Show Notes
TK and TC talk about the various types and categories of topical herbs that can be useful in the clinic and how to decide what kind of topical to use when.Â
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Episode Transcript
[00:00:03] Speaker A: Hi, everyone, and welcome to the Nervous Herbalist, a podcast for Chinese medicine practitioners who like herbs and want to learn more about their function, their history, and treatment strategies to use in the clinic. Let's get into it.
Hello, everybody, and welcome to another episode of the Nervous Herbalist. My name is Travis Kern, and I'm.
[00:00:25] Speaker B: Here with Travis Cunningham.
[00:00:27] Speaker A: And today we're going to talk to you guys a little bit about topicals. Topical formulations for all your needs, for itch, for pain, for making your skin bright and shiny, all the things that you might need.
And we wanted to talk about topicals because we get a lot of questions about them, actually, from residents and new grads and current students, current practitioners, because of all the things that we have really, really great information on in English in the Chinese medicine tradition, topicals, I think, is one of the places where we struggle.
[00:01:02] Speaker B: Right, agreed.
[00:01:04] Speaker A: I think there's a variety of reasons for that, but probably one of the biggest ones is that our classical texts that we spend so much time learning how to use for diagnosis and treatment do not spend very much or any time on topicals. Right. Or you'll get a passing half a sentence here and there about something that you could do. And, you know, there's a lot of speculation as to why, like, some people will say, like, well, this was sort of the realm of folk medicine, you know, this is.
[00:01:31] Speaker B: Or bonesetters, right?
[00:01:32] Speaker A: Bonesetters. Yeah, exactly. Right. So, like, in a professional setting, you had bonesetters who would have this kind of knowledge. It also belonged to a lot of the martial traditions. This is where we get, like, the dit da dao family of things. And then a lot of it was home auntie medicine. Right. Like your mom, your grandma, your auntie, like the sort of wisdom keepers and families would know, like, yeah, if you've got red swellings, you just need to crunch up a little bit of this herb, boil it, pack it on sort of poultice style.
And so it didn't really make its way, I think, smoothly into the TCM curriculum of the sort of late 20th century and therefore didn't really make it into a lot of the work that we have now. So, I mean, you can go to the Bensky, and you're going to find, I think, a dozen topical formulas, some of which we're going to talk about today, because they're actually really great formulas. But the details of it, you know, you read it there, and Dan Binsky and his other authors, they did a great job of pulling the information together. But it'll say Things like, you know, these herbs are cooked together with water and rice wine, and in the last 10 minutes of cooking, you'll add three pig gallbladders.
And then there'll be a little note that's like, these gallbladders are currently omitted in modern practice. And you're like, yeah, but, like, clearly there was something to that. But also, where are you going to find a pig gallbladder? Right. I mean, that's not really practical. So anyway, so I wanted to open the conversation in a more general way, and then we'll move into some specifics about topical. So the major question for me ultimately is with a topical, what are you trying to do?
[00:03:13] Speaker C: Yes.
[00:03:14] Speaker A: Right. What are you trying to do? So, like, in your case, t, you have some experience using foot soaks, Right. So when you think about a foot soak, what are you trying to do with that?
[00:03:23] Speaker B: I think a foot soak can be used for a few different purposes.
You can use a foot soak for general circulation in the whole body, and I don't think that works the same way as taking a shower or a bath. I think it works differently because it's targeted heat application to one part of the body.
And then if you add herbs to the foot soak, it can emphasize a particular portion of the function. So if you soak your feet in hot water or you tell a patient to soak their feet, first of all, the water should be at least up to about Spleen 6, not just the foot. Right. It has to be higher than that to get the circulation to go really strongly.
And then you want to sit in the soak. If you're trying to circulate for about 25 minutes, I would say, and you'll feel your blood go down to your feet, and then you'll actually feel it start to return. And most people will even start to sweat a little bit toward the end of it.
[00:04:31] Speaker A: Mm.
[00:04:31] Speaker B: And so it can actually be used as a sort of release the exterior function, which is kind of. I mean, not the first thing we think of with foot soaking, but it certainly can be used that way.
So you can use it for either of those things. You can use it for blood stagnation patterns that occur anywhere in the body, but it's particularly effective for the low back, lower jiao, knee, foot, ankle area particularly. It's very good for menstrual cramps, actually. Really knock out.
[00:05:04] Speaker A: How often are people soaking?
[00:05:05] Speaker B: Yeah, it depends on what we're trying to do. Right. But let's say somebody has a blood stagnation issue Pain related issue. I would say soak daily, maybe every other day if they can't do it daily, and it will help. Um, and then if you're. You can also use it for things like insomnia, actually, you can have people soak in the evening. And I try to have people soak for less long if they're using it for this purpose. Because really what you're trying to do is drive blood down to the lowest part of the body, but you're not, you don't, in my opinion, you don't want them to hang out for it to return and cause a sweat.
It's a little too long. You want the blood to go down.
And so you can use it for that purpose as well.
[00:05:59] Speaker A: And yeah, so I think there's a couple of key things for listeners to take away from that. So firstly, soaks belong to like, if there's sort of three general broad categories of topicals. Right. You have powders, you have salves, which includes like creams, liniments, lotions, like anything sort of like apply topically and then washes, which is the class that I think foot soaks belong to. Yeah, but they're kind of a special subcategory.
[00:06:26] Speaker B: They are.
[00:06:27] Speaker A: But one of the things that's common to foot soaks, that'll be common to all of the topicals we talked about today is you have to frequently use them.
[00:06:35] Speaker B: You do.
[00:06:36] Speaker A: And there's some very strong considerations for every type of topical that you're going to recommend to a patient that has to do with what actually is possible and what's actually practical.
[00:06:45] Speaker C: Yes.
[00:06:46] Speaker A: So, you know, as TC mentioned, like getting a vessel deep enough to soak up to spleen 6 or higher. I mean, like, honestly, if you can get up to like mid calf or all the way almost to the knee.
[00:06:57] Speaker B: Almost to the knee, yeah. Even better in China.
[00:06:59] Speaker A: But the truth is, is that like, that's not readily available equipment.
[00:07:03] Speaker C: Right.
[00:07:03] Speaker A: So like, if you go to CVS and you buy a foot tub, right, it's going to cover your ankle. Yeah, barely.
[00:07:09] Speaker B: Yeah.
[00:07:09] Speaker A: Right. And so then the question is like, well, what do I soak it in? And be like, oh, we'll soak it in a five gallon bucket. Well, if you have size eight feet or smaller, you can put them in a five gallon bucket. If you have size twelves or larger, as I do, you cannot. Right. At least not comfortably.
[00:07:23] Speaker C: Right.
[00:07:24] Speaker A: Because your feet literally can't sit on the bottom of that tub. So then you're like, okay, well what are you soaking in? Let's get a wooden soaking vessel, Japanese style. Okay. Find me one. You know, there's like one, like 150 bucks. Yeah, there's one for sale on Amazon. Yeah, 150 bucks. Right. So are we taking the patient who has never soaked ever? They have no relationship to this methodology whatsoever. And we're telling them, okay, I need you to buy $150 wooden soaking vessel. Here's some herbs that cost $30 for a week's worth. And I need you to soak every day for 25 minutes. That's a huge ask. Yeah, it's a huge ask. So what are the. You know, and some people are down, right? They're like, absolutely, this sounds great. I love the idea of soaking. I want to make this a part of my life.
I don't think that's most people. And so then you end up like, okay, well, what are the compromises? Like, what do we do instead? So, like, I've literally bought a $20 boiling pot on Amazon, like a stainless steel boiling pot because it was tall enough I could put my feet in it. But it's now also a thin walled metal boiling pot, which now means that if you want to soak for 25 minutes, your water is cold in 10.
[00:08:33] Speaker C: Right.
[00:08:34] Speaker A: So now what? Okay, well, now when we boil the water and we get it to the right temperature, which, by the way, should be very hot but not burning. So like less than 120 degrees.
[00:08:43] Speaker C: Right.
[00:08:45] Speaker A: You need to keep the kettle next to you so that you can top off your water. So, like, now we've added another layer to the process, and if there's herbs involved in it, the water is also now yellow, red in color.
[00:08:57] Speaker C: Right.
[00:08:58] Speaker A: Which means we also have a material staining problem. Right. Like, what do they have carpets? Is it by the couch? Where are they going to soak? Right. So I've just listed a whole bunch of the impediments that stand in the way of someone regularly foot soaking. And these kinds of impediments will exist in different forms and styles for every kind of topical. So it is absolutely imperative that as a prescriber, you consider and think about and strategize with your patient ways to solve each of these objections that they're going to have. Because otherwise they just won't do it.
[00:09:30] Speaker C: Yep.
[00:09:31] Speaker A: Right, Right. And if you can't solve them, you need to find something else.
[00:09:34] Speaker C: Right.
