Treating the Middle Pt 2 - "Upper" 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. Okay, everyone, welcome back to another episode of the nervous Herbalist. I am one of your hosts, Travis Kernan. [00:00:25] Speaker B: And I'm Travis Cunningham. [00:00:27] Speaker A: And today we are going to finish our conversation about the middle jow. Some of the things that ail the middle jow. If you listen to the episode right before this one, you would have heard us talk about this idea of an upper middle jow and a lower middle jow. And we spent a lot of time last time talking about the lower middle jow. And I just kind of want to relay out that concept for everyone who's maybe forgotten what we talked about last time or is joining us for the first time. So the distinction between an upper middle jow and a lower middle jow is purely for the purpose of having this conversation. This is not a traditional distinction. I'm not even sure clinically if I would say that it's a useful way necessarily to think about it. But it's just there's so many things to talk about with regard to the middle zhao that I thought it was a good idea to maybe break them up. So lower middle Zhao, as we talked about it last time, is primarily dysfunctions of bowel movement, right? Some kind of pooping problem, right? [00:01:27] Speaker B: Yep. [00:01:28] Speaker A: And a lot of what we talked about were pooping problems that are connected to excess accumulations. So we talked a lot about dampness and heat and some of the other major factors that tend to cause loose stool, constipation, bleeding, et cetera. Right. Irritable bowel syndrome. We touched a little bit on deficiency patterns because, of course, as we all know, as practitioners of chinese medicine, it's very rare for something to be purely excess or purely deficiency. Right. Lot of mixture of things that happen. But in this case, we now today, as we talk about upper middle jowl problems, what's likely going to be the case is that we're going to talk a little bit more about deficiency presentations. The distinction that I'm making with the upper middle jow is problems of digestion, like indigestion, heartburn, abdominal pain. What causes those things and why? Again, just like with the lower middle jow problems, can, I can be deficiency or excess problems. Obviously, upper middle jowl problems can also be deficiency or excess problems. But I think we're going to spend a little bit more time today talking about middle jowl formulas that I use, that we use for deficiency presentations. Yeah, makes sense. [00:02:40] Speaker B: Makes sense. Makes sense. So why don't we jump into it then? So for our upper middle problems, one of the most common complaints that we see in the clinic has to do with heartburn or acid reflux, as we would put it more clinically. Right. So let's talk a little bit about that. What do you like to do for acid reflux or heartburn? What are the different patterns that you tend to see? What are the formulas you like to use? The strategies, approaches that there. [00:03:16] Speaker A: So if you dive into a machiocha or a clinical manual and you look at sections on heartburn, acid reflux, and I will say that firstly, patients have different understandings of what is heartburn? What is acid reflux? I've also seen kind of varying discussions in professional textbooks about what exactly is heartburn versus acid reflux. [00:03:41] Speaker B: Oh, sure. [00:03:41] Speaker A: Sometimes people treat them interchangeably. Sometimes people treat them differently. For our purposes, heartburn, acid reflux are discomfortable sensations experienced from like sort of epigastrum or sternum up to the throat and into the back of the throat. It can be substantive, like people have bile or small amounts of vomit that come up out of their throat, acid from their stomach. Or it can be insubstantive. Right. Where it's just hot and painful. Right. And nothing actually ever comes up, but they feel it. Both of those things I'm going to just interchangeably refer to as heartburn, acid reflux in this conversation. Regurgitation, where something actually comes up into your throat, in my experience, is an exacerbation of an underlying problem. So it's just like when it gets really bad, then we start to have also regurgitation. But so if you're listening, it's like, okay, they're just mixed. Like, we're going to use the terms interchangeably here. The thing is, when you go to the textbooks and you look at the first primary patterns, the patterns always are laid out. And, um, is excess patterns, right. And they're often laid out initially as heat patterns. So you have like a stomach heat excess pattern. Right. Which if you think about the presentation of something like acid reflux, that totally makes sense, right? Except that I almost never see that same. It just, it just doesn't happen. It just doesn't happen. [00:05:04] Speaker B: It's not that simple. [00:05:05] Speaker A: Yeah, exactly. Right. I mean, I guess I always think too, like, you know, when the classics were written and, and stuff was put together, the world was a really different place. And sort of what people ate, what they had access to what kinds of digestive problems? You know how when you look at the old books and even in Bensky that references old books, you'll see these childhood nutritional impairment problems. [00:05:27] Speaker B: Sure. Right. [00:05:28] Speaker A: Wasting and thirsting disorders and just these kinds of things that we don't see as contemporary practitioners in America or in the west and. Or are less significant problems among children or the elderly or even, you know, full blown adults than they used to be. So I think the stomach heat, you can see it. I'm not saying it's impossible, right. There are definitely some ruddy complected, robust, irritable people who are walking around with some stomach heat. A lot of times it's still not excess heat. Right. It's a false heat. It's a heat from deficiency. Right. From a stomach yin deficiency that's then causing this flaring fire. And that's really what we're going to talk about, I think, today, relative to this issue. Most of the time, when I see this problem, it is a deficiency problem. [00:06:16] Speaker B: Yeah. Yeah. And so explain how that would work for people who maybe aren't as familiar with that term. Like, how do we get an acid reflux situation from a deficiency picture? [00:06:31] Speaker A: So, of course, like so many things, there's a lot of ways that it can occur. Right. But one of the things that I see a lot that happens is you'll have a patient come in sort of classically, a little bit overweight, a little bit visibly damp. Right. So flesh is a little soft, a little bit edema, maybe. You know, they've got a thicker tongue coating, some swelling on the tongue. So you've got tooth marks. Right. It's pale, a little lethargic, little brain fog. Classic kidney spleen deficiency, dampness. And any iterations of that that you might expect. What happens with the heartburn aspect of it, in my mind, is an interesting complexity. Basically, your spleen is underperforming, and as it's underperforming, it's producing an excess of dampness. That dampness accumulates in all kinds of different places and that accumulation stagnates and that stagnation causes heat. Right? [00:07:29] Speaker B: Yeah. [00:07:30] Speaker A: Now, we all know that relationship, right? Sort of heat from stagnation. And that can look like phlegm accumulation in the throat. It can look like pain in the joints, it can look like problems with bowel movement, and it can also look like heartburn. The other thing that happens, though, what I find that heartburn is a real issue in those patients that I just described, the damp patients. It was kind of downstream it didn't happen. It wasn't the first thing. Heartburn wasn't the first thing. That would have shown me 15 years ago that they had a digestive problem. [00:07:56] Speaker B: Right? Sure. [00:07:57] Speaker A: It would have been lethargy, loose stool, loose musculature, that sort of thing. Right. But now the dampness has accumulated long enough and stagnated long enough that the heat has cooked long enough that now more substantive yin materials have been damaged. Okay? So for me, because I use a lot of. I spend a lot of time with tongues, I see that often as increasingly cracked center lines on tongues. So here the tongue comes out, it's flabby, it's pale, it's scalloped, it has a whitish coating and a center line crack. Right. It's not red, it's not speckled, it's not yellow, it's not dry. In fact, it's all the opposites of that. [00:08:42] Speaker B: Right? [00:08:42] Speaker A: Yeah, but it has a center line crack. [00:08:44] Speaker B: Right. [00:08:45] Speaker A: What is that about? In my experience, that is lurking damp heat that has damaged yin stuff. In this case, yin stomach yin. [00:08:53] Speaker B: Okay. [00:08:54] Speaker A: Right. [00:08:54] Speaker B: Okay. [00:08:55] Speaker A: So how do you deal with that? Dump a bunch of yin tonics in it. Ooh, no, no, no. You cannot do that because the person that I just described cannot metabolize sticky yin tonics. [00:09:09] Speaker B: Right. [00:09:09] Speaker A: Can't do it. [00:09:09] Speaker B: Yeah. So how do we, how do we deal with that situation? [00:09:13] Speaker A: So the core problem is a damped problem that is rooted fundamentally in a deficiency problem. [00:09:22] Speaker B: Right. [00:09:23] Speaker A: So this is where the style and the art of what we do comes in. Right. So my approach is I got to work mostly top down for a couple of reasons, right? One, the patient is in here because they have heartburn. And if I'm like, oh, well, don't worry, I'm going to fix your kidney yang deficiency. I may not get at the heartburn very quickly, and then they're going to wonder why they're seeing me in the first. So even though we want to get at root problems, you got to remember to deal with branches. I need to build a formula that's going to address some part of this axis yang deficiency. Spleen, qi, kidney yang deficiency. At its root, a subsequent damp heat and heat from stagnation in the middle. I'm talking about layers here. So bottom, middle, and at the top, heartburn. So I'm not going to write a formula that goes all the way to the root of first thing, right. Because it's just not going to get me where I need to go in terms of patient outcomes. So I'm going to pick a formula that's going to address some of the heat from stagnation, lingering, damp heat factor that's sitting in the literal stomach, and probably small intestine. And combine that with the classic pair of heartburn herbs that constitute Zhou Zhen one. Right. [00:10:33] Speaker B: Yeah. [00:10:33] Speaker A: So Zhou Zheng is Wu Juyu and Huang Liande. It tastes terrible. Right. I'll just, I'll just. [00:10:40] Speaker B: It's like the two worst tasting herbs ever. [00:10:42] Speaker A: It's super. [00:10:43] Speaker B: Maybe put some shiba in there if you really want to make it. [00:10:46] Speaker A: It's disgusting for gnarly, man. Like, super, super gnarly. Um, so Zojun Wan, Wu Ju and Huang Lian, where the ratios of those two Huanglian is like five or six times the value of the Wu juyu. Right. So for a per day dosage in bulk, you're probably looking at something like, I don't know, again, it depends on how bad the