maeveodon: November 19, 2020, 10:41pm
Hi all, have this case that I would appreciate your thoughts on.
17 year old female
MC: Pain around coccyx which spreads up to about L1 when doing intense sports training sessions or when sitting
on a hard/cold surface for a long period of time. Feels it on BL channel on both sides, worse on left. The pain could
last all night, then will ease after a day or two. Better with warmth. Started after she fell on her coccyx about 2
years ago. Has been seen by consultant who doesn’t believe there is a fracture anywhere.
No other issues, no significant medical history, no medication, rarely sick.
Very pretty, well groomed. Slim but not skinny, abdomen quite firm and dense. Very polite, reserved and not very
forthcoming with details about herself but I feel that it’s more shyness than too-shielded?
LU10 area normal, skin normal except for dry scalp, stools regular and normal, tongue puffy with thin white
coating, purple distended subs.
Whole abdomen area tender on palpation, worse below naval, especially on the right.
Periods irregular and painful, usually every 5 weeks, some clots at the start but then gets quite heavy and colour is
red.
She sometimes gets headaches when she gets tired. Not able to pinpoint channels but all over the top and front of
her head she thinks.
Kid XS signs – Delayed (over consolidated?), painful periods with some clots, very purple distended subs. Some
visible blood vessels on BL40 area of both legs? Hands and feet freezing to touch.
SI XS – Heavy bleeding
BL XS – Pain on BL channel, better with warmth. HR ~60. Hands and feet freezing to touch.
HT XS – Pain on BL channel
SJ XS – Bright eyes +6, polite
Liv XS – Dense flesh, heavy bleeding
SP XS – Tongue puffy
LI XS – None that I noticed
LU XS – Tongue puffy
ST XS – Nothing that I noticed18/01/2024, 11:22Adverse reaction case and question – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/adverse-reaction-case-and-question/1408/print2/5
GB XS – Nothing to note until after the 2nd treatment, see below.
PC XS – Nothing excessive to note
1st Treatment
+SI right – plenty of stasis signs and does not seem to have any Kidney deficiency. Felt relaxed and seemed to
settle well. At next appointment she said that she did feel much looser in her lower back on the left, and that the
right seemed a bit stiffer now. So….
2nd treatment
+SI left – with all the stasis signs and with good result I felt two in a row would be okay.
But that night she started to get a headache which got worse as the weekend went on. She did not contact me but
went to the doctor on the Sunday as her mother was worried about the headache. It was a stabbing type pain on left
GB20 area and there is a little nodule. The pain then goes up over the right hand side of her head to forehead. The
doctor felt it was just muscular as it was all tight and tender down into her shoulders. He prescribed anti-
inflammatories. She called me on Monday and I asked her to come in but she was not able to come until today.
We talked about the headache and she also said she has been feeling dizzy, lightheaded and agitated all week and
can’t concentrate in school and I noticed her limbs are jittery. My thought for these new symptoms are GB XS
(could this also cause dizziness and lightheadedness?).
But, because of the adverse reaction and all the reminders recently to do the opposite, I thought I better try
+Kid….thinking it makes no sense at all for her though. But after 5 minutes she was more agitated and said she
didn’t feel great so I took them out. At that stage I probably should have tried +PC but I felt she was too agitated
for the jing well points so I just did 4 gates which seemed to settle her a bit.
She is coming again on Saturday and I plan to try +PC. Possibly +HT for future if needed for LBP. She has not
been able to focus on lower back this past week but it has not gotten any worse.
My main question here is about the adverse reaction. Any thoughts? I’m thinking too much movement caused this
but haven’t seen it kick off completely new symptoms before. Also wondering if Liver is XS and moving blood too
much could cause an issue like this?
George_Mandler: November 21, 2020, 3:41am
HI Maev
Thank you for your post I hope all is OK and safe in Ireland.
Some thoughts …
maeveodon:
MC: Pain around coccyx which spreads up to about L1 when doing intense sports training sessions or when
sitting on a hard/cold surface for a long period of time. Feels it on BL channel on both sides18/01/2024, 11:22Adverse reaction case and question – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/adverse-reaction-case-and-question/1408/print3/5
When she fell what time of year was it?
