The way we used to iOS and for stress really comes out of that early 20th century moment. We want to expand our think our, our clinical repertoire, because there's other things that we, I think we need to be thinking about and can constraint as this really complicated idea that has so many permutations and different presentations, so that we want to recognize that we may have a limit limited view of it. But I think you're right. I think you're right. This idea of stress, which is again, it's the most nondescript sort of term out that I don't know what it means clinically, but it becomes a kind of catch all, I think a little bit like nurse Daniel did. And so our first audit goes right to CIO San and Liberty constraint.

Hi, Michael Mack. And this is qiological outrage is in the new drug it's available on the 24 7 newsfeed. You can get a dose in your favorite distraction machine chat group. Our increasingly polarized and interconnected world seems to serve it up at every turn. You might find it in your practice as well, that patient, that no shows or doesn't take their herbs, or I like this one finally listens to the OB GYN. When they say don't eat sugar after you've been telling them to do that for months, there are so many moments in a day when we get angry or frustrated because others don't see things the way that we do. But really these are all moments to practice. One of the most difficult things for human being to practice. Some empathy, empathy is hard. You've probably heard me here on the podcast mentioned Seth Grodin. I started reading his stuff years ago, trying to understand something about marketing because frankly. He doesn't sound like a marketing guy. He's a keen observer of human nature, how we connect and maybe more importantly, how we don't empathy. Isn't particularly difficult for those with whom we feel a sense of kinship, but it's another story altogether. When we look to extend empathy to those that we seek to serve or understand, but hold a vastly different point of view. Here are a few questions. They're powerful questions that I got from uncle Sabbath that can help you to extend your empathy beyond its usual bounds. Three questions. What do they see that I don't see? What do they want that I don't want and what this one's great. What do they believe that I don't believe take a moment and consider these questions were saying. The people enrolled in weight Watchers or the people that exercise compulsively or not at all, or those who think that pharmaceutical medication actually makes them healthier or those who spend more money and thought on their dog's health care than they're on. And here's one that'll test your Buddha nature. Those who live on the other side of the political spectrum. The trick here is not to use pejorative language in your thinking, but rather positive language. Can you actually get the positive intent in their point of view? If you find this little exercise to be difficult, then you're doing it, right? Empathy is hard. It's hard because it requires that you find a place in yourself that can understand other people without having to agree with them. So that for a moment you can see and feel their experience without your usual storyline beliefs and judgments. And, oh man, do I know I have. A lot of people think empathy and tolerance for similar, but I suspect that empathy is actually the polar opposite of tolerance. Tolerance requires a stance of strength. It's really young. When you think about it, empathy on the other hand, unfolds with a softness it's yin. It comes from yielding, not the kind of yielding of weakness, but the yielding of being rooted stable enough in yourself that you can see and understand someone else from their own point of view. Right? So for a moment to stop selling yourself on yourself and your beliefs and listen for understanding, understanding from a perspective and a stance that for you. Is a foreign country. Empathy is hard and I suspect it's a worthwhile practice and you'll fail all the time. I still think it's worth cultivating. And if you need some help with this, go visit uncle Seth over@wwwdotseth.blog. You might learn a thing or two about marketing and the process. All right, I've got a quick housekeeping thing here, and then we're going to get into today's conversation on she constraints something. You'll no doubt run into on the way to being more fluent with the sense of empathy. Well, my guest today is Eric Eric is a Chinese medicine practitioner and assistant professor of anthropology at Appalachian state university. He studied Chinese medicine at the Joan ya'll DATIA, that's the Beijing university of Chinese medicine, and he graduated with a BA in medicine in the year, 2000, by the way, a BA from that school, it's like a couple of steps above the maze that we get here in the states. It's no small thing. In addition to practicing and teaching, Eric has an interest in medical anthropology, science studies, the politics and knowledge, Chinese medicine, Chinese studies colonial, and post-colonial societies. And ethnobiology what's. He's published articles with titles like the excitations and suppressions of time, locating emotional disturbances and modern Chinese medicine, as well as slow medicine. How Chinese medicine became efficacious only for chronic conditions. I'm telling you. He's a geeky dude today. We're sitting down for a little conversation about something that y'all think is one of the garden variety diagnoses of Chinese medicine, liver, cheek constraint. Guess what? It's a fairly recent idea. So buckle up. Hold on. Your worldview. Things are going to get a little Woody in here, Eric. Welcome to

qiological. Thank you, Michael. It's my pleasure to be here.

I want to start out. I've got a question here. How does a guy who teaches an Appalachia, a guy who works at a place called Boone healing, art. Find himself in China studying medicine. I don't think you were there looking for the ultimate child. So, uh,

uh, well, I, I start, I started in China first and so I came to Appalachia, uh, later. Uh, I spent many years living in China, kind of starting in the late eighties. I took a break in the early nineties. I was got interested in anthropology and want to study for a PhD in anthropology at UNC chapel hill. And then in the mid nineties, I went back to do my PhD research and one thing led to another. And, uh, I ended up sort of getting that BA, as you mentioned in, uh, Chinese medicine at the Beijing university of Chinese medicine, that led to a lot of things on a clinical practice and more research, and eventually ended up also teaching anthropology here at Appalachian state know.

So anthropology came first and then the medicine came a little

later. Th that's right. I started studying anthropology. This might sound a little silly to your viewers, but, um, maybe it was the times, or maybe it's just my own background, but th th the idea of studying Chinese medicine just seemed impossible to me. I didn't know. I didn't know who did it. I never imagined, I didn't really know about schools here in the U S it was something that intrigued me, but I also had this interest in China first. So, uh, so yeah, so I became kind of fascinated with Chinese society and, and, you know, kind of venture into Chinese medicine. You've got

this really vast background. I'm curious to know what was the thing was that first thing that really kind of caught your attention and made you go China? What, what true. To that place. What drew you to

that culture? Um, well, like a lot of things in my career, I kind of backed into it. I was just looking for a way to avoid going. I was pre-med in college and I was just looking for a way to go to avoid medical school, which is, I kind of was what's I felt, I sort of had said I was going to do that. And I think my, maybe my parents expected that I don't know, but I just wanted something different than what I've been doing in college. And I got a chance to teach English in China and that changed everything. Yeah.

You took, you took that shit. That's great.

