Show Notes
TK asks TC about a couple of chronic pain cases to better understand the theory as it applies to real people.
Chapters
- (00:00:00) - Introduction and Case 1
- (00:29:11) - Case 2
View Full Transcript
Episode Transcript
[00:00:03] Speaker A: Hi, everyone, and welcome to the Nervous Herbalist, a podcast for Chinese medicine practitioners who like herbs and want to learn more about their function, their history, and treatment strategies to use in the clinic. Let's get into it.
[00:00:18] Speaker A: Hello, everybody, and welcome back to the Nervous Herbalist. My name is Travis Kern and I.
[00:00:22] Speaker B: Am here with Travis Cunningham.
[00:00:25] Speaker A: And we are following up on our last episode where we talked about some chronic inflammatory conditions, some pain conditions, and some various presentations. And so we wanted to bring you guys a couple of case studies to round out the theory and give some practical insight. So t. What do you have for us today?
[00:00:46] Speaker B: Yeah, so for the first case, I have a person that I've. I'm actually still seeing. So this. This patient is still coming in to see me as we speak. So the case isn't complete, but it's worth sharing, I think, at this stage in the process anyway.
[00:01:02] Speaker A: Just because of how it's developed.
[00:01:04] Speaker B: Yeah, just because of how it's developed. And it's such. It's almost like an archetypical example of one way to treat this type of pain.
Yeah.
[00:01:14] Speaker A: Okay, walk us through it.
[00:01:16] Speaker B: So this person is a 43 year old female, and the chief complaint is chronic pain.
This person does have a fibromyalgia diagnosis and has had this type of pain for many, many, many years.
[00:01:32] Speaker A: Okay.
[00:01:33] Speaker B: And the pain is all over the body, but especially in the right. On the right side, the right foot, the hips, rib side, and then the occiput, the head. So it kind of spans the whole gamut, the major joints, but just on the right side. Mostly on the right side. So it's. It's both sides, but the right side is really what bothers this person.
[00:01:58] Speaker A: Okay. And then it's like, what kind of pain?
[00:02:01] Speaker B: It's heavy, achy.
[00:02:05] Speaker B: And the patient is also, if you look at the tissues, the tissues are slightly swollen.
So not like really swollen, but slightly.
[00:02:15] Speaker A: Okay. And then is that the thing that brought them in here in the first place?
[00:02:18] Speaker B: Yes.
[00:02:19] Speaker A: So they were like, I have this weird pain and I need help. Yeah.
[00:02:23] Speaker B: And this person is into yoga and somatic therapy. And so there they came in and were kind of like, you know, I'm usually pretty good at managing this stuff myself. I do all the right things, but I do have it.
She did say she has a history of PTSD and abuse that goes into childhood. She didn't get into detail, but.
[00:02:46] Speaker A: But.
[00:02:47] Speaker B: But this pain has been something she's.
[00:02:48] Speaker A: Dealt with for a long time.
[00:02:50] Speaker B: A long, long time. Yeah.
[00:02:52] Speaker A: Had she seen other practitioners about it before us?
[00:02:55] Speaker B: Yes.
[00:02:56] Speaker A: What did they say? They.
[00:02:59] Speaker B: So practitioners. Yes. Chinese medicine practitioners.
[00:03:03] Speaker A: No, no, no. Yeah, but the biomeds, what they say.
[00:03:06] Speaker B: They thought it was. They just called it fibromyalgia.
[00:03:09] Speaker A: Yeah. That was the end of it.
[00:03:11] Speaker B: Yeah.
[00:03:11] Speaker A: Okay. And I guess that's because she hit the. The point pain metrics, like, if you have, you know, seven of the 11 or whatever it is, then you end up with the diagnosis.
But they didn't have any treatment option for her.
[00:03:23] Speaker B: No, not really.
[00:03:24] Speaker A: Okay.
[00:03:25] Speaker B: Yeah.
[00:03:25] Speaker A: Okay. So you. She comes in, you do your analysis. What do you find?
[00:03:30] Speaker B: So there's a few interesting things about this case.
One of them is earlier on, in her teenage years, she had a hiatal hernia surgery. So pretty bad. Hiatal hernia and then surgery. And since the surgery, patient reports that the pain that she was experiencing there has gotten quite a bit better.
But she has to be careful how much she drinks fluids after she eats food.
[00:04:01] Speaker A: Right.
[00:04:01] Speaker B: Because if she drinks too much water after she eats, like in a meal, she'll immediately vomit.
[00:04:10] Speaker A: And this has been for how long? For like two decades. Wow.
[00:04:14] Speaker B: Yes.
[00:04:14] Speaker A: Yeah. Okay. Yeah. Pretty.
[00:04:16] Speaker B: Pretty extreme.
So she's learned to not do that, obviously.
[00:04:21] Speaker A: Yeah.
[00:04:22] Speaker B: If it's not around food, if the stomach isn't that full, then she can drink fluids and it's fine.
But if she drinks too many fluids, even on an empty stomach at once, she gets discomfort in the stomach. So she may not have the vomiting symptoms, but there is, like a discomfort thing that happens.
[00:04:41] Speaker A: Yeah. Does it matter? Did she say if it mattered? If it was like, hot liquids or cold liquids?
[00:04:47] Speaker B: She trends toward drinking warmer liquids anyway. I think because of the kind of. The yogic, you know, Ayurveda sort of slate.
[00:04:57] Speaker A: Sure, sure.
[00:04:58] Speaker B: Background Eastern.
[00:04:59] Speaker A: Eastern medicine influence has everyone running away from ice.
[00:05:02] Speaker B: Yes.
[00:05:03] Speaker A: Right. Okay.
[00:05:04] Speaker B: Thankfully.
[00:05:04] Speaker A: Thankfully, don't do it to your guts. I mean, it's nice to have a cool glass of water. Like, you know, where we live here in Portland, Pacific Northwest, the water is like. It just comes out of the tap, kind of cool even in the middle of the summer. And in the winter, it's, like, legitimately cold. But it's funny because where I grew up in Louisiana, the water's like, warm.
[00:05:23] Speaker B: Yeah.
[00:05:23] Speaker A: It comes out of the tap warm. Like, cold water isn't really cold.
So everyone's always using ice.
[00:05:30] Speaker B: Yeah.
[00:05:30] Speaker A: But you know, up here, and maybe just another context, just less cold.
[00:05:35] Speaker B: Yeah.
[00:05:36] Speaker A: Probably better. Yeah. Okay, so.
[00:05:39] Speaker B: So when I examined the abdomen, I found costal tenderness that was pretty stark in the right costal region a little bit on the left side, less so.
