Episode Transcript
[00:00:03] Speaker A: Hi, everyone, and welcome to the Nervous Herbalist, a podcast for Chinese medicine practitioners who like herbs and want to learn more about their function, their history and treatment strategies to use in the clinic.
[00:00:14] Speaker B: Let's get into it.
[00:00:18] Speaker A: Alrighty. Hello, everybody. Welcome back to another episode of the Nervous Herbalist. I'm one of your hosts, Travis Kern, here with Travis Cunningham, and we are excited to talk to you about another sleep insomnia case study. In the last episode, we went through kind of some details around diagnosis and some objective measures and we laid out a successful case. And in this case, we've got another successful outcome, but by more of a circuitous route a little bit. So t, why don't you lay out the case for us? What are we dealing with?
[00:00:52] Speaker B: Okay, so this is a 67 year old female, sorry, male, 67 year old male, who I saw earlier this year as well.
And this guy also had a chief complaint of insomnia, but he falls asleep easily.
But the insomnia is he wakes up in the middle of the night and then it takes him a while to fall back asleep and.
Yeah, and then he's tired in the morning because he's up, you know, three, four hours in the middle of the night, eventually falls back asleep. But then, as so many people do who have a pattern like this, they fall asleep kind of hard when they fall back asleep and then they have to get up to work or do whatever they're doing and then they're very tired. So. And this has been going on.
[00:01:44] Speaker A: He falls asleep okay.
[00:01:45] Speaker B: Yeah, he falls asleep. Okay. It's just that he wakes up kind of in the middle of the night and then can't fall back asleep.
[00:01:53] Speaker A: What wakes him up?
[00:01:54] Speaker B: He just wakes up like. So, yeah, it's. It's not like a noise or something like that. He just sort of has this, let's say, waking pattern, you could say after a few hours of sleeping.
[00:02:08] Speaker A: Okay. So when you hear something like that, person falls asleep easily but wakes up in the night like that not because they have to pee or not because of a noise or something.
[00:02:19] Speaker B: Right.
[00:02:19] Speaker A: What's the. What kind of patterns are jumping to mind at that point?
[00:02:23] Speaker B: At this point? I don't know.
[00:02:24] Speaker A: Really?
[00:02:25] Speaker B: Yeah, I, you know, I. When we got into this, I read a bunch of stuff about the different theories on insomnia patterns and heart blood deficiency. Looks more like this. Or there's heat with this one and yin deficiency, this one. And I haven't found any of that to be helpful.
[00:02:44] Speaker A: Really? Yeah, it's just not consistent enough.
[00:02:46] Speaker B: It's not consistent enough. So I like when I hear the insomnia, I really need to hear about the other pieces of the picture to make it make any sense.
[00:02:56] Speaker A: Gotcha. Okay, so you've got the basic parameters. What else did you learn?
[00:03:01] Speaker B: So this had been going on for a few months. Right. So that's, I think, important.
He has no indigestion. So one of the things I like to check is with people who have insomnia is, is their stomach full when they're going to bed? Because that.
[00:03:21] Speaker A: Eating too late.
[00:03:21] Speaker B: Eating too late. But also, you know, people with poor digestion, they can eat at a normal time, but their stomach is still full when they try to go to sleep. So it can just be slow to process and digest.
But he didn't say that he had any reflux or indigestion.
So I specifically asked about that. His digestion, he reported, was normal.
But he did say that sometimes he feels a fullness in his belly. His belly feels full.
[00:03:53] Speaker A: Okay.
[00:03:55] Speaker B: And then I asked him some more questions about that, and he says yes. You know, sometimes I feel bloated. Like, a little bit bloated.
[00:04:01] Speaker A: Mm.
[00:04:03] Speaker B: I asked him how many bowel movements he had per day. He said one a day. And then I asked him about the quality of the bowel movement, and he admitted that it was kind of sticky.
[00:04:13] Speaker A: Okay.
