Office Hours with Angelique and Toby, episode 6. Released July 23, 2025. 30 minutes.
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About this episode
Toby Daly and Angelique Britt start with listener questions: how changes in facial complexion give feedback after a Saam treatment, such as a pale face turning rosy after a heart treatment, using tongue photos before and after, and which needle sizes work at the jing-well points. Angelique describes treating her first patient with Bell's palsy, and Toby explains how working with sensitive patients made the qualities of the channels tangible for him.
Toby recommends choosing one clinical skill to focus on each week, from posture to observing the face to making three diagnoses per patient. They also discuss Chai Hu as an herb that opens the way for what follows, moxa at Bladder 67 for a breech presentation, the book Saplings: On the Path to Mastery in Herbal Medicine, and an ethical dilemma: a call about a suspected heart attack, and why emergency care comes first.
Topics
Facial complexion as feedback after Saam treatment
Tongue photos before and after
Needle sizes at the jing-well points
A first Bell's palsy case
Sensitive patients and channel qualities
A weekly clinical skill focus
Chai Hu, Mang Xiao, Da Huang, and the Shaoyang pivot
Moxa at Bladder 67 for breech presentation
Saplings, a book of early-career stories
When emergency care must come first
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.
Chai Hu (柴胡): bupleurum root, the chief herb of the Shaoyang formulas.
Bladder 67 (至陰, Zhi Yin): the jing-well point of the bladder channel, traditionally used with moxa for breech presentation.
A note for listeners: this is a conversation between licensed practitioners, offered for education, not as medical advice. Chest pain or other signs of a heart attack call for emergency care: in the US, call 911. Moxibustion for breech presentation should be done only in coordination with the patient's prenatal care provider. 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.
Welcome to Office Hours. Whether you're new to the acupuncture profession or have been at it for decades, this is the place where we discuss all things Chinese medicine and more. Join Toby Daly, a seasoned acupuncturist of the Saam tradition, and Angelique Britt, a nurse-turned acupuncturist who is brand new to the field as they explore topics in and around the world of acupuncture and Chinese medicine. There's something for everyone here. Drop in anytime.
Toby: Hey Angelique. How are you doing? Hi.
Angelique: Hey Toby, I'm doing pretty good. How are you out there in California?
Toby: Everything's going pretty well with me. What's the latest with our viewers?
Angelique: So we do have some questions. One of them actually was a comment plus a question, which I found very fascinating. It was regarding shifts in the face. So this is a person who has been self-treating and she mentioned that she did a lung treatment and that her face was fuller and puffier, but not in a bad way. She said it was actually like a good thing, and that lasted. For a couple of weeks. And she also said that when she did a kidney treatment, she said it was like putting two vertical lines through her eyes, realigning them and making the eyes bigger. And she said it was like an Instagram filter. And I was blown away because I did not realize that changes like that to the face were actually possible. And so she's wanting to know if you've had experiences like that, if I had experiences like that. I think I was in a box of limited perception. So I certainly have not had experiences like that, but certainly interested in your takes. And if certain channels, like what you've seen specifically for certain channels, what they have done to the face and that like micro structural change that she's describing.
Toby: Yeah, the face should change after every single Salam treatment, right? If you get all the points right, it's such a powerful shift on the body. It should make some change in the face, some discernible change in the face. I remember my teacher one time, we had a urinary bladder excess patient. He supplemented heart for her and he asked her to go look in the mirror because she had like apple blossom cheeks suddenly. She was all pale and then she had these apple blossom cheeks, looked like a young girl. So really, you know Big change from full pale to pink with apple blossom cheeks. So there should be something really discernible. And the qualities that we put in with the son system, those are reflected on the face. Like when you when you supplement heart, the face is going to become warmer, redder, pinker, right? Will really pink up, especially if it started pale. All the channels are like that, right? If the face is all dusky and bunched, when we supplement small intestine, it should be much more open. So much more movement in the body, things like
Angelique: That makes sense with regard to the complexion. I've seen shifts in complexion, but like changes to the eyes where it looks like they're more aligned. Like have you seen that happen?
