[00:00:02] Speaker A: Hi, everyone, and welcome to the Nervous Herbalist, a podcast for chinese medicine practitioners who like herbs and want to learn more about their function, their history, and treatment strategies to use in the clinic. Let's get into it.
Hello, everyone. Welcome back to the nervous herbalist. My name is Travis Kern, here with my co host, Travis Cunningham. And today we wanted to take some time to talk with you guys a little bit about challenging cases. Difficult cases. Things that can come up in practice that are very different from what you learned about in the textbooks in school.
So to start us off in this conversation, we wanted to just have a little general discussion around approaching a difficult case. And when I say difficult case, what I mean is you have someone who walked in the door.
Ostensibly, their primary problem is, say, sleep or anxiety. But in the process of talking to them, we discover that they also have really irregular digestion, they have chronic pain in several of their larger joints, they have a high stress situation at work and unpleasant family life, and they have irregular eating habits, and their energy level is very low.
And so now, of course, we've touched on all of the various categories of problems that people can have. And, you know, our medicine is really good at finding patterns. That's what we do. So we can relate things like your low appetite and your stressful job and your loose stool. Those things are not dissimilar for us. They're part of a similar pattern. But when we've got patterns that are laid on top of patterns, systems laid on top of systems, then it gets kind of hard to know where to start. Yep. So if you were to come across a case like that, t, like what, what's your, what's your methodology?
[00:01:56] Speaker B: So I would try to understand, before I get into diagnostics, I try to understand what the patient's experience is like, what are they going through?
Because that will influence how I talk to them and also how I make goals or try to pivot the treatment strategy around the different tools that I use. If I think I need to include somebody else in the mix, like we need to do a nutritional consult, I need to refer them to you for that, or I need them to go see one of my osteopathic body worker genius people. You know, like, can the tools that I have do the tools that I have have a high likelihood of helping them, and what do they really care about? Because they'll tell you, oh, I have this problem. I have back pain. But the thing that they care about is that they're depressed or that they really can't sleep, but they don't know that you can help with that. You know, maybe they don't know that we can really do anything about that. So I try to understand what their experience is first. I think that's really important. Some cases you're not going to figure out. Right. Which I think we're going to talk about today. Like, it's, it's not a case that, that in the end needs to be figured out. Right. There are different things in medicine that we come across that for better or worse, we're not going to find a way to treat them successfully with the diagnostic model, with the treatment tools that we have.
[00:03:40] Speaker A: So, yeah, there's a lot to be said for that in terms of cracking the code, because everybody wants to crack the code. Right. Like, that's the thing.
[00:03:47] Speaker B: Right. That's what we're all trying to do.
[00:03:49] Speaker A: Yeah. And this is the part that's interesting. It is about the medicine that we approach, but a lot of times the code itself is more muddled than we can immediately do anything with. And sometimes it may not matter. This is the thing that you kind of pointed out. Right. Knowing what the patient wants and what's actually important to them is also really important.
[00:04:09] Speaker B: Yes.
[00:04:09] Speaker A: Because, you know, our whole clinic is called root and branch. And so we, from the very beginning, really internalized this idea that, you know, there are branch problems and root problems. You got to get to the root problem, etcetera.
But if a person has a branch problem that they've told you about, and you're like, oh, no, but I think I have an idea what the root problem is, and I'm just going to go and treat that root because eventually it'll help with the branch problem. You might be right. I mean, it might eventually help with a branch problem, but is it helping them right now enough for them to keep coming back to treatment? Is it solving this, the branch issue, quick enough through your root treatment? And so getting some patient, some idea of the patient, of what's important to them will also then help you to set expectations around the outcome. Because it's certainly possible that even if their primary thing is sleep or something, based on how you look at it, you feel like we actually do need to peel back this layer. First, you have to tell them that.
You have to tell the patient what's happening, in which order and how much time and what to expect, and give them measurable ways to discern that their pattern and situation is improving. Because if they came in for back pain, then in the discussion, you figure out the real problem is insomnia but in order to treat that, you really need to balance their digestion. You're going to need, like they're like now three or four steps removed from what they thought was their problem.
[00:05:39] Speaker B: Right.
[00:05:39] Speaker A: And so you really have to take time to talk with them about that and make sure that the treatment plan is clear, the timeline is clear, everyone understands what we're actually trying to do.
[00:05:49] Speaker B: Yep.
[00:05:50] Speaker A: I think that's a really important piece that is too easy to forget about.
[00:05:54] Speaker B: Yeah, absolutely.
[00:05:56] Speaker A: So when you have all the, when you get into the diagnostic thing, so you've got a complex case in front of you. How do you know or how do you guess where to start?
[00:06:06] Speaker B: I think some of that is the experience. Like after you have case experience, you find. I find, I have found that you start a lot of the same ways. Regardless of what the person says they're coming in for, they want help with. You tend to start very similarly. So you have excess and deficiency. You have heat and cold, you have dampness and dryness. What do you do? You harmonize right there. The beautiful thing about our medicine is that there are treatment principles, formulas, acupuncture strategies, even bodywork strategies, things that you can do that specifically help cases and presentations where there are a huge variety of things showing up in the picture. And those tend to be the things that you need to do first, because when people come in here, they tend to have all of those things. Excess, deficiency, heat, cold all at once. There's not one that you're going to go after and tug on that corner and the whole thing's going to open up. Like, that's not how most cases are. And I think that's one of the hardest things to get to wrap your head around from school because we learn diagnosis, and then the person goes into the clinic and they're like, oh, this patient has liver Qi stagnation and spleen qi deficiency and dampness and kidney deficiency. And, you know, you see, you see where I'm going with this?
[00:07:48] Speaker A: You remember seeing those charts, too, like the student charts that had like 17, like, pattern and organ diagnoses later. And you're like, I mean, you're probably not wrong.
[00:07:58] Speaker B: It could be. It could be right. But then, like, how helpful is that to you? What's the right way in? That's the way I like to.
[00:08:05] Speaker A: You mean you can't just write a formula with like 50 herbs in it?
[00:08:08] Speaker B: You can.
You can.
[00:08:11] Speaker A: But good luck.
[00:08:12] Speaker B: Like, good luck, you know, that's the thing. You can do that, but, and you could be right by doing that. But if you're not right, then what do you do? Because you tried everything, nothing worked. So then what do you do? So diagnosis is not only about figuring out what to do now, it's about also figuring out what to do in the future. And if you start off with an approach, with a complicated case, this gets to the diagnostic part. Treatment approaches that are wise, I think you start simple. The more complex the case is, the simpler you start, because what you want to get from the first round of treatment is clear feedback. You're not actually trying to fix the problem. I mean, you are, but a lot of times you can't. So it's more important to figure out where they are. And to do that, you need to be clear in your approach. You need to be clear with what is happening with them. So if you give them a formula or you do an acupuncture treatment, whatever method you're using, it's crystal clear what you're doing. And then when they come back and they have any kind of result, you should be able to figure out what to do next. They had a bad result. You should be able to figure out, okay, now what do I do? They had a good result. Then you keep going in that direction. If it's mixed, then you know exactly how to modify it so that it can be fully productive the next time. So that's the second part of it that I'd say.
