Shanlarson: July 8, 2019, 7:14pm
I have a patient who has just started seeing me. I have so far treated her twice. Her chief complaint is extremely
heavy bleeding on day 2 and 3 of cycle and Fibroids. She doesn’t get a lot of pain with her periods but does get a
lot of digestive issues 1 week before that manifest as a glomus. She calls it gut rot and there is objective and
subjective stuck feeling under her epigastrium. She has sharp pain on palpation below her umbilicus both at Right
and left ST 27 area as well as REN 4 area.
She seems to me she has a lot of KID XS. She is an average build, brassy very confident women. Very fleshy and
soft medial heel. Her tongue has a slight dip in the lung area, fluting with a thin coat that is a slightly yellow.
On her first treatment she was day 3 of her period and felt the bleeding was just starting to taper down. The XS
blood stasis that was presenting as very painful to palpate her lower abdomen and visible pulsing around the
umbilicus made me feel SI was appropriate and she reported that the bleeding almost stopped that night and she
was shocked. And then just tapered off the next day which doesn’t happen for usually 2 more days. I saw this
patient last week and again felt SI was appropriate. She was 1 week away from her period. Once the needles were
in she felt the “gut rot” feeling got better. I am now scheduled to see her on day 2 of her period when the bleeding
is extreme and I’m not sure where to go from here. I don’t want to do SI again because of how heavy she will be
bleeding but also because I have done it twice. Would it be logical to do KI tonification? It does consolidate but I
feel that she is bleeding due to blood stasis from KI xs.
Any thoughts?
KristinWisgirda: July 8, 2019, 9:44pm
Shanlarson:
She seems to me she has a lot of KID XS. She is an average build, brassy very confident women. Very fleshy
and soft medial heel.
What are her Saam Kidney XS signs besides fleshy medial heels? Is she very symmetrical/beautiful or narcisstic?
Has she demonstrated outstanding fertility or constitutional resources? Does she have any hard masses in her
abdomen? Lots of varicosities?
If she really was super duper K XS with a significant hard mass in her abdomen, I might consider doing SI+
treatment a 3rd time, but I would want to see more than a fleshy medial heel to confirm. And would still be very
cautious during her expected heavy time.
Recheck her abdomen at the next visit and see what appears. If she doesn’t have significant K XS signs and her
lower abdomen is suddenly flaccid, I would consider a K+ treatment on cycle day 2.
Also, what else is going on with her? There are a number of elements that could be contributing to the heavy
bleeding besides the SI/K axis. Is she really cold/UB XS? Is she really SJ XS? Do you remember the case Toby
presented in St Louis of the 18 year old girl who was bleeding for several months after 2 rounds of plan B. She was
frozen and very pale from blood loss? A combo H+ and Liver+ stopped the bleeding after 2 days.19/01/2024, 11:19Heavy menstruation with Kid XS – Sa’am Clinical Questions – Qiological Community
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Shanlarson: July 8, 2019, 10:26pm
She has Fibroids but I realize that’s a WM diagnosis. She has severe sharp pain on even light palpation below the
umbilicus. She had this indication at both treatments. She is very beautiful. Is she on the side narcissist perhaps.
She is definitely very self confident.
I do remember the Bleeding case from St Louis but funny the 2 hits I get on her are Kid XS and LiV XS which
supplementing SJ and SI were both “wrong” choices in that case. The reason I say Liv xs is that she is very specific
about light. She needs things to be bright. She wants sun on her face. It’s not about lack of warmth but about the
brightness for her. She says she even arranges her bed so she can lie facing the window so she can have more light.
She’s not a particularly hot or cold person. Has combination skin and average build.
KristinWisgirda: July 8, 2019, 10:58pm
Thanks for the info. Toby says that hard masses in the abdomen are diagnostic for K XS even if they can’t be felt.
Along with her beauty that gives stronger weight to the diagnosis.
