I also play on "huge" and wouldn't consider playing the game on a lower setting. I have the benefit of a fast processor and lots of memory, so the only difficulties I encounter are with skirmishers and cavalry in towns - these units just don't fit very well into the restricted space inside the walls. The skirmishers are much more likely to blunder into melee, and the cavalry tends to get strung out in very long columns. This is a pain to deal with but probably also fairly realistic. I just avoid using these unit types when storming a town.

Question for pezhetairoi:

Yup, warbands on 360... Works for me.
I've also modded most infantry units up to 240 men per unit by changing the appropriate number in export_descr_unit.txt for each unit. What I don't understand is how you have jacked the number of men in a warband up to 360. I see no way to do this for a campaign - any number in export_descr_unit.txt larger than 60 causes a show_err and any change to the preferences file for UNIT_SIZE larger than 160 acts as 160. For custom battles, changing the preferences number only appears to work on the unit selection menu. As professorspatula said earlier, it has no effect on the actual number of men per unit on the battle map.

Am I missing something here?