The three things that we can do something about, uh, what I call the primary pathological triad. That's number one. And that's probably the most important. The second is a lingering pathogen of some sort, because once you've got a lingering pathogen in the system, you've got this constant conflict between the junkie and the pathogen. And the third one is this disconnection between the heart kidney axis, which is the Thermo regulation system of the body, the water fire balance.

I'm Michael max. And this is qiological the podcast for practitioners and students of acupuncture in east Asian medicine. If you're new here, welcome. And if you're a regular listener, I've got a great conversation with will McClean coming up today. By the way, if you're familiar with Will's writing, Eastland press has a new edition of the clinical handbook of internal medicine coming out, and you can snag it with a discount for another week or two pop on over to the podcasts page on the website and click on the Eastland press icon for details. If you listened to the podcast here for any length of time, you'll know that I've got an interest in marketing. Actually, what I have is an interest in how people connect with each other, make me. And create sense in their world, which is partly what attracted me to the practice of medicine in the first place. I've also got this interest in what I like to think of as first principles, the stuff that underlies any process or manifestation, kind of like us east Asian medicine practitioners think of yin and yang, where the resonant manifestation of the five phases. First principles are not like scripts, hacks or shortcuts, which I suspect are of limited value as those focus on results rather than on process. First principles in the area of marketing are the building blocks of how we make meaning and how we communicate with those that we wish to serve. You have probably heard me talk about Seth Goden, uncle Seth, as I like to think of him, he's a smart and funny uncle. I wish I had had as a kid. I recently read his latest book. This is marketing, and I want to tell you about. It's not a book about marketing, reading. This book could change how you interact with your spouse, dial down your activity to those idiots over there and open your sense of inquiry into situations that seem confusing. And without a lick, a logical sense, if all you learned from reading this book is it's for them. It's not for you. Then this book would have been worth your time. I think this has been one of those reoccurring lessons that's come around for me as a businessperson. It's come around again and again, for a long time, I thought I could help everybody with acupuncture. What I've come to discover is I can't understanding it's for them. It's not for you. Not only lets me take myself off the hook. It lets the people who may not be ready to use our. It lets them off the hook too. It's not a failure on anyone's part. And it saves a lot of waste of time and emotion. And beyond the arena of marketing our practices, I found that pausing for a moment to remember it's not for me, it's for them. This helps me to better understand aspects of life and culture. That don't make any sense to me. Like I dunno, stadium sports, small dogs, sneaky tofu, or a Kia soul cars. I think it just comes down to honest differences, differences that separate us into dissimilar crowds, but consider this wherever there's an outside. There's also an inside and I'm reminded by uncle Seth's work that we can focus and be generous with the inside, with those who we wish to serve. And we do it best, not when we try to exclude others, but recognize that there are those who just aren't interested and not waste our valuable time or energy, trying to change them. It's not for them. Keep your attention on those who our work is for and help them with the changes that they want to make. 1 0 1 last thing about marketing. I'm still looking for someone who genuinely loves doing health fairs and it shows in your paycheck too. I'd love to have a conversation with you here on the podcast. Again, it's an area that's completely out of my introvert's area of interest, but I'd like to better understand how these situations can be helpful for some people ping me if this is your balance. Hey everybody. Welcome back to chia logical. My guest today is will McLean will is a long time 30 year practitioner down in Australia. He's currently on sabbatical where he's doing some work on one of his books. He is trained both in Australia and did some time in Honjo China. In addition to teaching internationally, he is the co-author of a veritable library of books on Chinese medicine, including the three volume series titled clinical handbook of internal medicine, which by the way, we will be talking about later in the show. We'll welcome to GLI.

Thanks, Michael pleasure to be here.

I'm really excited to be talking to you. You know, I'm excited to talk to everybody that's on my show. Imagine that I'm the one who invites them. I think so, too. So you've done a lot of books. You've done a lot of writing. You know, we were talking earlier before we, uh, turned on the tape. A book is a lot of work and you've got more than a few. And anyone that hasn't done a book probably doesn't know that the incredible effort that goes into it. I'm a little curious, indeed. Yeah. What has incited you, whatever got you started with writing books in the first place? Well,

it was really practical because I was teaching that one of the colleges in Sydney, not too long after I graduated. In fact, I think I started teaching at about 19 91 92, something like that in those days, there just wasn't very much material. I was teaching a course on internal medicine amongst other things, but the source materials that I learnt when I was at school were pretty poor. That didn't really reflect the clinical reality that always starting to observe in practice. So I started to compile course notes, you know, things that I thought were a bit more realistic. I had some good source materials that I've picked up in China when I was there or Chinese was improving. So I started slowly to compile a series of lectures on internal medicine. So

it was really your class

notes

in a sense. Yeah, basically that's how it started. The first volume was certainly compiled from class notes. And then of course over time, as I got more and more experienced in practice, those course notes became modified by what I was seeing. There was often quite a, an interesting divergence between the original Chinese materials and what the reality of a Western clinical practice

was. I think this is something that we all go through. I know, I certainly know that I did where we learned this theory. We learned some stuff we get through school, and it's actually really curious when someone walks in and actually fits what we studied in school, because most people

don't that's right. It's very, it's, it's an, a unique situation you think, oh, wow. Maybe there is something in this after all, you know,

I often think I'm clearly missing something here. Cause this just fits the book.

Yes. But that particular in compatibility just became more and more clear over a period of time. But anyway, that's where the book started from. That was where the first volume started from.

It's sort of your journey with understanding clinical practice.

