Treating Cold and Flu

[00:00:02] Speaker A: Hi, everyone, and welcome to the Nervous Herbalist, a podcast for chinese medicine practitioners who like herbs and want to learn more about their function, their history, and treatment strategies to use in the clinic. Let's get into it. All right, everyone, welcome back to another episode of the Nervous Herbalist. I am one of your hosts, Travis Kern, here along with, I'm Travis Cunningham. Excellent. And we are back to talk to you guys about some exciting seasonal stuff. Cold and flu. Yes, everyone's favorite item, cold and flu. We deal with it all the time in the clinic. You guys probably see it all the time. Hopefully you do. Although interestingly, I mean, sometimes people don't think about us first for cold and flu. [00:00:50] Speaker B: Yeah, I think that's pretty common. [00:00:53] Speaker A: How do you think we, because a lot of our patients do know they think of us for cold and flu, but how do you think we got them there? Did we do anything to get them to understand that, hey, you can come see us for cold and flu. [00:01:06] Speaker B: I think both you and I like treating cold and flu. I remember even back in school, when we were in school, you and I both liked that particular topic of disease because you get to see patterns that are treatable. You treat them and they shift quickly, and so you get to see whether you are on point or not. It's internal medicine. It's acute internal medicine, but it's not usually life threatening, and at least immediately. [00:01:37] Speaker A: It'S not life threatening. Yeah, of course. [00:01:40] Speaker B: And so, yeah, I think we sort of set out in the beginning to do it, and then when we started seeing patients privately, we would just let everyone know, like, if you get sick, you're taking this formula, but if you get sick, stop taking the formula, give us a call. And then just through repetition, I think we informed. [00:02:05] Speaker A: That makes sense to me, I think, too, sometimes this time of year. So we're recording this in the fall, though. Cold and flu is, of course, not restricted to the fall, but recording this in the fall. And sometimes people will call to cancel their appointment because they've gotten sick. And so you've got that person on the phone and you're like, they're like, hey, I need to cancel my appointment. And I'll be like, oh, well, what's going on? And I've got the sniffles. And I'll tell people, well, if you feel like you can come to the clinic, chinese medicine has an amazing set of tools to help with that. You wear a mask, let us know that you're going to still come. We'll wear a mask to help keep everybody safe. But other than that. Come on in. You can get here. Come on in. And it's amazing to me the number of people who will be like, oh, are you sure? No, definitely. We deal in sick people. That's literally our job. So you should come here. And I think now for a while with COVID people were really nervous about that, right. Because they didn't want to expose anyone. And that totally makes sense. But the good news is that now everyone is also very familiar with the idea of wearing a mask. [00:03:07] Speaker B: Yes. [00:03:07] Speaker A: So you're just like, yeah, just put a mask on. We'll put a mask on. Great. Now we can actually help you out. So it's actually, in a weird way, kind of a golden age of treating cold and flu, because I feel like people are a little bit more aware of what we can actually do for them. [00:03:22] Speaker B: Yeah, absolutely. Not just for cold and flu, but, like, sequela symptoms or coughs. We all know somebody who's. Yeah, I had pneumonia that one year, and I just never really recovered or it took me months or whatever. And we're great at treating those cases, getting people back on their feet and back up to 100%. Not just, like 80%, but 100% fully back. [00:03:50] Speaker A: Yeah, I think it's really relevant right now with the amount of what a lot of the biomeds and naturopaths are calling long COVID, which, of course, is, like, a pretty general term. I'm not sure that has a great definition, honestly, from what I've seen. [00:04:02] Speaker B: Yeah, I don't know either. [00:04:03] Speaker A: A lot of people just get. I have long COVID and, like, well, yeah, maybe. I'm not sure, but definitely whatever you got going on, we can almost certainly help you with. Okay, so how do you want to lay out our cold and flu conversation today? Where do you want to start? [00:04:18] Speaker B: I thought it'd be cool to give a bit of a background on the. Shanghai Luna is a very good text for this topic. And there's different ways we can look at progression of disease, particularly externally contracted disease, which is the subject matter of the Shanghai lun. And so I thought it would be cool to first talk, give kind of a different picture or story to what happens when our body deals with an external contraction, and then to talk about how do the symptoms relate to the different levels of inability for the body to adapt, which is really what it's about, and kind of give a different lens and context and then plug in formulas, how the formulas are set up to deal with those different symptoms or different areas where the physiology is getting stuck, unable to perform its adaptive function in some way, shape or form. And then if we want to talk about cases, I have cases I've written up around this subject. If you want to talk about how you would do that, because you and I usually have a little bit of a different way of doing things, I think any of that would be interesting to at least some people out there. [00:05:38] Speaker A: Well, why don't we start with it through the lens of how these cases come into the clinic? [00:05:44] Speaker B: Right? [00:05:45] Speaker A: So like, someone shows up, they were going to cancel their appointment, but they're coming in anyway, and you're going to do your interview, you're going to get some key factors. When you're first walking into what you know as a cold and flu case, what are the major things that you are going to either question out or physically examine that's going to help to begin that first bifurcation or trication in terms of what kind of formula I might need here. What's your go to pieces there? [00:06:16] Speaker B: Yeah. So I'll first ask somebody how long they've been feeling symptoms. I try to get a timeline. The Shanghai has a kind of narrative about the days that somebody's sick correlated to different confirmations, maybe formulas. So generally, one to two days per confirmation is kind of a rough. So like one to two, you're in Taeyong, two to three, yangming. You know, it's kind of like that, so on and so forth. Of course, that isn't the only thing we use, but if you pay attention to timeline, it's actually pretty accurate in a lot of cases. So it's not 100%, but it's a good thing to know. So the first thing I try to do is establish timeline. When did you notice feeling off? When was the first sign of symptom and what was the symptom that you felt, and then what are you feeling currently? Those are the two things that I'm looking for. And then I pretty much always ask this question next. Do you have any fever, chills, body aches? I say it exactly like that, fever, chills, or body aches. And sometimes people will say yes, all three. Sometimes people will say, I don't have any fever, or I don't have any symptom of fever, but I do have chills, or I do have body aches. Whatever they say. If they say yes to any of those symptoms, I'm thinking that there's some kind of taiyang involvement, usually. [00:07:56] Speaker A: And when you're asking about fever, you mean like thermometer fever or their subjective sense of it. Or what? [00:08:02] Speaker B: I mean, their subjective sense of it. I don't care so much about the thermometer fever, but they'll usually offer that. That's okay. But then I'll redirect and say, but do you feel like, do you feel hot? And if they're in person, I might actually check. I might touch their forehead, or I might do some kind of palpation to figure that out. Most of the time, if they have something, they'll have chills. Right. Because you can have a fever, but you feel chilled and body aches. People will know if they're chilled and if they have body aches. [00:08:38] Speaker A: Right. [00:08:38] Speaker B: So if they have those things, then it's very likely that there's a taiyang level problem and maybe other things as well, but almost certainly a taiyang problem. [00:08:51] Speaker A: Gotcha. Okay, so that's clarifying the timeline, and then those questions are establishing the likelihood that it's Taiyan. Yeah. Right. And of course, for the listeners, as a reminder, the Shanghai lun utilizes this stages confirmations. There's a lot of translations that you'll hear for the phrases, but that's what we mean, the taiyang xiaoyang, like those phrases that you guys are familiar with, tai, et cetera. [00:09:19] Speaker B: Right, right. [00:09:19] Speaker A: So those are the levels that travis is