I found a water splash sound over the stomach.
[00:05:56] Speaker A: And that's the percussive move, right?
[00:05:59] Speaker B: Yep. And then there was a hard pee or hard glomus in the epigastric region. So I felt something that was hard pressed in and it was uncomfortable.
So there's that. And then the only other thing was the below the umbilicus felt kind of lax, empty. The tissue was very loose and felt like it didn't have much texture or tensegrity.
Does that make sense? Tensegrity, Tensegrity, like.
[00:06:32] Speaker B: Doesn'T.
[00:06:35] Speaker B: Like a trampoline. Right.
[00:06:36] Speaker A: Has a lot of like it doesn't have sufficient tension.
[00:06:39] Speaker B: Tension. Yeah. It doesn't have like a. Yeah. I don't know how to say that.
[00:06:44] Speaker A: Yes.
It's softer than it ought to be.
[00:06:47] Speaker B: Softer than it ought to be.
[00:06:48] Speaker A: Press into it and it just plummets. Yep. You know, I don't know that we've ever said maybe we have in some of these episodes, but when you're doing the abdominal palpation, are you touching the skin itself?
[00:07:00] Speaker B: Yeah.
[00:07:00] Speaker A: Yeah. So you're actually in contact with the skin, right?
[00:07:02] Speaker B: Yeah.
[00:07:03] Speaker A: So practically speaking, because I've noticed this with my own abdominal palpation now that we're recording this in the fall, so we're coming into winter, everyone's wearing more clothes. You've got more layers on.
Very fashionable toward high waisted pants right now, especially among women. So that means I've got like a high waisted pair of trousers on that's like basically right in the middle of the palpation zone.
[00:07:27] Speaker B: Yeah.
[00:07:28] Speaker A: So practically, are you just having them roll that down so that you can get to the whole abdomen?
[00:07:33] Speaker B: Yep, I have them roll it down.
[00:07:35] Speaker A: Yeah.
[00:07:35] Speaker B: And it just has to be like.
[00:07:37] Speaker A: A little bit below.
[00:07:40] Speaker A: The.
[00:07:40] Speaker B: The umbilicus. Like a, A good. I don't know, see, like CV4 or something like that.
[00:07:49] Speaker A: Yeah. So like two and a half inches below the.
[00:07:52] Speaker B: Yeah, exactly.
[00:07:52] Speaker A: Yeah.
[00:07:53] Speaker B: Yeah.
[00:07:53] Speaker A: Okay. Well, and this is something, you know, just as a pragmatic matter, if you're going to be examining people's abdomens, especially if you're just going to start doing it, your patients are not accustomed to you doing it, you're going to need to give them a little bit coaching about what to wear. Yeah. Because people will come in with, you know, under layers on or like athleisure stuff that's like really tight or like kind of leotard in style. And so you're gonna have a hard time actually getting to the skin. So it's important to just prep people with like, hey, make sure to wear loose fitting clothing, make sure we can actually get to the abdomen. And then once they're used to you doing it, you won't have to coach them. But. Right. Sometimes it's just a very small pragmatic thing that can happen where it's like, oh, I need to fill your abdomen, but there's actually like five layers of cloth right in between me and your skin. And so it's an important thing to remember.
[00:08:41] Speaker B: Yeah. And if you don't actually touch the skin, you can get some of the findings, but you don't get things like the warmth or coolness of the skin, which can be really diagnostically helpful. You can also tell if the surface is open on a lot of people because they're slightly sweating on the abdomen. So these kinds of things. And then the texture qualities are harder to get right, which is kind of what we're pointing to there.
[00:09:08] Speaker A: Like the texture of the tissue. Right. The texture of the tension.
[00:09:12] Speaker B: The tension, yep. Exactly.
[00:09:14] Speaker A: Yeah. Because the cloth can mask that, like create tension when there isn't any. Or it's usually that way where the cloth is sort of like holding things in a tighter way than is necessarily the case. If you were just touching the skin and the abdomen directly.
[00:09:28] Speaker B: Yep, absolutely.
[00:09:30] Speaker A: So we've got water splash sound, we've got hard pee, and we've got a soft lower abdomen. Right.
[00:09:39] Speaker B: And then the costal tenderness.
[00:09:40] Speaker A: And the costal tenderness. More on the right side, more on.
[00:09:42] Speaker B: The right side, but a little on the left side too.
[00:09:44] Speaker A: Okay.
Walk the listeners through how those signs interact. What are, what are each of them telling you, and what kind of constellation do they create?
[00:09:54] Speaker B: So without any other symptoms, which we'll go over in a second. Of course, I'm thinking costal tenderness is pointing me toward the need to move Qi with the Chihu method.
The hard, hard P or hard glow mass is pointing me toward a Ren Shen type method.
[00:10:15] Speaker A: Okay. Sweet flavor to soften.
[00:10:17] Speaker B: Sweet flavor to soften. Right. So the hardness is. Is a dryness that's showing up in the middle jiao from some kind of dysfunction there.
And then the water splash sound shows that there are fluids that are sitting in the stomach inappropriately.
So the, the fukushin thing would be water toxin. That's what they would say. Shui du ku.
So this is. The water isn't moving through the stomach and the intestines appropriately. It's kind of hanging out there for too long. That can be the case with a lot of patterns.
[00:10:52] Speaker A: Sure.
[00:10:53] Speaker B: And then the emptiness below the umbilicus shows kind of a lower Jiao deficiency probably underlying the condition. But we may not be able to address that right away. Well, all the other stuff on top.
[00:11:06] Speaker A: Right, right. Because if you try to do it all at once, probably the.
The corrective pressure of the formula would be too, Too diffuse.
[00:11:17] Speaker B: Right. And some of the principles over, they kind of outdo each other.
[00:11:21] Speaker A: Yeah. They can sort of contraindicate it. Not exactly, but they. Yeah, they have a contrary nature if you did them all together. Right.
[00:11:28] Speaker B: Yeah.
[00:11:29] Speaker A: Okay.
All right. So now what else did you gather though? Because probably we need some clarifying information.
[00:11:36] Speaker B: Yeah.
So the pulses are relatively superficial and a little bit wiry, especially in the middle positions.
The symptoms that I gathered were the person is thirsty most of the time.
Their temperature can be hotter or cooler, but they have aversion to cold at times. They don't like the cold.
[00:12:01] Speaker B: They also struggle with chronic fatigue, which is connected to the pain. The pain flares. The person is more tired, more fatigued.
[00:12:09] Speaker A: Okay.