Before that I had never studied Chinese language. I couldn't have been more ignorant about, about China. Nevermind Chinese

medicine. Yeah. So you learned your Chinese over there. I suspect

I did. I did. So I went there and I, and again, I had to, I mean, I wouldn't have, I don't never would have imagined learning Chinese except that I kind of had to, at that time, you know, very few people spoke English and I started studying in that actually was kind of, I was kind of through the language that I became really fascinated in China. Once I was able to speak suddenly, like this whole world opened up to me and, and that, I mean, that led to the anthropology and then ultimately to the, to the Chinese medicine,

similarly to their medicine, it's such a unique combination to have that deep, deep, very deep cultural view into the, into the well, into the place and into the people and into the history. And then to be able to take an overlay, the medicine with it. Well,

it's been a journey, but it's it's, but it's always been a fascinating one. So I feel, I feel fortunate and it's like I said, I backed into it, but it worked out in some ways, very nicely. If I'd ever planned to do it, I don't even know how I would have.

And you know, how many of us actually plan the lives that we have? I think very few, most of us, it comes from the periphery. We back into it. We get a lucky break that at the time seemed like a disaster. Yeah. Something like that. Yeah.

Yeah. I mean, it was, it was really like that. I mean, even to study Chinese medicine the way I did, I mean, that was definitely not allowed, you know, in, in my PhD program, but I mean, it was tolerated, I guess, because I came back to finish the PhD when I finished the Chinese medicine studies. If you were to try to do that in grad school now, I think you just get kicked out. I almost got kicked out, but I

did well, you know, I'd love it. How the Chinese language is so expressive. They say things like a right. That's impossible. Yeah. Which means keep negotiating. But if they say, oh yeah, I'm sorry. That's inconvenient. Forget it. You're screwed.

You know, one, one thing that's been really special about learning Chinese medicine in Chinese was the language and, um, And it's so rich. Uh, and, and I suspect a lot of that is lost in translation and then being able to, and getting, you know, I w I wasn't, I was, you know, a reasonably good conversationalist when I started, but I really wasn't great at reading or writing Chinese. And so I had to get up to speed on that. And, but not also open, like all these doors to all this literature that's available in China, it's, you know, that was special,

right? You get, you get access to the literature and you get access to the nuance, which, which is something else. So, so let's dive into this topic here, liver cheek constraints. You, you sent me an article about this recently, that was really eyeopening. So for our listeners that haven't had a chance to read the article. Actually, would it be possible to put a copy of it up on the website so they can go

get it? Uh, absolutely. And it's a it's available through open access, any, you know, so that they could, um, I think what we'd have to do as a link we'd have to we'd have a link, but it's available through open access and actually it's published together with three other papers. It was part of a collective research project. So for people who are interested in the topic, they also really want to look at the other papers because I was working at the time with Volcker Scheid, who some of your listeners may know. And I was also working with Sue young Sue is a scholar of Korean medicine and stategy. It was a caller, a scholar of Japanese medicine, and we all wrote about constraint and it's sort of different meanings and balances in Korea, Japan and China and, and Volcker took, took a much sort of earlier look at its meanings and, um, kind of late Imperial times. So all those papers really go nicely together on the vert. Very, really gives you a full picture of the meaning of that.

Terrific. It's, uh, it'll be up there on a qiological.com. Just look for the show notes page for this. So Eric talked to us about constraint. Where did, where does this idea come from?

Well, it's, it's a, it's an it's, it's an old term and it's, you know, it's, it's there in the inner cannon. It goes through some different permutations. And, uh, the paper by Volker side will, if I remember correctly will looks at sort of like what happens to it sort of in the post song era, my particular paper looks, looks at the term and the way it changes in the early 20th century China. And so one thing I think probably most of your listeners aren't aware of is just how much Chinese medicine has evolved and changed. And I would argue even been through a couple of revolutions. Or it's sort of 2000 years of plus of, uh, of history and practice. And, uh, certainly one important change was in the early 20th century. That's the part I know the best, this idea of sort of Liberty constraint is something that it's not, it's not born in the 20th century. It's a late Imperial idea, but it's very different than the idea of constraint that you would find in another formula that your listeners might be aware of, which is the Judas you formula Juwan, which she has you on restraint pill. Maybe I believe us.

I think that's it.

Now, one thing that's confusing is I think that a lot of writing on that particular format for instance, is then written through the idea of Liberty constraint, because it does have. Uh, shaoyang Fu in that formula. And so people then will try to make that formula primarily about liver cheek constraint, and then dealing with other, I think it's the six other types of constraint, uh, food phlegm, fire, um, gap can't-miss, uh, and, uh, well, It starts with Liberty to constraint. Uh, and this is where Walker's article will be very helpful here. But if you look at the formula, it doesn't, it doesn't make a whole lot of sense in terms of that formula. I think it's really talking about maybe constraint in the middle of burner. It's a very different idea of constraint, frankly. And when you get to the 20th century, And this is sort of what I get in my paper. Some really interesting things start to happen. A lot of scholars, some of those sort of more famous scholars that we know of. I think we might think of them as the conversion school folks who were practitioners of Chinese medicine, but who also had a pretty strong foundation in Western medicine. They start sort of pulling in some ideas from Western medicine and then constraint becomes something that's like quintessentially in the liver for these folks. Uh, that's not, they didn't totally invent that, but they, but I think they made it a thing. They sort

of popularized it.

They popularized it and the way they justified it. Super interesting. And so this is what I talked about in my book. The argument that they made. It's an argument that would be by today's terms, almost laughable, but they argued that. Um, but I think it's the basis for the way that like formulas, like shaoyang and rambling powder get used today, they argued that, uh, the liver in Chinese medicine is analogous to the nervous system.

Now, where did they get this idea? We, I remember in school, we're thinking nervous system. They kind of threw that in with the kidneys and modern TCM. Oh, really?

