Monday, December 17, 2007

Drop doses in Herbal Medicine

Herbalists often use standard doses of 5 mls 3 x/day of the prescribed tincture. Here is an article I wrote about the use of drop doses, a lot cheaper and better tolerated.
It was published in Avena, Journal of the New Zealand Association of Medical Herbalists, Summer 2007 and is reproduced here with permission of the Editor.

The use of drop doses in herbal medicine.

Dr. J. Rozencwajg, MD, PhD, NMD.

Like most of us, I have been taught the standard dosage of herbal tinctures as 5mls TID of the mixture prescribed to the adult patient and in proportion to body weight for children.
Within my first few prescriptions, I was confronted with two problems: the filthy taste of the remedies (take it in juice solved that one), and the high price. Another one appeared soon: the solutions were working well but with many digestive side effects. Following in the footsteps of my guru Sammy Hahnemann, I started reducing the doses and to my “surprise” (or should I write “as expected”), the efficiency was as good, while the side effects faded away and the price became a lot more affordable.
Nowadays, depending upon the perceived sensitivity of the patient, I start with 5 drops TID, climbing to a cruising dose of 30 drops TID, if need be.
Some very sensitive patients are having good results with 1 (ONE) drop in a glass of water, sipping during the day. The homeopath in me is not surprised, but how could that happen in terms of phytopharmacology and physiology? Yet I am not alone to practice that way in the herbal world: a few years ago, the famous herbalist Henrietta Kress was asked on a discussion list “what is the minimal dose of remedy that would work”; her answer was “one drop, if the remedy is well indicated”.
And that is where the secret lies: the proper, precise choice of the remedy or mix of remedies.
Let’s look at two examples from my practice; unfortunately I am not allowed to present the full cases, so a summary will have to do.
An elderly patient with heart failure and irregular pulse; he was given high doses of Crataegus, to no avail. He also complained of a painful sensation in the liver area and a feeling as if the heart would stop when turning in bed. All those symptoms put together are typical of Digitalis; yet digitalis or its conventional refined alkaloid digoxin is not often prescribed due to the closeness of therapeutic and toxic levels….at classical, conventional doses. I prescribed Digitalis 3X, which is a one –thousandth dilution (1:1000), 3 drops 3x/day; all symptoms disappeared within a few days.
Another patient (one out of a few with the same story) was having liver and gallbladder “problems”, not very specific. I was considering the usual mix of a few liver remedies while conducting the anamnesis, when the systematic questioning brought out the specific symptom that there was an associated pain at the tip of the right shoulder blade at the same time there was an increase of the liver/gallbladder symptoms; this is a keynote of the remedy Chelidonium which was prescribed at 1 drop 3 times/day of the tincture, with complete resolution of all the liver symptoms.
At those very low doses, the risk of intoxication or bad reaction is clearly almost nil, except for an allergic reaction.
How does it work? Conventional pharmacology teaches us that we need a certain amount of substance to act on receptors, enzymatic reactions or any other mechanism to have an effect and implies a dose-related effect: the higher the dose, the stronger the action, up to toxicity, and there is a linear relation.
Let me introduce you to the old and purposely forgotten pharmacological Law of Arndt-Schultz: low doses stimulates, medium dose regulates and high dose depresses; you will find this in old pharmacology textbooks, but is considered as a fluke, an abnormality by modern pharmacologists; nevertheless this has been demonstrated many times in laboratory conditions: when the dose of an active substance is sufficiently low, it often acts in the opposite way a high dose would; the dose-related, linear relation is always present at higher doses, the so-called therapeutic doses of conventional medicine and conventional phytotherapy.
The drop dose technique is situated at the extreme lower end of the linear relation, closer or within the area of regulation; therefore it still has the therapeutic potential of conventional dosage while regulating the systems it addresses but not yet presenting an inversion of indications, although this latter part is inherent to the therapeutic effect of the remedy.
It is within this area of pharmacology that the Homeobotanical remedies do work: they have the attributes of the herbal remedy and the attributes of the homeopathic remedy without the potential toxicity of the high herbal doses and the deeper effects of the homeopathic remedies.
Although Homeobotanical remedies are potentised (or dynamized, succussed, if you prefer) before using them, clinical experience with single herbs in dilution but not potentised has demonstrated clear efficiency.
Many herbalists consider homeopathy and potentised remedies as bogus science; so be it, it is not my purpose to discuss this here. Nevertheless the clinical information contained in homeopathic materia medicas overlaps and completes the one we find in phytotherapic textbooks, and reciprocally. Using that knowledge increases and widens the indications of many of our herbs while giving us the potential to use them more effectively, more sparingly and at lower cost to the patient.
The only effort has to come from our side, to know our herbs more in detail, to understand how they are used within different modalities so that we can have more precise and refined tools for cure.