Dealing with Dosage

Episode 1 • October 02, 2024 • 01:27:45
Dealing with Dosage
The Nervous Herbalist
Dealing with Dosage

Oct 02 2024 | 01:27:45

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Show Notes

There may be no more important aspect to successful herbal prescription that dosage. What each herb is dosed at relative to the others creates the heartbeat of herbal alchemy. And then, how much herb your patient takes how often will determine the ability of your alchemy to make meaningful and lasting change. TK and TC talk about the various aspects of dosing granules and bulk herbs and provide some strategies for thinking about your own dosing techniques. 

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Episode Transcript

[00:00:02] 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 B: Hello, everybody, and welcome back to another. [00:00:20] Speaker A: Episode of the nervous Herbalist. My name is Travis Kern, and I'm here with Travis Cunningham, and we're going to talk to you guys a little bit today about some important elements of herbal medicine, particularly around the question of dosage. Dosage is something that comes up all the time in our work in the pharmacy. I mean, it comes up in our work as clinicians, obviously, which is what we'll talk about today. [00:00:45] Speaker B: But the reason that we thought about. [00:00:47] Speaker A: This topic was because we have practitioners from all across the country, some even in other countries, who submit formulas to us that we fill in the pharmacy. And sometimes those formulas are really organized in a conventional manner. You know, it's a bulk formula. [00:01:02] Speaker B: Here's one bag of herbs. [00:01:03] Speaker A: This one bag lasts for three days. We're going to give the patient three bags. [00:01:08] Speaker B: So they've got herbs for nine days. [00:01:10] Speaker A: There's been a lot of thought that's gone into how the patient is being given the herbs and how they're supposed to take them. [00:01:16] Speaker B: Similarly with granules. [00:01:17] Speaker A: Right. Our software requires that people submit things with dosage information, but then well talk. [00:01:24] Speaker B: To patients or their practitioners and well. [00:01:26] Speaker A: Get this sense that dosage is kind of all over the place. I dont know, how much should I dose and does it matter? And well just take a little bit and then see what happens. [00:01:37] Speaker B: And it came to mind to us. [00:01:39] Speaker A: Because we talk about dosage all the time, that we should probably take a minute and talk a little bit about. [00:01:45] Speaker B: Dosage as a concept and sort of. [00:01:47] Speaker A: Like how it applies in herbal medicine. [00:01:50] Speaker C: Yeah, absolutely. [00:01:52] Speaker A: So the first place I wanted to. [00:01:53] Speaker B: Start is with like a general thing. [00:01:55] Speaker A: TC and I were talking the other day, and he, he actually had this phrase that I really liked, which is that virtually any formula can be prescribed at a low enough dose without the patient experiencing any negative effects, but also no positive effects. Basically, like you can give someone any formula at, at a sufficiently low dose and it'll be fine even if that formula doesn't match the pattern. [00:02:22] Speaker B: Right? [00:02:23] Speaker C: Absolutely. [00:02:23] Speaker A: Want to talk a little bit more. [00:02:24] Speaker C: About that hash t pills, right? [00:02:26] Speaker A: Yeah, I mean, exactly. [00:02:28] Speaker B: Right. [00:02:28] Speaker A: We get a bottle of t pills. What's the, like, the on the bottle dose for t pills is something like. [00:02:34] Speaker C: Three t pills three times a day. [00:02:35] Speaker A: Or something like that. [00:02:37] Speaker D: Yeah. [00:02:37] Speaker B: How much herb is actually in any. [00:02:38] Speaker C: Of those, it's like a minuscule right amount. Right. We were talking about to dose a t pill formula at a therapeutic dosage, from our point of view, you'd basically have to take three quarters of it for one dosage, like, for one use. [00:02:55] Speaker A: Yeah. [00:02:56] Speaker C: And then, you know, the second dose would be. You'd need a second bottle, that kind of thing. [00:03:02] Speaker A: I had a bottle of t pills, like a Huanglian wu juyu sort of traveler's aid style formula that I had with me on a recent trip. And I knew that food poisoning was oncoming, so I was like, oh, let me see if I can stave off some of the symptoms. And so I just grabbed the bottle, which was about half full, and I just ate them all. [00:03:20] Speaker E: Yep. [00:03:21] Speaker A: And I remember, like, my wife was looking at me, she's like, are you. [00:03:24] Speaker B: Are you taking all of those? [00:03:25] Speaker A: And I was like, oh, yeah, yeah. The only way we're going to get anything out of this is if I finish this bottle. And I remembered when I was doing it that the last time I had come across a similar situation, I ate the first half of the bottle. Yep. So it's one of those things where, like, if I only took three of those tea pills, that just wasn't going to do anything. Right. And we should talk a little bit about why and sort of like, what the issue is here. [00:03:48] Speaker F: Right. [00:03:49] Speaker B: It's important to remember that most people's. [00:03:50] Speaker A: Experience with dosing medications is pharmaceutical, right? [00:03:54] Speaker E: Yes. [00:03:54] Speaker B: And pharmaceutical medicines are incredibly potent. [00:03:58] Speaker A: Right? [00:03:59] Speaker B: In very small quantities. [00:04:00] Speaker A: I mean, in milligrams of active ingredient. When you actually take a pill, and. [00:04:06] Speaker B: You'Re taking the milligrams of a thing. [00:04:07] Speaker A: Right. [00:04:08] Speaker B: If you put that pill on a. [00:04:09] Speaker A: Scale that probably weighs half a gram, maybe a whole gram, that's because most of it is filler and press to. [00:04:15] Speaker B: Hold the powder in suspension along with. [00:04:17] Speaker A: Other things to aid digestion and whatnot. [00:04:20] Speaker B: But most of what you're holding is. [00:04:22] Speaker A: Not the medicine, because the medicine is. [00:04:23] Speaker B: Effective in the milligram quantities. That's not really true for herbs. [00:04:28] Speaker F: Right. [00:04:29] Speaker A: Though we'll talk a little bit later about people getting interesting results with lower doses than what we would think of as conventional dose. But realistically, if you're holding a t pill and that t pill weighs 250 milligrams, how much of that t pill is actual medicine? I mean, maybe 50 milligrams. [00:04:49] Speaker D: Right. [00:04:49] Speaker A: You know, and so if we're saying that many classical formulas are being dosed between, say, 50 and 70 grams. [00:04:58] Speaker F: Right. [00:04:58] Speaker A: And you're holding 50 milligrams. Okay. It's a thousand milligrams to a gram. [00:05:07] Speaker D: Right. [00:05:07] Speaker F: Right. [00:05:08] Speaker A: And we're talking. You need 50,000 milligrams of a thing for it to be effective. In many cases, you're holding 50 milligrams. [00:05:17] Speaker D: Yeah. [00:05:18] Speaker F: Right. [00:05:18] Speaker B: So it's a fraction of a fraction of a fraction. [00:05:20] Speaker A: It's tiny. [00:05:21] Speaker E: Yeah. [00:05:21] Speaker C: I think the other relevant factor in this discussion, too, is so you have the pharmaceutical comparison, but you also have the supplement comparison, where so much of chinese herbs on the market for western people is done through the scope of supplementation and not medically recommended supplementation, but supplementation in the form of advertising. So the recommended dosage for something is given at a, at such a small recommended dosage, because the thing that you don't want, if you're selling a product is for somebody to have a negative experience with your product. And truthfully, you almost don't, in some ways, arguably, don't want them to have too positive of an effect either, because then they'll finish the herb or the formula or whatever you're selling and then not need it anymore. [00:06:24] Speaker F: Right. [00:06:24] Speaker C: So the incentive for profit is around exceptionally low dosage that people take chronically, basically forever, and realize very few results, if any, and almost can have to convince themselves that they're feeling better after they take it. Sometimes, yeah. [00:06:45] Speaker A: I mean, how many times have we come across a patient who's taking MSM chondroitin supplements with a Berberine tablet? [00:06:54] Speaker D: Right. [00:06:55] Speaker A: You know, a multivitamin for men over 50 combined with probiotic. Probiotic in a gummy form that they bought from Costco. [00:07:06] Speaker F: Right? [00:07:07] Speaker E: Yep. [00:07:07] Speaker A: And you ask them like, well, is. [00:07:09] Speaker B: Any of this helping? [00:07:10] Speaker A: And they're like, yeah, I mean, I. [00:07:12] Speaker C: Feel a little better when I take it. [00:07:14] Speaker A: Yeah, maybe. Maybe it's better, you know, but I. [00:07:16] Speaker B: Mean, it can't hurt. [00:07:16] Speaker A: Right, guys? It can't hurt is just the sound of a cash register to supplement companies. Right? Like, it can't hurt. And that idea that it can't hurt. [00:07:29] Speaker B: Is also highlighted in the dosage factor. [00:07:32] Speaker A: Right. [00:07:33] Speaker B: Like, again, if you buy a bottle. [00:07:35] Speaker A: Of whatever xiaoyao San tea pills and you take three t pills twice a day. [00:07:40] Speaker F: Right. [00:07:41] Speaker A: Can't hurt. [00:07:42] Speaker F: Right. [00:07:43] Speaker A: You could literally give that to infants. [00:07:45] Speaker E: Yep. [00:07:46] Speaker B: Can't hurt. [00:07:47] Speaker F: Right. [00:07:47] Speaker B: And why is that like that? [00:07:49] Speaker A: Well, it's because, firstly, if you're going. [00:07:51] Speaker B: To sell something over the counter without. [00:07:53] Speaker A: Expertise involved with it, the company can't take on the risk that you might. [00:07:58] Speaker B: Give yourself terrible diarrhea or horrible headaches or heart palpitations or shortness of breath. [00:08:04] Speaker A: Or really hurt yourself. [00:08:06] Speaker F: Right. [00:08:06] Speaker A: Put yourself in the hospital, because as. [00:08:09] Speaker B: We'Ve said many times on the show. [00:08:10] Speaker A: In other contexts, people have this impression that because it's an herb, it's safe. [00:08:15] Speaker D: Right. [00:08:15] Speaker A: It's natural, it's safe. Well, I mean, we can have a different conversation about how herbs and quote unquote, natural things compared to pharmaceuticals, but. [00:08:24] Speaker B: The truth is, is that herbs are incredibly potent. [00:08:26] Speaker F: Right. [00:08:27] Speaker A: We have herbs in the pharmacy that can kill you. [00:08:29] Speaker F: Right. [00:08:30] Speaker A: And that's not because, like, oh, we. [00:08:33] Speaker B: Carry poisons, but it's because plants are potent. [00:08:35] Speaker E: Yeah. [00:08:36] Speaker B: And so if you make a product. [00:08:37] Speaker A: If you're a wellness company or a. [00:08:39] Speaker B: Chinese herbal company, and you're going to make a product that's meant to sit on the shelf that can be purchased by anyone. [00:08:45] Speaker F: Right. [00:08:45] Speaker A: Without any kind of oversight whatsoever, you are by necessity motivated to keep the concentration low, the dosage low. [00:08:53] Speaker F: Right. [00:08:54] Speaker B: And as you pointed out, maybe someone does get a little bit improvement from. [00:08:58] Speaker A: Their beyond wand for their sniffles, but. [00:09:01] Speaker B: It'S not going to correct their allergy presentation. [00:09:03] Speaker A: They're just going to buy ten or. [00:09:05] Speaker B: 15 bottles of your beyond one every spring. [00:09:07] Speaker F: Right. [00:09:08] Speaker B: And that's great news for your bottom line. [00:09:11] Speaker D: Right. [00:09:11] Speaker B: Great news for your bottom line. [00:09:13] Speaker A: And so, you know, again, not everything is a conspiracy. [00:09:15] Speaker B: Not everything is cynical. [00:09:17] Speaker F: Right. [00:09:17] Speaker B: But in this context, people should be. [00:09:19] Speaker A: Wary of what's there because the interests are not aligned in a way that's necessarily focused toward your good health. [00:09:28] Speaker D: Right. [00:09:29] Speaker A: So that brings us back then to. Okay, so you're working with a provider now, someone who's writing a custom formula for you, someone who's looking at things. [00:09:39] Speaker B: You are that provider. [00:09:40] Speaker F: Right. [00:09:40] Speaker A: The patient is working with you and you're writing a formula for the patient because they've decided that an over the counter Berberine isn't going to cut it. [00:09:47] Speaker D: Right. [00:09:47] Speaker A: Okay, so how do you formulate your dosage? And I think it's important to make a distinction, perhaps between bulk formulas, granule formulas. We don't have a lot of experience with tinctures, so unfortunately, I can't give you much insight into that space. [00:10:06] Speaker B: But that would also be a question as well. [00:10:07] Speaker A: And some of what we're going to talk about here relative to concentration and things like that, you can take into consideration when you're looking at tinctures. And then lastly, we're also going to take a look at what people are a lot of, well, some people are calling like San method herbs, which has to do with classical sans penguins, etcetera. But also using that same San quote unquote style with other formulas. [00:10:30] Speaker D: Right. [00:10:31] Speaker A: So maybe