[00:09:51] Speaker A: I think it's an important thing to highlight the idea that in school, you learn about formulas in this kind of vacuum, right? Where it's like, okay, if you're going to harmonize, we're going to use Xiao chai talk, and then that's it. The patient's just better now, right? Like it's done.
[00:10:06] Speaker B: Yeah.
[00:10:07] Speaker A: And so the parts that's missing, and this isn't a criticism of school, it's. It's the nature of school. You literally can't teach every possible iteration of everything. So it's just, it is what it is. It's why it's the starting point, right? I mean, like, graduating from chinese medicine school, learning herbal patterns and formulas is the starting point. Like, it's the base set of information that's necessary to go forward. Because what you realize when you're in practice is exactly what you were just talking about, that you have everything at once. You've got dampness and dryness, you got heat and you've got cold. So you've got to take this approach. But once you do it, and let's say it's even successful, and things are moving along that pattern. Presentation is going to change.
[00:10:44] Speaker B: Yeah.
[00:10:45] Speaker A: So now we have to adjust the formula to accommodate the change. And then this is really where the skill and the art comes in over time. Right. Is not only knowing what are the common pivots that occur when this disease pattern moves forward, but then also, how quickly do you pivot to the next thing? How long do you stay with what's working or even sort of marginally working, and then pivot to the next point? And the thing is, like, there's no easy answer here, right? There isn't like a formula, like a mathematical formula. Right. Well, they've been on it for this long, and so therefore, it's time to move it on to this other one.
If only it were that simple. But unfortunately, it's not. So this is why it's helpful, I think, to have, you know, people with more experience or mentors or being part of classes or to, like, read case study books.
[00:11:33] Speaker B: Yep.
[00:11:34] Speaker A: To get an opportunity to see, like, okay, well, how did this move forward? Now, that said, not all case study books are very helpful, right? You read one, it's like, patient took three bags of the formula and they were fine, and you're like, okay, great.
But other case study books have progression and they have development. And so then that's a good way to see how a change was made and a shift was made over time.
[00:11:55] Speaker B: Absolutely.
[00:11:56] Speaker A: So let's give that some context, then. So you've got a case to start us off here that does exactly this. It sort of evolves over the course of time. So tell us a little bit about that.
[00:12:06] Speaker B: Yeah, so this case is a woman who saw me in 2021. I had the first appointment down July 16, 2021. And she came in because she had shoulder pain.
But pretty quickly after talking to her, the first appointment, she told me that she had chronic digestive issues. She had chronic diarrhea in particular.
So she was having four to five bowel movements a day, liquid bowel movements, loud borborygmis. Like, you could hear her guts. She's a thin woman, but you can hear her guts on the table.
[00:12:49] Speaker A: Bloating.
[00:12:50] Speaker B: After meals and undigested food in the stool. And this had been going on for three years.
She'd actually gotten treatment from an acupuncturist, I think, in California, wherever she lived before she moved up here to Portland.
And she had difficulty sleeping as well, difficulty falling asleep, waking up many times.
She felt cold all of the time.
And then I checked the pulses, and the pulses were wiry. Big, hollow, and superficial all over. Like, the whole pulse. Very strong, very loud, very big, very superficial, which was a little surprising to me at the time. I was like, okay, I was expecting one thing, and this turned out to be the other thing. I did also check the tongue.
[00:13:47] Speaker A: What were you expecting in the pulse?
[00:13:49] Speaker B: I was expecting it to be deep, weak, given the history of, like, cold and loose stool and water, and, you know, like, I was really expecting it to be the opposite of that.
The tongue was pink, thin, white coat, some red dots on the sides and a red tip. And sublingual engorgement. I put it two out of five.
So the formula that I wrote for her, I did acupuncture and mostly targeted her shoulder with my acupuncture, but I also wrote her an herbal formula in bulk, and I ended up writing Ganzao Sheishintang with a subtraction of renshin and da zhao plus qianzhi and bai bien do.
My thinking process was to estringe more with those herbs.
So she came back the second time a week later, and she had no change in her digestion at all.
So I reevaluated the case. Most of the symptoms were the same. I don't think we got any movement in any of the other symptoms. I think she said her sleep might have been a little better, but it was hard to tell.
Her shoulder was doing better from the acupuncture, so that was good. I wrote her the second time, I wrote her futzili zhong wand plus bai xiao chow, and I did that in bulk. And I think I had futsa in there at 15 grams at first.
[00:15:33] Speaker A: So do you remember why you shifted from the. I mean, outside of the fact that it didn't do anything, but why did you shift from the Shaishintang to this next formula?
[00:15:42] Speaker B: So I was thinking Shaishintang, you know, is our textbook lean on formula for borber ignis. Somebody has super loud guts. That's like a very classic Shaishintang sign. And in the description of the Shaishintangs, you can also have undigested food in the stool, I think, for it's either Gansu Shentong or Shengzhong Sha shintong. It says that right in the lines. There's food or grains in the stool and then the border rigmas and then the big pulses. So if it was deep pulses and weak and things like that, then I would be thinking, oh, maybe we need an aconite formula to really warm and treat like that. So I'm thinking, because there was that superficial quality to the pulse and pretty strong. And then there were some signs of heat on the tongue too, right? The red dots and the red tip. So I'm thinking that there's some kind of heat on the surface that maybe needs to be treated alongside of the cold in the middle that's causing the looser stool. So that was the thinking process for the shaishin tongue. When that didn't work, then I was like, okay, maybe it's a yin confirmation strategy. Like we tried yang confirmation. I tried the best yang confirmation strategy that I could for this presentation. It didn't do anything. So then I'm going to go to Yin confirmation fuzzi Li Jung Wan combining xiao Yin and taiyin treatment. So Xiao Yin would be like Sinny Tang, right?
Li Jung wanna being the tie in representative formula. So combining the two would kind of put us in that neck of the woods. Early on, I had learned to differentiate Li Jung Wan from futsa Li Zhongwan by the type of diarrhea. If there was undigested food in the stool, then you need the addition of futza. That's what I remember learning at this time. That made me think, uh, to need that addition.
Um, and then I added the Bai Chow, which I probably wouldn't have done now, but I did back then. Um, because, uh, she's very thin and if you check her abdomen out, she has very pronounced, uh, rectus abdominis. Right. Which in the fukushin system is a sign for the need for Baixiao. Right. Or some moistening.
So I did chow the Bai xiao, but I did add that in there, which again, I probably wouldn't do now if I were to see her again.
