Resolving Seasonal Allergies

[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. All right, everybody, welcome back to another episode of the Nervous Herbalist. My name is Travis Kern, here with. [00:00:25] Speaker B: My co host, Travis Cunningham. [00:00:27] Speaker A: And we are going to take some time today to talk to you all about allergies. It comes up a lot in the clinic in the fall, in the spring. Allergies is something that a lot of people deal with, particularly depending on the climate that you're in or the actual sort of plants and other contaminants that might be in the space causing trouble. And it's something that patients are always looking for help with. Right. I'm sure many of you out there have dealt with people who are on the classic collection of Claridin, plus some flonaise, plus some Benadryl at night, and then they're red faced and snotty, and there's all that stuff going on. And the great thing is that chinese medicine is really helpful for allergies. And as I think most of us who do this work know, helpful in a way that isn't just symptom management. Right? I mean, we're not just saying, hey, let's figure out how to make your nose stop running. We're actually trying to get at a core understanding of physiologic change that can lead to allergies. And then also, what are the underlying symptomologies that cause allergies. Right. So, t, why don't you take us through a little bit? Maybe the sort of environmental changes, like what's happening in a body at spring or at fall, maybe let's start with spring and kind of walk us through what's happening there. [00:01:47] Speaker B: Yeah. So seasonal cheese is important, right, from our medicines perspective. And if we're moving through the spring, we're moving from winter to the summer. The wintertime is pretty cold and pretty consistent. In cold, the summertime is pretty warm, and it's consistent in being warm or hot. Right. So we say in the wintertime, yin predominates and the summertime, Yang predominates. I think it's also useful, though, to think about internal and external. So in wintertime, yin predominates externally, Yang is internalized, or it should be. Right? For the summertime, it's the opposite. Yang is externalized, yin is internalized. So our body has to make changes based upon the seasonal qi to adapt. In summertime, Yang is predominant, and it's on the surface. Yin is internalized. So heat is on the surface. Cold is internalized. Wintertime, it's the opposite. Yin is predominant. It's externalized. Yang is internalized. So for our body to be able to cope with winter well, it has to follow that same rhythm and cycle, the same adaptation to the external qi in the spring and the fall, we have a similarity in both of those seasons. In the chinese language, there's wind. Wind is, in my opinion, wind just showcases the element of change or transition. You have the most volatility between temperature changes in the spring and the fall. [00:03:39] Speaker A: Right. [00:03:40] Speaker B: There's going to be some days that are very cold and other days that are very hot, because we're coming off of either winter or summer, and we're moving toward either winter or summer. [00:03:50] Speaker A: Yeah, I mean, we just dealt with that here in Portland. Right. Like, three days ago, it was like wintry mix, and then it was sunshiny and, like 65 degrees. [00:03:58] Speaker B: Right. And people are saying it could snow this weekend. [00:04:00] Speaker A: Yeah. And now people are like, oh, it could be snowing again this weekend. They're like, what? [00:04:03] Speaker B: Right. Yeah. So there's more volatility in movement. And that movement means that physiologically, we have to respond and adapt. There's more pressure to adapt in both the spring and the know. The Chinese have this idea of, like, the wind that moves from below to above is the spring, and the wind that moves from above to below is the fall. So remember her qigong teacher, Liu Ka? She would say killing wind. Right. For the fall wind versus the spring wind is the other type of wind. It's the growing wind. It's like things are sprouting and blooming and kind of coming up and out, and we're moving toward the young surface. Right. So the dynamic of wind is the dynamic of change for me. That's what it means for me. So that means that our body has more circumstances where it has to adapt. There's less stability in those seasons than the relatively predictable quality of winter and summer at the opposite ends of the pole. Yeah. [00:05:17] Speaker A: Does it matter? You mentioned that winter is predominantly cold and summer is predominantly hot, but not everywhere in the world. [00:05:24] Speaker B: Right. [00:05:25] Speaker A: So how does weather and sort of geographic variations, how does that stuff affect us? [00:05:32] Speaker B: Definitely affects us. I think that it affects us. So again, there's macro effect, and then there's micro effect. And so you have the seasonal Qi that's kind of happening globally, and then you also have what's happening in your area, what the weather is like, and there's systems of assessment called yunqi calculation. Right. In chinese medicine, where they actually use astronomy and they look at the location of the dipper and how that corresponds to the six chi and all of these things. And so there's this cyclic tendency over the course of, I don't know how many years, 60, 80, whatever it is, it's this cyclic tendency for certain things to relate in a particular way for that year. And that's going to create a microdynamic inside of the seasonal dynamic, which is more global. And even the weather that comes about in that dynamic is going to be additional, and it's going to have other effects than the calculation effects. So, yes, the weather is going to definitely change it, and the season like this spring, is going to look different than last spring for us. And that's also a dynamic. So it can get very complicated as we move through these different layers of nuance. But the global movement of summer, winter, spring, fall, like these are going to be also standard pillars of transition, if that makes sense. [00:07:19] Speaker A: Yeah, I think that makes sense. I mean, I feel like if you get into the nitty gritty, it's when you start to get into some of the more chinese cosmological astronomy principles, you're getting more into five pillar stuff, bots of stuff. Right? And it's funny because we think of those things now as really independent of one another. Like medicine is separate from birth charts, is separate from divination, is separate from astronomy, whatever. But, I mean, classically, that wasn't really the case. Right. People knew a lot more about tendencies and expectations and stuff like that, and it doesn't matter. I think Liu Ming used to say in his lectures that the movement of the qi, the seasonal qi, is not the weather. The weather is a manifestation of seasonal qi. But even if you lived in a place that never snowed, there's still a shift in the chi in the wintertime such that one should still have more restraint and more ability to repose. Right. Even though it's not cold outside. [00:08:24] Speaker B: Yeah, for sure. Absolutely. [00:08:26] Speaker A: I wonder, it's so fascinating. We see that stuff in bodies, like in the physiologic changes with fluids and stuff that we're going to talk about here. But I wonder, because so much of this theory was, of course, developed in a place that was the mean. China is huge, right? So there, of course, really different weather in Guangdong than there is like in Tibet. Hugely different weather. But, of course, like many places, these theories are sort of from the middle, right, from the central part of the country where the weather has the most variation between winter and spring. And I think that you would definitely like, if you wanted to get deep into seasonal Qi and how to use it clinically in a very specific way, it would really matter where you are. Right. I think it'd be worth spending some time to deeply peel back those aspects. [00:09:19] Speaker B: Absolutely. [00:09:19] Speaker A: But the universal stuff is applicable no matter what, right? Yeah, for sure. Okay, so it's springtime. We're transitioning out. As you mentioned, during winter, yin is in an exterior position, Yang is in the interior position. And as we approach solstice, winter solstice, that yang is extremely diminished, deeply internal, but still there. Right. Obviously warm, sustaining you, carrying you through the winter. Lunar New Year happens, which marks in the chinese tradition the beginning of spring. But at that point, the Yang chi has been reemerging from solstice, but it is fetal. It's so small, it has no strength, no agency. Right. And so in the seasonal lifestyle stuff, the idea is don't get too excited that it's spring like. Yes. Time of transition, lots of symbolic traditions and rituals to welcome the Yang chi back and to set the stage for the future. But always considering the fact that at that moment in late January to late February, depending on where Lunar New Year falls, the young is weak. [00:10:32] Speaker B: Yeah, absolutely. [00:10:34] Speaker A: But of course, too, we don't usually see allergies so much in early February. [00:10:38] Speaker B: Right. [00:10:39] Speaker A: It's not until the young is stronger. And I assume that it's making this shift from its real interior position to the exterior position that we start to see the problems. So what's happening there in that transition? [00:10:52] Speaker B: So in the spring, we have an additional component, spring versus fall. So if we think of summer and winter being hot and cold, we can think of spring and fall being damp and dry. So dampness is more in spring. Right. The ground is like around know it's easy to see. The ground is covered like it's raining, all the mush, slushy. Where I come from in upstate New York, the snow is melting and it just turns to slush and everything is like damp and soggy. Right. And so that's the first part of spring. So that's the dynamic that wind has to contend with, is the dampness. So in the beginning of the emergence of that young yang, it has to contend with this thick damp quality in the spring. So that has a particular general characteristic for what we see with seasonal allergies. Similarly, in the fall, we contend with dryness. So dryness is on the surface, dampness is internalized. So there's some formulas. The reason that I'm bringing all this up is there's some formulas that specifically are created to deal with a dynamic movement of fluids at that time or in the springtime, and we can talk about what those are, which is not to say that those are the only patterns that you'll see at that time. Like anything else with our medicine, you still have to do, like, if you learn one thing, learn the differentiation of what's coming in the door right now. Forget about constitutional assessments. Fascinating. The Yoon Chi stuff is fascinating. All of this stuff's fascinating. But if you forget about all that and you can just pattern differentiate, you can figure it out anyway. That's the primary thing that we need to cultivate as practitioners, especially if we're using herbal medicine, because we can do damage if we're too far off. Right? So in the spring season, the spring and the fall have. The commonality is wind. So that means change. Our body is put through different circumstances, and it has to adapt with the subject of external contraction, which is basically how everybody treats allergies. That's