adambroder: October 17, 2020, 7:08pm
Female, 28 years old, with intense PTSD. She had her life threatened as a child. I do not know if it was a one time
occurrence or an ongoing thing but it has had a significant effect on her life. I’ve seen her several times now and
would appreciate some input on where to go from here. Her symptoms at the first treatment were:
Anxiety (+8), disruptive thoughts (replaying of the event/s in her head, +8), difficulty concentrating (+8), rapid
heart rate (+7), insomnia (+9), night sweats, sweating without exertion (+6); all of this is worse around her period
which also includes cramps and sugar cravings; she has a history of PCOS
Body type: on the heavier side but not quite obese, wouldn’t call it dense; skin alternates between oily and dry but
mostly oily (on face, chest, neck, armpits have a pungent smell according to her but I have never smelled it)+6;
skin is slightly dark as she is of Indian descent; tension in upper shoulders; eyes on the duller side, wears glasses; I
have not asked about vision/night vision
Demeanor/appearance: pleasant, friendly, calm, but with an underlying sadness (+7); wears shorts and tank tops for
treatment; says she can be irritable and quick to anger (+3) but does not express it (no outbursts)
Lifestyle: works as an engineer/scientist in New Mexico, originally from New York City; I get the impression she
would prefer to be back home as she probably doesn’t have family here and may also not have much of a social life
Digestion: gas at night, good appetite, sugar cravings worse around period (+5)
First tx: LR+
Chosen d/t heat (night sweats, rapid pulse), anxiety, and proximity to her period; I also have to admit that I’m
guilty of having my favorite channels, a habit I’m working to break myself of, and LR is one of them
Second visit (one week later)
She reported better sleep but for 4 days following treatment she experienced the following: emotional upset,
exhaustion, diarrhea, night sweats, two large red itchy spots on her left forearm
She has a history of red itchy spots; about 4-5 years ago during a stressful time she would have them on and off for
about a year, located mostly on her upper body but all over; antihistamines would help them go away temporarily
and after a year they sort of went away on their own
Second tx: LR+
Chosen for the same reasons, plus we got some traction with sleep and I chalked up the emergence of the red spots
(and diarrhea) as a healing crisis plus further evidence of SJ excess (heat above)
Third visit (two weeks later)
She reported better sleep for 4 days following treatment along with gas and diarrhea; after that her sleep got
progressively worse along with a return of most if not all of her other symptoms. I asked about weather and19/01/2024, 10:57Case study: PTSD – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-study-ptsd/1338/print2/8
temperature; she said her favorite time of year was around now (this was 9/18) when it starts to get cool and dry.
Third tx: LI+
Chosen based on weather preference, oily skin, sugar cravings, gas/diarrhea, heat symptoms and rumination
Fourth visit (one week later)
She had insomnia every night this past week and no improvement with other symptoms; in fact the pungent smell
from her armpits had gotten worse
Fourth tx: PC+
Chosen based on insomnia, heat signs, difficulty concentrating and quick to anger
Fifth visit (one week later)
Everything went sideways. She reported very little sleep and an increase in brain fog and panic attacks. She seemed
more sad than usual too. Already I’m beginning to realize the mistake I made; she must be incredibly GB deficient.
Instead of waiting for her to say she didn’t want acupuncture (she had come in for manual therapy from another
practitioner for her shoulder), I suggested we skip it and try ear seeds. Again another data point for GB xu—she
probably wasn’t going to assert herself and say she didn’t want acupuncture. I asked her, do you feel like you need
help standing up for yourself? As I said it, without thinking I sort of pantomimed in my body a more erect spine
and puffed up chest. She meekly nodded yes. I told her we can work toward that, put in a few ear seeds and sent
her on her way.
Sixth visit (one week later)
The patient has begun taking antidepressants. She was told it would be 4-6 weeks before she feels anything from
them. Symptoms have mostly returned to pre-treatment levels; not as bad as last week but not much improvement.
Sixth tx: KI+
At this point I’m feeling pretty confident that she is GB xu/PC excess but I don’t want to jump there yet even
though the patient verbalized an interest in the treatment I mentioned last week to make her more assertive. I want
to stabilize things a little in terms of heat signs and insomnia first. As a side note, I don’t know how often people
talk to their patients about what they’re trying to accomplish with their treatments. If and when I do share what’s
going on I’m torn over whether or not I’m over-sharing or if I’m making them a partner in their own healing. Feels
weird at times. Anyway I chose KI d/t her depression and a sense that her shen has been scattered as a result of this
traumatic event and is in need of consolidation. I also recall reading in my Stems and Branches book about the
importance of a strong KI if one intends to work on the GB.
