Vertigo poss brought on by PC+? (help!)

cassiopeia: July 17, 2020, 8:58pm
I took Toby’s intro course last weekend and have dived right in, using Sa’am strategies. As with learning anything
new, I’m running into complications already.
35yo F, CC vertigo
I’ve worked with her for about 10 months already. symptoms are generally controlled with Classical Pearls Serpent
Pearls (Wu mei wan) – b/c she can’t stand the taste of herbs. Current s/s:
thin, fit build
eyes with shen but not “diamond eyes”
healthy complexion
skin not dry or oily
she is a therapist and clerks at quaker meeting, isn’t a loud extrovert but clearly has a calling to be in conversation
with people.
vertigo, tinnitus, dizziness began suddenly June 2018.
In Jan 2018 she was in a car accident with concussion.
tinnitus constant – L ear
Dizziness – vertigo is a spectrum. triggers: rainy weather/changes (most clear trigger); associated with PMS phase,
stress, computer work.
often will have dizziness upon waking, but vertigo is more rare (lately hasn’t happened). when it happens, feels
HOT, sweaty, can have nausea with or without vomiting.
When vertigo present, needs to lay in a quiet dark room.
Recently, after a big road trip during which she lost her eyeglasses (she is very nearsighted), she’s had dizziness
daily upon waking.
Anger, irritability (d/t recent life stress)
Poor sleep, wakes at 3am with busy mind
GI: she has a pattern of having a full BM, well formed, easy, complete in the morning, but if she goes for a run
after that, then bowels get activated and she has to urgently stop in the woods to empty bowels – loose, mod-large
amount. (if she doesn’t go for a run, this does not happen)
Appetite, thirst, urine normal. temp/sweat normal except during vertigo onset.
GYN: ~28d cycle, PMS sx milder with tx/herbs but present: irritability, breast tenderness. menses now mod bright
red flow, no/mild pain.
MSK: neck pain along vertebrae
Abd: healthy soft overall, some pressure pain at ren 10, R st 25-26
I diagnosed as:
1. GB excess: convex – upsurge sx vertigo; GB channel/ear involvement; insomnia; anger (not sure if this is the
right kind of anger for GB? she’s not very aggressive, I think it’s more internalized anger); R PC+ seemed05/01/2024, 12:13Vertigo poss brought on by PC+? (help!) – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/vertigo-poss-brought-on-by-pc-help/1161/print2/9
right b/c when having vertigo she needs quiet, dark, calm.
2. SJ excess: heat in UW (heat during vertigo flare), eyes with shen, polite, considerate of others; ear/SJ
channel involvement
3. KD excess: symmetrical, fertile (2 kids, strong PMS symptoms)
She seemed to do well with the R PC+ points: neck looser, abdomen cleared, her coloring was good, she felt calm.
Later that day she emailed me to say she had a bad vertigo flare in the afternoon. It lasted 3h and went through her
fairly typical progression.
I’d appreciate some input:
1. does the GB excess seem correct?
2. Do you think the PC+ tx induced a vertigo flare?
3. What next?
thank you!
-Saam newbie, Fang Cai

