In some cases, the difference between bulk and granular herbs is minimal; other times, there can be dramatic clinical differences.
As an inherently processed product, there are a multitude of confounding factors that make it difficult to predict when granular herbs may be acceptable. Therefore, we firmly believe that bulk herbs, as traditionally prepared in decoction, are the most clinically effective and reliable form of Chinese herbs. This position stems from our clinical observations in China and Taiwan, as well as our own full-time clinical practice of using both granular and bulk herbs side by side, along with over a decade of exploration and debate with professional colleagues on the issues.
Although we share our thoughts and observations on this issue from our clinical practice, we encourage you to come to your own conclusions based on using both bulk and granular formulas on yourself and with your patients.
We have experienced two situations that have demonstrated clear and profound differences between bulk and granular herbs.
The first is seen when the same formula is given to the same patient in both bulk and granular forms. The variance is often so profound that sometimes we wonder if we have, in fact, given the same herbs. For example, we see patients doing great taking a bulk formula, and when they switch to the same formula in granulars, their symptoms return or they develop side effects.
The second situation occurs when we run out of a single bulk herb and in its place have the patient stir-in a granular form of the herb. Sometimes there is no problem, but we have also seen numerous cases of side effects. Because we are usually making the exact substitution for multiple patients we have an interesting data set. That is, if we see multiple patients (that have received the same substitution) report side effects, we know they are not coincidental incidents. For example, the latest episode occurred in May 2012 with Zhi Mu (Anemarrhenae Rhizoma). Two patients out of five reacted to the substitution with strong digestive complaints, diarrhea, cramps etc. One had celiac disease and was convinced, based on her experience, that there was gluten in the herbs. There was none that we know of (or that the supplier would admit to)! Besides the obvious question of what is actually happening to produce these side effects, such occurrences quite simply tell us one thing: there is a difference between the two.
As a result of these observations, we now use about 90% bulk herbs in our clinical practice and often discourage patients from switching.We do acknowledge that granulars have their place, especially related to when patients travel.
Bulk herbs are the gold standard in Chinese medicine. They are the most authentic, time-tested, and effective method of delivery. In China, the greater majority of doctors use bulk herbs. In Taiwan, the majority of doctors prescribe granulars, due to insurance reimbursement. However informal polls have indicated that these doctors do believe that bulk herbs are most effective in the majority of the cases.
In the West, the majority of practitioners use granular herbs. This is mostly due to the difficulties of running a bulk herb pharmacy and the commonly held belief that, “my patient won’t take bulk herbs.” Patients, though, will take bulk herbs when the practitioner becomes fluid in managing the issues.
Practitioners almost unanimously agree that bulk herbs are superior, but time and money stand in the way of making them available to our patients. However, once you learn how to navigate the terrain of bulk herbs, the clinical benefits are well worth it. See the article, How to get your patients to take bulk Chinese herbs and setting up a Red Pine bulk pharmacy.
Granulars and Concentrated Extracts
“When we say, for example, that Dang Gui (Tangkuei) has the actions of supplementing and moving blood we are saying that when cooked in a decoction as has been done for centuries, we have observed that this herb can have these actions. If prepared in a different fashion, where the components are present in different proportions than would be present in a normally-cooked decoction, the resulting product may or may not have the same actions.” – Andy Ellis, 2008
Dosing & extraction ratios:
Determining how to properly dose granulars has been an ongoing challenge for Chinese herbalists. Many have relied on the extraction ratios, also called source-product ratios (S:P), to calculate their dosages as compared to bulk herbs.
The extraction ratio is made up by a combination of two numbers, written as (X:Y). The first number (X) represents how much of a given substance one starts with (e.g. 5 KG). The second (Y) relates to how much of a substance one ends up with (e.g. 1 KG). In this example, the extraction ratio would be a 5:1.
Extraction ratios has become the industry standard and are the main requirement on granular product’s labels. Consequently, many base their decisions around dosage, quality, and company comparison on this concept. However, extraction ratios are of little help in determining proper dosing and present a very misleading reference point (Ellis, 2008).
They have created more confusion than clarity, especially related to the precision of dosing that is required by Chinese herbalism. Before getting into the details, I would like point out a few key points:
- A higher extraction ratio does not equate to a more potent product. That is, a 10:1 is not necessarily better than a 5:1, nor is it two times as potent (Ellis, 2008)
- There is no standard method to determine these ratios. Therefore companies can dramatically manipulate these numbers (Ellis, 2008)
- We know of no company that has a line of herbs that all have a single ratio (e.g. 5:1). This concept has more to do with marketing than a true standardization.
