Like we were talking about before the patients feel really heard. And I think my patients do too, because I'm really listening to them. Right. I'm listening with my eyes. I'm listening with my heart. You know, I'm really listening, trying to get a feel for what this patient needs. So I think it's, it's, it is really comforting for that patient, but also, you know, it's essential for our diagnosis system.

I'm Michael max, and this is qiological discussions on acupuncture, any station medicine I've been thinking about generosity lately, the generosity I've experienced over the years from teachers, the generosity of those who pointed me in a certain direction that might ripen into something of value and the generosity of the guests who take their time to talk with me here on the podcast, which gives me an opportunity to share the wealth of the perspectives that we have with our medicine. With you. Maybe it's the change of the seasons. I look out the window. I see the falling splashes of orange, yellow, and purple. I watched the summer's plump lushness with her into dry stocks and hollow stems calls to mind. Some of the people that have helped me on this journey who are no longer cure. I'm more keenly aware today of the generosity of those who gave me a basic framework so that I could get a footing on seeing the world through the lenses and the prisons of the east Asian medicine that we practice. I call it to mine. Those who helped my patients in the future by pointing out my blind spots and the moments when I thought I understood something, but I didn't. And I think about the teachers that didn't tell me what to see, but they showed me where to look men and the women that threw a spark on half try Tinder. I'm not sure I would have invested in someone like myself at earlier stages of learning, but they did. I think we all rely on tremendous generosity when learning medicine, we have people willing to share something of what they've seen. Share their understanding, even as it's constantly in the process of refinement and clarification, it takes a big heart to take the leading edge of your learning and share it with another. And it takes a generosity of spirit to share something honed in precise and perhaps have it fall on deaf ears or at all mind generosity. Isn't about giving away something for free. It's about sharing something that goes deep, and that requires work on our part. Sometimes we have to give up our small, comfortable story for journey of uncertainty that might, if we're lucky and we work at it, help us to see from a perspective that in this moment feels foreign and unreliable. Some lessons won't bear fruit for years, and by the time they do, the teacher might be gone. I didn't think I was going to talk about this today because it's still fresh and it's still raw. I and many others this week lost a friend and a teacher chip chase left us last week. Over the years, chip has generously shared the Enlive and edge of his learning and inquiry into medicine with us in the classes that he's pot in the depth, insight, and rigor of the writing. He shared over the years, I found ship to ooze a spirited inquisitiveness. He had a penetrating humor and he could gently touch on something tender and help it to be less fragile. And these past few weeks I've heard him say this. I am trying to fully embrace the reality of my situation with gratitude. I want to go beyond just coping with it all to a place where there's nowhere else. I'd rather be it's powerful medicine and powerful teaching. Don't you think? Who was going to say that that light is gone, but I don't think it is. It remains kindled in those he's touched and taught. Let's just take a moment here. Thank you. Chip today's episode more generosity from Toby Daley. Who's been on the podcast before. Check out episode 45 on some acupuncture. If you've not already listened today, it's not just Toby, but a couple of other practitioners who have been working with the som acupuncture perspective, this discussion is grounded in the clinical application of this method. Hey friends, welcome back to qiological. I'm delighted to have another conversation today, not just with Toby on this, um, acupuncture stuff, but a couple of other practitioners that have gotten interested in it. They've got some of their own experience, but more importantly, they've got tons of questions. And so we're here today for another group discussion, a practitioner's point of view on this on acupuncture system. So welcome to qiological. Why don't you all introduce yourselves? Let's start with the end. Jameela.

Thank you so much, Michael. I am new to some, um, uh, but I have been so. Encouraged by your enthusiasm and the great interviews I've already heard on geological and the Patrion page is on the subscriber. So it's great that you put the extra interviews that they got me to thinking, but I still have so many beginner level questions about this system. I tried it with a patient recently and I was really struck by how she felt, I guess I could put in quotes. She felt heard, she felt like I heard what she, what her chief complaint was and that it was addressed more deeply than she experienced before. So I've wanted to do more, but I have a lot of basic questions.

Great. I find the basics. You can never do too much of the basics. A dura. Tell us about yourself.

So I'm there calling from Portland, Oregon, where I have my acupuncture practice. And, um, I actually found out about some through listening to your first interview with Toby this summer. And I listened to it at a time when I was just really seeking a new style of acupuncture that I felt more at home with. And that felt more cohesive to me. TCN acupuncture has just never felt particularly satisfying. I have struggled with a system that I felt was effective and that I could relate to for particularly internal medicine complaints and mental, emotional complaints. And I was really struck by just the elegance and precision and the system that Toby described. I liked the way of combining points to give the body a clear message. And I started to try using it in clinic and was really amazed by the responses I got both positive and negative, and the fact that something was so clearly happening for my patients as a result of this point selection really OD me and made me want to study more and learn how to apply in the Psalm system. Well, um, so I've been really grateful to be in communication with Toby and, and try to learn it as best that I can

delighted to have you here on the podcast today for this conversation with Toby and Toby. Hello. Hey, good morning. Anything that you'd like to say to our listeners? They probably already know who you are by now. They're probably sick of hearing.