Seventh visit (one week later—yesterday)
Sleep has improved; she slept 8-9 hours each night though is was light and she still feels tired. Panic attacks have
not been present but she still has difficulty concentrating. No change in other symptoms. It is still too early to
attribute the improvement in sleep to her antidepressant so I felt good about the KI+.
Seventh tx: KI+19/01/2024, 10:57Case study: PTSD – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-study-ptsd/1338/print3/8
Again she expressed interest in the treatment to give her more assertiveness. I explained my intent to lay a
foundation before doing that treatment which can be more aggressive.
I should also say that I have never gotten a read on her when the needles are in. Even after the disastrous PC+ tx,
she seemed to feel fine once needles went in and when I came to take them out. I attribute this to her disconnection
with her body and her shen; her channels may be “confused” to the point where she doesn’t feel the effects right
away.
I’ll be seeing her again in a week. What recommendations would you have for the next treatment? All signs are
pointing to GB+ except the heat symptoms are giving me pause. Thanks in advance for your help.
KristinWisgirda: October 17, 2020, 8:57pm
Hi Adam,
Long time since your last post. Nice to hear from you.
adambroder:
I’m guilty of having my favorite channels, a habit I’m working to break myself of, and LR is one of them
This case should teach you never ever fall in love with a particular channel. Playing favorites with what works for
you is a sure fire way to obscure your view of the patient. Your blinders were on so tightly that you weren’t able to
see the adverse reactions.
With my first read through, I was hoping that you started with SJ+ because of the dull eyes and the replaying of
events in her head. She needs some outward focused brightness.
adambroder:
heat (night sweats, rapid pulse)
Have you asked if the nightsweats are hot or not? There are other reasons for sweating without heat. Besides the
rapid pulse and potentially the tank/shorts outfit, are there other signs of heat?
The symptoms she experienced for 4 days after the first visit were clearly an adverse effect. If her sleep was really
better then she wouldn’t likely be exhausted. Too much Liver gave her too much inward dullness and density. You
should have immediately needled SJ+.
How good of a reporter is she? Doe you really believe that she was sleeping better after the first visit. I am not so
sure.
adambroder:
I chalked up the emergence of the red spots (and diarrhea) as a healing crisis plus further evidence of SJ excess
(heat above)19/01/2024, 10:57Case study: PTSD – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-study-ptsd/1338/print4/8
This is mistaken thinking. You know that it is a healing crisis when there are actual signs of healing going on and
not just adverse effects. A true healing crisis might look like this: she had diarrhea for a short time but WOW she
really felt better and the diarrhea soon stopped.
adambroder:
Anyway I chose KI d/t her depression and a sense that her shen has been scattered as a result of this traumatic
event and is in need of consolidation.
While this is an idea, you don’t have any real Saam evidence that she is SI excess and there are sooo many other
reasons for her depression.
adambroder:
I also recall reading in my Stems and Branches book about the importance of a strong KI if one intends to work
on the GB.
The #1 mistake Saam students make is incorporating other systems. Toby’s intention when inviting students to
incorporate other systems was to include practitioner’s knowledge that was 100% tried and true, not ideas that have
never been tested. Now seeing that this invitation has lead many, many students astray he agrees that it was a
mistake to make this suggestion. This suggestion is made worse because Saam uses terms differently than other
systems. In future classes Toby is going to strongly encourage students to keep to Saam when practicing Saam.
adambroder:
Even after the disastrous PC+ tx, she seemed to feel fine once needles went in and when I came to take them
out.
You practically pushed her into paralysis during this treatment. You have to watch especially closely with P+
treatment because it can be extra hard to read whether they are really settled or made way, way too calm.
adambroder:
What recommendations would you have for the next treatment? All signs are pointing to GB+ except the heat
symptoms are giving me pause.
adambroder:
Again she expressed interest in the treatment to give her more assertiveness.
You chose theories over her clear and desperate pleas for help. She has clearly had adverse effects to the P+ and the
Liver+ treatments. She responses are the most reliable indications that she desperately needs the counterbalancing
treatments of SJ+ and GB+. I strongly suggest that you do one at a time and not both at once. While she clearly
needs both, it will be easier on her system to digest and integrate one at a time. She also had adverse effects from
LI+ so SP+ should be used at some point as well.19/01/2024, 10:57Case study: PTSD – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-study-ptsd/1338/print5/8
Before you treat her with anything but SJ+ or GB+, please go through the recommended steps for case analysis
presented here: Case Study Format Then present her case and I will help you through it.
Please go back and read the intro powerpoint, especially your notes on treating adverse events.
adambroder: October 17, 2020, 8:58pm
KristinWisgirda:
Have you asked if the nightsweats are hot or not? There are other reasons for sweating without heat. Besides
the rapid pulse and potentially the tank/shorts outfit, are there other signs of heat?
