So You're a New Herbalist

[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. [00:00:14] Speaker B: Let's get into it. [00:00:18] Speaker A: Welcome back, everyone, to another episode of the Nervous Herbalist. My name is Travis Kern, and I'm here with my co host, Travis Cunningham. And today we're going to take a little bit of time to talk to you all about what it's like to be a new herbalist. Someone who's just coming out of school, maybe, or someone who's been practicing for a while, but is interested in getting back into herbs or reinvigorating herbs or learning more about herbs. But basically you've been practicing or you're about to start practicing and you haven't been using herbs, right? Or you're not sure how to use them to their most potent impact. It might be a good idea to firstly, maybe make a little bit of a roadmap for that and also to provide a little bit of encouragement in the process. So, t, you're brand new, you've just graduated, you've loved herbs in school, you've learned a lot, you've been using them in clinic, but now you're out on your own. Right, and you want to start writing formulas. What are some of the things that we've heard that are stopping people from writing formulas? [00:01:19] Speaker B: Yeah, so I think that the two different people you mentioned, like the person who's starting in the clinic from school and the person who's in the clinic who wants to get back into herbs, but is maybe only using acupuncture, the advice would be different for those two people. [00:01:36] Speaker A: So let's go to the student first. [00:01:37] Speaker B: Yeah, the student first. So the first thing I would do is find a pharmacy to connect with that you can write herbal formulas from and get herbs delivered to your patients, too. If you don't do that, it's going to be harder to figure that part out. And I actually wouldn't recommend at this point that people try to do herbs, like have a pharmacy right off the bat. I think that's something you can do. And if time goes on and we can talk about what that would look like. We've done that before, actually, we've talked a little bit about starting a pharmacy. [00:02:15] Speaker A: Um, I think it, I think it's worth mentioning here, though, because a lot of people might have worked in clinics as students or seen other clinics that have a granule pharmacy. And so they're thinking like, well, I've seen granule pharmacy. I, you know, I think I could probably do it. And we're not saying that, like, you can't do it, it's just that if you're brand new and you're setting up shop, particularly if you're small business hanging a shingle, um, there's a lot of things that you're going to need to focus your attention on and like setting up a pharmacy. And frankly, the cost to do it is no small matter. I mean, if you were going to try and build a robust pharmacy, I mean, you're looking at ten or $15,000 in your annual cost. If you were going to do a small pharmacy, you don't really know what you're treating yet. Right, right. I mean, that's the thing. Like, if you don't really ever see postpartum women or skin conditions, there's a whole collection of herbs that you don't need to keep. Right, exactly. And so, but you don't know. So if you just walk out of school and you're just like, okay, I'm going to keep. I'm just going to make a little small pharmacy or whatever, even still, you're probably going to end up frustrated, I would be guessing, because you won't have three of the herbs that you want to have and you've got seven herbs that you never use. [00:03:25] Speaker C: Right. [00:03:26] Speaker A: So if you want to eventually stock your own pharmacy, it's totally fine. But you should probably figure out over the next year or two what you actually treat, what you like to treat, and what's coming through your door and frankly, what formulas you've been writing. [00:03:42] Speaker C: Yeah. Right. [00:03:43] Speaker A: Because right now you still don't know. So definitely get connected with a pharmacy. Most high quality training medicine pharmacies have a web presence. Right. You can search for them online. Most of us who run pharmacy have national distribution. So if you're on the west coast, you can obviously check out us, rootedbranchpharmacy.com. But we're not the only ones out there who do this work. You can work with large companies like Evergreen, you can work with blue heron herbs. Blue poppy does direct distribution. If you're on the east coast, there's Camwell. [00:04:14] Speaker C: Right. [00:04:15] Speaker A: And golden needle. So there's a lot of people. I mean, a lot. I guess I listed six, but I'm sure there's more than six. But those are the ones that just sort of come to the top of my mind. There are people out there who do this so that you don't have to, to be honest. [00:04:27] Speaker C: Right. [00:04:27] Speaker A: Like one of the reasons we keep the pharmacy the way we do is so that all you have to do is focus on writing a good formula. We'll take care of the rest because there's frankly a lot of stuff that goes into the rest. [00:04:38] Speaker B: Tons, tons of stuff. So the first piece of advice that I'd have then aside of that, is to figure your resources out for working with cases. So that means if you have colleagues that you trust that you can run a case by, that's good. If you need mentors or you have mentors, establish those kinds of things. It also includes buying books or apps or things that are going to help you in the clinic, getting that stuff available so that you can work through a case when you need to. And I think it's really important to have tangible guides. So those can be books, apps, or things that you can access and also personal feedback. You can talk to another person about cases. That's really, really important, whether that be a colleague or somebody who's got more experience than you. I think ideally you'd have both. One of the things that we've been fortunate to have pretty much since the beginning is kind of both of those things, right? We've had each other and then we've had teachers that we've had from OCom and different people that we've met along the way with more experience. So I think establishing your resources so that you don't feel like you're alone in the clinic, that's really, really key in the beginning. [00:06:10] Speaker C: Yeah. Yeah. [00:06:11] Speaker A: And you know, if you've gone through chinese medicine school, you got, you know, the herbal texts that you probably study from, right? You've got John Chen's book, you've got Bensky's book. Maybe you've got some Macioja. Those are great resources. They're not clinical manuals. [00:06:24] Speaker B: No, they're not clinical. Exactly. [00:06:27] Speaker A: And so, like, if you go and read Debinsky on, like, guadrafuhling one, you're going to read all about how it treats uterine fibroid cysts. [00:06:35] Speaker C: Right? [00:06:36] Speaker A: Which it does, but it also does so much more than that, right. And so you would be mistaken if you assumed that guagerflooling one is only applicable for uterine fibroid cysts and other sort of palpable blood masses. [00:06:49] Speaker C: Right. [00:06:50] Speaker A: Because there's a lot more that it does. The good news is there are texts. If you're looking for manual. Like, I'm a book person. I like books, right. And I like to have a text to go read. I want to go see the thought process. And so one of the books that I've leaned on heavily, especially in the early years, was the clinical Handbook of Internal Medicine, which is a really nice compendium written by a group of practitioners. William McLean, Jane Littleton, Mark Bailey, Catherine Taylor. It's, the latest edition is like a red bound book. It's got like onion thin Bible paper because there's so much stuff in it. But what's amazing about that book is it gives