Okay. Um, well, uh, a couple, I think a couple of things, one, you know, I don't know about your schooling, but you know, in my training, just teachers did not want their students to like, be assuming sort of these correspondences between Western medicine and Chinese medicine. We were sort of taught that the Chinese medicine body it's its own thing. It's uh, for example, we, now we often say it's functional. Whereas in Western medicine we might say. You know, it's, it's about structure. Uh, that's a, that's a dichotomy that I, that I think is problematic too, but it also begins to emerge in the, during this time period. But for the Republican period doctors, uh, they didn't really have these misgivings about sort of conflating the two bodies or using using bits of anatomy in Western medicine to correct what they thought were mistakes in Chinese medicine or to, you know, correct mistakes. I think that'd be the best way of putting it. The nervous system also is kind of a new thing and early twenties, earliest 20th century. So that's also part of it in one kind of aspect of what made it one aspect of, so I think the nervous, I think there was a. Um, now I'm getting online. I'm a little rough on the details here, but I think that, um, there was like a Nobel prize given to, um, and I forget the names of the two scholars who scholars, but it was like in the early 20th century for like the discovery of the nervous system, as we understand it, you know, so it's a relatively new discovery just in the world of Western medicine. Right. And so

that would make sense that it's a new discovery in the world.

It's a new discovery in the world. And one thing that became very popular, sort of with that new discovery is this, uh, is this disease of neuro Stainea, which is a very old fashioned disease that we don't talk about, but that was extremely popular and kind of in Japan and east Asia throughout the early 20th century, this is also a disease before we had like the disease of our modern psychiatric diseases like depression.

So what, what would you say in her Stainea is what is it that they were looking at, you know, in terms of someone coming into their. Their clinic

well nursing, it could be some things that we call depression today. Probably it's going to be how's it gonna present? Insomnia would be part of it. Um, just a lot of anxiousness or the things that were popper that diseases at the time, like, like loss of Siemens for matter, Rhea, uh, these other diseases of sort of weak, just general weakness. And it was thought to be a disease of modern societies to where like the pace of life seems to be quickening. Uh huh.

I mean, not unlike in our day we call it stress.

Yeah. Uh, a lot like stress. Yes. Yeah. Whatever

that actually means because when, I mean, people come in, they've got all kinds of stuff going on. It can be anything from a shoulder, tight computer, shoulders to headaches, to anxiety, all the things that they prescribed. Things like Prozac.

Yeah. Yes. Uh, yeah. And nurse theory standing was sort of the disease of, it was like almost, it was almost an elite thing, even Emile Durkheim called it. I think the disease of the upper class or something like that. Farmers don't have no time for that stuff. That's right. Yeah. Farmers, they just got to get to work. But, uh, so. W w was, uh, that was a very popular, uh, new diagnosis that was coming to China. And so some of these doctors and the early 20th century who were like speculating that the liver is a way of thinking about the nervous system. We're also trying to think, how do we treat nurse Dania? And that became like, um, if you make that equation that the livers and the liver and the, um, nervous system are related, then you've got like a link then you've, then you've got away. Okay. So maybe it's liver cheese stagnation. And so you can actually find, uh, cases from some of these. It's a kind of a special set of doctors. It's not like, I don't think it's necessarily every doctor from the spirit who are arguing that this is, this is this, like this idea of the nervous system helps us to under better understand what the liver does and to better understand liver T constraint. And now we've got, now that we have this way of thinking about it, we also have treatments for it, and it could be things like I'm rambling powder, but other things, but treatments that go to the liver in particular.

So back in this Republican. I know a little bit of the history. I don't know a lot. I know a little, first of all, there was the overthrow of the Ching dynasty. The Republicans come in, you know, it's not exactly a smooth transition, right? That's correct. I mean, it's kind of show up world war two, intervenes. I mean, pretty messy there for the first 40 years, first 45, 50 years of the century. Yes, absolutely. And in the midst of all that, you know, the golden dong the nationalist party, right there, they're even trying to outlaw things like Chinese medicine. They're saying, you know, this is superstition, we got to get rid of it. And then there's a big backlash from some Chinese doctors. So there's tons of stuff going on here. And also, like you said, there's. These influences of Western thinking coming in and not just Western thinking, but the newest ideas in Western thinking, like you're saying, Hey, look, there's a nervous system. Not too. Unlike these days, I go look, there's inflammation everywhere. It's it's suddenly kind of a thing that a lot of thoughts centers around. Yup. Yup. So how is it that liver cheat constraint came to be. It's such a garden variety of diagnosis.

Good, good question. I think, you know, uh, I think some of these Republican doctors were we're part of that, even though today we would, um, we would no longer you would be laughed at probably for saying that the liver is analogous to the nervous system, but I think they w they were, they helped us to think about treatments for nurse Stainea nurse Dania definitely stuck around in China for a long time. Uh, in fact, even when I was a student in the late nineties, and that was the beginning of like, uh, I think Prozac was coming into China, kind of in the very late nineties. Uh, but I still, I saw Dr. Still diagnosing they're staying out of it. I I'm thinking it would be diagnosed less and less today. And in fact, it's like, it's no longer. It's like, it's not in the DSM. It's no longer, um, considered, um, an appropriate biomedical diagnosis. It fell out of favor a long time ago, but it stuck around in China for a long time. So I think it became that diagnosis was, um, without, uh, hesitant to make some generalizations. But, but, but that was a pretty powerful diagnosis in a society where it was a little bit difficult to speak about mental illness. And, um, of course there's a lot of treatments for all kinds of mental illness in Chinese medicine, but the, the biomedical kind of way of thinking about it, wasn't too developed. And so nurse, I think, had this very long life in China. And, uh, and I think that that helped solidify this idea of liver chicken strain as being one way. And certainly not the only way, but one important way of, um, of, of dealing with all kinds of emotional issues.

Yeah. So I've, I've heard this said that, and this is a generalization, so, you know, take it with a big old shuttle assault that Chinese culture, traditionally speaking tends to somaticize. Emotions. Whereas here in the west, we tend to psychologize our physical experience.

I think that that might come from Arthur climate. Who's a medic who was a medical anthropologist. Who's done a lot of work in China. Yeah. I mean, I think that we want to be careful about those divides because they're, um, potentially misleading and in a lot of ways, but,

um, general screen of sorts.

But I think that, but I think that's true. Uh, I mean, even with my, in my own clinical practice here in the U S I have, uh, I have to kind of constantly explain to patients like the anxiety or depression or whatever those are. Those are things we can, we can work on. Like, you know, we get, we approach those things through the body. And in Chinese medicine folks, I think in the west are not used to things that way, because we probably tend to psychologize. We tend to have this mind body divide and we, we don't S and patients don't see those possibilities. Whereas I think in China and at least certainly in Chinese medicine, it was, you know, the mind was never separate from the body. Uh, and as I'm sure all your listeners now, um, there isn't much of a mind, you know, they're critically speaking in Chinese medicine. Uh, so we always go through the body. Uh, so I think, so I think classically, there, there there's some truth to that. Um, on the way, I'm sure we can find. As soon as I say that, well, somebody will put out lots of counterexamples,

but, well, I mean, this is the thing about Chinese medicine, right? There's always counterexamples. There's usually more than one right way to look at something. And those right ways often are contracts.