problem is, but you're probably looking at something to the tune of, I don't know, like, six to 9 grams of Huanglian and one or 2 grams of wujiu. [00:11:21] Speaker B: Okay. One to 2 grams of wujiu. [00:11:24] Speaker A: Yeah. Not much, you know, not much. The thing is, is that the original formulation was one, like an actual pill. [00:11:31] Speaker B: Sure, sure. [00:11:31] Speaker A: So you'd make pills using that ratio, that, like, one to six ratio, form them with honey, and then the patient would take a handful of pills. Right. So the actual, like, impact of the herbs is relatively small, but almost. No, I mean, in terms of weight, dosage. Right. But almost no one takes it like that anymore. So you gotta figure out a way to integrate this, like, kind of large difference between two ingredients in a way that isn't gonna blow the patient out of the water. [00:11:57] Speaker B: Right. [00:11:57] Speaker A: Because if you're writing a bulk formula and a patient's taking 9 grams of huangli in a day, that's a lot. [00:12:01] Speaker B: It is. [00:12:02] Speaker A: It's very bitter. [00:12:03] Speaker B: That's high Huang lian doses. [00:12:05] Speaker A: Very bitter. And it's going to be hard to drink. And it's very cold. Right. And while Wu juyu is very hot. Right. And it balances out the cold bitterness of the huangluyen, it's still a lot for a weaker body to take. Right. [00:12:18] Speaker B: And it's dispersive. Right. If you just use the super pungent of Wu Ju and then the bitter of Huanglian, there's nothing in there that's gonna, like, tonify, nothing that's going to slow it down. There's no sweet flavors in that. That formula. [00:12:32] Speaker A: Right, exactly. Exactly. And so I wonder, you know, I haven't. I haven't looked deeply into the classical origins of this formula, but I've often wondered to myself if Zo Jin Won was the omeprazole of the Tang dynasty. You know what I mean? Like, were they like, oh, shit. I just had, you know, this torto burrito equivalent of Tang dynasty China, some really spicy dandan noodles or something. And I have terrible heartburn now, so, like, let me pop a couple of zojin. One is the tums of the era I'm not sure I would love. This is the kind of stuff that, as you know, fascinates me. I'm fascinated by historical applications of things because we just get to inherit the formula, the ratio of math, even some of the clinical discussion. But practically, how are people using this stuff? I don't know what that means for our purposes, though, is, okay, I'm going to write a granule formula for this patient. My patient is probably going to take somewhere between twelve and 16 grams of granule per day. Right? And so when I'm thinking of how much of this zojin wan do I want as a percentage of the overall formula. Right. That's where the customization comes in. Right. So the patient's heartburn is out of control. So that means almost anything they eat causes heartburn. Not just triggers, like alcohol or spicy or greasy or sweet. Right. But just about anything causes it, then I'm probably going to make that zouzen 110% to 15% of the total weight of the formula. Right, okay. [00:13:59] Speaker B: Wow. [00:14:00] Speaker A: About 15%. Right. So practically, what that means, if you're, like, trying to. We're talking about this in this casual way, I think a lot of people don't think about their granules necessarily in these ratios. Right. But if I think that the core problem that this patient is experiencing is a spleen chi kidney yang deficiency that has turned into some damp heat that is now causing damage to stomach Ian and is therefore resulting in this heartburn. The layer of that formula, at its very base, conceptually, is Lijol wan. And then I'm gonna augment the lijong one with things that deal with heat from stagnation, so that if we didn't have heartburn, would probably still include Huanglian, jerza mu donpi. But since I actually have the Huanglian in the Zhoujian Wan, I'll probably just take my Li Zhong Wan, and I'm gonna add to it some mudan p and some djerza. Right. And then I'm gonna put in 10% of the total weight of the formula as Zo Zhen Wan, where the ratio between that is one part Wu Juyu, six parts Huang winden. [00:15:13] Speaker B: Okay, so the dosage is heavier on the bitter in terms of that than the pungent. But you also have ganjiang if you're using Lijiang Wan. You know, it occurs to me that that isn't that different from Wuzhuyutong. If you were to take the classical Wu Jutong and then add Huanglian into it, of course the difference would be the Wu juyu and Wu Juyu Tong, still quite a bit higher. But Wu Zhuyutong also has high dose of Xiangjiang. It has ren Shen in it, just with the addition of the Wu juyu being the primary aspect of the formula. But if you add the Huanglian into that formula, it's not that different, actually. [00:15:58] Speaker A: No. I mean, I think conceptually, you're getting into the same exact headspace. Right. Because, okay, what are we trying to do here? So we have dispersive action from the wuji. We have bitter action that's pretty dominant in that formula. Temperature wise, we are warming the middle, right? And a lot of people might be like, wait a minute. I thought the person has heartburn. [00:16:17] Speaker B: Right. [00:16:18] Speaker A: How are we warming the middle? [00:16:19] Speaker B: Exactly. [00:16:20] Speaker A: Okay, so let's step back for a second. A lot. So if you're out there dealing with heartburn patients, a lot of them are going to come in and they're going to be taking omeprazole. Right? So that's. Prilosec is one of the brands. Tagamet, maybe, I don't know. But omeprazole is the drug, right? Omeprazole was a drug that was originally designed for short term use of heartburn symptoms. So, like, two weeks or less. But for whatever reason, it's evolved into. Well, I know the reason. The reason is because there's no other solution that the bio meds have handy. So they just go ahead and throw omeprazole at a problem. Omeprazole is a PPi, a proton pump inhibitor, which effectively turns off the acid production, or it limits the acid production. Inhibitor, your stomach. That logic, being a person with heartburn, has an excess of acid that is surging upward through their esophagus and causing the problem. I mean, the logic of that is sound, right. The thing is, though, is that we have found over time, and this is courtesy of some naturopaths that we know. And, you know, sometimes I'm a little critical of our naturopathic brethren, but they do real good work in this space where they're asking questions like, well, is it necessarily that there's too much acid, or could there be another problem for why the acid is getting into the esophagus? And lo and behold, it turns out that the esophageal sphincter, the opening between your stomach and your esophagus, one of the triggering aspects for the sphincter staying closed is registering a certain level of acid content in the stomach. So the cells on that sphincter register that the acid is surging and moving in the stomach, and so it tightens up so that the acid doesn't go into your esophagus. [00:17:59] Speaker B: Right. [00:18:00] Speaker A: But if the acid is either diluted in your stomach, so it's not very strong concentration, or is somehow overall lacking in total volume, the sphincter doesn't respond like it should and tighten as tightly. So all of a sudden, the actual problem that the person is having is too little acid or an acid of too light a concentration. The sphincter doesn't close, and so then the acid moves into their throat. Right. You hand that person a PPI or. [00:18:29] Speaker B: Tums or tissue tums over the counter. [00:18:31] Speaker A: Yeah, absolutely. Tums, or especially a daily dose of omeprazole, which reduces the production of acid in your stomach, when the actual problem was that your acid wasn't concentrated enough in the first place. And now the overall sensation of heartburn is less because the actual total acid in someone's throat is less. But the problem doesn't go away. [00:18:52] Speaker B: Right. [00:18:52] Speaker A: So you'll find all these people who take, you know, meprazole every day, but you can just buy a Costco now, like in. Yeah, you can just buy, like, a bucket. Here's a five gallon bucket of omeprazole. Oh, my God. [00:19:02] Speaker B: Of course you can. [00:19:03] Speaker A: Yeah. Along with your probiotic gummies or whatever. And so you can. You buy that stuff and take it. And so you got these people who are like, yeah, if I don't take myomeprazole at heartburn, it's terrible. But if I do take it, you know, it's better. But it's still there, right? Yeah, that's a pretty good indicator. Not always, but it's a pretty good indicator that you're dealing with what we would call a deficiency presentation, where there's cold in the middle jow because Qi and Yang are deficient, the actual maneuver is to warm, even though the symptom set is warm and hot. One of the over the counter naturopathic remedies for that low acid actually is the apple cider vinegar maneuver, where people will actually mix. I'm not sure what the ratio is. It's like a couple of teaspoons of apple cider vinegar and a couple ounces of water. And then you just drink it before a meal or once or twice a day, and then you're literally just trying to acidify your stomach environment. Interesting. Yeah. Some people find great results from that, but in many ways, it's similar to what we would be doing at a deeper level, where we're saying we need to warm and nourish this middle situation. So Li Zhong Wan plus djerton mudan p plus wuzhuyu 10% with Zojin Wan, 10%. Right. If I have a stomach crack, I'm also putting Mimang dong in that formula. [00:20:21] Speaker B: That's what you like to do with a crack. You always loves putting Maimond dong in. [00:20:26] Speaker A: With the center crack. I know, but there's a couple of reasons about it. One is Maimondong, at a relatively low dosage, is easily assimilated. Easily assimilated. Jesus. Can't talk even by people with a weak middle jow or a weaker middle jaw. Obviously, if you dump huge amounts of maimondang in the formula, it'll still be too sticky. But it's a great way to start to get at the yin problem without having to, like, fill someone's guts with something that's hard to digest. [00:20:53] Speaker B: Yeah, makes sense. [00:20:54] Speaker A: The other thing that I like about maimondang is that specifically target stomach yin. It is easy to digest, and it has a moderating effect on some of the harsher components of the formula. Because even though Lijiang Wan is a really balanced formula. Bye. Large ganjang can hit some people's digestion a little much, even if they need warming. The maimondang comes in and says, hey, everybody, let's chill out. Let's relax a little. Let's not get too crazy. So that is the combination of herbs that I like for the damp, heat derived, yin. Damaged, heat flaring presentation makes sense for the heartburn pattern. And I think your instinct about the Wu jutang is really on point. I mean, conceptually, it's the same idea. The Wu ju is certainly more potent there. I think Wu jutang is someplace that I would get into if I really thought there was some deep, abiding cold. [00:21:45] Speaker B: Yeah, absolutely. In the middle, that would be, like, more damp, more cold. And you know that there's the