Hi Andrew. When a person displays a complex pattern such as some dryness and some possible damp/ stagnation issues; what do you focus on first? Do you focus on moving the stagnation first, or moisten the dryness? thank you, Sonia

Andrew said: That is a really good question! I think you would have to decide first, in that particular individual, which is the root symptom and which is the branch. To answer that question, think about which pathology is older and what the tongue looks like. Typically, the older pathogen is considered the root. Branches manifest later. In any event, tongue diagnosis often tells us what to do. In this case, if the tongue is wet, greasy, thick coat etc- you have a clear signal that damp/phlegm is stagnating. If damp stagnates in one part of the body-mind-spirit, fluids can not adequately nourish other places so you could find dry symptoms. In that case I might start by moving the stagnation of damp/phlegm/qi or whatever substance is stagnating. If the tongue is dry/peeled/red, the opposite might be true and I might start by nourishing the dryness/yin deficiency. This is where the art of herbal medicine comes in. You as the herbalist get to decide how to approach a mixed pattern. Generally, TCM says to treat root and branch together. For example, I might move the stagnant fluids with 70% of my formula if I think the stagnation is more prominent and 30% would be to nourish and support. The next question is WHERE to direct each component. Consider a post-menopausal woman (yin deficiency) with leg edema and vaginal dryness. I would want herbs to nourish yin, moisten the vaginal mucosa, and support the spleen. Simultaneously, I might add diuretics and herbs that move fluids specifically in the legs. Location is important because herbs can have tissue or location-specific effects. I hope that helps!

Thank you! yes that was very helpful