Show Notes
TK asks TC about different headache cases he has treated so that listeners can have an idea of how diagnosis and treatment playes out with real patients.
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Episode Transcript
[00:00:03] 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.
Alrighty. Hello everybody and welcome back to the Nervous Herbalist. My name is Travis Kern and I.
[00:00:25] Speaker B: Am here with Travis Cunningham.
[00:00:28] Speaker A: And we are finishing up the discussion on headaches. We wanted to put together some case studies for you. TC has some case studies to just try and give some real world, tangible idea of sort of like what it looks like to work through specific cases regarding headaches. So t, why don't you lay out the first one for us and let's poke around in it. Okay.
[00:00:52] Speaker B: So the first one, the first appointment, this is, took place on December 19, 2023.
This was a 72 year old female whose chief complaint was headaches. That would wake her up in the middle of the night and she would experience pain from her teeth to the upper jaw. That was how she described it. And then the pain would go up on the right side only to the temple.
And then she would notice later on pain behind the left eye.
The pain was described as sharp and heavy.
And she said, it leaves me crying in pain. It's very intense.
[00:01:37] Speaker A: Yeah.
[00:01:39] Speaker B: It lasts about 10 to 20 minutes and then vanishes inexplicably. So it comes suddenly, wakes her up in the middle of the night, lasts 10 to 20 minutes and then it goes away. She has no idea why it comes, why it goes.
[00:01:53] Speaker A: Wow.
How frequently was that happening to her?
[00:01:56] Speaker B: It was happening to her every few nights. So every two to three nights this was happening and it was getting more frequent and more intense. And she had one night where the pain lasted. It wasn't quite as intense as it was usually, but for several hours. So she was getting pretty concerned because it wasn't getting better, it was getting worse. And this has been happening for a few weeks.
This woman also was in care of her husband, who's declining from dementia. So obviously a very stressful and I think grief stricken time in her life.
[00:02:37] Speaker A: Yeah.
[00:02:39] Speaker B: She also reported that her temperature is cold. Overall, she has two to three bowel movements a day, which are looser in nature.
Her urination is inhibited, meaning it's hard for her to go completely. She feels like she has to go more, but can't.
[00:02:57] Speaker A: Okay.
[00:02:58] Speaker B: And when I checked her pulses, her pulses were rapid. I clocked eight beats per breath.
[00:03:08] Speaker A: Wow.
[00:03:08] Speaker B: So that's quite, quite rapid.
[00:03:10] Speaker A: Yeah.
[00:03:12] Speaker B: The pulses felt big, so they were very large and rapid.
And the abdomen, interestingly, Enough.
Had a water splash sound like we talked about last time. There was a little bit of recu, which is the rectus abdominal tension. But the most prominent thing on her abdomen was the pulsations. She had abdominal aortic pulsations. Really palpable, really easy to feel all the way from the epigastric area all the way down to actually below the umbilicus. Like two fingers, Two or three fingers below the umbilicus. I could still feel them. So pretty prominent pulsations.
[00:03:55] Speaker A: Yeah. Okay, so based on that strong abdominal pulsation from our conversation last time, indicating blood or water.
[00:04:05] Speaker C: Yep.
[00:04:06] Speaker A: Right. And then the fact that it's waking her up at night.
[00:04:11] Speaker D: Right.
[00:04:12] Speaker A: Sleep problem.
[00:04:13] Speaker C: Yep.
[00:04:14] Speaker A: So more blood indicator.
[00:04:15] Speaker C: Yep.
[00:04:16] Speaker A: Okay, so what did you end up writing for her?
[00:04:19] Speaker B: This one I jumped right to the running piglet formula. Lingui Sao Cao tang. So this is that water overtaking fire pattern that we talked about where yang is weak. Water is then accumulating because yang isn't transforming water. The water displaces the Yang and forces it up. And the nighttime is one time when this can happen because yin is predominant.
[00:04:42] Speaker D: Right.
[00:04:42] Speaker B: And especially if it's at, like. It doesn't say this here, but let's say it's at like 12 or 1am, right. This is peak yin time. So yin is at its predominance. Yang is weak. It gets especially forced up to the surface.
So.
[00:05:00] Speaker C: Yeah.
[00:05:00] Speaker A: So why. Why go straight there instead of like a Guizhetong formula or something if there was such strong blood indicators in the abdomen?
[00:05:09] Speaker B: Because of the extent of the pulsations. The pulsations below the umbilicus especially. And the whole thing being lit up like, I've never felt an abdomen like that before or since.
That shows me. Yeah. Ling Gui Sao Tao tang pattern has pulsations below the umbilicus. That's named in the Fukushin diagnostics. And I think you could use other formulas to treat it if you didn't know about Lingguay Sao Tzu tong, the closest is Ling Guizantang.
[00:05:42] Speaker D: Right.
[00:05:42] Speaker B: Because Lingguay Jugantang is just one herb away, but it's a dosage difference as well. Sure.
So I think that might have worked.
[00:05:51] Speaker A: But what in the abdomen, because, you know, lingua Jugantong was in our discussion last time was water formula. Right. And we know that the pulsations can be water or blood. But what else in the patient's presentation would have told someone that water was so dominant here, as opposed to saying like, oh, well, it's pulsations and they're waking up at night. So blood.
[00:06:13] Speaker B: It's blood. Well, the formula actually treats a little bit of both because it also has. So you have wager gan sao as our cornerstone herb pair for blood.
[00:06:25] Speaker A: Right.
