Show Notes
TK asks TC about his diagnostic tools for understanding the causes of headaches and which formulas he employs to resolve this common problem.
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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.
Hello, everybody, and welcome to the Nervous Herbalist. My name is Travis Kern.
[00:00:23] Speaker B: And I'm Travis Cunningham.
[00:00:24] Speaker A: And we are going to be talking to you today a little bit about headaches. And the thing about headaches, of course, is they are challenging, to say the least. In fact, there's an old adage, I think someone told me once that the doctor who treats headaches often gives himself a headache, which I think kind of really touches on the complexity of the different things that can cause headaches. So why don't we start the conversation with just kind of a general discussion of headaches as a pathology and maybe some of the patterns that go along with it.
[00:00:58] Speaker B: Yeah. So headaches are like many other things that deal with pain, where the pattern can be very simple. You can treat it with simple things and it can get better. And we can sort of run the risk if we have a few cases of headaches early on, thinking that headaches are easy to treat. It's a little bit like low back pain, actually. You know, like acupuncture. Oh, acupuncture is great at treating low back pain. Right. We treat low back pain all day, yada, yada, yada, until that one case comes in and all of the stuff we normally try doesn't work. Right. And then it's like, why doesn't it work? What do we do? There are cases of low back pain that come from a million different things in the body. Same thing with headaches. So it can be easy to treat, it can be extremely difficult to treat. And the key is always finding the cause. Right. Or the pattern that's related to it.
[00:02:04] Speaker A: So when you're thinking about the kinds of headaches that walk into the clinic, the ones that we've seen over the last couple of years, what kind of common patterns seem to emerge?
[00:02:15] Speaker B: Yeah. So there's a couple of different things with headaches. Right. People can get kind of regular headache after work, you know, like a strain headache or whatever. And those headaches, I think, respond really well to just simple acupuncture. Right. Like a lot of those things, we can do very simple techniques with acupuncture to basically open up the channels and get the person out of their head.
[00:02:44] Speaker A: Yeah.
[00:02:45] Speaker B: Help the neck tension to relax. The other thing that I like to keep in mind is it's always important to ask people about hydration with headaches. Right.
We have our friend. I don't know if you want to tell that story.
[00:03:01] Speaker A: Oh, yeah, we had a friend of ours who went to see an acupuncturist at OCOM at the college that we had gone to because he was having chronic headaches, his headaches. All the time. All the time.
[00:03:13] Speaker B: For years. For years he had prescription medication for headaches.
[00:03:17] Speaker A: And so the student was just doing the evaluation and tongue pulse, the usual stuff. And of course they did a treatment. But in the course of the conversation, they were asking this guy like, hey, so how much water are you drinking? And he's like, I don't know. I mean, I guess I drink enough water. And they're like, well, I think this might be like a dehydration type headache. Like, I think you might just be under hydrated. And he was like, I mean, you really think so? He's like, I mean, can't hurt to try. Right. Just go ahead and increase the water intake. And sure enough, as soon as he started drinking more water, literally his headaches went away.
[00:03:51] Speaker B: Yeah.
[00:03:51] Speaker A: And they've stayed away.
[00:03:52] Speaker B: Yeah.
[00:03:53] Speaker A: Because at its core it was a hydration problem.
[00:03:56] Speaker B: Right. And this guy had had prescription medication from the doctors that he had seen before. So clearly nobody had thought to ask him about how well he was hydrating or clearly distinct, you know, differentiate how much.
[00:04:10] Speaker A: Well, and I think it stood out because it's not like he had like dark yellow urination or like, you know, there weren't like signs of western diagnosis dehydration. Like, that wasn't the issue. It was just that given for his activity level, the way his headache presented, it just seemed like, I don't know, maybe let's just try, like, let's see if we can increase your hydration level. And. And it did. I mean, in some ways the analogy with low back pain is similar here. Right. It's like if someone comes in here with low back pain, we're definitely going to talk about their bed and their pillow.
[00:04:43] Speaker B: Sure.
[00:04:44] Speaker A: And their car and their desk. Like things that in and of themselves may not be causing the low back pain entirely, but they're certainly, if they're, if they're problematic, they're contributing to it.
[00:04:55] Speaker B: Right.
[00:04:55] Speaker A: Because of course, there are some people who could have had the same level of hydration as this friend of ours and wouldn't have had headaches even at the low level that he was at. But for whatever reason, in his case, it wasn't enough.
[00:05:08] Speaker B: Right.
[00:05:08] Speaker A: In the same way that some people can sleep in A mattress that's got a garbage support and they don't end up with low back pain, but other people do. So even though like it's maybe not the single cause it's always something that you want to investigate for sure. So how much water should people be drinking? I mean, that's the natural question.
[00:05:25] Speaker B: Yeah, I think.
Well, I don't, I don't know that I have a number of ounces. Do you have a number of ounces that you think about when you talk to patients?
[00:05:36] Speaker A: I mean, I, I do a fair amount of evaluation with what people are drinking already because, you know, technically, tea, juice, right. Coffee, milk, all of these things are hydrating.
[00:05:50] Speaker B: Sure.
[00:05:50] Speaker A: Right. But like when I talk to people about drinking like hydration, I'm talking about just water.
[00:05:55] Speaker B: Right.
[00:05:55] Speaker A: You know, especially because a lot of those other beverages are diuretic. So like you're going to be keying stuff out anyway. So I tell people 48 to 64 ounces. 64 ounces is my target.
[00:06:06] Speaker B: Yeah.
