Office Hours with Angelique and Toby, episode 12. Released October 31, 2025. 26 minutes.

About this episode

As the year turns toward its yin season, Toby Daly describes how he adjusts his clinic for winter, including ginger moxa along the spine and sacrum and more moxa for patients who run cold, and Angelique Britt weighs how to handle moxa smoke in an old mill-building clinic. Toby explains why he uses Dang Gui San for some first-trimester patients with threatened miscarriage, with an emphasis on diagnosis and caution around blood-moving herbs.

Angelique describes a patient with mixed heat and cold whose heat flared after a small trial of Wen Jing Tang, and Toby suggests clearing heat first when heat dominates. They compare ways of researching a case, from texts to mentors such as Dr. Angela Wu, recognize a pronounced Saam sanjiao-excess presentation, and close on easing anxiety about patient numbers, with Dr. Wu's advice that patients stop coming when the practitioner stops doing her own homework.

Topics

Winter clinic adjustments and ginger moxa
Managing moxa smoke
Dang Gui San and threatened miscarriage
Herbs in pregnancy: tradition and judgment
Heat flaring after Wen Jing Tang
Researching cases and seeking mentors
A sanjiao-excess presentation in Saam
Self-cultivation and anxiety about patient numbers

Key terms

Dang Gui San (當歸散): Tangkuei Powder, a formula from the Jin Gui Yao Lue traditionally used in pregnancy.
Wen Jing Tang (溫經湯): Warm the Menses Decoction, also from the Jin Gui Yao Lue.
Sanjiao (三焦): the "triple burner," one of the six fu organs and its channel.
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. Herbs during pregnancy should be prescribed only by a trained, licensed herbalist 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.

Toby: Hey Angelique. Now that we're getting to a little more yin time of year, are you doing anything different in your clinic? No.

Angelique: No, but I'm I know I should be. What do you do differently in yours?

Toby: I do a couple of things, but what are you thinking about doing for your clinic, now that we get a little bit more cool energy? Cool, dark, and wet.

Angelique: Old dark, right. So making sure things are warm and dry, like maybe not treating later into the day. You had mentioned tailoring your schedule so that, you know, as it gets darker, you finish earlier. I know needling technique we were taught in school, like during yin time, generally needling is a little deeper, whereas in summertime it's supposed to be a little more shallow. I'm not sure how that applies with Saam, if it applies at all.

Toby: Yeah, we you could you could consider that, right? Mostly everything's transvert transverse, so you could go a little bit deeper in the winter. I usually reserve that for if patients need a stronger stimulation or something like that. I usually go deeper. I don't usually do that for seasonal things, but you could consider for sure.

Angelique: Yeah. What else do you do?

Toby: For me, like I start doing different things in the office and especially like for practitioner, right? Almost every morning make now I make like guierton, sometimes slightly modified, sometimes not. It smells amazing in the clinic. It's nice for me to sip on some guierton all day. I don't know, it just it just it just feels right. So I start a couple of years ago I started doing that throughout the winter, right? Just getting some guiertong going is nice. And then my teacher Dr. Wu in the winter, she really she really followed like Jiang Jibin, right? His like, you gotta take really good care of the Yang. Yang is a life force. And so she does a ginger moxa on the spine. Nice. It's pr it's pretty amazing. So usually I don't do too much moxa the rest of the year, but like going into this season right now, you just take a slice of ginger, score it a couple different ways so it has a little bit of juice coming out, especially really fresh ginger, put that down this line, then back up. It really kind of glazes the spine with a whole bunch of ginger juice. And then, you know, because as Taoist, right, Doctor, we would always do seven times down and up. Seven times down and up. Patients find it amazing. And then really uncover the lower part of the body, like so you can get down to the sacrum, right? She really liked to mox it down the sacrum. Cold tends to congeal lower part of the spine. So especially, you know, you have to lower the patient's pants a little bit to get there. But that's yeah, that's one of the main things I do. Changing over, right? I start I start adding a whole bunch of amox, especially more senior patients, especially more already cold patients, right? Then I have a whole bunch of patients that are like need they don't usually need the heat of supplementing heart, but especially with this season when it goes to cold, they need more outward loving energy. So sometimes I keep this in my back pocket till it starts getting colder and then those patients start getting supplementing heart and then I start supplying more Sanjiao too because of the dark, all right. The tendency towards depression and things like that. So more San Jiao. So and then always I'm always trying to get rid of damp, but especially when it's really damp, it'd really rainy here yesterday. So a lot of supplying large intestine, lung, and stomach. So it you know, again, it's it's not a purely reacting to the seasonal changes, but for me that's an important factor for what's going on.

