Show Notes
TC lays out the details of a successful menopause treatment case while TK interviews him about his diagnosis and treatment strategy. A companion to the 04-05 Menopause Theory episode.
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Episode Transcript
[00:00:03] 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.
[00:00:22] Speaker B: Here with Travis Cunningham.
[00:00:24] Speaker A: And we are following up on our discussion about the theory and formulas for menopause with a case study today so that we can give you guys a sense of how this played out with a real person.
Particularly because menopause is something that has an initial presentation and then has a tendency to change as we treat it. And then ultimately we'll need some kind of either resolution or maintenance or how does that look? So we wanted to kind of lay it out so people could get a sense of it.
So t, you've got a case for us?
[00:00:56] Speaker B: Yeah, this is actually a perimenopause perimenopausal case.
[00:01:02] Speaker A: Where do you want to make that distinction for folks? I know that we did it when we were in the theory area, but like when we're talking about perimenopause, menopause, postmenopausal.
[00:01:10] Speaker B: Sure.
[00:01:10] Speaker A: What do we mean?
[00:01:11] Speaker B: It's just the time around a female bodied person's span of when the menstrual cycle begins to stop. Completely stops. And then the resulting factors with that perimenopausal would be as it's stopping or before, like kind of as it's moving into menopause.
[00:01:35] Speaker A: Yeah. So it's like the. Like the first part of it.
[00:01:37] Speaker B: Yes, the first part of it. And what will happen for some people is they'll start to get some of the same symptoms that you would associate with menopause. The reason that I picked this case is there's a couple of key features in the case that I think are good to talk about relative to the. To treating perimenopause or menopause.
[00:01:57] Speaker A: Okay, well, with that setting the stage, tell us a little bit about the case we've got.
[00:02:01] Speaker B: Yeah. So the case is a 46 year old female and the first visit was in November of 2024 here.
So her chief complaint is hot flashes and she has a very peculiar presentation of neuropathy that occurs in her hands and her feet, particularly after she goes to bed at night.
So she feels tingling and strange sensations in her hands and feet at night.
She also had her second child in May of that year. So close to seven months before. Yeah, seven. About seven months prior.
[00:02:47] Speaker A: Okay. And how old's the patient?
[00:02:49] Speaker B: Patient is 46.
[00:02:51] Speaker A: Got it. Okay.
[00:02:53] Speaker B: So a month or two. So this is the history. A month or two after the pregnancy, she experienced first pain in the left shoulder that was. She wasn't sure what it was related to. It wasn't obviously connected to. And an acute injury situation.
Then she started to experience tingling in the extremities, particularly in the hands.
And this does actually occur sometimes during the day, but most frequently at night is when she experiences it. She's noticed that it gets worse if she eats chocolate, drinks wine, or is stressed.
[00:03:36] Speaker A: Okay.
[00:03:37] Speaker B: And bowel movements can be sticky, slightly loose, or sometimes she can skip a day.
Her temperature is. She generally feels warm. She especially feels warm at night, but she has a preference for heat.
[00:03:54] Speaker A: So a history of being cold natured.
[00:03:57] Speaker B: Yes.
[00:03:57] Speaker A: But now she's got these hot symptoms. Okay.
[00:04:01] Speaker B: But she also prefers warmth, which is kind of interesting.
[00:04:04] Speaker A: Right. Even still. Even with the.
[00:04:06] Speaker B: Even with the hot flashes. Yeah, the general. The hot flashes and the elevated temperature, she generally prefers to be warm.
[00:04:13] Speaker A: Okay.
[00:04:16] Speaker B: Her periods have generally been scanty and a little bit painful. She's had cramping. She has to take a medication at times to deal with the pain from the cramping.
She doesn't have palpitations, which is something I asked about.
Her sleep is actually pretty easy for her to fall asleep. She wakes up sometimes with the sensation. Right. That we talked about, the neuropathy, the tingling.
But she doesn't get enough sleep. She's like, I got to get up, take care of my kids, and, you know, that kind of thing.
[00:04:50] Speaker A: Yeah.
[00:04:50] Speaker B: She says, I sleep fine. I just don't sleep enough. That kind of thing.
[00:04:53] Speaker A: Okay.
[00:04:55] Speaker B: And she has hot flashes several times per day. She notices it.
I was like, how many times has it happened per day? And she's like, somewhere between 5 and 10.
Seems to be happening.
[00:05:08] Speaker A: I was like, okay.
[00:05:11] Speaker B: I checked the abdomen. The abdomen had a cold. The skin was noticeably cooler in the epigastric region, but was not necessarily painful at all. When I pressed in, there was a little bit of what we call recu. The rectus abdominis tension, which is a. I think of it as a wet type req, which I can talk about that. It's just how the rectus abdominal tension presents.
And then below the umbilicus, there was a lot of lax skin, very soft and very easy to press deeply. Right. Which I associate with lower jowl deficiency.
[00:05:53] Speaker A: So the abdominal muscular tension was above the umbilicus. Yeah, yeah. And so once you sort of reached umbilical level and went below, it got soft yeah, Describe that. The, the difference there between like a dry versus a damp presentation in the palpation.
[00:06:11] Speaker B: Right. So you can have kind of two const. If we just say constitutional types are two instead of the five phase or six confirmation, whatever.
