How to get your patients to actually take herbs

[00:00:03] Speaker A: Hi, everyone, and welcome to the Nervous Herbalist, a podcast for Chinese medicine practitioners who like herbs and want to learn more about their function, their history, and treatment strategies to use in the clinic. Let's get into it. Hello there, everyone, and welcome back to the Nervous Herbalist. My name is Travis Kern, and I'm. [00:00:24] Speaker B: Here with Travis Cunningham. [00:00:26] Speaker A: And today we want to take a little bit of time to talk to you guys about less, maybe about the diseases and patterns of different illnesses that we talk about, but also something equally as important, which is discussing how to work with patients to take herbs, how to organize treatment plans for patients with herbs, and really just kind of the mechanics of getting people to take herbs regularly. [00:00:51] Speaker B: Yeah, absolutely. [00:00:53] Speaker A: So, I mean, let's start with, like, the most basic question to you, like, how do you get patients to take herbs? [00:01:00] Speaker B: The simple thing is you have to communicate the importance of taking herbs, what the herbs are doing, what the intention is and the timeline and the. The expected outcomes. [00:01:14] Speaker A: But a lot of people, you know, we'll hear from folks, they'll say, like, well, you know, I mentioned herbs to my patient, but they just didn't seem very interested. [00:01:23] Speaker B: Right. [00:01:23] Speaker A: When you hear something like, interest. Yeah. What. What do you. When you hear someone say that, what do you think? [00:01:29] Speaker B: I think they didn't properly communicate the intent of the treatment with the herbs, and they also didn't give them a strong enough indicator that the herbs are needed to achieve the treatment outcome. So most of the. Every once in a while you'll find a patient who really doesn't want to take herbs. Like, they try and whatever, and it doesn't. It doesn't work out. But that's like, you know, less than 5% of people that I've seen, most people will take herbs if you communicate the importance and that the treatment hinges upon them taking herbs. So it's way more convenient for someone to come in and get acupuncture. It's a lot less convenient for people to take herbs. So if they're going to take herbs, they need to know why. They need to know what to expect. They need to know how long they're going to need to take them, and they're going to need to know that it's not forever. Also, how quickly they can expect changes and how long it will take the changes to sort of save within the physiology to where they won't need to continue to take herbs. And there are general rules for what we can tell people with those things. There are specific case changes that we need to make over time. For some cases, but those are the big things, communicating that herbs are necessary to treat this condition. [00:03:04] Speaker A: Right. [00:03:05] Speaker B: And there's no other way that I can help you with it unless you do the herbs. In this case, with this chief complaint, there's nothing else I can do to help you except the herbs. If you don't want to do the herbs, I can't help you. It has to be that black and white for people. [00:03:20] Speaker A: Yeah, exactly. I mean, the thing that we'll hear, like some of our residents, like, when they're practicing this, right. And trying to figure out, like, how do I get people to take herbs? You know, they've got the patient in for the first visit, they've done their intake, they've done a physical exam, tongue impulse, whatever. Right. And, you know, in the beginning, everyone, you know, coming out of school, people generally know that they need to do some kind of treatment planning with the patient, need to tell them, okay, this is what I think's going on. This is how long I think it'll take, how many visits, whatever. And so then the residents will do that. Right. Okay. Based on what I'm seeing here, probably need to do weekly treatment, six to eight weeks. You know, the kind of standard stuff that you hear. [00:04:01] Speaker C: Right. [00:04:01] Speaker A: And then they'll say, and so also, how do you feel about Chinese herbs? [00:04:07] Speaker C: Right. [00:04:07] Speaker A: Will be the kind of. [00:04:08] Speaker B: Or are you interested in taking. [00:04:10] Speaker A: Are you interested in taking Chinese herbs? And the thing is, is that the patient always just says no, right? No. Like, I'm here for acupuncture. That's what I heard about. That's what I was recommended for by my doctor. [00:04:23] Speaker C: Right. [00:04:24] Speaker A: So, no, I'm not interested in Chinese herbs. And if that's the way that you approach the herbal prescription, a tiny fraction of your patients will ever take herbs. [00:04:33] Speaker C: Right. [00:04:34] Speaker B: And even if they do, the thing that they're committing to in that verbal agreement is interest in herbs, not taking herbs to establish an outcome or to change something. [00:04:45] Speaker A: Right? Right. This comes up a lot, even not just with internal herbs, but I see it with topicals because I do a lot with topicals, right. And so if I tell someone, like, okay, yeah, so we're doing acupuncture, we're doing herbs. And so now there's this topical, I think could be helpful, right? [00:05:02] Speaker B: Yep. Same language. [00:05:03] Speaker A: You end up with this sort of soft language. Right. And so a lot of times people will buy a topical, and we have a couple of really well made, like, circulation type topicals, right. For, like, blood stagnation in the local area. And so those topicals Work amazingly, but they only work if they're applied twice a day, every day for 10, maybe 14 days. [00:05:25] Speaker C: Right. [00:05:25] Speaker A: I mean, regularly. Three times a day would be even better. [00:05:28] Speaker C: Right. [00:05:29] Speaker A: So the thing is, is that if you don't express to someone, like, look, when you rub this on your joint, it's not gonna immediately stop hurting. Right. It's not topical lidocaine. It's not topical ibuprofen. Okay. This is part of changing the presentation, and then you'll feel better over time. But we have to tell the client, like, I have to tell the patient directly. Like, firstly, you're doing acupuncture, you're doing herbs, and here's this topical. You're doing all of those things together. Let me tell you exactly how to do them. They're all working in concert, and if you drop any of them off, we're going to really limit how much change we can get in the same amount of time. [00:06:07] Speaker C: Right. [00:06:08] Speaker A: So that way the patient understands that, like, none of this is suggestive, optional, supportive. In fact, if anything, they need to understand that the herbs are doing most of the heavy lifting. [00:06:20] Speaker B: Oh, yeah. If you want to use herbs, you have to sell the story that the herbs are doing the heavy lifting, at least for a certain component of the treatment. So let's say they're coming in for hip pain and insomnia. You can be honest with them about, like, yeah, you know, the thing that we're doing to treat your hip pain is acupuncture, but the thing we're doing to treat your insomnia is herbs. [00:06:46] Speaker A: Right, Right. [00:06:47] Speaker B: They have to know that it's connected to a complaint that they want to change. And, yeah, it's. It's really important to communicate that. [00:07:00] Speaker A: So the thing is, though, is that we know that, you know, we're an internal medicine clinic here. Right? [00:07:06] Speaker C: Right. [00:07:06] Speaker A: The vast majority of our patients take herbs. In excess of 85% of people take herbs here. The ones that don't take herbs usually can't, because they're, like, say, in chemotherapy treatments or they're taking some other complex drug presentations. And their doctors and us don't really want to add, you know, herbs into that mix because it clutters the issue. But. And then a handful of people just have, like, a real easy musculoskeletal situation. Right. You've got some shoulder pain. We're gonna knock that out in three, four visits, whatevs. Right. We're done. But everybody else pretty much takes herbs, and that's because most of what we treat is internal medicine. The thing is, though, is that you and I both know of practitioners, either directly or at least in the literature, who are able to treat internal medicine problems with acupuncture, able to move things in a way that we don't, that we use herbs to do work with. [00:08:04] Speaker B: Right. [00:08:05] Speaker A: So I think a lot of people out there will think to themselves, like, well, I mean, you can use acupuncture to fix insomnia, so why shouldn't I just try that first and then go to the herbs later? What do you say to the person who's thinking in those terms? [00:08:20] Speaker B: So there's a few things. The first is that I think you have two opportunities to use herbs in the clinic. The first is when you start a clinical relationship. So when the person comes in for the very first time, if you do the interaction, you do the assessment and then you tell them, this is what I think you need in order to get better. From my level of expertise, from the tools that I have, these are the things we need to intervene with for you to feel better. [00:08:51] Speaker A: Right. [00:08:52] Speaker B: You can recommend herbs at that time, and that's the strongest time to do it. You don't have to give the formula the first visit, but you have to give the plan to use the herbs the first visit. If you don't do it, then it's a lot harder to get people to take herbs. The second opportunity that you have to do herbs is when a new problem comes up that the patient complains about. So let's say again, you're treating hip pain or shoulder pain, the patients coming in, they're doing better, and then they start to get seasonal allergies and they complain to you about those. [00:09:27] Speaker C: Right. [00:09:28] Speaker B: At that point, you can say, yes, I can help you with your seasonal allergies, but you have to take herbs. [00:09:34] Speaker A: Right? [00:09:35] Speaker C: Right. [00:09:35] Speaker B: And then the buy in is the same. So if you don't do that, if you say, well, let's see if we can address it with acupuncture, let's see if we can treat your insomnia with acupuncture, and if not, then we'll do herbs. The buy in that the patient has is much lower by the time you get to the herbs. And they've already lost confidence in your ability to help them seriously. You've also lost confidence a little bit in the case because you've been trying to intervene with acupuncture and you haven't been successful or as successful as you wanted to be. So the way that you sell the herbs at that point in the treatment process is Less. For most of us, it would be less. The other thing is acupuncture can potentially be enormously helpful for any condition. [00:10:27] Speaker C: Right. [00:10:27] Speaker B: There's a potential for it to be enormously helpful for any condition, but unless you can manifest that potential in a curative way, it's not okay, in my opinion, to tell the patient that. That you're going to use it to treat their condition if they're looking for a cure. So let me give you an example. Seasonal allergies. [00:10:50] Speaker C: Right. [00:10:51] Speaker B: Some acupuncturists say that they can treat seasonal allergies with acupuncture alone. If you can do that successfully the majority of the time, then you should do it, Right? [00:11:03] Speaker A: Of course, yeah. [00:11:04] Speaker B: I have not ever seen. When I've done clinical observation with acupuncturists, I've not ever seen an acupuncturist successfully treat seasonal allergies case after case after case with acupuncture alone. I've never seen that. But people say they can do it. I haven't seen everybody's clinic. [00:11:24] Speaker C: Right. [00:11:25] Speaker B: So maybe there are people who can do it, and maybe there are people who can do it on a good portion of cases. [00:11:31] Speaker C: Right. [00:11:32] Speaker B: Even in those situations, I'd still say it's better to use herbs and acupuncture. You'll probably get results faster. But this is kind of where we get into this, this. This problem where you see the potential of something working, but you don't necessarily have the ability to manifest that potential with where you're at. [00:11:54] Speaker A: Yeah. [00:11:54] Speaker B: So then you might try it, but