ngmatthews: October 4, 2021, 5:15pm
Today saw an 11 yo girl for first visit. Complaint is onset insomnia since birth. Also drenching night sweats all her
life with thrashing. She is a highly sensitive child who is easily kept awake by any light striking her face or any
sound, even a sound machine or white noise source in the bedroom. Reports not being afraid, not worrying, but
constantly mind working reviewing the events of the day. This keeps her awake for at least 3 hours after she gets in
bed. She also wakes drenched every morning, even when sleeping with only a sheet or very light blanket. During
the day she is not hot nor cold. Dressed appropriately for the 72 degree day today in shorts and t-shirt. She does not
tend to wear sunglasses much. She does have some breast development but has not started her menses yet. She is a
highly intelligent child who reads large numbers of books, partially to escape from overwhelming stimuli.
This appears to be a pretty clear case of San Jiao excess, or Liver deficiency, however, I cannot figure out what to
think about the night sweats.
I am wondering how we think about night sweats in Saam. Is it some kind of lack of consolidation? Seems like
heat, but only at night, not during the day, so I m not sure it fits into the UB/Ht continuum.
So if this is San Jiao excess/ Liver deficiency, how do we explain the drenching night sweats?
KristinWisgirda: May 24, 2019, 9:14pm
Thanks for sharing this interesting case. To determine if the sweats are more of an out thrusting or a lack of
consolidation it would be helpful to know what she looks like and how she behaves with you.
The thrashing catches my eye as a relative GB excess and a source of out thrusting since she doesn t have any
obvious heat signs. Besides being bookish, does she have other signs of Pericardium excess like slow deliberate
movements and a rooted presence? I know plenty of bookish people who are erratic and emotionally labile.
Is she pretty, symmetrical with good solid bone structure? Is she interested in looking good? Or is she less
interested in appearances, more asymmetrical, with wispier bones?
Though it is common 11 years old is still on the earlier side for breast development. Sharon Weizenbaum sees
premature sexual development as a kind of lack of consolidation of the Kidney.
Any other morphological info would be helpful too- hefty/skinny, skin quality.
dcantor: May 25, 2019, 2:16am
26/01/2024, 12:0711yo insomnia with night sweats – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/11yo-insomnia-with-night-sweats/256/print2/6
Couldn t night sweats just be from Yin Deficiency (Lv and/or Ki), which would also benefit from Lv tonification,
along with her other sx?
ngmatthews: October 4, 2021, 5:15pm
This young lady is of slight build but not too skinny. Muscles are well developed. Flesh is neither excess nor
deficient. She has dark brown but bright eyes. She speaks in a very careful way. She is pretty, but not model
pretty. All of the children in this family are attractive and healthy, as is the mother. She is talkative with me, not
shy, happy to answer all questions and be helpful. She is appropriate size, height, and weight for her age, I m
guessing about 75 lbs, dark hair, medium tone skin. Skin is very clear, neither dry nor oily. I would not say she is
erratic or emotionally labile, however, I have only met her once. She is not dressed up nor down. Wearing jeans
shorts and a nice t-shirt. Since she is home-schooled she does not seem affected by trying to keep up with other
kid s fashions, but she is well groomed and neat. She does have symmetrical features and good bones, I would not
say wispy. Her skin is a bit thick. I learned this through needling. She found a couple of the needles painful. But as
I pinched up skin to insert Lung 8 I could see that her skin was thicker than in most of the older people I treat,
however, I think it is normal for a healthy child. While waiting to come in, she read a book while her two siblings
played with the dogs. She did not seem overly nervous about the treatment until the actual insertion of the needles,
which I considered normal. Her movements were not especially slow. She did move around while talking in the
interview. I would not say she is overly rooted in her presence. On the intake form she did not check any
symptoms; no digestive, no respiratory, no skin, nothing else indicating any pathology. There was no other
evidence of problems with water metabolism like runny nose, oily skin, obesity, loose stool, excess thirst or
frequent urination. Therefore, I was not drawn to the Earth/Metal considerations in this case. As for Gb/Pc, I saw
her as neither excessively bookish nor angry, though she does read a lot. So I was left with the Ht/UB, Ki/SI, or
SJ/Lv continua. My mind went to the UB somehow as related to cold/hot dynamics. But she reports being neither
cold nor hot during the daytime, only hot at night. She is also not excessively sweaty during the day, nor
excessively active during the day, only the night. She and her siblings are very active with hiking and outdoor
activities. The family is kind of a hippie family, vegetarian, home-schooled, nature-minded, focused on the
natural world. They have moved quite a few times due to the father s work, and the recent move from the
mountains of Virginia to Cedar Rapids has been difficult for the children as they are not used to so much hustle and
bustle. For example, they had not heard sirens before and found it disturbing. However, the patient reported that
this move did not exacerbate her insomnia and night sweats and thrashing.