from people who use Zhangfu organ diagnosis as their primary method of diagnosis, to Shanghan Lun, like six confirmation methods, to wen bing four levels, or sanjiao theory, like whatever you're using, if you're treating seasonal allergies and you see a large number of cases, a lot of the people that come in, you're going to treat through the lens of external contraction. So what is an external contraction? An external contraction is when our bodies meet a type of qi and don't know how to adapt to it. So then they receive that Qi as a type of strike against it. It's in the same. The way that I explain it in the residency classes, because we're doing cold and flu right now, is it's a little bit like you have a trigger, like an emotional trigger. So I don't have a sister, but let's say that when I was younger, I used to have an older sister who would call me a name or something, right? Then 30 years later, I'm an adult walking around at a party, and my female friend sees me and calls me the same name with no malicious intent, and maybe even I know that, but it triggers me. That's like I'm not able to adapt. My system doesn't know how to adapt to that circumstance. It's like frozen, and it can't adapt. It can't remain in contact with the movement of life in that instance. So it receives that qi as a strike against it. So then it goes into a process of transformation, adaptation, recovery, which we know as disease. Right. So that could be from the Shanghai perspective, the first thing that happens is we send warm blood to the surface. Maybe we develop a fever, and we try to open the surface. And if it fails to open in some way, then we have a taeyang disease. Right. With Zhangfu organ diagnosis, maybe the way that we choose to view that is that there's a problem with the lung, because the lung is the metal element. Right. Kind of the signature organ dealing with the metal element, and that governs the surface. So maybe we would think of using herbs or formulas that address the lung chi specifically for that system. [00:15:49] Speaker A: Yeah. And particularly the lung is the upper source of water and the primary driver of qi through the body. Right. So if it is having a hard time contending with this qi, it's been presented with its ability to move qi throughout. The rest of the body also can be affected, right? Absolutely. Thinking about it in that Zhang Fu way, like, why does cold and flu or allergies or any of these exterior patterns cause the kinds of symptoms that it does? Well, because of these various influences on organs, right? Yeah. Okay. So in the spring, relative to allergies, what are the kind of patterns that the body is contending with that we often see? What are the ways in which those things manifest? [00:16:41] Speaker B: So with seasonal allergies, constitutionally. Let's talk constitutionally first. So forget about five elements. Forget about all of the different microwaves. Our acupuncture herbal system might have constitutional assessment. If we just think about constitutional tendencies as somebody being more damp or more dry, it's useful for the subject of allergies, I think. [00:17:07] Speaker A: Okay. [00:17:08] Speaker B: Because whether you tend to be more dry constitutionally or damp, they can create problems with how your body's fluid system transitions between spring. Well, basically between summer and winter, the spring or the fall. So if you tend to be more dry, like, last fall, I think it was, was a very dry fall for us. Right. And pretty much all of the people that had seasonal allergies last year were people that were dry. Like, I had allergies last year. I never have seasonal allergies, but last year, I had pretty significant seasonal allergies that I had to treat for a few weeks. But it can be the opposite, too. If the situation is more damp, if it's a wetter season, then the chi of dampness will trigger certain kinds of changes in nature that will make it harder for people who are more constitutionally damp to move through that transition. So it'll just be easier for them to get an external contraction that we would identify as allergies. [00:18:22] Speaker A: Right. Okay. [00:18:23] Speaker B: And in the spring, the damp version is going to be more likely than in the fall. [00:18:28] Speaker A: Right. People who are tending to be more damp likely to have more spring allergies than fall. [00:18:34] Speaker B: Correct. [00:18:35] Speaker A: People who tend to be more dry likely to have more fall allergies than spring. Obviously, depending on the nature of that particular year, it can vary. [00:18:43] Speaker B: It can vary. And it could even, again, do your differentiation and live time. These are just general things to keep in mind as you're moving through the season. There are certain formulas, again, that are created, like the xiaoqing long tong Da Qinglong tong. The Qinglong tongs are specific formulas that tend to work well in the fall season. And it has to do with the fact that dryness tends to be on the surface. So it's very difficult when it's really dry out to force a sweat because you already have dry fluids in your body on the surface. So it's easy for something that's kind of cold to come in and shut the surface down. And then whether you have more dampness internal or more dryness internal is going to depend on whether you manifest more with Xiao Qing Long Tong, which is a damp internal formula where you have, like, phlegm and Tai phlegm in the lungs. Or if you have dryness internal, and then it's going to go more taiyang. Yang Ming, you're going to spike a super high fever. You're going to be dry, but you're going to be coughing. And usually people are going to be in a lot of pain, like body pain, and really uncomfortable. That's more Dod xing Wong tongue. So those formulas we're really going to see more likely in fall than we would in spring. But again, could you see them in the spring? Yeah, of course you could. Could you see other formulas that we're going to talk about that are more likely to occur in the spring and the fall? Yes, of course you could. [00:20:15] Speaker A: Yeah. I mean, it's important to always, you're always differentiating. Right. But it's helpful. I made this joke the other day about differentiation and trying to find things that are, like when you played minesweeper in the, you went to the box and try to find click the corners because it would get rid of most of the squares. And then you could focus your attention on these particular tricky bits. And that's how I think about internalizing these generalities. Right. Because, yeah, of course, you could see a xiao Qinglong pattern in the spring. Obviously, but it's helpful to just run through those basic common differentiations that can just help clear out some space and be like, oh, no, it's been a super damp spring. This person is super damp. Right. Probably not going to need dachshing long tong. [00:21:01] Speaker B: Right? [00:21:02] Speaker A: Probably not. I mean, I guess maybe there's some circumstance in which that would be the case, but probably. [00:21:06] Speaker B: But probably not. Yeah, exactly. [00:21:09] Speaker A: Okay, so maybe you mentioned a couple of those fall formulas, but let's consider just that. Exactly what I said. It's a damp spring. Got a damp person. What kind of allergy symptomology usually walks in the door in those conditions. [00:21:23] Speaker B: So most of the time when people come in for allergies, they have. Well, what's a typical allergy case for you? Like, if you think about symptoms off the top of your head? [00:21:33] Speaker A: Yeah. I mean, it's all the ones that you. It's the ones you can read on the back of the claritin box should. [00:21:38] Speaker B: Get a box of clarity. [00:21:39] Speaker A: Just read the symptoms. So it can be runny nose, congestion, sinus pressure, and then the eye piece can be kind of variable. But of course, like, red eyes, dry eyes, watery eyes, itching eyes. My favorite are the ones that are watery and itching. Right. Or, like, watery, but they feel dry. Like that sort of combo presentation. [00:21:58] Speaker B: We're going to talk about that. Yeah, exactly. [00:22:00] Speaker A: And then also, sometimes people will feel it in their ears, sort of auditory pressure, even sound distortions. But a lot of times, just like they feel the pressure in their actual ears. And then post nasal drip and phlegm in the throat. So, basically, like, your face is full of some disordered water, phlegm presentation that's either draining out of your nose or your throat, or both. And then something to do with eye gunk, dryness, watering, itching. [00:22:32] Speaker B: A lot of times, people will have, like you mentioned, some kind of throat symptom as well. So post nasal drip, or they'll feel like their throat is dry, or sometimes it'll be itchy or something like that. Right. There will be some feeling of something in the throat that's off. [00:22:51] Speaker A: Yeah. It's particularly gnarly, too. If they've been having a lot of post nasal drip and phlegm, then that mucus is also irritating the throat and causing trouble there, too. So that's always an interesting kind of differentiation. Okay, so that's what we've got. We've got a damp person, constitutionally damp, maybe tendency toward loose stool, weak digestion. Right. Kind of a weak spleen. Comes in the springtime with very strong sticky phlegm presentations like sinus congestion, headache, pressure behind the eyes, and their nose isn't running. They can blow phlegm out, but it's tough. It's pretty sticky, but it is running down the back of their throat. Right. And they've got a lot of pressure in the ears. What are we doing with that? [00:23:40] Speaker B: So my first thought would be, well, we would do the objective assessments. Right. Pulse and tongue and abdomen and stuff like that. So that would give us some context for what's going on. I think it's important to mention that, but just based on the symptoms. So external contraction tends to affect the superficial channels before it affects the deeper channels. [00:24:06] Speaker A: Sure. [00:24:06] Speaker B: Right. [00:24:07] Speaker A: Right. [00:24:07] Speaker B: So from a Shanghai perspective, we're thinking we're probably going to treat the yang confirmations first. If there's any symptoms in the yang levels of the body, we're going to treat those first. So if somebody has any kind of throat symptom, discomfort in the throat, along with pressure in the ears, the most common formula that I'm going to write and start with for my base formula is Shao chai Tong. So that's going to be prime and center to seasonal allergies because it's just so frequently where we find ourselves in the differentiation. [00:24:48] Speaker A: And when you say find yourself, you mean like dealing in the Xiaoyang space? [00:24:53] Speaker B: Yeah. [00:24:53] Speaker A: Okay. And is that a function of kind of like how it is with cold and flu, that it's a function of time? By the time we're actually seeing someone, those initial layers have probably already been worked through. Or maybe if this is someone's tendency, they just got skipped right over. [00:25:11] Speaker B: It's a little bit of time, but it's also deficient. It's a certain type of deficiency. So if a person's body is vital enough, let's say there's a little kid with allergies, the situation might be different than this. [00:25:26] Speaker A: Sure. [00:25:27] Speaker B: Because they have more qi, they have more yang. So if they have a problem adapting, they're