Episode Transcript
[00:00:03] Speaker A: Hi, everyone, and welcome to the Nervous Herbalist, a podcast for Chinese medicine practitioners who like herbs and want to learn more about their function, their history, and treatment strategies to use in the clinic. Let's get into it.
Hello, everybody, and welcome back to the Nervous Herbalist. My name is Travis Kern, and I.
[00:00:24] Speaker B: Am here with Travis Cunningham.
[00:00:26] Speaker A: And we are going to talk to you guys today a little bit about objective diagnostic tools, which is a fancy way of saying tongue, pulse, and abdomen.
The things that we think sort of stand out in an objective way. And what we mean by objective here are things that you can evaluate on the patient's body without their input.
[00:00:49] Speaker C: Right.
[00:00:50] Speaker A: More or less. There's some maybe a little bit input from the patient on abdomen, but we don't need their story in order to use these tools. Now, in school, we, of course, learned about pulse and tongue. Right. You pull out the machiocha and you take a look at what's in there, and every single pattern is going to have a pulse and a tongue that's connected to it. And of course, you, TC have added a lot of abdomen into your training now since we've graduated from school, so we wanted to take some time to kind of lay those different tools out and kind of just break them down a little bit. And where we have found that they are effective, where they're more challenging, and just some various factors on it. So maybe let's start with tongue and pulse, because those are the ones that sort of people immediately respond to. And I think we were talking before we started recording that. When you think of those two elements that in some ways, they're evaluating two different aspects of physiology. Why don't you talk a little bit about that?
[00:01:55] Speaker B: Yeah, absolutely. So the tongue is the one I think most people actually learn in school. I think the pulse is not learned in school for a few reasons, which I can talk about.
But the tongue is the one people come away with feeling some level of competency with. For most people that I've spoken with, after they get done with school, they feel fairly confident in evaluating the tongue. Almost nobody feels confident in evaluating the pulse that I've spoken to.
[00:02:28] Speaker A: Yeah.
[00:02:29] Speaker B: And I would say this was also true for me.
Leaving school and I spent extra time studying pulse. I was doing pulse seminars during the clinical year all the time. And so I was really interested in pulse diagnosis. I was doing training all the time. I was trying to figure it out. And I still, by the time we graduated, didn't feel super confident. Like, if I had honestly assessed. Do you feel more confident evaluating the tongue or the pulse? I would have said the tongue.
[00:03:00] Speaker A: Right. Of course. Now that I'm guessing, has to do with the fact that you and I can both look at a tongue.
[00:03:07] Speaker D: Yep.
[00:03:07] Speaker A: With our eyes, the same tongue.
[00:03:09] Speaker D: Yep.
[00:03:09] Speaker A: And if I'm good with tongues, I'll say to you, rit. You see how this tongue here is pale?
[00:03:15] Speaker D: Yes.
[00:03:16] Speaker A: Here there are red dots.
[00:03:17] Speaker D: Yep.
[00:03:18] Speaker A: See these scallops on the side? The tooth marks? And then you can confirm what I'm seeing.
[00:03:23] Speaker D: Yep.
[00:03:24] Speaker A: So the term that we hear in pulse areas for this is calibration.
[00:03:28] Speaker C: Right.
[00:03:28] Speaker A: But I think it's probably relevant here too, because if we use the same idea, basically, like, I can rapidly calibrate you right to tongue diagnosis.
[00:03:36] Speaker C: Yes.
[00:03:36] Speaker A: At least the basics.
[00:03:37] Speaker D: Yeah.
[00:03:37] Speaker A: Right. Obviously, there are some people out there who can see your whole lifetime on your tongue. Right. That's just like a different level of skill, but sort of basic calibration.
Look here. Also, the factors that we use to evaluate the tongue are, by and large, visual objective ones. So we say, like, you know, it's dusky. Okay, well, what exactly is dusky? It's kind of purplish, but, like, we're not. There's not that much room for interpretation around what's dusky, what's red? What's tooth marked? Right. And so people can read those descriptions and say, okay, but by contrast, pulse. The reason that perhaps it's difficult to really evaluate or to really learn in school is because of this calibration issue.
You learn in school, like, okay, slippery pulse in the middle position means, you know, this. Right. And then wire repulse in the first position.
[00:04:32] Speaker C: Right.
[00:04:32] Speaker A: Qi stagnation.
[00:04:33] Speaker B: I don't even remember, honestly, learning it positionally in school.
[00:04:38] Speaker A: I just remember. Yeah.
[00:04:39] Speaker B: It's like, oh, the pulse is slippery. Overall, the pulse is wiry. The pulse is deficient. I think those are the three that most people would use. And the other problem is pretty much everyone can agree mostly on tongues.
[00:04:54] Speaker C: Right.
[00:04:54] Speaker B: So if you have four supervisors.
[00:04:57] Speaker C: Right.
[00:04:58] Speaker B: And supervisor in the clinic, looks at the patient, looks at the tongue, they're gonna mostly agree on the tongue qualities person to person.
[00:05:07] Speaker A: Right. But pulse qualities, almost certainly not. Good luck. Yeah, exactly.
[00:05:12] Speaker B: So that's the other reason I think people learn it is because it's not only like, I don't know, a more agreeable feature, it's what the supervisors are. Can agree upon. So. So the points of reference that you're using to deepen your skill when you're initially getting into the clinic is going to line up toward tongue diagnosis. More than pulse diagnosis.
[00:05:36] Speaker A: Yeah.
[00:05:36] Speaker B: For those reasons, I think.
[00:05:38] Speaker A: I think this is also probably a reflection of what happens when Chinese medicine education is streamlined for the purposes of like, accreditation and curriculum and things like that. Because, you know, traditionally, and by traditionally I just mean like in a sort of pre modern Chinese medicine era, so say like late Ming or something. And pretty much all the time before that, if you wanted to be a doctor, you'd have to go train with another doctor.
[00:06:02] Speaker C: Right.
[00:06:03] Speaker A: And so you'd have to learn the objective material, you'd have to read and write all the classics, you'd have to memorize them. Like, you'd have what we think of as sort of like book learning.
[00:06:11] Speaker D: Yep.
[00:06:11] Speaker A: But then your teacher would calibrate you to all of these things, including the tongue. Be like, here's the tongue, here's a pulse. Teacher touches pulse, wrist says, hey, this is slippery pulse. So then you put your hand on it and you calibrate whatever that sensation is.
[00:06:26] Speaker D: Yeah.
[00:06:27] Speaker A: To slippery pulse.
The trouble is that as we standardized curriculum, because we wanted to be able to teach people that from textbooks and lectures and PowerPoint slides, we had to try and quantify slippery pulse in a really distinct way. And that, I think poses a lot of real problems because you have so many descriptions, what wiry means, what it feels like.
And the thing is that a teacher can just help you distinguish it, but not because this, I think an important point in that classical model, a teacher put, you put your fingers on the wrist and you, you calibrate your slippery pulse. That doesn't exist in a vacuum. It's connected to a treatment outcome.
[00:07:06] Speaker C: Right.
[00:07:07] Speaker A: So it's like, feel this, this thing I'm feeling that I'm telling you is slippery pulse. You now learn slippery pulse. And that's relevant because it's going to shape the formulas that you choose. So then you train with that doctor, you learn, quote, unquote, their system, though maybe they think of it that way, maybe they don't. But nonetheless, like, you learn this feeling, slippery pulse, therefore this formula, and then you start using it with patients and you get results.
[00:07:29] Speaker C: Right.