KristinWisgirda: July 17, 2020, 10:03pm
Hi Fang,
Thanks for the case and welcome to the forum!
It doesn’t take long to get complicated situations.
cassiopeia:
does the GB excess seem correct?
While the GB channel is involved, the non-aggressive, unexpressed internalized anger sounds more like P+, maybe
also SJ excess if it is directed toward herself . There are lots of discussions on this forum about anger and the GB/P
axis. Though anger is presented under GB excess, it is in context of rapidly changing emotions. You want to see the
volatility/reactivity and/or aggression along with the anger to diagnose GB excess.
Toby presents insomnia as likely GB excess because it is common but the reality is that any channel excess can be
involved in insomnia.
On the table: Sometimes SJ excess will tell you that they are calm and play calm as part of their politeness. But you
say her coloring was good and there were some positive physical changes, so it sounds like she settled on the table.
cassiopeia:
Do you think the PC+ tx induced a vertigo flare?
I’m really not sure. It sounds like she hadn’t had full on vertigo in a while and it happened soon after the treatment.
But she seemed settled on the table. Hmmm. Were there any other potential triggers present for her that day? So far05/01/2024, 12:13Vertigo poss brought on by PC+? (help!) – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/vertigo-poss-brought-on-by-pc-help/1161/print3/9
this isn’t so clear cut that I would want to GB+ at the next visit.
Fang, your case writing is great but please consider the case writing suggestions presented here:Case Study
Format
It suggests 3 tools:
Grading the patient’s symptoms and qualities on a +1 to +10 scale.
Listing the 12 channels and assigning all aspects of a patient’s presentation to all of the channels they could
possibly by related to.
Identifying the qualities/symptoms that are the grossest thing in the room.
Including these 3 pieces in your case presentation will help you and us better see your patient through Saam eyes.
From what you have written, SI+ would have been my first treatment for her. Dizziness is a windy condition.
Windy conditions are often treated well by SI+. She has plenty of Kidney excess. Toby’s teacher taught that small
boned+thin+dizzy means SI+. Extra points if she is pretty. We know she is thin and dizzy. Please let us know if she
is small boned.
I hope this helps.

cassiopeia: July 19, 2020, 2:17pm
Kristin,
thanks for the case format guidance. It looks super helpful. I will use it for future posts and will spend some time
poking around this forum to learn its ways.
I’m rethinking the GB excess. she’s definitely not volatile, the anger is more like a frustration that lead to
rumination and irritability.
KristinWisgirda:
Were there any other potential triggers present for her that day? So far this isn’t so clear cut that I would want
to GB+ at the next visit.
The only thing I can think of is she was on day 2 of her cycle; she also went running that morning and had an
urgent BM during the run (this had not happened in a few weeks). So maybe the lack of holding/stabilizing in the
lower warmer was a trigger for the wind to rise up (?). Since she’s not had vertigo in a while, it’s easy for me to
link the treatment with vertigo.
re: being small boned, it’s a new clinical concept that I need to pay attention to. Her bones match her thin frame;
even though not disproportionately small, yes I’ll call her small boned.
KristinWisgirda:
Extra points if she is pretty.05/01/2024, 12:13Vertigo poss brought on by PC+? (help!) – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/vertigo-poss-brought-on-by-pc-help/1161/print4/9
I never would have thought this would be legit phrase for us to say. but yes, she gets the extra points!
So it sounds like SI+ would have been most helpful, if her current chief complaint is dizziness. I’m going to call
her to come back in for a treatment next week. She did settle quite well on the table and felt good after the
treatment. Do you think that doing R SI+ for the next tx would be correct? It doesn’t feel right to do GB+ to
“correct” the last tx.
thanks so much for your help.

KristinWisgirda: July 19, 2020, 5:40pm
Sitting with your case longer, it doesn’t seem right to use GB+ next.
cassiopeia:
re: being small boned, it’s a new clinical concept that I need to pay attention to. Her bones match her thin
frame; even though not disproportionately small, yes I’ll call her small boned.
Based on small boned+thin+ dizzy with extra points for pretty, she is a great candidate for SI+.
My own curiosity, which needs to be run by Toby, is that if she really needs SI+ and you top off P+, perhaps the
rooting of P+ further pushes on her overconsolidated K excess. Even though P doesn’t counterbalance SI+, there is
a still too much down and in on a system that needs dynamic movement.
If a patient has an iffy reaction to a treatment, I make a note at the top of the chart in red so that it stays on my
radar.
cassiopeia:
I never would have thought this would be legit phrase for us to say. but yes, she gets the extra points!
Clinical decision making based on beauty and grooming takes some getting used to. Here are some examples of my
cases that were all guided by the look.
A usually well put together lady came in 2 weeks ago and her hair was all wrong. Time to do K+. There were other
signs too but the hair was such a big pointer.
A handsome 85 year old man with UB 27 area pain: He had dyed his thick mane of hair sometime in the recent
past. Sure he had 1-2 inches of roots but even so, the hair was the grossest thing in the room and reduced concerns
about using SI+ in an 85 year old.
By contrast, a 16 year old girl with average symmetry had zero interest in grooming and clothes. K+ helped her
sooo much with her neck pain and basketball related breathing problems.

