And I remember just saying, I'm going to go into each and I've done this for 20 years. I'm not going to go in with any book. Now I have all this knowledge, but I'm just going to, like, I'm going to go in like an Etch-a-Sketch with each patient just, and just be there and just take it and trust myself, you know, there's that whole, there's that whole tension between spontaneity and rote knowledge. Um, You know, I always think of miles Davis as the archetype of someone who knew a hell of a lot, but clearly lived in a receptivity to what spontaneously arises in spite of everything he knew every day.

Hello, Sheila magicians, Chilla cishan or that car. Anyway, this is qiological the podcast for practitioners and students of acupuncture in east Asian medicine. I'm Michael max. Hey first, thank you. Those of you that have sent in pictures and postcards from the places where you listened to qiological I really appreciate it. You know, sometimes I sit here in front of this computer staring into the void and wondering kind of, I wonder who's listening. So I love getting these emails, postcards, and photos of where you're listening to. Qiological app much. Appreciate it. If you're enjoying the podcast. And you find it helpful in your study or practice and medicine, please turn your friends onto it like ice cream. It's best when you share it with others. And in that spirit, I've got a podcast for you. If you're not already familiar with Laszlo Montgomery over at the China history podcast, you ought to check it out. He's got a great series over there on tea, another one on Chinese philosophy. And of course the usual lineup of luminaries and villains from China's long, long history in addition, and this part's really cool. He highlights some Westerners who have made their lives and some kind of impact in the middle kingdom. I'm particularly fond of the show on Morris to gun Cohen. The ne'er do well. Jewish thug who ends up his son yet sends bodyguard. Oh man, what. An episode, actually two episodes. That is so when you need a break from medicine and you still have a taste for something Chinese, Laszlo's your man. It's a Chinese history podcast. I want to take a moment before we get into today's show and share with you something that came up in clinic for me the other day, perhaps you've had this happen too. While you're looking at a patient's tongue here, she might ask, Hey, is it bad? I'm always careful about answering that question. But the other day I found myself saying to a patient good, bad. You know, it's not a helpful way to consider the tongue or the pulse for that matter. Really. It's just an indicator of what's going on and I'm quite reluctant to judge it as good or bad. Granted, there can be an excess or deficiency that showing up in some serious problems can clearly be seen if you know how to look, but the terms good and bad. I think they're rather useless. It's better to be able to see clearly what's present or maybe even what's missing. I'm finding that to terms, air quotes here. Good and bad. Really may not be that helpful. They don't really tell you anything or offering you useful information. The words are like check marks in a box, something you can feel good about and forget or feel bad about. And then let the mind start its endless cycle of worry and fear. Neither is really helpful when you think about it. Good and bad are handy terms to attempt to get children, to behave in social groups. The labels are a quick metric for who's in and who's out. You know, these labels when applied to people, allow us to quickly characterize them without going deeper into understanding, maybe labeling something good or bad is fine. If you're looking for a stick to hit yourself or others with again too often, applying these labels stops the process of inquiry that can take us into something more complex and nuanced digging a little deeper into what you dismiss as good or bad. We'll get you a lot more information about the situation. I've been more attentive this week to using the labels good and bad. And I'm noticing that when I use them, it makes me mentally lazy. I stopped looking for the puzzling details. It requires me to stay a little more awake and attentive, and I'm surprised at how often I make those snap value judgments. And then turn off the thinking process, being awake and attentive as part of the conversation that we're going to be getting into here in just a moment as we discuss adverse reactions to acupuncture and how these situations can help us to learn something, it seems to require a certain amount of maturity on both the part of the patient and the practitioner to not let unforeseen reactions stop. What might be an important turn in a patient's healing process. I'm hoping that dropping this good and bad thing will help me to become more of that kind of practice. One more thing before we get into today's conversation, you've probably heard me go on about sound quality on the podcast. The longer I do this podcast, the more I see ways to help improve the listening experience for you. I've got Daniel Schulman with me today. I can't remember how we actually connected my internet. Addled brain has trouble keeping track of things that used to seem so. But what I do remember is we began a discussion about adverse effects from acupuncture. And that started to turn into a conversation about whether acupuncture was simply harmonizing or if you could really cause your patients and problems with an incorrect treatment. You know, we like to think that acupuncture is powerful medicine, so like food. So room off on you can do a person, a lot of good, but you know, if used incorrectly, you might cause some troubles. And how do you sort that out from just the kinds of adverse reactions, sometimes people have to any kind of a treatment, depending on what's going on with that. This seemed like a good topic to chew on here at qiological. And I'm really curious to see where Daniel and I go, Daniel, welcome to qiological.

Hi, it's great to be here. I love your show.

Thank you. I have fun with it. You know, I get a new teacher every week.

Yes. It's clear. You're having a lot of fun.

And getting away

with it too. I know. You'll have to write a book about that.

Oh my God. I, you know, I've already got a couple of book projects, it's it? It, yeah. I'll, I'll, I'll add it to the list. Okay. Actually, you know, since you just brought that up, let me ask you a question. What kind of book would that be?

What would I write? Have fun and get away with it. Yeah. Oh, well, I mean the new age world is full of you don't follow your passion and all that stuff. So you'd have to steer clear of that. That market is full.

Well, it's not even a market I'm interested in. Exactly. Yeah. Every, every time I've set out to go do something that I thought was a good idea that usually didn't pan out, you know, it's the stuff that, that came in from the periphery that like barely caught my attention, but, you know, I couldn't quite let go of that. That's the stuff that

stuck. That's where the action is. I think. Yeah. Isn't that weird? Yeah. The, the thing I always think of is, you know, when you're looking at the night sky, the best falling stars are the ones you catch out of the corner of your eye. I know when you're not looking, but I call it a light gaze. Actually. That's when I do my best work in clinic is when I'm looking at the patient, but lightly from a, from an edge side, you know, not directly, not with too much, you know, forced intention or something, I don't know. Yeah.

Yeah. That thing about coming at it from the peripheral vision. Yeah. That's interesting. Well, let's see here, where are we going to begin with this? You know, we were talking. About adverse reactions to acupuncture. And then you turned me onto an article that you did. Oh my God. It was like ages ago, like 2004 or something.

