Extreme Muscle Tension & Excess Phlegm Case

joyblais: April 5, 2021, 10:02pm
Hi Fellow Sa’amsters!
I haven’t participated in the forum for a while, but I’m looking for suggestions on this case. I feel like I’ve thrown
the kitchen sink at it without much progress. Thanks in advance for any comments. I’ve been using Sa’am since
Toby’s Seattle seminar in January 2019 but haven’t used it exclusively so I could use guidance (and most likely a
refresher webinar sometimes soon); I think I’ve missed some more advanced signs & symptom education (like
pointy index finger for GB)!?! Please also give me feedback on formatting if it is not correct.
Case: 32 year old slender & timid male with pale to normal complexion (is a red head and can get rosy when
flushed).
Chief Complaint: extreme chronic (several years) muscle tension & spasms on the L side of the body (all channels
affected); muscle weakness on the R side of the body that feels like muscles aren’t engaging; and extreme bilateral
hip, low back, & jaw tightness
Secondary Complaints: clear copious phlegm in the sinuses that drains when his muscle tension improves, L
sided throat obstruction (that may or may not be phlegm related), one big loud sneeze a day with a funny smell &
subsequent salivation, tinnitus worse when muscles relax (when meditating)
Appearance: thin tight body (+8), small frame, wears all black clothing, quiet, shy & reserved (+8) but can be
friendly & engaging with nervous laughter, very intelligent (+9)
Lifestyle: IT guy with plenty of financial resources, plays guitar in a heavy metal band but has recently discovered
meditation, qi gong, spiritual awakening, etc.
Body & flesh: underweight (+3), moist skin (+5), minimal red pustular acne on face & back, sweaty hands & feet,
flat spinal curves esp. in neck (+5), jumpy spastic muscles (+10) – some areas are too painful to palpate & he has
even come in with multiple bruises on his calf muscles where his calves went into spasm & burst blood vessels
Body Temp: warm body (comes underdressed in winter) with cold feet
GI/Urinary: no complaints, regular BMs, some lack of appetite (+1) that manifests as general ambivalence
towards food, eats the same thing daily, some thirst (+3), urination normal
Respiratory: lungs are clear, all phlegm issues are in the sinuses (+7) & throat (see above)
Emotions: seems somewhat repressed emotionally (+8) but not depressed or lacking energy
Tongue: pale body, puffy front with slight toothmarks, purple dip in center, white coat – thicker in back, red tip,
distended sublingual veins
Excesses (not sure I’m doing this part right):
SJ: polite & hyperaware05/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print2/18
PC: quite & intelligent
ST: thin body, moist skin, acne
Grossest Thing in the Room: muscle pain & phlegm in sinuses
I’ve tried tonifying LR, GB, SI, & LU at different times without much change. So far the most profound treatment
has been to needle all acupuncture points on the L side that affect the vagus nerve. Stimulating these points at the
neck area seem to cause a domino effect in his body & his muscles relax & open up temporarily.
His muscles are so taut and his body is thin but he has all this phlegm in his head with a big puffy tongue. I’m not
sure where to go from here…
Thanks for your help!05/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print3/1805/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print4/18
1 Like05/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print5/18

michaelmax: April 6, 2021, 12:30pm
Hi @joyblais
Well, this is a tough isn’t it? So many contradictory signs.
Thin, but with clear signs of interior dampness and phlegm.
Sensitive and with signs of TB excess and plays in a heavy metal band
One of his body is tight, the other is slack
The thing that stands out to me is the contradictions he presents with.
I’ll start with something that is not Saam, but it might lead us back there.
You mention you’ve done needles that affect the vagus nerve, by using points in the neck. What points are you
using? And how do you know these affect the vagus nerve?
I know that the poly-vagal hypothesis is getting lots of play these days, and I’ve seen some interesting changes in
my clinic when I do treatment (it’s unrelated to Saam) with an eye toward changing the tone of the ventral vagus
nerve.
So maybe that is a discuss we could have off forum.
But back to Saam. One of the things that I’ve found, and there are quotes for this in the classics, is that phlegm can
cause all kinds of oddball symptom presentations and even can throw off treatments as it is an obstructive
influence. But not obstructive in a consistent way like blood stasis. My herb teachers in particular would say that if
you have oddball symptoms and presentations that don’t make a lot of sense and you see phlegm— then first clear
that.
So maybe double down on that dampness aspect, and then see what is the most notable aspect of his presentation.
Keep us posted!

