twedgle: September 30, 2020, 7:21pm
39 year old man.
Chief complaint : headaches and neck pain. Patient has a history of multiple head injuries and several concussions
from playing football as a teen and doing jiu jitsu as an adult. Tightness that causes pain in suboccipitals, SCM,
levator scapula and upper traps. Headaches feel like pressure around whole head and behind both eyes OR stabbing
in temples (unilateral or bilateral) and jaw tightness. Either headache pattern can be accompanied by blurry vision,
floaters, tinnitus, sensitivity to light and sound, nausea, dizziness, brain fog and changes in mood where he “shuts
down” (more on that below).
Worse with jiu jitsu (which he does 4-6x/week), lack of sleep, occasionally cardio workouts
Better with ice, rest/sleep, occasionally cardio workouts
Headaches are preceded by brain fog (poor word recall, poor brain endurance and a general feeling of foggy-
headedness) and seeing shimmers on lights. They start, peak, and recess over the course of 3-5 days and are
mostly every week.
Second complaint: Insomnia. Sleep is light and restless. He is wakeful, tosses and turns, can wake hot and
drenched in sweat. Pain occasionally wakes him. He has nightmares that center around danger or forgetting things.
Needs 8-10 hours of sleep to avoid starting a headache cascade. Feels un-rested upon waking and energy drops
between 1-3pm.
Appearance and demeanor : Average facial symmetry. Dresses in work-out clothes +9, big, round eyes, bright
+6. Friendly and warm +7 but speaks casually, uses “bro talk” for hello and goodbye (“’sup,” or fist bumps, calls
people “homie”). Drives a jeep held together in parts by duct tape with a broken grill and no a/c.
Lifestyle: Personal trainer and jiu jitsu student. Continues to do jiu jitsu despite seeing a direct increase in pain
when he does it. Works out multiple times a day teaching, coaching, and training for himself. Self-deprecating in
terms of being weak or fragile +10, not fulfilling his life’s purpose which is a source of hopelessness +8, feels
somewhat victimized by his bosses at work and their demands on him for his time and commitment. Sees suffering
as a virtue +7
Body morphology and flesh quality: Small frame, maybe 150 lbs, fit and muscular but has a slightly bloated
belly.
Skin Quality: nothing of note.
Body Temp: Tends to wake hot and sweaty at night. Warmer upper body, cold toes.
GI: Frequent blood sugar crashes where he feels shaky and loses brain endurance. Bloats after meals, tends toward
constipation with hard, dry stools alternating with loose stools. Thirsty day and night for cold drinks that don’t
really quench it.
Emotions: When he has headaches, he goes into a sort of “state” where he feels down, withdraws, disconnects and
“can’t really talk.” This state is obvious to outsiders because he gets so quiet. The mood improves as the headache19/01/2024, 11:14Case Study: Vulnerable Jiu Jitsu Blue Belt with Migraines – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-study-vulnerable-jiu-jitsu-blue-belt-with-migraines/1310/print2/4
lifts.
Urination: Frequent, 6+x/day and wakes 1-3x/night to go. Slightly urgent and occasionally cloudy.
Other Body: no varicosities, abdomen is tight in general but not painful to palpation.
Tongue: pink, red tip, thin white coat, no stasis in sublingual veins
Excess Presentations:
Heart: warm & friendly +7
UB: frequent urination and nocturia +8, UB channel back/neck pain.
GB: temporal pain, GB channel neck and head pain, clench teeth, tight neck and shoulder muscles, insomnia.
Sometimes makes jokes about choking people or punching them in the face. Let me add here, he is not clenched as
if “ready to fight.” He is more subdued and withdrawn than that.
P: Maybe his lack of self-assertion in his job? Opinionated about government, poverty +8.
SJ: bright eyes +6, light sensitive and sees shimmers on lights +9, self critical +9, empathetic to others +5, has to
control his surroundings to limit symptoms +6, warmer above with cold feet; vulnerable +8
Liver: withdrawn, disconnects/shuts down +9, blurry vision with floaters +8,
Lung: none really
Stomach: tired, loose stool on occasion, always lacking financial resources to do what he needs/wants +9
LI: occasional dry stool, thirst.
Spleen/Stomach (unclear which without the obvious presentation of dryness?): pressure headache around whole
head, tired, loose stools on occasion, bloating.
