I think we've clarified this already but um you know we do have a little bit of specialized verbiage that we want to be familiar with torpid intake um this is certainly not how most humans describe having no desire to eat or reduced desire to eat but um it is sort of a I don't even know if biom medicine says this but torpid intake is how we're going to talk about reduced appetite so torpid means inactive right if somebody's in a state of toror it means that they're not active AC that they're kind of lying around and intake is obviously appetite here so torbit intake means reduced appetite it is sort of like torpedo I used to play a a vampire based role playing game or like board game or something and like if if your vampire got messed up in a fight you know vampires mortal so they can't die but they would go into torper which meant that they kind of lied there in their tomb until somebody came around and gave them blood or something so it's a state of being inert right um but first tell me what is appetite you know tell me from any any perspective you want to say tell me you know maybe you have a poem about your own appetite maybe you have an experience maybe you have an understanding from TCM physiology yeah what what's what's appetite when you experience appetite what does it mean I mean I would say I would say primarily appetite is a feeling right like it's it's it's it's sort of preverbal it's something that um arises within us when you know obviously when our when our bodies experience it um different bodies experience appetite very differently um and having worked with a dietitians and health coaches very long uh for a while you know there's different signs of hunger and they're not uniform right they're not uniform sometimes they're actually a little bit disconnected from the act of eating so um sometimes we experience appetite as a desire for particular Foods or a desire for food in general but sometimes appetite actually hits people in a in a place where they realize that they're hungry because they feel lightheaded or they realize they're hungry because they get irritable or they realize they're hungry because it's 12 o'clock and they have an eaten since seven right so there's all sorts of different ways that people might recognize that they're that they should eat and what I would postulate is not all of these are appetite um I think actually um appetite is an engagement between the liver and the spleen right it's an engagement between the liver and the spleen and particularly the spirits of those two the intelligences of those two systems right so this is the Hun passing on information to the middle jaia or here we could say the E if we wanted to um it turns out that the E is not very imaginative right the E the spirit of the spleen is is very much about sort of um breaking things down maybe analysis that sort of stuff but the Hun is all about inspiration right and our appetites are also marked by inspiration right so our appetite for food is part of a larger category of appetite for life right to have an appetite or an inspiration to engage with life and um traditionally when we when we look at the classics a huge part of our assessment of patience and also um if we want to assess How likely we think that they are to recover it often hinges around appetite do people want to eat right but this wanting to eat is also do people want to live right if you don't want to eat then you kind of there's some part of you that doesn't want to live or is lacking inspiration right it's lacking a certain inspiration that's guiding you towards engaging with the world engaging with the world that you could then you know actually put in your mouth chew up and swallow so there is an element of inspiration in appetite um and my uh DS nutrition teacher was very very very big on this he said that um there's a lot of things that can interfere with your appetite or that can hijack your appetite um but if you're quiet and you can listen then your body gives you a very very strong message about what it wants um he was against going to the supermarket with a shopping list that was too specific you know he he said that we want to engage our appetite with all of our senses so you actually want to walk through the produce section and see what inspires you there not like okay I'm Gonna Get You know two pounds of potatoes and a head of garlic and I'm gonna do this thing but rather you know walking through the the produce section and be like oh what what gets you a little bit excited you know what what what what gets your imagination going and he was a chef so obviously his repertoire with this kind of stuff was a lot um deeper than many of ours um you know I have a friend who has no inspiration when he goes to the supermarket he always gets the same three things and that's all he that's all he lives on and he hates cooking and actually he's one of these people that um uh he's actually existed a significant amount of time just drinking these like weird industrial protein products there's one called soilent which is ironic because it's based on this old science fiction movie where they grind up dead humans and make food out of them um but now it's unironically s sold as a product um and there's a whole subculture and I worked with many of them when I worked in Tech of these sort of engineer types who just think