Treating the Middle Pt 1 - "Lower" Middle Jiao Problems

[00:00:02] Speaker A: Hi, everyone, and welcome to the Nervous Herbalist, a podcast for chinese medicine practitioners who like herbs and want to learn more about their function, their history, and treatment strategies to use in the clinic. Let's get into it. [00:00:18] Speaker B: All right, welcome back, everybody, to another. [00:00:21] Speaker A: Episode of the nervous Herbalist. Today we got some new stuff for you. And I am Travis Kern, joined, as always, with my co co host, Travis Cunningham. And we're going to talk to you guys today a little bit about the middle jow. [00:00:35] Speaker C: Do you want to get started, man, with a little bit of physiology of the middle jow review? Just, like, how things work helpfully. [00:00:44] Speaker A: Yeah. So the reason that I wanted to talk about this in particular is because the, you know, problems of the middle jow fundamentally stem from what we eat. [00:00:57] Speaker B: And how those things are processed in the body, right? [00:00:59] Speaker A: And so, of course, everyone's first thought is like, oh, well, we need to know what the patient's eating, what's their diet like, and, you know, we live in a world now, you know, as one of our teachers would say, that it's sort of, you know, everyone has a kind of morbidity around their existence, right? They're like, the food is full of poison and there's chemicals. [00:01:19] Speaker B: I literally had a patient this morning who was lamenting all the poison in. [00:01:24] Speaker A: Her food, and I was like, what are you talking about? She's like, oh, well, you know, just these chemicals and these things. And I don't mean to make light of the fact that, like, what is in our food matters, right? [00:01:33] Speaker B: Because it definitely matters. [00:01:34] Speaker A: But also, I think when people have. [00:01:37] Speaker B: Digestive problems, the very first thing that. [00:01:39] Speaker A: They'Re going to is a food analysis. [00:01:42] Speaker B: Which is good, but then it gets. [00:01:44] Speaker A: Deep into, like, well, what are the allergens in here? [00:01:47] Speaker B: Do I have a test? Is there yellow number five? [00:01:50] Speaker A: You know, it was made in a factory, whatever. I think people get a little bit maniacal about it, a little myopic, really sort of focused in about it. And the irony is that while on. [00:02:02] Speaker B: One hand, what you eat is a. [00:02:04] Speaker A: Huge component of having positive middle job. [00:02:06] Speaker B: Outcomes, the other thing that matters a. [00:02:08] Speaker A: Lot is the analytical, intellectual work that is supported by spleen cheat. This is something people forget about, right? [00:02:16] Speaker B: Digestion is not just the physical act. [00:02:20] Speaker A: Of turning food into qi, right? [00:02:24] Speaker B: It is physical and also intellectual, metaphorical. [00:02:27] Speaker A: Like when you read an article and you analyze it and think about it, that's splinchy, right? When you're intellectually involved in analysis or discussion, splenchy. [00:02:36] Speaker B: So if you first immediately go to your diet and say, hey, I need to analyze the hell out of this diet. [00:02:43] Speaker A: Ironically, you are utilizing the very depleted qi to do the analysis. [00:02:48] Speaker B: Indeed. [00:02:49] Speaker D: Right. [00:02:50] Speaker A: So middle jal, like, in a perfect world, right, human beings are, you know, more balanced, right. [00:02:59] Speaker B: Obviously, in all the ways that that means. [00:03:01] Speaker D: Right. [00:03:01] Speaker B: But as modern people, many, many of. [00:03:04] Speaker A: Us are, instead of using our physical bodies to generate our livelihood, we use our minds, we use our intellects. We essentially rent out our cognitive spleen function in order to make ends meet. Even people who don't necessarily work in. [00:03:20] Speaker B: White collar operations also are still thinking, processing, customer servicing, front facing. [00:03:26] Speaker A: I mean, you're not planting corn. You know what I mean? It's a different kind of effect. [00:03:31] Speaker B: And of course, we notice in occupations and pastimes that utilize a lot of. [00:03:37] Speaker A: Intellectual energy, we see a lot of depletion to the middle jaw. [00:03:41] Speaker B: And the reason is because in a perfect world, we would spend physical time moving our muscles and our body out in space. [00:03:49] Speaker A: Let's all remember that muscle tissue is also the purview of the earth element. [00:03:54] Speaker D: Right. [00:03:54] Speaker A: The middle jazz element. [00:03:56] Speaker B: And so you'd be out in the world moving physically, and then the food. [00:04:00] Speaker A: That you would be eating would be cooked by you or someone else probably. [00:04:05] Speaker B: Grown close to wherever you live. [00:04:07] Speaker D: Right. [00:04:08] Speaker B: Would be in season. [00:04:09] Speaker D: Right. [00:04:10] Speaker B: And then you would eat that food. [00:04:12] Speaker A: And frankly, not have to think that much about it. Right. You wouldn't have to be like, is this organic? [00:04:16] Speaker B: Was it grass fed? Did this come from a local farm? Like, these are not part of the. [00:04:21] Speaker A: Discussion that happens because in a perfect world, that food goes in, you didn't think about it too much. The spleen transforms that food substance into that which is clear and that which is turbid. [00:04:34] Speaker D: Right. [00:04:34] Speaker A: In the classic discussion. [00:04:35] Speaker B: So it's going to send up the clear. [00:04:36] Speaker A: It's going to descend the turbid. [00:04:38] Speaker D: Right. [00:04:39] Speaker B: And so we go through the digestive process. And in that circumstance, you didn't eat too much. You moved around physically. [00:04:46] Speaker A: You didn't think about it too much. [00:04:48] Speaker B: The food came locally and was cooked at home. In this circumstance, your spleen is not overburdened. [00:04:53] Speaker A: Right? [00:04:54] Speaker C: Yeah, absolutely. [00:04:55] Speaker B: It was able to take what came. [00:04:56] Speaker A: In efficiently, convert it into what was necessary, and expel that which wasn't. [00:05:02] Speaker D: Right. [00:05:03] Speaker A: Now, everybody listening knows that for most people, that's not the case. [00:05:07] Speaker D: Right. [00:05:08] Speaker A: And it's just not the case. [00:05:09] Speaker B: Not perfectly, no. And the crazy part to me is that people who try really hard, they're very interested in this. [00:05:15] Speaker D: Right. [00:05:16] Speaker B: Again, have a difficult time walking the line between overanalyzing and overthinking, which doesn't. [00:05:23] Speaker A: Serve the middle jowl in the long run. [00:05:26] Speaker B: So how do you thread that needle? [00:05:28] Speaker D: Right? [00:05:28] Speaker B: I mean, how do you thread the. [00:05:28] Speaker A: Needle between paying attention and be a conscientious consumer and voting with your dollars. [00:05:33] Speaker B: And all the sort of activist stuff. [00:05:34] Speaker A: That we talk about, how do you thread that needle with also paying attention but, you know, not too much. Right, right. [00:05:41] Speaker B: It's hard. [00:05:42] Speaker A: Yeah, it's hard. And what happens then is when people don't succeed at that, right. So they're working long hours, they're using their intellectual capacity. [00:05:51] Speaker B: They're depleting their spleen chi all day. [00:05:52] Speaker A: Because that's what it takes to pay the mortgage. [00:05:54] Speaker D: Right. [00:05:55] Speaker B: They're busy, so they're grabbing quick and. [00:05:58] Speaker A: Go food things that are processed stuff from the food truck outside, not really thinking too much about it. It tastes good, whatever. [00:06:05] Speaker B: And many of the flavors and compositions of those foods tend towards sweet. Right. [00:06:11] Speaker A: Sweet flavor stuff. I don't mean, like pastries, right. But I just mean, like, chicken and rice is sweet flavor flavor material. [00:06:17] Speaker D: Right. [00:06:17] Speaker A: Tortilla. Like, I'm thinking a burrito in my mind. [00:06:19] Speaker D: Right? [00:06:19] Speaker A: Like, a burrito is mostly sweet compositionally. [00:06:24] Speaker B: And it tastes good. [00:06:24] Speaker A: So you eat it, and then you eat too much of it because you. [00:06:28] Speaker B: Probably waited too long to eat. And so now you're starving. [00:06:30] Speaker A: So you put down, like, a whole double stuffed, like, chipotle burrito, and then you have that sensation in the afternoon where you're like, oh, my God, I'm about to pass out because I ate all this food. That circumstance is a perfect recipe, and I would say an unbelievably common recipe for what will become chronic middle jowl problems. [00:06:54] Speaker B: Not in that one instance, especially when you pulled that off when you were, like, 19 in college after a night. [00:06:59] Speaker A: Of drinking and you just, like, hammered it, you're like, oh, it's fine. [00:07:03] Speaker B: But you were depleting the spleen then just in small, tiny little ways, and. [00:07:07] Speaker A: It'S not going to show until you're 35. [00:07:09] Speaker D: Right. [00:07:10] Speaker A: I mean, depending on who you are, it could be earlier, but it's not going to show till later. But it was happening then anyway. [00:07:16] Speaker E: Yeah. [00:07:16] Speaker B: It was slowly sort of trickling through. [00:07:18] Speaker A: And so that ultimately lands us with the stuff that I treat, which is chronic middle jow problems. [00:07:25] Speaker E: Yeah. [00:07:26] Speaker D: Right. [00:07:26] Speaker A: And I think it's important to distinguish, too. [00:07:28] Speaker B: I really do mean chronic. Not necessarily like, I have Crohn's disease. [00:07:32] Speaker A: Or irritable bowel or like a. Like a biomed diagnosis, but that most. [00:07:36] Speaker B: Of your poops most of the days. [00:07:38] Speaker A: Are irregular and non formed and don't come at the same time of the day. That is a chronic middle jowl problem. [00:07:44] Speaker B: That'S reflecting something else that's going on. [00:07:46] Speaker A: In the system, and that's what I spend a lot of my time treating. [00:07:49] Speaker E: Yeah. [00:07:50] Speaker C: And how many other things can come from that? That could be the chief complaint that the patient's coming in for. Right. But then you can't really address any of those things without addressing the first thing. [00:08:03] Speaker A: Yeah. I mean, and think of the number of problems, like, if you've been. [00:08:08] Speaker B: I'm gonna use the phrase malabsorbing, but. [00:08:10] Speaker A: I don't mean that biomedically. [00:08:12] Speaker D: Right. [00:08:12] Speaker A: So, like, okay, the example that I gave you ate the huge burrito, and you felt tired or whatever, your spleen. [00:08:18] Speaker B: Was not able to convert a certain percentage. [00:08:22] Speaker A: We don't know how much. There's no way to measure it, but. [00:08:24] Speaker B: A certain percentage of what you ate. [00:08:26] Speaker A: It was not able to properly convert to. [00:08:28] Speaker F: Right. [00:08:29] Speaker B: And what happens with the food that. [00:08:31] Speaker A: You eat that isn't properly converted by. [00:08:32] Speaker B: The spleen because in this case, it's overwhelmed. Like, it is deficient from your day, deficient from the chronicity of this. [00:08:38] Speaker A: And then you just handed this, like, overworked, sad employee. You just handed them, like, a huge stack of folders and be like, get. [00:08:47] Speaker B: This done before five. [00:08:48] Speaker D: Right? [00:08:49] Speaker B: And it's like, I can't. [00:08:50] Speaker A: I can't. I can't do it. [00:08:52] Speaker B: So what does it do? [00:08:53] Speaker A: It stashes it under the. Under the couch cushions. Like, that's what happens. [00:08:57] Speaker B: So I can't process all that came. [00:08:59] Speaker A: In there, and it generates an irregular byproduct that we call dampness. [00:09:05] Speaker B: And dampness, in this case, is really. [00:09:07] Speaker A: It's a placeholder for, I'm sure, a very complex anatomical, physiologic thing. Chemicals and hormones and fat cells and who knows what. [00:09:18] Speaker B: But it doesn't matter. For our purposes, the biomedical specifics are irrelevant. [00:09:22] Speaker A: Like, you have this concept of dampness, right? And then we got to deal with that dampness. [00:09:27] Speaker B: When you're young, your body will process a lot of this dampness, assuming you. [00:09:31] Speaker A: Have reasonably strong jing and came from a reasonably healthy background. You'll probably have, like, beer shits, you know, and then, like, a little burping, and then it's done. You know what I mean? But eventually, that chronic overuse and over. [00:09:46] Speaker B: Demand of the spleen will reduce those reserves such that the spleen becomes increasingly inefficient. [00:09:51] Speaker A: And then by the time you're older. [00:09:53] Speaker B: That inefficiency is now happening all the. [00:09:55] Speaker A: Time with basically everything that you're eating. [00:09:58] Speaker B: Especially when it comes to the quantity. [00:10:00] Speaker A: Of what you're eating. Even if you had the most amazing. [00:10:03] Speaker B: Whole grain acai bowl from wherever the. [00:10:06] Speaker A: Hell you ate, too much of it and your spleen can't handle it, and. [00:10:10] Speaker C: Maybe too fast and too fast because you were reading or watching something on. [00:10:15] Speaker A: YouTube, you work in some place that gave you a 20 minutes lunche, so you had to, like, get back to work, you know? So the thing that happens with that. [00:10:23] Speaker B: Chronic malabsorption now is we have all kinds of downstream issues. So the problem is digestion. But now we've got a yin deficiency. Now we've got a blood deficiency. Now we're seeing brittle bones. [00:10:33] Speaker A: Now we're seeing hair falling out and nails being weak. [00:10:36] Speaker B: Why person eats, they're seemingly healthy, but, like, something's wrong. [00:10:41] Speaker A: Well, the middle jowl's wrong, right? I mean, the old phrase like, you are what you eat is literally true. Like, I think people, like, threw that around when we were, like, young. Be like, you are what you eat. [00:10:52] Speaker B: And you're going to be a nerd. [00:10:53] Speaker A: Because you're eating nerds, like, whatever. But, like, you are actually composed of what you consume biomedically or in chinese medicine, it doesn't matter. Like, you are. [00:11:03] Speaker B: Everything in your body is constantly being. [00:11:05] Speaker A: Remade from the core resources that go in your mouth. So of course it's going to matter a lot what those things are, but. [00:11:12] Speaker B: It'S also going to matter a lot how your body actually builds from it. [00:11:17] Speaker E: Yes. [00:11:17] Speaker A: And I think that's really what brings us to middle jowl problems, is like. [00:11:21] Speaker B: You'Re eating food, you're doing all the. [00:11:22] Speaker A: Right stuff, and yet problem x, y, and z, right. Is because your body has reached a point where it can no longer efficiently and correctly utilize what's coming in your mouth. [00:11:32] Speaker F: Right. [00:11:33] Speaker C: We've spoken privately about narrative and how important narrative is. Like, the relationship a person has to what they're eating. Part of that is the narrative that they tell them. Like, this is, oh, if I believe my food is filled with chemicals, right, what effect? How am I going to tense up when I'm eating that? How am I going to breathe when I'm engaging in that? What's the circumstances that I'm used to eating in the. Do I feel safe when I eat? Or do I feel like, you know, there's a battle happening around me because I'm shoving food in my face at work? Yeah, all of these things matter, right? [00:12:16] Speaker B: It matters a lot. [00:12:17] Speaker A: And I think the ingredient thing, I don't know, man. I struggle with this because, like, of course, in a perfect world, all the. [00:12:26] Speaker B: Food would be local and it would. [00:12:27] Speaker A: All be organic and everyone would have time to cook, right? But, like, we know that that's just not the case. And it's very annoying that even though it's not, like, the food situation that exists in America is the way it had to be. [00:12:39] Speaker B: Right? [00:12:40] Speaker A: Like, everyone's like, well, you know, it's. [00:12:41] Speaker B: Made in a factory. [00:12:42] Speaker A: It's gonna be garbage. Like, no. Like, it probably may not be as good as what you would make at home. It certainly won't be as good as. [00:12:48] Speaker B: What you made at home. [00:12:48] Speaker A: But it doesn't have to be garbage, right? Like, what is the. [00:12:53] Speaker B: How do we make these choices and shape these things? [00:12:55] Speaker