you condition material, chinese medicine, pathology, disease progression, and herbal formulas at various points in the disease progression, which I think is really important. So there are definitely books out there and then there's huge amounts of continuing ed that you can get into. And I think I want to underline what Travis just said too, about finding another human. Yes, very important. Ask questions too. And it doesn't need to be like, you don't need to like send them a case study, right? Like a 48 year old female bribes in clinic, presenting with like, nah, man. Like just find someone who also is trained and they also, by the way, they can be new. [00:08:06] Speaker C: Yeah. [00:08:07] Speaker A: They don't have to be a colleague by all means. If you have like a master that you can call for sure, but they can just be another person who's also recently graduated. [00:08:17] Speaker C: Right. [00:08:17] Speaker A: Like you're just having another human being around who also knows what, you know, to bounce some stuff off of and see if you're kind of on point. I mean, it's not crazy to imagine that you, you and another recent grad sit in a room and try and figure out what the formula is for this diarrhea pattern and you might both be wrong. [00:08:34] Speaker C: Yeah. [00:08:35] Speaker A: But it's okay because the act of sitting down there and thinking with that person and talking with that person exercises the essential muscle of herbalism and diagnostic process. [00:08:45] Speaker C: Yes. [00:08:45] Speaker A: So it's good, I mean, better if you have someone who's got more experience but not essential. [00:08:50] Speaker C: Right. [00:08:51] Speaker A: You can still do the work without it. [00:08:52] Speaker B: Yeah, 100%. [00:08:54] Speaker C: Yeah. [00:08:55] Speaker A: So, all right, so then the person, they've got some resources. So they're going to find an online pharmacy or some other source for their herbs. Yep, they've organized their resources. [00:09:05] Speaker B: Now what next thing I would say is whatever techniques you've practiced at school, pick a objective form of diagnosis to study and a subjective form of diagnosis to study. So what I mean by that is usually for subjective, it's asking questions. So study a system where you can learn how to ask better diagnostic questions. And usually what that looks like is finding somebody that's good at that. And then working with them. I think a really great resource for this is Sharon Weizenbaum. She's a fantastic diagnostician, and she asks really good questions. She does a lot of her diagnosis from questioning. And then there's other people that you can look up through continuing ed that are also good, but that's just one person that kind of comes to mind that's good at that. And then objective diagnosis would be, if you're a pulse person, find a way to study the pulse. If you're a tongue person, find a way to study the tongue. If you're an abdomen person, find a way to study the abdomen. If you like looking at people's ears or faces, find a face diagnostician, an ear diagnostician, and pick one. And it's really good to have a second one that you're maybe not as focused on as the first one, but that you can fall back on. And then I think those two are really important. And even if you're not good at them in the beginning, pick one and chart it every time. Don't miss a patient. Chart it every time you do it, even if it takes you longer. Like, just do it because you'll develop the skill. And even if you're not good at identify. Like, let's say you're doing abdominal palpation and you miss, like, 50% of what's on the abdomen, but you write down a key factor in the abdominal presentation, you check four treatments later, and you see that that's definitively different. That's hugely beneficial as a diagnostician. Like, oh, my God, they're no longer painful. When I press under their rib cage, there's no longer rib side pain. That's a huge thing to have shifted, and it's objective, and it's clear. So developing both of those skills, the questioning and the. And then a form of objective diagnosis or two, doing that, picking that right away, whatever you have an affinity for, some of that's going to be stylistic. If you practice a certain style or you know what that's like already, great. If you don't know that, then try some stuff out, figure out what you like, find people that you would like to train with who are good at those things, and then start practicing what they do and see how you like it in the clinic. So that would be the second piece of advice. [00:12:06] Speaker A: Well, I mean, the objective assessment piece, you know, we of everyone does that, or at least should be doing that with acupuncture, right? [00:12:14] Speaker B: 100%. [00:12:15] Speaker A: Like, just think of, like, a classic. I mean, in the most basic sense, like, someone comes in with shoulder pain, right? [00:12:20] Speaker C: Yep. [00:12:21] Speaker A: You're going to examine the shoulder. [00:12:22] Speaker C: Yes. [00:12:23] Speaker A: You're going to press on it, or does it hurt? You're going to make them move it. What's the range of motion? [00:12:27] Speaker C: Right. [00:12:28] Speaker A: And then you're going to do your treatment, and then hopefully during that session, you got some improvement. And certainly between sessions, you're going to have improvement. And so in that case, I think people forget that that's the same methodology. It's just that it's specific to the body part. [00:12:43] Speaker C: Right. [00:12:43] Speaker A: It's like, well, you do that to the shoulder or the knee or the ankle. [00:12:45] Speaker B: Right, right. [00:12:46] Speaker A: But in the case of, like, more internal medicine work, you're still doing that same exact level of assessment, but on a body part that isn't necessarily implicated in the problem. [00:12:55] Speaker C: Right. [00:12:56] Speaker A: So, like, someone's in front of you for insomnia, but you're still doing an abdominal exam. [00:12:59] Speaker C: Right? Right. [00:13:00] Speaker A: Because you do an abdominal exam on everyone. [00:13:02] Speaker B: On everybody. [00:13:03] Speaker C: Right. [00:13:03] Speaker A: That comes through. And, you know, what is the abdominal exam? Look, there's like, if you were going to do that, there's a lot of systems out there, right, that you can lean on. You don't have to make this up. [00:13:12] Speaker C: Right. [00:13:13] Speaker A: But if you don't know where to go for that, if you are interested in abdomens because you've heard that they're really useful, it would be perfectly sufficient, for example, to begin by just checking all four quadrants of the abdomen and line every time. You're not. You weren't trained in a special hara diagnosis. You're not coming from a kiko point of view. It's okay. [00:13:33] Speaker C: Yeah. [00:13:33] Speaker A: Like, you can literally just press in under the ribs on both sides, rest inside of the pelvis in the front end, check the midline, different depths, different pressures, record what you find. [00:13:43] Speaker C: Yeah, exactly. [00:13:44] Speaker A: That would be perfectly sufficient. [00:13:45] Speaker C: Yeah. [00:13:46] Speaker A: And there's so many really great ehrs now, too, that have built in systems to do it rapidly. So, like, you can type it up manually, you can upload graphics that you write on if you're using, like, an iPad or a tablet or a lot of them have, like, touch button systems that you can put it in. So, like, you can make it quick. [00:14:03] Speaker C: Yes. [00:14:04] Speaker B: It doesn't have to take long. [00:14:05] Speaker A: Yeah. I mean, I would actually strongly suggest to find a system to make it quick because if it's quick, you'll do it. [00:14:11] Speaker C: Right. [00:14:11] Speaker A: And if it's hugely involved, you'll