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.
[00:00:24] Speaker B: Here with Travis Cunningham.
[00:00:26] Speaker A: And we're going to talk to you guys today about menopause.
Menopause is the subject of discussion.
You know, Travis Cunningham and I, we are, we're not women's health specialists, but menopause and other menstrual conditions and sort of women's health conditions come into the clinic by default. So even though we.
[00:00:48] Speaker B: Right.
[00:00:48] Speaker A: We're not a fertility or pregnancy specialists, we still see this. It comes into our clinic or when we're working with patients for other conditions over many years and time. We'll see dysmenorrhea patterns, we'll see menstrual irregularities, and then depending on the age of some of our patients, we could just as easily find ourselves dealing with menopause symptoms. So we wanted to take some time to talk with you folks about how we deal with it and the things that we use to get into it. So T, why don't you layout for the listening audience like when people think of menopause, the symptoms and the various sort of stereotypical things like hot flashes and stuff, what are all of these things telling us about a body? Like what aspects of a body are being affected when we see those symptoms?
[00:01:35] Speaker B: Yeah. So the first thing that I think about with menopause is the health of the blood.
So is the blood healthy? Is it not healthy? To what degree is it healthy? We can talk about the different aspects of blood that make it healthy or not healthy. Right. Which is what the, a lot of this podcast will likely be about.
But that's the main thing. And then if that isn't healthy, when a female bodied person arrives at this part in their life and they go through the natural transition of menopause, they'll have more trouble with it, basically.
[00:02:14] Speaker A: Right.
So when we talk about healthy blood, I guess we're usually talking about, you know, is it dense and nourishing?
[00:02:23] Speaker B: Yep.
[00:02:24] Speaker A: Is it moving and is it warm?
[00:02:26] Speaker B: Yes.
[00:02:27] Speaker A: Which of course would be the very same questions we would ask in a younger female bodied person who was dealing with, say, menstrual irregularity or menstrual pain or any of those kinds of things.
We'd be asking similar questions about the quality of the blood. Yeah, right. Is it nourishing? Is it Warm. Does it move?
So, I mean, if you're gonna try and break down those aspects of the blood, I guess we'd have to do it based on the kinds of symptoms that we're seeing and then which parts of the blood are contributing to those symptoms.
So classic menopause symptoms. Of course, I think the one that immediately comes to mind for most people is hot flashes.
[00:03:07] Speaker B: Right.
[00:03:09] Speaker A: But of course, there's other things that we see. Right. We'll see swelling in the feet and hands. We'll see bloating and digestive discomfort, emotional fluctuation, insomnia, various types of sweating, even pain conditions, joint pain, lower abdominal pain. There can be a whole host of things that come out of that. So why don't we think about these three aspects of the blood, but let's put them into diagnostic criteria. So if you're evaluating a patient who's coming in with some iteration of menopausal symptoms, what are the aspects that you are looking at from a diagnostic point of view? What are you looking for?
[00:03:49] Speaker B: Yeah, I mean, in some ways, you evaluate the case exactly the same way you would for any other case. Right. Which is going to sound. It's going to sound like we're, I don't know, saying the same thing over and over again, but.
[00:04:03] Speaker A: Or you're just. You're just quoting Dr. Greg Livingston.
[00:04:05] Speaker B: Yeah, it's just like I may sound like a broke, broken record.
[00:04:08] Speaker A: Just, you know, just bian Zeng this every time. Sorry, Greg, if you're listening, we love you.
Anyway, carry on.
[00:04:16] Speaker B: Yeah, but it's true if you're.
If you're evaluating somebody and they have. So this is how we've organized this, this podcast is. If there's a problem at one level that's more superficial and going to affect the blood, you have to treat it first. You can't treat the blood first if there's something superior. Superior to that.
[00:04:41] Speaker A: Right.
[00:04:41] Speaker B: More.
It's a little bit like the body's attention is not on the blood. So you can't do anything to the blood. You can only assist the body where it's already working to resolve a problem.
[00:04:53] Speaker A: Right. So we've got layers, basically, that we have to work.
[00:04:56] Speaker B: We have layers, but if there isn't something at a more superficial layer, there's no need to treat it, obviously.
[00:05:04] Speaker A: Right. You can see that.
[00:05:05] Speaker B: So then we can skip right ahead. Okay.
[00:05:08] Speaker A: So if we're thinking about movement of the blood, quality of the blood, warmth of the blood, I'm guessing then that organizationally then we need to look at Qi movement first.
[00:05:19] Speaker B: Right.
[00:05:20] Speaker A: Then blood movement next.
Then the ability of the body to make blood. So that's really like a middle jiao question.
[00:05:29] Speaker B: Correct.
[00:05:30] Speaker A: So middle jiao functionality, metabolism, absorption, ability to hold the blood.
Stuff we think of like, with spleen quality.
[00:05:38] Speaker B: Sure.
[00:05:39] Speaker A: And then the bottom layer would be the actual blood weakness itself.
[00:05:43] Speaker B: Yes.
[00:05:44] Speaker A: So on the top, so we have four layers. Qi movement, blood movement, middle jiao weakness. Blood weakness.
[00:05:49] Speaker B: Yep.
[00:05:49] Speaker A: The top two are on some level, kind of excess problems.
[00:05:54] Speaker B: Yes.
[00:05:55] Speaker A: Stuff stuck. And the bottom two are more deficiency problems.
[00:05:59] Speaker B: Correct.
[00:06:00] Speaker A: Okay, so let's just take it top down.
[00:06:02] Speaker B: Yeah.
[00:06:02] Speaker A: And let's start with. Okay, person comes in with, you know, menopausal symptoms, how are we deciding whether there's a chi movement problem? What's the breakdown?
[00:06:13] Speaker B: So one of the things that you might observe in clinic is if you're treating somebody for menopausal symptoms or perimenopausal symptoms, and they get sick, the symptoms get worse.
So why is that?
[00:06:29] Speaker A: Like they get a cold and flu, you mean?
[00:06:30] Speaker B: Yeah, they get a cold. The symptom, hot flashes get way worse.
Right.
[00:06:36] Speaker A: Is that because the. The exterior invasion is creating like a stagnant need?
[00:06:41] Speaker B: Yes.
[00:06:42] Speaker A: Yeah.
[00:06:43] Speaker B: So most people, when they get a cold in the modern times, they.
The body meets that issue in Xiaoyang. Right. Xiaoyang is what stagnates. So the ministerial fire flares. Now, they won't get hot flashes per se if there's nothing else going on. Right. Like, I don't get hot flashes if I get a cold. Right. So there has to be something else taking place for hot flashes to occur.
But we see in the lines for xiao cai hutong. Right. Ultimate alternating hot and cold.
[00:07:17] Speaker A: Yeah, I mean, I was gonna say like the cold hot thing that happened shivers and.
And fever is hot flash adjacent.
[00:07:25] Speaker B: Yeah, it is.
[00:07:26] Speaker A: For sure.
[00:07:26] Speaker B: It is hot flash adjacent. The thing is, it's usually not just that for hot flashes. If somebody's had hot flashes for a while, it's probably not going to just resolve by giving them xiao cai hutong. But you may need to start there.
[00:07:40] Speaker A: Because we need to deal with this harmonizing problem at the chi level.
[00:07:45] Speaker B: Correct. Because that's contributing to it. Let's say it's. There's a part of the body that's stuck there and it's creating 35% of the issue.
But you can't really touch the other 65% until you resolve that part.
And if you try, it's not really going to work. It's going to take a long time. They're not going to get much better. So you really got to address it progressionally. And if there is a problem up there, by helping the chi to move, you'll help the ministerial fire to flare less and then you can address the other pieces underneath.
