Show Notes
Tk and TC talk about the common ways that cough can present in the clinic and ways to tackle it from surface to deep level infections.Â
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Episode Transcript
[00:00:04] Speaker A: Hi, everyone, and welcome to the Nervous Herbalist, a podcast for Chinese medicine practitioners who like herbs and want to learn more about their function, their history, and treatment strategies to use in the clinic. Let's get into it.
Hi there, everybody. Welcome back to the Nervous Herbalist. My name is Travis Kern, and I'm.
[00:00:24] Speaker B: Here with Travis Cunningham.
[00:00:27] Speaker A: And we are here to talk to you guys today about cough. Oh, yeah, everybody's favorite topic, cough.
I think maybe we say that about every disease that we bring up.
[00:00:39] Speaker B: Maybe we do.
[00:00:40] Speaker A: They're all everyone's favorite topic.
The thing about cough is, of course, we deal with it all year long. You know, I think people think about it related to cold and flu, which is important because that's, I think, where people see it a lot. But in the sequelae to cold and flu, there's a lot of cough.
[00:00:57] Speaker C: Yes.
[00:00:57] Speaker A: And also sometimes there's just cough.
Like this year in the summer, I dealt with cough almost independent, seemingly of an exterior invasion, or at least the exterior invasion went in, resolved itself fairly quickly, and then just left a cough to the point that the patient reports like, yeah, I don't know, I just had this cough.
And then that cough goes on for weeks.
Which, of course, is one of the reasons that they usually find themselves with us, is because none of the other biomed items were helpful with cough.
So let's break it down.
You know, when we think about cough these days, there's a lot of different ways to think about it. Think about it from which organ it's coming from, maybe which larger pattern is involved, a constitutional piece.
But when you think about cough, you think about it through confirmations.
[00:01:55] Speaker B: Yeah, primarily.
[00:01:56] Speaker A: Yeah. So why don't you tell us, like, which of the four, which. Which of the. The six confirmations are the ones that you think cough presents in. In a. In the most common ways. And then let's take them from most common to least common.
[00:02:10] Speaker C: Yeah.
[00:02:11] Speaker B: I think cough can come as a result of a problem with any conformation. But there's four of them that are major, that are happening most of the time when people come in to see us.
So you can have a Tai on cough, you can have a Xiaoyang cough, you can have a Xiaoyin cough, and you can have a tie in cough as well.
[00:02:31] Speaker D: Right, okay.
[00:02:33] Speaker A: And then of those, you know, I guess, you know, it depends on where you live and what kind of patients you see that might influence which of these are the most common that you see in your own practice. But, you know, from what you've seen here in the clinic, which of These confirmations is the one that's usually the culprit. If we've got a cough so far.
[00:02:54] Speaker B: And away, it's a Shaoyang is the main pattern we're going to see across the board.
[00:02:59] Speaker D: Yeah.
[00:03:00] Speaker A: Do you think that has to do with, like, that just being part of the. Like an exterior invasion pattern overall?
[00:03:05] Speaker C: Yeah, yeah.
[00:03:05] Speaker B: I think it's where modern people just tend to get stuck anyway. Like, I think it's. It's a problem anyway. The Xiaoyang has a problem anyway. And then when you layer a disease process on top of it, it just gets stuck there much more commonly.
[00:03:19] Speaker A: Yeah. So in some ways, all of the Xiaoyang stuff we're constantly talking about here is a. Is a product of being a modern person.
[00:03:27] Speaker C: Yeah.
[00:03:28] Speaker D: Yeah, maybe.
[00:03:29] Speaker B: At least in part.
[00:03:30] Speaker C: Yeah.
[00:03:30] Speaker A: Okay, so let's break that down then. So Xiaoyang, I mean, if you've been listening to the show at all, you've heard us talk a lot about Xiaoyang symptomology.
Of course. I assume the same classics apply here?
[00:03:42] Speaker C: Yes. Yeah.
[00:03:43] Speaker B: Any. Any of the particular. The specific criteria for Xiaoyang disease applies.
[00:03:48] Speaker A: So ribside tenderness, rib side tenderness, alternating symptomology.
[00:03:53] Speaker C: Yep.
[00:03:53] Speaker D: Okay.
[00:03:54] Speaker A: Sore throat, sore throat.
[00:03:56] Speaker C: Yep.
[00:03:57] Speaker B: Dizziness, dizzy vision. Right, yeah. Any of those things.
[00:04:03] Speaker D: Okay.
[00:04:03] Speaker A: And if you're a listener out there and you're thinking, I've heard these guys talk about Xiaoyang a lot, then that means that, you know, you can win the prize.
You know which formula is the formula that we need here, which is Xiaochai Hutong. That's right. That's right. Xiao Chao Tong, every Chinese medicine herbalist's workhorse.
I think, honestly, probably no matter where you live, like I was about to say here in the Pacific Northwest. But you know, if Xiaoyang symptomology is a consequence of modernity on some level, it doesn't matter where you live.
[00:04:38] Speaker B: No, I think it'd be useful anywhere.
[00:04:40] Speaker D: Yeah.
[00:04:41] Speaker A: Okay. But we can't just use xiaocha utang on its own in this context.
[00:04:44] Speaker D: Right.
[00:04:44] Speaker A: Because we're dealing with a pronounced cough.
[00:04:46] Speaker E: Right.
[00:04:47] Speaker A: So this isn't just someone came in with the usual cold and flu symptomology and sore throat. Now we have a cough. The cough is notable.
Does it matter at this particular stage, the quality of the cough, if all the other signs are pointing to Xiaoyang like that is if it's very phlegmy or it's hard to expectorate or something like that.
[00:05:07] Speaker B: If it's phlegmy or hard to expectorate, that might also qualify as a chest obstruction. Kind of situation. Okay, so we might do this and something else.
[00:05:17] Speaker A: Okay, so let's pin that for the moment, and we'll come back to chest obstruction. So let's just assume there's nothing particularly notable about the cough except that it exists.
[00:05:26] Speaker E: Right.
[00:05:26] Speaker D: It's.
[00:05:27] Speaker B: It's like a functional cough, if you will, like a functional impairment rather than material being involved.
[00:05:32] Speaker A: What do you mean by that?
[00:05:34] Speaker B: Phlegm or fluid that's stuck in the lungs that's triggering, like, you know, sticky phlegm that's getting in there and causing irritation when somebody breathes. That's not the reason this person's having a cough. This person's having a cough because they're having a surface issue, and it's creating a weird pressure problem in the body. And then there's a counterflow that's taking place in the upper burner.
[00:05:55] Speaker A: Gotcha. So instead of, like, feeling something substantive in your chest or throat, this is like that insubstantial tickle or something that leads to the cough.
[00:06:04] Speaker B: It's like a tick.
[00:06:05] Speaker A: Okay, so in that case, we got to modify xiaochaiutong. What's the cough mod here?
[00:06:10] Speaker B: Yeah, so the postscript cough mod in the Shanghan Lun is xiao cai, hutong, renshen, and dazao come out.
Sheng Zheng gets changed to Ganjiang, and then you add Wu Wei.
[00:06:23] Speaker A: Add Wu Wei.
So functionally, what's happening here? Like, why taking out Ren Shen, dacao, we're pulling out sweet flavor.
[00:06:31] Speaker C: Yep.
[00:06:32] Speaker A: Changing Xiangjiang to Ganjiang, we're changing the warmth.
[00:06:36] Speaker C: Yep.
[00:06:37] Speaker A: And then by adding in wei zi, we're adding in sour.
[00:06:40] Speaker C: Yep.
[00:06:41] Speaker A: Why does that matter here?
[00:06:43] Speaker B: Because it's.
You could think of it as a small pattern of fire overacting on metal. So you have Qi stagnation.
[00:06:52] Speaker E: Right.
[00:06:52] Speaker B: The Qi is trying to open the pores of the body in an external contraction. It's failing to do so. Therefore, you see Qi stagnate and signs of that stagnation.
As the Qi stagnates, ministerial fire accumulates and then flares.
And as it flares, it's hitting the lungs.
So then the lungs have an irritation, which then causes cough.
Now, the lungs are also one of the organs we associate with Taiyin.
So when you're in Xiaoyang disease, the worry of the doctor is that if you don't treat this, it's going to go into Taiyin, and then it's going to be a lot harder to treat.
[00:07:32] Speaker E: Right.
[00:07:33] Speaker B: Because Xiaoyang is the last of the Yang confirmations before we go into Yin.
So the Change of Ren Shen and Dazao out is the removal of the gesture to add nutritive fluids into the body, which we want to be careful of in this case, because if there's any tendency toward fluid accumulation or phlegm, it could be bad to add Rention and Dazzo in there because you're telling the body to create more fluids when it has too many.
[00:08:03] Speaker D: Right.
[00:08:03] Speaker B: So that's the first.
[00:08:04] Speaker A: And we definitely don't want fluids in the lungs.
[00:08:07] Speaker B: We don't. No, not excess fluids.
[00:08:10] Speaker A: Not excess fluids.
[00:08:10] Speaker D: Right, yeah.
[00:08:11] Speaker A: Okay. So we're removing the instruction in the formula to moisten.
[00:08:16] Speaker C: Yeah.
[00:08:17] Speaker A: Okay.
[00:08:17] Speaker B: To generate fluids.
[00:08:18] Speaker D: Yeah.
[00:08:19] Speaker B: And then the other thing that can tend to happen with coughing is the cough can tend to occur because the tie in is beginning to cool off. Functionally, as we're getting into Xiaoyang, we have this presentation where Qi is stagnating and there's this intermittent heat that comes up.
[00:08:43] Speaker E: Right.
[00:08:43] Speaker B: We call this fire ministerial fire flaring. When we get into Tyin, it's. The fire is gone. Like it goes away. So you go from a situation where there's chi moving, part of which is a fluid.
[00:08:58] Speaker E: Right.
[00:08:59] Speaker B: A mist, you could say chi moving around the body is like a mist, but there's heat involved.
