmly,

 

Will

 

 

 

--

William R. Morris, PhD, DAOM, LAc

 

http://www.aoma.edu/

http://www.pulsediagnosis.com/

http://health.PulseDiagnosis/

 

 

 

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Yes this whole SHL dosage debate is tricky to understand. Reading Arnauds

comments on his forum make it clear that he believes the dosages were high. He

talks about even Wu Zhu Yu being used at 45g doses!

 

Trevor

 

 

, " " wrote:

>

> Daniel,

>

>

>

> Thanks for the your below analysis. I am familiar with this argument in

> regard to dosage of SHL. As mentioned in my previous email there are two

> sides to this story, and the verdict is far from out. Some people believe

> that the dosages are smaller and some larger. Hence I do not think it can be

> used as proof that traditional styles were the majority of the time using

> large dosages. Especially since most texts that I have seen side with the

> smaller dosages.

>

>

>

> However, how can one not disagree with your observation that there are many

> styles in CM history all following various dosages as well as number of

> ingredients. However, this conversation originally started with the BeiJing

> doctor prescribing 180 grams a day. This was said to be a moderate dose in

> regard to traditional standards. I still disagree. Besides this SHL / JGYL

> possibility, I still find that bit high. Look through the F & S book and one

> can get an overview of dosing through the centuries. I think it is clear

> that 180 grams a day is a bit on the higher side for traditional standards.

>

>

>

> I guess it comes down to preference. If you like giving 100 grams of fuzi a

> day, then go for it. There are always going to be extremist on every end.

> Some give 1-2 grams of granulars a day. Some 300grams of bulk. I think that

> if I can find a way to prescribe that isn't extreme than all the better. I

> like moderation. Hence one again, I am not trying to invalidate any school

> of thought, one can learn something from them all, I just think some are bit

> much once one studies a more harmonious system. I of course will keep my eye

> out for that person who needs 100 grams of chai hu J..

>

>

>

> So if these high dosages are modern or classical, does not really matter.

> What I really think should be challenged are the high dose shotgun formulas

> that many modern doctors are using based on Western disease etc. But that is

> another topic.

>

>

>

> -

>

 

> On Behalf Of daltsch

> Sunday, April 12, 2009 2:00 PM

>

> Re: Dose of herbs prescribed to Westerner in Beijing

>

>

Hi Jason

>

> Thank you for your response. (as well as Trevor and Carl).

>

> Jason, you are certainly correct in catching me carelessly using the word

> 'tradition'. There are many traditions, all coexisting. It is also obvious

> that our 'lineages' are quite different, and that is the beauty of Chinese

> medicine--such diversity has created the amazing tradition we all share.

> However, I do disagree with your statement that high doses were the

> exception not the norm with regard to 'tradition'. There is a 2000 year span

> that antedates 'premodern' that can all be considered 'traditional'. In that

> time quite a lot has happened.

>

> Vast changes have been seen in dosaging over the centuries. The Shang Han

> Lun, from which I clinically and theoretically draw from the most, has

> extremely high dosages listed in the 'original' text. This 'tradition' is

> arguably the oldest. Mahuang is listed at 3 liang in Mahuang Tang and 6

> liang in Da Qinglong Tang. Guizhi in guizhi Tang is 3 liang. According to

> historical weights and measures scholarship, one liang in the Han dynasty is

> about double what it is now. So converting it over time and into grams, we

> get 1 liang a little more than 15g (a slight underestimate) x 4 or 6 comes

> to 45 to 90 grams for mahuang and 35g for guizhi. Now, these formulas were

> meant to be fast acting, but of course more dangerous. This is why there are

> so many formulas and counter-formulas within the SHL to take care of mis-use

> or over use of certain formulas. This tradition of high dosages is alive and

> flourishing in Taiwan and quite a few practiotioners in China. (I cannot

> speak for Korea or japan). Most practitioners who are ardent Shang Han

> Lun'ists don't use these classic doses, but do tend to fall in the range of

> 3 to 5 liang on average (say 12 to 20 grams) per herb. And, of course, few

> stick to the original formula, choosing instead to add in (for better or

> worse) quite a few herbs.

>

> Shooting more than 1600 years later, the Wenbing school (warm disease

> school) took a different approach. Their formulas tended to be weighted

> less, though certainly not lightweights. However, they were looking at a

> different types diseases (of course you could also say, in many cases, the

> same disease from a different perspective), and there was a need for a

> milder yet more patient therapy. For example, treating combined heat and

> damp diseases becomes quite tricky. Or extremely high febrile, including

> hemorragic, diseases that quickly move into the deeper regions of the body

> (chinese medicine speak). SHL doses of guizhi tang or mahuang tang, etc.

> would not necessarily be wise for such problems.

>

> Then your tradition--often dubbed the Shanghai School--has quite a

> distinguished lineage as well, with dosages not unlike the those found in

> the Pi-Wei Lun (famine underscored Li Dong Yuan's patients). An interesting

> aspect with many of the practitioners in this small-dose lineage is that

> instead of using a high dose for one herb, two somewhat redundant herbs

> might be used but each at lower doses. Thus 20 grams of cangzhu might be

> substituted for 10 grams each of cangzhu and baizhu. (random example)

>

> Then there is what is known as the Fire-God school. This is alive and well

> in China today and doses of some herbs (chaihu, fuzi, etc.) are in the 100

> -150g range.

>

> And, there is a whole lot of space to maneuver in between all these

> approaches, depending on individual practitioners, patients, and disease

> types. Certainly, there are numerous other reasons why a some practitioners

> alter dosages that have nothing to do with medicine at all (moralists and

> idealists should stop reading here). Doctors or patients who wish to cut

> costs lower doses. Doctors who wish to make money by selling the herbs or

> attempt to evoke professional respect with a big bag of weighty herbs

> increase doses--just as many practitioners in the US keep their consultation

> fees somewhat high at a 'respectable' rate citing the business model that

> the more a client pays, the more s/he will respect you. (Physicians in

> Taiwan make money off of the treatment, not the consultation fee.) I know

> many physicians and patients who fit into all of the above categories.

>

> In any case, proper use of herbs should not cause liver toxicity, unless you

> are treating a patient whose liver is already compromised (hepaititis,

> cirrhosis, cancer, etc.) or there are herbs which are known to potentially

> damage the liver (or kidney)--huangyaozi, di yu, fangji, etc. In all my

> years in Taiwan (15) observing patients with seroius diseases taking high

> dosed formulas for months and even years, I have yet to see any incuring

> liver or kidney problems.

>

> Anyway, thanks Jason for keeping me in check. I think that it is important

> to acknowledge all of the coexisting traditions. As long as the herbs are

> prescribed with wisdom, experience and a little creativity, and not

> halfhazardly, the patient should benefit.

>

> I have written this rather quickly and hope I have not made too many errors.

> Since I am relatively new here in the US, I welcome responses to this very

> interesting topic and am interested to hear the attitudes and experiences of

> other herbalists outside of Asia.

>

> Happy Spring to all

>

> Daniel Altschuler

> Seattle, WA

>

> -

>

>

> <%40>

> Saturday, April 11, 2009 1:46 AM

> RE: Dose of herbs prescribed to Westerner in Beijing

>

> Daniel,

>

> I actually believe the opposite, and would like to see some evidence that

> larger dosage formulas are the norm for a 'traditional perspective.' I think

> larger dosage formulas are a more modern approach, many times fueled by

> pharmacological / Western style research. I cannot speak for Taiwan, for I

> have only studied their once, but in the mainland there are plenty of famous

> doctors, actually most of the one's I have studied with, that do not use

> large dosages. It is also clear that one can get results with serious skin,

> autoimmune, etc with small concise formulas. THIS is what I see as a

> traditional approach, hence practiced usually only by the really old

> doctors, with strong classical training.

>

> Actually one just needs to look through case studies and see how small and

> precise the formulas were by some of the best doctors in history - hence

> what I call a traditional approach. Of course there are exceptions with

> doctors using large dosages, but there are plenty of examples of small

> dosage formulas. Check out Ye Tian-Shi, Ding Gan ren, Qin Bo-wei, Liu

> Bao-yi, and the meng-he doctors to see this style in real clinical

> practice.

>

> However your definition of traditional might be different than mine. I think

> of a traditional approach from doctors prior to 'Modern TCM " and who used a

> traditional approach to diagnosis and based their formulas on classical

> ideas and prescriptions. Just for the record there is too much debate for

> the SHL's dosages to weigh in on this topic.

>

> I also disagree that 'smaller dosages' has to do with the economic situation

> of the patient. There are doctors that I study with that just use small

> dosages because they find no need to blast people out of the water. The get

> some of the best results around hence are the busiest doctors. These

> doctors do say that overdosing is an issue and too many herbs can be

> harmful.

>

> I always wonder why one would opt for an approach where one has to

> constantly monitor Liver enzymes. Of course safe is best if you choose such

> an approach, but such a strong approach IMHO is just unnecessary.

>

> -

>

>

> <%40>

> [

> <%40> ] On Behalf Of Daniel

> Altschuler

> Saturday, April 11, 2009 11:37 AM

>

> <%40>

> RE: Dose of herbs prescribed to Westerner in Beijing

>

> 180 gms is actually quite a moderate dose from a traditional perspective.