[00:08:22] Speaker A: I mean, it's why, you know, there's a challenge in a layer model, you know, the, the warps and, you know, all the different terminology that we have for six. Six stages, six warps, six levels, six layers.
There's a real benefit to thinking about the, the body in a hierarchical way, particularly around the question of sort of depth. Right. Surface to organ. You know, there's like layers there. It's challenging, of course, I think, for a lot of listeners, because not everything moves progressionally. Like a disease can just pop into Tyene seemingly having either. It depends on, I guess, how you want to phrase it. Either it's passed rapidly through the other layers or it's just, I don't know, skipped ahead or something and entered at that particular point.
And I think it's the part that for a lot of people who are just getting into thinking about disease in that way, it's a real cognitive challenge because on the one hand, we lean heavily on this notion of like top down, like we're using in this episode. Right. You got to start up here at this, at this top layer and you got to resolve it before you can go deeper.
[00:09:26] Speaker B: Yeah.
[00:09:26] Speaker A: And there's a real sense that like, progression matters in terms of depth.
[00:09:31] Speaker B: Yeah.
[00:09:31] Speaker A: But then in other conditions, it's like all of a sudden, you know, a disease just shows up in this deeper layer and you're like, well, what the hell happened to the other layers? Like, did it just skip ahead?
I would say if you're thinking that to yourself as a listener, I don't know. Welcome to Chinese medicine. Right. Like, this is sort of how it goes. Like we, we try. The thing is, is that we are trying to apply not just Travis and I, but I mean, the medicine in general. The very accomplished doctors who came before us are trying to apply a reliable systematic process to something that is largely reliable and systematic, but also somewhat random.
[00:10:10] Speaker B: Sure.
[00:10:10] Speaker A: And so it's sort of like the best we can do with the reality that we're in. And in some circumstances, like menopause, a hierarchical, depth oriented way of thinking is really, really useful.
[00:10:24] Speaker B: Yeah.
[00:10:25] Speaker A: So if you find yourself listening, going, well, I just. It doesn't always seem to work like that.
That's correct. But in certain circumstances, like this one, it works really well.
So to stick within that image, then if we're stuck in the xiaoyang, so to speak, if the pivot door is broken. Right. And stuff's getting recycled back around and it's not flowing like it ought to, we have to start there before we go any deeper.
[00:10:52] Speaker B: Right. Yeah. And keep in mind too, that even in Chinese medicine, they say that there's three causes for disease. External contraction, internally generated disease, AKA disease of the seven emotions, and then disease that's neither internal nor external, which is the biggest category. Maybe that one includes deficiency taxation, which is a huge issue for this topic. We're going to cover deficiency taxation a lot when we get to blood weakness, because that's really, really important. Mm.
[00:11:26] Speaker A: Especially for modern people.
[00:11:27] Speaker B: For modern people. It's huge. Yeah.
[00:11:30] Speaker A: So I'm guessing if we have to deal in xiaoyang to start.
[00:11:33] Speaker B: Yeah.
[00:11:34] Speaker A: Xiao cai hutong. Yeah.
[00:11:36] Speaker B: Xiao cai hutong or a cai hutong method is gonna be likely where we're gonna start for that.
[00:11:42] Speaker A: Okay. And so if we're thinking shai hutong method, Sha chi hutong, obviously, we've talked many, many times on the show. Caihu huangchen.
What else would belong to the chihu method approach.
[00:11:53] Speaker B: Yeah. If that one isn't so necessary, then we' more chaihu by xiao method. Which s on which we think csan. Yeah, csan is going to be good.
[00:12:04] Speaker A: What's the distinguishing characteristic?
[00:12:06] Speaker B: So sinisan is going to be deeper, there's going to be more abdominal symptoms, and there's not going to be the same kind of surface symptoms.
[00:12:16] Speaker A: So what kind of abdominal symptoms?
[00:12:18] Speaker B: Yeah, cramping could be an issue.
Kind of like intermittent stools.
A little bit like I made. I mean, you think of IBS as a presentation. It doesn't have to be ibs, of course, but it's that kind of like, oh, I go and then I don't go. And the consistency is sometimes varied and there's cramping. The cramping is not always in the abdomen. Sometimes it's in the legs. I actually find that patients have more like leg cramping than they then they present in the abdomen. But then when you palpate the abdomen, you're also going to find generally a pretty tight rectus abdominis. So there's going to be physical muscle tension that you can put your hands on with that pattern, which is a lot less common with xiao chaihu tong. You could see a little bit of that with chihu guageng, because bai shao is included in the formula, but it's less pronounced.
And for xiao cai hutong, you're going to see oftentimes surface symptoms. So those could be aversion to wind or cold. The person is averse to drafts. You can also see temperature fluctuations which are going to be maybe more prominent than in Sinisan though again, in Sinisan you can see hot flashes, which I think is still strange for me to try to figure out how. But sinny san does work at treating hot flashes really well.
So those are going to be the main factors that. And there could be other xiaoyang symptoms. There could be a history of the person was sick recently and then the symptoms got worse.
So anything like that. Seasonal allergies could be included. Any of those things are going to make me want to start with the Xiaochai Hutong method.
[00:14:08] Speaker A: So basically indications of a surface level problem.
[00:14:11] Speaker B: Yes.
[00:14:12] Speaker A: Seasonal allergies, symptoms worse with cold and flu.
Recent cold and flu.
[00:14:18] Speaker B: Yep.
[00:14:19] Speaker A: These are going to indicate the need for chait method.
[00:14:21] Speaker B: Yeah.
[00:14:22] Speaker A: And then if we're thinking between the difference of Sha Chiyu tongue versus sinny san, we're going to reach for sinny san. If we have more abdominal indications which could be physically in the abdomen, tenderness, cramping, etc.
Could be more digestive in nature. Alternating stools, alternating quality of stools. And if there's like muscle cramping really anywhere in the body, but probably in the legs, this is all more indication because basically the difference here is that we need the baisha.
[00:14:52] Speaker B: Yeah.
[00:14:53] Speaker A: Right. So the muscle cramping is saying we need the baisha, whereas without that presentation, then we can probably just rely on the normal harmonizing function of xiaochaiutang.
[00:15:03] Speaker B: Yep.
[00:15:03] Speaker A: Okay, Are there any other things besides say cold and flu where symptoms got worse or seasonal allergies that would indicate.
[00:15:12] Speaker B: Chai who method pulse abdomen. The objective findings would be the other thing that would point me to it.
[00:15:20] Speaker A: So you're looking at subcostal tenderness, rib side pain, the usual abdominal indications of sort of above the umbilicus. Yep. Items. Okay, got it.
All right, so assuming that we do have those findings, we're going to write a chihu formula. What's the. I mean, obviously we're probably not going to solve the whole problem with just this formula.
[00:15:43] Speaker B: Right.
[00:15:44] Speaker A: So what kind of timeline are we talking about? Like two weeks, a month? How long are we harmonizing these folks?
[00:15:49] Speaker B: Two to six weeks.
[00:15:50] Speaker A: Usually two to six weeks. And in that time, what would the patient expect to see as a change?
Because again, we're not going to crack the whole thing. But ideally we would know it's working.
[00:16:00] Speaker B: Because well, generally the ext. Let's say they have hot flashes. The. The hot flashes should improve, so they should be less intense and occur less frequently.
So we should see improvement. But they probably won't go away.
[00:16:18] Speaker A: Right, right.
