Office Hours with Angelique and Toby, episode 13. Released November 19, 2025. 56 minutes.
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About this episode
Maya Joshua, an acupuncturist in her first year of practice at an insurance-focused clinic in western Massachusetts, joins Toby Daly and Angelique Britt to talk about the realities of bringing Saam acupuncture into the clinic. The three compare licensing exams, worry about school finances alongside growing demand, and discuss helping patients advocate for themselves amid long waits for primary care.
Maya describes a treatment that turned out to be unexpectedly distressing for a patient and what it taught her about candor, consent, and rebuilding trust. The hosts reason through cases together: a patient whose sweating and dry skin complicated the diagnosis, supplementing the bladder channel early in an external invasion, a self-treatment that went wrong before a switch to the pericardium, and how to choose a treatment around the most prominent current imbalance in a mixed damp and dry presentation.
Topics
Maya's first year in practice
Licensing exams, school finances, and access to primary care
Referring out for red flags and patient advocacy
Needling discomfort, consent, and rebuilding trust
A case complicated by sweating and dry skin
Bladder supplementation for early external invasion; gua sha in short appointments
A self-treatment lesson: gallbladder versus pericardium
Small intestine excess and avoiding judgmental labels
Mixed damp and dry presentations; moving between Saam and TCM
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.
Gua sha (刮痧): scraping the skin to raise petechiae, used to release the exterior and move stagnation.
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.
Toby: Hey Maya. Welcome to Office Hours. How are you doing?
Maya: All right. Very glad to be here. Thank you, Toby. How are you?
Toby: Everything's going really well with me. It's really nice to have you as our first guest. I wonder if you might want to give people like a little bit of your background, your like educational background and your practice experience so far, if you don't mind. So as we discuss everything today, people have a little bit more of your background.
Maya: I'm a recently new practitioner. I graduated last year in August and got licensed in California in October and then finished my national licensing process in December. So I've been practicing for a little under a year. I'm now living and working in Northampton and western Massachusetts, which is how I met Angela at a practice called Whole Body Healing, Acupuncture and Wellness, where there is a an acupuncturist named Liz who started the practice and over the years has hired three other practitioners to work with her. It's a clinic that primarily sees insurance patients, which is an amazing magical thing about being in Massachusetts, which I know Angelique has spoken about on this podcast. And so I've been there for about three months now, maybe four, and really enjoying it.
Toby: Any type of specialty associated with that clinic or is it just general health?
Maya: The clinic doesn't have a specialty wholehearted generalists. Of course, every practitioner within the clinic, there is a total of four of us. Every one of us has some different leanings. I would say Liz and Tim practice pretty much traditional Chinese medicine. But having observed them both, you know, and they've both been practicing for a number of years, I think Liz has been in practice for 17 years. I've noticed they do a lot of palpating. Things that, you know. One can say a practitioner practices primarily TCM, but that too can look so many different ways. And we, of course, so the third practitioner, Melanie and I, both trained at acupuncture and integrative medicine college in Berkeley, California. And that of course teaches towards the California boards, which are traditional Chinese medicine. And yeah, we enjoy sort of different things, but Neither of us has really gone down any very specific rabbit holes, with the exception of me taking your CEU through White Pine Circle in June and then going down the Som rabbit, which I've been enjoying.
Toby: Great. Okay, that's that's great to hear. I look forward to exploring that a little bit with you. What about how was your experience with Kale? And think about before you answer that, I've written a couple dozen questions for it. So be careful with the way you use.
Angelique: Be honest, it's okay.
Maya: How is my I actually I thought it was quite a friendly exam considering the psychological warfare that I had been going through prior. It's funny with today's political climate, you really have to worry about you really have to take into consideration how dramatic you are with your language. Hard to compare an exam, this of what's going on. That being said, it's it's exhausting to prepare for something, the dimensions of which you aren't sure of and the scope of which you aren't clear on, or the scope of which is so massive that it threatens to like eat you whole. I thought kale was much more reasonable and friendly than nationals. Hands down. Yes, I would take Kale four times over taking any of those national exams.
Angelique: Really? No kidding.
Toby: That's great. If you if you guys ever have the opportunity to work for the boards, I strongly encourage you to do it because the compensation is really low. It's kind of hard work and things like that, but it's really rewarding to just kind of shape you know, like the entry that students are going to take into the profession. It's really nice to get we had so many, like when I first got there, so many really bad, confusing questions. And so it was really nice to clean those out of the way and try and write make some more straightforward questions. So if you guys ever have the opportunity, I really encourage it.
Maya: Well, I'm very grateful for that because nationals are confusing and it seems counterproductive for what we're trying to do, which is get more people in the profession, right? Yeah. So
Toby: Right. Yeah, I have a little bit of news about that. Speaking about getting more people in the profession, I was just reading yesterday. I'll put a link about it in here about we have another Chinese medical school, Dr. Hammer, you know, the Sean Hammer pulse reading in Florida. Somebody's doing a like a reporting on like how the schools are doing and the financials for that boat for that school are horrible. And they were they were conclusion was it's surprising they're even letting anybody in anymore. So I'll put a link to that article. But I again just another Chinese medical school in trouble. And this really concerning I don't know the solution to this, but this really concerning for me just how much how much strain. The schools are going down and then and as at the same time as the demand for Chinese medicine, so much ill health out there and the demand for Chinese medicine going up. So we're not sure where this direction this is gonna go in. But again just more concerning information I was reading yesterday.
Maya: Great Toby. Thank you for encouraging us first to take hard work and second for giving us wonderful news to Brighton.
Toby: Right. But anyways, this means more patients for new practitioners. So I guess that's we wanna look at the silver lining of this, right? Not many more people coming through the shoot, practitioner wise. So we're gonna all be pretty busy.