going to manifest with more superficial adaptation problems than someone like you or myself who's been working. [00:25:45] Speaker A: What are those more superficial? [00:25:47] Speaker B: Those are going to look more like probably Guggen tongue type cases would be the first place that I would go. So Guggen tongue Guggen is a fantastic herb for treating nasal congestion. Maybe it'd be easier if I explain the levels so that we can see kind of how progression works here. So we get an external contraction. The first thing our body is going to do is try to open right that's the function of Taiyang. So the way that it opens is it's going to send warm blood to the surface of the body because warm stuff opens it up. Right. Blood is the warmest resource we have. So it's going to send it to the surface. That's why we get a fever. Blood comes up to the surface, we try to open. For a taiyang pattern to be present, that process has to have failed or has to be failing, like, not super successful. [00:26:43] Speaker A: Because if it had been fully successful, it would have ejected the path. [00:26:46] Speaker B: Exactly. Yeah. The body would have adapted. And we go back to homeodynamism. Right. I don't like the word homeostasis. You know what I mean? [00:26:56] Speaker A: That's that scenario where you wake up in the morning and you're like, I don't know, maybe I'm sick. And then by the end of the day, it never takes hold. [00:27:03] Speaker B: Right? It never takes hold. Your body figured it out. [00:27:06] Speaker A: Yeah. [00:27:06] Speaker B: It adapted. [00:27:07] Speaker A: Got it. Okay. So, okay, that doesn't work. [00:27:10] Speaker B: That doesn't work. So it fails in one of two ways. It either can't open at all. Mahong tong. Right. The surface is closed, but that yang is trying to push the surface open like this. Or it opens, but it does it in kind of a weak way where the door flies open and a bunch of stuff comes out that shouldn't come out. And the way that we learn about that in school is sweating. Right. Guajir tong pattern. There's sweating that's coming out. The other thing that can occur in Taiyang disease, because being in Wei are disharmonious. The movement of warmth on the surface and the fluids on the surface are disharmonious, is that a person can have, like, a drippy nose. So that can happen. So it's not really even phlegm. It's almost like a faucet, really watery. So that can happen again in Taeyong disease, because the fluids on the surface are not well controlled or mandated. So they're just kind of moving erratically. So we can sweat, we can have that drippy kind of nose. What eventually happens if Taeyong doesn't resolve is it starts to turn into dryness. There's a dryness problem. Fluids on the surface start to dry out. And the way that they dry out is either you sweat too much, your nose drips too much, or in a mahong tongue pattern, heat builds up beneath the surface and cooks the fluids from the inside. So either way, taeyong turns into yangming eventually. If it doesn't, right, right. So then yangming happens because the fluids on the surface start to dry out. So if you take the guezer tong pattern, you had an open surface, but the sweat was coming out in a disharmonious way. You had that drippy nose. Now the fluids on the surface are starting to dry out. So what does that mean? It means that they go out of the muscle layer. The fluids that are mostly, usually coating the muscle layer to keep it soft, lubricated and loose are now not there. So the person develops a stiff neck, which is what we associate with guggen tongue. What can also happen, the fluids in the nose that are drippy now turn a little bit more consolidated. They actually turn into phlegm. [00:29:33] Speaker A: Yeah. So they're thickening. [00:29:34] Speaker B: They're thickening because of the dryness. [00:29:36] Speaker A: Right. [00:29:37] Speaker B: The third thing that can happen in a guggen tongue pattern is eye stuff, and it's for the same reason the fluids on the surface are drying out. So the eyes get dry and then they tear reflexively. So it's the same kind of fluid disharmony pattern. So you can actually treat a lot of ocular eye problems with just guggen tongue or guajujia? Guggen tongue. Because guggen is going to help to go in there and put the fluids back into the upper burner in the right way so that those things stay moist and cool and they're good. [00:30:13] Speaker A: Yeah. [00:30:14] Speaker B: So seasonal allergies, you can start to see how this could be a very viable thing for certain types of allergy presentations. Right, right. Teary eyes, itchy eyes, red eyes, all of that stuff could just be a guggen tongue. Right. [00:30:28] Speaker A: And even sort of like basic nasal congestion. [00:30:31] Speaker B: Basic nasal congestion. You could treat it all with thick snot. Exactly. [00:30:35] Speaker A: I think it's worth pointing out, too, in the way that you've described what you've just laid out there, just with those basic layers. Right. That a lot of times when you read textbooks about allergy formulas or you look stuff up online or you go into acupuncturists on Facebook or something like that, there's a lot of reference to herb for symptom. Right. So this herb for runny nose, this herb for watery eyes. And you can certainly write formulas like that, right? Definitely you can. And you can get good results, but that kind of thinking doesn't really in reality, and again, please don't write in angry letters about this, but in reality, that's not really pattern differentiation to do that. Right. Like you didn't really yenzung your way to that outcome, you constructed a formula based on the individual function of individual herbs instead of considering the overall dynamic of the system that's leading to these outcomes. [00:31:39] Speaker B: Absolutely. [00:31:40] Speaker A: And I think the thing is that most of us who go through school, even if you go through a regular, really good program, actually, that has an herbal bent, there's so much that we're learning that it's very difficult, I think, to properly internalize even just what you described there, which I would say is on some level, a kind of fundamental understanding of Taiyang progression. Right. And yet, the ability of your average chinese medicine person, practitioner to articulate it as clearly as you just did, I think, is limited. And so if you're thinking, like, if you're hearing Travis explain that, and you're like, well, I don't know anything about, like, that's, like, that's why you're listening to this podcast, so that you can learn more about it and begin to start to think about these formulas from. [00:32:27] Speaker B: A more. [00:32:29] Speaker A: Sort of a universal. I mean, we use this word holistic all the time, but I think it really applies here, like, thinking about the disease presentation as a thing that fits into a larger constellation of other things, as opposed to allergies, is snot and runny nose and headache. So I need herbs that treat snot and runny nose and headache. As I said, you can write formulas like that, but I think that oftentimes they have less lasting ability or less ability to transform the underlying problem. Like, in many ways, you're creating herbal claritin when you do that. [00:33:06] Speaker B: And the other thing is, a lot of stuff works when it works, but systems show their value when the first thing you do doesn't work, and the second thing you do does. Right. Like, oh, that didn't work. Why didn't it work? Well, if I have a system of differentiation, I'm going to come back that second time and be like, oh, it wasn't that. It's got to be that. And that's really where you see a lot of really good doctors, very old doctors, very old chinese doctors, and a lot of the time. So they'll be right the first time around more often than someone like us with our level of experience. But the time that they're really more right is the second time around when they fail the first time. The second time they definitely know what to do. So it's not always about hitting it that first time. Obviously, we all want to do that, of course, but there's going to be a percentage of the time that we miss the mark with our diagnosis and treat, and it doesn't really help. So then we need a system to understand, like, okay, what do we do next? And then, even if it works, how much did it work? How on point were we, should we tweak it to make it more on point? Or should we keep it the same and wait? And then when it works for a certain amount of time, how do we transition? And that's where a system comes into play. That's like, where the value of a system also shines, is like, all right, we did this. What comes next in the system? What tends to come next? [00:34:46] Speaker A: Because if you don't have a system like that, particularly the what's next? Part, like a sense of progression and movement, right? If you just write the formula based on the symptoms, then what will happen is you'll give the formula, and let's say you used a bunch of components from Sanghart san, which is a great formula, but you were using it as like, all right, I need some sanghart san Shiniwa to open the nose. I need some, I don't know, chung ma for the throat. I need some juhua because it's in the eyes and a little boha to cool as well and support the juhua like you're thinking in those sort of, what do the individual herbs do, right kind of way. You give that formula and it doesn't work well, then the only thing that you're left with, if you constructed the formula under that understanding, is to now trade out herbs of a kind, hunting for the one that will do it, right. And I will tell you from experience, that that will leave you writing six or eight variations on a theme, none of which worked super well, right? Because there really wasn't an overarching guide to this. You were essentially taking treatment principles like resolve wind, clear heat, transform damp, or something, and then you just wrote a formula using those treatment principles, which, again, is in and of itself not a problem. But when it doesn't work, it's hard to adapt to the next thing. Because the truth is, there is no next thing, right? You applied all your knowledge to write this formula. Now you're just trading and mixing matching herbs, and sometimes you'll look out. Sometimes in the fourth formula, you'll have put together a combination of things, and it'll work. And then the funny part is, if you go and look back at it later, you'll be like, oh, actually, I ended up making chaihutang. Exactly. Because you're like, well, I think we need a cool acrid to open the exterior. Chai is good for that. And I think it is hotter than I thought, so maybe let's put some Huang chin in there. And now, all of a sudden, you're just, like, building Xiao chaiu tong, and lo and behold, it worked. Right? And that's because you sort of stumbled into the formula that was designed to deal with the underlying problem, the actual pattern. And so we've all gotten those calls, like, what's a good allergy formula? What's a good herb for sore throat? And you're like, and I hate to be that guy, right. But it's like, well, I mean, you know, I need more information than you. [00:37:17] Speaker B: Got to figure out what's going on. What's the whole thing? [00:37:20] Speaker A: Because I could write the formula, but whether or not it'll work is really. I mean, if I'm being honest, it's a crapshoot. Yeah. [00:37:27] Speaker B: You're just guessing at that point. [00:37:28] Speaker A: Yeah. And