Setting Up Your Own Medicinary

[00:00:00] Speaker A: Alright, so a little room noise. 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. Alrighty. Hello everybody and welcome to the Nervous Herbalist. My name is Travis Kern and I am here with my co host, Travis Cunningham. And today we are going to talk to you guys a little bit about setting up an herbal medicine. [00:00:45] Speaker B: Yeah, Travis and I thought that it would be a good idea to go back and consider some of the things that brought us into this line of work, specifically having an herbal pharmacy, setting it up. Some of the things could be useful to those of you who may want to set up your own pharmacy or are considering pharmacies to utilize for the purpose of your prescriptions for your patients. So to start the discussion off, why don't we go back to some of the early considerations. What are the things that you want to consider before going into the process of starting a pharmacy? An herbal pharmacy? [00:01:29] Speaker A: Yeah, I mean, I think the, one of the major questions that you really have to ask yourself right in the beginning is, you know, I mean, are you prescribing herbs? I mean, I know that sounds like a, like a silly thing, but I don't mean, you know, are you occasionally giving someone a bottle of patent T pills? [00:01:47] Speaker B: Right. [00:01:48] Speaker A: Is not really the same thing. I mean, like, keeping a stock of patents is relatively simple if you know which ones that you use. And also, honestly, these days, like patents, especially from like Jade Dragon and New Herbs and Golden Flower and a lot of the mainstream companies, you can buy those on Amazon. [00:02:06] Speaker B: Right. [00:02:06] Speaker A: You know, I mean, they're literally all over the place. So the capacity to get your hands on stuff like patent medicine, I think is a lot easier than it used to be. But that's not really what we're talking about here. [00:02:17] Speaker B: Right. [00:02:17] Speaker A: We're talking about a different kind of prescription where you need to customize and mix and match stuff. So the first question is like, what percentage of your patients actually take herbs? Yeah, you know, like if it's less than 10%, you probably don't need to set up your own pharmacy. [00:02:32] Speaker B: Right. [00:02:32] Speaker A: Medicine area. As a side note, we'll talk about later, that word pharmacy and medicine area, we need to explore that a little bit. You guys will hear us use it a bit interchangeably. That's not to suggest that you should. Local regulations apply. Right. However, you know, what's the number though? Is it 50%? Is it 70%? Like what's the percentage point at which you need to run your own pharmacy. Right. I'm not sure. I don't have a hard number there. I think it's going to vary for. For most people, but I think it's probably fair to say there's probably not a need for you to consider setting up a full, robust pharmacy unless most of your patients take herbs most of the time. [00:03:09] Speaker B: Right, Right. [00:03:10] Speaker A: So was that 51%? 51%. I'm not sure. But most of your patients most of the time. Right. Like, that's the very first question. Because otherwise you really just can't justify the time and the energy and the cost. Right. It's super expensive to do it on your own. So you need to make sure that you're actually gonna be able to sell the herbs that you get your hands on. So that's. That's the first question. [00:03:30] Speaker B: But how about, like, let's say for somebody who's maybe very interested in herbs and practicing herbal medicine, who has studied herbs, who likes herbs, but they just don't have easy access. Maybe they practice in a remote place. So for them, in other words, the practicality of prescription is also limited by their access. What would you suggest for that person? Because maybe they don't have a high percentage of their patients. Honorable formulas. [00:04:02] Speaker A: Right. [00:04:02] Speaker B: But they might want to start moving in that direction. [00:04:06] Speaker A: Yeah, I mean, I think that's a little bit harder to judge. Right. Because a lot of us get into rhythms in our practice that are reflections of our circumstances. So if you just didn't, like, you loved herbs in school, you wish you could use more herbs, but you don't have a pharmacy, a medicine area, you don't have access to one. You don't know how to get herbs to your patients. So you just didn't. I think that's probably fine. Like, I think you're in the right place to hear this conversation. We're going to ask some more questions about it that you can interrogate for yourself and decide, okay, I want to prescribe more herbs. Should I. Should step one be, let me buy a bunch of herbs and stock them in my clinic? [00:04:40] Speaker B: Right. [00:04:41] Speaker A: Or should step one be, maybe I can find a reliable pharmacy medicine area that'll supply my patients in my area or even nationally, there's pharmacies all across the country, Chinese medicine pharmacies, that will do this? And then maybe, let's see, like, because am I facile with herbs? Do I have treatment planning and systems around it? Because as we've talked about before and as we deal with all the time with our residents and our own patients. In order to get patients to take herbs regularly, you have to tell them that this is essential for their treatment. [00:05:12] Speaker B: Yes. [00:05:13] Speaker A: It's not going to work to be like, hey, are you interested in maybe exploring some herbal medicine? [00:05:18] Speaker B: Are you open to taking herbs? [00:05:20] Speaker A: Open to taking herbs? Like, that's not the game. Right. Not because we're, like, mandating people's outcomes, but it's just that, like, the way that you and I operate and the way that people with an herbal mindset operate is that herbs are an essential component to the healing transformative process. They're not optional. They're not supplementary. They are core. [00:05:39] Speaker B: Right. [00:05:39] Speaker A: And so when I tell the patient, this is a core element of your healing, and they say, well, I don't want to take herbs, and I say, well, I'm not sure I can help you. It's not a negotiating point. Like, I just. I'm not sure that I can help your insomnia if you don't take herbs. [00:05:52] Speaker B: Right. [00:05:53] Speaker A: Maybe there are people out there who. Who can, but, you know, I can't. And so that's why I know that my patients will take herbs. If you haven't been flexing that muscle and practicing that methodology with your patients, I don't want you to sink thousands of dollars into buying a bunch of herbs and then trying to, like, ask, like, why won't my patients take the herbs? Like that? No one's compliant. Because, honestly, it's about your expectation, presence, and presentation that gets patients to take the herbs. Not. Not in, like, every case. Obviously, some people are just resistant, but you should probably practice that part first. And a good pharmacy that can deliver herbs to your patients can give you the opportunity to practice that, to get your patients on board with taking herbs with, like, pretty low overhead. [00:06:38] Speaker B: Yeah, absolutely. Absolutely. Yeah. So what are some other things to consider? [00:06:44] Speaker A: Another thing is, like, all of these initial questions are very pragmatic, Right. Like, do your patients take herbs? Question one, question two. Do you have any space to put them? Mm. A lot of people operate in single rooms out of office suites or in buildings that are really tight, and you maybe have, like, half a shelf to put some herbs on. You know, the super common. If you're gonna end up carrying herbs for, like, if you're running a kind of complex internal medicine practice where you're seeing lots of different types of cases, you might need access to many dozens of herbs. Yep. And not just one bottle of them either. You're gonna need to keep more in stock and so do you have room to put them on a shelf, in a cabinet, in a box, in a drawer? Where are they gonna go? And once you put them there, can you access them easily? Because probably if you're doing this on your own, you're in your room seeing patients while they're on the table, you're gonna be filling the herbal formula. Is there room for a scale? Is there room for bowls? Do you have a sink to wash them in? Do you have ventilation if they're dusty? Do you. Do you have. You know, there's just so many questions about the literal space itself. [00:07:49] Speaker B: Yeah. [00:07:49] Speaker A: That if you're listening to this podcast in your treatment room right now and you're looking around going, oh, well, I've got, like, you know, a couple of square feet in the corner. Like, it's not enough. [00:07:58] Speaker B: Right. [00:07:59] Speaker A: It's just not, you know, and not. Not because you're going to have a pharmacy or a medicine area as big as ours. It's just because most people need, as we'll talk about later, like, you're going to need probably at least 25 herbs. You know, that's a really small number. Some people listening, like, only 25. It's like, yeah, we got a system, y'all. Don't worry. But you're probably going to need at least 25 herbs. And the square footage for 25 herbs is not small, plus a scale, plus a bowl, plus, you know, the spoons and the bags and the labels and label printer and the regular printer and all of the kind of stuff that goes into it. So that's my next big question. Just pragmatically, do you have space? [00:08:34] Speaker B: Yeah. And I have a colleague in San Diego, actually, who keeps his small line of granules. He does just granules, and he keeps a small line of them in a closet. Like, there's a closet in the. It's like a coat closet. [00:08:52] Speaker A: Yeah. [00:08:52] Speaker B: And he keeps them in there. And he says it's, you know, it's dusty, which is, you know, an unavoidable thing. But he rents a space in another practitioner's clinic, and part of the rental agreement is to use that closet for his herbs. [00:09:07] Speaker A: Yeah, yeah. [00:09:07] Speaker B: And he makes it work. [00:09:08] Speaker A: Yeah. So I think you can make it work. Right. I mean, there's sort of like the perfect and the functional and the suboptimal. Right. There's sort of all these things, but all three of those can still work. You know what I mean? It's just a matter of figuring out what's going to get