When we get into Tayin, there's the same fluid that's involved in the pattern, but there's no heat. So we call it cold damp. Instead of damp heat.
[00:09:15] Speaker D: Okay.
[00:09:15] Speaker C: Yeah.
[00:09:16] Speaker B: So the move to include Ganjiang and Wu Weizi is to make sure Taiyin is warm enough. Because the danger is that pretty soon it's not going to be a functional cough anymore. It's going to be a cough because there's a material that's pooling in the lungs and that's a lot harder to get out.
[00:09:36] Speaker A: So even though we're treating this cough that's lodged in the Xiaoyang layer.
[00:09:41] Speaker C: Yeah.
[00:09:42] Speaker A: Part of the addition of these herbs is a nod to the next layer down.
[00:09:46] Speaker C: Yes.
[00:09:46] Speaker B: We're preparing.
[00:09:47] Speaker A: Preparing and protecting.
[00:09:48] Speaker B: Protecting the tie in.
[00:09:49] Speaker D: Right.
[00:09:50] Speaker A: To try and prevent that substantive accumulation.
[00:09:52] Speaker C: Yes.
[00:09:53] Speaker A: Okay, so in the case of.
Well, let's actually just kind of talk about the tie in side of it. So let's assume that the person didn't come in in time.
[00:10:04] Speaker C: Yeah.
[00:10:05] Speaker D: Right.
[00:10:05] Speaker A: Or the. The herbs, you know, weren't dosed enough or what have you.
[00:10:09] Speaker D: Right.
[00:10:09] Speaker A: Speaking of dose, actually, in the Xiaocheutang mods, you've taken out the Rin Chen, take out the Dazao.
[00:10:14] Speaker C: Yep.
[00:10:14] Speaker A: Shangjiang becomes Ganjiang. Same dose.
[00:10:17] Speaker C: Yeah.
[00:10:17] Speaker B: I do nine ganjang nine and then.
[00:10:19] Speaker A: How much on the weight?
[00:10:21] Speaker B: Twelve. I always do twelve.
[00:10:22] Speaker A: Nine and twelve.
[00:10:23] Speaker B: Nine and twelve.
[00:10:24] Speaker D: Okay.
[00:10:25] Speaker A: So let's assume that that didn't hold out or didn't work or they didn't come in in time.
And so now the very thing that we would have been protecting against with this modification of xiaochaiotong has in fact occurred.
[00:10:37] Speaker E: Right.
[00:10:38] Speaker A: So now in tie in, we've got phlegm.
[00:10:41] Speaker C: Yep.
[00:10:42] Speaker A: They're clearing their throat.
[00:10:44] Speaker C: Yep.
[00:10:44] Speaker A: There's probably some other substantial damp phlegm presentation. So maybe, like, stools are looser.
[00:10:52] Speaker C: Yep.
[00:10:52] Speaker A: Body feels heavy.
[00:10:54] Speaker C: Yeah.
[00:10:54] Speaker A: That kind of stuff.
[00:10:55] Speaker B: And there's a distinct lack now of surface symptoms.
[00:10:58] Speaker E: Right.
[00:10:59] Speaker B: So there's no alternating hot and cold. There's not even really body aches anymore.
[00:11:04] Speaker A: Yeah. They don't appear to have a cold anymore.
[00:11:06] Speaker E: Right.
[00:11:06] Speaker A: Like in the classic sense of a cold.
[00:11:08] Speaker C: Yeah.
[00:11:08] Speaker D: Right.
[00:11:09] Speaker A: It's like, oh, the cold has resolved.
[00:11:11] Speaker E: Right.
[00:11:11] Speaker A: This is one of those things that I think is interesting for the listener. Right. Because unless your patient base is well trained to know that you can help with this stuff, a lot of the times people don't come to us first.
[00:11:23] Speaker E: Right.
[00:11:24] Speaker A: Or even second.
[00:11:25] Speaker E: Right.
[00:11:25] Speaker A: Or maybe even third.
[00:11:27] Speaker D: Right.
[00:11:27] Speaker A: Like, they come to us when it's been a month since they got a cold and they still have a cough.
[00:11:33] Speaker B: Well, let's say they took antibiotics.
[00:11:35] Speaker D: Right.
[00:11:36] Speaker B: They could have this present. They could have the tie in presentation after that, you know, no problem.
[00:11:40] Speaker D: Really? Yeah, yeah.
[00:11:41] Speaker A: Because the antibiotics will get in there. They'll rapidly kill off the exterior pathogen, but it's not going to do anything for the disruption to the mechanisms that we deal with.
[00:11:50] Speaker D: Right, right.
[00:11:52] Speaker A: So in this case, we now are looking at a tie in presentation.
We now have this substantive fluid material.
We obviously are not going to be using a harmonizing formula like Shao Caiutang anymore. What's the base formula now that we're in Tain?
[00:12:07] Speaker B: For me, the base formula would be Lingue Jugan tang. That's what I would think of. But lingue jugan tang by itself is not going to treat a cough.
So I tend to add the same modification to Lingui Jugantong, which is Ganjiang and Wu wei.
[00:12:22] Speaker A: And at 9 and 12. Again.
[00:12:23] Speaker B: At 9 and 12.
[00:12:24] Speaker C: Yep.
[00:12:25] Speaker D: Yeah.
[00:12:25] Speaker A: But nothing to take out of Lingui Jugan Tong.
[00:12:27] Speaker B: Nothing to take out.
[00:12:28] Speaker A: Just adding in the Ganjang Wu wei.
[00:12:29] Speaker C: Yep.
[00:12:30] Speaker A: And the reason for those two herbs is the same reason that we would have put them in the Shao chaotang.
[00:12:34] Speaker D: Right.
[00:12:34] Speaker A: So we're trying to, like, warm and Constrain.
[00:12:37] Speaker C: Yeah.
[00:12:38] Speaker D: Right.
[00:12:38] Speaker A: To prevent the fluids from getting out of control.
[00:12:41] Speaker B: Get the fluids and also the warmth. The wu weiza is interesting because wu weiza is sour.
So I always think of the function of wu weci with cough as an antispasmodic sort of quality. So I think of it as like if. If you have a wind in the lungs, if you have wind and metal.
[00:13:02] Speaker D: Yeah.
[00:13:02] Speaker B: The wuwaits is going to make metal. More metal. It's going to stop the wind from happening. If you think of the cough as a spasm or of a wind symptom.
[00:13:13] Speaker D: Yeah.
[00:13:13] Speaker B: And interestingly enough, I think that it also works for sneezing. Yeah, I could see that because I think of sneezing as another type of wind. It's like a.
It's like a spasmodic thing.
[00:13:25] Speaker A: The nose is the orifice for the lungs.
[00:13:27] Speaker B: For the lungs, exactly.
[00:13:28] Speaker A: So that makes sense. It's also interesting, wu wei zi in particular, because I know you've experimented a little bit with, like trying to replace wu wei zi with shanjuyu.
[00:13:37] Speaker C: Yeah.
[00:13:37] Speaker A: Because wu weizi is really expensive.
[00:13:39] Speaker E: Right.
[00:13:39] Speaker D: It's.
[00:13:39] Speaker B: Yeah, it's getting more and more expensive.
[00:13:41] Speaker A: Thanks. Tariffs.
And shajuyu is of course, very sour.
But what's interesting to me about wu weica as an herb is that it is dominantly sour. That is by far its most distinct flavor. But if you eat wuitsi and you crunch down on the seed inside.
[00:13:59] Speaker D: Right.
[00:14:00] Speaker A: You end up with a much more complex flavor profile. That's a little bit peppery.
[00:14:05] Speaker C: Yes.
[00:14:06] Speaker A: A little bit bitter.
I mean, they call it wu weizi like five flavor seed.
[00:14:11] Speaker D: Right.
[00:14:11] Speaker A: Or five flavor fruit.
So it makes sense that there's more going on there. And it's interesting because when we use weight in decoction or in san, it's crushed.
[00:14:21] Speaker C: Yes.
[00:14:22] Speaker A: So the seed is broken open. And that kind of peppery, you know, it's not. It's not exactly like. It's not spicy, like with Sichuan peppercorn, but it has a similarly kind of.
[00:14:34] Speaker B: You're totally right.
[00:14:35] Speaker A: Floral, complicated taste. Yeah. It's not spicy, but it's a similar, like.
[00:14:40] Speaker B: Yeah, it has some pungence, pungency or whatever.
[00:14:43] Speaker A: And it's interesting to think about that idea of the dominant flavor of this sort of like antispasmodic strengthening the metal. But also the plant has an integrated pungency.
[00:14:56] Speaker B: It does, yeah.
[00:14:57] Speaker A: Which I think also serves in all these contexts to prevent the fluid and substantial components from being overly stagnant.
[00:15:05] Speaker E: Right.
[00:15:06] Speaker A: There's a pungency in there. As Ganjiang has.
[00:15:08] Speaker E: Right.
[00:15:09] Speaker A: And also it has a kind of sort of Qi level functionality that you find in aromatic herbs, like in Sharon and saguo and stuff like that. And so it's interesting because, like, we're hunting for a sub primarily for cost, but as is so often the case with a lot of shanghan herbs in particular, there are approximations to their function, but there's very little.
[00:15:34] Speaker B: It's not a perfect substitute.
[00:15:36] Speaker C: Yeah.
[00:15:36] Speaker A: You know, it's like trying to find a perfect substitute for chai who.
A perfect substitute for ma Huang. A perfect substitute for weight. Yeah, it's tough.
[00:15:44] Speaker B: It is.
[00:15:45] Speaker A: It's tough. And you could probably cobble them together from a combination of other herbs, you know, but for the moment, at least we can get our hands on weights. It's expensive, but it's not terrible. And so we can, I think, leverage the interesting complexity of that particular herb to help constrain the cough, but also do these sort of subtle secondary functions.
[00:16:06] Speaker D: Yeah.
[00:16:07] Speaker A: So Linguiz plus Ganjiang plus Wu wei CI. That's dealing in the tie in space.
[00:16:12] Speaker C: Yep.
