Office Hours with Angelique and Toby. Released October 10, 2026. 26 minutes. This episode is sponsored by Classical Pearls.
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About this episode
In a clinic catch-up without a guest, Angelique shares two allergy cases treated with Wind Pearls, Toby describes what he has been seeing in his own practice, and the two compare notes on long COVID presentations with fatigue, brain fog, and dampness.
They then take up a question every newer practitioner wrestles with: how do you predict who will respond to treatment? Angelique draws on Matthew Bauer’s idea from Making Acupuncture Pay that the more a symptom varies, the better the prognosis. Toby agrees, then shares a case that challenges the rule. They close with a reminder that caring about the person in front of you remains at the heart of the work.
Topics
Two Wind Pearls cases: a blocked, painful ear and a year-round allergy patient
As-needed versus seasonal formula use, and cycling a formula
A brief history of smallpox inoculation in China
Long COVID in the clinic
Why Angelique now uses Saam acupuncture for most of her practice
Symptom variability as a possible prognostic sign
Setting realistic expectations with patients
A chronic back pain case that did not respond, reviewed from the chart
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. About the discussion of COVID-19 vaccination: the rashes and other symptoms Toby describes are anecdotal clinical impressions from a small number of patients, not evidence that vaccination caused them. Questions about vaccines are best discussed with a physician. The historical smallpox practice mentioned in this episode is variolation, an early form of inoculation documented in China by the sixteenth century, which preceded modern vaccination.
Transcript
This transcript was generated automatically and lightly cleaned up. It may contain errors, especially in names and Chinese terms.
Angelique: So this episode is brought to you by Classical Pearls again this week. Isn'that right, Toby Daly?
Toby: It'so great. again, we'really happy to have them as our sponsor.
Angelique: Yes.
Toby: Last week when we were talking about this, we started talking about you've been using some of the pearls and then I said, let's wait till this time. you any interesting cases you had using the pearls? Okay. Great. Yes. Tell me.
Angelique: Absolutely. so I had a patient come in. This is a patient that comes in, she comes in once a month, she tries to stretch her insurance visits. So it's like whatever's plaguing her that month. And she had a blocked ear that was really painful and sinus congestion, itchy eyes. And so I had treated her the prior month. I think I had tried Saam and it lessened the ear pain, but it's the congestion remained. And so she didn't want to come back again. She wanted to wait till the following month. So fine. So she dealt with this for an entire month, like this blocked ear. And so I did a Chinese style treatment for her. and I prescribed wind pearls. And you know, I explained how to take them. And she started that night and she called me or texted me the next morning that her ear had compl had opened up completely. And her allergy symptoms were like much better. And so she took them for another several days. And now they're a tool that she can use because she has allergy fluctuations that has that symptom constellation of like the itchy eyes, the congestion, fluid in the head. It was really remarkable. So I think it was a combination of both acupuncture and herbs, but having treated her the prior month with like, you know, a little bit of help, but then adding the herbs to that was really It was really cool. I was really excited. Yeah.
Toby: Yeah, that'such a nice potent combination, right? try and get the function of the body going well and then giving some material from the outside with the same idea. I really like to do that. you know, just introducing the those, you know, the same idea from just two different angles body. That's that seems tends to be pretty synergistic. So that's awesome. That's my experience with wind pearls too, is I have the patients take as needed.
Angelique: Yeah. And I've had I had another patient who I've also been seeing for a while. I had met him at a community event and seasonal allergies, you know, he has allergy symptoms most of the year, but then has peaks and was taking over the counter allergy pills for a while. And so when I started carrying the Classical Pearls, I was like, you know, you wanna try to give this a try. And so he was open to it. And so I think like you can do up to three twice a day or six a day, but you can split them up like two, or do three and three. And so I had told him to try like two, because I think that tends to be better tolerated if I'm remembering correctly. And he found it to be a little bit too drying. So he ended up finding that if he took two in the morning, he was good for the rest of the day. And that on really bad allergy days, he could repeat the dose in the afternoon and then that would take care of it. And he's been able to reduce his over the counter allergy medicines to almost nothing. Which has been really a cool thing and had really good relief from his symptoms, which are plaguing him a lot of the time.
Toby: It'so fantastic. Yeah.
Angelique: Yeah.
Toby: Yeah. And then I it tends to with my patients too. The it's almost like it's training that formula tends to kind of train them. So they tend to have less they need less pearls and then have less allergy symptoms. So it'll be interesting to see if you start noticing the same patterns too, where they just need less medicine and they're they're feeling great. So
Angelique: How often do you tend to have folks take them for just as needed, like kind of continuously, or is there sort of a cutoff that you found?