Toby: I don't remember that specifically happening, but I could see how that could happen. The body, the face is basically fixed, but there's there's still a lot of room with all the micromusculature in the face and things like there's there's a lot of room for the body to change, right? And you can do it yourself, move your face all around. And so you can especially with the channels, by supplementing those qualities, it's gonna have some impact onto the areas of the paste that can move. Like yeah, nothing's gonna change with your skull, but all the r other features in the paste, especially eyes and things like that. There's lots of room for changes.
Angelique: There. Pretty amazing. I was really grateful that she had reached out with us because it was perspective opening for me. Yeah. It's amazing what boxes we place ourselves in when we don't realize they're there until they get blown open. And you're like, wow, there is a bigger world out there. Things are possible that one would never even think of were possible before. That was
Toby: That's a good way of saying about clinic, right? You start off with a small box, then you get a little bit bigger box, a little bit bigger box as you get more and more experience, right? It's like you get more and more space to take things in. I think that's that's absolutely true. I know there's another practitioner also that was taking pictures of tongues before and after treatment, and that they were noticing really significant changes with the tongue also before and after the treatment. So lots of different areas to look. This tradition went the main area we look at for our feedback about the treatment is the face. Very cool. Anything else on your mind?
Angelique: I think I've got another practical question. I've got another practical question here. Trying to find it. Curious what size needles you use on gin wells. This one.
Toby: What are you what are you using right now? Yeah.
Angelique: Have 40 by these and I've been using them for all of things. I haven't ordered the 40 by 40s yet, although a new acupuncture friend of mine has ordered a bunch and is gonna give me some to try. I couldn't find shorter 40 gauge ones and so I just have been using the big long ones which sometimes fall out. So I was curious for that reason to wait.
Toby: Yeah, my teacher used half inch needles, right? I think I think they're 0.60s or so. His needle's really thick. So he would use half inch needles because otherwise it's too heavy. And the needle handle is gigantic and that gauge needles. So he would have to use half inch for ging wells. I'm like you, I use point four by twenty five. And that seems to work fine. They don't seem to fall out. Yeah, but if you can get half inch, point four I think that's that's probably ideal. If you can find it. It's a little bit difficult to find that though. Yeah, I have
Angelique: Able to come across it yet. I haven't gotten to other countries, but just from our suppliers, I haven't seen anything larger than a I think a twenty five by fifteen was the largest one I saw.
Toby: Yeah, that there's there's a opportunity for someone there, right? Because there's quite a few psalm practitioners now. And then there's some other traditions they like to use sticker needles too. So there's opportunity. I have contacted the needle supply companies and they made lots of promises, but one sort of delivered one time, but usually they don't I think it's probably just they're just not sure there's the there's as much demand as there actually is.
Angelique: Okay. So what you're saying is that all of us that practice SOM should just flood LASA OMS or our favorite supplier with emails requesting for eighty by fifteens.
Toby: Maybe they haven't listened to just me, so maybe to other people. Maybe. But for me they there really a lot of people like promised stuff, but it never materialized. So yeah, try. Okay.
Angelique: You hear that folks? Get to your email.
Toby: That's right. Angelique has ordered her army of acupuncturists to take action. What else is in your mind, Angelique?