[00:16:13] Speaker A: Okay, let's continue in this sort of narrative of it being slightly worse than that though, Right. Because again, maybe they really didn't. They were like the sixth person that they came to see.
[00:16:23] Speaker C: Yeah, Right.
[00:16:25] Speaker A: And it's important to remember too that like, sometimes the western interventions can. Can work against us a little bit.
[00:16:32] Speaker D: Right.
[00:16:32] Speaker A: Particularly on the question of antibiotics.
[00:16:34] Speaker B: Oh, man.
[00:16:35] Speaker A: You know, because, so look, antibiotics. Neither Travis nor I have any problem with antibiotics.
[00:16:40] Speaker D: Right.
[00:16:40] Speaker A: Like sometimes you need some antibiotics.
[00:16:42] Speaker D: Right.
[00:16:43] Speaker A: Particularly when infections are intense and you need to stop them in their tracks.
But the problem is that if you're a biomed doctor, you don't really have a lot of tools in this toolkit. So if you gave someone antibiotics and they got better, but then they saw this cough, and the cough is really phlegmy and intense, likely your patient's going to get prescribed antibiotics again.
[00:17:02] Speaker E: Right.
[00:17:03] Speaker A: And so antibiotics are cold.
They are, I think, themselves a little bit damp.
And we know that they damage middle jowl function, digestive fire.
And when those things are damaged, we end up with accumulative fluids which eventually become themselves more dampness and then eventually phlegm.
So if you're dealing with a patient who's kind of gone down the multiple trips to urgent care, maybe there are two, maybe even three rounds of antibiotics in.
And now a lot of the stuff that we were seeing in tie in is probably worse. Yes, Right.
[00:17:40] Speaker B: For sure.
[00:17:40] Speaker A: Because now it's progressed into xiaoyan. So What's. What's worse? Like what. What's the distinguisher for the patient coming in that says, actually, I think we're all the way to Xiaoyan at this.
[00:17:51] Speaker B: Point, everything is a little worse. So they're more tired, they're more heavy, they may have, you know, we said loose stools last time. They may have diarrhea. Like, they. It just may be a little bit worse overall.
[00:18:05] Speaker D: Right.
[00:18:06] Speaker B: And then the key symptom is they're much more fatigued, and they will often say they can't get their energy back by sleeping more. So they try to sleep.
[00:18:19] Speaker E: Right.
[00:18:20] Speaker B: And if I sleep 10 hours, I'm still not rested. Like, they just can't get enough from resting. They don't get their energy back from that.
So that's the biggest distinguisher, I think.
[00:18:32] Speaker A: I think that's an interesting thing that comes out. Cause people will. They will be able to tell you that.
[00:18:37] Speaker C: Yeah, right.
[00:18:38] Speaker A: I mean, it comes out in the questioning so easily when you talk about sleep. Because, you know, like, one of the questions I always ask when we talk about sleep, you know, I get to that section of the 10 questions, and I say, you know, what time are you going to bed? What time are you waking up?
Are you waking throughout the night? Are you sleeping throughout the night? And then when you wake up, do you feel rested? Like, I always ask that, do you feel rested when you wake up?
And, you know, some people will be like, I mean, you know, I'm not really a morning person. Like, I need a cup of coffee or whatever. And that's not what we're talking about here.
[00:19:09] Speaker C: No.
[00:19:09] Speaker B: This is like, I. I could sleep 12 hours a day and I'd still want to sleep more.
[00:19:14] Speaker A: Exactly.
[00:19:14] Speaker B: It's that kind of thing.
[00:19:15] Speaker A: Exactly.
[00:19:16] Speaker D: Yeah.
[00:19:16] Speaker A: It just doesn't matter what it is. There's just so much material accumulation at that point that's causing this problem in Shaoyun.
[00:19:25] Speaker C: Yeah.
[00:19:25] Speaker B: And the Shaoyun pattern is there's an inability for yang to store. So, like at nighttime, especially with sleep.
[00:19:33] Speaker E: Right.
[00:19:33] Speaker B: Our yang should descend and anchor. Our kidney water should rise and igloo the yang, getting it back into storage. And if it can't do that, it's not going to come back the next day. Like, it's not going to be able to rise and we're not going to be able to perform our activities that next day.
[00:19:52] Speaker A: Yeah. And then you're just dragging.
[00:19:54] Speaker B: You're just dragging.
[00:19:56] Speaker A: What do you think is actually happening here from a sort of a pathomechanism function that has now Started to impact the kidney water in the heart fire. Like what, what's, what's happening?
[00:20:11] Speaker B: Well, I think this, this pathology has just lingered. So like this will happen in people.
It can happen because they've taken antibiotics, I suppose. But it's mostly people who have lingering or chronic pathology or they're older. This is where you'll see this a lot. So if somebody's older, they're more deficient, especially if they're deficient in cold, like as a, as a general trend. Then when they get sick, they may move through the acute symptoms like most other people, but then they have this kind of stuff lingering.
And so it's really just a fatiguing of the yang. That's the way that I see it. It's just another layer of depletion of the yang. And xiaoyun is the function of storage. Right. So if, if it's fatigued at that level, it just means now it's affecting the ability for the body to store and regenerate.
[00:21:01] Speaker E: Right.
[00:21:02] Speaker B: So that's kind of how I see it.
[00:21:04] Speaker A: This kind of stuff is interesting to think about too, when it comes to the kind of correction that we can offer patients because, you know, you could just deal like human bodies are remarkably adaptable. So like a person young or old could just deal with like a little cough where they don't sleep well and they feel super run down and they're cold and their body feels heavy and sort of all of this sort of stuff and they have, they could sleep for 12 more hours and it wouldn't matter. And they could deal with that for like a decade.
[00:21:35] Speaker B: They could, you know, absolutely.
[00:21:37] Speaker A: But the truth is, is that if they have to deal with that for a decade, all of the other like functions of your body suffer 100%.
[00:21:46] Speaker D: Right.
[00:21:46] Speaker A: And that's the kind of stuff that in my mind, particularly with older patients, like these are the, these are the presentations that create the circumstances for the eventual illness or predicament that will kill you.
[00:21:59] Speaker B: Take some out.
[00:21:59] Speaker A: Yeah, yeah, that'll take you out.
[00:22:02] Speaker B: It's so a thing that we see people struggling with little bits of lingering pathology. The body gets 80 to 90% better in most cases and then it doesn't quite finish, it just moves on. The person goes back to work, they have a busy life, they have to take care of their kids, they have to do whatever and they never get to recover that last 10 to 15%.
And it just lingers and lingers and you know, thing.
[00:22:30] Speaker A: It goes on their metaphorical ledger as well.
[00:22:34] Speaker D: Right.
[00:22:34] Speaker A: Which is to Say, like, if you have a certain amount of bandwidth that you. That you just have constitutionally and from your sort of postnatal jing processes, every little bit of thing that never gets fully dealt with is now consuming that percentage of your bandwidth, is how I think about it. So it's like if you left 10% of the healing on the table, that's 10% less bandwidth you got going forward.
[00:22:56] Speaker B: Exactly.
[00:22:57] Speaker A: You got unmanaged stress at work. It's eaten up 15% of your bandwidth. You're eating irregularly. You're going to sleep super late. You're stressed out from politics and the phone. It's eating up another 25% of your bandwidth. And now all of a sudden, just waking up in the morning, 50, 60% of your bandwidth is already used. Yep, it's already used.
[00:23:16] Speaker C: Yep.
[00:23:16] Speaker D: Right.
[00:23:17] Speaker A: And that you haven't even done anything today.
[00:23:20] Speaker E: Right.
[00:23:20] Speaker A: Your kid hasn't vomited on you yet. Your boss hasn't yelled at you yet. There wasn't traffic across the bridge yet. You know, like, nothing's happened. And you already had 60% of your capacity consumed.
[00:23:32] Speaker E: Right.
[00:23:33] Speaker A: And then, of course, your life is going to put you to maximum or past it, into the red. And when that happens, none of the rest of your systems are operating optimally.
And that's when we get more health problems. And then you're in this, like, negative feedback loop. So it's, you know, as practitioners, when we're considering, you know, how much resolution is enough resolution in the context of stuff like this exterior pathogen, cough, you know, body ache, fatigue, that kind of stuff, we gotta shoot for 100%.
[00:24:05] Speaker B: We do.
[00:24:06] Speaker A: Like, we can't just leave that 5 or 10% on the table. It's like, well, the cough will probably be fine. I mean, maybe, maybe. Especially if they're young and robust or whatever. But the thing is that you can actually. You can get complete resolution. So you should.
Because if not, we're creating a lot of circumstances in which things could be much worse over time.
[00:24:26] Speaker D: Yeah.
[00:24:52] Speaker A: Okay. So we kind of walked through a progression here. Xiaoyang, Taiyin, Shaoyin. But of course, I don't mean to suggest that they're always like. It's not always just a progression.
[00:25:02] Speaker D: Right. That. Right, right.
[00:25:03] Speaker A: You could go straight to Shao Yin.
[00:25:04] Speaker C: Yeah.
[00:25:05] Speaker A: Because of the constitution of the person.
[00:25:07] Speaker E: Right?
[00:25:07] Speaker B: No, you could.
[00:25:08] Speaker A: Yeah, but we. You also mentioned that sometimes the cough presents as a Tai Yang cough.
[00:25:13] Speaker E: Right.
[00:25:14] Speaker B: But we didn't go over the formula for Xiaoyin.
[00:25:16] Speaker A: Oh, we didn't?
[00:25:16] Speaker B: No.
[00:25:16] Speaker A: Oh, gosh. We don't want to leave that.
[00:25:18] Speaker D: Yeah.
[00:25:18] Speaker A: What's the formula for Xiaoyin?
[00:25:20] Speaker B: So it's Zhen Wu Tong, but with a postscript cough mode, which is the standard Jen Wutang.
[00:25:26] Speaker A: Wait, can I guess what the kaufman is?
[00:25:28] Speaker B: Yeah, go ahead.