fail. And then by the time you fail, you can't use the thing that's actually easier to use for the problem. [00:12:03] Speaker C: Right. [00:12:03] Speaker B: The tool is. Some tools are more easy to use for certain problems than others. [00:12:09] Speaker C: Right. [00:12:09] Speaker B: And for something like seasonal allergies, cold and flu is another one. Can you treat cold and flu with acupuncture? You absolutely can. You know, I know people who can do that very well. But again, it's a lot easier to do it with herbs if you could just. [00:12:25] Speaker A: And I mean, the question is, like, can you treat it with acupuncture? [00:12:30] Speaker B: Yes. [00:12:31] Speaker A: Can a person or can acupuncture do it? [00:12:34] Speaker B: Right. [00:12:34] Speaker A: You know, presumably if you're listening to this podcast, you're a Chinese medicine person, and you know that Chinese medicine, for the vast majority of all of its history, was just medicine. Right. It wasn't. It wasn't alternative, it wasn't complementary. [00:12:47] Speaker B: Right. [00:12:48] Speaker A: It was just medicine. And so it, of course, can treat all the things. [00:12:53] Speaker B: Yep. [00:12:54] Speaker A: But also Chinese medicine isn't as acupuncture, Right? Right. Acupuncture is part of the Chinese medicine toolkit. And so the notion that you would limit the curative potential, because I'm not exactly sure why you don't want to inconvenience the patient. It's an awkward conversation. You're unsure of your herbal knowledge. These are all reasons, right, why people maybe don't jump in with the herbs to start. But it's important to remember that if you want to use herbs, which is presumably why you're listening to this podcast, if you want to use herbs, you have to use them, you have to prescribe them. It's the only way to actually get better at this work. And the way to do that is to make sure that your patient understands that they need to take the herbs. It's not an option, it's not a supplement, it's not a consideration. It's required. [00:13:48] Speaker C: Right. [00:13:48] Speaker A: This is the intervention, as is the acupuncture. And we're going to do both of those things. Particularly if you, you know, you work in a market where a lot of your patients are insurance patients. Insurance doesn't pay for herbs, Right? They don't pay for the herbs. They don't pay for an herbal consult. There's a lot of different ways that people account for that. You know, we just roll it in to what we do. [00:14:08] Speaker C: Right. [00:14:08] Speaker A: You know, because we're, we're an hour. We're a time based pricing system, so we calculate our stuff based on an hour. If I can get your herbs done in an hour along with your acupuncture and whatever, then we'll bill the insurance for the acupuncture and you'll pay for the actual herbs and we just consider it a wash. Right, Because I'm making enough dollars per hour for that to work out. But for sure, some people are going to come in and they're, you know, the patients are just expecting their $20 copay. They're not expecting to buy herbs. Right. And so now you're having to tell them like, all right, so here's the deal. If you come in here and we just do acupuncture, I'm not really sure that we're going to be able to cure this. But if we put herbs into the mix and the herbs do the heavy lifting, which is really the primary intervention for what you've got going on, then, now we have a real shot at a fundamental change. I want to hone in too on your point about curative versus I don't know, symptomatic, maybe. [00:15:00] Speaker B: Symptomatic, yes. [00:15:02] Speaker A: There's a lot of ways that you can use acupuncture for symptomatic relief. Right. Like, if someone's sitting on your table and they're, like, super congested with seasonal allergies. Right. Like, you can load up their face with needles, you can do some distal stomach points, you can open up large intestine, and they're gonna drain and they're gonna feel clear. [00:15:19] Speaker B: Yes. [00:15:20] Speaker A: And you're gonna be like, oh, my God, acupuncture is amazing. And the patient's gonna feel great for the rest of the day, maybe the beginning of tomorrow. [00:15:26] Speaker C: Right. [00:15:27] Speaker A: And then they'll be snotty again. [00:15:28] Speaker C: Yeah. [00:15:28] Speaker A: That's just what's gonna happen. [00:15:30] Speaker C: Right. [00:15:30] Speaker A: Because that's how acupuncture is. I mean, unless you are of a particular skill set. [00:15:36] Speaker C: Right. [00:15:36] Speaker A: And again, that person's probably not listening to this podcast, then maybe that's all you need. Also, if you are fortunate to run a clinic where your patients come in every day. [00:15:45] Speaker B: Sure. [00:15:46] Speaker A: Like they do in China. Well, then what you can accomplish in that context is different. [00:15:51] Speaker C: Right. [00:15:51] Speaker A: Because you have this daily intervention with acupuncture. Really phenomenal what you can achieve there. But if you're working in a standard Western clinic, an American clinic, European clinic, Australian clinic, most of your people are probably coming in once a week, and that's gonna be considered frequent. [00:16:06] Speaker B: Yep. [00:16:06] Speaker A: Here in our clinic, if we've got someone in here twice a week, that's crazy frequent. [00:16:10] Speaker B: Yeah. [00:16:10] Speaker A: Once a week is definitely the much more standard. And so you're only gonna do your acupuncture intervention once a week and expect that that's gonna be curative. I mean, let's be honest. Like, unless you have magic hands. [00:16:26] Speaker B: Yeah. [00:16:26] Speaker A: Right. Like, you've got 30, 40 years of experience, you can consistently do three needle treatments and move the needle with one once a week on something like seasonal allergies, you're just not going to be able to do it. [00:16:37] Speaker C: Right. [00:16:37] Speaker A: Not. Not consistently. [00:16:39] Speaker B: Right. We've all had cases. Right. Where, you know, you person comes in, you throw the needles in, and boom, like, something shifts and there's no more intervention. Like, I've had that happen, too. [00:16:52] Speaker A: Yeah, for sure. [00:16:53] Speaker B: But it's about consistency. What can you expect most of the time? And the reality is that when somebody comes in and. And you do give them herbs, if they have a magic acupuncture experience, you don't need them to take herbs again. It's a lot easier to have that happen than the Opposite. Where you undersell the herbs, then you find out you need them to help the patient. And they're already. Not like now, they're already on to the next thing. [00:17:22] Speaker A: Yeah. [00:17:22] Speaker B: Yeah. [00:17:23] Speaker A: Well, and we should maybe talk to you about what's happening there. Right. You and I usually describe it as like the window has closed. [00:17:29] Speaker B: Yeah. [00:17:29] Speaker A: And that's just. That's our observation in our experience with patients, what happens when you're setting them up on the path and what their expectations are. There are just these windows that you described at the very beginning of treatment, or if there's a. Which. Or if there's a new symptom or a new chief complaint, which really in some ways is like another brand new treatment intervention. Right. Like, it's almost always just at the top. Right at the top of the thing that you're treating. This is when you can actually get in there and get people on board with herbs. The reason that that's the case is because once you. There's a kind of finality to the treatment plan discussion. Right. Where you are making predictions, giving timelines, and some. Maybe much of your power as a clinician is rooted in that treatment plan. It's rooted in your confidence and direction in how this is all going to play out. [00:18:25] Speaker B: Yep. [00:18:25] Speaker A: And that confidence keeps the patient engaged with treatment and keeps them coming back. Because we've all had patients, even ones that we've treatment planned with, who flame out. Right. They're just sort of like, they did three visits and then they ghosted. You know, what happened to them? They're gone. I hope it wasn't me. Like, I don't know, everyone's had that situation happen. You minimize that happening by having clear treatment plans with clear outcomes, with clearance, clear measurables, timelines, et cetera. And so if you start changing that, so you give someone, okay, we're gonna do six to eight treatments once a week. Acupuncture with some cupping and E stem machine. We'll evaluate at four weeks and eight weeks to see how things are going. But you mentioned nothing of herbs. Right. And then you go ahead and run that treatment for four weeks. You get to your first evaluation, and you realize you haven't been able to achieve what you thought you'd be able to achieve in four weeks. And, and so now you say, you know, I think maybe we could. We could get some herbs in here. You might be able to do it if you're very convincing and you're very strong, but the patient is gonna have some resistance to it because that's not the plan that we talked about. And even if they do agree to it, your credibility is a little bit shakier. Now. It's not broken, it's not cracked, but it's shakier. So why set yourself up on a shakier footing? [00:19:48] Speaker C: Right. [00:19:48] Speaker A: Just do it in the beginning. [00:19:49] Speaker B: Do it in the beginning. It gives you more opportunity to iterate the formula, too. If you're off a little bit in your pattern differentiation also, it means it. [00:19:59] Speaker A: Can get done faster. [00:20:00] Speaker B: Absolutely, it can get done faster. The other thing is, I think you have a better shot of selling the herbs, let's say, after the first treatment plan. If you definitively say we're going to reevaluate at four weeks, and if we don't, if we're not getting the results we need at this time, I'm going to recommend that you take herbs. [00:20:24] Speaker C: Right. [00:20:25] Speaker B: If you say that at the first visit, you've got a much better shot of. Of selling the herbs in treatment plan. Round two. If you set it up ahead of time even, I mean, you're. [00:20:35] Speaker A: You're hedging your bets a little bit, right? Where you're just like, okay, I'm going to make sure that people know that this is important. And I'm going to. And I think the language, the specific language of we're going to reevaluate a treatment plan at four weeks, and then at that fourth appointment or that fourth week appointment, you're making it clear this is a reevaluation. You're hitting the pain scale numbers. You're reevaluating 10 questions. You're, whatever you're going to do. [00:21:04] Speaker C: Right. [00:21:04] Speaker A: And then you say, okay, based on the progress that we've had, based on what I've seen in the change in your case, I think the only real way we're gonna get any lift here is if we add some herbs in. [00:21:13] Speaker C: Right. [00:21:14] Speaker A: Much higher chance that someone's gonna come along with that. [00:21:16] Speaker B: Much higher chance. [00:21:17] Speaker A: But notice the theme here is the same. [00:21:19] Speaker B: You told the patient, communication, this is what you need. [00:21:23] Speaker A: Yeah. You told them this is what you need. So let's talk a little bit about. Okay, so that's around setting up the treatment plan. But of course, there's lots of factors that can then influence compliance. And there's really other things to contend with than just your own confidence and willpower as a practitioner. [00:21:44] Speaker B: Right, Right. [00:21:45] Speaker A: So convenience is always something that comes up with patients. Right. I don't want to cook them. I don't want to have to mix them. I don't want to have to taste them. There's like, all kinds of stuff that sort of comes up around it when you think about convenience and sort of picking the right type of herbal intervention. So what I mean by that is decoction versus powdered granule, or, excuse me, powdered bulk herbs, like a san or granules or tablets or pills. Like, what's kind of going through your calculus there about how you're firstly, picking it and secondly, introducing it to the patient. [00:22:26] Speaker B: So I think the most convenient herbal method of intervention that we have available to us as granules, I think that granules is the most convenient for a number of reasons. It's pretty