Office Hours with Angelique and Toby, episode 10. Released October 9, 2025. 23 minutes.

About this episode

Angelique Britt describes the pressure she put on herself as a new practitioner and how letting go of outcomes restored her trust in the medicine. Toby Daly notes how similar presentations can respond differently, and passes on his teacher's advice to start a new patient with about a quarter of what you want to do.

Angelique explains when she waits a few visits before prescribing herbs and how she modifies formulas, with examples ranging from sweating and grief to diabetic neuropathy, a swollen uvula, and wind-heat colds, along with the logistics of grinding raw herbs in clinic. The episode closes with Ying Qi, the nutritive qi, and its relationship to blood, Wei Qi, fluids, and the harmony of Ying and Wei.

Topics

Letting go of outcomes and trusting the medicine
Why similar cases respond differently
Starting new patients with a light touch
When to add herbs and how to modify formulas
Grinding raw herbs in clinic
Ying Qi, Wei Qi, blood, and fluids

Key terms

Ying Qi (營氣): nutritive or constructive qi, which travels with the blood inside the vessels.
Wei Qi (衛氣): defensive qi, which travels outside the vessels and guards the exterior.

A note for listeners: this is a conversation between licensed practitioners, offered for education, not as medical advice. 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.

Toby: Hey Angelique, nice to see How are you doing?

Angelique: Too. I'm doing okay. How's it going over there?

Toby: Doing pretty good well too. We got first bit of rain here in California, so everyone's kinda happy about that. What about you? What's it like over in Massachusetts?

Angelique: Today was beautiful, seventy five degrees. Nice. But it's been really dry. The foliage is coming early and it's browning early. So I don't think people are gonna be very happy with the color out here this year. Yeah, we haven't had a lot of rain. It's been really dry.

Toby: Sorry to hear it. It all came over this way, so it's been nice for us. Sorry so we took it away from you guys.

Angelique: Okay. Yeah, we've had I think maybe three days of rain in the last month. It's not been great. Please. Thank you.

Toby: Send some over that way. I want to start out asking you about how it went with that patient you saw you were switching from TCM to SAM for a patient that was possibly gonna go into labor. I wonder if you have an update for us.

Angelique: She had the baby and I don't know if she had to be induced or not. She kind of fell off the radar for a little while. And then I messaged her to check it and she sent me a picture of her baby. And so she ended up having to have a C section, which wasn't her goal. So I was waiting a little bit of time to let her adjust and then I was gonna reach out and see how she was doing. I didn't want to pummel her with clinical questions.

Toby: Yeah, that's that's fair. Yeah. Especially new moms, right? You gotta give them some space. They got a lot of stuff to do.

Angelique: Especially when it h it was her fear that she was gonna have to have a C section and so it kinda came to fruition for her. So perhaps next maybe in the next couple of times, depending on our timing of things, I can have more information.

Toby: Yeah, yeah, but anyway, so that's that's nice to get the full circle on that.

Angelique: Definitely, yes.

Toby: I was gonna ask you something else too. What about now that you've been in practice for a while, was there any assumptions that you had about what it was gonna be like to be a practitioner that were totally wrong?

Angelique: Yeah. I thought it's funny because this was sort of adjacent to something I was going to say. I thought it was gonna be easier, you know, because I had it together or because I necessarily knew what I was doing, but I thought like, this is this is this is gonna be all right. Like I've got a pretty good grasp and it's definitely been harder and I've placed a lot more pressure on myself than I thought that I would. So, I mean, those who know me are gonna roll their eyes when I say that because I tend to put place pressure on myself kind of a lot. But I had the intentionality of this is this is just gonna be what it is, how the business came about. It was sort of a last minute decision, and I just went with it. So I was really trusting the process. And I think in the meantime, I stopped trusting the medicine. And so I had a lot of conflict. And just this recently, I have started to really trust the medicine again and detach, like truly detach myself from the outcomes as much as I possibly can. You know, knowing, of course, I'm I'm doing my best, I'm trying my best, but not taking it to that level of it being a criticism necessarily of me or a failure of me if something doesn't work. And conversely, it's not my accomplishment either. Because the other thing that I noticed is. The difference between clinic and owning your own business. So the I don't know if they're, I don't know if the mindset was different when you're in clinic. It must be in student clinic, that is, you know, an acupuncture school, you're having you have a partner most of the time and you have, you know, people who've been coming through quite a bit. And you have some new people. But I've seen enough people now, maybe it's just the volume of people that I've begun to notice that there are some people who respond to acupuncture in a in a way that feels like magic. Like, how can this possibly be true? Like I had a patient this week was like was that had that kind of result with them. And then I've had others where there's next to no movement and I've pulled out all the stops. And I've had two patients come in with very similar presenting problems, able to really help one. And the other one I'm slowly helping, but the trajectory is different, but their pattern was basically the same. So I guess the difficulty factor of it. Both in running a business and seeing patients was different than I had expected. And also I didn't expect to lose my lack of trust in the medicine. And I think through it I gained more trust in it. So those are the two big things I can think of.

