Herbal substitute for warfarin

[Guest guest]

Hi everyone,

I have a patient who is on warfarin therapy for an increased risk of blood clot

formation. The side effects and lifestyle guidelines associated with using the

drug are too much for him and he'd like to try something else. Of course TCM

has a huge collection of blood invigorating/stasis removing herbs to choose

from, but I'm having a hard time finding data in English showing any of our

popular remedies having specific anticoagulant effects that increase INR. There

are plenty of studies showing Chinese herbs potentiating the anticoagulant

effects of warfarin that result in an increased INR, but none that I can find

using solely Chinese herbs. His wife is an MD and would like to be able to

measure his INR as a method of proof that any remedy is working. I've checked

the Chen books and PubMed but nothing so far. Any ideas?

 

Thanks,

Danny

[Guest guest]

Hi Danny,

Interesting question, did you find anything yet?

Take a look at this study http://tiny.cc/hrk5r

It's in Chinese with an English abstract. I can't cut and paste from the

pdf. To summarize, 71 patients were split into groups A and B. Group A

was given herbs (formula listed in Chinese with herbs in grams, prep and

dosage) and warfarin. Group B was given herbs but no warfarin. Scroll

down to Table 2 in the PDF (all the blood work values). The last row

(酶原时间 (s)) is Prothrombin Time in seconds. Group A's PT

increased from 9.5±3.8 to 18.2±4. Group B from 9.7±3.6 to

14±2.5.

The authors didn't provide the lab's Mean PT or ISI which would have

allowed us to calculate INR. But the change in PT in group B strongly

suggests that these herbs will result in a favorable change in your

patient's INR when used along side or in replacement of the warfarin.

Let us know how it goes.

Charlie

 

, Danny Johnson <dj

wrote:>> Hi everyone,> I have a patient who is on warfarin therapy for

an increased risk of blood clot formation. The side effects and

lifestyle guidelines associated with using the drug are too much for him

and he'd like to try something else. Of course TCM has a huge

collection of blood invigorating/stasis removing herbs to choose from,

but I'm having a hard time finding data in English showing any of our

popular remedies having specific anticoagulant effects that increase

INR. There are plenty of studies showing Chinese herbs potentiating the

anticoagulant effects of warfarin that result in an increased INR, but

none that I can find using solely Chinese herbs. His wife is an MD and

would like to be able to measure his INR as a method of proof that any

remedy is working. I've checked the Chen books and PubMed but nothing

so far. Any ideas?> > Thanks,> Danny

 

 

 

[Guest guest]

Charlie or group,

 

Can anyone out there easily translate the herbs and dosages and post them for us

non-Chinese readers?

 

Thanks,

Neil Pregozen

 

, " charlie_thomson_lac " <cthmsn

wrote:

>

> Hi Danny,

> Interesting question, did you find anything yet?

> Take a look at this study http://tiny.cc/hrk5r

> It's in Chinese with an English abstract. I can't cut and paste from the

> pdf. To summarize, 71 patients were split into groups A and B. Group A

> was given herbs (formula listed in Chinese with herbs in grams, prep and

> dosage) and warfarin. Group B was given herbs but no warfarin. Scroll

> down to Table 2 in the PDF (all the blood work values). The last row

> (酶原时间 (s)) is Prothrombin Time in seconds. Group A's PT

> increased from 9.5±3.8 to 18.2±4. Group B from 9.7±3.6 to

> 14±2.5.

> The authors didn't provide the lab's Mean PT or ISI which would have

> allowed us to calculate INR. But the change in PT in group B strongly

> suggests that these herbs will result in a favorable change in your

> patient's INR when used along side or in replacement of the warfarin.

> Let us know how it goes.