While lying awake trying to fall asleep, she reports that she has to think about everything that has happened during
the prior day. She called it processing . This highly intelligent and highly sensitive child appears to have some
qualities that one might say put her on the autism spectrum , though you would have to speak with her a bit to
pick that up. She chooses her words very carefully and thinks carefully about everything. Being absorbed in books
helps her modulate her sensory input, I think. During the treatment her mother put an audio book in her ear to help
her focus on something other than the needles.
I hope this helps clarify and shows you why I could only come up with San Jiao and not see where the sweating fits
in.26/01/2024, 12:0711yo insomnia with night sweats – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/11yo-insomnia-with-night-sweats/256/print3/6
ngmatthews: October 4, 2021, 5:15pm
Nights sweats can be from many things besides Yin deficiency. I guess according to TCM ideas, Yin deficiency of
Liver or Kidney and Heart could explain the restlessness, insomnia, and night sweats. However, these are
drenching sweats in a child and she has had them since infancy.
Excessive sweating can be from any part of the water metabolism not reigning in water. Lung could be involved,
and certainly Kidney or Spleen.
In Saam we don t exactly think this way so I had not really gone there. But since I don t see any other signs of Yin
deficiency here I think that perspective is not so useful. And especially since we are not using herbs, the Yin
deficiency hypothesis is not so helpful in designing a Saam treatment.
I guess you could think of Liver tonification as a Yin support. I do think of Liver in Saam as somewhat akin to
Liver Blood, based on what I see in patients.
Donley: May 25, 2019, 2:32pm
ngmatthews:
While lying awake trying to fall asleep, she reports that she has to think about everything that has happened
during the prior day.
As I m a complete novice in Sa am, I ll leave that to the rest of you to discuss, but this did jump out at me. In my
experience patients who have to process while trying to sleep benefit from journaling before going to bed. She
may be the librarian who must physically put away the books brought out during the day. Journaling may allow the
task of processing to feel complete before the time to sleep. Also, if she feels like she has to process in order to
not forget the events of the day, if it s written she will have it for as long as she wants.
dcantor: May 25, 2019, 5:10pm
In terms of Lv+ supporting Yin, cool, moist, dense energy certainly makes me think of Yin, and Yin and Blood are
so closely linked.
If I m remembering correctly, Toby once said that in cases of hot flashes and other Yin xu sx, even though Lv+
makes a lot of sense, he has had more success with SI+.
I agree that there are many other potential causes of sweating. It might be interesting to start with Lv+ and see what
improves for her.26/01/2024, 12:0711yo insomnia with night sweats – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/11yo-insomnia-with-night-sweats/256/print4/6
ngmatthews: October 4, 2021, 5:15pm
Yes I have started with Liver supplementation. I ll see her next week and evaluate.
Adina_Kletzel: May 26, 2019, 6:56am
HI,
I am also a novice at this but could consolidating water, her jumping mind, and her thrashing about by tonifying
kidney make sense? It also seems to be that fire and water are not working together correctly at night – with water
being released rather than cooling off the fire that is making her so restless. This fire-water relationship also relates
to kidney.