Maya: Yeah. It would be great to have more people coming through the shoot. It will be interesting, especially like in Massachusetts. I don't know how things are going in California right now, but in Massachusetts, this year primary care you're needing to book out. They won't see me till April. And this was booked three months ago. Yeah. So almost a year. And you know, in California we can acupuncturists can be primary care practitioners. Here we can't, providers here we can't. But we still sometimes are the first medical practitioner someone sees with a condition who might say, This is a red flag, you need to have this looked at urgently, because they might not be seeing anyone else. And my boss, Liz, was just telling me the other day that whereas it used to be even five years ago, when she saw a concerning case and she said, Have you spoken to your primary care about this? 80% of the time the answer was yes. She said, now 80% of the time or 70% of the time, the answer is, well, I have an appointment with them in three months, but I'll tell them when I see them.
Angelique: I concur.
Maya: So yeah. Mm-hmm. Concerning.
Toby: What about Angelique, especially with your dual background? Is that do you do you really push the patients more when you see those red flags? Can you okay. Even if even if even if they can't get care, what do you have any I'll send them to?
Angelique: Urgent care. Yeah. You know, if it's that much of a red flag, like with the patient I talked about, I think in the first episode when there's like a raging infection happening, like you need to go to the hospital. You need to go to the urgent care, at least urgent care first. You know, if it's something like nothing life threatening, like I haven't seen anything truly life threatening. I mean, one could argue that may have been had it been let to marinate for a while longer, but something of a more urgent nature, urgent care is faster usually than the ER. They're not spending hours and hours there. And they'll at least get screened to see if they then have to be going to the ER or not. So it's at least getting a point of contact with somebody who can, you know, evaluate, prescribe medication, do labs, whatever, or send them to the next level of care. Yeah. I've done that on a couple of occasions.
Toby: I never thought part of my job was gonna be talking people into going to see Western medical doctors. I again I just I'm I'm just so surprised about this because I thought patients were gonna be coming already like you know, not so traumatized from the Western side, right? That's that I think that's a big problem. People tend to, you know, it's it's hard to get in, expensive and things like that. But also some of their experiences they've had are been so traumatic for them that they just don't want to take it on for even really serious things. So yeah, I just I never foresaw that being, you know, a you know, a chunk of my job is to talk people into definitely try and go. So
Angelique: Or being the ones that help to reset the nervous system as a result of someone having gone through the medical system or who is currently going through the medical system and going through multiple specialists. Like I've got a patient now that's going to multiple specialists. And she was like, Every time I go to someone, they just order more tests and then it's more waiting. And it's just like helping them cope with the constant waiting that will then yield another result, sends them to another specialist. It's like a hamster wheel of doom in the medical system. And then the specialists don't talk to each other all that well. So like results are coming through and aren't getting to the next person. And it's really it's it's very nerve wracking for people. Yeah.
Maya: Wonder sometimes about coaching patients in the sense of advocacy, right? Because as you know, Angelique, because you've been part of the Western medicine system and Toby, it sounds like you know through your patients, but probably also through your experience, patients who aren't advocating for themselves in the modern Western medical system are more likely to get often likely to get hurt or rather than helped if they're spending a lot of time in it. And so how do we as Eastern medical practitioners who have a modality that really believes that it is your body that is doing the healing and your health really is in your hands and you have the power? How do we sort of empower our patients to move into that system with more of a voice and under an understanding of their own needs so they can advocate for them? It's hard to do in the short time slots we have.
Angelique: Sure. That and the generational issues that happen. So in the older, like north of 60, like older boomer, like younger silent generation folks that believe the doctor is right and they don't want to be a problem. Like I've had so I've had instances where a person has been you know, complaining of a symptom that has long gone untreated and that they didn't feel like their provider was really talking to them and they didn't really understand some of the instructions they were given. And so I've I've helped them to advocate for themselves to reach out. Cause like I don't want to be a problem. I don't I don't want to you know annoy them. I know that they're busy. Like I've heard that a lot of times and I've bounced it back and said, you know, this is your like what you said, Maya, like this is your body, this is your health care, this is your important. And I promise you they're not judging you. They are so busy, they're going to address your concern. And I can almost guarantee there's going to be no judgment attached because I mean the honest thing is that they're just they're whipping through these messages. It's usually a nurse that's triaging the messages from the portal anyway, you know. So just like reach out and get the information that you need. And you're not doing it in a disrespectful way, you're doing it in a way that's helping you to have the peace of mind and get the care that you deserve and that you need ultimately. Yeah. Wild times we're in, folks. So many ways.
Toby: Yes. Yeah. I again I always think about this. It's so nice, since we're a team of one, right? It's so nice it doesn't go to somebody else and lose track of it. It's all our responsibilities, right, when patients come to see us. So I feel like that is sort of nice. We don't have to nobody else lets us down. We can only let the patient down, especially since we're just solo, mostly solo practitioners.
Maya: We let ourselves down.
Toby: Yeah, some we could do that sometimes. Yeah. Ideally not. By how much psalm are you practicing right now? Is there is there is it emphasis for your practice or?
Maya: It's an emphasis in my practice. It's been fascinating using it in the clinic, especially because my colleagues in this practice, so the ones who have been there a long time, the two of them use 16s and practice a kind of acupuncture that is very, very gentle. And I think as a new Saam practitioner, I imagine that my as my skill improves in general with needling and specifically with PSM points, there will be less discomfort involved for my patients. But especially as a new practitioner, so I'm can involve quite a bit of discomfort. And it's actually been very validating to see in the videos where you are showing point location that even your patients, even with your skill, right, and your years of practice, the points in and of themselves can be just uncomfortable. But yeah, I would say I'm practicing, but it really depends on the day. There are days when 50 or 60%. I mean, I'll see anywhere from eight to eleven patients in a day. And I work about three days a week. It's it's shifting a lot because I'm I'm a new addition and this is the first time the practice has had four people. So they're figuring out logistics, but sometimes I'll practice it on half or more of the patients that day and someone just sometimes just two or three treatments. But I'm now at the point where I'm using it, I would say at least a couple of times a day.
Toby: How do you decide which avenue to go through?
Maya: Whether some or traditional Chinese men is well, if I can at all use some, use some.