[00:06:26] Speaker B: Guizhi is going to warm blood. Gansao is going to tonify.
[00:06:29] Speaker D: Right.
[00:06:30] Speaker B: And gansao is red.
[00:06:32] Speaker D: Right.
[00:06:33] Speaker B: Or kind of at least from a signature perspective.
[00:06:37] Speaker D: Right.
[00:06:38] Speaker B: So it has this affinity of sweet flavor, but going to the blood. So that's one side of tonifying blood. And then the other basic pair is guiji fuling.
[00:06:49] Speaker D: Right.
[00:06:49] Speaker B: Which is going to strengthen yang to push out water.
So lingui sao Ze tong not only has both of those, but also has dazao in it. So dazao is going to further strengthen the blood, provide more nutrient density, you could say, to the blood. And it's at 12, which is a little higher than standard, like guizhetong dosage for dazao. So you're actually kind of treating both in here. And you see evidence of both on the abdomen. You see a little bit of a need to strengthen the blood aspect with the requ and you see a little bit of the water aspect with the water splash. So you're kind of seeing both.
The need to treat both in this case.
[00:07:33] Speaker A: Gotcha. Okay. Yeah. Because the design of the formula helps explain why it treats both. But the diagnostic process to decide that that, like the design of the formula explains why it works.
[00:07:43] Speaker D: Right.
[00:07:43] Speaker A: But not how you would pick it in the first place.
[00:07:46] Speaker B: If the pulsations are less extensive.
[00:07:48] Speaker D: Right.
[00:07:49] Speaker B: Then I would try other things first. I would go, maybe Wuling san. I would go.
[00:07:53] Speaker A: And by extensive, you mean like the intensity of.
[00:07:55] Speaker B: The intensity of it. Yeah. Well. And thirst was low here, so I probably would do lingua juke on tongue.
[00:08:00] Speaker D: Right, Right.
[00:08:01] Speaker A: If so, if the pulsation was less intense.
[00:08:03] Speaker C: Yeah.
[00:08:04] Speaker A: Then because splash sound is in there. Right. Then we're thinking, okay, this is probably a more water look. So since thirst was low. Lingua Yukantang.
[00:08:13] Speaker C: Yep.
[00:08:13] Speaker A: But because the pulsation was very strong.
[00:08:15] Speaker C: Yep.
[00:08:16] Speaker A: And we have splash sound, we're thinking like, okay, this is probably a combined approach here.
[00:08:21] Speaker C: Yep.
[00:08:22] Speaker A: And so lingui sao Cao tang becomes the. The next move.
[00:08:27] Speaker C: Yep.
[00:08:27] Speaker A: Okay. So she takes that. What happened?
[00:08:29] Speaker B: Yep. So then.
So I saw her on 12 19, which is right before our holiday break that year. And the next time I saw her was almost a month later, 1:12.
So that's because we were away.
[00:08:45] Speaker D: Right.
[00:08:46] Speaker B: And I saw her, I think maybe the second week we were back or something. But Anyway, she had taken the formula for that time and the headaches were mostly gone at this point.
They had gotten better the first week and then had continued to get better.
She had one headache the last week and it was very mild. So mostly the pattern seemed to be improved. Her urine flow was also stronger. So she reported that.
So I just refilled the formula for another, let's see, another two weeks.
[00:09:27] Speaker A: Did you leave the wager dose as it was? I. Did you increase it?
[00:09:31] Speaker B: I did. I actually did wager 30 the first time.
[00:09:34] Speaker A: The first time, yeah.
[00:09:35] Speaker B: Yeah.
[00:09:35] Speaker A: So it's a strong wager dose.
[00:09:36] Speaker B: Strong wager dose, yep.
[00:09:38] Speaker A: Okay, so then you refilled it for.
[00:09:41] Speaker B: For two weeks.
[00:09:41] Speaker A: For two weeks. She comes back in, in two weeks.
[00:09:43] Speaker B: And the headaches were totally resolved.
[00:09:46] Speaker A: So she's not waking at night anymore.
[00:09:47] Speaker B: She's not waking at night anymore, no headaches. And she had some other things she wanted to be treated for. So we changed the treatment there. I think I treated her for another two months or so and the headaches never came back.
[00:10:01] Speaker A: That's amazing.
[00:10:01] Speaker B: Yeah, Pretty awesome, right?
[00:10:03] Speaker A: Super. Great.
[00:10:04] Speaker B: That freaking formula.
[00:10:05] Speaker A: And how was her thirst in the end? Did it stabilize?
[00:10:08] Speaker B: The thirst?
[00:10:10] Speaker A: The thirst, it was low before it was low.
[00:10:12] Speaker B: Yeah, it did come up a little bit, but I think it was still relatively low.
[00:10:16] Speaker A: Yeah, yeah, yeah. Low thirst is sometimes hard to fully assess with people. Like, is low thirst low or is it just normal? Right, like you're not thirsty.
[00:10:26] Speaker C: Yep.
[00:10:26] Speaker A: Right. Like it's, it's a little. That one's tricky to figure out. Okay, so lingua sao tong in that case. Key indicators here. The pulsation in the abdomen was very strong.
[00:10:36] Speaker D: Right.
[00:10:36] Speaker B: And all the way, like down to the umbilicus. Around the umbilicus, all the way up.
[00:10:42] Speaker A: So like epigastrum down past umbilicus?
[00:10:44] Speaker C: Yep.