let's start with granules and then we'll go to bulks and sans, since those are kind of connected. [00:10:38] Speaker E: Yep. [00:10:38] Speaker A: So in your experience, just in general, when you're thinking about a granule formula for a patient, total dosage for the day. [00:10:47] Speaker F: Right. [00:10:48] Speaker A: Where, where do you usually fall and, and why? [00:10:52] Speaker C: So I start my dosage for most people with most conditions at 8 grams twice a day. And the reason I do that is because the, the people that I saw in the beginning use herbs that I saw to be effective, dosed around that dosage. Some of them would do five or 6 grams three times a day. I find that doing eight twice a day is just a little easier for people to remember if it's three times a day sometimes. [00:11:24] Speaker A: Yeah. [00:11:24] Speaker C: People forget the third one or so. I just find that compliance is a little better if it's twice. But hitting that general mark is generally what I'm, what I'm looking at. But it is condition specific. So there are certain conditions that you would need to dose a lot higher than that with a granule formula. Maybe the same formula, but based on the condition, you need to go higher. [00:11:52] Speaker A: Yeah. We speaking with some folks in, in. [00:11:55] Speaker B: The granule industry over the years, we. [00:11:57] Speaker A: Got some interesting information in terms of averages by country. So in the US, most granule formulas are being prescribed between twelve and 16 grams per day. So that's six bid or eight bid. [00:12:14] Speaker F: Right. [00:12:15] Speaker A: And then in New Zealand and Australia, interestingly, the dosage is smaller, nine to 12 grams total per day. And then in China, particularly in the mainland, you're looking at 16 to 24 grams per day. So more. So here, the US is kind of in the middle. China's higher, New Zealand is lower. [00:12:37] Speaker B: When we probed the granule folks we were talking to about this, about why. [00:12:41] Speaker A: The answer was simply, the first one was cost. [00:12:46] Speaker B: Cost. [00:12:46] Speaker C: Yep. [00:12:47] Speaker A: And that granule herbs are, of course, cheapest in China, most expensive in Australia, and secondly, about tolerance and expectation. So there's like a cultural piece around how a person should feel relative to taking the herbs. And if you're listening to this conversation and you're thinking, like, I thought we were talking about dose from a clinical point of view, why would we be talking about it in terms of cost? [00:13:10] Speaker F: Right. [00:13:11] Speaker A: Like we really would adjust our dosage over cost. [00:13:13] Speaker B: The truth is, is that one of the reasons that people are experimenting with. [00:13:16] Speaker A: San method that we're going to talk. [00:13:17] Speaker B: About later has to do with cost. [00:13:19] Speaker D: Right. [00:13:19] Speaker A: You can't neglect the fact that cost is a huge factor in how likely. [00:13:25] Speaker B: Patients are to take herbs over time. [00:13:27] Speaker F: Right. [00:13:28] Speaker A: Now, that doesn't necessarily mean that you. [00:13:30] Speaker B: Reduce your dosage to the point that. [00:13:32] Speaker A: From your point of view, it's not effective because of cost. [00:13:35] Speaker F: Right. [00:13:35] Speaker B: That's probably a different conversation you need to have with the patient that says. [00:13:38] Speaker A: Look, this is what it's going to cost. Can we make investments in time and money and energy to do it? [00:13:43] Speaker B: Because there is a point at which. [00:13:44] Speaker A: Taking in cost into consideration will reduce your effectiveness. But you're dealing with two levers, right? [00:13:49] Speaker B: Potency, effectiveness and cost. [00:13:51] Speaker A: You can't ignore it for sure. But also in this other factor is tolerance and expectation, right? [00:13:57] Speaker E: Absolutely. [00:13:58] Speaker A: Classical. You know, chinese folks in China taking herbs, expecting a certain kind of result. [00:14:03] Speaker B: And a certain force and potency. [00:14:06] Speaker A: And of course, as we move into the western world, we have less tolerance for that. [00:14:10] Speaker F: Right? [00:14:11] Speaker B: Less tolerance for loose stools, less tolerance. [00:14:13] Speaker A: For urgency, less tolerance for bitter flavor. And so we gotta go more lightly. [00:14:18] Speaker F: Right. [00:14:19] Speaker A: So tell me, like, what kind of things? So if, if eight is kind of. [00:14:25] Speaker B: Your standard, eight twice a day, so. [00:14:26] Speaker A: 16 for the day, when would you. [00:14:28] Speaker B: Go up from that and why? [00:14:31] Speaker C: So I would go up for that a little bit with formulas that are larger in terms of their ingredient and dosage, if you were to give it in bulk. So let's take Chaihu jalungumulitang as an example. Chaihu jalungumulitang has, I think, 13 ingredients. I could be wrong by one or two, but they're heavily dosed ingredients. You got 24 grams of chihu. The way that I dose it, you're gonna do at least 30 of longu and muli. And then you have dahuang at twelve, you have xiangjiang at nine, you know, bancha at twelve. So you have a lot of ingredients that are dosed at a reasonably high dosage. [00:15:17] Speaker A: Yeah. [00:15:18] Speaker C: So if you were to give that formula in bulk, it would end up being probably 150 grams a day, the way that I would dose it. So then if you think about granules as a ratio, you would need to comparatively dose the granule formula higher. And so I will go up from eight twice a day to 910, eleven or twelve twice a day. I usually don't go above twelve twice a day. So if I'm getting, let's say I give the formula the first time and it's pretty good results, I might go up to see if I can get better results faster. There's also conditions that are specific to needing more dosage and granule. Cold and flu. Acute presentations of cold and flu. I've seen certain cases where people need double or triple that number of what I would normally give per day if I'm going to do treat it in granule. Same formula, same ingredients. If you give it at too small of a dosage, it doesn't work for some people. And if you just increase the dosage, you don't change any of the ingredients or do anything like that. So the formulation is fine, but you go up in dosage, it works great. So cold and flu is like one of those things where I still tend to like to use bulk herbs if it's real acute, just because I'm sure that two or three days of a really well dosed bulk formula will really change the situation. And maybe people don't need much more than that if you're on point with your prescription. So cold and flu is another area. Dermatology is an area where you could go up. Excuse me, that's one where you could definitely go up higher. And. Yeah, those are the two that come to mind that you would def condition specific ones that you'd want to go up. [00:17:32] Speaker A: Definitely. I think you mentioned about sort of. [00:17:35] Speaker B: Thinking about the concentration ratios of granules. [00:17:38] Speaker A: And how they relate to bulk herbs. Yeah, this is an interesting point because a lot of people have this idea. [00:17:44] Speaker B: About the potency of granules. [00:17:46] Speaker A: In fact, they're super concentrated and very potent. And you'll hear that granules are a five to one ratio, that five to one ratio is a convenient sort of across the board ratio. But actually, as it turns out, that granule companies, I'm thinking evergreen, Tianjiang, Tianjiang. [00:18:06] Speaker B: Being charges of the east and legendary. [00:18:07] Speaker A: And those are all the same brand. [00:18:10] Speaker B: Those companies have such a refined process. [00:18:13] Speaker A: That they have a specific ratio for. [00:18:17] Speaker B: Each individual herb, right. [00:18:19] Speaker A: That sometimes is one to two. Sometimes it's one to seven. Sometimes it's one to 4.23. And so therefore, we get a kind of average of one to five. That's sort of thrown around. But the truth is that it's not quite that exact. And you won't know that. You would literally have to get data. [00:18:37] Speaker B: From the manufacturers if you wanted to. [00:18:39] Speaker A: Get into the nitty gritty. And I want to say for the record that we don't think that's necessary. [00:18:44] Speaker D: Right. [00:18:44] Speaker A: Like, you don't need to have like, an exact conversion ratio, because while the weight of the bulk herb that's represented in this ratio. So that's what we're talking about here, right? Where 1 gram of granule is equal to 5 grams of bulk herb, right? That's a one to five ratio in this context. That, um. That's true insofar as the weights that were concerned. But if you actually were to take. [00:19:10] Speaker B: 1 gram of a granule and dissolve. [00:19:13] Speaker A: It into water and take 5 grams of a bulk herb and decoct it into water, and you were to taste those side by side, in almost every case, the bulk herb will be much more potent in flavor. [00:19:27] Speaker C: Absolutely right. [00:19:28] Speaker A: I mean, certainly things that are kind of ephemeral and chi quality, like Jing jia bohe xiangjiang, all that stuff, definitely going to be there. [00:19:38] Speaker B: But it's also true of roots, right? [00:19:40] Speaker A: I mean, even like shih changpu bulk. [00:19:43] Speaker B: 5 grams of sir Changpu cooked into. [00:19:45] Speaker A: Tea versus 1 gram of granule. That bulk, sir Changpu, is going to be dry in your mouth. You're going to feel the puckering of your mucosa. You're not going to fill that with a granule, right? [00:19:57] Speaker F: Right. [00:19:58] Speaker A: That's just the reality of the fact that it's been cooked and then evaporated into a powder and set with a excipient and put into a jar and shipped thousands of miles to where we are, like, it's just the reality of processing. [00:20:11] Speaker B: That doesn't mean that it's not useful. It just means that, like, spending a. [00:20:14] Speaker A: Whole lot of time being like, well. [00:20:16] Speaker B: 1 gram is 5 grams, and let. [00:20:18] Speaker A: Me figure out the math. It has a place, but you don't need to get super granular about it, right. [00:20:23] Speaker B: The place is in what you were. [00:20:24] Speaker A: Just talking about, which is really a. [00:20:26] Speaker B: Question of more overall dosage. [00:20:28] Speaker E: Yeah. [00:20:28] Speaker B: So if you consider, for example, let's stick with our one to five ratio, right? And you were dosing 12 grams per day. [00:20:34] Speaker A: Okay. Then you're looking at 60 grams equivalent, right? [00:20:37] Speaker B: In bulk. [00:20:39] Speaker A: Many, many bulk formulas, the common ones that you would know off the top of your head. Swanza rentong, you know, ban chao shae shintong, xiao chai hutong, et cetera. Fall usually between 50 and 80 grams. 1570, 515 80 grams, right. So that means that if you're dosing. [00:20:57] Speaker B: At between twelve and 16 grams a. [00:20:59] Speaker A: Day, you are in granules. [00:21:01] Speaker B: Twelve and 16 grams a day in granules, you're falling within a rough one. [00:21:06] Speaker A: To five equivalency for a bulk formula, right? [00:21:09] Speaker F: Right. [00:21:10] Speaker A: Interestingly, Guizhou tang, right. Is a relatively small formula, 40 some odd grams, right. In the classic bulk version. [00:21:18] Speaker B: And if you gave that guizhetang for acute cold and flu at a one to five ratio. [00:21:24] Speaker F: Right. [00:21:25] Speaker A: It means that you could just dose like 8 grams a day. 7 grams a day. [00:21:31] Speaker D: Right. [00:21:31] Speaker B: And I will tell you from experience. [00:21:33] Speaker A: That if you try to give someone. [00:21:35] Speaker B: 7 grams a day of Guizhou tank for acute cold and flu, you're not. [00:21:38] Speaker A: Going to get a lot out of it. [00:21:39] Speaker D: Right. [00:21:40] Speaker F: Right. [00:21:41] Speaker B: So this is to say that the ratios are relevant. You should think about them and consider them. But I wouldn't spend too much time finding exact equivalencies. [00:21:51] Speaker F: Right. [00:21:51] Speaker A: It's more important to think about rough relevance between the size of a formula and the granules, almost to the point that, like there's kind of like a minimum, and then from there you go up. [00:22:05] Speaker E: Yes. [00:22:05] Speaker A: So it's like, realistically, I wouldn't give anybody an acute cold and flu formula at less than 16 grams a day. [00:22:12] Speaker D: Right. [00:22:12] Speaker A: I just wouldn't do it if I wanted to get it, get results out of granules. [00:22:15] Speaker E: Yeah. [00:22:15] Speaker B: It could be much more than that. [00:22:17] Speaker D: Right. [00:22:17] Speaker A: It's probably not going to be less than that. [00:22:19] Speaker D: Right? [00:22:19] Speaker E: Yep. [00:22:20] Speaker B: And that's kind of true as well. [00:22:21] Speaker A: For most of the formulas we prescribe, it's worth, I think, maybe do taking. [00:22:26] Speaker B: A minute, though, about some circumstances in. [00:22:28] Speaker A: Which our dosing does drop below the usual 12 grams a day. [00:22:33] Speaker E: Yep. [00:22:34] Speaker A: For me, I do a lot of work with digestive patients and, you know. [00:22:38] Speaker B: Herbs travel through the digestive pathway. So middle jowl has to be functional. [00:22:43] Speaker A: Enough to make use of whatever it is that's coming in. And if it can't, then there's really no point in taking it. [00:22:50] Speaker F: Right. [00:22:51] Speaker A: Couple that with the fact that people. [00:22:53] Speaker B: Who have had chronic digestive problems