classical description of headaches, like, where you're, like, pressing your eyes all the way through your skull. You have such a bad headache, and you're vomiting out white froth is what the. [00:22:03] Speaker A: I'm certain that if you're vomiting white froth, you'll be in one of our clinics. Certain that's gonna happen. But, no, I think. I think that's exactly it. Right? Like, the level of cold is just so much more intense that you need that heat from the wujuyu. Because, you know, y'all, Wujiu is hot. [00:22:18] Speaker B: Wujiu is super hot. [00:22:20] Speaker A: If you have not recently played around with bulk wujuyu, find a bulk pharmacy near you. Ask if you can come play with their herbs and just get a handful and just smell it. Take the tiniest nibble. Yeah, the tiniest. [00:22:35] Speaker B: You don't even need a handful. Just a pinch, pinch of wujiu. [00:22:38] Speaker A: Bite off a little micro meter section, a little millimeter of wujiu, and chew on it, and you will know how hot that sucker is. [00:22:46] Speaker B: Yeah. [00:22:47] Speaker A: It also smells a little bit like skunks. [00:22:49] Speaker B: It does, yeah, it has a. And a little bit like cannabis. Like skunky weed. Yeah, kind of. [00:22:55] Speaker A: Yeah. Wujuyu's got a skunky weed quality, for sure, which you might want to prep your patients for, by the way. Sometimes I have some older patients that, like, pop open even a granule formula. Like, oh, this smells like weed. Like, don't worry, there's no weed in your. [00:23:07] Speaker B: We're not trying to get you stoned, at least not in that way. [00:23:09] Speaker A: Not in that way. Yeah, exactly. [00:23:11] Speaker B: So just to contrast that approach with kind of how I would handle a lot of acid reflux presentations, which is very similar, actually. It's just using different herbs. The first formula that I think of when somebody comes in complaining of heartburn or reflux is bansha sheshintang. And within bansha sheishintang, we have that same combination of warm pungent, which we have in the bansha and the ganjiang, and we also have Huanglian and huang chin. So we have this contrasting hot, acrid, and also cold bitter, both in the formula. And the ratio can be adjusted of those ingredients. And then we also have three herbs that are sweeter. You've got renshen, dazao, and zhuge. And in your version of the formula, if you're using the Lijong wan, you've got Ren Shen and Jurgan Sao in the formula. And then if you're adding in Maimondong, that's another sweet flavor. Right. So in some ways, it's balancing, I would imagine, pretty similarly. And then you're just adjusting the dosage, like if it seemed like there was more of a heat presentation for me and there's more chest symptoms, then I might change the formula to be more like Huanglian tang, which is just like banshee Shen Tong, but without, let's see, the dosages adjusted of the Huang qin is taken out. Guager is added in, the Huanglian goes up to nine. And so it's a little more bitter. And then there's a little bit of the guager aspect. If there's chest symptoms, if there's, like, palpitations or whatever going on in the. [00:24:53] Speaker A: Chest, I really like that ban cha chae Shenzhong has huang chin in it as well. [00:24:57] Speaker B: Yeah, it does. [00:24:58] Speaker A: You get that sort of multi axis Huang function. [00:25:01] Speaker B: Absolutely. [00:25:02] Speaker A: Which I think is really nice. And you can probably play, you know, because Ban cha cha shintong, I always think of, you know, what's the classic? It's like epigastric discomfort. Bancha sheit shantang. You know, like. [00:25:14] Speaker B: Yeah. [00:25:14] Speaker A: But I actually think in this case, like, the way that the heartburn can present, that really wins me over to the Huangchen aspect of Ban cha Shae Shintong is if there is, you know, some people experience their heartburn, like, in their throat. [00:25:27] Speaker B: Yeah, absolutely. [00:25:27] Speaker A: Right. [00:25:28] Speaker B: I feel like a stuck feeling in my throat. There's something that, like, I tongue esque. [00:25:33] Speaker A: You know, but then a lot of people feel it, like sub sternum. Right. And, like, when your sub sternum or, like, you know, just sort of distal to the sternum. Right. Right above what we really think of as, like, epigastrium. And that's where people feel the heat. I think Ban chao chai Shintong is actually better suited in a lot of ways, because the Huangchen and because the bansha and the bansha's descending sort of nature there. [00:25:56] Speaker B: Yeah. [00:25:57] Speaker A: And it also, I think bansha Shesenson tang sings well when you have a regurgitative aspect. [00:26:02] Speaker B: Yeah, absolutely. [00:26:03] Speaker A: Like, if there's. If there's regurgitation and nausea, like bachao sheshintang, I think, really works in that space. But I like how you pointed out that, like, sort of flavor and nature wise, they're working in the same. [00:26:16] Speaker B: They're working in the same jam in the same space. And even there's a modification of Huang lian tang, which is that we're up in the dos of Huanglian, where you. It's called, like, arjia Huanglian tong or something like that, where you add in Wu Juyu. So you're almost like, halfway to that same formula. If you look at it that way. [00:26:38] Speaker A: Yeah, well, and that really gets to, one of the things that you've been working on, sort of research wise, separately, is just sort of what really are the nature and flavors, compositions of the formulas that we think about and how much substitution or modification is available. One of the things that people we talk to about herbs, one of the things they struggle with is like, well, when should I use ban cha chai Shintong, as you've described it? And when should I use, you know, Travis Kern's modification? Come on. How am I supposed to know? I don't know that it matters, you. [00:27:16] Speaker B: Know, like, you gravitate toward a thinking space. [00:27:19] Speaker A: Yeah, I believe. [00:27:20] Speaker B: And then you fill in, like, the formulas and you see what's required from that perspective. And then I. It probably doesn't matter what you choose too much. [00:27:29] Speaker A: I mean, not specifically. Right. I mean, you know, you're as a, as a provider and an herbalist, you're going to pick herbs that you like. First of all, that you have relationships with that you've seen work for you. Right. You're also, in many cases, going to have to pick what's available. [00:27:42] Speaker B: Yep. [00:27:43] Speaker A: Which, for the moment, we have quite a diversity of choice. [00:27:46] Speaker B: Yep. [00:27:47] Speaker A: But geopolitics being what they are and the nature of climate change in the world being what it is, I don't know that over the course of our whole lives, we're going to have access to what we have access to now. And so that creates a real need to think about and understand how can you substitute. Right. And, yeah, of course, some herbs have unique qualities. Many of our episodes so far, we talked about the unbelievable potency of an herb like Chihu. Right. And finding a substitute for chihu is tough. But thinking about how Chihu functions in a formula in nature and flavor wise, and then substituting based on that principle is, I think, a lot more interesting. [00:28:24] Speaker B: Yeah. [00:28:24] Speaker A: Right. And so with these upper middle jaw problems that we're talking about, like, what are we trying to do? Well, we're trying to disperse accumulation. We're trying to drain and clear heat. Bitter. Bitter, exactly. So disperse, acrid, drain bitter. Right. And then nourish deficiency. Sweet. Right. And those three things together in a. In a well designed formula will not be overbearing in any of those three directions. Right. And that's really where the art of the composition comes in. And then you can rely on a classic composition like Bach, where this thinking has already been done, because that's actually really the rub, isn't it? The reason that we rely on a classical formula is not only because the classical formula has shown its effectiveness over time. I mean, maybe that's the primary reason, but it's also because we are able to stand on the shoulders of giants of the past and, like, we don't have to. You don't have to think of bansha she shintang in terms of nature and flavor. You can just think of how Bansha Shesentang works on the patient. [00:29:25] Speaker B: Yeah. [00:29:26] Speaker A: But the nice thing about thinking about it that way is then you can start to see how it works. And, in fact, how similar the ban Cho Shesentang approach you described is to the Li Zhong Wan approach that I described. [00:29:37] Speaker B: Right. Yeah. [00:29:38] Speaker A: They're not really that far apart, even though their names are entirely different and they are composed of seemingly different herbs. [00:29:43] Speaker B: Absolutely. [00:29:44] Speaker A: But in fact, they're really working in the same space. [00:29:46] Speaker B: Yeah, yeah, I agree 100%. And just an image that comes to mind that I heard one of the Nugent heads describe once about the shayshent, because somebody was asking in one of their classes. [00:30:02] Speaker A: Andrew. Andrew and Julianne, they have their clinic in the Carolinas, right? [00:30:06] Speaker B: Yeah, yeah, yeah. They're in Asheville, I think. [00:30:08] Speaker A: Asheville. [00:30:09] Speaker B: They have an educational institute online, and you can do workshops with them. They're great. So you guys can check those guys out. But one of the things they say is it's a little bit like a truck gets stuck in the mud, like a tire stuck in the mud. And if you just use acrid, you're just pushing one way, whereas if you use the bitter and the acrid, you're, like, rocking it. You know how you can get stuff out of the mud easier? If you rock it back and forth and then get it going. That's a little bit like how they justify the usage of both of those flavors for this kind of approach, which I think is helpful to think about. [00:30:48] Speaker A: Yeah, yeah. That makes a lot of sense, especially because the, you know, I guess in some ways, you could think of acrid and bitter as opposites. Right. And I guess, I guess on a diagram they'd be opposites. And that rocking motion is, you know, forward and back, like, literally working on the seesaw action. Right. To get things going. Yeah. It's such an interesting. Such an interesting way to explain why the two things will work together. Because I think at an initial read, when you haven't thought about it too much, you'd be like, well, you won't combine opposite things. They'll cancel each other out. [00:31:19] Speaker B: Yeah, yeah, yeah. Who would want to combine yin and yang together? [00:31:23] Speaker A: Exactly. What a terrible idea I can't combine. They'll just cancel each other out. [00:31:28] Speaker B: Cancel each other out. In fact, they enhance the effect. And then, like, if you were to just acutely settle something, this is something I've, like, experimented on myself when I've had too much pizza or something. And, like, oh, you're laying down at night and, oof, still pretty full, and this isn't so good if you just have that acute blockage. I find that combining the pungent or the acrid flavor with a bitter flavor is enough. But if it's a