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041 Considering Blood Stasis • Greg Livingston
Episode 4117th July 2018 • Qiological Podcast • Michael Max
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The words "qi and blood stasis" frequently work their way into our diagnosis of a patient's situation. But getting blood stasis from the realm of theory and  into our perceptual vocabulary takes some practice. And this can be quite helpful especially when working with cases that don't resolve the way we think they should.

In this conversation we look into how the long term effects of blood stasis can cause problems 5, 10, 20 years down the road that become baffling as the usual stuff just doesn't work. Or makes things worse.

Listen in for how paying attention to this commonly seen problem in clinic can help you to improve clinical results and unwind some knotty problems.

 

Head on over to the show notes page for more information about this episode and for links to the resources discussed in the interview. 

Transcripts

Michael Max:

The medicine of east Asia is based on a science that does not

Michael Max:

hold itself separate from the phenomenon that it seeks to understand our

Michael Max:

medicine did not grow out of Petri dish experimentation, or double blind studies.

Michael Max:

It arose from observing nature and our part in it east Asian medicine evolves not

Michael Max:

from the examination of dead structures, but rather from living systems with their

Michael Max:

complex mutually entangled interactions.

Michael Max:

Welcome to qiological.

Michael Max:

I'm Michael max, the host of this podcast that goes in depth on

Michael Max:

issues, pertinent to practitioners and students of east Asian medicine.

Michael Max:

Dialogue and discussion have always been elemental to Chinese

Michael Max:

and other east Asian medicines.

Michael Max:

Listen into these conversations with experienced practitioners that go deep

Michael Max:

into how this ancient medicine is alive and unfolding in the modern clinic.

Michael Max:

People seek out our services because they're looking for some kind of a change.

Michael Max:

Usually it's because they have something they don't want and

Michael Max:

they want to get rid of it.

Michael Max:

Although the opposite is also frequently true.

Michael Max:

They don't have something and they desire to get it.

Michael Max:

But something we might not think about is the nature of the change that our

Michael Max:

patients are seeking or the process of change that they might already be.

Michael Max:

the two character Chinese word for change can help to clue us in to the

Michael Max:

kind of change our patients are seeking.

Michael Max:

I'll be back a little later in the show to discuss how understanding

Michael Max:

the nature of change can help you with your clinical work

Michael Max:

Hey friends, before we get into today's conversation, I want to

Michael Max:

remind you that qiological is coming up to its first anniversary.

Michael Max:

And for that anniversary show, I'd like to have one of you join me.

Michael Max:

So if you've been listening to the show and you've been thinking, Hey, I'd like

Michael Max:

to be on qiological or I've got something that I'd like to discuss, or I've got

Michael Max:

something that I'd like to share, send me an email or better yet record your voice.

Michael Max:

Send me the idea that you'd like to talk about.

Michael Max:

And I'm going to put all of the good ideas into a hat.

Michael Max:

I'm going to pull one out and have one of you on the.

Michael Max:

So I'm really looking forward to hearing from you and having one

Michael Max:

of you join me here on the show.

Michael Max:

Greg Livingston learned his medicine in China, and about nine years ago,

Michael Max:

he returned here to the states.

Michael Max:

He teaches at the Oregon college of Chinese medicine in Portland,

Michael Max:

Oregon, and he schooled in various aspects of the medicine.

Michael Max:

And he's turned me on to some interesting books from some

Michael Max:

docs that I've never heard of.

Michael Max:

Yeah, just what I need.

Michael Max:

More books, you know, different people sort of develop an eye for

Michael Max:

different aspects of the practice, or they've got a knack for a particular

Michael Max:

illness or condition for Greg that would be blood status, which is

Michael Max:

something we often talk about.

Michael Max:

But Dr.

Michael Max:

Livingston here, he's like a blood status whisper.

Michael Max:

I'm looking forward to this conversation about a topic that we all deal with

Michael Max:

every day in our clinical practices.

Michael Max:

Gregg, welcome to GLI.

Dr. Greg Livingston:

Thanks, Michael.

Dr. Greg Livingston:

Thanks for having me,

Michael Max:

you know, it's so geeky getting together and talking

Michael Max:

about something like blood status.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

But you know, that's what we do.

Dr. Greg Livingston:

We geek out, you know, TCM geeks let's face

Michael Max:

this good Lord.

Michael Max:

What were your influences?

Michael Max:

Where there teachers were their books?

Michael Max:

Was there something in clinic?

Michael Max:

What got you going down the rabbit hole of blood

Dr. Greg Livingston:

stasis?

Dr. Greg Livingston:

It's certainly not the only thing that I concern myself with in Chinese medicine.

Dr. Greg Livingston:

But over time, I started to see that a lot of patients have blood stagnation

Dr. Greg Livingston:

and some teacher of mine said that health in Chinese medicine can be defined as

Dr. Greg Livingston:

high quality blood, nutritious blood, highly oxygenated, blood circulating,

Dr. Greg Livingston:

completely unimpeded throughout the.

Dr. Greg Livingston:

That's the definition of health, not physical fitness

Dr. Greg Livingston:

health is unimpeded blood flow.

Dr. Greg Livingston:

You have really high quality blood, highly oxygenated circulating unimpeded, and

Dr. Greg Livingston:

then all the tissues will function well.

Dr. Greg Livingston:

And that's not a new idea, certainly, you know, in Chinese medicine, the

Dr. Greg Livingston:

idea like futons it's all right.

Dr. Greg Livingston:

If there's obstruction there's then you on a block it, then the pain goes away.

Dr. Greg Livingston:

So Chinese medicine is all about circulation of chia and blood.

Dr. Greg Livingston:

I mean, not all about that, but it's so fundamental.

Dr. Greg Livingston:

I often forget about it.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

But it's just one of those basic things that you need to be

Dr. Greg Livingston:

concerned about and people end up.

Dr. Greg Livingston:

Impaired blood circulation for a variety of reasons, right?

Dr. Greg Livingston:

We can go back to, you know, the signing, the three categories of

Dr. Greg Livingston:

disease causing factors, right?

Dr. Greg Livingston:

Nene, why enable what the internal, external and miscellaneous causes

Dr. Greg Livingston:

of disease, either internal or external, either internal or external.

Dr. Greg Livingston:

So any of those things can ultimately cause blood stagnation, right?

Dr. Greg Livingston:

External pathogen, invades, and impairs circulation of GM blood and internal

Dr. Greg Livingston:

factors, the emotions, impairs circulation of GM blood and the miscellaneous things,

Dr. Greg Livingston:

trauma, uh, animal bites, those things, surgeries, they, those things end up

Dr. Greg Livingston:

impairing circulation of GM blood.

Dr. Greg Livingston:

So especially with chronic patients and older people, you see less

Dr. Greg Livingston:

with little kids, but even you can, but certainly people once

Dr. Greg Livingston:

they're middle age or, or elderly.

Dr. Greg Livingston:

They usually have a lot of blood stagnation.

Dr. Greg Livingston:

And so I've found that it's one of those things that if you know how to identify

Dr. Greg Livingston:

it and you know how to treat it, then the results are pretty miraculous.

Dr. Greg Livingston:

And I'm known for this at OCOM where I teach as being a little

Dr. Greg Livingston:

bit obsessed with blood stagnation, actually all the students that follow

Dr. Greg Livingston:

me in the clinic, they, they know that that it's a thing of mine.

Dr. Greg Livingston:

I don't think really that it's me being obsessed with it.

Dr. Greg Livingston:

It's just everywhere.

Dr. Greg Livingston:

Right.

Dr. Greg Livingston:

I think it's, it's everywhere.

Dr. Greg Livingston:

And I think it looks like I'm obsessed with it because a lot of

Dr. Greg Livingston:

people don't know how to see it and they don't know how to diagnose it.

Dr. Greg Livingston:

They don't know how to treat it.

Michael Max:

So what does blood stagnation look like?

Michael Max:

And more to the point, maybe what is it that your average practitioner like me

Michael Max:

might be overlooking sometimes in clinic?

Michael Max:

There's these weird signs and symptoms.

Michael Max:

I don't know what that is.

Michael Max:

And you kind of just put it off to the side, hoping it will later fall

Michael Max:

into the pattern, but it never does.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

I mean, it could be something like that, but a lot of times this stuff

Dr. Greg Livingston:

that's just staring you right in the face, but there are things that a lot of

Dr. Greg Livingston:

practitioners, I would say largely in the west, I didn't meet too many doctors in

Dr. Greg Livingston:

China that had trouble diagnosing that.

Dr. Greg Livingston:

But in the west, you know, I think generally people's diagnostic skill

Dr. Greg Livingston:

is not quite as good as in China.

Dr. Greg Livingston:

So there is exceptions obviously, but so what are we looking

Michael Max:

at then?

Michael Max:

What would, what would help us to make sure we're not missing

Dr. Greg Livingston:

the obvious?

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

Well, the first thing I would say is the complexion that you can see it.

Dr. Greg Livingston:

When people walk in the room, if it's significant, they

Dr. Greg Livingston:

have an ashen complexion.

Dr. Greg Livingston:

There's no sheen.

Dr. Greg Livingston:

You have to understand that the blood vessels that feed the skin.

Dr. Greg Livingston:

Our tiny little capillaries.

Dr. Greg Livingston:

And so it's easy to occlude those vessels.

Dr. Greg Livingston:

If this blood circulation is sluggish systemically, then almost sure the blood

Dr. Greg Livingston:

circulation to the skin will be impaired.

Dr. Greg Livingston:

So the skin is dry.

Dr. Greg Livingston:

Lacking sheen becomes ashen colored.

Dr. Greg Livingston:

Also in Chinese, we call jots hall jots who has that scaly looking skin.

Dr. Greg Livingston:

It's dry and looks kind of scaly, especially if you, if you take your

Dr. Greg Livingston:

fingers and you sort of squeeze the pinch, the skin together a little bit,

Dr. Greg Livingston:

it'll look a little bit rough and scaly.

Dr. Greg Livingston:

And then the other thing which a lot of people don't realize, for

Dr. Greg Livingston:

some reason that's not well known, or at least in my experience here.

Dr. Greg Livingston:

And the in the west is pigment spots, pigment spots as a

Dr. Greg Livingston:

huge sign of blood stagnation.

Dr. Greg Livingston:

I mean, like, exactly.

Dr. Greg Livingston:

Those are blood

Michael Max:

stagnates.

Michael Max:

So for you listeners, we actually have a video as we're talking to each other,

Michael Max:

but I'm showing the back of my left hand.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

So that's, that's clear sign of blood stagnation.

Dr. Greg Livingston:

Some people have freckles, that's not blood signage, but if they're what we

Dr. Greg Livingston:

call eight spots, that's blood stagnation.

Dr. Greg Livingston:

Why do people get that as the age?

Dr. Greg Livingston:

Because as people age, they tend to develop more and more blood stagnation.

Dr. Greg Livingston:

Do you know this?

Dr. Greg Livingston:

Dr.

Dr. Greg Livingston:

Yen does sheen, which is a very famous law.

Dr. Greg Livingston:

It's only not familiar with him.

Dr. Greg Livingston:

He's kind of the, the number one big guy in shy.

Dr. Greg Livingston:

What's his name?

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

And does sheen, Y a N D E X I N.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

Okay.

Dr. Greg Livingston:

We'll put

Michael Max:

his name on the show

Dr. Greg Livingston:

notes that he's very famous for his

Dr. Greg Livingston:

discussions of blood stagnation.

Dr. Greg Livingston:

He's also kind of obsessed if we can say that with blood stagnation.