Yeah. It's one of those embarrassing things where you go back and you look and you say, oh God, right. That so differently today. Oh, of

course, of course. You'd write it differently today that, you know, that just goes without saying, but I, I did go to the journal of Chinese medicine and download it cause I have subscribed to it. So I get, you know, the great thing about the journal of Chinese medicine. If you're a subscriber, you've got access to the whole back catalog. It's, it's kind of like, qiological right. You can listen to the whole dang thing if you want. There's a lot there too. Yeah. There's a lot there. It's the journal of Chinese medicine. So yeah. You wrote this article about adverse reactions. I read it. I actually thought it was quite spot on. I thought it, it held up over the years.

Yeah. I think the meat is there for sure. And, uh, uh, I just, I was trying to open up a richer conversation, you know, we tend to just, there's this superficial thing, you know, someone has. Less than perfect response to treatment. And we typically all say, oh, it's a healing reaction. Don't worry about it. And that may be true, but I wanted us to as a profession because as we get more scrutinized by the public and by society at large, we're going to have to be able to speak up about these things with some depth, uh, honesty. And so I think there's a way for us to really dig into that subject of less than pleasant responses to acupuncture. I don't like the word adverse, but I don't know what the right word is. So let's we

can go. Yeah. Let's, let's try on that. Maybe we'll come up with something. I, I think there's

a way to differentiate and pick it apart and actually identify many different possible things that are going

on. All right. Well, let's, let's, let's look at some of those because I to hear, and you hear this a lot in the I'm using air quotes here, alternative health world about a healing crisis. And a question that I've had. I mean, ever since I've been doing acupuncture is okay, what's the difference between a healing crisis and a screwed up treatment? I mean, let's be honest, let's be honest if our medicine is as powerful as we like to think it is, and we can really help people. Wouldn't it stand to reason that we could also really take them off the rails?

Yeah, it is. It's very powerful. I look, I practice acupuncture without herbs and I keep saying to people, this is seriously powerful medicine. I mean, the stuff I've witnessed in my clinic over 20 years is very powerful. It's not just this light fluffy thing. Yeah.

So let's start with healing crises. How do you know what's a real healing crisis and what's just, oops, I goofed that one out.

Ah, Ooh. Such a complex question. Well, I mean, I think that word healing crisis. Maybe we want to dispense with. Cause I think that comes from somewhere else. I think maybe it comes from homeopathy. I'm not sure

they do talk about that

perhaps significantly due to sort of Jeffrey Yuen and all of his students, although it's elsewhere in our medicine, for sure. There's, you know, w we were sitting on top of them 2000 year old history, uh, framework of understanding of the body as a series of layers and levels and depth, and the whole idea that as we proceed through life, we encounter all kinds of bumps and bruises, whether they're emotional or physical. Um, there's that whole concept that, you know, we either deal with them in the moment or they get embodied in some way and go into our body and they get stored. There are the term we use in English as kind of latent pathogens in some way. And they can sit there forever or they can cause trouble or they can go deeper. Or, and I think often what we do, I witnessed a time and time again with acupuncture is we mobilize those things. We get them moving. And so w what I, I don't, I don't know if it's a correct direct translation. I'd have to speak to a homeopath, but rather than healing crisis, I prefer to speak within, within our medicine as, you know, mobilization of latency. And that can be unpleasant. It can be mildly unpleasant or severely unpleasant. I've witnessed many examples of it in my practice. And I think particularly in the social and medical context of our culture, the minute someone has a reaction to something that's not pleasant. You immediately go into a hole. I mean, let's face it. We live in a very litigious culture. We live in a very simplified cause and effect framework of life culture, which is well past its due date. And so, so in the context, you know, it's difficult, you get, I get different kinds of clients or patients. Some people are ready to have a deeper discussion and some people, the minute there's something bad happens, you know, they go running back to their doctor and get treated for what happened from their acupuncture treatments. And I never see them again. And so there's quite a spectrum there, but so, so part of the adversity that I'd like to keep in the conversation is whether the patient themselves is actually

ready for it. Yeah. I think that's such a good point. All right. So often people will come in because of their knee or because of their back or anxiety. I'm using air quotes because I never know what that means to anyone. When they say it to me, I always have to inquire, but they come in because something's bothering them and they just want it to go away. Yeah, exactly. Sometimes something has been dogging somebody for decades, right. You're talking about latency, unresolved issues, traumas or illnesses, but something has been dogging them. Something has actually been really, really loyal to them and it is not going away until it gets dealt with in some way. And they've done a great job of keeping it below consciousness until they can't. And

even, even there mainstream medicine has supported that effort.

Let's hear it for psychoactive drugs, right?

Yeah. Or, oh, there's so many examples, but, um, Yeah, they may be coming in for what they think is small, but from our perspective, we immediately see it as the tip of the iceberg. And, and, you know, after 20 years of experience, I actually experienced this. Now I'll get a patient in a new patient. They'll come in for some little thing, this little thing, that's bugging me on my fourth toe and I'll take the whole history. Palp I do Japanese palpatory acupuncture. I'll palpate everything. And I'll be sitting there thinking to myself, oh God, I know, I'm pretty sure we're going to stir up a rat's nest here or a hornet's nest, you know? And then I looked at the patient and I asked myself, are they ready for this?