Keeping a close eye on the degree she settles during treatment will help you gauge the appropriateness of the
treatment you choose.
Please keep us posted.
sweiz: July 9, 2019, 11:15am
Hi Shannon,
Moxa Sp 1. Toby uses this for uterine bleeding as an add-on point to the treatment.
I also think of Lung+ for lifting. Are there any other St.XS signs? Could the fibroid itself be seen as wet on the
inside? Also the glomus and digestive issues.
Shanlarson: July 9, 2019, 6:43pm
Great. Thanks Sharon. Moxa SP 1 would be something I would consider even if I wasn’t using SAAM so I’m
happy to add it on. As for “Lung/ST glomus” I do think they may be involved in this but as for SAAM dx I can’t
see it yet. She’s a nurse who doesn’t seemed financially strapped. Single no children. She travels to Bali for 3
weeks every year. She’s not particularly thin but more average/fit. Her skin isn’t dry or oily. She does have wet
issues. She get water swelling before her period. She also had a lack of thirst but if she does drink only ice cold19/01/2024, 11:19Heavy menstruation with Kid XS – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/heavy-menstruation-with-kid-xs/358/print3/10
water
and she can get cloudy urine.
KristinWisgirda: July 9, 2019, 10:57pm
sweiz:
Moxa Sp 1. Toby uses this for uterine bleeding as an add-on point to the treatment.
The down side of adding additional points or therapies to treatment, at this stage of our learning, is that we will
have less of a clear idea of what worked for this patient, along with another missed opportunity to really learn the
effects of the 4 point treatment.
I know this has to be weighed against the urge to do all we can to help our patients.
Joanne_Tait: July 11, 2019, 4:22pm
Hi Kristen,
I may have heard this wrong in the past, so appreciate any clarification you can provide. I had thought that for
fibroids we were to tonify K? But this is saying the condition is K XS so we would tonify SI?
ngmatthews #9October 4, 2021, 5:15pm
Toby would say to have 3-4 diagnoses so that you can rotate. You should have them numbered by what you think is
most important. You can do the same pattern 2 times, maybe 3 but then change to #2.
KristinWisgirda: July 11, 2019, 5:36pm
Joanne_Tait:
this is saying the condition is K XS so we would tonify SI?
Supplementing Kidney consolidates. Hard masses in the abdomen are diagnostic for Kidney excess so you
supplement SI for hard masses.
Many of the patients we see have fibroids that can’t be palpated directly. Toby says that masses in the abdomen that
can’t be palpated are also diagnostic for Kidney excess.
For me personally, I’m not comfortable saying that fibroids are a for sure sign to supplement SI+, if they can’t be19/01/2024, 11:19Heavy menstruation with Kid XS – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/heavy-menstruation-with-kid-xs/358/print4/10
palpated as a hard mass. I would want to see more for sure Kidney excess signs like symmetry, beauty, narcissism,
varicosities, smooth plump medial heel, etc.
Shanlarson: July 13, 2019, 9:30pm
Follow up to this case. I have to say I’m really happy with the results. My patient didn’t want to do any herbs and
in the past I have felt that acupuncture for this kind of heavy bleeding rarely is enough. SAAM seems to be proving
me wrong. My first 2 treatments had been SI supplementation. My next visit was scheduled for day 2 of her period
when the bleeding is extreme. Before we started she said her PMS had been noticeably less and she had way more
energy even her on day 1 of her period however the bleeding hadn’t changed. As I said in my earlier thread I was
mulling over exactly how to proceed for the heaviest day of her bleeding. The sharp pain on palpation was really
reduced and only present on her right side ST 27 area. Because it wasn’t her whole abdomen I didn’t want to take
my chance with SI +. Her abdomen also didn’t seem def or flaccid and I still feel she really falls into the KI XS
archetype I didn’t want to strengthen KI. What did stand out though was her water retention. It was significant and
palpable, a little bit like a water bed. She also said right before her period her skin gets oily and she gets acne on
her chest, face and back. I toggled between LI or LU +. I decided on LI because she described herself as
waterlogged and also when putting pressure on LI11, &ST 36 the sharp pain at ST 27 was significantly less. I did
also moxa SP1. I know at this newbie stage it’s frowned upon doing more than just the 4 needles and I generally
have been really keeping to that but it’s a little bit of an extreme situation.