joyblais: April 6, 2021, 7:31pm
Thanks Michael Max! @michaelmax
Would you suggest LI+ on the right to dry phlegm? I hesitated to try it because of all the tight muscles, but the
patient is really open & willing to try anything (and at least I know the antidote if things go sideways). Currently, I
am giving him herbs to clear phlegm in the head, support his SP, & also tonify Blood & relax muscles (with Bai
Shao/Gan Cao/Ge Gen), but it’s still too early to tell I think…
As far as the polyvagal theory goes, I have thoroughly nerded out on the work of Stephen Porges for the last 6 or 7
years. Thankfully others have taken his theories and adapted them for clinical use in easy form. I find Porges’
books very academic and dense, although brilliant.
My patient has been to multiple specialists & been either misdiagnosed or given no diagnosis at all so we’ve been
really digging for causes to his issue, which are so unusual for a healthy man of his age. To me, he has clear vagal05/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print6/18
dysfunction signs (offset uvula, some facial tone flatness/reduced expression, & abnormalities in hearing, etc.) &
responded positively to the vagal exercises I gave him to do at home. One thing that really stood out for me was
how flat his cervical curve was and how changes in his head & neck would immediately cause a domino effect
down his L side along the vagus pathway (face, ear, throat, chest, diaphragm, etc.) causing relaxation of his
muscles. Then lots of phlegm would drain from his head.
I wondered if the phlegm obstruction could be causing pressure on the vagus nerve as well. I tried many treatments
& herbs for tonifying blood & relaxing sinews but I never really focused on addressing the phlegm primarily, so
that’s where I’m at in my process with him.
The points I referred to as affecting the vagus nerve were:
LEFT FRONT: GB12, SJ17, ST12, LU2, ST9, LI18, SI16 (plus LI4)
Auricular Points: Vagus, parasympathetic cranial nerves
And additional points for the flattened cervical curve:
LEFT BACK: BL10, GB20, Huatoujiaji C1-C6, DU14, KD1
I did all these points on the L side only. It was kind of radical (not my usual style) but he said it was by far the most
helpful treatment he’d had & feels he is slowly improving. To answer your question of how I knew these points
affected the vagus nerve, well I just sort of looked at anatomy charts and followed the pathway of the nerve, then
looked at all the acupuncture points that overlapped & were accessible (aka: I was winging it).
So, to bring this back around to Sa’am, I am thinking I should do a R sided treatment to address the phlegm, but I
get confused about what is considered inside vs outside dampness. Would you think that this kind of phlegm is
inside (the sinuses) and outside (the damp hands & feet), or is this outside damp (sinuses & sweaty hands & feet)
with inside dryness (tight muscles)?
Thanks so much for your feedback!