What is her body temp in terms of how she feels?? – she says the pain is better with warmth.
maeveodon:
abdomen quite firm and dense
Firm/cool abdomen may suggest a BL excess. Was it cool to touch?
maeveodon:
reserved and not very forthcoming
Hmmm OK in the back of my mind with what you’ve reported the thought ‘hypofunction’ popped in my head. (i.e
BL excess)
maeveodon:
Whole abdomen area tender on palpation
If a cool hard abdomen it could be BL excess
Below I see you categorized symptoms the way we learned in school. However for future case write-ups we should
all use the brilliant approach @KristinWisgirda suggested and that is to categorize it by symptom and give it a
weight to how strongly they present the symptom rather than by channel and listing the symptoms many times.
(that is here: Case Study Format)
maeveodon:
Kid XS signs – Delayed (over consolidated?), painful periods with some clots, very purple distended subs.
Some visible blood vessels on BL40 area of both legs? Hands and feet freezing to touch.
I haven’t heard of cold extremities as Kidney excess signs, but have only been in a couple of level 1 classes.
maeveodon:
SI XS – Heavy bleeding
I don’t believe heavy bleeding is a sign of Small Int excess – Heavy bleeding could be from many pathologies
maeveodon:
BL XS – Pain on BL channel, better with warmth. HR ~60. Hands and feet freezing to touch.
Because there is pain along the trajectory it could mean either pair, so BL/HT. A HR of 60 is moderate to slight
slow (If there was a rapid heart rate – 95bpm then you might think HT excess.) Hands/feet cold not a sign of BL18/01/2024, 11:22Adverse reaction case and question – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/adverse-reaction-case-and-question/1408/print4/5
excess.
maeveodon:
+SI left – with all the stasis signs and with good result I felt two in a row would be okay.
Yes clinic is hard. “No problem stays solved in a complex dynamic system” Quite reasonable to go to the same
channel because it worked the first time. If you are sure your technique and location were correct then yes this is
frustrating. Where was she in her cycle? I do find that SI+ supplementation may be the right treatment on CD26
but not the right treatment on CD6.
But although SI+ supplementation is good first choice for pain and she does have painful periods I would have
probably gone to a HT+ supplementation treatment as my first choice. HT+ supplementation is what jumps out at
me: BL channel pain, better with warmth, hard midline, kind of reserved, slower pulse. Also it is more along the
BL channel rather than at BL 23 or BL 28 where we think of SI+ supplementation.
maeveodon:
But, because of the adverse reaction and all the reminders recently to do the opposite, I thought I better try
+Kid….thinking it makes no sense at all for her though. But after 5 minutes she was more agitated and said she
didn’t feel great so I took them out.
Yes KD+ supplementation on the right was the correct treatment, but as you said it would have been a better
indicator sooner to the 2nd SI+ treatment. If you are sure of the technique and location then I am not sure why it
went sideways other than she already had Kidney excess with the varicosities and painful periods and maybe it was
before her period? And she is just 17 ya know what I mean?
maeveodon:
Also wondering if Liver is XS and moving blood too much could cause an issue like this?
I do not understand what you are thinking here, but would like to know.
maeveodon:
She is coming again on Saturday and I plan to try +PC. Possibly +HT for future if needed for LBP
If the MC is still the BL channel pain from coccyx to L1 and not headache/GB20 pain from the sideways treatment
where you need to do damage control, then I’d go HT+ supplementation.
Keep us posted.
michaelmax: November 25, 2020, 6:06pm
18/01/2024, 11:22Adverse reaction case and question – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/adverse-reaction-case-and-question/1408/print5/5
maeveodon:
My main question here is about the adverse reaction. Any thoughts? I’m thinking too much movement caused
this but haven’t seen it kick off completely new symptoms before. Also wondering if Liver is XS and moving
blood too much could cause an issue like this?
Hi @maeveodon, great case!
And thanks for your clear thoughts and questions.
I’m not sure that LV EX too much blood would respond poorly to tonifying the SI. If anything, I would think that
would be helpful. (build and move the blood)
Two things stand out for me:
The pain in the tailbone when sitting on cold surfaces along with the tight lower abdomen. That makes me think
cold is an issue. So maybe tonify the HT to warm her up, and you could also add the SI (yin/yang pair resonance)
Cold hands and feet. My herbal thinking comes in here and I look to see if there is:
1 yang deficiency
2 qi stagnation
Tonifying the HT can help with the warming the yang
When thinking of qi stagnation, it helps to get into what is stagnating the qi. Is there blood stasis? Damp
obstruction? Qi deficiency?
While we commonly tonify the SI for blood and qi stasis. I find it helpful to figure out “where” the qi stagnation is
coming from, and then address that.
Hope this helps.
Keep us posted!