forget and then you won't chart it and, like, all this kind of stuff. Right. [00:14:15] Speaker C: Okay. [00:14:16] Speaker A: So they've got a system now that they're going to use training on questioning and using an abdominal system. And again, you know, we're talking about here, like, again, you can find systems that already exist, but it's also just the simple practice of you doing it. Like, if you learn the ten, just the basic ten questions, right? Like, you learn to ask the basic ten questions in school, without doubt, you will have noticed that if you ask someone like, how are your bowel movements? That's not a useful way to ask that question, right. Because people will be like, they're fine. So you know that that's not a useful answer. So by default, you start to refine that questioning. Practice the questioning. [00:14:56] Speaker C: Right. [00:14:56] Speaker A: That's a perfectly fine way to start, too. [00:14:58] Speaker C: Right? [00:14:58] Speaker A: Like, you don't have to be a genius interviewer. [00:15:00] Speaker C: No. In the beginning. Right. [00:15:02] Speaker A: You're just recognizing that, like, when you talk about bowels, the first question you ask isn't, so how are your bowels? [00:15:07] Speaker B: Right, right. It's a waste of time. [00:15:09] Speaker A: Waste of time. Like, go straight to a targeted question, something that's actually useful to you. And so when you sit in front of the patient and you say, so how are your bowels? And they go, they're fine. Make a note in your mind, don't do that again. You know what I mean? Like, that wasn't useful. Like ask something else next time. [00:15:25] Speaker C: Right. [00:15:26] Speaker A: And that, and that's how you, I mean, it's literally practicing a skill. [00:15:30] Speaker C: Yeah. [00:15:30] Speaker A: Like you're going to the gym, you're lifting the weights, and in the beginning you got to start light, but eventually you'll get heavier. [00:15:37] Speaker C: Yep. [00:15:37] Speaker A: That's just how it goes. Okay, so they've got this skill set. What next? [00:15:41] Speaker B: Next thing would be if you know, and again, this, you might not know if you're fresh from school, if you know the type of population that you're going to see, that's going to come in. So let's say you're an orthopedic specialist and you want to start doing herbs. I would say pick three formulas that are relevant to the topic that you tend to treat and learn those formulas, like actually study those, study modifications if there are clean, easy modifications, and learn that first. So learn the thing that's going to be relevant to what you practice. And then the next piece of advice, maybe before that, if you don't know who's going to walk in the door, is to. When you write herbal formulas in the beginning, write simple formulas. [00:16:41] Speaker A: Few ingredients cannot stress that enough. [00:16:44] Speaker B: And you have to resist the tendency to over modify, to over add, to do all these wonky things because you want to try to get it right right away, when actually there are more important things, like being able to clearly assess and see the clinical direction that somebody needs to go in to get better. [00:17:03] Speaker A: Yeah, yeah. I mean, that's the classic maneuver. [00:17:06] Speaker C: Right? [00:17:06] Speaker A: Like, we see this with the residents a lot, right? They'll be like, okay, I'm writing this to Jinza Tong, but I'm going to add in shichang poo and hupo and bailienza, and I think they've got a little dampness, so damp heat, maybe some huanglian. And you're like, this whole thing has changed. Now, it's important to recognize that formulas need to be modified, but modification, elegant modification, effective. Elegant modification is not usually a kind of kitchen sink maneuver. Like, oh, shichan poo is good for. Like, it's going to expel this dampness. And that's, you know, Sejan Zitang is there because the spleen is weak and there's this extra dampness. So we're going to put in shi, changpu and Shaaren. [00:17:55] Speaker C: Right? [00:17:55] Speaker A: Like, I mean, okay, but, like, why don't we see what happens if we just give them sagins a tongue, right. And see what. What the deal is? Like, if we think that that tonifying approach is the thing that we need to do, then let's try that. Right, right. And if we feel like there's an excess of dampness, why are we reaching toward. And, you know, these other herbs? Like, what about Leo gen Zitam? [00:18:20] Speaker B: Right, right. [00:18:21] Speaker A: There's already an established modification to deal with the damp factor. Exactly. So I like your phrase, resist the temptation to get it exactly right the first time. [00:18:33] Speaker C: Right? Yeah. [00:18:33] Speaker A: And look, once you've seen hundreds of patients in a particular space, you will know which modification to go to first. Like, you'll be able. You'll be able to skip the first step. But you're new to herbs right now, right? Identifying a pattern well enough to decide which basic formula to use is a massive triumph. [00:18:56] Speaker C: Yes. [00:18:56] Speaker A: Like, congratulations. That is a massive triumph. So don't. Don't muddle your picture, because if you hand someone ginsetong plus five herbs, right, that all have different flavors and natures and all have different movements, and it doesn't work. Why didn't it work? [00:19:11] Speaker B: Exactly. [00:19:12] Speaker A: Yeah, you can't tell. [00:19:13] Speaker B: You can't tell. [00:19:13] Speaker A: You can't tell. Was it because you're way off? Like, you've totally misunderstood the weakness of the spleen and how it needed to be tonified in this particular way. Or is it off because you're dosing of your all random mods, like, change the overall pattern direction of sagensettom, so you never actually gave the patient sage time. [00:19:31] Speaker C: Right. [00:19:31] Speaker A: You have no idea what you gave them. [00:19:32] Speaker C: Right. [00:19:33] Speaker A: You know, so I think. I think that's really important. And, and you will have to fight with yourself a little bit. [00:19:39] Speaker B: Absolutely. [00:19:40] Speaker C: Oh, yeah. [00:19:40] Speaker A: No, I think they just need a little bit. Little bit hoopoe. [00:19:43] Speaker C: Right. [00:19:44] Speaker B: Oh, just, just a little bit of, like, you gotta. Yeah, exactly. [00:19:47] Speaker C: Yeah. [00:19:48] Speaker A: Don't do it. [00:19:48] Speaker B: We just, last week, we had a case we were talking about with one of the residents at lunch about this cold and flu case, right. And we walked through formula strategy. We identified the formula, and then, uh, the resident was like, I really think he could just use some church on. [00:20:08] Speaker C: Right. [00:20:09] Speaker B: Which, which isn't in the formula. It's not. It's not in any of the classical modifications. It's. And, um. But it was just like, it was one of those things, like, right. Where I just, I feel like it would be a good fit. [00:20:21] Speaker C: Yeah. I think. [00:20:22] Speaker A: Yeah. [00:20:22] Speaker B: And the thing is, it might be. [00:20:26] Speaker A: Yeah. [00:20:28] Speaker B: An amazing fit. [00:20:30] Speaker C: Yeah. [00:20:30] Speaker B: But if you haven't given Sichang poo before and you don't know how to dose Sichang poo, you don't know where it fits in the formula, you don't know what herb you're gonna take out to put Siucong poo in for, or if you're just gonna add it, you don't know what that's gonna do. And so what my advice was, I never tell people what to do with formulas, but I always say what I would do is this. [00:20:56] Speaker A: Yeah, for sure. [00:20:57] Speaker B: Take the personality out of it. What I would do is, is this. This is what I would do. I wouldn't do that, because if you gave that formula