Intake Questions

Adina_Kletzel: June 12, 2019, 2:21pm
I was thinking that it would be very helpful if members of this wonderful forum could share some of the intake
questions that they have found useful in helping clarify which archetype is out of balance. For example, I have
heard Michael mention that he asks questions to clarify who is a LI entrepreneur type. Another example would be
myself. I am LI excess – very dry and always always very busy and I recently did tonify spleen for myself and I felt
myself able to focus so much better and my thoughts are clearer and I am less dry. So now when I see dry dry I also
know to ask if the person has trouble focusing on details in order to add more weight to my diagnosis. So I am
looking to see how I can shed more light on discerning which archetype is out of balance from all different kinds of
angles.
Thank-you!
2 Likes
Saam intake quesions

KristinWisgirda: June 12, 2019, 8:12pm
Adina_Kletzel:
it would be very helpful if members of this wonderful forum could share some of the intake questions that they
have found useful in helping clarify which archetype is out of balance.
This is a great idea and something that I d like to work on and ask for Toby s feedback to be sure I m getting it
right.
Adina_Kletzel:
I recently did tonify spleen for myself and I felt myself able to focus so much better and my thoughts are
clearer and I am less dry.
It is so helpful to experiment on oneself and experience the effects of treatment whether we get it right or not. So
nice when we get it right!
Adina_Kletzel:
So now when I see dry dry I also know to ask if the person has trouble focusing on details in order to add more
weight to my diagnosis.26/01/2024, 11:59Intake Questions – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/intake-questions/291/print2/10
@Adina_Kletzel Your experience brings up many questions about how to understand the archetypes and how to
correctly identify them. I say this because outward focus on details is a hallmark of SJ excess and definitely not a
hallmark of Spleen excess contentment/boredom/lazy/numbness. Lack of focus on details isn t a hallmark of LI
excess either. Clearer thinking isn t a virtue of Spleen either.
Sooo- why did supplementing double damp spleen help your focus and clarity of thoughts? Maybe if you are
always always very busy it might have slowed you down a bit? Maybe you were spread too thin by all of your
projects and your thinking was more scattered? Please share the experience of a proven LI excess.
So if a patient complains of lack clarity of thinking and ability to focus, we really have to flesh out the situation. An
LI excess might have these problems because she moves too quickly or gets overwhelmed by too many projects
going at once. So different than the Liver excess patient who is shrouded in a cool dark forest. The Liver excess
might not even complain of cloudy thinking or lack of focus because her state might prevent her from see how
these things are really a problem. Something to contemplate.
All that said, we definitely have to be careful extrapolating our personal experiences or patient experiences into
guiding principles.

Adina_Kletzel: June 12, 2019, 9:06pm
I agree with you very much that being able to focus better is not necessarily a hallmark of Spleen. I was also
wondering why this was the result of tonify spleen when it really seems to belong to SJ. The way that I see it is that
as a LI AND SJ excess I am very focused on outside details and I want to get them all done. I am hard on myself
when I dont accomplish enough and I always need to be busy leaving very little , if any, idle time in my day.
In tonifying spleen and thereby counterbalancing LI I felt that I made more room to be in the present moment
without my mind needing to jump onto the next thing when I barely touched on what I was currently doing. I am
more able to be where I am now. I am more able to flow from one thing to the next rather than abruptly stop what I
am doing in order to jump into the next thing.
In taking a closer look it seems that the spleen fluids allow for more flow than the dryness of LI. It also almost
feels like the spleen fluids have lubricated my heart and brain to allow for better flow of mind and emotion.
There may also be an aspect of the stability of earth allowing for more presence than the rigidity of metal
There is a lot to learn and understand when it comes to the archetypes and it seems that there is some overflow of
possible outcomes. I guess the most important thing is still to do a proper intake and discern what key symptoms
need addressing. This is exactly where my question stemmed from
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KristinWisgirda: June 12, 2019, 10:33pm
It comes down to correlating the grossest aspect of the presentation and what is really true about the patient with
the archetypes. Of course, unless the grossest part of the presentation or the most relevant part of the presentation is
a channel problem or a problem that needs to be addressed by a channel presentation. Sometimes channel,
sometimes quality.
With patients who are more outwardly focused, I have seen them highly valuing their excesses. The Heart excess
who loves loves loves loving. The SJ excess who can t get enough details and strives to be more and more focused.