Toby: Yeah. I mean, I think it really is a hundred percent case by case. But you know, people with mild occasional allergies, I don't want to just keep blasting them with herbs and they don't need it. So they're more that take it, you know, if something comes out, they get exposed to something and then they have usually they have a couple of days of congestion. They'll take that right away and they can avoid those couple of days of congestion. But some people just suffer for like months on end. So I have them take like, you know, maybe four weeks before an allergy season starts, and then throughout the whole allergy season. sometimes giving a little bit of break in between there. Dr. Fruhoff tends to recommend about six weeks of taking the formula. And then you have to switch in some way. either take another formula or take a break and then and then resume again. So they they, you know, it's it's again case by case, but short term, long term, I again I think it's a really flexible formula. And that's usually I don't hear like you said with feeling a bit too dry. I think maybe just really sensitive patient only needing two caps. That's that's great to do that. But it has some moistening agent in it. So it's nice. It's not it's not just blasting dry. There is some moistening behind it.
Angelique: Yeah. That's what that's what's been helpful for me as a newer practitioner who feels very novice in the herbal realm. being able to prescribe these, knowing that they're they're so well balanced that you're not gonna hurt anybody. You know, but it's it's gonna like you said, it I was surprised that it was drying too based on what's in there, but that was his experience. But at the same time being in contact and like he knew what to do. And then knowing that going forward with other people that they can take them with some regularity and not worry about like damage, you know, to the yin anything. Which is really nice. Yeah.
Toby: Yeah, i it's it's it's thoughtful design. It's nice. Again, you're gonna be drying so you it's not gonna be able to get all only of the pathogen, it's gonna dry some of the body's true fluid. So it's nice it's nice to back, you know, backstop that.
Angelique: Yeah. That's been that's been nice. So what else is going on in your neck of the woods?
Toby: I'm just seeing patients and building a school. That's that's that's that's what I spend with that's what I spend with my time doing.
Angelique: Anything interesting come through?
Toby: I've never Yeah, about the school or about patients.
Angelique: About patience.
Toby: About patients, it's yeah, let'see if there's anything especially interesting. People d still tend to in my area get COVID vaccine. And for me I immediately wanted to dismiss any kind of side effects. but it seems like it's just like another batch of people coming in, getting the COVID vaccine and then within a week or so having all kinds of really bizarre things. So it's it seems like the weird rashes, weird sensations in the body, especially like pain and burning and things like that. Mostly rashes, right? I like a series of people coming through with different rashes. Wow. You know, not typically any kind of dermatological problems. And then just right after that. so yeah, I just I still think like this that'such an odd pathogen to introduce in the body either through vaccination or through natural exposure. Again, bodies just tend to ha present really oddly. So
Angelique: That is interesting. I haven't seen that out here as yet.
Toby: And people still doing a lot of vaccinations about you? Mm-hmm. Yeah.
Angelique: Yes. I've had people ask me like what do you think about it? And I've it's controversial. I don't know what to say. Like, you know, it's a very it's very personal.
Toby: Yeah. And I fe I feel like that's not our lane. So I just I tend to refer people back to someone in that lane to deal with it. I do give them some historical reference. I'm not sure if you probably know, right, that Chinese medicine in introduced the first vaccination for smallpox, I think fourteen hundreds, fifteen hundreds, something like that.
Angelique: I didn't know that.
Toby: That's cool, right? And so they had they were doing smallpox. People had really mild cases of smallpox. They were taking the scabs, grinding it up, and then inhaling through their nose. It was some kind of Taoist hermit come down from the mountains and told everyone to do that. And I guess that's mostly effective. So everyone was pretty happy about that.
Angelique: I'm just wild. I'm just thinking about like, so what did they scour the villages for the people who had the least like, you've got a mild case, come with us so we can pick your scabs like
Toby: Yeah, and then and then I guess the trust you would have. I mean the whole thing just seems pretty amazing, but I'm pretty sure it's well documented. And then that went from China over to Europe. They did it for a while and then they I mean I think that's what we call it vaccine. Then they started getting cowpox, right?
Angelique: Yeah, I was remembering cows, some a cow association with that, yeah. That's
Toby: Where the vaca comes from. So the idea came from China over to I think it was England that they used cowpox and then they used that. And anyway, so it is a it's a fascinating history. And I think it is a good idea in general, right? The idea of like presenting something to the body and then having it, you know, build up immunity to it. I think that's a good idea from transmissions. We like that idea, right? Not just blasting the body with something, having it prep a little bit. But yeah, I again I think. Just I think that just the configuration of that virus just seems to wreak a little bit of havoc.