[00:18:23] Speaker A: And you wouldn't do it now because it's overly wet.
[00:18:27] Speaker B: It's just not necessary for the diarrhea type presentation.
[00:18:30] Speaker A: Yeah, it doesn't.
[00:18:31] Speaker B: It's not needed and it's more complicated. Right? Yes.
Not the original prescription. And if I'm not sure about the case, I'm going to be more precise and modify my formula less. So I want it to be very clear by adding the bishop in. Then if, like, things didn't go well, could it have been that I put the bishop in or could it have been that my base formula was wrong? I wouldn't know that. Right.
[00:19:00] Speaker A: Right. So this is, this is another key takeaway, right? That when your first stab, which was a classic formula with slight mode, didn't work, creating some and also didn't work in either direction, didn't make things worse, didn't make things better. No effect.
[00:19:16] Speaker B: No effect.
[00:19:17] Speaker A: So when that happens, it's like, okay, I'm less sure of what I'm dealing with here.
[00:19:22] Speaker B: Exactly.
[00:19:23] Speaker A: So using a formula in an unmodified version is probably a better move because it clarifies the shift.
[00:19:32] Speaker B: Yes.
[00:19:33] Speaker A: Right. Because if you shift to a totally new formula, like in this case, fuzzily Chuangwan formula, that's also then heavily modified.
[00:19:40] Speaker B: Right.
[00:19:41] Speaker A: Was it the shift to this direction that was the problem or the mods?
[00:19:44] Speaker B: Right.
[00:19:44] Speaker A: Yeah, this is. I think this is hard for people. I see this with our residents. Right. Because you're like, okay, well, I'm gonna switch to this warming thing, but there's actually these other things that I need to address still.
[00:19:54] Speaker B: Right.
[00:19:55] Speaker A: So I'm switching to this warming formula with these four additional ingredients or these seven additional ingredients. Sometimes it could be a lot. I mean, I even struggle with this still. Sometimes. Like, I look at things and I'm like, yeah, but I also, oh, can we just a little, you know. But I do think that if you're unsure, it's still a good move. I mean, it's just another week, right? So, like, and then if it turns out that foods Li Jung won is showing some positive shift now, you're like, okay, we're in the right ballpark now I can start to mod exactly right and play around with it from there.
[00:20:25] Speaker B: Yeah. I'd also say that if you never give formulas at their base without modification, you'll never really learn what they do.
[00:20:34] Speaker A: Yeah.
[00:20:34] Speaker B: Like the classic example that I was taught was Xiao Chiyutong person has Xiao Chaiotong presentation and they have a sore throat. A sore throat's really bad. Do we need to modify Xiao Chiu Tong for the sore throat?
And the thing is, if you do by default, you'll never find out that Xiao Chaiotong can treat a sore throat. It doesn't matter how bad the sore throat is. If it's because of a xiaoyang pattern, there's no need to modify it. It will treat the sorest sore throat you can get without any need for modification. But you won't know that if you modify it automatically because of a sore throat, you'll never find that out. So it does benefit, I think, us as practitioners long term, if we trend toward less modification in the beginning because then it builds our understanding of what does a formula do by itself and what can it do without adding stuff. And it also makes for cleaner cases. Like, if you're presenting cases like I'm doing now, it's less clean that I had Bai Xiao Chao in there than if I would have just had fuzzily Zhong Wan. And it would be easier to learn from the case for people listening. Right. If I didn't have bai Xiao in there. So it's, you know, it's a point of. Point of clarification. I now try to modify less, if I'm not sure, so that I can be clear what's going on.
[00:22:07] Speaker A: Yeah, that makes sense. Okay. So she takes this slightly modified futilely, Zhonghua. Then what happens?
[00:22:12] Speaker B: So she. The bowel movements improved quite a bit. She started to have, instead of four or five liquid bowel movements, she had one to two. And if she had, she would have a pretty good bowel movement the first time, and the second one would be a little bit looser.
But the first one was pretty solid and well formed.
And then she had a night of drinking alcohol. She drank like she had friends over. Whatever. Something happened. She drank some alcohol, and then it reverted. So it was not as good. Um, but her sleep also improved on the formula. So both of those things happened, uh, until she had that night. And then, like, both of those things kind of got worse again for a few days before going back.
[00:23:00] Speaker A: So it settled back.
[00:23:02] Speaker B: It settled back, yeah.
[00:23:03] Speaker A: But it took. It took a while.
[00:23:04] Speaker B: It took like four or five days. Okay. Yeah.
[00:23:08] Speaker A: Okay.
[00:23:09] Speaker B: So then, uh, I went to futile Zhengwan base. So I took the Bai xiao chow out and just did that. And I sort of progressively worked up the dosage of futza to 30 grams a day. So I went from. I started at 18 and then I went to, I think it was 20 and then 25 and then 30. And I kind of kept her at 30 for a while.
[00:23:33] Speaker A: And this is all in bulk, right?
[00:23:35] Speaker B: This is all in bulk.
[00:23:36] Speaker A: Yeah.
[00:23:36] Speaker B: Okay. Yeah. So we decocted this here.
[00:23:38] Speaker A: Yeah.
[00:23:38] Speaker B: Right. Cooked it up and then gave it to the patient a week at a time.
So this is a. She was on this formula for a few months and doing pretty well, progressively better her shoulders at a point now where she doesn't need any more treatment.
And so she's really coming back in for the digestion.
[00:23:59] Speaker A: Yeah.
[00:24:00] Speaker B: And she's not coming back in as often, so she's maybe coming in once a month or something like that.
So.
[00:24:10] Speaker A: I ended up.
[00:24:11] Speaker B: So what happened is she came back in and she said she was still doing better than before, but about a week and a half ago. And keep in mind, this is like a month between visits.
It started to not be so great. She's like, I think I had like a lentil soup or something like that. And it started to get worse again. It was something. Something fishy like that. So then she's having two or three bowel movements a day. One of them's pretty loose, and there's water in one of them. No one digested food in the stool, but it's still kind of. It seems like it's kind of going back down. So I looked at the case, and I thought, well, the parameters are mostly the same. The pulses feel mostly the same.
Let's try removing some of the sweet flavor in the formula. Maybe the sweet flavor is too much. So instead of giving futsi Li Jung Wan, I gave sinitan, which is just Futzi ganjiang Zhuge.
So we made that switch. I kept the dosages of all those things pretty much the same.
Futza, still 30 ganjang, I think I did nine jurgon sao, I did six or something like that.
So then she was on that, and that worked better. She improved again for about two weeks and then had the same thing happen. Stopped working so well. And again, there was kind of another food incident. She sort of ate something or did something, and then it kind of started to revert again and back to, like, two or three bowel movements a day, one of them being loose and some of the gurgling coming back.
So I ended up trying a couple of different things at this point.