> Dosages in Taiwan tend to average 4 to 6 liang (one bag per day). One liang

> is, in taiwan, 37.5g. Small dosages on the mainland has a lot to do with the

> economic situation of the average person than it does with concern for

> 'overdosing'. In taiwan, many clinics (not herbal shop) have a set price for

> their formulas--they charge per bag not per gram. So they actually lose

> money with large prescriptions. Of course, this does not necessarily speak

> for what happened in Beijing, but there are quite a few well known

> physicians in China who retain old style treatment methods and use large

> doses.

>

> Daniel Altschuler

>

> irus Database: 270.11.48/2048 - Release 04/10/09 18:27:00

>

>

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Hi Jason,

 

I have a blood testing machine called the Reflotron. It tests liver enzymes and

a whack of other blood components. The results are very accurate. A sample of

one is here: http://www.diavant.com/diavant/CMSFront.html?pgid=3,1,9,0

 

If your are interested in the topic, I suggest that you read the article Mazin

published on his own research (if you haven't already).

 

http://www.jcm.co.uk/media/sample_articles/liverenzymes.pdf?fe=f00694ce82be57f20\

feb4c42bc23f00f

 

Best

Trevor

 

>

> Short and long term results in the clinic are the most important to all of

> us. I developed faith in a system that was shown to be effective and, from

> the hundreds of cases presented to me, safe. I look forward to seeing the

> new material coming out on the topics you mentioned. I hope that this will

> also be able to be backed up with presenters sharing their wonderful

> experiences of this system, so that we can all develop as much faith as you

> Jason.

>

> Trevor

>

> --- In

>

>

>

>

>

>

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Jason,

 

I would love for you to elaborate on what you said, " What I really think should

be challenged are the high dose shotgun formulas that many modern doctors are

using based on Western disease etc. But that is another topic. " I find this

topic very interesting and we can start a knew thread if you wish.

 

Are talking about treating based on:

Disease name in general?

Western disease names in general?

One size fits all for western disease name?

 

Best

Trevor

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This is an interesting exercise :-)

 

Although I agree with Carl that visuals are very important in diagnosing skin

disease, I will give it a shot based on the limited written info we have.

 

To me it seems clear that this child is suffering with some sort of eczema. My

Dx would be Blood heat with wind.

 

I have been to taught to discriminate between two main poles of manifestation

with Eczema. On the one side is damp heat and on the other is blood heat with

wind. The main way to tell the difference, besides a visual observation, is

through the ability to sweat(showing evidence of damp predominance) or not

(showing evidence that damp is not that extreme). Of course there is a lot of

various within this, but it is a good place to start.

 

With the rapid pulse, dry, red, itching, lack of sweating, and excoriated skin,

I am validating my Dx of blood heat with wind. The heat in the blood could also

explain the vexation and rough breathing.

 

I would probably base my Rx on Dao Chi San with modifications.

 

Sheng Di Huang 12

Mu dan Pi 6

Dan Zhu Ye 6

Deng Xin Cao 2

Fang Feng 6

Jing Jie 6

Lian Qiao 6

Jin Yin Hua 6

Bai Xian Pi 6

Sheng Gan Cao 2

 

I think I would start with this for a week and see how the little guy responds.

 

I would love to hear what the actual diagnosis, treatment method, and outcome

was :-)

 

Best

Trevor

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Jason,

 

Just to be clear, I do not think, nor do I feel challenged, that you are trying

to " convert " me to any one style. I really am just motivated by styles that have

been shown to be effective. Again I am VERY interested in your style and look

forward to learning more about it, as more work is published on it.

 

The great thing about skin disease, which is the reason I decided to focus on

it, is that results are objective and obvious. A person's skin either gets

better or not. Everyone present can see this with their own eyes. Short and long

term results can be measured and the argument becomes very clear. Thus it

becomes a lot easier to present/ teach/ and increase the student practitioners

faith in any given style- as they can more easily grasp what it is they are

working with and what kind of realistic treatment expectations to expect.

 

Best

Trevor

 

 

,

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Bill,

Is there any record or planned publishing of Dr. Shen's compiled

formulas? We need more texts of great physicians' case histories and

prescriptions, both herbal medicine and acupuncture.

 

 

On Apr 12, 2009, at 7:09 AM, William Morris wrote:

 

>

>

> Dear All -

>

> My apologies for not being engaged in dialogues on CHA over the last

> few

> years my job and study requirements have precluded that. Style of

> communication, which I have regarded as rather challenging in this

> forum, is

> something that we can all work on.

>

> To the matters at hand. I must agree with Jason about dosing, to a

> point.

> Small doses do have a strong body of support historically and in

> contemporary times. Most of my studies during the 90s were in the

> Menghe

> current, with Drs Shen and Hammer. I was on the East coast and sent

> many

> patients to Dr. Shen, analyzing their formulas in detail. Hammer

> also had a

> rather large collection of formulas from Dr. Shen. Every one of these

> formulas and the ones that we managed to collect from Shen's lectures

> throughout the world had small doses.

>

> There is also Yang Tiande, Al Stone speaks of him occassionally

> here. Yang

> is a genious practitioner in a Beijing family lineage and is

> arguably one of

> the finest in the LA basin. His reading list over the seven years

> that I

> observed his practice included Ye Tianshi, Li Dong Yuan, Zhang

> Zhongjing and

> their commentators. Yang's prescribing style used small herbs. I

> asked him

> one day about his refined adjustments to formulas (sometimes .5

> grams). He

> always would name Ye Tianshi under these circumstances. But - he

> also said

> to me one day - " I just think about how they taste. Then I adjust

> the doses.

> It is like cooking. "

>

> I also followed Neiqiang Gu, from a famous Shanghai family external

> speciality lineage. He and I developed a close relationship over a

> five year

> period. His doses were usually medium. However, I also saw him push

> the

> doseage for agents such as bai hua she she cao and hu zhang.

>

> What I have noticed is that there is a regional trend in dosing

> style among

> faculties providing services in US AOM institutions. Those from

> northern

> areas and ethnic areas closer to Tibet seem to employ larger doses

> than

> those practitioners who come from Beijing and Shanghai. This is a

> rather

> broad generalization based upon a limited set. But the northern ethnic

> practitioners do tend to be heavy handed in dosing style.

>

> I say heavy handed because it was a constant syle. In my opinion,

> large

> doses can be advantageous, just as small doses. The question is when

> and

> where? The style that I learned from Wang Jinling who was my first

> clinical

> instructor in the early 80s, was to treat the pattern based upon

> small and

> moderate dosing, and to push the dose of a specific herb that had an

> evidence basis for the condition under treatment. All in all, my

> preference

> is small dosing.

>

> Warmly,

>

> Will

>

> --

> William R. Morris, PhD, DAOM, LAc

>

> http://www.aoma.edu/

> http://www.pulsediagnosis.com/

> http://health.PulseDiagnosis/

>

>

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I don't mean to get this thread off-topic, but I wonder if this issue of low

dosage formulas could have any correlation to powdered extracts visa vis

could explain/give support to why doses of 10-16g/day of powdered extract

formulas are still seen as having clinical benefit by those who dose in that

range...

 

Joy

 

 

________

Joy Keller, LAc, Dipl.OM

Board Certified in Acupuncture & Oriental Medicine

Ramona Acupuncture & Integrative Medicine Clinic

Phone: (760) 654-1040 Fax: (760) 654-4019

www.RamonaAcupuncture.com

 

 

 

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Will, Jason, Daniel, all,

I have another take on this issue. I think dosing reflects the

basic foundational philosophies of different styles of practice. Many

of our patients have chronic, complex issues that are strongly

connected with their psychological/emotional states reflected as

physical symptoms (symptom patterns). They may have been treated for

specific diseases pharmacologically and otherwise, but either haven't

responded well or have developed what Zhang Ji called bian zheng/

transmuted patterns. These patients, in my opinion, need a greater

length of time of treatment, gradual, and process oriented. They are

usually too weak for sudden assaults with strong medicines. One can

choose prescriptions, for example, that are harmonizing to shao yang

(if appropriate) such as xiao chai hu tang or chai hu jia long gu mu

li tang in smaller doses and gradually open up the patient in ways

that will not cause 'revolt'.

 

In other patients, we have an acute attack or a clear disease

pattern that needs strong intervention, stronger prescriptions with

pharmacologically active substances to the fore. For example, in

exterior patterns I will greatly increase dosages of herbs to drive

out the exterior evils if appropriate. Also, strong patients with

acute conditions will not respond to relatively low dose therapy, they

may be 'desensitized'.

 

The same holds true for acumoxa therapy. We focus and strengthen

therapy or increase subtlety through the factors of

a) length of treatment

b) repetition of treatment (times per week)

c) strength of needle stimulus

d) depth of insertion

e) number of needles or moxas used.

 

In herbal medicine we have large and small prescriptions, strong or

mild ingredients, dosages, frequency and length of treatment. We need

to be prepared for a full spectrum of possibilities, which means a

large knowledge base, great flexibility, and the possibility that we

are biased in a certain direction that doesn't benefit our patient.

Then we need to refer out.