A: And I do. I do really feel frustrated on a. [00:12:59] Speaker B: Personal level and on a professional level. [00:13:01] Speaker A: That, like, people who don't have the time, they've got kids, they're working. Like, their circumstances are such that they. [00:13:08] Speaker B: Just cannot figure out how to make these decisions better. [00:13:11] Speaker A: And so they reach for a premade. [00:13:13] Speaker B: Food at Trader Joe's or whatever, and. [00:13:15] Speaker A: It'S just, it's garbage, right? [00:13:17] Speaker B: But what is the option? [00:13:19] Speaker A: Yeah, you know, one of our, one of our teachers would have just been like, well, they change their job and move. Like, it's just not practical. [00:13:26] Speaker D: Right? [00:13:26] Speaker A: I mean, like, what does that really mean to. [00:13:28] Speaker B: So I have a lot of sympathy. [00:13:30] Speaker A: For people in that situation. I will also say eating Trader Joe's, precooked food, like, don't worry about it too much. We're going to spend this whole thing talking about good decisions and better decisions or whatever. But please, please, please, on this subject of narrative, do not moralize your food choices. [00:13:51] Speaker B: You're not a bad person because you like chocolate covered pretzels from Trader Joe's. [00:13:56] Speaker A: Like, oh, if only I had more willpower. No. Mandez yourself some friggin slack, right? [00:14:02] Speaker B: There are so many more things that. [00:14:04] Speaker A: We can start to look at to begin to build the habits that yield better middle jowl outcomes and from my point of view, better long term health outcomes. Even if you still love chocolate covered pretzels from Trader Joe's, even if you're eating tikka masala frozen from Trader Joe's, like, it's okay, we're going to try and understand this and what we can do about it. Don't feel like you hear this. You're like, well, I can't do anything about it. I'm just going to keep eating frozen burritos, right? No, there are things we can do. [00:14:28] Speaker D: Right? [00:14:29] Speaker A: There are better choices than others, for sure. But do yourself a favor and don't moralize your food choices. [00:14:35] Speaker E: Yeah. [00:14:36] Speaker C: Well said. [00:14:36] Speaker A: Well said. [00:14:38] Speaker C: So we discussed sort of breaking up the disorders of the middle zhao into two categories that are not commonly discussed in chinese medicine necessarily, but they're useful for, I think, paring down the chief complaint or the things that people will come in for. So do you want to talk about those next? [00:15:00] Speaker A: Yeah. So, you know, middle jow is a huge. A huge section of. I mean, it's one of three jows, right? I mean, it's like a whole subcategory of what you're dealing with. And a lot of things, as we've. [00:15:13] Speaker B: Discussed, stem from the middle jow. [00:15:15] Speaker A: And so it's hard. [00:15:16] Speaker B: Sometimes you start looking at the formulas. [00:15:17] Speaker A: All the different formulas that can treat all of the different things that come out of a middle jaw dysfunction. And, like, you know, in some readings, it's almost all of them, right? [00:15:27] Speaker E: Yeah. [00:15:27] Speaker B: You're like, oh, shit. [00:15:28] Speaker A: Like, how am I supposed to, like, manage this? So I started thinking about it. I make some subcategories of middle jow, which I call upper middle jow and lower middle jow. [00:15:38] Speaker D: Right? [00:15:39] Speaker C: Okay. [00:15:39] Speaker B: This mostly comes from the idea that. [00:15:41] Speaker A: Like, technically, your intestines are, like, in your lower jowl. [00:15:47] Speaker D: Right. [00:15:47] Speaker A: But when people talk about lower jowl problems, they usually mean, like, bladder, kidney, gynecological, genito, urinary. [00:15:55] Speaker D: Right. [00:15:56] Speaker A: Like, yes, your colon is definitely in lower jow, but, like, the formulas for that, in my experience at least, are more connected to, like, a middle jow problem. So it's like, okay, all of this is middle jow, like, from your esophagus to your butthole. Like, that space is, like, the middle jow. [00:16:13] Speaker C: Be a great name for a workshop. [00:16:15] Speaker B: Exactly. [00:16:15] Speaker D: Yeah. [00:16:15] Speaker A: Oesophagus to butthole. [00:16:17] Speaker B: Congratulations. [00:16:18] Speaker D: Right. [00:16:19] Speaker A: So I think that that's the space we're looking at. So if upper middle jowl problems are. [00:16:25] Speaker B: Essentially sort of epigastric problems. [00:16:27] Speaker A: So, like, belching, acid reflux, epigastric pain, sharp stabbing pain, sort of like diaphragmatic and above ish. Like, you know, I don't know, belly button and above. I don't know. It's. It's not a. It's not a hard science, you guys. [00:16:42] Speaker D: Right. [00:16:42] Speaker A: It's sort of like a rough categorization of what's going on. And then the lower problems, when I think of this, lower middle jaw problems are mostly problems with pooping. [00:16:53] Speaker D: Right. [00:16:53] Speaker B: And somehow. [00:16:54] Speaker A: And what the relationship is between that, but it can also include, like, hemorrhoids and bleeding conditions and stuff because that's all related. Sort of like colon, small intestine, large intestine, and there's a little bit of fuzzy space with, well, with stools. So, like, looser stools can be a. [00:17:10] Speaker B: Sort of mixed pattern where it's like. [00:17:12] Speaker A: Definitely a spleen damp deficiency problem, but also a colon problem. So again, it's not a. I wouldn't say it's a hard division, but we'll. [00:17:19] Speaker B: Talk a little bit as we get into formulas. [00:17:21] Speaker A: It'll become apparent why we decided to. [00:17:22] Speaker B: Make this division, but it's mostly to. [00:17:25] Speaker A: Facilitate discussing it because you could really, I mean, we could sit here for the next, like, 5 hours and talk about the middle jowl. [00:17:33] Speaker B: I mean, there's just so much in it, and it's so connected to other things. [00:17:37] Speaker A: And is it the middle jaw by itself? [00:17:38] Speaker B: But is it actually wood overacting on earth? [00:17:41] Speaker A: And, like, there's just so many layers. [00:17:42] Speaker D: Right. [00:17:43] Speaker A: So I wanted to take the time today to really look at the lower middle jowl problems in the context of issues with pooping. [00:17:53] Speaker D: Right. [00:17:53] Speaker A: So, like loose stool or hard stool, and then urgency and constipation. [00:17:59] Speaker F: Right? [00:17:59] Speaker D: Yeah. [00:18:00] Speaker C: All right, so let's go into that lower middle jowl problems, which obviously there's pure patterns and then there's crossover that are not so easy to distinguish or delineate. So maybe where do you want to start on the spectrum of those things? [00:18:19] Speaker A: So I want to first start with some definitions. [00:18:22] Speaker E: Yeah. [00:18:22] Speaker A: Because this comes up a lot. All right. [00:18:24] Speaker B: So first and foremost, this is in. [00:18:26] Speaker A: No particular order, and maybe that's not true. Maybe this is the most important one. So constipation is a measure of frequency. [00:18:37] Speaker E: Yes. [00:18:38] Speaker B: And that's. All right, so in most common parlance. [00:18:42] Speaker A: When people say, I'm constipated, they mean. [00:18:44] Speaker B: I have a hard stool. [00:18:46] Speaker A: And that is a misunderstanding of the concept. [00:18:48] Speaker D: Right. [00:18:49] Speaker B: Because constipation is a function of frequency. [00:18:51] Speaker A: So, like, how often are you having a bowel movement? Is what. Like, that's what we're measuring is constipation or not the level of constipation, so to speak. [00:19:00] Speaker C: Technically. [00:19:01] Speaker A: Technically. But when people say constipated, they could mean anything. [00:19:06] Speaker E: Yes. [00:19:06] Speaker D: Right. [00:19:07] Speaker B: So in your questioning, you need to decide what kind of specific question you're going to ask that will give you. [00:19:13] Speaker A: The information that you need. So when I ask this question about bowel movement, I say, how frequently are you having a bowel movement. [00:19:20] Speaker F: Right. [00:19:20] Speaker A: That is the phrase. [00:19:21] Speaker D: Right. [00:19:21] Speaker A: I. [00:19:22] Speaker B: Any variation from that will probably get. [00:19:24] Speaker A: You something much less useful. [00:19:26] Speaker D: Right. [00:19:26] Speaker A: And so people be like, oh, I'm. [00:19:28] Speaker B: Having one once a day, three times. [00:19:29] Speaker A: A day, every other day, every four days. Okay, well, four times a day is. [00:19:34] Speaker B: Too frequent, and every fourth day is too infrequent. [00:19:37] Speaker D: Right. [00:19:38] Speaker A: And I think most people listening probably know the sort of, like, chinese medicine. [00:19:41] Speaker C: Golden poop is, oh, you should definitely walk them through. [00:19:45] Speaker A: Yeah. [00:19:46] Speaker B: One time a day. [00:19:48] Speaker A: The morning, complete, formed, easy to pass. [00:19:55] Speaker B: So, formed and easy to pass means the poop has a shape to it. You could see it in the bowl. [00:20:01] Speaker A: It comes out easily. [00:20:02] Speaker B: No straining or pushing. [00:20:04] Speaker A: And it's one time in the day, in the morning. [00:20:10] Speaker B: The complete part is a little tricky. [00:20:11] Speaker A: But all of you listening know what I'm talking about. [00:20:14] Speaker B: You've had a poop where the poop. [00:20:15] Speaker A: Comes out, and you're like, ugh, I feel so much better. [00:20:18] Speaker B: That is the poop. That's the complete. [00:20:20] Speaker A: Like, literally everything that was ready to go in your colon came out. There wasn't anything left. It doesn't require a lot of wiping. [00:20:27] Speaker B: It doesn't stick to the side of the bowl. [00:20:29] Speaker D: Right. [00:20:29] Speaker A: So once in the morning, easy to pass, formed, complete. [00:20:34] Speaker F: Right. [00:20:35] Speaker C: And then the classical description is, your head should clear after you go. [00:20:39] Speaker F: Right. [00:20:39] Speaker A: That's the sensation. [00:20:41] Speaker C: Let the clear yawn rise. [00:20:43] Speaker A: Exactly. Now everything's good to go. [00:20:45] Speaker E: Yeah. [00:20:45] Speaker B: Now that's the golden poop. [00:20:46] Speaker D: Right? [00:20:46] Speaker A: I mean, like, how many people really. [00:20:48] Speaker B: Achieve the golden poop? [00:20:49] Speaker A: It's. It's rare. [00:20:50] Speaker B: Well, no, actually, it's not that rare. [00:20:52] Speaker A: I would just say that, like, people. [00:20:53] Speaker B: Who come in to see me who. [00:20:54] Speaker A: Have digestive problems are not achieving the golden poop. [00:20:56] Speaker B: And when I tell them about it. [00:20:58] Speaker A: Most of them are, like, astonished that that is the standard. [00:21:00] Speaker E: Yeah. [00:21:01] Speaker A: One of the things you want to desperately avoid in conversations with people about. [00:21:04] Speaker B: Their bowel movements is using any. Well, this is probably true about physiology in general, but don't ask anyone if anything is normal. [00:21:10] Speaker F: Right? [00:21:11] Speaker E: Yeah. [00:21:11] Speaker B: Right. And if a patient says to you. [00:21:13] Speaker A: Something is normal, you gotta probe that. [00:21:15] Speaker E: Yeah. [00:21:16] Speaker B: Right. Because if a person has been constipated their whole life. [00:21:19] Speaker A: And again, we're using this in the technical definition, meaning they don't have a bowel movement every day. [00:21:23] Speaker B: Right. They may have one every three days, and that is normal. [00:21:27] Speaker F: Right. [00:21:28] Speaker A: So if they say, so, if you. [00:21:29] Speaker B: Say, how are your poops? Or, how's your bowel movement? They'll say normal. [00:21:33] Speaker A: That's not helpful for you. [00:21:34] Speaker F: Right. [00:21:34] Speaker A: You have no idea what that means. So how frequently you having bowel movement? I'm having it once a day. [00:21:40] Speaker D: Great. [00:21:41] Speaker B: Is it formed? [00:21:43] Speaker A: Yes. Easy to pass? [00:21:45] Speaker B: Sometimes. [00:21:46] Speaker A: Right. Okay. [00:21:47] Speaker B: Now you have some stuff to probe. [00:21:49] Speaker A: What do you mean? [00:21:50] Speaker D: Right. [00:21:50] Speaker A: You have to strain a lot of the stool. Yes. I have to force it a lot. When it comes, though, is it hard and dry? [00:21:57] Speaker B: Soft. Now you're getting into more territory. So step one, understanding that constipation is. [00:22:01] Speaker A: A measure of frequency. [00:22:02] Speaker D: Right. [00:22:03] Speaker A: And phrasing your questions appropriately. Second definition is understanding that. Or maybe just a follow up. [00:22:09] Speaker B: You can be constipated and have a loose stool. [00:22:12] Speaker C: Yes, absolutely. [00:22:14] Speaker B: It doesn't happen. [00:22:15] Speaker A: You know, a lot of people were. [00:22:16] Speaker B: Constipated, have hard and dry stool, but not everyone. [00:22:18] Speaker D: Right. [00:22:18] Speaker A: They'll have to go three days between. [00:22:19] Speaker B: A bowel movement and when they finally. [00:22:21] Speaker A: Have one, it's like, sticky, watery, loose. Yeah. [00:22:24] Speaker C: Or it's just wet. [00:22:25] Speaker B: Or it's just wet. [00:22:26] Speaker C: It's not dry. [00:22:27] Speaker A: Yeah. [00:22:28] Speaker C: Distinctly not dry. [00:22:29] Speaker B: Mm hmm. And that matters. [00:22:31] Speaker D: Right. [00:22:31] Speaker A: Like, the quality of the stool is the next thing you're investigating. [00:22:34] Speaker B: So frequency is the first one that's constipation. [00:22:36] Speaker A: The next is quality. [00:22:38] Speaker D: Right. [00:22:39] Speaker B: Is it softer? Is it watery? [00:22:40] Speaker A: Is it loose? [00:22:41] Speaker B: Is it hard? Is it dry? [00:22:43] Speaker D: Right. [00:22:43] Speaker A: These are the things you're looking at. [00:22:45] Speaker B: If it's on the watery, loose side. [00:22:46] Speaker A: Like, are we talking just, you know. [00:22:48] Speaker B: It'S little, small pieces, or is it complete liquid diarrhea? Is there undigested food in the stool? [00:22:53] Speaker D: Right. [00:22:54] Speaker B: These are things that are all giving us essential information. [00:22:57] Speaker A: Questioning about bowel movements for some people. [00:23:01] Speaker B: Who are new to chinese medicine can. [00:23:02] Speaker A: Be a little bit uncomfortable because you're asking them a lot of details about their poop. [00:23:06] Speaker B: If you approach those questions professionally, clearly. [00:23:09] Speaker A: And direct, people get over it almost immediately. [00:23:12] Speaker C: Yeah, that's been my experience, too. Any of the uncomfortable questions, if you project within yourself a feeling of confidence and, like, this is normal, people tend to. Just attuned to that. [00:23:27] Speaker B: Yeah. [00:23:28] Speaker A: And they just. [00:23:28] Speaker B: They roll right past it. And now all of a sudden, they're with you. [00:23:31] Speaker E: Yeah. [00:23:31] Speaker A: And they're giving you all kind of details. [00:23:33] Speaker E: Yeah. [00:23:33] Speaker B: And the next time they come in. [00:23:34] Speaker A: They'Re like, oh, yeah. So, like, we had a patient, remember, patient, like, took pictures of her bowel movement and pictures. So, like, we have more details. Like, this person was squeamish about in the beginning, and then all of a sudden, they're, like, pooping and taking a picture. [00:23:46] Speaker D: Right. [00:23:46] Speaker A: I don't think your patients need to. [00:23:48] Speaker B: Bring you pictures of their poops. [00:23:49] Speaker A: But the point being is that, like, you can just roll right past it. [00:23:52] Speaker D: Right. [00:23:52] Speaker A: So that's where I want to start with terminology. [00:23:55] Speaker B: Understanding constipation as a measure of frequency. [00:23:57] Speaker A: And then setting up your questions to get information about the quality of the stool really, really matters. Right. [00:24:04] Speaker B: The other part of the questioning, too. [00:24:06] Speaker A: When I do my ten questions is I have. [00:24:08] Speaker B: So I have questions about bowel movement. [00:24:10] Speaker A: And, of course, urination, but I have a separate set of questions that are. [00:24:13] Speaker B: An initial question about digestion in general. [00:24:16] Speaker D: Right. [00:24:16] Speaker B: And it played around with this question. [00:24:18] Speaker A: A lot to figure out, like, how to ask it. And so what I usually say to a person is, like, so after you have a meal, how does your digestion feel? That's the kind of way that I phrase it. Because if you're