Office Hours with Angelique and Toby, episode 9. Released September 2, 2025. 40 minutes.
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About this episode
Toby Daly and Angelique Britt start with listener questions about practical decisions in Saam acupuncture: why kidney supplementation is approached cautiously in pain, how to think through close calls such as mixed damp and dry signs, why Toby rarely supplements the kidney or gallbladder at a first visit, and how heavy movement in pericardium excess differs from the heaviness of spleen excess.
They share clinic-tested ways patients cope with strong needle sensations, what self-treatment can and cannot teach, and Angelique's experience treating a pregnant patient with the midwife's approval. The episode ends with the learning curve of a new clinic, workflows for raw herbs, and the pros and cons of tinctures compared with powders and capsules.
Topics
When to supplement the kidney in pain
Close calls: mixed damp and dry signs
Kidney and gallbladder at a first visit
Pericardium excess versus spleen excess
Helping patients cope with strong needle sensations
What self-treatment teaches
Treating a pregnant patient, with midwife approval
Raw herb workflows and making tinctures
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.
A note for listeners: this is a conversation between licensed practitioners, offered for education, not as medical advice. Acupuncture and herbs during pregnancy call for a trained practitioner working 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. Hi, Toby. It's good to see you again.
Toby: Hey, nice to see you, Angelique. How are you doing?
Angelique: Doing quite well. Thank you. Good. Can we start out with some questions from listener? Okay. So this person says they recalled learning from you that you should avoid a kidney supplementation in cases with pain, as we don't want to consolidate the pain deeper into the body. Although this makes sense. Is this always true? And might there be exceptions? And they list some examples, such as significantly severe SI channel or L2 pain. And asymmetric patients or for those who may also be lacking in self-love without any varicosities. So is it true that we should always avoid kidney supplementations in cases of severe pain? And what's the best way to navigate that if it looks like we have an SI excess person that has pain?
Toby: Yeah, this is a great question. Yeah, just first of all, like kind of like a meta answer for that. For the Saam system, nothing's ever certain, right? So I can't give any ironclad anything because there's always again the variability of what's going on with the patient and then trying to apply that system to it. But in general, I would say for patients with pain, you try not to consolidate. I would say that in general, but hundreds of times I've supplemented kidney. Help people with pain. So in general, right, if all things equal and you have pain along the kidney channel or the small intestine channel, the likelihood is you're gonna probably gonna go to supplement small intestine to deal with the pain on both of those channels. But like this person's saying, let's say this patient is 95 years old, like they said, asymmetrical. What was the other?
Angelique: It was asymmetrical our patients are for those who may also be lacking in self love and they don't have any varicosities. What about them?
Toby: Yeah. So per I mean, again, that's a strong consideration for supplementing kidney. Especially a case like this. Let's say, let's say I have that situation where I probably am gonna need to supplement kidney to deal with pain. If there's some other channel, I like to start off with that and then maybe not have to come up and make that decision. If there's something else really close nearby or another really compelling channel that needs to be supplemented. In general, I try anything that's a little bit difficult for me to decide, I try and put off to later. A lot of times later never comes because your really clear channels, the ones you there really there's no reason not to do them. A lot of times if we take those and then the other channels we don't have to go back and deal. So I like to procrastinate on anything that's not clear and then come back around later and do with it. And then a huge proportion of the times I don't even have to do that. I don't have to come back and deal with anything. So Yeah. So in the like to say it with less words than I just did, in general, try and for pain, try your preference is to supplement small intestine to get dynamic movement for pain and not consolidate. But sometimes you're you're backed into a corner and you're gonna need to consolidate you're gonna need to supplement kidney and that still will relieve pain. But it's it's much less likely.
Angelique: It's interesting because I had that patient that I talked about in our last episode that had the small intestine channel pain in the elbow and I supplemented small intestine. It was like the elbow and shoulder and it got worse and I had to supplement kidney to relieve it. So it's a I guess it's like it depends, right? That's always the answer in Chinese medicine and any sort of thing is it depends.
Toby: And but it's so frustrating, but it's true, right? Again, if it was phil philosophy, we were just talking about we could just make maxims and things like that, but we can't, right? We it's clinics, so we have to be s hyper flexible. I forgot about that case. Any anything that would have indicated for you to supplement kidney for that case, where you accidentally supplement small intestine when you shouldn't have. Was there signs? I forgot.