michaelmax: April 8, 2021, 1:47am
joyblais:
Would you suggest LI+ on the right to dry phlegm? I hesitated to try it because of all the tight muscles,
I’d start with tonifying the LI on the left. Because “left for male” and because I’m associating the flaccid muscles
with dampness.
joyblais:
As far as the polyvagal theory goes, I have thoroughly nerded out on the work of Stephen Porges for the last 6
or 7 years. Thankfully others have taken his theories and adapted them for clinical use in easy form. I find
Porges’ books very academic and dense, although brilliant.
I’ve trying getting through some of the more technical books on PV as well, without much success. I’m more
clinically oriented. I like the one that Stanley Rosenberg did.05/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print7/18
joyblais:
My patient has been to multiple specialists & been either misdiagnosed or given no diagnosis at all so we’ve
been really digging for causes to his issue, which are so unusual for a healthy man of his age.
Is he really a healthy man for this age?
He has some very odd issues going on, I’m not sure I’d characterize him as healthy.
joyblais:
I did all these points on the L side only. It was kind of radical (not my usual style) but he said it was by far the
most helpful treatment he’d had & feels he is slowly improving
So this curveball treatment you did that was not your “usual style,” I’m curious to know what you were seeing and
paying attention to, which in turn lead to trying something “new” for you. Sounds like the results were good (love
the Saam idea of treating one side to affect the other).
Given that treatment was seen as positive by the patient. What exactly changed for the better? Perhaps that will
help you to better understand the dysfunction of the right side.
joyblais:
So, to bring this back around to Sa’am, I am thinking I should do a R sided treatment to address the phlegm,
but I get confused about what is considered inside vs outside dampness. Would you think that this kind of
phlegm is inside (the sinuses) and outside (the damp hands & feet), or is this outside damp (sinuses & sweaty
hands & feet) with inside dryness (tight muscles)?
Again, I’d treat the left side to address the dampness, as I see the flaccid muscles as an expression of dampness
(my current working hypothesis)
As to what is “inside” and what “outside,” that always depends. Sometimes it is cut and dried (no pun intended).
But often and certainly in this case, the “line” is not clear. And with this patient there are aspects of dampness
being both what I’d call interior (what I’m seeing with the tongue” and exterior (damp hands and feet) and to some
extend the sinuses, which I see having the possibility of being interior or exterior. Sinuses often being easy affected
by wind and pollens, which I see as leaning toward exterior.
With this guy it seems there is not only interior/exterior aspect, but right/left as well.
Hope this helps
Onward!

Daniel: April 8, 2021, 1:56pm
Some Thoughts Joyblais . . . .05/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print8/18
In my experience, when the ‘congestion’ is ONLY in the sinuses, but not in the lungs at all – all very very upper
body . . . I have almost never found it to be a primary issue around getting rid of dampness . . . in my experience
this is much more often – almost always an issue of phlegm getting trapped in the very upper reaches of the body
for some reason (you’ve even confirmed that by noting that when his muscles relax, he drains).
He is thin. His body type is dry. that’s big for me . . . and he seems pretty active and industrious . . . IT guy, works,
earns money, plays in a band, etc . . . I’d ask more questions to bring out where he sits on the couch potato – active
spectrum, but I would seriously consider a Spleen plus treatment. I’ve had patients like this respond miraculously
to that treatment.
walking around scantily dressed in the winter with cold feet . . . thats big for me . . . he is very warm but also has
circulatory issues. And I get the sense from what you have written, that in spite of appearing ‘timid’, ‘quiet’, etc . . .
repression and suppression are key here . . . and while you did do GB+ without much response, I would consider
PC+ (what is his sleep like? does he have SOB with mild exertion, can you detect repressed rage? ask him a LOT
more about patience and frustration, I would . . . I have found so often, high levels of repression and suppression
need the Mike Tyson antidote!)
How is he around intimacy, intimate contact, warmth towards you, social warmth, personal relationships?
What is his relationship with himself vis a vis self-esteem, self- confidence, self-doubt?
Digestion? appetite? he is thin, does he eat a lot and not put on weight or does he eat very little? bowel
movements?
from what you have presented, the two things I would try are Sp+ and PC+