Just the two. A damp person and a dry person. Right. A dry person will tend to be more thin and wiry and will tend to have obvious. You'll be able to feel the breadth of the muscle in the abdomen, so you'll be able to feel the rectus abdominis fully. Right. With a damp type person, the skin will be softer and the parts of the Reiki that you feel will feel like little knots of very tiny knots, maybe the size of a pebble or something underneath the skin. And if you're palpating carefully, you'll be like, what is that? But it's actually just, it's still the rectus abdominis. It's still little dry spots in that muscle. It's just you can't feel the whole breadth of the muscle like you can in a dry type person. Okay, so then the difference would be like, okay, well, you can have somebody who's dry and, and then has dryness in the muscle layer. Right. That's an obvious correlation. But you can also, as it turns out, have somebody who's damp and has dryness in the muscle layer. And that would be like to, to pull up a formula real quick that would, would make sense. There would be like a Dong Wei Xiaoyao san where you're using Bai Shao at a very high dose, Xiaoya at a high dose, you're using Dongui.
But you also have fooling and Baiju and Zixie and you know, so you have these compounding factors where you're nourishing on some way, the, the, let's say the nutritive aspects of the muscle layer. But you're also helping the body to transform dampness and water that's accumulating.
[00:08:06] Speaker A: Sure.
[00:08:07] Speaker B: Yep.
[00:08:07] Speaker A: And so that, because this is the, the tricky thing about our medicine sometimes is that, you know, we say damp person, dry person. Yeah, but, but of course, it so rarely presents with such clear lines.
[00:08:18] Speaker B: Sure.
[00:08:19] Speaker A: You have a damp person who's got dry muscles.
[00:08:21] Speaker B: Sure.
[00:08:21] Speaker A: And you're like, what's that about?
[00:08:23] Speaker B: Yeah, well, and if you have a, let's say a problem metabolizing fluids or dampness, you could easily see how dryness could be created. Right. Because if it's not being nutritionally transformed, then it becomes not useful. But then the part of the body that needs that nutritional supplementation also, it isn't getting there. Right.
It's out of right relationship.
[00:08:48] Speaker A: Yeah. I think actually when you look at the way that people who carry a lot of dampness, the way that it manifests, there's actually almost always a significant amount of dryness in various parts of the body.
[00:08:58] Speaker B: Yeah, it's pretty common.
[00:08:59] Speaker A: And it's because the damp that's accumulating is accumulating because it's not being processed and disseminated. It's sort of like collected in this weird warehouses in your body, causing trouble when it should have been metabolized, processed and applied to some other layer in the system.
So if you come across people who, you know, they've got dry skin stuff or like thinning hair stuff or things that are like. But you're so damp, why is this happening? That's why the damp isn't making it where it needs to go.
Okay, so this is the finding. So for this patient, you found which type of the riku again, the damp one or the dry one?
[00:09:37] Speaker B: The damp one.
[00:09:38] Speaker A: The damp one. Okay.
[00:09:39] Speaker B: And the last detail in the abdomen is a slight amount of pulsations of the abdominal aorta kind of around where the cold feeling is in the skin, like in the epigastric zone. Actually in this patient, it's a little bit below what we would call the epigastric zone, but it's kind of like CV between CV 12 and 14 if we were to label it with acupuncture points, you know.
[00:10:03] Speaker A: Yeah, yeah. So right on the right on the like distal edge of epigastrium.
[00:10:08] Speaker B: Yep.
[00:10:08] Speaker A: Okay.
Okay. So with all those findings.
[00:10:12] Speaker B: Yeah. So I decided to give Guizhou Ren shentong, which is again the formula Li Zhongwan with wager.
And then the Jergan Sao dose goes up to 12 instead of being at 9. So it's Guager 12, Ren Shen 9, Baijiu 9.
Let's see, Zhigancao 12 and Ganjiang 9.
[00:10:35] Speaker A: Right.
[00:10:37] Speaker B: So I did that for 14 days, 8 grams twice a day and granule. So just, just that formula, no modifications. And I wanted to talk about this because the pattern of that versus the pattern of Xiao Zhen Zhongtang looks very similar.
Right.
It's also a wager formula. It can also present very similarly in the abdomen.
And so I decided because of the general constitution of the patient trending more as a wet type or a damp type, to do the Guizhu Ren Chantang method instead of the Zhenjong Tong method, which would be more for a dry type Person.
[00:11:18] Speaker A: Right, yeah. So when we were laying out the. The theoretical components for menopause, we kind of created this hierarchy, so to speak. Right. Of like Qi movement problem, blood movement problem, middle jaw problem, blood deficiency problem.
So based on your findings with this patient, you didn't find a need to move Qi or move blood intrinsically, is that right?
[00:11:44] Speaker B: Yep.
[00:11:44] Speaker A: And that's because you didn't see some of the signs that we talked about before.
[00:11:48] Speaker B: Absolutely. Yeah. Yeah. That like, so if, if there was a need to move Qi, we would see more costal tension and discomfort when I pressed under the rib side. Right, right.
There would be more physical discomfort even when I pressed into the epigastrium, you know, so that could be the Qi showing up in the abdomen. There would be different symptoms. There could be the tendency to. With hot flashes, it's a little tough to tell because people are generally alternating hot and cold.
[00:12:19] Speaker A: Sure.
[00:12:19] Speaker B: Right. So that part can be a little bit nuanced. But.
But the other piece is strange taste in the mouth, the person gets dizzy, or any of the other symptoms we associate with a Xiaoyang presentation aren't really there in this case.
[00:12:33] Speaker A: Yeah.
[00:12:34] Speaker B: You know, so no need to move Qi, the blood.