low cost to give a reasonable intervention two or three times a day. And it works for most conditions. Reason really well. There are a few conditions I don't think granules work well for at all. One of them being cold and flu, like acute cold and flu stuff. I think granules are terrible. The further I get along into this, the more I'm like, I'm not doing granules anymore for acute cold and flu. Not gonna do it, because I just don't think it works well. Even if you dose, like through the roof, it's really hard to get the same interaction that you would from just a regular bulk formula or a san formula. [00:23:28] Speaker A: Yeah. [00:23:28] Speaker B: Which is more. What I'm doing now is the. [00:23:31] Speaker A: I was taking the last cold that I had this fall. 20 grams of Xiao Chaitong. [00:23:37] Speaker B: Yeah. [00:23:37] Speaker A: Three times a day. [00:23:38] Speaker B: Three times a day, yeah. [00:23:39] Speaker A: And I mostly just felt the kind of stomach discomfort of taking 60 grams of granules. [00:23:46] Speaker B: Yeah. [00:23:47] Speaker A: I don't know that it did anything right for my cold. [00:23:51] Speaker B: I had the same thing happen to me when I was sick over the Christmas, sort of New Year's holiday. I got sick and I was taking granules, and I was starting to take buckets of them, just like you were saying. And I literally took the same formula. No change in ingredients, but I did bulk san method. And as soon as I took the first dose, I felt a shift, and it was like, definitive improvement. It's exactly how it's supposed to be. So for some conditions like that, I think to. To a lesser degree, maybe dermatology, though I haven't experimented enough changing the same person from a granule to a san or a bulk formula to. To really get a clear, distinctive difference between the three methods. [00:24:41] Speaker A: Yeah. [00:24:43] Speaker B: I think the. The granules are inferior, likely in those situations, but pretty much everything else, the granules are very good, especially for chronic interventions. The granules are relatively easy to take. We have some tricks about how we get. We. We give patients tips on how to take them. [00:25:04] Speaker C: Right. [00:25:04] Speaker B: Which we can talk about. But yeah. Otherwise, I think granules are a good place to start. The bulk formulas or the SAN method, I think have a particular advantage in certain circumstances. The bulk herbs, I think are maybe the best overall, but they're also by far the most expensive and they're getting to be very expensive. I think they're at least twice as expensive as they were when we started, when we were in student. When we were students. So they're a lot more cost prohibitive than they were. They're still useful in certain situations. When you have an acute problem and you need somebody to take bulk herbs for two or three days or a week even, depending on what it is, I think they're still really helpful. The SAN method is comparatively very good. I think we're still playing with this sort of SAN method because you can use a lot less of the bulk herbs. The cost is almost comparable to using a granule formula, and a lot of times the intervention is stronger in my experience so far. So I think those three are the ones that I use the most, depending on the condition. I would say for most people, though, I'm still using granules most of the time. [00:26:30] Speaker A: Yeah. And you're dosing Those granules like 8 grams twice a day. [00:26:33] Speaker B: 8 grams twice a day is kind of the minimum for me. I will go above that in certain cases, especially if the formula is big or there's a high dose of certain herbs. Like if I'm going higher with fuca or higher with longu muli, these, then I'll go up to 12 twice a day, actually. [00:26:52] Speaker A: Mm, yeah. Yeah, that makes sense. So the basically granules for most people because. Okay, they're dissolvable. Right. I'm sure most of our listeners are familiar with granules. So granules are bulk herbs that have been cooked into tea, into town, and then they've been evaporated into a powder. Depending on the company, the evaporatives can be set with what they call an excipient, which is basically like a binder. [00:27:18] Speaker B: Right. [00:27:19] Speaker A: Usually those binders these days are made from non GMO corn or potato starches. They're usually dextroses or things like that. They're almost always gluten free. You should obviously check with your pharmacy and their suppliers to make sure if those things matter to you. But usually that's the case. A lot of the manufacturers are aware of that now. And they're made from the excipients are made from things that are largely non triggering for the vast majority of people. So then you put that powder into a mug and you cover it with hot water and you stir it and dissolve it and drink it like tea. It's super straightforward. It's worth noting, by the way, that you can't hurt the granules. A lot of people ask like, what temperature should the water be? It doesn't matter. It'll dissolve better in hot water. So boil the kettle as soon as it's boiling, pour it in a cup, stir it and it'll dissolve. If you try putting it in cooler water, you might have a hard time getting it to dissolve and it'll clump. Get a reports of that. Oh, these herbs are clumping. Boil the water, man, and then it'll dissolve, it'll be fine. And then, you know, people are drinking them down. The amount of water is entirely up to the patient. It doesn't really matter. I even, I have a patient who still eats his herbs. Like his grain. He like literally pours the spoons in his mouth and eats them. [00:28:35] Speaker B: Interesting. [00:28:35] Speaker A: Yeah, I wouldn't recommend that. I think a T tastes terrible and it's crunchy and strange. But like he, he prefers it. So whatever. What I care about is the number of grams per day. Right. Like are you getting it in? So some people are mixing in a large amount of water, Some people are putting a small amount of water just to dissolve it and shoot it back. I don't think it really matters. You know, in the end, we usually tell folks to start their dosage between breakfast and lunch and between lunch and dinner. So sort of mid morning, mid afternoon kind of flow. It's also worth noting that a lot of folks these days, myself included, will just, I'll mix both of my doses in a thermos in the morning. Like I'll just put the whole day's worth of herbs into the thermos, put hot water in it, put the lid on it, shake it up, throw it in my bag. [00:29:16] Speaker B: Yep. [00:29:17] Speaker A: And then I'll either drink it in two doses or I'll maybe even take it in three or four doses. But I'm going to get it done before dinner. Sure. Probably not in one big chunk. [00:29:27] Speaker C: Right? [00:29:27] Speaker A: Right. So you can absorb it and not just excrete it out. [00:29:30] Speaker C: Right. [00:29:31] Speaker A: So that's a convenient way too because a lot of people be like, even though granules are crazy convenient, they'll be like, well, I'm at work and I forgot my granules and I just know hot water and, you know, whatever. In that case, mix them together, put it in a thermos. You can buy a good quality insulated thermos for like 20 bucks from Amazon these days. So, you know, put that in your bag. So on a convenience side, with granules, it is pretty hard to beat. Nonetheless, they do have a taste. [00:29:57] Speaker B: They do. [00:29:58] Speaker A: And that taste drives people to want other options. So they might want the granules encapsulated. They might want to do a pill of some kind. On the subject of encapsulation, I think it's probably fine, except that at the dose that we dose at 16 grams a day, most double zero vegetable capsules can hold about half a gram, right? [00:30:24] Speaker B: Yeah. [00:30:24] Speaker A: So that means that if you're taking 16 grams of granules in a day, that's 32 capsules. [00:30:29] Speaker B: 32 capsules. [00:30:30] Speaker A: So were you, were you planning on swallowing 32 capsules? There's a lot of capsules, right? I mean, that's kind of the thing is, like, people like, oh, it's convenient because I don't have to taste it. I was like, yeah, but is it convenient to swallow 16 capsules at a time like that? Seems kind of crazy to me. I suppose if you're doing a style of dosing where your dosing is much smaller, then capsules probably work out fine. But for what I think of as sort of a standard intervention dose capsule is just not practical. [00:30:57] Speaker C: Right. [00:30:58] Speaker A: So then people want to do pills. Right. And there's a lot of kinds of pills. We got the honey pills, the classical ones. So that's ground up herbs that are set with honey into a little kind of. They actually look like little rabbit turds, actually, but they're like about that size. I don't know what size that is, but that's the size. And those, of course, like, think of the formulas that those are like Li Zhong Guan, stuff like that. It's formulas, Shenziwan, that people would have likely taken for a long time. [00:31:27] Speaker B: Yes. [00:31:28] Speaker A: Because it's chronic disease and whatever. So it makes sense that even classically those got made into pills because, like, realistically, like, people need to store them, they need to be able to take them regularly, and the dosage doesn't need to be super high because it's almost like you're just trying to make this subtle change over time. [00:31:43] Speaker C: Right. [00:31:44] Speaker A: So, you know those formulas made into wands, there's a kind of modern version of that, I would say, which is like the pressed tablet, where we have powdered herb with some granule concentrate extractions that are mixed together and pressed into a tablet. Here in Portland, there's a company called the Institute for Traditional Medicine. They make a whole variety of pressed tablets. Very high quality, good quality stuff. But definitely a different dosing strategy, right? [00:32:14] Speaker B: Yes. [00:32:14] Speaker A: I mean people, people use them in a much different way. In fact, when you see people using the sort of 7 forest style tablet, what have you noticed is different about the way that they are using that versus say writing a granule. [00:32:28] Speaker B: So again, I don't have too many people that I have this info for, but when I've seen people use this as a strategy, it seems largely symptomatic to me. So this person has seasonal allergies and we're alleviating symptoms is kind of what we're going for. Like we're trying to get the congestion. This is really good for this type of problem. [00:32:56] Speaker C: Right. [00:32:57] Speaker B: And there's a fundamental difference in the goal. When, when I have a patient and I'm treating with herbs, I don't. My goal is not the symptoms. [00:33:09] Speaker C: Right. [00:33:09] Speaker B: The symptoms are of course, something that we want to shift because that's the reason the patient is in front of us. [00:33:14] Speaker A: Right. [00:33:15] Speaker B: But we want to shift the physiology. We want the physiology to become adaptive and corrective to the condition the symptom comes out of. And so by doing that, by targeting that their body should self correct and not need more intervention at some point, not just needing to take Sanger to San every spring because they have allergies. [00:33:40] Speaker C: Right. [00:33:41] Speaker B: There should be some weight to the intervention that's corrective so that the adaptive mechanism of the body figures it out then that's actually the goal. So the symptoms do get alleviated, but it's not a symptomatic treatment. And I think that's a big difference in what I've seen in terms of the approach for the pills. I have seen also that for certain conditions, like we carry Sanchi 17 for example. [00:34:14] Speaker C: Right. [00:34:14] Speaker B: Which is. [00:34:15] Speaker A: That's a seven forest. This is a. Which is forest also. Itm. [00:34:18] Speaker B: Yeah. So we carry a handful of the tablet, the tablet formulas that we found to be constructive in certain situations. Sanchi 17 is very good for chronic blood stagnation. Type of pictures. It's pretty convenient. And you've used that a lot, right? For different things. Do you want to talk about what you've used that for and how you've managed the dosage? [00:34:45] Speaker A: Yeah. So Sanshi 17, ITM Institute for Traditional Medicine, has a variety of lines that they've created and one's called Seven Forests. The Seven