Dr. Greg Livingston:

So I read a lot of his stuff actually, that he definitely

Dr. Greg Livingston:

had a bit of an influence on me.

Dr. Greg Livingston:

So Yenta sheens says that one of the main causes of aging aside from

Dr. Greg Livingston:

decline of essence is blood stagnation.

Dr. Greg Livingston:

So yeah, as people age, they incur more blood stagnation

Dr. Greg Livingston:

and they get those age spots.

Dr. Greg Livingston:

So you can see those anywhere on the body.

Dr. Greg Livingston:

It's very easy to see them on the hand.

Dr. Greg Livingston:

And since we're checking people's pulses, hopefully then, you know, you

Dr. Greg Livingston:

can have a look at people's hand and arm.

Dr. Greg Livingston:

You'll see pigment spots there.

Dr. Greg Livingston:

Purple lips is another thing that you'll see of course purple.

Dr. Greg Livingston:

And then one thing that I particularly like to inspect is the lower leg.

Dr. Greg Livingston:

Aha.

Michael Max:

What are you and what are you looking

Dr. Greg Livingston:

farther?

Dr. Greg Livingston:

The lower leg, the blood circulation is particularly difficult.

Dr. Greg Livingston:

It's far from the heart.

Dr. Greg Livingston:

And so circulation in the lower leg is particularly challenging.

Dr. Greg Livingston:

Blood stagnation signs will show up on the skin there very readily.

Dr. Greg Livingston:

So you'll see discoloration purple, blue, green color varicose veins.

Dr. Greg Livingston:

And then of course you get to see that dry, rough, scaly skin.

Dr. Greg Livingston:

Dr.

Dr. Greg Livingston:

Wong

Michael Max:

talks about that a lot.

Michael Max:

Yeah, he does.

Michael Max:

He's he's real big on that.

Dr. Greg Livingston:

On that lower leg, he loves to inspect the lower leg.

Dr. Greg Livingston:

That's right.

Dr. Greg Livingston:

Also Hong Kong showed me, I think it was Hong Kong showed this to

Dr. Greg Livingston:

me, but it's been a long time.

Dr. Greg Livingston:

So I can't remember exactly where I learned this, but a thickened here.

Dr. Greg Livingston:

Thickened skin on the heel is another sign of blood stagnation.

Dr. Greg Livingston:

Obviously you can't just automatically say, oh, that's, you know, 100%

Dr. Greg Livingston:

blood stagnation, but if the lower leg you can see discoloration, dry,

Dr. Greg Livingston:

rough, scaly skin pigment spots.

Dr. Greg Livingston:

And the heel is thickened even to the extent sometimes where

Dr. Greg Livingston:

cracks that's blood stagnation.

Dr. Greg Livingston:

So those things are the, uh, you know, it's part of the visual inspection.

Dr. Greg Livingston:

And you'll see that on a lot of people.

Dr. Greg Livingston:

It's, it's quite remarkable how many people have those signs and symptoms.

Dr. Greg Livingston:

And

Michael Max:

I suspect, especially as we get clued into it or clued into it

Michael Max:

again, it's like, oh yeah, there it is.

Michael Max:

And there isn't.

Michael Max:

Oh yeah,

Dr. Greg Livingston:

there it is.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

Like for example, I had a patient, this is a very.

Dr. Greg Livingston:

Memorable patient.

Dr. Greg Livingston:

Cause it was such a, it was a pretty serious case of a patient with very

Dr. Greg Livingston:

severe PTSD is a woman in her, I think maybe early sixties from central America.

Dr. Greg Livingston:

And she had been, I think she was from El Salvador.

Dr. Greg Livingston:

So she'd lived through the war there and her son was killed.

Dr. Greg Livingston:

Her son had been killed.

Dr. Greg Livingston:

So after that she had night terrors, uh, insomnia, anxiety, depression,

Dr. Greg Livingston:

fatigue, cause obviously not sleeping, eventually develop hypertension.

Dr. Greg Livingston:

So she was on hypertensive medications, Xanax, I think antidepressants

Dr. Greg Livingston:

off and on over the years.

Dr. Greg Livingston:

And this is, you know, decades long problem she'd had for.

Dr. Greg Livingston:

Easily like 20, 30 years and no one had been able to help her.

Dr. Greg Livingston:

And I saw her at the OCOM clinic.

Dr. Greg Livingston:

So oftentimes patients at the ACOM clinic, they've seen multiple practitioners,

Dr. Greg Livingston:

including other faculty, not just interns, but they've seen other faculty.

Dr. Greg Livingston:

And I look at the prescriptions that other doctors had given her.

Dr. Greg Livingston:

And a lot of them were calms and prescription, right?

Dr. Greg Livingston:

Like maybe swans are on Tom or or or for the high blood pressure.

Dr. Greg Livingston:

People's thinking can be that simplistic sometimes.

Dr. Greg Livingston:

They'll you have high blood pressure, just take TMR, go go-time, which

Dr. Greg Livingston:

that's a whole another conversation.

Dr. Greg Livingston:

Why that's not a good approach.

Dr. Greg Livingston:

But anyway, this patient walked in.

Dr. Greg Livingston:

The first thing that came to my mind, just looking at her face was, I don't

Dr. Greg Livingston:

know what's wrong with her, what her complaint is, but whatever it is,

Dr. Greg Livingston:

she's got a ton of blood stagnation because their face is very ashen.

Dr. Greg Livingston:

Her lips are purple.

Dr. Greg Livingston:

She's got pigment spots on her face.

Dr. Greg Livingston:

So I'm like, whatever her problem is, for sure.

Dr. Greg Livingston:

There's a ton of blood stagnation there.

Dr. Greg Livingston:

So then we got to talking to her and it took me all of about a

Dr. Greg Livingston:

minute to decide on the formula.

Dr. Greg Livingston:

But you know, it's an intern clinic.

Dr. Greg Livingston:

So, you know, we spent the next hour letting the interns do their

Dr. Greg Livingston:

intake and trying to sort out and figure out which formula to use.

Dr. Greg Livingston:

But she had chest discomfort, even some like a little prickly

Dr. Greg Livingston:

sensation sometimes in the chest.

Dr. Greg Livingston:

And should we get cold extremities when she's stressed?

Dr. Greg Livingston:

So automatically I'm just thinking shrift.

Dr. Greg Livingston:

If you read Ealing guides, whore, right?

Dr. Greg Livingston:

The one children's book where comes from, I'm not sure how to translate

Dr. Greg Livingston:

the title of the, that book's been translated into English.

Dr. Greg Livingston:

I think it's something like correcting the errors in the forest of medicine.

Dr. Greg Livingston:

I think that's how they translate that.

Dr. Greg Livingston:

I think that's yeah, but anyway, sure.

Dr. Greg Livingston:

If we'll do Taiyang and all those two tongues come from launching,

Dr. Greg Livingston:

and from that book, if you look at the entry for shifts where you're

Dr. Greg Livingston:

talking in that book, I think there's about 16 or 17 different indications.

Dr. Greg Livingston:

And about half of them are mental, emotional, including night terrors,

Dr. Greg Livingston:

yelling in your sleep, insomnia, nightmares, that kind of stuff.

Dr. Greg Livingston:

You know, wanting to identify blood stagnation as a cause.

Dr. Greg Livingston:

And in particular heart blood stagnation as the cause of these

Dr. Greg Livingston:

kinds of mental, emotional disorder.

Dr. Greg Livingston:

So automatically I just think sheriff.

Dr. Greg Livingston:

And so we did that.

Dr. Greg Livingston:

We gave her a shuffled futon.

Dr. Greg Livingston:

We didn't modify the doll.

Dr. Greg Livingston:

We didn't add swans out and we didn't add Longo Muhly,

Michael Max:

you know, it's, it's great to take these formulas and use them

Michael Max:

straight up, just watch what they do without getting in there and fidgeting.

Michael Max:

I mean, sometimes

Dr. Greg Livingston:

we need to, you know, because I teach, I just feel like

Dr. Greg Livingston:

a little bit of a broken record, cause I'm always saying the same thing over

Dr. Greg Livingston:

and over that ultimately it's all just been, so just pattern, differentiate and

Dr. Greg Livingston:

try to understand the pathol mechanism.

Dr. Greg Livingston:

Right.

Dr. Greg Livingston:

In Chinese.

Dr. Greg Livingston:

We often talk about being in being GI, being in, being etiology,

Dr. Greg Livingston:

being G patholo mechanism.

Dr. Greg Livingston:

So my teachers talked about being, being G all the time and I don't

Dr. Greg Livingston:

hear that or read that too much in English, but it's really imperative

Dr. Greg Livingston:

to understand Pathwell mechanisms.

Dr. Greg Livingston:

So it's like, okay, if, if someone has blood stagnation in the chest, First

Dr. Greg Livingston:

of all, how could it have gotten there?

Dr. Greg Livingston:

Well, this person went through some severe emotional trauma.

Dr. Greg Livingston:

That's going to constrain the chief at the very least

Dr. Greg Livingston:

constrained the liver chain, right?

Dr. Greg Livingston:

And then the liver channel goes to the chest.

Dr. Greg Livingston:

So that liver cheese stagnation, one of the Cardinal signs of

Dr. Greg Livingston:

liturgy stagnation, which also people forget is chest tightness.

Dr. Greg Livingston:

People remember subcostal discomfort, flank pain, but chest tightness, chest

Dr. Greg Livingston:

discomfort is another important symptom of, or sign of liver GI stagnation.

Dr. Greg Livingston:

So Luci stagnation constraints, the chief and the chest in Paris, heart,

Dr. Greg Livingston:

blood circulation, and then long term, especially with severe emotional

Dr. Greg Livingston:

stress like that kind of PTSD event that will make heart blood stagnation.

Dr. Greg Livingston:

Then the heart is not nourished because the blood circulation

Dr. Greg Livingston:

in the heart is impaired.

Dr. Greg Livingston:

I mean, literally the circulation in the heart is impaired.

Dr. Greg Livingston:

It's not metaphysics.

Dr. Greg Livingston:

It's literally the circulation in the physical heart is impaired and

Dr. Greg Livingston:

you can feel that on the pulse too.

Dr. Greg Livingston:

And those that patient actually had chest pain, little sharp, prickly, chest pain.

Dr. Greg Livingston:

It is the coronary arteries.

Dr. Greg Livingston:

There's some impaired circulation.

Dr. Greg Livingston:

It might be in the small vessels, but anyway, there's definitely

Dr. Greg Livingston:

impaired blood circulation there.

Dr. Greg Livingston:

So then if the heart blood circulation is impaired, then

Dr. Greg Livingston:

the ShaoYin is not nourished.

Dr. Greg Livingston:

Then you end up with all this different kinds of mental, emotional problem.

Dr. Greg Livingston:

So in that case, all you need to do is deal with this CIM blood stagnation.

Dr. Greg Livingston:

You don't swansong and doesn't address that pathology at all.

Dr. Greg Livingston:

Neither does . So it's all about proper differentiation pattern differentiation,

Dr. Greg Livingston:

and then understanding the patho mechanism and the etiology, if you can.

Dr. Greg Livingston:

And then it's very clear, like that's a shift, we'll do your tongue pattern.

Dr. Greg Livingston:

There's no need to add any other herbs to that form.

Dr. Greg Livingston:

And so we gave her a shrift with zutang and immediately within, I

Dr. Greg Livingston:

think even the first night after she took that she could sleep.

Dr. Greg Livingston:

It was just, it was remarkable.