[00:07:31] Speaker A: Another doctor could come in, put their fingers on that wrist and be like, oh, actually I think this isn't really slippery. I think it's, I don't know, deep and whatever scallion stock, whatever the phrases are. Right.
And those two doctors might disagree. In fact, they might even pick two different formula strategies. But they might both get results, in which case, this is, of course, the stuff that frustrates the western med people so much because they're like, wait a minute, two different pulses, two different formulas, same condition, same outcome.
[00:08:07] Speaker B: And can frustrate us, too, as students, as people trying to learn the medicine.
[00:08:12] Speaker A: Yeah, well, because people, I think, overly emphasize the notion that a slippery pulse is deeply objective.
[00:08:20] Speaker C: Right.
[00:08:21] Speaker A: And I mean, we're putting it here in the objective measures. And what we mean by that is that it's something you're going to evaluate without this patient's input.
[00:08:28] Speaker C: Right.
[00:08:28] Speaker A: But universally objective. Like, you and I will always agree that this is slippery pulse is much less likely than you and I always agreeing that the tongue is dusky.
[00:08:39] Speaker C: Right.
[00:08:39] Speaker A: Because. And I choose dusky intentionally because that's one of the tongue qualities. That's a little bit more like, I don't know, is it dusky? Is it pale? Sure. What's the lighting in the room? Is it daylight? Is it fluorescent light? Like, you can get, like, gnarly about it. Right?
[00:08:53] Speaker B: Yeah, sure.
[00:08:54] Speaker A: But ultimately, like, there's an evaluation there. So I think part of the tension that we experience as students and then eventually as practitioners actually is sort of systemic. Like, it's a systemic problem to the way that we design this.
[00:09:06] Speaker D: Yep.
[00:09:07] Speaker A: Whereas, like, if we. If we did more apprenticeship learning, if we did stuff that was more how we used to do it, I actually don't really think this would be much of a problem. I think people would leave their apprenticeships and they'd have a really good sense of pulse.
[00:09:18] Speaker B: I agree.
[00:09:19] Speaker A: Assuming the person that they worked with was a pulse person.
[00:09:22] Speaker B: Absolutely. Yeah. And the other thing about the pulse is, well, so say Chinese culture in general is there's a little bit of an air of secrecy and a hesitancy to get give detailed, quote, unquote, secret information to the public.
[00:09:38] Speaker C: Right.
[00:09:38] Speaker B: So I can vouch this for the people in some of the trainings that I've done, where the teacher will give a case study.
[00:09:48] Speaker C: Right.
[00:09:49] Speaker B: And the case study is, patient has abdominal pain, nobody can figure it out.
And then they give the details of the case, and then they say the pulse is tight and no more details. When. What I know is they felt tight in a specific place on the pulse and they chose to ignore the details in the case.
So in other words, they gave the pulse quality generally, but they didn't say where they found it or how they felt it. And those details matter a huge amount to the formula that they actually picked.
[00:10:29] Speaker A: Right. Because just tight in general versus tight in the sun.
[00:10:34] Speaker B: Yeah. Tight in the guan. Yeah. The church.
[00:10:37] Speaker A: Right. Chi tightness.
[00:10:38] Speaker B: Exactly. It's going to change if you have A detailed system, a pulse diagnosis that's set to formula patterns. The place where you find that is going to be very important. And you could find it in multiple places, too, but that's even gonna be more important. Right.
So there's a level of secrecy and mysteriousness to the pulse that's partially protected, I think, based upon the way Chinese medicine's been transmitted and the general hesitancy around giving away the secrets of the method to the public. And so people then learn the pulse, or they read a case and they say, oh, the. The doctor said the pulse was slippery. And they think that all the doctor did was check the pulse and generally verify the quality over the whole pulse as slippery.
[00:11:34] Speaker A: And that piece of information alone was sufficient to write.
[00:11:36] Speaker B: And that piece of information of salon was. Yeah, exactly.
[00:11:39] Speaker A: Yeah.
[00:11:39] Speaker B: And it probably wasn't.
[00:11:40] Speaker A: Almost certainly not.
[00:11:41] Speaker B: Almost certainly not, yeah. So there's a secret to the method that isn't being displayed in the case study.
But if we don't ever take the time to study a pulse diagnosis system, you won't ever know that.
[00:11:56] Speaker C: Right.
[00:11:56] Speaker B: Or you may not even think that it matters that much.
[00:12:00] Speaker A: Because you won't have the secrets.
[00:12:01] Speaker B: Because you won't have the secrets. Right. And they're not really secrets. They're just. It's pragmatic information. Like, you know, the sun was tight, not the chair. You know, it's not crazy. But if you don't know that piece and you also don't know what tight feels like to that person, you won't be able to replicate it in the clinic.
[00:12:25] Speaker A: So in the case of kind of what the pulse is evaluating versus what the tongue is evaluating. Yeah, I know we've talked before about them essentially having a kind of more like yang quality, yin quality, like a material quality versus.
Versus a more ephemeral quality. How do you break down that sort of variance?
[00:12:46] Speaker B: Yeah. So the pulse I think of as the most emblematic example of a functional diagnostic tool. So it's going to tell functional change immediately. So let's say somebody has an external contraction. They walk into the building before they come into your office directly. And the building is much colder than the outside. Let's say it's mid summer and it's hot, they're sweating. And then they come into the building and it's ice cold because of ac. And they start to feel a little bit of aversion to the cold. They start to feel chilled. They may even have a headache that starts.
[00:13:27] Speaker C: Right.
[00:13:27] Speaker B: And then they come to your office. The pulse is going to tell you that immediately it's going to change immediately. There's an immediate functional change. There's an immediate change of the priorities of that body's physiology. That's gonna be registered on the pulse that probably won't be registered on the tongue. Does that make sense?
[00:13:48] Speaker A: Yeah. And that's because the tongue is measuring something more substantive, more material. Yeah, more material. And therefore probably more long standing, less quick to change.
[00:13:58] Speaker B: Exactly.
[00:13:58] Speaker A: Yeah.
[00:13:59] Speaker D: Yep.
[00:13:59] Speaker A: I mean, that poses some really, I think, challenging questions for people to consider. Because if you again, if you go back to your machiocha, you pull it out and you look at, there's going to be a tongue and a pulse for a wind cold invasion.
[00:14:13] Speaker C: Right.
[00:14:14] Speaker A: There's going to be a tongue and a pulse for, you know, a sudden onset problem.
And the truth is is that like probably the tongue is not going to be helpful in diagnosing an acute problem. Yeah.
[00:14:27] Speaker B: The place where we see tongue diagnosis come into acute problems is in Wenbing disease. That's when they actually talk about it. Because if it's a heat thing, the first thing that it's going to do is heat up the blood in some way and then that's going to change first the tongue body color and then eventually the code and all of these kinds of things. But in Shanghan Lun, like, you don't see any reference to the tongue diagnosis at all. You see a little bit in the Jing way.
That actually might not be true. There might be one reference to tongue diagnosis in the Shang'an for jersey patterns, but I think that's about it.
And even in that case, jersey patterns are heat patterns.
So there's a distinction there that I think is worth noting.
[00:15:16] Speaker A: Well, and I think when you consider the various types of heat pathogens that Wingbing was solving, I think most people who are working in the west working on folks in a regular everyday Chinese medicine clinic.
[00:15:30] Speaker B: Yeah.
[00:15:30] Speaker A: While the people that we serve have, you know, pathologies. Right. They have health problems that we're trying to fix. They don't have Ebola.
[00:15:39] Speaker C: Right.