[00:10:44] Speaker A: Yeah. So very notable. Um, that in and of itself probably indicates linguizotang, but combined with the splash sound. Right. And thirst. Peace. Say. Okay, let's use this combined formula.
[00:10:58] Speaker C: Yep.
[00:10:59] Speaker A: Water blood. Manage the water. Overtaking fire pattern. Okay, so what about a, a more ongoing one?
[00:11:08] Speaker B: Yeah, so this one happened actually in the same year, but the earlier part of that year, 2 to 23. So 2-2-23, 38 year old female came in. Chief complaint of headaches. The headaches had been going on for four months and just like the last patient, they were getting worse.
She has three to four headaches a week and the intensity and the frequency seems to be increasing as time goes on. The headaches are debilitating.
She doesn't know what the causes are. They're unknown causes, unknown triggers. And she experiences them as like a headband really super tight around her head. And they're temporal as well.
There is some visual disturbance. She has eye pain when the headaches come, and her eyelids also twitch and spasm.
And she has other muscle twitching and cramping. I asked about that. Like, do you get cramping and twitching in other parts of your body? And she does.
She does not feel nauseous. And there's no GI changes when the headaches occur. So there's no nausea, there's no like diarrhea or nothing like that.
The headaches get better when she lays down.
She has to stop working when they occur at this time because they last for quite a long time. Hours usually.
[00:12:40] Speaker A: Okay, so this is a little bit.
[00:12:42] Speaker B: Closer to like a migraine presentation.
[00:12:44] Speaker D: Right.
[00:12:46] Speaker B: She gets cramping in her feet, which is just kind of an interesting thing. Her thirst is in flux. So sometimes she's thirsty, sometimes she says she's not thirsty. She's drinking a lot of water because the first doctor that she went to told her that she needs to make sure she's not dehydrated. So she's drinking like tons of water.
[00:13:06] Speaker A: Okay, Right.
[00:13:07] Speaker B: Which could play into her feeling of thirst or not feeling thirsty.
[00:13:10] Speaker A: Right, right, right. Because she's just satisfied all the time.
[00:13:13] Speaker B: Yeah, she's just like over drinking water probably. Her urination is infrequent.
[00:13:19] Speaker A: She drinks.
[00:13:20] Speaker B: The amount of water she's drinking, the amount of water she's drinking, it's infrequent. So it's only a few times a day.
She has a stuck feeling in the throat after questioning, her bowel movements are two to three times a day, sometimes looser.
[00:13:35] Speaker A: Okay.
[00:13:36] Speaker B: Temperature is normal. So she reports no problem with temperature. Her sleep sucks. I have that down in parenthesis or in quotation marks. She falls asleep. Okay. But wakes up at 1am and cannot fall back. She had night sweats previously, but doesn't experience those currently.
And this case, I didn't palpate the abdomen, unfortunately. It would have been a great help if I had, but I didn't. I wasn't doing that as much at the time, but I did take the pulses. The pulses are very strong and wiry.
[00:14:13] Speaker A: Okay.
So with all of that data, which pieces stand out to you the most in terms of figuring out what's happening with the head? Especially in this case, because you don't have the abdomen, which is a.
[00:14:24] Speaker B: You don't have the ab. Right. I didn't have the abdomen.
[00:14:26] Speaker D: Right.
[00:14:27] Speaker B: Which would have been super helpful if I.
[00:14:29] Speaker A: Well, it would have streamlined it for sure.
[00:14:30] Speaker B: It would have streamlined it, yeah. Okay, so we're looking at a stuck feeling in the throat.
[00:14:37] Speaker D: Right.
[00:14:38] Speaker B: So the first, first thing is like we look at Qi. Is Qi involved? So headband headache, temporal headache suggests Xiaoyang channel or Qi. Stuck feeling in the throat suggests Qi. Visual disturbance suggests Qi. All of these are possible for Qi stagnation, Wiry pulses, superficial, also suggest Qi.
[00:15:01] Speaker A: Right.
[00:15:01] Speaker B: So there's enough actionable information for me to want to circulate qi.
[00:15:06] Speaker A: Yeah.
[00:15:08] Speaker B: There is also difficult question to answer with thirst.
[00:15:12] Speaker D: Right.
[00:15:13] Speaker B: But urination is infrequent despite her drinking a lot of water. So I definitely want to treat water.
[00:15:18] Speaker A: Yeah.
[00:15:18] Speaker B: If water is getting stuck, can't be eliminated, it's going to create an unnecessary amount of pressure in her body and it's going to possibly create headaches. It's going to create counterflow of some kind.
I didn't write this down here, but I'm remembering this from the case. She had been to all kinds of different doctors at this point and the only thing they had done for her was give her blood pressure medication.
[00:15:42] Speaker A: Yeah.
[00:15:43] Speaker B: And her blood pressure wasn't that high.
[00:15:45] Speaker A: Sure. But they're, they were thinking, you know what's funny actually is first stage blood pressure meds, which a lot of people these days think are old school. Like some people will just skip right over hydrochlorothiazide, which is a diuretic.
[00:15:59] Speaker B: Which is a diuretic.
[00:15:59] Speaker C: Yeah.
[00:16:00] Speaker A: So there's this like the first move, you know, even from a Western model for blood pressure for many, many years though people are using other medications now like ACE inhibitors and stuff. But the, the move was to deal with water.
[00:16:14] Speaker D: Right.
[00:16:15] Speaker A: Like, oh, let's flush out some of the excess water. And of course, their understanding for why they were doing that's entirely different than why we do it. But curiously, the. One of the first successful tools they found for blood pressure, for which headaches can be a symptom.