Angelique: Mm-hmm. And is the Moxa pole? She's Moxa Pole.

Toby: Yeah, I just I just use regular so it's it's easy, it's relatively quick, accessible, and patients, I mean, but they just really love it. Especially really cold. And then to put heat, warm, hot, and dry right directly on the young reservoir in the body. Wow, patients really feel amazing with that. So again, you have to you still have to differential diagnosis. I wouldn't for every single patient. So especially like cancer patients. I have a few fertility patients. They really, they really feel amazing after that. And I like to reserve it for the winter. It always feels wrong for me to moxa, like saying blazing summer just doesn't feel right. But now this time of year, right? Some greater tongue going in the office and then clouds of moxa smoke, you know, it just feels right.

Angelique: I need to figure out a way to manage smoke in the place where I am. I'm not able to safely open windows. They're really old mill building windows. In fact, I had I had one when I started to when I started last winter, I was using Moxa on a patient and the high ceilings that I have were deceptive in that I thought it would just help disperse the smoke, but the room it was. Incredible how quickly the room filled with smoke. So when I opened the window, because of how old the windows are, it actually fell back on me. Like I caught it. All right. So just imagine patient on table, the mox is done, thank God. Right. And I'm opening the window, and all of a sudden I'm catching this like massive mill building panel. And she's like, my goodness. And I was like, my goodness. And I replaced it. We had a good laugh about it. It was probably like, I don't know, my third or fourth patient in the building anyway. So I don't touch the windows anymore. But and I tried doing it another time with just Moxapole and even that fills up the room. So I need to get some sort of mitigation system going. We used to have these great air purifiers at NESA. So I'm gonna have to ask like what they use because a friend of mine was looking into an actual like fume mitigation system. Thousands and thousands of dollars. Like expensive. We just need something to just suck it out of the air, you know, real like doesn't have to be industrial strength, but something. What do you use? Or do you just open your windows?

Toby: Yeah, my windows don't fall into my hands. Well that's well when you were talking about that, I imagine you had the moxapole burning in your hand as the window's coming. So I'm glad I'm glad at least you had two hands for you.

Angelique: I had two hands, thank God. Yeah, it was it was could have been awful, actually.

Toby: That could have been bad. Could have been bad. How my setup is, yeah, I've got like especially this seems really good. The rooms either have two windows in them or like right out the hallway there's another window. So between those two, it just really you know takes five minutes. It still will smell a little moxy, but you know, the major smoke is gone. So that seems to that seems to be working pretty well.

Angelique: Yeah, my goal is to be able to designate one room as like the Moxa room because I've got some I've had some patients coming through that are really sensitive to sense of things, like any artificial sense or any sort of like really strong sense. So that was my thought is to get one machine to suck out the air in one room and or the smoke rather in one room.

Toby: Yeah. I was gonna ask you something else too. Something I prescribe really frequently, but I'm not I'm just not sure how popular it is. Do you ever use Dongway san?

Angelique: Dangweisan, no. Mm-hmm.