Toby: That's how you rank it, right? If it feels like it's you got a good diagnosis, then you follow that.
Maya: If it feels like I've got a good diagnosis and I feel like the patient is an okay candidate, so I've actually I've moved away. It's hard to say sort of your advice when I think sometimes we're watching videos of yours and taking notes, and everything you say lands is sort of like as if you wrote it down in stone when really you're having a process and teaching and may make comments that are contextual or were true at the time, or you didn't mean to have so much weight behind them. But in my book, Toby says like. Don't warn them about the pain, right? And so I've had an interesting sort of evolution of how I talk to patients about the needles. I've learned so I had one case that I mismanaged quite badly with someone who's had a fair amount of medical trauma. And I really surprised him and he came in the f with the I, you know, I explained a little bit. This is a modality that comes out of. Korea and it's a straw modality, and I think it could be very supportive. And I think you're a good candidate. But I didn't give a heads up about the intensity of the needles. And I surprised him, and he came in the following week. This is someone who had like treatments, too much electroshock therapy, and they like damaged his short-term memory and just like a lot of medical trauma. And he came in the following week saying. Essentially he looked at me and this is someone who's not usually very direct and he said, What happened last week can never happen again. I spiraled into like PTSD from that treatment from just from sort of the breaking of the trust between us. You know, and I apologize profusely and shortly after I start we actually we wear white coats and shortly after that I started taking mine off when he comes in. Great. And that was helpful. But yeah, and then so I slowly move to a language that's more like there it only uses four points because I'm in my first year. I only I use the four points at every Saam treatment. The needle sensation can be pretty intense, I say. And then often patients ask, Will it hurt? And depending on the patient, I've just learned that I'm actually better off being really honest and getting buy-in. And actually for the first time last week. And so I've been doing I've been practicing some first on myself and then on patients for maybe about four months now. And for the first time I had to stop a treatment because like I didn't get all four needles in because the patient was yelling so loudly that I was there was just no way that I that it was legitimate for me and her or for anyone else in the building to keep putting needles in her. Yeah. That was interesting.
Toby: That's too unusual, you know, from my experience, that's two unusual things, right? For the patient to come back the following week and just that never can happen again. And then also not able to put all the points in and yelling so badly. So that's again, I think probably I don't have that experience now just because patients are so self-elective selective, right? Mostly word of mouth, and they just say it's gonna be four points, it's probably gonna be uncomfortable. And so patients are coming like that. So I think this is probably the most difficult time as you're getting your needling technique really refined and then just people don't know, right? So that I think that's that's just a that's a tough spot to be in.
Maya: And I mean the other the person the person who was yelling so loudly, it was the stomach supplementation, which I don't consider like of the more painful psalm treatments. That being said, we it's also different speaking to my colleagues in California, seeing primarily insurance patients and seeing patients who are paying out of pocket in California, we see pretty different demographics, just in terms of people who can afford to spend what they spend on acupuncture in California. And people whose insurance covers acupuncture here in Massachusetts. Even just that. So
Toby: Yeah. I feel like yeah, my cash patients, they just want the problem d out of the way. So, you know, I think yeah, that is that's just a really different dynamic, right? And maybe insurance people are looking for a more relaxing experience or something like that. You know, so yeah, you may not be able to serve them properly, especially if it involves ging wells. So but anyways, from my experience, right, patients want something done in that visit. So
Maya: Right, right. This is very different, right? Where I whereas I have anywhere usually from twelve to thirty-six treatments with transplant. And that of I've also learned maybe to build a little bit of rapport with a patient before I even suggest some if I think they're a medium on the pain. Angelique, I don't know if I told you this or not. The other day I was needling one of Tim's patients. He was on vacation and she was seeing me and I thought she was a good candidate for some. I explained it and then I started needling and she had the best line anyone's ever had while needling. She goes, Well, you're not making any friends doing that.
Angelique: And it's a
Maya: That's okay. I have a lot of friends.
Toby: That's super funny. Yeah, it is. Yeah. It yeah. Some sometimes I do I do especially patients sensitive patients, I do check in at the end of the four and say, is our therapeutic relationship still okay? You know, so that's that's what have been the friends' realm, yeah.
Angelique: That's almost as good as a patient of mine that tells me that she comes to me to get punished to feel better. Yes.
Toby: But there's no free lunch, right? I mean again, you if you really want something to happen in the body, the there's a little price to pay. So sometimes needle discomfort, right, is that price to pay, right? There's there's nothing that really happens in the body without something you have you have to stimulate it a certain way to get a really big effect. So again, yeah, if patients aren't aren't up for that, at least for from my practice, then I just refer them to somebody else if they're oak you know, that doesn't want to do strong sensation or something like that. But like I said. Everybody it's self selective, I guess at this point, but everyone's coming in like, Okay, it's only four. It's I'm you know, he helped my friend, my brother, you know, my son, every you know, so th they're just they're so prime. So
Maya: Yeah, you also have better. I mean, you're sort of in a different landscape, right? Just being where you are with your success rate and your experience and being in the first year practice, different landscape.
Toby: Yeah, yeah, yeah. That but I still I mean I remember that acutely, yeah, getting started, right? And just so unsure about the diagnosis, so unsure about the point location, so unsure about the needle thing. I mean, it just so much question marks, right? And then just kind of hoping that went well. So I st I still I reflect back on that acutely. So I can really sense that. Yeah, the I mean the key thing is that there's no substitute for clinical experience. You just you just have to keep layering that clinical experience and then that's yeah.
Angelique: And even if that means some bumbling on the way through or making people scream or having those hard conversations.
Toby: It has to be like that. Yeah. They have a saying in China, right? If you want to be a good calligrapher, you've got to waste a lot of paper. And so I mean, as clinicians, we have to, you know, we're going to make some errors, right? I it just has to happen. The nice thing about the solemn system is you can correct all those errors, right?
