Episode 32: Clinical Wins, Difficult Decisions, and Patient Goals

Office Hours with Angelique and Toby, episode 32. Released October 28, 2026. 26 minutes. This episode is sponsored by Classical Pearls.

Listen: Apple Podcasts · YouTube · Spotify

About this episode

Acupuncturists Angelique Britt and Toby Daly talk through the business and the bedside of a Chinese medicine practice. Angelique explains why she stopped accepting MassHealth and other Medicaid plans, how she transferred those patients to nearby practices, and what late cancellations and no-shows cost a solo practitioner. The two compare cancellation policies, discuss the hard step of discharging a patient who repeatedly misses appointments, and reflect on starting a practice from scratch.

The second half turns clinical. Angelique describes a patient with long-standing insomnia whose sleep, and rosacea, shifted most when she was treated on the bladder channel in the Saam tradition. Toby explains how he chooses between two Classical Pearls sleep formulas, Peace Pearls and Spirit Pearls, and how Heiner Fruehauf changed his view of Fu Zi (prepared aconite). The episode closes with a patient facing a third recurrence of colorectal cancer who hopes to avoid surgery and further chemotherapy. Drawing on her years as an oncology and hospice nurse, Angelique offers a framework for that conversation built around the patient's own goals.

Topics

• 00:00 Introduction

• 02:00 Leaving Medicaid plans and transferring patients

• 04:08 Late cancellations and practice policies

• 05:55 Training patients on cancellation rules

• 08:05 Discharging a patient after repeated no-shows

• 09:59 Bringing on a new practitioner without a top-down model

• 12:05 Starting a solo practice

• 14:09 Surprising outcomes in clinic

• 16:11 Insomnia, the Saam tradition, and the bladder channel

• 19:50 Peace Pearls, Spirit Pearls, and Fu Zi

• 22:06 The Classical Pearls clinical reference guide

• 23:53 A patient with recurrent colorectal cancer

• 25:51 Patient goals, quality of life, and hospice principles

Key terms

• Saam acupuncture (舍岩): a Korean Buddhist monastic acupuncture tradition that treats imbalance on one channel system at a time, using combinations of the five transport points.

• Sanjiao (三焦): the "triple burner," one of the six fu organs and its channel.

• Fu Zi (附子): prepared lateral root of aconite, a warming herb in the Chinese materia medica.

• Suan Zao Ren Tang (酸棗仁湯): Sour Jujube Decoction, a classical formula for insomnia from the Jin Gui Yao Lue.

A note for listeners: this is a conversation between licensed practitioners, offered for education, not as medical advice. Fu Zi (aconite) is toxic if improperly processed or dosed and should be prescribed only by a trained, licensed herbalist. Anyone considering changes to cancer treatment should talk with their oncology team. Patient details have been kept general to protect privacy.

Transcript

This transcript was generated automatically and lightly edited for readability.

Toby: Thanks so much to Classical Pearls for sponsoring this episode.

Angelique: Tomorrow is the last day that I'm accepting MassHealth in my practice, like all the Medicaid plans. It's a bittersweet situation. On the one hand, I don't have to deal with the administrative piece of it anymore: keeping track of referrals, dealing with no-shows and late cancels, and all of that. Not to mention that the compensation's not the best. But if I could have eliminated all of the administrative part, I could deal with the reimbursement. Quite honestly, it would have been fine. So that's the silver lining. The hard part is that it closes the door to some folks, because they don't have the access. For folks on Medicaid plans there's no copay; it's essentially free for them. There are usually twenty visits per calendar year, with the ability to advocate for more. For example, there's a patient I've been seeing for over a year now, almost every week, for chronic pain and other issues that have responded really, really well to acupuncture. They're going to go to another practice, but I will miss that person. So there are some patients I'm going to lose that I'm going to miss.

Toby: At least you have practitioners near you that take it.

Angelique: Yeah. There's one practice that takes one of the plans, and another practice that takes all of them. So I referred most of my patients to the practitioner who took all the same plans I did, just for ease of transition. Some of the other folks I sent to the practice that takes one of the plans, to distribute them evenly so I wasn't dumping a bunch of people into one practice at one time.

Toby: That's a nice way to do it. How did you make your final decision?

Angelique: I got really frustrated with so much of it: having to keep track of payment, having claims denied, not having any recourse with patients who late cancel or no-show, because one of the rules is you can't charge them. I'm a small practice. It's just me, and I have a limited number of spots. So I was starting to feel the hit of late cancels with no recourse. For everyone else I have a late cancellation policy; it's fifty percent of their fee. I know you think I should increase that to the entire fee. Maybe I will at some point. I remember there was a day where I had three late cancellations, and that's three patient spots I couldn't fill. So I had to make that decision.

Toby: You really tried. For me, late cancellations drive me insane. But with Stephanie, a late cancellation means we take a hundred percent of the fee. And a lot of times, if it's that day, we have a wait list, so she just puts somebody else in. It's actually financially really great if somebody late cancels.

Angelique: Well, one day when I grow up to be like you, I can do that too. There are some people on my wait list, and a couple of times someone has late canceled and I've been able to slot somebody right in. But I don't have a continuous wait list every day that I practice, so that happened to be a day where it didn't work out.

Toby: But it's nice financially, right? You collect the full fee for the late cancellation, and then you get to see another patient in that slot too. So it's win-win.

Angelique: I think I'll have to get frustrated before I change my policy.

Toby: It's also great for training patients. Stephanie just lays down the rule: you have to cancel within twenty-four hours, otherwise it's the full fee. Everyone knows that. Someone might do it once or twice, and then they realize we're serious. That really trains the patient. Then everything else moves around their acupuncture appointment, rather than swapping the appointment out for something else.

Angelique: Does she collect a credit card at the time of booking?

Toby: For some patients she does. Otherwise, when they come back to reschedule, she charges them for the missed appointment and that appointment.

Angelique: So if someone you don't have a card for drops off the radar and never comes back, you don't get the fee.

Toby: Yeah, that's possible too. But someone who no-shows and then doesn't pay for it, that's a nice filter for your practice too.

Angelique: That's true. It's a hard thing. I had a patient situation where I had to, how do you say it, fire a patient. I don't know if there's a better term for that.

Toby: It's called patient abandonment.

Angelique: Firing a patient is called patient abandonment?

Toby: I think if you do it wrong, it's called patient abandonment. My bad for assuming, sorry.

Angelique: No, it was a patient who had multiple late cancellations and a couple of no-shows. I have a three-strike policy in place, and I had given them way beyond that, and had face-to-face conversations with them. They would sometimes arrive twenty minutes late to their visits, and at one point I sent them away because I couldn't treat them; my schedule had gotten more full, so I didn't have the wiggle room I had initially. I was direct but kind. I was frank that it's a disservice to them and a disservice to me to show up late or late cancel, and I said I'd been really lenient with my policy, so if it happened again I would put them on same-day booking. I didn't boot them fully out of the practice. If I had an opening that worked for them, they could have it. They wrote an email asking for more leniency, and I said they could book the night before. I moved the bar slightly, and that's as far as I could go, because it had happened so many times. I felt badly, because I knew the person was having a rough time, and it was also a pattern that kept repeating. I didn't enjoy that experience, but it helped me stick to my guns a little more and value my own time a little more, because I tend to be a sucker about certain things.

Toby: It's a tough balance, right? You want to care for the patient, but if they don't let you care for them, you have to do something. How did it end up?

Angelique: I let them know they could book the night before instead of same day, and I just never saw them again. I had referred them to other providers and let them know who else they could see. I was kind about it. I explained that it was hard for me, and I'm sure it was hard for them, but this is what I need to do to preserve my livelihood. I don't have an acupuncture empire. It's just my own little self.

Toby: Not yet.

Angelique: I have no desire to have an acupuncture empire. Colleagues have shared stories with me about places they work where I feel for the business owner in a big way: hiring people off the street and dealing with whatever comes. I have no desire for that. The acupuncturist who will hopefully be joining me sooner rather than later is someone I know; we've known each other for a little while, and she's a really wonderful person. The way I'm going to do things is not "you're working under me, so you have to do all of these things." She'll be working for me, but I'm trying to give her as much agency over her work-life balance as possible. I'm not requiring scheduling every half hour. She can see however many patients she wants, however many days a week. There will be some minimum, because taking someone on adds overhead like the electronic medical record and payroll. But I won't be cracking a whip or creating stress beyond what's inherent in being a new practitioner treating patients on your own. I'm trying to do it a little differently from what I've seen others do. I don't want a million people working for me with me as the boss. At least not now. But life does weird things, and things change.

Toby: From my experience, being a solo practitioner is the ideal situation.

Angelique: I remember you sharing that with me. Initially I was going to start with another person and rent space, and that didn't work out. You said it was probably the best thing that could have happened, even though starting my own business from scratch was stressful at first.

Toby: Starting your own practice is horrible initially and then great as you go along. Working for somebody else is really easy at first and then probably gets horrible as you go along. You jumped in with both feet into, I think, the best possible model.

Angelique: So far it's been working out. Removing insurance plans was scary, because I had seen many people on those plans, so it was a leap of faith. I didn't know whether I'd end up half full. But as I've found in life, when you take leaps forward with faith and work hard, things seem to work out. I ended up with an influx of patients who pay cash or have the other private insurance plans I still take. So I've been fortunate that the hand has risen up to catch me.

Toby: That's great. People need care, and if you can provide good care, they will seek you out. It sounds like you're getting that reputation, and that will serve you for the rest of your career.

Angelique: I care a lot, and I think people feel that. I've got a lot to learn. And I still have anxiety every day driving in. This is real talk. Am I going to know what to do? Am I going to know how to take care of people? Seriously, every day, because I've got about a forty-minute drive from where I live out in the woods. It's this odd little psychological battle: is today the day everyone comes in and says nothing helped? Sometimes people do say that, but the vast majority report some benefit, and I find myself surprised. Does that ever happen to you still, or does it fade at some point? I'm like, whoa, really?

Toby: I'm still surprised at times. It's amazing. We're always trying to knock it out of the park, but sometimes something has been there for a decade, and then it just dislodges and resolves for the patient. Maybe surprise is the right word. I'll have a prognosis that something will take this much time, and sometimes it just sweeps away. The patient and I are both pleasantly surprised. It's amazing that biology can turn on a dime like that.

Angelique: It's pretty wild. There's a patient I've been seeing for insomnia. I'm hit or miss with insomnia. I'm better now that I'm doing Saam, because it works really well for insomnia for a lot of people, though not everyone. There's someone I was striking out with who didn't like the Saam style and wanted to go back to a more conventional Chinese medicine style. But this particular patient was getting maybe four hours of sleep a night for about a year. She overworks quite a bit and has a very radiant presence, very loving and caring, very heart excess, but also sanjiao excess, kind of both. Just a lovely person. The first time I treated her, she wasn't presenting as heart excess. She was telling me all the details of her life, down to the minutiae, and I thought, she needs liver. So I treated liver and she slept really well for a couple of nights. We also talked about sleep hygiene, because acupuncture alone can only do so much if you're staying up all hours or engaging your brain too long before bed. The second time, she came in a bit irritated with some gallbladder channel neck pain, which was a thank-you gift from the Saam gods: okay, let's treat the pericardium. So I supplemented the pericardium, and that helped. She was having incremental gains. Then one day she came in with a flare of rosacea. Her face was redder and she was warm, but she's also just a very loving person. It dawned on me that she needed a bladder channel treatment, so I did it. When she came back, she said there was something different about that treatment. The redness was gone from her face, the rosacea was much better, and she talked about how much better she slept and how easy it was to fall asleep. It clicked for me. She'd gotten some gains from liver and some from pericardium, but with bladder there was a big shift. That's probably what I should have treated first, had my thinking cap been on.

Toby: It's so interesting. I feel like two or three visits in, I suddenly realize what their body's been trying to tell me. It's been shouting at me, and then I'm like, okay, I got it now. It's always fascinating. I remember reading a study that humans sleep much better when it's cold. So if you can cool off that inflammation and agitation inside with bladder, they can drop into a deep sleep.

Angelique: Is bladder in your repertoire of channels you consider right away when people come in with insomnia?

Toby: I'm not sure I'd say that. My experience with insomnia so far is: whatever the biggest gap is, close that, and they sleep better.

Angelique: That's the thing with the system in general. Whatever the biggest gap is, close it and it helps.

Toby: Yes, but especially for insomnia. With some other things you have to close the small gaps first, but with insomnia there's usually something gaping. Especially four hours a night for a year; that was a big thing that needed to be closed.

Angelique: Is there a Classical Pearls formula you use for folks who come in with insomnia?

Toby: They have two main insomnia formulas, Peace and Spirit. I feel like Peace has a little more punch. It has Fu Zi in it. Spirit is a little calmer. So if the patient is really exhausted and can't sleep, Peace is really good. If they're a little agitated, Spirit is a little better. Have you used either one?

Angelique: I've used Spirit for one patient who was having a lot of anxiety related to sleeping, and it helped some. I'm wondering if I should have used Peace. So that's for empty heat rising, and you give them a big dose of Fu Zi in the Peace Pearls?

Toby: I'm not sure it's necessarily empty heat. They're exhausted. They're so tired that they can't sleep.

Angelique: So it gives them a little energy to be able to sleep.

Toby: Yes. I think people can push so far that they actually lose the capacity to sleep. They're so exhausted that they don't have that mechanism available. That's why it's such a valuable formula: Suan Zao Ren Tang plus Fu Zi. I don't think I would have come up with that on my own. It's really nice to have that in Classical Pearls.

Angelique: Can you talk a little about Fu Zi for those of us who might be nervous about it?

Toby: I was taught in Chinese medical school that it would kill you if you took it yourself or gave it to patients. Dr. Fruehauf really changed that around for me. He even uses it with heat conditions. He has another formula called Guan Yin Pearls that he uses for hot flash presentations, and it also has a high dose of Fu Zi. He feels that high-quality Fu Zi, especially from the region where it's traditionally grown, is enough to bring, in his words, the energy back into the battery. In school, everyone said prescribing Fu Zi was like killing your patients, and using it in a heat condition like hot flashes was completely foreign. But those strategies are really helpful. Some postmenopausal women with debilitating hot flashes are releasing all that energy and losing it all the time. A Fu Zi based formula can help lock that back in, so they're not harassed by the heat. That heat is good heat, and being able to pull it back into the battery, as Dr. Fruehauf says, can be really valuable.

Angelique: That's good. We talked about the book last time: the clinical reference guide, which has a great description of each formula along with indications and applications. I use both the spiral-bound copy you can purchase from them and the free ebook. I have the ebook on my computer and leave the hard copy at my office, so on a home visit I've pulled up the clinical guide in people's homes. When I visited you, that was the book we were looking through, where I was describing the patient profiles and thinking, my goodness, I recognize this person in this formula. It's a really great reference.

Toby: I don't know if you remember, but my physical guide is falling apart because I reference it so much.

Angelique: Do you have lots of notes in there from all the continuing education you've done?

Toby: Yes. It's been a really valuable guide, and I highly recommend it. I'll put a link with the YouTube version if you're interested.

Angelique: The ebook is free to download, and the printed reference guide is, I think, about fifteen dollars.

Toby: Highly recommended. Okay. I have a patient who contacted me yesterday with colorectal cancer. It was originally resolved with several rounds of chemotherapy. Then they found a metastasis in the liver, which has been treated, and now the original colon cancer has returned. Going forward, the only option they have is surgery with an ostomy bag, and they're really trying to avoid that. They reached out to ask what I might be able to offer. Let's say that reached your office. How would you handle it?

Angelique: Someone who wants to avoid chemotherapy or surgery?

Toby: Surgery and another round of chemotherapy.

Angelique: These are the moral and ethical dilemmas. So the tenor of their question is, can you help me avoid chemotherapy and surgery for a colostomy?

Toby: Yes.

Angelique: I was an oncology and hospice nurse for a long time, so I'm familiar with what chemotherapy does to people, and with the whole ostomy experience. I would probably tell them that there likely isn't something I could do that would replace proceeding with treatment for what sounds like an aggressive cancer. I wouldn't say the word aggressive, but I would imply that this is a third recurrence and this seems to be what's going to save your life. I'd want to ask about their feelings around the ostomy and whether they've had any education about it. But I don't think I could in good faith say, absolutely, come in, get some acupuncture, take some herbs, and don't get surgery and chemotherapy. I feel like that would be detrimental, although I know how hard both of those things are for people. It's a tough one.

Toby: I think that's similar to how I'm going to manage it. I want to see them in person and talk about it. Then we can gauge how opposed they are, and maybe I can educate them a little more. It's nice to be outside the oncology clinic, where the patient can talk more freely, and I can just listen. But it's basically the same as you: there's no guarantee. Especially with a second recurrence. Coming back like that after all those rounds of chemotherapy and the original surgery, that's technically aggressive.

Angelique: I probably wouldn't say aggressive to them, but I think talking in person is good. I might pull in some of my hospice nursing, not in terms of talking about end of life, but because one of the main premises of hospice care is identifying the patient's goals. We identify patients' goals for care when we're giving acupuncture, but in terms of their life: what is most important to you? What do you want to accomplish? What do you want to do? Is this a younger person who might live the rest of their life with an ostomy bag, or someone older? What are their concerns about the ostomy specifically? Do they know that certain things exist, like opaque ostomy bags that help manage odor, and ways to make it less conspicuous? A lot of times folks imagine the worst-case scenario, which is totally normal. I'd find out where they are with that, and help resource them back to the people in their oncology network who know this well, because they don't always talk with the social worker, though there's usually one involved. Probably more of the visit would be talking about things like that. But I couldn't in good faith say, let's just do acupuncture and herbs and hope, unless someone says, I'm not doing this, and I'd rather do something than nothing.

Toby: That's really valuable for me. I didn't have a framework like the one you've developed. Is your goal to never have an ostomy bag, or is your goal to live? That's a big fork in the road. It would be good to discuss that in person.

Angelique: Totally. Cancer is scary, and I get it. They've been through chemotherapy before, so they know what they're getting into. It can be rough.

Toby: It's not theoretical for them.

Angelique: Yeah.

Toby: Thanks so much for the "what's your goal" framework. That will be really valuable.

Angelique: Sometimes, depending on age and goals, not treating is okay too. I know that's controversial, because our society says you need to treat and do all the things. But there comes a point where it's quality of life over quantity of life. Has there been a conversation about prognosis, the likelihood of success, the likelihood of recurrence? If someone says, I really don't want to go through this kind of treatment anymore, and they're more in the realm of palliative or hospice care, then okay, let's do the best we can with what we've got in Chinese medicine. And if you do choose treatment, Chinese medicine can be a great adjunct to help you manage some of the symptoms, maintain some of your resilience, and deal with some of the side effects. It's a tough conversation.

Toby: Thanks so much for that framework. Let's leave it there for today. It's been great talking with you.

Angelique: Good talking to you. Sounds good. Bye.

Episode 31: Prognosis and Letting the Patient Tell You What They Need

Office Hours with Angelique and Toby. Released October 10, 2026. 26 minutes. This episode is sponsored by Classical Pearls.

Listen: Apple Podcasts · Spotify

About this episode

In a clinic catch-up without a guest, Angelique shares two allergy cases treated with Wind Pearls, Toby describes what he has been seeing in his own practice, and the two compare notes on long COVID presentations with fatigue, brain fog, and dampness.

They then take up a question every newer practitioner wrestles with: how do you predict who will respond to treatment? Angelique draws on Matthew Bauer’s idea from Making Acupuncture Pay that the more a symptom varies, the better the prognosis. Toby agrees, then shares a case that challenges the rule. They close with a reminder that caring about the person in front of you remains at the heart of the work.

Topics

• Two Wind Pearls cases: a blocked, painful ear and a year-round allergy patient

• As-needed versus seasonal formula use, and cycling a formula

• A brief history of smallpox inoculation in China

• Long COVID in the clinic

• Why Angelique now uses Saam acupuncture for most of her practice

• Symptom variability as a possible prognostic sign

• Setting realistic expectations with patients

• A chronic back pain case that did not respond, reviewed from the chart

A note for listeners: this is a conversation among practitioners, offered for education, not as medical advice. Patient details have been kept general to protect privacy. About the discussion of COVID-19 vaccination: the rashes and other symptoms Toby describes are anecdotal clinical impressions from a small number of patients, not evidence that vaccination caused them. Questions about vaccines are best discussed with a physician. The historical smallpox practice mentioned in this episode is variolation, an early form of inoculation documented in China by the sixteenth century, which preceded modern vaccination.

Transcript

This transcript was generated automatically and lightly cleaned up. It may contain errors, especially in names and Chinese terms.

Angelique: So this episode is brought to you by Classical Pearls again this week. Isn'that right, Toby Daly?

Toby: It'so great. again, we'really happy to have them as our sponsor.

Angelique: Yes.

Toby: Last week when we were talking about this, we started talking about you've been using some of the pearls and then I said, let's wait till this time. you any interesting cases you had using the pearls? Okay. Great. Yes. Tell me.

Angelique: Absolutely. so I had a patient come in. This is a patient that comes in, she comes in once a month, she tries to stretch her insurance visits. So it's like whatever's plaguing her that month. And she had a blocked ear that was really painful and sinus congestion, itchy eyes. And so I had treated her the prior month. I think I had tried Saam and it lessened the ear pain, but it's the congestion remained. And so she didn't want to come back again. She wanted to wait till the following month. So fine. So she dealt with this for an entire month, like this blocked ear. And so I did a Chinese style treatment for her. and I prescribed wind pearls. And you know, I explained how to take them. And she started that night and she called me or texted me the next morning that her ear had compl had opened up completely. And her allergy symptoms were like much better. And so she took them for another several days. And now they're a tool that she can use because she has allergy fluctuations that has that symptom constellation of like the itchy eyes, the congestion, fluid in the head. It was really remarkable. So I think it was a combination of both acupuncture and herbs, but having treated her the prior month with like, you know, a little bit of help, but then adding the herbs to that was really It was really cool. I was really excited. Yeah.

Toby: Yeah, that'such a nice potent combination, right? try and get the function of the body going well and then giving some material from the outside with the same idea. I really like to do that. you know, just introducing the those, you know, the same idea from just two different angles body. That's that seems tends to be pretty synergistic. So that's awesome. That's my experience with wind pearls too, is I have the patients take as needed.

Angelique: Yeah. And I've had I had another patient who I've also been seeing for a while. I had met him at a community event and seasonal allergies, you know, he has allergy symptoms most of the year, but then has peaks and was taking over the counter allergy pills for a while. And so when I started carrying the Classical Pearls, I was like, you know, you wanna try to give this a try. And so he was open to it. And so I think like you can do up to three twice a day or six a day, but you can split them up like two, or do three and three. And so I had told him to try like two, because I think that tends to be better tolerated if I'm remembering correctly. And he found it to be a little bit too drying. So he ended up finding that if he took two in the morning, he was good for the rest of the day. And that on really bad allergy days, he could repeat the dose in the afternoon and then that would take care of it. And he's been able to reduce his over the counter allergy medicines to almost nothing. Which has been really a cool thing and had really good relief from his symptoms, which are plaguing him a lot of the time.

Toby: It'so fantastic. Yeah.

Angelique: Yeah.

Toby: Yeah. And then I it tends to with my patients too. The it's almost like it's training that formula tends to kind of train them. So they tend to have less they need less pearls and then have less allergy symptoms. So it'll be interesting to see if you start noticing the same patterns too, where they just need less medicine and they're they're feeling great. So

Angelique: How often do you tend to have folks take them for just as needed, like kind of continuously, or is there sort of a cutoff that you found?

Toby: Yeah. I mean, I think it really is a hundred percent case by case. But you know, people with mild occasional allergies, I don't want to just keep blasting them with herbs and they don't need it. So they're more that take it, you know, if something comes out, they get exposed to something and then they have usually they have a couple of days of congestion. They'll take that right away and they can avoid those couple of days of congestion. But some people just suffer for like months on end. So I have them take like, you know, maybe four weeks before an allergy season starts, and then throughout the whole allergy season. sometimes giving a little bit of break in between there. Dr. Fruhoff tends to recommend about six weeks of taking the formula. And then you have to switch in some way. either take another formula or take a break and then and then resume again. So they they, you know, it's it's again case by case, but short term, long term, I again I think it's a really flexible formula. And that's usually I don't hear like you said with feeling a bit too dry. I think maybe just really sensitive patient only needing two caps. That's that's great to do that. But it has some moistening agent in it. So it's nice. It's not it's not just blasting dry. There is some moistening behind it.

Angelique: Yeah. That's what that's what's been helpful for me as a newer practitioner who feels very novice in the herbal realm. being able to prescribe these, knowing that they're they're so well balanced that you're not gonna hurt anybody. You know, but it's it's gonna like you said, it I was surprised that it was drying too based on what's in there, but that was his experience. But at the same time being in contact and like he knew what to do. And then knowing that going forward with other people that they can take them with some regularity and not worry about like damage, you know, to the yin anything. Which is really nice. Yeah.

Toby: Yeah, i it's it's it's thoughtful design. It's nice. Again, you're gonna be drying so you it's not gonna be able to get all only of the pathogen, it's gonna dry some of the body's true fluid. So it's nice it's nice to back, you know, backstop that.

Angelique: Yeah. That's been that's been nice. So what else is going on in your neck of the woods?

Toby: I'm just seeing patients and building a school. That's that's that's that's what I spend with that's what I spend with my time doing.

Angelique: Anything interesting come through?

Toby: I've never Yeah, about the school or about patients.

Angelique: About patience.

Toby: About patients, it's yeah, let'see if there's anything especially interesting. People d still tend to in my area get COVID vaccine. And for me I immediately wanted to dismiss any kind of side effects. but it seems like it's just like another batch of people coming in, getting the COVID vaccine and then within a week or so having all kinds of really bizarre things. So it's it seems like the weird rashes, weird sensations in the body, especially like pain and burning and things like that. Mostly rashes, right? I like a series of people coming through with different rashes. Wow. You know, not typically any kind of dermatological problems. And then just right after that. so yeah, I just I still think like this that'such an odd pathogen to introduce in the body either through vaccination or through natural exposure. Again, bodies just tend to ha present really oddly. So

Angelique: That is interesting. I haven't seen that out here as yet.

Toby: And people still doing a lot of vaccinations about you? Mm-hmm. Yeah.

Angelique: Yes. I've had people ask me like what do you think about it? And I've it's controversial. I don't know what to say. Like, you know, it's a very it's very personal.

Toby: Yeah. And I fe I feel like that's not our lane. So I just I tend to refer people back to someone in that lane to deal with it. I do give them some historical reference. I'm not sure if you probably know, right, that Chinese medicine in introduced the first vaccination for smallpox, I think fourteen hundreds, fifteen hundreds, something like that.

Angelique: I didn't know that.

Toby: That's cool, right? And so they had they were doing smallpox. People had really mild cases of smallpox. They were taking the scabs, grinding it up, and then inhaling through their nose. It was some kind of Taoist hermit come down from the mountains and told everyone to do that. And I guess that's mostly effective. So everyone was pretty happy about that.

Angelique: I'm just wild. I'm just thinking about like, so what did they scour the villages for the people who had the least like, you've got a mild case, come with us so we can pick your scabs like

Toby: Yeah, and then and then I guess the trust you would have. I mean the whole thing just seems pretty amazing, but I'm pretty sure it's well documented. And then that went from China over to Europe. They did it for a while and then they I mean I think that's what we call it vaccine. Then they started getting cowpox, right?

Angelique: Yeah, I was remembering cows, some a cow association with that, yeah. That's

Toby: Where the vaca comes from. So the idea came from China over to I think it was England that they used cowpox and then they used that. And anyway, so it is a it's a fascinating history. And I think it is a good idea in general, right? The idea of like presenting something to the body and then having it, you know, build up immunity to it. I think that's a good idea from transmissions. We like that idea, right? Not just blasting the body with something, having it prep a little bit. But yeah, I again I think. Just I think that just the configuration of that virus just seems to wreak a little bit of havoc.

Angelique: Crazy stuff to people. Yeah. It's the long COVID stuff that I see in my clinic more frequently. Just like the residual effects and the awful like fatigue. I mean of the MECFS, which is Miloencephalitis. A lot of people have it and you know some people treatment responds really well and some people don't.

Toby: What kind of things have you been successfully treating? What type of those patterns, like long COVID patterns, anything especially that you're helping?

Angelique: I'm trying to think of the last person. Cause even though I saw it a lot, I haven't seen one recently. The last person I can think of had some recovery of their energy where they felt like they were able to do a bit more and they weren't able to continue with the treatment. But we had gotten them to a place where they could do a bit more in terms of like their functional status. They felt less brain foggy. the other person I can think of moved, but she was doing really well. She had long COVID too, and sh her sleep was disturbed and she was tired and draggy. There was like a real damp, like heavy. Huffiness to her and with herbs and acupuncture, she did really well. and then she moved away.

Toby: Okay.

Angelique: Yeah.

Toby: So that's in general the patterns that you've been seeing more damp. the other one too, was it damp?

Angelique: The other one was more damp too. Yeah, it was like there was like a damp, like really brain foggy, like heavy feeling, like slow, just kinda goopy.

Toby: My needle finger is getting itchy with that.

Angelique: Yeah.

Toby: I just always w I always wanna attack that. So yeah.

Angelique: The good one. you know, and since visiting you, I'm probably ninety percent Saam with my patients now. Like I treat majority of folks with Saam there's a couple people that I've been seeing a while that they like what they like, you know, in terms of Chinese medicine style and they seem to respond better to it. And then there's the occasional new person that I'm like, if I do this, they're gonna never come back. but I'm getting there. I'm getting there with new people also. And so it's It's been really great to do that and to see the effects that it has on people. And then sometimes it's not as great, you know, sometimes it's kind of like a and so I've been thinking about that and I found a book. Hallie, who's was my assistant, sent me a substack of somebody names Matthew Bauer. I think I talked to you about him, and he has a book. And his book is Making Acupuncture Pay. And it's a weird book to read in public. But I it's

Toby: Like when like when I was in grammar school we used to have to put like paper around our textbooks. You could do that.

Angelique: Yeah. but no, it's it's been super helpful. Like the it's it's basically practical, it's practical advice to people starting out. And it was written in the early 2000s. I think he reinvigorated it somehow. So some of the numbers are off in terms of like price per visit and stuff like that. But one of the concepts that really stuck with me, I'd be interested to hear what you think about it, is when you're doing an intake with somebody. So one of the things that I struggled with and Up until recently, is sort of predicting who is gonna respond well to acupuncture and who's not. I've sort of been like, I don't know, you know, like, you know, someone who's had something. I mean, I knew someone has something that's like years entrenched, stuck, like that's less likely to, versus somebody who has an acute thing happening, like an ankle sprain is probably gonna respond easier than someone who's had chronic back pain for 25 years. Like Outside of basic things like that, it was been really hard. But one of the things that he says in the book, which has been really helpful, is that especially with pain, although it can be really with any symptom, that if there's a variation, like the more a symptom varies, the better the prognosis. So if someone comes in and they have, you know, four out of ten back pain for part of the day and then it goes to like seven out of ten, but it, you know, they can lay down and it gets better, or they like there's if there's variation and it's presentation. they would do much better than someone who's like seven out of ten back pain or even five out of ten back pain, but it's the same in the morning, it's the same in the nighttime. It's the same if they move. It's the same if they rest. Like it doesn't move. And that was really helpful. And so I sort of retroactively applied that and was thinking of patients that I've had trouble with and patients that I've had more success with. And there definitely has been, at least from my anecdotal memory, reflecting backwards. a correlation to that with patients that had wider variability in symptoms versus ones that had really stagnant, not really moving symptoms. And I'm curious what you think about that, promise.

Toby: Yeah, I think I'm so happy that, you know, that's that's like an idea that's just been bumping around in my head. And so that's great to have it articulated so clearly like that. I think that's right. That's that's my sense, that's right. And how I would think about it is like the body can make some progress or the body can't make progress. If the body can make some progress, it's much easier to help the body continue making more progress, or if the body's just stuck and can't make any progress. That's it's like you have to build something up first before you can get to move it. So yeah. that I think that matches my clinical experience as well.

Angelique: And he was saying too that like we acupuncture works essentially by giving the body's natural ability to heal itself like a booster of like 10 to 20 percent, depending on the person you're dealing with. And so looking at that in the context of the issue that they're coming in for, it's like, is this going to respond to like a thrusters basically 10 to 20% boost of their natural ability to do it? And it's been you like after reading that, I've used that language with patients and it helps. And I feel like a I feel more confident in talking about it using some of that framework. And I think that comes across to patients also. And it's now I know I'll better be better able to identify because I had a patient recently, because I don't want to just tell, you know, like superstar stories of like Saam did an incredible miracle thing.

Toby: That's all I like to hear.

Angelique: I had a patient that he came for a total of four visits, older person chronic low back pain, has had multiple surgeries. not a lot of variability in his back pain. Like it was pretty much the same a lot of the time. And didn't like and his back pain actually would get worse after treatment for a day or two, which I know can happen situationally because I prepare people for like, I wish there's a better word for the healing crisis, but whatever that phenomenon is where sometimes there's a spike in issues before it gets radically better. Except for him, it would just get worse for a day or two and then go back to kind of baseline. And that happened after every treatment. I couldn't figure out why. And I still don't know why that happened, but he's taking a break and I'm probably never see him again. but with somebody like that, I could have been a little more forthright to be like, hey, this is a entrenched issue. This has a lower likelihood of being solved in a shorter number of visits. And I would have been able to set up a more realistic plan of care for him, you know. So now knowing what I know, I can do better.

Toby: I think that's a helpful framework, but I think it doesn't capture everything. I just had a patient recently, it's like twenty years of neck pain, and then it's just gone after one visit. So I mean that's it was just steady twenty years of just always their neck hurt. And they're ecstatic now. But again, if I would have it would be interesting to see if you do that framework. Well, we're gonna need several treatments to get this moving because it'so chronic and it's always been the same. It doesn't change at all with you know exercise or movement or stretching. It's just always there. it would be interesting to see if like you set that up psychologically. Maybe she wouldn't have been able to move so quickly with just one treatment.

Angelique: Yeah, possibly. I mean, I think I think in terms of expectation setting, especially for out of pocket patients. Not that it shouldn't be that way for anybody, but with insurance, people tend to be a little more forgiving because their copays are smaller. So their financial investment is less. but I think just setting up, you know, because of this issue might, like using maybe and might, like the likelihood is or this could be, you know, you might respond really well. Cause how I was explaining it before is that, you know, some people have really wonderful results sometimes after just one treatment. I was like, com more commonly it takes more than that. and for some people, like I have had patients where it got to like visit six and then they were like, I feel this now it'starting to feel better. You know, it took building it up. so I use a lot of like hedging language around that because you really don't know for exactly that reason that you said. Like you got a person that had that entrenched issue and now suddenly it's gone. but yeah. So it was it was helpful because I kind of was I was Failing internally around like, I don't know, like how am I gonna, you know, so it kind of gave me a framework. Nothing, I mean, with everything in Chinese medicine, it always depends, right? Like that's that's the that's our underlying premise. But it helped give me a little bit more of a steady flat platform upon which I can stand, you know, to evaluate it internally and both explaining it to a patient that comes in.

Toby: Yeah. I think that's helpful. Can I ask you one more question about that four time treatment back pain one?

Angelique: Sure.

Toby: Did you ever do the opposite of the one of the channels you took? If you can remember.

Angelique: I don'think so. Cause I did Saam him twice and he was he was like, I don't know about this and one of them was a small intestine treatment 'cause of where his back pain was. and then I think I did A stomach treatment. And then I did TCM twice. So I think he could have probably he might have used a kidney. Like I was thinking, you know, he could have used a kidney treatment.

Toby: But especially with that kind of a response, pain worse and then pain about back to the same, I feel like that's you know, it's a potentially wrong treatment. Again, exactly quoting you from before, we never know anything for sure, but that's a potentially wrong treatment. just worse pain and then and then no progress.

Angelique: I'm actually gonna look. Okay, what did I do here? I can't remember why I did this. he had gallbladder channel pain. So the first treatment I did was pericardium. I did pericardium treatment and then it got worse and then got better. And then the second treatment, see, I was making up it got worse and then he said Well, here's what's curious, is it got worse and then it got a little better because he let me look and see what he said. He did some improved days, some unchanged days. He felt worse for about one day following the visit and then it was variable. So it was kind of like a like nothing great. And then I did a small intestine treatment. and after that one, see this is what was interesting to me because after that he had aggravation of the treatment for two days, but then gradual improvement through the week and he started doing some exercises. Like he started he walked a half a mile without stopping.

Toby: I think this is not my idea then. I think especially if you can do that, then that I think that's not wrong treatment.

Angelique: No. Well that well this was I wasn't giving you the right information. But then he was like it's not but he wasn't comfortable with it being hurting for a couple of days.

Toby: Yeah, that's a almost to the limit of me too, right? I you know, usually a day and then two day but especially I mean, that'significant that he's able to exercise, right?

Angelique: Yeah. And but he didn't he said the re he said the 'cause I was like, well, that'something. And he's like, Well, I think the reason my back was better was because I was I was exercising. And I was like, But you were exercising. You know, so but it'so it was one of those situations. I was like, All I'm not gonna we're not gonna fight City Hall here. And so then after that, because it had so he had some pain that he paused his treatments. So I don't know, I probably won't see him again. But it's okay. I live and I learn. Yeah.

Toby: Yes. And the and then you just do your best you can for every patient and then you just there's nothing more you can do, right? I mean that's maximum.

Angelique: But I always I'm always good in the service realm, you know? Like I always give good service no matter what. So like that well, that was one of the other principles in the book. is that you know, providing an environment and always providing like a good service. Like I'm always really kind and courteous and careful with everybody. And so, you know, I may not have knocked out of the park, but I still took good care of them while they were with me.

Toby: Yeah, but I again that is fantastic. I think that's like the crux of it what we provide, right? Is the secret to care for patients is actually caring about them, right? And I feel like then a lot of little things flow from that. But as long as you just have that intention, then yeah, again, you can knock it out the park with clinical results or maybe bit by bit, as long as the patient they feel like you someone's caring for them. Again, they'll they will report well and then they'll they'll try and work with you. So I think that's really key.