chronic problem, if that's happening all the time, if that stuckness is happening all the time, you really need the sweet flavor to sort of, like, it's almost like clicking the save button on that effect. Right? Like, if you were typing a word document, the sweet is like saving the action, like helping the body to remember that action so that it can eventually do it on its own. Whereas if you just did pungent and bitter by itself, it would work to disperse the blockage, but probably only temporarily. [00:32:33] Speaker A: That's because the earth remembers, my friend. [00:32:35] Speaker B: The earth remembers. [00:32:36] Speaker A: Yes, it does. Exactly. Sweet flavor goes in there to say, like, oh, yeah, yeah, yeah. I know how we did that. Yeah, let's do that again. Yeah. It's actually one of the interesting things about a formula you mentioned, like, overdoing it on pizza or thanksgiving or something like that. And, like, the classic food stagnation formula, ba huan baohawan. [00:32:53] Speaker B: Yeah. [00:32:54] Speaker A: Which if all you listeners out there do not have a bottle of good quality ba Juan in your medicine cabinet, you are doing yourself a disservice for all the times when you did have too much pizza, too much ice cream, thanksgiving, etcetera. Because that sensation of, like, I'm completely blocked and stuck is remarkably influenced by taking some bajawan. [00:33:16] Speaker B: Absolutely. Yeah. [00:33:17] Speaker A: And if you get a. If you get real bahawan made from whole herb, you know, honey pill bajawan, when you open the bottle, the smell that will assault you when you open the bottle is the. Of radish seeds. Right. That acrid, explosive, kind of almost rotten vegetable, sulfurous component that you get from cabbage and, you know, radish and stuff like that. And. But that flavor is exactly the flavor that you need. [00:33:47] Speaker B: Just pushes out. Yeah, exactly. All that stuff. [00:33:50] Speaker A: Yeah. That's a great formula. I love Bajuan. We. We started making Baja on here right when we started making wands, and it was really the primary motivation for us to figure out how to make wands for me was to have my hands on good quality baojuan. Yeah, it really was just like, because, you know, it's so nice to have when you, when you realize, oh, shit, I've gone too far. Yeah. You know what I mean? And you don't have, like, a handcrafted radicchio salad on hand to try and cut through the grease accumulation. But Baja wan will do it for you. [00:34:19] Speaker B: Yes, it will. Yeah. And if you want, if you guys want some baohawan made as a yuan, you can order it on our website, actually. [00:34:26] Speaker A: Yeah, absolutely. You can make a practitioner account with [email protected]. make an account. We'll approve your account. And then we have Baja wan and all kinds of other wands actually available for your purchase, handmade here by us and our amazing employees. So bow on is great. And you can do it with t pills. You can do it with pressed tablets, but I think the honey pill is the best. [00:34:50] Speaker B: Oh, by far. And t pills, like, if you really want to get usage out of t pills, you gotta take just a crap ton of those things. [00:34:58] Speaker A: I mean, you could just open your mouth and pour the bottle in. [00:35:00] Speaker B: Take as many as you can swallow until you feel some difference. You know, that's, that's the reality. Okay, so we have, we've talked a little bit about heartburn. Is there anything else you want to add to that? Are there other patterns of heartburn that maybe we haven't touched upon? I can think of a potential idea of something that, that might become more. [00:35:25] Speaker A: I do want to add that, you know, a lot of people who have had chronic heartburn who are trying to do something that isn't omeprazole about their heartburn also have a lot of anxiety and trepidation around their heartburn. Yeah. And so they're like, oh, gosh, I feel uncomfortable. I can't sleep. You know, sleep will often get affected by really bad heartburn. There are some mineral compositions that you can grind into powder and put into capsules that can kind of function as a, frankly, a little bit like a tums. You know what I mean? To sort of like rescue function for acid reflux. The thing about them, though, is they're all made from marine animals. So you have to, firstly, your patient needs to know that they're eating cuttlefish bone or whatever if they're. If they're vegans and if that matters to them. But there's also potential allergy issues. [00:36:18] Speaker B: Sure. And some people will have allergy issues if you're not careful. [00:36:23] Speaker A: I've had. I've had several patients actually have sort of allergic reactions to high piaoxiao, is what I'm thinking about in particular. So you can take high piaoxiao, which if you have in a bulk pharmacy or you have access to an in bulk pharmacy, looks like. I don't think if you looked at it offhand, you would know that it was from cuttlefish. But it's taken out of the cuttlefish, which is type of squid, and then it's dried, of course, and then you pulverize it into powder, and you pack the powder into double zero capsules. So there's like half a gram, maybe three quarters of a gram in a capsule. And patients can take two or three as an acute remedy for very strong heartburn. And basically that cuttlefish bone is salty and cool. Now, as we just talked about, the real problem is that the patient's digestion is weak and cold. So you can't expect that even if eating handfuls of hai piao xiao helps now, it will not help the problem long term. [00:37:18] Speaker B: Right. [00:37:19] Speaker A: In fact, if they take handfuls of high piage out all the time, it. [00:37:22] Speaker B: May make it worse. [00:37:23] Speaker A: It'll make it worse. It'll definitely make it worse. So, like so many things, just because it's good doesn't mean that more is better. And you want to be keeping in mind the fact that you might need other alternatives. I've never tried it with granule high piao Chow on its own. I don't know that that will work the same way. I have a hunch that probably won't, but I can't speak to that, certainly. I will say, though, that for the patients who don't have an allergic reaction to the high piao chow, it is effective, but you gotta have it powdered. It's gotta be in capsules, two or three, sometimes four, and short bursts. Acute need, not in perpetuity. [00:38:05] Speaker B: Right. I'm thinking of another thing that I hear patients report who also have a chief complaint of acid reflux or heartburn that people do in the morning that can be sometimes aggravating to the condition. Do you have any idea what I'm. [00:38:27] Speaker A: Thinking people do in the morning? [00:38:28] Speaker B: People do in the morning, like, start. [00:38:30] Speaker A: Drinking their coffee immediately. [00:38:32] Speaker B: That is it. Let's talk about that. Because I've literally had patients that have acid reflux, and I tell them, like, without even trying to treat the reflux, I tell them to stop. I find out that they're drinking coffee first thing in the morning with nothing in their stomach, and they stop that and then the acid reflux just goes away just because they stop that one habit. [00:38:58] Speaker A: I mean, coffee is hot and bitter. [00:39:00] Speaker B: Hot and bitter. Yep, yep. [00:39:01] Speaker A: And if you, that type of person, too, I would guess, has a weak middle jowl. [00:39:06] Speaker B: Yes. [00:39:07] Speaker A: Right? [00:39:07] Speaker B: Yeah, 100%. And they're probably not hungry when they get up. [00:39:11] Speaker A: And hot and bitter is just pushing them right over the edge right from the beginning. The unpopular opinion here. But wait to drink your coffee till after you had breakfast. [00:39:20] Speaker B: Please do that. Or just put something like, I'll tell patients, just eat, like, a little rice cracker. So, like, if you're not hungry, just have a little something in there. Liu he, the qigong teacher we had at Okong, she would say that. She said, she said this about drinking tea, but it's the same with coffee, I would think maybe even worse with coffee. If you drink tea on an empty stomach, it's like trying to boil a pot. Like boil water in a pot without the water being in the pot, the heat just goes in and it burns the pot. So the pot in the metaphor is your stomach. So just messes your stomach up. And you talk about scorching stomach yin. Like, yep, there's. I mean, there's nothing worse for your stomach's yin than to drink a bunch of coffee first thing in the morning without having anything in there at all. [00:40:14] Speaker A: And it's such a God. And, you know, I get it. Everyone in my life, many people in my life, are the most classic american pattern. That's right. Like, you work too much, you stay up too late, a poor relationship to. [00:40:29] Speaker B: Sleep overeat late at night. [00:40:32] Speaker A: So when you wake up in the morning, you are graggy and you are not hungry, and you have to be at work that you don't like. And so you drag your ass into the kitchen where the coffee machine is on program, and it's already making the coffee, and you go into the coffee drawer and you take out the coffee mug that, like, your mom gave you as a joke birthday present that says, you know, I'm a bitch till I have my coffee. You know, like, don't talk to me. I haven't had coffee or some ridiculous Etsy store b's on your coffee. And then you pour your coffee in and you probably put some sugar and some cream in it, right? And then you sort of shuffle out. And if your partner talks to you too early in the morning, you're like, you show them the text on the coffee mug as a reminder. Hopefully your partner knows you now not to annoy you in the morning. And then, you know, you finally start to catch your feet after the coffee moves through your system and kind of juices your chi a little bit. And you know, about an hour or so after you've woken up, you feel a little bit more like yourself. And then maybe, maybe you're like the tiniest bit hungry, maybe. And so you have like a yogurt, right? Or maybe you're not hungry at all actually, because you just don't eat until lunche, right. And then this whole cycle becomes the routine. [00:41:49] Speaker B: Yeah. [00:41:50] Speaker A: And it's been that way for so long that you just assume that that's normal and that there's no problem with it because whatever, you're just not hungry in the morning. I mean, I'm not gonna make myself eat if I'm not hungry. [00:41:59] Speaker B: Right? [00:42:00] Speaker A: And the thing is, is that like, like so many chinese medicine things, like yes and no. [00:42:06] Speaker B: Right? [00:42:06] Speaker A: Right about that. So firstly, you need to eat breakfast. Like the old wisdom is the best wisdom. You have to eat breakfast now. If you haven't eaten breakfast in 20 years, you're going to be like, well, I don't eat breakfast. And be like, well, that's right, because you have made this your reality by not eating breakfast for 20 years. You're going to need to start. Why? Why do I need to start? Well, because you're probably now in your forties or fifties or sixties, especially if you're in your forties, you're realizing that, hmm, I'm gaining a little weight and I can't seem to lose it as quickly and my metabolism feels