> Charlie

>

> , Danny Johnson <dj@>

> wrote:>> Hi everyone,> I have a patient who is on warfarin therapy for

> an increased risk of blood clot formation. The side effects and

> lifestyle guidelines associated with using the drug are too much for him

> and he'd like to try something else. Of course TCM has a huge

> collection of blood invigorating/stasis removing herbs to choose from,

> but I'm having a hard time finding data in English showing any of our

> popular remedies having specific anticoagulant effects that increase

> INR. There are plenty of studies showing Chinese herbs potentiating the

> anticoagulant effects of warfarin that result in an increased INR, but

> none that I can find using solely Chinese herbs. His wife is an MD and

> would like to be able to measure his INR as a method of proof that any

> remedy is working. I've checked the Chen books and PubMed but nothing

> so far. Any ideas?> > Thanks,> Danny

>

>

>

[Guest guest]

Dr. Chen was at the Great River Symposium in 2009, where he delivered a

presentation on TCM alternatives to drugs. From his handouts regarding " blood

thinners " he lists Dan Shen and Chi Shao as having anti-coagulant effects; Dan

Shen, Hong Hua and Chuan Xiong for anti-platelet effects; shui zhi, san leng, e

zhu for thrombolytic effects; and of course the standard formulas for moving

blood, are also listed. Unfortunately, no studies are referenced.

 

Amadea Shakti

 

, Danny Johnson <dj wrote:

>

> Hi everyone,

> I have a patient who is on warfarin therapy for an increased risk of blood

clot formation. The side effects and lifestyle guidelines associated with using

the drug are too much for him and he'd like to try something else. Of course

TCM has a huge collection of blood invigorating/stasis removing herbs to choose

from, but I'm having a hard time finding data in English showing any of our

popular remedies having specific anticoagulant effects that increase INR. There

are plenty of studies showing Chinese herbs potentiating the anticoagulant

effects of warfarin that result in an increased INR, but none that I can find

using solely Chinese herbs. His wife is an MD and would like to be able to

measure his INR as a method of proof that any remedy is working. I've checked

the Chen books and PubMed but nothing so far. Any ideas?

>

> Thanks,

> Danny

>

[Guest guest]

I personally think that trying to duplicate drug effects with Chinese herbs is

barking up the wrong tree. .. .apples and oranges. Huo xue/quickening blood

medicinals and formulas have very different effects than powerful drugs such as

wayfarin.

 

 

On May 11, 2010, at 8:03 AM, amadeashakti wrote:

 

> Dr. Chen was at the Great River Symposium in 2009, where he delivered a

presentation on TCM alternatives to drugs. From his handouts regarding " blood

thinners " he lists Dan Shen and Chi Shao as having anti-coagulant effects; Dan

Shen, Hong Hua and Chuan Xiong for anti-platelet effects; shui zhi, san leng, e

zhu for thrombolytic effects; and of course the standard formulas for moving

blood, are also listed. Unfortunately, no studies are referenced.

>

> Amadea Shakti

 

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

 

 

 

 

 

 

 

[Guest guest]

Z'ev:

 

I personally think that trying to duplicate drug effects with

Chinese herbs is barking up the wrong tree. .. .

Stephen:

I couldn't agree more

 

 

Stephen Woodley LAc

 

--

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

 

 

 

 

[Guest guest]

I also agree that looking for herbal substitutes for warfarin is inherently

a flawed stategy. The question, however is not an uncomplicated one.  First,

we practitioners of Chinese medicine for the most part are viewed,

unfortunately, as utilitizing a medicine that is still experimental and without

supportive studies.  As such, the legal, Western biomedical, and to some

degree, the general establishment lean toward viewing our intervention in

issues such as hypertension, congestive heart disease, and hyperlipidemia, as

overstepping our bounds, and so to engage them in dialogue so as to

consider a different paradigm I feel, at this point at least, would be most

likely futile and possible provocative. If our patients come to us and ask us

to support or substitute therapies with what we do, that's, of course, a

different story, and can be very effective in a very short amount of time. 

Yet, if we do take upon ourselves such

patients, there must be full disclosure of what they are taking, and they must

be told that if they decide to go back on Western meds, that they tell us!  I

had an elderly patient who I treated for hypertension and dementia, who was

doing incredibly well.  Unfortunately, she was overseas, and because I wasn't

able to follow up on her, I found out afterwards,  her nurse decided

independently to restart giving her " prophylactically " a half a baby aspirin

twice daily, while continuing to also take a formula that contained Dang Gui

and Dan Shen.  She died of internal bleeding!   

