Covid and Long Covid (Theory and Pathomechanism)

Covid and Long Covid (Theory and Pathomechanism)
The Nervous Herbalist
Covid and Long Covid (Theory and Pathomechanism)

Jan 28 2025 | 01:12:11

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Episode 6 • January 28, 2025 • 01:12:11

Show Notes

TK and TC discuss the change in COVID-19 presentations from the pre-vaccine days to the endemic status of the disease now and particularly discuss the complications and symptoms that are put under the umbrella term "Long COVID"

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Episode Transcript

[00:00:03] Speaker A: Hi everyone and welcome to the Nervous Herbalist, a podcast for Chinese medicine practitioners who like herbs and want to learn more about their function, their history and treatment strategies to use in the clinic. Let's get into it. Hi everybody. Welcome back to the Nervous Herbalist. My name is Travis Kern and I'm here with my co host, Travel Travis Cunningham. And we are here today to talk to you guys about the exciting world of COVID 19. That's right. Good old Covid, the pandemic disease that we've all been dealing with for 5ish. 5 years. 5 years. Basically about to be 5 years here in the next couple of weeks. And of course a lot has changed since we first heard about COVID Strange disease pattern emerging from China shows up in the U.S. and of course, in a pre vaccinated world, we end up, you know, quite a lot of fear. And well, you guys all live through it. You know, the story of the lockdowns and the deaths and all of the, the terror that was sort of put in place. And so of course now we're in this position where COVID 19 is really endemic. Right. It's not pandemic anymore. It's just part of the daily rotation of exposures. And we got people still contracting Covid, you know, regularly. And hopefully either through vaccination or through individual immunity, those people are more resilient. Right. Than they would have been before. But what we see a lot of once people recover from COVID is what people are now calling long Covid. [00:01:43] Speaker B: Right. [00:01:44] Speaker A: And so a lot of our discussion today is, is firstly about COVID itself, just to remind everybody of sort of like what that pathogen is from a Chinese medicine point of view, generally speaking. And then really to talk about the secondary effects of a COVID infection in many people, that is part of this kind of larger umbrella term. Long Covid, right? Yeah. So t think, let's think back. Let's put go into the time machine to four or five years ago and we're first hearing about COVID What do you remember being part of the discussion of sort of like, hey, there's this new disease and how do we understand it? [00:02:21] Speaker C: I think when it was first, when it first hit the news, there was a lot of fear, right. And a lot of unknowns. And I don't think we got much like. So we heard about it first. In fact, I remember having a conversation with you one night. We were closing up root and branch here and I had taken to this thing where like after we closed, after every. After you left and everyone was Gone. I would just sit on the floor for like half an hour. And you saw me doing it one day. Like you, you saw me sitting there and you were like, what are you doing? And I, and I said, I'm just trying to sort of recalibrate my mind to not feel like we're slipping into a post apocalyptic scenario. Because that's what it felt like at that time. It was like, yeah, like there's this disease, we don't know anything about it. It could be different than anything we've seen before and it might totally shut down and transform the world. [00:03:23] Speaker A: Yeah. [00:03:24] Speaker B: Right. [00:03:25] Speaker C: And then we started to get some, some data, some commentary on what people were doing for COVID 19 in China. [00:03:37] Speaker A: Right, Right. [00:03:37] Speaker C: Liu Li Hong went to. Where was the outbreak? The, the place where the first outbreak happened. I can't even remember the name of the town right now. But, but he went there with a group of people and then he wrote about it and, and there was material about like what they did and they did acupuncture and herbs. And then basically what he confirmed in that first report that I remember was that the formulas, the acupuncture points, the stuff that we've been using still works. [00:04:12] Speaker A: Yeah. [00:04:13] Speaker C: So like just, just validation for our medicine that we can still use the stuff that we've been using and it should work. And then there were some other people that started to put out material about how to treat it. There was the, the formula that came out that was sort of like a hodgepodge mishmash of a bunch of formulas that people were sort of taking without any modifications at one point. [00:04:43] Speaker B: Right. [00:04:43] Speaker C: It was like the official recommendation by the, the health Department of China. And the third, like there were these different manuals that came out around treating COVID 19 that the Chinese government put out. And in the second or third one, Chinese medicine started to be included. The first one, I don't think there was. [00:05:03] Speaker A: And, and then there were like, in the material that came out for Chinese medicine that was staged. Right. It was like initial stage COVID 19 and then second stage and third stage. And those original formulas were like chock full of like damp transformers and aromatics and stuff to kind of move and circulate wet, damp qi. [00:05:28] Speaker C: Well, there was this digging up of scholarly, like these different, you know, in our medicine there's different periods of scholarly advances or pursuits or whatever tendencies in the medicine. And one of those belongings sort of to the Wenbing type era, post, I think post Jinyuan dynasty, there was this epidemic disease treatise that came out by again, I Can't remember the, the gentleman's name, but that's where we get some of the formulas that are now used like I saw first used to treat things like Lyme's disease. [00:06:08] Speaker A: Right. [00:06:09] Speaker C: Really sticky, turbid, damp stuff. And there was some discussion about how there were these pathogen type things that could get into the body and then hide, right? They would hide. And there was this idea of is it Mo Yuan or like the membrane source. Right. Where the pathogen would get into the body and then go into the deep channels. And the doctor defined the hiding place somewhere between the organs of the abdomen and the spine. That's what, that's what the Mo Yuan or the membrane source was. [00:06:49] Speaker A: Right. [00:06:49] Speaker C: And then his method for treating it was like using Da Yuan Yin or like these, these, these really heavy, aromatic, damp transforming herbs like Saoguo and Bing Long and Hopo and these things, right? [00:07:06] Speaker A: Yep, yep. [00:07:07] Speaker C: And. And then you would. His strategy would be to like use these things kind of consistently. And then it would pop out, would be like a flare, if you will, or the, the pathogen would come out into the channels and it would hit a certain level of channel, and then you would modify the formula to hit that channel, basically. [00:07:29] Speaker A: Right. Sort of like where it popped up. [00:07:31] Speaker C: Exactly. [00:07:32] Speaker A: Yeah. [00:07:32] Speaker C: So if it was like a Shaoyang type of thing, then you'd add Chai huang chin or something like that, right? [00:07:38] Speaker A: Yeah. [00:07:40] Speaker C: And then people were discussing that. And then the, the Bensky crowd. I always think of it as the Bensky crowd. Andy Ellis, Stan Bensky and Ma Chochen, they, they came out. Craig Mitchell, this, that, that whole group came out with Volker. They came out with that publication around how do we treat COVID 19? And there was this, I remember this flow chart that came out about like the idea of toxic dampness. [00:08:09] Speaker A: Right. [00:08:10] Speaker C: And they're borrowing like a couple of different models, Shanghan and Wen Bing. And if it looks more like this, then you follow this part of the tree and you treat it through the like Sanren Tang and these, these kind of Wenbang formulas. And if it's more like this, then you can use Xiao Cai Hutong Wulingsan, these types of more Shanghan approaches, or you need to use like Shao Qing Long Tang, more of that standard type of thing. And then. But you treat it progressionally. It was definitely like a staged system of treatment. [00:08:42] Speaker A: Yeah. [00:08:42] Speaker C: So that's what I remember about the first part of COVID 19. [00:08:46] Speaker A: I think what stands out to me about that now on this side of the COVID situation is that of course, the vast Majority of people who received any kind of treatment for COVID infections, either pre or post vaccine, did not receive Chinese medicine interventions. [00:09:01] Speaker C: Right. [00:09:01] Speaker A: I mean, on some level in the beginning there really wasn't an actual intervention, right? It was sort of like fluids, antivirals, cross your fingers, that's kind of the limit of it. But what's interesting is that when we think about a kind of sort of pervasive, difficult to fully remove toxic dampness presentation, you end up with this idea of like, okay, think about it through a biomed lens, right? So a virus comes in, it infects the body, the body's fighting it off, and then through a combination of internal immune system and external factors or vaccination support or something like that, the body's actually able to destroy the virus. Right. So if we were to just look, if we were to look for proteins in the blood that indicated viral infection, we would say, oh no, they're no longer producing at the same rate. It appears that the virus has been destroyed. Great, you're good now, you're ready to recover. But of course, like from a Chinese medicine point of view, if you have a pathogenic presence that is lurking, that is hiding, to sort of personify it a little bit, then it would appear by many accounts that the infection is gone, is done. But then all of a sudden we've got people who have persistent headaches and phlegm accumulation, people