Office Hours with Angelique and Toby, episode 19. Released January 30, 2026. 18 minutes.

About this episode

Toby Daly and Angelique Britt work through a listener's case that Angelique brings in: a teacher in their fifties whose little finger kept contracting after surgery, with cold hands and feet and symptoms that worsen with cold and gripping. They look at the case through channel theory, from the heart channel at the scar to a possible small intestine treatment, and discuss how facial color, expression, needle sensation, and changes in the finger can tell an expected needling response apart from a treatment going the wrong way.

They describe a five-minute window for reassessing a strong reaction, why the patient decides whether to accept a corrective treatment, and how calm, confident communication helps. The episode closes on "live it to give it": sustainable clinic schedules, recovery days, and practitioners embodying the sleep, food, movement, and stress habits they recommend to patients.

Topics

Case: a contracting little finger after surgery
Heart and small intestine channels; a rash along the bladder channel
Telling a needling response from a treatment going the wrong way
A five-minute reassessment window
Patient consent and confident communication
Contracture, cold, and hypofunction
Sustainable schedules and recovery days
Living the health advice we give

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.
Dupuytren's contracture: a thickening of the connective tissue of the palm that draws one or more fingers into a bent position.

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 Angelique. Happy New Year.

Angelique: Happy New Year, Toby. I am wondering, I have a I have a case here from a listener. Do you think we could talk about it? All right. There's a it's a case of they identified it as wrong treatment, but here it is in sort of review. So this was a person, it's 51-year-old female. They're a teacher, and they came in with a main complaint. I'm gonna butcher the name of this condition because I've never been able to say it right.

Toby: Great, let's get started with that.

Angelique: Is it deep houtrin's contraction? Is that how you say it? Deep Houtrin. The finger contraction.

Toby: Is it the finger? I don't know how to say it, I only read it.

Angelique: I'm gonna call it deeprens. Correct me, listeners, if I am wrong, which they had this patient had surgery for. It was of their pinky finger on the left hand. And they had surgery in 2024 for this. It was progressively contracting and they wanted to avoid a second surgery. So they sought out acupuncture. They had a it was a polar fasciotomy that they had last year where the nodule in the cord was removed. They had a clear scar along the heart channel, thickening in the proximal phalanx. They use a brace at night. It's worse with cold use gripping and other history is that they'd run cold in general, cold hands and very cold feet, even with two layers of socks. They called this poor circulation. They even wore mittens growing up in California where it was warm. They have hemorrhoids following deadlifts, no pregnancies, low sex drive, perspires easily. Stress, they reported as three out of 10. They do quite a bit of exercise. Menstrual cycles every 28 to 30 days with two to three days of light flow. And they have a history of autoimmune progesterone dermatitis during their luminal phase, which resulted in a huge rash over their back that had puffs it got so bad and is controlled with birth control. And this listener knows that there was an odor in the room, possibly, but they were able to just they didn't describe here what that was. And so they disappeared heart.

Toby: That's really reasonable. Usually for this kind of case, again that's I've treated a few of these cases and that is the way to go because that we got that coal contracture going right on the heart channel. So yeah, that's a great opening salvo. What went wrong?

Angelique: So they said when they did the supplementation of heart on the right, their face got red. And initially within Carey, nothing was wrong with the point sensation. And the practitioner continued to observe them because their face wasn't peaceful. They didn't have bugged out eyes, but there were various emotions passing over with her. She wasn't able to rest. And so it took a moment, the practitioner says took a moment for it to sink in. And then she took the needles and then supplemented the ladder. And then looking at some of the notes here. It's not clear. Let me look at the other set of notes I had, if she recovered enough to share that the heart three had felt like there was a nail in her arm. And then actually she did not supplement. So she didn't couldn't she couldn't she felt because of the intensity of the reaction that the patient had that she didn't think she could talk her into doing a bladder supplementation. So they just did some talking and she'd offered several options. And so they sh the patient didn't want the reversal and not sure if this patient's gonna come back. So she was just curious what your thoughts might be on this case and why like around the reaction and if it was something that was wrong and the usual, you know.