have. [00:22:55] Speaker A: A lot, a lot of, and I'm. [00:22:58] Speaker B: Going to use the word neuroses here. [00:22:59] Speaker A: But I don't mean that in a judgmental way, but they have a lot of focus and sort of neurotic neurosis attachment to what they eat. [00:23:08] Speaker F: Right. [00:23:08] Speaker B: And exactly how they feel when they. [00:23:10] Speaker A: Eat it, particularly if it's something new. So if I give a digestive patient whose middle jow is admittedly weak, a formula that tastes bitter, tastes strong, because, you know, that's what our herbs taste like. [00:23:22] Speaker B: And when they drink it, if they. [00:23:23] Speaker A: Don'T have an immediately positive effect, like, oh my God, my stomach feels so much better. If there's any nausea, any whatever, it. [00:23:31] Speaker B: Feeds into these neuroses around food. [00:23:33] Speaker F: Right. [00:23:34] Speaker A: And coupled with a weak middle jow, and now we get negative results, people are rushing to the toilet, et cetera. So for some of those patients, I'm going to start my dosing lower than I would otherwise. [00:23:46] Speaker F: Right. [00:23:47] Speaker B: Probably go down to 4 grams twice a day. [00:23:49] Speaker E: Yeah. [00:23:50] Speaker F: Right. [00:23:50] Speaker A: So 8 grams. I don't necessarily expect 8 grams to be the requisite dosage to make the change for their ulcerative colitis. [00:23:59] Speaker E: Yeah. [00:24:00] Speaker B: But I'm going to need to start. [00:24:01] Speaker A: There in order to build resiliency in. [00:24:04] Speaker B: The middle jow and trust in the. [00:24:06] Speaker A: Patient that I actually do know what I'm doing. And I'm not pushing you over a cliff. [00:24:11] Speaker F: Right. [00:24:12] Speaker B: With, oh, God, my stomach can't handle it. [00:24:14] Speaker A: You know what I mean? I've even gone lower than that before. I've gone down to 6 grams a day. And notably, 6 grams split into two doses. [00:24:23] Speaker E: Yep. [00:24:24] Speaker B: 3 grams in the morning, 3 grams at night. Not 6 grams at once, because that might be a smidge too much for. [00:24:29] Speaker A: Their middle jow and their psyche to handle. So we split it up into two, and this is our gateway. [00:24:36] Speaker D: Right. [00:24:37] Speaker F: Right. [00:24:37] Speaker B: We're not going to stick with that. [00:24:39] Speaker A: We're going to increase it. But for a whole week, the patient may take it at that low dose. [00:24:44] Speaker B: But my goal is to get them. [00:24:46] Speaker A: Back up to what we think of as a therapeutic dose. [00:24:48] Speaker B: I need them probably taking 1214, 16 grams a day of the herbs to. [00:24:53] Speaker A: Really get the purchase that we need. Might even be more than that, but we have to, like, work our way up to it. [00:24:59] Speaker E: Yep. [00:25:00] Speaker C: Yep, absolutely. And some. Some other discrepancies and when we might have, um, go down in dosage, could be if the patient is really young and they, their body weight compared to the weight of an adult is very much below that. Or very old or very old. You could go. [00:25:21] Speaker A: You can go down in dosage. [00:25:23] Speaker C: Yes, you can. Yeah, absolutely. So, um. Yeah, some. Some of that would allow for different dosage. I do know of certain more experienced doctors than myself who will use specific formulas in very low doses and still get good results. But they're only for specific formulas. Like, wuling san is one of them that comes to mind, where they'll give, like, one or 2 grams of wuling san a day, something crazy, very low in granule, and they'll still get good results, but they'll also go heavy handed, you know, when they need to, and they know when to lean in and when to back off and what's going to be therapeutic. [00:26:09] Speaker A: I think that's an important distinction in a couple of ways. One, it's specific. [00:26:14] Speaker E: Yep. [00:26:15] Speaker A: It's contained, and it's in the hands of an experienced practitioner who knows when to use 2 grams of wooling. Sound. [00:26:23] Speaker D: Right. [00:26:24] Speaker C: I would never do that. [00:26:25] Speaker A: No, me neither. [00:26:26] Speaker B: Me neither. [00:26:26] Speaker A: I don't. [00:26:27] Speaker B: Wouldn't know how. [00:26:27] Speaker D: Right, right. [00:26:28] Speaker A: Like, I don't know what would be the diagnostic pieces in the patient to say, oh, yeah, we can just do a two grammar here. Like, I just, it wouldn't occur to me. I don't know how. [00:26:38] Speaker B: So if you're new, as many of. [00:26:40] Speaker A: The people listening to this podcast are, in terms of, like, how do I prescribe herbs? Our recommendation is not to, by default, rely on incredibly low dosage of granules. [00:26:51] Speaker B: Mostly because, as we said at the. [00:26:53] Speaker A: Top, you can give anybody any formula. [00:26:55] Speaker B: At low enough dose and it won't cause any reaction. And if you don't get any reaction. [00:26:59] Speaker A: As we've talked about before, positive or negative, it's very hard to know if you're doing anything good for the patient. [00:27:04] Speaker D: Right. [00:27:05] Speaker A: You know, not to mention that practically speaking, giving someone a very, very tiny amount of granule, there are built in. [00:27:12] Speaker B: Costs to the distribution of granules, right? [00:27:15] Speaker A: The packaging, the delivery, the spoons, the time, the scales, the weighing. [00:27:19] Speaker B: You start coming up into a situation. [00:27:21] Speaker A: Where if you're handing someone a formula that has a total of, you know, 25 grams for the whole week, that. [00:27:28] Speaker B: You will lose money on that enterprise. [00:27:30] Speaker D: Right. [00:27:30] Speaker B: And as we've talked about, and as all of you know, I mean, this isn't just a money making enterprise, but. [00:27:35] Speaker A: Also you need to keep the lights on. [00:27:37] Speaker C: Yeah, absolutely. [00:27:37] Speaker A: And if you're spending time doling out 25 grams of herbs at a time. [00:27:43] Speaker B: You'Re losing money on that exchange, almost. [00:27:45] Speaker A: Certainly unless you're charging people an upcharge. [00:27:47] Speaker B: To cover your labor and overhead. [00:27:49] Speaker A: And then people are asking themselves, like, why are my herbs so expensive? There's not that much here. [00:27:52] Speaker F: Right, right. [00:27:53] Speaker A: So that's something to keep in mind. [00:27:55] Speaker B: As well, is that there's a pragmatic. [00:27:57] Speaker A: Component to the distribution of herbs in that way. So to recap that then, for listeners, relative to granules, right. So most people in the US are. [00:28:06] Speaker B: Prescribing granules between twelve and 16 grams a day. [00:28:10] Speaker A: We tend to run in the 16. [00:28:11] Speaker B: Grams a day space, the higher end of that. [00:28:13] Speaker C: Yeah, 16 plus for most people. [00:28:16] Speaker A: Yeah. [00:28:16] Speaker B: And then you're going up from there, particularly in our experience, for acute conditions. [00:28:21] Speaker A: Like cold and flu, and also for dermatological conditions. [00:28:24] Speaker F: Right. [00:28:25] Speaker A: Where you need to push hard. You go down from that point for patients who are younger and smaller bodied, older and more frail, and people who might have distinct middle jowl weaknesses. [00:28:37] Speaker B: The difference between those three groups is that your children and your elderly might. [00:28:41] Speaker A: Actually have a fully therapeutic experience at that lower dose. [00:28:45] Speaker B: Many of my digestive patients, we begin. [00:28:48] Speaker A: At the lower dose and then scale back up. [00:28:50] Speaker F: Right. [00:28:50] Speaker A: So we're still trying to get back. [00:28:51] Speaker B: To the twelve to 16 range. [00:28:54] Speaker A: We just have to start small. [00:28:55] Speaker E: Yep. [00:28:56] Speaker F: Right. [00:28:56] Speaker C: So let me ask you a question. [00:28:58] Speaker A: Yeah. [00:28:59] Speaker C: So let's pretend for a second that cost doesn't matter and that convenience doesn't matter. So let's say everyone is on a bulk formula at full dosage. [00:29:11] Speaker A: Yep. [00:29:12] Speaker C: Do you think that there's particular value in giving somebody, let's say, a full bulk dosage of xiao chai Hu Tang versus, or let me, let me put it the other way. Giving somebody a granule version of Xiao chai Hu Tang versus giving somebody a standard bulk dosage of xiao chai Hu Tang. [00:29:36] Speaker B: If money and convenience are off the. [00:29:38] Speaker C: Table, money and convenience are off the table, then no. Than now. [00:29:41] Speaker A: Yeah. There's no reason to use anything but bulk if money and convenience are not factors. [00:29:47] Speaker C: Yeah, I mostly agree. I think that putting them back into the equation a little bit, there are conditions where the nature of the condition is acute and emergent and the hard hitting, immediate heavier dosing of a formula, the administration of a bulk formula perhaps is more valuable than in other conditions. Let's say where the condition is more of a chronic thing. [00:30:19] Speaker F: Yeah. [00:30:19] Speaker C: And then there is an upper limit. This is kind of what I'm trying to get at is I do believe there's an upper limit to what pushing hard with herbs will do for you, even if you get the right dosage. So let's say, like you give, let's say somebody. Well, seasonal allergies is another thing where I actually think bulk is better if you can do it than granule. But there are conditions, let's say the person has chronic fatigue or something like that. They've had it for years, and you do your differentiation and you're like, oh, I think they could take a xiao chai hu tangore as their first formula the first way in here. [00:31:02] Speaker A: Yeah. [00:31:03] Speaker C: That condition probably isn't going to send. Like, it's not going to resolve by doing the bulk particularly faster, or maybe it would be faster, but not in a dramatic way, in my experience, than doing granule. Like, they're still going to need to take herbs for weeks or months before the condition sufficiently shifts. And while it might be faster to do bulk, I do think there's a place where granules definitely has an advantage in that way. [00:31:38] Speaker A: Yeah, I mean, I agree with that. I think that from just a straight. [00:31:43] Speaker B: Nature and flavor point of view, I. [00:31:44] Speaker A: Think it's impossible to beat bulk herbs. Right. [00:31:47] Speaker B: Because you're closer to how they came out of the ground or off the tree. [00:31:50] Speaker A: And so that's going to be better. But I do think there is a point in which the potency for some chronic conditions where it, like, potency isn't the only factor. [00:32:01] Speaker D: Right. [00:32:02] Speaker F: Right. [00:32:02] Speaker A: I mean, like, there is, there are some conditions. I think chronic fatigue is a really good example, actually. Chronic fatigue did not happen overnight. [00:32:12] Speaker D: Right. [00:32:13] Speaker A: It will not be corrected overnight. [00:32:15] Speaker E: Yep. [00:32:16] Speaker B: And it doesn't matter how strong your herbs are. [00:32:19] Speaker D: Right. [00:32:19] Speaker C: That's what I mean. [00:32:20] Speaker B: Yeah. It doesn't matter. [00:32:20] Speaker A: Like, you can bring a bazooka to this party every day and it's not going to make it happen faster because the problem is chronic and there's a lot of things that have been going on and you're going to have to. [00:32:33] Speaker B: Peel back the layers. Now, obviously, there's a relationship here, right. [00:32:36] Speaker A: Like if you go granule and you. [00:32:38] Speaker B: Go too low a dose, you could. [00:32:39] Speaker A: Definitely extend the number of months it might take to fix the problem. And so in this case, like in classic chinese medicine fashion. Right. Like, the answer is not just one thing, right. We got to consider all the factors. [00:32:51] Speaker B: I do think there is a lower. [00:32:52] Speaker A: Limit still where you're under dosing a person and then you're going to extend their treatment time. [00:32:57] Speaker B: And you could do that in bulk. [00:32:58] Speaker A: Or you can do that in granule, you can certainly underdose, but more isn't always better. [00:33:03] Speaker D: Right. [00:33:03] Speaker A: Yeah. So, like, you can't always, you can't just say, like, well, we're going to do bulk because bulk's the best. [00:33:08] Speaker D: Right. [00:33:09] Speaker B: And therefore we're going to incur the cost and the inconvenience because we'll fix. [00:33:12] Speaker A: Your chronic fatigue in three months instead of five if we use bulk. [00:33:16] Speaker D: Right? [00:33:17] Speaker F: Hmm. [00:33:17] Speaker A: I don't know about that. [00:33:18] Speaker D: Right. [00:33:19] Speaker B: A well designed granule formula, it's sufficient. [00:33:21] Speaker A: Enough dose, you can still get it done in three months. [00:33:24] Speaker E: Yep. [00:33:25] Speaker B: Now, if your dose is too low. [00:33:26] Speaker A: It might take a year. [00:33:28] Speaker E: Yep. [00:33:28] Speaker F: Right. [00:33:29] Speaker A: So in that way you have a lower limit but not really an upper limit. [00:33:33] Speaker D: Right. [00:33:34] Speaker F: Right. [00:33:35] Speaker A: No, I said that the other way around. Yeah, I said that the wrong way. [00:33:38] Speaker C: Yeah. [00:33:38] Speaker A: Yeah. [00:33:39] Speaker B: You have, there is a maximum point at which your returns are now diminishing. [00:33:42] Speaker D: Right. [00:33:42] Speaker B: So you're capped on both sides. [00:33:44] Speaker F: Right. [00:33:44] Speaker