cassiopeia: August 19, 2020, 3:12am
In the July intro seminar, Toby said that he gives a treatment 1 chance. meaning, if supplementing one channel
didn’t help with the main complaint, he would move on. Did I understand that correctly?
The above question is somewhat related to my insomnia case:
62yo female
**Chief complaints: **** 1. insomnia many years, used to take ambien nightly during high stress job; retired,
stopped ambien and now everything has to be “just right” to fall asleep 10+ (i.e. no noise, no light, no deep
conversations); still often wakes during night, wide awake, has negative self-talk about insomnia. Experiences
anxiety/worry about not being able to sleep.
2. tinnitus starting 2013 while under high stress as VP of a large corporation. bilateral, ears v sensitive to
sound. unclear about what makes it better/worse. Saam tx LV+, PC+ slightly decreased intensity; she has felt
less bothered by it.
**Appearance, demeanor: ** powerful body, large ribcage 10+, symmetry 4+, grooming decreased from 6+ to 2+
since retirement last year. long, thick strong hair that is dyed black. malar flush 6+, bright eyes 4+, considerate 7+,
used to commanding a room at work and home 8+, detail- and process-oriented, is the person who “gets shit done”;
drives a late-model Mazda SUV
Lifestyle: retired VP of large corporation, breadwinner of family for many years, well-resourced 9+, husband
always managed the house, 2 adopted teenage daughters, loves gardening 10+, sewing/crafts 9+; since retirement
has helped to organize the family’s food inventory and shopping lists 8+; is proud to be able to bring order to the
“formerly wasteful” food budget 9+
Body morphology: tall, commanding form 8+, large ribcage like an opera singer10+, full breasts 9+, abdomen not
soft/sinking; muscular glutes that taper into average/lean ankles. dry skin 3+; hates humidity–>fatigue 8+; tissues
feel dense 5+
HEENT allergies, sinus dryness and pain 2+ (bw LI+); tinnitus
MSK arthritis, pain in hand joints (all knuckles) 3-7+ ww use, pain bilateral gb 29 3-7+ ww sitting
EMO: baseline positive, competent, logical; is frustrated by presence of tinnitus and insomnia. 2 sessions ago
mentioned that husband said she had a worse temper; more confrontational, quick to be agitated.
**Temp: ** tends to warmer, avg sweat in UW/MW; cold dry feet. av
Urine: occas cloudy 3+, not dark. Thirst average. If doesn’t drink enough water, has ache in R UB25.
GYN: infertility–>adoption; otherwise unremarkable23/01/2024, 11:46Is it really only one chance? (i.e. insomnia case) – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/is-it-really-only-one-chance-i-e-insomnia-case/1230/print2/7
Other/meds: armour – hypothyroid; prempro – peri/post menopause symptoms (brain fog, h/f);
hydrochlorothiazide – as diuretic b/c has hx of kd stones
Tongue: red, dry, crack MW–>lu, thin wtc
Excess presentations:
Heart: warm soft midline 5+
UB: cold feet 1+
GB: powerful commanding body 8+, confrontational (now less), insomnia 7+, convex up and out tinnitus (?); gb
29 pain
P: logical, strong intellect 7+
SJ: bright eyes 4+, considerate 7+, malar flush 6+, controlling 8+, warm moist UW/cool dry feet 4+; insomnia
associated with high sensitivity to environment 10+
LV: dense tissues 5+
LU: well-resourced 9+, large opera singer ribcage 10+, full breasts 9+; dry skin 3+; hates humidity–>fatigue 8+; lu
10 fullness 2+
ST: dry tongue w cracks; sinus congestion (?)
SP: Body morphology, sinus congestion (?)
LI: many projects 9+, orderliness 9+, dry skin 3+, dry sinuses, dry tongue
KD: symmetry 4+, grooming decreased from 6+ to 2+ since retirement last year. long, thick strong hair that is dyed
black 8+, used to commanding a room at work and home 8+; mixed warm and cool, pain
SI: mixed warm and cool
Most obvious things in the room: huge ribcage, commanding presence, solid body, 62yo female with beautiful
long thick hair; high sensitivity to noise; insomnia associated with high sensitivity to environment 10+
Treatment ideas: R LV+, R PC+, R ST+, R SI+
Treatment 1 R LV+: she felt more peaceful, clear decision-making, purposeful.