[00:12:10] Speaker B: Sleep is actually pretty good, strangely enough. Right.
[00:12:16] Speaker B: Urination is hesitant at times.
And the person does experience dizziness with postural changes.
[00:12:26] Speaker A: Okay.
[00:12:26] Speaker B: Frequently.
[00:12:27] Speaker A: Okay.
[00:12:29] Speaker B: So that's, that's the picture that I got there.
[00:12:32] Speaker A: So I mean, with the, like. Let's just start with the pulses. So relatively superficial and wiry, you said. Right. So that is, I'm guessing, further supporting this Chi. Need to move chi presentation with the Chihu method. Yeah, yeah. And then even some of the other stuff too. Right. Like the postural dizziness and things like that, indicative of a similar chi movement problem.
[00:12:54] Speaker B: Yeah. Dizziness is a funny symptom because it could be a chi thing or it could be a water thing.
[00:13:00] Speaker A: Right, Right. Yeah, yeah. Dizziness is a funny thing and it really looks different in a lot of different people. It can really change the way it looks over time.
Okay. So with that information and of course, keeping in mind that pain, this broad spectrum body pain, more on the right side, but particularly at these joints and articulations, is the symptom.
What was the first step?
[00:13:22] Speaker B: Yeah, so I did Chai lingtong, which is going to be Xiaochai Hutong plus Wulingsan.
And the way that I like to give that nowadays is to take out the Huang chin. And the reason for that is in the postscript modifications for Shao Cai Hutong. And the Shanghan lunatic says if there's palpitations or something going on in the chest with difficult urination, you take out the Huang chin and you add fuling.
So if we're going to add Wuling San. Fu Ling is in the formula. Right.
And so it's just an easy thing. I also like to take it out because if you're doing granules, I want to give as few ingredients as possible because I don't want the.
The effect of the formula to be too diffuse.
And if you're doing Xiaochai hutong regularly got eight ingredients, Wuling San, you've got another five.
So you're getting up to your 13, you know, like, you're getting up there a little bit. And I would rather have it be smaller if I can manage it. So I just, I've been doing it without the Huang Chin, and I've been liking that recently.
[00:14:30] Speaker A: Yeah. I wonder because, you know, we think of the Huang Chin and Xiao Caiutang. I mean, in some ways, Huangchen and xiaocheiutang is at first pass, a little bit odd.
[00:14:41] Speaker B: Yeah.
[00:14:42] Speaker A: Because you're like, oh, why do we need to like, it's a cooling herb, upper burner, focus.
But, you know, because of what happens with Qi stagnation over time and failure of Xiaoyang to pivot, like, of course there can be heat accumulation, cause vexation, et cetera. It makes sense. But in this context, because we need to, like, the core problem is not this higher surface level Xiaoyang issue. It's just that, like, we have a disharmony that needs to be corrected. So maybe by just including the other elements of it works. And as you've seen, it does work.
We don't lose the harmonization function by taking out the Huangchen. Right. Okay. So.
[00:15:25] Speaker A: All the other doses are the same for Xiao Cautang. Yeah, you just take long stand. Okay. And. And then you just add in the Wulingsan, also at the standard Shanghan numbers. And then what was the dosage per day?
[00:15:36] Speaker B: I did eight grams twice a day for seven days of a granule formula.
[00:15:40] Speaker A: Okay, and then what happened?
[00:15:43] Speaker B: Yep. So the next week, the patient came back and she was, this is a direct quote, shocked that she wasn't in pain every day.
Like, she had been.
[00:15:57] Speaker B: Pretty dramatic reduction in pain. So I recorded the first one. She sort of rated the body pain to be 6 out of 10 in intensity. And she said that after the first day or two of taking the formula, the pain went down to a 0 to 2 out of 10. So some days there was pain, but it was relatively minor. Other days there wasn't any pain that they noticed.
[00:16:20] Speaker A: Wow. This is just in the first week.
[00:16:22] Speaker B: This is one week.
[00:16:24] Speaker A: Unbelievable.
[00:16:24] Speaker B: Yeah.
[00:16:26] Speaker B: Urination also felt smoother. The patient reported feeling more grounded in their body and just generally feeling better.
[00:16:37] Speaker A: That's a pretty profound shift. Yeah. Okay, So, I mean, at that point, though, we're not imagining that, what, like two decades of discomfort is corrected in a single week? So. No, no, you just continue with the same formula.
[00:16:51] Speaker B: Same formula, refilled. Two weeks.
[00:16:53] Speaker A: Okay.
[00:16:54] Speaker B: Yeah.
[00:16:54] Speaker A: So then she comes back in. In two weeks. That's three weeks total on this formula. Yep.
[00:16:59] Speaker B: And actually this patient hasn't come back in yet. So this next week we're going to check back in about.
[00:17:05] Speaker A: So this will be to see. Yeah, Yep. So on a speculative note, I mean, so we have this example, and the reason we included it, even though, of course the case isn't concluded, is because it's such a powerful example of the transformation.
[00:17:17] Speaker B: Yes. And to. To illustrate, you know, like, we hear Chai Huijir Tong is indicated. We talked about this in the last episode. For joint pain.
[00:17:28] Speaker A: Right.
[00:17:29] Speaker B: But Chai lingtong can also be really good for treating joint pain. Xiao Cai hutong Wuling san. Now, there's no textual. Like, this combination doesn't occur in the Shanghan. There's no note of it. But of course, throughout the centuries, people have combined these things and found that they really work.
And so you're not going to find any lines for Chai Lingtong in the Shanghan line.
[00:17:53] Speaker A: Yeah, I mean, you're not even going to find that phrase.
[00:17:55] Speaker B: You're not going to find that phrase. Yeah, exactly. So, but it's a very useful formula structure for a lot of things. And the key aspects of this case that pointed me to it versus a, let's say Chai Huizhi tong or Chai Huger Ganjiang Tong pattern was the water symptoms in the stomach. This, like, tendency for water reversal.
[00:18:18] Speaker A: Right.
[00:18:18] Speaker B: Would be how the classics would put it, where the water goes in and when the stomach is full, it comes right back up.
[00:18:25] Speaker A: Right.
[00:18:25] Speaker B: That standard water reversal pattern, that's Wuling San.
[00:18:29] Speaker A: Well, and she's thirsty.
[00:18:31] Speaker B: Thirsty.
[00:18:32] Speaker A: Super thirsty. Yeah. Which is always such a strong indicator. I mean, it's interesting.
It's interesting that there isn't actually a specific Shanghan line for this Chilingtong idea.
