jedwardian: September 21, 2020, 7:17pm
Greetings all, I thought it would be good practice to write up a case and hear the way others might approach this.
I treated this woman regularly for over a year with mixed success before learning Sa’am. Since then I’ve given her
four Sa’am treatments. She’s noted more pronounced changes than with other symptoms, but despite seeming
progress, improvements have not lasted. This may simply be a case where repeating (reasonably) successful
treatments is the key, rather than jumping around too much. Anyway, here goes:
Approx 65 y.o. woman
CC:
-Insomnia (wakes several times during night and can’t get back to sleep, total hovers around 6 hours nightly).
Sleeps better in cooler weather. Some improvement since starting Peace Pearls (Qian Yang Dan / Suanzaoren
Tang).
-R-side sinus congestion, persistent, and associated migraines. These are worse with damp weather / low fronts.
In addition to these chief complaints, she has arthritis in her hands and feet, currently ameliorated by an herbal
liniment. She has been diagnosed with osteoporosis and receives biannual injections.
Patient’s affect is cordial but no-nonsense; she manages a contracting firm with her husband. She is fairly talkative,
I sometimes have to ask her to take some deep breaths so she’ll stop talking once needles are in. She only rarely
falls asleep on the table. I consider her to be “nervous-system tense” (as per the Shen/Hammer description).
Digestion is fine, though she had bulimia for years as a young woman. Only other real complaint is mild fatigue,
i.e. after a full workday she’s not good for much after dinner besides watching TV.
Excess patterns:
UB: runs cold overall +6, cold feet +7, midline tension above navel +6
HT: talkative +5, sleep worse in hot weather +6
SI: elderly +4
KD: blood stasis signs (e.g. in abdomen) +7, general achy-ness +5
LU: dry skin +5, allergies and sinus issues +8, well resourced +7
ST: allergies and sinus issues+8, fatigue (wiped after dinner) +6
SP: big toe pain +6, sens. to humidity +8, allergies and sinus issues +8
LI: very active +7, overall dry +6, big toe pain +6, sens. to humidity +8, allergies and sinus issues +8
LR:
SJ: warm above cool below +6, polite +7, bright eyes +4
GB: sleep trouble +8
PC:12/01/2024, 11:57Case study – insomnia + sinus/migraines worse with damp weather – Qiological Community
https://forum.qiological.com/t/case-study-insomnia-sinus-migraines-worse-with-damp-weather/1288/print2/6
Grossest thing in the room: how sensitive she is to low fronts / changes of barometric pressure. Sinuses and
migraines almost always resolve as weather clears.
Sa’am Treatment #1: SP+ (unilateral on L)
Response: “the congestion in the right side of my face/sinuses is a lot better. The shift I noticed during the session
has persisted. I feel less pressure and fogginess on that side. That said, I still don’t feel great, as I had a couple of
nights of a little too little sleep on Tuesday and Wednesday, but last night was better, and I hope the trend is in the
right direction. Despite the lack of sleep, I can still feel the reduction in the congestion. It is not 100%, but much
better, and I am quite amazed. It is definitely the most dramatic shift I can remember feeling from acupuncture –
yours or anyone else’s.” Improvement in congestion lasted about a week.
Treatment #2: ST + (unilateral on L).
Response: settled well on table, eyes closed the whole time (somewhat unusual for her), and reported immediate
clearing in the head. Improvement again lasted for ~ a week, until a thunderstorm moved in. Also noted marked
fatigue the day after treatment.
Treatment #3: LR+ (unilateral on L, as her pain and congestion are markedly R-sided)
Response: settled well on table. That night, she had a severe migraine on the left (they’re almost always on the
right for her), bad enough that she took a hydrocodone that she had left over from a foot surgery. But then slept
well and woke feeling well. She then went on vacation to a dry cool climate where she generally feels better, so
hard to gauge treatment effect.
Treatment #4: At her fourth visit, the patient reported a new issue: feet feeling tingly/buzzy at night. We decided to
focus on this. Treatment: SI+ (unilateral, left).