[00:06:06] Speaker A: So that's half a gallon, right? It's two quarts. So you're looking at about that amount of water. For a lot of people in offices and stuff, it's a lot of water.
[00:06:16] Speaker B: Yeah.
[00:06:16] Speaker A: Like it, it feels like quite a lot of water to quarts, but truly over the course of the day it may not be so usually I just have people do an actual analysis because most people don't have any idea how much water they drink.
[00:06:28] Speaker B: Right.
[00:06:29] Speaker A: And they'll be, this is my favorite thing. Hey, how much water do you think you're drinking? I don't know, like couple cups.
[00:06:35] Speaker B: Right.
[00:06:36] Speaker A: And I'm like, do you mean actual cups, like an eight ounce cup? Or you just mean like two vessels that hold water? You know, because it's, it's a little bit like asking people, like, how are your poops? Like you're going to get like, not a useful answer.
[00:06:49] Speaker B: Right.
[00:06:49] Speaker A: You really have to like drill it down. And what I tell people all the time about hydration is like, okay, here's the deal. Our target is this 48 to 64 ounce range. But you're probably not going to like be measuring out your water all the time because like, that seems maniacal and a little bit crazy. So instead, get yourself a water bottle that you like. Like it fits, feels good in your hand. It's the right shape for your car, for your bag. It has a mouthpiece that you like to drink out of and it has a lid and closer structure that makes sense to you, right? Like these are the things like small little things like how does the mouthpiece feel affect whether or not you're gonna make a difference.
[00:07:26] Speaker B: Yeah, for sure.
[00:07:27] Speaker A: So then you put water in that container and you measure it, like how much water goes in this container. And if it's a 24 ounce container, then you're like, well, I need to drink at least two of these, maybe three. And so that's, that's easy. Right. Like you fill it up in the morning. Okay. There's a whole one down, fill it up after lunch, there's a second one down. Right. And maybe you get a third one in, you know, before dinner or after dinner or something like that. Yeah. So I think it's easier to give people a fixed vessel, like drink two of those bottles or one of those bottles or five of those bottles, whatever it is, instead of making them like try to learn the math. Like there's 8 ounces in a cup, 16 ounces in a pint, 32 ounces in a quart. Like, who knows that? You know, so that's, that's my usual go to with the numbers.
[00:08:09] Speaker B: I think that makes sense. Yeah. I try to ask the patient, I try to get a sense of what they're actually drinking. And then I encourage them to do more if I think they need to. And then I'll use some of the same strategies, but I don't have like a number, I don't use a targeted number of ounces.
[00:08:29] Speaker A: Yeah. I mean, and also too like it can be challenging.
[00:08:32] Speaker B: Right.
[00:08:32] Speaker A: Because some people will be thirsty, some people won't be thirsty.
[00:08:35] Speaker B: Right.
[00:08:35] Speaker A: They will be thirsty, but then they drink water, they feel uncomfortable. Like there's, there's a lot of, there can be some boundaries, some barriers, right. To like getting people to drink water in the way that we want. But yeah, that's, that's usually the number that I go with.
[00:08:47] Speaker B: Yep.
[00:08:48] Speaker A: Okay. So the kind of sort of post work headache that you were talking about, maybe it's postural, maybe it's dehydration, maybe it's stress.
[00:08:57] Speaker B: Sure.
[00:08:58] Speaker A: So those, you know, we treat with acupuncture points that are primarily circulating points or.
[00:09:03] Speaker B: Yeah, anything that helps to open up the channels of the upper or the neck. Basically, if you can help the neck to open up, the headaches will. Should get better most in most cases. So that could be done from the feet, could be done from the stomach channel. It could be done from the channels on the arms. Right. Like the famous master dong points for headaches are. A lot of them are on the hands and the feet and the legs and stuff like that. So you can pretty much use anything. That's a valid strategy channel wise. If you can diagnose the channels that are involved. If you get those opening up, the headaches should get better for. Yeah. For those acute cases.
[00:09:47] Speaker A: Okay, so what about people who have chronic headaches? Maybe they have migraines.
[00:09:52] Speaker B: Yes.
[00:09:53] Speaker A: What do we. Basically, I guess the question I'm wondering, especially if I'm a new practitioner, is person comes in and says, oh, I've got headaches or I've got migraines or something that people often say, what is different about your questioning in that circumstance than someone who comes up with a different condition?
[00:10:11] Speaker B: So firstly, we want to see if it's the chief complaint. Right. It's really important to address the patient's chief complaint. So let's say they have headaches, but it's one of a constellation of things that they are dealing with and they actually care more about addressing their anxiety.
[00:10:27] Speaker A: Yeah.
[00:10:28] Speaker B: Or they're addressing their insomnia than they do about their headaches. So depending on how debilitating the headaches are, how high on the list it ranks, it makes a difference there. It doesn't make a difference in the differentiation, but it makes a difference for treatment targets and what we need to prioritize because the. If the patient's coming in for headaches and you help them with their digestion but their headaches don't improve, they're not going to be happy. Right? Right. Yeah.
[00:10:58] Speaker A: So, all right, so you got the patient, it's migraines. It is the chief complaint. They have to take medication for it.
[00:11:05] Speaker B: Yeah.
[00:11:06] Speaker A: And maybe it takes on a sort of classic migraine pattern, a sort of temple one sided throb with maybe a push from behind an eyeball.
What are the steps here to start to differentiate this headache?