if it works out, great, but a lot of times it won't. And in my opinion, it's not worth creating that kind of lack of trust and support for what we do when it's not so complicated to get the necessary information to do it better. [00:37:45] Speaker B: Right. [00:37:47] Speaker A: Okay, so talked about how Guggen Tang could be useful here. [00:37:52] Speaker B: Yes. [00:37:52] Speaker A: Talk to me a little bit more about Xiao chaihu tong presentations for allergies. [00:37:57] Speaker B: Great. All right, so we talked about Taiyang and yangming. So, by the way, if you take the mahuang tongue progression into yangming, then you could see a moshing shirgo and tongue pattern, which is where you're going to have more panting, more difficulty breathing. Your person's going to have a fever. You can actually sweat a little bit in the moshing Shirgan tongue pattern, but it's really hard to breathe. There's panting, there's no coughing, but there's, like, a lot of painting. So when the fluids moving from tayong to yangming, just for the sake of transparency, with our first two examples, that's the progression into yangming kind of from that side. [00:38:39] Speaker A: Yeah. [00:38:40] Speaker B: That is not so common with allergies. I don't think I've ever written moshing Shirgan tongue for seasonal allergies, but it could be an asthma formula. We saw a lot of moshing sugar tongues early COVID. A lot of people had that where they'd get hit with it, and then they'd feel like an elephant was standing on their chest and they couldn't breathe, smashing a sugar know. So it's worth mentioning, I think, for those cases. So we're in yangming disease. The body has tried to resolve or change through sending warm blood to the surface. Open Taiyang. That failed. The fluids on the surface got exhausted, creating dryness on the surface. Yangming. So Yangming failed. The last resource that the body is going to try to send to the surface, to open and close the pores properly, to harmonize, so to speak, is qi. Because qi is the easiest resource to move, it's also the resource that can move into the tiniest places in the body. We say Qi moves through the hollow spaces, right? What are the hollow spaces? Hollow spaces are any space where there isn't an obvious physical thing there, like between the skin and the muscle, between the muscle and the bone, between all the little junctions and the joints. All of that is hollow spaces. So the hollow spaces are going to be patrolled, you could think of, by qi. The qi is going to move there, so the body's going to try to regulate the surface. When the blood has been exhausted, when the water has been exhausted, the qi is going to then be summoned to try to regulate the surface again. If it's successful, we won't even notice. It'll go back to being status quo, healthy. The condition will seem to resolve. Right? [00:40:43] Speaker A: Right. [00:40:44] Speaker B: But if it fails, then we'll start to see Xiaoyang symptoms. So the xiaoyang symptoms are symptoms where heat is occurring because the qi is slowing down globally, it's stagnating globally. But the places where we're going to see the Qi stagnate are places where the qi has a harder time moving naturally. We call those areas pivoting spaces. They're just spaces in the body. They're hollow spaces in the body that are harder to get into and out of. So those are spaces like the eyes, the ears, the throat, the armpits, the rib side, costal region, the groin, and the joints from a tissue layer level. So we'll see some kind of heat building up in those places. Which is why the tigong lines for Xiaoyang disease are strange or bitter, taste in the mouth, dry or sore feeling in the throat, and dizzy vision. Right. Those are just talking about different places where this stagnation can obviously occur and create symptoms. We also see tinnitus ringing in the ears. We already mentioned dizziness for xiaoyang, dizziness, but specifically, something for relative to allergies, is feeling in the throat, pressure in the ears. Anything that has to do with itching, like itching, is a very common xiaoyang symptom, because again, the qi is stagnating. And heat is being created because the qi isn't doing its job, it's not moving well enough. So heat is being created that heat can locally create the sensation of itching, or it can create red eyes even. Right. Remember Greg, one of his. Greg was one of our teachers at Ocon. Greg would look at people's eyes to see if they were red when he was thinking about prescribing Shao Chayutong. It's just because that's meant the ministerial fire is flaring, the heat's building up, boom flares, and then it creates symptoms. And because the heat is being created because of the stagnation and not because of, let's say, like a full heat pattern, the heat is going to come and go. Symptoms are going to come and go, because it's like the heat builds up, it flares and then collapses. So if it were full heat, then it would just be hot all the time, or yin deficiency heat, even be hot all the time because there's not enough yin there. But if it's coming and going, it's ministerial fire flaring. So that's the qi is failing to regulate stagnating, and then heat is building up and flaring. So that's why a lot of people, when they. This goes to the other question we were talking about. Why do people, so many people present with these patterns, the xiaoyang type pattern? The reason is because we're already too depleted, basically, to manifest with the taiyang or the yangming. So sometimes we manifest with xiaoyang as a kind of bass note, and then we have small aspects of taiyang and yangming. So maybe I have some body aches, I get seasonal allergies, and I just feel a little achy, a little cranky. That's the taiyang. Or maybe I have those itchy, watery eyes, that's the Yang Ming. And then I also have strange taste in the mouth, maybe some soreness in the throat, and I have all that phlegm that's occurring. So now I need to use xiao chai Hu Tong to treat at the base and then layer in the other components. So we have chaihu, guajir tong, which is basically the combination of Shao chaihu Tong and guajotong. That's for xiaoyang and taiyang disease. And then we can easily just add Guggen. And now we have all three Yang confirmations being treated at once. And so that right there is probably how I'm going to treat the vast majority of allergy cases. Just that combination of things because most people come in and they have that combination, and then there's some modifications we can do in specific cases. [00:44:59] Speaker A: Right. Yeah, that makes sense. Right. And again, we're thinking through the progression and the movement of things as it can appear. And it, again, is important to note that we're describing this movement for the purpose of understanding how the qi and the body are interacting with its external forces in this case. But by the time you see someone, it's already Xiaoyang, as we mentioned, and even their lived experience of it, the transition from Taiyang to Yangming to Xiaoyang could have occurred in, like, a 40 minutes period. [00:45:37] Speaker B: Right. Well, they might not have even noticed it because there's not even enough yang in the body to try to meet it at the Taiyang only level. [00:45:46] Speaker A: So it just goes right there, just. [00:45:47] Speaker B: Goes right into the. They just start trying to adapt at that Qi level. [00:45:51] Speaker A: Exactly. Because sometimes I feel like when people hear discussions of six confirmation theory, they imagine that they have to be able to see all of those transitions. [00:46:02] Speaker B: Right. [00:46:03] Speaker A: The truth is, the thing will just show up however it looks. Right. And it's important conceptually, intellectually, and I would argue clinically to understand these movements. But it's important to recognize that you're probably not going to witness these movements in real time because they just moved too fast or they started. I mean, literally, the external invasion went straight to Yang Ming because all the other doors were open, and they just sort of walked right into it. So I think that's an important thing to consider. [00:46:38] Speaker B: Let's talk about the phlegm piece real quick for that imaginary patient. [00:46:42] Speaker A: That's the important factor, because I feel. [00:46:43] Speaker B: Like that's where people wouldn't be covered by that. [00:46:46] Speaker A: Exactly. And people want to know because the client's branch problem here is that they are. [00:46:51] Speaker B: So they're fleming. [00:46:53] Speaker A: So what do we do with that? [00:46:55] Speaker B: So one of the textbook modifications from the Shanghai and the postscript of Shao Chaiutong is for a patient that has this pattern with a cough. Take out Renshen and Da Zhao from the formula, change Shangjiang to Ganjiang, and add Wuiza. That's a cough modification for cough. Do this. That's all Zhang Zhongjing says. Right? [00:47:22] Speaker A: Right. [00:47:23] Speaker B: So if we look at why that happens, why we think, he suggests that we're changing the orientation of Shangjiang to Ganjiang. So we're using the Qi layer herb of the jiangs. Right. Shangjiang still has the juice in it, so it's affecting the water level of the body. The Qi layer is Ganjiang it's going to warm the air of the body more. And Poojang is of course going to work on the blood layer. Right. We can stop bleeding with poojang. So it's definitely a blood layer type thing. So we're going to change to Ganjiang. So we're going to affect the Qi layer more. We're trying to warm up the air in the body. If you want to think about it that way a lot of the time too. Ganjiang is used for treating the lungs as well as the spleen. So if we were trying to warm up that space, that air in the lungs, we may choose Ganjiang as opposed to Shangjiang as an herb. [00:48:25] Speaker A: Sure. Okay. [00:48:26] Speaker B: Wuitsa is a sour herb. It's a sour flavor, and sour is the tonification flavor. According to the naging of metal, it does what metal is. Right? It contracts, it pulls everything into the middle. So when we have coughing, which is what the modification was originally written for, we have a kind of spasmodic condition that's affecting the lungs. The disease may not be in the lungs, but the condition is affecting the lungs, and it's causing the lungs to spasm into the experience we call cough. The same thing could be said about sneezing. So I have taken to using the cough modification of xiao chiutong for allergies as a base. So I rarely will write just base Xiao Chaiutong for allergies. I'll tend to start with that cough modification, even if the patient has no cough, because a lot of times they're sneezing. [00:49:28] Speaker A: Right. [00:49:28] Speaker B: And I find that the wuitsa, the ganjiang wuitsa helps like that sour flavor goes in and it just helps to soften the tendency for that spasmodic sneezing or coughing reflex. So it's not the whole treatment, but it goes in there and it really helps if you get into a sneezing or coughing fit and you have a lemon or lemon juice around you drink it, it'll calm the fit down very quickly. So that's something about that sour flavor helps to decontract wind. Right? It's benefiting metal and it's decontracting that wind, that windy tendency. So the Wu weights is really helpful, I think, in the formula. So that pulls it into the lungs and the ganjiang helps it to work more on phlegm than if it were just the base Xiao Chaiutong. Because base Xiao