Forest formulas are Blends of herbs that have been organized, usually inspired by some classical formulation or at least sort of dwayao classical ideas. But they are the product of ITM's founder, Subudi Dharmananda and his team. So, like, they've built these things. So their formulas have these kind of peculiar names, like Sanchi 17. And the reason is because the emperor Herb in the formula sanchi, and there's 17 herbs in the formula, right? So they're literally all like that. So It'll be like Sapen 9. Yeah, exactly. So it'll always be this sort of. It's funny, Sanchi is actually like the only one that doesn't get translated because there isn't an English equivalent for Sanchi. It's always even just. It's like Herba Sanchi. But all the other ones are sort of listed by their Western pharmaceutical name and a number. So, like TC said, the Sanchi 17 is, if you look at the list of ingredients, it's largely a blood stagnation formula, right? So it's got all kinds of blood movers and stuff in it. It also has some Dahuang and some things to move the stagnation out through the bowel. And so it's really, really great for people who have. Well, there's two ways, I guess, in which I use it. One is in a way that's a little bit more akin to what you were talking about, sort of changing core physiology, but it works weirdly, by addressing symptoms. So this is a strange combo of things. This is why this formula is very interesting to me. So imagine you have someone who had a terrible car accident 15 years ago, right? And they had to have some, like, reconstructive surgery on, like, a hip and an abdomen and a knee where they got tore up in the car. And ever since then, they've had, you know, pain and discomfort, which the surgeons told them to expect because it was a pretty brutal accident, right? And no one expects usually to come away from those things without issue. But over the years, the stagnate, the. The pain has gotten worse, right? The stiffness has gotten worse. And so they make their way to us, and we do an evaluation there, and we're like, oh, this blood stagnation that was there from the trauma and also from the surgery has grown, right? Like, it has. It has increased the stagnation over time. And so a formula like Sani 17 can be given to the patient at a not insignificant dosage, right? So the tablets are pretty big. They're kind of like the patients always describe them as like horse spills. And they range, they range in pressed weight between like 0,65 of a gram, like 650 milligrams, up to a gram a gram. 2. 2. Like, they can be pretty heavy. So there's a fair amount of product in a single tablet. But even still, I mean, we're talking about 1 gram of herb per pill, right? [00:37:31] Speaker C: Yes. [00:37:31] Speaker A: And you know, you and I were just Talking about doing 16 grams a day of granule. So anyway, the, the package dosing for ITM stuff, which, keep in mind, can be sold over the counter and even on Amazon. So whenever you pick up a bottle of patent herbs like that, the dosing that's on the label that is just for the public is what we lovingly refer to as the CYA dosage, the COVID your ass dosage, which is to say, like someone picked up this bottle and they took it at the label dose, nothing bad would happen to them. Right, Right. And by nothing bad, I mean, like, not that they would die or anything, but that they would get like loose stool or a headache or heart palpitation or something that could happen from dosing the herbs. So when you're looking at the label, you are not looking at. This is very important. You are not looking at a therapeutic dose. [00:38:16] Speaker B: No. [00:38:17] Speaker A: Right. You're not. [00:38:18] Speaker B: Definitely not. [00:38:19] Speaker A: So the, you know, if you pick up the bottle of Sanji 17, it says take two to three tablets two to three times a day. [00:38:24] Speaker C: Yeah. [00:38:24] Speaker A: Right. And the thing is, is that if you take two to three tablets two to three times a day, I don't really think you'd notice anything. [00:38:30] Speaker C: Right? [00:38:31] Speaker B: Yeah, no, I don't. I don't think you would either. [00:38:33] Speaker A: So for the condition that I was just describing, like this sort of chronic, like many, maybe decades old blood stagnation that's now getting worse, the patient is likely taking eight tablets three times a day. [00:38:45] Speaker B: Yes. [00:38:45] Speaker A: Right. [00:38:46] Speaker C: Yeah. [00:38:46] Speaker A: And at that dosage, not only are we gonna see changes to the pain pattern, but they're also gonna be on the toilet. [00:38:52] Speaker B: Yeah, sure. [00:38:53] Speaker A: Right. And that was the point because of course, we're mo. Like the blood stagnation has to go somewhere, right? So the herbs go in there, we break it up into pieces and we pass it out through the bowel. And so the patient can expect looser frequent stool, maybe in the first, say, five to seven days, maybe very frequent stool. So you have to be cautious. Like, does this person already have loose stool? They already have weak bowels, have heartburn? There's things to consider. Right. With the formula, but the point being is that you got to dose it pretty hard. [00:39:22] Speaker B: Yes. [00:39:23] Speaker A: And what will happen simultaneously is the patient's symptoms of increased pain and stiffness will begin to abate. But more importantly, the herbs are also changing the underlying stagnation pattern. The thing is that's, and this might be a little bit nuanced, but this kind of blood stagnation that I'm describing isn't, isn't a pattern Exactly. [00:39:46] Speaker C: Right. [00:39:47] Speaker A: It's actually like a static chronic symptom. Because the thing that caused the blood stagnation wasn't necessarily like a physiologic breakdown. Right. It was an accident. Like someone got like hit by a injury. Yeah. And then they like got a sewn back up like it's damage. [00:40:07] Speaker C: Right. [00:40:07] Speaker A: And then there was just blood stagnation from that damage. And now over time, that blood stagnation has started to assert itself. Kind of like a pattern. [00:40:17] Speaker C: Right. [00:40:17] Speaker A: Like it's now messing with physiology because it's a factor in the mix. [00:40:21] Speaker C: Right. [00:40:22] Speaker A: But the reason that Sani 17 is effective even in that pill form, even in that relatively low dosage form, is because in fact we are attacking a symptom. [00:40:30] Speaker C: Right. [00:40:31] Speaker A: And we're breaking up that symptom and we're passing it out through the bowel and, and by removing it, physiology is going to reassert. That's not what happens when you give someone with allergies sangers on. [00:40:42] Speaker C: Right. [00:40:44] Speaker A: That's kind of our point here. [00:40:45] Speaker C: Right? [00:40:45] Speaker A: Yeah. [00:40:45] Speaker C: Yeah. [00:40:46] Speaker A: So if you got Sangerz, if you have allergies and get stuffy, congested face and give you Sangersisan, these pills, particularly the seven force ones, will open up your face like you will feel less snotty and that will be great because you've been having such a hard time breathing. But the reason that you get snotty every year will not be affected by taking Sungertasan pills. [00:41:05] Speaker C: Right? [00:41:05] Speaker A: Right. [00:41:06] Speaker C: Yeah. [00:41:06] Speaker A: And that's also, that's a pills versus also a formula. That's not really what sungurt has son does in general. Right. So even if you gave it to them in granules. [00:41:13] Speaker C: Yeah. [00:41:14] Speaker A: It's not going to fix the problem. [00:41:15] Speaker C: Right. [00:41:16] Speaker A: But the point being is that the pills are an effective way to treat symptoms. Sometimes treating those symptoms can even have physiologic improvement. [00:41:24] Speaker B: Well, I think. [00:41:25] Speaker A: But it's still symptom based. [00:41:26] Speaker B: I think you could use, I think it's possible maybe to systematically use the pills, maybe in combination to address physiology. But yeah, I'm just. My comment, just to clarify my comment from before, when I've seen people intervene with them, that's usually not what they're trying to do. They're trying to affect. They're trying to affect a symptomatic aid, not necessarily change the physiology, which is. This is a change of view and intention rather than a change of the approach. [00:42:00] Speaker A: Yeah. [00:42:01] Speaker B: But the approach also maybe lends itself to a certain intention. Does that make sense? [00:42:08] Speaker A: Yeah, I mean, I think. I think there's a core understanding of, like, okay, there's another. There's another formula in the. There are many. There are dozens and dozens of formulas in the ITM line, but there's one called salvia and amber. So that's a Danshen hupo Emperor herbs. There are other herbs in the formula, but those are the big players. And people have used that, for example, to help with stress and anxiety and sleep. [00:42:33] Speaker B: It's like an anchen dingzhi type of modification, like an adaptive formula from that. [00:42:39] Speaker A: Exactly. So we say, okay, you're having a problem sleeping, why don't you take four of these pills before bed, maybe six, you're getting crazy. And then maybe that helps a person sleep. It's not going to fix their insomnia, right? [00:42:54] Speaker B: Probably not. [00:42:55] Speaker A: And that's the point. Right. What's important to understand about using pills is that being able to create a potent enough physiologic pattern represented by the herbs. What I mean by that is we're all familiar with pathological patterns. That's like what our whole medicine is, right? Like, oh, the person's got liver, qi, stagnation wood, overacting earth, whatever. So we do this evaluation and we evaluate the pattern. We give it a name. Right. Imagine if you could draw that pattern if it had a shape. Right. Okay, here's the shape of the pathological pattern. We know how the body should operate. That's its physiologic pattern. Right. So you have physiologic pattern, how the body should operate, pathological pattern, how it's currently operating and the problems it's causing. [00:43:44] Speaker C: Yep. [00:43:44] Speaker A: So now we write a formula that is shaped in such a way that it will drag the pathological pattern and change its. Its confines and its. And its boundaries so that it starts to look more and more and more like the physiologic pattern. [00:44:02] Speaker C: Right. [00:44:03] Speaker A: And the art of this that we've been talking about in this podcast for ages and that all of you know, is that you can't just write any old formula pattern, because if it doesn't have enough little pieces where it matches the pathological pattern correctly, it won't be able to tug it over to physiology. The thing with pills is it's very hard to give someone enough pills with enough combined ingredients to make a formula pattern that is strong enough and well crafted enough to pull the actual pathological pattern toward physiology. [00:44:38] Speaker C: Right. [00:44:39] Speaker A: It's very hard to do. [00:44:40] Speaker C: Right. [00:44:40] Speaker A: You can sort of have these little small, small patterns like for runny nose and for, for run racing mind and for whatever. [00:44:48] Speaker B: Right. It can be, it can be an aid. [00:44:51] Speaker A: Yeah. You know, a very useful one. [00:44:53] Speaker B: And it's also possible perhaps to use it at higher dosages or to come to figure out how to combine these to treat the physiology truly and to correct it. But that isn't usually how I see people using them. That was the point that I wanted to make. [00:45:10] Speaker A: Right, Right. [00:45:11] Speaker B: And I think the, as long as we're talking about companies and styles and stuff, I think the Seven Forest and the itm, I think their stuff is the best of the pill, like of the tablet genre. [00:45:25] Speaker A: Definitely. [00:45:25] Speaker B: Right. That I've seen on the market. The other stuff that I've seen is not as good as that stuff and. [00:45:33] Speaker A: It'S just not as thorough. Right. There are all these companies out there. Maybe this is true of all companies, but in the business that we do here, not the treating patient side of things, but the sourcing of herbs, the finding of products, the testing of material. What I have found over the years is that the people, the individual human beings who are connected to each of those