[00:18:46] Speaker B: Yep.
[00:18:47] Speaker A: And, you know, obviously, Zhang Zhongjing could not cover every possible incarnation of a formula, but because it's so comprehensive, generally speaking, it's a little bit surprising because of how commonly we see today this combination need, like this harmonization, stagnation in the pivot, plus water accumulation, thirsty people with urinary stuff. Like, I mean, I see this Constantly.
[00:19:13] Speaker B: Yeah.
[00:19:13] Speaker A: I mean, even like in this context, we're talking about it relative to this inflammatory conditions and pain. Right. But I mean, I see it also in inflammatory conditions and bowels.
[00:19:23] Speaker B: Yeah, of course.
[00:19:24] Speaker A: Come in. And there's just, you know, strong thirst and weird fluid accumulation and a intense need to harmonize. And, you know, you and I have talked about this a little bit in other contexts, but increasingly, the longer we do this work and the more we see patients, the more it comes to my mind that there are some.
I don't know if they're trigger factors or what, but there's some component of being a modern person in a modern context that tends to cause certain types of disease presentations. And Xiaoyang failures, pivot failures seem to be one of the biggest ones.
[00:19:58] Speaker B: Yeah. So ubiquitous.
[00:20:00] Speaker A: And I mean, just, you know, I strongly encourage all of you listening who haven't deeply got yet into abdominal palpation. But. But you can learn a little bit from us talking about it. You'll eventually want to see someone do it. Find some local fukushin people in your area. But the truth is that once you. Even without that, even if you just start palpating the four quadrants of the body, so upper left and right under the ribs, and lower left and right, sort of right over the front of asis, like just tuck your fingers on the inside portion of the asis in that little valley and just do that alone. And you will be amazed with how many people have subcostal rib side pain.
[00:20:42] Speaker B: Oh, yeah.
[00:20:43] Speaker A: I mean, it's just like mountains of them.
[00:20:46] Speaker B: Yeah.
[00:20:47] Speaker A: And if you treat that with some chaihu method, oftentimes just straight up xiaochaiutong, your ability to make change deeper into the pattern is massively improved.
[00:20:59] Speaker B: Absolutely.
[00:21:00] Speaker A: And that is so fascinating to me, and I don't know what to make of it, except to say that of course, the world that Zhang zhongjing wrote, the Shanghan Lun in, is infinitely different than the world we live in now. And the humans are the same, which is why the formulas are so useful. But the qi of their circumstances is really profoundly different.
[00:21:19] Speaker B: Right.
[00:21:19] Speaker A: And so you can imagine if there were a doctor like Zhang zhongjing writing today, it'd be interesting to see how the Shanghai might be oriented differently because of the. The presentation of the humans in this time.
[00:21:33] Speaker B: Yeah, I think about that all the time. But, you know, we were talking about the text that Inaba wrote. This Inaba, for those of you who don't know, is one of the people in the Fukushin line. And Inaba was kind of an interesting character historically because he was an alcoholic. Then had this revelation of I need to do something useful with my life. And this Campo master kind of took him on, took pity on him and took him on as a student.
[00:22:04] Speaker A: Yeah.
[00:22:05] Speaker B: And one of his penances, so to speak, is to draw pictures of people with the different abdominal patterns and then publish this material. And there's some disagreement about is all the stuff that came out his or is it partially attributed to one of his students or whatever. But it doesn't matter. It's, you know, this is like 17 or 18th century Japan. Like it's pretty.
So it's a few hundred years ago and in that text there's commentary.
Inaba says six or seven out of 10 patients roaming the countryside have a chihu pattern. He says that in the text. And this is, you know, they're going into the, these busted villages of war torn Japan and people are sick. And you see, you see a bunch of intense formulas in that thing too that are used for purgation and all kinds of stuff that we don't see as much today. But he says that about the Chaihu patterns even then, that there's so much, such a high percentage of use for those things even a few hundred years ago.
[00:23:16] Speaker A: It's fascinating to think about. I think as modern people you have a tendency to imagine that the stresses of modernity are unique and to the time, you know, But I think on the other hand, I mean, they are unique insofar as that, you know, people in Innova's time couldn't have imagined like the stress of your phone dinging constantly and managing emails or whatever. But the specifics are maybe less important than the notion that human beings go through intense cycles of high stress circumstances. And, and we always have, I mean, for all of human history we have, I mean, even to consider, you know, some of the foundational philosophical texts of Chinese medicine, like Confucian thought and Taoist thought are the byproducts of the Warring States period, which is basically like 175 years of just constant warfare and death.
And that's 175 years just constantly. There's no stability in virtually that entire period.
And so, and that was, you know, 2,000 years ago. So it's just the idea that there's always these cycles, you know, and then after that was Han unification and relative stability for 250 years in China. Single ruling dynasty, pretty on top of it. And then of course history moves again. So I mean, on the one hand, the times we Live in now can be particularly challenging, for sure. But on the other hand, human resilience has always been there. And Chinese medicine, I mean, it hasn't existed in the west, but Chinese medicine has always been adjusting and adapting itself to the people in a period because the principles are widely applicable. It doesn't matter if it's 200 AD or 1500 or now.
The core principles are the same. It just so happens that we probably use more Chihu method than maybe someone living in a different era would have.
[00:25:09] Speaker B: Sure.
Yeah.
[00:25:11] Speaker A: Okay. So this case is promising. I mean, we'll have to do a follow up in a couple of months with folks to let people know how it went. But I mean, the expectation is that, you know, this trend would continue. Now, just postulating, obviously the formula will probably change as the abdomen changes, the pulse changes, but in terms of the profundity of the change like this, this person's feeling so much better than they ever have before. How long do you think that they'll end up having to take herbs of some kind or another before you start titrating them off to see how things hold?
[00:25:43] Speaker B: A few months? Yeah. Three, four months, something like that for sure.
And probably I think it's going to go. It's tough to say how things will change, but I'm guessing I'm anticipating it'll be.
So let's say they come back in and those costal findings are off now, they're no longer present and the person is less thirsty. But I still see that hard P there. Then we might go to Li Jongwan, post this formula as a method, and then that starts to sort of settle out and the tissue relaxes and the digestion gets stronger and things like this. And then we then maybe go to a Gen Wutong method. That's kind of what I'm looking at for a patient like this.
[00:26:30] Speaker A: Got it.
[00:26:30] Speaker B: Yeah.
[00:26:31] Speaker A: Yeah. Because we're going to need to keep the fluids warm.
[00:26:33] Speaker B: Yeah.