Dr. Greg Livingston:

And, uh, I mean, we dosed it pretty high too.

Dr. Greg Livingston:

You can't take some small dose of it and expect those kinds of results.

Dr. Greg Livingston:

What do you call a high dose of it?

Dr. Greg Livingston:

I'm pretty sure we gave her bulk herbs.

Dr. Greg Livingston:

Uh, cause I I'm pretty adamant about that in situations where

Dr. Greg Livingston:

the it's a kind of a severe case.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

Like childhood, probably 15 Michelle 30, just should of 15 guns house, six to nine.

Dr. Greg Livingston:

I can't remember what we gave her maybe because she's hypertensive.

Dr. Greg Livingston:

We gave her six Tara and 15 home law, nine Sunday.

Dr. Greg Livingston:

But like a bag of day like that, I'm going to come back to

Michael Max:

this in a moment, but I want to veer off to the, to the

Michael Max:

side here, this, this, this may be getting into troubled waters, but yeah.

Michael Max:

So what you were talking about, how your experience learning in China,

Michael Max:

there was a big emphasis on really knowing the path of mechanism.

Michael Max:

What are we actually looking at here?

Michael Max:

What's going on?

Michael Max:

You're saying we don't get that so much here in the United States.

Dr. Greg Livingston:

Well, that's my experience talking with Chinese

Dr. Greg Livingston:

medicine practitioners here.

Dr. Greg Livingston:

What's your

Michael Max:

stance.

Michael Max:

How come we don't go into that?

Michael Max:

Is that not in our education?

Michael Max:

Is it, do we think differently?

Michael Max:

What's

Dr. Greg Livingston:

I think it's just not in the edge.

Dr. Greg Livingston:

It's not emphasized in school as much.

Dr. Greg Livingston:

And trying to it's a big thing is that everyone knows you need to

Dr. Greg Livingston:

understand being in being G is they, they emphasize on that, but here.

Dr. Greg Livingston:

I met a lot of people, even people who've been in practice for some time that sure.

Dr. Greg Livingston:

They probably had heard those terms before, but they weren't obsessed with it.

Dr. Greg Livingston:

I'm obsessed with that.

Dr. Greg Livingston:

That's, that's something you need to be obsessed with.

Dr. Greg Livingston:

In my opinion, you need to not just be differentiating patterns you

Dr. Greg Livingston:

need in order to be good at pattern differentiation, you have to understand

Dr. Greg Livingston:

etiology and patholo mechanism because that's how you arrive at good pattern.

Dr. Greg Livingston:

Differentiation.

Dr. Greg Livingston:

You have to understand what's the mechanism behind this

Dr. Greg Livingston:

person's signs and symptoms.

Dr. Greg Livingston:

So for example, the case of blood stagnation, why do you get rough,

Dr. Greg Livingston:

dry, scaly skin pigment spots?

Dr. Greg Livingston:

Well, the blood circulation is impaired.

Dr. Greg Livingston:

The blood circulation to the skin is particularly difficult because it's

Dr. Greg Livingston:

all capillary circulation capillaries.

Dr. Greg Livingston:

If the blood circulations systemically slugging.

Dr. Greg Livingston:

Then certainly capillary circulation is going to feel it the most, your aorta.

Dr. Greg Livingston:

There's still going to be plenty of blood flowing through aorta.

Dr. Greg Livingston:

Otherwise you're, you're dead.

Dr. Greg Livingston:

Your capillary blood flow can be, you know, somewhat impaired

Dr. Greg Livingston:

and you still get around.

Dr. Greg Livingston:

You might, you might feel a little tired we'll sluggish, but you still survive.

Dr. Greg Livingston:

So what is it that makes the skin look like that?

Dr. Greg Livingston:

Right?

Dr. Greg Livingston:

That's Pathwell mechanism.

Dr. Greg Livingston:

So the blood circulation there is difficult.

Dr. Greg Livingston:

The skin doesn't get enough blood and nutrients, so it becomes dry and rough.

Dr. Greg Livingston:

And then how does the pigment accumulate there?

Dr. Greg Livingston:

Well, when people are exposed to sun, pigment is deposited in the skin

Dr. Greg Livingston:

and then when they're not, then the blood comes around and metabolizes

Dr. Greg Livingston:

those pigments and takes them away.

Dr. Greg Livingston:

And that's why a 10, especially if you're me, cause I'm pretty pale.

Dr. Greg Livingston:

It doesn't last, very long.

Dr. Greg Livingston:

Right.

Dr. Greg Livingston:

You get 10 and then it goes away because your body came around

Dr. Greg Livingston:

and metallic, literally the blood came around and metabolize those

Dr. Greg Livingston:

pigments and took them away.

Dr. Greg Livingston:

If you have blood stagnation, the pigments are deposited, but they never leave.

Dr. Greg Livingston:

So then you end up with pigment spots, that kind of analysis.

Dr. Greg Livingston:

That's pathol mechanism.

Dr. Greg Livingston:

It's important to do that across the board when you're seeing patients, it's not so

Michael Max:

much a thing of going, oh, this patient looks

Michael Max:

like they fit in this box.

Michael Max:

It's more, oh, here's what I'm seeing.

Michael Max:

Oh yeah.

Michael Max:

It's this.

Dr. Greg Livingston:

How do we explain all these signs and symptoms?

Dr. Greg Livingston:

It's not enough to just say, oh, to memorize.

Dr. Greg Livingston:

You know, for example, a lot of people have this impression that

Dr. Greg Livingston:

night's sweat is from individually.

Dr. Greg Livingston:

I think if you ask a lot of people, what's the cause of night's sweat.

Dr. Greg Livingston:

They can only come up with that.

Dr. Greg Livingston:

One thing they think in deficiency causes nights.

Dr. Greg Livingston:

Well, I, you know, it's one of those things,

Michael Max:

that's the first thing you learn.

Michael Max:

It's almost like a native tongue, right?

Michael Max:

Your native tongue is easiest.

Michael Max:

You can speak other tongues if you learn them.

Michael Max:

But it's like, there's a certain default.

Michael Max:

I mean, when I think of like cheats efficiency kinds of things, the

Michael Max:

first formula that comes to mind is . Why is the first formula

Michael Max:

learn for cheetah efficiency?

Michael Max:

It's like, there's these things, these various aspects about

Michael Max:

the medicine that we learn.

Michael Max:

And it's like the first time we hang an idea on it, but there was all these other

Michael Max:

possibilities, you know, we have to keep looking at all the other possibilities.

Dr. Greg Livingston:

Right.

Dr. Greg Livingston:

If you think patho mechanism all the time, analyzing the signs and

Dr. Greg Livingston:

symptoms, not just memorize a pattern.

Dr. Greg Livingston:

For example, we can talk about chia deficiency.

Dr. Greg Livingston:

So chia deficiency pattern.

Dr. Greg Livingston:

Well, let's just talk about sweating from G deficiency.

Dr. Greg Livingston:

That's an interesting thing, right?

Dr. Greg Livingston:

Cheat deficiency people.

Dr. Greg Livingston:

There's not enough cheat to regulate the opening and closing of the poorest, right?

Dr. Greg Livingston:

So typically upon exertion, when you're consuming your key, then you have

Dr. Greg Livingston:

a little less cheap after exertion.

Dr. Greg Livingston:

Then there's less cheat to regulate the poorest of the poor slack open.

Dr. Greg Livingston:

And the sweat comes out.

Dr. Greg Livingston:

That's understanding the path on mechanism of deficiencies sweating.

Dr. Greg Livingston:

If all you know is that cheat efficiency, people sweat upon exertion, but you

Dr. Greg Livingston:

can't explain why that's not enough.

Dr. Greg Livingston:

You need to ask why for all these things, the why is the path home mechanism?

Dr. Greg Livingston:

So that's in my mind and all my teachers' minds.

Dr. Greg Livingston:

And I think in most Chinese medicine doctors in China, they understand

Dr. Greg Livingston:

the importance of not just memorizing patterns, but understanding the mechanism

Dr. Greg Livingston:

behind all these signs and symptoms.

Dr. Greg Livingston:

And if you, if you practice that way, if you think that way, then over time,

Dr. Greg Livingston:

it actually becomes pretty simple.

Dr. Greg Livingston:

You start to understand, and you can, you can really unravel a lot of difficult

Dr. Greg Livingston:

cases that other people weren't able to treat because somehow the presentation of

Dr. Greg Livingston:

the patient didn't match any recognizable pattern that they have memorized.

Dr. Greg Livingston:

They don't understand how to think about Pathwell mechanism in a sophisticated way.

Dr. Greg Livingston:

So then they fail and their diagnosis, their diagnosis comes

Dr. Greg Livingston:

up short like this patient.

Dr. Greg Livingston:

We were just talking about this PTSD page.

Dr. Greg Livingston:

People see insomnia or hypertension, right?

Dr. Greg Livingston:

The patient has hypertension.

Dr. Greg Livingston:

So I think someone had given the patient Tambo go and they see insomnia.

Dr. Greg Livingston:

So they use done.

Dr. Greg Livingston:

That's not thinking about patho mechanism, that's just link a particular sign

Dr. Greg Livingston:

or symptom to a particular pattern.

Michael Max:

Well, and then you wouldn't know what to do when something like Swan

Michael Max:

sour N would maybe make that situation

Dr. Greg Livingston:

worse.

Dr. Greg Livingston:

Exactly.

Dr. Greg Livingston:

Actually swans around town could make this patient worse.

Dr. Greg Livingston:

I mean, as far as the runtime, at least it has . So that's, you know, maybe

Dr. Greg Livingston:

not the worst thing you could do for the patient, but like for example, you

Dr. Greg Livingston:

give that patient tell on bougie and dad you'll definitely make them worse.

Dr. Greg Livingston:

All those cold sticky herbs, it's going to gum up her blood circulation

Dr. Greg Livingston:

even more and TMO goats hanging.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

People love that for hypertension, but not all hypertension is liver young, rising.

Dr. Greg Livingston:

Some of it is, but a lot of hypertension actually is due to blood stagnation.

Dr. Greg Livingston:

After she took the strip.

Dr. Greg Livingston:

At two time, her blood pressure actually started to come down.

Dr. Greg Livingston:

Her blood pressure came down, she came off some of those blood pressure

Dr. Greg Livingston:

meds and some of the psych meds.

Dr. Greg Livingston:

And yeah, she was sleeping through the night.

Dr. Greg Livingston:

I mean, it's still, she had some issues, but, uh, she was

Dr. Greg Livingston:

much, much better even after.

Dr. Greg Livingston:

And I don't think we just gave her shrift futon.

Dr. Greg Livingston:

That was the first formal.

Dr. Greg Livingston:

And then over time, the formulas changed a little bit, but definitely blood

Dr. Greg Livingston:

stagnation was part of her treatment.

Dr. Greg Livingston:

I think for almost the entire time, because one of the things about blood

Dr. Greg Livingston:

stagnation is very stubborn stuff.

Dr. Greg Livingston:

It's often takes a long time to address it, but anyway, she was taking this

Dr. Greg Livingston:

blood stagnation nurse for a long time and her complexion improved too.

Dr. Greg Livingston:

She was really happy about that formula.

Dr. Greg Livingston:

It is a beauty formula.

Dr. Greg Livingston:

Her skin started, it was more moist and had more shine.

Dr. Greg Livingston:

And the pigment spots start to lighten a little bit.

Dr. Greg Livingston:

She looked less ashen and more like Rosie cheat like that.