companies, either an import company, a farmer, a manufacturer, et cetera, the individual human people are the things that we have to put our trust in. [00:46:05] Speaker C: Right? [00:46:05] Speaker A: Right. Because those people and their intellectual capacity, their attention to detail, their ethics, their safety, like all of those things are the things we have to put our energy in. And so ITM and Sabudi and his team of people are a perfect representation of intellectually clear, ethically safe and potent oriented company. [00:46:28] Speaker C: Right, Right. [00:46:29] Speaker A: Like they care. [00:46:29] Speaker B: They do care. [00:46:30] Speaker A: It's not like, oh, I'm just trying to figure out a way to sell some shit. [00:46:33] Speaker C: Right. [00:46:33] Speaker A: Right. It's like, okay, we like pills, we think they're effective. We've arranged these formulas in such a way that they have a certain level of potency and the company produces a massive. It's called Bag of Pearls. It's a book, like a huge book that talks about all the different formulas, how they work, how to use them together. Like it's absolutely possible, like you said, to use a pill based system for treating pathology. [00:47:02] Speaker B: Yes, for sure. [00:47:03] Speaker A: It's just like you said, not how most people are doing. [00:47:05] Speaker B: It's not how most people do it. [00:47:06] Speaker A: Could you do it? Yes, and not how most people do. [00:47:07] Speaker B: And if I was going to do it with tablets, that's probably the company I would pick the system I would pick. Because we have seen that it does work. It's a workable system. [00:47:20] Speaker A: Definitely. And other big names in this place are going to be classical pearls. I know those aren't tablets, those are herbal, concentra, whatever, granules basically, that are in, in capsules. But they do a similar thing. If you learn that whole system, you're combining like six tiger pearls plus three lightning pearls plus five moon pearls and like, that's the formula. [00:47:41] Speaker C: Right. [00:47:42] Speaker A: And so that again, is trying to use tablets to treat pathology as opposed to symptoms. So of course it can be done. It's just not how most people are doing it. And it's particularly not how most people are doing it if they're, if they're handing people T pills. Right. [00:47:58] Speaker B: Oh, my God. [00:48:00] Speaker A: About T pills. [00:48:00] Speaker C: Yeah. [00:48:01] Speaker B: T pills is a. As a whole, this is like a different world from, from what we've just mentioned. [00:48:06] Speaker A: No. [00:48:07] Speaker B: Yeah, yeah. [00:48:07] Speaker A: T pills are. If you're not familiar with T pills, there's a variety of brands that make them. They're very popular, I think, out of the mainland China. And they're tiny little BBs. They're sort of waxy. [00:48:19] Speaker C: Right. [00:48:19] Speaker A: Little BBs. And they are marketed as the sort of like liquid herbal concentrate formed into pills. And frankly, I think, because western medicine, you know, like pharmaceutical medicine is incredibly potent at very small doses. [00:48:36] Speaker C: Right. [00:48:37] Speaker A: So you're going to take like 5 milligrams of some chemical. [00:48:42] Speaker B: Yeah. [00:48:42] Speaker A: And it's going to like radically change your brain. [00:48:45] Speaker C: Yes. [00:48:45] Speaker A: Okay. That's not, that's not how herbs work. [00:48:49] Speaker C: Right. [00:48:49] Speaker A: Like, there's no way to take the potency of an herb with the hundreds of compounds that are inside of it and concentrate it into something that's going to work like a pharmaceutical. Like, stop believing that. Like, if anybody tells you like, this is hyper potent concentrated herbs, you should immediately be skeptical. [00:49:09] Speaker B: Unless you're doing homeopathy, in which case you should just do homeopathy. [00:49:14] Speaker A: Right? Yeah. Homeopathy is like a whole other world, like a whole different set of. Of deals. And not to get into homeopathy. But even the basic principle of homeopathy is even the opposite of that. It's not concentrated at all. Right. At least not substantively. So this idea that a tea pill or a tablet or a capsule could Somehow capture in a tiny physical volume the punch of a whole herbal plant. [00:49:44] Speaker C: Yeah. [00:49:45] Speaker A: Is to date, not real. [00:49:48] Speaker B: It's. [00:49:48] Speaker A: It's marketing. [00:49:49] Speaker B: It's a placebo. [00:49:50] Speaker C: The. [00:49:50] Speaker B: Like, if you get results consistently with T pills, it's largely due to placebo. And I think. Unless you're having them take half the bottle per dosage. [00:49:59] Speaker A: Yeah. [00:49:59] Speaker B: I mean, which case it's not. [00:50:01] Speaker A: Fiscally, I have done that. [00:50:02] Speaker C: Yeah. [00:50:03] Speaker A: So, like. Because I. Because we had some. Like, we got a bunch of samples in school and whatever. And so I had a. I had a T pill bottle of beyond one. [00:50:12] Speaker B: Yeah. [00:50:12] Speaker A: Which is a. Allergy congestion. Sure. [00:50:15] Speaker B: Like nasal. [00:50:16] Speaker A: Nasal congestion formula. And I was taking it at what I thought was like a high dose. I'd pour out like 15 BBs, you know, take it. And of course, the bottle says, like, take two to three, three times a day, like, whatever. So I took 15 nothing. Right. I was like, well, let's see what happens. I go to 30 nothing. So then I just poured as many as would fit in my mouth, like from the bottle. It ended up being about three quarters of the bottle. [00:50:39] Speaker C: Yeah. [00:50:40] Speaker A: Right. Which was rather challenging to swallow. But I did. And at that, I got some nice nasal relief. [00:50:46] Speaker C: Yeah. [00:50:46] Speaker A: Right. But a bottle of tea pills usually retails for like, 20 bucks, so. [00:50:51] Speaker C: Right. [00:50:51] Speaker A: There's no. Like, you're going to get two doses for 20 bucks. Like, come on, it's a game. Yeah. So I just, you know, reasonable people can disagree for sure. I'm sure there are some listeners who's like, I love tea pills. They're so helpful. I'm gonna say it's not a reliable method. Like, if you're. If you're trying to figure out, like, hey, I'd like to do herbs more. I want to help my patients with herbs. Please don't lean into T pills. Right. Unless. Unless you're working with someone who can, like, demonstrably show you how 4T pills twice a day is fundamentally changing health. Like, unless you can see it with your own eyeballs on the regular. Don't. Don't invest your time there. [00:51:33] Speaker B: Now, T pills are like, they're an added revenue stream for practitioners. [00:51:39] Speaker A: Yeah. [00:51:40] Speaker B: And not a big one. [00:51:41] Speaker A: Yeah. [00:51:41] Speaker B: That's really. [00:51:42] Speaker A: Honestly, selling T bills, kind of like just from a shelf in your clinic is a little bit like, in my mind, selling chocolate bars. [00:51:48] Speaker C: Yeah. [00:51:48] Speaker A: Like, they were not doing anything. Sure. Like, people like chocolate, it makes their mood better. I guess. [00:51:52] Speaker C: Yeah. [00:51:53] Speaker A: But I'm just trying to sell some stuff to make some extra money. So, you know, But. But that really Gets to the point, right? About. About price and about cost. Because one of the things is that if you don't know that about T pills and you pick up a bottle of T pills and says there's 150 pills in here, 200 pills, and you only have to take four a day according to the package, right? Well, now you've got like a month worth of herbs. Worth of herbs for 20 bucks. [00:52:17] Speaker B: For 20 bucks, right? [00:52:18] Speaker A: Look, y'all, there's. That's not real. Like, there's no. Like, that's not what herbs costs. That's not what the, the investment piece is. Even if you sold herbs at cost, which you should not do because you are paying shipping and labor to put them together, let's just assume you sold herbs that you bought from a granule company at cost, gram per gram for what you bought them for, right? A week's worth of herbs, granule herbs being sold or being dosed at 16 grams a day, Right. Cost to you is still going to be about 12 to 15 dollars. [00:52:57] Speaker C: Right? [00:52:57] Speaker A: Right. Cost to you. So there's no way to give somebody a month's worth of herbs that are therapeutic for 20 bucks, right? Just can't do it. [00:53:08] Speaker B: You can't do it. Not, not right now. [00:53:10] Speaker A: No, not right now. I mean, it's probably. Honestly, it's been 20 years since you could do that, right. Like, it's just not, it's not realistic. That does mean, though, that we do have to think about price though, right? Like that's going to connect into how people are making choices about stuff. And I think it's one of the reasons that people are drawn to pills. Yes, right. And of course, there are some companies that are beyond even just itm. Like we mentioned classical pearls. Who's sort of setting these things up? Like, what's been your experience with. With that, that style? [00:53:42] Speaker B: So I think firstly, I have to say, you know, after you and I did our traveling to China and we saw the business style over there and kind of the things I've become kind of skeptical around, any company that says their ingredients, their formulas are cleaner or more alchemical or specialized in certain ways, I don't believe that. [00:54:13] Speaker A: Why is that? [00:54:14] Speaker B: Because there's no follow up. What makes your stuff more alchemical, what makes it cleaner, what makes it better? And if you do the research, like if you've gone to the different companies that you can buy herbs from and you're willing to ask the people who supply those companies those herbs, they'll all tell you the same stuff, right? They'll tell you. And you know, we, we have a bit of a. An in with this. Right. Because we have a personal friend in Eric Brand. And you know, we have some. We know some people who are up on herbal identification who can give us credible information about the reality of the market. And it's easy to sell people things with a story. [00:55:04] Speaker A: Yeah, Right. Eric Brand is the owner and operator of Legendary. Legendary, which is a granule company that we buy from. But Eric is also, I mean, probably the foremost English language expert on herbal ID. [00:55:17] Speaker B: Yeah. He has a PhD in herbal pharmacology. [00:55:20] Speaker C: Right. [00:55:20] Speaker B: And he's one of the, One of the top. [00:55:23] Speaker A: Yeah. I mean, and in English, I think. I think it's hard to find a better expert than, than Eric. Right. I mean, in other languages maybe, I'm sure his teachers, you know, would. Would qualify. But in English, Eric is definitely in top of the game. [00:55:35] Speaker B: Yeah. And so any like. So putting that part aside, because I think a lot of people choose classical pearls for that aspect. This kind of the story around. Oh, we have the best, like this thing or whatever. So I'm not. That to me is neutral. It's a neutral factor. Classical pearls has older lines that are, let's say a few formulas added together constructed by the founder of classical pearls, Heiner Fruehof. [00:56:07] Speaker C: Right. [00:56:08] Speaker B: There's also newer formulas that they've come up with in the last few years, which are just like shanghanlun formulas or like Wendan Tang. You know, just Wendan Tong. [00:56:19] Speaker A: Yeah. [00:56:19] Speaker B: Just Guizhu Tong. Just Xiao Cai U Tang. [00:56:21] Speaker C: Right. [00:56:21] Speaker B: So there's also that line of things. And the, the problem with using any of those, I think, is you have to learn to combine to get good results. [00:56:36] Speaker A: Yeah. [00:56:37] Speaker B: Which is a choice you can make. If you want to learn to combine them together, you can do that. My, my personal preference is with the older formulas where there's, let's say formulas and herbs already combined in the formula, is that it faces the same problem that a lot of other systems face. If you are intervening and you use the formula and you get good results, there's no problem. If you intervene using the formula and you're not getting good results, it's very hard to figure out why. Because the formula is already mixed and modified and because, let's say, let's say if you get used to using those. Those strategies, you may not sort of build the skill around