[00:26:34] Speaker A: And then maybe move out, continue to move out, whatever pathological fluids remain.
[00:26:39] Speaker B: Right.
[00:26:39] Speaker A: But maybe just not as aggressively as we do with willing son. Right.
[00:26:42] Speaker B: And I, I do want to point out too that you can have a lot of the same symptoms in a Chai Huizhi Ganjung Tong pattern that we just described in this case. So you can have chai who symptoms. You can have thirst, high thirst, you can have difficult urination, you can have dizziness, all in a Chihuahui Ji Ganjung Tong pattern, which is talked about in the Shanghan Lun and in the Jing way.
But the difference Is for me, there's no water reversal symptoms.
So if the person has nausea, for example, this is not a good cai huiju. Ganjang tong is not a good formula because.
[00:27:22] Speaker B: The lower dose of the ganjang is not enough to warm the stomach overall when compared to 12 grams of Tianhua fen and 15 grams of Muli. Those are gonna cool the stomach too much. And the main reason people get nauseous is because their stomach is too cold.
So this person taking that formula, I think, would not be a good idea. It's way better to have standard xiao cai hutong, which includes bancha and shengjiang, into a wuling san, which is going to help transform the water, push it through.
So the key difference for me in those two patterns, even though all the symptoms can look very similar, is nausea or stomach reversal. Those are the key differentiators.
[00:28:08] Speaker A: Yeah. And also, too, wuling san is gonna, you know, deal with the fluids through bland flavor as opposed to something like cold and bitter, trying to move something out.
[00:28:19] Speaker B: Yeah, that's the key difference right there.
[00:28:21] Speaker A: Bland flavor.
Okay, well, that's. I look forward to finding out how it's stuck and ultimately maybe tracking the full resolution of that over the next several months. But it's an important indicator into how using that method result in really positive outcomes.
[00:28:39] Speaker B: Yeah.
[00:29:11] Speaker A: But you have another case for us?
[00:29:12] Speaker B: I do.
[00:29:13] Speaker A: Okay.
[00:29:13] Speaker B: This one's a throwback case to 2020.
So this was more than five years ago, actually.
[00:29:20] Speaker A: Oh, the easy times of 2020. What a year.
Yeah. For real.
[00:29:27] Speaker B: So this person also had a diagnosis of fibromyalgia, but they might as well not have. Like, there's so much going on with this person.
You know, they have pain everywhere.
[00:29:38] Speaker A: Right.
[00:29:38] Speaker B: Pain in the joints, double knee replacement, left side hip replacement, all kinds of pain, all the joint. So if you ask this person, where is your pain? That say, every joint in my body, in my muscles. It's everywhere, but not the bones.
So no report of pain in the bones.
Right.
[00:30:05] Speaker B: But especially the pain in the lower body. So all of my joints hurt, but especially my hips, my knees, my ankles, that kind of thing.
[00:30:14] Speaker A: Okay.
[00:30:18] Speaker B: Let'S see. This is also a 63 year old female. I should preface with clear.
Clear data here.
Chronic knee and low back pain, especially double knee replacement. Lots of swelling. So a ton of swelling.
[00:30:35] Speaker A: And we're talking like edematous swelling.
[00:30:37] Speaker B: Yes.
[00:30:38] Speaker A: Okay.
[00:30:38] Speaker B: Edema, swelling, a lot of swelling.
Very easy to sweat.
[00:30:45] Speaker B: Chronic loose stools, three to six times a day.
Chronic fatigue. Picture.
[00:30:51] Speaker A: Okay.
[00:30:53] Speaker B: Thirst is a little difficult to say.
So thirst if you guys haven't tried questioning people about thirst to get a clear answer, it's tough. It can be tough for a lot of people. They'll say, oh, you know, I never really feel thirsty, but they drink water all day. You know, I'm like, just. They're constantly slugging water as you're talking to them. No, I never get thirsty. Oh, I stay pretty hydrated. Or they'll say, I drink plenty of water. Which isn't the question. Right. The question is, do you feel thirsty?
[00:31:24] Speaker A: Right.
[00:31:25] Speaker B: But they don't answer that question.
[00:31:26] Speaker A: I would say, like, the majority of people answer my question, do you feel thirsty? With I drink a lot of water.
[00:31:33] Speaker B: Yeah.
[00:31:33] Speaker A: It's really fascinating. And my follow up to that is, are you drinking a lot of water because you're thirsty or because you know you should? Yeah, that's literally what I. What I say. And so many people are like, oh, yeah. I mean, I just drink it because I know I'm supposed to.
[00:31:48] Speaker B: Yeah.
[00:31:49] Speaker A: You know, like. But you need to force that clarifier because people are imagining that asking if you drink a lot of water, which isn't what I'm asking. Right. It's also easier if people have, like, dry mouth or tacky mouth or like a hot mouth. Like, people will be like, yeah, I just, like, put the water in my mouth.
[00:32:04] Speaker B: Yeah.
[00:32:04] Speaker A: And just hold it there. You're like, okay, you're a thirsty person, you know, but sometimes it's. It's not. People just aren't sure, you know? And then they're drinking water all the time. Because people who are really thirsty in the Wuling San Wei drink water.
[00:32:19] Speaker B: Yeah.
[00:32:19] Speaker A: But they're just like, as soon as they're done drinking, they're thirsty again. Right. You know? Yeah. So in this case, it's unknown. The person thirst is unknown. Unknown.
[00:32:30] Speaker B: They do get short of breath. So I noted that as well.
I wasn't doing Fukushin back in 2020, so unfortunately, I don't have that to contribute. But I can say that the pulse is soft, moderate feeling and floating. So it's superficial.
[00:32:45] Speaker A: Okay.
[00:32:47] Speaker B: So the formula that I wrote for this person is a formula called Fengji Huangxi Tang.
[00:32:54] Speaker B: Which is a Jingwei formula for something called skin water.
[00:32:59] Speaker A: Right.
[00:32:59] Speaker B: Which is the presence of. It's a little bit like when we were talking about Yuebitang in the last episode, but Yuebitang is a little more excess Fengji Huang Qi Tong is a little more deficient cases.
And I ended up using.
This is when we were doing primarily bulk herb. So we did bulk, and I did huang qi at 15 grams. Kind of have a tiering of Huang Qi dosage, so I included that in the case here.
[00:33:31] Speaker B: So I did that for two weeks.
Person came back in two weeks later and said that their pain was about 50% better.
In addition, sweat is less frequent, Bowel movements are slightly better.
She said three times a day instead of three to six. Still on the softer side.
