Dosing strategies.

Date: Mon, 16 Jan 1995 19:53:45 -0800
Sender: Medicinal and Aromatic Plants discussion list <HERB.TREARN.BITNET>
From: moon2peg.NATURE.BERKELEY.EDU
Subject: Re: Dosages and formulations

In reply to:
>try five drops per day and then increase to bid if patients tolerates the initial dose for several days. You can also dilute homeopathically if n ot comfortable with tincture.

Greetings:

Hmm. This seems haphazard. First, "drops" are not an adequate unit for dosage. Drops differ according to such things as viscosity, temperature, stickiness, atmospheric pressure, and the users pressure on the dropper, not to mention the size of the hole! Secondly, with a few exceptions, the symptom pictures for homeopathic indications are not the same as they would be for full strength usage! One cannot just dilute an herbal tincture with the expectation of a result due to a homeopathic dose. One of the basic tenets of homeopathy is "like treats like". In other words, homeopathic remedies may work by activating the body's own defenses through aggravating the symptom. Full strength herbal preparations, in spite of much of the industry's marketing information, are most often used (with the exception of, i.e. Arnica montana) for the opposite of what the homeopathic dosage would indicate.

Cheers,
Peggy

From: Paul Bergner <bergner.TELEPORT.COM>

> Hmm. This seems haphazard. First, "drops" are not an adequate unit for

But in actual practice, sometimes drop doses, 1-5, even of a mild herb (i.e. not aconite or the like) have profound healing effects. I like to think of dosing strategies, rather than an absolute "correct" dose.

1. Pharmacological dosing: higher doses to produce a strong physiological effect, often in the healing context of suppression of symptoms.
2. Physiological dosing: The minimum dose to produce a physiological effect. This approach is the essence of healing in the vitalist herbal tradition. It respects the vital force and respects the symptoms it is producing in an effort to heal.
3. "Wise Woman" dosing. Thanks to Susun Weed for clarifying this approach to healing. This is taking milder, more common alteratives and nutritive herbs in larger food amounts, i.e. how about a plate of dandelion green with a little lemon and olive oil instead of a dandelion tincture? How about a big pitcher of raspberry leaf iced tea on a summer day.
4. Drop dosing. This method was common among the Eclectics, and not just with powerful potentially toxic herbs. It is also common in the homeopathic literature, i.e. Beoricke is full of it. The homeopaths gave crude mother tinctures of many herbs, and, the dogmatism of some modern homeopaths notwithstanding, they were not always given according to the law of similars.
5. Homeopathic dosing. Dosing according to the law of similars, regardless of the amount of the dose or the dilution. Usually this is with potentized remedies in small doses.

All these methods work in some situations. It depends on the practitioner-patient relationship, the skill of the practitioner, and the situation. People locked into any one method usually are in denial about the periodic utter failure of that approach, when another approach would have worked better.

Paul Bergner
Editor
MEDICAL HERBALISM

From: Jonathan Treasure <jtreasure.JONNO.DEMON.CO.UK>
Subject: Re Drop dose

Hi Peggy,
Hope the floods have not been too bad where you are!

> This seems haphazard. First, "drops" are not an adequate unit for dosage.

*I would say your anti-droppism is open to dispute.

>Drops differ according to such things as viscosity, temperature, stickiness, atmospheric pressure, and the users pressure on the dropper, not to mention the size of the hole!

*All measurements vary according to various physical parameters.That is why there are standard defintions eg of a metre length, and somewhere (i forget where, probably Paris or Brussels) in europe there is a the platinum standard reference metre rule kept in a temperature controlled case.This is hardly a basis for attacking drops. There is a standard drop, by definition, like there is an apothecaries definition of a "teaspoon". Just because it varies at the top of mount Everest isn't really a problem. Most herbalists would write 3 tsps three times a day on a bottle rather than 5ml TDS, a teaspoon being defined as 5ml (or indeed 60 drops ) when the required dosage is 5ml.

>Secondly, with a few exceptions, the symptom pictures for homeopathic indications are not the same as they would be for full strength usage!

*actually quite a lot of exceptions, but perhaps the main reason there are not more is simply that the classic homeopathic "symptom picture" is a different thing (ie a picture of the specific remedy's effects by proving the remedy in a healthy person) from a Specific Indication in the sense that the Eclectics would differentiate the appropriateness of a herbal remedy according to its Theraputics (in different illnesses) Both ultimately emphasise the specificty of remedy to condition - just differently.

>One cannot just dilute an herbal tincture with the expectation of a result due to a homeopathic dose.

*Yes but this is of course how homeopathic dilutions start out - from a "standardised" herbal mother tincture.

> One of the basic tenets of homeopathy is "like treats like".

