RMcMahon: December 10, 2019, 7:58am
Good afternoon Qiological crew,
this is my first attempt at Saam acupuncture and I would love any assistance if possible. Apologies if it’s long-
winded and not in the correct format, this is my sister and I don’t have access to a full class yet.
Female 40 years old – main complaint – inability to get sleep, intense bouts of anxiety with racing heart and strong
nausea with strong abdominal tightness for about 3 months.
Previously very healthy, regular moderate activity, yoga and a well balanced vegetarian diet(currently eating some
meat to try to build up again), previous sleep issues and minor depression/anxiety episodes. Recent collapse seems
to be nervous burnout from intense study over many years and the start of social working in a chaotic work
environment, has quit her job due to health concern.
Has lost a lot of weight in last 3 months due to inability to eat due to strong nausea, was very gaunt when the
condition was at it’s worst. Temperature seems normal and no unusal sweating, bowels were very loose to start and
frequent urination both of which are normalised with herbs. Abdominal tightness/nausea/anxiety improved with
previous acupuncture and herbs but although treatment has always helped, it has not held for more than 4-5 days.
Recently each time she has a set back she is having major emotional collapse, mainly anxious but sometimes deep
despair/sense of hopelessness/fear and a couple of severe panic attacks. Pulse is weaker, heart rate is rapid. Skin
seems normal moisture, maybe slightly dry, average finacial status, money/appearance not a big focus for her life,
more focused on doing the right thing.
Performed Saam Stomach tonification with great result, best she had felt in a long time, ate a huge meal, was able
to eat and better energy over the next 2 days, slight change to early waking with racing heart and feeling of anxiety.
Followed up with same treatment 3 days later with increase in appetite, reduced stomach contraction/nausea again
but didn’t last as long as first treatment. As I had done 2 treatments in a row I decided to shift to tonifying the PC
meridian due to the sleep issue, palpitations and her strong emotional reactivity when she has set backs. Prior to
this issue she was a personaltiy who would always stick up for what she thought was right even at the cost of
conflict at work so I thought her GB energy probably would be strong enough. She was calm during treatment but
no major immediate shift, heart rate was better the next day but sleep was still poor, stomach is still weak but has
improved overall since earlier treatments.
BL: strong fear/panic, can feel cold at times
HE: heart rate is elevated, anxiety?
PC: insomnia, palpitations, studious
GB: previous was a person who would always fight the good fight and could get very irritable quickly if she
thought someone was being unfairly treated.
SP: lack of appetite/nausea/looser bowels
SI: some dizziness but no real pain except for some moderate menstrual pain
ST: nausea/contracting stomach/loss of body weight
LV: would be considered blood xu, has needed glasses her whole life
SJ: is very concerned with the state of the world and humanitarian issues? Can be sensitive to light?24/01/2024, 12:07First Saam Case – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/first-saam-case/781/print2/5
KI/LU/LI I don’t feel are present.
There are many options I can see:
-Strengthen the ST again as it worked well and alternate treatments going forward.
-Strengthen the Heart to build her Yang/stable warmth, self love, she is feeling “useless/a failure” as she has had to
quit her job due to this collapse. Not sure if double fire influence would be too strong at this stage, ? starting with
SJ to test response to this increase in heat and will enable her to look outwards again instead of being consumed by
her condition.
-Strengthen the Spleen to nourish the earth and help to put weight back on, concerned about adding any dampness
to her system with nausea/palpitations and previous loose bowels.
-Strengthen the LV to nourish the blood to support sleep and stimulate wood to produce fire. LV has been
suggested to produce a more gentle tonification than HE in some of the podcasts.
Any suggestions would be appreciated.
Thank you.
Richard
KristinWisgirda: December 10, 2019, 5:48pm
Hi Richard,
Thanks for the case. So sorry that your sister is having such troubles! Here is some, but not comprehensive,
feedback to help sharpen your Saam thinking. I really recommend going back to Toby’s power point and really
making sure that your analysis matches his teaching. Saam is a whole new system to understand and keep straight.
Keep referring to your notes and cross check with Toby’s powerpoint.
RMcMahon:
Strengthen the Heart to build her Yang/stable warmth, self love,
RMcMahon:
HE: heart rate is elevated,
Do you really want to supplement H for a patient with elevated heart rate? Adding Heart will supplement love for
others, not self love. Feeling cold at times isn’t reason to bring on the double fire of Heart when you also write
RMcMahon:
Temperature seems normal24/01/2024, 12:07First Saam Case – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/first-saam-case/781/print3/5
Lack of appetite is the body saying no to food coming in. That can be from inner dampness (possible Spleen or
Lung excess) or internal tension/controlling (maybe Sj excess). It is good to be open to the possibilities of what
might explain the poor appetite.
In your list of excess , you said there was no Lung excess, yet you used ST+ twice.
RMcMahon:
SI: some dizziness but no real pain except for some moderate menstrual pain
Menstrual pain is possible Kidney excess, as is dizziness.