[00:16:19] Speaker B: And if there's any other symptoms that we would associate with Xiaoyang disease, those should also get better or go away. So feeling of stuffiness or tension in the chest, irritability, those kinds of things. They should get better on a Xiaochai Hutong method.
Yeah, stuff like that.
[00:16:39] Speaker A: Okay, so that's how we're going to track it. And then once the Xiao Caiutang symptoms. So let's say alternating symptomology or muscle cramping or whatever it is that we're using to indicate the need for Chihu method in the first place, once those symptoms are mostly resolved. But the hot flash symptoms say remaining or the other menstrual or. Excuse me, the other menopause symptoms are remaining.
Now we know it's time to go to the next layer.
[00:17:04] Speaker B: Yeah.
[00:17:05] Speaker A: Okay. So if that's the case, we're now going to examine the movement of the blood.
[00:17:09] Speaker B: Right. And the objective finding should also help us.
[00:17:12] Speaker A: Right, right. So we should see less of the costal tenderness.
[00:17:17] Speaker B: Exactly.
[00:17:17] Speaker A: Less of the, you know, above the umbilicus signs.
[00:17:20] Speaker B: Yeah.
[00:17:21] Speaker A: Okay. And the pulse would change.
[00:17:22] Speaker B: Pulse would change.
[00:17:23] Speaker A: How would the pulse change?
[00:17:24] Speaker B: It gets a little deeper and less.
Less wiry. Less. Less stringy. Less cutting. That's a good way to put it. Less cutting to your fingers. A little softer like that. And it should start to sink in a little bit. The pulse is going to show you generally where the resources of the body are working.
So if it's superficial, they're working on the surface. Right. And as you resolve help it to resolve that condition, they're going to start to settle in a little more.
[00:17:59] Speaker A: So once we're working at the next layer, which is the movement of blood.
[00:18:03] Speaker B: Yep.
[00:18:04] Speaker A: So we dealt with the qi layer. Now we need to deal with the blood layer.
[00:18:07] Speaker B: Right.
[00:18:08] Speaker A: Okay.
Okay.
All right. So we're finishing the chi piece of it because the symptoms have shifted and now we need to go to blood.
What are we looking at to know whether or not we need to treat the movement of blood?
[00:18:25] Speaker B: Yeah. So there would. If there's any sharp or fixed pain, especially in the lower abdomen, we're going to think we need to treat the blood.
Any kind of systemic blood stasis signs. So some people will say their legs get achy. They feel like the veins in their legs get achy. I've heard patients say that before.
You can tell with the abdominal exam fairly easily by doing the oketsu palpation. You can see it underneath the tongue. If you see the abgorged sublingual veins, if those are particularly purple, then you know, you probably need to do a little bit of blood movement.
Yeah. And in extreme cases, there, there may also be dry constipation, which is connected to the difficulty with the body descending both with the physical material of the stool and potentially with the blood.
[00:19:25] Speaker A: Right. That's pretty rare though, right?
[00:19:27] Speaker B: It is rare.
[00:19:28] Speaker A: Dry constipation piece.
[00:19:29] Speaker B: It is rare. Yep.
[00:19:30] Speaker A: Yeah. So, okay, pain is obviously going to stand out as a core need to treat the blood does that. Is it specifically the abdominal pain or is it pain anywhere? Like joint pain and stuff?
[00:19:42] Speaker B: If it's more global than it could be, it doesn't need to be specifically addressed in the same way. I would say.
[00:19:51] Speaker A: Yeah, but if you have lower abdominal pain.
[00:19:53] Speaker B: Lower abdominal pain, especially if it's fixed and stabbing like class, like when, when we learn about blood stasis signs in school. That's really what. What I'm talking about.
[00:20:03] Speaker A: Yeah. Fixed, sharp. Yeah, yeah, pinpoint.
So Chi's moving.
[00:20:38] Speaker B: Okay.
[00:20:39] Speaker A: We've harmonized, but now we have, say, some engorged sublinguals. We've got some other classic blood stagnation signs. Maybe there's spider veins on the inside of the knee, there's visible veins on the legs or arms.
Maybe there's also some fix stabbing pain. We need to address the movement of blood. What is the formula that comes to mind there?
[00:21:02] Speaker B: So the key formula is going to be Guiji Fuling wan, which is the.
[00:21:06] Speaker A: Same formula we would have used, say if someone had similar presentation while they were still menstruating.
[00:21:11] Speaker B: Absolutely.
[00:21:13] Speaker A: So Guiju Fuling wan. So are we just leaving that? So we finished with the Chihu method. We switched them onto a Guizhu fuling one.
Are we just observing the same sort of shift over time, expecting that, say, the pain presentation would retreat?
What's happening in the background with the other sort of key elements here, like the hot flashes and the sweating and the insomnia, Are we continuing to expect those to mildly retreat? Or when we're working on this blood movement problem, are we mostly just focused on the things that indicated our need to treat it, like the sublinguals and the pain?
[00:21:50] Speaker B: Some people will just move to treating blood and do things kind of singularly.
I like some things about that, but that's not what I do most of the time. I will start to move the blood if I think there's an issue with the blood at the end of moving Chi. So before I transition away from the Chihu method, I will add the Guizhi Fu Linguan method in. And then a lot of the time after the Qi method gets done, I'll continue to move the blood when we go to the next layers. So if there's a middle jiao issue, I'll continue to move the blood while I'm treating the middle jiao. If the blood is deficient, I'll also continue to move the blood. And you can do it easily with Guizhin because it's a soft formula to use to move the blood.
[00:22:41] Speaker A: Yeah. It's mild in its movement.
[00:22:42] Speaker B: It's mild in its movement. But there are people who just use Guizhi Linguan as well in. In a kind of stage and progression process. It's just not really how I usually do it. So you.
[00:22:53] Speaker A: You're positioning it more as like a transitional formula.
[00:22:57] Speaker B: Correct.
[00:22:57] Speaker A: That's kind of a. A constant beat in the background as you move through the progression.
[00:23:02] Speaker B: Yeah.
[00:23:03] Speaker A: I mean, that makes sense in a lot of ways. Right. Because if the chi movement component is. Is not just. It's not actually just about coursing Qi. Right. It's about fixing a pivot transitional problem in Xiaoyang. So it's a harmonizing approach, really. Yes, more than anything else. So we're harmonizing the ability for Qi blood and body fluids to move smoothly through the system by the time then we have blood stagnation presentations that therefore need to be moved.
The reason that that blood is stagnant is probably manifold. Right. Probably the Qi was stuck. Probably it's a little bit weak. Probably it's not being well made. So there's gonna be a need to move that blood while you're dealing with the other stuff.
[00:23:43] Speaker B: Right.
[00:23:44] Speaker A: Probably until the thing is resolved.
So of course it's going to be kind of just running in the background. But as you said, some people will just take it stage by stage and focus Guizhu Fulinguan alone and then move to the next thing. So you could go either way.
[00:23:59] Speaker B: You could go either way, yeah.
[00:24:01] Speaker A: On the rare case that someone has the dry constipation component that's also concurrent with these other blood stagnation signs, I'm assuming we're going to need a more forceful formula.
[00:24:12] Speaker B: Yes.
[00:24:12] Speaker A: Than Guizhou Fuling Wan. Yeah. What's the go to there?
[00:24:15] Speaker B: So the go to formula that I think of is Taohe Chang.
[00:24:19] Speaker A: Okay.
