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053 Investigating Errors and Adverse Effects - Grist for the Mill of Practice • Daniel Schulman
Episode 539th October 2018 • Qiological Podcast • Michael Max
00:00:00 01:12:30

Shownotes

Like hitting black ice, suddenly all sense of traction and stability evaporate into a gut wrenching vertigo. Adverse reactions of our patients to acupuncture can trigger this kind of disorientation. And this is when we have an opportunity to learn something that we didn’t previous know.

 Adverse reactions could be due to a botched treatment, we were thinking one thing, but did another. Or our diagnosis was off. Or maybe it was on, spot on but the patient’s processing of the treatment gives rise to a frightening amount of discomfort and sends them scurrying for a quick pharmaceutical fix to calm their fear and anxiety.

 It requires a certain amount of maturity the part of the practitioner to hold steady in a moment of deep uncertainty. And degree of personal development on the part of both patient and practitioner to not let unforeseen reactions stop what might be an important turn in a patients healing process.

In today’s conversation we consider adverse reactions to acupuncture, how to tell the difference between an uncomfortable healing process and an unskilled treatment, and how uncertainty is part of the game when practicing medicine.

Transcripts

Daniel Schulman:

And I remember just saying, I'm going to go into each

Daniel Schulman:

and I've done this for 20 years.

Daniel Schulman:

I'm not going to go in with any book.

Daniel Schulman:

Now I have all this knowledge, but I'm just going to, like, I'm going to go in

Daniel Schulman:

like an Etch-a-Sketch with each patient just, and just be there and just take

Daniel Schulman:

it and trust myself, you know, there's that whole, there's that whole tension

Daniel Schulman:

between spontaneity and rote knowledge.

Daniel Schulman:

Um, You know, I always think of miles Davis as the archetype of someone who knew

Daniel Schulman:

a hell of a lot, but clearly lived in a receptivity to what spontaneously arises

Daniel Schulman:

in spite of everything he knew every day.

Michael Max:

Hello, Sheila magicians, Chilla cishan or that car.

Michael Max:

Anyway, this is qiological the podcast for practitioners and students of

Michael Max:

acupuncture in east Asian medicine.

Michael Max:

I'm Michael max.

Michael Max:

Hey first, thank you.

Michael Max:

Those of you that have sent in pictures and postcards from the

Michael Max:

places where you listened to qiological I really appreciate it.

Michael Max:

You know, sometimes I sit here in front of this computer staring

Michael Max:

into the void and wondering kind of, I wonder who's listening.

Michael Max:

So I love getting these emails, postcards, and photos of where you're listening to.

Michael Max:

Qiological app much.

Michael Max:

Appreciate it.

Michael Max:

If you're enjoying the podcast.

Michael Max:

And you find it helpful in your study or practice and medicine, please turn

Michael Max:

your friends onto it like ice cream.

Michael Max:

It's best when you share it with others.

Michael Max:

And in that spirit, I've got a podcast for you.

Michael Max:

If you're not already familiar with Laszlo Montgomery over at the China history

Michael Max:

podcast, you ought to check it out.

Michael Max:

He's got a great series over there on tea, another one on Chinese philosophy.

Michael Max:

And of course the usual lineup of luminaries and villains from China's

Michael Max:

long, long history in addition, and this part's really cool.

Michael Max:

He highlights some Westerners who have made their lives and some kind

Michael Max:

of impact in the middle kingdom.

Michael Max:

I'm particularly fond of the show on Morris to gun Cohen.

Michael Max:

The ne'er do well.

Michael Max:

Jewish thug who ends up his son yet sends bodyguard.

Michael Max:

Oh man, what.

Michael Max:

An episode, actually two episodes.

Michael Max:

That is so when you need a break from medicine and you still have a taste for

Michael Max:

something Chinese, Laszlo's your man.

Michael Max:

It's a Chinese history podcast.

Michael Max:

I want to take a moment before we get into today's show and share with you something

Michael Max:

that came up in clinic for me the other day, perhaps you've had this happen too.

Michael Max:

While you're looking at a patient's tongue here, she might ask, Hey, is it bad?

Michael Max:

I'm always careful about answering that question.

Michael Max:

But the other day I found myself saying to a patient good, bad.

Michael Max:

You know, it's not a helpful way to consider the tongue

Michael Max:

or the pulse for that matter.

Michael Max:

Really.

Michael Max:

It's just an indicator of what's going on and I'm quite reluctant

Michael Max:

to judge it as good or bad.

Michael Max:

Granted, there can be an excess or deficiency that showing up in some serious

Michael Max:

problems can clearly be seen if you know how to look, but the terms good and bad.

Michael Max:

I think they're rather useless.

Michael Max:

It's better to be able to see clearly what's present

Michael Max:

or maybe even what's missing.

Michael Max:

I'm finding that to terms, air quotes here.

Michael Max:

Good and bad.

Michael Max:

Really may not be that helpful.

Michael Max:

They don't really tell you anything or offering you useful information.

Michael Max:

The words are like check marks in a box, something you can feel good

Michael Max:

about and forget or feel bad about.

Michael Max:

And then let the mind start its endless cycle of worry and fear.

Michael Max:

Neither is really helpful when you think about it.

Michael Max:

Good and bad are handy terms to attempt to get children, to behave in social groups.

Michael Max:

The labels are a quick metric for who's in and who's out.

Michael Max:

You know, these labels when applied to people, allow us to quickly

Michael Max:

characterize them without going deeper into understanding, maybe labeling

Michael Max:

something good or bad is fine.

Michael Max:

If you're looking for a stick to hit yourself or others with again too

Michael Max:

often, applying these labels stops the process of inquiry that can take

Michael Max:

us into something more complex and nuanced digging a little deeper into

Michael Max:

what you dismiss as good or bad.

Michael Max:

We'll get you a lot more information about the situation.

Michael Max:

I've been more attentive this week to using the labels good and bad.

Michael Max:

And I'm noticing that when I use them, it makes me mentally lazy.

Michael Max:

I stopped looking for the puzzling details.

Michael Max:

It requires me to stay a little more awake and attentive, and I'm surprised at how

Michael Max:

often I make those snap value judgments.

Michael Max:

And then turn off the thinking process, being awake and attentive as part of

Michael Max:

the conversation that we're going to be getting into here in just a moment as we

Michael Max:

discuss adverse reactions to acupuncture and how these situations can help us to

Michael Max:

learn something, it seems to require a certain amount of maturity on both the

Michael Max:

part of the patient and the practitioner to not let unforeseen reactions stop.

Michael Max:

What might be an important turn in a patient's healing process.

Michael Max:

I'm hoping that dropping this good and bad thing will help me to become

Michael Max:

more of that kind of practice.

Michael Max:

One more thing before we get into today's conversation, you've probably heard me

Michael Max:

go on about sound quality on the podcast.

Michael Max:

The longer I do this podcast, the more I see ways to help improve

Michael Max:

the listening experience for you.

Michael Max:

I've got Daniel Schulman with me today.

Michael Max:

I can't remember how we actually connected my internet.

Michael Max:

Addled brain has trouble keeping track of things that used to seem so.

Michael Max:

But what I do remember is we began a discussion about adverse

Michael Max:

effects from acupuncture.

Michael Max:

And that started to turn into a conversation about whether acupuncture

Michael Max:

was simply harmonizing or if you could really cause your patients and

Michael Max:

problems with an incorrect treatment.

Michael Max:

You know, we like to think that acupuncture is powerful

Michael Max:

medicine, so like food.

Michael Max:

So room off on you can do a person, a lot of good, but

Michael Max:

you know, if used incorrectly, you might cause some troubles.

Michael Max:

And how do you sort that out from just the kinds of adverse reactions, sometimes

Michael Max:

people have to any kind of a treatment, depending on what's going on with that.

Michael Max:

This seemed like a good topic to chew on here at qiological.

Michael Max:

And I'm really curious to see where Daniel and I go, Daniel, welcome to qiological.

Daniel Schulman:

Hi, it's great to be here.

Daniel Schulman:

I love your show.

Michael Max:

Thank you.

Michael Max:

I have fun with it.

Michael Max:

You know, I get a new teacher every week.

Daniel Schulman:

Yes.

Daniel Schulman:

It's clear.

Daniel Schulman:

You're having a lot of fun.

Michael Max:

And getting away

Daniel Schulman:

with it too.

Daniel Schulman:

I know.

Daniel Schulman:

You'll have to write a book about that.

Michael Max:

Oh my God.

Michael Max:

I, you know, I've already got a couple of book projects, it's it?

Michael Max:

It, yeah.

Michael Max:

I'll, I'll, I'll add it to the list.

Michael Max:

Okay.

Michael Max:

Actually, you know, since you just brought that up, let me ask you a question.

Michael Max:

What kind of book would that be?

Daniel Schulman:

What would I write?

Daniel Schulman:

Have fun and get away with it.

Daniel Schulman:

Yeah.

Daniel Schulman:

Oh, well, I mean the new age world is full of you don't follow

Daniel Schulman:

your passion and all that stuff.

Daniel Schulman:

So you'd have to steer clear of that.

Daniel Schulman:

That market is full.

Michael Max:

Well, it's not even a market I'm interested in.

Michael Max:

Exactly.

Michael Max:

Yeah.

Michael Max:

Every, every time I've set out to go do something that I thought was a

Michael Max:

good idea that usually didn't pan out, you know, it's the stuff that, that

Michael Max:

came in from the periphery that like barely caught my attention, but, you

Michael Max:

know, I couldn't quite let go of that.

Michael Max:

That's the stuff that

Daniel Schulman:

stuck.

Daniel Schulman:

That's where the action is.

Daniel Schulman:

I think.

Daniel Schulman:

Yeah.

Daniel Schulman:

Isn't that weird?

Daniel Schulman:

Yeah.

Daniel Schulman:

The, the thing I always think of is, you know, when you're looking at the night

Daniel Schulman:

sky, the best falling stars are the ones you catch out of the corner of your eye.

Daniel Schulman:

I know when you're not looking, but I call it a light gaze.

Daniel Schulman:

Actually.

Daniel Schulman:

That's when I do my best work in clinic is when I'm looking at the

Daniel Schulman:

patient, but lightly from a, from an edge side, you know, not directly,

Daniel Schulman:

not with too much, you know, forced intention or something, I don't know.

