Office Hours with Angelique and Toby, episode 11. Released October 22, 2025. 31 minutes.

About this episode

Angelique Britt brings Toby Daly a seasonal-allergy case: the allergies improved, but the patient's bowel habits changed after repeated, modified stomach supplementation. Toby explains how changing a four-point combination can make a treatment less predictable, why supplementing the bladder might fit some allergy presentations better, and how signs such as rosy cheeks and frequent laughter can point to heart excess even without obvious heat complaints.

They also talk about abdominal palpation (and warming your hands first), noticing the most striking feature in the room while still matching the pattern, the difficulty of using Saam confidently for acute severe pain, why outcomes vary and how much is outside the practitioner's control, and which patients each finds hardest and most meaningful to treat.

Topics

Case: seasonal allergies with digestive changes
Modifying four-point combinations
Bladder supplementation and heart excess in allergies
Abdominal palpation
Noticing the most salient feature
Saam in acute severe pain and radiculopathy
Why patient outcomes vary
Hard cases: cancer, dampness, allergies, and tinnitus

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. 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, welcome back to Office Hours. Nice to see you too.

Toby: Angelique, nice to see you.

Angelique: Is it okay if I start out today with a with a case? Correct. Okay. So I had an interesting thing happen. So I've got a patient that I see sometimes I see him every month. Sometimes I'll see him every couple of weeks, sometimes I'll see him every couple of months. He travels to another state and sees an acupuncturist there. He has a couple of, I think he goes to another home that he has. And so I'm his Massachusetts acupuncturist and he's got another acupuncturist. And I actually talked to this person in the beginning of care just to be like, hi, you know, we're sharing a patient. How you doing? I had a conversation with her. It was kind neat to connect another colleague. So initially he had come in for knee pain. That was his primary issue. You had medial left knee pain on the spleen channel, by spleen nine, sort of where like the pesancerine tendons are. And acupuncture did well. Between the both of us treating him, that his knee pain had mainly resolved. And so his complaint that he started coming to see me for most recently was allergies. So I saw him last month. I saw him last month. He's a male in his 60s. Came in complaining of just seasonal allergies that got worse. He does a lot of out outdoor work. He likes to work in the yard that gets exacerbated by work in the yard. His symptoms are, you know, quote unquote junk in his throat, goopy eyes, sneezy. And he has clear runny discharge. And then just feeling overall stuffiness in his maxillary sinuses. His skin is normal, like not too dry, not too moist. This time it was occasionally itchy. Temperature is normal. He gets occasional dry mouth at night. His face, he usually has a rosy complexion to his face, and he's very smiley. Like the grossest thing in the room about this patient is he laughs a lot. Like when he talks, like ha Like I'll say something and you know, there's a lot of laughter like when I ask questions, like how about the brow movements? They're like, you know, blah, blah. You know, it's one of those situations. So like a hard excess type guy in that way, like TCM. So face is sometimes shiny, sometimes not. This time it wasn't so much his digestive system, he had no complaints, bowel movements were formed, easy to pass, not a lot of wiping, sleeping well. And so I did a stomach supplementation modified on his right side because the skin wasn't super either way. And

Toby: Do you mind talking about the modification what you did? Yeah.

Angelique: Yeah. So instead of stomach forty one, I did stomach thirty six. Because his skin was kind of in between. Neither he wasn't super, super dry, but he also wasn't like super moist either. And he was more wet on the inside. So I had he was a lung excess. So I did that on his right side just because occasionally he get a twinge in his left knee. That was really the only other complaint. There wasn't one side of his face that was more stuffy than the other. And Helped his allergies. He came back two weeks later. He had decreased his over-the-counter antihistamine from daily to weekly use. And he said that rather than having constant low grade allergies, he had a couple of spikes that he said was caused again by yard work. His skin was less itchy. But what was interesting, and what I'm bringing this up for is that he said after treatment, his daily bowel movements went from daily to twice a day for three to four days before they normalized. And I said, okay. So again, his main complaint that day, although his allergies were better, they had kicked back up again. So he was also really drippy and sneezy and congested again. And so because I wanted to treat the inside and dry it out, I was like, I'm gonna see what happens if I do the stomach modified again. So I did. And then he came back a week later. And the reason that he came back a week later was that although his allergies got better, like much better. He started having gastrointestinal distress. He was gassy. He had a lot of cramps. His stools became looser and were more uncomfortable. And so that's why he came back because he wanted a correction. So then I corrected him with a TCM treatment. I did like the four doors. I did very much like spleen stomach channel treatment with the four doors on his stomach. I need a PC six, spleen six, stomach thirty-six. I didn't write those points down. And then I did I think I did some local things for his allergies that time just to help. Consolidate them, but was curious why that happened. Was it just too descending to do that twice in two weeks? That was the only thing that I could consider.