Toby: It's a do you mind if I talk about it? Please. Okay. Yeah, it's it's a it's it's a Jiangjongjing, I think from the Jingui, right? For the chapter. I think it's about like kind of emergency case things for women that are like first trimester and prone towards miscarriage. So it's it's a great formula, and really simple. That's what I really like about it. It's super simple. Like Juan Shi, the 14th century, one of the fourth great masters, I think probably the most famous of the four great masters. He really likes it because it's got Hong Qing and Baiju in it, which he feels that like those is like, you know, historically banned, and I think maybe some modern research, I'm not sure about it, are like really especially good for the fetus. And so it's just really protective for the body for the body, especially if you feel like the miscarriage is due to heat, like this patient I prescribed it for yesterday. It's got just so much heat. And so that's a little bit protective to that Hong Qin in there. So it's a good simple formula. Again, since we've been using for 1800 years for especially for threatened miscarriage in first trimester or so, I feel like, you know, a lot of confidence in prescribing it. So almost routinely I do that for especially you know, usually when I see patients are gonna be first trimester, usually it's it's it's status post infertility and then they just conceived like this case yesterday. So it's just it's just a nice insurance. Nice simple formula and I think it's not used very often, but anyway, so I just want to mention it.

Angelique: Remember learning this formula because I actually I pulled up the Eastland herb app as we're talking to look at it. I remember learning about this. And this is a good reminder because I have a patient now that should she conceive would probably benefit from this. Although, so how do you approach this? Is always one of those controversial topics in herbal medicine. So I've read like warnings around using Dong Wei and Xuanshang. In the presence of a pregnancy because of the moving nature. And so if you look some things up, some things will say not to use them. Particularly because I'll do like a Google search to find out like if a patient were to Google this particular herb, what would they see to kind of be prepared? And you can see you'll see that you'll see that they'll say like, you know, this isn't indicated or it's contraindicated. So how do you approach that?

Toby: Yeah, I feel like, you know, since it's blood moving, I feel like it's okay. Right. I think I think a little bit of gentle blood moving is good in that kind of case. I would never use like blood breakers, like a Sanglang, a Jew, or something like that. I would really I'd be hard pressed to use. But I think a little bit of gentle blood movement, like Gui Chu Fuling Wan, right, with Tao Ren in it, right? That's four fibroids during pregnancy. So I mean that's Tao Ren's so much stronger than Daong Gui and even Chuanxiang. So I feel like Yeah, I think I think it's okay. And again, like if I was building a formula myself, I think I just would avoid these, but especially with so much use for almost two millennia, you know, I feel like, okay, this has definitely been a identified problem and patients have benefited from this, right? Otherwise it would have been discarded long ago. So I feel like it's yeah, moving a little bit of blood in the lower part of the body, I think it's you should be cautious with that, but I think I think it's really helpful.

Angelique: Do you stick generally to the traditional proportions of the herbs?

Toby: Yeah, that like this one. It depends upon if I'm making raw formula or like this one I prescribed yesterday, it's from Classical Pearls makes it Dongwe san. And then Heiner, Heiner Fruehauf again, who sources all that, he gets a special, I forget exactly the Dong We, but especially this is more protective than being a problem during pregnancy too. Again, I forget the details about it, but he sources from a certain area that has the terroir that's correct for it or something like that. Again, it's it's nice to just refer to Heinerfruff figuring all that out and then just be able to prescribe it with confidence. Yeah. But yeah, almost every patient that I've gotten that's infertility that conceives, almost everybody I go to Dongguesan, maybe with a combination of something else. This patient yesterday just by not that. Okay, sure. Yeah. Again, it came up yesterday, so I was thinking about