That sounds super reassuring to me that you've got some diagnostics. You've got some ways of inquiring directly with the body to go, what else is here? What's happening here? Because, because then we don't get blindsided. Right. If you don't know that, that is there. And you do a treatment and Kaboom, something happens. It's like, God, now why I still

get that too? Yeah, I had to just the other day, tell us about this the other day. Okay. This is, uh, this is humbling. Cause I've been in practice 20 years. It was easy to think, you know, everything. Right? This 80 year old woman, I live in a place where a lot of people come here just for the summer. So she's what I call a summer visitor. She shows up she's very. Bullheaded and like she's bossing me around. Okay. And even after 20 years and I've gotten pretty good with a lot of people, she's exceptionally good at bossing me around. And so I actually, I hate to admit it by I kind of succumbed and she has wicked neck pain. She can't turn her head at all. It's just, it's killing her and I want it fixed now. And the last time I had acupuncture, 10 years ago, it worked in one treatment. I want you to do that, you know, no pressure. Okay. Sure. So, you know, she's, and she's a summer visitor, so I know, you know, she's not a long-term patient. It's just kind of okay. Get her through her vacation and get her home or what not. She has a cottage here, so she's here for a month. So I did one treatment and she got up, oh, it's no better. And she was a little bossy with me. And then she left and Michael, the next day she called, she said that night I broke out in a sweat. I got very weak. And wicked diarrhea, just watery, runny diarrhea. That won't stop. It's like I'm going. And she, and she's like, she went to the outpatients at the hospital and, and I'm thinking, I mean, okay, could be coincidence, who knows. But of course the reasonable thing to suggest is what did I, I must've unleashed something. I must misdiagnosed missed something, you know, she's 80 years old. Right. Which is, you know, so I'm just like, holy cow, what did I, what happened? And I still, I haven't seen her, we've talked on the phone. She, she went to the hospital. I mean, I gave her a good advice. I said, let's keep in touch, keep me in the loop with, with, you know, the diarrhea and the weakness. And I said, you know, keep drinking fluids. I suggested ginger tea. You know, I suggested all the things. We would suggest that. And, but she was getting us thorough workup from the hospital. They w they were suggesting C difficile, which I, she hadn't been in a hospital in years. So anyway, But I CA I called her every other day. How you doing? And she said, by the way, my next all better, I think you're amazing. I don't know. We, we, that's, another part of this picture is we can kind of get away with a lot of this because people don't realize we're practicing a comprehensive framework of medicine, so they don't know the connections. So they often don't suspect that things are triggered by what we do, because they don't see the connections that we see. I don't, I'm not sure she suspected that my treatment triggered that, but I'm certain it did. And I still don't know how or why. Cause I haven't seen her since, although she assured me in our last phone call, the hospital had cleared her of everything. She's now feeling fine. Uh, but you know, an 80 year old woman, three hours after your treatment becomes very weak, starts sweating profusely and as severe diarrhea, that's a little nervous. I did something and I don't know.

Yeah, what well, what happened right? Or something happened, something happened, and this is such a good question. And I think it's one thing when patients come in and they say, I got this, I got that. You get the history. I mean, all this kind of makes sense. Right. We put in our little boxes. Oh yeah. I know what to do about that. And then when we see a response and it's so unexpected, right. Of course first there's that emotional moment of oh shit.

Yeah.

And I think that's a really human response. You know, I suspect any healing, professional, any medical professional, you know, has that goes through that from time to time. It's if anybody,

even Western modern medicine, of course probably happens

every day. Well, of course it happens every day. I mean, their, their stuff is, is super strong. And if you look at the possible side effects of, you know, most, any medication, the list is longer than your. Right. So, so there were of that, but you know, to be able to take something that's a surprise and go, wow. I thought I knew what was going on. How do I make sense of this? You know, and this is one of the great things about the medicine we practice. We, while there's all kinds of different methods and there's many streams of medicine, and often we're actually arguing with each other, which I suspect is very counterproductive. You know, at the root, there is a set of principles that we all share and that set of principles, if we can somehow touch in on that, my suspicion is it can be helpful in helping us unpack what these responses are that we see. Yeah,

I'm sure if I'd seen her over the next couple of visits and, you know, delve deeper into her issues to pay more attention to her Pauls. And I probably would have figured out some reason for why that happened, which might've, if she was a long-term patient, actually, uh, deepened our capacity to go somewhere.

Right. Yeah. And you know, and then there's the other thing, which is maybe she stopped at Joe's cafe and that burger was a little not, you know, we don't know. We don't know. We ended up with a lot of not knowing what her net pain got better.

She thinks I'm awesome.

I'm wondering if you've seen this. I suspect you have people come in, you ask how, how are you doing, how you doing right. And sometimes you'll hear something like, oh, maybe a little bit. Uh, and I find that means one or two things. It means nothing has changed from being mice or it means everything has changed and I've already forgotten. I had the problem. Yeah.

That's, you're making a brilliant point. I've actually gotten really punchy about responding to that. I think a little better, or the one I hate even more is, well, I'm no worse. I immediately push it back at them. I say, look, you know, are you just being nice to me? Cause I don't want you to be nice to me. That's one thing I say. And another thing I say as well, a little better means mostly not better. Right? Like, you know, one plus 99 equals a hundred. So if you're 1% better, you're 99% not better. So, and then they say, oh yeah. And then, and then I dig deeper. I say, so why did you say that? And then I repeat to them why they came in. I say, well, when you came in, you said this, this, and this has that changed. And then usually we pick it out. It's either they're really not better, but they're just being nice or actually they're a little better than they wanted to admit.

Yeah. And sometimes they're like phenomenally better and they have him, this to me, this is such a curious thing to me. It's like, they drop into this natural state of where they're supposed to be. Yeah. It's like the best treatments are the ones that they don't notice.

Yeah. That's very humbling for us. Isn't it? Yeah, no, we get that all the time too, but, uh, that's fine.

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

I mean, this is getting a little off topic, but like I practice in a smallish town. So I bumped into my patients all the time at the grocery store. So like, you know, someone you'll finish a few treatments with someone and they'll say, well, I'm not sure it's working. I'm going to stop now. And then you'll run into them a year later in the grocery store. And they'll say something like you changed my life. There seems

to be a thing with trajectory. Yeah. Sometimes there's like a little shift that happens and you don't notice it. Like you barely notice it. It's like the turn of a season. Like this morning here in St. Louis, I walked outside and it's chilly. It was chilly enough that it's like, I'm putting socks on. It's first time I put socks on in months. Um, but they're like tiny changes and you don't even hardly notice it until the season or two goes by in

retrospect, some kind of retrospect. Yeah. So there's that. Yeah, but the fascinating things are, what's our medicine about it's about change. So this is a really interesting,

so let's get back to this thing about lingering pathogens or, you know, physiological issues, traumas, things that, that have not found their way to resolution. What's your sense of what's going on with all this?

