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.
[00:00:24] Speaker B: Am here with Travis Cunningham.
[00:00:26] Speaker A: And we are going to talk to you guys today a little bit about a pretty big topic in the realm of chronic pain.
Try and take a look at some common conditions that we often see in the clinic, like fibromyalgia. See if we can get an understanding of sort of how they begin and how they work and things like that. So as we jump into the conversation, before we get into the kind of nitty gritty of patterns and formulas, maybe let's take a second and talk a little bit about sort of the headspace, the experience of a lot of the people that finally come to see us with chronic pain, particularly in the idea that, I mean, sometimes we're lucky. And people that come to see us are people who already know that we treat this kind of thing. Right.
[00:01:12] Speaker B: Yeah.
[00:01:12] Speaker A: But a lot of times, by the time people come to see us, we are the last option.
They've been to everyone else.
They've seen the biomeds, the naturopaths, the kairos.
They've gotten specialty Reiki. They've got all kinds of stuff before they get to us.
And that usually means then that they've been dealing with it for, in some cases, many years and certainly have spoken to a lot of people with a lot of different perspectives and points of view.
When those people show up in our clinic, what are some of the things that you seem to notice? What kind of commonalities are there in those folks? Headspace.
[00:01:50] Speaker B: Yeah. I think for a lot of people that have chronic pain, there's the tendency to want to separate the idea of the mind from the body or the idea of the self from the body.
So you'll hear things like, my body hates me.
[00:02:07] Speaker A: Right.
[00:02:07] Speaker B: Or my body, I am different in my mind. And when I look at the mirror, my I. I don't know what I see or I don't recognize what I see. Like, that isn't me. I'm in there somewhere, but my body isn't me. There's this kind of tendency to dissociate from the body. And then there's also, with that, I think, the understandable movement toward not wanting to be in the body conceptually, mentally, somatically, you could say, which means maybe I'm not gonna Pay attention to when I'm tired because no one else is tired, you know, so I'm just gonna keep pushing through in a way that, wow. Like, I really felt that later on, you know, and nobody else did.
But nobody else did, so I'm gonna push on, you know, so there's this kind of.
[00:03:09] Speaker A: There.
[00:03:09] Speaker B: There tends to be a kind of a cultivated, in a way, disconnect, which is understandable.
And at the same time, maybe then the cues that are there for you need to rest, you need to pull back, you need to do something different. They don't get hurt or honored in the same way.
[00:03:31] Speaker A: Yeah. Do you think that's.
Do you think that's a sort of social function that, you know, a lot of people. A lot of people, for example, who present with, say, fibromyalgia tend to be women.
[00:03:43] Speaker B: Yeah.
[00:03:44] Speaker A: And, you know, women in our culture are carrying a lot of the burden of everything about a household. You know, they're doing the lion's share of the domestic work. They're taking care of the kids. Many of them are working full time.
They're the organizers, the planners, the information keepers, you know, and so I think a lot of times when I talk to folks in this situation, they don't feel like they have the luxury, quote, unquote, to be tired or to rest in the way that we would like to see them rest because they've got stuff to do.
[00:04:19] Speaker B: That's true.
[00:04:19] Speaker A: Yeah. Do you think then that something about the way that pain, particularly severe pain, you know, we're talking here in sort of like body pain, but I also see it too, with headaches, migraines, things like that, very cataclysmic, super intense pain presentations that really knock someone out, you know, I mean, if they're fully overwhelmed by a flare of any of these types, they can't take the kids to soccer practice Right. This afternoon. Like, they just can't do it.
And sometimes I wonder if that pain manifests as a way to almost protect them.
[00:04:59] Speaker B: Yeah.
[00:04:59] Speaker A: It's an ironic situation, really, because obviously nobody wants to be in pain, but the truth is, is that your body will force you to take a break.
[00:05:08] Speaker B: Yeah.
[00:05:09] Speaker A: But it's probably going to not do it in a way that you would prefer.
[00:05:12] Speaker B: Yeah.
[00:05:14] Speaker A: So what. What do you think contributes to that? I mean, why. Why do you think that people have, like. Why is the body designed in such a way to react to what? To the hostility of modernity? I mean, what's going on there?
[00:05:27] Speaker B: I think the body is a part of ourselves that we can't separate from, at least when we're humans, maybe afterwards or before, who knows?
[00:05:36] Speaker A: Right. But in this exact moment.
[00:05:37] Speaker B: But in this exact moment, bound together. So there isn't really a way, like we can imagine that we're different, or we can do a visualization where our mind projects outward, or maybe when we're playing a video game or on social media or whatever, we can kind of pretend that we don't have a body, but we still do. There's like one foot still in the body all the time, no matter what.
[00:06:02] Speaker A: Right, right.
[00:06:02] Speaker B: Which means that it's going to give us signals and cues, and it's going to express part of our mind or part of our condition, and that's inextricably linked to who we are as human beings. I just don't think there's a way to get away from that. So there's going to be some reflection about the dynamic. And then I actually think we could use the term subconscious, that our nervous system, our body is going to subconsciously behave, in a sense, and enact certain kinds of patterns that maybe signal that there's a problem, but they can sort of keep the problem hidden.
You see this sort of talked about and all the work that's being done in Somatic therapy. Now, my mother, for those of you who don't know, I don't think I've talked about this on the podcast, is a therapist. She's a PhD marriage and family therapist. And one of the things that my mom has told me before is that a lot of times with sexual trauma in particular, just to take an example, there will be body pain that shows up at some point in someone's life that if they explore that pain, they uncover repressed memories of sexual trauma.
And so my mom, you know, when I was talking to my mom about this at one point, she said, you know, maybe it's better to have the pain than to have to know that this person in my family did a terrible thing to me and I was helpless. Like, all of this, all the stuff that goes along with that, you know, but it's still not gone. It's still there.
So the body is going to reflect that somehow.
[00:07:49] Speaker A: Right.
[00:07:50] Speaker B: I just think that's part of being human.
[00:07:53] Speaker A: Yeah, it's an interesting idea. I mean, obviously not all pain is connected to something like sexual trauma. Right. But the idea that some people could have experienced something like that, and then maybe in the process of trying to solve the pain, they discover this other pain, this other.
We call it trauma now, where you have this title for it, but it's pain of another type. And so, you know, this is tricky. There's that classic book. Now classic, I guess is, I don't know how old something has to be to become a classic. But the body keeps score, which I recently learned has come under some scrutiny because the author had some, maybe some dodgy opinions and personal life behaviors. And some people have the opinion that the book is overly simplistic and you know, whatever. There's criticism for everything. But I think the broad spectrum idea that there are things that we experience as humans that we as western minded people categorize as emotional, say because we do this thing, this is really the core of the discussion. The reason we wanted to bring it up here is that we're all programmed to divide out our human experience into little sections. Yep. Physical ones, mental ones, spiritual ones, emotional ones, dream ones, etc.
But classically Chinese, Chinese cosmology doesn't do that.
I mean, of course they talk about the emotions and the spirits and things like that, but they're not, they're not categorical.
[00:09:23] Speaker B: No.
[00:09:23] Speaker A: In the way that they are for Westerners. And so sometimes even, even to say something like the body keeps score suggests that the things live in different houses. Right. That your mind is a thing and your body's going to show it up. And I mean, the underlying thought is that they're connected. But even having to lay it out like that tacitly suggests that they're separate.
[00:09:46] Speaker B: Right.
[00:09:46] Speaker A: And we need to remind you, in fact, that they are connected. So we're already starting in a chronic pain condition at a disadvantage philosophically because we're thinking in this way of stuff being divided.
[00:09:57] Speaker B: Yeah.
[00:09:57] Speaker A: But if we start reconnecting those parts and say being a human being is a composite thing, it's an alchemical, dynamic, composite thing and you can't really separate the stuff out. Right. That when we start to say that, we start to look at the questions of chronic pain and frankly, the way that people get talked to about it, other doctors and providers explaining or not explaining or dismissing chronic pain or I mean like the, the Dr. Google message board structure, I mean, you've seen that with your patients, right?
[00:10:33] Speaker B: Yeah, yeah, yeah. The, the messaging boards and yeah, there, there's all, all kinds of ones and, and they seem to serve two functions.
[00:10:43] Speaker A: Right.
[00:10:43] Speaker B: They serve the function of this person has this experience and they're not alone. So that, that's a good thing.