sluggish. And you think to yourself, well, I mean, I'm in my forties now, so it's probably fine, right? Instead of recognizing that like, the habits of the last 20 years have created the reality of the current decade that you're in, right? And then, in fact, if you eat regularly, your metabolism is more robust, right? Your body knows when the food's coming in, when what it needs to hold on to, what it can let go of, right? You eat your food before you have your coffee. And instead of the coffee, like using Leo ho's thing, sort of scorching the pot and creating all of these potential downstream effects, instead, you warm that which you just put into your system even further and you can then digest better, right? So drink the coffee before your, your food. Appetite suppressant damages digestive power. Drink the coffee after you've eaten, right? Boost the digestion better outcome. Yeah. So drink your damn coffee after your breakfast. And I know that that's an unpopular opinion. We're gonna get some, like, hate email about it. [00:43:36] Speaker B: Oh, my God. [00:43:37] Speaker A: It's impossible. I can't do it. [00:43:39] Speaker B: It's against my religion. [00:43:41] Speaker A: It is? Yeah. You know what? Change your religion. [00:43:43] Speaker B: Like, just the reason we're talking about it is because if you have patients that are having heartburn or acid reflux, and they're not gonna change this habit you're pushing against the wall, it's like so many things, like, oh, the person is coming in, and they have loose stools and super weak digestion, and they have no energy and all of these things. And then you try to give them hot herbs with ganjang and futza and all this stuff, but then they're drinking cold smoothies twice a day. [00:44:13] Speaker A: Yeah, exactly. [00:44:14] Speaker B: It's like. [00:44:15] Speaker A: But they put the spirulina powder in it. [00:44:17] Speaker B: Oh, man. Yeah. [00:44:19] Speaker A: All the micronutrients, they have more nutrients in this one smoothie. [00:44:24] Speaker B: Oh, my God. [00:44:24] Speaker A: Than you can consume in a week. [00:44:26] Speaker B: Good. Good luck. [00:44:27] Speaker A: Good luck. [00:44:28] Speaker B: That's the thing. Like, there are certain things that we can work around in our medicine. Like, I am impressed constantly with how much our medicine can actually do, but there are things that are direct barriers that patients do that can really disallow improvement in their condition. And if we don't talk to them about it, and that's why we're bringing this up here is this is one of the ones for reflux or for heartburn. Right. This kind of issue, it's also a problem for people with weak middle, like, really weak middle jowls, too, even if they don't have heartburn. [00:45:08] Speaker A: Yeah. Especially around appetite and metabolism. [00:45:11] Speaker B: 100%. Yeah. [00:45:12] Speaker A: You know, I work with a lot of diabetic patients, and I, almost 201 diabetic patients have a complex relationship with sleep and a very complex relationship with appetite. And many, many of them are no breakfast people, and many of them have also struggled with their weight, and there's been an association that, like, well, it's probably better that I don't eat breakfast because it's fewer calories. If I'm eating breakfast, well, I'm just eating more calories. That's not necessarily the case, because metabolic issues, middle jow issues, weight gain. Many of you out there probably have patients who have called you, like, oh, what can you do for helping me lose weight? I mean, weight gain and metabolic disease is a middle child problem, exactly what we're talking about now. But a lot of it has to do with a poor understanding of what's helping to boost and improve metabolic function and what is actually creating starvation states and weakness and patterns that are harder to break out of. Yeah. [00:46:14] Speaker B: And fear. Fear of appetite. This is something like we have to coach people about all the time. If you're. If you have no appetite ever and you want to lose weight, we're gonna give you herbs, and your appetite is gonna come back. That's a good thing, right? Because your metabolism is moving again. It's starting. Like your digestive fire has come back. Your earth is starting to function again. Do not resist your appetite. Like, your appetite is a positive force. Do not fear it. Which people do. They start to fear their appetite and. Well, my appetite is the problem. [00:46:53] Speaker A: Oh, yeah. [00:46:54] Speaker B: Story. [00:46:54] Speaker A: Right. [00:46:55] Speaker B: I ate too much and. Yeah. Anyway, going along thing about that, but just, I think the coffee thing and the appetite thing, these are good things to consider. [00:47:06] Speaker A: I think it's also important, too, to make sure you guys are hearing us talk about these things you need to talk to your patients about. I do want to say, importantly, that in my opinion, our role as practitioners is to provide quality advice and roadmap to success. But I don't think it serves very many people to lecture, berate, or create a you must circumstance with patients. [00:47:36] Speaker B: Right. [00:47:37] Speaker A: Even though our clinical experience confirms the fact that if a person will not make this kind of coffee change, for example, that it does fundamentally limit what we can achieve. Even though I know that that's true, even though we just talked about it and explained it, when I tell the patient that I'm going to do it in an open, compassionate acceptance way, you don't sit across the table from your patient and be like, you need to do this. And if you don't, you're fucked. Sorry for the vulgarity, but that's the idea. No, don't bring that energy to the table. Understand and recognize that the human experience is complicated, and people have a lot of stuff wrapped around appetite and food and habit. And even though it is true that they need to make that change, you got to figure out a way to talk to them about it. I would also suggest that in many cases, it's probably not a first visit conversation. Build some rapport. Make sure that you want to let them know we're going to need to talk about food and habits so they have an idea. It's not coming out of left field, but I don't usually recommend that you give someone a huge list of prescription activities right from the get. [00:48:48] Speaker B: Yeah. [00:48:48] Speaker A: You know what I mean? [00:48:49] Speaker B: Yeah, that's true. [00:48:50] Speaker A: Because I think in a lot of ways, like, people get a lot of that they do. They go to the medical doctor. A lot of people don't go to the doctor because they don't want to have a lecture. [00:48:59] Speaker B: It's true. [00:49:00] Speaker A: And you don't want that relationship with your patients, right. Where they're hiding things from you or not telling things to you because they're worried that you're going to be judgy about it. You know, don't be judgy. We're not trying to, like, prove who's the best humanity. We're trying to give people tools to improve their outcomes based on what they told you they needed. And I think that's really important to keep in mind. [00:49:20] Speaker B: Yeah, I agree. Okay. So then we spoke about indigestion as kind of our next. Another thing we wanted to cover. So what do you mean when you say indigestion? What's like. What are you talking about with that? [00:49:36] Speaker A: So indigestion, for me, I mean, I guess as a broad spectrum term, it can, I suppose, technically include stuff like heartburn. Right. But usually I think of heartburn and indigestion. Indigestion is like, I had a meal, and shortly thereafter I had some kind of movement in my guts that doesn't feel great. Maybe some bloating, some gas gurgling could also go all the way to abdominal pain. Either ache, general ache, or sharp pain. Right. For most people, I don't think it gets quite that far, but there are a lot of people. A lot of people who every time they eat, they don't feel great. [00:50:15] Speaker B: Yeah, right. [00:50:17] Speaker A: Even if they've tried to eat all the right things, quote unquote. Right. So they've cut out everything. They're eating, like white rice and, I don't know, broccoli. [00:50:26] Speaker B: Right. [00:50:27] Speaker A: And chicken. [00:50:27] Speaker B: Yeah. [00:50:28] Speaker A: Plain poached chicken. And then they're still like, oh, God, I feel terrible. Usually when that's the thing that I'm looking at, when people just cannot digest. Again, fundamental deficiency problem, almost certainly. How do we approach it? This gets us back as everything that we get back to, it's the same core diagnostic principle. Are you dealing with something that's hot or cold? Are you dealing with something that's excess or deficiency? These are the same questions that you're always going to ask for something like indigestion. The only other aspect that I think really matters in this discussion is how much of their indigestion is also emotionally connected. [00:51:06] Speaker B: Yeah, sure. [00:51:06] Speaker A: Right. Because the emotional access for indigestion is a huge one. Everyone's experienced that, and it is the one of the major indicators for a wood overacting pattern and the involvement of the liver and its influence on spleen. And then ultimately, the formula that that brings us to, in many cases is shy ozone. Right. So you need to discern that when you're talking to the patient. Like, is this just all circumstances always, like, I eat anything and I have indigestion, or is this in certain circumstances? Right. It's also interesting to note, by the way, that it's not a bad idea to talk about. To talk to patients about the context of their eating. Some people, like, they eat, like, watching the news, like always. Like, they, like, read their phone on the news, like, for lunch. And then they, like, sit down in front of the news at dinner. I had a patient last week. It was just. It hadn't occurred to me that this was one of the problems. But I knew that the patient was kind of anxious. But it seemed like all of their meals caused problems. And then they went on vacation. This is a common thing. Went on vacation. They were in France, and they ate all kind of stuff that should have messed up their guts. Cheese, rich food, cream, sauce, alcohol, bread. So much bread with butter, pastry. Right. They felt great. [00:52:29] Speaker B: Yeah. [00:52:30] Speaker A: No problems. Right. And so the way that this came up was, the patient was like, you know, I don't know what's. So we gotta adopt those European Union growing rules. They got so much better food there. And I was like, I mean, don't get me wrong, like, yeah, the food is definitely better on a lot of levels in France, but that's not why. Like, you were. It's the emotional factor. Like, you were on vacation. [00:52:51] Speaker B: Yeah. [00:52:52] Speaker A: Like, for the first time in ages, it was super chill. It was paid for by someone else. Like, what a great vacation. Like, you literally have no concerns whatsoever. And so they were totally invested. Right. They had no problem. Upon discussing what it was like to come back, their digestion problems all just came raging back. And it was in this conversation that I discovered that they watch the news. This is like a hyper political person very, very impacted by