amyjenner: February 8, 2020, 2:29pm
62 yr old woman, history of trauma (alcoholic parents, neglected, alcoholic husband after 2 kids, situation
dangerous) Currently single and pretty happy in her life. She is retired from a job as the customer service person in
an alternative health care clinic and has some almost militant views against western medicine. During the stressful
time getting away from the husband and protecting kids 25 years ago, she started to experience insomnia. She
started using unisom at that time. Has used it consistently for sleep for 25 years. She takes lots of supplements
“intuitively”, including things like theanine and GABA and melatonin for sleep. 23 days ago, she decided to go
cold turkey on the unisom and hasn’t really slept more than a couple hours a night since. Sleeps 2-3 hours, up for
4-5 and back to sleep 1-2. She is a wreck. I saw her for the 1st time yesterday.
Appearance: tidy, casual, appropriate dress. Warm, friendly, engaged in process. A little plump and squishy. +4
GI: some sensitivities, but manages through diet. No stimulants, no refined sugar, mostly organic, mostly veg but
regularly has org. chicken, fish eggs etc.
Cardio/Pulmonary: has times of high blood pressure.
Skin: dry +5
Temp: tends to chilly +4
musculoskeletal: tightness in neck and shoulders, +3, bunions since teen +6, ankle arthritis +4
Emotional: Aside from the crisis at hand, she is easily susceptible to stress and sensitive to other people’s energy.
+8
Sexual: considers herself a very sexual person. Says that if she doesn’t have an orgasm every 4-5 days she gets
“mean”. +8
Tongue: distended sublinguals, indents/flattening along the sides+, not sure what we call that but I read it as liver qi
stagnation, color is dark, purple, red +.
Abd: Soft squishy flesh, warm, the muscles are hard and tight +5, and the area below the navel is completely empty
and I can feel the chopstick +7. There is okestu on the rt. +4
Resources: Would like more friends, recently moved here to the coast and is looking for her tribe. Has an
inheritance that affords her a comfortable but not extravagant lifestyle.
Thenar is flat
heels flat and dry
eyes attentive, loves cloudy days
My breakdown of all this:
GBxs: insomnia, mean w/o orgasm, grinds teeth, indented tongue
LUxs: body type, resources
STxs: flat thenar
Kidxs: bld stag ( tongue and sublinguals),
SIXS: dry heels, empty bow tie, age,
SJxs: loves cloudy, people sensitive, trouble regulating temp
1st treatment: PC+rt. Brought about a chilly trembling/shaking that went on for about 10 min. I read it as the GB
fighting thing and decided to ride it out. She wasn’t distressed by it, found it kind of cool that acupuncture would
do that. Once the shaking subsided, she relaxed and drifted off. She was warm by the end of the treatment.15/01/2024, 17:18Extreme insomnia – Qiological Community
https://forum.qiological.com/t/extreme-insomnia/883/print2/4
She didn’t have any better sleep night last night and is quite desperate this morning. I will see her again in a little
while. What to do next? My order of priority would be PC (did it), SI, Liv, ST
Thoughts?
KristinWisgirda: February 8, 2020, 4:32pm
Thanks for the case. P+ looked like a good place to start but her problem is longstanding with an intense history so
it isn’t surprising that the first treatment wasn’t a home run.
What does she experience when she is up in the middle of the night? Hot, fearful/anxious, wakes with a start,
physical restlessness, mental restlessness, hungry, just awake?
amyjenner:
Says that if she doesn’t have an orgasm every 4-5 days she gets “mean”. +8
Patient behavior is often self medication. Sexual addiction can be an attempt to stimulate something that isn’t
circulating. Along with the blood stasis signs, this points me strongly to SI+. Considering the empty lower
belly/chopstick, you might need to use K+ at some point, but only after cleaning up other areas Liv+, St+ which
both look like good candidates too.
Please let us know how she makes out.
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amyjenner: February 8, 2020, 6:55pm
I saw her this morning. She couldn’t fall asleep for hours last night. up till 2 or so before finally drifting off a little.