Chaiutong, we're going to have renshen and Dodzao. We're going to have three sweet flavors. Actually, if we count Jurgon's out in the formula. So we're pulling out two of the sweet. We're adding in one super pungent, or we're changing it to super pungent. We're reorienting that pungent, spicy flavor, and then we're adding in that sour flavor. [00:50:39] Speaker A: And your removal of the sweet here is. So you're not engendering more phlegm. [00:50:43] Speaker B: More phlegm fluids. Yes, exactly. So that's one way to do it. That would be one way to treat the phlegm. Another way to do it would be to take out the wrenchen and dodzal for the same reason we don't want to create more phlegm. And then I would replace it with fooling and baiju, and that would create lingui jugantang, because we already have guajer, we already have Jurgon Sao. So we just need fooling and baiju. So we just pull out those two super sweet herbs, and we add in fooling and baiju, and now we have a formula to deal with. Phlegm room in the upper and middle burners. And the nice thing about lingui jugantang is it's also a tai yin remedy. So if people tend to be Tai yin damp, it can be really nice to add that in at the beginning. And then kind of as the xiaoyang pattern starts to resolve, we can start to pull those aspects of the formula off and then lean more into the Taiyin treatment as we progress. There's a saying that somebody said one time, xiaoyang often resolves in Tai Yin, so we treat xiaoyang first. Really hit it. Get the qi moving, get the pores open, get all that stuff going. And then once that resolves, we treat tai yin and we make taiyan really strong. And if we can do that, then the xiaoyang pattern will typically not reoccur. So that's the larger scope of the treatment. [00:52:19] Speaker A: Got it. Okay. Yeah. I mean, that makes a lot of sense. So one of the things that stands out to me about that is it doesn't have in it, for example, Baijer chuanxion. [00:52:33] Speaker B: Right. [00:52:34] Speaker A: Xininhua, juhua Boha, which are herbs that are often associated with opening the sinuses and the nostrils. [00:52:44] Speaker B: Right. [00:52:45] Speaker A: And if you've never played with those herbs in bulk, you should try, because if you stick your face in a bag of bijer, you'll immediately understand what it is that is happening. It will happen when you inhale it. Right? [00:52:59] Speaker B: Absolutely. [00:53:00] Speaker A: You're like, whoa, that's super drying. So why not include those kinds of players into something like this modified phlegm, shao chagu plus lingua juganta. [00:53:13] Speaker B: I think maybe it just isn't needed. That's the thing, is when you get used to using the base remedies more and simple modifications like that, you just start to see like, oh, maybe I don't need to add this other stuff in there for kicks or for like, oh, yeah, I'll add two herbs for this or one herb for this or whatever. I think if you understand the pathomechanism more clearly, and again, there are still cases where I'm sitting in front of a patient and I'm not super clear on the pathomechanism. Right. That happens to everybody, sure. But for a lot of these allergy cases, it's much clearer to me now. And it's like, what would you need? Xinying hua? What would you need that for? With this case, we already have plunge and herbs like ganjiang in there. We already have baiju and ganjiang. Those are both going to open and work on that phlegm. Right. We have stuff that's going to lift the fluids and put them back into the right places. In the upper zhao, we have Gugen and the combination of Gugen, Bai Shao and Guajer together. So I think the reason is it just doesn't seem to be necessary. [00:54:31] Speaker A: Yeah, it's redundant. Yeah. It's interesting too, because over the years, we've done a lot of prescribing with whole formula granules in that taiwanese style. And I have written a formula that is 60% Shao Chaiutang, 35% lingua jugan tong, 5% sungar tasan. Right. And the thought process was like, oh, well, this will just more acutely deal with the congestion. Right. Because the sungursasan in that first dose, I mean, they could literally drink one dose and feel their sinuses opening up. But if you play with that formula in that way, and you're thinking about it with the acute symptomology, what I think you will find is that for a formula like sanghartisan, with those active movers, to keep someone's sinuses open in a realistic way, they'd need to take it like every 4 hours. [00:55:19] Speaker B: Right. [00:55:20] Speaker A: It would be like the weakest possible Benadryl. Right. You just got to take it all the time where I think it matters more. Those kinds of herbs, those more quote unquote symptom based herbal prescriptions is in rescue formulas or acute allergic reaction formulas. [00:55:37] Speaker B: Oh, sure. [00:55:38] Speaker A: So, for example, people who have really strong sensitivity to pet dander, pollen, things like that. It can be a formula that they can take with them if they travel. [00:55:49] Speaker B: Sure. [00:55:49] Speaker A: And something like. So maybe they don't deal with allergies a lot, but every time they go back to their mom's house in Florida, there's allergies. So they can take something like that because they'll be willing to take a formula for two, three days while they're in Florida to just deal with it when they come back home. It's fine. And I like it for also, we had a friend for a long time who is very allergic to animals, to dogs, and we have a big dog at our house. And so I would always keep actually, bulk Samir san with a couple of other things added into it that I could boil up for him real quick if he suddenly felt overwhelmed by the pet dander. Right. But as a formula, it wouldn't really, I think, work for shifting the underlying patterns. Right. [00:56:31] Speaker B: Because at its core, maybe not by itself. [00:56:34] Speaker A: Not by itself. It's actually not designed for that. It is an acute symptom based response. Right. Like, person is a little short of breath, instantly congested, red, itchy eyes, feeling like mucosa are closing up and getting tight. Here, drink this. Everything will open up. The panic will go down, the headspace will clear, and then you can obviously modify where you're at or what's going on. And then now we need to have a conversation. I think, more importantly, about these formulas that you've been talking about. What is the underlying pathogen mechanism that's creating this possibility for such intense response to an environmental allergen? So I think that that's a place where if people are used to relying on those kinds of formulas, and they're like, I don't understand why this isn't part of the game. I would say it is part of the game, but in a different way of thinking. [00:57:29] Speaker B: Yeah, I think there's a couple of things there. First, usually when someone's having an acute allergic reaction like that, we would use in the Jingfung system, we would use different formulas. Use like UAb jab bonshaw tongue or something like that. For those kinds of presentations, break out of hives or Uabju tong, you use songju and UAb tongue together or something like that. But I think that I'm just describing one way to do it. I believe that you can do the exact same thing with a different theory and thought process with treatment. Right. [00:58:16] Speaker A: For sure. [00:58:17] Speaker B: We know that that's true. It's way more about this is one of the revelations I had last year when I was kind of going through allergy season and looking at what other people were doing, and I was looking at somebody who uses fu organ diagnosis as their primary method of diagnosis. A very well known herbalist, and he was using primarily sang ertsasan for almost all of his cases, but it was heavily modified, so it would be like Sanghur san, and he liked to add one sour herb. Interestingly, his favorite herb was wume, so he didn't use wuitsa, but he used wume. Same idea, shower flavor, decontract metal. And then you have Yuping Feng san. He would add aspects of Yuping feng san into the formula as well, depending on how much deficiency there was that he saw or kind of what looked like herbs that come from. Couldn't think of the name of it, aspects of Yinchao san in there if it needed, if there was a little more heat showing, different things like that. [00:59:36] Speaker A: Slightly toxic heat presentation. [00:59:38] Speaker B: Yeah. And what was funny is if I compared what he was doing, like, if I read the case and I compared what his formula was doing and what I would do with the Jingfeng method, and you took the names of the way from the herbs, and you just looked at the flavors and the natures. They're almost identical. [00:59:57] Speaker A: Yeah. I mean, this is a theme that comes up every time we talk. Right. Which is that we are talking in terms of these formulas, because these formulas are well trod, well experienced. But the reality is that the formulas are representatives for nature and flavor. [01:00:14] Speaker B: Yes. [01:00:14] Speaker A: Because that's actually what's doing the work. [01:00:17] Speaker B: Right. That's actually what a formula is. [01:00:19] Speaker A: Yeah. A formula is a pattern of natures and flavors which could be recreated with different individual herbs. Because that's actually, I think the most important part of this, right. Is that I think sometimes people, I mean, everyone knows nature and flavor, if you're a chinese medicine practitioner. But I think that some people sort of think of that as like an extra thing, like ancillary piece. [01:00:42] Speaker B: But that is how we learn it. [01:00:43] Speaker A: Right. [01:00:43] Speaker B: We learn it in school as an extra thing. [01:00:45] Speaker A: It's just in the list of factors of what Guager is. [01:00:48] Speaker B: Right. [01:00:49] Speaker A: When in fact, Guager is an ancillary factor to being accurate and warm. You know what I mean? There are a lot of things that are accurate and warm, and they're not all equally substable. [01:01:03] Speaker B: Right. [01:01:04] Speaker A: Because sure, accurate and warm in and of itself is not quite sufficient to fully grasp what's unique about Guager. But it is absolutely the base patterning that if you were going to start to make your own. Right, that worked in the same way. To harmonize Ying and Wei and to deal with the external invasion in that way, and to manage the fluids in that way, you would need to consider the nature and flavor profile of Guejer Tong, find substitutes for it, and then look at the secondary piece. What are these other nuances about Guajer, specifically about Baishao, specifically beyond its nature and flavor. But it would always start with the nature flavor piece. [01:01:42] Speaker B: Right. [01:01:43] Speaker A: You couldn't substitute Guager with something that was, like, bitter, cool. It just wouldn't work. It's not the same thing. And not because it's not Guager, it's because it's bitter and cool. [01:01:56] Speaker B: Right. [01:01:56] Speaker A: You know what I mean? If you could imagine some alternate universe where there was, like, a species of cinnamon that was somehow bitter instead of accurate and warm, you'd be like, yeah, you can't use that one, even though they're related plants, because it doesn't have the same nature and flavor. [01:02:11] Speaker B: Yeah. So let's flip the game around a little bit. So for you, when you're working with allergy patients, because you tend to think a