Originally, it was all going to go into one book, but you know, internal medicine is really a huge and complicated field. So the first book only covered four of the organ systems. That's all we could actually physically print basically,

unless you put wheels

on the thing. Yeah, that's right. It was a little cam to a thousand pages or something. And I think in those days, the physical limit was around about a thousand pages for the paper type that we had. So my dream of having an all in one got thrown out pretty early. So we went for a second volume thinking that that would be the end. And then of course it just keeps on going. It grew like topsy essentially. And in fact with the new edition has grown again

earlier, we were talking about inflammation. Inflammation is a big thing these days it's in, you know, it's in the news a lot. I really like to hear your thoughts about inflammation, how it looks in Chinese medicine, what we do with it. What are you thinking about this

stuff? Inflammation particularly chronic inflammation has been one of my major clinical and research interests for the last probably 10 years. Just because it appears to be so phenomenally common. This is not just from a general medical point of view, but from a Chinese medical point of view. So many of my patients present with what we would describe as some type of heat complex, which is giving rise to at least a portion of their problem and a whole bunch of their symptoms. And what, let me go back a little bit. I've worked in a number of different practices. And one particular practice that I worked in was a general medical practice with GPS and osteopaths and a whole bunch of other people. And we used to cross refer a great deal between each other. And I would end up getting a lot of patients with auto immune diseases referred to me because the treatment, as you know, for autoimmunity, at least this was probably 20 years ago. Wasn't especially good. You know, it was steroids, methotrexate, immunosuppressants, And patients that often end up feeling worse than they did initially with all other drugs. And they weren't really well controlled and so on and so forth. So I was exposed to a lot of patients with so-called auto immune diseases. And one of the things that they generally had in common from a Chinese medicine point of view was this persistent peat. They had some degree of heat somewhere, whether it was in their warm, swollen, painful joints or in the skin problems that they had, which were sort of red and raised and whatever it might be, your ulcerations of the oral cavity, uh, you know, the whole bunch of different examples of that, but take was the consistent finding. And as you do as a practitioner, you think, okay, well, what do I do here? I have to clear away, Hey, we can clear why, Hey, that's not a problem. There's lots of ways to do that. And patients will often get somewhat better, but it always seemed to come from. You know that stop the treatment that go away. They come back a few months later and everything had returned in much the same sort of fashion. So the problem seemed to me that it wasn't just getting rid of heat. What the hell is the heat doing? Where is it coming from in the first place? That was the initial thing that got me started on that. I had one particular patient, a lady with an auto immune disease called disease. Also known as Silkroad disease. You're familiar with that.

I'm not familiar with that one. Tell us about

it. Very unpleasant disease runs. There's a strong genetic component to it. It runs, you know, banned from China across to Turkey, and it was first described by a Turkish physician. Anyway, it's characterized by very unpleasant ulceration of the oral cavity, the genitals and the eyes, as well as joint pains and fevers and all the rest of this sort of stuff. Now with this lady, you know, we were clearing hay clearing heat to deal with those symptoms as much as possible, nothing was happening, nothing was really doing anything. And I ramped up the treatment quite considerably. We started using much more hardcore medications. In fact, I ended up using a thing called Lagos. Are you familiar with that? It's a strict regime, will 40. And it's actually used from a Western medical point of view. It's an immunosuppressant, it's a vine. And it's used fairly extensively in China for auto immune problems. Isn't it a bit toxic? Yes, it is. You've got to monitor liver function while your populations are taking it. She was dedicated to treatment and she gave this a go, nothing we weren't getting anywhere. And I really liked this patient. You know, sometimes you really have a special empathy with certain, you know, you try to have empathy with all your patients, of course, but this lady had some small kids and I really liked her a lot and she was dedicated to her treatment as well. So we went back to original materials to try and find some answer. And as it turned. This particular disease was described in the jingle jingle, a LOA. It's a thing called hidden Fox who were, who were being

hidden from disease.

Anyway, the solution given by John, John gin to this was a harmonizing prescription, I think, or gunshot she has in tongue. And you think, okay, well, what's going on there? She's full of hate. She's burning up. You know, she's got inflamed joint, she's got all these ulceration. She's hot all the time gunshot. She is, she in tongue is not really a heat clearing formula. What's the rationale, very harmonizing. And of course, John does not give any rationale for its use, but I thought, look, we'll give it a go and see what happens. I'm running out of ideas. So we tried it and it made a difference, not a huge one, but it made a difference. What

were the initial things that shifted. Well, she

felt better in general, that sort of overall sense of wellbeing improved. She wasn't feeling so terribly distressed. Her oral ulcerations improved somewhat her joints while still fairly uncomfortable were also slightly better. She had one knee, which was really a problem, um, and her wrists were problems. So it was terrible for her to pick up her children. And that improves slightly to now these weren't dramatic by any means, but there was a qualitative shift that we hadn't been able to achieve doing anything else. And that really got me thinking about what was the rational what's behind this thinking? Anyway, that started the process. I mean, basically when you've got this sort of hate, you have to discover the source of the hate. That's the only way to really move forward with treatment. Where is that heat coming from and why is it being continually created over and over again? The more you clear it, fine, you get rid of it, but it comes back, right? Something is smoldering. Something is smoldering. Something is continually producing these hate. So that was the starting point for thinking a bit more deeply about the problem. And then over the years with a lot more research and a lot more clinical experience, I came to the conclusion that there are three major sources of this persistent heat in the body. And this seems to be reasonable to model. So I'm not claiming that it's the answer by any means, but it's certainly been a very helpful guiding principle in my practice over the years. And the three sources of heat, uh, without going into too much technical detail, this

is a shelf for practitioners. We can go as deep and geeky as you want to go.