Angelique: Well thank you for the reminder about that. I have the current herbal conundrum that I have that I'm fully unprepared to discuss fully, but just in general, the things that the one thing I've had a couple of mixed heat and cold patients. For example, one has a history of endometriosis, craves warmth in the lower uterus, like in the uterus area all the time, just craves warmth, like when it doesn't matter, middle summer. Wants warmth there. So I have a heat lamp that usually I'll use that. But the rest of her body can get very hot. I had her try Wenjingtong just to see. Like to I had a patent and I had her use like small dose Wenjingtong just to see. And I'm glad it was small dose because she had a very, very much flair of the heat symptoms. And so I was trying to discern because I was looking up, you know, like why these sorts of things happen. And one of the things I found referencing back to one of our classic texts. As I said, I'm not fully prepared to like have discourse, but it was something along the lines of basically when you move cold that's been there for a long time, that it that cold is covering laden fire. And so you could have a rising of the heat symptoms. So I was trying to discern whether that was that or whether the herbs were just too warm. For her in the setting of having heat in other parts of her body. Like a lot more heat above, but she also had some heat below. Like she had some damp heat in the lower burner symptoms as well as cold in the uterus. So it's that's tricky. I'm trying to figure out I'm trying to figure out a formula for her to take those two things into consideration.

Toby: Usually I do that kind of mix things more with acupuncture, but for herbal medicine, right, I would consider especially since more heat presentation, maybe clear the heat first and then go after the cold. That's that's probably what I do, but again, that's it's difficult, right? Because that kind of mixed presentation, right? You have to be careful.

Angelique: First. Thankfully they're a good sport and open to trial and error. So that's good.

Toby: How do you research like you're saying before you research that you start to research that? What do you what's your go to like resources for that kind of stuff?

Angelique: So I have on my computer a bunch of Chinese medicine ebooks. So I will open and search. I've got a big red one. It's by McLean and Littleton. It's their main manual of internal medicine. It might even be like the clinical handbook of internal medicine. I have that as a an ebook format. And so we'll frequently look that up. I have started using Chat GPT. I've uploaded a bunch of the books that I have to it and have it search for me. That's been helpful. That found the quote from the classics. Cause I had a couple of PDFs of I think I've one version, I think, of this. So I think I've got both the Suean and the Ling Shu on there. Anyway, so I had it look up references for that and then went back to them and was reading about that. That's my those are my two main things. And then I'll bust out books that I actually have that I think and like physically look through. But my go to is usually the ebooks first with a search function.

Toby: You're looking for symptoms or what are you searching?

Angelique: I started with I did a heat above cold below search and then I'll look at and like I'll look at Western so you say I'll do endometriosis herbal formulas like I'll still search by herbal formula and then if I'm not quite sure that's when I'll go to the actual physical book and look at their table of contents and then start searching by condition. Like I'll look at different conditions. So they yeah. So that's how I've done it. Do you have a more refined approach?

Toby: No, that's sometimes also I have reached out to mentors, right? So that's that's still what I do. You know, so because again, I feel like a little of a disconnect when I look at just text, right? Because I feel like they didn't have to prove anything. Like especially I look like machiaves text or something like that. I feel like they didn't have to prove anything. I spent my first like year or two in practice looking up they still have gold machiaves, right? It's the really thicker one. It's more

Angelique: That's that's version two.

Toby: Yeah. So I would look through that and then it just never worked, right? It never worked, that kind of thing. So I try and reach out to actual clinicians. That's one of my main things I like to reach out to. I a couple of people that do DERM. I meet with my teacher, Dr. Wu once a week. You know, I just I really try to I don't know. I feel I feel like I reach out more to practitioners, but I used to more look to books. So I was just curious about your thing.

Angelique: Yep, I'm definitely into the books realm. I don't, I mean, this is probably blasphemy, but I don't I don't love the Machiogia reference books for the reason that you're saying it they just it's a little bit too dry. The other book that I the mu the McLean and Littleton book has a bit more of in depth discussion about each. Yeah. Yeah.