Uh, that's right. And you know what this issue of constraint too, and that's why that's what I think would be great for your listeners to look at all four of those papers that we published because, um, constraint often involves emotional issues. Although that's something that emerges slowly over time in China, but if you compare sort of Korea, Japan, and then China, maybe at its and, uh, and others, other countries do at its various time periods, you see a real evolution of, of the way constraint is dealt with. One thing I remember that was really interesting from, um, our research. I think my Japanese colleague Keiko Digi was really interested in, uh, in a Japanese scholar who, uh, who used, um, a formula called, uh, uh, which literally translates as the drink that separates Archie. Um, in fact, that's probably a terrible translation. I can divide the heart Chine offense, Cici. So F so splitting the heart she drank. Okay. That's it? That can't be in a correct translation and it's actually a form of that. I feel like I don't really understand very well, but if you look at the formula, it has nothing to do with liver cheese stagnation at all, but this was sort of a, it's an old song, dynasty formula. That's mostly fallen out of favor in China. It's not terribly important, but it, it deals with, uh, the lungs and perhaps the middle burner a little bit. And I think it's, it's a form of that. If I remember correctly, it's sort of a combination of, uh, quippy tonks or the cinnamon twig decoction and we'll piece on the five. Oh, the five feels. Powder, which is about a DEMA and swelling and T deficiency. If I remember correctly, that's clearly like a very different understanding of, uh, of constraint and a very different way of thinking of how constraint might relate to emotional conditions. And that was a very popular format for this when Japanese scholar that my colleague was looking at,

I will look that up or, or you could send it to me. Yes. I'm going to put that in the show notes page so that people can check that particular prescription out so they can, uh, you know, get a sense of what we're talking about here. You know, sometimes it's, it's so much easier if you can just look at the herbs in a formula, you know, a whole lot about what you're looking at an illnesses right inside of it. Yeah, for

sure. But there's, it's not Liberty stagnation that's for sure. Yeah. So

take us, can you take us on a short tour from Junan Xi and the, uh, uh, you had. To shout outs on and some of the different ways that constraints has been seen and worked with through your, uh, well, both clinical and anthropological lens,

I'll do my best. Uh, and actually this is probably where Volker's paper is going to be a, a Volcker size paper is going to be helpful. But if we, uh, but uh, you know, as a formula developed by Judah and she, so this 15th century scholar, uh, doctor, um, now kind of considered one of them, the one of the four great masters of the genus UN period, supposedly it treats, um, you know, six different types of, uh, stagnation. There's been a lot of debate about that formula and later scholars have argued for example, uh, that it's maybe a little bit more of a. It's it's it's, it is both clinically useful, but it's also sort of an, I guess, an overview of the different types of constraints you can encounter in your practice. Uh, and you should modify that formula as, as needed, but something that definitely goes a little bit more to the it's got some tongue drew in it attracted loyalties. And so some of that goes a little bit more to the middle burner and it's thinking of sort of, uh, some sort of, um, uh, impediment, some sort of obstacle to the key mechanism to the TG, the sort of up and down movements of T in the body. Yeah, the liver is definitely quite secondary shaoyang Stan, and I'm going to be a little rough on the history here too, is a form of that is originally kind of a gynecological formula. It's not really used primary and gynecology for many, many centuries, uh, and in the latent period period. And I'm going to forget who, uh, could be, uh, Josh, because I think if I'm right, uh, some leading period scholars start saying, this is something that we can use in general for men and women, some of the emotional ideas are, uh, kind of become, start becoming more important there. But that's something that's really quite different than you had you won. And what you'd asked you was talking about. And then it's, I would say it's really in the Republican period that this idea of, um, uh, liver T constraint really kind of becomes extremely important in, uh, in this way for the quintessential way for dealing with emotional issues. And of course, if you know, when you study, when you study about Liberty constraint, it's, I mean, one confusing thing is that we know that liver is the anger is the emotion that's related to the liver. Uh, yeah, but with a shaoyang San and liver chicken strip, we think of it as sort of feeding all emotions too. So whether it's stress or depression or anxiety. And so that becomes sort of our, the first one that we go to. And that, that itself may be a bit of a problem

given what we were talking about earlier with nurse denia and how. In some ways it's a little bit like I'm using air quotes here. Stress. Yeah. Yeah. I mean, we're using it the same way. And we were thinking about it as if it were neuro Stina. We're thinking about it as this overall thing about life. If you're not just a farmer, eking out a living, you got time to actually be concerned about your emotions and you know, back then they were looking at it and going, oh yeah, well, there's this nervous system thing that we've just discovered. And one of the things to me about Chinese medicine, that's fascinating. And you've got a deeper view of this than I do. So please correct me if I stray too far out of the boundaries here, but it seems like Chinese medicine has been very good at looking at things, know, looking at nature, looking at how things unfold, being able to notice change and the pace and rate of change. And when new ideas come in, When the first things they do is they snap up on and go, all right, how's this fit in with everything else that we know. And you know, it's a little bit like the Borg, right? So the new comes in, it goes, all right, we're going to grab this and add it. You know, we're going to use your knee uniqueness and add it to our collective.

Yeah. Well, I think that's exactly, I mean, I think that the way we use shaoyang for stress really comes out of that early 20th century, uh, kind of moment. I, again, I think it's, uh, we wanna, we wanna expand our, think our, our clinical repertoire, because there's other things that we, I think we need to be thinking about and constraint is, um, and one of the things we wanted to show on this project too, was that constraint is this really complicated idea that has so many permutations and different, uh, presentations, uh, so that we want to recognize that it's, uh, that we may have a limit limited view of it, but I think you're right, but I think you're right. This idea of stress, which is again, Um, it's the most nondescript sort of term out that I don't know what it means clinically, but it becomes a kind of catch all, I think, a little bit like nurse Dana did. And so our first audit goes right to CIO sign and Liberty constraint. And I, and that also, I think misses also misses the point a little bit about some of the, the, um, a Republican or a doctors who were thinking about the liver and the nervous system together. And when I've, as I remember correctly, when I was looking at some other cases, I don't think I ever saw shaoyang in there in any of their clinical cases, per se. Although they, they were thinking about the liver in different ways and had different kinds of herbs for treating the liver, but it wasn't necessarily about, um, it might be a more of a, a liver kidney. Um, double deficiency or something like that, that, uh, that they were trying to treat. So they also, there, there was a, there was a richness, I think also to their, um, their own innovations to that's also been lost too. And, uh, in kind of its aftermath and their writings of kind of, you know, even in China, that's mostly forgotten. And when I, when I tell some of my classmates or friends in China about, oh, you should have seen what a Louie LA or UNT a child said about the liver. They're, they're sort of, they're shocked. They have no idea that anyone would ever say anything

like that. Can you give us an example of.