you where you need to go. But I mean, if you, if you don't have a closet, though, you know, what are you going to do then, right? Are they just stacked on the floor next to your desk? Like, it's going to be difficult to use that. So I, I think space is a real consideration. The next big piece, too, then gets us closer to the question of, like, okay, well, I have some space, but how much space do I need? Which gets to the question of, like, well, how many herbs do you need? [00:09:47] Speaker B: Right. [00:09:48] Speaker A: Which then gets to the question of, like, well, what do you treat? [00:09:50] Speaker B: Right. [00:09:51] Speaker A: You know, what do you treat? So if you're practicing now and you've been practicing for a while, and you do a little bit herb, a little bit patent, but you want to expand and you want to maybe keep your own stock because, you know, let's talk about what the advantages are keeping your own stock. Right. If you have them here, it means that when you're done with the appointment, the patient's gonna walk out the door with their herbs. That is really, really important for a lot of conditions because you need to be agile with your delivery. [00:10:18] Speaker B: Right. [00:10:18] Speaker A: So, you know, if you live in a place in the closest herbal medicine area that you could use, it'll take three or four days for herbs to be shipped from that medicinary to your space, to your. To your clients, your patients. You know, that's going to really impact your flexibility, your agility, you know, especially if you're prescribing, like, stuff for cold and flu or for acute infection, you know, five days later. I mean, the cold in many people is basically done right. [00:10:44] Speaker B: You know, by the time it's totally different pattern or. [00:10:47] Speaker A: Yeah, it's gone deeper or changed or something. Right. So the benefits of having your stock is immediacy and agility. The other benefit, of course, is that you have an easier control over the positive impacts to your revenue stream. How much you mark up the herbs, how much you sell them for. Like, you have much more direct control over how much money you can make from selling herbs. The downsides, of course, are space and time. So if you're looking at your client base and you're saying, like, well, you know, mostly I run a, you know, a musculoskeletal acupuncture practice. [00:11:23] Speaker B: Yep. [00:11:24] Speaker A: But I've done some CE and I've listened to this podcast and I've talked to some other people and like, I want to add herbs in here because I think it'd be really helpful to speed up recovery, improve outcomes. You know, in that case, you can probably, you don't need a huge collection of things. There's probably some pre blended mixes and formulas that you can keep on hand that'll be largely applicable to most kind of, shall we say, everyday musculoskeletal problems, shoulder pain, knee pain, low back pain, et cetera. These will probably belong to Jiuyutang family formulas. You can buy them pre blended from Evergreen and other companies. Very little modification, very straightforward. [00:12:04] Speaker B: Yeah. You know, what are some examples of that? Just so in case people have a, you know, some people have a slower ear for herbal names and formula names. So Juyu tongs. What, what are some examples of those formulas? [00:12:18] Speaker A: So the classic one, the sort of the main named one is Shui Fuji Utong. [00:12:23] Speaker B: Yeah. [00:12:24] Speaker A: Which is the. If you recall from school, everyone, it was the mansion of blood formula, the Shui Fu. Right. That's in the center of your chest. The original prescription describes what sounds a lot like sort of cardiovascular problems and chest constraint. [00:12:37] Speaker B: Yeah. [00:12:38] Speaker A: But it becomes a sort of progenitor formula for a family of formulas that many people refer to as the Jiuyutang formula. So that's Shu Jiuyutang, Shin Tong, Juutong. Juutang. Right. They all have Jiuyutang at the end. And so in those formulas you find a similar, you know, approach to essentially mild blood nourishment with blood movement. Right. As sort of like roughly speaking. And then the question is like where in the body? [00:13:07] Speaker B: Right. [00:13:07] Speaker A: Lower Jiao extremities, Chest, head, Head. And so when you look at that set of formulas, I guess there's what, five of them? [00:13:15] Speaker B: Yeah, there's, there's the, there's like I can think of four off the top of my head. [00:13:19] Speaker A: Shu shentong, gefu. And then isn't there tongcha tungsha. Anyway. Yeah, there's four or five of them. They belong to the Jiu 10, the main ones. Yeah. And the use for those formulas is they're pretty applicable to almost every sort of like physiological, like musculoskeletal problem you can think of. You know, maybe you add to that, you know, Du Huo Ji Shengtong. Great formula for lower leg, lower body. [00:13:49] Speaker B: And better for deficiency cases. [00:13:51] Speaker A: Better for deficiency cases. Yeah, absolutely. But the point being that you could probably build an effective pre blended granule pharmacy with probably less than 10 formulas. [00:14:04] Speaker B: Right. [00:14:05] Speaker A: You know, that would really give you pretty broad access that is easy to store. You know, 10 formulas, easy to store. You can even sell them to people in the whole bottle. [00:14:14] Speaker B: Yep. [00:14:15] Speaker A: You know, so the bottles come 100 grams from Evergreen or anybody else really who does pre blended, it doesn't have to be evergreen and you just sell the whole bottle at a straight markup. Easy peasy. Right. Nothing complicated. This is better than giving people t pills. Just going to 100% is better. It is is of a similar style, however, in that you're dealing with an unmodified patent. [00:14:37] Speaker B: Yep. [00:14:38] Speaker A: So, you know, is that formula always going to be the best fit for the patient in front of you? Maybe not. But if most of your work is musculoskeletal in nature with relatively robust patients, I think is no problem. [00:14:52] Speaker B: Right. [00:14:52] Speaker A: You know, once you get past that though, if you run an internal medicine clinic as we do, and you've got digestive disorders, insomnia, anxiety, depression, just look at what you're treating. So like, if you're already treating these people, look at your caseload, like literally open up your ehr, go look at the last like three months of cases and just say like, okay, if I would have written an herbal formula for all of these cases, what would I have written? Okay. [00:15:21] Speaker B: Yep. [00:15:21] Speaker A: And you know, this isn't going to be everybody's favorite solution, but go ahead and crack open Excel and build yourself a spreadsheet where you put in all the formulas. Right. And then you can sort them and just see like, okay, well, how many times would I have written bancia shay shintang? How many times would I have written, you know, whatever other thing, guizhu tong, some foods of formula, who knows what. Right. Just look at it and then you can actually begin to figure out for yourself what you're already doing. [00:15:47] Speaker B: Right. [00:15:48] Speaker A: It may be though, that if you are kind of a general practice Chinese medicine provider, you may have dozens and dozens of formulas. [00:15:57] Speaker B: Yes. [00:15:57] Speaker A: That you could have written. Right. Because you've been in practice for a while, you're good at diagnosis, you see complex cases. And if that's the case, if you're looking at dozens and dozens of formulas, you're going to be in an ingredient list that's probably upwards of 50, somewhere between 50 and 75 single ingredients in order to make all of those formulas. And now you're starting to really get into a real estate question. [00:16:20] Speaker B: Right. That's a lot of space. [00:16:22] Speaker A: That's a lot of space. [00:16:23] Speaker B: Right. [00:16:23] Speaker A: It really is. I mean, 70, 75 granule herbs on vertical shelves are probably going to take up a space that's probably equivalent to four by eight. [00:16:34] Speaker B: Yeah. [00:16:34] Speaker A: You know, five by seven. Like a pretty big. [00:16:36] Speaker B: There's the investment. Right. Like what's, what is the Investment initially to, to dig into something like that, it's going to be much more than. Than 10, you know, patented remedies for things. [00:16:48] Speaker A: Yeah. I mean, if you, if you just bought one bottle of sort of, let's say, 50 formulas, you know, that you were going to keep on hand, or let's say 50 ingredients for your three dozen formulas, you're looking at between 600 and $1,000 just to buy one bottle. [00:17:08] Speaker B: Right. [00:17:09] Speaker A: Of all of those ingredients. [00:17:10] Speaker B: Yep. [00:17:11] Speaker A: Right. And that's, that's not an insignificant amount of money. And that's just one bottle of those. You know, our pharmacy, we do a lot of business, so the stuff we keep on hand is, you know, we keep, you know, hundreds of grams of herbs on hand. So I've got 4, 5, 6, 10 bottles of a thing on the shelf that wouldn't be the scale that you would need to operate on if you're just getting started. But you're going to need more than one bottle. [00:17:35] Speaker B: Yes. [00:17:35] Speaker A: Of most everything. So realistically, you're looking at $1,1500 in just the single ingredient startup cost. [00:17:43] Speaker B: Yep. [00:17:43] Speaker A: You haven't bought a bag to put them in, spoons, bowls, labels, scales, nothing. Right. You've just bought basic material and you're already at 1500 bucks. And then the question is, like, well, how long you're going to keep? Like, how long will that last you? How much of that money that you just put on the shelf is actually just sitting there waiting to get used? Because you've made that capital investment, but you're not going to make any of that money back till you sell it. [00:18:07] Speaker B: Right. [00:18:07] Speaker A: And so then when you look back at your list for the last year and you see that you wrote a formula, you wrote Wu Mei Wan one time in the last year, but that formula totally worked for your patient. Knocked it out of the park. Knocked it out of the park. Right. Wu Mei Wan would have been the killer. But you only wrote it for one patient. Are you going to keep all the ingredients