Response: settled well on table. Wrote: “My feet are better, though maybe not 100%. I did not go into the hot tub
on Friday and Saturday nights, and they were still OK…congestion also seems a little better, but not as
dramatically so as from the previous treatment. Migraine pattern continued through mid-day Saturday, but not
really in my sinuses, more in the back of my head. I think that’s all finally passing now as the weather lightens up.”
Then later the same evening: “the foot stuff came back. It’s very mysterious. Sometimes I don’t feel it at all during
the day and even as I go to sleep, and then it shows up later in the night. Both Tuesday and Wednesday nights I
woke up in the night with migraines, and both times, my feet were doing the buzzy thing, too…the other
interesting thing is that I paid close attention to what changed after I took the migraine med [a vasoconstrictive
drug] last night, and my feet got better, too…all quite weird, and not in a good way.”
This is where we are currently.
I had been getting discouraged at the lack of lasting progress, but it occurs to me as I type these notes that there are
several overall successful treatments worth returning to, starting with SP+. Given that ST+ helped but also
triggered fatigue, I am also considering LU+.
Nothing seems to be helping the sleep much. I could try PC+ but have not noted a lot of GB excess signs besides
the sleep itself; she’s not aggressive or notably convex, tongue tip is not red, etc.
Look forward to others’ thoughts.
Jonathan12/01/2024, 11:57Case study – insomnia + sinus/migraines worse with damp weather – Qiological Community
https://forum.qiological.com/t/case-study-insomnia-sinus-migraines-worse-with-damp-weather/1288/print3/6
jedwardian: September 21, 2020, 9:54pm
Forgot to mention that her worst join pain by far is the right big toe. She had a surgery for a bunyon there (they
shaved down the bone) but the pain didn’t improve. So additional weight to SP/LI (and perhaps LR/SJ) based on
channel location.
Also, I want to call myself out (or in, lol) for succumbing to false-binary thinking: just because SP+ helped her
doesn’t mean I shouldn’t consider LI+ as well. She’s wet inside (runny nose/congested sinuses) even if not outside,
so perhaps she needs LI and SP to be toggled. Upon first learning this system I tended to assume that if one channel
helped, the complementary channel would be harmful, but I’m increasingly understanding that this is just not the
case. Anyone who’s seen a need to toggle back and forth between channels as opposed as double-damp SP and
double-dry LI? Obvsly it could also be LU/ST that are needed here…
KristinWisgirda: September 22, 2020, 2:31pm
Thanks for taking the time to write up your case @jedwardian
First a few readability and clarity notes:
It would be much easier for this reader if you summarized the treatment effects in pithy statements or short bullets.
Using fewer words overall helps you and your readers see your patient more clearly.
It is helpful to break down symptoms. Migraine can manifest in a number of different ways with or without
headaches. What are her symptoms? You also forgot to mention the runny nose in the first post- is it like a faucet or
a little drip?
Please take a look at this thread if you haven’t already:
The Many Faces of Head Congestion . .
Yes. Often patient complain about “congestion” but you have to dig in. Sometimes they can breathe just fine
through the nose and there is no sinus pressure. But they say they are “congested” when in fact I think their
sinuses are dry. dry and withering and they experience that discomfort as “congestion” as they don’t know
what else to call it. And no one else has inquired as to if the can actually breath through their nose. So for those
folks, yes… bring the fluids.
It helps to look beyond damp/dry and the Stomach channel with sinuses.
jedwardian:
KD: blood stasis signs (e.g. in abdomen) +7, general achy-ness +5
What are the blood stasis signs in her abdomen? I would put a question mark next to the general achiness because
it is not a for sure K excess or blood stasis sign. What about the state of her medial heel, spider veins and
varicosities, symmetry to give us a better idea of her K/SI balance.12/01/2024, 11:57Case study – insomnia + sinus/migraines worse with damp weather – Qiological Community
https://forum.qiological.com/t/case-study-insomnia-sinus-migraines-worse-with-damp-weather/1288/print4/6
jedwardian:
Forgot to mention that her worst join pain by far is the right big toe. She had a surgery for a bunyon there (they
shaved down the bone) but the pain didn’t improve. So additional weight to SP/LI (and perhaps LR/SJ) based
on channel location.