Toby: Could be. And then by modifying it, right, you make that point combination a little bit more unstable. So that tends to go a little bit more funky. And so it's possible that we don't really know because you because of the modification. We could say if it was unmodified stomach two times in a row, we'd say, then that's just too much. But since it was you know, three quarters supplementing stomach, one quarter supplement large intestine, maybe the large intestine that modification either the modification or adding a little bit too much large intestine energy is was off for him. So it's it's hard to speculate that. And then usually it's call it's okay to repeat something twice, but in general try and come up with something else. So that could you know that there's three or four different possibilities of why that happened. And then for acupuncture and then it's possible, right, he didn't notice but got a bug or something and it's not acupuncture related at all. Right. Sometimes that's, you know, that's a possible other factor, right?

Angelique: That's true. And I don't think I asked him about that. Maybe I d I usually do, but I don't remember. I don't mind my notes here for today if I had asked him about that. But yeah, that's a good point. So what do you mean what do you mean by unstable by making by modifying you make the combination unstable?

Toby: Four-point combinations are so stable for the body. The body seems to accept them really well. When we start to modify the four-point combinations, it's it's it's harder for the body to respond to it in a really clean fashion. That's what I mean by unstable.

Angelique: Do you mean in terms of balance?

Toby: In term of when we modify the four point combinations, it's more likely for other symptoms to be kicked up rather than cleanly going to the body and doing just that one thing. Now we've kind of slightly modified so it's it's giving the body a little bit of mixed signal, so it's more likely to be problems with it.

Angelique: And so then for folks who may not know, can would you mind explaining why we would use a stomach? I can explain why I'm using stomach modification with the skin, but can you explain from your perspective when a stomach supplementation modified is indicated?

Toby: Yeah. You can do all kinds of things with a four point four points for supplementing stomach, but one of the main ones that I do that this is one referring to is when we take stomach 41 off the modification off the four point combination and add stomach 36. This is a little bit like adding large intestine energy, about 25% of large intestine energy, to the supplement stomach energy. So it's it's a little bit better for drying on the inside. And a little bit less for drying on the outside. Okay. By combining that. But again, then it makes it a little bit that's a little bit more rather than cleanly putting a four point combination in, it but you're asking the body to do two things at once. It's sometimes bodies have a hard time with that.

Angelique: Okay. That makes sense in terms especially with adding the large intestine energy. Maybe that was why. Because I told him I would ask. Because he's really interested in studies. He's like, I wonder why what happened. And I don't I generally don't repeat the channel twice, but I do sometimes. And this yeah. In the case of somebody that has like chronic allergies that are their issue and that's what they come to see you for. And that's their primary like he doesn't have outside of when he's having some knee pain. He doesn't really have a lot of other imbalances that I can see that he reports symptomatically. Like he sleeps pretty well.

Toby: But like you're saying, he was a heart excess. So it's possible that bladder might really might even help better than stomach for the allergies because we could think of the allergies as being a hyper functioning in the body. And so by supplementing bladder, it could really cool and soothe that down and he might be respond below to

Angelique: Okay. So even in the absence of excess heat, because he's not one that has that, he's a little rosy.