[00:04:14] Speaker B: Right.
I took his pulses, and his pulses were actually kind of slow, big, and felt strong. Like, pretty strong big. But there was a slowness to the rate.
[00:04:29] Speaker A: Okay.
[00:04:30] Speaker B: And then I checked his abdomen. We did the abdominal palpation, and the abdominal palpation showed a soft epigastric obstruction, which is where you press into the epigastrium. And as a practitioner, you don't feel anything abnormal, but the patient reports that there feels full. Or sometimes they'll say it's uncomfortable, but probably not painful. If it's painful, it could be something else. Falls into a different category. Just feels a little uncomfortable, full whatever.
But to me, it doesn't feel abnormal. So we found that. And then the most interesting thing about his abdomen was actually the temperature of the skin was different in different places. So in the epigastric region, it felt quite warm. But then as I got toward the umbilicus, it felt much cooler. And kind of in a circle around the umbilicus, it was cooler.
[00:05:34] Speaker A: And this is actually the temperature of the skin.
[00:05:36] Speaker B: The skin, yeah. The skin itself, he did have. Let's see.
Yeah. I just wrote down that there was a little bit of req, which is, again, the rectus abdominal tension, or Hardness. But the specific version of that that he had was around the umbilicus, which kind of. The further you get down the abdomen, the more we're thinking the muscle layer dryness is more like blood stasis.
[00:06:07] Speaker A: Right.
[00:06:07] Speaker B: It's like turning into blood stasis. So it's maybe more chronic or something like that.
[00:06:11] Speaker A: Okay.
[00:06:13] Speaker B: Excuse me.
Yeah, so that's what it showed. Um, and that's pretty much all the information I felt like I needed to have to write him a formula.
[00:06:23] Speaker A: Okay, so give us the sort of bullets of that that are starting to shape the pattern for you.
[00:06:29] Speaker B: So some of this pattern, I have to admit, is because I know this patient pretty well. I've seen this patient on and off for the last couple of years, and I know that a lot of his problems tend to stem from having a sluggish digestive system or a digestive system, let's say, that's not processing things correctly. Okay, so that was on my mind.
[00:06:55] Speaker A: Like, you've seen other digestive stuff from him.
[00:06:57] Speaker B: Yes.
[00:06:57] Speaker A: In the past.
[00:06:58] Speaker B: Correct.
[00:06:58] Speaker A: Okay.
[00:06:59] Speaker B: Yeah.
And which is why I specifically asked, like, my first question when he told me that he wasn't sleeping well. Was, is he having any reflux or indigestion? Right.
So the abdomen, even though the symptoms didn't show very much of a problem happening, the abdomen, to me, did. So the soft epigastric obstruction, or soft glomus.
[00:07:26] Speaker A: And it's your favorite term, glomus. Never. It's never too early to start the day with glomus.
[00:07:32] Speaker B: So that, to me, was that what. That was important. And then the difference in temperature showing a kind of mixed heat and cold pattern that were taking place in the.
[00:07:42] Speaker A: Abdominal feature, and that's literally from the skin temperature.
[00:07:46] Speaker B: Skin temperature, okay. Yeah, exactly.
[00:07:48] Speaker A: So we've got glomus. We've got variation in temperature.
[00:07:51] Speaker B: Yep.
[00:07:51] Speaker A: We have a history of digestive upset.
[00:07:54] Speaker B: Yeah.
[00:07:54] Speaker A: Okay.
[00:07:55] Speaker B: Yeah. And this patient also tends to get a little bit of dry psoriasis, like a more dry version of psoriasis, too. So there's a history of skin stuff with this person. He tends to get it kind of like, around his face.
Sometimes it's like, kind of on his neck, but it's kind of. It's basically in his upper body. That's what's relevant for me.
[00:08:19] Speaker A: Okay.
[00:08:20] Speaker B: Diagnostically.
And then. Yeah, so I observed this. And so what I wrote him the formula I wrote him is Gan sao Shashintong. I just wrote him that straight up, no modifications.