A: Like you can't go too low, but. [00:33:46] Speaker B: There is not just a endless growth. [00:33:48] Speaker A: Potential on the other side. [00:33:49] Speaker D: Right. [00:33:49] Speaker A: You have to find the appropriate level in the middle. Certainly for acute conditions. I think it's, I mean, I'm certain it's hard to beat bulk. [00:33:57] Speaker B: That doesn't mean that I don't use granules for acute conditions. [00:34:00] Speaker A: I had a cold, like a summer cold a couple of months ago, and I had some xiao chi Hu Tang granules at the house and I just took it. I think I probably took like 30 grams a day. [00:34:10] Speaker C: Yeah. [00:34:11] Speaker A: Like, it's really high. [00:34:12] Speaker B: And because I had it and I. [00:34:14] Speaker A: Know, like, I'm, I take a lot of herbs and so my tolerance is fairly high. High. And I knew I could stomach that. Um, but it worked great. [00:34:20] Speaker E: Yep. [00:34:21] Speaker F: Right. [00:34:21] Speaker B: It worked great. [00:34:22] Speaker A: But 30 grams a day of xiao. [00:34:23] Speaker B: Chai tong granule isn't cheap. [00:34:25] Speaker C: No, no, no. [00:34:26] Speaker B: Right. [00:34:26] Speaker A: It's important to remember that, like, there. [00:34:27] Speaker B: Is also, like, when you're considering quite. [00:34:29] Speaker A: Like costs and stuff, when you start comparing your dosing, at some point, if. [00:34:34] Speaker B: You keep increasing the granule dosage, you. [00:34:36] Speaker A: Might should switch to bulk, right. Because you'll get potency. [00:34:39] Speaker B: And now the cost is about the same. [00:34:41] Speaker A: So you might as well just go ahead and switch over to the bulk. So youre really considering both of those factors. I want to point out that this. [00:34:49] Speaker B: Whole time weve been talking about granules. [00:34:50] Speaker A: Weve been talking about total daily dose as the primary lever for potency and effectiveness, and we havent really talked much. [00:34:58] Speaker B: About individual ingredient dose. [00:34:59] Speaker F: Right. [00:35:00] Speaker A: And thats, I think because in the. [00:35:02] Speaker B: Context of granules, your individual ingredient dosing is fundamentally a ratio, or shall we. [00:35:11] Speaker A: Say a relative dosing, which is if there's 24 chihu and twelve huangchen, right. You could just as well write that. [00:35:20] Speaker B: As two chihu and one huangchen. [00:35:22] Speaker D: Right. [00:35:23] Speaker A: Because the actual amount of the individual ingredients doesn't matter. [00:35:26] Speaker D: Right. [00:35:27] Speaker B: The ratios, the relative relationship between all. [00:35:29] Speaker A: Of them is what matters in terms of designing the formula correctly. But then the reason we've been talking about total daily dose is because that's. [00:35:37] Speaker B: Where you are really adjusting the levers. [00:35:40] Speaker A: In terms of potency. [00:35:42] Speaker C: I want to say something about that real quick, which is just that on most of the continuing education CEU stuff that I've seen out there, that is not clear. It's not clear. Like, when people talk about how they're dosing formulas, they talk about that as if they're dosing a bulk formula. [00:36:03] Speaker A: Yeah. [00:36:03] Speaker C: But then if somebody asks a question and, you know, like me, if I'm there, I'm always the one pressing into this kind of stuff. But what do you actually give the patient? Like, how much, how many grams do you give the patient. And then, and then they'll tell you, well, I'm mostly doing granules, or I'm doing some granules and I'm doing some bulk. And I put these doses up because they could be done either in bulk or granule. But if I'm doing granule, which is most of the time, I'm generally giving, and then they'll give you a generally a scoops thing, which just drives me crazy because that's even less precise. But generally they're doing, between those dosages that we talked about, between twelve and 16 grams a day, sometimes a little more, sometimes a little less, depending on the person and the style of practice. But, um, yeah, let's talk about the scoops thing real quick, because that's something that, before we. [00:37:05] Speaker B: Yes, but before we move on to. [00:37:07] Speaker A: That, I just want to say that. [00:37:09] Speaker B: Writing a granule formula using a bulk. [00:37:11] Speaker A: Ratio is actually the easiest way to do it. [00:37:13] Speaker C: It is. [00:37:13] Speaker A: So that way you don't have to, like, try and do weird conversion in your mind. [00:37:16] Speaker F: Right. [00:37:17] Speaker A: It's like when I write a bulk guager tongue, right. I write it 1212, nine, six, six. [00:37:22] Speaker F: Right? [00:37:23] Speaker A: So that's guager, Baishao, Jurgon, Tao dot, Sau Xiang. [00:37:27] Speaker B: I have more jerk on style. [00:37:28] Speaker A: My formula. Don't write in about it. I just like it. So 1212, nine to six. [00:37:32] Speaker B: That's also what I write in a granule. [00:37:34] Speaker D: Right, right. [00:37:35] Speaker B: Those are literally the numbers I type into our software. Our software, of course, is smart and. [00:37:39] Speaker A: Knows that those are ratios to each other. [00:37:43] Speaker B: And then I tell the software, well. [00:37:44] Speaker A: I need 12 grams twice a day. [00:37:47] Speaker B: 24 grams a day, and it does. [00:37:48] Speaker A: The math for how much of each. [00:37:50] Speaker B: Of those ingredients is necessary to equal. [00:37:52] Speaker A: That total amount of herbic that'll be distributed to the patient. Right. If you're still doing this stuff by hand. [00:37:59] Speaker F: Right. [00:38:00] Speaker A: Then it can get a little bit trickier because now you have to figure out all that math. And so a lot of times, people, you know, this software that we use is not unique, but it's not everywhere. And so a lot of people for. [00:38:10] Speaker B: A long time had to do this math by hand. And so they got around to usually. [00:38:15] Speaker A: Writing formulas that equaled a total of 100 grams. [00:38:19] Speaker D: Right. [00:38:20] Speaker A: Because that was easy to. [00:38:22] Speaker B: Easy math and easy to distribute. [00:38:24] Speaker F: Right. [00:38:24] Speaker B: And so sometimes when you're in ces. [00:38:27] Speaker A: It'S important to push a little bit. [00:38:29] Speaker B: Like ask some questions and be like. [00:38:31] Speaker A: Like Travis said, like, okay, so wait, this is a bulk formula? If it is, if I use it in granules, how much would I take per day. Like, exactly. [00:38:39] Speaker B: This is the key question, which is. [00:38:41] Speaker A: Really why we're talking about dose. [00:38:42] Speaker B: Is that for you, as an herbalist. [00:38:44] Speaker A: You should always be thinking, how much is my patient taking? [00:38:47] Speaker D: Right? [00:38:48] Speaker A: That's the question. [00:38:49] Speaker B: Always, how much are they taking? [00:38:50] Speaker D: Right? [00:38:51] Speaker B: What do we get? [00:38:51] Speaker C: How much did the patient in that case study need to take to get the result? [00:38:55] Speaker A: Yes. [00:38:56] Speaker C: And, like, there's a little bit of it. I'm not criticizing putting up the dosage for a granule formula in that way. Chihuahu 24 or whatever, but what I'm saying is, like, it can get a little sneaky or confusing if you're like, I'll just give a. A super basic example. Let's say I like to dose big doses of futza, right? Because I think of myself as a fire spirit school practitioner. And so, like, when I write this case study, I have futza 90 by it, right? But then when you check in, they're giving a granule formula, and it's actually 6 grams twice a day. They're not giving 90 grams of futsa like somebody in Sichuan does. [00:39:42] Speaker B: Right? [00:39:43] Speaker C: Like, they're not. They're not. [00:39:44] Speaker B: Like, the patient is not drinking 90. [00:39:46] Speaker C: Equivalent grams of fluzza per day, and we shouldn't like. And if they got great results, we shouldn't. Like, that's great. You know, doing that, dosing it that way, that's fine. But we also shouldn't pretend that we're giving that patient 90 grams of futsa as, like, an ego thing, which I think it gets a little bit messy sometimes in our field with that kind of stuff. So I just wanted to point out, like, if you guys are doing ceus and you're paying attention to classes, you want to find out what are they actually giving to the patient? Like, what's the patient actually taking? Because you want to know what did they need to take to get better and what didn't they give? You know, like, didn't they. They did nine twice a day, not six twice a day or not three twice a day. [00:40:38] Speaker A: Yeah. [00:40:38] Speaker D: Right. [00:40:39] Speaker A: Yeah. [00:40:39] Speaker C: They needed. Maybe they needed nine, or maybe they didn't need nine. Whatever it is, you want to know that. [00:40:45] Speaker F: Yeah. [00:40:46] Speaker A: Because if you write this, this fire spirit types formula, like you were just talking about, right, and you did it in bulk and you had 90 grams of futza a day, those 90 grams of futsa, relative to the other ingredients. [00:40:56] Speaker B: In the formula is also a ratio and a percentage. [00:40:58] Speaker C: Yes. [00:40:59] Speaker F: Right. [00:40:59] Speaker G: I. [00:40:59] Speaker A: But that patient also drank 90 grams of foods at home. [00:41:03] Speaker C: 100%. [00:41:04] Speaker F: Right? [00:41:04] Speaker E: Yep. [00:41:05] Speaker B: So both things are true in a bulk. Only one of them is true in a granule. [00:41:08] Speaker E: Yes. [00:41:09] Speaker F: Right. [00:41:09] Speaker B: So in a granule they're just ratios. [00:41:11] Speaker A: And you could, I suppose, give the patient enough total daily dosage so that. [00:41:17] Speaker C: Yeah, five times ratio. [00:41:18] Speaker B: Yeah. [00:41:19] Speaker A: So that way you did all the math and you'd be like, okay, they're. [00:41:21] Speaker B: Taking a 90 grams equivalency. [00:41:23] Speaker D: Right, right. [00:41:24] Speaker A: Most people are not thinking about it like that though. So that's why you got to plug in on the spoon thing. We'll just mention this again, because I'm going to mention it every single time it ever comes up because it's just. [00:41:34] Speaker B: A little hobby horse of both of ours. [00:41:36] Speaker A: But there is no consistent relationship between the volume of a granule spoon and the weight of granules it contains. [00:41:46] Speaker D: Right? [00:41:47] Speaker A: So let's say that again, there is no consistent relationship between the volume of a granule spoon, the weight of granules it contains. So when you pick up your herbs. [00:41:59] Speaker B: And someone hands you a spoon, some random plastic spoon, right, that has nothing written on it. You don't know how many milliliters are in that spoon. You don't know how many ounces if. [00:42:06] Speaker A: You'Re doing crazy english units, here's a spoon, random plastic spoon. [00:42:11] Speaker B: This spoon is 1 gram. [00:42:13] Speaker A: No, it's not possible. It's not possible. [00:42:16] Speaker F: Right. [00:42:17] Speaker B: The grant, the granules are not made of water. [00:42:20] Speaker A: There's not a consistent relationship between weight and volume for these things, right? [00:42:26] Speaker B: If one company is making the grain, the granules. [00:42:30] Speaker A: So you only ever deal with evergreen or legendary or sun ten or KPC, right? [00:42:36] Speaker C: And you deal with none of the others, literally none of the others at all. [00:42:41] Speaker A: You might get pretty close because those. [00:42:44] Speaker B: Companies have a consistent production process that yields a consistent grain size and a. [00:42:48] Speaker A: Roughly consistent density, right. So one of their spoons also not just any old spoon, but the spoon. [00:42:55] Speaker B: Given to you by the granule manufacturer. [00:42:57] Speaker A: May have a consistent weight for their granules only. But if you run a pharmacy like we do, it's impossible to get all of your granules from one company. Not everybody carries everything that we need. And so as soon as you start mixing and matching granules from different companies. [00:43:15] Speaker B: You'Re going to get different grain sizes. [00:43:17] Speaker A: So I mean like the actual particles, the powder itself, different grain sizes, some big, some smalls, you're going to get different densities, right? [00:43:26] Speaker B: Because not all herbs are the same. If you get granules made out of. [00:43:28] Speaker A: Langu and granules made out of boho. [00:43:30] Speaker B: They have a different density. [00:43:32] Speaker F: Right. [00:43:32] Speaker A: And just because that's the difference in the manufacturing process. So if you're, you know, for the. [00:43:38] Speaker B: Vast majority of formulas, it doesn't matter. [00:43:40] Speaker A: If you're like, plus or minus a gram, right. So if you're using a spoon, then, and you're doing some rough equivalency, it's okay. [00:43:48] Speaker F: Right. [00:43:48] Speaker B: If you want to know exactly how much you should take, get a gram scale. You can buy them from Amazon. [00:43:53] Speaker A: They're literally like $20. Get yourself a kitchen scale that weighs. [00:43:57] Speaker B: Grams up to a 10th of a gram. [00:43:59] Speaker A: So that's like 1.1 gram. Okay. And just use that, by the way. Just put one of those in your kitchen like you need one for making biscuits and stuff. [00:44:08] Speaker F: Right. [00:44:08] Speaker A: But it's very, very useful in this context. In our pharmacy, we take the gram dosage. So if someone says on their, their