 

We should remember that the herbal tradition was based largely on

the triad of heaven, humanity, and earth, superior, middle and

inferior grade medicinals, with superior grade being supporting the

correct qi, and inferior the treatment of disease (in the Divine

Farmer's Materia Medica). While we have an obligation to treat

disease, don't we also have an obligation to support our patients'

health?

 

I am also a fan of the Menghe tradition. Although I have

relatively little exposure to it, what I've seen resonates with me

strongly. I like what Volker Scheid says about it in his " Currents of

Tradition " text and in the new " Formulas and Strategies " . I also know

that Chip, Bill Morris and Jason appreciate it as well. From what

Volker writes, it would seem that the Menghe physicians such as Fei

Boxiong had patients who suffered from 'exhaustion and fatigue', due

to 'damage by the qi shang/seven emotions'. They had 'weak

constitutions, were unaccustomed to exercise, stressed by too much

work and thinking, frequently were unable to express their personal

worries (openly). "

 

A majority of my patients fit this category, therefore the more

long-term, gentle treatment with formulas that harmonize qi

transformation fit the bill. . .most of the time. My style and

demeanor, the setting in which I practice, are copacetic with these

clinical concerns.

 

When we have these discussions, while we must define what has come

before us in tradition, and pay heed to the roadmaps and markers

placed before us, we must find our place in this great tradition in

the style that suits us best, otherwise our therapies will not be as

useful as they might be otherwise.

 

 

 

 

On Apr 12, 2009, at 7:09 AM, William Morris wrote:

 

>

>

> Dear All -

>

> My apologies for not being engaged in dialogues on CHA over the last

> few

> years my job and study requirements have precluded that. Style of

> communication, which I have regarded as rather challenging in this

> forum, is

> something that we can all work on.

>

> To the matters at hand. I must agree with Jason about dosing, to a

> point.

> Small doses do have a strong body of support historically and in

> contemporary times. Most of my studies during the 90s were in the

> Menghe

> current, with Drs Shen and Hammer. I was on the East coast and sent

> many

> patients to Dr. Shen, analyzing their formulas in detail. Hammer

> also had a

> rather large collection of formulas from Dr. Shen. Every one of these

> formulas and the ones that we managed to collect from Shen's lectures

> throughout the world had small doses.

>

> There is also Yang Tiande, Al Stone speaks of him occassionally

> here. Yang

> is a genious practitioner in a Beijing family lineage and is

> arguably one of

> the finest in the LA basin. His reading list over the seven years

> that I

> observed his practice included Ye Tianshi, Li Dong Yuan, Zhang

> Zhongjing and

> their commentators. Yang's prescribing style used small herbs. I

> asked him

> one day about his refined adjustments to formulas (sometimes .5

> grams). He

> always would name Ye Tianshi under these circumstances. But - he

> also said

> to me one day - " I just think about how they taste. Then I adjust

> the doses.

> It is like cooking. "

>

> I also followed Neiqiang Gu, from a famous Shanghai family external

> speciality lineage. He and I developed a close relationship over a

> five year

> period. His doses were usually medium. However, I also saw him push

> the

> doseage for agents such as bai hua she she cao and hu zhang.

>

> What I have noticed is that there is a regional trend in dosing

> style among

> faculties providing services in US AOM institutions. Those from

> northern

> areas and ethnic areas closer to Tibet seem to employ larger doses

> than

> those practitioners who come from Beijing and Shanghai. This is a

> rather

> broad generalization based upon a limited set. But the northern ethnic

> practitioners do tend to be heavy handed in dosing style.

>

> I say heavy handed because it was a constant syle. In my opinion,

> large

> doses can be advantageous, just as small doses. The question is when

> and

> where? The style that I learned from Wang Jinling who was my first

> clinical

> instructor in the early 80s, was to treat the pattern based upon

> small and

> moderate dosing, and to push the dose of a specific herb that had an

> evidence basis for the condition under treatment. All in all, my

> preference

> is small dosing.

>

> Warmly,

>

> Will

>

> --

> William R. Morris, PhD, DAOM, LAc

>

> http://www.aoma.edu/

> http://www.pulsediagnosis.com/

> http://health.PulseDiagnosis/

>

>

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Carl,

 

 

 

Of course seeing the patient is helpful, however one should be able to use

written record to discuss cases.

 

 

 

For example it was asked from me to provide " proof " that such difficult

cases can be solved with smaller - more traditionally sized dosage formulas.

People for some reason just can't believe that it is possible. This proof,

though, was to via case studies. I would have to ask how would anyone

provide " proof " to people who a) do not believe such a feat is even

possible, and b) without seeing patients.

 

 

 

No information would ever be enough. No one will take my word for it nor why

should they. So I find the request a bit odd. Quite simply what would it

take to provide Trevor (or others) with proof that such conditions can be

treated in this manner. Can it be done through the internet? This is

precisely why I said wait for Greg's book or find a master doctor to follow.

 

 

 

However I believe otherwise. I believe written record is valid and we should

be able to discuss such a case as presented in the previous email. One

should always be able to get into the ballpark with some idea on how to

treat a patient even if it is just an exercise on paper. If one needs a

specific skin manifestation to use a given herb or to confirm a diagnosis

that can be mentioned. However, just saying one must see the patient to

comment is a bit of a cop out. Really there is not a right answer, we just

try to learn from the answer.

 

 

 

There is a large tradition is CM that uses written record case studies

including dermatology to learn from. I find such exercises important because

they can show you that there are completely different ways to treat

conditions than one is used to. If one views a given case through a various

lens, but the doctor cures the case with something totally different than

bammm. One can see the possibility of something different. This is why there

are literally 1000's of case study book.

 

 

 

If one is trained that everyone needs fu zi or large dosages it will hard to

believe otherwise. The only issue I have with this discussion is the

potential toxicity that accompanies any form of extreme or high dose

treatment (albeit, Chinese medicine Western or otherwise). All herbs are

potentially toxic. The more we give, the more harm that can occur.

 

 

 

Without exposure to the vast options out there we can easily only see one

way. This also validates the idea that if we don't know that high dosages of

herbs like fuzi etc are possible, then we might miss an opportunity. Since I

have not studied with anyone that does this I personally am at a deficit

here. Are their people on the list that find that high dosages of fuzi are

the only thing that will help certain conditions?

 

 

 

Ultimately I guess all that any of us can do is get exposed to as much as

possible and find what works and then choose the safest treatments. Hence

why I am huge fan of eclectic (meng-he) medicine.

 

 

 

Thoughts?

 

 

 

-Jason

 

 

 

 

 

 

 

 

On Behalf Of Carl

Sunday, April 12, 2009 5:49 PM

 

SV: Dose of herbs prescribed to Westerner in Beijing

 

 

 

 

 

 

 

Jason

 

I can not speak for either Mazin or Trevor of course, both whom are a lot

more experienced in treating skin problems than me, but for me to treat any

skin problems I need to see the patient visually at least through one or

several photos.

 

Basically I admire any system of thought that can get good results

constantly, without jeopardizing the patient's health in the process. Being

able to write formulas with small dosages would be very nice, but as Trevor

said, I have not found anyone that could time after time show good results.

 

Mazins style is very convincing, since he can back it up with case after

case.

 

It seems to me that you are very lucky being able to follow such a good

teacher with all that experience.

 

Thanks to you and Trevor for an enlightening conversation, I am just sad I

can not keep up since my English is not the best.

 

Happy Eastern!

 

Carl

 

 

 

 

 

 

 

 

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Z'ev,

 

 

 

I don't think anyone can argue with what you say (or at least I won't). I

also vary considerably my dosage dependant on the situation, patient etc.

 

 

 

However, I think there is a bit of a terminology issue here. I think when

one says small dosage we are thinking of some minute amount, actually I am

just contrasting it to the large heavy handed approach of modern Chinese

hospitals, e.g. as this BeiJing doctor prescribed 180grams a day for no real

disease. There is plenty of history with the dosage and methodology that I

describe.

 

 

 

This Beijing 180g is common though, and IMHO not representative of

traditional medicine. They often choose herbs at 30-60 grams because of

pharmacological actions based on disease or disease process etc. For better

or worse this really is a different medicine. But as we all know, there is a

lot of ideas out there and I would love someone to bring forth a

traditional lineage / famous doctor's case studies that routinely used high

dosages.

 

 

 

Also to elaborate, the meng-he current / tradition are really just

eclectics. The studied all the major traditions and used what was needed for

the situation. Qin Bo-Wei through influence of Ding Gan-Ren was the most

articulate and prolific at laying this out in a system of study.

 

 

 

Their thrust was not merely using small dosages, but really about using

precise diagnosis to nail the problem and hence just using a push instead of

a hammer. If one is only doing SHL and one encounters a wenbing problem

sometimes one might need the hammer to get results. Often (but of course not

always), IMO, the more off your diagnosis is the more heavy handed your

approach is needed to get results. This is one reason why modern Chinese

formulas are so large and what I consider " sloppy " , they have no clear

diagnosis. This is something to contemplate.