Daniel Schulman:

Yeah.

Michael Max:

Yeah.

Michael Max:

That thing about coming at it from the peripheral vision.

Michael Max:

Yeah.

Michael Max:

That's interesting.

Michael Max:

Well, let's see here, where are we going to begin with this?

Michael Max:

You know, we were talking.

Michael Max:

About adverse reactions to acupuncture.

Michael Max:

And then you turned me onto an article that you did.

Michael Max:

Oh my God.

Michael Max:

It was like ages ago, like 2004 or something.

Daniel Schulman:

Yeah.

Daniel Schulman:

It's one of those embarrassing things where you go back and you

Daniel Schulman:

look and you say, oh God, right.

Daniel Schulman:

That so differently today.

Daniel Schulman:

Oh, of

Michael Max:

course, of course.

Michael Max:

You'd write it differently today that, you know, that just goes without

Michael Max:

saying, but I, I did go to the journal of Chinese medicine and download

Michael Max:

it cause I have subscribed to it.

Michael Max:

So I get, you know, the great thing about the journal of Chinese medicine.

Michael Max:

If you're a subscriber, you've got access to the whole back catalog.

Michael Max:

It's, it's kind of like, qiological right.

Michael Max:

You can listen to the whole dang thing if you want.

Michael Max:

There's a lot there too.

Michael Max:

Yeah.

Michael Max:

There's a lot there.

Michael Max:

It's the journal of Chinese medicine.

Michael Max:

So yeah.

Michael Max:

You wrote this article about adverse reactions.

Michael Max:

I read it.

Michael Max:

I actually thought it was quite spot on.

Michael Max:

I thought it, it held up over the years.

Daniel Schulman:

Yeah.

Daniel Schulman:

I think the meat is there for sure.

Daniel Schulman:

And, uh, uh, I just, I was trying to open up a richer conversation, you

Daniel Schulman:

know, we tend to just, there's this superficial thing, you know, someone has.

Daniel Schulman:

Less than perfect response to treatment.

Daniel Schulman:

And we typically all say, oh, it's a healing reaction.

Daniel Schulman:

Don't worry about it.

Daniel Schulman:

And that may be true, but I wanted us to as a profession because as we get

Daniel Schulman:

more scrutinized by the public and by society at large, we're going to have

Daniel Schulman:

to be able to speak up about these things with some depth, uh, honesty.

Daniel Schulman:

And so I think there's a way for us to really dig into that subject of less

Daniel Schulman:

than pleasant responses to acupuncture.

Daniel Schulman:

I don't like the word adverse, but I don't know what the right word is.

Daniel Schulman:

So let's we

Michael Max:

can go.

Michael Max:

Yeah.

Michael Max:

Let's, let's try on that.

Michael Max:

Maybe we'll come up with something.

Michael Max:

I, I think there's

Daniel Schulman:

a way to differentiate and pick it apart and

Daniel Schulman:

actually identify many different possible things that are going

Michael Max:

on.

Michael Max:

All right.

Michael Max:

Well, let's, let's, let's look at some of those because I to hear,

Michael Max:

and you hear this a lot in the I'm using air quotes here, alternative

Michael Max:

health world about a healing crisis.

Michael Max:

And a question that I've had.

Michael Max:

I mean, ever since I've been doing acupuncture is okay, what's

Michael Max:

the difference between a healing crisis and a screwed up treatment?

Michael Max:

I mean, let's be honest, let's be honest if our medicine is as

Michael Max:

powerful as we like to think it is, and we can really help people.

Michael Max:

Wouldn't it stand to reason that we could also really take them off the rails?

Daniel Schulman:

Yeah, it is.

Daniel Schulman:

It's very powerful.

Daniel Schulman:

I look, I practice acupuncture without herbs and I keep saying to people,

Daniel Schulman:

this is seriously powerful medicine.

Daniel Schulman:

I mean, the stuff I've witnessed in my clinic over 20 years is very powerful.

Daniel Schulman:

It's not just this light fluffy thing.

Daniel Schulman:

Yeah.

Michael Max:

So let's start with healing crises.

Michael Max:

How do you know what's a real healing crisis and what's just,

Michael Max:

oops, I goofed that one out.

Daniel Schulman:

Ah, Ooh.

Daniel Schulman:

Such a complex question.

Daniel Schulman:

Well, I mean, I think that word healing crisis.

Daniel Schulman:

Maybe we want to dispense with.

Daniel Schulman:

Cause I think that comes from somewhere else.

Daniel Schulman:

I think maybe it comes from homeopathy.

Daniel Schulman:

I'm not sure

Michael Max:

they do talk about that

Daniel Schulman:

perhaps significantly due to sort of Jeffrey Yuen and

Daniel Schulman:

all of his students, although it's elsewhere in our medicine, for sure.

Daniel Schulman:

There's, you know, w we were sitting on top of them 2000 year old history,

Daniel Schulman:

uh, framework of understanding of the body as a series of layers and levels

Daniel Schulman:

and depth, and the whole idea that as we proceed through life, we encounter

Daniel Schulman:

all kinds of bumps and bruises, whether they're emotional or physical.

Daniel Schulman:

Um, there's that whole concept that, you know, we either deal with them in the

Daniel Schulman:

moment or they get embodied in some way and go into our body and they get stored.

Daniel Schulman:

There are the term we use in English as kind of latent pathogens in some way.

Daniel Schulman:

And they can sit there forever or they can cause trouble or they can go deeper.

Daniel Schulman:

Or, and I think often what we do, I witnessed a time and time again with

Daniel Schulman:

acupuncture is we mobilize those things.

Daniel Schulman:

We get them moving.

Daniel Schulman:

And so w what I, I don't, I don't know if it's a correct direct translation.

Daniel Schulman:

I'd have to speak to a homeopath, but rather than healing crisis, I prefer

Daniel Schulman:

to speak within, within our medicine as, you know, mobilization of latency.

Daniel Schulman:

And that can be unpleasant.

Daniel Schulman:

It can be mildly unpleasant or severely unpleasant.

Daniel Schulman:

I've witnessed many examples of it in my practice.

Daniel Schulman:

And I think particularly in the social and medical context of our culture,

Daniel Schulman:

the minute someone has a reaction to something that's not pleasant.

Daniel Schulman:

You immediately go into a hole.

Daniel Schulman:

I mean, let's face it.

Daniel Schulman:

We live in a very litigious culture.

Daniel Schulman:

We live in a very simplified cause and effect framework of life culture,

Daniel Schulman:

which is well past its due date.

Daniel Schulman:

And so, so in the context, you know, it's difficult, you get, I get

Daniel Schulman:

different kinds of clients or patients.

Daniel Schulman:

Some people are ready to have a deeper discussion and some people, the minute

Daniel Schulman:

there's something bad happens, you know, they go running back to their

Daniel Schulman:

doctor and get treated for what happened from their acupuncture treatments.

Daniel Schulman:

And I never see them again.

Daniel Schulman:

And so there's quite a spectrum there, but so, so part of the adversity that

Daniel Schulman:

I'd like to keep in the conversation is whether the patient themselves is actually

Michael Max:

ready for it.

Michael Max:

Yeah.

Michael Max:

I think that's such a good point.

Michael Max:

All right.

Michael Max:

So often people will come in because of their knee or because

Michael Max:

of their back or anxiety.

Michael Max:

I'm using air quotes because I never know what that means to anyone.

Michael Max:

When they say it to me, I always have to inquire, but they come in

Michael Max:

because something's bothering them and they just want it to go away.

Michael Max:

Yeah, exactly.

Michael Max:

Sometimes something has been dogging somebody for decades, right.

Michael Max:

You're talking about latency, unresolved issues, traumas or illnesses, but

Michael Max:

something has been dogging them.

Michael Max:

Something has actually been really, really loyal to them and it is not going away

Michael Max:

until it gets dealt with in some way.

Michael Max:

And they've done a great job of keeping it below consciousness until they can't.

Michael Max:

And

Daniel Schulman:

even, even there mainstream medicine

Daniel Schulman:

has supported that effort.

Michael Max:

Let's hear it for psychoactive drugs, right?

Daniel Schulman:

Yeah.

Daniel Schulman:

Or, oh, there's so many examples, but, um, Yeah, they may be coming

Daniel Schulman:

in for what they think is small, but from our perspective, we immediately

Daniel Schulman:

see it as the tip of the iceberg.

Daniel Schulman:

And, and, you know, after 20 years of experience, I actually experienced this.

Daniel Schulman:

Now I'll get a patient in a new patient.

Daniel Schulman:

They'll come in for some little thing, this little thing, that's

Daniel Schulman:

bugging me on my fourth toe and I'll take the whole history.

Daniel Schulman:

Palp I do Japanese palpatory acupuncture.

Daniel Schulman:

I'll palpate everything.

Daniel Schulman:

And I'll be sitting there thinking to myself, oh God, I know, I'm pretty

Daniel Schulman:

sure we're going to stir up a rat's nest here or a hornet's nest, you know?

Daniel Schulman:

And then I looked at the patient and I asked myself, are they ready for this?

Michael Max:

That sounds super reassuring to me that you've got some diagnostics.

Michael Max:

You've got some ways of inquiring directly with the body to go, what else is here?

Michael Max:

What's happening here?

Michael Max:

Because, because then we don't get blindsided.

Michael Max:

Right.

Michael Max:

If you don't know that, that is there.

Michael Max:

And you do a treatment and Kaboom, something happens.

Michael Max:

It's like, God, now why I still

Daniel Schulman:

get that too?

Daniel Schulman:

Yeah, I had to just the other day, tell us about this the other day.

Daniel Schulman:

Okay.

Daniel Schulman:

This is, uh, this is humbling.

Daniel Schulman:

Cause I've been in practice 20 years.

Daniel Schulman:

It was easy to think, you know, everything.

Daniel Schulman:

Right?

Daniel Schulman:

This 80 year old woman, I live in a place where a lot of people

Daniel Schulman:

come here just for the summer.

Daniel Schulman:

So she's what I call a summer visitor.

Daniel Schulman:

She shows up she's very.

Daniel Schulman:

Bullheaded and like she's bossing me around.

Daniel Schulman:

Okay.

Daniel Schulman:

And even after 20 years and I've gotten pretty good with a lot of people, she's

Daniel Schulman:

exceptionally good at bossing me around.