Toby: What did that look like? That not having trust in the medicine, what did that look like?

Angelique: Obsessively looking things up, a lot of internal self-talk around like overthinking of patterns, overthinking of diagnoses. I had, you know, thoughts in my head or beliefs that, you know, if I used certain points too many times, that I really wasn't doing good acupuncture. You know, there's a the set of, you know, Miriam Lee's big 10 points. Familiar with those? I'm sure. Yeah. Yeah. So, you know, I had, I had a time when I was feeling Like there'd be patients that would come in that I didn't know really what to do. So I used that for their first treatment just to kind of get some treatment going because there was so much complexity and I was really hard on myself for using that. And then I thought and then they came back and they were so much better even like after something simple like that. And so it was it was sort of it was humbling in a way because I thought like, it's like the mail it in, you know, acupuncture treatment. But it was really like a balancing acupuncture treatment for them. Yeah. Did I answer your question?

Toby: Yeah, but so I think yeah, so you're the tr you said trust you didn't have to lost trust in medicine, but you lost trust in your s your ability to deliver the medicine. Is that

Angelique: Two kind of both. Like so I was like, is this actually working? And am I able, am I doing this right? You know, and really attaching, like, maybe I'm not doing it good enough, maybe I'm not doing it or well enough, maybe I'm not doing it right. And also, is this actually working? And so it started first with trusting myself of you know, I know I've I did a lot of studying. I know how to use reference books. I have a person I can talk to on a regular basis, I have local colleagues I can talk to. I have the resources and then Using my brain, allowing myself to trust my diagnosis and then treating the patient based on what I'm seeing and just knowing that I'm doing what I believe to be the right thing and trusting that their body either will take it or it won't.

Toby: That's sort of my sense about it, but that thanks for fleshing that a little bit. Right. That's that's an important crisis to get past that.

Angelique: I'm sure it'll circle back around as we know through some lifer spirals, but currently I've moved. I'm outside of that, you know.

Toby: Yeah. I that sounds familiar to me too, but you know that like what am I doing in clinic? That happens to me, yeah, much less now. But especially like my again, I started out b before I knew anything about today's medicine, the acuncture just couldn't work. And so now that I've seen it work so many times, I feel like that's that's good. Now that's solid for me. And then especially using the Saam system, right? Getting your diagnosis wrong, wrong, wrong, and then finally right. Then that's giving me a lot of like faith is not the right word. Just like that the system if you can diagnose and treat perfectly, the patient will respond to that i if you get the right diagnosis and treat. I guess trust you're not gonna be you're gonna be able to do that every time though, right? So

Angelique: And so I try to also not to not to say that I never have to think critically, but I just trust the process and you know, don't think about what happened. Like once they come back, I evaluate the result and then pivot from there. But I give myself the grace of particularly with a first treatment to just treat what I see, whether that's using Som or whether that's using TCM acupuncture or an orthopedic approach or what have you. Yeah.

