dcantor: April 12, 2019, 9:42pm
Saw a patient this week with chronic pain that occurs in her coccyx, sacrum, lumbar spine, and pelvic floor. She
had an interesting and complex medical hx including some significant psycho-emotional challenges and didn’t
initially seem to fit into any clear diagnosis pattern. The thing that really struck me in our interview was her
statement that her most prominent emotions are shame and guilt, particularly related to her pain, and that “the pain
and shame feed on each other.” I decided to supplement Kidney, primarily because of its association with self-love,
and the location of her pain in the pelvic region. She came in with 6/10 pain, and it resolved completely on the
table. I’m interested to see if she will have sustained benefit or not, and will see her again next week.
Curious if others have had interesting recent experiences with diagnosing and treating Ki channel deficiency?
haunani: April 13, 2019, 7:25am
@dcantor it is beyond exciting to hear your results with ONE treatment. Please keep us updated.
mferguso: April 13, 2019, 6:02pm
So in this case you are doing Kidney tonification to balance a SI excess? I only mention it here because I start
getting confused about the system if I don’t see the excess channel mentioned prior to talking about a kidney
deficiency treatment to balance the excess. Part of me being a noob to the system I guess.
dcantor: April 14, 2019, 9:36pm
@haunani I’m definitely doubtful that this will be a one and done sort of case, but it was neat to see such a
dramatic shift when she was on the table, and to make that particular connection with the Kidney channel through
the phrasing she used. I’ll let you know of any interesting developments!
dcantor: April 14, 2019, 9:46pm
@mferguso In this case I was just focused on boosting Kidney channel energy, and suspected a deficiency based
on the shame/lack of self-love, the pain manifesting her her pelvic bowl and low back, and an overall weak pulse
particularly in the proximal positions. There is probably Qi and Blood stagnation in her pelvis/lower body as well,31/01/2024, 11:19Kidney supplementation and Sacral/Pelvic Pain – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/kidney-supplementation-and-sacral-pelvic-pain/88/print2/5
and so potentially tonifying SI on a different treatment could also be helpful (i.e. SI wouldn’t necessarily need to be
Excess to diagnose Ki Deficiency). Toby mentioned that these are two opposing channels he often identifies as
both being deficient in patients, and so one can consider supplementing them on alternating visits. However, he
also mentioned that if the Kidney is really weak, sometimes supplementing SI doesn’t go as well.
Joanne_Tait: May 6, 2019, 4:42pm
However, he also mentioned that if the Kidney is really weak, sometimes supplementing SI doesn’t go as
well.
This is a very good point and reminder that I don’t recall hearing in the podcasts. Thanks so much!
dcantor: May 27, 2019, 10:44pm
Meant to write a little update on this case a while ago. The patient has continued to experience a significant
reduction in pain, with small flare-ups, and comes in less often. When she comes in these days it tends to be with
2/10 pain rather than 6/10, and she usually leaves the visits pain free. Ki+ has continued to be the most effective
treatment for her, and she made another big step in her progress with several visits of SJ+. She reports that her
feelings of shame and depression have significantly improved.
Interestingly, she reported no benefit from SI+. She didn’t seem particularly ill-at-ease on the table but there was
not a positive shift in her sx. I suspected that this would be a case in which I would need to supplement both SI and
Ki, but that does not seem to be effective for her…even with signs of Qi and Blood Stagnation such as a dusky
tongue, tight pulse in the pelvis-lower body, hx of injury to the tail bone, etc. My sense is that her Kidney energy
can’t support the SI tonification, but not sure.
Joanne_Tait: July 12, 2019, 3:30am
I had an interesting case yesterday that reminds me of this thread so I’m posting it here. I had a patient come in a
day or two before her menses complaining of chronic low back pain that never really ceases. She’s tried many
things over many years and she says no matter what she does, the pain never really goes away. Her symptoms point
to liver blood deficiency. Her menses are usually heavy, long and painful and she needs pain meds to get her
through. Her sleep isn’t great as she wakes at night often. It seems to me that her back pain isn’t resolving because
she’s very blood deficient or as Sharon would say, she has crappy blood. She was clearly irritable when she came
in and was visiting from out of town, so I don’t think I’ll get to see her again. But, it raised some question about
timing around the menses for treatment. I supplemented liver thinking that would help ease the PMS and help
nourish the blood and help the back, but she wasn’t comfortable at all. (maybe pericardium would’ve been more
appropriate?) I ended up doing some suction cups on her lower back which helped ease her pain somewhat, but the
marks were pretty deficient. In hindsight, I’m wondering if I should have moved blood with small intestine, but
wasn’t comfortable doing that just before her period. Then I thought, and I know we’re told not to do this as31/01/2024, 11:19Kidney supplementation and Sacral/Pelvic Pain – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/kidney-supplementation-and-sacral-pelvic-pain/88/print3/5
beginners (which I used to do), that it may have been a good case for supplementing the liver and the small
intestine together. Thoughts? Should we avoid SI prior to or during menses in a patient with heavy, painful
periods? Especially if they’re blood deficient? Thanks for any insights.