who have cardiovascular issues, they've got blood pressure problems and shortness of breath that they never had before. We've got ongoing sleep problems and body aches that people didn't have before. And of course the problem is that because COVID 19 was so like, it affected so many millions of people just by the sheer effect size, like the whole sample size of people that were affected, many, many people ended up with what we're now calling long Covid symptoms. So like secondary post COVID infection symptoms where on paper your Covid is done. But we see enough people who are reporting similar type symptoms after having Covid that the biomeds have had to give it like a title because it's so consistent. I mean, not everyone, right, but like enough people to say, oh, this isn't just Sally making it up. Sure. [00:11:11] Speaker B: Right. [00:11:11] Speaker A: Like, no, no, there's enough Sally's and Johns and bills out there that like, it turns out that in fact there's something here, but biomedically that doesn't really make any sense, at least not at the moment. Like they're hunting for it. Right? Like, well, what, what was the nature of The COVID virus, that it impacted cardiovascular tissue. [00:11:29] Speaker B: Right. [00:11:30] Speaker A: And you know, good luck figuring that out from a biomed point of view. Like there's no money in that. So I'm sure the research will dry up quickly, you know. But what is fascinating from our point of view is like, it makes sense that a pathogen that is pervasive and lurking, which are terminology that we use here, right. To describe something that isn't easily removed from their body and affects multiple systems, that it can appear to be gone. Like, okay, you don't have fever and chills anymore, you don't have body aches, you don't have awful like congestion, you know, like you would if you were having a cold, but all of a sudden you're like constantly short of breath even though you don't seem to have a cold anymore. [00:12:09] Speaker B: Right. [00:12:10] Speaker A: You have a really hard time focusing on tasks. Right. Like foggy brain anxiety. Anxiety. Right. A lot of people got the palpitation that goes along with that sort of thing. And all of a sudden people are like, well, what, what's happening? Like, what the deal? Well, the deal is is that you have like your pathogen isn't done, right. Like it's evolved, it's changed, it's modified. And so, yeah, it's no longer the sort of exterior toxic dampness invasion that it began as, but the effect of that toxic dampness in your system has now exacerbated a whole host of other problems. Yeah, because like not everybody has long Covid symptoms. [00:12:49] Speaker B: Right. [00:12:49] Speaker A: And so they either don't because constitutionally or sort of like we'll call it pre infection health presentation, they didn't have problems that would be made worse by very, very strong damp presentation. [00:13:03] Speaker B: Right. [00:13:03] Speaker A: You know, and so if that's the case, they get terrible toxic dampness infection, they purge it, you know, through immunity response and no secondary effects because, well, they didn't have stuff for that toxic dampness to pile on. But of course, like where we live in Portland, where it's damp most of the time, got a lot of patients who carry around excess dampness, which is really like an American Western problem in general, but I think made worse from like being in a place that is also damp. [00:13:29] Speaker B: Right. [00:13:30] Speaker A: So who is showing up with a lot of our post Covid symptoms? Right. People who are damp, people who have weak yang Qi, people who have constrained Qi circulation. [00:13:43] Speaker B: Yep. [00:13:44] Speaker A: And so those people, when invaded heavily by strong dampness, toxic dampness, their system's overwhelmed. And while the toxic dampness itself has been quelled, the accumulation and the stagnation that was caused by it. The body can't seem to purge on its own. [00:14:02] Speaker B: Right. [00:14:03] Speaker A: And so now we have all these other symptoms. [00:14:04] Speaker B: Y. [00:14:05] Speaker A: And so that. That's what's really interesting now because, you know, we are treating several patients in the clinic now for long Covid. We've been treating long Covid for a while. I think it's important to say that, like, long Covid is of course not actually a thing. [00:14:20] Speaker B: Right. [00:14:21] Speaker A: Like it's a category of a thing. [00:14:22] Speaker B: Right. [00:14:23] Speaker A: It's like saying. It's like saying sandwich, soup. Like it's a category of a thing. Like, oh, I'm having a sandwich for lunch. That's just a general thing. I'm having a French dip. That's a specific thing. [00:14:33] Speaker B: Right. [00:14:33] Speaker A: So it's the same here. Like people say, oh, I have long Covid. Like, long Covid is not a disease. I just want to be clear. Long Covid is a category of a variety of things that are not necessarily consistent from person to person that are a byproduct of having had a COVID 19 infection. [00:14:49] Speaker B: Yes. [00:14:50] Speaker A: Yeah. So what specific things? Maybe let's start with COVID itself. So, okay. Because people are still getting Covid now, although more and more, I think people aren't really testing for it because it's just sort of like, whatever. I just. Whatever. I have terrible cold. But that actually jives with what we want to talk about, which is this idea that at particularly this stage, but probably always there wasn't necessarily a need to treat Covid as a concept so much as what is the cold and flu pattern in front of me. [00:15:24] Speaker B: Right. [00:15:24] Speaker C: It's really just bianzung. And there's a particular bent to that for COVID 19. And I also think it's changed, as you pointed out. [00:15:34] Speaker A: Right. [00:15:34] Speaker C: When we were first seeing COVID 19 situations, and I think in our clinic, we saw them mostly over the phone. We had people calling in and we were treating people herbally through telemedicine at first. But that has definitely changed. When somebody gets COVID 19 and they test positive today, it looks different than it did when we were first getting those cases. [00:16:01] Speaker A: Yeah, definitely. And I think that's. That's a byproduct of built up immunity either through vaccination and maybe the disease. [00:16:09] Speaker C: Has, you know, transformed and definitely. And changed, you know? [00:16:13] Speaker A: Yes, definitely less virulent or. Yeah, seemingly. I don't know. It's hard to know. Right. Because so many people have either been vaccinated or they've had Covid or both. [00:16:21] Speaker B: Right. [00:16:22] Speaker A: And so like, the kinds of humans that are interacting with the pathogen are just sort of fundamentally different. [00:16:28] Speaker B: Yeah. [00:16:28] Speaker A: And so, you know it. A lot of people, then those that first summer, you know, the number of people who got Covid were severely infected, horrible respiratory problems, cardiovascular issues. And they died. Right. Millions of people died. My grandparents died. Yeah. Good friends of ours, parents died. So it's very like, acute and personal. Like, the idea now, it's like, oh, Covid, no big deal. But at the time, it was quite a big deal. [00:16:56] Speaker B: It was. [00:16:57] Speaker A: And the way it presented and the. [00:16:59] Speaker C: Fear around it too, like, if you. [00:17:01] Speaker A: Got it right for sure, like, what will happen to me? [00:17:03] Speaker C: What will happen. [00:17:04] Speaker A: Yeah, exactly. And so I think now, though, because we're on the other side of that and because we have so much more resilience as humans to that particular strain of illness, people get Covid today, and it's kind of like, oh, okay, I got a really terrible cold. Right. And the risk factors are kind of the same as before. Right. Because if you're elderly or immunocompromised, colds and flu have always been an issue. Right, right. Those have always been a problem for you. We got people who are like, HIV positive, for example, and like a quote, unquote, regular cold is always a risk for someone who has an immune compromised system. So all of those risks remain. Right. If you're elderly, immunocompromised, et cetera. Even though we're in this time of COVID where for most people it's not nearly as serious as it was, it is still very serious for some people. So I want to acknowledge that. But when we're treating it these days, like you said, it's bianzung. [00:18:00] Speaker B: Right. [00:18:01] Speaker A: So what are the kinds of patterns that we're seeing that people are testing positive with COVID What do those patterns tend to look like? [00:18:10] Speaker C: So I think they're not, at this point, they're not that different from regular colds and flus, from my perspective. That's what I would say first. During the height of COVID 19, when people were getting it and getting really sick, what I saw was the. The need to treat. So from a jingfong perspective, the need to treat through the chest obstruction lens really quickly, that was different. Because usually when people get sick, what you want to prevent, if somebody's coming in and they're seeing one of us, Right. And they get sick, we want to prevent the cold going into their chest. [00:18:54] Speaker B: Right. [00:18:55] Speaker C: That, like, that's our priority. Because most people, when they get sick, they're not at risk for their life, you know, unless they're severely deficient, depleted, or have. Or immunocompromised or there's some kind of. There's something else happening. So the worst thing that can happen for most people when they get sick today for like the sort of normal, mostly healthy person, is it can go into their chest. [00:19:22] Speaker A: Right. [00:19:22] Speaker C: And then they have a cough, they have phlegm. It takes them a long time. It can take months for people to recover. Some people don't seem ever to really fully recover without some kind of intervention. So what I saw with COVID 19 is the same base patterns that we see for cold and flu, which we can talk about, but then in addition to that, the need to. To treat through the chest obstruction