Show Notes
TC and TK talk about some examples of real clinic case studies on cough to help you understand how the diagnosis and treatment develops over time
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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.
Hello everybody and welcome back to the Nervous Herbalist. My name is Travis Kern and I'm.
[00:00:26] Speaker B: Here with Travis Cunningham.
[00:00:28] Speaker A: And we are following up on our discussion of cough with a couple of case studies to take a look at.
A lot of the discussion in the theory section on cough is very, you know, the diagnosis process is fairly straightforward in terms of symptomology and like what you're looking for. So we did want to provide a real case example of kind of a everyday standard cough presentation using the models that we talked about in the theory section.
But we did also want to offer a more outlying cough example just because, you know, sometimes things come into the clinic that are not the classic standard situation. And so it might be good to look at it. I think also too, as a reminder that a lot of times, you know, you can get into the habit of thinking of cold and flu as kind of mundane work. Oh, it's, you know, whatever. People get better on their own and by and large that's true. But also the way that we are able to treat and deal with cold and flu symptoms is, is important because it's not always just a dismissive thing. It can be quite serious depending on underlying conditions and constitutional factors. And so it's just a good reminder to even to take the bog standard things but treat them with the seriousness that they have.
So let's start with a classic presentation to begin. So t, walk us through a case that is kind of how a lot of these cases look.
[00:01:51] Speaker B: Yeah, so this is a 39 year old female bodied person.
This, this was, I saw this person at the end of August, so 0829 this year. 25.
This patient was staying in a hotel when she noticed that she was feeling a little bit off on Monday of this week. I ended up seeing her Friday, so about five days later.
And when she came to see me, she had common cold symptoms. Fever, chills, body aches.
[00:02:31] Speaker A: Okay.
[00:02:32] Speaker B: She had a headache, she was coughing and wheezing.
She had, she reported chest congestion with green phlegm coming out.
She had nasal congestion.
And she actually said she was a little bit constipated.
She hadn't had a bowel movement in two days, which is not common for her. She's pretty regular, typically.
[00:03:00] Speaker C: Okay.
[00:03:01] Speaker B: She had sweating and I asked her about thirst and the thirst was a little bit mixed in Terms of an answer, she said, oh, sometimes I'm thirsty, sometimes I'm not.
[00:03:13] Speaker C: Whatever.
[00:03:14] Speaker B: So this was the symptomatic picture. I checked the pulses, and the pulses were pretty superficial is generally what I'd say. Superficial and fairly wiry, you would say.
[00:03:29] Speaker C: Yeah.
[00:03:29] Speaker A: And when you clock superficial and wiry in this kind of case, what's that telling you?
[00:03:34] Speaker C: Yeah.
[00:03:35] Speaker B: So I'm taking superficial being external contraction that the body's managing on the surface.
[00:03:42] Speaker A: Okay.
[00:03:42] Speaker B: So we need a surface formula. A formula that addresses the surface of the body. And then wiry could be a lot of things, but it's one of the things that you can see for Chai Hutong type presentation.
[00:03:57] Speaker C: Got it.
[00:03:57] Speaker A: Yeah, yeah. And in the context of, like, this person has cold and flu cough presentation, and they have surface level pulse reed wiry as an indicator toward Chaihu method.
[00:04:08] Speaker C: Yeah, got it. Okay. Yep.
[00:04:10] Speaker B: So I ended up giving her Caihu Guizhitong with a cough modification that we talked about.
[00:04:18] Speaker C: Right.
[00:04:20] Speaker B: Which is the subtraction of Renshen and Dadzao from the formula.
[00:04:25] Speaker A: Adding our good friends.
[00:04:26] Speaker B: Adding a good friend.
[00:04:28] Speaker C: Yep.
[00:04:28] Speaker B: Adding Ganjung and Wu weights, changing Xianjiang to Ganjung so they're not both in there. And then I also put in. Go again to mimic again tong.
[00:04:40] Speaker A: Okay.
[00:04:41] Speaker B: To put that in there.
[00:04:42] Speaker A: Why. Why include that here?
[00:04:45] Speaker B: So if it's just the Chaihu presentation, there's not really going to be body aches.
If there's body aches that shows a Tai yang, the Taiyong is having trouble as well.
[00:04:59] Speaker A: Right.
[00:04:59] Speaker B: So then you think, okay, Caihu Gui Jir Tong.
[00:05:02] Speaker C: Right.
[00:05:03] Speaker B: We have Guizhutang in the mix to. To address the Taiyong syndrome. And then the things that make me think we need to include Gogen are nasal congestion, stiff neck, and any symptoms in the eyes.
[00:05:19] Speaker C: Okay.
[00:05:20] Speaker B: Because those things all show a problem with the fluids on the surface are being dried out as a result of the febrile process. So the fluids in the muscle layer are dried out, so the muscles constrict, particularly in the neck, we have dryness in the eyes, which then will sometimes cause reflexive tearing.
And then we also have the same presentation in the nose, so the nasal passages actually dry out.
And then phlegm comes out. So it's the same situation as the tearing eyes.
[00:05:58] Speaker C: Right.
[00:05:58] Speaker B: You'd think, oh, if it was dry, why would there be phlegm? But the dryness is actually a disproportionate relationship with the fluids that are naturally occurring on the surface. So the fluids Actually clump in disharmony and then come out as phlegm.
[00:06:15] Speaker C: Right, right.
[00:06:16] Speaker A: Yeah, yeah. Because I think people sometimes imagine dryness to be like the desert, but actually there's flu. Like, you can't be a human meat sack and not have liquids in you. Like, it's just not. There's some fluids in there, some way to do it. So when the dryness takes hold, stuff gets thick and gummy and sticky. And that's what you think of as phlegm.
[00:06:37] Speaker C: Yep. Yeah.
[00:06:37] Speaker A: Okay, so the xiaochaiutong cough mod plus go gun.
[00:06:43] Speaker C: Yeah.
[00:06:43] Speaker A: Chaihu guager tong, chai guider, tong, Kaufman.
[00:06:46] Speaker C: Right.
[00:06:46] Speaker B: Which is just xiaochai, hutong plus guijer and baishao.
[00:06:49] Speaker C: Right.
[00:06:50] Speaker A: So you're combining xiao, chayutang, guijetong, basically.
[00:06:52] Speaker C: Yep.
[00:06:53] Speaker A: And then go again.
[00:06:54] Speaker B: And then go again.
[00:06:55] Speaker A: Okay, right. And so because you have this sort of combined picture of the muscle layer component of taiyang and then this cough chaihu tong presentation, we're like, oh, we need to use both together.
[00:07:10] Speaker C: Yep, yep.
[00:07:11] Speaker A: That's a good reminder, too, because sometimes people have a tendency to be really linear, like, oh, it's either guijer method or chaihu method. But in fact, like, the classical text is like. No, no. Sometimes it's mixed.
[00:07:22] Speaker C: Right.
[00:07:23] Speaker B: Oftentimes it's mixed.
[00:07:24] Speaker A: I was gonna say, a lot of times it's mixed just because the likelihood that you're gonna catch someone in exactly the right stage of their cold to just use one.