to a patient and they came back with a super dry throat, I don't know if my formula is wrong or if the modification of the shirch on poo added in there is wrong. [00:21:15] Speaker C: Right. [00:21:16] Speaker B: I don't know if I had given it at 9 grams, if I would have given it at 3 grams, if it would have been okay. And what I've first, just to go on a bit of a tangent, a personal story with Sir Chung Poo. I took an Shen Dingji wan at one point. This was like, maybe our first or second year in clinical practice. So I was having trouble sleeping, and I was trying everything in the kitchen sink out, as we do when we're getting started. [00:21:43] Speaker C: Yeah. [00:21:44] Speaker B: And I tried anjou want in bulk with 9 grams of Sir Cheong poo in it. And I took the formula and within 30 minutes I had a completely dry throat that I could not quench. Like, I could sip water every 15 seconds to try to moisten my throat. And my throat was bone dry. And the next day I got a cold. And I think, I strongly think that taking that formula was so wrong in that way for me at that time that it messed with my system and it made me vulnerable to getting sick. And I got sick the next day. So. [00:22:24] Speaker C: Sure. [00:22:24] Speaker A: Cheng Poo is wicked dry. [00:22:25] Speaker B: Sir Cheong Poo is so dry and it can be a great herb. [00:22:30] Speaker A: Yeah, for sure. [00:22:31] Speaker B: It's fantastic. [00:22:32] Speaker A: There's not a lot of fluid accumulation and dampness in the tissue. Sichuan poo, amazing. [00:22:35] Speaker B: There's amazing uses for it. But again, knowing dosage, knowing timing, knowing which formulas are typically given with Sichuan pool, when is it used, how is it combined? That's way more important than to just have an idea of what it is and then throw it in a formula. [00:22:54] Speaker C: Yeah. [00:22:55] Speaker A: And you know, the thing is too, is that like, if you get into this as a new herbalist student or previously existing practitioner, you will probably find yourself quickly dealing in a space dominated by classical formulation. Right, sure. [00:23:12] Speaker C: Yeah. [00:23:13] Speaker A: Particularly Shanghan stuff. [00:23:14] Speaker C: Right. [00:23:15] Speaker A: But also, you know, fire school stuff and things like that. But you know, if you live in any place that's cool and damp. [00:23:20] Speaker C: Right. [00:23:20] Speaker A: Shanghai stuff's definitely going to be at the top of the list. [00:23:23] Speaker C: Yeah. [00:23:23] Speaker A: And of course what you will find is that, like, there aren't any classical formulas with, like, you know, Bon Julian. Right, right. And so you're asking yourself like, well, how could I ever learn to use Bonjour lien? And I would say that you in the beginning may not need to. Right, right. Because there are a lot of things to know in the world of herbs and you will never know them all. And so in some way you have to sort of narrow your focus a bit. [00:23:56] Speaker B: Narrow the scope, for sure. [00:23:57] Speaker A: And look, you're going to talk to some classical herbalist who will tell you that the reason they've narrowed their scope is because there's really no need for any other herbs. All the ones we ever needed were known 2000 years ago and all the other herbs are buck. [00:24:07] Speaker C: Right. [00:24:08] Speaker A: That is a zealot position. That's a hardcore position. And that is not the same as saying I've limited my focus, at least in my early study, to a classical point of view, mostly because there are literally thousands of herbs, and it just doesn't make sense to spread your attention that far. [00:24:28] Speaker C: Right. [00:24:28] Speaker A: So if you can deeply understand Zhang Zhongjing's formulas and the classical modifications to those formulas and the nature and flavor pieces that are being manipulated in order to make those modifications, that skill set can then be parlayed into any other herbal model. Because now we're not thinking about Xi Changpu as an herb itself necessarily, but we're thinking of Sher Jiang Poo for its qualities. [00:24:56] Speaker C: Yes. Right. [00:24:57] Speaker A: What is Shenpu like from a sort of macro viewpoint. And so that means that if I understand how, say, a xiao cha Yu Tong formula has been modified by the removal of x word and the adding of Y herb and the reason that we made that change, and it's not because we all just don't like Ren Chen and we really, really love Xiangjiang. [00:25:16] Speaker C: Right. [00:25:17] Speaker A: I mean, it's just a modification was made for a specific purpose, then you can say like, oh, well, we took out a sweet thing, we added an acrid thing and we took out this tonifying thing and we added in this draining thing. [00:25:29] Speaker C: Right. [00:25:29] Speaker A: And then you think, oh, well, maybe I could use a bit of shichung poo in the acrid sub. [00:25:35] Speaker B: Right. [00:25:36] Speaker A: Because I have an understanding of why we made the change. So again, if you use Bensky as a clinical manual, you will find yourself, I think, bouncing around a lot like formula of types. Because, because Bensky is an unbelievable compendium of knowledge and it pulls formulas from like, literally the last 2500 years. [00:25:58] Speaker C: Right. [00:25:59] Speaker B: There's a lot of stuff in there so broad. [00:26:01] Speaker A: It's so broad. [00:26:02] Speaker C: Yeah. [00:26:02] Speaker A: And so it's helpful, I think, to probably narrow your focus a little bit as you get into learning more. [00:26:09] Speaker C: Right. [00:26:10] Speaker A: So you mentioned learning, say, three formulas that might be good in your area. [00:26:15] Speaker C: Right. What? [00:26:16] Speaker A: Like, how is someone supposed to figure out which three formulas are the ones that say, let's say someone? [00:26:20] Speaker B: Yeah, that's a great question. [00:26:21] Speaker C: Yeah. [00:26:22] Speaker A: Let's say someone's been doing a lot of, like, stuff. We see a lot like anxiety, depression, insomnia. [00:26:28] Speaker C: Yep. [00:26:28] Speaker A: That's what's been coming through people's clinic a lot. How, how are they supposed to figure out which three or five formulas they need to put their attention on? [00:26:37] Speaker B: The best way to do that is to ask somebody who treats that in your area a lot. If you can, if you can't find somebody in your area, find somebody who's more global. You can always, like, anybody who's listening to this can ask us about this. Anything. Like, we treat everything with herbs. So, yeah, any, any topic you wanted to hear about, like what are some good formulas that, like, you can ask us? You know, in fact, what I'd like to do a little bit later is go over some for different topics like orthopedics or our top three orthopedic. [00:27:11] Speaker C: Yeah. [00:27:11] Speaker B: Formulas, stress, anxiety and some. [00:27:14] Speaker A: We will give you some start. [00:27:16] Speaker B: We'll give you some. [00:27:17] Speaker A: But if we don't, if we don't hit the thing that you're wondering about. [00:27:20] Speaker C: Right. [00:27:20] Speaker A: Shoot us an email. [00:27:21] Speaker B: Yeah, you could shoot us an email so that's available. So it's way better to ask somebody who actually does it than to read a book, because a book may be written by somebody in a different time, in a different space, in a different culture, with a different context. It's way better to ask somebody who is in the clinic on the ground, day in and day out, ideally in the same location relative to where you practice now that isn't going to be possible for everybody. So you can use the network, like the East Asian Medicine Network, more globally than that. [00:28:00] Speaker C: Yeah. [00:28:01] Speaker B: So that supersedes looking in a book. The