[00:11:22] Speaker B: So it's good to try to understand where the headache is. You gave some of that information already, like location can be helpful, but it's also not the only thing we consider. Right. So the channels that are involved are not the only thing we consider with headaches. We still need to do full differentiation for what of the resources of the body could be involved. And we can kind of break those up in a few different ways. I prefer to think of them in the Japanese campo style of, of thinking, which is to break them up between chi, water and blood. Right. And. And any one of these resources that's in discord can involve headaches.
[00:12:06] Speaker A: Right.
[00:12:07] Speaker B: With some more likely being the case than others.
So chi, we're all familiar with Right. How can Chi stagnation create headaches? We all know about that. Right.
One of the things, though, that's. That's interesting about chi is in Campo, you look at the rib side area. That's where you palpate to understand the circulation of Qi. Right. And in the central location, the epigastric area, you're assessing for qi, that's moving through the middle or the central aspect of the body.
And if you go to the rib side, more peripheral, you're assessing. It's almost like a hologram for assessing the peripheral Qi circulation in the body.
[00:12:58] Speaker A: Okay.
[00:13:00] Speaker B: What's most likely to cause headaches is the peripheral Qi stagnation, as opposed to the central.
Not saying that the central one couldn't do that, but it's most likely a peripheral one.
So when you're palpating, this is just one of the tricks you can use. If you do any amount of palpation on the abdomen, it can really help to figure out, oh, I need to address the Qi just by palpating that section. And, ooh, that's uncomfortable for the patient. Or I can't even press in very much. It's so tight in there, I can't even press in. There's a whole bunch of anatomical connections between the diaphragm, rib side area, and the neck.
Even from a western anatomy point of view, the phrenic nerve goes through this whole area and connects into, I think it's C. C3 to C5 or something. So you can have a neck pain that has nothing to do with the neck. It's actually the diaphragm or the organs involved in the rib side. Could be a liver, gallbladder, could be the spleen, pancreas, could be the stomach. That can all reflect into the neck and then eventually create a headache.
So this is why it's good to assess these things first. If you don't have objective diagnostic skills, it's harder to figure this out. You have to ask more specific questions. But I think the objective diagnostic skills for headaches are actually pretty easy to talk about. So maybe that's a good place to start.
[00:14:34] Speaker A: Yeah. Walk us through.
[00:14:35] Speaker B: So we talked about QI for the abdomen.
Water and blood are a little harder to differentiate, but they both tend to present with what we call pulsations.
So pulsations are, imagine the ren line or the CV line, from the zipe sternal joint all the way down to the umbilicus. And a little bit below and to the sides, you have the abdominal aorta running through that area.
So part of the fukushin or the compo assessment is to very gently, with just a little bit of pressure, palpate that area and look for, if you can, feel the abdominal aortic pulsations, and if you can, if you can feel it at that light pressure. That's a pathological finding. And what it shows universally is that there's some kind of counterflow that's taking place. It doesn't tell you whether it's from the blood or the water or the qi, but it says that there's counterflow.
Now, to figure out if it's water, blood, qi combination, you have to look at the other findings to figure that out.
[00:15:43] Speaker A: Right.
[00:15:45] Speaker B: So you can tap the stomach for the splash sound, where you pull the skin taut and you tap the stomach, and then you listen for a splash sound. Right. That can tell you that water's involved. You can also ask them questions to differentiate if water is involved, namely if thirst is abnormal, so the person's very thirsty or they're not thirsty at all. Both are worth noting. To address water, if there's any difficulty with urination, meaning it could be urgent, it could be inhibited, meaning it's hard to fully go. It could also be discomfort. There could be discomfort involved in the process of urination.
[00:16:28] Speaker A: So all of those things are water signs.
[00:16:31] Speaker B: They're water signs. Exactly. Something is going on with water.
And the other thing that can be a water sign or a chi sign is dizziness.
So dizziness can occur with either Qi stagnation or a water counterflow type of problem. And the reason for that is when the water, let's say water is excess or it accumulates, the body isn't transforming water. Well, the water accumulates in the lower burner and then presses on the abdominal aorta, sending a counterflow up that can easily create a headache or the predilection for headaches over time. And it can just be, like, as simple as a Wuling san pattern or a Lingui jugan tong pattern. And if you just give those formulas, it can help with the headaches.
[00:17:20] Speaker A: Okay. You're on the abdomen. You go to feel into rib side, and you find tenderness or extremely firm, like it's hard to get in there. Yep. Right. And so that's indicating qi.
[00:17:33] Speaker B: Yes.
[00:17:34] Speaker A: As the problem.
[00:17:34] Speaker B: Yep.
[00:17:35] Speaker A: So then for the water side, so let's say we go to reach out. There's nothing there.
[00:17:39] Speaker B: Right.
[00:17:39] Speaker A: It feels normal. Yep. It's pliable.
[00:17:41] Speaker B: Great.
[00:17:42] Speaker A: So now we palpate the midline, the RIN line.
[00:17:45] Speaker B: Yep.
[00:17:46] Speaker A: Looking for abdominal aortic pulsation.
[00:17:49] Speaker B: Yep.
[00:17:50] Speaker A: And that's relatively soft pressure. Right? Like you're not going deep.
[00:17:54] Speaker B: No, it's light. Light pressure.
[00:17:56] Speaker A: Yep. All right, so maybe you feel it, maybe you don't. But you go to do splash sound, so you sort of hold the skin taut and percuss the abdomen, and there's a little bit splash sound. But maybe you're new at this. It's hard to really hear it because sometimes that's a challenging one.