Angelique: The companies. So I have my first, actually, my I have two firsts. So my first patient that has Bell's palsy that I decided I have not ever treated Bell's palsy with acupuncture at all. So this was my first go around. And I said I'm gonna do some. So I got brave and did. And she remarkably, she's a very sensitive person. And when I supplemented, so it was it's on her left. No, I'm sorry, my left, her right. It's on her right side along the stomach channel. And it was along the triple warmer channel as well. She was having pain. She had the sensation that things were coming up and out of her ear. And then there was like rapidly changing different flickerings of pain in different places. So the first channel I supplemented was small intestine. And she's like, wow, I can really feel things moving everywhere. I didn't tell her anything either. I didn't, you know. Sometimes I'll I'll tell patients, especially if I sense some skepticism in them, like what I'm trying to do. But for her, I just did it. And so I thought that was neat. And then she came back and the pain in her ear was completely gone. So it disappeared on the table. So that was really cool. And the sensation changed quality. From more like a more of electric to more of just like a tingling. And then the subsequent week she came back. So then I said, if we can come twice a week, that would be great. So she came at the end of one week and then came back at the beginning of the following week and I supplemented stomach. And she immediately was like, Wow, things feel like they're drying out. And like I couldn't believe it, you know Actually, you know, this is what I did. No way. I mean, no, maybe no, no. She told this was like, this is her. So you got me down it now. Not nice. Yeah, she was definitely perceiving that. And then the following week she came in and she said that the she didn't have any more pain and she had some more movement. She was feeling like the corner of her mouth was starting to kind of come up some of the day. When she got tired, it was harder, but Especially in the morning, she was feeling some of a corner of her mouth being able to come up. And she was just the for her, she was so she was so emotional. She's has a loss situation going on in her life. And she was talking about just feeling hot and she was just like noticing everything. And she's a constitutional sound job excess. So I was like, I'm gonna supplement liver. And I did, and she was like, I think things feel so cool. And I was like, come on, like, are you serious? So Forever and ever am I gonna use song with her because she just feels it so much. So those are three treatments I've done and the most remarkable thing. Sure, there's been some nice clinical changes, but her ability to sense what I what the needles were doing was unbelievable. So that was very neat. Have you had patients with that experience? Yeah.
Toby: Work with a lot of monastics and they really they can feel the channels really clearly and the qualities. They always report back to me really interesting, like basically like your experience to really textbook kind of thing. So yeah, I think that's enjoyable when the patient when the patient you put it in and they ex you know tell you the qualities that their experience are the same. I gave a talk a couple of years ago and it was like In the talk, was what were like things I've learned from the Saam system. And one of them was that the five phase qualities and the six confirmation qualities, they're real and they're in the body. We have those qualities in the body. And before using the psalm system, I would say that's just not, you know, that's like theoretical or something like that. But now with enough experience, I feel like, yeah, these qualities really in their body, hot and cold, in and out. Up and down, all these kind of aspects of the body, they're they're they're present. It's interesting. Yeah. Really sensitive patients, they can give us that feedback of what they're experiencing exactly.
Angelique: Yeah, it was it was amazing.
Toby: Do you ever give yourself weekly skill focuses?
Angelique: Feel focuses. Is that what you said? And what do you mean?
Toby: I mean like I give myself every week something to specifically focus on for that whole week in clinic so I can really make sure I do that every time. Yeah. Do you ever do that? No.
Angelique: No, but that's a fantastic idea. I feel like I'm still very much in the survival mode of getting my clinic up and off the ground and sustainable. I can tell you what I have done, which is I've decided to take 20 minutes of every day to start reading foundational things again. So I have the first edition of the Gospel of Machiogia and I start from the beginning and I'm just kind of reading for 20 minutes each day, just going back over the basic things because. I want to make sure I've got it just to be like, let's remember. And it's been interesting doing that because my brain that has learned it already is now seeing it a little bit differently. So that's what I just this week have started doing, but I have not done what you have suggested, which is a very cool and good idea. And I will aspire in my future to do that.
Toby: But you are right. You are doing that. But I think it's nice to have like a theme for the week and something that you're gonna just do throughout that week and then something new deck next week. Because otherwise like your experiences, right? You just get kind of blown away in clinic. And it's nice to have something, at least one thing a week that you're really focused on. So I think, yeah, foundational study for a week. I think that I think that's really that'll be really valuable. And like you're seeing now before the theoretical student reading that same text. Has a totally different eye than the practitioner, right? When the practitioner looks at that again, you think, I've never seen that table in Machiapcha. I've never seen that in a patient. And but then the student thinks, I can't wait to get in clinic because I'm just going to be, I'm going to be presented over and over again with that table. So I think I think that's that's really valuable to do that. Go back and look at the foundations, the theoretical, and then and then see how much gap there is between actually what you do in clinic.