Toby: He's laughing with a red face. So that's that's heat for me. Well, that's enough if we're really fishing for something else, a otherwise really healthy person, and we're looking for another channel that we need to supplement, then yeah, that's that's pretty good. Did you check his abdomen? Do you remember?

Angelique: That's enough. Okay. No, I haven't been doing a lot of abdominal palpation. I've been having trouble keeping my own hands warm. And your words have stuck with me about touching patients with cold hands. So I'm doing my best to not do that as much. I remember that I would feel the midline, right? And see if it was a an open and warm midline to identify hard excess. Yeah.

Toby: Right. That may guide you, especially if you're if you're looking for something else to do on the outside, right? If that felt cold and hard, then I would I'd definitely skip that. Right. Because that would be a definitely contraindication for that. So yeah, it's just one more way, one more avenue to check. What do you how are you keeping your hands warm? What are you doing?

Angelique: I have portable hand warmers. Right. But they don't like I keep my hands in my pockets, but then my hands like I'm holding them, like sometimes during the intake, I'll switch from one hand to the other. And they don't stay warm that long. Yeah. I need to take more herbs.

Toby: Okay, cool. Okay. Yeah. But and then also I just have another practical thing too, right? I have like Yeah, hold up, we cup of tea is nice. I don't do that when I'm interviewing the patient though. And so especially now we're going into winter, right? And we have heaters in the rooms and I and I'll just excuse myself for a sec, walk over to the heater in the room, put my hands, get them really toasty, and then come over and see the patient. That's slightly disruptive, but it's much better than touching the patient with cold hands. Yeah. Do you have heaters in your room?

Angelique: Yeah, bad heat lamps. Yeah. I just they don't they don't warm as efficiently as little hand warmers. Yeah. Yeah. Which don't warm sufficiently to be able to touch an abdomen sometimes. Like my hands can get really, really cold.

Toby: Okay. Keep working at it because again this is a really important part of the interaction.

Angelique: I've I've carried your words with me that when you touch a patient with cold hands that you are not giving, you are taking from the patient. And so I think of that every time we have cold hands, which is constantly. Thank you very much.

Toby: That's from my teacher, Dr. Wu, right? So yeah, she really emphasized that for me. And then my hands also tend to get cold. So yeah, I just I have all kinds of workarounds for that. Yeah.

Angelique: Okay. Well that makes that makes sense to me. I can all right. That's sufficient. I can tell him when he comes in next time.

Toby: Yeah, especially I mean, and then again, I think your intuition on that's probably right too. You took two descending organ systems at the same time, stomach, three quarters, large intestine one quarter, both descending, right? That just might be too much. You got like a preview of that with that first visit, right?

Angelique: Mm-hmm. And I thought maybe that's an outlier, you know? Like I didn't pay so much attention. I was just like, huh, that's interesting. Because I also thought because I don't think the quality, no, he the quality of his stool didn't change. It was just the quantity. So I thought maybe he had to clear something, you know. And then when he came back that second time, I was also surprised that the quality of the stool had changed to a bit more loose. Yeah. Particularly with stomach being drying.

Toby: But that makes sense. I mean, it if it's if your theory is correct, that's a descending problem. There's just not time for it to pull that drive.

Angelique: Go too fast. Yeah. Okay.

Toby: So again, that would be even another tip towards supplementing bladder, right? Because you want to cool and slow that down.

Angelique: Yeah, actually. Thank you.

Toby: Okay, yeah, sure. Anyways, thanks for presenting such a clear case, right? Then I feel like I can kind of see that patient. Yeah. Especially it's nice to note those, again, that grossest thing in the room. It's nice to try and treat that if you can get an angle on it. Mm-hmm.

Angelique: Even if the grossest thing in the room isn't actually gross. Like it's like the grossest kind of sweet.

Toby: Yeah, yeah, yeah. No it's endearing. That's that's why yeah. Yeah, but it's it catches your attention. We it's so gross, yeah.

Angelique: Well, using that phrase helps me to zero in on it though. It just I know there's something about referring to it as the grossest thing in the room, even though it's not gross, it's like what's the most obvious thing, but that just pull it just pulls you right in, yeah.