that food is just this thing that gets in the way you know you just kind of put things in your body to keep it going and they would describe it just as fuel or as calories and make sure that they have a certain nutrient profile um you know my my Dallas nutrition teacher was alarmed by this kind of stuff and he suggested that it was actually he described it very graphically as a as a loss of our Humanity like if you engage with food like that you're actually losing your Humanity because one things humans really like to do is eat right and we like to eat lots of things and we also like to eat together this is a big thing this is pretty Universal that eating together is one of the ways that we Bond it's one of the ways that we celebrate um and in most cultures part of any kind of funeral um and grieving process is eating together and by eating together you are demonstrating that you are moving on right and that maybe one person in your group died but the rest of you are still engaging with life and you're still moving forward right so uh I want I just want to point that that appetite is um on the one hand it's just a question you can ask somebody do you have good appetite but it kind of It kind of plugs into this larger sense of Engagement of the shun with the word world how much inspiration is there right and so maybe we have appetite for food maybe we have appetite for other things we have appetite for ACT certain activities or certain locations or certain people um we might have appetite for sex we might have appetite for the outdoors you know there's different kinds of appetite um when we talk about stomach which in Chinese is way in a couple different context we want to know if something has stomach right if something has stomach and appetite is part of this you know if we have if we have stomach if if if we have a stomach for life we actually want to push forward and engage we want to engage if we have stomach if we don't have stomach we might be a little bit withdrawn and maybe our hun is a little bit disconnected right so from sort of a bigger picture we want to um keep appetite and focus and and kind of have an idea that if we can reduce the noise then our body tells us very clearly what it wants um if there's a lot of noise and that can be our own internal stress it can also be things like advertisements right that can kind of hijack our appetites like I'm sure you know this is why Billboards exist you know you're driving down the freeway and you know maybe you're not really thinking about anything and then you see a billboard for something and all of a sudden you're thinking about a particular branded food right um and the same Dallas Dallas nutrition instructor Leo Ming said you know if if you're appetite has a brand name it's probably been hijacked you know like if you're craving a particular brand name that appetite it's probably not the cleanest information from your system because ideally what the liver is doing is it's analyzing the blood analyzing is too strong a word it's getting Impressions from the blood and then those Impressions from the blood um it sees what's the yinyang mix to make that blood maximally balanced and it passes that on that inspiration ation onto the spleen so if the blood you're eating doesn't have enough vegetables it'll hit the liver and the liver will say h don't you want some vegetables vegetables sound good and it'll make you dream of vegetables and you pass that dream onto the spleen and then the spleen makes a plan the plan says okay I just I just have this inspiration for vegetables and where I'm gonna get them okay I'm gonna go here and I'm gonna get these vegetables you know so um internally appetite is a little bit complex but we can say that if there isn't strong appetite there's probably some sort of dysfunction going on in the body um so an openness to seeing what's appealing um an appetite that lacks compulsion and has a curiosity and the last part we'll say is that um an appetite a healthy appetite also and this is important so healthy appetite also ceases with sufficiency right so when you have enough you're full and you're done you know so this is a very DST thing cease with sufficiency stop you know recognize when enough is enough um and there's certainly you know there's a lot of foods out there that are engineered to try to make sure that you don't cease with sufficiency um because the flavor are not things that we've adapted to um so obviously this appetite is strongly related to the stomach or we could say broadly the middle Jou because maybe we can't separate stomach and spleen here um the stomach is sometimes described as a sea of water and Grain and please I understand grain gets a very very bad wrap these days but um grain is a short hand for food right for food um so any pathology of the stomach or the spleen can actually reduce your appetite um generally uh when we talk about these we can talk about excess and deficiency which we do all day long um but generally if there is some sort of excess we're going to be looking at some sort of dampness with cold or with heat um that then obstructs the the Yang activation of the middle gel if there is an excess we have dampness you know probably some sort of dampness with heat dampness with cold obstructing the activity or we could also have a stagnation of fleem of food and