And the reason that I picked Gansao Xiaishan tongue is because I saw the mixed heat and cold reflected in the abdomen. And then because it's been happening for a few months. Gansous is the version of a Sha Shintang like most people have heard of. Ban Sha Sha Shintang.
[00:08:54] Speaker A: Right, Right.
[00:08:55] Speaker B: There's Ban Sha Sha Shintang, Shangjiang Xintang and Gansao Xiantong are the main three. There's actually also a formula that's just called Sha Shintong.
[00:09:05] Speaker A: Right.
[00:09:06] Speaker B: And then there's Dahuang Huang Lian Sha Shintang, There's. And then there's a version of it with Fuzi where Futza is added in as well.
[00:09:16] Speaker A: So these are all part of a family of formulas.
[00:09:18] Speaker B: Yeah.
[00:09:19] Speaker A: That are kind of championed by Ban Cha Sheshintang as the starter.
[00:09:23] Speaker B: Bansha Sheishintong is the base one that's like the sort of generic version of the pattern. And then each of these others are displaying. They all treat the. The epigastric obstruction. That's really what they're. They're for. But they treat slightly different versions of the pattern. And Gansous is treating the most deficient version of the pattern.
[00:09:46] Speaker A: Okay.
[00:09:46] Speaker B: So there's. There's more chronicity, there's more deficiency with Gansa Xiaishan Tong. Gansa Xie Shintang is also the only one that's mentioned in the Shanghan and the Jingui and it's mentioned in the Jingwei and in this very bizarre chapter called the Fox and Confusion chapter. Right. There's this whole history in Chinese actually all of. Of East Asia culture around foxes and fox spirits. It's. It's kind of wild, but it describes a person who's kind of doing strange behavior.
[00:10:19] Speaker A: Right, Right.
[00:10:20] Speaker B: They're getting up like they act like they want to sleep, but then they can't sleep and they get up and they move around and then they feel restless and then they feel tired and like there's all these different things. They also. There's also a description of them like not wanting to speak very much. So some one way. And then there's a description of sores erupting on the skin.
[00:10:44] Speaker A: Okay.
[00:10:45] Speaker B: So there's this possibility that they're.
They're experiencing some kind of sti. That's what modern scholars have.
[00:10:55] Speaker A: Have interesting postulated like a sort of syphilis presentation.
[00:11:00] Speaker B: Exactly. Yeah, yeah, yeah. And they're embarrassed about it, so they don't want to talk. That's part of the pattern.
Now of course, we can treat a lot of other things that also present this way. So I chose Gansau Xintang, because it is the only Sha shintong that's mentioned for treating insomnia as well.
I think all of them can actually treat insomnia if the pattern is there. But Ganso Shai Shintang is especially highlighted for that because it's mentioned for treating that and it matches the other pieces of the presentation.
So even though the symptoms are not that extreme, I felt that a lot of the, I felt like the reason for his insomnia is because of this kind of mixed heat and cold pattern in the middle jowl and also deficiency underneath.
[00:11:52] Speaker A: Right, right. I think it's important to take a minute and talk too about. You said they're like, even though these symptoms are not that extreme, I think if the listening audience is spending, you know, if one of their first places to go to read about a formula is to pick up the Bensky or the Chen.
[00:12:07] Speaker B: Yeah.
[00:12:07] Speaker A: Both of which are excellent resources. A lot of times though, you'll read the description, the classical descriptions that are excerpted in Bensky, for example, about a formula, and you'll read about all of these symptoms and indications that are not part of your patient presentation.
[00:12:24] Speaker B: Absolutely.
[00:12:25] Speaker A: And you'll think to yourself, oh, well, that's not really a formula that I'm really going to use. You know, but if you, I mean, in some cases there are definitely some formulas that use rare herbs, uncommon herbs, toxic herbs that maybe do treat conditions that are of a more extreme nature. But if you look at the composition of Gan Sauxia Shintang, there's nothing in that formula that you'd be like, oh my gosh, I don't know if I can use that. Right, right. I mean, it's just standard Shanghan herbs. You know, there's nothing crazy about it. It's just their dosage, their arrangement, their collection has.