necessary for Wu Mei Wan on the shelf? Because some of them are going to cross over with other stuff for sure. But Wu Mei is not. [00:18:36] Speaker B: Right. [00:18:36] Speaker A: So the womay is going to sit on your shelf for another year, two years, three years, how long? Right. Yes. They don't expire. But that's money that came out of your pocket that's sitting on the shelf. Was that really the best use for your money? Or would it still have been better to find another source to deliver that to your patients? [00:18:54] Speaker B: Right. [00:18:54] Speaker A: You know, I think that's really, the. Those are the questions that I'm always asking myself when. When people wonder like, okay, what should I start up with? If you're already practicing, I actually think it's a little bit harder than if you're brand new. [00:19:05] Speaker B: Yeah. [00:19:06] Speaker A: Because if you're already practicing, you probably have some facility with different cases and complexity, and that's going to feel like you need more herbs to serve the diversity of what's in front of you. Because you've built systems. Right. You know how you're diagnosing and what you would prescribe. But if you're new, I actually think that's a little bit easier. Right. And mostly because of the work that you've been doing around trying to help our residents get set up with a more simplified diagnosis and delivery system. [00:19:38] Speaker B: Right, sure. [00:19:39] Speaker A: So, in fact, why don't we, as we talk about the sort of, like, herbs to stock, like, let's just talk a little bit about this idea because it'll be relevant to what I'm going to recommend for people who are brand new. [00:19:50] Speaker B: Sure. [00:19:50] Speaker A: So basically you've been developing a system, a simplified herbal diagnosis and formula selection system for new practitioners who are just getting into the work of herbal use. Because there's so many formulas out there, it's hard to know what to pick. [00:20:10] Speaker B: Absolutely. [00:20:11] Speaker A: So what was the final number? How many formulas in the initial kind of starter kit, shall we say? [00:20:17] Speaker B: Yeah, the starter kit is 12 formulas. And many of them have crossover ingredients or structures. [00:20:24] Speaker A: Right. Because they're mostly like wager type formulas based off of Guizhetong. [00:20:29] Speaker B: Yeah, it's like almost half of them are based on Guizhetong. Yeah, exactly. And so you add one or two herbs, you get another formula kind of thing. [00:20:41] Speaker A: So in that case, what's nice about a system like that? And you know, this is not the only place that you could access the system from Cunningham here. There are other people who have simplified systems. But what's nice about a simplified system is like to make those 12 formulas is 25 herbs. [00:20:57] Speaker B: Right. [00:20:57] Speaker A: 25 single herbs will let you make 12 formulas, and those 12 formulas will let you treat a wide, wide host of conditions. Huge. Yeah. In fact, I. I'll let you guys know, users, that when as TC has been putting this together, I find it fascinating. I love systems that are like, applicable. And so I've been running tests on my patients. Uh, sorry, patients. You're not guinea pigs exactly, but a little bit to see. Okay, well, what if I just restricted my diagnostic, my diagnostic sort of viewpoint to this system? This 12 formula system and to, to, to very briefly cover it. The general idea here is that you've got some core differential systems that you or differential symptoms that you pick up in your questioning abdominal exam, pulse and tongue, and that that drives you toward a formula or a combination of formulas. It doesn't have to be just one. Yep. And so then you put those formulas together and then deliver them to the patient. Unmodified. [00:21:58] Speaker B: Yep, totally unmodified. [00:21:59] Speaker A: This is a key piece. Unmodified. So you know, if you've got a certain set of symptoms that call for Xiaochai Tong. My favorite example we've talked about before is sore throats. You've got a presentation that calls for Xiao Chaotong. You got alternating symptomology, Xiaoyang presentation and a sore throat. We're not going to add Shung Ma and Mabo into that formula. [00:22:20] Speaker B: Right. [00:22:20] Speaker A: Just gonna give them Xiao Chaiotong. [00:22:22] Speaker B: Yep. [00:22:22] Speaker A: Unmodified. Fun fact, everyone. It works. But the, the reason behind this idea is that modifications, firstly from a just a pragmatic point of view, it's more herbs you have to carry. [00:22:36] Speaker B: Yes, Yep. [00:22:37] Speaker A: But also from a diagnostic point of view, modifications can muddy initial diagnosis and delivery. [00:22:43] Speaker B: Absolutely. [00:22:44] Speaker A: Because, because what? I mean, you can't tell. Right. Like if you put too many things in it, was it my mods or was it the formula? [00:22:52] Speaker B: Exactly. And you don't get as much good information when you, when you write the prescription. So when you write a prescription. When I write a prescription, I want three things to happen. I want to have good information that comes with the prescription, whether it's successful or not. So if it's not successful, I still want that to be a situation where I get good information. Right. So if you give a formula that's overly modified and then they come back and it didn't get any better, it can be very hard to figure out what to do next. I want to avoid that. So if I give a formula and it doesn't help or the patient gets worse or the there's some negative consequence, I want to have that experience deliver good information to me so that I'm much better, much more likely to land on the right remedy the second time around. Right. So that's important. If it does give me, if we did get good results, it also, by keeping the formula simple, it informs me of where the case is likely to go next. If the formula is too complicated in structure, it can be hard to predict what's underneath the initial part of the pattern. Right, right. And, and so those components are really Important. Yeah. [00:24:20] Speaker A: Well, and you'll have to forgive us listeners for. For teasing material that will definitely come out in a future podcast. But we mention it here primarily to point out that your system of prescription and delivery is the most significant determinant for how many herbs you got to keep on hand. [00:24:38] Speaker B: Exactly. [00:24:39] Speaker A: And if you can use a system, especially as a new practitioner that's relatively constrained from an ingredients point of view, you can still treat a widely wide host of problems. [00:24:53] Speaker B: Absolutely. [00:24:54] Speaker A: In fact, in the last two months that I've been using this system, I haven't found a single thing yet that I was like, oh, I don't know, I think I might avoid the system for this one. Right. [00:25:05] Speaker B: Yeah. [00:25:05] Speaker A: And this has been insomnia, this has been idiopathic neuropathy, this has been digestive disorder, it's been epicondylitis. I mean, it's just hugely diverse set of cases all falling within this system. So if you're thinking like, oh, I don't know if I could actually treat people with only 12 formulas, I'm going to tell you right now, you can. You definitely can, especially if you're new. [00:25:28] Speaker B: Yeah. [00:25:29] Speaker A: Right. So 25 herbs in that bundle. If you were going to add to that bundle, we were looking at some herb lists and thinking like, okay, well, maybe you want some pain herbs in there or some other herbs that, you know, deal with stuff outside of the basis for modification later on. And. But, you know, that's another five herbs. [00:25:46] Speaker B: Yep. [00:25:46] Speaker A: You know, rushing mo yao, sanchi, yanhusuo, stuff like that. [00:25:50] Speaker B: Yep. [00:25:51] Speaker A: So now you're looking at 30 herbs, right? 30 herbs is a much more manageable number of herbs that you could find space to put in your, in your pharmacy, in your clinic somewhere. The pharmacy section of your clinic. I think it's important to remember other considerations. Right. Do you have any expectation that you're going to powder herbs or process them? We've just been talking about granule here, right? [00:26:15] Speaker B: Yep. [00:26:16] Speaker A: But you can buy powdered granules, Right. You can buy baishao and you can buy chow baishao. Right. You can buy FA ban cha and jiang bancha. Right. There's different modifications. Are you going to keep multiple versions so that you have more control and specificity? And what if you want to do bulk? [00:26:32] Speaker B: Right. [00:26:33] Speaker A: What if you want to grind up a topical. What if. You know, a lot of times what has happened over the years is that because there hasn't been good access to this kind of delivery system, people just don't do it. You know, even a topical soak would Be great for this, you know, psoriasis presentation or, you know, a face mask would go great for that. Cystic acne. And maybe, you know, this cold and flu would be better served by a bulk delivery. But people can't get it. They can't find it. They don't know how. They can't stock it themselves because they only use it four times a year. And so that doesn't happen. And that's a real tragedy. That doesn't mean you need to go stock it, though. [00:27:11] Speaker B: Right? [00:27:12] Speaker A: Right. There are other people who do this work. We do it on the west Coast. There are pharmacies and medicine areas on the east coast that do it. There's even some central, middle part of the country places you can do it. There's not a lot of us, but we're around. And you can find one that's close enough to you so that you can get deliveries in two or three days. Post is pretty good about that stuff now. And so you can still access these useful tools without having to do it yourself. [00:27:37] Speaker B: Yes. [00:27:38] Speaker A: Right. Let's talk a little bit about profits. [00:27:43] Speaker B: Yeah. [00:27:44] Speaker A: Everybody's favorite topic on. [00:27:45] Speaker B: Yeah. Huh. [00:27:48] Speaker A: So when we. When you buy herbs, right. Let's say you go to Evergreen and you're gonna buy a bottle of chaihu and you're gonna buy that bottle of chai who, and it costs, you know, like 14, 15 bucks. So you just bought 100 grams of chaihu for 15 bucks. Your cost per gram of chai