lens. So that would be adding herbs like gualo and xiebai for me, and particularly the formula Xiao xian xiong tang. [00:20:01] Speaker B: Right. [00:20:02] Speaker C: Which is gualo, bansha and huanglian, those three herbs, adding that into something like a xiaochai hutong structure. In fact, in Japan they have. They like to add those two formulas together for a lot of things. They call that, and I think in China too, chai xian tong. It's like this, you know, nickname for the. Because you use it together so much for. For certain things. [00:20:32] Speaker A: Yeah. [00:20:32] Speaker C: And I definitely saw that a lot in COVID 19, especially if people were using granules, using very high doses of Gualo, like up to 60 in ratio to the other ingredients. [00:20:47] Speaker A: Yeah, I mean, that makes sense because of how wet Covid looked Right. In those early days, is super wet. [00:20:53] Speaker C: Very wet, and again, like, difficult to. There's like that sticky, damp, phlegm, congested quality that would be present for a lot of people. So using something like xiao cai hutong or a caihu Guizhou ganjiang tong as a base, or even a bansha shay shintong, which can be a very good formula for cough, already has huang lian in it and bansha. So all you need to do is add gualo to get xiaoxian shong tang. Yeah, that's a nice way to kind of go for it as well. So I saw a lot of patterns like that. The other thing I would say is there's a tendency for multiple. From a shanghan perspective, for multiple confirmations to be involved. So we're not just treating taiyang with guizhitang, we're not just treating yang ming, we're treating taiyang, yang ming and xiaoyang, maybe with a little hint of taiyin in there. So maybe we modify for cough or something like that. And then we need to add a chest obstruction type of gesture. So there's a little bit of simultaneous action that needs to happen with. With the treatment. But otherwise I didn't see any need to add in herbs that were like antiviral, you know, like. [00:22:14] Speaker A: Right. [00:22:15] Speaker C: With a more that kind of perspective. [00:22:17] Speaker A: With that point of view. Yeah, yeah. Because, I mean, the combination of gualo and Shia, by which, you know, doesn't taste great, but it's. It's a great. It opens the chest. Like, we use that all the time for like, cold and flus that have gone too long before people come see us. And now they have like, that upper chest, like, they're hacking up, like, substantial phlegm that's got like a dark green color. It's like, oh, yeah, you're going to need Gualo Xiebai open up the chest, the Huanglian to manage the heat accumulation. That makes sense. And I mean, even if you look at the original construction of the formulas, which we I think would think of as sort of like modern formulas, like the, the stage one COVID 19 formula that came out of China in the. In the early days is not, you know, it's not a formula that, that Zhang Zhongjing wrote. [00:23:04] Speaker B: Right, right. [00:23:05] Speaker A: But I mean, it has really similar structures. Right. Like you've got Sangju, Chen PI Hopo. Right. That are in here trying to manage some of the, like, they're trying to dry, like this accumulation that's there. You've got Tian Wafen. Right. You've got Shangren Su. Yeah. Stuff that's like, focused on long opening. And then a bunch of this other stuff that, you know, Xiebai is such a useful herb because it targets the chest and it's the strong, pungent aromatic quality. But the original formula design included a lot of those aromatic herbs. They just weren't Shabbat. Right, right. So you had like, Salgo, you had Ho Xiang. Because a lot of the original herb presentations, too, had concurrent loose stool. And that was an interesting thing that was kind of confusing to the biomeds is like, wait, I thought this was a respiratory infection. [00:23:52] Speaker B: Right. [00:23:53] Speaker A: Why are people having liquid urgent bowel movements? And so those early formulas were trying to, like, kitchen sink the approach. Cause, like, people are dehydrating, they're coughing, they're also constrained, like all at the same time, which is pretty wild. So, yeah, I mean, I think that core element that differentiated in the beginning was that it was very wet and it was likely constraining that wetness in the chest. And so we needed to move It. It seems less like that now. Like, now it's just sort of like, really gnarly xiaoyang problems. Right, Right. It's just sort of like classic. We got sore throat, we got body aches, we got a headache. We got all this kind of stuff. And it's like, okay, we really just need to hit this hard with the usual stuff that we would hit hard. [00:24:34] Speaker B: Right. [00:24:35] Speaker A: And if it moves quickly into the chest, you would apply the same principle, which is what you would use whether it was Covid or not. [00:24:40] Speaker B: Right, Right. [00:24:41] Speaker A: You know, it's like, oh, it's in the chest now. So. Gua lo xie. [00:24:44] Speaker B: Right? [00:24:44] Speaker A: Huanglian. [00:24:45] Speaker B: Yep. [00:24:45] Speaker A: Yeah. So I. I think it's interesting, like, in some ways, treating Covid today with Chinese medicine is a little bit unremarkable. [00:24:54] Speaker B: Yeah. [00:24:54] Speaker A: Not because. Not because, like, Covid is unremarkable. Exactly. It's just that, like, the bodies. The human bodies who are becoming infected have adapted. [00:25:02] Speaker B: Yeah. [00:25:02] Speaker A: The pathogen has shifted. [00:25:04] Speaker B: Y. [00:25:05] Speaker A: And so now in many ways, it appears to be a very. I mean, still a potent virus, but sort of visually, symptomatically, the way we would measure for it. It really just sort of is. Is part and parcel to the other kind of stuff that we treat. [00:25:20] Speaker B: Yep. [00:25:21] Speaker A: Yeah. So all that to say, like, if people are like, do you guys treat Covid and you're treating cold and flu? The answer is yes, you definitely treat Covid. Like, there's no reason you couldn't. [00:25:29] Speaker B: Right. [00:25:29] Speaker A: Deal with COVID 19. Particularly at this stage. Particularly even if you're still, like, a relatively new herbalist, you know, you're just still figuring that stuff out, like, it doesn't matter. [00:25:38] Speaker B: Right. [00:25:38] Speaker A: You know, like, there isn't anything about COVID now these days that you need to strongly consider. That would be different than having to consider any other type of cold pathogen. [00:25:47] Speaker B: Right. [00:25:47] Speaker A: A very aged patient who's immunocompromised, you have. You have strong considerations about your ability to help that person. Covid or not. [00:25:54] Speaker B: Right. [00:25:54] Speaker A: You know, and so you got to be careful with that. But. So maybe let's then shift to perhaps, what's the more ongoingly. Perhaps a more interesting question around. What are we seeing with the stuff that people are sort of colloquially referring to as long Covid? [00:26:11] Speaker C: Yeah. A lot of different symptoms. So some people have the loss of smell and taste. [00:26:17] Speaker B: Right. [00:26:17] Speaker C: That's a thing that lingers. Residual congestion and phlegm. Digestive disorders that people. And then in the naturopathic community at this point are calling sibo. I've even had a patient who developed definitively developed ulcerative colitis as a result of COVID 19 a few years ago. And so digestive disorders, either functional or material in nature, and then circulatory problems. Right. We've all heard about COVID toes or things like that, or even dermatology, you know, rashes and things like that. I had, I treated a couple people with rashes in the acute stage of the, of the disease, like when they were still getting sick, like within the first couple of days, developed rashes and stuff. So. So skin stuff too? [00:27:15] Speaker A: Yeah, I think the skin stuff was interesting because I didn't. It's, you know, a dermatological problem from a biomedical point of view is so far removed from a respiratory virus that even when we were collecting case history for people coming in with a dermatological problem, the patient, no one was connecting the COVID infection with a flare in the dermatological presentation. [00:27:39] Speaker B: Right. [00:27:39] Speaker A: Like even if they occurred in a timeline that it was like, no, literally, you got Covid, you recovered over a two week or three week period, and then your psoriasis spread from the top of your head to your face and hands. [00:27:51] Speaker B: Right. [00:27:52] Speaker A: And everyone was like, yeah, I guess we're just in a psoriasis flare. Like there just wasn't any. [00:27:56] Speaker B: Right. [00:27:56] Speaker C: There was no known connection. [00:27:58] Speaker A: Maybe this has to do with COVID because again, biomedically, that's madness. Right? I mean, there's no. Why would that be the case? But of course, I would just like to point out that, like, bodies are complicated and even from a biomedical point of view, like, well, perhaps especially from a biomedical point of view, we have a hard time understanding the complex movements of the various parts of health. [00:28:18] Speaker C: Especially with dermatology. [00:28:20] Speaker A: Especially with dermatology. Yeah. [00:28:21] Speaker C: Like why do people get like so much of dermatology is completely unknown from a biomedical lens? Like why, why does this happen? [00:28:29] Speaker A: Autoimmune. [00:28:30] Speaker C: Autoimmune. Yeah, it's autoimmune. Something coming from the central nervous system. We don't know why. [00:28:35] Speaker A: We don't know why. Bad luck, I guess. [00:28:37] Speaker B: Yeah. [00:28:38] Speaker C: Steroids or antibiotics or another steroid, a. [00:28:42] Speaker A: Different antibiotics, keep changing. And then we'll do a topical steroid and then maybe we'll do a cortisone. [00:28:46] Speaker B: Right. [00:28:47] Speaker C: And then internal antibiotic, topical. [00:28:49] Speaker A: And now we've used the two tools that we have over and over and over again. [00:28:54] Speaker C: Maybe an off label medication. That's for diabetes. Yeah, or diabetes. [00:28:59] Speaker