Dr. Greg Livingston:

So she was very happy.

Dr. Greg Livingston:

Not only she felt better, but she looked better.

Dr. Greg Livingston:

So that was a very, very nice case.

Dr. Greg Livingston:

It's a very instructive case.

Dr. Greg Livingston:

Yeah.

Michael Max:

Yeah.

Michael Max:

So I think most of us are familiar with that.

Michael Max:

There's a deep, deep connection between the ShaoYin and the blood these days.

Michael Max:

I don't know what your practice looks like, but I would say at least a third and

Michael Max:

at certain points up to half or so of my patients are in some kind of, you know,

Michael Max:

Xanax or Lexapro is the big one over here.

Michael Max:

And in the Midwest pack, fill, you know, all these, these kinds of mood meds.

Michael Max:

What's your experience with these kinds of psycho emotive issue is

Michael Max:

where people have been given these medications that really in many ways,

Michael Max:

keep them away from their emotions.

Michael Max:

How do you see that playing in with blood

Dr. Greg Livingston:

spaces?

Dr. Greg Livingston:

It would be wrong to say that all those people have blood stagnation.

Dr. Greg Livingston:

I mean, maybe they do to some extent or another, it would be wrong to

Dr. Greg Livingston:

say that all those people's mental, emotional problems, you could just

Dr. Greg Livingston:

simply chalk up to blood stagnation.

Dr. Greg Livingston:

I think it's often at least part of the pattern.

Dr. Greg Livingston:

It may not be the only thing.

Dr. Greg Livingston:

I mean, that's the other thing to remember is that people's problems are

Dr. Greg Livingston:

often, there's many things going on.

Dr. Greg Livingston:

The blood stagnation is part of it, but there can be underlying deficiencies and

Dr. Greg Livingston:

there's HEA there can be cold, right?

Dr. Greg Livingston:

There's all different things going on and you just sort of have to peel the layers.

Dr. Greg Livingston:

But blood stagnation is often one of those layers.

Dr. Greg Livingston:

It's often one of the overlooked layer.

Dr. Greg Livingston:

I would say that a lot of those people, I do end up treating

Dr. Greg Livingston:

them for blood stagnation.

Dr. Greg Livingston:

Again, not because I think the blood stagnation is their only

Dr. Greg Livingston:

problem, but they do have that they, those people often have, you

Dr. Greg Livingston:

know, they have emotional problems.

Dr. Greg Livingston:

So they have chief stagnation.

Dr. Greg Livingston:

She stagnation leads to blood stagnation and, and, uh, so ultimately you do

Dr. Greg Livingston:

end up putting in some herbs for blood stagnation, put some dance and

Dr. Greg Livingston:

in there, or, you know, you can use a shift for two Taiyang or of course

Dr. Greg Livingston:

you need to figure out where the blood stagnation is and go after it.

Dr. Greg Livingston:

For example, if you read song Hyla and D downtown downtown is FOC harm, right?

Dr. Greg Livingston:

Quality craziness, right?

Dr. Greg Livingston:

Mania, craziness.

Dr. Greg Livingston:

So D downtown is blood stagnation in the lower abdomen, right?

Dr. Greg Livingston:

Lower back.

Dr. Greg Livingston:

right for the lower burner blood stagnation.

Dr. Greg Livingston:

It's not just heart blood stagnation that can make people have some

Dr. Greg Livingston:

mental, emotional problems.

Dr. Greg Livingston:

It could be blood stagnation anywhere.

Dr. Greg Livingston:

So you don't have to try to figure out where their blood stagnation is.

Dr. Greg Livingston:

You can palpate the abdomen.

Dr. Greg Livingston:

You can of course, try to feel it on the poles or look on the tongue or

Dr. Greg Livingston:

facial diagnosis, all those things you just go back to Benza on, you

Dr. Greg Livingston:

know, and, uh, to basics in some ways back to it's really back to basics.

Dr. Greg Livingston:

I think for me, one of the key mistakes I see students make is

Dr. Greg Livingston:

they focus on chief complaint.

Dr. Greg Livingston:

That's for me is a big mistake.

Dr. Greg Livingston:

Chief complaint is only important in that.

Dr. Greg Livingston:

Okay.

Dr. Greg Livingston:

That's what the patient came in to see you for.

Dr. Greg Livingston:

That's what they want you to fit.

Dr. Greg Livingston:

You know, you're working for them there.

Dr. Greg Livingston:

They hired you.

Dr. Greg Livingston:

So you should fix the thing that they want to have fixed, but how you fix

Dr. Greg Livingston:

it, that's, that's your job, right?

Dr. Greg Livingston:

If you decide, okay, this patient has, we can go back to this PTSD patient.

Dr. Greg Livingston:

Right?

Dr. Greg Livingston:

Okay.

Dr. Greg Livingston:

They, they, they have PTSD.

Dr. Greg Livingston:

They want to sleep through the night.

Dr. Greg Livingston:

They don't want to have night terrors anymore.

Dr. Greg Livingston:

So that you're obliged to treat that how you do it.

Dr. Greg Livingston:

Like if you decide, you need to treat that person, say, say,

Dr. Greg Livingston:

you believe their problem is because of their digestion there.

Dr. Greg Livingston:

They don't want you to treat their digestion, but to say, it's their

Dr. Greg Livingston:

digestion causing the problem.

Dr. Greg Livingston:

Well, then you explained to the patient from a Chinese medicine perspective,

Dr. Greg Livingston:

I believe your problem is coming from the digestion or whatever it is.

Dr. Greg Livingston:

And in order to get at this problem, we need to work on this.

Dr. Greg Livingston:

I will

Michael Max:

often use a kind of a metaphor to try to

Michael Max:

get them to understand that.

Michael Max:

So for example, I have certain patients, they come in and they, they,

Michael Max:

you know, ask them about their sleep.

Michael Max:

They're like, well, you know, I'm up several times a night,

Michael Max:

you get a little deeper into it while they sleep kind of lightly.

Michael Max:

And their spouse snores like a freight train.

Michael Max:

Oh, you know, maybe if the spouse snored less, you would sleep better.

Michael Max:

And in some cases that's actually the solution.

Michael Max:

Yeah.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

It can be, but students, I see, I find, and again, you know, I, I

Dr. Greg Livingston:

guess, cause I'm teaching, I maybe my impression of Chinese medicine in the

Dr. Greg Livingston:

west, it's not even fair to say maybe it's, it must be skewed because I'm

Dr. Greg Livingston:

just around students all the time.

Dr. Greg Livingston:

Right.

Dr. Greg Livingston:

So they're, they're, they're newbies, right.

Dr. Greg Livingston:

They tend to see chief complaint and then they, they try to match

Dr. Greg Livingston:

the chief complaint to some pattern.

Dr. Greg Livingston:

But it's important.

Dr. Greg Livingston:

I think to step back and re remember the chief complaint.

Dr. Greg Livingston:

Is not more important than any other sign or symptom.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

It's the thing that the patient wants you to treat, but it doesn't carry

Dr. Greg Livingston:

any more weight in your diagnosis then any other sign or symptom.

Dr. Greg Livingston:

So step back and look at the big picture, try to figure out, you know,

Dr. Greg Livingston:

what is this person's overall pattern?

Dr. Greg Livingston:

And, you know, you've got to focus on, on that.

Dr. Greg Livingston:

So, you know, the bowel movement and the urination, temperature, sweat, those

Dr. Greg Livingston:

things are as important to understand as their, you know, their chief complaint,

Dr. Greg Livingston:

all those things carry equal weight.

Dr. Greg Livingston:

Well, it helps us

Michael Max:

understand

Michael Max:

Dr. Greg Livingston: their chief complaint.

Michael Max:

That's exactly right.

Michael Max:

So that's what gets you to the diagnosis?

Michael Max:

Not like, oh, they have hypertension.

Michael Max:

Therefore that must be liver.

Michael Max:

Young, rising hypertension is just one sign, right.

Michael Max:

That you can use.

Michael Max:

So you need to look at all those different.

Michael Max:

Again, just from what we talked about, the very beginning of this conversation,

Michael Max:

blood stagnation, I feel it's not something that I'm obsessed with.

Michael Max:

I think it's just something that other people overlook and therefore

Michael Max:

it makes me look like I'm obsessed because I can identify it very easily.

Michael Max:

And I just see it in a lot of people.

Michael Max:

That doesn't mean that I'm obsessed with it.

Michael Max:

It just means I'm good at identifying it.

Michael Max:

And maybe other people are not

Michael Max:

time for

Michael Max:

a little break here.

Michael Max:

I don't want to share with you some brilliance that I gleaned from Sabine.

Michael Max:

Wilms' new book humming with elephants.

Michael Max:

It's chapter five from the PSU end.

Michael Max:

And it's about the resonant manifestations, a yin

Michael Max:

and yang in the book.

Michael Max:

She points out that while in modern Chinese, the two characters BNY mean

Michael Max:

change in a sort of generic way.

Michael Max:

Each of the characters separately.

Michael Max:

Speaks to a different kind of change.

Michael Max:

Again is more of a step-by-step incremental change.

Michael Max:

Whereas Y is a transformation that profoundly and

Michael Max:

irreversibly changes something.

Michael Max:

So for example, a rainstorm would be a BN type change while the

Michael Max:

typhoon that blows your house down.

Michael Max:

That's why slowly Stephanie arthritic joints that's BN I cancer diagnosis.

Michael Max:

Well, now you're looking at why it's helpful to keep these distinctions in

Michael Max:

mind as your patients might be in the midst of a hot type change, but they

Michael Max:

were really hoping for a more of a PN.

Michael Max:

Likewise, they might not want to step-by-step incremental nature

Michael Max:

of a BNY type change when the transformative Hua is what they're after.

Michael Max:

So the next time a patient comes in looking for I'm using quotes here, change.

Michael Max:

See if you can differentiate what kind they're looking for.

Michael Max:

Is it PN or is it.

Michael Max:

You know, I created qiological as I think the practice of medicine

Michael Max:

requires us to constantly study and change our perspectives.

Michael Max:

I've created a Patrion page, so you can contribute to this endeavor by

Michael Max:

becoming a contributing subscriber.

Michael Max:

In addition to feeling the satisfaction of knowing that you're helping to

Michael Max:

support a podcast that you love.

Michael Max:

There are a few special goodies available for contributing

Michael Max:

subscribers to the podcast.

Michael Max:

For those details, head over to qiological.com and click on the

Michael Max:

Patrion page button to help keep a little inspiration in the.

Michael Max:

Thanks for your consideration.

Michael Max:

And now let's get into the second half of this show.

Michael Max:

So, I mean, we talked about pigment on the skin that, you know, what's,

Michael Max:

the skin looks like the dryness, the luster, of course we have tongue

Michael Max:

and pulse, that kind of thing.

Michael Max:

I mean, have you got any other kinds of, uh, secret blood stagnation signs

Michael Max:

or, or things that maybe we'd over, some people might overlook that you

Michael Max:

just, you just know how to tune into it's like, oh yeah, that's blood stasis.

Dr. Greg Livingston:

None of this stuff is secret.

Dr. Greg Livingston:

I think it's just stuff that maybe people haven't learned

Dr. Greg Livingston:

or they forgot or something.

Dr. Greg Livingston:

But like I said, the first thing is a visual inspection because

Dr. Greg Livingston:

often that will give it away, but then the pulse, but post-diagnosis

Dr. Greg Livingston:

is of course a little trickier.