joyblais: April 8, 2021, 9:03pm
Hi Michael,
I would love to know how you inserted my text in little chunks to reply to. That’s a cool & useful feature! Since I
don’t know how to do that though, I will address a few of your comments piecemeal:
I had not thought about the flaccid muscles as dampness. That’s interesting & I will ponder that. Sometimes he has
said that the R side only feels dysfunctional compared to the L side which is the real trouble maker. I do think both
sides are tight in general, it’s just that the L side is uber tight and the right sided muscles don’t engage. I will dig
deeper with some questions & explorations to see if “flaccid” is an appropriate description.
Stanley Rosenberg’s book on the polyvagal theory is good but a bit incomplete I think, certainly easier to digest
though. I would definitely recommend some of Stephen Porges’ interviews on Youtube. Here are a couple
suggestions but there are so many more that are quite interesting:
You bring up an interesting point about the state of his health. It sounds odd, but he does seem healthy to me in the
sense that he is young and had no issues before this problem began. He still gets on with life despite being in a lot
of pain. It’s as if once this thing gets addressed, he could rebound back into this young energetic guy again. Maybe
I need to look from a different perspective on this…05/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print9/18
What made me try this new style was how unsatisfactory all other treatments had been. He always says that he
feels better after acupuncture but then he is right back to the starting point when I see him next. He thinks he is
slowly getting better. I think it’s going snail paced as I have been treating him for years. Busting out the vagus
treatment was an attempt to stimulate the nerve to see what kind of response I could get. I only did it on the L side
because the L side is the crux of the problem.
I really appreciate all your suggestions and comments. It’s always helpful to see what others have thought about
that I may have missed

joyblais: April 8, 2021, 9:01pm
Daniel thank you for your thoughts!
Yes, you are right about phlegm being trapped. That seems clear. And of course, since pathological fluids can’t act
on the body physiologically, this is a real problem for him. Something is making these fluids collect while the rest
of him is dry & tight. A SP+ treatment seem logical when I look at it this way.
He is not really a couch potato (he’s even been running a few times a week for short periods of time) but he does sit
at a desk for long hours at work. He definitely has elements of repression & suppression of emotions but at the
same time we have had very deep and beautiful conversations about spirituality and life purpose. He is really such
a sweet thoughtful guy and is easy to be with. I suggested a therapist who he has been working with to explore the
origins of some repressive tendencies. He has rare moments of frustration but it’s not really a big problem. At the
same time, he does play in a heavy metal band (an outlet for feelings of rage perhaps!). I think of his emotional
state more as protection for a very kind & vulnerable interior – not so much repressed rage, as a cue for others to
leave him alone. There may be some self-confidence issues, but he is extremely smart and capable in life, has a
loving wife, generally likes his life & acknowledges he is very lucky to have so much (wife, house, pets, lots of
money, etc.). Maybe the Mike Tyson treatment is something to revisit to bust him out of his shell a little. We have
not discussed sexual intimacy issues, so I can’t comment there. You said at the end of your post to try PC+, but I
assume you meant GB+, right?
I have asked him about digestion, urination, and bowel movements so many times and he assures me that
everything is normal & like clockwork. The only obvious earth deficiency I can see is his indifference towards
food. He eats the same things at the same times every day. He is thin but at the same time I have questioned
whether I put him in the “thin” category just because he is physically small. He is only in his early 30s and claims
that his father is also small and never even got a little pot belly or anything as he aged. So, I don’t know…maybe
he is just genetically a smaller person with a normal body (not thin).
Thank you for taking the time to respond. You have given me some things to think about & I appreciate your
suggestions!
Joy

Daniel: April 9, 2021, 4:12pm

05/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print10/18
Hi Joy
Yes, that is a clinical tough one – to assess ‘thinness’ (dryness) on a short person . . . are they just appropriately
‘thick’ for their height or not??
I actually did mean PC+ . . . but you know, it is so hard without the patient in front of you.
I have found in my own experience that the PC-GB pair can be tricky in cases with significant repression and
suppression of frustration . . . when they are not so much ‘punching out’ at the world, but they are punching up and
out at themselves . . . . bruxism, shoulder tension, some headaches, sinus . . . sometimes GB+ moves it all out and
sometimes its PC+ that settles it all.
just some thoughts
Daniel