No change in tinnitus nor sleep
Treatment 2 (when she mentioned being more confrontational) R PC+: chest felt great and open, felt had calmness
during the week, tinnitus decreasing/less bothersome.
No change in sleep
Treatment 3 R ST+: deep calm during session
I will see her again this week. My questions:
1. Any other ideas about what I should look for to address the insomnia?23/01/2024, 11:46Is it really only one chance? (i.e. insomnia case) – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/is-it-really-only-one-chance-i-e-insomnia-case/1230/print3/7
2. She is 62, though quite robust. Would I put her in the “elderly” category (Toby says women over age 49) and
never do the same treatment 2x in a row?
3. It seems like the PC+ should have done something for the insomnia, given her powerful body and what her
husband said was quick temper. But it didn’t help; should I try it again?
4. Is what Toby said true – i.e. if the treatments she’s already had didn’t help at all with the insomnia, do I
completely move on and choose other channels to treat?
thanks for reading and inputing!
fang
michaelmax: August 19, 2020, 4:23am
Hi @cassiopeia, thanks for this interesting case.
I would not say we do a channel once and then not again. If you have gotten some kind of positive response with it,
then you can use it. Just don’t use it 3 times in a row.
Where you either get a negative response, or no response at all, then don’t use those channels again at this initial
stages of treatment. But do consider you might need to try them again later after the patient’s body and situation
begins to change.
Given that she had good responses on the table to LV and PC you can toggle between them. Also if she is LI+ then
consider treating the SP as well. Usually yin channels are more helpful for insomnia.
And it sounds like there is some heat with her so the cool LV can be helpful and if you wanted to see if strongly
clearing heat would be helpful, then tonifying the UB would be a good test for that. Probably something you’d only
need to do once or occasionally if it turns out heat is part of the issue.
Again, if a treatment is effective, you can use it 2x if the situation is right for it. But if something has not effect,
then don’t do it again.
Hope that helps.
Keep us posted!
M
KristinWisgirda: August 19, 2020, 7:10pm
cassiopeia:
Toby said that he gives a treatment 1 chance. meaning, if supplementing one channel didn’t help with the main
complaint, he would move on.23/01/2024, 11:46Is it really only one chance? (i.e. insomnia case) – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/is-it-really-only-one-chance-i-e-insomnia-case/1230/print4/7
This is my understanding of that statement. If your technique was good but the treatment didn’t work, why repeat
it?
cassiopeia:
Any other ideas about what I should look for to address the insomnia?
It sounds like the insomnia started with the stress of her high powered job. Being still such a super-doer even
though she is retired, I wonder if SP+ would be helpful. Even though SP+ isn’t a match for her morphology, the
personality is enough to consider it. The dry signs help too and the need for hydration to keep the UB25 area pain
away. She needs some moisture.
How cracked is her tongue? Are the cracks like clean cuts or are they softer like they have healed over? Just one
centerline crack or more diffuse? The level of cracking is a tongue sign that we look at in Saam to determine the
need for fluids- usually via Taiyang supplementation but other moistening channels can be considered too.
The decline in her grooming intrigues me. She no longer has to doll up for work, so she just doesn’t care that much
about her appearance. Put that and the infertility under SI excess. Did I miss what her medial heel looks like?
The red tongue and warm soft midline intrigue me too. I want to rule out H excess as a cause for the insomnia too,
even though she doesn’t sound that heat intolerant.
Is she really talkative or doesn’t she talk effusively and lovingly about her kids or her garden?
cassiopeia:
She is 62, though quite robust. Would I put her in the “elderly” category (Toby says women over age 49) and
never do the same treatment 2x in a row?
Being over 49 can be added to the SI excess category but she isn’t elderly enough or deficient enough to qualify for
the never tx 2x rule- in my opinion.
cassiopeia:
It seems like the PC+ should have done something for the insomnia, given her powerful body and what her
husband said was quick temper. But it didn’t help; should I try it again?
No- for the reason discussed above. Not all quick tempered people need P+. GB excess tendencies can come out
when it perceives the being to need rescuing because they are over tired or overtaxed. I’m seeing a new mom- 4
months postpartum who complained of insomnia and the desire to rip people’s heads off. She has responded so
well to Liver+, Lung+ and Kidney+.
cassiopeia:
if the treatments she’s already had didn’t help at all with the insomnia, do I completely move on and choose
other channels to treat?23/01/2024, 11:46Is it really only one chance? (i.e. insomnia case) – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/is-it-really-only-one-chance-i-e-insomnia-case/1230/print5/7
My vote is yes- look to other treatments. You may consider revisiting P+ and Liver+. I had a righteous patient with
insomnia that seemed related to her getting jacked up watching political shows before bed. P+ was settling but
didn’t help the first time. Sp+ really improved sleep but not completely. I used P+ again and she had a big heart
opening and more improvement with sleep. (I wrote about this patient somewhere on this forum). This case taught
me the important of timing and layering. One treatment can lay the foundation for being able to receive and benefit
from subsequent treatments.