* there is a "philosophical" opposition between the law of similars and the principle of contraries as treatment approaches. The arguments between homeopaths and herbalists will go on ad infinitum, (or nauseam) but in practise, I find it is more interesting to look at the effects of a plant as being continnuously modulated from pharmaologic, through physiological to minimal (drop) dosing, on through physiologic homeopathic and beyond Avagadro's Number to the "high potency" homeopathic (and flower essence).

Among US herbalists Matthew Wood is especially notable for practising this approach (see his Seven herbs As Healers), and the general principle here is that the more subtle the dose the more one starts working with emotional, psychological and spiritual aspects. This is partly what the homeopaths meant be "ultmisation" - driving the illness out to higher and more esoteric levels with higher and higher potencies until it is completeley eliminated from not just the gross but even the subtle ( or whatever you want to call them) body levels. For example, you mentioned the effect of doses of Scutellaria on your dreams. What about Mugwort, not internally dosed, but simply hanging in the bedroom? Hypericum too has esoteric dreaming qualities.

>In other words, homeopathic remedies may work by activating the body's own defenses through aggravating the symptom.

* This is the sort of intuitive medical herbalistic description of the mechanism of homeopathy which ends up causing great arguments between homeopaths and herbalists. No further comment!

>Full strength herbal preparations, in spite of much of the industry's marketing information, are most often used (with the exception of, i.e. Arnica montana) for the opposite of what the homeopathic dosage would indicate.

* I don't understand this. Are you saying that marketing info by USA herb producers claims homeopathic effects because of the legal constraints?? I know the situation re labelling is bizarre in most states but .....! However as I said above, Arnica is not a rare exception. What about Chamomile?

cheers to you too,
jonathan

From: Jonathan Treasure <jtreasure.JONNO.DEMON.CO.UK>
Subject: More Drops

>The biological variation within the species calls for standardization of dosage form preparations whenever possible. (My concern about "drops" comes into play here)

Aha Peggy!

I had a hunch that this might have been the real reason for your *droppism*

Firstly - as an aside to the physics - Fred is quite right (and very poetically so) about the determinants of a drop size being surface tension, rather than the bore of a dropper. A drop is precisely the expression of the molecular forces of cohesion distributing evenly as the forces of surface tension throughout its body. Hence a drop from the end of a matchstick, which is a dropper with an infinitely small bore, is not substantially different from a drop of the same substance through a glass tube. Once the bore of the tube is large enough so that the forces of adhesion (capillary) do not restrain the liquid against gravity, then you are dealing with a hosepipe not a dropper. But drop size is remarkably constant within the dropper range from infinitely small to a couple of mm.

Secondly - on drop doses. Once again I would take the vitalist position. It is only necessary to measure accurately (in drops) the dose of a remedy to the extent that the remedy is very "strong" and a minimal physiological dose is required eg to avoid emesis with lobelia.

Of the different philosophies of dosage outlined by Paul Bergner, ie Pharmacological, Physiological, Drop, and Homeopathic (leaving wise woman's food aside for the moment) The Drop dose is confusing for herbalists because it is not based on the Pharmacokinetic model of remedy action that underlies the first two approaches, but rather is based on the energetic or essence nature of the plant remedy. From this point of view the drop is analagous to the low (physiologic) homeopathic potencies eg 1x, 3x, which MAY contain molecules of the mother tincture.

Herbalists who are happy to deride homeopathy, especially in its high potency forms ie anything greater than (6.23 x10 to the minus 23) Avogadro's number are really shooting themselves in the foot as far as wholistic healing is concerned.. As i said in my earlier post, the effects of a plant remedy are fundamentally given by the Essence of the plant, which is not ultimately a material substance. There is a full spectrum of possible effects of administering the remedy, modulated by the actual method of dosage. To argue that drops must be standardised to me is much the same as the argument of reductionist botanical medicine which demands standardisation on a percentage active constituent. This is the pharmocokinetic model of allopathy emerging at the core of naturopathic vitalism, and needs to be understood as such. The drop dose philosophy however is similar to the homeopathic approach in that vibration (imprinted through water) not substance is the basis.

There can be no claim to wholism if herbalism throws out the subtle body with the allopathic bathwater.

Once again I would cite Matthew Woods case histories as exemplifying one of the few practitioners who seem to me to be able to move effortlessly, seamlessly and intuitively from flower essence, through homeopathic to drop dose and physiologic posolgies as required by the situation. magic. pure magic

best wishes

jonathan

PS The tibetan word Tigle translates literally as *drop* but is actually the essence of luminous mind ...the ultimate expression of enlightenment (in esoteric tantra) - hum that just popped into my head - oh well.