[00:24:19] Speaker B: Which is going to be. It's a Chung Chitang formula. So it's going to be purgative. There's Dahuang, Meng Xiao in there, but there's also guijer mu dan PI. So there it's. In other words, it's, it's purgative, but it's really for the blood, right? And this is gonna be some. For some people in this progression, you will not be able to move forward. Like, you won't be able to tonify anything. If things are really stuck this way, you have to purge. It's gotta be. Or the classical phrases attack the blood, you have to attack.
So this would happen.
Let's say the person has a cyst or something like that, or growth or a really painful hard spot in the lower abdomen that's getting bigger. And as it gets bigger, it's actively painful.
So in this, in this kind of scenario, we attack.
That's the phrasing of zhan zhongjing. You attack by using these formulas. Tao chungxi tong or da huang mu dan pitong is another one. And it's very forceful, it's very fast. It's usually not done for very long. So a few days, maybe a few weeks.
And the person is going to have liquid diarrhea. Like they're just, they're gonna take it until they have the diarrhea, and in most cases, then they're gonna stop. But I've actually heard of cases where people continue to be on tawhachungcitang for weeks or months with a diarrhea, but they feel better and better and better and better the whole time.
So I don't have much experience myself with those cases, but I have heard about multiple cases where people have done that before and treated really, really pernicious blood stasis presentations by using these methods.
[00:26:17] Speaker A: I think if something like that is walking into your clinic and you don't have much experience with it, you're going to want to seek some help.
Because using Tahoe chung qi tong, say you've got dry, hard constipation, you use tahoe chung qi tong till the person has liquid bowel movement and then retreating from that is very safe. I think anyone with minimal experience can use it is no problem.
But of course, to know that the problem is severe enough that we need to continue purging them with the liquid diarrhea. Because remember, liquid diarrhea is incredibly depleting for our body. It is so the ability to evaluate a person's general robust capacity to actually tolerate having that kind of purgation. And remember, there's so much, so much Caution in the classical texts around purgation.
[00:27:06] Speaker B: Over purgation.
[00:27:07] Speaker A: Exactly. And formulas to deal with over purgation. Right. Because it was very obviously a problem where it's hard to know where the line is.
[00:27:18] Speaker B: Right.
[00:27:18] Speaker A: Between pushing someone to where they need to go, which could be uncomfortable, liquid stools, et cetera, depleting, but better than allowing the blood stagnation to continue to expand and saying like, actually we've hit the point where this person can't tolerate this anymore, even if it might still be helping the stagnation. The downstream effects of liquid diarrhea and the depletion of that is now outstripping the positive benefits on the other side. That's a hard call. It is a hard and challenging call that people are able to make. I want to be clear. It's certainly possible for us to do it that way, but if you've never gone down that road before, you definitely want to try and seek out some, some help with people who could help. You know where the line is.
[00:28:02] Speaker B: Absolutely.
[00:28:03] Speaker A: But the short term use of, of Tao chung chitang, some days, maybe a week, week and a half.
[00:28:08] Speaker B: Yeah, that's no problem.
[00:28:09] Speaker A: It's fine.
[00:28:09] Speaker B: And usually after you do an approach like that, you're going to follow up with something that's more warming and more nourishing eventually. Right. You're gonna go to a middle chow sort of supportive thing to help rebuild the function and also the material that's lost in the purgation process.
[00:28:27] Speaker A: Right. And I wanna emphasize too that this is not work that's done with great gaps between meeting with the client, the patient and such. Like this is, this is agile work. Like you're, you know, kind of like a take two and call me in the morning kind of structure. You really want to make sure that you're on top of what's happening so you can give the patient guidance. And so this isn't like, oh, here's this, Tahoe Chungxi Tong at a high dose and we'll see you in a month. Like that's not. You gotta be on top of it more than that.
[00:28:57] Speaker B: Yeah.
[00:28:57] Speaker A: Even for the short term use.
[00:28:58] Speaker B: Yes.
[00:28:59] Speaker A: Yeah, for sure. Okay.
So we've harmonized at the top layer. We've used our chaihu method. We now recognize that there were some blood stagnation signs. So we tacked on Guizhu Fuling Wan to the end of our, say, sinisan approach.
We've dropped off the chaihu piece. We ran Guizhu Fuliwan maybe on its own for a week or Two. And now we need to take a look at the other two layers.
[00:29:23] Speaker B: Yeah.
[00:29:23] Speaker A: So the next one, we're kind of making a pivot here from the sort of quote unquote excess components. Right. The, the movement questions into the deficiency side of things.
So let's talk about this idea of middle Jiao weakness and what are we talking about? Because it seems a little bit. I mean, I guess we could say it's like middle Jiao Qi deficiency. Right. But like that's a little bit cumbersome. So what are we talking about here?
[00:29:52] Speaker B: So when we get to the middle Zhao there, the constitution becomes more important to discuss.
So when people are deficient, they tend to be deficient from chronic conditions or chronic wear and tear, and they're going to become deficient in a way that's closer to their constitution, usually. Okay, so we generally have two. If you just forget about five phase and all this six confirmation constitutional diagnosis pieces, people do this and that's great. But if you just do yin and yang diagnosis, and if we take yin to be the damp cold type constitution and yang to be the dry cold type constitution, we have two basic constitutional types. So when people tend to be deficient, you have a person that's a little thinner bodied, their hips are a little smaller than their shoulders. Right. Shoulders are a little broader than hips. This would be like me. Right. That's going to be a cold, dry type person.
They're going to tend to have more dry skin. Things like this.
The damped body type is going to be opposite to that. Their skin is generally going to be softer. Actually, both people can have skin issues, but the damp type is going to be. Their skin is going to be softer, they're going to be a little bit rounder in shape, and their hips are going to tend to be more broad than their shoulders. Generally speaking, of course, you have people that are kind of, that can kind of go toward the middle of that distinction. And then you just have to do your best.
[00:31:32] Speaker A: They're points on a continuum.
[00:31:33] Speaker B: Yeah, exactly. Yeah, exactly. But in general, you're going to have somebody who's damp Qi deficient and cool, and then you're going to have somebody who is dry Yang deficient and they're going to have Yang displaced upward, but on the inside they're going to be cold.
[00:31:56] Speaker A: So that means they're going to tend toward hot head, sweating, red face, that kind of thing.
[00:32:03] Speaker B: Yes. And this is the early symptoms that the body is experiencing some form of taxation, usually. And the Yang is leaving the blood and floating.
So the yang is actually deficient, but it's coming out of the blood and floating.
So the deficiency is presenting with a yin and yang separation in the blood. And in this case the blood is drier, so it needs to be more nourished rather than the blood being, let's say, in disharmony. And the body is experiencing dampness and the same situation with blood deficiency, which we're going to talk about a little bit later.
[00:32:49] Speaker A: So I mean when you're, I mean as we sort of laid out at the top here. Right. We're talking about quality of blood.
[00:32:55] Speaker B: Quality of blood. Yep.
[00:32:57] Speaker A: We were talking about its movement before, now we're talking about its, its quality, its temperature. Yeah. Whether it's cold, whether it's warm.
But we haven't quite gotten all the way to the, the deep analysis of blood deficiency itself. Right, right. We're sort of. Right. Before we get there and we're thinking about how does the body produce the quality of blood.
[00:33:18] Speaker B: Yes.
[00:33:18] Speaker A: That we need to address.
So it's like a manufacturing question on some level.
So if you have a person who tends to be say more damp.
[00:33:29] Speaker B: Yeah. Versus more dry, that's actually simpler. The damp pattern is a little simpler in this case.
[00:33:34] Speaker A: And, and pretty common.
[00:33:36] Speaker B: Yeah. Oh yeah.