who is 15 cents. Okay. [00:28:07] Speaker B: Yep. [00:28:08] Speaker A: If you look at sort of the world of retail and how things are marked up, you know, like if you go to your local grocery store, although these days, maybe grocery store, not a great example, but I mean, if you're going to any place that marks up products, the space between the person who manufactured that product and what they sold it for, and how much you are going to buy it for at the retail point has been marked up probably three, four or five times. [00:28:32] Speaker B: Right. [00:28:32] Speaker A: Okay. And each time it's been marked up, it's been almost doubled in price virtually every time. [00:28:39] Speaker B: Yeah. [00:28:39] Speaker A: You know, and why is that? Like, people say, like, oh, you bought it for 15 cents, you sold it for 30, that's like 100% profit. What are you doing? Right. It's like, well, firstly, it's not 100% profit, it's 100% markup, it's 50% profit. Because the 30 cents I sold it for, half of which is material cost. [00:28:57] Speaker B: Right. [00:28:58] Speaker A: And it would honestly be a little bit crazy to say that it's even 50% profit because that's only based on the cost of goods. [00:29:04] Speaker B: Right. [00:29:04] Speaker A: What about the labor time it took to make it, the space it took to store any of the equipment costs that went into the initial creation of the space itself. Right. This is eating into your costs. What about credit card transaction fee? [00:29:17] Speaker B: Yeah. [00:29:18] Speaker A: What about the 30 cents on every transaction of the 3% you lost? You know, what about the shipping costs for getting those herbs to you? Did you account for that in your pricing? So when you really start, like if you do a deep accounting analysis on what's called cost of goods, so that's like, how much did you pay for it when you got it? It's usually the thing that people pay attention to for the markup. Like, you bought it for 15 cents, you sold it for 30 cents. Look at that, it's 100% markup. That's true. But 100% markup is only 50% net. Right. In that cost of goods analysis. And that 50% is also itself going to be eaten up by labor and other costs. [00:29:55] Speaker B: Right, Right. [00:29:56] Speaker A: So that means for every dollar that you sell in herbs, in the best case scenario, you're making about 30 cents. [00:30:05] Speaker B: Right? Exactly. [00:30:06] Speaker A: For every dollar. Right. Even with 100% markup. Now, is there variation that's possible here? Yeah, for sure. But remember that like, not everything can be marked up that well. Because let's say you buy an expensive herb, a bug shway, zhi or tu bia chang or, or renshen or fuca. Renshen or fuca. Any of these things that are expensive at some point. Like I just bought, I just bought some, some scorpion. Yeah, right. And chuan is like almost ninety dollars for a hundred grams. [00:30:41] Speaker B: Yeah. So ninety, almost ninety cents per centigram. Right. [00:30:46] Speaker A: Now, if someone wants to use that in a formula, they don't usually have to use a lot. Right. Four or five grams and a hundred gram dosage or something. Right. So 4 or 5% of the formula. But if you double that price and you make it a dollar, 80 a gram, and now someone's using it in a formula regularly, and they're all of a sudden adding anywhere between eight and ten dollars to the formula cost every time practitioners are looking at that and they're going, I don't know, can I pass on that cost to my patient? Can they afford it? And so now chuan chi is not getting used. [00:31:15] Speaker B: Yep. [00:31:16] Speaker A: So then you lower the markup. And so if you have herbs, for example, that are expensive, chuan cha is very expensive. But like bancha is expensive. Chai. Who's expensive? Swanzo, Ren. Crazy expensive right? Now, you know, these are common herbs, herbs that we use used in high amounts, especially chaihu. And it costs a lot. So you might have to throttle your markup on those herbs, pull it back, because to keep it at a full 100% just pushes the cost of the formula so high. But when you do that now, for every dollar of chai who you sell, instead of making 30 cents, maybe you make 10. [00:31:52] Speaker B: Right, right. [00:31:53] Speaker A: And so now all of the effort and time that goes into the production of that formula, the storage of it, the buying herbs, the delivery, the shipping, the cost, when you start adding all of that up, the markup potential, like the profit potential is not huge. [00:32:09] Speaker B: Right. And while we're on the depressing side of the discussion, we might as well give the full picture. The other thing that I find incredibly depressing about owning a pharmacy is that you sell. So you buy the herbs, right? You're out money. You have the herbs in your place, you write a formula, the patient gives you the money for the formula that you've written for them, but then you're down herbs again. So you have to order more. Right. So even though you've made a profit on the herbs that you've ordered the first time, you have to order more before you can really do anything else. So it feels very much like you're always buying herbs and you're never making money on them. Yeah, like that. Just even though you technically are making money, eventually it feels like you're never making money. It feels like you're always ordering more and you're never making money. So I just wanted to bring that up because I think it can be depressing. [00:33:11] Speaker A: Yeah, yeah. [00:33:13] Speaker B: Psychologically, when you're. When you're starting off with this. So if people are prepared for that, maybe that part of the process will be easier, you know? [00:33:21] Speaker A: I mean, consider all of the. All of the overhead costs, right? So if you sold $1,000 in herbs, retail price this month, Thousand dollars. If you really crunch your numbers. Well, at least half of that was the cost of the herbs themselves. So you only had $500. And then probably another 20% of that is going to be the packaging, the labor to fill it, the printing costs, a portion of your initial startup, and any labor. Now if you're doing it yourself, you might be thinking like, well, you know, I was here anyway. I don't need to pay myself. Like, okay, that's fine. But if you get to any scale where you need support in order to do it, or you can't deliver those herbs yourself. Now you got to pay someone, and that's a not insignificant number. [00:34:06] Speaker B: Well, and even if you decide to do it yourself, how is that going to work? You really. You would have to think through that process. So let me give you an example, a couple of examples of people that I know who own their own pharmacies, how they do this, just single pharmacies, like, they're the only people that use it. My friend in San Diego, who does his thing, he sees few enough patients at once. He only works one room at a time in his practice, so he can put needles in, go out, and fill the formula while the patient's there. But a lot of us see more than one patient at a time. And if you add herbs onto the top of seeing multiple patients at a time, the time in between each patient interaction gets more. More and more constricted, particularly if you're giving herbs to most of your patients. Right, right. So then another strategy that a friend of mine does, I think she practices in Tennessee. She sees three patients in a row, and she does. They are stacked. So it would be like every half an hour. Every half an hour. Right. And then after the third patient, she has a break that's like a half an hour. And she'll fill. Because the majority of her patients get herbs. She'll fill the formulas of those three people in that half an hour and put them at the front desk for them to pick up later that day or the next day or whenever they can get around. But that's how she does it. So even if you structure your schedule that way, she's taking time out of her day that she's not getting back. Right. Like, it's not like she has a break, really. [00:35:46] Speaker A: Account for as a payment that she. [00:35:48] Speaker B: Would have to account for as a payment piece, because that time is time. She's not seeing patients. It's also time, by the way, that she's not, like, eating lunch. Yeah, right. So you would need more time for any of those other activities. So I just want to bring that up because I think we don't do a good job of defending our own time as practitioners in our field. And we should. We should consider our own time and how much we're getting paid and where time is going, and that it always costs us money if we're putting out time for these other things. [00:36:22] Speaker A: Yeah, I mean, absolutely. And I get the impulse. Right. I mean, we've encountered people, for example, who will buy a bottle of herbs, like a Pre grant pre formulated granule from evergreen. They'll buy 100 grams for 20 bucks and they'll sell it for 20 bucks. [00:36:36] Speaker B: Right. [00:36:37] Speaker A: You know, like, you bought it for 20, sell it for 20. I don't want to pass on that cost to my patients. Totally understand that impulse. I get it. But in reality, unless you were ordering enough to get free shipping, and even then, you can't always get free shipping. You know, you actually lost money. You did on that exchange. [00:36:53] Speaker B: You lost money on that exchange, even. [00:36:55] Speaker A: Though they gave and it wasn't a lot of money, but you lost some money on that exchange. And to be honest, there really wasn't any reason for you to. [00:37:01] Speaker B: Right. [00:37:02] Speaker A: You know, you could have even bought it for 20 and sold it for 25 and made a very tiny margin, but at least you wouldn't have lost money on the exchange. [00:37:10] Speaker B: Right. [00:37:10] Speaker A: The point being is that you just have to pay attention to all the moving parts. Right. It's not, it's not enough to only look at how much you bought this for. [00:37:18] Speaker B: Right. [00:37:18] Speaker A: There's a lot of pieces that go in it. And so like in the example that we were talking about before, you know, you sold $1,000 worth of herbs, 500 of those dollars was cost, another $200 was labor and incidentals. And so for every, and this is in a good scenario, for every thousand dollars you sold, you put $300 in your bank account. But as you pointed out, now we need to buy more herbs to fill back