just like, how's your digestion? You get the same, like, normal, it's fine, but after you have a meal, how's your digestion? [00:24:34] Speaker B: It's still kind of general. [00:24:35] Speaker A: And so some people be like, oh, it's fine. [00:24:37] Speaker B: And then I follow up with, like. [00:24:38] Speaker A: Any gas, bloating, gurgling acid reflux. [00:24:42] Speaker B: Like, I'll prompt with a couple of pieces. And now they're like, oh, yeah, actually. [00:24:46] Speaker A: I do feel pretty bloated after I eat. [00:24:49] Speaker D: Right. [00:24:49] Speaker A: But again, they feel bloated every time they eat, so it's normal. [00:24:53] Speaker F: Right, exactly. [00:24:54] Speaker A: That's why you've got to probe that information. [00:24:56] Speaker D: Right. [00:24:57] Speaker A: So I don't usually like to lead. [00:24:59] Speaker B: The patient too much. [00:25:00] Speaker D: Right. [00:25:01] Speaker A: I don't want to plant ideas in their mind, but sometimes with digestion, you've got to give them a little idea of what you're talking about. [00:25:07] Speaker F: Right. [00:25:07] Speaker E: Yeah. [00:25:07] Speaker C: That makes a lot of sense. [00:25:08] Speaker D: Yeah. [00:25:09] Speaker C: What about questions that mesh well? Like, after you have your basic digestion questions, do those lead you into other questions, or do you tend to ask your questions in the same order every time? [00:25:26] Speaker A: Yeah. This is a little tricky, because, you. [00:25:27] Speaker B: Know, if someone's coming in with a. [00:25:29] Speaker A: Bowel problem, like, they've got a digest, that's their chief complaints. A digestion problem. Usually the way that I conduct an. [00:25:35] Speaker B: Interview is I flesh out the details. [00:25:37] Speaker A: Of the chief complaint first. Like, before I do ten questions, and then I jump into ten questions. So, like, if it's a shoulder pain problem, then they won't have answered any. [00:25:46] Speaker B: Of my ten questions yet, right. [00:25:48] Speaker A: Because I'm just getting the details of the shoulder pain. But if it's a digestive problem, they will probably have touched on all these various aspects. And so you have to be organized right. [00:25:58] Speaker B: To see, like, what did they already answer? [00:26:00] Speaker A: And where did you need more probing? Because it's not going to be in quite as neat an order as if you could ask it in exactly the way that you want. [00:26:08] Speaker D: Right. [00:26:09] Speaker A: A lot of times, if digestion is the core problem, then the other thing that I really. Well, and this kind of gets us. [00:26:15] Speaker B: Into this sort of lower middle jowl problem. If we're looking at a bowel issue, got a poop problem, and someone's telling. [00:26:21] Speaker A: Me, like, okay, well, I'm having four bowel movements a day, and the stool is unformed. [00:26:27] Speaker D: Right. [00:26:28] Speaker B: My mind is immediately going to deficiency. [00:26:31] Speaker A: Questions of the middle jowl. [00:26:32] Speaker B: The spleen's deficiency. [00:26:34] Speaker D: Right? [00:26:34] Speaker A: Like, we've got a wet stool. It's very frequently like, what's going on here? So I want to know more about temperature, right? Are they cold? [00:26:44] Speaker B: Are they cold people? This matters a lot with middle jowl. [00:26:47] Speaker A: So if I've got someone who's got loose, wet stool that's frequent, I absolutely want to understand their body temperature. So what's your sense of temperature? [00:26:54] Speaker B: Run hot, run cold. Cold hands and feet. [00:26:57] Speaker A: Right. [00:26:57] Speaker B: At night, do you notice any changes in temperature? I really probe a lot into how. [00:27:02] Speaker A: People'S body temperature, because that's going to help me pick my formulas. What's coming up next at its core? The reason I started with the physiology. [00:27:11] Speaker B: Question is that so much of helping digestive problems for me is thinking about. [00:27:17] Speaker A: Or basically measuring the relative values of. [00:27:21] Speaker B: Spleen, qi, strength, damp accumulation, stagnation, and heat. [00:27:29] Speaker E: Yeah. [00:27:29] Speaker A: Okay. Those are really like the columns that I'm juggling. [00:27:33] Speaker B: Based on my questions, I need to. [00:27:34] Speaker A: Figure out how much of those things. [00:27:36] Speaker B: Is there and in heat, because often. [00:27:39] Speaker A: It presents as actual heat from stagnation, like that you would use a dahuang type formula for. [00:27:44] Speaker B: But I also mean cold. [00:27:46] Speaker D: Right. [00:27:46] Speaker A: The opposite of heat. [00:27:46] Speaker B: Temperature. [00:27:47] Speaker D: Right. [00:27:48] Speaker A: Is sort of the thing. Usually I think about it in terms of heat, because that's what I see a lot of. But really, we're saying clean qi, strength, damp accumulation, general stagnation, temperature. [00:28:00] Speaker E: Yeah. [00:28:00] Speaker C: Okay. [00:28:01] Speaker A: And so all the questioning is basically centered around that. [00:28:04] Speaker E: Yeah. [00:28:04] Speaker C: Okay. All right. And then, so let's say we have a patient, and you find out through your questioning that they have loose stools. [00:28:16] Speaker F: Right. [00:28:17] Speaker C: So what comes to mind in terms of formulas, strategies, approaches, what do you want to know as soon as you hear loose stools? You talked a little bit about it before, but let's go a little deeper with that. [00:28:28] Speaker A: Yeah. [00:28:29] Speaker B: So if loose stool is the first. [00:28:30] Speaker A: Thing, then of course, the specific details of what we're talking about. How loose are we talking watery, undigested food? Or are we just talking not that well formed? And then I also want to know. [00:28:42] Speaker B: How consistent that is. [00:28:44] Speaker F: Right. [00:28:44] Speaker B: One of the things that happens a. [00:28:45] Speaker A: Lot with middle jaw problems is the actual poops are all over the map. Right. Sometimes loose, sometimes hard, sometimes flaky, sometimes watery. [00:28:52] Speaker B: Oof. [00:28:53] Speaker A: Those can be more challenging. Let's assume for this case that it's relatively consistent. They have two bowel movements a day. Once in the morning, once before bed. Bowel movement tends to be, you know. [00:29:04] Speaker B: Unformed to loosely formed mush. [00:29:08] Speaker A: But it's not watery. There's no urgency. So these are the secondary questions. Right. So how consistent is it? [00:29:15] Speaker B: Is there urgency here? [00:29:16] Speaker A: Like, you got to go now. Is there any gurgling? That's sort of. [00:29:20] Speaker B: I call it the squirrelly sensation. [00:29:22] Speaker A: There's an animal in your guts that everyone's had when they've had diarrhea, that kind of feeling. So I want to make sure. I want to get those senses for this kind of person. It's twice a day, which is more than once a day, but it's not crazy. They're also bookended. [00:29:38] Speaker B: You've got one in the morning, one in the evening. [00:29:40] Speaker A: That tells me that there isn't an extreme deficiency that's leaving this person with an incomplete bowel multiple times a day. [00:29:49] Speaker F: Right. [00:29:49] Speaker C: Sure. [00:29:50] Speaker A: Because, you know, it has a regularity to it. There's a rhythm. Middle Zhao and earth loves rhythm. [00:29:56] Speaker C: That's a good point. [00:29:57] Speaker A: Even if the rhythm is technically aberrant. [00:30:00] Speaker D: Right. [00:30:01] Speaker B: It's still rhythmic. And that tells me that there is a kind of strength to the middle. [00:30:07] Speaker A: That isn't present when people are having three bowel movements within an hour in the morning. [00:30:11] Speaker B: And then one, sometimes after lunch, and then two or three, depending on what. [00:30:15] Speaker A: They ate, and another one before bed. [00:30:17] Speaker B: That is a kind of depletion that's more obvious. [00:30:20] Speaker D: Right. [00:30:20] Speaker A: Because the spleen's ability to regulate that middle jow energy is just gone. It's just all over the place. Push it if you can. Don't if you can't. [00:30:30] Speaker B: I don't know what's happening. I just work here. [00:30:32] Speaker A: You. You gotta talk to management. You know what I mean? Like, there's. [00:30:35] Speaker B: There's a really intense breakdown in the process. [00:30:37] Speaker A: So. [00:30:40] Speaker B: The next thing that I'm gonna. [00:30:41] Speaker A: So let's stick with this example. So we've got two bowel movements, morning and evening. [00:30:46] Speaker B: Relatively unformed, but not watery. [00:30:49] Speaker E: Yeah. [00:30:49] Speaker A: The next thing I wanna get into. So again, frequency was the first question. The next thing that we're gonna get into, that's spleen chi, is what we're assessing. Now I wanna look at dampness. So this is going to get into. [00:31:01] Speaker B: Other questions about the patient's sort of. [00:31:03] Speaker A: Lifestyle and habits around what they actually eat. [00:31:06] Speaker B: Have they noticed any rhythms? So this is when I talk to. [00:31:09] Speaker A: People about food, and I will say, talking to people about food can be really tricky. [00:31:14] Speaker E: Yeah. [00:31:14] Speaker D: Right. [00:31:16] Speaker A: And I want to put a couple. [00:31:17] Speaker B: Of important caveats out there in your. [00:31:19] Speaker A: Probing, in your paperwork, in your initial questionnaires. [00:31:22] Speaker B: You also need to suss out if. [00:31:24] Speaker A: People have any history of, of eating disorder, because understanding how people relate to food is really important. And you want to make sure that you're not stepping in the way of. [00:31:36] Speaker B: Repairing history, something that's improving the eating disorder problem. [00:31:41] Speaker A: Because if people aren't in the right place for it and you start telling. [00:31:44] Speaker B: Them like, well, you should eat this. [00:31:45] Speaker A: Less of that, more of this, it can create a lot of problems. [00:31:48] Speaker D: Right. [00:31:49] Speaker A: I don't want to make anybody paranoid. [00:31:50] Speaker B: You need to talk to your patients about food, but you also need to. [00:31:53] Speaker A: Be prepared and understand what the space is that you're walking in. [00:31:57] Speaker C: That's very important. [00:31:58] Speaker A: So let's assume that my patient doesn't have any history with eating disorder at this stage. [00:32:03] Speaker B: I'm going to start asking them a. [00:32:04] Speaker A: Little bit about what's their diet like, what's normal breakfast like, right? Have you noticed after you have dairy. [00:32:11] Speaker B: Or eggs, any phlegm in the throat? Have you noticed any foods make the stool looser or harder? [00:32:18] Speaker A: And you know, it's a mixed bag here. [00:32:20] Speaker D: Right? [00:32:20] Speaker A: Like, some people know they've been paying attention for a while. Some people, when you ask them, they'll be like, oh, yeah, every, you know. [00:32:27] Speaker B: I have yogurt and a banana every morning for breakfast. [00:32:30] Speaker A: And then I have to like, clear my throat for like 2 hours, right? [00:32:33] Speaker C: Yeah, exactly. [00:32:34] Speaker A: Like, do you think that has something to do with it? [00:32:36] Speaker E: Yeah. [00:32:36] Speaker A: And I'm like, yes, yes, it definitely does. [00:32:39] Speaker B: But they never. [00:32:40] Speaker A: Why would they know that, right? [00:32:41] Speaker B: Like they just, oh, it's normal. [00:32:42] Speaker A: This is what happens. [00:32:43] Speaker D: Right. [00:32:44] Speaker B: So I probe about that and I'm. [00:32:45] Speaker A: Going to get a sense then of. [00:32:47] Speaker B: Is this person tends to eat kind of damp food, sweet flavor. [00:32:51] Speaker A: So we're looking at dairy, sugar, grease, alcohol. These are the spaces that we're looking at. [00:32:57] Speaker D: Right. [00:32:57] Speaker A: I'm also doing a physical assessment. What's the person's build like? What's their musculature like? Are they overweight, which isn't always an indicator of dampness, but it can be. When I look at their tongue, is it swollen? Does it have tooth marks? Are the things that are telling me. There's, like, fluid accumulating in the system. [00:33:16] Speaker B: For some very damp people. [00:33:17] Speaker A: You can smell it. [00:33:19] Speaker E: Right. [00:33:19] Speaker A: There's. We've talked a little bit about my nose before, but you don't have to have a very strong nose to, like, to smell dampness. You can literally walk out of a. [00:33:25] Speaker B: Treatment room and walk back into a room. [00:33:27] Speaker E: Yeah. [00:33:28] Speaker B: And there's a. [00:33:28] Speaker A: There's a wetness. [00:33:29] Speaker B: A mustiness. [00:33:30] Speaker C: Yeah, mustiness. I remember in. In the clinic at Ocom, I had a patient, every time I'd walk in the room, they smelled. There was a smell like cafeteria mashed potatoes. [00:33:43] Speaker A: That's really specific. [00:33:44] Speaker C: Yeah. Like, just musty and, like, kind of like cheap mashed potatoes. That's where my mind went. [00:33:51] Speaker A: Yeah, it's the smell of that accumulation. [00:33:53] Speaker C: Yeah, absolutely. [00:33:55] Speaker A: Yeah. And I mean, like, again, it's not. [00:33:56] Speaker B: Something like the person. The person isn't malodorous. [00:33:59] Speaker A: Like, that's not like, oh, they smell bad. [00:34:01] Speaker B: It's just something you would notice if you're looking for it and if you're. [00:34:03] Speaker A: In a small room with contained air. You know what I mean? [00:34:07] Speaker B: But so these. [00:34:07] Speaker A: This is how I'm. [00:34:08] Speaker B: That's the first sort of, like, physical. [00:34:10] Speaker A: I'm looking at tongue, I'm looking at body, I'm looking at food as the sort of, like, macro assessment of dampness. [00:34:16] Speaker D: Right. [00:34:17] Speaker B: And then if you're a pulse person. [00:34:19] Speaker A: As you are, I'm sure you can feel more of the dampness in the pulse. In particular, I cannot feel the dampness in the pulse unless, like, dampness is shooting out of their veins. Like, otherwise I can't feel it. So I rely on other things to determine that. So the quality of the stool and its frequency and stuff is one of the ways I'm looking at Qi quality deficiency, relative deficiency. [00:34:41] Speaker B: Then I'm looking at dampness and assessing that dampness. [00:34:43] Speaker A: And while I'm doing that, in my. [00:34:44] Speaker B: Mind, I'm checking off what kinds of. [00:34:47] Speaker A: Herbs I'm likely going to need at. [00:34:49] Speaker B: This point, not really a formula, but so much as types. [00:34:53] Speaker A: So I'm like, all right, this person, their chi is weak, but I wouldn't. [00:34:57] Speaker B: Say it's deficient yet. [00:34:59] Speaker D: Right. [00:34:59] Speaker A: So maybe I don't need Ren Shen or Huang chi, and if I do, maybe it's just a little dangshan and a little spicy at the end, you know, a little little finish, you know, a little moose bush of sheet tonic. Yeah, but it doesn't seem like I'm gonna need a lot of it there. [00:35:16] Speaker B: The person is not cold. [00:35:18] Speaker A: In fact, if anything, they run a little bit warm. So probably don't need a lot of. [00:35:22] Speaker B: Warm ganjiang and stuff to, like, warm. [00:35:25] Speaker A: Up that middle jowl. It doesn't mean I might not need something like futza. It's a different description. But actual warming, like Wu Ju, ganjang, those kinds of things, probably don't need those. [00:35:36] Speaker B: The dampness factor, though, is fairly high. [00:35:39] Speaker A: Person's a little overweight, swollen tongue, you know, tendency toward phlegm with dairy. I'm thinking, okay, we've got a larger damp factor in here. So now I'm thinking of the damp drainers. Sangju ho po chen PI. [00:35:55] Speaker D: Right. [00:35:55] Speaker A: Things that are aromatic and drying. And this is how I'm categorizing this in my mind. [00:36:01] Speaker D: Right. [00:36:01] Speaker A: Like, okay, imagine that you've got these four, these bars in front of you, right? [00:36:06] Speaker B: And you're adjusting the levers. [00:36:07] Speaker A: And so if everything was equal before, for a balanced person, I've lowered the. [00:36:11] Speaker B: Qi deficiency a little bit, but not. [00:36:13] Speaker A: All the way down. [00:36:14] Speaker B: I've raised the dampness bar a little high, but it's not crazy high, but. [00:36:18] Speaker A: It'S higher than the deficiency is low. [00:36:20] Speaker D: Right. [00:36:21] Speaker A: And so then after I've got those. [00:36:23] Speaker B: Two pieces, now, I'm going to roll. [00:36:24] Speaker A: Over and I can choose what I want to look at next. [00:36:27] Speaker B: Stagnation. [00:36:27] Speaker A: If dampness is higher, then stagnation is