ronhubbs: September 8, 2019, 12:38am
36-year-old female. Was in a severe car accident a couple of years ago that caused:
1. Very severe constant, debilitating pain: Headache / Eye pain (8-9/10), Cervical pain and stiffness, thoracic
back pain
2. Severe sensitivity to light / sound + difficulty with cognitive processing, dizziness, sometimes nausea
3. Severe Fatigue: Was debilitating, w/ px having to sleep 16 or more hours per day. After first few Saam txs
(Supp LV 2X), this got much better to where px didn’t completely crash after work and was able to be active
at night and on weekends. (Though pain persisted)
Px has recently resumed working at Nike as she was going to otherwise lose her job. She had not worked for nearly
2 years. She just shifted into full time hours over the past month and is struggling to keep it together.
CHANNELS AFFECTED:
Eyes / Head / Temples: GB, SJ, UB, ST, DU, LV?, H?
Neck pain: UB, SI, GB, DU
Back (thoracic): UB, DU
(Below are my cut and pasted Saam chart notes – Sorry for the all caps, but it’s easier for me to read & review
them in the EMR this way):
PULSE MODERATE RATE
TONGUE: RED TIP, FRONT AND SIDES, TOOTHMARKED, SWOLLEN, SL DRY YTC
BODY: soft, fleshy, with relatively normal skin (used to be really oily); px is former collegiate athlete, but body is
starting to degrade from being unable to exercise / be active
HX: FEET COOLER THAN HANDS (USED TO BE SEVERE) (BOTH FEEL WARM / NORMAL AS OF 9/3
after Saam tx)
DRY, PARCHED MOUTH (HAS GOTTEN BETTER AS OF 9/5/19) DESPITE DRINKING LOTS OF
WATER (STILL DRINKING LOTS OF WATER)
FEELING LIKE RUNNING PRETTY WARM, BUT NOT TOO HOT
BRIGHT personality and complexion 7/10 (which is considerable considering her very difficult ongoing
situation / condition)
HAS ALWAYS BEEN CLUMSY
Px had intense rage / anger outbursts after accident (which is difficult to believe as she is very polite and sweet);
She has been on lexapro and has not felt this way since
NO R/L-SIDED PAIN / PROBS TREND
NOT FEELING LIKE GETTING ENOUGH SLEEP (though feeling better energy and not sleeping nearly as
much as did before)
INSOMNIA: GOES TO BED EARLY BUT LAYS THERE AND DOESN’T GO TO SLEEP RIGHT AWAY;
RECENTLY (9/3) WENT TO BED 7:30 PM DIDN’T SLEEP UNTIL NEARLY 1 AM
NO SOB / SHALLOW BREATHING30/01/2024, 13:35Extreme Pain Case & Question about Shock – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/extreme-pain-case-question-about-shock/584/print2/7
LIBIDO: NORMAL
ONE SPIDER VEIN ON CALF;
SMALL SPIDERS ON SI CHANNEL AT NECK NEAR T1, 2
DARK BLUE/PURPLE VEINS UNDER TONGUE (not engorged but distinct)
HX: IN HIGH SCHOOL WAS HOSPITALIZED FOR TWISTED INTESTINE; was put on pain meds, woke a
day later feeling better; was very stressed in high school, had “sports bulimia (purging through exercise) /
anorexia: “I never felt like I could work out enough” “perfectionist”, counted calories to extremely low levels
(“a big problem within the culture of female athletes of the high school”. This continued into college until a
coach demanded she stop or be removed from the athletics
HX: ULCERS IN COLLEGE FROM EXCESS USE OF NSAIDs / PAIN KILLERS
ABDOMEN: SL CLAMMY, WARM & COOL IN SPOTS
HAD HEAT SYMPTOMS BUT IMPROVING
LU10: PRETTY NORMAL
FINANCIAL / RESOURCES: “HARDCORE SAVERS” – ALWAYS FEELS A SENSE OF CONCERN IF
DOESN’T HAVE AN ABUNDANCE OF SAVINGS (through this ordeal, much of their savings have been
wiped out)
SWEATS NORMALLY
SKIN IS NORMAL
T-ZONE OILY; BAD ACNE WHEN YOUNGER – TOOK MEDICATIONS
SWEET TOOTH
NUMBNESS EARLY ON IN INJURY (HANDS/ARMS, FEET/LEGS), BUT NOT AS INTENSELY NOW.
