Office Hours with Angelique and Toby. Released May 26, 2026. 29 minutes.

About this episode

Toby and Angelique discuss fertility treatment as tending the whole garden: finding and filling the biggest gaps so that conception can happen naturally, drawing on what Toby learned from Dr. Angela C. Wu. They also talk about how acupuncture can support patients and families at the end of life, including integrating cultural rituals.

They share cases involving an autoimmune eye condition and recurrent herpes, and explore channel theory, including divergent and sinew channel treatment strategies. Toby also announces his new book, Tracing Our Lineage: The Enduring Legacy of Chinese Medicine’s Great Masters.

Topics

Fertility care as tending the whole garden
Acupuncture at the end of life
A case involving an autoimmune eye condition
Recurrent herpes
Divergent and sinew channel strategies
Toby’s new book, Tracing Our Lineage

Key terms

Divergent channels (經別): jing bie, channels that branch from the primary channels
Sinew channels (經筋): jing jin, the muscle and tendon channels

A note for listeners: this is a conversation among practitioners, offered for education, not as medical advice. Patient details have been kept general to protect privacy.

Transcript

This transcript was generated automatically and lightly cleaned up. It may contain errors, especially in names and Chinese terms.

Angelique: Have you had any interesting patient cases or just front of the mill stuff?

Toby: Especially everything's been going well fertility wise for me. just yesterday I saw a patient visit three and they've been trying for three years. And so we're able to conceive on this cycle. So they'really, yeah, they'really pleased about that. just, yeah, a few fertility cases, especially going well. Yeah, it seems like every once in while it seems to trend up, right? Where treatments just... team, especially potent. last month or so everything's been especially potent. Could be spring energy, but you know, it just seems like just like a more locked in clinic sometimes and especially locked in right now. yeah, we had a patient that couldn't see autoimmune disease taking away her sight. And I had to try to read that need, you know, doesn't have anything visual things. So I had her

Angelique: Energy.

Toby: Hold the box of needles and try and read it. And she said, I just can't read anything. I placed needles and then gave her the needle box again. She's all, AcuFast was like, whoa. Yeah. she was really pleased.

Angelique: Okay, so what was her imbalance and what did you treat?

Toby: Guess in a minute, I'll you.

Angelique: Jesus. She had an autoimmune illness that was taking away her eyesight.

Toby: And she's at a major medical center and they, you know this better, but they'd give her maximum steroids in the eye. They were putting pouches in. She said they were putting pouches of steroids in the eye. That seemed odd to me, but they're directly injecting. anti-inflammatories into their eye and that wasn't helping and then a bunch of other things. mean, no one can quite figure out this case. So usually that's good for us, right? They just can't figure out the pathomechanism from the Western side. Then usually it seems like it'straightforward from the Eastern side. Not always, but it seems like that's the case.

Angelique: To supplement her liver. Yeah.

Toby: Yeah. Because she was complaining of she was having all these sparkles. When it first happened, she couldn't see it was like piercing light coming out of her eyes. Again, patients just tell us right if we listen.

Angelique: It's true. And then sometimes, this is, I know I got a long way to go, is that you think like, yes. And then,

Toby: Yeah. Again, there's red herrings in the clinic, right? For sure. But this one seemed pretty straightforward, right? Because it was eye, sparkly. She was ultra polite, like crazy polite. The left side of her face has Vitiligo know, like so, you know, really light coloring. So not enough dark all around the eye into the cheek. I was like, wow, this is, you know, it a really clear and then, and then freezing cold feet and it's like eighties here. Yeah.

Angelique: I this patient that I've been treating pretty regularly to prevent HSV2 and it's been going pretty well. I, it's herpes simplex too. genital herpes. And I've been treating, I've been treating her for a while and they've reduced in frequency, which is cool. And one of the, she,

Toby: Tell me what that is again, please.

