KristinWisgirda: April 18, 2019, 11:41pm
A conversation about evaluating treatment effect on the table came up in the post on Year Long Headache. I asked
Toby questions that arose from that conversation. My questions are in brackets <>. His answers are below my
bracketed questions.
<A group of questions has come up around evaluating the immediate effect of the treatment. If the patient presents
with a symptom that is easily evaluated in the treatment room, subjectively or objectively, should proper treatment
always create some change with that symptom within 5 minutes of needling?>
Usually, but almost always the face will change.
<In the absence of the deep dropping, are there other factors, such as improvement in other signs or symptoms, that
will let you know to keep the needles in for longer than 5 minutes if the chief complaint hasn t changed on the
table?>
As above, the face is the most reliable.
<Last weekend, you mentioned that you might wait longer before evaluating Heart supplementation because cold
can be slower to respond. Is 5 minutes enough for a cold patient or would you wait longer?>
Usually – unfortunately there s no fixed rule for how much time to wait for a response.
<The patient in question is an icy cold, blue toed 16 year old girl with a frontal headache. Supplementing the liver
created warmth in one leg, but didn t change her headache or create any kind of relaxation after 5 minutes, so the
practitioner removed the needles and tried SI+ with similar results. The post subject is Year Long Headache if you
would like more details. There are still some questions about the diagnosis that we are working through as a
group.>
Warmth in one leg after 5 minutes is a good response! Please tell them not to expect a complete resolution of a one
year long continuous cold pattern in 5 minutes!
michaelmax: April 19, 2019, 1:03am
KristinWisgirda:
Warmth in one leg after 5 minutes is a good response! Please tell them not to expect a complete resolution of a
one year long continuous cold pattern in 5 minutes!
Oh wow does this hit home. Our patients hope for miracles. We do too. And the problem is that often enough we do
indeed get rockstar stellar holy mother of God results. Which feels good to all involved. But if we take that as26/01/2024, 12:40Evaluating treatment effect on the table – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/evaluating-treatment-effect-on-the-table/114/print2/4
the norm, then we have a skewed view of reality.
Being able to track some results that fit with the diagnosis and who we imagine our patients to be I suspect
this is enough in the beginning. Especially for long term and deep seated issues, which most likely are multi-
layered. (this does not mean you do three channels on the same side). It means we unwind the hairball.
The chief concern (I hate using the word complaint ) may or may not change on the table, but hopefully
something that is connected to the channel you are treating will show a change.
Face is a really good marker to cultivate, and I need lots more practice with that one. And I ve found that tongue,
pulse, feeling in the room, fluids (if you do that weird cranial stuff) sense of settling in the patient all are helpful
markers. I suspect the key here is to build our placatory and observational vocabulary
lauramcgraw: April 19, 2019, 4:09pm
This is great to read given this is my patient. After some advice to not needle the same channel twice if not
addressing the chief complaint I got discouraged and switched my treatment strategy. That s for the clarification
Toby. My first treatment was to suppl. the heart and that warmed her the most, she felt warm on both sides but it
didn t resolve the headache so after posting here I had some advice to try other channels. The liver was good too
but not as effective as the heart. I will carry on with the treatments and see what time shows with this patient.
Thanks everyone for the input!!
Laura
lauramcgraw: April 19, 2019, 4:13pm
Kwisgirda
Thanks so much for taking the time to ask Toby about my case !!!
KristinWisgirda: April 19, 2019, 9:02pm
Your welcome @lauramcgraw. Your case brought up so many interesting issues. I would like to ask Toby more
on the topic of how to evaluate treatment response, especially with more severe, chronic conditions and those
involving cold. In another encounter Toby mentioned that when supplementing the Heart for cold conditions
involving pain, he might give the treatment 20 minutes before reevaluating the pain, because cold responds more
slowly. Aha! So the treatment response for cold can be expected to be slower. Sounds like we need to look for
positive changes in the face/demeanor and building overall warmth before we can expect the symptom to change.
And use clinical judgement to be on the look out for complicating factors. I wonder how much this patient s
swimming might be an obstacle to treatment.
michaelmax:26/01/2024, 12:40Evaluating treatment effect on the table – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/evaluating-treatment-effect-on-the-table/114/print3/4
Face is a really good marker to cultivate, and I need lots more practice with that one. And I ve found that
tongue, pulse, feeling in the room, fluids (if you do that weird cranial stuff) sense of settling in the patient all
are helpful markers. I suspect the key here is to build our placatory and observational vocabulary
michaelmax:
Our patients hope for miracles. We do too. And the problem is that often enough we do indeed get rockstar
stellar holy mother of God results. Which feels good to all involved. But if we take that as the norm, then we
have a skewed view of reality.
I came to the same conclusions as @michaelmax. The often magical results have skewed my expectations so I get
confused when they aren t there.
michaelmax:
Face is a really good marker to cultivate, and I need lots more practice with that one. And I ve found that
tongue, pulse, feeling in the room, fluids (if you do that weird cranial stuff) sense of settling in the patient all
are helpful markers. I suspect the key here is to build our placatory and observational vocabulary
We have all had that amazing feeling when a treatment is just so right on. It makes sense that Toby emphasizes the
face for evaluating treatment efficacy. If the shen can shine through the face clearly and calmly, the patient is
obviously aligning with heaven and earth in a balanced way. Trust that- and don t worry about the details so much.
That s my new pep talk for myself.
Sorry for splitting this conversation into 2 topics. I am just getting the hang of this forum. :).
KristinWisgirda: April 20, 2019, 3:04pm
Found another Sa am resource for considering treatment results:
4 factors
Correct Diagnosis
Correct Treatment
Strength of Constitution
Strength of Pathology
The first 2 are our domain and responsibility. The second 2 are out of our control. Horrible constitution and really
gross pathology can slow and dampen the effects of the most perfect diagnosis and treatment. Most patients don t
present us with such obstacles to treatment but it is good to be aware that such situations exist.
A grounding message to help balance the expectation of 1 treatment miracles.
3 Likes26/01/2024, 12:40Evaluating treatment effect on the table – Sa’am Clinical Questions – Qiological Community
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michaelmax: April 22, 2019, 1:13am
Thanks @KristinWisgirda, it s a helpful reminder that in any treatment there is what we are responsible for and
there is what is not in our hands. So often we think we are supposed to do miracles. Makes it worse that sometimes
we do. Easy to get an inflated sense of our abilities.
I had a patient who once said to me “I d like to get better as quickly as nature will allow.”
What a keen heart that fellow had to know that we unfold in time and there is a pace and rhythm to it. And it
reminds me of what Toby said about “sometimes we do slow miracles.