talking about. And again, you use the word confirmations, I think, most commonly. [00:09:26] Speaker B: Right. [00:09:27] Speaker A: But you'll hear people use other words, but we're all talking about the same thing. [00:09:30] Speaker B: Right. [00:09:30] Speaker A: Why have you found that thinking about it in that way is useful? Like, why that versus anything else? [00:09:37] Speaker B: I just think it's the way that I've learned to be the most clear and detailed in my diagnosis and treatment. So I don't think there's anything special per se about that theory versus any other theory, but how we learn to see things, what our viewpoint is, is informed by the people we see do medicine, the people who we learn medicine from and who we're inspired by. And then the level of detail of the system, for me, the six confirmations is very detailed. There's a lot of connections and ways that that system can be utilized in thinking. So it's a really neat system to use, and it's really useful clinically. And it's easy to see how each one of these components comes alive in cold and flu and to a greater extent, the idea of external contraction. [00:10:37] Speaker A: Okay. All right. So the patient reports that their symptoms started two days ago, and they are having, in fact, all three fever, chills, and body aches. [00:10:48] Speaker B: Yeah. [00:10:48] Speaker A: Now what? [00:10:49] Speaker B: So then I would ask them what other symptoms they're noticing. That's usually a quick way. Yeah, I have a cough. I have this thing, I have that thing. I might feel nauseous, I might have a headache. I want to know what the general features of their experience are. [00:11:09] Speaker A: Okay. And those additional symptoms, those are going to be modifications likely that you're going to make on a formula that you're already thinking of from the initial data. [00:11:19] Speaker B: Yeah. So let's say they say yes to the first major question. I have fever, chills, body. Yeah, I have all three. Right. It tells me that I need to address Taeyang, but it doesn't tell me whether I need to address other things as well or not. That would be confirmed by other symptoms, other findings. [00:11:45] Speaker A: Okay, so this patient, then, they have sore throat, they have a mild cough, they have a headache. [00:11:51] Speaker B: Yeah. So pretty much as soon as I see the symptom of sore throat, I think it's probably xiaoyang. [00:11:57] Speaker A: Okay. [00:11:58] Speaker B: That's like the number one. If I wasn't able to evaluate anything objectively, like I wasn't able to feel the pulse or do the abdomen, which happens sometimes if somebody calls and you're doing it over the phone, the number one symptom that I look for to indicate xiaoyang disease is sore throat. Gotcha. Yang disease or sore throat doesn't really happen in Taiyang. It can happen in yangming, but it's very rare and it's very common to have happened in xiaoyang. [00:12:29] Speaker A: So even though the first answers to the questions were like, oh, this is probably Taeyang, the fact that the patient throws out yang throws out sore throat makes you, ah shaoyang. [00:12:39] Speaker B: Yeah. I need to treat xiaoyang. So then I would think I need to treat both of those. Right. I need to treat taiyang and xiaoyang concurrently, which we have a couple of formulas. But the main formula that would treat both of those is guejutong. Right. Because basically just the taiyang formula and the xiaoyang formula put them together and you have that as a structure you can use. [00:13:04] Speaker A: Right. Because the taiyang formula is chutan. [00:13:08] Speaker B: Yeah. [00:13:09] Speaker A: And the Xiaong formula, shao chai Tan. [00:13:12] Speaker B: And in taeyang, you have a problem of opening. That's the function of taiyang is to open. So when there's a pattern of taiyang, it means that the function of opening is impaired. Now, there's two different versions of that. There's an inability to open, period, which we would think of mahong tong for. So that's also taeyang formula, but that's for an inability to open, and then the one where it opens kind of in a wrong or problematic way. That's Guezer tongue. [00:13:47] Speaker A: Right. [00:13:48] Speaker B: And this is the interesting thing. You can have taiyang disease and yangming disease. You can have different versions of that. When you get to xiaoyang disease, you can't really have a taiyang mahong pattern anymore, because if xiaoyang symptoms are showing up, it shows us that the body has been depleted to a certain level, that it's resorting to using the function of xiaoyang to regulate the surface. And it's also failing to do that, which is why there's a pattern for xiaoyang. So then if you have that level of, say, deficiency in the case, then you no longer can use mahuang, because it's too opening. [00:14:39] Speaker A: It's too open? [00:14:40] Speaker B: Yeah. It'll create an upsurge of qi, which is discussed in the jingwei. Actually, there's a case example of that. So you can have taiyang and xiaoyang concurrent patterns with Guejer tong as a base taiyang formula. You can also have it mixing wooling song, like a taiyang organ level pattern, and a chai utong type of pattern. But you can't have Ma Huang Tong and Xiao Chai Tong together. You'll never see that. [00:15:09] Speaker A: Right? Yeah. So if you're mixing those together, probably a misunderstanding of what's going on. What does the jingwei say about that shift? [00:15:22] Speaker B: There's a case. So it's in the phlegm room chapter. There's a case where a person has all of these different symptoms, and I don't have the progression memorized, but essentially, there's a person that I believe there's a person that's in. It looks like there's either a Shao Qinglong tong or Da Qinglong tong pattern, both of which have Mahong in them. [00:15:52] Speaker A: Right. [00:15:52] Speaker B: And it looks like it's that pattern. But the implication is there's kind of 1ft in Xiaoyang, and then the formula is given, and then it creates an upsurge. Right. [00:16:08] Speaker A: Which looks like headache, dizziness, that kind. [00:16:11] Speaker B: Of thing, like palpitations, yang surging up to the surface. The person is now sweating. There's that kind of presentation that's kind of where it's discussed. [00:16:25] Speaker A: So in a normal setting, if you were trying to distinguish that Mapong tongue versus guaju tong, that lot has to do with sweating. Right? Like how intensely sweating someone is, or the ability to sweat in general. [00:16:41] Speaker B: The ability to sweat in general. [00:16:44] Speaker A: This has always been an interesting question to me. So you're talking to someone about sweating and stuff. Right. And then you're like, so are you asking in that, questioning whether they're able to sweat now or in general? That's my question. So a person doesn't sweat. They sweat all the time, normally, but now they're cold. They have a cold. They're feeling both hot and cold. They have body aches, but they're not sweating at all. While this is happening, how do you read that relative to the mahuang pattern? [00:17:14] Speaker B: Sweating is in the textbook differentiation, sweating versus not sweating is very clear. Like, oh, sweating, guijer tongue. No, sweating, mahuang tongue. In the clinic, sweating is a much harder thing to get by asking a patient. So you can ask them if they can sweat, because a lot of people who are really cold and chilled, they'll try to warm up. Like, they'll get in the shower, they'll take a burning hot shower, they'll cover up in blankets, and they'll be super cold. Right. [00:17:50] Speaker A: This is relative to them having the cold and flu, not just in general. [00:17:54] Speaker B: Yeah, not just in general. [00:17:55] Speaker A: Right. [00:17:56] Speaker B: Okay, so that's, like, what will happen a lot of times in a mahuang tongue pattern. To be honest with you, I've only seen a mahuang tongue pattern, like, two or three times, like, very few times in the clinic. And we can talk about why that would be. And the times that I've seen it hasn't even been in the clinic. It's been like when people have had a pattern at my house, like my family members or my roommates or whatever. I've seen Ma Hong tongue patterns there. I haven't seen it in the clinic, actually, because usually by the time people come in to see us, they're not in a mahong tongue pattern anymore. They're usually in Xiaoyang pattern or they're in something else. So the way that you would differentiate it, though, in practicality, is you would ask about sweating. You may or may not get good information about that. Well, I don't really sweat that much. But then you would ask about the other symptoms. Right. And people who have mahwang patterns are going to have body aches. They're really going to have body aches way worse than a guajir tong pattern, because in Mahuang tong, the surface is closed, so the yang cannot move and open the surface. And it's trying to. It's pushing, it's pushing, it's