[00:33:36] Speaker A: Pretty modern folks. Especially where we are here in Portland, the climate is, is generally pretty damp. So a lot of people are coming in with damp digestion. Something for example, that like. Because we're talking about this in the context of menopause, but like I deal with damp digestion all the time in the context of ibs.
[00:33:53] Speaker B: Yep.
[00:33:54] Speaker A: You know, so it's a super common condition. And also with IBS people, chronic weak digestion with a tendency toward damp accumulation damages the blood.
[00:34:03] Speaker B: Yes.
[00:34:03] Speaker A: Like we see it over time.
[00:34:05] Speaker B: Yeah, absolutely.
[00:34:06] Speaker A: And in people who are not female bodied, it can show up in other ways.
[00:34:10] Speaker B: Right.
[00:34:11] Speaker A: We can see a whole host of secondary conditions that show up in male bodied people, from skin conditions to erectile dysfunction to hair loss to all kinds of stuff that are the same mechanism that we're talking about here.
[00:34:23] Speaker B: Right.
[00:34:23] Speaker A: The body's failure to produce high quality blood.
[00:34:26] Speaker B: Correct. Yep.
[00:34:27] Speaker A: In the context of menopause, then if we're breaking down this middle jaw weakness into sort of like the damp people and the dry people is essentially the break.
[00:34:36] Speaker B: Right. Yes.
[00:34:37] Speaker A: So what are the, what's the damp formula here?
[00:34:39] Speaker B: The damp formula is Lijongwan Lee Jongwon.
[00:34:42] Speaker A: The same one we would use in many contexts.
[00:34:44] Speaker B: Exactly.
[00:34:45] Speaker A: For damp metal.
[00:34:45] Speaker B: Yeah, Same thing, same dosage, same deal.
[00:34:48] Speaker A: So are we seeing then like Loose stool.
[00:34:51] Speaker B: Yep. Frequent stool, more tendency to loose stool. Frequent stool, maybe diarrhea.
But the this type of looser stool is going to be a little bit smelly. Not as much as damp heat stamp cold versus damp heat. Right. But damp in and of itself is going to have a little bit of an odor to it.
And this is also going to be the type of person that tends to have a difficult time holding the blood in the vessel. Right. So this could literally damage the blood by that person when it comes time for menses, or has come time for menses many years before, they just bleed like crazy.
[00:35:34] Speaker A: Excessively.
[00:35:35] Speaker B: Excessively.
[00:35:35] Speaker A: So very heavy menstrual cycle.
[00:35:37] Speaker B: And this is because the spleen is weak, it's not able to hold the blood in the vessel. Right.
So this is another. So yeah, damages the blood in a few ways. Indirectly it doesn't assimilate nutrients well, which then rob the blood of nutrient density. But it also deprives the blood in a female bodied person potentially by leaving them vulnerable to really heavy bleeding during menstruation, which is directly going to impact the quality of the blood.
[00:36:07] Speaker A: So we end up in that case in kind of a negative feedback loop.
[00:36:10] Speaker B: Absolutely.
[00:36:11] Speaker A: So you have poor and weaker blood production and then the ability inability to hold the blood in the same way, which then is depleting in nature because of heavy menstrual flow.
[00:36:22] Speaker B: Absolutely.
[00:36:22] Speaker A: Which then means we have less nutritious available blood to support the body's functions. And round and round we go.
[00:36:27] Speaker B: Yes. Yeah. Yes.
[00:36:29] Speaker A: Okay. So Li Zhong Wan then to warm.
[00:36:33] Speaker B: Yeah.
[00:36:34] Speaker A: And tonify middle Jiao function.
[00:36:36] Speaker B: Right.
[00:36:36] Speaker A: Okay.
[00:36:37] Speaker B: Yep.
[00:36:37] Speaker A: On the dry side, what's the formula there?
[00:36:41] Speaker B: The dry side is Xiao Jian Zhong Tang.
[00:36:45] Speaker A: Right. Which Travis is saying intentionally because it's easy to confuse it with Xiaoxian Shong Tang, which sounds very similar, but it's an entirely different formula. So Xiao Jian Zhong Tang. So that formula, what would we expect to see like if we're doing the differential between is this a damp digestion weakness or a dry digestion weakness? What are we expecting to see on the dry side?
[00:37:09] Speaker B: So earth is dry versus wet. So in wet you're going to have heavy muscles. Everything's going to feel heavy. The limbs are going to feel heavy. The person's think about Eeyore, you know, it's kind of like that. Internalized.
[00:37:23] Speaker A: Yeah.
[00:37:24] Speaker B: Whereas Shaojinjong Tong method or pattern is going to be dry muscles, they're going to be tight, they're going to be quivery, crampy, they're going to be ornery.
And you're also going to see a little bit of yin and yang separation from the middle jiao. So you're going to see the potential of palpitations in the heart. You're going to see a dry mouth, thirst.
You may see some of the yin deficiency, the classic yin deficiency signs, the five palm heat, these kinds of things. The palms feel hot, the chest feels hot, the person's thirsty, right? So this xiaojian zhongtang does nourish yin, but it also nourishes yang, nourishes qi and nourishes blood.
And below this is the other part of it, yin and yang separate. Below there tends to be cold, so you'll see excessive dreaming. For example, you may see like this is a good follow up formula in the classics from Wager ja Longumulitang for men that have spermatorrhea at night, right? Because what's happening is the heat is leaving the yang is leaving the blood and it's going up and floating in the chest. And then the person has all these vivid kind of fantasies that happen. But down below, things are actually cold, they're too cold. So the lower jiao doesn't contain the essence and then it leaks out.
So Xiao Zhen Zhongtang has some of that picture, not all of it, but some of it. And it's a good follow up formula. If you're treating spermatorrhea in, let's say younger male bodied people who watch too much Internet porn and things like this, this is a really good follow up formula for them. After you use Guizhu Ja Long Go Mulitang can be very helpful.
[00:39:14] Speaker A: Is there ever a situation in which these things present at the same time? Yeah, like, because I'm, I'm thinking of patients that have like combined symptom patterns there, right? Where you'd have like, you know, like loose stool presentations, you're thinking like oh, li jong wan. But then you've got like strong thirst, you've got like a strange way, it's hard to differentiate because you've got muscle cramping and stuff. Feels like tight but also heavy, you know what I mean? Like sometimes this stuff gets kind of mashed up.
[00:39:44] Speaker B: It's true. And actually the case will go over eventually.
I float between these two ideas in that case because it can be confusing. You can see sort of mixes. So there are, there are steps in between these things. First of all, Lee Jongwon has a modification called guizhi renshentang which is just the addition of guizhi and the Dosage of Jurgan sao is upped to 12 instead of 9.
So that's Guizhou and Chintong. So this is for Li Zhongwan symptoms, but with heat on the surface, there's still an exterior. Zhang Zhongjing says there's an exterior that hasn't fully resolved, but it just means there's heat on the surface.
[00:40:26] Speaker A: So that's like the Yang floating stuff.
[00:40:28] Speaker B: The Yang floating stuff. And you can have palpitations in that case. Right. Because Guiji is actually at 12, which is the dosage that's used for palpitations to treat palpitations with Guijer. So that can look a little bit more like a Jian Zhongtang picture. Inside of the Li Zheng Wan method, you can also have different types of zhenjongtang pictures. Zhenjongtangs can actually treat bloating, which you might not think would be possible because of Yitang is so sweet. But it can actually treat certain cases of bloating due to tension, due to the muscle tension. So the reason that it helps with bloating is it relaxes the muscles and allows for motility to occur.