Daniel Schulman:

And so I actually, I hate to admit it by I kind of succumbed

Daniel Schulman:

and she has wicked neck pain.

Daniel Schulman:

She can't turn her head at all.

Daniel Schulman:

It's just, it's killing her and I want it fixed now.

Daniel Schulman:

And the last time I had acupuncture, 10 years ago, it worked in one treatment.

Daniel Schulman:

I want you to do that, you know, no pressure.

Daniel Schulman:

Okay.

Daniel Schulman:

Sure.

Daniel Schulman:

So, you know, she's, and she's a summer visitor, so I know, you

Daniel Schulman:

know, she's not a long-term patient.

Daniel Schulman:

It's just kind of okay.

Daniel Schulman:

Get her through her vacation and get her home or what not.

Daniel Schulman:

She has a cottage here, so she's here for a month.

Daniel Schulman:

So I did one treatment and she got up, oh, it's no better.

Daniel Schulman:

And she was a little bossy with me.

Daniel Schulman:

And then she left and Michael, the next day she called, she said

Daniel Schulman:

that night I broke out in a sweat.

Daniel Schulman:

I got very weak.

Daniel Schulman:

And wicked diarrhea, just watery, runny diarrhea.

Daniel Schulman:

That won't stop.

Daniel Schulman:

It's like I'm going.

Daniel Schulman:

And she, and she's like, she went to the outpatients at the hospital

Daniel Schulman:

and, and I'm thinking, I mean, okay, could be coincidence, who knows.

Daniel Schulman:

But of course the reasonable thing to suggest is what did I,

Daniel Schulman:

I must've unleashed something.

Daniel Schulman:

I must misdiagnosed missed something, you know, she's 80 years old.

Daniel Schulman:

Right.

Daniel Schulman:

Which is, you know, so I'm just like, holy cow, what did I, what happened?

Daniel Schulman:

And I still, I haven't seen her, we've talked on the phone.

Daniel Schulman:

She, she went to the hospital.

Daniel Schulman:

I mean, I gave her a good advice.

Daniel Schulman:

I said, let's keep in touch, keep me in the loop with, with, you

Daniel Schulman:

know, the diarrhea and the weakness.

Daniel Schulman:

And I said, you know, keep drinking fluids.

Daniel Schulman:

I suggested ginger tea.

Daniel Schulman:

You know, I suggested all the things.

Daniel Schulman:

We would suggest that.

Daniel Schulman:

And, but she was getting us thorough workup from the hospital.

Daniel Schulman:

They w they were suggesting C difficile, which I, she hadn't

Daniel Schulman:

been in a hospital in years.

Daniel Schulman:

So anyway, But I CA I called her every other day.

Daniel Schulman:

How you doing?

Daniel Schulman:

And she said, by the way, my next all better, I think you're amazing.

Daniel Schulman:

I don't know.

Daniel Schulman:

We, we, that's, another part of this picture is we can kind of get away

Daniel Schulman:

with a lot of this because people don't realize we're practicing a

Daniel Schulman:

comprehensive framework of medicine, so they don't know the connections.

Daniel Schulman:

So they often don't suspect that things are triggered by what we do, because they

Daniel Schulman:

don't see the connections that we see.

Daniel Schulman:

I don't, I'm not sure she suspected that my treatment triggered

Daniel Schulman:

that, but I'm certain it did.

Daniel Schulman:

And I still don't know how or why.

Daniel Schulman:

Cause I haven't seen her since, although she assured me in our last phone call, the

Daniel Schulman:

hospital had cleared her of everything.

Daniel Schulman:

She's now feeling fine.

Daniel Schulman:

Uh, but you know, an 80 year old woman, three hours after your

Daniel Schulman:

treatment becomes very weak, starts sweating profusely and as severe

Daniel Schulman:

diarrhea, that's a little nervous.

Daniel Schulman:

I did something and I don't know.

Michael Max:

Yeah, what well, what happened right?

Michael Max:

Or something happened, something happened, and this is such a good question.

Michael Max:

And I think it's one thing when patients come in and they

Michael Max:

say, I got this, I got that.

Michael Max:

You get the history.

Michael Max:

I mean, all this kind of makes sense.

Michael Max:

Right.

Michael Max:

We put in our little boxes.

Michael Max:

Oh yeah.

Michael Max:

I know what to do about that.

Michael Max:

And then when we see a response and it's so unexpected, right.

Michael Max:

Of course first there's that emotional moment of oh shit.

Daniel Schulman:

Yeah.

Michael Max:

And I think that's a really human response.

Michael Max:

You know, I suspect any healing, professional, any medical

Michael Max:

professional, you know, has that goes through that from time to time.

Michael Max:

It's if anybody,

Daniel Schulman:

even Western modern medicine, of course probably happens

Michael Max:

every day.

Michael Max:

Well, of course it happens every day.

Michael Max:

I mean, their, their stuff is, is super strong.

Michael Max:

And if you look at the possible side effects of, you know, most, any

Michael Max:

medication, the list is longer than your.

Michael Max:

Right.

Michael Max:

So, so there were of that, but you know, to be able to take something

Michael Max:

that's a surprise and go, wow.

Michael Max:

I thought I knew what was going on.

Michael Max:

How do I make sense of this?

Michael Max:

You know, and this is one of the great things about the medicine we practice.

Michael Max:

We, while there's all kinds of different methods and there's many streams of

Michael Max:

medicine, and often we're actually arguing with each other, which I

Michael Max:

suspect is very counterproductive.

Michael Max:

You know, at the root, there is a set of principles that we all share and that

Michael Max:

set of principles, if we can somehow touch in on that, my suspicion is it

Michael Max:

can be helpful in helping us unpack what these responses are that we see.

Michael Max:

Yeah,

Daniel Schulman:

I'm sure if I'd seen her over the next couple of visits and,

Daniel Schulman:

you know, delve deeper into her issues to pay more attention to her Pauls.

Daniel Schulman:

And I probably would have figured out some reason for why that

Daniel Schulman:

happened, which might've, if she was a long-term patient, actually, uh,

Daniel Schulman:

deepened our capacity to go somewhere.

Michael Max:

Right.

Michael Max:

Yeah.

Michael Max:

And you know, and then there's the other thing, which is maybe she stopped

Michael Max:

at Joe's cafe and that burger was a little not, you know, we don't know.

Michael Max:

We don't know.

Michael Max:

We ended up with a lot of not knowing what her net pain got better.

Daniel Schulman:

She thinks I'm awesome.

Michael Max:

I'm wondering if you've seen this.

Michael Max:

I suspect you have people come in, you ask how, how are you

Michael Max:

doing, how you doing right.

Michael Max:

And sometimes you'll hear something like, oh, maybe a little bit.

Michael Max:

Uh, and I find that means one or two things.

Michael Max:

It means nothing has changed from being mice or it means everything has

Michael Max:

changed and I've already forgotten.

Michael Max:

I had the problem.

Michael Max:

Yeah.

Daniel Schulman:

That's, you're making a brilliant point.

Daniel Schulman:

I've actually gotten really punchy about responding to that.

Daniel Schulman:

I think a little better, or the one I hate even more is, well, I'm no worse.

Daniel Schulman:

I immediately push it back at them.

Daniel Schulman:

I say, look, you know, are you just being nice to me?

Daniel Schulman:

Cause I don't want you to be nice to me.

Daniel Schulman:

That's one thing I say.

Daniel Schulman:

And another thing I say as well, a little better means mostly not better.

Daniel Schulman:

Right?

Daniel Schulman:

Like, you know, one plus 99 equals a hundred.

Daniel Schulman:

So if you're 1% better, you're 99% not better.

Daniel Schulman:

So, and then they say, oh yeah.

Daniel Schulman:

And then, and then I dig deeper.

Daniel Schulman:

I say, so why did you say that?

Daniel Schulman:

And then I repeat to them why they came in.

Daniel Schulman:

I say, well, when you came in, you said this, this, and this has that changed.

Daniel Schulman:

And then usually we pick it out.

Daniel Schulman:

It's either they're really not better, but they're just being

Daniel Schulman:

nice or actually they're a little better than they wanted to admit.

Michael Max:

Yeah.

Michael Max:

And sometimes they're like phenomenally better and they have him, this to me,

Michael Max:

this is such a curious thing to me.

Michael Max:

It's like, they drop into this natural state of where they're supposed to be.

Michael Max:

Yeah.

Michael Max:

It's like the best treatments are the ones that they don't notice.

Daniel Schulman:

Yeah.

Daniel Schulman:

That's very humbling for us.

Daniel Schulman:

Isn't it?

Daniel Schulman:

Yeah, no, we get that all the time too, but, uh, that's fine.

Michael Max:

Yeah.

Michael Max:

I actually like it when, when that happens for people,

Daniel Schulman:

I mean, this is getting a little off topic, but

Daniel Schulman:

like I practice in a smallish town.

Daniel Schulman:

So I bumped into my patients all the time at the grocery store.

Daniel Schulman:

So like, you know, someone you'll finish a few treatments with someone and they'll

Daniel Schulman:

say, well, I'm not sure it's working.

Daniel Schulman:

I'm going to stop now.

Daniel Schulman:

And then you'll run into them a year later in the grocery store.

Daniel Schulman:

And they'll say something like you changed my life.

Daniel Schulman:

There seems

Michael Max:

to be a thing with trajectory.

Michael Max:

Yeah.

Michael Max:

Sometimes there's like a little shift that happens and you don't notice it.

Michael Max:

Like you barely notice it.

Michael Max:

It's like the turn of a season.

Michael Max:

Like this morning here in St.

Michael Max:

Louis, I walked outside and it's chilly.

Michael Max:

It was chilly enough that it's like, I'm putting socks on.

Michael Max:

It's first time I put socks on in months.

Michael Max:

Um, but they're like tiny changes and you don't even hardly notice it

Michael Max:

until the season or two goes by in

Daniel Schulman:

retrospect, some kind of retrospect.

Daniel Schulman:

Yeah.

Daniel Schulman:

So there's that.

Daniel Schulman:

Yeah, but the fascinating things are, what's our medicine

Daniel Schulman:

about it's about change.