 

 

 

-

 

 

 

 

 

 

 

 

On Behalf Of

Monday, April 13, 2009 3:07 PM

 

Cc: Simcha Gottlieb

Re: Dose of herbs prescribed to Westerner in Beijing

 

 

 

 

 

 

 

Will, Jason, Daniel, all,

I have another take on this issue. I think dosing reflects the

basic foundational philosophies of different styles of practice. Many

of our patients have chronic, complex issues that are strongly

connected with their psychological/emotional states reflected as

physical symptoms (symptom patterns). They may have been treated for

specific diseases pharmacologically and otherwise, but either haven't

responded well or have developed what Zhang Ji called bian zheng/

transmuted patterns. These patients, in my opinion, need a greater

length of time of treatment, gradual, and process oriented. They are

usually too weak for sudden assaults with strong medicines. One can

choose prescriptions, for example, that are harmonizing to shao yang

(if appropriate) such as xiao chai hu tang or chai hu jia long gu mu

li tang in smaller doses and gradually open up the patient in ways

that will not cause 'revolt'.

 

In other patients, we have an acute attack or a clear disease

pattern that needs strong intervention, stronger prescriptions with

pharmacologically active substances to the fore. For example, in

exterior patterns I will greatly increase dosages of herbs to drive

out the exterior evils if appropriate. Also, strong patients with

acute conditions will not respond to relatively low dose therapy, they

may be 'desensitized'.

 

The same holds true for acumoxa therapy. We focus and strengthen

therapy or increase subtlety through the factors of

a) length of treatment

b) repetition of treatment (times per week)

c) strength of needle stimulus

d) depth of insertion

e) number of needles or moxas used.

 

In herbal medicine we have large and small prescriptions, strong or

mild ingredients, dosages, frequency and length of treatment. We need

to be prepared for a full spectrum of possibilities, which means a

large knowledge base, great flexibility, and the possibility that we

are biased in a certain direction that doesn't benefit our patient.

Then we need to refer out.

 

We should remember that the herbal tradition was based largely on

the triad of heaven, humanity, and earth, superior, middle and

inferior grade medicinals, with superior grade being supporting the

correct qi, and inferior the treatment of disease (in the Divine

Farmer's Materia Medica). While we have an obligation to treat

disease, don't we also have an obligation to support our patients'

health?

 

I am also a fan of the Menghe tradition. Although I have

relatively little exposure to it, what I've seen resonates with me

strongly. I like what Volker Scheid says about it in his " Currents of

Tradition " text and in the new " Formulas and Strategies " . I also know

that Chip, Bill Morris and Jason appreciate it as well. From what

Volker writes, it would seem that the Menghe physicians such as Fei

Boxiong had patients who suffered from 'exhaustion and fatigue', due

to 'damage by the qi shang/seven emotions'. They had 'weak

constitutions, were unaccustomed to exercise, stressed by too much

work and thinking, frequently were unable to express their personal

worries (openly). "

 

A majority of my patients fit this category, therefore the more

long-term, gentle treatment with formulas that harmonize qi

transformation fit the bill. . .most of the time. My style and

demeanor, the setting in which I practice, are copacetic with these

clinical concerns.

 

When we have these discussions, while we must define what has come

before us in tradition, and pay heed to the roadmaps and markers

placed before us, we must find our place in this great tradition in

the style that suits us best, otherwise our therapies will not be as

useful as they might be otherwise.

 

 

 

 

 

 

 

 

 

 

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Z'ev, Jason, Trevor, etc etc

 

Z'ev

 

I agree with you. Thank you for your perspective. Chinese medicine's strength

lies in its ability to adapt. Different populations with different climates,

geography, diet, stress issues, pathogens (ie germs you wouldn't treat the

common flu the same way you would the Spanish flu) and previous or concurrent

(mis)use of other medical intervention--meds, IV's, etc. as well as misuse of

herbal, acupuncture, colon cleansers, etc etc... all change the condition of the

patients constitutional and pathological condition and necessitate a fluid and

skillful adaptations of the therapeutics. (Sorry for the long sentence.)

 

In addition, the actions of many herbs change with dosage. Small amounts of

huanglian, for example, act to strengthen the spleen, while larger doses drain.

Huangqi, chaihu and many others are like this. It sometimes is useful to think

of practicing Chinese medicine like martial arts. Each person has a style that

they master, but in application it is sometime necessary to just put your hand

gently out, others, you need one large focused punch or kick, then in other

instances you might be forced to release a flurry of defense and offensive

moves.

 

Jason

 

This is a most interesting topic and I appreciate your passion. I like to play

with the range of dosages and sometimes find a 20g formulas works great, while

other times I am up to 200g. When I see a new patient who has been taking herbal

medicine from another practitioner and they claim the formula they were taking

wasn't/hadn't worked, if I believe that the formula is

fundamentally/theoretically appropriate the first thing I do is check the

dosages of each herb. Sometimes a little tweak (up or down) will do the trick.

 

I just saw your email come in and you are completely correct in the tendency for

many practitioners to be sloppy. The majority of physicians in China and Taiwan

are unfortunately mediocre at best and do not represent the ghee. Without

knowing the situation or background of that doctor, the patient or the

condition, it is hard to make any blanket statement.

 

This is a very hectic week for me, so I will have to limit the length and

timeliness of my posts. Thank you all for this very interesting exchange.

 

Daniel

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Hi Daniel, Jason, et al,

 

I've just recently joined CHA, and have been following this thread with

interest. Daniel, you mention the " fire god school " , and I've recently been

reading a book on the subject

( & #24352; & #23384; & #24716; & #12298; & #20013; & #21307; & #28779; & #31070; & #27966; & #25506\

; & #35752; & #12299;). As you mentioned, some people in this line use huge doses of

hot and spicy herbs like fuzi, ganjiang, rougui, etc., supposedly with good

results. In fact, there are some case studies in the book where people's lives

are saved by this method. On the other hand, as Jason mentioned, our main

teacher here in Hangzhou gets very good results with small formulas, and talks

about cases where Qin Bowei and other teachers of his saved people's lives with

small formulas.

 

I think this shows that there is clearly no one " correct " methodology to which

one should dogmatically adhere. While I tend to think that there is

theoretically one " best " treatment for each patient (but figuring that out is

the trick!), there are probably many different treatments that can help each

patient. Obviously, we should strive to get as close to that " best " treatment as

we can, but I think this requires a very flexible and open-minded approach.

 

Furthermore, Chinese medicine always has to consider the time, location, and

individual in treatment. Fire God School originated in Chengdu, Sichuan, which

is one of the dampest, cloudiest, least sunny areas of China, and where the

people are constitutionally quite tough, and where some people actually take

fuzi as food. I've never tried to dose fuzi anywhere near as high as these guys,

so I can't say from experience, but I imagine if you take this method to say,

where Jason lives, Boulder, Co, where it is super dry, super sunny, and people

have never taken a Chinese herb in their life, let alone fuzi, and they have

wimpier constitutions than the average Sichuan nongmin(farmer), the results may

be less than desirable.

 

Same with the Jiangnan region of China (Jiangsu, Shanghai, Zhejiang), where the

Menghe docs are from, and where the " Shanghai School " Daniel mentioned is from.

The people here are not as tough as in Sichuan, the climate is damp in summer,

but winter is actually quite dry, they don't eat spicy food, and certainly don't

take fuzi as a food. Because of this, some docs here developed a more " gentle "

style, and they get good results with it here. Maybe if they tried this method

in Chegdu the results would be dissapointing.

 

So, I think we should be careful not to latch on to one style and attempt to

force it to work with our patients. One must be much more thoughtful than this,

considering the constitution of the patient, the season, the weather, etc., and

then with careful observation over time figure out what works with the people

where you are at different times of the year.

 

I think this is an extremely important point, especially now that it seems

everyone in the west is getting so excited about studying Shang Han and Jin Gui

(I love these books too, and my PhD is centered around them). Jason mentioned

that his friend Chip Chase in Boulder, who is highly regarded by many and has

been in practice for many years, has been unable to make certain Shanghan

formulas work well in Boulder. Yet he gets good results with other methods (I'm

not saying he doesn't use any Shanghan/Jin Gui stuff). If one gets over

enthusiastic about a particular style, becomes dogmatic about it, and tries to

force it to work (I've recently heard of people who after taking a Shanghan

seminar decide they will only use Shanghan/Jingui formulas), at best it will be

effective some of the time, at worst it may harm patients. IMHO, what is

required is a more flexible, thoughtful, and careful approach, that is refined

over time to meet the needs of our respective patients, location, weather, and

season.

 

I'm tempted to go to Chengdu to study with a Fire God doctor, learn how to use

200g of fuzi in one day (one case study the doc uses 500g per day!!), and maybe

even one day have the guts to try it out if the situation presents itself. But I

also like to study with my teacher here, using 0.5g of Wu Zhu Yu per day, or 3g

of Da Huang Tan per day. Then it's a matter of flexibly drawing from your

knowledge and applying what you think is most appropriate for each patient

during each season, etc.

 

Finally, just as an example, in my practice here in Hangzhou where the weather

is extreme and particularly in winter when it is quite cold and there is no

insulation in the housing here, I can get away with using fuzi, ganjiang,

rougui, etc. In the summer it is hot and humid, often over 100 degrees, and

entirely different herbs are required. I also treat Chinese and western patients

differently. Westerners love cold drinks and raw food, and Chinese never touch

them. Westerners eat more rich food, such as meat and dairy, and often less

vegetables than Chinese. Westerners from northern climates don't sweat as easily

as local Chinese. etc, etc.