[00:25:29] Speaker A: Does it involve Ganjiang and Wu Weizi?
[00:25:32] Speaker B: It does. It does. It does. But what's interesting is I was looking back at this recently, so it's Ganjiang, Wu Weizi, and Xixin.
[00:25:42] Speaker A: Shixin is additional Ganjiang 9 Wu Weizi 12.
[00:25:45] Speaker B: That's the interesting thing.
[00:25:47] Speaker A: It's different.
[00:25:47] Speaker B: It's different.
[00:25:48] Speaker A: Okay, what you got?
[00:25:49] Speaker B: It's 1 Liang Ganzhang, 1 Liang Xixin, and 4 Wu Weizi. So 12 Wu Weizi, 3 Ganjiang, and 3 Shixin. Now, I've always like. Because I assumed it was the same. For years, I've been giving Ganjiang 9 Shixin 9 Wu Weiza 12. And it's worked fine.
[00:26:08] Speaker A: Sure. Yeah, it works fine.
[00:26:09] Speaker B: But that isn't what the Shanghan Lun says, apparently.
[00:26:11] Speaker A: 3312.
[00:26:12] Speaker B: 3, 312 for Zhen Wu Tong.
[00:26:15] Speaker C: Yeah.
[00:26:16] Speaker A: Why do you think that is?
[00:26:17] Speaker B: I have no idea.
I have no idea. I wonder if it's because we have futa in Zhen Wu Tong.
[00:26:24] Speaker A: That was gonna be my guess.
[00:26:25] Speaker E: Right.
[00:26:25] Speaker B: So we're already strongly pushing the water out with Fuca. Yeah, already strongly warming water.
[00:26:30] Speaker A: So you just don't want to over warm. Yeah, but it's also worked fine at night.
[00:26:34] Speaker B: It's also worked fine.
[00:26:35] Speaker C: Yeah.
[00:26:36] Speaker A: So I wouldn't stress about it.
Okay, so xiaoyang was Xiao cai hutong kauf mot take out Ren shen, take out Dazao, add ganjang, add Wu Weizi.
[00:26:46] Speaker C: Yes.
[00:26:47] Speaker A: Taiyin linggwe Jugantong kof mod. So Lingguay jugan Tong standard plus Ganjiang 9 Wu Wei 12, and then Xiaoyin formula Zhen Wu Tong.
[00:26:58] Speaker C: Yep.
[00:26:58] Speaker A: Plus Ganjiang 3, plus Xixin 3 plus Wu Wei to 12. Correct. Could also do 9. 9.
[00:27:05] Speaker D: 12.
[00:27:05] Speaker B: Could you could do 9912.
[00:27:07] Speaker A: I've.
[00:27:07] Speaker B: I have some experience with that one.
[00:27:08] Speaker A: It might be fine.
Okay, so as I was saying before I jumped ahead there, we still have the Taiyang question of what's going on with the Tai Yang cough. Now, Taiang cough is, I think, rather substantially different from these other three.
[00:27:28] Speaker C: Yes.
[00:27:28] Speaker A: In terms of its intensity.
Why don't you walk us through that?
[00:27:33] Speaker B: So if we go back to Xiaochai Hutong cough, remember, Xiaochaihu tongkof is happening now, not because there's a material problem in the lungs yet, but because there's a problem with A surface.
And anytime there's a problem with a surface, the surface gets obstructed or it can't open and close properly. Pressure can't diffuse in the body and weird things happen.
[00:27:53] Speaker D: Right.
[00:27:53] Speaker B: Primarily, certain things can't descend well.
So one of the things that has a hard time descending, as we learn in the Taiyong chapter for Ma Hongtang.
[00:28:04] Speaker C: Right.
[00:28:04] Speaker B: Is if the surface gets obstructed, the lungs can't descend.
[00:28:09] Speaker E: Right.
[00:28:09] Speaker B: So the person has wheezing.
[00:28:11] Speaker D: Right.
[00:28:11] Speaker E: Right.
[00:28:12] Speaker B: Now, Mahuang tong does not treat a cough. It treats wheezing.
So if you have a cough, you need something else.
And typically, if you have a cough and you have a mahuang like presentation, the person has. They have a very difficult time sweating. They have horrible body aches. Everyone that ever has had a mahuang tongue, by the way, that I've seen has had a horrible headache. That's a big part of the pattern, I think. Terrible headache. They cannot sweat. Averse to cold.
If they then have a cough, they almost always also have a predilection toward phlegm in the lungs.
So they're damp and tie in to begin with. That's been my experience.
[00:28:55] Speaker A: Right, right.
[00:28:56] Speaker B: And so then the surface shuts and they have dampened Taiyin already, but the surface is closed now they have a really hard time breathing and they're coughing.
That formula is Xiao Qing longtang. So Shao Qing longtong is going to treat that cough.
[00:29:14] Speaker A: So Caiyang, we've got the strong body ache, body pain, headache, maybe high fever.
[00:29:22] Speaker B: High fever, yeah. High fever is very common in these.
[00:29:24] Speaker A: So like this pattern, this is like.
[00:29:26] Speaker B: These are pretty serious.
[00:29:27] Speaker A: This is what an infection looks like.
[00:29:28] Speaker C: Yes.
[00:29:28] Speaker A: You're like, oh, that person has an infection.
[00:29:30] Speaker C: Yeah.
[00:29:31] Speaker A: From a biomed point of view.
[00:29:32] Speaker C: Yeah.
[00:29:32] Speaker A: Probably Tai Young thing.
[00:29:33] Speaker C: Yep.
[00:29:34] Speaker A: Notably here, probably not sweating.
[00:29:38] Speaker B: Probably not sweating. Technically you can have a little bit of sweat, but probably not.
[00:29:43] Speaker A: Probably not.
[00:29:44] Speaker C: Yeah.
[00:29:45] Speaker A: And then notably here too, you're going to have a floating pulse.
[00:29:49] Speaker B: Floating pulse? Yeah. Any of the Tai Young disease, the first thing we learn is that the pulse is floating, which could be pretty different than some of the later patterns, especially the tie in and Shaoyun patterns. Pulse is going to be deeper for those.
[00:30:01] Speaker A: Right, right.
[00:30:01] Speaker B: Xiaoyang, it could be a little bit here or there.
[00:30:05] Speaker A: Yeah. But the nice thing about Xiaoyang is like the xiaoyang other symptoms are so. They're so. So disc.
[00:30:10] Speaker C: Yeah.
[00:30:10] Speaker D: Right.
[00:30:10] Speaker A: You're like, oh, alternating symptomology. Riverside tenderness, sore throat, Shao Tao Tan.
[00:30:14] Speaker E: Right.
[00:30:15] Speaker A: There's just there's no point in even debating it.
[00:30:17] Speaker D: Right.
[00:30:18] Speaker A: Okay. So in the case of the. The formula that you mentioned, Shaoqing Long Tang.
So in that context, like, it's. It's pretty wet. So like you, like you said you had this Tai Yang. Excuse me, Tai yin, damp tendency.
[00:30:31] Speaker C: Yeah.
[00:30:32] Speaker A: That's now basically been trapped.
[00:30:33] Speaker C: Yes.
[00:30:34] Speaker A: By the lockdown surface.
[00:30:35] Speaker C: Yes.
[00:30:36] Speaker A: And so now we've got coughing.
That's wet.
[00:30:40] Speaker C: Yep.
[00:30:40] Speaker A: And is there like. Are they expectorating?
[00:30:44] Speaker B: Yeah, they can be.
[00:30:45] Speaker A: They can be expectorating, but it sounds wet.
[00:30:47] Speaker B: When they sounds wet and they have. They're very uncomfortable.
[00:30:51] Speaker D: Yeah.
[00:30:51] Speaker B: The Qing long tongue patterns are just brutal, man. People are in a lot of pain. They have a lot of body aches again, because the surface can't open. So there's all this pressure building up in the body that they can't diffuse. A lot of the time with these patterns too, the person has a hard time peeing.
[00:31:07] Speaker E: Right.
[00:31:07] Speaker B: For the same reason, the pressure just can't diffuse. That surface is plugged. And so the descent just can't occur. So it can occur. The diaphragm has a hard time going down. The fluids have a hard time going down. Like everything just has a hard time descending. And so you have this horrible situation.
[00:31:27] Speaker A: Now, a couple of important things about this formula. Firstly, it's going to have in it a lot of our friends that we've been talking about.
[00:31:35] Speaker C: Yes.
[00:31:35] Speaker A: Okay. Right. We have Ganjiang, we have Xixin, we have Wu Weizi.
[00:31:39] Speaker C: Yep.
[00:31:41] Speaker A: Now it's a Mahuang formula, though.
[00:31:43] Speaker C: Yes.
[00:31:44] Speaker A: So what do we do about that? Because it's hard to get Ma Huang in a lot of places.
[00:31:48] Speaker B: Well, you and I have been experimenting recently with two herbs. We've done, actually, more recently, we've been working with Mormon tea.
[00:31:58] Speaker D: Yeah.
[00:31:58] Speaker B: Trying that guy out.
So tell people what you found about that.
[00:32:03] Speaker A: So Mormon tea is a domestic US Ephedra. So it's a different. It's the genus Ephedra, but it's not the Seneca, the species that we use from China.
And phenotypically, it looks just like Ma Huang. I mean, it's the same sort of thin, bright green, knobbly kind of pieces.
And the smell is the same, the texture is the same. The tanniny mouthfeel is pretty close to the same.
[00:32:35] Speaker D: Right.
[00:32:35] Speaker A: It tastes the same kind of green openness.
But I don't think it's as potent, nearly as potent as the Chinese Seneca. And I think that probably just, you know, I'm spitballing here, but I think that it actually has to do with the fact that Ma Huang has been cultivated for medicine.
[00:32:53] Speaker E: Right.
[00:32:54] Speaker A: For thousands of years.
[00:32:55] Speaker C: Yeah.
[00:32:55] Speaker A: So I literally think people have been like, we got to get that good mahong.
