maeveodon: May 23, 2020, 8:40pm
Hi all, hope everyone is keeping well. I have a case which I would appreciate some help with. I’m based in Ireland
and not back practising yet so this patient is my husband.
43 year old male
CC: Chronic stiffness and poor flexibility of lower back, posterior legs muscles and Achilles tendons. Also,
occasional plantar fasciitis.
Difficult to bend down and put on socks. No sore spots on palpation but he points to sacral area on both sides for
stiffness.
Stiffness since his early twenties but is getting progressively worse, severe for about 6 years now. Played
contact sports for 20 years.
Had MRI years ago which just showed some mild disc degeneration on L4/L5. Has had many different types of
treatment and plenty of local and other acupuncture treatments over the years with relief for intermittent pain in
lower back.
Does a posterior-chain exercise program to strengthen his core and back muscles and is diligent with doing it
and has no pain since but the stiffness remains. Feels great during and just after intense exercise, very flexible,
but after about an hour back to usual stiffness. Does lots of stretching/yoga poses with same temporary relief.
Had ACLs in both knees replaced as a result of tearing them during sports.
Appearance and demeanor: Very friendly and polite +8, very organised and likes everything to be planned out +9,
Lifestyle: Works in an office environment and finds sitting for long periods worse for stiffness +9. Works hard but
has a good balance with relaxation. Exercises 5-6 days a week as it helps. Eats healthily enough but think would
benefit from cutting out some dairy, wheat etc.
Physical appearance: Average frame, healthy weight with good muscle tone but some extra weight around the
middle.
Skin Quality: Normal. Sweats excessively during exercise only +6.
Body temp: normal
GI: Currently fine. Has a tendancy to loose stools and gas +8. Discovered after past Saam treatments that +SI
makes this significantly worse, food travels through his system very quickly +10
Respiratory: No issues
Sleep: No issues19/01/2024, 11:11Chronic muscle stiffness – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/chronic-muscle-stiffness/1053/print2/9
Emotions: Very positive outlook on life, very even-tempered and relaxed. The stiffness does cause him to be in bad
form at times but not for long.
Tongue: Wet, puffy, reddish, slightly redder tip, slight crack down the middle, usually thick white coating at the
root. Sublinguals not purple at all.
Excess Presentations:
BL: Stiffness is along lower bladder channel +9, tongue very wet, excess sweating?, stiffness better with warmth
+10
HT: Stiffness is along lower bladder channel +9, affectionate +6, reddish tongue with slight mid-crack +6
SP: Loose stools +7, puffy tongue with thick white coat on root +8, excess sweating during exercise +8, extra
weight around middle
LI: Works hard and always has a project on the go +6
LU: Good resources +6 (not fat-banker type but is always able to source what he needs) and thenars quite full +5
ST: Not sure if the 2 ACL replacements would fall under this?
Kid: Plantar fasciitis, stiffness better with movement.
SI: Food travelling very quickly through GI system +6, plantar fasciitis.
LIV:
SJ: Polite and socially aware +8, organised/planner/controlling +8, very sensitive/ticklish feet ??,
GB: Tip of tongue redder +5
PC: Very even tempered, never loses temper +6
Main treatment ideas:
Over the past year I have tried every channel, some a few times, and the only ones that have had any effect were
Kid, SI and LI. With all 12 channel treatments (even SI which was clearly wrong), he falls asleep within minutes of
needles going in! Not that he’s very tired but he does enjoy a nap.
+SI caused worsening of stiffness and GI issues
+Kid improved both temporarily
+LI improves GI issues and thick tongue coating temporarily
My initial 2 ideas were:
+SI because of improvement with movement – wrong treatment
+HT because of the stiffness on the BL channel and improvement of stiffness with warmth – no change
+LIV to nourish the muscles and tendons – no change19/01/2024, 11:11Chronic muscle stiffness – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/chronic-muscle-stiffness/1053/print3/9
None of these or any of the other channels have made any difference either way. I use 30 x 40mm needles and get
good qi and have had a lot of results with other people with Saam so I don’t think it’s just down to my technique.