FEELS HEAVINESS SOMETIMES
NOT LAZY / TENDS TO FIND SOMETHING THAT NEEDS TO BE DONE
SA’AM DX:
EXCESS SJ
EXCESS GB
EXCESS K (PAIN / STASIS) (Now reconsidered as WRONG Dx)
EXCESS UB / H (mixed cold and heat signs; channel involvement; Shock?)
EXCESS ST
Treatments:
TX #1: SUPP P (Not much discernible effect; I started with this one bc I had not fully flushed out the Saam Dx and
the GB headache, insomnia, and history of rage / outburst seemed like the grossest thing at the time. The next
treatment, I settled on treating the excess SJ)
TX #2: SUPP LV (GOOD EFFECT)
TX #3: SUPP LV. (FURTHER GOOD EFFECT: Px reported having considerably better energy as mentioned
above; pain had not improved however)
TX #4: SUPP SI: Px GOT EXTREMELY STIRRED UP W/ PAIN FOR TWO DAYS AFTER TX; She was
overwhelmed and had to leave work early. I had px return for complimentary tx:
TX #5: SUPP LV + GB: I started with supplementing LV after pressing LV8 + K10 seemed to improve headache
and symptoms. After needling, improvement was minimal. I continued to test some points with acupressure and
supplemented GB which seemed to help more. The immediate effect was that the px calmed down and headache
improved, with her feeling better upon leaving; 2 days later, px says that pain levels are trending towards what they
were before Tx #4 but are still high; energy still seems better but not as good as before tx #430/01/2024, 13:35Extreme Pain Case & Question about Shock – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/extreme-pain-case-question-about-shock/584/print3/7
So obviously supplementing SI was a bad move. I can see now that moving the blood that strongly was too much,
but since the fatigue had gotten so much better, I thought this was the best way to tx the pain and saw SI channel
going to eyes / temple, some signs of stasis and thought that it fit.
Now I am left thinking that supplementing UB is the best way forward (or possibly H if that doesn’t hit the mark),
but she doesn’t have anxiety, fear, or urinary problems and has mixed cold / heat signs. So I had some questions
about categorizing / treating PTSD / Shock. I’m a little confused as to distinguishing between UB / H (when there
aren’t overt Hot/Cold signs). Excess UB signs include Fear, while Excess H signs include Anxiety.
Aren’t Fear and Anxiety somewhat intertwined? Further, how would we characterize PTSD / Shock in Saam?
Thanks for considering.
KristinWisgirda: September 8, 2019, 3:00pm
ronhubbs:
So obviously supplementing SI was a bad move.
This is really important feedback from the patient. When a patient has such an obvious adverse reaction from the
SI+ treatment, treating the counterbalancer Kidney is indicated.
ronhubbs:
how would we characterize PTSD / Shock in Saam?
PTSD has such a broad range of manifestations any of the 12 channels can be involved. “Shock”- I’m not sure
what leads you to characterize the current state of this patient with this label.
ronhubbs:
Excess UB signs include Fear, while Excess H signs include Anxiety.
A more helpful distinction of the qualities of Heart vs UB excess is hyperfunction for Heart and hypofunction for
UB.
Anxiety can be a manifestation of any of the 12 channels. Fear can be part of UB excess but could be other things
as well. She is running warmer/warm to the touch so I would think very carefully before supplementing H.
ronhubbs: September 8, 2019, 5:22pm
KristinWisgirda:30/01/2024, 13:35Extreme Pain Case & Question about Shock – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/extreme-pain-case-question-about-shock/584/print4/7
This is really important feedback from the patient. When a patient has such an obvious adverse reaction from
the SI+ treatment, treating the counterbalancer Kidney is indicated
This is very good to know. Thank you and I will take this heavily into account.