There's no hard oketsu finding in the lower abdomen.
I didn't mark it down here, but the. I did look at the tongue at some point, and the tongue didn't have the engorged sublinguals.
[00:12:50] Speaker A: Right.
[00:12:51] Speaker B: So there's. I'm not finding any need to really move the blood in a big way either, you know, which could be a little surprising in a case like this, you know.
[00:13:01] Speaker A: Well, and I mean, you're going to this, you know, the Guizhou Rentian formula. But of course, that's a warming formula. Li Zhong Wan plus Guiji.
[00:13:09] Speaker B: Right.
[00:13:09] Speaker A: Which is of course like warming and moving. And I mean, it doesn't move the blood in the way that, you know, Tauren moves the blood.
[00:13:15] Speaker B: Right.
[00:13:15] Speaker A: But there is a kind of passive tonification to blood movement by swarming and working in that space.
[00:13:22] Speaker B: Yeah.
[00:13:22] Speaker A: Plus, you know, Guager's red and that fun Dr. Jeff signature stuff. So basically in your evaluation, you could tell like, oh, we don't need to do anything with Qi. We take a look at the blood. Doesn't seem like we need to move anything directly with the blood. So we go to the next layer, which is this middle Jiao function piece. And that's basically. That's where you start.
[00:13:41] Speaker B: That's where. Yep, that's where I started.
[00:13:43] Speaker A: Okay. So she took it for two weeks Yep. And then what did we get?
[00:13:49] Speaker B: So the two week mark. So I have down. She finished bleeding yesterday. So her menses, her period ended yesterday. Pain was not as bad this time, so pain had an improvement.
The bleeding was a bit heavier, actually.
Clots, some clots, big and small.
Neuropathy has in general been much better over the last couple of weeks. She didn't experience any the week prior to menses, but after bleeding some has returned. It's still better than before.
[00:14:23] Speaker A: What did you make of the neuropathy itself? What do you think's going on there?
[00:14:26] Speaker B: So I think the neuropathy is related to blood deficiency.
And because the circulation is slowing down at night.
Right. The blood is moving less at night. And if the blood is already deficient, then it's not able to circulate and nourish the tissues in the extremity in the same way. So the channels aren't being properly opened, you know, with the lack of resources there.
[00:14:51] Speaker A: So then tingling and numbness.
[00:14:53] Speaker B: The tingling and numbness is related to that.
[00:14:55] Speaker A: Got it. Okay.
So stuff's better after two weeks, but still obviously present.
[00:15:02] Speaker B: Still obviously present.
[00:15:03] Speaker A: So what's the move?
[00:15:04] Speaker B: So I checked the abdomen again. I found pretty much the same thing, but to me the Riku was a lot more discernible this time. So it was more prominent. I felt more spots, which again shows the muscle layer dryness piece. So I actually switched to Dong Wei Zhenjongtang. So I actually used the Zhenjongtang principle second after the. After doing Guijer and Shentong.
[00:15:32] Speaker A: And that's because you didn't feel like the first one was moistening the layer, the muscle layer. Enough.
[00:15:37] Speaker B: Yeah.
[00:15:38] Speaker A: So even though she's got this sort of constitutionally damp presentation, you go for that move.
It seems to nourish a little bit, but not enough. And the muscle layer feels maybe even more dry than before. Right, so you shift more toward the dry approach.
[00:15:55] Speaker B: Yes.
[00:15:55] Speaker A: Because it's going to be more moistening to the muscle layer. Yep. Okay. Dosage.
[00:16:00] Speaker B: Yeah, I did again, I did eight twice a day. And then let me look at the next.
Yeah, Basically two weeks. Again, two weeks until the next appointment.
[00:16:11] Speaker A: Okay.
[00:16:12] Speaker B: So at the next appointment she came back in and basically since the previous appointment, since she started taking the new formula, she had no neuropathy symptoms.
And I don't think we mentioned the hot flashes actually, which is kind of one of the points. Hot flashes were much better after the first one. After the first one, yeah.
[00:16:34] Speaker A: Yeah. So I mean, stuff in general was better, but the hot flashes Were distinctly better.
[00:16:38] Speaker B: Yes. Yeah.
[00:16:39] Speaker A: Okay.
[00:16:41] Speaker B: So at this point, basically both symptoms stopped. The hot flashes she hadn't experienced in at least a week.
[00:16:49] Speaker A: Okay.
[00:16:50] Speaker B: And the neuropathy hadn't occurred since the previous appointment. So like two weeks, the neuropathy got better faster. And the hot flashes seem to get better, you know, a little bit later, but. But still better.
[00:17:06] Speaker A: I'm interested by that, by that shift, because it sounds like the first formula that you gave. Right. It. It obviously was still focused on nourishing the muscle layer.
[00:17:16] Speaker B: Yeah.
[00:17:18] Speaker A: And the. And that nourishment, which you hypothesized was the lack of that nourishment was why she was having the neuropathy.
[00:17:25] Speaker B: Yep.
[00:17:25] Speaker A: That she's getting nourished from the first two weeks of the formula because, like to start taking the next formula for like a day or two and all of a sudden neuropathy just goes away. That wasn't just because you switched to that formula, Right.
[00:17:36] Speaker B: It was already trending?
[00:17:37] Speaker A: Well, yeah, like the, the moistening was already happening and here we just turned up the moistening more rapidly, I think also too.
