KristinWisgirda: April 29, 2019, 11:42pm
A thin, sallow, curious, bright eyed, 40 year old woman wants to prevent allergy symptoms of headache, foggy
head and runny nose. Treatment with acupuncture 8 years ago worked well. Her skin is slightly dry with rough pale
patches of eczema at the SJ channels of her elbows. She wasn’t having allergy symptoms at the time. She was
having moderate to severe abdominal bloating, weak and aching knees since her pregnancies, constant pelvic pain
after 2 csections that were 4 + years ago, 2 week long periods with several days of flooding flow. Her abdomen
was overall flaccid with what felt like rocks in lower abdomen. Light sensitivity, a history of migraines, strong
appetite and no digestive problems.
The first treatments were Liv+ and SI+ which dramatically relieved her bloating and pelvic pain. They prevented
PMS and preperiod spotting. The third treatment was on cycle day 1 of her period so Kidney supplementation was
used to prevent flooding. Her period had a moderate flow but only lasted 2 days.
The fourth treatment she was feeling so much better in many departments and no allergy symptoms yet though the
trees were in full bloom and other people were suffering. Her chief concern that day was that for 4 months her lips
has been very dry, peeling, and every few days would crack and become so painful she had to limit talking. Her
lips looked swollen and had a bright red rim that was a reaction to having the area above waxed several days
before. A mixed wet/dry presentation. I supplemented Lung, strongly guided by her bilateral knee weakness and
the lips belonging to Yang Ming and less strongly guided by her thin body with skin that was only locally very dry
at the lips and elbows.
Several days later she lets me know that her lips were 100% back to normal- psyche!- but that her allergy
symptoms of headache/head fog/sinus congestion with profuse white and yellow nasal discharge has been full blast
since the day after the lip treatment. Yikes! At the next visit, she was still miserable with the allergy symptoms and
her skin was clearly drier than usual. She was also having some scant brown vaginal spotting midcycle I
supplemented St. Though she seemed to drop deeply with previous treatments she reported that the St+ was the
most deeply relaxing. Ummmm-probably because the Lung+ treatment left her extra hungry for St+.
At the next visit, the patient reported that her allergy symptoms were dramatically better and the spotting stopped
the day after the last treatment but that nasal discharge remained significant through the week. Her skin remained
drier and her eczema was getting itchy. I repeated the St+ treatment.
This great learning experience leaves me wondering how could I have finessed the treatment plan. This patient has
so many elements that need supplementing. The SJ/Liv imbalance is the grosser constitutional presentation with
her. If replayed I would treat her dry lips by supplementing Liv to bring some cool moisture to the upper body
before disrupting the less clear Lung/St axis. Any other insights are welcome.
George_Mandler: May 2, 2019, 2:24am
@KristinWisgirda Interesting to me you brought up this case and in the end you thought about using the more
constitutional treatment to help her lips rather than focusing on location. I had a similar patient over the past couple
of weeks with a main complaint of burning, dry, swollen, chapped red lips. It has been going on for a couple of31/01/2024, 11:24Schooled by Lung and Stomach – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/schooled-by-lung-and-stomach/170/print2/5
months and she was using the standard dermatological steroid. She practices yoga regularly and is quite polite and
pleasant. I had worked with her a couple of years ago so knew a bit about her but now learning Sa’am see her a bit
differently.
I got asking about anger for her because you can feel this pent up pissed off nature underneath. “Oh yeah I get
really pissed off”. I asked her about current sleep – not so great, can wake up a couple of times per night. She gets
migraines 2x/week that always start on right GB20. This is clearly supplement PC. My thought was “let’s see if we
treat constitution if this lip symptom clears”. Anger == out of control red lips I thought.
It worked! She emailed me the next day (3 weeks ago) she woke up and the lips are the best they’d been since on
the heavy steroids… She slept great too. (Holy cow!). I’ve done 3 Left PC+ sessions on her since migraines start
on right. (3rd tx today). Migraines have been 1x/week instead of 2 and not so bad and lips were not even in the
conversation today.
So it was a learning experience to really take in the whole picture and go with the feeling and parse out what feels
like the primary channel.
Similarly I had a woman today (the one that lives in RI I talked to you about) – She is coming for bilateral foot pain
and SI+ has helped immensely. But today she was in a rage at everything. I did PC+ instead and am interested if it
helps her foot pain, I’ll report back. Such a fun art this Saam is!
michaelmax: May 2, 2019, 11:54pm
KristinWisgirda:
This great learning experience leaves me wondering how could I have finessed the treatment plan. This patient
has so many elements that need supplementing. The SJ/Liv imbalance is the grosser constitutional presentation
with her. If replayed I would treat her dry lips by supplementing Liv to bring some cool moisture to the upper
body before disrupting the less clear Lung/St axis. Any other insights are welcome.