Right. So I just want to offer it as a kind of cautionary item that just because you read about a formula description that has some very specific descriptor or some kind of intense sounding descriptor, it doesn't mean that you're not going to use it. Right, right. It doesn't mean that it's off the table. So just keep that in mind when you read about seven tailed fox spirit formulas. You know, that's like, well, there's a lot of things. I mean, there's that you can definitely treat it for that. But also there's other things too.
[00:13:27] Speaker B: Yep. Yeah, absolutely.
[00:13:28] Speaker A: Okay. So mixed heat and cold, the abdominal obstruction and the history of digestive weakness.
[00:13:36] Speaker B: Yep.
[00:13:37] Speaker A: These undercurrent this idea of deficiency mixed heat and cold pattern. So you pick gun, Sachin, tongue, what dosage, what happens?
[00:13:45] Speaker B: Yeah, so I did 8 grams twice a day of a granule formula. Do you want me to go through the individual ingredients for people?
[00:13:51] Speaker A: Yeah, just break it down so people remember what's in that formula.
[00:13:54] Speaker B: Yeah. So I did ban Sha at 12, Huang Qin at 9, Huang Lian at 3. I tend to go a little lower on Huang Lian than some people do. Ganjiang 9 Ren Shen 9 dads out 9 jargon CEO 12. So in Gansao Xiantong, you bump the dose of Jirgan Sao all the way up to 12. Some people go up to 15.
[00:14:18] Speaker A: Why do you go a little lower on the Huanglian than some folks?
[00:14:22] Speaker B: I find that it's not necessary to go as high. Like, I just don't get. I don't get that much benefit from going higher unless it's specifically emphasized in a formula. Like there's a modification of the Sha Shintangs that we call Huang Lian Tong. Right. Which is where you go very high on Huang Lian. It goes up to like nine, and then, you know, the. But it's basically a Sha Shintong formula, Right?
[00:14:50] Speaker A: Right.
[00:14:50] Speaker B: So unless it's specifically emphasized in the pattern, I don't feel like it's need it to go that much higher.
[00:14:56] Speaker A: Yeah. I mean, 3 grams of Huanglian is. It's still going to be incredibly bitter.
[00:15:01] Speaker B: Yes.
[00:15:02] Speaker A: Like that formula. Very bitter, super bitter.
[00:15:04] Speaker B: All you're going to taste?
[00:15:05] Speaker A: Pretty much, yeah. I. I just prescribed a Shae shantung for my own patient, and the number one thing that he keeps complaining about every time he comes back, it's like, oh, it's just so difficult to drink it.
[00:15:15] Speaker B: Yeah.
[00:15:15] Speaker A: And I too, am at like 3 grams of Huang Lian. So you do also need to keep in mind your patient's likelihood for compliance here as well. Now, you can't remove a formula, just remove an ingredient just for compliance. But if you don't need to punch up the bitter.
[00:15:31] Speaker B: Yeah.
[00:15:31] Speaker A: Then don't.
[00:15:32] Speaker B: Right?
[00:15:32] Speaker A: Yeah. Okay, so what'd you say, eight grams twice a day?
[00:15:36] Speaker B: Eight grams twice a day.
[00:15:37] Speaker A: All right. And then how long for the first dosage round?
[00:15:40] Speaker B: So I had him take it for two weeks, and then I had him check in. And this guy's kind of on a maintenance plan with us. Right. So he's kind of coming in like once a month, But I had him check in with me via phone call two weeks later, and he reported his sleep is better. He's not waking up anymore at night. He's sleeping through the night. And he also. I also asked him about his bowel movements, and his bowel movements were much more solid and smooth. And I actually had him continue with the formula for another two weeks just because I know that these types of patterns usually need a little bit longer for treatment to stay good, if that.