Toby: I don't know, not sure if that's blasphemy, but that's my experience too, right? Is yeah, that's a little bit more textbooky theoretical things. And then but I think it's it's so great to talk to clinicians that have seen 10,000, 30,000 patients, right? What do you what do you do in this situation, right? Then that's I don't know. I just feel I feel like that's better and then more interactive too, because otherwise you're reading the book and you have like further questions and things like that. So, anyways, that's I feel lucky to be able to reach out to mentors and things like that now. But it that Anyway, that's my most reliable research now. And then especially now it's it's dec two and a half decades in, right? So now I need I have less questions too. But that's just always kind of nice, right? I then I kind of draw well, I just draw my own experience a little bit, right? So that's that's something to look forward to.

Angelique: I look forward to it very much. I had have I've had several new patients come through. I'm now hitting an up uptick again, so I'm seeing twenty plus patients per week now the last few weeks, which is nice. And so one of them it was I've so like it was

Toby: All right. What else is on your mind?

Angelique: Handing the son, it was handing the Sanjo excess to me, just like on a platter. It just unbidden sitting there doing the intake. And I had, I had no intention. It was a very brand new patient. And I don't, you know how you know how I am now with like haven't fully, you know, been super brave about doing first patients with some. But I'm just sitting, I'm thinking, I'm like, So she was just, you know, big, bright, big, bright blue eyes, very sensitive, very polite. Talked about how like hot and flushed. They get in the upper body, and how they have just like perfuse sweating, but then also have like a really hard time regulating their temperature. Like sometimes they get really cold, and she's like, Yeah, and when I get these, like she gets these migraines and it happens on her left ear. And she's like, as a matter of fact, it's the left side of my body that just gets everything. And I just was like checking off the boxes.

Toby: My needle finger's so itchy.

Angelique: I was like, so then of course I don't know, I was feeling a little cheeky that day. So I was like, tell me where I'm wrong. I was like, do you just love a rainy, cloudy day? It's just like kind of drizzling. She's like, Yes, I absolutely love those days. I was like, good, good. And I was like, and when people are, you know, kind of impolite and not thoughtful, like, how do you how do you feel about those kind of people? And she's like, I can't stand it. It's it's awful. And I was like Okay, so I do this kind of this kind of acupuncture. You know, and I explained it and I did it. And she said something interesting that I had never heard before. So I she tolerated the insertions well. I didn't prepare her for, you know, I didn't preamble because I stopped doing that. And she's like, you know, the first one, it was like, that's a lot. She's like, But the other three at the end of each time, it was like happiness. Yes, I was like wonderful. I'm so glad.

Toby: If only all patients would be like that.

Angelique: No, yeah, it was it was great. It was just it was I was like laughing internally the whole time. It was as if she was like reading the book to me and just like reading off all of the things that could possibly have been it.

Toby: Sometimes I feel like that when people come in, I'm like, come on. Yeah.

Angelique: Well, that's that's the first time it was so obvious. I'm like, please do this every time. Send all of these people to me who just are very obviously one symptom, like one channel excess. Thank you. Thank you very much. And then she loved it, which is good. And I had another patient come in too, who had Som from a previous acupuncturist years ago, also a constitutional Sanjo excess.

Toby: That's great.

Angelique: That you know when I was talking to them about the different kinds of acupuncture that I did was did not want to even consider Som at that time because they said that when they had it, when the liver supplementation was done, they always felt great. But if any other channel was supplemented, they would feel worse than when they came in. So they were feeling really reticent about trying it.

Toby: Yeah, I again I can certainly understand that from patients' perspective, but especially if you know that practitioner and you could reach out to what they did, the other channels, because you could just do the reverse of all those other channels they've taken. Okay, right. Because for sure that'll be right then, right? Yeah. Because patient response is the most guiding thing that we have. So I can from the patient perspective, I can certainly understand that. But actually you've got a lot of keys to the kingdom from that information if you can get it.

Angelique: Yeah. I'll have to think about it. Yeah. Those are the those are the main rise to the top stories from my week.

Toby: Okay, yeah. Where do you think that uptake's coming from?