[00:16:28] Speaker D: Right.
[00:16:29] Speaker A: Was get out the water.
[00:16:31] Speaker D: Right.
[00:16:32] Speaker A: Yeah. It's interesting. So they've given her blood pressure meds, but they weren't helpful.
[00:16:35] Speaker B: They weren't helpful, no. The problem was clearly getting worse despite the medication. I don't think the medication made the problem worse. It just didn't help.
[00:16:43] Speaker A: Well, and I mean, the thing is, is that if there's so many cheese stack signs, hydrochlorothiazide is not going to do anything for your cheesesteak problem. Right. So it drains out the water. Side. But if, like let's. I mean not that patterns are this easy to break down, but like if you imagine that it was like a 65% chi problem with like a 25%, 35% water problem.
[00:17:03] Speaker D: Right.
[00:17:04] Speaker A: Well, if you took the 35% water out with the hydrochlorothiazide, it wasn't gonna do anything for the other 65% of the problem.
[00:17:11] Speaker D: Right.
[00:17:11] Speaker A: So you just stay with headaches.
[00:17:13] Speaker C: Yep.
[00:17:13] Speaker A: Yeah, for sure. Okay, so you've got the water indicators, you've got the QI indicators.
[00:17:18] Speaker C: Yep.
[00:17:19] Speaker A: Anything else?
[00:17:20] Speaker B: We've got some blood indicators too.
[00:17:21] Speaker A: Oh boy. Blood indicators. And lo and behold, listeners, this is the reality, right. Is that like people come in the door and it's easy. I mean easy. I'm doing air quotes here. It's easy if it's one thing.
[00:17:35] Speaker B: Yeah.
[00:17:35] Speaker A: You pick the one formula. It's also easy to check whether you were right or not because it works or it doesn't, you know. But here you've got pieces.
[00:17:44] Speaker C: Yep.
[00:17:44] Speaker A: All over the place. So what were the blood indicators?
[00:17:46] Speaker B: So the blood indicators were just the difficult falling that she wake up at 1am and couldn't fall back to sleep.
[00:17:52] Speaker A: Sucks.
[00:17:53] Speaker B: Her sleep sucks.
[00:17:54] Speaker A: That's right.
[00:17:54] Speaker B: Quote history of night sweating as well. Even though they're not present. You can also ask people if they feel hot at night when they get up. Yeah, that's kind of a miniature version. It's not quite night sweating, but it's still floating. Young. Young is at the surface. So.
[00:18:10] Speaker A: So with those three pieces.
[00:18:11] Speaker C: Yep.
[00:18:12] Speaker A: Based on, I mean the thirst piece is a little bit hard to, to discern, but let's assume, let's just take her word for it, that she's not thirsty.
[00:18:20] Speaker C: Yep.
[00:18:20] Speaker A: So that's going to be Xiao Qiutang.
[00:18:23] Speaker C: Yep.
[00:18:23] Speaker A: Ling Guizhugan tong.
[00:18:24] Speaker C: Yep.
[00:18:24] Speaker B: Guizhu tong Guizhi Ganzao longo mulitng.
[00:18:27] Speaker A: Guizhu gansao Longga mulitang.
[00:18:29] Speaker B: Yeah.
[00:18:30] Speaker A: So did you put all three of those together?
[00:18:31] Speaker C: Yep.
[00:18:32] Speaker B: That's. That's what I did.
[00:18:33] Speaker A: That's it.
[00:18:33] Speaker B: That's nothing. No modifications, nothing else, Just straight and.
[00:18:36] Speaker A: Just like we talked about before, adding the total numbers together, putting them into the formula together.
[00:18:42] Speaker C: Yep.
[00:18:43] Speaker A: If they're pre formulated granules, if they're individuals, you just pick the one with the higher number.
[00:18:47] Speaker C: Yep.
[00:18:48] Speaker A: Now your guijer jalonga mulitang, is that what you did?
[00:18:53] Speaker B: So guijer gansao longamulitang is just those four, Right. Versus Guijer jia longu mulitng, which is the whole form plus longo and muli. Yeah.
[00:19:02] Speaker A: So what's your dosing for the guns, for the muli and the longu in that?
[00:19:07] Speaker B: 30.
[00:19:07] Speaker D: 30.
[00:19:07] Speaker A: 30. 30, yep. Okay, so you give her that at 16 grams.
[00:19:13] Speaker B: I actually went up.
[00:19:14] Speaker A: Went up to how much?
[00:19:15] Speaker B: 10, twice a day.
[00:19:17] Speaker A: So 20 grams total for the day. And then what happened?
[00:19:21] Speaker B: Yep. So next appointment was a week later, I think eight. Eight days later. 2, 10, 23. First appointment was 2223.
She's doing better. Headaches happened twice a week instead of three to four times.
They were less severe when they came.
[00:19:42] Speaker A: Okay.
[00:19:43] Speaker B: Sleep also improved. She still wakes up at night, but she's able to fall back asleep whereas previously she wasn't.
And that's about it.
[00:19:53] Speaker A: So basically, she ends up with reduction in frequency by almost half.
[00:19:57] Speaker C: Yep.
[00:19:57] Speaker A: And then the severity when they do happen is less.
[00:20:00] Speaker B: Less.
[00:20:00] Speaker C: Yep.
[00:20:00] Speaker A: And I think that tracks actually, like that style of early resolution tracks with a lot of disease presentations. Like where someone has something that happens every day and it has a certain intensity. Usually what I see happen is that the frequency will come down, then the intensity will come down.