Angelique: Crazy stuff to people. Yeah. It's the long COVID stuff that I see in my clinic more frequently. Just like the residual effects and the awful like fatigue. I mean of the MECFS, which is Miloencephalitis. A lot of people have it and you know some people treatment responds really well and some people don't.
Toby: What kind of things have you been successfully treating? What type of those patterns, like long COVID patterns, anything especially that you're helping?
Angelique: I'm trying to think of the last person. Cause even though I saw it a lot, I haven't seen one recently. The last person I can think of had some recovery of their energy where they felt like they were able to do a bit more and they weren't able to continue with the treatment. But we had gotten them to a place where they could do a bit more in terms of like their functional status. They felt less brain foggy. the other person I can think of moved, but she was doing really well. She had long COVID too, and sh her sleep was disturbed and she was tired and draggy. There was like a real damp, like heavy. Huffiness to her and with herbs and acupuncture, she did really well. and then she moved away.
Toby: Okay.
Angelique: Yeah.
Toby: So that's in general the patterns that you've been seeing more damp. the other one too, was it damp?
Angelique: The other one was more damp too. Yeah, it was like there was like a damp, like really brain foggy, like heavy feeling, like slow, just kinda goopy.
Toby: My needle finger is getting itchy with that.
Angelique: Yeah.
Toby: I just always w I always wanna attack that. So yeah.
Angelique: The good one. you know, and since visiting you, I'm probably ninety percent Saam with my patients now. Like I treat majority of folks with Saam there's a couple people that I've been seeing a while that they like what they like, you know, in terms of Chinese medicine style and they seem to respond better to it. And then there's the occasional new person that I'm like, if I do this, they're gonna never come back. but I'm getting there. I'm getting there with new people also. And so it's It's been really great to do that and to see the effects that it has on people. And then sometimes it's not as great, you know, sometimes it's kind of like a and so I've been thinking about that and I found a book. Hallie, who's was my assistant, sent me a substack of somebody names Matthew Bauer. I think I talked to you about him, and he has a book. And his book is Making Acupuncture Pay. And it's a weird book to read in public. But I it's
Toby: Like when like when I was in grammar school we used to have to put like paper around our textbooks. You could do that.
Angelique: Yeah. but no, it's it's been super helpful. Like the it's it's basically practical, it's practical advice to people starting out. And it was written in the early 2000s. I think he reinvigorated it somehow. So some of the numbers are off in terms of like price per visit and stuff like that. But one of the concepts that really stuck with me, I'd be interested to hear what you think about it, is when you're doing an intake with somebody. So one of the things that I struggled with and Up until recently, is sort of predicting who is gonna respond well to acupuncture and who's not. I've sort of been like, I don't know, you know, like, you know, someone who's had something. I mean, I knew someone has something that's like years entrenched, stuck, like that's less likely to, versus somebody who has an acute thing happening, like an ankle sprain is probably gonna respond easier than someone who's had chronic back pain for 25 years. Like Outside of basic things like that, it was been really hard. But one of the things that he says in the book, which has been really helpful, is that especially with pain, although it can be really with any symptom, that if there's a variation, like the more a symptom varies, the better the prognosis. So if someone comes in and they have, you know, four out of ten back pain for part of the day and then it goes to like seven out of ten, but it, you know, they can lay down and it gets better, or they like there's if there's variation and it's presentation. they would do much better than someone who's like seven out of ten back pain or even five out of ten back pain, but it's the same in the morning, it's the same in the nighttime. It's the same if they move. It's the same if they rest. Like it doesn't move. And that was really helpful. And so I sort of retroactively applied that and was thinking of patients that I've had trouble with and patients that I've had more success with. And there definitely has been, at least from my anecdotal memory, reflecting backwards. a correlation to that with patients that had wider variability in symptoms versus ones that had really stagnant, not really moving symptoms. And I'm curious what you think about that, promise.
Toby: Yeah, I think I'm so happy that, you know, that's that's like an idea that's just been bumping around in my head. And so that's great to have it articulated so clearly like that. I think that's right. That's that's my sense, that's right. And how I would think about it is like the body can make some progress or the body can't make progress. If the body can make some progress, it's much easier to help the body continue making more progress, or if the body's just stuck and can't make any progress. That's it's like you have to build something up first before you can get to move it. So yeah. that I think that matches my clinical experience as well.
