Why Are Dosing Recommendations So Inconsistent in Herbal Medicine?

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The good news is that dosing for dried herbs taken as such (for example by chewing or as a powder in a capsule or stirred into water), or in simple water-based preparations such as infusions and decoctions, are often remarkably consistent even across cultures (e.g. traditional Chinese and traditional Western).

The perplexing thing is that with other kinds of preparations, notably tinctures and other liquid extracts, dosing recommendations differ widely between authors and between schools of thought. And yet you will not meet a practitioner who does not claim good results.

What is happening here? Here are some possibilities which we ought to consider:

  1. Many plants have a very wide therapeutic window.
  2. Herbs work in different ways when prescribed at higher, lower or minute doses, however they work to the same end. For example, some practitioners believe that in small doses herbs nudge the body towards a healing response rather than taking over parts of its physiology, which happens with larger doses: the difference between a subtle suggestion and a command. Others believe that it is some “subtle energy” conveyed by the herb, rather than the chemicals it contains, that interacts with the body’s “energy” to produce a healing response. This, they say, explains its effectiveness when used in extremely tiny doses.
  3. Practitioners’ perceptions and beliefs are subject to considerable biases and therefore are not reliable reflections of reality. The reality might be that in many cases the patient’s encounter with them and the associated treatment did not materially affect the course of the patient’s condition.
  4. The patient’s encounter with them and the associated treatment did affect the course of the patient’s condition, but this was not due in any way to the kind of herb prescribed, its dose or the nature of its preparation. It was due to other factors in the context of the interaction which we shall call “non-specific factors” e.g. the patient liked the practitioner and perceived them to be trustworthy and competent, which engendered belief in the treatment prescribed.
  5. More than one of these things are happening at the same time.

Number 5 is my best guess, with the proviso that with regard to number 2, I do not believe in “subtle energies” disembodied from the chemistry of life. But I would like to direct people’s attention to numbers 3 and 4, the importance of which I believe most practitioners vastly underestimate, and some even deny. As practitioners of a non-conventional system of medicine, there is a tendency to be defensive on these matters, which is understandable as it is a commonplace for sceptics to assume, “Well, it’s all placebo, isn’t it?” But non-specific effects along with patient and practitioner biases and are normal phenomena occurring every day in all branches of medicine, conventional and non-conventional, all over the world. Only if we admit their importance and attempt to account for them can we move to a more mature understanding of our discipline and our art as practitioners.

Copyright © Robert Hale 2021.