joyblais: April 9, 2021, 6:45pm
Thank you for the clarification Daniel. I see what you mean…it’s about assessing if there is an “inner Mike Tyson”
beating ones self up vs an “outer Mike Tyson” taking it out on the world. Thanks again for your thoughts!
michaelmax #10April 9, 2021, 8:57pm
Daniel:
He is thin. His body type is dry. that’s big for me . . . and he seems pretty active and industrious . . . IT guy,
works, earns money, plays in a band, etc . . . I’d ask more questions to bring out where he sits on the couch
potato – active spectrum, but I would seriously consider a Spleen plus treatment. I’ve had patients like this
respond miraculously to that treatment.
@Daniel thanks for pointing this out. I see that wet phlegmy tongue and I get rather transfixed on “some serious
internal dampness” but you are right, there are all these other signs of dryness, and LI+ type activity. So even
though it seems contradictory, the SP tonficiation can help as most of his system is dry. And a dry system will hold
on to impure fluids and phlegm if that is the only fluid it has to work with.
Thanks for the reminder!

michaelmax: April 9, 2021, 9:09pm
joyblais:05/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print11/18
I would love to know how you inserted my text in little chunks to reply to. That’s a cool & useful feature!
Since I don’t know how to do that though, I will address a few of your comments piecemeal:
Hi @joyblais
Yes! These little insert text blocks are cool, and helpful.
To insert a text block from a previous comment, simply select it and press the Blue Reply button, It will pull that
text and pop it into a new response.
Thanks for the links for Steven Porges. I’d like to reach out by email as I’ve got some more questions, but they are
not relevant to the Saam discussion. Can you send me a message to , so I’ll have your
email and we can then continue the discussion?

joyblais: April 9, 2021, 9:28pm
michaelmax:
Hi @joyblais
Yes! These little insert text blocks are cool, and helpful.
To insert a text block from a previous comment, simply select it and press the Blue Reply button, It will pull
that text and pop it into a new response.
Thanks for the links for Steven Porges. I’d like to reach out by email as I’ve got some more questions, but they
are not relevant to the Saam discussion. Can you send me a message to , so I’ll have
your email and we can then continue the discussion?
Yes, will do! I want to be respectful to the Sa’am forum

George_Mandler: April 10, 2021, 11:46am
Thank you guys for a thoughtful discussion on a difficult case with so many contradictions.
I see this forum as sort of a Sa’am wiki with its easy search function. For the sake of new comers I am going to
step in as a Sa’am grammar police as sometimes we get loose with how we phrase excess and treatment.
michaelmax:
…LI+ type activity. So even though it seems contradictory, the SP tonficiation can help
Should have been …LI Excess activity…the SP+ supplementation.
I feel we should save the “+” and “-” for Supplement/Drain of the channel and use the words excess when we are
talking about the paired channel we are considering. Thoughts?05/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print12/18

joyblais: April 11, 2021, 3:31am
Thanks George! Yes, I think it’s always helpful to be as clear as possible and standardizing the grammar does help
us all get on the same page. I appreciate you jumping in
Daniel #15April 11, 2021, 11:06pm
yes!! + and – should be reserved for supplement and drain
XS for Excess

Adina_Kletzel: April 12, 2021, 9:13pm
joyblais:
is a red head and can get rosy when flushed).
joyblais:
warm body (comes underdressed in winter)
joyblais:
minimal red pustular acne on face & back,
HI Joy,
the above quotes are indicative of some heat in the system.
JUmpy spastic muscles may come from dryness in the muscles
phelgm in the sinuses may come from water being cooked by heat
some of the bruises are on the calve muscles – which is the Bl meridian
My vote would be to try BL+
this would bring some cool nourishing water to the muscles and cool off the body.
The heat itself could be drying up fluids all over the body and causing the spasming – undernourished fluids.
Take a look where the red acne is and see if it is on the BL meridian.
Feel all along the BL meridian down the back and see if it feels tight and hard.
Just a thought to throw into the mix.05/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print13/18

joyblais: April 12, 2021, 9:41pm
Thank you very much for your insights Adina!