I ended up giving that formula, and I didn't write it down. It's the daybreak diarrhea formula. You remember that?
[00:26:10] Speaker A: Sushin Wan.
[00:26:11] Speaker B: Sushin wan. That's it. And Sushin Wan had a very similar effect to Sinitang. It worked initially, and then it stopped working again. And so I'm kind of working my. I was like, okay, so I tried Tai Yin shaoyin. Then I switched to Xiao yin. So I'm kind of working my way diagnostically through the six confirmations.
And I remember reading a bunch of cases, trying to figure out what to do next. And I started reading a bunch of Wumewan cases. The Wumewan is a formula that's always puzzled me because it seems like, very strange. You've got a huge dose of this very sour plum, and then you've got futsa and xixing, and then you have Huanglian and Huangbai, and you have Sichuan peppercorn, and you just have, like, all of the things in there, right? So it seems very, like, strange.
But one of the lines in the Shanghan is that, you know, there's lines that describe the Wumewan picture.
And then the Wumewan, you know, but then there's another line that's separate from that that says, for chronic diarrhea, Wumewan governs or something like that. Right. So I read a bunch of these cases, and I was like, oh, geez, I think it's a Wu mei wan pattern. That's gotta be it. So I ended up giving her Wumewan in granule, which is different than the bulk herbs, and it was like magic. So she ended up taking the granule, and the very next day, her digestion totally regulated. She had one bowel movement, clean, easy to pass, no diarrhea, really well formed. The next day, she was also taking, I didn't mention this, but she's taking Zoloft for anxiety. Her anxiety got a lot better on the formula. Her sleep improved, and not only did it improve, but while she was taking the formula, she could also eat stuff a little bit out of the range of what she was eating before, and it wouldn't get worse, which is a key thing, right, because that was happening before.
So she was super happy. Um, a lot of the discomfort and, like, the gurgling in her belly also went away. So she's like, if I'm sitting in meetings, I don't have to be embarrassed anymore, make jokes about myself.
So that was great.
So anyway, I gave her that formula.
Probably over the course of the next six months, she was on Wumewan. There were two periods in that timeline where she went on a trip for work, and while she was at, in the trip, eating differently, sleeping differently, high stress, some of the digestive symptoms reverted, and then she made an appointment, came back in, and I ended up looking at her symptoms and presentation, and I actually gave her Xiangjiang Shae Shintong for about a week or two, I think once I gave it for a week. The other time I gave it for two weeks, and then I switched her back to Wu Mei Wan, and that worked great. So the sort of, the flare was taken care of by the Xiangjiang shish. And then we went back to Wu Mei Wan as, like, the chronic formula. And after about six months of being on the formula, I titrated her down in dosage. So she was taking, I think she was taking 9 grams of granules twice a day.
So I had her titrate down to eight and then six twice a day and then eight once a day and then down to nothing. And then I checked in with her a month later, and the symptoms were still good without any herbs.
I saw her. I actually, I talked to her on the phone the next year sometime. I don't know how many months later it was, but it was at least six months later, the next year, and she called me because she was asking me about us. She wanted to ask my advice about a supplement. Like, I need this kind of supplement. What do I do? Are there any brands you recommend or whatever? But I asked her how she was doing, and she was still doing well. Like, the symptoms had not reverted. So, yeah, that's the last that I've talked to that patient. For all that I know, she's still doing very well. So it was a pretty cool case result, I think.
[00:30:54] Speaker A: Yeah. I mean, almost certainly she's still doing well because we know that she knows that we're here to support if she needs anything, and she's used it in the past. So the fact that she isn't on the schedule right now suggests that things are still going well. So the pivot from the Futsili Zhongwan that was, you know, sort of holding it was working okay.
[00:31:15] Speaker B: Yeah.
[00:31:16] Speaker A: But it wasn't great.
To the wume one, that shift was predicated primarily from not being satisfied with the effect of the futile wan and looking for another angle.
[00:31:28] Speaker B: Yeah.
[00:31:30] Speaker A: And then deciding that it was the Wume Wan was based on some other case studies where it had been effective.
[00:31:35] Speaker B: Right.
[00:31:36] Speaker A: Thinking back on it now, what do you think there was about the particular pattern presentation that made Wume Wan an effective choice?
[00:31:45] Speaker B: Wumewan is a really complex pattern, and it has a variety of different things happening in it. Right. It's like one of our textbook jwiyin remedies. So Wumewan and Dangwe Sinnitong is the other one.
And in Juayin, you have this.
This description of something rising up and striking the heart or the pericardium. So one way to interpret that would be anxiety. Right. Now, you can have anxiety and xiao yin disease as well, with a standard futsa formula. But this person was taking medication for her anxiety and still having pretty severe anxiety at certain points. So that was the thing that was of interest. The other thing is, it seemed like there was a little bit of. Clearly, there was cold in the picture, but to me, it also seemed like there was a little bit of damp heat.
And that's the confusing thing. I've now, since this was my first case where I used W Mi Wan successfully, since this case, I've seen, I think, four or five other people where I've used Wu Mei Wan successfully, and every single one of them, to me in the beginning, has looked like a Shaishintang presentation, but they've actually been a wume Wan. So there's this thing about you, like in a Shaishintang, you think about mixed heat and cold. There's dampness and there's dryness. Right. You have dryness because you're using Ren Shen Dao, Zhao Jurgan Sao, but you also have dampness because you're using the bitter Huanglian and Huang Qin and the spicy ganjiang and bancha. Right. So you're treating dampness and dryness in a sheishentang, hot and cold. Wu Mei won is a lot like that, but in yin confirmation territory, in addition to that, there's also wind symptoms in Wumewan. So there's this weird thing that goes up and strikes the heart or the pericardium, as we think about it, in six confirmation diagnosis, there's also oftentimes muscle twitching and spasming, which I do think was a part of her picture that I didn't talk about. But that's another thing that you'll see in these cases. Sometimes people with Lyme's disease or these kinds of chronic things, they'll have all kinds of twitchy muscle stuff or headaches that have a wind connotation. So there's usually some kind of wind thing that's going on with Wu Mei Wan, and she definitely, she definitely had that. The other thing that I've seen in Wumewan cases, everyone, so far, none of them have had very deep, deficient pulses. They're all bigger pulses, more superficial.
None of them have been very.
In the drein chapter, we think of expiring. Zhang Zhongjiang says expiring is a quality that you feel in the pulse, which sounds very weak. Right.
[00:34:55] Speaker A: Yeah, yeah.
[00:34:55] Speaker B: But in these, in these cases, for Wumewan, the pulse has not been like that in any of the times I've used it successfully. It's been very big, very loud, and I think that speaks to the quality of wind that's happening in the picture, that that's such a big portion of what's happening that.
Yeah, it's just showing up that way.
[00:35:17] Speaker A: Yeah. And wume wan, you know, of course, it's originally written as one, so the taste of it is less apparent.
