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Granule Dosage

By Eric Brand

Japanese Granule Trends


In Japan, the majority of practitioners are
physicians who prescribe herbal medicine based
on biomedical disease differentiation.
The formulas used are generally neither
combined nor modified, and nearly all of the
formulas in use are classical formulas that were
created prior to the Song Dynasty (before 960
CE).

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Granule Trends in Taiwan
In Taiwan, granules dominate the market,
owing largely to their convenience and
integration with the national insurance
system.
All major hospitals and clinics use granules.
The most striking feature of Taiwanese
prescriptions is the tendency for
practitioners to mix whole formulas
together.

Granule Trends in Mainland China


Decoctions made in decoction machines or at home are
more prominent than granules at present.
Many large Chinese hospitals stock granules, and this
trend has increased in recent years.
Practitioners tend to build raw formulas from scratch;
this is essentially the same as the prescription style used
in the West.
When using granules for patient convenience, many
doctors build a formula by combining singles.
Single herbs are packaged in a standard dose quantity

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How to Take Granules
As a general rule of thumb, a total dose of about 10-18
grams of granules per day is ideal for most cases
Dose may vary depending on constitution and formula size
Can be taken in multiple divided doses or in one dose
depending on the case
To build a formula from single herbs, most herbs will be
added at a dose of about 0.5-
0.5-2.0 grams
Bring a cup of water to a boil
Dissolve a measured amount of granules into the water

Dosage
Two main ways to calculate dosage
1) Total daily target dose
Herbs or formulas are used proportionally
Attention is paid to the particular characteristics of
the individual herbs
2) Based on raw herb equivalence
Mathematical relationship to raw herbs
Full equivalent dose or slightly less?

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Total Daily Target Dose
In general, the total granule dosage should be between
10-18 grams per day.
For children, the dosage often ranges from 3-10 grams
per day
Severe and acute conditions can be treated with 15-25
grams per day.
If the case is mild or the patient is weak, the dosage
should be on the low side.
If the case is severe or the patient is large and robust,
the dosage should be on the high side.

If prescribing a formula with 15-18 ingredients,


the total dose should be closer to 18 grams per
day.
If only 5-12 ingredients are used, a dosage of 10-
18 grams is probably sufficient.
As a rule of thumb, multiplying the number of
ingredients by 1.5 should give a reasonable total
daily dose.

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Medicinals that are potent by weight or extreme
in nature should be given at low doses, generally
0.3-1.5 grams per day.
Rou Gui (Cinnamomi Cortex)
Ren Shen (Ginseng Radix)

Fu Zi (Aconiti Radix Lateralis Praeparata)

Sha Ren (Amomi Fructus)

Chai Hu (Bupleuri Radix)

Wu Zhu Yu (Evodiae Fructus).

Medicinals that have a balanced nature and a


relatively high standard dose in raw decoctions
should be used at higher doses, around 1-3
grams per day.
Shu Di Huang (Rehmanniae Radix Praeparata)
Shan Yao (Dioscoreae Rhizoma)
Yi Yi Ren (Coicis Semen)
Mu Li (Ostreae Concha)
Yu Zhu (Polygonati Odorati Rhizoma).

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Moderate, mid-range herbs are often used at a
dose of 1-2 grams per day.
Dang Gui (Angelicae Sinensis Radix)
Bai Zhu (Atractylodis Macrocephalae Rhizoma)

Bai Shao (Paeoniae Radix Alba)

Ba Ji Tian (Morindae Officinalis Radix)

Some items are used at different dosages for different


purposes.
Chai Hu (Bupleuri Radix) is used in low doses to raise yang in
formulas such as Bu Zhong Yi Qi Tang
0.3-
0.3-0.8 grams
If Chai Hu is instead used to course the liver qi,
qi, slightly larger
doses are typical
0.5-
0.5-1.5 grams.
For treating lesser yang disease, even higher quantities would
be called for
1.5-
1.5-3.0 grams.