Well, I mean, I love it. I think, I think that's what better strength of our medicine is there then to help people, uh, ex express to the outside what's lingering. I mean, that's, what's in the way. Yeah, but that's a very different, I mean, I think that's, what's radically different about our medicine. I mean, I see it all the time. I'll needle, a channel on the patient patient will come in the next week and say, you know, I developed this huge, did you stick a needle here? And they'll point to this boil, you know, this big boil on the channel, I'll say, no, not even close. And then it turns out in their history. We, we delve into there. There's some reason for some, uh, latent, toxic heat to be in that part of their system. Maybe they had some major infection a few years ago, or they had surgery along that channel somewhere. And they went to the hospital with post-surgical infection or something so that, you know, that's just at the simplest level. I see that all the time in some kind of boil or skin reaction along a channel or in some channel relationship to what I did that is, that's just, that's nothing but good from our perspective that they, they expressed that, you know, you don't want that lingering. And I think we provoked that all the time. I think often it's even below the radar. We may not even know we've provoked. I always like to say in the treatment room, there's 10,000 things happening and I'm lucky if I can see 20 of them, but I mean, I've had some pretty radical and dramatic cases. Like I had one woman I'll never forget this. And she was a massage therapist and this is only what we discovered was only discoverable by the fact that she knew her body. So well as a massage therapist, but we did a series of treatments and she started to develop skin reactions after each treatment. And because she's a massage therapist, she actually mapped the skin reactions for me each week. That's helpful. So first of all, most patients after the first treatment would have called and said, I don't think I'll come back. They would have gone to their doctor, gotten steroids and suppressed and skin reaction and concluded that they have some kind of quote unquote allergy to acupuncture. And that would have been the end of that. But because he was in the alternative health field, which was a massage therapist, she was curious, she was interested. She trusted the process and she mapped the skin reactions. Stunning, Michael, you could actually see over a course of six treatments that her body was expressing something through our six levels on the young side. So first I can't, honestly, it was a long time ago. I can't remember, but let's say first it was expressed in, on the young Ming aspects or body than the show young and the Taiyang I forget the order, but it was very clear that every two weeks progressed through distinct young ages and then it was, and then it was gone and it never came back. She got all better. And I saw her a year later and she said, I've just had the best year of my life. So clearly that was radical. And that's an example of something. That's an example of something that I probably would have never seen in another patient because a, they might've never come back after the first week or B they wouldn't have had the knowledge or the curiosity or the interest to map it. So that case just offered that opportunity to really witness a profound process. That's fully in line with our whole framework of her body, getting rid of a latent pathogen

through the levels that they talk about it going through.

Exactly. It was very clear.

Well, you know, this, this is, I'm making a note to myself here that the next time something seems a little bit off the rails to see if I can somehow engage my patients' curiosity about that. It's like, is, is there a way that I can get them involved in mapping it? You know, some people come in with a list, right? It's like, how you doing? They, they pull out a little notebook and they got everything written down. Right, right.

Right. Or to type pages for you

and others are just more like, well, I don't know. So I, I suspect it has something to do with the patient's personality, whether you could enlist enlist them in that process, but it seems like that would be very helpful if we could.

Yeah. But, but, uh, I really, really, really believe strongly that our, where we go with each patient is unique to the degree, to which you already in Louisiana, the degree to which they're ready and the degree to which we're ready. So each, each trajectory of a clinical encounter I believe is constrained or defined by that unique combination. So there's no one trajectory. I mean, you have patients who can go far with, and you have patients who, the dynamic between the two of you is just such that you're just, you're just not going to go very far.

I think that's a really good point. There a patient may be willing. We may not have the, the wherewithal.

We may not, or we may be ready,

but they may not, but they may not. I've seen, I've seen that. I had someone just the other day, remember asking them a question about a question about something that to me made a lot of sense, and I got this blank stare back. Like, is there supposed to be an answer to that question? And I thought, oh, okay, well let's, let's connect where we can connect. And then I'll just wait for you to tell me what the next step.

Exactly. But I think we also have to be careful because there's also that kind of, I've heard people in alternative medicine in general slip, a little too superficially into, well, they just weren't ready. We have to be a little careful about, so

I think we need to be very careful around that.

Very humble on our side too, because it's also possible that they're ready, but they just don't trust you yet. Well,

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

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

you know, that's an, it's interesting that you say betrayed by medicine. I, I often feel like I see refugees from the conventional medical system and oddly enough, I mean, before we started rolling tape here today, I was, I was, we were talking about stuff and I said, yeah, I never expected to be involved in Metro. That was, that was never on my radar that came in from the periphery. And partly because yeah, I, with the best of intentions, I was betrayed as a child with the medicine with conventional medicine.

Well, I have another interesting, I mean, we can turn this whole thing on its head and use our medicine to evaluate modern medicine. So which, which is something I find FA a prospect that I find fascinating, but will never happen on a significant level until we're equal partners with modern medicine and the system, if that ever comes to pass. But you know, a great example. I had someone come in once for psoriasis and when I took her history, she actually had a bad case as a little child, two or three years old, I was strabismus, which is it's an eye muscle issue and was subjected to surgery to cut some of the muscles on the side of her eyes so that our eyes stopped deviating out to the left. I think. Uh, so that's at age three. Now, if you read Julian Scott's pediatric book, he's very clear that strabismus in children is a lingering pathogenic factor and he's got a whole thing about it. Um, so then in her twenties, she developed severe ulcerative colitis and wound up, uh, having, um, a bowel resection. And then in her thirties, she developed severe psoriasis. And that's when she showed up in my clinic now and we treated her and she actually got better, but that's beside the point. The point I'm making here is that we can look at that and say, well, that's interesting. Imagine if an acupuncturist had treated her strabismus as a kid, you know, we might've inline with everything we've just talked about for the last half hour helped her body expel the lingering pathogenic factor that was implicated in the implicating, the strabismus, and maybe stop this whole progression altogether, but modern. We'll have to be careful. This is just a suggestion, but we certainly have a strong capacity in our medical frameworks, in Chinese medicine to say that modern medicine drove that pathogen deeper and deeper and deeper. And so we can also look back at the other half of medicine in our culture and make suggestions about adverse effects. Yes,