[00:35:25] Speaker B: Yes.
[00:35:26] Speaker A: Right. But if you take it as a, as a granule, and certainly if you take it as a bulk decoction, the flavor is intense.
[00:35:34] Speaker B: Yes.
[00:35:35] Speaker A: And it's such a strange flavor combo because it's super sour and also super bitter.
[00:35:40] Speaker B: Yes.
[00:35:40] Speaker A: And those two flavors together is a strange thing. To actually taste as a person, because, like, there are not foods, like culinary foods that you have had experience with that are intensely sour and intensely bitter at the same time.
[00:35:54] Speaker B: Right.
[00:35:55] Speaker A: And then because of the shishin and the futzip, particularly the shishin, it feels very warm, too.
[00:36:01] Speaker B: Yeah.
[00:36:01] Speaker A: So it's like sour and bitter, but then it's warming your throat, warming your stomach.
[00:36:05] Speaker B: You can even get hua jow.
[00:36:07] Speaker A: Yeah. Is in there. So there's that, like, strange, like, numbing sensation that comes from Sichuan peppercorn. Like, it's a very strange experience to drink it. Right. And of course, having it as a one is a little bit different. The dosage is a little bit different. Less. A little less potent, potentially. But I think it's interesting to think about this particular patient, too, and how those flavor pieces, particularly the intensity of the sour flavor, plays in compared to the other two formulas that you used which don't have that nearly that level of source flavor. Yep.
[00:36:42] Speaker B: Or bitter. You know, there's a little bit in Shishan. Yeah. The shishan tongs. There's a little bitter in baiju. Some people say baiju is a little bitter, but it's bitter, warm. It's not like Huang lian bitter, you know?
[00:36:54] Speaker A: Yeah. Huang lian bitter is a special kind of bitter. The only thing that's worse than a huanglian bitter is a longdon tsao.
[00:37:00] Speaker B: Yeah.
[00:37:00] Speaker A: Bitter. Because Huang lian is.
Well, you know, it's a good. It's a good case to talk about because of its evolution and its change and sort of like thinking through the logic of the pieces and it has a good outcome.
[00:37:13] Speaker B: Right.
[00:37:13] Speaker A: You know, I have a case to add into the mix as well that I offer in not exactly contrast, but to say where the pivots are less successful and the end result also different.
[00:37:30] Speaker B: Yeah.
[00:37:30] Speaker A: So I have a patient, a 79 year old female in otherwise excellent health, very mobile, lives on her own, cognitively present, no real body aches and pains. Fit everything that you would want to be if you were almost 80. Right.
But she came to me because she was having this.
Well, she described it as an abdominal or stomach ick, like I c k ick. And, you know, it's not uncommon for patients to come to us with explanations for their conditions that are odd. So, you know, you just go through the normal process. Right. You're like, okay, we're questioning it out. So is there pain? No.
Let's check for pressure issues. Any issue? No. Is it nausea? No.
Any history of vomiting? No. Acid reflux? No. Bowel movement? Regular? Once a day, every day formed, easy to pass, no constipation, no loose stool. Appetite low, primarily because of the issue ick.
But there's no real understanding of what the ick is.
Right? That doesn't have a pain piece, it doesn't have a nausea piece, it doesn't have a burning or a heat piece. It's not cold to the touch or to the patient's experience.
It's just a feeling. Well, you know, that's pretty challenging to figure out, like, what is actually the thing that we're working on here. Talk to the patient some more, of course, and realize that they have a tendency toward worry and anxiety and that the presentation of this ick seems to be worse under higher stress presentations. And also, interestingly, if she hasn't been eating regularly, so the ick would be particularly bad in the morning. But then once she would have a little food and a cup of coffee, all of a sudden the ick would be reduced. So then I'm thinking like, okay, is this like a, it's like a blood sugar thing, like a metabolic appetite thing, like the cheese, just really sluggish. And then some kind of stagnation leads to this feeling of heaviness or something. And then she has a little bit, food metabolism gets going because she feels better, she starts moving.
Unfortunately, it's not consistent. Right? It's not every morning. It's not after every meal. It's not even before every meal like that. There's just no consistency to it.
So as we have discussed, when a patient has a lot of weird stuff going on in a variety of different areas, I was like, well, let's harmonize.
[00:40:03] Speaker B: Right?
[00:40:03] Speaker A: Right.
Let's harmonize. So I write the patient a sha chaoyu tong, and I didn't modify it for exactly the reason that we just discussed. So here's a xiao chaotang. Let's just see what we get from it.
[00:40:16] Speaker B: Right.
[00:40:17] Speaker A: So patient takes it for a week, comes back in, and there's been no change to the ick sensation, whatever it is that that is. But she's sleeping a little better, mood feels a little more stable, but she just, quote, feels awful some days, but not all the days. So before it was pretty much every day. Now it's some days, but also sometimes in the morning, sometimes in the evening, still all over the place. So I say like, okay, let's just continue with this formula and let's see, because it's a little bit different, some stuff's improved. See what happens. Right. Another week goes by, patient comes back in. Worst week ever. She had a horrible week. The ick is off the charts.
No amount of snacking seems to impact it. She's really restricting her diet because she's worried that it's the food that's doing it. So she's literally on a brat diet. Right? So that's like bananas, rice, apples, toast.
[00:41:16] Speaker B: Oh, man.
[00:41:17] Speaker A: Right. So that's what the acronym is for. So she's barely getting any calories. She didn't have a lot of excess calories to shed to start with. Right. So I'm a little bit worried about her overall weight gain.
And it doesn't seem to matter either, whether she's eating rice or bananas or apples or toast. And so why she picked that, by the way, is because historically, when she's had some version of this, this ick, in the past, she'd switch over to Brad diet and it would go away.
So she felt very confident that this would go away again. But no, not this time. And so now I'm sitting here going like, okay, so wait, the formula seemed to help. Then we did it for another week and now it's worse and you're like, is that because of my formula or is that because something else is different? Like, okay, well, let's, let's try one more time. But this time I'm going to add a couple of just sort of base digestive supporters into a shao chai tongue. So chao, baiju, shao Ren, mo xiang, just some things like, okay, I'm thinking this ick thing is some sort of, like, I don't know, chi type indeterminate stuckness. So a little bit aromatic to pierce through. While we're trying to harmonize the underlying pattern. We'll see what happens. Right. Patient comes back in feeling so much better.
[00:42:30] Speaker B: Mmm.
[00:42:31] Speaker A: Feeling so good. Ick is reduced, still terrible in the morning, but almost non existent at night. And she was able to go out with a friend, had a cocktail, felt great because, you know, that's the other thing. The patient's trying to live her life, right? And so all of the stress, the restricted diet, she's not going to do the social things she wants to do. She's not going out with friends for a coffee or a drink. She's not going to restaurants. She's a big foodie, she likes food. Can't go super stressful or depressing for her.