the ones that we just sold. So of that 300, let's say half of it is going to go back into buying more herbs because we needed the liquid to do it. So the actual true usable capital beyond what you needed to buy more herbs is even smaller than that. So you're looking at 15% of your total sales. And is money in your pocket, Right? [00:38:04] Speaker B: Not very much. [00:38:05] Speaker A: It's not very much. You know, and then if people listen to this, have more business experience, you know, you might say, like, well, you need to charge more for your herbs or you need to do a better job with labor. And it's like, yeah, no, you're totally right. These are things that people have to consider. But our market has limits. [00:38:19] Speaker B: It does. You know, I, I have a question about, so what then? As far as calculating, we have a very sophisticated software system that we utilize that we can utilize because we have a pharmacy as big as the one that we have, and it supplies many practitioners around the country, not just ourselves. But what do you do as far as calculating cost and Even dosage. Like if you have 25 herbs, individual herbs that you're going to put into a formula and you have to calculate the dosage and you also have to calculate a cost to charge the patient, what do you recommend people do for, for those systems? [00:39:02] Speaker A: Yeah. You mean like people doing it by hand? [00:39:04] Speaker B: Yeah, or like by hand. Or if there's a. I don't know if there's. I wouldn't expect that you'd recommend using a system like the one we use. [00:39:13] Speaker A: As it would be too expensive. [00:39:14] Speaker B: Too expensive and it's not designed for an individual person to use. [00:39:19] Speaker A: So. Yeah. [00:39:19] Speaker B: What, what would you recommend for somebody like that? [00:39:22] Speaker A: I mean, there's, there's basically three ways to go about it. The, the simplest and most direct way is to basically take all the cost of your herbs that you bought and figure out an average price per gram. [00:39:34] Speaker B: Yep. [00:39:35] Speaker A: And then just charge that. [00:39:36] Speaker B: Yep. [00:39:37] Speaker A: So it doesn't matter what the formula is, it doesn't matter what's in it. It's just this is the cost per gram on average. And that will probably work well for most situations. [00:39:47] Speaker B: I can add another example to how that would work because I have a colleague in the, on the east coast who just decided, he did a bunch of math in the beginning and said, you know what, I like to use a bunch of futsa. Futa is expensive. Right. And I need to charge 50 bucks a week for my patients to make sure that I'm making a profit on all of my formulas. So he just, he looked at his dosage, he looked at what he did, and a lot of the time the formula cost fell underneath that for what he would need to make a profit. But sometimes it actually went a little over that. [00:40:26] Speaker A: Yeah. [00:40:27] Speaker B: So $50 was his line. So if he does herbs with patients, he just says, all right, it's part of the program. And he also does exclusively treatment plan based work. So he's, if people come to see him, he's going to be selling them on a treatment plan that includes an herbal option. And if they do do herbs, then it's 50 bucks a week for as long as the treatment plan is. So if it's a month, you know, two months, whatever it is, it's going to be 50 a week. So that's a simplified way of making this distinction. [00:41:03] Speaker A: It's an extension of the same idea. So basically you just took an average. The thing about averages is it's in the middle. [00:41:08] Speaker B: Right. [00:41:08] Speaker A: So sometimes it'll be below that, you'll make some money. Sometimes it'll be Right. On it. And you won't. [00:41:13] Speaker B: Right. [00:41:13] Speaker A: And sometimes it'll be above it and you'll lose some money. [00:41:15] Speaker B: Yep. [00:41:16] Speaker A: So you're hoping that it all kind of just levels out and you pick whatever number is a profitable number, you know? So like, let's say you add up all of your herbs, right? And you spent a hundred dollars on herbs and you had 10, 10 herbs that you bought. So that's 10 cents a gram cost, right? Average. And so we're going to make the cost 20 cents a gram. All right? So now we just. We pay 20 cents a gram. You could write a formula like a Shao chai hutong formula. It's going to be more expensive than that, you know what I mean? Just because the herbs in it are more expensive, the chaihu and the bancha and the renshen. And so if you're slinging a whole bunch of xiao chaitong, there could be weeks or even months at a time where you're actually losing money on your herbs. [00:41:57] Speaker B: Right. [00:41:57] Speaker A: But then, you know, the winds shift and you're slinging a bunch of guizhu tong and all the ingredients in guicheong super cheap, and you're still charging 20 cents a gram. So, like, for example, guager runs usually about 6 cents a gram cost, and you're selling it for 20. So you're making much, you know, you're making more than three times the cost. So you would have to do your math over the course of like a whole year, Right. Or at least many months at a time to see, like, is this working for you? [00:42:25] Speaker B: Yeah. [00:42:25] Speaker A: Are you actually coming out ahead? Because it'll be hard to tell which an average based system, but it is the simplest way, right, to do it. If any of the listeners have any facility at all with Excel, then you could actually build a spreadsheet that you could type it when you bought herbs. Like when the invoice came in, you could type them into your spreadsheet that had some fixed markup math, right. That said, if an herb costs less than 12 cents, triple the price, Right. If the cost of the Europe is between 13 cents and 25 cents, double the price. Like, you can create formulas inside of Excel that have conditions like that. So you could literally get the invoice in. You were looking at Guiger, you type guager, you type the price that you put in, and then the spreadsheet just does the math and spits it out at the end. Like, this is the price of guijer. [00:43:19] Speaker B: Right? [00:43:19] Speaker A: Right. But that means that when you wrote the formula, you'd have to have like a good sheet where you like rogue wager, you looked up the price, did the math. Right. So most people, for practical purposes, who don't use software like we have, that basically. Does this work for you? They end up picking a fixed granule price. [00:43:37] Speaker B: Right. [00:43:37] Speaker A: That's what I've seen. [00:43:38] Speaker B: So then if they were going to pick a fixed granule price and let's say just for the sake of example, that they're dosing their formulas similarly to how we do. Right. Which is like roughly between 6 and 9 grams twice a day. So between 12 and 18 grams a day. [00:43:59] Speaker A: Yeah. [00:43:59] Speaker B: What price would you offer or think would be about an average for that, like off the top of your head? [00:44:07] Speaker A: I don't think I would do it in a way where I charge the patient a fixed price every week. [00:44:11] Speaker B: Yeah. [00:44:12] Speaker A: I think I would just have a fixed price for total grammage. And so when I weighed out the formula, the formula weighed 100 grams. [00:44:18] Speaker B: Yeah. [00:44:19] Speaker A: Then it's, you know, $20 or whatever. It's like, because it's, you know, 20 cents a gram. So that would just be the, that would be the system that I would build because, you know, some people are going to have different doses and different amounts. I think if you were going to go like, if you just look at our numbers. Right. I would say our retail price for herbs at that dosage comes somewhere between 30 and $45. [00:44:42] Speaker B: Right. [00:44:42] Speaker A: So I think if you were going to really. And ours is a per item cost system, so it's more specific. If you wanted to avoid the vagaries of loss, your friend system is probably pretty accurate. I would say somewhere between like 45 and 50 a week where dosage is somewhere between, you know, 16 and 24 grams. [00:45:02] Speaker B: Right. [00:45:03] Speaker A: Probably works out most of the time. [00:45:05] Speaker B: Yep. [00:45:05] Speaker A: I would say if you don't have that kind of consistency though, like in your practice, you're like prescribing, you know, you got old people, young people, robust people, some people getting 6 grams a day, other people getting 24 grams a day. Then it might behoove you instead of having like a fixed price per week to just go to a fixed price per gram. [00:45:24] Speaker B: Yep. [00:45:24] Speaker A: And then just do the math. [00:45:25] Speaker B: Yeah. [00:45:25] Speaker A: And that's easy math. Right. I mean, you're going to weigh it out anyway. You know what, the total. [00:45:29] Speaker B: The total grams. Yeah. Should be easy to figure out. [00:45:31] Speaker A: So yeah, if It's a. It's 200 grams of herbs and it's 40 bucks. [00:45:34] Speaker B: Right. [00:45:34] Speaker A: If it's 20 cents a grammar. Right. Or whatever the, whatever your math turns out to be. [00:45:38] Speaker B: Yeah, yeah, yeah. Makes sense. [00:45:40] Speaker A: For the, for the record, 20 cents a gram would not be enough. [00:45:42] Speaker B: No. [00:45:43] Speaker A: Yeah, it wouldn't be enough. Especially if you're using, especially if you're using pre blended whole formulas. [00:45:48] Speaker B: Yeah. [00:45:48] Speaker A: And because most of the companies that do that, especially like Evergreen, which is a great company with great herbs, but they're a little spendy, a lot of those pre formulated granules are coming in at cost, 26 cents a gram. [00:45:59] Speaker B: Right. So a lot of. Just to explain that a little bit more, especially the proprietary formulas. Right. Like, especially like chronic neck and shoulder pain. Like those formulas are going to be double what we're talking about here. [00:46:17] Speaker A: Yeah. I want to say Chronic Neck and Shoulders from Evergreen, which is a great formula by the way, but it's like 32 cents a gram cost. [00:46:25] Speaker B: Right, cost, cost. [00:46:27] Speaker A: So you know, this is why when I say average, like averages can work but they can get you in trouble. Right. You have to stay on top of it. You couldn't pick an average number and then never look at it