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The Fusion of Western and Eastern Herbal Medicine with Paul Keogh

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The Fusion of Western and Eastern Herbal Medicine with Paul Keogh

Is there a way to reconcile the opposing viewpoints of Eastern and Western Herbal Medicine? 

This is a question naturopath and herbalist Paul Keogh has been facilitating conversations about through his entire career, attempting to find the synergy and commonalities between what initially appear to be two very different modalities.

In this episode, Paul and Andrew explore these differences, examining both approaches from different perspectives. They also discuss adaptogens vs. chi tonics in relation to immunity and Paul explains menopause through the lens of a TCM practitioner.

Covered in this episode

[01:05] Welcoming Paul Keogh
[02:02] Paul discusses his background and what drew him to herbal medicine
[10:48] Discussing adaptogens
[13:30] Adaptogens vs chi tonics
[20:12] The energetic values of herbal medicine
[23:11] Choosing your adaptogen wisely
[26:53] Giving chi tonics during acute infections
[29:35] Differentiating between chi deficiency and acute infection
[34:16] Western vs TCM diagnostics
[37:23] Menopause through a TCM perspective
[50:43] Discussing blood stasis


Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook. And joining me in the studio himself today is Paul Keogh. During 12 years of full-time naturopathic practice commencing in 1987, Paul, Paul developed a unique clinical approach synergising the pharmacological and energetic effects of Western and Chinese herbal medicines. In 1999, he co-founded Global Therapeutics to commercialise clinical insights and fund ongoing research and development. This work culminated in the launch of a small range of integrated Western and Chinese herbal medicines under two brands, Fusion Health and Oriental Botanicals in 2001. Paul has extensive knowledge of herbal medicines on both a technical and practical level ranging from sourcing, extraction, and including clinical applications. Welcome to FX Medicine, Paul. 

Paul: Thank you, Andrew. 

Andrew: Now, Paul, we're gonna be talking about something that, A, is dear to my heart and that's herbal medicine and, B, confuses the hell out of me and that's Chinese herbal medicine. So...

Paul: I'll see if I can help demystify that.

Andrew: Well, indeed. I need to let our listeners know that you are the one who saved my mind. You saved my ethics of herbal medicine, if you like, because I was going down the "standardised is the way to go" herbal medicine. And I do find that that is clinically relevant to a point…

Paul: Yeah.

Andrew: …but I don't find that they are "actives". They may be more important as markers, but you were the one who saved me from going down that very pharmacological road. And I think it was Denis Stewart who might have said the words just because... What is it? "A good red wine is not defined by how much resveratrol there is in it."

Paul: Yeah, that would have been Denis, sure.

Andrew: It's Denis, I'm sure.

Paul: He had to relate to wine or beer.

Andrew: And indeed, you've got a very close relationship with Denis Stewart, haven't you?

Paul: I do. Yeah, really close. Not that we catch up as often as I'd like, but I did see him a few months ago and had a good chat.

Andrew: Well, let's go back down that road because you have, as I said, extensive knowledge. So, what was it that first drew you to do naturopathy, herbal medicine first?

Paul: Well, that does go back a long way. I'll make that really short. But it was quite a perchance experience when I was in my early 20s having traveled around a bit and trying to find myself and got into healthy living…

Andrew: Yep.

Paul: …and knew that there was definitely something in it but didn't understand it well. Back in the early '80s, late '70s, early '80s, there was a bit of a doomsdayist...we weren't up to 1984 yet, you see? So there was a bit of mentality that...

Andrew: Oh, the book.

Paul: ...yeah, that the world could end, you know? That things could become dire. 

Andrew: I remember it.

Paul: And I remember thinking, "If things do come dire, the one thing that will be of value is an understanding of health and wellness. A lot of people will probably want some simple solutions." And so I looked around for some herbal medicine courses because that's what interested me most. 

Andrew: Why? 

Paul: Well, I think because nutritional therapies, food-based therapies were, and vitamins, sort of all had relevance but they were represented pretty well back in that day. Well, not well, but they were represented back in that day by nutritionists and naturopaths. I didn't know what a naturopath was. So, nutritionists sort of had the field in that respect, and it was a perchance encounter with "The Times Magazine" that was running interviews, Simon Shot and Denis Stewart, and a number of other leading lights in the day were interviewed in this Times Magazine, Australian version, I think?

Andrew: Wow. 

Paul: And I just rang them all up, you know? Dorothy Hall as well…

Andrew: Yeah.

Paul: …and I had to ring them all up to have a chat. And they all took my call…

Andrew: Wowee.

Paul: …and I got to talk to them individually and just go, "Well, what are you doing? Like, what is this about?" And then the person I settled on to study with was Denis Stewart, so I headed from Brisbane down to the Central Coast and lived in a caravan and started studying with him, you know? Which was certain evenings, he'd run courses, and then the weekends, he'd do workshops and then he'd have these assignments to do and...

Andrew: It's worthwhile explaining a little bit about the mentality of that middle to late '80s. I mean, this really was the end of the Cold War. In fact, it wasn't at the end.

Paul: No.

Andrew: And there really was this...it was like a background subconscious worry…

Paul: Yeah.

Andrew: …about somebody really did have their finger on the button.

Paul: Yeah.

Andrew: Indeed, who was it? Peter Gabriel…

Paul: Yeah.

Andrew: …did a tongue-in-cheek song about a maniac president having their finger on the atomic football, wasn't it? 

Paul: Yeah. Yeah.