Daniel: April 13, 2021, 12:23pm
Adina_Kletzel:
bring some cool nourishing water to the muscles and cool off the body
I find myself wondering about this . . . .
cool off the body . . . a big yes!
That is my understanding of what a UB+ treatment does.
like pouring ice water over the body
I am not so sure about ‘bringing nourishing water to the muscles’.
My understanding is that a UB+ treatment is like pouring cold water over the body.
but I am not so clear it brings water / moisture to the interior
My understanding (and my clinical experience supports this fully) is the LU+ and SP+ treatments are what do that.
Certainly, if the internal dryness (in this case, of the muscles) is because excess heat is drying it up, then of course,
cooling the heat will stop the drying and the body’s natural internal moistening mechanisms will resume their
effectivenss.
I think its an important distinction.
Thoughts??
Daniel

Kikster: April 13, 2021, 11:02pm
Hi @joyblais! Have you tried working with his right side at all? You mentioned his tension and throat blockage
both worse on the left, so contralateral may be helpful. The heavy metal band makes me think about bringing in
self-love supplementing the Kidney+. What was his response after the liver+, he may need a repeat of that also
with his flushed face. It it blotchy(LV+) or full red face? (more UB+) Keep us posted!

joyblais: April 13, 2021, 11:39pm

05/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print14/18
Daniel:
I find myself wondering about this . . . .
cool off the body . . . a big yes!
That is my understanding of what a UB+ treatment does.
like pouring ice water over the body
I am not so sure about ‘bringing nourishing water to the muscles’.
My understanding is that a UB+ treatment is like pouring cold water over the body.
but I am not so clear it brings water / moisture to the interior
My understanding (and my clinical experience supports this fully) is the LU+ and SP+ treatments are what do
that.
Certainly, if the internal dryness (in this case, of the muscles) is because excess heat is drying it up, then of
course, cooling the heat will stop the drying and the body’s natural internal moistening mechanisms will
resume their effectivenss.
I think its an important distinction.
Thoughts??
Daniel
Hi Daniel,
Thank you for your comments. What you say makes sense, especially considering that SP & LU are internal
(Taiyin) and BL is external (Taiyang).
I find it fascinating that I have received many different diagnoses & treatment suggestions to this case. I have been
unclear using Sa’am primarily because I find the diagnosis aspect so difficult. I understand that finding “the
grossest thing in the room” often zeros in on the obvious malfunction, but I don’t quite get how addressing the
biggest symptom (manifestation) is the same as formulating a comprehensive treatment plan (treating the root). Am
I understanding “grossest thing in the room” incorrectly?
Also, in the Seattle class (if my memory serves me) we were collectively going through some cases as an exercise
on formulating our diagnosis & treatment. I remember a particular patient was a knitter and someone suggested
that knitting was a humble kind of hobby, but then another person interjected that knitting is actually quite an
expensive hobby and this fact was shifting the perspective about the patient to mean that they had lots of resources
(and therefore could be a LU excess type). This was really troubling for me and did not feel logical in terms of how
to come to a diagnosis. I think that we could easily make a case for this or that based on a single criteria, but unless
everything lines up into one category, we still end up guessing a bit.
I wonder if you can shed some light on your interpretation of the diagnosis aspect. Do you look at the archetypes
and fit the patient into the closest classification, or do you do a different kind of diagnosis and then see what makes
sense in regards to what the organ supplementations do (i.e. moisten interior, cool heat, move blood stasis, etc.).
In regards to your above comments, being able to see if the patient is dry from excess heat that needs to be cooled
vs moistened from the inside from internal dryness is an important distinction. It requires us to search a bit deeper
than just the symptom of dryness.05/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print15/18
I hope I’m not being too contrary here, that’s not my intention. I have had pretty amazing results using Sa’am when
the diagnosis has been obvious to me. Supplementing SI after car accidents & injuries with clear signs of blood
stasis can be really miraculous! I have also had success with supplementing LR with quite a few folks, but maybe
that’s because I can see those disharmonies clearer than some of the others.
Any advice regarding this? Again, I appreciate your participation in this thread