again. [00:46:39] Speaker B: Right, right. [00:46:41] Speaker A: It just wouldn't work. Like realistically, if you were going to do this sort of manually yourself, you would need to pick your number, sell those herbs, keep copies of like you can buy like a carbon copy paper where you would write down kind of like receipts, manual receipts. Obviously you can do it digitally, but some people don't love the digital system. But you would need to keep some kind of record so that every quarter or certainly every six months, but probably better every quarter to go back and just check like what was. Do a spot check, grab 15 formulas in the quarter and just be like, did I make money on these? And if more than half of them are coming out that you didn't make money, you probably need to adjust your system. [00:47:22] Speaker B: Yes. [00:47:24] Speaker A: If this sounds like a lot to you. [00:47:26] Speaker B: Yeah. [00:47:26] Speaker A: If you're like, oh my God, get the money and the whatever it is, it is a lot. This is why it's useful to have a pharmacy in your back pocket. That's helpful so you don't have to do this. Right. I'm a business minded person. I like it. I like the math, I like the Excel documents, I like the nitty gritty. Most of the people I know who do what we do don't. [00:47:50] Speaker B: Yeah, I don't. [00:47:51] Speaker A: Yeah, yeah. TC doesn't like it. So I make the spreadsheets and then I tell them about them later. [00:47:58] Speaker B: Works out pretty well. [00:47:59] Speaker A: Yeah, exactly. So like the thing is, is that if you're listening to it and you're getting excited about all the pivot tables that you can create in Excel, then you should do this yourself. Right. If you're listening to it going, oh, my God, my eyes glazed over because they just kept talking about numbers and profits and material. Then, okay, find a. Find a medicine area that you can just make an account with. Like, you don't need to do this. It's not necessary. Fifteen, 20 years ago, it was. There just wasn't the sophistication that. That existed in order to deliver herbs to you and your patients. But it exists now, right? We have it. China Herb Company has it. Camo has it. Blue Crane has it. Excuse me. Blue Heron has it. Like, there. Crane Herbs is the other one. Blue Heron. [00:48:47] Speaker B: And Fat Turtle is another one. [00:48:49] Speaker A: Yeah. Fat Turtle. [00:48:50] Speaker B: Drop ship. Yeah. [00:48:51] Speaker A: So there's. There's a. There's people out there, right, that can do this for you. My recommendation is to find either people that you like or a medicine area that's relatively local to you, roughly in your quadrant. Just because if I have to mail herbs from Portland, Oregon to Florida, it's going to take like, five or six days, right? [00:49:08] Speaker B: Yeah. [00:49:08] Speaker A: You know, which is kind of frustrating, weirdly. We can get from here to, like, Virginia in three days, but if it needs to go to Florida, it's gonna take six. [00:49:14] Speaker B: Like, that's bizarre. [00:49:16] Speaker A: I don't understand. But that's just how it is. So if you can find someone in your region, that's really my recommendation because then you can just focus on the diagnosing and the writing, and you don't need to worry about all the business stuff. [00:49:27] Speaker B: Right? [00:49:28] Speaker A: Right. [00:49:28] Speaker B: And even if. Even if you can't get the herbs as at, you know, in the beginning, we were talking about agility with prescription, which is ideal. If you can be agile, if you can get the formula out to the patient the same day or the next day, that's absolutely ideal. But there's so much work in our field that's easier to do if you include an herbal formula, even if it isn't immediate, like, orthopedic stuff, man. Like, even if we come back to that, like, there's so many orthopedic things that you can dramatically improve with acupuncture, but if you add herbs to the mix, it really just takes it to the next level, and it makes your job as an acupuncturist so much easier. A lot of those cases where you're getting immediate improvement and then there's a backslide. Don't have the backslide anymore, you know, or OBGYN type stuff, you know. [00:50:27] Speaker A: Yeah. Women's health in general. [00:50:28] Speaker B: Women's health in general or men's health, you know, if, if you're interested in that. Those formulas are things people generally need to take for a long time anyway. [00:50:38] Speaker A: Yeah. [00:50:38] Speaker B: And it's not going to hurt them to wait an extra two or three days to get their herbs. [00:50:43] Speaker A: Right. [00:50:43] Speaker B: So even if you need to wait for the shipping to come in or whatever, you can, you can make it work. You can absolutely use a different pharmacy. [00:50:52] Speaker A: And once you've done it and you get the rhythm of it, you know, like, let's say you see a patient once a week. So you write that first formula. Write it for 10 days. [00:51:01] Speaker B: Yeah. [00:51:02] Speaker A: So then it takes a couple of days for it to get to them. Then when you see them, they've still got it. [00:51:06] Speaker B: Yep. [00:51:07] Speaker A: You can talk about it, you can modify it if you need that. Probably they can finish the one that they've got. It's not going to hurt them. And then the new one will arrive just as they're finishing up with the last one. [00:51:17] Speaker B: Right. [00:51:17] Speaker A: So, I mean, there's definitely a way to accommodate for delay. [00:51:20] Speaker B: Absolutely. [00:51:21] Speaker A: And shipping and stuff like that. Because particularly if you're dealing with chronic conditions. You know, when it comes to now, let's take into account the people who are excited about getting this set up. Right. Who, like, okay, I love Excel. I'm going to make my spreadsheets, I'm going to do my math, I'm going to figure it out. I want to give you guys, and we'll put in the show notes, we'll put some links to some documents for you guys. So you can see the 12 formulas, the 25 ingredients, and just kind of like a general list of, of stuff that you want to consider, but just sort of like as a broad spectrum idea. Right. You need the herbs, obviously you need things to put the herbs in. [00:51:59] Speaker B: Yep. [00:52:00] Speaker A: So a lot of people will reuse the bottles. Right. They come in plastic bottles. They reuse the bottles. Okay, great. But you need to clean those bottles and wash them and take the labels off them before you put herbs back in them. Or at least you should. Okay, so do you have a place to do that? And if you don't have a place to do that, then maybe they need to go in something else. So you need to find some vessel that the herbs are going to go out in. These little sort of like pop up craft paper bags. So you're going to need the herbs. You're going to need bags. You're going to need labels. [00:52:28] Speaker B: Right. [00:52:29] Speaker A: That go on the bags. [00:52:30] Speaker B: Those bags, by the way, are good to ship because they have. They're sealable. And then you can also get a vacuum. Not a vacuum sealer. Heat sealer. [00:52:39] Speaker A: Yeah, the impulse sealer. [00:52:40] Speaker B: The impulse sealer for. Not very expensive, right? [00:52:43] Speaker A: No, no, I think they're like 25 bucks. Yeah, yeah. It's not expensive, which is good for. [00:52:47] Speaker B: Shipping because then if it comes open as it's shipped, it's sealed on the top. So that's why that's important. So if you did want to ship something to a patient of yours, it's valuable to have that option. [00:52:58] Speaker A: Absolutely. Yeah. So your packaging is going to need to be labeled in some way. Right. And let's take a minute and also talk about some regulatory requirements, slash suggestions. So it's important to remember that Chinese herbs, from a federal regulatory point of view, are considered food. [00:53:17] Speaker B: Yes. [00:53:18] Speaker A: So herbs fall into the same category as nutraceuticals and supplements, the stuff you buy at your local health food store, your Omega 3s. That's all from a federal regulatory point of view, considered the same category of thing. Okay. That said, what we deliver takes on an extra component because of our suggestion to the patient that this formula can cure or correct a specific condition. [00:53:44] Speaker B: Right. [00:53:45] Speaker A: Now, you have all seen packages at your grocery store that say, like, you know, such and such bone formula promotes bone health. And then there's a little tag on that bottle that says, this product is not intended to treat or diagnose any condition. These claims have not been verified by the fda. [00:54:03] Speaker B: Right. [00:54:03] Speaker A: Okay. We've all seen the disclaimer. That's for products that are commercially available to the public. And a commercially available product to the public cannot make any claims about specific health outcomes that are not supported by scientific evidence. So that means you can't say that this blend of herbs corrects bone spurs. [00:54:26] Speaker B: Right. [00:54:27] Speaker A: Because that's a specific claim. You can say improve or increases bone health. Or promotes is the big word you'll see. Promotes quality bones. [00:54:40] Speaker B: Right, right. [00:54:41] Speaker A: I mean, everything promotes quality bones. [00:54:43] Speaker B: Yeah. [00:54:44] Speaker A: Walking, drinking milk, jumping on the trampoline. Jumping. Right. So you. That's why the claims on those products are so nebulous. [00:54:52] Speaker B: Yeah. [00:54:52] Speaker A: Right. But when we prescribe a formula to someone, I'm giving it to you, and I'm saying this is going to correct your ibs. [00:54:58] Speaker B: Right. [00:54:58] Speaker A: Okay. The reason that we can do that is because, number one, it's not a product that's sitting on the shelf that can be Purchased by anyone. So it's not a public product. And number two, we have established what the law refers to as a patient practitioner relationship between us and the person who's taking the product. Once we've established that relationship, it allows us to make specific claims. And it's because our licenses and all of the various states give us permission to use herbal medicine in the furtherance of these health improvements. [00:55:32] Speaker B: Right. [00:55:32] Speaker A: So you've got to follow the sort of permission