Andrew: And waking, you know, the...and we wonder where we are now. But anyway...

Paul: No, there was a lot of anxiety back then, but there was a real belief in the value of nature and the contribution that nature could make to the health system. And although it may have been fringe back then, my strongest desire was to make it mainstream…

Andrew: Right.

Paul: …was to contribute to developing a mainstream approach to what was called alternative medicine back then, and it's probably known as integrative and complementary medicine now. 

Andrew: So, what interested you specifically in traditional Chinese medicine as opposed to Western herbal medicine? 

Paul: Well, I studied Western herbal medicine, so I got a diploma of botanical medicine from Denis Stewart…

Andrew: Yeah.

Paul: …from Southern Cross Herbal School. And the principles that I studied under Denis were physio-medical principles, Western herbal medicine principles, but there were energetic values to them and he was a master and still is a master.

Andrew: He is a master, yeah.

Paul: In terms of the training that he gave, it was masterful training in regards to an understanding of the chemistry and the pharmacology from a strong Western perspective, but he always talked about the Thomsonian elements and the energetic elements, and we'd have workshops on Ayurvedic medicine and some introductory stuff on Chinese medicine, so, during my training, I was interested in that. But I started my practice as a Western herbal therapist. 

And it was only when some of the Western approaches that I was taking seemed deficient or seemed insufficient, I won't say deficient, just insufficient. I remember back in the day working on immune therapy and having, you know, some good, acute immune remedies, and they worked excellently for acute phase but I had nothing in the restorative class. And I didn't even know what that meant. Like, restorative therapy for an immune system? Like, what? 

Andrew: What?

Paul: Are we talking one of these deficiency disorders or chronic fatigue? And I did start to see some chronic fatigue patients. And then in the early days when candida was big and, you know, people had symptoms of depletion…

Andrew: Yep.

Paul: …as a result of digestive dysfunction, and immunocompromise, and probably some lifestyle factors there too and went... Because I was practicing at that point up in the Northern Rivers, I saw people who were coming in from Nimbin and the outlying suburbs of Lismore, and I had a small practice in Kyogle...in Casino, I mean, and also was centering myself in the Alstonville area. So, I had quite a range of people. And there were people presenting with deficiency symptoms, like, resistance problems that weren't just a matter of me stimulating the immune system, and in fact, some cases didn't respond to immune stimulation at all. You know, your echinacea and your andrographis and these sort of more acute, active remedies that people weren't responding, and I'm going, "Why? Why is that? What's happening?" And then when you look deeper into it...and these just weren't the alternative-minded people. Alstonville, I don't know if you know, but it's like the Baptist heartland of the Northern Rivers.

Andrew: Yeah, very conservative.

Paul: Very conservative. And the local medicos were quite conservative, but, you know, I happened to meet some that were quite open-minded too. 

Andrew: So, this is a very interesting point that you make because I remember being a nurse, so many of these terms that are used in naturopathy were alien to me. Indeed, the sort of way that you treat was very alien to me because I was used to the drug-disease framework, that model of how to combat, how to... We used even preventative health. It wasn't preventative at all. It was early intervention once you had a diagnosis. There's nothing preventative about it.

But I remember these terms and these frameworks were very alien to me, and so I really have this appreciation for somebody who might be listening to this podcast and going, "What the hell are you talking about?" And yet it makes sense, indeed, it made sense to the Chinese culture for millennia. 

So, I guess to start off, where we're going go with herbal medicines? And you've just mentioned them, the adaptogens. Indeed, this was when it was a very important...

Paul: Well, that's an interesting point.

Andrew: ...stepping point, one with Denis Stewart because he had this...

Paul: Formula.

Andrew: ...formula from experience that just it was magic, still is today.

Paul: Yeah. And it was to address immune depletion, not immune deficiency, but immune depletion, and immune compromise. But when you looked into the formula, you saw that many of them were tonics and adaptogens specifically. And so that was the beginning of my journey with Chinese herbal medicine. So, this formulation that was based around astragalus, it was an eight Chinese herb formula. And Denis had originally got it from a book written by Dr. Subhuti Dharmananda who's in Portland, Oregon, and a really interesting guy. I wouldn't mind doing an interview with him. I met him for the first time in my life last year. 

Andrew: Wow. 

Paul: Yeah. And he was pretty interested in hearing the story of what had happened to this medicine that he'd originally formulated, and that Denis had found in a book and then extracted in a Western context like it wasn't being extracted as a liquid. And Denis was the one that pioneered that...

Andrew: Oh, okay. It would have been a decoction.

Paul: It was just a decoction, dried herbs put together. And Dr. Dharmananda was very surprised at what had happened to it in Australia. Not because it didn't deserve to be developed but because he hadn't envisaged that. He hadn't seen that future…

Andrew: Wowee.

Paul: …for a formula like that. In fact, from his perspective as a clinician, he took that core spectrum of adaptogens and chi tonics, let's say, which we can elaborate on, and developed specifics like a whole range of specifics for different nuanced aspects of immune weakness and immune compromise, which is a natural thing to do in a clinical context. But Denis went ahead and created this formula which was so…had such breadth of action. It could be applied in many different diverse contexts. 

Andrew: Many, many.

Paul: Many.

Andrew: And indeed it was and still is one of these...it is a hallmark formula. 

Paul: Yeah.

Andrew: Particularly in the Northern Rivers there's this real devotion to it. Indeed around Australia. But there's this real devotion around the Northern Rivers where you introduced it and, Denis, he has as well. I would dare say down Gosford way as well.