Dr. Greg Livingston:

But I think ultimately when you're thinking about pulse and actually

Dr. Greg Livingston:

everything in Chinese medicine, even everything in the universe,

Dr. Greg Livingston:

we can boil down to either.

Dr. Greg Livingston:

Everything boils down to India and same with the pulse.

Dr. Greg Livingston:

So when you think about the pulse, if the pulse is eating and what is the impulse?

Dr. Greg Livingston:

Well, deep is Ian versus floating as a young, thin pulses in wide pulses.

Dr. Greg Livingston:

Young rabbit poles is young, slow pulse is in like that.

Dr. Greg Livingston:

We just think about the pulse, just break it down to young like that.

Dr. Greg Livingston:

And if you think about it, any, any of us can do that.

Dr. Greg Livingston:

Anyone who's studied Chinese medicine, it's super simple.

Dr. Greg Livingston:

Right?

Dr. Greg Livingston:

So then you think about, okay, if you have an EAN Paul's well, then

Dr. Greg Livingston:

there's IIN phenomena in the body.

Dr. Greg Livingston:

And if you have a young pulse, there's some young phenomenon

Dr. Greg Livingston:

occurring in the body.

Dr. Greg Livingston:

Right.

Dr. Greg Livingston:

Okay.

Dr. Greg Livingston:

Then what is blood stagnation?

Dr. Greg Livingston:

Well, blood belongs to IIN.

Dr. Greg Livingston:

Blood stagnation is dead blood.

Dr. Greg Livingston:

So that must be even more in than regular blood.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

Let's stay nation is, is impacting.

Dr. Greg Livingston:

Just like phlegm.

Dr. Greg Livingston:

Damp is also Ian pathogen, right?

Dr. Greg Livingston:

Let's stagnation is in pathogen.

Dr. Greg Livingston:

So it makes the post in.

Dr. Greg Livingston:

It makes the pulse deep.

Dr. Greg Livingston:

It makes the pulse thin, but blood stagnation is an excess.

Dr. Greg Livingston:

Excess is young deficiencies, right?

Dr. Greg Livingston:

So let's stagnation poles is often thin and deep, but forceful

Dr. Greg Livingston:

because it's, Yangming the main thing to differentiate excess and

Dr. Greg Livingston:

deficiency on the pulse is strength.

Dr. Greg Livingston:

That's the main thing.

Dr. Greg Livingston:

You can have a thin pulse, thin POLST and wide polls do not

Dr. Greg Livingston:

represent excess and deficiency.

Dr. Greg Livingston:

I think people forget that they think, oh, thin that must be

Dr. Greg Livingston:

more on the deficiency side.

Dr. Greg Livingston:

Why that must be more on the excess side, but remember Shuma deficiency

Dr. Greg Livingston:

Paul's the actual deficiency poles is floating and wide.

Dr. Greg Livingston:

You could even have

Michael Max:

a deep, thin,

Dr. Greg Livingston:

tight pulse.

Dr. Greg Livingston:

Yeah, deep, thin and forceful deep, thin type.

Dr. Greg Livingston:

Also typically like excess cold.

Dr. Greg Livingston:

So deep thin with a little bit of force and it is typical blood stagnation pulse.

Dr. Greg Livingston:

So for example, the left one, because liver stores the blood, we often can feel

Dr. Greg Livingston:

blood stagnation in the left glide, right?

Dr. Greg Livingston:

Liver blood stagnation will typically show up as a deep thin, but forceful pulse.

Dr. Greg Livingston:

Remember when there's stagnation, you often get heat from constraint.

Dr. Greg Livingston:

That's another thing I'm, it's probably fair to say that I'm obsessed with

Dr. Greg Livingston:

this constraint, heat constraint, heat,

Michael Max:

heat, secondary to constraint.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

That's a big deal.

Dr. Greg Livingston:

And I think most people don't really understand that very well, that they

Dr. Greg Livingston:

don't understand how to treat it very well because it's different.

Dr. Greg Livingston:

Treating heat from constraint is different than treating some other types of heat.

Michael Max:

Can you give us an example of that one?

Michael Max:

It's a great example.

Michael Max:

I think it's something that we.

Michael Max:

Run into, on a regular basis.

Michael Max:

It's why is prescribed by so many practitioners,

Dr. Greg Livingston:

well, heat from constraint.

Dr. Greg Livingston:

There's a thing in Chinese as a whole, you thought, well, if you had to means

Dr. Greg Livingston:

fire constrained, then disperse it.

Dr. Greg Livingston:

So constrained heat, you need to disperse.

Dr. Greg Livingston:

You don't use cold, bitter, downward, draining cold and bitter things.

Dr. Greg Livingston:

They have an inward movement.

Dr. Greg Livingston:

They cause constraint.

Dr. Greg Livingston:

Actually, they tend to actually cause contraction in the body.

Dr. Greg Livingston:

So whole you fads a means for fall is a young treatment method,

Dr. Greg Livingston:

accurate warm herbs, young type herbs to disperse constraint.

Dr. Greg Livingston:

When you disperse the constraint, then the heat naturally goes away.

Dr. Greg Livingston:

Now, the reason has in it is you want to mop there's heat there.

Dr. Greg Livingston:

So you need to mop up the.

Dr. Greg Livingston:

It's not like there's no heat.

Dr. Greg Livingston:

So you don't, you can't put any, you can only use warm disbursing herbs.

Dr. Greg Livingston:

No, you use moving herbs on the accurate side.

Dr. Greg Livingston:

Some of them can be warm.

Dr. Greg Livingston:

That's fine.

Dr. Greg Livingston:

They're generally not hot herbs, but sometimes they are.

Dr. Greg Livingston:

But then you put a little bit of some cold herbs in there that mop up the heat

Dr. Greg Livingston:

because you do need to mop up the heat, but it's not a predominance of cold

Dr. Greg Livingston:

herbs when there's constrained heat.

Dr. Greg Livingston:

Otherwise you will get rid of the heat because you're using cold herbs.

Dr. Greg Livingston:

The heat will go away, but you're going to make more stagnation.

Dr. Greg Livingston:

And then ultimately there will be more heat.

Dr. Greg Livingston:

When the person stops taking the medication, then the heat is going

Dr. Greg Livingston:

to come back with a vengeance and you'll make more stagnation.

Dr. Greg Livingston:

You're actually going to you.

Dr. Greg Livingston:

You can actually plant the seed of someone's tumor doing that.

Dr. Greg Livingston:

You know, if Chinese medicine can dissolve tumors, if seen it,

Dr. Greg Livingston:

you can dissolve people's tumors.

Dr. Greg Livingston:

You don't think you can make people's tumors.

Dr. Greg Livingston:

Oh yeah.

Dr. Greg Livingston:

You absolutely.

Dr. Greg Livingston:

Can't you may not realize it.

Dr. Greg Livingston:

The patient may not realize it because it's happens 10, 20, 30

Dr. Greg Livingston:

years later, but you can very easily plant the seed of someone's

Dr. Greg Livingston:

malignant tumor by wrong treatment.

Dr. Greg Livingston:

The patient will never come back and say, oh, Greg gave me this, you know, tumor.

Dr. Greg Livingston:

They'll never connect those two things together.

Dr. Greg Livingston:

And most doctors also won't connect it and you can't 100%

Dr. Greg Livingston:

connect those things anyway.

Dr. Greg Livingston:

Right.

Dr. Greg Livingston:

There's too many variables you can't say, oh yeah, this mistaken formula causes

Dr. Greg Livingston:

person's tumor, but you absolutely could.

Dr. Greg Livingston:

So that's, that's another huge topic, heat from constraint and how to treat that.

Dr. Greg Livingston:

But, well, and also it just

Michael Max:

gets into the thing of how we know that we're doing no harm.

Dr. Greg Livingston:

Oh yeah.

Dr. Greg Livingston:

That's, that's a tricky one.

Dr. Greg Livingston:

It

Michael Max:

is a tricky one because people are looking for help.

Michael Max:

We're looking to help with the best that we know.

Dr. Greg Livingston:

You know, when I look back at some of the stuff I did early

Dr. Greg Livingston:

on in my practice, it's far from ideal.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

I, I do not envy the patients that I treated when I was, uh, you

Dr. Greg Livingston:

know, younger practitioners, uh, definitely made a lot of mistakes.

Dr. Greg Livingston:

I still make mistakes, but just less and less, the mistakes are less, less severe.

Dr. Greg Livingston:

Now that mistakes are inevitable.

Dr. Greg Livingston:

I emphasize this to my students all the time.

Dr. Greg Livingston:

It's like, if you think you're good, think that you're right.

Dr. Greg Livingston:

Most of the time you need to take a step back and, and have a look at yourself

Dr. Greg Livingston:

because it's very easy to be wrong.

Dr. Greg Livingston:

It's actually very difficult to be.

Dr. Greg Livingston:

Right.

Dr. Greg Livingston:

Right.

Dr. Greg Livingston:

Diagnosis is really difficult to be wrong.

Dr. Greg Livingston:

It's super easy.

Dr. Greg Livingston:

The odds are completely stacked against you being right.

Dr. Greg Livingston:

So always be second guessing yourself, always realize you can do better.

Dr. Greg Livingston:

Even you get good results with a patient, you almost sure could have done better.

Dr. Greg Livingston:

How

Michael Max:

long have you been practicing now?

Dr. Greg Livingston:

How long have you been here?

Dr. Greg Livingston:

20 years.

Dr. Greg Livingston:

A little over 20 years.

Dr. Greg Livingston:

And then, you know, in China saw a lot of patients.

Dr. Greg Livingston:

That's, that's the main thing is this.

Dr. Greg Livingston:

I got to see it because I was licensed in China and I practiced there

Dr. Greg Livingston:

as well as followed my teachers.

Dr. Greg Livingston:

So I saw thousands of patients and then I followed a lot of good teachers.

Dr. Greg Livingston:

So they, I didn't make any of this up.

Dr. Greg Livingston:

You know, I don't take credit for any, anything that I know

Dr. Greg Livingston:

or do in Chinese medicine.

Dr. Greg Livingston:

I didn't make any of it up.

Dr. Greg Livingston:

I just learned what other people do and copied them.

Dr. Greg Livingston:

Well, this is, this

Michael Max:

is how we learn.

Michael Max:

Right.

Michael Max:

And then at some point something comes through that.

Michael Max:

That probably is ours

Dr. Greg Livingston:

maybe, but, but it's,

Dr. Greg Livingston:

it's

Michael Max:

a process of refinement.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

I don't really consider that.

Dr. Greg Livingston:

I made anything up.

Dr. Greg Livingston:

I just, you know, even like the formulas, I tend to not make up my own formulas.

Dr. Greg Livingston:

I tend to use old formulas.

Dr. Greg Livingston:

And I mean, I, I kind of default towards the Jean falling approach,

Dr. Greg Livingston:

the classical formula approach John's own gene because I find that super

Dr. Greg Livingston:

effective, but I'm not dogmatic at all.

Dr. Greg Livingston:

Or, you know, I'm, I'm kind of eclectic.

Dr. Greg Livingston:

So I'll use launching runs formulas and I'll use John J

Dr. Greg Livingston:

beans formulas and I'll use yeah.

Dr. Greg Livingston:

Modern stuff.

Dr. Greg Livingston:

all that stuff.

Dr. Greg Livingston:

I'd use anything.

Dr. Greg Livingston:

I learned a bunch of stuff reading.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

Does Shane's book, right?

Dr. Greg Livingston:

Like I learned how to use bugs, a lot of bugs actually, by reading about.