Regarding the diagnosis of Shock, I’m not sure how familiar you are with the term in Classical or 5 Element
acupuncture, but many things about this case trumpet the idea of shock or “Heart Shock”, which in many ways is
synonymous with trauma. From a 5 elements perspective, it is described as “separation of the five elements and
loss of integrity in the Heart/Kidney axis due to shock” (Jarrett, Clinical Practice of Chinese Medicine).
Before I started doing Saam, I had worked with this patient for several months off and on. At one point, I did a
psycho-emotional release exercise and the patient had a very emotional release regarding the guy who hit her car in
his brand new truck. She was T-boned and spun around in a 360 and right afterwards he got out and (despite it
being his fault) started yelling at her while she was still in a state of shock. She didn’t respond as she was in a
stupor and people intervened and berated him and pointed out that it was his fault. She shook and cried intensely
for several minutes during the release as the pent up pernicious Qi released (at least some of it anyway). There
were some improvements (primarily with dizziness and ability to walk) after this and other treatments, but the pain
and fatigue persisted.
Jarrett (I believe based on the Worsley school) states such shock as an issue with the Shaoyin H/K axis. I’m not
exactly sure how others (Hammer, Rosen, etc) characterize it, but it seems like there would be more specific organs
involved in the way we absorb / hold emotional and physical traumas that are too big to process at the time we take
them on. So, in that way, I am interested if Saam theory and practice has any gems (or pebbles) regarding this.
Again, thank you for the information regarding the counterbalance indication.
KristinWisgirda: September 8, 2019, 7:48pm
ronhubbs:
So, in that way, I am interested if Saam theory and practice has any gems (or pebbles) regarding this.
The Saam system is the gem: “Love medicine with a technique on top.” What is really true for your patient beyond
her words and her stories? Listening and observing your patient with your heart first and foremost will show you
the way.
Trauma derails patients at their individual weakest points. Any of the 12 channels can be involved. When working
with Saam it is important to put aside other methods and systems, so you can see your patient clearly through the
Saam lens.
adambroder: September 27, 2019, 9:56pm
30/01/2024, 13:35Extreme Pain Case & Question about Shock – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/extreme-pain-case-question-about-shock/584/print5/7
ronhubbs:
it seems like there would be more specific organs involved in the way we absorb / hold emotional and physical
traumas that are too big to process at the time we take them on
This makes me think of the complement channel system of classical acupuncture, specifically the UB luo, although
there may be others that are also involved. Viewed in this way it would be appropriate to treat HT+ with Sa’am in
my opinion. The patient may not present with overt fear signs or even be aware herself that she is fearful but
looked at through this lens she is probably still holding onto that emotional trauma in some way.
adambroder: September 27, 2019, 10:00pm
KristinWisgirda:
When working with Saam it is important to put aside other methods and systems, so you can see your patient
clearly through the Saam lens.
I would respectfully disagree, based on what I wrote above about the UB luo channel being responsible for
processing fear. Toby has said that Sa’am is a great system to incorporate other ideas into. And I’ve seen you
yourself say (in response to a question about cracked heels representing KI def) that there isn’t enough time in the
intro class to talk about every way a channel pathology can present. I’m open to being corrected but, with some
exceptions, it seems like Sa’am can wrap in other systems quite well.
adambroder #7September 27, 2019, 10:00pm
Btw can you share any follow up of what’s been happening with this patient?
ronhubbs: September 30, 2019, 4:47pm
Sorry about the delayed response. I did the “antidote” treatment of +K after stirring things up with +SI. This didn’t
seem to have much effect.