[00:17:46] Speaker B: This was the day after bleeding finished. So if you have a blood deficiency person who then goes through the bleeding process, the symptoms that we associate with blood deficiency are worse. During the bleeding.
It may just take a few days for the body to recover the blood loss and the symptoms get better.
[00:18:07] Speaker A: The cycle point is changing. So now the body's going back into build and construct and nourish and accumulate. So it's also like trend wise in terms of the menstrual cycles, different sections. It's a good spot to grab it because you're actually on the building and nourishing side. That's a great spot to transition the formula to be more nourishing. Lean into the natural curve that the body's on.
[00:18:29] Speaker B: Yes.
[00:18:30] Speaker A: Okay. So at the end of the second two weeks, the neuropathy's gone.
So she hasn't had it at all.
[00:18:37] Speaker B: Right.
[00:18:37] Speaker A: That's great. And the hot flashes are also gone.
[00:18:40] Speaker B: They're also gone.
[00:18:41] Speaker A: Completely gone.
[00:18:41] Speaker B: Completely gone.
[00:18:42] Speaker A: Wow.
[00:18:43] Speaker B: Yeah. For at least a week.
[00:18:45] Speaker A: The.
[00:18:45] Speaker B: The second week. Yeah. Was really when they. They sort of stopped.
Yeah. According to the patient's report.
[00:18:52] Speaker A: Okay, so then what then.
[00:18:55] Speaker B: So I stayed the course. You know, I didn't feel like anything major needed to change. I found pretty much the same thing on the objective findings. The symptoms are getting better. The objective findings are very similar.
So I basically stayed the course. And we did that for about another month. Okay. And then at that point, the patient had still had no return of the hot flashes and the, the neuropathy had not come back.
[00:19:22] Speaker A: Okay.
[00:19:23] Speaker B: So she, we ended up concluding treatment at that point with the understanding that like, okay, if something comes up in the future, come back in, you know.
[00:19:33] Speaker A: Yeah.
[00:19:35] Speaker B: So then we fast forward to almost, let's see, this is almost eight months later, eight months after this. Okay. So the patient comes back in and this is at the end actually of this summer. So at the end of this summer she comes back in and she said that for most of the time the hot flashes, the most of the time in between the appointments, the hot flashes in the neuropathy had completely gone away.
But within the last couple of weeks of the summer they started to return.
[00:20:15] Speaker A: Okay, so how, how long again between when you saw her and things were great and when she came back in?
[00:20:20] Speaker B: It's about eight months.
[00:20:21] Speaker A: Eight months?
[00:20:22] Speaker B: Yeah.
[00:20:22] Speaker A: So the majority of the year.
[00:20:24] Speaker B: The majority of the year.
[00:20:25] Speaker A: So of that eight month period, most of the symptoms are completely abated.
[00:20:29] Speaker B: Yeah.
[00:20:30] Speaker A: But then in the last two, three weeks they've come back.
[00:20:32] Speaker B: They've come back. Yep.
[00:20:33] Speaker A: Okay.
[00:20:33] Speaker B: And not as bad as before, but they started to come back and she's like, oh, I gotta get back in, we gotta start working on this, I don't want it to get worse. Right.
So she comes back in and she. Oh this, this is important too. She described the summer to be extremely demanding and stressful.
[00:20:54] Speaker A: Yep.
[00:20:55] Speaker B: I recorded a quote here, I don't have one second to think.
And she came back in actually after her first child is back in school. So she has a little more time and space because during the summer both of the kids are home. Right now it's just the little one that's home. And so she has a little more time and space for herself, coincidentally decides to come back in to get treatment.
So in this case I assessed things and I found pretty similar situation to what I found before.
There was noticeable recue on the abdomen, there was pulsations kind of between maybe we'll say CV13.
[00:21:46] Speaker A: Sure.
[00:21:47] Speaker B: It's not, maybe not that specific, but good old 13. Sure.
[00:21:52] Speaker A: Use that one all the time.
[00:21:53] Speaker B: Sure.
When she came back in this time, I didn't feel a cold feeling on the skin in that particular place, but I did feel, it was more striking to me the vacancy that I felt in the integrity of the tissue below the umbilicus. And there was a little bit of a cold feeling down there actually.
So I basically the formula I gave her was Huang Qi Zhen zhongtang and then I added in Fuci.
[00:22:30] Speaker A: Okay, so maybe why don't you explain why that formula? And then I want to talk a little bit about the timing of the case.
[00:22:39] Speaker B: Yeah.
So that formula in the Jingwei, so we kind of have three Zhen Zhongtang formulas that we think about. There's Xiao Zhen Zhongtang, which is the standard one.
[00:22:53] Speaker A: Right.
[00:22:54] Speaker B: We have Dang Guijian Zhongtang, which is introduced first, actually, by Sun Simiao. That's not a Zhan Zhongjing formula necessarily, but it's very close.
And Dang Gui Zhenzhongtang is introduced specifically for postpartum insufficiency.
[00:23:11] Speaker A: Okay.
[00:23:11] Speaker B: So blood deficiency Qi deficiency after, in postpartum.
And then you have Huang Qi Zhen Zhongtang, which Zhang Zhongjing says, for all types of insufficiency, use Huang Qi Zhen Zhongtang. So it's just like if there's deficiency, use this. If there's more deficiency, use Huang qijenzhongtang.
[00:23:31] Speaker A: Got it.
[00:23:31] Speaker B: Right.
I'm also thinking a little bit about the neuropathy at this stage being close to the one formula where numbness is mentioned in the Jinggui is Huang Xi Guizhi Wu Wu Tong, which is another modification of Guizhi Tong.