cassiopeia: July 20, 2020, 8:35pm

05/01/2024, 12:13Vertigo poss brought on by PC+? (help!) – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/vertigo-poss-brought-on-by-pc-help/1161/print5/9
Kristin, thanks for offering so many gems here.
KristinWisgirda:
Based on small boned+thin+ dizzy with extra points for pretty, she is a great candidate for SI+.
I’ll do that this week and report back!
I read in another thread the same gem from Toby’s teacher. It brings up the question of what “small boned” actually
means. I typically think of KD excess types, those beautiful fertile people, as having strong bone structure: high
cheekbones, strong wide jaw, not willowy. Their heads and rib cages look proportional to the rest of the body.
Whereas KD xu types would have the thin jawline with a small head, often tiny ribcage (this is my experience with
quite a few women with fertility issues). So how does “small boned”, get to be part of this KD excess gem?
Small Intestine – Kidney Counterbalance – Core Features
-in women who are small boned, thin and dizzy. This is a gem from Toby’s teacher.
You specifically mentioned this is in women. So… a small-boned, thin, pretty, dizzy woman calls to mind a fragile
bird-like creature who is vulnerable. My feminist self hates thinking along this line, but is that like a patriarchal
archetype of of a desirable woman, who, though not constitutionally strong and hearty like a typical KD excess
type, is a maiden worth rescuing?
That might be going too far. I am just trying to understand the WHY of this pattern. Do you have a way of
categorizing it or do you just take it as a gem?
KristinWisgirda:
A handsome 85 year old man with UB 27 area pain: He had dyed his thick mane of hair sometime in the recent
past. Sure he had 1-2 inches of roots but even so, the hair was the grossest thing in the room and reduced
concerns about using SI+ in an 85 year old.
So are saying that even though he was 85, the fact that he is handsome, has thick hair and cares enough to dye it,
made you feel ok about using SI+?
Today I saw a 75yo woman who is quite pretty and normally very put-together. her main complaint is typically
pain and terrible itching. I had analyzed her case ahead of time and was all ready to do SI+ on her. But today she
had on no makeup, and was in despair over a friend’s death. She used the words “I’m a total fucking wreck,” which
she’s never said about herself even though she suffers so much from her physical symptoms. I wasn’t sure about R
SI+ anymore, but did it anyway. her cheeks got paler and she began to have anxiety in her abdomen. I removed
them and did L KD+. cheeks got pink, anxiety settled, and she became much more positive. the shen returned and
she even looked prettier by the end of the session. amazing lesson!
KristinWisgirda #6July 20, 2020, 9:16pm05/01/2024, 12:13Vertigo poss brought on by PC+? (help!) – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/vertigo-poss-brought-on-by-pc-help/1161/print6/9
cassiopeia:
So how does “small boned”, get to be part of this KD excess gem?
Not sure. It goes against my initial idea that K excess should have big bones. We just have to put the idea that small
bones= SI excess. Also, the pretty part is optional which makes it less consistent with K excess. Just take the
teaching as a gem.
Toby confirms that small bones thin and dizzy can apply to men too. I had a patient who got SI+ for this reason. He
was also very handsome and into his looks. Sorry, I miswrote when mentioned women specifically. I just see so
many women with the presentation, often with infertility too. With infertility they get SI+ and K+ toggled at some
point. Remember that going to great ends to reproduce yourself is another K excess sign!
cassiopeia:
So are saying that even though he was 85, the fact that he is handsome, has thick hair and cares enough to dye
it, made you feel ok about using SI+?
Yes. He was also totally into himself, like an actor on stage, which made the call even easier.
Thanks for sharing your SI/K case. What a great learning experience! Now you know to take changes in grooming
seriously.