we could. They probably wouldn't be seen that way. One of the things I find that we're up against here is how do you measure something that didn't happen, right? I mean, you can measure something that's formed and present, right? Right. Evidence-based medicine. I'm using air quotes here, all the different kinds of blood tests and imaging. I mean, all these things, we can find stuff that's formed. We can find stuff that's pre. Yeah, but how do you recognize that you swept the stones and branches out of a person's path so that in trip on them, I mean, there's really no way to measure this, right? I mean, we, and we'd like to talk about it and we can make some great stories about it, you know? And from our perspective, yeah, you, you clear something out at age three, they don't have to, what have you prevented? What have you prevented? There's no way to measure it. No

way. And you could have prevented a

lot. We could

prevent a lot. I mean, you've hit the nail on the head. I think the biggest thing we're up against is, you know, what philosophers call materialistic science, which you know, is predicated on. If you can't measure it, it's not real. It doesn't exist. I like to say I've noticed in most of the arguments and debates I get in with people, whatever we're talking about, we could be talking about climate change, Donald Trump, you know, the middle east medicine doesn't matter. If you look underneath you notice that people tend to fall into, to be simplistic, two camps, one camp predicates, its perception on the fact that we know almost everything. And we're just, we're just cleaning up the details. And the other camp is predicated on the notion or the posture that, well, we still almost know nothing. And I think that sets in motion most people's capacity to have the kind of discussion we're having. I like to suggest that it's both, that the problem is in saying it's one or the other that actually we know a hell of a lot and it's impressive. And at the same time, we also don't know

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

so will your, your point about, you know, how can, how can we talk about something we can't measure? Just because we can't measure it doesn't mean we can't see it. Um, and I often think you're working with a patient let's say on some kind of kidney or liver issue. And they happen to be getting blood tests from their doctor at the same time. And like their liver enzymes are getting better as you're treating them or their creatinine levels are improving as you're treating them. And so we like to think, oh wow, it's actually really happening. But you know, my reference point is never to forget that the creatinine or the liver enzymes is probably at best 2% of everything that's going on. So, so it's awesome that they're getting better at, on as a creatinine or a liver enzyme measurement. That's awesome. It's fantastic. But let's not forget that 98% of what's improving, isn't included in that measure.

I think that's such a good point. And I think it's so easy for us to point to some of the Western diagnostics and go see, look, it proves that our medicine it's really happening. Exactly. You know, it's like research a lot of research. I, you see this stuff come across Facebook or you'll, you'll see it in different places. Oh, acupuncture is shown to blah, blah, blah, blah, blah. And we use researches. Marketing is

so powerful. It's those? The doctors

it's well, it tells a very compelling story in our modern materialistic world.

Absolutely. But so let's say a patient has six treatments with you and they come back and they say, wow, my liver enzymes are normal or my blood sugars normal. And my husband's saying that he hasn't felt this way about our relationship. Since we got married 35 years ago. So good about it. What impresses you more or are they coming after 16 minutes and say I'm actually, I'm finally decided to quit the job that's been killing me for the last 30 years.

All right. Yeah. When people make those really big changes or they come in because of problem X, and then they notice that, well, you know, I still got my problem X, but my sleep is like this and wow. My bowels are really working well. And I've noticed, I've noticed that my children are not so irritating.

You know, that's a great point. Oh, I've always wondered. You know, like for example, one symptom that's notoriously difficult to treat with active measures 10 tonight is right. But, but people come in for it and then we do a bunch of treatments and like 25 other things get better, but the tinnitus doesn't and then that begs the exact question you just asked is what is it? We're. And what's important and one symptom may have brought them in, but of course we're treating the whole system.

Yeah. And sometimes we don't even, I was going to say, we don't even know the depth of what we're touching into and I was going to back off from that. But actually I think I'm going to stick with it. Yeah. Often I know in my practice, I think I know what I'm doing. And then the patients will say something or like we're talking about, there's a, there's a response of some sort that's surprising and maybe frightening to them. Yep. And, um, and I think we need to take that stuff seriously. It's like, wow, here's some very useful information. How do we put that all together? You know, if they come back. Right. I mean, I've had people that called me and said, you know, am I supposed to have numbness in my hands and feet after acupuncture? Yeah. Yep. And I'm thinking, and I'm thinking, oh God, I hope I wrote good clinic notes. Right. Cause it's like, where did that come from?

Well, I am finding that more and more patients, and these are the ones I find rewarding. And I love working with them. Really do recognize this as a process. And it's a bumpy process and there's, you know, getting back to our main theme of adverse reactions, it's a bumpy process. There's ups and downs. We can trigger things that are not welcomed, but are part of the process. So, you know, those are, those are the ones. I mean, that's the rewarding work, right?

It is. Well, let me ask you this. Especially if the patient is a bit freaked out. Yeah. How do you invite them into that process? How do you invite them into, oh, there's something here. Shall we, shall we see what's here?

Well, I think the first point is what we talked about earlier. You can only take the process. The process is first limited by both where, how far you're willing and able to go and how far they're willing and able to. Uh, that's the first thing is to really look at that, like, cause you're getting it in trouble. If you try to go somewhere that either you or the patient don't have the capacity to go. That's the first thing, but then if, if everything's good and everything, you know, then I just, I just really work hard to win their trust, just to say, can we, can, we let's trust the process. First of all, I say, you've got my cell phone number with me all the time. You know, a lot of assurance you can call me on Sunday morning. If, if something happens, call me anytime. If you get my voicemail, leave a message, I'll call you right back. You know, all that, all that stuff to let them know I'm with them. And then I think, you know, if you're willing, if you're interested, I've been at this, you know, 20, I can use my 20 year thing and I've seen this a lot 99.9% of the time. It's, it's not a bad thing in the long run. Can you, can you just trust, surrender a bit and trust the process I'm with you. Let's let's continue, but, but then I'll also let them know, but look, if you don't want to do it, that's fine. Don't worry about me. You want to, you know, some people actually don't want to upset their doctors. Right. You know, that's a big thing. Well, I even let them know. Don't worry about me. If you want to cancel the next appointment and think about it. No problem. Like, you know, I just try to set the whole context in a very kind of assured trustworthy frame