[00:15:40] Speaker B: Exactly.
[00:15:40] Speaker A: You know, like they're, they're not in the middle of like some horrifying fibril, like epidemic.
[00:15:48] Speaker C: Right.
[00:15:48] Speaker B: If, if you, but if you're volunteering in Africa, you know, like maybe be worth learning.
[00:15:53] Speaker A: Yeah, yeah. Because I think what you would see there, like it's probably more likely that you would see a tongue that could be reflecting a relatively recent heat pathogen invasion. Whereas if you're working in the US or Europe or Australia or any of those places, like, I mean, it's Possible. But the truth is, is that if people have that kind of serious infection, they probably didn't think to come to you first.
[00:16:15] Speaker B: That's true.
[00:16:16] Speaker A: You know, I mean, for better or for worse. I would argue for worse. But for better or for worse, people go, oh, this is a serious problem. I need to go see the serious doctors.
[00:16:23] Speaker D: Yep.
[00:16:24] Speaker A: Which I'll just not be insulted by that. But the, but that, that affects the tongue reality. So that means if you're out in a regular clinic and you're looking at people's tongues all the time, probably A, they don't change very rapidly and two, they probably don't ever really look that bad.
[00:16:40] Speaker C: Right.
[00:16:41] Speaker A: I mean, if you're working in hospice with aged people who have like terminal illness, chronic disease, you might see a really, you know, geographic tongue with black coating, like maybe. But most of the folks that you're going to see are going to have like a pale red tongue with a thin white coat and it'll maybe be swollen or not.
[00:17:01] Speaker C: Right.
[00:17:01] Speaker A: And then maybe red dots or not. I mean, that's like the sort of standard tongue. In fact, like that tongue, if we're talking on this material side, then that material reflection is probably a long standing condition. That's why the swelling of the tongue is a notable item, because it's telling us about systemic dampness that's been around for a long time that didn't come from them standing out in the rain today and getting rained on and having a sudden damp cold invasion. That's not why their tongue is swollen. But from your experience, you could feel that in the pulse.
[00:17:36] Speaker B: Yes, absolutely. And the other thing to consider is we can look at really good acupuncturists, some of the better acupuncture people, and I only know of a single acupuncturist, all the high level people that are around who check the tongue before and after a treatment.
[00:17:56] Speaker C: Yeah, Right.
[00:17:57] Speaker B: So plenty of people check it before, especially if they haven't seen the patient before to get an orientation of diagnosis. But expecting that the tongue is going to change fundamentally after an acupuncture treatment. I only know one person who does that.
[00:18:12] Speaker A: Yeah.
[00:18:13] Speaker B: And so again, we're seeing more of a reflection here around. Well, and then an addendum to that would be a lot of people that do acupuncture check the pulse. Not everybody, but a lot of people do before and after, before and after and during. Sometimes like immediately after needling to recheck the pulse.
[00:18:34] Speaker C: Right.
[00:18:34] Speaker B: So the pulse is a much more functional tool. It's a Better tool for assessing channel pathology.
[00:18:41] Speaker C: Right.
[00:18:42] Speaker B: It's also a better tool for seeing where, let's say, the priorities of the physiology are. Right away you can see, oh, there's a chi problem right here.
[00:18:55] Speaker C: Right.
[00:18:56] Speaker B: Right away there is. You can see fluid metabolism problems in the pulse as well, though maybe easier to see in the tongue, I don't know.
And blood problems you can also see in the pulse, though maybe easier to see in the tongue, depending on what they are. Again, blood. We're getting more into the material realm, so there's likely going to be some more showing up on the material aspects of objective diagnosis.
[00:19:24] Speaker A: Yeah, I think too that the linkage between acupuncture and pulse makes sense because of how we think of acupuncture's ability to leverage qi as a primary force.
Of course, you can use acupuncture to circulate blood, you can use it to do lots of physiologic things. But the functional aspect of acupuncture is the movement of qi and the pulse diagnosis, the functional quality of the pulse is an evaluation of the qi. So of course, you can evaluate it rapidly right now, functionally on the pulse, then you can use needles to influence that qi immediately right now. So it makes sense that then you would be able to feel a difference in the pulse. By contrast, if tongue is a more long standing sort of state of the body, and while constitutional, suggests universal forever and always, I would argue that the tongue gives you a better sense of what a person's norm is, whether that norm is pathological or not, who can say? But you have, like, when you look at someone's tongue, you're looking at the last several years of time and buildup. I mean, this isn't something that happened this week or this month even.
So in that case, the tongue is the real indicator in my mind of what the kind of improvements happen through. Probably almost certainly herbal, but could also include acupuncture. But basically the whole treatment plan, you're implementing it, you're working on it, you push hard on a particular chief complaint, you help solve that chief complaint, you move on to two or three other things the patient has. And now they're eating using Chinese medicine parameters, they're living a more seasonal life, they're being mindful of too much sweet flavor, damp stuff, whatever. And now, over the course of four, five years, 10 years, you've got a sort of ongoing maintenance patient where you are really working with this person.
It would be amazing, I think, to look at the tongue pictures, assuming you're using A digital chart. Right. Look at the tongue pictures from five, six years ago.
[00:21:30] Speaker C: Right.
[00:21:31] Speaker A: And now look at them now. Once someone has really gotten on board with sort of peeling back the layers of their dysfunction, that would be really, I think, telling.
[00:21:40] Speaker D: Yep.
[00:21:41] Speaker A: Not so useful in the immediate. Like, if you come in, even. Even I gave you an herb formula, and next week, come in, let me look at your tongue.
[00:21:49] Speaker C: Right.
[00:21:49] Speaker A: It's probably not gonna be that different.
[00:21:50] Speaker C: Right.
[00:21:51] Speaker B: And honestly, depending on the condition, the pulse might not be that different either. Yeah, you know, Yeah, I think that's possible.
[00:21:57] Speaker A: I think heat stuff. It makes sense that the windbing folks were looking at the tongues more because heat, by its nature as a pathogen, is more rapid. It moves quickly, it inflames quickly, it consumes quickly. And so therefore, it's going to show, even in the material realm, more quickly. But cold stuff, damp stuff, is by its nature slow and accumulative, and therefore, it's going to take some time for it to appear and also for it to go away. Yeah, that's really interesting. So, okay, if the pulse lives in this functional space and the tongue lives in a material space, where does the abdomen fit into that paradigm?
[00:22:38] Speaker B: Right in the middle.
Right in the middle. I would say it's more material than functional, but it shows both. And I would say it also tends to show more detail about the material body than the tongue does. For most people that use the tongue, you can see relative to the jowl where there's different material problems. Upper jiao, middle jiao, lower jiao, you can see these kinds of things on the abdomen. So, yeah, I think the abdomen sits right in the middle of the two.
[00:23:14] Speaker A: So when you're saying abdomen, we're basically talking about an objective evaluation methodology in the kind of Japanese hara zone.
[00:23:23] Speaker D: Yeah.
[00:23:24] Speaker A: Basically subcostal to, like, down past umbilicus to the sort of upper pathway of asis.
[00:23:34] Speaker D: Yep.
[00:23:34] Speaker A: Right. So if you take the abdomen, then, and essentially divide it into the classic biomedical four quadrants. Right, upper right, upper left, lower right, lower left.
[00:23:44] Speaker D: Yep.
[00:23:44] Speaker A: And then umbilicus, epigastric midline.
[00:23:48] Speaker D: Yep.
[00:23:48] Speaker A: So those are sort of the rough zones. And I think we've talked a little bit about abdominal diagnosis before, but somewhat like pulse, we need some calibration with abdominal.