Angelique: She came in and she was like having a lot of heat. She's definitely like a hot, a heart excess presentation, like really red face, like red and like the happy way, not the liver way. You know what I mean? Yeah. laughs a lot. just as really warm sort of energy about them. And definitely she's got some sound gel excess stuff too, but, was having, was having a bladder channel pain at one point, like what else is going on? So yeah, she was warm. So I supplemented her bladder and I can't remember what the other symptom was necessarily. And I've done this before and it's been really helpful. But this was like a go, like months ago, I think I supplemented her bladder. When she started to have an uptick, she's got some POTS symptoms going on. And I think that the hot flashes, like she would get really like warm over all of her body. And she said that during the treatment and at the end, and she's like, I didn't mention this to you, it happened right at the end. She got like a vertex headache that was like very brief. And then went away. And then when she went home, she said that she had a migraine that lasted for two days and then has had headaches along her gallbladder channel since then, which was really interesting. So I'm like, how did that happen? And she was having sweating without heat. So I don't know if I like to, you know, by supplementing the bladder, like the heart, she got deficient. So there'spontaneous sweating, you know, I don't know.

Toby: Yeah, maybe too much of a good thing. I'm just thinking about two for me for herpes that worked really well is supplementary liver, supplementary large intestine. So those two things and especially with that sweating without heat and large intestine might be especially good for you.

Angelique: Yeah, I've done both of those. I had done the liver the last of the time before that. And this person comes every couple of weeks. So I was always trying to like not repeat unless it's necessary. You know, good. But I do cycle back to the liver more often because she has a constitutional Sanjo excess that presents itself. So anyway, then I supplemented her pericardium. She was also really angry and she's having trouble sleeping. And the headache. disappeared during the treatment. So that was neat, but I was like, why did that happen with the bladder supplementation?

Toby: It seems like sometimes it is maybe too much of a good thing. was maybe a smaller gap than it appeared. And so then that just knocks out the system. And also sometimes let'say it is the right diagnosis. It kind of squishes something out when it goes to balance out again. And that squishing out thing then goes to another channel and then you have to deal with it. overall they're doing better, but you're actually bringing latent pathology out of the body. It's a good direction. to go in but sometimes it's like that.

Angelique: So how can you tell what's, which is which? How can you tell whether it was wrong?

Toby: Yeah, if she complains of being along with those headaches, cold or something like that, then you know you're going too far there. If it's just headaches, if it's just gone to another channel, then I think it's more like squishing out that toxicity.

Angelique: So it jumped.

Toby: Yeah, I think they think they are better right there over that channel is much better and more balanced But that latent pathology that was in there the body couldn't metabolize it out cleanly and now you got to clean that up

Angelique: That reminds me, I can't remember, I think it might be a divergent channel treatment methodology, something that they taught at Taoist traditions. And I can't remember if this is exactly right, if I'm what I'm going to describe, but there's a method of needling. Goodness, I can't remember if it's the Luo channel or divergent channel treatment, but essentially.

Toby: Mr. Virgin, know this strategy. Ten years with Jeffrey Yuen

Angelique: Yeah. So yes, you try it.

Toby: It is. No, but it is divergent channel. So you can, if everything's going well with the patient, you can take things out of the divergent channel, just kind of clean everything up. Or if the patient's in really bad shape and you just have to put something away because so overwhelming for the patient, you can put it into the divergent channel.

Angelique: Then I'm wondering if I'm thinking of a sinew channel then, because there's a particular channel treatment where you need a little point to basically block what you're describing, the pathology moving to another channel. Does that sound remotely familiar?

Toby: I don't know about that specifically doing that.

Angelique: Okay. I'll have to look it up after because there is, it's like you're supposed to needle down, have to, you needle a particular point. I don't know it's called the confluent point. Goodness, I'm like dredging the wells with my memory for this. And it'supposed to prevent that very thing. So you're supposed to be moving the pathology down the channel. And I think it is a sinew treatment. You down the channel and then out the Jingwell and then you're, you're needling. Yeah. then.

Toby: Yeah, probably sinew you're right.