Daniel Schulman:

So this is a really interesting,

Michael Max:

so let's get back to this thing about lingering pathogens

Michael Max:

or, you know, physiological issues, traumas, things that, that have

Michael Max:

not found their way to resolution.

Michael Max:

What's your sense of what's going on with all this?

Daniel Schulman:

Well, I mean, I love it.

Daniel Schulman:

I think, I think that's what better strength of our medicine is there

Daniel Schulman:

then to help people, uh, ex express to the outside what's lingering.

Daniel Schulman:

I mean, that's, what's in the way.

Daniel Schulman:

Yeah, but that's a very different, I mean, I think that's, what's

Daniel Schulman:

radically different about our medicine.

Daniel Schulman:

I mean, I see it all the time.

Daniel Schulman:

I'll needle, a channel on the patient patient will come in the next week

Daniel Schulman:

and say, you know, I developed this huge, did you stick a needle here?

Daniel Schulman:

And they'll point to this boil, you know, this big boil on the channel,

Daniel Schulman:

I'll say, no, not even close.

Daniel Schulman:

And then it turns out in their history.

Daniel Schulman:

We, we delve into there.

Daniel Schulman:

There's some reason for some, uh, latent, toxic heat to be

Daniel Schulman:

in that part of their system.

Daniel Schulman:

Maybe they had some major infection a few years ago, or they had surgery

Daniel Schulman:

along that channel somewhere.

Daniel Schulman:

And they went to the hospital with post-surgical infection

Daniel Schulman:

or something so that, you know, that's just at the simplest level.

Daniel Schulman:

I see that all the time in some kind of boil or skin reaction along a channel

Daniel Schulman:

or in some channel relationship to what I did that is, that's just, that's

Daniel Schulman:

nothing but good from our perspective that they, they expressed that, you

Daniel Schulman:

know, you don't want that lingering.

Daniel Schulman:

And I think we provoked that all the time.

Daniel Schulman:

I think often it's even below the radar.

Daniel Schulman:

We may not even know we've provoked.

Daniel Schulman:

I always like to say in the treatment room, there's 10,000 things happening

Daniel Schulman:

and I'm lucky if I can see 20 of them,

Daniel Schulman:

but I mean, I've had some pretty radical and dramatic cases.

Daniel Schulman:

Like I had one woman I'll never forget this.

Daniel Schulman:

And she was a massage therapist and this is only what we discovered

Daniel Schulman:

was only discoverable by the fact that she knew her body.

Daniel Schulman:

So well as a massage therapist, but we did a series of treatments

Daniel Schulman:

and she started to develop skin reactions after each treatment.

Daniel Schulman:

And because she's a massage therapist, she actually mapped the

Daniel Schulman:

skin reactions for me each week.

Daniel Schulman:

That's helpful.

Daniel Schulman:

So first of all, most patients after the first treatment would have called

Daniel Schulman:

and said, I don't think I'll come back.

Daniel Schulman:

They would have gone to their doctor, gotten steroids and suppressed

Daniel Schulman:

and skin reaction and concluded that they have some kind of quote

Daniel Schulman:

unquote allergy to acupuncture.

Daniel Schulman:

And that would have been the end of that.

Daniel Schulman:

But because he was in the alternative health field, which

Daniel Schulman:

was a massage therapist, she was curious, she was interested.

Daniel Schulman:

She trusted the process and she mapped the skin reactions.

Daniel Schulman:

Stunning, Michael, you could actually see over a course of six treatments

Daniel Schulman:

that her body was expressing something through our six levels on the young side.

Daniel Schulman:

So first I can't, honestly, it was a long time ago.

Daniel Schulman:

I can't remember, but let's say first it was expressed in, on the young Ming

Daniel Schulman:

aspects or body than the show young and the Taiyang I forget the order,

Daniel Schulman:

but it was very clear that every two weeks progressed through distinct

Daniel Schulman:

young ages and then it was, and then it was gone and it never came back.

Daniel Schulman:

She got all better.

Daniel Schulman:

And I saw her a year later and she said, I've just had the best year of my life.

Daniel Schulman:

So clearly that was radical.

Daniel Schulman:

And that's an example of something.

Daniel Schulman:

That's an example of something that I probably would have never seen in another

Daniel Schulman:

patient because a, they might've never come back after the first week or B they

Daniel Schulman:

wouldn't have had the knowledge or the curiosity or the interest to map it.

Daniel Schulman:

So that case just offered that opportunity to really witness a profound process.

Daniel Schulman:

That's fully in line with our whole framework of her body,

Daniel Schulman:

getting rid of a latent pathogen

Michael Max:

through the levels that they talk about it going through.

Daniel Schulman:

Exactly.

Daniel Schulman:

It was very clear.

Michael Max:

Well, you know, this, this is, I'm making a note to myself here that

Michael Max:

the next time something seems a little bit off the rails to see if I can somehow

Michael Max:

engage my patients' curiosity about that.

Michael Max:

It's like, is, is there a way that I can get them involved in mapping it?

Michael Max:

You know, some people come in with a list, right?

Michael Max:

It's like, how you doing?

Michael Max:

They, they pull out a little notebook and they got everything written down.

Michael Max:

Right, right.

Daniel Schulman:

Right.

Daniel Schulman:

Or to type pages for you

Michael Max:

and others are just more like, well, I don't know.

Michael Max:

So I, I suspect it has something to do with the patient's personality,

Michael Max:

whether you could enlist enlist them in that process, but it seems like

Michael Max:

that would be very helpful if we could.

Daniel Schulman:

Yeah.

Daniel Schulman:

But, but, uh, I really, really, really believe strongly that our, where we

Daniel Schulman:

go with each patient is unique to the degree, to which you already in Louisiana,

Daniel Schulman:

the degree to which they're ready and the degree to which we're ready.

Daniel Schulman:

So each, each trajectory of a clinical encounter I believe is constrained or

Daniel Schulman:

defined by that unique combination.

Daniel Schulman:

So there's no one trajectory.

Daniel Schulman:

I mean, you have patients who can go far with, and you have patients

Daniel Schulman:

who, the dynamic between the two of you is just such that you're just,

Daniel Schulman:

you're just not going to go very far.

Michael Max:

I think that's a really good point.

Michael Max:

There a patient may be willing.

Michael Max:

We may not have the, the wherewithal.

Daniel Schulman:

We may not, or we may be ready,

Michael Max:

but they may not, but they may not.

Michael Max:

I've seen, I've seen that.

Michael Max:

I had someone just the other day, remember asking them a question about a question

Michael Max:

about something that to me made a lot of sense, and I got this blank stare back.

Michael Max:

Like, is there supposed to be an answer to that question?

Michael Max:

And I thought, oh, okay, well let's, let's connect where we can connect.

Michael Max:

And then I'll just wait for you to tell me what the next step.

Daniel Schulman:

Exactly.

Daniel Schulman:

But I think we also have to be careful because there's also that kind of, I've

Daniel Schulman:

heard people in alternative medicine in general slip, a little too superficially

Daniel Schulman:

into, well, they just weren't ready.

Daniel Schulman:

We have to be a little careful about, so

Michael Max:

I think we need to be very careful around that.

Daniel Schulman:

Very humble on our side too, because it's also

Daniel Schulman:

possible that they're ready, but they just don't trust you yet.

Daniel Schulman:

Well,

Michael Max:

why should they, I mean, if they've just met us.

Daniel Schulman:

Yeah.

Daniel Schulman:

And maybe they'd been betrayed by medicine 50 times already, you know, we don't know.

Daniel Schulman:

Well,

Michael Max:

you know, that's an, it's interesting that

Michael Max:

you say betrayed by medicine.

Michael Max:

I, I often feel like I see refugees from the conventional medical system and oddly

Michael Max:

enough, I mean, before we started rolling tape here today, I was, I was, we were

Michael Max:

talking about stuff and I said, yeah, I never expected to be involved in Metro.

Michael Max:

That was, that was never on my radar that came in from the periphery.

Michael Max:

And partly because yeah, I, with the best of intentions, I was

Michael Max:

betrayed as a child with the medicine with conventional medicine.

Daniel Schulman:

Well, I have another interesting, I mean, we can turn this

Daniel Schulman:

whole thing on its head and use our medicine to evaluate modern medicine.

Daniel Schulman:

So which, which is something I find FA a prospect that I find

Daniel Schulman:

fascinating, but will never happen on a significant level until we're equal

Daniel Schulman:

partners with modern medicine and the system, if that ever comes to pass.

Daniel Schulman:

But you know, a great example.

Daniel Schulman:

I had someone come in once for psoriasis and when I took her history, she

Daniel Schulman:

actually had a bad case as a little child, two or three years old, I

Daniel Schulman:

was strabismus, which is it's an eye muscle issue and was subjected to

Daniel Schulman:

surgery to cut some of the muscles on the side of her eyes so that our eyes

Daniel Schulman:

stopped deviating out to the left.

Daniel Schulman:

I think.

Daniel Schulman:

Uh, so that's at age three.

Daniel Schulman:

Now, if you read Julian Scott's pediatric book, he's very clear that strabismus in

Daniel Schulman:

children is a lingering pathogenic factor and he's got a whole thing about it.

Daniel Schulman:

Um, so then in her twenties, she developed severe ulcerative colitis and wound

Daniel Schulman:

up, uh, having, um, a bowel resection.

Daniel Schulman:

And then in her thirties, she developed severe psoriasis.

Daniel Schulman:

And that's when she showed up in my clinic now and we treated her and she actually

Daniel Schulman:

got better, but that's beside the point.

Daniel Schulman:

The point I'm making here is that we can look at that and

Daniel Schulman:

say, well, that's interesting.

Daniel Schulman:

Imagine if an acupuncturist had treated her strabismus as a kid, you know,

Daniel Schulman:

we might've inline with everything we've just talked about for the last

Daniel Schulman:

half hour helped her body expel the lingering pathogenic factor that was

Daniel Schulman:

implicated in the implicating, the strabismus, and maybe stop this whole

Daniel Schulman:

progression altogether, but modern.

Daniel Schulman:

We'll have to be careful.

Daniel Schulman:

This is just a suggestion, but we certainly have a strong capacity in our

Daniel Schulman:

medical frameworks, in Chinese medicine to say that modern medicine drove that

Daniel Schulman:

pathogen deeper and deeper and deeper.