[00:32:58] Speaker E: Right.
[00:32:59] Speaker A: You pick the one that's got.
[00:33:00] Speaker B: You need the one that's.
[00:33:01] Speaker A: Yeah. You just literally are, you know, Carl Linnaeus seeing the whole thing.
[00:33:06] Speaker D: Right.
[00:33:06] Speaker A: Like, you're picking the ones that are the most opening, the most, you know, surface expanding. And we just keep breeding that one and breeding that one and breeding that one. And so ultimately, the ephedra sinica that. That we used to be able to get, I mean, you could just take a little stick of that and chew on it. And it was like you had taken a Sudafed. I mean, it would just open your face. I mean, it was just wild.
That stuff is really hard to come by. And if you can even get it in the States, this stuff tends to be kind of old. It tends to be kind of dusty.
[00:33:34] Speaker C: Yeah.
[00:33:34] Speaker A: You know, and there's some discussion about growing it in the States. There are some people playing around with it, and there's no reason we couldn't grow it here, except that, like, you know, it's just a pain in the ass to grow Chinese herbs and there isn't a huge market for it. So, like, it's not really happening. So we've been playing around with Mormon tea, sometimes called Brigham tea.
Again, it's a domestic ephedra, and I think it has a pretty clearly similar function just at a fraction of the potency. So if you were going to dose mahuang at 6 or 9, you probably need to dose this Brigham tea at 18 to 30.
[00:34:10] Speaker C: Yeah.
[00:34:11] Speaker B: So at least double.
[00:34:13] Speaker A: Yeah, at least double.
[00:34:14] Speaker B: At least double.
[00:34:15] Speaker A: At least double. Maybe two and a half times.
[00:34:16] Speaker B: I found similar things. I've used a slightly smaller dose in cases where I'm using like a. An arthritis, sort of like a. Yeah, yeah, like a B syndrome type of thing.
[00:34:28] Speaker A: And that's different anyway.
[00:34:29] Speaker D: Right.
[00:34:29] Speaker A: You're working at an interior level of opening. Whereas, like. Like in this thing that we're talking about here.
[00:34:33] Speaker D: Right.
[00:34:34] Speaker A: Like, the surface is just snapped shut, it's so tight. And the fact that we don't have MA1, like, the actual Chinese mahuang available to use is a real loss. I mean, it really is. Now, I guess, on the other hand, when people are this sick, they don't tend to come to us, at least not first.
[00:34:52] Speaker B: They don't. First. But, you know, if you get into this medicine and you're around sick people, even in your family or yourself, or your neighbor. You'll see these patterns 100%, and they will be desperate for help.
[00:35:06] Speaker A: The people who actually benefit with this pattern are the friends and family of herbalists.
[00:35:11] Speaker D: Right.
[00:35:12] Speaker A: It's not probably your patients just because, like, I don't know, they got sick on Saturday and you're not open till Monday. So there's just practical reasons, even if they know you could help them, that they just don't have access to it.
But you do, Your partner does and your kids do and your friends do. And so, like, you know, all of my close friends, like, I get a call as soon as anybody's sick.
[00:35:33] Speaker C: Yep.
[00:35:34] Speaker A: I mean, it's like, oh, I woke up this morning, got some sniffles. Can, can you bring me some herbs when you come home? It's like, yeah, I can. So it's important to know this pattern and to know what to do about it. If you're going to write a shouting long tongue right now and you're going to write it in granule.
[00:35:48] Speaker C: Yeah.
[00:35:48] Speaker A: You're going to need something else besides Mormon tea as well, because you're not going to be able to find that in granules. So what do we think? What do you think about what should we recommend to people if they were going to write a granule for this?
[00:36:01] Speaker B: Well, it's, it's tough. So with an acute pattern like this, I wouldn't recommend using granules.
[00:36:08] Speaker A: Right. Just in general. It's just in general to say, yeah.
[00:36:11] Speaker B: Yeah, it's just not very effective. I don't think you, you can technically do it, but you, you need to dose the crap out of the herbs like many, many times higher than you would give somebody a normal granule formula.
[00:36:22] Speaker D: Yeah.
[00:36:23] Speaker B: And yeah.
[00:36:25] Speaker A: I don't know what the cost, the cost gets a little crazy. That's. I, I don't want people to think like we're just like poo, pooing on granules. We use granules. All it's about figuring out what's going to work best in the context. And the thing is, is that if you have a strong infection like this that you want to hit with granules, you're literally dosing people like 12 or 14 grams three times a day.
[00:36:45] Speaker D: Yeah, right.
[00:36:46] Speaker A: Yeah. For real. And when you dose at that level for granules, you might as well write a bulk formula.
[00:36:51] Speaker B: Might as well write a bulk formula, do it for a couple days and then they're done.
[00:36:55] Speaker C: Yeah. Yeah.
[00:36:56] Speaker A: And so if you don't have access to a bulk formula or, excuse me, a bulk formula pharmacy in your area, of course, we can help. Root and branch can always ship herbs directly to patients anywhere in the U.S. so that's, that's an easy solution. But, you know, depending on which quadrant of the country you're in, there are other bulk pharmacies that you can get access to material.
And a lot of these too, you can, you can keep on hand packaged up. You can even grind them and vacuum seal them or put them in the freezer and like hold them. So you've got them on hand, you know, as something that. To keep stocked.
But I think if you were going to try and do something with granule, I think honestly, you're going to use something that's not exactly a copy from Ma Huang, but it's going to be something kind of accurate and opening like baijieza.
[00:37:39] Speaker D: Right.
[00:37:39] Speaker A: And you probably need to put a couple of things actually in.
[00:37:42] Speaker E: Sure.
[00:37:42] Speaker B: Songju maybe something like that.
[00:37:45] Speaker D: Yeah.
[00:37:45] Speaker A: Sangju bai jieza. Something that has a kind of acrid, warm, moving quality, that sort of surface oriented.
But you're up against a bit of a tight spot. Yeah, for sure.
Okay. If, though, like, we do know also that not always does the tai yang cough look super wet and gross.
[00:38:04] Speaker E: Right.
[00:38:05] Speaker A: It can be dry.
[00:38:07] Speaker B: Can be dry.
[00:38:07] Speaker A: And if it's dry, it's probably going to be painful.
[00:38:10] Speaker B: Very painful. Way more painful than the wet version because then the fluids are consumed too.
And you can also have.
So we're talking about the mo, the movement into a da qing long tong pattern. So da qing long tong is tai yang plus dryness of yang ming, but the surface is completely shut, so the person has even more pain.
More, more pressure, more pain, more achiness. Like these people are not happy and their fluids are drying out. So this person, these, these, these patterns are both dangerous for people in different ways. You can be very dehydrated in a da qinglong tong pattern and you can die if it gets bad enough. You can die from pneumonia in a Shaoqing long tong pattern, which I think.
[00:39:02] Speaker A: For most people is. I think that's the more likely high danger factor is that this cold becomes pneumonia, particularly in older people.
[00:39:13] Speaker B: Yes, for sure.
[00:39:13] Speaker D: Yeah, yeah.
[00:39:15] Speaker A: So in the dodging long tongue pattern, you know, because the surface is so tight here.
[00:39:20] Speaker D: Right.
[00:39:21] Speaker A: There's no sweating at all.
[00:39:22] Speaker B: No sweating.
[00:39:22] Speaker A: One lock on.
[00:39:24] Speaker D: Yep. Yeah.
[00:39:25] Speaker A: Okay. Same problem though, right? Like if you literally came across someone with a daching long tongue pattern and you were gonna write them a formula and you don't have any access to mahuang, that's tough. That's a tough, that's a tough road, which is hard, which is hard to do. So again, you could try something like the Mormon tea. You could also try a combination of things. It's interesting to me too, because when I was thinking about subs in Shaoqing Long Tang, I was like, oh, probably do Bai Jih and Xingren. Like, I would put those two things together. Even though Xingren is not well, Shingren.
[00:39:56] Speaker B: Is actually named as a replacement for Ma Huang if it's a more deficient case where the person can't tolerate Ma Huang. So that's actually a good choice. It's just not going to do exactly the same thing by itself.
[00:40:09] Speaker A: Right, exactly. Because it doesn't. I mean, if you made a tea out of Ma Huang and made a tea out of Shingren, like, they don't taste anything the. Right. But. But if you just eat Shingren, which, by the way, you can't eat very many of them because they're toxic. But if you just eat one, you'll notice that there is a kind of like buzzy opening quality to it in your mouth and your nose when you eat a Shingren piece. And of course that's being alchemically extracted into a decoction.
And of course daching long tongue has Shingren in it.
[00:40:37] Speaker E: Right.
[00:40:38] Speaker A: So we're like already kind of on that path.
[00:40:40] Speaker D: But yep.
[00:40:41] Speaker A: I would say if you, if you don't have access to something like Mormon tea, try, try some baijitsa as something that you can throw in there. You could also try Sua or Su Ye. Either of those could be like, you could kind of do like a little seed blend of things that are kind of accurate and opening. So that could be something to play with as well.
Okay, so that's kind of. That's our four basic patterns. And I want to emphasize that while the Tai Yang one is pretty dramatic looking and it's can be dangerous, it's not the one that I think we see in clinical practice the most.
[00:41:13] Speaker B: No, I wouldn't say so.
[00:41:14] Speaker A: But it might be the one that you see in your friends or family. Sure.
[00:41:17] Speaker D: Right.
[00:41:18] Speaker A: And so that's why it's still, I think, useful to keep around in all of these patterns, though. Like, we're mostly just talking about the cough.
And I mean, it's in some ways a combination of a functional cough, but also a substantive cough. And so what we mean by that is like one that has phlegm or doesn't.
[00:41:33] Speaker E: Right, right.
[00:41:34] Speaker A: It's a substantive one having phlegm and wetness to it.
So the Shao Yin Taiyin ones have some substance to them. But in any context, even at the xiaoyang layer, there could be more phlegm presentation. So, like, okay, patients in front of you, right rib side tenderness, alternating symptomology, sore throat. Okay, very clearly xiaoyang.