 

 Second, though Professor Chen does list many herbs with anticoagulant

properties in his very extensive herb book, I agree with Z'ev's comment that

this approach is bark up the wrong tree.  I believe that we need to

educate both our patients as well as our Western Biomedical, and Naturapathic

colleagues to think differently-- to not treat symptoms but rather patients

according to their complex patterns, treating the whole patient from the

root.  We shouldn't take the approach of thinning the blood, but rather

strengthening and invigorating the blood, viewing herbs and medicinal

substances (including phamaceuticals!) from that perspective.  And we need to

view these substances according to their properties, temperatures and Channels.

 This is the essence of the idea to " first do no harm. "   Any substance

which simply thins blood viscosity without strengthening and (to the appropriate

degree) moving it, causes damage and bleeding

and is frought with dangerous side effects, as my story above illustrates.

 

respectfully,

 

 

 

 

 

 

 

 

 

 

 

________________________________

<zrosenbe

 

Tue, May 11, 2010 10:36:02 AM

Re: Re: Herbal substitute for warfarin

 

 

I personally think that trying to duplicate drug effects with Chinese herbs is

barking up the wrong tree. .. .apples and oranges. Huo xue/quickening blood

medicinals and formulas have very different effects than powerful drugs such as

wayfarin.

 

 

On May 11, 2010, at 8:03 AM, amadeashakti wrote:

 

> Dr. Chen was at the Great River Symposium in 2009, where he delivered a

presentation on TCM alternatives to drugs. From his handouts regarding " blood

thinners " he lists Dan Shen and Chi Shao as having anti-coagulant effects; Dan

Shen, Hong Hua and Chuan Xiong for anti-platelet effects; shui zhi, san leng, e

zhu for thrombolytic effects; and of course the standard formulas for moving

blood, are also listed. Unfortunately, no studies are referenced.

>

> Amadea Shakti

 

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

 

 

[Guest guest]

I agree Z'ev. Not only that, but warfarin does not cure blood stasis. One can

be taking warfarin, plavix, etc and still have blood stasis s/s that do not

resolve until blood stasis medicinals are used.

 

-Steve

 

On May 11, 2010, at 12:36 PM, wrote:

 

> I personally think that trying to duplicate drug effects with Chinese herbs is

barking up the wrong tree. .. .apples and oranges. Huo xue/quickening blood

medicinals and formulas have very different effects than powerful drugs such as

wayfarin.

>

>

> On May 11, 2010, at 8:03 AM, amadeashakti wrote:

>

> > Dr. Chen was at the Great River Symposium in 2009, where he delivered a

presentation on TCM alternatives to drugs. From his handouts regarding " blood

thinners " he lists Dan Shen and Chi Shao as having anti-coagulant effects; Dan

Shen, Hong Hua and Chuan Xiong for anti-platelet effects; shui zhi, san leng, e

zhu for thrombolytic effects; and of course the standard formulas for moving

blood, are also listed. Unfortunately, no studies are referenced.

> >

> > Amadea Shakti

>

>

> Chair, Department of Herbal Medicine

> Pacific College of Oriental Medicine

> San Diego, Ca. 92122

>

>

[Guest guest]

Hi Neil,

 

base formula:

dang gui 15 g

chuan xiong 12 g

tao ren 12 g

hong hua 10 g

wu shao she 20 g

chai hu 12 g

niu xi 15 g

mu gua 20 g

 

for blood stasis add:

ji xue teng 30 g

dang pi 15 g

tu yuan 15 g

 

for damp evil add:

fang yi 12 g

ze xie 12 g

yi mu cao 15 g

 

for tendency toward yin xu ( & #20559;pian1 yin1 xu1) add:

sheng di 20 g

xuan shen 15 g

mai dong 15 g

hua fen 20 g

 

Put herbs into pot, add 500 to 800 mL water, bring to boil at high heat, then

lower heat to simmer 30 mins, down to about 200 mL. 1 batch of herbs per day,

each batch to be cooked twice, drink in 2 to 4 portions. [i take this to mean

cook the herbs twice for a total of 400 mL. Then drink this 400 mL each day,

either as as 200 mL BID or 100 mL QID, or in thirds.] 6 days is one course of

treatment. Stop one day, the take next course of treatment [another 6 days of

herbs]. According to the patient's condition, can add low molecular dextran or

" 706 blood plasma substitute " [hydroxyethyl starch] and chuan xiong qin

injection or compound prescription of IV drip of dan shen.