[00:10:50] Speaker A: It's a good thing for people. Yeah.
[00:10:52] Speaker B: For a lot of people to not feel alone, especially coming from a biomedical system that doesn't really have great treatments or a great.
[00:11:01] Speaker A: Or.
[00:11:01] Speaker B: Or can really tell people, like, yeah, this is in your head, you know, like, because I can't find anything.
[00:11:08] Speaker A: There's, quote, nothing wrong with you.
[00:11:09] Speaker B: There's nothing wrong with you, or there's nothing that we know of that is wrong with you that we can find.
[00:11:14] Speaker A: Right. So the test says no.
[00:11:16] Speaker B: The test says no. So, so these messaging boards, you know, can come up and be helpful in that way for people, but they can also kind of pigeonhole people into a diagnosis, which then can become an identity, which then can become a difficult thing to let go of.
[00:11:34] Speaker A: Right, right.
[00:11:35] Speaker B: You know, if, if the condition could possibly change with treatment.
[00:11:39] Speaker A: Yeah. And I, I see this too, even in my digestive clients where, you know, people will go to the message boards to see, like, well, what. What have other. What other medications have people used? What other supplements have people used? You know, and so I'll get people in here taking, you know, a bag full of stuff, and when I ask them why, it's like, oh, well, I read about it online, I did some research, you know, and some people get some results from this stuff.
And, you know, like, it's such a tricky situation because I never want to be in a position where we're not empowering patient agency. Right. You know, because this part of the question that we're having here is about agency and how, like, how do you actually steer the direction of your life and not be steered by reactions to your life? You know, so agency is a really important part of it. But I think the other thing is that message boards are.
This is going to sound, maybe overly harsh, but this is what I, I think listeners will probably get it, which is that the people in those message boards are not, quote, unquote, qualified to evaluate the effectiveness of various interventions. Right. And I don't mean in like a conventional way, because there's plenty of, quote, qualified people who told all those people they don't have problems. You know what I mean? So we have to take the idea of, quote, qualification with a. With a pretty big chunk of salt. But I guess what I mean is there are things that clinicians do and that we know about that are part of being a clinician of any kind that people who are not clinicians don't possess. So, for example, you read that melatonin is going to help with your sleep. You hear about this all the time, people taking melatonin. Well, how much melatonin should you take?
Well, I googled it. Or, or Now I asked ChatGPT about it, and it said I should take 20 milligrams or whatever the dose is.
And you're like, yeah, but I'm pretty sleepy. So, like, I have a hard time getting sleepy, so I'm gonna take 30 milligrams, I'm gonna take the extra strength dose.
[00:13:42] Speaker B: Sure.
[00:13:43] Speaker A: And then I'm not gonna set up any systems for evaluation.
So how long should I take it for? How much improvement should I expect if I sort of fall asleep easier, but I'm still not sleeping well?
Like, there's no one. There's no one directing and evaluating the case.
[00:14:02] Speaker B: Yeah.
[00:14:02] Speaker A: Which is what clinicians do. Right. That's what we're trained to do. We listen for things, we provide benchmarks, we, you know, provide feedback. And so the problem is, if someone goes through a kind of, you know, what I may be a little flippantly refer to as the Dr. Google Path. But, like, you know, they Google something and then they get to a message board and then read some Reddit stuff, and then they end up taking 4, 5, 6, 7, 8 things over the course of a couple months, and they don't know if it's helpful, but they didn't introduce them in a way that made sense. Or actually, in some cases, maybe taking all that stuff is actually unhelpful, but you're sort of feeling a little bit better, so you don't want to stop taking it. It's just a mess is really my point.
And I love the idea that a message board can have someone be seen and be told, yes, what you're experiencing is real.
Yes, there's something that people can do about it, something that you can do about it. Take control, take agency. I love that. It's something that we do all the time with our patients, but also, not everyone can know everything about everything. Right. You need some people with some insight, some expertise, some evaluation, and, like, we exist. Yeah, they're around. I mean, sometimes you have to hunt for them, but they're there. And that person can also be the person who you can, in some ways, like, outsource the burden of treatment to, you know, so that you, the patient, don't also need to carry all this. You know, some patients will come in, you know, with like. Like a binder of papers, research material. Like, they've just been working so hard to solve their problem because no one else seemingly would do it for them, so they feel like they had to do it, and now that itself is potentially contributing to the problem.
[00:15:52] Speaker B: Yeah.
[00:15:53] Speaker A: So, you know, some people may think of it as a luxury, it shouldn't be. It doesn't have to be where someone can say, hey, I see you, I see you have a problem.
Let me be the person who steers it for a while. Right. And, you know, maybe we're not the fit, maybe we're not the clinic for you, the practitioner for you, the style for you. But let someone else take the lead and of course, hold them accountable. Don't just give over your agency to them and do whatever they say, like be critical, all those things, but just let somebody else do the research for a while.
Because I think that it contributes quite a lot to the potential for transformation.
When a person can release their narratives, release the expectations into the hands of a qualified, learned person, and then see what comes out of it.
[00:16:42] Speaker B: Yeah, I agree.
[00:16:45] Speaker A: All right. Anything else we want to say on the headspace of it all?
[00:16:49] Speaker B: Just that sometimes, you know, we'll go back to Liu Ming. His idea of a person that exists in a hostile environment has to give up some of their chi to continue to exist in that environment.
[00:17:03] Speaker A: Sure.
[00:17:04] Speaker B: So there's a certain amount of, if I'm in a place that doesn't feel safe, if I'm in a place that's hostile, that's not a good. It's not a healthy space for me to be in. Let's say it's a workspace, Right. Or something like this.
It's very difficult to treat through that on some level. Doesn't mean we can't help at all.
[00:17:29] Speaker A: But if the, if.
[00:17:31] Speaker B: If there's a perpetuation of this experience that the person has over the long haul, it's a little bit like the diet, right. Like, you can treat, you can make great progress. With most patients, even if they have a digestive condition and they don't change their diet, if you give them herbs, you can make changes, but they're usually temporary. Right. The long haul thing, if they continue to eat poorly, especially if it's really poorly, really contrary to the way that we're trying to help the body, it will come back in the long run because the longer game is going to be more impactful.
It's the same thing with the environment that a person lives in.
Like, if you live in, this is where I think in part, like we talk about feng shui, right? Where you have a person who lives in a house that's like I think I told on this podcast before, Story of the Hoarders, right. That came in to see me both with constipation and we could make a little progress. The constipation with formulas.
But there was still a block and I had to get them help to deal with the hoarding.
That had nothing to do with me but calling around services and figuring out somebody that could help to intervene. And that's actually when the constipation got a lot better, is when they cleaned up their house.
[00:18:59] Speaker A: Yeah.
[00:19:00] Speaker B: So the environment that we're in affects us. And I think we should be considerate of that as practitioners that we're trying to treat through a hostile environment.
And there's a reason why maybe that person has the condition that they have because they've acquired that condition so they can exist in this environment perpetually.
And there's, there's a, there's a limitation to what we can do if that condition is extreme.
[00:19:33] Speaker A: It's interesting because I think everyone knows at this point that environment matters, but I think most people don't understand how much it matters.
[00:19:43] Speaker B: Yeah.
[00:19:43] Speaker A: Or even if they do, they don't feel empowered to actually change it.
This is the real crux of it in my mind is that people can look at their lives with any level of even marginal self analysis and say, work is stressful, My spouse is not supportive.
My kids are kind of annoying.
I don't feel satisfied from my career.
I definitely don't walk enough.
Like, it's analysis of things that make you go, oh, things are not great.
[00:20:16] Speaker B: Right.
[00:20:17] Speaker A: But then people don't really feel like they can do anything about that. Right. Because they need the job, pay their bills to pay the mortgage, put the kids in college, food on the table.
Yeah. Maybe my relationship with my spouse isn't great, but what are you going to do?
Blow up your life? It's not so bad, you know, so these are the kinds of things, these, these justifications that we all make because we live in the real world. We don't live in an idealized version of things.
And so sometimes as practitioners, we are, we're just, we're plugging holes in boats. Yes. You know, because life is just punching holes into boats.
And maybe that's our role. I don't know. I go back and forth about this as a practitioner all the time. I just, like, what is my job actually? Is my job to plug the holes in your boat so that it sinks a little slower? So that maybe at some point you can feel like you have enough bandwidth to make a significant change?
