Laura.Marion: April 18, 2021, 11:56am
Hi everyone,
I’d really appreciate your insights. I’ve been using SAAM for 6 months now and this is the first patient who I may
have mistreated but I’m unsure.
61 yo, female
CC: Frozen shoulder, bilateral, worse on left side.
Location is San Jiao (follows this trajectory down arm to elbow) & Small Intestine.
Presentation: Limited range of motion, she can’t open out for lateral rotation from elbows. Pain is sharp & deep in
the joint, per her observation.
Secondary concern: eyes are blurry, especially after reading.
Appearance & demeanor: Bright eyes 4+, Slight suspicious of acupuncture (wants documents of things she signed
and has had bad treatments in the past from another acupuncturist).
Describes herself as “determined”- wants this pain to resolve so she can do CrossFit again.
Pain has been chronic for about 2 years. She gets chiropractic and massage every week even though there are no
improvements. My colleagues in the office who do chiro and massage report that she often talks way too much &
have a hard time wrapping up the treatment to stay on time.
Skin: Fleshy body & slightly overweight, mixed dry and moist skin.
Body Temp: She does have night sweats, which almost made me supplement Liver.
Grossest thing in the room: somewhat rude personality, or what some would describe as “to the point”, channel
pain on San Jiao, She can’t open arms out so somewhat shielding. Eyes are dull and has vision issues.
My treatment: Supplemented San Jiao on the right.
Afterwards, I come into the room and notice she’s wide away.
I asked her how she felt once she sat up, but she had no change to ROM or pain.
So, I added gua sha to both shoulders.
Next day: I contacted her and asked how she was doing, to which she replied, “no positive or negative change to
frozen shoulders”. Essentially that my treatment didn’t work.
3 days later I hear from her. She’s stating that her pain is worse and her arms are stuck again like before she did PT.
Essentially, she’s experiencing a reversal in her condition, going to worse.
Special note: On the same day she saw me, she also had chiropractic and body massage before she saw me for
acupuncture. I’ve been hesitant in having a patient do all 3 of those therapies in one day, and have had some
patients experience rebound pain because all 3 were too much.
So, did I mistreat and cause the rebound pain? What are your thoughts?
I’ve always read that with SAAM you pretty much know right away if it was the wrong treatment.08/01/2024, 14:24Did I mistreat using SAAM? – Qiological Community
https://forum.qiological.com/t/did-i-mistreat-using-saam/1553/print2/4
Meaning, there is no delay in poor results.
Many thanks, Laura
George_Mandler: April 18, 2021, 1:15pm
Hello Laura
Thank you or your case and question.
Laura.Marion:
On the same day she saw me, she also had chiropractic and body massage before she saw me for acupuncture
My take is you did not mistreated but she was over treated. Other modality treatments after Sa’am are strongly
discouraged. We need to respect that a body can only take so much input. if we give it too many signals the body
will get confused. I do not let my patients get any Chiro or other modalities for 48 hours after Sa’am and I usually
say to wait at least 24 hours or more after another modality to get Sa’am. More is not better – In this case her brain
already has a lot firing to that shoulder and Gua Sha, Chiro,massage all likely amplified that neurological firing.
Also it was 3 days after your SJ+ treatment that things deteriorated and given all the other treatments she has done
it is unlikely that you treatment is the culprit, but rather the combined effect of too much.
Given her presentation supplementing SJ+ seems like a reasonable 2nd or 3rd choice.
Given there is SI trajectory – and she does CrossFit she sounds like she is a ‘young’ 61year old. How are her medial
heels? Any varicosities or oketsu? I might think supplementing SI+ as a first choice if any of those signs.
Laura.Marion:
Body Temp: She does have night sweats, which almost made me supplement Liver.
Careful here. Night sweats can be helped with many channels – LI+, BL+, LU+, LR+…Don’t jump to a channel
based on one sign. I would supplement LR+ for night sweats If the person showed clear SJ excess signs.
Laura.Marion:
She can’t open arms out so somewhat shielding.
I don’t think we can call this shielding in the SJ excess terms if that is what you are implying.
Laura.Marion:
My treatment: Supplemented San Jiao on the right.
I would stay with a patient – did her complexion change?. Do you know if she settled? I often check on the table if
any ROM changes. I have a frozen shoulder case now where she feels so relaxed and ‘good’ but we get no ROM
changes.08/01/2024, 14:24Did I mistreat using SAAM? – Qiological Community
https://forum.qiological.com/t/did-i-mistreat-using-saam/1553/print3/4
If you do want to use Sa’am and since you are new at this I highly suggest watching/listening to everything Toby
Daly Sa’am that you can. I’ve taken the same classes repeatedly and received new insights each time with different
student cases.
michaelmax: April 19, 2021, 1:33am
Laura.Marion:
On the same day she saw me, she also had chiropractic and body massage before she saw me for acupuncture.
I’ve been hesitant in having a patient do all 3 of those therapies in one day, and have had some patients
experience rebound pain because all 3 were too much.
While the Saam treatment might not have been on target, maybe tonify the SI to get things moving. But she also
sounds a bit aggressive. If her sleep is also not good, perhaps consider tonifying the PC to level the GB.
That said. Chiro and Massage, and then sees you. That is a patient asking for over treatment. And while we don’t
often talk about this in Saam or common garden variety acupuncture I think it is possible to overtreat patients then
we have no idea of what cause the condition to get worse. My suspicion is that it is not one thing that made it
worse. I was asking her body to do too many things in a short about of time.
Sometimes patients think more is better. For them, I tell them to come in 2 days after another treatment. Flat out
refuse to see them sooner.
Given that things got worse after all that treatment I think it is useful to see what is the grossest thing in the room.
Blood stagnation, qi deficiency, fluid excess or deficiency. Whatever is it, treat that. And with instructions that she
get no further treatment till you see her next time, that way you have a clear and valid datapoint to work with.
Laura.Marion: April 19, 2021, 12:16pm
Hi George & Michael,
Thanks for your responses, & for validating my thoughts that she was over treated. I like the recommendation of
waiting 2 days before another treatment.
Unfortunately, this patient won’t be seeing me again since she already had suspicion of acupuncture and now this
has happened. I explained what you both said but who knows if it sunk in for her.
I don’t recall what her medial ankles looked like, so can’t answer if she had that kidney excess signs. Looking
back, I wish I would have not only waited to see her, but also treated by supplementing small intestine. If I happen
to treat her again I’ll do a follow up on this.08/01/2024, 14:24Did I mistreat using SAAM? – Qiological Community
https://forum.qiological.com/t/did-i-mistreat-using-saam/1553/print4/4
I’ve been doing a deep dive on SAAM again by watching case studies and conversations between Toby and
Michael again, so this has been helpful lately for other cases. Thanks to Michael for helping Toby share this style
of Acupuncture…I’ve really enjoyed using it and have experienced great results clinically!
Thanks for the idea of supplementing PC. I’ll keep that in my back pocket.
Warm regards,
Laura