[00:07:34] Speaker C: Right.
[00:07:35] Speaker A: You know, without any mod. With nothing. I mean, sometimes, you know, it definitely happens, but it's important to keep in mind that you can combine these methods together.
Okay, so you give her that in granule.
[00:07:47] Speaker B: Actually, I gave this to her in powder. The san method.
[00:07:51] Speaker A: And why. Why that?
[00:07:52] Speaker B: I think it's a little better for acute situ. We've talked about how useless, I think granules are for acute cold and flu. Like, if it's super acute, if it's in the later stages, you know, like, if there's no longer surf symptoms and they're just. There's like a cough and phlegm, then you can just do the granules and it works fine.
[00:08:12] Speaker A: Sure.
[00:08:12] Speaker B: But I think for this is like, she's still having body ache. She's still having. She's still in the throes of it.
[00:08:19] Speaker C: Yeah.
[00:08:19] Speaker A: She's actively dealing with a cold.
[00:08:21] Speaker C: Yes.
[00:08:21] Speaker A: This is not sequela to a cold.
[00:08:23] Speaker B: No.
[00:08:23] Speaker C: Right.
[00:08:24] Speaker B: So I did the San method. So I'm dosing 15 grams of that powder, and I'm telling her to take that three times a day. So 45 grams a day total in powder.
[00:08:35] Speaker A: So you wrote the formula using the sort of Shanghan standard numbers in terms of ratios to one another.
And then because of the magic of technology, our software converts those numbers essentially into ratios and then spits out the total amount of each ingredient we need. So that she can take 45 grams of that formula per day.
[00:08:58] Speaker C: Yep.
[00:08:59] Speaker A: So it's 45 grams of coarsely ground raw herbs.
[00:09:03] Speaker C: Yes.
[00:09:03] Speaker A: And we've talked. I mean, we've touched on San method a little bit, but maybe we should explain a little bit further here. So she's taking the powder, she's doing overnight soak method, or is she doing quick boil?
[00:09:13] Speaker B: In this case, she's doing quick boil because it's acute.
[00:09:17] Speaker A: So there's. There's basically two primary ways we see people using San. The more traditional one you can think of as quick boil method.
So if you're thinking in just like a purely kind of alchemical, almost culinary way, there is qi within. The herbs that needs to be accessed by cooking can also be accessed by eating. There's a lot of ways you can access it. But if you think of a decoction, you put all the herbs in the pot, you cook them, they tend to be kind of whole ish. They're sliced and broken or whatever, but they're whole ish. And so a lot of times you got to soak them, you got to cook them, and there's a lot of herb that gets extracted into the liquid. Very potent classical decoction. But of course, we have classical sans. There's like a million of them. Like famously, Xiao San. Right. Sasan. The idea here is.
Exactly. Yeah. So many formulas that could be essentially stored and used as needed over a prolonged amount of time. Less total herb and cooked in a faster, simpler way.
So there's a lot of different ways that the classical. Different classical texts will describe taking San. Sometimes it's thrown finely ground and thrown into hot water, and the whole thing is drunk. Sometimes it's quick boiled, which is what we're talking about. Now, what we mean by that is basically you throw your powder into a pot with water, you bring it to a boil, boil it 5 to 10 minutes, strain the contents out, and then drink it.
[00:10:41] Speaker C: Yep.
[00:10:42] Speaker A: Why does this work? Well, everything's crushed and ground, so you literally just have easier extraction because there's more surface area in the water.
You don't need to cook it for as long. And a lot of times the herbs that we use in these kinds of formulations are not ones that need slow, long form cooking.
[00:11:00] Speaker C: Right.
[00:11:00] Speaker A: They tend to be accurate, they tend to be aromatic, they tend to be moving.
So a brief cooking is plenty fine to extract the content.
And in this case, the nice thing about a quick boil is like you literally just throw your powder into water in a small pot and 10 minutes later you have formula.
The overnight method that I mentioned, though, this is something that we've seen Dr. Greg Livingston use a lot of. I know the nugent heads over on the east coast use this method, but you basically put your raw herb in a thermos, like a well insulated thermos.
[00:11:32] Speaker C: Right.
[00:11:33] Speaker A: And then cover that with boiling water, seal it and let it sit overnight.
[00:11:37] Speaker C: Right.
[00:11:38] Speaker A: And then you strain off the liquid and drink it.
[00:11:40] Speaker C: Yep.
[00:11:41] Speaker A: So that method seems to work really well for chronic conditions, ongoing stuff. There's a rhythm to it, you know, and you can take that dose throughout the day, but if somebody's sick, you don't want to send them home with powder. Right. And be like, wait 12 hours.
[00:11:53] Speaker B: Yeah, exactly.
[00:11:54] Speaker A: Until you can start taking your herbs.
[00:11:56] Speaker C: Right.
[00:11:56] Speaker B: You want to take it right away.
[00:11:58] Speaker A: And then on the granule side, when you said it's been challenging to get granules to be effective here, this is even at really high dose, right?
[00:12:05] Speaker B: Oh, yeah, Even at high dose, it's like you can use six or seven times the dosage of what you would normally do for like a normal condition. That's not, that's not super acute for cold and flu. And it's like maybe feel a little better with it, but it's still not the same.
And I proved this to myself over the Christmas holiday last year with when I got sick, I took the exact same formula in granule at very high dose. I think I was taking 45 grams of granule a day.
[00:12:42] Speaker C: Right.
[00:12:42] Speaker B: Which is, you know, do the math on the extraction for what that's supposed to be like. And I was barely feeling any different. And then I did the exact same formula with the San method. Quick boil.
[00:12:55] Speaker C: Right.
[00:12:55] Speaker B: And immediately started to feel a change.
[00:12:59] Speaker C: Yeah.
[00:13:00] Speaker B: And I still think probably the bulk, like for acute cold and flu, the bulk method that like the classical method is still probably the best.
The problem is it's just so expensive now. So if you want to do like four days worth of herbs and you make a shout sha, like we do the same formula that I did for this patient here. How much would you think that would be? Chai huijir tong plus gagan cough mod with wu weiza.
[00:13:31] Speaker A: With wu wei CI for four days.
[00:13:32] Speaker C: Yeah.
[00:13:33] Speaker A: Probably $70. Five?
[00:13:35] Speaker C: Yeah. Yeah.
[00:13:36] Speaker B: It's like crazy expensive. So like if somebody's, if somebody's coming in and they have a cold and you're weighing like, well, if I'm going to give herbs, it's going to be $75.
[00:13:47] Speaker C: Right.
[00:13:48] Speaker B: For a cold. It just doesn't make sense.
[00:13:51] Speaker C: Yeah. Right.
[00:13:52] Speaker B: But if that, I mean, I think this, I'll have to look up how much it was, but this was probably like 30 bucks or something like that. Like not, not, not too bad.
[00:14:02] Speaker C: Yeah.
[00:14:03] Speaker B: And I was able to give her seven days worth. She ended up only needing to take it for four days.