There's even versions of loose stool that can occur in Xiaojian Zhongtang. But again, it's because of tension. It's because of there's so much tension that there's a disharmony in the dynamic of motility. And that leads to loose stools. And usually it's not just loose stools. It's a little bit alternating in nature.
[00:41:38] Speaker A: Yeah, yeah. I always am interested by the times when this stuff blends together, because, you know, whenever we talk about it, whenever people read about it, you look at case studies, you know, for the purpose of explaining it, we take the time to really create these dichotomies and try and create clear separation. And many times it is clearly separate.
[00:41:56] Speaker B: Yeah.
[00:41:56] Speaker A: But sometimes I think, especially when you get into middle jiao, in any pattern, in any disease presentation, the middle jiao, in my experience, is where the stuff gets mashed because it's a complicated system. And there's a lot of different ways that different aspects of things can manifest. Like people being incredibly thirsty, but they're not actually dry. They're actually way too damp. And the damp is obstructing the movement of fluids. But they seem thirsty. And so these are the kinds of things that are difficult, you know, I think, for people to distinguish.
So assuming you've been able to categorize your patient now as a damp person, you're using Li Zhong Wan. If they're in A dry pattern. You're using the xiaojianzhongtang.
And we're running that again, tracking through the case here. Because if we're following this from start to finish, let's say we had to treat all four of these components.
We were, say, two to four weeks harmonizing. So we're about a month in.
We did maybe two weeks of transition where we were moving blood and also harmonizing.
So now we're six weeks in, and now we're going to deal with middle jiao. And almost certainly if there's a middle jiao weakness that didn't start yesterday.
[00:43:09] Speaker B: No, right.
[00:43:10] Speaker A: I mean, middle jiao weakness is constitutionally inherited and then perpetuated by a lifetime of habits and circumstance.
How long are you treating at this stage? At the middle?
[00:43:21] Speaker B: Yeah, a while.
But again, it's a little bit difficult to say because like we mentioned with the blood movement approach with gui jui fu ling wan, like, if I give somebody gui jui fu linguan, I'm going to give them that formula for a month minimum. Right. And that could be in combination with other approaches.
[00:43:43] Speaker A: Right? It could be in the background of other forms.
[00:43:45] Speaker B: Exactly. Yeah. It doesn't need to be unique, but it's gonna be there for at least a month. Cause it doesn't move blood quickly. It's not supposed to move blood quickly. It's a gentle formula. But it will move the blood. So you gotta be on it at least a month.
And I could thread that. Let's say we were moving qi first into a xiaochai hutong or a sinni san. I could have the guizhi fuling wan in at a point and then take the xiao cai hutong sinisan out and then put that into the guizhi fu ling wan, into a li zhonghuan or a shaojian zhongtang after.
[00:44:19] Speaker A: Yeah, yeah, yeah.
[00:44:19] Speaker B: Right.
[00:44:20] Speaker A: So realistically, say you went. Say we did pure sinisan two weeks.
[00:44:25] Speaker B: Yep.
[00:44:25] Speaker A: Then we did sinisan guizhu Fuming Wan for two weeks.
[00:44:28] Speaker B: Yep.
[00:44:28] Speaker A: Then we did guizhu fuling wan, li zhongwan for two weeks.
[00:44:33] Speaker B: Yep.
[00:44:33] Speaker A: And then we did li zhong wan for another month on its own.
[00:44:36] Speaker B: Right.
[00:44:37] Speaker A: So basically, guizhu fuling wan ran for a whole month, but it was threaded into the chi movement correction and the middle jiao correction.
[00:44:46] Speaker B: Right? Yeah, yeah.
[00:44:48] Speaker A: And so at that point, like, if you get to the end, then, you know, you've taken Lijong 1 for six weeks total.
That's probably a good amount of time for many people who aren't wildly deficient in the Middle jiao to be warmed up and prepped to consider the next stage. But I think just based on my experience with digestive patients, I mean, it ranges wildly.
[00:45:13] Speaker B: It does. Yeah. It really does range wildly.
[00:45:15] Speaker A: Yeah. I mean, some people are ready to take another stage after six weeks of treatment, and some people are on that for three months.
[00:45:23] Speaker B: Yeah.
[00:45:23] Speaker A: Five months. It could go long, depending on what we're doing. But we would anticipate that if you're at that stage, having harmonized, having coursed the blood and now we're working on middle jiao, that the middle jowl is producing better blood, which is solving or beginning to correct the lower problem. Deepest problem.
[00:45:42] Speaker B: Exactly.
[00:45:43] Speaker A: Which is that the blood was weak to start, which is. Is why we had all these symptoms.
[00:45:46] Speaker B: Yep.
[00:45:46] Speaker A: So even if you're not leaping immediately into the final stage of blood weakness treatment, the truth is, is that you're still treating it and making sure that the middle jiao is functioning like it ought to.
[00:45:57] Speaker B: Yeah. And you're treating it when you move qi, because the qi is helping the quality of the blood. Like every stage of the way, you're indirectly or directly changing the quality of the blood. You just have to make sure you're addressing what the body's struggling with the whole time.
[00:46:13] Speaker A: Right.
Okay. So let's say the patient's doing really, really well.
Their middle jaw weakness was present, but not wildly profound, and you're able to go ahead and move toward a direct addressing of the blood weakness. So essentially, like a direct blood tonifying approach, what are the. What are the go to formulas here, and how are we distinguishing which one and where?
[00:46:39] Speaker B: Yeah.
So following that constitutional method of moving down the ladder, the Li Jong Wan people tend to go to a Dongwei Xiaoyao san pattern long term. In my experience, Dongwei Xiaoya san is mostly a temperature neutral formula.
So if they tend to be cold, you may need to add another formula in as well to address the cold piece. So that could be keeping Li Jongwan in the formula.
[00:47:11] Speaker A: Right.
[00:47:12] Speaker B: It could be moving to.
There's another formula called Shenzhou Tong, which is similar to Li Zhong Wan, Ganjiang Baiju. Like these kinds of herbs. And it's just a little higher dosage of Ganjiang. It's Ganjiang at 12, and it's a formula that's indicated for pain below the belt. It's like the person's wearing a belt of a thousand coins or something like that. It's a really nice addition to Danglishyayasan, because dengue shyasan is the formula that's principally about correcting the relationship between blood and water deeply in the body and.
[00:47:53] Speaker A: The disharmony between blood and water is what when dengue shaya san is indicated.
[00:47:57] Speaker B: Dongwei shaya san is a pattern where the blood, you know, Sharon Weizenbaum uses the term crappy bl.
Right. It's like blood is a little deficient, a little stagnant, and because it's not moving well, the yin and yang start to separate in the blood vessel. But in this case, the yin goes out in the form of water and the yang goes out in the form of heat. So there's very minor sort of heat symptoms, but they're all because of stasis. They're not really true heat symptoms at all.
[00:48:32] Speaker A: Right.
[00:48:33] Speaker B: And in my experience, a lot of the time danguisha ya san co occurs this pattern co occurs with some other deeper need to warm water at a deeper layer, but with a different constitution than the person that we're going to talk about the other formula for.
[00:48:50] Speaker A: So what? And that constitution is what?
[00:48:53] Speaker B: That's the cold dry constitution. Right. This is the other one.
[00:48:57] Speaker A: Right. So the, the cold wet person is again, that's why there's a linkage here with Li Zhong wan.
[00:49:02] Speaker B: Yes.
[00:49:02] Speaker A: Because again, tendency toward damp accumulation, tendency toward deep cold, even though again, notably the person may have a lot of surface level heat because the yang is actually deficient and separating out of the blood. So that person, and this is very important, I think, when you're talking in this lane. And again, I see it a lot in digestive conditions where people come in and they're like, I'm hot all the time. Yeah, right. Easy to sweat, hot face hot at night, but they're cold people.