formula 6 grams twice a day, our. [00:44:18] Speaker B: Staff is going to take one of. [00:44:20] Speaker A: Our spoons, which are spoons from evergreen, they are roughly a half teaspoon. [00:44:24] Speaker F: Right. [00:44:25] Speaker A: And we're going to weigh out 6. [00:44:27] Speaker B: Grams using that little spoon and give. [00:44:30] Speaker A: You an approximate conversion. So for most of the formulas that leave our clinic, for example, 6 grams is actually about four spoons. Could be four and a half spoons, could be five spoons, could be six spoons. [00:44:42] Speaker F: Right. [00:44:42] Speaker C: Could be two. [00:44:43] Speaker A: Could be two spoons. [00:44:44] Speaker F: Right. [00:44:45] Speaker A: I will also tell you that the higher your dosages, the small variation between. [00:44:50] Speaker B: Weight and volume increases. So if you're dosing something at 3. [00:44:54] Speaker A: Grams, right, then it's probably going to be two and a half, almost three spoons. You dose it at 15 grams, then it's probably going to be more like seven and a half or eight. [00:45:05] Speaker D: Right. [00:45:05] Speaker B: And you're like, wait, that doesn't seem to scale. And that's because there's a small variation. [00:45:09] Speaker A: Each time you weigh it. [00:45:10] Speaker B: That compounds the number, the more number. [00:45:12] Speaker A: Of spoons that you weigh. So all of that to say, if. [00:45:17] Speaker B: You really are concerned about the specificity. [00:45:19] Speaker A: Of your dose, weigh it. [00:45:20] Speaker C: But, and let's talk about why that matters or why that matters for, for us. [00:45:26] Speaker A: Yes. [00:45:26] Speaker C: Like, how did that start to become a thing that we got careful about? [00:45:31] Speaker A: It's primarily because patients complain that they ran out of herbs. [00:45:34] Speaker C: That's why. [00:45:35] Speaker A: That's what happened. [00:45:36] Speaker B: So this is a patient care point of view, right. Because the truth is, is that if I weighed 120 grams and put it in a bag and I handed it to the patient, they got all the herb they paid for. [00:45:44] Speaker E: Yep. [00:45:45] Speaker A: But they were taking more at a. [00:45:47] Speaker B: Time than they needed. [00:45:48] Speaker E: Yep. [00:45:48] Speaker A: Or let's say, then they were prescribed. [00:45:50] Speaker E: Yes. [00:45:51] Speaker A: I don't know what they needed or didn't need, but they were taking more. [00:45:53] Speaker B: Than they were prescribed. [00:45:54] Speaker A: So they had a seven day formula. They finished it in five days. And now they're calling me saying, hey, why'd you short me on my granules? [00:46:00] Speaker C: Right? [00:46:00] Speaker A: I didn't have enough granules. [00:46:01] Speaker D: Right, right. [00:46:02] Speaker A: Oh, no, you definitely had enough granules. [00:46:03] Speaker B: We weighed it before I left here. You've been running heaping spoons or something. [00:46:06] Speaker A: Also, fun fact, I see some practitioners prescribe heaping spoons. Guys, like a level spoon is difficult enough to get people to find some. [00:46:15] Speaker B: Consistency around a heaping spoon. Come on, how big is your heap? I mean, it could be plus or minus a whole gram on a heaping spoon. [00:46:22] Speaker A: So if you insist on relying on spoons, for God's sake, make them level spoons. [00:46:27] Speaker F: Right, right. [00:46:28] Speaker A: And then, let's be honest, they should just be weighing them. But we started putting the conversion on the bag so that patience would understand. Like, wait a minute, this dosing in spoons is not a real thing, which. [00:46:39] Speaker C: We do for every single formula. Every single formula, we will remeasure, because the same, even if it's a refilled formula, let's say we got one herb from evergreen in last week, and then this week we got it in from legendary. The consistency of that same ingredient may be different, which way may alter the total number of spoons, because the density of the full formula is going to change. So even if it's the same exact formula from week to week, it can be a different density and therefore need a slightly different amount of spoons to equate the same number of grams. [00:47:18] Speaker B: Exactly. Yeah. [00:47:19] Speaker A: And so this matters because when you're. [00:47:21] Speaker B: Talking to your patient about their dosage. [00:47:23] Speaker A: How much are they taking, how long it should last? [00:47:26] Speaker F: Right. [00:47:27] Speaker B: We don't want the patient having herbs, being done with their herbs two days. [00:47:30] Speaker A: Early or having two days extra, because now you aren't getting a good sense. Like, maybe they come reporting back to you that, like, every time they take. [00:47:36] Speaker B: Their herbs, they feel a little nauseated. Well, it turns out they're taking too much every time. [00:47:40] Speaker D: Right. [00:47:41] Speaker A: Or they come back into you and. [00:47:43] Speaker B: They haven't noticed anything, but they've still got three days worth of herbs left in the bag. [00:47:47] Speaker A: Well, they haven't been taken enough. [00:47:48] Speaker D: Right. [00:47:48] Speaker A: So it's important that, again, we don't have to get down to, like, oh. [00:47:52] Speaker B: They were off by 0.25 grams. [00:47:55] Speaker D: Right. [00:47:55] Speaker A: I'm not talking about that level of. [00:47:56] Speaker B: Specificity, but over the totalness of the patient's experience. [00:48:00] Speaker A: We want there to be rough equivalents between. If I say this formula lasts for seven days and it lasts for six and a half days or seven and a half days, like, fine, right? [00:48:09] Speaker B: You have an extra dose here and there. [00:48:11] Speaker A: Fine. But we don't want to, like, consistently put the patient in a position where they're running out of herbs. [00:48:16] Speaker D: Right? [00:48:17] Speaker A: I will tell you, too that, like, people have trouble with this. [00:48:19] Speaker C: Yes. [00:48:20] Speaker F: Right? [00:48:20] Speaker B: In fact, as you've been listening to. [00:48:22] Speaker A: Us, maybe you've had trouble with it. [00:48:23] Speaker B: That's totally normal, right? The US education system did not do. [00:48:26] Speaker A: A very good job, I think, of. [00:48:27] Speaker B: Helping us all understand deeply the relationship between weight and volume, even when I say that weight and volume, some people. [00:48:34] Speaker A: Are like, what are you talking about? [00:48:35] Speaker B: What I mean is, like, how much. [00:48:36] Speaker A: Something weighs versus how much space it takes up, right? So if you have a cup of flour, a cup is a volume measurement, but if you put it on a scale, it has a weight, and weight is a fixed measurement. Weight is very repeatable and calculated. [00:48:49] Speaker B: It's always the same. [00:48:50] Speaker F: Right? [00:48:50] Speaker B: Like 10 grams of flour always weighs 10 grams. [00:48:53] Speaker A: It can't be anything different. But a cup of flour could weigh a hugely different number of grams each time. [00:49:00] Speaker D: Right? [00:49:01] Speaker A: If you packed it, if you leveled it, if it was heaping. Like, there's so many variables, right? [00:49:05] Speaker B: So that's why we, of course, do all of our work in grams. [00:49:08] Speaker A: Grams is a specific measurement tool, but. [00:49:10] Speaker B: When you're talking to patients about it, like, you don't need to give them. [00:49:12] Speaker A: A seminar on, like, physics, you know what I mean? But, like, you just do need to take some time to explain, like, what that relationship is. You know what I mean? The thing about the dosing question that we're talking about here is just that. [00:49:25] Speaker B: It'S important to pay attention to the. [00:49:27] Speaker A: Moving parts and it's important as best you can as a provider to understand that there is this difference between weight and volume and that communicating that to patients is important. Again, as I said, you don't need to give them, like, a detailed science lesson to do it, but at the same time, it's probably a good idea to actually talk to them about it in general. One of the things that's interesting about it relative to the work that we do now is even when you consider. [00:49:52] Speaker B: The fact that this has always kind. [00:49:53] Speaker A: Of been a question, even historically. [00:49:55] Speaker E: Yeah. [00:49:56] Speaker A: When we look back at ancient texts. [00:49:59] Speaker B: Right, and we read them in translation. [00:50:00] Speaker A: And we have, like, the chinese dosage numbers, and you read things that are. [00:50:04] Speaker B: Dosed in Liang and in Fen and in Sheng and in tails and in. [00:50:09] Speaker A: Caddies, and you're like, what does any of that mean? Its important to also know that what. [00:50:16] Speaker B: It means has changed over time. [00:50:19] Speaker A: So if you go and look up the chinese measurement system since the communists took over, for example, its a much cleaner metric system. Youll see whole numbers, multiples of five, multiples of ten. But of course, when Zhang Jong Jing was writing or when any of our other classic, you know, prescribers were writing, they weren't using the communist imperial system. [00:50:43] Speaker G: Right. [00:50:44] Speaker A: Metric system. [00:50:45] Speaker B: So instead they had different meanings. [00:50:47] Speaker A: So maybe we should take a second and like, look at some of those numbers and just sort of think about. [00:50:52] Speaker B: I mostly want to offer it as. [00:50:54] Speaker A: Like, a point of reference that I. [00:50:55] Speaker B: Think is interesting, but also to point. [00:50:56] Speaker A: Out that, like, it's not 100% known, right? [00:50:59] Speaker B: Sure. Even now. [00:51:01] Speaker F: Right? [00:51:01] Speaker E: Yep. [00:51:01] Speaker A: So what are some of the, what are some of the terms that you come across when you're studying classics, like the weights? [00:51:08] Speaker B: Which ones? Yeah. [00:51:09] Speaker G: So I think depending on how deep you get into classic study, you may or may not look into these things. But if you study the Shang Hanlun, then you're going to see Guizhou Tang written in Liang. So Guizhou is three Liang Baixiao, three liang, or Xiaoya, three liyange. [00:51:29] Speaker D: Right. [00:51:30] Speaker G: And then we sort of roughly assume today, because it's what we do, that three liang, like a liang, is about 3 grams. So then the dosages that we learn in school, 9 grams, about, sometimes there will be a ratio, like it'll be eight to ten or eight to twelve or something like that. But we're pretty much falling within three to one Liang. But then there's some other things that you come across, like in Xiao Chaihu Tong, you have chaihu at half a jinn, right, which is a different measurement. And then you have Ban cha in all of the bancha formulas, the Sha shintongs, the Xiao Chihu tong as half a shung, which is another measurement. [00:52:23] Speaker B: And that's a volume measurement. [00:52:24] Speaker G: And that's a volume measurement. Yeah, yeah. And then, so, you know, we, there was some pretty interesting research that was done on this topic a few years ago, and why don't you, because you've looked into this a little bit more than I have. So why don't you walk us through what the researchers have found about translating roughly what people were doing at that time and what that could mean realistically for our modern understanding of dosage. [00:53:00] Speaker A: Yeah, I mean, okay, so if you consider if you were going to try and figure out what someone meant when they said Wen Liang a thousand years ago. [00:53:08] Speaker E: Yeah. [00:53:09] Speaker B: The real winner there would be to. [00:53:11] Speaker A: Find a piece of metal that was stampede one Liang, right. And then you would date it, and you'd be like, oh, yeah, this is from this period. And then you'd stick it on a scale. [00:53:21] Speaker E: Yep. [00:53:22] Speaker A: And then you just figure that out, right? [00:53:23] Speaker E: Yep. [00:53:24] Speaker A: And in some ways, that's kind of what we've done. [00:53:27] Speaker F: Right. [00:53:27] Speaker A: And so there's some research done in the nineties by a chinese doctor, Doctor Fu Liu. And Doctor Liu, basically, through the archaeological record, there was a palace museum that. [00:53:41] Speaker B: Was holding on to some pieces of. [00:53:42] Speaker A: Metal that were labeled with a certain number of caddies, right? So to put this into reference for everyone, so going from smallest to largest in weight measurements, we have the words Li Feng Qian, that's with a q, Liang and Jin's. Right. So Jin is like the large unit. [00:54:06] Speaker B: And it's the number one unit, right? [00:54:07] Speaker A: So the one jin is made of 16 liang. Right, where one jin is made of 160 tian. So Jin is like the big number, and everything is sort of portions of a jinn, right? So we know those ratios, those are preserved in a lot of the texts that have come forward. [00:54:24] Speaker B: So we understand, like, what the ratios were relative to each other, but we. [00:54:27] Speaker A: Just don't know what the starting point was. So Doctor Fu ends up with four hunks of metal that are labeled three, six, nine, and 60 caddies. And, of course, again, terminology here, a. [00:54:40] Speaker B: Jinn is a caddy. [00:54:41] Speaker D: Right. [00:54:42] Speaker A: And a liang is a tail. [00:54:43] Speaker B: And so, depending on what point in history you're reading or talking about things. [00:54:47] Speaker A: You'Ll see different words used. But we know that there was equivalency. So, for example, during