And then I saw her again the following week and we did, we actually, I had her save the rest of it because it's good stuff for a long time. She can use it the next time she gets sick. And then we, we did a different formula.
[00:14:24] Speaker A: Yeah. I mean the, the benefit of the San method if stored in a relatively airtight container. So like we, we send them out the shop in Ziploc bags. But like it could go out in anything that's relatively airtight, sealed up, kept in the dark in a room temperature space. Those herbs are good for at least a year.
[00:14:43] Speaker C: Yeah.
[00:14:43] Speaker A: And if they weren't ground up, they'd be good kind of indefinitely.
[00:14:46] Speaker C: Yeah.
[00:14:46] Speaker A: And I would say like, good here is a relative term. I don't even know how you would properly quantify how their potency has declined over. It'd be tough.
[00:14:56] Speaker C: Right.
[00:14:56] Speaker A: But I would say when you grind something up, it now has a shelf life on it that it didn't previously unless it's vacuum sealed and frozen. Other than that, it's slowly leaching its qi into the environment. Cause it's just crushed up so small. But if you seal it up pretty well. So in the case of acute cold and flu, probably most people are gonna get a cold or two every year.
[00:15:19] Speaker B: Sure.
[00:15:19] Speaker A: And probably in most situations it presents very similarly. And so it means having a formula like this on hand that they now know how to identify what the symptoms are and can use is great.
[00:15:32] Speaker C: Yeah.
[00:15:33] Speaker A: If for no other reason than they just call us and they say like, hey, I got this cold and flu. I still have some of this formula left over. Can I use it? And then we take three minutes to ask four or five questions to confirm the presentation and we say, yeah, go ahead and get done it, or let me write you another one. Cause it's a little bit different, but probably they can still use it. And that's always really nice.
[00:15:54] Speaker C: Yep.
[00:15:54] Speaker A: Cause then people have medicine in their medicine Cabinet that they can immediately get on top of either because they've been seeing us long enough that they can essentially self diagnose. Cause they've seen it enough. Or they just do a quick call and they say, yep, that's the one.
[00:16:07] Speaker C: Do it. Yep.
[00:16:08] Speaker A: Okay. So she took that four days.
[00:16:11] Speaker C: Yeah.
[00:16:11] Speaker A: And then what happened?
[00:16:13] Speaker B: She came in the next week after that and she's doing much better.
There's just a little bit of congestion left in the mornings that she.
She gets. She has to, you know, cough up or whatever. But as far as the cough goes, the presentation, it's basically done like there's no fever, chills, body aches, there's nothing like that.
I did notice when I checked her hands that her fingertips are pretty cold and she has a little bit higher thirst. I noted that.
And the pulse is similar, let's say a little deeper but still superficial and a little bit. Still a little wiry, but it feels a little more standard now, I should say. It's not as actively enraged.
[00:17:02] Speaker C: Yeah, yeah.
[00:17:03] Speaker A: It's not at the same high frequency. Yeah, yeah. Okay. Did you say too what her abdomen looked like?
[00:17:10] Speaker B: I did actually check her abdomen.
So her abdomen on that date had costal tenderness under the right side, not the left side. But I put down two lines, which means it was fairly tender.
And then there's a little bit of a soft pee. So that's when you press into the epigastric area. There's no tangible thing from the practitioner side, but the patient is a little uncomfortable with it. So those two.
And then this patient definitely has some recu. Rectus. Abdominal tension. She tends to be a pretty thin bodied, so you can easily feel the recu on her.
And a few pulsations just above the umbilicus in this case.
[00:17:59] Speaker A: Okay.
[00:18:00] Speaker C: Yeah.
[00:18:01] Speaker A: And that's how it was when you first saw her on the second round.
[00:18:03] Speaker B: This is the second one.
[00:18:04] Speaker A: The second round.
[00:18:05] Speaker B: I don't think I checked it on the first one. So with acute cold and flu, it won't always show up on the abdomen. It's important to remember that. And they say that in some of the compo texts, unless the disease has gone to a certain level, the abdomen won't show very much.
So this is one of the ways, one of the places where the pulse is the best objective diagnostic tool because it will show stuff right away, it will change.
And so with acute cold and flu, I'm going to rely a lot more heavily on pulse than any of the other ones.
[00:18:40] Speaker C: Yeah, yeah.
[00:18:41] Speaker A: It makes sense that if you're thinking of the three objective diagnostic tools that we talk about a lot here. So pulse, abdomen, and tongue.
[00:18:49] Speaker C: Yeah.
[00:18:49] Speaker A: You're really going from sort of most dynamic and changeable to least dynamic and changeable, most embodied.
[00:18:55] Speaker C: Yep.
[00:18:56] Speaker A: So tongues tell you what a body's been like for a while.
[00:18:59] Speaker C: Right.
[00:18:59] Speaker A: And abdomens tell you the in between space between rapidly dynamic and changing pulse.
And that's why the abdomen is really useful for a lot of the stuff that we deal with here because it does change. Like in a week's time, two weeks time, you can see a change. But if you want to know, a person caught this infection two days ago. Is it going to show in the abdomen? Probably not. Like what you're clocking in the abdomen is a little bit more ongoing constitutional than it is the cold.
[00:19:29] Speaker C: Yep.
[00:19:29] Speaker A: Okay, so she still had some phlegm congestion left. Did you give her another formula or just let her?
[00:19:34] Speaker B: I did, yeah, I gave her.
I gave her another formula. I also.
So thirst is higher with the similar situation. So now I'm thinking I want to check the lymph nodes, right. To see if the lymph nodes are still swollen. So I check the lymph nodes in the neck, and they're pretty swollen. They're still like the little golf balls or something like that.
[00:19:57] Speaker C: Yeah.
[00:19:58] Speaker B: So I'm going to do Chai Huger Ganjung tongue in this, in this case. And then I added fuling and Baiju, which creates lingue. Jugan Tang is the gui ju. The gansao are already in the formula. So I did that nine grams twice a day in granule for the next two weeks.
[00:20:19] Speaker A: So why. Why not just have her keep taking the formula you gave her before for longer? Why switch it?
[00:20:25] Speaker B: I think the presentation has shifted so we can use that formula again at a different time so it's not wasted. So that's the first thing. And then the second thing is the presentation is shifted so she doesn't have the fever, chills, body aches anymore.
The thirst is higher and so. And the lymph nodes are swollen, which means that there's some fluid congestion in the upper burner.
That is more of a Tianwa Fan Mu Li picture.
So if the picture has shifted right, I want to. And I can change the formula. I want to follow the change with the formula. So would it have been okay if she took the rest of the previous one? Probably would have been fine, but I wanted to follow up with something that was a little bit more apparent and.
[00:21:15] Speaker A: Realistic for where she was and particularly in this case. Connected to the fluid aspect that's now presenting more obviously.
[00:21:24] Speaker C: Yep.
[00:21:24] Speaker A: And I mean, there was a fluid aspect to the first one. Right. We had the muscle layer, fluid tension stuff, but now we actually have like very palpable swollen lymph nodes. And the patient's reporting congestion.
[00:21:36] Speaker C: Yeah.
