pattycakes: June 15, 2019, 8:46pm
I have a treatment that didn’t go last week, and thought maybe someone would have some insight:
I have a 37yo female patient who is a regular and initially came to me for IBS. She is tall, thin and fairly active.
She has her own business doing some sort of service for wealthy/famous people her in Los Angeles, which is
probably kind of high maintenance and where she has to hustle. She has described herself as having a lot of
masculine energy, which I took to mean that she really has to push to get things done. She is also a single mother of
a 10yo, and I see her as having a lot of chronic stress and uncertainty in her life. In general she is friendly, likeable
and outgoing but can also be demanding. She sometimes yells for me from the treatment room, when she could
press the call button.
After we dealt with her IBS symptoms over the last year, we’ve started working on her sleep. She has very poor
sleep, routinely waking at 3-4am. She uses cannabis regularly, including to go back to sleep. She also often has
neck tension.
When she came in this week, she really wanted help with her insomnia, so I used +Pc on the right side. After 15
minutes she called me back in, and wanted the needles taken out. She said she had been able to rest some, but then
had become very restless. She found Pc9 to be very uncomfortable the whole time. I then offered to re-needle her,
and did +Liv, thinking she needed some calm/cooling. After 5 minutes she called me back, and said she was too
restless and wanted to get up. She didn’t seem unsatisfied, but I would consider this an unsuccessful treatment
(we’ll see how her sleep is when she comes back, but I bet it doesn’t improve much, as it has been very stubborn).
So what went wrong? It really seemed to me like the pattern fit her presentation. Perhaps Pc9 was too painful (I’ve
had this happen to me)? Maybe she had taken some sort of stimulant? Should I have used a colder channel like SI
or UB? Did I miss something? Maybe I’m being too quick to judge?
The strangest thing was that my next patient came and immediately told me that she probably wouldn’t be able to
rest on the table as she had slept poorly the night before and was very restless. This turned out to be true, she
stayed on the table about 10 minutes. At the same time, another practitioner in my clinic had that happen with their
patient. So maybe it was just some sort of external influence?
Adina_Kletzel: June 15, 2019, 9:31pm
Is she by any chance very dry – as in LI excess? I have seen LI excess types to be very bossy and demanding but
not in an aggressive GB way. LI excess could have issues sleeping because of their mind racing with all they need
to do and accomplish. If this is indeed the case then tonifying Sp may help.
pattycakes #3June 16, 2019, 3:21pm05/01/2024, 12:19What happened? Insomnia – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/what-happened-insomnia/302/print2/5
Yes, that is an idea, she has dry skin. I would bet she spends a lot of time thinking about what she has to do.
KristinWisgirda: June 17, 2019, 3:25pm
Are you positive that you needled all the points of P+ correctly? Lack of proper angle and stimulation can make a
difference.
pattycakes:
She said she had been able to rest some, but then had become very restless.
pattycakes:
Perhaps Pc9 was too painful
If she was able to rest with it the first part of the treatment, she probably would be able to rest for the whole time if
P+ was the proper treatment.
Does she already have a good amount of Pericardium qualities? Just because someone is assertive doesn’t mean
that P+ is the way to go. If both GB and P are relatively strong, you need to look at the other channel balances.
Patients with strong Gb energy will often use it to protect when other systems are weak. I have relatively strong
GB energies that come out when I am over tired or feeling like I lack resources. Treating Lung or Spleen works
better than P for me, because lack of P is not my weaker spot.
pattycakes:
I see her as having a lot of chronic stress and uncertainty in her life.
Exploring the theme and character of her stressors- money, time, nourishment, overstimulation, overexposer?- can
help you point you to which channel pair is more in need of balancing.
pattycakes:
She is tall, thin and fairly active.
More detail about morphology can be helpful too-. Is she thin and sinewy or thin and flabby/soggy. Is her skin
moist and resilient or is it dry and saggy?
pattycakes:
Should I have used a colder channel like SI or UB?
How hot or cold is she really?05/01/2024, 12:19What happened? Insomnia – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/what-happened-insomnia/302/print3/5
pattycakes:
So maybe it was just some sort of external influence?
Since we are all Saam newbies here, I think going back and looking at the details of what happened will be a better
learning experience than writing it off it as an external influence.
pattycakes #5June 17, 2019, 10:02pm
I’ve been working with the patient for probably about a year, and so I know her decently well. As I look into her
situation and diagnosis, I can’t find anything else that really stands out in Saam terms. I said she was tall and thin,
but in reality she is neither under nor overweight. She has a moderate, healthy build, her skin is mildly on the dry
side and her musculature feel a little on the soft side. Because of this I wouldn’t think much of Lu/LI/St/Sp.
I don’t think she is very hot or cold – she is talkative, active, uses cannabis and can be restless, but she always
comes wearing a sweater and often complains of the AC in our office. She isn’t particularly fearful. She is a
mother, and clearly cares about her child, but it has never seemed overbearing. So I don’t see her Ht/UB as
imbalanced. Her ego seems balanced to me, in that she is neither egotistical and self absorbed, nor does she seem
to have self-esteem issues. She does have mild PMS. So her Kid/SI seem balanced to me.