The Nei Jing says that GB channel also goes to the big toe. (Maybe the Stomach channel too in some
interpretations). An author of one of the Saam books mentions GB+ as his go to treatment for gout.
jedwardian:
Grossest thing in the room: how sensitive she is to low fronts / changes of barometric pressure.
I’m not a master of cases of sensitivity to barometric pressure and weather changes but my sense is that this is
more than a damp/dry issue. A low pressure system is air moving centripetally and upward bringing in warm moist
air and creating strong wind. Changing weather is wind too. What are all the explanations of why she is having
such a hard time processing wind?
jedwardian:
I consider her to be “nervous-system tense” (
What does the Saam system say about your findings here?
jedwardian:
several overall successful treatments worth returning to,
jedwardian:
Nothing seems to be helping the sleep much.
These seem to be contradictory statements.
Reconsider her in light of these suggestions and, please, let us know what happens.
jedwardian: September 22, 2020, 2:46pm
Thanks Kristin, some helpful avenues for exploration here esp. re: GB channel and thinking of the low pressure
sensitivity in terms of wind.
Regarding the seeming contradiction that you point out, several treatments have helped the sinuses, hence
“successful,” but nothing has really touched the sleep. I’m going to look more closely at GB/PC as well as SP/LI,12/01/2024, 11:57Case study – insomnia + sinus/migraines worse with damp weather – Qiological Community
https://forum.qiological.com/t/case-study-insomnia-sinus-migraines-worse-with-damp-weather/1288/print5/6
and meditate on wind, which I also associate with the nervous system tension (though that could perhaps be seen
through a UB excess lens or even a GB excess lens as well).
A technical question on forum mechanics: how to highlight folks’ comments (in gray boxes) so as to reply to
specific people/remarks? For some reason I’m not catching how that works.
KristinWisgirda: September 22, 2020, 3:19pm
Highlight the text you want to quote and you will see Quote in a gray box hovering around the highlighted text.
Click Quote and it will paste the text in your reply box. Makes replying much easier!
This is not an easy, straight forward case. I suspect that improving her sleep would help her system function better
overall.
One last note: the severe left sided migraine the night after treatment 3 sounds like an adverse reaction to Liv+ to
me.
jedwardian: September 22, 2020, 3:24pm
KristinWisgirda:
One last note: the severe left sided migraine the night after treatment 3 sounds like an adverse reaction to Liv+
to me.
A ha – I hadn’t been sure (as the migraine improved and then she slept better than usual) but it makes sense that
SJ+ could be needed, what with the Lr being moist and SJ being clear/dry/desert-like. I’ll likely try SJ+ at the next
treatment and report back.
See you at the advanced class this weekend!
KristinWisgirda: September 22, 2020, 4:03pm
jedwardian:
See you at the advanced class this weekend!
So glad you can make it!
jedwardian:12/01/2024, 11:57Case study – insomnia + sinus/migraines worse with damp weather – Qiological Community
https://forum.qiological.com/t/case-study-insomnia-sinus-migraines-worse-with-damp-weather/1288/print6/6
Lr being moist and SJ being clear/dry/desert-like.
Many students come away from the intro class thinking this way. Upon further questioning, Toby has shared that
Liver is only slightly moist and SJ is only slightly dry. There are a couple of threads discussing the scales of
moisture and temp.
Thermal, Moisture and Movement Scales . .
Some refinements from my perspective: It isn’t useful to think about P or GB as drying. Moist/dry just isn’t
part of their profile. SJ being slightly dry makes it more dry than either P/GB, but dryness for sure isn’t the
most important part of the SJ profile. With your outward progression it would be more helpful to frame it as
what is going outward: GB outward activity SJ outward focus and attention H outward love GB/SJ/H- one
doesn’t function essentially more outward than the other. Thi…
Degrees of heat and moisture
In the discussion time between clinical observation in Tuscon, we went through the channels in terms of heat. I
find this useful in clinic so thought I would share. (Kristen or anyone else who was there, please correct me if
I’m wrong). They were: HOTTEST Heart (double fire) San Jiao (bright warmth) Spleen (warm swamp –
dampness can contain heat) Gall Bladder Lung and Stomach > both neutral. Toby’s teacher wouldn’t commit to
their temperatures Pericardium (slight cool breeze) Large Inte…