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Target Doses with Formulas
A patient presents with diarrhea that is accompanied by
tenesmus and pain. Upon examination, the patient is diagnosed
with a wood-
wood-earth disharmony complicated by damp-
damp-heat. The
following prescription is given:
Si Ni San (Counterflow
(Counterflow Cold Powder) 6 grams
Tong Xie Yao Fang (Painful Diarrhea Formula) 6 grams
Huang Lian (Coptidis Rhizoma)
Rhizoma) 1 gram
Mu Xiang (Aucklandiae
(Aucklandiae Radix) 1 gram
In this example, two compound formulas are used together, with
two single medicinal additions.
Si Ni San and Tong Xie Yao Fang address wood-
wood-earth
disharmony manifesting in painful diarrhea.
Huang Lian and Mu Xiang are added here to eliminate tenesmus
due to damp-
damp-heat.

Simple Dosage Calculation Style


Several shorthand methods for calculating
granule dosage have emerged, but few standards
exist in the West.
Unique features of Western granule dosing
practice
The West is the only place that uses a 5:1 paradigm
Most formulas built from singles based on raw herb
equivalence
Different dosing styles in different markets

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One Simple Method
Write out daily dose of raw herbs in grams
Huang Qi 12g, Rou Gui 3 g, Ren Shen 6g, Bai Zhu 10g, Fu
Ling 10g, Bai Shao 10g, Dang Gui 8g, Shu Di 12g, Chuan
Xiong 6g, Zhi Gan Cao 6g
Simply dispense the same weight in granules, but
administer the prescription for 5-6 days.
This example dispenses 83 grams of granules, which is
about 17 g/day if given for 5 days, 14g/day if given for
6 days, or 12g/day if given over 7 days
Adjust the # of days based on constitution of patient

Another Simple Method


Write out the raw herb dose weight
Huang Qi 12g, Rou Gui 3 g, Ren Shen 6g, Bai Zhu 10g, Fu
Ling 10g, Bai Shao 10g, Dang Gui 8g, Shu Di 12g, Chuan
Xiong 6g, Zhi Gan Cao 6g
Simply multiply the dosage of each ingredient by about
1.5 to get the number of grams per week
Huang Qi 18g, Rou Gui 4.5 g, Ren Shen 9g, Bai Zhu 15g, Fu
Ling 15g, Bai Shao 15g, Dang Gui 12g, Shu Di 18g, Chuan
Xiong 9g, Zhi Gan Cao 9g
This gives 124.5 grams per week, or approx. 18g/day
Ideal for small-
small- to average-
average-sized prescriptions
For larger prescriptions, consider multiplying by only 1 or 1.2

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Taiwanese Method
National insurance in Taiwan will pay for 34
doses per day of 6.0 grams of extract powder.
The prescription is created by using ingredients
proportionally within the 12-18 g daily dose
Tendency is to start from whole formulas with
single-herb additions
This creates complex formulas that can be
simultaneously perceived as eloquent or chaotic
depending on ones perspective and experience

Dosing Granules Based on Raw


Herb Equivalence
For items that are a 5:1 extract, simply write the dosage
as though it were a normal raw formula and divide the
dose of each herb by five.
Generally can round down a bit (10-
(10-25%)
Most items that are not concentrated (1:1) are
substances that rarely used in decoction form
Dose them as though they were being taken as a raw powder
with the decoction
1-3 grams is typical for most of these items, with the notable
exception of E Jiao and other gelatin products

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Dosing Granules with Variable
Concentration Ratios
Most granules, whether openly stated or not,
have variable concentration ratios
If using granules with unstated concentration
ratios, precise equations are impossible but
reliable clinical results are still apparent if the
dose range is reasonable (10-18 g/day or so)
If the concentration ratios are stated, simply
write out the raw herb dose weight and convert
it to the granule weight mathematically

For each ingredient, With a concentration With a concentration With a concentration With a concentration

how many grams ratio of 3:1, how ratio of 5:1, how ratio of 6:1, how ratio of 9:1, how

would you prescribe many grams of the many grams of the many grams of the many grams of the

in decoction? granule do you need? granule do you need? granule do you need? granule do you need?

3g 1 0.6 0.5 0.33

6g 2 1.2 1 0.67

9g 3 1.8 1.5 1

10g 3.33 2 1.67 1.11

12g 4 2.4 2 1.33

15g 5 3 2.5 1.67

30g 10 6 5 3.33

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Limiting Factors
Cost
Yi Yi Ren vs. Ren Shen
Items that are weak by weight
Challenging if one must limit total prescription size
Minerals
Often not concentrated
Gelatins
Not concentrated

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