[00:09:35] Speaker A: Because otherwise, like, what are you doing? Right. It's sort of like, you know, we'll read these things. Like the pig bladder thing I mentioned before, it's like, oh, yeah, yeah, I'll send you these. These herbs home with you. You just need to go to the Asian store, see if you can find a pig bladder, and then boil that. Like, what are you talking about? Like, that's not real. No one's going to do that. So we don't live in China. It's not the Middle Ages. So you have to be practical with what people are actually going to do. And I think that that's really one of the major challenges of topicals. It's not insurmountable, but you also need to be clear with the patient that one soak for 10 minutes once a week is not doing anything.
[00:10:12] Speaker C: Right.
[00:10:13] Speaker A: Right. Like, that's just. It's like taking your herbs for, like, half a dose one time. Like, it's just not gonna do anything. Right.
The other thing I think that's really notable about what you described on foot soaks is that they have a broader spectrum internal medicine effect than I think a lot of other topicals do.
[00:10:30] Speaker B: I agree.
[00:10:30] Speaker A: And that is also a major difference, and I think why they belong to a category on their own. So if you can actually figure out a way to help patients overcome some of these delivery challenges, then actually, foot soaks can become a really useful tool in your arsenal, right?
[00:10:47] Speaker B: Absolutely.
[00:10:47] Speaker A: And you can also create your own custom blends. Like, here at root and branch, we have a soothe and circulate one that's primarily blood movers. Right. And then we have one that's a sleep version that has a lot of, like, minerals and anchoring stuff in it. And so people can get these really remarkable localized effects for pain and swelling, but also general blood stagnation, circulation effects.
That's really, I think, if not unique, certainly characteristic of something like foot soaks. That's different than other topicals.
[00:11:18] Speaker C: Yeah.
[00:11:19] Speaker B: And I think to the application, we tend to think of things as one. As one direction or one movement. But if you apply heat, for example, for a certain amount of time, it's going to do one thing. If you double that time, it may do something else. Right. So if I soak my feet for 15 minutes, I know that for myself, it's primarily going to be about getting the blood to my feet and to my lower body. If I soak for 25 or 30, then I'm going to start to sweat.
So I know that for myself, I can stop the foot soak at 15 and have a lot of blood flow in my lower body, but not emphasize the flow so much so that it returns. And then eventually I start to feel hot in the upper part of my body. So if I'm trying to sleep better and I identify that a portion of the problem is getting my yang to descend right, then I can use the strategy to mimic that effect in the evening.
And it's helpful, I'd say, too, to. If you're. If you're using it for that effect, to do something calming. So don't watch like the Viking show or something like that while you're foot soaking. You know, if you're using it for that purpose for blood stagnation, I think it's way more general. You just. You soak for a bit longer. You want hotter water.
And.
Yeah, I think you. You want that effect, that global effect.
So, yeah, there's a lot. There's a lot you can do with it. It's also, I think, the best treatment for foot fungus, because a problem with foot fungus people have is topical application of essential oils.
[00:13:14] Speaker A: Right.
[00:13:14] Speaker B: This is what people are doing with their foot fungus.
[00:13:16] Speaker A: Stop it now.
[00:13:17] Speaker B: And people have been doing that for years. They still have foot fungus. Daily application of essential oil onto the toes, and it doesn't work.
[00:13:26] Speaker A: Nope. In fact, if you're using tea tree oil, you're probably making it worse. Yeah.
[00:13:30] Speaker B: I mean, the. The foot fungus, like anything, isn't just about the fungus. It's about circulation. It's about getting the immune system to function at the extremity. So a foot soak can deliver a topical application of, let's say, an antifungal agent. Right. But can also deliver the function of blood flow, can communicate the movement of fluids or lymphatic drainage, you could say. Yeah, right. So it's going to be a way better treatment for foot fungus than a topically applied essential oil. So if people are looking for answers for foot fungus, this is another thing that they can do. And it's also a relative. I mean, there are barriers to entry, as we discussed, but there are people who are familiar with soaking their feet. Some of the older population, the older generation remembers when people did foot soaking. Right. Like in. In America, you know, old people soaking their feet is a thing here.
[00:14:34] Speaker A: Yeah.
[00:14:34] Speaker B: Historically. So a lot of people will have methods for doing this that are older or people who come from Asia or people who come from Eastern Europe. Actually, a lot of our Eastern European patients have some memory of doing foot soaking or their grandma doing foot soaking.
[00:14:53] Speaker A: Yeah.
[00:14:53] Speaker B: So they'll know what to do. And if that barrier to entry is overcome, then it's actually a relatively inexpensive treatment that people can do just with the Water if they don't have money for herbs or Epsom salts or something like that. And the water does a lot of the work by itself. The herbs definitely create an emphasis to the treatment. But people can treat themselves if they have chronic blood stagnation for relatively low cost. And if they're diligent with it, they can get better.
And it can be a real service. It's something we can tell them to do, that if they do it, it can really help in some cases.
[00:15:37] Speaker A: Yeah, I think that there's, like we discussed, the barriers to entry can seem, I think, to a lot of people that they're overwhelming. And I mean, practically they can be right. I mean, people. I'm always really conscientious of what we ask people to do because a lot of times, you know, everyone's been in that scenario where it's like, well, I should probably exercise more and eat better and meditate and breathe deeply. And now I should foot soak. And like, it just goes into a list of things that people know they should do but like, aren't gonna do because they're overwhelmed with their sort of, you know, post capitalist modern lifestyle that's sapping their souls out. And so they get home and they're just like, I just want to watch Netflix. So like, I get that.
But I do think that foot soaking is something that can be figured out. You know, if anybody out there listening has a connect to someone who wants to make high sided foot soaking tubs, we'd be forever in your debt. Yeah, because I actually think legitimately, I think that's actually the biggest impediment. Like if someone could just go to CVS and buy a 12 inch deep foot soaking tub. Yeah, this problem would be solved tomorrow, like literally. But because that doesn't easily exist, I got people using like trash cans. Like you're going to Amazon and being like trash cans and planter, like outdoor planter boxes. Like you're just trying to hunt for a thing that has the same rough dimensions, which is just annoying. So if someone could just like make us the right kind of one, that'd be great.
I want to pull out then and kind of look at other things that fall into the wash category because soaks are their own sort of deal. But a lot of times when you start looking into the topicals, you'll find formulas that are described as washes, which are essentially decoctions. So you'll just like take a whole herb, sometimes like coarsely crushed herb, that'll be made into a powder that you can Keep in your medicine cabinet. And then you'll take a portion of that and boil it, you know, in two, three cups of water, strain out the herbs, and then do a wash. So that could quite literally be soak a wash rag in it, pat it onto the skin, let it dry. Right. And we see these applications for a lot of dermatological problems. So you've got like psoriasis, eczema, dermatitis of all kinds, even like scabbing conditions a lot of times. Super common with itch, people have itching that's going on.
And the thing about a topical wash is, like, all topical issues, very effective if you can get someone to do it.
[00:18:13] Speaker C: Yeah.
[00:18:14] Speaker A: So this is another piece where you got to think about the flow. So if you're going to say, let's think this through. So we want to take a powder, we want to boil it into a decoction, want to soak a rag in it and want to apply it to the skin. And then the most common prescription is you apply it to the skin and then let it dry. So basically you like, get it saturated, you rub it all over your skin, and then you just let your body temperature dry it in place. Right.
When's the patient going to do that?
[00:18:40] Speaker C: Yeah.
[00:18:40] Speaker A: Right. I mean, really, like, when are they gonna do that? In the morning or when they get home from work or at lunch? You know what I mean? Like some. I've literally seen prescriptions come through the pharmacy that's like, topical wash, boil in 2 cups water 3 times daily and apply.
[00:18:54] Speaker C: Yeah.
[00:18:54] Speaker A: And I thought, I mean, unless this person is at home, which I guess a lot of people are, and has the time to break that up or has someone else to do it for them, I just don't see how that's gonna happen.
[00:19:05] Speaker B: Yeah, that's a really good point.
[00:19:07] Speaker A: Yeah. And so, like, when you consider the topical. So what do we know about topicals? What do I know about topicals? Because I use them a fair amount. Twice daily application is basically the minimum.
[00:19:17] Speaker C: Yeah.
[00:19:18] Speaker A: So if you've got a salve, you've got a powder, you've got a wash, it doesn't matter what it is. Twice daily application, foot soaks, get away with a different application because it's prolonged. Yeah, Right. And again, they're in their own kind of category, but everybody else, twice daily applications, kind of the minimum.
So if you have a thing that is only effective at twice daily, what I'm telling you is effective at twice daily. And you're like, well, the patient can only do it once, then Pick something else. Like, don't waste their time, don't frustrate them with, frankly, a kind of unfamiliar and somewhat complicated process if they're not gonna get the results. Right. Not only is it twice daily, it's twice daily for 10 to 14 days.
