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Using KPC Granular Concentrates

Prescribing granular herb concentrates requires a different reasoning process from that which is used for crude herbs. Calculating the dosage of herb concentrates also demands a unique method, which is quite unlike that used for crude herbs. This paper aims to address these two issues.

Concentrated herb granules are available as single herbs and as prepared formulas. Three strategies exist for combining these two forms:

1. Use of one or two classical formulas with or without single herbs.
2. Combination of several classical formulas with or without single herbs.
3. Combination of single herbs only.

Use of One or Two Classical Formulas With or Without Single Herbs

This strategy uses one or two classical formulas as the base for treatment and adds single herbs to meet the exact needs of the patient. These two cases serve as examples:

Case I. A patient who suffers from blood vacuity as evidenced by scant menstrual flow, pale tongue, fine pulse and dizziness, also has insomnia. The practitioner selects Si Wu Tang (Tangkuei Four Combination) to address blood vacuity and adds Ye Jiao Teng (Polygonum Multiflorum) and Suan Zao Ren (Zizyphus) to treat the branch symptom of insomnia. A ten day formula was prescribed as follows:

Si Wu Tang (Tangkuei Four Combination) ÂÂÂÂ	75 grams
Ye Jiao Teng (Polygonum Multiflorum)	15 grams
Suan Zao Ren (Zizyphus)ÂÂÂÂ	10 grams
TotalÂÂÂÂ	100 grams

Case II. A young boy presents with chronic nasal congestion. The practitioner determines from the boy’s pulse, tongue and other signs and symptoms that if this patients had come to her without nasal congestion she would have prescribed Bu Zhong Yi Qi Tang (Ginseng & Astragalus Combination). She decides to use that formula and combine it with Cang Er San (Xanthium Formula). Because the nasal discharge is yellow the practitioner also adds Huang Qin (Scute).  A ten day formula is prescribed as follows:

Bu Zhong Yi Qi Tang (Ginseng & Astragalus Combination)ÂÂÂÂ	25 grams
Cang Er San (Xanthium Formula)	30 grams
Huang Qin (Scute)	5 grams
TotalÂÂÂÂ	60 grams

Combination of Several Classical Formulas With or Without Single Herbs

Taken to the extreme, this strategy employs formulas as if they were single herbs. Three or more formulas are combined to address the complex picture with which the patient presents. Case III and IV are examples of this approach.

Case III. The young boy with nasal congestion in Case II now, several weeks later, still has nasal congestion (though improved).  He presently, however, also has yin vacuity signs such as night heat, excessive thirst and a fine, rapid pulse. The practitioner adds Liu Wei Di Huang Wan (Rehmannia Six Formula), Qing Bi Tang (Pueraria Nasal Combination), Shi Hu (Dendrobium) and Ge Gen (Pueraria Root). The adjusted 10 day formula is as follows:

Bu Zhong Yi Qi Tang (Ginseng & Astragalus Combination)	15 grams
Cang Er San (Xanthium Formula)	7 grams
Huang Qin (Scute)	5 grams
Liu Wei Di Huang Wan (Rehmannia Six Formula)	15 grams
Qing Bi Tang (Pueraria Nasal Combination)	8 grams
Shi Hu (Dendrobium)	5 grams
Ge Gen (Pueraria Root)	5 grams
TotalÂÂÂÂ	60 grams

Case IV. An older gentleman has a diagnosis of prostatitis from his Western medical practitioner and presents with frequent, weak and inhibited urination. He also complains of low back pain that is worse at night when he is fatigued, cold limbs, gas and bloating after eating, low energy, poor sleep and dizziness. The patient’s tongue is pale, with thick fur in the rear. His pulse is fine, moderate and weak. The practitioner decides that the patient suffers from yang vacuity, blood vacuity, and damp-heat in the lower burner. He settles on using Bei Xie Fen Qing Yin (Tokoro Combination) for damp-heat in the lower burner and You Gui Wan (Eucommia & Rehmannia Formula) to supplement yang. Xiang Sha Liu Jun Zi Wan (Saussurea & Cardamon Combination) is added to supplement and rectify qi in the central burner. He Shou Wu (Polygonum) and Ji Xue Teng (Milettia) supplement blood and Yuan Zhi (Polygala) and Yi Zhi Ren (Alpinia Fruit) address frequent urination and insomnia. The ten day formula is as follows:

Bei Xie Fen Qing Yin (Tokoro Combination)ÂÂÂÂ	40 grams
You Gui Wan (Eucommia & Rehmannia Formula)	15 grams
Xiang Sha Liu Jun Zi Wan (Saussurea & Cardamon Combination)	10 grams
He Shou Wu (Polygonum)ÂÂÂÂ	10 grams
Ji Xue Teng (Milettia)	12 grams
Yuan Zhi (Polygala)ÂÂÂÂ	5 grams
Yi Zhi Ren (Alpinia Fruit)ÂÂÂÂ	8 grams
TotalÂÂÂÂ	100 grams

Combination of Single Herbs Only

This method is used when no formula can be found that meets the patient’s disease pattern or when it is desirable to use only a few herbs. It is important not to use more than twelve herbs for this method, as the amount of each herb would be too small if more herbs than that are used. Ideally, ten or fewer herbs are prescribed when this method is used. An example follows:

Case V. A fifty year old woman is diagnosed with heart disease by Western medicine. She presents with what Chinese medicine sees as blood stasis and qi vacuity.  She is given the following formula (amount is for ten days; 2 grams per dose, 3 times per day):

San Qi (Pseudoginseng)	15 grams
Dan Shen (Salvia)	20 grams
Ren Shen (Ginseng)	17 grams
Xue Jie (Dragon’s Blood)	8 grams
Total	60 grams

Discussion

Of the three strategies here, that of using one or two classical formulas with or without single herbs is the most common. The strength of using formulas as the basis for a prescription is that in the formula the herbs are cooked together before they are concentrated. This closely follows the traditional process used to prepare crude herbs and thus is a more sound strategy than simply mixing single herb concentrates to form a prescription.