Her night sweats are hot, plus she has the red itchy spots and feels hot during the day without exertion
adambroder: October 17, 2020, 8:59pm
KristinWisgirda:
How good of a reporter is she? Doe you really believe that she was sleeping better after the first visit. I am not
so sure.
Good point, hard to say…
adambroder: October 17, 2020, 9:05pm
KristinWisgirda:
She responses are the most reliable indications that she desperately needs the counterbalancing treatments of
SJ+ and GB+
As I was typing this out it occurred to me that SJ+ might be a good idea
KristinWisgirda: October 17, 2020, 9:20pm
SJ+ isn’t just a good idea, treating the counterbalancer after adverse reaction is the correct action. Treating GB+ is
also desperately needed.19/01/2024, 10:57Case study: PTSD – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-study-ptsd/1338/print6/8
I also wonder if she might have been taking something to help her sleep while she was having those adverse
events.
You wrote that
adambroder:
sweating without exertion (+6)
not that she is hot with exertion. You can sweat without being hot so you have to be really clear.
adambroder: October 17, 2020, 9:21pm
KristinWisgirda:
While this is an idea, you don’t have any real Saam evidence that she is SI excess and there are sooo many
other reasons for her depression.
My notes from the intro workshop say that SI excess is diminished love for self. Did I incorrectly evaluate this and
if so how? She seemed to improve with KI+ the first time.
adambroder #8October 17, 2020, 9:24pm
KristinWisgirda:
treating the counterbalancer after adverse reaction is the correct action
I recall a previous discussion on this forum where it was advised not to necessarily counterbalance at the next
treatment, and the only instance when counterbalancing was absolutely indicated is when they have an adverse
reaction immediately after needles are inserted. Is this a correct interpretation?
adambroder: October 17, 2020, 9:28pm
I just looked at my notes again and she reported feeling hot, both during the day and at night. I ask patients if there
are any new medications at the beginning of each treatment and she did not say that she was taking anything to
sleep.19/01/2024, 10:57Case study: PTSD – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-study-ptsd/1338/print7/8
adambroder: October 17, 2020, 9:29pm
KristinWisgirda:
She also had adverse effects from LI+ so SP+ should be used at some point as well.
I don’t see LI excess signs at all but I will reformat the case and see where we’re at. Thanks for your input.
KristinWisgirda: October 18, 2020, 11:06am
adambroder:
I just looked at my notes again and she reported feeling hot, both during the day and at night.
You did not state this in your initial case presentation and just mentioned sweating. We can’t give you appropriate
guidance unless you present the facts of the case clearly.
adambroder:
I recall a previous discussion on this forum where it was advised not to necessarily counterbalance at the next
treatment, and the only instance when counterbalancing was absolutely indicated is when they have an adverse
reaction immediately after needles are inserted. Is this a correct interpretation?
This is not a correct interpretation. You must have been reading another student’s mistaken idea. The other
possibility is that there might have been a very extraordinary circumstance where something else needed to be done
first. Even in such a circumstance, you should always be eager to do the counterbalancer ASAP. Adverse reaction
to treatment, whether on the table or in the days after the treatment, indicates that you have injured the patient.
Counterbalancing is necessary to counteract the injury you have done to the patient.
adambroder: October 18, 2020, 11:54pm
KristinWisgirda:
The #1 mistake Saam students make is incorporating other systems. Toby’s intention when inviting students to
incorporate other systems was to include practitioner’s knowledge that was 100% tried and true, not ideas that
have never been tested. Now seeing that this invitation has lead many, many students astray he agrees that it
was a mistake to make this suggestion. This suggestion is made worse because Saam uses terms differently19/01/2024, 10:57Case study: PTSD – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-study-ptsd/1338/print8/8
than other systems. In future classes Toby is going to strongly encourage students to keep to Saam when
practicing Saam.
What would be advised in situations where pain presents on one channel but knowledge from another system tells
us that the problem is actually on another channel? Like if the GTITR is pain on the UB channel but the source of
the pain is a vertebral facet injury on the KI channel? Or pain on the GB channel which is coming from an injury at
the SI joint on the UB channel?
KristinWisgirda: October 19, 2020, 6:46pm
When using Saam treatments, use Sa’am diagnostics.
If you have more confidence in other systems, use those systems.
I am a graduate of Matt Callison’s sports medicine acupuncture program and was a big fan of Whit Reaves’
approach before I found Sa’am. When learning Sa’am, relying on forms of diagnosis from those systems was never
a good idea unless it could be backed up with solid Sa’am diagnosis. Sa’am diagnostics always have way, way
more clinical weight than imaging findings or findings from other systems.