A: Exactly. [00:28:59] Speaker B: Yeah, yeah. [00:29:00] Speaker A: You guys, listeners can tell we have a little bit of frustration with, with the dermatological community because it often seems to me that the approaches are like the same thing over and over again, and it's not helpful. [00:29:13] Speaker B: Right, right. [00:29:14] Speaker A: Like, it. It drags people's dermatological problems out for, like, months or years, and then they finally come to us. And the. This is. This is really my. My beef is that, you know, people come to us for stuff, like, long Covid for dermatological problems after they have done everything else. And so we end up in a situation where, like, we have a problem that's two, three, four years older than it would have been if they came to us first. [00:29:37] Speaker B: Right. [00:29:38] Speaker A: Which makes it harder to treat. And more importantly than that, the patients are exhausted. [00:29:43] Speaker B: Yes. [00:29:44] Speaker A: Emotionally, spiritually, financially. Physically exhausted from having tried to do all of these things. Medications, pt, ot, allergy tests, like, whatever it is, like just the endless list of doctor's visits. And so then they come to us and then, like, we have stuff for them to do, but honestly, it's a bunch of stuff. [00:30:06] Speaker B: Right? [00:30:06] Speaker A: Like dietary shifts and, like, sleeping habits and herbs you gotta take and acupuncture you need to come to. Like, it's demanding. Right. It's a demanding thing. When we deal with chronic disease and they're already all their bandwidths used up. [00:30:19] Speaker B: Right. [00:30:19] Speaker A: And so it frustrates me because people finally come to us, and then I'm like, okay, we gotta slow roll. You're here, so we don't overwhelm you with all the things that we want you to do. And then once the patient sort of gets the full picture of all the things that are probably gonna be necessary to resolve this, then they don't have the energy to execute it. [00:30:37] Speaker B: Right. [00:30:38] Speaker A: And that's very frustrating. [00:30:40] Speaker B: Yes. [00:30:41] Speaker C: Yeah, that's definitely a big part of the picture. And you can start to make progress with somebody in these kinds of conditions, and then they have a little bit of a resurgence of symptoms. And then depending on the patient, they may not want to continue with treatment. Because the other thing that happens when people get chronically ill is, especially if anxiety is a part of the picture, is anything that could make. Could have made something worse. They stop. [00:31:12] Speaker B: Yeah, right. [00:31:12] Speaker C: Like, oh, my God, I. I ate a thing of jello and then I didn't sleep for four nights. Like, I'm never eating jello again. It's. It's like, yeah, that kind of stuff. Oh, I tried the herbs and the first night I just felt, like, all this stuff moving. Well, were you not able to sleep? No, I slept fine. Were you okay? I just. I just felt it, like, I felt all this intensity. And it was so I didn't take it the next day. It's like, well, but nothing got worse. Why didn't you take it the next day? [00:31:45] Speaker B: It's. [00:31:46] Speaker C: That could be a good thing. You know, like, but sometimes these people can be really anxious and like, anything that they feel is. That could be problematic, they shy away from. So it can be difficult to work with people like that. [00:32:01] Speaker A: It makes sense too, right? I mean, they, they've been dealing with it for so long, so they have. They've usually two people have gotten advice from like 75 different angles. [00:32:10] Speaker B: Yeah, right. [00:32:11] Speaker A: And a lot of that advice is conflicting. [00:32:13] Speaker C: Hashtag the Internet. [00:32:15] Speaker A: No, really? Right. And then I just Dr. Google. So, like, they're on a Reddit thread, they're in five Facebook groups. They've talked to their biomeds, they've talked to Nature Path. [00:32:23] Speaker B: Right. [00:32:24] Speaker C: Long COVID support group. [00:32:25] Speaker A: Long COVID support group. And like, honestly, you know, look, we live in a world where I'm glad that people can find other people to resonate with, because most people deal with being like, gaslit by medical establishments all the time, where they're just like, oh, that's probably not real, or it's in your head. And so, like, because of a super messed up mainstream medical system, people go to the Internet seeking justification and, and to have their points of view honored. Right. And they find that which is good from like a human point of view, but the information that's in those places is suspect. Right, Right, it's. It's suspect. I mean, it's, it's not rigorous, it's anecdotal. It doesn't at all represent the complexity of what it is to be like a trained clinician working from a point of view with, with a patient. And so then patients get peculiar. Like, best case scenario, they're like unconventional, peculiar ideas. Worst case scenario, they're actually harmful ideas and they just want to try them out. Because, like, you know, Johnny Q. Public on the Internet said that this completely cured his long Covid. [00:33:35] Speaker B: Right? [00:33:35] Speaker A: Right. As if long Covid itself was even a disease. But, like, he did whatever and it cured his long Covid. So, like, can I do that too? Like, based on what? Like, what's the angle here? Where are you going? How would you measure it? What's the deal? But people are desperate because they've been ignored. They've been sort of like made to feel guilty, like they did something wrong. Like, there's Right. There's so many messed up parts of our healthcare system that drive people into that place. And so for those of you out there who are writing herbs and working with patients and. And, you know, you're in a clinical setting, it's really important to, like, beef up on your compassion muscles. Right. Because, like, I see. We've seen clinicians. I mean, they're not trying to do this, I guess, but they end up sort of blaming patients for, like, how stuff isn't working out. And a lot of times they're not wrong. Right. Like, the patient didn't take the herbs, they didn't follow the advice. You know what I mean? Like, they didn't actually do anything. So, like, of course you could say, like, well, sorry, you know, the patient's just not doing anything. But I think it's important to, like, try and exercise and keep warm your compassion muscles to just be like, look, they're not. Not doing it because they're trying to, like, spite you, you know, they're not. They're not like a teenager. They just. They've been through the wringer. [00:34:50] Speaker C: Yeah. [00:34:51] Speaker A: And they don't know which way is up. And so, like, a lot of our work, even before we're picking the formula with people with chronic disease of any kind, but I think particularly with long Covid, because it's so mysterious, quote unquote mysterious, Right. From a biomed point of view, is like, we have. We have to build rapport with these people. [00:35:11] Speaker B: Yeah. [00:35:11] Speaker A: We have to prove that we're trustworthy, prove that we have a point of view, prove that we know what we're doing. Right. We're not just, like, handing you a bottle of some, like, random tea pills and being like, take three of these. [00:35:22] Speaker C: I knew the tea pills were gonna come. [00:35:24] Speaker A: Yeah, man, you know me. I can't resist. I can't resist a cheap shot on. [00:35:27] Speaker C: Like, we're just handing tea pills out on the sidewalk. [00:35:30] Speaker A: There you go. Get a handful of tea pills. How many of these should I take? Oh, probably just three. [00:35:34] Speaker B: Yeah. [00:35:34] Speaker A: Like one at a time. [00:35:35] Speaker C: 313 times a day or one 3. [00:35:38] Speaker A: Times one 3 times a day. That'll probably help. So, like, you know that we have to prove that we have more bona fides than that. Right. That we. That we actually know what we're doing. [00:35:47] Speaker B: Yeah. [00:35:48] Speaker A: And that can be slow and it can be frustrating, and there can be, like, financial realities that make it hard for us to prove that trust. So in order to be able to do that, outside of the sort of soft patient skills that, of course, are necessary for that, it's. It's important to think about, you Know, what are the, what are the different pathologies that we're dealing with? And therefore, what are the formulas that we're likely to use? [00:36:11] Speaker B: Right. [00:36:11] Speaker A: So the things that you mentioned there, digestive stuff like even strong ones like IBS and ulcerative colitis, headaches, anxiety, respiratory problems. Yeah, these are all, I mean, if you're a Chinese medicine person, you're listening to that list, you can see that those are all extensions of chronic dampness. [00:36:30] Speaker B: Right? [00:36:31] Speaker A: Right. Like, so it goes without saying that you're going to need to do something with the dampness. [00:36:37] Speaker B: Right. [00:36:37] Speaker A: But of course, through what angle? [00:36:39] Speaker B: Right, right. [00:36:40] Speaker A: Are we purging it? Are we transforming it, Making it thin? Like what, what are we doing? And so let's maybe talk then about some of the, some of the types of formulas that we used for certain pattern presentations. And then we'll have a follow up episode where we'll look at a couple of specific case studies that I think will be illustrative. But like, for now, let's, let's just talk about the generals. [00:37:00] Speaker C: Okay? [00:37:01] Speaker B: Okay. [00:37:02] Speaker C: The main formula that I would use initially for someone with long Covid is Chai Hunjang Tong, or commonly as Caihu Guiganjiangtang. And that's because there's usually some lingering pathology in the Yang confirmations from a Jingfang perspective that needs, let's say, multi tiered effort similar to the acute presentation. But it's almost like the acute presentation has gone chronic. So what you see is like people with really swollen lymph nodes, for example, this is like one type of patient. I've even seen patients like this that have a skin, some kind of dermatitis or skin problem