Recently did double +LI in case damp could be blocking other treatments working and the thick tongue coating is
almost gone so I was thinking of trying +LIV right and +HT left (read from Kristen that this might be an
alternative moving treatment to SI) but any other insight/thoughts/questions welcome as I feel I am missing
something.
KristinWisgirda: May 24, 2020, 10:46am
@maeveodon I hope you and yours are doing well. Thanks for the case. Nice that your husband is willing to teach
you more about Saam!
A couple notes about your analysis:
Technically tongue findings in Saam have low clinical weight, with the exceptions of red tip (GB excess) and
deeply fissured (Taiyang fluid xu suggesting UB+ or SI+, but also often amenable to SP+). It is always fun to
notice tongue changes anyway.
Some of the symptom/channel correlations you questioned can be discarded: Excess sweating/UB, ticklish feet/SJ.
The knee/Stomach excess correlation is for weak unstable knees, especially after losing money. The more the knees
fit this picture, the more clinical weight toward Stomach excess.
Looser stools, possibly being internal, and excess weight around the middle can be put under Lung excess. I have
plenty of thin to normal weight patients who are bloated or have extra weight around the middle who respond well
to ST+.
maeveodon:
he points to sacral area on both sides for stiffness.
The GB sinew binds the sacrum. The primary channel goes there too. Any problems standing upright or standing
up for himself?
maeveodon:
Sweats excessively during exercise only +6.
But his skin is normal otherwise. Not on the dry side or moist side. Sometimes it can be helpful to separate general
skin quality from situational sweating. Sweating can be a leakage as well as wet on the outside.
Anything visually interesting about his back or body? Moles, pigmented areas, structural interest- creases, bulges?
What we know: His lower body is affected. What is preventing normal circulation to this area, besides his desk
job? Is abdominal bloating part of the gassiness?
We know that K+ helps the stiffness. (As an aside: most of my plantar fasciitis patients have responded well to19/01/2024, 11:11Chronic muscle stiffness – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/chronic-muscle-stiffness/1053/print4/9
K+.) Any other signs of SI excess that might show you how deep it is- lack of interest in grooming, low fertility,
asymmetry? The patient’s constitution is a big factor in treatment effect.
LI+ is of some benefit.
maeveodon:
I was thinking of trying +LIV right and +HT left (read from Kristen that this might be an alternative moving
treatment to SI)
Not sure about the strategy of wanting to add more movement, even in a gentler way, when SI+ was clearly wrong.
H+ makes sense if you look at the stiffness as a hypofunctioning and it is better with warmth 10+. The Liver+
might make sense if heat above/cold below fits. I would try them singly first before trying H and Liv combined.
Sometimes ordering of treatments can make a difference. I wonder if some of the channels that you tried earlier
might have a better chance at working since you did the Kidney + treatments.
Please let us know what happens.
michaelmax: May 25, 2020, 2:18pm
KristinWisgirda:
Technically tongue findings in Saam have low clinical weight, with the exceptions of red tip (GB excess) and
deeply fissured (Taiyang fluid xu suggesting UB+ or SI+, but also often amenable to SP+). It is always fun to
notice tongue changes anyway.
I have a different point of view on this. I find the tongue to be quite helpful both in diagnosing and tracking the
effectiveness of treatment.
In your husband’s case, it sounds like there is excess dampness, which can lead to stiffness as the tissues are a bit
swollen with fluid.
As I read this my first thought, like your’s, was +SI, but reality quickly told you that was not the way to go. And
since it cause his digestion to worsen with the extra movement I’m thinking you might be on the right track with
+LI.
I also thought +HT to deal with cold, as I think of tightness as a kind of contraction.
I like @KristinWisgirda’s idea of seeing if there might be some GB involvement.