KristinWisgirda: June 13, 2019, 6:53pm
Adina_Kletzel:
it seems that the spleen fluids allow for more flow than the dryness of LI
Just to play devil s advocate, as we are learning the system, it is best to keep returning to the archetypes as they are
taught and differentiating between primary treatment mechanism and secondary results. For instance, you can talk
about the net result of experiencing more flow from a Spleen+ treatment but keep coming back to the primary
double damp moistening function of Spleen that made that happen. It is so easy to want mix our knowledge from
other traditions with Saam as we seek to understand it.
Saam makes it easy in a way: just keep coming back to damp/dry, hot/cold, light/dark, outwardly oriented/inwardly
oriented, circulating/consolidated.
Back to your original question about intake. Observing Toby with interact with patients, he takes special care to
really get to know the patient and develop rapport. The overall impression of his approach is loving curiosity.
Interviews flow organically. If a patient isn t so forthcoming, he might ask about hobbies and activities to get a
better idea of the patient s resources and how the she using her qi. Always looking for more clues and
confirmation, Toby often says Tell me more about that. When the interview is done, he asks Is there anything
else? several times before he needles.
In my interview process, my questions seek to get info on how damp/dry, hot/cold, light/dark, outwardly
oriented/inwardly oriented, circulating/consolidated. I might offer the patient environmental scenarios- hot sunny
summer days, cool dark forests, cold winter nights- to observe their reactions. With suspected Pericardium excess, I
might ask at how good they are with asserting themselves when needed. If there is any glimmer of Liver/SJ
imbalance, I ask about night sensitivity and night vision. If they say their night vision is poor, is it because of the
bright oncoming lights driving at night or because they don t see so well in the dark? Can they walk around their
house at night with the lights out? WIth Lung/St, I ask if they have any anxiety around resources/money with the
preface that having lots of money doesn t protect one from anxiety around money.
These are the questions I can think of off hand.

Adina_Kletzel: June 13, 2019, 8:20pm

26/01/2024, 11:59Intake Questions – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/intake-questions/291/print4/10
Thank-you so much. This was a very helpful response.
I just need to clarify though – Liver excess would have trouble seeing in the dark because things are already too
dark for them? ANd SJ excess would be blinded by bright lights because it is already too bright for them?
And please explain the LU/St references to money – I am only aware that lung excess has plenty of resources and
St excess does not have enough. Where does the anxiety aspect come in exactly?

KristinWisgirda: June 13, 2019, 9:30pm
Adina_Kletzel:
Liver excess would have trouble seeing in the dark because things are already too dark for them? ANd SJ
excess would be blinded by bright lights because it is already too bright for them?
Correct.
Here s a discussion on money issues/resources and the Lung/St dynamic.
Money issues and Lung?
Hi Toby, I have realized I don t really understand how to consider people s relationship with money in SAAM
acupuncture. I think I understand that Lung deficiency goes along with people having money issues. but I m
not sure I have this right nor am I sure what money issues means. Does it have to do with abundance in
general or just money? Could you help? Thank you!
Stomach excess will tend to be anxious about money/resources because they have a hard time holding onto them. A
Lung excess won t be worried about resources because they have a great capacity to attract qi/resources and hold
onto them.

michaelmax: June 14, 2019, 12:44am
Adina_Kletzel:
I agree with you very much that being able to focus better is not necessarily a hallmark of Spleen. I was also
wondering why this was the result of tonify spleen when it really seems to belong to SJ.
This is such a juicy conversation!
Indeed it is easy to think oh, this channel does x and so if I need more x I m going to do that channel. But as
you point out here @Adina_Kletzel:
Adina_Kletzel:26/01/2024, 11:59Intake Questions – Sa’am Clinical Questions – Qiological Community
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In tonifying spleen and thereby counterbalancing LI I felt that I made more room to be in the present moment
without my mind needing to jump onto the next thing when I barely touched on what I was currently doing.
Often things work out better when they are in a better functional balance. And so while the TB is great at noting
detail. Giving a LI more TB detail gives them more information to do something with. More is not better. The
slower paced SP that allows for more space between the thoughts in your case helped to bring more clarity of
thought.
This is both the joy and the frustration of this medicine.

Adina_Kletzel: June 14, 2019, 9:17am
Ok this is great thanks! Just to clarify though – if someone is a lung excess type but cannot hold onto money and
has a lot of financial concerns we still would NOT tonify lung correct? Because this would be a case where
constitution would override quality right?

Adina_Kletzel: June 14, 2019, 9:22am
Yes! That is exactly what I felt. ANd to hone the point in further, I did try to tonify SJ for myself and I became
extremely ungrounded – I couldnt focus on anything, couldnt figure out how to start and finish any task. I twas as if
I was floating without any ground underneath. Tonify spleen had the very opposite affect on me. I felt so calm and
grounded and able to focus on the tasks at hand.
It is so encouraging that as we learn and use this medicine more and more it becomes more clear and more alive. I
look forward to what is ahead!