[00:42:59] Speaker B: Yeah.
[00:43:00] Speaker A: So she's able to get a little bit back into her life and think, oh, great, yeah, this is it. Like chi stagnation, ick, whatever that is. Throwing a little great.
Put her on for the next week. She's supposed to come in and I get a notification from our software that she's canceled the appointment.
And, you know, this patient and I have excellent rapport, get along really well. Super funny, interesting lady. And here we are making headway, and all of a sudden, the appointment gets cancelled. So, of course, I'm thinking, like, oh, well, maybe something's come up.
She's an older person. A lot of older people don't think to reschedule. They just cancel.
So I'm literally about to call her, and I get an email from her that lays out that since I've seen her last, which was like, four or five days previously, that it's just completely dropped off a cliff again. Like, it's complete the worst ick she's ever had. Worse than ever.
And she had to go to the emergency room over the weekend because she was in such discomfort. And of course, I forgot to mention at the top here that she's, of course, seen all the biomeds, like gastroenterologists, all of the primary cares. She's had endoscopies, she's had colon checks, she's had biopsy. I mean, literally, they've done the whole thing, and they have no explanation for what's happening biomedically. There's nothing wrong with her, right. Which, you know, we see that all the time, so, like, not. That doesn't really stand out. But she's having this horrible weekend. She goes to urgent care. Urgent care is like, you're fine. Of course she doesn't feel fine.
So she went to urgent care. She's feeling terrible. The reason she canceled her appointment is because the urgent care doctor suggested that they get her set up with yet another specialist and she'd rather just work with them.
[00:44:43] Speaker B: Right.
[00:44:44] Speaker A: And I was like, man, like, I thought we were making headway. Plus, you know, it's hard to lose a patient in that context. Like, you feel like, I haven't succeeded here. I failed to nail the case. The patient's clearly uncomfortable.
But also, you know, we're only like, three and a half, four weeks into an eight week treatment plan.
[00:45:03] Speaker B: Yeah.
[00:45:03] Speaker A: Like, we had talked about it. You know, you and I are very good about laying out patient expectations. So we had a timeline, we had measurables. We had talked about the fact that it's likely to ping pong around a little bit. Like, I had done absolute top notch patient education on all of the things that could happen in this treatment plan to avoid this exact scenario. Because we've seen this before. And so here it plays out in exactly the way I didn't want it to.
[00:45:27] Speaker B: Right?
[00:45:27] Speaker A: And so I'm like, oh, man, like what? Like, how did I miss this? You know? But then ultimately, I just thought, well, what are you going to do? You know, a patient needs to find the kind of treatment that's going to work for them. And if so, if they don't have investment in what we were doing here, it's just not working for them how they expected. Okay, no harm, no foul, right? So a month goes by, kind of forgot about the patient, honestly. And then they pop up on my schedule again, and I'm like, huh, that is unexpected.
[00:45:57] Speaker B: Yeah, right?
[00:45:58] Speaker A: Given how everything else played out.
Get back into it, talk to the patient again. And she says, yeah, I went to the specialist. We did all this other stuff, and they don't have any other answers. They just think it's anxiety.
And I said, well, it's probably worth really taking some time to explore that because I, too, think that there is absolutely an anxiety component that's connected to this, and I think that we can take some time to work it out. So she tells me that at the end of this week that she's come back. She has some friends coming in town, and they have all these. They're like big foodies, they have all these restaurant plans. They've got reservations, they've got wine tastings, got all this stuff. She's super nervous about it because they're coming in town, you know, and like, she's like, what if I can't? What if I don't feel good? And, you know, stuff? And I was like, look, let's do some acupuncture, supportive digestive points. Let's get you back to this basic formula that we used a while back that seemed to be pretty effective. And let's just get you in the best prime shape you can for the end of the week. Your friends will be here, you'll have a good time. That's what we did.
Comes back in, I think, like, more than a week after because her friends were in town.
She had the best week.
[00:47:05] Speaker B: Yeah, best week.
[00:47:07] Speaker A: And ate and drank whatever. Yeah, they've got these high end restaurant reservations, specialty cocktails, wine from the reserve selection. Ate and drank whatever they wanted, stayed up late, went swimming. Like, just. Yeah, all this stuff. Right? Great weekend or like, you know, five days or whatever. No problems. A little bit. Ick in the morning. Wake up in the morning. Ick while she's putting on her face, she said, right. So while she's doing her makeup. She has some ick. By the time she's done with the makeup, it's gone. And then she's good to go. Yep. So she's like, I don't know if these herbs or what, but I think that's really great. And I said, look, I actually don't think it's the herbs. She's like, what do you mean? I was like, I think it has to do with your mood and what's happening relative to all these things. I said, you had your friends in town. You love these people. You went out, you didn't think about your problem.
You ate all the foods you wanted to eat.
And what we now know definitively from having now worked on this for almost three months, is that restricting your diet makes virtually no difference, that a formula can work seemingly and not work within the same span of time, and that you can eat things that are on paper should be problematic for you to eat and drink without any issue.
[00:48:23] Speaker B: Right.
[00:48:24] Speaker A: So if that's the case, then there is another piece of this puzzle that has very little to do with the physical inputs and a whole lot to do with the headspace around it.
[00:48:37] Speaker B: Yeah.
[00:48:38] Speaker A: Now, again, this patient and I have really good rapport. So we were able to have this conversation in basically these frank types, you know what I mean? Because she likes me, I like her, she trusts me, I trust her. We have a good way to talk about this.
The problem is, is that in the course of this conversation, she found herself, like, rather disheartened by the realization, so to speak, that, like, well, this is how she said it. She's like, I just don't know what to do about it if it's all in my head. That's what she said.
And I said, well, firstly, I wouldn't categorize it as, quote, all in your head. I would say that this is just a thing that's influencing your health. It's not more or less real than anything else because you're experiencing it. It's absolutely real. It's right here in front of you. I said, on the other hand, what's nice about it being quote unquote all in your head is that it means that we can do other things to intervene here. And we know for sure that spending time with your friends and thinking less about your condition is a way to actually improve the outcomes. So one of the things that we did majorly from there, she had been keeping a food journal. She was a very type a person. So I had given her a food journal way back when. We started to just figure out, like, what she was eating. But then she started keeping this little notebook where she would actually rate her feeling of, like, the day on a percentage. So she was like, 100% is, you know, everything's good. And she'd be like, oh, this was a 10% day or 20% day. So she literally had this notebook, pages and pages and pages of, like, evaluating her percentage, sometimes multiple times a day. Right?
[00:50:05] Speaker B: Wow.
