Office Hours with Angelique and Toby, episode 2. Released April 25, 2025. 37 minutes.

About this episode

Toby Daly and Angelique Britt compare what they keep in an emergency kit, from needles and bandages to San Qi, burn cream, and loquat syrup, and how it came in handy for a deep fingertip cut and a kitchen burn. They talk about sourcing Chinese medicine supplies, concerns about counterfeit products and ingredient testing, and offering gua sha as a brief follow-up for established patients with neck tension and headaches.

On the clinical side they discuss a complex depression case treated alongside Western medical care, avoiding the same Saam combination visit after visit, caution when kidney excess and small intestine excess appear together, and why Toby suggests a year of unmodified four-point treatments before adding modifications. They finish with clinic workflow: Toby's three-room schedule and office manager, Angelique's move to three longer clinic days, and the idea of a low-cost group auricular treatment for stress.

Topics

What goes in an acupuncturist's emergency kit
Sourcing supplies and counterfeit concerns
Gua sha as a follow-up service
A complex depression case alongside Western care
Varying Saam combinations; kidney and small intestine excess
A year of unmodified four-point treatments
Scheduling across three treatment rooms
Longer clinic days and group auricular acupuncture

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.
San Qi (三七): notoginseng root, used to stop bleeding and move blood.
Gua sha (刮痧): scraping the skin to raise petechiae, used to release the exterior and move stagnation.

A note for listeners: this is a conversation between licensed practitioners, offered for education, not as medical advice. Depression with any risk of self-harm calls for care from a medical or mental health professional; in the US, call or text 988 for the Suicide and Crisis Lifeline. Patient details have been kept general to protect privacy.

Transcript

This transcript was generated automatically from the published audio and lightly edited for readability. It may contain errors in names and terms.

Toby: Hey Angeli. Hey, welcome back to the second episode of our show Office Hours. Where we're going to discuss all things Chinese medicine. But we can start off with a real practical question for you. Is that okay? Do you carry around a Chinese medicine emergency kit with you?

Angelique: Hi Toei. Course. Acupuncture needles with me. I do. I should have some herbs. I don't yet.

Toby: Okay. Maybe we can talk about it. Recently I had to use my emergency kit twice. I was w doing some volunteer work in a commercial kitchen and I had to use my emergency kit twice. So maybe I was thinking about this is over time. I've made this emergency kit. Do you mind if we talk about what's in my kit and then maybe to add to it? Yeah. Okay. Great. So first thing I did is almost cut off the tip of pericardium nine with a like a

Angelique: Sorry.

Toby: Cleaver, like a cartoon size cleaver, and I was cutting an onion and first of all I should never be in a commercial kitchen or having a huge cleaver, but there I was with that. And so I took off so much of the tip that it was two butterfly bandages and it was still bleeding through them. Yeah, so it was pretty bad. And then part of my emergency kit is Unim I Al. So it was pretty amazing, right? Yeah, because it was so much blood I was able to take it. No, I poured it on. Okay.

Angelique: I believe it.

Toby: I died in this many times with other patients with open wounds and things like that. So I just poured it on, it stopped bleeding immediately, and then was able to wrap it. And this is almost two weeks later. It's still pretty chunk missing, but I think it's okay. So that's that's part of my that's part of my emergency kit is you name by out because again, internally or externally is fantastic. And then the other thing is somebody that was helping out in the kitchen also burned themselves horribly. Opening up a oven door. It was a big industrial oven. So coming it burned all the inside of their arm. And then gosh, I even forget what the name brand is. I'll I'll I'll flash it on the screen here. But that really burn that really good burn cream.

Angelique: Like a Shango cream.

Toby: I think that's Japanese, right? Yeah. Okay. Yeah. This is the more the Chinese one. They tested all the burn creams they have on like in a steel plant in China. They don't have any OSHA, so everyone was just getting burned by steel all the time. So they tried all these different burn creams. This is the best one from that test at the steel thing. All right. Again, I'll f I'll flash it on the screen here. Yeah. But that was great because that was a bad burn and then it just basically resolved with that. Yeah, I was able to put it on right away. Thing in that kit, yeah, but besides needles, I had those honey loquat drops. Have you ever had those?

Angelique: No, I've heard of them. We studied them, but I have not taken them right.

Toby: But that's great for sore throat and cough and when sometimes you just can't cough. So it's really nice to have those on hand. I have a three edge needle in there, but I've never used it. But I just it seemed like that would be a good thing for a Mercedes kit.

