adambroder: October 15, 2019, 11:50pm
What to do when one channel is clearly deficient but the rest aren’t giving you much to work with? Below is my
writeup of a first-time acu patient. As you’ll see I was pretty certain he was PC excess, so I went ahead and did a
GB+ (L) tx even though his only complaint was insomnia. I saw him one week later and he reported improved
sleep for 3-4 days following treatment, particularly with regard to staying asleep. He doesn’t recall waking up as
frequently or at all, and he felt like he slept later than usual too. For the next few days he also had less waking up
but it took him longer to fall asleep. Considering this a success I repeated the treatment. Now I’m at a loss as for
what to do when I see him again in a few days (it will have been one week since the second treatment). I figured I
have some options, which I’ve outlined below the writeup.
54 y/o male
Chief complaint : insomnia, difficulty falling and staying asleep, for the last 10 years or so; not every night but
most nights; often he wakes around 4-5 and cannot fall back asleep or cannot achieve a deep sleep again; has
gotten worse in the last 3-4 years; the only life change that has occurred in that time is that two of his four
daughters have left for college; when he cannot sleep he says he is not ruminating
Appearance and demeanor : bookish, wears glasses, dresses casually (does not make an effort to be fashionable),
lack of facial symmetry, polite, introverted +7 (says his wife and daughters would describe him as introverted vs
extroverted)
Lifestyle: works as a scientist +7; when asked what he likes to do in his spare time he said he likes to read +8, and
does not exercise much (even though he lives in an area with easy access to many outdoor activities)
Body morphology and flesh quality: thin frame, taller than average, flesh not sinewy and more on the soft side,
extensive varicosities around both ankles +4
Skin Quality: slightly dry
Body Temp: normal on palpation but when asked he normally runs cold, full body; he was wearing a fleece
pullover and shorts on a warmer fall day +5
GI: no issues, BMs formed and easy to pass, has a sweet tooth
Respiratory: no issues
Sleep: see chief complaint
Emotions: very even keel, though he reports having a short temper and irritability when tired (when asked if he
ever expresses that irritability he said no…+10)
Urination: no issues
Other Body: no vision problems or sensitivity to light; midline not overly soft or tight; nothing of note at LU10 or
KI3 regions (except for varicosities around ankles, but those are present on the lateral malleoli as well)25/01/2024, 11:35Clear on one channel, murky on the rest – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/clear-on-one-channel-murky-on-the-rest/689/print2/6
Tongue: dusky, puffy, small yin cracks, little to no coat
Pulse: slightly slow
Excess Presentations:
Heart: none
UB: full body cold +5
GB: none
P: intelligent, likes to read, introverted, doesn’t express irritability +10
SJ: polite
Liver: none
Lung: dry exterior and slightly damp interior
Stomach: none
LI: seems like the kind of person who doesn’t get bored easily, enjoys his job which keeps him busy +3
Spleen: sweet tooth
SI: none
K: varicosities around ankles +4
The Grossest Thing(s) in the Room: his PC excess signs are the grossest, and not much else stands out
Main treatment ideas: GB+
Other treatment ideas: HT+, SP+
For the third treatment…
Option 1: repeat GB+ again (assuming he experienced continued improved sleep following the 2nd tx)
Option 2: choose another channel (in case I don’t want to do GB+ for a third time, or in case his sleep got worse
following the 2nd tx); the problem is I’m not very confident in my two secondary choices
Option 3: do something other than Sa’am
Jeffrey: October 16, 2019, 2:23pm
how about considering the toggle of GB/P?25/01/2024, 11:35Clear on one channel, murky on the rest – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/clear-on-one-channel-murky-on-the-rest/689/print3/6
KristinWisgirda: October 16, 2019, 2:30pm
adambroder:
Option 1: repeat GB+ again (assuming he experienced continued improved sleep following the 2nd tx)
Two times in a row is the recommended max, with a possible 3rd time for extreme cases only. Given GB’s volatile
nature, avoid doing it 3 times in a row, even with strong P excess signs.
adambroder:
Option 2: choose another channel
Patients without dramatic presentations can be challenging. The next visit will be an opportunity to look at your
patient with fresh eyes. Observe and inquire along the lines of your other choices to see if you can find some
corroboration of the next line of treatment. Be curious about his insomnia and his habits. What changed when 2 of
his daughters left for college- did he become less active or have grief? What is he reading- technical materials for a
project he is excited about or fun spy thrillers?