Toby: Yeah, the you the I mean, the patient's presenting so cold. I probably would have done the same thing. So that's maybe some comforting to whoever that is. But I mean that rash along the bladder channel, right? That's that's the only heat sign we're really seeing besides cold. I still might have I might have probably just put that to the side too and supplemented heart because again I've I've so many good so many good responses to that. Syndrome by supplementing heart. So I might have done that. The other, you know, the other channel I like to take for there is small intestine, like that's over consolidation right there on the small intestine channel too. So, you know, if you really decided to heavily weight that rash on the back, then you know, but that would have been a way to move away from that really heating of heart and then still work with that area, maybe supplement small intestine. But yeah, I again if patients just refuse to get the counterbalance, I don't I don't remember ever having that experience myself. Usually patients feel so lousy, right? That we've done the wrong thing. Usually they're happy for me to correct it. I don't think I've ever had anyone refuse to let me correct it. So yeah, that's just a that's a tough clinical spot to be in, right? You start to take the patient the wrong way, especially if they realize right away and remove the needles. I think I mean, supplement with counterbalancing is ideal, but especially if it's just a few minutes of that, that's probably okay without counterbalance, right? Sometimes you know, if it's a full treatment and I'm for sure it's wrong, I would try and insist and try and talk the patient into we you know, we really need to correct this. But again, ultimately the patient decides. So but I from my experience I've never had a patient refuse for me to try and help them further.

Angelique: Does it sound like from the reaction that was shared that this was a wrong treatment reaction? Or is it one of those times where maybe if you actually waited a little while longer, they might have settled? I've struggled with this myself. Like some people have really strong reactions to the initial needling and kind of be like, and then they seem to be okay. And then there are other folks that I feel like there's just a little bit more. Unease that go beyond like what I would consider the initial reaction to needle sensation, where I'm kind of like, I wonder if I should.

Toby: That's what that five minute decision point is for me, right? Because after five minutes that needle sensation is negligible or gone, you know, a lot of times, especially at that breathing, seems to really even settle down the point sensations. By five minutes, yeah, I wanna feel like the patient's, you know, again, especially if they had some of that contraction and it was starting to open up and have less contracture, then even if they're A little bit more red faced or something like that. Sometimes that will happen with supplementing heart, right? It should be a good red, though not a you know, like a beat red or a really blotchy red. It should be a good pink red. And then all in it if the finger's actually doing better, then yeah, I'm more likely to do that. It's not like this was just all bad though, right? This patient didn't get anything positive from the note.

Angelique: I mean, it sounds like there was the needle insertion and over the course of a few minutes all of this happened and then the needles were taken out and I don't know that this patient is gonna come back because it doesn't sound like the patient wanted to have further needling. Yeah. And I don't I mean, I don't know if this is the case. I know personally when I know personally it's been my fear of hurting them a second time that has prevented that has been sort of How do I say this eloquently? So when I have done wrong treatment, especially earlier in like earlier this year, let's say in my early days of my the earliest of my early days, right? When I've done this and I've been and like, because you know some can it hurts. Okay. And so it you're you're hurting someone to help them and you mess it up and then you have to hurt them to fix it. And so I know myself personally that I Have likely conveyed the energy of not feeling super confident. And even if it's not coming across in full force, I think there might be an energetic component to the patient that kind of feels like, you know. And because I think if we present with like, okay, so we're gonna do the other side, this is what we're gonna do with this, and you're gonna feel better and just present it as solid facts, less likely I think to get refusals. Cause I've done that since then and have not experienced the absolutely not. It's usually when I have felt not confident that. I have gotten the refusal for correction personally. I don't know if that's the case with this person.

Toby: Like patients can sense if you're there to help them, right? And so for me, right, if I've done exactly the wrong thing, then I'm just there to help, also, right? You know, so I d I don't you know, again, the needle sensation is what it is, but I'm there to help them. And I think yeah, I think you're right. Yeah. As long as you as patients can sense that, then they you know, they're not yeah, yeah. I mean, I guess. The Neal sensation is really painful. And then plus they're getting at the wrong channel right. It's it's pretty disconcerting for the patient. But you can just say, Well, I'll fix that, you know. That's it's usually acceptable for the patient, right? Because yeah, that they're there to be helped. So again, from our theoretical from our theoretical standpoint, too, th this is a really valuable information. If we've done exactly the wrong thing, then we're you know, then we're really it really guides what the next thing to do.