First, different herbs require different extraction ratios to preserve the correct ratio of constituents as compared to a decoction. Therefore some herbs are best extracted at a 20:1 ratio and others at a 2:1. Because companies are required to put the extraction ratio on the bottle, they often just label them as all “5:1”. This number is often because the average of multiple formulas (or singles) comes out to around 5:1. Interestingly, one may find the exact same granular sold in the US with a 5:1 on the label, and the same Chinese version will have a vastly different ratio printed on the bottle (e.g. 1:1 or even 20:1).
One reason that companies do not publish the ´exact´ ratio is that they change from batch to batch. This is normal and actually preferred. For example, depending on the content of moisture, quality of a given batch of herbs, and other factors, one batch might need a larger amount of starter herb (thus increasing the extraction ratio) to arrive at the proper ratio of constituents in the end. This flexible process might yield one batch at 4:1, while the next at 3:1. That is, the most accurate extraction methods are attempting to mimic constituent profiles that resemble decoctions as much as possible, not just force a 5:1 ratio. Therefore many aspects are considered for determination of the proper extraction ration for each batch of herbs.
For example, Skye Sturgeon, the quality control manager at the very well-respected Mayway Corp., reveals that the Plum Flower® 5:1 formula extract powders may range anywhere from 2.88 to 14.81. In general, single granular extract medicinals often range from 0.25:1 to 30:1 (Sturgeon, 2012).
However, many companies market convenient fixed ratios (such as 5:1). Of course it is possible to start with five kilograms of any herb, and with enough time, repeated cooking, etc., produce a one-kilogram product. This is a 5:1 extraction ratio. However, this would yield a very unbalanced profile of constituents, and we know of no reputable company that does this.
There is also a practice whereby companies use the proper extraction ratios for each individual herb (2:1, 14:1, etc.), and then add what are essentially fillers to create a 5:1 ratio.
However, as Mr. Sturgeon points out, it is impossible to make a 3:1 ratio into a 5:1. In practice, anything below 5:1 is left alone. He points out that anything above a 5:1 yield can be made into a 5:1 by adding additional filler; however, sometimes 50% filler or more is required.
Of note, because minerals, resins, etc. extract poorly in water, they are dealt with in varying manners. The first is either by using poorly yielding ratios such as 30:1, and then converting them to 5:1. The second is to pulverize the bulk herb, making a straight 1:1 ratio. Finally, a solvent may be used in the extraction process. These processes will yield very different results, but it is rarely clear on the bottle which method has been used.
I think it should be clear that there is no chance of producing a complete line of 5:1 extracts without making serious compromises to active constituents. That is, by forcing herbs that should be, for example, 3:1 into a 5:1 creates an extract that gets farther away from how that herb â€œfunctionsâ€ in a standard decoction.
Although these issues apply to both singles and formulas, examining the common practice of mixing single herbs into a custom formula is also worthwhile. Here are three common ways that herbalists use these ratios to mimic bulk herb dosages.
Method #1:The individual extraction ratio of each single herb is estimated and then used to calculate the appropriate dosage in relation to an original bulk formula. For example, a 10:1 single herb is perceived to be two times more potent than a 5:1, and so twice as much of the latter (5:1) is used. Each medicinal therefore has a specific conversion number / multiplier. Such calculations can become quite cumbersome. The thinking is that if we knew the exact ratio of each herb we could make the appropriate conversion. However, not only do we not know exact ratios, but a 10:1 extract is NOT 2 times more potent than a 5:1.
Method #2:Because of this difficulty, companies will market that all of their single medicinals are produced with equal extraction ratios, e.g. 5:1. If this were true one could easily convert a bulk formula to a granular version with a single multiplier. For example, 2 grams of granular is used for 10 grams of bulk, and 1 gram of granular is used for 5 grams for bulk.
Method #3:Some forgo any math and just approximate with doses of 1s and 2s and 3s. Although this bypasses the issues above, it still brings the practitioner no closer to the precision that our medical tradition requires.
All of these methods have problems as discussed above.
Dosage related to spoons
Finally, granulars are almost always dosed by using a spoon or a number of grams a day. For example, patients are often told to take anywhere from 2-6 scoops two to three times a day. Of note, spoons from different companies are different sizes, with up to a 50% difference in volume. Although confusing, this is not the real issue. A bigger problem exists in using spoons to equate to grams, because different herbs have different densities. One spoonful of one herb (or formula) may weigh 1.5 grams, while another herb (or formula) may weigh 1.9g (same spoon). This is a 26.667% difference!
Of course, bulk herbs potentially have their own issues in regard to dosage: patients may cook herbs incorrectly, and there may be minor variations in levels of active constituents between batches. However, we are misleading ourselves if we think that granulars, because they have ‘modern technology’ behind them,represent a more accurate delivery system.
