adambroder: September 6, 2019, 6:47pm
I treated a 37 year old woman yesterday for a case of double vision which began two weeks ago. She’s pretty
healthy, has two children and no other problems really. The double vision began after what was probably a panic
attack related to stress from a new job. She has not had any issues with stress or panic before. She’s been to urgent
care and has seen doctors and they can’t find anything wrong (no stroke or other brain/CNS disfunction to speak
of). There is some nausea which would be expected, but no vomiting. Her stress level is up, also understandable,
because she cannot work or function as normal. She has been prescribed anti-anxiety meds which she is taking but
does not like to. I asked if she’d had any unusual bleeding lately to which she responded no, and her pulse was not
thin, if anything a bit slippery. I forgot to look at her tongue. I tonified SI based on Toby’s recommendation of SI
for dizziness. Her KI qi is strong based on the flesh at the medial heel and the fact that both pregnancies and
deliveries were good. I just texted her to follow up on yesterday’s treatment. What are some other ideas for me to
think about? I was considering SJ if I could look at the double vision as dull vision. Hard to say if she’s shielded
because she appears to have that tendency but I couldn’t comment on her demeanor without this issue (this is my
first time seeing her). She doest not display any rudeness, if anything quite the opposite. Any help would be
appreciated.
adambroder: September 6, 2019, 6:57pm
I just heard back, and her vision got worse after yesterdays treatment. Score a point for Sa’am being effective, but I
need to take a different approach.
KristinWisgirda: September 6, 2019, 7:43pm
Hi Adam,
It would be helpful to see her big picture.
We have a case study format to follow, which is designed to help readers see your patient better. It also asks you to
generate ideas. Going through the whole presentation with a Saam perspective is more helpful than starting from
the symptom.
Case Study Format
Here is a proposal for case a case study format for our forum. I welcome any and all feedback. The goals are to
help you sharpen your Saam diagnostic skills, help your readers see your patient and stimulate conversation
that will helps us grow as Saam practitioners. When presented with the idea of a case study format/intake sheet,
this was Toby’s response: Great idea, basically the Saam diagnosis is interested in everything. I think the Shen
Kuo quote from the lecture is a good starting framew…25/01/2024, 11:51Help with case of double vision – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/help-with-case-of-double-vision/582/print2/7
adambroder: September 6, 2019, 7:51pm
I have provided all the clinical details that I’ve gathered so far. I’m new to Sa’am and I’m looking for guidance.
Jeffrey: September 6, 2019, 8:13pm
Hi Adam,
any change with nausea, dizzy and or anxiety?
Any more info as to her qualities; dry/damp, hot/cold?
+SI with your info sounded reasonable for the dizzy, but no go apparently.
My next tack would be to consider the channels involved for each symptom and then revaluate.
eyes>GB,ST,UB, and LV as it opens to the eyes, and internally relates to tissues around the eye.
dizzy, nausea and anxiety are not unlikely companions though certainly don’t have to come together.
From your description we can see some xs possibilities; polite,anxious, perhaps ask more about SJ xs qualities.
Getting more info is going to be a good tool for making a good diagnosis and coming up w/2-3 possible channels
to treat. I have seen +P, +ST,and +UB all be useful for dizzy, nausea and anxiety. I encourage you to investigate the
xs in the counterbalance of those channels and to assess the hot/cold, dry/damp. Sometimes straight forward,
sometimes not. Because Ive only treated apx 100 people or so w Sa’am, I arm myself with as much knowledge/
info as possible to come up with a few options. Good luck, curious to see how it goes.
adambroder: September 6, 2019, 8:25pm
Thank you for your input. I believe her moisture balance to not be a factor. Skin appears healthy and she is not
damp or dry interiorly; though I should look at tongue to gauge this more, her body type and the fact that she isn’t
vomiting leads me away from this. I will inquire about body temp. I know this is a factor in SJ/LR dynamics but
what else would lead me to SJ excess?
adambroder: September 6, 2019, 8:32pm
Also, since LR excess is dull vision, wouldn’t that move me away from tonifying LR? Or not necessarily?