Angelique: Yeah. And I have found, you know, and now that with my sage wisdom of almost two years in practice, that if I, you know, there I spend a lot of time in my head, as you know, and like just thinking too much. And I have found that when I do just that, I'm just like I know I care and I know I'm trying to do the best job that I can do. And when I go into a room with that and just trying to trust that. I do a much better job. Like I think you know, like I actually care about the human being in front of me. I really want to help them. And just coming from that space, things are just easier. And I think when we had talked to Sharon Weisenbaum, and one of the quotes I had brought up to her that she had mentioned before was, you know, like your only job in clinic is to enjoy yourself or like to enjoy being yourself. And I think it means that like you're you show up and you really just want to help people and you are caring and you just operate from that place. And that's okay, you know, and trusting that you know what you know what you know and that something's gonna come out of it. That's gonna be all right. And I my I feel like clinically I've done better when I am more relaxed in that space and I'm not like in my head trying to puzzle solve. actively while I'm listening to the person. If I'm just listening to them and then the answer comes and I'm like, okay, like what you had mentioned at your clinic, the let the patient tell you what they need. And that was so profound. Patients literally, I'm telling you guys out there, would come in and I didn't realize they were also doing this for me. But it's like they would just they would start talking about like, okay, what's going on? They'd be like, yeah, my back, you it kind of hurts and it hurts over here. And then they would be like, and also my foot on this side. And they would like, point to an acupuncture point. Or it would be somebody, like I remember there was somebody, a kidney excess patient that you had that had toenails on display. And it was just so obvious, like, okay, you know, like that makes sense. And being able to trust your sense of that, like looking at the quote grossest thing in the room and being like, that's what it is, and going with it. And when I remove myself from that like intellectual, like physiology qi mechanism stuff in my head and I just look at what's there and I let them tell me what it is that they need. Invariably they tell me. And often it's the last thing they say or the last thing they do. And it's like, this probably doesn't mean anything. But blah. And it like seals the deal for me. It's like, and that's what we're gonna do now. Like I just I knew it. It was just there it is. So I wanted to mention that as well.

Toby: It's beautiful, right? That's awesome. two years in, almost two years in. That's amazing. try and project that out 10 years, 20 years out, right? It just it just gets amazing. This is the best job in the world, right? So it's nice to get a little bit better every time we go in clinic. You know, we'll be a little bit better for the next patient.

Angelique: Yeah, it's kind of wild to think back, like, wow, it's almost two years. So I'm still plugging away. Yep.

Toby: Great. All right. let's let this go for right now. And then let's what do you think about reaching out to Matthew Bauer to see if he'll come on the show and we can pepper him with questions. Okay.

Angelique: Will do.

Toby: Okay, great. All right, bye everybody.

Angelique: Bye.

Episode 30: Patient Empowerment and Clinical Observation

Office Hours with Angelique and Toby. Released September 22, 2026. 21 minutes. This episode is sponsored by Classical Pearls.

Listen: Apple Podcasts · Spotify

About this episode

Toby brings a case from his teacher, Dr. Angela C. Wu: a patient with a history of recurrent miscarriage who is unsure whether recent bleeding is another miscarriage or a menstrual period. The case opens a broader discussion of a clinical principle: whenever possible, give patients the tools to recognize and understand their own bodies rather than taking that authority away from them.

Angelique and Toby also talk about the pace of practice: taking a few breaths between patients, slowing down enough to observe changes in complexion, expression, and relaxation after treatment, and a Daoist image of drawing back the bow before releasing the arrow. In the sponsor segment, Angelique describes moving from hesitation to using Classical Pearls formulas such as Wind Pearls and Bamboo Pearls in her practice.

Topics

• A case from Dr. Angela C. Wu: recurrent miscarriage and uncertain bleeding

• Letting patients become the authority on their own experience

• Pausing between patients

• Observing complexion and expression after treatment

• Starting to use Classical Pearls formulas

A note for listeners: this is a conversation among practitioners, offered for education, not as medical advice. Patient details have been kept general to protect privacy.

Transcript

This transcript was generated automatically and lightly cleaned up. It may contain errors, especially in names and Chinese terms.

Toby: Angelique. welcome back to our office hours show. I'm really happy to announce that we have our sp our first sponsor, Classical Pearls. Yeah. later on in our show we'll be discussing a little bit about their products and their formulas that they do.

Angelique: Yeah, I've got some good stories.

Toby: Awesome. For sure. I was hoping we could get started with if you're interested in it. I meet with my teacher, Dr. Wu once a week and she often provides case studies for me. And I failed this one, so I was gonna I was gonna give it to you if you want to take a take a crack at it.

Angelique: Okay, preparing to be humbled. Let's do it.

Toby: Let'see. May maybe you'll nail it. it's a medical interview case study. Okay. So Dr. Wu, she's mostly treats infertility now in San Francisco. And so she'seeing a patient. her background, she's never been she's never delivered a healthy baby. She's her history is four miscarriages in a row. And she has a irregular menstrual cycle. Trying remember if there's any other key things for that. She's like in her 30s. you know, just so you can get a well-rounded view of her. Anyway, so she's coming to see Dr. Wu and she'six weeks out from her last menstrual cycle and she starts bleeding again. And so the patient asks Dr. Wu, is this a miscarriage or is this my menstrual cycle coming? And so Dr. Wu said, okay, if that was your patient and with all that background, how would you answer? I'll tell you my answer after you tell me your answer.

Angelique: I would wanna know the consistency of the menstrual blood fluid. Like what is what is she seeing?

Toby: She wasn't sure. she wasn't I think Doctor Wu I can't remember if she asked her that or not, but the patient wasn't sure.

Angelique: This is somebody who miscarried in history historically like first trimester.

Toby: Four times, yeah.

Angelique: In the first I mean, I don't know if there's a way to know. I would probably say there's no way to know. That's but I bet that's wrong. Doctor Wu was like, No, you would know and you would tell by this. So what did she s how could you tell?

Toby: I asked I'll I'll tell you what Dr. Mu knew at this point at the end. but she said to the patient, this is Dr. Wu's way. She always wants to give power back to the patient. So it's a little bit like what you were saying about what's the what's the consistency of the blood, you know, i can we tell something that way? But Dr. Wu asked her, now you've miscarred before and you've had so many menstrual cycles. What about in your body? How does this feel?

Angelique: That's nice. And what did the patients say?

Toby: Patient starting crying a little bit. and it was because nobody redirects backs to the patient, right? So again, it came back to the patient. this really is my body. It'so trustworthy. And if I pay close attention, it will tell me the answer to that. And so then she said, you know, it feels like a menstrual cycle. And Dr. Wu said, yeah. So it's good to know these kind things to differentiate these they feel differently in your body, and they had an interesting conversation about it. So I said to Dr. Wu, Dr. Wu, could you tell? From pulse reading, she's real pulse master and she said, Yeah, obviously it was menstrual cycle. But instead of just, you know, showing, I knew it was your menstrual cycle, she just always does that redirect back to the patient.

Angelique: It's really valuable.

Toby: It's extremely valuable. I she trained me so many years to do that kind of thing. And I just I often forget, right? Because I want to be technically correct or you know, not mislead the patient in a certain way. It's really nice to give the power back to them. That's really where everything's gonna happen inside their body. Yeah. And so the more you can empower them and then bring them back into their body, then just everything gets better from there. So yeah. yeah, that's that's one of our main teachings and I again forgot it.

Angelique: Yeah. Well, thank you for sharing it with me. Okay. And with everyone, 'cause I think that's really a valuable a valuable thing to do. Especially

Toby: I think so, yeah.

Angelique: With the biomedical system. There's not a lot of empowerment. I feel like, you know.

Toby: They always want to tell you. Right. And again, I think that's what I want to, you know, when she put me in that in her shoes, right? I also want to tell her and you know, give her some medical authority. it's like this or like that. But truly, you know, it should go back to the patient, right? And especially if they can learn something from it and be embodied again. Again, that's that moves their health along and helps their body functioning better, much better than, you know, from the outside imposing something.

Angelique: I wonder what Doctor Wu would have said if the patient was like, I don't know.

Toby: Yeah, but I think that's that's another invitation, right? To say, well, you know, try and feel about how this is feeling and then later on you can see like, this feeling and then try and match it to future menstrual cycles and see if that was right or not. You know, something like that. I mean again, she would just she just all that's a good speculation, but I that's my sense. She just always likes to bring it back to the patient.

Angelique: Mm. No, that's great. I like that. Yeah. Yeah.

Toby: So thanks for going through that with me.

Angelique: Yeah, sure. I knew. Humbled again, you know.

Toby: That's it that's me.

Angelique: Yes. Well, it I think it's it's helpful. It's helpful. I think this practice is humbling in a lot of ways.

Toby: Yeah. It's hard to be arrogant and a clinician that pays attention. I think I think that's incompatible.

Angelique: Yeah. And one thing that I've been really trying and I have not always been successful, but breathing between patients, like you've mentioned, I actually even wrote myself a note on the desk where I sit. It was like breathe between patients, like underlined because I'm in this flow of like I'll come out of the room, I'll sit down, I'll do some charting and then I'll go into the next room. But I found that when I do just sit, and it's like sometimes only for five breaths. And I try to do ten, like ten sometimes isn't it feels uncomfortable, like I start to feel like antsy, which probably means I should just sit there for twenty breaths, right? Like that's the whole adage with meditation. But it is it is helpful. It's like a I don't know, spiritual squeegee in a way, just kind of like clears the clears the glass a little.

Toby: Yeah. It that pause in between patients. Yeah. I feel like I really get up to see a patient. And then it's nice to just pause and then everything can kind of go down and then get up to see the next patient rather than just I used to I think I might told you this. I used to see almost 30 patients a day and I'd just be up. And then by the end of the day, I was just kind of wacky. but so now I feel like just as I see patients, right? See a patient and then let down and then see a patient and let down. Again, it just it yeah, it did everything the my flow was much better rather than just ratcheting up my whole day.

Angelique: Yeah. And we haven'talked about this yet, but I saw I went out to visit you in May and got to watch that in action. And I think you had fourteen to sixteen patients between the two, like each day. And it did not feel that way. Like I've I've seen up to fourteen fifteen in my own clinic and did not it did not feel the way the fourteen fifteen felt in your place. And I mean, in fairness, you have Stephanie who's amazing and just takes care of the whole front of the house business and changes the rooms over and stuff. And I think that, you know, speaks volumes when you have a person that's her seeking her clone on the East Coast, you know, 'cause my person is now in acupuncture school. But it was really and it was nice and being able to sit and I remember being uncomfortable at first even then because I was like, I had questions and I wanted to know stuff. And but then I got used to that. And it really does sort of like let you down, like in the best way. It just kind of shinks you in and then okay. And then proceeding. And the day went by quickly and without stress and frenetic energy, which was really nice to see. It's like, that's possible. All right, cool.

Toby: Yeah. And let'say let'say you're you're two minutes late for the next patient, but then you're totally you know, let down from the patient before. I mean, that's a little bit of a gift to the patient. I mean, you want to try and be on time as possible, but if you're just a couple of minutes late, but then totally present for the next case, I feel like that's that's one of the better moves you can make.

Angelique: Yeah. And you're doing it without pulling from a reservoir. Cause I think I think when I have I like to believe that I'm present most of the time, right? The majority of the time. But I think sometimes there's a lot of effort behind the presence, which is less effortful when you've actually allowed yourself to be at ease before going in to see a person.

Toby: Like in Dao's image, right? If you want to shoot the arrow forward, you have to pull back first, right? Right. Yeah. That's that two minute of pull back. So then yeah, you can really be sharp for going to see the next patient.

Angelique: And it really does feel different. So I'm not perfect at doing it, but it'something that I've been conscious of. And when I forget, I just the next time it happens, I go back to it and I've got the little note to remind myself. And now that my assistant person has gone to acupuncture school, which will be great for our profession, but it'sad for me. I have my patients spaced in a way where they're close enough together, but not so close together that I feel the push.

Toby: Yeah, but that's an easy that's an essential. especially Chinese medicine clinicians, right? It's not pure algorithm, right? There's there's a lot of things we have to pull from. And so to look things up, to just ponder something for a little while, you need that little bit of space.

Angelique: Which is good. And one of the one of the nice things about being able to watch you practice is being able to see Saam working and you're not the one doing it. Like myself personally, I wasn't doing it. So I was watching you and still like diagnosing alongside of you and like writing it down and seeing how I was doing throughout the day in terms of channels and watching you do it and then watching the patients and watching the faces. Like I didn't realize how important. Like I kinda got it. Like the watching people's complexions change, watching their faces relax, watch just so there's the quiet that comes over people. There was just it was so great, so Or not relaxed.

Toby: Yeah, or not relax, right? Again looking for both of those, right? yeah, that's been great. I have an interim with me this week and it that's been really valuable too, looking at faces.

Angelique: Yeah, it's it's a subtle thing. But it and it's easy to I think it's easy to not pay attention to as closely. But I know since going and visiting with you, like I am much more aware of people's faces now than I was before.

Toby: I think psychologically too, right? We're we're, you know, and socially we're designed not to like kind of stare at someone's face. Right. So you have to you have to be a little bit careful with that because yeah, you gotta be creative and I mean you wanna help them. So that the I think the vibe is totally different, right? Because they know you wanna help them, but still you've gotta you've gotta really take in that complexion. So yeah, that's it's that's I think that's hard for people to look at other people's faces, right? There's there'something about that makes that difficult. So And then especially and then and then to note, you know, I think yeah, you're right. They can be subtle, but sometimes they can be really significant. Sometimes it is especially anything really significant, we want to be able to notice that. So

Angelique: I just remembering prior to watching how you did it, which is just like you'd look and then you'd kind of like fuss with something on like a side table and then like look again. And like I remember kind of trying to position myself, like looking at people, you know, and then like having them like look at me. Yeah. And being like, It's okay. I'm just I'monitoring, you know. And then realizing like, I can just go fuss with other stuff in the room and go back to them. Like I don't have to sit there and like laser focus on their face, which is too super weird. I always thought like that's part of the reason why I sort of like didn't do it as much because it was such an odd like, how do I do this without being a weirdo? You know? And so bussing about in the room is a way to do it.

Toby: Yeah, you do you take over your accu trash and then do something. Yeah, I really do have that kind of style, right? 'Cause again, we just need a few seconds. And then this tends to what happened to is we have patients too take three deep breaths and then they tend to close their eyes almost, you know, ninety nine percent of the people. So that's a little bit nice too. Then it's not it's not direct eye contact, just staring at them. Again, they've gone they've gone to their nice acupuncture relaxation place. So we can just monitor their complexion easily that way.

Angelique: Yeah, that was good. And then watching you use the Classical Pearls because I had previously been intimidated by them. And when we spoke to Heiner Fruehauf and he was basically like, use them. And I said, Okay, and I did. But it was seeing you use them first and looking in the book and you pointing out like Read this description and tell me what you think. And it was like a description of a formula, but it was also very similar to the patient we had just seen. And so then I started reading through that book and started thinking of patients that I had, but still felt really sort of intimidated. Like I need to have more education. I always think I have to have more classes or something. I'm one of those people. Like I must take 17 classes before I can actually do something. but I after talking to Heiner on that episode, I ordered several of them and I started using them. And, you know, I would say With pretty good success. Not a hundred percent some weird stuff's happened, but I've had pretty good outcomes with wind pearls, which is for allergies, and also with bamboo pearls for people that just have a lot of like joint pain, especially of like the rheumatoid arthritis type joint pain, or what might be but isn't fully diagnosed as that, but kind of presents as a little warmer and achy. So that's been really that's been really great. So I'm excited that we're being sponsored by them because I'm actually using their products. I'm excited by their products. And I tell my patients about them because I had used other patents that will remain nameless prior because that's what we used in school. And I just they didn't, I didn't feel like they hit the mark all that well. But these feel like good to give to people, especially because they're clean, you know, too. So that's my story.

Toby: Okay. So that's awesome. Yeah. That's that's maybe be one of our sponsorship things. One of us has to been using that product for 15 years really successfully and excited about it. That maybe that'll be our sponsorship mark for them to hit. Cause that's what I've been using that those classical reports for about 15 years. Yeah. So I feel like yeah, that's I gonna I'm really happy that they're they're wanting to sponsor our little show.

Angelique: Yes. You've been using them for fifteen years. I've been using them for fifteen minutes. So far, so good.

Toby: Yeah, maybe nice contact us. So I think they're gonna sponsor a few of our shows. So we'll you know we'll anyways we'll take a few minutes for each show to just talk about our experience.

Angelique: Yeah, and tell stories like real ones from our clinics with them for better or worse, right?

Toby: So that's next time episode for sure where you'll present one of your cases, especially with bamboo or wind pearls. I feel like those are both. Yeah. Those got some real clinic well, I maybe all the formulas have some decent clinical potency, but those tend to move things pretty quick. So

Angelique: Yeah, it was remarkable. I'm like actually ex I'm excited to talk about it.

Toby: All right. W hold on until next up.

Angelique: Holding on. I'm holding on. All right.

Toby: Anything else you really want to talk about today?

Angelique: I wanted to tell you about a case that I had with a patient that I've been treating probably for close to the full almost two years that I've been in practice now of my own, which is crazy to say out loud that in December it'll be two years since I opened my practice. That's great. And this person found me pretty quickly. I don't remember exactly how she found me, but she did. And she comes fairly regularly. She's kind of like an every two to three weeker person for like a tweak or whatever's going on. and I had tried she's I enjoy her very much that she's a very gallbladder excess person. So like super irritable and kind of, you know, cranky about the world and just sort of cranky in general and sort of comes like has gallbladder presentation, like really big, like eyes that are sticking out, you know, like kind of walks kind of forward almost like Du channel excess a little bit too. and You know, for the longest time I was like, I really want to try this. And so I had tried Saam once before, several months ago. And the needle pain was such that she like she actually started crying from pericardium nine. So I was like, Okay. We like reeled it back in and I stayed away from it. But she kept bringing it up because she was really curious because she cried, but then she felt better. And then she's like, you know, I'm really wondering about what you were doing before. I'm really wondering about that. And so I talked about like the Chinese medicine concept of the pericardium and like all those things. It was little a little while ago. I talked to her and do it again. I said, you know, I really think this would help you. And she has all kinds of body pain. She takes over-the-counter medication for and She has some like blurry vision and she sleeps kind of weird. She's got all this stuff going on. She gets a little short of breath from time to time. So I'm like, she needs a pericardium supplementation so bad. So she let me do it and I use the 25 by 30s instead of the 40 by 30s. And she tolerated it okay. And I sent her on her way. And when she came back in, she started crying because she was so grateful for how good she had been feeling for two weeks. She talked about how. And she keeps these little this little journal where she writes down like her days. And she flipped back to like before the acupuncture treatment and had me read some of the entries. And then she had me read the entries after. And it was like, today's actually a good day. I feel good today. No medication today. Wow, I feel pretty good today. Things are looking up today. And she was less irritable. Like it was profound the effect that it had on her. And she was like in tears, so grateful for. me doing that for her. And then of course I'm redirecting, like your body needed that. Like it needed the message to be able to correct these things. And yeah. But it was just it was interesting to me that I had tried it. It didn't work out 'cause she couldn'tolerate it. But she remained really curious about it almost like part of her knew she needed it. And then she let me do it. And it has really helped her.

Toby: That's amazing. Just have a few seconds of it and be like, I'm really curious about that pain I had, what I started to feel. That's that's amazing. And then and try and loop back on it. That is amazing. Yeah, I think you're right. Her body I mean, I we don't even have to speculate anymore. her body recognized what she needed. You know, that little that little glimpse of it. And then you came back around and we gave it gave her a big gulp of you know, what she was really thirsty for.

Angelique: And it was shocking. Like I didn't I didn't expect that either. Like I didn't expect that. You know, I expected her to feel maybe a little better because it was such a clear like that you're obviously gallblad excessive. Yeah. You know, gallbladder tension, channel tension, you know, just the whole the whole it's like a ticked all the boxes. Like and I'm not supposed to be a hundred percent sure about anything, right? Because then you're usually wrong. But it's I mean, probably ninety nine percent. I'm like, this is what this person needs. Like just I felt it in my bones. So that was really cool. I wanted to tell you about that.

Toby: Yeah. Every once in a while I feel like someone's read a Saam book and then come and present it that to me. You know, I'm like that's that's just too perfect of a map.

Angelique: As we won't like side eye them like really.

Toby: Shortness of breath and for sleeping, come on.

Angelique: And you're cranky and you're like kind of aggressive. Okay. All right. That's my big story. Anything for you?

Toby: Is working on that school. So that'seeing patients and trying to create a school. the welcome the first cohort a year from now. So that's a lot of prep for that. Yeah. Yeah.

Angelique: That's good. And I understand some acupuncturists have donated.

Toby: Yes, acumuncturists are donating to it. So this is the idea of the school is not burden the students. So the idea was to have, you know, take donations for the startup cost for the school. So a lot of patients have been really generous and starting to trickle in a few acumcurists also wanting to pitch into the school. So I really appreciate that too, because again, the whole idea is not to put it on the students. So the school itself is gonna have to write a hundred and fifty thousand dollar check very soon to accreditation. So yeah, we th we needed a few a few dollars to gather for that.

Angelique: Mm-hmm. Just a few.

Toby: Yeah. I'm acupunctures too, so I know yeah, I don't know, just have my hundred and fifty grand sitting around. So

Angelique: All right. Okay. Maybe we leave it here for today?

Toby: Read. Yeah. It's always nice to see you and talk to you a little bit.

Angelique: Yes, likewise. We'll see you next time. Bye.

Toby: Okay, I'm

Angelique: Bye.

Episode 29: Roots, Trunks, and the Foundation of Yin and Yang with Sabine Wilms

Office Hours with Angelique and Toby. Released August 26, 2026. 60 minutes.

Listen: Apple Podcasts · Spotify

About this episode

Translator and teacher Sabine Wilms, PhD, joins Toby and Angelique to talk about classical Chinese medicine and the difference between literal translation and lived interpretation. She explains how her book Humming with Elephants grew out of years of teaching the Su Wen, and why small translation choices for terms like ben and gen can change how practitioners understand ideas such as the root and the foundation.

The conversation moves to Sun Simiao’s writing on the ten months of pregnancy and on postpartum care, with its emphasis on nurturing the mother and family as well as the fetus, and to Sabine’s upcoming projects on pregnancy and on self-cultivation. It closes with reflections on moderation, rest, movement, service, and listening to the body and the seasons.

Topics

• Sabine’s path through East Asian studies, anthropology, and medicine

• Literal translation versus lived interpretation

• Humming with Elephants and teaching the Su Wen

• Ben and gen: root and foundation

• Sun Simiao on pregnancy and postpartum care

• Self-cultivation and listening to the seasons

Key terms

• Su Wen (素問): Plain Questions, the first part of the Huangdi Neijing

• Ben (本): root, origin

• Gen (根): root (of a plant), foundation

• Sun Simiao (孫思邈): Tang dynasty physician and author of the Qian Jin Fang

A note for listeners: this is a conversation among practitioners, offered for education, not as medical advice. Patient details have been kept general to protect privacy.

Transcript

This transcript was generated automatically and lightly cleaned up. It may contain errors, especially in names and Chinese terms.

Toby: Okay. Sabine Wilms, thanks so much for coming to office hours and spending some time with Angelique and I.

Sabine: Thank you for having me. It's it's delightful.

Toby: Okay, great. if you wouldn't mind, I th I think a lot of p of our listeners will be really familiar with your background in your work. but would you mind giving us like a brief sketch of what you've been working on, how you came into the profession? And then if you could bring us all the way up to one of your latest projects, the pebble in the cosmic pond with Leo Lok if you could bring us through there, if you if you wouldn't mind setting us up like that.

Sabine: Okay. The five minute version? Or the two hour version?

Toby: The broad br the broad brush stroke so he can set us up for the rest of our conversation.

Sabine: So I have a I started out, I come from a family of, they're all biomedical doctors. So I went the other direction, rejected all that, and went into East Asian studies to study Chinese philosophy. And somehow came back to medicine as and anthropology as well. And medicine somehow I took some classes in medical anthropology. And my professor was like, my god, you can read the ancient stuff. This is so awesome. So I learned from my anthropology professors how to ask questions to try and understand early Chinese culture. And I happened to be pregnant at the time and the female body is a really juicy topic. So I translated a text on gynecology, and my Buddhism professor told me, there was no because I wanted to know about the relationship between medicine and or the influence of Buddhism on medicine and medicine on Buddhism. And he told me that was not a thing in ancient China, in early China. And then my other professor told me that there was no gynecology in early China. So of course I had to pick a topic that. Proved them wrong. so that was my dissertation. And then I just started over time teaching practitioners, in addition to being originally an academic, because practitioners care about what I do and what I know in a very different way from academics. So I feel like I'm really lucky because I'm not a clinically licensed practitioner. my background is as an academic and a translator, but I have an audience and students and colleagues who practice. And I think the older I get, the more I just acknowledge that I healing is like it's in my bloodline on both my mom and my dad's and all my relatives and grandparents and my daughters side. So it's ta it's been like a really long and then in the in there I was like a biodynamic goat farmer and somehow that related to fertility and agriculture and healing the land. I don't know, like nothing really makes sense, but somehow I've ended up in a place in my life which I love to share with people. It's like I just have made decisions, some of it dumb luck. But I followed my heart and I've always wanted to do something that is meaningful to me. And sometimes I haven't made any money at it. I've worked really hard. But I'm now in a place where I get to sit at a desk looking at the ocean, having my goats and my little mini farm, and teaching students, creating classes with my business partner Leo Locke. Who happens to be in Vietnam and I just got to visit him and spent a few months in Vietnam working on creating a class on nurturing the inner nature, like longevity, spiritual, physical cultivation. And here I get to have a conversation with you guys. So I really want to encourage all the upcoming people who listen to our sorts of podcasts. And then Leo and I had the Pebble in the Cosmic Pond podcast. You know, I feel like the young practitioners enter our profession with such most of them with this passion and dedication towards making the world a better place through their presence. And I really feel like if you follow your heart, it's possible. And the world depend like I don't know, there's a way in which you can maybe it'stubbornness, may I don't know, maybe it's luck. And I'm sure you too have that experience, right? Where we can create a better world with our

Toby: Yeah, I think so. especially, I mean, it'so great. Your role really helps inform what we do in clinical work. huge impact for me was your Journal of Chinese medicine article on Sun Summiao. This is several years ago, made it just a gigantic impact on me. And then one of my favorite Chinese medicine books of all the Chinese medicine books available is Humming with Elephants, which that was just fantastic. So maybe Let's l maybe if you if you don't mind, take us into your work with humming with elephants, right? What were you thinking about that? Again, just from my perspective, it's an amazing text because we get to look in Su Wen five, but not usually like a translation of it, but through the translator's eyes of Su Wen five. So did the project start out like that or how did that go?

Sabine: No. What I've really learned in that process is that, you know, none of us

Angelique: No, like

Sabine: Each of us have all this knowledge in our heads, and we think everybody around us has that same knowledge. So when I wrote that book, it actually so the book came it's a compil it's basically just a transcript of my notes based on teaching that text over many years at the NUNM, the National University of Natural Medicine, in several different classes. I was teaching a class on history of medicine. I was helping with the foundations. I was doing the classics, whatever the classical texts course. So whenever I we would cover that chapter, I would my translation and my discussion and my notes just kept getting bigger and bigger and bigger. And then it was like, all right, I'll just, you know, translate the first five chapters and turn it into a little book. And then and then I looked at Su Wen Five and it turned into a big book all in its own right. And when I published this, I was actually really worried that it was so obvious because to me everything I wrote in that book is so obvious because that's the world I live in. And then my friend Deborah Betts, I sent her a copy. The gynecology, the I don't know if it you're familiar with Deborah Betts who wrote the book on pregnancy.

Toby: Very familiar with her, yeah.

Sabine: Yeah. And she was like, Sabine this is brilliant. This is the best book you've ever written. And I'm like, what? So it was basically just a transcript of what I'd been teaching for many years in at college and at conferences and things like that. So it wrote itself actually pretty quickly. It was a fun book to just put the stuff together.

Toby: Okay, that's a that's amazing because yeah, that's not just my opinion. I was talking to a colleague the other day and they were saying, that's my favorite of your works too is that humming with elephants. Again, because we get the translation plus the translator's view while we'reading that. And it's just so valuable. Especially that particular chapter in the Su Wen So there'so much that comes out of that. I mean, that's the basis. I mean, if we only had that chapter, we could probably recreate you know a huge portion of Chinese medicine because all the basic theories are presented in that chapter and everything like that. But it's great to have your again, your looking through your eye it's like looking through your eyes at that text and it's just it's just it's it anyways really valuable. So I highly recommend that to other people. I often do.

Sabine: You know, I love that chapter. And I mean part of it is just like I just feel like it's inspiring, it's beautiful, it really is. Like yin and yang and the five agents, five phases, five elements, whatever you want to call That's the root of our medicine. And that chapter makes this argument that our medicine is so much bigger than just, you know, point prescriptions and matching patterns to formulas. Like it to me that chapter is just such a beautiful condensation of this grand vision of the medicine of it's not correspondences, it's resonances. You know the resonances and it's all about qi and microcosm, macrocosm. So I love the text and I think it's really My work is really inspired by the attempt to take the classics out of that dry academic context where if you read Su Wen Five in translation, just a text, it can be the best translation, you just don't get it. Because you there's no way you can read a sentence in English, in English words, and know all the beauty that's in that text. To me.

Toby: Okay. now I'm I have a request from the rest of the profession. What about the other eighty chapters in Su Wen? Is that is that is that is that on your you have like a big whiteboard of like projects going forward and could you put the other eighty chapters of

Sabine: Sure. I'm I'm finishing I'm finishing two books that I just I got a ton of work done in Vietnam. So I'm finishing up a book on pregnancy and then I'm doing a book on Yang Xing, on nurturing our nature, which is based on this class that I taught with Leo Locke two years ago and that we're gonna teach again starting in September. And that's about physical and spiritual and moral cultivation. self cultivation and also longevity practices for the profession to share with their community and patients. So those are priority because I figure that'Sun Sumiao and that's never been translated. And the Su Wen there are so many other versions out there. But I do have most of the Su Wen chapters in draft form with lengthy commentary. So it's totally on the list.

Toby: Okay, that that's that's that's really exciting to hear. do you mind talking about those two books or is it do you are you not able to talk to about are they still too much in flux to talk about or are you okay talking about?

Sabine: One is one is the pregnancy one is basically done. So that's a translation of the ten months the Yang Tai, the ten month on nurturing the fetus. Or it's really about nurturing pregnancy. So I've realized that Tai, the character, doesn't just mean fetus, it also means pregnancy. So it's about nurturing not the fetus, but nurturing the mother and the fetus, which is a really essential Difference.

Toby: Yeah, th something just clicked in my head about that. So yeah, that's that's really important, right? Of course, in order to nurture the fetus, you have to nurture the mom, right? That's that makes perfect sense. You can't directly

Sabine: Yes, and it's even bigger. It's it's the ultimate goal is in biomedicine. I think I don't want to put down biomedicine, but I think in our current dominant model and in our culture, the focus in reproductive medicine is on the baby. And my one of my areas of interest, and that's also why we Leo and I did a course on postpartum pampering and that's Another book on my list of almost finished manuscripts is a volume on postpartum care. but it's really it's not just about the fetus, it's about the family and nurturing life means taking care of the mothers and not just cranking out babies. So this whole prejudice that we have against early Chinese medicine being misogynistic, patriarchal, patrilineal, and you know, like people in our profession, some people still have prejudices and they say that our modern Chinese medicine is so much more superior to what's in the classics because we live in this enlightened culture where, you know, we have the integrative medicine and there's progress. And I'm like, no,

Angelique: No

Sabine: Actually When I read Sun S Miao, there's a care for the female body that I don't see in modern biomedicine or the popular culture, like concerns about menstrual conditions, whether the woman wants to get pregnant or not. And so I'm a big advocate of reproductive care, not just for the per not just with a aim of taking care of the producing babies but really the full circle of the family.

Toby: What does that look like for those 10 months then? Can you give us a overview of those 10 months? What's happening? Is that too hard to do?

Sabine: Well, for every month no we can take this con this conversation wherever you want to. Okay. so there is advice, there's information on the development of the fetus from month to month to month, and then there is for each month you get an associated channel that is in charge of nurturing the pregnancy And so each channel, each month is associated with the channel and with the five elements or dynamic agent. I like five agents better. so you go through the months and It actually matches nicely with biomedical knowledge where in the beginning it's all about avoiding miscarriage, right? So you are avoiding fright, the scattering upward, and the fear, the going downward, the sudden exposure to emotional turmoil, you'really careful about rotten foods. So in the beginning it's really important that the mother is protected and living in stillness. and then in the middle she's encouraged to be really active and move like a monkey and also with diet eat the food of eat the meat of predatory beasts and watch like lions and rhinoceroses and then and in the third month the this is the key time when the fetus after the third month the sex of the fetus is set so up to the third month you can manipulate the sex by exposing the mother to jewels to female things female associated things if you want a daughter and to male associated things if you want a if you want a male and a son and that sort of thing and then so Yeah, it's really cool. And then in the middle she's encouraged to be really active, move and shake a lot, and then in the end it's all about releasing, letting the hair down, so to speak. releasing the belt and having her wait it on and eating sweets and really relaxing and feeling safe and then in the end taking certain substances to help. The birth goes smoothly. Hmm.

Toby: What two channels do they leave off? because every all ten months have a channel and then two are left off.

Sabine: Wait. the heart? And I think that no, the Sanji is part of it. the heart is definitely left off.

Toby: That's interesting.

Angelique: Well

Sabine: You don'treat the heart, right? You treat the pericardium. So you don'treat the you never manipulate the emperor. So that makes sense from a classical perspective.

Toby: Yeah.

Sabine: Yeah. what's the other one? That's a good question.

Toby: I didn't mean to stump ya.

Sabine: Yeah, you did you did stop me. I have to think about that. Sorry. You're a channel person and I am not so much a channel person.

Toby: But anyways, so yeah, t each channel gets a month for ten months. So that just I just did a quick math there. but anyways, maybe that's a teaser for people to get the book. They can find out which channel's left off besides the heart. That's good.

Sabine: Thank

Angelique: Sure.

Sabine: You for getting me out of that one.

Toby: All right. What about can we talk about the other book too? or is that still too in flux?

Sabine: We totally can. I mean, I've been teaching it. So basically it's the translation and both of these books are so they're literal translation of two vol different volumes, different texts from Sun Tsumiao, from the Thousand Gold, the Beiji Chien Jin Yao Fang, the Thousand Gold Formula. So the Yang Xing, the Nurturing Our Nature, is volume twenty-seven, which is one of the last chapters, and it's a really complicated text because it's this it's not just medicine but it's a lot of Buddhist and Taoist concepts and terminology flowing into and merging with the medical language. So that I've been working on that people have been asking me about that for decades. And it's been really great to have Leo Locke to help me with the translation. Because he's extremely knowledgeable in Buddhist texts and in medical history in general.

Toby: And Taoist text, right? Yeah. I heard I heard him talk before about meditation sickness and it was really helpful. I have a really good friend that'suffering from meditation sickness right now. It was great to have him with all his historical perspective on all that. It's it is really valuable.

Sabine: Yeah. And then and then I'm always including the Jiang Lu, the seventh seventeenth century, I think, commentator, the only commentator on the Chen Jin on this text by Sun Tsuniao. So I've

Toby: Wow. I didn't realize that. I just ama in my mind I imagine we've you know, like the Su Wen we've got dozens or hundreds, right? Just one. Wow.

Sabine: Yeah, it's really interesting, huh?

Toby: What's the reason for that just one commentator over having it for all that time?

Sabine: I mean one thing is that it's a very different text. The Yellow Emperor's Classic, as you know, is a really complicated text. And it makes sense. And it's more it's much more of a philosophical text. so the commentary really is necessary. And it's also an earlier text, so it's more of a, you know, classic in that sense, because it's from the Han Dynasty. Whereas Sun Ts Miao Sun S Miao's text is a collection of formulas mostly. So it's much more of a clinical text. And if you're a person who knows how to read classical Chinese, for the most part, the formulas are fairly straightforward where you can read the symptoms, you read the ingredients, the indications, ingredients, and the preparation. But the juiciest part are the theoretical essays and they are pretty challenging. And especially that volume, the Yang Xing volume, it's it's it's a really hard text. It'so I've been working on it for decades, and now I've been teaching it with Leo. We did it two years ago, and then we're currently preparing to teach it again. That's been the best way. I love teaching to prepare for writing a book actually. Cause

Toby: Yeah.

Sabine: It's a little bit less hardcore, right? You're you're you're sharing drafts and you're discussing them with the students.

Toby: Direct feedback from clinicians, yeah.

Sabine: Yeah.

Toby: Wha where's that class gonna be held from? is a platform? Okay. No, but I mean a platform. Okay, great. All right.

Sabine: Yeah, you can find all my books and everything at happygoatproductions.com.

Toby: Awesome. Okay, I was gonna let Angelique ask you questions now because I got a dozen but I'm gonna try and hold back.

Angelique: I always it when I have the opportunities to listen to the discourse of two folks who've been in this profession for so long, I just I love to just listen. But I'm curious. I'm I'm newer to the profession. I'm almost two years in and it's my second profession. I was a nurse for a long time before that. wow. And so yeah, it's great. It's nice to have the merging of the two mindsets sometimes not so much. But, you know, one of the things that I mean, I feel like I'm on this little boat floating in the sea of knowledge that I'm never going to be able to learn all of. And I know I've got classmates that I speak to that, you know, we have this fantasy of being able to learn how to read classical Chinese ourselves. And I understand you teach lots of folks how to do this. And so I'm just curious what your thoughts are on that and when one should maybe delve into that or not, or just sort of any gems you have around that.