Or are we just trying to like, you know, to change the metaphor here, just trying to, trying to land the plane in such a way that it doesn't explode when it falls, but it's still going down. Like the plane is going down, that's happening. We just don't want it to nose dive.
So we're going to try and make shifts, you know, herbs here, pattern there, you know, or is our job to confront that reality and be like, look, your illness is a manifestation of the hostility in which you exist.
And until that hostility is really adjusted, this will always be here.
And maybe it's some fusion where we communicate that to the patient and then we plug the holes in the boats, you know, But I think it's a really tough situation. It's no surprise to me that therapists are in more demand than they've ever been before. You know, that people are asking, what is happening and what am I supposed to do about it and what's the way forward? And that they're seeing it manifest in all these physical realities in their lives.
So, you know, I don't know that I have a great answer for that exactly. But I just.
It is the thing that we deal with. I mean, we're the people that people talk to, you know, we're not therapists.
Sometimes people want us to be their therapists, you know, and we're like, nope, no, no, let's get you set up with someone whose job this actually is. But that doesn't. I mean, we're still going to talk to them, they're still going to have questions. And we're also in a position to provide advice from our point of view.
[00:22:47] Speaker B: And a different narrative.
[00:22:48] Speaker A: And a different narrative. Because maybe that's.
And maybe that's the answer. Maybe it's not so much about changing the circumstances so much as changing the story about those circumstances.
Maybe those things are the same. Maybe they're really different. I'm not sure. But it definitely feels more daoist to me, which is how I often think about this stuff. To change the story of the facts versus the facts themselves. Because as we have said, as I have said a lot of times, people can't change the facts, can't change the reality on the ground in terms of the specific details, but perhaps they can change their relationship to those facts, and that might be enough. In fact, it might be the real move to fundamentally breaking through a narrative or a story that traps people in pain or other types of conditions.
[00:23:39] Speaker B: Yeah. At least in some cases.
[00:23:40] Speaker A: At least in some cases, yeah.
Okay, let's talk about. Let's talk about some real. Let's put them into some tangibilities here, because the philosophy of it all is interesting. Of course. But how does this really look in the clinic? So, sure, we've. Pain is a big category. Obviously, lots of different types of pain. The kind of pain that we're talking about here tend to be chronic conditions. They tend to be things that biomedically are idiopathic or poorly understood, like fibromyalgia.
[00:24:37] Speaker B: Yeah.
[00:24:38] Speaker A: But also some kinds of joint pain and stuff that are not necessarily arthritic or maybe stuff that sort of will look like rheumatoid arthritis, but it hasn't actually fully passed the test for it yet.
[00:24:48] Speaker B: Yeah.
[00:24:49] Speaker A: Weird creaks and annoyances when people move, but again, there's no tears, no breaks, no 10. You know, it's stuff that doesn't show up on the test.
[00:24:57] Speaker B: Yep.
[00:24:58] Speaker A: But people still have the pain.
So you. You've broken down sort of. You know, how do we deal with a chronic pain condition of this type?
And there's a lot of ways that you can approach it, but I think you've organized it in such a way that we can do some basic differential that largely has to do with fluids and qi.
So let's start at the top of that tree, particularly around the idea of sweating.
[00:25:24] Speaker B: Sure.
[00:25:25] Speaker A: Because sweating is something that's reliably reported, usually by the client, and it's by the patient, and it's something that you can also observe yourself.
[00:25:34] Speaker B: Yeah. So if somebody comes in with pain in one of these chronic conditions, we definitely want to ask about sweating.
That's a huge. Like, one of the first things you want to ask about is sweating. You want to ask if the person can sweat first at all. Like, can you sweat at all when you exercise or when you get hot?
[00:25:52] Speaker A: Right.
[00:25:54] Speaker B: So we need to know that we also get some usefulness out of sweating that appears in different places around the body.
So let's say somebody only sweats in the upper half of their body or chest and above. That's useful to us. Right. Versus somebody that sweats over their whole body or somebody that sweats only in their creases, let's say right armpits and groin and. And, you know, joint spaces, like behind their knees and stuff. That's also interesting. That's helpful for us to understand.
[00:26:29] Speaker A: Right.
[00:26:29] Speaker B: Because where the sweating is happening will help us to understand where the body is able to open the pores of the skin, where it's able to diffuse pressure, or if it's able to diffuse pressure or not. Which is primarily going to be where pain starts, is the body can't diffuse pressure in some way, shape or form through the surface.
And there's a huge number of reasons why that can be the case, but that's gonna be one of the main things that we're looking for.
So sweating and their experience of temperature is another important.
[00:27:08] Speaker A: Like running hot. Right?
[00:27:09] Speaker B: Running hot. Running cold. Exactly.
[00:27:11] Speaker A: Okay.
[00:27:12] Speaker B: Yep, those two things.
[00:27:14] Speaker A: So on the sweat side, if the pores can't open.
[00:27:18] Speaker B: Yeah.
[00:27:18] Speaker A: Or if the pores are overly open.
[00:27:21] Speaker B: Yes.
[00:27:22] Speaker A: In either of those circumstances, we could have pain presentation.
[00:27:25] Speaker B: Correct.
[00:27:27] Speaker A: But of course, exactly why or in what way the pain manifests is probably going to be different.
[00:27:31] Speaker B: Yep.
[00:27:32] Speaker A: Yeah. Okay, so in the case that most people are coming into the clinic with a chronic pain condition, do you find that more of them can sweat or are over sweating or are most of them not sweating? Like, what's, what's the usual?
[00:27:46] Speaker B: So most, most pain conditions, people can sweat unless they're really, really severe, the person's older, let's say, or the case is really severe, like in rheumatoid arthritis or like really significant joint and bone pain where there's material changes in the body, meaning the joints are deformed, their form has taken a different shape.
That's a really good distinguisher between a material level problem, which would point. Point me more to a Jingwe method of treatment versus pain in the joints, where you look at the joints and there's no obvious change in the joints, which would point me more to a Shanghan method for herbal medicine.
[00:28:33] Speaker A: Okay. So since most people are probably sweating to some degree.
[00:28:37] Speaker B: Yes.
[00:28:38] Speaker A: And the not sweating ones probably belong to maybe a whole episode more on arthritic conditions.
[00:28:46] Speaker B: We're gonna cover that at a later date, probably.
[00:28:49] Speaker A: Yeah. So then let's, let's stay on the can sweat and over sweat side. So let's start with can sweat. So patient comes in, they can sweat, but they're not profuse. It's not, you know, it's not dripping off of them, but like, they can sweat when they get warm, they sweat if they go to the gym.
What, what is, what do we do from that point? Like, what's the next step?
[00:29:10] Speaker B: The next step is to figure out, um, so if we go back to the Shanghan Lun and diagnosis, we see the ability to sweat and aversion to wind. Right. Floating poles. So in other words, the aspects or the resources of the body are on the surface. They're trying to make something happen on the surface. They're trying to diffuse and open the pores of the skin to accomplish something. Right. This is the Taiyang function. And when it's not happening that's when we get Tai young disease. So when the attempt is being made but it's not successful, that's when it's in disease.
That's taiang disease.
[00:29:50] Speaker A: Because if it were successful, then it would just resolve and it would resolve.
[00:29:54] Speaker B: Yeah, it would resolve and go back to normal.
[00:29:57] Speaker A: This is the. You woke up, you thought you had a cold, you had a little bit cough at lunchtime, and then you felt better the next day. It worked.
[00:30:04] Speaker B: Exactly.
Now, there's another version of this that's described in the first couple of chapters of the Jingwei, where in addition to this dynamic of wind, we have water.
So this is going to include body pain. Myalgia, particularly pain in the upper body, is more common.
I'm thinking mostly when I've seen this pattern before, it's been more in the hands and in the joints and the tissue, the flesh of the arms and stuff like this.
But there's also swelling.
Now, we just talked about material change to the body.
When I say material change, we have to be careful because somebody can be swollen like there's fluid in the tissue, like classic edema. Classic edema versus.
The joints are literally deformed.
[00:30:56] Speaker A: Right.
[00:30:57] Speaker B: So when I say material change, I mean more the latter. The joints are changing, the bones look different. Yeah, that's material change.
[00:31:06] Speaker A: Yeah.
[00:31:06] Speaker B: This.