Angelique: What is a three edge needle for?

Toby: For like piercing carbuncles and things like that. Yeah, for Lancing. Somebody had given it to me and then I just thought, wait, I maybe an emergency. So not yet, but maybe someday. Hopefully I never need that one.

Angelique: Got it. Lancing. Okay. Yeah, running across a carbuncle or a fur uncle.

Toby: Yeah, yeah. And then the other thing I just as a nod to Western medicine isn't have band-aids in there. Yeah. So that's the main thing. It kind of covers a lot of, you know, things, especially needles. I think that's the most important. I think that's the key thing you want to have. And then it's nice to have some other things just as necessary. So consider bulking up your emergency kit. Again, I use frequently, but especially like it last week I used twice, you know, two things from that were pretty essential. I think I might have had to go into urgent care or something to get that sealed up 'cause it was so bad if I didn't have to get in my house. So

Angelique: I mean, in fairness, I do have a first aid kit with me, but it's very Western med. You know, band-aids, antibiotic ointments. I think I have some hydrocortisone cream, stere strips, gauze pads, like wipes, like antimicrobial wipes for cleaning out wounds. So I have to integrate my kit.

Toby: I think yeah, east and west. I mean it'll be it'll be pretty bulky, but it's it's just nice to have like something like that around.

Angelique: Yeah. Where do you get the Unanum Bayao? Where's your what's your supplier?

Toby: I really like getting it from Blue Poppy. I think it appears to be like the genuine UN buyout because you know, like don't get it on Amazon. I think that's copied frequently. So I'm pretty sure a blue poppy you know imports it directly from China but probably tests it or something like that. I remember looking at that quite a bit when I realized that there's so much do you know the term third shift?

Angelique: In terms of your working.

Toby: In terms of China. No. So a lot of times they have two shifts for a factory and then they close the factory supposedly at the night, but then they have a third shift that comes on that use the exact same packaging and just puts sawdust in things and does all these kind things. So is actually a term in China, third shift work where they just come the way they just come and just do counterfeit stuff for an entire shift. I know, but it's super well organized, right? You've got the employees, the managers, everything, and then they just use the actual packaging.

Angelique: Shift. Cheers.

Toby: When I looked about it before Poppy had the it seemed like anyways the most genuine stuff. And then this definitely I've at least this batch of unimbio I had definitely stopped. Definitely stopped that bleeding, so that was great.

Angelique: To know that's one of the things that's hard when you're new is where do you get the things, you know, because there's a million different places you can get them from. There's lots of different vendors, lots of different prices, lots of different herb places. And it's just nailing it down to like what's where's the best place to get the things, you know?

Toby: Yeah. Who do you like so

Angelique: I need that info that you have to share.

Toby: Yeah. Who do you like so far?

Angelique: So I use Lhasa OMS for most things and they're in Massachusetts. So stuff comes pretty fast and they run, you know, specials fairly regularly. So my needles and things, and basic supplies like cotton balls and q tips, things of that nature. Like I got my cupping set from them, guasha spoons, I use thirty seven cream, things like that I get from Lassa OMS. And then I ordered patents from Blue Poppy. I also have, I mean, when I was in acupuncture school, I feel like I signed up for just about everything just to be like, 'cause I could order from there if I wanted to, but I use blue poppy for the patents that I have and spring wind, I just ordered my raw herbs from them because they have a lot of organic options and they do a lot of testing in-house. So you can get a pretty clean supply, which is important to me.

Toby: Yeah. I think Springwind's pr probably best in the world. And then I've got a few local growers here in California for Chinese herbs. And then they sell to Springwind now too. So that's that's super fresh and just really high grade some of these things I get from local herb growers. Yeah. I've got somebody about thirty minutes away from me. His name's Dave Melli. And he was acupuncturist in Berkeley for many years. And then as is retirement, he's growing a whole bunch of Chinese herbs, kinda living the Chinese medicine you know, retirement dream. But he's super meticulous about things. I've been to his farm and then his stuff when it arrives is just so amazing, so aromatic. So it's nice you know, you don't have to go to Dave's farm, right, to get that, right? You can get that through spring wind now. So that's great.

Angelique: That is great. See, I like them. And it's beautiful when you get these packages, these big packages of fresh herbs. They're so pretty. Yeah. I was so happy opening the boxes.