Angelique: There's but there's like a block I had like a visual in my mind of how I remembered of like a block like a needle blocking the way so that the pathology didn't jump to the next channel so that's what that reminds me of what you just told me.

Toby: Divergent channel actually interesting. I remember using one time I had a patient that was dying actively dying and they wanted more family members to come and I just learned the Divergent channel treatment. So I took the pathology and put it in the Divergent channel and they were parked up and everything was going great and the family was so happy and they're like, well keep doing that. And I was like, well, you know, we that's just a time buying thing. Because I mean, she just really was so much better and I mean, the patient ultimately died, but a few weeks later than they thought. So that was, that was sort of my profound remembrance of that divergent channel that you can take everything on the surface and put it in, put it into latency when you really need to. And this patient really wanted to see family members before they pass. that was a nice, yeah, that was, that was a nice, anyways, especially when you're learning a new channel system, right. It's nice to see that it does, it does function as advertised. Yeah.

Angelique: Was it pretty immediate?

Toby: Right away. After that general, they just start feeling better and better for a few weeks and then passed away. The family just kept saying more. Oh yeah, like a yin-yang separating, but this was like status post immediately after that treatment. I think probably.

Angelique: It something to do with it. Yeah. Goodness. Yeah. That reminds me. remember when having had a hospice background, like learning about the PO gate, you know, and one of the, have we talked about this before? Have I told this? I feel like I've talked about this, but I can't remember if it's here or not. so at end of life there, it's, it's very common that if a patient can't move their bowels, it's very hard for them to die. And so one of the protocols that we would use in hospice care, especially the last place that I worked, it's like, we would not allow more than three days to pass without a bowel movement. And some people would be like, but they're not eating, but they're not eating. it's like, I used to go through my whole education where it's like 70 to 80 % of the dry weight of stool is actually bacteria. And there's always product being made. so sometimes a small amount can an irritation in the colon. in Chinese medicine, our soul, our Po exits through the anus when we die. And so if that's blocked with stool, we can't die. And that I've seen it. I've seen it. I've seen it. People having, know, like people, you know, the movies, often will present, you know, someone dies and then they have a bowel movement. And I think if you're not end of life and dying from a terminal illness, that's more common. But as we tend to like to dilate, so our bodies are processing all of that stuff out ahead. But even a small amount in there can sometimes create an agitation and creates agitation. So we keep that highly clean. it's one of the ways that Chinese medicine also mirrors. stuff in Western medicine that we have seen.

Toby: That's really interesting.

Angelique: Yeah.

Toby: Have you, given any, patients, easing transition with the acupuncture yet or not an opportunity yet? That's a really beautiful thing to do. Right. Again, it's opposite of all our training. We're always just trying to save everything. And, I just had opportunity one time, but it's really nice to send somebody off like that in a, in a nice lined up state. and like you said, sometimes they're trying to but they just can't, something's hung up. I didn'think about the Pogate part of it for that treatment I gave, but anyways, it was nice. Do you know what Japanese death poems are? It'so Japanese, right? So you write a poem just before you die, but also you can't write it too early. they feel like, you know, if you still have weeks to go, right? They'd be like, this is not really a death poem. It's got to be within a day or two of your dying.

Angelique: No.

Toby: I remember I needled this patient and then told them that one of these Japanese death poems and then took out needles and then an hour or two later passed. it was quite beautiful.

Angelique: That is beautiful. Yeah, I look forward to that opportunity, actually. I think it would be like a full circle moment for me.

Toby: Yeah, especially with all your hospice experience, right? For me, just regular acupuncture. So, well, anyway, but I just don't, I don't have that experience in that area, but I really could see how, what a nice service that is too for the whole family, right? Just that, anyways, in this case, maybe other cases, too, there'some agitation, right? Because you don't know how to die. You've never died before, right? So there's a lot of agitation and it's really nice to calm that down. for the person, also for the family that's circling around, Everyone was so much happier when that patient really just kind of settled down more.

Angelique: Yeah, you're not just there for the patient themselves ever.