[00:19:55] Speaker C: Right?
[00:19:55] Speaker A: Right. So twice daily, 10 to 14 days. Honestly, let's say 14 days. So that means you gotta get somebody on board to do a thing twice daily for two weeks. And it's only at that point that we can then say, do we think this was effective.
[00:20:09] Speaker C: Right.
[00:20:10] Speaker A: So it's important to keep in mind. And people might hear that and they'll be like, well, are they even that effective if, like, you know, it takes that long? And the answer is, yeah, because in that same time, you are probably doing internal herbs. You're probably also doing acupuncture. Right. As part of this whole constellation of things. And most of the things that we use washes in particular for are chronic derma dermatological conditions. Right, Right. There are other types of washes that you can use for like acute poison, IV or things like that.
And in those cases, we're obviously going to be expecting results sooner rather than later because it's, of course, you know, it's a contact dermatitis problem. But if you've got someone with eczema that they've had since they were 15, like, you got to apply something daily for at least two weeks along with your internal herbs to see, like, hey, is this. Is this moving the target?
[00:21:01] Speaker C: Absolutely. Yep.
[00:21:03] Speaker A: So practically, what does that mean for washes? So usually let's consider parts of the body. Firstly, can the part of the body that's affected be soaked on its own? Right, right. So instead of having to make a wash where you, like, pat it on your body and let it dry, if someone's got something on their hand or their foot. Right. Can you just make a small batch of it and let them soak their hand in it? That's much easier.
[00:21:27] Speaker C: Yeah.
[00:21:27] Speaker A: Right. They don't have to wait for it to dry. It's less messy. Right. But honestly, it's pretty limited to just hands or feet.
[00:21:33] Speaker C: Yeah.
[00:21:34] Speaker A: Like, I suppose in theory you could, like, stick your elbow or something in it, but that's not real, you know. So then you say, well, what if we just made a big batch? Like, let's say they've got a hip problem or a knee pain problem. Right. They can just soak in a bath. Right. Of the material. That's possible. But now you need to consider your ingredients because you're Going to be exposing sensitive tissues to an herbal soak.
[00:21:53] Speaker C: Yes.
[00:21:54] Speaker A: So anything that's we use to drive. This is the thing you'll read in the text to drive herbal effect through the skin layer.
[00:22:01] Speaker C: Yeah.
[00:22:02] Speaker A: So that's going to be alcohol, ginger, chili pepper, and then some of the other herbs like bing pian and jiangnao. Right, right. Very aromatic, spicy moving vinegar wine. You'll see those things, too. Absolutely cannot be part of something that someone's going to soak their genitals in.
[00:22:20] Speaker C: Right.
[00:22:20] Speaker A: You will hurt someone. Yeah, right. Don't do that. The other herbs are pretty innocuous. Right. But even still, if you're asking someone to soak their whole lower body because they've got a hip problem, you've got a lot of skin and a lot of sensitive tissues exposed to those areas. And so you're going to need to approach that with some caution.
[00:22:38] Speaker C: Yeah.
[00:22:38] Speaker A: So those things that I listed. Right, so ginger, chili powder, alcohol, wine vinegar, bing pian and jong. Now, all of those things are no gos in sensitive tissue soaks. Right. Or anything that has, you know, could, you know, it's like, around the eyes or something. Like, you want to be very cautious of those, of those items. They're really useful in all kinds of other applications, but not for a full body soak. Right, right.
So again, is it practical, you know, like, are they actually going to be able to get in the bath and soak? You think, oh, that's probably cool. Well, I'll grind up some herbs and, like, we'll throw them in the bath. That's easy. It's easy to package. True. Now they're sitting in a bath with a bunch of, like, finely powdered herb. Right. Which is going to make the bath water orangey yellow.
[00:23:21] Speaker C: Yep.
[00:23:22] Speaker A: Right. Could stain their bathtub.
[00:23:24] Speaker B: Yeah, it could.
[00:23:25] Speaker A: That happens. Right. Especially an older bathtub. The porcelain's a little, you know, a little pitted, and now they've got a slight yellowish tinge to their bathtub. They're not going to love that. Right. Similarly, I've seen prescriptions where someone had dermatitis on, well, psoriasis actually, on their scalp. And so we had a soak application that was, you know, decocted into a soak, put a washcloth in it, set the washcloth on top of your head, the patient's head, and, like, let it kind of soak down. Right, Yep. Great. That's actually a great way to get herbs directly onto the scalp. But it's gonna run down their head.
[00:23:59] Speaker C: Yes.
[00:24:00] Speaker A: So that means they can't do that just, like sitting at the vanity, they need to do it, like, frankly, in the shower or like in the bath. Like someplace that they can wash it off eventually. So, again, it's thinking through the whole process of what you're recommending to a patient from a topical point of view. And what you will find, at least what I have found, is that there is a reticence among people to engage in things that they're unfamiliar with and that seem messy.
[00:24:28] Speaker C: Yep.
[00:24:29] Speaker A: Again, some patients are super stoked. They're like, oh, my God, I can't wait to try this. It sounds great.
[00:24:33] Speaker B: And a lot of it depends on how bad the issue is. True.
[00:24:37] Speaker A: What else they've tried?
[00:24:38] Speaker B: Yeah, what else they've tried? If they're really in pain or they're really an itch, which some people will prefer pain to. Right.
[00:24:45] Speaker A: Because itches.
[00:24:45] Speaker B: Because itches. Terrible.
One of the most useful, I think, applications of topicals in dermatology is that it takes care of itching. It can take care of itching faster than an internal remedy.
[00:24:59] Speaker A: Yes.
[00:25:00] Speaker B: So while you're sort of changing, you're waiting for the terrain to change.
[00:25:05] Speaker C: Right.
[00:25:06] Speaker B: From the inside out to affect the skin with the. In with the internal herbs, the topicals can go right there and start doing the work.
[00:25:14] Speaker C: Right.
[00:25:15] Speaker B: And which is this similar to the effect of acupuncture and any topical technique you do with bloodletting or moxa even. Like, these are things that you can do on the skin, with the skin to affect it before the internal herbs are going to get to the skin.
[00:25:34] Speaker A: Yep.
[00:25:35] Speaker B: Which is a big problem in dermatology.
[00:25:37] Speaker C: Right.
[00:25:37] Speaker B: You've got the right remedy. They're getting better, but they're still uncomfortable.
[00:25:42] Speaker A: Right. They can't sleep because the itching.
[00:25:44] Speaker B: Because the itching.
[00:25:45] Speaker C: Right.
[00:25:45] Speaker B: So they are improving. We're on the right track. But they need to hang out with it long enough for it to really get there. And the topical can be the answer to that.
[00:25:55] Speaker A: Yep. And the topicals will solve that problem. Like, they're very well suited for it. Twice a day, every day. Right. For 14 days.
[00:26:02] Speaker B: Yes.
[00:26:03] Speaker A: Like, I.
[00:26:03] Speaker B: Be consistent.
[00:26:04] Speaker A: Yeah, you have to. Like, the problem is a patient will go through a complicated process. They'll soak the rag on their head one time and they'll be like, yeah, I don't know if it really made that much of a difference. And it's like, no, of course it didn't.
[00:26:14] Speaker C: Right.
[00:26:14] Speaker A: You know, like, you got to do it consistently. Yeah. This is not topical steroids. You know, it's a different kind of Thing So washes, I think, very potent. The nice thing about a wash and really in a lot of ways, topicals, it's important to remember, like we now live in kind of a consumerist environment where you can go to CVS and you can just like buy a lotion that's like made it's shelf stable. You can put it on your body. Right. A lot of the traditional medicine topicals were made from crushed herbs, coarsely powdered or finely powdered herbs that could be stored.
[00:26:45] Speaker C: Yep.
[00:26:45] Speaker A: And then mixed as needed.
[00:26:47] Speaker C: Right.
[00:26:47] Speaker A: And that's a big difference. Right. So like the thing is, is that most of what we talk about in the custom prescription space requires the patient to do some work. You know, like we'll send them home with some materials, some tools, some herbs, they do have to do a little bit work. So in the wash case, you're basically making a san, like a, like a. You're boiling the powder right into liquid. Quick decoction using the liquid. Some people even use the herb, you know, like strain out the herb and put it in a little muslin bag or like cheesecloth or something and use it as a compress.
That can work well too, particularly for like wound situations or like broken bones, swelling, stuff like that.