Angelique: I don't really know. I there's been more word of mouth that's happened. I don't know how much spiritual waxing we want to do here, but I sort of released my death grip on the need for more people. It was it was sort of along the lines of what we talked about in one of our previous episodes where I was trusting the medicine, and I'm not sure that I articulated that the way that I wanted to. In trusting the medicine, it's like knowing that it will work. Like you will put the needles in, you will do and it will it will do its thing. Like when you've diagnosed, it's like trusting that this system will work. And it was along those same lines of I sort of released that like fearful grip of, my God, what if the patients don't come? And at least for the moment, you know, a few episodes down the road, let's see where we are. But at least for the moment I've kind of let that go and In that letting go, all of a sudden all of these people have appeared, all of these new people, and people telling me that they're referring their partners or their friends, or and then the people are actually coming. So that's been an interesting experience and a lot less stressful for me. I just sort of like surrendered to the process, I guess.

Toby: Yeah. That's fantastic. My teacher, Dr. Wu, she'd see 150 patients a day, right? So w the most successful accounts I know in person, right? And she always says, Patients stop coming when I stop doing my homework. And I was like, even you? She said, Yeah. You know, if I'm not doing it, like you're saying, just trying to do that self cultivation, like I've got to release this death grip, right? And then you do it and then patience come. So that was her experience. That's my experience. Sounds like that's your experience too, right? If as long as you do your homework, patience will come.

Angelique: I expect that to mean literally, Toby, like doing my homework, like going home and hitting the books.

Toby: Yeah, then she wasn't talking about that. She's a Taoist, so book cultivation's part of it, but self cultivation is the major part of it.

Angelique: Okay. I like that way better because I put myself through too much homework as it is.

Toby: You know, you know that Taoist saying, right? If you seek knowledge, right, try and gather something every day. If you seek the Tao, try and lose something every day. Yeah. So that's she's more of the lose something every day, right? Again, that we're loosen that grip, right? And then patients recognize that energetically and then they tend to come. Again, because you'll be a much you'll be a much better practitioner for them. And so that something about that you just get tuned up with that.

Angelique: Yeah, it was it was a profound play had a I had a dip, goodness, who knows? A few weeks ago I had a dip below like where I where my minimum I think it was like a dip below 15. I think I had like 13 patients one week and I was all in like a pit of despair, you know, and trying to remind myself what you had said that things people come and people go, but you know, going down the negative self talk, you know, like I just must be terrible and then just being like, cut it out, you know. I don't know. I had a moment where I was just like, Well, this is gonna be what it is and it's gonna be okay. And the people who are gonna find me are gonna find me. And I and I connected with that in a way I hadn't before. And it and I felt something shift inside of myself, like just relax. And I have the last couple few weeks have been able to maintain that relaxed position and all of the people like I have another I have a voicemail on my phone like right now that I got before coming to do this with you, that of another patient wanting to be seen. So Neat.

Toby: I don't assume this is gonna be a problem managing all the patients that are coming. I know, but I'm saying that th that's gonna be this could be a new problem. You're gonna the now you're letting the death group go into, you're gonna have to be like, okay, how am I gonna manage all these people?

Angelique: So far no, but We do it. For the death grip back on. No.

Toby: Well that's right. Maybe yeah, release your cultivation and pull back. Yeah. That might be that's good. I'll run that I'll run that by Doctor Wu and see what she has to say. All right. Anything else for today? Anything else pressing?

Angelique: I don't I don't feel that good. No, do not. No, no. I don't think so. Anything for you on your end?

Toby: I've got always got tons of things I want to talk to you about, but let's leave it for next time. Remember coming forward, our next episode, we're gonna have our first guest. And then I'm gonna put up on the screen here the email to get in touch with us if anybody wants to contact us about questions and things like that or ask us about anything. So that's I'll put that up here. I've been neglecting to say that. So I want to remember to I'll put that on the screen right here. All right. Let's leave it here for right now. It's always nice to see you, Angela.

Angelique: Yeah, that's right. Awesome. Nice to see you too. We'll see you time.

Toby: All right. Bye, everybody.