rmayroz: October 2, 2019, 11:35pm
Hello everyone. I am very new to Sa’am, and would be very grateful for your input on this case.
57 yr old woman presenting with severe L facial pain over eye, GB/ST/BL channels
She also suffers from insomnia & anxiety and depression
The pain is constant, the vision can become blurry at times in that eye and there is a sensation of numbness on top
of the pain.
At times the pain can develop into a migraine.
Pain over eye feels cold, and a sensation of pressure with an occasional referred pain down her neck (GB/SJ)
History of pain: 4 years ago she tripped on footpath curb and fell on metal car door, injuring the GB & Tai Yang
area of eye. She suffered severe complex migraines and it was established on investigation that she sustained a
microbleed in the brain. She was prescribed Tegratol for the pain and that kept it at bay. Recently she opted to go
off medication because of the side-effects (increased appetite and drowsiness) and the pain returned. Currently on
Lyrica which is not helping. She also feels clumsy and dizzy.
**Medication:**Lyrica, antidepressant (SSRI), asthma preventer
Appearance and demeanor: Obese (136 kg/300 lb), gentle nature, dresses casually, polite +5; seems a bit shy,
average symmetry
Lifestyle: Lives by herself after a terrible break-up 4 years ago (just before the eye injury). Has grown children (2)
and 2 grandchildren which she looks after 1-2 days per week.
She is the manager of a woman’s crisis service 1 hour drive from her home.
Has suffered childhood sexual abuse and ongoing trauma, felt a lot of shame and as “damaged goods” all her life.
Flesh quality: Abdomen: soft and lax +7, skin slightly dry +4, Limbs have average tone. Cracked & dry heels.
Thenar eminence average
Body temperature: When anxious, she gets a rush of pins & needles sensation on her back reporting that half of
them feel cold and half of them feel hot.
This can happen quite regularly and mostly evening/night.
Still hot menopausal hot flushes, happens ass soon as lies down at night.
Generally prefers warmth.
Respiratory: history of asthma, uses preventer (steroid), prone to respiratory and sinus infections (currently taking
antibiotics for purulent sinus infection)
GI: gas +4, stools on the soft side (s/e of meds), always diarrhoea with undigested food whenever gets sick.
appetite ok now.
Urination: stress incontinence with sneezing or when vomiting (not currently vomiting). Night urination 1-2/night
M/S: pelvis injured by MVA at age 6, has 2 bulging discs (sorry, I realized i didn’t check the level of injury!)23/01/2024, 12:06Facial pain post trauma – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/facial-pain-post-trauma/651/print2/5
GYN: polycystic ovaries. Hist of bad pmt, very painful menses with a lot of clotting.
1 miscarriage
emotional: Feels like in an ongoing emotional crisis (worse since break-up, was excommunicated by all her
friends and was left alone and with no housing etc for a while). Feels immobilized by anxiety, hard to concentrate.
worries a lot.
T: swollen, broad, slightly dry, purplish, thick =5 white c
I have treated her before doing a Sa’am seminar. with negligible results for the pain.
I started with SI tx to move the pain and numbness, but pain got worse on the table, so removed needles and
corrected with Ki – settled. In hindsight I shouldn’t have used SI as there was microbleeding.
last treatment i treated LI to dry the damp. On the table things seemed to improve, but in the past I have treated her
and pain was improved on the table and then went back to square 1 soon after.
Lu : outer dryness inner damp, numbness
SJ: polite, temperature changes,
PC: quiet, pleasant, slow movement
SP: lots of excessive dampness, although skin not moist/damp, has damp & phlegm in u/body; sloppy stools
SI: diminished love for self
i was thinking to strengthen GB. LR HT but as you can see i lack clarity here, any insight would be greatly
appreciated. Thank you.
KristinWisgirda: October 5, 2019, 2:01pm
Thanks for sharing the case. I know it take lots of effort to write up. You may not have seen our case study format
Case Study Format which contains some tools that will help clarify your Saam clinical thinking.
rmayroz:
Lu : outer dryness inner damp, numbness
SJ: polite, temperature changes,
PC: quiet, pleasant, slow movement
SP: lots of excessive dampness, although skin not moist/damp, has damp & phlegm in u/body; sloppy stools
SI: diminished love for self
It would be helpful to go through all of the patient’s existing symptoms and relevant history and assign them to
channels. Grading the symptoms can also help create a better picture of the patient. Identifying the grossest aspects
of the patient’s presentation will help guide you as well. Redo the list and we can discuss.
rmayroz:
I started with SI tx to move the pain and numbness, but pain got worse on the table, so removed needles and
corrected with Ki – settled.
