In This Episode..

ACU-041 In this episode I meet with Phil Settels the Dean and creator of the DAOM program at ACCHS, the Academy of Chinese Culture and Health Sciences. We decided to bring the long held tradition of teaching thru case studies to the AcuSprout airwaves.

Listen in and puzzle through with me as Phil presents a case and shows me a new way to reason through the formula prescription based on his teachings with Dr. Huang Huang, Arnaud Versluys, and Dr. Suzanne Robidoux.

Enjoy the journey and get a flavor for the teachings of the DAOM program at ACCHS.

today’s guest

PHIL SETTELS, DAOM, Dean of Academics at ACCHS

Phil Settels graduated from ACCHS in 2011. Early on in his engagement with Chinese Medicine, Phil had the opportunity to study with several amazing Shanghan Lun teachers, including Dr. Arnaud Verluys, Dr. Huang Huang and Dr. Suzanne Robidoux. Phil uses Classical Formulas almost exclusively in his own practice and in his teaching.

Phil was brought in to design the curriculum of the ACCHS DAOM program which started in 2017, and he is currently the Dean of Academics. This program was guided by the ideal of what would best serve clinicians while honoring both the roots of the medicine and its development over time, and empowering graduates to be stewards of Chinese Medicine. The program has a dual focus on Classical Chinese Herbalism as well as Orthopedics and Pain Management, with the goal that graduates have increased skill and confidence to treat any patient who walks through their door, whether their condition reflects an internal or a musculoskeletal dysfunction.

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sense of it. is harmonization comes into play a lot more frequently than straight tonification, at least at first with a, with a patient when they first come in. I think there's an idea that over time, as you harmonize the excess qualities of what you're treating diminish, and then you might be able to, to straight up tonify down the line.

Um, but I think a lot of times we might tend to skip harmonization and move into tonification too. and then we might exacerbate dampness. We might exacerbate blood stasis, We might create more stuckness in some way.

I think that sounds like exactly what I would do,

Uh,

like that. Yeah, like a rookie thing that, that statement that you just made. Totally. Yes,

probably.

so you're always, I often feel that way, like I'm chasing dampness and then I'm like bouncing back and forth a little bit sometimes. 📍 welcome back to the show. My name's Stacy Whitcomb. I'm the host of the AcuSprout Podcast. In today's episode, I'm gonna be talking with Phil Settles of Ach S, that's the Academy of Chinese Culture and Health Sciences, located in Oakland, California.

Phil is the dean of the D A O M program, which he. Wrote, the curriculum for, and I think it's probably one of my favorite. , He's been on the show a couple of times. He was on most recently, I think in episode 35, to explain the differences between the DA OM programs and the DA CM programs. . In the past. He came on and did a case study with me, which was amazing, I have since been working on creating more of those for you, and so I'm super excited because I am here today with Phil again to present a case review.

Now I have to tell you something before we start. I was this student who hid behind the students who liked to talk in class. I hated talking in class because I'm always afraid of, yes, my perfectionist , takes poll position, and I, I just get super. Anxious. So this is a little bit of a, um, a leap for me.

. But it turned out great and you guys are gonna love it, hopefully as much as I did,

so, without further ado, I am going to shift over and we are gonna do a case review with Phil Settles of ach. Welcome to the show, Phil.

Thank you so much, Stacy. It's nice to be with.

So he said again, guys, so Phil was on, I think it's episode 35, where we broke down the differences between the doctoral programs. So if you guys are interested in programs, um, and the differences between like a Dac a d a o M, check out that episode. today are actually going to do a case presentation. From, Let's see here. This is one of Phil's patients, not mine. And we're gonna kind of break it down using my beginner skills and his great teaching skills. um, do you wanna tell us a little bit about

Sure, sure. Yeah.

So the, the case we're gonna look at today will be through a lens of, um, a form of hanlan analysis diagnosis. Specifically in this case, I was employing a type of thinking, a clinical reasoning called Formula presentation, and it's called FANG in Chinese. And uh, it's very much represented in the work of Dr.

Huang won from Naji University and he has a few books out in English, like 10 Key Formula families and um, I think it's called like 50 50 Medicinals in the Hanlan. Um, so he is got four or five books translated into English and we're gonna delve into this case together through his clinical lens.

Can you talk a little bit about that briefly?

Yeah,

what does that lens look like?

I think, um, philosophically I think it's very fascinating to think about different diagnostic styles in Chinese medicine and to think about different types of human logic or just logic like deductive versus inductive and the main systems we learn in school. Uh, our processes of, uh, we use the four diagnostic methods of looking, touching, um, inquiry and listening, smelling.

And we gather all the information we can and we start to move forward, creating a narrative of patterns, of disharmony, uh, a main path, mechanism, treatment strategies, and all of that leads to treatment principles. And then finally, uh, intervention. And that's inductive. It's a very much a step by step, methodical process.

Um, and the formula presentation system, I would say is more deductive, where it's very quick recognition of patterns. And then the questions you ask, um, are very, um, specifically, uh, engaged with in order to confirm or deny the hunch. So it's a system where a hunch is formed very quickly by knowing the formula as well.

And oftentimes within 30 seconds or a minute, you could be thinking, ah, this looks like Oran or cha. And then you just ask the specific questions that are going to add to your evidence base for that formula or, uh, be counter evidence or make you think maybe it wasn't that type and tongue after all.