I just like to remind everyone that I'm just a senior student in the system, so I'm eager to help anybody. I can along the way, but, uh, I still consider myself a student

in the system, you know, I I've got a teacher that I've been studying with for ever since I started studying acupuncture. And he's one of these guys I've been in classes with him, with other people. He doesn't come in as a senior practitioner. He comes in as a student kind of interesting thing. Yeah. Good. So we're all students at one stage or the other. Why don't we begin today with Jameela?

Thank you. My practice is focused primarily on obstetrics and gynecology. I see a lot of women who are pregnant that different points during their pregnancies. And I also work with women and couples who want to conceive and are having different challenges. And I have questions about. How I understand what my patients are presenting through this system. And it sounds like I'm thinking about three different things. So yin and yang relationship, the six confirmations, and then the five phases. And, but I'm also from listening to previous interviews, you've done Toby and Michael, it sounds like I'm also wanting to pay attention to the qualities that a patient presents, um, their emotional qualities. And one thing I like about the system is it's seems to take in more than just the symptoms, but you know, the clear identifiable physical symptoms. So for instance, if I see someone who. It's very concerned about going past her due date and the obese that, um, she sees are suggesting that she may need to have a medical inducement to go into labor and not be able to wait on her own. If someone comes to me with that kind of concern, I'm going to pay attention to whether or not they are more introverted person or whether they are more fearful as well as what's the intention of trying to encourage the onset of labor in terms of yin and yang. And in terms of the five elements, am I thinking of it the right way?

Uh, I agree. Yeah. I think you are really trying to take into account everything. Like you were saying, the three aspects that you take into the system really. Yeah, you have to take into account that every single time. So eventually that kind of comes kind of coalesces and comes together. And you just start to understand that organ systems as those three aspects. But initially it's hard to keep all those things in your head at the same time, but you really should for this system, this system requires you, you can't use like a little portion of it. You have to use the whole system. I think so it's hard to get started, but once you get going and you know, this isn't really good is able to capture quite a bit of the clinical experience. So if

I give you an example, can you tell me, can you talk a little bit about how I would take all three into account? Yeah, I

think that's a great idea and we'll make it real concrete.

Okay. So I just, yes, the other day saw someone who. There's normally very grounded and centered and a little lean, lean more toward introversion, but, um, is, so, was so upset about her doctor telling her that they wouldn't be able to just wait for her to go into labor. That they'd have to promote it with medications. And, and she wanted her birth to be as natural as possible. So she was very anxious and wound up. She was sweating. Her skin didn't feel dry at all. And, but interestingly many pregnant women, I see it, you know, 40 weeks or run hot all the time, but she was sweating, but she said her hands and feet felt cold and she had some swelling in her. Ankles and risks. And it's a lot interface actually. So I was trying to think, how do I look at this from a Psalm perspective?

Yeah. So my first thought is to try to counterbalance that fear and I'm with this system that fears associated with the urinary bladder, that cold water. And so the water aspect could be the sweat. So in this case, I would definitely consider supplementing the heart, especially if she's not too hot. Like you said, a hands and feet were a little bit cold, so definitely you can consider supplementing the heart that is going to bring a whole bunch of fire. And also how much of love into the situation. So I, I think especially, uh, to counterbalance that fear and then to really piggyback on the love for the coming child too, I think supplementing heart would be very good idea in that case, uh, is as long as you feel like she's not overheated already. And

do I also have to consider the baby, who's almost a fully formed person.

Yeah. Th the baby is definitely a part of the equation, but the baby should reflect in the body in, in the, in the mother's body. So if the baby has a lot of heat, it would really reflect in the body and the mother's body. So as long as you're reading the mother correctly, I think you take good care of the baby.

That's very helpful. So then when I consider these three categories, I do want to be sure I follow the system as outlined on these charts and your article. I study your article a lot, so I don't want to mix things up. Like if, if I'm, I want to decide what channels I'm going to focus on and then do that without like mixing up points from two different channel categories. I have a lot of questions about points.

Okay. Yeah, I think you're right. Uh, the best way to do it is when you first learned this system, just cleanly, use the system exclusively to get a real good feel for it. But, um, my teacher did recommend ultimately, right. You're going to really mix and match these systems and take even non, uh, shoe points later on the system itself starts out with a really basic fundamentals, but you can really take it a long ways, but you know, so this is what we're recommending right now to supplement the heart for this patient. So obviously that's a year in Oregon and then fire five phase and then a ShaoYin. So also fire. So that's what I was saying. You got to keep in mind that you're going to be using double fire for this patient. So you gotta make sure it's approved. And how do I do that? Usually you usual ways of diagnosing the patient. You want to make sure they just don't have too much heat in the body because you're going to be adding a whole bunch of heat. But definitely fear is going to is she's got, you know, real fear about what's going to come up then that's that almost guarantees you have plenty of counterbalanced to add those to other fire aspects because that deep fear is, is ice cold water.