Maya: Okay, so I have a question about that. I it's it's a case. I had someone come in, big guy, slightly dry skin to the touch, but sweats a lot, wakes up at night so sweaty that he needs to change his shirt. This is happening like four times a week, complaining of numbness in his and bilaterally, but primarily in his right hand. So I supplement large intestine, thinking that even though the skin is a little bit dry, All the sweating would indicate that it might make sense to dry in and out. And he comes back three weeks later and tells me that it's never been as bad as when he left. This is one of the only times I've given myself the wrong treatment, and that was terrible. And I've seen patients not improve and wondered. And I've seen a lot of great success, which is why I keep. Being so enthusiastic about it. But this is the only patient I've had come back being like, I'm worse. And so, but I was so two things. First of all, he was he was new to acupuncture and he was new to me. So I wasn't, I didn't feel like I was going to supplement his spleen channel and main and keep seeing him. I was like that, I need, I need a little bit more to this relationship before I can do that. But I was also hesitant. So I Did sort of a TCM treatment and I got him back to baseline with that TCM treatment. And then I saw him again and I gave him another TCM treatment, hoping to gain some improvement and gain some rapport before I go back to Saam, which I would like to do. But do I, do I, in that case, in your world, Toby, would I then supplement the spleen on someone who is has excess weight and is sweating a lot because large intestine worsened their condition?
Toby: I'd like to Angelique to answer this and then
Angelique: I knew you were gonna do that.
Maya: Well, she's prepared 'cause I've asked her already.
Toby: Okay, okay. Sh she Angelique's getting to know me.
Angelique: Goodness. This is the person. Okay. I think I remember because in the chat you had mentioned it, right? Okay. So I was out I asked a lot of other questions. I asked like what the inside was like. Was it dry or was it wet? I remember I mentioned you had mentioned there are other ascend there are other I remember ascending symptoms. You had tinnitus, was that one thing that you had mentioned?
Maya: I run a lot of my I text Andrew so edge like about a lot of my cases, so you're understandably mixing that up.
Angelique: Okay. I guess in this case if the if it went that bad, then yeah, supplementing the spleen. If you know for sure that the large intestine made it bad, like for that's like that's your way. You're like, okay, I know for sure this is wrong. So he must need the spleen. Yeah. That would be my answer.
Maya: Good questions.
Toby: Yes. That's that's my answer too, because the only thing you know for sure is the patient's response. So if you're sure it's from the needles, right, I would really drill down on nothing else you did, nothing, you know, something else that a lot of patients they want to attribute all the bad things to acupuncture and all the good things to something else that they did. So I would drill down to that, but if you're sure, then you I would do that. And then also, I mean, look for again, because it's a metal earth. Phase that we're discussing right now, the body type is predominant, but that's not exclusive, right? So I would look a little bit more in the personality a little bit too. It's see if you can see something else, some other sign. And if you can see even a glimmer of that, then I would consider spleen. Because again, it's all theoretical to you put the needles in and then get the patient's response. If you can really trust that response, then for sure it and it's so against what you're looking for, then it I mean it just it lays it up for you that it needs to be done the other way. So
Maya: Okay. Yeah. Thank you. I do. I see a glimmer. He's stubborn as all heck. And he Yes, I th I think I see some large intestine excess in the personality.
Toby: Yeah. If it makes you feel any better w how you presented it, I might have done the same, right? Especially for that numbness, with that sweating at night. Yeah. Okay, good. But yeah, but part of that caution, right? If I saw that really dry skin, right? That's right. Maybe.
Maya: It would have been maybe a safer
Angelique: It's confusing when that happens though. I can relate when someone's really sweaty, but like under the sweat, they're dry on the surface. Cause you're like,
Toby: Yeah, I tend to what are they doing most of the time? That's sweating four times a night for a little bit of time. So that's you know, it's mostly dry, but with some damp. So I would I would just go to that, you know, it's more baseline dry. And then with that stubborn, right, then that's again, it's completely reasonable to do this, to supplement a large intestine, but with those new ideas and that response, right? Without that response, there's there's there's no reason to supplement split.
Maya: Right. Is there anywhere, Toby, where you talk about external invasions and some?
Toby: Yeah, talked about that a little bit. It's it's just basically like you already understand the fundamentals of the system, right? Small intestines good for wind, you know, real extreme heat, you can do bladder, minor heat, liver, all those kind things, right? So depending on how it's going in and phlegm, you can treat dampness wise, but there's a special part for the SOM system for really early stage external pathogenic invasion, then we use the bladder. And I've been able to do this a few times. And when people are just coming in, say like half a day or a day in, they get the sore throat and they feel like they're gonna go down, then the ladder's been amazing.
Maya: Good to know. Thank you.
Toby: If they yeah, if they don't need the really cold nature, then my teacher would only do the two points, large intestine one and stomach thirty-six.
Angelique: Why that one? Is that because of where we get the invasion? We're trying to I'm trying to think of like dis it's descending the bladder channel. Explain. I'm trying to visualize why it works.
Toby: Yeah, because the Tai Yong, right? So we're we're just flushing the Tai Yong. This is a little bit risky, right? Because let's say it is a cold invasion. I mean, you can do this for wind cold, wind heat. You can just flush it. But let's say it's a cold invasion and you haven't caught it on the surface and doing bladder that's a little that's a little bit risk. Well adding, you know, cold to cold. But like I said, early stage, you know, decent robust you know, presentation for the patient, then that's I mean, it's really yeah, it can be like magic. So everything that you already know, but that's a special one for external pathogenetic factors is a supplement bladder for.
Angelique: And only the first two points if they don't need the cold. Okay. Thank you.
Maya: Thank you.
Toby: Mm-hmm, yeah, of course. Yeah, they do.
Maya: A good time of year to be having that indoor.
Angelique: Gua sha. Yeah. Gua sha too. I like to do guasha when people come in with the cold.
Toby: It's not part of the solemn system, but okay.
Angelique: It's so good. Do you do gwasha? Maya.