 

Before and after each course of therapy, measure and record limb circumference,

reexamine blood viscosity, PT, FN.

 

Charlie

 

, " neil " <npregozen wrote:

>

> Charlie or group,

>

> Can anyone out there easily translate the herbs and dosages and post them for

us non-Chinese readers?

>

> Thanks,

> Neil Pregozen

>

> , " charlie_thomson_lac " <cthmsn@>

wrote:

> >

> > Hi Danny,

> > Interesting question, did you find anything yet?

> > Take a look at this study http://tiny.cc/hrk5r

> > It's in Chinese with an English abstract. I can't cut and paste from the

> > pdf. To summarize, 71 patients were split into groups A and B. Group A

> > was given herbs (formula listed in Chinese with herbs in grams, prep and

> > dosage) and warfarin. Group B was given herbs but no warfarin. Scroll

> > down to Table 2 in the PDF (all the blood work values). The last row

> > (酶原时间 (s)) is Prothrombin Time in seconds. Group A's PT

> > increased from 9.5±3.8 to 18.2±4. Group B from 9.7±3.6 to

> > 14±2.5.

> > The authors didn't provide the lab's Mean PT or ISI which would have

> > allowed us to calculate INR. But the change in PT in group B strongly

> > suggests that these herbs will result in a favorable change in your

> > patient's INR when used along side or in replacement of the warfarin.

> > Let us know how it goes.

> > Charlie

> >

> > , Danny Johnson <dj@>

> > wrote:>> Hi everyone,> I have a patient who is on warfarin therapy for

> > an increased risk of blood clot formation. The side effects and

> > lifestyle guidelines associated with using the drug are too much for him

> > and he'd like to try something else. Of course TCM has a huge

> > collection of blood invigorating/stasis removing herbs to choose from,

> > but I'm having a hard time finding data in English showing any of our

> > popular remedies having specific anticoagulant effects that increase

> > INR. There are plenty of studies showing Chinese herbs potentiating the

> > anticoagulant effects of warfarin that result in an increased INR, but

> > none that I can find using solely Chinese herbs. His wife is an MD and

> > would like to be able to measure his INR as a method of proof that any

> > remedy is working. I've checked the Chen books and PubMed but nothing

> > so far. Any ideas?> > Thanks,> Danny

> >

> >

> >

[Guest guest]

My Grandfather was on Warfarin when I was caring for him. The doctor's office

supplied us with some literature on the drug and it actually listed quite a few

herbs that one should be careful with. TCM herbs included Dang Gui and Gan Cao.

I gave him some formulas at a fairly light dose that included both of these

drugs and I noticed no adverse effects. Still, it is a very squirrely drug. He

was going to a " Coagulation Clinic " weekly for a while to have his levels

checked and they had a hard time keeping them stable. I would be very very

careful when treating someone on Warfarin with herbs.

 

On another note, when I was a student a Naturopath teacher mentioned natto

extract as having very strong clot-busting/preventing effects. Natto is a

fermented soy product eaten in Japan. I found several abstracts online. Here's

one:

http://www.ncbi.nlm.nih.gov/pubmed/12620531?dopt=Abstract

It's great food if you can get used to the taste. Most Japanese supermarkets in

the states sell frozen natto. I just had some for breakfast!

 

Carl

acupuncturecarl.blogspot.com

[Guest guest]

On May 12, 2010, at 7:52 PM, carlstimson wrote:

 

>

> On another note, when I was a student a Naturopath teacher mentioned natto

extract as having very strong clot-busting/preventing effects. Natto is a

fermented soy product eaten in Japan. I found several abstracts online. Here's

one:

> http://www.ncbi.nlm.nih.gov/pubmed/12620531?dopt=Abstract

> It's great food if you can get used to the taste. Most Japanese supermarkets

in the states sell frozen natto. I just had some for breakfast!

>

> Carl

> acupuncturecarl.blogspot.com

>

> __

>

 

Ewww. I've had some Japanese friends who scramble natto w/ raw egg and eat it

that way. Double ewww. Now why would you want to do that to yourself, when you

can get nattokinase in pill form, not too expensive. Unless you're in training

for a trip to Japan - you'll really impress 'em!