Paul: Oh, it's massive. Yeah, and Newcastle where he still practices it.

Andrew: One of my, I'm going, call it misunderstandings…

Paul: Yeah.

Andrew: Let's also maybe call it a bug-bear, and that is...

Paul: Do you want to get an axe and grind that a little?

Andrew: Well, I just think we don't have... As somebody who has been taught some herbal medicine but as somebody...

Paul: Oh, that's right. I remember that story now.

Andrew: But as somebody who's been taught some herbal medicine, I've had this issue with the immune aspects of the adaptogens and when they should...

Paul: And that gets back to when we first met.

Andrew: Yes. That's indeed right. 

Paul: Yeah.

Andrew: And when they should and shouldn't be used. And I do find there's a real arrogance out there. There's this sort of Western way of interpreting the herbal aspects, sorry, the properties of an herb and, for instance, astragalus or astragalus…

Paul: Yeah.

Andrew: …that you shouldn't use it in an acute situation or else it will set the infection. It was the quote that I've been taught…

Paul: Right, right.

Andrew: …and I questioned it because, when I looked further into it, it was actually unless there is deficient chi. 

Paul: Exactly.

Andrew: Now I've got two issues. One is, who in the 21st century doesn't have deficient chi?

Paul: Well, who in the 21st century knows what that is?

Andrew: But who isn't stressed, who isn't overworked, overburdened? And so is this really an acute thing or are we just overstressed, overworked, overburdened and our immune systems just fall at the first opportunity, in which case a tonic would actually be implicated?

Paul: Yeah. Well, actually.

Andrew: So, when do you tease apart the use and indeed the avoidance of something like astragalus or astragalus?

Paul: I'd probably put that in really practical terms, and I think that should help ease some of your... Well, not anxiety but issues.

Andrew: No, I'll still have anxiety.

Paul: Yeah. Okay. You must have nightmares too, this astragalus monster.

Because the notion of... And maybe we should just wind back a little bit. We talked about adaptogens. We have mentioned chi tonics. Is a chi tonic an adaptogen? And are all chi tonics adaptogens?

Andrew: Ah.

Paul: Is chi tonic a subclass of adaptogen or adaptogen subclass of a chi tonic?

Andrew: Don't ask me that question, mate. I am not the first... Oh really...

Paul: Yeah. So, if we look at it... Let's just look at first principles. 

Andrew: Yeah, yeah. Yeah. 

Paul: So, we know an adaptogen is something that helps the physiology of the body cope better with stress. We know that... 

Andrew: Any stressor...

Paul: Any stressor, really. Yeah, exactly and there's a whole cascade. The hypothalamic-pituitary axis is activated, and there's a whole cascade.

Now, when you overlay... Oh and a chi tonic is something that supports the healthy propagation of chi, and chi is vital energy. 

Andrew: Right.

Paul: And it's not ATP, it's not cellular energy. It's the essence of what is borne of the kinetic relationship between the opposing or dualistic forces in nature, yeah? Really simple.

Andrew: And simple but very alien to a medicalised sort of approach.

Paul: Yeah. But from a medical perspective where we're dealing with the push and the pull of physiology all the time. I mean you've just got to look at the autonomic nervous system…

Andrew: Oh, yeah.

Paul: …and understand like in terms of stress exactly how much we're in this tidal flux from day to day to day. And we're constantly correcting and rebalancing. And more and more these days, we're told to get into practices that help to calm the mind and mindfulness practices that help reduce that flux...

Andrew: The sympathetic…yeah.

Paul: ...the peaks and the troughs of our nervous system response or our physiological responses to things because extremes are exhausting.

Andrew: Yeah.

Paul: Extremes are exhausting. And in fact, low lows are as bad as high highs in that sense. So, adaptogens help even it out, right? So, an adaptogen will help your body respond to a stressor more efficiently and effectively and recover as it were or normalise its physiological responses and hormonal responses more quickly. 

Now, a chi tonic, if it's born or manifest out of the kinetic relationship of opposing forces in nature, and the opposing forces we can call yin and yang, let's say…

Andrew: Yep.

Paul: …and the chi is basically the manifestation of those oppositions, then we're also looking at a fundamental, I guess, source of resistance to the world, you know? Chi fundamentally provides the essential resistance to the impost of our life. And it could be down to the importance of digestion…

Andrew: Yeah.

Paul: …you know? Where stomach chi is essential for helping break down our food. Liver chi is essential for helping us process and metabolise. Kidney chi is essential for...this is an interesting one which we might get to talk about later, but kidney chi is critical, is really, really important for its ability to vaporise or mist the pure water or pure essence of our waste to return good fluids back into the body, separating it from the bad fluids that we'll then eliminate. 

Andrew: Hence the kidneys are not a filter but a siphon. 

Paul: Yeah. And there's an intelligence there. So, I think the whole point about what is a chi tonic, what is an adaptogen, well, I can probably save you some angst around that because an adaptogen is really a class, I guess, is a type of chi tonic, but not all chi tonics are adaptogens. 

Andrew: Yes. Yeah. Yeah. So, can I ask then, and this is getting off-track a little bit, just sparked in my mind, chi gung. What does that mean?

Paul: I haven't been a practitioner of chi gung. I'm a yoga practitioner. 

Andrew: Right.

Paul: If I told...

Andrew: But there's got to be energy, so, I don't know what... 