political reality. And they watch the news at every meal. [00:53:21] Speaker B: Wow. [00:53:22] Speaker A: Just by habit. So they read the news on their phone at breakfast. They either watch something on YouTube or read the news again at lunch. And then they watch the news on tv at dinner with their partner. And I was like, you should stop that, because I know how much this patient gets worked up by the political reality. And, you know, a lot of the work that we had been doing for their indigestion was. Was not dissimilar. From what we were talking about with the heartburn stuff, Li Zhongwan pattern. But this, in this case, the futzi Li Zhong Wan pattern. Right. Without the Wu Juyu and stuff, because there's no heartburn. But then I thought, you know, I think I've been missing this whole time, how much of this was emotionally induced. And the reason I had discounted it before is there what didn't seem to be any distinction between high stress and low stress environments. It's just all the time this was the case. So it wasn't until I had this sample of. They were on vacation, and all of a sudden, everything was fine for me to be like, oh, wait, hold up. I think there's something I missed here. And so we rewrote the formula using Chaiozan, right. To add that liver soothing aspect that we get from the chaihu that's in there and all the digestive support from the rest of the herbs. And I'll be interested to see what happens and see if now we get a little better traction, because what happened with the futsal Luiz pattern was we got a lot of traction. We plateaued. Like, stuff was better. It wasn't so bad. They could eat a variety of things again, what have you. But still, almost everything would cause some low grade digestive problem. And now I'm wondering how much of that was the emotional piece. [00:54:57] Speaker B: Yeah. Do you ever. So this kind of groups the two sides of our topic over the last two podcasts together. But do you use the bowel movement question, like, to differentiate some of these other, more particular patterns for the upper middle? So, like, let's say there was acid reflux, is the bowel movement question going to clarify which. Like, which herbs do I use? What's the ratios? Is the same thing with this version, like, the indigestion question going to clarify some of those things? [00:55:39] Speaker A: Yeah, I mean, I think it has to. Right. There's just. Because the bowel movement question, as we talked about last time, is one of the key ways to determine, you know, how much dampness there is, how hot something is, or how cold something is. [00:55:50] Speaker B: Right, right. [00:55:51] Speaker A: It's just so key. So, you know, if you have someone who has wild heartburn and indigestion after meals, but they aren't cold, they're not tired, they're not lethargic, and they have hard, dry stool. Right. Lijong won is probably not the base formula, right? [00:56:08] Speaker B: Yeah, exactly. [00:56:10] Speaker A: There clearly is not the level of deficiency cold that we would have to deal with. You know what I mean, so the ganjang itself will be a mismatch. Right now, the Wu ju piece with Huanglian is probably still relevant for the immediate pattern that's causing the heartburn, as the maimondong may also still be relevant because of the crack in the tongue, and also it could help moisten the stool. But now we're going to have a different base pattern because we're dealing with something that's clearly not a young deficiency. Cold presentation, right? [00:56:43] Speaker B: Yeah. [00:56:43] Speaker A: So of course it matters. I don't think there's any way to distinguish it entirely. In fact, I think you would be probably likely to be off the mark, you know what I mean? If you tried to do it without a poop question. [00:56:57] Speaker B: Right. [00:56:58] Speaker A: You know what I mean? But I think really, when, you know, just like with the poop questions, I'm also going to want to know about, like, if I'm treating a lower middle jaw problem, I still want to know about appetite and digestion. Like, the upper part of the digestive tract still matters when treating the lower and vice versa, I think. More importantly, though, when I think of a lower middle jaw problem, it's because I'm primarily trying to treat the poop. Right. And solve that at first, versus an upper middle jowl problem, where I'm trying to deal with what's upstream as opposed to down. So in this case, like, the heartburn, although, of course, let's be real. Like, people with weak middle jowls that are cold and have heartburn probably also. [00:57:37] Speaker B: Have loose stool, right? Probably, yeah. [00:57:39] Speaker A: Not always, but if they. [00:57:40] Speaker B: But, like, in that example you just gave right there, the stool is more dry and hard, right? [00:57:46] Speaker A: Yeah. [00:57:46] Speaker B: So, like, my mind then goes to a dachai hutong or something like that, where we're using a little bit of dahuang, but we're also, like, high dose of xiangjiang, and, like, we're, you know, we're still warming, we're just also facilitating the movement of that stool. [00:58:02] Speaker A: And this is the pattern where the damp heat is more heat than damp, right? Whereas some other iteration where it's more damp than heat, or where the damp heat is from cold stagnation. I mean, like, of course, now here we are causing the same anxiety that people have with, why. How do I know which formula to. Right. Everything's possible. [00:58:19] Speaker B: Yeah, sure, sure. Well, that's kind of why I wanted to go through this, though. Because if we isolate the symptoms, the diseases, so to speak, then we add back in the texture. The texture actually helps us with differentiation. [00:58:36] Speaker A: Yeah. [00:58:37] Speaker B: So, like, epigastric, disorders, heartburn, reflux. But then the bowel pattern comes in, and the bowel pattern is different than we would expect. Like you would expect for somebody that has reflux in general, to have more wetter, like, looser stools, right. Because you're thinking, like, maybe there's damp heat, maybe there's some kind of, like, there's a problem there, right, for the shishentong patterns, sometimes there's this really interesting bowel pattern where in the same movement you have, the first part of the bowel comes out and it's harder, and the second part comes out wetter. That's one manifestation of the mixed heat and cold in the middle. You have to deal with that. You could expect with that pattern, but you wouldn't expect the stool to be hard and dry. Right? If it is, then maybe, like, part of the reason that there's reflux is that the bowel is actually backing up. Like, it's not moving through quite so well. Right. And then we might need to facilitate the movement of the chi in some other way, either with, like, sha Ren or hope or Jurhi or something like this. Right. That's gonna help to facilitate that movement through and keep it from backing up. [00:59:56] Speaker A: Because effectively, what you're dealing with is some sort of digestive reversal pattern. Right, where she's not descending like it's supposed to. Yeah. I mean, this is, this is the beautiful thing about what we do, right. And why we broke the show into two parts. Because the middle jaw is complicated. Right. There's so many things going on. And I think it's important, though, as, as a clinician. Like, part of the reason we made this show was, of course, to talk about herbs and have people think about different formulas and stuff. But it's important to just remember your training. Right. Go with the pieces that you know. Right. Is this a hot problem, a cold problem, a dry problem, a damp problem, an excess problem, deficiency problem, etcetera, and just make a decision based on what is in front of you. So, like, in the pattern that you just, like, you don't need to, you don't necessarily need to understand a sort of, like, digestive reversal pathomechanism to make the right call here. [01:00:46] Speaker B: No. [01:00:47] Speaker A: Right. You just need to recognize that, like, you know, formulas like Dacha Hu Tang that utilize the potency of an herb like Dahuang to facilitate downward action. When I clearly have a problem with downward action, with a hard, dry stool and the presence of acid reflux, both of those things are pointing out that there is a downward movement problem. You know what I mean? And so, since those two things align together, it makes sense to use a formula like dai ChagutanG that's focused on downward movement, right? Whereas if you have acid reflux, which is a downward movement problem, but then you have loose stool, which is excess downward movement. So I suppose technically a downward movement problem, but from the opposite end, then the activity of the action, the activity of the formula you're going to choose is inherently going to be different, right? And so you pick the formula that deals with the loose stool and the warming, and then include something like Zojin wan to deal with the resurgent problem, or you go with your Shishan Tong, like we talked about, which has that collective action together. So I just think it's important for people to not get gummed up in, I don't know, pathomechanisms. I don't know all this theory. It's okay. Like, you know the basics, right? You know the core components. Components. And so you start pulling these formulas together. So, I mean, based at this point. Now, last time, we talked a lot about the use of ping Weisan, right? We talked a lot about adding herbs in to tighten stool or loosen stool, right? So I'd encourage you guys to go back and listen to that discussion. And in this context, we're talking about basically herbs that are warming and supportive to the middle, right? And then augmenting that kind of formula. Li Zhong one, in this case, with herbs that have a balancing effect on the excess heat pattern that's showing as a byproduct of this deficiency, or in the one you just described. We're going back to an even further back conversation about how Chihutan formulas work and sort of what da Chaiutan does in particular, in order to correct for a downward flow problem, right? So, you know, that's the thing, right? Like that, we talked about Chahutang in the context of chihu family formulas, outside of the world of the middle child, like all these other places that it can manifest. But of course, it can be hugely appropriate when you have this other presentation on the other side. [01:03:09] Speaker B: Okay, so anything else that seems relevant with the upper middle jow? Any other symptoms? Like, what about, like, vomiting disorders? People are sick. [01:03:23] Speaker A: I see such rare vomiting patterns outside of, like, acute stuff. Like, I literally had a patient this morning. [01:03:29] Speaker B: Usually is kind of acute, right? [01:03:31] Speaker A: Yeah. But, you know, you read about it in the text, and here you go. Here's another thing. Be cautious. We love Benski, don't get me wrong. But sometimes you read those patterns. And you're like, well, my patient is vomiting constantly, and they're like, yeah, it's okay. They don't need to be. Right. I had a patient this morning, actually, who took their herbs and had this, like, vomit. Like, they vomited, like, four times in a row. [01:03:52] Speaker B: Is that right? [01:03:53] Speaker A: Yeah. And then they felt