She emailed me yesterday with the results. She didn’t bleed through night and on her shift the bleeding was greatly
reduced. She had been using a Super tampons and pads together and needing to change every hour. This time she
only needed to change ever 2 1/2 hours never leaked through and by midday day she switched to regular tampons.
She is super happy. I suspect next cycle I probably will leave SP1 out but I am pleased none the less.
KristinWisgirda: July 14, 2019, 8:29pm
Interesting! Imagining that Sp1 was out of the picture and wondering how double dry LI+ might stop excess
bleeding. By firming water logged tissues??? Not sure. Supplementing the weakest link in the wheel is going to
improve the function of the entire wheel.
Could be that treating static blood twice with SI+ helped the flow of this cycle. Some patients report improvement
in their periods even when we don’t treat directly before.
Shanlarson: July 15, 2019, 6:44pm
Yes at the time I was trying to think about how moving fluids in the tissues would help stop bleeding but I was
coming at it from the view she bleeding because of blood stasis and blood stasis is a branch and the root being the
dampness. In a way with SI being cold water Tai yang and Fire it’s moving fluid as well so it seemed like a19/01/2024, 11:19Heavy menstruation with Kid XS – Sa’am Clinical Questions – Qiological Community
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supportive treatment to my original diagnosis and she had such clear water issues on that day. She reminded of the
SP XS slide Toby presented.
George_Mandler: July 16, 2019, 9:56am
sweiz:
I also think of Lung+ for lifting. Are there any other St.XS signs? Could the fibroid itself be seen as wet on the
inside? Also the glomus and digestive issues.
Just to clarify wet on the inside would be Lung excess, not ST excess, yes? Has Toby talked of masses such as
Fibroids this way – being damp on inside?
Taran: July 16, 2019, 12:12pm
What I have heard Toby say about masses in the lower abdomen, like fibroids, is that they are signs of Ki+. I have
not heard him specifically talk about them as dampness.
KristinWisgirda: July 16, 2019, 2:41pm
George_Mandler:
Just to clarify wet on the inside would be Lung excess, not ST excess, yes?
Correct. Wet on the inside is Lung excess. Too much downward motion causing things to not be held could be
Stomach excess.
We discussed 3 factors in this thread:
-the bleeding
-the presence of the fibroid that can’t be palpated
-the patient presentation.
@Shanlarson’s treatments have been very effective and very consistently attended to most dramatic part of the
patient’s observable presentation in the room, that day.
The wandering monks practicing Sa’am didn’t have imaging devices to reveal abdominal masses that aren’t easily
palpated. This is good to remember as we weigh what the patient presents in the room and what their ultrasounds
present.
I haven’t heard Toby discuss hard abdominal masses as anything but K excess and haven’t heard him speak on
fibroids in particular.19/01/2024, 11:19Heavy menstruation with Kid XS – Sa’am Clinical Questions – Qiological Community
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Taran: July 22, 2019, 2:19pm
I was just re-listening to the St Louis livestream and heard the reference that prompted my previous comment on
this thread. Someone was talking about fibroids as a potential cause for infertility. Toby pointed out the masses in
the lower abdomen/Ki+ connection. That person then asked if the practitioner had to be able to palpate the masses
and Toby said, “No.”
KristinWisgirda: July 22, 2019, 4:50pm
Taran:
Toby pointed out the masses in the lower abdomen/Ki+ connection. That person then asked if the practitioner
had to be able to palpate the masses and Toby said, “No.”