So that's gonna make this really interesting cuz my chops are a little weak on, uh, herbalism. So this is actually really great. I also like the juxtaposition of like my training as an herbalist and, and then how this is gonna feel a little bit different, which will come out in the questioning. So, um, quick thing before we start. I do know that your doctoral program um, heavy in orthopedic acupuncture. Is that correct? And then heavy in herbalism. Would that be fair

That's very fair to say. And as a, as a clinician who. Was involved with creating that doctoral program. Um, I have my own distinction that I made internally, and I know I'm not alone, but I also know that there are others who don't make the same distinction that for a lot of internal medicine cases, for chronic complicated cases, I tend to think primarily about herbs.

And there are some amazing acupuncturists out there who treat dermatology and autoimmune and all kinds of conditions with acupuncture. But I consider my main tool to be herbalism for that. And then for musculoskeletal conditions, for pain complaints, I consider my main tool to be acupuncture. And it's kind of, uh, associated modalities like cupping and guha and manual therapy.

So with those two specializations, I really do feel like any patient who walks in the door, whether it's acute, whether it's chronic, whether it's internal medicine, whether it's musculoskeletal, that I have very good training through our doctoral program to address that.

For sure, for sure. Okay, excited.

into this. So go ahead.

so I have a patient that I'm seeing in my practice who first came in about two months ago, um, 41 year old female. And, um, I got a chance to talk to her on the phone before she came in and she let me know that her chief complaints that she wanted to address were irritable bowel syndrome, depression, and a sense of sensory overload.

So those three, um, chief complaints I knew were what were going to, uh, to have to be addressed. Um, as she filled out her intake form, I was able to see a little bit of a history of, uh, previous illness, um, Epstein Bar virus. At age 15, she'd been in a couple of major car accidents, but only suffered minor injuries that she's aware of.

Okay, so interrupting real quick, just to make sure, backing up, uh, irritable, irritable bowel syndrome, uh, sort of like a sensory overload situation like overstimulation and what was the

Depression.

depression. Okay.

And all of those things she's had for more than 10 years. So she would, and, you know, certainly fall into the, the sense of chronic conditions and over 10 years things have not really gotten much better with the other things that she had tried.

You have more or should I start asking you questions?

um, well, I. Um, kind of elaborate how, when I asked her to tell me about her IBS and her experience of it, and she fleshed that out so we could flesh out those three chief complaints.

Sounds great. Go for it.

So her digestive system and her symptoms associated with digestion, she, uh, thought were largely based on her emotional state.

Uh, there were certain trigger foods and they were also based on how she was eating, meaning the timing of it and the quantity as opposed to simply what she was eating. Um, so if she eats too quickly or if she overeats, then she will trigger the types of symptoms that she gets. The symptoms themselves are pain in the epigastric region that alternates between cramping and burning, and it travels down her right side of torso.

Um, she generally has a feeling of discomfort in the epigastrium, as I pointed to it, It's, you know, beneath the sternum, the upper part of the abdomen and the center. . Um, when I did palpate that later, it did feel soft, so uncomfortable but soft. It didn't feel hard or rigid. Uh, in terms of bowel movements, she gets constipation for a few days, followed by diarrhea for a few days, and she generally alternates between the two with relatively few normal bowel movements.

It's generally off in some way, and she does get a lot of intestinal rumbling. Um, now that would've been something that I would've asked versus patients volunteering that information. They don't, they don't often talk about intestinal rumbling, but the fact that I have that way up when she was first talking about her chief complaint means I was already thinking about something specific and we'll loop back to that intestinal rumbling later.

Okay.

Um, she had had an endoscopy and a colonoscopy. over the course of the last 10 years and they didn't find anything. So they were able to rule out, I think, what they call organic cause of disease. There was no, um, uh, visible inflammatory issue of Crohn's or colitis. Um, so she has all these symptoms, all this discomfort, this, this suffering.

But from a gastroenterologist perspective, they could rule out certain conditions

for her nervous system overload. Um, circumstances in her life are, in her words, pretty crazy. Um, a lot of burnout. A recent divorce solo parenting, two small kids 50% of the time and trying to keep up with work and all of that feeling somewhat untenable and overwhelming, and she feels exhausted. She also feels like it's diminished her ability to be patient with her kids, to be with her kids in the way that she would like.

um, one of her children, uh, six year old is, uh, undergoing a lot of kind of, um, I guess testing, but also care and is likely autistic. And as they've been engaging in that process, she's learning that she is probably undiagnosed with autism as well for her whole life. Um, and she thinks that has a lot to do with both her depression and her irritable bowel syndrome.

So she's doing a lot, Um, psychotherapy, trauma therapy has been working very, uh, hard and engaging a lot of, a lot of different, um, strategies and techniques to try to address a lot of psychoemotional issues. This is bringing her back into her body after a long period of being strongly disassociated from her body.

But as she comes back in, she's finding it overwhelming sensitivity to lights and sounds, um, feeling kind of frightful, like, uh, easily startled.. So as she comes back into her body, the experience of being in her body can be very uncomfortable. Uh, and her responses to things seem to her disproportionate to the things themselves.

Um, in terms of depression, a lot of sensitivity, a lot of sadness, um, feeling a lot of times of kind of hopelessness or, or just lack of, uh, lack of joy, lack of happiness. And then to go with that sensitivity and sadness, there's also irritability and anger and frustration as well. And that she, she might take that out on others so it doesn't just get held inside.