the opium wars, the Chinese were basically only selling. They had a trade export that was. [00:55:00] Speaker B: Going out, and they were being paid in taels of silver. [00:55:03] Speaker D: Right. [00:55:03] Speaker B: By the British. What does that mean? [00:55:06] Speaker F: Right. [00:55:06] Speaker A: Of course, it meant something different in 1750 than it did in. In 750. But anyway, the great thing is that Doctor Liu ends up with these four items. Three of them have stamps on the back that say legal nine caddies, legal 60 caddies, and they've got an imperial seal on it, so, you know, that's a good place to start. The funny thing, though, is that they all weigh a little bit different when you break them down to the weight of a caddy. [00:55:30] Speaker B: Now, why is this? [00:55:31] Speaker A: Well, of course, the exactness of scales in the past weren't as exact as the electronic ones that we have now. In some ways, also significantly, it's a. [00:55:40] Speaker B: Physical material that's over a thousand years old. So it literally wears away. [00:55:44] Speaker D: Right? [00:55:45] Speaker B: You hand it to a person, hand. [00:55:46] Speaker A: It to another person, hand it to another person. Like, microscopic pieces of that material just wear off, and so its value will change over time. So the older something is, the more variation there is in the weight. [00:55:57] Speaker D: Right? [00:55:58] Speaker A: So anyway, Doctor Liu takes these four items, we do some math, right? [00:56:01] Speaker B: And he calculates that the value of. [00:56:03] Speaker A: One gin or one caddy, on average, between these four documents, these four pieces of metal is 244 grams. [00:56:11] Speaker F: All right? [00:56:12] Speaker A: If you use that as the basis. [00:56:15] Speaker B: Then you end up with a liang. [00:56:16] Speaker A: That's about 15 grams, give or take. [00:56:19] Speaker F: Right? [00:56:20] Speaker A: It's important to note also that the communist Liang today is 50 grams, right? [00:56:26] Speaker E: Yeah. [00:56:26] Speaker G: Interesting. [00:56:26] Speaker A: So that's an also, like, you know. [00:56:29] Speaker G: It can be confusing easily. [00:56:31] Speaker B: They also change the ratios. Like, remember, 16 liangs is one jinn or one caddy. 16 tails is one caddy. [00:56:37] Speaker A: 16 liang is one jin in the Wang Mang period. [00:56:42] Speaker B: These pieces of metal come from the Wang Mang period. [00:56:45] Speaker A: So Wang Mang was an emperor, sort of between warring states and Han. [00:56:49] Speaker B: Kind of is like this one emperor. [00:56:51] Speaker A: Dynasty called the Xin dynasty. You're looking from 45 bce to about 2023 CE, something around there. [00:56:58] Speaker B: So turn to the millennium. [00:56:59] Speaker E: Yeah. [00:56:59] Speaker B: So quite old. [00:57:00] Speaker C: So that's pre. [00:57:01] Speaker G: Just to set that up for our classics. That's pre our classics. That's pre Shanghai. [00:57:06] Speaker A: It's pre Han unification. [00:57:08] Speaker G: Yeah, yeah, yeah. [00:57:10] Speaker B: So, and that's also an interesting note, right? [00:57:11] Speaker A: Because the Han were extremely important in. [00:57:15] Speaker B: Creating the systems that we rely on now, because the Han were long running. [00:57:19] Speaker A: They were well organized. And so it would be fantastic if we get our hands on some Han tails, but apparently they're hard to come by or have been melted down or what. And I mean, it's a long time ago, so it makes sense. But anyway, so they run some other calculations using millet seeds based on some other, you know, textual material from Wang mang. Get a different calculation for the caddy. That puts it at, like 225 grams. But I mean, roughly speaking, you're like 220 to 250 something around there, right? Which puts your liang somewhere between, like 13 and a half and 15 and a half grams. [00:57:52] Speaker D: Right? [00:57:53] Speaker A: So, you know, relatively speaking, in the same zone. [00:57:56] Speaker E: Yeah. [00:57:57] Speaker A: Again, notably, the modern versions are all different. [00:58:00] Speaker D: Right? [00:58:00] Speaker B: Even the ratios, like, there's ten liang. [00:58:02] Speaker A: In one jin in the modern chinese weight system. [00:58:06] Speaker C: Interesting. [00:58:07] Speaker B: Yeah, because it's easier, right? [00:58:08] Speaker A: Like, ten is easier than 16. So when the communists, I mean, they literally just made it up. [00:58:12] Speaker D: Right. [00:58:12] Speaker A: They were like, okay, from now on, a liang, 50 grams, and it's a ratio of ten. Right, I get it. It's easier. [00:58:19] Speaker F: Right. [00:58:19] Speaker A: But anyway, so what that means then, practically, like, let's consider. [00:58:24] Speaker G: Right, let's, let's translate that so far for people. So if, if we're used to taking Guizhou tang, three liang, and assuming that a liang is 3 grams, that's gonna put our total dosage at 9 grams a day of guager. If a liang is 15 grams, or 13 to 15 and a half, that means our typical dosage of guizhou and Guizhou tong is going to be like 45 grams. [00:58:51] Speaker D: Right. [00:58:51] Speaker G: For a single dose. [00:58:52] Speaker A: Right. And that's, you know, the xiaoyao and the guizhou are going to be in equal parts. So that's 45 of each. [00:58:58] Speaker B: Of each. [00:58:58] Speaker A: And now you've got 90 grams there. And then basically it's. [00:59:01] Speaker G: And the same for xiangjiang. [00:59:03] Speaker A: Yeah. It's a five time variance. Yeah. [00:59:04] Speaker G: I mean, so it's going to be a hugely different dosage. And then what about for Xiao chai Hu Tang with half a gin is the original dosage of chai Hu. [00:59:15] Speaker A: This is really interesting, actually, because just a second ago in the last segment, we were talking about how in a granule formula, the herbs are in ratio to each other, and then you're sort of picking this total dose, but that. [00:59:28] Speaker B: Bulk formulas are in ratio and also. [00:59:31] Speaker A: True value, because if you prescribe 90 grams of futza per day, it is. [00:59:37] Speaker B: A ratio to the other herbs. But someone's going to take 90 grams. [00:59:40] Speaker A: Right, right. [00:59:40] Speaker B: It's the same here. And this is why it's interesting with. [00:59:42] Speaker A: Xiao chihu tongue, because if we say. [00:59:44] Speaker B: That chaihu is dosed at half a. [00:59:46] Speaker A: Gin, right, if we pick the sort. [00:59:49] Speaker B: Of middle ground in these numbers, right. [00:59:51] Speaker A: A half a gin is, you know, basically like 115 grams. [00:59:57] Speaker E: Yeah. [00:59:57] Speaker A: You know what I mean? Something like that. Um, and then if you follow that through. So what was. So that's 115 grams of chihuahua. [01:00:05] Speaker B: The huang chin dosages is three liang. [01:00:08] Speaker A: Yeah, three liang. Right. So it'd be 45, 45 grams. [01:00:10] Speaker E: Yeah. [01:00:10] Speaker A: And that is, you know, more like two and a half times the value. [01:00:16] Speaker B: Which is a little bit more than. [01:00:17] Speaker A: Our standard 20 412 chai Huang Chen. But it's close. [01:00:21] Speaker G: Well, and I learned Huang chin at nine, you know, so it's even less. So that would be, yeah. Even even more accurate in that sense. [01:00:31] Speaker F: Right. [01:00:31] Speaker A: Yeah. And, you know, again, if you think. [01:00:34] Speaker B: About it in ratio. [01:00:36] Speaker A: It's. [01:00:37] Speaker B: The ratios are relatively the same even today. [01:00:39] Speaker D: Right? [01:00:40] Speaker B: Like, we're still dosing it and relatively. [01:00:41] Speaker A: Same because, okay, if someone handed you a formula with weights for words and quantities you didn't understand, right? But you had a little key that said, one jin is 16 liang, one liang is 32 Joshua's. It doesn't matter what it is, right? [01:01:02] Speaker B: But if you had a key that. [01:01:03] Speaker A: Showed the ratios between them, which we've had in text for a long time, then you could just decide, okay, one liang is 9 grams, and then just. [01:01:15] Speaker B: Run your formula, and you'd have the. [01:01:17] Speaker A: Same ratio, right, as the original formula, because you know, the interrelation between it all, but you wouldn't have the same total daily dose. And that is a substantial shift. [01:01:30] Speaker F: Right? [01:01:30] Speaker B: I mean, we're looking at here, like, if. [01:01:32] Speaker A: If the liang is 15 grams, classically, Guizhi Tang is literally five times the amount of herb that someone would take. [01:01:39] Speaker B: In a single dose compared to the standard one now, right? [01:01:41] Speaker A: And that would be true also of Shao Chaoton. Yes. Five time variance. So that's pretty huge. [01:01:47] Speaker G: That's huge. That's pretty huge difference. So then, if you think about. [01:01:54] Speaker C: The. [01:01:54] Speaker G: Amount of dosage we're giving people today, if we follow the dosage in the Shanghai, even the modern understanding of that dosage, or the modern average of that dosage, it's almost the amount that John Zhongjing might give. Like, we would give that amount for a week. Zhan Zhongjing or five days. Zhan Zhong Jing would give that in a single day. [01:02:21] Speaker A: Yeah. [01:02:21] Speaker G: So, and then you think about, like, xiao Qinglong Tang or Da Qinglong tong, where you have Ma Huang in Liang, Shi Xin in Liang. And you think about, like, taking 90 grams of Ma huang in a day. Yeah, that's 60 grams of shishin in a day. [01:02:41] Speaker B: Wild. [01:02:41] Speaker G: It's so different, right? [01:02:43] Speaker A: I mean, it begs so many questions that we just don't have answers for. And, like, people speculate about it all the time, but I mean, you just don't know, right? I mean, people guess, and they make educated guesses for sure. Historians and anthropologists and stuff will try and recreate, you know, like, what were the circumstances on the ground for everyday. [01:03:01] Speaker B: You know, villagers and farmers and stuff, or even royalty that would have predicated. [01:03:07] Speaker A: The need for so much herb, right? [01:03:09] Speaker B: And there's any number of questions. [01:03:11] Speaker A: For example, this is, I think the most obvious one to me is the chihu we grow today, the same chihu. [01:03:20] Speaker B: That was grown 2000 years ago. [01:03:21] Speaker A: And I don't mean, by species? [01:03:22] Speaker B: I mean by selection. [01:03:24] Speaker A: Right, sure. [01:03:25] Speaker B: Because the truth of the matter is. [01:03:26] Speaker A: Is that we grow tomatoes today that never existed when we first found tomatoes, right. [01:03:32] Speaker B: I mean, when tomatoes were found, they're a new world food. [01:03:34] Speaker A: They were not red, they were yellow. [01:03:36] Speaker F: Right. [01:03:36] Speaker A: And everyone thought they were poisonous. And so then they were brought to. [01:03:39] Speaker B: Europe as a table decoration. [01:03:41] Speaker A: And then some enterprising farmers were like. [01:03:43] Speaker B: I don't know, maybe this could be eaten. Peasants, of course, because royalty didn't. [01:03:47] Speaker A: They had a choice, but peasants didn't. So then we hybridize and hybridize and hybridize and hybridize. [01:03:52] Speaker B: And now, if you open your seed catalog in the spring, if you grow. [01:03:54] Speaker A: Tomatoes, there are 75 kinds of tomatoes. [01:03:58] Speaker E: Yep. [01:03:58] Speaker B: Different sweetnesses, different textures, different moisture levels. [01:04:01] Speaker F: Right. [01:04:02] Speaker A: And that's in. You know, we discovered tomatoes in the 16 hundreds, right? [01:04:06] Speaker E: Yep. [01:04:07] Speaker A: And they didn't make it to Europe until the late 16 hundreds. So, I mean, this is like 350 years we've been playing with tomatoes, and look how much variation there is. [01:04:13] Speaker B: And this is just for food, not for medicine. [01:04:15] Speaker E: Yeah. [01:04:16] Speaker A: So imagine the chihu of 2000 years ago, right? Probably different than now. [01:04:23] Speaker B: Yeah. [01:04:23] Speaker G: And, you know, chihu is supposed to be like a pioneer plant in the place that it's native to. So you can imagine it growing like dandelions grow for us, you know, like. [01:04:34] Speaker C: It'S all over the place. [01:04:36] Speaker G: So using a massive dose like that would be easy. Like, it wouldn't be. It wouldn't be a big thing to get that much chihuahu. [01:04:46] Speaker B: And the truth is that you might need it. [01:04:48] Speaker G: You might need it. [01:04:49] Speaker A: These. [01:04:49] Speaker B: These days, we have this notion that. [01:04:51] Speaker A: Like, a wildcrafted thing, for example, is more potent than the agricultural thing. [01:04:55] Speaker E: Yeah. [01:04:56] Speaker B: And that may be true for some. [01:04:57] Speaker A: Plants, but it's certainly not true for all plants because we selected those variations over time. [01:05:02] Speaker B: And I'm not talking about GMO's or anything here. [01:05:04] Speaker A: I'm just talking about classical. [01:05:06] Speaker G: Right, right. [01:05:07] Speaker B: You select a plant for specific qualities. [01:05:10] Speaker A: Over time, and you can breed an increasingly potent plant. The best example that a lot of. [01:05:16] Speaker B: People have access to these days, weed. Right? [01:05:19] Speaker G: Yeah. [01:05:19] Speaker A: Seriously, when I was a kid, you get a bag of weed, you know, get your dime bag, and you'd have to, like, smoke the whole blunt or a couple of bowls to have an effect. [01:05:29] Speaker F: Right. [01:05:29] Speaker E: Yeah, yeah. [01:05:29] Speaker