Oh, that's very helpful. So then for the, I guess I'm trying to figure out how to think through these three categories. Should I start with one? Like what confirmation am I looking at? And then that kind of will help me see what phase the patient's presenting. And from there, figure out the confirmation. I wouldn't break them up at

all. I would give them all your really similar. Uh, the fact that heart is yin, the heart is fire and the hardest shit hardest ShaoYin I would give that all equal weight and then just try and keep all three aspects in your mind when you diagnose and have that image in your mind, does this patient really need these things?

Oh, and then how do you determine what direction you want to move in then, like you talked about, I want to help her be more in touch with love, especially stoking that fire, then it, and it's not just to balance out the coal, but it's to help her be in touch with the love energy. So then that sounds like I want to also make some decisions about what might be most helpful for their emotional state or their psycho emotional wellbeing. Does that make.

Yes. And again, I mean, really with the system you want to try and take all that into account at the same time. It's difficult, but yeah, if you can do that, but so like you were saying for this case, um, with a cold hands and feet and lots of fear and, uh, like I am picturing this patient in my mind. And then the idea of like piggybacking on that coming love for her, her coming child. Right. I think heart would be really appropriate for that because you don't, you don't want that baby getting too much of this ice cold fear energy into the baby. So especially I think it's especially appropriate for that kind of

case. Okay. Well I'm now I'm going to share with there. I'm not going to monopolize. Thank you so much.

You're welcome. Yeah, hopefully that makes sense. And I want to say one more thing. Um, as long as it's not too confusing, but in the system, a lot of times, if the patient doesn't need tons of heat, then sometimes we pair this with supplementing liver at the same time. So for this case, he would supplement heart and supplement liver. Liver would make it take a little bit of edge off that extreme heat with heart and ultimately the system, uh, liver supplements blend. So I think that would probably be really appropriate for, um, assumed to be a new mother. So, uh, to supplement a warmth and blood, I think is really reasonable

and liver

supplements blood, and this is a great

hair with a heart. And do we want to promote movement in a case like this,

as it gets closer, if you can consider something like that, usually I'm like early on in the pregnancy, we try not to use much small intestine because that does a lot of movement. But if she's past her due date yeah. You can consider supplementing small intestine.

Okay. That's very helpful. Thank you. Sure.

Um, so Toby, I actually have a couple of questions about the liver. I'll start with a brief one. Um, you had mentioned that you can tonify the liver or drain the Sohn Zhao for a yin deficient heat. And I was considering that and wondering if it's because liver tonifies blood and then maybe also relates to yen or that kind of cool Misty forest that you described being similar to yen and tonifying in. And if that's a correct understanding of why you would tonify liver to address the inefficient heat and relatedly, if you can ever tonify spleen or a lung in order to kind of effectively ton of 5g,

Yeah. Your understanding of the liver Saundra dynamic. I think it is right. That that's usually how I think about it. And then I just want to remind, uh, other people listening that if you can, you want to always try and supplement. So, um, if, if you really wanted to drain the sand gel, it's much better to supplement the liver. Instead, it may take a little bit longer, but just to remind people about that with the system and then supplementing lung and supplementing spleen and supplementing fluids. So that, that is the beginning category. So yeah, definitely. I would consider that supplementing spleens a little bit, a slightly warm influence though. So I'd be a little bit careful if there was real inefficiency. I think maybe you liberate a little bit.

Okay. Okay. And then I love to ask you a more complex question, I guess, about the liver and sun Zhao. Um, that's the pair I've been struggling with the most and I, the image that you gave of the cool dark moist forest for the liver, and then the kind of clear piercingly bright day for this Anja was really helpful. And I think helped me get a more, a better sense of them as dynamic opposites. And so I feel like I, I understand them in theory, but then in the clinic, I'm, I've been struggling to. Really identify when someone needs supplementation of one or the other. And for instance, I often see folks who suffer from depression and a tendency to sort of descend into dark murky places within themselves, but also equally tend towards mental fixations and obsessions. And I was thinking maybe this is the Pacific Northwest phenomenon. I'm not sure, but, but that presentation combines characteristics of the two channels. And I haven't really been sure what to do. Um, and then similarly, I commonly see folks who are both severely depressed and very blood deficient or. Sometimes in polite and blood deficient. So I'm curious if you have any further thoughts on how to approach those two situations or just more insights into the liver. Sonja's dynamic.

Yeah, several thoughts about that. But one of the first ones is sometimes we do see this like say the other 10 channels are in really, really good shape and just the liver and the Jo are both deficient relative to the other organs. So sometimes we have to step in both apps. So sometimes that supplement liver sometimes supplement sand gel, maybe at different appointments. That that's a little bit rare, but sometimes I have to do that. If the other organ systems are fine and these both are deficient together, then I slowly walk them both up. And, uh, you know, depending on the presentation that day, when I see. Does that make sense? Definitely. Yeah. Relative to the other organ. So sometimes I do that and then if they're blood deficient, but they really need some heat or something like that, just like I was discussing before with the pregnancy, you could probably a supplement liver and supplement heart at the same time. It seems to be a really good pairing for this system, especially for female patients. That, that seems to be a really good combination in general to consider. Yeah, I've liked

that. I think you mentioned it for menstrual cramps and other reproductive issues and I, I definitely have seen good results with that. Oh, I'm curious about in particular, maybe the depressed and blood deficient patient who needs kind of some of that clear bright energy, but is also very pale and tired and then pulse, would that be a good instance to alternate between Joe and liver?