seeing, oh, this base formula structure should do these things. It shouldn't do these things if these negative things are happening. I need to pivot this way you don't get the practice of seeing that by itself. And then you sort of miss out on the ability to pivot the formula if it's not right or exactly how to pivot it. [00:57:51] Speaker A: Well, I mean, and this is a problem of all patent based systems in the first place, right? Because if you're working with, I suppose if you just had a massive collection of Shanghan based formulas, for example, and they were in concentrated capsule form like classical pearls is, you could I guess, see just that version of the formula. Right? And then if you also had one that was say, okay, I've got Xiao Caiutang in capsules and then I have Xiao Caiutang cough mod in capsules, right? Okay, maybe you could do that. But that's a lot of inventory to stock. [00:58:28] Speaker B: It is a lot of inventory. [00:58:30] Speaker A: And it also means that if, and you know, it's a guess about where you want to put your energy to learn stuff. Because if you want to learn how to use ITM pills, if you want to learn how to use classical pearls, that will be the focus of your study, the combining of specific formulas from those companies, right? And you will have to spend a not insignificant amount of time learning how to combine xanthium 7 with Sanchi 17 with Sapin 14. Whatever. Similarly, of I need 5 moon pearls and 2 lightning pearls and 3 whatever wood pearls, in my opinion, I think that effort would be better spent learning the formulas themselves. [00:59:18] Speaker B: Yes. [00:59:18] Speaker A: And using the formulas themselves for a couple of reasons. One, that knowledge is not like, that's universal knowledge, right? It is traditional knowledge. It's knowledge that does not rely on huge factories to produce a specific product with a specific concentration with a specific outcome. Like I suppose you could argue that that's sort of true with granules and, and I suppose it is from the individual ingredients, but you don't always have to use granules, right? Like you can use the plants themselves. And the knowledge of how Chai who works and how Shao Chaihu Tong works is infinitely more universal than how wood pearls work, right? [01:00:00] Speaker B: But even with, even with granules, let's say you like, like you get used to using Evergreen's proprietary blend of granules, right? So you're using granules, you're using a system that's potentially more potent, easily more potent than to use a tablet or pill based system. But you're still using a proprietary formula set. That proprietary set is going to be twice as expensive for you to buy and work sell to your patients as any other formula that you buy from Evergreen. Yeah, because they make double on proprietary formulas. So if you're going to take the time to learn a system of prescription, which you kind of have to do anyway, even if you learn a patented system of combination, it's way more bang for your buck. If you learn how to use traditional formulas, they work just as well, if not better, you get clearer results. And yeah, it doesn't take that long to learn a few good formulas for a condition, you know? [01:01:08] Speaker A: Well, and I, I just think you pigeonhole yourself right unnecessarily. Like you, you've now bound your clinical effectiveness to a specific product line. [01:01:17] Speaker C: Right. [01:01:18] Speaker A: That especially these days, can in no way, shape or form be guaranteed to continue to exist. [01:01:23] Speaker B: Yes. [01:01:23] Speaker A: You know, and sure, we could suddenly not be able to get imported Chinese herbs, and maybe we can't get granules like that. The realities of sort of market forces exist for everybody, no matter what. But at every stage that we move further from the field, right. Where the herbs are grown, we increase complexity and the likelihood that we could not get our hands on that. [01:01:46] Speaker C: Right. [01:01:46] Speaker A: And so if we're talking about baishi roots pulled out of, you know, south central China, dried and sliced versus granule, baishao versus classical pearls, proprietary combination in a capsule versus an evergreen proprietary granule that can only be bought from them, in each stage, you're increasing the likelihood that you can't get what you need. [01:02:10] Speaker C: Right. [01:02:10] Speaker A: I mean, I just made the herbal order today and we, we keep a variety of whole formula granules. Right. And we can't get those from all one company, so we have to go round and round. And we've been low stock on Dahuang Mudan Pitang for some time now. We have some, but we don't have a lot. And I've been, it's been on my order sheet for six weeks. [01:02:32] Speaker C: Yeah. [01:02:33] Speaker A: Because the only company that produces it is Evergreen and it's out of stock, so I can't get it. Now that's a, that's not a proprietary formula. [01:02:42] Speaker C: Right. [01:02:42] Speaker A: So of course we can just make it from singles. [01:02:44] Speaker C: Yes. [01:02:45] Speaker A: But imagine if you had built your whole system around proprietary formulas that you know how to use and even work well. [01:02:50] Speaker C: Right. [01:02:51] Speaker A: But now you can't get that. [01:02:51] Speaker B: But now you can't get it that way. Now what do you do? [01:02:54] Speaker A: You're going to try and make it out of singles, but if they're proprietary granule blends from Evergreen, there's going to be six or seven Taiwanese herbs in there you can't get. [01:03:01] Speaker B: Exactly. [01:03:02] Speaker A: And you'll what, spend A bunch of time trying to sub it anyway. It just seems like a big mess. [01:03:06] Speaker B: It is a big mess. It seems like it's a good idea, I think, for newer practitioners when they get started. But in the end, it's so much better to just learn to just do the work of learning the classical formulas and learn how to use them because it gives you better feedback. They work just as well. And a lot of times they work faster because their construction is simpler. And more to the point, the other thing you see with patented formulas is extraneous herbs added to sort of make it a unique formula. [01:03:41] Speaker C: Right. [01:03:41] Speaker B: So, like, oh, I'm going to add three extra herbs in this one for nasal congestion, but they don't really need that to get the right result. [01:03:50] Speaker C: Yeah, right. [01:03:51] Speaker B: And the thing is, like, it might be better for nasal congestion, or it might give more direction, more. It might scatter the power of the formula. If you add more herbs when a simpler version might be better, it might work faster. It might give you a better result. [01:04:11] Speaker A: Yeah. So, I mean, I think new herbal providers in general should also, you know, I don't want to make anybody cynical about the work that we do and the business environment that we live in, but you should approach the claims of anyone, us included, with skepticism. Like a little bit of it. [01:04:32] Speaker B: Healthy skepticism. [01:04:33] Speaker A: Healthy skepticism, Right. That just says, well, what does it mean for this to be extra potent? Like. [01:04:39] Speaker C: Right. [01:04:40] Speaker A: Super concentrated? Like, what does that. What does that. [01:04:42] Speaker B: What does that mean? [01:04:43] Speaker A: Yeah, exactly. You know, and one of my favorite things is to say, like, okay, well, this granule is a 5 to 1 ratio of. Of herbs to, like, of granule to raw. Right. Okay, so you're telling me that one gram of this powder has the same taste and potency of 5 grams of the raw herb. Right. Of the bulk herb. I mean, y'all, if you have access to a bulk pharmacy, you can test that theory in two seconds, and you will immediately know that that's not true. [01:05:16] Speaker B: It's not true. [01:05:17] Speaker A: It's just not true. Like, you put one gram of granules into water, and then you take five grams of that herb and you steep it in water, and the potency of taste difference will be marked. [01:05:28] Speaker B: Yes. [01:05:28] Speaker A: Right. Now, are some of them closer than others for sure. Some of them farther than others for sure. But the idea that there's a sort of, like, universal concentration that's occurring, and where does that come from? Right, like that. That's math. It's a mathematical conversion where we say, like, okay, we took this many grams of herbs, we boiled Them into tea. We evaporated that tea, and we compared the weights, how much weight of powder at the end compared to how much weight of the herbs that went in. And if the amount of powder is less than the amount of herb that went in. Oh, now it's concentrated. Right. By gram. But. But concentrated how? Like, that's a. Like, what are you even measuring? We don't do chemical analysis of herbs, not in any real way. And even if we did, I don't even know what that would tell you. [01:06:10] Speaker C: Right. [01:06:11] Speaker A: Show you what one or two active ingredients like. Okay. The way that we have always evaluated the potency of herbs is nature and flavor. [01:06:20] Speaker C: Yeah. [01:06:20] Speaker A: That is the core methodology. And while it's certainly true that baisha is sour, and if you boil it, it doesn't really taste sour, at least not like. Wait, it tastes sour. That's still the primary evaluative principle. It's not a chemical analysis. It's not what shows up in a, you know, a mass spectrometer. It's nature and flavor. And you can feel nature and flavor when you just drink the herbs. And that potency isn't there. And so what's happening? Like, what is even the potency of tablets and encapsulated products, like that tiny fine powder in there? What is that? And what's its taste? And how do you even know that that is what you think it is? [01:07:05] Speaker B: Right. [01:07:06] Speaker A: Like, there's just so many. So many questions in there. Like, it's one of the reasons that we love bulk herbs. Right. Because the herbs arrive and you can look at them. And over the years, it's like this Dangui is dry. It doesn't smell strong. Right. This jersey, when I open it, it should be like punching me in the face with orangeness. And this one is flat. You can tell? Yes, because it's the whole plant. If you buy that powdered, even raw herb, but powdered, you can tell less. [01:07:35] Speaker C: Right. [01:07:36] Speaker A: Now you buy it in granules, you can tell even less. [01:07:38] Speaker C: Right. [01:07:38] Speaker A: And now you buy it in a capsule with a dusty gray powder inside. [01:07:43] Speaker B: Yeah. [01:07:43] Speaker A: You don't know anything about that, right? Nothing. [01:07:45] Speaker C: Yep. [01:07:46] Speaker A: And, you know, again, we have to have trust. As I said at the beginning, the person who manufactures this, who started the company, if you trust that person, you trust their integrity, you trust their systems. Okay, we can't know everything. We have to pass on trust to other people. But I still think that as a new herbalist, in particular, a little bit healthy skepticism can go a long way. [01:08:10] Speaker B: Absolutely. [01:08:11] Speaker A: So let's get back to this idea of pricing in general. So obviously we need to consider the patient's ability to pay. [01:08:17] Speaker C: Yes. [01:08:18] Speaker A: There's also a question of how we actually charge for the herbs ourselves. [01:08:22] Speaker C: Right. [01:08:22] Speaker A: And so a lot of that will come into it. So some folks who are running their own pharmacies and they don't have, like, super sophisticated software will often just charge like a flat price per week. [01:08:32] Speaker B: Yes. [01:08:33] Speaker A: So just say, okay, you do herbs with me, it's $40 a week, it's $60 a week, it's $100 a week, whatever. That makes sense. Because if you don't have sophisticated software, it's very hard to know exactly how much to charge for these formulas. Some people will also just do it by per formula. So it's just like each time you get a refill of Xiaochai hutong, I charge $28 for granulng. Like, they'll just be like a fixed value that's there. And then when you get to what we do, we charge by the gram because we have sophisticated software that lets us do that. So at each time, you know, it really is a function of, like, what tools do you have as a practitioner to set your prices in a way that makes sense? I'll say from the business side, if you're doing like