second piece of advice I give is if you can't do that, then. [00:28:08] Speaker A: Look at a book. [00:28:08] Speaker B: But definitely do the first thing, because if you can, if you can listen to this podcast, you can write an email. [00:28:15] Speaker A: Yeah, exactly. You can send us an email. [00:28:17] Speaker B: So there's no excuses. But a book is going to be secondary. The problem with a book is that so often in the clinic you're going to get a book. [00:28:27] Speaker C: Right. [00:28:27] Speaker B: And you're going to read about eight patterns that are common for insomnia. But then if you were to follow the doctor who wrote that book in the clinic, they would combine two or three of those together when they treated the patient. [00:28:43] Speaker A: Yeah, right. [00:28:44] Speaker B: So if you have a quick conversation with somebody about, well, what do you actually do? Then you can talk about, like, well, I typically would start off with this structure for this type of patient, and then I might think about changing these aspects depending on, depending on these things. And so you get more of a sense of progression in the diagnosis and the treatment versus just maybe more of like a protocol based, well, if it's these symptoms, it's this pattern and that's this formula in the actual clinical practice, a lot of times it's a little messier than that. And the transmission of that knowledge doesn't need to be confusing. It can actually be very clean. If you talk to another human being and get their experience. [00:29:31] Speaker A: It's why it's not in the book. That way. Because if you write it down, it is confusing. [00:29:35] Speaker B: It is confusing. [00:29:36] Speaker A: There's too many variables in a book. So the book is sort of streamlined. [00:29:41] Speaker C: Right. [00:29:42] Speaker A: To say, like, okay, if you and I sat down to write a book about insomnia, for example, we would have to try and build the eight patterns that we see for insomnia. And then because it's me and you, we'd also have a section about disease progression and modification. [00:29:57] Speaker B: Right. [00:29:57] Speaker A: We would add a thing that's not in a lot of books. Yeah, but that part, the disease progression modification would be hard to write. [00:30:05] Speaker C: Yes. [00:30:06] Speaker A: And it would be hard to make. Easy to understand for someone who just picked up the book off the shelf. [00:30:12] Speaker C: Right. [00:30:13] Speaker A: Even a practitioner, I mean. [00:30:14] Speaker C: Right. So, like. [00:30:14] Speaker A: Cause you'd have to really think through, like, okay, I guess we need to make, like, a flow chart for each of these. Cause there's so many conditional items that would make it hard to understand without talking to one of us about it first. [00:30:26] Speaker C: Right. [00:30:27] Speaker A: So. [00:30:28] Speaker C: Yeah. Okay. [00:30:28] Speaker A: That makes sense. Well, why don't we give some of the formulas that we're thinking of? So which categories, which category of problem shall we start with? [00:30:38] Speaker B: I think orthopedic. A lot of our colleagues are in orthopedic medicine. [00:30:43] Speaker C: Right. For sure. [00:30:45] Speaker B: So what I see a lot is people in the orthopedic space go to, let's say, the evergreen prescript formulas that are kind of a fudging of diagnosis, if we're being honest. [00:30:59] Speaker C: Right? [00:31:00] Speaker A: Like, there's not like the. This is the plantar fasciitis formula. [00:31:03] Speaker B: Yeah, yeah, yeah, yeah. [00:31:03] Speaker A: For sure. Because you didn't actually diagnose. [00:31:05] Speaker B: There's no diagnosis. You know, it's kind of just like this, this thing and this thing. [00:31:11] Speaker A: Now, could you give me some good herbs for plantar fasciitis? [00:31:14] Speaker B: Yeah, exactly. [00:31:15] Speaker A: Come on, man. [00:31:16] Speaker B: Now, if you look at the herbs and those formulas and you have some knowledge about what the herbs do, you can see the pattern in those formulas. So it's not like they're bad formulas. [00:31:25] Speaker A: Oh, they're definitely not bad formulas. [00:31:26] Speaker C: Yes. [00:31:27] Speaker A: In fact, they're usually very effective formulas. [00:31:28] Speaker C: Yes. [00:31:29] Speaker A: But also incredibly expensive. [00:31:31] Speaker B: They're doubly expensive as any other formula you're going to write from scratch because they're making a double markup on the proprietary nature of the formula. So if you can figure out what to do without using those formulas, it's recommended by me, at least, that you should. [00:31:48] Speaker A: Yeah, certainly cheaper for your patient. [00:31:50] Speaker B: Certainly cheaper for your patient and better for you, you know? So for orthopedic stuff. Well, let's just take, let's go from the head down. [00:32:02] Speaker A: Okay. [00:32:03] Speaker B: So somebody who has head trauma, what formulas come to mind for you in your clinical practice? Practice? [00:32:11] Speaker A: As soon as we deal in anything trauma based in any part of the body, the first thing that I'm thinking is ju gyutang family formulas in general. [00:32:20] Speaker C: Me too. Yep. [00:32:21] Speaker A: So which one? Shaofu shui fu goxie. Like, whatever. [00:32:25] Speaker C: Right. [00:32:25] Speaker A: There's like, so many different versions of the juyutan formulas, but that's always where my mind goes first and then using them as they're already written, because by and large, they are sent to different parts of the body, like which one you're gonna work with. So if you're starting at the head, which is it a juyutang that you're going to start with? [00:32:45] Speaker B: That's exactly what I was going to start. [00:32:46] Speaker C: There you go. Yep. [00:32:47] Speaker A: Ju Yutan. [00:32:48] Speaker B: Juyutang. So the formula I was thinking of at first. So if you want a fantastic formula, it's written by the doctor who did all the Zhu Yutong formulas. Who wrote formulas? I found this out. This is kind of interesting. He wrote all of his formulas with ingredients that were cheap for his patients. So he created this whole system of prescription with ingredients that are, that were super cheap and easy for people to get. [00:33:21] Speaker A: That's awesome. [00:33:22] Speaker B: So now what's ironic about that, of course, is that now they're huge formulas, and so if you try to use them in bulk, especially, they're very expensive. [00:33:33] Speaker A: Yeah, I know. Talk about that for irony, right? [00:33:35] Speaker B: Right. So I think the best, the crowning jewel of that doctor's formulas, all of the formulas, he's written the best one overall for every kind of blood stasis, if you were to pick one to learn, which is especially applicable for head trauma, blood stasis, trying to get blood moving into the brain is undoubtedly the case. [00:34:00] Speaker A: But I thought it only treated the mansion of blood, right? [00:34:02] Speaker B: The mansion of blood. [00:34:03] Speaker C: Yeah. [00:34:03] Speaker B: What's the mansion of blood? [00:34:04] Speaker A: I found that formula just for, like, heart palpitations and upper jowl constraints. I thought I read that in the Bensky. [00:34:10] Speaker B: Yeah, yeah. Well, it can be for that. [00:34:13] Speaker A: It is for that. It is for that. This is exactly my point. [00:34:16] Speaker C: Right. [00:34:16] Speaker A: Like, there's only so much information you can possibly ever contain in a book. [00:34:20] Speaker C: Right. [00:34:20] Speaker A: And I just want to again say for the record, for the umpteenth time, I love the Bensky. [00:34:25] Speaker C: Yeah. [00:34:25] Speaker A: I'm not in any way, shape or form suggesting there's a problem with that book. It is the cornerstone of learning herbal