Toby: Calls you. Yeah, it took a long time to articulate that. But yeah, I think that is that's valuable clinical information. And then sometimes it's like this is pretty like after the bowel movement and then laughing, you know, that's pr that's pretty straightforward. But every once in a while, the grossest thing in the room for me will be a mole. You know, something it can be something really small, but it just it just grabs your clinical attention. So that tends to be really valuable. And nothing's a hundred percent in clinic, but that's up there. You know, up there with being really important to treat.

Angelique: Yeah. And to track back to the previous conversation we had on our last episode about trusting, like trusting yourself to what is the grossest thing in the room to you, because that's valid. Like whatever you're noticing most, that's valid. Listen to that. Yeah. You know, I wouldn't have thought about bladder for this patient because of the lack of I thought of and that's that's where I'm with the where I'm toggling with the song or not toggling, but tuning. I don't know. I can't get the right word where I am. Calibrating, that is the right word where I'm calibrating is learning things like that. There doesn't have to be a person who's radiating heat necessarily, you know, or but you can they can still have an excess in the heart. Because this person, because he wasn't radiating heat or really complaining of feeling hot in any fashion, but just those couple like just rosy cheeked laughing is sufficient.

Toby: Yeah. Yeah. Especially in a healthy person, right? Usually then you have a little bit more leeway.

Angelique: Yes. I'm treating another person I'm thinking of right now who is absolutely a heart access person in all of the ways that I haven't done Saam with yet because they were a new person and I do some I do psalm for new people sometimes, but not often. And but I'm thinking of that for this that just like put that in my brain for this person. So thank you for that.

Toby: So yeah, but especially textbook presentation, then yeah, you should you should consider getting on that pretty soon. Especially sometimes it's confusing and things like that. Yeah, then it you're not sure what channel to do. You know they're so powerful. So I think I think it's reasonable to do all kinds of things. But sometimes if it's just laid out for you some. It's right.

Angelique: There. Yeah. This person this person is a bigger build, like stocky. I can feel the heat radiating off of their body. And they're also one of the nicest, kindest, most open and loving people I have probably ever met. Like just such a warm person.

Toby: My needle finger getting itchy, but that is

Angelique: It's like you need the platter channel. Yeah. They'll have it next week.

Toby: Yeah. Okay, okay, okay, good. Any other cases you're thinking about?

Angelique: The that was that was really the only one. I still I where I am working on trusting the PSM system is when people are in acute severe pain. I haven't done enough of that to know that it'll really work well and from my own clinical experience. And so I definitely revert to orthopedic and TCM because I had a couple of people come in with facet joint nerve impingements and pretty significant pain. And one person Goodness, I was barely. I mean, I pulled out all the stops. They were my last person of the day. And so I spent and they're the first to visit. So I spent like two hours with this person. Wow. Just trying different things because they were in s they were in such severe pain that they were sweating. Like they were they're just so uncomfortable. It was awful. It was like one of those times it was one of those times where I was just like, Man, I wish I had medication on me. I wish I had drugs. Cause I was like, I want to just give you something. Yeah, just cover that up. Just cut just for now, just so that you could just Like exist like they were just in such severe pain. And so like maybe was able to take an edge off. And I saw them a few days later. They were much better, but they also had been going up on their gapapentin dose. But I was able to do a face-down treatment on them and do the C5 C6 Wattos because they really they're having like the pretty characteristic ridiculopathy down their arm and everything. And I had another patient with a very similar presentation that was easier to help doing a similar treatment. Had they had much better result from that. So that was, I think I'd mentioned in the last episode, like where you have somebody that presents the same and a couple of different people, but and even like the underlying like the root was the same. And actually no, the root was a little bit different. That might be why. But anyway, being able to apply the treatments and then just seeing the different response despite diagnosing correctly, I think, and doing what you know to do and having like really good results and then like You wish you had more fiend results, you know?