So you're unsure about the water diagnosis, so you ask the questions, and it turns out that the patient is pretty thirsty.
They drink a lot of water because they feel like they need to, but they can feel sloshy.
[00:18:25] Speaker B: Yes.
[00:18:26] Speaker A: When they drink the water. So now. Okay, we got pretty good indications for water.
[00:18:30] Speaker B: Yeah.
[00:18:30] Speaker A: What about the blood indicators?
[00:18:33] Speaker B: The blood indicators are.
They're a little bit more so on the surface. We can assess blood in a few ways. Firstly, is the person sleeping? Well, blood circulation at the surface level has a lot to do with sleep.
And if the person isn't sleeping well, then we could think that there's a blood thing, especially if there's a sweating issue that's connected to it. So let's say they have night sweating. Right. Vivid dreams, difficult time, either falling asleep or staying asleep. To me, it doesn't matter that much. If there's some trouble, it's possible that the blood is involved. The other thing that could be the case is the purse. The person could have just regular sweating spontaneously. Right. We hear this idea of spontaneous sweating. I tend to think that the way that shows up in the clinic mostly is when people are nervous. They sweat because they're nervous, they sweat because they get anxious.
And I think about that as like a ying way disharmony type of thing, which I. I categorize as a blood type of problem on the surface. Yingway disharmony.
[00:19:42] Speaker A: Yeah.
[00:19:42] Speaker B: So that could mean that they need a Guager formula. Right. If it's a night sweating type of problem with sleep, then it may need. It may mean that they need guijer gansao long gumuli type of treatment strategy. And that will also help to anchor the yang back into the blood. Right. That's kind of what that's doing. So that the yang isn't rising up and potentially causing a headache.
[00:20:08] Speaker A: So is there a simple abdominal piece for the blood?
[00:20:13] Speaker B: The blood is so in the. In the upper, sort of the upper section, which is above the umbilicus. The best assessment for blood is the abdominal aorta. So that's the. That's the thing we're going to look for mostly for that. And then as a question, follow up to answer questions. We're going to be thinking about is there a sweating problem? Right. So we ask them about sweating. If their sweating is mostly normal, maybe not if they're having trouble sleeping, that's the next thing we go to to assess the quality of blood. And if there's no problem sleeping, it's probably not a blood problem.
[00:20:47] Speaker A: Gotcha.
[00:20:48] Speaker B: Yeah.
[00:20:48] Speaker A: Even if there was abdominal pulsation.
[00:20:52] Speaker B: Even if there was abdominal pulsation, because that can occur from water. Right. It can even occur a little bit from qi, but the pulsations are usually a little different. They're higher up, so they're more epigastric and they don't go down as far toward the umbilicus in that case.
[00:21:09] Speaker A: Right? Yeah. Okay.
So rip side for qi, the thirst, difficult urination, water splash sound for water. Abdominal pulsation is water or blood.
[00:21:24] Speaker B: Right.
[00:21:25] Speaker A: But usually a good indicator for blood is a good starter. And then follow up questions. If you've got abdominal pulsation to distinguish if it's water or blood, the blood questions are going to be sleep.
[00:21:37] Speaker B: Yep.
[00:21:38] Speaker A: Sweat.
[00:21:39] Speaker B: Yep.
[00:21:39] Speaker A: And the water questions are thirst and urination.
[00:21:42] Speaker B: Right. Thirst and urination. And dizziness is a good one, is a good follow up too. Or tinnitus. But that can also occur in qi or water. Right. So you can have tinnitus, you can have ringing in the ears.
[00:21:54] Speaker A: Sure.
[00:21:54] Speaker B: From either either of those pictures.
[00:21:57] Speaker A: So in your experience, how often is a headache pattern just one of those three things or are they usually combined?
[00:22:05] Speaker B: It's usually combined, but it can be one.
The most common version of it being only one is if it's a water pattern.
So wuling San patterns can manifest as headaches, a lot like chronic headaches. And you can just give wuling san if it's that pattern. There's high thirst, the urination is difficult or abnormal in some way. The person tends toward dizziness, they have headaches. If wuling San, that takes care of it. So it's possible for that to be the case. If it's a mixed pattern, then it tends to be Qi water, maybe blood as well. It could be all three.
And that's again very clear to see if you do some of the objective findings if you lean on those diagnostically, the tongue I think will show water and blood the easiest, Right?
[00:23:03] Speaker A: Yeah. Substantive things.
[00:23:04] Speaker B: Substantive things. Qi is a little harder to see on the tongue. So if you're used to tongue diagnosis.
[00:23:09] Speaker A: I think it's like impossible to see on the tongue.
[00:23:11] Speaker B: Yeah. I don't. I mean, I don't. I don't rely on the tongue for Qi diagnosis. Yeah.
[00:23:16] Speaker A: I just don't think it's useful there.
[00:23:17] Speaker B: Yeah.
[00:23:18] Speaker A: Because qi is too ephemeral.
[00:23:19] Speaker B: Too ephemeral. Yeah.
[00:23:20] Speaker A: And it changes too much when, like, tongues take on the shape of substantive component. Like, a tongue is a really yin.
[00:23:28] Speaker B: Yes.
[00:23:28] Speaker A: Thing. It's wet and fleshy.
[00:23:30] Speaker B: It's substantive, very material form of diagnosis.
[00:23:34] Speaker A: And it. And it gives great indications for water problems.
[00:23:37] Speaker B: You know, it does.