Lack of herbal processing (pao zhi) options – Quite simply there are only a small handful of herbal preparations available in granular form, which greatly limits treatment options, and require compromise on the part of anyone using granular herbs. For example, jiu xi dang gui (wine-washed Angelicae sinensis Radix) is traditionally used in bu zhong yi qi tang (Tonify the Middle to Augment the Qi Decoction), but is not available (as far as we know) as a single granular herb, or even used in granular versions of the formula that we can find. Other basic herbal processing, such as mi zhi huang qi (honey-prepared Astragali Radix), or yan chao huang bai (salt-fried Phellodendri Cortex) are unavailable as well, along with the numerous processed herbs used in China and found in our textbooks. While some practitioners are unaware of the availability and importance of using appropriate processed medicinals, they can be essential to the success of a prescription. For more information, see What is herbal processing and why is it important?
Cooking time options – Different herbs require different cooking times. That is, the same medicinal can be cooked for varying times to obtain different functions. For example, most practitioners are familiar with the significantly different effects of da huang (Rhei Radix et Rhizoma) when added at the end of decoction as opposed to when cooked together with the main formula. Other medicinals, such as bo he (Menthae haplocalycis Herba),chai hu (Bupleuri Radix), zhi zi (Gardeniae Fructus), dan dou chi (Sojae Semen preparatum) etc. may be cooked 5-10 minutes or 45 minutes depending on the desired function.
Granulars simply do not afford this type of flexibility.To make up for this, manufacturers of granulars often try to manipulate the extraction process. For example, many companies manipulate their extraction process for da huang (Rhei Radix et Rhizoma) to try to obtain a similar product as unprocessed da huang (Rhei Radix et Rhizoma) used as an add in decoctions, to obtain a more purgative effect. Thus, the granular is fixed with a certain type of function, which may or may not be known to the practitioner except through experience and undesired results in patients.
Expense & Dosage – There are numerous factors that go into determining prices of herbs and a large number of dosage strategies. One might give 1 scoop of granulars a day or 20. One may give 25 grams of bulk herbs for a day or 250 grams. However it is reasonably clear that if one were to price 100 grams of bulk herbs and the equivalent of granular they price would be much higher. Thus higher range dosages of granulars becomes cost prohibitive for many.
Change of Qi During Processing – Quite simply, the more an herb is processed, the more that the qi of that herb is disturbed, changed, and weakened. Think of a frozen dinner or instant coffee. Anyone serious about comparing bulk to granulars should cook a batch of bulk gui zhi tang and then prepare the equivalent amount in granular form (in the same amount of water) and compare the taste, quality of qi, effect, etc.
Fillers and Non-Transparent Labeling – A granular bottle of herbs may contain a large portion of fillers or excipients, which can cause reactions in patients. Unfortunately, we have seen reactions over and over in our clinic. Along with very clear and serious allergic symptoms, we have seen gastrointestinal issues, along with a multitude of other varying reactions, and a number of people reporting just ” not feeling right “.
Some manufactures are not transparent as to what they are using in the final herb product, using the ubiquitous “proprietary blend ” under ” ingredients “. Common fillers and excipients are potato starch (nightshade family), rice starch, and maltodextrin (potentially derived from GMO corn) -Â all potentially allergenic substances. As medical practitioners, and with the ongoing rise in food sensitivities, it is our responsibility to know exactly what we are giving our patients.
Synergy – There is a beautiful symphony of interactions that occurs when we cook bulk herbs together. We know from scientific research that cooking single herbs together often produces new molecules that are not present in the original herbs. These new molecules have been shown to have specific therapeutic value. Putting a bunch of single granular herbs together into a capsule or a cup of hot water simply cannot have the same effect as cooking herbs together.
There is no question that there are a whole host of variables that we must contend with when we use granulars. We may try to debate some of these issues, but in the end, our clinical experience and monitoring of clinical results have definitely shown that granulars and bulk herbs are just different.
It should be made clear that the author still uses granulars, especially when patients travel, and positive results are obtained in a percentage of cases. In certain situations, herbs in any form are better than no herbs. However, the vast majority of patients in our clinic are given bulk herbs. For more information on using bulk herbs, see our previous blog post on how to get your patients to take bulk herbs.
We welcome any comments or corrections.
- Sturgeon, S. Powders and Granulars RCHM (Register of Chinese Herbal Medicine) (UK) (Spring 2012).
- Ellis, A. Discussion of Extraction Ratio Expressions for Concentrated Herb Extracts. Notes from Cinnabar Creek. Vol. 011, Spring 2008.
[i] Our Boulder pharmacy, Chautauqua Apothecary, has been in service for over 25 years. It currently exclusively fills formulas for 6 in-house Chinese herbalists. It carries over 450 bulk herbs as well as a complete granular pharmacy (singles and formulas).