 

So, I think flexible is the key word. That said, I myself do tend to think that

small doses are preferable, just because I think that the job should be done

with the minimal amount of intervention possible. Figuring out that minimum is

the trick. However, regarding the common practice of large formulas and heavy

doses that I personally have seen a lot of in China, I think a lot of it (not

all of it) is the doctors and clinics/hospitals trying to make money, and has

nothing to do with the best interests of the patients.

 

Respectfully,

 

Greg Livingston

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Wow, Thanks for taking the time to say all this Greg.

 

--- On Mon, 4/13/09, Greg A. Livingston <drlivingston wrote:

 

Greg A. Livingston <drlivingston

Re: Dose of herbs prescribed to Westerner in Beijing

 

Monday, April 13, 2009, 9:34 PM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hi Daniel, Jason, et al,

 

 

 

I've just recently joined CHA, and have been following this thread with

interest. Daniel, you mention the " fire god school " , and I've recently been

reading a book on the subject ( & #24352; & #23384; & #24716; & #12298; & #

20013; & #21307; & #28779; & #31070; & # 27966; & #25506; & #35752; & #12299;). As you

mentioned, some people in this line use huge doses of hot and spicy herbs like

fuzi, ganjiang, rougui, etc., supposedly with good results. In fact, there are

some case studies in the book where people's lives are saved by this method. On

the other hand, as Jason mentioned, our main teacher here in Hangzhou gets very

good results with small formulas, and talks about cases where Qin Bowei and

other teachers of his saved people's lives with small formulas.

 

 

 

I think this shows that there is clearly no one " correct " methodology to which

one should dogmatically adhere. While I tend to think that there is

theoretically one " best " treatment for each patient (but figuring that out is

the trick!), there are probably many different treatments that can help each

patient. Obviously, we should strive to get as close to that " best " treatment as

we can, but I think this requires a very flexible and open-minded approach.

 

 

 

Furthermore, Chinese medicine always has to consider the time, location, and

individual in treatment. Fire God School originated in Chengdu, Sichuan, which

is one of the dampest, cloudiest, least sunny areas of China, and where the

people are constitutionally quite tough, and where some people actually take

fuzi as food. I've never tried to dose fuzi anywhere near as high as these guys,

so I can't say from experience, but I imagine if you take this method to say,

where Jason lives, Boulder, Co, where it is super dry, super sunny, and people

have never taken a Chinese herb in their life, let alone fuzi, and they have

wimpier constitutions than the average Sichuan nongmin(farmer) , the results may

be less than desirable.

 

 

 

Same with the Jiangnan region of China (Jiangsu, Shanghai, Zhejiang), where the

Menghe docs are from, and where the " Shanghai School " Daniel mentioned is from.

The people here are not as tough as in Sichuan, the climate is damp in summer,

but winter is actually quite dry, they don't eat spicy food, and certainly don't

take fuzi as a food. Because of this, some docs here developed a more " gentle "

style, and they get good results with it here. Maybe if they tried this method

in Chegdu the results would be dissapointing.

 

 

 

So, I think we should be careful not to latch on to one style and attempt to

force it to work with our patients. One must be much more thoughtful than this,

considering the constitution of the patient, the season, the weather, etc., and

then with careful observation over time figure out what works with the people

where you are at different times of the year.

 

 

 

I think this is an extremely important point, especially now that it seems

everyone in the west is getting so excited about studying Shang Han and Jin Gui

(I love these books too, and my PhD is centered around them). Jason mentioned

that his friend Chip Chase in Boulder, who is highly regarded by many and has

been in practice for many years, has been unable to make certain Shanghan

formulas work well in Boulder. Yet he gets good results with other methods (I'm

not saying he doesn't use any Shanghan/Jin Gui stuff). If one gets over

enthusiastic about a particular style, becomes dogmatic about it, and tries to

force it to work (I've recently heard of people who after taking a Shanghan

seminar decide they will only use Shanghan/Jingui formulas), at best it will be

effective some of the time, at worst it may harm patients. IMHO, what is

required is a more flexible, thoughtful, and careful approach, that is refined

over time to meet the needs of our

respective patients, location, weather, and season.

 

 

 

I'm tempted to go to Chengdu to study with a Fire God doctor, learn how to use

200g of fuzi in one day (one case study the doc uses 500g per day!!), and maybe

even one day have the guts to try it out if the situation presents itself. But I

also like to study with my teacher here, using 0.5g of Wu Zhu Yu per day, or 3g

of Da Huang Tan per day. Then it's a matter of flexibly drawing from your

knowledge and applying what you think is most appropriate for each patient

during each season, etc.

 

 

 

Finally, just as an example, in my practice here in Hangzhou where the weather

is extreme and particularly in winter when it is quite cold and there is no

insulation in the housing here, I can get away with using fuzi, ganjiang,

rougui, etc. In the summer it is hot and humid, often over 100 degrees, and

entirely different herbs are required. I also treat Chinese and western patients

differently. Westerners love cold drinks and raw food, and Chinese never touch

them. Westerners eat more rich food, such as meat and dairy, and often less

vegetables than Chinese. Westerners from northern climates don't sweat as easily

as local Chinese. etc, etc.

 

 

 

So, I think flexible is the key word. That said, I myself do tend to think that

small doses are preferable, just because I think that the job should be done

with the minimal amount of intervention possible. Figuring out that minimum is

the trick. However, regarding the common practice of large formulas and heavy

doses that I personally have seen a lot of in China, I think a lot of it (not

all of it) is the doctors and clinics/hospitals trying to make money, and has

nothing to do with the best interests of the patients.

 

 

 

Respectfully,

 

 

 

Greg Livingston

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Greg,

Nice to hear from you again. I have a few questions and

comments. I'd like to put them between the paragraphs, but either

or the Apple mail program won't cooperate.

 

1) Can you name the text/author in pinyin, as the Chinese characters

are not coming through for some reason. Usually my e-mail reads

Chinese well.

 

2) Your points on flexibility are well taken, especially with

considerations of environment, constitution, and season. I moved to

southern California from Colorado/New Mexico twenty years ago, and it

is interesting to see the difference in patients here from there.

I've often wondered if there is a regional medicine in China that

corresponds with the high desert/Rocky Mt. climate, other than Tibet

which practices an indigenous medicine that is somewhat different from

the Chinese.

 

3) I've been teaching a Shang Han Lun course at PCOM for the last five

years, so it has been a major study and focus for me. However, I

remain an 'eclectic' at heart. What I've discovered from such

teachers as Arnaud Versluys and his teacher Zeng Rongxiu is that being

rooted in a particular approach allows you to gain a lot of depth and

focus that sometimes is missing in many practitioners. Having said

that, my own idea is to use the principles of the Shang Han Lun and

try to apply them to the region in which I now live (along, of course,

with the other schools I've studied, such as the supplement earth

current of Li Dong-yuan).

 

4) This last winter I worked a lot with gui zhi tang and modifications

with my patients. One of the interesting aspects of the Southern

California coastal climate which is often overlooked is that there are

subtle shifts going on much of the year. We have a clear rainy

season, with cool humid weather, regular fog in the springtime, a

'fire' season when the desert winds dessicate the environment (after

months of no rain), and a few weeks of hot/humid weather in the summer

(with no rain at the coast). The ocean is cold and damp, the desert

is hot and dry. The fluctuations between a marine and desert climate

here make many people sick. The houses are poorly insulated, so

winter can feel quite cold here.

 

5) As a result, every shift in weather brings colds, flus, allergy

flareups, over and over again, from autumn through mid-spring.

Especially with my student patients, variants of gui zhi tang have

been very successful indeed. It seems that people here are quite yang

xu and cold inside from not properly responding to our climate with

warm foods and clothing. Young people especially dress like it is

Miami, and lots of iced drinks, ice cream and raw foods are consumed.

I've got lots of pictures of pale tongues to confirm this.

 

In conclusion, you and I agree that we must study our environments,

patients, seasons, diet, clothing, and lifestyle very carefully in

prescribing for our patients. What a privilege it is to practice

Chinese medicine, and learn something new every day!

 

 

 

On Apr 13, 2009, at 6:34 PM, Greg A. Livingston wrote:

 

>

>

> Hi Daniel, Jason, et al,

>

> I've just recently joined CHA, and have been following this thread

> with interest. Daniel, you mention the " fire god school " , and I've

> recently been reading a book on the subject

> ( & #24352

> ; & #23384

> ; & #24716

> ; & #12298

> ; & #20013; & #21307; & #28779; & #31070; & #27966; & #25506; & #35752; & #12299;).

> As you mentioned, some people in this line use huge doses of hot and

> spicy herbs like fuzi, ganjiang, rougui, etc., supposedly with good

> results. In fact, there are some case studies in the book where

> people's lives are saved by this method. On the other hand, as Jason

> mentioned, our main teacher here in Hangzhou gets very good results

> with small formulas, and talks about cases where Qin Bowei and other

> teachers of his saved people's lives with small formulas.