Angelique: Yeah, there was sh she was kind of even. If I were to have employed the strategy that you had suggested, I probably shouldn't have done either because they were so close. So she had mixed. So the face was not super asymmetrical, but not super symmetrical. She had no varicosities, she had smooth medial heels and she had pain that was on she had some large intestine channel pain, but mainly small intestine channel pain that was worse at her elbow, like SI eight. And then was up at like the SI 1415 areas where the majority of the pain was. One could have made a case that there was some gallbladder channel pain as well. So yeah, and she also like there were there are others when I reflect backwards, like she's a very hard excess person too. So there are other channels that I could have chosen. And ultimately the kidney channel was helpful to her. And I treated her again, and I can't remember what I treated her with this time, honestly. But for the same for the same problem. And I did I choose, I can't remember. I'd have to look back at her chart. But yes, that was those are the those are little outliers. They're kind of even in terms of a case for kidney or small intestine. So it's a good strategy that you suggest is if it's too close. Where I get messed up personally when it's close like that is when there's the damp and dry mix that's really close. Yes. And so what to do in that situation? Because I really love the damp, dry discrepancies. That's that's like a big yes, like if it's a clear. Dry on the inside. We're like awesome. Cause then you have two choices automatically. You're like, this is great. But when you have somebody, for example, like I have a patient that I've been treating with Saam for a while. And this person has a very dry mouth, very drippy nose. And their bowels vary. So they're sort of an even damp dry. Or is the nose on the outside? Is the mouth on the outside? Is it on the inside? And at what point, you know? Exactly. But there's so many even things that I would love it's hard for me to choose.
Toby: But go try to go to something else. If not, then you just have to choose.
Angelique: Then just have to. And I have. I have. And not without detriment. You know, it's usually been positive. All right. There's another question. This is a rumor. This person had heard from a group. We're not gonna name the group, although the group has been named, but that one should never supplement kidney at a first visit.
Toby: Yeah, but again, that comes back to our rule. It's possible I might have said that at some point, but that I said that erroneously, right? I wait I don't think we should we should say ever a hundred percent certain we should do anything. Okay. But in general, I think it's not to supplement kid it's not wise to supplement kidney on the first visit. Do you have a sense why? And otherwise I'll tell you why I don't recommend that.
Angelique: Could it since it's a consolidating treatment if someone comes in with an issue, would it be sort of like pushing it deeper into the body?
Toby: Potentially, right? Okay. And especially when you I first meet a patient, I don't feel like I have a good beat on them. So I don't want to start locking things in until I know them well. So yeah, again, like we were saying before about supplement kidney for pain. Many times I've done that, but many times I must have started with I can't think of anything recently, but starting with the supplement kidney. But in general I try not to do that. Yeah. So I'm really hesitant to supplement gallbladder too, even long standing patients. I just feel like that's such a squirrely channel. So
Angelique: It is.
Toby: But I'll I'll do that, right? I'll I did recently start with a brand new patient by supplementing gallbladder. So I will do that, but in general, I try not. I would try not to supplement kidney right away and gallbladder until I get a real feel for the patient, unless their case demands it, right? Mm-hmm.
Angelique: So what was it about that case that demanded a gallbladder supplementation?
Toby: Patient was really sick. This is a status post vaccine reaction. Again, I spend a lot of time really trying to deny this, but this is the this seems to be the proximate cause for this. Had vaccine and then developed ALS. And there is some in the literature pointing to that as a possible link too. So Anyways, we need to get started right away. This patient's far out of town and was presenting extreme pericardium excess. And so I started out right out the gate with by supplementing gallbladder.
Angelique: What were some of the pericardium excess signs that you were seeing?
Toby: That really heavy feeling everything had was really going inward for the patient. They're they're they present intellectual and so physically down and heavy careful steps and then just really intellectualizing everything. So we really need to get gallbladder up to spring that out.
Angelique: So you perceive so heaviness I had thought was more of a dampness like spleen excess quality.
Toby: Th the this heavy, careful steps, like you see with ALS or Parkinson's also. I see that. Yes. That is a pericardium XS. Gallbladder is like light and ready to fight. Sure.
Angelique: So in the heaviness category, if someone feels heavy, that's more spleen or if someone is moving as if they are heavy, is that more pericardium? Is that where there's a distinction? Yeah.
Toby: Yes. I mean, usually damp has some physical component and go and pericardium could like this patient was really lean, but just really careful steps, careful, heavy steps. Okay. That's more pericardium, especially with being lean. And then also we could see that with like spleen excess, they might also take, you know, less ev the body's so heavy they'll take less steps, be a little bit more lazy about, you know, activity and things like that. But then we'll see the physical component, the actual dampness in the body.