Sabine: You know, it'such a great question. And I think there are there are peop like it there are people who have a brain that is easy, that can that has a like for me and maybe part of it is that I grew up in Europe and I l I started studying Latin and Greek when I was in fifth grade. And we went to Italy and France. when I was a little kid and my parents would just leave me in France, you know, with a bunch of French kids. And so I grew up with a lot of foreign languages around. So that really helps, which a lot of Americans have not had that exposure. And that makes it I've been teaching American students now for a long time and it and it's it's hard. I think it's really important to be clear that you do not now there are so many high quality teachers and publications and online courses available for Western for practitioners who don't speak Chinese that you know don't put any pressure on yourself. It's it's a big project. It's really fun. I love teaching. I love teaching classical Chinese. It'such a weird thing. I remember being in Korea and I was at it a conference on East Asian traditional East Asian medicine in Korea like ten years ago or something. And it was all East Asian people. It was mostly Koreans and some people from Ch some medical historians from China and Japan and Taiwan. And I was the only foreigner and I was explaining to them what I do at my class at NUNM at my program with this classical text program. And they were just like, Are you insane? Like, what? You're teaching people who are learning to be practitioners. You are, in addition, teaching them how to read the classic. And I'm like, no, we are not creating translators. And that's what I tell my students. It's, you know, if you want to be a translator. of classical text. You really have to go to East Asia and live in that environment and you have to be fluent in modern Chinese and in classical Chinese and ideally in Japanese or at least be able to read Japanese secondary literature. Think practitioners can get so much clarity out of just a little bit of Chinese, a little bit of access, so that you can read the English trans or whatever Western language you use, the translation alongside the traditional classical Chinese text. And the same with texts like the Yijing or the Lao Tzu. Because we have translation projects, you know, translation software now. And I'm I'm a total dinosaur with technology, but Pleco So I the first thing I teach my students is here's how you set up your dictionaries on Pleco for classical Chinese translation, and then here's how you plop digital versions of the classics into Pleco. And then you look them up character by character by character. And then in my I run a two-year training program in classical Chinese that's very involved. And it's you know it's expensive and it's a big commitment. But even the first class, it's the foundations and it'six months or something, and we cover the basics of grammar. And if you have the very basic rules. in combination with these digital tools that like it'so fun for me to teach like a little bit and then read the text with people and that's really how what I kind of wanted to replicate with the Su Wen F with the Humming with Elephants book. That process of just looking at the English, looking at the Chinese, and then digging a little bit deeper. But there's there's you know there's no there's no need There's no urgency.

Angelique: Glad to hear that. I don't feel urgency, certainly, but just sort of like I wonder. And so that sounds like I'll read your s your translations for now.

Sabine: Yeah, and play with it. And you know, there's there's there'so much fun that you can have with just plopping digital versions into Pleco Mm-hmm.

Toby: We should we should say you think

Sabine: Toby.

Toby: About I think I think anyways what I have is just like a minute semi working knowledge of Chinese language, right? I feel like that has unlocked so many things for me to be able to directly look at things and understand what they're saying. I think is really valuable. Like you say Thai is not just the fetus, but the mother also. I mean that again, that's another unlock for me. or pregnancy.

Sabine: Pregnancy.

Toby: Pregnancy, sorry. but anyways, it'so valuable, right? Because again, right, that character's there. And then you can just add more and more knowledge on it. Whereas just the English word, I guess, I think it's kind of locked in, right? If it if it's just fetus if it's always translated as fetus and not pregnancy, then you're you're kinda you don't get that fuller knowledge. So I again I feel like that's valuable. But again, like you said, I mean, to be a translator level, which again, it's too late for me for that kind of thing, but working knowledge. I think almost every practitioner would really benefit from just some basic working knowledge of it.

Angelique: Mm-hmm.

Toby: It is Chinese medicine after all, right? So we should, you know, we should be able to, you know, look through some of the basics. And then Sabine, I wanted to thank you so much for we're we're working right now with having you come on to the Chinese Medicine Benevolent Academy and then you'll be teaching some of the basics of Chinese language for the students, right? So again, so they can start off straight out the gate having some basic knowledge about you know what they're learning so they can directly impact things. So I think that's great. Like Teaching them the tools how to they can fish later, especially with Pleco is so valuable. Pleco has that tool where you can just you can take a picture of the character and then it can import that and tell you what it is too. So I mean it is really valuable. When you know, once you get introduced to that tool, then again, that could help you for the rest of your career. Maybe you go to translator level, right? But otherwise it I think it'so valuable to have a working knowledge of that. The curriculum for California actually doesn't require that. But we were able to shoehorn that into our program because I think it'so valuable.

Angelique: Mm-hmm.

Sabine: And think it's inspiring, right? When you when you figure out that, like in Su Wen 5, like I think it's the second sentence where it's like so to treat disease, you must seek it's always translated as you must seek the root, right? And it's actually you must pursue it in the foundation. There is a you must pursue it. In there is a there is an in and then the ben is not root, it's it's the core of the it's the trunk of the tree

Toby: Mm.

Sabine: Or the foundation, which is very different from root. It's actually way bigger. So you know you can get me going. I'll talk for an hour about the difference between gen which is root, and ben, which is trunk. And what's the difference between pursuing The root. And it's always translated as in order to treat a symptom, you have to look for the cause of the disease. And it's actually way bigger than that. It's you have to look You have to look at the foundation and it is in that text it'so clear that it's talking about the foundation of yin and yang. So it's not saying you must look at look for the root of the disease, but it but it'saying you must track it through this foundation of yin and yang. So to me it's like I mean maybe I'm just like really nerdy, but it's like if you're a new practitioner, that's like gold, right? That'so inspiring. It's like you gotta study yin and yang. Like what does that mean in terms of summer and winter, being active and passive, rest and activity, male and female, sun and shade, and like there's a million ways in which you can think of yin and yang and what how that can contribute to cultivating the ability to heal whatever shows up in your clinic.

Angelique: I don't know. I could listen to you forever. Carry on. It's good stuff. Yes, it is.

Toby: But may maybe let's drill down on that just a minute because I that's that's my understanding. I forgot about that from your book is I always thought gen and ben was the same, that was root and just different ways of saying root. Can you can you tease that out easily for us or is that a too big of a topic?

Sabine: The problem is that even in classical Chinese is already used it's when you look at the character, it's the character of the tree with a little extra line in it. It's a depiction that focuses on the trunk. It's the that's the literal the original meaning of that character. But already the trunk of the tree, and I'm looking at this giant maple tree right out my window right now. There's very and I used to run an apple orchard and you know what does it take to create fertility? there's a big difference between taking care of the roots and taking care of the tree from the core. It Ben is really it means foundation in a metaphorical sense. And I think In English, you know, when you read the word foundation, you think roots or and then we go to the f to the literal roots. Whereas if you really want to be literal, you talk about the core. Like the core would be a much better translation for it. Foundation is a it's it's that's the problem when you have a Chinese character, it's like a Venn diagram, where a Chinese character means this. And the English word means this and they do overlap. So foundation is absolutely a correct way of translating ben in many contexts. And a Chinese person would absolutely agree with that. But in this particular quote, It's in the context of this of the sentence before it and the sentence afterward. It's it's really important that it's talking about yin and yang. It's it's not talking about the root of the disease, but it'saying to treat disease and even the character bing doesn't just mean disease, it means disorder, it means social chaos. Bing it is things that are not healthy, that are so it's Bing is also a political situation, social unrest, or an earthquake, or like even Bing is so much bigger. And then you must pursue it in this core of yin and yin and yang and then the text goes on and says yin yan yang are the father and mother of creation and the palace of the Shenming and all of that, right? So the whole introductory paragraph is about yin and yang and the importance of yin and yang and the whole chapter is about the resonant what is it the help me out here.

Toby: But that's what I was gonna say about why you get why you chose that I kept meaning to say that, why you chose that title for your book, because again it could mean that. The chapter of Su Wen five could mean, right? humming with elephants, right? That's a possible translation of it. Is that right, Sabine? But it's not, right?

Sabine: It is, yeah. It's a joke. I mean and that's really that's my proudest accomplishment for that book is the juicy title. I love it when I find a good title.

Toby: Okay, yeah. But I mean that's fantastic because it could be translated that way, right? But it with like the resonant images, right? Isn't it the Xiang, the L. Resonant manifest

Sabine: Manifestations of Yin and Yang, I think the great teeth tweeters on the resonant manifestations in Yang Inxiang Ta Lun, yes.

Toby: Isn'this great to have a scholar on the program we can just we can just turn to for these kind of things?

Sabine: I try and keep it keep it too And I

Angelique: And

Sabine: Didn't even know that elephants hum.

Toby: Really? Did they literally hum?

Sabine: They yes, I love this. I have students who are pediatricians and my friend Patricia pointed out to me that elephants communicate at a sound level that humans at a frequency that humans can't hear.

Toby: Yeah, fascinating.

Sabine: Over like, I don't know, hundreds of miles or something. Very cool. Yeah, it's very cool.

Toby: Wait, you knew about that before you did the title or after?

Sabine: I did not, when I created that title, I did not know that.

Angelique: That is even cooler. Yeah.

Sabine: Yeah. And humming, you know, the resonance is kinda like it's one I mean it's one it the humming is I'm stretching it, you know. the Xiang is the origin of the character, the manifestation, the image, that character. When you look at the it's a pictograph originally that depicted a elephant. So it's one of the potential meanings, but it's obviously not the meaning in the title of the chapter. And the humming I'm it's resonance. But you know, when you'resonating, that's that's humming resonance. Yeah.

Toby: Right.

Angelique: Totally.

Toby: Okay, with that's that's that's a good yeah. anyways, because otherwise people think I want to read a medical text, I won't read a like zoological text about the elephants, right? So that's good for them to know, right, where that title is coming from. But again, the whole book's like that, right? Where you just keep saying, Well, could be this, could be that, taking from this angle. I just want to circle back to one more thing. So does ben does it never mean root or it can mean root, but just not in that context for Su Wen Pi.

Sabine: It can mean root in the metaphorical sense in which we use it in English.

Toby: Okay. But don't we like the Shennong Bencao JIng isn't it talking about the roots and the grasses or no? The literal roots and grasses? I'm asking you because I have your translation of the Shenlong Ban Xiaojing on my on my shelf, so I know you that one.

Sabine: I love how you're pushing back. This is great. And I have to think about that. ben cao means materia medica. Or it mean well, you know, this is great. It's like you're throwing things back at me. yeah, what is the literal meaning of ben cao Because we are used to it as a technical term and we translate it as materia medic when it's really information about Substant natural substances because as you know, it also includes animals and minerals. So that's the first problem. But bencao most literally it refers to yes, usually translated as roots and grasses. So in modern Chinese it's always the compound genben the two together. So Yes, ben can refer to the physical root. I don't know. I did a lot of research on this years ago and I need to do another linguistic analysis or get Leo Loc roped into it to answer this. There might be contexts where ben is used to mean the physical roots as opposed to the trunk or the core.

Toby: Okay.

Sabine: Never say yes or no clearly in Chinese, right? Like all of our listeners know that, right? In Chinese medicine, it's it there's never a black and white answer. It's always like yes in general, but you know, when and the problem with Chinese language is the language changes. So even in the Yellow Emperor's classic, like the language, the meaning of a character, and this is what people ignore so often, the a single character. completely changes often from the Han Dynasty to the Tang dynasty. So between the Neijing and Sun S Miao, a character. And this is really tricky when you're translating a text like the Neijing that is composed of all these different textual layers. So which layer in one chapter, in a single chapter, Elisabeth Shu is the master of analyzing she did this with the medical the shi the biographies in the shi

Toby: Yeah.

Sabine: Where there are all these different textual layers and this is the original textual layer and then this is the commentary and this is the commentary so even within a single chapter in the Nei Jing we can't just assume that it's first century because There are and the Su Wen Five is definitely one of those chapters where there are different textual layers. And the same with the Sun Tsun Miao information on nurturing the fetus or the information on the Yangxing chapter. That it gets really messy. And then when you read a text from the 7th century, do you assume that the meaning of the character is based on the 7th century? Or Do you read it? Like, do I read it the way Sun S Miao would have read a certain character? Or do I read it in the way that it was originally meant by the third century source that Sun Ts Miao used and quoted? Did Sun Ts Miao think, like think about for you today, if you'reading an English quote from Shakespeare or whatever, and I don't really know any Shakespeare? but do you when Shakespeare uses the word heart, do you read that word heart with the meaning of a biomedical doctor, a Buddhist cultivator, or do you have any idea what Shakespeare or whatever meant when they used the word heart? Like it gets really messy. That's why I don't give straight answers.

Toby: Okay, but that's what Angelique and I are just reconsidering with all this that we're we'really happy. We thought being in clinic was hard, but I guess being at the translator desk is also really hard, right? Because you're never like you're never sure in clinic, but it sounds like you're never sure translating either.

Sabine: I feel like you clinicians have it a little bit well, no, we all have intuition, right? Like clinical practice and in a certain way, translation as well is a balance, it's like a play between the right and the left side of your brain. Where when you overintellectualize it just gets really messy. And that's where I try and encourage my students, and it's harder to do in a book. to also access the texts at some point by shutting out I guess it's the left brain, the rational brain, and really just letting those characters stand and sink in and meditate on them or, you know, go to the beach or dream or somehow access like a Laozi quote. You can analyze a quote or Zhuangzi you can analyze that. And then it's like a like a poem, analyzing a poem. I hate doing that. Because you basically kill the poem, the beauty of the poem.

Toby: You should feel a poem, not analyze it.

Sabine: Yeah. And I think the same is true for the classics.

Toby: You should feel the classics, not analyze the

Sabine: Yeah, they're they're like poetry. They're beautiful and there's a flow and a lot of times the characters are there because of the rhythm and there's you know, like there's a sound component and an and an image component to each character that just gets lost in English.

Angelique: How wonderful that you can experience that every day.

Sabine: I know. I

Angelique: Yeah.

Sabine: Know. And it and it's great that, you know, I do this work and then I get clinici like compared to other academics. I mean I haven't been an academic in a long time. But it's great that I translate something and then I have clinicians who are like Deborah Betts when I used to teach with her. We used to get together regularly in like Europe and America or Australia or somewhere and neither of us want to travel anymore. So we don'teach together anymore, but when we used to teach, it was so cool when I would like throw something out there and she would be like, my god, this is exactly like this the like the newest stand of biomedical knowledge about where the fetus is at whatever the fifth day after implantation or you know, I don't I have a totally non-scientific brain, but the overlap, it's it's really fun.

Angelique: Fascinating. Yeah.

Toby: Yeah, it'so great. Yeah, your work is academic work, but again, it's it's translated into practical clinical work. So that yeah, that must be really rewarding. It

Sabine: Yeah.

Toby: Has to be right too, right? That's what we can't just get too philosophical. We have to we have to keep it grounded in the you know clinical reality too. So that I think that's really helpful. Otherwise, if it's just philosophical, you can just kind of drift off a little bit. But again, clinic really pulls everything back because it has to be really pragmatic.

Sabine: Yeah, which is a great I love challenges. So that's you know, that's really fun in teaching because you get that feedback. It's like, okay, great. Is this just a empty intellectual exercise? Or what does what does that mean for you concretely in clinic?

Toby: Yeah. Can we apply it to help the hundred trillion cells of our patients when they come in the door, right? Yeah.

Sabine: Yeah. And where I'm at right now and I don't know like where you guys stand on this, especially Angelique, as a as a nurse, I feel like nurses are and I started out when I was young in my dad's hospital. I thought about becoming a nurse and then I was like, no, because this was in Bavaria and I didn't it was the doctors there was one male doctor. It's totally different now, but at the time the doctors were all male and the nurses were all female. And I'm like, no, I don'think that would be a good job for me. But I love the fact that nurses get to, you know, be physical with patients. And I mean, I know this is this was Germany whatever, thirty-five or more years ago. But nurses got to be present with the patient in a way that the visiting doctors in the white coat didn't get to be. and that's why I'm I'm having fun with this Yangxing pursuit in the many dimensions of healing that beyond the brain, like you know, there's the intellectual fact that a certain needle has a certain effect. that is documented and measurable or a certain herb or a certain formula. But then there's all these other dimensions. And both of you, like Toby, right? You'really inspired. You're a Buddhist practitioner. I all I know about you is that you're you're you're you've worked with the monks, the Korean monks, right?

Toby: Yeah, tha that's my first teacher

Sabine: Yeah.

Toby: Almost thirty years ago now, yeah.

Sabine: Yeah, so how has that influenced can I ask you questions too?

Toby: Yeah. Doesn't have to be and Angelique and I have to check with our corporate sponsors and see if that's okay. But let's assume it's okay. yeah, you can ask me anything. so yeah, but so like you were talking about before, the influence on Buddhism, Taoism on Chinese medicine. For me the lens is Buddhism first and then the medicine, you know, for my teacher's introduction. So now I just see that everywhere, right? Buddhist ideas. well it Sun Simiao it'so overt, but A lot of the ideas in Chinese medicine are right to alleviate suffering, especially on the mundane field. And this is such a such a such a profound way to do it, right? Have the patient produce their own medicine in their body with acupuncture needles and then alleviate suffering in the patient's body. it's yeah, I mean it'so Buddhism and Chinese medicine for me, they don'there's not a big separation between the two. They'really interwoven together.

Sabine: Yeah. And Anjalique, what do you what do you what do you like you must be a practical person. Nurses are like, you know, if you want to get anything done, you a if you have a nurse on the other side, you it happens. True.

Angelique: It's true. Yeah. it's what's interesting in listening to you talk about like the other dimensions. So there's when I approach part of part of why I think it was it wasn't easy, you know, learn Chinese medicine is not easy. There's nothing about it that's easy, but the lateral move because nursing is so patient focused and patient centered and being there with people that part of school and that part of the learning came easy to me. It was really easy for me to be with people and continues to be easy for me to be with people. It's the intellectual stuff. And so where I find my brain will get twisted is if I start seeing Western medical things, like a patient that comes in just recently was like feeling really dizzy and having some numbness in one of their legs and like has some transient headaches and like neurological things and they've had spinal MRIs and everything is fine. So then my main like no my mind starts going to like, should they have a brain MRI? Is this something else that should be happening? And then having to shift back to be like, well, what are those signs and symptoms in Chinese medicine and how do we approach it that way? So I find that I'm having a constant dialogue with my own self, you know, around patients as it comes. But it's been, it's been a nice transition. it's been, it's been good, I think. And

Sabine: Yeah.

Angelique: Then spiritually, like I'm working on the self cultivation part. I'more eclectic, I think, and working on that because Toby is my teacher's. very much letting me know self cultivation is first that you need to really work on yourself and your spirit and being able to be with people to access that dimension that you're talking about, that extra something that isn't really measurable but is palpable, if that makes sense. It makes sense. Yeah.

Sabine: Yeah, and how do we how do we cultivate that? How do we how do we even talk about it or make space for it?

Angelique: Yeah. How?

Toby: What about used to be a would it you have a personal cultivation practice?

Sabine: This kind of goes with when people used to challenge like this was decades ago. I would go to these conferences and people would say all sorts of things about ancient Chinese medicine, and I would be like, actually, that's not true, because I can read the text, and that's not what Sun Tsun Yao or the Yellow Emperor said. And it happened a few times that I would get shut down, like Sabine, Dr. Wilms doesn't know anything because she's not a practitioner. And I used to be very apologetic about that and very much aware that I'm not a practitioner. So I look at the body, you guys have an access and an experience and an intuitive understanding of the human body as a microcosm in resonance with the macrocosm, just by like feeling pulse. Like your experience of body after body after body gives you a level of knowledge that I don't have. and now I re I say very proudly that I'm a practitioner of Chinese medicine. I just don't practice I'm not clinically licensed and I don't practice Chinese medicine professionally. in the meaning of medicine in modern Western culture. But to me, Chinese medicine is so much bigger. It's about harmonizing heaven and earth. I mean it's kinda like what do you mean by Chinese medicine? It's little things like I wake up and I think about yin and yang. Do I push myself in the morning to get out of bed early to do my Qigong exercises? Or and I've spent a lot of time calibrating with my friend Leo Locke, who is my Buddhist advisor and my clinical advisor. So I learn a lot because we teach together and we teach a class on you know self-cultivation. So What does Sun S Miao talks about moderation? between rest and activity, between overeating and like overindulging, like making the body comfortable and pampering the body and giving it taxing it too much. Like as a farmer and as a person who I've really suffered from insomnia in the past because I have worked my body into the ground and I've I have the body of a farmer and I'm older now. So I'm German. I have overworked. I physically refuse to accept the limitations of my poor female body, throwing around too many hundred-pound hay bales in the days. And I have fallen off of many half-wild mustangs and done all sorts of fallen off of trees. I have not been kind to my body. So I'm like, what does Cultivation, what does moderation look like every day as I open my eyes and look at the sunrise? Do I stay in that zone and call it meditation? Or is it like lazy? I'm too lazy to do qigong this morning. Or the cold water swimming. I love swimming in the ocean every day. not every day right now. and it'so subtle. It's like five seconds are the difference between I'm pushing my body to be healthy by exposure to cold and I'm like ramping up my wei chi. It's like the I'm stoking the fire inside me and it feels so good. I get out and I'm just like roar and I run naked on the beach and the with the dog and it's like this total it's my drug, this flood of hormones. Or am I exhausting my body by exposing it to too much external cold? So, you know, in terms of food, am I eating too much sweet? Am I eating too much salt? Am I eating healthy food that is not pleasurable as opposed to the benefits of deriving pleasure from a really good piece of pie or chocolate? Like what is cultivation? when do you call something meditation? Lillian, my friend who died, Lillian Bridges used to have this joke that yeah, thank you. she used to have a joke where it's like when you'really rushed, she used to tell people to slow down and embrace doing nothing. And in our culture this there'so much pressure to and this is certainly as a German in my family, my parents get really uncomfortable when they see me doing nothing. When they see me not even reading a book, I'm studying, right? I'm doing I'm I'm increasing my knowledge. Doing nothing is they have they're they're they're they're they're around 90 years old and they have just recently embraced the fact that they can actually lie down for an hour in the middle of the afternoon.

Toby: No.

Sabine: And I was in Vietnam just now and it was super hot. And in Vietnam In the middle of the day you have to rest. So I don't know if that's cultivation. Dancing. I love ecstatic dancing. Is that cultivation? I do my I do I totally, you know, go through my kidney channels and my liver and I bang myself up while I'm doing ecstatic dancing. It'shaking, right? Like I milk my goats. I'm

Angelique: Dwink.

Sabine: Touch and cheat like when I when I like my goat loves we touch foreheads every morning we do this at the end of when I milk her. Or with my dog. I don't know. I like a lot of I think we need more play.

Toby: Hmm. W but that's your self cultivation, kind of calibrating yourself with the day, the hour, the minute, what's needed, so you don't expend too much or get too lazy and then you just sharpen that all the time, right? That's that would be your cultivation, right? To make sure you're not overdoing it or underdoing it all the time. Is that

Sabine: Yeah, and then at the same time you don't want to overanalyze it. It's

Toby: Right, yeah.

Sabine: The Taoist thing. The way

Toby: It's more of a somatic sense of my not rather than an intellectual, I wonder how many calories I should eat and how many calories I'm burning. It's more of a somatic sense of like, should I go in the water or not?

Sabine: Yeah. Really being present with Well, in the Buddhist sense, you know, we've got a human body. That's our that's our form. So we have to honor that form and take care of it but not pamper it, not over indulge it, but also not over tax it.

Toby: Yeah, there's a sweet razor's edge between those, right?

Angelique: Mm-hmm.

Sabine: It's a tricky one.

Toby: Yeah. And then like you said, then in the winter sometimes you have to you have to air more on the pampering side. In the summer you can be less on you know, so it really is changing throughout the seasons, the days and hours, what you should do.

Sabine: Yeah, absolutely.

Toby: Okay, well that's that's that's much more nuanced than I thought that answer would be. I thought it'd be strictly thirty minutes of qi gong in the morning and then you know

Sabine: You know, I've done those things as well. And yeah, I think right now I'm I'm getting older, so I know how precious I've lost, you know, my like Lillian was my soul sister. And once you lose your closest human being. It's like you just it just changes the way you are in the world because you're aware of how precious your time is. So I wanna use my time wisely. And part of that is do I want to crank out more books, right? I hear you want so when volume one to three next. And I'm like, fine, it's gonna take me a couple of months and I can do it. But at the same time, the beach is calling, the dog wants a walk. What does Sabine want?

Toby: Mm. Right.

Sabine: And then what do my students want? My students want me to be really well prepared, but at the same time, there's also I'm sure this is the same for every practitioner who listens to us. The great I feel like the greatest gift, especially in the US right now, it'so important that we cultivate a good way of being in the world. Because there are a lot of freaked out people. I mean, I don't know where it's like where you guys are. But I'm on an island, it's rural, it's very mixed, there's a lot of tension. So every here's another example. My favorite way of cultivation is I help out in the soup kitchen on Monday mornings in our local soup kitchen. I love doing dishes and I love serving soup.

Toby: Mm-hmm. That's really sweet. Yeah. Anyways, it really is a what do you give, not what you get in this world, right? For ultimate cultivation. So that's really nice.

Sabine: Well, but ultimately it's about what you get.

Toby: Well yeah, but you get by giving, right? I mean that's that'sort of the secret to the whole thing, right? you don't you don't get the mansion and all the fancy cars. That's that's not where it's at. It appears to be that would be the direction for happiness, but it really isn't.

Sabine: Yeah. Yeah. As I'm sure you and your listeners know all too well. Otherwise

Toby: Yeah.

Sabine: You wouldn't be acupuncturists.

Toby: Right. Or Chinese Buddhist in front you. This is this is my teacher. he's a wandering Buddhist monk, so doesn't even have a monastery. He just has a begging bowl. And that's he just travels around the world. So again, the happiest person I ever met in my life by several miles. And so yeah, that's I mean, there's the example. And then I known some really mega wealthy people that are just beyond miserable. So again, that's that's that's clearly not the right direction just to hoard. I got mine jack is definitely not the right direction. But also, yeah, then you can expend too much outside of yourself too. So that again, back to our razor's edge idea. You have to put something in, but then especially what are you gonna put it out for? And who are you gonna put it out for? It'such an important distinction.

Sabine: Hmm. Yeah, it's really it's really important to think about.

Toby: Hmm. But it sounds like you're thinking about that all the time. That is your cultivation, right? How to calibrate between in and out.

Sabine: Yeah. I mean part of me is like I love writing poetry and I only have so much verbal creativity. And then some days, like you know, I'm tempted like Lao Tzu to ride away on the water buffalo. And because the older I get, the more I feel like and here we are having a podcast and I teach online. And the older I get, the more I feel like there'such a limitation to verbal intellectual exchange. And what really matters, I'm sure you know this, right, Angelique? Like holding somebody's hand. Yeah. There's there's you can say something, but it's the presence.

Angelique: Very much. Yeah.

Toby: You're you're right, you're right, Sabine. Anjali's background isn't hospice, so she really knows that the medicine of holding someone's hand. Yeah.

Sabine: Yeah. And the older I get, the more the more I just appreciate silence, which is really funny for a writer.

Angelique: But

Toby: Yeah, the space between the words is important, right? All

Sabine: Yeah.

Toby: Right. Sabine, we're we're gonna thanks so much for carving out a little slice of time with us. We really appreciate it. it is a real pleasure talking to you. And then I hope it's really nice to have this nice conversation with you. And then hopefully this can just resonate out and help our fellow practitioners. yeah, thanks so much for the time.

Angelique: Yeah, thank you.

Sabine: Thank you, Angelic. It was a pleasure to meet you. Thank you, Toby. I just I'm really grateful that we keep having little opportunities to get to know each other. And thank you both for what you're doing.

Toby: Thanks so much. A real pleasure. Everyone take good care. Okay.

Angelique: Take care. Bye.

Sabine: Bye-bye.

Episode 28: The Dao of Medical Insurance Billing with Eoin Gregory

Office Hours with Angelique and Toby. Released August 12, 2026. 58 minutes.

Listen: Apple Podcasts · Spotify

About this episode

Insurance billing is one of the most frustrating and financially consequential parts of running an acupuncture practice. Dr. Eoin Gregory of Family Billing Solutions, a retired chiropractor and former educator, explains what practitioners need to know before they sign an insurance contract, submit a claim, or hand their billing to someone else.

He covers when to bill yourself and when to hire help, how to read payer participation agreements and fee schedules, why medical necessity and documentation matter so much, and how to avoid the compliance mistakes that lead to denials, recoupments, or audits.

Topics

• From chiropractic practice to medical billing

• Why new solo practitioners should often bill for themselves first

• Why submitting a claim is the easy part

• Being careful with billing advice from other clinicians

• Reading participation agreements and fee schedules

• Medical necessity, documentation, and audits

A note for listeners: this is a conversation among practitioners, offered for education, not as medical advice. Patient details have been kept general to protect privacy.

Transcript

This transcript was generated automatically and lightly cleaned up. It may contain errors, especially in names and Chinese terms.

Angelique and Toby: All right, everybody. Welcome to Office Hours. We have the pleasure of having Dr. Eoin Gregory with us from Family Billing Solutions. Thanks so much for being here.

Eoin: Absolute pleasure. Thank you for having me.

Angelique and Toby: Can we begin by you giving us a bit of your background? Tell us a little about yourself.

Eoin: Absolutely. So I am a retired chiropractor. I unfortunately got hurt and way back when and prior to doing what I do now, I was in clinical practice in New York. loved seeing patients and working with patients every day. And I was an educator as well. I taught acupuncture students, I taught besides therapy students. So I just absolutely loved doing that. And when unfortunately when I got hurt, I could no longer practice and I couldn'teach anymore. a friend of ours Who owns a medical billing company said, Hey, you know, you should start a billing company because there's a whole group of people who need help that her company was too big to handle, but could really benefit from someone who knows what they're doing and who's made all the mistakes, which is I like to say, we've made all the mistakes. so we started a company. My wife's an acupuncturist, back eight years ago, with the intent of treating practices and treating providers, not treating patients anymore. But with and with that we wanted them to be better and to be awesome and to reach the height that they can or the height that they want to by taking the load off them that medical billing often creates the stress and the all the anger.

Angelique and Toby: Yeah. How many providers, groups do you do you have with you now that you help?

Eoin: We have I was just trying to figure out the other day 'cause it's always in flux. We have about a hundred and thirty providers that we bill across over a hundred companies. A big chunk of those happen to be in Massachusetts, which we happen to love Massachusetts, but I'm a little biased since I grew up there. and then we but we have providers in twenty-eight states currently, so we work across the country And there's also a lot of providers who need help.

Angelique and Toby: Yes, there are so many of us that need help. as I know that you know, but I tried doing this myself because I thought it can't be that hard, right? So I enrolled in a couple of, you know, insurance companies. This is a couple of years ago, and I was like, I can figure this out, I can do this. And I lasted about seven weeks before I reached out to you. I was like, help me, I need help. Because it's not it's not that simple. It's not

Eoin: It's you know it's not that it's not simple. It's just a lot of work. It's a lot of work and there's a lot of organization that goes into it. There's a lot of patience that goes into it. There's a lot of phone calls that go into it.

Angelique and Toby: So many.

Eoin: And I last I heard you were an acupuncturist, not a phone representative. So I think your time is best spent in the treatment room, not on the phone.

Angelique and Toby: Agreed. Agreed. And I didn't realize how much time I would be spending on the phone. I really didn't. I was I was unbelievable. And so yeah, it's been it's been a blessing to have family billing solutions helping out. And but I think you had made a you had talked about before and I think one of the things that's important to get some perspective on is why you think when why you think someone should do their own billing before hiring a biller.

Eoin: I think it's actually really important for solo practitioners, chiropractors, acupuncturists, anyone who's billing to bill on their own at least initially, because you generally have a little bit of a time. You have that time factor if you don't have a full schedule. you also have the chance to take billing coding classes, which are really important because you really need to understand what the codes mean because it has a big effect on your documentation, what you include. in your documentation, what you don't include in your documentation. And it also gives you a perspective on how much work is involved. So if I have someone who's brand new who says, I want to work with you, I say, okay, for example, how busy are you? Well I'm not that busy at all. I said, you need to take billing encoding class and do it for yourself for a little bit. One, because usually they're not generating enough revenue to make it economically feasible for them to hire a biller, unless you know they're independently wealthy, in which case I'll be happy to help. but the other side of it is that experience of understanding how much work goes into the billing process and the actual we say billing, but it's not billing that's the issue. But billing is super easy, you know, submitting a claim, you know, click, claim sent, you know, that's that is easy. And it's it's everything else that's a pain. But it's and it's worse than a pain. There'so many inconsistencies, there'so many battles to be fought. And if you're a provider, You're treat you're you're trained to treat patients. You're you're trained to help people heal. You'really not trained to help figure out their insurance. And you're also not trained to fight the battle, to fight the fight, you know, file the appeals, you know, call and make get reconsiderations. And it's it was a really big issue in particular in COVID because there were no phone representatives. Everything took an hour, two, three hours to make phone calls. It was it was just an amazing amount of work. And the and so for providers, even though they weren't busy, they just they still couldn't reach anyone either. It was just it was nuts.

Angelique and Toby: Yeah, I can imagine. one of the things that I don't know. So when I as when I came out of school and I took the billion coding course and you know, I knew an acupuncturist, like, well, Toby, your ca your practice is not insurance based at all. And so I had to make a decision. And as a newer one, I thought, well, there's a lot of acupuncturists out in this area. I think I have more of a chance to be viable financially if I accept some of the insurance plans. So I just decided I'm going to take all of the insurance plans and I did. Like ultimately, once you were on board, I started out with a couple and then I took a whole bunch of them. And so when people are coming out of school, like what do you think as someone who's done work in this world, both in our sphere of medicine and in the insurance realm, what do you think's what do you think are some important things for the new folks to be aware of or even folks who've been in practice for a while that might consider opening the doors to insurance?

Eoin: Yeah. There's a lot of things to consider. The first thing is any advice given to you by another provider should be taken with a grain of salt, unless they are some sort of expert. Because I sus I think the biggest issue that we have is providers come on board and they say, Well, so and so is making X number of dollars and this person is making X number of dollars. And w they're being told to bill in a way that's really not compliant and or f technically fraudulent. And that's Big deal for us because we won't do that. We won't we won't bill massive bills just because they're gonna pay it. Because it's it's not ethical, it's not moral, and it's b illegal in many cases. So if people come out of school and they say, What should I do? They should be leery of what their friends and or other acupunctures tell them. They need to take a billion coding class, first off, even if it's a short one, two-hour one, even if it's free or whatever the case may be, even if they should go on some of the websites that are out there. And learn a little bit about it and understand that there's a responsibility when you are billing insurance to meet certain requirements. So that's the that's the first part. The second thing is understanding what a network participation agreement means. What does it mean when you go in network? And essentially it means that you're agreeing to what that company pays for care and also the restrictions of what they don't pay for. And I don't want to go into individual specific insurance companies because that's outside the scope of this, but people get the impression that they can, I can bill a this code and that code and the other code and only to find out the insurance company only pays for four codes, the four acupuncture codes, and they only pay for two units or three units. And so when you get this participation agreement, you need to make sure that the fee schedule's on there because that's a actually interesting. You'll get a whole billing agreement to bill with that. payer participation agreement and there'll be no fee schedule attached. Where

Angelique and Toby: Yeah.

Eoin: Is that? Where is that? That's important. and because and the thing and the other thing is not just the numbers. Say, look at this, they pay this, they pay this, and they pay this. It's the it's a payment policy on top of that. So an insurance company might have fees for exam codes, E and codes, or they might have fees for therapies, but their reimbursement policy might say they pay a maximum of hundred dollars a visit, they pay a maximum, which is not bad, but a maximum of fifty dollars a visit, a maximum of forty one dollars a visit in California. And so no matter what you bill, it might add up to $150 based on the fee schedule. You need to read the details, the individual lines that say, this is a global rate. and I think that's important because they need to understand what they're committing to, what they can't do, and particularly balanced building when you're in network, and also The other aspects is, you know, when you decide if you decide to leave, you know, what your obligations are both to your patients and also to the you know, insurance company. You can't just say, All right, I'm no longer taking insurance. It's there's a time period where you have an overlap where have to continue care and you have to treat these patients, otherwise it's patient abandonment. And I think that aspect and the other aspect is important to know what the medical policy is. What does a plan cover? Because if you're, for example, with a company, not going to pick on individual insurance companies, but the medical policy says they'll cover migraines and chronic tension headaches only. Would it make sense to be a network with that company? No not really, because what percentage of your patients come with migraines and coron chronic tension headaches? And the answer is not that many compared to low back pain or not that many compared to other complaints or you know depending upon if you have a specialty. So that'so that those are things that you really need to keep an eye on because The insurance companies are in business to make money. They're not in business to make providers lots of money. so you so you definitely gotta look at those things. And if you don't understand them, if you're not an attorney, then spend a little bit of money and have an attorney look at them and give you some guidance or some advice because you're making a legal contract, you're signing a legal contract to do something and you have to be wary of what you're doing.

Angelique and Toby: Mm-hmm. That's good advice. And it takes a long time to read those contracts. They're they're

Eoin: My gosh, they're so boring.

Angelique and Toby: So boring. They're so long. It's incredible.

Eoin: So my wife Jessica as an acupuncturist is actually one of the people who reads everything. And I always make fun of her. Are you going to read everything? You're going to read everything. Well, it turns out if you don't read everything, you might miss something very important. And she's caught a couple things that were in the cracks about what certain things that were not covered in. we only cover two units of any given coded therapy or time service. Like suddenly, wait a minute, only I pay for two units of acupuncture. And those types of things of reading the read it down to the details is hard because

Angelique and Toby: Yeah.

Eoin: We're not lawyers.

Angelique and Toby: Right. And it's created for the lawyer to look at, right?

Eoin: Yeah. We wanna know how the cr contract feels, not what the contract says.

Angelique and Toby: Correct. Yeah, totally. so when do you suggest someone looks for a bill or

Eoin: That is a great question and it varies provider to provider, insurance company to insurance company. But this is my advice for anything. When you get to the point where you're losing time to do the things you both enjoy and the things that generate revenue, then you need to consider having someone do it for you. So if you're spending every Friday night until midnight doing your billing rather than having movie night with the kids or you know, going on a date or going out with friends, then it's time to get a someone to help. If you're losing two or three patient hours of care a week because you're doing your billing, then it's time to consider selling it out and having someone manage it for you.

Angelique and Toby: And so when someone is ready to hire a biller and they're not sure who to choose, I mean, I personally would say you. But let'say, you know, they want to kind of play the field a bit. What are what are things to look for when hiring a biller?