that's around the diaphragm, specifically around the diaphragm and a little bit around the joints. And they tend to be thirsty. This patient, you check their pulses and they're pretty strong, wiry and superficial. And they, it's almost like you, you look at them and they're holding. Like there's so much that they're holding. That's the feeling that I get when I look at a Chihu Guijiganjungtang patient. And there's pressure, there's like pressure in the system. They may feel tired, but there's like a, there's an intensity behind that tired, which is different than somebody who's more depleted. They may have chronic phlegm and congestion. Typically they'll have post nasal drip. If that's the case, like you can ask about that. It's less like sinus Congestion and more experienced as post nasal drip. And the bowels can kind of be all over the place. They could be normal or they could be alternating in nature. They could be a little more trending toward loose or a little more trending toward dry stool. But it's kind of middle of the road, usually for chiyuge Jiganjung tong patient. [00:39:05] Speaker A: Yeah. [00:39:06] Speaker C: And so the neat thing about that formula is you have gualo muli san in it. [00:39:13] Speaker B: Right. [00:39:13] Speaker C: Tian wafen and muli as a base modification of xiao cai hutong. And those two herbs go in and they. The bitter flavor of the gualo takes the heat out of the fluids in the san jiao and the muli. The salty flavor of the muli helps to soften the hardness of the congealed fluids. And especially in the upper burner, which would be like the lymph nodes. So it's a really good lymphatic swelling formula as long as those other conditions are there. And you will often see too, if you palpate the abdomen, costal tension or tenderness or discomfort. So when you press up under the ribs, there's some level of, like, innate tension you could feel. And often the patient will also feel uncomfortable when you do that. And they're typically thirsty. Is the other thing that I look. [00:40:12] Speaker A: For for that presentation, Is that formula sufficient? If the patient, instead of just having, say, post nasal drip, if they've got like really strong congestion, you know, they've got sinus headache, pressure behind the eyes, like, just like a real sense of like hardcore substantive phlegm in their face. [00:40:33] Speaker B: Right. [00:40:34] Speaker A: Is that formula sufficient to get at that, or is there something we need to add or a modification? [00:40:38] Speaker C: I would. I would add something for that. So if the. If the sinus congestion, then I'm thinking more I need gogen in the formula. So I'm going to add baishao and go gen to create like a guizhujia gu gen tong sort of gesture there. If it's phlegm just. Just in the throat, I would probably add lingue jugan tang, which is in this case just fuling and baiju, because the other ingredients are already there. [00:41:05] Speaker A: Right. [00:41:05] Speaker C: So that should take care of that most of the time. [00:41:08] Speaker A: Got it? Yeah, yeah. Because I see a lot of the long Covid folks that I have come in, irrespective of kind of what the other pattern of symptoms that they have is, a lot of them have this, like, strong congestion that just lingers, you know, and they were people usually who had a tendency toward, like, allergies and seasonal allergies Anyway, you know, these are folks who have taken Zyrtec or something like for a lot of their life to just manage the general sense of congestion. And now like post COVID infection that just seems to be like on steroids and like the Zyrtec doesn't really do anything anymore to manage it. And it's one of the things that contributes worse like the most I see to like the headache patterns. [00:41:49] Speaker B: Yeah. [00:41:50] Speaker A: People just chronic headache all day. [00:41:51] Speaker B: Right. [00:41:52] Speaker A: And so then chronic headache all day makes it really hard to do your job and like to be present because you just have this lingering discomfort. [00:42:00] Speaker B: Yes. [00:42:01] Speaker A: So using those various elements to break down the substantive phlegm and dampness. [00:42:09] Speaker B: Yep. [00:42:09] Speaker A: And then adding to it the components of lingua, jugan, tongue, if we've got a throat flemmy piece, and then for the sinus congestion part of it, you're going to add what again, go and. [00:42:24] Speaker C: Bai Xiao just to create Guizhujiao Guguan Tang sort of gesture in there. [00:42:28] Speaker B: Yeah. [00:42:30] Speaker A: Okay. What's the timeline for that? [00:42:34] Speaker C: If somebody has that type of thing, two to six weeks on that formula that I would say also is just the beginning. And not everybody needs that. So you can have patients that come in that are way more depleted and they don't, they don't need any Yang confirmation work. They actually need something in the yin confirmations like Jan Wu Tong or, you know, they like need a stronger Yang building formula that's going to push out cold water and fluid accumulation like that. But a lot of people will come in and they'll need some, some work on the Yang before we get to the yin confirmations. [00:43:15] Speaker B: Yeah. [00:43:16] Speaker A: And so the primary indicator for deciding if you're going to start with that Yang or you're going to go straigh into the yin piece is objective measures. [00:43:25] Speaker C: Objective diagnostics are super important. So like pulses that are superficial abdomens that have findings above the umbilicus. So if there's costal or ribside findings, or especially if there's like epigastric findings, epigastric obstruction, those kinds of things, you usually have to treat the Yang first before you go to the yin. And when I say Yang in this case, I mean superficial. The parts of the body that are more middle and upper burner as opposed to middle and lower burner. [00:44:03] Speaker A: Right, right. And if you've got findings in both zones in the abdomen, both above and below, you're going to start with above. [00:44:10] Speaker C: They'Ll resolve a lot quicker and a lot of the stuff below won't really be possible to get at. If you try to treat that first, it will backfire. [00:44:19] Speaker B: Yeah. [00:44:20] Speaker A: So in that case, so two to six weeks, that's a pretty big range. So you're giving them the. The herbs and then you're rechecking these objective findings. [00:44:28] Speaker B: Yeah. [00:44:29] Speaker A: Like, you're really. You're palpating under the ribs. You're going in and seeing like, oh, there's actually less tenderness here. [00:44:34] Speaker B: Yeah. [00:44:34] Speaker A: I don't have as much, you know. And then once those symptoms are resolved, if there are also lower abdomen symptoms, now we pivot, then we go and we. [00:44:43] Speaker C: We get at that. [00:44:44] Speaker A: And that's looking at something like Zhen Wu Tong, potentially. [00:44:47] Speaker B: Yeah. [00:44:47] Speaker C: Jen Wu Tong is the first one that I think of. Zhen Wu Tong. I don't. You could do Li zhongwan, but I don't like to give Li Zhong wan if they still have phlegm because I don't want to give ren shen when they have phlegm or anything. Say you substitute ren shen for something else like dang shen or baisha shen. I don't want to give sweet, cool, fluid building herbs if they're congested still. [00:45:11] Speaker A: Yeah. I think this is a really important point for listeners to think about, because if you just go read about Legion one, it's going to seem like a really applicable formula. [00:45:21] Speaker B: Yeah. [00:45:21] Speaker A: To. To spleen damp deficient folks. And it is. [00:45:27] Speaker B: Yep. [00:45:27] Speaker A: If they don't have phlegm. [00:45:29] Speaker B: Right, right. Yeah. [00:45:30] Speaker A: But if they have phlegm, like, they're clearing their throat a lot. [00:45:33] Speaker B: Yep. [00:45:33] Speaker A: If they eat damp foods, they get phlegm. Yep. Tendency toward, like, sinus pressure and headache. Like, these are probably not Li zhongwan folks. [00:45:43] Speaker B: Right. [00:45:43] Speaker A: Like, there's something better to use in that case. And in this case, it's probably going to be Jen wutang because it's cold water. Like, we gotta. We gotta deal with this cold water accumulation. That's a. I think that's a useful differentiator for people just sort of like figuring out, like, okay, what's the spread here? How do I actually decide which way to go? Because Li Zhong Wan, you know, these people are cold and Li Zhong wan is warm. And if you use something like fuzi Li Zhong wan, you'd be like, oh, yeah, this is gonna really warm up that middle jiao. But it's a sweet formula. It's a sweet formula. And that Ren Shen, or whatever Ren Shen equivalent, like you said, is going to contribute potentially to the phlegm accumulation. [00:46:23] Speaker B: Yeah, yeah, yeah. [00:46:23] Speaker A: And so what happens is like, some people will still get better. This is, I think, an important thing to realize. Like, you give Li Zhong Wan to someone who's phlegmi, but they have, like, a cold middle jowl and like a weak spleen, and they, like, kind of get better. [00:46:35] Speaker B: Yeah. [00:46:36] Speaker A: But they don't get so much better. [00:46:38] Speaker B: Right. [00:46:38] Speaker A: Like, it kind of. It stalls out or thick. It just sort of. It's very slow. Like, it's hard to tell. And they stay phlegmy. And one of the things about phlegm as a symptom is it's for many people, like a daily. We deal with this all the time. And it's one of the ways that they're measuring whether they feel better. [00:46:56] Speaker B: Right. [00:46:56] Speaker A: Because it's really palpable. Right. Like, whether I wake up with a headache or not is really clear. Whether or not I have snot in my throat all the time is really obvious. [00:47:04] Speaker B: Yeah. [00:47:04] Speaker A: And so not only is it, of course, better for the patient to recover more rapidly, just in general, but if you really want to keep the patient inside of your sphere of influence so that you can actually bring their condition to resolution, they need to trust. [00:47:19] Speaker B: Right. [00:47:20] Speaker A: That you