Angelique: It. Thank you. That's helpful. Yeah. Speaking of pericardium, I had two different folks report that when they supplemented pericardium, either on themselves or a patient, there was a sensation of bubbles.
Toby: Great. Okay, good.
Angelique: Isn't that interesting? Yes. You had told me that has that happened sometimes. So it was interesting to hear that unsolicited from people. And I have had that actually personally happen to myself when I've supplemented pericardium where I felt like there's a weird, like a tingling. It didn't feel like bubbles necessarily, but it was like a tingling. Maybe it could have been bubbles, like an effervescence, I guess.
Toby: It really does feel like bubbles. From my experience, right? And yeah, again, unsolicited, that's really valuable, right? Because we have this theoretical idea that this pericardium's oxygenating everything. And then when the patients can actually feel those bubbles inside them, right? I think it's it's interesting, right? Mm-hmm. What about are you are you doing much self treatment?
Angelique: More, not with as much regularity as I want to. My goal is to do it at least once a week, but I've been doing it more. And I find that I tend to have similar excesses on a continual basis. And so I'm always wondering, like, should I still like for example, I have to supplement my pericardium kind of a lot. Or my liver or my large intestine, like those are like my top three that I have that I tend to rotate through. On a more regular basis. Is that a common and okay thing?
Toby: Patients I see on long term, I tend to find three excesses or three deficiencies I need to supplement. There tends to be about three. Usually for the intro class, I have students come up with three channels to come up with for each patient. Cause it seems like that seems to be about right. Again, that's there's no fixed rule on that, right? Sometimes this is one or two, and sometimes it's eight, but it seems like almost everyone has three things, three constitutional things that they could just work on. Your lifetime. So that's probably right. Jeffrey Wen had a nice recommendation for this for self-treatment. If possible, treat yourself. If you if you get into any trouble and can't figure it out, then go to other people. But I think that's a good one two step framework, right? You'll learn tons by treating yourself, but you're not gonna have a very clear perspective on it. It's so much easier if one to Patient we've never met before comes in and presents in front of us. But are our we're we're just got pure diagnostic window on them. And we can just use all of our perceptions, all of our training on that. Whereas we go to turn that back on ourselves, it's always going to be a little bit distorted. So we should try. And then especially if you're successful, it's great. Then you'll learn a lot. Even if you're unsuccessful treating yourself, you'll learn a lot too.
Angelique: Yeah, that's that's true.
Toby: Clinically and about yourself. Yeah.
Angelique: Yes, I can I can concur. So it's okay to do that. So I because I've I've seen that there's been some patients that I've seen fairly long term. I mean as long term as I have been treating with Saam, right? So six, seven, eight months in my own clinic now. And there I see patterns because I have a little system in my in my medical record where you can make a note and I star it so it kind of comes up all the time and I just will list the channel treatments that I've done over time. So I've got like an at-a glance. And I've I see like a rolling sort of pattern with some people where it's just like, you know, a couple different channels, small intestine, a couple different channels, small intestine. Like stomach and lung, I find that those come up quite a bit. And sometimes one week I'll treat a stomach and then the other one I'll supplement lung.
Toby: That's unmute for the same patient? Yeah. That's unusual, but you're sure that can happen.
Angelique: That's happened a couple of times. So I wondered if I did something if I could have chosen a different channel. Like I'm wondering if I tipped the balance in one direction and required supplementation with its counterbalanced part. That's what I was wondering.
Toby: But I mean always watch, especially for that first time you supplement lung, make sure something good happens. Sometimes it happens like that where you just in order to get something good going, you have to supplement lung and then come back and supplement stomach. Mm-hmm. But that's that's unusual.
Angelique: I was treating a pregnant patient with Som, and I may I got permission from their midwife to help because they're they're not quite at term, but they might have an induction ahead of time and to support the natural onset of labor with acupuncture. And this patient I was treating with TCM acupuncture up until I don't know, maybe five weeks ago. And I was like, there just there didn't seem to be much movement in her way feeling like she felt better, but it was sort of not quantifiable. And I started treating her with Saam. And just the way she was existing is different. Like the way she walks into the clinic is different. The way that she talks about her week is it's just there's just like it's it's an up there's like an uptick in her way of being. And I did supplement lung on her last week and she talked about how much energy she had. And I was like, is that real? Does that really happen? It was wild. So yeah, it's very cool when you can get it right. Yeah.
Toby: I feel like that's one of the more rewarding things we do to help induce just natural labor. I think it's really rewarding work. Yeah, but Saam seems to be pretty effective in that.