little more along the Zhangfu organ lines for your central diagnosis. So how do you tend to work with seasonal allergy cases? What have you found? [01:02:33] Speaker A: Yeah, my stuff's been changing a lot, I would say, in the last year, I think probably inspired by all the work that you've been doing on it and just sort of, like, seeing kind of how that's evolved and trying to get your head around the systematic process. I think for most of my years, relative to allergies, I have been writing formulas that were more symptom based. And I think that Zhang Fu organ diagnosis, to be honest, lends itself to that a little more because it doesn't have. What is the representative lung chi deficiency formula you would honestly have to reach? Well, honestly, you'd go to Shankan and you'd pull from there. And so to even phrase it that way isn't really accurate, because that's not necessarily the representative lung qi deficiency formula. It's the representative know problem formula. Right. So when you think about stuff from a Zhong fu organ diagnosis, I think sometimes you're drawn toward symptom based formulation. And I would say if you're trying to be more sophisticated than just still, then you're thinking like, okay, the organ, its organ pair, right. And its element. And so then you're, like, trying to design formulas that deal in that space and so I think that's when you get a little bit more sophisticated, a little bit more nuanced. But the thing that it's missing. But I think Zhang Fu organ diagnosis is missing, at least as far as I understand it so far. And my understanding is still shallow relative to the grades, but it doesn't come with the same kind of implicit progression that six confirmations does. I think one of the real gems of Zhang Zhongjing's work is actually that it's the charting of essentially, you can imagine as the charting of like, a single case of a wind invasion that becomes like a blood toxicity problem. Right. You could literally do that. I mean, I don't know how practical or real that is, but the theoretical model allows for that understanding. Whereas Zhang Fu on its own. Yeah, there's definitely some linkage. We know that stuff because of the wood overacting on earth element. We know there's a relationship between liver cheese stagnation and spleen chee deficiency, but it doesn't have the same kind of fluid arc that you find in six confirmations. So I think that's one of its limitations. I think then what has happened to me over the years is that I've been thinking about organ specific items. So in the case of allergies, I'm always thinking about, like, what is the overall function of the lung itself here? How deficient is it? How excess is it, how wet is it, how dry is it? [01:05:16] Speaker B: I think that's where you would have to go. Right. If you're thinking external contraction and your surface representative for that system is the lungs, you got to check out what the lungs are know. [01:05:29] Speaker A: Absolutely. And so then you're thinking for me, because most of the stuff I feel like I see here in Portland relative to seasonal allergies is don't, I don't know. I don't think I've seen that many fall dry allergy patterns since we've been here. Right? Yeah, because it is dry here in the fall, but I don't know, it's different. [01:05:48] Speaker B: Well, and honestly, last year when I had allergies, I'm a dry constitution. I have dry skin. If you look at my dad's skin, it's super dry. So I'm trying to buffer myself so that doesn't happen to me as much when I age. But I had allergies last year and I usually don't. And it was really dry, like at the end of the summer, early fall, really dry here. And the formula that I needed was Xiao Chaiutong. It wasn't like the Qinglong tongs or any of that stuff, because for Qinglong tongs to happen, you really have to get hit with cold, and the surface has to shut for that to start to happen. Right. And it was still hot at that time, so it was warm and dry. And so what I needed is my cheetah circulate and open those pores up. So that's what it was. [01:06:39] Speaker A: As a person with a damp constitution. Last fall was glorious for me. Yeah, right. It was prolongedly warm and dry, and I had one of the best falls I've had. [01:06:47] Speaker B: Same for Katrina, my partner. [01:06:51] Speaker A: Such a good fall. And so in the spring then, and that's the other thing. I feel like a lot of Portland's population is also damp because of where we live. So even if it's not constitutional, intrinsically, like, you live here long enough, and a lot of people get pretty damp. So you got damp people showing up in the spring with damp allergies. Right. And so what I see a lot of is encumbered lungs that are just, there's too much fluid accumulation, and then that fluid accumulates, and then that stagnation caused by the accumulation lends to some low grade heat, which cooks the fluids even more. And so now we've got people with hacking up phlegm, especially in the morning, they're waking up with pretty gross phlegm that's coming up sometimes with color, something that you would think of almost as like a respiratory tract infection, but it doesn't appear to be, it seems to be draining out of their sinuses, and then a lot of sinus infection as a byproduct of that. Then the phlegm does get yellow and green, but it's not coming in from the bronchioles and the upper chest. It's actually in their face. And so in that case, I am often looking know one of my faves, the Beimu Gualosan structure, because Bamu and just, I love those herbs together. I think they work so well in damp people with damp problems, because they deeply engage with thick fluid and break them into smaller, thinner parts so that your body can then deal with them. And so then the question becomes like, okay, and again, Bay McGuilosan, I've said this a million times, I think, on the podcast now, but if you go read the Bensky about Bay McGuilosan, it's for, like, lung dryness problems or something, is how he describes. Like, it would work for that, but you've got to get past that. If you read the Bensky and Wellison. I don't think you'd ever use it, right, because it's just so specific, but in, like, the function of it to moisten without cloying and transform easily, it has this really dynamic quality. So I would use that a lot. When people start having the sinus infection piece, I was reaching a lot for pieces from Yinchao san, actually, like you mentioned. So, like, you're pulling in Jeannie Hua and the other components that are going to actually deal with that stagnant heat that's there. The hard part for me was figuring out how to. I think the problem that I had ultimately, was that I feel like I would land on a formula, say a modified bay McGuires on with some pieces in it to deal with infection in the upper part of the body. And then I feel like it wouldn't actually deal with the congestion quickly enough. Right. It would get things looser, stuff would drain faster. But the client is sitting here in front of you. The patient is in front of you, they can barely breathe out of their nose. They've got terrible headache. And so I was often reaching for the symptomatic herbs. So in that case, I liked a lot Baijar Chiang wool. Right. And so let's just put something in the front of this formula, 10% of the formula, just in those two herbs, to try and open up that sort of frontal sinus, maxillary sinus, and just get in there and space it. And what I like is that when you combine that with something like Baymagualosan, you don't end up overly drying out the client, because this is this weird thing that can happen, right, where you're, like, throwing in these herbs that are really accurate and moving and opening kind of aggressively trying to put an herbal balloon in their sinuses and try and open it up. The problem is the phlegm is thick. So if you pour too much of that stuff into someone, the phlegm gets thicker in the end. [01:10:43] Speaker B: Right. To take it back to the thing we just talked about, there's also dryness. There's phlegm and dryness simultaneously. [01:10:50] Speaker A: Yes. [01:10:51] Speaker B: So you have to be delicate about how you go in and break that up. And just to side with you on the. I think gualo approaches is exactly how to approach that thick, sticky phlegm that's difficult to expect to read. You got patients that are like. [01:11:11] Speaker A: They. [01:11:12] Speaker B: Breathe, and then they get triggered into a coughing or sneezing spasm. That's because there's that little sticky phlegm. [01:11:18] Speaker A: In that sitting on top of their glottis. [01:11:20] Speaker B: You need gualo for those cases. [01:11:23] Speaker A: And if it's in their chest, then we get to everybody's favorite formula, gualo xia by bachelor, which is the most disgusting formula. [01:11:32] Speaker B: That one. And xiaoxinzhongtong is the other one I thought of. So xiaoxinjiang tongue is for that wind fun. So that's when you breathe and then there's, like, that triggered fit. [01:11:42] Speaker A: It's interesting to imagine the different ways that you can use individual groups of herbs to deal with that phlegm component. Right. But I think keeping Gualo, like you said, in your back pocket for really sticky, heavy phlegm pieces is huge. And I'm using gualo, sure, for most of that. But that's what I do too. Yeah, I just like the whole fruit. Right. But, I mean, there are some people, I think you can get interestingly subtle with people have, like, sure, no fun. Got herb jokes over here, you guys. Yeah. Like, gualo pea will definitely get into some of that phlegm stuff on that cheese space, and then the gualo ren will also deal with phlegm, particularly, like, in lower jow spaces. But it's a seed, so it can get stuff loosened up a little bit digestively. So you got to be mindful of that. But, yeah, I think overall, my approach has been at this stage, I would say I think I have found it to be more symptomatic than I want at this point. But that said, and this is why I think it's important to remind everyone, if you're thinking like, well, I don't have Travis Cunningham's level of sophistication around these stages, so how am I supposed to know what to do? That's not necessary. Get in it and start playing around with stuff. And if your level of knowledge at the moment is more organ based, more symptom based, you should still attempt to write these formulas, right? Because absolutely, without doubt, I've had excellent success by really understanding the organs movement, the organs strength and weaknesses, and then trying to design a formula that was focused on that. I think the reason that I'm interested in transitioning that style and that skill set more now is because, to be honest, I think we get harder cases now than we used to. [01:13:37] Speaker B: Absolutely. [01:13:37] Speaker A: Because we advertise ourselves that way. Right. We are internal medicine specialists. We deal with chronic conditions. So when we first opened and we were first in practice, I felt like I got, frankly, some pretty simple slam dunk cases, right? Like, oh, I've got some hay fever, and I'd be like, oh, here's some bei mugwala san and thank you so much. And they were like, oh my God, change my life. I mean, there were even some cases where you could even give them a Meiway patent pill. Was that Bing chirp wan? Bing Wan. I can't think of the name of it now. Anyway, it's like a common patent and it is basically sungir to sun mixed with some other stuff. [01:14:19] Speaker B: Beyond