[00:49:33] Speaker B: Yeah.
[00:49:33] Speaker A: And that's a difficult thing to figure out.
[00:49:35] Speaker B: Right.
[00:49:36] Speaker A: You know, especially if a little bit, they have also lower jiao damp heat.
[00:49:40] Speaker B: Oh yeah.
[00:49:41] Speaker A: And you're like, wait a minute. Yeah. So are they cold people? Are they hot people? Like, what's going on? But the truth is in that context is that the middle jiao has been overwhelmed by cold and damp.
And so it's in this context been making poor blood because of that.
[00:49:55] Speaker B: Right.
[00:49:55] Speaker A: So now it's warmer, it's producing better. But we need to continue to nourish a person who's at that base level constitution. And so therefore dong gui shaozan.
[00:50:03] Speaker B: Right.
[00:50:04] Speaker A: Okay, on the other side then. So an extension from the person that we had put on Xiaojian Zhongtang, what's the formula that follows up there for the more cold dry person yeah.
[00:50:15] Speaker B: So I would transition as a stutter step between Xiao zhenjongtang and Wen Jingtong is going to be our goal.
Dong Wei Zhen zhongtang, which is just the addition of dongwei, and it makes it very. It's like kind of like even closer to Wen Jingtang and structure, but it's a little bit of a stutter step between them. It's a Zhen Zhongtang that's focused a little more on blood.
So I will often make that transition. That's a sunset Miao modification was a Dongwei Nebu Zhen zhongtang.
[00:50:50] Speaker A: So you're pulling. You're adding dongwei into Xiao Jian Zhongtang.
[00:50:54] Speaker B: Yep.
[00:50:55] Speaker A: As a way to sort of tease the effect away from middle Jiao specifically and more toward blood.
[00:51:02] Speaker B: Yeah.
[00:51:03] Speaker A: But still leaving the middle Jiao pieces in place.
[00:51:06] Speaker B: Correct.
[00:51:06] Speaker A: So that way, when you eventually introduce Wen Jingtang exclusively, it won't be such a jarring transition. Right, Got it. Okay. And so again, that's going to be the same. The same things that would have led you to choose Xiao Jin zhongtang in the first place are the same things that are indicating the need for Wen Jingtong. Yeah, yeah. Is there ever. You know, we talked about sort of combined presentations at the middle Jiao level. Is there combined presentations when we get to the blood weakness level or. Usually at this point, we've clarified enough to know which way to go.
[00:51:38] Speaker B: For me, no, it doesn't really combine that much.
Well, let me put it this way. I've never combined dangui, xiaoya san, and wenjingtong together. I've never made that combination. You can have.
So you can put easily Guiji fu ling wan into wenjingtong. You can put it easily into dongwei, xiaoya san.
Most of the herbs are already there. In either case, it's very easy to add. If you want to add Guizhou fuling wan into these things as well, and just do a little more soft blood movement while you're building blood up and resources up so that that can happen. Wen jingtong. There are other combinations that people do.
If I'm giving wen jingtong, I'm a novice with Wen jingtong. I pretty much only give wenchingtong. If I'm going to give it. I don't have a lot of experience modifying it. I work. I do a lot of work before I get to wenchington so that I can just give Wen jing tong. I like keeping it as a piece in and of itself most of the.
[00:52:45] Speaker A: Time, which Is again, when you're, when any practitioner is getting into understanding of formulas, movements and natures and qualities, it's always a good idea to be able to just use it on its own. Yes, if you can.
[00:52:58] Speaker B: Yeah, if you can.
[00:52:59] Speaker A: Because then you can see how does this work on its own, which makes a lot of sense.
So at this stage, I mean, if we've gone through all four of these layers and we finally are treating at the blood weakness layer, we would expect, I would imagine at this stage that the intensity and the number of the menopause signs are deeply in retreat. Definitely at the point that we're treating it there. How are we expecting that a patient is going to be taking one of these blood weakness formulas throughout the menopausal period? I mean, are we in that kind of supplemental stage or is it possible to actually shift the physiology? I guess really in this case move the pathology more toward physiology. So the person has very minimal or no symptoms or are they taking this formula for, you know, a year or more?
[00:53:50] Speaker B: You can have either case. Yeah, you can have people who the symptoms pretty much resolve on, I've seen that.
Or you can have people who the symptoms are super minimal and then you pull them off of the herbs and then they kind of start to creep back. You go back on the herbs, they get better. So with those cases I tend to just reduce the dosage and I have them take it kind of more like a supplement for a while and then eventually they don't need it. But sometimes it takes a long time for these things. Remember, this is not just an occurrence that happens at the age spontaneously. It's been building their entire life. So you're pill you like, if you treat this correctly, you can really help people with these problems that have been happening for a long time and, and can affect a lot of different systems of body and mind, as it turns out.
[00:54:46] Speaker A: Yeah, and that's an important distinction because I think a lot of people, a lot of female bodied people can easily be frustrated by biomedical solutions to menopausal symptoms because they can be very invasive or a little bit health dubious, like whether or not we're going to use hormone supplementation or other things. There's a lot of ongoing discussion around whether that's a good idea or not. A lot of debate inside the space. There's also questions of its general effectiveness and side effects.
And so it's not uncommon that women in circles of other women who are dealing with menopausal symptoms will hear, oh, you know, acupuncture can help with that.
[00:55:27] Speaker B: Right.
[00:55:27] Speaker A: That's usually how it'll go. Acupuncture can help with that, which I'm sure acupuncture can be helpful for it for sure. But herbs are going to move the needle much more potently than acupuncture alone.
And so they're going to make it to you being like, oh, someone told me that Chinese medicine, acupuncture, good for menopause. What can we do? Well, now we have a great opportunity to actually get in there and start to move some things around that you, as you said, the way that their menopause is presenting isn't just, it didn't show up today like it's a, it's constitutional and life based.
[00:55:58] Speaker B: Right.
[00:55:59] Speaker A: That created the circumstances of a quality of blood that are making the symptoms appear as they are.
[00:56:04] Speaker B: Yes.
[00:56:05] Speaker A: And so a lot of the work that we've described here is relative to relieving the direct symptoms of menopause.
But in fact we're doing a lot of work to support the quality of blood that isn't really all that dissimilar from if this person had come in in their mid-20s with some kind of dysmenorrhea, you know, we would have been doing a very similar kind of analysis.
[00:56:27] Speaker B: Absolutely.
[00:56:28] Speaker A: Looking at the quality of blood. And that shift 20 years previously could have actually made the menopausal presentation a non issue.
[00:56:37] Speaker B: Right.
[00:56:38] Speaker A: You know, and so this is something to keep in mind when we think about, you know, how disease and pathology manifests over time because menopause is a normal physiologic function that's going to happen no matter what the question is. Like if there are problematic symptoms as a, as a byproduct of that change, of that physiologic change, we could actually prevent that from being hugely problematic by getting into the mix earlier and improving the quality of blood earlier.
[00:57:06] Speaker B: Absolutely.
[00:57:07] Speaker A: Which would have made menstruation better, would have made fertility higher, increase the quality of skin and hair and nails.
[00:57:15] Speaker B: Right.
[00:57:16] Speaker A: Helped with emotional stabilization, improve the quality of sleep. All of these things are made better when blood is better.
[00:57:23] Speaker B: Absolutely.