[00:31:06] Speaker A: And. And you've seen this. If you've seen particularly an older person with arthritic hands.
[00:31:11] Speaker B: Absolutely.
[00:31:12] Speaker A: Or a younger person with really bad rheumatoid arthritis. Like, the literal joints themselves are knobbly.
[00:31:17] Speaker B: They're knobbly.
[00:31:18] Speaker A: Whereas the flesh between them tends to be frail.
[00:31:21] Speaker B: Yes.
[00:31:22] Speaker A: But the. The round, like the actual articulations are round.
[00:31:25] Speaker B: Round.
[00:31:25] Speaker A: Yeah. And red, usually.
[00:31:26] Speaker B: And red.
[00:31:27] Speaker A: Yep. Okay. Yep.
[00:31:29] Speaker B: So this. This version, though, that we're talking about now is not that.
[00:31:33] Speaker A: It's.
[00:31:34] Speaker B: It's the. The tissue.
[00:31:37] Speaker A: Is.
[00:31:37] Speaker B: Looks swollen, like there's too much fluid in the skin.
[00:31:40] Speaker A: Right.
[00:31:41] Speaker B: So this plus the normal signs for Guizhu Tong, which are like aversion to wind, the person is easy to sweat, but they. But they're swollen.
So that's the textbook pattern for Yuebitang. Right. Which is if we look at Yuebitang, spelled Y, U, E, B, B, I, T, A, N, G. For those of you who are having a hard time catching the Chinese, Yuebitang is a formula that is guizhitang. So it has shengjiang, dazao, zhiganzao, the same three ingredients at the tail end of the formula, but instead of guizhi and bai shao, it's ma huang and Shi Gao.
[00:32:23] Speaker A: Right.
[00:32:24] Speaker B: Now, for those of you who aren't aware of the Mahuang differentiation, Ma Huang plus Guizhou formulas mean that we're trying to open the pores, specifically to open the pores that are having a difficult time opening. Ma Huang plus Shi Gao. We're not trying to open the pores. We're trying to regulate something on the surface. But the pores are usually already open.
[00:32:46] Speaker A: Right. We don't have to force them.
[00:32:47] Speaker B: We don't have to force them open. So it's the combination of Ma Huang and Guizhou that opens the pores.
Ma Huang and Shi Gao, the pores can definitely already be open. The person can be sweating totally fine. Okay. So don't be afraid when you hear Yuebitang to give this formula. If somebody's sweating in a Yuebitang pattern, the person can sweat.
[00:33:12] Speaker A: Right.
[00:33:13] Speaker B: And they have a tendency to sweat.
[00:33:15] Speaker A: Right? Yeah. I mean, this is the place where I actually think it's largely because Ma Huang is such a hard herb to get in the US that we don't see a better, deeper understanding of this among clinicians, because, frankly, they just don't get to practice it. 100 and so people have just internalized from school that, like, Ma Huang makes people sweat. Right.
Which it can in a combination of other things. Right. It's not just by its own function gonna make people sweat. So, okay, so someone can sweat.
If you're heading to the uebitang side of things, you're seeing this fleshy swelling. Yes. Edematous type swelling. Yep. Okay. And so we just apply Yuebitang as is and say, like. Okay. And what we would expect to happen then is that the swelling would retreat. Yep. And as the swelling retreated, the pain would go down.
[00:34:06] Speaker B: Correct.
[00:34:07] Speaker A: Okay.
If, though, someone doesn't have that edematous swelling. So we were thinking Guizhetong.
We could just give Guizhetong on its own. You know, you could see how that goes. Which again, for listeners is like. They're thinking, really Guitang, like the cold and flu formula. It's like. Yes. It's in fact, not really a cold and flu formula.
I mean, especially. I mean, it is, of course, but I just think of that. It's so funny because when people come to the clinic for cold and flu, they're usually way past Guadang. Right. Almost always in Xiaoyang. Right. So we're always giving Xiao Chaitong, never giving Guizhu Tong.
[00:34:41] Speaker B: Yeah.
[00:34:41] Speaker A: If I use Gui Zhu Tong, it's not for cold and flu.
[00:34:43] Speaker B: Right.
[00:34:44] Speaker A: It's for stuff like this.
[00:34:45] Speaker B: Yeah.
[00:34:46] Speaker A: So we give the gui zhe tong. Maybe they feel better.
[00:34:48] Speaker B: Great.
[00:34:50] Speaker A: But sometimes there's more confounding factors than just a person's having sort of non specific diffuse body pain and they can sweat.
What about if someone is having joint pain and, you know, specifically in the joints. So, like, I can say, like, oh, my elbows hurt, my shoulders hurt, my knees hurt. This is where I'm feeling the pain. But it's not swollen.
[00:35:16] Speaker B: Right.
[00:35:16] Speaker A: So we're not seeing the fleshy swelling. Right. And they can sweat. So we're not assuming it's on the not sweat, Mahuang side, Ma huang side. Right.
What do we do there? What, what do we.
[00:35:27] Speaker B: What are the next steps that points us to a. A combination Taiang Shaoyang picture. Okay, so that's gonna. The first formula that you think of there is Ch Chaihu Guager tong. Because it's mentioned in the lines there that there's pain in the joints. And the way that I've.
That's been explained to me is in addition to the surface diffusion difficulty that we see in taiang disease, the body's recruited a second resource to try to open and close the pores, which is the qi.
[00:35:57] Speaker A: Right.
[00:35:57] Speaker B: And the qi circulates through all the hollow spaces, particularly what we call pivoting spaces. So those are the tight places anatomically in the body.
[00:36:07] Speaker A: Yeah. I mean, your joint is a literal pivot.
[00:36:09] Speaker B: Your joint is a literal pivot. And if the qi is slowing down, stagnating, the places that are going to heat up are those pivoting places. That's called ministerial fire flaring.
[00:36:20] Speaker A: Right.
[00:36:22] Speaker B: So you're going to.
[00:36:23] Speaker A: Would we expect the joints to be actually warm?
[00:36:25] Speaker B: They could be. They could be warmer or in. You could even see skin conditions come up only on the joints. And this pattern can. This formula can treat this pattern, actually.
[00:36:36] Speaker A: Okay, yeah. Interesting. So caihu Gui zhe tong, Chaihu gui, zhu tong.
[00:36:41] Speaker B: Yep. Just Xiao Caishutong plus Guizhi and Bai shao, which includes guizhu tong.
[00:36:47] Speaker A: So we just combine them straight up.
And I assume because we're using xiaocha you tong in that way, we would also see other xiaoyang classics. Maybe like hypochondriac discomfort. Yep. Alternating symptomology, weird taste in the mouth.
[00:37:00] Speaker B: Absolutely. So that would be the thing. If you're like, oh, it's joint pain. I can see the guager piece, but there's specifically joint pain. Then I'm gonna inquire, is there also xiaoyang? And then you can Ask those questions. Right.
[00:37:15] Speaker A: And do your abdominal exam.
[00:37:16] Speaker B: Obviously do the abdominal exam, check the pulse, do those things.
[00:37:20] Speaker A: So we've got, oh, there's like a wiry pulse and we've got subcostal tenderness on the right, tenderness superior to umbilicus.
Okay. We've got some exterior indications, so we're thinking shout Cheyenne. Okay. But of course, what if they don't have that? Right. So you know, we have, usually when we're looking at this sort of differential, there's a question of like, all right, shy, who's getting involved here?
Because we have some complex, some, some added complications. So we either had joint pain, in this case with xiaoyang symptoms. What if we have like body pain where the body feels heavy?
That's a super common way that people describe it. They come in so they're not pointing to a specific joint and saying like my knees hurt, but like just the muscles hurt.
[00:38:15] Speaker B: Right, the myopathy.
[00:38:16] Speaker A: Yeah, they're, they're wet, you know, they just feel damp that way. What are we, what are we looking for in that context?
[00:38:24] Speaker B: So that points us to a fluid metabolism type of pattern.
[00:38:28] Speaker A: Right.
[00:38:28] Speaker B: So especially if the thirst is stronger and urination is difficult, person gets dizzy, maybe they feel sloshy after they drink water or they have some counterflow symptoms. They get phlegm in their throat after they drink water immediately, or they have reflux after they drink water specifically, anything like that.
Then we're thinking about the formula Wulingsan.