Toby: Patients really like it, right? When herbs come in and then even patients like to look in and see what's going on, you know where their stuff's coming from. So it's been great. Yeah. Okay. What about you mentioned you use you get gua shaw supplies from Las OMS. I'm I'm not really familiar with gua shaw. Do you do a lot of that in your practice?

Angelique: I do it. I ha well, I would say a lot. I mean, I don't have a lot of patients so far, but I've got four or five of them that really enjoy it. It's really wonderful for relieving tension in the neck and the back and also anxiety. So the basically the rule that I've established, I didn't want to have like an adjunct menu. There are some practices that have adjuncts menus where you can go in and just get cupping or get gua shaw or get whatever. And that just felt complicated to me. And also like I consider Gua sha. I mean, there's cosmetic gua sha, which you can do to the face. I don't do that. It's mainly just for like musculoskeletal stuff up here. So I have I have a little carve out for patients that are established with me that have really enjoyed ga. For example, if they just want to come in between treatments, because I got a couple of patients that really enjoy it, they get a lot of tension headaches, a lot of neck pain, and really, really liked it. So they come in and they don't they can't always come in for treatments every week or every couple of weeks for various reasons. But they sometimes can afford to come in for gua sha. It's like 15 minute appointment and I'll come in and I'll do that. I'll like a quick assessment and go for it. They enjoy it a lot.

Toby: But th that makes a lot of sense, right? You already have your initial diagnosis so you know Grasha's appropriate and then you can have come in as needed. That sounds like a great

Angelique: Yeah, and I've known that they've they tolerate it well too. You know, they're not gonna pass out on me. There hadn't been any excessive bleeding, that kind of thing. So it's not like a person off the street, you know, coming in for it. So as a new person, that makes me feel more comfortable that I've done the complete assessment and can proceed from there.

Toby: That seems like a great way to manage it. Yeah. What about what about other cases recently, like challenging cases, successful cases that come to mind?

Angelique: Yeah, especially with regard to psalms. So I have continued on my Saam journey despite my first experience, which was a good learning experience, albeit slightly traumatic. But yeah, yeah, of course. I hope it helps. Kind of stuff happens, right? So there's a patient that I am treating now that came in that was one of my first patients that came in with intractable depression.

Toby: Thanks again for sharing that with everybody.

Angelique: And has been through all of the Western medical and treatments, including electroconvulsive therapy, has tried basically every pharmacological drug. It just from they mentioned like since childhood basically they've had this low level of depression. They've had like five major depressions to the point where, you know, they're considering moving somewhere at some point to be able to euthanize themselves. It was pretty heavy and intense. I know. So I of course, just a disclaimer, made sure they were connected and safe and did all the things you're supposed to do when you have a patient that talks about suicidality and treated them with TCM acupuncture for a while. And then they were also doing a lot of Western modalities at the same time. And they always had relief after acupuncture. They always felt good. Their mood felt lifted. They felt okay. You know, it would last a couple of days. And then it got to a point where the electroconvulsive therapy was too much for them to tolerate. And so because they were going on an as-needed basis, sort of I wasn't familiar with this particular structure. I was used to patients going inpatient and having a series and then being done. And so they tried to go into the hospital for the inpatient series, weren't able to tolerate it and then, but felt there might have been some effect. And so they had this sort of a la carte approach where they were doing it two or three times a week and they were going to do that for a series of weeks, but it was too intense for them. And so they had hit another point of bottom after they had come up out of the depression for a little bit. And so I tried. Some and I believe the first channel I supplemented was pericardium. And the reason I did that was there was a there was a lot of anger. So this person's body type is more large intestine body type, small, very, very lean, almost too lean, dry skin, just dry, dry, dry everywhere. But I wasn't feeling like supplementing spleen was what they needed this point because they were really angry. And when they were talking about being angry, it's like they were angry at a lot of other people. They were angry and they had new acne that they had never had before. And what was like the clincher for me is that there was new left sided flashing in the eye, like lightning is what they said. And so I was like, okay, we're gonna try pericardium. And it worked really well. Mood shifted. They had gone to the eye doctor as well. And so this was like not a retinal detachment or anything. That would be Western med like emergency. But that diminished the skin got a little bit better. And then I've treated them subsequently. But the coolest result really was when they came in, mood has been doing much better. And they were having trouble with constipation. And that is when I supplemented spleen because they were dry on the outside, dry on the inside. And they texted me after their appointment, like an hour afterwards, saying that they had like Five pounds of poop come out of them once they got home. And then the subsequent day they had messaged me again saying, and it happened again. So that was neat.