Let me go back. There are actually six sources of persistent hate, but three that we can do something practical about. You know, we can actually intervene with in our practice, the three that we can't really do a whole lot about. There's a constitutional component. Patients who have a liver fire or a heart fire type constitution, they seem to be prone to developing heat type pathology as they get older. And there's not a whole lot. You can really do about that in my experience. Diet is also extremely important and you know, you just put too much fuel in like a compost tape, which gets hot basically. And my experience has manipulating people's diet is one of the hardest things to do in practice. I'm

a real failure at getting people to change their diets. It's

very, very difficult. The three things that we can do something about, uh, what I call the primary pathological trial. That's number one and that's probably the most important. The second is a lingering pathogen of some sort as once you've got a lingering pathogen in the system, you've got this constant conflict between the junkie and the pathogen, which creates its own source of hate, which creates the fire of battle. If you like the conflict of battle. And the third one is this disconnection between the heart kidney axis, which is the Thermo regulation system of the body, the water fire balance. All right. So if that heart kidney axis is out of whack for some reason, then either there's not enough water to control the fire, or the fire just gets out of control on its own of its own accord. And then you get this persistent level of heat and they all have their own signatures, clinical signatures, which you can identify fairly clearly in a practice, but they all end up causing rather similar looking clinical profile. No, they all generate hate. They all generate ongoing heat. And unless you deal with the underlying reason, if you don't get rid of the lingering pathogen, that's there, or you don't balance out the tryout in some way, or try and reestablish the connection between the heart and kidney. Basically, all you're doing is putting a bandaid on the hate and it will keep on coming back,

which is what Western medicine does

basically. Exactly. In fact, most treatments do seem to just put a bandaid on it. And that's certainly what I was doing by just clearing huddle at the time. It wasn't really doing the job. I'm

not familiar with this primary triad that you're speaking about, or maybe I am, but I don't know it by that name. What are, what is the primary triad?

Basically, it's a very simple concept. It's essentially the relationship between the liver and spleen. One of the major primary axes of the body and how that relationship when broken down starts. Some type of hate. And I tell you, the triad is dysfunction, the liver dysfunction of the spleen and the generation of heat, which those three points of the triangle. And the interesting thing about that is that once the triad of pathology is established, you know, once the liver and spleen are out of balance and the hate's been created, it tends to be self perpetuating and you can deal with one point on the triad, like clearing away the hate. But unless you deal with all three at once, the whole thing just keeps on going. It rolls around and reestablishes itself. This was one of my seminal insights. So I think as far as my own practice is concerned, you know, you would see patients with this mix of pathology, some sort of liver, pathology, cheese stagnation, some sort of Splendas function, deficiency, or damp or phlegm or something along those lines. And some type of. And focused on strengthening the spleen perhaps, or regulating the liver or clearing away heat and the patient would get a bit better, but then it would come back again. That was a consistent finding in my practice. You know, you really never got satisfactory long-term clinical outcomes and it wasn't until I put this together in my own head, there's nothing new. Of course. I mean, this has been described in the literature, but I got the hang of it that I started to see the rationale for the concept of harmonization and how that then fits back into what we were talking about before John John Jennings insight in using gunshot shish in tongue to treat hidden Fox disease, which is characterized by masses of hate.

And this is a situation here with delivering spleen and balance where harmonization would be really helpful.

Absolutely harmonization is the strategy. And of course the primary pathological triad is so common because the modern lifestyle is essentially tuned to. Sedentary life, you know, increasingly sedentary habits, which Microsoft display crummy diet, which also mucks up the spleen, certain medications, which muck up the spleen, financial, global, emotional family stresses of various sorts, which impact on the liver additives and preservatives in foods, medications also, which muck up the liver. You know, the endless looking at screens, which damages liver, blood people staying up late at night, which mucks up the liver by because the liver is of course involved in regulating all of the various cycles, the day of night cycle, the menstrual cycle and so on and so forth. So there's many ways to impede delivering the spleen, largely lifestyle based. And once that relationship's out of whack, then it's so easy to generate heat because you've got chronic T stagnation. You often generate some degree of stagnant hate when this plane's out of whack, it generates damp and the hate that's there can then generate, can interact with the heat and you've got. Hate will eventually damage in. So you end up with the inefficiency plus the heat. So it becomes quite a complicated scenario, but I have found that the primary pathological triad is at the base of so much pathology in my clinical practice. Now I can only speak for my practice. You know, everyone's practice is different. I have attracted over the years, a certain type of patient. So I've got a certain clinical bias. Of course it may well be different than other people's practices, but the understanding of the primary pathological triad and of course, lingering pathogens and the heart kidney axis issue really revolutionized the way that I swore chronic inflammatory problems. And I saw a lot of them. It makes a lot of sense.

I want to get into some of these other ones here in just a month. And I can see how the guns, how station Tom would really fit in there. And to me, this, I got a big smile on my face because I've done a fair amount of study with Dr. Wong Wong and one of his favorites for ulcers that go anywhere along the mucosal membranes from the mouth to the anus, to the vagina, uh, God's house, ShaoYin tongue. And as we're having this conversation, it's great. I'm getting another point of view and going, oh, I can really see the, the beautiful harmonization, you know, it's a fairly gentle formula. And when we see the situations with lots of heat and inflammation and big sores, and you're like, this is going to take care of that. What it's extraordinary, it really makes us think about patho mechanism.