logic, Right. That says the state gave you a license that said you can do this work, and inside of that license, it says you can prescribe herbs. And because that license exists, it means that you can establish a patient practitioner relationship, which then means you can give someone a quote, unquote unregulated product and make a claim about its efficacy because you have the relationship, which is possible because of your license. [00:56:00] Speaker B: Yep. [00:56:00] Speaker A: All right, so go back and re. Listen to that three times if you didn't follow me. The point is that when you are setting up your. Your pharmacy medicine area, there are some things that are encouraged both by the NCCAOM through their standards of herbal medicine practice, by what's called gmp, good manufacturing practices, and by what's considered best practices in the nutraceutical herbal world. Notice that none of those things are legally required. [00:56:32] Speaker B: Yeah. [00:56:32] Speaker A: Okay. If you get into the game of producing products that you sell on shelves or online, stay tuned for a future episode. There's a lot of stuff you need to know about that. Please don't just go do that without thinking about it or doing your research. You will get in trouble. Maybe not now, but at some point. And it can be really messy. So definitely do your research before you get into that. If you're just like the rest of us and you're prescribing formulas for patients, there are some things you need to consider, like labeling. Please don't put granules in a ziploc bag and write formula one on it with a Sharpie and hand it to your patient. [00:57:09] Speaker B: Right. [00:57:09] Speaker A: Don't do that. Right. That's crazy. What's in that formula? Your patient has a right to know. What's the dosage that they're supposed to be taking? They need to be reminded. What's your contact information? What are they supposed to do in an emergency? How. How are they supposed to get a refill? Like, there's so many kind of mechanical questions that need to be communicated to your patient that historically have not been communicated. I can't tell you the number of people who even in our system where all of this stuff is generated for the patient. I get patients calling and be like, what do I do with this? What's this for? Like, their practitioner didn't say anything to them seemingly about it. Now take that with a grain of salt. Patients can often be full of it. Right. Like they just forgot whatever they were told. But please don't hand people a paper bag full of herbs or a random, like, granule bottle that still has the label from the previous product on it. Like, no, make a label. Okay. You can make a pre generated label yourself. That's like an Avery label. That's generic. You know, you just print them on your inkjet and it's got blanks for patient name, formula name, and dosage. Great. But honestly, the patient is, in my opinion, owed a little more than that. Like, what's in this formula? They have a right to know. So you should have some kind of info sheet that goes along with it that shows them the ingredient names and not just in pinyin or Chinese. Right. It needs to be also in English. Are patients going to be able to look that stuff up and really understand it? No, probably not. But they have a right to know. It also means that if they ever have to talk to their doctors about what they're taking, it makes you look so much more legitimate. Yeah, because they have a list of ingredients, they have dosage information, they have contact information, they have emergency response information, all on paperwork that they can bring to their doctors. Much more likely that you'll get agreement from a standard medical doctor if you look like you're not just handing people random bags of powder. [00:59:03] Speaker B: Oh, yeah. They're still not gonna know what the heck is going on with the formula. And they may even be disparaging about it. But it. But you look more official. [00:59:12] Speaker A: Yeah. You look like you are a professional, which is what you are. And so that's what you should do. So you've got your herbs, you've got your bags, you've got your labels, you've got hopefully info sheets that go along with your product. In order to put all that stuff together, you're gonna need a scale. You're gonna need bowls to put on that scale. You need more than one bowl. You need some funnels, some spoons, and a space to actually work with good lighting. So that's sort of like the core, bare minimum. Herbs, packaging labels, paperwork, bowls, scales, spoons, funnels. Got to have all that. [00:59:47] Speaker B: Yep. [00:59:48] Speaker A: Outside of that kind of, the sky's the limit. Right. I mean, you can have an impulse sealer, you can have A heat gun, you can, you know, vacuum seal stuff. I mean, it can get wild, but those are the things that you really have to have in place. And so when you consider the extra costs. Right. Let's say you did your bare minimum, 25 herbs that we're suggesting. Right. You're looking at probably about $2,500 or so in herb costs. Right. If you're doing combined formulas and singles, then you've got probably another, say, $300 worth in ancillary costs. Materials like bowls and spoons and things. And even though a single bag that you might put the herbs in cost 10 cents, they only come in a box of 3,000. So you had to shell out $225 for a box of bags because that's the size that they come in. So there's lots of small things like that where, like, the individual cost of something may not be that big, but your startup cost could be because they only come in a certain package size. [01:00:44] Speaker B: Right. [01:00:45] Speaker A: So if you were kind of putting those numbers together, you're looking at about sort of $3,000 bare minimum, hard. Hard line minimum for having materials to send herbs out the door. And that, of course, doesn't take into account building any of the systems we described for pricing for labels for things like that. You'd have to take the time, of course, to do that, but that's mostly not cost, you know, and then the other thing is, you got to stay on top of that over time because the first time you do it and everything's so fresh and shiny and it's beautiful. Okay, when in the week are you going to count all your inventory to see what you need to buy? How often are you checking on your stock of everything so you don't run out of it at the last minute? Like, when's that going to go into your flow, you know, and that's another piece that you got to consider. So like you said, when are you going to write the formula and give it to the patient? When also are you going to do your inventory? [01:01:37] Speaker B: Yep. Yeah, that's a lot. A lot of stuff that goes into it, actually. [01:01:43] Speaker A: Yeah, it is a lot of stuff. And again, this is why you're going to hear us say it over and over again. I think it's why, you know, unless you are really excited about this and unless you have good space to put it in, probably better to just use a service. [01:01:56] Speaker B: Yeah. [01:01:56] Speaker A: You know. [01:01:57] Speaker B: Yeah. [01:01:57] Speaker A: And a lot of services will have perks for you. Right. Because one of the. One of the reasons that people Prescribe herbs. I mean, the first one is because they want better patient outcomes. But also a lot of people would like to add a revenue stream. [01:02:08] Speaker B: Absolutely. [01:02:09] Speaker A: To what's, what's going on. And herbs can absolutely add revenue to your clinic. I mean, our clinic benefits from the pharmacy for sure. It is, just so you guys know, not the best use of our time and energy from a profit margin point. [01:02:25] Speaker B: Definitely not. The clinic brings in a lot more money than our pharmacy. [01:02:28] Speaker A: Way more money, like per hour. Like if you take the, if you take the revenue and you just break it down like, okay, what's the actual net per hour for work in the clinic or work at our at root and branch? The clinical work is much more profitable. Yeah, much more profitable. But, you know, nonetheless, the pharmacy does bring in some revenue. So if you want to add revenue stream to your clinical flow, then you really do need to spend the time with the math and the markups and the spreadsheets because you're going to do a lot of work and sink a lot of your hard earned cash into something. You need to know if that's actually working for you. Because if you can't tell in a quarter or six months or a year whether you're making any money doing that, that's a lot of your time that's being burned on something that's not making you any money. [01:03:13] Speaker B: Is it possible for the person who's listening to this and they're like, this sounds like a lot of, a lot of stuff. I think I'd rather use a different pharmacy. Is it possible for them to make money off of their herbal prescriptions? [01:03:27] Speaker A: It can be. It depends on where you go. So like in our case, our medicine area is set up where any practitioner can add a markup to their formula. So you write your formula, you write, guide your tongue, whatever it comes out to be 2285 for a week. And then you have the option to add a markup. You can add a fixed dollar markup. Most of our people do that. So like we have practitioners, every time they write a formula, it gets plus $4 or plus $7 or some number amount. Right. The patient never sees that markup. So in this example, you had 2250 for your, for your Guizhetong plus $4 markup, the patient just sees 2650. [01:04:08] Speaker B: Right. Even if they get an invoice, even. [01:04:10] Speaker A: If they get an invoice, when they get the like, as far as the patient is concerned, the formula costs 2650. In our case, we collect that from the patient. Like they Pay us. And then it gets credited to the practitioner's account, which they can see on their dashboard. It sort of tracks how much money they're making. [01:04:25] Speaker B: Yep. [01:04:26] Speaker A: And then once that dollar amount is more than 50 bucks, they can ping us through the system that they'd like to have it cashed out to them. And then we just. We actually direct deposit now. It's super exciting. Like, we get our regular users get set up with direct deposit, and then we just directly deposit that markup straight to you. Just all things considered. In fact, it's pretty sweet deal at the moment because, like, we don't even