And the fatigue seems to be improving a little bit.
[00:34:01] Speaker B: Check the pulses again. They're still similar.
Yeah, go ahead.
[00:34:05] Speaker A: So let's think about this case a little bit for a second. So fangji Huang Qi Tang is a very interesting formula. Han Fang Ji is the fangji of the name there.
And that herb is.
It's weird because it's actually kind of hard to find. And the reason is because there was an adulterant for fangji that was toxic that made its way into the. The. In the material. It wasn't the official species, but it made its way into the industry in the middle. Part of it was like the 80s or something. It started in the 50s, but it moved all the way through the 80s and 90s. And then people, frankly got sick, and some of them died with kidney failure and other poisoning and stuff. And so fangji became a. Like, a scarier people like, oh, Fang Zhi is dangerous, but actually, as is so often the case is because the herb was adulterated.
[00:34:58] Speaker B: Right.
[00:34:59] Speaker A: So Han Fang Ji is the whole plant that you're looking for now. It's like a chalky white root that has little tiny holes in it, kind of in the style of mutong, sort of like little tiny holes, right? Yeah, it does kind of mutong's more woody, but it just has those little holes in it.
So anyway, I think it's a formula that we just didn't really learn a whole lot about because people were, like, afraid of the fangji in it and just sort of disregarded it. Like, oh, this is not really a formula we can use, but it's a great formula, particularly for managing this kind of water accumulation.
So based on the pulses and the questioning and your knowledge at the time, what did you think was the underlying problem here? Like, what was causing the pain?
[00:35:45] Speaker B: So the main thing that I looked at being related to the pain was the swelling. The swelling and the tissue was extreme. Like.
Like the. This person's legs are like the size of my torso. I'm a relatively thin guy. Yeah, I should preface you guys don't know what I look like, but this person's legs were like the size of.
[00:36:07] Speaker A: My torso and like, shiny swollen.
[00:36:10] Speaker B: Yes, very swollen.
Yeah, extremely swollen. So the swelling was a big issue, but also the fact that they're easy to sweat.
So those two things. Again, talked last time about how important it is to assess for sweating, because sweating is really important. Talking about how the body's diffusing pressure on the surface and a picture that's really easy to sweat with a lot of swelling points us to different things than if they can't sweat at all with a lot of swelling.
[00:36:41] Speaker A: Right.
[00:36:41] Speaker B: You see Guizhu Shaya, Jrmutong in the lines, they say that the person's so swollen that their extremities look like they're gonna fall off. Right.
But this is a non sweating sort of pattern versus, in this case, the person is easy to sweat, and the pulses are superficial and soft.
So this points me to that Huang Qi method. Right. We need to tonify, we need to strengthen, and we kind of need to lift.
This is also a patient that not a part of this case, but in a different time. When I was treating her, I was able to successfully use bujongnichitang, which anybody who's tried to use bujongnichitang knows it's a very difficult formula to get to work in clinic. You read it, it makes a lot of sense. People should respond really well to Bujeonggi Tong. But then you try to get it to work, and it's like, not too many people need. Can. Can tolerate this formula.
[00:37:43] Speaker A: Yeah, yeah. Interesting. So basically the. The pain pattern is essentially the excess fluid that's accumulated in the tissues is literally just swelling and pushing against all the joints and tissues in the swelling.
[00:37:57] Speaker B: Pushing against the joints, pushing on the blood vessels. Right. Causing like this. This patient definitely has blood stasis. But the way that I'm ruling that is the surface is so dysregulated, the Qi mechanism is so deficient, the fluids are blooming out of control and putting pressure on everything else. And that's the cause of the pain.
[00:38:16] Speaker A: Right, Right. Okay.
So by going with fungi, Huang Xi Tong. So the Huang Qi side of that is tonifying some of the. The deficiency. That's part of the pattern.
[00:38:26] Speaker B: Yeah.
[00:38:26] Speaker A: But the rest of the formula is moving the fluids out, correct? Yeah.
So gave it to them in bulk.
They took it for a week.
[00:38:35] Speaker B: Two weeks.
[00:38:36] Speaker A: Two weeks. And then what did we. What did we find? The pain was better.
[00:38:39] Speaker B: Pain was about 50% better. Now this is chronic, chronic pain.
[00:38:43] Speaker A: So visually, was the swelling different? It was, yeah. So you could see it.
[00:38:47] Speaker B: You could see A difference for sure.
[00:38:49] Speaker A: Okay, great. So what happened then?
[00:38:52] Speaker B: Yeah, so the pain was about 50% better.
This person also said that they felt like they were sweating less frequently.
[00:39:00] Speaker A: Okay, so that's good.
[00:39:02] Speaker B: Bowel movements were slightly better three times a day instead of three to six. Still on the softer side. Okay, so not perfect. And the fatigue seemed to be improved a little bit.
[00:39:12] Speaker A: Nice. Yeah. Okay, so, I mean, all signs pointing to the theory of the fluids being the core problem and moving the fluids out to alleviate the problem, supported by the results from those two weeks. So did you just keep her on it?
[00:39:27] Speaker B: Yeah, I kept her on it, but I bumped the Huang Qi dosage up to 30.
[00:39:30] Speaker A: Why?
[00:39:32] Speaker B: Because 15 is a low dose for Huang Chi. As far as what I've seen when I watch, when I've seen other people use Huang Chi. Yeah, people can use a lot of Huang Qi. So if that was successful, my. My thought is then, like, okay, can we get it even better?
[00:39:49] Speaker A: Yeah.
[00:39:50] Speaker B: If we bump the Huang Qi dosage.
[00:39:51] Speaker A: Yeah.
[00:39:52] Speaker B: And this is bulk herbs. So this is a true dosage increase. It's not like in granule, where you.
[00:39:57] Speaker A: It's relative.
[00:39:58] Speaker B: Yeah, where it's a relative, but then the other ingredients ratio downward.
[00:40:03] Speaker A: Right. So in this case, she's just literally taking twice as much Huang Chi in the same day.
[00:40:06] Speaker B: Correct.
[00:40:07] Speaker A: Yeah.
Man. It's really too bad that bulk herbs are so expensive.
[00:40:10] Speaker B: I know.
[00:40:11] Speaker A: Because the. The ability to directly leverage a change like that is so remarkable. Because even if you increase the Huang Chi in the granules, unless you're going to increase the amount of granules that they're taking, you're not going to get the same lift, and you're also going to have them taking more of everything at that point, as opposed to just adjusting the one item, because it's a different. A different mod. Unless somehow you had just individually packeted granules, you know, and you were like, okay, we're going to double the Huang Qi in this individual packet of granules, then everything else would stay the same. But that's just not how it works. Right.