She, she can express some of that. So that was her fleshing out those chief complaints, and then it, it shifted to my asking specific,

Okay, so of course the way I'm trained, I'm hunting down a diagnosis. Right, specifically. And then from there I would go from diagnosis to formula. So that's kind of where thinking is gonna go. And of course, you know, , I would ask, one of the questions that I would definitely ask is, when you were palpating her abdomen, was it cold

Very good question. I didn't write down the temperature of the abdomen, so I don't think it was notably cold or notably warm to the touch.

Okay. Okay. , what did her tongue look like?

Her tongue was pink on the, on the slightly pale side, um, thin white coat without very significant, dark, distended, sublingual veins. So it actually looks like a relatively normal tongue pink with a thin white coat.

of. And then, and was it swollen at all, or No, it was just kind of normal.

Not particularly puffy, no teeth marks. Yeah, so

think I even mentioned to her that her tongue looks like a textbook, relatively healthy tongue.

Yeah. And then what were her pulses like?

Her pulses were most pronounced in the positions bilaterally. On the left, it was slightly wiry. Um, and there was a slight don sensation, which is the spinning bean sensation between the sun and the Guan on the left pulse. In the right pulse, it was most pronounced in both the sun and the gu. It felt more floating in the sun and slippery in.

Okay. Now let's touch on that Don, real quickly because I have a little bit of training there. And that you would see is the problem in the epigastric between upper and lower. Is that correct? Or can you talk about that for

Yeah, I think in, in looking at the pulse as an anatomical representation of the body with sun being upper gel go, being middle jail, being lower geo, then yeah, that between the first and the second positions would, would really represent that epigastric area, kind of the, the demarcation between upper geo and middle geo and generally would indicate some kind of blockage or stuckness.

Um, so for her, that's part of her chief complaint is the actual discomfort in the epigastrium. And I did find kind of that correlate in the pulse.

Right. Okay. Um, this is good. This is hard. This is good. Okay. So, so of course, you know, many of the, of the, uh, well, I would say wood overacting on earth. How can you not say that? Right? So some liver tea stasis, overacting on earth. Um, I was looking for cold, but there seems to not be cold. which can also be a big of, of irritable bowel or loose stool.

, curious. Um, you mentioned a couple things and I can see where you're headed with your thinking a little bit. I kind of wanna hear about them. The stuckness in the epigastric is very important to you. So now I'm reading you, um, and, uh, And you mentioned something else about that. What else did you mention about that?

Um, I did mention as well, uh, the intestinal rumbling, which was a question that I,

Right,

that you right. The gurgling sounds and the

gurgling. So tell me a little bit about that.

Um,

what are those two things telling you? As far as formulas,

yeah, so a moment ago you mentioned that your mind starts to go into diagnosis, like looking for the path mechanism, and in the formula presentation style, what happens instead is based on a few key signs and symptoms, formulas themselves come to mind, and so you can start to have a hunch for like, number one, number two, number three, potential formulas that are gonna be relevant for the patient versus.

Just that gathering of information and then sorting that information into categories and then making sense of those categories. So with the epigastric stuckness, the, the bowel movements that kind of, uh, are sometimes hard. And then after the hardness, after the constipation becomes soft and the intestinal rumbling, once you confirm that intestinal rumbling, um, I, I started to think about one particular formula.

Um, I think I can say the name of that formula.

can you let me, let me see if I can start guessing like parts of it. So is this a cha who and by sha

Good, good question.

mentioned the wood earth disharmony, then right away then I would think about Uhhu Baha as a harmonizing approach. So this was a harmonizing approach, but not with chai.

Okay, let's hear it

Um, so ban.

by Chasta. Oh, uh, Descending Bancha.

That's right. So it has banya and ang, which are gonna harmonize andand rebellious stomach G Um, it balances hot and cold. Banya gang wrenchen are all warming, but it also has one G and one the end, which are cold and bitter.

Um, and it's got also as, uh, as well the, the zao and ganza. So it's got a big emphasis on nourishing and strengthening, uh, the middle gi, but also on cooling and descending and opening up blockage with that bitter curing earth type approach.

So with.

So talk a second about Bon Sha for a moment. I love Bon Sha. love Bancha Hoang. Like I've used it as well for this like opening up a blockage that's going, that's especially emotional. there like a bigger relationship with Bon Shot and emotions per

There absolutely is. And, um, Huang, in his teaching about herb indications and formula indications, he'll talk about the bancha type and sometimes we use the term constitution. Um, and in, in the Chinese it's teacher, so Bancha teacher is like the type of person who responds well to Bancha and there very often is a psychoemotional component.

Um, and it's often juxtaposed with Hoo. So we'll talk about the HOO type and theia type. Some patients really fall strongly into one camp or the other and some have characteristics of both or it becomes more difficult to kind of tease them apart. Um, but both the cha who person and the baia person can have a lot of psychoemotional symptom.

The childhood type tends to be guarded and is marked more by constraint and holding. So they often have, uh, less facial emotion, less emotive faces. Their eyes are more like thin and like a little, uh, I always think of Clint Eastwood, like with the sun glaring. He's kind of squinting. He's got that poker face and the standoff, um, in the shootout.

Whereas Baia, it's very emotive and there's a lot of facial expression, and the eyes are big and the eyes are really telling the story. So you're talking to someone and their eyes are just, uh, if the window, if the eyes or the window to the soul, the window is wide open and a lot of information goes in with baia, but a lot of information comes out as well.

So the, the baia person tends to be very empathic and can be, can have that sensitivity to stimuli because so much stuff comes in for them. And they're not guarded, they're not poker face. Um, they can wear their heart on their sleeve and that creates a kind of vulnerability for them as well.