take into account like, credit card transaction fees and stuff. Like, you just get the full dollar amount. Yeah. Like, we. We eat that. That 3%. You know, maybe we shouldn't, but, you know, whatever we do. And. And then if you end up with more than $150 in a. In a month, because you've been doing lots of markups, I'm going to cash it out for you, mostly just to get it off my books, so I can see that it's there. But, you know, some of our practitioners who write a lot of herbal formulas and have a fixed markup, you know, we're paying out 6, 7, $800 a month. [01:05:18] Speaker B: Yep. [01:05:19] Speaker A: In markups. [01:05:20] Speaker B: Yeah. And just. Just to give, like, what is. What's the highest markup that a practitioner using our system will charge would be a percentage one, probably. Right? [01:05:31] Speaker A: Yeah. I mean, the highest. The highest one I've seen on. On the regular. [01:05:35] Speaker B: Yeah. [01:05:35] Speaker A: Like a regular recurring dollar amount per formula is $7, $7, $7. However, I've seen individual formula markups as high as $40. [01:05:45] Speaker B: $40. Yeah. [01:05:47] Speaker A: Yeah. Right. Now, that's because I assume that the practitioner knows their patient and their financial means and whatever. [01:05:54] Speaker B: Right. [01:05:55] Speaker A: And they feel like that patient can afford that level of markup that's not an ongoing markup. It's not. Like every formula gets $40, but that one had $40. I'll often see a percentage markup at about 15%. [01:06:07] Speaker B: Yep. [01:06:07] Speaker A: Yeah. Somewhere between 10 and 15% is usually pretty standard. I really like the fixed dollar amount more than the percentage just because, like. [01:06:16] Speaker B: It'S a little cleaner. [01:06:17] Speaker A: Yeah, it's a little cleaner. And it just reflects your work in a more fixed way. Right. Because if you're writing small formulas, if you have a small dosage, small formula writing style, and you're doing a 15% markup on a. On a $15 formula, it's just not a lot of money. [01:06:29] Speaker B: Right. [01:06:29] Speaker A: You know, so Just put a fixed dollar amount on there, all the better. Most people I know who run kind of practitioner benefit systems in their pharmacy medicinaries are usually store credit. Right. So you do the markup, you get store credit. [01:06:45] Speaker B: But which means that they could use the credit to buy herbs for themselves. [01:06:50] Speaker A: Yeah. Or one of their patients. [01:06:51] Speaker B: Or one of their patients, but they couldn't get it cashed out. Like what you were just saying. [01:06:55] Speaker A: Okay, Exactly. Yeah. I'm sure someone else out there does a cash out. I know that we're one of the few, though. [01:07:02] Speaker B: Yeah. [01:07:02] Speaker A: That does it. And we do offer that. That was an intentional choice. Right. I mean, who doesn't like store credit? But at some point, store credit is not super useful. But you know, you could do it that way if you wanted. We do cash. It works for us. And I like it because then someone out there who wants to do herbs but doesn't want to do all the hassle, but maybe would take on all the hassle in an effort to make some money, and maybe that doesn't work out for them in the long run because they're kind of doing something they didn't want to do in the first place. Can now just sign up with us and put a markup on there. We'll collect it for you. And at the end of the month, I'm going to direct deposit into your account. Like, it's effortless, you know, all you have to know is what dollar amount can your patient population absorb? And if you're writing enough formulas, you know, it doesn't really matter. Right. Like if you're doing three or four dollars, like, honestly, patients will not notice that most of the time. I don't want to speak for everyone's patients, but most patients are not going to notice a four dollar increase in the formula. And you know, if you're writing, I don't know, 30, 40 formulas a month, like, that's not insignificant. It's a couple hundred bucks. [01:08:07] Speaker B: Right. [01:08:07] Speaker A: You know, for. For doing nothing except just writing the formula. [01:08:10] Speaker B: And you could even, like I could see somebody doing that. Let's say the goal was to start a pharmacy. Yeah, right. [01:08:16] Speaker A: Yeah. [01:08:17] Speaker B: But in order to start a pharmacy, you need to raise. You need to have a certain amount of income or money for it. [01:08:23] Speaker A: Yeah. [01:08:23] Speaker B: So you could even do that in the beginning, save up enough money and just gather that. [01:08:29] Speaker A: Yeah. [01:08:30] Speaker B: Until you have a thousand bucks or three thousand bucks or whatever in the bank and then open your own. [01:08:36] Speaker A: Absolutely. [01:08:36] Speaker B: Right. [01:08:37] Speaker A: And it gives you the opportunity to practice what we were talking about in the Beginning, like retooling your systems so that you figure out how to talk to patients so they take their herbs. Figuring out like what it means to prescribe regularly, what those systems look like, maybe even what do you like to use? [01:08:53] Speaker B: Yeah, what, like. Yeah, exactly. [01:08:55] Speaker A: Yeah. So like you can get in the game now at basically no cost to you. Except a little bit of time it takes to learn our system. But it's pretty intuitive and we have a lot of videos or someone else's. Right. I mean, you could do it with camo, you can do it with anybody. [01:09:07] Speaker B: Yep. [01:09:08] Speaker A: Get into someone's system with ours, you would have the benefit of potentially doing the markup and then taking that cash. And you can either just, hey, you decide that's good enough for you and you don't need to do the thing yourself, or you take those herbal markups and you make that a little kitty for yourself to go ahead and open your own medicine. Ready? Yeah. And you have the time to practice it in the meantime. So I think any of those circumstances are, are useful. At the end of the day, people ask me this version of this question all the time because they. I'm happy to talk about it. And this is what we do. My thing is, like, I would love to see this country covered in herbal pharmacies. Like, I would love that because it would tell me that like, people are writing herbs. [01:09:48] Speaker B: Right. [01:09:48] Speaker A: Patients are getting better and there's an awareness of herbal medicine that frankly just doesn't exist even in big markets like Portland, you know, San Francisco. So I would love to see more herbal pharmacies. But the truth is, is that running one is challenging and you have to have a certain kind of headspace mindset, affinity for the mechanics of business and retail. That, that isn't part of Chinese medicine. Like running a pharmacy has nothing to do with medicine. [01:10:19] Speaker B: Right, right. [01:10:20] Speaker A: It's a business proposition. It's a, it's a retail delivery proposition. Now getting the patients to take the herbs, what are you going to prescribe? Of course, that's medicine, but the actual business of it has nothing to do with that. So you need to have a kind of certain headspace to, to be able to do it well. And so I always, I hate to see people put themselves in a situation that maybe isn't their strong suit, that they don't want to do that. They're going to shell out. Frankly, they're very hard earned cash. As we all know, this work is difficult. Make money in this business. And so you've worked hard, you've got Your little, small, little treasure chest over here, and you're about to shell it out into a pharmacy, and then you just end up kind of taking it on the chin, just eating it in a way that, like, wasn't great. You maybe didn't have to is really just my point. You know what I mean? Like, there are systems that exist now that, that are accessible and usable that maybe you didn't have to do that. By all means, take a look at the documents we're going to provide for you guys. Re. Listen to this episode. Run the Excel numbers, look at the math. And if you're excited about it and you want to open a pharmacy, you shoot me an email within your questions, I will be happy to get you to open it. You know what I mean? Like, I really would love to see that. But if you're nervous about it or you're uncomfortable or you're like, oh, God, that sounds like a nightmare. But I really want my patients to get herbs. Then just go to rootandbranchmedicinary.com and make an account. Yeah, like, don't. Don't worry. Like, don't bring that stress into your life. Yeah, if you don't need to. [01:11:49] Speaker B: Should we talk about the. At least to just name the formulas or the herbs that are on that list? [01:11:55] Speaker A: I'm going to post them. [01:11:56] Speaker B: You're going to post them? [01:11:57] Speaker A: I'm going to post them. Yeah. I mean, we could list them, but I think people will just be like, what? Basically, they're Guitang formulas, y'all, plus some. But yeah, I'm going to post a list for you guys as PDFs, that'll show the formulas, the dosages that we use them at the total list of ingredients and then my just general list of other supplies and things you might want to consider when you're going to open things up. And then there'll be more information about the clinical side of that system. [01:12:22] Speaker B: Right. [01:12:22] Speaker A: You know, down the road. But just from a planning point of view, you guys can see what we were talking about on paper. [01:12:28] Speaker B: Cool. All right, sounds good. [01:12:30] Speaker A: Well, guys, as always, if you have any questions about this or any of our other material, you can reach us at infoootandbranchpdx.com that's info info, rootand branch, papadeltaxray.com we'd love to hear from you. If you have questions about pharmacy or you're doing it yourself, you want to chat with someone, either of us would be happy to talk with you. And of course, if you have something else you'd like to hear about in the future, please shoot us an email and let us know. Wherever you're listening to this podcast, please make sure to rate and review it. We would love to have some comments and some reviews so that other people can find us more easily. And so, as always, my name is Travis Kern. [01:13:09] Speaker B: And I'm Travis Cunningham. [01:13:11] Speaker A: And we will catch you guys next time. See you next time.