But also they've got difficult expectoration with sticky phlegm in the chest and a feeling of heaviness. Right now we're talking about the thing you mentioned at the top, right.
[00:42:05] Speaker B: Chest obstruction.
[00:42:06] Speaker A: Walk us through that.
[00:42:07] Speaker B: So chest obstruction is defined as a pain radiating from the front of the chest to the back.
Now that. That line, I believe, comes from a specific formula called Guolo Shi by Baijiu Tong. Remember baijiu in China?
[00:42:24] Speaker A: Disgusting.
[00:42:24] Speaker B: Yeah, Horrible stuff.
[00:42:25] Speaker A: Disgusting.
[00:42:26] Speaker B: That's the worst tasting stuff.
[00:42:28] Speaker A: I like a drink as much as the next guy, for sure, but let.
[00:42:30] Speaker B: Me tell you, that is not a drink.
[00:42:32] Speaker A: It's horrible. I don't, you know, and I'm very open to, like, other stuff. But my favorite part was when we were in. In China, and our friend Eric Brand, who owns and runs Legendary Herbs, he was our tour guide showing us around. And I was like, eric, baiji, it's so gross. And he was like, oh, no, you just haven't had any good baijiu.
[00:42:50] Speaker E: Right.
[00:42:51] Speaker A: And I was like, well, I don't speak Chinese, Eric, so why don't you get us some. Some good baiji? He's like, okay, no problem. So we were out of, like, karaoke or whatever, and he's like, oh, I got us a good bottle of baijiu. And he poured it out. Still tasted like shit.
[00:43:02] Speaker B: Yeah, it was horrible.
[00:43:03] Speaker A: It tasted the same.
[00:43:04] Speaker C: Yeah.
[00:43:04] Speaker A: I was like, okay, I guess, like. And I. You know what I mean? I drink wine. I like liquors. I have a pretty decent palate. Tasted like shit.
[00:43:12] Speaker B: Yeah, it's awful.
[00:43:13] Speaker A: However, it is actually a useful tool. We use it in the medicinary. Like, we wine fry stuff and like. Yeah, it's a very useful tool for, like, moving things around. I just wouldn't recommend, like, having a bijou cocktail cavalierly partaking rough if you love baijo. I'm sorry to offend you.
[00:43:29] Speaker C: Yeah.
[00:43:30] Speaker A: But, yeah, I think it's terrible.
[00:43:31] Speaker C: Yep.
[00:43:33] Speaker B: Anyway, pain radiating from the front to the back of the chest, that's the definition of chest obstruction. But in reality, we can extend that to a sense of pressure in the chest, heaviness, even in. In this context, difficult expectoration of phlegm, which is clearly coming from the chest.
[00:43:53] Speaker A: Right.
[00:43:53] Speaker B: So when somebody breathes or they cough, you can Hear when they have phlegm in their chest.
[00:43:58] Speaker E: Right.
[00:43:58] Speaker B: Like you can hear when it's sticky and gunky in there. That's going to trigger me to want to go to chest obstruction right away, probably in addition to one of those other formulas. So I rarely give these by themselves. I usually put them into another formula, like a Xiao cai hutong, like a Lingguay Jugan tong, Like something else I've never seen, by the way, I've never seen these added to a Tai yang picture before. I've never done that. So I've never, like, added them into xiao or Da Qing Long tong.
[00:44:30] Speaker C: I don't.
[00:44:31] Speaker A: I don't think you'd need to.
[00:44:32] Speaker B: I don't think you need to.
[00:44:33] Speaker D: Yeah.
[00:44:33] Speaker A: Because of the way those are composed.
[00:44:35] Speaker B: Exactly.
[00:44:36] Speaker D: Yeah.
[00:44:37] Speaker A: Okay, so the two formulas, what are the two formulas then that you're thinking of for chest obstruction?
[00:44:42] Speaker B: So the main two are a formula called Shao Xian Xiong tang, which literally means lesser or minor chest obstruction decoction.
And that formula is gualo, which is important. Gualo is going to be featured in every one of the chest obstruction formulas that we use commonly. So gualo, bansha and huanglian, those are the three herbs. So it's just those three.
Now, what's interesting is if you look at a formula like Ban Xia Shay Shin tong, we already have two of the three.
We already have bansha and we already have Huanglian.
[00:45:24] Speaker D: Right.
[00:45:25] Speaker B: So what I will often do with these post, it's usually like post acute, there's no surface symptoms anymore, but the person still has a cough. Maybe they have chest obstruction. Maybe they have yellow phlegm. Maybe it's difficult to expectorate. Maybe they have a cough is actually modify a bansha Shae shintong with the Koff mod, just like it was a Shao Cai hutong.
[00:45:49] Speaker A: To take out the renshen.
[00:45:50] Speaker B: Take out the renshen, take out the dazao, Add Wu weizi.
[00:45:54] Speaker A: Okay.
[00:45:54] Speaker B: The ganzhong's already in there, so that's easy. And then I add gualo.
[00:45:58] Speaker A: And now you've effectively added Shaoxian chongtong.
[00:46:01] Speaker B: And now we've added Xiaoxian chongtong.
[00:46:03] Speaker C: Yep.
[00:46:04] Speaker A: Which we're saying that very clearly because that's one of those ones that gets auditorily confused with Xiao Jian Zhongtang.
[00:46:11] Speaker B: Yeah, not at all the same.
[00:46:12] Speaker A: Not at all the same.
[00:46:13] Speaker C: Yeah.
[00:46:14] Speaker A: So this one, Xiao Xianxiong tang. That's XXX tang.
[00:46:19] Speaker D: Yeah.
[00:46:19] Speaker A: Triple xt, Triple X Tang.
[00:46:21] Speaker D: Yep.
[00:46:22] Speaker A: Okay, so Xiao Xian Xiong tang. And then what else?
[00:46:27] Speaker B: Yeah, and then if there is. So that's for sticky phlegm. That's for. If the person is. It actually mentions panting. So, like, breathing quickly.
Some think that you can use this formula to avert acute heart attack or stroke. If you take it right when somebody is in the middle of a cardiovascular event and it's just starting, you can arrest that behavior. I've never done that before, but there are people in China who swear that you can do that. So.
[00:46:58] Speaker A: And you'd have to be really on point, though, to have it ready.
[00:47:00] Speaker B: You'd have to be very on point.
[00:47:02] Speaker A: Just keep it, like, frozen or something. Like, how would you seriously have it? Hold on. Hold your heart attack for an hour? I got to gather the herbs and cook them. Yeah, yeah, I don't think. Do you think they use patents to do that?
[00:47:14] Speaker B: Maybe, But. But in those cases, I will say the gualo is a lot higher. So in this formula, Normally I use 18 Gallo. In a formula like that, the gualo would have to be, like, 66 0. Like, very high qualo. So very, very high. And it's probably going to make you have diarrhea.
[00:47:34] Speaker A: Oh, for sure.
[00:47:34] Speaker C: Yeah.
[00:47:35] Speaker D: Yeah.
[00:47:35] Speaker A: But better than having a heart attack.
[00:47:36] Speaker B: Better than having a heart attack for.
[00:48:08] Speaker A: So that one says sticky phlegm, yellow phlegm.
[00:48:12] Speaker B: But there's not, like, feeling of stuffiness in the chest. Feeling of heaviness in the chest.
[00:48:16] Speaker A: But it's not painful.
[00:48:17] Speaker B: It's not painful, right?
[00:48:18] Speaker A: Okay, it's not painful. But if it is painful.
[00:48:21] Speaker B: If it is painful, then you need a really warm, pungent herb that's specified for the chest. In this case, we're gonna use xie bai, our favorite herb. It's the worst.
[00:48:32] Speaker A: Tastes terrible.
[00:48:33] Speaker B: Tastes terrible.
[00:48:34] Speaker A: It's not too bad in granule.
[00:48:35] Speaker B: Yeah, no, no, granule is not as.
[00:48:37] Speaker A: Bad, but in bulk.
[00:48:39] Speaker C: Yep.
[00:48:39] Speaker B: So then the formula that we're gonna use typically is guolo xiebai, bansha tong, which is just those three herbs, guolo xiebai and bansha.
And it's one herb away from Shao shenzhongtang.
[00:48:56] Speaker E: Right.
[00:48:56] Speaker B: So guolu and bansha are in both formulas in Shaoxin chongtang Huang lian is in that.
[00:49:04] Speaker E: Right.
[00:49:04] Speaker B: So it's going to be a little better for yellow phlegm.
[00:49:08] Speaker E: Right.
[00:49:09] Speaker B: For guolo xiebai, ban xiatong, xie bai is involved. So it's better for pain, like the pain that's in the chest. So that could be pain that the person feels kind of all the time, or it could be pain that they only feel when they cough, but it feels like it's painful when they cough.
[00:49:27] Speaker C: Yeah, yeah.
[00:49:29] Speaker A: The pain is an interesting and important distinguisher here, I think, about just sort of which one you might use and the xie bai, you know. So let's say you took your ban xia shayshan tong, you made the similar kof mod that you did with xiaochaiutang, added in the gualo and then added in the xiebai.
[00:49:46] Speaker C: Yeah.
[00:49:46] Speaker D: Right.
[00:49:47] Speaker A: Because you had painful. Right, Painful cough. That was going to be addressed by the shishan tongue pattern. So I think that that's a very interesting shift. So, you know, it's funny because people talk about combining formulas together, but in some cases you're really just adding one herb to an already existing formula, and then in reality, you have two combined formulas, even though you just added one herb in.
[00:50:11] Speaker C: Yes.
[00:50:11] Speaker D: Yeah.
[00:50:12] Speaker A: Talk just a little bit about the shayan tong, the use of banxa shayshan tong. I don't think we touched on that exactly. Like, we talked a lot about the Xiao Caiutang use, but, like, why would you be using shay shintong to start with anyway?