Paul: So, chi gung fundamentally is the movement of chi through the body resulting from specific postures that activate meridian centres and points to sort of move energy in a fluid fashion. Now, that energetic flow is the key to good health. In fact, keep chi flowing, you will stay healthy. 

There's a traditional Chinese medicine principle that says, "Where chi goes, blood follows." Logical. And that's got all sorts of ramifications in regards to, you know, this stagnant, sort of sedentary lifestyle that we have now.

So, I guess my point about the energetic values of herbal medicine, which is really and fundamentally what we're talking about, why incorporate them? Why value them when we've got these Western terms that seem to answer or explain what it is that we're doing with herbal medicine?

Well, I think fundamentally the Western terms don't explain ethically what we're doing with our medicine and they don't have a holistic vision for how the body works as an integrated whole. And TCM was what gave me the first insights that you could actually influence various organ systems through an understanding of the flow of chi or the flow of a vital energy in the body. And chi gung is a way of moving vital energy in the body. 

Andrew: Right.

Paul: Yoga is a way of moving vital energy in the body, it just happens to be called prana in the Ayurvedic system. And to be honest, Western herbal adaptogens, if you break them down and look at what an adaptogen really does, you know, sort of on a functional level, you see things like it can inhibit the initiation and proliferation of pathogens, right? We know that. And you'll probably get to that question that keeps burning in your soul around, "Should we take astragalus and those sort of adaptogenic immune modulators during acute infection?" But also these notions of adaptogens support cellular immunity and they support certain lymphatic functions. They regulate endocrine glands and endocrine functions which are part of the resistance process. They provide protection of body cells through their antioxidant constituents. They have strengthening effects on digestion. 

Like, this is another reason why be careful when you choose to use adaptogens. Because if you’re, you know, in a phase of health or if you're needing to take flight or fight…

Andrew: Yeah.

Paul: …you don't want to be bothering yourself with digestion.

Andrew: Ah, you don’t want an adaptogen, ah, okay.

Paul: You just really want to get going. So, choose your adaptogen wisely in that sense because you don't want to be using adaptogens that have, say, a lot of splenic activity from a TCM perspective, or stomach and spleen activity because they’re the balancing or the regulating organ systems for digestion. You don't want to focus attention on that. 

Andrew: Yeah.

Paul: You want to take ginseng…

Andrew: Yeah, yeah.

Paul: …you know, which is a really…you know, it’s a pure, pure chi tonic.

Andrew: Is it Korean ginseng? 

Paul: Korean ginseng. Like, they don't classify it as an organ system tonic at all. It's just pure chi tonic.

Andrew: Oh, right. 

Paul: Pure and simple. 

Andrew: Right.

Paul: So, that's why a lot of people have, you know, concerns and issues around it.

Whereas astragalus is a spleen tonic and has, you know, effects on digestion. So, you know, looking at that, so you get strengthening of certain digestive and absorption processes. You know, tonics and the adaptogens help rectify this sort of homeostatic balance. And not that yin and yang are purely homeostatic regulators, all right? But they are part of that, and there's more to it. Yin and yang has much more to it than just homeostasis. But they are the opposing forces that regulate nature.

Andrew: And it's not as simple as male and female, it's more diverse than that. 

Paul: Yeah, it's so much more than that.

And then the last thing is to potentiate. Like, frequently, some of these adaptogens have potentiating effects, which probably leads us to that point you made or alluded to; can you take an adaptogen, an immune-modulating adaptogen with immune stimulus? And this is one of my early lessons when I was working with the Western herbal immune stimulants, and finding some patients were not doing well on them. It was like their body didn't respond at all. And I'm going, "Oh, the extract must be, you know low-grade or there's a problem there." Like, I thought immune systems were, you know, just like a horse, you just jump on it and...

Andrew: And it goes.

Paul: ...and it goes. Give it a bit of a spur and off it goes. But the thing is if your horse that you've jumped on is knackered, literally, you need to restore it. You need to tonify it and nourish it. And so I went back to the literature and looked at this and went, "What is the distinguishing feature?" And it really comes down to those symptoms that would represent or reflect chi deficiency…

Andrew: Right.

Paul: …and you'll see that with those patients that I was talking about before that didn't respond to immune stimulation…

Andrew: Yep, yeah.

Paul: …your medicines failed but had these symptoms of significant fatigue, and exhaustion, and digestive compromise, and low-grade recurrent infections,  but just always had sort of those classic fatigue symptoms. They may even have had a little bit of anaemia, they could have had some problems with blood, because chi leads blood, it could have manifest in different organ systems in disorders that don't seem directly related to chi deficiency, but if the blood is stagnating, in a chronic context, it could relate to a failure of the chi to lead the blood through the system. You got to keep chi moving, you got to keep blood moving.

Andrew: Now, I've got to say, so, two points here. One is when you said they weren't working for these patients they didn't necessarily "set the infection in", they just didn't work very well. They required a different approach.

Paul: Yeah, they just didn't work at all and that's what I mean. We don't have to be sort of overly, you know, evangelising around or sort of fundamentalist around what these chi tonics do, and there are strict, you know, contraindications during acute infections.

Because if you identify the symptoms of chi deficiency in your patient or, you know, in your client, then they need tonification, they need adaptogenicity, and they probably should be on those herbs that have... and this is the other thing around adaptogens and immune and, you know, adaptogens are different classes, you know?

Andrew: Yep.

Paul: And so are chi tonics.

Andrew: Yep.