Angelique: Yep. And I will say that the first volume, like volume one, that's a nice one because it's like an inch thick, not four inches thick, and it's simpler. And I just think it's a nicer read than like the big third edition that they had us have in school recently. So highly recommend finding that one for review.
Toby: I was trained on that first edition, so that
Angelique: Can you give an example of what are the some of the themes?
Toby: Yeah. Like recently this week, I'm really trying to focus on my posture when I needle. I have a tendency to I'm six foot five. So I have a tendency to really hunch over for needling. And so I've really been focusing on my posture all week while I'm needling. And I feel like that helps. Again, there's so many different things you could be doing in clinic. It's nice to have that one focus and then you get a little bit better on that. And then I find that if I do that for a whole week. Focusing on something, then that momentum kind of carries into the other weeks when I switch to something else. But in the past, right, I've really had myself focus on like the face and like every patient just be laser focused on the face, almost ignore what they're saying and just focus on their face the whole time. That's really helpful. You know, that's been a helpful thing in the past. One of my assignments I used to give myself to was make sure every single patient had three diagnoses when they came. I think that's been one of the more helpful skill set that I made myself do for a week at a time. Made sure every single person that came in the clinic got three diagnoses. That's really played out well for me. Lots of different things I can't think of right now. But yeah, I think it's really valuable. Anything you really want to focus on, it's nice to make yourself do it for a whole week and then switch to something else the pull.
Angelique: I can tell you that I did the three channel thing from the beginning of starting to treat with some, especially at my own clinic, because you told me to. And it was really helpful because I had to go back to the book multiple, multiple times to read through and make sure. And it helped me to learn the system a little bit better. Not a little bit, a lot better, where I feel like I've got a lot more recall just naturally and not having to reference so much. On certain channels anyway. There are other ones that I haven't treated as much, but doing that, like picking your top three channels has been super helpful. I've definitely done it more than just once a week or for just one week at a time.
Toby: Okay, yeah. That the that's not a there's not a cutoff for that. But it's nice to give yourself that one laser focused assignment. And then of course, yeah, you do all your other things as well. But I think that's a really valuable one. Yeah, come up with three diagnoses for every patient because it just makes you work usually the first two usually easy, and then that third one oftentimes you have to work hard to get that one. All right. I think I told you I'm taking a three year herbal program with Volker Scheid. Did I tell you about that?
Angelique: I don't think so. Well maybe you did. Yes, you did. You did.
Toby: Yeah. Anyways.
Angelique: But I don't remember all the details.
Toby: Okay, yeah. He was talking about in the Sheng Ban Shao Jing that there's only three herbs that generate the new and push out the old. Do you know which three herbs do that?
Angelique: Generate the new and push out the old. I mean like generating flesh.
Toby: Yeah, it they don't specifically say what it is.
Angelique: I'm gonna say generate the new and push up. So I mean I could throw out some guesses, but nothing's common.
Toby: Does it does it help you at all? This one I didn't know at all. I feel like I've heard it before, but I didn't know any specific herbs for it. So the three herbs that do it, it sort of makes sense when I say these first two. It's Mong Xiao and Dahuang, right? To get rid of the old so that the new can come in. And then the unusual one, the one you spend a lot of time talking about, was Chai Hu. Okay. Chai Hu also does the same thing.
Angelique: Mm. Interesting. In what way? Interesting.
Toby: It's nice that to think about what chai hu does, right? Is it doesn't just move things, it also allows the things behind it to flourish, right? We got lots of things that move qi or move blood or something like that, but then to have to leave things so it can flourish behind it. He you know, he was really saying that chai hu is the our preeminent herb for that. So again, that's just a nice angle on chai hu. I hadn't thought about it.