Toby: Right. Yeah. Yeah. It was nice to see again, usually we see individual patients come to our office. So it's nice to go to the house and then see everyone circling around. And then yeah, you treat the patient and everyone, you know, they're the hub and all this it goes out to the spokes, everyone settled down well to

Angelique: I love home visits to this day. I'm seeing one patient at home now and I really, it'such an honor to go into people'space. You know, as someone who's quite a private person myself, like I don't always love people coming into my sanctuary, know? Like I could easily be a hermit. It would be no problem for me. and going into people's homes and being able to see, I just, I know we've talked about that part before, but I just, really enjoy that a lot.

Toby: Yeah, same. I just went last week for a home visit and a patient that's been coming really regularly, but now, not especially getting towards the end, right? So then it's really nice to go and visit, right? Rather than just cutting off, we can't come to the office, then we can't see you. And my grandfather's a medical doctor in San Francisco, and he used to do house calls all the time. I feel like, especially just part of that lineage, right, to be able to do that. and he had his western doctor bag, you know, when he did. I've got my little Chinese medicine bag, you know, it'so, you know, our technology is so small, it'so portable. It's really nice to do that.

Angelique: Yes, I use a tackle box. Yeah, that's all my little compartments for all the things I need.

Toby: And tackle box nice. Yeah, that's nice and organized. just jam all my stuff in one big bag.

Angelique: Yeah, that's good. About fertility patients, when you approach, so I don't love fertility. I like all the other parts of menstrual health, but the fertility part doesn't really resonate with me. I think you really got to practice what feels exciting to you and what feels right to you. But with Saam when you approach fertility, Is there a special approach you take or are you still treating the imbalances that you see primarily?

Toby: Yeah, I think I'm a little bit with you too. Like I don't seek out fertility. That was Dr. Wu'specialty. So I have four years of training in that one. I'll answer your question in a sec. did I tell you Dr. Wu's three things that babies need? Okay, this is again, Dr. Wu distilled this from, you know, hundreds of thousands of patient interactions and successful ones. Babies need heat, blood and upward energy.

Angelique: This does sound familiar. You might have mentioned this before. Heat blood and upward energy. That does make sense.

Toby: I said, Dr. Wu, must be more complicated than that. She said, no, right? That's just it. That's what babies need. So I tip towards that way a little bit for infertility cases, but mostly what I try and do is just look for the biggest gap and fill it. again, that fertility leaps forward as a side effect of filling up all those gaps. So yeah, like I said, especially fertility cases now are just really moving forward. This maybe was a year or two ago, but I had a patient that wanted to prep, they were going to go to Colorado because there's cheaper IVF in Colorado. So they wanted to prep with me for two months and then go there for one month of their IVF thing. after that first month of prep, she was pregnant and then took a whole baby to term. So again, especially some of these gaps are so obvious to us, but I think from the fertility specialist, they're just always thinking about preparing the cycle for harvesting the egg. They're just not thinking about the person that's providing the garden, they're just thinking about just the eggs, right? So with us focus on the whole garden, sometimes it's really easy to see these gaps and then things move quickly.

Angelique: And do you still maintain you're still like three treatments a week and then space them out? do you three treatments for the whole month? Don'tell me it depends.

Toby: Yeah, I was going to tell you, it depends, unfortunately. But like some of it looks like obvious, like this patient that just, it's just recently pregnant, right? She's early twenties or something like that. Everything looked great. So I said, I was seeing her every two weeks, right? Just kind of, before, ovulation and then, and then after just to consolidate everything. And so, like I said, I think it was just two or three. visits, I think third visit she was already pregnant. So yeah, again, it really is case by that one just seemed like I was shocked she wasn't already pregnant. And so that assessment ended up being right because just within I think, like, by third treatment, she was confirmed pregnant. So just closed up a couple of those gaps and then and then she was good to go.

Angelique: Do you remember what her imbalances were and what channels she treated or where her treatments might have been?