amazing. [01:03:54] Speaker B: Yeah. [01:03:54] Speaker A: And when it worked in the yard for 5 hours, that's what they told me. And I was like, oh, well, that was unexpected. Like, that's not. That's certainly not. And the patient was like, do you think that had something to do with getting things moving? And that's why I felt better. And I was like, I mean, maybe. Yeah. I don't know. Right? Like, you don't always know, you know, what's going to happen. But I have not seen a lot of vomiting patterns as what I would think of as an intrinsic path of mechanism. I see a lot of people with cold based nausea that makes them feel like they need to vomit. But almost no one ever gets to the point of vomiting in those cases. We're almost always using some banjo ganjiang combo. You know what I mean? So, again, shaishingtong or totally. Or Lijianguan, you know, how about for. [01:04:43] Speaker B: Things like food poisoning? This is a good topic. Like, how do we see food poisoning in our medicine? I just have a super cool case to talk about with that. That was like an inside the family situation. But I'm curious what you like to do about those kinds of cases. Like, how do you see those kinds of cases, usually? [01:05:03] Speaker A: So food poisoning is amazing. So I've had the fortunate, unfortunate situation to have been able to treat some food poisoning, like, in my family recently, I guess within the last year. So I think of it as a toxic heat problem, primarily. Sort of like an accumulation of damp toxicity. Right, right. So it's hot, it's damp, it's toxic, which is why it's so intense and it's so problematic. The trick, of course, is that people are vomiting and pooping wildly, and so being able to hold something in their stomach to actually help is really tough. Really, really tough. And strong flavors and smells can facilitate vomiting, in particular, once people have already started vomiting because of whatever they've had going on. So one of my favorite base formulas to start with, when someone can at least tolerate. So here's the thing. You get food poisoning, you're like, oh, something's not right. You start having really frequent diarrhea. Worst scenario, you're having diarrhea and vomiting at the same time. Like, whoa, the worst case scenario, in my experience so far. You got to get through the first couple of hours of that because there's nothing that I can give you. [01:06:21] Speaker B: Yeah, you'll actually be able to keep down. [01:06:23] Speaker A: You just want not long enough for it to work. And so the goal there is minimize your discomfort as much as possible. Make sure you're drinking water when you can so you're not dehydrated, but you're looking at probably six to 12 hours of misery that we've all experienced. Right. It's after that point, once you are no longer completely sitting on the toilet for the whole afternoon, that we start to ask ourselves, like, well, what can we do now? Because the pathogen is almost certainly still there. It's a real nasty string of noroviruses that we saw a lot recently. [01:06:58] Speaker B: Yeah, everybody got hit. I got hit on the east coast when I was there, like, late last year. [01:07:04] Speaker A: Yeah. And people. And they last. Right. So you get these bursts, and then even after you're feeling better, it's like, for a week or two after, it's, like, still liquid stools. There's a lot going on there. So I love the classic ho Shangjang shi tang formula because it has a lot of what I think of flavor wise is necessary components. So you have the aromatic quality of Hwoshan, which I think deals really, really well with the damp accumulation that is part of that damp toxicity problem. And then you have all of the digestive supporter pieces, which I think are pretty key. And then the element that really matters, that will depend on how bad the infection is, is how much toxic resolve toxicity type herbs do you need to put into a formula for that kind of pattern? Right, right. Because, you know, if it's. If someone has stomach pain, if they've got really hot diarrhea, you know, it's painful. Like, there's clearly a toxic heat thing that's going to need to go. Right. Also, I want to say importantly, when someone's in an acute food poisoning state, it's not a good idea to give them something like imodium to stop the diarrhea. [01:08:13] Speaker B: Oh, yeah. In the first stage, the diarrhea is the therapeutic process. [01:08:17] Speaker A: It's gotta go. I mean, I know it's terrible, and you will dehydrate yourself if you're not careful, but you, in the first 12 hours in particular, really don't want to try and stop the diarrhea. Right, right. It's your body's purging that really does need to happen. Right. Hwoshan. Jungji sang also has dafupi in it. I love dahphapy. [01:08:39] Speaker B: Yeah, daphapi is a great herb. [01:08:41] Speaker A: Daphotopy. And binglong. Daphopi is the shell, right? And Binglung is the seed. And if you read about those herbs, you'll be like, I never have parasites. Why would I need these herbs? But dafopi and bing long have so many more applications than parasites. The great thing about that plant, the areca plant in this case, is that it deals in residual toxicity. That is often the case with these kinds of stomach pain, food poisoning problems. So I think in many cases, for standard run of the mill, I don't know, had some bad yogurt or something from the corner store, food poisoning, I think a standard Hwoshan Jiang Qi Tang with the Benski numbers is great. If it's something more virulent, more norovirusy, more painful, you might need to reach more into your toxic heat collection of herbs. And that could be things like Ban Lan gen lianchiao jinhua, your kind of classic heat clearing, cool herbs. Right? They don't need to be like, wild, intense herbs. You just need to put enough of them in there. So if you're gonna add resolve heat, clear toxicity type herbs, maybe it's the other way. Clear heat and resolve toxicity, whatever Betsky calls them, I usually put in a cluster of them. So I'll put in, like, four or five, all at standard dose, as opposed to, like, two at high dose. [01:10:04] Speaker B: Right? Sure, sure. [01:10:05] Speaker A: And I really like Jining Hua and lianchiao. I think of those as a dwayao pair. I use those a lot. Right. I like ban languen, which just on its own, I think is a really great herb. And so that'll go in there as well. And then after that, I might just take elements of the Hwoshan jungjitang, like the dafu PI, and boost it. Right. So that that goes in there as well. And then, honestly, at that point, it's kind of like, what do you have access to? And what's your flavor? You know, I might put one more toxic heat herb in there. I don't know. In my experience, as it matters so much which one. They're all kind of the same. Don't tell the herb people that. But they're. They're kind of all. I mean, I'm sure someone's gonna be like, no, bonjour. Lien is so different than. Whatever. That's fine if you want to. [01:10:55] Speaker B: What about the, you know, Heiner Fruhoff talks about, like, some of these goo herbs that are like the arrow that kills the demon or whatever. In Chinese. [01:11:06] Speaker A: Yeah, your magic herbs, man. It's fine. Like, if you got, let's be honest, if you have magic herbs, you put that shit in the formula, you do it, man. Yeah, use your magic herbs. I'm not saying don't use them. I'm just saying if you don't have magic herbs, don't stress about it. You can just use Lian chao and Qin Yin Hua, like, you'll be fine. You know what I mean? You don't need the special magic from high on the hill, you know, toxicity pattern. The other thing to keep in mind is that in most cases, unless you're exceptionally deficient or older or have some kind of other immunodeficiency problem, your body's going to clear that food poisoning. [01:11:42] Speaker B: True. [01:11:42] Speaker A: It just, it will happen. It might take a while and it's unpleasant. And so in many cases, what we do herbally after that twelve to 24 hours, misery, pain. Point is to just try to make the recovery shorter. It's trending in the right direction anyway, so you don't have to super stress about it. You just got to make sure the patient stays hydrated and that they can start to get food down when they can. And bland, simple foods, saltine crackers for the win. Really simple. But herb wise, I think you do need something that's aromatic. I think you need something that's spleen supportive, so something earthy, some baiju, something. And then you're going to need stuff that deals with residual toxic heat, however much you think is left in the pattern. And then you're going to need something. The reason that again, like Ho Shang Jungjitang, is that Dafupi comes in there and Dafupi and Bing Lang, I almost always use them together, even though I think it's just dafupi in horse and Jiang dong, I think they have, those are my magic herbs. People are like, oh, what's your magic herb? I'm like, oh, you got a weird toxic thing happening. Dafu pinglang. What exactly do they do? Well, the magic, let's put them in there. Technically, Bing long, you know, it's doctrine of signatures. It's got these tiny little, they almost look like capillaries in the cross section of the seed. So it goes into deep places. [01:13:00] Speaker B: So you have some lol. It's one of the loyal mai and. [01:13:03] Speaker A: You know, virus in particular, the strain that was happening, people would be sick for like two weeks, three weeks. That's a lol. My thing like you need an herb that's going to take your formula deep into the places where the pathogen is lurking and get it out. Right. So that's the magic effect of the Binglong piece. And then Dafupi is this furry hard shell that protects the bing lung. Right. And it has this. It's not accurate exactly. So I don't know if I want to use the word dispersive, but there is something dispersive about dafupi in its action inside of a toxic heat formula. I think it takes the heat clearing and toxicity resolving function, and it puts it into, like, the flesh substantive space. Right. So between the two parts, between the shell and the seed, you can take the potency, the heat clearing, resolving function of your formula and drive it deep into the body, into a place that the pathogen can't hide anymore. So, you know, in the, in the magic herb realm, dafu pingla da fupi, bing lang. [01:14:03] Speaker B: Yeah, those are good, good herbs. [01:14:05] Speaker A: Yeah. [01:14:06] Speaker B: So I have a kind of a different approach to treating the food poisoning type patterns. I like to use the sudden turmoil distinction of like, the classical chinese language, like where, you know, sudden turmoil, for those of you who forgotten our schooling distinctions is the confluence of vomiting and diarrhea simultaneously. So any kind of condition with that confluence is considered sudden turmoil. So food poisoning obviously falls into that. [01:14:42] Speaker A: Right? [01:14:43] Speaker B: A lot of cases fall into that. And the nice thing about using that distinction for me is it makes the formula choice of very simple, because there's really only like two or three formulas that treat sudden turmoil, like from the Shanghai's perspective. So we have wuling san as our chief formula. And Wuling san is nice because of how bland it is. [01:15:07] Speaker