[00:57:23] Speaker A: And so, you know, if you're listening out there and you work with younger patients and you're like, oh, I don't, I don't ever see menopausal people. This is still a very useful metric and framing for thinking about the management of blood in everybody, but in particularly in female bodied people, because this stuff matters in the long run, it matters in the short term and in the long term, like it's, you're really working at an important level. I think it does.
[00:57:46] Speaker B: And people come in to see us who are perimenopausal who talk about wanting to work toward a better menopause. Like I've, I've had multiple patients come in and talk to me about that. And I'm not a, a women's health specialist. So the, the way to do that, in my opinion, is help the blood.
If I were to, you know, we make a bumper sticker, help the blood. You know, acupuncture, Chinese medicine. Yeah. And if you're a whiz with acupuncture and you're good at getting changes with a lot of these things, if you just throw even a low dose herbal formula in with your acupuncture, if you're already good at acupuncture, it's going to take your game to a whole nother level. And it doesn't need to be that complex. Just follow the steps, try to figure out which one needs to be treated, and then use the formulas we mentioned. And it should be really helpful.
[00:58:40] Speaker A: Yeah. I mean, this entire presentation is basically differentiating at the first level of Qi movement, two formulas, that's all.
Then probably 99% of the time, your blood movement stage is going to be Guizhu Fuling Wan.
[00:58:53] Speaker B: Yeah.
[00:58:53] Speaker A: Because the Tao Chung Qi Tong thing is rare, so there isn't really even much distinguishing that happens there in terms of which formula.
Then you go to Middle Jiao and you're basically doing a pretty. Again, it can be complex, but generally speaking, a pretty clear distinction between dry type people versus damp type people. And at that point when you make that choice, then your blood weakness formula is in many ways probably already selected.
[00:59:18] Speaker B: Yes.
[00:59:19] Speaker A: So this whole conversation that we've had is really predicated on seven formulas, two per level, with really just one at the blood movement level. So it doesn't have to be complicated.
[00:59:30] Speaker B: No.
[00:59:30] Speaker A: Like you said, and the ability to make choices and progress people through it is about watching for changes in the signs and symptoms that led you to that stage and then pivoting as necessary.
Before we leave the conversation, though, I do want to address a formula that probably everyone's heard of. If you went to school, maybe two formulas, which is Ar Xian Tong.
And then you'll also hear people talk about using Jerbai Di Huang Wan in these cases. Let's deal with Arcian Tong first, because I think a lot of people will think, oh yeah, menopause, Arcian tongue. Just straightforward.
[01:00:05] Speaker B: Right.
[01:00:05] Speaker A: What, what's your experience with that and how does it fit into the puzzle.
[01:00:09] Speaker B: So I don't use our shantung anymore. I used it a lot when I started my practice. It works great. There's nothing wrong with that formula at all. The key differentiation point that I learned from Greg Livingston, who we mentioned earlier, was that the person is always cold before they hit menopause, and then after menopause. Now they have hot flashes, and they're always hot.
[01:00:33] Speaker A: Right.
[01:00:34] Speaker B: So there's this underlying Yang deficiency. But then when menopause comes, there's now surface heat and flaring heat and stuff like this.
So our shentong works by supposedly tonifying both yin and yang of the kidney. Right. It's a zangfu organ sort of diagnostic method, and I think it works great. You'll get the same.
I would treat that same picture with Wen Jingtong. If you look at Wen Jingtong, you have a lot of Yang tonification, and you have a lot of yin tonification. There's 24 grams of maimondong in wenjingtong. It's a huge dose of maimendong, Right?
[01:01:13] Speaker A: Yeah. Maimondang is super moist.
[01:01:15] Speaker B: Super moist, yeah. And then wuzhuyu and dong gui and guizhi and baixia. So there's both in there. So I would tend to land more on that side of things. So I don't have a preference what people do.
I think both formulas work. I just use the structure and formulas that I'm used to using because it helps me to think through the case better.
But I think you could. You could do it with either. Either formula.
[01:01:45] Speaker A: Yeah. So you would basically move through the same progression as we described, but by the time that you got to pivot from Xiaojian Zhongtang.
[01:01:52] Speaker B: Yeah.
[01:01:53] Speaker A: You could slot in Ar Xiantang.
[01:01:55] Speaker B: Yes.
[01:01:56] Speaker A: Instead of Wingingtong.
[01:01:57] Speaker B: Sure.
[01:01:57] Speaker A: And with a similar approach.
[01:01:59] Speaker B: Yeah.
[01:01:59] Speaker A: Okay. What about Jerbai Di Wang Wan? Because that one's like a. That's a wild. Like, you hear about it, but it's like, what do you even do with that?
[01:02:06] Speaker B: I think I have a. I have a sort of a chip on my shoulder about yin deficiency as a diagnostic. I don't think yin deficiency occurs very often by itself.
And so I don't understand how to use a formula like jury by D1 very well.
Yeah. I can't really speak to it other than I don't see it to be an important method of treatment, given the other formulas that I would use for things.
[01:02:35] Speaker A: Yeah. I think that's the thing that stands out to me, is that, you know, without doubt, there are practitioners out there successfully using Jirpy D Huang Wan because it slots into a methodology that makes sense to them with a similar progression. I think that's the thing that's always important whenever we talk about these formulas and processes. You know, we talk about it in the context of a disease presentation, but a pathology.
But we're always trying to situate the process of herbal use within a framework of diagnostics and understanding so that people can understand how an individual formula works, how formulas slot one after the other after the other in a progression. And so in that case, if you're looking at formulas and you're thinking to yourself, well, I don't know which way to go. And I've heard Jerbai Di Wang Wan could work, or Archenton could work.
My suggestion is that you avoid just sort of randomly using a formula and lean into a thinking process, a methodology, a progressive thinking process, such that if you've not treated this before and it's coming into your clinic and you're like, I'm not really sure what to do, just try this. Start with this. Now, I can't guarantee you that this will be the place you land, but if you start with this because it's systematic, you can track it, you can follow it, and you can decide, is this working?
[01:03:54] Speaker B: Yep.
[01:03:55] Speaker A: Whereas, like, if you just give somebody a drip id huang1.
I don't know, man. Like, is that the right formula? Did you give it at the right time, at the right dosage? There's too many questions, you know, that are. That are coming in here.
On the last topic, then, before we go in terms of dosing this stuff, if we're talking in granules, what are we. Are we just sticking with you and I as sort of like 8 grams twice a day?
[01:04:18] Speaker B: Yeah, that's what I would.
That's what I would do.
[01:04:20] Speaker A: No need to, like, push it particularly harder than that.
[01:04:23] Speaker B: I don't think so. Not for any of these. These approaches.
No, I don't think so.
[01:04:28] Speaker A: Okay. Yeah. So if you're working in granules, 16 grams a day, 8 grams twice a day is usually what TC and I do for most conditions. I mean, there's some variation, but that's generally the case. And then, of course, you're working in bulk. You're just going to use the. The Shanghan numbers. Yeah, yeah, exactly. Okay.
Well, we hope that the discussion on menopause was helpful for all of y' all today.
We're going to follow up as usual with a case study in the next episode. So we'll have some specifics for you to break down there as we progress through this season. Of course, we'd want to. We want to deliver for you guys things that you want to actually hear. So if you have any topic ideas, go ahead and send us an email to thenervousherbalistmail.com thenervous herbalist gmail.com and we always, of course, appreciate a rate and a review wherever you listen to this podcast because it makes it easier for other people to find the podcast. And we appreciate you guys joining us for another conversation. So I'm Travis Kern.
[01:05:22] Speaker B: And I'm Travis Cunningham.
[01:05:24] Speaker A: And we'll catch you guys next time.