weekly pricing, it probably would be a good idea to build out some Excel documents, some what we call pivot table structures, to figure out, like. [01:09:26] Speaker C: Sure. [01:09:26] Speaker A: You know, what's happening with pricing over time. And you should probably reevaluate that. I mean, at the absolute bare minimum, once a year. But honestly, you should probably do it every quarter. Sure. And just make sure that, like, you're still charging the right amount. [01:09:38] Speaker B: Yeah. Because prices change. [01:09:39] Speaker A: Yeah. I mean, dramatically, like since the beginning of. I guess since the fall of last year, the price for swans are in like child swan Zoran. Whole raw swans are in has almost doubled. [01:09:54] Speaker C: Yeah. [01:09:55] Speaker A: So. And I can't even find truly raw swans are in anymore. Just chow swans are in right now, which is fine. That's how we use it anyway. But it's like $115 a pound. [01:10:04] Speaker C: Yeah. Right. [01:10:05] Speaker A: This is the price of ginseng. [01:10:07] Speaker C: Yeah. [01:10:07] Speaker A: Right. That's the price of Bi Renjen is the same as Swanzo Ren. Now. Shihoo has gone up since. In the last. Since COVID Shy, who has gone up probably 80%. [01:10:18] Speaker C: Yeah. [01:10:18] Speaker A: In cost. So there's just a lot of. A lot of changes that are there. So make sure you're keeping track when you're thinking about it for your patients. You know, our Patient granule price usually comes in somewhere between 30 and 40 a week. That's kind of like the retail price for the. For the client, for the patient. And as we play around with San stuff, that also seems to be the case, people coming in, 30, $40 a week, which I think is, you know, it's something to consider. So when you're talking to the patient and you're building out a treatment plan, okay, we're doing, you know, six weeks of herbs. We're doing six weeks of acupuncture. You know, you've got a 20 copay per week. I haven't written your formula yet, but you can budget somewhere between 30 and 40 a week. You know, that way the patients have all of the information that they need in order to be able to make a decision about price. I want to caution listeners to not manipulate your dosage to get a better price. [01:11:21] Speaker B: Yeah, super important. [01:11:23] Speaker A: Yeah. This is something that happens, right? Like you. You write your formula how you want. You're like, okay, it's eight grams twice a day or eight grams three times a day. And then you get to the bottom. Like in our case, like, if you're using our software, it gives you, you know, subtotals. You get to the subtotal, and you're like, oh, shit, it's like $54 for the week. And you go, well, I mean, do they need eight grams, right? Maybe. Maybe we just do seven grams three times a day. Or maybe let's do. Let's make it. Let's make it six, three times instead of eight, two times. Like, you'll just start moving stuff around. [01:11:53] Speaker B: Yeah, moving it around. [01:11:54] Speaker A: Trying to get a better outcome. Look, for sure, there's. There's maybe some small place that you can manipulate those items, you know, Dongsheng versus Ren Shen, whatever. But if you reduce the dose below what you think the patient needs, then a. They may not get the results that you're looking for at all. [01:12:14] Speaker C: Right. [01:12:14] Speaker B: And the whole thing is a waste. [01:12:15] Speaker A: The whole thing's a waste. Or it takes longer to get the outcome. So now they're actually buying three more weeks worth of herbs than they would have if they had just paid for it upfront, which will almost certainly be more expensive. So resist the temptation. [01:12:29] Speaker C: Yeah. [01:12:30] Speaker A: To manipulate your dosage. [01:12:32] Speaker B: Just be honest about the price of it from the get. Like, give them. Give them the average price of. Of how this. This is. And then. And if you're not sure what an average price is, then just use what we. What we said here. You know, 30 to 40 bucks a week is average. [01:12:49] Speaker A: Yeah. [01:12:50] Speaker C: Yeah. [01:12:51] Speaker A: And then, I mean, at that point, the patient gets to decide. [01:12:54] Speaker C: Right. [01:12:55] Speaker A: Like they can. They always get to decide. Like, you tell them, this is what it costs. This is what the timeline is. This is what it looks like. And then they make an evaluation for themselves. It's important to remember that setting the prices for things is not about what you can afford or what you would prefer to pay. [01:13:13] Speaker C: Right. [01:13:14] Speaker A: It's what it costs. [01:13:15] Speaker B: It's what it costs. And what they. [01:13:17] Speaker A: And they have to decide can afford to pay. [01:13:19] Speaker C: Yeah. [01:13:19] Speaker A: People spend money on all kinds of stuff. [01:13:21] Speaker B: Yes. [01:13:21] Speaker A: Right. I mean, all kind of stuff. [01:13:23] Speaker B: Oh, my God. I don't know if I can afford an herbal formula. Meanwhile, there's $300 worth of supplements being spent online with no evaluation. [01:13:34] Speaker A: Exactly. [01:13:35] Speaker B: That are, you know, speculative. [01:13:38] Speaker A: And. And I'm not suggesting that you need to, like, confront people about. [01:13:41] Speaker B: No, no, no. [01:13:42] Speaker A: That's not my point. It's just that people get to decide where they spend their money. [01:13:46] Speaker B: Yeah. [01:13:47] Speaker A: And like, when you give them the dollar amount and you say, this is what I think is going to happen, then they get to decide whether that's worth it to them. [01:13:55] Speaker C: Right. [01:13:55] Speaker A: And if they say, hey, I don't. I don't think I can afford that, Your move is not to say, oh, well, let me see if I can make it cheaper. [01:14:02] Speaker C: Right. [01:14:02] Speaker A: Your move is to say, okay, in that case, this is what I think we can accomplish without the herbs. [01:14:07] Speaker C: Right. [01:14:08] Speaker A: But otherwise, I think on some level, I'm limited. [01:14:11] Speaker B: I can't help you with these things if we don't do herbs. [01:14:14] Speaker A: Exactly. So maybe we should talk a little bit about that sort of last bit of the treatment plan, too. So it's like, okay, you've done your evaluation. You've told the patient that we're doing acupuncture and we're doing herbs, and maybe there's a topical. You've laid out the timeline. You've talked about the price. The core question, of course, in any treatment planning is like, well, how long is it gonna take to see results? [01:14:36] Speaker C: Right. [01:14:36] Speaker A: You know, like, when will I know that it's working? Because without that, I mean, like, what is the treatment plan anyway? How do you keep the patient engaged with. With outcome? And, you know, I think most people will be familiar with the six to eight week, you know, six to eight treatments kind of acupuncture pitch for. For most conditions with herbs. I think there's some similarity there, but I changed my language a little bit, and I'll be interested to see where yours is, which is with an herbal situation, which is most of what we deal with. I let the patient know, Look, I'm gonna write this formula for you, the first formula that I'm gonna give you for seven days, just a week's worth. Cause you're gonna be coming in next week for acupuncture. Right. Because we're seeing them weekly. So the nice thing about the acupuncture side is that coming in weekly gives you a weekly evaluation. You can check in weekly, which in the beginning is very helpful. So, okay, I'm going to write this formula. It's going to be a week's worth of herbs. This is essentially a test balloon formula. You've not taken this formula. Maybe you've never taken herbs at all. I'm picking a formula that I think is a good match at a dose that I think is appropriate. And what I'm looking for you to tell me next week is were there any digestive issues with this formula? Did you notice any negative shifts to sleep, energy, bowel movements, et cetera? And then were there any positives that came out of it also? But our primary focus is. Is a test just to see how is this tolerated and then anything else you might have noticed. [01:16:04] Speaker C: Right. [01:16:05] Speaker A: And so that throttles the expectation that they're going to take two doses of the herbs and all of a sudden they're sleeping like a baby. [01:16:11] Speaker C: Right, right. [01:16:12] Speaker A: Because they might. They might. [01:16:14] Speaker B: They might. [01:16:14] Speaker C: Yeah. [01:16:15] Speaker B: But very well might. [01:16:16] Speaker A: But I don't want them to guess at that. Sure. Right. There are some conditions though, Right. Like say you've got allergies and the design of your formulas to help with the congestion. Again, my test balloon formula is primarily to see for tolerance. But hey, you know, after you've been taking this consistently for three, four days, you should start to notice a little bit loosening. [01:16:35] Speaker C: Yeah. [01:16:36] Speaker A: We're not going to cure this in a week, but you should start to notice some loosening. We'll check in about that next week. [01:16:41] Speaker C: Yeah. [01:16:41] Speaker A: So you want to give the patient. [01:16:43] Speaker C: Yes. [01:16:43] Speaker A: A measurable piece without overselling it and also giving yourself room for the formula to not work. Yeah, because that's the real. The reality. The reason that I only write the one week is because I don't want you to burn herbs on or burn money on herbs that maybe don't work. [01:17:00] Speaker C: Right. [01:17:01] Speaker A: So they come in the next week, they say, yeah, everything was well tolerated. And yeah, maybe my congestion is a little bit lighter, but I didn't notice too much. I say, okay, no problem. Well, look, I'M gonna go ahead and write you two weeks worth of this formula. You're gonna take it for another two weeks and then at the three week mark, we're really gonna see like, okay, you've been taking it regularly. We should have a pretty good idea of the moving parts. But then the total time, our real sort of initial intervention here is six weeks. [01:17:25] Speaker C: Yeah. [01:17:26] Speaker A: So I'm explaining this to the patient before I've given them an herbal formula before anything's happened. Like, first week is a test balloon. Things go the way we expect. I'm gonna give you two more weeks worth. At three weeks, we're gonna do a deeper evaluation, but we're probably gonna be taking herbs at minimum six weeks for this outcome. [01:17:42] Speaker C: Right. [01:17:43] Speaker A: And then depending on the condition, which is many of the conditions we treat, especially if it's been going on for a long time, we're probably not gonna fix this in six weeks. It's likely that for your five year long insomnia that you're gonna be taking herbs for at least three months, but maybe longer. [01:17:59] Speaker B: Yeah, sure. [01:18:00] Speaker A: I always remind them, though, the goal is not for them to take herbs forever. Yeah, that's like, yeah, no, that's important to drive home. We're not trying to make them do it forever. [01:18:09] Speaker C: Right. [01:18:10] Speaker A: Does that line up with how you approach that stuff? [01:18:13] Speaker B: It's similar, very similar. So I will say depending on the condition. Of course, the language I use is most people, when we intervene for this type of problem, will need to be on herbs for this long. So which will be a longer number. So let's say. Well, let's say I think we're going to treat them for three months. [01:18:44] Speaker C: Right. [01:18:44] Speaker B: I'll say most people with this problem, they need to be on herbs for about three months. We're going to have you take the formula and check in at the six week mark because some people respond faster, some people need longer. And then I say the amount of time it should take you to feel a difference, a constructive difference, is much sooner than that. It should be within the first week or two. We should start to see positive differences. And some of this is my responsibility to figure out exactly the right formulation so that we're getting progress. How do we know that the progress will last when we take the herbs away? And I explain this to them. The way that I'm going to know that is because I'm going to look at your objective findings, which I say are, for me are the tongue, the pulse, the abdomen. [01:19:40] Speaker