hopefully not but possibly of blood um blood states of the middle J is not something anybody wants if we look at more vacuity um we certainly know this some sort of damage to the um Jing or the yin of the spleen or stomach or the chi right um so uh or Chi or the um I say middle J because it could be stomach it could could be spleen and I think it's also interesting that right here um dong highlights that it could be a damage to the Jing so actually a damage of the essence and uh there is a pediatric diagnosis for newborns where when newborns are are don't want to eat uh it's called failure to thrive you know so this this want desire of newborns to actually eat if they if they if they're Jin isn't strong enough to actually want to eat they may die they may fail to thrive although these days we usually do intravenous things and feeding tubes and things like that but back in the day that wasn't a possibility so this is intimately intimately intimately um involved with the deepest Core Essence of us in fact you know I remember when I was doing Biology one of my biology teachers said that um when we think about animals basically from the simplest animal to the most complex animal we are a m to eat a way to point that mouth at food and then a way to poop out what you don't need and you know that's true of worms it's true of amibas and it's true of humans too so we could think of all this complex stuff with arms legs and fingers and eyes and ears and all this kind of stuff is just a way to move a mouth around and eat what's out there so maybe a little bit reductionist but suffices to say that if we don't have that Primal relationship of wanting to put things in and the Jing wants to you know if we talk about Jing it's a tendency to become substantial what do we need to do to become substantial we need to put substance in us right so this is very very very very Primal if that Jing is damaged we may have you know failure to thrive and interestingly there's two times typically that um inpatient hospitals will um kind of diagnose failure to thrive one is with um neonates with newborns and the other one is with people that are terminal patients and we know that once somebody's very very old or very very sick when they decide to stop eating is really that that's that's often the mark of when when this when this when this game of Yin and Yang that we call life is is coming to a close so the very beginning and the Very ending is uh sort of when this is most likely to be diagnosed right when the Jing is either trying to First establish itself or the Jing is running out right um so looking at the various patterns we've talked about all these before so one of them is cold damp encumbering the spleen which is a tie-in pattern if we're talking about six confirmations um nausea maybe vomiting loose toools reduced appetite which we've talked about um abdominal distension that's The Damp right um heaviness General heaviness of Limbs and maybe the head too fatigue um The Damp can give us a bland taste in the mouth so this is important um reduced appetite reduced appetite can be spiny deficiency we've talked about but then with that bland taste that's really talking more of dampness right um we expect there to be lack of thirst because we don't have any heat here so just a lack of thirst um and maybe we could have things like bber rigmas too rumbly cuts um the tongue fur for cold damp and cing the SP spleen is probably going to be white probably sticky or slimy um so we've seen we've seen this a few times before um we've also talked about how this is often categorized as an excess pattern but we know that there's there's either a deficiency underlying or deficiency right around the corner because this cold damp is going to beat up the spleen young very soon it's not it doesn't take long so probably clinically we experience this mostly cold damp encumbering the spleen with spleen T deficiency um and maybe we have to do tongue imp pulse to really get an idea of how much deficiency is there we could also have spleen Andor stomach damp heat and we've certainly talked about this before before so we'll just review this could be sloppy stools there could be thirst without desire to drink some signs of heat this could be lowgrade fever sticky fever UNS surface tee we talked about that before where you touch somebody and it doesn't feel hot at first and if it feels hot after a little bit um spleen and stomach damp he especially some sort of jaising of the skin of the eyes um General yellowing maybe not the bright yellow that we think of for like um a hepatitis jaundice but a gentle yellowing maybe some puffiness edema additionally spleen and stomach damp heat damp heat in general but particularly the stomach and spleen May percolate underneath the surface and give people itchy skin which is also described as a manifestation of toxic retention of water or water toxins in in Japanese medicine um tongue is no surprises yellow slimy firm maybe red body pulse slippery and wrap it pretty straightforward we only have a few other excess patterns to cover here so let's zip through those um probably the most common one and the one that all of us have experienced at some point from perhaps overeating or eating too late is food stagnation or sometimes called food retention um really the model we want to see here for food retention is