Jeffrey #8September 6, 2019, 8:47pm25/01/2024, 11:51Help with case of double vision – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/help-with-case-of-double-vision/582/print3/7
The way I understand it Adam, everyone fits on a spectrum even if its not extreme. Therefore, we need to look for
hot/cold, dry/damp as another bit of clinical value even if its subtle. Also my understanding in Sa’am is that the
tongue is not necessarily needed to assess damp/dry internally. Is the person thin/heavy, how does that look on a
spectrum?
but what else would lead me to SJ excess?
bright eyes,good night vision, detail oriented, meticulous,perfectionist,focused outwardly, dislikes light/sunshine…
“sometimes channel, sometimes quality” I am also new and thats why I need as much clinical weight as I can get to
choose 2-4 channels to treat. Sometimes a mind boggling puzzel.
adambroder: September 6, 2019, 9:19pm
This is helpful. Her body type is athletic but not in a marathon runner kind of way, meaning healthy muscle tone
and not dry. The skin is also in between. That’s why I’m saying the tongue may provide more information on the
state of fluids. I hope I get another chance to treat her. The jing-well points were pretty uncomfortable and I don’t
know if she wants to undergo that again based on the results of the first tx.
Tobydaly1: September 7, 2019, 6:51pm
Liver excess does not necessarily equate with dull vision.
Tobydaly1: September 7, 2019, 6:52pm
Supplementing SI does not involve jing-well points.
KristinWisgirda: September 7, 2019, 9:13pm
adambroder:
her vision got worse after yesterdays treatment. Score a point for Sa’am being effective,
Given that you are so new to Saam and recognize how powerful it can be, before treating with Saam again I
suggest taking a class or rewatching a class if you have already taken it. There is so much to learn. Then reevaluate
your patient with fresh Saam eyes considering the state of all the channels and get back to us with what you see.
Sometimes younger, generally healthy patients require more careful questioning and evaluation to see the25/01/2024, 11:51Help with case of double vision – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/help-with-case-of-double-vision/582/print4/7
dynamics. As well, new patients in distress often don’t offer their true selves easily so careful listening and inquiry
is required.
adambroder: September 8, 2019, 11:08pm
Right, I meant to say that the ying-spring points were very uncomfortable
adambroder: September 8, 2019, 11:36pm
I finished watching the replay of the most recent seminar in New York a few weeks ago, I’ve listened to several
qiological episodes regarding Sa’am, even relistened to some, read Toby’s article several times, and I’ve thought a
lot about it. This is one of the first treatments I’ve done using it; I need to start somewhere. This case is difficult
because there’s nothing gross about her presentation, it’s all very subtle, and I’m dealing with a language barrier.
Toby said he wanted people to begin using Sa’am the next day in clinic. I did him one better and waited a couple of
weeks, but you’re saying to stop using it until…? With all due respect I don’t feel like your responses have been
positive or helpful.
adambroder: September 8, 2019, 11:20pm
What, if anything, can be said definitively about Liver excess and vision?
KristinWisgirda: September 9, 2019, 12:31am
adambroder:
This case is difficult because there’s nothing gross about her presentation,
That makes it a more challenging case, no matter how long you have been practicing. It might be helpful to
practice with this system on patients with grosser presentations. Practicing on yourself can also be really
informative.
adambroder:
With all due respect I don’t feel like your responses have been positive or helpful.
You are not giving us much information to help us see your patient, so it wouldn’t be responsible to guess and
throw out ideas based on conjecture.25/01/2024, 11:51Help with case of double vision – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/help-with-case-of-double-vision/582/print5/7
Close observation of patients is really key to using Saam. It can take some time to get in the habit of really looking
at patients closely with an eye to the Saam channel balances. My responses have been an attempt to encourage you
to go back and take a closer look. Even if the patient doesn’t report being hot or cold, touch the patient and gives us
your feedback on her body temperature. Palpate the abdomen to let us know if her midline is soft and warm or cold
and hard.
adambroder:
She doest not display any rudeness, if anything quite the opposite
Is there anything else you could say about her temperment? Or her facial complexion- pale, dark, flushed, acne?
adambroder:
Her KI qi is strong based on the flesh at the medial heel and the fact that both pregnancies and deliveries were
good.