KristinWisgirda: July 24, 2020, 8:53pm
Toby just gave his perspective on this situation. He words are in bold italics. My question is in brackets <>
<If the patient really needs SI+, could topping off a P that isn’t in need cause enough stagnation to aggravate her K
excess enough to send her into vertigo?>
Possibly. Also the vertigo happened s/p a car accident so supplementing SI looks very good. Since it’s likely but
not certain that supplementing Pc was inappropriate I’d recommend supplementing SI for the next treatment
and then consider supplementing GB after that if the patient requires more treatment.
<Do you have any thoughts on adverse events from similar situations?>
Supplementing GB is the most likely channel to cause seemingly adverse reactions on the table even if it is
correct and supplementing Pc is most likely channel to cause settling reactions on the table even if it is
incorrect.
(Even though this makes sense, this statement makes clinic seem that much harder.)
It’s possible that supplementing Pc was inappropriate and the settling in qualities of Pc covered the overt
reaction up on the table.05/01/2024, 12:13Vertigo poss brought on by PC+? (help!) – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/vertigo-poss-brought-on-by-pc-help/1161/print7/9
So glad I asked! This casts light on a recent case at the next visit after using P+ (which had been a dramatic
positive turning point treatment a couple weeks back), the patient reported some regression in her sciatic pain and
that she was edgy during the previous week’s treatment but decided not to say anything. She just thought that the
“special breathing” she does during treatments wasn’t working. She seemed pretty settled during the P+ treatment
but at the end got off the table more quickly than she usually does. I thought that this was because she was feeling
better. Wrong!
Now the patient knows to speak up if she isn’t going deep but I know where the responsibility really lands.
Thanks again for the case Fang.

Shanlarson: July 25, 2020, 2:05am
That answers a weird reaction I recently had with a patient with PC+. She has bad Irritability, moody, quick
changing emotions before her period. I supplemented PC+ and she said it was worse the night of the tx . She was
ready to break up with her partner. The next time I saw her I went to GB+ but she immediately didn’t like it. I took
it out and moved to something else. But I’ve been very confused about it. She is very sweet, gentle and polite in
clinic. She seems more PCXS but her description of her mood swings/ irritability seemed so extreme. I would be
interested to hear how Toby would evaluate GB+ is right but the patient on the table is presenting with a seemingly
adverse reaction.