pushing, and it cannot open the surface. So that means that they're going to have a lot of pain, and they usually have a big headache. People with mahong, tongue patterns usually have a massive headache, and sometimes they have a difficult time peeing because their surface isn't open. [00:19:34] Speaker A: I literally had a new patient today who came in, self described long COVID patient who's avoided COVID, like, the whole time that COVID has been going on. And they got it in September a couple of months ago, and they said that the experience, they had a little bit sore throat, and then overnight they had an explosive headache that then resulted in unbelievable shoulder and neck pain that then, over the course of the COVID moved through their whole body. Joints pain, muscle pain, ankle pain, all kinds of old injuries. Hurting all of a sudden. Right? Almost no fever and chills, no sniffles, no snot. Like, it literally was just this horrible body pain. Right? [00:20:20] Speaker B: Yeah. [00:20:21] Speaker A: So I was listening to them describe it, and we're working on this was many months ago now. So the COVID infection, of course, has passed, but they weren't able to use chinese medicine for it. They weren't set up for it. They didn't have a provider. But in the course of questioning out the rest of their history, they talked about, of course, I always ask about sweat. Right, just in general. And they were like, yeah, I don't really sweat. My husband kind of makes fun of me about it because we will be super active. If I'm backpacking for miles and it's really hot, then I'll have a little bit pit stain. Right. But my husband, he's covered in sweat all the time. And it wasn't until you just said something there where I just thought, I bet. And the person is relatively fit. They're an older person, but their constitution is strong, very active, very healthy diet, even from a chinese medicine point of view, probably robust enough as a person to use a Ma Huang tong formula. And of course, they didn't have access to it when they got COVID. Right. And I wonder if they had and we had been able to vent the surface rapidly. It's worth noting something you mentioned there in the past. If you ask clinicians about what's the most useful cold and flu formula, they'll tell you, Shao Chaiutang, right? And of course, Xiao Chaiutang, without doubt is a workhorse of any modern chinese medicine pharmacy. But I think a lot of that is circumstantial because by the time people get to us, it's more than a day or two, three days, four days, five days before they make it into the clinic for an appointment. So of course, the disease pattern has progressed. So this patient that I'm talking about probably would have not been able to benefit from a mahong Tang formula here anyway because we wouldn't have seen them. Right. But, man, if there was a different way in which our medicine was delivered and they show up with these patterns and they can just walk into every chinese herb shop that's on every corner, like there are Starbucks and say, hey, this is what's going on. And they go, oh, gosh, yeah, here they take that formula that night. They have intense sweating and diaphragms. The surface opens, and maybe this persistent, damp, penetrating pain that she's been dealing with for months wouldn't be an issue. [00:22:33] Speaker B: Right. [00:22:33] Speaker A: Because you just sort of opened the surface and gotten it out before it had time to really deeply settle in. [00:22:38] Speaker B: Right. Yeah. [00:22:40] Speaker A: So it's interesting because, like you said, we don't see mop long tongue patterns much in the clinic, but that's not because people aren't experiencing them or couldn't be useful. It couldn't be a useful formula to them. It's just that by the time they come to the clinic, it's probably progressed. Although, honestly, in hindsight, that's almost better, because Mahwang is so hard to get hold of. It is as an herb that, honestly, if everybody was needing mahuang tang and we just didn't have it. We have Mahwang granules right now. We have some Mahwang bulk in the pharmacy, but it's hard to keep in stock. [00:23:13] Speaker B: It is? Yeah. [00:23:14] Speaker A: Like, that's one of my primary jobs, is to hunt down and maintain the pharmacy collection. And Mahwang, just for people out there to know, Mahwang is a gray area herb from a legal point of view. Right. And that's because ephedra, which is the name of Mahwang in English, but the compound ephedras, it's an extract from Mahwang, or a chemically created ephedra. It's a primary ingredient in a series of over the counter supplements that were used for weight loss, that caused heart damage and killed six people in the late 90s. Right. And they were using, like, on label dosage, and it still killed them. Right. So the FDA recalls all that material and then places ephedra on a banned substance list for medications and supplements in the US. But, of course, when they wrote that, it's literally called ephedra. But they meant the compound ephedra. Right. But of course, Mahuang is called ephedra in English. Right. And so did they mean the chinese herb plant, too. [00:24:14] Speaker B: Right. [00:24:15] Speaker A: And what we know because of context that we have in the herb import market is that whether or not Mahuang can be imported from China into the US, as in, I brought it in on a ship, are you going to let me pass it through? Customs comes down to the judgment of the individual human customs officer who is inspecting the shipment that day and how that person interprets the Mahong prohibition. And so enough importers got burned on their product not being allowed into the US. So that means they bought it in China, they paid for it to be delivered here. Custom says, sorry, you can't bring this in, you have to destroy it. So the importer paid to buy it, paid to ship it, and then had to pay to destroy it and couldn't sell an ounce of it. Right. And so even though, technically speaking, they probably could, yeah. Someone would have to make a lawsuit about it and get clarification on it, and there's just no money or time in that, so no one's going to do it. So the importers just stopped importing it because it's not worth the risk. So if you're out there being like, why can't I get my hands on Mahwang? Well, that's why. Because it's an unclear legal space that no or few business people are interested in importing it. So if you have a source, probably you're dealing with something that's either been in the states for a while or you have someone who has literally taking trips to Taiwan or China and loading up a suitcase. Literally loading a suitcase with, know, kilos of mahuang or kilos of mahuang granules and bringing it back to the states. I mean, it's funny to say, but, I mean, that's literally how it's getting in here. It's not getting in here through conventional import pathways, because it's just too dicey. So all that to say, maybe better that we don't see a lot of patterns, though. It's such a great herb. It's too bad. [00:26:11] Speaker B: It'S important in certain cases of cold and flu, but it's really important in other conditions. So, yeah, anyway, it's too bad we can't more easily get our hands on it. [00:26:23] Speaker A: Yeah, we have some for now, but for how long? Okay, so the person's then reported this sore throat you're going to need to treat concurrently. Taiyang xiaoyang. Right. And you said the formula that you would use for that chai who? [00:26:41] Speaker B: Guijer tongue. [00:26:41] Speaker A: Chai who guiju tong. [00:26:42] Speaker B: Which is just guiju tongue and Shao. [00:26:45] Speaker A: Chaiu Tong put together exactly do you do any special shifts to the dosage relative to what you'd find in the Benski for those guys? [00:26:54] Speaker B: I use the same dosage well, so I use the same dosage ratio every time I write the formulas. So if I was doing granules, I might shift the dosage of how much someone takes based on the condition, like the total, the total grammage, but I would still use the same dosage ratios. So in my mind, Chai, who's still 24, Wong chin is still nine, Bonshaw is still twelve. I could go through the whole thing if you want, but it's all of the standard dosages that I would use. And then I prefer to use bulk herbs for cold and flu. So that's literally what I would give to somebody per day as that dosage. If it's granules, then my starting dosage would probably, for most people, would probably be at least 8 grams three times a day. [00:27:50] Speaker A: Okay. Yes. You're looking at 24 grams a day. Yeah. [00:27:53] Speaker B: At least for cold and flu. [00:27:55] Speaker A: Yeah. I think that's an important thing to keep in mind for granule users in cold and flu. We'll hear reports back from people. They're like, well, I'm just not sure if granules are very effective for cold and flu. Can be, but you have to dose them. Yes. You can't mess around. I know we're going to get some people out there, be like, no, I can definitely treat cold