one. [01:14:20] Speaker A: Beyond one, yeah. And people would eat like twelve of those little BB's and be like, oh my God, my life is so much better. And that's awesome, right? Because like minimum effective dose is always the goal. [01:14:31] Speaker B: Absolutely. [01:14:32] Speaker A: But these days I don't feel like I get those cases so much anymore. I get much more complex things. And so because of that, if my first swing is amiss, then I find myself in the situation that I described earlier where now I'm just sort of like plugging and playing individual herbs. Sort of like sliding something out and sliding something else in. And it feels less satisfying, it feels less intentional, it feels more scattershot. And a lot of our clients, they've been dealing with stuff for a long time. And so in my experience, that kind of breaks them into two camps. There's one camp of people that are very forgiving of figuring stuff out because they've been dealing with it forever and ever. And so this takes a long time, whatever. Or the other camp that, because they've been dealing with it for so long, they would really like to see some results, like now. [01:15:23] Speaker B: Right? [01:15:23] Speaker A: Because they're actually at the end of their rope. They've come to us at the very end. And so they don't have a lot of bandwidth for tolerating those mix and matches. So it's much more efficient to get to the right formula. If you have this kind of progressive understanding that is represented by sort of Jingfeng style work. You know what I mean? [01:15:46] Speaker B: Let's talk a little bit about timeline so people know if I'm going to write an allergy formula, what do I expect? How quickly should it work? What's the resolution time for the symptoms? Does it work like Claritin? Doesn't it work like Claritin? What do I need to dose? Should I use granules, bulk herbs or san method? [01:16:12] Speaker A: Yeah, a lot of questions. [01:16:14] Speaker B: We can go over our preferences. [01:16:16] Speaker A: Yeah, I mean, my position is that it should work a little bit like Claritin, which is like, it's not going to be a 24 hours one a day or they're going to have to take the herbs. But a patient should notice change fairly rapidly. I mean, it's not going to completely resolve, but if they've taken your granules for two days and they've seen nothing like no change in the phlegm, nothing at all, it's probably going to be a miss. [01:16:42] Speaker B: Probably a miss, yeah. The other thing is, I think for this problem in particular, it's better if the patient can. Right. That's the big F. But if the patient can to take more doses over the course of a day than to take. So, like, normally, my starting dose for granule would be 8 grams twice a day. But for a person like this, I might do six, three times a day or five, four times a day or something like that, because that constant administration is really going to help to mitigate the symptoms and the misery of the patient more quickly and more completely. It doesn't mean that the condition will resolve faster, necessarily, but it will feel better to the patient. And the thing is, when somebody has allergies, they're suffering, and they're not used to suffering with symptoms, because there's so many over the counter medications people can take to just numb the symptoms out that don't actually resolve the condition at all, doesn't help the physiology, but it does mute the discomfort that they have. So if the herbs aren't doing that to some degree pretty quickly, they're going to go to other things very fast. And what you're going to end up is polypharmacy land. Well, I'm going to my naturopath, and I'm taking these anti inflammatories, and I'm taking a claritin, and I'm taking your herbs, and I'm taking Tylenol PM for. [01:18:14] Speaker A: This other, you end up with nightquil. [01:18:18] Speaker B: Yeah. And then it's going to be impossible to know whether your formula was on point or not because they're taking a million freaking things. [01:18:26] Speaker A: Right. Yeah, exactly. [01:18:27] Speaker B: So I think I completely agree with that. So we do multiple administrations if the patient can. Right. What do you think about granule, bulk or San, for allergies? [01:18:44] Speaker A: Man, this is a great question. I think that if you are dealing in a less congested form of fluids, so, like watery eyes, drippy nose, like that kind of presentation, I think the sans are really effective there still, because what we've learned, I think, so far, and we're still developing this because, san, for everyone who's listening, what we're talking about is bulker that's been grounded to a powder. And everyone, I think, is familiar with the formulas that are sans, Ping Weissan and Yu Ping Fung San and whatever, that's in the name. So you've heard that. But the truth is that most people don't take those as sans anymore. Right. They take them as granules, and even if they're taking them in bulk, they usually take them as a decoction, the actual San administration method, which, by the way, there's a little bit controversy over exactly what that method is. But anyway, point being, the thing is that we, Travis and I, have been playing with this a lot because bulk herbs are very expensive, but because we keep a bulk pharmacy and we deal with bulk herbs all the time, it is endlessly apparent to me that bulk herbs are a superior product over granules. Right. In terms of effectiveness, yeah. I mean, their potency is so much more apparent even just in the smell of them, the flavor of them, the taste of them. If you want to take 5 grams of bulk herb, right, and boil it into a decoction, and then theoretically, you should be able to just do 1 gram of granules, and that those two things will be equivalent. That is never going to be true. [01:20:14] Speaker B: Yeah. [01:20:15] Speaker A: I challenge anyone to bring me 1 gram of granules dissolved in the same amount of water as 5 grams of bulk cooked in a cup to tell me that those are the same. They are not. They're just not. If you don't believe me, go do it. Pick any herb. It doesn't matter. Right. And so the thing is that what that tells us is that bulk is really valuable, but bulk is really expensive, and bulk is cumbersome for patients to produce. So can we do san? So we've been playing with san, and what we mean by that is taking a formula, grinding it into a coarse powder, picking a percentage, basically, of the dosage amount. So let's say the daily dose for this formula is going to be like 85 grams, right? We're doing like 20% of that total dose. Right. So we're doing 20, 30 grams of the formula. That seems to be the case for most of the formulas, that the San dosage is about 20 to 30 grams of the formula using whatever ratio is grounded to a coarse powder. They put that powder into a pot, they put hot water in it or water in it, and boil it for some time of minutes, three minutes, five minutes, something, strain it, drink it. Right. Other things we played with soaking the songs overnight, very popular these days. You put the saun into an insulated thermos, you pour boiling water over it, you put the lid on it, you soak it overnight. Next day, strain it out. Right. Seems also pretty effective. The thing is that all of those methods with San seem effective when you're dealing in a more ephemeral disease space. What I mean is qi level space, yang level space, something that can be affected by the more effervescent quality of an herbal intervention. So, in fact, herbs like sanghurzasan are great in this. I mean, it's in the name Sanghartzasan. Not a coincidence that this was being used as a san, because those herbs contain a sort of effervescent, ethereal qi quality that affects stagnation and moves it in a really great way. And I think san is excellent for that. I don't know yet exactly how good it is for things that are a little bit deeper. [01:22:22] Speaker B: Right. [01:22:23] Speaker A: But in our experimentation so far, it still seems to hold true. I mean, again, big McGuila san was a sun historically, so it seems to work well in that case too. And Big McGuila san, I would say, is distinctly a denser, thicker formula than sanghartesan is. Right. It's not a tonic or anything like that, but it has more density to it, and it still seems to work there. The trouble, of course, is, like, now you have to prepare that. And, yeah, it's way less work than decoction, but still have to boil or measure out or remember to soak it. Do you have a scale? And I don't know what this is with Americans and scales. People treat the idea of having a scale like, I asked them to buy the most specific kitchen implement ever made, right? And I'm just like, it's a freaking scale. [01:23:08] Speaker B: You want me to do heart surgery too? [01:23:10] Speaker A: Yeah. I mean, it's wild how they react. I'm like, you can literally buy an excellent 10th of a gram scale from Amazon for, like, less than $20, and you can use it for everything. Fun fact, you can use it for cooking. You don't just have to weigh out your herbs, but anyway, so there's an added layer. And yes, you can give it to them in tablespoons or whatever, you can figure out a workaround. But ultimately, there is a patient compliance question with san, right? Are they actually going to do it? And the reason that granules continue to dominate the market is because they are cheaper. Maybe not as cheap as some people think, but they're still cheaper than bulk in almost every case, and they're easy to use, and so you can take them with you. You can travel. It's simple. So I think relative to allergies, as always, maybe to any condition, the herbs that matter are the ones the patient will take. Yes, for sure. Right. And then you just have to make sure to modify your approach based on what they're willing to take. [01:24:08] Speaker B: Right. [01:24:08] Speaker A: So like, in the case of granules, like you said, consistent administration throughout the day, four or 5 grams four times a day, is going to be more useful to the client than taking eight twice a day or ten twice a day, which is different than other conditions. [01:24:24] Speaker B: Right. You're not the same with other conditions. [01:24:26] Speaker A: And I would say, though, it is similar with cold and flu, which we talked about. Right. More frequent dosing is better with cold and flu. So when you're thinking of these kind of acute things, these external attack things, these are things you're going to need to dose more regularly throughout the day, even with sans. It's true. Like, if you were doing a San version, this three times a day. Right. So now you're also. That's the other thing you got to keep in mind. You're asking the patient to prep the san and cook it three times a day. Right. I don't know. To be frank, we haven't really done a lot of. Not recently anyway, with allergies in bulk decoction. [01:25:00] Speaker B: I used to do that. I have a couple of cases of that. So firstly, I would say I think granules work a little better for allergies than they do for cold and flu. That's been my experience. [01:25:16] Speaker A: Yeah, I would agree with that. [01:25:16] Speaker B: They're a little bit more effective. I think the way we're going to do this in the future, once we figure it out, allergy season is coming up, so we're getting ready to really refine these things here at Rooden branch. But I think San is going to be our method for allergy treatment. I really think that's going to be the most effective, the most cost effective for the