Daniel Schulman:

And so we can also look back at the other half of medicine in our culture and

Daniel Schulman:

make suggestions about adverse effects.

Daniel Schulman:

Yes,

Michael Max:

we could.

Michael Max:

They probably wouldn't be seen that way.

Michael Max:

One of the things I find that we're up against here is how do you measure

Michael Max:

something that didn't happen, right?

Michael Max:

I mean, you can measure something that's formed and present, right?

Michael Max:

Right.

Michael Max:

Evidence-based medicine.

Michael Max:

I'm using air quotes here, all the different kinds of

Michael Max:

blood tests and imaging.

Michael Max:

I mean, all these things, we can find stuff that's formed.

Michael Max:

We can find stuff that's pre.

Michael Max:

Yeah, but how do you recognize that you swept the stones and branches

Michael Max:

out of a person's path so that in trip on them, I mean, there's really

Michael Max:

no way to measure this, right?

Michael Max:

I mean, we, and we'd like to talk about it and we can make some

Michael Max:

great stories about it, you know?

Michael Max:

And from our perspective, yeah, you, you clear something out at age three, they

Michael Max:

don't have to, what have you prevented?

Michael Max:

What have you prevented?

Michael Max:

There's no way to measure it.

Michael Max:

No

Daniel Schulman:

way.

Daniel Schulman:

And you could have prevented a

Michael Max:

lot.

Michael Max:

We could

Daniel Schulman:

prevent a lot.

Daniel Schulman:

I mean, you've hit the nail on the head.

Daniel Schulman:

I think the biggest thing we're up against is, you know, what

Daniel Schulman:

philosophers call materialistic science, which you know, is predicated on.

Daniel Schulman:

If you can't measure it, it's not real.

Daniel Schulman:

It doesn't exist.

Daniel Schulman:

I like to say I've noticed in most of the arguments and debates I get in with

Daniel Schulman:

people, whatever we're talking about, we could be talking about climate

Daniel Schulman:

change, Donald Trump, you know, the middle east medicine doesn't matter.

Daniel Schulman:

If you look underneath you notice that people tend to fall into, to

Daniel Schulman:

be simplistic, two camps, one camp predicates, its perception on the

Daniel Schulman:

fact that we know almost everything.

Daniel Schulman:

And we're just, we're just cleaning up the details.

Daniel Schulman:

And the other camp is predicated on the notion or the posture that,

Daniel Schulman:

well, we still almost know nothing.

Daniel Schulman:

And I think that sets in motion most people's capacity to have the

Daniel Schulman:

kind of discussion we're having.

Daniel Schulman:

I like to suggest that it's both, that the problem is in saying it's

Daniel Schulman:

one or the other that actually we know a hell of a lot and it's impressive.

Daniel Schulman:

And at the same time, we also don't know

Michael Max:

much.

Michael Max:

That's a very Chinese medicine way of thinking about it.

Michael Max:

And

Daniel Schulman:

so will your, your point about, you know, how can, how can we

Daniel Schulman:

talk about something we can't measure?

Daniel Schulman:

Just because we can't measure it doesn't mean we can't see it.

Daniel Schulman:

Um, and I often think you're working with a patient let's say on some

Daniel Schulman:

kind of kidney or liver issue.

Daniel Schulman:

And they happen to be getting blood tests from their doctor at the same time.

Daniel Schulman:

And like their liver enzymes are getting better as you're treating

Daniel Schulman:

them or their creatinine levels are improving as you're treating them.

Daniel Schulman:

And so we like to think, oh wow, it's actually really happening.

Daniel Schulman:

But you know, my reference point is never to forget that the creatinine

Daniel Schulman:

or the liver enzymes is probably at best 2% of everything that's going on.

Daniel Schulman:

So, so it's awesome that they're getting better at, on as a creatinine

Daniel Schulman:

or a liver enzyme measurement.

Daniel Schulman:

That's awesome.

Daniel Schulman:

It's fantastic.

Daniel Schulman:

But let's not forget that 98% of what's improving, isn't included in that measure.

Michael Max:

I think that's such a good point.

Michael Max:

And I think it's so easy for us to point to some of the Western diagnostics

Michael Max:

and go see, look, it proves that our medicine it's really happening.

Michael Max:

Exactly.

Michael Max:

You know, it's like research a lot of research.

Michael Max:

I, you see this stuff come across Facebook or you'll, you'll

Michael Max:

see it in different places.

Michael Max:

Oh, acupuncture is shown to blah, blah, blah, blah, blah.

Michael Max:

And we use researches.

Michael Max:

Marketing is

Daniel Schulman:

so powerful.

Daniel Schulman:

It's those?

Daniel Schulman:

The doctors

Michael Max:

it's well, it tells a very compelling story in our

Michael Max:

modern materialistic world.

Daniel Schulman:

Absolutely.

Daniel Schulman:

But so let's say a patient has six treatments with you and they come back

Daniel Schulman:

and they say, wow, my liver enzymes are normal or my blood sugars normal.

Daniel Schulman:

And my husband's saying that he hasn't felt this way about our relationship.

Daniel Schulman:

Since we got married 35 years ago.

Daniel Schulman:

So good about it.

Daniel Schulman:

What impresses you more or are they coming after 16 minutes and say I'm actually,

Daniel Schulman:

I'm finally decided to quit the job that's been killing me for the last 30 years.

Michael Max:

All right.

Michael Max:

Yeah.

Michael Max:

When people make those really big changes or they come in because of

Michael Max:

problem X, and then they notice that, well, you know, I still got my problem

Michael Max:

X, but my sleep is like this and wow.

Michael Max:

My bowels are really working well.

Michael Max:

And I've noticed, I've noticed that my children are not so irritating.

Daniel Schulman:

You know, that's a great point.

Daniel Schulman:

Oh, I've always wondered.

Daniel Schulman:

You know, like for example, one symptom that's notoriously difficult to treat

Daniel Schulman:

with active measures 10 tonight is right.

Daniel Schulman:

But, but people come in for it and then we do a bunch of treatments and like 25

Daniel Schulman:

other things get better, but the tinnitus doesn't and then that begs the exact

Daniel Schulman:

question you just asked is what is it?

Daniel Schulman:

We're.

Daniel Schulman:

And what's important and one symptom may have brought them in, but of

Daniel Schulman:

course we're treating the whole system.

Michael Max:

Yeah.

Michael Max:

And sometimes we don't even, I was going to say, we don't even know the

Michael Max:

depth of what we're touching into and I was going to back off from that.

Michael Max:

But actually I think I'm going to stick with it.

Michael Max:

Yeah.

Michael Max:

Often I know in my practice, I think I know what I'm doing.

Michael Max:

And then the patients will say something or like we're talking about, there's a,

Michael Max:

there's a response of some sort that's surprising and maybe frightening to them.

Michael Max:

Yep.

Michael Max:

And, um, and I think we need to take that stuff seriously.

Michael Max:

It's like, wow, here's some very useful information.

Michael Max:

How do we put that all together?

Michael Max:

You know, if they come back.

Michael Max:

Right.

Michael Max:

I mean, I've had people that called me and said, you know, am

Michael Max:

I supposed to have numbness in my hands and feet after acupuncture?

Michael Max:

Yeah.

Michael Max:

Yep.

Michael Max:

And I'm thinking, and I'm thinking, oh God, I hope I wrote good clinic notes.

Michael Max:

Right.

Michael Max:

Cause it's like, where did that come from?

Daniel Schulman:

Well, I am finding that more and more patients, and

Daniel Schulman:

these are the ones I find rewarding.

Daniel Schulman:

And I love working with them.

Daniel Schulman:

Really do recognize this as a process.

Daniel Schulman:

And it's a bumpy process and there's, you know, getting back to our main theme of

Daniel Schulman:

adverse reactions, it's a bumpy process.

Daniel Schulman:

There's ups and downs.

Daniel Schulman:

We can trigger things that are not welcomed, but are part of the process.

Daniel Schulman:

So, you know, those are, those are the ones.

Daniel Schulman:

I mean, that's the rewarding work, right?

Michael Max:

It is.

Michael Max:

Well, let me ask you this.

Michael Max:

Especially if the patient is a bit freaked out.

Michael Max:

Yeah.

Michael Max:

How do you invite them into that process?

Michael Max:

How do you invite them into, oh, there's something here.

Michael Max:

Shall we, shall we see what's here?

Daniel Schulman:

Well, I think the first point is what we talked about earlier.

Daniel Schulman:

You can only take the process.

Daniel Schulman:

The process is first limited by both where, how far you're

Daniel Schulman:

willing and able to go and how far they're willing and able to.

Daniel Schulman:

Uh, that's the first thing is to really look at that, like, cause

Daniel Schulman:

you're getting it in trouble.

Daniel Schulman:

If you try to go somewhere that either you or the patient

Daniel Schulman:

don't have the capacity to go.

Daniel Schulman:

That's the first thing, but then if, if everything's good and everything, you

Daniel Schulman:

know, then I just, I just really work hard to win their trust, just to say,

Daniel Schulman:

can we, can, we let's trust the process.

Daniel Schulman:

First of all, I say, you've got my cell phone number with me all the time.

Daniel Schulman:

You know, a lot of assurance you can call me on Sunday morning.

Daniel Schulman:

If, if something happens, call me anytime.

Daniel Schulman:

If you get my voicemail, leave a message, I'll call you right back.

Daniel Schulman:

You know, all that, all that stuff to let them know I'm with them.

Daniel Schulman:

And then I think, you know, if you're willing, if you're interested,

Daniel Schulman:

I've been at this, you know, 20, I can use my 20 year thing and I've

Daniel Schulman:

seen this a lot 99.9% of the time.

Daniel Schulman:

It's, it's not a bad thing in the long run.

Daniel Schulman:

Can you, can you just trust, surrender a bit and trust the process I'm with you.

Daniel Schulman:

Let's let's continue, but, but then I'll also let them know, but look, if

Daniel Schulman:

you don't want to do it, that's fine.

Daniel Schulman:

Don't worry about me.

Daniel Schulman:

You want to, you know, some people actually don't want

Daniel Schulman:

to upset their doctors.

Daniel Schulman:

Right.

Daniel Schulman:

You know, that's a big thing.

Daniel Schulman:

Well, I even let them know.

Daniel Schulman:

Don't worry about me.