RMcMahon:
LV: would be considered blood xu, has needed glasses her whole life
General blood xu belongs to SJ excess. Needing glasses is not a sign of Liver excess. Vision worse in dark, dark
spots in vision, blindness could be considered Liver excess.
The bulleted organized formatting really helps this reader as it is so much easier to refer back to than big dense
paragraphs.
Going over the case again will help you see your sister more clearly with Saam eyes and give you better treatment
results. Presenting her more clearly will help us give you better feedback.
RMcMahon: December 11, 2019, 5:21am
Hi Kristin,
thank you for your time and feedback. Unfortunately I don’t have access to the cours
Update: PC+ Rx 2 days ago. Nausea/gag sensation almost cleared, was able to sleep in an hour later than usual-
6am and AM heart pounding reduced and able to lie down again (normally has to get up and walk around/drink
warm tea as lying flat agg heart pounding), felt a shifting sensation in the chest the night after PC+, has felt a
change, seems less emotionally reactive, bowels moving well/no urinary frequency, some dizziness when standing
after lying down, added some more specific questions and is more sensitive to light at night and day-prefers less
light/always sunglasses/too sensitive/empathetic as discussed during review with psychologist yesterday who
suggested this may be why her job has effected her so strongly, no irritability/aggression, dealing with physical
activity better, skin not dry, normal sweating/thirst, temperature normal.
I repeated PC treatment today as she felt a large internal shift in chest sensation and it has been the first time the
AM heart pounding has improved and normally she is up at 5am due the pounding. The new information seems to
point in the direction of SJ excess so a Liver+ treatment would be indicated. With the LV/PC jueyin connection it
may be why the PC treatment has had such an impact even though it seems like she is SJ excess at heart.24/01/2024, 12:07First Saam Case – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/first-saam-case/781/print4/5
KristinWisgirda: December 11, 2019, 3:27pm
So glad that she is getting some relief! Great job.
RMcMahon:
added some more specific questions and is more sensitive to light at night and day-prefers less light/always
sunglasses
If you expect some hypersensitivity, asking about light sensitivity specifically is so easy to ask and is such a
valuable confirmation of SJ excess.
RMcMahon:
With the LV/PC jueyin connection it may be why the PC treatment has had such an impact even though it
seems like she is SJ excess at heart.
I would be cautious about how you entertain such thinking. When a certain treatment helps dramatically, it tells
you that the person really needed those qualities supplemented. Yes, supplementing what is needed is going to have
a cascade effect and support other channel qualities. P+ helped her because it counterbalanced GB excess.
This may sound nitpicky but as students it is better not to extrapolate. Keeping your Saam perception and thought
process clear and simple will serve you and your patients better. I just want you to be able to think back and
recognize the Gb excess pattern that was prominent so you see when it needs to be addressed in other patients.
RMcMahon: December 12, 2019, 1:04am
Thanks again Kristen,
update: after second PC+ treatment felt very grounded straight away and felt strange moving sensation in the chest
during treatment. Upon waking this morning no palpitations at all on first waking and still feeling grounded. Some
period pain with start of cycle last night which woke her a couple of times but able to get back to sleep. Will have
to re-assess properly when she comes again in a few days but interestingly she has only had period pain since a
laparoscopy 3 years ago for cysts but she was getting some funny paraesthesia at that time as well as an
aggravation of emotional state, the current episode also had tingling in face and right arm as initial symptoms. This
make me consider the possibility of a SI+ treatment before returning to PC+ to address lingering blood stasis.
RMcMahon #6December 17, 2019, 7:51am24/01/2024, 12:07First Saam Case – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/first-saam-case/781/print5/5
Good response to last rx, calmer in general/heart sensations have been imp. menses started Wednesday abdo pain
overnight, started with heavy flow/little clotting, next day some strong pain episodes 3 doses of pain killers,
yesterday feeling of upward rushing/anxiety had returned day 3 of cycle-after heaviest blood loss, today wanting to
curl up in a ball to help with strong abdo tightness/flexed posture when sitting due to internal tension feeling, slight
return of nausea but still able to eat, feels like cycle will finish tomorrow, no pain today but general flexor tension
is worse, emotionally more sensitive/weepy, some anxiety/fear about the bad symptoms returning and upward
rushing, no real dizziness, fatigue but strong restlessness, no inc in external sensitivity, tired eyes, no change to
thirst/bowels/urination all normal, no cold or heat sensations, skin normal dryness.
Rx LV+ as SJ temperament seems dominant, I had already done 2x PC+ and her anxiety/muscle tightness inc with
blood loss.
The patient was a bit uncomfortable initially during treatment as the upward rushing increased with
supplementation points but settled after the draining points were added, strong muscle twitches and sensation of
circular movement in the whole chest and abdomen. Follow up the next day reports, good steady energy after
treatment and calmer emotionally, no chest sensation.