Toby: Yeah, but I think that's I think that's hyper reasonable way to do it, right? And then also, especially almost always, every patient I see is complex, right? So yeah, but you got to try and meet that complexity with as simple of an intervention as you can and then and then and start to see that, right? I think where we get into a lot of trouble, a lot of our colleagues right, try and do everything at that first visit. I might have told you my teacher doctor who I think I might I forget exactly the percentage, but she said first patient when you see them, do about twenty five percent of what you want to do. And that's that's really that's really helped with me because first patient I want to do everything. And so I really try and dial that back into for me is a simple four point combination almost always for new patient because again, you're getting to know them. You don't have a perfect beat on them yet. You haven't seen respond to any treatment. Consider that you know, like first visit. It seems like you don't have to consider it seems like that's what you're doing. You're really simplifying it down and doing whatever you see and then and then moving forward. Yeah. I think that's that's a really great way to do, especially first.

Angelique: Yeah. And it's been it's been helpful and a lot less stressful. I was definitely putting my putting more pressure on myself to have it all figured out in the moment. And that was too much. Don't have to do that.

Toby: Yeah, but it's impossible to completely understand another human being and then have find the exact perfect way to intervene with their body. That's impossible. But yeah, you get a good sense and then yeah, like you said, you the top thing that you see and then try and intervene that way.

Angelique: And then with herbs, I allow myself a couple of visits before I engage with an herbal formula so that I feel like I get enough information to do diagnosis. And I've been doing okay with the herbs. I've been people have been responding fairly well. I've got one patient that I'm a little stumped with that I have to look at again more carefully. But the majority of the others I have had pretty, pretty good results so far from the herbs I've given them, which is kind of cool.

Toby: I think that's really great. The hard part about herbs is it's it tends to be kind of gradual response and patients sometimes take and sometimes so it's nice for acupuncture because they're you observe them getting the acupuncture and then you can see right away. So that's really valuable. The herbs sometimes patients get you know, they don't take regularly or whatever, you know. So that's that's always a little bit there's more variables, I think, for herbal medicine.

Angelique: Yeah, so far I've had the majority of the patients have been really compliant. It's very lucky they've taken them. I do the raw ground kind and this makes it really affordable.

Toby: So you were telling me last you were telling me last time you're gonna stop grinding 'cause it's too loud.

Angelique: I was gonna I was gonna stop grinding the individual herbs themselves. I grind yeah. So I have to just strategically time my grinding and I got a set of headphones. So I put the head little like noise cancelling headphones on and I grind But it is loud.

Toby: D do you know offhand what formulas you've chosen to grind? Yeah. How many do you have and like what formulas are you doing?

Angelique: That's lot of questions at one time. So I have in process right now. I've got they're all modified. I love that. I love modifying formulas. It's so fun. I feel like a wizard. The I've got a Yuping Feng San modification for somebody that has excess sweating and has had a lot of loss and therefore grief. And also has had a bunch of colds in the last six months. So I did that modified for that person. I've got one person on Wenjingtong. Patent. I've got another person taking a Xiao Fu Jutang modification for endometeosis. And then another person, the one that's that's kind of stumped me a little bit. I have a Feng Chi Gwij or Wu Tong modification just for like a diabetic neuropathy with a lot of numbness with a secondary issue of some sexual dysfunction. And I've done treatment of colds a couple times. I think one I mentioned before with the person that had a swollen uvula. I don't know if I told you that on camera or off camera. I did this is a I did a yin chason modified. I think it increased the licorice a bunch and I add some heat clearing, some additional like fire toxin clearing herbs to it and it cleared them up within 20 like 24 hours, 48 hours, 48 hours. And then a couple of other people that have started with colds that were of the The wind heat variety that I started them on Yin Chao and one person didn't get sick and the other person was sick for like a day or two and then was much better. That's great. So really basic things.

Toby: Yeah, but the basic is best. This is my clinical philosophy. As simple as possible. And then if you get into like a clinical corner, then you have to get complicated.

Angelique: Yeah. And I have found that. So like my modifications aren't crazy. Trying to think of an example. Like the person that I'm doing the Shao Fu Jutong modification is pretty deficient underneath the blood stasis. And so I basically have a I've got a it's not a full bajantong addition to that, but it's got a bunch of those it's got it's got like maybe four of those herbs in it, like blood tonics and qi tonics underneath it based on their issue. And it's been going quite well. And I think I added something additionally too because there was some constipation and it wasn't blood deficiency. Constipation. I have to look at the charge know for sure. But anyway, I think I might have modified that one the most of all of them. And I think I did like five additional herbs. And I think I swapped out a couple. Like I didn't have any Wooling Shar and they didn't need pooong either. So I pulled those two out.