 

ann

 

 

[Guest guest]

Yes, our clinical supervisor in school prescribed a dan shen containing formula

to a patient on warfarin. The patient had to be admitted to the hospital a few

days later due to severe internal bleeding. This is a risky drug to experiment

with.

 

What makes Danny's original question interesting to me is the idea of using the

PT/INR test in conjunction with . It's not about finding an

herbal substitute for warfarin. Do the standard diagnosis and

treatment. A favorable change in INR is a positive " side effect " of the CM

treatment, which shows that the therapy is " working " from a western medical

perspective. It may not be replicable or may not even be a valid protocol for

other patients, but it could improve the quality of life for this particular

patient. And it's an ideal situation that the patient and his MD wife are

willing to give it a try and to do the necessary monitoring for safety and

effectiveness (from a WM perspective). I would otherwise not be experimenting

with warfarin / herbs. Not from a philosophical perspective of not using herbs

as substitutes for pharmaceuticals, but for safety and liability reasons.

 

BTW, ITM has a relevant article on warfarin and mentions natto at the end.

http://www.itmonline.org/arts/warfarin.htm " Unlike warfarin, which has the focus

on preventing clotting, natto-kinase appears to have the primary effect of

breaking up clots, via a fibrinolytic activity; it interacts with the

plasminogen system, by reducing the PAI level and increasing the amount of

plasmin. " I just had some yesterday for lunch as well

 

 

, " carlstimson " <carlstimson

wrote:

>

> My Grandfather was on Warfarin when I was caring for him. The doctor's office

supplied us with some literature on the drug and it actually listed quite a few

herbs that one should be careful with. TCM herbs included Dang Gui and Gan Cao.

I gave him some formulas at a fairly light dose that included both of these

drugs and I noticed no adverse effects. Still, it is a very squirrely drug. He

was going to a " Coagulation Clinic " weekly for a while to have his levels

checked and they had a hard time keeping them stable. I would be very very

careful when treating someone on Warfarin with herbs.

>

> On another note, when I was a student a Naturopath teacher mentioned natto

extract as having very strong clot-busting/preventing effects. Natto is a

fermented soy product eaten in Japan. I found several abstracts online. Here's

one:

> http://www.ncbi.nlm.nih.gov/pubmed/12620531?dopt=Abstract

> It's great food if you can get used to the taste. Most Japanese supermarkets

in the states sell frozen natto. I just had some for breakfast!

>

> Carl

> acupuncturecarl.blogspot.com

>

[Guest guest]

John Chen says in his seminars to be very cautious about mixing coumadin

derivatives ie Warfarin, Heparin etc. with blood moving medicinals, since

people have lost their license over this and people have had serious

complications due to negligence.

Dang gui is also something to be careful with, since it naturally contains

coumarins.

Any other herbs that aren't in the " Blood moving " category, we should also

be cautious about?

 

K

 

 

 

 

On Wed, May 12, 2010 at 8:17 PM, charlie_thomson_lac <cthmsnwrote:

 

>

>

> Yes, our clinical supervisor in school prescribed a dan shen containing

> formula to a patient on warfarin. The patient had to be admitted to the

> hospital a few days later due to severe internal bleeding. This is a risky

> drug to experiment with.

>

> What makes Danny's original question interesting to me is the idea of using

> the PT/INR test in conjunction with . It's not about finding

> an herbal substitute for warfarin. Do the standard

> diagnosis and treatment. A favorable change in INR is a positive " side

> effect " of the CM treatment, which shows that the therapy is " working " from

> a western medical perspective. It may not be replicable or may not even be a

> valid protocol for other patients, but it could improve the quality of life

> for this particular patient. And it's an ideal situation that the patient

> and his MD wife are willing to give it a try and to do the necessary

> monitoring for safety and effectiveness (from a WM perspective). I would

> otherwise not be experimenting with warfarin / herbs. Not from a

> philosophical perspective of not using herbs as substitutes for

> pharmaceuticals, but for safety and liability reasons.

>

> BTW, ITM has a relevant article on warfarin and mentions natto at the end.