Okay, so you doubled the huang qi to 30, and then she took the formula for another two weeks.
[00:40:58] Speaker B: She probably took it. I probably saw her in between now and this next date, but the next date I have recorded here is basically a month later. So I kept her on the same formula for a month.
[00:41:10] Speaker A: Nice.
[00:41:11] Speaker B: Um, and the result is the pain is continuing to improve.
Sweat is much less frequent. Seems. Seems normal when she describes it to me. Not to her, to me, to her, it seems like she's not sweating. It's abnormal.
But to me, it seems like she can. She sweats, you know, with exercise or something. But it's not. She's not just like walking around the house and sweating or sweating when the. When the person eats. This is a really interesting. I don't know quite the mechanism of this, but this is one of the things I learned that if a person gets sweaty when they're eating, this is a Huang Qi sort of method indication.
[00:41:49] Speaker A: Interesting.
[00:41:50] Speaker B: Yeah.
[00:41:50] Speaker A: I have no idea what that would be about.
[00:41:52] Speaker B: Yeah, me either.
[00:41:52] Speaker A: But.
[00:41:53] Speaker B: But that is, you know, one thing to look out for anyway.
[00:42:00] Speaker B: Fatigue is better still. Present bowel movements are similar.
[00:42:05] Speaker B: And then I inquired a little bit deeply, and the patient did say that there's some undigested food in the bowel.
[00:42:13] Speaker A: Okay.
[00:42:14] Speaker B: So this is still. Still a factor, which would mean that.
[00:42:17] Speaker A: They'Re still fairly loose.
[00:42:18] Speaker B: Yeah, they're still fairly loose.
[00:42:20] Speaker A: Yeah.
[00:42:20] Speaker B: Yeah.
[00:42:20] Speaker A: Okay.
[00:42:22] Speaker B: So I changed the method at this point to futility.
[00:42:26] Speaker A: Okay.
[00:42:27] Speaker B: Yeah. And I did it in bulk.
I think I used. I didn't write it down here, but I. Back in those days, I would always start fut15 and then go up if I. If I thought it would be more effective. So I very likely did that. And then Lijong Tang's just 9 grams for all the other ingredients, right?
[00:42:47] Speaker A: Yeah.
So that switch to warming the middle and warming the water is because you felt like you had drained enough and it was time to start restarting the internal mechanism to manage the water.
[00:43:01] Speaker B: Yes. Yeah. And I think if I were treating this patient now, I might have done it the opposite way, really, where I start with, because if I, If I heard that she was having three to six bowel movements a day, I would want to work on that more directly.
And there's no, there's nothing in the lines for Feng Ji Huang Qi Tong about digestion.
[00:43:23] Speaker A: Yeah, it's just water in the skin.
[00:43:25] Speaker B: Yeah, it's just skin water. And it. Clearly it was an effective method for the chief complaint. And.
[00:43:30] Speaker A: Yeah.
[00:43:31] Speaker B: So the patient was happy.
[00:43:32] Speaker A: But.
[00:43:33] Speaker B: But you might.
This person very likely could have done better on a futility Zhong Tang first and then move to a Huang Qi method later. That's also possible.
That would be my orientation more today, probably, if I saw this patient.
[00:43:49] Speaker A: Yeah, yeah, yeah. That's an interesting one. I don't know what I would. I think I might still lean on the fungi style of it just because the swelling was. So swelling was in your dispositions.
[00:43:59] Speaker B: Yeah.
[00:43:59] Speaker A: And like, you're going to warm the middle and help the, the digestion for sure, which will help the fluids, but maybe not as quickly.
[00:44:06] Speaker B: Right. It may not be as quick.
[00:44:08] Speaker A: And when such like when swelling is so obvious like that, like the skin is shiny, you know, you're like, oh man, we got to get these fluids out of here.
So probably I would guess that if I were doing it now, I maybe just wouldn't have run it for as long, but I probably still would have started with it. Because you ended up with basically six weeks on Fang Ji Huang Qi Tong. Right. So maybe you run it for three and then switch over. Or maybe even write some kind of fusion intermediary formula where you start warming.
[00:44:37] Speaker B: Up fuzza to the mix or something like that.
[00:44:41] Speaker A: Some ganjiang in like just start warming the formula and then put pull it over toward the futility Zhong Wan in the end. Right. But man, that's interesting. So ultimately she goes on to Fuzzi Li Zhong Wan. And then what happens?
[00:44:53] Speaker B: Bowel movements improved. So the next appointment was a little over two weeks after that last appointment, but like 16 days or something like that.
Bowel movements have improved two times a day. Soft but not loose. No more undigested food in the stool.
Pain is about 75% better from the beginning, and energy level is also improved.
[00:45:21] Speaker A: Nice. Yeah, so that's a, that's a win for futility, Jong Wan. Yeah, but of course, with so much fluid accumulation, so much chronic stuff, I mean, how long was this woman on herbs?
[00:45:34] Speaker B: So I, I just noted that I refilled this formula for two weeks.
And then what happened is the patient continued to take that, continued to feel better, and then we're getting closer and closer to the holiday at this time in the year.
And she just fell off of treatment. Right. Which was fairly typical for this patient. We ended up treating her intensely for a while, and then the treatment falls off, and then inevitably, six months later or something, she came back for a different thing. Right, right. So that's what happened in this case.
[00:46:06] Speaker A: Got it. And then was the pain still somewhat abated when you saw her six months later?
[00:46:11] Speaker B: The pain was better, but it had come back a little bit. Sure, yeah.
[00:46:16] Speaker A: Yeah. Because I mean, moving that, I mean, given age, that much fluid accumulation, that much middle jaw weakness for that, for the level of transformation that you saw to really stick?
[00:46:28] Speaker B: Yeah.
[00:46:29] Speaker A: I mean, practically speaking, that woman would have been on herbs for a year.
And with really, really intense and intentional dietary shifts toward avoiding cold and rot, warm foods, activity like all that kind of stuff like that would have been a heavy lift for that to Stick.
Realistically.
[00:46:50] Speaker B: Actually, the thing that changed, that stuck the most was the digestion. Yeah, the digestion improvement was the thing that stuck the best in that when she came back interesting months later.
[00:47:04] Speaker A: Well, and I mean the thing is that if, if you really warm up somebody's digestion well and they're not breaking it constantly with like smoothies and salad or whatever.
[00:47:14] Speaker B: Right.
[00:47:14] Speaker A: It will, it will stick.