Toby: It's really important to float the boat. So spleen can do Yeah. I think I like the ordering that you did on that for two, especially depressive patients, right? Supplementing spleen, we always want to be a little bit cautious for because it makes the body kind of heavy, right? And so depressive patients sometimes already there. So it's nice to get the mood established first and then do physical things. Yeah. We should just mention for people, right? Supplementing you diagnose large intestine excess.

Angelique: Do that. Yeah. Yep.

Toby: So that's dry on the inside, dry on the outside, and you supplement spleen, which is moistening on the inside, moistening on outside to help all that constipation going. That large intestine dryness, that's our number one idea for probably constipation, right? There's other ways we can address that, but that's our number one idea is like I said, float that boat. Yep.

Angelique: So that was that was pretty awesome. And this person I think constitutionally is a Sanjiao excess and I have supplemented liver and that has been helpful because I you know, you can't do it more than a channeled system more than twice in a row, right?

Toby: There's usually I recommend this is the wording I like to use, right? If you have a whole bunch of other ideas, try not to even repeat it twice. And then and then really try not to repeat it three times and then fourth time you really that's very unusual, right? Usually you're missing some other channel that you need to do if it if it if the case is not resolved. Sometimes it will resolve with one or two, say you need supplement liver twice. There's no other channels, it should be kind of resolved. If not, then you have to go to some other channels because otherwise you can't just keep hammering the same thing.

Angelique: Right. Won't work. Yeah, I've used the two the two time in a row rule. Like I'm tempted if the problem is still present, because this is a chronic issue for this patient. And so I feel like she could probably always enjoy this the spleen treatment. You know, I think that might always help, but at the same time, I don't think that's gonna help other things. What's really interesting, so the reason I bring this up is because there are signs that seem pretty even for both kidney excess and small intestine excess. At the same time. Like it's a very even mix. And there is a lot of blood stasis, like a lot, like very, very profound varicosities in the legs. But there's also a lot of that like inward self loathing of small intestine. And so it's like, how do you if they're so they feel even to me? I feel like I could treat them both. Like, is there a detriment? To supplementing small intestine to somebody who's feeling such self-loathing because of the blood stasis? Or is it is it detrimental to supplement kidney with such extensive blood stasis, even though they need self-loathing?

Toby: Yeah. I have an easy way out of that. I avoid that pairing. We should say for other people too, kidney excess has to do with self-love and small intestine excess. Small yeah, small intestine excess means the blood moves really well. So that's kind of the two things you're toggling between. I like to look at other channels, especially if it's so even like that. It's possible you can supplement small intestine and then come back and supplement kidney, but I'd be really careful with a suicidal patient. And supplementing small intestine. I you know, I would I would have to if I had no other ideas and it was so extreme, then I might do something like that. Especially a case like this, maybe if you do decide you have to do that toggle between those two, then I would supplement kidney first, just to make sure that goes up, you know, if it's really even supplementing kidney goes up a little bit, then you have room to supplement small intestine. Whereas if you supplement small intestine, it's going to be little bit above before you get that next treatment in. And especially with a suicidal patient, I'd be really cautious.

Angelique: Yeah, I haven't done it yet. I've done kidney. I've done kidney and it seems to it doesn't have a as profound of an effect as I would have thought, but I

Toby: It could be because it's so even like that. Yeah. A lot of times like the pericardium right one, you had gallbladder excess. So extreme all that anger, right? So supplement pericardium, and you get a big effect. The patient's notice was even like that, that a lot of times there's not a as big of an effect. And usually, especially if you can take care of those other channels, that small intestine kidney will also rise up together. So sometimes you're not you don't have to do them separate. A lot of times. And then also let's say they get better moods better and they're less suicidal, then you can go to small inten you know, then that opens up small something small intestine for you. Okay. Thank you. But that's tricky, right? That's tricky to mean is that kind of case when they both present like that. The safest go to go to the ten other channels and then otherwise you know, do one and then the other back to back treatments. In this tradition, we don't recommend treating those of the same treatment. It's just too much torque on the body. Mm-hmm.