[00:23:58] Speaker B: You do.
[00:23:58] Speaker A: But also somewhat like tongue, you can also just read and get a description of things and try it. So even experientially, it seems to fall kind of between the two.
[00:24:09] Speaker B: Yes. And I would say it's closer experientially in the time that it Takes to become competent to the tongue than it is to the pulse. So that's a. I think of that as a positive thing. The pulse takes a lot longer for people to learn, a lot more repetition for people to feel a certain level of competency with.
Whereas the abdomen, you can do a weekend and maybe do another weekend a few months later, like six months later, and practice it in the clinic, and boom, you got major skills that are useful to you. Yeah, yeah.
[00:24:48] Speaker A: That's interesting also, because I think the.
Again, that gets to this question of sort of where. Where more people can agree. So, for example, if I go to palpate, say, upper right or left quadrant. Right. So I'm going to take the blade of my hand, I'm going to go up underneath someone's ribs in the costal region there. Right.
And I'm checking for the texture of the tissue as I move through it, and then I'm checking for tenderness on the patient's side.
[00:25:15] Speaker D: Yep.
[00:25:16] Speaker A: And those things are. I mean, the tenderness on the patient's side is reported by the patient.
[00:25:20] Speaker B: It is.
[00:25:20] Speaker A: And so that, you know, you don't have to calibrate that at all. You literally just make sure you're putting your hand in the right place and that you are going deep enough.
[00:25:28] Speaker C: Right.
[00:25:28] Speaker A: So then you can, like, anyone listening to this can hear, like, blade of hand under ribs, upper right quadrant, left white quadrant. Like that. That's simple. You could do that.
And if I say that it's fairly strong pressure, you'd be like, okay, yeah, but that part's the calibration part.
[00:25:43] Speaker D: Yes.
[00:25:43] Speaker A: You have someone show you, like, okay, this is the level of depth that we're talking about, which is why you can do it in a weekend. It's a handful of practice runs.
[00:25:50] Speaker D: Yep.
[00:25:51] Speaker A: And then you just start doing it and you start, like, pulling that information. Now, abdominal diagnosis has more subtleties to it than just like, of course, poking in four quadrants. Right. But it's still pretty. It's still pretty straightforward, which I think is pretty phenomenal. I always think it's interesting if you've never used abdominal diagnosis and you're thinking, like, well, wouldn't it be tender for everyone if you, like, put your hand up underneath someone's ribs? That means you're probably tender.
[00:26:16] Speaker D: Yeah.
[00:26:17] Speaker A: And I will tell you. No, it's not, actually.
[00:26:19] Speaker D: Yeah.
[00:26:20] Speaker B: A lot of people that don't have any tenderness with it at all.
[00:26:24] Speaker A: It's kind of amazing. Like, I've slid my hand basically, like, underneath someone's ribs. Like, I feel like if I Could cut my hand down. I could just, like, grab their stomach or their diaphragm and, like, pull it down. And I'm like, oh, is that. Is that tender? And they're like, no, no.
[00:26:38] Speaker D: Yeah.
[00:26:39] Speaker A: And it's soft and supple. There's no resistance. It doesn't feel tight.
[00:26:42] Speaker D: Yep.
[00:26:42] Speaker A: You know, so that. That's definitely something to consider when you think about, you know, how it would work. So if we have these three things. Pulse, tongue, abdomen, and someone is getting into herbs more, they want to write formulas more, maybe they're feeling that the training that they had in school was standard, nothing wild. And they probably didn't get any abdominal diagnosis, potentially.
What do they do? What's the next step? How do they start to try and actually hone the skill so it could be useful to them?
[00:27:18] Speaker B: I think the best. So I think the best one to learn, as far as the speed of which you can become competent and the level of linkage to a specific treatment method is the abdomen. So the pulse, I think, is maybe possibly the best of the three to learn. For a few different reasons, certain stuff won't show up on the abdomen. Let's just say that. So that wind, cold thing that we talked about at the beginning, that probably won't show up on the abdomen because that's affecting the upper channels of the body.
There may not be any sign of that in the abdomen yet.
[00:28:03] Speaker C: Right.
[00:28:04] Speaker B: So in this way, the functional piece. Piece doesn't really start to affect the abdomen until you get to, like, from a Shanghan Lun perspective, either Yang Ming disease or Xiaoyang disease, that's when it starts to affect the abdomen. So if it's in Taiyang, which people can have. It may not show up depending on what it is.
So it's good to. So what I have the residents do here is I show them how to take the pulse. So we line the fingers up, which is easier said than done, actually.
Find the pulse and start very softly, like light, light as a feather. Put your hands on the pulse and then see if you feel anything. Play around with the.
Let's say, the distance between the styloid process and the palmaris longus tendon, whatever that tendon is in the middle, that thing. Play around with the distance between the two. See if you can find the trajectory, the radial artery, and then line up the fingers and just see if it's. If you can feel it superficially or if you need to press deeper to feel it, and if you need to press real deep to feel it at all, then the pulse is deep.
So just feeling the pulse generally, can I feel it right away?
That's superficial. If I need to press in to feel something, that could be mid or it could be deep. Right.
We just start with that. And what I tell people is, do that on every patient. It takes, what, 15 seconds maybe. And you're using it to understand basically where the resources of that person's body are working. So if it's on the surface, there's resources working on the surface.
If you can't feel it until you go real deep, then it's. All of them are deep. And that tells us something about the treatment method. The treatment method should either be superficial or it should be deep for that patient.
So I have them do that, and then I tell them, just do that on every patient. So you get used to lining your fingers up. You start to feel the nuances of pulse, but you're not too distracted by qualities.
[00:30:26] Speaker A: Right. Because if you're sitting there with your fingers on the pulse and you're like, is this slippery? Is it scallion stock? Is it wiry?
That's way too much. That's a lot of pressure to put on yourself.
[00:30:37] Speaker B: Way too much.
[00:30:38] Speaker A: Yeah. Especially if you haven't trained that up with someone.
[00:30:42] Speaker B: Oh, right, yeah, exactly. Whereas if you start doing the abdomen and you just learn the basic kata for compo, which you can learn from a variety of people. You know, Nigel Dawes is teaching constantly. You know, you can learn from him. There's. By the way, there's good videos on YouTube of him practicing the kata. The basic kata, which is useful to watch once or twice and look at what he's doing. And then if you read his book or you. You just try. You take a class on it, it's good to refresh just the visual. Like, how deep is he going? You know, like that kind of thing with the rib side. And just. Just checking the visual piece a few times is really helpful.
[00:31:24] Speaker A: The. The kata, by the way, if you're not listeners, if you're not familiar with that term. Right. That's a Japanese term for, like, the flow.
[00:31:32] Speaker D: Yes.
[00:31:32] Speaker A: Like this. The. The order in which protocol you do the things. Yeah. A kata. You might have come across that if you've ever, like, studied karate.
[00:31:40] Speaker D: Yep.
[00:31:40] Speaker A: Or something as a kid. Right, exactly. It's like, do the kata.
[00:31:43] Speaker D: Yeah.
[00:31:43] Speaker B: Do the katana.
Yeah. So that. That's.
You can study with him. You can study with Kumiko Shirai.
[00:31:52] Speaker C: Right.
[00:31:52] Speaker B: She teaches all over the US and there's people that. That you can learn from.
[00:31:57] Speaker D: You could.