This is great information and you did the correct fix.23/01/2024, 12:06Facial pain post trauma – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/facial-pain-post-trauma/651/print3/5
rmayroz:
In hindsight I shouldn’t have used SI as there was microbleeding.
The history of the microbleeding in no way makes SI+ contraindicated. In a discussion of emergency medicine,
Toby says that he has never seen SI+ cause more bleeding and suggests it as a potential acute treatment for any
traumatic injury. Given the pain and history of trauma SI+ wasn’t a bad choice. Use her reaction to SI+ as a
learning experience and see what in her picture supports an SI excess- the cracked heels and diminished self love
for sure, the dusky tongue maybe. But what else- does she have any varicosities? Did she have painless, perfectly
timed periods (ie no blood stasis)?
rmayroz: October 6, 2019, 6:07am
Thank you so much for replying Kristin!
” The history of the microbleeding in no way makes SI+ contraindicated. In a discussion of emergency
medicine, Toby says that he has never seen SI+ cause more bleeding and suggests it as a potential acute
treatment for any traumatic injury”
During our class in Sydney, Toby mentioned not to use SI for haemorrhagic stroke, so I thought that maybe it
applied here too (although I am not sure there is still a microbleed, the incident happened 4 years ago).
I will go over the whole case again and will provide more details.
KristinWisgirda #4October 7, 2019, 1:47am
rmayroz:
During our class in Sydney, Toby mentioned not to use SI for haemorrhagic stroke,
Thanks for letting me know this @rmayroz. This contradicts what he has said previously on the subject. I will ask
for clarification.
As always, watching the patient’s response to treatment is the best safety measure.
rmayroz: October 7, 2019, 7:41am
23/01/2024, 12:06Facial pain post trauma – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/facial-pain-post-trauma/651/print4/5
HI Kristin,
It was a specific discussion on haemorrhagic stroke vs. thrombolytic stroke. Toby cautioned about the use of SI+
and advised to maybe use SJ or HT as a more careful approach.
KristinWisgirda #6October 7, 2019, 3:03pm
Of course, it makes sense that the optimum treatment for bleeding may not be to move blood though there are cases
where bleeding is caused by blood stasis.
In an emergency situation you are unlikely to have the means to evaluate what is going on. The question is, without
that information, what is safe to try? In a previous discussion of head trauma and emergency stroke, Toby
suggested that SI+ would be safe to try and watch patient response. I have sent him a note to clarify.
KristinWisgirda: October 7, 2019, 11:35pm
<During our class in Sydney, Toby mentioned not to use SI for haemorrhagic stroke
I asked T:
In previous discussions of emergency medicine, I understood you to say that you are not worried about SI+ causing
bleeding, even with stroke. Any clarification is appreciated.
He responded:
Yes, I would consider supplementing SI even for a hemorrhagic stroke but I would still be cautious.
rmayroz: October 8, 2019, 8:22am
Thank you Kristin. It”s so great to have this forum and thank you for your commitment and valuable insights
Tal_Carmel: June 22, 2020, 11:57am
KristinWisgirda:
Yes, I would consider supplementing SI even for a hemorrhagic stroke but I would still be cautious.
Thank you Kristin for your great help to anyone on this forum.
When Toby says to be cautious, what does he mean clinically? To shorten the treatment time? To put only 2
needles?23/01/2024, 12:06Facial pain post trauma – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/facial-pain-post-trauma/651/print5/5
KristinWisgirda: June 22, 2020, 1:45pm
Tal_Carmel:
When Toby says to be cautious, what does he mean clinically? To shorten the treatment time? To put only 2
needles?
Caution here would be evaluating the SI/K balance. If SI excess is more heavily weighted then SI+ is less likely to
be the right move in the moment.
Caution also means watching the patient like a hawk when the needles are in. Any sign the treatment is going
sideways means abort.
Caution in general doesn’t mean shortening treatment length. However, there have been discussions of some
patients doing better with shorter or longer treatments. This is based on observation and again watching the patient
closely, which you certainly would be doing with a stroke patient.
Splitting up the point combos is not recommended. Toby emphasizes that the 4 point combo is more stable than
using 2 points. The 4 points do 1 thing together.
In the advanced class you will learn some 2 point combos that are the exception to this.
I hope that helps.