It’s interesting that in one of your comments you mentioned the UB channel in relation to fear, because this is what
I addressed last week. She has mixed symptoms of both hot and cold as well as fear and anxiety. Also, her CC
pains are pretty much all UB channel. As the heat symptoms were slightly more, I decided to start with +UB. I will
see tomorrow how that worked. Immediately it seemed to have a positive effect (but then again, so did +SI and that
wound up getting things really stirred up). Depending on the results she had this week, I am considering +H as
well.30/01/2024, 13:35Extreme Pain Case & Question about Shock – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/extreme-pain-case-question-about-shock/584/print6/7
I agree with the incorporation of other concepts / knowledge / understanding into the Saam approach. (And H and
UB certainly fit with the Shock dx). With time I will, I’m sure, incorporate more and more. For now, I am trying to
operate as much as possible from purely the Saam diagnostics and treatment approach alone to force myself to
more deeply understand and master it.
KristinWisgirda: September 30, 2019, 11:57pm
It is natural to want to try to incorporate your base of knowledge when you learn a new system. But with Saam, this
will only cause confusion. Clinic is hard enough.
Toby is trying to pass on what he learned from his teacher. In classes, the gems of his teacher’s teachings are in the
slides. This should be the foundation for your diagnosis.
ronhubbs:
For now, I am trying to operate as much as possible from purely the Saam diagnostics and treatment approach
alone to force myself to more deeply understand and master it.
This is the approach Toby recommends if you really want to use the system to best effect and Saam Responsibly
since it can work powerfully either way.
adambroder:
Toby has said that Sa’am is a great system to incorporate other ideas into.
I believe this is a misunderstanding. Toby is really, really hesitant to share any ideas that weren’t passed down from
his teacher, because his teacher’s teachings are what he finds absolutely reliable. If he is hesitant to incorporate
other ideas into Saam, after practicing 20 years, why would he suggest new students to do so?
adambroder: October 3, 2019, 5:27pm
I don’t know. Assuming I’m remembering him saying this correctly, it would be a great question for him.
It should be noted that I’m not suggesting a radically different approach from what has been taught. What I’m
suggesting, in this case, is to consider fear (UB excess) that can still be present from an accident as clinically
relevant even though the patient may not be aware of it. Since the UB luo channel is responsible for processing
overwhelming fear from a shocking episode, this idea can lead a (responsible) Sa’am practitioner to look into this
dynamic. Jeffrey Yuen teaches things such as this, and I know Toby has studied with him, so I can only assume that
he brings these ideas into the Sa’am framework.30/01/2024, 13:35Extreme Pain Case & Question about Shock – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/extreme-pain-case-question-about-shock/584/print7/7
adambroder: October 3, 2019, 5:56pm
Here’s a theoretical case to further illustrate my point. A patient has extreme pain (to the point where it’s the
loudest thing in the room) on the LI channel of the right forearm. Through orthopedic testing it’s revealed that the
problem is actually stemming from the SI channel of the right shoulder. Should we ignore the information from
outside of Sa’am and tonify LI? In my opinion it would be more accurate to address the root of the problem and
tonify SI.
adambroder: October 4, 2019, 9:22pm
Direct quote from Toby in his conversation about focus as a diagnostic with Michael: “You don’t forget about all
your understanding of Chinese Medicine. The Sa’am system is a nice umbrella for the understanding you already
have about Chinese Medicine.”
KristinWisgirda: October 6, 2019, 2:48am
adambroder:
Should we ignore the information from outside of Sa’am and tonify LI? In my opinion it would be more
accurate to address the root of the problem and tonify SI.
Using SI+ for pain is standard Saam. But to your point:
The loudest thing in the room is one guide.
Another guide is Sometimes channel, sometimes quality.
Patients can be complex. It is important to observe them closely and note all possible treatment strategies.
Palpating the channels and noting channel changes is well within Saam.
adambroder:
In my opinion it would be more accurate to address the root of the problem and tonify SI.
What is guaranteed accurate is the patient’s response to your treatment.