And you sort of said that she does express her anger, like you noted that. Right. And that was why you were noting that like you were distinguishing between a Tahu and a Bon Sha type of person at that point.

that's a very, very good question to answer that I go a little bit outside of the formula presentation system into more like sick syndrome as Suzy do teaches it, where if there's, um, annoyed feelings, but they're kind of contained inside, it's maybe more half and half if they're

half and half of

a half and half, um, being like shall young or it's way in so that some,

of the confirmations are external, some are internal, some are considered half, and.

So if someone is annoyed but they don't express it and they just have like internal resentment, I would actually associate that with JHU quite strongly. Like there's a holding, uh, and we talk about irritability related to Liberty G stagnation, and we could have that same thing related to, you know, SHA young disease.

It's still trying. If they express anger, then I might think there's a little bit more fire here. That fire can be a sure GAL problem, but I think it can also be a Huang problem.

I.

Um, so from ahu perspective, if we are going through a little bit more song food and the formulas that we learn in our Ms. TCMs, we could say that maybe the difference between Shaan and Giaan, if someone is annoyed but they hold it, maybe that's a shaan pattern.

If they express it and they get angry and they have more like outward aggression. Then we say, Oh, there's more fire. And then we add the herbs to clear heat more strongly.

Even if they didn't show heat signs per se, like tongue presentation or, Yes.

This, this would be

gonna tank their digestion. Right. Like as long as you're not gonna.

precisely, yeah. And we do definitely have a lot of different opinions expressed in Chinese medicine from different teachers and authorities about, well, when the symptoms and the pulse don't match, some people will follow the pulse. Some people will follow the symptoms, some people will try to reconcile the two, but they don't always align.

All the sources of information don't always align in the same direction. So then it does come up to, uh, the operator's decision, you know, the clinicians' decision about what to go with when they're not all in alignment.

Well, and there's just that, it's all a learning experience too. Like you, you make your best choice with the formula move forward and that's diagnostic, how they

Absolutely. Yeah, absolutely.

yeah. So you just keep moving and, and make good decisions

Yeah.

So, Tell me a little bit. So there's no concern with the cold herbs with her. How does this, tell me a little bit about the alternating between constipation and loose stools with this. What is that component? What does that, what does that mean? What is that about?

So, when we first learn alternating constipation and diarrhea, we do think about wood earth disharmony. The base formula that we learn, and it's also a formula, is Sydney san.

San, I would expect cold hands and feet. And when I started to inquire about temperature with this patient, she generally feels warm.

Warm, extrem. Sensitive to heat likes the cool, So there was no, uh, physical sensation of cold in her body, not in her torso, not in her extremities. ,

I stop you really

yeah.

Can you, for the people who may not know, can you tell me the what's in Sydney?

Yes. The Nissan is four herbs. It's chiu by shall shaher and Jal. And Si son is a, is ahu based formula. So it's someone who, again, has that holding and that type of constraint. And the constraint in Sydney sun can be emotional constraint. It could be muscular constraint with cramping or type muscles or pain.

It could be, um, a constraint in the actual blood vessels, preventing warm blood from reaching the extremities and causing cold hands and feet. And the cold hands and feet. In Sydney stone is usually more like fingertips and toes, and it's related to emotional state. And when they move or when they feel really relaxed, their hands and their feet warm up.

But when they're nervous or stressed or irritated, then they get cold.

Which is, it's often of, it's usually just part of a formula.

It's a very, it's very often combined with other formulas. Um, I do a lot of formula combination in my own practice. Some of my teachers, um, if I think about R no versus Lus for example, I think very often gives the single formula. Uh, and I think it can be amazingly effective. Sometimes when it's just three or four herbs and everything shifts, formula combination or modifications, there's sometimes a little bit more of like a hedging your bets type of thing.

So I can catch myself thinking like that sometimes.

yeah,

Again, the patient's response will determine whether or not it was a good idea. But for a lot of people, those smaller formulas will be built into larger, larger formulas that they do.

I tend to, as a, as a newish practitioner, like to start with just the ultimate, just the formula and see how they do with that. And if they get a little bit of traction, then I might start you know, fixing it or, you know,

I think that's

a beautiful approach. Yeah, there's a lot of logic to it. And then you learn what the single formula can do before you start adjusting it every time.

Yeah. Yeah, yeah. Okay. Well, so I just took us on a, a crazy little path, but let's get back to, um, our patient again. So did you give this formula, if so, what? What

Yeah. So as I started to think about bon tongue, I wanted to find either corroborating evidence or negating evidence. So the first one I'd asked was the intestinal rumbling, and that was there. So that's a big. Four. Then I asked about nausea and there was consistent nausea, lots of nausea, not vomiting.

Um, but even though she started by talking about pain, once I asked if there was nausea, she said the nausea is actually more pronounced than the pain. So nausea for us is stomach g counterflow.

now we have epigastric, distension, stomach, g counterflow, loose stools and rumbling intestines. We've got four really strong points for tongue, doesn't usually treat constipation, but for her it was constipation followed by diarrhea.

And there are, there is clinical experience of people talking about tongue treating the stool that starts harder and more dry and finishing looser. Now that can be the same bowel movement, having a different beginning and ending. It could be multiple bowel movements in rapid succession where the first one is more dry and the last one is more loose.