[00:47:16] Speaker B: Yeah.
[00:47:16] Speaker A: You know, because like the body wants that to run and then it will over a decade peel off some of that fluid if you can keep it warm. But it's just going to take a really long time. Absolutely. Especially because it didn't like that condition didn't show up yesterday, right? No, no, no. Accretive over a long amount of time. And I think this is always a really interesting challenge because.
[00:47:39] Speaker A: People want to know, you know, can our medicine solve X? Can Chinese medicine correct Y?
And the thing is, is that. Yeah, yeah, for sure. You know, because the medicine scale, like the range of things that it can treat is the full range of the human experience. Like there isn't something that's like outside of our scope from a, particularly from an internal medicine point of view.
[00:48:02] Speaker B: Right.
[00:48:03] Speaker A: Trauma medicine and stuff, as we've said, is different. You know, if you get your arm ripped off, like please go have a biomed sew that back on. But the other stuff that we do, functional medicine, operational medicine, internal medicine, this is the, the real bread and butter. Frankly, most of what the lived human experience is, is where Chinese medicine really shines.
[00:48:24] Speaker A: But because people usually don't make their way to us, like this woman's case, until the problem is decades Old Person.
[00:48:32] Speaker B: 63, They've been dealing with pain. I mean there's double knee replacement, one of the hips.
[00:48:38] Speaker A: So much pain for so long.
[00:48:40] Speaker B: So long.
[00:48:40] Speaker A: Yeah. I mean in this point we can help to relieve it. We can make quality of life better. But.
[00:48:48] Speaker A: The ability for a 63 year old person with lifetime of pain to suddenly be spry and flexible and pain free and energetic is possible. It is possible. It just requires a huge amount of lift of effort on the part of the patient to change lifestyle, to stick with some stuff, to take herbs for a year or years, plural, you know, different formulas and different conditions, that's a lot. Because we have a lifetime of work to try and reorganize because every, every year of life shapes the trajectory of the future.
And it, it can, you know, contorts it to a particular direction. And the thing is that, that that trajectory can always be changed. Nothing is fixed. It's Just that after it's been, you know, hammered into form. Hammered into form, Hammered into form year after year after year, the ability to dramatically change its trajectory is hard.
[00:49:47] Speaker B: Yeah.
[00:49:48] Speaker A: It's just hard to do.
[00:49:48] Speaker B: It is.
[00:49:49] Speaker A: It's not impossible. By no means is it impossible, but it's hard. And so in this case, like, what can you realistically expect for a person in this condition? It's probably what you described. Stronger digestion, less, you know, undigested food, less frequent and urgent stool, less sweating, and less intense swelling. I mean, that's great. I mean, you know, it's not a perfect resolution of the case, but it's a remarkable change.
And it also indicates that that trajectory has shifted. You know, so, like the. The movement toward looser stool, more fluid accumulation, more pain. Like we've changed the curve.
[00:50:24] Speaker B: Yep.
[00:50:24] Speaker A: It's still on a curve, though, right? I mean, it's not an exponential jump, but it's. We've. We've altered the outcome. And I think that's also a really useful takeaway.
[00:50:33] Speaker B: Yeah, absolutely.
[00:50:34] Speaker A: Okay. Anything else on that case?
[00:50:37] Speaker B: I don't think so. I mean, I think that's pretty. Pretty good. Yeah. I wanted to give a case where we. Where I used fungi, Huang Qi tong, because that's another really good one to know for treating pain. But pain really as a result of swelling and deficiency, those kind of key symptoms are like, it's really a lot of swelling.
The pulse is really soft and superficial. You would think with somebody with that much swelling, they look wet. Right. And they are wet, but the pulse is still superficial. So there's this kind of strange orientation of the swelling where it's like, we need to treat that. We need to treat with a Huang Chi method. And the sweating is obviously an important part of that as well. That shows the same dynamic. The sweating is happening frequently. The pulse is superficial and soft. The surface isn't being regulated well because of how deficient you could say the Wei Qi is. Right. So then the result of that for that patient is that the water accumulates because the Qi mechanism is fitted.
[00:51:44] Speaker A: Yeah, yeah. And that is why you reach for Huang Qi.
[00:51:47] Speaker B: That's why.
[00:51:47] Speaker A: Yeah.
[00:51:50] Speaker A: What about this case specifically.
[00:51:54] Speaker A: Because we talk about this a lot, this sort of unregulated surface, cold water accumulating. And that is part of the pathomechanism for a lot of conditions that use other families of formulas besides Huang Qi, especially, like Guizhou stuff and Fuci stuff, warming water and things. What about this particular set of things said Huang Chi, particularly, versus any of those Other methods.
[00:52:19] Speaker B: I think, like I said, if I were to see this person fresh today, I may have used some of those other methods first.
[00:52:27] Speaker A: Sure.
[00:52:27] Speaker B: That could be the case. But I'm thinking when I think of this formula, I always think of Dr. Huang Huang, actually, because Dr. Huang Huang's Huang Qi person fits this patient exactly.
Swelling, easy to sweat, superficial, soft pulse, and kind of an eeyore disposition.
[00:52:49] Speaker A: Like, yeah, there's a melancholy.
[00:52:51] Speaker B: Yeah, there's a melancholy. Or there's an orientation of like, oh. Like this patient at one point said they were having a particularly tough week, and they came. I said, how are you doing? And they came in and they said, well, you could just take me out back and put me down with the cows.
[00:53:08] Speaker A: Wow.
[00:53:09] Speaker B: So that's just this kind of.
[00:53:11] Speaker A: Yeah.
[00:53:12] Speaker B: This kind of general orientation.
[00:53:14] Speaker A: And you're talking about the 10 key formula families.
[00:53:17] Speaker B: Yes.
[00:53:17] Speaker A: From Huang Huang. Mm. Yeah. Okay. All right. Well, I think that's everything we've got on these case studies for y', all. So hopefully that was helpful in getting just a little bit more context, a little bit more meat on the bones, so to speak, for these sort of autoimmune pain conditions that we were talking about.
So, as always, we love for you guys to rate and review the show wherever you're listening to it. Putting those ratings in there helps other people find us. And of course, if you've got some topics that you'd like to send over to us, shoot us an [email protected] thenervousherbalistmail.Com we'd love to hear from you. Love to hear any suggestions or just thoughts on the show in general.
And as always, my name is Travis Kern.
[00:54:00] Speaker B: I'm Travis Kunst.
[00:54:02] Speaker A: And we will catch you next time.
[00:54:03] Speaker B: Catch you next time.