[00:20:20] Speaker C: Yep.
[00:20:20] Speaker A: Then the two of them will come down together.
[00:20:22] Speaker D: Right, right.
[00:20:23] Speaker A: So it's like if you're having terrible headaches five days a week, now you're having terrible headaches two days a week.
[00:20:28] Speaker C: Yep.
[00:20:28] Speaker A: The intensity say, still as bad, but it's less frequent. You're like, okay, great.
[00:20:31] Speaker D: Right.
[00:20:32] Speaker A: And then the. Maybe it stays at two days a week for a while, but now the severity comes down.
[00:20:37] Speaker C: Yep.
[00:20:37] Speaker A: So I'm still having headaches twice a week, but they're actually like half of what they were before.
[00:20:42] Speaker C: Yep.
[00:20:42] Speaker A: Cool. And then now they both start to come down together. So they're. I'm having once, one a week, maybe one every other week, and they're way lighter than they used to be.
[00:20:51] Speaker C: Yep.
[00:20:52] Speaker A: So that's something like if you're. If you're trying to track, like, what's likely to occur, particularly when you talk to patients. Because sometimes I think people imagine that headaches and other conditions, it's like an on off switch.
[00:21:03] Speaker B: Yeah.
[00:21:03] Speaker A: Right. Like, oh, I'm having headaches all the time and now I'm not having headaches.
[00:21:07] Speaker D: Right.
[00:21:07] Speaker A: So if I'm still having headaches, but they're less frequent and less severe. I know it sounds crazy because as clinicians, we're looking for that as, like, clear indicators of progress, but there are some patients who are like, it's not working.
[00:21:18] Speaker D: Right.
[00:21:19] Speaker B: Yeah.
[00:21:19] Speaker A: Right. They're like, I'm still having headaches and I'm like, no, you are. You are still having headaches, but they are less frequent and less severe. That's progress. A lot of people will miss that. So when you're talking to the patient about what to expect, like, in terms of timeline, I often will describe the resolution of condition exactly the way I just did to you guys. Right. So it's like, okay, frequency usually comes down first, then severity follows, then the two together.
[00:21:44] Speaker D: Right.
[00:21:44] Speaker A: So, like, we're not gonna just like. If it's a good formula, your headaches aren't just gonna end tomorrow.
[00:21:48] Speaker D: Right.
[00:21:49] Speaker A: Because the pattern of the formula is dragging the pathology pattern back toward physiology.
[00:21:55] Speaker B: Yes.
[00:21:55] Speaker A: But it's not gonna be able to do that in just one swoop.
[00:21:58] Speaker D: Right.
[00:21:58] Speaker A: Right.
[00:21:58] Speaker D: Yeah.
[00:21:59] Speaker A: Okay, so it's good progress. Great. You refilled at the same.
[00:22:03] Speaker B: Refilled the same. Same thing.
[00:22:05] Speaker A: Okay, so same dosage, same comes back in another week later.
[00:22:08] Speaker B: So I actually skipped ahead to appointment number six, which is almost two months later.
[00:22:15] Speaker A: So she's been taking this formula every week.
Just about two months.
[00:22:19] Speaker B: For two months.
[00:22:20] Speaker A: So the first evaluation was just a week later.
[00:22:21] Speaker B: Just a week later.
[00:22:22] Speaker A: And then you were like, okay, keep taking this.
[00:22:24] Speaker B: Well, I did see her in between then. But I. For the sake of discussion, to speed up the conversation.
[00:22:31] Speaker A: But it's like you're seeing her every week.
[00:22:32] Speaker B: Yeah.
[00:22:33] Speaker A: And you're just kind of tracking it.
[00:22:34] Speaker D: Right.
[00:22:35] Speaker A: Okay, so she keeps taking it. We're now at week six.
[00:22:38] Speaker D: Right.
[00:22:38] Speaker B: Well, appointment number six, which is four hours, 13 minutes and 23 seconds.
[00:22:44] Speaker A: So, yeah, two months.
[00:22:45] Speaker B: Two months.
[00:22:46] Speaker A: Yeah. So eight weeks later.
[00:22:47] Speaker B: Eight weeks later.
[00:22:48] Speaker A: Okay.
[00:22:50] Speaker B: The patient now has almost no headaches. Sleep is still improving, but not perfect. Okay, so she's. Sometimes she's not waking up at all. Sometimes she is, but she falls back asleep.
[00:23:04] Speaker A: Nice.
[00:23:05] Speaker B: She's still having cramping. That was one of the things that I wanted to keep checking in with. Urination is normal.
[00:23:13] Speaker A: Gotcha.
[00:23:14] Speaker B: At this point.
[00:23:15] Speaker A: So like leg cramping like Charley horse? Yeah, yeah.
[00:23:18] Speaker B: Leg cramping.
[00:23:19] Speaker A: Specifically at night or just all the time?
[00:23:21] Speaker B: All the time. All the time, yeah.
[00:23:23] Speaker A: Okay.
[00:23:25] Speaker B: The pulses were way less excess, way softer. Feeling. Okay, a lot softer still. Relatively superficial, but softer.
So the next formula was.
I used xiao zhenjongtang plus longu muli, which includes guiju mulitang in it.
[00:23:51] Speaker A: So you decide to make a pivot because the headaches are pretty much gone.
[00:23:55] Speaker D: Right.
[00:23:55] Speaker A: So the formulas they're using for that piece, it's like, okay, we can drop these off.