I would, I would definitely consider it and I would be really careful, like, especially, I mean, that's such clear, um, blood deficiency signs I, you know, would start with supplementing never. And then if you could combine with, uh, liver with heart, and then that's sort of a way of just kind of testing with the body, thinks about having some heat also at the same time. And that might be a good way to go before you went direct, uh, some.

Got it. So in that case, the supplementing heart could also address those, that kind of depressive state, because it's love and joy and things like that. And

that warmth to, um, you know, your you're right to think of Sandra is that brightness, but heart is in that same category with, with so much more. Okay, great. Thank you.

Um, I do have a question too, about the working with the earth TaiYin and Yangming because I do see a tendency, uh, obese or overweight patients who always have the dry skin. And I tend to think of that as just the moisture, not being able to get to the surface of the body either because of cold, internally, not circulating. So in cases like that, what I look at the Yangming treating the Yangming, I couldn't figure out excess or deficient. Well, yeah, no, but,

but I think you're right. I mean, if you're sure it's coming from cold, that that's, I'm making the skin dry, then you can consider some of the more warming, uh, channels in the system. But do you think it's just an imbalance with what's going on with the body? It's not due to extreme cold that made the skin dry. Then we really do think of that as a lung excess. So you would supplement the stomach for that. If they're too wet on the inside and too dry on the outside, um,

Michael tried to explain this to me, but somewhere my brain just gets stuck and doesn't make the leap to where are they and why, and where do we want them? Would we want to promote, well,

let's break it down the three aspects. So, uh, I'm saying they have a lung excess, uh, when they're obese with dry skin. So I'm saying that that, uh, there's, they've got too much TaiYin on the inside, right. And too much metal on the outside metal

dry, right. That's right. Okay. I understand.

So then the, the counterbalance is the opposite. When you supplement stomach, it's going to dry and insight and moisten on the.

So a lot of times I want to ask myself, where do I want to counterbalance this presentation?

That's the crux of the system is yeah. What, what needs to be counterbalanced and you're right. I mean, you can drain excess, but in this system we really try not to do that. We try to counterbalance whenever possible.

Well, that's a real helpful, important distinction. Yes. Not trying to actively shift something, just counterbalance,

right? The counterbalance by counterbalancing, we're adding something to the system. So it becomes more balanced by draining. We're taking something out of the system, then it becomes more balanced. But actually the system itself has lost something.

Um, Toby, you mentioned supplementing small intestine being a possible treatment for dizziness. And that one surprised me. I was thinking of. Uh, either relating to wood, maybe being too much movement or too little movement outward or inward. Um, and I'm curious if you can talk about why w one was supplement small intestine for dizziness

theoretical wise. I'm not sure exactly why, but, uh, clinically this definitely works and my teacher recommended it, I think possibly, you know, the slight blood, um, moving aspect of small intestine and the moving aspect, I think by supplementing a little bit of blood and then moving the wind helps with the dizziness aspect. Definitely it works in clinic. I never specifically asked my teacher why.

Okay. And would you say almost any kind of dizziness? Um, that could be inappropriate treatment?

Yeah. As long as they have enough, um, as long as the kidney energy is okay. I think, yeah. Often I consider that and say if you're definitely sure it's coming from blood deficiency, then I would supplement liver and supplement small intestine at the same time.

Great. Oh, I'm just going to jump in for a second. If just cause I there's a patient that I've seen recently, if there's dizziness, because there's a fluid accumulation in the ears say they had been ill and they hadn't recovered all the way. Now they're given a bunch of antibiotics and that's kind of thrown things off a bit. And so the ear feels plugged in and it feels full and there's, there's some dampness in the system. You can see it on the tongue, feel it in the pulse. I've been doing small intestine for this person because obviously that's partly where the issue is. And I'm trying to get things moving along. Would you throw in something that helps to create some dryness, something out of the Yangming category to kind of heat it up a bit and dry that stuff out or, or just go with the smaller. No, I

think that would be a great combination, especially. Yeah. If you're sure it's coming from dampness, then it would be great to, you know, add a, um, large intestine or stomach or something like that. Whatever's really appropriate. Plus a small intestine. I think that would be great. That'd be a great combination. Okay.

Um, gosh, I have so many potential questions. Um, I have a patient that I'm seeing today whose main complaint is inhibited urination and BPH. And I think actually some erectile dysfunction too. And I was trying to think what I would, how I would approach that with some, uh, particularly inhibited urination.

I just swim in the ocean. And, um, this really reminds me a lot of the urinary bladder ice cold because it's in Northern California is really freezing, but I just, uh, went in real quick yesterday. And, um, this, this really stimulates a urinary bladder, uh, immediately when I got at the ocean at urinate. So I, you know, consider for this, especially if it's coming from a lot of heat in the lower jaw, you could consider supplementing, um, urinary bladder. It really, uh, stimulates the bladder and really wants to flush things down. You haven't, you haven't seen the patient yet, so you don't know hot

or cold. Right. You know, I have seen him in the past, um, and he's kind of been on a, an herbal regimen for a while and I haven't seen him in a couple months, so he's going to come back in and I'll see how he's doing, but he's definitely more on the hot side. Um, so that fits well.