And quite typically in clinic, Wu Lingsan plus Xiaochai Hutong is a really common way to treat these things that can also treat the joint pain, actually. So you can have joint pain plus really heavy musculature, achy, sore, like flesh, that kind of thing. But then there's additional to that. There's clearly this fluid piece that's a part of the pattern.
Then I'm going to think about Xiaochai Hutong plus Wu Lingsan, which we call Chai Lingtong for short.
[00:39:27] Speaker A: Yeah, well, and that makes sense because if we're using Cai Hu Guizhu tong to deal with joint pain, but then let's say there is just still joint pain, but it's not only joint pain or we have the difficult urination, the strong thirst, frankly the indicators for Wu Lingshan.
[00:39:44] Speaker B: Correct.
[00:39:45] Speaker A: Well then really, we're almost taking.
It's always so funny when you think about like, how does a formula move? Because like, well, chai lingtong is Wuling san plus Cha Chaotang. But if you, let's say you had you remembered this conversation and you were thinking chai huizhetong, but then they also have wuling san symptoms. I mean, in a lot of ways, you just take some things out of that formula and add in the wuling sign ingredients, and now suddenly you have chai lingtong. Right. You know, so is that what you did? Or did you pivot and say, no? No, it's actually shao chai you tong plus Wulingsan. You know, it's. So sometimes it's hard to describe the thought process, but I mean, essentially what's happening is we're saying we need shaihu, we need gui ger, but if we don't have the Xiaoyang side of stuff, Right. The subcostal tenderness and whatever, then we probably don't need Huangchen and bansha that are part of that. That game.
Right. And so instead we say, oh, let's look at the fluid side.
And so we're going to pull wuling san, which of course wagers in there, and then all of your bland flavored herbs to, like, leech out the fluids.
So it's.
It's a sort of differential. It's also kind of a progression. It just sort of depends on what you're looking at.
[00:40:56] Speaker B: Yeah. And you can see a difference, too, in the tendency for somebody who. Who's generally more damp versus more dry in constitution.
[00:41:04] Speaker A: Sure.
[00:41:05] Speaker B: So let's say I come in with fibromyalgia and you come in with. Well, actually, they don't know what we have.
[00:41:10] Speaker A: They can't see us. They don't know. Well, the short version is I am much more damp than TC is.
[00:41:15] Speaker B: Yeah.
[00:41:16] Speaker A: So there you go.
[00:41:17] Speaker B: So if I had fibromyalgia type pain, it's much more likely that I'm going to need chai huay Zh Tong.
[00:41:23] Speaker A: Right.
[00:41:24] Speaker B: Versus if, if TK came in with fibromyalgia type pain, it would be much more likely chai lingtong.
[00:41:30] Speaker A: Right, right, right.
[00:41:32] Speaker B: So you can kind of even look at the constitutional tendencies and, and have that guide to. This is a little bit, I think, where Dr. Huang Huang goes with his formula family piece is sort of training people to see constitution and types and things and symptom pictures that align with tendencies.
[00:41:52] Speaker A: Right.
[00:41:53] Speaker B: And it is helpful in differentiation to have some of that, even if you can just do damp versus dry, that kind of thing.
[00:42:01] Speaker A: Okay. So I mean, essentially then we're looking at a spread of, shall we say, four formulas on the canned sweat side. So can sweat plus specific joint swelling. That's not deformative.
Uebitong can sweat with non specific diffuse body pain. Guizhetong can sweat with joint pain, body pain and Xiaoyang symptoms.
Chai Huizhetong. Yep. Can sweat body pain with a fluid layer.
So body heavy, strong thirst, urinary difficulty. Qiling Tong Qai lingtong.
[00:42:38] Speaker B: And I should mention too that Chai Lingtong generally doesn't have a ton of swelling. There can be like a little bit of swelling in the tissues, but there's also going to be no thirst in Yuebi Tong and there's definitely going to be thirst in the Qai Lingtong picture as per the Wuling San pattern. So if you're confused, you're starting to see swelling and you're like, I think it's one of these two. Ask about the thirst. That's really going to be a helpful picture.
[00:43:09] Speaker A: Yeah. So no thirst go the UAB Tong side.
[00:43:11] Speaker B: Yes.
[00:43:12] Speaker A: Thirst definitely go the Wuling sand.
Chai Lingtong. Yep. Okay. And then if you're. So we're just using the Shanghan numbers here and then if you're doing granules, I mean we would do this at least at 8 grams twice a day.
[00:43:25] Speaker B: Yeah, yeah, I would.
[00:43:47] Speaker A: Let's look at the other category of sweat. So we were just talking about people who can sweat, but it's not particularly remarkable except that they can.
So let's look at the over sweating side, which is to say people who sweat profusely or sweat randomly. Profusely. There's just like, there's clearly something up with sweat. The pores are more open than they ought to be. Yep. In general, what's that saying when people are over sweating?
[00:44:12] Speaker B: It's saying, so you can have.
In the Shanghai Lun, the way that this is introduced is the person has a pattern.
They get sweated, but then they get over sweated.
[00:44:24] Speaker A: Right. As a part of treatment.
[00:44:25] Speaker B: As a part of treatment. But then part of the condition is that they're continuously sweating as well.
So the over sweat is both the improper treatment and a symptom of the condition.
[00:44:37] Speaker A: Right.
[00:44:38] Speaker B: I think this could be mimicked today by people who are overworking, who are over training. Specifically bodybuilders and people who run a lot of.
[00:44:48] Speaker A: Sure.
[00:44:48] Speaker B: You can see this, this progression happen with them. Oh, I have joint pain. I've been training for a marathon.
[00:44:54] Speaker A: Right, right, right.
[00:44:55] Speaker B: Well, you know, how much have they been sweating?
[00:45:00] Speaker A: So what time of year are they doing it?
[00:45:02] Speaker B: What time of the year are they doing it in for? Sure. Exactly.
[00:45:04] Speaker A: Okay. Yep. So the fact though that they're over sweating let's assume that it wasn't from treatment. Right. But its activity. Yeah.
Is it. It's a Yang deficiency thing. Is that what we're talking about here?
[00:45:17] Speaker B: You can have yin deficiency created by it or Yang deficiency. Yang deficiency is going to be far more common because sweat comes out of the body, let's say, through the skin surface, whereas yin deficiency presentations are created more easily after purgation occurs, whether it's improper or. Well, usually not if it's proper. But if it's improper, purgation, if somebody's vomiting or having diarrhea, it's easier to create some yin deficiency than if you're sweating. Sweating. It's easier to create Yang deficiency.
[00:45:53] Speaker A: Sure. It's also interesting, too, because we. In other episodes, we've talked about yin deficiency and how in not aged people, it seems like such a rare thing. Actually.
[00:46:05] Speaker B: It is.
[00:46:05] Speaker A: Yeah. Deficiency.
[00:46:06] Speaker B: Yeah, totally.
[00:46:07] Speaker A: And the fact that I feel like I only ever see it in older people is because they've literally just had a natural decline in yin. Mm. But the more that, the longer I do this too, I think probably some of that has to do as well with the fact that, as we were saying at the top of this episode, you know, people's daily habits and lives are the primary medicine that engages, that they engage with and producing yin from food. Modern food is pretty easy because food's sweet.
[00:46:33] Speaker B: Yes.
[00:46:33] Speaker A: Food's abundant in most parts of the world, obviously not everywhere. But in the Western world is often the case for most people.
And even for people for whom there might be food scarcity, the actual yin density of many processed foods, many cheaper foods, things are very sugary, very sweet, very carbohydrate, rich, very fatty. These things produce lots of yin.
So the ability to be yin deficient, in the way that, say, the machiocho would describe yin deficiency, I think is.
It's not impossible. But if you're working in the developed world with people with modern food systems, it's rare. You know, if you were in a different environment, for sure, even today, even in 2025, but I think in the past, Yin deficiency would have been a much more common thing because of food scarcity.
[00:47:21] Speaker B: Yeah.
[00:47:22] Speaker A: And I think if you worked in a different economic reality and in a different country and in different circumstances, you might see it more.
[00:47:29] Speaker B: Yeah.
[00:47:29] Speaker A: But for the population, most of the population that's regularly seeking Chinese medicine care in America, indeficiency is not something that we see a lot of.
[00:47:37] Speaker B: No, not by itself.