[00:21:37] Speaker A: So we just need to shift into something that's going to help manage that accumulation better.
[00:21:42] Speaker C: Right.
[00:21:42] Speaker B: And I will say this is a. This is closer to what the patient chronically sort of shows up as most of the time. So it's closer to the constitutional nature of her pattern.
[00:21:56] Speaker C: Right? Yeah.
[00:21:57] Speaker A: Okay. So then she took that for two weeks.
[00:21:59] Speaker C: Yep.
[00:22:00] Speaker A: In granule.
[00:22:00] Speaker B: In granule.
[00:22:01] Speaker A: And you felt comfortable with the granules at this point? Because we're out of the heart, we're.
[00:22:05] Speaker B: Out of the acute stage.
[00:22:06] Speaker C: Yeah.
[00:22:06] Speaker B: We're just managing kind of the chronic pieces.
[00:22:10] Speaker A: And then after that two week period, she was back.
[00:22:12] Speaker B: Back to normal.
[00:22:13] Speaker A: Back to normal.
[00:22:14] Speaker B: Switched. Yeah, we switched back to an interior type of treatment.
[00:22:18] Speaker A: Okay, that's great.
So notably here, was she on a constitutional formula before she got sick?
[00:22:24] Speaker B: She was.
[00:22:25] Speaker A: And of course she discontinued that formula.
[00:22:27] Speaker B: Yes.
[00:22:28] Speaker A: While you were dealing with this.
[00:22:29] Speaker C: Yep.
[00:22:30] Speaker A: That's an important thing to remind patients about when you're working with a patient for a long time for a chronic condition. You know, you're probably going to see them for months at a time. It's going to cross over different seasons. And so the likelihood that your patient will pick up a cold or flu or something while you're working on their ibs, their insomnia, their anxiety, whatever it is, is pretty high.
So we need to always make sure that we remind the patient that if the formula they're on is probably not going to help with their cold, sometimes you just get lucky. Like sometimes someone's just taking Xiao Chahutong unmodified, right?
[00:23:07] Speaker C: Yeah.
[00:23:07] Speaker A: And then they exact moment that they get sick and you're like, oh, actually that's fine. You just keep taking that. But by and large, you want to train your patients that that the formula that they're taking for whatever chronic condition you're treating is written for them as they present normally.
But if they get a cold or anything else, really, something changes, they should check in with you. And almost certainly they're going to need to discontinue that formula they're on. Just hold it, because we're almost certainly going to go back to it, but we need to deal with what's in front of us.
There's some suggestion that, you know, if people are on certain kinds of formulas. Oh. Like with Renshen or whatever can drive the disease deeper, like this kind of thing.
[00:23:47] Speaker B: Oh, yeah, sure.
[00:23:49] Speaker A: I think that's largely probably overblown.
[00:23:51] Speaker C: Yeah.
[00:23:52] Speaker B: The way I think about that is Renshen and xiaochaihutong is creating fluids, right? It's. It's going to build some fluids. So if the person is.
Has too many fluids or the fluids are pathologically manifest, then you don't want Ren Shen in the formula for the purpose of building more fluids right at that time.
[00:24:12] Speaker C: Yeah. Yeah.
[00:24:13] Speaker A: But if they kept taking it, I don't think they would be, like, wrecked.
[00:24:17] Speaker B: No, I don't think so.
[00:24:18] Speaker A: I mean, it wouldn't be great.
[00:24:19] Speaker C: Yeah.
[00:24:19] Speaker A: But I just mean to say that, like, sometimes I've watched some of our residents, for example, talk to a patient about stopping a formula. Like, patient's taking a formula, patient comes in, they have a cold, and then the resident will freak out a little bit and be like, oh, you gotta stop that formula. And like, whoa, don't say it like that.
[00:24:37] Speaker C: Right. Yeah.
[00:24:37] Speaker A: Now the patient is really nervous. They're like, oh, my God, was.
[00:24:41] Speaker B: Was I poisoning myself?
[00:24:43] Speaker A: Like, it's like, well, you know, take it easy.
Dial it back. The best move here, which is pretty much always the case with herbal stuff, is just make sure your patients understand that they're part of, like, that there's just the goal happening here. Like, I'm monitoring this case. It's for this specific thing. And, like, right now, we're recording this in the fall, early fall. And so I'm actually reminding my patients, even ones I've told this to, I've been working with for years. It's like, hey, just remember, we're coming into cold and flu season, Right. If you catch a cold, check in with me. Probably we're gonna need to stop this formula and go on to something else. Like, it's just sort of like a ahead of time, get ahead of the curve, let them know, hey, this is likely to change because it does matter. I mean, obviously in the fall and the spring, we see more of this with colds and flu in the fall and seasonal allergies in the spring. But it's still just good to make sure your patients understand that, like, you're not just handing them a bag of powder and being like, yeah, you know, take this or whatever, you know, I guess check it. Let me know how you feel. Like, no, you got to be more specific than that.
[00:25:45] Speaker B: Absolutely.
[00:25:45] Speaker C: Guide them.
[00:26:09] Speaker A: Okay, let's.
Let's shift over then to a more complicated case. Yeah. Which we wanted to include to just highlight some different methodologies and different aspects than the ones we spend most of the time talking about.
So lay out this one for us.
[00:26:25] Speaker B: T.
So this is, this is a 42 year old female patient that came in in January of this year.
[00:26:37] Speaker C: So quite.
[00:26:39] Speaker B: Actually quite a few months ago now because we're in autumn.
But I saw her on the 15th at this time. And this is a patient who I've been treating for actually a few years on and off, kind of touching up mostly for fatigue. And she's a hypothyroid person, so managing fatigue and insomnia and things like this kind of like chronic body pain stuff.
So anyway, in December she was hospitalized after getting sick.
The cold went into her chest, she developed pneumonia and she almost died.
She was intubated in the hospital.
They weren't sure she was going to make it for a few days. It was really, really intense.
She had, this is another story, but she had kind of like trippy near death experience type of things that we don't need to go into. But she had some of that type of experience when she was under.
But she did eventually recover enough to get out of the hospital.
And she was discharged 10 days prior to the appointment here.
So she would have been discharged on the 5th of January.
And then as a follow up to the hospital visit, her primary care doc wanted her to get a bunch of different vaccines. I think probably because they didn't want her to get sick again because they were worried that, you know, it could, it could kill her, literally.
[00:28:16] Speaker C: Yeah.
[00:28:18] Speaker B: But after she took, after she went to the appointment to get the vaccines, she told me as soon as I got out to the parking lot after having the injections, I can tell it was going to be really bad.
I started to have trouble breathing again and basically had asthmatic symptoms that she had to manage.
So she reported that to her doctor. Her doctor gave her prednisone. So she started to take the prednisone and at this point she's still. So this is where I. Now I'm seeing her 10 days later. This is the 15th.
So she's coughing a lot in the office. She has an asthmatic sounding cough.
She's got shortness of breath. It's really hard for her to.
She kind of looks out of it from my perspective.
She reports no phlegm or congestion in the chest that she's aware of.