Patients often give up more in depth information with each session if you ask.
2x GB+ might have changed him significantly.
Besides Heart and Spleen, you might want to inquire along the lines of the stasis side of K excess and of Lung
excess.
You can also ask: what qualities does this patient need? Does he need the dynamic movement of SI? Does he need
the hot outwardly directed love and connection of Heart? etc, etc. Sometimes framing the inquiry this way will give
you a stronger answer than trying to piece together an intellectual argument for a particular treatment.
adambroder:
Option 3: do something other than Sa’am
Always a good choice if you aren’t confident in your other options. It can also buy you some time as you get to
know the patient.
adambroder: October 16, 2019, 4:39pm
Thank you for your feedback. How would his choice of reading material sway you in one direction or the other?
adambroder #5October 16, 2019, 4:43pm25/01/2024, 11:35Clear on one channel, murky on the rest – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/clear-on-one-channel-murky-on-the-rest/689/print4/6
With his loud PC excess presentation I would be hesitant to do that but that doesn’t make it an inappropriate choice
necessarily. And like Kristin said, two GB+ txs may have changed him significantly. What would you look for to
give yourself confidence to make this choice? If he suddenly starts displaying or reporting GB excess signs that
would begin to lead me there.
KristinWisgirda: October 16, 2019, 5:19pm
adambroder:
How would his choice of reading material sway you in one direction or the other?
Insatiable curiosity on a variety of subjects would point to LI excess. An excuse to be a couch potato would be
Spleen excess. Reading only one author might point to a certain stuckness- maybe Kidney excess?? Obsession with
finances because of fear of not having enough would point to St excess.
Saam is interested in the quality of the behaviors not simply the behavior itself.
Jeffrey: October 16, 2019, 7:02pm
adambroder:
If he suddenly starts displaying or reporting GB excess signs that would begin to lead me there.
this of course would be the obvious if he was over supplemented by GB+ treatments.
adambroder:
What would you look for to give yourself confidence to make this choice?
just something I would want to be open to and watch for. Not to be sexist, but there are not that many straight
males that dont have some GBxs, just sayin… Im often looking for this. You may have an exception to this “non-
rule”.
@KristinWisgirda’s inquiry sounds more likely. You never know about the changing tides of humans
George_Mandler: October 17, 2019, 12:12am
25/01/2024, 11:35Clear on one channel, murky on the rest – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/clear-on-one-channel-murky-on-the-rest/689/print5/6
KristinWisgirda:
Obsession with finances because of fear of not having enough would point to St excess.
I am not clear on this relationship with lack of finances related to SI excess. Finances being about consolidation of
resources? This is a new idea for me.
KristinWisgirda: October 17, 2019, 2:30pm
Hi George, Looks like you saw SI excess when I wrote STomach excess. Easy to do.
Stomach excess can present with fear of not enough because they can’t hold onto resources.
George_Mandler: October 18, 2019, 1:08am
KristinWisgirda:
Hi George, Looks like you saw SI excess when I wrote STomach excess.
Oh man My presbyopia is getting so much worse!
adambroder: October 18, 2019, 10:46pm
I am seeing this patient right now for his third visit. He’s resting with harmonizing points in his back. His sleep was
not as good this past week as it was after the first tx. Thank you Kristin for your feedback. I asked about his
daughters leaving for college and it sounds like he had a healthy outlook about it. I asked about his choice of
reading material and he said he reads a lot of Sci-fi, history and biographies. Asking myself the question of what
does this patient need, I’ve come to the conclusion that SI would be good for him. I get a real sense of, maybe not
stuck-ness per se, but that life is rather routine for him. Along with the varicosities and the dusky tongue I’m
feeling pretty good about it. I will treat SI+ and report back.
KristinWisgirda: October 20, 2019, 11:20pm
The reading material suggests more passive enjoyment than dynamic engagement.
Thanks for the update.
SI+ would be my choice for him too. That GB+ initially helped him sleep might have been that it activated and
opened his system so that it could then close again for sleep. You have to go up and out fully so you can go down25/01/2024, 11:35Clear on one channel, murky on the rest – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/clear-on-one-channel-murky-on-the-rest/689/print6/6
and in. SI+ might have a similar effect, kind of like the acupuncture equivalent of a good workout that then makes
one tired in a healthy way. It would be interesting if he sleeps better after vigorous exercise.