But for her it was a couple of days of more dry and then a couple of days of more loose. But I still saw the relationship

and we could say in a sense that Jiang, uh, or sorry, that, um, um, gunung gonna be warming the spleen and Juan are gonna be cooling. So there could be like a, a hot, dry, young Ming component with a cold, damp tie in component within the same person.

Hot, dry, Young Ming might give us the constipation and the cold. The dam tie in could give us the loose stool.

So

See, this is where like as a beginner practitioner, I would've been like, like, You didn't ask any questions about young mean well or a dry young mean, or were you looking, or was there something that you could see or, or you just went to the formula and you're like, Okay, I can see where this is.

Yeah, that was it. In this case, I just went to the formula and so ultimately what we give is the formula. So Dr. Horn will kind of emphasize and he, he's not the first, Historically there have been doctors in China over the last few hundred years who've argued that what you ultimately give are the herbs.

So your theories and your philosophy of the patho mechanism, um, is not necessarily important in terms of, it's not what's gonna change the patient's outcome. What's gonna change the outcome is what herbs you select. So in this type of model and is strongly influenced by, by Japanese herbalism as well, by kaul, which is Han practice primarily.

You start to think about that formula and you start to gather evidence for it. So now I had very good evidence for Banong, so that was my number one contender.

And not everything was perfect. The tongue wasn't perfect for banong, um, and a lot of cases. A bunch, yes. And to have kind of heat above cold below, so there can sometimes be cold feet.

And this person didn't have that. It was pure warmth. Um, but I felt like I had enough to really still go with. I did consider also we don Tongue. Now we don Tongue is also a ban formula, whereas is primarily digestive in nature. It's about the epigastric distension, it's about stomach G counterflow. It's about loose stool and rumbling intestines.

Um, when dont is more about, I would say, Uh, depression, dark thoughts, easily startled, insomnia. So it's very much a psychoemotional formula. There's a, uh,

what's, what's in wind on Tong

we don tongue is very close to, even though it's not a hanlin formula, Wang Kong uses it a lot and I'm very familiar with it. Um, it's very close to urchin to which we learn urchin to is like middle

accumulation,

Yep.

um, and urchin to uses the Banya Chen P combo we to has that as well.

So it's got our banya base that we were already thinking about, but it's also got Chen p um, it also has Jer and jewelry to address a kind of a phlegm heat in the chest affecting the heart. So it's

Okay.

phlegm heat, disturbing the heart, causing psycho-emotional symptoms in wind on.

And tell me again, Sorry, I'm, I'm listening, but maybe you can repeat again, the emotional, the emotions are bigger. What did you say about the emotions with wind on

When done tongue, I would say is primarily a psycho-emotional formula versus a digestive formula, at least in the way that I understand and use it and have seen it used. So I would think, oh, the patient has depression. Um, anger, easily startled, doesn't sleep well. Those for me would be evidence of we dont.

A little bit of a phlegm presentation somewhere.

That's right, that's right.

, so when dont I had in mind, and then I also had a very different formula in mind, which was Don Guan and I started to think about ue, which is UE

six herbs, where we've got three herbs for the blood, three herbs for fluid. And the patient had a pale tongue, um, irregular menstruation with abdominal cramping, um, and a sense of breast distension and soreness and a little bit of swelling in her legs with her period. And those things made me consider when done, uh, sorry, in terms of nourishing and invigorating blood, um, and dealing with fluids that tend to accumulate and make puffiness associated with the cycle.

So that was my number three, like maybe down the line idea, but the same way you'd said as a newer practitioner, uh, you sometimes would like to give the base formula and see what happens. I wanted to give a single formula to see what would happen. So I wrote down in my notes to consider when Don down the line, but we just gave es.

Tone,

So Tong, are you doing acupuncture as well or are you just strictly doing, is this just an herbal consult?

I did acupuncture as well. Um, I largely, in a sense, I divided her presentation up a little bit into the digestive component that I was primarily addressing with the herbs and the psychoemotional component where I did things that were primarily calm spirit with our acupuncture. So I did ear shemen and, and Chinese sympathetic.

I did Yong, um,

did, uh, heart seven and six. did,

you do any abdominal, Did you do CV 12

I did, I did, yeah, Ren 12, Ren six and stomach 20 fives. So the four points on the abdomen.

12. Yep.

Yeah. So that, that would.

just like to, I just like to bring that up cuz I think, uh, um, newbies need to know that, know enough, Right? Those are such basic, fundamental, typical points. That is a, that's actually exactly what I would've done almost to a t.

so, it's good. It's just good to hear.

And I, and I just wanted to share that with the listeners so that they feel a little more secure in their selections, because I've had new practitioners tell me, Oh, I need to go learn something else because TCM doesn't work. Or, you know, this, this basic acupuncture doesn't work. And I'm like, No, you just need to keep working and it'll work.

Yeah. Yeah, I think, I think our patients give us evidence a lot of times that very simple thinking,

simple points. There's nothing like you said it was, it is basic. The point prescription was basic. There is nothing really advanced that didn't have to go to crazy seminars with teachers from esoteric lineages.

These are standard points that we learned.

Yeah.

the patient felt really well getting up off the table, you know, the next few days. In a sense, the herbs, I think, start to work in a way that builds up over time, and the acupuncture's the opposite. It works right away and the effects come down.

So when a patient does really well for the first few days after their visit, then, then I do think the acupuncture had a role to play there.

Oh, that's a really good point. I had never really thought about it that way, but I think that's a really also a great way for people who are doing both herbs and acupuncture at the same time. To be able to like ramp up, like you just said, ramp up the herbs while the acupuncture is kind of dissipating a little bit.

