Shanlarson: March 9, 2020, 8:49pm
Hi All,
This question pops in my head from time to time when treating an injury. I have someone who came to see me
today with an acute injury to his brachioradialis muscle with most of the pain around LU5 area. The area was quite
bruised. I did some testing with acupressure on a few different channels. None of them really helped mobility or
pain but I got a small amount of more mobility with SI+ so I decided to start there. Directly post treatment there
wasn’t really any difference. (Although as we know with SAAM that could change in a couple of days). After he
left I really got the feeling that it’s probably a situation where I need to treat constitution rather than channel. He is
a super SJ XS person. It really is the grossest presentation in the room. His pain is on the right side. Liver we
generally strengthen on the right side for either male or female. Would I treat opposite side of the injury (Liv + on
the left) if I was thinking more about treating to constitution or would I treat how I would for his constitution as if
he didn’t have an injury (Liv+ on the right).
I hope my question makes sense.
KristinWisgirda: March 9, 2020, 9:57pm
In my thinking, if your treatment principle is to support the constitution, you would use the right side for Liver+
treating Liver on the right creates a bigger impact. Liver + doesn’t address the channel or the quality of the chief
complaint so I wouldn’t make a point of using it contralateral to the injury. My thoughts only.
I’ll ask Toby his thoughts but also if he finds treating constitutionally helpful with injuries.
Shanlarson: March 9, 2020, 10:25pm
Thanks. That’s helpful. There is a caveat to this. 6 months ago he got roughly the same injury in his left side
catching his son on the monkey bars. It felt like it never fully healed and now he was hit by a snowboarder on his
right side. Almost the same injury on the opposite side.
KristinWisgirda: March 9, 2020, 10:56pm
That adds some weight to the constitutional approach.
It reminds me of a recent case of a man who had left shoulder surgery that didn’t resolve his pain. Soon after he
developed right shoulder pain worse than the original left shoulder pain- SI channels both sides. A year of physical15/01/2024, 16:48Basic SA’Am question about what side/when – Qiological Community
https://forum.qiological.com/t/basic-sa-am-question-about-what-side-when/943/print2/4
therapy made little difference in his pain levels. Movement temporarily relieved his pain. His morphology is
clearly St excess and he even has a line of dark moles along his right SCM. While SI+ helped, Lung+ made a
bigger impact.
KristinWisgirda: March 10, 2020, 11:58am
Here is what Toby says about this question:
That’s a great question. I’d lean towards needling the Liver on the left because I’d be most interested in
affecting the side of the injury.
Then I asked him:
<When an acute injury is the chief complaint, do you ever find treating a patient’s constitution helpful if it is the
grossest part of the presentation? Or is it better to stay focused in the channel and/or quality of the injury?>
He answered:
I usually start with the latter and then go to the constitution if I’m not making progress.
sweiz: March 10, 2020, 8:01pm
Hi Shannon,
It sounds like, if you were only treating the injury, you would either tx St + or Lu+ on the left since the pain is on
the right both on the lung channel and on the lung side. I would then wonder about treating the most prominent one
of those on the left and maybe liver on the right. If it is really hard to tell which was most predominant
predominant between the injury and the constitution, that would be an approach. I am not sure if this would be a
kind of situation that Toby would recommend treating two sides. Kristin, could you ask about this?15/01/2024, 16:48Basic SA’Am question about what side/when – Qiological Community
https://forum.qiological.com/t/basic-sa-am-question-about-what-side-when/943/print3/4
Shanlarson: March 10, 2020, 8:43pm
Hi Sharon!
Thanks for piping in. I was between Lu+/St+ and Si+ when he first came in. I often will do acupressure on the
tonification points of each channel and ask the patient to move the injured side. Sometimes it helps clarify for me
where to start. As I said because of the bruising and the most response to Acupressure on SI, I went with needling
it.
This is a great question about needling Liv and Lu at same time. It was on my mind. I was thinking next of Lu+
because he slightly matches that constitutionally more than ST+ but the SJ XS is just so big and the weird situation
of acutely injuring himself on the opposite side as well just feels like it’s telling me something. Liv+ on the right
and LU+ on the left seem like a good idea. i do wonder what Toby would think about it.
KristinWisgirda: March 11, 2020, 6:59pm
Shanlarson:
I often will do acupressure on the tonification points of each channel and ask the patient to move the injured
side.
How is this practice working for you? Starting out with Saam, I used a similar practice and felt it was helpful. Now
I am not so sure and have abandoned it. I’m not able to properly stimulate all 4 points at the same time so I no
longer trust the feedback. I’ve had cases where acupressure on the points I could reach made no difference in pain
or range of motion but needling the 4 point combination had good outcomes.
Shanlarson:
the weird situation of acutely injuring himself on the opposite side as well just feels like it’s telling me
something.
I understand the thinking behind SJ excess being a block to healing of injuries. What is also plausible is that there
are other channels/factors involved in the lack of healing of the old injury and the susceptibility to the new injury.
Sometimes channel and sometimes quality.
Toby’s decades of experience- treat channel or quality of the injury, before going to constitution- makes sense.
sweiz:
I am not sure if this would be a kind of situation that Toby would recommend treating two sides.
The problem that always comes with treating 2 channels is that you won’t know what helped or didn’t help. At
every class and crowdcast, Toby repeats that he more often uses 1 channel. At this last crowdcast he clearly stated
that he only treats a second side if he is sure, ie he has used the channel before with good outcomes. He also15/01/2024, 16:48Basic SA’Am question about what side/when – Qiological Community
https://forum.qiological.com/t/basic-sa-am-question-about-what-side-when/943/print4/4
strongly leans toward combining channels that he saw his teacher use. Other factors when considering using 2
channels:
Do they ask the body to do contradictory things?
Is the patient more frail or very robust? In both cases, you only want to treat one side.
Do you know the patient well? Even if the presentation is loudly SJ excess, Liv+ is still a risk if you have never
treated it before. Adding another channel potentially muddies the water that much more.
We are still Saam first graders but many of us are experienced acupuncturists with years of developing clinical
judgement. We all take risks- sometimes with great success and sometimes not.
I can understand the impulse to want give my patients the fastest relief possible but experience has taught me 2
sides can leave me back at square one at the next treatment, rather than a step ahead with a clear understanding of
what the patient responded to.
Toby reads the forum regularly and lets me know I’m doing ok by liking my posts, but I will ask him to be sure to
look at this discussion and chime in if he has another perspective.
Shanlarson: March 12, 2020, 10:17pm
I am glad to hear you say you ditched the acupressure. I find it’s sometimes helpful but I also have been thinking I
may be giving it too much weight like my patient above. I was between the LU or ST or SI. I made my final
decision based on the acupressure ( and the visible bruising) to go SI+ but I think if I hadn’t been doing the
acupressure I may have gone towards one of the channels to start and had better results.