Dr. Greg Livingston:

His stuff like how do you, how to use bugs is a big

Michael Max:

thing

Dr. Greg Livingston:

for blood Stacey's that's a huge one.

Dr. Greg Livingston:

All right.

Dr. Greg Livingston:

In a moment,

Michael Max:

I want to come back and talk to you about clinical mistakes.

Michael Max:

Cause there's some gold to mine in that.

Michael Max:

And I just have some personal questions.

Michael Max:

So we're going to come back to that, but first.

Dr. Greg Livingston:

Oh yeah.

Dr. Greg Livingston:

Well, there's a thing in Chinese SRE, yo yo Ching shadow shadow means literally

Dr. Greg Livingston:

means blood and flesh, blood and meat.

Dr. Greg Livingston:

That means animal products Yotes seeing means has an affinity.

Dr. Greg Livingston:

Literally blood and flesh has an affinity.

Dr. Greg Livingston:

So animal products have an affinity for the body.

Dr. Greg Livingston:

Animal products have an affinity for the human body because it's

Dr. Greg Livingston:

closer to us than plant and mineral.

Michael Max:

So that's why we eat meat to tonify.

Dr. Greg Livingston:

That's one of the reasons I would say, but from an

Dr. Greg Livingston:

herbal perspective, what, what does that mean should reel your chin?

Dr. Greg Livingston:

It means that the animal products they're eating, first of all, they're

Dr. Greg Livingston:

easily assimilated by the body.

Dr. Greg Livingston:

That's the first thing.

Dr. Greg Livingston:

And the second thing is they go deep into the body.

Dr. Greg Livingston:

They go into the deep space where those plants and mineral

Dr. Greg Livingston:

substances can't easily get.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

10 should have talked about this, a fair amount about the law.

Dr. Greg Livingston:

My right.

Dr. Greg Livingston:

Here's the thing.

Dr. Greg Livingston:

Joel being drew law, Joe being law means all disease goes to the law, the law am

Dr. Greg Livingston:

I being the small vessels and what we're talking about, blood circulation and blood

Dr. Greg Livingston:

stagnation and blood stagnation tending to be a chronic problem, a GL being

Dr. Greg Livingston:

an old disease, it ends up in the law.

Dr. Greg Livingston:

Let's stand nation ends up going and settling in the loop.

Dr. Greg Livingston:

That's one of the reasons that it's so stubborn,

Michael Max:

it's in the law.

Michael Max:

It's these tiny little vessels.

Michael Max:

Yeah.

Michael Max:

And sometimes there's Fleming there as well.

Michael Max:

That makes it even more interesting.

Dr. Greg Livingston:

Absolutely.

Dr. Greg Livingston:

Cause blood stagnation and phlegm.

Dr. Greg Livingston:

There's another thing we say, Todd, you told you that TaiYin is flat.

Dr. Greg Livingston:

You blood stagnation, tome, you and means same origin, which just means

Dr. Greg Livingston:

not that not necessarily that they come from the same place, but that

Dr. Greg Livingston:

they're, they're related to each other.

Dr. Greg Livingston:

They transform into each other.

Dr. Greg Livingston:

When there's blood stagnation, there's almost always stagnant fluids.

Dr. Greg Livingston:

And when the fluids stagnate, there's almost always stagnant blood.

Dr. Greg Livingston:

So because of that, blood stagnation becomes really stubborn problem.

Dr. Greg Livingston:

Very hard to get rid of, even to the point where you're not going to be

Dr. Greg Livingston:

able to get rid of it and all the patients, that's why people are more.

Dr. Greg Livingston:

If, if, you know, if Chinese medicine could cure all these things, right.

Dr. Greg Livingston:

Get rid of all blood stagnation, you could, tonify the kidney

Dr. Greg Livingston:

endlessly, then you're immortal, but clearly that's not happening.

Dr. Greg Livingston:

Or at least I'd haven't met any immortals yet.

Dr. Greg Livingston:

So that I know of.

Dr. Greg Livingston:

So you can't get rid of all the blood stagnation, but you

Dr. Greg Livingston:

can get rid of some of it.

Dr. Greg Livingston:

You can extend people's life by getting rid of their blood stagnation by

Dr. Greg Livingston:

tonifying their kidney and all that.

Dr. Greg Livingston:

And you can help with their PTSD.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

Improve their quality of life.

Dr. Greg Livingston:

And it literally, you can extend longevity, but proper

Dr. Greg Livingston:

Chinese medicine treatment.

Dr. Greg Livingston:

That's sure

Michael Max:

there's a friend.

Michael Max:

I have some conversations with in Taiwan and he's into various Dallas practices

Michael Max:

and martial arts and, and, and we've had some discussions around what it means to

Michael Max:

be a mortal from the Chinese philosophical and talus perspectives and all that.

Michael Max:

He has a really interesting take.

Michael Max:

His take is not that you live for.

Michael Max:

His take is that you completely and fully live your lotta days.

Michael Max:

And if we can do things that help people to live their fully allotted days, that's

Michael Max:

an aspect of being immortal, right?

Michael Max:

I mean, if they're not able to completely live their full days,

Michael Max:

like this woman with PTSD, right?

Michael Max:

You take some of that away.

Michael Max:

They, they get to live more fully.

Michael Max:

I suspect this is why there are some herbs and you know,

Michael Max:

there you eat a bunch of this.

Michael Max:

You become a mortal it's, it's not that you live forever.

Michael Max:

It's that you live more fully and better what you have.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

Well, we're definitely capable of helping people with that.

Dr. Greg Livingston:

Chinese medicines well suited.

Dr. Greg Livingston:

It's amazing how, how good it is at accomplishing that.

Dr. Greg Livingston:

So

Michael Max:

let's finish up with the bugs here and then I want to get into mistakes.

Dr. Greg Livingston:

So anyway, the bugs go to the.

Dr. Greg Livingston:

That's the thing.

Dr. Greg Livingston:

They Ching idea that they have an affinity for the body.

Dr. Greg Livingston:

They go deep into the body.

Dr. Greg Livingston:

They go to the law of Maya.

Dr. Greg Livingston:

So they're used typically as guiding herbs, you don't

Dr. Greg Livingston:

necessarily need huge doses of them.

Dr. Greg Livingston:

People are scared to use those things because when you read about them in the

Dr. Greg Livingston:

book, they're usually they push yeah.

Dr. Greg Livingston:

They break the blood and they, it makes it sound like they're the

Dr. Greg Livingston:

strongest blood moving herbs out there.

Dr. Greg Livingston:

And they're dangerous.

Dr. Greg Livingston:

They're going to make you bleed.

Dr. Greg Livingston:

It's like taking warfarin or something like that.

Dr. Greg Livingston:

It's absolutely not the case.

Dr. Greg Livingston:

They're not actually stronger than other herbs.

Dr. Greg Livingston:

They just go deeper and work on that old stubborn blood

Dr. Greg Livingston:

stagnation, actually sun lung hoods.

Dr. Greg Livingston:

As an example, I would say are more damaging to the blood, which is stronger

Dr. Greg Livingston:

to move the blood than a lot of the bugs.

Dr. Greg Livingston:

That lot more than leach, more than to be at home.

Dr. Greg Livingston:

More than D long, which those are kind of the big, well, amongst home, of

Dr. Greg Livingston:

course, which is hard to get anyway.

Dr. Greg Livingston:

But, uh, I think most people are kind of scared to use, switch, right?

Dr. Greg Livingston:

The leech and to be at song the cockroach probably cause they're,

Dr. Greg Livingston:

they're, they're, they're stinky and they're kind of gross, but

Michael Max:

patients freak out when they see bugs in their

Dr. Greg Livingston:

formula, they do, but you can explain to them.

Dr. Greg Livingston:

And I mean, my patients, they're fine with it.

Dr. Greg Livingston:

Most of them, I rarely had anybody object to that.

Dr. Greg Livingston:

Um, I'm going to have had some, but mostly not.

Dr. Greg Livingston:

But anyway, again, it's not that they're so strong.

Dr. Greg Livingston:

It's just that they go to the law, my, and they get at the old blood stagnation

Dr. Greg Livingston:

and you don't even need to dose them high.

Dr. Greg Livingston:

You, you use them as guiding herbs to help direct the formula and bring

Dr. Greg Livingston:

the other parts of the formula to that space in the body where that

Dr. Greg Livingston:

old blood stagnation is hanging.

Dr. Greg Livingston:

And so you use them that way.

Dr. Greg Livingston:

Like is a perfect example of that, which is the formula.

Dr. Greg Livingston:

Most people don't know of.

Dr. Greg Livingston:

Docklands is Hawaiian and Dawn's is Hawaiian is from Jinga Yala.

Dr. Greg Livingston:

And it's from interestingly, actually very interestingly is from the Shula chapter of

Dr. Greg Livingston:

Shula was the deficiency taxation, right.

Dr. Greg Livingston:

That's extreme.

Dr. Greg Livingston:

And in fact, if you read the line for Docklands is Hawaiian it's, um, Shula,

Dr. Greg Livingston:

G law G Lao means extreme taxation.

Dr. Greg Livingston:

And then it gives a bunch of signs and symptoms for that, which include like jot

Dr. Greg Livingston:

the rough, scaly skin and a dark circles around the eyes is one of the symptoms.

Dr. Greg Livingston:

But anyway, it's extreme deficiency, taxation where this person overdid,

Dr. Greg Livingston:

it made their body extremely weak.

Dr. Greg Livingston:

And now they have this old blood stagnation.

Dr. Greg Livingston:

And when you look at the formula, it's got, of course Dajuan,

Dr. Greg Livingston:

cause it's called it's all one.

Dr. Greg Livingston:

So this home is to be at home.

Dr. Greg Livingston:

It's got swayed, drew the leech tall, Jen it's, it's like a, it looks like a

Dr. Greg Livingston:

really heavy blood stagnation formula.

Dr. Greg Livingston:

Like you you'd be scared to give that to people if you're, if you're scared of

Dr. Greg Livingston:

blood stagnation, herbs to begin with.

Dr. Greg Livingston:

I think a lot of people are.

Dr. Greg Livingston:

So when you look at that farmer, they're like, oh my God, that's that formula.

Dr. Greg Livingston:

Is so strong, where are you going to find a place to use it?

Dr. Greg Livingston:

And then the place to use it is in some person who's incredibly weak

Dr. Greg Livingston:

and debilitated deficient at first glance, it doesn't make a lot of sense.

Dr. Greg Livingston:

But then when you think about it, what's happened, there is this

Dr. Greg Livingston:

patient for whatever reason has developed old and very stubborn blood

Dr. Greg Livingston:

stagnation throughout their body.

Dr. Greg Livingston:

That's impairing obviously circulation of normal, healthy

Dr. Greg Livingston:

ch he blood and body fluids.

Dr. Greg Livingston:

And then all the tissues become malnourished.

Dr. Greg Livingston:

And they can't recover from this situation because their circulation is so poor

Dr. Greg Livingston:

that their organ function and all their tissue function just starts to decline.

Dr. Greg Livingston:

And so that kind of patient, you can't tonify them cause

Dr. Greg Livingston:

they can't accept tonification

Michael Max:

right.

Michael Max:

In fact, if you give them tonics, you'll make it work.

Michael Max:

You only increase the stagnation

Dr. Greg Livingston:

right there.

Dr. Greg Livingston:

You absolutely make it worse.

Dr. Greg Livingston:

So then the F the formula is Don's, it's a line which very notably

Dr. Greg Livingston:

important to note is it's a wine, it's a pill, it's a honey pill.