Eoin: Well, I appreciate all the love, but I will say that the biggest thing is finding someone who f both feels like a good fit for you and also makes it quite clear what it's gonna cost to work with them. Because we see them saying the company saying we have this low rate, we have this low rate and if but if you don't read the contract and realize well, a low rate, but you pay a certain number of on top of it. so there's lots of little details within the agreement. The other thing you wanna look at is what is billing experiences the company have. You know, there's lots of amazing billing companies that work with all different professions. Acupuncture is a tough profession to bill for, mainly because and Jessica loves to use this expression, dermatology. Dermatology, you're covered. You just go and they you're covered. You know, if but acupuncture you can't just go and be covered. There'so much detail and there'so many little things that are involved with making sure that the care that you provide is paid. And so looking at different billing companies, do they have that experience? Do they have that knowledge? And then the other side of it is that how approachable are they? Was it hard to reach someone? do they answer the phone? will they talk to you on the phone? You know, is everything by email? And I think that For me, every claim matters, which is actually a problem because I then I focus too heavily on claims, but every claim matters because every claim is a unique person's care. And the ability for you to see that patient means that you have to have the care paid for. And if you have a biller who's just looking at numbers, it's like, we have a 1% finale, we're okay, or we have a five percent finale, we're okay. The that doesn'that doesn'translate well to small providers because That could be five percent of your income. That could be more than five percent of your income because a claim is just a number. It doesn't actually tell you how much that claim is worth. And so, you know, for me, it's like you need to know that the person really wants to do it and is willing to fight for those claims to get them paid. And when, for example, the insurance company provides wrong benefits, is willing to do your do the appeals. And isn't ch gonna charge you extra for the appeals? Or if they are gonna charge you extra, how much is an appeal gonna cost? And what level of appeal will they do? So there's all these little things. and I think it's not a problem to necessarily pay for these little things as long as you know what to expect. And that's that's again, you know, you go to buy a car and the car is X thousands of dollars and then you go to the finance and then you realize it's another twenty percent more for all the other add ons. And if you know that's gonna happen, then you can deal with that. But if you go in thinking you're gonna pay you know, X number of thousands of dollars and suddenly now you're paying X number of thousand plus twenty percent. That's a huge difference. That's a huge amount of your practice. So I think one of the biggest things is transparency. How transparent is the company? The second thing is experience with acupuncture billing, which I mentioned before. and also manpower. Is it is it just one person working for herself and does she have help? Does she have a lot of clients and she's overwhelmed and How often is she submitting claims? How often is she falling up on claims that aren't paid right? And there's nothing wrong with the individual who does the billing, except they go on vacation and they're not always available. And those things are important, especially when you're a small provider and someone calls you last minute. my gosh, I put my back on. I need to come in and see you. Do you take my insurance? Question mark. And then the answer is maybe. And let's find out if there's coverage. Is there someone available to do that? And do they have do they have you know that team?

Angelique and Toby: Yeah. I must say that's one of the things that have been really helpful because there's a box that I can check on the website where it says rush. So in that kind of situation, I can check that box and usually someone gets back the same day, sometimes the next day, which has been really wonderful.

Eoin: We shoot for two hours, but some days you just can't reach insurance.

Angelique and Toby: Companies. No, it's it's really awful. I mean sometimes you guys even can't like you can't get through period despite multiple attempts.

Eoin: We've had people hang on hold for five hours. Like so they'll have they'll have their phone on in the background and it's just on hold. And then at a certain point the other company's phone system just cuts the call because it didn't pick up. and it's it's unconscionable that the insurance companies and the payers expect you to provide care, but they don't provide the service that they need to for you to be able to know whether or not the care is covered.

Angelique and Toby: Correct.

Eoin: And that's a that's a big problem. And I hate setting out those verifications that say we weren't able to reach the insurance company. This is what we found online. The exception is when we know the policy, we know the insurance company. And that's the other thing is does the biller you might be working for have experience working with that payer? You know, we send thousands of claims out to Blue Cross Blue Shield in Massachusetts. You know, we know, we know how they work. We know what's necessary. They ha they require you to mail stuff. We know that. Okay. We do a mail run twice a week. We you know, it's those things that you need to know. MassHealth, you have to use our website, which is ridiculously horrible. I'm I'm sorry, I'm not supposed to mention individual insurance companies. But

Angelique and Toby: Yeah.

Eoin: But if you know if you know that system and you have that experience then you can do those things. Yeah. And it's just it's just part of your routine, it's part of your you know, daily plan.

Angelique and Toby: Yep. Toby, I don't want to leave you out hanging. Do have any burning questions? Because I could keep going. Yeah, do you have any leverage on them? like, you know, if you're you're on hold for five hours and they cut you off, is that there's just nothing you can do? You just have to call back, or is it is there any leverage that you have on your side?

Eoin: So the first thing we do is tell the providers to tell the patients that the there's a their insurance is a contract between the patient and the insurance company and maybe their employer. And if we're not able to reach the insurance company, it's they have an obligation to verify their benefits and find out if there's coverage. And if there is coverage, we give them a list of questions they should ask. But if the claim is not covered, we can'take responsibility for it. There's there's nothing we can do. And if the insurance company doesn't pick up and never answers and you see a provider and you submit that claim and it's not paid and you didn't verify benefits, even if the insurance company wasn'there's nothing we can do. Even when they misrepresent benefits, they you get a you get someone at an insurance company, very large insurance company, one of the biggest in the world, sorry, biggest in the United States. I don't can't say world, and their poorly trained representatives provide wrong benefits. and not just one but three people provide wrong benefits because then we'll call back again and check is this right or is this right? there's there's you do misrepresentation of benefits appeal. And I have to say those are successful ten percent of the time. So there's no there's no accountability for the insurance companies. None they none.

Angelique and Toby: I wanna shake my fist.

Eoin: Right here. I'm already shaking it. There's there's no accountability. And that is the f tough part too because providers are accountable to their billing agreement, but the insurance company should also be accountable to the billing agreement. And that billing agreement says that you'll provide care, but also the insurance company is gonna provide the benefit information. And frankly, i acubunction benefits are not available online for some companies. And that one particular company that has poorly trained representatives they don't have accuracy benefits online, which means that we're dependent upon the phone representatives to provide the information. And we have situations where we will call three times and see, okay, best two out of three, which two people agree on what the benefits are. and then we tell the provider list, we've talked to three different people and they told us three different stories and That's the best we can do. Tell your patient because you're the contract with the insurance company is between the patient and the insurance company. So if we file an appeal because of misrepresentation of benefits and it's not successful, the next level appeal is usually a patient appeal. So the patient has to be willing to step up. And that actually is important from a billing standpoint as a provider, because if you are going to be billing insurance, you have to make it crystal clear to your patients that they are responsible for the cost of care. that they're gonna be responsible for paying this bill if their insurance company doesn't pay it because it's their policy and it's their insurance. There'some exceptions like Medicaid plans and stuff, but if they understand that they'responsible for paying for this bill, then when the claim is not paid, the onus is on them to go to try to get paid. But you bill them. Sorry, insurance didn't pay. Here's a here's a bill for the care.

Angelique and Toby: Which is which is at least nice to have recourse in that regard.

Eoin: So

Angelique and Toby: But it'so asymmetrical, right? It'so asymmetrical, right? You provide the care, and maybe you'll get reimbursed or not. That's that just seems like a tough spot to be in.

Eoin: It's even worse than that, honestly, Toby, because let's let's talk about acupuncturists as an example. If we were to measure acupuncturists on a l on a scale of like rigidly following the rules and big softies, they tend to be more on the big softy side. and that's a problem because when you're on that big softy side, you write things off. You don't charge patients, you don'tell patients they owe money, you don't collect what you should collect. And that's because there's a fear of telling a patient they owe you money. And that's a very realistic problem for those of us who are softies. And I will admit that I'm a softie. I love my patients. There are some patients who probably owe me thousands of dollars that I'll never collect because I'm not going to ask for it. And that's a that's a big issue for acupuncturists. So I always say do two things blame the insurance company and blame your biller. My biller says you owe me this amount of money. You know, I don't care. They blame me. But that's why you have a biller. That's why you have someone standing behind you to do this work. Because you can hold them accountable, even though they're not responsible, but you can blame them for the patient owing a balance. my billing person told me that this is how much you owe. Or my board of the insurance company says this is how much you owe based on the benefits and whatever. and but there's no accountability on the insurance company side. the only exception is Filing complaint with the state because they are f not all, but some plans are accountable to the state for the thing. And church companies don't like complaints to the state.

Angelique and Toby: What would warrant a complaint? Yeah.

Eoin: Have I have I done it? Yeah. I can't neither confirm nor deny that I have filed complaints with multiple states on my own when I was in practice on my own. we don't file complaints for providers. We will provide them all the information they need to. in many cases we go honestly, we go above and beyond to get that information to put together or help them put together a letter about what they're what the issues are. And a lot of times. I hate to say it a lot of times insurance companies do not want to look bad in front of the state and they'll like cave right away, or nothing will happen. But it's very important to understand though. These this is insurance that's regulated by the states. If you have a self-funded policy that falls under something called ERISA, E-R-I-S-S-A, one or one s eri sa, these ERISA plans are regulated by the federal government. They're not they're self-funded plans. You complain all you want to the state, it makes no difference because The state has no influence on the insurance company. Mm-hmm.

Angelique and Toby: So what would merit a complaint to a state?

Eoin: I think a big thing would be repetitive failures to follow their own guidelines or own rules. you know, we had a situation where there was an audit. The audit said that the provider didn't do XYZ and their requirements said that this was required and that was required and this was required. And the fact is that's not what their requirement said. That's not what the rule the that's not what the medical guidelines say. And that's the kind of thing that we're That would be if the insurance company is not willing to work with you to go right to the state and say, I've worked with the insurance company, I have done this, I was audited, they took this money back, or they didn't pay me for these claims. And they're saying it's for this reason. But the problem is that this reason isn't legitimate because they don't have this written down anywhere. And it's a lot of work. And for this one particular provider, I have spent 30 hours working with this provider. Now why? Well, two reasons. One, I hate it when the bad guys win. I just can't stand it. I can't stand it. Because I'm here to help providers. I'm I look at I look at our list of providers and I was saying before that we have a directory with pictures of our providers because we are treating providers and practices. They'real people and every claim isn't paid is money that they don't have to pay their people or buy needles or pay their rent or rent at home or I hate to say it, but buy food. I mean, there's there's a lot of issues. Each claim matters. And so taking it to the next level and going to the state is sometimes your only recourse. And we've done it and we've been successful in some situations and we've been unsuccessful in others. And a big part of that has to do with how good the documentation was that the provider had, how poor the documentation the insurance company had was. So there's a lot of variables inside. And if the insurance company is regulated by the state, you know, do they want to have a black mark on their record over three thousand dollars, which is a huge amount of money for an individual provider, but is nothing for an insurance company. Mm-hmm. But that get that actually gets me to another point and I just want to bring this up. one of the problems we have with chiropractors and acupuncturists and such that physic even physical therapy to a certain extent, is that we have to understand that care is subject to medical necessity. And medical necessity is like, well what does that mean? It basically means that you have to treat the patient until they're as good as they're gonna get. And the way you're gonna treat them is an appropriate way to treat for that condition. So it goes there's a lot more that goes into it. There's huge classes on it. I've talked with providers ad nauseum about it. But ultimately, if you're treating the patient every week for fifty-two weeks, I can guarantee the insurance company could come back and say, This is all wellness care or this is all maintenance care. This shouldn't be covered. And that's where both good documentation and being aware of how you're billing is so very important. And in no way do I tell providers that they should that they should make up things or they should do things that are inappropriate, but y it's oftentimes a game that you have to play. That you have to make sure that you're meeting what's called medical necessity and you're actually treating the patient in a way that's appropriate to their condition. And that's tough. And providers, I mean listen, we're big softies and the our healing traditions are not are not one time and done. You know, it's not even a six week course of treatment in many cases isn't enough for what the patients need. Or 12 weeks or even 28 weeks, you know, it just depends on what you're doing. So that meeting the medical necessity is important. And the other thing that providers are really not good at in general is having treatment plans. And the treatment plans are what you can use to help establish that medical necessity. medical necessity is so very important if you particularly if you're you're gonna get audited to say, hey, you're overtreating these patients. The answer is no, I'm not over treating these patients because here's my records to show that I'm not.

Angelique and Toby: Mm-hmm. Which is a lot of work for us on the provider end, I must say, as one who is a bit of a stickler for the rules.

Eoin: It so and this gets into another aspect. So you have a biller who might cost you about a bit of money, but it's gonna save you a lot of money. It might actually save you more than you spent. But the other side is software. If you're taking paper notes, that could that's great. Is you if you're no there's nothing wrong with paper notes, all right, at all. Nothing wrong with them. But if you're using software, your software can provide so many resources. To help you establish medical necessity and speed up the documentation time and speed up the process of getting things done. And you have to invest some time and energy into figuring out what works for you, what works for your practice, what works within the both the profession and also what's required under those CPT codes. And you can have a great source. But it fact the fact is you have to do the work. You have to put it to have to do your notes. That being said, if you have a care that's driven by a treatment plan, Your notes do not have to be wild and crazy. It's it's like how you do when? Are you getting better, getting worse, staying the same? All right, we're gonna continue with the treatment plan and here's what we did for the day and here are the CPT codes. Literally, that's all you need as long as you have a plan in the beginning. And setting that up to be a course is not difficult, but it requires you to pay attention. And it'so hard. You there's no doubt, you pay attention. We know you pay attention. You are the type of provider we love. And the reason why is that you're heavily involved in the billing. And that's another thing. I'll go back to the beginning. It's very important that you have a your biller has a system where you can check on the status of claims. You can read the notes of what's been done. So there's transparency in the billing itself. So this claim was sent on seven one and on seven twenty-eight or eight two, we followed up and this is the status of the claim. It's in process. Or you know, that 30 day mark is kind of like the timely processing period, we're right at that 30 day, 35 days or so. And we have all that information available for our providers. And if you have a biller who's using a system that you can't access and you can't see, your claims are lost to you. You have no idea what's happening. And that's not comforting because you don't know. The and the other thing and I just want to mention this real quick when you're billing you should not be giving your chart note to someone to create an a CPT claim for or create use add CPT codes and then send out a claim form because your claim is representative of your care you need to be explicit in terms of what you did and what codes you want to bill you can't be dependent upon someone else unless they're like a specialized coder who specializes in that and your notes are super clear. Otherwise You're going to end up with two things. You're going to end up with claims with crazy diagnoses. And you're going to end up with claims that are way overpriced because you didn't pay attention to how much was being billed. So there's and there's a couple of factors that go into that is did you help create that fee schedule? I never create I never tell someone what to bill. I always give them a sample fee schedule based on their cash rates and if they offer a time service discount. And that's because it's their fee schedule. It's not my fee schedule, it's their fee schedule and they should know what's being billed. And when a patient gets an EOB and you bill eight hundred dollars for a visit, and I seen it's like how can you justify billing that much when your cash rate is eighty or a hundred or even two hundred? How can you can't justify billing eight hundred dollars with a care, unless you made a mistake. and so that's where owning your claims and owning your that d that level of detail is so very important, and that's where good documentation system can help because you know what you did, you know what codes to bill. You and also that's where good insurance verification comes in because you know it's covered. Right. You know it's not covered. and also just personal experience of saying, Hey, you know what, I just can't bill this code to this insurance company, or someone who's auditing your charges you put in and say, Hey, we don't recommend billing this code because it could flag the claim and you won't get paid. Or, you know, so all of those things play into it. and so they're your claims. You need to know what's going on. And if you don't know what's going on and there's a problem. You're ultimately the one who's gonna be stuck, you know, dealing with it. You know, if there if there's an audit and, you know, the biller's not gonna I mean, they might say, Okay, I'll help you, but at the end of the day, you're the one who got paid. You're the one who did the care, you're the one who did the note and it's your it's your claim.

Angelique and Toby: 'Cause insurances can take their money back down the road.

Eoin: They can take the money back. for the most part, they can'take it back as much as they can withhold. They can withhold the money that they say you owe from a future payment. And whenever you get a request for money back, that'something that you need to get to your biller right away and have your biller look at it and say, Is this legitimate or not? And it this

Angelique and Toby: That feels like a rose by any other name, right?

Eoin: They're not gonna pay you for other precare. But the thing is that is the is the recoupment legitimate? It's it's and now we s we hear all these different terms, clawback and but w the official term is recoupment. They'recouping funds. Is it legitimate? Did you submit a void because you billed the wrong patient on an accident? It happens, you it's just administrative mistake. Or i are they asking for money back because the patient had other insurance that we didn't know about, or the patient, and this is a big one for one local company, Because the patient didn't respond to a letter that was sent to them whether or not the care was related to a motor vehicle accident or personal injury. And that'something that needs to be on your intake forms. Is this care related to a motor vehicle accident or personal injury? Because that makes a huge difference. You can then clearly say the patient reported that this was not related to that. And so when the insurance company says we want this money back, you need to go in your or your biller needs to look at it and say, Is this legitimate? And if it's not legitimate, your biller. should be the one who's doing the work to get it fixed. You shouldn't be the one doing the work to get it fixed.

Angelique and Toby: I just had that happen the first time. Got one of those letters and you guys actually caught it before I did and said, Hey, this happened and so I had to get it.

Eoin: We caught it before you. Yeah. That's that's good. We must have been right on top of things.

Angelique and Toby: He did, you got it before I dead saw and I was because the patient didn't complete a survey. Yeah.

Eoin: That's exactly right.

Angelique and Toby: So they withheld, you know.

Eoin: It's a coordination of the benefits denial and they're right now they're working on like October November of last year. So you'll get a letter saying, you know, this, you know, we're we think there may be other insurance involved. We're gonna take this money back. Yeah. And if you're a solo provider and you're working the office by yourself, you don't have time to call the insurance company, figure out what this means. Right. Figure out why. or one of the other ones that we get every once in a while is in the and this happens, particularly at a network providers, is someone's method deductible And then you get paid the full amount that was for the claim. And then someone else sends in a void or changes a claim and now the deductible is owing again. And rather than taking out a the future claims, they ask the money back so they get the patient can be the deductible. Which means you have to go back to the patient asks for that money. And that puts you in a really tough position.

Angelique and Toby: So awkward.

Eoin: It'so awkward and it's not fair to you, but this is where you say, My biller says that you owe or my insurance company says that you owe this money.

Angelique and Toby: The insurance.

Eoin: Yeah. Yeah. They got thrown under the bus of the expression. Yes. So okay.

Angelique and Toby: What's the most egregious thing you've seen from the insurance companies?

Eoin: So let me let me preface this with saying that I don't believe that insurance companies today are out to just throw papers away. I mean, back in the we were like, well throw every third claim away, but you know, it's everything they wanna do things legitimately, but their systems are put into place to help save them money. So the most egregious thing I've seen, I don't yeah, you know, that's that's a tough question. I think it's I think it's recouping money years later when someone had a personal injury and they had a settlement and the insurance company said, Hey, this person had the settlement for this care and the settlement should pay for your care and so we want all the money we paid you back. And so now you have to go to the patient and the lawyer three, four Or five years ago and say, Hey, you owe me for this care. And you ha and if you didn't know in the beginning and you don't have a document that says they agree to was called a lien essentially a lien on their care, then you're the one who's left paying the insurance company back. And that's that's the insurance company's job is to protect the owners of the insurance company, whether they be stockholders, whether they be the insurers, but it's it puts the providers in a very awkward position, particularly solo providers and small providers.

Angelique and Toby: Yep. Yeah. Yes, for sure.

Eoin: And you get that letter and you want to cry.

Angelique and Toby: I haven't gotten that letter, so thank God yet. Knock on all the wood.

Eoin: You're like this is Blooney. Let me go send it over to Ian's team.

Angelique and Toby: I would I would one hundred percent. Yeah. It's I mean it's it's a comfort as a person that's out there like doing all the things myself to know that I've got a resource or it's like if I have a problem I can like, Hey, help me and you guys do,

Eoin: We do, we try. We try to be responsive. because we have that clinical background and not just that the practice background, I can provide practice guidance, not because I'm some practice guru. Because I made those mistakes. I did that. I d I did exactly what you're doing. And I'm gonna tell you, hey, you shouldn't do it, you should do it this way instead. Or hey, you wanna make sure you have this form, or hey, you wanna make sure the patient signs this. hey, you wanna make sure you don't do XYZ because we've done it. We made those mistakes and we were practice. We started a practice during the recession. we survived. and then of course, unfortunately I got hurt and had to figure out what to do with my life. And I love people, I love treating I love treating people, so let's treat practices.

Angelique and Toby: That's really a lovely way to look at it. It is.

Eoin: We want you to feel like you're hiring like your cousin to work for you or your aunt to work for you or even a family member to work for you, that you trust they're they're out for your best interests, that they're they're they're there not to slack off and not do their job, but they want you to be genuinely s genuinely want to be you to be successful in practice. And that's that's hard in a corporate environment and a even a small company environment to maintain that. And you've experienced this. We've we've actually we made a mistake and we made it right.

Angelique and Toby: You did.

Eoin: We made it right. And we've made it right because it was our fault. And I'd say this to my kids all the time, my kids are little bit older, said it's not about right or wrong. It's about who's gonna fix the problem. And yes, there's a certain amount of responsibility that's there, but yes, there's a certain amount of work you can do. But if you make a mistake, you just accept responsibility and deal with it. And I would rather deal with and fix a problem and maybe lose money or pay back money or whatever than I than lose someone who's valuable to me as a both in an individual as a and as a business and as part of my business in terms of my revenue. Your patients are important because they help you live, but they're also important to you because they're like your family or extended family. that you want to know. You've you particularly when you're in practice a long time, you watch them get married, you watch them have kids, you watch the kids go through the years and graduate high school and then graduate from college and you realize that you genuinely love these people. They've been with you for a long time and you don't want to have to say, I'm sorry I can'treat you anymore because you I don'take your insurance or hey I don't want to I can'treat you anymore because you're out of benefits. But I will say at the same time, those people want you to be successful and are willing to pay you. People are willing to pay you. I d I don't know why we're suffering such big softies.

Angelique and Toby: We I we are. It's and Toby's been really helpful in helping me be soft in the right ways, not in the like give everything away for free ways. it's it's hard because I you know, I can I can relate to that. And I think one of the harder things that happens is regarding medical necessity where you have somebody that has an insurance but it only covers low back pain and they want to come in because they have menstrual pain. Or you've got someone who just wants to do wellness care and then zero percent of insurances cover wellness care. I mean, I know if it's zero percent, but I haven't seen one that's just like, you can come in for anything you want. and having to have that conversation, being like, you I would love to treat you. I just can't bill your insurance for that. And I've had folks get angry with me as if I'm, you know, well, I had another provider that did this and that and the other thing or You know, isn't Chinese medicine whole person care? And it's like, absolutely, Chinese medicine is whole person care. And I will be treating all of you. However, we need a clinical focus that is based on what your insurance will pay for covering. So if that's neck pain, then we have to be focused on your neck pain while we also treat the entirety of who you are. And I have had people who get very upset. And I, you know, it's this is the insurance rules. And I'm not, you know, I've had folks actually and un they didn't ask directly, but essentially what they were asking me for was to commit fraud. You know, to be like, well, just bill for this and do what I want, you know, or just say that I that I have this. And I'm like, I am not, I'm not doing that.

Eoin: It's it's even it's actually even worse than that. in the sense that let'say the insurance company only pays for low back pain or neck pain and the person's coming in for something like a knee pain, all right. Now maybe their back hurts, okay, then they legitimately have some back pain. But if someone has a condition like for example, back pain and you treat it, then you're great. But if someone doesn't have back pain and you diagnose them with back pain, they now have that diagnosis for the rest of their lives. It's in the system. And don'think that once that insurance company knows they have back pain that every other insurance company doesn't know as well. Prior to me becoming a chiropractor, I worked for a life insurance company. And one of the things we did was we looked at insurance records and said, Hey, this person got treated for this condition, but they didn't document that condition at all. So we were not going to cover them because they had this low back pain, which they really didn't have. So or we're not going to insure them because or we can't give you this job because you have back pain and This job requires you have a strong back. So there's all of these things that you can do negatively for a person by treating them in a I don't want to say sketchy kind of manner, but treating them in a manner that's not consistent with their condition. You don't want to give someone a care. and I think the other s the other thing that is very important is try to avoid mental health care diagnoses. Please, you are not mental healthcare professionals. Yes, someone can tell you they have anxiety, but treat the symptoms. Okay. Don'treat the anxiety because you're not treating anxiety. You're treating the symptoms of the anxiety. And that's very important because if you're treating a c patient for anxiety, four one nine, whatever it is, and they have anxiety, but it's a situational anxiety, and it's not really truly weren't diagnosed by mental health care professional with anxiety. You know, they're they're anxious because they have this test or that test, whatever the case may be. now they have this anxiety for the rest of their lives and it's in their record. And they want to get life insurance, they want to get health insurance, they health insurance is a is an issue because while the ACA says you can't if you have continuous care, you can't deal with you know prior existing conditions, other plans don't ha don't cover that. If they're not ACA plans, they don't have to take you if you have a history of anxiety because you're a potential risk. They don't want to spend that money. So don't give people mental health care diagnoses.

Angelique and Toby: Insomnia can be con is one for some plans. I triggered somebody's deductible by billing insomnia once. I triggered because I had a separate deductible for mental health. So that one was tricky.

Eoin: That one that is tricky. I can't I can't see that. I mean, insomnia goes with so many other conditions. But that's the thing is okay, so i if you're if they have multiple conditions and you build for insomnia, can you justify taking that insomnia diagnosis off the claim? If it was the primary diagnosis, it's kind of hard to say, No, we're gonna we treated low back pain. But if you treated low back pain as primary insomnia secondary, there's no reason why you can'take insomnia off the claim. Yeah. You know, it because you're you're there to make sure that the patient's getting the care that they need and the care that their body needs and in a in a holistic manner, but ultimately you need to build a in a compliant manner. And one diagnosis is enough. If that diagnosis meets medical necessity, then don'throw every diagnosis in the book at the claim. Yeah. Don't do it. Don't do it. Just pick one.

Angelique and Toby: Sometimes I do too. Okay.

Eoin: Two's okay.

Angelique and Toby: One other so I have a quasi-hypothetical situation. So I have I've heard through the grape vine that sometimes folks have heard themselves that there have been practitioners in the past that have sort of done what you've described. So like someone has come in for wellness care or for something that isn't part of their insurance benefit and they're just like, they've got neck pain. they've got back pain. And then just treated them anyway. And maybe it hasn't gotten figured out, right? At some point, when it does get figured out, if the insurance company doesn't audit, like what actually happens to the provider and what does that look like to the rest of the profession? Like what does that do to the profession?

Eoin: I won't I'll speak to the profession in just one moment and I can only talk from a chiropractic standpoint, but the first thing is documentation. Did the patient document on their intake form that they had these conditions? If they did, then you're halfway there. All right. The next thing is in your documentation, did these conditions cause functional loss and or did was the patient not able to Do things that they needed to do or wanted to do because of it. And did you treat them for 26 times and they're still exactly the same? You know, so the insurance company has to figure out, okay, what is normal, what is a normal number of visits that an acupuncture patient gets? And let'say it's 12, right? The average acupuncture patient gets 12 visits. You treat someone 26 times, they're going to look at you and say, Hey, we want to see your notes to make sure these visits were approved. That's a post-payment option. So they already paid you, they're looking at it to see if whether or not you're okay. The other thing is if they think you're doing things that are not appropriate and you get hit with a prepayment audit, that is they won't pay you until they review your documentation. And that documentation could include the patient history. They might want the patient history. and that And that means you to have one. That's the other thing. You have to have a patient history. You have to have an initial exam. You have to have say, hey, care is needed. Treatment plan really helpful. but so you have a prepayment audit, and that prepayment audit is: was this care medically necessary? Now, if it was, then you're good. Then you'll eventually get paid. All right. If it was and it's good, but they decide not to pay you or they want their money back or they don't and prepayment they don't pay you, then you have to fight and file a complaint with the state as an example. that's a situation that we've seen. Now let's go back to as a profession. I can't speak to acupuncturists specifically because it is a relatively new profession from an insurance building standpoint. I mean, some insurance companies just started covering acupuncture. California, they've been covering it for decades, but I will talk about from a chiropractic standpoint. And in chiropractic standpoint, Medicare covers chiropractic care for speci very specific conditions and for a certain number of visits based on a d a diagnosis. And there's no set number of visits. So the Medicare had a contractor that did an audit and the audit came back that 93% of the care that was provided was wellness care or maintenance care. Now, that's very damning evidence to say that you're not practicing in a way that's consistent. But what it really was a wake-up call saying, Your documentation stinks. And you do need to t keep in mind that patients have to have medical necessity, that you have to meet that medical necessity requirement to be continue to treat them. You can't just continue treatment. You have to let them go. So the a lot of the Medicare contractors did a lot of audits and went back and looked at notes and they asked for hundreds of thousands of dollars back in many cases. I know providers who've who've bought these and lost and bought them and won. But what is d what does it do with the profession? It makes a profession look like you're a bunch of scumbags. I had I don't want to use that term. now. We practice in New York. New York has quite a few what are called mills, you know, personal injury mills in and work comp mills, not so much because work comp is highly regulated in New York, but a personal injury mill is where an attorney sets up a relationship with a provider to establish the treatment of care. And that treatment of care establishes that the person was legitimately injured and the person gets care. eventually there'some sort of lawsuit in the settlement. The question is, was that care because the patient wanted to sho to generate more revenue for that, you know, for the patient? Or was it in fact, care that was medically necessary and the patient needed it? And there's two sides to every coin, as we say. And certainly there are inappropriate things on one end, but there are pretty legitimate injuries on the other side. It doesn'take much to get hurt in a car accident. and I will say that. One of the reasons why I don't practice as a chiropractor is because I had three car accidents ten years. So there's there's legitimate ways. So what does that mean? That means I've lost I've lost my profession. I lost my job. Very tough for me to accept. But was I getting care regularly to see if I could get better? I was. But there's a certain point at which I'm just not gonna get any better. And that's when you see stop care. And that whole idea of terminating care is so foreign those of us who practice in a manner that means that you get the care that your body needs, not that the care that's necessarily medically necessary. And that's that tradition, that treatment tradition of essentially maintenance or wellness care doesn't work in a Western model. Yet we still try and cram it in there. Yeah. And patients still expect it. And I had a conversation earlier today with someone that a particular insurance company Only pays a certain dollar amount for claims and you can balance bill the patient. You're in network, but you can balance bill the patient up to the allowed amount. This only works if you communicate with the patient ahead of time, and the patient understands that they'responsible for X number of dollars, that they're gonna have to pay X number of dollars. That's where the communication comes in with the patient ahead of time, saying, Hey, we have X number of visits from the insurance company. Let's try this short period of treatment. Let's let's try it. Treatment plan says we're gonna try six visits. We'll treat you for six visits. We'll reassess where you are. And that assessment can be something as simple as, hey, I could pick up my grandkids and I couldn't pick them up before. Functional thing, something that's actually so important, particularly if you have little grandkids. or I can walk without falling down. And I will tell you that those of us who have falling problems, that's a win. If you can say I didn't fall down today, that is a win.

Angelique and Toby: Yeah.

Eoin: If you have that treatment plan in place and you have those goals as part of the treatment plan and the treatment plan, that's a whole nother l a whole nother thing about medical necessity. But then you tell the patient, Hey, once you get to the point where you're as good as you're gonna get, we have to stop care because you're now no longer medically necessary. Care is no longer medically necessary for you. But we would love to continue to treat you. We'd love for you to get that and maintain that level that where you're at. But that is maintenance care and your insurance company doesn't pay for it. But here's how we can help you pay for it. Or here's what we can do to help you figure out what works best for you and your body. And have that discussion at the beginning. Saying, listen, your insurance covers this much, the only curve care that is medically necessary, that is that you're going to get better Once you get as good as you're gonna get, we have to stop care. And at that point you can decide if you want to continue with maintenance care. And letting the patient know ahead time. You know, care is not forever. They may have seen another acupuncturist who just treated them once a week for fifty-two weeks in a year. But unless that insurance company is willing to pay for maintenance care, there's you just can't justify that.

Angelique and Toby: Before we close, Toby, do you have any other questions? I see we're getting close to our hour here. Yeah. I have a few, but I'm gonna keep them for next time when Ian visits us. good. We'll get to have him back again if he wants to come out. That would be great.

Eoin: I think that our biggest concern and our biggest issue is that we have a hard time figuring out where we fit in the medical model. And we've placed ourselves in a box that prevents us from billing patients out of pocket for care that is appropriate. For their condition, but not covered by insurance. And because in patients expect that they have these visits and this care, that they are not gonna have to pay or anything or only pay their copay. And that and that's an education component. and that's educating our fellow providers. You know, that's educating new grads coming out of school. that's helping existing providers have been doing things a certain way and understand, hey, that's not really the way to do it. So there's a lot. That goes into this profession of chiropractic and acupuncture, this holistic medicine idea, if you want to use that term, that we need to educate our providers to say, hey, you gotta do it a certain way to show that this care is needed, because we want you to be successful. We want you to help people for the rest of their lives. But we want you to do it a way that's not going to jeopardize everyone else's ability to stay in practice and everyone else's ability to stay in insurance. and I just wanna end with I love to educate the providers that we work with. but at the same time, I hate disappointing providers. And there is a certain level of disappointment that comes with learning that they can't do certain things that they want to do. But it's kind of like the tough love approach to you know practice. Hey, this is what this is all you can do. I would love to be back sometime if you'll have me. But there'so many little things that acupuncturists and chiropractors can do to help establish and medical necessity, help show that the care is needed. And it doesn'take much. It just takes a line or two in their notes and it takes an extra form the patient fills out. And it takes, you know, doing re-exams, even though they don't get paid for them, doing little re-exams and establishing changes. And if we do those things, then we can show that the care we need is medically necessary. And then we can show that we are responsible providers and working within the scope of our practice and the scope of what the insurance company's gonna pay for. And they're not gonna drop acupuncture as benefit. do it the right way, and we'll all be happy.

Angelique and Toby: Thanks so much, Ian, for being here with us.

Eoin: My pleasure.

Angelique and Toby: Thanks for thanks so much for your time, Ian. We'll see you next time.

Eoin: My pleasure. Yep.

Angelique and Toby: Bye. All right. Bye for now, everybody.

Eoin: Bye.

Episode 27: Food as Medicine with Warren Sheir

Office Hours with Angelique and Toby. Released July 11, 2026. 31 minutes.

Listen: Apple Podcasts · Spotify

About this episode

Warren Sheir talks with Toby and Angelique about Chinese medicine, nutrition, and food as an everyday therapy. He traces his path from macrobiotics to Chinese medicine school in 1995, and explains why he and his co-authors wrote Ancient Wisdom, Modern Kitchen: to give students and patients clear, practical recipes rooted in Chinese dietary principles.

He describes his approach to good, clean food: whole and organic foods where possible, plenty of vegetables, some whole grains, clean animal products, and simple meals eaten slowly without overeating, along with how he brings dietary advice into clinical practice.

Topics

• Warren’s path into Chinese medicine

• Good, clean food in real life

• Why he wrote Ancient Wisdom, Modern Kitchen

• Food as medicine in clinical practice

• Helping patients make dietary changes that last

A note for listeners: this is a conversation among practitioners, offered for education, not as medical advice. Patient details have been kept general to protect privacy.

Transcript

This transcript was generated automatically and lightly cleaned up. It may contain errors, especially in names and Chinese terms.

Toby: Warren Sheir welcome to our show Office Hours. thanks so much for coming on.

Warren: You're welcome. It's a pleasure to be here.

Toby: Thanks for saying that. if you'd if you don't mind, could you give a little bit of your professional background for some of our listeners that might not be familiar with your work? And if could somehow lead it into your book, Ancient Wisdom, Modern Kitchen. So if you can incorporate that in your bio, i if you don't mind.

Warren: Yeah, so started my Chinese medicine education 1995, moved to San Diego to Pacific College. And by I actually before I came from a background of macrobiotics. This is when I was undergraduate, which I don't recommend. But

Toby: Too strict? It's too strict, Warren, or what? Okay, yeah.

Warren: Yeah, but I was in my twenties. Yeah. So that's like sort of like being religious in your twenties, you know. I you know, I shed that after maybe five or six years, I became of like the energetics of food at that point, even though I don'think a lot of what they teach is necessarily accurate. some of the framework is. and of course the yin and the yang temperatures, things like that. They don't exactly not exactly like we would learn in traditional Chinese medicine, but the ideas were there. So I came in with that background a pretty strong background in that. I studied with Michokushi in Boston and other people in the borough, also. And I took it very seriously when I was younger, and then I just as seriously dropped it. But always kept a sense of eating good clean food. Which course could mean different things to different people, but we'll get into that.

Toby: Yeah. Well what does that mean to you now? I think that might be valuable for us to know. What does eating good clean food mean to you now? Well

Warren: Well okay, so now it means whole foods whenever possible, foods whenever possible. I a mixture of like lots of different of vegetables, some whole grains, some I guess I would call them sort of clean animal products, like f wild fish. I do eat pastured chicken. I don't actually haven't not eaten red meat in many years. Occasionally I'll lamb. Take it like a year. So I'm not like dogmatic or religious about it. It just how things have happened. So that's that and then I just also don't overeat anymore at all ever. how do I stray from that or whatever? And I don't. Okay. That's the thing. I mean, I was my partner, she eats chocolate, good quality dark chocolate. I was doing that for a And I don't anymore. I just sort of eat simple foods. I'll have porridge in the morning and we do a lot of soups, stews.

Toby: Even in the summer?

Warren: Yeah. we have we have a garden in the back. So she she grows greens, different greens, beet greens, a lot of Japanese greens, brunamis things like that. And she actually grew up on an on an organic farm. Her dad is originally from Japan and he's a scientist, but they decided to become sort of like weekend farmers in rural Canada, north of Toronto. And he had this large, it's the largest garden I've ever seen. Has to be like a I don't know, half an acre or something. It's big. Yeah, it'still there. And so she grew up eating like, you know, kabocha and Japanese greens and all these fresh vegetables. So we've brought that into our current diet, all the these things. we do of vegetables, and that's the summer thing. And then

Toby: Do

Warren: You know, occasionally I'm I'm I you know, they say in Chinese medicine, don't eat cold, raw foods. don't buy that at all in the summer.

Toby: Right. When San Diego in the summer, that's that's probably all right, huh?