definitely the big question. [00:36:31] Speaker B: Right, right. [00:36:32] Speaker A: So I'm looking at nail quality, skin pallor and tone hair. [00:36:38] Speaker D: Right. [00:36:38] Speaker E: Yeah. [00:36:39] Speaker B: These are normally things we look at for blood stagnation. [00:36:41] Speaker F: Right, right. [00:36:42] Speaker B: And you can definitely look for that, too. [00:36:44] Speaker A: Spider veins and whatever. But dampness stagnates. It gets in the way of everything, including blood and chi. So when people have a tendency toward damp stagnation, it can show in these extremity places. [00:36:57] Speaker F: Right, right, right. [00:36:58] Speaker A: It's also helpful to take a look, too, at the extremities, at foot funguses, yellowing, discoloration. That sort of stuff is usually an indicator of stagnation, either from blood or. [00:37:09] Speaker B: In this case, dampness. [00:37:10] Speaker A: Could even be heat, technically. But anyway, stagnation, foot odor and foot odor. Yeah, exactly. [00:37:15] Speaker B: Body odor can be a part of. [00:37:16] Speaker A: It, and that will get us into. [00:37:17] Speaker B: The heat question that's coming next. [00:37:19] Speaker D: Right. [00:37:20] Speaker B: But I'm doing a physical assessment of. [00:37:21] Speaker A: The actual physical body, looking for signs of stagnation. [00:37:25] Speaker D: Right. [00:37:25] Speaker B: And then I'm also in the questioning. [00:37:28] Speaker A: Now, talking usually a lot about energy as well. So it's easy to think about energy as a deficiency, qi deficiency problem, which it almost is. [00:37:36] Speaker D: Right. [00:37:36] Speaker A: It has that as a component, but. [00:37:39] Speaker B: Dampness creates that classical description of wet. [00:37:43] Speaker A: Blanket over the head. I'm just, oh, my body's heavy. I'm not motivated. [00:37:50] Speaker B: And this is an important distinction between. [00:37:52] Speaker A: Physically tired, like, I cannot keep my eyes open. I'm about to fall asleep, and I'm unmotivated, don't want to do anything. [00:38:00] Speaker B: Those are different things. They're both tired, like, I'm tired, but they're different. [00:38:06] Speaker A: I physically can't keep my eyes open, is usually not a damp problem. My body feels heavy. I'm demotivated. I don't really want to do anything. I just kind of want to be here. Just sort of sink into the couch and watch Netflix. That is a spleen deficient damp presentation. [00:38:30] Speaker B: Now, there are other factors because it's. [00:38:31] Speaker A: Chinese medicine, so it's not just that. [00:38:33] Speaker B: The liver is involved, of course, some. [00:38:34] Speaker A: Gallbladder dash on there, other stuff. But, like, of course, when you're looking at that piece, I'm thinking, and honestly, the more you do this investigation with. [00:38:41] Speaker B: People, you start asking those questions, they'll. [00:38:43] Speaker A: Be like, yeah, like, I don't want to. I'm tired. I don't want to do anything. [00:38:46] Speaker F: Right. [00:38:47] Speaker A: Are you sleepy tired, or, like, demotivated? Tired, like, oh, demotivated. [00:38:51] Speaker E: Yeah. [00:38:51] Speaker D: Right. [00:38:51] Speaker B: Almost every time. If the damp lever is high, the. [00:38:54] Speaker A: Stagnation is also going to be about the same height of. And people tend to be demotivated. [00:38:59] Speaker E: Yeah, yeah, yeah. [00:39:00] Speaker C: I remember Jimmy Chang used to talk about how blood stagnation and dampness go together because the fluid accumulates in the muscles, and then it, like, sits in pockets and weighs on the blood vessels, and then the blood moves more sluggishly, and then you get, like, damp, and you have blood stasis because the blood isn't moving well. And then you get stuff like high blood pressure. So you see, like, why diuretics work? Like, why diuretics are such a common thing that's prescribed, even from biomedicine's point of view, to encourage the fluid metabolism to churn a little more. [00:39:42] Speaker A: Yep. Yeah. It's huge, actually. Like that. You know, a lot of people think high blood pressure is a heart problem, a cardiovascular problem. In chinese medicine, what I see is not. It's a damp problem almost always. I mean, there are some exceptions, but, like, it's a water fluid problem. [00:39:57] Speaker C: I see a lot of that as well. Like, a lot of water you do. You know, you might be able to do a little bit to work on the heart directly or the function of the heart, but a lot of it is water accumulation or other things. [00:40:10] Speaker A: Well, and using Jimmy Chang's analogy, like. [00:40:13] Speaker B: The problem is not that your heart has a pumping issue, is that the. [00:40:16] Speaker A: Vessels are constrained by the dampness. [00:40:18] Speaker C: Right, exactly. [00:40:19] Speaker A: So, like, the heart doesn't need fixing, the dampness needs removing, and then, okay, now this stuff's going to work, and it's important. Right. Because, again, digestive. So we call these, broadly speaking, metabolic problems. [00:40:30] Speaker D: Right? [00:40:30] Speaker E: Yeah. [00:40:31] Speaker A: So digestive stuff comes through the door, but it is very rare that it's alone. [00:40:37] Speaker D: Right. [00:40:37] Speaker A: It's almost always mixed in with any number of things. [00:40:40] Speaker B: But most of my patients would biomedically. [00:40:43] Speaker A: Be considered, like, people with metabolic issues, quote, unquote. So they have weight gain, they have bowel problems, they have high blood sugar. [00:40:53] Speaker D: Right. [00:40:53] Speaker A: So they tend to be, you know, pre diabetic or diabetic. They have high cholesterol, and they usually have high blood pressure. [00:41:01] Speaker E: Yeah. [00:41:02] Speaker D: Right. [00:41:02] Speaker A: So that combination of things, all in this constellation that we're talking about are. [00:41:08] Speaker B: Spleen, chi deficient, damp accumulation problems. [00:41:10] Speaker A: Yeah, those three things. [00:41:12] Speaker B: Spleen, qi deficient, damp accumulation. [00:41:14] Speaker A: That is stagnation problems. [00:41:16] Speaker D: Right. [00:41:16] Speaker C: Okay, so if we're more on the qi deficiency side of things, where does that tend to go with herbs? Like, when you're thinking of herbs and then maybe formulas off of those herbs. [00:41:29] Speaker F: Right. [00:41:29] Speaker C: Where does your mind tend to go if it's more like that? First of all, symptoms, it sounds like the person is more demotivated. [00:41:37] Speaker F: Right. [00:41:38] Speaker C: And still tendency toward looser stool or wetter stool. Does that change at all based upon body type? Does the body type tend to make you think it's more likely one way or the other? [00:41:52] Speaker B: It does, yeah. [00:41:53] Speaker A: So body type, where we have, like, people with larger body mass, with soft, like tissues, and the tongue is swollen, like, without doubt, I. The chi is deficient because that's why they're accumulating dampness. But the core problem is gonna be to drain and transform the dampness before we tonify the spleen. I mean, you could try and tonify your way out of it, but it's gonna take however many years it took them to put on that extra 100 pounds. You know what I mean? It's a long, long game to only go that way. And probably much of your herb is gonna be pooped out in five loose bowel movements per day. You know what I mean? Cause the middle jow is just nothing handling itself well. [00:42:32] Speaker F: Right. [00:42:33] Speaker A: So when I think about, like, that. [00:42:35] Speaker B: Constellation of things, the damp part of. [00:42:37] Speaker A: It, you know, in this, in our little example. [00:42:39] Speaker D: Right. [00:42:39] Speaker A: Cheese, slightly deficient damp is excessive. It's stagnating the system. [00:42:43] Speaker D: Oh. [00:42:43] Speaker A: I also wanted to add in. For male body people, erectile dysfunction can also be a function of accumulated dampness. [00:42:50] Speaker C: Oh, 100%. [00:42:50] Speaker D: Right. [00:42:51] Speaker E: Yeah. [00:42:51] Speaker A: Even in people who are not metabolically. [00:42:54] Speaker B: Weak, who don't seem to be overweight. [00:42:56] Speaker A: Or things like that, like, really systemic damp accumulation can negatively impact the ability to get and maintain an erection. So a lot of people think like. [00:43:05] Speaker B: Oh, my, testosterone's low, and I need. [00:43:07] Speaker A: To use yang tonics to just, like. [00:43:10] Speaker B: Get a better erection. [00:43:11] Speaker A: But actually, no, I mean, maybe. But probably also dampness is a factor there. [00:43:17] Speaker C: Even in formulas like jingue Shen Chi Wan, you have some nod to yang chi with fuzza and. And some kind of cinnamon, but you also have fu ling zeiss. Yeah. You know, you have things in there that are promoting the movement of water. [00:43:34] Speaker B: So. [00:43:35] Speaker C: Yeah, absolutely. [00:43:36] Speaker B: So the last factor in our four level factor for assessment is temperature. [00:43:40] Speaker A: In this case, heat or cold. [00:43:42] Speaker C: Right, right, sure. [00:43:43] Speaker B: So the cold assessment is, in my. [00:43:46] Speaker A: Mind, actually usually done with the qi assessment. [00:43:49] Speaker B: Right. [00:43:49] Speaker A: So if someone's qi yang is, they're going to be cold or colder. That was the tendency to go for. So if that. [00:43:56] Speaker B: If my chi lever, in the example. [00:43:58] Speaker A: That we were talking about, if I had lowered that even more, one of. [00:44:01] Speaker B: The things that would determine me lowering it more was that they're cold. [00:44:04] Speaker A: Sure. [00:44:04] Speaker F: Right. [00:44:05] Speaker B: They run cold. Their abdomen is cold. [00:44:07] Speaker A: They have cold hands and feet. [00:44:08] Speaker B: They hate the cold weather. [00:44:10] Speaker A: Like, all of those things are like, chi is definitely weaker. Yang is weaker here. [00:44:14] Speaker D: Right. [00:44:15] Speaker B: On the heat side, this matters a lot. Some of it, again, initially, is going. [00:44:19] Speaker A: To be physical assessment. Complexion, redness, tendency toward, like, that kind. [00:44:24] Speaker B: Of ruddy, bright, sort of sweaty, hot. [00:44:26] Speaker A: Presentation probably tells me a little more heat in the system. Any burning with defecation, bleeding, blood, hemorrhoids. [00:44:34] Speaker B: Any of that stuff, strong odor. [00:44:36] Speaker A: Those are the other things that I'm inquiring about. [00:44:38] Speaker D: Right. [00:44:38] Speaker A: So if I have any suspicion that. [00:44:40] Speaker B: There'S some heat in the system, which. [00:44:42] Speaker A: If there's dampness and there's stagnation, you. [00:44:45] Speaker B: Should absolutely assume there's some heat somewhere and probe it. [00:44:48] Speaker F: Right, sure. [00:44:49] Speaker B: And the easiest way is usually to. [00:44:52] Speaker A: Start, since we've been talking about poop. [00:44:53] Speaker B: With the patient all this time, is odor. [00:44:55] Speaker D: Right? [00:44:55] Speaker C: Yeah. [00:44:56] Speaker A: So I usually phrase that question because you can't ask someone like, does your poop stink? Yeah, of course it does. [00:45:03] Speaker D: Right. [00:45:03] Speaker A: It's feces. But I usually say, like, is there. [00:45:06] Speaker B: Any particularly strong odor? [00:45:09] Speaker C: That's a really good way to ask that question. [00:45:11] Speaker A: Is there any particularly strong odorous? Because people know, like, everyone knows, if you. [00:45:15] Speaker B: You've eaten different things, you're in a different digestive state. [00:45:17] Speaker A: Like, your poop doesn't always smell the same. [00:45:18] Speaker F: Right. [00:45:19] Speaker A: And a particularly strong odor will tell me that there's some extra heat in that lower jaw. [00:45:25] Speaker C: Are you embarrassed to leave the restroom afterwards? [00:45:29] Speaker A: Basically. Right. [00:45:30] Speaker B: That is, that is the thing. [00:45:32] Speaker A: Like, if someone's, you know, if you say, is there any particularly strong odor? And they're confused about it, you can find a tactful way to essentially ask that. Where you're, like, you have to use a lot of air freshener, light up. [00:45:41] Speaker C: You carry a match in your back socket. [00:45:44] Speaker A: Exactly. And it also usually comes through with flatulence as well. So people are passing gas. It's very strong odor. That's another way to tell. [00:45:51] Speaker B: Of course, tongue is so important. [00:45:54] Speaker A: I want to talk about this too, for a second. [00:45:56] Speaker B: Tongue. So I use tongues a lot. [00:45:57] Speaker A: You know that in general, the thing. [00:45:58] Speaker B: About tongues is, in my experience, they. [00:46:01] Speaker A: Don'T change very quickly. [00:46:02] Speaker E: Yeah. [00:46:03] Speaker D: Right. [00:46:03] Speaker A: So I always think it's funny when you read in the text, like, for an acute cold and flu, where it's. [00:46:08] Speaker B: Like, tongues, red and dry, I'm like, right. Probably not, actually. [00:46:12] Speaker A: Like, unless it was already red and dry. You don't mean because, like, tongues don't change because you got a cold. [00:46:17] Speaker F: Right. [00:46:17] Speaker A: At least I don't see it changed that way. [00:46:20] Speaker B: But what's amazing about tongues is they. [00:46:22] Speaker A: Represent the sort of longer standing norm of a body. [00:46:27] Speaker B: So when someone sticks out their tongue and it is redder than it should. [00:46:31] Speaker A: Be and swollen with tooth marks and a center crack. Right. [00:46:37] Speaker B: You have dampness, stagnation, and heat. [00:46:40] Speaker A: Like, without a doubt, it's just right. [00:46:42] Speaker B: There on the tongue and staring at you. [00:46:43] Speaker A: Now, how much heat? What do you do about it? These are obviously the big questions, but. [00:46:47] Speaker B: When you're messing with those levers, don't. [00:46:50] Speaker A: Neglect the heat factor. [00:46:51] Speaker B: Even if the stool isn't very malodorous, even if there isn't any bleeding. Okay. [00:46:55] Speaker A: That means you don't have to knock. [00:46:56] Speaker B: It the hell out with mounds of Huanglian. [00:46:58] Speaker A: Right. [00:46:59] Speaker B: But there might still be some Huang bai or even a little dash of Huanglian in this formula because the tongue. [00:47:04] Speaker A: Is cracked and it's red. [00:47:06] Speaker D: Right? [00:47:06] Speaker E: Yeah. [00:47:06] Speaker B: There's some heat there that needs managing. [00:47:09] Speaker C: I think the tongue diagnosis, like where it's mentioned in the different texts we have, is interesting. Like in the Shanghai, you hear very little about the tongue, only in specific patterns, like jerzy pattern, for example, you'll see the tongue mentioned. Or, but for the wenbing tradition, when there's like a heat, like a really strong heat presentation, that's when they start looking at the tongue. Because in febrile disease, like when you have ebola or like some really serious viral thing, and the person could like literally die in a day by sweating too much, right. They have like, extreme yang Ming condition, their tongue is going to change really fast, of course, and it's going to subside really fast. But I think that's a valuable thing to know for people getting into the clinic is that you may be treating somebody for a digestive problem and look at the tongue and be like, well, why? They seem like they're doing better. [00:48:08] Speaker A: Why hasn't the tongue changed? [00:48:10] Speaker C: And there's cases too of different famous people talking about treating really bad skin conditions and stuff where they treat them for seven, eight months, they look back at the tongue and the tongue is the same. [00:48:26] Speaker F: Right. [00:48:26] Speaker C: And you would, you'd be like, why? Why is the tongue the same? Right, right. And most of the time it won't be like that, but sometimes it is. And I feel that's similar with the pulse. Like, most of the time, you know, the pulse changes like you would expect it to. If the person's getting better, the pulse follows. But there's always times when you feel the pulse or maybe when you look at the tongue and you're like, WTF? Like, why isn't it different than it is? And then if the person's symptoms are changing, right, if they're still getting better, then it means we're on the right track still. So I think diagnostic symbols are good to study and interesting to study. And also it's important that we don't get too dogmatic about one thing being everything for us, right. Even if the pulse is my thing, I still palpate the abdomen and I still ask questions. Even though you like the tongue, you're still paying attention to the body type, you're still asking questions. There's different things we