medicine in the west, without doubt. [00:34:33] Speaker C: Right. [00:34:34] Speaker A: But the thing is, is that it's a school book. Like, it's a textbook for school. [00:34:38] Speaker C: Right. [00:34:38] Speaker A: And there's, there's a lot of really great commentary in there and excerpts from classical texts. Like, you shouldn't forget about that book. In fact, you should go back and read the entry on. But don't use the signs and symptoms as the only way to know how to use shoi fujuta. [00:34:55] Speaker C: Right. [00:34:55] Speaker A: Because you probably wouldn't end up using it for head trauma. [00:34:57] Speaker C: Right. [00:34:58] Speaker A: Is what would happen. [00:34:58] Speaker C: Yeah, exactly. Agree that. [00:34:59] Speaker A: Be like, oh, this doesn't really. Right. [00:35:01] Speaker C: Yeah. [00:35:02] Speaker B: But you get your NVA patient, boom, hit their head on the thing, the airbag comes out, pop, right in the head. And now I have a concussion and I can't think straight, and I have pain and I feel like I'm under water. Right. The easiest to know formula that treats that is for what I would do for that type of patient is I would automatically add in bugs. [00:35:32] Speaker C: Yeah. Yep. [00:35:33] Speaker B: I would be adding in Schwager and tu Biachan right from the start. Cause you wanna get in there nice and deep. You really wanna get between the blood brain barrier. Like you want. You want the loami collateral action for those kinds of cases. [00:35:47] Speaker A: And this is what bugs do, you guys, they crawl into the small space. [00:35:50] Speaker B: Get into those small spaces. [00:35:51] Speaker A: I wouldn't recommend, by the way, that you use that image with your patients. A little bit creepy, right? The bugs are crawling into my brain. Like, that's a bad image, but for you to remember what they do, right? I suppose leeches aren't technically bugs, but you know what I mean? [00:36:07] Speaker C: Right? Sure. Yeah. [00:36:08] Speaker A: Like the animal, the creepy animals, you. [00:36:10] Speaker C: Know what I mean? [00:36:10] Speaker A: The centipedes, the roaches, the leeches, they get into the small spaces. And that's what really matters here, right? Because without doubt, somebody's had a traumatic brain injury, a TBI. Like you want to, you want to take that blood moving deep into the space. [00:36:26] Speaker C: Yes, you do. Yeah. [00:36:27] Speaker A: So shui fuji u tang, plus bucks. [00:36:28] Speaker B: Plus bucks. [00:36:29] Speaker A: Specifically tu Beijing and schwager. [00:36:31] Speaker B: To be a Chung and schwager. Schwager is more expensive. To be a chung is super cheap. So they. Yeah, yeah, exactly. They work well together. So if you do that, you can have. You'll have miraculous cases with that combination. Head trauma, concussions, things like that, even chronic stuff, acute or chronic, you can use that formula. So, yeah, I think that's a thing. If we're just going to give one for head trauma. That's the one to give right there. [00:37:03] Speaker C: Yeah. [00:37:04] Speaker A: And so, all right, let's move down the body a little bit. So what about, like, shoulder pain, hand pain? [00:37:12] Speaker C: Yep. [00:37:13] Speaker A: You know, sort of like limb pain. [00:37:16] Speaker B: What are you doing with that shoulder pain? Um, limb pain, again with blood stasis. So traumatic injury type stuff. Our ju Yutong of the month formula is Shentong juton. [00:37:29] Speaker C: Yep. Right. [00:37:30] Speaker B: That's going to treat anything in the. [00:37:31] Speaker A: Extremities, including in the legs. [00:37:33] Speaker B: Including in the legs, yeah. [00:37:35] Speaker A: It's not just upper body. [00:37:36] Speaker C: Yeah. [00:37:37] Speaker B: But I would say that a lot of stuff from this is now from clinical practice, trying things, seeing what works, what doesn't work. A lot of stuff in the shoulder, the hand, the elbow, anything in the upper extremity is actually related to the neck. If the neck is involved, then a basic guggen tongue could be your formula. And it will treat all that crap in the hands and the elbow and the shoulder just by opening up with the guggen formula. And a lot of the evergreen neck and shoulder formulas. [00:38:11] Speaker C: Right. [00:38:11] Speaker B: They have guggen in them. They're not guggen Tong specifically, but they do have the guggen principle. [00:38:16] Speaker C: Yeah. Right. [00:38:17] Speaker A: Yes. You could use just a guggen tongue if you think that's it. Or you could do a simple modification and add some guggen to your shintong zhutong. [00:38:25] Speaker C: Yep. [00:38:26] Speaker A: Yeah, for sure. Okay. Lower body, let's say we've got foot pain, plantar fasciitis, that kind of presentation. What are we using? [00:38:36] Speaker B: That's going to be a little bit more case specific. So Shentong juton could work for that too. [00:38:42] Speaker C: Right? [00:38:42] Speaker B: Because it's still extremities. It's still. It lives in that space. But that's going to be, again, for a blood stasis type of presentation. So that's just going to move the blood. [00:38:54] Speaker A: Right. [00:38:56] Speaker B: For a significant number of patients, anything with the feet is related to, especially for older patients or patients that have been depleted, is related to a deficient lower jiaon. So in simple zongfu organ terms, kidney deficient patient, or in shangha diagnosis, we might say a xiaoyan type patient, somebody that has weak yang and the reason that their feet are in pain. This is the case for a lot of peripheral neuropathy people. By the way, the reason that their feet are painful or sore or lack of feeling is because the yang is so weak, it's staying in the middle of the body and it's not able to get out to the extremity. So the stuff in the extremity starts to suffer because of that. And the furthest extremity that we have in our body is our feet. So it's definitely going to show up there, but it could also show up in the hands. Cause that's also an extremity. [00:40:04] Speaker C: Right. [00:40:05] Speaker B: So it's possible that there is a deficient component to the picture. And then you would want to figure out if that's the case. If they're cold, then there's a whole series of formulas that would treat that. Depending on the other aspects of the case, that could be like a jingue, Shen Chi Wan. That could be. [00:40:25] Speaker A: But let's say if we're, again, we're saying traumatic, let's stick with the traumatic space. Shintong juton again, probably, right? [00:40:34] Speaker C: Yep. [00:40:34] Speaker A: Okay, so traumatic injury, three formulas. [00:40:37] Speaker C: Right? [00:40:37] Speaker A: Schuei Fujiutang. [00:40:39] Speaker C: Yep. [00:40:39] Speaker A: Shantong, jutang. Shantong, Jutong. What is our third one for body pain? Traumatic injury style? [00:40:46] Speaker B: Yeah. So there's another, there's a formula called xiao fu juyutang. [00:40:52] Speaker C: Right. [00:40:53] Speaker B: Which is more for the lower jiao. That's more for like, menstrual irregularity type stuff. [00:41:00] Speaker C: Right. [00:41:00] Speaker A: Less traumatic injury. [00:41:01] Speaker B: Less traumatic injury. But there's still blood stasis, and that is a good formula to know. So, yeah, I would say that that would be like, if you're working on traumatic injury, blood stasis, those are your three. [00:41:14] Speaker C: Yeah. [00:41:14] Speaker B: You know, for sure. Those are really good ones to know. Another one that might fit as a general blood moving formula is our friend Guager Fuleymore. [00:41:24] Speaker C: Right. [00:41:24] Speaker B: Where you can, you can use that for blood stasis anywhere in the body. And it's soft blood movement. So it's really applicable to a lot of cases and it's good to add into other