Warren: Yeah, that's just like it's like I don't get religious about these things at all.

Toby: Uh-huh. I think I think that's an important message, right? Is like you we have some guidelines but not you know yeah. You that term orthorexia? That means like you're so strict eating that you make yourself sick. Like is that apple organic? you know, you're just scared of food and you're scared of things and yeah, so I feel

Warren: No, what is that? Like it is.

Toby: That yeah, but that maybe you started out a little bit like that. so now the pendulum swung into the middle with w it's just such a sweet spot to be in.

Warren: Yeah, and I'm that way with patients too. I mean I don't it's like you can't beat people with a stick, so you know. So yeah, so th so I still eat simply it probably more than ever now. and I don't really I don't cheat or whatever. I don't have ice cream or been My sin is do coffee. Which is not it's not probably not good for me because it's I think it's drying. Yeah. And I'm getting older and I'm getting drier. Okay.

Toby: All right.

Angelique: But coffee'so good. My sin too.

Warren: Yes, it is. I'm not giving it up.

Angelique: Okay.

Toby: I try and move a lot of my dry patients from like half a cup of coffee to like five cups of tea. And that seems like it goes okay. No, doesn't it doesn't work for you, Dr. Sheer?

Warren: I tried that. Yeah, but I sip it. No, it doesn't work. but yeah, it doesn't work for me. But I do sip the coffee. So my first cup, which is I'll have in the morning, it'll last for two hours.

Toby: Okay, yeah, that's that's all right.

Warren: Yeah. So I think these I think there'something, at least from my experience, qualitatively different about sipping something than about guzzling it down. Yeah. Same true for food, I think.

Toby: Yeah. Yeah, the body has time to integrate what you're putting in rather than just yeah, big chunk coming. Yeah, that makes sense.

Warren: And that's another thing I've done over the last few years is just eaten more slowly, which I recommend to patients always. If you can

Toby: You have any tips for that? You know, because I think people have that idea. have that idea.

Warren: Somebody should create an eating app like they have meditation apps.

Toby: Yeah. Like you could you could have a little gong.

Warren: Like a breathing app, like one, two, three, four, five, chew. Yeah.

Toby: Yeah. That's all right.

Warren: I don't I mean I just I don't know, I just gently try to suggest that as I do to myself. 'cause my mother used to say, Chew your food. And I didn't.

Toby: Okay. All right. But you finally got around to taking that advice. That's fantastic. What about what led you to writing your book?

Warren: No I do. Yeah. yeah, so there was a need. I mean, first of all, that's that's a really good question. this goes back God, it goes back to like 2005. And I had been out of school and I'd been teaching for five years at that point at Pacific since 2000. And everybody there, all students ate pretty crappy food. I mean, there were exceptions because it'Southern California. But I mean like there were machines in the student lounge with any I mean you name it candy, potato there wasn't anything healthy at that.

Toby: No miso soup dispensing.

Warren: No, no seaweed. And these are things by the way I still eat miso soup and seaweed. But anyhow, so just horrible people just, you know, just mindless. Nobody really took the students really didn'take care of their health. And I guess maybe at that point I was a little judgmental about that, less certainly more so than it would be now. But I thought, okay, here's there's a need for really exploring how do we get people patients and practitioners to become more of just good food, good diet. And I noticed, you know, there were books out there like Paul Pitchford's book. What's that what is that book again?

Toby: Yeah.

Warren: But he but I don't really think he had a legitimate background in Chinese medicine. And there weren't any recipes in there that were like usable. I'll just take the this, mix it with that, cook it. I think, you know, in of like cooking, you need, at least I need, and I think most people need a very step by step process to and so to effectively create the food, right? If you want to make it taste good.

Toby: Yeah.

Warren: So that was really the goal was creating recipes and make it to the practitioner, but also to the patient. Yeah, I think it only touches the surface in some ways, but that was the start. And then we went the conventional route. And so we got a co came up with a book proposal first, found a representative, what do you call them? A agent. Yeah, we got an agent. And that was a whole process that took months because he had to send them a whole bit from the book, and which they you know, like 40 pages or whatever. And then and then eventually the agent found us a couple different publishers.

Angelique: Agent.

Warren: And this was a slow process. And we just took we took the publisher that gave us the largest advance.

Toby: A pretty good metric.

Warren: It is, except for the other publisher was like was more adept at like I think it was Twelve Speed Press or something. Yeah, that was the one we didn't use. no. And they're more adept at cookbooks. So I don't know. It is what it is at this point. So it was what it was. So yeah. So that was the process. And then having to like God, countless we had to test to and taste every recipe. So we I think we did

Toby: They're great. Yeah.

Warren: Every recipe three or four different times to make sure it was really down.

Toby: That sounds delicious. It seems like you're complaining about that. That sounds delicious.

Warren: It's a lengthy pro a l a lengthy, delicious process.

Toby: Yeah, that's that's what the your book is a perennial favorite in my waiting room. I think that's why because people really like their recipes and they especially like the index in the back. So they you know they can look up something that's going on with them. They have a common cold or yeah, they have a little bit of constipation, and then you even have one of your index ones is like for your beauty. That's been really popular, those recipes.

Warren: From those are from Yuan Wang, the she's actually she was a senior doc at Chengdu. great. Probably before you were there for a little bit, right?

Toby: Yeah. I was there in two thousand two. Yeah.

Warren: And she was there in the nineties and she was a senior doc there. And she I mean, she's from Chengdu.

Toby: You're lucky every recipe wasn't hot pot.

Warren: Okay. I've been to her house countless times for hot pots. So that's another one of my that I probably eat too much of is spicy food. Okay. But that's whole other thing. Sichuan food especially.

Toby: Okay, yeah. Okay, well you look really well, so you're you're you're weathering that heat pretty well. Yeah.

Warren: Yeah, I take I do take care of myself. I can I can say that I actually do. yeah, so that's that was the process and Yuan was is a wealth of information in terms of knowledge about especially foods from China and the nature, the taste, temperature of the different foods. And

Toby: Warren, if you don't mind. I know there's there'sometimes a little bit of controversy. I know from my own experience looking at the different texts, like the nature of the food, especially like it like the Materia Medica is pretty well set, right? Bo He's always gonna be cool, right? Fu Zi is always gonna be hot. But I know for food there'some there's there'sometimes some from different texts. How did you guys navigate that? Yeah.

Warren: So I think what I did or we did is just go with a Chinese source it.

Toby: But even sometimes those conflict, right? Yeah.

Warren: And then just the sphincter in the lower burner.

Toby: I think I think I'm talking what you're talking about, but so you guys tried to just be not get too uptight about making sure you had it exactly right. If it was slightly cool or cool, you guys just went Okay, right. But I think

Warren: Yeah, whatever. You know, it's just like i usually it does it really matter. I mean, because you know if you have a like formulas, right? You're gonna have a formula with seven herbs on it in it and it's gonna clear heat, and there's gonna be an herb in there that'slightly warm and shitty than what it is, you know, so

Toby: This is how we started talking about that pendulum swinging, right? So it is really nice to get something closer to the middle.

Warren: Yeah. That's yeah, that's that's really it. So didn't obsess about the did our best. Yeah. And then just like let it go.

Toby: Yeah, anyway, every when I was looking through your book, everything you know, just before this I was looking through everything looked reasonable to me, right? That's that's my sense about the temperatures, about the natures too. So

Warren: Yeah, and we went to a number of different sources. And then I was just like, Well, okay, this. Yeah. Well, what did you do in your app? I mean that's

Toby: Yeah, that was difficult. How I got around that, the app itself, I made it editable. So like if you really think that watermelon is not cold, which almost every source I had said cold, you could change it to slightly warm. Watermelon could be slightly warm. And then it will that will f that's in the app now a as slightly warm, and then all your dietary recommendations and everything like that will follow it as a slightly warm really

Warren: Are there sources that actually say it'slightly warm or

Toby: No, but I'm I'm saying just as an example, right? Because there were so many different conflicting things, I thought, well, the way to get around that is someone feels really strongly that their tradition wants to say it's this, then they can do that in the app itself. So that was my way of getting around it.

Warren: Yeah, and actually the slightly I think is good because slightly warm or slightly cold is like close to neutral and it's often jumps the fence.

Toby: Yeah. It Chinese medicine loves that kinda wiggle room like that too, so I like that.

Warren: Also not being rigid, I mean that's the whole It's amazing that there were three authors, Yuan, me, and Mika. And we really there was no little to no It was really interesting 'cause you expect conflict, think, and old and it was just like, you know, we s we still go to Yuan's house for like lunch or dinner and yeah, years later, yeah.

Toby: Nice. But that's nice. Everyone kinda had their own tranche and then and brought it all together for the book then, huh?

Warren: Yeah, and I what's the word? I mean, I so respect her wealth breadth of that it was just like, okay, you know, I don't don't need to like stick my ego in there.

Toby: Okay, that this is like a smart way of navigating it.

Warren: It is, yeah. and it's kept me in this my relationship with Mika for all these years too.

Toby: Okay, nice. I was gonna ask you about clinical question if I can. what about have you ever seen something where we thought, I'm gonna definitely need herbs for this, for a case? And then just by dietary recommendations you were able to pull things around? anything like that come to mind?

Warren: Yeah, I mean the first thing that comes to mind is like spleen deficiency diarrhea. And congee like you know, slightly so like I don't know, what would be representative formula for that? Shenling baizhu san right? gens ginsen and poren intractylotus, right? And so that would be spleen deficiency diarrhea, but instead I like to give a congee And put in the con put like herbs in there like I don't know. Like well definitely fu ling yi ren lotus seed, lian zi qian shi like urealis, fox nuts, yeah. And just make a congee out of it, and that's worked.

Toby: Okay. But that's great. So that's kind of straddling it, right? You're taking the congee from the food world. And I mean there I know there's no fixed line between the two, but anyways. Yeah, food grade herbs. it's interesting. I have a patient that just cannot digest any herbs. but then gave her the fox nuts the qian shi and so she can do that, right? Because it's it'so food grade. And she'she's able to maintain her you know, she d she just massive diarrhea problems. And so with just that single food grade herb, she's able to do it.

Warren: Those are fruit herbs, so yeah.

Toby: So I think that it is a nice way of doing it, right? For especially the really sensitive patients, then get closer to the food grade kind of

Warren: Yeah. And of course, yeah, the for a l this my experience is that keep it simple these kind of spleen deficient herb sensitive patients, you know, not to like throw fourteen things at them for because it can overwhelm the digestion very easily.

Toby: Yeah. Okay. That sounds like a good strategy. my colleague Angelique, I'm just constantly trying to talk her into to prescribing more nutrition for her patients. She stopped listening to me a while ago about that. Warren, could you take a swing at it? trying to talk Angelique into prescribing more nutrition for her patients. Okay, please do.

Warren: It's hard to proselytize. Yeah, I mean it's it's challenging, you know. I mean it's it's important. Because thing obviously it's hard change somebody's diet. You know, they who I don't know who said it's like changing somebody's religion.

Toby: Ooh. What? said, Ooh, that it does feel like that sometimes, yeah.

Warren: Yeah, but without the atta if people take one step forward and two and sometimes three steps back their diet. Yeah. And so even sometimes baby steps with the diet can really make a difference. Just adding something or having them what's a good one, just like a good warm breakfast kind of a thing. can make a difference, but the it's the one step forward and two steps back that I think is and I and do you use herbs or

Angelique: Yes. I'm I'm I am eighteen months into practice I've just and I opened my own practice and so that whole drinking from a fire hose from school has continued as I learned to run a business and treat patients all by myself. And nutrition, yeah. I mean I've I know how important it is. And I've also seen how challenging it's been with patients. It's a there's low hanging fruit, you know, if someone's drinking ice water and eating ice cream three times a day, like obviously I don't just be like, No problem, you know. And Send them on their way. But when it comes to being knowledgeable, it's a gap, you know, in my own personal education. I have your book. recommended reading.

Warren: It's a gap in the education.

Angelique: Yeah. It was a very short course.

Warren: Yeah, because it's like I was just thinking this morning that like Western Medical School is the same way. Yeah. I mean, how many classes on nutrition do they have? Yeah.

Angelique: Probably not enough. Just like us, you know.

Warren: So yeah, I can't it's hard to proselytize.

Angelique: Look at his inspiration. Inspire.

Warren: It's it's I mean, it's guess maybe the best thing is if you can actually take baby steps towards doing it and then have some success and have that sort of like you can feed on that.

Angelique: Yeah. know, I ha I did this has happened a couple of times. I've had I've had patients shift their diet. I've got them on board and been like, look, let's just do this. So I had one person who was like very phlegmy and so dairy, so much cold food. And so she quit for like a month's time. We did some alternatives, did nut based dairy, you know, things like nut milks and stuff like that. She got so much better. And when she hit the end of that 30 days, right back into it. Just like went right back and I was god. Yeah, just loved the ice cream so much, loved the regular milk so much. And it was just like and it's almost like she had amnesia about how much better she was doing without that too. So, know. I'm sure do.

Warren: I feel your pain. There you know there's it's it's it's challenging, that's all though.

Toby: Yeah. In her defense, cheese is delicious. sure. in her defense, cheese is delicious.

Angelique: Please. It was ice cream for this person. She I mean the ice cream was I agree. And

Toby: But that's also delicious.

Warren: It's like I called that the triple yin. The triple yin cold, it's dairy, it'sugar, it's yeah, it's just And it's delicious.

Toby: Yeah.

Angelique: Yes, of course. I'm gonna steal that from you. you got the triple yin disease. Okay, let's work on that together. I've people add, like, okay, if you're gonna have yogurt in the morning, like add some cinnamon, you know. Yeah, add something more.

Warren: Yeah, see that's a good one. I was actually gonna into that a little bit of just adding the warming spices, you know. Ginger. I mean, I was doing that for myself years ago actually when I was in school, because I was like a digestive what was I doing that point? I was drinking some kind of a cold beverage with spirulina. Yeah, exactly. Cold. and

Toby: That's really cold.

Warren: I got just horrible indigestion. It's first term at Pacific. And what helped that was I continued doing the spirulina, but I added ginger and cortex, you know, rou gui And it actually helped. And I stopped doing it because I learned more. It's like, yeah, this is not good for my constitution, but the warming spices are a good thing.

Toby: So cinnamon, fresh ginger, anything else that you that people you it I think I think we want to tap into like your clinical knowledge, right? What have you recommended that people take on or stick to?

Warren: Well, yeah, so Well, the warm breakfast for sure. and know, I try not to like at least initially take away too much. Yeah. But thing that one thing I do like to take away is the cold food. Yeah. Yeah. Cause that's that I really believe is injurious. What else?

Angelique: Except in summer, cold foods okay.

Warren: In the summer, yeah. But in you know, everything in balance, right? Yeah.

Toby: But me yeah, maybe first meal of the day, right? Do you think it'something worse than raisin bran with cold milk on it? Yeah.

Warren: That's yeah, that's that, yeah. Just substitute it. I mean, not gonna have like miso soup or something. Yeah. But certainly some kind of porridge. I mean, I myself I do steel cutoats. Easily done in a instant pot where you just like set it up. I put what do I put there? Some warming cinnamon I put in there, warming spices, goji berries. great. So that's a simple thing to give people to really make a difference initially. Especially in the instant pot.

Toby: And they may feel something right away, right? If they go from cold raisin bran with milk to hot pot, excuse me, instapot congee, right? They may they may feel different quickly. Is you think that's true and you th you think that's motivating for them?

Warren: Sometimes. least for the first month.

Toby: Okay, all right. You got patients like Angeliques that they feel a bit they feel like a million bucks and then they're like, okay, well that month is over.

Warren: And then, you know, sometimes you really don't know what they're doing also, you know.

Toby: That's what they report certain things.

Warren: A great story is that the we I had this patient taking herbs supposedly every week in bag of herbs, right? Every week, And I forget the chief complaint was. I it was a long time ago. And then the roommate in.

Angelique: Yeah.

Warren: And

Toby: She had a small apothecary at her house.

Warren: Yeah. The roommate said, I don't know, what's this pile of white doing on my kitchen counter? There's like fourteen of them. So the one guy was like buying the herbs but not cooking them, just stacking them like

Angelique: That's an expensive charade, you know.

Warren: Yeah, I but who knows how common that is. I don't know.

Toby: To cook someday. Yeah.

Warren: I mean I think it was a UCS D student and I think not from this country and maybe it was is I need to please the doctor syndrome. Yeah. Possibly. Culturally.

Angelique: That makes sense.

Warren: Yeah.

Toby: It's been a little bit more than fifteen years since you published a book. Anything you know, you change your mind on about since then, something you wish you would have put in or taken out. you have any sense about that?

Warren: Yeah, I wish I had created an app to go with it.

Toby: That would that would that would have closed off my lane. but that would have I got I got pl I don't have a shortage of ideas, so I would have gone into something else.

Warren: Yeah, but that's that was that's probably, you know, I also wish that we collectively had the energy to like do what we intended was create a website with the whole recipes.

Angelique: It's not too late for that.

Toby: Yeah.

Warren: Well, it's too late. Okay.

Angelique: Okay.

Toby: The reci the recipe's only available in your book? There's no online

Warren: Okay. Well we just we ran out of gas and Nika changed j couple jobs a couple of times and we moved twice and just you know life shifts. Yeah.

Toby: Yeah.

Warren: And then other stuff happened and we just don't have the bandwidth really to do that, but somebody should. And I like a just a whole god, I the Eastern Nutrition class of Pacific for a number of years, and the one of the pro school projects was to create a recipes on my 'cause it's all on a hard drive now. So it'still there. Yeah. Well I wish we had done that. Yeah.

Toby: We could have an intrepid colleague reach out to you to put that out there.

Warren: I would give it away. Definitely. Yeah. Yeah, so that's what else would I have done differently? Probably lower my expectations.

Toby: Yeah, nice.

Warren: Well, I mean they're they're they're about actually making a difference with you know, it'so hard to make a difference with diet. You know, it just it's painfully difficult. so in that sense. Everybody would be like me. Okay. It's like in some ways. I mean, God forbid, but in the way of like, you know, you know, I'm actually even though sort of a wild and crazy guy, i it's not it's not hard. For me to like stop eating something or except for coffee. And that's pretty much it. You know, other than that, it's like, okay, I'll do it. Or to start eating at something. I could just do it. And not everybody's like that.

Toby: This may be comforting to you though, because so many of my patients have gotten your book and cooked several of the recipes out of it. That's I mean, at least anecdotally I'm hearing about you know, that your book is making impact on my patients. So I think you know, there's there'significant impact, right? We Yeah.

Warren: That's that's really good to know. I mean really. You know, 'cause I th I sometimes I reflect why am I doing all this? You know, yeah, I mean we all reflect in that way somehow. But there is that sort of, I guess, a ripple effect that goes on that you know w that's that's nice to know.

Toby: Yeah, I heard I heard this you can never measure the impact of a book. You know, it just goes out and out and then you can never measure where it stops, right? Because then that person might make that recipe and then share it with their friend. You it may just ripple out forever. meal is opportunity enhance degrade your health. And so, you know. And so each time that people choose the yeah, know, to not degrade their health but enhance it with a meal, then that's good. And then your book really gives a nice clean framework. And, you know, I it like you said, it's hard to change like changing someone's religion is like changing their diet. So it's it's nice to have something, you know, your book's and organized well. So it's you know, that's they have a framework where they could kind of do that

Warren: I think another thing that just came to mind around that is I think I would have gotten into more like the idea of mindful eating more because I think that'so important like slowing down eating at the same time every day much not overeating and Slow really slowing down and breathing and chewing, that kind of making it a more of a personal ritual. with think gratitude also. Yeah. Like a sense of this is just my personal ethos, of connectedness to the food and appreciation for where it came from, who grew it, does that make sense at all or

Toby: Yeah. And that doesn't sound like a personal ethos. That sounds like biology and physics, right? Yeah, that you to stay alive you have to have these people helping you to get this food. You know, so I think it just that's reality. So I think yeah, a little nod to reality I think is that's that's a nice way to eat.

Angelique: Particularly in the distracted world we live in. Where everyone has a screen or something

Warren: Yeah, you know, and walking around eating and you know, talking on the phone and you know, you don't have a phone, but you know not gonna ever eat while you're on the phone.

Toby: That's right. That's a that's one safe thing for me. I was just envisioning anyone who was listening to this show or watching this show continuing their meal right now. so

Warren: Well I always joke with my students like I on Zoom, but it's like another eating and I'll I'll talk about whatever it is, spleen deficiency and indigestion and it's just like and don't don't eat while you're driving, don't eat while you're in herb class, etc. But you know, also walking around and also the idea of eating communally, which I really think important. That's a personal ethos.

Toby: What about eating community? What can you unpack that a little bit?

Warren: There's value to that like as in a social setting sharing food at that's my personal experience and i recommend that to patients i mean obviously if you live alone and you don't have any friends it's not very but it but it is a way of sort of like sort of sharing the experience

Toby: Yeah, it seems like we've been eating communally for so long too, that it's just it's a recent thing that we just yeah, look at a screen and eat that's

Warren: See I don't have a television. You don't have a phone, I don't have a television.

Toby: Yeah. I don't have either one, Warren. So you're not I'm still ahead of you.

Warren: My phone? I'm gonna smash.

Toby: Okay, then we'll be even. Good. Warren, thanks so much for spending a little bit of time with Angelique and in Office Hours. And I really recommend everyone check out your book. thanks so much for your time, Warren. Thanks. Real pleasure. Thank you.

Warren: Pleasure meeting you both. It's great.

Episode 25: Ellen Goldsmith on Food, Seasons, and Prevention

Office Hours with Angelique and Toby. Released June 12, 2026. 41 minutes.

Listen: Apple Podcasts · Spotify

About this episode

Acupuncturist and author Ellen Goldsmith discusses the role of food in healing and prevention. She describes how her practice evolved from shiatsu to Chinese dietetics, her years teaching health self-care, and why she wrote a book on Chinese food principles with accessible recipes.

She explains how seasonality shapes what and when we eat, the place of condiments, flavor, and texture, and quick cooking methods suited to each season, with practical suggestions for spring foods such as asparagus, nettles, radishes, fermented greens, and rhubarb. She also talks about why practitioners should deepen their own understanding before advising patients about food.

Topics

• From shiatsu to Chinese dietetics

• Teaching health self-care

• Prevention as the core of Chinese medicine

• Seasonal eating: who and when

• Spring foods: asparagus, nettles, radishes, rhubarb

• Building competence before giving dietary advice

A note for listeners: this is a conversation among practitioners, offered for education, not as medical advice. Patient details have been kept general to protect privacy.

Transcript

This transcript was generated automatically and lightly cleaned up. It may contain errors, especially in names and Chinese terms.

Toby: Ellen Goldsmith, thanks so much for joining us on Office Hours.

Ellen: Thank you for having me, Toby. So you'd like to know who I am, I guess. So

Toby: Yes. Yes. we'really excited to have you here. if you wouldn't mind for our listeners, if you could give like a little bit of your professional background and if could somehow lead it into how you wrote your book, nutritional healing with Chinese medicine.

Ellen: Absolutely. So am a licensed and board certified acupuncturist and Chinese herbalist. I've been practicing since 1999 in that aspect of the field, but I've been in the field in Asian medicine since 1983, starting out Shiatsu and a study of macrobiotics way back when, which macrobiotics for those of you don't know. was a way of eat it's a way of eating based a little bit of a topsy turvy way of looking at yin and yang. that was started by George Osawa in Japan and brought to this country. Mostly people know about it through Michio Kushi on the East Coast and Hermanahara on the West Coast. so I practice Shiatsu did that and taught for decades on health. I taught at New York University in the Tisch School of the Arts in the drama department. I started a program because drama students were burning out, so I they wanted the students to learn how to take care of themselves. So what I did was I taught about how to build body awareness, focus, energy, and bring that into their presence on the stage. It was a very covert way of lear teaching them how to care for themselves, how to eat right, how to manage their energy, et cetera. And then for twenty years I've taught at the National University of Natural Medicine's College of Classical Chinese Medicine, which was one of the first colleges of classical Chinese medicine in the country, founded by Heiner Fruhoff. Many of you might know him. And I've Chinese dietetics there for two decades, and I've taught for the Academy of Integrative Health and Medicine, teaching food energetics and Chinese dietetics to Western physicians and healthcare providers. And also teach a course online called Five Element Nutrition, which is open to anybody. We have students from all over the world. And it's a three-month intensive basically into the foundations of Chinese dietetics. So and through that all maintained a brick and practice acupuncture. I work a lot with people around really to manage their health connecting into their body, which I think acupuncture is a great therapeutic tool for You know, giving people a different sense of feeling and different sense of possibility that, you know, you can walk in one way and walk out feeling completely different and nothing has changed in your life except the flow of qi and blood in your body. You know, so that's beautiful thing and I always I love continuing to practice. And then I maintain a consultation practice as well, working with patients and practitioners who we might want to discuss some cases. So did I write a book on food? And like as I tell my students, I said, you know, people will come to you and they will come to you for acupuncture because they have a problem that they won't solve. And once they feel some symptom relief, they may leave you. know, or they may stop taking their herbs, but we never stop eating. Hopefully, and we that every day. So, in a way, that's our most powerful medicine. And the beauty of our medicine, of Chinese medicine, is it's found founded in the principles of basically prevention. know, do we manage our lifestyle? Right. And the in the NeiJing it talks about You know, why is it that people used to live to one hundred years and now they die at fifty because they don't know how to eat well, they don't sleep right, they don't move their bodies, they don't manage their stress, they drink wine like water, you know. so it's it's an age old problem with human beings. And I think it's a great entryway into connecting nature. You know, food is our connection to nature. We Eat food. Hopefully, if you're eating real food, it's grown under the sun or it's raised on the earth or in the or in the waterways. it is the way we interact with it. So we can adjust it. We can manage our chi. We can change our blood chemistry. We can change our consciousness really with our food through a to our bodies. So I think it's a marvelous entryway in most people can relate to. And I wrote the So that it would be accessible to anybody who was interested in health and had some little curiosity about Chinese medicine. I wrote it for students of Chinese medicine who wanted to learn about dietetics. And I wrote it for my patients. And really, in a way that you could enter the book at any point, whether you enter it learning about the foundations of Chinese medicine, the foundations of dietetics, seasonal eating. how to set up your kitchen, right? You know, a lot of people are intimidated and don't know how do I cook even? What do I have in my pantry? Like how do I do that? So giving people a guide to that, you know, so it's doable and accessible. And then I along with my recipe co-developer, we developed a hundred and seventy five recipes according to the season. So you can not even read the book and cook seasonally and learn about the foods through you can learn about the health tips of the food, you know, what are the energetics of the food? What why is that food in recipe? I'll you'll some culinary tips. And you each we wanted to make was, you know, had a lot of flavor, a lot of interest. It's not just Chinese. I'm not Chinese, obviously. but You know, the beauty of our medicine again is it's translatable across all culture, right? Because it's founded in nature. And nature is universal. I mean, it's a it's a real kind of strange idea that we're all different. We have different cultures, we have live in different climates, we have different of functioning in our in our daily lives, but we're all human, we all live on this planet. And you know, I thought seasonal eating was a great way to enter it. And then in the book also I the urging of Sabine Wilms, Sabine Wilms, who's a PhD in classical Chinese medicine, I have a chapter on blood tonic recipes for postpartum post surgery, and then another small chapter on condiments, you know, how can you make your food, your dishes a little bit more palatable? How can you bring more flavor in? because condiments in Chinese are a way to do that. Increase the digestibility, increase the palatability, know, bring a little bit of magic into a meal. And it's a great way to cook a meal for many people and have different condiments so people can adjust foods. you know, I have a big passion for food because we all eat and we're all experts in eating. figure we're things that don't serve us well, but you know, most people like to eat. and So yeah, so that's that's me. That's where I s my kind of short story of the long road to hear. Okay.

Toby: Yeah, that's a great framework for us and everything. And you touched on the two things I really liked about your book. You really addressed the who and the when aspect. The who being like, you know, you have constipation or something like that. But also I really like that little section you had on there, what type of cook are you? You right? To really orient people about how they're gonna start approaching things. And my personal favorite, and then they this always cut off usually is the when aspect, right? What's what's happening climatically, what's happening with the season. right now we're late May, about to go to June. What kind of individual foods, what kind of recipes maybe from your book, are you recommending to people in general?

Ellen: Well, I always recommend number one, go to your if you can, if you have access to a local farmers markets because you'll see foods there that you may not see n see in your supermarket. right now, especially well, on the West Coast and on the East Coast. I was just, of course, in Western Mass where you have Hadley asparagus. and is a great cooling food. It of helps get rid of built up heat in the body. And So there's a lovely risotto recipe that I use asparagus and nettles. We're little past the nettle season, but nettles are a wonderful spring food, early spring food that are really rich in iron. It's very good for the liver, blood cleansing. It's also a natural antihistamine. So that's a lovely way to do it. I take you know, spring radishes are out and It's interesting because on the East Coast, where I am now, it's a little bit different than what I just left in Portland, Oregon. but there were some beautiful different kinds, all different kinds of radishes. And radishes are like a pungent food, so they'really great for kind of breaking up congestion in the body or, you know, built up winter heat or fats, et cetera. And so they're kind of spicy, right? But they're also lovely when you steam them. So I have this very simple, very simple recipe where I the radishes that I cut them in half. I have some cauliflower florets, and then I take the greens, the radish top greens, which are a little bit spicy, you have to wash them really well because they're usually quite muddy. and you wash them really well, you pat them dry, and then you mix in some sea salt with them, you cut chop them up. And you mix in sea salt and you kind of massage them like the way people massage a kale salad, until it gets shiny and a little wet, and you just let it sit for about you can even let it sit overnight. And what it does is does light ferment. So you have kind of steam, very simple, where the radishes turn almost sweet, like the way Daikon radish will do that when you cook it. And the cauliflower, of course, is a little bit fragrant, but also kind of sweet. And then you put this, you know, this kind of lightly fermented spicy green on top. And it's just a very nice way to get a little bit of a surprise in a vegetable dish. And spring-like. know, chives, garlic chives, spring chives, of course, again have that kind of pungent upward motion of you know, coming out the earth and also moving. Pungent is a flavor in Chinese dietetics that, of course, we use it in herbalism as well, that it rises and brings things to the surface, is a great energy of spring, right? Spring is about, you rising up, growing, bursting And so it's a beautiful kind of metaphor, but also true in its food action, to bring in little bit more flavor. You can chop up chives and put it on steamed rice if you have that. you can mix it in a light kind of salad dressing,

Toby: Corners the corners of my mouth were starting to get a little moist as you were talking about all that. So hope you're not seeing that on camera too well.

Ellen: And then one of my favorite recipes in my book, in the spring book, in spring section, is baked And rhubarb is vegetable, but we mostly know it as like a strawberry rhubarb pie. That's a very kind of common American dish. but what I do is I take some white grape juice, which is high in sugar, of and rhubarb is very sour. And I chop up the rhubarb into about two to three inch pieces, put them in this mixture of white grape juice, some honey and some cinnamon ginger, and then cover it with foil, put it in a baking pan, and cover it with foil and put it into the oven and bake it at 350. And the nice thing about it is that, you know, most of the time when we cook rhubarb, it kind of dissolves and becomes like an applesauce. You but this you keep the shape of the rhubarb. There's an integrity to it that makes it gives it a different mouthfeel. And mouthfeel is very important in our food preferences. and you that's one of in Chinese cuisine, a very important part of the cuisine. What is the mouthfeel? What's the texture? Having different textures in a meal can really satisfy us as eating. So You know, these are just a little bit some ideas. think the thing in spring is we want to lift our energy up so we don't want to cook things long and slow. We want to do more stir fries or quick sautés. of course, are always great because they're so hydrating and nourishing, an easy way for people to get really deep nourishment. And So those are just, you know, some ideas and we wanna ha use herbs. We wanna use different herbs and spices, not in the spicy sense, but in the sense that it awakens your senses because we really the medicine starts when we smell. Mm. You know, my Chinese teachers would say to me, you know, the medicine starts when you smell the herbs cooking in the kitchen, right? In the old days when all of us used to do raw herbs and you know, before granules kind of came into the picture. that's the medicine starting. So that kind of aromatic kind of food, herbs that we can add to our dishes, you know, really activate our digestion, work on our middle jiao and make delicious. that's the only way we're gonna eat well is if the food is delicious.

Toby: Yeah, that's true. And that just reminded me, just last week I had a patient that we were cooking herbs for. that was gonna be a patient later. And we were able to cook the herbs. We do raw herbs at my at my office. And it was just so great. The whole office just had that really beautiful smell. So I'm gonna try and do that a little bit more often. Angelique doesn't do much recommendations of dietary recommendations for her patients. I wonder if you could talk her into it.

Ellen: Mm-hmm.

Angelique: Well, I can tell you why.

Ellen: Was just really curious what keeps you from doing that.

Angelique: Because don't feel so we had a single like part semester course in Chinese nutrition. And haven't I we went through it and it was in the tumult. I'm about I'm seventeen months into practice. wow, so I'm a newer practitioner and so I haven't circled back. I have your book. It was one of the recommended readings for the nutrition class. So I like leafing through it, but I haven't dove into it enough to feel like I have the competence and the like the way that you speak, it is so clear that it's part of you. You know? And I would love to be able to speak from that space or at least fifty percent of that space if I'm gonna be giving recommendations to folks. So I just need to deep dive it again.

Ellen: You know, absolutely. I mean, this is a question I get a lot, Angelique, from practitioners both in our field in Chinese medicine and also Western doctors. You know, look, we all want to help people and we want to give them good advice so that they make good choices. But always say, physician, heal thyself. Do deep dive. And as of my wonderful dance teachers many years ago said to me,

Angelique: Mm-hmm.

Ellen: Do not noise your fortune abroad. Do not noise your fortune abroad. What does that mean? That means let the fortune rise in and kind of seep into your body. Let you have the experience of what it does for you, what you discover, what you learn about yourself, what you start to observe in yourself. And don't worry about your patience. And then you can start to observe it in your patience. You can start to ask them questions, you know, and be curious about, well, you know, Just asking them, you know, you feel hot? I think a great way to start is, you know, are you hot or cold? You know, it's one of our 10 questions, right? And you could say, well, what kind of foods do you like to eat? You know, do you like spicy food? You know. mean, the simplest thing you can do with somebody like that who's maybe hot and irritable and has that kind of liver qi kind of you know, is and if they like lot of spicy food, is to cut those things back, you know. But first work on yourself, discover what it is, discover what it isn't, and then you can take that out into the world. I think we're in such a rush to help others that sometimes we f we forget about ourselves. So it's you know, it's a beautiful way to increase power of observation internally. and attune ourselves to our environment and to the impact and feeling sense, you know, really feeling sense in the body of how food makes us feel. And I'm, you know, and really, I mean, I really think food needs to make us feel like when we eat, we enjoy it. It goes down well. It doesn't get we don't feel bloated or gassy or anything like that. And then we have energy. to forth, you know, and then we get hungry and then we eat again, you know. So it's I think we can be patient with the process and not be in a hurry to kind of help everybody, but just to learn about it for ourselves. And I think when you hear it in me, I think it's because that's what I've been doing for 40 years. You know, I'm older, so you know, I've been doing this a long time. And I think in the beginning I was maybe a little bit more I was really enthusiastic and I was kind of prescriptive a and now I realize, you know, food is a complex thing for people. It's emotional, it's cultural. It's cultural not only in the culture that of origin that we may come from, but it's the culture of our family. You know, how did our family deal with food? Was there food? Was there tension at the dinner table? You know, there'so many different elements. Were we made to eat things we didn't like? You know, all these kinds of things play into it. So I think the more we can explore it in ourselves and the more we become comfortable with just observing and knowing what it is without judgment and attachment, the easier it is for us to help people step by step, inch by inch, you know, it's because changes Everybody wants to change like know right away, you know. but change is such a process. And sometimes it's three steps forward and two steps back and then ten steps back, and it's it's okay. You know, it's just if we can if you can be someone's guide and acknowledge and kind of help them connect to what's working and what isn't, I think we do ourselves and our patients a great service. You know, to be human is it's quite a task.

Angelique: Sure is. Thank you for that beautiful reorientation that really nicely.

Ellen: Okay, great. I'm so happy. Yeah, so explore it and let me know. Or you can always shout out with questions and stuff. I'm happy to I'm always happy to engage and talk to people. Yeah, for sure. Yeah.

Angelique: Thank you. Of the practitioners that you are in contact with, how many how many of us are new to the medicine versus how many are the seasoned ones that come for the case consultations?

Ellen: Not working with that many practitioners. You know, sometimes I work with like medical doctors and that's really tricky because if you don't know the medicine, again, you're looking for the prescription. and it's hard to do that without the foundations. so I'm not working with that many practitioners right now, like on case studies specifically. When I teach my graduate students in the class

Angelique: Right. Yeah.

Ellen: College of Classical Chinese Medicine, we will do case studies and explore that. But they're new, you know, they're not even out yet. And then in the online course I get different people from different, you know, they're acupuncturists, they're medical doctors, they're Shiatsu practitioners, they're Qi Gong practitioners. So it's a quite it's a big mix of people, yeah.

Angelique: That's really great. I'm I'm heartened to know that there are medical doctors that are also seeking out your and knowledge. I had a very recent encounter with a doctor in my own life where you know it's people do they just want to prescribe medication, prescribe medication. And so I was like, What? But there must be other things. And this doctor who is a doll of a person was like, I'm not your wellness coach, I'm your doctor. Literally said to me. I was like, Clutch my pearls, you it's like, my goodness.

