Shanlarson: April 1, 2020, 10:06pm
Hi everyone,
I was just listening to Toby and Michael’s Crowdcast talk about Covid and I have a question.
I know we need to separate SAAM from other modalities so I’m wondering how do we see someone who has a
fever in SAAM. Often when people have a fever they feel very chilled. In the GMP we see this a cold sign because
they have a subjective experience of cold, even if they have a temperature on a thermometer. Toby in the
Crowdcast conversation talks about using BL+ for fever. So I am wondering are we taking this fever as objective
(they feel hot to touch by the practitioner, they have temperature) rather than subjective (they personally feel hot)?
KristinWisgirda: April 1, 2020, 10:59pm
Hi @Shanlarson,
I’ve noticed that “fever” can have different meanings to different people. When patients mention “fever”, I am sure
to try to pin them down on what they mean.There is the thermometer fever and the subjective feeling of heat with
or without chills or a feeling of being sick.
In a discussion on treating colds- not the Covid crowdcast- T talks about using UB+ to treat fever. Then he goes on
to say that if “cold is the pathogen” you can use H+ or SJ+. My interpretation of this last instruction is that if the
patient has a fever but is dominated by a strong aversion to cold plus/minus chills, H+ or SJ+ can be used.
In the Covid crowdcast, he mentions that you can also use Liv+ to treat “fever”. My interpretation is that UB+ and
Liv+ treat “fever” that is a subjective aversion to heat or being objectively hot to the touch. As well, my thinking is
that the thermometer is a relatively new invention and just not that important for Saam diagnostics.
Shanlarson:
Often when people have a fever they feel very chilled.
If the hot and cold signs of a “fever” are pretty equally matched, my thinking goes to the SI/K axis. I don’t have
experience to back this up in circumstances when a patient is coming down with something. I’ll ask Toby about it.
To a lesser extent theoretically SJ excess could be considered as well but we would expect to see less extreme hot
and cold manifestations.
In the treating cold discussion, he also mentions a partial treatment of UB (LII1 supplemented combined with ST36
drained) for early stage mild fever and chills in a robust patient. The principle here is to release taiyang without
adding the full on ice cold water.23/01/2024, 12:21Fever in SAAM vs what I’ve learned in GMP – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/fever-in-saam-vs-what-ive-learned-in-gmp/972/print2/6
Shanlarson: April 1, 2020, 11:39pm
thanks Kristin. Yes that makes sense. That’s interesting about using LI1+ ST36- for early stage of mild fever and
chills in a robust person.
KristinWisgirda: April 2, 2020, 11:52am
Regarding SI+ in fever, here are my questions (< …>) and Toby’s answers (bold italics):
<Have you used SI+ when thermometer fever or subjectively high body temperature is equally matched with
chills/aversion to cold in a patient who is coming down with something?>
I don’t remember doing this specifically, but theoretically you could consider this.
<What about using SI+ in a patient with early stage coming down with something instead of the partial UB+
treatment?>
Again theoretically you could, but I find UB+ or partial UB+ to work incredibly well.
<You haven’t mentioned SI+ much in discussions of colds/flus/corona. Is this because you find other strategies
more helpful?>
Yes, especially UB+.
michaelmax: April 7, 2020, 9:54pm
Hi @Shanlarson
When I see patients with “fever” I usually start with my herbal thinking. All of which can be tied into using Saam.
Most people think of fever as a reading on a thermometer. But of course we are looking for something more
nuanced.
So if they have objective sense of fever, but also body aches and chills, then that is clearly a taiyang stage issue.
Toby talks about using +UB in the early stages of this with robust people.
I see it as a hot and cold mix. The cold is constraining the qi, which bottles up and generates heat. This is not from
Toby… this is from me… I think you could use UB or SI as they are both Taiyang and we are looking to activate
the Taiyang as this is the conformation that resolves issues on the exterior.
If they had more chills than feeling of fever, then I’d consider +HT (which is a bit like ma huang in this context) or
+SJ (which is see is a bit more like gui zhi in that it is not as fierce with its heat)23/01/2024, 12:21Fever in SAAM vs what I’ve learned in GMP – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/fever-in-saam-vs-what-ive-learned-in-gmp/972/print3/6
If they have more fever than chills, then of course +UB
I realize I’m mixing my metaphors and methods here. Perhaps not the way Toby would work this, but it is my
current understanding especially as I’m constantly thinking about herbs and so that often plays into my mutated
thinking.
Shanlarson: April 7, 2020, 11:38pm
Hi Michael,
Yes that makes sense to me. I think I was getting a little confused with something Toby said but at this moment I
can’t quite remember what it was.
But basically I was wondering if I was presented with someone who had strong aversion to cold, felt very chilled
and achy but I put my hands on them and they were hot to touch which way would I go in SAAM. In my mind I
too see it at the surface is closed and the body’s own physiological Yang is trapped and it hasn’t yet moved into
yang ming. I think in that situation you are saying +Bl. Which in a way is a little different than herbal Medicine
where we would think of Ma huang Tang to open the exterior with warm pungent herbs. But I think that’s the
difference between SAAM and herbal Medicine. It seems to me in herbal medicine we restore the conformation’s
function but SA’AM we strengthen the function of the conformation. I’m not sure if that makes sense but it does in
my head! Ha!
KristinWisgirda: April 8, 2020, 2:55pm
This discussion brings to mind a patient who was NOT coming down with something. She had a strong aversion to
cold and wanted to be covered with many blankets and heat lamps but to the touch she was a normal temperature.
She was emaciated and very dry. Equal to her aversion to cold was her non-stop agitated talking. UB+ calmed her
down and warmed her up!