When you consider sort of like the ways in which you can apply a topical. We've been talking about it in a wash, but really what we're talking about are powders. Right. So at its base, the most common topical preparation is a powder. Right. Of varying degrees of fineness. If it's coarsely ground, it's probably going to be used to make a wash. Right. Or to be extracted into oil or alcohol to make a salve or another type of, you know, topical like that. If it's finely ground, then it can be mixed in with something like an oil or petroleum jelly or something like that, or it can be used directly. And so that's one of the things that I like. So one of the formulas we'll talk about later. Jinhuangsan, really phenomenal broad spectrum formula that you can use for everything from like you know, a hangnail that's gotten infected. Right. All the way to like a bulbous red sore that needs to come to a head and burst, sort of everything in between. So if something's kind of wet, like think of a cut that's a little bit infected, you know, normally you'd put some triple antibiotic cream on that, you know, like a Neosporin or whatever. You can take the finely ground Jinhuang San and just sprinkle it directly onto a cut or a wound, like something that's kind of wet. And it works because it's wet. Right. So the powder will literally stick to the wetness of the cut, the wound. Right. You put a band aid on it. Good to go. But you can't exactly just sprinkle dry powder on your skin.
[00:28:55] Speaker C: Right.
[00:28:55] Speaker A: And be like, oh, I think that'll help.
[00:28:57] Speaker C: Yeah.
[00:28:57] Speaker A: Because I guess it's not going to cross the skin. Right. Like there's nothing driving it through the skin. It's not going to have prolonged contact.
So traditionally you take a little bit, Jin Wang San, for example, or any of the formulas that fall into this category, and you would mix it with water, or mix it with tea, or mix it with sesame oil, or mix it with vinegar or wine, like something to make it wet. Right. You'd place it over the area and then you'd bandage it and you leave it in contact and then your body heat. So like if it's water based, tea, water, vinegar, wine, your body heat will dry out that powder. Right. And when you take the bandage off, it'll kind of be flaking off of you. Right. And at that point you reapply. Right. So you're just sort of making this little, just enough paste that you need, apply it to the area, bandage it, your body heat will dry it, flake it off and repeat. So that's two or three times a day is usually what's happening with those kinds of changes. And that's a lot of the stuff we see for wound care. So minor cuts, small surgical sites, puncture wounds, stuff like that. Right. We're not talking like not. You haven't been eviscerated in like a farming accident like that. That's a different thing. Yeah, but small wounds and cuts, stub your toe, skin breaks, et cetera stuff works really well. It's also great for like wet and weeping things that are heat based. Yeah, so we'll talk about that in a little bit more detail later. But the broad spectrum of powders, right. Means you can apply them directly as powder. If the thing is wet, you can mix it with something to make the powder wet. If the skin contact point is not itself weeping or wet so that it'll make contact and it'll pass the barrier. And if it's something coarsely ground, then you can extract it into either water, make a wash, or extract it into oil and make a salve, lotion, cream, et cetera, or fourthly, put it into alcohol and make a liniment.
[00:30:45] Speaker C: Right.
[00:30:46] Speaker A: So let's talk about that category then.
[00:30:49] Speaker C: Okay.
[00:30:50] Speaker B: The liniment category.
[00:30:51] Speaker A: Liniment, salves, creams, lotions, that thing.
[00:30:53] Speaker C: Yeah.
[00:30:54] Speaker A: And the reason is because that is the thing that patients will use the easiest.
[00:30:58] Speaker C: Right, right.
[00:30:59] Speaker B: That's what people are used to.
[00:31:00] Speaker A: Exactly. They're used to it. They don't have to do anything except apply it.
[00:31:05] Speaker B: Right.
[00:31:05] Speaker A: No preparation required. They don't have questions about like, well, how much water and how wet should the paste be? And I made. It's too wet and I'm making a mess and it drained on my clothes, my shirt got stained. Like those kinds of things are less of an issue with a pre prepared product. Problem is you have to make it.
[00:31:23] Speaker C: Yeah.
[00:31:23] Speaker A: Or I mean, you can buy it from somebody else who makes it for sure. But if you're talking custom formulation, you have to actually make it yourself. So what, what are we talking about? Three categories belong to. The three subcategories belong to salves. Right. The first and most common is an actual salve, sometimes also pronounced salve. Right. That is herbs extracted into oil and set with wax.
[00:31:47] Speaker C: Okay.
[00:31:48] Speaker A: So that, that's just the general idea of a salve. So you take oil, any kind of oil, olive oil, sesame oil, palm oil, whatever you're using, coconut oil, doesn't matter. You take it, you heat it up, you put herbs in it, you keep it at a low temperature. Depending on how long you're extracting for, some people will go 24 hours. Right. Strain all the herb material out and then you melt a certain percentage of wax, usually beeswax. Unless you're trying to make a vegan product into that oil. And then when it cools, however much wax to oil, whatever that ratio is, will determine how set and hard the salve is. So the more wax, the harder the set, the less wax, the softer the set.
[00:32:30] Speaker B: Okay, Right.
[00:32:31] Speaker A: That's like the general idea.
There's a, there's some degree of variation there depending on what you're using. Right. So for example, if you use coconut oil, coconut oil is solid at room temperature, but olive oil is liquid at room temperature. So if you use olive oil, then you have to put more wax into that to set it than you do coconut oil.
[00:32:52] Speaker B: I see, Right.
[00:32:52] Speaker A: Because they're different constituencies or consistencies. Excuse me. So if you're thinking like, well, I don't know anything about that, that's okay. Most people don't. Right. Like that's not a normal thing that you would know about. But how can you learn more about that? Well, my friends, this is actually the place where our western herbal colleagues really have done the most amount of work. Because if you think about western herbs, this is the kind of stuff that they do a lot of, right. Topicals, extractions, you know, whatever. So I would strongly recommend that if you're interested in making topicals, tinctures, flower waters, like any of that kind of stuff, should check out a book called the Herbal Medicine Makers Handbook. The Herbal Medicine Makers Handbook by James Green.
And that book, in my opinion is the single best tome for rapidly learning how to make a whole collection of topicals ranging from liniments to creams. Right. Like, and sort of everything in between. It's all designed for at home use. So it uses like blenders and like nothing, no crazy equipment, nothing special. You need a scale, need a blender, and that's pretty much, you know, the specialized equipment.
[00:34:05] Speaker C: Yeah, cool.
[00:34:06] Speaker A: Yeah, you can do everything else on the stove, you know, and yeah, you can use a crock pot. Like you can get crazy crazier, but even the most crazy equipment based thing is probably something that you or someone you know already owns.
[00:34:17] Speaker C: Yeah.
[00:34:18] Speaker A: There's nothing special, you know, that goes into it.
So that's a really great way, if you're interested in the topical is to get into your home kitchen and just tinker around and experiment so that you can understand what does it mean to make a salve, like how much oil to wax to which combination makes this work.
That is something I strongly recommend topical herbalists to get into just so you understand it better. But it's, it's not something that you're going to be able to rapidly do for an individual patient, especially if they're.
[00:34:48] Speaker B: Right in front of you.
[00:34:49] Speaker A: Yeah, exactly. And, and it's not, it's just not cost effective. Like you're not going to make one batch of salve for one patient. Like you just don't have the time. It would be too expensive. It doesn't make sense. Right. The good news is that a lot of the stuff we use in this form is broadly applicable.
[00:35:06] Speaker C: Yeah.
[00:35:06] Speaker A: So like, you know, you make like a circulation pain salve or you make like a bone knit salve or something and you can, you can give those to pretty much anybody.
[00:35:14] Speaker C: Yeah.
[00:35:14] Speaker A: You know, so if you like this stuff, you can get into making it yourself. Of course there are a ka trillion million companies, Chinese medicine practitioners and stuff, who make these things, you know, and so the question then becomes like, well, does it work?
[00:35:27] Speaker C: Yeah.
[00:35:28] Speaker A: Is it any good?
And you know, there are some products that we like that we keep stocked here, you know, Classic things like Jingushui. Right. Because they do work well and they're relatively inexpensive stuff like Tiger Balm. Oh, some oil. Very famous kind of topicals. The topical adhesive plasters that you can get from like Imei Shan or Huato plasters, like those all exist find products. I have any issue with them at all, really. And if you're just looking to have something you can give a client to use regularly, both to improve their outcomes and also to add a little bit of revenue stream for you, that's the easiest way to do it.
[00:36:07] Speaker C: Yeah.
[00:36:07] Speaker A: Like, don't, don't reinvent the wheel. Right, right.
[00:36:11] Speaker B: Can we, can we talk a little bit about those?
[00:36:13] Speaker A: Specifically those products?
[00:36:14] Speaker B: Yeah, yeah, yeah. What they're particularly useful for, like when do we want to use a plaster versus, you know, post a mom or whatever?
[00:36:24] Speaker A: So let's start with maybe the oily based ones. So Tiger Bomb, I think, like everyone in America, I think, knows about Tiger Bomb now.
[00:36:34] Speaker C: Yep.
[00:36:35] Speaker A: Which is great. And you can buy it at Walgreens. You know, you don't have to even stock it in your clinic.
