Clinical Dosage Reflections: From My Own Experience Taking Cinnamon Twig Decoction
Beijing's smoggy weather weakened my immunity, and I seem to have caught something—signs of a cold, plus rather severe skin itching lately. Based on my own constitution, I prescribed myself three doses of Cinnamon Twig Decoction (Guizhi Tang). The formula is as follows:
Cinnamon twig (Guizhi) 9g, white peony (Baishao) 9g, honey-fried licorice (Zhi Gancao) 6g, fresh ginger 3 slices, jujube 3 pieces
After taking the medicine, following the Guizhi Tang aftercare method, I drank two bowls of hot thin congee; sure enough, a faint sweat appeared all over the body, and the whole set of symptoms—headache, runny nose, itching—disappeared.
The clinical dosage of Chinese herbs has been endlessly debated. If one follows the view of certain classical-formula-school doctors, a Han-dynasty liang converts to 15 modern grams, in which case Cinnamon Twig and white peony in Guizhi Tang should each be dosed at 45g, and honey-fried licorice at 30g, otherwise there is no clinical effect. But in practice, converting one liang to 3g also works very well.
In treating various chronic diseases these days, I am accustomed to using small formulas and small doses, gradually increasing the dose only if there is no effect. At the low end I use only one or two herbs, with doses as light as under 1 gram; not only do patients take the prescription away full of doubt, the pharmacy dispensing the medicine is also full of doubt, wondering whether such a prescription can possibly treat disease. Yet most of the time, for certain stubborn chronic diseases, a single dose produces immediate effect—so much so that patients can hardly believe it is the Chinese medicine working and suspect it must be coincidence.
Some TCM colleagues also like to use the poor quality of herbs in today's medicinal market as an excuse to justify writing large-dose prescriptions—of course, I am by no means opposed to large-dose prescriptions; for chronic, stubborn diseases, sometimes if the dose is insufficient the effect really cannot be achieved. But from my own outsider's observation, many large-dose prescriptions are purely overmedication. In this era of fully competitive markets, the quality of herbs on the medicinal market is not that bad; although problems such as pesticide residues exist, the efficacy is not discounted so severely that several-fold higher doses are required to be "effective."
Moderate, balanced, light dosing is both safe for medication and saves patients money. Moreover, for chronic disease patients, quick cure is impossible; most have been treated for years, their spleen and stomach already damaged, and using large doses of Chinese herbs to inflict new irritation on the gastrointestinal tract is really inappropriate. As a doctor, if one can make the principle of moderate, balanced, light dosing a personal pursuit, one's therapeutic results can be greatly improved—it is just that this principle conflicts with the doctor's income.