there's something in that belly that's now fermenting and so we can expect some sort of abdominal distension feelings of fullness but there's something sour about it there's often burps that taste bad or smell bad or a feeling of sourness in the stomach um we probably see a lot of food stagnation marked also by esophageal reflux right so sometimes people have heartburn with food stagnation um there may be vomiting uh distending pain but there's a sourness sour taste a putrid taste um and distension of the belly bloating and this is typically marked by some sort of irregular diet either excess eating or drinking or eating at intemperate times um and just an anecdotally we'll mention that um this is very common with uh with young humans um both babies and children to have some degree of food stagnation because their spleen young is not very strong right so a lot of the Pediatric formulas that we see for all sorts of diseases will have all the normal things that you see plus a couple food stagnation herbs just to help the digestion because that's such a part of the pathology that we see in children if we have blood stasis blood stasis is usually a more Advanced pathology in general um we expect this to be some sort of reduced appetite because that's the category we're talking about with pain so blood stasis is usually fixed in location um there's two places we might see blood bleeding in this so it could be spitting of blood and it would be dark or perhaps tar stools in terms of biom medicine we could be looking at ulcers here right we could also be looking at tumors here uh so I was talking and I said the word tumors and then I got disconnected so this could be also it could also be something as serious as like stomach cancers and things like that if we do have blood stasis in the stomach dung mentions that one of the consequences of sometimes uh uh having uh an exterior invasion is reduced appetite and so I think all of us have experienced sometimes when we get sick we're not eager to eat um he also mentions a condition which sounds probably maybe worse than it is um I've used up on my whiteboard so I got to kill some of them hang on um so he calls it malign obstruction in pregnancy um so the technical term for this would be hyperemesis gravid gra darum anybody want to guess what this might be hyper imis what does an edic make you do and gra arm just means serious it means vomiting a lot so this is our morning sickness when my wife was pregnant she said I don't know why they call it morning sickness I feel sick all the time unless I'm actively swallowing is what she said so she just had to kind of eat constantly um it can be very bad for some folks uh this is some combination if we look at Chinese medicine it's almost some combination of some sort of Flem stag um maybe there's some stomach cold there maybe it's stomach heat maybe it's spiny deficiency that's not how you spell heat um it may involve liver heat sometimes it has headaches and other heat signs honestly with your patients that are experiencing morning sickness you just got to kind of ask a little bit and figure out what are their predominant signs and symptoms and you know how do I actually treat that with Chinese medicine and acupuncture um some people respond like magic to Chinese medicine like you do pericardium 6 stomach 36 and their morning sickness is really under control and I've had other patients that we have tried literally everything under the book and these these poor pregnant people were vomiting for months and months straight so um actually one of my partners at octagon Community Acupuncture uh that says liver heat sorry um one of my business partners at octagon Community Acupuncture Michelle Hirsch who used to be faculty here also especially for her first pregnancy she just she said the only thing that kept her from vomiting every day was eating a whole chicken she said if she ate a whole chicken every day she wouldn't spend the day vomiting so uh it can be pretty intense um um there's two other excesses that um that dung mentions and one of them is is worm accumulation and you know we're so lucky to live in a place where um worms are actually not a huge part of daily life but traditional traditionally in many many parts of the world to this day um having a certain number of worms in your body at any point it was kind of part for the chor and it was only when they got to be too much that um that it became a real real problem but um you know worm accumulation is assuming that there's a lot of worms and then we can expect some sort of yellowing of the complexion emaciation as the worms start to get the nutrition that you're supposed to be absorbing and obviously if you have any kind of worms in your vomit or your stool this can be accompanied by severe epigastric pain or severe we'll say abdominal pain and worms in vomit or St um so yeah depending on where you're where you're practicing you may see more or less of this um there's pretty effective Pharmaceuticals for getting rid of worms right now there are some pretty effective Chinese herbs for getting rid of worms as well but they're all pretty toxic right um because you're trying to kill these things on the inside of your body um there's another accumulation that dung mentions called gun accumulation and this is this is basically he's describing Gan accumulation