[00:23:37] Speaker A: Like, you've got scalloped tongue, you've got puffy tongue. That's great. And it'll also really give you great information about kind of what the state, like the base level of the body is and has been for some time.
[00:23:51] Speaker B: Right.
[00:23:51] Speaker A: You know, so I think it's great for constitutional diagnosis, for example, just sort of like what the tendencies are of a person. But. Yeah, for qi.
[00:23:58] Speaker B: Yeah.
[00:23:59] Speaker A: Not very useful.
[00:24:01] Speaker B: Yeah. Questions for. We should go over questions you can confirm for Qi. Right?
[00:24:06] Speaker A: Yeah.
[00:24:06] Speaker B: Would be.
I follow the Shanghan Lun diagnosis. The. The most. So the T gong lines for Xiaoyang disease, which would be the Qi problem in the. In the upper channels would be a strange or bitter taste in the mouth, a dry sore or stuck feeling in the throat, and then dizziness. It literally says dizzy vision. So it could be visual changes, which some people will have with. With migraines or headaches, auras.
Or it could be the person feels dizzy, like they just don't feel, you know, stationary in their orientation. Right, right. Or balance.
[00:24:52] Speaker A: So the combination of rib side indication plus any of those questions confirmed. Yeah, strong indication.
[00:24:58] Speaker B: Strong indication for qi. And then there's also alternating hot and cold. Right. You can look at classic Xiaoyang. Classic Xiaoyang. Any of the classic Xiaoyang. Other symptoms can. Can help to define the chi stagnation.
[00:25:12] Speaker A: So I'm guessing then that the. The formula for the Qi problem is good old xiaochaihutang.
[00:25:19] Speaker B: Yeah. Xiaochaiutong is going to be our base formula for a lot of the chi findings.
[00:25:24] Speaker A: Okay. So xiaochaiutang is the base for Qi. The base for the water then is wulingsan.
[00:25:30] Speaker B: It could be Wulingsan if there's stronger thirst, Lingui Jugan Tang if there's not as strong thirst, if thirst is low or normal.
And if you take water to the other side, which is a lack of water or dryness, that could look like the muscles are hard and dry. So we actually need to moisten. We need to put some good stuff in the body and moisten the Muscles. You can think about it that way. And our key formula for that is going to be Guggentong or Guizhu Jiao. Guentang is kind of our key muscle layer, relaxing, moistening, circulating formula for. For these kinds of things.
[00:26:11] Speaker A: So if strong thirst and essentially like Wuling San and Li Wei Jugantong are falling in a sort of excess water problem.
[00:26:21] Speaker B: Yeah.
[00:26:22] Speaker A: And then the Guizhu Jakugentang on a sort of deficiency.
[00:26:25] Speaker B: Deficiency problem. Yeah, the deficiency water. Yeah, for sure.
[00:26:29] Speaker A: So on the excess water side, Wuling San for strong thirst.
[00:26:32] Speaker B: Right.
[00:26:33] Speaker A: Lingua Jugantong for normal or low thirst.
[00:26:35] Speaker B: Yep.
[00:26:36] Speaker A: And then if you've got tight, hard muscles, crunchy muscles, maybe dry stool and muscle spasms.
[00:26:45] Speaker B: The spasming is much more common in a dry pattern than a wet pattern, although it could occur in a wet pattern too, but it's much more common in a dry pattern.
[00:26:54] Speaker A: And so in that case, you're looking at Guizhu Jia Keganton.
[00:26:57] Speaker B: Right. Because we also have Bai Xiao. We also have Xiao Yao Gansao Tong in there. Right?
[00:27:00] Speaker A: Sure. Yeah. Okay, so then on the blood side, what's the lead formula there?
[00:27:06] Speaker B: Guizhu Tong.
[00:27:06] Speaker A: Guizhou Tong. Yep. And then. All right, so Xiaochaiotong for Qi Wuling Sun Lingue, Jugan Tong, maybe Guijer Jia Gogan Tong in the water category. And on the blood side, Guizhu Tong.
[00:27:19] Speaker B: Right.
[00:27:20] Speaker A: So why is it that the water ones seem more complicated in terms of formula choice? Right from the beginning?
[00:27:27] Speaker B: I think the water patterns are confusing because you often see too much water in one place and not enough in another place. So in Wuling San, you have strong thirst. Right. Which you would think is a dryness finding. Right, Right. But you also have. And you can also have a fever or the feeling of heat in Wuling San. That's very clear.
But then you also have this problem with processing fluids. Essentially. You have too many fluids in the body.
People can have inhibited urination where there's clearly a problem, or it can just be like they never pee. Like, they pee four times a day or three times a day or something like that. Right.
And they're thirsty. They're drinking water all day long, but they're just not peeing. So then it's like, where's the water going? What's happening? Yeah, right.
[00:28:25] Speaker A: Yeah, yeah, yeah. That's an interesting. I've always thought it was fascinating that you end up with someone who's crazy thirsty.
[00:28:33] Speaker B: Yeah.
[00:28:34] Speaker A: With like a tacky, dry mouth, and then they stick out their tongue and it's swollen and covered in tooth marks.
[00:28:39] Speaker B: Yeah, right, right.
[00:28:40] Speaker A: Because. And maybe they're, like, a little bit fleshy, their. Their tissues a little bit wet.
[00:28:46] Speaker B: Super common.
[00:28:47] Speaker A: Yeah. Tendency toward, like, congestion and like, phlegm accumulation. Like, they're wet, you know, wet, like itchy skin, dermatological problems. Like there's. There's wetness all over the place, and yet crazy thirsty, dry mouth. And they don't pee that much even though they're drinking water all the time.