Tiger Bomb and Post Emom. Postmom, if you're not familiar with, is very similar to Tiger Bomb, but it's oily, it hasn't been set with wax, so it's an extracted oil. Whereas Postmom is a salve, like a topical salve. Both of them are applied to areas of musculoskeletal pain, primarily joints, hands, wrists, elbows, shoulders, knees, ankles, any type of those topicals, regardless of the brand. Tiger Bomb, Tiger Bomb, whatever. Even a custom made one. You always have to remember that if you're trying to deal with, say, arthritic hand pain.
[00:37:16] Speaker C: Yeah.
[00:37:17] Speaker A: You got to get through the skin into the muscle and tendon layer. Right, right. And in order to do that, you need to be able to, to actually apply it topically. Work it in.
[00:37:26] Speaker C: Right.
[00:37:27] Speaker A: Like you're going to massage. The patient's going to massage it into their skin, and it's almost always going to come with some kind of aromatic quality to it to help penetrate through the skin.
[00:37:35] Speaker C: Yeah.
[00:37:36] Speaker A: And this is the primary criticism that we hear of stuff like Tiger Bomb postmom is they have a very strong smell.
[00:37:41] Speaker C: Right.
[00:37:42] Speaker A: That's part of the medicine.
[00:37:43] Speaker B: They have to.
[00:37:43] Speaker A: Yeah, they kind of have to. Right. There's a handful of other topicals we've worked with that have less smell, and I think they're still effective, but the, the smell is part of it.
[00:37:52] Speaker C: Yeah.
[00:37:53] Speaker A: Not just psychosomatically. It's actually driving stuff through the skin. Right.
The other thing to keep in mind though is like, let's say for example, someone has like sciatic pain, Right. And you've done your, like, you're doing treatment for it and it's like classic gallbladder 30, like deep, deep in the glute, like piriformis or whatever. I'm not an anatomy person, but whatever the muscle in there, there's a lot of flesh between the skin and where the pain is. And the truth of the matter is is there is no topical that's going to go through all of that flesh to get to where the pain is with any reliability.
[00:38:31] Speaker C: That's a good point.
[00:38:32] Speaker A: So you can't expect to rub Tiger Bomb on someone's gallbladder 30 regularly and have that really affect the difference. It works amazingly at knees or at pain at the greater trochanter, depending on body shape. Right. Where basically where the location of the locus of the pain is closer to the skin surface. That's where you're gonna get the best effect from the application of those topicals. So again, hands, wrists, elbows, knees, ankles, feet, all great. Right. Thick body parts, tougher, right?
[00:39:05] Speaker B: Yep, makes sense.
[00:39:07] Speaker A: And that's also going to depend on body types and body sizes and stuff like that. So there's a lot of factors that go into it. So the oily topicals I think work really great for places where you really can access and can massage it that the patient can. So like they can get to their own knees, hips, ankles. Right. Et cetera. It's a little harder for them to get to say like the middle of their back.
[00:39:30] Speaker B: Gotcha.
[00:39:30] Speaker A: Or even their low back in some cases. Right. Like it's just hard to like massage it on there. So if they've got another person around that can do the massaging for them, great. But honestly, that's a lot to ask a partner or a friend to do regularly. And so that's where we come in with the patches. Right, Right. So you can probably get your other person who lives in your house, friend, partner, whatever, to stick a patch on you in the morning. If you can't reach it, that's no big deal.
[00:39:55] Speaker C: Yep.
[00:39:56] Speaker A: But to get them to massage and oil into your mid spine, every day is a different story. So that's where the patches are useful because the patches are going to be loaded with usually very aromatic kind of essential oil based topicals. They're loaded into the patch and they're stuck with an adhesive to your skin. And then they can stay there, I mean, all day and you can take it off in the shower. And so in that case, you have that sort of localized penetrating effect all day long from the plaster.
[00:40:27] Speaker B: Those things, if you haven't tried them before, are pretty amazing.
[00:40:30] Speaker A: Yeah.
[00:40:30] Speaker B: You put those on and boom, you get like a big hit of blood flow in there and it kind of, it lasts like, it can last six, eight hours, you know.
[00:40:41] Speaker A: Yeah. Plasters. So plasters is a broad category of things that you adhere to the skin prolongedly.
[00:40:49] Speaker C: Yeah.
[00:40:49] Speaker A: This is a modern adhesive plaster. It basically looks like a big band aid.
[00:40:53] Speaker C: Yes.
[00:40:54] Speaker A: It's like 3 inches by 5 inches big band aid. You can cut them. So when you take it out of the package, you know, you haven't peeled off the sticky part yet. So you can cut them into whatever shape you need and then you can stick them on. So that's handy if you're like on a hand even or like a flexi joint space or small area, you can cut them and stick them on. I love adhesive plasters. My skin, I have sensitive skin.
[00:41:18] Speaker C: Yeah.
[00:41:19] Speaker A: Doesn't love them.
[00:41:20] Speaker C: Yeah.
[00:41:20] Speaker A: And it's not because of the herbs in it, it's because of the adhesive. So the problem is if you stick one on, they're very sticky.
[00:41:29] Speaker C: Yeah.
[00:41:30] Speaker A: I recommend that people usually peel them off in a hot shower because the adhesive's a little looser. But even then, for myself, very sensitive skin to things like adhesives. I can wear plasters probably three days in a row and then I can't. I will literally have like a red.
[00:41:45] Speaker C: Yeah.
[00:41:46] Speaker A: Itchy spot. The shape of the plaster.
[00:41:48] Speaker C: Yeah.
[00:41:48] Speaker A: From peeling it off of me and sticking another one back on. So if you have people with sensitive skin, there's a limitation to the plasters. Right. Because of that. So that's your sort of oily ones, your stick on plasters. The third one that I mentioned is liniments. In this case, jingu shui, upright bone water, which is like, you know, healing the bone water, whatever. It's a combination of herbs that have been extracted into alcohol. Primarily blood movers, stuff that you would expect Hong Khua, Tao, ren ruxiang, Mo Yao san, stuff like that. Right. Extracted into alcohol and then the herbs are removed and then the alcohol is applied directly to the skin. So the alcohol itself is the carrier. Right. So that's going to help penetrate into the skin. The herbs are aromatic and they're all blood moving. So jingu shuis are amazing sports, post workout, sporty kind of stuff. And the reason is because they're easily transportable, they don't melt. They're not affected by temperature. So someone can throw it into their gym bag and keep it in their gym bag so that when they get done with a hard workout, they can. The best ones actually come in little aerosol sprays, like little pump spray things. Those are the best because then you can literally just like onto your shoulder and then rub it in, let it dry, go about your day.
If they don't come like that, you have to sort of put it on a cotton ball or something and dab it on. But the nice thing about that is they're again, prepackaged or they're just ready to go. They've got the penetrator in there. They're strong. They do have a smell, both an alcohol smell and an herbal smell. That's just sort of part of the deal. But they're nicely penetrating. The thing to watch for alcohol based liniments is skin drying. Right. So if someone has a tendency toward dry skin, particularly say at hands where they're washing their hands a lot or whatever.
And you'll notice like people will get kind of dry, flaking skin. We, I think a lot of people are more familiar with this now that everybody's using hand sanitizer all the time.
[00:43:44] Speaker C: Yeah.
[00:43:44] Speaker A: This is a similar effect. Alcohol has a drying effect on the skin surface.
[00:43:48] Speaker C: Yeah.
[00:43:49] Speaker A: So a lot of liniments are pain based. So we don't use liniments really for dermatological conditions because the alcohol tends to dry skin and that causes itching.
[00:43:57] Speaker C: Right.
[00:43:58] Speaker A: So the thing to be cautious of is, like, if someone keeps applying, you know, liniment to their hands and they're like, oh, my hands are like dry and itching. The liniment's not helping.
[00:44:06] Speaker C: Right, right. Yeah.
[00:44:07] Speaker A: So again, application really matters here. You know, the nice part about an oily thing is you're not going to dry out your skin.
[00:44:13] Speaker C: Yeah.
[00:44:13] Speaker A: But also it's oily. So, like your hands are a little slick, you know, your elbows a little slick. Like you don't want to put on a bunch of tiger bomb and then like put on your best silk shirt. You know what I mean? Like, that's not. You're going to ruin it. Like you're going to ruin that shirt. So you got to be conscientious of those, those aspects. And really that I think gets us to some general cautions about topicals a little bit. Like we were talking about where you have things like color. Right. Most topicals are reddish yellow.
[00:44:43] Speaker C: Yeah.
[00:44:43] Speaker A: And they will stain things.
[00:44:45] Speaker C: Yeah.
[00:44:45] Speaker A: So people need to be Aware of that. So if you tell someone like, okay, I want you to apply this topical, this tiger balm or whatever on your knees, which have been bugging you before bed.
Well, they need to give it time to dry and soak in before they slide into their sheets. Otherwise they might end up with oil stains somewhere on the sheets. Right. Bedding is a really great example because most people are not washing their sheets every day.