Angelique: Yeah, she comes in once a week, sometimes every other, because she's been doing so much better. Now she comes in every other. And she is doing a lot of Western med interventions with like hormones, hermenopause, and she's seeing a endocrinologist. There's there's a lot going on that end. So I know that the results that she's having are not solely as a result of treatments that I'm doing and her response to those treatments. It's sort of like a it's a melding of them all, which is kind of nice. At the same time, it's sort of like, but how do you know like what's working and what's not working? Right. So that's hard to parse out.

Toby: Especially for the psalm system, we look at the face right away on the table. And then, you know, the next couple of hours right after the treatment, if it's significantly better, then that you know, that's probably the approximate cause for that. You're right. Yeah. I always like fantasize about having my patients just being in a bubble and only I get to do the interaction with them, right? But that's that's just not especi especially twenty five, right? There's so many different inputs. Mm-hmm. Media inputs, pharmacological just so many inputs to people. So right, you're never quite sure. But that's why it's nice. If you can evaluate the face right, you know, once you put the nose in and then at the end of twenty minutes, right, it can really tell you if we're on the right track or not. Mm-hmm. And then yeah, like I said, that those next few hours, the next day or two, right, that's probably you, especially if it's a big bump up, it seems to be at that time. So Yeah.

Angelique: Good to know. I also think it's important to know too that I'm like a sub level one practitioner. So for folks that might not be familiar, that there's tiers of education. Do you want to talk about that a little bit? Toby?

Toby: Yeah, I mean yeah, I think that's reasonable. I've I've been I've been working with the Saam system for a while. I still consider myself a student of the system, right? So but yeah, it gets it starts off with really basic concepts like how we've been talking right now, you and I. Yeah. Yeah. That we take the twelve channels, the qualities in each associated with each channel, and then we supplement that channel. That's the basic level. Then you can combine things, you can start breaking up the four point combinations.

Angelique: Supplementing one.

Toby: There's a whole bunch of really unusual things as you go further. But about sixty percent of I what I do, I actually did a little bit of like minor research at my clinic. I took a hundred patients, maybe two hundred patients, something like that, and looked back at what I did. And about sixty percent of what I do is four point combination unmodified. In that basic level, right, is really your foundation for the rest of your practice. So you're not missing much, right? And then sometimes it's just a little bit more nuanced or something like that to do other things later on. Okay. J that's where we want to try and stay. Is it's taking one channel at a time, a four point combination and then just unmodifying it. So that's in general that's what we try and do. But yeah, that there's there's ways to modify those four point combinations and combine them later on. We you can discuss them, but I think it's it's good. Usually I recommend about a year of really getting a feel for the channels themselves, four-point combinations unmodified, diagnosing correctly and watching response before you start doing other things. The problem with more complicated treatments is you lose your clinical clarity because with that four-point combination, you're just putting one idea into the patient's body and then you get to evaluate that. When you combine or you break up the combinations, it gets murkier and murkier. And so you're not quite sure what's going on with the patient. So in general, for clinical results and clinical clarity, it's great to stick with that four-point combinations. And personally I try and do that as much as I possibly can.

Angelique: Thanks for clarifying all of that and giving more context. Cause I think it's tempting. I know I was personally tempted to just blast straight through the different modules that are available. I was because I was like, I want to know it all right now, you know. So it's it's nice to know like it's okay to start slow and to take the very basic things and then take your time with it. So I'm in that first year of just supplementing and seeing what's happening. And it's fun. It's really fun. And it can be terrifying as you all may or may not have remembered from last episode. But mostly fun, you know, mostly intriguing and challenging. And it's easy to try to figure out. And I what I like most about the Saam system is that, you know, you it's kinda like you figure out what the pattern is and then you have your points right there. And you just have to decide, you know, like what side you're treating and do it. Like whereas with TCM, I know what I found really challenging, what I still find challenging. Is, you know, you have a brand new patient that comes into the room and I'm not brave enough to just go straight to Saam because I don't feel like I have as much of a grasp. I feel like I need to get to know a person for a little while, both because of their needle tolerance and because of, you know, just being so new. I kind of have to build up courage to be like, let's try this four needle technique. I know. And what's challenging about the TCM is that you have to like figure out the pattern and the prescription, like all right there. And I don't, I didn't memorize prescriptions like I had to for boards. You know, so I know like basic pair. I mean, everyone knows the four gates and you know, like lung seven LI four, like things like some host guest stuff. Like I've got some basic point pairs that I've memorized. It feels overwhelming sometimes to like have to figure it all out in one in like in the moment. So with Saam, it's you pay more attention, I feel like to the person and to the pattern and like what's happening, and then you have the points that are they're here's what they are already. So it kind of feels I don't know, it feels more integrated to me in some ways.