Dr. Greg Livingston:

So those herbs are ground into powder, mixed with honey and

Dr. Greg Livingston:

taken that a fairly light dose.

Dr. Greg Livingston:

The honey moderates, the harsh nature of the herbs, and

Dr. Greg Livingston:

it's taken out a small dose.

Dr. Greg Livingston:

So you just little by little whittle away at that old blood stagnation.

Dr. Greg Livingston:

And then you can bring the new blood to the tissues.

Dr. Greg Livingston:

And then the, the tissue organ function starts to recover.

Dr. Greg Livingston:

And then at a certain point, when, once you've resolved some of that stubborn

Dr. Greg Livingston:

stagnation, you could start to add some tonic herbs to a patient like

Dr. Greg Livingston:

that, but that's really instructive.

Dr. Greg Livingston:

You know, that that shows you that those herbs they're not damaging the body

Dr. Greg Livingston:

unless you use them inappropriately.

Dr. Greg Livingston:

Of course, like if someone has a lot of blood stagnation, you might think,

Dr. Greg Livingston:

and they're really debilitated like that, you might think, oh, moving

Dr. Greg Livingston:

the blood more is going to damage the blood more damage the body more.

Dr. Greg Livingston:

But those people there's, you can't do anything until you get their blood moving.

Dr. Greg Livingston:

Right.

Dr. Greg Livingston:

So we're

Michael Max:

really back here to something we talked about earlier in the show,

Michael Max:

really main point of yours, which is understand the path home mechanism.

Michael Max:

When you understand what you're looking at, it makes it

Michael Max:

a lot easier to go, oh yeah.

Michael Max:

This formula here.

Michael Max:

And here's why it works.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

Absolutely.

Dr. Greg Livingston:

Patho mechanism is the key in my mind to be a good clinic.

Dr. Greg Livingston:

Because in order to be a good diagnostician, you have to

Dr. Greg Livingston:

understand patho mechanisms.

Dr. Greg Livingston:

You have to analyze you.

Dr. Greg Livingston:

For example, you could just memorize all the signs and symptoms associated

Dr. Greg Livingston:

with Docklands it's online.

Dr. Greg Livingston:

And then when you, you see all that stuff, you're like, oh,

Dr. Greg Livingston:

just apply Docklands as someone.

Dr. Greg Livingston:

But it's much better to not only have that memorized, but

Dr. Greg Livingston:

know why those things appear,

Michael Max:

because you could take someone with Shula that didn't

Michael Max:

match that pattern, give them

Dr. Greg Livingston:

song one, right.

Dr. Greg Livingston:

And kill them.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

Absolutely.

Dr. Greg Livingston:

No, you can, you can definitely shave time off people's life.

Dr. Greg Livingston:

If you can add days, you can very easily shave some off.

Dr. Greg Livingston:

I think

Michael Max:

that's really important to remember, you know, so often we think,

Michael Max:

well, we didn't really help them, but we prepped, but we probably didn't hurt them.

Michael Max:

And that's, I think that's.

Michael Max:

Yeah, I think you're right.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

You don't know.

Dr. Greg Livingston:

You may have only shaved an hour off that person's life.

Dr. Greg Livingston:

Well, the outright

Michael Max:

they wasted with you.

Michael Max:

I want to come back to mistakes for a moment because anyone that's

Michael Max:

been in practice for 20 years, um, we've made a lot of mistakes.

Michael Max:

I heard it the first week of school, when I first went to acupuncture school,

Michael Max:

there were some teachers that came in and they told us about cases that, that

Michael Max:

they did that totally went off the rails.

Michael Max:

Right?

Michael Max:

I think all of our teachers, we, we hear these great stories.

Michael Max:

I thought it was this.

Michael Max:

I gave him that this thing happened.

Michael Max:

Wheels came off the bus.

Michael Max:

I realized it wasn't sheet efficiency.

Michael Max:

It was blood stagnation.

Michael Max:

Give them this other formula, you know, they get better.

Michael Max:

And we love these stories, right?

Michael Max:

It's like, that's so cool.

Michael Max:

We love these stories, but here's the thing.

Michael Max:

When it's us, who's in the middle of treating someone.

Michael Max:

And we think we know what we're doing and we get very unexpected

Michael Max:

and, you know, frankly, bad results.

Michael Max:

It really is one of those moments where it's like, oh great.

Michael Max:

I get to learn something now, but rarely do we go to, oh, cool.

Michael Max:

I get to learn something.

Michael Max:

It's more like, oh shit.

Michael Max:

Now what?

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

I mean, especially serious case.

Dr. Greg Livingston:

Any advice

Michael Max:

for us on when we come up to that moment of, oh, wrong,

Michael Max:

how do you sort of keep it together?

Michael Max:

Mind, thought emotions, take all of this and move it into something

Michael Max:

that can be helpful for the patient and help for you to learn something.

Michael Max:

Yeah.

Dr. Greg Livingston:

Well, I think the first thing to remember is that

Dr. Greg Livingston:

you're always going to make mistakes.

Dr. Greg Livingston:

Medicine is really complicated.

Dr. Greg Livingston:

And so it's par for the course.

Dr. Greg Livingston:

So you need to cut yourself some slack.

Dr. Greg Livingston:

First of all.

Dr. Greg Livingston:

I saw my teachers, some teachers with 50 years experience and

Dr. Greg Livingston:

50 years of experience in China is not like 50 years here.

Dr. Greg Livingston:

50 years experienced there.

Dr. Greg Livingston:

It would be like a thousand years here.

Dr. Greg Livingston:

I mean, some of these doctors see a hundred patients a day, five, six days

Dr. Greg Livingston:

a week, and they hardly take holidays.

Dr. Greg Livingston:

So they're just, they see hundreds of thousands of patients in their career.

Dr. Greg Livingston:

If those doctors make mistakes and they definitely do, I've seen it, then

Dr. Greg Livingston:

it's perfectly normal that us lesser practitioners will make mistakes.

Dr. Greg Livingston:

So first of all, don't beat yourself up too much about it, but

Dr. Greg Livingston:

hold yourself to a high standard.

Dr. Greg Livingston:

I hold myself to a really high standard.

Dr. Greg Livingston:

So I'm constantly thinking, how can I do better?

Dr. Greg Livingston:

And even like I said, when I, when results are, are quote unquote, good.

Dr. Greg Livingston:

I still believe that I could have done better.

Dr. Greg Livingston:

Maybe I'm not capable of doing better, but there is something better.

Dr. Greg Livingston:

Sure.

Dr. Greg Livingston:

Just whether or not you can achieve that.

Dr. Greg Livingston:

But anyway, when you actually make an obvious error and people

Dr. Greg Livingston:

are getting worse, well, then you just, you need to step back.

Dr. Greg Livingston:

First of all, you need to be, you need to admit it like you, I see this a lot

Dr. Greg Livingston:

where people, and it's not just Chinese medicine practitioners, it's in the,

Dr. Greg Livingston:

in the alternative medicine fields.

Dr. Greg Livingston:

I would say, I don't know that MDs are saying this, but a lot of alternative

Dr. Greg Livingston:

medicine practitioners chalk up those kinds of things to healing crisis.

Dr. Greg Livingston:

And there is such a thing as a healing crisis, but not every patient.

Dr. Greg Livingston:

Uh, having adverse symptoms is a healing crisis.

Dr. Greg Livingston:

How do you

Michael Max:

differentiate a healing crisis from bad treatment?

Dr. Greg Livingston:

That's a really important question.

Dr. Greg Livingston:

So healing crisis, my theory about what a healing crisis is, I think it's first

Dr. Greg Livingston:

important to understand what that is, is that oftentimes patients have, they

Dr. Greg Livingston:

have a lot of excesses in their body, phlegm, blood stagnation, heat, whatever.

Dr. Greg Livingston:

And when you start to move those things around, dislodge them and

Dr. Greg Livingston:

you need to dislodge those things and purge them from the body,

Michael Max:

right?

Michael Max:

You got to

Dr. Greg Livingston:

metabolize it out.

Dr. Greg Livingston:

You have to first dislodge it and then get it to leave your body.

Dr. Greg Livingston:

But in that process, those things will circulate around

Dr. Greg Livingston:

the body and make people sick.

Dr. Greg Livingston:

From a Western perspective, there's a lot of metabolic waste toxins.

Dr. Greg Livingston:

For example, when people have blood stagnation, Well, since we're talking

Dr. Greg Livingston:

about it, when the blood stagnates, the blood is at once the delivery,

Dr. Greg Livingston:

people bringing oxygen, nutrients, more fluids, and all that to the

Dr. Greg Livingston:

tissues, it's also the garbage people taking away all the metabolic waste.

Dr. Greg Livingston:

So it delivers the good stuff.

Dr. Greg Livingston:

It takes away all the junk.

Dr. Greg Livingston:

If the blood stagnates, then all that junk starts to collect there.

Dr. Greg Livingston:

It's like the garbage man doesn't come around.

Dr. Greg Livingston:

So you have all this garbage collecting in your tissues.

Dr. Greg Livingston:

That's the stuff that's making you sick aside from the fact that not enough oxygen

Dr. Greg Livingston:

and nutrients are getting to your tissues.

Dr. Greg Livingston:

So there's starved, but there's also all this waste buildup.

Dr. Greg Livingston:

That's making things go haywire as well.

Dr. Greg Livingston:

So when you dislodge that stuff, it starts to circulate around the body.

Dr. Greg Livingston:

And if it doesn't leave quickly enough, or there's just a large amount of it,

Dr. Greg Livingston:

You'll have some symptoms from that.

Dr. Greg Livingston:

That's the healing crisis.

Dr. Greg Livingston:

That's what I think healing crisis is.

Dr. Greg Livingston:

You can minimize healing crises by promoting the rapid

Dr. Greg Livingston:

elimination of those waste toxins.

Dr. Greg Livingston:

When you go to do those kinds of things, to move those just lodge and

Dr. Greg Livingston:

move those things around, you gotta be sure to open the windows and doors.

Dr. Greg Livingston:

It's like when you're cleaning your house, you have to say that

Dr. Greg Livingston:

some carpet in your house, right.

Dr. Greg Livingston:

Or a rug, a rug in your house that's, you know, gets a lot

Dr. Greg Livingston:

of dirt and stuff accumulate.

Dr. Greg Livingston:

You don't pick the rug up and start beating it until all the

Dr. Greg Livingston:

windows and doors are open.

Dr. Greg Livingston:

If you beat the rug in the house with the windows and doors shut, now

Dr. Greg Livingston:

the dust is just stirring around.

Dr. Greg Livingston:

It's going to settle somewhere else.

Dr. Greg Livingston:

Right?

Dr. Greg Livingston:

So

Michael Max:

you want to make sure your patients are pooping before

Michael Max:

you start moving too much blood.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

You gotta make sure all that stuff's coming up.

Dr. Greg Livingston:

You know, like I love to use dot child Hutong for that exact reason that . It

Dr. Greg Livingston:

takes care of blood stagnation.

Dr. Greg Livingston:

It's got in it.

Dr. Greg Livingston:

You can use church, you could use buy shop, but I often will use Tricia, right.

Dr. Greg Livingston:

Because

Michael Max:

for the blood stagnation guy.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

And then promote the liver detoxification pathways, right?

Dr. Greg Livingston:

So you're, you're using to help clean the bodies is pretty amazing.

Dr. Greg Livingston:

But anyway, healing crisis, you can minimize by promoting rapid

Dr. Greg Livingston:

elimination of those waste toxins.