Ellen: Yeah, I mean it's tricky. I mean I feel for the medical doctors these days. I mean, they're in such a bind if they're working under the insurance thing is really hard. But I do wanna give a really big shout to Dr. David Eisenberg. Do you know him? No. Dr. David Eisenberg is out of Harvard. He's a medical doctor in the Harvard the Chant School of Public Health. He was One of the first people in the nineties that did a big study on the out-of-pocket costs that Americans spend on alternative healthcare. And it was like back then, 30 years ago, it was like $3.5 billion out of pocket. And that was homeopathy, acupuncture, massage, et cetera, et cetera. And he has started a program called Healthy Kitchens, Healthy Lives. he's been doing it for I think a couple of decades. And He does it and when I first heard about it, I was curious like why culinary medicine, like, huh? You know, why are the medical doctors quote using this? But he credits it all to Chinese medicine. He was when he was very young, he was very interested in food and he ended going to Harvard and he went to the medical school and he still was curious, like, why aren'they talking about food? And then an acupuncturist came, this was in the 70s, acupuncturist came and talked about Chinese medicine, and he became incredibly curious and on to study Mandarin and went and was one of the first eight white medical in China just after Mao died, after the Cultural Revolution ended in 1978. And he studied for a number of months acupuncture, herbs, tai chi. Cooking, very interested in cooking. he offers a program for Western medical professionals called Kitchens, Loves, every year at the Culinary Institute of America. And he always starts the program out with talking about the Neijing and just what I talked about at the opening of this conversation, which is that Chinese medicine, you know, prevention is superior to cure. And prevention comes through our daily lifestyle, through mindfulness, through food, through exercise, through how we sleep, how we manage our stress, etc. And so I am constantly because he does this every time he introduces, he talks about Chinese medicine. Yet in the program he never talks about Chinese medicine. But you medical doctors doing cooking classes, you have all kinds of different people teaching as medicine in community centers and churches and schools, through the teacher TKC teaching kitchen collective. so I really want to just give him huge credit for the work that he's doing and that the work that has been done to bring more nutrition and culinary medicine into conventional medical schools. when I teach my class at college, which is unfortunately now not required any longer. It used to be required. It's part of the getting your but now because of the entry level doctorate, it's not required, so to speak. It's an elective. when I teach my class, it's very heavy hands on, experiential as well as didactic, so that people really, you know, can integrate those foundational principles in the kitchen in a way that is therapeutic, intentional specific, you know, to the condition, to the season, to the skill level, even, because there's really simple things you can do, and have very therapeutically healthful food. So I think there's a I wanna just say there is a lot going on out there, but not everybody's doing that.

Angelique: Mm. I'm glad to hear it. So you're saying you cook with your students? that'so great.

Ellen: Absolutely. How are you gonna learn about food if you don't cook?

Angelique: My goodness. Yeah.

Ellen: You can you can learn product. I mean you can learn a lot reading my book, but

Angelique: Still. How great. my goodness. We are all that would have been amazing. We're all burnt out to go into a class. We could cook and eat good food. Are you kidding? Acupuncture schools everywhere do this.

Ellen: Yes, and I and I do it with that in mind, Angelique, you know, as a restorative way, as a as an aspect of self-cultivation, really. Mm-hmm. You know, that we do it for ourselves and then we talk about how it's applicable. And I'm really, know, when we're first practicing, we're very enthusiastic. And we talk about yin and yang to our patients and everything, and they kind of nod their heads and don't know what we're talking about. You know. how do we make it doable? So like your Aunt Sally in Nebraska, who likes corn dogs, can get it, you know? And there's a way to do it. Because everyone understands when they're too hot, they understand when they're too cold. They understand when food is too bland. They understand when food is too salty, you know. So we kind of we have to meet people where they are so we can get them excited, you know, about it. Yeah. It's like why else would you do it? It's just a burden for a lot of people. I'm too busy that's like what I get. I'm too busy. I'm going, really?

Angelique: Yeah.

Toby: To see doctors, right? Because of all their problems. Yeah.

Ellen: Exactly.

Toby: Thanks for a super answer on that one. I thought you were gonna give Angelique the top three tips that you should start doing things with, but it'such a deeper answer. Thank thanks so much for that.

Angelique: Yes.

Ellen: And I can I think I did gave you a couple of tips you could do.

Toby: Yeah, no, that no that I'm saying. And you took the answer really deep, so I really appreciate that. Angelique and I are putting together a new Chinese medical school model too, and that's that's intrigues us for a nutrition class that includes cooking. That would be that would be amazing.

Ellen: Yes, I mean I think I think anything we do in Chinese medicine, the more we can bring it into our daily into daily life, whether it be through qigong practice or meditation or cooking on herbs and cooking with herbs, you know, I think the more integrated it can be, you know, into who we are and that can come forth to our patients too, you know.

Toby: Yeah, that'some the somatic learning never leaves you. You could forget the facts and things like that, but when once it's in your body, then you always have that. So yeah, I th I think that's some of the most valuable learning I've ever had is that I felt it throughout all my cells and just never forget.

Ellen: Yes. I mean I mean, how did I get into Chinese medicine? I felt it.

Toby: Yeah. Same. That was my experience too. I felt Chinese medicine, so then I didn't need a study. I didn't need a research study double blind or anything. Like I felt it in my body. So okay.

Ellen: Well, now with this study with about the interstitium, you know, like, validate it, you know, but

Toby: That's not very important to me, that validation. I'm already I know. I feel like clinic clinically validated I'm

Ellen: Exactly. Exactly. I think we forget that, you know, part of evidence based research is large swaths of populations experience, you know, anecdotal evidence is that over long periods of time is part of evidence.

Toby: You know. Say a couple of millennia. Do you feel like that's enough time, a couple of millennia? I wanted to touch back on something you said earlier, just some really pragmatic things. You were talking about in your book the extra part for postpartum and post surgery. What would about would you mind telling us like some of your basic strategies for those two conditions? can you can you speak briefly about that?

Ellen: Well, yeah, I mean, first of all, when women give birth, that's you l women lose a tremendous amount of blood. And it's an it's a very stressful event. I mean, it's a beautiful event, but it's a very stressful event, both for the in baby being born and the woman. and it's really important to rebuild our blood, our yin, because in of course in women, blood is our essence and blood yin. So we need to rebuild that. and along with that, of course, our qi. you know, we need to lift our qi up, etc. So, you know, most of those foods are kind of broths, whether it be one of them I think is, you know, cordyceps with duck, very rich, you know, tonic building food or black silky chicken, which is hard to find, but it can be found in an Asian grocery store, which is

Toby: In San Francisco it's easy to get. My teacher doctor would love that one for fertility and then postpartum too, yeah.

Ellen: So you'really looking, and you're also looking at foods that are easy to digest. That's why soups are so brilliant. or you can make kangees and add herbs to them as well. You know, goji berries, data, red dates, dang gui, different kind of configurations. I have a vegetarian cheetonic broth in that in that section. And ginger braised pork, sauteed prawns and rice wine are with garlic, ginger, and leeks. very traditional for, you know, postpartum women. yeah, so I it's really important to have these of again, easy to digest. You know, because you're tired, you know, and also to replenish the blood. dang gui and astragulus tea, of course, dang gui is the women's ginseng. It builds the blood, it moves the blood, it's warming. astragulus lifts the qi. So to bring that back, so that you know, I think need to rest. I mean, and they're not really we're not really resting because you're breastfeeding or you're dealing with breastfeeding, you're you're being up. many times in the night to feed child. so it's really important. The nourishment is really important. And of course in Chinese tradition, also in Mexican tradition and I think Vietnam, I think Asian traditions for sure, but I know in Mexico as well there's a that tradition of sitting out the month where you just really rest and people take care of you. that would be so sweet, right?

Angelique: Goodness. Goodness.

Ellen: Yeah. So but also, you know, post surgery too, you need much more nourishment after surgery to heal. it said you need more protein. So having these broths where you're not having to chew and digest, but you kind of get that IV infusion, you know, the extraction of the nourishment into the liquid that you've cooked for a long period of time. is very nice.

Toby: Would it would any temperature component for that? 'Cause I know like surgical theater are always so cold, right? I wonder if you feel like you need to warm them back up after that? again, taking into account their constitution as well.

Ellen: Absolutely. Well, a really nice way to warm yourself back up is to do like a ginger foot bath. know, just to get that heat in. if you have scars, of course, that's tricky, but even doing moxa on stomach thirty six, or if you don't have a scar, you know, on C V C V four is really nice to kind of give that, you know, support to just a whole body qi and that deep kind of source qi in the body.

Toby: Nice.

Ellen: Yeah. Also helps you know, helps you to relax. You know, when you when you're cold, it's hard to relax. You know, your tenses up. So have that But you know, really heating from the feet up is really can really a big difference. Yeah.

Angelique: That sounds wonderful. I've had patients do Epsom salt soaks like at night before bed, but I didn't consider adding ginger. That makes so much sense.

Ellen: Yeah, I think more for the feet. Yeah.

Angelique: That's what I'm saying. Like feet soaks, like have them soak their feet.

Ellen: Yeah, very nice. Up through kidney one. Yeah.

Angelique: Yeah. I like that a lot.

Toby: Ellen, what role does intuition play in your clinical work?

Ellen: Hmm. That's a great question. I mean, it plays I think everything in it in a way. But again, I think that's over years and years and years of experience. And also in the beginning, I really hasn't changed, but I'm I'm very curious about people. So, you know, people come into our into our clinic space and tell what the problem And A lot of times people will rush through that and then they'll get to something else. And it's always good to go back to the first thing that a person says. You know, tell me more about that. I think I like to space in the in the clinic setting where someone can open up a little bit, you know, and kind of see I think 'cause people when we have If especially, you as an acupuncturist, a lot of people come to us because of pain, right? and pain is something that we have an aversion to, meaning we pull away from it or it becomes a source of focus that is like this a little bit of an invader into our lives. And do we kind of get under that to see what the experience of it is? Because I think we have to sense the person, you know, it's not just the problem that they're bringing, but the person who is experiencing this. And you know, sometimes people have this problem, but they're very kind of shut down and defended and so it's hard to enter, right? So we have to be gentle. And then sometimes people are very vulnerable with a problem, and we have to be gentle. But it's a different way in. You know, I really know, I've seen it over the years, that people's nervous systems can take only so much. I to pay attention to that. And one my always said less is more. You know, so it think if we're very intentional in how we needle or we're very intentional in how we converse. It can have a very strong impact on people and we don't have to work so hard and we don't have to do so many points. everyone has a different style. Like one of my first teachers was a Japanese practitioner in New York, and he did many needles, but in a very interesting way. So I have, you know, a little bit of his kind of teaching, and also because I came from dance and movement therapy. And Shiatsu. So I have a deep study of the body and also a deep kind of study of palpation of the body. And so, know, being able to feel the body and sense like, the needle goes here, even though maybe the point says it's here, you know. or just kind of inquiring with the person. So it's become a little bit more automatic, but you know, it did take me decades to kind of see what is the system, you know, who is the person, what's coming in the door, what are they ready for? can they leave with that they can integrate back into their lives, you know? So I think in that way my intuition plays a huge role. And of course my training plays a huge role too. So

Toby: Yeah, they interact, right? Your intellectual understanding and the intuition.

Ellen: Yeah. I mean, do you have do you work a lot with your intuition?

Toby: Yeah, I think it takes the lead for me.

Ellen: Mm-hmm, mm-hmm, mm-hmm.

Angelique: I would say same. I was a nurse for a very long time before becoming an acupuncturist. And so that's I think probably the strongest skill I bring to my own practice because I learned that interaction, that gentleness that you talk about, and how gentleness can have different flavors. And you have to find way it with the right with what's what's right for the patient in front of you. Yeah.

Ellen: Yeah. And you know, it's it's again like I said when I first started talking, I mean, if someone walks out of my clinic with a sense of feeling their body and feeling a sense of hope or possibility, then I know that's good. That was a good treatment. That's good. You know, 'cause how do you We jump out of our bodies so quick. I mean, people have their phones, you know. always tell people, Don'turn your phone on right away, okay? Just take a little walk, take a few breaths, have a little snack or have some tea and then turn your phone on. But it never works. People are like out the door with their phones in front of their faces. sometimes. So, you know, how do we help people get in their bodies? I mean, how do we help us stay more human in this time? That's That's a really big question. And how do we share some kindness? I in these times these things have a lot more value than we realize, you know, because the world is kind of rough right now. Mm-hmm. For a of people. Yeah.

Angelique: Yes.

Toby: Yeah, but it's it's we're s I feel yeah, so fortunate. Our role is to put a little bit of kindness, a little bit of health back into the system, right? That's can be so unkind and so unhealthy at times. It's really nice to put a little bit different spin back on it person by person, right? I feel so lucky to be able to do this work.

Ellen: Yes, absolutely. also, you know, I'm I'm very aware just of what's going on, you know, how can I support someone in when they choose both paths? You know, like sometimes we just need a doc you know, we need a medical doctor for some reason for some things. Yep. and so how can we help someone, you know, put those two together in the in the way that they are both working, you know, together. to help the person feel healthier and be healthier and more vital, really.

Angelique: That's the aim in my practice, being an RN and also an acupuncturist, trying to blend both seeing people from all around the area, doing that very thing. Yeah.

Ellen: Great. That's great, yeah.

Toby: All right. Ellen thanks so much for your time and spending a little bit time with us with office hours. We really appreciate it. I highly recommend everyone go out and get the book for themselves and then a second copy for your waiting room, because if it's like my waiting room, that is always out rented by other patients. So maybe two better say two for the waiting room, one copy for you.

Ellen: Absolutely. That's great. I love it. I mean, if my greatest hope is that this book is of benefit to people or that it just it connects them to something that they can, you know, a choice for themselves that is delicious and good for you. I mean, there's a saying in Chinese medicine, chi yao, eat your medicine, you know, like eat your medicine, you know, food and medicine are inseparable. Enjoy it and do it with joy because eating healthfully is not a chore. It should be a great a great pleasure that gives back to you times.

Toby: Yeah, but thanks so much for making a tool that makes that a little bit easier to do. So we really appreciate that.

Ellen: Yeah, well thank you so much for having me. I'm really I cannot wait to hear you guys are up to soon. So please stay in touch. And yeah, if anyone has questions for me, they can reach me easily like at my website, pearl natural health.com or LNG at health.com. I'm always happy to answer questions.

Toby: That'so generous. Thank you.

Angelique: Yes, thank you so much. Very inspirational.

Toby: All right. Bye everybody.

Episode 24: Infertility and End-of-Life Care

Office Hours with Angelique and Toby. Released May 26, 2026. 29 minutes.

Listen: Apple Podcasts · Spotify

About this episode

Toby and Angelique discuss fertility treatment as tending the whole garden: finding and filling the biggest gaps so that conception can happen naturally, drawing on what Toby learned from Dr. Angela C. Wu. They also talk about how acupuncture can support patients and families at the end of life, including integrating cultural rituals.

They share cases involving an autoimmune eye condition and recurrent herpes, and explore channel theory, including divergent and sinew channel treatment strategies. Toby also announces his new book, Tracing Our Lineage: The Enduring Legacy of Chinese Medicine’s Great Masters.

Topics

• Fertility care as tending the whole garden

• Acupuncture at the end of life

• A case involving an autoimmune eye condition

• Recurrent herpes

• Divergent and sinew channel strategies

• Toby’s new book, Tracing Our Lineage

Key terms

• Divergent channels (經別): jing bie, channels that branch from the primary channels

• Sinew channels (經筋): jing jin, the muscle and tendon channels

A note for listeners: this is a conversation among practitioners, offered for education, not as medical advice. Patient details have been kept general to protect privacy.

Transcript

This transcript was generated automatically and lightly cleaned up. It may contain errors, especially in names and Chinese terms.

Angelique: Have you had any interesting patient cases or just front of the mill stuff?

Toby: Especially everything's been going well fertility wise for me. just yesterday I saw a patient visit three and they've been trying for three years. And so we're able to conceive on this cycle. So they'really, yeah, they'really pleased about that. just, yeah, a few fertility cases, especially going well. Yeah, it seems like every once in while it seems to trend up, right? Where treatments just... team, especially potent. last month or so everything's been especially potent. Could be spring energy, but you know, it just seems like just like a more locked in clinic sometimes and especially locked in right now. yeah, we had a patient that couldn't see autoimmune disease taking away her sight. And I had to try to read that need, you know, doesn't have anything visual things. So I had her

Angelique: Energy.

Toby: Hold the box of needles and try and read it. And she said, I just can't read anything. I placed needles and then gave her the needle box again. She's all, AcuFast was like, whoa. Yeah. she was really pleased.

Angelique: Okay, so what was her imbalance and what did you treat?

Toby: Guess in a minute, I'll you.

Angelique: Jesus. She had an autoimmune illness that was taking away her eyesight.

Toby: And she's at a major medical center and they, you know this better, but they'd give her maximum steroids in the eye. They were putting pouches in. She said they were putting pouches of steroids in the eye. That seemed odd to me, but they're directly injecting. anti-inflammatories into their eye and that wasn't helping and then a bunch of other things. mean, no one can quite figure out this case. So usually that's good for us, right? They just can't figure out the pathomechanism from the Western side. Then usually it seems like it'straightforward from the Eastern side. Not always, but it seems like that's the case.

Angelique: To supplement her liver. Yeah.

Toby: Yeah. Because she was complaining of she was having all these sparkles. When it first happened, she couldn't see it was like piercing light coming out of her eyes. Again, patients just tell us right if we listen.

Angelique: It's true. And then sometimes, this is, I know I got a long way to go, is that you think like, yes. And then,

Toby: Yeah. Again, there's red herrings in the clinic, right? For sure. But this one seemed pretty straightforward, right? Because it was eye, sparkly. She was ultra polite, like crazy polite. The left side of her face has Vitiligo know, like so, you know, really light coloring. So not enough dark all around the eye into the cheek. I was like, wow, this is, you know, it a really clear and then, and then freezing cold feet and it's like eighties here. Yeah.

Angelique: I this patient that I've been treating pretty regularly to prevent HSV2 and it's been going pretty well. I, it's herpes simplex too. genital herpes. And I've been treating, I've been treating her for a while and they've reduced in frequency, which is cool. And one of the, she,

Toby: Tell me what that is again, please.

Angelique: She came in and she was like having a lot of heat. She's definitely like a hot, a heart excess presentation, like really red face, like red and like the happy way, not the liver way. You know what I mean? Yeah. laughs a lot. just as really warm sort of energy about them. And definitely she's got some sound gel excess stuff too, but, was having, was having a bladder channel pain at one point, like what else is going on? So yeah, she was warm. So I supplemented her bladder and I can't remember what the other symptom was necessarily. And I've done this before and it's been really helpful. But this was like a go, like months ago, I think I supplemented her bladder. When she started to have an uptick, she's got some POTS symptoms going on. And I think that the hot flashes, like she would get really like warm over all of her body. And she said that during the treatment and at the end, and she's like, I didn't mention this to you, it happened right at the end. She got like a vertex headache that was like very brief. And then went away. And then when she went home, she said that she had a migraine that lasted for two days and then has had headaches along her gallbladder channel since then, which was really interesting. So I'm like, how did that happen? And she was having sweating without heat. So I don't know if I like to, you know, by supplementing the bladder, like the heart, she got deficient. So there'spontaneous sweating, you know, I don't know.

Toby: Yeah, maybe too much of a good thing. I'm just thinking about two for me for herpes that worked really well is supplementary liver, supplementary large intestine. So those two things and especially with that sweating without heat and large intestine might be especially good for you.

Angelique: Yeah, I've done both of those. I had done the liver the last of the time before that. And this person comes every couple of weeks. So I was always trying to like not repeat unless it's necessary. You know, good. But I do cycle back to the liver more often because she has a constitutional Sanjo excess that presents itself. So anyway, then I supplemented her pericardium. She was also really angry and she's having trouble sleeping. And the headache. disappeared during the treatment. So that was neat, but I was like, why did that happen with the bladder supplementation?

Toby: It seems like sometimes it is maybe too much of a good thing. was maybe a smaller gap than it appeared. And so then that just knocks out the system. And also sometimes let'say it is the right diagnosis. It kind of squishes something out when it goes to balance out again. And that squishing out thing then goes to another channel and then you have to deal with it. overall they're doing better, but you're actually bringing latent pathology out of the body. It's a good direction. to go in but sometimes it's like that.

Angelique: So how can you tell what's, which is which? How can you tell whether it was wrong?

Toby: Yeah, if she complains of being along with those headaches, cold or something like that, then you know you're going too far there. If it's just headaches, if it's just gone to another channel, then I think it's more like squishing out that toxicity.

Angelique: So it jumped.

Toby: Yeah, I think they think they are better right there over that channel is much better and more balanced But that latent pathology that was in there the body couldn't metabolize it out cleanly and now you got to clean that up

Angelique: That reminds me, I can't remember, I think it might be a divergent channel treatment methodology, something that they taught at Taoist traditions. And I can't remember if this is exactly right, if I'm what I'm going to describe, but there's a method of needling. Goodness, I can't remember if it's the Luo channel or divergent channel treatment, but essentially.

Toby: Mr. Virgin, know this strategy. Ten years with Jeffrey Yuen

Angelique: Yeah. So yes, you try it.

Toby: It is. No, but it is divergent channel. So you can, if everything's going well with the patient, you can take things out of the divergent channel, just kind of clean everything up. Or if the patient's in really bad shape and you just have to put something away because so overwhelming for the patient, you can put it into the divergent channel.

Angelique: Then I'm wondering if I'm thinking of a sinew channel then, because there's a particular channel treatment where you need a little point to basically block what you're describing, the pathology moving to another channel. Does that sound remotely familiar?

Toby: I don't know about that specifically doing that.

Angelique: Okay. I'll have to look it up after because there is, it's like you're supposed to needle down, have to, you needle a particular point. I don't know it's called the confluent point. Goodness, I'm like dredging the wells with my memory for this. And it'supposed to prevent that very thing. So you're supposed to be moving the pathology down the channel. And I think it is a sinew treatment. You down the channel and then out the Jingwell and then you're, you're needling. Yeah. then.

Toby: Yeah, probably sinew you're right.

Angelique: There's but there's like a block I had like a visual in my mind of how I remembered of like a block like a needle blocking the way so that the pathology didn't jump to the next channel so that's what that reminds me of what you just told me.

Toby: Divergent channel actually interesting. I remember using one time I had a patient that was dying actively dying and they wanted more family members to come and I just learned the Divergent channel treatment. So I took the pathology and put it in the Divergent channel and they were parked up and everything was going great and the family was so happy and they're like, well keep doing that. And I was like, well, you know, we that's just a time buying thing. Because I mean, she just really was so much better and I mean, the patient ultimately died, but a few weeks later than they thought. So that was, that was sort of my profound remembrance of that divergent channel that you can take everything on the surface and put it in, put it into latency when you really need to. And this patient really wanted to see family members before they pass. that was a nice, yeah, that was, that was a nice, anyways, especially when you're learning a new channel system, right. It's nice to see that it does, it does function as advertised. Yeah.

Angelique: Was it pretty immediate?

Toby: Right away. After that general, they just start feeling better and better for a few weeks and then passed away. The family just kept saying more. Oh yeah, like a yin-yang separating, but this was like status post immediately after that treatment. I think probably.

Angelique: It something to do with it. Yeah. Goodness. Yeah. That reminds me. remember when having had a hospice background, like learning about the PO gate, you know, and one of the, have we talked about this before? Have I told this? I feel like I've talked about this, but I can't remember if it's here or not. so at end of life there, it's, it's very common that if a patient can't move their bowels, it's very hard for them to die. And so one of the protocols that we would use in hospice care, especially the last place that I worked, it's like, we would not allow more than three days to pass without a bowel movement. And some people would be like, but they're not eating, but they're not eating. it's like, I used to go through my whole education where it's like 70 to 80 % of the dry weight of stool is actually bacteria. And there's always product being made. so sometimes a small amount can an irritation in the colon. in Chinese medicine, our soul, our Po exits through the anus when we die. And so if that's blocked with stool, we can't die. And that I've seen it. I've seen it. I've seen it. People having, know, like people, you know, the movies, often will present, you know, someone dies and then they have a bowel movement. And I think if you're not end of life and dying from a terminal illness, that's more common. But as we tend to like to dilate, so our bodies are processing all of that stuff out ahead. But even a small amount in there can sometimes create an agitation and creates agitation. So we keep that highly clean. it's one of the ways that Chinese medicine also mirrors. stuff in Western medicine that we have seen.

Toby: That's really interesting.

Angelique: Yeah.

Toby: Have you, given any, patients, easing transition with the acupuncture yet or not an opportunity yet? That's a really beautiful thing to do. Right. Again, it's opposite of all our training. We're always just trying to save everything. And, I just had opportunity one time, but it's really nice to send somebody off like that in a, in a nice lined up state. and like you said, sometimes they're trying to but they just can't, something's hung up. I didn'think about the Pogate part of it for that treatment I gave, but anyways, it was nice. Do you know what Japanese death poems are? It'so Japanese, right? So you write a poem just before you die, but also you can't write it too early. they feel like, you know, if you still have weeks to go, right? They'd be like, this is not really a death poem. It's got to be within a day or two of your dying.

Angelique: No.

Toby: I remember I needled this patient and then told them that one of these Japanese death poems and then took out needles and then an hour or two later passed. it was quite beautiful.

Angelique: That is beautiful. Yeah, I look forward to that opportunity, actually. I think it would be like a full circle moment for me.

Toby: Yeah, especially with all your hospice experience, right? For me, just regular acupuncture. So, well, anyway, but I just don't, I don't have that experience in that area, but I really could see how, what a nice service that is too for the whole family, right? Just that, anyways, in this case, maybe other cases, too, there'some agitation, right? Because you don't know how to die. You've never died before, right? So there's a lot of agitation and it's really nice to calm that down. for the person, also for the family that's circling around, Everyone was so much happier when that patient really just kind of settled down more.

Angelique: Yeah, you're not just there for the patient themselves ever.

Toby: Right. Yeah. Yeah. It was nice to see again, usually we see individual patients come to our office. So it's nice to go to the house and then see everyone circling around. And then yeah, you treat the patient and everyone, you know, they're the hub and all this it goes out to the spokes, everyone settled down well to

Angelique: I love home visits to this day. I'm seeing one patient at home now and I really, it'such an honor to go into people'space. You know, as someone who's quite a private person myself, like I don't always love people coming into my sanctuary, know? Like I could easily be a hermit. It would be no problem for me. and going into people's homes and being able to see, I just, I know we've talked about that part before, but I just, really enjoy that a lot.

Toby: Yeah, same. I just went last week for a home visit and a patient that's been coming really regularly, but now, not especially getting towards the end, right? So then it's really nice to go and visit, right? Rather than just cutting off, we can't come to the office, then we can't see you. And my grandfather's a medical doctor in San Francisco, and he used to do house calls all the time. I feel like, especially just part of that lineage, right, to be able to do that. and he had his western doctor bag, you know, when he did. I've got my little Chinese medicine bag, you know, it'so, you know, our technology is so small, it'so portable. It's really nice to do that.

Angelique: Yes, I use a tackle box. Yeah, that's all my little compartments for all the things I need.

Toby: And tackle box nice. Yeah, that's nice and organized. just jam all my stuff in one big bag.

Angelique: Yeah, that's good. About fertility patients, when you approach, so I don't love fertility. I like all the other parts of menstrual health, but the fertility part doesn't really resonate with me. I think you really got to practice what feels exciting to you and what feels right to you. But with Saam when you approach fertility, Is there a special approach you take or are you still treating the imbalances that you see primarily?

Toby: Yeah, I think I'm a little bit with you too. Like I don't seek out fertility. That was Dr. Wu'specialty. So I have four years of training in that one. I'll answer your question in a sec. did I tell you Dr. Wu's three things that babies need? Okay, this is again, Dr. Wu distilled this from, you know, hundreds of thousands of patient interactions and successful ones. Babies need heat, blood and upward energy.

Angelique: This does sound familiar. You might have mentioned this before. Heat blood and upward energy. That does make sense.

Toby: I said, Dr. Wu, must be more complicated than that. She said, no, right? That's just it. That's what babies need. So I tip towards that way a little bit for infertility cases, but mostly what I try and do is just look for the biggest gap and fill it. again, that fertility leaps forward as a side effect of filling up all those gaps. So yeah, like I said, especially fertility cases now are just really moving forward. This maybe was a year or two ago, but I had a patient that wanted to prep, they were going to go to Colorado because there's cheaper IVF in Colorado. So they wanted to prep with me for two months and then go there for one month of their IVF thing. after that first month of prep, she was pregnant and then took a whole baby to term. So again, especially some of these gaps are so obvious to us, but I think from the fertility specialist, they're just always thinking about preparing the cycle for harvesting the egg. They're just not thinking about the person that's providing the garden, they're just thinking about just the eggs, right? So with us focus on the whole garden, sometimes it's really easy to see these gaps and then things move quickly.

Angelique: And do you still maintain you're still like three treatments a week and then space them out? do you three treatments for the whole month? Don'tell me it depends.

Toby: Yeah, I was going to tell you, it depends, unfortunately. But like some of it looks like obvious, like this patient that just, it's just recently pregnant, right? She's early twenties or something like that. Everything looked great. So I said, I was seeing her every two weeks, right? Just kind of, before, ovulation and then, and then after just to consolidate everything. And so, like I said, I think it was just two or three. visits, I think third visit she was already pregnant. So yeah, again, it really is case by that one just seemed like I was shocked she wasn't already pregnant. And so that assessment ended up being right because just within I think, like, by third treatment, she was confirmed pregnant. So just closed up a couple of those gaps and then and then she was good to go.

Angelique: Do you remember what her imbalances were and what channels she treated or where her treatments might have been?

Toby: I think following Dr. Wu's idea, right? I think I did supplement heart. then most of when I just saw her confirmed pregnant now, I supplemented liver because again, that idea of babies need blood. And she already has that beautiful rosy, you know, like pregnant, you know, like that Malar flesh, but not like the weird Malar flesh where it looks pathologically. mean, just that beautiful rosy. Yeah. She, I mean, it was, she radiated, it was, it was shocking how strong that was. but then also with cooler feet. then supplementing liver is reasonable, right? Because we want that blood. So heart and then I can't really remember. It might've even been small intestine because again, she was so young and you know, maybe like painful menstrual cycles and things like that or something. So I might've done small intestine. So probably small intestine heart and then she's pregnant and then liver just to fortify.

Angelique: What if someone were like, small intestine, that might be too moving. Why would you do that? Isn'that risky?

Toby: Yeah, but she's not pregnant yet. And, yeah. And she'so young and symmetrical and you know, like, mean, the case wasn't making sense otherwise, right? It's not like she was older, like a lot of, a lot of cases where they're a little bit older, where you want to really get a supplement in kidney, but she'so young and especially symmetrical, right? Again, the kind of case we think shouldn't be infertility case. So just small intestine seemed much more appropriate. Small intestine heart.

Angelique: Before.

Toby: And then that's, that was it.

Angelique: Nate, thanks for reviewing.

Toby: Yeah, but it's nice, right? as a side effect of increasing your health, fertility came wrong for the right. Yeah, but I don'think I want to do just fertility, right? Especially like Western fertility, right? Where you really damage the patient hoping for them to conceive, right? They're financially devastated, emotionally devastated, and then hormonally devastated after your work, right? I wouldn't want to do that. and this is worst possible case scenario. They're much healthier after. That's worst possible case. So that's okay.

Angelique: This is Yeah. I've been, I basically, I give the spiel to folks that are seeking fertility treatment with me is like, you know, it's not, it's not my area of clinical specialty. And I know that there are acupuncturists in the area. This is like what they do. so I often will refer to them, you know, give them the option, like if you want to stay and. know, take a crack at it. Okay. But just, I think because of the, usually I'more eloquent, but usually I'll, I'll usually tell them like, this isn't my thing. And. this is this person's thing and send them to that person.

Toby: But that's fair, but as a Saam practitioner, you should be able to treat everything.

Angelique: Yeah, I just, it's the whole... I think for me with so birth and death are so close together. And as much as I would really enjoy the opportunity to help someone at end of life again with acupuncture, I spent so many years in the like steeped in the emotional intensity of that end of life dynamic that you're describing with the patients and the family and the ups and the downs and all of that fertility care feels so close to that I don't know that my heart is ready to be able to hold that again, at that level. Because when someone is seeing you and they're wanting to conceive and then they don't, and then they might, and then they don't, and having to go through that roller coaster, to me that feels really intense to hold.

Toby: Yeah, that's fair. I mean, but I want to just remind you've got the clinical skill set, no problem. But yeah, if you just don't want to the emotional entanglement, I feel like that is really raw and real, which I like is when I mean, the male is like, tangentially involved. Usually I work with the female patients, right? And they, I, this is something Dr. Wu has them do, put their full hope into that cycle. working. She felt like it's emotionally, you know, you try and protect yourself. But that's that's not energetically good. You should put yourself open to the possibility of being pregnant every cycle. And that can be brutal, but also kind of beautiful. The patients learn so much about themselves, right? Because they're they're they're super vulnerable. And this is really what they want. And then, yeah, many cycles, they don't get it right. And there's just tons of learning. from the patient. anyways, for me, I feel comfortable guiding that kind of thing because I just done so many times now. I could I could certainly see why that especially if you already done for so many years, right, that you just don't want to go through that.

Angelique: Again. At least not yet, you know? Yeah. Because I also, the kind of person that I am is that I really wanted like, it's a specialty. So I want to deep dive it and understand it well. Like I want to be able to read the books and understand the theory and like really get into it and like know a bit more about what they do on the Western medical side. I just don't feel super prepared to do that, nor do I feel motivated to do it at this particular juncture. So I think it's almost a disservice. to a patient that would come to me for that because I'm not in my best space and I want to treat from my best space.

Toby: You make a compelling case for that,

Angelique: Yeah, so maybe someday, but certainly not now. Once they're pregnant, cool. That's fun.

Toby: Like that. Once they got over that hump.

Angelique: Once the baby's in there, we're good. Yeah, that's okay. That seems to be okay for me. Yeah, I haven't had someone have a pregnancy loss, you know, like during that time, but.

Toby: That's brutal too.

Angelique: Sure. And for some reason, I don't know, that scares me less. It's not logical. I feel like I can handle that a little better. yeah, the pregnant patients that I've had, it's been fun to treat them.

Toby: Yeah, and it's just so rewarding, right? They just need calories so desperately. then especially if you can reverse that counterflow nausea, everyone'so much happy.

Angelique: The reflux in the back pain.

Toby: Yeah, the reflex in the back. That's the standard part of it. Yeah.

Angelique: Yes, That's interesting. Well, I understand that you have some news.

Toby: Okay, what do you think? yeah, there's a big whirlwind of stuff happening right now. is like, usually this is a big deal. Usually, this is a big deal. This felt like it just relief that it finally came out and was able to get off my off my to do list. It was nice. Yeah, there is a book out. Yeah, thanks for mentioning about that. Yes. There was a book out.

Angelique: I've got lenses. the aperture there.

Toby: This book I wanted to write for 30 years. I remember being in Dr. Wu's clinic and walking down one of her hallways and she had all the great practitioners of Chinese medicine, the portraits. And every once in a while I'd ask Dr. Wu, who's this? And she'd be like, okay, so that'Sun Tzu-Miao, right? So the Tang dynasty. so I just had like little brief, these great Chinese medicine masters. And then, I looked up to Dr. Wu so highly and she looked up to these practitioners. So I was like, whoa, you know, this is amazing. So I always wanted to, you know, bit by bit I've been learning about these. I always wanted to put all this together. Basically I wrote the book for myself, right? Put all these together, the little biographies of the great masters of Chinese medicine, what they've contributed. And so that's what this book's about.

Angelique: And what is the book called?

Toby: Tracing our lineage, right? So again, we always, we have these things that just appear to us, how the patients not eat cold foods or drink cold, right? But someone had to put that into Chinese medicine. So it's really nice to find that out. So that was Sun Tzu-Miao'student Meng Shen he's in the book, and he's the one that did. really did all the foods, the food categorization, food as medicine, almost like putting in herbs, what channels it goes to and things like that. was the first person to do that, also Tang Dynasty. So it's cool that these things don't just appear and like 10 questions didn't just come from nowhere. That's Zhang Jingyue He's also in the book. presents just as these are facts and it's really nice to consider the context of everything. Who came up with this? Why do we still use it? It'sort of interesting. So that's the impetus for the book.

Angelique: And so where can folks find it?

Toby: Okay. Thanks for guiding me with all this. You're welcome. Yes. The usual place on Amazon. And then if you would like a avoid Amazon or a signed copy, you can reach out to Stephanie. She's organizing that she's flourishmedicine at gmail.com.

Angelique: Great. Well, congratulations.

Toby: I think we don't have any advertising budget for this book, so thanks for asking about it.

Angelique: We'll put the image up on the screen, I imagine. And make sure to put the Stephanie's email address and the show notes too.

Toby: If I can figure it out. Thanks so much. for mentioning that. Let's wrap this one up for today. Unless you have anything really pressing. Okay. Great. We're looking forward to your book when it comes out. Okay. No, but let's talk about this offline about I have four book ideas for you. Okay.

Angelique: I don't. Yeah, I'm not really reading a book. Okay, sounds good. See you next time.

Toby: Okay, bye everybody. Bye.

Episode 23: Allen Tsaur Reveals the Darth Vader of Chinese Medicine

Office Hours with Angelique and Toby. Released April 28, 2026. 68 minutes.

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About this episode

Translator and practitioner Allen Tsaur describes his journey from a childhood in Taiwan and a career in engineering to Chinese medicine. He talks about the value of the classical texts, the challenges of translating them, and why commentary and historical critique are essential for understanding formulas.

Along the way he discusses how major figures such as Zhang Jingyue, Wu Jutong, Ye Tianshi, Zhu Danxi, and Wu Youke shaped the theories practitioners use today, and offers practical advice for students and practitioners engaging with ancient texts. The episode notes suggest watching on YouTube, where visuals accompany the physicians and formulas he mentions.

Topics

• From engineering to Chinese medicine

• Classical poetry and early reading

• Challenges in translating classical medical texts

• Commentary and historical critique of formulas

• Major historical physicians and their influence

• Advice for students reading the classics

Key terms

• Jingfang (經方): classical formulas from the Shang Han Lun and Jin Gui Yao Lue

• Zhang Jingyue (張景岳): Ming dynasty physician and author

• Wu Jutong (吳鞠通): Qing dynasty warm disease physician

• Ye Tianshi (葉天士): Qing dynasty warm disease physician

A note for listeners: this is a conversation among practitioners, offered for education, not as medical advice. Patient details have been kept general to protect privacy. Herbs and doses mentioned are historical or professional references; some, such as Ma Huang (ephedra) and Fu Zi (aconite), are restricted or toxic and should be used only under the care of a licensed herbalist.

Transcript

This transcript was generated automatically and lightly cleaned up. It may contain errors, especially in names and Chinese terms.

Toby: Allen Tsaur so much for coming to our show, Office Hours. We really appreciate you making the time.