Yeah, I've used that before for any Hebrew, the urination and it's pretty, uh, pretty effective urinary bladder by itself.

Um, I guess I'll throw in one more and then, um, give it back to end Jameela. But, um, this is a practical question I've been noticing that the system is just so radically different from the way I've been practicing up until now, which honestly, it just takes a lot of time. I take the pulse for a long time. I do a lot of needles. A lot of times I add in bodywork and home exercises or other homework. And, um, since I've been using the som system, I find that the treatments go a lot more quickly and it seems like it would work well with seeing multiple patients an hour, which I historically haven't done. And I'm curious if that's what you do and how long you devote to an initial treatment and a followup treatment.

So for new patient, I usually do an hour and a half just because I want to be sure and really get a good rapport going and then follow up visits. I do half hour. And then also I was doing like two hours a week. I would just open up my clinic. It had five treatment rooms and just anybody who came in those two hours. Seeing, you know, six plus patients an hour, um, in the system works really well for that because especially once you get a feel for it, you can see right away, you know, between the chief complaint and how they present to you, you can make a pretty quick decision. So, um, I think it's better if at all possible to really go slow and work with the patients to make sure you're right. Definitely hot, definitely cold or something like that. But, you know, once you get a feel for it, you can go really quickly.

Okay. And so you have that initial hour and a half visit and then follow ups. And do you do kind of a longer re-evaluation at some point, or do you find that you don't really need to have a longer visit again?

Um, I don't usually find that sometimes. Like if I'm confused or something like that, I will spend longer with the patient just to try and drill down on something that's going on and then maybe like see another patient and then come back to that patient really quickly to see. Sometimes I do that when, when it gets really confusing. But like, you can see from your experience with the system, usually get pretty quick feedback right away. Right. So it tells you almost right away, your idea's wrong or right.

And so if the person that you had been treating were to come in with a new complaint, you think, you know enough about what could be contributing to it at that point, because you've gotten a sense of their constitution, or I guess, would that take longer to kind of get really clear about what was contributing to. That complaint, if that makes sense. Yeah,

that makes a lot of sense. I think it's much better if I've been seeing the patient for awhile and I know that they responded well to certain Psalm channels. Then I feel a lot of confidence with whatever comes up next. You know, I already have a good feel for what they, what their body likes. So usually they can accommodate that pretty quickly.

Great. Okay. Yeah. Thank you.

So my question piggybacks a little bit on what they're just asked. I wondered how you do an intake and because you have such a clear understanding as a student of this system, how to apply it, how long do you spend with an intake and what kind of elements are really important for you to be sure to cover? When you talk with a patient for the first time.

I think I do like a normal kind of intake, like the 10 questions ish, but then there's all a bunch of unusual ones with a system. Like a lot of times I'll ask the patient, oh, uh, what's your best friend, describe you as more introverted or more extroverted or something like that. If I'm trying to really figure out between now the burn San or something like that, or oftentimes I try not ask the patient directly because they'll try and give me the answer that they think I want to hear, or the socially acceptable answer, but I'll say, oh, you know, what about your best friend? Would they describe you as, uh, someone that likes to read or someone that likes to go out and be more active or more argumentative with people and things like that. And it seems like that can elicit a pretty good with that response. Okay.

And then I guess what I was asking though, is are there specific kinds of questions. That help you with diagnosis or the 10 questions should still be able to guide me into, through these three state phases, these three categories.

That's what I was saying. So I mean the 10 questions is great. You know, it gives, it gives us a good baseline, but if I'm really trying to decide about, uh, am I going to supplement Sangita or supplement liver? That's when I would ask them about their best friend, describing them as an introvert or an extrovert or something like that, that will really give me clues about that Oregon system specifically. Or like I was saying the other example too, if I'm trying to decide, am I going to supplement pericardium or gallbladder, ask him if they're, they're more into reading and more into fighting, you know, with, with their best spent describing this like that. So there is a little bit of nuance aspect to this system is not like standard TCM. Standard TCM informs it. It just goes a little bit more nuanced, I think.

Yeah. I just want to pop in for just a second. Uh, there was something that Dara said about that, uh, the system is radically different from what we've learned in school and, and this is something that I've been discovering in my conversations with Toby over the past few months, it's actually not radically different. And in fact, at least in my experience, the system, everything that we've learned in school and really everything that we've learned in our experience, it all is helpful. It's all grist for the mill, so to speak. And it's simply taking things that we already know, but we're looking at it a little bit differently or we're putting it together in a slightly different sequencing or we are. Yeah. Like, instead of thinking of all, I'm going to balance, even in young, all of a sudden you're looking at, oh, I'm working with the liver and the sun JOL. And at first that seems, oh, that's odd. How do those go together? And then you begin to see via the six level correspondences or different aspects of the five phases. Oh, they actually are connected in this way. Right? Like you look at the liver as being Dre union, and you look at the sun jail as being shaoyang. And of course we work with trillion shaoyang relationships all the time and clinic often with GCM, we're looking at it as liver and gallbladder. But in this case, it's just a slight little shift over to the sand jaw and this whole other aspect of how things work comes into being. So it's not at all that we're learning something. And I would even disagree a little bit with the Dara it's radical because it's not radical. It's simply standing in a slightly different place and taking things that we've already been working with for years and just read, mixing it a little bit. And it can be really powerful when we get those results. The results are radical. No doubt. They can be radically good. Like what engine Neela was saying with patients saying, wow, I actually felt heard it and it can be radical in terms of, you can take someone off the rails and really cause them some problems. So the results can be radical. But the system itself, I think, is deeply.