Daniel Schulman:

If you want to cancel the next appointment and think about it.

Daniel Schulman:

No problem.

Daniel Schulman:

Like, you know, I just try to set the whole context in a very

Daniel Schulman:

kind of assured trustworthy frame

Michael Max:

and let them know you're available.

Michael Max:

I'm here.

Michael Max:

I'm not, I'm not leaving you hanging.

Michael Max:

No.

Michael Max:

Are there any, I'm going to call them like early warning signs, anything

Michael Max:

that you sometimes might pick up in the pulse or the tongue or your

Michael Max:

pal palpatory work that lets you know, Ooh, might be an iceberg here.

Michael Max:

Might be something else here.

Michael Max:

Any do, do things that tip you off.

Michael Max:

Well

Daniel Schulman:

more just my experience.

Daniel Schulman:

I mean, I think particularly in the whole depression and anxiety field,

Daniel Schulman:

if someone's been medicated for a long time, I'm always very quick to warn them.

Daniel Schulman:

This could be a Rocky road.

Daniel Schulman:

Are you ready for that?

Daniel Schulman:

And I let them know I'm there with them.

Daniel Schulman:

And then in the long run, I feel confident we can, we can probably do great work

Daniel Schulman:

together, but, but are you ready for this?

Daniel Schulman:

Yeah.

Daniel Schulman:

And I even, do you have the supports in place?

Daniel Schulman:

Do you have a good husband or wife?

Daniel Schulman:

Do you have brothers or sisters?

Daniel Schulman:

Do you have a good friends?

Daniel Schulman:

Because sometimes it's easy, but sometimes I've had patients who

Daniel Schulman:

have gone off the rails emotionally.

Daniel Schulman:

Uh, it's just too

Michael Max:

much.

Michael Max:

Well, you know, we're not psychotherapists.

Michael Max:

Nope.

Michael Max:

And yet at the same time, because of the kinds of questioning that we do,

Michael Max:

because we do have this rather holistic, I hate that word, holistic approach.

Michael Max:

We need different language, but you know, but in some ways, because

Michael Max:

we see the mind and the body as an integrated fabric, Completely together.

Michael Max:

We cannot help, but tread into some of the area that a psychotherapist would

Michael Max:

tread into, just because we're asking certain kinds of questions and because

Michael Max:

we're attending to certain aspects of who a patient is, what are your thoughts

Michael Max:

about treading into some of the psycho emotive material that is bound to come up?

Michael Max:

Because it's just part of who a person is.

Michael Max:

And we tend to invite the whole person into the treatment.

Michael Max:

Well,

Daniel Schulman:

I personally feel very comfortable with all of it.

Daniel Schulman:

Like I don't, it doesn't bother me.

Daniel Schulman:

It doesn't, I'm not nervous about that at all, but I think each of us is

Daniel Schulman:

different based on our own experience.

Daniel Schulman:

I think, I think that's the half of what we've been talking about.

Daniel Schulman:

That's important.

Daniel Schulman:

Isn't it?

Daniel Schulman:

It's not just that it's the patient ready?

Daniel Schulman:

Is that, are we ready to, and if we're not, then let's not go there.

Daniel Schulman:

Let's, let's be quick to say, okay, we need to get a

Daniel Schulman:

therapist online onboard here.

Daniel Schulman:

Yeah, that's one thing.

Daniel Schulman:

The other thing of course is depending on the jurisdiction you're in, you

Daniel Schulman:

could be into some scope of practice, uh, conundrums, just legally or

Michael Max:

whatever.

Michael Max:

I don't know.

Michael Max:

I've heard of situations where acupuncturists have been sued for doing

Daniel Schulman:

psychotherapy, but our medicine offers so much not

Daniel Schulman:

in the regard of the integration of mind, heart, body, et cetera.

Michael Max:

Oh, well, you know, we don't even, we never saw it as separate exactly.

Michael Max:

I mean, saying that they're integrated, still predisposes

Michael Max:

the idea that it's separate.

Daniel Schulman:

I mean, uh, I, I like to say, you know, your frustration

Daniel Schulman:

and your liver enzymes are one thing.

Michael Max:

Yeah.

Michael Max:

Let's dive into that for a moment.

Michael Max:

Cause there's, there's sometimes this idea think about the Oregon's in the Oregon

Michael Max:

functions and you know, if we let it slip, oh, I'm worried about your liver.

Michael Max:

People are like, oh God, my liver, what do I have cirrhosis?

Michael Max:

Can you know what?

Michael Max:

No, no, I'm not talking about that.

Michael Max:

Liver.

Michael Max:

I'm talking about other liver.

Michael Max:

It has nothing to do with it.

Michael Max:

But what I hear you saying is it absolutely has something to do with it.

Michael Max:

It does,

Daniel Schulman:

but you know, I mean, I agree with you a hundred percent.

Daniel Schulman:

Uh, many years ago I stopped using the terms, liver and kidney,

Daniel Schulman:

unless I'm really pushed by the.

Daniel Schulman:

It's kind of weird.

Daniel Schulman:

I actually, I mean, part of my evolution clinically is I now think more in

Daniel Schulman:

terms of a tie in shaoyang JueYin.

Daniel Schulman:

Oh,

Michael Max:

tell us more about that.

Michael Max:

That really caught my attention in the past few years as well.

Daniel Schulman:

Yeah.

Daniel Schulman:

I don't know.

Daniel Schulman:

I just kind of evolved.

Daniel Schulman:

I think it was after I did the ed doctor, ed Neal's online Neijing studies program.

Daniel Schulman:

And that just got me thinking it more in clinic.

Daniel Schulman:

Well, and then I, I remember I started doing renderings on cold pulses for about

Daniel Schulman:

two years with every patient and it just, my own predilection is that this is going

Daniel Schulman:

to sound a bit extreme, but I'll say it extremely just to get people's attention.

Daniel Schulman:

I don't, I don't care about people's symptoms.

Daniel Schulman:

I want to go deeper.

Daniel Schulman:

Um, of course I care, but I'm just saying that for shotgun, but if you don't,

Michael Max:

you don't get stuck with just a symptom.

Michael Max:

But, um, I,

Daniel Schulman:

this, my inquiry in clinic has taken me to a place.

Daniel Schulman:

You know, I really do first and foremost, try to focus on treating the six levels

Daniel Schulman:

where at what level is this problem?

Daniel Schulman:

And I know the D the levels go in a scholarship way and herbal medicine and

Daniel Schulman:

acupuncture are very different concepts.

Daniel Schulman:

There's, it's not clear, but, and I'm just an acupuncturist, but I do find

Daniel Schulman:

based on palpation, which is what I do.

Daniel Schulman:

That's how I intake my patients primarily as palpation is shockingly.

Daniel Schulman:

And, you know, 70 to 80% of my patients, I find most of their issues are either in a,

Daniel Schulman:

I think you had a recent conversation with somebody about this with som acupuncture

Daniel Schulman:

are either in tie in, um, Yangming or shaoyang joy in, or ShaoYin Taiyang.

Daniel Schulman:

I just find that it's like, it's blowing me away.

Daniel Schulman:

It's like, it just keeps showing up.

Daniel Schulman:

So I'll focus the tree.

Daniel Schulman:

On one of those three core tats of channels, most of the, and the treatments

Daniel Schulman:

are very powerful that way I find.

Daniel Schulman:

And so I've actually gotten to the point where that's, regardless of their

Daniel Schulman:

symptoms, that's what I'm treating is what channel, what, which levels and which

Daniel Schulman:

channels are screaming to be treated here.

Daniel Schulman:

And the amazing thing is that it takes you away from the symptoms alone.

Daniel Schulman:

Of course, as you know, anything can be it.

Daniel Schulman:

Great.

Daniel Schulman:

I really can.

Daniel Schulman:

I mean, six, six cases of colitis can be six completely

Michael Max:

different problems.

Michael Max:

Is it a TaiYin colitis or trillion

Daniel Schulman:

colitis?

Daniel Schulman:

I had a patient in recently and she's a physiotherapist.

Daniel Schulman:

She knows her body.

Daniel Schulman:

She, all of her symptoms, symptoms lined up on Yangming all of them.

Daniel Schulman:

It was like, this is cool.

Daniel Schulman:

You know, one of those moments of, wow, this is cool from her, from her

Daniel Schulman:

toes to her nose, everything lined up on Yangming and I got seduced by that.

Daniel Schulman:

I got seduced and I treated Yangming for like six.

Daniel Schulman:

And, and there was no response.

Daniel Schulman:

In fact, her colitis was almost getting worse.

Daniel Schulman:

Oh man.

Daniel Schulman:

So I did what I call.

Daniel Schulman:

I had what I call an extra sketch moment where I just, you know, I

Daniel Schulman:

just said, okay, it's time to go.

Daniel Schulman:

Tabula, rasa cleared those screens.

Daniel Schulman:

You know, no one, you shake that screen and start over.

Daniel Schulman:

And I, and I, and she, because she's a physiotherapist, she was with me.

Daniel Schulman:

He said, okay, let's do this, let's do this.

Daniel Schulman:

I'm just going to reevaluate everything.

Daniel Schulman:

I retook our poles, read palpated, her body and Michael, everything

Daniel Schulman:

showed up as an injury in everything.

Daniel Schulman:

I mean, even on her pulse that you could feel this heat in the blood level.

Daniel Schulman:

So I gave her a Dwayne shaoyang true.

Daniel Schulman:

And poof, she called me and said, my colitis just got like 80% better in a

Michael Max:

week.

Michael Max:

Holy smokes.

Michael Max:

Okay.

Michael Max:

Hang on a sec.

Michael Max:

I want to unpack this a little bit.

Michael Max:

This is

Daniel Schulman:

I just pay less and less attention to the symptoms

Daniel Schulman:

and I evaluate the channels.

Daniel Schulman:

And so then getting back to your original, let me just finish getting

Daniel Schulman:

back to your original question.

Daniel Schulman:

You know, people want to know how I don't mention liver anymore.

Daniel Schulman:

I don't mention kidney.

Daniel Schulman:

I try to just be quiet and just do my work.

Daniel Schulman:

I'm just working on which channels are obstructed here.

Michael Max:

Two things.

Michael Max:

First, I want to, I want to get into what you were seeing as Yangming and

Michael Max:

how you have that extra sketch moment.