and let them know you're available. I'm here. I'm not, I'm not leaving you hanging. No. Are there any, I'm going to call them like early warning signs, anything that you sometimes might pick up in the pulse or the tongue or your pal palpatory work that lets you know, Ooh, might be an iceberg here. Might be something else here. Any do, do things that tip you off. Well

more just my experience. I mean, I think particularly in the whole depression and anxiety field, if someone's been medicated for a long time, I'm always very quick to warn them. This could be a Rocky road. Are you ready for that? And I let them know I'm there with them. And then in the long run, I feel confident we can, we can probably do great work together, but, but are you ready for this? Yeah. And I even, do you have the supports in place? Do you have a good husband or wife? Do you have brothers or sisters? Do you have a good friends? Because sometimes it's easy, but sometimes I've had patients who have gone off the rails emotionally. Uh, it's just too

much. Well, you know, we're not psychotherapists. Nope. And yet at the same time, because of the kinds of questioning that we do, because we do have this rather holistic, I hate that word, holistic approach. We need different language, but you know, but in some ways, because we see the mind and the body as an integrated fabric, Completely together. We cannot help, but tread into some of the area that a psychotherapist would tread into, just because we're asking certain kinds of questions and because we're attending to certain aspects of who a patient is, what are your thoughts about treading into some of the psycho emotive material that is bound to come up? Because it's just part of who a person is. And we tend to invite the whole person into the treatment. Well,

I personally feel very comfortable with all of it. Like I don't, it doesn't bother me. It doesn't, I'm not nervous about that at all, but I think each of us is different based on our own experience. I think, I think that's the half of what we've been talking about. That's important. Isn't it? It's not just that it's the patient ready? Is that, are we ready to, and if we're not, then let's not go there. Let's, let's be quick to say, okay, we need to get a therapist online onboard here. Yeah, that's one thing. The other thing of course is depending on the jurisdiction you're in, you could be into some scope of practice, uh, conundrums, just legally or

whatever. I don't know. I've heard of situations where acupuncturists have been sued for doing

psychotherapy, but our medicine offers so much not in the regard of the integration of mind, heart, body, et cetera.

Oh, well, you know, we don't even, we never saw it as separate exactly. I mean, saying that they're integrated, still predisposes the idea that it's separate.

I mean, uh, I, I like to say, you know, your frustration and your liver enzymes are one thing.

Yeah. Let's dive into that for a moment. Cause there's, there's sometimes this idea think about the Oregon's in the Oregon functions and you know, if we let it slip, oh, I'm worried about your liver. People are like, oh God, my liver, what do I have cirrhosis? Can you know what? No, no, I'm not talking about that. Liver. I'm talking about other liver. It has nothing to do with it. But what I hear you saying is it absolutely has something to do with it. It does,

but you know, I mean, I agree with you a hundred percent. Uh, many years ago I stopped using the terms, liver and kidney, unless I'm really pushed by the. It's kind of weird. I actually, I mean, part of my evolution clinically is I now think more in terms of a tie in shaoyang JueYin. Oh,

tell us more about that. That really caught my attention in the past few years as well.

Yeah. I don't know. I just kind of evolved. I think it was after I did the ed doctor, ed Neal's online Neijing studies program. And that just got me thinking it more in clinic. Well, and then I, I remember I started doing renderings on cold pulses for about two years with every patient and it just, my own predilection is that this is going to sound a bit extreme, but I'll say it extremely just to get people's attention. I don't, I don't care about people's symptoms. I want to go deeper. Um, of course I care, but I'm just saying that for shotgun, but if you don't,

you don't get stuck with just a symptom. But, um, I,

this, my inquiry in clinic has taken me to a place. You know, I really do first and foremost, try to focus on treating the six levels where at what level is this problem? And I know the D the levels go in a scholarship way and herbal medicine and acupuncture are very different concepts. There's, it's not clear, but, and I'm just an acupuncturist, but I do find based on palpation, which is what I do. That's how I intake my patients primarily as palpation is shockingly. And, you know, 70 to 80% of my patients, I find most of their issues are either in a, I think you had a recent conversation with somebody about this with som acupuncture are either in tie in, um, Yangming or shaoyang joy in, or ShaoYin Taiyang. I just find that it's like, it's blowing me away. It's like, it just keeps showing up. So I'll focus the tree. On one of those three core tats of channels, most of the, and the treatments are very powerful that way I find. And so I've actually gotten to the point where that's, regardless of their symptoms, that's what I'm treating is what channel, what, which levels and which channels are screaming to be treated here. And the amazing thing is that it takes you away from the symptoms alone. Of course, as you know, anything can be it. Great. I really can. I mean, six, six cases of colitis can be six completely

different problems. Is it a TaiYin colitis or trillion

colitis? I had a patient in recently and she's a physiotherapist. She knows her body. She, all of her symptoms, symptoms lined up on Yangming all of them. It was like, this is cool. You know, one of those moments of, wow, this is cool from her, from her toes to her nose, everything lined up on Yangming and I got seduced by that. I got seduced and I treated Yangming for like six. And, and there was no response. In fact, her colitis was almost getting worse. Oh man. So I did what I call. I had what I call an extra sketch moment where I just, you know, I just said, okay, it's time to go. Tabula, rasa cleared those screens. You know, no one, you shake that screen and start over. And I, and I, and she, because she's a physiotherapist, she was with me. He said, okay, let's do this, let's do this. I'm just going to reevaluate everything. I retook our poles, read palpated, her body and Michael, everything showed up as an injury in everything. I mean, even on her pulse that you could feel this heat in the blood level. So I gave her a Dwayne shaoyang true. And poof, she called me and said, my colitis just got like 80% better in a

week. Holy smokes. Okay. Hang on a sec. I want to unpack this a little bit. This is

I just pay less and less attention to the symptoms and I evaluate the channels. And so then getting back to your original, let me just finish getting back to your original question. You know, people want to know how I don't mention liver anymore. I don't mention kidney. I try to just be quiet and just do my work. I'm just working on which channels are obstructed here.