Toby: Yeah. Yeah. It's it's it's comforting for me when I just remind myself, that I did the absolute best I could do. Mm-hmm. W with my clinical knowledge at this at this junction and what's going on with the patient, right? I just try and match that as best I can. And sometimes yeah, it's out the park. And then sometimes yeah, you just can't get something happening right away. So it's it's frustrating, but I think it's just part of it, right? I mean, we can't we can't put everything out of the park all every time.

Angelique: And I think it's much if we'd like to. It's an it's idiosyncratic to the patient as well, I think. Like I said, like some patients, it's it's you breathe on them and they're like, I have everything is better, you know, like by 75%. And other people, you treat them three or four times and they're like, maybe, you know, I had that one person that I just after four treatments, there's like no change of nothing, which to this day still bothers me because I think there must have been something, but maybe there wasn't. And it's just like at that point, it's kind of like, well, you know. I did I did my best here and there was absolutely nothing that was different. Okay, this isn't for you. Maybe acupuncture's not for you.

Toby: Yeah, and then it's also yeah, I mean, I think that's reasonable to consider, maybe that patient's just not a good reporter.

Angelique: Yeah, or maybe, you know, I think in a different space, I'd probably just refer them to someone else too, because maybe I just I'm not seeing something that someone else might be able to see. Yeah. You know, that's fine. I'm okay with that too.

Toby: Yeah. Too much variables to get comfortable in clinic.

Angelique: Yeah, there's so many variables. Noticing that people do respond so idiosyncratically and reminding people that it's their body that's doing it. You know, this is we're giving the body a message, but your body is picking that message up and using it. And so yeah, it's super gratifying when people have this amazing response. But I'm I'm learning that it's more about them and less about me, you know. Which is which is good, actually. It's it's a relief. Yeah.

Toby: Yeah. And then it's it's nice to tell the patient that too and direct it back to them, right? That you did this, right? Yeah. Yeah, because otherwise, yeah, they just heap blame or praise on us. And really, yeah, mostly I mean, of course we have to have the right diagnosis and as best technique and everything as we can, but yeah, ultimately the body decides. Biology decides what's gonna happen.

Angelique: Certainly, yeah. It is hard. It is still hard though when you're when you're seeing good results and they're they're reporting good results and you're the only variable in their life. So they're doing nothing different but coming to acupuncture. But they s believe that maybe because they put some paprika on their eggs, that maybe that was the thing that changed the course of their history. So it wasn't the fact they were coming to acupuncture and you just want to like shake and be like, What do you mean? No, that's not right. It wasn't the paprika on your eggs, okay? It wasn't. I promise. Yeah. What's on your mind?

Toby: I was just wondering about how your clinical gaze is. Can you turn it off when you leave clinic or are you diagnosing everybody in the grocery store?

Angelique: It's I definitely diagnose people in the grocery store. But I did that as a nurse. Like you when you have a particular training, like you don't unsee it. You don't unsee it. Like I notice people's breathing pattern. I notice their skin color. I notice the way they walk. Since acupuncture school, I tend to notice more of, you know, like, is their foot everting or inverting? You know, do they have hip hike? Are their shoulders even? You know, I tend to notice breathing and skin without trying the other things I kind of tune into. So

Toby: That's great. Now you see Sean or no Sean?

Angelique: Yes. Yes. Definitely that. Yeah. You notice it becomes part of you, I think, in the healthcare field when you're having to diagnose people.

Toby: Yeah. I always thought that was anyways. I no medical background. Yeah, I went right into just trans medicine and I realized that I was really becoming a clinician when yeah, I just couldn't turn it off, right? I really try and amp up for when I was in clinic and then yeah, and then when I'd be walking down the street, I'll be like, Okay, wow, I gotta treat that. And like, okay, that's not a patient, right? But it's it's like your gaze gets trained to that, looking for pathology and then instantly coming up with ideas of how you might want to treat that.