and flu with 3 grams of granules. [00:28:15] Speaker B: For some people you can. [00:28:16] Speaker A: I mean, cool. That's amazing if you can do it. I think if you have not succeeded with that dosing or have you not succeeded with treating cold and flu with granules, in my opinion. In our opinion, I think it's probably because you're not using enough. [00:28:30] Speaker B: Yeah. You can always find a patient or two that responds really well to herbs at a very low dose, but to up your results for everyone, you have to dose higher for certain conditions like that. There's a couple of conditions where you generally need more dosage to get better results for most people, I think. [00:28:53] Speaker A: And cold and flu is absolutely one of those. [00:28:55] Speaker B: Yes, 100%. [00:28:56] Speaker A: Okay, so based on this patient, how would we modify or how would we reimagine the formula that they would need? What would be the symptom? Spread that sends you straight to xiaoyang. No taiyang inclusion. [00:29:12] Speaker B: So there might not be any fever, chills, or body aches. [00:29:16] Speaker A: So if those have gone, we're assuming that the illness has progressed beyond the fever, chill, body ache level. [00:29:25] Speaker B: Right. [00:29:25] Speaker A: Okay. [00:29:25] Speaker B: But they might say I feel hot, right? And then I feel cold. [00:29:30] Speaker A: So they're alternating. [00:29:31] Speaker B: It could be alternating, right? But they won't say that. They might say, like, yeah, I just feel hot, right? And then, well, are you, like, sweating profusely? No, I'm not sweating profusely. So probably not yang Ming. [00:29:46] Speaker A: Right? [00:29:46] Speaker B: So then you're like, okay, well, there's heat on the surface. If there's heat on the surface, it has to be yang confirmation. Or it could be in confirmation, but that's really rare for cold and flu, and it probably wouldn't look like a fever. You're thinking yang confirmation, taiyang, yangming, or shaoyang. [00:30:06] Speaker A: Right? [00:30:09] Speaker B: So if you see that, but there's no body aches, there's no chills, there might not even be a fever. A lot of people get sick and they say, I have no fever. Like, I don't have any. Don't have any feeling of temperature. Like, one of our older patients, you see this a lot with elderly people. They don't get any temperature symptoms at all when they get sick, and it's usually because their yang is too weak to be able to manifest a yang confirmation pattern. So they're like, yeah, it was no big deal. I didn't even have a fever. I didn't have any problem. But they have a cough, and the cough lingers, and they might have digestive symptoms. I have loose stools. I have diarrhea. Now, the cold was fine, but now I have diarrhea. So in those people's constitutions, their yang chi is so weak that the external strike landed in Tai yin. It didn't even go through the Yang confirmations. It went right into the yin. [00:31:13] Speaker A: Yeah. It completely bypassed the forces that would normally stop in a pathogen from coming in. [00:31:20] Speaker B: Right. Yeah. [00:31:20] Speaker A: I think it's important to remember that fevers are a normal physiologic response. [00:31:25] Speaker B: Absolutely. [00:31:25] Speaker A: Like, in fact, if your constitution is robust and your chi is strong, there should be a fever response to pathogen. Right. If there's not, probably because, I mean, there could be other reasons, but probably because something's a little weaker than it ought to be. I think this is something a lot of people just forget about when they're thinking about what's normal. Because you spend so much time thinking about pathology, a lot of people forget about physiology. And, in fact, that a fever response is a physiologic response to a pathologic invasion. [00:31:55] Speaker B: Absolutely. [00:31:56] Speaker A: That's totally normal. It's like, the number of times I have to mention to people that being hungry is a good sign, right? [00:32:03] Speaker B: Yeah, but I'm trying to lose weight. I don't want to be hungry. [00:32:07] Speaker A: Oh, it's great that I'm not hungry. I'm not hungry until two in the afternoon. That's not good. [00:32:12] Speaker B: Not good. [00:32:14] Speaker A: And particularly in the long run. I mean, people in the short run will be like, oh, well, I just don't eat much, and it's great. Yeah, fine. But metabolically, this is not the thing that we're looking for. We don't want you to be ravenous. [00:32:26] Speaker B: Right. [00:32:26] Speaker A: But we want you to be hungry at a regular mealtime. We want you to mount a fever when you get infected. And it could be very brief. [00:32:34] Speaker B: Right. [00:32:34] Speaker A: I mean, if your constitution is very strong weight, chi is very strong. Ideally, the fever is brief because it expels the pathogen. You sweat a little bit. Great. [00:32:44] Speaker B: Right. [00:32:44] Speaker A: No problem. [00:32:45] Speaker B: Well, we have to ask ourselves, when somebody has a fever, what is that? From the point of view of our medicine, and depending on the perspective you take, you can use different theory to justify what a fever is. But the way that I was taught is that the fever is the body's response to the insult of the external strike. So the qi of the environment hits the body, and the body isn't ready. It doesn't know how to adapt to it. So the way that it receives it, as if it's striking it. So it's not like it's evil. It's just not able to figure out how to work with it. The body isn't able to figure out how to work with that particular type of qi. So then what it does is it does the same thing that the body does when it gets a traumatic injury. It sends the most nutrient dense resource that it can send to the area of assault, which in this case is the surface. So it sends warm blood right to the surface. And what does that look like in an experience? It looks like a fever, or it looks like I feel warm. Or you touch the skin and the skin is warmer. They might feel chilled, but the skin feels warm. So there's still that warm blood that's come up on the surface. The heat from the blood, or the wei chi comes to the surface. Right. So then that's what the fever actually is. It's your body's vital resources moving to the area of assault to try to adapt to it, and particularly in Taiyang, diseases, to open. Right. We're trying to open the surface. That's what the body tries to do. [00:34:30] Speaker A: First, which makes sense because the pathogen is coming in from outside. [00:34:34] Speaker B: Right. [00:34:34] Speaker A: Open it back up, kick it out. Okay, so you mentioned using the standard ratios, the 24 chaihu, nine huangchin, twelve bancha in the Shao chaiu tongue. Why do you think that those ratios are important? [00:34:52] Speaker B: I think that they're. Well, so they've been used for a long time. Those ratios are relatively. Those ratios have been used. Different people will use slightly different ratios and stuff, but they've been used for a long time, and they've been seen to work at that ratio. I think the ratios of herbs have a lot to do with the flavors. Right. And the flavors and the natures of the herbs in combination are what give the body a particular message. Right. And that message, gesture direction, is what is the therapy that we're giving. So it's not the individual ingredients. It's the combination, the alchemical combination of those flavors in the proportion that we're giving them is what's the medicine? That's what the medicine is. That's what gives the body the signal that it needs. And then the body takes that, and it's like, if it's correct, it takes it, and it's like, oh, great, I can do this. And then it figures out how to adapt. [00:36:04] Speaker A: It's an interesting way to think about it in a lot of ways, because I think a lot of folks, chinese medicine people included, because of the world that we've grown up in and sort of being modern people, we are hunting for, say, like, pharmacological components and herbs. Right. Chemical constituents. This has berberine in it. This has whatever compound in it that has some physiologic action. And I think it's important to remind everyone that, classically speaking, that is irrelevant. The people who made up this medicine, who used it, practiced it, refined it, and made it functional, had no understanding of that material whatsoever. [00:36:45] Speaker B: Right. [00:36:46] Speaker A: And that lack of understanding, that ignorance, makes no difference at all in its effectiveness. In fact, the system that we're implementing does not require or rely on those data points. [00:36:58] Speaker B: Right. [00:36:58] Speaker A: And it's not a position of blind ignorance. Right. It's not that they don't know. Well, we just didn't know. So well. Now we know. We know what's really going on. No, we don't know what's really going on now, because you did a mass spectrometer test on, like, one herb. In fact, it's only going to give you the tiniest little