Allen: It's my pleasure to be here.

Toby: Yeah, we'really excited and we got a whole bunch of questions for you I think to get us started, if you don't mind, would you mind giving us a little bit of your professional background just so listeners are familiar with what doing? And if you don't mind when you're giving us your background, if you can weave in how you became a translator of Chinese medical texts with that, if you don't mind.

Allen: Okay, so if we want to talk about translator, then we had to go all the way back. So I was born in the US, but I was brought to Taiwan I was three. So I spent 10 years of my travel in Taiwan. And that's when began to develop a lot.

Toby: Okay great.

Allen: Classical poetry and also classical writing. during grade school, I read the art of warm and also I began to read a lot about poetry from the Han dynasty at the time. Later I went more into the Song dynasty because I feel like Han dynasty poems more gutsy, more... Han dynasty is just like, okay, the world was beautiful and I a lot of first world issue basically. And Han dynasty is like, well, people are suffering warm.

Allen: Starvation. I really love that old type of writing from a very young age and also my school teacher gave me a challenge because I was not really a good student back then. I never really finished my homework and so my grades were falling behind so my teacher gave me a challenge like well if I can recite the art of warm from memory And she would give me extra credit. I did. Memorize Art of War

Toby: Wow. How many characters is that, Art of War?

Angelique: Don't even remember, like...

Allen: 2,000, 3,000. I think I still remember part of the first few chapters. Later chapters I don't remember. keep reciting the over-over. Anyway, when I was 13, I came back to this country.

Toby: Jeez, okay.

Allen: Well, first, my English was my absolute worst subject ever in Taiwan. So I was doing really well in Chinese. I was doing really well in math and science, but English is the one I never got a passing grade ever. So I came back to this country and took the English as the second language test and I got a score of zero out of 100. I got kicked out within like 20 seconds because I couldn't even begin the listening test. So started over with English. So because of that, I think in school, just thought, OK, I need something I could survive with. So during high school, I focused really strongly into math and science. So in college, I actually went to engineering instead. So I studied material science engineering in Northwestern University.

Allen: Throughout the time around graduation, was doing research because in my major, if you wanted to graduate, we had write honors thesis. So I did it and also I did summer internship here and also in ITRI in Taiwan.

Allen: I think I was okay. also pretty good with math and science and engineering, but it wasn't really my passion. So most of my classmates went out to pursue higher degree that masters and PhD. My roommate right now a professor in a U Mish Arbor. And I think some of my other classmates were also professors. So for me, just like, it's not really my Then I took a job offer to do engineering work in Shanghai. That was when I got in touch with Chinese medicine because during the weekend when we had nothing to do, someone said, hey, do want to like de-stress? Do you want to like relax? So somehow they noticed a local doctor somewhere in Qibao, Shanghai on the Western suburb of Shanghai.

Angelique: And to like and.

Allen: Took me there. That's the first time I experienced acupuncture. So had no idea what she was doing. And environment was far from sanitary. So she literally just picked up a needle from over place and just needle me. It's by that I didn't get hepatitis B or something. yeah, at the I was just like, wow, this, that acupuncture thing is so weird. It's magical. But at the same time, it'so weird. Why is it? So I think that started my curiosity in Chinese medicine And around the time my best buddy from college, he enlisted in the Marine Corps. So he was in a training pool before he was going to join the Marine. And around the time he received a request, I think it was from a boy from Texas. Basically, he's Because at the time in college, we both joined this bone marrow drive. So he was matched with a kid, 14 year old kid from Texas. because he's Asian like me. So it's really hard for Asian teenage boy to get a match from anyone else here because Asian American are in the minority of the registry. So he was like, okay, so he might be the only one who can help this kid who has leukemia. And he was asking me to say, hey, Allen, you're pretty good at research, you look into this? I was like, if I donate my bone marrow, will it affect my performance as a Marine recruit? do suggest I go through it. So at the time, just look into it. So for Western literature, seems like, well, there's no issue. Just take two months of break and just walk it off and you'll be fine. But then I look into the Eastern side, it's like, do not do it because that's your essence. you give it away, you will never recover from it. So I was just like, that is very interesting for science, we learn never to exclude. Each one of must be saying something, but somehow why don'they?

Allen: Do not overlap. That's my question. because of that, looked more Chinese medicine. Because I read more about Chinese medicine, I realized I did not understand any of it. So I needed to read more. And the more I read, I dig a deeper hole for myself. So I just read and read and read. And eventually, think it culminated with the

Toby: Much.

Allen: I was in China, I was really bored. So I went on to this, I worked with this charity organization hand out financial aid to college students, especially from the impoverished region in China. we travel, first site I went to was Yunnan So it's like two, three hours from Xi'an. So that's where basically that's where the Chinese Communist Party went to hiding during the single Japanese warm after the so-called Long March, or the Long Retreat the land of China. So I went there and then met the students and talked with them and this and that. And after that, I went to, I think plus cities throughout China. One thing occurs throughout the time was that poor because while they're just from impoverished region with parents.

Allen: Or

Allen: But I noticed some of them were well, for...

Allen: They went into the state of destitute because of medical expenses. So especially if the parents came down with a Crohn's disease, became unable to work. First you had medical expense and second they are out of work. So what usually happen is that then the eldest sibling would drop out of school to go work in Guangzhou. So it'sent home the money. And second sibling would then... continue to work in the field and third sibling might even drop out to help with the health. And then just so they can send that one kid to college. So that happened almost like a repeat pattern. So that was, think is that is there anything we can do with Chinese medicine? Because first I don't see any cause was just needle. That's all you need, right? So at the time I was had this fantasy that, Oh, why one day I can just travel around with like 1000 needles and just treat everywhere. where everyone I met. So I think that's around time then I became truly passionate about medicine.

Angelique: And then, and then,

Allen: I think around 2012, I made a decision to switch track again because again, I think I was decent with my work, but I just didn't really feel the passion about it. So then I switched consulting in the chemical industry into Chinese medicine. So in 2013, I enrolled myself into a school. The school was, went to, back then it was called Tai Sophia Institute, then it was called Maryland University Institute Integrated Health, and now it's gone. So I to school, and one thing the school required at the graduation is that we need to do a senior community project. For me, going to do charity work is kind of okay, but at the time, intrigued and fascinated by the ideas of 8 Principle, because I feel like something off, because when we talk about 8 Principle, we only really talk about six of them, in interior, exterior, cold, heat, and repletion and vacuity

Toby: Thanks

Allen: So usually go to abstract and then at the end they'll give something slightly more solid with like, yeah, it's a yin-vacuity, yang vacuity thing.

Allen: But you already have vacuity and profusion, why do you have to repeat by yourself? Wouldn'that be independent variable instead? So then of course.

Allen: Was introduced by us, so I did some research and I traced it back to Zhang Jinyue.

Allen: I began to read about his work and I was fascinated by his ideas. But at this time I didn't quite get it. didn't really get ideas until much later, until I began to do translation.

Toby: What year was that when you first started reading his work?

Allen: I started reading the casework around 2014-2015.

Toby: But at that point, no ambition to try and translate it? No.

Allen: So it wasn't until when they announced we needed to do the senior community project. I was like, hey, maybe I could just translate that. It would be a service to the field because it seems like no one has any idea where this even came from. So I was like, hey, maybe I can do this as a favor to the profession. So then I proposed the idea to academic dean at the time. And it was accepted. then I went on to do a translation. So I think we really needed to do 80 hours or 100 hours of the senior community service. It cost me more than 400,

Toby: The end of- We're getting a sense about your personality, Allen.

Allen: Yeah, just, I just keep editing it forever. so that was the first ever translation I did, but it was almost immature-ish.

Toby: No, but how much of the text did you translate then?

Allen: At the time I translated the first volume. So, Jing Yue Qian Shu has 64 volumes, I translated the first volume. Because I feel like... One coherent volume, so I can translate the whole thing. Yeah, it's quite sizable. At the time, I had absolutely zero idea about how the thing I was translating. Because at the time, I didn't read Zhu Dan Xi, didn't read Li Dong Yuan, I didn't read any of...

Toby: Chill!

Allen: I just like, try to do-

Toby: Right, just that one text, but it's actually embedded in a whole bunch of other texts and a whole bunch of other ideas. That must have been really difficult.

Allen: Yeah, I did it. And it's just mostly more like a, what would they call, literal translation. So I got a literal meaning. I had no idea about the context. So did a translation.

Toby: No idea about clinical application. You're just a student.

Allen: I mean, get some ideas, but I didn't quite get it. mean, some of the things is very clinically applicable because it tells you about, oh, did you the 10 questions, what did you inquiries.

Toby: That'so great to know where the 10 questions come from too, right? just presented in like TCM text, just these are the 10 questions, but who developed it, you know, anyways.

Allen: Yeah, Zhang Jinyue first started it and then Chen XiuRen refined it a little bit. And then it became TCM version. So, yeah, so you know what he talks about YinYang and also it was also the place where it came up with the I think now they call prenatal postnatal or pre-heaven late heaven concept. Of course, I didn't understand any of this. was like, oh yeah, later heaven, of course.

Allen: So I just translated it. I didn't understand any of this. I finished the project, sent to my community. to academic dean and also for my teacher, Evan Rabinowitz, and also my fellow students in the program because I was always talking about it. So I think I annoyed them enough, so I need to send you some tokens. So send them to them and then I just kind of forgot about it. just like left it my... my hard disk never spoke about it because at the I it was not ready.

Allen: Think that was my first try at translation. So first, it was way harder than I thought. I thought it would be easy, but it was pretty hard. And also, it just kind of shows how unprepared I was for the time.

Angelique: So I think that.

Allen: I really got into translation when Michael Brown reached out to me in 2017. So Michael Brown is my longtime collaborator. I think I don't even remember how many times we collaborate on seven, six or seven.

Allen: At the time he was translating Yue Hanzhen's explanations of channels and points. So I remember why I was going to Asia at the time. basically I was like traveling to Asia, I got this email from someone I do not know, his name is Michael Brown. He was like, hey, can you help me out with this translation? I have some extra, can you look at them and see if you can see?

Allen: Review it and see if there's anything off with it. I just went into just edit everything and send it back to him. And after that editing, he decided to, we decided to work with together. And we have been collaborating ever since. So that was the beginning to, for me into translation. I actually learned a lot from Michael because I understood nothing about terminology. I did not know there was a dictionary available with all the terminology ready.

Allen: That would have saved me so much pain back in the house.

Toby: You're making up your own, like, glossary?

Allen: Yeah, I was. it was so painful.

Toby: That'so ambitious.

Allen: Just had no of any of this. So I think I just jumped into water without knowing anything. So after, especially I was like jumping back and forth for the choice of Xu and Shi. I was like, at first we use the TCM terms like deficiency, insufficiency, excess. so, but then when you're writing at the sometimes like, wait, Xu also means a state of almost like a fake.

Toby: So bad.

Allen: Falseness to it. So, doesn't quite get it. And also sometimes it's more qualitative than quantitative. And in those times, it also doesn't get it. So, I remember I was just like, I was just like, decide on one turn and wrote down like 10, 15 page later, then I saw another user just like, okay, let's change to something else. Then I just reapply change to everything else.

Allen: I went through this process back and forth so many times until then.

Allen: Michael then saved me with this challenge because he's like, know, Nigel really did that work like 30 years ago, you know. You can do it. Yeah, so. Right. yeah.

Toby: That must have been a relieving day there. so you learn so much, but then also then you got like a golden ticket at the end of it. So you got the learning plus then you got a glossary that you can rely on going forward. That'so great.

Allen: This day, I don'think that struggle is worth it. It me realize how valuable that is. Weissman, professional for us, was so valuable. I actually to meet him on a virtual conference last year, so I just couldn't help but to express all my gratitude and thanks to him. like, my God, if it weren'the work he did for us, I don'think I do translation. It's just so painful. Pretty much that's how I began to translation. So Michael's project on the explanation of playing is like, I heard you already got this translation by Jinyue already. Why don't you do it? I just, it's pretty bad. I don't want to do it. But he just insisting me to do it. And I think luckily or at a time, Phil Settles from ACCHS reached out to me. He wanted me to teach a course called Historical School of Chinese Medicine. I think I just did not know what was involved back then. So I just, oh, sure, I'll do it. And because in my head, I was just, oh, yeah, I took that class before. Of course I can do it. But nowadays, I can barely build a... raft myself and then someone else was asking me to an aircraft carrier. So got in, so I just I agreed and I started preparing, my god my reading list is like 80-90 books. So that's when began read So I started with the Chinese TCM curriculum book.

Allen: Various schools and doctor of various language in Chinese medicine. So that book is like 1200 pages long. So I didn't read everything, of course, it's crazy. So I only focus on bits and pieces. But sometimes when I read into this and it has the reference, then I put on my shopping list and I'll buy it right away. And so

Angelique: So yeah, we'll just.

Allen: Crazy amount of reading and then I thought I really prepared a pretty good course based on that and also all this reading data became my foundation of doing translation later because without doing this course there's no way I could do any other translation later on because for example Zhang Qingyue referenced Liu Wansu all the time, Zhang Yuansu all the time, Li Dongyuan all the time and attacked Zhu Danshi all the time. You have to understand why he attacks them.

Toby: Okay, so first of all, want to thank you so much for that Zhang Jinyue translation. I just love it. But then if you can remember some of the put-downs he puts about Liu Wansu and then also Li Dongyuan. If I remember correctly, it'something like Li Dongyuan, I look at his formulas and I have to sigh. Something like that. It's amazing, know, one of the four great masters and he's just like, oh, these formulas, no good.

Allen: Yeah, so

Allen: Think he, for Li Dong Yuan he was okay with, but Liu Wansu and Zhu Danxi, he has issues with. And I think it has a lot to do with, is my personal take on this, from historical context, because happened was Liu Wansu came up with famous decorations that six entities or 60 entities can all turn to fire. So I the final historical context because at the time the mainstream medicine China had was called Imperial Bureau formula. So basically it's like Imperial Pharmacy Bureau employ

Allen: By the Imperial court and also staff with the Imperial physicians who studied mostly Tang Dynasty like the Chaoyuan-fang texts. So have this philosophy. Let me just pick out two of the main points. Two main points, all disease began with wind cold That's number one. Second one is all disease occurred because of insufficiency. So they quoted Su think they say, So wherever the evil getters, there must have been vacuity.

Toby: Place for it to come in.

Allen: Yeah. So based on that, you can see from Cao Yuanfang's and also Sun Simiao's formula, there's a very common strategy. first, doesn't matter what disease it is. You always want to eliminate wind. So even internal disease, will see ma huang. Or two of will see chuanxiong to vent out wind. So even if it's internal disease, it's very quite frequent.

Allen: To see multiple which is quite unusual because you don't really see that in the modern strategy. You see it in the older strategy. So they use that. And the other thing is they use a lot of tonics in the Tang dynasty formulas because of the two guiding principles. And also for the Imperial Bureau to treat all the people and often without diagnosing. So a lot of those so-called pet formula, prefer formula, they are kind of messy.

Angelique: So that was a

Allen: Condition of mainstream medicine, Liu Wansu to come to power, can do is around his time here. And also he part is in the North. there'something in the, something in the North is that, for example, Beijing, 20, 30 years ago, very few household had shower. You go to baths and sometimes people don't even shower, like maybe shower once a week or once a month.

Allen: So, did not 800 years ago. So 800 years ago, most likely, Kipion did not shower at all. So, I mean, was a frequent practice, not only here in Asia, but also in Europe. Some people never shower in their life. I think Luis XIV showered like four times in his life or something. and so Northlander, they have very different constituted than Southlanders. So first of all, they have...

Allen: Different diet. And also climate is very different. It's very frigid, very dry, and also they don't shower, and also they eat a lot more meat than grain and vegetable. So that makes it quite likely that first your pores are never open, so everything cannot stay within, becomes stagnant. so with that conditioning, and if you further take those formulae per square foot and bureau formula,

Allen: We're venting and also warming and drying, you can create something called depressed heat or stagnant heat. And so I do think that's the reason why Liu Wansu begin to advocate for this idea that, hey, all things can turn into fire. So one of the most important things that you want to eliminate stagnation. So his focus is on that point. And so attacking evil school is basically Zhang Chongzhen, was basically Liu Wanshu'student. And Zhang Wansu, is, Zhang Wansu is Li Dongyuan's teacher, was also a student of Liu Wanshu. So they all had this idea, oh, patho mechanism. So Li Dongyuan is kind of a different case, so let me skip that part. Zhu Danxi is also from the Liu Wanshu lineage. So Zhu Danxi started with... I don't remember his name, but was something like Zhang Taiwu or Xue Taiwu or someone. And Taiwu studied with Jin Sanfu. Jin Sanfu studied with Liu Wanshu. So Zhu Danxing himself is also a Liu Wanshu lineage person. So he also all this idea from him. So basically what... he did was he concluded all of the study of the Liu Wansu lineage plus Zhang Chongzhen plus Li Dongyue, together. So he wrote... He wrote two books in his lifetime, so...

Allen: First book is called 聚方法會, so basically he attacked everything that was about the bureau of formal medicine. So that was the first book he wrote. And second book was something about material medical. He didn't finish the most famous book until his death. His disciple actually finished it for him. It's called 金貴溝雄. So in English is grasping the concept from the...

Allen: The profundity of the Golden Cabinet. So for now we know he was inspired by Jinggui Yao Lv, Golden Cabinet. So what is that book? So that book lists, I think, 300, 400 diseases in different categories. What caused them and how do you treat it? And if you read through it, then you quickly come to one conclusion. these occur mostly because of stagnation.

Allen: And also at the time he said yin-vacuity, but it's more likely blood deficiency. Yeah. And also phlegm But the blood-vacuity thing is his own addition. Liu Wansu did not say that, he added that part. So blood-vacuity part is because, I would say his main thesis work is

Toby: That's interesting.

Allen: Gezhi yu lun. So gezhi refers to ge wu zhi. It means contemplating acquire complete knowledge. So it's a neo-confucian idea. He was himself a neo-confucian. He never really wanted to practice medicine until he was in the 40s. The reason is because he failed imperial exam so many times.

Allen: And he became super depressed and his teachers said, maybe you should not study, you should do practice medicine instead. But I don'think we should have anything against him though, because he happened to run into some of the hardest imperial exam ever in Chinese history. what happened was it was after the Mongolian conquest of China. So they did have imperial examination for 20 plus years. And when they restarted this whole process, They have a severe quota for the southerners.

Toby: Yeah, mostly Mongolians and then a little bit for southerners, right?

Allen: I think they were very, they were very fair. So they have four quotas, but all of them have the same number of people. So for example, if you have 100 people, 25 of them for Mongolian, course, 25 of them for Central Asian, and 25 % of them for Northern Chinese and 23 % for Southern Chinese. the thing is Southern Chinese is like 70, 80 % of the population. became the most competitive imperial exam ever. So he actually took it a couple of times he failed he became depressed and he became a practitioner instead. And so from that work is very interesting. It reads more like a new Confucian work rather than medical work because he actually began the book with one quote from Confucius. He says, the greatest desire for a human being is

Toby: Yeah.

Allen: Food and sex. he actually goes into that book in go through great lengths to talk about you should practice abstinence. should have very bland diet, no seasoning. And he advocated for veganism. So basically he says, well, if you add any seasoning, that's not a natural flavor over the food. It's not nourishing. It's killing you. So, and also if you use those seasonings, you're creating a strong fire instead.

Allen: So if you want to avoid those fire, eat bunfu, eat leek. And if you eat meat, you'll create phlegm so don't eat meat. Same thing with sex. Sex is like, oh yes, according to the fire element, sex is a kidney fire or something. So you should not do it in winter because you need to store the fire in winter. And you should not do it in summer because that's fire season. Fire plus fire is bad. And also you could just... I think there are like six months of year, are at least two, three seasons a year where you cannot have sex. and also late summer you can have it because that's when spring is going against the water. So I it either. So, and also said, well, the status of it's like, it's almost like the moon. So it's never a whole, it's only whole for like one, two days a month.

Toby: In C.

Allen: For all of us, it's a half full and most of us is empty. So he advocated that when it's less than half full, you cannot have sex either.

Toby: Didn't sound like any fun, Allen.

Allen: No, he's not a fun guy. So towards the end of it, he said, well, basically, should just abstain from sex. And even during the time when you feel if you're sousing, you should just go off for a travel and just avoid sex. So yeah, go for one. so anyway, so that's Zhu Danxi. But I think they may pull back to the topic we were talking about.

Toby: For a walk instead.

Allen: So back to the topic is what did Zhang Jiyue have against him? So basically it's that book I mentioned, the Elucidated Profoundity from the Golden Cabinet, in which it gives you almost like a, it's almost like a clinical manual of how do you treat all diseases. then begin to have a few issues because if you just see everything as stagnation, everything as phlegm, you will always, be using strategy. And also you see everything as yin-vacuity or blood-vacuity.

Allen: Are just continually giving people tonics and it would destroy their digestion. I think that's where Zhang Jinyuan came in and said, okay, we need to put a stop to this. He does agree with some part of it. But I think in Chinese they say, when they try to correct one thing, go...

Toby: Yes, know, but it's nice, especially if you read all the text, then you can get a real middle path through all of it.

Allen: Yeah, so think that's why was like, I really feel blessed and at every opportunity I get a chance, I do want to thank Phil Settles for asking me to build my effort career from the very beginning. Without that experience, would have read so many books. And also, most of those books were not on my book list because when I first studied in medicine, consider myself like Jingfang purist or you can even call I could even call myself back there as a fanatic or fundamentalist. So I the first books I read was Chen Xiuyuan He was like a purist He's like when he turned 40, he burned all the books. That's not jingfang. He's like those books only create confusion. And so the first few years of my learning as an herbalist,

Toby: Hmm

Allen: I only read Shang Hanlun and Omni,

Toby: Bad you can't go back in time to tell yourself that you're to be translating Wu Ju Tong.

Allen: Think that was the most, I say that would be the most absurd idea I ever heard.

Toby: Got something for your past self to see.

Allen: Yeah. So yeah, it's actually really funny because when I went through my program Evan Rabanelvitz,

Allen: He challenged me to say, hey, one day I want to see you say that's not Shanghanlun. One day, you can practice warm disease, you have become more balanced. I think that was a very good challenge he gave me and maybe a really good or something.

Toby: That's really profound. of something I really wanted to ask you today. Maybe this is a good time to ask it. What about, I'm sure some of the people that are going to be listening to this are really still hardcore Jing Fang And kind argument can you make to them to read your book? Wuju Tong's text, Systematic Differentiation of Warm Diseases. What kind of argument can make to your former self for them just to take a look at this book?

Allen: So, just start from Wu Jutong.

Allen: The first time I read this book I was really quite surprised because

Angelique: I always thought it would be some

Allen: Something like, almost like Wu Youxin's, Warm Epidemics, the Wenyi Lun. I thought it be a book that's like, oh, warm epidemics, how do you treat it? And through it with a lot of bitter and cold medicinal and get rid of it. So I read this book during COVID because, you know, COVID, we tried Jingfang and, there were a few issues. Yes, Jingfang was effective, but the, especially original strain evolved way too fast.

Toby: Perfect

Allen: By the time the medication the patient, especially if are not your neighbor, the disease already moved on to somewhere else. And also the time, we couldn't really quite predict where it went. And so it became quite problematic. And even if we could predict where it went, the stock jingfang formula couldn't quite do the job well. So at first I saw it as, cold phlegm cool, Xiaoqing Longtang, done.

Toby: Hmm.

Allen: But later on I like, wait, do I say blastasis? So, okay, then let me change that bai to chi shao Let me just be cute, just do that.

Angelique: And it's like, wait, it's also causing heat or de-

Allen: It collapsed along and also, okay.

Angelique: It works, but it only works

Allen: Worse if you reach it within two days.

Angelique: So, and also a lot

Allen: More and more variable came out and we just didn't quite know what was going on at the time so later on I threw the big bruise in my jingfang ego by prescribing people Huo Xiang Zheng Qi San because it seemed to work quite well at the time so yeah I was like oh okay it seems to work I just to at least you're not killing me and I just like

Toby: So modern.

Allen: They can recover at 18 and also they can get reflame and then we can clarify things and diagnose later. yeah, by myself sometimes. So, combine Wu Ling San and Xiao Chai Tang So are my usuals. Yeah, I put a cover on my face. You know, when you're not sure, just use a combination, use a Xiao Chai Hu Tang. Then you're set.

Toby: Buy yourself some time. Cover your bases.

Allen: So I was kind of desperate at the time. So around time I was like, maybe we're missing something from Jingfang. Maybe just see what they got from the West side. And maybe I can steal some ideas. So I first look into, of course, at the time we call it pestilence, we call it epidemics. Okay, let me look into Wenyin Lun by Wu Youxin. It's probably the most famous book on epidemics. So I read into it. I just don't see the pattern it describes in the book. So at the time, think some people did suggest using the...

Allen: Da Yuan Yin, yeah, Da Yuan Yin. So at the time they tried to use this out-thrust membrane source. But the thing is, it didn't quite match with what we saw in clinic because that one you're supposed to have a lot heat pattern and heat condition. So I decided to steal some herbs from it. I remember I stole Cao Guo, I stole a few herbs and applied to my bigger formula.

Toby: Yeah, that's a that's a history of chinese medicine stealing from here is here and there trying to make something yeah

Allen: Yeah, I stole from it. then Chai Hu Tang is so flexible. You can just like stuff anything to it. It's I stole some from it. And then also first Da Yunyin, and also there's a San Tou Tang or something. Basically a modification based on that. which I think to be valuable because at the time it says, if in Tai Yang add this. If you've seen Shao Yang I deserve. If you've seen Yang Ming I deserve. So I was like, oh, that's a cool idea. Maybe steal that as well. So I stole that. But at the same time, it's like...

Allen: Not quite, because I read the whole book and I only came up with some tidbits where I found it but it's not super useful. So then I'm looking to the next book on my list, which is Wen Bing Tiao Ben of Warm Diseases. I thought it would be the same thing as that. So was wrong, that book doesn't just talk about warm diseases. actually talks about...

Allen: As it stated in the general outline, it's a book about six Qi entities. Basically, it doesn't just talk about heat or wind heat. It also talks about cold damp. It also talks about dryness. It also talks about other conditions of where I previously struggled with. So, and to my surprise, when I look through the cold damp, I think it's in the middle, burner chapter. I saw my trusty Huo Xiang Zheng Qi San.

Toby: Mm.

Allen: Also it has five different variations of that. How do you modify it Huo Xiang Zheng Qi San to use it? for me, from that get-go, it's like, even if I just learn those five variations, this book is it. I think one of coolest things I saw then

Angelique: I don't remember which chapter. I saw a cough formula.

Allen: But it is. It's exact same formula I came up with myself and I thought I was being very smart.

Toby: Thought you were so original. Centuries earlier.

Allen: Yeah, I thought it was original. Yeah, Xiao Chai Xiaotang plus Hou Pu plus ren.

Toby: To give you a little bit of confidence, that's good.

Allen: Yeah, so I was like, wait a second, someone already came up with it and also he actually had a ratio of all those herbs and actually have reasoning behind them. That's probably better than my random try. I just go with like regular users like, how much is it? I don't know, Ban Xia I don't know, 3 qian And he actually has some reasoning for that. So then...

Angelique: Was like, wow, this.

Toby: What's name of that formula, do you remember? The Cough formula?

Allen: I think just show. I think it's just Xiao Ban Xia Tang Yeah, jia Xing Ren Hou Po OK, so this is minor Penelia decoction plus. apricot seed and kernel and Hopo was Magnolia bark, official bark. yeah, that's a formula I saw and... So basically became my almost asset storing tool, overcome my bias against the warm disease.

Toby: That's the history of Chinese medicine and also like clinical need pushes you past your self-imposed limits. Okay, good.

Allen: Yeah. so basically I then started reading that work and also his other works such as his study. Because what I did was I actually read the book and then I read about Wu Jutong's biography by this called Luo Da Neng. It's like the highly dramatized biography of him. But it actually gave me some idea of who Wu Jutong was as a person. From that one, Yashu led me to one of his case study, which to this day is considered as the craziest usage of Jingfang form I ever heard in my life. Wujitong used the highest F, 240 grams. himself. So he an illness in think winter something and it just didn't go away. he took the regular of Gui Zhi Tang, didn't work, increased the dose, didn't work, then increased after 240 grams.

Toby: Confidence your formula there. Not just which formula, but just change those. I don'think have that.

Allen: Yeah, and also, so because of that, I look into his case study as like, so if he can go that high on Guizhi, how about Ma Huang? So he also went super high on Ma Huang. I think he went up to 120, 130 grams in one day. Wow. But there's a caveat. He didn't do it in one go. He didn't do it in liquor style. People take it and they pass out, put in their mouth and they recover. He didn't do that. divided the Ma Huang Tang into 12 portions. Took one, if he didn't help, in a while, take another one. If he didn't help, take another one. I think in that case, the person took 8 or 9 doses and he recovered. So even this day, I've never heard of anyone who dared to prescribe guizhi and huang in such high doses. So my mind, at the time, I OK, maybe this guy

Toby: Huh.

Allen: Even now they would call him the or founder of the warm disease or the person who put together the warm disease school. He was pretty good jingfang practitioner. so based that, argued to my jingfang brethrens and followers, fellow followers. And would just say, well,

Allen: Just look into Wu Jutong's work. You can ignore all the wind heat parts. Just look for the wind cold part. Just look for even the first one in the book is Gui Zhi Tang surprisingly. Yeah, so just start here and just ignore everything you don't feel comfortable with and just skip to the parts where you see. So I think that's what talked to Michael on our podcast. mentioned that.

Toby: Amazing.

Allen: The cited more than 100 Jingfang forms. So even if we just learn the modification of those, it's good enough already.

Toby: Yeah. So that's a solid argument, right? People feel more comfortable when they see the first formula out the gate is Gui Zhi Tang. Okay, good. So that's really good. then, read the whole text, but just take in anything that might be valuable to you. Don't be of this text, right? That's the nice thing to say, right? It's not going to really threaten your identity, right? It may expand of the...

Allen: Yeah, because I Wu Jutong himself...

Allen: I mean, he did practice later on in his life, but he didn't really practice until he was like... Once again, he didn't practice until like his late... I think around 40s.

Toby: Hmm

Allen: His life, he was mostly So what he did was at the time he joined this national effort called the Sikhu Xuanxun, the four bureau of the Grand Library. So was a Imperial Library project conducted during the time of Qianlong, in they read through all the compiled it into a coherent, standardized version of Imperial Library. he was in the medical section. So he worked as a copyist. So he had access to literally all the medical literature you could access at the time. So he was fortunate that he could read through all that. One thing I really think is quite valuable about him is that, well, he read through all of them, but he didn't quite go into that abstract realm because he see

Angelique: And In the meantime, for

Allen: For example, people like Zhang Jinyue and also Zhao Xianke, they both. They go so hard into the abstract grand theory building arena. Everything is sexy, everything is yin and yang interplay.

Allen: The pre-heaven state and late-heaven state, they kind of borrow from Taoists and Taoist borrow from Buddhism, the Nagarjuna's overview. that's comeback too. And so, went so hard into that. Wu Jutong is like, okay, he writes all that. Then he kind of stayed grounded by focusing on the study of Ye Tianshi.

Toby: Also wasn't he really grunt wasn'there like a lot of pandemics at the time of you're or something so you had to stay grounded he couldn't just be you know theorizing he had to actually treat people isn'that right or no

Allen: Yeah, I just think so because he came to fame was... There was a great epidemic in a capital city at the time, so...

Allen: He finally decided to treat people and...

Allen: I don't remember which forum he used. I think he used the Dong Yuan's. but with some modification and later on he also came up with one formula himself called PDS and it's a pretty messy formula but somehow it treated everyone well, everyone recovered.

Allen: But I think one of the cool things I discovered later as I did the translation, I should have captured it earlier, but I did not, was that a lot of his formula actually came from Ye Tianshi's case studies. So lot of modification, those came from, so for example, if you have, me just up with one disease, reversal. So reversal disease can manifest in different way with different symptoms. In Ye Tianshi's books, he would categorize it as a category of reversal. Here is the main formula. Wu Jutong would cite the main formula, sometimes with his little twist to it based on what he understood from Ye Tianshi. And then he would tell people how to modify it based on what Ye Tianshi experienced himself. What worked for Ye Tianshi, he would cite it. And then just tell people, this person had reversal, with heat add this. If this person had reversal, it was that.

Allen: Do this, do that. yeah, basically he's basing his format by actual clinical insight into Ye Tianshi and also has such a degree of flexibility. And also he chose a really good source of material because Ye Tianshi himself is studying with how many teachers are there. Yeah, and some of are team found masters and he himself, think he's, argue his father was

Toby: It'so valuable.

Angelique: So, from here, and. and

Toby: I think 17, yeah.

Allen: Dermatologist. So, where he was an external practitioner. So that's why he was more open to all this idea and he wanted to learn a lot of I think that'something quite valuable. What made me tell you is that first you get a little bit of theory, a good of things. You get insight into the six qi

Allen: On six qi not just when he'd also tested formula from Tianshi and also summarized to you by which you told him also he like every single bit of his reasoning, like every single lie formula, he would say, I said this term because I'm thinking that because of that, are the patho mechanism. And that's why I'm using those herbs. So which I

Toby: Yeah.

Allen: Do think is a pretty good teaching material.

Toby: Okay, I think that's a really sound argument for that. Okay, great. Hopefully you're enticing some people to consider that. And then also, I mean, just from reading your translation of his foreword too, he's a really humble guy, right? Like he didn't want to put all this together, but he just felt like forced to because of the pandemics and you know, like a whole bunch of people like said, oh, you got to write this down, you got to write this down, but he really didn't want to, right?

Allen: Yeah.

Toby: So that's nice coming from that rather than from ego. Like just feels like he has some knowledge that might help people. this is why he's doing the book. So like the framing on that too.

Allen: For me, that's quite moving too because I felt a very similar sentiment the early stage of my translation. I mean, not looking back, might have been insecurity, but at the time I justified myself. I do not want to mislead people. Yeah. So he also displaced a little. So I really resonate with him on that regard. And also one thing that's humble for him to stay, I think was towards the end of the general outline where he said, feel free to reproduce this work and just make sure you attribute to him, just reproduces. and distribute to everyone and also you can spot any error and add anything feel free to do it.

Toby: Yeah, I remember this from your translation, right? It doesn't matter if you're a brand new person studying medicine or a master. I welcome criticism from everyone in that whole range. I thought it was so

Allen: Yeah,

Toby: All right. hesitant to ask you, would mind if you still got the energy, would you telling about the Sanjiao framework that he proposes? Do you mind discussing that or is that too big?

Allen: Think I can touch on a little bit. think got this idea mostly from Ye Tianshi and also from Wu Jutong.

Toby: From Wu Jutong, I'm asking about...

Allen: Sorry, from Wu Youke. Wu Youke. so I think because one of the key jobs for him at the time here is that he needed to showcase the warm diseases are another disease category from cold image. And also, based on what people have observed earlier, those type of disease seem to be contracted through a mouth and nose, which is

Toby: Yeah.

Allen: Which was stated as early as Wuyoke. So Wuyoke mentioned, going from mouth and nose and goes into lung and it goes in the membrane source. So that's a Wuyoke assertion. Ye Tianshi further added more to that. So Ye Tianshi said, yes, go from there, it goes in from the hand tai yin goes from the top to the bottom. So I think that's his inception of the three burner

Allen: So first it goes in from the Tai Yin rather than the Tai Yang, which is different from the Shanghan Lun. So it's almost like a couple. So one from the top, Tai Yin off the arm, the other going for the foot Tai Yang off the, at the bottom. So that's the direct opposite.

Allen: So it goes in from there. And then he cited also from Ye Tianshi'side, well, when it goes into the lung in the upper part, it can also go, I don't even remember how I translated it. So it goes out of its order. It goes in a contrarian order into the heart, the pericardium. So that came from Ye Tianshi. So I think that was the basic building block he received.

Allen: So then he further asserts that, okay, so after that, it goes into burner. Because in the middle burner, you don't really see anything very as specific as the pericardium one. So I think after that, it's because...

Toby: No specific organs right pericardium the organ and then when it goes to middle burner then you're just talking about that region but not

Allen: In the middle of the word, mean, sometimes he does say, that's a Tai Yin disorder, that's a Spleen that's a Stomach disorder. But it doesn't stand out as much. It feels more like a... Because when you say something like, it goes into a pericardium, that'such a bold statement. You know, someone stood for it. Someone came up with the idea. I know this sounds so weird, but yes, it happens. So what I saw was that's cool. And Ye Tianshi came up with that, man, that guy has some guts. So he cited that and then he's like, so, and also he took the ideas of everything started from upper burner. But after middle burner, you see everything is more like in categories.

Allen: So of course, if you are a practitioner or scholar, you can just kind of sort it out. So after it gets into the middle burner, it becomes a little bit category. then I think he just. like

Angelique: Don't want to say assertion.

Allen: But almost like a logical is that, if you start from top, you must have travel to the bottom. So then it goes through a lower burner So I think that's where the three burner idea came from. So I think the first one is the most clinical insightful. The two to me more like categories. So that would be my personal take. But at the time,

Toby: Yeah.

Allen: Ye Tianshi also say you start from the top and go to the bottom. So maybe Ye Tianshi was onto something. So that I do not know. Right now I'm working through the lower burner. It has been slow. I only worked through one section. Another section is quite interesting. They use a lot of animal shells and lot of warming decoctions, which is very interesting.

Toby: I'm surprised about that. your sense about it?

Allen: At a moment

Allen: Well, I think in terms of his ideas, when it gets down to there, it tends to manifest into a Yang depletion pattern, strangely.

Toby: As it goes through the burners, the bottom, when pathogenic factor is in the bottom, then it manifests as yang depletion.

Allen: That's quite weird because...

Toby: Digesting that, but okay.

Allen: Yeah, because I think how he reads on Jueyin and So because he's a middle burner he did state a Taiying disease and...

Allen: Yang Ming disease, so Yang Ming disease, of course, it's a type, you so you get real heat, right? But with Shaoyin disease, you start to need to get rid, try to get rid of the dampness. starting from the middle part, you see a little bit of warming herbs In the lower burner, now I'mostly Shaoyin disease and Jueyin disease, but I haven't been through the whole chapter, I don't know.