malnutrition [Music] accumulation um malnutrition or maybe non-wm related parasites and the textbook picture of a gan accumulation would be um perhaps folks that are have very very little access to to to food and poor sanitary conditions you know the picture is always a child with a big bloated distended abdomen that's also has nutrition malnutrition and often you can see the veins on the abdomen and things like this so if we hold that image um in our heads about what G accumulation means uh I think we have a pretty clear picture um and you know I I hope that we don't have to treat very much of this in our career as um providers all right so last time we started um getting into reduced appetite and we said that you could call this torpid intake we talked about some excess reasons that you might have your appetite reduced which generally were some sort of dampness heat stagnation of food or blood you know in the middle Jou typically but we could also see this you know you could have torbit intake because of liever and gallblader damp heat middle Jou damp heat um cold damp encumbering the spleen food stasis blood stasis we talked about um this is also common in pregnancy and that the Chinese have a unique traditional description of uh what we call morning SI sickness often called malign obstruction in pregnancy right um which is sort of an equivalent to morning sickness and then we touched upon uh parasitic things like worms or um consequences of malnutrition right which we called gone accumulation and worm accumulation um worm accumulation obviously being things that you can see more easily and gone accumulation maybe being parasites that don't show up in the vomit or the stools but you know that they exist and this is your classic sort of malnutrition profile um today we'll talk about vacuity reasons and we'll get through this really quick so um we know that the middle Jia is really really important for actually giving us an active appetite um and one of the these patterns we call stomach cold congealing and damaging oh I just lost my page hang on sometimes Siri thinks I really want to talk to her forgive me okay so this is um it's actually a mixed excess and deficiency pattern but we're focusing on the um the deficiency here um the image here is typically of somebody who has uh overindulged in cold or uncooked foods and the efforts that it takes to actually digest those food Foods over time has reduced the Yang function of the spleen here um so this will be you know this will be a painful stomach it's worse with cold either worse with cold food um or environment so it could also be season seasonal because there is an excess of cold on top of a deficiency of young um we actually expect the excess of cold to give us a bland taste in the mouth and when we look in this patient's mouth we expect the tongue to be pale because of the cold and also because of the Y deficiency and with white fur and the white fur just gives you a nice temperature reading we know it's not yellow so it's not heat when we feel this patient's pulse it will be slow due to both the cold and due to the reduced Yong of the middle gel there's an additional possibility which would be um the stomach actually in a state of counterflow which is when we would have vomiting after eating and this vomit we expect to be more clear fluid vomit as opposed to sort of foul chunky vomit so um culturally a common pattern maybe not in the in the um super intense vomiting clear fluid after eating but the sort of cold stomachs are something we see a lot you know when you sit down at a restaurant they give you ice water regardless of the Season just to make sure that your stomach is nice and cold before you try to actually activate it and interestingly there's there's you know if you're into things uh where we look for biomedical um explanations or observations um we do know that if you put cold into the stomach it contracts all the blood vessels that supply the stomach with blood and energy so it reduces stomach motility right and there's also a group of enzymes in the stomach that operate at room at body temperature and when we put cold into the stomach it actually reduces the um the quality of those enzymes and so the the food that gets passed from stomach into the small intestine is less digested than it would be otherwise which can then lead to other things that the functional medicine people talk a lot about like different kinds of disbiosis of the small intestine where you have the wrong Critters we want Critters in our entire digestive tract Critters are why we can absorb food right but you get the wrong Critters if the wrong materials are being passed on to the small intestine so um we do have biomedical explanations of how this cold can be bad for you um so import important here is that this has a lot of excess appearance but we've called out that there's stomach cold congealing and damaging the yangong and I put in parenthetically this is the Yang of the spleen which is the function right the function of the org um also not uncommon is stomach Yin deficiency so typically here we do have hunger but we call it torpet intake because there's no desire to for food so what do we actually mean by that H hunger with with no desire for food is sort of a gnawing hunger that the idea of actually eating and swallowing is not appealing because