[00:16:26] Speaker A: Makes sense for it to stick.
[00:16:27] Speaker B: And I also couldn't. I didn't evaluate him in person. So if I could have checked him in person and done the objective findings and done all the evaluation, that I might have been able to tell whether he needed to stay in the formula for longer or not.
But I just had him continue for another two weeks.
[00:16:48] Speaker A: Okay, so total of a month.
[00:16:51] Speaker B: Total of a month.
[00:16:52] Speaker A: Then he came back in for. In person.
[00:16:54] Speaker B: Yep.
[00:16:54] Speaker A: And when you spoke to him in those two weeks out, what were you mostly checking for? Just sort of tolerance of the formula or what? Like the first phone call check in?
[00:17:03] Speaker B: I wanted to see if it was improving. Like, I wanted to double check to see if I was correct.
[00:17:08] Speaker A: Right. Before making a month.
[00:17:10] Speaker B: Yeah, yeah, yeah, got it.
[00:17:11] Speaker A: So he reported some marginal improvement.
[00:17:13] Speaker B: Yes.
[00:17:14] Speaker A: Okay, yeah, yeah. So you confirmed two more weeks. He came back in a month after initial prescription. And what did you find?
[00:17:21] Speaker B: Yeah, I found so his, his waking up at night had continued to be good. So he was sleeping through the night. His digestion was much better. I went and I checked that his pulse was pretty much the same or pretty similar.
The abdomen was a little different.
But I. So basically I felt the obstruction up top that we talked about to be gone. Or he didn't report because it's a subjective finding, he didn't report discomfort when he came in the next time.
What was interesting is the cold was still there around the umbilicus.
So because this guy isn't coming in, he's on a maintenance plan. I said, okay, you know, you've taken the herbs for. For a month. Let's try going without and see if the, the pattern reasserts itself or if. If you're. If you're doing well, you know. And he was kind of game to stop taking the herbs. Right. There's definitely a leaning to, well, if I don't need to keep taking these. Right. It's a shae shintong. It's not the best tasting formula in the world. World.
[00:18:33] Speaker A: Right.
[00:18:35] Speaker B: He was excited to try not taking them. So, okay, so he went off of the herbs. I saw him a month later and the problem came back.
So basically I found similar to what I found the first Time he came in with the. The findings, his digestion had kind of backslid, so to speak. The bowels were a little stickier again. And I found similar things in the abdomen again.
So what I did was I put him back on the gonzo shashing tongue for two weeks.
[00:19:14] Speaker A: How long did he go without the herbs?
[00:19:17] Speaker B: A month.
[00:19:18] Speaker A: A month. So it was a month on herbs and then a whole month. And then when he came back in a month later, he was right back to where he had started. Or it was just a partial backslide.
[00:19:27] Speaker B: It was a partial backslide.
[00:19:28] Speaker A: Okay.
[00:19:29] Speaker B: Yeah. He was waking up at night. Not every night, but some nights. And when he would wake up, it was tough for him to fall back asleep. But it didn't sound like it was. It took him quite as long as initially when he came in, because when he came in initially, he said it could take him three or four hours to fall back asleep. That's pretty long.
[00:19:51] Speaker A: That's a long time.
[00:19:52] Speaker B: And it sounded like this particular visit, he would get up and it'd be like an hour, hour and a half. So it wasn't quite as bad as before, but it was clear that, like, it was worsening.
[00:20:06] Speaker A: Yeah. I mean, the pathology pattern is, like, slowly pulling at the physiology again. Right. And.
[00:20:12] Speaker B: Yeah.
[00:20:12] Speaker A: You know, without intervention. Right. You would have been right back there.
[00:20:16] Speaker B: Yep.
[00:20:16] Speaker A: Okay, so it's a month later you put him back on a formula. What'd you put him back on?