[00:29:06] Speaker B: Absolutely.
[00:29:06] Speaker A: That is such a fascinating pattern. It's one of the things that I think can mislead new people. Right. If you're not listening closely to sort of how easy it is for wet patterns to present with.
[00:29:17] Speaker B: Yep.
[00:29:17] Speaker A: Dry mouth.
[00:29:18] Speaker B: Yes.
[00:29:19] Speaker A: Yeah. Okay. So obviously you're, you know, in the model that we've been talking about on this show for a while, you would start with any of those formulas. Unmodified.
[00:29:29] Speaker B: Yeah, unmodified.
[00:29:31] Speaker A: Just give it direct.
[00:29:32] Speaker B: Yep.
[00:29:32] Speaker A: See how it goes. If you're doing it in granules, what are we doing? 16 grams a day? Yeah, yeah, yeah. And then what kind of. What kind of turnaround time? I mean, like, if you pick the right one, I guess. Actually, let's back up. You've picked one.
[00:29:46] Speaker B: Right.
[00:29:46] Speaker A: You don't know if it's the right one.
[00:29:47] Speaker B: Sure.
[00:29:48] Speaker A: How much time do you give yourself before you make a pivot?
[00:29:51] Speaker B: A week.
[00:29:52] Speaker A: A week?
[00:29:52] Speaker B: There should. If it's. It depends on the frequency. Right. If somebody's coming in and they're having like two migraines a month, then a week isn't long enough.
[00:30:01] Speaker A: Right? Yeah. Because you just won't know.
[00:30:02] Speaker B: Because you won't know. But if it's multiple times a week, you'll know in the first week or at least the second week. If you're on the right track, there will be definitive improvement in that time.
[00:30:15] Speaker A: Yeah. And if it's not, Then go back to your diagnosis.
[00:30:19] Speaker B: Yeah. Then go back to the diagnosis. Look at something else. Yep.
[00:30:23] Speaker A: Okay. So that's if there's straight patterns. Right?
[00:30:25] Speaker B: Yeah.
[00:30:25] Speaker A: Okay. But almost no one's a straight pattern.
[00:30:27] Speaker B: Right.
[00:30:28] Speaker A: So what happens when you've got a combined water problem, Cheese stack problem? No. Yeah. Like, how do you do you just take Shao Chaitong and mix it with wiling sound.
[00:30:37] Speaker B: Yep. You can do numbers. You can.
[00:30:40] Speaker A: No changes.
[00:30:40] Speaker B: You can absolutely do that. If it's Shao Chayutong Wuling san, it's going to be.
Yeah. You're going to find costal discomfort or tightness. You could find those pulsations and you're going to hear a splash sound in the abdomen. You're also probably going to see a puffy tongue, maybe tooth marked.
So you're going to see that there. You're probably going to see more superficial pulses as well. Though if water is involved, the pulses could be a little deeper.
[00:31:13] Speaker A: Right.
[00:31:14] Speaker B: Because you know, dampness or water pathology can suppress the circulation. So the pulses could be deeper, but they're probably going to be superficial.
That's most of the, that's most of the cases that I've seen. So you could just do Xiao Chaiutong plus Wulingsan. You could do Xiao Qiutong plus Lingue Jugan Tong.
That's fine.
[00:31:37] Speaker A: Yeah, yeah. So it's just a straight combo.
[00:31:39] Speaker B: Just a straight combo.
[00:31:40] Speaker A: You don't need to like overthink it.
[00:31:41] Speaker B: No, you don't need to overthink it.
[00:31:43] Speaker A: All right. So when we do that here, usually we're gonna mix the pre formulated granule.
[00:31:50] Speaker B: Sure. So.
[00:31:50] Speaker A: So when we do that to mix preformulated granules together, because of the way our software works. Right. We can just tell the software, okay. We want the person to take 8 grams twice a day.
[00:32:01] Speaker B: Yep.
[00:32:02] Speaker A: And then I'm gonna type in Xiao Chaiutong, it's gonna load the pre formulated granule. And then the quantity that I'm gonna enter is just the sum of all of the individual ingredients.
[00:32:13] Speaker B: Right.
[00:32:13] Speaker A: Which I think for Wuling San is like. Or sorry for Xiao Caiutang is like 48 grams.
[00:32:18] Speaker B: It's like 82 or something like that.
[00:32:21] Speaker A: Oh, because Chai, who's big.
[00:32:22] Speaker B: Yeah, Chai who's big.
[00:32:23] Speaker A: Maybe it's wooling sounds 40.
[00:32:25] Speaker B: Yeah, it's like 42 or 48 or something.
[00:32:27] Speaker A: So basically you go into the Bensky and you just add up your. The grams.
[00:32:33] Speaker B: Right.
[00:32:34] Speaker A: Of all of the ingredients in Wuling San and all of the ingredients in Shao Chaotang. You Type Shao Chaotang 80 something, whatever the total math is. And then you type in Wuling San and you put 42 or 48, whatever the total math is.
[00:32:46] Speaker B: Yep.
[00:32:46] Speaker A: And so that in that way the software will know the relative proportions of Xiao Cayutang to Wulingsan because you're using the total numbers of all the ingredients.
[00:32:57] Speaker B: Right.
[00:32:58] Speaker A: What happens though if you're writing it from singles, as a lot of people are writing singles, and you're combining formulas where there's ingredient overlap.