cassiopeia: July 25, 2020, 6:41pm
Kristin, thanks for checking in with Toby. The answers are helpful but, as with any good answer, brings up more
questions for me
KristinWisgirda:
Supplementing GB is the most likely channel to cause seemingly adverse reactions on the table even if it is
correct and supplementing Pc is most likely channel to cause settling reactions on the table even if it is
incorrect.
Whaaaaat? based on this, it seems possible that my patient settled well on the table b/c of the settling nature of PC,
not bc it was the right treatment. (though her neck tension and some abdominal reflexes improved on the table).
KristinWisgirda:
Now the patient knows to speak up if she isn’t going deep but I know where the responsibility really lands.
May I ask what/how you instruct your patients in order to assess this? Do they all know that “going deep” is a
necessary sign for the right treatment?
Back to dizzy lady. Her PC+ tx was on 7/16.05/01/2024, 12:13Vertigo poss brought on by PC+? (help!) – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/vertigo-poss-brought-on-by-pc-help/1161/print8/9
I saw her again on 7/22. She reports: after the 3h vertigo spell, she has had the typical post-vertigo sequelae: L ear
tinnitus is very loud, with full stuffy feeling – this is decreasing daily. The day after vertigo had a bad h/a and was
exhausted.
She made changes: stopped caffeine, sugar, stopped running in the mornings and is meditating instead. She also got
new glasses with the correct Rx.
Daily morning dizziness has clearly improved. But it was hard to discern if this is due to the PC+ or the other
changes she made.
I asked more about the anger. She said it had to do with moderating sensitive topics within the quaker forum, and
she was confrontational in emails, which was very uncomfortable for her. It was hard to let go of the anger, which
affected her sleep <– I’m understanding this as more of the SJ control energy rather than aggressive GB energy – is
that a reasonable analysis?
Closer observations: she’s thin in an athletic way. Small bones? not at the wrists and ribs. But her face and chin
could belong on a smaller-boned body.
She’s quite pretty. I did R SI+. It felt good to her.
I got this email on evening of 7/23: “I feel quite a bit of relief today. Just wanted you to know.” woot!
So… now I just keep hammering double SI+ right? kidding. But her prettiness and small chin won’t be going
away. If she still has some tinnitus or dizziness, would I repeat the SI+? I read somewhere else on the forum to not
do the same treatment twice on the deficient/elderly. Assuming I should use my clinical judgement to look for the
grossest thing in the room, but as always if there’s general guidance for next steps I’m all ears.
thanks!

KristinWisgirda: July 31, 2020, 6:02pm
cassiopeia:
it seems possible that my patient settled well on the table b/c of the settling nature of PC, not bc it was the right
treatment. (though her neck tension and some abdominal reflexes improved on the table).
Toby did say to consider supplementing GB based on the turn of events.
I came to Saam from practice heavily oriented to reducing palpatory referents during treatment. I still palpate pretty
extensively but I no longer rely on improvements in the referents to evaluate treatment effect. Too many times
referents improved on the table but overall treatment effect was meh. I wish it weren’t so. Evaluating “settling” is
way harder, even without masked patients.
cassiopeia:
she was confrontational in emails, which was very uncomfortable for her. It was hard to let go of the anger,
which affected her sleep <– I’m understanding this as more of the SJ control energy rather than aggressive GB
energy – is that a reasonable analysis?05/01/2024, 12:13Vertigo poss brought on by PC+? (help!) – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/vertigo-poss-brought-on-by-pc-help/1161/print9/9
A Quaker being “confrontational” in her own eyes, may or may not be very confrontational at all. To me anger
generally speaks to boundary issues in the P/GB realm more than SJ/Liver. But if the essence of the problem is that
she is upset because she can’t control the situation and smooth everything over then Sj excess is better. Saam
analysis really requires that you look beyond the patient’s words to see the real nature of the dynamic.
cassiopeia:
“I feel quite a bit of relief today. Just wanted you to know.” woot!
Yay!
cassiopeia:
I read somewhere else on the forum to not do the same treatment twice on the deficient/elderly.
This is correct. It doesn’t look like this rule applies to her so SI+ again isn’t off the table.
cassiopeia:
Assuming I should use my clinical judgement to look for the grossest thing in the room,
Assumption correct. Keep getting to know her through the filter of Saam.
Please let us know what happens. Thanks for all the efforts you put into your sharing and inquiry.

cassiopeia: August 1, 2020, 7:08pm
Hi Kristin, I’m so happy you’re back!!! Thank you for the answers. They make sense.
More updates from her are that the daily morning dizziness is gone; no more vertigo episodes.
BUT the tinnitus continues to be bad and she has some hearing loss as a result. It’s on the left, constant, loud. Does
Saam consider tinnitus in any particular way? I wonder if I should consider this a wind issue and use SI+, or if it’s
a manifestation of “lack of shielding” and, given her SJ excess signs, use LV+ next.
May I ask for your input on that one?
so.much.to.learn. but so fun. and thank you so much.