[00:20:21] Speaker B: I put him back on the same formula, Gansa Xiantong, but for two weeks. Just for two weeks. And then I actually wrote him a different formula after those two weeks, which was Li Zhongluan.
[00:20:33] Speaker A: Why?
[00:20:34] Speaker B: Usually to. So if we think of the six confirmation model, Sha Shintang is a Xiaoyang and Xiao. Sorry, Xiaoyang and Yangming formula. So we're kind of covering two of the Yang conformations with that formula. A lot of the time for a Xiaoyang pattern to fully resolve and not reassert itself in the clinic, it's necessary to treat the layer below it.
And because Xiaoyang confirmation is a bit complicated, the layer below it could be Tai Yin, or it could be. Sometimes, Juan, sometimes you actually need to treat the blood to make sure the Xiaoyang pattern doesn't reassert itself. But for this patient, given the Sha Shintong pathway and the cold. The presence of cold in the abdomen. Yeah, I'm thinking, oh, it's not so much a blood problem as it is a. It's a digestive problem. We need to warm the digestion and help the transformation of, you know, the nutritive substances. So that's why I picked Li Jungwon. Li Jungwon is a common run through after a Sha tongue as well. That's a pattern that I've seen a lot.
[00:21:57] Speaker A: Okay.
[00:21:58] Speaker B: Yeah.
[00:21:58] Speaker A: So the two weeks of the same Shae Shintang formula basically push against a lot of this mixed pattern piece of it.
[00:22:07] Speaker B: Yep.
[00:22:08] Speaker A: So at the point that you decided to switch him from the Sha Shintang to the Li Jung Wan, what. What told you it was time to do it now? Like what, what had changed?
[00:22:18] Speaker B: Yeah, mostly. So mostly it was a guess, if I'm being honest. It was kind of like.
Well, it's clear that the formula before was helping. I'm starting to see that pattern reassert itself. So I feel like I have to treat the pattern again to some degree.
And I just assumed because we've been on this monthly schedule, it's kind of. It would be nice to do it for two weeks and then go to the next formula for two weeks, and then I'll be able to reevaluate at the end of that and see a difference.
[00:22:49] Speaker A: So some of it's mechanical?
[00:22:50] Speaker B: Yes.
[00:22:51] Speaker A: Like when he actually comes in here.
[00:22:52] Speaker B: Yep.
[00:22:52] Speaker A: Okay. So do you think that you, if you had started with the Lijong Wan first, do you think that would have more rapidly improved the outcomes, or did you need to go xiantong than Li Zhongwan?
[00:23:08] Speaker B: I think I needed the Sha shintong first because there was also a bit of heat showing up in the abdomen and then the pattern. So I think the. The Sha shintong is going to treat both the heat from the stagnation in the middle jiao and the underlying cold to some degree.
[00:23:27] Speaker A: Yeah.
[00:23:28] Speaker B: But then once you clear the heat and you get movement, you purge the heart or you purge the epigastric region, so to speak.
[00:23:37] Speaker A: Yeah.
[00:23:38] Speaker B: Then what's needed often is warming, because then ultimately the warmth is what's going to keep the transformation of those substances smoothly happening and not lead to a stasis which is going to be the more acute version of the pattern.
[00:23:55] Speaker A: Right?
[00:23:56] Speaker B: Yeah.
[00:23:57] Speaker A: Okay. So you use the Shae Shintang to address the mixed heat and cold element primarily, mostly resolve that pattern and then move to the deeper layer with the Lijung wan.
[00:24:09] Speaker B: Yes.
[00:24:09] Speaker A: How long did they take? So two weeks until you reevaluated. So they came in. What. What did it look like at that point?
[00:24:16] Speaker B: Yeah. So a month later I rechecked. So the sleep had again improved. It was solid when he came back in and I rechecked the Abdomen. And the abdomen was no longer cold.