First @KristinWisgirda I love the title of this “Schooled by Lung and Stomach”
I think you’ve really put your finger on it… sometimes we have to follow a process of learning how to unwind
things. Sure, once we reach a certain place of understanding we wonder if we could have gotten there in a more
direct way. But I suspect that when in the midst of learning something, that curvy, winding road is the way.
George_Mandler:
I got asking about anger for her because you can feel this pent up pissed off nature underneath. “Oh yeah I get
really pissed off”.
just so @George_Mandler, often our patients present as who they would like to be, but it is our job to treat them
as they are. Which means extending an invitation to show up as who they are. Only then can we really help them.
Toby talks about treating people as who they believe themselves to be. And while your patient was polite, you did
not let that distract you from who she might be under that veneer.31/01/2024, 11:24Schooled by Lung and Stomach – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/schooled-by-lung-and-stomach/170/print3/5
Great case on the power of treating the constitution!
Ryan_Gallagher: May 5, 2019, 3:47pm
Hi @KristinWisgirda
Would you mind explaining why you chose your treatments in this case? It’ll help me (and maybe others) learn!
So: Why did you start with +LR? Was it to balance the SJ markers of bright eyes, curiosity, and SJ-channel
eczema, along with digestive issues (SJ) and heavy menses (LR)?
Did you then +SI because of the rock-like lower abdomen (thus moving stasis)?
Why the +KD to prevent flooding? Is this drawing on KD Yang to strengthen and lift?
Why was your decision to +LU influenced by the weak knees? Was this to counter ST channel?
Since her chief complaint was seasonal allergies, I feel like I would have been attracted to damp-dry dynamics
from the beginning, perhaps with +SP to counter her thin body and dry skin…but this is likely too simplistic. Why
do you consider SJ/LR the primary imbalance?
Thanks for elaborating!
KristinWisgirda: May 6, 2019, 1:21pm
George_Mandler:
Such a fun art this Saam is!
Yes! The treatments are so powerful that each patient is an opportunity to learn, even when it goes badly.
Thanks for sharing your case George.31/01/2024, 11:24Schooled by Lung and Stomach – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/schooled-by-lung-and-stomach/170/print4/5
KristinWisgirda: May 6, 2019, 1:23pm
michaelmax:
often our patients present as who they would like to be, but it is our job to treat them as they are. Which means
extending an invitation to show up as who they are. Only then can we really help them.
A useful question is “What is true here for this patient right now?” Trying to remember to keep asking that one.
KristinWisgirda: May 6, 2019, 2:06pm
She wasn’t presenting with her allergy symptoms and she had so many other things going on, I decided to ignore
the allergies and address the grossest part of the the presentation: SJ/Liver imbalance = bright eyes/light
sensitivity/outward focused and very blood deficient. This woman did not need to have another 14 day period
including flooding. My sense was that the SI/K axis would be important to use based on the flaccid abdomen with
rocks in it. Working with her cycle the Liver + would better prepare her for using the moving SI+ before her period
to move stasis and then using the consolidation of K+ during the period to control bleeding. Maybe the K+
treatment early in her cycle was less than ideally timed, but creating a too short cycle but less bleeding is better
another flood and drip cycle. Her flaccid abdomen and overall presentation said profound overall deficiency so I
chose Kidney and really didn’t even consider the lifting of Lung. I was influenced by the idea of always using
Kidney for excess menstrual bleeding comes from studying herbal medicine with Sharon Weizenbaum- not
something from Sa’am. I am experimenting too.
I was a bit fixated on wanting to Lung+ because of the weak knees and let that override the somewhat dry skin. I
thought she could handle being a little drier outside and more moist inside. She is quite thin but her flesh is soft and
has a little fluid fog to it.
I also wonder if St+ would have helped her lips as well as Lung+ without the consequences.
mariamorris: June 30, 2019, 1:59pm
@KristinWisgirda
Hope you all had a great course in St. Louis
I have the same question as Ryan:
what is the connection between weak kness and supplementing Lungs?
KristinWisgirda: June 30, 2019, 11:28pm
Hi Maria,31/01/2024, 11:24Schooled by Lung and Stomach – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/schooled-by-lung-and-stomach/170/print5/5
Weak knees after losing/being low on money or other resources has strong clinical weight for diagnosing Stomach
excess. Weak knees by itself is something to consider in the Lung/Stomach balance.
St Louis has been great so far. Looking forward to clinic day tomorrow.
mariamorris: July 3, 2019, 6:05am
Thanks for the explanation,
Kristin. Wish I could have been there. Glad you are picking more of Toby’s pearls.