Paul: So they need the immune-modulating adaptogens which will invariably have chi tonifying effects, and they probably should be on them all the time. When and if an acute infection manifests, you then just ease it back.

Andrew: Tweak the…yep.

Paul: Tweak the balance, ease it back, introduce the acute immune stimulants and then...

Andrew: You've just answered a massive question. So, astragalus is not necessarily "contraindicated" but you should be using the appropriate herb for the patient's needs, whether it be a tonifying herb or a chi tonic.

Paul: Yeah, exactly. And that's where Chinese medicine has excelled. And it's more about not that it's a contraindication as such, but the importance is that we look at need. 

Andrew: Yep.

Paul:  And if someone doesn't need a chi tonic, then by giving a chi tonic... This is the way I've conceptualised it. By giving a chi tonic during an acute infection to a patient who doesn't need a chi tonic because they're strong and they've got resistance, the only value that will have energetically is to the bug. Because chi tonics are indiscriminate in respect to their tonification. They will tonify the body or they will tonify the bug. 

Andrew: Right. And that's your only warning...

Paul: And this is where the perception of contraindication comes in. It's not a real contraindication, it's just be aware of what your patient's needs are. 

Andrew: Yep.

Paul: And if the patient has fundamental reserves that you can harness through immune-stimulant herbs, then harness those. That will be to the benefit of the patient and the detriment of the infectious infecting pathogen. 

Andrew: Yeah.

Paul: But if you go, "Oh, look, I've heard that tonics are really good and I just want to make sure that this patient's got enough on board to fight this infection," unless the signs are there, you’re just, you’re not helping them. 

Andrew: So, although this may actually be a very arrogantly framed question, can we, from a Western-type perspective, easily tell the difference between deficient chi and, you know, an adaptogenic need or even an “acute infection” from a Western standpoint? 

Paul: Yeah, I think so.

Andrew: Is there other ways that you do this?

Paul: Yeah, I think so. Like, the signs and symptoms of chi deficiency, I wrote this lovely...I think it's lovely and people who've got a copy of it think it's lovely too. Back in the day when I was trying to figure all this stuff out...

Andrew: Well, I need one. I need a copy.

Paul: ...this little booklet. It was published under the Oriental Botanicals banner, and it went into all this really intricate detail about what are the symptoms and... you know, I didn't train as a TCM practitioner, I trained as a Western herbal medicine practitioner and I trained as a naturopath as well. And I had to figure this out because not that I couldn't go back to training, but I had a young family, and I was busy in practice, and it was like, "No, hang on. Something's not working here. I just need to look at the evidence and figure it out for myself." 

And traditional evidence is legitimate evidence. The TGA actually acknowledges traditional evidence as legitimate evidence. So, I went to those books and they were just revelational. They were much more poetic and pictorial, less sort of analytical and sort of linear. Do you know?

Andrew: And we're talking about the traditional Chinese herbal pharmacopeia, yes?

Paul: The traditional texts, yeah, or some of the materia medicas.

Andrew: Materia medica, forgive me, that's the one I was thinking of.

Paul: And some of the textbooks that were being studied by TCM practitioners in the colleges and universities, like, awesome translations in Western context and great sort of detail on the disease state and what the energetic effects of herbs work.

Andrew: They're huge books.

Paul: And they're very thick books.

Andrew: They're very thick books. They're not lightly undertaken. 

Paul: And they're not so light when you pick them up, but when you start to read them I found them incredibly light. 

Andrew: All right. 

Paul: Yeah, because they told a story. 

Andrew: Yeah.

Paul: They didn't require rote learning. They developed concepts of health, and disease, and healing, and an integration of those herbal qualities and properties with the relative deficiencies, and insufficiencies, and dysfunctions within the body, and then associated those two together to give you indications for different remedies. 

So, the simple answer in terms of the signs and symptoms of chi deficiency, I mean, it really does depend on the organ-meridian system that's affected, but fundamentally it's a lack of energy, it's dizziness, it's blurred vision, shortness of breath, sweating with little exertion. Do you know like those cases that will present and they’ll sweat with little exertion? They're depleted. A weak voice, pale complexion, and then you get into some of the tongue and pulse signs, so they'll have a pale tongue, they may even have a little bit of a furriness on the tongue, which indicates there's digestive involvement too, spleen deficiency and spleen chi deficiency particularly, and then a weak pulse and obvious susceptibility to minor infections. 

So, they're the things that you'll see for someone who's in need of a chi tonic, but if they're not, do you know, and they don't have any of those signs and symptoms but they present with something like a pathogenic infection, fever, and inflammation, and headache, and a full and distended sort of pulse, if you do pulsing. And it's probably not a bad thing to learn. I never learned it and I never applied it. I always wanted to. But you might see signs of a facial flushing. You could also get blurred vision there, but the vision that's blurring in deficiency is more just weakness and tiredness of the eyes, and someone will say, "My eyes just can't focus." 

Andrew: Yeah.

Paul: But whereas the blurred vision in that inflammatory state of infection without the deficiency signs is going to be more as a result of, you know, the fever. And there'll be bloodshot eyes, and there may be sort of ringing in the ears, and throbbing in the head, and irritability. Whereas in the deficiency state, it's exhaustion. It's just depletion and, you know, essentially low energy states.

So, a practitioner I think is aware of that from both a Western herbal perspective or... Sorry, a Western clinical perspective where you're looking at signs and symptoms. 