the yin of the stomach has been compromised right the stomach is not receiving as well as it should and that's part of the yin is to receive Food we expect that the stomach because the yin is reduced the Yang is an excess and may be going up right and if it is going up we can expect counterflow Chi every organ has a predominant Direction the stomach Chi is supposed to go down if it's counter flowing it's going up and so we may have um clear fluid vomit here as where as well and then we expect um signs of dryness and Yin deficiency signs so this Canna be dryness can be the tongue it can certainly be the mouth stools and we might have reduced urine because it is y deficiency right additionally we could have any kind of other sorts of um y deficiency signs or symptoms um what about when you feel hungry but nothing sounds good to you I don't know let's brainstorm that are you wellfed or not is this this a compulsive hunger like you know you've actually eaten a meal but you want to keep eating because that would be stomach heat maybe right but if you really feel hungry and nothing sounds good to you this is usually exhaustion of the Hun right so your inspiration is compromised right so the the message that the liver is trying to give to the spleen about how to inform the appetite is somehow disrupted right um and often this is be you know this is often because people have a lot lot on their mind you know so I would say it's probably some sort of we might call it wood Earth disharmony where wood is the liver and the Hun using the imagination um to sort of inform the appetite and make a plan to gratify it right so there's some sort of disharmony between the way that the the liver and the spleen are talking right which we would talk as wood Earth disharmony we talked about stomach cold which is um this excess with an underlying deficiency we talked about stomach stomach Yin deficiency which is H hunger with no desire for for food stomach Yin deficiency is common if we eat a lot of dry spicy foods right this damages the yin of the stomach if we eat foods that don't have much fluid in them over time they will damage the yin of the stomach right um a further torpid intake pattern we've talked about which is probably the textbook torpet intake pattern is spleen shei deficiency there's not a lot to say about that except that if your middle Jou energy is decreased because you think too much because you do too much all these other things then you know you may have reded Ed appetite um if this goes on for a while then we may end up with spleen Yang deficiency and we're now what week 12 somebody G me a pissy way to differentiate between sple spleen Chi deficiency and spleen Yang deficiency that's exactly what I want um exactly what I want to hear splen Chi deficiency with deficiency cold signs um and what is this we talked about this even earlier today what is the likely consequence of having spleen Yang deficiency for any length of time so if the spleen young Young's job is to heat and transform what we put into it if that's reduced we end up with a byproduct of dampness right I'll just put that parenthetically often often accompanied um and then the last um one is liver spleen disharmony which we literally just spoke about worth say worth mentioning this is also known as wood Earth disharmony um and this is in our patient base it's most commonly stress people have reduced appetite because they're stressed right so the the liver gets stuck and it doesn't give the inspiration to the spleen to go out and eat right so yeah you know and this is a great great opportunity for us to practice our plain language Communications if we do think that this is something our patients are suffering from it doesn't do them very much service if we just say oh you have wood Earth disharmony or liver spleen disharmony you know what we want to say is that you have you know your digestion is impacted by stress and then they understand it you know and typically maybe you all can can help me understand this from a zangu um perspective people's appetites react in typically two ways from stress one is I want to eat everything and one is I don't want to eat anything right what do we do with that information oh yeah you know I've been really stressed interest recently how does that affect your appetite oh I I just don't want to eat or versus I've been really stressed recently oh what does that do to your appetite I just want to eat everything I'm like just comfort food all the time what what what do you think what what can we do with that information what's going on on the inside so we just talked about how it can reduce appetite by sort of depriving the spleen of ambition or maybe beating up on the spleen and reducing its energy you know but why would we get increased appetite that I hadn't thought about that but that that that that may be true and then we would go ahead and ask like okay you know how do you feel after eat what are your stools like what's your energy like things like that yeah yeah so that that's a possible answer it could be the spleen is deficient and it's looking for something easy right um it could also be that the liver is a little bit hot right and the liver is handing some of that heat to the stomach right and so if we're hot and irritable and then we are also having these Cravings everything's a little bit