Maya: I do gwa shaw since we got together at a cafe three months ago and you were like I'm crazy about gwa sha. I do gua sha more since then. Okay. I do it when I can fit it in. You know, I really a lot of my calculations are around time and I hope to become more efficient with that. I really time management can be, I don't think it's hard for me specifically. I think there's just I'm ambitious and
Angelique: I just
Maya: I think in your last you guys Toby was saying you do twenty five percent of what you want to do with your a first time patient and that was helpful. I'm just like I'm so trying to bite off more than I can chew with patients. And so often I can gua I'll gouacha if I feel like I have the time.
Angelique: How much time are you having per patient?
Maya: So we see a patient every half hour and we have a front desk, right? Like you see a patient every half hour and you don't even have a front desk.
Angelique: Modified, I'll tell you, because I don't go every half hour continuously anymore. That was nuts. That was crazy making. Nope.
Maya: Yeah, that's that's but yeah, every half hour and we don't need I don't need to deal with anything beyond treating. But or I do if I'm giving them herbs, granular herbs, then have to measure those out and we're figuring things out still.
Angelique: Mm-hmm. That's quite a pace. Usually. Unless someone's super, super stressed. Like if someone comes in the room and they're like vibrating with energy and they're like so stressed out and they're they're like they're they're elbow like this presentation or they're like their shoulders are up by their ears and they have some neck pain and they're like freaking out. Like you can feel the crackle of energy on them. I'll sometimes start with gua shaw just to relax them to then get them on the table. But that's rare. Usually it's after.
Maya: You do gwa shot after needles though, right?
Angelique: When someone has early stage EPF gwasha like to the neck and upper traps is has been really helpful. It kicks it opens the pores. It's like it's like manual exterior pathogenic factor. Yeah. Thank you. It opens up the pores and kicks it out. So I've had that help with either stopping the invasion or having it be less. Yeah.
Maya: Okay, good to know. I recently started coming down with a cold and made the mistake of deciding that I was over it before I was over it and went back to taking my Xiao Chai Hutong and plumb it in myself into the depth depths of I don't know exactly what how that worked with the herbs. My herbal game is not particularly strong, but it's so I got so sick, boom. Like
Angelique: Do it to make it worse.
Maya: Dri throughout that day of taking the Sha Chahu Tong, unfortunately too late to realize after I take in the evening dose. I was like, I but there may have also been some other you know, we love to blame the Arabs. There may have been other things going on. Yeah.
Toby: Yeah, from my limited experience though, sometimes Xiao Chai Chu Xiao Chai Hutang will do that though, right? Just release other pathogens that are in the body. So especially that complicates healing. So
Maya: I see what you're saying. You're saying now I'm really purged and I'll feel amazing in a couple of days. That's great to know.
Toby: Yeah, you'd be much better on the other end of this, but it's it's best not to complicate it at the time. And also I think it's so much better. Any kind of clinical experimentation on yourself is so much better than on patients. So that's good. Yeah, but
Maya: Great. I finally supplemented the lung channel on myself after a long time of hesitating because I consider myself so damp on the inside and damp on the outside that I was scared to supplement lung. But it was probably one of the more successful, more impactful sound treatments I've done on myself. So I actually did it today, being like, Okay, my waii chi needs a boost and it I felt quite a lot better.
Toby: That's great. What w any other factors that besides weight G need a boost that you thought about today?
Maya: Mostly honestly, I today I was like, you know, at like thirty percent c cognitive capacity. I was feeling pretty icky and I was like, okay, well, not this one, not this one, not this one. Was a little bit of diagnosis of elimination and just knowing that it's worked in the past. And well, just like, you know, feeling a little bit of restriction in my breathing. And no, I can't say that there was too much thought went into it other than it seemed like a safe bet.
Toby: Yeah, but especially that's good to especially th that's the best way to put qi in the body by supplementing lungs. So I think that's really reasonable with that kind of presentation. Okay, nice.
Maya: That was the reasoning.
Angelique: I'm curious about what your wrong treatment of self was and what happened, if you feel comfortable telling us.
Maya: So I am, I am a like very clear gallbladder excess in constitution. Like I will fight at the drop of a like I am always I've had to really unlike learn some behaviors because constitutionally I'm just like very gallbladder excess. And I was actually texting with a colleague of ours about something that was going on with me. And I had supplemented pericardium before and had felt and had been good. But on this day, something was going on. And I was texting with a colleague who also practices psalm and I don't think doesn't see me as the like aggressive and sane person that I am on the inside because she has such a loving view of me. And so she was like, Well, maybe gallbladder could address this and this. Like, and so I supplemented gallbladder on myself, and every needle was so excruciating. I mean, and when you're when you're practicing psalm on yourself, like First of all, I'm starting with my left hand on the right side of my body. And they're thick needles and I'm not experienced. I'm doing them slowly. Like I have to say, when you're doing it on yourself in the beginning, it's painful. And it's exciting and fun and super worth it. But like this was these were the most painful needles I have ever had in my body, even like through acupuncture school when people who didn't know what they were doing were practicing on me. Like it was so and then I finished the fourth one. It was actually really funny. So I finished the fourth one. My partner, my girlfriend was on her way. She was like meeting me at the house like half an hour later or something. And I lay down and I was in so much pain. And immediately I was like, She's gonna be late. She always does this. I'm going to pick such a fight with her when she gets here over this and this. It's just like my and then, but I was in so much pain. I texted the colleague being like, I don't think I can lay here for 20 minutes. Like I'm in too much pain. And the colleague was like, Take him out, balance it out with. Pericardium. So I took him out and I put in pericardium. And I am not kidding. My thoughts turned to like, you're late too, so much of the time. She's trying her best. Like it was such a 180 from like I'm gonna pick a fight to like peaceful sort of understanding. And I was like, okay, we're back. We're back in equilibrium. It was interesting.
Toby: I'm glad you recognize that. You better send a thank you note to that colleague.
Maya: Yeah, I send her money, thank you notes. She's
Angelique: Nice. But now you know what it feels like. Right, the wrong treatment.