Angelique: Yeah, I might get to do it. And you just find the imbalance in the moment. Yeah.
Toby: Yes. I again this is from Dr. Wu, how I try and apply that, right? Remember babies like upward, warm in blood. So especially then I consider downward, cool or dynamic movement.
Angelique: So like bladder or small intestine?
Toby: Yeah. Okay. Or stomach or large intestine, depending on how it's presenting. Okay. But it's rewarding, right, when they come to your clinic and then go directly to the hospital to deliver. Okay, no, but I'm saying that's really rewarding.
Angelique: I don't I'll tell you if it happened. Yeah, that I can imagine. Yeah, if that's gonna work out, that'd be great.
Toby: Especially I have a lot of patients that really don't want C section right or you know, like their intellectual understanding of what's going on or just they just don't want intervention, but like that kind of a hard you know, what more natural things. And so it's really nice to be able to do that. Yeah. Usually the body's just like a little hitched up. I mean it's designed to do this, right? So that's why just a couple of needles sometimes can be so powerful.
Angelique: Yeah. But I did the I did the safe thing and covered myself and got permission from the midwives.
Toby: Okay. That's it.
Angelique: 'Cause they're not full term quite yet. That's how it's basically given the general okay. Like basically what they told me was that like basically anything after thirty eight weeks, they're they're cool with acupunctures being an intervention for supporting the natural labor process.
Toby: Great. Yeah. I like having a little bit more time like you have too. That's nice. Yeah, usually it's like they're gonna induce in two days when I see them. So I'm like, okay, we really gotta get going. Yeah. So I just have a little more time to just kind of prep the body. Yeah.
Angelique: It's interesting experience. So what is on your agenda?
Toby: I was gonna ask you another question if it's okay. Sure. You were saying before that you have a patient that does like numbing agent on the points. What about do you have any other what do your patients do for like coping mechanism to deal with some of these Saam points?
Angelique: They make sounds. They'll hold their breath and I'll try to tell them not to do that. But they'll have to remind them to breathe. Yeah, that's those are the top two. Is it there'll be some kind of like exclamation of like or something along those lines. Sometimes an expletive or two might escape and then just like I'll feel they'll tighten or they'll hold their breath and I have to it's okay, it's relaxed. It's just a moment, it's a moment, you know, big sensation, big reward. That's like my go to line these days, you know. That's great. Yeah.
Toby: It's true. So it's it's nice to reassure patients with true things. So that's really nice to be able to say that. Yeah. I read a study about that. Every culture has taboo words. And everyone says those taboo words help alleviate pain. And actually it works. You know, they used to study with like shock therapy where they would check, yeah, when they give a shock and then they allow people to swear, allow people not to swear. And actually the people that swore they thought the shock was less. The people that did without. So it's it's for I'm not sure exactly the neurology on that, but by setting a taboo word really helps relieve the pain. So I always encourage patients to say it. I say I don't mind a little bit of sailor when I put these points in. And yeah I have patients also do all kinds of crazy things. Like I have a patient that really shakes her head it seems to really help her. Again, body has a hard time paying full attention to two things at once. So by shaking her head by shaking her head then that the points have less pain for them.
Angelique: Interesting. I have a patient I don't treat this person with saw, but I actually use serins for this person. But when I needle them, they rub their face. Yeah.
Toby: I think it's okay, right? It's it's so important for us to get the points in. So any coping mechanisms the patients come with, I think it's okay.
Angelique: That's good. I'm going to coach him to swear now. Thank you for that.
Toby: I have one patient that has to yell. And so I actually have her yell into a rolled up towel, just so it doesn't disturb the other patients in the clinic. But she has to yell like it's actually much better now, but it started off by like almost movie scream yell, you know. Yeah. So loud. So anyways, into a towel now. That's that's my method for that right now.
Angelique: How do you not startle? I find that I sometimes still will flinch when people scream if I'm not expecting it. Like to the point where it's like, I'll go and I'll start the insertion, they'll scream and I'll reflexively pull it back and I'm like, shit, you know? I'm like, you okay? I'm okay. We're okay. Okay.
Toby: I think that's just n I think that's natural. Okay. I think I just I've endured that so many times I just continue through. And then I think I think now my instinct is to finish that w whatever technique I'm doing there to so we can stop that, right? Rather than trying to pull back, right? I go forward to make sure that's we get the most out of that screen. Yeah.