Two things. First, I want to, I want to get into what you were seeing as Yangming and how you have that extra sketch moment. I want to unpack that a little bit. And then, and then I want to talk a little bit about Dr. work and why that caught my attention and why this six level thing now is, is so juicy to hear, but tell us more. You said everything was toes to nose Yangming what were you looking at? And then. And then how are you able to go? Oh yeah. Well, I mean, obviously sixth street, Mister didn't help. It's clear. You need an extra sketch moment. What is it later that you weren't, that, that drew you to the Dre yet? How did, how did you get from Yangming to Dre you?

Okay. Well, she came in because her large intestine five, you know, what do they call it? The anatomical snuffbox they're on her right hand. Oh yeah, the tendons they're at large intestine thought. Right. We're just causing her unbelievable daily grief. That's why she came in. I mean, this is a person perfect example of the tip of the iceberg, right? I mean, she came in because part of her wrist was bugging her and she couldn't do downward dogs and yoga. She couldn't even do her work. You know, it was, it was killing her and then it turned out. She, I can't remember, she had some, some weird problem with her second toe on the right side, she has chronic rhinitis and she would point exactly to large intestine 20 and say, it always hurts right here. Intestinal colitis. I mean, the list went on and on and I'm just going, you know, literally from your toes to your nose, right? All your symptoms are lined up on one channel. This is incorrect. So I got seduced by that as we do, it's very seductive. And I just said, oh man, we gotta treat young MIG. And, and, and actually I did her, her the symptoms she came in for got all better, like 90% better for her wrist issue at large intestine five after just two or three treatments got all better. And she kept coming, which was interesting, which tells me, okay, she's coming for something deeper. And then we start talking about her colitis and they said, well, I mean, I've actually had great success with colitis. So I said, I should be able to help that it usually responds well, but it wasn't. And I mean, I'm the kind of guy after three to six treatments, if something's not responding, I'm like, Um, I'm missing something here. Yep. So that's when I did the, I'll be candid and admit that I got lazy. I felt so confident about Yangming that I actually stopped freshly evaluating her every visit I would just launch into my young men

treat. Right. Well, you know, this is the problem of thinking that

we know. Yeah. I got sucked in by my own, you know, arrogance or whatever. And so the extra sketch moment was okay. Okay. I need to, I need to back off here and just pretend I know nothing. And, and then I re palpated her. I mean, I practiced the whole palpatory Japanese thing combined with, uh, Jason Robertson's work with laundry yang and a whole palpation approach. And when I read palpated, her, every, all the reactivity was on pericardium and liver channels. And then, then when I took her pulse, there was at that blood level, there was. Some kind of toxic heat thing. And her D her colitis had gotten quite bloody. So I just said, okay, I gave her a, what, I call it a joy in a shaoyang treatment. And poof, she emailed me or called me a few days later and said, wow, like I'm a lot

better. There it is the power of the six confirmations. You know, we talk about it a lot in herbal medicine. And there's an one things I love about Dr. work. You know, he really looks at constitutional types. He was the first guys to get me thinking outside the usual boxes that I was used to thinking in. Right. And then eventually that led me to some, some of the work of Dr. Hershey shoe and a functioning loan. Right. Susan Roboto Suzanne Robyn. I'm doing her course right now. So the way that those cats look at the six levels, holy smokes. That's a whole different amusement park right there. Right. Radical. Yeah. And. The thing that I love about it is is who shoe and Dr. Funk Sherlyn, they really look at, okay, what levels are being touched by this? I'm using air quotes here, illness. We're not looking at the illness. We're not like, okay, they got colitis. It's like, okay, where are the tentacles of this thing going into, where are the levels go to those levels?

Like, where are the bodies screaming in terms of symptoms is not necessarily where the problem is.

Yeah. And conveniently, we have these other ways of looking and going. So what's effective. What else is involved? I mean, this is what you're talking about. This, um, uh, Korean acupuncture, right? Toby daily, uh, was on recently, we had that interview. Toby's, Toby's been really generous with me. I've been starting to use this stuff in clinic and, and I have to call them up from time to time. He hit him with some clinical questions about this. One of the things that I find so interesting about that type of acupuncture, it really looks at the six confirmations. Yeah. It's really working at that level.

The, the burning question I have, I mean, I'm not a scholar in terms of translating classics and all that, but you know what I get from the people who study this stuff is this the six levels in acupuncture and the six levels of herbal medicine are not the same thing, but I don't, I don't know. I, you

know, I don't, I don't know. Yeah. There's, there's the answers you have to give on the national exam about what the six levels are. Right. There's that piece. And then again, you look at who she shoe and your loan. They're looking at it a little bit differently. Yeah. I don't want to bring up this other piece. This is just something I've been chewing on here. Like you I'm about 20 years into this. So that makes me a good, solid journeyman. Right? Well, good solid journeymen at this point. I'm a little beyond apprentice. I'm a solid journeymen. We talk about the scholars. We talk about the masters, you know, and, and, but my suspicion is very few of us are going to be scholars, probably even fewer are going to be masters. Most of us, the best shot we got at this solid journeymen. I agree. And I think there's a lot to be learned and gleaned in that our own clinical experience bumped up against like in this conversation. So what else has clinical experience bumped up against some stuff that we've read bumped up against what actually happens in the clinic?

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

I think so, you know, I remember one of my teachers and acupuncture schools saying, if you go to a really good acupuncture school, you learn about 12% of what you need to know. And if you go to you go to an average, when you learn 8% of what she needs to know all the rest you're going to learn from your patients.

Right. And it's perpetual. I mean, I get humbled regularly and after 20 years and look at the trouble I get into, if I get too cocky about it now,

well, I've found this to be true as well. As soon as I think I kind of got this one dial in, or I pat myself on the back, um, man, it's it. It's just asking for trouble.