Maya: Now I did also this is a curiosity, Toby. One time I supplemented someone had a pretty clear indication for so pain on either side, pain along the UB channel on the back. Pretty acute pain. Level with there was another indication. He like really seemed like a hard excess, darker complexion, so harder to like separate obvious redness, but still like sort of a like a redness to his presentation. And I supplemented UB. Also he'd never had acupuncture before. The needles were excruciatingly painful. I saw the big eyes, like the terror eyes. I took out the needles. There was no way that I was balancing, gave him a TCM treatment. He came back the following week and said the pain, which had been present for like over six months and was really severe, went completely away the next morning for a few hours and then came back. And so at that point I was pretty confused. I was like, it was the wrong treatment. It wasn't the wrong treatment. Then of course, but the TCM treatment I gave him was a three. I put in Shenmen, LI four, and liver three. So a little bit like what Anjalique was also saying the last episode, I was like, that's a really basic treatment, but acupuncture is powerful. Was it the TCM that made him feel so much better? But have you had have you had treatments that you thought were I don't know, I guess, yeah, curious what your thoughts are on that?
Toby: Every day in clinic, right? I'm I'm never sure about anything. And then you always have to wait and see it play out. But especially with those two variables, right? Then you're not sure what gave them that little bit of temporary relief the next day.
Maya: Yeah. Well it's fine 'cause either way he was never gonna let me put more saw needles on him. So
Toby: Plenty other patients out there that are eager to change the change their medical condition quickly. So
Maya: And this is true.
Angelique: They'll find you. And you'll know.
Maya: Well, I have many more questions if that's the direction we want to go in, but we also
Toby: Angelique's ready.
Angelique: Am I? Okay. Ask some questions.
Maya: Perfect. Okay, here's a question for you, Angelique. Something I realized, I also you two are like, this is a podcast for all things Chinese medicine, but then you spend so much time talking about psalm, which I love. I don't want to listen to anything else, but I have wondered if practitioners who aren't practicing psalm are hanging in there. Do you guys know?
Angelique: I don't know.
Toby: We haven't gotten any feedback about that yet, but I thought about that. Yeah. We try we try and mix in other things, but I mean this is my this is my main tradition for acupuncture. So obviously we're gonna talk about it. And it's leaks, you know, going into practice and using this a lot. So it just comes up a lot. But yeah, I feel like yeah, we try and talk about other things, but yeah, that's that's probably that's one of our main that's our that's our G
Angelique: Default. Should probably change our change our
Maya: That's all I wanna talk about, but I was just curious because your tagline, yeah, it kinda says.
Angelique: It's kinda like all things. Yeah. We have we that's a good point.
Maya: When you started practicing, Angelique, so something I realized recently is I started practicing and I was very much like attached to my notes, right? And I never actually so there are point prescriptions that I now have memorized because I've done them enough, but because of the way my brain works, because of sort of well, I could make so up so many excuses, which by the way, I think is a stomach excess constitutional inclination. I haven't memorized the point prescriptions. And I've realized that's really a mistake. Because I yes. Because I need to look at I have them on my computer as a phrase in Jane. So they just pop up. I type in slash stomach plus and it pops up. And some of them I do have memorized. But the need to sort of look back at my computer to see what points I'm doing really pulls my attention away from how well I could be needling point location and sort of focusing on the Dutchie, which it makes me laugh that Toby is like, you can't miss it. I'm like, Toby, you can't miss it. I can miss a lot of things that you can't miss, let me tell you. But did you did you ever sit down my question is did you ever sit down and memorize h spend any time actively memorizing the point prescriptions or did they just come to you with repetition?
Angelique: They still haven't come to me. I use I use a card. I ha I actually have it. This card.
Toby: Well, I'll I'll send that to you.
Maya: But that's does it?
Angelique: I can see it. It has it has it in order of the it doesn't have them paired, but it has it in order of the sequence of the channel. So like long
Maya: But the points cause Toby, you say it needle top down, right? Is that
Angelique: No, they're not in order. It goes like a major
Toby: But I think it's more important, yeah, it's to make sure you're supplementing or draining. So that's why I grouped those together rather than top to bottom. So I had to make some decisions with that card. But my I'll send you one. My office manager will send you one of those because I again I think that's what I did, right? I didn't have a printed card like that. I'd written my own out, but I had a piece of paper I'd bring in with me and put on the patient's table because they, you know, just They wouldn't see that. But I think it you know, all your effort should be going into diagnosis and not into remembering those four point combinations. So it's nice to have something with that. And it eventually just comes, right? Eventually it just comes.
Angelique: There's some channels that I know now because I've used them so much. So I don't have to look anymore. But some of the oddballs, like I don't supplement bladder a whole lot or kidney a whole lot. I gotta look at those.
Maya: Toby, do you when you're needling yourself, do you still go top down? Cause it's very uncomfortable to lean in towards my foot to put needles in my foot when there are already multiple needles in my hand.
Toby: Yeah, I'm not sure if I talked to you about in the video you watch, but actually there is a it's not top to bottom. There is a point combination that we do in Saam for the four points, the order. But we my I think the second to last time when my teacher was here, we had like an entire half day set aside to discuss that. And something happened. I forget what we had to do. We had to treat patients or something like that. And so we never got to that. So as I'm driving to the airport, he just said, do everything top to bottom. So there is an actual point combination and I think it's a little bit involved because we had a whole half a day set aside for it. So I still don't understand what that is, but that's that's his default is just do everything top to bottom. But there is a combination. So when I treat myself, I'll treat bottom to top usually.
Angelique: That seems like a lot that seems a lot easier to do. Yeah.
Toby: Espe especially my left hand really useless. So you know, at least I can do the bottom half, you know, with my right hands.
Maya: Don't you normally treat on your left anyway?
Toby: Depends upon what I need to do, but yeah. Okay.