Angelique: And he was saying too that like we acupuncture works essentially by giving the body's natural ability to heal itself like a booster of like 10 to 20 percent, depending on the person you're dealing with. And so looking at that in the context of the issue that they're coming in for, it's like, is this going to respond to like a thrusters basically 10 to 20% boost of their natural ability to do it? And it's been you like after reading that, I've used that language with patients and it helps. And I feel like a I feel more confident in talking about it using some of that framework. And I think that comes across to patients also. And it's now I know I'll better be better able to identify because I had a patient recently, because I don't want to just tell, you know, like superstar stories of like Saam did an incredible miracle thing.
Toby: That's all I like to hear.
Angelique: I had a patient that he came for a total of four visits, older person chronic low back pain, has had multiple surgeries. not a lot of variability in his back pain. Like it was pretty much the same a lot of the time. And didn't like and his back pain actually would get worse after treatment for a day or two, which I know can happen situationally because I prepare people for like, I wish there's a better word for the healing crisis, but whatever that phenomenon is where sometimes there's a spike in issues before it gets radically better. Except for him, it would just get worse for a day or two and then go back to kind of baseline. And that happened after every treatment. I couldn't figure out why. And I still don't know why that happened, but he's taking a break and I'm probably never see him again. but with somebody like that, I could have been a little more forthright to be like, hey, this is a entrenched issue. This has a lower likelihood of being solved in a shorter number of visits. And I would have been able to set up a more realistic plan of care for him, you know. So now knowing what I know, I can do better.
Toby: I think that's a helpful framework, but I think it doesn't capture everything. I just had a patient recently, it's like twenty years of neck pain, and then it's just gone after one visit. So I mean that's it was just steady twenty years of just always their neck hurt. And they're ecstatic now. But again, if I would have it would be interesting to see if you do that framework. Well, we're gonna need several treatments to get this moving because it'so chronic and it's always been the same. It doesn't change at all with you know exercise or movement or stretching. It's just always there. it would be interesting to see if like you set that up psychologically. Maybe she wouldn't have been able to move so quickly with just one treatment.
Angelique: Yeah, possibly. I mean, I think I think in terms of expectation setting, especially for out of pocket patients. Not that it shouldn't be that way for anybody, but with insurance, people tend to be a little more forgiving because their copays are smaller. So their financial investment is less. but I think just setting up, you know, because of this issue might, like using maybe and might, like the likelihood is or this could be, you know, you might respond really well. Cause how I was explaining it before is that, you know, some people have really wonderful results sometimes after just one treatment. I was like, com more commonly it takes more than that. and for some people, like I have had patients where it got to like visit six and then they were like, I feel this now it'starting to feel better. You know, it took building it up. so I use a lot of like hedging language around that because you really don't know for exactly that reason that you said. Like you got a person that had that entrenched issue and now suddenly it's gone. but yeah. So it was it was helpful because I kind of was I was Failing internally around like, I don't know, like how am I gonna, you know, so it kind of gave me a framework. Nothing, I mean, with everything in Chinese medicine, it always depends, right? Like that's that's the that's our underlying premise. But it helped give me a little bit more of a steady flat platform upon which I can stand, you know, to evaluate it internally and both explaining it to a patient that comes in.
Toby: Yeah. I think that's helpful. Can I ask you one more question about that four time treatment back pain one?
Angelique: Sure.
Toby: Did you ever do the opposite of the one of the channels you took? If you can remember.
Angelique: I don'think so. Cause I did Saam him twice and he was he was like, I don't know about this and one of them was a small intestine treatment 'cause of where his back pain was. and then I think I did A stomach treatment. And then I did TCM twice. So I think he could have probably he might have used a kidney. Like I was thinking, you know, he could have used a kidney treatment.
Toby: But especially with that kind of a response, pain worse and then pain about back to the same, I feel like that's you know, it's a potentially wrong treatment. Again, exactly quoting you from before, we never know anything for sure, but that's a potentially wrong treatment. just worse pain and then and then no progress.
Angelique: I'm actually gonna look. Okay, what did I do here? I can't remember why I did this. he had gallbladder channel pain. So the first treatment I did was pericardium. I did pericardium treatment and then it got worse and then got better. And then the second treatment, see, I was making up it got worse and then he said Well, here's what's curious, is it got worse and then it got a little better because he let me look and see what he said. He did some improved days, some unchanged days. He felt worse for about one day following the visit and then it was variable. So it was kind of like a like nothing great. And then I did a small intestine treatment. and after that one, see this is what was interesting to me because after that he had aggravation of the treatment for two days, but then gradual improvement through the week and he started doing some exercises. Like he started he walked a half a mile without stopping.