B: We've now, just in a handful of. [01:05:31] Speaker A: Years in the legal weed market, selected cannabis to being unbelievably potent. [01:05:37] Speaker E: Yes. [01:05:37] Speaker A: Right. Small, tiny, tiny fractions of a gram. [01:05:41] Speaker B: Will send you to the moon compared. [01:05:42] Speaker A: To the stuff that was available illegally in the nineties. [01:05:45] Speaker E: Yeah. [01:05:45] Speaker F: Right. [01:05:46] Speaker A: And that's just been a handful of years. [01:05:48] Speaker B: And if you think of cannabis as a medicinal. [01:05:50] Speaker A: As many people do, and that those. [01:05:52] Speaker B: Effects, the psychotropic effects and the body. [01:05:55] Speaker A: Effects as a medicinal effect, look at. [01:05:57] Speaker B: How much change we were able to. [01:05:59] Speaker A: Facilitate in 25 years. [01:06:01] Speaker E: Yeah, right. [01:06:02] Speaker B: And changing the plant almost fundamentally to. [01:06:05] Speaker A: The point that, like, the weed of 1990 is almost unrecognizable compared to the weed of today. [01:06:11] Speaker E: Yep. [01:06:11] Speaker F: Right. [01:06:12] Speaker A: So I say all of that to say that, like, if you wanted to get what we think of as the chi moving, transformative, harmonizing effect of Chihu that we get today from, say, 24 grams of medical grade selected, high quality. [01:06:28] Speaker B: Chihu grown in the terroirs that it. [01:06:30] Speaker A: Needs to be grown in in China. [01:06:32] Speaker B: It'S not inconceivable to imagine that you. [01:06:35] Speaker A: Would need some largely higher dosage in the old days. [01:06:39] Speaker E: Yeah. [01:06:40] Speaker A: You know, so that's one reason. [01:06:42] Speaker E: Yep. [01:06:43] Speaker A: The other reason is that we could be entirely wrong about these numbers. [01:06:47] Speaker G: Sure. [01:06:47] Speaker F: Right. [01:06:47] Speaker A: Seems unlikely based on the research, but could. [01:06:50] Speaker B: It's possible. [01:06:51] Speaker E: Yeah. [01:06:52] Speaker B: Also could have something to do with the hardiness. [01:06:54] Speaker E: Yeah. [01:06:54] Speaker A: Of people. [01:06:55] Speaker C: Of people, yeah, absolutely. [01:06:57] Speaker B: I mean, most everyone lives outdoors, basically. [01:06:59] Speaker A: Like, I know they live in a house, but, like, let's. You know. [01:07:02] Speaker E: Yeah. [01:07:02] Speaker C: It's not exactly a bomb control. [01:07:04] Speaker A: Yeah. [01:07:05] Speaker C: For modern day standards. [01:07:06] Speaker A: Yeah, exactly. So it's a little. Basically, everyone lives outdoors. Basically, everyone is very physically active, and it may take a lot to push those people. You know, they have a level of sensitivity very different than our own. [01:07:20] Speaker E: Yeah. [01:07:21] Speaker A: So anyway, all of that to say, it's super interesting, and if you dive deep into classical prescription, you're going to come across a lot of this discussion around how much do we dose and what's the deal? And so it just highlights, again, the importance between ratio and then understanding total dose, like, really playing with those two things. So something we've seen a lot of. [01:07:44] Speaker B: And I think this is really important. [01:07:45] Speaker A: On the question of dose, is a shift among some of our practitioners from. [01:07:50] Speaker B: Writing decoctions or realistically actually writing lots. [01:07:52] Speaker A: Of granule formulas, because most people write. [01:07:54] Speaker B: Granule formulas for their convenience and their. [01:07:56] Speaker A: Price to ground soaked herbs. [01:08:01] Speaker D: Right. [01:08:02] Speaker A: Which many people are referring to as San method. [01:08:04] Speaker D: Right. [01:08:05] Speaker A: I take a little bit of issue with calling a San method, because I think san, classical san has a particular quality to it that this doesn't. [01:08:12] Speaker E: Yeah. [01:08:12] Speaker A: Which we can talk about, but maybe let's. For the purpose of making that distinction, let's call it the what do we think soak method. Steep method. [01:08:20] Speaker G: Yeah, the steep method makes sense. [01:08:22] Speaker A: Yeah, let's go with steep method. So tell. [01:08:24] Speaker B: Tell the listeners to you a little. [01:08:25] Speaker A: Bit about what we've. What people are doing. [01:08:27] Speaker G: Yeah. So, firstly, like, before we transition into that, the thing that I care about, and I think the thing that you care about, we talked about this many times, is actually what works. So as you're listening to this and as you're thinking, like, oh, my God, we're not prescribing enough Chihu. If you were to write a formula with 115 grams of chihu per day, it'd be insanely expensive. And I I think most of the patients that we see wouldn't be able to afford the formula for very long. Maybe they wouldn't need to take it for very long in certain cases. But like we said before, it does seem like there's an upper limit on how much you can move. Even if your formula is correct, if you continue to pound the dosage, it doesn't necessarily help things to move faster at a certain level. So the thing that I care about as a clinician is what actually works. So even if, like, John Zhongjing was doing this massive dosage, what I care about is, does it work today? Can I get it to work at a fifth of the dosage today? Is that okay? [01:09:34] Speaker A: Yeah. [01:09:35] Speaker G: Because that's what we see to work. [01:09:37] Speaker A: And we. Yeah, we see it working. [01:09:38] Speaker G: We see it working all the time. [01:09:39] Speaker A: Definitively, we know that it works. [01:09:41] Speaker D: Right. [01:09:41] Speaker G: But there is a thing, like, we've already sort of talked about this with under dosing and dosing things more strongly. And our experience is generally that stronger dosage in more, in most cases is better in terms of its effectiveness in the clinic. And we want to dose strong enough so that we get clear feedback and that we know that we're moving in the right direction. So there's a trend that I've seen in the last couple of years. Some of my colleagues, some of our colleagues, especially in Australia, have been doing this for a while, but some of our us colleagues as well, where we're moving to a wave. So it's not granule and it's not bulk herbs. So they're taking bulk herbs, grinding them up into powder, as you would in a San preparation. But instead of doing a draft quick boil situation, where you take the powder and you chuck it in some water and you simmer it for five to ten minutes and then discard the dregs, drink the giraffe down, that would be classic, more classic San method. Instead of doing that you take the powder, you put it in boiling hot water in a thermos, a good heat sealed thermos, and then you let it sit there overnight so that it basically cooks, you know, and draws out all of these things overnight. And then the next morning, you get up, you get rid of the dregs of the herbs, you strain it out, and then you drink the brew over the course of the next day. [01:11:19] Speaker F: Right, right. [01:11:20] Speaker G: So that's the. That's what's. That's what people are doing now. The question is, what are they doing for dosage? [01:11:27] Speaker A: Yeah. [01:11:27] Speaker G: Right, yeah. Are they dosing it like a traditional sandhorn? What is the dosage of a traditional san? That's another question we could have because there are things in the texts, like the Shanghai, that talk about San dosage, but again, it's a little bit nuanced. It's not super clear. And so what I'm more interested in is what people have been doing now. And there's a couple of different resources for this. Our perspective is largely informed by what we see practitioners doing in our pharmacy. [01:12:03] Speaker F: Right. [01:12:03] Speaker G: When we fill formulas. When we fill San formulas, what are people doing in our pharmacy? And we have a couple of practitioners who are writing these types of formulas for thermos decoction or for the steep method that are using about. Generally it's about a third. [01:12:22] Speaker A: Yeah, I'd say so somewhere between 25 and 35%. [01:12:27] Speaker G: 25 and 35% of what you would normally dose a bulk formula if you were just going to do. So let's say a modern bulk formula, like. All right, so let's say we're doing Guizhou tong and we have 9996. Right. So what is that? That's 27. [01:12:51] Speaker A: 36. 32 plus your. Yeah. Six twice. [01:12:54] Speaker G: Yeah. So 442. So let's say Guizhou tong dosage, 42 grams total, would be like a classic bulk decoction. [01:13:03] Speaker F: Yep. [01:13:04] Speaker G: So then the San method, you might write as, like 15 or something like that. 15 total grams. And then that. That will be per day. So it'll be about 15 grams per day. In this method where you grind it up, you put it in a thermos, you let it steep overnight, and then that day you would take your herbs over the course of the day. [01:13:28] Speaker F: Yeah. [01:13:29] Speaker G: And the people who are doing this are reporting pretty good results. [01:13:35] Speaker A: We've got people saying, like, it's way better than granules. [01:13:38] Speaker G: Oh, my God. I'll never go back. [01:13:40] Speaker A: Exactly. [01:13:42] Speaker G: I have a colleague in ice who's actually in the Seattle area who's doing less than that in their dosage, who also swears that he's getting amazing results. And so the way he does it is he actually doses what he thinks of as a standard classical dosage. So let's say xiao chai Hu, Tang chai Hu, 24. [01:14:06] Speaker D: Right. [01:14:08] Speaker G: Huang Chin, nine, those doses. So he'll put that up and then he'll grind that, and then he'll have the patient take that for about a week. So in other words, it's about the bulk equivalent dosage for a day, but he'll have them take it over an entire week between five and seven days is what he told me. So that's. That would even be less, I think. [01:14:29] Speaker A: Third, I mean, that's going to probably drop you into, you know, if you were doing dosage for a day. Well, I guess it just depends on the formula. Right, right, because. [01:14:40] Speaker G: Yeah, that's a good point. [01:14:41] Speaker B: Yeah. [01:14:41] Speaker A: Because, like, a bigger formula, like Xiao chai tongue or Qian Wang Bushindan or something, it will be taking more. [01:14:46] Speaker G: Yeah, for sure. [01:14:47] Speaker B: But it's a handy metric to be. [01:14:49] Speaker A: Able to say, like, we're gonna take one day's dose and break it into five to seven days. [01:14:53] Speaker G: Right. [01:14:54] Speaker A: And that's an easy method to understand. [01:14:55] Speaker G: And also speaks to the importance of keeping the ratio. Right. That's. That's kind of the end game. Discussion in this is like, the ratio of the ingredients is incredibly important in dosage, maybe even more so than the amount. The ratios are really important. [01:15:12] Speaker A: And I think we have evidence in the historical record that we were just. [01:15:15] Speaker B: Talking about to support that. [01:15:16] Speaker A: Right. Because we say that Zhang Zhongjing may have, may have been dosing five times the total quantity of herb that we're dosing now, but in almost exactly the same ratio. [01:15:27] Speaker G: Yes. [01:15:28] Speaker F: Right. [01:15:28] Speaker A: So in that case, and again, it's. [01:15:31] Speaker B: Relatively small example, but I think a significant one, that ratio is almost certainly. [01:15:36] Speaker A: The most important factor. [01:15:37] Speaker E: Yep. [01:15:38] Speaker A: Because that's the alchemy. [01:15:39] Speaker E: Yep. [01:15:40] Speaker F: Right. [01:15:40] Speaker A: That's the alchemy of the game. Like, how are these things working with each other and creating the final product? So your ice am guy is doing one day broken in, like, one day of bulk dose broken into five to seven days. [01:15:55] Speaker D: Correct. [01:15:55] Speaker A: We've got other people doing a little. [01:15:57] Speaker B: Bit more complicated math and just saying. [01:15:59] Speaker A: Like, okay, what is the total daily dose? [01:16:03] Speaker G: If I were writing a bulk. [01:16:04] Speaker A: If I were writing a bulk formula, and then I'm going to take a third of that per day. [01:16:09] Speaker F: Yeah. [01:16:10] Speaker A: And in that model, that's actually interestingly. [01:16:13] Speaker B: Very similar to how you would write. [01:16:14] Speaker A: A granule formula, but just for bulk. Yes. Right. In fact, 100%. We're waiting on a software update for. [01:16:20] Speaker B: Our pharmacy software, hopefully sometime by the end of the year, where the software. [01:16:24] Speaker A: Will actually do this calculation for you for bulk, just like it does for granule. [01:16:29] Speaker E: Yes. [01:16:29] Speaker A: So you would just write up your ratio, plug it in, and tell the system, okay, I want the patient to take 30 grams of ground powder per day. [01:16:39] Speaker D: Right. [01:16:39] Speaker A: And then it'll just do the math. [01:16:40] Speaker D: Right. [01:16:41] Speaker A: Can't wait for that day. It's going to save a lot of people a lot of math. [01:16:45] Speaker E: Yeah. [01:16:45] Speaker A: Uh, but for now, you'd have to do that math manually. Right, to, like, get the total numbers. [01:16:50] Speaker E: Yeah. [01:16:51] Speaker A: Um, there. [01:16:52] Speaker G: There is a third. There's a third scenario. [01:16:55] Speaker F: And then. [01:16:55] Speaker C: And then we'll just. [01:16:56] Speaker G: Then we can kind of jump into it. [01:16:58] Speaker B: Yeah. [01:16:59] Speaker G: So the third scenario, um, was introduced recently on a white pine circle talk. And