[00:33:08] Speaker B: Yeah.
[00:33:08] Speaker A: Do you just add the two together from the two?
[00:33:11] Speaker B: Yeah, I pick. No, I don't add it. I pick the higher number. So let's see what's a good example for that.
[00:33:21] Speaker A: Well, so like if you combined well, Wuling San and Guijer Song.
[00:33:27] Speaker B: Yeah.
Yeah. I would just do nine. Wager.
[00:33:31] Speaker A: Yes.
[00:33:33] Speaker B: The higher wager. Right. Wuling San wager six. Wagertong wagers nine. So I would just pick nine. I wouldn't do like nine plus six.
[00:33:41] Speaker A: Right.
[00:33:41] Speaker B: In that case. Yeah.
[00:33:42] Speaker A: Okay, so if you're writing from whole formula granules, our recommendation is to add up the totals and use those ratios to each other. If you're doing it in singles, you're going to line up all the ingredients where you have crossover between the ingredients. You're going to pick the one that has the higher dosage.
[00:33:59] Speaker B: Yep.
[00:33:59] Speaker A: And then that'll be the combined version of the formula.
[00:34:02] Speaker B: Yep.
[00:34:02] Speaker A: Yeah. And then we're recommending 8 grams twice a day, 16 grams.
Depending on the person's obviously constitution and needs and severity. It could be higher or lower. Right. But it's probably, you know, TC and I, we don't really dose low.
[00:34:20] Speaker B: No.
[00:34:20] Speaker A: Anymore.
[00:34:21] Speaker B: Yeah.
[00:34:21] Speaker A: Just because, I mean, okay, maybe I have like literally a patient or two who are aged and sensitive and so maybe those folks are getting five or six grams twice a day. But it's pretty rare.
[00:34:34] Speaker B: Yeah, I agree.
[00:34:36] Speaker A: So make sure if you're using granules that you're dosing appropriately. Um, what are your thoughts on. On using the sod method for this for headache?
[00:34:43] Speaker B: I think it could work great. Yeah, I don't have as much. I haven't tried it as much. Cause we're, you know, we're just kind of getting into using that more for things. But I think it could work great.
[00:34:54] Speaker A: Yeah.
[00:34:55] Speaker B: Especially because like wooling san is a san originally.
[00:34:58] Speaker A: Yeah.
[00:34:58] Speaker B: It started so.
[00:34:59] Speaker A: Yeah, for sure. Yeah. I think there's a lot of, there's a lot of potential there with sans and we continue to experiment with methodology and the eth and the best process for it.
And as it's emerging right now, we really like the short boil of Assan.
[00:35:14] Speaker B: Yes.
[00:35:15] Speaker A: Versus a soak.
I'm not exactly sure why there's something about like the soak works well for a lot of stuff, but there's just something about the short boil of the powder that seems to agitate and extract in a way that's different than the long soak. It definitely seems to be the case for any herbs that have any more yin stuff to them as opposed to like chi kind of flavor based stuff.
It seems it's harder to get that stuff out in a soak than it is in a boil.
[00:35:48] Speaker B: Yeah.
[00:35:49] Speaker A: But anyway, more to come as we discover more on that particular subject.
[00:35:52] Speaker B: Yeah.
[00:35:53] Speaker A: All right. Any other sort of parting diagnostic wisdom on headaches here?
[00:35:58] Speaker B: I think those are the main things. There's. There's also the other thing to consider for headaches for me is this old category of disease called Benton, or Running Piglet disease, which is in the Jingle Yao. Right. And this describes this disease or this problem that people have where there's a feeling that starts in the abdomen and then it rushes up to the chest and maybe the head. And so I think that description could fall into a number of disease categories in modern language. One of them being, let's say, a panic attack. Right. Or anxiety in general, but also could be headaches. So the formulas that exist in that chapter, there's not that many, but those formulas all display a slightly different pattern, and the patterns for those formulas can be useful in treating headaches. So I also consider the usage of those formulas. I can go over those real quick if you think it'd be a good idea or.
[00:37:06] Speaker A: Yeah, give us a little rundown so that some folks have an idea of what you're talking about.
[00:37:11] Speaker B: So the.
The formula Ben Tun Tong, which is literally Running Piglet disease, is a formula that's complex. You guys should look it up. It's got quite a few ingredients, and it's interesting because it sort of combines a Huang Qin method, which we think of being related to Xiaoyang disease in the shanghanlen, but it also has Dongui and Quanzhong, which we think of being related more to Dre in or blood. So it kind of combines those two methods together. And it also says in the lines that the person is alternating between hot and cold, which is another line. Right. That we think of related to Xiaoyang disease.
[00:37:52] Speaker A: Right.
[00:37:52] Speaker B: But it's sort of a way to treat the Qi and treat the blood at the same time with a counterflow picture. And it also has a higher dose of Gaugen. So that's in the formula, too. Very interesting.
We also have Guijer Jia Guitang, which is just the formula Guizhe Tong, with almost a double dose of Guijer. So. So if we're using nine, most of the time, we up it to about 15. It's kind of like an extra 2/3 of the original dosage.
[00:38:25] Speaker A: Yeah.
[00:38:26] Speaker B: And that's for a more, let's say, a Yang deficiency picture. But Yang is coming out of the blood, and we need. We still need moistening herbs to build the blood in there. So we still have Baisha, we still have Gansao Dad Sao, et cetera. Right. But we really want more guager to strengthen the yang so that it can go down. Right. Because strong yang descends, weak yang floats.