patient, and also the quickest symptom relief, symptomatic relief. So I have this slide for the residents when we talk about allergies around expectations and resolution to the allergy conditions. So there's some cases that you'll do like three treatments for and they'll be done great. That's actually one of the nice things. If you ever find a Xiao Qinglong Tong allergy, if you find it and you give them Xiao Qinglong Tong, because it's mostly yang confirmation, it'll tend to resolve much faster for a lot of those cases. Right. But most people hanging out in Xiaoyang with a little bit of tai yin, they're kind of hanging a little lower. So generally those cases are going to take longer to resolve. And I give the residents three to six weeks as a basic timeline for allergy treatment. I think that's how long it takes for the majority of cases to move to a point in their treatment, not only where they're feeling better, but they're feeling better. And if you took them off of the herbs, they wouldn't revert. Right. Their physiology has adapted and changed. Three to six weeks is kind of what I say for most patients. I think if you do bulk herbs, I think you can take two to three weeks off of that. I do think it works faster. Of the cases that I've seen work with it. If you do the bulk herbs and you do them at the right dose, you don't half dose it or whatever, you really give the full dose. It's going to be more expensive, it's less convenient. Yada, yada, yada. But I do think the resolution time is faster. So that is an option to talk to the patient about. Well, we can do this granule. We can do the granule option, which is maybe a little bit more convenient, but it tends to resolve a little bit longer. It takes a little longer to resolve. [01:27:47] Speaker A: Right. [01:27:47] Speaker B: So even though the bulk herbs are more expensive, if you did the math, you do three weeks of bulk herbs or six weeks of granules, the bulk herbs might actually be cheaper at the end of the day, and the patient gets better faster. So it's just something that you can play with. You'd have to try to figure out, I think. But I really do believe once we dial in the San method, that that's going to be the best of both worlds, because I think we'll get faster resolution. I think it'll be cheaper, and it's not as convenient as granules. But if somebody's got allergies and stuff and they really want to get on top of it, I think people will do. Mean, we've seen people do it already. [01:28:27] Speaker A: Particularly if they're suffering. Yeah, if they're suffering, they've tried all the other stuff. And the other thing that's important to remember is that a lot of the over the counters, they have diminishing returns over time. So for a while, people have been able to manage their condition with Claritin and flonase and Tylenol PM, but now it's working less and they've cycled through. They did Claritin and then they did Tavist, and then they did Allegra. There's kind of shifting the antihistamines, and now they're out, and nothing seems to be helping. And it gets really distracting for people. It makes it hard to sleep, and then if you can't sleep, it gets worse, and so people will find themselves really looking for any kind of solution. Now they're talking about getting allergy shots and seeing allergists, and it's starting to really escalate. And the thing is that, by and large, it doesn't need to. [01:29:19] Speaker B: Right? It doesn't. [01:29:20] Speaker A: Chinese herbs are an excellent tool for managing this. Like, people who have decided that they're, like, sensitive allergic people, and they went to the allergist, and they got the report back that they're allergic to everything that can sort of become an identity that ends up sort of expressing itself in all kinds of ways. Right? When, in fact, what we know about how that dovetails with our medicine is, like, by the time a person is feeling so allergic that they go to the allergist to get the allergy test, of course, they're allergic to everything, right? I don't know that it's very rare. I mean, it has happened, but it's very rare that someone was like, yeah, I went to the allergist. They did the allergy test, and I was only allergic to pollen. [01:30:04] Speaker B: Right, sure. Yeah. [01:30:05] Speaker A: It's like, nah, man. And in that case, when that person went, they went kind of begrudgingly. I don't think it's that serious. But the doctor was like, no, you got to go get this test. They did. Basically, everyone else was, like, at their wits end. At the doctor. They've tried everything else. They're having horrible allergies, and they go get the allergy test, and they're literally allergic to themselves. [01:30:24] Speaker B: Right? [01:30:25] Speaker A: And so that's not an intrinsic quality. You're not just, like, an allergic person. [01:30:32] Speaker B: In our medicine. [01:30:33] Speaker A: In our medicine, in the biomedicine, it is. Oh, sorry. You drew the short straw. But in our medicine, it's not your system, as you, I think, really eloquently put it earlier. Your body is reacting poorly to these patterns that it doesn't understand, and it continues to react poorly to the patterns that it's wearing itself out and therefore reacting poorly to more and more patterns. It's a self feeding cycle. Your body's ability to deal with external issues, the failure to do so is depleting it, and that depletion contributes to more failures. [01:31:14] Speaker B: Right? [01:31:14] Speaker A: And so now, when you're failing at all of these things, and then you go to the doctor, and they give you the allergy test, then you come back allergic to everything. The thing then that we get into is that, as we discussed at the top, we get into the core problem of why your system is failing to adapt to these various patterns. We shift that underlying position and now all of a sudden your body has the skills to deal with this, right? And even the biomeds know this, right? I mean, we talk about, you'll hear the phrase like, oh, yeah, he grew out of his allergy, right? The hell does that mean? [01:31:46] Speaker B: Yeah. [01:31:47] Speaker A: Really? Biomeds have no idea. [01:31:49] Speaker B: Right? [01:31:49] Speaker A: Well, I don't know. Stuff changed, okay? Your whole system is predicated on a very deep, articulate understanding of small moving parts. But this huge thing, well, I just grew out of it. Right. Somehow people forget about that. Like they're in their 20s or thirty s and they're allergic to everything. And we forget that human bodies are so dynamic that you could have been deathly allergic to peanuts. Like you saw peanuts as a child and just keeled over, and now you're like eating peanut brittle every day, right. And people are like, yeah, I don't know, I just grew out of it. The fact that your body can be that dynamic in those circumstances, that doesn't change just because you're 30, right? It just happens with children so often, because children are in a state of change by nature. Adults are less so, but it doesn't undermine the fact that you can shift. And I think that's an important thing to remember is that you're not, hopefully not just writing formulas so that people can not have a runny nose like you're trying to participate and encourage these fundamental changes so that people are less allergic. Over many seasons of working with clients, we have seen people who, in the end, barely have allergies. [01:33:02] Speaker B: Oh, yeah, that's a big thing. Another great point to make about treating allergies is you can not only treat the symptoms this time around, if you hang out with them long enough and you treat them deeply enough, you can often prevent the reoccurrence of allergies from coming back. [01:33:20] Speaker A: That is the biggest piece for me. I had a client years ago who, they were down in Corvallis in Oregon, and they grew up in Portland and they moved to Corvallis and Corvallis. You know, the plant nature of things. It's just different. Portland and every single spring this patient would wake up with so much gunk in their eyes that they would describe it like they were almost sealed shut. [01:33:44] Speaker B: Yeah. [01:33:45] Speaker A: Just like just peeling this gunk out of their eyes. Terrible congestion. Right. And it took us like three seasons, so, I mean, three years, right. Not consistently working on it, but stuff would get better. And they're in school, so whatever. And then come around. In fact, I'm wondering if I'm going to hear from them this year, because at the end of last year, it was pretty much done. Yeah, they called to be like, hey, there's a little bit of itchiness in my eyes. I was like, oh, how about the gun? No, it's gone. Didn't happen this bad. But they had now been using chinese medicine long enough and trained long enough, in my experience with them and work with them that they knew to call me right at the beginning and say, hey, it's not quite done yet. And so this year I'm wondering if I'm going to get a call at all, because we actually shifted the underlying pattern to the point that now her body's system is able to cope with those external pieces in a way that doesn't deteriorate and deplete her. That's huge. What a fundamental change. We're not writing herbal claritin, right? [01:34:44] Speaker B: We are not. [01:34:45] Speaker A: That's not the goal. [01:34:46] Speaker B: That is not the goal. [01:34:47] Speaker A: Yeah. [01:34:47] Speaker B: It's to shift again. If we look at the dynamic, the body adapting, we help the body to adapt where it's getting stuck, and then that negative perpetuating cycle of exhausting resources and going deeper and more problems and then less ability to adapt, that cycle reverses, and then the body is able to, like, I've had cases where for allergies, cold and flu, you treat them well for that. And the body takes care of two other things that you didn't even know about. The person's incontinence goes away that they've had for years, or their asthma symptoms don't show up again for a super long time. All of these different things, they kind of just resolve or they get better and you're not even really thinking about them. Just because you look where the body's struggling and you help it to get through that particular spot, and then it takes care of all this other stuff. [01:35:43] Speaker A: Well, that's really the promise of chinese medicine in all capacities. Right. Is that in this particular narrow instance, we're talking about it relative to allergies. But the real gem of the whole thing is that we're trying to reorient your body's reaction to things, including things it's been dealing with for a long time. [01:36:01] Speaker B: Yeah. [01:36:03] Speaker A: All right, well, let's put a pin in it there and we'll give these folks a lot of stuff to digest. So, as always, everyone, thanks for listening to the nervous herbalist here. If you have questions, comments, concerns, you can always email us at [email protected] that's all spelled out, rootandbranchpapadeltaxray.com. And if you have any ideas for shows, feel free to shoot us an email. Let us know what you're thinking, what you want to hear more about. We've got a nice slate of things set up coming up for the rest of the season, but we're always looking for more advice, and we want to make sure that we can tailor this to our listeners and what you guys want to hear about. So thanks again, as always, for listening, and we'll see you next time. [01:36:44] Speaker B: This is Travis Kern and Travis Cunningham. See you next time.