KristinWisgirda: July 12, 2019, 1:33pm
@Joanne_Tait You have given us a collection of symptoms without a clear picture of the patient in terms of Saam
so it is impossible to know which direction is correct.
Taking a class will really help you with the basic perspective.
Joanne_Tait: July 12, 2019, 9:48pm
Hi Kristin,
I should’ve provided more Saam details. She’s a medium build, a little on the damp/soft fleshy side with dry skin.
She claims to have money issues, but is living in San Francisco, so I take that with a grain of salt. She tends toward
running cold and has difficulty sleeping through the night. Her tongue is thin body, slightly red and thin coating.
Her lips are dry as well. She was definitely irritable and a bit curt with her responses which is why I thought
Pericardium may have been a better fit (from my info above). I would guess she’s lung excess, but I still am
unclear as to how to treat her back pain given she was about to start her menses. So that being the case, I think my
question still is valid? How do you approach a patient that is about to start their cycle with heavy painful periods
that is blood deficient given these additional symptoms? Or is this not enough information to go on?
I have been practicing saam and following the podcasts and this forum since the beginning, though I’ve yet to
attend a class, which I agree would be of benefit. Thanks for any insights.
haunani: July 12, 2019, 11:01pm
Joanne,
She does sound possibly LU Xs type but one thing Toby emphasized at the St. Louis training is to become aware of
the person’s archetype if it is apparent (in the case of Earth or Metal) but always treat the patient’s concern first.
With that said, focusing on her back pain was important.
What other blood deficient signs does she exhibit? I don’t get a clear picture of this in your descriptions above.
Heavy menses with lots of bleeding sounds like possibly stasis or heat (again, without seeing her I am just
speculating).
Where was her back pain? What channels? More UB or more GB? Or both? The channel can help us in diagnosis
as well. We learned in St Louis, if the back pain is associated with a Shu point, that can help us direct us toward a
diagnosis as well. I.e. if her pain was at UB25, we might be able to look more at treating SI or KI (need more
evidence though).31/01/2024, 11:19Kidney supplementation and Sacral/Pelvic Pain – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/kidney-supplementation-and-sacral-pelvic-pain/88/print4/5
Was her curtness more out of anger and irritability? If so, that may be a sign of GB Xs in which case +PC would be
suggested (which is good for sleep issues too).
If her curtness was more out of rudeness or lack of awareness of her curtness this points more to Liv Xs in which
case +SanJiao would be suggested.
I highly recommend attending one of the seminars if you have been enjoying the Saam podcasts and this forum. I
am in Japan and the Live stream was awesome. Soooo much was covered and I found so much clarity and feel
much more comfortable (although like all of our medicine, still have so much to learn). Forever a student.
KristinWisgirda: July 12, 2019, 11:42pm
How does your diagnosis explain the heavy bleeding? If it doesn’t, what are you missing? This would be a good
starting point to be able to treat the patient safely. Blood xu doesn’t explain the bleeding. Lung excess doesn’t
explain the bleeding. GB excess is an unlikely cause of bleeding unless she had GB excess to the point of young
Mike Tyson- even then I am not sure.
haunani:
if the back pain is associated with a Shu point, that can help us direct us toward a diagnosis as well. I.e. if her
pain was at UB25, we might be able to look more at treating SI or KI (need more evidence though).
This info would really help your diagnosis- though pain located at Ub25 is the back shu of the LI and points to LI
or its counterbalancer Spleen. Pain located at UB23 would point to K or its counterbalancer SI.
For heavy bleeding my first thoughts go back to 4 of the old 8 parameter- is it hot or cold, excess or deficient? For
Saam, fleshing out the heat/cold balance She’s cold but how cold is she? How cold does she feel to you- ice cold
blue extremities, or just cool hands and feet? The H/UB hot and cold axis is important here. Ub excess is a kind of
hypofunction where the yang can’t secure the blood. H excess heat could be pushing the blood out of the vessels.
How about the SI/K axis? Does she have signs of significant blood stasis, any varicosities? How
pretty/symmetrical is she? What does her abdomen feel like- any hard masses or empty areas? Is her face sunken
from long exhausting illness? Blood stasis from K excess or Kidney not securing/SI excess could both explain the
heavy bleeding. Super important axis to have fleshed out.
The 3rd area to consider with bleeding is St excess which translates as Lung xu= qi xu not lifting and
consolidating. Less likely from the info you gave above.
Using Saam safely really requires that you have a clear Saam diagnosis which means 3-5 top ideas about the
patient’s condition seen through the lens of Saam.
haunani: July 12, 2019, 11:48pm
I love when you chime in @KristinWisgirda31/01/2024, 11:19Kidney supplementation and Sacral/Pelvic Pain – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/kidney-supplementation-and-sacral-pelvic-pain/88/print5/5
And thank you for catching the Back Shu correction. Eeeek.
Joanne_Tait: July 15, 2019, 9:09pm
Yes, forever a student agreed @haunani! Thanks for your feedback.
And @KristinWisgirda thank you for all the information as well. I am probably not going to see this patient again
since she was just visiting from OOT, but this discussion has been so helpful. I am also taking the GMP with
Sharon so have a lot of new information that’s getting integrated all the time. I will continue to ponder this case.