KristinWisgirda: June 14, 2019, 9:27am
You are describing a mixed Lung excess Stomach excess presentation. The clinical challenge is trying to determine
which pattern is the most relevant to the patient s chief complaint. Orienting to the grossest part of the presentation
can help, but there are no hard and fast rules. Who is this person really? , a smart Qiologician once asked.

KristinWisgirda #12June 14, 2019, 9:36am26/01/2024, 11:59Intake Questions – Sa’am Clinical Questions – Qiological Community
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michaelmax:
Giving a LI more TB detail gives them more information to do something with.
Thanks! I ll add this insight into the mix when trying to distinguish between LI and TB excess in mixed LI/TB
excess presentations. TB excess has laser like focus on outward details and wants to control. LI excess is interested
in a million things and wants to do. Does the person need to see less or do less to be in better balance? Hmmm.

ngmatthews: October 4, 2021, 5:15pm
One of the questions I like to ask people is this: Do you wear sunglasses? A lot? , or rarely? This seems like a
really simple way to confirm a San Jiao excess type. These are the people who come in wearing sunglasses even on
a cloudy day. I will also sometimes ask, Do you feel unshielded, unprotected? That is similar. I also like to ask
what weather makes people feel better and worse. that can bring out a lot of dampness or cold/hot things.
Exploring peoples ability to express anger is also very interesting. Sometimes I have discovered a true Gb
deficiency in a couple of women who I just thought were a little quiet. I found they actually had a lot of anger that
they could not really express in a healthy way.

ngmatthews: October 4, 2021, 5:15pm
I often think of Liver excess type as being similar to Liver Blood deficiency in Sharon W s diagnostic system,
where lack of ability to see under poor light conditions is unequivocal for the diagnosis. So I ll often ask, do you
have trouble driving in the dark? Or reading in poor light? They are amazed that I ask that if I am right on.
Otherwise they don t understand what that has to do with anything.

KristinWisgirda: June 25, 2019, 8:41pm
ngmatthews:
I often think of Liver excess type as being similar to Liver Blood deficiency in Sharon W s diagnostic system,
where lack of ability to see under poor light conditions is unequivocal for the diagnosis.
This is an interesting finding. I wonder if these patients with blood deficiency and poor vision in low light are
actually low in both SJ and Liver.
Toby has mentioned blood deficiency as evidenced by pallor, as being an indication for supplementing Liver and
Liver supplementation being a key treatment after heavy or prolonged blood loss. So far my blood deficient
patients have run more toward SJ excess and have benefited by Liver supplementation, though one did have poor26/01/2024, 11:59Intake Questions – Sa’am Clinical Questions – Qiological Community
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vision in low light that responded well to a SJ+ treatment.
A classic Saam Liver excess patient will have dense flesh, which is not consistent with blood deficiency. Liver
excess types will have little outward awareness, very different from the hypersensitive blood deficiency patients I
see.
It is normal to want to draw correlations with other diagnostic systems as we learn this system but we all need to be
cautious and keep coming back to what Toby is transmitting. I m chiming in here just so new Saamsters don t take
our musings as definitive for diagnosing in Saam.

haunani: July 7, 2019, 12:35pm
I m loving this discussion mostly because after taking the Saam course this past week I m still curious about my
own type. I am seeing it more and more in others but my own still seems so vague. So along this conversation
line
A person who always wears sun glasses because it s always bright. Prefers to turn the lights off around the house
because the natural sunlight is more soothing seems like a lot of SJ Xs indicators. Right?
At the same time, this same person has slowly diminishing eyesight (glasses prescription keeps getting stronger
every year) and has a hard time driving at night because it s just harder to see with the lower amount of light and
lack of detail at night is this Liver Xs??? Or is this an indication that SJ and Liv are in good balance with each
other???

michaelmax: July 7, 2019, 2:56pm
ngmatthews:
Sometimes I have discovered a true Gb deficiency in a couple of women who I just thought were a little quiet. I
found they actually had a lot of anger that they could not really express in a healthy way
I ve had some of these too @ngmatthews, often they turn out to be TB excess, as they are taking that anger and
directing it inward that themselves.