check in on for a reason. [00:49:27] Speaker A: Yeah, yeah, yeah. [00:49:28] Speaker B: It's good to point out. [00:49:29] Speaker A: I mean, the tongues are slow. I mean, of course, Ebola is a different story, right? So if anybody out there is treating Ebola in their clinic, like, props to you, but super intense conditions that can. [00:49:39] Speaker B: Kill you rapidly, of course, will force the change. The thing about digestive illness is that. [00:49:44] Speaker A: It absolutely does not kill you rapidly. [00:49:47] Speaker F: Right, right. [00:49:48] Speaker B: I mean, if anything, it is the. [00:49:49] Speaker A: Slowest possible degradation to like what's going on. So of course your tongue is going to show that change slowly. [00:49:56] Speaker B: It took 15 years for your tongue. [00:49:59] Speaker A: To look the way that it looks now. It's going to take a little while for it to change. But that's what I like about it is it actually gives me insight into what's underlying situations. [00:50:08] Speaker B: So one of my favorites is actually center tongue crack. [00:50:10] Speaker D: Right. [00:50:11] Speaker A: So center tongue crack. You'll have a lot of people when you do your interview with them. [00:50:16] Speaker B: They won't have malodorous stool, they won't. [00:50:19] Speaker A: Have hemorrhoids or bleeding. And, you know, maybe they run a little warm or whatever. [00:50:25] Speaker B: So there's definitely some heat, but it. [00:50:27] Speaker A: Just doesn't seem like it's that big a deal. Like the dampness and the stagnation is going to stand out more. And then they stick out their tongue. [00:50:32] Speaker B: And there's a pretty obvious center crack. [00:50:35] Speaker A: That maybe even is, like, kind of deep. And that doesn't necessarily tell me that there's heat in the way that a. [00:50:43] Speaker B: Bright red tongue would and bleeding at the rectum would. [00:50:46] Speaker D: Right. [00:50:46] Speaker A: But it tells me that the stomach yin is being destroyed in some way. [00:50:53] Speaker D: Right. [00:50:53] Speaker B: And the most common thing I see. [00:50:54] Speaker A: In people with chronic damp stagnation is that there's damp heat living in that sort of stomach small intestine space. [00:51:01] Speaker B: And it's just low grade burning up that yin. [00:51:05] Speaker C: Yeah, sure. [00:51:06] Speaker B: And that can look like a weaker stomach for digestions. [00:51:09] Speaker A: Like when people say, oh, I eat things and it doesn't agree with me, like I have indigestion. That can be a stomach yin problem. [00:51:14] Speaker F: Right. [00:51:14] Speaker A: It can also be low grade, occasional sensitivity with, like, anal tissues where things can get hot really easily, especially from wiping. That is this low grade heat which is there. [00:51:27] Speaker D: Right. [00:51:27] Speaker B: And so I look at the tongue and I see this center crack. And almost irrespective of what else I'm. [00:51:32] Speaker A: Writing, I'm thinking I probably should put some maimondang in this, right? Because Maimondang is just a great, relatively easy to digest stomach yin supporting formula. This is one of the few places that I do a little bit of sort of like rote, like, oop, stomach. [00:51:46] Speaker B: Cracks, center crack, tongue crack, oop, maimondong, right. Almost always I include it. Now, how much depends on the rest of case, right. [00:51:54] Speaker A: But almost always I'm going to be like, oh, need a little diamond dung? There's probably other herbs you could use for that, but I really like it. It travels to the stomach. It's not overly sticky, but it supports stomach, and it's a great herb for it. [00:52:04] Speaker C: Makes sense. What about, like, do you find that. So, for me, I see a lot of where there's fluid disharmony. Like, the body isn't able to process fluid, and then it seems like the fluid moves out of, like, the nutritive layer or the physiologic yin layer, for lack of a better term. [00:52:25] Speaker F: Right. [00:52:25] Speaker C: So there's dampness that's accumulating, but that dampness seems to be a result of a process where water just doesn't transform and go to the right place. So what do you, like? Do you see stuff? Like, is that part of your differentiation as well? [00:52:41] Speaker A: Yeah, it's really common. So this is the crazy thing where you'll see, like, someone's clearly damp and there's fluid in weird places, but then, like, they're always thirsty. [00:52:49] Speaker C: Yeah, yeah, exactly. [00:52:50] Speaker A: Always thirsty. Or they're crazy damp. [00:52:52] Speaker B: I can smell it in the room. And their bowels, like, their stool is hard. [00:52:56] Speaker E: Yes. [00:52:56] Speaker A: And you're like, hmm. Okay. So I will say that the way that I think about this is I think it's hard to move the fluids back where they need to go once. [00:53:08] Speaker B: They'Re in the wrong place. [00:53:09] Speaker E: Yeah. [00:53:10] Speaker B: You have to get rid of the. [00:53:12] Speaker A: Ones that are in the wrong place and then encourage the physiology when the body processes fluids. Next, put them in the right place. Okay. I used to think about it as. [00:53:23] Speaker B: Like, oh, well, there's all this moisture. [00:53:24] Speaker A: Like, in their tongue, but not in their mouth. That makes sense. [00:53:28] Speaker D: Right? [00:53:28] Speaker A: It's like, tongue's all swollen and weird. [00:53:29] Speaker B: But they're so thirsty. [00:53:31] Speaker A: Can I just, like, I don't know. [00:53:33] Speaker B: Squish it out of their tongue into their mouth, like, with herbs, you know. [00:53:37] Speaker A: Like, no, man, that doesn't work like that. So, like, all this fluid, like, they've got edema in the lower leg. Like, well, how can they get the fluid. Fluid from the lower leg to the mouth? Like, no, no, no. Get the fluid out of the lower leg and then fix the pathology to. [00:53:51] Speaker B: Encourage physiology so that there's moisture where. [00:53:54] Speaker A: It needs to be. But it does come up a lot. [00:53:57] Speaker D: Right. [00:53:57] Speaker A: And this. [00:53:58] Speaker B: This gets us to. So now we've laid out these levers. [00:54:00] Speaker A: Right. So we had the quality of the chi deficiency or not. The dampness, the stagnation and the heat. [00:54:05] Speaker D: Right. [00:54:06] Speaker A: And in the case I just described, the heat factor is, you know, there's. [00:54:09] Speaker B: A center tongue crack, like I mentioned. [00:54:11] Speaker A: But it's nothing very hot. There's not hemorrhoids, there's not foul odor. So the heat part isn't very large. So now I got to think to myself, like, okay, what am I going to do with this person? [00:54:20] Speaker E: Yeah. [00:54:21] Speaker D: Right. [00:54:21] Speaker A: What is the, what is the next step for me? [00:54:24] Speaker B: When I'm looking at my profile, the dampness and the stagnation are high. [00:54:27] Speaker D: Right? [00:54:27] Speaker A: Yeah, they're top of the list. [00:54:29] Speaker B: The reason there's dampness and stagnation is. [00:54:31] Speaker A: Because of the deficiency. [00:54:33] Speaker D: Right. [00:54:34] Speaker B: And now you get into the art. This is the art of it. [00:54:36] Speaker D: All right. [00:54:36] Speaker A: Because obviously, in order to solve the. [00:54:38] Speaker B: Problem long term, you got to fix. [00:54:40] Speaker A: The deficiency, but you got all this excess sitting on top. [00:54:43] Speaker D: Right. [00:54:44] Speaker B: So my go to for this pattern. [00:54:46] Speaker A: Is Ping Wei san. [00:54:47] Speaker E: Yeah. [00:54:47] Speaker D: Right. [00:54:47] Speaker B: I love ping Weiss on. [00:54:49] Speaker A: I think it's an amazing formula. [00:54:50] Speaker E: Yeah. [00:54:50] Speaker A: If you can take it as an actual song. Like, if you have a pharmacy near. [00:54:53] Speaker B: You who can grind up some fresh. [00:54:55] Speaker A: High quality ping Weissan just smell it. You'll just be like, wow, it's so aromatic. [00:55:01] Speaker B: It's great. It's so bright. [00:55:03] Speaker E: Yep. [00:55:03] Speaker B: It's very drying. [00:55:05] Speaker E: Yep. [00:55:05] Speaker D: Right. [00:55:05] Speaker A: It's very transformative. And it kicks the butt of excess dampness. [00:55:10] Speaker E: Yes. [00:55:10] Speaker D: Right. [00:55:11] Speaker A: Very quickly, however, it is dry. [00:55:14] Speaker E: Yeah. [00:55:15] Speaker D: Right. [00:55:15] Speaker B: And so when people have fluid problems, which is often the case with damp. [00:55:19] Speaker A: Accumulation and stagnation and with that metabolic issues that we've been talking about, you. [00:55:23] Speaker B: Got to be careful how dry you make someone. [00:55:26] Speaker F: Right. [00:55:26] Speaker D: Right. [00:55:26] Speaker A: You can't just like, all right, I want you to take 30 grams of ping Wei san a day for the next two weeks. [00:55:31] Speaker B: Like, those people will be dry. Their sinuses will hurt, their nose will. [00:55:35] Speaker A: Get crusty, be super thirsty. [00:55:38] Speaker C: You get, like, I remember I dried myself out with a shirt shampoo formula, like a Dingjewan sort of modification back in the day. And I had this, like, I took the formula, and within an hour, I had this dry spot in the back of my throat that I could not quench. [00:55:56] Speaker A: Like, I just chugging water. Chugging water. [00:56:00] Speaker C: Could not get it taken care of, and I got sick the very next day. [00:56:04] Speaker A: Yeah. [00:56:05] Speaker C: Because I created some kind of vacancy in my, you know, my system there. So. Yeah, so that, that's a, that's well taken, I think. [00:56:14] Speaker B: So the thing is, is that you. [00:56:15] Speaker A: Have to then place something like Ping. [00:56:17] Speaker B: Wei sun into a constellation of your treatment. [00:56:21] Speaker A: Right. So in this case that I've described, I would probably reach, I mean, oldie, but goodie Butjinsetang right. [00:56:30] Speaker B: Is such a simple formula. It's four ingredients. [00:56:32] Speaker A: Like, it's easy to manage. And, of course, Liu Ginsatong has banchan Chen PI added to it. [00:56:39] Speaker D: Right. [00:56:40] Speaker A: And so you end up with those drying aspects of that. So I will say that I think of this as Sajinsetang plus Ping Weisan is the relationship. [00:56:49] Speaker B: Of course, Ping Weisan has Chen PI. [00:56:51] Speaker A: In it, and so that's there. And so, like, which formula is it, really? [00:56:54] Speaker B: Is it Liu Jinsitang plus Ping Wei San? [00:56:57] Speaker D: I don't know. [00:56:57] Speaker A: Who cares conceptually. The idea is you need to do something for the spleen qi, which Sejinsetang will. [00:57:06] Speaker B: You need to encourage that diuretic process. [00:57:10] Speaker A: Mildly, because we're gonna be drying with the ping Wei San piece. [00:57:15] Speaker F: Right. [00:57:15] Speaker A: So if you build a formula that's full of diuretics, fu Ling zixie, ju. [00:57:21] Speaker B: Ling, like, you open up the floodgates, you're gonna send moisture down and out. [00:57:26] Speaker A: Through the bladder channel. [00:57:28] Speaker B: If you put on top of that, herbs. [00:57:30] Speaker A: Like, I literally think of when you were in grammar school, if someone, I. [00:57:34] Speaker B: Don'T know if they did this everywhere. [00:57:35] Speaker A: But, like, if someone vomited when I was in, like, middle school, like, the. [00:57:39] Speaker B: Janitor had a bucket of kitty litter. [00:57:42] Speaker E: Yeah. [00:57:42] Speaker C: And they would, like, dump the kitty litter. [00:57:44] Speaker A: I don't know how frequently people were vomiting that I think about. It's, like, he had, like, a bucket of kitty litter, and it would just, like, immediately suck up the moisture and kill the smell. [00:57:53] Speaker F: Right, right. [00:57:53] Speaker A: Which was the reason that he had it there. And then you would just literally scoop up the kitty litter and then wipe it down. It's way less messy than if you had to, like, sop it up, you know, with towels. Weirdly, I think about ping Weisan like that. So, like, ping Weisan's drying function is. [00:58:09] Speaker B: That it comes into a thing, and it sucks the moisture into it. [00:58:13] Speaker D: Right. [00:58:13] Speaker A: It's, like, sucks it all up, which is why, if you overdo it, like. [00:58:18] Speaker B: I had a patient once describe who. [00:58:19] Speaker A: I gave too much pinguissa, and she. [00:58:21] Speaker B: Described her sinuses as being crunchy. [00:58:23] Speaker E: Yeah. [00:58:23] Speaker D: Right. [00:58:24] Speaker A: She, like, pressed on her face and was like, oh, they're so, like, crunchy. [00:58:28] Speaker B: And that's because ping Weisan pulls moisture from mucous membranes and damp tissues and interstitial space. [00:58:36] Speaker A: It sucks it up. [00:58:38] Speaker D: Right. [00:58:39] Speaker B: And places it, in this case, the. [00:58:40] Speaker A: Middle jow and lets you excrete it. And in my experience, also excrete is it excretes it through the colon, through the large intestine, as opposed to your. [00:58:51] Speaker B: Fu ling Zixia julian combination which will. [00:58:53] Speaker A: Go out through bladder. [00:58:55] Speaker B: If you're not careful, when you build this formula, you're going to send fluid out through bladder. [00:58:59] Speaker A: You're going to send fluid out through large intestine. And the person's going to be so dry. [00:59:04] Speaker C: They can be very dry, and they'll be very uncomfortable. [00:59:08] Speaker A: Sometimes they'll end up with abdominal pain. [00:59:10] Speaker D: Right. [00:59:10] Speaker A: Because they're so dry. So sagenza, tongue, as, say, 40, 50, 60% of the formula and 40%. So let's do 60% sojensatong, 40% ping Weisan. [00:59:21] Speaker D: Right. [00:59:22] Speaker B: Is for the patient I've described who's kind of middle of the road. [00:59:25] Speaker D: Right, right. [00:59:26] Speaker B: Like, she's not crazy weak. The dampness is there, but it's not. [00:59:29] Speaker A: Incredibly, they don't have erectile dysfunction. They're not, like, unable. They're nothing super demotivated. They're just a little wet and stagnant, and there's not a lot of heat. That's the ratio. Right, right. You're doing mostly qi support, but, you know, not crazy. And then you're drying out up here with. With the ping we sun. [00:59:47] Speaker D: Right, right. [00:59:47] Speaker E: Yeah. [00:59:48] Speaker A: And that's gonna open up some breathing room for the patient. [00:59:52] Speaker B: Key element. We're talking about using herbs here for this problem. [00:59:54] Speaker A: That's gonna help dry up that stool. [00:59:56] Speaker E: Yeah. [00:59:57] Speaker A: It's gonna firm it up a little bit more. [00:59:58] Speaker E: Yeah. [00:59:59] Speaker D: Right. [00:59:59] Speaker A: It might even help with the. The first thing that we're going to see, though, is firming and then frequency change. That's usually what I see. [01:00:06] Speaker C: Okay, that's a good distinction. [01:00:07] Speaker A: Gets tighter first, and then it becomes less frequent, because what will happen then is, at that first bowel movement in the morning, there's enough chi to completely move the fully formed stool out. [01:00:21] Speaker D: Right, right. [01:00:22] Speaker A: And so, boom, they have a great golden poop in the morning, and everything's great. [01:00:26] Speaker B: But until that stool gets tightened up, their spleen can't recover enough. There's still too much dampness in the system. [01:00:33] Speaker A: Spleen can't recover enough in order to actually push the stool out in the way that we would want. [01:00:37] Speaker F: Right. Cool. [01:00:38] Speaker B: Okay. [01:00:39] Speaker C: So we have two archetypes of formulas for these issues. So if we have the, like, the qi deficiency category, we have our sojun Sitong as the archetype formula for that, and then ping Weisan being the archetypical formula for dampness. And then in this case, we're kind of combining them together at different ratios depending on what's taking place. [01:01:03] Speaker B: Correct. [01:01:03] Speaker F: Right. [01:01:04] Speaker C: Okay, so then let's say you have more heat in the picture, right? So very similar case, but there's a little bit more heat in the picture. What would that look? What does that look like in the symptomology usually? [01:01:20] Speaker A: So in this case, in this exact case that we're talking about, what we. [01:01:23] Speaker B: Would probably see is occasional burning with. [01:01:26] Speaker A: Defecation, which is made worse by the consumption of spicy food. Now, everybody, if you eat spicy food, is going to feel it. [01:01:34] Speaker B: Everybody knows. [01:01:36] Speaker A: But even just mildly spicy food, the stool will become more frequent and looser, and it'll burn a little. [01:01:43] Speaker C: What about alcohol? [01:01:45] Speaker A: Same thing. [01:01:45] Speaker E: Yeah. [01:01:46] Speaker C: So that's what I see, is if people have just a little bit of alcohol, like, I can't drink. I used to be able to drink a little bit of wine with my dinner, and now if I have even a little bit, I just have, you know, loose stool. [01:01:58] Speaker A: That's a little stool. [01:01:59] Speaker C: That's a little hot the next. [01:02:00] Speaker A: Yeah. So that's like mild level heat, right? [01:02:02] Speaker E: Yeah. [01:02:03] Speaker B: As that grows in intensity, we can. [01:02:05] Speaker A: Start to see consistent burning with defecation, regardless of what they eat. There could also be bleeding upon wiping. So that means we're having small capillary breaks. There could be, you know, we're increasing intensity here. And then you can get all the way to hemorrhoids and then all the. [01:02:20] Speaker B: Way to anal fissures even. [01:02:22] Speaker F: Right, right. [01:02:22] Speaker A: Where that heat is just getting completely out of control. Usually as that escalates, we also start to see pain. [01:02:28] Speaker B: Right. [01:02:29] Speaker A: So the dampness has stagnated, which caused the heat. [01:02:32] Speaker B: And now the heat and the dampness are stagnating each other in this awful. [01:02:36] Speaker A: Feedback loop, this damp heat feedback loop. [01:02:39] Speaker B: And this is where we get to colitis. Ulcerative colitis. [01:02:43] Speaker A: This is that space. [01:02:44] Speaker D: Right. [01:02:44] Speaker B: So the dampness, the weakness in the spleen promoted the dampness, which stagnated, which became hot. And then those two things are now. [01:02:52] Speaker A: Feeding on each other, further weakening the spleen, further contributing to the dampness, further building the heat. [01:02:59] Speaker B: And now all of a sudden, we. [01:03:00] Speaker A: Have ulcerations in the colonization. [01:03:03] Speaker E: Yeah. [01:03:03] Speaker A: You could have polyps growing. [01:03:05] Speaker B: You have cancerous issues. All kinds of stuff comes downstream from that escalation in heat and completely unmanaged. [01:03:13] Speaker A: In, like, the worst case scenarios, the heat will eventually become toxic heat. And now we have, like, a real problem. Like, a real, real problem. [01:03:19] Speaker C: Then you have abscess and bleeding, and. [01:03:21] Speaker A: Now we have, like, surgeries and stuff. [01:03:23] Speaker B: Sections of your colon being removed and. [01:03:25] Speaker A: All kind of stuff. [01:03:26] Speaker F: Right, right. [01:03:27] Speaker A: So the heat factor is where things. [01:03:30] Speaker B: In my experience, tend to escalate. [01:03:32] Speaker F: Gotcha. [01:03:33] Speaker D: Right. [01:03:33] Speaker A: Into really what we quote, unquote, serious problems. I mean, like having bad poops. I think long term is a serious problem. But, like, when you're having stabbing abdominal pain and blood in your stool, that tends to send people to the emergency room. [01:03:44] Speaker F: Right, right. [01:03:45] Speaker C: So then, so from a symptomological perspective, we have those things taking place. What do we do? What do you think, herbally to transition? Like, is there an archetype for more heat? [01:03:56] Speaker A: Heat. [01:03:59] Speaker C: Like we had before with the other two? [01:04:01] Speaker B: So there are. [01:04:03] Speaker A: So, I mean, if you go into. [01:04:04] Speaker B: The Bensky right of the chin, there's. [01:04:06] Speaker A: These, there are archetypal formulas for this that are usually dat long formulas. I don't usually think about it that way. [01:04:13] Speaker B: I think about them as individual single herbs or clusters of herbs that'll add. [01:04:17] Speaker A: Into the other formula. [01:04:18] Speaker F: Right, right. [01:04:19] Speaker B: It depends. Also, I will say on the level. [01:04:21] Speaker A: That you're dealing with. [01:04:22] Speaker B: So in our case that we're talking. [01:04:24] Speaker A: About, let's, we've added in a little bit of heat. [01:04:26] Speaker D: Right. [01:04:26] Speaker A: So our patient periodically has burning with the stool and, you know, whatever. I'm going to take that same sajinta tong Ping Weisan, and I'm going to. [01:04:36] Speaker B: Stick a little bit Huang lian in. [01:04:38] Speaker A: It, or maybe a little jerzy or maybe a little Huang chin Huang by. [01:04:42] Speaker B: Huang Lian triple Huang approach. [01:04:45] Speaker A: And that can depend on what the other factors are. But, like, in this simple case that. [01:04:49] Speaker B: I'm talking about, I'd actually probably just. [01:04:50] Speaker A: Start with some jerza. Okay. [01:04:53] Speaker D: Right. [01:04:53] Speaker B: Because it's not very strong. It's not, it's intermittent. The tongue's not red. I'm gonna put some maimondang in this formula because he has a cinnacrack. [01:05:01] Speaker A: I'm gonna put a little bit jerzale, like, like 3%, maybe less. Just a little taste. [01:05:08] Speaker C: Yeah. [01:05:08] Speaker B: And if anybody's ever had jerza before, jerza is pretty bitter. [01:05:11] Speaker A: Yeah. [01:05:12] Speaker B: And it stands out a lot in a formula. Like, even you put 3% of drizzle. [01:05:15] Speaker A: In the formula, like, oh, a little better. Right. [01:05:18] Speaker B: And even more so with Huanglian. [01:05:20] Speaker D: Right, right. [01:05:21] Speaker A: I think of. [01:05:22] Speaker B: So let's talk a minute about the huangs. [01:05:24] Speaker A: Since we're talking about heat. I think this is an important one. A lot of digestive formulas. [01:05:27] Speaker B: You'll see combinations of Huang Chen Huang. [01:05:30] Speaker A: By Huanglian in various iterations. You can read a lot of people's opinions on, like, where they work and how. [01:05:36] Speaker D: Right. [01:05:36] Speaker A: I think the sort of classic example. [01:05:38] Speaker B: That Huang Qin is a little bit upper, right. [01:05:41] Speaker A: Whereas Huang Bai is a little bit lower. And Huang lian tends to work in the guts. I think it's pretty accurate. [01:05:47] Speaker D: Right. [01:05:48] Speaker A: So if you've got, you know, upper respiratory tract infection, probably Huang Chin. [01:05:52] Speaker D: Right. [01:05:53] Speaker A: If you've got bladder infection, genital genitourinary problems, probably Huang Bai, you got something in your guts, probably Huang Liang. In practice, a lot of them just get combined, right? [01:06:03] Speaker C: Because like formulas combine them, you get a ban Sha shae shintong, you have function, Huang Lian. [01:06:10] Speaker A: Right, exactly, exactly. And like, if you, if you have access to a bulk formula, I would bulk pharmacy, I would definitely recommend. Go and check this out. [01:06:18] Speaker B: Go and taste them. [01:06:19] Speaker C: Yeah. [01:06:19] Speaker A: Because they're really different. [01:06:21] Speaker B: Like, yes, they're all bitter, they're all. [01:06:23] Speaker A: Yellow, although actually really good. Huanglian is actually almost orange coloration. But Huanglian is crazy bitter. Yeah, like crazy crazy bitter. [01:06:32] Speaker B: Like not quite long dan sao bitter. [01:06:33] Speaker A: But like, pretty close. So it's amazing for quickly just obliterating. [01:06:40] Speaker B: Heat accumulation in the guts. [01:06:42] Speaker D: Right. [01:06:42] Speaker B: But at a small percentage, and frankly, in my opinion, only when the heat. [01:06:46] Speaker A: Is strong enough to warrant it because it's very cold. And so you can throw that into a situation and actually exacerbate lower jowl problems if you're not judicious about its use. [01:06:56] Speaker F: Right. [01:06:56] Speaker B: So I start with Jerza, because Jerza. [01:06:59] Speaker A: Isn'T like a, not a lower gel. [01:07:01] Speaker B: Herb or anything, but it's the sort. [01:07:02] Speaker A: Of heat from stagnation works in all three jows. [01:07:06] Speaker B: Like, it's a kind of good starter herb for heat. [01:07:09] Speaker A: That's probably a byproduct of damp accumulation. [01:07:11] Speaker E: Yeah. [01:07:12] Speaker A: Right. [01:07:12] Speaker B: So just, poof. [01:07:13] Speaker A: Little Jerzo, right? Patient, comes back to me and says, yeah, I feel a lot better. You know what I mean? [01:07:21] Speaker B: Here's the other thing, expectations. How much turnaround are we talking about? [01:07:24] Speaker A: Not a week. A week is not enough time. [01:07:27] Speaker B: So I write the formula for one week as a tester just to make sure this isn't going to, like, completely. [01:07:32] Speaker A: Knock them off, you know, their normal path. And then they come back and say. [01:07:36] Speaker B: Yeah, it was well tolerated, no issues. I feel okay when I take it. Awesome. [01:07:40] Speaker A: Take this for three more weeks and. [01:07:41] Speaker B: Let me see you after a month. [01:07:42] Speaker E: Yeah, yeah. [01:07:44] Speaker A: This is important, right? Because digestive stuff is slow. It's going to take some time when. [01:07:50] Speaker B: They come back in, in a month. Now, I'll also say in the intervening time, I probably would have sent them home with a food journal. [01:07:57] Speaker E: Yeah. [01:07:58] Speaker D: Right. [01:07:58] Speaker A: So when they come back at that week, you know, they've had the herbs for a week. They filled out a food journal for the week. I'm going to look at it assuming. [01:08:05] Speaker B: That its formula was well tolerated. We don't need to talk about the. [01:08:08] Speaker A: Herbs so much their case anymore. [01:08:09] Speaker B: I'm going to take most of the. [01:08:10] Speaker A: Time in that meeting and talk about their food. [01:08:13] Speaker E: Yeah. [01:08:14] Speaker B: Because my goal is digestive herbs in a non acute flare situation. [01:08:20] Speaker A: What I mean is, like, you're not currently in stabbing abdominal pain with bleeding poops every time you eat. [01:08:26] Speaker D: Right. [01:08:26] Speaker B: But you have something else going on. What my goal is with herbs is to essentially give your spleen and your middle jowl enough bandwidth to start to recover. [01:08:37] Speaker E: Yeah. [01:08:38] Speaker D: Right. [01:08:39] Speaker B: There is no amount, I'm going to stress this heavily. There are no amount of herbs on. [01:08:44] Speaker A: The planet that can overcome problematic dietary habits. [01:08:50] Speaker C: That's so true, period. [01:08:52] Speaker E: Yeah. [01:08:53] Speaker A: Like, you can take these herbs and you can start to feel better, but. [01:08:56] Speaker B: If you don't start to make changes, these herbs will only ever be a holding pattern. [01:09:02] Speaker E: Yeah. [01:09:02] Speaker B: Will never solve the problem. If you stop taking them, everything will come back. [01:09:06] Speaker A: And at some point, their ability to. [01:09:09] Speaker B: Change the pattern for the better will diminishe. [01:09:11] Speaker E: Yeah. [01:09:12] Speaker B: Like, they won't always be good because the problem's getting worse. The herbs are just holding. [01:09:16] Speaker A: They're like, pressing up against the dam, being like, don't break. Don't break. You know, but, like, it will at some point. So, you know, all the way back. [01:09:24] Speaker B: To when we first started, and I said, don't moralize your food choices. I stand very strongly by that. [01:09:29] Speaker A: But that also doesn't mean you don't have to do anything about it. [01:09:31] Speaker F: Right. [01:09:31] Speaker D: Right. [01:09:31] Speaker A: It's slow, it's habits. It takes time. So I talk with patients a lot about that in the second round. Right. What are we talking about in chinese medicine? What does nutrition really look like? [01:09:42] Speaker B: And I will say that that is. [01:09:44] Speaker A: An unbelievable rabbit hole for all the practitioners out there. A lot of books, a lot of discussion, a lot of people disagree. A lot of stuff you can recommend to people. There's like, all these chinese medicine, nutrition, cookbooks. Right? [01:09:56] Speaker C: Oh, my God. [01:09:57] Speaker A: Ancient wisdom, modern kitchen, which I will say actually is a great book. If you already know how to cook. [01:10:03] Speaker B: You only want to eat asian food. [01:10:05] Speaker C: Yeah. [01:10:05] Speaker D: Right. [01:10:06] Speaker A: But, like, most people don't. So, like, if you tell someone, like. [01:10:09] Speaker B: Oh, I need you to eat more millet and some lotus root or this. [01:10:13] Speaker A: Is something I see all the time for nutrition. [01:10:15] Speaker B: People will hand a patient a list of foods. [01:10:17] Speaker E: Yeah. [01:10:18] Speaker A: Right. Okay, so we need to have more. [01:10:20] Speaker B: Burdock and spinach and winter melon. [01:10:24] Speaker A: And it's just a list, right, y'all, nobody knows what the hell to do with that, right? [01:10:29] Speaker B: That is worthless and advice. [01:10:31] Speaker A: I'm just going to come out and say it right now. [01:10:32] Speaker B: It's worthless advice. [01:10:33] Speaker E: Yeah. [01:10:33] Speaker A: Like telling someone they just need to eat more millet, who mostly eats, like, spaghetti and meatballs and gets a burrito from the food truck is worthless advice. [01:10:43] Speaker E: Yeah. [01:10:43] Speaker B: So if you're going to get into. [01:10:45] Speaker A: Nutrition, which you need to, if you're doing digestive work, you need to start figuring out what for yourself is going to be helpful. [01:10:52] Speaker B: Over the years that we've been a. [01:10:53] Speaker A: Root and branch, I've created recipes, I've created explainer packets. So it's like, this is a damp heat diet. [01:11:00] Speaker B: What is damp heat? [01:11:01] Speaker A: What does it look like? How does it represent in your condition? [01:11:04] Speaker B: Here's some lists of foods. I do still include lists. These are foods that we want to minimize. [01:11:09] Speaker A: That's the way that I use things. Minimize. I never tell people, don't eat this, it's bad for you. It's going to hurt you. Because remember, as we know, in chinese nutrition, in chinese medicine, there is no bad food. [01:11:22] Speaker F: Right. [01:11:23] Speaker B: It doesn't exist. There are just foods that will make. [01:11:25] Speaker A: Your problems worse now. [01:11:27] Speaker E: Exactly. [01:11:28] Speaker B: But maybe not in the future. So here's the list of foods that you should minimize. Here's the list of foods you should maximize. [01:11:35] Speaker A: Here are five recipes that use these things, right? That you can cook on your own. [01:11:41] Speaker B: Here is a menu I give people. [01:11:42] Speaker A: A week menu, breakfast, lunch, and dinner. Here's a breakdown. [01:11:45] Speaker B: So in my damp heat packet, it's. [01:11:47] Speaker A: Like, okay, here's damped explanation. Here's how you should conceptualize your food. It's mostly vegetables with a little bit grain and a tiny bit of meat. [01:11:55] Speaker B: Here are good vegetables that'll help drain the dampness. Because again, you've already given them the theory. [01:12:00] Speaker A: You explained it to them in the beginning. [01:12:02] Speaker B: You walk them through macro rules, right? Now, here's some specific content. Here's some recipes. Here's a menu. [01:12:10] Speaker F: Right, right. [01:12:11] Speaker B: That information. [01:12:12] Speaker A: Now, how many of my patients really use it? Mixed bag, right? It's a mixed bag. Even with all that work, it's a mixed bag. [01:12:19] Speaker B: But I feel better handing someone an actual plan. [01:12:23] Speaker E: Yeah. [01:12:24] Speaker A: Because then we can talk about implementing a plan. [01:12:26] Speaker B: If I give you a list of ingredients that says you should eat more. [01:12:29] Speaker A: Millet and burdock root, what's their expectation that that's really gonna do anything? Yeah, maybe you went to the asian. [01:12:34] Speaker B: Store by your house, and you bought. [01:12:35] Speaker A: A burdock root, and you got home, you're like, what the hell do I do with this? [01:12:37] Speaker F: Right, right. [01:12:38] Speaker B: So now you're frustrated, and I'm frustrated. [01:12:40] Speaker A: And nothing's changing in digestion, right? So that's one of the places that you need to talk to people about it. [01:12:46] Speaker B: So, okay, write the formula for a week. [01:12:47] Speaker A: They come back, everything is great. We spend most of the time talking about the food, and then I say. [01:12:51] Speaker B: Now go and practice. [01:12:52] Speaker A: Yeah, right. [01:12:53] Speaker B: Go home, you know, eat and be merry. [01:12:56] Speaker A: Like, I want you to just go. [01:12:58] Speaker B: And take your herbs, and I want you to play with this stuff. And I remind them, like, look, I want you to practice with making these changes in the diet. [01:13:04] Speaker A: Don't try to do it all at once. I usually set up a plan, an. [01:13:07] Speaker B: Incremental plan with people, okay? And this week, we want to try this. [01:13:10] Speaker A: Then two weeks