joyblais: April 13, 2021, 11:50pm
Kikster:
Hi @joyblais! Have you tried working with his right side at all? You mentioned his tension and throat
blockage both worse on the left, so contralateral may be helpful. The heavy metal band makes me think about
bringing in self-love supplementing the Kidney+. What was his response after the liver+, he may need a repeat
of that also with his flushed face. It it blotchy(LV+) or full red face? (more UB+) Keep us posted!
Hi Kikster!
Thanks for your input! I have indeed done right sided treatments and repeated the LR+ treatment on multiple
occasions. No red face, more pale than anything. The acne is red & moist with a pimple or two coming & going
here & there. Sometimes one is on his back (something Adina suggested checking). I would say BL channel on his
back, ST channel on his face.
I have seen him for a few years now & it seem that no matter what I do his symptoms don’t change very much. It’s
been really challenging! I appreciate everyone’s support & will definitely update my post if I can gain some
traction!

michaelmax: April 14, 2021, 12:12am
George_Mandler:
I feel we should save the “+” and “-” for Supplement/Drain of the channel and use the words excess when we
are talking about the paired channel we are considering. Thoughts?
I think that is a good idea George. Less likely to cause confusion.
I do use. +LI to mean tonify the LI, and LI+ and LI excess in my own clinic notes. But that is my own shorthand
and I’ll do my best to not bring it in here.
George_Mandler: April 14, 2021, 12:25pm

05/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print16/18
Ok going to jump in this confusing case with a mixture of so many channels if you don’t mind…
What is his pulse like? Looking for a clue here. I use an oximeter to get the rate. Is it very different comparing the
left vs right? (Toby’s teacher Do’am certainly had abilities beyond what I will ever attain in this lifetime. He could
visibly see the invisible so I postulate that the tongue and pulse were primitive for him. So although not taught in
this oral monastic tradition I have been correlating the pulse and tongue to my treatments). If it is towards rapid
and thin and given other signs I really like @Adina_Kletzel idea of BL+ supplementation especially if a rapid (or
slight say upper 70s and above) pulse too, plus red face, is warm, tightness says hypertonicity.
Thinking out loud…
joyblais:
SJ: polite & hyperaware
What are his hyper aware signs?
He seems to have a mix of both LR and SJ excess
A heavy metal band. Could this be his dark cool forest counterbalancing? All black clothing could be a
compensation for SJ excess too. But being in a heavy metal band would tell me he is not that sensitive to sound. He
sounds like a good reporter, but also his reporting more inward on self? If so then this is more LR excess. But red
cheeks and cold feet. – Hmm a mix. What do you sense from his eyes? – bright and outward or dull? This may be
the biggest clue.
joyblais:
seems somewhat repressed emotionally (+8)
He is timid and intelligent. Does he want to show off his intelligence? There is no feeling he will blow up at all? –
like a sitting powder keg? Is his heavy metal band a way to get out his anger? Have you delved into his history at
all? In his upbringing was there anger in the house and he doesn’t want to be that way so forcing to be calm? His
tongue tip may be a little red too. I am not suggesting to supplement GB+ just want to get a feel considering the
only thing that worked was this vagal nerve treatments which sounds a little thunderous.
joyblais:
I’ve tried tonifying LR, GB, SI, & LU
The safest best and least conflicting of those two seem to be SI+ and LU+. That puffy tongue and phlegm can
certainly be exterior as has been pointed out. Even though good resources with that moist skin and thin body LU+
supplementation seems a reasonable 3rd choice. , SI+ seems like a good one given moistening and moving and that
deficient Blood.
The fact that you had zero change negative or positive from the treatments makes it more perplexing. A negative
reaction can be so helpful in a case such as this.
I have occasionally found a treatment not working because of my error of needle location. How thick a needle are
you using? I use .40. Sometimes people do need that stronger stimulation.05/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print17/18
joyblais:
eats the same thing daily
What does he eat? Birdseed or is he eating an omnivore diet? (I am putting on my dietitian hat here). Could be a
lack of hunger because he is eating an unbalanced diet. And I think Chinese Medicine has a thing or two to say
about diet and health. It is not the main cause as clearly he has old trauma, but if it is inappropriate then some
change may make some difference in his physical body. Did your vagal nerve treatment help his appetite? – he does
seem undernourished.
I hope that was helpful Joy and not more confusing!