Maya: Okay. Next, Angelique, will you speak a little bit to this? And then both of you. I the kidney small intestine, like the way that it's been presented, and I struggle with it because I find that like this warning not to consolidate pain and trauma. It's like when someone is a small intestine access, we wear our lives on our face. Right. We wear our beliefs on our face, we wear our life experiences on our face and in our bodies. And when people are small intestine excess, by definition, it's not necessarily just an asymmetry that they were born with. I find that like when I look at someone and I'm like, wow, you present as a small intestine excess in that way that is kind of cringy about Saham when we divide people into these categories, which still is like a little hard for me to sit with peacefully, but whatever the judgment is there and I use it diagnostically. Inevitably, almost always, those people are going to have trauma and pain that I don't want to consolidate by using the kidney channel. And they're coming in often for pain. So now I'm looking at someone who might very well benefit from a small intestine supplementation, other than the fact that they're presenting small intestine access. And I understand, too, but you've said that of all the channel pairs, this is the channel pair that is most likely to sort of have someone who needs both, but often they're not older patients. And so then I don't have the sort of reasoning that potentially because of their age, they need both the kidney and the small intestine channel supplemented. So I have I guess I sh I've I'm kind of finding myself a little bit writing off the small intestine excess presentation if I think a small intestine supplementation will help with their pain because of the presence of blood stasis or because of recent surgeries that seem to have accumulated contributed to the pain. Do you see what I'm saying?
Angelique: I think so. So have you done it and it's been helpful?
Maya: Been yeah, mostly. It's been a little bit of a mix, or sometimes I hesitate and I do what we're taught, which is I try to go to more obvious gaps, but I wonder about coming back to that with those patients. And I wonder about your thought processes with these patients who and again, the patients maybe that I'm seeing they're not so selective around patients who have a certain amount of money or have found a certain amount of money, like patients who are paying it out of pocket in for c in California, like. Either they have it to begin with or they have put their minds to it to an extent that they are sourcing it to figure it out, right? That's not the case here. So I might also be seeing sort of more patients who are just less resourced. You know?
Angelique: Mm-hmm. So the way I've looked at it is basically I like really just finding the most imbalance. Because if I have a question, and this is where I had a patient where it kind of went wrong on me, where I thought small intestine would be the one for them. I think I might have even talked about, I can't remember if I talked about it here or if I talked about it with just you, Toby, but this patient had pain and it was pain on the small intestine channel. And They were pretty close in their kidney and small intestine excess, but I thought like I'm going for it. And so I did the small intestine and the pain got worse. And so then I treated them with kidney and they got better. So I think in the context and for me, when it's not when I'm not super sure, I go with what is most obvious, like what the what their grossest thing in the room is, you know, like what's the most obvious thing. And what their biggest imbalance is. So even if they have a lot of pain, if they if they are a small intestine excess person, I would be less, especially having had that experience, less inclined to use that channel. I would use something else. Toby, what do you think?
Toby: Yeah, I think I wanna go back to the first part of that presentation. Like you were saying it's a little bit cringy to diagnose with this. I definitely understand what you're saying about that, right? About the attractive, non-attractive part. Is that what you mean, Maya? Yeah, that so that's I definitely recognize that. But patients are paying us for our clinical judgment. And so our judgment is the most valuable thing that we have. So try and move I understand that, but try and move away from cringy and more towards, this is my clinical judgment. This is this is how you're presenting and this is my clinical judgment. A little bit like you would with hot and cold. So attractive, not attractive is the same, you know, you don't think, it's cringy to go, are they hot? Are they cold? So try and make it just a little bit more clinical judgment. And I remember one of my other classes too, the one of the participants in the class was like, I don't want to judge people. And I just say, I mean that's that's our job, right? We have to judge people. Right. But again, clinically, right? We're we're you know, hot or cold, wet or dry, ascending, descending, in or out, all these things. We're we're just we're just really trying to judge that. So just anyways, I recognize that. Thank you. Yeah, but I recognize that too, that uncomfortableness. Now I moved past it, but I remember having it being really uncomfortable about that. But it's really important. So just the cleaner you can diagnose, especially that dynamic, the better. And then in general, yeah, I think you're right. I mean, you don't want to consolidate pain in general for Chinese medicine. But if it's small intestine excess and they have pain, then you have to use the kidney. So it's like in general, try not to consolidate pain. But if it's the small intestine excess presenting like that, then you have to use it. So yeah, so many times I've I've supplemented kidney successfully, you know, to treat things. So especially pain, but But again, your first thought is probably pain supplement small intestine, right? Because almost always we have to move, or like you were saying before, maybe move back and forth between both of those. And especially if it's pain and you're going to move back and forth between both of those, maybe start with small intestine because that's less likely to congest everything, especially if you get everything moving and then come back, you have some space to consolidate. That's in general to do.
Maya: Unless they're presenting as a clear small intestine excess, in which you wouldn't start with small intestine. Right. Would you would you ever move to that with people who are in pain after using kidney? Or you just no, period, no, because that's their excess. There's no reason you would ever move to that.
Toby: Yeah, there's no reason to. Well, patients are always changing. So I just always try and re-evaluate every time I see them. You're right, like structurally, you know, symmetry-wise, they're not changing. But I guess people attitude things like this. And let me remind you about this too. My teacher really said about the channels, if the patient feels in their heart of their hearts that they're like that, then you have to treat what they really feel in like their heart and heart. I remember seeing again, we were cheating patients in St. Louis for something. And we had a patient come in that in the heart inner heart of her heart, she really felt like she was a kidney excess, dressed that way, all kinds of you know, presentation like that, but just structurally that just wasn't there. So, but we did supplement small intestine for that case because that was the assessment in the inner heart of her heart, she really felt like she was, you know, just really attractive and everyone was really into her. And so again, so that's again the structure guides, but we have to take into part the whole picture.
Maya: Thank you. That's helpful. And a follow-up, of course, in an attempt to oversimplify, and it's not this simple, but if you'll indulge me or tell me that I can't, if I see a patient and I supplement they already have a gap and I supplement the wrong channels, I can't see what you're seeing because I've hidden myself use. So if my hands stop making sense, let me know. If I see a patient and they have a gap and I supplement the one that is in excess, so now they have an even b even bigger gap. And I see them the next day, or I realize in that same moment. And I supplement or the next treatment, I supplement the opposite channel to bring them back to where they had been. Logic would then have it that the next time I saw them, I would yet again supplement the channel I had missed the first time to sort of continue pushing them in the direction because now I've just gotten by them back to where they were, or not necessarily the case.