See? Good point.

Yeah, I think that timing works out nicely. So the first follow up was one week later, I wanted to see her weekly for maybe about four sessions, and then hopefully switch to every other week. You know, over the two months, that's what we've done. Um, there was some improvement in loose stools, in abdominal pain, in intestinal rumbling, and much less nausea.

So really across the board, all the symptoms we wanted to hit with bun Tongue all improved. Um, at first she found it really difficult to drink the tea, and by the end of the first week she kind of had a, a strange, um, amicable relationship with it where there's, you know, a little bit of comfort and craving associated with her bunch.

And she, So you're, you're prescribing bulk herbs that the patient goes home to cook per Yes.

I actually used, um, straight granules, so pre-mixed from, uh, from Treasure of the East, uh, was the, the brand. So, I don't know, sometimes the brands use the exact same ratios from the Hanlen, and I actually don't know, like I, I didn't, uh, Analyze the back of the bottle. So I couldn't say the dosage of each herb in there, but it was pre-mixed and that's why I'm mentioning the company is if someone wants to look up the dosages.

Um, so it was, yeah, just a single bottle, unmodified and I would say really good results. Patient, again, 10 plus years of ibs, trying probiotics, trying different things. No diagnosis had really been offered, no insights, no improvement. And then one week of man and everything seemed markedly better. So she was very happy.

Um, now she also felt a lot better in energy and mood, but there's a conflating factor there, which was she took a little, uh, leave from work. So one of the big things going on in her life was suddenly less stressful. So the herbs may have helped with energy and mood, or it may have just been her changing life circumstance.

Is that she was taking, uh, a leave of absence.

But I love this too. I love it when. Just, just to note something like you gave a formula that was gonna allow she to move and in allowing she to move, was also probably able to more handle, like, handle that transition better. You know, I've always, I've noticed that a lot. Like I've had patients on, um, know, I had a patient on, on uh, Bancha who is grieving and, um, talked to her next and she doesn't associate it, but she's like, you know, we did, we did like two bottles, you know, like consecutively.

And I asked her how she was one day and she was like, Oh, I think I'm, I'm much better. I'm not, I'm not as bad as I was. And, and you know, things had changed in her life too, which I think patients attribute that to. But sometimes I think that that acupuncture and that, um, especially the herbs really kind of everything to move amplifies.

It's fascinating. So thank you for letting me interrupt you

Yeah, I think that's very true. And um, from like a scientific perspective, we don't have the means to tease it all out and say what, what effect was taking a break from work? What effect was the Arabs? But they were all there and the outcome is what we see. And there's certainly, is certainly plausible that yeah, things generally moving better, having less stuckness, um, between the upper and the middle gel where again, when there's stagnation, it generates heat, that heat goes up and vexes the heart.

Like there's a lot of reasons to think that focusing on this digestive formula could have had the secondary beneficial effects for the psycho-emotional state.

So we kept that going for one more week with just at the end of the second week sleep had not improved. Everything else, that digestion, she really said like, it's great.

like her daughter told her, You seem happier. Mommy And her daughter didn't know if she's necessarily doing acupuncture or taking herbs or anything. So just things getting better in her life. In her house relation, you know, her ability to be the mother she wanted to be with her children, but the sleep had not improved.

So that was like the final thing that I was like, Let's see. Cuz sometimes tongue absolutely does help sleep when people feel abdominal discomfort or get heartburn or difficult to fall asleep. It could be that activity in the stomach generating heat, vexing the heart.

Yep.

In this case it didn't really help with sleep.

So then I, I added the herbs from Wen Don to, So that was my number two in mind. Like in the future, consider we don to, I added juchen and fooling to ban to.

Thinking there was a hidden phlegm component perhaps that was harassing the heart.

Yeah. Or in a sense thinking that the, the, the dampness or phlegm that was there was indeed affecting the heart. And, uh, so, so tapping into the psycho-emotional component and the heart calming properties of Wen Don Tongue. So I, I combined them and in a way you pivot cuz they have the same, they're both based on bia, so you can use BIA as like the common friend and two groups of friends can get together because they all know BIA really well.

Um,

Spoken like a true teacher. I won't forget that now. That was

So in herb combination, when there's similar herbal method, I think there's a very, uh, a good chance that they're all gonna play well together.

and then after incorporating and tongue, she liked that formula even more and that became her base formula. . Um, and that did start to affect her sleep. Her sleep started to get better.

now fast forward a more weeks to, to two months.

Can I jump in? Sorry. Um, did you take any of the sleep into consideration, or did you? Once again, So you're thinking formula is first, uh, with sleep, and I would've been like, you know, down the standard, Well, are you having trouble falling asleep? And once you are asleep, do you stay asleep?

And, and how that play in, or not play in? You're directly just like, almost like the way that you're working is so much more streamlined than thinking through every thousands of questions and different possibilities that we're trained in. Um, it's just next level and I

is is that the thinking?

Like you're already, Well, I already know the formula, so it's fine. Stacy, I don't

Um, I did ask the different questions about sleep, whether it's difficulty falling asleep or tendency to wake up, whether there was a lot of, uh, dreaming, whether it was tossing and turning. Um, and usually for when done, Tom, I think there's an association clinically with, with bad dreams, with nightmares, with, again, being easily startled.

She didn't have that. She had easily startled during the day, but she didn't really have bad dreams. She would, she would have easy waking with lots of thinking,

was not the bullseye sleep problem that I would think ah, went on time for nightmares.

but for me it was still ballpark enough that the sleep had not been improving with, um, with

So I wanted a bunia formula that's little bit more oriented towards sleep, Promot.