[00:31:57] Speaker B: There's people that you can learn this from. And even if you do just one weekend, it's great. It's, like, very helpful. You can get a lot done in a weekend. And if you. It's even better if you do, like, a weekend and then you practice it on every patient that you can, and then a few months later, or six months later, a year later, you do another one, then you're going to get a ton. It's like the skill level is going to go up, like, a lot. And that is not the case with the pulse. The pulse you can get things from right away, but you don't get anywhere near the level of detail and confidence that you will from learning abdominal diagnosis. It takes time.
You know, I do. The pulse is my main tool in the clinic, but I do clinics with, you know, a supervisor every two months, and I've been doing that for the last, like, three years.
And I feel confident with the pulse, but there's still cases where I go in the clinic and I feel the pulse and I'm like, what the heck is going on here?
[00:33:07] Speaker A: Yeah.
[00:33:07] Speaker B: You know, relative to that, I've done much less training with the abdomen, but I feel very confident with the abdomen, so I use both.
[00:33:16] Speaker A: I mean, I think it is just simpler.
[00:33:18] Speaker B: It's just simpler.
[00:33:19] Speaker A: It's just simpler. Like, the. The amount of variation isn't so great. And, you know, I think the problem is that people will heal, hear simpler, and they'll hear less valuable.
[00:33:29] Speaker C: Right.
[00:33:30] Speaker A: Or. Or they'll hear not as sophisticated.
[00:33:33] Speaker D: Yep.
[00:33:34] Speaker A: And, I mean, I suppose you could read it as not as sophisticated, but I certainly wouldn't read it as less valuable because, of course, it's only value. Like, any of these objective measures are only as valuable as you can make them.
[00:33:47] Speaker C: Right.
[00:33:48] Speaker B: Yeah, exactly.
[00:33:48] Speaker A: So if you're like, oh, pulse is so much better, I can take someone's pulse and see that they broke their arm in the fourth grade. I mean, except, can you do that?
[00:33:57] Speaker C: Right.
[00:33:57] Speaker A: Right. Like, I don't think.
[00:33:58] Speaker B: Can you actually do it?
[00:33:59] Speaker A: I don't think you can, because I think there's, like, three people on the planet right now who can do that. You're probably not one of them. So why? Like, I think it's a pragmatic thing. Like, by all means, continue to study the pulse and refine it.
[00:34:13] Speaker C: Right.
[00:34:13] Speaker A: Like, but the thing is, is it will be the work of years. Right, Right. And not just the work of years of you taking pulses in your clinic. If you don't have anyone in your sphere who Uses the pulses point you.
[00:34:26] Speaker B: To the different things.
[00:34:27] Speaker A: Yeah. And he's like, better at it than you.
[00:34:28] Speaker D: Yeah.
[00:34:29] Speaker A: You are reinventing the wheel, Right. It's not to say you couldn't do it.
[00:34:33] Speaker C: Right.
[00:34:34] Speaker A: You could, but, man, that's a lot of work.
[00:34:35] Speaker B: It would take 10 times as long, probably, at least.
[00:34:39] Speaker A: Yeah. And with patient traffic that's, like, hard to imagine. You would have to have, like, Chinese hospital level patient traffic in order to have any hope of sort of discovering the movements yourself.
So by all means, continue to study the pulse. But from like, a pragmatic, like, easy to use item, you could literally read an explainer sheet on the abdomen and watch three or four YouTube videos.
[00:35:03] Speaker B: Exactly.
[00:35:03] Speaker A: And then immediately go and use it and have it be useful.
[00:35:06] Speaker B: Have it be useful. Yeah, it'd be way useful, much more quickly. And you can practice it and still refine it. Just by rewatching video, looking at different lectures. You can do a lot more with the abdomen than you can with the pulse. I do think the pulse is still worth doing. So then we go to the other end, like, well, why? Just. Just forget about the pulse. Use the. I actually still think it's worth taking. Even if you can only tell superficial or deep. Yeah, it's still worth doing because it really orients the treatment process. Do I need to treat more superficially or do I. Oh, there's nothing going on on the surface. I actually need to treat the deep part of the body right away. Maybe I'm gonna use futsa right away.
[00:35:53] Speaker C: Right.
[00:35:54] Speaker B: Whereas I might be afraid to do that otherwise. It's really going to help us orient that way.
[00:35:59] Speaker A: I mean, that's what I do.
[00:36:01] Speaker B: Yeah.
[00:36:01] Speaker A: Like, I don't really use pulse at all. Except. Yeah, except to be like, superficial or deep. Yeah, like, that's.
[00:36:06] Speaker B: That's great.
[00:36:07] Speaker A: That's it. Because I. I never did that extra training and I find it tedious. Like, I don't actually don't like training the pulse. Like, I find the inconsistency.
Yeah, I find. I find the inconsistency of it very frustrating, you know, and that, in fact, as students, I remember, though that continues to be so many more years ago now, every year that passes. But I remember doing supervisor rotations and feeling a pulse and spending a whole quarter feeling a pulse and being like, okay, I've got it now. I finally understand what wiry pulse is.
And then we'd switch rotations, a new supervisor, and I'd feel a pulse and put my fingers on it and be like, wiry, I got you. I See you right there. Supervisor comes in, fingers on the pulse. Not wiring.
[00:36:53] Speaker D: Yeah.
[00:36:53] Speaker A: Something else.
[00:36:53] Speaker D: Yeah.
[00:36:54] Speaker A: And you're like, what the hell, man? Like, what's going on? You tell the supervisor that. Well, you know, and then they've got a different explanation for why, you know.
[00:37:01] Speaker D: Yep.
[00:37:01] Speaker A: And that's not to say that like any of those people are wrong.
[00:37:05] Speaker C: Right.
[00:37:06] Speaker A: Though I suppose they could have been, but like, they're coming from their own experience.
[00:37:09] Speaker B: Sure.
[00:37:10] Speaker A: And they're saying, like, when I feel this, I call it this. Sure. Which means that. And I think this is really. If I can drive home this takeaway is a point I made earlier. It's a little bit like, you know how years ago we talked about building out the organoleptic assessment process for herbs.
[00:37:27] Speaker D: Yeah.
[00:37:27] Speaker A: So for listeners, that means that we would use like taste and smell basically to determine the nature and flavor of herbs.
[00:37:35] Speaker B: Like with wine. Like what people do with wine.
[00:37:38] Speaker A: Coffee.
[00:37:38] Speaker B: Yeah. You get trained as a sommelier and then you have a skill set.
[00:37:42] Speaker C: Right.
[00:37:43] Speaker B: Then you would then apply to understanding the process of herbs.
[00:37:48] Speaker A: Calibration. Calibration, same process. The thing about that skill set though is one of the ways that you train it is you get these collections of scents that are in little vials. They have like a liquid inside of them that has an odor. Right. And that's standardized across the industry. So if you are in Europe or in Australia, in the us, whatever, this vial, which is called cut grass, is the same everywhere. So you chain, you train your nose that when you smell this thing that's cut grass, what happens if you smell it and you think, well, that doesn't smell like cut grass to me. Right. It doesn't matter.
[00:38:26] Speaker B: Doesn't matter. You train the. The term exactly into that smell.
[00:38:30] Speaker A: No one was asking your opinion on whether you thought this was cut grass or not. The thing is, is that this smell is cut grass. Cut grass. Therefore, when you smell it, then you're gonna write down cut grass.
[00:38:44] Speaker C: Right.
[00:38:45] Speaker A: That is really almost identically analogous to systematized pulse diagnosis.
[00:38:51] Speaker D: Yeah.
[00:38:51] Speaker A: Right. Which is like 100% fingers on wrist. That slippery.