Angelique: I even as a nurse with injections, that's part of the reason I didn't like to do injections because if someone flinched or if they made a sound, I would reflect it was a reflex. I would reflexively draw it back. So I yeah. I've got to work on that a lot.
Toby: I think it's natural. And then also it's nice to know who's gonna be doing the more loud noises. You know, it's always our male patients, right? So it's nice to know that in general the male patients are gonna there's gonna be some emoting for sure. Fuel invasion is so stoic, right? Usually just nothing.
Angelique: Be some inbooding. Yeah, there are those, yes, those patients I worry about sometimes. But I'm also grateful for my own nervous system because it's like you're not going to make any sounds. This is great. So I can do what I need to do and not have to worry about the armor I have to put on myself to treat you.
Toby: Yeah. L a lot of female patients they talk about how, you know, they had three or four kids. So they're they're just like this there's nothing. So I think everything's relative in this world. Sometimes men, I don't know, just haven't had, you know, voluntary, you know, you're you're there, it's it's you're gonna have pain. You're you're volunteering to have that pain. I think something psychological about that, men just have a hard time with. Even though I mean I mean empirically, right? It's not that painful. Considering like all the realm of pain you could have in your body.
Angelique: No, but I c but bladder sixty-six hurts. That hurts. I don't like doing that one on myself. And I feel like I've got a pretty solid capacity for pain. And that one I it's like, I know it's happening. It's like okay, I have to like grip my teeth to do it and I do it. But I will say that your tip, which is really helpful, was to angle it toward the bone. So I have a person that frequently requires this in their channel pairing. And was able to give me feedback. She's like, wow, it didn't hurt as much. It was like great because I angled it. And then I kind of like pecked the bone actually, just like duplic got it right in that area. And it was fine. That the right thing to do, like kind of like peck the bone a little bit.
Toby: I try not to hit the bone, but I come really close.
Angelique: Okay, it definitely hit the bottom. So
Toby: Yeah. I mean I can y you've you've got a lifetime of refinement ahead of you. So I think in general for Chinese medicine the advice is not to hit bone. So but there's not much space there. So I get really close, but I do try not to hit the bone.
Angelique: Yeah, there's not a lot of flesh there. I'll I'll do my best to not hit the ball.
Toby: I think that's that's why it's so painful, right? There's there's just not much room there. Yeah.
Angelique: Yeah. And like even like liver one's not even that bad. I've got one person who really hates liver one. They love it, but they also hate it because they feel the relief from the needle there, but they also just hate the sensation of it being needled and will often swear when that one goes in, which is I guess appropriate, right? Or needling the jingle of the liver channel swearing. Makes sense. Yeah.
Toby: I think we talked about that too, also on the net from Jeffrey Wayne to really pump the I L'S right.
Angelique: I do and I put my fingernail in them. To try to prep them. Like I'll rub them and then I'll put my fingernail in them and then I'll put the needle in. And, you know, I think it's still just gonna hurt. Like some of them are just gonna hurt. Yeah. And I get the feedback often, like I can feel it throbbing. Like, yep, you're gonna feel that's okay.
Toby: But the nice thing is, especially since you're treating yourself, right? This I often re tell patients about that too, right? Is you have a real sting and a real throb for right now. In the next few minutes, that will start to fit. You can just really talk them through. Yes. I say these exact words, right? I'm my own patient. I'm not always on the handle side of the needle, right? I'm my own patient. So I know exactly what that feels like. That's real comforting. And Surgeons don't get to say that to their patients, right? I know exactly what it is to take out my own appendix, right? So it's really nice. Since we're treating ourselves and we can share our experience with the patient, it really it really bonds you. And then yeah, it's not just intellectual what you think they're going through. You felt that yourself many, many times. So it's it's nice to be able to say that to the patients.
Angelique: And I do. I always saw I'm I'm in solidarity with you. I've done bladder sixty six on myself. I understand. We're gonna take a nice deep breath. I'm gonna do it. Are you ready?
Toby: Nice, right? Yeah. Again, i it's much more of a team thing that way then too, right? And yeah, your empathy's high because you know exactly what that's gonna feel like. Exactly. Yeah. Sometimes I joke with the patients too, I say, this hurts me a lot more than it hurts you. So then they laugh and I put the needle on real quick. So sometimes it's nice to it's nice to distract them too.
Angelique: I try to get them talking because when they're talking, it seems to go better. But now that I've treated some folks a few different times, they get wise to what I'm doing. And so it's like as they feel me start to touch the point, they stop talking. And I'm like, no, no, no, keep talking. They're like, no, I'm gonna wait. They'll just totally clam up. Like mid-sentence will just like cut themselves off because they're waiting, they're bracing for that point to go in.