Angelique: Yeah. It's not such a bad thing. I mean, I've I visit a friend in Brooklyn on a regular basis and I've been on a train on a few different times, like on the Amtrak, taking it down there and had people in my vicinity that I was like, man, am I gonna have to use my CPR skills? Like it's like just keeping an eye 'cause they're breathing. Remember this lady. My goodness, her breathing was so terrible. It was before it's before my time in acupuncture school to the point where I checked in and you know, like Are you okay? Do you have medication with you? Do you have an inhaler? It was just I thought that she was going to code on any minute. I was like, I don't want to do CPR on drain.

Toby: Did that person appreciate you asking about it and checking in?

Angelique: Nope. Not very much. Nope. But it was it was to the point and generally I don't generally I just keep an eye. But it was the they were in distress, like their breathing, it was a distressful, like I can see their accessory muscle use, like the things that like it was not good. And so I felt like okay, I'm gonna try to I'm gonna be proactive here a little bit and see if you know because you know, you think about in Like people sometimes there's like that bystander effect where everyone thinks that everyone else is handling something when nobody's handling it. So I went out on a lamb. They didn't get mad at me, but they sort of were like, I'm fine, I'm fine. I'm like, Okay. And then I continued to watch them until they got off the train and I carried on my

Toby: Okay. But anyway, that's that's that's nice. You've got a skill set and you're recognizing a problem. So that's that's nice. Yeah. Yeah. Anyways, to try and intercede before there's a major problem. I think that's really reasonable.

Angelique: Yes. And in all fairness, I wouldn't I wouldn't try do twenty six to revive them.

Toby: Okay. All right. You got something else on your mind? Otherwise, I got a question for you.

Angelique: I'm wondering what you have found the complaint that comes in your door, the one or two complaints that you find the most challenging to treat, where you're just like, man, when they come in, their main complaint is.

Toby: My first hit I think is cancer. I see a lot of cancer patients. And I just feel like by the time the cancer patient comes in, right, so many problems have accumulated in the body for that to finally manifest that so I feel like that's that's really difficult to treat with those patients because multi-problems going on and a ticking time table, right? You don't have much time for those kind of patients. So I feel like that's that's the more difficult that tends to be the patients I like the most too right because they're so sincere, they're so clear about everything, right? They're not, you know, they have a real sense of their mortality. And so they're they're really present for the for everything and then appreciative, right? If you can help them with things. So I think that's that's my number one difficult one. It's probably cancer patients. And I again that's a huge portion of my practice right now. Not they I don't have a second, you know, the second would be so far below that.

Angelique: About okay, cancer, that's fair. And yes, I can see that. I guess maybe symptom if you move the cancer diagnoses out. If you think of patients that come in with symptoms, like this is my complaint, lesser symptoms. Like we're not talking like mortality-based patients when you see patients. Okay. Like for example, never mind, I'll go ahead. I'll let you.

Toby: Let me have let me have an example and then I have some okay. I just cannot treat that. So I just refer I just refer that out immediately. Yeah, I mean so many good herbal formulas, so many good like the Saam system has got special protocols for it. I just I've never been able to help that. So yeah, I just I just refer that out.

Angelique: Tennitus. Tennitus.

Toby: If that comes in. So usually that's they don't come in exclusively for that. And I just try and refer them to somebody else. Okay. So that's not good. And then the other thing I was going to say is like the most recalcitrant things usually related to dampness. So that's that any symptom related dampness I always that's extra frustrating because like you were saying before, right? It'd be nice to just move things quickly and have a big change with biology and that stickiness that holding back of dampness always seems a little frustrating.

Angelique: Yeah. The runny noses. The allergies. That's my other it's my other symptom that I just I dislike. Allergies. And there's so many allergies out here. Allergy patients. Just that's like there's this it's like a secondary issue for I don't know, probably sixty percent of the people that I'm currently seeing. Especially right now it's ragweed season, so everybody's all congested and itchy eyeballed and all the things. And it's a tough

Toby: Right, consider some other things, right? Like I've had you know, allergy patients respond really well sometimes and like even supplement bladder for sure, but even like supplementing gallbladder, just making sure getting everything off the body sometimes i if that if that matches the pattern well, that's can be really valuable.

Angelique: That's a creative way to look at gallbladder. Okay.