[00:38:55] Speaker D: Yep.
[00:38:56] Speaker A: Feel another one. That wiry. That slippery. That wiry. This is not universal. It's also not your opinion.
[00:39:04] Speaker C: Right.
[00:39:04] Speaker A: Like, oh, I actually I feels more wiry to me. No, like, this is slippery. I told you this is slippery.
[00:39:09] Speaker D: Yeah.
[00:39:09] Speaker A: Train your. Train your feeling and then once you reach a point of mastery of being able to repeat those things, then like minded people could disagree. Right. People with similar levels of training and like, whatever. But honestly, if you went through the Same training paradigm as. As 10 other people. And we put you guys in this room, there will be some variation. It will not be dramatic.
[00:39:31] Speaker C: Right.
[00:39:32] Speaker A: It just won't.
[00:39:32] Speaker B: 100%. Yeah.
[00:39:33] Speaker A: Because everyone's been calibrated to the same evaluation system.
[00:39:36] Speaker B: And different pulse traditions also will have different meaning for these terms, which is also why it's confusing. So, like, when I was a student in school, I studied Schenhammer pulse diagnosis. That's what I was doing my last year and for the first few years after.
And they have a definition for like a tight pulse that is not the same thing as a tight pulse in the system that I study. Now, the system of acupuncture that I use also has a tight pulse, and none of them are the same. They all mean something different in feeling. Actually, the acupuncture one and the Schenheimer one are the closest in meaning, but that would not translate to the current system that I use. But then it also. You have to check in with what does it actually mean as far as how do I treat it in each system.
[00:40:27] Speaker C: Right.
[00:40:28] Speaker B: And each system will define what it means a little differently when they feel that thing. And there will be a different way of addressing it, all of which work, but it has a different meaning within the context of the system. And so that's the other thing that makes pulse diagnosis confusing is there's different systems, and the meaning of things like tight or wiry or slippery may be different in each system.
So it's important to not try to learn every system either. Like, you pick one system, you can try different ones out, of course, but if you're going to learn, like if you decide you want to go deeper with the pulse, try a few different ones out, and then you've got to kind of commit to one for a while. It's sometimes possible to bring another one in later, but probably not every system will jive with every other one.
[00:41:22] Speaker A: No, I mean, at some point you will. Even if you studied multiple systems, which is a lot to do, actually.
[00:41:28] Speaker B: It is.
[00:41:29] Speaker A: But even if you did, at some point, you're going to leave some on the table.
[00:41:32] Speaker B: Yes.
[00:41:33] Speaker A: At some point you're going to be like, yeah, this isn't the one.
[00:41:35] Speaker C: Right.
[00:41:37] Speaker A: So I think it's probably worth saying also, I mean, here we are talking about learning all these objective systems, but we didn't really explain at the top why. Yeah, like why? I mean, outside of, like, feeling like you're a good Chinese medicine. Sure, sure. Take the tongue in pulse.
[00:41:52] Speaker B: Gratifying your ego. Yeah, exactly.
[00:41:54] Speaker A: I'm good at the pulse. Outside of that, why do we need objective measures? Why can't we just listen to what the patients tell us?
[00:42:01] Speaker B: There's no more unreliable source than the patient's words.
It is the most unreliable source of information that you're going to encounter in the clinic. It is.
[00:42:12] Speaker A: Yeah, it is. And that's not a slight on patients. Like, that's just what it is to be a human.
[00:42:18] Speaker B: It is.
[00:42:18] Speaker A: You're asking someone to report their subjective experience, and we're trying to make that conform to a systematized method of diagnosis. And so even if you're really good at questioning, which I think we've gotten to be over the years, and we train our residents with it. Right. So, for example, which is important too.
[00:42:38] Speaker B: It's important to be good at asking questions.
[00:42:40] Speaker A: Yeah. Because you can't just say, like, so how's your digestion? Like that. That will not give you anything useful, you know, like, how's your digestion? Will always be, it's fine. Like, there's nothing, you know, unless that person is literally pooping blood every day.
[00:42:54] Speaker C: Right, right.
[00:42:55] Speaker A: They'll be like, it's fine, even if they. They have a bowel movement every three days. But they've had one every three days for 15 years, so that feels fine to them. So obviously, you have to learn how to question to try and get the patient's sort of subjective reality into some structure that's useful.
But at some point, the questioning. You can honestly get past a lot of questioning if you have a reliable, objective tool.
[00:43:21] Speaker B: Absolutely.
[00:43:22] Speaker A: So if the patient keeps telling me that there's nothing strange about their urination and they don't have thirst and the things that would normally indicate that we have a water problem, but I go and I do an abdominal evaluation, and it very clearly indicates water problem. Yeah, Right. We're doing splash sound on the abdomen. We've got the tenderness in the right locations.
And then I look at their tongue and I see that it's swollen with tooth marks.
[00:43:50] Speaker C: Right.
[00:43:50] Speaker A: We got a water problem.
[00:43:51] Speaker B: You got a water problem.
[00:43:52] Speaker A: It doesn't matter that they're not thirsty. They don't have strange urination. No, we got a water problem.
[00:43:57] Speaker B: You got a water problem. And then maybe you're like, do you ever get dizzy? And they're like, oh, my God, I'm dizzy all the time. I have no idea what it's. And like, that one question can justify Wulingsan or Linguiz, Yugan Tong or whatever.
[00:44:11] Speaker A: Whereas all the other things you asked said, oh, that's not the formula.
[00:44:14] Speaker C: Right.
[00:44:14] Speaker B: That isn't the formula. It's not painting the right picture. And you see this, like, if you look at, if you look at one of our residents charts, the first time that they see a new patient, there's so much detail.
[00:44:28] Speaker A: So much detail.
[00:44:29] Speaker B: It's almost hilarious.
[00:44:30] Speaker A: Plus their hearts from school.
[00:44:31] Speaker B: Yeah.
[00:44:32] Speaker A: So much detail.
[00:44:33] Speaker B: So much detail.
[00:44:33] Speaker A: That means they were trained well.
[00:44:34] Speaker B: It means they were trained well. You look at one of our charts, the first time, it's kind of like runs hot, you know, like it's super, like simplified and pithy and like, I still want to know about my patient's experience, but that's all done in conversation. It's not something that I'm vigorously notating for diagnosis.
[00:44:57] Speaker A: Right.
[00:44:58] Speaker B: One of the things I think that's really important for people to learn early on is we don't treat the patient's story as such in diagnosis.
[00:45:09] Speaker C: Right.
[00:45:09] Speaker B: You can treat the patient's story by talking to them, by listening to them, by helping them to understand conceptually what they're going through and maybe a more empowering way.
[00:45:20] Speaker A: Yeah.
[00:45:20] Speaker B: But you don't treat their story with a diagnosis and with an intervention.
[00:45:24] Speaker A: Right.
[00:45:25] Speaker B: And with an intervention.
[00:45:26] Speaker A: Here's the story.
[00:45:28] Speaker B: No. Without any objective diagnostic criteria, if you try to treat their story, you're going to be running in circles.
[00:45:35] Speaker A: Yeah.
[00:45:35] Speaker D: Yeah.
[00:45:36] Speaker A: Especially as your cases get more complicated and more chronic and more long standing. Because the longer a person deals with a problem, the more their health narrative gets messy.
[00:45:46] Speaker B: Yes.
[00:45:47] Speaker A: And that then sort of creates this problematic feedback loop where their health narrative is messy, which is the story that they tell. And the retelling of a messy health narrative manifests messy health.