A: Super bland. [01:15:08] Speaker B: Super bland. So if somebody is like really having a hard time taking things and getting it down, you might be able to get wuling sawn into them. Right. [01:15:16] Speaker A: That's a good point because actually Huoshan Jiang Shi Tang is very flavorful. [01:15:20] Speaker B: Very flavorful. [01:15:21] Speaker A: And I have had, I've had family members be unable to take it even in the post set of like the post recovery thing, because it's too strong. The flavor is too strong. [01:15:30] Speaker B: Yeah. [01:15:30] Speaker A: So having Wuling san, that's a great idea. [01:15:32] Speaker B: Wuling san is a nice one. And then, so the, in the shanghai, the distinction is sudden turmoil with thirst and fever, without thirst, without fever. Li Zhonghua. So it's just a very simple distinction because the idea is that like, basically with Wuling san, we think of Wuling san as a bladder problem, right? [01:16:00] Speaker A: Yeah, primarily. [01:16:01] Speaker B: But it also works the other side of Tai yang at the organ level is the small intestine. Right. So the sudden turmoil pattern is there's actually, like, water that's accumulating in the small intestine. And for some reason, the yang gets pulled out of the small intestine. So it's not able to transform the water. So then any introduction of anything, it's just trying to get rid of, because it can't transform anything. Right. So the wuling san pulls the water out of the small intestine and pees it out through urination. [01:16:33] Speaker A: Right. [01:16:34] Speaker B: And with the Wu Ling San pattern, you have the confluence of thirst, where the body is desiring more water. But when you drink water in sudden turmoil, you're gonna vomit it right back out because your body can't transform it at all. So from that perspective, it's not actually, it's not really the pathogen that's causing this is a weird thing to say. It's not the pathogen that's causing the problem. It's actually the physiology is disorganized. So by helping the physiology to reorganize transform the water, it's then able to process out whatever accumulation is in the way. Then if there's no thirst and there's no fever, then we know that we're not in the Yang confirmations. We're actually treating more of a spleen problem. And so then you can have the same symptoms, but you need really more to warm. And usually I found that to be kind of rare. Usually the wooling sun is what we end up doing. I had a, I read a case where this chinese medicine practitioner's kid drank a bunch of. Took a bath. Like, drank a bunch of the soapy water. Like, he left him alone. He drank a bunch of the water, and he got super sick. You know, it was like vomiting, diarrhea. And that kid didn't have thirst and didn't have a fever, so he gave him Li Jung wan, and that was helpful in that case, usually for food poisoning. The wuling San pattern is really clear. And I had an experience recently where my brother, who lives on the east coast with his girlfriend, girlfriend had food poisoning, and he's texting me about it, right? I'm asking him questions. And so he's like, you know, the bridge, the middleman in between me and his girlfriend discussing about her symptoms. And she had thirst, and she had a fever, and they're in the east coast. They're in upstate New York. There's no chinese pharmacy around, right? But I was like, what do you have? What does she have in her refrigerator? Right. So she had two different types of mushrooms, like, culinary style mushrooms. She had cinnamon as a spice. Right. So I had her brew up, like, I had no idea if this was going to work or not, but I had her brew up, like, basically decocked, chop up some of these mushrooms and then put some cinnamon in it, like, last as the last thing. And she took it and she was able to drink it down, which wasn't possible before she was trying to drink water, and she was throwing it right back up. But for some reason, with this combination, she was able to actually drink it down, and she didn't vomit, and then she was able to pee. And then the symptoms got a lot better, like within a couple. Within an hour or so. [01:19:26] Speaker A: That's so interesting. [01:19:27] Speaker B: Yeah. [01:19:28] Speaker A: Cause, you know, it's interesting to think about what the pathogen is for food poisoning, because, like, in many cases, it may very well just be toxic dampness without heat initially, and then it can have heat depending on what happens to the stagnation of a super toxic dampness. Right. And when I say toxic dampness, I mostly mean quite intense dampness. Right. Dampness. It's funny because toxic always gets attached to heat. It's toxicity and heat. Toxic heat. [01:19:59] Speaker B: Right. [01:20:00] Speaker A: But toxic dampness is a really great way to describe dampness that has aggression. Dampness is not normally an aggressive. It's not an aggressive pathogenic process. Right. It's like, it's an accretive one. It sort of happens over time. [01:20:12] Speaker B: Right, right. [01:20:13] Speaker A: But toxic dampness is the aggressive yang component woven into a dampness pattern. And so if that's the case, like, you get rapid onset, rapid proliferation. But something like Wuling san would be a great way to immediately pull the plug on dampness's aggression being like, oops, sorry, you're getting drained, the bath is filling up with toxic dampness, and you. [01:20:36] Speaker B: Just drain it right out, pull the. [01:20:37] Speaker A: Plug, and all of a sudden it starts going out. That's a really interesting way to approach it, because Ho Shang Jiang Shitang is getting at the toxic dampness, but in a much more complicated way than straight up Wuling san. I think there's really a lot to be said for the simplicity of drinking a bland formula like wuling san and being able to riff on it with mushrooms and. And cinnamon. You know what I mean? That's pretty solid. That's a very interesting idea. So I think if people are listening, it's important to think about particularly what your patient can handle, what you have access to, what your patient can handle. I mean, Travis just describing this MacGyver version of a chinese medicine, no idea. [01:21:21] Speaker B: If it would work. [01:21:22] Speaker A: But it did. [01:21:23] Speaker B: But it did, in fact, work. [01:21:24] Speaker A: And why that? Well, because you have enough of an understanding of the mechanism of wuling san to then guess that those kitchen ingredients could be used in a similar fashion. Right. Right. Now, was it exactly the same as wiling san? No, of course. But it did work in the same vein. Right. And I think that's an important thing to remember. Like, food is the first medicine. It's the daily, constant thing that you're inputting in your body. And herbs are just a concentrated, potent form of food. Right. I mean, I wouldn't suggest you have a big salad made out of wujiu. Right. It's not gonna. It's not gonna taste good, but at its core, I mean, the stuff is food. You're eating it. And so there's no reason that food, things can't function in the same way if we have that kind of understanding for how to apply them. So. Yeah, I love that. [01:22:09] Speaker B: Yeah. And it's. And then, like, maybe to follow up, the formula might be more like Ho Shanjiang shi sanyam. [01:22:16] Speaker A: Yeah. Or something more supportive, more like something that's got some tonification in it, you know, something to really lift and build while also a strange bowels and, you know, whatever. So, I mean, I definitely. I think that's one of the things, you know, we talk a lot about which formula to pick for a case. We don't. Maybe we'll. Maybe we'll do this in the future is talk, too, about the evolution of single cases. Like, you know, the formula is not always the same formula. Right. A person takes a formula for a fixed set of patterns, and it's a complex situation, so it changes. And now we have to change the formula to accommodate that change, and so on and so on. And so there's an evolution in a really well managed case where here, acute food poisoning. Wuling San, second stage, post acute, where doing something that's a little more aromatic. Hwo Shang Jung recovery stage, because it was really gnarly and the patient was already deficient, and they've been really depleted by this whole experience. We've got a beefed up shenling baiju san to keep the stool dry and firm, and then to restore some of the qi that was lost. So that's an evolution of a single case with three different formulas. You know what I mean? That all are working on a single positive outcome, but from really different angles. [01:23:28] Speaker B: Yeah. [01:23:28] Speaker A: So I think that's important for people to hear, too. [01:23:31] Speaker B: Yeah. Evolution is something that's missed, I think, a lot in case studies and in clinical discussions. Like, it's, there's a lot of emphasis on differentiating the pattern, how to see this pattern versus this pattern, but how to see this pattern first and then what's below that pattern? How do we move with the case as the pattern shifts, and how do we treat the deeper pattern that's there afterwards? And I feel like that is something that's not discussed often enough. And to really understand how to use herbs to support people and, you know, acupuncture for a lot of cases is also like that. You know, there's, you're going to do different things in the beginning than you would do as you continue to treat patients, you know? So without a doubt. Yeah, maybe that's something we'll riff on. [01:24:23] Speaker A: Yeah, we should. We should look at that because I think it would be cool for listeners to hear some cases that we picked that we walk through the whole evolution. Yeah, you're right. Because if you pick up a case study book, it's like the patient took four packets and they were fine and. [01:24:34] Speaker B: They were, they were better. [01:24:36] Speaker A: They were better. You're like, yeah, but how much better did they keep coming? See you? And like, was it part of a bigger problem? You know, there's, there's always so many other layers to deal with, so. Well, I think we should, we should call it there. [01:24:48] Speaker B: Yep, sounds good. [01:24:49] Speaker A: Alrighty, my friends. Thank you for listening again. This has been the nervous herbalist produced by Rootin branch, chinese medicine pharmacy. You can always reach [email protected]. make an account in order to use our pharmacy. We ship herbs all across the country in granule and in bulk and in wands and soon to be sans and a whole other system of things for you to have all the herbal needs that you require. So don't hesitate to reach out to us as well. If you have any questions or if you have suggestions for shows, you can reach us at info ootandbranchpdx.com. that's info rootandbranch, papadeltaxray.com. and yeah, I've recently learned all of the letters because I have to talk to insurance companies all the time and I have to say letters and they're like, what? And I'm like, Papa Delta x ray. Papa Delta x ray. PDX for all of your radio needs. Right. To talk to the flight towers. Right. But anyway, it's good talking with all of you guys, and we'll see you next time. [01:25:51] Speaker B: This is Travis Kern and Travis Cunningham. [01:25:54] Speaker A: Have a good one. [01:25:54] Speaker B: See ya.