can. [00:47:20] Speaker B: Yes. [00:47:21] Speaker A: And so you got to continue to deal with the branch problems that they experience every day. And so being conscientious about when you would use something like zhen Wu Tong vs Li Jong Wan is important, I think. [00:47:36] Speaker C: And Li Zhong wan is the context for giving Li Zhongwan is almost in the Shang'an Lun. It's almost always after somebody's had diarrhea or been vomiting. So there's a fluid loss in both diarrhea and vomiting that needs to be replenished by Ren Shen. So we think of Ren Shen as like cold, damp, spleen, which is correct. But there's also fluid deficiency in Ren Shen that needs. Or, sorry, in Li Zhong Wan that needs Ren Shen in it. So if you have too many fluids, though, Right. If you have pathological fluids, you. You don't want to give Ren Shen because Ren Shen is going to give more fluids. It's going to tell the body to make more fluids. [00:48:20] Speaker A: Yeah. [00:48:20] Speaker C: So you could have a Xiaoyang pattern, for example, and the person has phlegm and congestion, and you leave Ren Shen in there. And as long as the formula is close, they'll still get better, but they won't get better as fast. If you take the Ren Shen out or you modify for cough, like the postscript modification, take out Renshen and Dazo, change Xiangjiang to Ganjiang, add Wu Weizi, or sometimes what I'll do is I will just use Shao Chaihutong, take out Renshen and Dazo and add lingue Jugantong. So that's another trick that I'll do. But yeah, that's. That's a little bit on Ren Shen. [00:48:59] Speaker A: Yeah. I mean, this is something. I think it's also one of the challenges, actually, of using formulas that were written for humans in a very different era. [00:49:10] Speaker B: Right. [00:49:11] Speaker A: For people that live in this era. [00:49:13] Speaker B: Yeah. [00:49:13] Speaker A: Because the truth is, is that the ability for humans, modern humans living in Western countries, to be able to generate their own sweet flavor. [00:49:24] Speaker B: Yeah. [00:49:24] Speaker A: Effortlessly and in many cases, like, unconsciously. [00:49:29] Speaker B: Right. [00:49:29] Speaker A: Is easy. [00:49:30] Speaker B: Yeah. [00:49:30] Speaker A: And so the level of deficiency, like fluid loss, that's represented by, like when the classic text talks about vomiting and diarrhea, like, that's kind of like food poisoning level. Right? [00:49:42] Speaker C: Yeah. Imagine food poisoning. [00:49:44] Speaker A: Like, that's the level of loss that we're talking about. Not like, oh, this regularly has loose wet stool. [00:49:49] Speaker B: Right. [00:49:49] Speaker A: Because the thing is, unless they're having like 12 of those a day and they're completely emptying their guts, even though if they have three bowel movements a day and they're entirely watery, they're eating enough sweet flavor throughout the rest of the day just from their food. [00:50:02] Speaker B: Absolutely. [00:50:03] Speaker A: To replenish that loss. You know what I mean? They're drinking water and they're eating sweet flavor. So we don't need to do it with the herbs. [00:50:10] Speaker B: Right. [00:50:10] Speaker A: In fact, we need to be doing something different because there isn't this worry of recovery. [00:50:16] Speaker B: Yes. [00:50:17] Speaker A: That. That is represented by using renchen. [00:50:19] Speaker B: Right. [00:50:19] Speaker A: You know, and renchen over time has just evolved into a general tonic is the problem. [00:50:23] Speaker B: Yeah. [00:50:23] Speaker A: It's like, I'll just take some ginseng or ginseng candy and ginseng cupcakes and ginseng, whatever. Right. But it. It was a much more targeted tool than that historically. [00:50:31] Speaker C: 100%. [00:50:32] Speaker A: Yeah. The. One of the last things I want to add on this too, while we're just discussing kind of things to consider in general about treating Long Covid. But, you know, anticipating a case study that we'll do in the next episode. But you know, one of the things that happens is, like, we were just saying a lot of people come in with weak digestion. [00:50:49] Speaker B: Yeah. [00:50:50] Speaker A: So people come in weak digestion, and you. Sometimes it's. It's not so on the edge. You know, it's loose or unformed stool. But it's once or twice a day. It's not urgent. They don't have bloating or acid reflux or like it's not ulcerative colitis, it's not super severe. Right. Um, and in that case, you can probably just go straight to whatever formula you were going to use. Right. So you're going to use, you know, the Chaihu formula, or you're going to use, you know, Jen Wutang. Whatever you're going to use, you can just go straight to it and that's fine. You can start to chip away at it. But if you have a more severe digestive presentation, you may not be able to give that formula. [00:51:29] Speaker B: Right. [00:51:29] Speaker A: Because the person's not going to be able to process it. [00:51:31] Speaker B: Yeah. [00:51:31] Speaker A: Like, they just literally can't do anything with it. It'll just come right out and it'll be unpleasant and they won't really get any absorption or transformation. [00:51:38] Speaker B: Right. [00:51:39] Speaker A: And so when that happens, like, you really have to start considering, like, how do we stabilize this digestion in such a way that we could give herbs and they could be absorbed? [00:51:49] Speaker B: Right. [00:51:50] Speaker A: And so depending on what you're dealing with. And that's a big caveat. Right. Because it can be quite broad. I mean, it can be everything from hyper frequent loose stool all the way to ulcerative colitis and kind of everything in between. So is it very damp? Is it very hot? Is it very painful? Is there bleeding? Like, there's a lot of questions. [00:52:07] Speaker C: Right. [00:52:08] Speaker A: But two things that you can consider as an herbalist is figuring out angles with which you can manage that weak digestion primarily through like a damp clearing, fluid management perspective. And so that makes me think actually of Ping Wei San. [00:52:23] Speaker B: Yep. [00:52:23] Speaker A: And also actually Wulingsan. [00:52:25] Speaker B: Right. [00:52:25] Speaker A: As a. Because Wuling san is easy, it's easy for people to take. Like, even with people with weak digestion, Wuling sign is generally well absorbed. It's not triggering. And by and large, it's a sort of like bland leaching formula that can help to pull out some of the excess fluids that are likely contributing to the problem. If you have more active indigestion. Right. Like, people eat something and their stomach, it almost doesn't matter what they eat. It's just like they always feel bad. Assuming, of course, you've done all the usual screenings for digestive stuff. Right. Like, people need to stop eating raw food, they stop eating cold food. Right. So like no salads for dinner, like that's gotta go. Smoothies for breakfast, gotta go. Other things to be mindful of too, when people have really reactive stomachs, just in general are things that a Lot of people eat and think of as healthy, like bananas, nut butters, nuts, stuff that's like oily and damp and wet. It just tends to have a congealing quality in digestion. So you've done your screening with the person, they understand that they should be eating hot cooked food, fruits and vegetables, you know, whatever spread throughout the day. And anytime they eat something, it tends to cause an issue. Ping wei san is a good formula to consider with that because ping wei san has lots of angles to it. Right. It's got, it's got aromatics in it, it's got damp transformers, it's got drainers. Right. It has, it has all of these factors that are in place. And I would strongly suggest that if you're going to use pingwei san, that you use an actual sand, like the actual herbs themselves. And the reason is because probably most of you don't have a big bulk pharmacy that you can grind up herbs and experience them. But I will tell you that the smell alone of freshly ground up pingweisan, like, you can literally just like open the jar and take a whiff of it, and you can suddenly feel your digestion, like a little bit cleaner, a little bit drier, because it's. So the potency of the aromatics inside of pingwei san are really, really acute in a san. [00:54:20] Speaker B: Yes. [00:54:21] Speaker A: And they hardly exist at all in granule. [00:54:24] Speaker B: Right. [00:54:24] Speaker A: Like, if you open the jar of granules and smell it, I mean, it's almost like it's not even the same thing. [00:54:30] Speaker B: Yeah. [00:54:31] Speaker A: You know, and so, you know, you grind up your pinguesan, and then what dosage do you want to use? Like, how much ping wei san should a person take? Probably somewhere between like 6 and 12 grams. [00:54:42] Speaker B: Yeah. [00:54:42] Speaker A: Two times a day. [00:54:43] Speaker B: Right. [00:54:44] Speaker A: You know, and so you take your powder, you throw it in a pot, you put 10, 12 ounces of water over the top of it, bring it to a boil, drop it to a simmer, five minutes, strain it out, drink it. [00:54:54] Speaker B: Yep. [00:54:55] Speaker A: Right. So it's like a, like a rapid decoction is what you can think of. Um, there are other methods, like people soaking overnight and stuff like that. I think that's fine too. [00:55:03] Speaker B: Yeah. [00:55:03] Speaker A: You know, if you've got a good thermos, you can put it in there and, you know, you can do both doses for the day at once and spread it out like it's totally fine. You know, but in the most classical sense, like you're just gonna put your powder into a pot with just, you know, a little bit more water than you want. To drink because some of it's going to boil off and some of it's going to absorb into the powder and then strain out the powder and drink it. You don't need to eat the powder. [00:55:25] Speaker B: Yeah. [00:55:25] Speaker A: People are like, oh, I could eat the powder. I mean, you can, I guess, if you want. But, like, it's gross. It's gross. And it's like, it's, you know, and when you strain it, some of it's going to come through the water anyway. So you're going to be drinking some, like the finest powder you're gonna be