ALipsett: September 27, 2019, 5:09pm
So, I’m struggling with how to make sense of physical signs and symptoms through the Sa’am diagnosis lens. Here
are some recent examples…I’d love any insight!
Nausea- worse with eating, better with vomiting, epigastric fullness. Normally I would think of that as an excess
presentation- St counterflow. Would that still be ST excess in Sa’am? Even if there aren’t any typical ST x/s Sa’am
presentation?
Edema… Does it matter in the Sa’am system where the edema is? I think of edema in the upper body to be more
Lung related, centre- spleen, and lower body a possible kidney presentation. Is all edema just dampness in Sa’am?
For example, does edema in the lower extremities (pitting) with other kidney yang xu signs such as cold body,
weak low back, pale puffy tongue relate at all to KD/SI, or more SP/LI, UB/HT?
I understand that you need to diagnose the whole person but I still don’t know what to do with certain symptoms to
help me get to a clear Sa’am diagnosis.
Clear as mud?
Thanks!
michaelmax: September 28, 2019, 7:39pm
Hi @ALipsett
Yes… clear as mud
ALipsett:
Nausea- worse with eating, better with vomiting, epigastric fullness. Normally I would think of that as an
excess presentation- St counterflow. Would that still be ST excess in Sa’am? Even if there aren’t any typical ST
x/s Sa’am presentation?
Generally speaking it is not helpful to pick just one thing… as in this case with nausea and try to build the
diagnosis around it. More helpful to see how that one thing fits without a larger picture with a sense of coherence.
So first in Saam a ST excess is by definition a LU deficiency. So this person, if they are ST excess would be thin
(dry on the inside) and with greasy skin (wet on the outside)
I would not say that “vomiting” is a ST excess. If anything it might be an aspect of ST deficiency as ST qi should
go down. But again… we have look at the whole picture here.
What is this person’s body like… thin… fat…
Are they hot or cold? Does their energy go out, or withdrawal inwards?
When I think of nausea and vomiting I’m often looking to see if there is dampness… is there in case?25/01/2024, 11:49Basic unanswered questions that confuse my diagnosis – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/basic-unanswered-questions-that-confuse-my-diagnosis/635/print2/3
ALipsett:
Edema… Does it matter in the Sa’am system where the edema is? I think of edema in the upper body to be
more Lung related, centre- spleen, and lower body a possible kidney presentation. Is all edema just dampness
in Sa’am?
For example, does edema in the lower extremities (pitting) with other kidney yang xu signs such as cold body,
weak low back, pale puffy tongue relate at all to KD/SI, or more SP/LI, UB/HT?
Sure you could look to see where the edema is and see if that correlates with other aspects of the clinical picture.
Generally I’d call dampness “wet on the inside” and first look to see if the issue is taiyin earth (spleen) or taiyin
metal (lung). But yes there could be an issue with the Kidney being weak, especially if the dampness is in the legs
and the person did not have good bone structure or symmetry in their face.
While you can see your TCM diagnosis within a Saam diagnosis you get there in different ways. Stick with the
basics. Is the patient hot or cold, where is the dampness… inside or outside?
Again, see if you get a sense of who the patient is from the Saam perspective and then see how these other issues
fit in… or not. That will help you to clarify.
Does that help?
ALipsett: September 28, 2019, 11:08pm
Thanks for your response Michael! Yes it is helpful…but clinic is hard!
The reason I asked specifically about the nausea and vomiting was because it is clear to me that with this patient
the yangming ST is not open through and would potentially benefit by a descending action, so in the Sa’am system
that would be more a supplementing ST treatment. That means that I have to see signs of LU excess which aren’t
super apparent. This seemed confusing, namely the idea of supplementing a more excess presentation. So I guess I
need to think about it as supplementing will encourage the natural action or direction of that organ. Perhaps if I
treat what is most obvious the ST will naturally descend!
I’ll try to write up the whole case when I get a minute.
It sounds like it would be easier for me to really look at the macro level of temperature, directions, interior/exterior,
personality, etc., and then see how the micro level- specific symptoms- fit in.
I just don’t want to guess or try to make something “fit” without a clear understanding of the whole picture.
Thanks for your insights!
michaelmax: September 29, 2019, 12:54am
ALipsett:25/01/2024, 11:49Basic unanswered questions that confuse my diagnosis – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/basic-unanswered-questions-that-confuse-my-diagnosis/635/print3/3
The reason I asked specifically about the nausea and vomiting was because it is clear to me that with this
patient the yangming ST is not open through and would potentially benefit by a descending action, so in the
Sa’am system that would be more a supplementing ST treatment. That means that I have to see signs of LU
excess which aren’t super apparent. This seemed confusing, namely the idea of supplementing a more excess
presentation.
Of course @ALipsett you do not want to supplement an excess.
When you say the ST is “not open” does that mean it is blocked? Or it does not have enough qi to properly move?
As to not seeing object LU excess signs. It’s nice if you do. But sometimes things are more subtle than gross.
Again, getting why they have the nausea and vomiting is the key. And my experience is that if you want to sent
something downward… the ST is a good choice.
Ideally, this patient would come in and have nausea. You can test the +ST strategy by needling them and see if they
get better or worse (while checking complexion, pulse and tongue). If it’s right, you’ll know really quickly. If it’s
wrong… well… you’ll know really quickly.
ALipsett:
It sounds like it would be easier for me to really look at the macro level of temperature, directions,
interior/exterior, personality, etc., and then see how the micro level- specific symptoms- fit in.
I just don’t want to guess or try to make something “fit” without a clear understanding of the whole picture.
I find it helpful to start with those macro level distinctions. And yes, trying to “shoehorn” in a diagnosis is rarely
helpful