viewpoint about what's happening, instead describing the function in this more classical terms, as you just did, that the flavor of an herb is a language that the body can understand, because our physical selves evolved in the space that we've evolved into to use flavor and nature to nourish ourselves and to create continuity through time. Like, if you stop eating, you're going to notice real quick that there are some problems. Right. Like, our physical cells are predicated on flavor in nature in order to move forward. So I think it's really a fascinating, interesting, and elegant way to think about and talk about what's actually happening. Right. And you also said kind of in passing there, too, and I want to make sure people heard it, that it's not exactly about the specific ingredients. [00:38:12] Speaker B: Right. [00:38:12] Speaker A: But about the flavors that they represent. [00:38:14] Speaker B: Correct. [00:38:14] Speaker A: So, like, we're sitting here talking about chaihu, huangchin and bancha, because, of course, those were the plants that existed in the formula at the time, and those are the ones that we've been using. And if you can have access to them, by all means, you don't need to reinvent the wheel. But if at some point in the future, like, you don't have access to chaihu or bancha or Huangchin specifically, but a different herb that has a similar flavor and profile, likely you can communicate the same alchemical message to the body. [00:38:41] Speaker B: Absolutely. [00:38:41] Speaker A: Because you're relying on this more universal language of flavor as opposed to the plant itself. [00:38:47] Speaker B: Correct? [00:38:47] Speaker A: Right. [00:38:48] Speaker B: Yeah, absolutely. [00:38:49] Speaker A: So I think that that's valuable. Obviously, it's an endless rabbit hole. Like, you can go down into the question of which herbs for which thing forever, and no need to do that if you have access to these herbs that we were already talking about, because they've been well tested in cold influx. But I think it's a good thing to keep in mind that should the nature of what we have access to change, there's more opportunity than may initially seem like it. Like, oh, gosh, there's no more chihu. How can we do Xiao chaihu tong? Right. Well, what other herb, chinese or otherwise, could we use that has a similar taste profile, a similar nature profile. Right. And that's, I think, a really great space if there's anybody out there who's interested in that. It's a way of assessing herbs called organileptics. Organileptic assessments. Smell and taste primarily, it's the methods that are used by coffee people, beer people, wine people, Somalia type stuff to sort of understand something through taste and smell. And it has a similar application here relative to the medicinal quality of an herb, because it is, in fact, the taste of it that makes a difference. How do you think that plays out into people actually tasting the herbs when they drink them. So, for example, like, if you encapsulated it or put it in a tablet, how do you think that impacts the experience? [00:40:10] Speaker B: So I think that there's a connection between flavor and taste, but I think also that the flavor is a kind of, like, I hate to use the word symbolic gesture, but it's the language we have to communicate a type of function in our medicine. Right. Well, even if we were to take the lens of taste, we have taste receptors all over the like, we have them in our stomach. We have them in our gut. We have taste receptors that are not in our mouth. Right. So I think even from that perspective, you could say whether or not the person tastes, literally tastes the formula. Some part of them does, and so then it works well. [00:41:03] Speaker A: And if taste is in the most chinese medicine way possible, it is simultaneously exactly what it sounds like and something else. [00:41:11] Speaker B: Yeah. [00:41:12] Speaker A: Like, if the idea of an herb being sweet is a placeholder for its actual taste in your mouth, but also in the way that, say, qi is a conceptual word that we use to describe a method, a mechanism, a process. Sweet is the same thing. Like, we say that chihu has this acrid quality. Right? Well, acrid is a thing, for sure. You've all bitten into, like, fresh ginger. You know what acrid is like, but is also something bigger than that. Right. Like, it's your liver. It's also not your. Like. It's a classic chinese medicine thing to have a word that represents a very discernible, palpable thing, and then also something bigger than that. So even if you didn't taste it in the way that you tasted ICE cream, you tasted it because you put it in your body. [00:41:59] Speaker B: Right. [00:41:59] Speaker A: And that is how those things are absorbed. Right. Okay. We talked about Taiyang and xiaoyang. In a general sense, I think a lot of people are less familiar with a yangming cold and flu pattern. [00:42:19] Speaker B: Sure. [00:42:20] Speaker A: And so maybe talk about what that looks like, and why don't we see more of that? Or do we see it and we just don't realize it? [00:42:27] Speaker B: We see one type of it commonly, I would say so. Taeyang, we talked about what happens. The body receives an external strike. There's a qi that the body doesn't know how to adapt to. It identifies the external qi as a kind of assault. And the response that it has is to bring the warm blood to the surface, and the heat from the warm blood we call Wei chi. Right. So what that does is it tries to open something that's warm, opens something that's cold contracts. Right? So in Taiyang disease, the mechanism of opening is trying to occur and it's failing. For it to be a disease, it has to be failing. [00:43:12] Speaker A: Right? [00:43:13] Speaker B: So in Guejer tongue pattern, you have an opening that's disharmonious. It's opening, but it's like slamming the door open, or like the door opens so far it hits the back wall, and then there's stuff that leaks out. Right? In the form of sweating or in the form of nasal congestion. But that's not really phlegm. It's just like that kind of drippy water. That's the same thing. It's just ying wei disharmony. Or the other problem with Taeyang is that it's not able to open at all. Right? And then the blood, the wei chi is trying to open the pores of the skin, but it can't. In either scenario, heat builds up and fluids get exhausted. In the mahong tongue scenario, where the surface can't open, the heat is building up. [00:44:09] Speaker A: It's time to clean up here at the clinic, you guys. So the vacuum has started in the background. Finish that thought and we'll take a break and come back. Yeah. [00:44:21] Speaker B: So in the mahong tongue pattern, the heat builds up at the surface, but it can't open the surface. Right. So then the fluids that are also on the surface get cooked. And then eventually we go into yangming, which is a disease of dryness. Right. Same thing with guejutong. The same process happens. Like we lose fluids through sweating or through disharmonious ying and wei. So we eventually exhaust fluids from either direction of tayong disease. And that brings us into yangming disease, which is a disease of dryness. So we can have different types of yangming disease depending on which one of those avenues we took to get there. [00:45:08] Speaker A: Right, because that'll have a different set of symptoms. [00:45:11] Speaker B: It'll have a different set of symptoms, yep. [00:45:12] Speaker A: Right. So distinguishing characteristic of yangming, cold and flu pattern, dryness. [00:45:19] Speaker B: Dryness, yeah. [00:45:20] Speaker A: And that's when we say that, we mean like dry sinuses, dry throat, dry eyes. Is that what we're talking about? [00:45:27] Speaker B: So you can have two forms of tube. You can have like a channel pattern of dryness, right? You can have an organ pattern of dryness. So we're all familiar with like Dachungxi tong, there's stool that's stuck. But actually what makes the stool problematic is that it's dry. That's the reason that it can't move. So when we say we purge dryness and a stool comes out. The thing that we're purging, actually is the problem, which is the dryness of the stool. And when that happens in yangming disease from the organ level, the yang tries to descend and it can't because there's a roadblock. So it hits the roadblock, and then it comes back up. That's for an organ level yangming pattern. For cold and flu, we're more likely to see a channel level yangming pattern. So the one that we learn in school, four bigs, big pulse, big sweat, big thirst, big fever. Right. I think those are the four baihu tong pattern. So in a baihutong pattern, the fluids, e. G. The yin, the component of coolness that our body has in physiology on the surface is what's used to close the pores. That process, because the fluids get exhausted, fails, so the pores of the skin can't close. And then the young that's on the surface just floods out, and with it, you have sweating, and then