Michael Max:

I want to unpack that a little bit.

Michael Max:

And then, and then I want to talk a little bit about Dr.

Michael Max:

work and why that caught my attention and why this six level thing now is,

Michael Max:

is so juicy to hear, but tell us more.

Michael Max:

You said everything was toes to nose Yangming what were you looking at?

Michael Max:

And then.

Michael Max:

And then how are you able to go?

Michael Max:

Oh yeah.

Michael Max:

Well, I mean, obviously sixth street, Mister didn't help.

Michael Max:

It's clear.

Michael Max:

You need an extra sketch moment.

Michael Max:

What is it later that you weren't, that, that drew you to the Dre yet?

Michael Max:

How did, how did you get from Yangming to Dre you?

Daniel Schulman:

Okay.

Daniel Schulman:

Well, she came in because her large intestine five, you

Daniel Schulman:

know, what do they call it?

Daniel Schulman:

The anatomical snuffbox they're on her right hand.

Daniel Schulman:

Oh yeah, the tendons they're at large intestine thought.

Daniel Schulman:

Right.

Daniel Schulman:

We're just causing her unbelievable daily grief.

Daniel Schulman:

That's why she came in.

Daniel Schulman:

I mean, this is a person perfect example of the tip of the iceberg, right?

Daniel Schulman:

I mean, she came in because part of her wrist was bugging her and she

Daniel Schulman:

couldn't do downward dogs and yoga.

Daniel Schulman:

She couldn't even do her work.

Daniel Schulman:

You know, it was, it was killing her and then it turned out.

Daniel Schulman:

She, I can't remember, she had some, some weird problem with her second toe on the

Daniel Schulman:

right side, she has chronic rhinitis and she would point exactly to large intestine

Daniel Schulman:

20 and say, it always hurts right here.

Daniel Schulman:

Intestinal colitis.

Daniel Schulman:

I mean, the list went on and on and I'm just going, you know, literally

Daniel Schulman:

from your toes to your nose, right?

Daniel Schulman:

All your symptoms are lined up on one channel.

Daniel Schulman:

This is incorrect.

Daniel Schulman:

So I got seduced by that as we do, it's very seductive.

Daniel Schulman:

And I just said, oh man, we gotta treat young MIG.

Daniel Schulman:

And, and, and actually I did her, her the symptoms she came in for got all

Daniel Schulman:

better, like 90% better for her wrist issue at large intestine five after just

Daniel Schulman:

two or three treatments got all better.

Daniel Schulman:

And she kept coming, which was interesting, which tells me, okay,

Daniel Schulman:

she's coming for something deeper.

Daniel Schulman:

And then we start talking about her colitis and they said, well, I mean, I've

Daniel Schulman:

actually had great success with colitis.

Daniel Schulman:

So I said, I should be able to help that it usually responds well, but it wasn't.

Daniel Schulman:

And I mean, I'm the kind of guy after three to six treatments, if

Daniel Schulman:

something's not responding, I'm like, Um, I'm missing something here.

Daniel Schulman:

Yep.

Daniel Schulman:

So that's when I did the, I'll be candid and admit that I got lazy.

Daniel Schulman:

I felt so confident about Yangming that I actually stopped freshly

Daniel Schulman:

evaluating her every visit I would just launch into my young men

Michael Max:

treat.

Michael Max:

Right.

Michael Max:

Well, you know, this is the problem of thinking that

Daniel Schulman:

we know.

Daniel Schulman:

Yeah.

Daniel Schulman:

I got sucked in by my own, you know, arrogance or whatever.

Daniel Schulman:

And so the extra sketch moment was okay.

Daniel Schulman:

Okay.

Daniel Schulman:

I need to, I need to back off here and just pretend I know nothing.

Daniel Schulman:

And, and then I re palpated her.

Daniel Schulman:

I mean, I practiced the whole palpatory Japanese thing combined with, uh,

Daniel Schulman:

Jason Robertson's work with laundry yang and a whole palpation approach.

Daniel Schulman:

And when I read palpated, her, every, all the reactivity was on

Daniel Schulman:

pericardium and liver channels.

Daniel Schulman:

And then, then when I took her pulse, there was at that blood level, there was.

Daniel Schulman:

Some kind of toxic heat thing.

Daniel Schulman:

And her D her colitis had gotten quite bloody.

Daniel Schulman:

So I just said, okay, I gave her a, what, I call it a joy in a shaoyang treatment.

Daniel Schulman:

And poof, she emailed me or called me a few days later

Daniel Schulman:

and said, wow, like I'm a lot

Michael Max:

better.

Michael Max:

There it is the power of the six confirmations.

Michael Max:

You know, we talk about it a lot in herbal medicine.

Michael Max:

And there's an one things I love about Dr.

Michael Max:

work.

Michael Max:

You know, he really looks at constitutional types.

Michael Max:

He was the first guys to get me thinking outside the usual boxes

Michael Max:

that I was used to thinking in.

Michael Max:

Right.

Michael Max:

And then eventually that led me to some, some of the work of Dr.

Michael Max:

Hershey shoe and a functioning loan.

Michael Max:

Right.

Michael Max:

Susan Roboto Suzanne Robyn.

Michael Max:

I'm doing her course right now.

Michael Max:

So the way that those cats look at the six levels, holy smokes.

Michael Max:

That's a whole different amusement park right there.

Michael Max:

Right.

Michael Max:

Radical.

Michael Max:

Yeah.

Michael Max:

And.

Michael Max:

The thing that I love about it is is who shoe and Dr.

Michael Max:

Funk Sherlyn, they really look at, okay, what levels are being touched by this?

Michael Max:

I'm using air quotes here, illness.

Michael Max:

We're not looking at the illness.

Michael Max:

We're not like, okay, they got colitis.

Michael Max:

It's like, okay, where are the tentacles of this thing going into, where

Michael Max:

are the levels go to those levels?

Daniel Schulman:

Like, where are the bodies screaming in terms of symptoms

Daniel Schulman:

is not necessarily where the problem is.

Michael Max:

Yeah.

Michael Max:

And conveniently, we have these other ways of looking and going.

Michael Max:

So what's effective.

Michael Max:

What else is involved?

Michael Max:

I mean, this is what you're talking about.

Michael Max:

This, um, uh, Korean acupuncture, right?

Michael Max:

Toby daily, uh, was on recently, we had that interview.

Michael Max:

Toby's, Toby's been really generous with me.

Michael Max:

I've been starting to use this stuff in clinic and, and I have

Michael Max:

to call them up from time to time.

Michael Max:

He hit him with some clinical questions about this.

Michael Max:

One of the things that I find so interesting about that

Michael Max:

type of acupuncture, it really looks at the six confirmations.

Michael Max:

Yeah.

Michael Max:

It's really working at that level.

Daniel Schulman:

The, the burning question I have, I mean, I'm not a scholar in

Daniel Schulman:

terms of translating classics and all that, but you know what I get from the

Daniel Schulman:

people who study this stuff is this the six levels in acupuncture and the six

Daniel Schulman:

levels of herbal medicine are not the same thing, but I don't, I don't know.

Daniel Schulman:

I, you

Michael Max:

know, I don't, I don't know.

Michael Max:

Yeah.

Michael Max:

There's, there's the answers you have to give on the national exam

Michael Max:

about what the six levels are.

Michael Max:

Right.

Michael Max:

There's that piece.

Michael Max:

And then again, you look at who she shoe and your loan.

Michael Max:

They're looking at it a little bit differently.

Michael Max:

Yeah.

Michael Max:

I don't want to bring up this other piece.

Michael Max:

This is just something I've been chewing on here.

Michael Max:

Like you I'm about 20 years into this.

Michael Max:

So that makes me a good, solid journeyman.

Michael Max:

Right?

Michael Max:

Well, good solid journeymen at this point.

Michael Max:

I'm a little beyond apprentice.

Michael Max:

I'm a solid journeymen.

Michael Max:

We talk about the scholars.

Michael Max:

We talk about the masters, you know, and, and, but my suspicion is very few

Michael Max:

of us are going to be scholars, probably even fewer are going to be masters.

Michael Max:

Most of us, the best shot we got at this solid journeymen.

Michael Max:

I agree.

Michael Max:

And I think there's a lot to be learned and gleaned in that our

Michael Max:

own clinical experience bumped up against like in this conversation.

Michael Max:

So what else has clinical experience bumped up against some stuff that

Michael Max:

we've read bumped up against what actually happens in the clinic?

Daniel Schulman:

Yeah, I mean, that's where the rubber hits the road.

Michael Max:

I think so, you know, I remember one of my teachers and

Michael Max:

acupuncture schools saying, if you go to a really good acupuncture school, you

Michael Max:

learn about 12% of what you need to know.

Michael Max:

And if you go to you go to an average, when you learn 8% of what

Michael Max:

she needs to know all the rest you're going to learn from your patients.

Daniel Schulman:

Right.

Daniel Schulman:

And it's perpetual.

Daniel Schulman:

I mean, I get humbled regularly and after 20 years and look at the trouble I get

Daniel Schulman:

into, if I get too cocky about it now,

Michael Max:

well, I've found this to be true as well.

Michael Max:

As soon as I think I kind of got this one dial in, or I pat myself

Michael Max:

on the back, um, man, it's it.

Michael Max:

It's just asking for trouble.

Daniel Schulman:

What's that?

Daniel Schulman:

There's a great Bob Dylan line.

Daniel Schulman:

There's no success like failure and failure's no success

Daniel Schulman:

at all or something like

Michael Max:

that.

Michael Max:

I don't know what to look that one up that's that sounds, I didn't know.

Michael Max:

He was an acupuncturist.

Michael Max:

Um, man, this is wandered far and wide.

Michael Max:

Hasn't it

Daniel Schulman:

adverse rate.

Daniel Schulman:

We were talking about adverse reactions

Michael Max:

and we've come back to the six, the six levels

Michael Max:

keeps banging around here.

Michael Max:

So one of the things that I've, I've found and, and Toby daily talked about

Michael Max:

this in his interview and he talks about in his fantastic article that he

Michael Max:

did in the journal of Chinese medicine.

Michael Max:

Y'all can just download that.

Michael Max:

Yeah, you can get it from the website as well.

Michael Max:

Get it from qiological if you want it's over there too.