Absolutely. And you know, this is the interesting thing I think about for me about China's medicine is the detective component of it, you know, the puzzle solving, but to solve puzzles, you need to have a lot of material. You need to have a lot of background material in your head that you can draw upon a lot of different models to draw upon. You

know, we were talking about this earlier, before we got on the line about you've been in practice 30 ish years. I'm coming up. I'm in my 20th year. And I was saying how I was reading something recently, fairly basic stuff. I don't know how many nth time I've been reading it, but it comes through. And I just it's like, wow, I really get it. And I'm thinking, why did it take this long to get out? You know? And it's, I think you're really putting your finger on something here. There's this iterative process. We have to see something again and again and again, in a variety of contexts,

China's medicine is very much a holistic. Well, I should say, holographic is what I meant to say. System whereby each piece of information doesn't really mean anything on its own. It only means something in relationship to many other pieces of information. And as you gather experience and your ex your information base expands, then each individual piece of information starts to take on a different meaning within the context of your expanding knowledge base. So many things you won't get until you've been, you've seen hundreds or thousands of patients with a particular sort of problem, because you just don't have that background knowledge to draw upon. And it's like the pulse. It really can't get the pulse. I don't think until you have matched pulse states with thousands of patients, it's that physical memory of something tied to an observation and doing that over and over and over again is when you start to think, oh yeah. Now I can see where that pulse is coming from and what that actually means because I've seen it over and over and over and over and over again. Staying

with this primary triad for a moment, we talked about the God's house station. Taiyang what are some of your other strategies, thoughts, or formulas, or even acupuncture for working on this particular

piece? From a herbal point of view, the strategies are almost always drawn. Well, they're always drawn from the harmonizing group of formulas, but that's a really broad category of formulas. And the intent of a harmonizing formula is to deal with all three points of the triad at the same time. Now in practice, what you see is that patients will tend to skew towards one corner of the triangle, depending on where they are in their life. It's a dynamic process. So from treatment to treatment, it can change. And that's what you want. You want it to do. You want it to change from time to time, so you can track where they're at depending on their life, their diet, their emotional world, their work habits, and so on and so forth. They might swing between having more heat or more component of chicken strident or more Splain issues. So the, all of those harmonizing prescriptions, uh, aimed at dealing with different combinations, if you like of the three pathologies. Now, another thing that, uh, informed me in this particular area was the understanding of shout shy, who Taiyang. Now everyone knows certainly one of the most interesting prescriptions in the materia Medica, and one of the most widely used. In fact, my understanding is that in Japan shy, your tongue is the number one formula manufactured in granules. I've heard that as well. And it used to, before I understood the process, it confused me. I couldn't work out what was going on because my understanding of shaoyang tongue was that it's for shaoyang syndrome, shaoyang syndrome being a post-infectious states. A week or so after someone's had some upper respiratory tract problem or whatever, it might be the lapse into a shower chair, your tongue confirmation, which was fine, but it didn't explain why so many people were using shout show tongue. And it wasn't until I started to look at this in the context of the primary pathological trial, that it all started to make sense. And as it turns out, when you look at the triad, if you imagine a triangle with a liver pathology, splint, pathology, and hate, and we've got a whole bunch of harmonizing formulas, which are aimed to deal with this particular mix of pathology, it turns out that shout show tongue does a bit of each of those. It regulates deliver. It's got chai hu in it. So it regulates liver Chi it's strengthens and protects the spleen. It has wrenching Gunshow it clears hate it has one chin. So it does a bit of each of these necessary balancing steps without doing too much of any. So when you map formulas, according to their therapeutic bias, Ciao. Ciao. Taiyang essentially maps pretty much right in the middle. So it's the most well-balanced of all of the harmonizing prescriptions when it comes to tuning up the primary pathological trial. And as it turns out, primary pathological tried is such an incredibly common mix of pathology in the clinic that you could actually go into clinic and just give everyone shout, shout your tongue and your strike rate would probably be pretty good even without knowing what you're doing, because most people feel a bit better. It's like,

it's a broad spectrum. Harmonizer.

Exactly. That's exactly right. If you've got a bit more heat in the system, you'd want to go somewhere else, Goa shaoyang or or something along those lines. I'm not familiar with that one. Uh, that's one of the most interesting formulas it's used for drum distension drum distension is a type of societies

and what's the name of

it again? yeah, it's traditionally considered to be. Sort of a, it's a purgative formula, which clears away fluid from the abdomen. But it, in fact is a harmonizing formula. The definition of harmonizing prescriptions is that they're often quite complicated recruitment. They combine herbs with opposing actions. So they'll have very cold and very hot herbs together. For example, should gal and foodstuff or gangs, young and chin, you know, that sort of thing. They'll combine herbs with opposing natures, bitter sweet and so on and so forth.

Yeah. Well we see that one a lot in a Oh yes. I love that. I go through that stuff like crazy around here.

Absolutely. That's been a mainstay of my practice over the years, too, and exactly for that very same reason. It balances the primary pathological triad. That's the way that I look at it. All right. It's got guns young. It's got one chin, those opposing Herb's they drive dynamic movement within the. You got the hot herbs, which elevate, she lift up splint. She improve the spleen and its ability to move things upwards. You've got the bitter cold of the one group, the Hong Chin's one lens Hong buyers, which caused to move downward. So automatically you're setting up this sort of dynamo of movement, this physical driving physical movement of cheap. I

sometimes think of it as like really turning a heavy flywheel. These are the herbs that give it some toric, really give it some energy to set it in motion.