Toby: Yeah. I have the same experience. It's really hard to diagnose, but once you have, then yeah, everything just flows from that. So yeah, you that like a hundred percent of my clinical work is it's trying to diagnose, right? So that's nice. I'm not trying to think about point combinations or something like that. That's that just that just flows right out of your diagnosis. So that's that it is nice. It's it's a much cleaner way to do and diagnosis is so difficult. So it's really nice to be able to just completely focus on that. Yes.

Angelique: Yep. Very much.

Toby: I was gonna ask you one other thing today and then we'll wrap it up. Have you initiated a delivery yet for a pregnant woman?

Angelique: No.

Toby: Okay. I've recently done that. And it's so rewarding to do this kind of work because especially like pain and things like that, we can you we can say, maybe it's site there's some psychological aspect, but this is pure biology, right? And biology's stuck. And it's so rewarding to unhitch that kind of biology. So this was like

Angelique: What did you do? So what was it like?

Toby: Yeah, well it's it's great. And then this is the patient's, I believe, fourth pregnancy. These last two, there was some infertility issues and then and then some delivery issues. Approximately delivery number three, the patient was, you know, just past their due date and the doctor was talking about, we might have to do C section or induce or something like that. And so came to see me and I can't remember that point combination, but put a four point combination in. She went from my office to deliver. And so sometimes that happens, right? But this fourth one, right? This is just really recently, a week or two ago, right? And so she was going to be induced on Friday. And so she came to see me on Monday. Her presentation, she was typical pregnancy, right? Just crazy warm and crazy wet, like a little sweaty, and then had everything had really puffed up quite a bit for her. So that like we were talking about before this spleen excess, right? Everything super wet on the inside, wet on the outside. And then also that slight warmth, right? We didn't mention before a spleen itself has a slight warmth. And so she had that presentation. And then she's really symmetrical. And I really wanted large in larger families, so more of a kidney excess type of presentation. So when I saw her that first time, I told you don't usually do this, but this is what I did. I supplement large intestine and small intestine at the same time for her. Okay. So contraction started while she was on the table and continued that whole next night until the morning and then it everything stopped. So then I saw her again on Wednesday, right? This is our last shot at it. And so when she came in, she lost the mucus plug. Angelique, help me with that, right? That's the right process, right? You lose the mucus plug, but the water doesn't break yet, right?

Angelique: It can happen. Usually use the you lose the mucus plug first, but I think sometimes it can happen at the same time. I know personally I've had it ha I had it happen at the same time. Like it like or like in quick succession.

Toby: Okay. Yeah. So from all that contraction, she lost the mucus plug, but the water hadn't broken yet. And so then but then all of her heat was gone and then her skin instead of being really wet, it was dry again. So no extreme heat, dry skin now, and then still wet on the inside. So that I supplemented stomach for her and for the SOM system it's it's drying on the inside and moistening on the outside. So perfect for her pattern. And then also when we supplement stomach has a descending nature. Mm-hmm. So supplemented stomach for her, and then I didn't hear back from her, and then I got the picture of the baby, right? So No, she didn't have to be induced. Again, it was getting a little bit close there, but yeah, she didn't need to be induced. So, anyways, it again, that's really rewarding work because especially to avoid C-section, especially some mothers, right? They just really want to avoid C section inducing. This was her case. So it's really nice to again, the biological process is just a little bit hitched up.

Angelique: So she didn't have to be induced.

Toby: And it's so rewarding to unhitch that with just a couple of needles.

Angelique: That is very cool. Yeah.

Toby: Yeah. So anyways keep that in mind again as you think about the applying the solemn system, it seems to be especially well suited for this delayed birth.

Angelique: Nate. It's stored for later for sure.

Toby: Okay. Great. Yeah. All right. Anything else you want to discuss today?

Angelique: I mean we could code on a whole of the rabbit hole of things. I know I had discussed that one patient, because I'd written that down. I have I mean maybe we could do this next time, but I have general questions about just how you run a clinic, what you've learned specifically about that.

Toby: L let's do a couple now and then we'll save some more for next time. Let's do two or so. Do you have two good ones? Do you have two pressing do you have any pressing questions? Maybe we could do pressing ones.