later, when I try this, right? Try and create something that's accomplishable. [01:13:16] Speaker B: Success in digestive matters is, of course. [01:13:19] Speaker A: Dependent on good diagnosis and a good formula. [01:13:22] Speaker B: But a lot of it has to. [01:13:23] Speaker A: Do with helping people reframe their narrative. Like we talked about in the beginning, reframe the idea of, like, what is my relationship to food? What is my appetite? Like, how do I decide what to eat and when? [01:13:34] Speaker B: Where does it fit in my schedule? [01:13:36] Speaker D: Right? [01:13:37] Speaker B: If you try to give that to. [01:13:39] Speaker A: Everybody that you see all at once, it almost never works. [01:13:43] Speaker E: Yeah, yeah. [01:13:44] Speaker B: It's too much. [01:13:45] Speaker C: It's too much. In fact, maybe we should have an extra episode where we just talk about food and dietetics. [01:13:51] Speaker A: Yeah, that'd be cool, because I think. [01:13:52] Speaker C: I think a lot of practitioners out there would like to use more chinese medicine principles for dietetics. [01:13:59] Speaker A: But don't. [01:14:00] Speaker C: Don't really know where to begin. Like, oh, they have a damp problem, so don't eat dairy and don't eat sugar. Like, is about as far as you get. [01:14:09] Speaker B: But here, have some congee. [01:14:10] Speaker A: It's easy to digest. [01:14:13] Speaker C: Travis K. Has a thing against kanji. Not a big congee fan over here. [01:14:19] Speaker A: It's disgusting. I know all you kanji lovers out there, look, can't do it. [01:14:23] Speaker B: And, you know, it's funny. [01:14:24] Speaker A: Rice is, like, my favorite food. [01:14:25] Speaker E: Yeah, yeah. [01:14:26] Speaker A: Rice and potatoes, like, my favorite food. But kanji can't do it. [01:14:29] Speaker E: Yeah. [01:14:30] Speaker A: Yeah. I think that'd actually be a great idea. Give people some more ideas specifically about how to use it, because it is a huge. I mean, it's an entire sub discipline, right? It is. [01:14:40] Speaker C: It is. And, like, when I speak to my patients about food. I try to make suggestions, simple and pivotal. Like, I try to find little things that I can say, okay, I want you to try this this week. [01:14:57] Speaker A: Do this. [01:14:58] Speaker C: And. And that seems to be better than to do the whole. Unless it's a particular type of person. [01:15:06] Speaker F: Right. [01:15:06] Speaker C: That they're like, all right, I'm ready. I want to, you know, come to Jesus. Yeah. Very, very rare. The other thing I would say is, if you don't want to talk to your patients about food at all, it's worth finding somebody else that you can refer to who will. Who will do it in a way. And this is where we've had trouble, who will do it in a way that's in concert with chinese medicine principles, very difficult to find. There's a lot of people who will, you know, well, I don't want to go down a rabbit hole about that, but just, you know, suffice it to say, there's a lot of ideas about what somebody should or should not be eating and bring. [01:15:50] Speaker A: And that's an important factor. You really have to when it comes. [01:15:54] Speaker B: To digestive disorder, because food is going. [01:15:57] Speaker A: To be part of the conversation. It's really important upon, like, for the. [01:16:02] Speaker B: Point of view from the practitioner to. [01:16:03] Speaker A: Approach that interaction with compassion and with. [01:16:06] Speaker B: Understanding and recognizing that your patient has. [01:16:09] Speaker A: Been told 40 different ways that they should eat. [01:16:11] Speaker D: Yeah, right. [01:16:12] Speaker A: There's this fad diet, there's whole 30. Whatever, you know, paleo, and then, you know, a blood type diet, and there's a million things. [01:16:20] Speaker B: Weight loss and wellness is a multibillion. [01:16:22] Speaker A: Dollar industry in America. It's a multi trillion dollar industry globally. Like, there's a lot of money made in telling people, buy my book, eat this way. Follow this YouTube channel. Right, right. And, I mean, I guess we're also telling people how to eat. So whatever. But, like, my point being is that. [01:16:37] Speaker B: You need to approach that interaction with. [01:16:39] Speaker A: The patient, with compassion, and understand that. [01:16:41] Speaker B: Like, they don't know what. [01:16:42] Speaker A: You know, they don't understand the principles at play, and they're hearing a lot of different stories, and so you gotta feel ashamed. [01:16:49] Speaker B: And they feel ashamed. [01:16:50] Speaker C: Usually people feel shame. [01:16:52] Speaker A: Yeah, because they're failing. That's the way they think about it. I'm failing. [01:16:57] Speaker B: I see other people who are thinner. [01:16:58] Speaker A: Than me, who don't have these issues, who don't have to run to the bathroom. Like, clearly, my willpower is wrong. [01:17:04] Speaker B: There's a lot of cultural shame wrapped into it. [01:17:07] Speaker A: So bringing compassion into the mix, I think, really matters a lot. [01:17:10] Speaker B: And, I mean, you're not deprecating, you're not pandering, but you're compassionate, passionate. [01:17:13] Speaker A: You're holding good professional space for those people, which I think really is important. And I want to also re hit on what you said there about simple but impactful advice. [01:17:23] Speaker B: Pivotal. Pivotal. [01:17:24] Speaker C: Something that can make a. [01:17:25] Speaker A: Pivotal. Great word. [01:17:27] Speaker B: My big one with that is cold, raw food. [01:17:29] Speaker C: Yes. [01:17:31] Speaker B: So many people. [01:17:32] Speaker C: Oh, man, we're going to piss so many people off. [01:17:35] Speaker B: I know, I'm sorry. [01:17:36] Speaker A: Raw foodists out there, but your shit's messing with people. I know. [01:17:40] Speaker B: Some, some people can. [01:17:41] Speaker D: Right. [01:17:42] Speaker A: I mean, here's the thing. [01:17:42] Speaker B: If you have a smoothie every morning. [01:17:44] Speaker E: Yeah. [01:17:45] Speaker D: Right. [01:17:45] Speaker B: And your poops are great and you're energized and everything, you don't need to do what I'm telling you, you don't have a problem. [01:17:51] Speaker F: Right. [01:17:51] Speaker B: Right. But if you have seven poops a day and they're loose and your energy. [01:17:55] Speaker A: Is low and you're uncomfortable and you have a smoothie for breakfast every morning, you need to stop. Yeah, stop with the smoothie. [01:18:01] Speaker E: Yep. [01:18:01] Speaker D: Right. [01:18:02] Speaker B: This, I'm going to say it again. [01:18:03] Speaker A: There are no bad foods, chinese medicine. [01:18:06] Speaker B: There are foods that will make your bat, your, your situation better or worse. [01:18:10] Speaker F: Right. [01:18:10] Speaker B: So if you don't have any problems. [01:18:11] Speaker A: And you have a smoothie, good for you. [01:18:13] Speaker B: Smoothie. Yeah. Many of us cannot do that. [01:18:16] Speaker E: Yeah. [01:18:16] Speaker D: Right. [01:18:17] Speaker B: And the thing is, is that people make their smoothie and they're like, oh, but it's full of all the good stuff. [01:18:20] Speaker F: Right? [01:18:21] Speaker A: Well, it's got twelve vegetables in it. [01:18:23] Speaker B: And the green powder and the red powder and the whatever. Magic mushroom mix. [01:18:27] Speaker E: Yeah. [01:18:27] Speaker A: You know, I don't know. Yeah. When I drink this going out in an hour, I get enough vegetables. [01:18:34] Speaker B: Like, you couldn't eat this many vegetables in five days. Right. [01:18:39] Speaker A: And you're like, well, you probably shouldn't drink. That's too much. You know what I mean? [01:18:43] Speaker C: Why do we think we need so much more? [01:18:46] Speaker D: Right. [01:18:46] Speaker C: Right. Is a whole another thing entirely, which. [01:18:49] Speaker A: You just need what you need. [01:18:51] Speaker E: Yeah. [01:18:51] Speaker C: You just need what you need. [01:18:53] Speaker A: Yeah. [01:18:53] Speaker B: So cold, raw is, I think that's. [01:18:55] Speaker A: One of the biggest ones for people who eat too much. Cold, raw. [01:18:57] Speaker E: Yeah. [01:18:58] Speaker A: Salad, you know, is another big one. [01:18:59] Speaker B: People are obsessed with salads. [01:19:01] Speaker A: You know, I have a huge salad at lunch every day. It's so healthy. Probably not in January, actually. [01:19:06] Speaker B: Not for you. [01:19:07] Speaker D: Right. [01:19:07] Speaker A: It's cold, you know, season. So again, this gets us into the details of, like, how we determine that. But targeted, simple instructions, tiered approaches for patients. Don't give them everything at once. Right? [01:19:18] Speaker B: Your herbs are giving them the bandwidth. [01:19:21] Speaker A: To expand into the space to start to make change. [01:19:25] Speaker B: And then the real heavy lifting, the. [01:19:27] Speaker A: Actual long term heavy lifting, is lifestyle change. That's really where the work is right now. Let's talk about if we have a more serious condition. [01:19:36] Speaker C: But before we get into that, I wanted to ask, because you mentioned Ping Wei san, one of the archetypical formulas, that it's powerful as a San, we've had amazing results with Ping Wei san. As, as I think we should talk about how that's administered and what the difference is in cost, how to give it to somebody. The length of cooking time is another thing that's important that people find interesting. So why don't you talk a little bit about that first? [01:20:06] Speaker B: So, in general, broad spectrum concepts for. [01:20:09] Speaker A: Sans in general compared to decoction, has to do with the grind of the herb. So if you think about, you make ping, we sand from whole herb and you put it in a, into the cottage pot and you cook it in order to extract well from that those. [01:20:22] Speaker B: Herbs, which are big hunks of stuff. [01:20:23] Speaker A: You have to cook them, right. They have to be hydrated, and they would be cooked 2030 minutes, maybe double boil. [01:20:29] Speaker B: That length of cooking will extract deeply from the herb, but it will also. [01:20:33] Speaker A: Cook out some of the yang qualities of that herb. [01:20:37] Speaker D: Right. [01:20:37] Speaker A: That sort of cutting, aromatic, strong qi quality will be boiled off. [01:20:42] Speaker F: Right. [01:20:43] Speaker B: Even if you didn't boil it hard. [01:20:44] Speaker A: Or whatever, it doesn't matter that much exposure to heat for that much time boils off. [01:20:49] Speaker F: Right. [01:20:50] Speaker B: In the case of a properly made saw and the way that we grind. [01:20:53] Speaker A: Them up here, we sort of do a coarse grind. [01:20:56] Speaker B: It's a little more than a crush. [01:20:57] Speaker A: But not really a grind and not a powder. And the reason is because I don't like drinking it. [01:21:02] Speaker F: Yeah, right. [01:21:03] Speaker A: True. The matter is, like, it goes through a fine mesh sieve if it's ground up really small, and then I have to drink it, and it's gross. A lot of people are like, but. [01:21:10] Speaker B: You have to drink the sun. [01:21:11] Speaker A: Now, you don't have a million opinions about this. [01:21:13] Speaker B: I don't think you need to. [01:21:13] Speaker A: We get great results without it. Like, you don't need to drink the powder. It's gross. [01:21:17] Speaker D: Right? [01:21:17] Speaker A: So you crush it up into, you. [01:21:19] Speaker B: Know, small bits, and then you have two options. [01:21:22] Speaker A: You can, the quickest way. [01:21:24] Speaker B: You know, I keep ping Wei san in a jar at home if I'm. [01:21:26] Speaker A: Having a little digestive stuff myself, and then I'll put, you know, usually between nine and I guess 16 grams into a serving. [01:21:34] Speaker D: Right. [01:21:35] Speaker A: Now, obviously, depending on the grind, the volume will be different. A tablespoon or two, something like that. [01:21:39] Speaker D: Right, right. [01:21:39] Speaker A: Just to give you a rough idea about how much that is. So I'll put, let's say 12 grams into a pot. I'm going to cover it with twelve to 16oz of water. I'm going to bring it to a boil, drop it to a simmer, simmer it for five minutes, strain and drink easy. [01:21:54] Speaker D: Right. [01:21:55] Speaker A: You don't have to boil it that way, though. [01:21:57] Speaker B: Another equally effective way to do it is to put your powder into a. [01:21:59] Speaker A: Thermos, like a double walled insulator thermos. Boil some water in the kettle, pour. [01:22:05] Speaker B: It into the thermos. [01:22:06] Speaker D: Right. [01:22:06] Speaker A: Probably about 30% more volume than you want in the end, because some of it's going to get absorbed by the powder. Right, right. So if you want to drink 12oz in the end, you should probably put about 16oz in there. [01:22:18] Speaker B: And then you seal it up top. [01:22:19] Speaker A: And let it sit on the counter. Now, minimum time, probably half an hour to overnight. Yeah. [01:22:26] Speaker F: Right. [01:22:26] Speaker A: Soak that sucker overnight if you want. [01:22:27] Speaker F: Right. [01:22:29] Speaker A: I think it's. I mean, if I need ping Weisan right now, practically, the boil method is the easiest. [01:22:34] Speaker C: Yeah, sure. [01:22:35] Speaker B: For a patient who's taking it consistently. [01:22:37] Speaker A: Though, as part of their regimen, the soaking method is actually probably easier because then it fits into their rhythm. [01:22:44] Speaker C: The thermos method seems to be, and we're playing around with this now with different formulas and stuff, but it seems to be relatively contained to not boil off too much extra stuff. [01:22:57] Speaker F: Right. [01:22:57] Speaker A: No, I don't think we lose anything. [01:22:59] Speaker C: But one of the cool things that I'm thinking of, particularly a case, one of yours and one of mine, that was a ping Weissan case. A while ago, a good friend of mine's wife came in after having some kind of an infection. I don't remember the context, but she was really suffering body aches and fever and all kinds of stuff going on. And I looked at her tongue and her tongue washing. Her tongue coating was so thick, it was like tofu. [01:23:29] Speaker D: Wow. [01:23:30] Speaker C: And I, like, I remembered, I don't remember who was talking about it, but tofu, like tongue coding, ping Wei sang was like, what came up in my memory is like, okay, we're gonna do ping Wei sang. We're gonna do it the real way. We're gonna grind it up into a song. We're gonna give it. [01:23:46] Speaker A: And the other. [01:23:46] Speaker C: The other benefit of this, by the way, is it's much cheaper. Like, way cheaper than granules. Way more effective, 100%. Like, you'll, you'll be surprised at how effective it is. And I had her take it, you know, just like Travis Kern described a moment ago and had her report back to me. And she took it the first two days and was doing much, much better. And then the third day she took it, and she was starting to feel a little dry. Right. So what I had her do is I actually had her cook it for longer right now. [01:24:22] Speaker B: What? [01:24:22] Speaker C: Like, instead of doing five minutes, do it ten minutes. [01:24:26] Speaker B: And. [01:24:26] Speaker C: And so she did that, and then she was able to take it, like, for the remainder of that week and continue to feel better and better. So that longer cook actually makes the formula weaker at transforming because you're cooking off more of the properties. [01:24:43] Speaker A: Absolutely. [01:24:43] Speaker C: So that's another way you can sort of play with san is the amount of time you're cooking for. [01:24:49] Speaker F: Right. [01:24:50] Speaker C: Will change the differential of effectiveness, especially for a formula that's bitter and pungent and aromatic, like ping Wei san. [01:24:58] Speaker D: Yeah. [01:24:58] Speaker C: Whereas wuling san maybe a little different. [01:25:00] Speaker B: No. [01:25:01] Speaker A: In fact, with Wuling san, it'd be. [01:25:03] Speaker B: Interesting to play with that, actually. [01:25:04] Speaker A: Wuling san might actually like a longer cook, might get you more. [01:25:07] Speaker F: Right. [01:25:08] Speaker A: Than a shorter cook. [01:25:09] Speaker B: Like anything that's aromatic. [01:25:10] Speaker D: Right. [01:25:10] Speaker E: Yeah. [01:25:10] Speaker B: Like when you smell penguins, I swear. [01:25:12] Speaker A: If you guys can go and get some ping, we sun ground, the smell is amazing. Anything that smells like that will be. [01:25:19] Speaker B: Diminished in drying yang capacity with longer cooking. [01:25:22] Speaker A: Yeah, it's just what's going to happen. [01:25:23] Speaker B: Like, the young aspects of herbs are, by their nature, effervescent. [01:25:28] Speaker A: Like, they will disappear, like, into the. [01:25:31] Speaker B: Ether, and heat will drive them