Toby: Yeah, th they get wise to you. But I feel like too patients I have to see long standing to that they tend to get less needle sensitive as things go on too. So that's sort of nice too. They know it's coming, but then they kind of you know, again everything's relative. So they've had needles so many times, so then it just this is another set of needles they're getting. So yeah, it's less traumatic for them too. So that's nice. Do you tell patients jokes?
Angelique: Yeah, I've seen that happen. Not routinely. I usually my demeanor is usually just playful. I usually catch something they say, but no, I'm not like a why did the chicken cross the road type person?
Toby: A hippie got married. What did they call her after she got married?
Angelique: The hippie got married. I don't know Toby what they call her.
Toby: Mississippi. That's that's from my friend from Mississippi. So I thought that was that was pretty that was pretty good. But so sometimes patients so tense you just have to say, what do they call the hippie after she got married? And then they're thinking about that. And then you put in a ging well, and then you tell them that, and then it really releases things. So try and put it not every patient, right? A lot of patients so they don't need joke that you know, they have so many things going on, but some of them just so overly tense over nothing, it's nice to just kind of joke with them a little bit. Especially that's age appropriate everyone joke. That's what I like to remember that, right? But and you could tell anyone that joke.
Angelique: Okay, I've got one then. So you probably have heard this one before, but what do call a cat with no legs? Ground beef.
Toby: I don't Okay. So that's good.
Angelique: Right. What do you call a cow with no legs on a grill?
Toby: I don't know. That's good.
Angelique: Daddy. Right.
Toby: I yeah, the dad joke elk is nice because it again it's sort of a ten situation, they're about to get a needle, so you don't want too complicated, too intellectual joke. You want just a little silly joke. Yeah.
Angelique: But my teenagers would call cringe. Mom, you're so cringe. Yeah.
Toby: You d you have to tell cringe jokes when the patient's cringing from the needle. That's you gotta match the situation.
Angelique: Match the energy. I like it.
Toby: Yeah. All right. Can I ask you another question? Sure. What about I was wondering now how long practice now, like a year plus in practice? No, just in general. In general?
Angelique: Some no, I got my license in October of last year. I'm coming up on my anniversary. Okay. A year. Almost a year.
Toby: So almost Okay. What about anything if you reflect back on it, right, that you learned in school that now in clinic you're like, that's what they were talking about.
Angelique: Off the top of my head. Let's see.
Toby: Yeah, I don't prep you beforehand, sorry.
Angelique: I gotta give that one a thought. Nothing is coming to the fore. Do you have that experience?
Toby: I want to tell you mine. Had to give a lecture one time about like what have I learned from the Saam system. And one thing I really learned with, you know, after so much clinical experience, right? Is that the six confirmation, the five phases, yin yang, that's not intellectual concepts, that's not on a list kind of things. Those qualities are actually in the body, right? And so again, I intellectualized that, memorized that and thought about that, but now I just I accept that those qualities are in the body. The points inhabit them, the channels inhabit those qualities, right? So it was real dry intellectual at school, but now I feel like, those are actually in the body. You can see that yeah, the qualities that the words that those are associated with, I see that manifest in the clinic and then I can see them change. So again, it was just dry intellectual in school for me, and then in now in clinical practice. It's it's not it's not dry intellectual anymore. I think I though I believe those are really in the body. And I believe that because I've seen I've I've elicited responses to those so many times now. I feel like yes, those are those qualities leap forward when you use the four point combination. So things like that, right? Where you just you just memorized it for a test, but then actually you see it now.
Angelique: I feel like I'm still very much I'm looking forward to the time when my brain is not in survival with starting the business and trying to figure out the raw herb pharmacy and seeing patients and dealing with insurance and doing all of the things. Like I'm I'm having clinical experience that's really good and helpful, but I'm wondering I'm I'm actually surprised that I'm not able to come up with something more quickly. And I'm wondering if I'm focusing on so many things right now that it's hard to really. Catch. I think I'm missing probably some really key details in the effort to hold all of the things that I'm holding, if I'm being perfectly honest. There's a lot going on.
Toby: Yeah, th it is. This is the worst time to practice. It will just get better and better from you.
Angelique: Yeah, that's that's what I keep holding on to.