And so I'm thinking about sort of leaning in that direction. Like, I want to supplement the deficiency. I want to tonify more, but I want to tonify with a little bit of the Huang Qi method because.
Because of the neuropathy piece, I'm thinking about that more specifically this time.
So that's what makes me lean toward Huang Qi Zhen Zhongtang as opposed to just Xiao Zhen Zhongtang or Dongwui.
[00:24:19] Speaker A: Is there something particular about Huang Qi as an herb that is connected to the neuropathy symptoms as you see it? Like, what about Huang Qi?
[00:24:28] Speaker B: It's a good question. I don't know.
It's in a lot of approaches to treat arthritis and neuropathy.
But Huangchi is, I'll admit, one herb that I don't understand that well. I'm still working on my understanding of it. I think the way that I think about it currently is that it's a sweet flavored herb.
So it's a tonifying herb, but it has a kind of lifting property to it that allows to, let's say, assists in the distribution of resources to the periphery.
So if there's a peripheral problem, a symptom, an insufficiency or deficiency. Right. Then Huang Chi is a useful herb to use in this case.
I also took the story to be sort of an indication that the patient has been over sweating.
So if I'm working too hard and it's the end of the summertime, it's been warmer, the patient's been sweating, and it just so happens that the symptoms have come back.
Right. So in the Shanghan Lun, there's all kinds of discussions of how someone damages their body by over sweating. Yeah, right. Sometimes it's through improper treatment or whatever, but over sweating is a big issue. So I'm thinking of the overwork, the over sweating as a taxation that's relevant to the oncoming set of the symptoms coming back.
[00:25:58] Speaker A: So then sweet flavor from Huang Chi to tonify that resultant deficiency.
[00:26:03] Speaker B: Yes.
[00:26:03] Speaker A: And then the mystery of Huang Chi's uplifting quality and the other way that it works. Yeah. And this is something you and I have talked about, you know, offline many times, which is just that Wang Chi, it's mysterious. I mean, places where like really famous formulas we talk about a lot, like Bujong Ichitang.
[00:26:20] Speaker B: Yeah.
[00:26:21] Speaker A: You know, Huangchi is a major player in that, in that formula. And you know, you give it and you can get it to work. But it's like, how exactly is this herb playing into it? Yeah, it is a little bit mysterious.
I'm very interested in the seasonality of how this played out.
[00:26:36] Speaker B: Yeah.
[00:26:36] Speaker A: Because basically you would have been initially nourishing her enough in mid winter, sort of November, December, which is the ideal time for restoration and nourishment. Right. That is the time for warming, internal building up fluids, all that kind of stuff. Right.
And then it works. So, you know, in, in the seasonal cycle, the curve of things is toward restoration and rest in general and the building up of things that are deficient.
So you give a formula who. Whose pattern is oriented that way, moistening and building, and then, man, it works like gangbusters. It takes off and things are doing really well. And then her body takes over that work after the formula is done because it's the time of the year for it. So of course it makes sense that that is what's happening. Right.
And then she goes through the rest of the year, goes through the spring, goes through the summer, as a mom of young kids and is just busy.
[00:27:46] Speaker B: Right.
[00:27:46] Speaker A: And doing stuff all the time. All the time, all the time. And so even though summer is the time for doing so, it makes sense that you should be doing stuff. Then it also means that there isn't the same level of restoration in a body that already had a tendency to being depleted 100%. So then you get to the end of the season of doing in a body with a tendency toward depletion, who hasn't had enough time to restore during the time of doing?
And all of a sudden the symptoms that are fundamentally related to being depleted.
[00:28:14] Speaker B: Show back up, come back.
[00:28:16] Speaker A: Yeah.
[00:28:16] Speaker B: Yeah. And it's difficult because, you know, we work with people and like, the first part of this case is really great. Like, it's a. I couldn't have predicted that the result would have been that positive that quickly, you know.
[00:28:30] Speaker A: Sure.
[00:28:30] Speaker B: But.
But it was. And then treated for a little bit afterwards, maybe, you know, a month after, we got the hot flashes and the neuropathy symptoms away, and then the patient's like, what am I still doing? Yeah, why am I still here?
[00:28:48] Speaker A: You know, you did.
[00:28:49] Speaker B: You fixed me kind of thing.
[00:28:51] Speaker A: Yeah.
[00:28:51] Speaker B: And then you're like, well, should, you know, you. You kind of run this thing through, or at least I do. Where it's like, well, should they keep coming? Like, should they take stuff just to buffer the fact that it may come back later? Should we treat deeper? Like, what's the. What's the deal there? And I'll admit I'm still figuring that out.
But it's also hard to sell the patient on. No, you really need to keep taking herbs for, like, a long time.
Well, I mean, even though your symptoms.
[00:29:23] Speaker A: Are gone, In a perfect world, actually, though, their lifestyle would pick up the slack.
[00:29:30] Speaker B: Yeah, it's true.
[00:29:31] Speaker A: I think that's the problem. Right. So much of the work that we do is plugging holes in people's boats.
[00:29:36] Speaker B: Yeah.
[00:29:36] Speaker A: And those holes get put there by life, by the demands of their modern existence and stuff that people in a previous time or even, you know, modern people in different cultures might know about rest and restoration and seasonal change and stuff. Like, we just don't have those beats.
[00:29:52] Speaker B: Yeah.