[00:47:39] Speaker A: Okay. So if a person's over sweating, we're assuming there's this Yang presentation. What's the Yang deficiency presentation? What is the first formula we're reaching for?
[00:47:49] Speaker B: Yeah, so the first formula is Guer Ja Futang. And this is where the person is described. They're just eeds of sweat are rolling out, like, constantly sweating, sweating, sweating.
[00:48:03] Speaker A: And the futza is coming in to deal with this Yang deficiency. Right.
Guizhujia Futang is just Guizhu Tong.
[00:48:11] Speaker B: Plus foods.
[00:48:11] Speaker A: Plus foods. How much foods are we talking about here?
[00:48:14] Speaker B: I think about this.
So in granule, I would start this at 30, 30 grams, which is, to me, the lowest dose I'd give futza in.
[00:48:23] Speaker A: Right. And so this is again, like, this is an important conversation which we're gonna have today again, and every other time it comes up because the dosage thing is tricky. So if you were. Since most people are writing granule formulas, we're going to start with that conversation. So if you were writing this formula, what are your. What are. We'll say, what are your numbers? And what I mean by that is what are the proportions? The ratios.
[00:48:47] Speaker B: Right, the ratios.
[00:48:48] Speaker A: So, okay, Guizhou, you're writing at 9 Baixao 9 Jergan Cao 6, Shengjiang, 9, Daza 9. Okay.
And then Futsa 30.
[00:49:01] Speaker B: Correct.
[00:49:01] Speaker A: Okay, now, for everyone listening, remember, this is a granule formula we're writing. So we're going to write out those numbers. And now essentially, what you have just heard is 9 parts Guizhi, 9 parts Baishao, 9 parts Shengjiang, 9 parts Dazao, 6 parts Zhigan Cao, 30 parts Fuca.
[00:49:22] Speaker B: Correct.
[00:49:23] Speaker A: That's what you've heard.
And then we'll say this person should take 8 grams twice a day, 16 grams.
Now, if you're fortunate to have a piece of software like we do, that will just do this math for you. It's going to spit out some hard numbers that I'm actually going to pour out of a bottle into a scale.
But the ratio that someone is taking are those numbers. And those numbers are essentially Shanghai numbers. Right.
And so you. Those are also the numbers not on the futsa side at the moment, but for the Guizhetong part that we would use if we were writing a bulk formula. And that would be literally 9 actual grams of Guijer, 9 actual grams of Bai Xiao. In that format, how much futsa, if you were doing a day dose of bulk, probably 15.
[00:50:13] Speaker B: 15, yeah. I'd cut it in half.
[00:50:16] Speaker A: And that's largely a function of just the difference between bulk, herbs and granules. And to get the same punch out of Food, say, and granule that you would get out of bulk. We up the number. Yep. Okay.
In that model, those numbers are real, true numbers. And that would be the amount that a person is taking per day.
And that's a different game than if they're doing it in granule. But since most of you are writing formulas in granules, when we give numbers, we're giving you essentially ratios, proportions of one herb to the next, essentially in a number of parts. Right. But the amount of herb that the person is taking, 16 grams a day, is kind of our standard right now. Some people are going to write smaller formulas, 12 grams a day. Some people are going to write bigger formulas, 24 grams a day, but we tend to stay in that 16ish range. Yeah. Okay, so Guizhu Jia Fu Zitan person sweating, beads of sweat rolling down the face.
They've got diffuse body pain. Right.
[00:51:17] Speaker B: And it says the limbs are stiff, like it's hard to move the limbs or it's uncomfortable to move the limbs.
[00:51:23] Speaker A: Okay, but we don't have any particular, say, swelling or targeted joint pain. No, it's relatively non specific at this point. Right.
And so instead of, say, just writing plain Guizhetang, which we would have done if they weren't sweating so heavily, we're now writing Guizhu Tong with Fuza in it. Guizi Jia Futang. Because of the sweating.
[00:51:46] Speaker B: Yep.
[00:51:47] Speaker A: Okay, Got it.
[00:51:48] Speaker B: Now, in this pattern too, it's important to contrast with the next one. The pulse is still relatively superficial.
[00:51:55] Speaker A: Right.
[00:51:56] Speaker B: Floating.
And the person is still averse to wind.
[00:52:00] Speaker A: Okay.
[00:52:01] Speaker B: Which is the typical presentation for Guizhetong.
[00:52:04] Speaker A: Right, Exactly.
But then if the pulse goes deeper.
[00:52:08] Speaker B: Yes.
[00:52:08] Speaker A: Or it gets weaker, faint.
[00:52:11] Speaker B: It says for the next pattern, which is fainter pulse, and the aversion to cold sort of comes up.
[00:52:20] Speaker A: So still averse to wind, but now also averse to cold.
[00:52:23] Speaker B: Yeah.
[00:52:24] Speaker A: Which implies that the Yang deficiency is greater.
[00:52:27] Speaker B: Yes.
[00:52:29] Speaker A: Then we need to modify the formula. So what happens then?
[00:52:32] Speaker B: So then we take out Baisha.
[00:52:34] Speaker A: Why do we take out Baisha?
[00:52:35] Speaker B: Because Baishao is a little bit of a yin constraint on the movement of Guadeng. It's gonna. It's gonna kind of buffer the lifting effect. It's gonna stop.
It's basically gonna stop the Yang from. From generating too much.
And in this pattern, because it's now showing more Xiaoyin signs, which is aversion to cold. So aversion to wind with surface open is a Taiyang Guizhetong pattern.
Aversion to cold with the surface closed is a ma Hong Tong pattern.
Taiyang Ma Huang Tong.
Aversion to cold with the surface open is a Shaoyin pattern.
[00:53:22] Speaker A: Right.
[00:53:23] Speaker B: So lots of people in Shaoyin can actually still sweat. They're averse to cold. There's not enough yang, in other words, to govern the surface. So it's just kind of open.
[00:53:33] Speaker A: Has your experience been with stuff like aversion to wind and aversion to cold?
Do patients know that? Like, do they articulate that?
[00:53:40] Speaker B: Well, no, but sometimes it's good to know for us, because sometimes they will spontaneously say something that brings it right in.
So it's good to know the differentiation because it's simple and it's clear.
[00:53:55] Speaker A: It's also easier with cold, in my experience, than with wind.
[00:53:57] Speaker B: It is, yeah. Because a lot of people will have both. Yeah.
[00:54:01] Speaker A: And people will just say, like, you know, we're recording this in the fall, and so things are getting colder. And so people will come in, they'll be like, ugh, cold. Like, I hate how cold, and I'm so cold all the time. Like, they'll just talk about it in a way that's more simple, direct.
But drafts, wind, breezes, sometimes those seem to be a little bit harder for people to articulate. And sometimes I even find it a little difficult a question to ask.
[00:54:28] Speaker B: It's tough.
[00:54:29] Speaker A: It's tough to question. How do you feel about breezes?
[00:54:31] Speaker B: Yeah, yeah, yeah.
[00:54:32] Speaker A: It's not exactly revealing.
What if the patient, you know, because one of the things that's interesting to me about this is that with over sweating, sometimes the patient feels hot and sometimes they don't in terms of the sweating could go either way. But in many cases, if you're over sweating and you expose yourself to cold, you can stop the sweating.
So I've had some patients who.
I had a patient actually who worked in professional kitchen, and if they'd start sweating really heavily, not because they were hot, but because they had a kind of over sweating thing, they would just go stand in the walk in fridge and the cold air would like, you know, some of it is that the cold air is drying, dehumidifying. But the other part was that it would. It would interrupt the sweat pattern.
[00:55:19] Speaker B: Yeah.
[00:55:20] Speaker A: And so in that case, like, you know, they. They're using cold to stop the sweat pattern. And I think, I. I don't. This was a long time ago, so I didn't have the patient to ask now, but I don't know what she would have said about aversion to cold or not because it would have been kind of messy. Because it's like, well, I mean, she doesn't want to hang out in the fridge, but she's not averse to it insofar as, like, she's using it all the time to stop sweating.
[00:55:44] Speaker B: Yep.
[00:55:44] Speaker A: What do you make of something like that?
[00:55:46] Speaker B: Well, you're putting yin on top of Yang, which is what you're trying to do symbolically in every one of these approaches. You're trying to get Yang to descend and you're trying to get yin to go on top. Right. So whether you're putting yin on top of Yang and getting Yang to go inside that way with a bai hutong method.