Angelique: Yes. Pressing questions. Yeah. So in terms of workflow, so you see three patients. You can you have three rooms. So I'm just curious what like very basic things like scheduling wise. Like do you have patients come in every 20 minutes, every half an hour? How much time do you take between patients? I know you mentioned that you see maximum typically, unless you have special circumstances, 16 people a day. So I was just curious how you block your day out. Because I made some changes. For myself for the future, based on things that you've told me, which is exciting. But I'm curious what you do.

Toby: Yeah. I've seen up to six to eight patients an hour. That's insane. Yeah. That's from my other office. I told you I had five treatment rooms. So you could you could do something with that kind of room. Now I've got these beneficial constraints of only three treatment rooms. I think you could see patients every twenty minutes, but then you're stressed the whole day. Yeah. So I like to see patients every half hour. And then and that's that's sort of luxurious. And for me, like money wise, that's reasonable too, right? I charge ninety for a return visit. So Seeing two patients an hour, $180 an hour, that just works really well for me. And it's so much less stress. Like I was saying before that, you know, seeing so many patients an hour, like up to eight patients an hour, is just really stressful because but you're just buzzing and running all the time rather than you don't get to let down a little bit in between patients. So yeah. I like I like to see patients every half hour.

Angelique: And so do you just kind of like work down your treatment rooms? Like so you put patient one like at nine a.m. At nine thirty and ten and then you just kind of like start over. And is there somebody cleaning up your rooms behind you?

Toby: Yes, I have help. Okay. For ye for years I didn't have any help and I've got an amazing office manager. This is what we were discussing about before about diagnosis, how important that is and how much effort that is. So my office manager takes care of everything except for diagnosing and treating. And that just frees me up to do everything like that. So does

Angelique: Do you take out the needles or do you take out the needles? No.

Toby: I removed the noodles. Okay. So that's still part of the treatment. But this is still part of the treatment for me. Cause I've got to evaluate that face. Mm-hmm. And then also, I think you notice this too, right? The patient's in really unusual state after that acupuncture treatment. Yeah. And so this is especially potent a time to say something to them. You know, a dietary recommendation or a lifestyle recommendation or something like that, because they're in you know you've got that momentum of they're feeling so good. A lot of times at that moment I'll I'll I'll save a thing or two to tell in that state that seems to be more receptive for the patient after that. And then they a lot of times they'll they'll do things rather than when you're just discussing before the needles, they're less receptive to those kind of things. So I really like that. Evaluate the face and then send them off with something. So I like to do that. Yeah. So I think if I really wanted to press, I could see every twenty minutes. But again, then some patients really require something. And especially if you're working with patients long term or one of the main cohorts I treat is cancer patients, right? I have guidelines for myself. For cancer patients, I never rush them. And I always want to be as sincere as possible for them. This is these patients really sensitive, especially they're, you know, the time is really limited. So I just don't want to ever brush past them or something. I like to be really present for them. So by having three rooms and then I have some flexibility there, a half hour per patient, but if the patient requires more time, I just give it.

Angelique: Cool. I like that. That's helpful to know. And do you use my other pressing question about that? Is do you use what medical record system like how do you record keep

Toby: A paper I do and or write it in Chinese, my diagnosis and some notes in Chinese. So I again I think this is super valuable for us to keep thinking in Chinese medicine and then by writing a little bit in Chinese is really helpful. I did read some research about this that if you know a second language and you think or write in it, you're much more logical about it. Something about having that second language can you can do much more you can be more logical and more clear thinking about it. Whereas your native, your native tongue is a little bit more wishy washy. So anyways, one I've been doing that for many years. And then once I read that research, I'm like, that really is nice. Cause it you do you just stay in Chinese medicine mode for even writing things down. Anyways, it seems to be at least a little bit helpful. So yeah, paper. It's really old school.

Angelique: I use Jane.

Toby: Yeah, th I think that's what normal practitioners do.

Angelique: Think everybody there's lots of different kinds. I've got I can call them colleagues now with past classmates that yes they're using different systems. So there's a few different systems out there. I like I like Jane especially because I'm billing insurance. So it adds some ease to that process. So yeah those are my pressing practice questions.