Andrew: Well, yeah, there is where my, I guess, my mind was going here. And maybe this is, you know, my skeptical part, you know the roots in my orthodox training with nursing is, when you're describing those symptoms, like the first set of symptoms and I'm thinking heart. I'm going pallor, sweating, dizziness, anxiety, blurred vision, and I'm thinking blood pressure, acute coronary syndrome, ACS, and I'm worried. So…

Paul: In the context of infection, we're talking.

Andrew: Yeah, so, this is the difference, is that we really have to be mindful and be respectful of the whole framework of traditional Chinese medicine because it's not easily, I'm going to make up a word here, equivalated. There's no easy equivalent from Eastern to Western in very many cases. 

Paul: Well, but I might contradict that...

Andrew: That's cool.

Paul: ...because I think that the difference between TCM and Western diagnostics, really, is about perspective, and it's still looking at the same elephant. 

Andrew: Right.

Paul: It’s still looking at the same beast but just from a different perspective. The Western perspective is very much about diagnostic criteria, you know, and testing, and objective assessment. The Eastern perspective is all about observation. It's about character. It's about nuanced variances in personal experience and emotional states. And that's not all mumbo jumbo. That's the practitioner interfacing between nature as it were or interpreting the signs and symptoms of nature for a patient, for their patient who can't come to terms with those, who can't deal with them, and he doesn't know what to do to resolve them. 

So, they go to an Eastern practitioner, let's say, to interpret it in the context of that paradigm. But when I investigated the interpretation of the paradigm relative to a disease state from an Eastern perspective and then looked at it from the Western, you know, symptomatic perspective, because I was trained as a medical herbalist, it was very symptomatic.

Andrew: Yes.

Paul: Like, really just symptoms, you know, symptom, symptom, symptom, symptom, and you associated the botanicals with the symptoms. That was the other area I felt was deficient in my training, not deficient but I wanted to explore more, had a passion to explore more was this real interpretation of what was on the inside, what was really giving rise to those symptoms. 

And that's where an understanding of the energetic relationship of organ systems and tissues to the symptomatic manifestations of disease gave me the bridge. So, I don't think it's alien; there's a bridge, and the bridge is more and more being articulated in Western language in ways that can be understood. Maybe I've contributed a little bit to that by demystifying some of those notions of chi and yin and yang. 

But if you sit down and look at those with a Western mind, seriously, I want to take you on a journey…

Andrew: Yeah.

Paul: …and the journey is an understanding of menopause from a TCM perspective. And at the end of it, I would like to have your feedback in regards to, is that perspective bridging your very medically trained sort of approach? 

Andrew: Great.

Paul: Medical understanding of menopause as a hormonal insufficiency manifesting in all sorts of physiological symptoms which are clearly and accurately defined in the medical literature. There's no question that there's a good understanding of what underscores the symptoms of menopause and why the woman's experiencing them. But tell me why? 

You know, when I was in practice, I struggled with the why because those symptoms seemed so disparate, so diverse. Like, how can it be that you can have... and you can’t…like, yes, we understand it's hormonal but it's not just oestrogenic, it's not just deficiency of oestrogen. 

Andrew: No, no, no.

Paul: There's a whole range of sort of other influences that are coming to bear. And sure we know that oestrogen helps to modulate inflammatory responses and certain metabolic processes. And certainly a woman who's been enjoying the benefits of oestrogen through her menstrual life, her menstruating life and now comes to an end is goiing to suffer skin dryness, and nervous system complaints, and probably mood swings. And depending upon what her menstrual life was like, she may not sail through it.

Andrew: And that is a very good point. 

Paul: She may not sail through it. And in traditional cultures, there was always an understanding of how to support a woman through that phase.

So, we get the Western perspective, and we understand it hormonally, and we understand it physiologically, but it still didn't tell me what herbs to give my patients. Which formulas, which herbs? There were so many cooling herbs. And do we just take a cooling herb because the woman's getting hot flushes? There's more to this concept because... And this is after my journey with the immune system and looking at the astragalus 8 Chinese herb formulation. I started looking at what underscores menopause, what underpins menopause in an energetic and organ system, dysfunctional context? How does that line up with the Western understanding of this being essentially, you know, a life stage associated with hormonal decline, deficiency?

Andrew: Yep.

Paul: For which in my day, you know, in the '80s HRT was all the rage. You know? So, I open-mindedly, scientifically opened the textbooks and started looking at it. And within a short while of looking at some of these great textbooks, I discovered that menopause is actually a deficiency condition. It's not a cold condition. 

Andrew: Right.

Paul: It’s a deficiency condition and it's a deficiency of yin and yang

Andrew: Oh?

Paul: In different degrees. 

Andrew: Right.

Paul: And the concept that underscores it is that yin has a cold nature, okay, or cool nature.

Andrew: Yep.

Paul: Yang has a hot nature. When there's deficiency of both yin and yang... 

Andrew: Oh, so it’s a swinging effect. 

Paul: Well, I'll get to that. But the deficiencies of both in different degrees…

Andrew: Yeah. Right.

Paul: …but the reality is that yin is the more material energetic quality of the body, the substantial, the condensed, the more physical. Yang is a little bit more ethereal. It also tends to be expansive. It also tends to rise, and yin will condense. So, if there's deficiency of yin, there's nothing to anchor yang. 

Andrew: So, therefore, the hot flush...

Paul: What happens to the yang?

Andrew: ...comes up from your boots. 

Paul: It does. The yang as an energetic quality rises, and with it comes heat. And it's not the heat of inflammation and infection, it's the heat of deficiency.