Toby: It seems from my experience that patients metabolize the wrong treatment a little bit worse than they metabolize the right one.
Angelique: Meaning what?
Toby: Meaning they get more effect from the right treatment and less effect from the wrong treatment. So you can actually be a little bit ahead that way. Got it. That seems to be the case. Again, I just limited clinical experience, but that seems to be the case. Hey Maya, do you have any more questions, especially really difficult ones for Angelique before we go?
Maya: Thank you. Theoretically, could someone be a spleen excess so that they're damp on the inside and damp on the outside, and say a stomach excess in other ways, so that they're damp on the inside and dry on the outside in other ways.
Angelique: Yeah, they can. Example. Yes. So someone who has super loose stools, like lots of loose stools all the time, their mouth is so dry, so dry, eyes are so dry. So they're damp on the inside and dry on the inside. Then they can also have really shiny face, like really kind of like almost like me, like shiny face, and then dry rest of their body. What do you do?
Maya: They can't. Sounds.
Angelique: That's horrendous. So right. So then that's where when I so I'm thinking there's a particular patient that I have that's similar, not fully. I was a little hyperbolic about the shiny face. She doesn't have the shiny face, but I have a patient that her dry mouth, so dry, loose stools all the time. And I have treated her, and she also has really bad, she got post-nasal drip. So drippy nose, super dry mouth, loose stools. So I have done both lung and stomach for her and I've tried them both. And the stomach tends to work better than the lung.
Maya: And you think large intestine would also work well on her?
Angelique: I have done large intestine on her also. And none of them have been like, huh, you know what I mean? So I've also treated her. She's a she was a liver excess constitutional type person. So I treated her with Sanjiao. She is someone like over the course of time, I have seen a change, but nothing has been like spectacular. Like she would email me and be like, This is slightly better for like a day, or this is this is feeling better. But I noticed like she's a person who was just in her affect was much brighter. Like her eyes got brighter over time. Like she just seemed happier. Like she's someone who I was like, I don't know if she's gonna come back ever to see me. And she comes back all the time. You know, she became like one of my biggest fans, someone who I was like, this person is definitely not coming back here. So yeah. You just try to I define like the biggest imbalance. So like I think on one of the stomach excess days that I that I treated her with a stomach plus stomach plus. She was really, really drippy that day. So that was a bigger problem than her dry mouth. And on like really bad dry mouth days, then I supplemented the lung.
Maya: Yeah, I have to say the contextual inside outside for the dry, damp situation with those phases is incredibly unhelpful, Toby. Very unhelpful.
Toby: It gets better. That was my feeling. I just pressed my teacher. And it's it's pretty bad when you're pressing a Buddhist monk. You gotta tell me what's the what's the answer, right? So that would but again, now it's it's super valuable now, but in the beginning that is a little bit difficult. And I really agree with Angelique's answer to that. Yeah, I mean that could be, but it's a little bit less likely, right? It's a little bit less likely to have those contradictory things to happen. So it does happen, but it's less likely.
Angelique: Happens.
Toby: Yeah. Like every in clinic, everything happens, right? Like you were saying, numbness and then it got worse after supplement large intestine. That happens, right? That is again, we have all these guidelines and things like that. But again, now that now you know that if that's truly from the more numbness from your treatment, you know that stubbornness is so strong it overpowered the physical findings. But again, it's nice to get that feedback directly from the patient, then we know what to do.
Angelique: And I think it comes down to us to sort of owning our style and owning it and gathering the confidence. I like you, when I have had that kind of thing happen, I've fully abandoned Saam. Okay, DCM all the time. Here we go. And just like stuck with it for a while. Totally. I know I'm so sorry. But it's because it's so painful, especially if someone's had a strong response both to the needle insertion and then their response to the treatment is not great.
Toby: Not right in front of me, please.
Angelique: You know, I haven't I haven't found that confidence to own it myself yet either. So I totally feel what you're saying.
Toby: That's the best reason to go back to Saam, right? Because then you ren know something for sure then.
Angelique: Sure. But I haven't done that enough times. Like I haven't done to know. So I did that one time and then now I know that one time. But it's it's hard because and I think it's I think it might be the newness, Maya. I don't know. But it I don't I don't I don't want to be the one that's like she hurt me so many times and I'm never going back to acupuncture again, you know? So how I have mitigated that similar to what Maya was talking about is okay, let's let's try a different approach this time and then see how it goes. And then tried to warm them up again. And that's happened to the point where then the patients who I've who've had it, I did that and then gone went to TCM and went back to Saam and they had a good response from Saam. And I treated them with Saam for a little while and they're like, you know what, let's go back to TCM. And I'm like, okay. And then treated them with TCM. Then they actually asked to go back to Saam because of the difference. So I think it's okay to have some movement and Until we have that like we'll we'll have to be brave sometimes and just do it, right? But until we have that sense with that particular patient that it's okay to do it. I think it's okay to do it the way we are in our ginger little fashions.
Toby: I'm not I'm not sure if I'm okay with it, but I'm glad you guys are. Yes.
Angelique: It's what we have to do. No.
Maya: Right now. We're building our faith.
Toby: Yes. All right. Maya, thanks so much for coming on our show. It is really nice to have you as our first guest. It was a real pleasure to meet you.
Maya: A pleasure and such an honor. I was really looking forward to meeting you, Toby, and to participating. This is my favorite podcast. I've been going around telling my friends how many people do you know who get to be a guest on their favorite podcast? Like maybe I'm excited about being the tree in the Christmas play, but I'm still very excited. Thank you.
Angelique: Ha. All right.
Toby: You real pleasure to spend time with you. Okay. Everyone, take good care.
Angelique: Bye.