Yes, indeed. Well, that's how all of these harmonizing formulas actually really work in my that's the way that I think about them. Anyway, they drive physical processes rather than just thinking about them, firing the spleen or regulating the liver or clearing away heat. They stimulate movement. And in fact, I think most of the really interesting formulas in the materia Medica do much the same sort of thing. They work like acupuncture. They draw. The movement of G essentially they're really dynamic. Yeah. Sri Fuji. Your tongue does the same thing. It's not a harmonizing formula, but you know, the combination of Geogen and new sheet together near, she pulls things down. Geogen lifts them up. You've got the pivot, the dynamo,

tonify the blood a bit and you move the blood and you move the cheese with, with that formula. It's another one, kind of a big, heavy hitter. When you think about it, it's moving

everything. I couldn't imagine a practice without that one. That's been another mainstay of my practice over the years. I'm curious

about the heart kidney connection. Is this, is this something that you would say is more emotionally based

very often? Yes.

Tell us a bit about what you see with that one in which formulas helped set that particular mechanism. Correct. Again,

to go backwards a little bit, the heart kidney axis and the liver spleen access to the two main axes of the. Now the liver spleen accesses for generating the daily cheek we require for daily activities, physiology, normal physiology. Whereas the heart kidney axis is your, your deeper axis. It's the relationship between your template, your DJing, and how you perceive the world through the shin and how normal your perception is. Essentially the liver spleen access is easily mucked up. You know, most people have experienced that, you know, you get upset and you get a knot in your stomach. That's the liver's plan disharmony, but the heart kidney access is being so critical to our ability to form memories and our ability to see the world clearly and therefore reproduce, which is ultimately what it's all about from an evolutionary point of view is a very robust access. Very hard to break, very hard to disrupt, but it gradually becomes weakened. As you get older, as your yin is consumed by living hard, kidney axis does become more fragile. And is easier to disrupt. However, in younger people who are robust, it takes a great deal of emotional trauma to really make a significant impact on it. And this is where it gets interesting in clinic because there's a whole group of disorders, which occur when someone has had a major psychological trauma. Now this can be a major car accident or some type of severe emotional shock. The heart kidney axis is disrupted by severe emotional trauma. So what we observe is the development of certain types of pathology, which reflected disruption of heart, kidney access, generally six to nine months after. A big shock someone's spouse dies, or they were in a car accident and they thought they were gonna die. Whatever it might be in Australia some years ago, we had some very big bushfires in Melbourne called the king lake fires. And, you know, a lot of people were killed and we saw some patients after that who had terrible problems with their heart kidney access because of the terrible trauma of that experience. So

PTSD would fall into this category as well, then.

Yes, PTSD certainly can, but there's a very specific set of physical symptoms that emerge out of this. And very often they overlap with endocrine problems in Western medical sense. So for example, dysfunction of the thyroid is quite a common experience. So hyperthyroid problems, you know, be one example of disconnection between the heart and. The kidney water is not containing hot fire anymore. So we ended up with this sort of flaring of heart fire, which manifests in all the heat, the tachycardia, the insomnia tremors, the shin disturbances, and so on and so forth, which are characteristic of the body's ability to regulate its internal temperature. People get really hot and can't cool down and they get cold and can't warm up. So they have dysfunctional thermoregulation.

Would you also see this to some degree with hypothyroid people, but in this case, it's more that the heart fire has been extinguished. And so you've got more kidney water the

other way as well when the hot kidney axis gets disrupted. And this is discussed in the Shanghai Luna as well. I think it's a Shanghai. When you get disruption to the heart kidney axis, it can go one of two ways into what's called heat transformation or cold transformation. The transformation is more common in. But the culture transformation is certainly there as well. And they ultimately look to all intents and purposes like heart and kidney inefficiency or heart and kidney yang deficiency. So yes, called transformation is common in women. It seems to be much more common than it is the heat transformation. And in men it's slightly more common than it's a call to transformation. I'm

thinking about so many women I've seen in my practice who have thyroid issues and primarily hypo thyroid. Maybe they're just a little hypo thyroid. It's a little off, and I hadn't put this together until we're having this conversation right now, but I'm wondering if there's, as women have often experienced trauma that there's some hidden trauma there that's depressing that heart fire that's in increasing that kidney water. And, and there, there goes to the heart kidney axis.

What actually often happens, it seems is that the initial response to some sort of traumatic experience, if that's what's causing it, it's not always. You have to remember that as you get older, the heart kidney axis becomes more fragile would after 40 half year Yin's gone. So the access is really robust in your twenties and thirties, but as you hit your forties, fifties, and sixties, the access becomes naturally more fragile. So it takes less and less of a trauma to actually start to disrupt it even without any sort of traumatic experience the access ultimately becomes disrupted. Anyway, you know, one of the manifestations of a poor relationship between the heart and kidney is the inability to form short term memories because the heart kidney access is critical in the ability to form memory in the first place. You know, it's the relationship between the spleen part and the kidneys, the spleen being the perception of being the, the focus of attention on something to be. The ShaoYin the perception of course, and the storage and the kidney. But if that process isn't working very well, then people can't form those short-term memories. And of course, that's incredibly common as you get older and older, that's just a natural part of that disruption. Hi, this is Dr. Sky sturgeon with may way or so the basic question is how do I know how many T pills to prescribe the answer is it depends. May we standard dose is 24 pills per day, but you should rely on your clinical judgment. If 24 pills seems like too many, realize that 24 pills is about equal to nine to 12 grams of a raw herb formula. Also, you may want to adjust the dosage up or down depending on your patient's weight, because the standard dose is forty one hundred and twenty five pounds. Other factors to consider are the severity of the condition, whether the condition is acute or chronic excess, or deficiency, your patient's age, constitution, the presence of other health issues and other factors based on your clinical assessment, for more information, check out, determining the right dosage for your patient on may way.com by Laura strokes.