Toby: Okay, any way you can make billing insurance easier, I think that's important. For me, I just do just cash only, so that's

Angelique: Yeah. Well it's interesting. What I had wanted to share with you is I know when we talked last time and you had talked about the ideal amount of days to treat patients, was three. And I had I had figured that would been like an ideal. And so I sat with that because I know that I had answered like, yeah, maybe someday in the future. And so I was like, Well, what's actually the barrier? And when I sat down and did like I did numbers and figured it out, there really isn't one. So starting in June, I'm gonna go three longer days per week and see how that goes. And it felt really good inside to like know that's coming. Like it almost felt like a relief. Not that working four days a week is a bad thing, but just knowing that I'll be able to have that break in between like a Monday, Wednesday, Friday schedule, knowing that I can bring myself fully to the fore on a Monday and then have Tuesday as a down day or have to do some administrative stuff or whatever. And then again on Wednesday and so on and Having more time and then having more predictability because the way that I have my schedule now, like my start times are different on the days that I work just to try to fit in the rest of the pieces of my life. And I won't have to do that. So it was really a gift to hear that you do that and to be able to sit there and be like, I could do that too. And I figured it out. So we'll see if the patients will fill all of the spots that are required. Because there'll be longer days, but I'm hopeful about it.

Toby: Yeah. And then especially as patients get to know you, then they start changing their schedule to vis fit yours, right? Because that you can really provide something that they really need. So then they start doing that. That's been my experience too. And then yeah, remember your days off, right? There's so much Chai's medicine to absorb to be able to help patients, right? But if you're just working all the time, just being a clinician all the time and not doing any scholarship or anything like that, then you don't my teacher, Dr. Wu, who did that three days a week, right? She said, I always have to do my homework. Mm-hmm. When I when I do my homework, then I'm ready to see the patients. But if I don't do my homework, everything goes a little bit wonky. So yeah, it's nice to let down and not see patients. But then yeah, some scholarships, some admin things, right? I mean, there's there's tons of there's tons of things to do rather than trying to jam it on the same as a day as a clinical day. It's much better to separate those. The energy is totally different for seeing patients, right? Bringing everything up to be super present for the patient and then doing your, you know, reading through old Chinese medicine books, doing your admin, it's totally different energy.

Angelique: Yeah. Or learning Chinese someday down the road.

Toby: Yeah. You know that there's a good app for that.

Angelique: Heard there was. I heard there was. Do you know the guy who made it?

Toby: Yes, that person has he did the best he could. Yes.

Angelique: Yeah, it's on my list. But that was that was a good, a good change. And then with insurance billing, there's certain rules you have to follow. So I know when we when I had first talked to you when I was opening my practice and kind of freaking out about like the logistics of things and you had mentioned accessibility is a big it's like a big deal for me, especially as a new patient where I live and the demographic area around me to try to make it as accessible as possible. And you give me really great advice, which was. Do a community style acupuncture like one or two or three days a week or something, like for an hour and you know, do that. And then with taking insurance, like they kind of own you, you know. And so if you're doing any sort of individual diagnostic and treatment of patients at a lower cost than what you're billing insurance, they can get you for fraud for like overbilling. So once I chose, it was like a kind of an either or. So once I chose to take insurance, I tied my hands to that. However, I think I found a way to do something similar because I don't know if you're having a Similar experience out there on the West Coast as I am on the East Coast, but people out here are stressed out, especially about the political climate, the socioeconomic climate. People are like are carrying around so much stress. I would say 70% of the people have that as one of their primary issues coming to acupuncture. So what I figured out I could do to make again an accessible thing on the end of each of one of those days, I think I figured out I could do it six times a month is to hold a group where I'm just doing a very set auricular treatment for people that's just for relaxation. So there's no individual diagnostics. There's no individual like treatment plans. It's like you self identify as having stress or needing nervous system support. Great. Come into this wonderful room. I'm going to get comfy chairs and just have like a max of 10 people and then just do like just a 10 point or a 10 needle five point auricular protocol for folks for just that purpose for like really low cost sliding scale like 25 to 45 bucks per session.

Toby: And that community that th they'll be all together is really nice.

Angelique: Be together. So I'm I'm working around. So there's ways around stuff for those new folks paying attention to this.

Toby: That's great. Anyways, any little new ideas that you have, yeah, let's let's always try and share So

Angelique: People. So I'll let you know how it goes with this. You can learn along with me. Let me learn for you.

Toby: Nice. Yes. Great. All right. Maybe l let's wrap it up for now. Okay. And yeah, if you if you again like w we always say, right? If you enjoyed this video, please like it. If you didn't enjoy this, Angelique and I will do much better next time. You know? Yes, let us know why. Okay. Everyone, take care.

Angelique: Yes, and let us know why. All right. Bye everyone.