The second strategy of combining many formulas together is most often reserved for very complex cases where enduring disorders have created multiple disharmonies. The argument against this strategy is that so little of each herb exists in the final prescription that its effect is limited. Proponents of this strategy counter by insisting that they are using each formula as a functional unit. They claim that a formula once cooked together, is different from a single herb only in that its functions are by design and it is more balanced within itself than a single herb.

The third strategy of mixing only single herbs should be reserved for occasions where there is no classical formula that addresses the patient’s pattern.  Given that there are over two hundred and fifty formulas available in concentrated granules, this should be the exception rather than the rule.

 

 

KPC Dosage

Concentrates are vacuum-dried granules of a decocted herb or formula and their dosage is less dependent on the density of the herb in its original form and more dependent on how easily the herb is extracted in the decoction process. Therefore, calculating the dosage of herb concentrates demands a unique method that is quite unlike that used for crude herbs. What is being weighed is a concentrate and not an agent that requires decocting. The system described here is what is used in Taiwan where concentrated granules have been prescribed for more than twenty years.

 

The usual adult dose is between 2 to 3 grams, three times a day; the most common is 3 grams per dose.

A four-step process can be used to arrive at appropriate dosages when using a combination of single herbs, combining two or more formulas, or using formulas in combination with single herbs:

1. Calculate the total number of grams to be dispensed by multiplying the grams per day times the number of days the formula will be taken. For example, if ten days of herbs are to be given at 10 grams per day, to total equals 100 grams. (To simplify calculation, one can round the daily dosage to 10 grams per day—although 9 grams would be the actual amount taken.)
2. Dose the single herbs in the prescription at 0.5 to 2 grams/day. Herbs which are typically given in small dose such as Yuan Zhi (Polygala) and Fu Zi (Aconite) should be about 0.5 grams/day and herbs which are typically prescribed in large doses such as Ji Xue Teng (Milettia) and Yi Yi Ren (Coix) should be prescribed at 1.5 to 2 grams/day. Most herbs should be dosed at 1 gram/day. Determine the total number of grams assigned to single herbs.
3. Subtract the total number of grams assigned to single herbs from the total number of grams to be dispensed (from step 1). This number is the amount left for the formulas.
4. Divide this amount among the number of formulas within the prescription allowing larger amounts for the formulas to be emphasized.

Here is an example of using a formula combined with single herbs. Let’s run through the four steps of dosage discrimination.

Prescription:
Si Wu Tang (Tangkuei Four Combination)	75 grams
Ye Jiao Teng (Polygonum Multiflorum)	15 grams
Suan Zao Ren (Zizyphus)	10 grams
Total	100 grams

1. The prescription is for ten days and the dose is 10 grams/day. Thus the total number of grams we have to work with is 100.
2. The next step is to determine the amounts of the single herbs in the prescription. In this prescription there are two single herbs. Since Ye Jiao Teng (Polygonum Multiflorum) is commonly given in large dosages we will give 1.5 grams/day (a total of 15 grams for ten days). Suan Zao Ren (Zizyphus) is assigned the normal daily dose of 1 gram/day (a total of 10 grams for ten days). The total number of grams assigned to all single herbs in the prescription is 25.
3. Next, we subtract the number of grams assigned to single herbs (25) from the total number of grams we had to work with from step one (100). This leaves us 75 grams for the formula.
4. Since this prescription only has one formula in it we give all 75 grams to that one formula [Si Wu Tang (Tangkuei Four Combination)]. If we had wished to include two formulas we would have divided the 75 grams between the formulas giving a larger dose to the more important formula.

Discussion

This four-step method works best when using one or two classical formulas with or without single herbs, but can be applied to all three strategies discussed above.

Dosages should be adjusted for children, older patients and patients with serious disorders. Small children can be given doses as small as 1 gram/day. Patients with serious, acute cases sometimes call for doses of 12-15 grams/day.

Herbs that are commonly given in small dosages owing to possible side effects should not be given in dosages that exceed 0.5 grams/day. It is best to start with an even smaller amount and gradually increase the dosage to make sure that the patient suffers no discomfort. Examples include: Xi Xin (Asarum), Fu Zi (Aconite), Yuan Zhi (Polygala), Wu Gong (Scolopendra), Quan Xie (Buthus), Cao Wu (Aconite Tsao Wu), Fan Xie Ye (Senna Leaf) and Lu Feng Fang (Wasp Nest).

Capsules

KPC Capsules are 1/2 a gram (500mg) per Capsule.  The recommended adult dosage is 4 Capsules 3x per day.

 

“L” Tablets

KPC’s line of Tablets are a 7.5g to 1 ratio.  The recommended adult dosage is 2 Tablets 3x per day.

Conclusion

Designing a prescription using concentrated granules differs greatly from what we are taught about prescribing crude herbs. The system above was designed to take the inherent qualities of this form of herbs into account and has been used effectively for over twenty years.

As the use of concentrates grows in the West it is certain that new insights will be gained on how to best administer them. In the meantime, it is hoped that this article will help practitioners take advantage of the convenience and effectiveness of this method of prescribing Chinese herbs.