Angelique: Yeah, that's really interesting. I was thinking about it in the context of what I've learned with studying the with Sharon Weizenbaum and the concept of the Xiaoyang block and the pivot and how Chai Hu is a very key herb in allowing the flow of the body's fire to pivot into the right position. So that makes sense with Chai Hu being something that unblocks but then allows whatever's behind it to flourish because the fire is then able to move into the position it's supposed to be in. So that is an interesting perspective that is pretty much the same, I think, just worded differently.
Toby: Yeah. I th I think it's a beautiful way to understand herbs from many different theoretical concepts so you can really understand it. Volker was talking about how in Chai Hu that's the reason it's in Bujong Yichi Tong. Remember Bujong Yichi Tong is one of its kind of odd indications is like low grade fever, right? And he was saying about that, right? That way it can push out the old so that the new so that fire can get in its proper place. I don't know. I've something about that really clicked in my mind. Theoretically to help with herbal medicine. So anyway that also I find really interesting.
Angelique: I just remembered that I didn't mention my second new thing. So I don't want to leave a loose end because we can't have that. It'll be a brief story just because it's exciting. And I haven't done Saam with this patient yet, but I have my first pregnant patient. And she's gonna be 33 weeks this Saturday and just breach baby. So I get to try the Moxa at stomach at bladder sixty seven, which you know you read about, but I hadn't gotten to try it yet. We talked about using the Moxapole and I gave her a Moxapole to take home. I'll see her again Friday and like show her how to do it. But That's like in the window. I think it's like thirty three to thirty five weeks is when you're supposed to be able to help the baby turn. Great. So I thought that was neat. Is there a psalm approach to a breach baby?
Toby: We do, right? In general, if it fits, we like to use s small intestine for that to get that dynamic movement in the lower part of the body. I have some I don't think I've done that personally, but I have some students that have done that successfully. So that's that's a reasonable thing to do. Again, if you don't find kidney excess, you can't use that strategy. You have to use something else. But it's it's not like it's indicated for every breech baby. You have to have some kidney excess as well there. So you can consider I remember reading I think if I remember right, there's pretty good research on, you know, U B sixty seven and Moxa and flipping breach babies. I'm pretty sure like they did that on ultrasound and watched that flip. Have you seen anything like that?
Angelique: Mm-hmm. Have I seen anything like that? Yeah. I looked up some research studies before just to see, like, is this actually a thing? I did this in school and then I reviewed them briefly again this week when she was there. And I was like, I'm so excited to try this. I'm so excited just to see.
Toby: It's really pretty amazing, right? To take, you know, a few cents of material, right, and then ignite it by a toe and then have it such a big physiological change. I really we're so lucky to be able to practice this medicine. All right. More anything else more you want to say about your case?
Angelique: I don't think so about my cases, but I did find a really interesting book that I think other new practitioners might enjoy. I was given some books, and this one, it's called Saplings. It's called it's On the Path to Mastery in Herbal Medicine. And it's edited by Carl Stimson. And for those who are watching, it looks like this. You can see it. And essentially it is a collection of stories of the first months to years of practice. In the words of those that went through it. So basically all of our predecessors and what it was like. And there's a wide variety of experiences. I'm about halfway through, from really being super successful in the beginning to having a whole lot doubt to talks about all the feels that we have as new practitioners. And so I've found it a balm for my soul to read it and be like, I'm not alone, you know. So if anybody out there's interested in reading a good kind of short book, it's not super thick, I recommend.