Toby: I think following Dr. Wu's idea, right? I think I did supplement heart. then most of when I just saw her confirmed pregnant now, I supplemented liver because again, that idea of babies need blood. And she already has that beautiful rosy, you know, like pregnant, you know, like that Malar flesh, but not like the weird Malar flesh where it looks pathologically. mean, just that beautiful rosy. Yeah. She, I mean, it was, she radiated, it was, it was shocking how strong that was. but then also with cooler feet. then supplementing liver is reasonable, right? Because we want that blood. So heart and then I can't really remember. It might've even been small intestine because again, she was so young and you know, maybe like painful menstrual cycles and things like that or something. So I might've done small intestine. So probably small intestine heart and then she's pregnant and then liver just to fortify.

Angelique: What if someone were like, small intestine, that might be too moving. Why would you do that? Isn'that risky?

Toby: Yeah, but she's not pregnant yet. And, yeah. And she'so young and symmetrical and you know, like, mean, the case wasn't making sense otherwise, right? It's not like she was older, like a lot of, a lot of cases where they're a little bit older, where you want to really get a supplement in kidney, but she'so young and especially symmetrical, right? Again, the kind of case we think shouldn't be infertility case. So just small intestine seemed much more appropriate. Small intestine heart.

Angelique: Before.

Toby: And then that's, that was it.

Angelique: Nate, thanks for reviewing.

Toby: Yeah, but it's nice, right? as a side effect of increasing your health, fertility came wrong for the right. Yeah, but I don'think I want to do just fertility, right? Especially like Western fertility, right? Where you really damage the patient hoping for them to conceive, right? They're financially devastated, emotionally devastated, and then hormonally devastated after your work, right? I wouldn't want to do that. and this is worst possible case scenario. They're much healthier after. That's worst possible case. So that's okay.

Angelique: This is Yeah. I've been, I basically, I give the spiel to folks that are seeking fertility treatment with me is like, you know, it's not, it's not my area of clinical specialty. And I know that there are acupuncturists in the area. This is like what they do. so I often will refer to them, you know, give them the option, like if you want to stay and. know, take a crack at it. Okay. But just, I think because of the, usually I'more eloquent, but usually I'll, I'll usually tell them like, this isn't my thing. And. this is this person's thing and send them to that person.

Toby: But that's fair, but as a Saam practitioner, you should be able to treat everything.

Angelique: Yeah, I just, it's the whole... I think for me with so birth and death are so close together. And as much as I would really enjoy the opportunity to help someone at end of life again with acupuncture, I spent so many years in the like steeped in the emotional intensity of that end of life dynamic that you're describing with the patients and the family and the ups and the downs and all of that fertility care feels so close to that I don't know that my heart is ready to be able to hold that again, at that level. Because when someone is seeing you and they're wanting to conceive and then they don't, and then they might, and then they don't, and having to go through that roller coaster, to me that feels really intense to hold.

Toby: Yeah, that's fair. I mean, but I want to just remind you've got the clinical skill set, no problem. But yeah, if you just don't want to the emotional entanglement, I feel like that is really raw and real, which I like is when I mean, the male is like, tangentially involved. Usually I work with the female patients, right? And they, I, this is something Dr. Wu has them do, put their full hope into that cycle. working. She felt like it's emotionally, you know, you try and protect yourself. But that's that's not energetically good. You should put yourself open to the possibility of being pregnant every cycle. And that can be brutal, but also kind of beautiful. The patients learn so much about themselves, right? Because they're they're they're super vulnerable. And this is really what they want. And then, yeah, many cycles, they don't get it right. And there's just tons of learning. from the patient. anyways, for me, I feel comfortable guiding that kind of thing because I just done so many times now. I could I could certainly see why that especially if you already done for so many years, right, that you just don't want to go through that.