Andrew: Right.

Paul: And it's this notion of deficient heat which is the underpinning of the Chinese energetic, the TCM energetic concept of menopause. 

But the other big thing around menopause and TCM I discovered, was that for yin and yang to have, to be replenished, particularly yang, because yin essentially, because it's very condensed. Yin, it has presence in all organ systems. There's no cellular presence in an organ if there's no yin. So yin is there and there's chi there. There's vital energy there that helps drive the functional processes of that tissue or that organ system. And there's yin because there's substance, okay? The cells have substance.

Andrew: Right.

Paul: But the yang is supplied by the kidney organ-meridian system. And if the kidney organ-meridian system is depleted, then the cellular function of the organs and the tissues will degrade…

Andrew: Right.

Paul: …and you'll get deterioration in the integrity of those tissues and systems as a result of the yang deficiency. And so you get these really interesting dynamics. You've got yin deficiency so you're getting integrity issues with the tissue. Like ageing sort of deterioration.

Andrew: So, ageing skin. 

Paul: Yeah, exactly. 

Andrew: Dry vaginal walls, that sort of skin integrity.

Paul: Exactly. 

Andrew: Even cardiovascular issues I would imagine? 

Paul: Exactly, yep. Bone.

Andrew: Bone density issues.

Paul: Bone turnover density issues.

Andrew: Memory issues.

Paul: Hormone production because endocrine systems have a big need for functional tissue. You know, their tissue has to be integral, otherwise the hormones can't be produced. And then you've got the deficiency of yang as well which is the functional impetus to that potential within the organ system that yin holds. 

Andrew: Right.

Paul: Yin holds the potential within a tissue or an organ system. Yang drives the functional expression. You've got deficiency in both. 

Andrew: So, then you've got things like the expression of sleeplessness, anxiety, the hot flushes. Is that where we're leading? Is that where you're...?

Paul: Exactly. The really exciting part about this that I got really excited about…

Andrew: Yeah, yeah.

Paul: …and I still do, it sends shivers up my spine. When I realised what was at the heart of it, it's kidney organ-meridian dysfunction. Kidney energy deficiency. Because I looked up what the kidney organ-meridian system governs, and it's just mind-blowing. Do you want me to read it to you?

Andrew: Sure, please do.

Paul: I've actually got it written down here. So, when I was looking at the yin and yang, okay? And the fact that yang comes from the kidney organ-meridian system, and it drives the functional expression of the organs or the tissues, and yin holds the integrity of those organs and tissues…

Andrew: Yep.

Paul: …and I found that kidney organ-meridian system stores...or not stores but distributes yang to all tissues and organ systems in the body. 

Andrew: Yep.

Paul: And then I looked at what the kidney organ-meridian system governs. It's mind-blowing. The kidney organ-meridian system governs, of course the physical kidney but as well the adrenal glands, the ovaries, the testes, the brain, the spinal cord, the skeletal structures...

Andrew: Oh, my God.

Paul: ...and especially the lumbar and lower back regions, the teeth...

Andrew: Vertebral collapse, wow. 

Paul: The teeth, the sphincters, anal/bladder sphincters. 

Andrew: Yeah, the bladder. Yeah.

Paul: The urethra, the inner ear, as well as fluid…

Andrew: Bloating, fluid. 

Paul: ...fluid balance. The hormones and other substances produced by the adrenals and the gonads, and this is coming into more of the Western medical physiological approach.

Andrew: Yeah, yeah.

Paul:  If you just look at it from a TCM perspective, that list of organs from that list of tissues, what do they correspond to?

Andrew: Yeah. Hmm, that's amazing. 

Paul: And when that penny dropped, I saw... 

Andrew: That would have been more like a sledgehammer. 

Paul: Oh, that was massive. I was in practice and I went, "Oh, my God." 

Andrew: Wowee. 

Paul: From an energetic perspective, menopause is a kidney deficiency disorder. 

Andrew: Right.

Paul: It is also of course, a deficiency of the regulating energies which are yin and yang…

Andrew: Yep.

Paul: …and the consequences of that systematically. But most particularly affecting the organ systems that the kidney organ-meridian system governs...

Andrew: That was an amazing list.

Paul: ...which they're all of the tissues and the organ systems that are affected in the menopause, all of them. 

Andrew: What I think is really interesting is, you know, from a Western medical perspective, they've tried to look at, for instance, acupuncture…

Paul: Yeah.

Andrew: …and they thought, "Oh, it'll just be working on the opiate system or on the endorphin system." Well, actually, no. Because you can't knock it out with naloxone. 

Paul: Right, right.

Andrew: You can't undo that effect with naloxone. You still have an analgesic effect. So, therefore, two things; one, the pain gate theory doesn't answer it.

Paul: Yeah. Yep.

Andrew: And two, it's actually working outside of your endorphin thing, so there's another system at play. And yet Western medicine continues to ignore the eons of tradition of successful practice of the Chinese medical methodology...

Paul: But not all.

Andrew: ...or Chinese medical system.

Paul: I mean and I guess this is the thing that I found and maybe it goes back to my days in Alstonville when I was collaborating with a lot of conventional practitioners. And I found that, sadly, a lot of my fraternity in the naturopathic and herbal medicine, you know, sort of areas I didn't have a lot of contact with them for many, many years because I was busy running an exceptionally, you know, incredibly busy practice, seeing 60 - 80 patients a week and running my dispensary. And I had staff to assist in manufacturing some of my own extracts because I was a one-to-one, you know, high-strength sort of extract guy. So, I was busy just dealing with patient care and collaborating with their medicos, mainly. 