Always fun (and at times frustrating) when things don’t quite go the way we expect. But then, that is when we get
to learn the system at a deeper level.19/01/2024, 11:11Chronic muscle stiffness – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/chronic-muscle-stiffness/1053/print5/9
maeveodon: May 26, 2020, 8:30pm
Thank you both for your replies and insights.
KristinWisgirda:
The GB sinew binds the sacrum. The primary channel goes there too. Any problems standing upright or
standing up for himself?
No, while he doesn’t show any aggression he is confident and has no problem standing up for himself. I had
considered the GB channel link with the sacrum and tried both +PC and +GB with no effect. Although +PC was
last year and +GB was about 2 months ago and since soon after that he has had a recurrence of an irritating split in
the middle of his nail on middle finger so am planning to try +PC again at some stage, maybe it is a piece of the
puzzle.
KristinWisgirda:
Anything visually interesting about his back or body? Moles, pigmented areas, structural interest- creases,
bulges?
He does not have any moles anywhere but the skin colour on his lower back is a bit mottled/purply looking which
is different to everywhere else and when I do cupping there it comes up very dark purple. This was another reason
for me thinking there is stasis and he needed +SI but maybe it is more blue and indicative of cold?
Also, his heart rate has always been between 45 and 50. I know that fast heart rate can be part of the HT excess
picture but does slow heart rate mean BL excess? It would seem to be an obvious assumption but i know Saam
doesn’t always work like that and I don’t remember hearing that specified.
KristinWisgirda:
Any other signs of SI excess that might show you how deep it is- lack of interest in grooming, low fertility,
asymmetry?
He is well groomed, no fertility issues and i am biased but I think he is quite symmetrical. Also he is very
healthy, very rarely sick, plenty of energy so i was a bit surprised that he might be kidney deficient…but maybe
that is my TCM thinking.
michaelmax:
In your husband’s case, it sounds like there is excess dampness, which can lead to stiffness as the tissues are a
bit swollen with fluid
michaelmax:19/01/2024, 11:11Chronic muscle stiffness – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/chronic-muscle-stiffness/1053/print6/9
I also thought +HT to deal with cold, as I think of tightness as a kind of contraction.
This is good to know, and to bear in mind for my future cases too, that you consider both of these can cause
stiffness/tightness, thanks!
I will try +HT this week and update
KristinWisgirda: May 26, 2020, 9:24pm
maeveodon:
I will try +HT this week and update
Given all that you wrote above this sounds like a good plan. The mottling is interesting- yes blood stasis but maybe
the cold is the reason behind the blood stasis. The low pulse rate isn’t definitive for Sa’am but does make one think
of hypofunction.
I’m interested in how he responds. Please keep us posted.
KristinWisgirda: May 28, 2020, 3:18pm
I checked my notes again and saw that slow pulse is an indication for UB excess that Toby spoke to. This makes
sense.
Adina_Kletzel: September 8, 2020, 7:43am
KristinWisgirda:
As an aside: most of my plantar fasciitis patients have responded well to K+.)
HI,
I am curious to understand why you would think of tonifying Kid for plantar fasciitis. Isn’t it an accumulation that
causes pain? I would think this would point to more kid excess and therefore need SI+.
I have a patient with plantar fasciitis coming in this week and so I am eager to understand your thinking.
Thank-you19/01/2024, 11:11Chronic muscle stiffness – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/chronic-muscle-stiffness/1053/print7/9
KristinWisgirda: September 8, 2020, 6:00pm
Sometimes channel, sometimes quality.
Sometimes both.
Adina_Kletzel:
Isn’t it an accumulation that causes pain?
In your understanding, what is accumulating in PF?
If we just consider SI and K, pain can be from lack of consolidation just as easily as it can be from blood stasis,
especially in an area that receives the whole weight of the body.
I definitely did the usual local heel and foot and global Saam evaluation though I didn’t get it right on every first
try. One patient didn’t respond to SI+, so K+ was the next most likely option.