[00:23:59] Speaker D: Right.
[00:24:00] Speaker A: But sleep is still problematic.
[00:24:02] Speaker B: Sleep is still Problematic.
[00:24:03] Speaker A: And so you're making a pivot to deal with that and then the cramping.
[00:24:07] Speaker D: Right.
[00:24:07] Speaker A: Which are still going on. Okay. So the qi piece drops off.
[00:24:11] Speaker B: The qi piece is done.
[00:24:12] Speaker A: The water piece drops off.
[00:24:14] Speaker D: Right.
[00:24:14] Speaker A: Because the urination is regular now.
[00:24:16] Speaker B: Urination is regular.
[00:24:17] Speaker A: So now you're sitting with your blood piece.
[00:24:20] Speaker B: Blood piece. And we're going to build a little stronger.
[00:24:22] Speaker A: Gotcha. And so now you said you switched to xiaojianzhongtang.
[00:24:26] Speaker C: Yep.
[00:24:26] Speaker A: So what's different about that formula?
[00:24:28] Speaker B: Xiao Zhen Zhongtang is wagertong with double bai xiao and Yitang. So more sweet.
[00:24:35] Speaker A: Yeah. Yi tong is very sweet.
[00:24:37] Speaker B: Yi tong is very sweet. And it's basically, it's a good formula for cramping.
[00:24:42] Speaker D: Right.
[00:24:42] Speaker B: Because you have double bai Shao, you still have Xiao yao gan Sao tong in the formula, but it's more baishao. It's actually more sweet and more sour. So it's helping with cramping of the muscles more. It's putting good nutritive fluid back into the muscle layer. You can think about it that way.
I'm expecting at this point that the, like we said, the qi piece and the water piece is resolved. And so I'm really just treating the blood piece at this point. And I'm using the longu muli, keeping that in there just because of a little extra anchoring. I want a little bit of that gesture still to be helping instead of just going to Xiao Zhenjongtang, which you could also do. But I was sort of playing it safe, keeping that in there.
[00:25:29] Speaker A: I also think it's a neat link, actually, between the previous iteration of the formula and what's happening next. It sort of serves as a little bridge between the. The original formula pattern and this new formula pattern. And I think it actually makes it easier for the body to just sort of like casually move into this more blood focused direction. Whereas if you pull it out entirely, in some ways, I think the body's physiology is like, oh, wait, this is something new. Whereas if you link it together like that, it makes the transition smoother.
[00:26:02] Speaker D: Right.
[00:26:02] Speaker A: Somehow I agree. Yeah. Okay, so you give her that and then how long does she take that for?
[00:26:07] Speaker B: So the next appointment I have on here is at 4:28, which would be about two weeks later.
[00:26:14] Speaker A: Okay.
[00:26:15] Speaker B: And she's still doing better. She's had one headache the last few weeks, but it was clearly connected to dehydration. She got working, I forgot to drink water, whatever, and she got a little bit of a headache. Still wasn't as bad as before, she's still having muscle cramping, so it's happening about the same amount.
And the pulses I felt this time were quite a bit deeper.
So that's the main note I have there.
So at this point, I decided to switch the formula to Dangui Xiaoya san.
[00:26:47] Speaker A: Why?
[00:26:48] Speaker B: Because I sort of had the feeling that there's a little bit of the water aspect that still needs to be treated, but we need to treat water and blood together at a deeper level. So great formula for that long term is Dongwei Xiaoyao san.
[00:27:06] Speaker A: What about that formula? It seems to bring it into a deeper space.
[00:27:10] Speaker B: The Dongwei and Baishao combination.
[00:27:12] Speaker D: Yeah.
[00:27:13] Speaker B: Anytime we're using Dongwei, we're really targeting blood physiology more specifically. And the Baishao dosage or Xiaoya dosage in that formula is huge relative the other ingredients, it's like 48 or something like that. It's crazy high. Now, of course it's a San, so you know, it doesn't need to be like if you did a bulk formula, you don't need to use 48 grams of Baisha, that would be kind of crazy.
But you can go very high relative to the other ingredients and it works. And then it also includes fooling Baiju Zixia. So there's this, the water aspect of. Of the water. And so you're kind of harmonizing blood and water but at a deeper level.
[00:27:55] Speaker A: Yeah. So when you're writing in a granule though, you keep that high.
[00:27:59] Speaker B: I do.
[00:28:00] Speaker A: Bishop number.
[00:28:01] Speaker C: Yep.
[00:28:01] Speaker A: Yeah. Okay, so we started with the original triple. Triple threat.
[00:28:06] Speaker C: Yep.
[00:28:06] Speaker A: Then we pivot to this formula that's more blood focused but still has some of the minerals and anchoring components of the second one. And things are better. Sleep is better, headaches are there, but there still appears to be a water component. And the muscle thing is gnarly.
[00:28:22] Speaker D: Right?
[00:28:23] Speaker B: The muscle thing is still happening.
[00:28:24] Speaker A: Yeah. So the sweet sour combo of the xiaojianzhongtang didn't quite get it there.
[00:28:28] Speaker D: Right.
[00:28:29] Speaker A: So you pivot to Dangui Shao San in an effort to target the blood more directly while still including the water component. Because there's, you know, clearly like she quickly got a headache from not drinking enough water.
[00:28:42] Speaker D: Right.
[00:28:43] Speaker A: Like there's. There's clearly not a fully balanced water presentation here.
[00:28:46] Speaker D: Yes.