Um, so I'm like, I just have to say, I totally agree with everything you said. And I have loved that. Um, I've been able to apply the theory and practice of, of the medicine that I have learned. I think what I meant was that on a practical level, like day to day in the clinic, in terms of how I'm spending my time, that's what feels radically different. So prior to this, I practice the Shen hammer pulse system. And so a full pulse intake is actually, you know, 45 minutes to an hour, which is what I was doing. Um, initially until I realized that I just was not going to be sustainable for me. And then I tend to use a lot of points. I use the, I kind of intramuscular motor trigger points system for pain, which I usually use quite a bit more needles than four or H and even treating internal medicine conditions. I would use a lot of needles and basically. Crafted a treatment style where I was spending a lot of time and a lot of acupoints. Um, and so that's what feels so radically different is sometimes I just put in four needles and that's it. And I'm like, I feel like I should be doing more, but I also get results with just that. And so what more could I want then than results from the treatment? So that's, that's kind of what I'm dealing with shifting in my practice, if that makes

sense. Oh, it, it, it totally makes sense in describing the way we work as being radically different. I would absolutely agree. And the other thing that I'll say for myself, because I'm basically a lazy person, this is a great acupuncture perspective to use. If you're. Well, because I don't spend tons of time on the pulse. I don't spend tons of time trying to figure out in my head, oh, well, you know, there's this yin deficiency it's giving rise to this thing and then, you know, blah, blah, blah, dah, dah, dah, you know, I'm not crafting this big elaborate thing. I'm looking at them and going well, first of all, if they're skinny and kind of rude and you know, they got acne and kind of greasy skin, and they're always complaining about how stuff never goes, right. For them. I just immediately go, oh, well, that's a stomach excess. I need to treat their lung and maybe throw in some pericardium to chill them the hell out. And I can do that diagnosis in five minutes. I mean, I've had people come in, they just start acting a certain way. I look at their body type and I go, oh yeah, that's that? I mean, unless something comes along that makes me go, oh, double thinks that sometimes it's very easy to dial things in the big fat woman with dry skin. Driving a very nice Mercedes carrying a purse. That's more than I'm going to make in a day and just got some breathing issues. I mean, that's super simple. That is a long excess, you know, again, unless there's other things that come up that make me go double think that it, this is very helpful. And, and again, I don't want to say you should put people in boxes, but it's very helpful. Kind of like Dr. Hong longs work with the herbs and looking at constitutional types. If you, you know, if you screen someone in as being a wager person, you can probably for the moment, forget about the fruits of formulas till you're proven, you've proven yourself wrong. So this is a way of being able to dial some things in, to get started pretty quickly. And then the other great benefit of this system is it will give you feedback again, quickly as to if you're on it, or if you've got. So again for a lazy person like myself, this is great, really super helpful. And

most of the time when you gave the example of the skinny woman, the you, well, most of the time are you using four needles, max or eight? Some to be, if you're combining, that's a good question.

So there's a part of me that wants to do more than the four. And I do that from time to time, but mostly at this stage of the game, because I feel like I'm still learning it. I usually just want to do four needles on occasion. I'll do eight if I'm super clear, but as much as possible. I just want to do the four needles because I want clear, direct feedback on one data point alone as to how things are going. Hmm. And again, because I'm still learning it. You know, it's a little bit like if you're really wanting to learn shaoyang huddle and formulas, you don't want to start off with a bunch of combinations. You want to start off with just the formula, use it in an unmodified way, really learn how those things work by themselves. And then you can start combining things, but it helps to have a baseline and a bunch of data points on the basics before you start mucking around with things. And me, I like to muck around with things. So this has been a good practice for me and just dialing back, staying with the basics, observing and seeing what happens and learning from just having one data point at a time.

Okay. That's really helpful. So today I'm supposed to see someone who just ran a marathon and has needed to have IVF fluid and fusion. And as well as, uh, coding and one other medication, because I guess it was like she got all tra dehydrated running 26 miles and she said, she's having severe nausea and abdominal pain. And the scan showed that her Colin's inflamed, I would imagine from dryness, but I'm not sure. So can you to Toby and Michael and Dera, all three of you, walk me through how I would think this through, please. I'm

going to take a shot at this and then we'll, then we'll hear from the advanced student. So yeah, first of all, she, well, she's a marathoner. So is she, does she tend to be thin?