[00:50:06] Speaker A: Which in the beginning, I thought was actually a really good tool for her because it helped, because I like it when patients can track their improvement. But then what I realized over time was that it put so much sort of myopic energy on rating the day that she was doing this constant inventory multiple times in the day. Like, how am I feeling right now? What's happening in my body right now? And this gets us to this place that we've talked about on this show, and you and I talk about all the time, which is that super important for patients to pay attention and to be plugged into their bodies, but not too much.
[00:50:38] Speaker B: Right?
[00:50:39] Speaker A: Like, there is actually a point in which checking in with yourself is too much. And in this case, I was like, okay, so here's the deal. No more food journal, no more percentage rating, right? We know that if you're feeling some ick in the morning, that a small snack, especially something a little bit sweet, little dried fruit and granola, something like that, a piece of fresh fruit, we know that works well. So let's just put that in the mix. No herbs. We're not going to do any herbs. We're going to just let you get back into your normal life and you're going to use these food tools. If you start to feel like something's a little bit off, right, come back and see me in two weeks. Just give it time. Also, you don't even. You're not going to be back here next week. You're not going to report to me next week. I just made this conscious choice to, like, push past all of the narrative that was connected to the story and frankly, just stop.
[00:51:29] Speaker B: Yeah.
[00:51:29] Speaker A: Just be like, nope, we're not going to do this part of it anymore.
Two weeks go by, she comes in and she's mostly fine.
[00:51:37] Speaker B: Yeah, right.
[00:51:38] Speaker A: Mostly fine. A little bit ick in the morning still, but mostly fine. And so all of a sudden, we're just like. We're now. I find myself now in an entirely different space than we normally are in because I'm not pulling needles and herbs as the primary intervening tool. Instead, I'm sitting here, talking to the patient and having them relate to me the details of their experience and essentially being their cheerleader.
[00:52:03] Speaker B: Right.
[00:52:05] Speaker A: Importantly, through all of this, I recognize that we needed some professional help in here, too, because I'm not a therapist. You're not a therapist. We don't have this training.
But the patient had a lot of nervousness about finding a therapist. And will they like them and will this work out? So some of my work was actually sitting down with this patient with a computer and, like, showing them how to search their health insurance, find a therapist and giving them some advice on how to select one. You know, literally down to, like, do you want to talk to a man or talk to a woman?
[00:52:36] Speaker B: Like, just basic for it, too.
[00:52:37] Speaker A: Basic stuff. Right. But they need some help, right. Because if you just say, hey, you need to find a therapist, it's not. It's not enough.
[00:52:45] Speaker B: They're not going to do it.
[00:52:46] Speaker A: They're not going to do it. It takes too much work. Right. But they need someone. They need someone in their corner who has the training and the skills to help reframe their lived experience. And I offer this case in this context, even though it's on some level not really herbal, to just say that a lot of times, complex cases deal in all of the aspects of human experience. So it's physical, it's mental, it's spiritual, it's deeply emotional, particularly things that are chronic.
[00:53:17] Speaker B: Right.
[00:53:17] Speaker A: And so if you find yourself in a bind with your herbs or things that don't make sense to you, or your acupuncture is not getting you where you need to go, it is important to always remember these other dimensions of what creates a health outcome. That doesn't mean you need to be a therapist. It doesn't mean you to be sitting there doing counseling with your patient. Right. But it does mean you need to be aware that not everything is fixed by just pushing against it with another pattern.
[00:53:45] Speaker B: 100%.
[00:53:46] Speaker A: A lot of it has to be done on the patient's end. Right. To figure out, like, okay, how do I interact with this and how do I manage it and what do I. What do I do for it? So this patient is coming in next week, and I haven't seen them. Haven't seen her in a month.
[00:54:02] Speaker B: Nice.
[00:54:02] Speaker A: So it'll be interesting to see, like, okay, how's the last month been? She went on a trip to see her family. Her kid lived out of town.
Children are older. Obviously they have families. I think it was her kid's birthday. So there's a lot of good stuff like family stuff that get along well, she could trip back where she grew up and see all these people that she knows. So I'm hopeful that as we continue to peel back the narrative aspect of her health, that then it will give me some clarity to actually get back into what we really do, which is herbs and needles, because we will have pulled back some of the obscuring clouds of the case to be able to say, like, oh, okay, I can see here there's actually some cold digestion because there is. Right, right. And I can see that there are these things that are obvious in the pattern, but it doesn't seem to matter because there's all this other stuff obscuring the outcome. And so even the most perfectly designed formula doesn't land because there's all this stuff in the way.
[00:55:03] Speaker B: It reminds me of the phrase that we talk about in qigong, which is the Yi leads the qi. Right. The idea that our mind, our awareness, like, where we put that and the quality that we keep that in, affects our chi. Right. So if we're constantly, like, hyper vigilantly looking at our health, afraid that something's wrong, afraid that it's getting worse or whatever, it can absolutely make it worse.
[00:55:32] Speaker A: Yeah. I mean, we see that all the time.
[00:55:34] Speaker B: See it all the time.
[00:55:34] Speaker A: Yeah. And I mean, this stuff exists even in the sort of mainstream, I guess it's sort of like the self help wellness world. Right. But I mean, like, years ago, they wrote that book, the secret.
[00:55:45] Speaker B: Oh, sure.
[00:55:46] Speaker A: And then you ended up with, like, you know, people talk about manifesting and all this kind of stuff. And so it gets a little bit of a bad rap that it's just sort of like a think your way out of a problem. But the truth is, how we think about it absolutely feeds or starves different aspects of our experience. And to neglect that, to say, oh, that's just placebo, or it's just in your mind, that is such a fundamentally unhelpful way to frame up the power of your narrative and your headspace.
And, you know, people will say to us, you know, I love chinese medicine. I really believe in chinese medicine. You know, I think it's, I believe in it. You know, I know it works. And I always, a little part of me laughs a little bit because, like, chinese medicine does not require your belief.
[00:56:35] Speaker B: No.
[00:56:36] Speaker A: Like, it's not a, it's not a religion. You know, you don't have to believe in it to work, but it does help, right?
[00:56:44] Speaker B: Yeah, sure. If people, well, they have to be.
[00:56:47] Speaker A: Open to it or, and just invested in their health in general. Right. Like, if you're certain that you're just a sick person and that there's nothing that can be done about it because you're unlucky and whatever the universe has, has frowned upon you, nothing's going to help.
[00:57:05] Speaker B: Right.
[00:57:06] Speaker A: Right. Like, nothing.
[00:57:07] Speaker B: You're not going to find anything that will help you because what you're looking for is colored by that, that basic assumption.
[00:57:14] Speaker A: You've already decided you can't be helped.
[00:57:16] Speaker B: Right, right, right.
[00:57:17] Speaker A: And the thing is that that doesn't sit well with a lot of people, like very rational people because it shouldn't matter. Like, as I said, it shouldn't matter if you believe in chinese medicine or not. If the medicine's effective, it should work. And the thing is that we will if certain conditions are met. And this isn't just true of chinese medicine, it's true of western medicine, too. Right?