You didn't see a child, I think is a good example. He's got a, he's got a book. You take showers. So for your listeners is one of the, um, you know, most well-regarded and most famous doctors from that Republican period. He, if I believe correctly died in 19, maybe 1935 or so. And he, somebody acute came late to Chinese medicine. He was, um, in the world of, um, literature and, um, the publishing world for awhile. What are the kind of the most interesting thinkers out there? And he has, uh, he developed his own, he developed his, um, and this was very common in the real public and period. He developed his own school. He had to, he had a correspondence school. Other kind of leading doctors at the time were developing private schools, uh, at that time. And then before that, of course, sort of the master disciple model is just the primary way of learning Chinese medicine, but that still goes on to the Republican period, but, but sort of experiments with school F uh, first starting as a YouTube, you can take a child, develops his, um, his own correspondent school and different, Rhett's a whole series of textbooks about them. And one of them is a textbook on the pulse, and he has a very interesting explanation for like a wirey pulse, a shunt shrimp. And he argues that, um, we usually have a watery pulse and that's connected to the liver is because we have like tension, you know, this is again through the nervous system tension in the, in the, in the laws of the, of the arteries cost by whatever, but it's, but it's that physical tension in the walls of the artery that explains her shed mine. So again, he kind of uses this idea of the liver is analogous to like the nervous system to explain how to the pulse we're feeling. And that's that's right in this textbook. Yeah, yeah,

yeah. His name.

You and Tia chow. So the smell that would be a Y U N. Okay. And then, uh, T I

E C R E Q I a O shaoyang. Okay. Just one of my favorites. What else did he have to say about constraints?

He, well, he, he, more or less, uh, uh, he, more or less agreed with this idea that, uh, about the nervous system and the liver. Let me give you another example because, um, you can teach us a lot to say about a lot of things, and I can kind of sum up a little bit what some of these folks say in a second, but I'll give you another example from another famous doctor named, uh, ju wage. You, she weighed you two, which was the last name is, uh, drew what's a C H.

And then w and then we're J

you to wait for famous clinician from this time. And if I remember correctly, he argues that, um, I don't have the passions in front of me, but it's, but it's in the paper. He said Tommy's medicine, didn't have a notion of the, um, the nervous system at all. But it turns out that, uh, all discussions of QI are like a pretty good approximation of it. And he says something to the fact that the liver, then he expends a little bit. He says liver cheat and heart GI issues are all about the nervous system. And then I think he says, Anything related to heart, she is the involuntary nervous system, anything related to Liberty as the voluntary nervous system. And so we eat that up. That's interesting. Yeah. Super interesting. Yeah. And I should, I should say a little bit more about, about these doctors too, because, um, because actually some of these speculations about the way the body, like the body of Western medicine and the body of Chinese medicine connects like goes together with some other parts of the way they thought they thought about Chinese medicine, which is really important. So a lot of the doctors who are making this, this same kind of connection between the liver and the nervous system, we're also deeply involved in like some debates that are also very much forgotten from this time period. And one of them is the debate between the cold damage tradition and the warm illness or the warm disorder. I like to call it the warm disorder tradition. Uh, so, uh, your listeners I'm sure are familiar with the Shanghai, lone, the treaties and cold damage disorder. How could we not be? Yes. And you probably also learned about warm illness when being in your

we're being challenged.

And, um, and the warm illness school or the warm disorder school is a, is a development of the late Imperial period, but particularly the Ching dynasty and especially the, the 19th century. Uh, and one of the things that these doctors, um, absolutely hated. So this is, um, this would be doctors that include, uh, Lu ULA, uh, ju Wade, you, you, and THL those last two, I just mentioned, uh, but a whole number of other ones who are very interested in sort of this who are sometimes lumped into that convergence of school. But one of the things I absolutely the tested was the warm illness school. And they just thought that was like a travesty. They thought that was just a complete, um, bastardization of, of Chinese medicine. And, uh, and folks just like losing their way. So their ideas about the body go together with some other, these like really intense debates at the time. And another thing that's kind of, part of it too, is also. That's an important to understand this. I think one reason they felt at Liberty to sort of make these connections between like say the liver and the nervous system. Whereas today we would be scolded by all of our teachers for doing that is also a Western medicine is a very different thing to in the Republican period. So not only do you have like diseases like nurse Dania coming to China, uh, but Western medicine, isn't the, like this clinically dominant form of medical practice that it is today. So for these doctors, most of them thought that Chinese medicine was clinically much more efficacious than, than Western medicine. And this, I talk about a little bit in this other paper, slow medicine. They were often very involved in treating all kinds of acute diseases because there weren't antibiotics or other Western medicine solutions for these problems, their views on the body are part of this. A really comprehensive, a very complicated way of understanding Chinese medicine that, uh, in some ways was also. So at the same time that they were trying to like bring in pieces of Western medicine, they're also trying to get back to like the song Han Lorne in like the early Han dynasty and sort of what they think of as true Chinese medicine, which is kind of like emerges in the Han dynasty. And they, they mostly think that anything that happened after the song dynasty was just garbage. You know, it's really

hilarious to me. We have the same stuff going on today. Right. There's the people that say, oh, TCO, modern TCM. Well, you know, that's a bunch of BS. Yeah, yeah. Some Imperial formulary. Yeah. Right. You know, government intervention, blah, blah, blah. We got to get back to basics. Let me throw out the history. Yes. There've been doctors arguing about, you know, we got to get back to basics this new stuff. Yeah. I don't know. Right. Or this school over here. I mean, I love translation of the non-judging because it's got all these great commentaries in it. The commentaries are fantastic because you've got doctors. Not just on the texts, but coming on other commentaries through decades and, and you'll see some really inflammatory stuff like, you know, oh, you treat your patients this way. They will die. It will be your fault. Uh,

yeah. Yeah, that was, that was exactly the language. So the Republican period, uh, what, when being formulas were like the kiss of like literally the cause of death that, that was, um, that was a guaranteed way to kill your patients. Uh, if you, if you took that approach according to these right. And vice versa that the winning folks thought that formulas were much too much too powerful. They're overwhelmed with overwhelm sort of like more delicate constitution, particularly in the south of channel where people fought to be a little bit more

delicate. So we're delicate and let's add more cultured, right. And more culturally humble, you know, northerners.