Mostly frustrated in the night. She has been a little alarmed by the number of times she is needing to pee at night
recently. I’m thinking that is the adrenal/kidney fatigue after 23 days of hardly sleeping. When she came in today,
she was also freezing. She went to bed after a nice meditation, felt peaceful when she went to bed but anxious
about whether or not she would sleep. I was nervous about SI given that she was peeing so much and freezing. I
went to Liv + Ht with the idea of more settling for her nervous system with some warming. Also thinking HT
would help with Shao Yin. Not sure if we can think of it that way…In this case, where there is so much Kid
deficiency, with the bld stagnation, what’s your advise with how proceed re SI/Kid?
Her response to the treatment was a little teary as she felt very held and supported. she relaxed and rested.
KristinWisgirda: February 8, 2020, 10:32pm
Beautiful!
After I wrote the last post, I kept thinking about H+Liv for her, given the history of living in dangerous15/01/2024, 17:18Extreme insomnia – Qiological Community
https://forum.qiological.com/t/extreme-insomnia/883/print3/4
circumstances and possibly still experiencing underlying fear. I recently had a newly pregnant patient with a
history of 6 miscarriages but also running quite warm and very hot at night. Needless to say she was terrified as
well as not sleeping and having daily headaches. She was like a new person after treating H+ Liv- much less
scared, sleeping much better, headaches gone, no aggravation of heat. (Liv+ by itself wasn’t so helpful) H+ Liv
provided the warm love of Heart with the cool shielding of Liver.
amyjenner:
In this case, where there is so much Kid deficiency, with the bld stagnation, what’s your advise with how
proceed re SI/Kid?
When there is blood stasis in pregnancy, where SI+ is contraindicated, Toby recommends H+ Liv as an alternative –
a safer way to provide some movement by mixing Fire and a cooling element. By extension, my guess is that H+
Liv could serve the same purpose when there is overt SI excess/kidney xu and blood stasis.
Your patient likely will benefit from both the gentle movement AND the warm love + shielding of this combo.
1 Like
amyjenner #5February 9, 2020, 3:23pm
She slept 8 hours last night! Yeah for that! In addition to the acupuncture I also mixed up some suan zao ren tang
with ye jiao teng, huang lian, and long chi to take before bed. Also, there is a formula by pure encapsulations with
5HTP, theanine, GABA, and taurine that I find super helpful in these type of cases where there is some level of
anxiety that is impacting sleep so I had started her on that. It was just the 2nd day of taking it and it can take a few
days to get to level. I also suggested she take a little of the unisom and do a more controlled weaning over the next
6 weeks or so now that she is getting some other support with acupuncture and herbs etc. So, it all worked. She is
so grateful to have slept. She is feeling optimistic. I will see her again later this week and then I am away for
vacation.
Thanks for the idea of gentle moving with the Liv and HT combo. That is very helpful. I have been having a
question about working with chronic pain and not wanting to over use SI for that.
Also, the notion of addiction being an attempt to move something…I have to think about that. It seems to me that it
can also be an attempt to not move (ie lock down) something as well. I see a number of people who use sugar or
alcohol to control their anxiety, for example. Does that make sense? Or are you saying that they are using the
substance to move the anxiety out, kind of off the top of the messy pile underneath, without addressing the
underlying issue?
KristinWisgirda #6February 9, 2020, 4:34pm
Thank goodness she slept. Cutting back on the unisom slowly sounds like a more compassionate way to move
forward than the cold turkey method.15/01/2024, 17:18Extreme insomnia – Qiological Community
https://forum.qiological.com/t/extreme-insomnia/883/print4/4
amyjenner:
Also, the notion of addiction being an attempt to move something…
My comment was on sexual addiction in particular. Sex moves the qi and orgasm provides a release. Needing to
engage in sex frequently means the qi is stuck.
I agree that other addictions can act as an attempt to dull, insulate or lock down.
KristinWisgirda: February 10, 2020, 3:11pm
KristinWisgirda:
In this case, where there is so much Kid deficiency, with the bld stagnation, what’s your advise with how
proceed re SI/Kid?
I ran this question by Toby to be doubly sure. Here is his response in bold italics.
I think that if supplementing SI is contraindicated for a patient then supplementing Liv (which supplements
blood like SI does) and supplementing Ht (which improves the hypo-functional state of blood stasis like SI does)
is reasonable.
amyjenner: February 10, 2020, 10:28pm
Thanks, much appreciated and it makes sens