So when you're thinking chronic inflammation and it's the heart kidney access, what are some of the kinds of issues that show up? And then what are some of the formulations that you found helpful?

Well, in terms of inflammation, it's almost always, of course the, uh, heat transformation, the in damage component of it. So not enough kidney water, heart fire starts to flare, but of course, one of the things that happens with heat is that it it's a very young pathogen, so it tends to dissipate over time. So even though if someone had quite a significant degree of heat, initially that will naturally wane as time goes by. So the more chronic the pathology becomes, the more muted the heat component becomes as well. When there is this participant heat, as a result of the heart kidney access, there's a number of ways you can address the problem. But my favorite is the standard formulation. It's ten one Bush, and Don is one of another, one of the standout formulas. Oh

man. You know, I order that stuff in by the wheelbarrow load. That is one of my, that is an amazing

prescription. It is. It's a remarkable prescription and it's for exactly this heart kidney disconnection or a weakening of the heart, kidney ax. A very, very common problem. Of course, as you will know, yes. As I said, it doesn't have to be traumatic as you get older at wakens naturally. So a small upset can often be enough to tip the balance, but in a younger person, in their twenties, you would expect to find some more significant trauma. Unless of course, they were born with some diminishment of their gene in the first place. So if they didn't have the full compliment to start off within the heart, kidney axis is by definition going to be somewhat weaker to start off. As far as production of inflammation is concerned, that's actually quite a minor one that causes a particular type of problem, which as I said, often manifest as thyroid problems or pancreatic problems or reproductive problems, but mostly thyroid and pancreatic. So diabetes type two diabetes will often be along those lines as well. But most commonly thyroid, but of those three causes of inflammation that we can influence the primary pathological trial is by far the commonest. And as it turns out, unfortunately, the most difficult to deal with because, you know, the patient has to participate pretty substantially in the process. Whereas in the case of a lingering pathogen, they often don't have to, if you get rid of the pathogen, the problem often will resolve the patient. Doesn't have to do anything. So that's quite an quite a different sort of situation. So

lingering pathogen tends to be less of a lifestyle issue. Very

often it does. It depends on exactly the pathogen and where it's located, but certain sorts of other new. And in fact, the most common pathogens are quite easy to deal with. And if you can dislodge the pathogen from where it's hidden in the body, then homeostasis takes place and the body just looks after itself without the patient having to do exercise or change their diet.

Well, these lingering pathogens be like from injuries or would they be from having had a bad, cold or a flu? Where do these tend to come from?

Well, the most common is, is a poorly managed infection. So a wind heat or a wind cold or something along those lines of lung hate pathology. It can be anything. It doesn't matter. That was badly managed. He's a very common cause of a lingering pathogen. And you can think about, you know, it's fairly obvious when you think about it. You know, if you've got a wind heat pathology, for example, from a Chinese medicine point of view, what are you trying to do? You're trying to open the paws up and push the pathogen off the surface and away get rid of it that way. So you're venting it from the body to the outside. The way the treatment goes now is that people will often resort to antibiotics, for example, or bitter cold herbs. And they have the opposite effect of what we're trying to achieve. Bitter cold substances of which antibiotics are one type, you know, bitter, cold, uh, substances. They shut pause. The coldness closes, pause and pulls things into the body. You know, we use that when we using one chin or dark one to purge out through the bell, but that's exactly the opposite of what we're trying to achieve when we're using a venting prescription, like in Charleston, for example. So a great way to get a lingering pathogen. One of the most common is to. I have a bad treatment. You know, our poorly managed acute infection will frequently go on to cause a lingering pathogen. There are many other ways as well, people who go to the gym when they've got something, trying to sweat it out. For example, they've got a finite resource of cheese to overcome the pathogens, but if they're burning up in activity, there's much less lift for the immune system to use. And that's another way that pathogens can occur. It's not always the result of an infection. It can be related to medications. Certain medications act like a pathogen on the body. Essentially what a lingering pathogen is from this perspective is a persistent and abnormal immune response. The immune system is set up to work and then it doesn't switch off properly. And so that's signaled by a small group of persistent symptoms, which are fairly easy to identify. But basically, regardless of what the etiology is, the immune system, rather than going back to its normal resting phase is to continually doing something which it shouldn't be doing. And this manifests with various sorts of heat.

How do you like to treat these particular lingering pathogens? You vent

them. You have to get them out

with a more harmonizing. So you go more.

Yeah. Venting is the way to eliminate a pattern. It depends on where the pathogen is. This is quite a large topic, as you can imagine. And

it's disgusting. The Shanghai wound quite a bit as well, where sometimes you'll, you'll want to get it out. Sometimes you'll want to take it in. And you know, like through the stool, uh, it depends on which, uh, the, the judging the six levels it's lodged in.