Toby: Yeah, but make sure it matches the pattern. But that could that can be really helpful.

Angelique: I think I only supplemented gallbladder one time. It didn't go well for me. Yeah. Yeah, I didn't. I'm usually a pericardium supplementer, if anything. Yeah, it's inter it's interesting. I mean so there's a PSM protocol for tinnitus.

Toby: You have to be careful of that. Yeah, in s in some of the written psalm text, I'll send it to you and I'll put it here. But in some of the written psalm text, there's tinnitus protocols. And yeah, I mean I've tried them all and I tried regular, you know, like formula. I just tried so many different things. I just feel like that's just something for whatever reason I don't have good clinical results with.

Angelique: It's really hard. I had a I had a good one time in school, someone who was having ringing that it was reduced and stayed reduced. It was a I don't think she had it for a very long time. I don't know if it was like a if it was like a situational young rising specific and we corrected that. And I just had a patient this week and I don't know if she was just highly suggestible. Some we'll joke about that sometimes because she'll be like, Well, maybe it's because you told me and I'm like, Well, maybe it is. But I treated her because usually I treat her knee and her knee is healed for the most part. She's one of my patients that comes every two weeks. God bless her soul for tune-ups. And the tinnitus has been really bothering her. And so I it was a high pitched and she kind of she kind of matches having some young rising stuff. The political climate is really getting to her. And so one of her therapies has been to not watch the news. Like I've been asking her to really reduce her news intake. She just gets so upset. And I treated her and she said, You know, I think it might be a little less even now. And I was like, Really? I'm so funny in the treaty room and I'll joke with people because I'll just be like, I'm gonna be incredulous that this is working because I'm so fascinated.

Toby: You but you gotta get a better poker face and

Angelique: I do because some time like I had no, I was like, well, I'm gonna try this. I did I did local needling too. Like I did the gr the you know grounding points like liver three and you know spleen six to support the liver and the kidneys. And then I did was it SI nineteen up here? I think it's SI nineteen and then triple warmer seventeen. And on both sides, I think I did some I think triple warmer five. I can't remember her full protocol, but anyway, did all that and she's just like I think it may actually be a little bit less. And I literally I couldn't even it just really And she's like, Yeah, I think it might be. So we'll see.

Toby: Okay, keep me keep me up to date to that one because and then write down that point combination because I'll I'm gonna

Angelique: You're gonna try to use it. Yeah, I don't I don't it's an out no, no, this wasn't this was an outlier. I think that was these are outlier because I've tried other people doing similar things with no effect whatsoever. It's just constant, constant. So that's a tinnitus is a tough one. When people say, Well, how can it treat this? It's like, well, in theory, sure. You know, we can give it a try.

Toby: Now we're just gonna send refer everyone to you. Nope. Again, it seems so reasonable. Especially it's if it's not a structural thing, right? You feel like, that's a functional thing, that's right in our ballpark, we should be able to really handle that. But yeah, I just personally I've I haven't been able to see it.

Angelique: I don't know how we as acupuncturists can really tell if it's a structural versus a functional thing by patient report.

Toby: Right no, but does that mean I mean if it if it is not structural then that's that's our that's our jam, right? So yeah.

Angelique: Yeah. So everyone should go get CAT scans of their ear canals before embarking on acupuncture to make sure there's no

Toby: Maybe I think it doesn't matter for me, structure, not structures. Either way, I don't I don't I don't budge that.

Angelique: Okay. Those are my those are my questions for Great.

Toby: Should w should we leave it on my clinical failure then for right now? No.

Angelique: I can't leave it on a clip here.

Toby: Okay. I think I think we I think we better than running out of our time, so but let's let's wrap it up right now then, okay?

Angelique: All right, we'll leave on a clinical failure then I suppose.

Toby: Okay. Well we'll we'll highlight something I do well, started next time, okay?

Angelique: Will be that will be the top of the hour. So we'll do.

Toby: All right. Everyone take care. Thanks for hanging out with us.

Angelique: Okay, everybody. Bye.