And the heat that was, I should say, too, the heat that was there after the resurgence, you could say, had also gone away. So the abdomen was, like, kind of neutral feeling, and it felt like there had been a significant shift when I palpated. So that was ultimately what led me to believe that I could remove the herbal formula and the pattern wouldn't reassert itself was the objective findings.
[00:24:58] Speaker A: Right. So he only took the Lijiang one for two weeks.
[00:25:01] Speaker B: Two weeks.
[00:25:01] Speaker A: Okay. And so then he stopped taking.
[00:25:03] Speaker B: Stopped taking it? Yep.
[00:25:05] Speaker A: And you evaluated a month later when he came back in.
[00:25:07] Speaker B: Yep.
[00:25:08] Speaker A: And did it stick?
[00:25:09] Speaker B: Yeah, it stuck.
[00:25:10] Speaker A: Wow. And his digestion was also then improved. Yes, as a byproduct. So less sticky stool.
[00:25:16] Speaker B: Less sticky stool, Yep.
[00:25:17] Speaker A: Okay. So ultimately, in this pattern, his insomnia root cause here was a digestive weakness.
[00:25:26] Speaker B: Absolutely.
[00:25:27] Speaker A: Yep. And that the part that was waking him up, you were guessing, was this sort of stagnation in the middle jowl because of that digestive weakness.
[00:25:36] Speaker B: Yep.
[00:25:37] Speaker A: And then that stagnation was causing our. The heat that we're seeing in the mix pattern.
[00:25:42] Speaker B: Yeah.
[00:25:42] Speaker A: So the core problem is cold, but I'm seeing heat because the cold is causing stagnation, which is causing the heat.
[00:25:47] Speaker B: Yep.
[00:25:48] Speaker A: Sha Shintang takes care of that layer, and then we can go deeper to the Lijiang one.
[00:25:52] Speaker B: Yep.
[00:25:53] Speaker A: Yeah. So I think this is another good example, too, of just this idea that, you know, we, you know, the name of our clinic, for example, is called Root and Branch. Like, we care a lot about this idea of sort of, what's the root problem, what's a branch problem? And that can sometimes be really simplified. Right. Into sort of like, you know, someone comes in and they're anxious, but the reason that they're anxious is actually that they're blood deficient.
[00:26:16] Speaker B: Right.
[00:26:17] Speaker A: So then you're like, well, let me give you some yin tonifiers and some blood tonics and get you drinking bone broth, and that'll help your anxiety. And the truth is, is that it will, but probably in like a year, you know, so we might need to do something on a different layer to deal with the branch problem. Right. Because the patient's feeling anxious right now.
Some of that is just conceptually, philosophically the maneuver, but a lot of it is actually really pragmatic. Right. Which is when a. When a client, a patient comes in to see us, you only have so many visits to build trust and expectation that our medicine can do what we say it's going to do.
[00:26:56] Speaker B: Right.
[00:26:57] Speaker A: And so if you don't do something to address what one might call a branch presentation because you're overly focused on the root and it might take you months and months for root treatment to cause improvement, probably you won't get those months.
[00:27:11] Speaker B: Right.
[00:27:11] Speaker A: Because the patient's going to think to themselves, well, I don't really feel any better. What am I taking these herbs for? So this is where there's a kind of patient management pragmatic piece. It's not just a diagnostic question, not just a pattern recognition question. But you're dealing with two layers, one which is patient buy in, and the other is appropriate peeling back of the layers of a condition.
[00:27:32] Speaker B: Yep.
[00:27:33] Speaker A: So in this case, you know, your patient's been around for a long time.
We don't really have a lot of issue with buy in.
[00:27:40] Speaker B: Right.
[00:27:40] Speaker A: He understands that what we do is helpful.
[00:27:42] Speaker B: Yep.
[00:27:42] Speaker A: That's why he comes in regularly.
But even still, we need to address the problem quickly.
[00:27:49] Speaker B: Absolutely.