[00:46:02] Speaker D: Yes.
[00:46:02] Speaker A: And so we go round and round and round. And so you jump in there, right. And you're like, okay, I'm trying to really understand this story.
And as you said, there's a huge amount of value inappropriately listening, reflecting, validating experience.
[00:46:16] Speaker B: Like creating treatment plan, explaining what we're.
[00:46:19] Speaker A: Working on, you know, magic there.
[00:46:21] Speaker D: Yeah.
[00:46:22] Speaker A: Powerful. And not, not just from a solutions problem, but also just from like a human dignity situation. Like this person is sitting in front of you and they're telling you about this shit story.
[00:46:31] Speaker D: Yes.
[00:46:32] Speaker A: The last five years they've been dealing with this thing. Every doctor told them there's nothing wrong with them, they did all the scans, blah, blah, blah. You've. You've all heard these stories.
We, of course, just as profession and as humans and just trying not to be bad people is like, it's important to hear that story. But if you base your whole diagnostic approach just on the story, you might solve it. But honestly, that'll mostly be luck.
[00:46:59] Speaker B: You'll be very lost very quickly.
[00:47:01] Speaker A: You'll write a formula and then nothing will happen. And you'll write another formula and nothing will happen. You're like, I don't what's going on here.
[00:47:08] Speaker C: Right.
[00:47:09] Speaker A: And look, that also happens with objective measures. I'm not trying to say that it's a perfect system, sure. Especially if your cases are chronic and long standing, but you will have a much better shot, a much better shot of actually landing the. To a good solution if you use the objective measures as a primary indicator and then. And then weave it together with the subjective.
[00:47:30] Speaker D: Yes.
[00:47:30] Speaker A: Patient components.
[00:47:31] Speaker B: Agreed.
[00:47:32] Speaker D: Yeah.
[00:47:32] Speaker A: So this is why it matters. Like we're talking about matters. Because a lot of times the patient's narrative is too sticky to be able to really peel back the layers and see what's going on.
[00:47:45] Speaker B: Yeah. And it also takes a long time.
[00:47:48] Speaker A: Oh, yeah, that's true.
[00:47:49] Speaker B: Like, you know, if you're good at objective diagnosis, any one of these met, like, even the abdomen, which I would say maybe takes the longest for most people to check rel, like, so the tongue is the fastest to check, right?
[00:48:03] Speaker A: Yep.
[00:48:04] Speaker B: The pulse, depending on the system you practice, could be long or it could be very short. For me, pulse diagnosis lasts at most a minute and a half, usually less.
[00:48:16] Speaker C: Right.
[00:48:16] Speaker B: So it's actually pretty quick.
And then the abdomen takes maybe a little longer, but not much. So they're all relatively fast.
But there are degrees of variation in the measure depending on the method. They're all faster than asking a person a million questions.
[00:48:41] Speaker A: Yes.
[00:48:42] Speaker B: Every single one is way faster than that. And again, it's not that we shouldn't make time to talk to our patients or listen to their story or whatever, but you don't want your diagnosis to depend upon that as much as possible. You want to be able to. Okay. No matter what their story is, which I can listen to if I choose to.
[00:49:01] Speaker C: Right.
[00:49:02] Speaker B: I've got the diagnosis. I know what I'm doing.
[00:49:05] Speaker A: Yeah.
[00:49:05] Speaker B: We want to get to that point as quickly as possible.
[00:49:08] Speaker A: This is also the pathway to being a faster herbalist. So if you're thinking, like, I want to do more herbs, but it's hard to figure out the time. Maybe you're working in a clinic where you've got patients every half an hour, you work in two rooms. If you work in three rooms.
[00:49:25] Speaker C: Right.
[00:49:25] Speaker A: You don't find a lot of clinics that are working three rooms who are doing real Herbs, Right, right. I mean, they're handing like T pills.
[00:49:32] Speaker B: Unless they're Chinese, you know.
[00:49:33] Speaker A: Yeah, yeah, yeah, yeah, that's true. If you're China trained practitioner, you're coming from Chinese hospital system. That's a different story.
[00:49:41] Speaker D: Yeah.
[00:49:41] Speaker A: You know, but those Chinese doctors are usually not doing acupuncture and herbs.
[00:49:45] Speaker C: Right.
[00:49:46] Speaker A: In that time they're just one or the other.
[00:49:47] Speaker C: Right.
[00:49:48] Speaker A: But so if you're working in a primarily acupuncture clinic, you're doing two or three rooms at a time. Right. Two or three patients in an hour.
And you're thinking, how do I actually find the time to do more herbal stuff? Objective measures is one of the ways.
[00:50:04] Speaker B: That'S going to be the fastest way to.
And a method that's going to point you directly to formula strategy. Because there are plenty of systems of objective diagnosis that give you a diagnostic feature, but they don't point you to a formula that's really important. So the systems there are really good systems for that. And if you're nervous about herbs and you want the objective diagnosis to point you to an herbal method, there are systems that are specific for that. And one of the main ones is campo compo is that is what it is. It's like a lock and key diagnostic formula method.
[00:50:48] Speaker A: Yeah. I think that there's a lot to be said for that. So, okay. If people want to, they want to learn more about these different kinds of things. So if they want to learn more about abdomens. You mentioned Nigel Dawes, right? Nigel Dawes, Kumiko.
[00:51:02] Speaker B: Kumiko.
[00:51:03] Speaker A: Yep, yep. She's teaching. And then there's YouTube videos on the subject.
[00:51:07] Speaker B: There's YouTube videos.
[00:51:08] Speaker A: So those are two names that are probably good to start with if they want to do more with pulse. I think most people have probably heard of the Shenhammer system.
[00:51:14] Speaker D: Yep.
[00:51:15] Speaker A: It's very involved.
[00:51:16] Speaker D: Yes.
[00:51:17] Speaker A: A lot of details. But you would need to find some folks in your area who are doing Shenhammer.
[00:51:21] Speaker D: Yep.
[00:51:22] Speaker A: You could always travel, of course, to learn more Shenhammer.
[00:51:24] Speaker D: Yep.
[00:51:25] Speaker A: And then if you're looking at tongues, there's a whole host of. Of books that exist. Right. Atlas of Tongue Diagnosis is probably the most famous one. Lots and lots of pictures. To be honest. It deals with stuff that most of you won't see because most of the tongues that you're going to see are going to look kind of in one zone.
[00:51:45] Speaker C: Right.
[00:51:46] Speaker A: Kind of like what I mentioned. I love tongues as a tool, but mostly just because I work with a lot of patients who have digestive problems and that they're chronic and longstanding. And the tongue lets me know kind of right from the beginning how hard I can push with a formula.
[00:52:03] Speaker C: Right.
[00:52:03] Speaker A: So if I. Someone sticks out their tongue and it's pale, it's wet, and it's got tooth marks on it, and they're here for irritable bowel syndrome, I'm going to need to be cautious about how punchy the first formula is. I write them because there's a kind of wet, boggy stagnation that's clearly inside of their digestive process.
[00:52:24] Speaker D: Yep.
[00:52:25] Speaker A: That if I throw a formula in there, that's. That even is the perfect formula, but the dose is too high. They're gonna end up with, like, acid reflux or rapid loose stool or something that makes it so that they can't take it. And so that's useful to me. Over the course of working with a person for six months, that tongue is just barely gonna move.
[00:52:46] Speaker D: Yeah.
[00:52:47] Speaker A: Even if we really figure out a really solid formula, it'll be more ruddy, less pale.
[00:52:52] Speaker D: Yep.