on the compulsive pushy end of the spectrum right and so some of this liver heat may have been passed off to the stomach as a sort of Rapid appetite or it could be that um you know we might have a little bit of a spinge deficiency classics will say that um the classics will will separate out the spleen role in in sort of um you know over cogitation what's the word I'm looking for there's another word that they say over rumination um pensiveness that's the word pensiveness and I think that honestly we're we're standing at sort of the the limits of the ability of modern TCM to tease apart different systems and assign them you know completely freestanding roles because all of these things are are are related to each other right um the the Chinese view would be that the spleen aspect of that that activity is being stuck in the deliberative process right that you're just thinking you're churning churning thoughts kind of stuff right whereas the liver is the liver reaction to that is sort of the the tension that builds around that right the tension that builds around that and that's why we get a wiry pulse is that actually the liver tightens up all the smooth muscle of the body so even down to the radial artery of the wrist we can feel that little bow string tension because the smooth muscle is activated by what we call the fight ORF flight response you know sympathetic activation you know um so it's possible to have this kind of cogitating mind that thinks too much without having that sort of um reaction amongst all the smooth muscle and tension in the body and things like that in that case that would just kind of be spleeny more spleeny right but if there's this um aspect of tension reactivity irritability imp patience then that's certainly pointing towards the liver at that point it's just like it's possible possible to be anxious and that anxiety is really just a heart-c centered thing but sometimes you're anxious and irritable or anxious and short-tempered and then it's like okay now this sort of vexation which we might describe as a heart blood deficiency or heart G deficiency has filled over so that the the liver is also involved because the liver is starting to get a little bit hot right and where you kind of you know where you where we can kind of get into trouble is the fact that like we say with any any intense emotion the liver is involved with any intense emotion the heart's involved so the edges bleed over a little bit right so may maybe maybe just say leaving the word as stress isn't enough and we need to get into the physiology of what's actually happening oh I'm really stressed well what does that mean for you I'm just thinking all the time are you irritable no you know okay maybe this is more spleeny are you anxious yeah I'm anxious and I can't sleep oh maybe this is more heart you know so maybe we need to get get down underneath what stress is and will say you know one of the lovely lovely things about the medicine we do um is that uh it's very good for treating stress you know because stress is all almost always something in the future or something in the past you know like it's either thinking about what you need to do or thinking about what you should have done feeling like you don't have enough resources to get done what you need to get done but it means that you're quintessentially not in the moment if you're in an ACC Clinic I would say um and if we lie them on the table and hit them with a bunch of needles they come into the present moment really quickly you know it puts them into the present moment and you know this is mindfulness you know we talk about mindfulness all the time now as you know one of the number one mindfulness-based stress reduction is a whole gigantic product now and the reason is because we we need to put down the over cogitation and reenter the present moment and um tell you a pointy object going into your body puts you in the present moment it really does right so you don't even need to be that specific about the points which is also really nice did you ever read that book by um spolski I think it's a why zebras don't get ulcers anybody familiar with this one he's um really really compelling um and he he goes into into the physiology of stress and just talks about how animal reactions to stress are are very different than human reactions to stress you know um there's another um a lot of stuff around PTSD around this too um LaVine wrote a book a series of books about trauma and talks about how animals natural response to a traumatic vent is to shake their bodies out you know they'll shake their bodies out we see our animals even even my dog she shakes her body out all the time you know and humans don't do that as much although kids do and and you know the the idea is that you can actually um DET traumatize your nervous system by doing certain physical things right um but yeah both of those I think the why uh spolski I think is the name of the why zebras don't get ulcer guy and uh and then LaVine is the PTSD guy his very interesting the LaVine studies because he I think he's Mo you know I think he's a Californian so he's moderately informed about East Asian medicine as most new age Californians are but um he ends up uh having a very sort of chi stagnation understanding of PTSD even though he's not a Chinese medicine practitioner so super interesting