[00:29:53] Speaker A: In. In American society. And so we end up in a situation where the solution. Because someone isn't actually going to go to bed earlier and get up later in the winter, and they aren't going to. Going to make sure to build in quiet, stare out the window time in the summer so that they can have the resources necessary to go, go, go, go. They're just going to burn the candle at both ends, and they're going to do it because as they see it, their life demands it, and there's not really any other way around it. And so our answer has been in wellness culture writ large, to supplement.
And in Chinese medicine, there's a million patent supplements you can buy. Of course, you can go to your local grocery store, especially Health food store, and there's whole aisles of every kind of everything you can take. You know, get your horny goat weed and your astragalus root and your whatever. You know what I mean? There's so much supplementation that goes in it, and then there's even, on the pharmacological side, people taking testosterone and estrogen and other hormones. Because the idea is that you're just worn down. Your life continues to wear you down. And there's not really, like, sometimes this is my struggle with it.
I want to recognize the reality of the fact that people live in the world we live in. We don't live in a perfect world. We don't even live in a marginally good world sometimes.
[00:31:12] Speaker B: Yeah.
[00:31:13] Speaker A: And so it's hard for Pete, you know, like, what are you supposed to do? You got to go to work, you got to feed your family, you got to bring them to school. Like, literally, what are you supposed to do? Just feel guilty about what you're not doing?
But then, on the other hand, part of me wonders if one of the reasons that we don't do better, quote, unquote, in this space is because we make room to do badly.
[00:31:34] Speaker B: Yeah.
[00:31:35] Speaker A: Right. And it's such a tension.
[00:31:37] Speaker B: Yeah.
[00:31:37] Speaker A: Because, you know, I don't think there's really much good in playing the blame game or the, like, moralizing the right choice, the wrong choice. I just, you know, that's a losing game.
But also, I really wonder if by just saying, like, yeah, look, you know, your life is really rough, your job is terrible, you're stuck, spouse doesn't help, and your kids are nightmares.
So here, just take this formula. It'll help you get through it.
[00:32:03] Speaker B: Sure.
[00:32:04] Speaker A: I think that's great. In the short term, let's give you some bandwidth so that you can maybe figure out how to sort through these things that are causing you the trouble. But the problem is these things are causing the trouble.
[00:32:15] Speaker B: Yeah.
[00:32:16] Speaker A: And I think it's hard to have that conversation with patients.
In this case, it's not so dramatic. Um, but it's clear that, like, in when we would have hoped was that the patient's life would have been able to support and continue to nourish her in such a way that she wouldn't need to come back.
[00:32:33] Speaker B: Yep.
[00:32:33] Speaker A: But on the other hand, I mean, she did get eight months out of feeling pretty good.
[00:32:37] Speaker B: Yeah.
[00:32:37] Speaker A: And then she came back to see you.
[00:32:39] Speaker B: Yep.
[00:32:39] Speaker A: You gave her a formula again.
[00:32:41] Speaker B: Yep.
[00:32:41] Speaker A: This time the Huang Qi Jiang chong. And then what happened?
[00:32:47] Speaker B: So this was maybe 10 days ago or something. Like that. So she came back a week later and the symptoms were doing way better, but they weren't completely gone. But on the pathway to resolution, once.
[00:33:01] Speaker A: Again, I mean, that's what we would expect. Yeah, Yeah. I mean, I see this with all kinds of. I mean, we're talking about in the context of menopause here. Right. But I see this in the context of ibs, where someone gets resolution, they're feeling great, and they might feel great for a year, 14 months, then they're getting some more frequent stool again, it's getting a little more urgent again.
And then fortunately, because they know how this looks and that we can help, they get in here before it's a real problem.
And then they'll take herbs for another six weeks.
[00:33:31] Speaker B: Yeah.
[00:33:32] Speaker A: And then they'll get another two years out of stuff. Yep. And if they continue to manage their stress, eat mostly cooked warm food, you know, do the lifestyle things that we were just talking about, then they need a readjustment less and less frequently.
[00:33:49] Speaker B: Yes.
[00:33:49] Speaker A: You know, and they can use their. Their lifestyle stuff to do it without us more and more. And I think that that's absolutely the same situation here with the menopause symptoms.
[00:33:59] Speaker B: Yeah.
I. I do want to say, for the sake of if. If you're just getting into herbs and you haven't.
You haven't done this very much, doing six weeks of herbs and maybe even less, I have to go through and check this out. And expecting that the hot flashes that somebody has are just going to go away completely is probably not realistic. You're going to need a lot longer and you're going to be looking at like, oh, it's better, they're less intense. When they. I was sweating before, and now I'm not sweating.
And they're happening three times a day instead of like, basically every 15 minutes. You know, it's like going to be more like that.
[00:34:40] Speaker A: Yeah.
[00:34:40] Speaker B: And then eventually you can get the. You can usually get them to a place where it's either not occurring or it's occurring very rarely.
And that's pretty. Pretty dang good.
[00:34:51] Speaker A: Yeah. Because, I mean, this patient is exceptional. Right.
[00:34:53] Speaker B: This patient is.
[00:34:54] Speaker A: Basically gave her four weeks of herbs and then the hot flashes went away.
[00:34:56] Speaker B: Right.
And this is a perimenopausal person, not a menopausal person, which is important.
[00:35:01] Speaker A: All the more reason, though, to catch.
[00:35:03] Speaker B: It early to do it now. Yeah, exactly.