[00:50:26] Speaker B: So bansha shayshan tong, I think of as a little bit of a xiaoyang formula and a little bit of a yangming formula. It's kind of in between the two. It's a modification of xiao cai hutong.
[00:50:37] Speaker E: Right.
[00:50:38] Speaker B: It's just instead of chihu, you have Huanglian, and instead of sheng zheng, you're using ganjiang. That's the only difference. So it's pretty much the same. The same flavors and natures. If you use the shenong Ben Sao Jing's idea of flavors.
[00:50:54] Speaker E: Right.
[00:50:54] Speaker B: Chaihu is bitter, Huanglian is bitter. So it's the same. It's just different. Functionally, the chihu is going to be moving and helping the cheetah move. Peripherally, the Huanglian is going to be helping the chi to move centrally.
[00:51:07] Speaker D: Right.
[00:51:08] Speaker B: So in a shay shintong, the main difference is there are no peripheral symptoms. There's no chills and fever. There's no alternating temperatures.
All of the problem with the qi, the movement of qi, is through the central place in the body.
In fact, in one of the Fukushin classics, Inaba's book, he says that problems with chest vexation or agitation with rib side discomfort are chihu patterns. Problems with chest vexation, agitation without rib side discomfort are Huanglian patterns.
So Huanglian, it just illustrates that super clearly. Like, Huanglian is working in the center to dislodge the Qi dynamic. Chai who is working in the periphery. And the periphery in this case includes helping qi to move through the pores, pores of the skin, which is why you're going to see it help stuff like chills, fever, alternating temperatures. Whereas in a shay shintong, none of that's happening. You may have heat, but the heat's going to be all central.
[00:52:20] Speaker E: Right.
[00:52:20] Speaker B: It's going to be in the center. It's going to be coming from the stomach, or the stomach is too full. So then there's counterflow and there's heat coming up, but it's still in the center of the body. It's not peripheral.
[00:52:31] Speaker D: Yeah.
[00:52:32] Speaker B: So if you try to use ban xia shai shintong initially, when the person has alternating chills and fever, you know the typical xiaoyang symptoms when you need chihu, it's not going to work.
[00:52:45] Speaker D: Yeah.
[00:52:46] Speaker A: Because you need to deal with the stuff at the periphery.
[00:52:48] Speaker B: You need to deal with the stuff at the periphery. But once you've done that, and that's no longer the problem, you can still have the need to order the qi in a way in the middle.
[00:53:00] Speaker E: Right.
[00:53:01] Speaker B: And a lot of people that are healthier, people that get sick and then don't get treatment, they kind of end their basic pattern ends. Looking closer to a shay shintong, maybe their bowels are not quite loose, but they're a little sticky, and maybe they have some fullness in their epigastric area, like they have a little bit of this kind of shay shintong sort of stuff, you know? So it ends up being a really great base formula to treat cough if you modify it just slightly.
[00:53:35] Speaker C: Yeah.
[00:53:35] Speaker A: And if the person, if the presentation is such that the stuff that Chaihu would be treating is finished.
[00:53:43] Speaker B: Correct.
[00:53:44] Speaker A: Yeah. Or transformed.
[00:53:45] Speaker E: Right.
[00:53:45] Speaker D: Yeah. Okay.
[00:53:47] Speaker A: The last thing I wanted to add in, because I know a lot of listeners listening to discussions around cough and phlegm and chest obstruction will probably have heard of the formula Bemu gualo san, which is not a classical formula, but I think it's probably worth talking a little bit about.
[00:54:04] Speaker B: Absolutely. It's a great formula.
[00:54:06] Speaker A: It's a great formula. I use this formula with some regularity, particularly because I feel like many of the patients that come to see me in the clinic for these kinds of, like, cough and chest obstruction things are two, three, four, six weeks down the road from the initial infection.
[00:54:22] Speaker E: Right.
[00:54:22] Speaker A: And so a lot of the things we've been talking about here are not hugely relevant anymore, because what it's now looking like there's been some, you know, Their body kicked out the pathogen at some point, but there was damage to their systems.
And the presentation probably, you know, wormed its way somewhere through like a xiaoyin. Excuse me, Xiaoyang Taiyin thing.
But the thing that's notable to me about bay mugualo san is that for whatever reason, either the pathogen itself, the constitution of the patient, the timeline, the season, who knows, they now have a kind of dryness that's presenting in combination with the phlegm, just a dry phlegm pattern.
And for me, there's a couple of key things that indicate bay muguala san. So, okay, firstly, the cough has likely been chronic. It's been going on for a while.
That's still phlegmy, but it's not like wet phlegmy cough, like in the Taiyang Shaoqing Long tang.
[00:55:21] Speaker B: Sure.
[00:55:21] Speaker A: Like, if you listen to their lungs, it's not going to be like the heavy rails in the lungs and it's like, wet. You know, it sounds like you're pushing water through a faucet or something. It's not like that at all, but still very phlegmy.
But when they cough, it's really hard to get the stuff up, right? So the hints, chest obstruction, right. It's, like, difficult to expectorate. But what they do, finally expectorate, sometimes they'll cough so hard that they'll, like, throw out a rib, right. Or they'll damage. Like, they'll hurt themselves.
They can also end up, like, vomiting because they'll, like, cough so much that, like, you just end up agitating that upsurge movement. But when the. When the phlegm finally does come out, it's, like, really substantive. Like, it's like little chunks kind of sticky. Like, if they coughed it out on the desk, you'd be able to, like, pick it up. Like, it's like a piece of phlegm, right? And you're like. Which is different than the sort of, like, runny, wet, kind of viscous, kind of mucusy stuff that you think when it comes out of your nose, like, this is, like, chunky. And patients will even describe it that way. They'll be like, yeah, it's like chunky phlegm, but it's very difficult to get up. It tends to be chunky and dry, and it's usually a little bit yellowish.
And in that scenario, bemu guala san comes into the mix. Because what's different about bemu gualasan is, of course, the use of bemo, right? Which is such a really interesting herb not to really Be to overshadow gualo. Because I know we mentioned the importance of gualo here, but gualo is an amazing herb.
[00:56:47] Speaker D: Right.
[00:56:47] Speaker A: You have gualo in its whole form, gualo shi gualo ren. That's the seed, gualo PI, the skin. And then of course, tianhua fence, which is the gualo gun. The gun.
[00:56:58] Speaker D: Right.
[00:56:58] Speaker A: So the root. So it's important to remember that, like, we use a lot of the guala plant because it has these really interesting relationships with fluids.
[00:57:10] Speaker D: Right.
[00:57:10] Speaker A: And their ability to, like, move and transform fluids. Bamu comes into the mix with a similar ability, but to deal with with phlegm and dampness on the dry side, which is a funny thing to say, like dampness on the dry side. But the. The things have gotten sticky, right, because they've dried out.
[00:57:28] Speaker C: Yeah.
[00:57:29] Speaker A: Like, it's like if you were like, I don't know, putting something in dehydrator and you like, got it like 2/3 of the way through being completely dry, and you went to touch it and it was like, tacky and sticky.
[00:57:39] Speaker B: Yeah.
[00:57:39] Speaker A: That's what's happening right inside the lung pattern.
So in that case, I like to use bay mugualo san because it has a simultaneous phlegm transformation, lung moistening, and anti cough property that I think is really, really useful when that phlegm is the chunky bits, right?
[00:57:59] Speaker C: Yeah, yeah.
[00:57:59] Speaker A: If it hasn't gone all the way to chunky bits, you know, you could use any of these combinations still, because it's probably not gotten that far. But what's interesting is, like, you could use bemugualo san on a patient that presents in one way. And you could also use shayshin tong with these mods you talked about. And the patient would, like, look very similar.
[00:58:17] Speaker B: Yeah, they would.
[00:58:18] Speaker A: And it would work in both cases.
[00:58:19] Speaker D: Right.
[00:58:20] Speaker A: Because you're just sort of working on both ends.
I would also mention, while we're talking about it, that nobody uses chuan beimu.
[00:58:28] Speaker E: Right.
[00:58:28] Speaker A: Because it's too expensive.
[00:58:30] Speaker B: It's unbelievably expensive.
[00:58:31] Speaker A: Chuan beimu is. I can't even remember. I haven't looked it up in ages. But like, before COVID even so, I can only imagine what it would cost now. But before COVID you couldn't even buy a pound of Chuan Bimu. 150 grams of Chuan Baemu was like $250.
[00:58:46] Speaker B: Yeah.
[00:58:47] Speaker A: So, like, it's just irrelevant. So like, if you hear people say, like, oh, but chuan bemu is much better for. It doesn't matter. No, you can't use it, it is absolutely irrelevant. You cannot use it. Jobemu works great.
And don't think about it like, oh, well, if only we could get the chuan BEI bu. Like, no man, no one that you're talking to who didn't spend years and years in China decades ago has ever seen chuan beimu versus Zhou Bamu in any reasonable distinction.
[00:59:14] Speaker E: Right.
[00:59:14] Speaker A: So it only exists in text.
Do not, you know, feel like you're getting short shrift to the patient if you're using jabemu, that is bemu. As far as I'm concerned, chuan beimu just. It's an extinct species, basically.
[00:59:26] Speaker C: Yeah.
[00:59:28] Speaker A: So, you know, use what you can get your hands on, obviously.
But it's a really great combination of herbs that comes to us from a, you know, a modern thinking point. It's not a Shanghai formula, but it's still. It's notably doing the same thing.
[00:59:40] Speaker D: Yeah, right.
[00:59:41] Speaker A: It's doing the same kind of work that these combinations we've been talking about do.
[00:59:45] Speaker C: Yeah.
[00:59:47] Speaker B: I think we should talk about one more thing, which is when somebody says they have a dry cough versus a wet cough.
[00:59:56] Speaker D: Yeah.
[00:59:56] Speaker A: Which is an important distinction.
[00:59:58] Speaker B: It's an important distinction, but I think it can be disarming. I think people get the wrong idea about that.
[01:00:03] Speaker E: Right.
[01:00:04] Speaker B: So bemu gualo san is a great example of a formula that could be used for a dry cough.