With regards to Liv/SJ: my impression was that she was very interested in the calming aspects of acupuncture, but
when I asked her if she was inclined to vacation in the Redwood forests, she responded that she would much more
prefer a sunny beach setting. My impression of her was that she gets acupuncture as a refuge from the stressors of
her daily life, indicating some Liver weakness, but I could be wrong in this impression. I would say that she is
quite socially aware and has attention to detail, but perhaps her SJ isn’t super strong. She is routinely late to our
appointments, and might not have a lot of inner-concentration/ability to maintain focus. So maybe Liv/SJ are
weaker.
With regards to Pc/GB: she definitely is extroverted and can change emotions quickly. I would describe her as a
little more aggressive than the average person. I wouldn’t think of her as calmly considerate and slow to react. This
combined with her insomnia made me fairly comfortable treating Pc.
The main stressors in her life are financial (being self employed with an irregular work load) and relationship
(uncomfortable with increasing commitment to boyfriend).
KristinWisgirda: June 17, 2019, 10:39pm
Something is missing here.
The way you talk about her stress is phrased in such a way as to make it sound like your impression of her rather
than something that you have heard directly from her. Have you heard directly if money and lack of resources are
anxiety provoking from her? If so you might want to supplement the Lung to treat a Stomach excess.05/01/2024, 12:19What happened? Insomnia – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/what-happened-insomnia/302/print4/5
pattycakes: June 17, 2019, 11:24pm
We’ve had clear discussions about her financial and relationship stress, sorry if it wasn’t clear. Lu could be a
possibility if her money worries are keeping her awake, thanks for that.
michaelmax: June 19, 2019, 4:59am
pattycakes:
I used +Pc on the right side. After 15 minutes she called me back in, and wanted the needles taken out. She said
she had been able to rest some, but then had become very restless. She found Pc9 to be very uncomfortable the
whole time. I then offered to re-needle her, and did +Liv, thinking she needed some calm/cooling. After 5
minutes she called me back, and said she was too restless and wanted to get up
@pattycakes, I’d take this as jueyin is not the direction to go. So for the moment you can count that out.
Thin and with dryish skin and hustles for a living… Sounds a bit Lg Intestine excess to me. Maybe +SP
ngmatthews: October 4, 2021, 5:15pm
My hit is that she is a LI excess type. So Spleen might be good. I remember Kristin saying something about the
sweet mama spleen energy, and perhaps that would be helpful for her.
amyjenner: July 4, 2019, 8:40pm
pattycakes:
refuge from the stressors of her daily life, indicating some Liver weakness
Not sure I would go from stress to liver in this system. I know that for me, stress mounting is way more about
resources in terms of juggling time/energy/commitments. I would much more appreciate the bright light to see my
way through than cool mistiness. I had a similar experience not long ago except that PC did nothing and when I put
in LIV she went into full anxiety. SJ fixed it. I saw her yesterday and did another SJ treatment for her anxiety and
she said she felt really good. In hind sight, it made perfect sense to me, as she is someone who suffers with the
overcast environment here. I just forgot about that when I tried liv.05/01/2024, 12:19What happened? Insomnia – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/what-happened-insomnia/302/print5/5
pattycakes: July 4, 2019, 9:00pm
Yeah, I’m still trying to get out of my TCM mindset.
Laura, I’m of the opinion now that she has a dry exterior (she complains of dry skin, and has a large crack in her
heel on the left UB CH) but some damp internally (tissues are soft to palpation), and a history of diarrhea. This
would suggest Lu excess, and she has cried in the treatment room a number of times, but she has financial issues.
So we will see.
adambroder: October 4, 2019, 6:32pm
Does a patient’s cannabis use help us clinically? In my own experience, using cannabis has a very cool, dark forest
kind of effect, so I would think that would indicated a SJ excess. However, most have ruled out LR/jue yin as being
beneficial for this particular patient, and I would agree. It’s also worth considering that cannabis has different
effects of different people, so maybe this isn’t very helpful for us on the surface. Perhaps if we ask a follow up
question of what do you feel when you smoke cannabis, or what sort of effect are you seeking with cannabis use?
Any thoughts?
allyson_nevard: November 5, 2019, 5:11pm
I like the idea of a LU+ treatment if financial worries are keeping her up. I cant help but think she really is a TW
excess person with the nervous energy, feeling cold, the desire for calming energy, attention to detail. Does she
flush up easily with embarrassment? Does she have really sparkly eyes? Is she overly sensitive to bright light
(maybe not if she suffers from dark, dreary days but its worth asking). I wonder if the LV+ treatment didn’t make
her restless but wasn’t enough to calm her after the inappropriate PC+ treatment? Did you do the LV+ on the right
side? It might be worth trying one more Right sided LV+ treatment on its own to see what happens.