[00:27:50] Speaker A: So that way he feels like he can keep taking a very bitter, unpleasant formula because even though he knows herbs work, he's thinking, I don't know if I want to keep drinking this.
[00:27:59] Speaker B: Yeah.
[00:27:59] Speaker A: Right. So I think it's a good example of not just diagnosis and sort of understanding the problem, but understanding that we need to move through different formulas as things present. And in this case, that the first one that you picked wasn't enough. Right. It wasn't enough to completely solve the problem. Now, we don't know what would have happened if you just kept taking that Shae Shintong formula for another three months.
Honestly, he probably would have kept sleeping fine because it was addressing that. The stagnation, the heat from stagnation is likely causing the waking, but his stool probably would have stayed sticky. Digestion would have been relatively unchanged. And so as soon as he stopped taking it, all of a sudden the problems come back.
[00:28:43] Speaker B: Right.
[00:28:44] Speaker A: So I wonder too if, if you have any thoughts on, you know, something that people will say to us all the time. I get asked like, so do I have to take these herbs forever?
[00:28:53] Speaker B: Right.
[00:28:53] Speaker A: You know, and you and I both are of the opinion that if a person has to take herbs forever, we've missed something.
[00:28:59] Speaker B: Yeah.
[00:28:59] Speaker A: Right. I mean, that's not the goal here. That doesn't mean they might not need to take it for a long time.
[00:29:03] Speaker B: Right.
[00:29:03] Speaker A: But like in perpetuity.
[00:29:05] Speaker B: Yeah.
[00:29:05] Speaker A: No.
[00:29:06] Speaker B: Yeah.
[00:29:06] Speaker A: So in this case, you know, if you hadn't pivoted to the Lijiang one, you might have found yourself in a rubber banding in perpetuity problem with a with this formula. Not because it's the wrong formula, just overall. It's just like this formula isn't the one to fully crack the problem.
And so this is something that I want our listeners to internalize, that if you find yourself with a formula that's effective but doesn't make it stick.
[00:29:35] Speaker B: Yeah.
[00:29:36] Speaker A: Then you probably need another formula.
[00:29:38] Speaker B: Yes.
[00:29:38] Speaker A: Right. There's a. There's another layer you got to work at. Not because you were wrong, because you got results. It just won't stick. And it won't stick because there's another layer.
[00:29:47] Speaker B: Yeah. And. And there's another component to the. This pattern, as it turns out, which if. If you look back at the case, there's evidence of cold in the case even from the first visit. Right. There's the. The cold that we. That I palpated in the abdomen. But then there's also. I said he has a slower pulse. Right. Slow pulse. Like there's. This is like basic pulse diagnosis. Right. Rapid pulse means heat. Slow pulse means cold.
[00:30:15] Speaker A: Yeah.
[00:30:15] Speaker B: You know, and so even though the pulse was big and strong, there's an underlying cold piece. So even in the pulse diagnosis that showed the need for likely that we need to warm at some level before the treatment strategy was done.
[00:30:32] Speaker A: Nice.
Okay, well, I'm glad that he is sleeping better.
[00:30:36] Speaker B: Yeah, me too.
[00:30:37] Speaker A: And that we have a. A better understanding of kind of moving through different layers of a problem to kind of get where we need to go. So.
Well, everybody, we are going to be coming at you with our next episode. We'll have a new topic to dive into. So hopefully the last this episode and the last one will give you something to chew on about moving through formulas and details and flavors.
And we will. We'll catch you guys on the next one. Let us know if you have any suggestions for episodes or if you have things you'd like to know more about. You can always reach us at info. That's info at root and branchpediax.com. it's all spelled out root and branch papadeltaxray.com and we'd love to hear from you guys. So please like and review rate and review the show. It'd be really great for more people to be able to find us. So we appreciate your time and we will see you next time. I am Travis Kern.
[00:31:30] Speaker B: And I'm Travis Cunningham.
[00:31:31] Speaker A: Talk to you later.
[00:31:32] Speaker B: See ya.