Angelique: And I've sort of cribbed on you in those situations and been like, Great, I know now exactly what you need.

Toby: True, it's true. So it's nice to share that with the patient.

Angelique: It's all it's all good. It's like an exploration.

Toby: But you're right. Yeah, the differentiation with that, I feel like that within that five minutes you'll know, right, is this definitely wrong or definitely right. Yeah. It's hard to make that distinction, especially if you're a little bit nervous about it or especially new to using the system too. That's that's hard to do. But over time, right, that'll be really clear where it's just either reacting in the needle sensation or you've you've done the wrong thing.

Angelique: Yeah. And it's a top it always feels awful when these things happen. It's happened to me. It feels just feels awful. So we're not alone out there. That's right. It's like this happens to everybody.

Toby: You should do it less. So that's that's comforting, but that's the worst time what practicing the sound system is now. And then it would just get better.

Angelique: Yeah. We just have to go through the hard knocks as you're learning.

Toby: There's no way of going around that.

Angelique: Was. Me too. Me too. Goodness. If you're figure out a way, do sh

Toby: Okay, I don't know. I think it's just it's time in the boat and then you become a better sailor. Yeah. Okay, anything more about that case?

Angelique: Exactly. No, that was it. I think your response is helpful. Actually, do you consider now that I say that, do you consider contractures can that be in the realm of hyper functioning?

Toby: Could be, but it's more it's more likely floppy is usually more hot and more contractor is more cold. Usually it could be, yeah, it could be, but like the vast majority of contracture is cold. That's that's my limited clinical experience. I found that and that's I mean that the straight from my teacher too, right? About that hypo functioning of the joints and then hyper functioning, everything's just all floppy.

Angelique: I see, I had it the other way. 'Cause I thought of contracture as being like a hyper cause your the sinews are tightening, like everything is tight.

Toby: Yeah, I could see that, but it's the cold that's doing that. And the heat's that keeping everything loose.

Angelique: I think that will be very helpful to this person.

Toby: Okay, great. Yeah. So many nuances things to do. So but yeah, so I this well in that case just a little bit more. I think I would've let that ride a lot longer, just supplementing heart, just because my clinical experience has been so helpful for that pattern. So even if it was red face and heart three felt like a nail, right? I'd still like, well, let's we give it little more time and see. So but again, w without that clinical experience, then you know. Yeah, it's hard to make that d decision, even with clinical experience. And then without much clinical experience, it's even more difficult.

Angelique: And I'm so glad that we can talk about it and share these cases so that everyone can learn. So I deeply appreciate. Thank you, listener, for sending that in because I think that's helpful and I just learned something that I didn't know as well.

Toby: Yeah, again, this is some so straightforward, but just the applications of it to the 10,000 things. Those I'm so glad you're willing to talk about this in public, because then it's nice as we as we talk about things, then yeah, we should be able to make things more clear. Yeah. All right. I was gonna check in with you. How's everything going with your self-cultivation for your clinical work?

Angelique: My self cultivation with regard to in general.

Toby: Yeah, do you have do you have formal self cultivation practices or

Angelique: I do yoga. I was thinking of it because I was thinking of we had a conversation before about self-cultivation in general. And I think just I had I had attached that to actions or things that I was doing. But actually I think my biggest self-cultivation is in not doing trying to really rein it in. And I didn't realize that's what I that was that counted. But it actually counts. Isn't that crazy? And then I thought about it. I was like, of course that counts. So I've maintained the three day week clinic schedule where I work Monday, Wednesday, Friday and I Tuesday, Thursday I don't see patients. And I really felt the difference from when I was seeing patients four days a week. It's much nicer. I just if there's like a there's a wave that I tried. It's like I bring myself up like you had mentioned and I'm there for patients. And then I've got a day where I don't have to have that level of intensity. And there's other stuff to do is a Small business owner on my own, of course, but bringing the clinician part of myself forward on an intermittent basis feels better to me than working more than that. So I'm grateful.