Angelique: Again. At least not yet, you know? Yeah. Because I also, the kind of person that I am is that I really wanted like, it's a specialty. So I want to deep dive it and understand it well. Like I want to be able to read the books and understand the theory and like really get into it and like know a bit more about what they do on the Western medical side. I just don't feel super prepared to do that, nor do I feel motivated to do it at this particular juncture. So I think it's almost a disservice. to a patient that would come to me for that because I'm not in my best space and I want to treat from my best space.

Toby: You make a compelling case for that,

Angelique: Yeah, so maybe someday, but certainly not now. Once they're pregnant, cool. That's fun.

Toby: Like that. Once they got over that hump.

Angelique: Once the baby's in there, we're good. Yeah, that's okay. That seems to be okay for me. Yeah, I haven't had someone have a pregnancy loss, you know, like during that time, but.

Toby: That's brutal too.

Angelique: Sure. And for some reason, I don't know, that scares me less. It's not logical. I feel like I can handle that a little better. yeah, the pregnant patients that I've had, it's been fun to treat them.

Toby: Yeah, and it's just so rewarding, right? They just need calories so desperately. then especially if you can reverse that counterflow nausea, everyone'so much happy.

Angelique: The reflux in the back pain.

Toby: Yeah, the reflex in the back. That's the standard part of it. Yeah.

Angelique: Yes, That's interesting. Well, I understand that you have some news.

Toby: Okay, what do you think? yeah, there's a big whirlwind of stuff happening right now. is like, usually this is a big deal. Usually, this is a big deal. This felt like it just relief that it finally came out and was able to get off my off my to do list. It was nice. Yeah, there is a book out. Yeah, thanks for mentioning about that. Yes. There was a book out.

Angelique: I've got lenses. the aperture there.

Toby: This book I wanted to write for 30 years. I remember being in Dr. Wu's clinic and walking down one of her hallways and she had all the great practitioners of Chinese medicine, the portraits. And every once in a while I'd ask Dr. Wu, who's this? And she'd be like, okay, so that'Sun Tzu-Miao, right? So the Tang dynasty. so I just had like little brief, these great Chinese medicine masters. And then, I looked up to Dr. Wu so highly and she looked up to these practitioners. So I was like, whoa, you know, this is amazing. So I always wanted to, you know, bit by bit I've been learning about these. I always wanted to put all this together. Basically I wrote the book for myself, right? Put all these together, the little biographies of the great masters of Chinese medicine, what they've contributed. And so that's what this book's about.

Angelique: And what is the book called?

Toby: Tracing our lineage, right? So again, we always, we have these things that just appear to us, how the patients not eat cold foods or drink cold, right? But someone had to put that into Chinese medicine. So it's really nice to find that out. So that was Sun Tzu-Miao'student Meng Shen he's in the book, and he's the one that did. really did all the foods, the food categorization, food as medicine, almost like putting in herbs, what channels it goes to and things like that. was the first person to do that, also Tang Dynasty. So it's cool that these things don't just appear and like 10 questions didn't just come from nowhere. That's Zhang Jingyue He's also in the book. presents just as these are facts and it's really nice to consider the context of everything. Who came up with this? Why do we still use it? It'sort of interesting. So that's the impetus for the book.

Angelique: And so where can folks find it?

Toby: Okay. Thanks for guiding me with all this. You're welcome. Yes. The usual place on Amazon. And then if you would like a avoid Amazon or a signed copy, you can reach out to Stephanie. She's organizing that she's flourishmedicine at gmail.com.

Angelique: Great. Well, congratulations.

Toby: I think we don't have any advertising budget for this book, so thanks for asking about it.

Angelique: We'll put the image up on the screen, I imagine. And make sure to put the Stephanie's email address and the show notes too.

Toby: If I can figure it out. Thanks so much. for mentioning that. Let's wrap this one up for today. Unless you have anything really pressing. Okay. Great. We're looking forward to your book when it comes out. Okay. No, but let's talk about this offline about I have four book ideas for you. Okay.

Angelique: I don't. Yeah, I'm not really reading a book. Okay, sounds good. See you next time.

Toby: Okay, bye everybody. Bye.