>

 

 

 

>

 

>

 

> I think this shows that there is clearly no one " correct "

> methodology to which one should dogmatically adhere. While I tend to

> think that there is theoretically one " best " treatment for each

> patient (but figuring that out is the trick!), there are probably

> many different treatments that can help each patient. Obviously, we

> should strive to get as close to that " best " treatment as we can,

> but I think this requires a very flexible and open-minded approach.

>

>

>

> So, I think we should be careful not to latch on to one style and

> attempt to force it to work with our patients. One must be much more

> thoughtful than this, considering the constitution of the patient,

> the season, the weather, etc., and then with careful observation

> over time figure out what works with the people where you are at

> different times of the year.

>

> I think this is an extremely important point, especially now that it

> seems everyone in the west is getting so excited about studying

> Shang Han and Jin Gui (I love these books too, and my PhD is

> centered around them). Jason mentioned that his friend Chip Chase in

> Boulder, who is highly regarded by many and has been in practice for

> many years, has been unable to make certain Shanghan formulas work

> well in Boulder. Yet he gets good results with other methods (I'm

> not saying he doesn't use any Shanghan/Jin Gui stuff). If one gets

> over enthusiastic about a particular style, becomes dogmatic about

> it, and tries to force it to work (I've recently heard of people who

> after taking a Shanghan seminar decide they will only use Shanghan/

> Jingui formulas), at best it will be effective some of the time, at

> worst it may harm patients. IMHO, what is required is a more

> flexible, thoughtful, and careful approach, that is refined over

> time to meet the needs of our respective patients, location,

> weather, and season.

>

>

>

> So, I think flexible is the key word. That said, I myself do tend to

> think that small doses are preferable, just because I think that the

> job should be done with the minimal amount of intervention possible.

> Figuring out that minimum is the trick. However, regarding the

> common practice of large formulas and heavy doses that I personally

> have seen a lot of in China, I think a lot of it (not all of it) is

> the doctors and clinics/hospitals trying to make money, and has

> nothing to do with the best interests of the patients.

>

> Respectfully,

>

> Greg Livingston

>

>

 

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

 

 

 

 

 

 

 

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Daniel,

Welcome back to the U.S. I've been aware of your work for many

years, and it is nice to be finally be able to communicate with you.

I answered Greg Livingston's e-mail separately here at CHA, and I

wanted to bring it to your attention as it also addresses our

discussion as well. Please feel free to respond if you have some time

to do so. . .

 

Z'ev

On Apr 13, 2009, at 2:18 PM, daltsch wrote:

 

>

> Z'ev

>

> I agree with you. Thank you for your perspective. Chinese medicine's

> strength lies in its ability to adapt. Different populations with

> different climates, geography, diet, stress issues, pathogens (ie

> germs you wouldn't treat the common flu the same way you would the

> Spanish flu) and previous or concurrent (mis)use of other medical

> intervention--meds, IV's, etc. as well as misuse of herbal,

> acupuncture, colon cleansers, etc etc... all change the condition of

> the patients constitutional and pathological condition and

> necessitate a fluid and skillful adaptations of the therapeutics.

> (Sorry for the long sentence.)

>

> In addition, the actions of many herbs change with dosage. Small

> amounts of huanglian, for example, act to strengthen the spleen,

> while larger doses drain. Huangqi, chaihu and many others are like

> this. It sometimes is useful to think of practicing Chinese medicine

> like martial arts. Each person has a style that they master, but in

> application it is sometime necessary to just put your hand gently

> out, others, you need one large focused punch or kick, then in other

> instances you might be forced to release a flurry of defense and

> offensive moves.

 

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

 

 

 

 

 

 

 

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Hi Z'ev,

 

Thanks for your kind and thoughtful response. Please see my responses below.

 

 

> 1) Can you name the text/author in pinyin, as the Chinese characters

> are not coming through for some reason. Usually my e-mail reads

> Chinese well.

 

Not sure why, but seems like I can never get Chinese text to come through on a

. In any case, the name of the book is " Zhong Yi Huo Shen Pai Tan

Tao " by Zhang Cun Ti, published by Renmin Weisheng. It's been a fun and

educational read, but I have to say I am a bit skeptical. I'd really like to

follow one of these guys in the clinic for a period of time and see what kind of

results (or side effects) they get. I can see how there may be instances where

this method is appropriate or necessary, but this would be really dangerous if

one was over-enthusiastic about it. haha

 

>

> 2) Your points on flexibility are well taken, especially with

> considerations of environment, constitution, and season. I moved to

> southern California from Colorado/New Mexico twenty years ago, and it

> is interesting to see the difference in patients here from there.

> I've often wondered if there is a regional medicine in China that

> corresponds with the high desert/Rocky Mt. climate, other than Tibet

> which practices an indigenous medicine that is somewhat different from

> the Chinese.

 

Yeah, I'm from San Francisco and have always thought it would be useful to study

in a region of China that had a similar climate, but I have yet to find one

here. I've studied in many regions of China, and none of them is anything like

San Francisco. So, when I treat patients in SF I always adjust what I've learned

here to try and better fit the needs of people there. As for the high desert, I

think you could find something similar in western China, and aside from

indigenous medicine traditions, there are also CM docs in those regions. I

actually know one who practices in Zhongdian (aka Shangri-la), which is at about

10,000 feet, very cold and dry. Maybe that's a bit too extreme? hehe

 

>

> 3) I've been teaching a Shang Han Lun course at PCOM for the last five

> years, so it has been a major study and focus for me. However, I

> remain an 'eclectic' at heart. What I've discovered from such

> teachers as Arnaud Versluys and his teacher Zeng Rongxiu is that being

> rooted in a particular approach allows you to gain a lot of depth and

> focus that sometimes is missing in many practitioners. Having said

> that, my own idea is to use the principles of the Shang Han Lun and

> try to apply them to the region in which I now live (along, of course,

> with the other schools I've studied, such as the supplement earth

> current of Li Dong-yuan).

 

I'm pretty eclectic as well. But I do think a firm grounding in SHL/Jingui is

very important for all of us because of the immense influence these texts have

had on everything that came later, thus allowing for a deeper and clearer

understanding of these later developments, and because they themselves are also

incredibly useful.

 

 

> 4) This last winter I worked a lot with gui zhi tang and modifications

> with my patients. One of the interesting aspects of the Southern

> California coastal climate which is often overlooked is that there are

> subtle shifts going on much of the year. We have a clear rainy

> season, with cool humid weather, regular fog in the springtime, a

> 'fire' season when the desert winds dessicate the environment (after

> months of no rain), and a few weeks of hot/humid weather in the summer

> (with no rain at the coast). The ocean is cold and damp, the desert

> is hot and dry. The fluctuations between a marine and desert climate

> here make many people sick. The houses are poorly insulated, so

> winter can feel quite cold here.

 

Sounds like some real challenges. This is part of the fun of CM. MD's don't get

to take much if any of this stuff into consideration when they prescribe- pretty

boring I think. hehe

 

>

> 5) As a result, every shift in weather brings colds, flus, allergy

> flareups, over and over again, from autumn through mid-spring.

> Especially with my student patients, variants of gui zhi tang have

> been very successful indeed. It seems that people here are quite yang

> xu and cold inside from not properly responding to our climate with

> warm foods and clothing. Young people especially dress like it is

> Miami, and lots of iced drinks, ice cream and raw foods are consumed.

> I've got lots of pictures of pale tongues to confirm this.

 

It's ironic because Americans have all the resources with which to prevent cold

exposure, but because they don't have this concept, they expose themselves a

lot, and cold pathogen and yang xu conditions are actually quite common, making

SHL?JGYL formulas really useful in many cases. This is actually the subject of

my dissertation.

 

 

> In conclusion, you and I agree that we must study our environments,

> patients, seasons, diet, clothing, and lifestyle very carefully in

> prescribing for our patients. What a privilege it is to practice

> Chinese medicine, and learn something new every day!

 

A privilege and a real pleasure. Thanks for the discussion!

 

Best wishes,

 

Greg

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, mystir <ykcul_ritsym wrote:

>

> Wow, Thanks for taking the time to say all this Greg.

 

Thanks for the thanks, mystir. :-) I hope it's something useful....

 

Best wishes,

 

Greg

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Greg, Stephen,

Interestingly, I've been working more with fu zi scripts

recently, such as zhen wu tang, gui zhi shao yao zhi mu tang, and

other warming prescriptions such as dang gui si ni tang. Heiner

Fruehauf has several articles and videos on the huo shen pai/fire

spirit current at his website, including with a physician from this

lineage. He also has developed an herb line " Classical Pearls " which

have influences from this school. He sells a premium grade fu zi

powder that is processed in a special, 'traditional' manner which you

can find at the Classical Pearls website. I think that the Portland,

Oregon climate is similar to Chengdu at least in terms of cloudiness

and humidity, the chill really gets into the bones there, so these

warming medicinals would seem to be good in that region.

Interestingly, the cold of winter in Colorado/New Mexico/Montana is

dry, not the same, so other medicinals may be better there, with less

acridity and dispersion.

 

I've noted that in Tibetan medicine they use a lot of astringing

medicinals. In fact, Tibetan prescriptions use a lot of he zi/

terminalia chebula, which is very bitter and astringent, to hold qi in

the channels, instead of gan cao. One reason other than availability

may be the tendency described by some Tibetan physicians for qi to

dissipate in high altitudes. They also use bear bile to 'close the

channels', and oil the body to increase vitality.