[00:56:07] Speaker A: Right.
[00:56:07] Speaker B: Or you're strengthening Yang to get it to descend so that it stops, it's not logical anymore. You're still trying to get Yang to internalize and Yin to externalize because that's the tendency. Yin and Yang separation is what happens at death.
[00:56:21] Speaker A: Right? Yeah.
[00:56:21] Speaker B: So any little miniature version of this is what we're treating with when we have a disease.
[00:56:27] Speaker A: Right.
[00:56:27] Speaker B: It's always some kind of Yin and Yang separation that's beginning to occur.
[00:56:34] Speaker A: Okay, that makes sense. So in that case, I mean, she may not have been able to articulate that she was averse to cold, but we would then probably just rely on the pulse.
[00:56:43] Speaker B: Yeah, the pulse. And also you can have that, right. Where the cold actually helps to constrain the sweating. But you can have the opposite, where somebody has, let's say, really cold, sweaty feet, and then you put the table warmer, the lamp, the TDP lamp on them and the sweat dries up.
[00:57:01] Speaker A: Right.
[00:57:02] Speaker B: So this is adding Yang and then causing the sweat to stop.
[00:57:07] Speaker A: Yeah.
[00:57:08] Speaker B: Right.
[00:57:08] Speaker A: Yeah.
[00:57:08] Speaker B: So you can have that too.
[00:57:10] Speaker A: Yeah. I think the interesting thing to me about it as well is this patient, I'm thinking about sweats or sweated. It's been like I said, a long time, easily, easy, easy, but doesn't feel hot.
Right. You know, so they just don't feel hot about it. Such a peculiar situation.
Okay, so faint pulse, deeper pulse, aversion to cold. We're shifting Guia futang to guijer chu Xiao futang, which basically is the same formula, but Choo sha, we've taken out the baishao. Okay.
From there though, you know, usually when we have. I don't want to necessarily say that the over sweating presentation is more severe, but sometimes it can seem that way where people are, the pain is stronger, you know, deeply diffuse in the body.
But there will be other symptoms because at this point, like the symptoms are, are really just the pain. Like they Hurt. And then we're like, okay, how, how badly does the surface need to be shut? Right.
[00:58:08] Speaker B: These are, these are B syndrome type formulas that we're, that we're heading into their pain formulas as a chief complaint kind of thing.
[00:58:16] Speaker A: But if fluid metabolism is a game player here, which we've discussed in the canned sweat versions, and that's probably going to show up, excuse me, among people who are over sweating.
So same. Let's think about the same breakdown. So if we have a fluid metabolism problem, people are say having urination problems. The same stuff that would have potentially clued us into Wulingsan.
[00:58:38] Speaker B: Right. Dizziness and things like that.
[00:58:39] Speaker A: Yeah. In a just regular canned sweat place. What's happening in this sort of Guizhou Futza strategy when you are having urination problems?
[00:58:49] Speaker B: Right. So then you would think the deeper version, let's say that Wuling San pattern, the person's going to get colder on the interior. They're going to have a much more difficult time trans transforming fluids, but they're probably not going to be as thirsty. That's going to be the difference here.
[00:59:05] Speaker A: Right.
[00:59:06] Speaker B: The cold is going to be more profuse and the person may experience somnolence or the ability or the desire to want to sleep a lot.
[00:59:15] Speaker A: Right, Right.
[00:59:15] Speaker B: So then this is going to point us to a gen Wutong type picture.
[00:59:19] Speaker A: Got it.
[00:59:19] Speaker B: Which could also have pain in the flesh.
[00:59:23] Speaker A: Right.
[00:59:24] Speaker B: Body aches, that kind of thing. But it's going to be. Usually it's more chronic. It's possible to have gen Wu tong acutely, but it's not very common.
[00:59:32] Speaker A: Right.
[00:59:33] Speaker B: But this is going to be a very common approach to treating fibromyalgia cases for sure. Like in, in more deficiency cases.
[00:59:42] Speaker A: And that person's still sweating.
[00:59:44] Speaker B: That person can still sweat.
[00:59:46] Speaker A: Yeah.
[00:59:47] Speaker B: You can have heat on the surface again because the Yang is deficient. So it's floating at this. In this situation.
[00:59:54] Speaker A: So then how about in the, you know, because Zhen Wu tong has foods in it, so we're still in this like wager futa space.
What if the person's cold? You know, we sort of took Guizhu Jiao Fu zitang and we said, okay, well the Yang deficiency is more, more severe. We take the baisha out to increase the Yang tonification factor. But then what if the cold seems still more predominant? We need to warm them more.
Something like Guiji Futang.
How are we making a differential there? Like what's, what's encouraging us to increase guer. Increase fuca inside of that formula. What's the indicator.
[01:00:34] Speaker B: The indicator. So it's interesting. The progression is a little different. So, right, in Guizhi ja fu zitang, we have the profuse sweating, superficial pulse.
[01:00:44] Speaker A: Right.
[01:00:45] Speaker B: And then the aversion to wind.
Then we have the worst version of the pattern.
The pulse gets faint and the person is averse to cold.
[01:00:55] Speaker A: Right.
[01:00:55] Speaker B: Wager Chu xiao zhao fu zitang.
Then we have the worst, an even worse version of the pattern, guage, or futang, not to be confused with guer ja futong.
[01:01:08] Speaker A: Sure.
Right.
[01:01:09] Speaker B: Which is a progression of. It's basically just a dosage change from the previous formula.
[01:01:15] Speaker A: The chu sha.
[01:01:16] Speaker B: The chu shao, yeah. So guage I learned wager goes up to 12 versus 9.
[01:01:21] Speaker A: Yeah.
[01:01:22] Speaker B: There's no baishao. And then everything else is the same except futsa goes up to 45. And again, this is instead of 30, which is again, granule ratio dosage is how I thinking about this.
[01:01:32] Speaker A: Sure.
[01:01:33] Speaker B: So in this pattern, the pulse actually comes superficial again. Says the pulse is superficial, but it says the person has difficult urination and then they have vexing body aches. Vexing pain generally in the body. It says eight or nine days, which just means it's long. They're hurting.
[01:01:54] Speaker A: They're hurting a lot.
[01:01:54] Speaker B: They're hurting a lot.
[01:01:55] Speaker A: Yeah, yeah.
And.
[01:01:57] Speaker B: And so there's more pain in this condition that's emphasized than in the previous two.
So with Guizhi jia fu zitang, the limbs are a little stiff.
[01:02:09] Speaker A: Right.
[01:02:09] Speaker B: Guizhio jia fu zitang. There's not even a mention of pain. Now, we know that there could be a little pain because of the previous formula, of course, but in this condition, the main thing that's mentioned is pain.
[01:02:23] Speaker A: Got it.
[01:02:24] Speaker B: So the pain is big, plus they have difficulty or a nation.
And it says they're not nauseous.
It says something like.
Says they're not nauseous or thirsty.
[01:02:39] Speaker A: Right.
[01:02:40] Speaker B: Not nauseous or thirsty.
[01:02:41] Speaker A: So it's like a urination presentation, but not a wuling san one.
[01:02:44] Speaker B: Not a wuling san one. So in this case, the yang has become deficient to the point where it's now starting to float again.
So we kind of went deficiency on the surface. The surface is over sweating. The yang is becoming deficient, and then it's starting to go. The pulse is going to get deeper and more faint.
And then if it proceeds, the yang is going to start to float again in its deficiency. So the more deficient version of the pattern is the yang starts to float up, which we can see in a lot of older patients. Right. Elderly people tend to have superficial pulses.
[01:03:20] Speaker A: Right.
[01:03:21] Speaker B: Sometimes very strong feeling pulses. But if we press into them, if we're careful and we assess it properly, there's nothing underneath it. It's all on the surface. It's all floating away.
[01:03:34] Speaker A: Right.
[01:03:35] Speaker B: So this is what's happening in guadrifutsitang. Vexing body aches, eight or nine days, difficult urination, no nausea or thirst. So it's not primarily a fluid metabolism problem. The difficult urination is happening because the yang is no longer in the interior. It's floating on the exterior.
[01:03:54] Speaker A: So it's insufficient to operate urination functions like you do.
[01:03:57] Speaker B: Exactly.
[01:03:58] Speaker A: Right. Or at least it's not where it's supposed to be.
[01:03:59] Speaker B: It's not where it's supposed to be.