Toby: In the Saam system asks so much from its practitioners, right? So that's why I feel like yeah, you it's it's taking so much from you to be in clinic, and then I just always think you have to put something back in. Yeah. So I think it's great, especially yoga and then just not being too frantic on the time and you're not being in clinic. I think I think it's valuable, right? Let that field be a little fallow for a little bit so then it can produce again otherwise. Yeah. I don't know many clinicians that work six, seven days a week, right? And that can maintain that really high level, right? Because again, then the field never gets to be fallow. They're just always trying to produce from there. And then I've known personally a couple of clinicians that just crash from that because again, it's not like it's not like you don't have to put yourself all the way into your clinical work, right? You it's not like you can hold back and keep some reserves, right? You really, you really have to be there fully present with the patient. So in order to do that, you have to have to take some time. Back so you can move forward into your clinical.

Angelique: Finding that balance is challenging. I think. And you know, there's the reality of the financial aspect of it. You know, some people I don't think can do that. I've chosen to do that for multitudes of reasons. And it seems to be working. So I work longer days, three days a week, and I prefer it. And I'd rather pack in more patients on those days than sprinkling them a little bit more diffusely across the course of an entire week.

Toby: Right. Yeah. I mean, depending on what your patient population is. But yeah, instead of doing it five days a week or like you're doing four days a week, putting it into longer three days. Again, that worked really well for me. And then I'm pretty sure I told you that's that's just crypt my teacher, Doctor Wu. She would see up to a hundred and fifty patients a day, right? But only three days a week, right? You couldn't this is impossible to do that other times, right? She would she would again your field would be fallow on those other days, right? And She was Taoist, so she did a lot of Taoist self-cultivation and things like that in those other times. So that you could be really present and really effective for especially that volume of patients. It was just chaos in that clinic. But she just smoothly moved through the whole thing as the chaos went around her. Again, because all that so all that self-cultivation that stays with you, right? And that really serves you.

Angelique: It's probably more Western, but I also prioritize what I instruct my patients to prioritize, which is like the four foundations of health for me, which is sleep. Sleep is huge. Gotta prioritize the sleep, nutrition, movement, and then stress relief. So I really like those are the four things that I try to prioritize in a daily, just so that I have the ballast to function.

Toby: That's stress relief for you, that's yoga or something else you do, or is yoga the main stress relief part of that?

Angelique: Yoga's main any sort of any sort of movement. I'm kind of a walking cheese stagnation person. You know, movement is really helpful and therapeutic for me. So any form of it's either walking, walking if it's too cold, I won't walk outside. I hate the cold. But usually walking outside when the weather's temperate or walking inside on a treadmill when it's not. So a combination of those two things are really helpful for me. And I notice a very large difference if I fall off a good schedule.

Toby: Yeah, but I think it's so valuable, right? Because you're gonna tell those patients about those four foundations, but especially you're embodying them yourself, then that's just so much more it's so much more weight. I remember another one of my patients, they had just gone to seeing somebody that was like counseling them on nutrition, but they were grossly overweight. Yeah, I mean you just you can't do that, right? You can't you have to you have to you have to live it and then you can share it, right? You can't just intellectualize it and say things. Again, you're you're doing those four foundations, then that'll naturally inspire patients. They might even ask you what you do and then you can share. You know, it's just so much more powerful than giving them, you know, a bullet point list of you need to do these things. So great. Yeah. I think it's it's so great. We have to embody health ourselves so that we can inspire it for our patients.

Angelique: Yes. Martha Beck says you gotta live it to give it.

Toby: New game. That's a snappy way. Now I'm gonna put that in my head 'cause that's not a snappy way of that long that long going around I was doing. All right. Anything else you want to discuss today?

Angelique: Think so nothing's coming to top of mind at this moment unless we go into the topic of changes of business practice, which you can decide whether or not we talk about that.

Toby: Let's do it next time. Okay. Good. Okay. Great. Let's wrap it up for now then. All right. All right. Take care. All right.

Angelique: Okay, that sounds good Thank you.