I read about a surgeon who observed that the tissues of all feet with PF had significant avascular necrosis with the
fat pad in the heel breaking down because of poor blood supply. He was observing this in patients who had not
responded to other therapies and needed to resort to surgery. This partially explains why another patient responded
well to SP+. She had chronic tension in her deep calf muscles including posterior tibialis but it also fit her LI
excess personality. However her pain was clearly on the K channel, not Spleen. This case is a reminder to consider
any potential blockages to the irrigation of the area.
maeveodon: September 18, 2020, 9:53pm
Hi all,
Apologies for the late update on this case, but just in case it helps anyone. So after the 2 +LI treatments (no
improvement in stiffness but definite improvement in digestive system) I did another +Kid, then +HT x 2 (big
improvement after first one, nothing immediately noticeable on 2nd one) and then +Liv. To be honest I think I had
been asking him too frequently about any changes so I left it a month, while observing quietly, and then asked him
and he said that while he no longer knows what it feels like to have zero stiffness, he now feels that he at 85% out
of 100% of non-stiffness. His golf game is best its been in years so he is happy! Go Saam!
His Plantar Faciitis is also better but does still have it for few minutes on waking every morning.
He still plans everything to a tee so Saam definitely does not change personality
On a related note the low heart rate has really helped me with a number of cases since where there are no major
signs of cold or heat but heart rates of 50-60 and have benefited so much from +HT. In this past few weeks I had 2
patients who talk incessantly and have quite high colouring, but HR of 50-60 and I treated HT and they had so
much more energy and for one BP has come down! Obviously I looked at all the other signs and symptoms but no
major cold signs and the talking and the red faces threw me…red face not SJ XS either as +LIV did not go well.
Just something to bear in mind anyway. I knew from feeling their pulses that they didn’t have high pulse rate, but i19/01/2024, 11:11Chronic muscle stiffness – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/chronic-muscle-stiffness/1053/print8/9
guess I’m not very good at it as I didn’t realise they were so low, so I am using a finger pulse oximeter now
It is certainly making me look more deeply into the effects of cold on the body…and living in Ireland i need to be
aware!
KristinWisgirda: September 19, 2020, 10:24am
Thanks for the update @maeveodon.
maeveodon:
no major signs of cold or heat but heart rates of 50-60 and have benefited so much from +HT
Slow pulse is a gem for UB excess so as a gem it should be given a good amount of clinical weight. Being extra
talkative and having high color would likely have thrown me too, so I am glad to hear of your experience. Your
idea of using a pulse oximeter is a great idea for busy clinicians who are not pulse masters, eg me. Thanks!
kellykd: September 25, 2020, 10:46pm
I have experience tight plantar fascia, but not really pain, since giving birth to my child 12 years ago. I have had
the feeling that my feet were lacking stability (consolidation). Especially first thing in the morning and after sitting
down for a while, when I get up I hobble a bit and my feel like unstable; right after the birth I felt like my feet were
like pancakes.
So I have given some thought to this and it does feel like the muscles and tendons are holding on for dear life
because there is a lack of consolidation.
So it is kind of excess consolidation due to a lack of consolidation. That’s what it feels like, anyway.
Hmm, maybe I’ll K+ myself!19/01/2024, 11:11Chronic muscle stiffness – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/chronic-muscle-stiffness/1053/print9/9
KristinWisgirda: September 25, 2020, 11:20pm
Hi @kellykd,
I have treated a number of patients with similar post partum instability in their feet or elsewhere. K+ has always
given excellent results. GB+ and Liv+ have usually been the follow ups.
Treat yourself and let us know what happens. Self treatment is a great way to learn and you know what to do if the
treatment goes south
Daniel: September 26, 2020, 11:04am
KristinWisgirda:
pain can be from lack of consolidation just as easily as it can be from blood stasis
SO Important – this point!! . . . . .
michaelmax #14October 5, 2020, 8:39pm
Here are back to the basics… is it excess or deficient?