[00:28:46] Speaker A: Right. Okay, so then how long does she take the Dongwei Shaya san?
[00:28:50] Speaker B: She took that for basically another two weeks.
[00:28:54] Speaker A: Okay.
[00:28:55] Speaker B: At which point, so 5, 12, 23. Headaches are non existent. So she hasn't had a headache since the last appointment.
[00:29:02] Speaker A: Great.
[00:29:03] Speaker B: Sleep is good.
Not waking up any longer. Muscle cramping is still occasional, but it's better.
So at this point, I chose to change the formula again. But I probably could have stayed on the same formula if I wanted to. But I switched to a simpler formula, just Xiaoyao Gan Saotang, and I had her take that for one month.
And then I followed up with her via phone call and. Or no, I followed up with her in person and then I had her book a phone call session in a month with nothing after that to check in.
[00:29:44] Speaker A: Yeah.
[00:29:45] Speaker B: And when we followed up on the phone, she'd had no headaches. She hadn't been taking herbs for a month, no headaches, sleep was still good. Basically, she's doing great.
[00:29:55] Speaker A: So when you gave her the shyogan sao tang, she took that for a month.
[00:29:59] Speaker B: She took that for a month.
[00:30:00] Speaker A: And you saw her in person?
[00:30:01] Speaker B: Saw her in person.
[00:30:02] Speaker A: And she's feeling pretty good.
[00:30:02] Speaker B: She's feeling great.
[00:30:03] Speaker A: So we drop off the herbs entirely.
[00:30:05] Speaker B: Drop off the herbs.
[00:30:06] Speaker A: Phone call, check in in a month.
[00:30:07] Speaker C: Yep.
[00:30:07] Speaker A: Okay. So from initial appointment, so triple threat to blood focus to Dong gui shaosan to that point to the end of that treatment process was basically three months. I think you were February, mid February to mid March or mid May. Excuse me, Mid February to mid May.
[00:30:30] Speaker B: Yeah, mid May.
[00:30:31] Speaker A: Yeah. So three months and then you put her on Shayogan Tse tongue.
[00:30:36] Speaker C: Yep.
[00:30:37] Speaker A: For one month.
[00:30:37] Speaker D: Right.
[00:30:38] Speaker A: That's another month, four months and then no more herbs.
[00:30:42] Speaker D: Right.
[00:30:42] Speaker A: Check in with her after that.
[00:30:43] Speaker C: Yep.
[00:30:44] Speaker A: So realistically, I mean, firstly, it's important to note that there was improvement in the headache pattern within the first week.
[00:30:51] Speaker B: Yes.
[00:30:51] Speaker A: Right.
But it took four months.
[00:30:55] Speaker D: Right.
[00:30:56] Speaker A: Right. Now, notably, it really took two months to handle the headache.
[00:31:01] Speaker B: Yes.
[00:31:01] Speaker A: Right. Like sufficiently that most people probably wouldn't notice.
[00:31:04] Speaker D: Right.
[00:31:05] Speaker A: But because the patient had gotten positive results and because things were looking good and because sleep was also improving, you pivot the treatment where by the time we're done in four months total, we actually haven't been treating headaches for two months right. Now. Some of the work with like dongwei Shaya san and stuff was still dealing with some lingering fluids, things that. And this is where. Honestly, in my mind, this is the hard part of treatment. Right. Because you fix the chief complaint mostly in two months headache, that's pretty standard. Right. We tell people six to eight weeks is just kind of like that's minimum treatment for herbs, you know?
[00:31:40] Speaker D: Right.
[00:31:40] Speaker A: So great. We took care of the headache, working on this other thing which is improved. It's interesting to Me, because if a patient had been like, yeah, I'm pretty. I don't want to. I don't have time or money or whatever, and my headaches are better, so I'm done.
I don't think the water problem was fully resolved.
[00:31:56] Speaker B: No. And for this patient, too, it's probably constitutional. There's a constitutional weakness of this type.
[00:32:05] Speaker D: Right.
[00:32:06] Speaker A: Well, and I think my point is just that if they had dropped off with a constitutional tendency without a real resolution to the water problem, probably would have been three, four months, the headaches.
[00:32:15] Speaker B: Would have been bad, and it would have come back. I think so, too.
[00:32:18] Speaker A: Yeah. So now, by taking it all the way through to the end, not only do you fully resolve the water pathology, now we can't do anything for constitutional norms. Right. I mean, like, we can. We can push against them and encourage lifestyle stuff to, like, push against it, but there's. People just have tendencies. Right.
So with no kind of intervention, with no awareness of the water metabolism, with no, you know, focused effort to, like, mitigate those constitutional factors, it's not impossible to imagine that the water problem reasserts itself and this patient ends up with headaches again in a year.
[00:32:51] Speaker D: Right?
[00:32:51] Speaker A: Right. But the difference now is that, firstly, she knows that she can come to you and handle it.
You can be the first person to see it this time instead of the eighth person to see it.
And the ability to shift the pattern back is probably the work of two or three weeks as opposed to four months. Someone comes in and, like, I've been having headaches a couple of times a week. Again, it's like, oh, no worries. Take this formula. Let's readjust this item. And then in two weeks, they're back to normal. They get another year.
[00:33:20] Speaker C: Yep.
[00:33:21] Speaker A: And in many ways, like, because we see this all the time, the way to. To talk to your patients about that. Right. Is like, hey, look, this is. This is handled. You're feeling great. You call me as soon as you have any issues with it.