That's right. There's a famous book by Marto Hanson. If folks are interested in this debate a little bit, there's a whole history of the, of the warm, almost school. And, uh, she really talks about know robust northerners and delicate southerners. Oh

yeah. We'll put that on the show notes too.

So, but, uh, so, uh, so yeah, I think one important piece of the story, and it's not really fully elaborated in the article that I wrote. It's a little bit there, but I think it's something that I, I, uh, was sort of discovering at the time is that some of, some of these other influences these other debates, the influence from Japan also is very important for these doctors. I don't think I've, uh, I think I mentioned that in the article, but I think that's something even more important than I realized that. Well, so first Japan is, um, so as you, as you mentioned, uh, this is, uh, uh, uh, the early 20th century as a, is a time of political weakness in China. The chin dynasty was overthrown in 1911, but it was already sort of. Teetering for really since 1895, when Japan defeated China. And, uh, what did we call that war? I think maybe it's the first time of Japanese war, but it was a battle that was fought in Korea, really for control of Korea, in some sense, or at least for control of sort of political influence in Korea and Japan is growing quickly becoming a military power, uh, in the early 20th century, it's colonizing parts of China, just like European powers are as well. Eventually it takes over Korea, uh, then moves into Manchuria in 1931 and sets up a puppet government there. And of course later there was the war with Japan, the 19, the second war, which is 1937 and kind of the beginning of world war two, at least in China, but Chinese scholars are relatively unaware of sort of what's going on in the rest of east Asia, Korea and Japan, uh, in terms of, uh, medical scholarship, uh, it sort of. Mostly, I mean, that's again, a little bit of a simplification, but it's mostly a one-way street for many centuries ideas from China, make their way to Korea and Japan. And, uh, and they don't really come back and that's, that starts to change in the early 20th century. And it's really in part because of the rise of Japan as a, as a military power. Uh, but also as a cultural center too, because Japan is modernizing very quickly. So you have Chinese intellectuals and the early 20th century, uh, going to Japan to study, um, bringing back lots of ideas of, uh, uh, about sort of Western, not Western sciences and humanities with them, but eventually also some of the ideas of Japanese compound medicine, uh, come back as well. And so some of these, uh, folks that I'm, um, writing about and the 1920s are sort of discovering, discovering Japanese scholarship and they were kind of delighted by what they discover. It's, um, it's really original. It's very different. That's a very different approach to, uh, to clinical practice. So that's also part of the, part of the mix a little bit less. Um, if I'm, I think a little bit less in terms of this relationship with like the liver and the nervous system, I don't know if that really kind of, I don't know if there's a direct Japanese, uh, inspiration there, but definitely sort of about debates about like warm illness and cold damage. That's very influential in there because there's like, it turns out there's incredible Japanese scholarship on the treaties of cold damage. That's also very different than what's been happening at China. Well,

I mean, compo medicine, you know, hon Fung. Yeah. I mean, that really comes from the Shawn Conlin.

So that, that comes from this on low. And, and so I think that's becoming now a little bit more popular here in the us and, and it certainly in China too. And that is that sort of, that sort of way of thinking about the treaties or cold damage also is influencing some of these Republican or scholars as well. You know,

as I recall and correct me if I'm wrong, Because I remember reading the article, but it's been a couple of weeks now. It sounds like a lot of these Western medicine ideas, like you were saying, they started to trickle in because people were going to places like Japan and they were getting exposure to these ideas and then they bring them back. And again, Chinese medicine being what it is. Oh, how do we incorporate this into the way that we already think about it? Like you said, there wasn't a whole lot of Western medicine in China at the time. And in fact, if you had an acute illness, you didn't go to a Western doctor. That would be a bad idea. That that was, this was before antibiotics and steroids and such, right. Republican era Chinese doctors that actually knew how to treat this stuff.

Yeah, absolutely. And so that's, uh, and that was, um, and this gets into this other paper, uh, how Chinese medicine became efficacious only for chronic illnesses. Uh, but I interviewed a number of very elderly doctors who had kind of trained and practiced in the Repub Republican period. They're all sort of in their eighties and nineties. Um, and some of these interviews were eight, nine years ago. A few of them are a little bit more recent, but they also the same thing. There was like, you know, in my village, certainly in the countryside, there was, there was essentially no Western medicine, uh, or if there was, it might be like somebody with the skill level of maybe like a nurse or something, maybe a nurse practitioner, like an a. County scene. And then even in the cities, you know, there was missionary hospitals and there was some private practitioners of Western medicine, but they may be very expensive. Missionary hospitals certainly had a number of patients, but in general folks, uh, sought out Chinese medicine practitioners. And so, so one of the things that stunned me in those interviews was that, um, you know, sort of asking them, so what did you treat? And, you know, it was things like, well, cholera. So there was a smallpox epidemic in 1946, bubonic plague was big. And at first I thought they were just like, you know, trying to pull one over on me or something. Uh, I, I learned very, you know, I've learned very clearly in my clinical practice that if, if, if we saw any infections that were pretty much going to use antibiotics, but they also, they also did the same thing. And they all said, if, if you're going to be a, if you're going to make it as a Chinese medicine doctor, you better make it treating acute, you know, in this case, uh, mostly infectious diseases because that's, you know, that was the big thing.

Yeah. It's so different from how we think about it. Now we can. I mean, that's, that's a whole different podcast. So

just leave that kettle,

you know, with, with all this background that you've got all this anthropological study, plus you've got clinical work. I'm curious to know how all of this looks for you in your current practice when you're seeing patients. If you have someone coming in with something that looks like, well, what most of us would think of as liver cheek constraint, are there other ways that your mind is working and perhaps other formulations that you lean on for this? I'm going to say neurasthenia stress. Complex of ball symptoms.