michaelmax: July 7, 2019, 3:06pm
KristinWisgirda:
A classic Saam Liver excess patient will have dense flesh, which is not consistent with blood deficiency. Liver
excess types will have little outward awareness, very different from the hypersensitive blood deficiency
patients I see.26/01/2024, 11:59Intake Questions – Sa’am Clinical Questions – Qiological Community
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I m still working on wrapping my mind around all this as well.
Here s my hypothesis at this stage of the game. Liver excess types are dense because they have too much blood.
(again think the counter balance TB excess as having not enough blood)
In TCM we are taught that Liver Blood Xu causes eyesight problems. But do consider the Liver as dense cool and
dim, like a forest makes for dim light.
I think we are dealing here with another area where TCM and Saam are similar but different. So we need to tread
carefully, be observant in our clinical work, and work these ideas out as we see the opportunity.
haunani:
has a hard time driving at night because it s just harder to see with the lower amount of light and lack of detail
at night is this Liver Xs
We need to make clear distinction here. Many TB excess types have trouble driving at night because the lights of
the oncoming cars overwhelms them. Seeing well in the dark is not the same as comfortable driving at night. If
they can see well in the dark at home or in a place with low lighting conditions, or well in dim light, AND are
bothered by the coming lights of cars then likely TB excess.
If they don t see well in the dark, need lights turned on to feel comfortable and not particularly bothered by
oncoming headlights likely Liver excess

KristinWisgirda: July 8, 2019, 12:53am
haunani:
Prefers to turn the lights off around the house because the natural sunlight is more soothing seems like a lot
of SJ Xs indicators. Right?
SJ excess patient won t like excess light from any source. Toby specifically asks suspected SJ excess patients about
their night vision- do they need to turn on the lights when they walk around their house at night?
haunani:
has a hard time driving at night because it s just harder to see with the lower amount of light and lack of detail
at night is this Liver Xs???
Difficulty seeing in dim light is a Liver excess sign. I ll have to ask Toby about needing a stronger and stronger
prescription but my initial impression, from sitting in clinic with him, is that the light intolerance/diminished vision
in the dark is really critical information for people with vision problems. If they have lost sight, he asks if they see
lights (SJ excess) or have darker or black spots (Liver excess). I have a light intolerant patient with macular
degeneration who is responding to Liver+ treatment.26/01/2024, 11:59Intake Questions – Sa’am Clinical Questions – Qiological Community
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When asking about driving at night, be sure to have the patient distinguish between being disturbed by low light
levels and being blinded by oncoming headlights or harsh streetlights.
haunani:
Or is this an indication that SJ and Liv are in good balance with each other???
A patient with light intolerance and poor vision in the dark in equal amounts has a good balance of SJ and Liver,
but they both are low. If vision problems are a chief complaint, you will need to toggle both, choosing to treat
whichever is more prominent or troublesome that day, as well as keep an eye on other Liver/SJ excess signs, and
watch treatment response closely . I have a number of patients like this.

michaelmax: July 8, 2019, 4:29am
KristinWisgirda:
A patient with light intolerance and poor vision in the dark in equal amounts has a good balance of SJ and
Liver, but they both are low. If vision problems are a chief complaint, you will need to toggle both, choosing to
treat whichever is more prominent or troublesome that day, as well as keep an eye on other Liver/SJ excess
signs, and watch treatment response closely
Thanks @KristinWisgirda this is a great example of a situation where there is balance between the opposite ends
of the counterbalance, but both are low.

Adina_Kletzel: July 9, 2019, 9:06pm
I am having trouble with the fact that difficulty seeing at night in the dark is liver excess because one of the signs
for blood deficiency is difficulty with night vision and so how can a symptom point both to liver excess and liver
(blood) deficiency?

KristinWisgirda: July 9, 2019, 10:52pm
This is part of the system as it is transmitted. See if it works for your patients or not.
I have a patient with poor night vision (to the point that it made her anxious) that resolved after 2 treatments of
SJ+.
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ngmatthews: October 4, 2021, 5:15pm
This is something that I was talking about on another thread. yes, it is interesting and it shows that we have to be
careful not to mix systems. The Liver Blood deficiency unable to see in the dark is for herbs for sure.

haunani: July 12, 2019, 5:24am
Woah, really?! This is incredible to hear. I am blood deficient (after having two babies back to back). It s been
getting better. I also noticed my night vision diminished dramatically in the years following the births. I wouldn t
say I have anxiety about driving at night but I do not like it at all if I have my glasses on it s because of the
glare of the oncoming lights but if I have my contacts on I just can t see as well (and it s getting worse).
You really brought a lot of clarity for me in this thread, especially the part mentioned above about both Liv and SJ
being low in equal proportion. Just reading that made me light up inside responding in a big yesssss way. I
tonified Liver yesterday and LOVED it but now I will seriously consider and watch the other signs of SJ and
toggle as needed.
I m really so grateful for your responsiveness to these threads and your additional clarifications in the courses. It s
always nice to hear the same information said in different ways.