 

 

 

On Apr 14, 2009, at 8:49 AM, Greg A. Livingston wrote:

 

> Not sure why, but seems like I can never get Chinese text to come

> through on a . In any case, the name of the book is

> " Zhong Yi Huo Shen Pai Tan Tao " by Zhang Cun Ti, published by Renmin

> Weisheng. It's been a fun and educational read, but I have to say I

> am a bit skeptical. I'd really like to follow one of these guys in

> the clinic for a period of time and see what kind of results (or

> side effects) they get. I can see how there may be instances where

> this method is appropriate or necessary, but this would be really

> dangerous if one was over-enthusiastic about it. haha

 

 

On Apr 14, 2009, at 10:24 AM, stephen woodley wrote:

 

>

>

>

> Greg, Michael and all

>

> a few points

> first, let's remember that the " fire gods " sect is not

> representative of Shang Han Za Bing Lun tradition nor the Jing

> Fang style

>

> of course, being dogmatic about anything is risky and completely

> different from being dedicated to it

> anyone wanting to incorporate medicinals like fuzi should learn

> from and shadow someone trained and experienced in it's proper

> use

> to just start playing with it is beyond irresponsible

>

 

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

 

 

 

 

 

 

 

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Hi Z'ev

some really good points!

 

As I expand my use of fuzi I also am following these formulas as

they are proven to be

harmoniously balanced.

Certainly a big part of the use of these meds is what they are

paired with and when/how they are administered

 

I've seen the information on Heiner's website...interesting

perspectives and a great reminder of the different lineages and

interpretations

of this style - definitely a worthwhile read

 

Stephen Woodley LAc

--

www.shanghanlunseminars.com

 

--

http://www.fastmail.fm - The way an email service should be

 

 

 

 

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Tibetan physicians for qi to dissipate in high altitudes. They also use bear

bile to 'close the

 

channels', and oil the body to increase vitality.

 Z'ev, you are an expert, like many in this group. I learn from you all. Bear

fat and bile, like snake gall bladders and bile. Powerful medicine.  The

Tibetans would put butter in the mouth of newborns so their skin would be

lustrous the rest of their lives. Bear bile, snake bile has so many human health

benefits, it would be crazy to say them all these days, almost a hidden

knowledge. I was very much into animal products. 

 Now, the emphasis is on more humane, less animal based products.  I agree, so,

what are the substitutes for animal products? Musk? Snake bile?... etc

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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This has been an interesting thread, it is great to see such interesting

feedback from practitioners across the globe.

 

The one comment that I would like to make is that formula size cannot be reduced

to something as simplistic as traditional vs. modern. Certainly there has been

historical variation in terms of the number of ingredients and their dosages in

formulas, and different forms of herbal medicine delivery utilize dramatically

different dosages. Different delivery forms and different formula styles each

have their advantages, and are often best suited to particular types of

diseases, particular types of patients, and particular classes of medicinals.

 

I would strongly dispute the notion that the majority of doctors base their

prescriptions primarily on financial considerations. For sure, superfluous use

of expensive medicinals occurs with regularity (it is quite common in Korea in

addition to China), and indeed some doctors and pharmacists do write larger

prescriptions than necessary so that they can charge more or make patients feel

like they are getting greater value. The same thing happens in the US. However,

I think that the prescriptions written by such practitioners represent only a

very small minority of the total number of prescriptions in use. Most

practitioners simply try to write the prescription that they believe will best

help their patient.

 

Regional variations are common in terms of dosage. In Taiwan, raw herb

prescriptions are often very large and doses are robust, though most doctors use

granules at a comparatively lower dose. Taiwan is both very traditional and

very modern, and there is a wide variation of dose ranges in use. In different

parts of mainland China, dosage trends vary dramatically, though of course many

other factors such as preferred pao zhi methods, preferred species, and the

varying popularity of individual medicinals are equally major regional trends.

For example, I noticed that in Sichuan the doctors dosed relatively high. Of

course, all of China doses higher than the US for the most part, since

practitioners in America often prescribe one pack for two days instead of one

pack per day (the norm in China). It should also be noted that Korean herbal

medicine is often taken in robust doses while Japanese medicine is often taken

in relatively low doses.

 

Anyone who makes sweeping statements about how the doses are all wrong in

such-and-such a place or in such-and-such a time period is probably selling

their own personal angle. It just isn't that simple, there is tremendous

variation. Other CHA contributors have mentioned that some historical texts use

high doses and others use lower doses, and different famous doctors had

different preferences. The idea that low doses are " more traditional " doesn't

hold water at all. For example, one of my first teachers recently gave me a

very old herbal book that had been passed down from master to student in his

family for over 200 years. This particular herbalist has never studied " modern

TCM, " and his formulas and the ones in his book are not necessarily small, some

are quite large. Maybe the lineage-style training that he has cannot

approximate the depth of flexibility that modern style pattern diagnosis can

provide, but can we really say that it is not traditional?

 

Small formulas can be very eloquent and they encapsulate the concise, simple,

yet profound style that typifies many Chinese arts. Many of history's early

formulas often used few ingredients because a more narrow range of medicinals

were available in earlier times. The distinctive combinations of medicinals in

classical formulas illustrate brilliant functional units that have been

incorporated into different formulas ever since. But large formulas can still

maintain direction and clarity, and even some very complicated formulas have

tremendous balance and utility. We all agree that formulas should not be

haphazard and poorly composed, but this has relatively little to do with size

and dosage.

 

Eric Brand

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Eric,

 

 

 

Thanks for joining us. Just to clarify I don't think anyone is saying that

the majority of doctors base their prescriptions on financial inceptive.

This is just one factor, that must not be overlooked, when e.g. a laowai

goes to China and leaves with a huge formula. We will never know the truth

of why, but that is something we must consider. Of course there are many

reasons that formulas are large these days, that being only one. However, I

guess there is no way to prove it, but many believe that it much more than

just a " small minority. "

 

 

 

Furthermore I don't think anyone is saying that all the dosages are wrong in

any place or time period. However you may have missed some emails, the

original statement was that 180g a day (what some consider large) was the

average dose from a traditional perspective. This statement spurred this

great conversation. This general statement must then be in the context of an

average of all traditions. Although it is clear to most people that there is

great variety within Chinese history on dosage and # of ingredients. I

personally find more evidence in historical record for the average formula

not being this big, hence smaller.

 

 

 

Taking a survey of the famous formulas (e.g. on can check the F & S) one can

get an idea of how people as a whole dosed in the past. This is a useful

exercise, especially if juxtaposed to modern China's formulas. That is

really what we are talking about. Of course there are exceptions, but noting

the general trend of the past, is useful. This quite simply represents one

way to get an average dosage for an 'traditional approach. "

 

 

 

No one denies that there weren't plenty of doctors out there writing crazy

formulas. Actually I could care less about the mediocre ones. What interests

me is the cream of the crop. What were they doing? From my meager attempts

to find and study many of the greatest known clinicians in history, I see

that at least they do not use large dosages. That actually is enough for me

and I would assume that the majority of CM agrees (indirectly) because the

formulas books and famous case study books are mainly filled with these

'smaller' formulas. Please page through a formula book and add up the grams.

I welcome any contrary information.

 

 

 

So Eric states that the idea of smaller dose formulas being more traditional

doesn't hold any water? HMmmm.. A couple of thoughts. I say there is

evidence that at least the most effective clinicians and hence our most

famous formulas are on the small side (in comparison to modern Chinese

hospital formulas). Eric sites his lineage book as evidence to the

contrary. I am glad Eric has this book, I would love to see it, but I think

it proves very little. Of course we know people used large formulas, that is

not the debate. However, most important to me is, how effective were they. A

book here or there only shows exceptions, but the mass volumes of texts

speaks loudly. Of course there might have been a great physician who slipped

through the cracks, but let us look at the big picture.

 

 

 

Consequently, are we then to believe that there is really all these gigantic

formulas out there that missed our modern textbooks and are more effective

than what we read about. Possibly, maybe that would make a good thesis. I

however cannot find such evidence.

 

 

 

But since I am always open to any great doctor or system that is effective I

will make my request again. Can someone point out a famous clinician (or a

few) in CM history that has a case study book that demonstrates 200+g

formulas a day as the average treatment style. I personally do not own any,

and would love to pick up a few of these books before I head back to the

states. On the flip side I can list book after book of famous case studies

that demonstrate smaller formulas as the norm, if anyone is interested.

 

 

 

But why does any of this matter? " So what " you may say. some people wrote

large formulas and some wrote small. End of story right? Wrong! :) -

 

Volker for example has done an excellent job juxtaposing the thinking

methodology of modern treatment strategies

 

to traditional methods. He finds a big difference. I tend to agree.

Understanding how older doctors, IMHO, can give us tremendous incite that is

difficult be glean from modern TCM. IMO, It does not take much reading to

notice that formulas look different now than they did in the past (as a

whole - I know there are exceptions). Consequently, one must first see the

difference before one can actually analyze what the difference may be.

Really dosage is just one small piece of the puzzle, which For example may

be linked to something as simple as doctors prescribing on Western

pharmacological data, for better or worse.