She feels warm overall, but she can't sweat.
[00:29:27] Speaker A: Okay.
[00:29:28] Speaker B: She still requested. I noted this specifically because I've seen this be Important. A few different times. She still requested a heating lamp when we did acupuncture on the table.
So if people are warm but they're still requesting the heating lamp, I'm suspicious that we still need to treat it as cold.
[00:29:48] Speaker C: Yeah. Right.
[00:29:50] Speaker B: Her digestion is normal. She's got one bowel movement a day. She has been able to sleep.
She props herself up at night and then kind of settles herself down. And she has been able to sleep, which is good.
Her right arm is feeling numb and painful after all the injections, which were done there.
[00:30:12] Speaker A: Sure.
[00:30:12] Speaker B: That's from the wrist all the way up to the shoulder.
And that's pretty much the set of the symptoms. I checked her pulses. The pulses are rapid, which is atypical for her. Not typical. Constitutionally, the pulses are very superficial rapid, especially in the first positions, the first two positions, and deeper in the third on both sides.
And that's pretty much it. I did also check her abdomen. Actually.
Her abdomen showed discomfort when I pressed into sort of between the epigastric area on the right side and the costal area. So there's like a little bit of a. Kind of like, where we would think the gallbladder is kind of difficult, like, discomfort there.
[00:31:05] Speaker C: Okay.
[00:31:06] Speaker B: I did find a water splash sound when I did the tympanic thing on the stomach.
And this patient has req, like, a lot of the. Let's say the wet or the damp constitutional type req that we've talked about before.
[00:31:23] Speaker A: So the thing that stands out to me a lot from that presentation is a couple of things, I guess. But one is that her reaction to the vaccine administration was asthmatic breathing.
[00:31:38] Speaker C: Yeah.
[00:31:38] Speaker A: And that, of course, the thing that had put her in the hospital, had her intubated, was fluid in her lungs.
[00:31:44] Speaker C: Yes.
[00:31:44] Speaker A: Right. So we have. Okay, we clearly have, like, a breathing lung access problem.
[00:31:50] Speaker C: Yes.
[00:31:50] Speaker A: We have a fluid accumulation problem.
But by the time she's seeing you, she doesn't feel any fluid anymore, which is quite a testament to what they were able to clear out of her in the hospital, because otherwise that would have been bad. But then she can't sweat.
[00:32:05] Speaker C: Right.
[00:32:05] Speaker B: And it's important to say that she doesn't report any noticeable phlegm or congestion in the chest. But I got a splash sound.
[00:32:14] Speaker A: Right.
[00:32:15] Speaker C: Yeah.
[00:32:16] Speaker A: Well, I mean, without doubt, she's still wet. Right.
[00:32:18] Speaker C: Yeah.
[00:32:18] Speaker A: But, like, just like her. Her experience of it is like, oh, I'm not drowning in fluids anymore.
[00:32:22] Speaker B: Yes.
[00:32:23] Speaker A: Which could also just be a relative sense.
[00:32:25] Speaker C: Right.
[00:32:25] Speaker A: Like, she's thinking, like, oh, yeah, right. I'M betting.
[00:32:27] Speaker B: Yeah, exactly. No, that's a good point.
[00:32:29] Speaker A: Compared to what? Compared to when I was intubated, like. Yeah, it's a million times better.
But of course, like lungs, asthma, fluid, no sweat.
[00:32:38] Speaker C: Yeah.
[00:32:38] Speaker A: I'm immediately thinking of Ma Huang.
[00:32:41] Speaker B: Ma Huang. Yeah, exactly.
[00:32:42] Speaker A: Of course. Which always poses such a tricky bit because we can't get any mahuang easily.
[00:32:48] Speaker C: Right. Yeah.
[00:32:48] Speaker B: Ma Huang is very hard to find.
[00:32:50] Speaker A: So what'd you do?
[00:32:51] Speaker B: So I did Xiao qinglong tong plus shi gao. So Shao Qing longtong plus shi gao is kind of like the movement between Shao qing long tong and Da qing long tong.
The movement between shouting long tongue and da qing long tongue, just as a refresher, is the movement between phlegm in the lungs. So damp cold tie in, plus a closed surface.
[00:33:18] Speaker C: Right.
[00:33:18] Speaker B: That's xiao qing long tong.
Da qing long tong is a closed surface with dryness underneath.
So the picture appears hotter in Da Qing longtong, but the surface is completely closed and the closure is related to cold.
So there's cold at the surface and then underneath there's a lot of hot air and dryness. So the fluids are drying up underneath because there's so much pressure, let's say from the febrile process.
[00:33:54] Speaker A: Excuse heat from constraint.
[00:33:56] Speaker B: Kind of.
[00:33:57] Speaker C: Yeah.
[00:33:57] Speaker B: But the constraint is the closed surface. The pores literally can't open to diffuse any of that heat.
[00:34:03] Speaker A: So the cold is keeping the pores shut.
[00:34:05] Speaker B: Yes.
[00:34:05] Speaker A: Body can't open them.
[00:34:06] Speaker B: Body can't open.
[00:34:07] Speaker A: And the constraint that results from that generates heat, generates heat and that heat cooks the fluids.
[00:34:14] Speaker C: Yes.
[00:34:14] Speaker A: And we end up with dryness.
[00:34:15] Speaker C: Yes.
[00:34:16] Speaker A: But before. So like the shouting long tong piece of that is like the constraint is I guess, relatively new, or at least not.
It's not as level of intensity. Maybe time is a factor, maybe not. Where they just. It hasn't generated that much heat yet.
[00:34:32] Speaker C: Correct.
[00:34:33] Speaker B: And there's usually pre. In most Shao Qing Long tong cases that I've seen, the patients are pre existingly phlegmy and damp and tie in.
[00:34:41] Speaker C: Yeah.
[00:34:41] Speaker B: So that's like there and then boom, External contraction, the surface closes. So then the surface is closed. There's phlegm, damp and taiyin. So it's very hard to breathe. It's really problematic to breathe in that situation because the things we need to breathe are one. We need our surface to open and close so pressure can diffuse.
[00:35:04] Speaker C: Right.
[00:35:04] Speaker B: And then we also need relative health of yin and yang in the lungs and the function between the lung and the kidney could say.
[00:35:14] Speaker A: Okay, yeah. So Shaoqing Longtang plus Shi Gao.
[00:35:17] Speaker C: Right.
[00:35:17] Speaker B: Which is again, like I'm reading that as she's in Shaoqing Long Tong. But there's heat. That's dryness. That's starting to show itself, which is why there's not as much. She doesn't report phlegm, congestion in the lungs.
[00:35:32] Speaker A: Sure. But I think as it was before.
[00:35:34] Speaker C: Exactly.
[00:35:35] Speaker B: I'm thinking that it was there and now it's changing. That's kind of how I'm reading the picture.
[00:35:40] Speaker A: And you're reading that because of the case history.
[00:35:43] Speaker B: The case is. Yeah, some of it is the case history.
[00:35:45] Speaker A: And then also the wetness in the abdomen.