[01:00:10] Speaker E: Right.
[01:00:10] Speaker B: Would you agree with that?
[01:00:11] Speaker D: Yeah.
[01:00:11] Speaker C: Yeah.
[01:00:12] Speaker A: Although, again, we have to. Yeah, go ahead. Because it depends on what people mean when they say that.
[01:00:16] Speaker E: Right.
[01:00:16] Speaker B: It does.
[01:00:17] Speaker A: For sure.
[01:00:19] Speaker B: My experience is that a true dry cough. So if you have.
Let's. Let's use old, like, pattern differentiation. A yin deficiency cough. Let's talk about that. A yin deficiency cough. I have never seen a yin deficiency cough in my life.
[01:00:39] Speaker A: Not once. Me neither.
[01:00:41] Speaker B: So I want to point this out, because when Travis K. Is talking about dry phlegm, what's happening there is the body has experienced the febrile process. It's heated up.
Particularly the upper burner has gotten hot. The fluids have gotten cooked in the lungs, and then they've congealed and gotten sticky. So that's what quote, unquote, dry phlegm is. It's phlegm that's not able to move and it's stuck.
[01:01:09] Speaker E: Right, Correct.
[01:01:10] Speaker B: So the herb, the principal herb that treats that rehydrates the phlegm in a weird way, if you want to think about it like that, is gualo.
[01:01:18] Speaker D: Right.
[01:01:18] Speaker B: Gualo exists in all of these chest obstruction formulas. And bamu Gualosan, obviously.
So any of those patterns can be treated by a gualo formula.
Wet phlegm is going to be phlegm that's easier to expectorate.
[01:01:33] Speaker E: Right.
[01:01:34] Speaker B: And it's typically not as hot, so it won't. Probably won't be yellow, probably won't be green. It'll be white.
[01:01:42] Speaker D: Yeah.
[01:01:43] Speaker B: Or clear.
[01:01:43] Speaker A: Clear. Ish.
[01:01:44] Speaker D: White.
[01:01:44] Speaker E: Yeah. Right.
[01:01:45] Speaker B: And those are the things that are going to be treated by warmer herbs. Ganjiang xixing.
We talked about a bunch of formulas with those.
The thing, the reason that I wanted to bring this up is I don't want people to be confused when they say the patient has a dry cough and think that they need to moisten the yin using yin tonic herbs.
[01:02:07] Speaker A: Oh, yeah, no, don't do that.
[01:02:08] Speaker B: Tianhua fen or not. Sorry, not tianhua fen. Tianmendong. Tianmen dong, BEI sha shen maimendong. This is not the way to treat most coughs. And if you do that, the patient will get worse.
[01:02:21] Speaker D: Yeah.
[01:02:22] Speaker B: So this is just one of the things that again, we learned all of these patterns in school. Maybe you guys have remembered, like, oh, baihe gu jintang, and these ones for this true yin deficiency in the lungs. And I can tell you that as a sequela to a cold and flu, I've literally never seen that pattern at all.
[01:02:41] Speaker A: It just doesn't happen. Well, it's a different thing.
[01:02:43] Speaker D: Right.
[01:02:43] Speaker A: It's a very different thing to be a cough that presents with an entirely different story.
[01:02:47] Speaker D: Right.
[01:02:47] Speaker A: In terms of the process of it. And could there be a yin deficiency cough as a sequela to a cold? Like, yeah, sure. I mean, anything is possible. But that's not.
That's not how it works.
[01:02:56] Speaker B: Don't think yet. If you're gonna guess, don't guess that way. That is not likely.
[01:03:00] Speaker A: What's happening if someone has a dry cough that's at all related to a previous infection, you're gonna be using gualo.
[01:03:08] Speaker B: Gualo, yes.
[01:03:09] Speaker A: That's just the truth of it. And gualo is also an amazing herb because it's inexpensive, which I really like about it. But it.
[01:03:16] Speaker D: It.
[01:03:16] Speaker A: You know, you said rehydrate, but that is what happens.
[01:03:18] Speaker D: Right.
[01:03:18] Speaker A: Like, it's a weird way to think about it, but it's like you got this sticky, dehydrated phlegm.
[01:03:24] Speaker C: Yeah.
[01:03:24] Speaker A: That gualo comes in and re. Moistens and then the other components of the formula, Xiabai and bansha, for example, or in like with beimu and jiegang and Chen PI. That's in Beimu, gualo, san you rehydrate the phlegm and then the body can kick it out.
[01:03:43] Speaker E: Right.
[01:03:43] Speaker A: But if you don't rehydrate it, it's hard to kick out.
[01:03:46] Speaker B: Absolutely.
[01:03:47] Speaker A: And so that's why, that's why Gualo is such an important player in here, is because we're taking something that's. That's been condensed through the pathomechanism of this, of this disease that was at some point could have happened very rapidly, it's important to remember. But at some point, the phlegm was loose and runny and white and clear. And then through the process of pathomechanism got thicker and thicker and thicker. I mean, like, you're reducing the phlegm sauce.
[01:04:13] Speaker E: Right?
[01:04:13] Speaker D: Right.
[01:04:14] Speaker A: Until it's now a sticky mess and it's baked onto the skillet.
[01:04:18] Speaker C: Yeah.
[01:04:18] Speaker D: Right.
[01:04:19] Speaker A: And now you got to rehydrate it before you can clean it off. Yes, that's a.
[01:04:23] Speaker B: That's a good way to think of it, actually.
[01:04:24] Speaker A: Yeah. It's baked on now and you could try like with other. Scrape it off, you know, you could also just, you know, pour oil on it and try and moisten it that way. But that's not the most direct way. And it's going to. It's going to make a mess.
[01:04:37] Speaker E: Right, right.
[01:04:38] Speaker A: Using our little analogy here. So if the yin tonics are pouring oil on it, eventually it might rehydrate, but not before your whole sink is a mess. You can't wipe it off of anything. It's cloying and sticky and weighed better to use a guala.
[01:04:52] Speaker C: Yeah, way better.
[01:04:52] Speaker D: Yeah. All right.
[01:04:54] Speaker A: Anything else we need to leave our folks with?
[01:04:56] Speaker B: The only other thing would be there are patterns of cough that the person literally can't stop coughing at night.
So you give them a formula like the ones we've mentioned. And sometimes the chest, if you add a chest obstruction formula into the mix, it will take the phlegm out and the coughing will stop.
[01:05:18] Speaker D: Yeah.
[01:05:18] Speaker B: What happens for some of these cases is they literally cannot sleep because anytime they try to go and recline at all, they will just start coughing and their body will not stop coughing the whole night and they won't sleep at all. And what happens eventually is the body gets super tired and it deteriorates, the oxygen level goes down and all these things.
There are formulas that treat these patterns. I actually think Bemu Gualosan is not a bad bridge formula to treating some of that. But the other formulas that treat that kind of pattern are in the Jingwei from the Shanghan Lun Perspective. Those are like the Shugen Ma Huang Tong and Tingly Dazao Shifei Tang. I just wanted to mention, if somebody's listening and they're like, I was trying to treat this patient and they just couldn't. I tried to do these things and it didn't work and they kept coughing. And it's usually those formulas are the answer. Something where there's literally herbs in there almost symptomatically to stop a cough, even if it's not going to treat the pattern fully, just to stop the cough so the person can sleep. We have formulas like that.
[01:06:34] Speaker A: It's also important to remember, too, there are a handful of useful patents here, actually.
PayPal Core, the Cantonese patent cough syrup, which you may have seen, comes in the, like, red and white checkered box. It's a cool formula. It's a thick syrup.
[01:06:53] Speaker D: Right.
[01:06:53] Speaker A: And it's actually an excellent nighttime cough remedy to help moisten the lungs a little bit and to suppress that cough so a person can sleep.
[01:07:03] Speaker C: Yep.
[01:07:03] Speaker A: You're not going to cure cough.
[01:07:04] Speaker E: Right.
[01:07:05] Speaker A: With Pepakua, but it, it is a great tool to just have. I always keep some in my medicine cabinet.
[01:07:10] Speaker E: Right.
[01:07:11] Speaker A: And even if I'm on herbs that are helping the cough, I'm probably going to take a dose before bed.
[01:07:15] Speaker B: Before bed? Just asleep.
[01:07:17] Speaker A: Just to sleep.
[01:07:17] Speaker D: Right.
[01:07:18] Speaker A: In the way that a lot of people will use, you know, like Mucinex or Nyquil or something. You can use Pepakua for that sort of nighttime cough.
[01:07:26] Speaker C: Yeah.
[01:07:27] Speaker A: And you can dose it pretty heavily. You can take a nice big spoonful, you know, or two before bed.
[01:07:32] Speaker B: That's a really good trick to know about.
[01:07:34] Speaker A: Yeah. And it's. It's shelf stable, like forever. So that's really handy too, especially because, you know, sometimes. Sometimes you just need a little smidgen of a thing to let someone sleep.
[01:07:43] Speaker C: Yeah.
[01:07:44] Speaker A: And then these other formulas will do the heavy lifting.
[01:07:46] Speaker B: Exactly.
[01:07:47] Speaker A: But if they can't sleep at all, these guys might not be enough to get it there.
[01:07:51] Speaker D: Yeah.
[01:07:52] Speaker A: Well, guys, as always, thanks for listening to the Nervous Herbalist. If you guys have any suggestions for topics for this season, you can reach [email protected] we'd love to hear from you. Love to hear your suggestions.
As always, we'd love for you also to rate and review the show wherever you listen to it. If you pick us up on Apple Podcasts or Spotify or some other place, rating and leaving us even a little review is helpful for other people to find us. So we'd love more Chinese medicine people to be able to join our community and join the conversation because we're nerds and we like to talk about stuff. So find us again. Thenervousherbalistmail.com thanks again for listening. My name is Travis Kern.
[01:08:31] Speaker B: I'm Travis Cunningham.
[01:08:32] Speaker A: We'll catch you next time.
[01:08:33] Speaker B: See you next time.