drinking. But, like, you don't need to get down the grit. [00:55:41] Speaker B: Yeah. [00:55:42] Speaker A: And so what's nice is, like, people can also take pingu san, like before a meal or after a meal, or you can actually take it like, oh, I'm gonna prime my guts a little bit here and take, you know, half, maybe the cup before the meal, have the meal, take the other half after. Like, you can use it that way to help manage your gut's immediate response to food that's coming in. And so you can prescribe pingwei san like that. Have the patient take it for 10 days. Two weeks. [00:56:06] Speaker B: Yeah. [00:56:06] Speaker A: Like a little while, like, not like three days. [00:56:09] Speaker B: Yeah. [00:56:09] Speaker A: You know, so that what we should see is that their stomach is less reactive to the inputs. And particularly if they've been having, like, frequent loose stool, it should be starting to be more formed. [00:56:22] Speaker B: Yeah. [00:56:22] Speaker A: Ping wei san, I mean, in two weeks of ping wei san, in a person with really wet stool is not suddenly going to give them like a perfectly formed Right. Bowel movement. Right. But it's going to shift it noticeably from like really wet and watery to like a loose mush. [00:56:38] Speaker B: Yeah. [00:56:39] Speaker A: And that, that's good. [00:56:39] Speaker B: Yeah. [00:56:40] Speaker A: That's telling us, like, we have better formation here. We obviously have a ways to go. But if someone has one to two bowel movements a day that are mostly loose mush. [00:56:51] Speaker B: Yeah. [00:56:51] Speaker A: You can probably give them a different kind of formula for the condition and they'll be able to take it. [00:56:56] Speaker B: Yeah. [00:56:56] Speaker A: Right. If they've got three plus bowel movements a day of any style that isn't hard and dry, probably they need. You need to, you need to fix the guts a little first. [00:57:07] Speaker B: Yeah. [00:57:07] Speaker A: You're not going to correct them perfectly. They don't have to have like golden banana poops. Right. In order to, like, be able to use a formula, but three plus bowel movements a day, particularly if they're very wet and particularly if they're very urgent. [00:57:19] Speaker B: Yeah. [00:57:20] Speaker A: Don't, don't Start with the curative formula. You got to do something with the guts first because they're just not going to be able. Probably they're just not going to be able to absorb it. [00:57:28] Speaker C: What. What does that mean? Is that. Does that like a wuling san or what? What, So I fix the guts first? [00:57:34] Speaker A: It's that. It's ping wei san or wuling san. Probably. [00:57:36] Speaker B: Yeah. [00:57:36] Speaker A: You know what I mean? It really just depends on what's there. But what I really want to see is. Is just that the wetness in the stool itself is. Is pulled back. So that can either be by literally draining out excess fluids in the body. So if you have someone, for example, who's got like, say three to five bowel moons a day, they're mostly watery with like little pieces of bowel in there, but it's wet. And that person is like edematous. Right. Like they take their socks off and they've got sock line. Right. Their flesh is like, kind of soft in general. Wuling sun. Yeah, right. There's just water in the tissues. There's water overwhelming the guts. And as I said, wuling san is easy to absorb for most people, even with weak digestion. [00:58:17] Speaker C: Well, people take it when they have food poisoning. [00:58:19] Speaker B: Right? [00:58:19] Speaker A: Exactly. [00:58:20] Speaker C: It's not. I always think about that. Like, if you have food poisoning, you don't want something that's that pungent or that bitter or like. Cause you'll throw it right back. [00:58:30] Speaker A: Yeah. It's gotta be bland. [00:58:31] Speaker C: It's gotta be bland. [00:58:32] Speaker A: Yeah, yeah, yeah. Think of, like, what do people reach for when they have food poisoning? Right. Like saltine crackers. Yeah, right. Like toast salty, bland. Like that's what you need when you're in that case. And so Wulingsan. So again, mostly watery stool, edematous patterns like sock lines and soft flesh. [00:58:51] Speaker B: Yeah. [00:58:52] Speaker A: Wulingsan. Right. Similar kind of person, but with a really reactive stomach. So, like, they really have a hard time finding anything that doesn't make them feel bloated and uncomfortable with urgent stool. That's probably ping wei san. [00:59:05] Speaker B: Yeah. [00:59:06] Speaker C: You know, it occurs to me, too, that this is a good. Maybe a good time to talk about the distinction between water pathology and dampness, because there is a little bit of a difference. And those two formulas illustrate that difference pretty well. Wulingsan being more of a water pathology, like you just said, the swelling in the legs. [00:59:26] Speaker A: Yeah. [00:59:26] Speaker C: And loose stool. That's urgent. Which has water. Right. Literally in the bowel somewhere. [00:59:33] Speaker A: Yeah. [00:59:34] Speaker C: Maybe their. Their. Their diarrhea is watery, in fact, whereas a ping Wei San structure being more about dampness? Could be maybe the stool is stickier or smellier. Right. Or something like that. You might. What, what would you expect as far as differences in like a tongue pattern for those two. Two cases? [00:59:59] Speaker A: Yeah. Unfortunately, the tongues in my experience tend to be pretty similar. [01:00:03] Speaker B: Yeah. [01:00:03] Speaker A: And that's only because tongues, you know, tongues are not a responsive, like they're not a quick response diagnostic tool. Like they give us the sort of state of the body over months or years really at a time. And so, you know, the tongues are likely to be swollen. So you have tooth marks for sure. You probably, if it's. If there is a distinction, the damp representation I'll see with like a thicker greasier coat. [01:00:30] Speaker C: That makes a lot of sense on. [01:00:31] Speaker A: The Ping Wei San. [01:00:32] Speaker C: On the Ping We San. [01:00:32] Speaker B: Yep. [01:00:33] Speaker A: And on the Wulingsan side, they tend to be like pale and wet. [01:00:37] Speaker B: Yeah. [01:00:37] Speaker A: A little shiny, but not in a greasy way. Like in like the wet way. [01:00:41] Speaker B: Yeah. [01:00:41] Speaker A: You know, but they're both swollen. They both have tooth marks. They may have other like, symptoms on the tongue that are part of the like, deeper pathology that go beyond what we're talking about now. So like you might look at a swollen tongue, for example. It's got like a deep center line crack. [01:00:56] Speaker B: Right. [01:00:57] Speaker A: Well, that's a complicated pathology. Right. Like there's excess fluid, but then it's like not in the stomach, in the middle jowl. And so like those are the kinds of things we'll see on like long standing IBS patients or colitis patients where like the dampness in the system that we could have dealt with with like Ping Wei San in the beginning has accumulated and coagulated and become so sticky that it's now generating heat. And that heat is now damaging the Yang Ming pathway. And so stomach is dry and, and not in a way that it wants to be because stomach doesn't like being dry. And then that heat is transferred into the large intestine. And so that's when we start to see like ulcerations in the colon and bleeding and pain and hemorrhoids, anal fissures, like all of that kind of st that comes from heat excess in the colon. And that's a different. That's the kind of work I do on the daily with digestive problems. Usually when we're in this long Covid presentation, it's not, I mean, although you've had a patient with this, but it's not usually the case that it goes that far that quickly. Usually what we're seeing is more Damp inclinations in the tongue, stickier stool, maybe, strong odor, maybe not. It just kind of depends on how hot things have gotten. But sticky for sure. And usually a little bit like sluggish to pass. Like the client will have a need for a bowel movement, they'll sit down and it doesn't immediately happen. Right. But then it does happen. It's like sticky and unformed, but it's not like quick. Whereas the water side, when we deal with cooling san, your colon's not designed to hold water. It's designed to allow substantive material to gather form into the stool so that you can pass it. And if you've ever had like an enema, a colonoscopy, like any sort of like anal douching for any reason, like putting fluid into your colon, you can only hold it for so long and then it evacuates rapidly and urgently. And if you're not near a toilet, it's going to be a problem. So that's essentially what's happening with a fluid, like a water dynamics problem in your colon. Like all of this water is, is going in the wrong places and it's moving on its pathway out. But it hasn't been sufficiently removed from your, your large intestine because there's a, a water problem. And so now it's gathering in your colon and that's where the urgency comes from. Yeah, like you're like, oh, I gotta go now. [01:03:25] Speaker B: Yes. [01:03:25] Speaker A: Because like there's literally water in your colon and it's not designed to hold that. So that's the real, I think, gap there. So urgency, wetness, like a very watery stool. And frequency. [01:03:36] Speaker B: Right. [01:03:37] Speaker A: That tends to indicate this water pathology. Wuling sod. [01:03:40] Speaker B: Right. [01:03:41] Speaker A: Sensitive stomach, like indigestion oriented sensitive stomach that then results in like a sticky. Can still be urgent, but usually it's a weird pattern where like the first part of the bowel movement is wet, like there's the water side of it. And then the client, the patient is still sitting on the toilet waiting for the damp sticky part to come. [01:04:00] Speaker B: Right, right, right. [01:04:01] Speaker A: So there's an urgency and then you're like stuck on the toilet because, you know, obviously water and dampness are different, but they're related. So it's not uncommon for them to have some crossover. But that sticky presentation, greasy tongue probably. And sensitive stomach, Ping wei san wet edematous, watery stool. [01:04:21] Speaker C: