Ryan_Gallagher: April 15, 2019, 9:51pm
Thought I’d share a case—thanks for sharing any insights, crew!
59yo male
This patient’s chief concern is lumbar weakness and pain (L5-S1, disc deterioration). He has difficulty remaining in
any one position (sitting, lying, standing) for any length of time. He can have episodes of muscular clenching in
butt with sciatica coming down the right side. He walks and moves very gingerly so as not to exacerbate the
lumbar weakness and pain.
He is on the tall side, with moderate build and a slight pot belly. He is extremely outgoing, chatty, his mind always
moving from subject to subject. He considers himself a spirit medium, and frequently receives messages. He has
very poor boundaries. He is often sarcastic, whiny, and judgmental—these qualities seem to increase when he’s in
pain. He is comfortable financially, and thinks quite highly of himself.
He has patches of psoriasis on his elbows, hands, and hip, and his skin is quite dry overall. He tends to be thirsty
and loves cold water, and yet he doesn’t like being cold—he loves summer weather and being hot. He has a history
of GB removal; cataract surgery; and KD stone surgery.
Pulse is on the rapid side and is irregularly irregular.
I haven’t yet landed on a Sa’am pattern for this fella. I’m considering +KD. He also seems to have an abundance of
LU (very dry skin, pot belly, financially comfortable), so I wonder if +ST would make sense. If you have thoughts,
please let me know how you’d proceed!26/01/2024, 12:41A case for your Sa’am consideration – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/a-case-for-your-saam-consideration/102/print2/4
michaelmax: April 16, 2019, 1:54am
Hi @Ryan_Gallagher
It is very easy to think back pain = kidney. That is a very TCM idea, and while it can be part of pattern here. there
are usually some other patterns that would get you more traction than considering him to be Kidney deficient.
As to body type. A slight pot belly is not at all like someone who is obese. He sounds more like a Lg Intestine
excess. Dry inside (thin=dry) and dry outside, especially with the skin issues.
Mentally active and busy… often the case with a Lg Intestine type. Try asking him if he’s ever bored. If he laughs
and says never… then that is a firm sign. LI types are not usually as well off as Lung excess types, but because
they can hustle… they often have some resources.
and consider this… the back shu of the Lg Intestine is pretty much at the level of the spine with the problem.
Ryan_Gallagher: April 16, 2019, 1:35pm
Thanks for the insights, Michael! Would you (or anyone else) mind comparing the LI vs SP, in terms of their
mental-emotional tendencies? This is new to me—that the LI type is mentally active; I would have thought that
their cool/dry minds would be fairly calm and focused.
michaelmax: April 17, 2019, 2:05am
@Ryan_Gallagher
This podcast https://www.saambenevolentsociety.org/questions-saam-2/ really goes into it. Give it a listen and then ping us here if
you have further questions, or to share your new found insights.
KristinWisgirda: April 17, 2019, 5:38pm
Hi @Ryan_Gallagher,
Thanks for posting your case. For pain, it can be really helpful for Sa’am differentiation if you ask the patient if
there is a center point of their pain. Very often they will point to a back shu point. Knowing which channels are
lighting up when the pain radiates down his leg would be helpful to.
Once channel or back shu levels are indicated, you have to consider if that channel/organ and its counterbalancer is
the more appropriate to supplement.
Let us know what you find and the results of treatment. The more cases to learn from, the better.26/01/2024, 12:41A case for your Sa’am consideration – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/a-case-for-your-saam-consideration/102/print3/4
Ryan_Gallagher: April 18, 2019, 6:53pm
Thanks for the feedback, y’all. The LI/dryness perspective made a lot of sense, so I gave him a +SP treatment this
week, which he enjoyed. I’ll report back anything pertinent.
I do have another interesting case: 15yo male patient seeking help with misophonia (intense aversion to certain
sounds). He especially struggles with the noises of meals—utensils on plates, chewing, etc. It causes him great
anxiety.
He is a skilled musician and his aural perception is acute. He attunes to stimuli that don’t register with his peers.
(He says “I feel like I can hear more than other people can hear.”) Seems very SJ (piercing concentration on
external objects), no?
Otherwise, he’s quite healthy. He has a tall, very thin build (6’2”, 130); runs warm; a strong appetite; and has a bit
of concavity at the chest.
He’s always working on projects—very creative. Enjoys travel and new experiences. When he’s immersed in the
world, the misophonia subsides. It comes to the forefront when he’s at home with his family—especially
dinnertime.
I treated +SP to balance what I perceived as an LI abundance, and am planning on +LR to balance SJ the next time.
Please let me know what you think!
KristinWisgirda: April 18, 2019, 7:45pm
Hi Ryan, Thanks for the contribution of your cases.
With the misophonia patient, I am wondering how dry/moist his skin is to differentiate LI versus Stomach excess.
Notes say concavity of the chest can point to Stomach excess. If his skin doesn’t show any dryness or is clearly
moist/oily, you will want to consider Stomach excess and supplement the Lung. Treating the liver sounds like a
good possibility too. Please update us when he follows up. It may be helpful to find a way to stimulate his
misophonia while he is on the treatment table, so you can evaluate the effect of the needles right then and there.
Ryan_Gallagher: April 18, 2019, 8:58pm
Thanks for that, @KristinWisgirda
His skin was neither very dry nor oily. In choosing to supplement SP, I was mainly responding to how very tall and
thin he is, and how creative/productive he is (all of which suggested LI to my nooby brain). It makes sense, though,26/01/2024, 12:41A case for your Sa’am consideration – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/a-case-for-your-saam-consideration/102/print4/4
that chest concavity is a LU deficiency/ST excess. I’ll likely proceed with +LR the next time and see where we go
from there.
michaelmax: April 18, 2019, 9:24pm
Ryan_Gallagher:
very tall and thin he is, and how creative/productive he is (all of which suggested LI to my nooby brain).
Indeed @Ryan_Gallagher these are something to point you toward LI excess. Toby often talks about your “top
three” channels. I like that idea. Helps to keep the mind and perception a little more fluid and open.
ngmatthews: October 4, 2021, 5:15pm
I lean toward supplementing either LV or Pc for this kid. His irritation seems like GB to me, and his extreme
awareness of the outside world seems like TW excess. I’m not so drawn into the SP/Lu/LI/St realm yet for him,
mainly because the symptoms are so emotional for him. I think I’d tonify Liver a couple of times and see how it
goes.