Toby: That's fantastic. I love that title to saplings. That I really feel that I that's that's a great as you as you're first starting to reach towards the light there, yeah, that's a lot of a lot of feels going on then. Yes. Okay. So I'm gonna be presenting soon like a ethical cases class. And so one of the cases I'm gonna be presenting there, do you mind if I run it by you and get your take? I'll go. Okay. So this is a couple months ago. I have a ninety four year old patient I see really regularly, once a month or so. I've been seeing her for a really long time. She's got some cardiac things, but basically she's in pretty good shape. Everything's going pretty well. That once a month just kind of tune up to keep her in good shape. You know, she's doing amazing for a 94-year-old. Anyways, her I get a phone call from her on a Sunday. Usually I don't have the phone, but my assistant didn't have the phone at that time, so I had the phone and I got the f I got the voicemail from her and the voicemail she's distraught and she's saying my son, who's her son's like in his seventies, is having a heart attack. He won't go to the hospital and he'll only see you, meaning me. And so I got that voicemail and so and Also, what's going on? I want to put you in my shoes and I wanna get your feedback for this, but I'm like an hour and a half away from my office. So when I get this call. So what about your first thoughts? How do you navigate something like that? And I'll I'll tell you how I went through it.
Angelique: First of all, wow, that's a whole lot of pressure. As you know, I'm a nurse. Wow. So you by chance had the phone. So if you I'm curious about some other contextual things. So would your have a s your assistant have otherwise had the phone?
Toby: Yes, but she would just refer to
Angelique: Like would she have gotten this phone call?
Toby: Yeah. She but she's trained really well. She would just refer to Okay. You have to go to the hospital.
Angelique: So okay. So you get this call and you have an emotional attachment to this patient. She's tuning her a long time. Goodness, that is and you're an hour and a half away and it's a Sunday and he's having a heart attack. I would be so worried that he would die. I would call and try to convince this person to go to the hospital. I mean, time is of the essence of a heart attack.
Toby: That's exactly what I do.
Angelique: That would be that would be my first thing.
Toby: That's exactly what I did. Okay. And the patient they continue to refuse. They will not go to the hospital. They will not call 911. It's your step two.
Angelique: And what did they say? Why? Did they tell you why?
Toby: I know they just had a whole bunch of horrible experiences in the hospital and so now they're they're distrusting about entire hospital systems. I disagree with this, but that's that's where that patient's at. So you made a really compelling argument that you're not equipped and well suited to treating something like that, and you're an hour and a half away. You've made that argument. The patient re refuses that argument and will o will only see you. What's your what's your response to that?
Angelique: So I would probably in that circumstance, I would probably God, I feel I like feel it in my heart right now. I would feel so bad, but I don't think I would treat them. I mean you're an hour and a half away. Who knows if they would even live that long? My God. There's part of me that almost wants to call nine one for them, but I wouldn't do that because I think that people have the right to make bad decisions. Yeah. I don't know. I think it's a I don't think I could I don't think I would have done it. I mean, there would have had to be some other compelling reason. Cause what I mean, liability wise too, like if you go and you try and do it, but then on the other hand, if you actually could have helped, that's super tough. There's also the boundary issue, like the boundary situation. So I know having done nursing and home care for a really long time, that there comes a point where you kind of have to you have to draw a line. Just in order to preserve your own self and to get calls like that on off hours and then respond to them, I feel like tough one, tough one. I think my verdict would be I probably wouldn't do it and I would have been so apologetic and explained that I was an hour and a half away and that acupuncture is probably not the approach. And I know that there's been great results with your mom. And I really, I really, really I want you to go to the hospital and you know, maybe I can go and see you there. Yeah. Goodness. So what did you do?
Toby: It doesn't have a great unfortunately I wish that this was a great case study, everything goes amazing. It this is a real life one. So what happened is I said, Okay, I'll be in my office an hour and a half. I just wasn't sure what else to do. I think now that you've explained it, right, and I think maybe if I had more time to think about it, I would maybe might have refused. But still my in general I just want to help. And so I think that probably, you know he just will not go for anywhere else. So en route, by the time I got there, he died.
Angelique: See?
Toby: Yeah. He just we just refused. He wouldn't go.
Angelique: It's like that's too bad.