Toby: I had an herb teacher that said, be careful what herbs you dispense because always imagine yourself in a court of law defending your dispensary habits. So like woodling your right, imagine being in a court of law and saying, Well yeah, I gave flying squirrel feces. I tend to leave that one out too.

Angelique: I would have used it. I mean, I might have used it. Not necessarily would have. Like if there's a pain issue, just because the Xi Xiao San, you know, in theory looks pretty good. I'm not personally afraid of taking the Ling Sher. And it's part of Chinese medicine. So yeah, it sounds bad. I guess. I don't know. Part of part of this whole process with me is trying to cleanse the fear from my nursing profession. Like because there you're very indoctrinated with fear of that sort, of that particular imagine yourself in court. It's not documented, it's not done. You know, they basically like jam the fear down your throat in very, very large amounts. And so with acupuncture, I'm trying not to be as fearful because I had so much of that with my last profession. I just don't want to do it.

Toby: Make sense. But th there's so many other blood movers. So that's that's that's that's my personal philosophy. There's so many things. And then also my office manager makes up the formulas too, so there's certain things that she like she can barely tolerate, Chan Twei, and you know, there's a couple of things, yeah. So I just can't I can't put theses in.

Angelique: Flying sprout. Sean Tui is scary looking and it's crunchy. Like I understand it's good.

Toby: She's okay. She's okay with it. But yeah, w I gotta I gotta her sensibility. And then also, yeah, just that my that repeater did say that. Again, we have so many good options. That's the nice thing about Chinese medicine, so many of the good options. So then it's it's nice to switch around.

Angelique: Sorry I'm having the most fun is with the herbs.

Toby: Yes, I think it is fa it's it's intellectually f fascinating for the rest of our careers, right? How to modify, how to swap out things. I have one practical thing and then I've got a question for you. So what about so you make the diagnosis and then you grind and then the patient has to come back and pick it up or how do you do that? So

Angelique: I would see the patient a couple of times. So on their third visit-ish. Unless it's obvious, unless someone's coming down with a wind heat or something like that. And I make the diagnosis. And I use Notes from South Mountain by Andy Ellis. Andy Ellis, yeah. Yeah. So it's such a great book because I don't have all the dosages and proportions and things in my mind. And the I've never been super clear on Penske's ranges. Like even in school, I couldn't get a clear answer as to how you're supposed to choose between, you know. Three to twelve grams. You know what I'm saying? Like a like a really clear, I think it just will come with time. So I've used the notes from South Mountain as a solid foundation for that. And then with my modifications, I've gone to Lebensky book and sort of found out, you know, the range and then chosen one based on the symptom that I'm trying to treat as a modification. So the severity of the symptom. And I did modifications that way. And so I'll measure out, I'll get my proportions and then I'll measure them all out. I have all of my herbs and mason jars and I'll Measure them all out on my scale and then hopefully when no one's in the office I'll grind them. Otherwise I'll warn them that I'm gonna do it and then I'll grind them. And the majority of people so far have said it's not terrible. The ones in the treatment rooms where I've done it, like particularly if they're on the table and they need a refill and they didn't tell me ahead of time or something like that. I'm like, okay, I'm gonna grind your herbs or just prepare yourself for a large noise. And the majority of them have said it's okay. One person was like, that was scary. And I was like, I'm really sorry.

Toby: In your future office you're gonna have to have a soundproof room to do all that.

Angelique: Yeah, or like a soundproof box or something to put over the I don't know if they make that or if I can figure out how to engineer one myself, but something to like maybe put over the grinder. Put the sides of a blender.

Toby: Yeah, but that's great in a way, right? Because then you can in real time then you can modify for the patient and then they can leave with it. That's that's I think that's super valuable. So I was just wondering logistically how you're doing that.

Angelique: And I have my visits scheduled in a particular fashion so that I'm there for eight hours. I can see up to ten patients, but there's enough of a gap in time the way I have my schedule set up that there's there's some time for me to be able to go to the bathroom if I need to eat food, you know, and grind herbs. Yeah, without too much additional stress. I tried packing them in a little closer because I know I could if I had a third treatment room, see, you know, people pretty continuously on the half hour, but I don't know the pace of that.