things if you need to. [00:41:38] Speaker A: Yeah. Lightning round formula naming for some conditions. [00:41:44] Speaker C: Yep. [00:41:44] Speaker A: Insomnia. [00:41:46] Speaker B: Insomnia. The first thing that I look at with insomnia is digestive health. If there's a problem with digestion, if the person's stomach is full when they're going to sleep, that's the first thing you need to treat. So none of the other stuff works. If you give them Swan Zaran Tang and their stomach is full and they have acid reflux and they're going to bed and because their stomach is full, their heart rate goes up and their metabolism goes crazy, they're not going to be able to fall asleep with buckets of Swan Zhao Rentong. It's not going to work. So the formula that is great at treating that is Gansauchie Shintong. It's a fantastic insomnia formula. If you want to add a little bit more. Their colder presentations, let's say their extremities are colder, they tend to run colder, but they have this fullness in the stomach. They have a mixed heat and cold pattern in the middle. So their bowels are like, mixed then, but they're a colder presentation. Then you can add rogue into Gan Sao Shaitian tong, and that creates a formula called zhao Taiwan, which is simple. Huanglian and Rogue way together. There was a post on one of the only useful posts on the Facebook, like this, like, crazy Facebook acupuncturist groups. The only useful post I ever remember reading from that group was there's this woman who clearly had, like, a fair amount of clinical experience. And she's like, for every patient that has insomnia, I just give them Zhao Taiwan and roguelike just going to taste like crap. [00:43:26] Speaker C: Right. [00:43:26] Speaker B: But she was like, yeah, I just give it to them before bed. They take it and everyone sleeps better. [00:43:32] Speaker C: Yeah. [00:43:32] Speaker B: And that right there just goes to show you how prevalent the pattern of people having a full stomach when they go to bed is and how much that can interrupt our sleep. So Gan sao Shai Shintong, I would say, is the key formula for that. Zhao Taiwan is an easy add. And you just add rogue to that formula because we already have and the formula. [00:43:54] Speaker A: And then I think if you're trying to figure out formulas, like, again, so quick formula naming Gan Southeast tang with its mod. And then, honestly, I think people should understand how Swanzo, Ren Tang and Guipitang actually work. [00:44:07] Speaker C: Yeah. [00:44:08] Speaker A: Like, don't just be like, oh, they had sleep problem. Here's Swan Sorentang. Like, you need to take some time to understand how those formulas work. [00:44:15] Speaker C: Right. [00:44:15] Speaker A: Because there is a really applicable circumstance for Swansea rintang. We need to understand why. [00:44:20] Speaker C: Right. [00:44:20] Speaker A: So if you're dealing with a lot of sleep stuff, Sheng formulas are going to be great in general as a family, but specifically Ganso shesentan and then swans are. [00:44:30] Speaker C: Yep. [00:44:31] Speaker A: Okay. Formula name. Give me three. Give me a formula for digestive problem. [00:44:38] Speaker B: Well, we could use ganso shaishin tongue again. [00:44:40] Speaker A: There you go. [00:44:40] Speaker C: Good. [00:44:41] Speaker A: Because ganso shaishin tongue is dealing with the root cause of the sleep problem is digestion. [00:44:45] Speaker B: Yeah, absolutely. [00:44:47] Speaker A: But again, we're thinking, what are three formulas? I've got a patient seeing a lot of digestive upset. [00:44:51] Speaker C: Yep. [00:44:51] Speaker A: And as we know, digestive stuff is broad. [00:44:54] Speaker C: Right. [00:44:54] Speaker A: And so upper gi is not the same as lower gi, et cetera. [00:44:58] Speaker C: Right. [00:44:59] Speaker A: But nonetheless, um, I think it's worth just, okay, three formulas. So chaise and tongs again, shishentongs are great. [00:45:06] Speaker B: Um, the other thing that I would say is if there's any, uh, trouble with temperature fluctuation, if there's any signs of the classic signs of xiaoyang disease, strange taste in the mouth, dizzy vision, a feeling of soreness, stuckness or dryness in the throat, and any kind of alternating pattern, I have, uh, tend to have more loose stool and then it's more dry. I tend to feel this way and then I feel this way. I have symptoms that cycle. Anything like that. Xiao cha, Yu Tang. [00:45:41] Speaker A: Yeah, for sure. [00:45:41] Speaker B: It's just such a great, and it will treat Gi problems. [00:45:45] Speaker C: That's the thing. [00:45:45] Speaker A: Absolutely. [00:45:46] Speaker B: You know, I mean, if you have. [00:45:47] Speaker A: That presentation, like, I can't stress this enough, like if you have classical presentation for Xiao Chaotang and you have alternating symptomology, give them xiao chao. [00:45:56] Speaker B: It doesn't matter what it is, right? [00:45:59] Speaker A: Oh, they have digestive problem, they have sleep problem, they have cold and flu. They have, like, it doesn't matter. Like if the thing presents how it's supposed to present, don't let yourself get caught up in the fact that, like, xiao Chia Tang is a quote unquote cold formula, right? It is not a cold formula. [00:46:14] Speaker C: Right. [00:46:14] Speaker A: It's harmonizing formula that treats all kinds of pivot imbalance, which can show up in any number of ways. So, yeah, if you have those symptoms, give them xiao cha Hu Tang, especially if you have like two, three or four of them. Like stop at, stop it. Which I, I mean, it looks like xiao chi Hu tang, but it's a digestive problem. Give them, give them xiao chai. That's what they need to do. [00:46:33] Speaker B: It'll get better. [00:46:34] Speaker A: If you have excess presentations for stomach, I think it's worth looking at Ping Weisan particularly. And also don't neglect good old baohawan. Baohawan is a formula that we, you know, people think of for food stagnation, stagnation after thanksgiving or whatever. [00:46:48] Speaker C: Right? [00:46:48] Speaker A: But food stagnation, I mean, is that right? It definitely serves that purpose. But a lot of people's dietary food habits that create excess presentations in the stomach, right? So like an excess type of heartburn, right? Excess type of bloating and discomfort, excess type of like heat and halitosis in the, in the stomach. Look at Ping Weissan, look at baohuan. Baohawan doesn't have to be a thanksgiving only formula, right? Because people overeat, they eat things that are heavy and cloying, and baohuan can open up that stuff. You're not going to solve a long standing digestive problem with either of those formulas, but they're going to get open up the doorway. So understanding those formulas, I think, would be, would be helpful as well. [00:47:26] Speaker C: Yep. Okay. [00:47:27] Speaker A: What about people dealing with ongoing anxiety? [00:47:32] Speaker B: Yeah, well, the formulas we already mentioned. [00:47:35] Speaker A: Can be used for that. [00:47:37] Speaker B: Additionally, I would say a lot of people with anxiety do really well with high guager formulas. So formulas like, let's say Xiao zhenjiang tang is one of those. So that's a Guizhou tong modification right there. If the person has palpitations or a skipping heart rate, then Guijer tongue modifications without Bai Xiao are advised. There's a whole series of formulas that do that. Guid your chu Xiao Yao Tung, which is just gui Jiu tong without Baixiao. That's where you start. And then another formula that's fantastic for yang floating, coming out of the blood is Guijer Gansao, Wangu Mung Litan, which is just those four herbs. That formula works really well. Combined with xiao chai Hu Tang, with gansao, Shaishin Tong, you can put it into all kinds of different stuff, and