Toby: The other thing too is I didn't Yeah, I didn't know exactly where he was. Somebody I presented this case also at White Pine Circle. I did I did ethics class for them and it presented this case and somebody said that, you can have a nine one reverse the whatever the telephone numbers that they called you from, which I didn't realize, you know, now I understand that. But so I didn't I couldn't it couldn't even force you know, an ambulance on him, even if I wanted to. But Now I understand that you can do that with NIMO.
Angelique: That's good to know. I didn't know you could do that with 911. But yeah, that's that's rough. I have a mixed I have a mixed response because part of me, like I feel deeply when people call for that and you know that you might be able to help, but at the same time they're making a decision that you also know medically it's just like, God, you're gonna, you know, you could totally die. And also putting that on you to do, like I will only see you. It was you're the only one. Right. Man, that's dangerous sometimes, I think, because when you're when you're When you're pedestalized like that, is that how you say it? Pedestalized, pedestalized, pedestalized. Anyway, when you're put on a pedestal by people, the higher the pedestal, the farther you can fall. And like, God forbid, you went and you tried and then he died. And they were like, You killed him, you know? Geez. Right. That's a it's it's slippery.
Toby: Yeah. So anyways, th that's unfortunately it was a difficult situation to navigate, but I think it's interesting for the ethics case study class. I think that's interesting. It really evocative because it was such a high pressure situation. Yeah, I think again with perfect knowledge and then that feedback from before, I think I would have forced nine one on that patient, which I didn't know I could do before.
Angelique: Do. So if it ever happens again. Yes. You know, maybe that's part of it, that whole learning thing. Yes. When are you doing the ethics class? 'Cause I know there's a bunch of us that need that for our N C A O certification.
Toby: I had a date. I know Seattle invited me to do ethics class. Or sorry, not Seatt it'd be in Seattle, but it's the Washington State Acupuncture Association. They invited me to do ethics class, but the date that was fixed and now it's not fixed. So I don't have anything right now. A date for that. But that class is coming. Yes, of that ethics class.
Angelique: Yours specifically. So from an ethical point of view, if one of us were to get a call like that tomorrow, what do you advise?
Toby: Is I think we're not really well equipped for emergency cases like that. Let's say we're in a remote area and we're the only responder there. I think that's that's all you got, then you've got to do what you gotta do. But I think especially for modern ED, it's the best place in the world to be with a heart attack, right? So why you would take somebody out of being the best place in the world for their current situation, I can't ethically advocate for that. This was such a unique situation that the patient would not go to the what I felt like was the best possible survival place for them. And so I was a way down the list, you know, second option for them. But they wanted to elevate me to the first option. So I agreed to do that, even though I thought that was not a good idea. Again, in the future I would just it say the exact same situation again. Then I would just force nine one and get them to where I thought was the best thing. Again, you can argue about this later, but now we don't get to argue with the patient. The patient's passed away. So I feel like Number one thing is survive and then you can you can talk about other things after that. And the best place to survive with a heart attack is modern ED.
Angelique: For sure. Strokes, heart attacks, anything related, go to the emergency room.
Toby: Yeah. Again, we can do all kinds of Chinese medicine later. They've got a trained team for that. Unless, you know, I think especially like in China, there's a lot of people with more experience with that, with acute things. But if you don't have personal experience with that, you know, a couple of decades of personal experience with that acute situation, then I think it's much better to give to people that do, which is modern EV. For sure. All right. So I thought it w I always thought it was a little bit weird that I spend a little bit of time trying to convince people to go to medical doctors. I didn't think that was going to be my role at all. Right. I thought I was always going to be, you know, working with people that weren't that interested in Chinese medicine, but it seems like more and more, especially as people have worse and worse experiences in the hospital, right? Then it gets harder and harder to convince them to, you know, get care that's really best served there. All right, Angelique. Let's let's leave it here. I've got a few other things, but maybe let's discuss it next time. Right. Everyone, thanks so much for hanging out with us. And we'll see everybody next time. Take care, okay?
Angelique: See you next time. Bye.