What's that? There's a great Bob Dylan line. There's no success like failure and failure's no success at all or something like

that. I don't know what to look that one up that's that sounds, I didn't know. He was an acupuncturist. Um, man, this is wandered far and wide. Hasn't it

adverse rate. We were talking about adverse reactions

and we've come back to the six, the six levels keeps banging around here. So one of the things that I've, I've found and, and Toby daily talked about this in his interview and he talks about in his fantastic article that he did in the journal of Chinese medicine. Y'all can just download that. Yeah, you can get it from the website as well. Get it from qiological if you want it's over there too. One of the things that he talks about is that if you're on with this stuff, you can really help people. And if you're off with it, you can really send them off the rails. And I'm here at Italia. I have sent some people off the rails with this in the, in the process of attempting to learn it. Really? Yeah. I had a patient the other day. I was, you know, I'm trying to learn a new system here and that means on occasion, I make a big mistake. Because I'm still thinking partly in an older system. And so I had a patient with what I'm going to call a spleen excess. Yeah. Right. Very, you know, Ty in excess, she was a tie in excess, very overweight, went on the inside and, uh, kinda kind of wet on the outside too. And just kind of that very damp sort of slow thought process and a lot of mental chewing on things. Right. And from a TCM point of view, it's like, oh, we got a ton of fire. The spleen, we got to work the spleen. Well from this arm point of view, you don't, tonify the spleen. You don't bring more damp to damp. That would be a bad idea. You want to bring in the cool high, dry mountain air of the, uh, of the large intestine of the Yangming. To dry up some of that dampness that's, that's what you should do. But I was like, oh yeah, her spleen, I got to fix her spleen. So I tonified her spleen and I, and I missed the signs and the, I missed some of the stuff. I, in retrospect, I should have caught. And she comes up after the treatment goes, am I supposed to feel dizzy and nauseous or shit? And at the same time, I'm thinking, oh man, Toby Taylor, he was right about this. Yeah. So, so, so I'm thinking to myself, how do I approach this? Do I say, oh, I made a mistake here. Let me fix this now. Or do I, I sort of file it away. Oh yup. This is what happens. I'm here. Right? I said, I'm going to check in with you tomorrow, which I did. And, uh, you know, basically what happened with that is after a few days, she felt okay, again, And I go, okay. Be very, very careful Michael max, because this is what can happen if you do it wrong. You know, if you see a spleen excess don't, tonify the spleen or som acupuncture, right. Because we're not working in an Amazon Fu way, we're working it through the six confirmations. And so that, I mean, there's a little tick in the chart for me of six confirmations, very powerful medicine.

Yeah. I mean, don't forget patients go to their psychiatrist all the time and they say, oh, well, let's try Zoloft. And then they come back and say, you know, I've got all these terrible side effects. Okay, well, let's try Prozac. I mean, we're a wash and a medical culture that tries things. And if they work great and if they don't, I mean, there's a lot of educated, guesswork going on in modern medicine. So absolutely. You have to give ourselves a little leeway as long, I believe, as long as you Michael max are coming from a place of high integrity. It's okay. That the treat, the diet, the response to treatment as part of your

diagnosis.

Absolutely. Yeah. And I've had one of my teachers, one of my herbal teachers,

you just keep doing the same stupid thing over and over and over. That would be

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

she's just not ready for it or something. Yeah.

So w herbal teachers early on said, you can say that you understand the formula, or you could say, you understand an herb when you've used it and it's worked and you know why, and you've, you've used it and it didn't work. And you know, why only then can you say you understand it? So. Part of our process is, is to be able to recognize the errors like that. It's it, it's part of what we have to do there. Isn't, there's no way around it. I think the question is how do we engage ourselves and how do we engage our pagans to, to keep things moving forward?

Well, my experience is that it that's get back to the original point. You know, where is your, where are you at? And where's your patient at? If you're, if you're both fairly well along in your maturity and your humility, um, they're, they're, they're going to stay with you. And if either, or both of you aren't, then what's going to go off the rails pretty fast and

well speaking from the practitioner side, what are some of the things that you found helpful over these years that help you stay present with this that helped you to be ready for moments when in, oh my gosh. Now what?

Yeah, that's a great question. I'll never forget. My first weekend practice, I just graduated from the new England school of acupuncture. Moved back home, opened my clinic. I had 25 patients the first week. Oh wow. Some of them like really sick. And I remember just saying, I'm going to go into each and I've done this for 20 years. I'm not going to go in with any book. Now I have all this knowledge, but I'm just like, I'm going to go in like an Etch-a-Sketch with each patient just, and just be there and just take it and trust myself, you know, there's that whole, there's that whole tension between spontaneity and rote knowledge. And, you know, I always think of miles Davis as the archetype of someone who knew a hell of a lot, but clearly lived in a receptivity to what spontaneously arises in spite of everything he knew every day, that's kind of. Operating principle. My, what are the military people? My, my, my mode of engagement. What do they call it in the military? The what's my rule of engagement, everything that I aspire to every minute. And so I just trust that the right thing will come up, but it doesn't always work out. Well, the thing

about dooming, the work learning what you need to know that, I mean, that's essential. You, you don't get to do the spontaneous stuff. I mean like miles Davis, you don't get to, you don't get to do the miles Davis, you know, crazy wild man. Amazing thing. If you haven't done your scales for, you know, ridiculous amounts of time and listened to all kinds of other music as well.

Exactly. Yeah,

exactly. So keep reading folks, keep learning.

And yet there's that magic moment where you're just surrender at the same time.

Yeah. Every now and then you hit that sweet spot. Don't you? She has in clinic medicine, which we could hit it every

time. Well,

why we practice Daniel? Anything else to share with our listeners before we wind this down for today? The

other piece I had written some notes about, you know, the whole adverse reaction thing is I think one of the flies in the ointment that we don't know about our medications. And I think that often, you know, what is our, what is acupuncture doing? It's optimizing physiology. And a lot of medications are dosed at a higher, a higher than perfect dose, for example, because, because of physiological inefficiencies, right? So I've witnessed many times. What I believe is on triggering, essentially an overdose in someone who's on a medication at a certain dose comes to get acupuncture. So their physiology gets optimized, then they start using their meds more efficiently. So I think meds are a big unknown in this business. So just, just pay attention,

you know, that's a really good point. It's really, I have seen some patients who, yeah, they were having issues with the medications working too well. And I suggested, well, why don't you go talk to your doctor? Maybe you don't need as much of this medication. And some of them were like, no, I do not want to mess with my medication. I am stopping this dang acupuncture because it's messing with my medication. They didn't see it as healing. They saw it as being in interference.

And then others are more than happy. Their goal is to get off their meds. So you have to be with the patient where they are.

You gotta be with them where they're at. There you go. Well, Daniel, thank you so much for this time today. This has really been delightful.

You're a delight.