it just helps to root the yang back into the blood, which can help people with sleep, can help people with anxiety. It can help people with a lot of different things. [00:48:43] Speaker C: Yeah. [00:48:43] Speaker A: So for anxiety, take a look at wager formulas. [00:48:47] Speaker B: Wager formulas. [00:48:48] Speaker C: Yeah. [00:48:49] Speaker A: I would also throw into the mix. It's worth spending some time understanding. Tian Wang bushindang. It's a big formula. It's a newer formula than the classics, but it has wide applicability for stuff that has, like, sort of heart blood deficiency kind of presentation. So that's insomnia, anxiety, irritability, restlessness, like all that kind of stuff. And, you know, again, we're talking about these things like they're in silos. Like people who have anxiety often have insomnia. People with insomnia have anxiety and digestive upset. Nothing. As you know, if you're listening to this show and you deal with patients, nothing lives in a vacuum. [00:49:23] Speaker C: Right. [00:49:23] Speaker A: Like, it's very rare for someone to walk in with just one thing. [00:49:25] Speaker C: Right. [00:49:26] Speaker A: But, you know, we're giving you these general categories of stuff to consider. Okay, I like that. I mean, I think that's a good starting point. Obviously, if you're wondering out there what might be three or four good formulas for this category of things, send us an email info. Rootandbranchpdx.com dot. That's infooodendbranchpapadeltaxray.com. And we will let you know because this is, I think, a good place for people to start and get into it. So what does that mean? [00:49:57] Speaker C: Right. [00:49:57] Speaker A: What does it mean to start to understand these formulas? Go and read Debinsky. Go start there. And then if they're Shanghan formulas, take a look at a good Shanghai translation and see what the modifications and the commentaries are in that space. Talk to someone who has been practicing a little bit more than you have. Right. Talk to people who haven't been practicing any more than you have. Just use them as sounding boards. [00:50:21] Speaker C: Right. [00:50:21] Speaker A: Hey, I'm thinking about this, and I read about this modification. And then here's the other thing. Keep good notes. [00:50:28] Speaker B: Keep good notes. [00:50:29] Speaker A: If you wrote the formula and then two weeks later you modified the formula right in your chart, why? Because I have gone back to charts and, like, I'll see a change in the formula and I'm like, why did I do that? Why did I do that? Because you see too many patients and you can't remember now, like, what the thought process was. But if you write it down, you will. And it also means that you'll be. [00:50:48] Speaker B: Able to track it. [00:50:49] Speaker C: Right. [00:50:50] Speaker A: So I added this modification because I think there is too much sweet flavor. So I pulled the sweet flavor out, I added some acrid. Try and bring it closer to the skin surface and reduce the cloying. [00:50:59] Speaker C: Right. [00:51:00] Speaker A: And then next week, it turns out that the abdomen is actually less tender, less bloated. [00:51:05] Speaker C: Awesome. Right. [00:51:06] Speaker A: Now you're seeing that your shift in those flavor profiles has affected the outcome in the patient. And you may not notice that, obviously, in the beginning. But if you're recording the details, at some point when you're reviewing the track record of your effectiveness with a patient, you'll be able to see it for yourself. [00:51:23] Speaker C: Yep. Right. [00:51:25] Speaker A: It's obviously much faster to learn this kind of stuff if you're working with someone who already knows it. Absolutely. [00:51:31] Speaker C: Yeah. [00:51:32] Speaker A: But I actually want to give a shout out to the self empowerment of learning. It is much slower. [00:51:39] Speaker C: Right. [00:51:39] Speaker A: Because you don't know what you don't know. [00:51:41] Speaker C: Right. [00:51:42] Speaker A: But not having a guru, a master, the money to spend on CE, living in, in a community where you can talk to people, those are all just excuses for not getting into this. If you like herbs, prescribe herbs. Take notes of what you're doing and embody the excitement and the spirit of the early herbalists. When people began doing this, they didn't. [00:52:07] Speaker B: Know how to do it. [00:52:09] Speaker A: Now, we are the inheritors of thousands of years of experimentation, so we don't have to start from scratch by, like, randomly pulling plants out of the ground and seeing what happens. We already know, but that doesn't mean that it's very clear for everyone how that plays out clinically. [00:52:24] Speaker C: Right. But. [00:52:24] Speaker A: But you can figure it out. [00:52:27] Speaker C: Right. [00:52:27] Speaker A: So I want to. I want to challenge all of you out there who are like, well, I live in a small town. I don't know anybody to talk about this stuff. I love herbs, but I don't know where to start. [00:52:36] Speaker C: Right. [00:52:36] Speaker A: You start by doing exactly what we just said. You take a category of things. You learn three formulas about that category of things, and then you try applying them in clinic, and you write down what happens. [00:52:48] Speaker C: Yep. Right. [00:52:49] Speaker A: And then you will refine and you will strategize and you will get some clarity on what it is you need to do next. Don't let yourself. Don't let a lack of resources or a lack of, like, the perfect scenario. I love the phrase, like, don't let the perfect be the enemy of the good. [00:53:05] Speaker C: Right. [00:53:05] Speaker A: Like, just because you don't have all of it perfectly arranged doesn't mean you shouldn't do it. [00:53:10] Speaker C: Right. Right. [00:53:11] Speaker A: Like, get in it, play around with it. [00:53:13] Speaker C: Yep. Yeah. [00:53:13] Speaker B: Absolutely. [00:53:16] Speaker A: All right, well, guys, we're going to hold it there just as a little. A little taste of things to consider. We're going to keep revisiting this topic over and over again because it's, I mean, many ways, the primary driver of the show. Like, we want to have people feel empowered and emboldened to do stuff with herbs and to kind of add to the stack of things. But if you're new or you're getting back into herbs. Right. Remember these key pieces of advice. [00:53:39] Speaker C: Right. [00:53:39] Speaker A: Like, first and foremost, make contact with a pharmacy that can fill your herbs so that you don't have to spend time doing the business of pharmacy. You can just focus on the clinic. [00:53:48] Speaker C: Right. [00:53:49] Speaker A: Step two, organize the resources that are around you. Who can you talk to? What books do you have? What ce can you tap into? [00:53:55] Speaker C: Right. [00:53:56] Speaker A: Step three, try and get a little bit of sense of what's walking through your door. [00:54:00] Speaker C: Right. [00:54:00] Speaker A: To see what. What it is that you're treating and how. [00:54:02] Speaker C: Right. [00:54:03] Speaker A: And then you're going to dive into some formulas related to those things. Don't feel like you need to go and relearn all 165 formulas that you studied for your board exam. [00:54:14] Speaker C: Right. [00:54:15] Speaker A: That's too much. [00:54:16] Speaker C: Right. [00:54:16] Speaker A: You'll be overwhelmed. Narrow your focus. Go into that space, and then just do it. Like, literally just do it. Stop making excuses. Go into it. [00:54:27] Speaker C: Yep. [00:54:28] Speaker B: Absolutely. [00:54:29] Speaker A: All right, well, guys, this is Travis Kern. [00:54:32] Speaker B: And I'm Travis Cunningham. [00:54:33] Speaker A: Thanks for listening. We'll talk to you again next time. [00:54:35] Speaker C: See you next time.