you have big thirst because you're exhausting fluids. You have big sweating because the yang is coming out, big heat, because all the yang is on the surface and the pulse is big because of those things. Right. It's just showing that same dynamic. So that's baihu tongue pattern. We almost never see a baihu tongue pattern either in the clinic, particularly not for cold and flu. So the common version of yangming disease that we see for cold and flu is a progression from a Guajer tongue pattern, actually. So you have a ying wei disharmony, you have taiyang pattern. The blood is on the surface and it's trying to open the pores, but it does a crappy job. And so the pores open too much, and then the sweat comes out and the fluids get exhausted. And then at a certain level of that, you have a thickening of the fluid. So let's say you have that little drippy, runny nose. The phlegm starts to. It actually starts to turn into phlegm. Right. So what's the difference between dripping water and phlegm is a thickness which occurs from drying out. The fluids actually dry out and thicken and thicken. The other thing we see with that pattern is there's more stiffness, particularly in the upper burner, in the nape of the neck. So the neck gets stiff. Why? Because the fluids are getting exhausted and they're no longer able to coat the muscle layer. And that's particularly the case on the surface of the body, the upper burner, because that's where the problem is, right, so the neck gets tight, and then a third symptom that sometimes happens, but not always happens, is the fluids of the eyes start to dry out because it's in that same channel pathway. [00:48:51] Speaker A: Right. [00:48:52] Speaker B: And so then you actually get people who have tearing, their eyes start to tear. Why do they tear? Because again, the fluids start to dry out. So then there's this disproportionate relationship with fluid in the eye. So then we have tearing of the eye, which you don't see as often with cold and flu. You see it more with seasonal allergies. But this is, of course, our Guggen tongue pattern. Right. So that's the version of it, of yangming disease that we see in cold and flu, most commonly is Guggen tongue. [00:49:25] Speaker A: Which is a progression from the taiyang. [00:49:27] Speaker B: Guajir tong. [00:49:28] Speaker A: Yep. Yeah. Interesting. Okay, let's take a little break, and then we'll be back. All right, so we're back from our break. Okay, so we just went through the yang confirmations, generally speaking. So obviously, of course, we have guider tang mahuangtang. For the Taiyan distinguishing characteristics, there are the fever and chills and the body aches. [00:49:55] Speaker B: Right. [00:49:56] Speaker A: And particularly the duration, the chronicity of that infection. Right. Like, it's really the first layer that's going to come in and that the distinguishing factors between the guijer tongue and the mop Wong pattern have to do with the sweating. [00:50:11] Speaker B: Yes, the sweating. And theoretically, the level of discomfort with body aches. [00:50:19] Speaker A: Right. And probably a little bit something with constitution. Yeah. When you're looking at someone, like, someone who's very robust and ruddy and younger and strong. Probably more likely if there were to have a mahwang pattern, it would look like that. [00:50:34] Speaker B: Absolutely. [00:50:35] Speaker A: Probably not like a 94 year old man. [00:50:38] Speaker B: No. Yeah, probably not. [00:50:40] Speaker A: Okay, so then Shao Yang pattern, of course, the big formula there. Shao chaihutang. Right. And part of the important indicators there are, of course, that there's classically alternation of symptoms. Right. But more significantly, one of the ones that stands out to you is the presence of sore throat. [00:50:59] Speaker B: Yeah. Sore throat is almost always a Shao yang indication. [00:51:03] Speaker A: Yeah. So that's a good, I think, a good tool for listeners to keep in their back pocket. Now, like, with everything that we do, there's not 100% one on one relationship. Right. But if you're not sure this is a good indicator. [00:51:14] Speaker B: Right. [00:51:15] Speaker A: And then the Yangming presentation, classically, you've got four bigs, as you mentioned. But more likely what you're seeing is Guggen presentation, which is distinguishing out the neck pain as a clear indicator. [00:51:32] Speaker B: And a nasal congestion. [00:51:34] Speaker A: And a nasal congestion, which is thicker than more phlegmy than what you would see with the guager tongue pattern. Right. [00:51:41] Speaker B: Where it's just dripping like a faucet. [00:51:44] Speaker A: Nose, where you're always having to use, like, a tissue to just absorb it. [00:51:47] Speaker B: Right, right. [00:51:48] Speaker A: Okay, so what about the yin confirmations? [00:51:52] Speaker B: Yin confirmations. So once you get out of the Yang confirmations, you no longer have the same level of heat present. So yang confirmations are yang. Yin confirmations are more yin. [00:52:08] Speaker A: Clever names we got there. Yeah, exactly. [00:52:11] Speaker B: Genius. Right? Yeah. So the thing is, when you get to a yin confirmation pattern, it stops looking like a cold and flu. It can look like a sequela to cold and flu. It can look like I have a chronic cough or I have phlegm and congestion, or I have a cardiovascular problem or I have edema, or I feel chronically fatigued. But it doesn't really look like a cold and flu anymore most of the time, yeah. So that's the reason we don't commonly associate it with. [00:52:48] Speaker A: Right, so you're not thinking like, oh, this is a taine cold, because by the time it's a tai, it could have started as a cold, but by the time it's progressed through the body and morphed and changed, it looks like something entirely different. Now people have, like, chronic loose stools and abdominal. They have a cough. Cough. [00:53:09] Speaker B: Yeah, things like that. [00:53:10] Speaker A: So now we're not thinking of that as a cold and flu problem. [00:53:12] Speaker B: Right. [00:53:13] Speaker A: And I suppose on some level, it's mostly just an intellectual exercise about whether that started with a cold or not. Right. Because you may not know, the patient may not know the timeline. [00:53:23] Speaker B: But again, this is where we get into external contraction. Right. So external contraction is really easy to see in the presentation of cold and flu, but actually, an external contraction is anytime our body registers an assault and then starts to try to harmonize the surface with resources. Right. So anytime that happens, that's an external contraction. So a lot of times we see people with chronic disease, IBS, IBD, whatever it is we're treating, they're on a formula, and then the formula stops working. Right. It stops working. There's a good case of there was a doctor. I can't remember where this was, but a doctor is treating rheumatoid arthritis in a child and is using the formula Guajer Xiayao germutong, which is a jingui formula. It's great if you know one formula for rheumatoid arthritis, know Guajer Xiaoyao Germutong. It's a futza formula. It has futsa and mahuang in it. It's a very good formula. And the case was going very well. And then it stopped. The results stopped. And the practitioner at first upped the dosage of the futza. Up the dosage of the. We got to hit it harder. Didn't work, didn't help at all. And the kid wasn't presenting as being sick. But the practitioner referred the patient to a different, more old school doctor. Right. And then that guy wrote Chaihu Guaju Ganjiang Tong. Right. Which is a shao chaihu tong modification, basically. And that worked. It got the kid out of the particular pattern he was in, and then they put him back on Guaju Shia Drumu Tong, and then it worked again for the rheumatoid arthritis. So even though it might have not been a cold and flu situation, it was still some kind of situation where there was an external contraction. The priorities in the body shifted, because now I'm going into a defensive mode, right? And so, boom, the blood goes up to the surface, the chi goes up, and then the situation is different. It's like you can't treat this chronic thing anymore. You've got to temporarily shift and adjust and address where the physiology is now asking for help. [00:56:04] Speaker A: I wonder what that other doctor saw in the chain, because the case doesn't include details. Yeah, exactly. [00:56:14] Speaker B: A while since I've read about that. [00:56:15] Speaker A: It's just interesting to think, because the other doctors would have been looking at the same set of symptoms. But this more old school doctor was like, oh, no, this is an external thing that's going on, but it's an important thing to remember only insofar as external contraction, we think of as cold and flu, which, of course, it is, but there are other ways in which it could impact something that you're treating besides. [00:56:38] Speaker B: Absolutely. [00:56:39] Speaker A: Just the sniffles. It's also, I think, worth pointing out in that story and in others, that if you are treating a client, a patient that has. You're treating chronic irritable bowel or some dermatological condition or whatever, and the patient gets sick. Your patients, all your patients should know, particularly when cold and flu season is in full force, that they need to probably discontinue the formula they're taking for the chronic condition that you're treating and give you a call so that you can write them something appropriate for the cold and flu. A lot of people don't know that. In fact, no one knows it unless you tell them, right? They'll just assume, like, oh, no, these herbs are good for me. I should keep taking these herbs. And I don't generally subscribe to the notion. I mean, it's certainly possible, but, like, oh, they'll be harmed by continuing to take this formula. I mean, maybe more practically, whatever it is that you're working on is not being advanced while they're sick, so just don't have them waste their time and money. Even if they're not going to come and see you for a cold and flu formula, they should still just ride out this cold and flu, feel better, and then get back on the chronic formula, because otherwise they're just burning herbs that are not probably advancing the case. [00:57:54] Speaker B: Yeah. [00:57:55] Speaker A: So as usual, words from us about guiding the patient experience, make sure that your patients understand that the formula that you gave them for whatever you gave them that formula for whatever condition it is, that is what it's for and not for just random stuff like, oh, they're herbs, they're good for me. No, this is not omega three supplements you bought from costco, okay? This is specifically targeted for you for a specific item, and you should not take them. If the thing that led us to write that formula changes, essentially what we would call their base pattern has changed because there's an external invasion now we got to use something different. So I think that's important for people to know. What else do you think the users need to, the listeners need to know relative to thinking through cold and flu in this way? What are kind of some standouts from your clinical experience that I think is important gems that they can utilize. [00:58:51] Speaker B: Most patterns are mixed. So shachaiyu tongue is a really common formula to use, but I would say I rarely use it by itself. I'm usually using it with guajra tong, maybe with guajujia, Gogan Tong. So then you treat all three yang confirmations at the same time. You can use chai guaju, ganjang tong, which is another modification of xiao chai Tong. It's another way to treat all three yang confirmations. Sometimes that's better, but most patterns are mixed, so that's the first thing I'd say. [00:59:31] Speaker A: Okay. [00:59:31] Speaker B: And the way that that looks is just like the symptoms that you would see for each one of those confirmations is all there with a case. So you have, somebody has a sore throat, and they have nasal congestion and their neck is super tight and they have body aches like, boom, you have chai who graduate. The other thing I'd say is a lot of the time when phlegm starts to develop, there needs to be some gesture toward protecting Taiyin and not generating more fluids. So that looks like, practically speaking, taking a look at if there is a shaoyang pattern, taking a look at removing Renshen and da dao from the formula, and including, if you're worried that it's going into tai, which is, again, no more fever, no yang and phlegm, damp heaviness, fatigue, loose stools, adding in something like lingui jugantang, which is our kind of textbook taiyin formula for the lung side of things, or doing the cough modification of chaihutong, which is in the text, it's in the postscript, which is just getting rid of Renshen and da dao and adding in wuiza and then changing the shangjiang to Ganjiang. That's the cough modification. So some version of that can be really helpful. And then the only other thing I'd say that's really important to know practically, because a lot of the cases we see are not people that are acute cases. They've been sick for, like, three weeks, and then they come in, and then the problem is in their chest. Right? That's what they say. It went into my chest. It went into my lungs. Most of those cases need a chest b formula, a chest obstruction formula, and we've had discussions about this topic. There's modern versions of that, and then there's classical versions of that. The way that I would tend to work with that is by using one of three formulas, most of which usually have gualo and shabai. [01:01:46] Speaker A: Are the two herbs delicious? [01:01:48] Speaker B: Yeah. Terrible tasting herbs, bitter and pungent and all kinds of weird. [01:01:53] Speaker A: Throw some chamoff in there. Yeah, for the wind, man. [01:01:57] Speaker B: Yeah. But usually if there's pain in the chest, if there's phlegm in the chest, if there's yellow phlegm or there's sticky stuff, that's really hard for the patient to get up. Even if the patient says, I have a dry cough. Right. Does that mean we need to throw yin tonics at the lungs most of the time? No, it's actually we need to lubricate the phlegm in the lungs with bitter flavors like guallo and then help the body to transform and expel it with plungeon flavors like shabai. So you can use other formulas. I don't know if you want to talk about different stuff you like to use for that. [01:02:34] Speaker A: Gualo is a real champ here, too, as an herb, even if it's just a single that you're adding in. But yeah, I use Bay mugualosan a lot for that action. I like that combination of herbs. If you go to the text and you read about Bay mugualosan, to be honest, like a lot of things in the Minsky, sometimes you'll think, well, I'm never going to use that, because that description doesn't seem to fit like anything. But Bay mugualosan has a similar, so distinguishing, say, like gualo, shiabai, banchatang, or bay mugualosan. Like, Bay mugualosan doesn't have that acrid, pungent function that the shiabai does in that first formula, but it does have the non sticky moistening function that is really, really helpful for expectoration. Right? So by the time that someone has something that's in their chest and it's sticky and they're coughing it up, and it could be gummy and it could be yellow, basically, what is an upper respiratory tract infection to some degree or another, Bamaguelosan will get in there, it will soften hard phlegm, it'll moisten what's there. It'll also reduce pain in the cough, like that painful bronchial cough. The pain will go down with that. So you can take something like that and combine it with accurate herbs to help open up the chest some more. You can also combine it with stop coughing herbs like Wuita and stuff like that if you wanted to reduce the intensity of the cough. But any of the herbs that live in that phlegm transforming space that are slightly moistening. But again, they're not tonics, right? They're dumping something sticky in there. In fact, that would probably work against you in the long run, because you're going to obstruct that expectoration movement. But gualo, I think, really can't be undersold or oversold, excuse me, in this environment, because it's so useful. I like Beimu. We're, of course, talking about Jebemu, not Chuan Beimu, because who can mortgage their house to buy Chuanbe? It's so expensive. But Jebemu is fine. Don't stress about that. And then, of course, other upper jow herbs like Jegung and stuff like that, that work in that upper space, I think are really great, and you can mix and match your pieces. But I use Bay Muguelasan as an additive because you and I, both these days, if we're doing granules, we write a lot of whole formula combos, right? So I'm looking at this formula and I'm thinking like, okay, well, there's this sticky phlegm in the chest, but there's still some neck pain and some stuff. So maybe I'm doing tongue plus Bay mugualisan, and just like, moving the ratios around to achieve more neck, more warming, more phlegm management, just depending on what it looks like. And I think that's a really, it's a handy way to think about it. Like, think about the whole formula's mechanism of action instead of just the individual pieces. Last thing I wanted to mention in this topic of cold and flu. So we, of course, have been talking about this from the Shanghai's point of view, primarily just now, we were talking about some more modern formulas, right? What about the yin chaosans, the heat patterns? There are people out there who want to know, like, when am I supposed to use Yinchao san? And what's up with that? What do you have to say about that? [01:05:54] Speaker B: So I think one of the biggest artificial distinctions or juxtapositions that we learned in school is, is it wind heat or is it wind cold? We basically never see wind heat. I've seen two cases of wind heat