Yes, on several occasions Toby has clarified that hard masses on the abdomen don’t have to be palpable to be
considered a sign of Kidney excess. I haven’t heard him discuss if he gives palpable and unpalpable abdominal
masses different clinical weights toward diagnosing Kidney excess.
My personal newbie take is that an unpalpable masses would have less clinical weight for K excess than a palpable
mass. My personal take is that the hardness of the mass, if palpable, would be taken into consideration too. A soft,
squishy masses doesn’t shout excess consolidation as much as a very firm mass.
T has mentioned that you are also taking into account the location of the mass in terms of channel trajectories. So
hard abdominal mass might put Kidney excess on the list of things to treat, but it likely won’t be there alone if you
are considering the whole presentation.
amyjenner: July 23, 2019, 1:02am
I have treated 2 women with very large fibroids. The heavier of the 2 had an easily palpable softball sized mass. it
was located on the front/top of the uterus. The thinner of the 2, I was not able to palpate and it was similar sized but
low on the back of the uterus. Both ended up having surgery. It was pre Saam days…
Alvaro: July 23, 2019, 3:55pm
Does this relate to any type of mass. For example I have a female patient who recently mentioned she has a small
benign tumor on her adrenals. I would assume this is also Kid excess (consolidation) sign but just want to make19/01/2024, 11:19Heavy menstruation with Kid XS – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/heavy-menstruation-with-kid-xs/358/print7/10
sure since I could also see it as separation of yin and yang given her night sweats and fatigue
thank you!
KristinWisgirda: July 23, 2019, 4:55pm
Alvaro:
Does this relate to any type of mass. For example I have a female patient who recently mentioned she has a
small benign tumor on her adrenals.
From the Kidney excess slide from Toby’s class powerpoint: “Tends to exhibit hard masses in the lower abdomen.”
Toby has mentioned that for masses anywhere in the abdomen, you can consider Kidney excess. The harder the
mass, the more it is in the lower abdomen, the more clinical weight to Kidney excess. Being on the Kidney channel
would give it even more weight.
We don’t know how hard the small tumor is on the your patient’s adrenal but it is the Kidney organ (and therefore
channel). If it were my patient, I wouldn’t give it much clinical weight but if she is already Kidney excess it would
strengthen that diagnosis.
Shanlarson: August 28, 2019, 2:40am
A follow up to this case:
So this has been such an interesting learning experience for me. Last I posted I had supplemented LI because of all
the severe water swelling and patient’s bleeding and energy were better.
However she had some spotting post period and night sweats leading up to the next ovulation that she never had
before. When she came to see me about one week before her next period she was highly irritated at me because of
it. I think she thought she was now even closer to menopause. ( PC+ was then on my mind! ) but she was also at
that time was having terrible digestive issues presenting as a severe glomus. This time I did Lu + and she wrote me
that night that she felt so much better and could eat a big meal. I saw her then again 1 day before her period.
Because there was no more lower abdominal pain with pressure and no more water swelling I decided to try kid+
but she didn’t settle at all so I switched back to Lu+.
That period bleeding was heavier for 2 days but everything else was great. Her energy was good. She didn’t feel
faint like she use to and It was done by day 5. She has now come in on day 1 of her next period. She is super happy
because she was having so little symptoms leading up to it that it surprised her when it came. Today I did Kid+ and
she REALLY settled.
So this seems to have been something that needed to be done in stages and other channels had to be addressed
before I could address the kidney directly. This will be her 4th cycle since we started working together so we’ll see
what happens.19/01/2024, 11:19Heavy menstruation with Kid XS – Sa’am Clinical Questions – Qiological Community
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Jeffrey: August 28, 2019, 2:34pm
@Shanlarson
she was highly irritated at me because of it. I think she thought she was now even closer to menopause. ( PC+ was
then on my mind! ) but she was also at that time was having terrible digestive issues presenting as a severe glomus.