Well, you know, she was more obese and dropped half her body weight in a less than a year. And did a lot of hot yoga and keto diet then yeah. Cut her body weight in

half. Okay. So she's, I w you know, in the same with her Cole and being inflamed, you said there was a scan. What kind of, was it colonoscopy, or what else? What

did they do? It was a CT. She thought something was wrong with her appendix, I guess she's having pain too. Yeah, no abdominal pain on that side where the appendix is.

So my thought would be that there's some internal dryness exacerbated by doing a marathon and getting dehydrated. So super dry on the inside. I would look to increase the fluids and probably tonify the spleen, because the spleen was double down. So I'd double, I would double down on the dampness. I first want to check her tongue, you know, for tongues, like real, super puffy and damp. I'd, I'd have to double think that. But as long as I wasn't seeing signs of extensive dampness, I doubled down on the spleen, you know, again, just one side and if what happens, you would really give you some very good, quick feedback. Tell me what are your thoughts on that?

I'm curious.

Yeah, that's funny. I was going to say based on what we were talking about earlier, my first tendency would be to go for liver and tonify liver, both for the blood and sort of yen nourishing aspect. And I was thinking someone that's just run a marathon and is that focused on, you know, losing weight, doing this really restrictive diet, running a marathon, that's some pretty intense mental focus. And it seems like the cool looser energy of the liver combined with the blood and the enduring nourishing aspect would be exactly what she would need and hopefully would help kind of more moist than her insides as well.

Yeah, I think that's, that's a reasonable idea. I was thinking the same thing to definitely want to moisten. Right. How, how FIC do we want to moisten? I guess you really have to wait till you see the patient, but, so I think those are two really good ideas, supplement liver and supplements bleeding. I would just do a third aspect is maybe the supplement, small intestine. Uh, that's going to give you a little bit of fluids with the water, and it's going to give you a little bit of movement too. Especially with that kind of pain. I always consider supplementing small intestine. So the small intestine plus liver or small intestine plus spleen, I think is a really good idea. I might even consider starting with small intestine and then adding one of those two after.

Hmm. That sounds really good. And right in sometimes she's is you could snap her meat is like the kind of dry stick you get snap. But, um, but also very intense. And ultra high focus. And actually I had a lot of problems sleeping from anxiety for a while, but we worked on that with our

well, that ultra focus sounds very to me, which would put another tick mark in, uh, in the column of liver.

Did you supplement blood for that insomnia?

No, actually just kind of tried to bring the Xi down, try to like balance yin and yang, because it was like her young was not rooted at night. He's like, um, grade your tongue with the Mooney and longer. So you liked that a lot. Settled her heart too. So yeah, that's what we did. She liked that a lot, but then when she started training for the marathon, she didn't want to be that calm. She liked that anxiousness. Pushed her to run.

That's interesting.

Thank you. Yeah.

Um, Toby, can I ask you a question about the system with the shin hammer pulse? Is that okay? So in kind of paring down what I do with the pulse, I pretty much always take first impressions. And then if there's a particular position that I'm interested in, I'll, I'll check out one or two individual positions. And I know you mentioned that you'll use like individual positions to corroborate your diagnosis, or if the whole pulse is tense and overflowing, then you're thinking access or maybe deficient heat and so bladder, or maybe liver. And I think maybe particularly with the first impressions when I'm getting. A sense of the pulse as a whole, and then through the depth, what else I can glean from that, that I could help for my diagnosis with like, if the pulse is very thin, can I pretty much assume liver deficiency, if it has a strong vibration, could I assume there's anything, a disharmony with the heart? I imagine slippery would equal dampness, but I guess so more succinctly, I guess my question is, what do you think I should key into with the first impressions and, or do you think it's more important to really go to individual positions to see what's going on with individual organs for a diagnosis?

That's a great question. I really like, um, first impression it really helps me orient and I do think about, you know, a lot of times the width of the pulse, and then I start thinking about, oh, do I need to moisten or do I need to dry based on that with, yeah, that's a key thing for me. And then yeah, a lot of times I'm just trying to think about it. I'm trying to break down what I usually do. I do like the pulse as a guiding aspect, but I very rarely make exclusive decisions based on just the pulse. Um, I w I wish I could give you a more direct thing, but yeah, definitely the first, one of the first things I considered was the width of the pulse.

Okay. And so, but you're looking at that more in terms of fluid versus blood, which I know are very similar, but like for instance, you know, the thin being blood deficient versus tight being in deficient, I'm kind of thinking about it a little. I dunno, like the width of the pulse also sometimes relates to heat. It seems like, but you're also thinking that that means there's enough fluids.

Is that right? I agree with you yet. Uh, I think about the words as blood and, uh, actually, uh, fluids themselves. And especially I've noticed if the whole left side, you know, your first impression and just the left side is thin and almost always, that means I'm going to supplement the liver, you know, even, yeah. I'm contradicting myself a little bit sometimes even if I don't see any other thing else, but it stays just really thin on the whole left side and that there's no other like symptoms of liver deficiency still supplement liver for that, something like that. It seems like I've seen that so many times in that works well. So often now.