Toby: We won't hold you, we won't hold you. This is your final opinion, no?

Allen: In song, you still had two different manifestations. You had the song heat which is a Huang Liao E Jiao Tang pattern. It a little bit of heat, interior heat, but it's almost like a vacuous heat. So in that you want to use something like a tonic with something that cools the fire a little

Allen: Other type of disease are basically Yang depletion If you get further into Jueyin disease, you not only have a Shaoyin pattern, which is Yang depletion disorder, you also have other weird things. So I think the way how he raised Jueyin disease is more like the end of both Yin-Yang state. So he actually needs to work on both of them. That's my current take on that. and also, as we watch the translation, strangely, we shot

Allen: We shut down part of our brain. We cannot see the brain picture because we get stuck into this tunnel vision, trying to read lines and passage. Sometimes we miss a big picture of things. right now I'm not stuttering. I remember what's fascinating me at the time.

Toby: You have only patients that have lower burner problems, that's your mind is right now.

Allen: Unfortunately, I don't really want to see it.

Toby: Okay, all Too bad you can't differentiate for that. It's coming in only for that now.

Allen: Yeah, usually we see mostly, well, patients don't really see us because they say, if I'm sick, I should stay home. I'm not better. And so we see a lot more middle burner disease. lower burner disease. I see it more in Chinese patients because I treat, right now I treat 50 % Caucasian, 50 % Asian. And so most Asian patients want herbs and they want to deal with chronic disease. And most Western patients come in with pain management and they want acupuncture and nothing to do with that, those like grass and mud and stuff. So it's kind of interesting.

Toby: Mm.

Toby: That's great clinical experience 50-50. That's

Allen: Yeah, so sometimes I do have Chinese patients coming with chronic issues. I'm not sure if it's my bias or me being here in mid-Atlantic. Almost everyone in city has like deep pulse and almost everyone has. So when I first started my practice, since I was a hardcore Jingfang practitioner, everything is Fuzi, right? So now do more.

Toby: I don't know.

Allen: For Cangzhu, I do a lot more Fuling Yeah, and try to just the gank of them and see what happens. Cangzhu, Fuling, and also Hopu. Those are my main herbs here.

Toby: It is. Okay, that's over here on the west coast who'saying, right? So much damp. feel like I'm dealing with so much damp all the time. It might just be an American thing.

Allen: I was in... I just came back from Asia and I was in LA and just said, wow, the air is so crisp. The light is golden. Every day is a sunny day. Unlike Here we had to deal with pollen

Angelique: Yeah, I should and

Allen: Hay fever almost five months a year. So maybe that's why I use hou po so

Toby: That's right.

Angelique: Yeah, I feel it.

Allen: Feel like West Coast should be cleaner.

Toby: I don't know. Maybe I'misdiagnosing, Allen I don't appreciate you criticizing my diagnostic.

Allen: No, I'm pretty sure you know what I want to know. I don't know. We only know the... with the patient we're working I don't have a California license so I don't practice any of it. So don't know. That's right.

Toby: It's fascinating. And especially that's great for you to see the two different populations side by side too, right? And that you can really get insight into both. Right. We're getting close to wrapping this up for today. I'm going to really recommend people get your translations. They're so amazing. And then this is what I wanted to say too, before I is like, if you only read the footnotes for text, it's it. Like the Chinese medicine education just from the footnotes is just unbelievable. And then I really appreciate with the Wuju Tong text, all like you set up the characters that you're to be talking about and referencing throughout it. So it's really nice to have that little bibliography about the characters that are going to be part of that in the beginning too. So can't recommend your text enough. I'm, I finished it yet, but the I've read so far has just been fantastic. I read all the, Zhang Jingyue translations was incredible. That really helped me a lot. One of favorite things from that too is I don't know if you remember But, Zhang Jing Yue is criticizing people that use root and branch as a, as know, like, there's like an excuse to do things. And again, that my thinking about that so much. Cause I always feel like it was a little bit of a, yeah, like excuse, right? I'm just going to treat the branch or something like that. If you, if you don't mind, you remember that section, if you don't mind commenting on that, and then we'll let you go. We know you have a stack of translation to get to, but if you don't mind setting us off with it, with a. So, Root and Branch, Zhang Jingyue take on that.

Allen: So I can offer you my personal speculation. Because I feel you can get some of his message from the group already. But I think I want to insert a little bit more context. So remember why I mentioned earlier why Zhang Jingyue attacked Zhu Danxi so much is because Zhu Danxi is a patho mechanism. Everyone'stagnation phlegm, et cetera. if you at disease and condition in that point of view, every single disease is a branch disease.

Allen: Actually.

Toby: Single, I'm sorry, what?

Allen: So if you look at it from that perspective, single disease is a result of stagnation. So every single disease is a branch disease. And also point of view, the only constitution issue in vacuity. So basically if you practice from Zhu Danxi perspective, where you'll ultimately at. So I think Zhang Jiyue is cautioning us against that.

Allen: So in that, fight against that, he created a pre-heaven and late-heaven concept. What pre-heaven? they start what's late-heaven. So what's post-heaven is basically everything Zhu Danxi is talking about. Everything Zhu Danxi is talking about is basically... And Zhang Jingyue himself actually acknowledges that. Okay, that is actually... He doesn't get a true essence, which is an earlier heaven.

Toby: They have it.

Allen: So basically he created a thing and in some way he redefined, he created a grand framework and just kind of put Zhu Danxi into one corner of which is called the late heaven category. Now he wants to spend the whole week talking about the pre-heaven. And that's I want to arrive at this root and branch. Basically he's like, whatever Zhu Danxi does is a branch. Now let's talk about the root. What is root? We call the root simply as constitution.

Allen: His work, was like, he would call it a, that's a formless qi That's a formless yin formless list yang That'so hard to diagnose, so hard to answer. That's why you had to do the 10 questions, 10 inquiry to figure them out. So if look into the 10 inquiry, basically you are really aware whether it's a root or branch. And also it gives you more information if it's a root. So I think that is his whole philosophy, why he created those networks, why he gave us those tools. And also,

Allen: Why he's ever later focused so much into the ming men Today we call it kidney in and kidney out. So if we look into his formula, it's it's really heavy on the kidneys. So.

Toby: Yeah. To redirect our attention back to the root. Yeah.

Allen: Precisely. So basically when you're treating disease, yes, at times we do want to remove those branches, but do not take the constitution under the constitution. I think that's his greatest contribution to us. to this day, including with, I think sometimes we do take it a little bit too extreme to the point that when Chinese patients come to me, like, oh yeah, Chinese medicine, oh, they help with chronic disease and help with the constitution, cannot treat it.

Allen: Are you for real? Can I give you some Da Huang? I guarantee you'll poop in phlegm of me in one hour. But to this day, I think he tells the Chinese medicine so much into the constitution, which is a great thing. But at the same time, we must not forget Zhu Danxi

Toby: The pendulum, right? You know what the pendulum is going to Mario? It'll have keep pulling back to the middle.

Allen: You want to get a full package. also, from his formulas, he does have some really interesting formulas. So some formulas he does deal with both at the same time, but with different degree of emphasis. that's why after the Zhang Jingyue books, I went into his formula. But at the same time, I don'trust Zhang Jingyue by himself. feel like sometimes he can be his somewhere and where he is like the greatest

Allen: The lower of all. So bring in the Darth Vader of the Chinese medical realm, which is Chen Xiuyuan, which attacked every single one of his formula, which is fun. So think the best part about that work is Chen Xiuyuan is like, this formula is actually great. That's why I'm like, OK, I think that's a very good formula, even Darth Vader say so.

Toby: Appreciate you putting it into Star Wars references so I can follow along with your argument. I really appreciate that. Okay. I'm going you one more question and then we're going to let you go. So in this metaphor, who's Yoda of Chinese medicine?

Allen: No, you're the Chinese

Toby: Yes.

Allen: I had to think about this. So it's very easy, very tempting to just say either someone like Zhang or Sun Simiao I think that's too boring. I need to think harder.

Toby: Okay. You want to think hard now or let us know later. We'll put it, if you're watching this on YouTube, we'll put it here. If you're watching, if you're listening to this, we'll put it in the show notes. Allen's answer, who is, this is like a little bit of a teaser. Who is the Yoda of Chinese medicine The last couple of millennia of Chinese medicine, who's the Yoda of that?

Allen: I think in my head right now there are two people. one is the unknown author of the Nei Jing

Toby: Okay, yeah. Okay. I'm so glad you dug into this because yeah, I think that is the correct answer, right? So that's the true Yoda. mean, light years ahead of its time, even now we're still trying to understand it. So, okay.

Allen: The unknown author, singular Case. That's my personal take from early Eastern Han dynasty. so he, because he defined how we look at channels nowadays, which kind of went through a complete revolution from the Moldova to tiankui development. So six channel flip and also everything got connected together. And also we look at Qi completely differently. And also he linked, I think, I'll just choose this end together and also merged two linears together.

Toby: Okay.

Allen: He is a Yoda. So that's one. And what is...

Toby: Okay, wait, you're saying the other one is Baby Grogu. Okay, go.

Allen: Maybe. one I always argue is why do people like Jingfang so much? Because formula seem be so versatile, so robust and so well. We kind of forget one thing. It is because we have more than 100 commentators working on things for 2000 years.

Toby: Yeah.

Toby: And I'll

Allen: Jingfang is so viable. So I think all the commentators, even the ones we no longer remember, those are the greatest contributor to our practice because they were the one who took those formula ideas, cast them, tell us how to tweak them, how to work it, how to refine them. What makes Shanghanlun formula so great today? It's not the formula itself isn't great. I mean, they're great, but there are also really weird ones like

Allen: On the last chapter of Jinggui Yao Liyuan. Look at the formula. You will never use any of them. But all the other testers ones, it's because we have all the commentators. So the reason why I wanted to do the Zhang Jinyue formulas, because I feel like he has a lot of ideas. But he didn't have commentators. He only had like two, three people.

Angelique: And it's actually one. Hmm.

Allen: Why I kind of went through all the different sources, tried to bring as many commentators, as many critiques possible to hopefully to give us a better representation and ideas about his formulas.

Angelique: And to make them

Allen: Viable and sometimes I would just randomly look through Sun Simiao He has a lot we only have one commentary in history.

Toby: That's amazing, right? I didn't realize that. Okay, Allen, we're gonna let you go to get back to your translations and everything like that. Thanks so much for taking the time and educating Angelique and I. We really appreciate it. Okay, in the future, we'll talk, we'll bring you back and then see if we can get who's Qui-Gon Jin of the other. Okay, we'll bring you back for the next one for that, okay? Yeah. All right, Allen, thanks so much for your time. Thanks everybody. you. All right, bye for now. Bye.

Allen: We.

Strategies for Navigating Peaks and Valleys

Office Hours with Angelique and Toby. Released April 1, 2026. 13 minutes.

Listen: Apple Podcasts · Spotify

About this episode

Angelique’s practice is approaching fully booked several weeks out, and she asks Toby how he manages rapid growth. They discuss leaving buffer slots for emergent care, communicating capacity limits to patients, telling a temporary peak from a new normal, building a referral network for urgent needs, and when to consider going all cash or adding staff.

Topics

• Approaching full booking

• Communicating capacity limits

• Peak or new normal?

• Buffer slots for emergencies

• Managing new patient intake

• Referral networks

• When to go all cash or expand staff

A note for listeners: this is a conversation among practitioners, offered for education, not as medical advice. Patient details have been kept general to protect privacy.

Transcript

This transcript was generated automatically and lightly cleaned up. It may contain errors, especially in names and Chinese terms.

Angelique: So I'm actually curious what and how you manage. I'm approaching the kind of place of being fully booked and being fully booked a few weeks out, is a new and different and experience. And again, not throwing myself a party just yet. I'm that place where I'm getting all of a sudden a whole bunch of new people. So I don't know if I'm at a peak right now and there'll be a valley later or, but it feels very much when I first started and started to gain some momentum. have so many inquiries and then I'm trying to schedule them in a mindful way, but I'm still finding that sometimes the patients I've been treating who haven't, for example, booked out are now no space for them. And that's an awkward conversation to have. And then I found myself. squishing people into places where I don't like doing necessarily and staying longer for some people just to make sure that care isn't interrupted. So yeah, I know if like, I remember we talked about maybe an assistant being hired at some point, which I think would be a dream, except that I don't for sure this is my new normal or if this is just a peak and I don't want to pull somebody into my sphere that I might not be able to support. for the longterm and then be in a weird place that way. So yeah, I'm just kind of juggling. And then I received an email that there's another practice that's gonna be dropping a particular insurance and they have a multitude of patients that have this insurance. I take that insurance. There's only a couple of other practices. And so they're trying to find homes for them. And I'm like, my God. I'm feeling overwhelmed by the volume all of a sudden, which is new. And I guess I'm that's a good problem to have, I guess. But at the same time, I'm... Like I'm like, whoa, cause you know, I'm the one woman show at my place. So of my head spinning a little bit. I'm feeling some of that like nervous sort of energy I had in the very beginning.

Toby: Yeah, it's certainly, yes, it's certainly understandable. I've been through this certainly. This is a peak followed by a valley. Okay. So can cover yourself a little bit with that because especially first starting ultimately it will just be just peaks. And so, then that's a little bit conversation, but now you want to kind of weather this peak. How I it is, I and leave a one or two slots, you know, that I can put somebody in comfortably in per.

Angelique: Okay.

Toby: Clinic day because almost always there'something emergent, almost always there'something. And then again, people have to reschedule. So then that opens up another spot or two, but always have make a little bit of breathing room because I work with a of cancer patients. Almost always there's a crisis almost every clinical day. So I need those one or two slots. So I always do that. So I recommend as you are under pressure, and put out, and this another part of that is try and put out new patients as far as possible to give yourself plenty of breathing room so you can take care of the patients that you already have. Again, I tried to treat everybody all at once. When I first started, just, again, that really harmed my health and I've learned, I have a somatic understanding of that you can'treat everybody in the world. So you have to manage that well. You want to take care of the patients you already have and have a little bit of breathing room for emergent things that are happening with your current patients. That's my first recommendation. Second recommendation is you were thinking about going to all cash, eventually this will be a good push for you to do that. And then any practitioners newly graduated, you could bring into office and then have them do the insurance for these people so can learn that process. It may be great learning for them. Again, it take a lot of pressure off you. again, something like might be reasonable to Aside from taking somebody into office, again, local practitioners that maybe are new or a little bit more space, then you want to make sure you have that referral network. I've got a few Saam practitioners near me. especially patients that I need Saam I need it now, especially new patients that don't want to, if want to wait three months or something, that's okay. But otherwise, if they want something now, then I have some local practitioners that I can refer to. So again, this is a tough balancing act. But I think likely this is a peak and then valley. So yeah, don't do anything dramatic yet. But try and capture new patients, but just put them off a two months, and then be ready they're like, that's too long, then say, you might want to consider these local practitioners. And again, if those local practitioners take your insurance, then they just have to wait for you. But at least you're trying to help them get care sooner. But some people will want to come to you. or their insurance and then they just have to wait because you want to take care of the patients you already have. So a good way of doing it. Just the new patients push off patients already have, give a little bit of breathing space.

Angelique: OK, those are good tips. I haven't had anyone be like, I need Saam now. That would be a great thing.

Toby: Be next week. That happens. Because this tradition sometimes really potent, right? And so when it's potent, and they associate that with Saam, patients, they're not super educated, they understand Saam and then something amazing happened to me. So then they demand that or something. So that may be happening soon with

Angelique: Yeah, I don't feel I don't feel confident enough to be able to be like, yeah, I'll just take all cash now. I feel Not yet.

Toby: But as you only peak, then you'll have to do something. all cash is very comfortable. And then you just get rid of the entire insurance billing, which is just a sweet space to be in. then you just do everything all yourself, just cash. other thing is when you get to full peak is then you have to get some Again, that is one of the smartest things I've ever done. And then again, you want to make sure that it'someone that's going to be able to really help you. rather than harm you, which I think I shared with you before. I had people that made things worse. I was paying them to make things worse.

Angelique: So how does one know when they're past the peak and valley point and at the point when it's time to make a move?

Toby: Wait for two or three peaks and valleys and then you'll have a sense about it. Again, I think every practice is totally different. And let'say if it's a sustained, peak for three months, I would say then that's just your new normal. But again, likely cure some people will away or something and then there'll be a little bit of coming down. As you stay the same area for longer, it's coming up in 25 years for me, right? So then people know you. you won't see them for 15 years and they'll reappear and things like that. So that gets even worse forward, but especially as a new practitioner, right? It usually comes up like that and then drops.

Angelique: Yeah, is the first time that this has happened since I've opened. Like I had a newspaper article done my practice just to like say, hi, I'm here, know? And I had this of people coming at that time because I was new in the area and whatever. But this was unspurred by anything I did, you know?

Toby: Not true. Anyways, been delivering clinical results at a price. people can't help talk about that.

Angelique: Okay, I mean, but I didn't intentionally put out an ad or, know, do something.

Toby: But this is much more effective. this is what I had patients, right? Scheduled for a knee replacement, you give them an acupuncture treatment, they get full range of motion and no pain. They're not going to keep that to themselves.

Angelique: Yeah, that's true. That's true. Okay. Yeah. It's just been a, it's been a wild, a wild time looking at my schedule and just being like, my God, I had someone have to cancel an appointment for next week, but wanted to reschedule in the same week. And I was like, there's no spike. There's no space.

Toby: But again, someone that like in that case, then you push them off and say, you should have kept that. You know, makes it makes your people really to cancel and reschedule because they realize that's that's a valuable slot for you. So that's that's helpful. A little bit training your patients to like it's very rare for me to get cancellations because they know again, my office Stephanie, has like an algorithm, right? If you cancel, then you're way down the list. you know, for getting back in. it could be five or six weeks to get in again.

Angelique: So don't cancel.

Toby: Yes, it's training the patients to really respect your time because they not get another shot at you for weeks.

Angelique: Yeah, that's a good point. Yeah, so that just organically occurred with one patient. added him. There's a wait list function on the EMR that I use. so I just added them to their ideal time to the wait list. But now I have people like three and four deep stacked on my work days that are wait list people because they aren't able to get in, which is great if I have cancellations because then I can just pull people from that list. So been really nice.

Toby: It automatically do that? Does it automatically pull?

Angelique: It depends. It doesn't. Well, it depends on if have to have formulaically added it correctly. if the patient, I have particular appointment times that I have that I have set because I allow online booking and it was complete madness when the electronic medical record, if you just say I work from 6.30, it would put people in kind of. willy-nilly and I'd have people like 1255, like who had who come? No, absolutely not. So I had to have predictable slots. So I built my schedule so that each is its own like shift in Jane so a patient adds in the right parameters, it won't automatically pull them. But when they do, it does, it brings that person down and then it starts a timer for me where I have like four hours or something before it will release the slot to accept the patient into the slot. I have to confirm it.

Toby: That's it. That's interesting. you might at some point, you'll have a human do this because Stephanie, my office manager, she triages the patient to she knew I've told her enough about the patients to know, oh, this person needs that slot. This person doesn't. If she's unsure, then she just finds me in a clinical room, lets me know this is what the situation and then do. So again, this is invaluable having a office manager that do this. I think AI is good and probably getting better all the time, but again, it's nice to have a human in the loop for that.

Angelique: No, I can't wait to have a human. just don't know. I haven't reached. I'm in that middling ground. I'm in the true growing period of, OK, we might be approaching that time.

Toby: More of advice, right? As peak comes, try not to stress out. And when the valley comes, try not to stress out. I so much time doing that. Okay, but again, try at least try and remember my words when this because you're to panic, oh, too many people. And then you're going to be like, oh, not too many people. And then once you go through that cycle a couple of times, again, if your practice is like a normal practice, you go through it a few times and eventually you're like, okay, well, this is so great. I'm in a valley. I can study. can, I mean, you know, get caught up on your admin. You know, there'so much stuff to do. So you kind of look forward to those valleys. And then, like I said, at some point it just peaks. So then you have to figure out something else.

Angelique: If I'm lucky, it'll just stay peaks.

Toby: Yeah, again, people need Chinese medicine. And so once they find someone that can help them, they continue for any Chinese medicine problems they have in the future and then tell everyone about it. that's usually that's what happens.

Angelique: Yeah. And one of the things that I remember you telling me too is that people will pay for what they value. And I've noticed that more from people, but on both ends, either they're willing or they're not. And it's like, well, I'm now seeing what you value. people who are saying they had a hard time paying for acupuncture, spending $200 a month on supplements that are silly. In my opinion, were silly. was like...

Toby: Anyways, we can use the term, we can substitute that for ineffective sometimes. So $200 a month for ineffective things or your services which can be effective. it forces people to decide again, especially with limited budgets. anyways, yeah, I think anyways, almost to a person, we provide such incredible value for people, especially when you look at biomedicine field, right? It'so crazy expensive. Somebody went to ER for... a day and a half that was recently told me it was like $200,000. So, I mean, again, with sophisticated things, everything, of course, yeah, that's expensive, but 200,000, you know, I mean, it just seems insane.

Angelique: My god. It's insane. Well, that's like my update for So I appreciate your tips of advice. And for those of you out there that are in the same boat, I guess welcome to that boat with me. Let's it together.

Toby: Yes, again, you're starting to have good problems. I'm so happy to see that.

Angelique: Thanks. see how it goes for sure. I'll keep you posted. Right. Well, until next time.

Toby: Yeah, everyone take good care, okay?

Angelique: All right, take care, bye.

A New Model for Chinese Medical Education

Office Hours with Angelique and Toby. Released March 22, 2026. 22 minutes.

Listen: Apple Podcasts · Spotify

Editor's note: This episode was recorded in March 2026, during early planning. Several details discussed here, including the program's length and structure, have since changed. For current information about the Chinese Medicine Benevolent Academy, visit cmbenevolentacademy.org.

About this episode

Recorded in March 2026, this conversation lays out an early version of the plan that became the Chinese Medicine Benevolent Academy: a nonprofit school built on an endowment rather than tuition dependence, software that reduces administrative cost, and community spaces in place of a fixed campus. Toby and Angelique discuss the financial pressures facing Chinese medicine schools, crowdfunding and support from practitioners and patients, and the timeline from concept to funded reality.

Topics

• Financial challenges facing Chinese medicine schools

• Endowment-based models

• Software and AI for administration

• Community classroom and clinic spaces

• Building a durable nonprofit institution

A note for listeners: this is a conversation among practitioners, offered for education, not as medical advice. Patient details have been kept general to protect privacy.

Transcript

This transcript was generated automatically and lightly cleaned up. It may contain errors, especially in names and Chinese terms.

Toby: Hey Angelique, happy St. Patrick's Day. That's right, it's my middle name. So this is especially relevant for me today. My true name is Toby Patrick. It used to be O'Daly three generations ago. So pure Irish. You might have noticed from the complexion, just pure Irish. So, okay. I want to get started with a new feature on office hours. We have a new feature called our digital bulletin board.

Angelique: St. Patrick's Day to you

Toby: And on our digital bulletin board right now, we have a friend at the show, Kaysie Lingo. her office space is going to be available in Chicago Five treatment I believe. If this is, if you're watching this, pictures of will appear up here and like this. I visited this when I was teaching in Chicago, I visited her office. It's amazing. Right? it's kind of by the bean. It's a couple blocks from Lake and it's an old school Chicago building, right? You got to go up to like 50th floor or something like that. So it overlooks the city, all this treatment, things like that. is leaving and so she's like, wants people to know about it So that's that's on the bulletin board right now. I want to let people know about it. Really cool space. So okay, that's on the bulletin board. What about what's going on with you?

Angelique: I'm actually curious, does the bulletin board have a physical location that folks can look at?

Toby: It's a digital bulletin board. it's in a digital space. The same space that office hours occupies, this bulletin board is in that same space. So it'sort of everywhere and nowhere. Yeah, so it'll be here with us. It'll be in the show notes and things like that.

Angelique: In a digital space. So it's here with us. Okay, got it. Good.

Toby: Okay, what's the latest with you on this?

Angelique: Well, keep getting email updates after he had Ryan Hofer on with his sub stack. I was sent a recent article from woman from Poca Tech Lisa. Lisa, yes.

Toby: It starts with an R. I don't know how to pronounce her last name.

Angelique: And we won'try. anyway, read her most recent article. And so I'm just kind of, I don't know, feeling a little apprehensive about the way it's looking for the future of Chinese medicine education. Yeah.

Toby: It's on my mind as well. And I think I have a response to it. I'm developing it right now with the team and hopefully you can be part of this team going forward. the problem with Chinese medicine is money, right? The most fundamental problem is all medical schools always started with an endowment, like Stanford, imagine Johns Hopkins, MD Anderson. Harvard, it all starts with an endowment. And then so then you don't put all the burden on the students, right? But Chinese medicine schools aren't like that, right? They come in and they just, have to just keep as they increase the administration of the school and have the campus and everything like that. They just put all the debt onto the students, right? Ryan was explaining this to us. So the problem with Chinese medicine is money. Chinese medicine itself is beautiful. And so helpful for millennia. So Chinese medicine itself doesn't have the problem. It's how it's being delivered. That is what has the real problem for Chinese medicine. So my idea is a new model for Chinese medicine education. Again, we can't like tinker with a current model. It's unsustainable. And again, if you follow Lisa or Ryan's work, it's basically going to be obliterated, right? It sounds like a big word, but basically that's what's going to happen. Chinese medicine in its current configuration is going to be obliterated starting in July of this year. And then by 2028, that's kind of a cutout for the debt loan caps, right? So you have to prove that by going to Chinese medical school, that you can actually benefit to at least doesn't harm you financially. Currently, it's better if you went to high school and just had a high school diploma. you make more money than if you go to Chinese medicine school and get a master's degree or even doctorate. It's the worst financial mistake you can make. Again, Ryan Hofer explained this to us before, but it just really hit home for me. I've been thinking about ever since that interview. And so I kept thinking over and over again, somebody has to do something. my God, Chinese medicine, somebody has to do something. It just kept coming over in my head over and over again. And then eventually hit me maybe myself and a team. do something. Maybe we could respond to this. The key thing is money. So the key thing that we need to do is change how everything goes. Like I started to say the endowment, right? We have to start with an endowment. For Chinese medicine schools, they never start this way. But I think in the future, we need some money to be able to operate from so you don't put it on the students. My idea is successful patients, people that have really benefited from Chinese medicine as patients, they might want to contribute to that. So I've done an N of one study so far. I approached one of my patients who's moderately successful in finance and things like that, and asked if they would be considering contributing to an endowment for Chinese medicine school, a new model. I explained a little bit about the problems and my idea for a solution, and she immediately donated. $25,000. and said, we'd like to do more ongoing forward. So again, basically I just need 19 more people with that level. And then, and then this program will go, which again, just based on the end of one, hopefully that can go. So the endowment will come from, patients that have been financially successful and want to continue Chinese medicine. as we know it, right? Again, all the other medical schools have always done this with an endowment, so we need that. And then also, this is a little bit of call out to all those successful Chinese medicine practitioners that don't want this pipeline of Chinese medicine to be cut off for other people, then also they can contribute to that. So again, then we have this endowment, and then we can start with the school. So again, we start on really solid footing because we start with this endowment. My idea of endowment should be about 500 grand. Okay, again, so it'substantial enough to sustain anything. If anything happens, the school doesn't just close or something that there's a substantial endowment. Going forward, the school itself, we got to cut it problems looking at from first principles, right? The expensive things for school is administration and the campus. traditionally, these are fixed and we just can't do anything about it. But actually, since it's 2026, administration can be almost completely replaced with software. I'm working with a developer right now. He was a software engineer for Uber and he's going to help me an administration that's almost completely replaced with software. Again, that's inexpensive, efficient, quick. for accreditation, you have to have a team that takes months to put together accreditation, report and everything so that they know what's going on. takes a few moments with AI. So again, it's just an immediate financial savings by the administration being AI and software. And it's really doable because 2026, however things going, that's not like hopeful. mean, we're building this right now. So that's really good for that part of it. Can you see that in your mind right now? You take all those salaries that usually play, that don't really add to the educational component for

Angelique: Okay.

Toby: The Chinese medical students, The admin, if it's replaced with AI, it just doesn't harm their education at all. It only helps it. then it's, again, back at the envelope calculation, huge savings, right? By doing that with software instead of administration.

Angelique: Question about that, though. Who's double checking it to make sure it's doing its job, right?

Toby: Again, I'm putting together a board for this. And then we have human people. Again, we have our tech expert. His name's Anton, right? Just so we can put a name to it. He's amazing. And then also my office manager who is usually working on my clinical work. She's also going to be looking at this. So there's going to be humans in the loop, but AI is going to be doing all the grunt work. All this stuff that, again, it used to take months to compile. That'll be done by AI and then double checked by humans, really competent humans. So yeah, that's the important part for me too. Like, yeah, we can't make AI slop. We have to make AI something significant. And again, so humans in the loop will be really helpful for that. And AI, looks like we'll just get more and more competent as the hours go by. So that'll be less and less human involvement. But again, there'll always be some type of human involvement.

Angelique: Okay. To be the devil's advocate, what would you say to people who are appalled at the thought of replacing human beings with AI for this purpose?

Toby: It's grunt work. Okay. So all those people that would be those like cubicle jobs in the school, everyone was so depressed that worked those cubicle jobs at my Chinese medical school. don't know about yours. It was such a depressing job. All those people could potentially be clinicians instead, which is such more rewarding work. You know, again, we just take the grunt workout and then, and then we can do, you know, much more fulfilling work rather than just doing, you know, like those reports and things like that. heard legends of a how difficult that was to compile those reports that were needed for credit. Again, they need it because you have to tell them what you're doing to maintain your accreditation, but it'so much better rather than wasting human time. You could just have software do it.

Angelique: Okay, I can see that as acceptable. is quieted for the moment.

Toby: Okay, again, I, you and I have talked about this before. I also was a real AI skeptic. I was actually afraid of AI and then skeptical. And now I feel like I'm a careful user of artificial intelligence, right? Being really careful for what it can do and what it can't do. But again, if it can take away human drudgery. I'm all for it. And it looks like in this case, so far, looks like it's going well. Again, we are building this, so we're not just going to theorize about this. As you and I speak, we're building this right now.

Angelique: OK, so then how would you imagine the clinical coursework going, both classroom theory-based learning and then the hands-on training?

Toby: That's the next really expensive part of Chinese medical school. So the administration was a huge chunk. And then also having a fixed campus that'sometimes empty, right? Like at night, weekends, you know, basically you're not using it all the time. So my idea is to make pop-up things, pop-up clinics just as needed and then pop-up classroom as needed. Otherwise things are on Zoom.

Angelique: So when you say like a pop-up, that we would organize and find space kind of ad hoc.

Toby: Yes, I've already got the idea starting, right? Again, we'll start with a really small cohort just to stress test this. And then, mean, it potentially unlimited what we could do. Again, I think it's probably better if we can prove this model that people can take this and duplicate it throughout the country. As the traditional models fall apart, then people could take what we're, for sure we'll make mistakes, right? So again, all the learnings we can do, we could just pass on and the future for people, but we have to move pretty quick for this. I feel a little bit like I was asleep for this crisis. And then when I woke up to it, I feel I understand the house is burning, right? So I'm quite a bit late to this, but now I'm fully engaged and fully active in trying to solve this problem.

Angelique: Yeah, and it seems that opportunities are presenting themselves pretty incredibly to you.

Toby: I kind of, the last thing I want to do is start a Chinese medical school. But I love, I love this profession so much. Yeah. And, part of my time building up to this is I asked so much people to try and talk me out of it. No one was able to yet. I have one more person that's going to try, this afternoon to try and talk me out of this. But again, I, this is the last thing I want to do. I thought maybe somebody else will solve this. But I think I may be in a uniquely well-suited place to solve this, though I don't want to. I love the profession, so will, I'm gonna try my best. So start out with, yeah, let me give you concrete things. clinic I'm in right now has three treatment rooms and we could possibly make a fourth one. So again, that would be a great way to start. Again, the first cohort will be really, we're going test it. We're going to keep it to 10. So that's easy to do with a four treatment room. I use just Monday, Wednesday and Friday. So Tuesday, Thursday, Saturday, Sunday. especially for the first cohort, they'll just be observing. So all the current patients I have that are used to interns coming, again, we'll just do that same model. So they can come in and observe in the clinic for that first year or just be observing. But then eventually, while they expand this out a little bit, the clinic I have by me, it's just opening a new campus that's gonna have tons more space compared to what they've had before. I know the director for there. And so we may be able to have people work there. Also, there's an emergency room I know the emergency room director for. We may have people to be able to emergency room. There's a hospice by me. There's just tons of options. There's a new retirement home that's run by Zen Quakers. It's amazing. And so again, there's tons of partnerships available here. In addition, as we need classrooms, the area right next to me, I'm looking out the window at it right now, is this beautiful home from the 1890s. And that's available as a VRBO. So as needed for the didactic things like point location and things like that where you have to be in person. that can be available. And then again, there's no cost when it's not being used. So we'll reserve it beforehand, because we'll know nine months to a year before when we'll need that, reserve it, and then it just goes away when we're not using it. It's $5.75 a night. So again, we use it for one or two days and then it's gone. So again, this is substantial savings because nothing's ever sitting there. And there's no, you don't need insurance on it. There'so many things that are needed, right, for the brick and mortar school. by abolishing that and just pop up as needed didactic classroom space or clinic space, again, we can just start right here. So that's actually no fee for the school. already have this space. It's already underutilized kind of by design. I like to have a little bit of space, but willing to the space away shot at really helping Chinese medicine education.

Angelique: And so for now, it would be on the West Coast.

Toby: Well, yeah, I have to start where I am, right? These things are all in place for me. And I know this area really well. But like I said, especially if we can prove this model or if people just want to discuss this model and maybe start something by them, I feel like we're going to need a lot of people on this team. I'm not going to, this is not going to, this is, this is a wide open master plan, right? So this is the master plan I have again, I'm going to pivot. I've already done several times, right? As I get more and more information as I learn more, but this is the overall. idea, right? Get a big endowment, pop up as needed structures. this is a nonprofit entity. 501c3. So anybody else who already has incurred these debts. So this will be helpful for future practitioners of Chinese medicine. They won't come out with amazing amounts of debt. And then anyone who's already come out and just dragging down with that debt, we have that 10-year loan forgiveness. If you work for a nonprofit, will be a nonprofit. So this will help both paths. people that are coming into the profession, people that have gone into the profession the last couple of years, especially just drowning in debt. So it's a big life preserver I'm hoping to build it.

Angelique: I can feel how excited you are about it.

Toby: A little bit too excited. I'm trying to calm down a little bit about it because again, it's a lot of work and things like that. I'm already pretty heavily scheduled. So I'm going to have to jettison some other things if I do this. But anyways, it feels like the profession's top priority. I want to, actually I don't want to, but it feels like I'm compelled to be part of the solution. least take my best swing at the solution.

Angelique: It's interesting timing wise too, because I just had a local nurse reach out to me as a nurse interested in acupuncture school. And I'meeting with her on Friday and I was thinking to myself like, what am I going to tell her? You know, like, uh-oh, like school's in trouble.

Toby: Yeah, this one, I can't in good conscience, the last couple years been able to recommend a single person go to Chinese medical school. Yeah. It's unconscionable to do that. So again, I just, I really kept thinking this is someone else's problem. They're going to have to solve this. But now I feel like, since we haven't and the house is on fire, I'm going to try and put it out.

Angelique: Yeah, well that's exciting news. as things progress, I imagine.

Toby: Yeah. I like this. This is nice in this. I'm working in a journal of Chinese medicine article about this right now. So this would be more fleshed out and more clear really soon. But again, this is as it's emerging. One month ago, I would say there's no way I'm starting a Chinese medical school. And now it's 30 days later. And it just gets more compelling every day. So it looks like I'm starting a Chinese medical school. Ideally, it'll be a model for future Chinese medicine schools going forward.

Angelique: Do you know what you would like to call it?

Toby: Has the provisional name of Chinese Medicine Benevolent I thinking lot about like school, college or something like that. I'm not sure if it will be a master's degree. For me, that's not that important, right? They just need be able to be licensed and have the most basics of Chinese medicine and be able start safely and pass the board doesn't have to be a college. think academy, especially this is from Plato, right? about, just it's a place of learning, right? Of learning a skill. And that's my vision for this. Then you'll be able to come out of this three years later. We're penciling him in right now for $19,000 a year for three years. then you'll come out substantially less because again, and no administration.

Angelique: Less.

Toby: That's the huge, again, there was no way to get rid of that until recently, right? I mean, you had to have those things, but so much flexibility now with VRBOs and things like that, AI, that you can do this. mean, when Chinese medicine absolutely needed it, there was paths going forward. So we'really lucky about the timing on this.

Angelique: Are you envisioning it to be a year round for three years program? So it would be similar to current structure of the quote unquote accelerated programs.

Toby: It would have to be. Yes. And how I have it now, you'll be able to sit for NCCAOM They just changed their name. I forget the acronyms for that, but also for CALE, the California Acupuncture Board too. So you'll be able to sit for one both of those through this program. So again, you could come from around the country and, you stay, you even have to be here because again, a lot of it would be online, but then certain times you'd have to be here in person, especially for clinical work and things like that. If you can make that flexible, you could go back and forth. Yeah, but so anyways, this is the idea for right now.

Angelique: That is exciting. The lot in one month's time to sounds like you went from nope, not doing that to having a fully formed, partially funded, connected plan.

Toby: Yeah, every idea and every problem that came up in my mind, my mind immediately came up with a really viable solution. So it was a little bit annoying because again, this is the last thing I want to do actually.

Angelique: And so, I don't know, my experience in life has been one those things when things happen with that level of ease and clarity, it'sort of, to me, it's always meant that I was on the right track. You know, even if it's not really what I wanted to do or what I envisioned myself doing, the path laid itself out.

Toby: Yeah, we'll see. Our show will be documenting the process as I go through this, And me and my team, as we go through this, right? We should be able to document a little bit of, hopefully hit some milestones on this show.

Angelique: Yeah, right in the wave authentically as it come up. Well, that sounds really great.

Toby: All right, so let's leave the show here for today and I'm going to get back to work building this thing, okay?

Angelique: Sounds good to me. We'll talk to you next time.

Toby: Okay, thanks everybody.

Angelique: Bye.