> http://www.itmonline.org/arts/warfarin.htm " Unlike warfarin, which has the

> focus on preventing clotting, natto-kinase appears to have the primary

> effect of breaking up clots, via a fibrinolytic activity; it interacts with

> the plasminogen system, by reducing the PAI level and increasing the amount

> of plasmin. " I just had some yesterday for lunch as well

>

>

> --- In

<%40>,

> " carlstimson " <carlstimson wrote:

> >

> > My Grandfather was on Warfarin when I was caring for him. The doctor's

> office supplied us with some literature on the drug and it actually listed

> quite a few herbs that one should be careful with. TCM herbs included Dang

> Gui and Gan Cao. I gave him some formulas at a fairly light dose that

> included both of these drugs and I noticed no adverse effects. Still, it is

> a very squirrely drug. He was going to a " Coagulation Clinic " weekly for a

> while to have his levels checked and they had a hard time keeping them

> stable. I would be very very careful when treating someone on Warfarin with

> herbs.

> >

> > On another note, when I was a student a Naturopath teacher mentioned

> natto extract as having very strong clot-busting/preventing effects. Natto

> is a fermented soy product eaten in Japan. I found several abstracts online.

> Here's one:

> > http://www.ncbi.nlm.nih.gov/pubmed/12620531?dopt=Abstract

> > It's great food if you can get used to the taste. Most Japanese

> supermarkets in the states sell frozen natto. I just had some for breakfast!

> >

> > Carl

> > acupuncturecarl.blogspot.com

> >

>

>

>

 

 

 

--

 

 

""

 

 

www.tcmreview.com

 

 

 

[Guest guest]

Keep in mind that Western medicine warns about fluctuating the amount of

intake of green vegetables.

 

 

 

-Jason

 

 

 

 

On Behalf Of

Thursday, May 13, 2010 5:29 AM

 

Re: Re: Herbal substitute for warfarin

 

 

 

 

 

John Chen says in his seminars to be very cautious about mixing coumadin

derivatives ie Warfarin, Heparin etc. with blood moving medicinals, since

people have lost their license over this and people have had serious

complications due to negligence.

Dang gui is also something to be careful with, since it naturally contains

coumarins.

Any other herbs that aren't in the " Blood moving " category, we should also

be cautious about?

 

K

 

 

 

 

 

 

 

[Guest guest]

On Thu, May 13, 2010 at 4:29 AM, <johnkokko wrote:

 

>

> Any other herbs that aren't in the " Blood moving " category, we should also

> be cautious about?

>

> K

>

Many of the herbs that are described as hepato-protective can lower liver

enzymes. At that point, the speed at which the liver metabolizes a drug is

slowed potentially leading to a change in the amount of drug that is found

in the blood stream.

 

This process is identical to the affect that grapefruit has on the liver.

 

Another issue, though I have yet to find any clinical examples of this, is

herbs for either diarrhea or constipation. If herbs cause the intestinal

peristalsis to speed up (to treat constipation) or slow down (to treat

diarrhea), the amount of time in which a drug is available in the intestines

to be absorbed can be shortened or lengthened leading to unforeseen changes

in bloodstream concentrations of a given drug.

 

-al.

 

--

, DAOM

Pain is inevitable, suffering is optional.

http://twitter.com/algancao

 

 

 

[Guest guest]

, <johnkokko wrote:

>

> John Chen says in his seminars to be very cautious about mixing coumadin

> derivatives ie Warfarin, Heparin etc. with blood moving medicinals, since

> people have lost their license over this and people have had serious

> complications due to negligence.

 

That's interesting because he used to say that he uses herbs with coumadin all

the time and hasn't had a problem (that was a long time ago though) as long as

you use careful monitoring. I followed that advice and just use a small dose

until the patient gets their next INR / PT and then make sure it's playing nice.

If I had a patient who did not have their clotting under control, I just follow

common sense and avoid blood moving herbs or use very small doses and request

they have their next blood test in a week. I haven't had a bad outcome yet and

rarely seen large changes in clotting when we up the doses to normal levels that

require much other than slightly lowering the coumadin (dictated by the PCP).

Generally, now that Plavix is on the market you don't see as many patients on

coumadin and I think plavix plays more 'nicely' with others.

Geoff