[00:33:34] Speaker D: Right.
[00:33:34] Speaker A: Also, I want you to particularly pay attention in fall and spring.
[00:33:39] Speaker B: Yes.
[00:33:39] Speaker A: Because that is usually when the patterns get messed up. Right. Like, things are steady through, like, late spring, summer, early fall. And then, like, October, November in the Northern hemisphere, people are like, oh, something's weird. Like, fluids are getting weird. I'm, like, congested. I have a tight headache. I'm dry. And then the opposite in spring, right. Where like, early spring's fine. And then about, you know, mid, late March, early April, people are like, oh, man, the pollens and the allergies and, like, all of a sudden, those other extraneous factors, like, people associate it with the pollen. Right. But, like. And the pollen's a. A thing for sure. But we know that it's the yang emerging outward again. Right. So that yang bursting out from the surface messes with the equilibrium that was established over the winter. And similarly, its retreat and contraction in the fall messes with equilibrium established in the summer. So if there's a likelihood for reemergence, it's often in the pivot fall. In the pivot seasons. Yeah. And then people know that. So they're like, yeah, actually, you're right. My headaches were coming back in the fall. I gave you a call. Poof. We wrote you a formula. Back to normal, see you again in spring. I mean, realistically, if someone needed to check in with their doctor twice a year, take herbs for a week or two. Twice a year, that's on the far end, I would imagine. And if you do that regularly over a couple of seasons, you may not need to do it for several years.
[00:35:02] Speaker C: Yep.
[00:35:02] Speaker A: Right. Because, like, you're addressing the little stumble in the spring that would eventually turn into a limp, which would then eventually turn into, like, not being able to walk at all, which is my metaphor for how that progresses. But if you address the stumble in the beginning and now they're walking again in the summer, and then you address it again in the fall, maybe the following spring, you don't have to.
[00:35:22] Speaker B: Yeah, they don't. They don't have. We see that a lot with seasonal allergy treatment.
[00:35:26] Speaker D: Right.
[00:35:26] Speaker B: Like, you treat people for a couple of cycles, and then the next year they don't have allergies at all. Yeah, you know.
[00:35:32] Speaker A: Yeah, exactly. And if it starts to show up again, we know what to do in two or three years. Right. Like, the idea that a person would never fall sick again to something that we have treated is ludicrous. Right. People get sick. It's like the nature of being human. Like, you will get sick. The thing that I think is really important, I tell patients this all the time, is that from a Chinese cosmological point of view, a Chinese medicine point of view, never getting sick, like, nothing ever happens to you is also weird. Like, that's not. Something's off. Right.
[00:36:06] Speaker B: Like, it's not good actually.
[00:36:08] Speaker A: Like, maybe you're not actually paying attention to your experience. Like, and I don't mean, like, you don't get sick often. I just mean, like, people will tell me, like, I literally never get sick.
[00:36:17] Speaker B: Yeah.
[00:36:17] Speaker A: I never get sniffles, I never have a headache. I never. Nothing. That's probably not true. Firstly, like, you maybe just aren't paying attention that well. And even if it is true, that's odd from our point of view.
[00:36:28] Speaker C: Yep.
[00:36:28] Speaker A: The thing that I care about is, is when you get sick or you. You divert from feeling good, from feeling well, how long does it take you to get back to feeling well?
[00:36:40] Speaker B: Yes.
[00:36:41] Speaker A: Like that space between sick and well. Right. The return from sick to well, that is actually, in my mind, the measure of health. Right, right. And it's not just. I'm not just talking about cold and flu. You know, like, you're working in the yard and you're moving a bunch of wheelbarrows around and your back's a little tender. So firstly, you acknowledge that, hey, my back's a little tender. I'm not gonna lift concrete bags tomorrow. Also, and when you take off tomorrow doing just lighter work, more conscientious of your posture, by the third day, you're feeling normal again. Great.
[00:37:12] Speaker B: Yeah.
[00:37:12] Speaker A: Your back's in good health. It's fine. Like, you acknowledge the pressure. Nothing happened. But then, you know, by contrast, you have a little tender back. Maybe you still don't work again, but on the third day, it's still tender, and you turn in the kitchen and throws your back out and you're on the floor, you've got an underlying problem. Yeah, right. Like you should have been able to recover in that amount of time with rest and observing, you know, all that kind of stuff. So the space between health and illness is really the thing that matters to me. Like, how quickly can you get back?
[00:37:44] Speaker B: Responsiveness, right?
[00:37:45] Speaker A: Responsiveness. Yeah, exactly. Like how body. How does your body react? And so that's why the spring fall thing, I think is relevant. Right. Because it's like, okay, you might start to have headaches again, but, like, if we can give you the pattern of herbs real quick and you just snap right back into health, then perfect.
[00:38:00] Speaker D: Right?
[00:38:00] Speaker A: That's what we needed.
[00:38:01] Speaker B: Yeah.
[00:38:01] Speaker A: Cool.
Alrighty. Well, I think we gave some good insight here into some cases for folks to consider. So as always, everyone, thanks for listening to the Nervous Herbalist. We are always taking suggestions from our listeners. You can send those to info infoootandbranchpdx.com that's rootand branchpapadeltaxray.com and we'd love to hear from you. So let us know. Please remember to rate and review the show so other people can find us. And as always, my name is Travis Kern.
[00:38:31] Speaker B: And I'm Travis Cunningham.
[00:38:33] Speaker A: And we'll talk to you next time.
[00:38:34] Speaker B: See you next time.