Wulingsan and probably there's a difference in thirst too, I would imagine. [01:04:25] Speaker B: Right? [01:04:25] Speaker A: Yeah, yeah. Wuling san people are thirsty. [01:04:26] Speaker C: Wuling san people are thirsty. [01:04:28] Speaker A: Pingwei san people probably unremarkable. [01:04:30] Speaker B: Yeah. [01:04:31] Speaker A: Like they're not. Not thirsty. [01:04:32] Speaker C: Sure. [01:04:33] Speaker A: Like, they'd probably drink water because they know they should. [01:04:35] Speaker B: Yeah. [01:04:36] Speaker A: A lot of people these days. Pretty good about that. [01:04:37] Speaker B: Yeah. [01:04:38] Speaker A: Like, they're like, oh, no, I drink water, I have my cup, whatever. [01:04:40] Speaker B: Right. [01:04:40] Speaker A: But they're not like, oh, my God. [01:04:42] Speaker B: Right. [01:04:42] Speaker C: They're not thirsty. [01:04:43] Speaker A: They don't get dry mouth. [01:04:44] Speaker B: Yeah. [01:04:44] Speaker A: You know what I mean? Because the dampness is like, making up for it. [01:04:47] Speaker B: Yes. [01:04:48] Speaker A: You know, it's sort of there and it's like, that's fine. And sometimes, though, both people can have, like, watery stomach if they drink a lot of water. [01:04:57] Speaker C: 100%. [01:04:57] Speaker A: So penguinsan person drinks like a pint of water and they feel sloshy. And a Wuling San person will too. [01:05:03] Speaker B: Yep. [01:05:03] Speaker A: So that's not a helpful diagnostic tool. But the overall sense of thirst. Wuling San people pretty much always thirsty. [01:05:10] Speaker B: Yep. [01:05:10] Speaker A: And I would say, though, if you still had, you know, three plus bowel movements a day that are urgent and watery and the person is not thirsty, I'd still give them Wuling San. [01:05:20] Speaker B: Yeah. [01:05:20] Speaker A: Right. Like, the thirst piece is like a nice bow on the. On the present. [01:05:26] Speaker B: Right. [01:05:26] Speaker A: But if someone wasn't thirsty, I still wouldn't be. Oh, I don't think I can use Wooling's arms. No. Probably still going to. [01:05:32] Speaker C: The other findings are there for sure. Send it. [01:05:34] Speaker A: And again, because, like, we're using this as a stepping ladder to another intervention. Right. Cause like, we. We have a larger complexity that needs to happen here. We're just trying to manage the. The middle Jiao's ability to actually process this larger intervention. [01:05:50] Speaker B: Yeah. [01:05:51] Speaker A: Needs to begin with, with one of these things. When a patient looks the way that we've described, and it may be the case because water pathology is an interesting kind of pathology, you may end up leaving elements of Wulingsan or all of Wuling San in place when you add your other formula in because the water still needs to go. It's probably not likely that you would leave Pingweisan in the mix once you pivot to your other formulas, just because the angles of those things are not quite as synergistic. They don't link together as well. But it. But for someone who has that tendency, Pingwei san is a great sort of, you know, kind of herbal Pepto Bismol equivalent kind of. [01:06:34] Speaker B: Yeah. [01:06:35] Speaker A: Right. Like, Pepto Bismol is actually a really great thing. Like we invented it in the 20th century. It's like, made from, like a single mineral. It's actually in a Weird way, like if, if the ancient Chinese had invented like, purple bismuth, like, like, if they had just like isolated that mineral, it would be like a Chinese herb today for sure. Yeah. Because Pepto Bismol is not a composite thing. It's like one thing that's powdered and mixed into a slurry solution. It's very effective for short term indigestion, diarrhea, discomfort. Super effective. And it's easy to drink and, you know, whatever. Ping Wei san is a sort of answer to that. Right. Something you could keep in your pantry that if you're like, oh, I had a meal and like, oh, I'm not feeling great, you know, mix up a little Ping Wei sign. Drink it down. [01:07:20] Speaker B: Yeah. [01:07:21] Speaker A: Definitely take the edge off. [01:07:22] Speaker C: Yeah, for sure. [01:07:23] Speaker A: So it has a kind of similar function in that way. [01:07:26] Speaker B: Yep. [01:07:26] Speaker A: So good formula to have around in general. So even if you're not gonna use it long term in a long Covid presentation, having a patient with a tendency toward, like, weak tummy, it's not a bad idea to just have some ping Wei san in the house anyway. [01:07:41] Speaker C: Yeah, that makes sense. [01:07:42] Speaker A: And train them how to use it. Yeah. You know, this is the context. Pop it in like this, use it like this. [01:07:45] Speaker B: Yep. [01:07:46] Speaker A: And it's something that could be helpful for them. They could use intermittently while they're taking other herbs if they feel like their stomach is going off. [01:07:52] Speaker B: Right. [01:07:52] Speaker C: Yeah, that makes sense. [01:07:53] Speaker A: Yeah. Okay. Well, I feel like we've probably covered the sort of generalities here of what's going on with. With long Covid. Some formulas to consider, some patterns to consider. Of course, because it's such a diverse problem, you know, like, we didn't really talk a whole lot, for example, about like, cardiovascular presentations, stuff like that. Um, but again, it always comes down to, like, people get. People in our field get little caught up on the biomedicine. Oh, but what if they've got cardiovascular issue? Like, what if they have this other diagnosis, Biomed diagnosis. It's like, just remember, you guys, I mean, I know we, like, say this all the time, but like, it is still the same process. [01:08:36] Speaker B: Right. [01:08:37] Speaker A: What is in front of you? What is the pattern? Like bianzang, make your differentiation and then treat that. Like it doesn't. It doesn't matter that there's like 40 things involved, because as we have talked about and as you and I have seen in the clinic, keeping your formula approach simple. [01:08:55] Speaker B: Yeah. [01:08:56] Speaker A: Keeping it relatively unmodified allows you to understand whether you're in the right space. And a lot of times, all you need is the base formula. [01:09:07] Speaker B: Right, Right. [01:09:08] Speaker A: Like, how much purchase could you get by just treating the patients we've been talking about with the wuling sun if they're super wet, like, what? [01:09:15] Speaker C: That's a good one to just do by itself. [01:09:17] Speaker A: By itself. Like what. What happens here? Like, how long does this go for? What. What can we track and see? And if you're seeing the patient regularly, you have agility here. Right. You're seeing them every two weeks, every month, depending on, like, how frequently, you know, you know, you expect things to move along. If you're seeing a patient every week or every two weeks in the beginning and then every two weeks or every month after, you've got a pretty good touchstone about what was different from time to time. And so you can see like, oh, yeah, no, this wooling sound's still moving things along. No need to change it. [01:09:47] Speaker B: Right. [01:09:47] Speaker A: Don't rush yourself off of it. For things that are chronic. [01:09:51] Speaker B: Yes. [01:09:51] Speaker A: Right. Because chronic disease is slow to change. [01:09:54] Speaker C: You could see that in interstitial cystitis cases, too, where there's, like, almost chronic UTI symptoms. Put people on wooling sun for a long, long time, and they just continue to get better and better, but they need to be on it for a long time. [01:10:10] Speaker A: Yeah, yeah. And if you're using, like, a physical, objective finding, like, like edema. Right. Particularly, like, it's a simple thing. Right, y'all. Because most of us are doing herbs in concert with acupuncture, which means most people are hopping on your table and they're probably taking their socks off. [01:10:25] Speaker B: Yeah. [01:10:25] Speaker A: And a sock line is a really great indicator. How deep is it? How long lasting is it? Because, you know, we all learn in school, like pitting edema, like, oh, you poke and then it. [01:10:35] Speaker C: You count or whatever. [01:10:36] Speaker A: See how long. Like, firstly, this is a little strange to just, like, poke patients, you know, in a place that it'll show for a prolonged amount of time. And because many people, if not most people are wearing socks, you can see the sock line. [01:10:50] Speaker B: Yeah. [01:10:51] Speaker A: And so how deep is it? How long does it last? And this can be like a really great thing in your chart. That's just like a note about the sock line. [01:10:58] Speaker C: It's a good thing to check. [01:11:00] Speaker A: Yeah. Because you. It's going to be there anyway. [01:11:02] Speaker B: Yeah. [01:11:02] Speaker A: Right. They're going to hop up there. You're going to see the time it took between them taking their socks off and get on the table. And so you can continue to measure that over time. So if that edema sock line remains. Probably your wuling sign is still working. [01:11:15] Speaker B: Yeah. [01:11:16] Speaker A: You know, like, it's getting less and less deep. It's lasting for less time, but it's still there. Just keep. Keep going. [01:11:22] Speaker B: Yeah. [01:11:22] Speaker A: Keep trucking away. [01:11:23] Speaker B: Yeah. [01:11:24] Speaker A: Cool. All right, everybody, well, thanks for listening again to our little discussion here on patterns around long Covid. We're going to follow up this episode with a case study or two that'll help illustrate the specifics of what we're talking about. And as always, if you are interested in what we're doing and you have suggestions for topics, you can always email us at info [email protected] it's all spelled out root and branchpapadeltaxray.com and you can send us some ideas for shows. And we would always appreciate a little rate and review on wherever you listen to your podcast so that way more people can find us. And we really appreciate your time. So this is Travis Kern and I'm Travis Cunningham. We'll talk to you guys next time. [01:12:08] Speaker C: See you next time.

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