 

 

 

But if one doesn't know what is what, then one can easily think that such

prescriptions are the way it has always been.

 

This, as Volker clearly points out, in just not the case. There are

differences, and one must recognize them. Giving giant dosages of yan hu suo

or bai jiang cao for sleep is modern, and as far as know, such formulas are

not traditional, hence the dosages of these herbs in them are not

traditional. But that doesn't mean it doesn't work!

 

 

 

Respectfully,

 

 

 

-

 

 

On Behalf Of Eric Brand

Wednesday, April 15, 2009 2:51 PM

 

Re: Dose of herbs prescribed to Westerner in Beijing

 

 

 

 

 

 

 

 

This has been an interesting thread, it is great to see such interesting

feedback from practitioners across the globe.

 

The one comment that I would like to make is that formula size cannot be

reduced to something as simplistic as traditional vs. modern. Certainly

there has been historical variation in terms of the number of ingredients

and their dosages in formulas, and different forms of herbal medicine

delivery utilize dramatically different dosages. Different delivery forms

and different formula styles each have their advantages, and are often best

suited to particular types of diseases, particular types of patients, and

particular classes of medicinals.

 

I would strongly dispute the notion that the majority of doctors base their

prescriptions primarily on financial considerations. For sure, superfluous

use of expensive medicinals occurs with regularity (it is quite common in

Korea in addition to China), and indeed some doctors and pharmacists do

write larger prescriptions than necessary so that they can charge more or

make patients feel like they are getting greater value. The same thing

happens in the US. However, I think that the prescriptions written by such

practitioners represent only a very small minority of the total number of

prescriptions in use. Most practitioners simply try to write the

prescription that they believe will best help their patient.

 

Regional variations are common in terms of dosage. In Taiwan, raw herb

prescriptions are often very large and doses are robust, though most doctors

use granules at a comparatively lower dose. Taiwan is both very traditional

and very modern, and there is a wide variation of dose ranges in use. In

different parts of mainland China, dosage trends vary dramatically, though

of course many other factors such as preferred pao zhi methods, preferred

species, and the varying popularity of individual medicinals are equally

major regional trends. For example, I noticed that in Sichuan the doctors

dosed relatively high. Of course, all of China doses higher than the US for

the most part, since practitioners in America often prescribe one pack for

two days instead of one pack per day (the norm in China). It should also be

noted that Korean herbal medicine is often taken in robust doses while

Japanese medicine is often taken in relatively low doses.

 

Anyone who makes sweeping statements about how the doses are all wrong in

such-and-such a place or in such-and-such a time period is probably selling

their own personal angle. It just isn't that simple, there is tremendous

variation. Other CHA contributors have mentioned that some historical texts

use high doses and others use lower doses, and different famous doctors had

different preferences. The idea that low doses are " more traditional "

doesn't hold water at all. For example, one of my first teachers recently

gave me a very old herbal book that had been passed down from master to

student in his family for over 200 years. This particular herbalist has

never studied " modern TCM, " and his formulas and the ones in his book are

not necessarily small, some are quite large. Maybe the lineage-style

training that he has cannot approximate the depth of flexibility that modern

style pattern diagnosis can provide, but can we really say that it is not

traditional?

 

Small formulas can be very eloquent and they encapsulate the concise,

simple, yet profound style that typifies many Chinese arts. Many of

history's early formulas often used few ingredients because a more narrow

range of medicinals were available in earlier times. The distinctive

combinations of medicinals in classical formulas illustrate brilliant

functional units that have been incorporated into different formulas ever

since. But large formulas can still maintain direction and clarity, and even

some very complicated formulas have tremendous balance and utility. We all

agree that formulas should not be haphazard and poorly composed, but this

has relatively little to do with size and dosage.

 

Eric Brand

 

 

 

us Database: 270.11.53/2054 - Release 04/11/09 10:51:00

 

 

 

 

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, " " wrote:

Just to clarify I don't think anyone is saying that

> the majority of doctors base their prescriptions on financial inceptive.

> This is just one factor, that must not be overlooked, when e.g. a laowai

> goes to China and leaves with a huge formula.

 

For sure, foreigners in China should be constantly on guard against being

overcharged. While this type of thing does happen with regularity to locals and

foreigners alike, we cannot say that all doctors writing heavy formulas have

this malicious intent. It may simply be that the patient needed a formula with

minerals like long gu and mu li in it, which could easily add 60g to the formula

from two ingredients alone. Since the thread started from a Beijing experience,

it is also worth noting that Beijing dose trends are often on the high side

(admittedly, since Beijing has roughly the population of Australia there is a

wide variety of everything there, so any simplification is a bit imperfect).

 

However you may have missed some emails, the

> original statement was that 180g a day (what some consider large) was the

> average dose from a traditional perspective.

 

180g/day isn't " average, " it is on the high side, without a doubt. But it is

not atypical, that's my point. Just because someone prescribes 180g doesn't

mean that they don't understand good formula composition, are less traditionally

oriented, etc. It may be that the case was complex or severe.

 

When I worked in the clinic with Bob Damone at PCOM, we would often talk about

how satisfying it is to have a small, concise, eloquent formula because it

satisfies our sense of aesthetics. But he mentioned that sometimes when he tried

to trim down he felt like he lost his edge on some of the cases, and concluded

that he had to prioritize his patient's results over his own sense of

aesthetics. Certainly Bob favors a traditional approach, and he isn't building

big formulas so that he can charge more or so that he can throw in a bunch of

half-baked pharmacological ideas.

 

Some cases simply need small doses and minimal complexity, others need more

power and complexity. One cannot judge a practitioner by formula size alone,

especially if you are just looking at a single case.

 

A

> book here or there only shows exceptions, but the mass volumes of texts

> speaks loudly. Of course there might have been a great physician who slipped

> through the cracks, but let us look at the big picture.

 

The big picture and the massive collective experience of Chinese medicine quite

plainly shows us that both large and small formulas are in common use. Doctors

that prescribe 100-200g/day formulas are not rare exceptions by any stretch of

the imagination. Categorically dismissing whole schools of thought leads to

more limited and extreme perspectives.

 

Chinese medicine is beautiful because it is balanced and flexible. Categorical

statements generally show up when someone is trying to sell their own personal

angle or lecture material, if anything this is the thread in CM that is most

associated with selling an overpriced " prescription. " Your attempts to dismiss

the large dose approaches of hundreds of thousands of doctors reeks of this type

of zeal, like a new convert who got out of a seminar and now only does one

approach that is somehow more real and authentic than all the rest. I respect

that you have great teachers that use small doses and I'm sure that you are

learning a lot with them, but no matter how good one's teachers are, we must

study widely and not be bound to the same limitations that any one given teacher

has. The consensus of the historical texts and the real-life doctors clearly

shows that diverse, balanced, and flexible approaches are the main thing that CM

revolves around.

 

> Consequently, are we then to believe that there is really all these gigantic

> formulas out there that missed our modern textbooks and are more effective

> than what we read about.

 

Most well-educated doctors have the same respect for Fang Feng Tong Sheng San as

they have for Gui Zhi Tang, even though one formula is massive and the other is

tiny. How about pu ji xiao du yin? I don't know what modern textbooks you are

reading, but all the main ones I have certainly have big formulas along with

small ones.

 

Can someone point out a famous clinician (or a

> few) in CM history that has a case study book that demonstrates 200+g

> formulas a day as the average treatment style.

 

Jiao Shu-De comes to mind. He is a very famous clinician, on par with someone

like Qin Bo-Wei. His prescriptions are often quite large, and his book is

universally well-regarded in the Chinese clinical community.

 

Eric Brand

 

My blog: http://bluepoppy.com/blog/blogs/index.php

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This whole debate on formula size and dosage is really great. I totally agree

that if the job can get done using a smaller amount of herbals then wonderful.

It is just knowing when and where this is possible.

 

As you mentioned Jason, clear diagnosis is the key to formula building. You

pointed out a great alternative method to view a child's excematous rash, using

a small formula that had good outcome. This is very useful information and

should be shared so that everyone can gain this type of insight and confidence.

 

Now on the other side, I question having such strict measures/ thinking in terms

of formula size with certain types of disorders. My main argument has always

been for psoriasis. From the three sources I have in front of me- Mazin Al

Khafaji, Li Lin, & Xu Yihou, formulas for psoriasis manifesting from a blood

heat pattern, all have formulas starting at 150g per day dose.

 

The authors of these sources have seen hundreds and if not thousands of

psoriasis cases in their clinics. Surely they must have weight to their formula

stradegies. Mazin was able to prove his outcomes with precise photographs.

 

I am still curious to see a doctor obtain consistent results, showing complete

recovery, with psoriasis using small formulas- as in these formulas of less than

50g that you mention Jason. If this is possible and is more than just a few one

off situations, I want to learn the system.

 

Otherwise tell me how a system is sloppy when it can prove time and time again

that it works? Particularly when these systems are being compared to western

Medicine, whose clinical outcomes with psoraisis are a lot less than the 65%

that Mazin has been able to document in his clinic.

 

Perhaps someone can illuminate me on the lineage of Professor Zhu Ren Kang, the

main dermatologist that influenced both Li Lin and Mazin. His formulas were big.

 

Trevor

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