[01:04:00] Speaker A: Right. So, I mean, if that's impacting urination, I suppose it could also impact bowel movements then.
[01:04:07] Speaker B: Correct.
[01:04:08] Speaker A: So similar level of floating young. It's not able to facilitate the downward movement through the intestines like it ought to. Right. I'm guessing we're going to need to make a change to deal with that. If we have also some kind of constipation, probably a wet constipation look. So what happens then?
[01:04:26] Speaker B: So the last line in that description says if there is smooth urination, so the problem isn't with urination, but there's difficulty with the stool instead.
Then we take out guijer and we add baiju.
[01:04:41] Speaker A: Got it.
[01:04:42] Speaker B: So same presentation, just with difficult urination, not there, and difficulty with the bowel movement is there. That's when we take out the gui ju and we add baiju. And the reason we're going to do that is because what's not said explicitly in the lines is that this is a wet type of constipation. We can't make the mistake in clinic of thinking that all constipation is dry.
[01:05:07] Speaker A: Right.
[01:05:07] Speaker B: A lot of it is either wet or mixed, which we've talked about before in our episode on constipation. Right. But this is one of the lines where it's explicitly named that you can treat constipation with baiju, a bitter warming herb, which is gonna treat a wet type of constipation, AKA a type of constipation that's caused by the internalization of dampness, obstructing the qi mechanism of the intestines. Mm.
[01:05:36] Speaker A: In that case, Baiju Futang, the guizhu's pulled out.
[01:05:42] Speaker B: Yep.
[01:05:42] Speaker A: Replaced with the baiju. The futa still remains in this granule ratio at 30 or is it up at 45.
[01:05:47] Speaker B: It's the, it's. It's at 45.
[01:05:49] Speaker A: It's at 45.
[01:05:49] Speaker B: It'S the same. Same ratio as the tongue.
[01:05:52] Speaker A: Yeah. Okay, so we still increased the futa, but we've just taken out the gu. Put in Baiju.
[01:05:56] Speaker B: Yep.
[01:05:57] Speaker A: What if people have both urine problems?
[01:05:59] Speaker B: It's a great question. Actually. In Castivision, I was. So we were going through this, I was like, I need to ask somebody about this to be sure. So I asked one of my colleagues and actually one of my British colleagues got back to me and he was like, the postscript line says if there's also difficult urination, keep Guizhu in.
[01:06:22] Speaker A: So you just leave it in.
[01:06:22] Speaker B: So you just leave it in.
[01:06:23] Speaker A: Just put them together.
[01:06:24] Speaker B: You put them together.
[01:06:25] Speaker A: Yeah. Guizhu Fu Zitang plus Baijiu.
[01:06:27] Speaker B: Right. Or I think it does make sense. Or I think you could do the next formula, which is going to make sense after we go over the ingredients to that one.
[01:06:36] Speaker A: Right. So essentially the final one here in our Guijer Futza method is we have a chronic problem.
I mean, all of these are chronic, but this has been going on for a while.
Plus the other thing that we were talking about in the canned sweat category. Right. So joint pain and swelling. Is this the same kind of flesh level swelling, not deformative swelling?
[01:07:02] Speaker B: This is the same kind of.
Yeah, it's in the, in the last formula you're talking about. Yeah, I think this is a little bit of the deformative.
[01:07:11] Speaker A: So we're starting to get to it. We're starting place.
[01:07:13] Speaker B: Yeah.
[01:07:14] Speaker A: Okay.
[01:07:14] Speaker B: Yep.
[01:07:15] Speaker A: And so that formula, what changes are we making to get there? So we've gone through this whole thing where the person, you know, maybe has urine problems and constipation problems. The pain is more, it's less, just generally diffuse. And now in the joints, it's been going on for a while. And we've got both the flesh level swelling and potentially the early stages of deformative swelling. Right. What do we have to do with that?
[01:07:39] Speaker B: So this is, this formula is called Ganzhou Fucitang, which is Gui zhi, fuci, Baiju and Ganzao. So it's just those four. So the structure changes a little different. It stops looking like a Guizhu tongue.
[01:07:55] Speaker A: Right.
[01:07:55] Speaker B: Formula.
[01:07:55] Speaker A: Because you've taken out the Shengjiang and the data. Right? Yeah. Why do you think those are gone?
[01:08:00] Speaker B: That's a really good question. I'm not totally sure.
[01:08:03] Speaker A: I wonder if there's some concern about the sweet flavor like contributing to fluid accumulation or maybe or something like that.
[01:08:13] Speaker B: Because of the swelling tank. Yeah, maybe.
[01:08:15] Speaker A: Although I don't know, to be honest, why you'd pull the Shangjiang out, though, I don't either. That's a confusing one. Because you'd think you would want some of that warm, acrid.
[01:08:23] Speaker B: Right.
[01:08:23] Speaker A: Movement, you know, but who can say? All right, so Guijer fuca, Baiju, Gansao.
[01:08:31] Speaker B: Right, Gansao Futong, Gansao Fu zitong. So difficult urination is mentioned again.
[01:08:37] Speaker A: Right.
[01:08:37] Speaker B: Just like in the previous formula.
[01:08:39] Speaker A: Right.
[01:08:39] Speaker B: But it. But we don't have any mention of constipation. But if the Baiju was introduced.
Right, you could have difficult urination and wet constipation for this formula.
[01:08:49] Speaker A: Zhangjiang Jing just forgot to write that down.
Yeah, I mean, it's the same because it's like, it's progressive.
[01:08:55] Speaker B: Yes.
[01:08:55] Speaker A: And if the Baiju got added into the formula for Baiju fucitang, that's why it's still here.
[01:09:01] Speaker B: Right.
[01:09:01] Speaker A: In fact. And it also wouldn't surprise me that someone who had this increased level of complexity in the presentation is having elimination problems because the body's wicked deficient.
[01:09:11] Speaker B: Right.
[01:09:12] Speaker A: You know, just the Yang is insufficient to run all of the systems that need to be run. And so of course you're going to end up with elimination problems and you wind up with elimination problems then. Well, we need to get stuff out. So insert the Baiju.
[01:09:24] Speaker B: And in addition to that, we have shortness of breath and sweating mentioned again, which I think is just in there to show us that this is a more chronic deficient picture.
[01:09:36] Speaker A: Sure.
[01:09:37] Speaker B: And then there is also the difference between vexing body aches. So it's diffuse, which is in the previous two formulas.
[01:09:46] Speaker A: Right, Right.
[01:09:47] Speaker B: Wager and Baiju Futang versus specifically joint pain is mentioned in this line. So there's a little bit more emphasis on joint pain.
[01:09:56] Speaker A: Yeah.
[01:09:57] Speaker B: And it's. And there is a mild swelling line mentioned, which I think is. This is the joints. The joints are starting to change in their quality. So this could be like early stage rheumatoid arthritis even, or some. Something like that.
[01:10:12] Speaker A: Right? Yeah, yeah. Some kind of autoimmune presentation that's attacking joints.
[01:10:16] Speaker B: Right?
[01:10:16] Speaker A: Yeah, that makes sense to me.
Okay, well, I think that's probably a good spread. I think we. There's a fair number of formulas of people to play with, and using sweating as sort of the introductory differential to help kind of put people into rough categories, I think is a good methodology and understanding sort of how sweat or the lack thereof or the abundance of is some relationship to Yang's health. Yep. And how we actually have to get in there I think is really, it's a good thing for people to play with.
[01:10:47] Speaker B: Yeah, for sure.
[01:10:49] Speaker A: Okay.
Well, everybody, thanks as always again for listening to us chat about some formulas on the Nervous Herbalist. We really appreciate your time and your attention.
Wherever you listen to podcasts, please rate and review us. It helps other people find the show and we always would love more people to listen to what we have to say and to offer us some other ideas for topics. So if you have anything you'd like us to talk about, send it over to thenervousherbalistmail.com, thenervousherbalistmail dot com we'd love to hear your suggestions or to just hear from you if you have some follow up questions. And let everybody know in your Chinese medicine community that they can come and listen about different ways to use herbs because we always want people to use more herbs whenever possible.
And so with that, I'm Travis Kern.
[01:11:36] Speaker B: I'm Travis Cunningham.
[01:11:37] Speaker A: And we'll catch you next time.
[01:11:38] Speaker B: Catch you next time.