[00:38:50] Speaker A: Right.
[00:38:51] Speaker B: So that's the second pattern. And then the third pattern is a formula called lingue sao zao tong, which is a fantastic formula. It's four ingredients. It's super simple.
It's fu, ling, guizhi, dazao, jurgon, sao. So super simple. But the key is the dosage of fooling and guager. Fooling is the highest we see, it's 24 and guager, I think it's originally like 12. But what I found, and I didn't invent this, I saw people do this, is that if you bump the dose of guager considerably higher, it works way better. Like it's, it's a much more effective formula. Um, and I will go, so I start my wager dosage with that formula at 18 and I go then up to 30 and I'll even go up to 60 relative to the other ingredients. So the formula ends up being like mostly guager.
[00:39:49] Speaker A: Right.
[00:39:49] Speaker B: And it's really, really powerful. That formula pattern is water overtaking fire. So it's a five phase differentiation where essentially the water, the yang is too weak to control water.
So the water accumulates and it forces the yang up in the head as it starts to build. So the person feels anxious, they often have heart palpitations and then they have yang ming channel symptoms, which is kind of weird. They have tend to have jaw pain, they have headaches, they can even have pressure in the eyes. And it's this forcing of the yang up because the water is accumulating around the heart and it works really well. If you find that pattern and you give the formula, it's one of those magic formulas that it works right away. Like in a day or two, the person's going to have a different experience.
[00:40:50] Speaker A: So the parameters of that pattern are a headache type that is like pressure behind the eyes.
[00:40:59] Speaker B: Could be pressure behind the eyes, could be jaw tension.
[00:41:02] Speaker A: Jaw tension.
[00:41:03] Speaker B: It could be palpitations. And notably it's a headache that get. That gets worse as the day goes on. So especially after noon, the day goes on. Yang is in decline after noon. Right. Noon is kind of the high point of yang. So then as the day goes on, the headache gets worse.
That's very distinct with that pattern.
[00:41:25] Speaker A: So then the final number is. So starting. Starting numbers. Yeah, 24. Fuling.
[00:41:31] Speaker B: Yep.
[00:41:31] Speaker A: 18. Guager.
[00:41:32] Speaker B: Yep.
[00:41:33] Speaker A: How much?
[00:41:33] Speaker B: Datsao Dazao is 12.
[00:41:35] Speaker A: 12.
[00:41:35] Speaker B: And then Gansao Gansao's regular. So 6.
[00:41:38] Speaker A: Just regular Gansao, not jargon sao.
[00:41:40] Speaker B: You can. I think I use Jergan Sao usually, actually. Yep.
[00:41:43] Speaker A: So six Jergan Sao, 12 Datsao, 18 Guager, 24 Fuling.
[00:41:48] Speaker B: 24 Fuling. And don't be afraid to go up on the wager.
[00:41:52] Speaker A: What indicates if you need to go on the glitter?
[00:41:55] Speaker B: So if they get good results with.
[00:41:57] Speaker A: It, I go higher. Yeah.
[00:41:59] Speaker B: Basically I test the water to see if it's helpful and then pump it. Like I go higher. Same thing with, like futsa dosage. For me, if I give a futsa dosage at a lower dose and they get, they. They're starting to feel better. I'm going to up the dose the next time by an incremental number. In Futza, it's usually 15, but it could be 30. Could be as much as 30, depending on the situation.
[00:42:25] Speaker A: Yeah, those are definitely some. Some additional formulas to put into the mix, I think, you know, if you're just starting out, you know, consider the, the three sort of compost style formulas that we mentioned.
[00:42:37] Speaker B: Yeah.
[00:42:37] Speaker A: That are connected to the abdomen.
[00:42:39] Speaker B: Right.
[00:42:39] Speaker A: But if you're looking for something a little bit more advanced or the picture.
[00:42:42] Speaker B: Seems or it doesn't work, you try treatment and it's not helping.
[00:42:46] Speaker A: Yeah.
[00:42:47] Speaker B: And by the way, those three formulas will also have patterns on the abdomen as well that we can talk about.
[00:42:55] Speaker A: Yeah, I think probably for the moment, let's leave it. Let's leave the simple pieces. Right. For folks to look at and then consider these other formulas for your reflection. Because ultimately, like, the ability to use the abdomen to make this distinction is frankly part of continuing ed. Right. It's more than the scope of what we can. I mean, we can describe some of it to you, but at some point you gotta get on some abdomens, you gotta read some books, gotta go to some classes to be able to like, figure out if that. If that's really the case, you know? But I think that that spread of formulas would be sufficient to. To start.
[00:43:33] Speaker B: Right.
[00:43:33] Speaker A: And kind of see where to go from there.
[00:43:35] Speaker B: Yep.
[00:43:35] Speaker A: Cool. For sure. All right, well, I think let's go ahead and call it there on the diagnosis patterns. We'll be back with another episode looking at some case studies on headaches. And then that way you'll have an idea of kind of how to work through different presentations of headaches in the clinic.
As always, thanks for listening to us. You can rate and review us wherever you listen to your podcasts. And of course, if you have any suggestions for the show, go ahead and email to them to us at infoootand branchpapadeltaxray.com it's all spelled out rootandranchpdx.com and we'd love to hear your suggestions. And so, until next time, my name is Travis Kern.
[00:44:14] Speaker B: And I'm Travis Cunningham.
[00:44:15] Speaker A: We'll talk to you soon.
[00:44:16] Speaker B: See you soon.