[00:45:09] Speaker C: Right.
[00:45:09] Speaker A: So if, you know, if you got a little bit oil on an undershirt and then you washed it a day or two later, it's fine. But if you keep sliding into your bed night after night after night with like oily knees, you're going to literally have like two oily spots on your sheets. Right. Like at knee level because it'll end up being stained. So those are things to consider, right? Like, literally, is it wet, is it damp, is it colored, is it oily? Like, how's that going to affect a person's clothing and bedding? But also, don't forget, it can affect their skin as well.
[00:45:40] Speaker C: Right.
[00:45:40] Speaker A: So like, you can actually yellow someone's skin a little bit. This actually will come up with foot soaks for, for toe fungus, use circulating herbs that are red, yellow. And people end up with like slightly yellowed toenails. And they'll be like, oh my God, it's. The fungus is getting worse and it's like, no, no, it's just like a slight dying from the, from the foot soak. From the foot soak. But it can happen. And so like.
[00:46:01] Speaker B: Yeah.
[00:46:02] Speaker A: So if you have a salve, for example, that you know someone's got a blemish on their face, a red spot, right. And you've got a salve that has a lot of yellow herbs in it, and they're regularly applying that spot, the red blemish might go away and then they'll have like a dime sized yellowy spot right in their skin. So that's the kind of stuff you, you gotta think about, right? Like, how's this actually gonna play out with the patient's real life?
[00:46:26] Speaker B: You know, how about, is there any consideration for you with, let's say like a muscle thing versus a joint thing versus a bone thing? Is there any preference for these commonly used products, topical products, for those?
[00:46:43] Speaker A: I don't think there's much difference in terms of the method. So that has to say, like, soak versus salve versus liniment. Right. I do think there's something to be said for the ingredients.
[00:46:56] Speaker C: Yeah.
[00:46:57] Speaker A: And then whether or not it contains a driver so that's something to push it through the skin. Right. So all of the pain related topicals are of a kind. Right. Like you're literally just going to see some variation on Sanchi mo, yao, ru, xiang, tauren, honghua, jerza, san lung, oju. Maybe there's a bug in there. Sure. Like basically blood movers. Right, blood movers. But then if you have one that's designed for say like connective tissue disorders like golfer's elbow, tennis elbow.
[00:47:35] Speaker C: Okay, yeah.
[00:47:36] Speaker A: Arthritic hand stuff where like people's hands are crunchy, you know what I mean? Then you're going to see some additions in there that are ostensibly bone and tendon herbs. So like weiling xian, mu gua, du jong. Right. Things that are. And all of those herbs either are known to function in those areas or like they have a signatures issue. Like du jong, if you peel apart the bark, it has those like sinewy strings, you know, that come off of it. So like here for example, we carry two types of salves. One of them's a circulate salve, that's mostly just blood movers and then a bone and tendon salve that's like 2/3 of those blood movers plus du jong, weiling xian and mu gua. Yeah, right. And I have found that it makes a difference. Yeah, right. So like for things that are stretchy and tendony, the attributes of those particular herbs in the salve is useful. Okay, what if you don't have it though? Can they just use the circulate salve? Yeah, of course. Yeah, right. It's fine. But there is a little bit more specificity that comes to it at that point. With bones. I don't know that the composition matters so much. Like there's not like bone herbs. Make sure there are these bone herbs in there. But I do think you need to have a carrier, like a driver. Right. So a bone formulation needs to have alcohol, vinegar, wine, zhangnao bing pian, something like that. Some combination of those probably. So that the force, the qi of the herbal pattern can actually get through the skin, get through the muscle all the way down to the bone. Because the bone is deep. Right? The bone's deep. And again, depending on where you're applying. So like if someone has like a fractured femur, might be tough to like realistically get a topical for the bone. Now you could definitely do a topical for the inflamed tissue for the break, like for the bruising. For sure.
[00:49:27] Speaker C: Yeah.
[00:49:28] Speaker A: For the bone itself, who can say? And at that Point. You know, you kind of find yourself in the. What I think of as the sort of passive tonification quality where, like, okay, so the formula isn't for the bone, which is broken, but the formula does move and circulate the blood and qi and the tissues. It does remove the stagnation in the hematoma. So, of course, the bone heals better because, like, all this other stuff's pulled out. So, like, it's not a bone formula. Right, exactly. But the quality of improving all of those aspects around the bone.
[00:49:58] Speaker C: Yeah.
[00:49:59] Speaker A: Excellent.
[00:50:00] Speaker B: And then the internal herbs work great for bones.
[00:50:03] Speaker A: Absolutely.
[00:50:03] Speaker B: And. And you can also use the topical like this for certain things where there's a complex picture.
[00:50:10] Speaker C: Right.
[00:50:10] Speaker B: Where you have maybe a cold condition globally, but topically, there's heat.
[00:50:16] Speaker A: Yes. This is a great point. This is the dermatology point. Right?
[00:50:20] Speaker C: Yeah.
[00:50:20] Speaker A: Because, okay, most people's dermatology problem is not a heat problem.
[00:50:24] Speaker C: Yeah.
[00:50:25] Speaker A: Right.
[00:50:25] Speaker C: Whoa.
[00:50:26] Speaker A: Yeah. I know. It's crazy. I mean, even if there's, like, heat in the blood, like, you'll see a lot of, like, the big, punchy formulas from famous doctors will use a lot of, like, Shang D in the internal formulas because, like, okay, you got to get rid of the heat in the blood. And that's true. Right. You do need to. But, like, the root cause of this is not, like they're just, like, invaded by the sun and it's boiling their blood or something. Right. Like, there's heat in the blood probably from some damp accumulation or cold stagnation.
[00:50:54] Speaker C: Right.
[00:50:54] Speaker A: That's like, causing this eat to. To engender. And then, of course, it goes into the blood and it comes out of the skin.
[00:51:02] Speaker C: Yeah.
[00:51:03] Speaker A: So a lot of folks will design formulas that are moving and circulating internally to deal with the damp or the cold that's causing the stagnation, which is causing the heat. But that doesn't change the fact that there's heat in the blood that's manifesting at the skin. Like, there's a problem. So using a topical, where you can use cooling, damp, transforming herbs Right. At the skin surface, where the heat is coming out through the pores, is a great way to be able to do two things at once. It's really hard to do internally.
[00:51:33] Speaker C: Yeah.
[00:51:33] Speaker A: You know what I mean? So, like, you can clear heat at the surface level. Right. Where it's manifesting while you're scouring it out internally by moving and circulating.
[00:51:42] Speaker C: Right.
[00:51:43] Speaker A: So. And, you know, we. I'm not a dermatology expert. There are people who do a lot of work with Dermatology, Chinese medicine stuff. And I think it's very specific work, and I think there's a lot of nuance to it, but of course, it almost always involves topicals. Right. And so the exact composition, the internal medicine approach, that's the subject of a different podcast for sure, and probably with someone who's more expert on derm than I am. But in terms of just the idea of topicals, broadly, you can absolutely combine one approach for the exterior, like, at the skin surface, and a different approach at the interior. And that's a good way to, like, hit, you know, two things at once.
[00:52:21] Speaker C: Absolutely, yeah.
[00:52:23] Speaker A: So I wanted to talk just a little bit about some specific formulas, just so that people have some in mind, and we'll throw some of the details into the show notes and just sort of like, you know, if you. If you haven't done much with topicals or you've only ever, you know, perused the Bensky formulary on topicals, some of these are in there, you know, so you can find them and then just sort of thinking about it in general. So the big one, the most versatile topical, like, if there was only one topical that you ever learned for sort of inflammatory skin conditions, it would be Jin Huang San, in my opinion. Jin Huang San. So j I in Huang San, golden yellow powder.
[00:53:06] Speaker B: There it is.
[00:53:07] Speaker A: There it is. So Jinhuang San is a versatile formula, and it's versatile because you can use it as a powder. You can put it into a salve, you can extract it into a wash. So you can. You can literally take the combination of herbs and use it in all of the forms that we talked about, just by having the powder on hand.
And if you're mostly using it in topicals or directly on the skin, we recommend a very, very fine grind. What we think of as a dermatological grind. So, like, when you touch it, it just feels like baby powder, like super, super, very, very fine, microscopic. If you're extracting it into oils or you're extracting it into, like, a wash, you want a coarser grind so you can strain it out. Right, right. Because we don't want plant particulate in our oils or salves or creams in particular, that's something to consider.
So Jin Huang San is essentially a combination of heat clearing and damp drying herbs. Right. So like tianhua fen, huang bai, jiang huang, dahuang, baizhi, ho, po, chen PI. These are the herbs that are in there. So what that means is that if the wound is wet or weeping, we got some dampness. Great. If it's red infected, itchy. We've got damp combining with heat. Right. So that's the presentation. So think someone cut themselves like they were working in the garden and they just cut their hand and maybe they didn't wash it very well or they didn't do first aid. And now it's like a little raised and red and it's scabbing, but it's like kind of oozy. Right. That's a great opportunity to just sprinkle fine gin huang zhan powder directly on it and cover it.