[00:35:48] Speaker B: Wetness in the abdomen. And then the.
[00:35:51] Speaker C: The.
[00:35:52] Speaker B: But the pulse is kind of rapid.
[00:35:53] Speaker A: And that's the heat.
[00:35:54] Speaker B: So that's the heat part that's starting to occur.
[00:35:57] Speaker A: Gotcha.
[00:35:57] Speaker C: Okay. Yeah.
[00:35:59] Speaker A: Because this patient, I mean, you would expect shouting Long Tong.
[00:36:03] Speaker C: Yeah.
[00:36:03] Speaker A: Given constitution and case history, but because you've got this rapid pulse, which is really uncommon.
[00:36:09] Speaker C: Right.
[00:36:09] Speaker A: Thinking, oh, it's starting to heat up in here.
[00:36:11] Speaker C: Right.
[00:36:11] Speaker A: Okay, so you give her that in granules.
[00:36:14] Speaker B: This is also the San method.
[00:36:16] Speaker A: Gotcha.
[00:36:17] Speaker B: Because we're acute.
[00:36:18] Speaker A: Acute.
Okay. And then dosage on this one.
[00:36:22] Speaker C: Yeah.
[00:36:23] Speaker B: So I did standard dosage for Shaoqing longtong, so Bai Xiao 9, Dragonzao 6, Bansha 12, Shishi 9, Ganjiang 9, Guager 9, Wu Wei CI 12, Shi Gao 6.
And instead of Ma Huang, I'd used an herb called Xiang Ru in this case. And I just did it at 9. I think it was the first time I had tried this, like subbing. Subbing Xiang Ru for Mahuang. So I wasn't sure what to dose it at.
And so I just did the equivalent dosage of what Ma Huang would be in the formula, ratio wise. I think now if I were doing it, I would have gone up a little bit.
[00:37:03] Speaker A: Yeah, I would go up now just have. We've seen how it works a little bit differently now. So.
[00:37:08] Speaker C: Right.
[00:37:08] Speaker A: Yeah, maybe 12.
[00:37:09] Speaker B: Maybe 12. Yeah, 12 to 15, something like that.
[00:37:12] Speaker A: And so we ground it up into sun. And she was taking what, 30, 35 grams a day, something like that.
[00:37:17] Speaker C: Yeah.
[00:37:17] Speaker B: I have down here 1 tablespoon which we were talking before recording was.
What do you think how much that would be for?
[00:37:24] Speaker A: Yeah, for this formula, it's probably about between 10 and 12 grams. A tablespoon like that. This is early days when we were experimenting with this new method. And most of our patients are, for whatever reason, unbelievably resistant to Using a scale?
[00:37:37] Speaker C: Yeah.
[00:37:38] Speaker A: Which is like, mind boggling to me. I'm like, just buy a scale. And they're like, who weighs things? I'm like, everyone in the world except Americans. Apparently you can buy a really great gram scale, you guys, from Amazon, for like 20 bucks. But anyway, we were giving them dosage in tablespoons because that was just easier for folks. But yeah, so probably somewhere between 30 and 36, 38 grams a day.
[00:37:59] Speaker C: Yeah. Yeah.
[00:38:00] Speaker A: Okay. So she did that quick boil method.
[00:38:03] Speaker B: Quick boil method, Yep. I said on the instructions here, simmer for 10 minutes and then strain and drink. Strain and drink. Okay, so three times a day.
[00:38:14] Speaker A: Three times a day, yeah. And then how many days did she take that?
[00:38:17] Speaker B: So I actually called her the next day because I wanted to make sure she was doing better.
I talked to her the next day and she said, it's like magic. She can breathe. She's doing way better.
So great, continue. So I had her do the same thing for a week, and then I followed up with her the following week.
[00:38:37] Speaker A: So she went a whole week basically on that formula?
[00:38:40] Speaker B: Yes.
[00:38:42] Speaker A: And then a week later.
[00:38:44] Speaker B: A week later she came back in.
She's breathing much easier, coughing much less.
Throat now feels open.
The main complaint at this point is fatigue. She gets fatigued very easily. Like walking up the stairs.
[00:39:02] Speaker A: Sure.
[00:39:03] Speaker B: She's not feeling cold.
She's feeling a little warm most of the time.
She started physical therapy earlier that week. Her right arm is still painful, but it's a little better.
And that's about it. That's all the stuff that she reported to me.
When I checked her pulses, they had completely shifted back to their kind of normal, deep, weak sort of standard.
[00:39:35] Speaker C: Yeah.
[00:39:36] Speaker A: Which indicates that that heat that was building has dissipated.
[00:39:39] Speaker B: The heat that was building has dissipated.
[00:39:41] Speaker C: Yep.
[00:39:42] Speaker B: And she's kind of back to a more.
More standard pattern for her, which is a deficiency, like a severe taxation deficiency pattern.
[00:39:53] Speaker A: Sure. So did you guys start to shift back to her more constitutional approach?
[00:39:56] Speaker B: I shifted back to a constitutional approach and what I did in this case was I used Jen Wu Tong plus Dangui Sinitang, and then I modified the Jen Wu Tong for cough.
So it sounds a little complicated, but you have Xixin and Dangui Sinitang.
[00:40:16] Speaker C: Right.
[00:40:17] Speaker B: So that's part of the cough modification. So I basically added Wu Weizi and Ganjiang to the formula.
[00:40:26] Speaker A: And so this, of course, is going to deal with the deficiency taxation presentation she normally walks with with some added stuff to support the lungs. And Tyene, as we're managing this transition away from Very serious cold and flu infection back to her more normal.
Look, there's a couple of things that really stand out to me about this case. Not only. It's just not that often, honestly that we get to use Mahuang approach. People don't usually show up in our clinic with the kind of presentation for which the Mahuang formulas are called for.
Added to the fact that as we discussed, having Mahuang is very difficult.
So you have to come up with some adaptation.
[00:41:10] Speaker C: Yeah.
[00:41:10] Speaker A: In this case, you were using Xiang Ru.
[00:41:13] Speaker C: Yep.
[00:41:16] Speaker A: And we'll probably do a show, I think, on ways to manage a lack of Mahuang.
[00:41:21] Speaker C: Yeah.
[00:41:21] Speaker A: Super annoying. It is, I have to say, like, just like as an herbalist, it's so annoying to have this really.
Like when you need it.
[00:41:30] Speaker C: Yeah, you need it.
[00:41:31] Speaker B: It's so unique as. As a medicinal.
[00:41:36] Speaker A: It is. And finding substitutions is okay, but it'd be just much better if we could easily get our hands on Mahong. And because of weight loss pills.
[00:41:45] Speaker C: Yeah.
[00:41:46] Speaker A: In the aughts, we can't. If you don't know that story, it's a long story.
[00:41:49] Speaker C: Well.
[00:41:49] Speaker B: And Covid, you know.
[00:41:52] Speaker A: Well, but. But we were still like having to black market it in.
[00:41:55] Speaker C: Yeah.
[00:41:56] Speaker A: To the U.S. like, we can't. We can't black market it into the US because of COVID Right. This is basically all the granule. Mahuang got used up during COVID and the stores are very slowly being replenished.