SI: feels “selfish” talking about self +8. Occasional dizziness with headaches.
K: not seeing any, no blood stasis signs.
The Grossest Thing(s) in the Room: the contradiction between the severity of his pain and how he pushes
through it, all the while seeing himself as weak.
Main treatment ideas: Help! Seeing so much Liver and San Jiao!
Treatments: Only two so far.
First: + L PC. Came in tense, neck pain and jaw tightness, said he was angry at work and wanted to punch people
in the face. After 5 minutes he was agitated with wide eyes so I pulled them and did + R GB. Result: migraine after
treatment.
Second: + L SJ. I chose this because he was heading into a migraine with his liver excess symptoms predominating
(withdrawing, dull inner focus, floaters/shimmers on lights). Result: migraine after treatment.19/01/2024, 11:14Case Study: Vulnerable Jiu Jitsu Blue Belt with Migraines – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-study-vulnerable-jiu-jitsu-blue-belt-with-migraines/1310/print3/4
I’ll add here that I am not too shy to needle according to the Sa’am prescription, so I feel pretty confident that the
lack of treatment success isn’t because the needling style was too gentle.
Thank you all for your help with this!
KristinWisgirda #2October 1, 2020, 1:17am
Thanks for the case @twedge. This poor fellow is in quite a rough state.
I encourage you to sit down with the intro powerpoint section on the qualities of channel excess and go through his
presentation again. You can also use the forum search function for discussions on particular symptoms. We have
discussed lots and lots of migraine and insomnia cases so you will find plenty of info. With a fellow who is doing
some obvious posturing, it is extra helpful to evaluate how believable his words are- such as feeling selfish talking
about himself. Here are some ideas to get you started.
twedgle:
Tends to wake hot and sweaty at night. Warmer upper body,
It sound like heat is a significant factor in his insomnia but also his headaches which are better with ice. It is really
important that you cool him down. He sounds hot enough for H excess. You also need to add the UB channel neck
and headaches to the H excess entry.
That he didn’t respond well to SJ+. tells you something about his Liv/SJ balance. It still would be helpful to look at
it more closely. Blurry vision is not a Liver excess sign. Liver excess vision signs all have to do with too much
darkness, such as dark spots in vision, needing extra lights to see or poor night vision. I am wondering how dense
his flesh is- density being a Liver excess sign. If his light sensitivity is only during the headaches, I don’t give it
much clinical weight because in my experience using Liver+ during a light sensitive migraine hasn’t been helpful.
Shimmer on lights says to me that the lights are moving, not that they are extra bright. You need extra brightness to
say SJ excess. Needing to control your surroundings because you are suffering with a migraine is not a SJ excess
symptom.
twedgle:
Opinionated about government, poverty +8.
Having opinions isn’t a P excess sign unless you are really intelligent or think you are really intelligent.
twedgle:
no blood stasis signs.
History of concussions/head injuries can be put under K excess.
His car could be a sign of St excess.19/01/2024, 11:14Case Study: Vulnerable Jiu Jitsu Blue Belt with Migraines – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-study-vulnerable-jiu-jitsu-blue-belt-with-migraines/1310/print4/4
twedgle:
First: + L PC. Came in tense, neck pain and jaw tightness, said he was angry at work and wanted to punch
people in the face. After 5 minutes he was agitated with wide eyes so I pulled them and did + R GB. Result:
migraine after treatment.
He does sound clearly GB excess in general but especially on this day so you have to wonder what happened here.
There is a phenomenon of GB excess fighting back a bit before calming down when it is given the down and in of
P+. I’m not positive that this is what happened. You can search the forum for discussion on this subject. When
someone is volatile or has rapidly changing emotions, the other option is throw a bucket of ice water on them with
UB+ which it sounds like he needs anyway.
Take another look at him and let us know how it goes.
twedgle: October 1, 2020, 10:05pm
thank you @KristinWisgirda. I overlooked the amount of heat he was experiencing and bladder makes a lot of
sense. I appreciate you taking the time to help me outline the symptoms a little more clearly. I wasn’t aware of how
much I was misunderstanding his vision symptoms. I will dig into that powerpoint again.
KristinWisgirda: October 1, 2020, 10:49pm
It takes lots practice going through symptoms and making Saam sense of them. Picking apart cases is a great way
to get into the groove of Saam thinking.