that have been actual in the terms of cold and flu, not like for any condition, but for cold and flu. I think I've seen two cases the entire time I've been in the medicine where a Yin Chow san or sungju yin or one of those formulas was prescribed, and it actually helped, like, the person actually got better. [01:06:33] Speaker A: And we should specify that. We are, of course, in Portland, Oregon, where it is cold and damp most of the time. So if you're in like Sedona or. [01:06:44] Speaker B: Phoenix or something, you could see more of those. [01:06:46] Speaker A: It might be different from our point of view. [01:06:49] Speaker B: Yeah, I mean, yincha san is a great formula in skin conditions, right? Stuff like that. I've used it for those. I've seen people use it for stuff like that. I think there are cold and flu versions that you could see for. You could use the wenbing model to treat. Here's a fun one, the case study of Li Dongyun using chi Tong to. [01:07:19] Speaker A: Treat cold and flu. [01:07:20] Speaker B: Can you imagine that? [01:07:21] Speaker A: No, I can't. [01:07:26] Speaker B: Have. Is it possible to have those? Yes, it is. Also, it's important to know that wind heat formulas, damp. Wind damp formulas, those are still in the jingway. Zhang Zhongjing has an answer to what do I do to treat wind heat? What do I do to treat wind damp? There are examples of that in the Jingway, they're just in the Jingway because the jingway is about weird stuff. Right. Stuff that doesn't happen, that much less common things. Yeah. And complex disease and all kinds of stuff. So I would say if I were teaching an herbal program, I would almost not introduce wind heat concepts until people had thoroughly internalized the stuff that we talked about today, because that is what you're going to see, at least, that's the stuff that we see. Let me say that we don't see wind heat. I've seen, again, maybe two cases since I've been in practice, and we've been a lot of places, like, we've been to China, we've been to clinic, like, lots of different clinics, and every time I've seen somebody treat through that lens for cold and flu, it doesn't work very well. [01:08:42] Speaker A: Yeah. The only place I've ever seen, like Yinchao san in particular, be, I guess, probably effective. But this is a place where it's hard to tell, is at the earliest onset of the potential symptoms of cold and flu. So I'm talking, you wake up in the morning and you're like, am I sick? I might be sick. I'm not sure, like, you feel off, but there's really no active symptoms yet. I've actually watched and I've even experimented on myself with this, with using press tablet raw herbie in Chassan from ITM. So that's Institute of Traditional Medicine here in Portland. They have a brand called seven Forests. They make a variety of classical formulas, whatever. And they call it something different, because Sabuti loves to rename things, whatever he names it. So it's like, I can't even think of 15. Yeah, it's got a number. Yeah, exactly. Ilex 15, I think, is basically in Chasan. Right. And you wake up in the morning and you throw down your throat, like, oh, I'm a little off, and I'll just eat like ten ilex 15s. Right. As just a throw in there. Right. And it's interesting because it's not diaphragtic, it's not going to open your pores, it's not a warming formula. Right. But the bitter flavors of that formula. I think at the very earliest stages of body's response to an external attack is sufficient enough to drain and move what could be there. But I think, firstly, almost every time that happens, I would guess it's actually still a wind cold attack. But the herbs that are being used so quickly at the very earliest onset could potentially move something. Out if it were a real wind heat problem. I also think that the speed at which it can progress through the body is so rapid that by the time it gets to us in the clinic, it's a mixed pattern. [01:10:41] Speaker B: That's true. [01:10:42] Speaker A: There's almost no way. It's just too fast. The things move too fast. So even if I had, when I was playing, when I play around with this at home, is a wind heat pattern. I'm taking it early enough. Okay. Maybe it resolves. If it's a win cold pattern, I'm just downing this complicated cluster of bitter herbs, but also not at a crazy high dose, because they're pressed tablets. So even if you ate ten pressed tablets, you're maybe consuming 5 grams of herbs, right? Maybe. Right. Some of it's extracts or whatever, but even still, as a total dosage, it's pretty small. And so you're sort of subtly shifting the pattern by encouraging it with these particular flavors. But it's just an interesting thing to note that these formulas exist because they were important to exist at the time that they were created. Right. I think it's important to remember the context in which a lot of classical stuff was made, like it was in response to what was known and visible on the ground. [01:11:37] Speaker B: Absolutely. [01:11:40] Speaker A: If we had a zhang zhongjing of this era who was observing primary conditions and thinking about treatment for these conditions relative to what they're seeing all the time, they might look different. Right. In fact, we might have a whole new set of formulas that are pulling some guejutang concepts, some yin chaosan concepts, some Shao Chaitan concepts, into a new formulary. I only offer that to say that we don't want to suggest that there's any one method that is superior to the others. Right. They all have their value. But from what we see, leaning on the wind, cold patterns, quote unquote, is probably more likely to be clinically relevant to your work. And look, if you've been slinging wind heat formulas and you're killing it with that, and people are getting great, I'd love to hear about it. Honestly, I would too, because that would be fascinating. Like, what are you seeing? What's different? [01:12:31] Speaker B: Cold and flu. Cold and flu, skin stuff, whatever. [01:12:35] Speaker A: Yeah, absolutely. Blood heat with wind is like the dominant dermatological prescription ever. That's a different story. But yeah. For cold and flu in particular, we would love. Send us an email. We'd love to hear about it. Because I'd love to see what that looks like, because we don't get to see it. Up here because environment does matter in terms of what's coming through. Okay, well, we touched on some major cold and flu stuff today. Hopefully that'll be helpful for listeners to kind of think through some key distinguishing factors and the formulas that you're going to reach for. And keeping in mind those important factors, that patterns are often mixed, that it's probably a wind cold pattern, and that you need to dose appropriately in order to realistically get results. If you can use bulk, use bulk. Y'all just do it. [01:13:24] Speaker B: For this topic in particular, bulk. [01:13:27] Speaker A: On that topic, how many days write the prescription? [01:13:30] Speaker B: It's a really good question. I will typically write a bulk formula for four days for somebody with an acute cold and flu. So let's say that situation, chai utong, chai wajutong plus guggen. I'll do four days. [01:13:45] Speaker A: What about if it's granule? [01:13:47] Speaker B: Granule? I would probably do a week just to make sure. [01:13:54] Speaker A: Yeah, something to remind patients of too sometimes, especially if that formula is just right and you caught it at just the right moment. They'll take a day's worth of herbs and they'll feel amazing in one day. You got to keep, they got to keep taking it. Remind them. Use the analog with antibiotics. They're all familiar with it. Like you got to finish the course. You can't just stop in the middle because you feel better. So just remind them, like, okay, you're feeling better. That's great. But take your herbs. [01:14:19] Speaker B: Yes. [01:14:20] Speaker A: All right, well, that's probably good wisdom for everybody. Take your herbs. Thanks for joining us, you guys. For another nervous herbalist, you can find more information about the show at ww dot rootandbranchpdx.com. If you have questions, comments, or you want to tell us about your awesome success with treating wind, heat, cold and flu, shoot us an email [email protected] seriously, we actually want to know about that. Yeah, I would love to hear that. I'd love to read some cases about it. That'd be super cool. And if you guys have any suggestions for show topics or things that you want to hear, you can send an email to the info box as well. Again, [email protected] please like and subscribe. And it really helps us get better podcast exposure, too. If you guys subscribe to the podcast, we're hopefully going to continue to produce these every couple of weeks. So there's a growing body of information for people interested learning more about how to use chinese herbs effectively. Thanks a bunch I'm Travis Kern. [01:15:17] Speaker B: I'm Travis Kern. [01:15:18] Speaker A: We'll see you next time.