But the fact that we just can't import it standard into the US that it's a complicated piece at all is because of regulations around ephedra as a weight loss drug, which is super tedious.
So yeah, that's a little rant on Mahuang, but I mean, at least in this case, this substitution worked well to open the surface and release sort of what was happening there. The thing that also stands out to me though is the next day check in.
[00:42:33] Speaker C: Yeah.
[00:42:34] Speaker A: And I want to.
In the States, we tend to see, like, if we're seeing someone frequently, we're seeing them once a week.
In an internal medicine clinic like ours, we usually write people formulas for a week. Because I'm going to see you next week and we'll check in about it, modify it if we need it. And then once someone's on a formula, maybe I give you two weeks, three weeks, a month at a time if. If I know you're going to really need it for that long. But you know, we kind of run on this weekly cycle.
The thing is, is that like with A cold of any kind, a severe one like this patient had, or a less severe one like the first one you talked about? A lot happens in a week.
[00:43:11] Speaker C: Oh, yeah.
[00:43:11] Speaker B: I mean, a lot happened. A lot can happen in a few days.
[00:43:14] Speaker A: That's what I mean. Yeah. So it's like if you, if you give someone a formula and just be like, we'll check in in a week.
[00:43:19] Speaker C: Yeah.
[00:43:19] Speaker A: I mean, like two or three things could have evolved in that time.
So if you want to be able, if you want to be good with herbs in cold and flu contexts, you have to build systems in your interaction with patients that can create more agility with connecting with them and talking to them. And this can be a challenge, especially when you're thinking about the business of it all and your time. And do I bill an appointment? What do I need? Because the truth is that what you really need is probably seven minutes, Right. You just need like.
It reminds me of that thing people used to say about doctors, you know, like, take two and call me in the morning. Yeah, but there's a reason that's a joke because like, that's how your sort of small town doctor operated. Because I need to know how you feel tomorrow.
[00:44:10] Speaker C: Right.
[00:44:11] Speaker B: Like, are you trending well?
[00:44:12] Speaker A: Yeah, exactly. Because like, you should be. I've given you this medication and it should change the pattern trajectory. And if it's not, then I need to change because this is serious. And I think this is the piece that we sometimes forget about because so many of us treat things that I don't want to suggest that they're not serious. Right. Because like the people that I treat who have horrible irritable bowel or Crohn's disease or whatever, it's serious. Right. Those are serious conditions.
But the rate of change in those conditions is slow.
And so if there's a complication, it's not happening overnight, it's not happening in a two day period.
But if you're going to get into the game of treating cold and flu, particularly with people who have very strong reactions or weak constitutions, change can happen rapidly.
And that means you need to stay on top of it. Because it's not just a matter of taking a 35 year old healthy male or female person and helping them not feel like garbage.
It's like, oh, you're dealing with a 70 year old woman who has an easy tendency toward pneumonia because she's actually had pneumonia three times in the last two years.
That's a potentially mortal condition.
[00:45:21] Speaker C: Right.
[00:45:22] Speaker A: And so if you're going to treat with Herbs, which we are really good at. Chinese medicine is really good at cold and flu in a way that our biomed counterparts, in my opinion, have virtually no reasonable answer for. Yeah, oh, antibiotics maybe. Like, it's just so weak. And that's not their fault. It's just their medicine isn't designed for it in the ways that ours is.
And yet a lot of practitioners don't get the opportunity to work in this space because they don't have systems built that let them do it.
[00:45:52] Speaker C: Right.
[00:45:53] Speaker A: So, like in our case, people come in. It's mostly the. Most of the cold and flu we deal in are people that we've already been treating for something else because they already know that we can do this.
So that's kind of the first end, is like, make sure your patients know that you deal in cold and flu and you just got to do some training. I mean, like, how many calls do we get when people are like, I need to cancel my appointment because I've got a cold.
[00:46:15] Speaker C: Oh, yeah, yeah.
[00:46:17] Speaker A: Because they're thinking we're like the massage therapist or something.
[00:46:19] Speaker C: Right.
[00:46:20] Speaker A: Where they tell you, like, don't come in if you're sick.
[00:46:22] Speaker C: Sure.
[00:46:22] Speaker A: And I can't. My phrase is literally. I mean, it sometimes sounds silly, but I literally say, well, we deal in sick people.
[00:46:28] Speaker C: Like, that's our right.
[00:46:30] Speaker A: That's our whole job. Like, we deal in sick people. So if you're sick, like, come, come. If you can get here safely, come to the clinic.
[00:46:37] Speaker C: Right.
[00:46:39] Speaker A: So number one is you got to make sure your patients know that you can actually treat this stuff. And then number two is obviously you need to, you know, train up on your cold and flu formulas, which is presumably why you're listening to this show and other discussions. And then number three is you have to have a system in place where you can check up with people. And for us, we do what we hear at the clinic. Call, phone call, check ins.
And they go on the calendar, like onto my clinic calendar. I schedule them so that I don't miss them. And I tell people, hey, I'm going to call you tomorrow at 10 or whatever time we agree on.
So at 10, a phone number is going to ring on your phone that you don't recognize.
Answer it, because that's me. This is a big deal because you don't have to answer the phone.
[00:47:18] Speaker B: You have to say it. Yeah, you do.
[00:47:20] Speaker A: Even though it's like, on the calendar. I'm going to be like, I'm going to call you at 10.
And the number rings at 10 o' clock and you don't recognize it, answer the phone, yep, it's me, you know, and then you literally just over the phone, ask them whatever follow up questions you need to ask to make sure that they're trending in the right direction. And then you make a pivot in the prescription writing of your formula.
We don't charge for that.
[00:47:43] Speaker C: Right?
[00:47:43] Speaker A: We don't charge for a seven minute conversation. And I'm not saying you should or you shouldn't. I'm just saying we don't. And the reason that we don't is because, of course, we made money on the clinical interaction the day before.
We also are going to make some kind of small margin on the herb sale.
But honestly, the reason that we don't charge for it is because it just doesn't seem necessary in the service of the patient's ends. It's not a huge amount of my time.
It's blocked out on the calendar. I'm not going to use it somewhere else.
And the thing is that this is the place where, you know, this show is mostly about herbal prescription. We don't talk about the business of medicine a lot, but the thing is, is that doing good work, consistently doing good work is the best way to make sure you have work to do. Which is to say, like, your reputation grows, your patients grow to trust you, they tell other people about your work. And if there's any place to be generous with your time, it's in circumstances that create agility for your herbal delivery. Yeah, so what I mean by that is like, for example, we don't offer discounts in our clinic. Like, people will be like, can I get it? I'm a student or I'm a veteran or I'm an old person.
And we don't, we don't do discounts.
[00:49:00] Speaker C: Right.
[00:49:00] Speaker A: We set our prices at a thing that we think is competitive and works for our community.
But we don't, we don't do discounts.
[00:49:06] Speaker C: Right.