So, I got to look into where the discord or the disagreement was and see if there was anything really substantial. There's not. And you know, whenever I talk to a specialist and I talked to conventional pharmacists nowadays, we have such a lot in common. Like there is… And I guess it's because I've spent a lot of years interpreting a very alien system called TCM, from a Western perspective. I did not jump into the TCM camp...

Andrew: But you've done it successfully.

Paul: ...and learned about TCM as a TCM practitioner and then try and bring those concepts to the West through the eyes of a TCM practitioner. I looked at TCM through the eyes of a Western practitioner.

And so when I talk to other practitioners that aren't of my training, I have a natural instinct to look at the world through their eyes. And when I look at the world through their eyes, I see parallels and I see patterns that conform in a really beautiful way to the patterns and forms that come out of TCM when I look at it. Where a foundational part of the Western training I would hope that you've already had, the physiomedicalism or physio-medical properties of, you know, stimulants, and relaxants, and astringents and so on, not as well developed as the TCM energetic colleagues, but look at them. Start looking at your herbs energetically and see how you can reinforce Western herbs with some traditional Chinese herbs. 

Andrew: There's one more phrase that I'd like you to clear up for me.

Paul: Sure. 

Andrew: Blood stasis.

Paul: On a roll.

Andrew: Blood stasis. Help me?

Paul: Yeah. Okay. So, this is really interesting. Where chi goes, blood follows. Okay? So, blood stasis fundamentally is...

Andrew: Deficient chi?

Paul: Well, it may not also always be. It could be that heat conditions have caused a congealing of the blood, let's say.

Andrew: Right. Okay.

Paul: But blood stasis, keeping the blood moving is really critical to health and wellness. Keeping healthy chi is the lead to blood is also critical. And I think preventative healthcare, if we want to get back to that terminology, should be focused on chi and blood, and energetically focused on herbs that support that process. But blood stagnation if we looked at it from a cardiovascular perspective, it doesn't mean the blood has stopped moving but energetically...because in TCM terms, blood is both the physical substance of the blood but also the nutritive forces within the blood and also...

Andrew: Oh, poor oxygenation.

Paul: Exactly.

Andrew: Gases. Blood gases alteration.

Paul: Exactly. Yeah, you give me the scientific stuff. I'll throw you the energetic terms for it because... 

Andrew: Respiratory acidosis/alkalosis, those sorts of thing.

Paul: Exactly! Exactly. And you're going to end up...if you have blood stasis, which any TCM practitioner can determine…

Andrew: Yeah.

Paul: …and we could go through the symptoms like we did with chi deficiency, what are the symptoms of blood stasis? But you're going to have far-reaching effects. It's not just cardiovascular. It's endocrine. It's all the tissues of the body. Chi influences all the tissues of the body. Blood influences all of the tissues of the body. And as a result, it's very important, you know, to understand those two of the four vital forces or vital energies. The other two are yin and yang. 

So, if the only takeaway today is that there's these four forces in TCM which we need to come to understand. Yin and yang is the opposing forces in nature. Chi in blood as the nourishing, regulating forces, as it were, within the body that come out of that dynamic interaction between yin and yang. We've got a lot to work with. 

Andrew: There's so much more. I mean, hey, there's thousands of years that we could talk about. What about the timing of medicines? Can we perhaps discuss that in another podcast? 

Paul: Yes, because that's, again...

Andrew: I would love to dove into that.

Paul: ...is a beautiful body clock that they've developed that talks about the timing of taking, and what we need...

Andrew: Excellent.

Paul: ...to take based on the organ systems affected. 

Andrew: Well, I've got to say, Paul Keogh, thank you. Once more in my career, you've cleared up something that dogged me for years, not just...

Paul: I can't believe it's taken us so long to link up again.

Andrew: Well, I should've asked you this 20 odd years ago, shouldn't I? So, not just...

Paul: I didn't know then.

Andrew: Not just did you clear up the, you know, me falling down that rabbit hole of being too reductionist, in my opinion now, to only look at one or maybe two...I call them 'marker chemicals' rather than "actives" because we've been disastrously wrong...

Paul: In proving them.

Andrew: In showing, yes.

Paul: As active, exactly.

Andrew: In showing that they're actives. Indeed, we've changed our framework with St. John's Wort and three different chemical marker compounds over the years, and we're still not on top of it because the one with the evidence is actually looking at flavonoids. 

Paul: Wow. Yep.

Andrew: So, I think we're just being really arrogant when we're thinking that they're actives. I do however believe that there may be some facility that use them as marker compounds for a framework of quality or reproducibility. But you can't do that with one, you've got to do that with several...

Paul: We can talk about that because...

Andrew: Oh, that's brilliant.

Paul: ...I'm deeply engaged in the areas of chemical profiling or profiling of botanicals, and also identifying markers and actives, and also ensuring that you get a broad spectrum of compounds within an extract such that you haven't gone chasing one constituent and at the expense of the whole herb. And it's the whole herb…

Andrew: That’s right.

Paul: …I think we could kick off another conversation.

Andrew: Paul Keogh, thank you so much...

Paul: My pleasure.

Andrew: ...for joining me at FX Medicine today. 

Paul: Thanks for inviting me. 

Andrew: This is FX Medicine and I'm Andrew Whitfield-Cook.


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