[00:35:06] Speaker A: This to be the pattern of like, oh, I've had these hot flashes for the last year and a half. They're entrenched like don't wait. It just gets worse.
I think that point you made just there, though, about how symptoms abate is a really important one. And I think it's by and large true for almost any kind of chronic condition, which is that the symptoms don't. It's not like an on, off switch.
[00:35:27] Speaker B: Right.
[00:35:27] Speaker A: It's not like, oh, I'm having 12 bowel movements a day and now I'm good. Yep. Like, that's never how it goes.
[00:35:34] Speaker B: Right.
[00:35:34] Speaker A: It's always a retreat of symptoms in frequency and. And severity. Frequency and severity in some capacity, you know, and it's not always the same.
Right. Like someone might, you know, they're having, you know, five, six hot flashes an hour and they're super hot. Like they're sweating to take their shirt off.
That could go to. Well, I'm actually still having five an hour. But they're. They're just warm.
[00:36:00] Speaker B: Sure.
[00:36:01] Speaker A: I don't even take my shirt off. Yep. Or it can go from. They're still crazy hot, but they're only two an hour.
[00:36:05] Speaker B: Right.
[00:36:07] Speaker A: Or you get both. Or it's only two an hour now and they're less hot. That's great.
[00:36:10] Speaker B: Yep.
[00:36:11] Speaker A: And then the next stage of it, it's like, well, they're actually still the same level of hot, but I'm only actually having them like once a day.
[00:36:17] Speaker B: Yeah.
[00:36:18] Speaker A: But they're still pretty hot. Like, it's. I think it's almost impossible and probably not useful to try and predict exactly which way it will peel back. But it's important for the patient to know that that is the progress, that's the trackable progress, is like, oh, it was this very specific way we did all our measurables. We have a baseline. And now it's getting better, either in frequency, how often it's happening or severity, how badly it's happening, and some combination of the two. But it's very, very rarely. Almost never on, off.
[00:36:50] Speaker B: Right.
Yeah.
[00:36:52] Speaker A: And I think it's really worth explaining this to patients, by the way, for new herbalists that are out there. Like when you're talking about when you're building treatment plan with someone and you're like, okay, this is what I think is going on.
This is what our initial herbal intervention is going to look like.
Probably you're talking in the realm of at least eight weeks for a chronic condition. This is how much time a patient should anticipate. Not a solution, not a complete resolution. But this is eight weeks is how we'll know if this is working.
[00:37:18] Speaker B: Yeah.
[00:37:19] Speaker A: Like, if we're a Good match. If I can understand your case, if your body responds in the way that I think it ought to, and if this type of intervention even jives with you, like we get people all the time, never taken herbs before and then they can't.
[00:37:33] Speaker B: Right.
[00:37:33] Speaker A: Some people just, they just can't. They're like, I can't do it, I can't drink them. I don't like the way they taste or I can't remember or whatever. And if that's the case, well, yeah, no harm, no foul. This just isn't for you. Like the medicine we have, you gotta drink. Yep. And if you can't drink it, we can't do anything. We can't help you. And so you know. But you don't know that like people come in and they're like, oh, it'll be totally fine, I can do it, it's no problem. And then they do it and they can't. So that initial, when you're describing that whole initial treatment plan, it's worth describing or giving people an idea based on the specific case in front of you, how they might anticipate their symptoms abating.
[00:38:09] Speaker B: Yes.
[00:38:09] Speaker A: And if you can give them a sense that it happens in pieces like that, this severity, frequency thing, in my experience at least you get a lot more long term buy in because people are looking at their case going like, oh no, things are better. Yeah, I still have hot flashes. But like, it's definitely better.
And that's really, that's important for buy in.
[00:38:27] Speaker B: And you always have the most available buy in pretty much almost the first session. Like people are the most open, they have the most variability with expectations. Right. They're not expecting it to go a certain way or have to do a certain thing yet. And so you want to use that to your advantage to craft the space of the treatment and the process so that it's going to line up with what you need as far as time and space to work with the patient for them to get better.
[00:38:59] Speaker A: Yeah, exactly. If the, if the patient thinks it's going to go too fast or faster than it, it will, then you're gonna have problems with buy in in the long run.
[00:39:07] Speaker B: Yeah.
[00:39:08] Speaker A: I've even had this problem with patients who I've seen for, you know, condition, you know, a.
And we had it kind of like with this patient which it just went so well.
[00:39:18] Speaker B: Yeah.
[00:39:18] Speaker A: Problem solved in like four weeks. Yep. They're feeling like a million bucks and then they come in for another condition later, completely separate one. Cause they're like, oh, this works so well. For my, whatever, my heartburn. So I'm gonna come in for insomnia and we don't knock it out in four weeks.
And it's important. And you know, I'm always telling people the same thing. Like even people who have been in before, it's like, hey, this is insomnia. You've had it your whole life. It's probably going to take us 812 weeks to like figure this out. And then you might be taking herbs for a long time after that. And they're hearing me, but also they remember the last time I told them that it got fixed in four weeks.
And so then when we get to the four week mark, they're like, I don't know if these are, I don't know if these herbs are doing it.
[00:40:00] Speaker B: I know.
[00:40:01] Speaker A: And you have to be like, no, you're good man. Like you're still making progress. Remember how we said this is probably 8 to 12 before we make an evaluation? But it can be real tough because people like, they got such good lift out of one condition in one round that they're hoping it's going to go that way every time.
[00:40:17] Speaker B: Yeah.
One of my herbal instructors told me this story of bringing one of his patients to his teacher.