[00:49:08] Speaker A: And some people are like, that's weird. No student discounts. When you guys are students, it's like, nah, we just don't. And the reason is because we think that the time that we spend is worth this amount of money.
And because, and we don't advertise this anywhere. Exactly. But because we also know that there's some follow up built in. You know, we're gonna send an email or two or five, depending on the patient's needs, we're gonna be agile by phone, we're gonna check in directly if necessary. And all of that's just Sort of built in to the price.
Now caveat, you need to make sure that you're not doing a half an hour phone consult right in your phone call.
[00:49:44] Speaker C: Check. Yeah, yeah, you gotta keep it, keep.
[00:49:47] Speaker A: It tight, Keep it tight, constrain it.
But if there's any place to be generous, in my opinion, it's not in creating complicated payment schemes with sliding scales and discount structures and all this kind of stuff. Set a price that you need to get to make your ends meet and then be generous within that structure because then people get better, you get better at your work, they get better from their illness, they tell their friends, and now you have more work.
[00:50:11] Speaker C: Yep.
[00:50:11] Speaker A: So, you know, a little aside there into the business of things. But if you're gonna do cold and flu, you need to be agile.
[00:50:19] Speaker B: Yeah, it's acute. Acute disease.
[00:50:22] Speaker A: Yeah, acute disease. Yeah, for sure.
[00:50:24] Speaker B: If you treat urinary tract infections, those, those things can morph like crazy in 24 hours.
[00:50:29] Speaker A: And you got to check in.
[00:50:30] Speaker B: Yeah, you got to check in.
Um, yeah, there's, there's some, some conditions where you really do need to, to check in before a week. And it's important that you do if you're trying to, if you're really trying to treat it.
[00:50:42] Speaker C: Yeah.
[00:50:43] Speaker A: If you really want to be the, the clinic and the intervention that's going to make a difference. I also just want to say too that, you know, this is not that level of attention to detail, specific human to human interaction is also not really the medical standard anymore in the West. Right. So like people are overwhelmed. The hospital systems are, you know, largely unfunctioning. And like people are constantly just like rushing to urgent care to get help. But like they don't have a consistent physician at that urgent care. They're just going like they're just another faceless, nameless chart, you know, in a pool.
And so for you to take the time to intentionally call that person and check in with them and make sure that things are moving in the right direction and to be available when you said you'd be available. And again, we're not scheduling this stuff at 10 o' clock at night. We're not doing it at wild times. Like we're just putting on the calendar like you were here at 10 on Tuesday, I'm gonna call you at 10 on Wednesday and we're gonna see how it looks.
So I'm not suggesting that you need to be like a martyr in this context.
[00:51:42] Speaker B: Right, sure.
[00:51:43] Speaker C: Yeah.
[00:51:44] Speaker A: But that personalization is also really, really helpful in not only building rapport with your Patients in general, but also helping their own healing process.
[00:51:54] Speaker C: Yeah.
[00:51:54] Speaker A: Because they see seen, they feel seen, they feel taken care of. And that matters. Particularly when there's so many circumstances in which people don't feel seen and they don't feel taken care of. If we can be that, why not?
Seems to go a long way.
[00:52:10] Speaker C: Yeah.
[00:52:11] Speaker B: I do want to say, on the heels of the last case, the fatigue that this patient experienced took a long time to fully recover. Like, even with the herbs. Even with the. And every week or every time I saw her, I usually see her like once a month at this point, but she.
It took her a long time to feel back to normal. She ended up losing a lot of her hair.
As is common when people go through really intense medical situations, if they're life threatening, sometimes people will lose their hair. Luckily, in her case, it's all come back.
[00:52:48] Speaker C: Yeah.
[00:52:49] Speaker B: But it's taken a while to. To fully treat. So I, I did want to mention that because sometimes I don't think there's a way to avoid a longer process in medicine. Like, you've just got to be like, you just got to help with what you can do and.
[00:53:05] Speaker A: Yeah, well, because it's intense. I mean, she went through a wildly intense.
[00:53:10] Speaker C: Yes.
[00:53:10] Speaker A: Health scenario.
[00:53:11] Speaker B: She did. And she wasn't like, she's also coming at the situation with a bit of an empty tank to begin with.
[00:53:19] Speaker A: Yeah, yeah. This patient has this deficiency taxation presentation with damp phlegm accumulation. I mean, they're just like, the system was already stacked against her in a lot of ways. And then she went through a really intense medical situation, followed up by, you know, because it's important to remember, too, that our herbs do the work of helping patterns realign, but it requires qi.
[00:53:42] Speaker C: Yeah.
[00:53:42] Speaker A: To respond even positively. Right. Like, your body has to interpret the pattern of the formula and apply that physiologic pattern to the pathology in its system. And that requires chi. Like, it's not a free 100% game, you know, so, like, the process of healing itself can be taxing in a taxed body.
And so it's not surprising to me that she was tired for so long.
[00:54:06] Speaker C: Yeah, yeah.
[00:54:07] Speaker A: But she's less tired now.
[00:54:08] Speaker B: Oh, yeah. She's basically back to status quo now.
[00:54:11] Speaker C: But.
[00:54:12] Speaker B: But it took months. I just wanted to mention that because sometimes some of these details get left out when you talk about cases and, and then you get in the clinic and you're like, I'm treating, but is it working? Or, you know.
[00:54:25] Speaker A: Yeah, but of course, I mean, the main, the big. The big Red flag symptoms were handled fairly rapidly.
[00:54:31] Speaker B: They were handled in almost a week.
[00:54:33] Speaker A: But it was the recovery.
[00:54:34] Speaker B: The fatigue. Yeah, the fatigue and the.
All of that stuff that took a long time.
[00:54:40] Speaker C: Yeah. Yeah.
[00:54:41] Speaker A: It's a good thing to remember. And it's a good thing, too, if you haven't treated a lot of this stuff to check in with people who have to get a sense of that.
Probably you're on a fine trajectory. But it's always good to just check in with people, shoot us an email and be like, hey, I've been working on this case. It's been three months.
Do you think everything's looking okay?
Because it's good to know that you're on the right track.
[00:55:03] Speaker C: Yep.
[00:55:04] Speaker A: All right. Well, a couple of cases for your consideration, listeners on the subject of cough and sort of occult. Excuse me, acute cold and flu.
Occult flu.
God, can you imagine what that would be?
[00:55:17] Speaker B: Oh, man, we have to deal with.
[00:55:18] Speaker A: Plagues of occult flu, esoteric witch curses that are. That are making everyone sick.
Anyway, I hope you guys enjoyed listening today. If you have suggestions for show topics, please shoot us an [email protected] the nervous herbalist gmail.com. we'd love to hear from you and, and take any of your suggestions. We would love to make shows that you guys are interested in.
And wherever you're listening to the show, if you wouldn't mind rating and reviewing it, it helps other people find the show and make sure that more people can. Can plug in to learn more about prescribing herbs and helping their patients. And so, as always, my name is Travis Kern.
[00:55:58] Speaker B: I'm Travis Cunningham.
[00:55:59] Speaker A: And we'll catch you guys next time.
[00:56:01] Speaker B: Catch you next time.