Yeah. I mean, I think I, I try to, um, at least not jump to that. And, uh, and I think, you know, one, so one, we all, I think we all learned this, but you know, I think when we start to make those equivalences, like, uh, rounding Potter risks, good for stress, we start forgetting about the Chinese medicine indications. You know, I kind of try to stay within sort of the Chinese medicine system. As best I can, but I think also, at least for me, you know, some of them, we, in fact, we've had this discussion a little bit by email, at least some of this research that I think opens me up to at least thinking differently a little bit about what I've, you know, the sort of basic textbooks, textbooks, knowledge that we've, that we've learned. And to go back and look at something like which frankly, I don't, I don't use that much in my, in my practice, but I certainly understand it very differently now than, uh, than I would have. And I, if an, if I did have occasion to use it, I would, I think, be trying to think about it more in its kind of historical moment then. Uh, and then as I sort of like a treatment for liver cheek constraint. So maybe

if there's more middle burner indications, or I remember you saying earlier in our conversation today, there's what five or six different constraints in there. You can kind of look at it and go, well, it works on these various levels of constraints. Take it as a blueprint, modify it based on what you actually see.

I think that's certainly one lesson. And, uh, I mean, another lesson from all the Republican doctors is, um, that, that I look at it as that, um, is that there's there's so there's so much more diversity of thought out there in the world of Chinese medicine than we realize. I sometimes don't like the critique of TCM. We can talk about that in a second, but at the same time, we need to always kind of recognize just, you know, what we've learned is sort of the tip of the iceberg. If we can kind of get back into, um, some other writings and, um, really dig into some of these formulas that we use in our clinical practice, we might discover other aspects of it that we, that we just didn't appreciate, you know, the first time around. Yeah. I had a few thoughts actually on this idea of like, um, TCM and, um, textbooks and things of that if you want. Yeah, because I studied in China, I'm a little bit disconnected from like the, the world of Chinese medicine here. So I don't totally, but I, as my understanding sort of TCM is almost a dirty word and the Chinese medicine community, and everyone wants to get back to classical Chinese. Is that right?

We don't know about everybody. Here's here's what I've discovered TCM. This is just me, right? My opinion. I'm on a soapbox actually. I'm not on a sofa. But I got a soap box. It's called qiological. Anyway, we all learn TCM TCM gives us a common language. It gives us some, um, ways of parsing reality. It gives us some ways of understanding physiology from another point of view. And what I discovered is it gave me a basic language. So when I ended up in Taiwan and China, I could talk to Chinese doctors and they would understand what I was saying. I could ask them questions that made sense to them. They would give me back answers that I could understand. Sometimes that was within the fond way of TCM. Sometimes that was other ideas that they had, that they got from a family tradition or their own experience or wherever. But the bottom line was, is we had a common language to communicate with. So I know TCM gets a lot of bad play. I don't know how much it is at TCM is bad stuff. And how much of it is. You know, much like the Monko doctors right. Back in the day, it's like, well, you know, I'm a Mancha doctor, right. I'm out like that. You know, McDonald's like doctor down the street, you know what I mean? I think human beings forever have been setting themselves as what my stuff is different than that stuff. And here's how, and here's why it's important. So do business with me. Yeah. Some of that I think is branding as human beings saying, you know, I got something different. I mean, I guess I'm just grateful to it in a way, because it's what got me started. It was, I mean, we'll hear your opinion here in a moment, but it just seems to me that TCM, was it an attempt at a certain moment in time to try to keep the population of a giant Teeter in country healthy. And they actually pulled from the brilliance of a number of different people. Not that there's only TCM, but it's, you know, it's not a bad sort of a reader's digest version of Chinese man.

Yeah. I mean, I really, I really agree with that. I think, um, no, I think one, maybe one F you know, I sent sort of maybe one frustration here in the U S is that perhaps people take, and I think TCM kind of refers to probably textbook medicine and folks who are getting their textbooks and, you know, getting sort of the Chinese medicine textbooks and translation more or less in the us. But, um, when that's taken a sort of like the beginning of the end and all there is in Chinese medicine, um, maybe it was some people reject it because then they're like, oh, there's more. And I think that, I think the, the more as always. It's always apparent in China. Everyone knows the textbooks are just as your starting point. It's definitely not where you're going to end, but there also it is. I think, I think it, uh, not only does it give you a common language, but it, um, it also kind of served a lot of really important functions. You know, what we have all benefited from, which is that it helped to establish sort of the institutions of Chinese medicine. Uh, you know, literally the school I went to, but also the hospitals where I trained at. So it was part of, kind of an institutionalization of, of Chinese medicine that took place in the 1950s. And part of what happened too, was there was an attempt to, or part of, I think this is both the strength and its weakness is that it was a compromise. So it had to, it had to sort of, it had to be sort of general knowledge that most everyone could agree on. Like, you know, there was a whole set of doctors that were pulled together to write the textbooks. So it had to be sort of common knowledge that everyone could more or less agree on it, but it was just this idea of consensus was really behind it. So things like I just mentioned, like debates between like the cold damaged school and the woman on the school like that. Um, uh, and, uh, and the textbooks. And also, I think another thing happens too, which is that in the really beginning of the 1950s and certainly by the sixties and seventies is that Western medicine is changing profoundly. It's clinically becoming a much more efficacious form of medicine. It's becoming sort of the dominant medicine in the world. And it's also become the dominant medicine in China. The communist party is really behind, uh, not only institution of Chinese medicine, but even more so the institutionalization of Western medicine. So Chinese medicine starts the profession as a whole starts to, uh, rethink like, who are we like vis-a-vis Western medicine. And that's a very different kind of way of thinking about Chinese medicine than in the Republican period. So that's why it was totally fine for or, uh, to wage or any of those doctors to say, yeah, the liver, the really great way of thinking about the nervous system, because they weren't particularly threaten. The professional of Western medicine, which was like, there was very few doctors in China at the time. And it was just like this other body of knowledge that seemed really useful to borrow from. Uh, whereas in the, in the, in the communist era, Western medicine is a, is a real challenge to the practice of Chinese medicine. And so textbooks have to be written and kind of in light of that challenge, although they're very careful to sort of never acknowledge that to never like state that. Uh, but you know, Western medicine really can't be part of Chinese medicine textbooks, Chinese medicine textbooks have to then highlight the characteristics of Chinese medicine, but the, the characteristics really increasingly kind of vis-a-vis Western medicine. And so it must be sort of in this complicated relationship, it's got to be different, but not too different. And so that's part of what happens with Western medicine. And if you just take this idea of like Liberace constraint, some of the ideas from the Republican or doctors make their way into the textbooks, but they don't make, they don't make it with the same explanation. Hey, the liver is just like the nervous system that would be, you know, totally verboten. Uh, you know, you can't, you can't make that analogy, but the, like the treatments, the idea, the idea that liver chicken strain treats all kinds of emotional disorders do make it into the textbooks. And in the paper I wrote, I sort of traced that, like, you can see the early additions of the textbooks, you know, very much carry on sort of some of that thinking from these Republican era innovators, but they put it in this form. That's. Uh, maybe very textbooky for lack of a better, better word, but it's this kind of consensus driven sort of series of documents and texts and it, uh, and I think that's just one small example. So, but a lot of things are coming in and, and they're not gonna throw out warm illness because not everyone can agree to throw it out and they're not going to throw out surely not going to, and they're not going to have maybe this different notion of cold damage, but that's not everyone can agree on that. So it has to be like, whatever goes into the textbook had to be things that more or less everyone can kind of agree on. And so that, uh, and even actually the cold, the cold damage is another example. Um, some of these same scholars or talking about liver cheek constraint, and they're probably impaired, or also like. Radical reinterpretations of like the treaties on cold damage disorders. And, um, you know, none of that carries on in the communist era because it was just too radical. And so textbooks are these consensus documents. That's part of the frustration is because we don't know how to read them. We don't know to how to, we can't quite see that they're just taught to us and given to us as sort of like, this is