[00:54:46] Speaker C: Yeah.
[00:54:47] Speaker A: Right. And you can just do that, change it out twice daily. Right. Wash it off first, reapply, stick it on. Great. Right.
If you've got a swelling, a bug bite, something like that.
[00:54:59] Speaker B: What about poison ivy, poison oak, that kind of stuff.
[00:55:02] Speaker A: Better things for that.
[00:55:03] Speaker C: Yeah.
[00:55:03] Speaker A: Though you could use Jinhuang San for it. Jinhuang San is not great for the itching part. It's great for the infection.
Like heat is sort of coagulating fluids. Stuff that's going to start to get pussy. Stuff that could have a smell.
[00:55:21] Speaker C: Gotcha.
[00:55:21] Speaker A: That's Jinhuang San's world. Right, so like pussy, gross infection y stuff.
[00:55:26] Speaker C: Yep.
[00:55:26] Speaker A: Right. Or stuff that could go that way.
[00:55:29] Speaker C: Yeah.
[00:55:29] Speaker A: Like cuts.
[00:55:30] Speaker C: Yeah.
[00:55:30] Speaker A: Right. So that's like its primary space when you think of something for itching.
[00:55:35] Speaker C: Yeah.
[00:55:36] Speaker A: So poison ivy, poison oak, that kind of stuff.
Washes are better there.
[00:55:42] Speaker C: Yeah.
[00:55:42] Speaker A: Because usually it's broad area. Like there's a lot of your body, you know, that needs it. And so what I recommend for that is a formula called cushion tong.
[00:55:50] Speaker C: Yeah.
[00:55:51] Speaker A: So cushion is the primary formula. Cushion or the primary ingredient. Shichuangzi, baiger, Jinyinhua, juhua, huang bai, a couple of other things.
And this was a formula that has broad spectrum application for anything that's like, you know, like scape, like sores, like scabies, bed bugs, fungal disorders, stuff that's like super itchy, like, like poison ivy, poison oak. And what's nice is you can actually soak in this. So like you could actually put your body in it. It's actually genital friendly, like it's not going to cause any strong issues. You can actually get into it when itching is the primary thing that drives it. It has like d fuzi, shichangpu, shi chuangzi, which are ostensibly parasitic killing herbs. I have, I have never used this for scabies, which of course are bugs that live under your skin.
[00:56:50] Speaker C: Yeah.
[00:56:51] Speaker A: In theory you could apply it. I think if we were in apocalypse scenario and we had no Other choice. That's probably what we'd do, honestly. Go get the pharmaceutical for the scabies. Scabies? No, Jo. Very, very infectious.
[00:57:02] Speaker B: Infectious.
[00:57:03] Speaker A: Incredibly infectious. Incredibly transmissible. Go to the western meds, get the heavy hitters, kill those bugs, right? If you had no other choice, by all means use it here. I think in more practical applications, right, it's for fungal disorders, itching conditions, and then like scabby things. So like bed bugs, for example, don't live in your skin, but they've been eating you and biting you all over the place. You got little tiny bites. Or if you went camping and just got ravaged by mosquitoes, right? And you're like, lower legs are just like covered in like mosquito bites. The cushion tongue is going to be helpful for that.
[00:57:36] Speaker B: That's great, great to know.
[00:57:38] Speaker A: Yeah, I think that's a, that's a great formula.
Another thing to keep in mind, less on the soak side, but also really, really great for contact dermatitis. So that's poison ivy. Poison oak is a formula called qingdai san. So ching daisan, ching dai shi gao hua shi huangbai. If you're hearing those herbs, the primary thing that you're hearing is clear heat, right? So they're clear heat and toxicity presentations. And so ching daisan is often made into a salve. So in Chinese they call it a gao. So they'll take the finely ground ching daisan and literally just mix it with petroleum jelly, like just with vaseline. And then you just rub the vaseline over the areas where the itching is. So if you had like poison ivy on your hands, you take the qing dai san, finally, finely ground, mix it with usually one to one with vaseline petroleum jelly. And then you just slick that right on over the area where it hurts. And so you get both the heat clearing effect from the herbs and you get the itch reduction from that going away and you get the soothing effect of petroleum jelly. I know everyone's listening like, did he really just recommend petroleum jelly? And the answer is yes, I did. And the reason is because it's a singular product, it's unbelievably hypoallergenic. And people are like, but it's made out of oil. And I just want to be like, bro, your whole life is made out of oil. Like, take a step back, right? Like, are you listening to us on a phone? That whole phone's made out of oil. Like, I know you're not applying it to your skin, but we just need to recognize that like oil in and of itself is not the end of the world. Right. And petroleum jelly is not a composite thing. It's a single chemical element. It's a byproduct of petroleum refining.
And it's hypoallergenic. It doesn't clog pores, which feels counterintuitive because you're like, oh, it's super sticky. Right.
It's an excellent shelf stable carrier. So no mold is going to grow in it, no bacteria is going to set up in it. And it will keep those herbs that you mix it with in a perfect level of stasis that you can rapidly apply it. And then the petroleum jelly itself is soothing to skin.
[00:59:43] Speaker C: Yeah.
[00:59:44] Speaker A: So I know it's like, whoa, that surely I can use an all natural version and be like, the oil's natural. Like, I know it doesn't feel like it, but it is, it comes out of the ground.
So there are things that we can use in the realm of petroleum jelly, if you don't want to use petroleum jelly, you can like mix it with sesame oil or other things. You can do something else, but it's frankly just easier to mix it with Vaseline and it works really well.
[01:00:07] Speaker C: Yeah.
[01:00:08] Speaker A: So Jinhuang san versatile powder, Qing Daisan, usually made into a salve for topical contact dermatitis. And then kushin tong as a full body wash for itchy presentations. So like Kushan tong for super itch. Qing da san for itch, but more practical with a salve, you don't have to soak your whole body in it. And Jinhuang san for like infectious red, potentially pussy things.
[01:00:33] Speaker C: Yeah, yeah.
[01:00:35] Speaker B: Where can people get these? Like, let's say somebody's listening to this and they're like, where can I get this stuff?
[01:00:41] Speaker A: Yes, you need a bulk pharmacy, number one. And you need a bulk pharmacy that can grind up the formulas for you to the sufficient level of fineness.
[01:00:49] Speaker C: Yeah.
[01:00:50] Speaker A: And that's not a small thing. The grinding process for herbs is challenging. You know, we grind a lot of stuff here and people will send us formulas and be like, I need this ground into a fine powder. And all of the herbs in it will be like sticky resins and like sticky roots. And I'm like, I can't. Like, I don't. Yeah, I don't have the equipment to take something super sticky and turn it into an ultra fine powder. It's very difficult to do. Fortunately, all the ones I mentioned, Kushin tong, qingdai san, Jinhuang san, they're all easy to grind. So their roots, they're. They're not Sticky, sort of. Intrinsically, it's easy, easy to grind up. So a bulk pharmacy that can grind herbs. So obviously we can do that. Root and branch can do that. We can ship it to you anywhere in the country. But we're not the only ones. I think Camo can do it.
Plum Dragon, you know, they have pre batched versions. I don't think you can do a custom with Plum Dragon, but they have things that are already ground up that you can just buy. And you can actually buy finely powdered herbs from meiway.
[01:01:48] Speaker C: Yeah.
[01:01:48] Speaker A: So meiway.com, long standing herb importer, I would not recommend that you buy powdered herbs from, from any place that isn't hyper reputable.
[01:01:58] Speaker C: Yeah.
[01:01:58] Speaker A: So Mayway is like May we is not going to sell you a bag of powdered shirtwangsa that's actually like acorn husks, you know what I mean? Like it'll be the actual herb. And it's coming from their production facilities in China where they have excellent equipment for grinding. And so the ultra fine powders from Meiway are ultra ultra fine.
[01:02:16] Speaker C: Yeah.
[01:02:17] Speaker A: So they're great. How old they are, how potent they are. Okay, maybe there's some questions there, but they're vacuum sealed, they're double bagged. Like, honestly, if you're looking to experiment and you want to play around with it and you don't have equipment or you don't know what to do, you can make a practitioner account with Meiway and you can buy powdered herbs directly from.
[01:02:34] Speaker B: Yeah, that's good to know.
[01:02:35] Speaker A: So I think that's a, that's another thing to consider.