Dr. Greg Livingston:

So a lot of people though, they, they do wrong treatment.

Dr. Greg Livingston:

And because for whatever reason, maybe they're, they're scared to admit

Dr. Greg Livingston:

that they make mistakes or they just think that they can't make mistakes.

Dr. Greg Livingston:

They think they're really great at, you know, being a clinician or they

Dr. Greg Livingston:

don't want to tell, admit it to the patients that they made a mistake.

Dr. Greg Livingston:

They just chalk those things up to healing crisis healing crisis.

Dr. Greg Livingston:

After the healing crisis, especially if you're good at eliminating

Dr. Greg Livingston:

those toxins from the body, the patients should feel better.

Dr. Greg Livingston:

That's one way, you know, they might feel amazing, but they might just feel a little

Dr. Greg Livingston:

bit better because you know, they might have a lot of problem going on and you

Dr. Greg Livingston:

just eliminated one little layer of it, but there should be some improvement after

Dr. Greg Livingston:

that, the tongue, the poles, the symptoms, the patients should feel a little bit.

Dr. Greg Livingston:

If they feel worse, okay, it's probably wrong treatment.

Dr. Greg Livingston:

And anyway, back to this thing about right diagnosis and wrong diagnosis, the odds

Dr. Greg Livingston:

are completely against you being right.

Dr. Greg Livingston:

So the odds of you, of it being a healing crisis versus wrong

Dr. Greg Livingston:

treatment, the odds are highly in favor of it being wrong treatment.

Dr. Greg Livingston:

So that's, I think really important to keep that in mind that it's

Dr. Greg Livingston:

easy to be wrong, but it's okay.

Dr. Greg Livingston:

Don't beat yourself up about it.

Dr. Greg Livingston:

And you can tell the patient.

Dr. Greg Livingston:

I mean, I'm super honest with my patients and I think they appreciate it.

Dr. Greg Livingston:

I'm just like, cause a lot of patients, especially around here in Portland,

Dr. Greg Livingston:

they know about healing crisis.

Dr. Greg Livingston:

They heard it before they've been to other doctors and they had the had

Dr. Greg Livingston:

symptom aggravation and the doctor's like, oh, that's a healing crisis.

Dr. Greg Livingston:

And then the patient was thinking, well, I don't know, because I don't feel better.

Dr. Greg Livingston:

So they know that they actually know the doctor is being dishonest or if not

Dr. Greg Livingston:

dishonest, then the doctors, it's not a good doctor because they don't realize it.

Dr. Greg Livingston:

So I'm just perfectly honest.

Dr. Greg Livingston:

I'm like, so that from the made you worse and that definitely happens to me.

Dr. Greg Livingston:

I make people worse all the time.

Dr. Greg Livingston:

I

Michael Max:

mean, the reason I'm asking the question, I think because all of us

Michael Max:

do of course, you know, at some point all of us do and to be able to look

Michael Max:

at it and go, oh, that made you worse.

Michael Max:

We're getting back to pathol mechanism here, made them worse.

Michael Max:

And what way.

Michael Max:

Can be a really helpful question.

Michael Max:

Oh, it went like that.

Michael Max:

Oh, well we know not to do that.

Michael Max:

And that actually tells me something else

Dr. Greg Livingston:

that helps you hone in on the proper diagnosis.

Dr. Greg Livingston:

It's an important thing to analyze carefully because it it'll help you

Dr. Greg Livingston:

get closer to the right diagnosis.

Dr. Greg Livingston:

If you, if you analyze it properly, you know, if you're honest with a

Dr. Greg Livingston:

patient, you say, look, let's see, you know, what are the signs and

Dr. Greg Livingston:

symptoms you have from these herbs?

Dr. Greg Livingston:

How did it go wrong?

Dr. Greg Livingston:

Or maybe it was a healing crisis.

Dr. Greg Livingston:

You analyze that with the patient, then you're like, okay.

Dr. Greg Livingston:

Yeah, that was a healing crisis.

Dr. Greg Livingston:

It looks like, just keep going with this formula.

Dr. Greg Livingston:

And I think you'll feel better or no, that's not a healing crisis.

Dr. Greg Livingston:

That formula definitely.

Dr. Greg Livingston:

There's something wrong with it.

Dr. Greg Livingston:

You know, stop taking it now and come in as soon as you can.

Dr. Greg Livingston:

And we'll, we'll reassess and change the formula.

Dr. Greg Livingston:

Patients really appreciate that.

Dr. Greg Livingston:

So I'm super honest with patients.

Dr. Greg Livingston:

If I make mistake, I'll just be like, that was a mistake.

Dr. Greg Livingston:

You know, this is, medicine's hard stuff.

Dr. Greg Livingston:

You just be honest with patients.

Dr. Greg Livingston:

They appreciate

Michael Max:

it, especially when you're able to say it's wrong and

Michael Max:

here's the reason why it's wrong and here's what we're going to do

Dr. Greg Livingston:

instead.

Dr. Greg Livingston:

That's the key is like to analyze, okay, what does that tell me if I gave this

Dr. Greg Livingston:

person, let's say that Shula patient, the deficiency, taxation patient.

Dr. Greg Livingston:

If I decide, oh, that patient's super weak.

Dr. Greg Livingston:

So their weakness and their taxation, that must be just due to cheat deficiency.

Dr. Greg Livingston:

And I taught a few of them and they get worse and it's like, okay, well maybe,

Dr. Greg Livingston:

maybe there is underlying deficiency there, but there's something else there.

Dr. Greg Livingston:

There's gotta be something else there.

Dr. Greg Livingston:

Otherwise my treatment would have worked so clearly you need to, you

Dr. Greg Livingston:

need to step back and reanalyze it, especially if you're treating.

Dr. Greg Livingston:

Isn't all over the place.

Dr. Greg Livingston:

And this is another thing we could talk about is when you're not

Dr. Greg Livingston:

super clear, sometimes you want to do something very unidirectional.

Dr. Greg Livingston:

You don't want a formula.

Dr. Greg Livingston:

That's all over the place.

Dr. Greg Livingston:

You do a little of this and a little of that.

Dr. Greg Livingston:

And a little of the other thing.

Dr. Greg Livingston:

Then when the patient comes back the next time, if it works, you

Dr. Greg Livingston:

don't really know why it worked.

Dr. Greg Livingston:

And if it didn't work, you don't know why it didn't work.

Dr. Greg Livingston:

So you're just back to square one.

Dr. Greg Livingston:

If you do something simple, straightforward unidirectional, then

Dr. Greg Livingston:

when the patient comes back, you can make sense of their response to it.

Dr. Greg Livingston:

You've got some data points to work with.

Dr. Greg Livingston:

Yeah, you actually have.

Dr. Greg Livingston:

Yeah, you can actually start making progress that way, as opposed

Dr. Greg Livingston:

to just starting over again.

Dr. Greg Livingston:

So analyzing those mistakes.

Dr. Greg Livingston:

It was a huge, important thing.

Dr. Greg Livingston:

And the first thing though, you gotta be able to be willing to

Dr. Greg Livingston:

admit it and not just chalk up everything to a healing crisis

Michael Max:

and be a little kind with yourself in the process.

Dr. Greg Livingston:

You cut yourself, some slack, don't beat yourself up.

Dr. Greg Livingston:

Cause everyone's making mistakes.

Dr. Greg Livingston:

You know, those 70 year old doctors they're making mistakes.

Dr. Greg Livingston:

So it's okay.

Dr. Greg Livingston:

You know, just, uh, learn from them,

Michael Max:

learn from them.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

That's the key learn

Michael Max:

from?

Michael Max:

Well, holy smokes Greg.

Michael Max:

We're out of time.

Michael Max:

I hate to say, I hate to say that we're out

Dr. Greg Livingston:

of time.

Dr. Greg Livingston:

Uh, well we can, we can talk another time.

Dr. Greg Livingston:

Let's talk another time to have another

Michael Max:

conversation.

Michael Max:

Absolutely.

Michael Max:

Any final things you'd like to leave our listeners with

Michael Max:

before we say goodbye for today,

Dr. Greg Livingston:

just got to keep studying.

Dr. Greg Livingston:

There's no end to it and stay humble.

Dr. Greg Livingston:

You got to stay humble.

Dr. Greg Livingston:

It's interesting.

Dr. Greg Livingston:

It at the college where I teach, I get students, you know, they, they

Dr. Greg Livingston:

give us feedback and I often will get the most of the students like me,

Dr. Greg Livingston:

but I there's a there's, you know, certain percentage of them that have

Dr. Greg Livingston:

called me arrogant and condescending.

Dr. Greg Livingston:

I don't know.

Dr. Greg Livingston:

Maybe I do come across that way.

Dr. Greg Livingston:

Most of the people that know me, well, wouldn't say that about me, but in the

Dr. Greg Livingston:

clinic, I certainly don't feel that way.

Dr. Greg Livingston:

I don't think I carry myself that way in the clinic.

Dr. Greg Livingston:

And I think any of the students that actually end up following me in

Dr. Greg Livingston:

the clinic, they see that I'm very willing to admit my mistakes and to

Dr. Greg Livingston:

just to stay humble, just be like, yeah, there's so much, I don't know.

Dr. Greg Livingston:

There's so much that all of us so much more for all of us to learn and yeah,

Dr. Greg Livingston:

we're going to make mistakes and.

Dr. Greg Livingston:

Don't try to bury them.

Dr. Greg Livingston:

Don't try to cover them up, do your best to face them and learn from them.

Dr. Greg Livingston:

The biggest learning experiences, most impactful learning experiences

Dr. Greg Livingston:

or from mistakes I've made.

Dr. Greg Livingston:

I've actually sent patients to the hospital before with herb formulas.

Dr. Greg Livingston:

You know, it never forget that because some patients, herb formula, and then you

Dr. Greg Livingston:

find out, you know, they had to go to the ER, that would keep you a little humble.

Dr. Greg Livingston:

Wouldn't it?

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

That's happened to me twice.

Dr. Greg Livingston:

And the most recent time was only a few years ago.

Dr. Greg Livingston:

Actually.

Dr. Greg Livingston:

That's a very interesting story, but I'd

Michael Max:

love to get that story and we'll pick, maybe we'll

Michael Max:

pick up with that next time, the time break, send someone to the

Dr. Greg Livingston:

hospital.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

But I'm quick to admit that I always tell my students that I'm not ashamed of that.

Dr. Greg Livingston:

I wish it hadn't happened.

Dr. Greg Livingston:

But I'm sure I'm not the only one that's ever done that.

Michael Max:

Yeah.

Michael Max:

Well, you know, you were one that happened to hear about it,

Dr. Greg Livingston:

right?

Michael Max:

Because I just happened to others of us and we just don't

Michael Max:

know, you know, a lot of times patients, they don't want to give

Michael Max:

you a bad news for whatever reason.

Michael Max:

Sometimes you got to dig it

Dr. Greg Livingston:

out or they just won't come back.

Dr. Greg Livingston:

Well, there's that?

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

Yeah.

Dr. Greg Livingston:

The reason I know this is because that patient, even after that, she still loves

Dr. Greg Livingston:

me, which I just find kind of remarkable.

Dr. Greg Livingston:

You know, she still thinks I'm the best doctor around.

Dr. Greg Livingston:

Alright,

Michael Max:

we're going to, we're going to pick that up on the next time.

Michael Max:

We're going to start with that story, Greg.

Michael Max:

Thank you so much for taking the time today.

Michael Max:

It's been a, it's been a delight hanging out and geeking out on blood stagnate.

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