And the patient arrived to the clinic with the teacher's teacher. With my teacher's teacher, I guess, and said, you know, I'm really struggling, I'm glad I'm here. And I'm just, I'm not getting very much benefit from the treatment.
And you know, this guy was like, oh, well great, you know, you're here, we're going to take a look at you, we're going to assess things and we'll will set you straight, you know. So he does the assessment and, and then just going through the case history a little bit verbally and the patient was like 40% better from a rheumatoid arthritis chief complaint in like two months.
And so, so he turns to this, this student and he's like, you gotta work on talking to your patients better about this stuff. Like 40% for an issue that this person has had for decades.
[00:41:23] Speaker A: Yeah.
[00:41:23] Speaker B: In two months is a big deal.
[00:41:25] Speaker A: And that the biomeds say there is no solution for.
[00:41:28] Speaker B: Right.
[00:41:28] Speaker A: Like you can just take these various steroid medications and biologics and maybe it'll feel better.
You know that, that rheumatoid arthritis is a great example. That's like a, that's a curse disease from a biomed point of view. Right. Like whoop, whomp, whomp, short straw. You're out of luck. You're just gonna hurt. There's not much you can do about it. So. Yeah. A 40% improvement in two months for a lifelong diagnosis. That's a good point. That's a good point to remember, though, is that it's. You got it. You got to remind patients.
[00:41:57] Speaker B: Yes.
[00:41:57] Speaker A: Of when things are going well.
[00:41:59] Speaker B: Right.
[00:42:00] Speaker A: And I don't mean, like, selling them on stuff. That's not true.
[00:42:02] Speaker B: No, no, no.
[00:42:03] Speaker A: Like, you're not trying to, like, make a mountain out of a molehill of, like, oh, I mean, maybe my stools are better. Like, no, no, no. Like, ask them the questions, they report it back to you. And this is why it's important to have measurables. Like, in the case that we're talking about here with hot flashes, it's like, okay, I'm having hot flashes. Okay. How often?
[00:42:21] Speaker B: How often? Yeah.
[00:42:22] Speaker A: I'm not really sure. Well, I want you to think about it, right? Like, start paying attention.
[00:42:26] Speaker B: Are they daily?
[00:42:27] Speaker A: Yeah.
[00:42:27] Speaker B: Are they hourly? Are they happening a few times every couple of minutes? Like, you got to get some parameters.
[00:42:34] Speaker A: How strong are they?
[00:42:35] Speaker B: Stronger.
[00:42:35] Speaker A: I don't know. They're very hot. Like, so hot you start sweating immediately. You need to. You need to change your clothes. You stand in front of a fan. Like, what? Let's get some terms in here.
[00:42:45] Speaker B: Yes.
[00:42:46] Speaker A: Because then you. If you don't do that, then you don't have any points of comparison. And somebody says, like, I don't know. I'm still having hot flashes. And I say, well, has a severity change. Well, we didn't establish a baseline to start.
[00:42:56] Speaker B: Right.
[00:42:56] Speaker A: And now we don't have anything to compare it to.
[00:42:58] Speaker B: Right.
[00:42:58] Speaker A: Maybe they're, like, a million times better, but the patient's just not plugged into it. So, you know, again, don't. You don't make stuff up. But it's. It's incredibly important to just. And I. When I say remind the patient, I'm not like, hey, let me. Let me point out, this is actually a lot better. It's a little Socratic. Right. Like, they say it, and then I'm literally looking at my chart, and I was like, well, actually, you know, when you first came in here, it looks like. Let me see here. Yeah. It looks like the hot flashes were actually, you know, six, eight times an hour.
[00:43:27] Speaker B: Yeah.
[00:43:27] Speaker A: And you were having to stand in front of a fan. So where is it now?
Like, oh, well, I think it's not even every hour, so. Yeah, I guess that's better. Like, because that's the thing is I'm just restating what's in my chart as a real question. I do actually want to know. This is what you told me. Where is it now? And if they're like, oh, it's actually, wow, it is better, they can suddenly realize it, even though of course, they've been living in their body the whole time, but they didn't notice.
[00:43:56] Speaker B: It's very rare that somebody is neutral with their perspective on their own health.
Usually people skew things positively or skew things negatively. It's our job as practitioners to figure out what is it really like? What's, are they really getting better?
And that's why parameters, objective things can be really helpful. Objective findings, Yeah.
[00:44:23] Speaker A: I mean, abdominal stuff, pulse checks, tongue over time. If you're doing long term stuff, tongue is helpful and being able to really compare it. I think you're right. It matters a lot.
Just to make sure that you and the patient are on the same page about how this treatment is improving. Because it's time consuming, it's expensive, you want to make sure that it's valuable.
[00:44:41] Speaker B: Yes.
[00:44:42] Speaker A: Cool.
All right, well, thanks everybody for joining us in a little case study conversation on menopause and some ongoing suggestions about how it's helpful to set parameters for your patients so that they know and you know that they're getting better.
As always, if you guys have suggestions for show topics, send them over to us@thenervous herbalist gmail.com thenervous herbalistmail.com and if you're listening to the show, we'd really appreciate a rate and a review. Wherever you're listening to it, it helps other people find us. And as always, we enjoy chatting with you. So I'm Travis Kern.
[00:45:17] Speaker B: I'm Travis Cunningham.
[00:45:18] Speaker A: And we'll catch you next time.
[00:45:20] Speaker B: Catch you next.