Yes. And that certainly is a great starting point, but I found it rather confusing when I was confronted with patients who clearly had some sort of post-infectious process. And that's what. The whole concept of the lingering pathogen came about essentially as a, as a simplified way of trying to understand what's actually going on with these pathological processes, the Shanghai loans, fantastic piece of work, but it didn't clearly reflect what was going on in my clinical practice and without going into a lot of technical stuff, cause it's a know it's a huge topic. I teach this and it takes two days to get a start on the lingering pathogen concept. But it's a really important one out, of course, it's really, at least when I was training, it was, it was undervalued and skipped over somewhat. And it took me years of trying to nut out what was going on with some of my more difficult patients to work out that in fact, what they ended up having was a lingering. So since then, I've kind of put together a simplified model of how this works, which again, reflects my own clinical experience. Other peoples are going to be quite different because it's going to vary depending on your geographical location, you know, the predominant environment that you're in, of course. Um, and I live in a temperate, you know, fairly mild climate and the lingering pathogens tend to reflect that, but it might be different in Russia or, you know, the tropics of central Africa. This is

one of the amazing things about Chinese medicine is we so have to take the context, not just of the person, but their lifestyle, where they live, all those other influences. It's uh, yeah, it makes it fun and incredibly annoying at times to try to get these things

dialed.

Well, it does. But having said that I've also taught this lingering pathogen business in different places in, in the U S and in Norway and London, you know, places with quite different climates. And it has been the experience of the participants in the class to have a great deal of recognition of what I was talking about in, in their own patients. So there's a fair bit of overlap even with different climactic situations. So

when you're looking to do this venting of the pathogen, are you also at the same time giving some support to the normal cheek? So you've got something to work

with. Absolutely. You can. And many of the formulas that are of the venting class do exactly that because you have to not only encourage the pathogen to move from the inside to the outside, which is the main strategy, you know, you've got to open the pause and give it an exit point and then encourage it to move from where it's stuck, which is most commonly the key level as it turns. In my experience, which is lucky because it's actually quite easy to vent a pathogen from the CI level. What are some of the ways that you like to do that? Again? It depends on the type of pathogen and where it is within the particular level, because there are different zones within each level. So the chair level, for example, is essentially the zone between the surface, the Taiyang the way level and the deeper internal organ systems, the yang and the blood levels. But within that, you've got different levels. So if a pathogen is sitting up quite high within the chair level, and as much closer to the surface, it tends to influence the lungs and the TaiYin lungs and colon predominantly because they're close to the surface. If the pathogen sits down before. It tends to influence the spleen a bit more. So you get a lot more gastrointestinal symptomatology. So it depends on where the pathogen is and what type it is. Dan Pete pathogens by nature tend to sink down deeper in, within the levels because the nature of damp is to sync. Whereas straight hate pathogens tend to sit up high because he tends to rise upwards. So if you're dealing with a straight heat pathogen in the chair level actually turns out a very easy situation to deal with, even though they can persist for months, if not years, the herbal solution is a thing called two. Yeah, that's the one that I liked the best. There are a number of ways to do it, but seems to be the most reliable in my experience. Juliet Shugar. So

there's JueYin, which is a wonderful peak clearing herbs, shrugging out very strongly heat clearing. What else is in that?

JueYin Shugar Taiyang it also has, let me just have referred to my textbooks here. I'll look it up and tell you exactly. Ah,

great. Yeah, I can. It's so funny. After years of practice, I will sometimes I just think of a formula by itself, but don't always think

about what's in it. Yeah. And this is one of those ones, cause you don't ever modify this. It's never mucked around with. Okay. So it has done JueYin Chicago a bunch. Yeah, my dong wrenchin so it's a modification of shall charge essentially. And it only appears once you think it's in clause, 116 of the shouts of the Shanghai lawn. So it's, it's really under regarded in my experience, but I have found it to be highly reliable for this particular problem. It's only used for this particular problem, but I've found consistently if someone has, what I diagnose ultimately is a heat pathogen in the chest. And we give them Shugar tongue, then all being equal and without any other complicating factors within a week or two, the problem is resolved very often. It's quite dramatic in many cases because unless the pathogen is vented in some way, it's got to get out and enlist. It's gotten out. The whole thing just keeps on kicking on. And

that brings us right back to the beginning of this conversation. You see these patients, they've got this ongoing thing. You can clear some heat. They're better for a while, but it comes back. And so this is, this is, this is what you gotta do. You gotta really get into that level. Your way of thinking about this is really helpful that we've got these three different places to look and begin to think about. Where do

I see. Yeah, I've found it very useful, but again, let me just stress that this is my experience and other people's is likely to be different. There's probably other sources of this persistent hate, but ones that, you know, maybe more common in, you know, somewhere else. I don't know. I'm

sure that's the case. We all have our own particular clinical gaze. If you will, our way of interacting with things I find for myself, just in having this conversation with you, that having these three sort of buckets to think about it just opens up lots of possibilities. Are there other ways of looking at it? Are there other ways of going about it? Yes, of course. This just seems really doable. At least given the clinical experience that I've had

it simplifies. The analysis of water is often quite complicated situations. Cause very often patients who come in with this with one or more of those problems, you know, they've had a problem for some time. They've often been through the ringer, the medical ringer they've often medicated. So when they present, there's a lot of different things going on. So this is a way of, I've found this helpful as a way of clearing away some of the complexity and getting, and focusing my attention. If you like on the underlying important things that need to be addressed rather than just looking at symptoms and attempting to do that. Yeah. That makes a lot of sense. And it's made a big difference, you know, certainly it doesn't work in every case by any means, but I would say that, um, it's much more satisfactory

and unless you have some other comments about this, I'd like to turn to your book for a moment. Our friends at Eastland presser are bringing out. Tell us a bit about the book. It's a, it's a re printing, as I recall, it's a second edition, a second edition. Even better. Yeah,