If you get into the, the experimentation place. One of the things that you'll often find is, you know, people are very interested in this question of natural. That's why I went on about the petroleum jelly. Like, I want something that doesn't have chemicals, it doesn't have stabilizers, et cetera. It's important to remember that some things are naturally shelf stable, like oil and wax. Right. Bacteria, fungus, mold, those things don't grow in oil, they don't grow on wax. Right. But if you make a cream, so you think in your mind, lotion cream, what are those? Those are what we call emulsions where we took oil and we took water and we combine them together to make a lotion. Right. The thing is, is that as I think most of our listeners will know, oil and water do not mix.
[01:03:27] Speaker C: Right.
[01:03:28] Speaker A: If you put them together without something called an emulsifier, they'll split. And so what will happen is you'll have, like a kind of watery solution with like little globlets of oil floating around in it because they don't stay together. Right. There are some natural emulsifiers that exist. Egg yolks, for example, a couple of other things. Mustard powder. Like, there are just some things that will help oil and water to bind. But the natural emulsifiers are more challenging because they're not predictably emulsifying like a chemical emulsifier is.
And then most importantly, if you were to, say, use egg yolk powder to emulsify herbs extracted into oil with a decocted herbs, Right. You're like making a really cool, fancy thing. I decocted herbs in water, I extracted herbs in oil. I'm going to emulsify them together in a blender with egg yolk powder, and I'm going to have my all natural, fully unchemical, topical. Right. In three days, it'll be full of mold.
[01:04:26] Speaker C: Yeah, right.
[01:04:27] Speaker A: Why? Because there's water in it. Right. And this is the simple answer. If there's water in your product, it will mold.
[01:04:36] Speaker C: Yes.
[01:04:37] Speaker A: Period.
[01:04:37] Speaker C: Yeah.
[01:04:38] Speaker A: Right. The only way that your Aveeno moisturizer from Costco doesn't mold is because it has chemicals in it.
[01:04:44] Speaker C: Right.
[01:04:45] Speaker A: That stop it from molding. So, like, when you look at the back of the product and you see all of those things you can't pronounce, right. Those are in there. They're not like just in there because they, like, hate you and they want to put chemicals in your skin. They're there because that's what makes it shelf stable. It's also what gives it the texture that you like. It's what keeps it smooth and clean smelling. It's what keeps it white. It's what keeps it from having little chunks in it. Like, there's reasons that all of that is in there. So can you make an all natural cream product? Yes, you can. Can. You will have to refrigerate it and it will still get moldy in a week.
Are there alternatives you can buy to put into your topicals that are quote unquote, natural preservatives? Sure. But honestly, at this point, it feels to me like you're splitting a hair. Right?
[01:05:33] Speaker C: Yeah.
[01:05:33] Speaker A: It's a natural preserve. Like, what does that even mean? Like, aren't they all natural on some point? Like, it's chemically derived. It came from petroleum. Like, okay, we need to have a conversation about what the goal is here. The truth is, is that the things that most people are accustomed to in the realm of creams and lotions are a product of modern chemistry.
[01:05:51] Speaker C: Yeah.
[01:05:52] Speaker A: That just is what it is. 150 years ago, people did not have water based creams that they could use if they had anything. They were savs. Oil and wax based savs that has been around forever. Alcohol based things, wine based things, vinegar based things. All of these are naturally shelf stable.
Lotions are not.
[01:06:12] Speaker C: Yeah.
[01:06:12] Speaker A: Right. And so that's really the big thing that you got to keep in mind. So if you're looking to make products and you're looking to make a specific style and type with a particular texture. Right. You're going to have to play with some kind of chemistry, whether it's basic items like sodium hydroxide or you're using like Germa band combos that involve a series of quote unquote naturally derived stabilizers and what have you. But that's just part of the game. If you're really opposed to that, then don't, don't get into, don't get into lotions.
[01:06:45] Speaker C: Right, Right.
[01:06:46] Speaker A: Just stick with salves. Right. Because you can do it easily with salves. You know, it's a little bit. This is a strange analogy, but it's a little bit like gluten free baking. Right?
[01:06:54] Speaker C: Right.
[01:06:54] Speaker A: Like you can go and eat, you know, food and baking that comes from North Africa and southern Spain where they don't use flour, they use almonds and other nuts and things to make products. And so you can have these amazing olive oil and citrus almond cakes. Delicious. Right. So tasty. Naturally gluten free. Not because they were trying to make it gluten free, but just because it was natively. Whereas if you want to have gluten free chiffon cake. Right. It's just not as good as chiffon cake. Right. And the reason is because you had to put all kinds of like stuff in it to try and copy the thing that it was.
So it just doesn't get you there. So it's the same thing here. Right. If you're really concerned about the chemical additives, stick in the salve space. If you are a little bit more flexible about what goes into your products, then creams and lotions are much more doable.
[01:07:44] Speaker C: Yeah.
[01:07:45] Speaker A: But it is challenging to make a shelf stable product that doesn't, that has water in it, that doesn't also have chemicals in it.
[01:07:51] Speaker B: That makes a lot of sense.
[01:07:52] Speaker A: Yeah.
Okay. Any other final questions? What are we thinking? I think we hit all the highlights.
[01:07:57] Speaker B: I think we did. Yeah, we hit, we hit the highlights.
[01:08:00] Speaker A: I want to mention on the pain formula thing, we didn't include any pain formulas in here. And that's because there's a lot of them and they're kind of all the same and all different at the same time.
If you're interested in pain formula combinations, there are not a lot of great books. The only one that I would recommend. Well, recommend is a loose term. I would. I will say a name of a book. You can take what you want from that. It's a formula. It's a book called Ancient Martial Formulas. Marshall here, like fighting Marshall by a guy named Wolfgang Kruger. Probably actually German though. So like Wolfgang Kruger.
Anyway, I would recommend it insofar as like, it's a book that has a collection of formulas in it. But like, honestly, it's very poorly written. Like the recipes are like grams and ounces in the same recipe or no, no ratios or no preparation instructions. And this is common. This stuff was taken from dojos and teachers. And this, all these formulas belong to what I think of as sort of the dit dat jiao category. If you've heard that phrase, dit dat jiao dit da jao is not a thing itself. It's a category of things. And they're basically herbs extracted in alcohol primarily, and then they're used in pain and martial traditions. So if you look through that book, you'll find a bunch of formulas that are all like ish, the same and they're all just from different families and different backgrounds. Right. So take a look at it. But what you will find is that the bulk of the of the herbs are the ones that we mentioned, the blood mover ones, Sanchi hong khua ruxiang, et cetera. Some of them will include the bone and sinew herbs that I mentioned. Du zhong, weiling, xian mua. And then there'll be some blend of a carrier slash penetrator. Right. Alcohol, bing piang. Now ginger, chili peppers, alliums like garlic and onions, stuff like that, wine vinegar.
And so at that point it's kind of like dealer's choice, you know, like, do you want to make the one that's like, this is the one rumored to be the original Shaolin Dit da zhao, right?
[01:10:02] Speaker C: Yeah.
[01:10:02] Speaker A: This is from the way families hungar tradition. It doesn't matter. You just pick something that seems good to you that you have access to. You crush up some herbs, you throw them in some alcohol, forget about it for two months, strain it out and see how it works.
[01:10:17] Speaker C: Yep.
[01:10:17] Speaker A: You know, and all of that's really of a kind. You know, I think it, it's A little bit just like having a really refined palette or something. Right. Like, if I drink a wine and you drink a wine, like you have a better palette than me. Maybe you're like, pulling out some nuance from it that I can't pick up on. But we both had a good time. The wine was very tasty. It feels a little bit like that to me. Sometimes with dit jowls, it's like, okay, if you're like hyper plugged into your body, a hyper refined delivery of topical pain formulas, maybe you can really see the difference. Where, you know, this guy doubled the Hong Khua and that guy tripled the San Lung, and that guy put in some bugs and it really makes a difference. I think mostly it's kind of just of a kind. Yeah, you know, I think it doesn't really matter all that much.
[01:11:00] Speaker C: Yeah.
[01:11:01] Speaker A: Yeah. Okay. Well, we'll throw some of these formulas up into the show notes for you guys so you can take a look at them. Some links to our website that'll have material there. And as always, we're interested in hearing some topical ideas from you guys. You can reach us at info, that's infoootandbranchpdx.com root and branch, all one word. Papa, delta, xray. Xray. Excuse me. Dot com. I've apparently become an expert in the phonetic Alphabet now, so I can just read that to everyone. And we look forward to hearing from you. Also, it's always a good idea if you're a new graduate or soon to be new graduate and you're interested in doing some further education. Our residency program is open and available. It remains that way all year long, so you can read about it and take a look at the application deadlines and things like that. But you can come and learn more from Travis and I about being a practitioner, particularly if you're new in the field and looking to do it. And so, as always, my name is Travis Kern.
[01:11:58] Speaker B: And I'm Travis Cunningham.
[01:11:59] Speaker A: And we will talk to you next time.
[01:12:01] Speaker B: Talk to you next time.