Toby: I think this is not my idea then. I think especially if you can do that, then that I think that's not wrong treatment.
Angelique: No. Well that well this was I wasn't giving you the right information. But then he was like it's not but he wasn't comfortable with it being hurting for a couple of days.
Toby: Yeah, that's a almost to the limit of me too, right? I you know, usually a day and then two day but especially I mean, that'significant that he's able to exercise, right?
Angelique: Yeah. And but he didn't he said the re he said the 'cause I was like, well, that'something. And he's like, Well, I think the reason my back was better was because I was I was exercising. And I was like, But you were exercising. You know, so but it'so it was one of those situations. I was like, All I'm not gonna we're not gonna fight City Hall here. And so then after that, because it had so he had some pain that he paused his treatments. So I don't know, I probably won't see him again. But it's okay. I live and I learn. Yeah.
Toby: Yes. And the and then you just do your best you can for every patient and then you just there's nothing more you can do, right? I mean that's maximum.
Angelique: But I always I'm always good in the service realm, you know? Like I always give good service no matter what. So like that well, that was one of the other principles in the book. is that you know, providing an environment and always providing like a good service. Like I'm always really kind and courteous and careful with everybody. And so, you know, I may not have knocked out of the park, but I still took good care of them while they were with me.
Toby: Yeah, but I again that is fantastic. I think that's like the crux of it what we provide, right? Is the secret to care for patients is actually caring about them, right? And I feel like then a lot of little things flow from that. But as long as you just have that intention, then yeah, again, you can knock it out the park with clinical results or maybe bit by bit, as long as the patient they feel like you someone's caring for them. Again, they'll they will report well and then they'll they'll try and work with you. So I think that's really key.
Angelique: Yeah. And I have found, you know, and now that with my sage wisdom of almost two years in practice, that if I, you know, there I spend a lot of time in my head, as you know, and like just thinking too much. And I have found that when I do just that, I'm just like I know I care and I know I'm trying to do the best job that I can do. And when I go into a room with that and just trying to trust that. I do a much better job. Like I think you know, like I actually care about the human being in front of me. I really want to help them. And just coming from that space, things are just easier. And I think when we had talked to Sharon Weisenbaum, and one of the quotes I had brought up to her that she had mentioned before was, you know, like your only job in clinic is to enjoy yourself or like to enjoy being yourself. And I think it means that like you're you show up and you really just want to help people and you are caring and you just operate from that place. And that's okay, you know, and trusting that you know what you know what you know and that something's gonna come out of it. That's gonna be all right. And I my I feel like clinically I've done better when I am more relaxed in that space and I'm not like in my head trying to puzzle solve. actively while I'm listening to the person. If I'm just listening to them and then the answer comes and I'm like, okay, like what you had mentioned at your clinic, the let the patient tell you what they need. And that was so profound. Patients literally, I'm telling you guys out there, would come in and I didn't realize they were also doing this for me. But it's like they would just they would start talking about like, okay, what's going on? They'd be like, yeah, my back, you it kind of hurts and it hurts over here. And then they would be like, and also my foot on this side. And they would like, point to an acupuncture point. Or it would be somebody, like I remember there was somebody, a kidney excess patient that you had that had toenails on display. And it was just so obvious, like, okay, you know, like that makes sense. And being able to trust your sense of that, like looking at the quote grossest thing in the room and being like, that's what it is, and going with it. And when I remove myself from that like intellectual, like physiology qi mechanism stuff in my head and I just look at what's there and I let them tell me what it is that they need. Invariably they tell me. And often it's the last thing they say or the last thing they do. And it's like, this probably doesn't mean anything. But blah. And it like seals the deal for me. It's like, and that's what we're gonna do now. Like I just I knew it. It was just there it is. So I wanted to mention that as well.
Toby: It's beautiful, right? That's awesome. two years in, almost two years in. That's amazing. try and project that out 10 years, 20 years out, right? It just it just gets amazing. This is the best job in the world, right? So it's nice to get a little bit better every time we go in clinic. You know, we'll be a little bit better for the next patient.
Angelique: Yeah, it's kind of wild to think back, like, wow, it's almost two years. So I'm still plugging away. Yep.
Toby: Great. All right. let's let this go for right now. And then let's what do you think about reaching out to Matthew Bauer to see if he'll come on the show and we can pepper him with questions. Okay.
Angelique: Will do.
Toby: Okay, great. All right, bye everybody.
Angelique: Bye.