Toby: Okay. But anyway, th that's my experience. And then colleagues have spoken to. They talk about how sweet it is now because there's no substitute for clinical experience like what sailors call time in the boat. There's just no there's no substitute for that. You're really fortunate, at least you had from your western side, you have that c whole much of that clinical experience, right? So I think that's really gonna help you now. But you have just get your time in the Chinese medicine boat in. Yeah. After a while, right? I mean it just It gets sweeter and sweeter, and you just you just get more and more helpful. Everything's a little bit less stressful. You know, it's it but you can't start there, right? You have to you have to start at the beginning. Yeah. This is the worst time to be practicing. So you should take a lot of comfort that you're you're doing so well at the worst time to be practicing.
Angelique: Thank you. I appreciate you saying that. It's it's one of those I have those moments, you know, riding the peaks and valleys of things. And just being like, man, what did I do? You know, there's some days where I'm just like, what did I do? And other days I'm like super happy I did it, you know. And then other days it's like, man, I want to jump out of the damn boat. You know, like maybe I shouldn't have gotten in the boat to begin with or what am I doing in my forties starting over.
Toby: That ratio will get better and better. Yeah.
Angelique: That's good. Thank you. So for all of you out there that are new doing this, especially starting your own, goodness. It's not for the faint of heart. I remember you telling me you know, in the beginning when you start your own clinic that it's harder up front but easier at the back end. Like and then if you're working for someone else, it's easier up front but can be a little more challenging down the road.
Toby: Usually much more challenging because you never get to pick the artwork. You never get to pick the hours. You know, it's it's great in the beginning because you have a job and you have patience and things like that. I mean it's just so great, easy. But then as you go on, you're like, I'd really like to do Moxa, but we don't do MOXA here. It'd be great to have a raw herb formula. But we can you know all those you just get more and more hemmed in or starting your own thing is so difficult because you have to make all the decisions. Am I going to do raw herbs? Am I not going to do raw herbs? How am I going to do it? I mean it's so difficult to get started. But then you just have nothing but freedom. And then also as you get more and more experience, it's nice that you get you make those decisions better. Now you have to just kind of guess what you might need, what you might want to do, how you know, it's
Angelique: Yeah, it's you try and Stefan.
Toby: Yes. But it's it's so nice once you have your outfit, right? Then you just put that on and just keep doing that over and over again, right? Especially you have so you will try some outfits that just do not work, but then you just you just discard them and never pick them up again. And then we're the outfits that work so well, right? You just you just keep putting on over and over again.
Angelique: One of those with the herbs particular. So I have raw herbs. And so I started to grind them individually and just like, I hate this. I don't want to do this. Like ever have because I thought, you know, it'll be easier. Cause I'm by myself. So I have to figure out a workflow that's going to be okay for me with, you know, visit intervals and time to prep herbs. I have more people now that are wanting herbs. And so coming up with formulas for herbs. And that's, you know, exciting and scary in its own right, you know, being new with this as well. And I was dreading and I was dragging my feet. I was, I think I talked about this on here, like to just to do this because I was like, I really don't want to grind every single I got through five herbs. I ground five of them, like little individual amounts, and I was like, I'm not doing this. So I'm just doing them in formula. So I weigh all the raw herbs together and then I grind the formula together. And then that makes more sense. And my and of course it seems like obvious to why wouldn't you do that? The grinder is really loud. So that's the only downside. So when folks are I haven't had to do this yet. I've been able to do it kind of in an after hours. But when folks are resting, it might be a problem because where I am, the walls are fairly thin and that thing is loud. Yes. So we're gonna see how that goes. But I am not grinding individual herbs. I'm not doing it.
Toby: Yeah, but that's great. I think it's it's good to do that rather than just wear yourself out for something that's not gonna give you good feedback. I forget if we talked about tinctures yet, making tinctures.
Angelique: You talked about it. I know how to do I know how to do it. It is easy and quiet. What do you what do you Yes, I know when a Western because I started my whole foray into this, you know, to jump into the Chinese medicine boat was by way of going and learning about Western herbalism that segued into some Eastern and Native American herbalism. And so tinctures were good. That's what I learned.
Toby: Yeah, but it's really easy and quiet. Compliant and really compliant for patients.
Angelique: It was tinctures and yeah, I totally agree with you. Where I'm getting into sort of brain knots in my own head about tinctures is that there's some argument that the alcohol changes the energetics of the formula. And so how you account for that.
Toby: I think it does. Yeah. I mean a lot of times it enhances it. But especially, I mean it ha we know so well for I think it's Shenong Bansa Jing, right? Where we know alcohol is hot, right? If not there early on in Chinese medicine, we recognize it's hot. So you know it's gonna have a warming nature to the to the formula. I think if you boil off the alcohol, then you it's gonna have less of a warming nature. Otherwise you can have them take room temperature water if you wanna have that. Have a little bit more of a warming nature with it.