And see, that's where, in my lack of like your the way that your knowledge, I would've then shifted to like a spleen tonic, right? That's where I would've changed that situation,

would've continually been playing with this, So from where I would've been, I would've gone with a Yahoo formula, right?

And then I would've been going back and forth, back and forth, back and forth with this toy spleen soothes the liver, toy, spleen, toy heart, like all of that situation. So this is interesting. It's just juxtaposition and, and more knowledge.

And I think with the, the idea that with Chinese medicine, if you ask 10 acupuncturists, you get 11 opinions.

have interpreter reliability. And that can be, uh, a beautiful thing too, because Acha who Formula might have rocked her world, you know, like it might have been amazing. So, uh, the fact that things went well with a.

Really for us, doesn't mean they wouldn't have gone well with a different approach that a different practitioner might have had. Um,

but yeah, it turned out that without really a lot of tonification, I mean, the is the harmonizing formula, so it does have the /.,Ang and the Wrenchin. The Doza Theile. There is in a sense strengthening, nourishing warming, um, um, but it's not like a spleen sheet tonic or a spleen, young tonic or anything like that.

this kind of harmonization and movement energy got a lot better. a lot of things that we might associate with spleen sheet efficiency, um, did improve without directly trying to tonify s.

Sense of it is harmonization comes into play a lot more frequently than straight tonification, at least at first with a, with a patient when they first come in. I think there's an idea that over time, as you harmonize the excess qualities of what you're treating diminish, and then you might be able to, to straight up tonify down the line.

Um, but I think a lot of times we might tend to skip harmonization and move into tonification and then we might exacerbate dampness. We might exacerbate blood stasis, We might create more stuckness in some way.

I think that sounds like exactly what I would do,

Uh,

like that. Yeah, like a rookie thing that, that statement that you just made. Totally. Yes,

probably.

so you're always, I often feel that way, like I'm chasing dampness and then I'm like bouncing back and forth a little bit I always feel like there's this balance that I'm trying to get between liver and spleen and dampness

Yeah. Um, and interestingly, this, the, the debate about different strategies has been going on forever in Chinese medicine since, you know, at least the Song Dynasty. We have a lot of statements from historical doctors who are saying, Oh, everyone else is tonifying too much, or Everyone's doing this.

And then in the J End Dynasty, we had. Spleen, Stomach school and school of attack and pretation, a nourishing school and heat clearing school. And you know, these different methodologies or, or ideas of what you should be emphasizing in clinic. So we definitely have folks over time, over the last thousand years saying that their contemporaries are using too many sweet medicinals and are toying indiscriminately.

And uh, and I think that when we come through TCM school like that, that could definitely be a tendency that we start to think everyone's deficient. Everyone needs to be strengthened. And um, a lot of the doctors that I really admire and have learned from, I've really made it clear that, that it's overdone and a lot of patients will run into troubles through over tonification.

Yeah. Yeah. can feel that, Like I can sense that with my own. Minimal experience so far. Um, but also too, like that's what we were taught and so then it's up to us to up level, know, keep

Yeah,

that's it.

anyway. how did she do with the combination with the wind on Tongue

So she loved the combination with the wind on tongue. It seemed to hit the digestive and the psycho-emotional components together really well. Um, acupuncture now is every other week, and really it's that same approach of com kind of combination, spirit calming with a little bit of digestive. Um, and this seems like a really good place for her to be right now.

So she has gone back to work after her, her leave, she went back to work, um, was better able to handle it than before she left, but it was certainly an increase in stress again in her life. Um, and then a couple of weeks after going back to work, she got, uh, an appointment with another doctor. Uh, or a psychologist who used Ketamine.

So she'd been waiting for that for a while. And so that's the newest change in the case is ketamine has been introduced and she loves it. says, Would, you know, recommend 10 out of 10.

fascinating.

I have not researched ketamine. So now that you mentioned it, I'm sure that you've probably Ketamine. So can you tell me a little bit about

yeah, so I, I don't know a ton, but it is a, um, it's a hallucinogen. Um, so it's, I think it goes with the idea of kind of like micro-dosing and a lot of people finding like a lot of positive, um, uh, impacts on psychoemotional health and wellness and productivity and ability to, to feel creative and not overwhelmed, et cetera.

Um, it's being used more in, um, uh, type types of trauma. Yeah, T so there's definitely a lot of research emerging. Um, it's not without potential side effects. There are people who, who it does go badly for the same way. We have sometimes patients who went on Ayahuasca or even Tai Chi or Chigong uh, or yoga and they, they end up getting a really unsettled spirit from some kind of experience like that.

Like I'm sure that does happen with these modalities as well. But I, I have a sense it happens a lot less than wind standard pharmaceuticals. I think that the side effects are less, and in this patient's experience so far it's, it's been wonderful and way better for her than the antidepressant medication and anti-anxiety medication she tried in the past.

It is been a really nice case cuz two months is not a long time she'd suffered with these conditions for over 10 years. Um, she'd gotten, you know, far better in kind of the, the six weeks or so taking herbs and acupuncture and then ketamine maybe was the cherry on top.

And she's just feeling really better than she has in a very long time in her life.

Great. I only have one more question, I really push for the twice a week The first six visits if they can.