[00:52:52] Speaker A: Slightly less swollen. But it's not gonna be like a perfect tongue. Sure. Even in six months. And that's how long it takes for that stuff to change. But I think if you're interested in tongues, I would start with Atlas of Tongue Diagnosis. And just get the. Get the pictures. Right. So you can just start to look at more picture pieces that are there. And then at that point, you can. If you have an EHR system that'll let you take a picture of the tongue and store it. I also highly recommend that a little bit like you said, with just taking the pulse at superficial or deep.
[00:53:25] Speaker B: Yes.
[00:53:26] Speaker A: It's the same. Just take the picture.
[00:53:27] Speaker B: Yeah, just take the picture.
[00:53:28] Speaker A: Take the picture. In fact, you can take the picture every time if it just helps your own.
[00:53:32] Speaker C: Right.
[00:53:33] Speaker A: Clinic flow process. Like, you're not. That tongue is not going to look different next week.
[00:53:37] Speaker C: Right.
[00:53:37] Speaker A: But if. If you just want to, like, as part of your thing, when every time a patient comes in here, you touch the wrist on both sides, checking superficial deep.
[00:53:47] Speaker D: Yep.
[00:53:47] Speaker A: And you take a picture of the tongue.
[00:53:48] Speaker D: Yep.
[00:53:49] Speaker A: And you just do that every time.
[00:53:50] Speaker B: That's great.
[00:53:51] Speaker A: Eventually you end up with, like, a pretty large collection of data that you can mine for yourself. You could, with a single patient, if they saw you for a long time, have like a gallery of tongues.
[00:54:01] Speaker C: Right.
[00:54:01] Speaker A: Which could be kind of cool, actually, if you were to look at that. So I think that that's a good place to start. And then with abdomens.
Get online and look at the videos.
[00:54:09] Speaker D: Yeah, yeah.
[00:54:10] Speaker A: Look at the videos.
[00:54:10] Speaker B: Look at the videos. We should also say that we're beginning to put out content for, for training these basic systems too.
[00:54:18] Speaker A: Yeah, exactly. So if you're in person in Portland, T.C. here is going to be doing more public facing classes for practitioners and folks to come and actually see what the abdominal system looks like. You can find information about that from our education website, which is Jisha Academy, so JX Academy, Juliet X Ray Academy, Learning all the phonetic letters here.com and so you can see the class schedule there and kind of see what's coming up. And you know, we've also mentioned several times now in this show and others about our residents.
[00:54:52] Speaker D: Yes.
[00:54:52] Speaker A: I don't think we've ever mentioned the fact that we run a residency program. Yeah, so we run a residency program here. It's primarily geared toward folks who have just graduated from Chinese medicine school. So they've just finished and then they start with us in the fall and it's essentially an 18 month program. So they start with us in the fall and they sort of finish out that Chinese year and then they run the whole next one.
[00:55:18] Speaker C: Right.
[00:55:18] Speaker A: So for example, right now we're in the Year of the Snake residency and we've just opened applications for Year of the Horse.
But at any point, you know, even if you listen to this show in the future and you're like, wait, it's not Year of the Horse anymore, that's okay. Just go to Rooting Branch's website, rooting branchpdx.com and there's always going to be a link there to the residency. There's also one on G Shaz website, so you can read about it and just sort of see what the relationship is there. But we basically take on two or three people every year who come with us and we give them a bunch of new practitioner basics in those first six months. Like stuff that doesn't have anything to do with Chinese medicine, how to build your business, how to set up a website, all the sort of like business stuff. And then once those folks have passed their boards and we're not worried about confusing them with the information we're gonna teach them, Travis Cunningham has a really robust advanced clinical training system that then begins usually at the beginning of that real Chinese year, and then that sort of goes through the whole year and people end up seeing patients here with us, they get, you know, direct mentorship from us and then a whole bunch of support on both the clinical delivery side and also the business delivery side. Because I'm sure as many of you out There know, you know, we, people get into this medicine because they want to do the medicine, they want to teach, treat patients. But the reality is, is that most of us are self employed.
[00:56:43] Speaker D: Yeah.
[00:56:44] Speaker A: And so that means you gotta, you gotta know how to do your books and you gotta know how to run your business. So that's, that's another side of things. So anyway, all that to say, if you've been hearing us mention the residency and you're like, what are they talking about? Go to rootinbranchpdx.com, click the residency tab and you can see more about each of the programs and the years that they flow and the timelines and stuff like that. And if you're interested in joining us, if you're a student and you're thinking, hey, that'd be cool, check it out. Applications usually open sometime in the spring every year, and then they go around and they stay open for a certain amount of time. And if you're not a new student and you're like, oh, that also still seems interesting, you should shoot us an email because in the last year we've actually had more folks who maybe graduated two years ago or three years ago and now they kind of want to get back into this thing and get some more information. And that is possible. It's not the standard program, but we've worked out a sort of alternative version of it. So shoot us an email infooootandbranchpdx.com if you have any questions about that or if you want to suggest a show idea.
[00:57:45] Speaker D: Yeah.
[00:57:46] Speaker A: All right. Any other thoughts on objective measures before we go?
[00:57:54] Speaker B: I think we covered quite a lot.
The only other thing I would say is the level of detail in diagnosis ranges with those three as well. I think the potential detail in pulses, very high. The potential detail in abdomen is very high. Potential detail that you're going to get out of the tongue is a little bit less.
[00:58:14] Speaker A: Yeah, I'd agree with that.
[00:58:16] Speaker D: Yeah.
[00:58:16] Speaker A: I mean, I think just like all of them. Right. I'm sure there's a tongue person listening who's like, no, oh yeah, I can see the face of God in the tongue.
[00:58:23] Speaker B: Yeah, I have the. They poke the tongue. They do, you know, maybe other stuff.
[00:58:27] Speaker A: Too and look like, for sure, like as we've said many times, like you can pretty much do anything in this medicine. Like if you train it well enough and you invest your energy and time and focus on it. You could almost certainly see a child, a person's childhood disease on their tongue. Sure. But that's not gonna be Most people. Right, right. So if you're just like a regular person, a regular practitioner, the detail in the tongue is gonna be less. Yeah.
Just because of how it is. Like, it's just a different kind of tool. It would be funny, though, to like, I was just thinking you mentioned poke the tongue. I was like, imagine if someone created a material evaluation system like the abdomen before the tongue. So you took like a tongue depressor.
[00:59:04] Speaker D: Yeah.
[00:59:04] Speaker B: And you're poked.
[00:59:05] Speaker A: Poked it for, like, pressure.
[00:59:07] Speaker B: I'm sure you could, like, you could figure that out.
[00:59:09] Speaker A: Yeah. You just pull a Richard Todd and be like, just invent a new system today.
[00:59:13] Speaker D: Yep.
[00:59:14] Speaker A: So it's like one of my favorite quotes from him. It's like, oh, he's just inventing new systems all the time. Invented one while he was on the toilet this morning. But importantly, don't confuse yourself.
[00:59:23] Speaker B: Don't confuse yourself. Right.
[00:59:24] Speaker A: Pick one and you. You stick with it. So. Alrighty. Well, as always, everybody rate and review the show. If you. If you've been enjoying listening to us, it helps other people find us and we're always interested in ideas for the show. So shoot us an email@infoud branchpdx.com and I think that's it. My name is Travis Kern.
[00:59:42] Speaker B: I'm Travis Cunningham.
[00:59:44] Speaker A: And we will see you guys next time.
[00:59:46] Speaker B: See you next time.