This case was such a demonstration of sometimes channel AND quality. For her all 3 aspects of UB helped-
cold+water+location. The cold of UB cooled the trapped internal heat causing the agitated talking. The water of
UB quenched her dryness so that fluids could flow to her surface carrying warmth and nourishment. The
stimulation of the location of UB supported its overall function of being a permeable yet consolidated boundary.
Mixed hot and cold patterns and the function of the surface can be so confusing. So many different pathodynamics
can come into play. I certainly don’t always get it right.
adambroder: April 10, 2020, 3:27pm
So in order to replicate (so-to-speak) guizhi tang, you’d need a channel to play the bai shao role, as we’d need to
harmonize ying and wei. LR comes to mind, though SJ at the same time seems like a no-no. What about SI and LR23/01/2024, 12:21Fever in SAAM vs what I’ve learned in GMP – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/fever-in-saam-vs-what-ive-learned-in-gmp/972/print4/6
together? SI to release the exterior as gui zhi does, since it’s tai yang; LR to nourish blood as bai shao does…both
have resonance with the sour flavor. It’s a midday-midnight pairing as well.
michaelmax: April 12, 2020, 12:21am
Hi @adambroder
I really like this thinking. In theory it holds together for me. Of course, now we need see how it works in the wild.
And I think the clock opposite aspect of this is not to be taken lightly. I suspect you are onto something.
@Tobydaly1, how does this land for you?
KristinWisgirda: April 13, 2020, 8:27pm
adambroder:
SI to release the exterior as gui zhi does, since it’s tai yang;
It is fun to play along with the thought experiment but the devil’s advocate has to come first. Best practice is to
wear the Saam hat when practicing Saam and herbal medicine hat when practicing formulas. And then be delighted
when there is overlap that works in the clinic and interested where there isn’t clinical overlap.
Here are some of my notes and ideas relevant to this discussion of gzt, SI and “releasing the exterior”:
Nowhere in my study of Saam does it say that supplementing SI releases the exterior. In discussing treating colds
and flus Toby doesn’t mention SI+ much at all, even though SI is part of Taiyang! I recently had a discussion with
him about this. When I asked Toby about using SI+ for early stage of coming down with something, he said “I
don’t remember doing this specifically, but theoretically you could consider this.” Instead he most often uses UB+.
If there is a significant cold factor, he mentions H+ or SJ+ but not SI+. Not what I would expect, but I respect his
experience.
In a class, Toby played the Saam pattern= herb game. He mentioned that gui zhi is most similar to SJ+ (not SI+ or
Heart+). SJ +and gui zhi are both warm and help one to be open to the exterior. I agree with @adambroder that
there is likely a resonance with bai shao and Liver+, both sour, cool and creating more density.
Of course, you can’t use SJ+ and Liver+ in the same treatment. So what about the gzt pattern and Saam? My
understanding of gzt is that there a deficiency on the surface. The surface is too porous and there isn’t enough
physiological warm steam (ying and wei) to protect the surface and firm the pores. The whole formula of GZT,
including the GZT method of bundling up and eating porridge, generates the warm steam from the
inside(Spleen/stomach) out to the surface. This warm steam firms up a surface that is too open. Using the dynamic
movement of SI+ in such a scenario doesn’t seem appropriate even though SI is hot (and cold) and the location
would seem right. However, H+ combined with Liv+ sounds like a better potential match.
With GZT we aren’t really “releasing the surface”. Releasing sounds like “unblocking” to me and that sounds like
a job for ma huang if what is blocking the surface is cold. Maybe here you use H+, SJ+ (or SI+), without the
densification of Liver+ which would be contraindicated.
My 2 cents into this thought experiment.23/01/2024, 12:21Fever in SAAM vs what I’ve learned in GMP – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/fever-in-saam-vs-what-ive-learned-in-gmp/972/print5/6
michaelmax: April 14, 2020, 4:31am
Great discussion @KristinWisgirda and @adambroder
I agree that especially in the early stages of learning Saam it is a good idea to keep it separate for the other things
we do. Not just a good idea, I think it is essential, because then the system and your experience can teach you.
And I think Adam’s points are worth consideration. And for me the hot/cold nature of the taiyang SI makes a lot of
sense if there is an issue at the surface that I want to address.
I like that idea of using LV to add the “bai shao” and I suspect that perhaps UB+SI could be more ma huang tang.
Again, thought experiment and something to watch for in the clinic.
One of the things I really enjoy and find helpful at the saam system is that it really does invite us to consider things
from a new perspective and it has helped me to knit together otherwise disparate aspects of my learning medicine.
Adina_Kletzel: April 29, 2020, 5:14am
KristinWisgirda:
SJ +and gui zhi are both warm and help one to be open to the exterior.
HI,
One of the issues in a GZT pattern is that the exterior is too open and there is not enough protection on the surface.
THis can also be someone who has no shielding emotionally and feels others emotions too strongly. This would
seem to point to Liv+ as necessary in order to provide that shielding to a surface too open. I dont see how opening
the surface further with SJ+ would be helpful in this situation.
KristinWisgirda: April 29, 2020, 11:40am
It is so easy to read gui zhi and think gui zhi tang. But I am talking about the single medicinal here.
Gui Zhi is acrid, warm and sweet. It has a strong element of up and out, warming from the middle all the way out
to the surface. It enhances ma huang’s ability to warm and open the surface when used in formulas like ma huang
tang. If we are playing the herb Saam game, it is most similar to bright, warm, outward focused SJ+.
Cool sour bai shao is more similar to cool shielding Liver+.
@Adina_Kletzel, read my post again and you will see that we agree on the function of gui zhi tang. But you can’t
swap out gui zhi tang and Liver+ therapeutically because there are some significant differences.23/01/2024, 12:21Fever in SAAM vs what I’ve learned in GMP – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/fever-in-saam-vs-what-ive-learned-in-gmp/972/print6/6