medicine. In fact, it's kind of. The table of contents of medicine. Yeah, yeah, yeah. You know, and we've got to go in and dig the rest of it out on our own. It helps if you read some Chinese. Yeah,

yeah, yeah. So there's so many examples about, there's so many examples of this and, uh, and we have a hard time kind of looking at those textbooks critically. Uh, and I think also, perhaps for practitioners in the west hard time to even know that there's so much beyond what's, what's in the textbooks. And I think that's where people kind of reject them as TCM as some sort of perversion of Chinese medicine. I think that's not giving the textbooks enough enough credit because they really enabled kind of this institution to persist and flourish. Uh, even, even though it was again, more of a consensus form of medicine and really perhaps not the way anyone would, I actually practice medicine. Yeah.

It's sort of like the top of the bell curve. Right. You get the average of something, but you see very few people that are actually having. Yeah. Yeah, that's right. Well, you know, I mean, as I listened to you explain this, the pressures that were brought to bear on the country on the medicine, you know, as, as things move through time, you know, it's, it's impossible to escape the influence of our times. And it was lovely having this conversation with you today, getting this glimpse of Republican early Republican, uh, China, what the medicine look like, where some of their ideas came from. And then we look at the pressures that were brought to bear for TCM. I remember when I was in school, my teachers said there are some patterns here. This is to help guide your thinking. These are boxes and there are things that we see out there. Don't put your patients in a box, understand the mechanisms behind what creates these boxes, pay attention to those mechanism. Yeah, I think one of the problems with air quotes, again, TCM, we expect to see these, uh, you know, boxes and when they don't show up, it's like, well, what's that? Or, oh, well this is not effective. Well, we need to actually understand the path or dynamic that's going on, which I think the books are like, um, exercises and thinking, if we can learn to understand that stuff, then we can take those principles and apply them in all kinds of ways. And you could sit down in the same room with a wind being person in a shaoyang huddle in person, and, you know, enjoy some whiskey together because you probably got more commonality than differences when you get down to that level.

Uh, well, yes. And hope, hopefully you would find the commonalities. Now, even the word pattern that you just mentioned, I would also argue that, um, Benjen, linter, you know, which we think of as our key methodology, Discrimination and treatment determination. It's a, it's a term that doesn't, it doesn't appear until the late 1950s. So it's, it's, it's really

just opened a whole new can of worms here.

It is. It is really an invention of, of, of the textbooks themselves. So that's a whole nother that's, uh, that's that's the next podcast.

That really is a food for another conversation. I think we're gonna have to put a bookmark in it for today though, but we can certainly pick that up another time before we, uh, before we sign off. I, I'm just curious to know, in addition to all the writing you're doing the practice you're doing, I mean, what do you got going on? I mean, you've got your, it sounds like you have your finger in a number of pies these days. I mean, what's your day look like?

It's a bit, it's a bit hectic, but, um, uh, yeah, so I'm busy teaching and, uh, and I had my clinical practice, which, uh, you know, I have to found balance with my, my teaching schedule. And I'm also a member of a, uh, a founding member of a new company called Dow labs. Uh, so we've been, um, working on developing, uh, at the moment, mostly just classical formulas, but trying to, um, help popularize them a little bit, uh, with, with consumers and work with practitioners to, to sell those formulas. One thing we've been doing is to try and, um, flavor them so that maybe people will be a little bit more excited about, uh, uh, taking them. But anyway, so that, so yeah, I've got a couple, I've got my fingers in a couple of times you say

you've got a cherry flavored. Ooh, may warrant,

but, well, we have. Now now, now you're, now you're, now I'm going to forget the different flavors, but, um, uh, well, for example, we're working on, um, which is, uh, one of my favorite formulas and, um, we're trying to make us sort of a Mexican chocolate sort of, uh, beverage. Um, but you know, if it, if it, if it works, I think it's great because then, um, one of the, one of the hard parts for me always is getting my patients to take the, take the, take the medicine. And, uh, so if we can, um, come up with some ways that are a little bit more innovative and make it a little bit more appealing, I think that'll be, be great for everyone.

Well, Eric, thank you so much for taking the time today. I thoroughly enjoyed your articles. We will have those up over on the show notes page. So, uh, y'all listening to this right now. You can go check those out. They, they take an evening to read. They take a little bit of thought and it will broaden your perspective and. Some really delightful ways. I think you'll like them. So, so look for those, uh, any other items that we've talked about of interest you'll, you'll find some stuff there on the show notes, Eric, thank you so much for your time

today. Uh, Michael was a pleasure, always fun to get to talk about my research. So, um, anytime love to talk about some more of it.