it's a new edition. So it's a fairly substantially expanded. What I should say, is it the first volume of it? There's three books in the original series. The first one came out in 1997. So it's like 20 years old now. And I'd been in practice for 10 years by that stage. And I was still pretty green, you know, after 10 years just you're really pretty grain. So the first volume was essentially derived from Chinese source materials. You know, and as I mentioned before, it was this sort of a compilation of lecture notes that I'd been compiling for a number of years for courses that I've been giving it various schools, but it was after that, that it really, when you start to get more and more experience, you start to see the disconnect between the Chinese materials and what at least I was seeing in my practice. There wasn't a lot of overlap. So that first volume I don't think was particularly good in hindsight. I mean, it was helpful by all means. It was certainly a great starting place when you're looking at trying to get a grips to with internal medicine pathology. But my thinking on a lot of those problems has really changed a lot since then. So the new edition basically has rewritten the first volume pretty substantially. And the second one also with the hindsight of 30 years of clinical practice and the addition of some collaborators as well, who have also put their inputs into the new edition. So it's not just mine and Jane Middleton's input anymore. There are other people who have contributed fairly substantially to the text. Who else has helped out with this? Well, my partner, Katherine, who's been in practice for about 20 years now. She specializes in women and children's pathologies another longterm practitioner, friend of mine called Mark Bailey. These are the main contributors and their contribution is essential. They've edited the text they've gone through and pointed out things that they think don't necessarily gel with their experience enhance things where they think this is particularly useful and so on and so forth. Basically it, there are other people as well, who've contributed a little bits and pieces here and there. And ultimately what I would hope this would be my ultimate dream is in a book like this. And, you know, a big sort of compendium fucking encyclopedia really becomes the collective work of the profession rather than, you know, the work of a few people. Ideally the experience of many is compiled into a book that reflects our clinical world in the west because it's not different to China. It's not the same, you know, our diets, our lifestyles, our habits, our cultural background is different and this produces different types of pathology. There's no question about.

Well, you know, I, I love that you've started with your experience early on teaching. You brought in things that you learned in China, you know what a great start that was 20 years ago with this book. And now you've got all kinds of other experience that's baked into this new edition, along, along with the experience of other practitioners, like you said, it's not just you, it's a community of Western practitioners in a sense, or a small community of Western practitioners that have taken this stuff, worked it distilled it. And now we're going to have the second edition. When does it come out?

Well, we're still working on it, but hopefully this year all going well, you know, you have this, this, this ideal, and it, things have a way of not really happening like that, but. Four years down the track. And I think it's going to have to happen this year. We're on track for that. I think at this point, like we were

talking earlier it's it's that last rereads and dotting the I's and crossing the T's. And, but that's such a huge piece of the book. I mean, nobody, really? Anyone who reads a book, I think so often it's easy for us to think, oh yeah, someone just wrote this and you know, they run it through a spellchecker or whatever, but there's so much work that goes into the very end, unless you've done a book, you just don't know that last bit, that takes so

long. Oh yeah. And when you're dealing with a book that have thousands of pages, just physically reading it and reading it closely is a huge and demanding task on its own. I should just point out one other thing that's changed in this edition is that the source materials from the first edition and the second from the first book, the first volume and the second volume, the source materials that I use from China have improved immensely as well. There's a whole lot of new stuff. That's come out in internal medicine in China recently that's really significantly better than the original materials that I was using and a much broader range of stuff too. So there's all the bibliography of this new edition is huge. A lot of really interesting stuff is happening in China as well. But China's medicine now. Well, are there any

closing thoughts that you have that you would like to leave us with before we say goodbye here to.

Look, I've, I would say that over the course of my career, I've noted a couple of things in particular. We certainly we're getting a lot better at it in general. And I think what that means is that we're getting much more familiar with what our strengths and limitations are, you know, so we can focus on the things that we do well, rather than trying to do everything and not doing so well. You know, so as a professional, I think we're getting better at identifying what we can do. And that, that really works into integrating much better into the health system in general. You know, I've never liked the epithet that we go by, which is the alternative medicine set and others, as far as I'm concerned, there's only medicine and it either works or it doesn't in this country. At least we're getting to the point where we're becoming more just medicine and we do certain things. Well, we don't do other things very well, but we're getting recognized for the things that we do well, and we're doing more of it in, in a much more interesting context within the hospital system. From time to time, that's ramping up quite a bit now as it happened. Yeah, happening

in the states

as well. That's one thing that I've noticed and that's really, I think, incredibly positive, you know, if we can overcome the unrealistic expectations that a lot of practitioners used to have, you know, and when I got out of school and not in 87, I didn't know what I could do and what I couldn't do. I'd been told that we could do anything that does leads to masses of disappointments and pretty poor clinical outcomes. When you try to do things, you can't really do very well

knowing what you can do and what you can't is it's really important. It was a long

learning experience to find out where to focus our talents and it made for a much more satisfactory clinical experience too. When you get lot of good results consistently

for everybody, the patient and the practitioner.

Absolutely. And we've tried to, I think, incorporate some of that experience into the clinical handbooks, to the new edition in particular, to help to guide people. We'll realistically.

Well, I look forward to reading it. It's one thing to read the stuff from China. And then it's another thing to read a Westerner's actual clinical experience will thank you so much. I really appreciate you being on qiological today. Maybe we'll do a part two sometime. Maybe I haven't been, maybe after the book comes out, we can sit down and dig into something there.

Absolutely. My pleasure.