C: Right. [01:19:41] Speaker B: These things when you come in, these are the things I'm waiting for to see shift definitively. And when those things shift, that tells me because the symptoms will get better sooner. How do we know that the symptoms will stay good without the herbs? The objective findings will shift. That to me, is the sign that the core physiology has adapted and no longer needs that type of intervention. [01:20:04] Speaker A: Yeah, yeah. [01:20:05] Speaker B: And so that's kind of how I tell them. [01:20:08] Speaker A: I think the conclusion piece is really helpful there too. Right. Like, how will we know that it's done? [01:20:13] Speaker B: Yes. [01:20:14] Speaker A: And my objective, like abdominal skills and stuff are not as developed as yours, so I rely on it as best I can. [01:20:22] Speaker B: Well, even if they're not, you can still tell them that, right? [01:20:25] Speaker A: Oh, yeah. [01:20:25] Speaker B: That there's this objective checking thing that we're doing that's extraneous to the symptomology. [01:20:32] Speaker A: Well, and what I add to that is I often tell people that because, you know, most of my work is in digestive stuff. [01:20:38] Speaker C: Right. [01:20:39] Speaker A: And so I tell people, we're going to titrate you is what's going to happen. Right. So like, okay, you've been taking the formula, everything's good. You're feeling like a champion. So this next week we're gonna drop the herbs back by half. [01:20:52] Speaker C: Right. [01:20:52] Speaker A: They're gonna take em at half and we're gonna see like, how's it, how's it going? Yep, still good. Like no issues. Awesome. The next week we're dropping to zero. So like we're gonna titrate it down. If we go to half and all of a sudden the symptoms have returned. Now I have some work to do. Right. Like I've gotta reevaluate and see what the deal is. But I think in that initial pitch. Right. Cause that's what we're talking about here is that initial treatment planning. The patient knows the first week or two. We're working it out. But you should notice some change. [01:21:19] Speaker C: Yes. [01:21:20] Speaker A: Total timeline for real evaluation, six weeks. [01:21:23] Speaker C: Yep. [01:21:24] Speaker A: And then at six weeks, we'll have a better idea of how much longer you need to take these herbs. But a lot of people are taking herbs for three months. [01:21:31] Speaker C: Right. [01:21:31] Speaker A: For ongoing. [01:21:32] Speaker B: And it could be a lot longer than three months, depending on the condition too. Right. Like we talked, we were saying OBGYN type stuff can be longer. And then chronic, chronic disease stuff can be quite a bit longer. [01:21:45] Speaker A: But yeah, I mean, if you're dealing with menstrual issues, for example, like three cycles is kind of the minimum. [01:21:51] Speaker B: Yeah, that's, that's minimum. But even stuff like diabetic peripheral neuropathy. [01:21:56] Speaker A: Oh, yeah. [01:21:57] Speaker B: That's going to be longer. [01:21:58] Speaker A: Yeah. [01:22:00] Speaker B: I mean, anything that's autoimmune is likely going to be longer. [01:22:06] Speaker A: Exactly. But you still have improvements along the way. [01:22:08] Speaker B: Exactly. And you should still evaluate, like you make your treatment targets for the. The longest I'll make my first treatment target for is three months. I won't go longer than that because it feels too long mentally for the patient, I think. [01:22:22] Speaker A: Right. [01:22:23] Speaker B: So. [01:22:23] Speaker A: And honestly, you need to be able to prove yourself in three months. [01:22:26] Speaker B: You do. [01:22:26] Speaker A: In fact, you're probably gonna do it. [01:22:27] Speaker B: Should be some really good improvement then. Yeah, yeah, yeah, you do. Yeah. [01:22:31] Speaker A: And so this is really the takeaway, right. That the patient can't leave that first interaction without understanding the scope of the intervention. [01:22:42] Speaker C: Right. [01:22:43] Speaker A: Which includes what we're using, what form it's going to be in, what dosing is. Like, what are we measuring? Like, what are the actual objective measures? [01:22:54] Speaker C: Right. [01:22:54] Speaker A: When will we evaluate those? When should they notice the first bits of change? And how long are we likely to be dealing with this? Right now, the thing is that you don't know. You're new, maybe you haven't seen this condition, whatever. That's why we rely on these general terms. Right, Right. Six weeks, three months. [01:23:14] Speaker C: Right. [01:23:15] Speaker A: These are nice whole. In fact, in many ways, it's the herbal equivalent of the six to eight treatments for acupuncture. [01:23:20] Speaker C: Right. [01:23:21] Speaker A: There are a lot of things you can knock out with acupuncture, like pain conditions you can knock out in two, three visits. [01:23:26] Speaker C: Right. [01:23:27] Speaker A: And there are some things that will take much longer, similar with herbs. So by giving people a general timeline, a conservative one, like a small C conservative one, where we just say, like we're telling them it might take longer than it than we think it might even take, just so they're prepared. [01:23:41] Speaker B: Yes. [01:23:42] Speaker A: And that way people understand what to look for. [01:23:45] Speaker C: Right. [01:23:45] Speaker A: Now, you know, you and I have been doing this for a while, and so our spiels with clients are very, well refined. People don't leave here without that information. And yet still just last week, I had a patient come in, did the whole thing. Patient's got, you know, chronic disease. The issues, insomnia. He's been dealing with it for almost four months. So, you know, it's going to take a little bit because it's also connected to a chronic disease, like a quote unquote incurable Western chronic disease. [01:24:16] Speaker B: Sure, sure, sure. [01:24:17] Speaker A: So, you know, it's complicated. Lay out the whole spiel, go to check in with him a week later, and he's like, yeah, I didn't really see any results. I think I'm going to do something else. [01:24:25] Speaker C: Right. [01:24:26] Speaker A: Ugh. [01:24:27] Speaker C: Yeah. [01:24:27] Speaker A: Brutal. Like, I don't know how he managed to leave the interaction with me and imagine that he was gonna have results in the first week, like, because I was explicit that that wouldn't happen. So even with excellent communication. [01:24:40] Speaker C: Yeah. [01:24:41] Speaker A: You can't. You can't control everything. [01:24:43] Speaker B: No. And people. People will do need to decide whether they want to do it or not. [01:24:49] Speaker A: Yes. [01:24:49] Speaker B: And sometimes they can't really decide until they've tried it. And they can sort of feel and see the. The trajectory of the intervention. Like, after they're taking herbs for a week and they see what the. Like, they look at all the things like, okay, I'm gonna have to go back and this often, and I'm gonna have to take these for this long. I would rather have people bow out then, honestly, than to stay with it for another five weeks and then decide that they can't do it. Not because it's not getting better, but because they're like, oh, yeah, I don't. [01:25:24] Speaker A: I don't like taking herbs. [01:25:25] Speaker B: I don't like taking herbs. I'd rather have my horrible rheumatoid arthritis. [01:25:29] Speaker A: Yeah. Because the herbs taste bad. [01:25:31] Speaker B: The herbs taste bad. I'd rather have my pain. Like, okay, that's your choice for sure. [01:25:36] Speaker A: And we say that with all seriousness, like, it's not a judgment position. [01:25:43] Speaker B: No, no. Like, people are welcome to make that decision. That's okay. [01:25:47] Speaker A: Absolutely. [01:25:48] Speaker B: But then we have to just say, like, okay, like, I don't think I can help. I can't help you out with this. I don't know how. [01:25:53] Speaker A: Yeah. [01:25:54] Speaker B: Help you. This is the only way I know to be able to help you with this particular thing. [01:25:58] Speaker A: Exactly. And that. That statement's not a punitive one. It's not like, oh, well, I can't help you then. [01:26:03] Speaker C: Right. [01:26:03] Speaker A: It's just like, screw you. Right. No, it's just like, literally, I don't have any other ideas like these. [01:26:08] Speaker B: This is my expertise, the definitive way to work. And you're asking my expertise. This is what my expertise says will work or has the best chance of working. These other ways, I don't. I can't reliably recommend. [01:26:22] Speaker A: Right. [01:26:22] Speaker C: Yeah. [01:26:22] Speaker A: And I think it's worthwhile as a provider, new or experienced, to. To amicably part ways with a client in those circumstances. Like, there's no. Like, some people will be like, oh, well, I'm gonna. Well, let me see what I can do. Well, maybe we'll change the Acupuncture schedule, or we're adding these other things. Like, that's not what you thought was gonna help, Right. Not from the beginning, anyway. And now you're sort of like, scrambling because you wanna keep that patient in on your book. But the truth is, if they're not interested in interacting with your treatment plan in the way that you think is most effective, then just let them go. [01:26:58] Speaker B: Right. Which I think for newer people, you might have a harder time doing that. [01:27:04] Speaker A: Super hard. [01:27:05] Speaker B: But the thing is, do it whichever way you want. [01:27:08] Speaker A: In two years, you're gonna let them go. [01:27:10] Speaker B: You're gonna let them go because you're gonna try it all the ways, and you're gonna. It's gonna fail. And then you're gonna be like, oh, God, this isn't worth my time. I'm. [01:27:19] Speaker A: And it's demoralizing. [01:27:20] Speaker B: Demoralizing. [01:27:21] Speaker A: And the other thing is, like, in that case, at least you had a conversation with the patient, Right. Like, what will happen if the patient makes that call later? They just ghost. [01:27:30] Speaker B: They just ghost. [01:27:31] Speaker A: They're just gone. It doesn't look good what's going on. [01:27:34] Speaker B: Yeah, it's better. Like, they'll respect you more if you're like, yeah, I can't. I can't. I can't help you out with this. [01:27:39] Speaker A: Yeah. And let me give you a referral. [01:27:41] Speaker B: Let me give you a referral. [01:27:42] Speaker C: Yeah. [01:27:42] Speaker A: Yeah. Here's another colleague of mine who maybe has a different take that you could explore, but I'm not going to be able to do it. [01:27:48] Speaker C: Right. [01:27:49] Speaker A: And I think that's valuable. Yeah. So I think. I think the listeners have a pretty good idea of. You know, we've been talking for a while about just sort of managing the patient experience, but, you know, most of the time we're talking about disease patterns and treatments and herbs and formulas, because, of course, that's the sort of, like, intellectual clinical work that everyone's very interested in. But there is a really important component of what I think of as sort of the business mechanics, the sort of patient management mechanics of how do you get people to actually take their herbs? Because all the intellectualizing in the world is not useful if you can't implement it in the clinic. [01:28:26] Speaker C: Right. [01:28:26] Speaker A: And so you have to be able to sort of follow through with those pieces to make it happen. So hopefully this discussion will give people a little bit more of an idea about how to do that. [01:28:35] Speaker B: Yep. [01:28:36] Speaker A: Cool. All righty, guys. Well, as usual, thanks so much for tuning in with us. If you have some ideas for shows, feel free to email them to us at info@rootand branchpdx.com. that's info at root and branch. It's all spelled out root and branch. Papadeltaxray.com and we really appreciate you taking the time to listen to us. If you want to rate and review this podcast, wherever you listen to your podcast, it makes other people, makes it easier for them to find us. So we really appreciate that. And so this is your host, Travis. [01:29:07] Speaker B: Kern, and I'm Travis Cunningham, and we. [01:29:10] Speaker A: Will talk to you guys next time. [01:29:12] Speaker B: See you next time.

How to get your patients to actually take herbs

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Episode Transcript

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