Angelique: Okay. Do you so you make out do you make and press out your own tinctures? I don't.
Toby: Press them, I just put them in and then pour them out two weeks later. At the soonest. And then mostly they're just sitting. Okay. Because pressing is a pain in the neck and you don't get that much out of it. So I mean it's just really easy. And it seems to be really effective. I did hear one story about a very successful acupuncturist. She was in Texas, I believe, and she was doing infertility. And so she had raw herbs, powders and tinctures. And she did a little study. And she found that the tincture the patients that took the tinctures tend to get pregnant better than anyone taking even the raw formula, which she was really surprised, or the powders. Again, that's a small little study from her experience. But I think that's similar to me. I think the tinctures themselves have a little bit more potency than maybe not raw herbs, because again, I feel like if you can dial that in properly, that's the most potent one. But definitely compared to Powders or capsules, I feel like the tincture does have a little bit more potency.
Angelique: When you powders, do you mean granules? Okay. Interesting. Okay. It gives me something to think about. I do I've made my own tinctures before. I know how to do it. I always thought that I had to press them out to really get all the goodness out of there.
Toby: I do mean to say yes. I got that press and you barely get anything out of that press. It's such a pain in the neck, so
Angelique: But did you get the hydraulic one, like the hand crank one?
Toby: No, I got something that was like for potatoes. It's supposed to be for smashing potatoes. But it's some kind of some kind of hack for herbalists to do that. So I did it. You press a little bit more, but it's so much work. So yeah. And I mean the color's amazing. I mean, the color, the sm it's definitely pulling it out. I mean, that's that's the cool thing about alcohol. It's a solvent and a antimicrobial too. So it's really nice. Pulls out all the things we want and then protects it. It's it's ideal.
Angelique: Yeah, it is.
Toby: Yeah. You know, too, the Chinese character for medicine, right? The base of the character is alcohol, right? So I think we've been doing this for so long. We you know, I think it's it's just part of the medicine, right? Making tinctures.
Angelique: Thanks for giving me some more food for thought.
Toby: Okay, yeah. Again, this is one of one of my stumble upons and now I just love it. Again, I think it's a little bit more effective. It's easy, and then I can use a lot of locally grown Chinese herbs, which is nice. It's a nice, it's nice to be able to do that rather than granules, right? It's just in Taiwan. I'm you know, I'm not sure about the sourcing. It's nice, it's so nice to see the herbs like you're doing with the green. But this is quiet and easy.
Angelique: Yeah, I like I like the herbs. Do you tincture whole formulas sometimes or do you do simples? So you tincture a whole formula. Okay.
Toby: Yeah, I ha I have just one or two single herbs like Mahuang. I have a single herb, maybe some other ones.
Angelique: Okay. And then do you do the standard, like your standard, like let's say Xiao Ching Wong Tong, like would you just put all the herbs in out maybe parse out the Ma Wong but then put everything else in the in your little jar and then fill it? No.
Toby: No, no, like if I make that, I make it like ma shing shirgantang. I make it with mahong already in it. You do that. Yeah. But I have just mah I would I got scared during COVID and got five pounds of mahong. And so then I used almost no, I think I might have used no mahong for all my COVID patients, right? It just it w it wasn't part of the pattern when I saw the patient. So yeah. So then I was like, man, my mahong. So I just started tincturing into anything I could think of, mahong tong. Mushing sugar, anything that Ma Hong. I just start making that formula and then did single Mahong too. So again, that's that's mostly just sitting there. Again, that's so valuable, right? Because then you can activate and preserve it and teach your good forever.
Angelique: Yeah. Yep. That's true. I've got some Mahuang. I need to take sure as well. 'Cause I mean I have some, but like am I gonna use it? I don't know, I'm little afraid.
Toby: Yeah, but again, you may really need it, so it's nice to have it on hand.
Angelique: Yeah, yeah. Very good. What other questions do you have? I don't think I have any. There's no more from the readers or the readers, the listeners.
Toby: It's again really appreciate listeners. Thanks for listening to us. And thanks for getting in the conversation by sending your questions to Angelique. That's really
Angelique: Really appreciate it. Always fun to get an email. Yeah.
Toby: I got a few more questions for you, but let's let's save it till next time, okay?
Angelique: Okay, that sounds good to me. All right. All right. Take care, everybody. Yeah. Bye.
Toby: Take care.