Is she pretty, symmetrical, really into herself? Any varicosities, painful periods or significant PMS symptoms that
are better with the onset of the period? These would help strengthen the Kidney excess diagnosis. The medial heel-
which can be buffed and tended- and 2 successful pregnancies aren’t particularly strong indications. Her negative
response to SI+ is a strong indication that she would benefit from a K+ treatment.
Jeffrey:
Therefore, we need to look for hot/cold, dry/damp as another bit of clinical value even if its subtle. Also my
understanding in Sa’am is that the tongue is not necessarily needed to assess damp/dry internally.
Jeffrey is correct about both of these points. It is worth a second look at her muscles and flesh. Are her muscles dry
and tight? Is her belly tight or soft and flabby? Did you ask if she uses moisturizer?
adambroder:
but you’re saying to stop using it until…?
Mentioning that the patient didn’t like the jing-wells that were part of your SI+ treatment was the biggest reason
why I suggested you step back from Saam. Now I see your correction of that post. Can you understand why I
would be worried if I thought you were needling the wrong points?
adambroder:
I was considering SJ if I could look at the double vision as dull vision.
This misunderstanding also was reason to suggest that you revisit the intro course.
adambroder:25/01/2024, 11:51Help with case of double vision – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/help-with-case-of-double-vision/582/print6/7
What, if anything, can be said definitively about Liver excess and vision?
Liver excess is dense, cool, dark and inwardly focused. Poor vision in the dark or dark spots in the vision are
indications that point to Liver excess. The inward focus also makes the patient unaware of her surroundings and the
external world so she might be clumsy or just not notice what is going on around her.
In contrast SJ excess is too open and exposed. This patient will be light sensitive. She might complain of poor night
vision because when driving bright headlights will bother her. With vision problems, she might see flashes or
lights. She is outwardly focused and will have detailed awareness of her surroundings.
Even if she doesn’t return, reviewing the details of this case and coming up with other ideas will help you learn
Saam and help other patients.
adambroder: September 20, 2019, 10:36pm
KristinWisgirda:
Mentioning that the patient didn’t like the jing-wells that were part of your SI+ treatment was the biggest
reason why I suggested you step back from Saam. Now I see your correction of that post. Can you understand
why I would be worried if I thought you were needling the wrong points?
I see, so you diagnosed me as Sa’am deficient based on this one data point?
I was really just looking for some thoughts on vision as it relates to Sa’am. As I may have mentioned, I probably
won’t get a chance to work with this patient again. And while there may not be many gross signs in this case, at
least from what I’ve observed so far, to my mind it doesn’t get more gross than a sudden case of double vision with
no known cause.
michaelmax: September 23, 2019, 5:05am
HI @adambroder, it’s frustrating when patients only come in once. We don’t really get much of a chance to help
them unless our first treatment really knocks it out of the park. And then we left wondering… should I have done…
this, should I have done … that.
I think it is easier in the beginning to use Saam when we see pretty clearly what is going on for someone. And as
your patient, other than the double vision, was pretty healthy, it is harder to see what other imbalances are in play.
For a vision thing like this… and this is purely speculation. If her vision seemed duller or darker, then I’d go for
+SJ. If she was more sensitive to light I’d go with +LV. As I’m seeing this as a kind of stirring of internal wind.25/01/2024, 11:51Help with case of double vision – Sa’am Clinical Questions – Qiological Community
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adambroder: September 26, 2019, 7:35pm
If a patient becomes sensitive to light during a migraine would that symptom be considered SJ excess? And
regarding treatment, if they are at that moment experiencing a migraine with light sensitivity, would LR+ be a safe
call?
KristinWisgirda: September 26, 2019, 9:16pm
Sensitivity to light is a strong sign of SJ excess.
Currently experiencing light sensitivity gives a diagnosis of SJ excess much stronger clinical weight for the
treatment that day, so Liv+ could be considered, unless … there is something more gross in the room at the time.