joyblais: April 14, 2021, 10:23pm
Thanks for chiming in George!
His pulse is wiry on the L side with the L cun floating. R side is somewhat deep. Both sides are slightly rapid.
I may have been unintentionally misleading about his face, it is pale and his skin is pale overall. There is no red
face, but his acne is red and pustular. His “hyperaware” signs are that he is very observant and intelligent. He’s
very calm and very humble. He is not snobbish with his intelligence at all. He is really kind & gentle. His
upbringing was very religious which may be why he chose to explore the heavy metal scene. He loves music and is
very creative. I take the love of heavy metal & black clothes to be more of a protection of a sensitive person, not a
sign of aggression. He does not seem like a person prone to burst out in anger. He does seem more like a person
who may not assert himself though. He is passive & I don’t think he really speaks his mind or stands up for himself
unless someone is genuinely interested in what his thoughts are and provides space for him to speak.
As far as the eyes go, I have always had a hard time interpreting that one. In the Seattle class we had two lovely
volunteers open their eyes up at the same time to demonstrate the difference. I was pretty clueless. I couldn’t really
see it.
As far as needle gauge goes, I am guilty of taking it easy on people. I use .20 gauge. He is so sensitive that I just
can’t go any higher. He is already screaming I have gotten good results in the past with other people using this
same gauge though, so I’m not sure if this is the problem or not.
His diet is not horrible but not great. He has coffee and a muffin for breakfast, burrito for lunch, rice/veggies/meat
for dinner. He also likes pizza & burgers. He does not eat snacks or dessert. Drinks water, no soda. No change in
his appetite after the blowout vagal treatments.
Again, I appreciate the time you took to shed some light on this case. I am enjoying hearing everyone’s
perspective. You have all given me lots to think about!
George_Mandler #25April 15, 2021, 3:53pm05/01/2024, 11:58Extreme Muscle Tension & Excess Phlegm Case – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/extreme-muscle-tension-excess-phlegm-case/1542/print18/18
Thank you Joy for the clarification and more info on this case. So many conflicting counterbalancing pairs in this
one. Slight rapid pulse vs pale face/sin. But he has heat too with the acne. Thirst?
It could be needle gauge that is the difference as the .20 are pretty thin.
That SI+ and LU+ still sounds good to me – maybe BL+if his pulses are rapid. But they didn’t work and there were
no observable negative effects which make it more difficult. I wish I could see more in this but do not.

joyblais: April 15, 2021, 4:19pm
Thanks for your input George. Yes, he does feel thirsty a lot. I may try a bigger gauge needle if he’s up for it.

Shanlarson: April 18, 2021, 3:33pm
When I read this whole thread there is something that makes me think a wild card of BL XS and do HT+. I know
he comes under dressed but he does have noticeably cold feet and I believe you may have said a tight epigastrium?
I just wonder if this is a hypo function situation. I agree it’s murky with a more rapid pulse and red acne. I guess if
you do BL+ and he doesn’t settle it would add more weight to HT+. I’ve had a few patients recently surprise me
with BL/HT axis.

joyblais: April 18, 2021, 5:56pm
Thanks Shannon! The responses to this thread have really given me a lot to think about with this patient!