off. [01:25:33] Speaker D: Right. [01:25:33] Speaker B: And that doesn't mean we're not suggesting you need to eat that shit raw. [01:25:37] Speaker D: Right? [01:25:38] Speaker A: That's not what I'm saying. Just because things have changed by heat. [01:25:41] Speaker B: Doesn'T mean heat's bad and everything should be raw. [01:25:43] Speaker A: It just gives you an idea about how that stuff changes relative to dosage and relative to cooking time and all that kind of stuff. [01:25:54] Speaker B: But the San piece is huge. [01:25:55] Speaker A: You know, nobody writes so many, few or so few people actually take sans as Sansa. It just doesn't seem to happen that much. And I think people are really missing out. [01:26:04] Speaker B: Right, right. And there's so much discussion that, like, well, bulk herbs are expensive. [01:26:08] Speaker D: Right? [01:26:08] Speaker B: And that's true. [01:26:08] Speaker A: Decoction is expensive, man. Like a full seven days of, like, a properly dosed shao chai hu Tang. [01:26:14] Speaker B: Whew. [01:26:14] Speaker A: Expensive. [01:26:15] Speaker E: Yeah. [01:26:16] Speaker B: That doesn't have to be the case with sans. [01:26:17] Speaker A: Right, Sinny san and Ping Weisan and all those guys, like, you can really, I mean, basically 12 grams a day. [01:26:24] Speaker B: Of finished ping Wei san here. [01:26:26] Speaker A: I mean, it's like a dollar. [01:26:27] Speaker E: Yeah. [01:26:28] Speaker F: Right. [01:26:28] Speaker B: You know what I mean? [01:26:29] Speaker A: Like, it's really, it's not expensive. And so that's the kind of thing where you can really do a whole lot with a lot less if you start to play around with those components, you know? [01:26:39] Speaker B: So the last thing I wanted to. [01:26:40] Speaker A: Throw in here, just because it comes. [01:26:42] Speaker B: Up more and more these days, is for more intense applications. [01:26:45] Speaker A: Right. So we've been talking about these, these four layers, the qi deficiency piece, the dampness piece, stagnation piece, and the heat piece. [01:26:54] Speaker D: Right? [01:26:54] Speaker A: And we've mentioned that the qi stagnation formula, or, excuse me, the qi deficiency formula that I think of first is sijinsetong, the damp transforming piece. Ping Weisan, the stagnation piece, we didn't talk about a lot directly, but a. [01:27:09] Speaker B: Lot of times, stuff like Ping Weisan, because it's aromatic and moving, can help manage that stagnation. [01:27:15] Speaker A: Yeah, but don't forget about other delightfully aromatic herbs like sha Ren, which is an amazing herb for just cutting through that damp stagnation. And then also Xiang fu as another. [01:27:31] Speaker B: One, especially most bulk xiang fu in. [01:27:33] Speaker A: Particular is vinegar fried. So there's already this sort of, like, sour, acrid quality from vinegar that's in there. And then we talked about some of. [01:27:40] Speaker B: The heat players, the three huangs. [01:27:42] Speaker A: Jerza. [01:27:44] Speaker B: When you start to get into more. [01:27:46] Speaker A: Serious, acute problems, like someone's in an ulcerative colitis flare, what does that look like? [01:27:51] Speaker B: Basically everything that they eat causes sharp abdominal pain. [01:27:56] Speaker A: Their appetite is incredibly low. [01:27:58] Speaker B: They tend to be flushed and hot. [01:28:00] Speaker A: Sometimes they can even have fever. And their bowel movements will be incredibly. [01:28:04] Speaker B: Painful and often bloody. The blood will tend to be bright in color. If you've got dark blood in color. [01:28:12] Speaker A: Now, you've actually probably got a bleeding. [01:28:14] Speaker B: Problem further up the line. [01:28:15] Speaker D: Right. [01:28:16] Speaker A: And so you've probably got, you know, it could be a lot of things. [01:28:19] Speaker B: If someone has dark blood in the. [01:28:20] Speaker A: Stool, you probably want to suggest that they go see their primary care for. [01:28:25] Speaker B: Some sort of scan. [01:28:26] Speaker E: Yeah. [01:28:26] Speaker A: Either a colonoscopy or an endoscopy, depending on where the bleed is, because there's. There's some bleeding upper in the system. [01:28:33] Speaker D: Right. [01:28:35] Speaker B: In the lower dowel situation, when the blood is bright. You've got to do something now to address the heat and the accumulation, the stagnation, or, excuse me, that the qi deficiency that's at the root of this. [01:28:46] Speaker A: Problem is not what you need to focus on in an acute flare, which. [01:28:51] Speaker B: Seems obvious, but I feel like a. [01:28:52] Speaker A: Lot of people are like, yeah, but. [01:28:53] Speaker B: We got to get at the root. [01:28:54] Speaker A: Yeah, it's like, nope, not right now. Yeah, you will definitely need to get. [01:28:58] Speaker B: At the root, but for the next. [01:28:59] Speaker A: Week to ten days to 14 days, we got to get this thing handled. [01:29:04] Speaker B: And so depending on the scale of. [01:29:06] Speaker A: That, you're definitely going to be using heat clears, right? [01:29:09] Speaker B: Definitely going to be in the Huang. [01:29:10] Speaker A: Space where you're going to start reaching. [01:29:13] Speaker B: Into a different set of herbs. [01:29:16] Speaker A: My favorite three herb formula. That isn't. It's not really a formula name, but it's just the three herbs. [01:29:22] Speaker C: Oh, it's like. [01:29:25] Speaker A: Which surprise is I ren fut and Baijiang Sal. [01:29:29] Speaker D: Right? [01:29:30] Speaker A: Which Travis and I have this ongoing joke that I think it's funny to. [01:29:32] Speaker B: Call those formula names because it's just. [01:29:34] Speaker A: A list of what's in the formula. [01:29:35] Speaker D: Right. [01:29:36] Speaker B: But you'll start finding your. [01:29:37] Speaker A: Your formulas will start to lean toward these other spaces, stop bleeding spaces, bland, astringent spaces, like with Eiren and Xiao and stuff like that. [01:29:52] Speaker B: So you'll find these chalky white herbs. [01:29:55] Speaker C: Like Tao Hua Tong is one of my favorites for. [01:29:59] Speaker A: Exactly. And I wouldn't say that, you know, I don't like to think about diagnosis. [01:30:04] Speaker B: As, like, well, for ulcerative colitis, we. [01:30:06] Speaker A: Always use this formula. [01:30:07] Speaker F: Right. [01:30:07] Speaker B: Because that's dumb. [01:30:08] Speaker A: Like, ulcerative colitis can look any number of ways with any number of subtle pieces. So I don't have a specific formula to reach for to say, hey, look at this one first. But I do want to say you need to focus on the excess acute presentation first. So leave Sejin Zitang off the table. [01:30:25] Speaker B: Also, Ping Weisan is probably a little. [01:30:27] Speaker A: Bit too warm and accurate and moving for that. You're looking to transform dampness, stop bleeding, and get rid of heat. And so that's going to be more in the white chalky herbs. Right, Fu Ling. I, Ren Shanyao, you're going to be looking at potentially stop bleeding or because we love chinese medicine, blood moving herbs, because the heat can cause the blood to stagnate, which goes back and forth. [01:30:53] Speaker B: So we could have a whole conversation. [01:30:55] Speaker A: On dealing with those more intense acute scenarios. But a couple of herbs that I want to put into everybody's mind when you're seeing that, right. Is Yi Ren shanyao. Fu Ling, look at Baijiang Sao again and how it sort of interacts in that space. There's even some room for aye in some of those formulas. [01:31:16] Speaker B: And then how are you gonna balance your huang? [01:31:19] Speaker D: Right. [01:31:20] Speaker A: Are we just trying to transform the. [01:31:22] Speaker B: Heat in the colon itself with Huanglian, or do we need to actually push. [01:31:25] Speaker A: That heat out with Dahuang? [01:31:27] Speaker D: Right. [01:31:28] Speaker A: And so Dahuang is almost always going. [01:31:30] Speaker B: To be in those early stage formulas. [01:31:31] Speaker A: Maybe just for, like, three, four days. They don't need to take Dahuang formula necessarily for five days. [01:31:37] Speaker D: Right. [01:31:37] Speaker A: And, you know, a lot of people think about dahuang as an intense purgative, mostly because of, like, dachongitang, but really, Maan Shao is the thing that's driving hard on the loose liquid bowel Dawang. [01:31:51] Speaker B: Is purgative, but it's not like your. [01:31:53] Speaker A: Pants will explode from. It's so overrated. [01:31:56] Speaker D: Right. [01:31:56] Speaker B: Also, the longer you cook dahuang, the less potent it is. [01:32:00] Speaker A: So if you just use a small. [01:32:02] Speaker B: Amount, short boiled, you're going to get more purgation. [01:32:04] Speaker D: Right. [01:32:05] Speaker A: More heat clearing, longer cook, less purgation. [01:32:08] Speaker B: Pre cooked like wine, cooked off on even less pure. [01:32:12] Speaker A: Right. Heat clearing. [01:32:13] Speaker B: So there's ways to moderate it, just. [01:32:15] Speaker A: Like we were talking about with the ping Wei san. But almost certainly, your acute presentation is. [01:32:21] Speaker B: Going to include middle jow heat clearers. [01:32:24] Speaker A: One of the huangs, plus dahuang. [01:32:27] Speaker D: Right. [01:32:27] Speaker A: And then some chalky herbs to manage that sort of damp accumulation and some of the bleeding that's happening there. So there's some astringency going on. [01:32:35] Speaker D: Right. [01:32:35] Speaker A: So put those into your mix if you've got an acute case in front of you. [01:32:40] Speaker B: Also, if you got an acute case. [01:32:41] Speaker A: And you're not sure what's going on. [01:32:42] Speaker B: Send us an email. [01:32:42] Speaker D: Right. [01:32:43] Speaker A: I'm more than happy to look at a specific case. We talk in generalizations in this podcast, right, to just sort of give people a sense of what's going on. [01:32:50] Speaker B: But anybody who does what we do. [01:32:52] Speaker A: Knows generalizations can only really take you so far. [01:32:55] Speaker C: So what about, like, formula? Like, what formulas do you think of for those cases? So we mentioned I fuzzi Baijung san, I would say, right from my practice, I'm looking at, like, gansao Shen Tong with maybe a mod to a pao Zhang instead of a ganjang. [01:33:15] Speaker A: That's a great mod. Yeah. Especially if there's a lot of blood. [01:33:18] Speaker C: Yeah, if there's a lot of blood. Plus, the taoho tongue is really good for acute bleeding. And that's gonna be more. That's gonna be a deeper kind of bleeding, like a more taxed presentation. And then the opposite of that that has, like, cold involved. There's going to be your baijung san, because you have futza in that formula as well as the Iiren and the baijung Sao. [01:33:43] Speaker F: Right. [01:33:44] Speaker C: Baijung Sao is going to be cooler, but the futs is going to be warmer. So you're seeing, like, this deeper deficiency that's in place for that formula that needs warming, but you also need to clear the acute heat that's. That's coming up with. With the. With the formation of the abscess. [01:34:03] Speaker B: And that's a great example of mixed pattern. [01:34:05] Speaker D: Yeah, right. [01:34:06] Speaker C: Because a lot of these patterns are mixed. [01:34:08] Speaker A: A lot of them are mixed. [01:34:09] Speaker B: And then you can also add to. [01:34:11] Speaker A: That the, you know, wood overacting completely unmanaged can, in certain people with a tendency toward damp accumulation and other things, find that space here too. [01:34:21] Speaker D: Right. [01:34:21] Speaker A: Where all of a sudden, like, the liver would factor the high anxiety stress pattern, that sort of cheese stack pattern, and spill over into earth and bring that heat with it. [01:34:33] Speaker F: Right. [01:34:33] Speaker A: So, you know, Shia San could find its way even in a mixed pattern there too. So there's definitely a lot of stuff to consider. I think, you know, for. [01:34:44] Speaker B: Most of the. [01:34:46] Speaker A: I'm trying to think about all the. [01:34:47] Speaker B: Cases that I've seen so far for ulcerative colitis. [01:34:49] Speaker A: I think almost all of them are qiyang deficient people who have ended up with enough damp accumulation and stagnation that we got heat from it. [01:35:00] Speaker B: So the heat clear. [01:35:02] Speaker A: So I will probably write something like the. If we want to think about that as a base. I mean, it's a three year formula, but, like, okay, that's the base. [01:35:11] Speaker B: And then we're gonna go from there and say, okay, we need to add. [01:35:14] Speaker A: In whatever else is in play. So probably we've got some da huang, probably we're going to add in some xiao, some baiju, some stuff like that. So start cobbling together a formula from. [01:35:26] Speaker B: Composite parts as opposed to having, like. [01:35:30] Speaker A: A sort of iconic formula as a starting point. And that's mostly because, again, I don't find, in my experience, at least, I haven't seen enough consistent consistency to be like, oh, yeah, let's always go for, I don't know what, like, oh, ping Wei sun again, plus guypitang, plus whatever. Like, there's too many moving parts to sort of, like, figure out what's going on. And the real goal is acute relief, right? [01:35:56] Speaker E: Yeah. [01:35:56] Speaker D: Right. [01:35:57] Speaker B: And an acute relief, I need something. [01:35:59] Speaker A: That'S gonna be punchy and fast, and you need to stay on top of it. [01:36:02] Speaker D: Right. [01:36:02] Speaker A: You need to talk with the patient. You need to let them know what to expect, you know, that kind of thing. But in many cases, it's like, let's. [01:36:09] Speaker B: You know, deal with the deep cold. [01:36:11] Speaker A: In the futza, but really everything else in this formula is dealing with the acute presentation. [01:36:17] Speaker F: Right. [01:36:17] Speaker B: So the futsa in that setup is. [01:36:19] Speaker A: Really like, that's the nod to the root. [01:36:21] Speaker F: Right. [01:36:21] Speaker C: That is the nod to the root. [01:36:22] Speaker A: That's the nod to the root. [01:36:23] Speaker B: Everything else that we deal with is the branch. [01:36:26] Speaker F: Right. [01:36:26] Speaker D: Right. [01:36:26] Speaker B: Because that is the real problem. [01:36:27] Speaker E: Yeah. [01:36:28] Speaker B: And then once that shit is handled. [01:36:30] Speaker A: Now, we can say, okay, let's get back at addressing the problem, which might be a foods formula. [01:36:35] Speaker F: Right. [01:36:36] Speaker D: Right. [01:36:36] Speaker A: Because if there's that much cold and that's maybe the way we need to go. But ultimately, I think for those acute level presentations, I have built formulas from collections of singles. [01:36:46] Speaker E: Yeah. [01:36:47] Speaker A: You know, as primary thrust. Okay, well, we've gone on and on. [01:36:52] Speaker B: About a variety of the lower middle patterns. The lower middle patterns. [01:36:57] Speaker A: Yeah, lower middle jaw patterns, such as it were. We'll write a secondary book. So we're gonna. I think we'll hold it here for. [01:37:05] Speaker B: Now, and then we're gonna get into. [01:37:06] Speaker A: Some other middle jaw stuff in future episodes. So stay tuned for that. [01:37:10] Speaker B: As I mentioned, if you have specific cases that you want to send us. [01:37:13] Speaker A: For us to take a look at, you can always send an email to info. That's infotandbranchpdx.com. and you can visit our pharmacy website if you're interested as a practitioner out there using our pharmacy to build herbal formulas, you can find that from rootandbranchpharmacy.com. it's all spelled out, rootandbranchpharmacy.com. and you can read about our pharmacy. [01:37:36] Speaker B: You can make an account. [01:37:37] Speaker A: We ship herbs all across the US to Canada and even as far away as Australia. So if you're out there listening, we can send herbs to all of those places. And if you're in a place that's different than that, we can probably figure. [01:37:49] Speaker B: Out how to send it to you too. [01:37:51] Speaker A: So let us know if you have any questions. And I think that's about it. [01:37:57] Speaker C: People would have any topics that they'd be interested, like they'd want to discuss in the future and keep our topic job a little bit easier. [01:38:05] Speaker A: Yeah, absolutely. If you have stuff, cases out there or something you've been worrying about or. Yeah, just a general discussion. We're always open to new ideas. [01:38:13] Speaker B: And you can send it to the. [01:38:13] Speaker A: Same email address, infoertbranchpdx.com. and we look forward to hearing from you. So. All right, I think that's it. This is Travis Kern and Travis Cunningham. And thanks for listening to the nervous herbalist. We'll see you guys before long. [01:38:27] Speaker B: See you next time.