Obviously you're talking about a single mother with a job and small children and juggling a lot of life. Um, but I always tell people, Yeah, that's my dream. Like that's the way that I really feel like this works best. Um, but if, if you can't do that, then we go once a week, you know, and, and I meet you where you are and we go from there.

It doesn't mean your treatment's not gonna be great. It just means that's what we do is that how do you, how do you handle that? What is your thought process

Yeah, I think there's a lot of wisdom in the way that you do it and the way that you communicate it. I think, um, you know, we learn that in China people often get acupuncture every day. Or like five days a week. Um, and so they'll get 12 or 20 treatments within a month kind of thing. And we know that there's efficacy with that.

We know that when people go to community acupuncture with increased frequency, there's benefits from that increased frequency. There's research now that's been published about how acupuncture is dosed specific, and it even implicates a lot of the research on acupuncture for being underdosed. So it's kind of like, of course your findings don't show the true benefit because you prescribed it at a lower than optimal dose.

If you prescribe pharmaceuticals at lower than optimal dose, you'll also get, you know, a reduced findings. Um, so I, you know, in my own clinical practice, I actually see patients in Oakland on Mondays, in Sacramento, on Wednesday and Thursday, and in another town, Jackson, on Fridays. So the way I'm

out means I don't usually see people more than once a week.

Um, but that could be to the detriment of, uh, you know, our clinical outcome. And, uh, so I would recommend to listeners absolutely to think about seeing new patients twice a week, in particular when you wanna make a bigger change. So when you wanna establish momentum with a new patient, or when it's someone in acute pain, there's a lot of benefit to doing twice a week over once a

I also talk about, just to throw this on top of that, like this is the best bang for your buck. I, I maybe don't say it quite like that, but like for your investment it's, it's like the best way to go for your investment as well. Cuz people think with their money too, so they're not insurance wise.

So anyway, I tacked that on as well.

Yeah.

yeah. Do you have anything else to say about the case? It was really really appreciate your time with this. It's, it's, uh, and hopefully the listeners really enjoyed it as,

Um, yeah. Nothing else about the specifics of the case, but just an idea. Again, for our listeners, we come through our master's education, we learn a certain diagnostic method. I would say it's all inductive. It's all that process of gather as much information as you can, then start to try to make sense of that information.

One that can be very time consuming. Two, it can be complex because now that you've got every sign and symptom through inquiry, um, you start to get many, many, many patterns that emerge. And you can make a case for spleen sheet deficiency and liver g stagnation and heart blood deficiency. And, you know, you just, you start to get 5, 6, 7 zone food patterns without necessarily a way to navigate was there one thing that caused all of the others?

Or do you have to treat all of those things with all of your acupuncture points and herbs? Um, so to be able to balance that with the deductive process of starting to get a hunch right away of, Oh, I have, I have two or three pieces of evidence for bong. Let me see if there's any more. within a minute, within a minute to, to a minute and a half, you can start to just work your way towards the formula you might ultimately be prescribing if you're getting positive evidence and not negative evidence for it.

So, uh, that's something that I learned from Dr. Huang is something we emphasize in our, our DA one program. In a sense, we teach both the formula presentation as well as the sick syndrome. Um, so we, you know, reduce causes for error by reducing, uh, confirmation bias. you can kind of check your work in a sense by having two different ways where you arrive at the same conclusion.

One last question before I let you go. So, um, Your D a O M program is, like I said before, heavy in herbs and then heavy in orthopedic or, or pain management. Um, a practitioner actually have to have their herbal portion from the master's degree in order to be accepted into that d a OM program or can they just come.

Very good question. Um, because we're in California and there's a, a necessity for people entering a DM program in California to be able to sit the California licensing exam doesn't mean they have to have a California license, but they'd have to be eligible to sit for the exam. So then we have to look at the, the herbal education in a Masters and all entrance, all people who enter the program have to have an equivalent education in terms of hours.

So if they went to a program that didn't have herbs, Then there are a few programs that exist in the US where they can go and study outside of school or after school and kind of, uh, top up their herbal knowledge where they would be able to apply for licensing in California, and then they could apply for the D O M.

Got it, Got it. And I'm guessing they can just, uh, contact you to find out what programs might be applicable if they're interested in the DM program.

Absolutely. Yeah. There's a few that I have in mind that I recommend, so anyone who's interested could contact me.

Great. And we will have your contact information in the show notes for listeners if they need to you. And, um, last words for new practitioners fell?

Um, yeah, I, I tell my students that at ACHs, and I think it applies for new practitioners everywhere, um, , um, one to. faith in what you've learned so far in the same way we were talking about acupuncture, that sometimes those very basic points can have a very, uh, positive outcome and be really helpful to a patient who has struggled 10 plus years.

And those very basic points that you already know can start to turn things around for them. Um, but also to balance that confidence and that faith in yourself with a humility that Chinese medicine is so vast. It's so deep. Um, there should be no expectation that you graduate as a strong herbalist. Um, and that you, you know, in a sense, uh, that you're, you've not reached any kind of terminal level or anything like that once you've graduated.

And so it's an invitation to go deeper and graduate with a master's and a license. But I would say it's like a yellow belt from a martial arts perspective. And there's still a lot of room for growth and mastery. So to find the teachers that you're interested in, Um, or the programs that you're interested in and, and keep going, go deeper, and all your future patients will.

Thank you.

Yeah. Awesome. Thanks so much for coming on. It's always such fun adventure to have you on the podcast. Thanks again,

You're very welcome. I enjoy it so much and, uh, all 📍 the best days you'll talk to you soon.