[00:57:35] Speaker B: Yeah.
[00:57:35] Speaker A: Every medicine, every medicine requires a kind of openness and investment on the part of the patient for it to be useful and to be effective. And, you know, there's lots of cases where we can talk about, oh, well, if something did something, they weren't expecting to work, and it did. So, like, what do you do with that? You know, it's complicated for sure, but I just want to say that if you find yourself in a complicated case and you've tried your herbs and you've tried your acupuncture and you're getting weird results and you've gone through a process like you just described for your patient and you're still getting these weird mixed results, don't forget to address the mental, emotional aspect, the shen aspect of what's happening here in the health presentation.
[00:58:19] Speaker B: Yep.
[00:58:20] Speaker A: All right. So based on the two cases that we looked at and this sort of general idea, what other key elements do you think are important for folks to consider when approaching a complicated case?
[00:58:32] Speaker B: So I think it's important to, like we said at the beginning, try to understand the person's experience of what they're going through, what they actually care about. Even if they tell you, I'm here for you to treat my back or my shoulder, the thing that they really want help with is this. Right. It's good to know that because that changes how we talk to our patient and also, like, what we might suspect is going to be a pathway for them to get better.
So that's the first thing. Second thing would be have a diagnostic, have diagnostic progression in your mind, a type of diagnostic progression in your mind that you can use for cases and use that system, if not every time, a lot like find a system to specialize in. You really. Like Zongfu organ diagnosis. Specialize in zongfu organ diagnosis. Think about cases that way and then think about progression. Like most cases that when people come in, I need to treat the liver and the spleen first.
Sometimes I need to treat the lung first, or sometimes I need to treat the kidney first. But those are rarer, right? So like get the basic sort of awareness of where you need to go first in most cases and where you need to go later. Right. For me, like in the case that I described, I'm using the six confirmations as my primary modality of thinking. But it doesn't have to be that way. It can be any system. In our medicine, they all work. You just have to learn how to see with those eyes in these cases. And you can use more than one system, but it's really good. I think when you're starting, you really need to find one that you primarily use. You need reps. You need reps in a system to develop your vision and view so that you can actually use it. If you just float around and you do wenbing and then you do zongfu, and then you do six, like, it's too much.
So pick one that you like and then learn how to progress, how most cases progress in those systems and learn how to pop out. Like we talked about in this case, doing Wu Mei Wan, we're in yin confirmation. We're treating juiyin, and then she had a flare back into yang confirmation. So I used Chengjiang shai shintong, which is Yang Ming and Xiaoyang formula. And then we go back down to Juiy yin. So using the six confirmations, that's often what happens where after we work on the yin, we have to work on the Yang a little bit. And then we go back to treating the yin. That kind of understanding that you need to not only do one thing, but actually like, okay, we're primarily working here, and then we do that for a while and then go deeper and we work there and then there's a flare. So we need to work back up here. Like, that is the majority of cases that you have to do that you're.
[01:01:41] Speaker A: Pivoting back and forth and so learning.
[01:01:44] Speaker B: Within the system that you use that, how that works. What formulas do you typically need when you pop back up to treat on a more superficial level or a deep level? Like, where do you go with that? That's really.
[01:01:58] Speaker A: So if someone's gonna, you know, they're, they're new, they're trying, they want to take your advice and they want to pick a system.
How do they do that? I mean, like, what's the actual process?
[01:02:10] Speaker B: I would look for teachers that you like to learn from.
If you know people. Like, if you have teachers that you studied with in school, that's a great way to go. If not, then check out continuing ed. Like, do some shopping around your first year or two with continuing Ed and see what's out there, see what you like.
There's a lot of ways to do this medicine, you know, and it's better if you can find somebody that you can study with in person, at least for certain meetups or workshops or whatever, but it doesn't have to be that way. You can refine your skills in a number of ways. And so I would recommend doing that, like, go with what you feel is interesting and that, that seems to resonate for you. I think that's the cleanest way to get to a pathway of thinking and of diagnosis and treatment that's systematic.
[01:03:10] Speaker A: Yeah, I think continuing Ed is a good, a good methodology because you can actually google that.
[01:03:14] Speaker B: Yes.
[01:03:15] Speaker A: You can literally just google it.
[01:03:16] Speaker B: Yep.
[01:03:16] Speaker A: Chinese medicine, continuing Ed. And there's so many good quality programs out there, and they have sample stuff. They've got sample online things. They've got videos, they've got YouTube channels, they get podcasts. There's like, stuff you can actually listen to and figure out, like what to do. It's worth noting that it's, it's not inexpensive to do it. There is definitely money that's involved, and that can be a little frustrating or annoying, especially if you're in your early, you know, stages of building a practice. Money is always a tight question, but it's worth, if you find something that you resonate with, it's really worth taking the time to make that investment because it will help clarify your clinical outcomes. And if you can clarify your clinical outcomes faster, your practice will benefit.
[01:03:59] Speaker B: That's the other.
[01:04:00] Speaker A: Because your patients will get better. They're going to talk to people more about it. You'll spend less time, meaning you can spend more patients, like, see more patients. There's. There's a lot of cascading benefits to having some clarity of diagnosis and treatment beyond just being better.
[01:04:14] Speaker B: Right.
[01:04:14] Speaker A: Right. I mean, there's really practical applications for having made that choice as well. So it's definitely worth taking the time to find something that can work for you.
[01:04:23] Speaker B: Yep.
[01:04:24] Speaker A: Cool.
All right, guys, well, as always, thanks for listening to the nervous herbalist. You can find more information about our
[email protected] read all about the services that we offer there. You can also get more information about our ongoing residency program from rootandbranchpdx.com. that's root and branch papadeltaxray.com. i have, in fact, learned the entire phonetic Alphabet so that when I talk to the insurance companies, I can say Papa delta x ray.
[01:04:54] Speaker B: Skills you get from insurance.
[01:04:56] Speaker A: That's right, that's right. So if you have questions about whether tango and whiskey are actually a w, the answer is yes.
Anyway. You can get more information about our ongoing residency program at www.rootingbranchpdx.com.
our residency usually begins in the fall of every year, and it's a great opportunity if you're in the greater Portland area to come and actually work with live, real clinicians running an actual practice. You can learn all about the clinical skills that Travis Cunningham was talking about, learn a whole lot about the business management skills that we teach here in our program. And as always, if you guys have any ideas for other episodes or questions about what we've been doing, shoot us an email at info info ootenbranchpdx.com and we'd be very, very happy to hear from you. So I'm Travis Kern.
[01:05:45] Speaker B: And I'm Travis Cunningham.
[01:05:46] Speaker A: We'll catch you next time, y'all.
[01:05:47] Speaker B: See ya.