Please let us know what happens. Thanks for the case.
cassiopeia: August 20, 2020, 1:55am
thanks Michael and Kristin. super helpful.
KristinWisgirda:
How cracked is her tongue? Are the cracks like clean cuts or are they softer like they have healed over? Just
one centerline crack or more diffuse?
one central crack, 5+ deep, clean cut.
I don’t know anything about Saam’s use of tongue cracks. It sounds like there’s varying degrees of fluid
nourishment needed. PLEASE say more.
maybe related? – about 2 years ago she went through a period of feeling like the tongue was dry and swollen, with
a weird taste. that resolved with probiotics and Kiiko’s mouth point.
KristinWisgirda:
Did I miss what her medial heel looks like?
medial heel average
KristinWisgirda:
Is she really talkative or doesn’t she talk effusively and lovingly about her kids or her garden?
she talks like she’s used to being listened to. i.e. not overly talkative. She obviously loves her kids but never talks
about them like that – more like she’s their manager and problem solver. the garden too, is more “enjoying working
on it, I had fun doing all these things, this is now blooming,” rather than “I get so much pleasure and the flowers
are so beautiful”. So, I don’t get a Heart vibe.
Now that I think about these dry signs plus her very extreme need for projects and order, doing SP+ makes sense. I
was hung up on her morphology not fitting LI+. thanks for giving permission to look beyond that : ) I was having
trouble finding another yin channel to treat. Will try that next!23/01/2024, 11:46Is it really only one chance? (i.e. insomnia case) – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/is-it-really-only-one-chance-i-e-insomnia-case/1230/print6/7
KristinWisgirda: August 20, 2020, 10:10am
The tongue finding that indicates fluid xu looks like it has been sliced with a razor blade so is called a sliced
tongue. Traditionally it means there is a need for the cold water of Taiyang but I have used Sp+ in such patients to
good effect. It sounds like her fissures aren’t extensive but enough to point to moistening dryness.
This post has a picture. His cracks are more rounded over than what you might see.
UTI, heat and antibiotics
This patient is a 68 yr old retired art museum curator, skinny, dry skin, abdomen is warm and a little tight under
the ribs. He runs chilly but dresses for it and enjoys being outside (in Maine) all year. He is friendly and
engaging, curious- researches everything to death. Has some spider veins and slight swelling in the ankles at
times. Has UTI’s a few times a year (antibiotics), due to the swollen prostate (on meds). His energy is good.
HIs tongue is red, with a diffused crack pattern, t…
cassiopeia:
I was hung up on her morphology not fitting LI+. thanks for giving permission to look beyond that : )
She reminds me a little of the case I used for the case study format where her inner being is very LI excess while
her morphology doesn’t match.
cassiopeia: August 21, 2020, 2:51am
Saw her today. The insomnia is clearly better as of last week (R ST+) though I had committed the unspeakable sin
of also starting her on phosphatidylserine at bedtime to calm down her stress response. We talked about all the list-
making that she feels compelled to do before bed… I at some point called it “frantic list-making,” and she said, “oh
no, it’s not frantic.” perfect!
I did L SP+ and noted that her face had the most calm, gentle smile that I’d ever seen on her. It was a slight smile,
but so warm and content. She was deeply relaxed and her R UB25 ache also subsided by the end of the treatment.
Thanks for all the guidance, Kristin.
michaelmax: August 22, 2020, 4:03am
cassiopeia:23/01/2024, 11:46Is it really only one chance? (i.e. insomnia case) – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/is-it-really-only-one-chance-i-e-insomnia-case/1230/print7/7
I was hung up on her morphology not fitting LI+. thanks for giving permission to look beyond that : )
I have noticed that sometimes I have patients and they don’t fit the LI excess morphology, but they have the
personality, drive, endless projects and get joy from “doing cool things” that challenge them. tonifying their SP is
usually helpful. It’s something you can layer in with the other things you see going on.