Toby: There's always contingencies. It's always going to take a little bit longer for a couple of patients per day than you would expect. So it's nice to have that little bit of leeway. Yeah.

Angelique: I need

Toby: Okay, but that's w th your workflows are getting great. It took me years to get my workflows going well, so that sounds like you're really on the way to that.

Angelique: That's all getting there. It's not perfect, but it's getting there. Yeah.

Toby: Can I ask you about yin qi?

Angelique: You can.

Toby: This is Unchuled translates it as camp qi, right? And then usually everybody else translates it as like nutritive qi or something like that. Do you and th this is why I'm asking this, because I didn't know what it was, but I'm I told you I'm doing that three year program with Volcershide. He's talking about it right now. So I was gonna ask you what you know about it and then I'll share what he's saying about it. What is Ying Chi and what does it do?

Angelique: I understood it as the nutritive qi. So the more yin, it's a more yin qi that flows with the blood.

Toby: What's what's the relationship between blood and ying qi?

Angelique: I believe isn't it wrapped around the blood or it flows with the blood? It's like with it. I see it like in my mind as together. They're not the same.

Toby: Says it's the stuff that's not the red blood cells that's the like plasma.

Angelique: Plasma? Really? Interesting.

Toby: Okay, th that's an interesting take on it. But that makes sense, right? The nutritive part of the of the blood that's gonna feed everything else, right? That makes sense. Yes. What does it do? What's the functions of ying chi in the body?

Angelique: That's that. It's nourishing. So it has relationship with the relationship with the waichi. To nourish and warm and do all the things with the body. So I know like the ying wei, the ying wei harmony is the things that are supposed to go up, go up, the things are supposed to go down, go down, the things that are supposed to go out, go out. So when there's a I know when there's a ying we disharmony, there's a separation. So things tend to like a lot of fluid, like there's a fluid metabolism issue. So there's usually a lot of sweating or a lot of excess urination when they're not joined together well and harmonized well.

Toby: I mean, yeah, that's really close to how Volker's presenting it, right? That yin wei harmony, that is the yin is the nutritive part. And that's why Unchou translates it as camp qi. It's where the way like the soldiers come in to get nourished and then they go back out to fight. So that's if that if that's not happening, the soldiers are coming in and like rampaging in the you know, where they're supposed to get the food and rest and like that. That's a big problem, right? Or if they the camp that they're supposed to come in doesn't have enough food or something like that, that Wei Chi can't be nourished. So that's a lot of disharmony between those two things i if they're not both doing their jobs. Or Volk or how he's explained Yin Chi is the that like plasma. So it's responsible for like the viscosity of the blood and how well it travels in the body. And then how it nourishes Dampness and dryness is from yinchi. So like skin being dry, he feels like yin chi is not getting there properly to nourish that, or skin being too wet, like too much sweat in there like that. That's the yinchi coming out of the vessels a little bit. So it kind of keeps the fluids in the vessels properly. And you know, he's got a good point. He's got, you know, several, you know, different clinicians throughout the centuries and then nating references and things like that. So I feel like that is that is a pretty good way. The only thing I knew about Ying Chi was that harmonized Ying in way using greater tongue. That was the totality of my Ying Chi knowledge. It's it's nice to th this is an important concept for Chinese medicine, but a lot of times overlooked. Anyways, interesting to just have a again, this is an evolving understanding of Ying Chi to write maybe we'll be different at other time, but you know, for right now that's that seemed good and with good references. So that's valuable that these vital substances in the body for Chinese medicine. It's nice to be able to have a clearer idea about them. So I'm sharing that. Okay. So that's just interesting thing about Ying Chi. Let's let's wrap it up for today, okay? And then I g I got a whole bunch of other things to talk to you about, but let's let's save it till next time, okay?

Angelique: Share. Okay. That sounds good. We'll see you next time, Toby.

Toby: Yeah, it's always good to meeting you and spending some time talking to you. All right, everyone, take care. All right.

Angelique: Goodbye.