Michael Max:

One of the things that he talks about is that if you're on with this

Michael Max:

stuff, you can really help people.

Michael Max:

And if you're off with it, you can really send them off the rails.

Michael Max:

And I'm here at Italia.

Michael Max:

I have sent some people off the rails with this in the, in the

Michael Max:

process of attempting to learn it.

Michael Max:

Really?

Michael Max:

Yeah.

Michael Max:

I had a patient the other day.

Michael Max:

I was, you know, I'm trying to learn a new system here and that means

Michael Max:

on occasion, I make a big mistake.

Michael Max:

Because I'm still thinking partly in an older system.

Michael Max:

And so I had a patient with what I'm going to call a spleen excess.

Michael Max:

Yeah.

Michael Max:

Right.

Michael Max:

Very, you know, Ty in excess, she was a tie in excess, very overweight,

Michael Max:

went on the inside and, uh, kinda kind of wet on the outside too.

Michael Max:

And just kind of that very damp sort of slow thought process and

Michael Max:

a lot of mental chewing on things.

Michael Max:

Right.

Michael Max:

And from a TCM point of view, it's like, oh, we got a ton of fire.

Michael Max:

The spleen, we got to work the spleen.

Michael Max:

Well from this arm point of view, you don't, tonify the spleen.

Michael Max:

You don't bring more damp to damp.

Michael Max:

That would be a bad idea.

Michael Max:

You want to bring in the cool high, dry mountain air of the, uh, of the

Michael Max:

large intestine of the Yangming.

Michael Max:

To dry up some of that dampness that's, that's what you should do.

Michael Max:

But I was like, oh yeah, her spleen, I got to fix her spleen.

Michael Max:

So I tonified her spleen and I, and I missed the signs and

Michael Max:

the, I missed some of the stuff.

Michael Max:

I, in retrospect, I should have caught.

Michael Max:

And she comes up after the treatment goes, am I supposed to

Michael Max:

feel dizzy and nauseous or shit?

Michael Max:

And at the same time, I'm thinking, oh man, Toby Taylor, he was right about this.

Michael Max:

Yeah.

Michael Max:

So, so, so I'm thinking to myself, how do I approach this?

Michael Max:

Do I say, oh, I made a mistake here.

Michael Max:

Let me fix this now.

Michael Max:

Or do I, I sort of file it away.

Michael Max:

Oh yup.

Michael Max:

This is what happens.

Michael Max:

I'm here.

Michael Max:

Right?

Michael Max:

I said, I'm going to check in with you tomorrow, which I did.

Michael Max:

And, uh, you know, basically what happened with that is after a few days,

Michael Max:

she felt okay, again, And I go, okay.

Michael Max:

Be very, very careful Michael max, because this is what can

Michael Max:

happen if you do it wrong.

Michael Max:

You know, if you see a spleen excess don't, tonify the spleen

Michael Max:

or som acupuncture, right.

Michael Max:

Because we're not working in an Amazon Fu way, we're working it

Michael Max:

through the six confirmations.

Michael Max:

And so that, I mean, there's a little tick in the chart for me of six

Michael Max:

confirmations, very powerful medicine.

Daniel Schulman:

Yeah.

Daniel Schulman:

I mean, don't forget patients go to their psychiatrist all the time and

Daniel Schulman:

they say, oh, well, let's try Zoloft.

Daniel Schulman:

And then they come back and say, you know, I've got all these terrible side effects.

Daniel Schulman:

Okay, well, let's try Prozac.

Daniel Schulman:

I mean, we're a wash and a medical culture that tries things.

Daniel Schulman:

And if they work great and if they don't, I mean, there's a lot of educated,

Daniel Schulman:

guesswork going on in modern medicine.

Daniel Schulman:

So absolutely.

Daniel Schulman:

You have to give ourselves a little leeway as long, I believe, as

Daniel Schulman:

long as you Michael max are coming from a place of high integrity.

Daniel Schulman:

It's okay.

Daniel Schulman:

That the treat, the diet, the response to treatment as part of your

Daniel Schulman:

diagnosis.

Michael Max:

Absolutely.

Michael Max:

Yeah.

Michael Max:

And I've had one of my teachers, one of my herbal teachers,

Daniel Schulman:

you just keep doing the same stupid thing over and over and over.

Daniel Schulman:

That would be

Michael Max:

a problem.

Michael Max:

Hey, the patient doesn't fit the model at the hell.

Michael Max:

Oh,

Daniel Schulman:

she's just not ready for it or something.

Daniel Schulman:

Yeah.

Michael Max:

So w herbal teachers early on said, you can say that you understand

Michael Max:

the formula, or you could say, you understand an herb when you've used it

Michael Max:

and it's worked and you know why, and you've, you've used it and it didn't work.

Michael Max:

And you know, why only then can you say you understand it?

Michael Max:

So.

Michael Max:

Part of our process is, is to be able to recognize the errors like that.

Michael Max:

It's it, it's part of what we have to do there.

Michael Max:

Isn't, there's no way around it.

Michael Max:

I think the question is how do we engage ourselves and how do we engage our

Michael Max:

pagans to, to keep things moving forward?

Daniel Schulman:

Well, my experience is that it that's

Daniel Schulman:

get back to the original point.

Daniel Schulman:

You know, where is your, where are you at?

Daniel Schulman:

And where's your patient at?

Daniel Schulman:

If you're, if you're both fairly well along in your maturity and

Daniel Schulman:

your humility, um, they're, they're, they're going to stay with you.

Daniel Schulman:

And if either, or both of you aren't, then what's going to go

Daniel Schulman:

off the rails pretty fast and

Michael Max:

well speaking from the practitioner side, what are some of

Michael Max:

the things that you found helpful over these years that help you stay

Michael Max:

present with this that helped you to be ready for moments when in, oh my gosh.

Michael Max:

Now what?

Daniel Schulman:

Yeah, that's a great question.

Daniel Schulman:

I'll never forget.

Daniel Schulman:

My first weekend practice, I just graduated from the new

Daniel Schulman:

England school of acupuncture.

Daniel Schulman:

Moved back home, opened my clinic.

Daniel Schulman:

I had 25 patients the first week.

Daniel Schulman:

Oh wow.

Daniel Schulman:

Some of them like really sick.

Daniel Schulman:

And I remember just saying, I'm going to go into each and

Daniel Schulman:

I've done this for 20 years.

Daniel Schulman:

I'm not going to go in with any book.

Daniel Schulman:

Now I have all this knowledge, but I'm just like, I'm going to go in like an

Daniel Schulman:

Etch-a-Sketch with each patient just, and just be there and just take it

Daniel Schulman:

and trust myself, you know, there's that whole, there's that whole tension

Daniel Schulman:

between spontaneity and rote knowledge.

Daniel Schulman:

And, you know, I always think of miles Davis as the archetype of someone who

Daniel Schulman:

knew a hell of a lot, but clearly lived in a receptivity to what spontaneously

Daniel Schulman:

arises in spite of everything he knew every day, that's kind of.

Daniel Schulman:

Operating principle.

Daniel Schulman:

My, what are the military people?

Daniel Schulman:

My, my, my mode of engagement.

Daniel Schulman:

What do they call it in the military?

Daniel Schulman:

The what's my rule of engagement, everything that I aspire to every minute.

Daniel Schulman:

And so I just trust that the right thing will come up,

Daniel Schulman:

but it doesn't always work out.

Daniel Schulman:

Well, the thing

Michael Max:

about dooming, the work learning what you need to know

Michael Max:

that, I mean, that's essential.

Michael Max:

You, you don't get to do the spontaneous stuff.

Michael Max:

I mean like miles Davis, you don't get to, you don't get to do the miles

Michael Max:

Davis, you know, crazy wild man.

Michael Max:

Amazing thing.

Michael Max:

If you haven't done your scales for, you know, ridiculous amounts

Michael Max:

of time and listened to all kinds of other music as well.

Daniel Schulman:

Exactly.

Daniel Schulman:

Yeah,

Michael Max:

exactly.

Michael Max:

So keep reading folks, keep learning.

Daniel Schulman:

And yet there's that magic moment where you're

Daniel Schulman:

just surrender at the same time.

Michael Max:

Yeah.

Michael Max:

Every now and then you hit that sweet spot.

Michael Max:

Don't you?

Michael Max:

She has in clinic medicine, which we could hit it every

Daniel Schulman:

time.

Daniel Schulman:

Well,

Michael Max:

why we practice Daniel?

Michael Max:

Anything else to share with our listeners before we wind this down for today?

Michael Max:

The

Daniel Schulman:

other piece I had written some notes about, you know, the

Daniel Schulman:

whole adverse reaction thing is I think one of the flies in the ointment that

Daniel Schulman:

we don't know about our medications.

Daniel Schulman:

And I think that often, you know, what is our, what is acupuncture doing?

Daniel Schulman:

It's optimizing physiology.

Daniel Schulman:

And a lot of medications are dosed at a higher, a higher than perfect

Daniel Schulman:

dose, for example, because, because of physiological inefficiencies, right?

Daniel Schulman:

So I've witnessed many times.

Daniel Schulman:

What I believe is on triggering, essentially an overdose in someone

Daniel Schulman:

who's on a medication at a certain dose comes to get acupuncture.

Daniel Schulman:

So their physiology gets optimized, then they start using

Daniel Schulman:

their meds more efficiently.

Daniel Schulman:

So I think meds are a big unknown in this business.

Daniel Schulman:

So just, just pay attention,

Michael Max:

you know, that's a really good point.

Michael Max:

It's really, I have seen some patients who, yeah, they were having issues

Michael Max:

with the medications working too well.

Michael Max:

And I suggested, well, why don't you go talk to your doctor?

Michael Max:

Maybe you don't need as much of this medication.

Michael Max:

And some of them were like, no, I do not want to mess with my medication.

Michael Max:

I am stopping this dang acupuncture because it's messing with my medication.

Michael Max:

They didn't see it as healing.

Michael Max:

They saw it as being in interference.

Daniel Schulman:

And then others are more than happy.

Daniel Schulman:

Their goal is to get off their meds.

Daniel Schulman:

So you have to be with the patient where they are.

Michael Max:

You gotta be with them where they're at.

Michael Max:

There you go.

Michael Max:

Well, Daniel, thank you so much for this time today.

Michael Max:

This has really been delightful.

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