Just a thought
rappeports: May 26, 2019, 12:46pm
Since this has happened since birth, I m wondering re gestation and labor
ngmatthews: October 4, 2021, 5:15pm
She had a healthy gestation and normal birth. She was breast fed and born vaginally with no complications.
ngmatthews: October 4, 2021, 5:15pm
I like this idea a lot. It reminds me of the idea of Heart and Kidney not communicating in a way. Like the idea that
the Kidney is the place where Heart can go to rest and be grounded. The lower Tan Tien must be working properly
for the Fire of Heart to home to it. Kiiko Matsumoto works a lot with this. This concept is more useful, I think,
than the classic Yin deficiency way of seeing, because it incorporates more of the concepts about the Qi
mechanism. However, I have often told patients that their Yin deficiency caused their restlessness. I tell them you
are not consolidated enough .
All along I did not feel that UB deficiency was quite it, because she is not hot all the time, only at night. I
considered that Ht/UB continuum, but felt that Heart excess seemed to not quite describe the situation either, since
during the day she is pretty quiet.
The question of Ki/SI of course came up in my mind, with SI managing the dynamics between Fire and Water
obviously. But I forgot that Kidney also involves Fire and Water, but in a more consolidating and less moving way.
This is where they hold each other in check, like the Tai Ji symbol, as opposed to SI which helps them interact in a26/01/2024, 12:0711yo insomnia with night sweats – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/11yo-insomnia-with-night-sweats/256/print5/6
whoosh to create movement. So I guess in that sense, you could see her as SI excess and Ki deficient. I often use SI
to treat pain, but had not thought deeply about it for other types of presentations.
I m also sure my old TCM mind came back in and complicated things by thinking that a healthy child could not
have Kidney deficiency. That old TCM mind. Its been 35 years in development and is reluctant to let go.
I ll keep this in my back pocket for the next treatment. Thanks Adina, you may be a novice, but you are getting it.
Adina_Kletzel: May 26, 2019, 7:29pm
Thank-you! That is quite encouraging
Please keep us posted!
KristinWisgirda: May 28, 2019, 3:37pm
ngmatthews:
She does have symmetrical features and good bones, I would not say wispy.
These features show abundant Kidney energy in the Sa am system.
ngmatthews:
So I guess in that sense, you could see her as SI excess and Ki deficient.
I m not seeing any for sure excess SI, deficient Kidney signs with her.
The thrashing really stands out to me as a GB excess sign. I wonder how much of her reviewing the events of the
day and careful thinking is a system working hard to develop a strong Pericardium knowing it will help manage a
Gb excess versus a true inherent Pericardium abundance. In the balance of GB/P, the thrashing is a dramatic
enough sign to tip the scales and points to a relative GB excess.
I would also consider SI+ because of the relative Kidney excess, along with the heat at night and sweats.
ngmatthews: October 4, 2021, 5:15pm
Saw my young patient last Friday afternoon. She slept better for one night after the Liver tonification, but still
thrashed a lot and had night sweats. It seemed that Liver tonification was not it for her. She had gotten inoculations
the day before, and had the shots in her legs. She was quite traumatized by that experience, so I was not able to use
any needles in her extremities. I was able to do a GV 20 with the dark blue Seirin facial needles, like 44 g or26/01/2024, 12:0711yo insomnia with night sweats – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/11yo-insomnia-with-night-sweats/256/print6/6
something. Due to the fact that she was not open to using needles on hands and feet, I used some essential oils on
the points, which I held with pressure in the correct direction of the meridian. She got very relaxed during the
treatment of course, due to the oils and possibly the Pc tonification treatment that several of you recommended as a
balance for Gb excess. And this time she did seem irritable so I could see the Gb more clearly. I agree that her
constant reading is an attempt for the Pc to get more energy to balance the Gb. I ll see her again on Friday and
we ll find out how things worked. Maybe I ll be able to use needles this time.