This time I did Lu + and she wrote me that night that she felt so much better and could eat a big meal.
Shannon, did you +LU as it has and ascending (and sl,descending) movement and that it is neutral in temp? and to
add moisture where +LI may have dried her? pls excuse my ignorance. I’m just trying to get this correctly.
kind regards
Shanlarson: August 28, 2019, 4:39pm
Hi Jeffrey,
Sorry If you hadn’t been following when I originally posted that could be really confusing. When I first saw this
patient she had extreme heavy bleeding and had been diagnosed with a fibroid. She also had extreme water
swelling before her period, no cramps but had sharp pain on palpation in her lower abd. Toby has said of thinking
of Fibroid as a gathering stasis in the lower abdomen Kidney XS. Adding to the kid xs idea she is very attractive
and perhaps slightly towards that narcissism side.
She also has a lot of digestive issues and has a glomus in epigastrium.
When I saw her the first 2 times it wasn’t during the heavy bleeding time of her period so I did SI+ and she
responded really well but I wasn’t sure what to do when I was seeing her during her very heavy bleeding day. I
didn’t want to do Kid+ yet because she still had so many signs of blood stasis in the lower jiao. Sharon brought the
idea of doing LU+ for its ascending quality and she did have a glomus. That was my plan but when I saw my
patient next the water swelling was just so severe I did LI+ instead and Moxa’s SP1 (which as a newbie probably
should have left it out but I wasn’t confident how LI + would help with the bleeding.) That treatment seemed to
help because the water swelling decreased significantly and the bleeding lightened up. I’m not sure if it was the SP
1 Moxa or the LI+ or both together. And that brings us to my last post where I decided to do the Lu+ for the
ascending qualities and her glomus and finally the last treatment when all that pain on palpation was gone and no
water swelling I did kid+.
So to answer your questions, yes I did Lu for its ascending qualities and LI a separate time for its drying qualities.
She’s athletic/slim and her skin is more towards the oily side.
Jeffrey: August 28, 2019, 4:54pm
Thanks for the clarification Shannon. I had read this case study before, yet really wanted to follow up and make
sure I was understanding correctly. “sometimes in question, sometimes understanding”19/01/2024, 11:19Heavy menstruation with Kid XS – Sa’am Clinical Questions – Qiological Community
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Tal_Carmel: September 18, 2020, 1:17pm
Hi @Shanlarson,
It’s basic but I’m confused:
I thought that glomus is a feeling of distention/stasis in the epigastrium that is caused by impediment to the Yang
Ming downward movement.
If so, why +LU and not +ST is the right thing to do? or is it the thin build and tendency to oily skin that supported
+LU?
Thank you
KristinWisgirda: September 18, 2020, 2:37pm
Tal_Carmel:
I thought that glomus is a feeling of distention/stasis in the epigastrium that is caused by impediment to the
Yang Ming downward movement.
Without rereading this particular case, it might help to remember that the YM downward movement can be
impaired by deficiency and/or dryness or tension. In my experience, Sp+ has treated glomus, Liv+ has treated
glomus and Lung+ can treat constipation with or without dryness.
I know the instinct to hear glomus and want to use ST+, but there are so many other possibilities.
Tal_Carmel: September 18, 2020, 6:57pm
Thanks @KristinWisgirda ,
As usual, you broadened my point of view.
michaelmax: September 19, 2020, 11:26pm
KristinWisgirda:
We don’t know how hard the small tumor is on the your patient’s adrenal but it is the Kidney organ (and
therefore channel). If it were my patient, I wouldn’t give it much clinical weight but if she is already Kidney19/01/2024, 11:19Heavy menstruation with Kid XS – Sa’am Clinical Questions – Qiological Community
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excess it would strengthen that diagnosis.
@KristinWisgirda such a good point and reminder here… that we have to consider any symptom within the entire
context of who the patient is.