Okay. And then that question of the smooth vibration, like I see so many people with some level of heart cheat agitation, and some level of Smith's vibration in their pulse. It seems like in this system with a heart, heart being double fire and mostly about heat, and then the emotional aspect of love, like that doesn't really translate. Does it to a heart pathology if you're feeling a lot of vibration?

No, I think that a lot more vibration that I usually give to the gallbladder. So then I consider supplementing with the pericardium, especially with rough vibration. Yes. I think about almost always with ref preparation, I think about

supplementing pericardium. Okay. Because it sort of indicates like agitation and maybe aggressiveness aggressive energy. Yeah.

Especially rough vibration. Yeah. Yeah. Then I usually put in that category again. I still won't always make a decision based on the pulse, you know, if there's rough vibration, but I definitely start thinking about it. Gallbladder better. Got

it. Yeah. I mean, I think part of what was so appealing to me with the show or what has been so helpful with the ShaoYin hammer pulses, you get such clear diagnoses with the pulse qualities, like thin equals that, like it's not super nuanced and what's at least some of the qualities can mean. And so I liked that assurity that I had with the pulse, but at the same time, the system has really encouraged me to pay attention to so much more, which has also been really satisfying, like people's affect and how they look and the color of their skin and how dry they are and things that I should have been noticing more before, but maybe I was getting too focused on the pulse. So I like that, but yeah, I'm still trying to figure out how much, I guess, clinical weight, like you said to put on each observation.

Yeah. I mean, it's so hard to figure out how much to weigh things. I think just time will tell you, like I was saying that with the thin poles on the line, Yeah, the I'm almost always considering supplementing, never. And there must be other things, you know, when I think about it, um, maybe I'll, I'll contact you and let you know, but it just on the spot, it it's hard to come up with that. I really wanted to say, like we were talking about before the patients feel really heard. And I think my patients do too, because I'm really listening to them. Right. I'm listening with my eyes. I'm listening with my heart. You know, I'm really listening, trying to get a feel for what this patient needs. So I think it, it, it was really comforting for that patient, but also it's essential for our diagnosis in the system.

Yeah.

That's a great point. Well, this has been a delightful conversation. I'm so grateful to you all showing up this morning. I'd like to wind this down by just taking a moment to, uh, share a takeaway that, uh, we've each gotten from this morning and then we'll wind it down for this particular.

I'll begin. There have been several, but one that feels most important is that this system is not so radically different from what I'm already doing. It's just a different take, a different way of listening and I'm more focused, nuanced way of treating. And it's doable if I just kind of play with it and hopefully don't cause anybody any too much upset from a wrong diagnosis. So thank you.

You know, I guess the thing that is sticking with me the most is actually something that I've heard Toby say before. And that we've talked about, which is, you know, whenever possible, add something to the system rather than take something away. And I think at times, even though I know that, and I've heard him say that before. I really want something to change for this person. And so I, I think of the draining channels as being more dramatic maybe, and their impact. But I also see the disadvantage to that when someone, you know, for instance, might really need more pericardium energy, and all you're doing is draining the gallbladder. Um, and that perhaps it's a slightly longer process, but that you're sort of filling them up more than taking something away. That's an excess. And I think it was just a good reminder of how important that is and helps me commit to continuing to do that with, with my patients.

Well, for me, this conversation this morning has been, it's been deeply nourishing because while I love my conversations with Toby, it's just two voices. And I've learned a tremendous amount in the past few months. And I learned a lot from my patients by practicing it, but being able to sit here. With all of you in here, the way that you're working through it, and here, the sense that you're making, going through that case together, uh, engine melees, marathon runner, and we each had, you know, a little bit different nuanced look at it. I just feel like I, I come away with a lot more bandwidth in terms of being able to look at my patients. And I'm also so delighted to hear that here, you guys are beginning, just beginning your journey with this and are ready. You're you're speaking about it in really cogent and clear and nuanced ways. So it just makes me really happy.

Um, my big takeaway this morning is I'm so excited that people are starting to use the system. My teacher really wanted a. Me to get this system out there and for people to be really aware of it, he's a monk. And he would really like to eliminate as much suffering as possible. And this system is really helpful for doing that. I've been so introverted and, uh, just being an introverted clinician. Uh, it's been great. Uh, since I met Michael we're in really being able to get this information out there. And, um, it's just been, it's been so pleasing to hear about people helping their patients using the system. So I'm really grateful that people are taking up the task of adding one more clinical tool to their clinical tool belt. People are willing to do that. I really appreciate

it. I thank you both to Toby for putting it out there and to you, Michael, for, um, providing the venue for it. It really, I don't know if I would have discovered this otherwise. Um, if I hadn't listened to the podcast, so thank you both very much.

Yes. I would say the same. And uh, thank you all three of you, because I learned a lot from each one of you in this conversation. That I'll continue to practice and use. Can I

say one last thing? Uh, let us know what happens with that. A marathon runner I'd be interested with what channels you ended up taking and how the results.

Yeah. And I'm really grateful to have your guidance on it because they'll know what to look for. I'll know what to ask and I'll know how to give a simple treatment. That just won't be too overwhelming. Cause she's already pretty weakened. It sounds like. So, yeah, I'll definitely write to you.