I can't remember the gentleman's name who gave the talk, but he's a practitioner in Canada, and he just does. [01:17:15] Speaker C: This method of herbal prescription, the soaking. [01:17:19] Speaker G: Overnight method, and the dosage that he gave. He quoted Zhang Zhongjing his thoughts that this is what Zhan Zhongjing was doing? I think that that's tough to say for reasons that we already discussed. It's hard to figure out exactly what Zhan Zhongjing meant were the dosages. A lot of people think the dosage information was kind of added in there later. Not that Zhang Zhongjing didn't give dosages in the original Shanghai, but that they were listed in a different section, and then it was reorganized for the sake of reading later by different people. So there's a lot of different things we could talk about there. But his dosage prescription is basically between five and 10 grams per day of powdered herb, which is significantly lower than even the last scenario we discussed with my colleague in the Seattle area. So five to 10 grams, like, just to give people a sense of what this is like, for the first scenario, where people are basically doing a third of the bulk dosage, that's going to. [01:18:32] Speaker A: Land between 28 and 40 grams. [01:18:36] Speaker G: 28 and 40 grams per day. [01:18:38] Speaker D: Right. [01:18:38] Speaker G: Of bulk powder that you're putting into a thermos, whereas in the second situation. [01:18:46] Speaker D: Right. [01:18:46] Speaker G: It's probably half of that. [01:18:49] Speaker A: Yeah. [01:18:49] Speaker B: Although depending on the formula, it could be closer to your white pine circle guy. [01:18:53] Speaker G: Right? It could be, yep. [01:18:54] Speaker A: Yeah. [01:18:54] Speaker B: Because if you did that with Guizhou. [01:18:56] Speaker A: Tong, for example, and you took 42. [01:18:58] Speaker B: Grams and broke it into five days. [01:19:00] Speaker E: Yes. [01:19:00] Speaker B: I mean, yeah. [01:19:00] Speaker A: You'd be taking eightish grams. [01:19:02] Speaker C: Yeah, absolutely. [01:19:03] Speaker A: You know, so it would depend on the formula in that case. [01:19:05] Speaker B: But this guy, the white pine circle. [01:19:07] Speaker A: Guy, is doing that level of dosage irrespective of the formula. [01:19:10] Speaker G: Irrespective of the formula in general, it sounds like if he thinks it's a. [01:19:15] Speaker C: It's. [01:19:15] Speaker G: If it's a standard, and I could be. I could be wrong about this, y'all should go listen to the talk. But if it's a standard formula, like, let's say it's wuling san, he's not adding anything or subtracting anything, then he's going to do 5 grams a day. Five to 6 grams a day. If it's a different formula where he's like adding and subtracting stuff, then I think he goes up a little bit, but not above, like ten or twelve or it's still a very low dosage from my perspective, you know, for a San formula. [01:19:48] Speaker A: Yeah. [01:19:49] Speaker E: Yep. [01:19:50] Speaker A: So it's interesting that a lot of. [01:19:53] Speaker B: People are playing with this now, because. [01:19:54] Speaker A: About two years ago, maybe three years ago now. [01:19:58] Speaker E: Yeah. [01:19:59] Speaker B: You and I were playing around this inspired by some of the Nugent heads. [01:20:03] Speaker A: Work on the east coast Andrew and. [01:20:05] Speaker G: Julianne Nugent had down in ash. [01:20:07] Speaker B: They also do a soak method. [01:20:08] Speaker A: I think in their case, it's almost whole herb or something that they're soaking. Yes. But we started playing around with soaking. [01:20:15] Speaker B: Crushing it, not crushing it. Coarse grind, fine grind, all kind of. [01:20:19] Speaker A: Stuff to see, like, what the results were and what we found in our. [01:20:24] Speaker B: Own internal experimentation, limited though it was, was that it seemed pretty effective for things that required movement. [01:20:31] Speaker E: Yeah. [01:20:32] Speaker B: Or harmonizing. [01:20:33] Speaker E: Yep. [01:20:34] Speaker A: Or basically think of things that are. [01:20:37] Speaker B: More on the yang side of stuff. [01:20:38] Speaker E: Yeah. [01:20:39] Speaker A: Right. Seemed very effective. It seemed a little less potent on the yin tonifying side of things. [01:20:47] Speaker B: So if you were like, blood nourishing. [01:20:48] Speaker A: Postpartum or trying to rebuild elderly or frail people, it seemed fine. But it didn't seem all that different from granule for the level of inconvenience that was attached to it. And I'll also say that for most. [01:21:03] Speaker B: Of our providers that are pushing these. [01:21:04] Speaker A: Formulas through right now, that's also where they're using them. That is to say, in the Yang spaces. So I see them. Qi stag problems, accumulative problems, either blood or heat or dampness. [01:21:18] Speaker F: Right. [01:21:19] Speaker A: I haven't seen a whole lot of yin tonifying stuff. I just ground up one yesterday that had a bunch of yang tonics in it. Yin yang, Huo Lu Rong, stuff like that. So that'll be interesting. But I don't know, as yet, as we've seen, at least from the stuff. [01:21:36] Speaker B: Coming through our pharmacy. [01:21:37] Speaker D: Right. [01:21:37] Speaker A: A deep usage of this methodology for yin tonifying. [01:21:41] Speaker D: Right. [01:21:42] Speaker A: Was there any, did your white pine circle guy talk anything about that distinction, or was it just sort of across the board? [01:21:48] Speaker G: He uses it, not that I remember, but again, like, yeah, people go, go and listen to the talk. It's interesting. And, yeah, this is something that's now kind of being played within our field. It's starting to get a little bit more notoriety, and we haven't really had much. I had one patient that came in this past spring for seasonal allergies that I was playing with this method for, and it seemed to be roughly equivalent to granule in my experience. I didn't find it to be particularly more effective in the one case that I had, but I've only, you know, I don't have enough, enough data to really comment on it yet. [01:22:32] Speaker A: Yeah, it'll be interesting to play with this fall and kind of see how it goes. I mean, okay, so we should probably say too, like, the motivation here, right? Is that a lot of people like bulk herbs, but for years and years. [01:22:44] Speaker B: And years in the west, who just had all kinds of problems with using them, right. [01:22:48] Speaker A: Primarily they're expensive, they, of course, are inconvenient, and there are no other pharmacies. [01:22:55] Speaker B: That I know of in our area. [01:22:56] Speaker A: For example, that will cook herbs for patients. [01:22:58] Speaker D: Right? [01:22:59] Speaker A: Yeah, I've got some folks who will. [01:23:00] Speaker B: Use the big chinese decoction machines and. [01:23:02] Speaker A: Like, mail you the little plastic packets, you know? I know Mazen and a couple other people will do that for folks, but it's still expensive. [01:23:10] Speaker B: It's heavy to ship. Like, there's just a lot that goes into it. [01:23:12] Speaker A: So basically, people were like, nah, just. [01:23:14] Speaker B: Give me those granules. [01:23:15] Speaker A: They're cheaper and easier. [01:23:16] Speaker B: So some of this motivation came from people who love bulk herbs, and they wanted to figure out how to use them more. [01:23:21] Speaker E: Yes. [01:23:22] Speaker A: So that's cool. [01:23:23] Speaker B: We love bulk herbs. I love grinding up the fresh herb. [01:23:26] Speaker A: The chi is readily apparent. [01:23:28] Speaker E: Yeah. [01:23:28] Speaker B: Right. [01:23:28] Speaker A: In the smell, the texture, just the. [01:23:31] Speaker B: Look of them, the brightness of the color. They're vibrant. [01:23:34] Speaker F: Right. [01:23:35] Speaker B: They have a kind of resonance to. [01:23:37] Speaker A: Them that's really profound that I've never experienced with granules. [01:23:40] Speaker F: Right. [01:23:41] Speaker B: Every now and then, I'll open a. [01:23:42] Speaker A: Fresh batch of granules, and you're like, oh, that jingjia has got some good smell. Or usually it's something terrible, like shibai or like, oof, sulfurous and painful, but. [01:23:54] Speaker B: They don't have the same kind of resonant. Quality. [01:23:55] Speaker A: So I appreciate the movement for it. [01:23:57] Speaker B: And by using a fraction of the. [01:23:58] Speaker A: Total dose, we're obviously going to reduce the cost. You know what I mean? However, there's a lot of labor that. [01:24:04] Speaker B: Goes into grinding up herbs. [01:24:05] Speaker A: And so, like in our pharmacy, we have to add some cost back in. [01:24:09] Speaker B: To cover the additional labor it takes to do it. [01:24:12] Speaker A: I mean, I can whip up a 15 grams granule formula in less than five minutes. [01:24:16] Speaker E: Yeah. [01:24:16] Speaker A: If I need to do that same thing in a bulk formula. Grind it, pack it, sift it, all the kind of stuff that goes into it. 1520 minutes. [01:24:23] Speaker D: Right. [01:24:23] Speaker A: So it's a substantial difference in labor costs. So there are some built in things that prevent it from being as cheap as someone might hope it would be, but nonetheless, it's cheaper, particularly for bulk herbs. So people are positively motivated to figure out a way to make this work. [01:24:40] Speaker B: And I think you and I are. [01:24:41] Speaker A: Both excited and generally proponents of the idea. Right. I just want to see it. I just need to see more people's. [01:24:47] Speaker B: Continued use to figure out how to do it well. [01:24:50] Speaker D: Right, right. [01:24:51] Speaker B: And as we've said, I think it's. [01:24:52] Speaker A: There'S a lot of evidence for the things. And if you think sort of classically about sans. [01:24:59] Speaker F: Right. [01:24:59] Speaker A: Ping Wei san, Shiao san, Wu Ling San. These are not yin tone ifying formulas. [01:25:05] Speaker G: No. [01:25:05] Speaker F: Right. [01:25:06] Speaker A: These are formulas that move things that are stuck. Right. They are yang in nature, for sure. [01:25:12] Speaker B: Relatively thin in quality. [01:25:14] Speaker F: Right. [01:25:15] Speaker A: So, you know, I'm sure there are some classical sounds out there that someone is thinking of right now that's like. [01:25:20] Speaker B: Oh, here's a yin tonic san. [01:25:21] Speaker A: I'm not saying they don't exist. [01:25:23] Speaker B: I'm just saying that, like, if you. [01:25:24] Speaker A: Go to the blood tonic section of a pharmacopeia and you look at what's there, you're gonna find tongs. [01:25:31] Speaker C: Yeah, a lot of tongs. [01:25:32] Speaker A: And you're gonna find nutritional therapy. [01:25:33] Speaker E: Yep. [01:25:34] Speaker A: And you're gonna find boil a black duck with ginseng and shooti and drink it as soup. You know what I mean? Because, like, tonification from the deepest part of the body is usually not done by soaking something overnight. [01:25:46] Speaker D: Right, right. [01:25:47] Speaker A: So I think that's an important distinction about likely what I think this is gonna play out to be. But I don't know. [01:25:54] Speaker B: I mean, it'd be fun to actually try. The truth is, I really don't see. [01:25:57] Speaker A: That many people who are just straight yin toneifying patients to really try it on, you know what I mean? [01:26:03] Speaker B: And if it was not a disease presentation but maybe someone who is, say, elderly and a little bit deficient. [01:26:08] Speaker A: It actually could be a cool, low grade tonic, not like medicinal tonic, like. [01:26:13] Speaker B: Oh, we got to move this now. [01:26:14] Speaker A: Because you're having whatever kind of problems. But just like, here's your morning tongue, your morning soak. Right? In this case, your morning steep method. That's not potent, potent, but it's putting. [01:26:26] Speaker B: Some good stuff in there. And so if a frail person were to drink it every day for a. [01:26:30] Speaker A: Year, probably be good for them. [01:26:32] Speaker C: Yeah, absolutely. [01:26:32] Speaker B: Almost certainly. But, like, enough to move an underlying problem. [01:26:36] Speaker A: I don't know yet. I. Yeah, I don't know yet. [01:26:38] Speaker C: Yeah. [01:26:39] Speaker A: Okay. Well, I think we hit on a lot of the highlights here with dosage and some of the things that are going on. So, as always, listeners, you know, if you guys have idea topics, we've got a season set up for us. [01:26:51] Speaker B: So this is the first episode of. [01:26:52] Speaker A: The third season, the nervous Herbalist. [01:26:54] Speaker B: We finally kind of hit a stride here. [01:26:56] Speaker A: We've got a production schedule. We know what we're talking about, but we're always really interested to hear what you guys would like to hear more of. [01:27:03] Speaker B: So you can always shoot us an email at info [email protected] dot. Please check out the pharmacy website, rootinbranchpharmacy.com. you can also reach [email protected] dot. [01:27:16] Speaker A: It's all spelled out, and you can. [01:27:18] Speaker B: Read a lot of our materials there. [01:27:20] Speaker A: We've got supporting materials on herb dosage and other things. You can always make an account to. [01:27:25] Speaker B: Use our pharmacy from anywhere in the. [01:27:26] Speaker A: US, Canada, or Mexico. And so that way we can stay in touch and we can help you guys out with whatever it is that you need doing. So, as always, this is Travis Kern saying thanks for listening. [01:27:38] Speaker C: And I'm Travis Cunningham. [01:27:39] Speaker A: Thanks for stopping by. We'll see you guys next time. Bye.
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