Shanlarson: July 8, 2020, 3:45pm
Hi there,
Kristin you asked for more cases so here is another one of mine
I am having one of those confusing SAAM patient’s where you at first think it’s straight forward and then it’s the
opposite of what you think.
43 yr/old female. Originally came in for arm pain on the right arm. Started a month previous. Arm felt achy. Pain
located along the SJ and LI channels. She also had just changed her diet plan and started having some bloating a
few days before her first appointment. She has low appetite but normal BM. No thirst. She describes herself as
having extreme attention to detail but complains her house is a mess which really bother’s her. She has 2 children.
Her last one was a surprise and she got pregnant at 40. Postpartum she had very heavy periods with no pain and
then went on an IUD a year 1/2 ago. From her c-section her OB told her she has a fibroid but she hasn’t looked into
that since. She takes medication for depression and anxiety. Says she has self deprecating thoughts and mood
swings.Things that shouldn’t affect her self confidence easily do. She is self critical. She has been coming off the
anxiety medication and now using low dose of CBD oil with guidance of her MD. She sleeps deeply and has a hard
time waking in the morning. She feels her energy is really low. She is tall with a lax belly and some extra weight.
Her skin is a little dry to touch. She usually feels on the warmer side. She is very friendly and chatty.
female. Ht XS
pain along SJ channel 7+ LIV or SJ XS
pain along LI channels. 7+ LI or SP XS
bloating 4+ later became 9+
low appetite 6+ (possible) LU XS
attention to detail 8+ SJ XS
bright eyes=6+
facial symmetry 6+
pregnant at 40. KIDXS
very heavy periods 7+( possible) SI XS
No pain with period SI XS
Fibroid 5+ KIXS
self deprecating thoughts 7+ SI XS or SJ XS
mood swings. 7+ (possible GBXS)
low self confidence 7+ (possible PCxs or SI XS)
self critical. 7+ SJ XS
lax belly/ extra weight. 6+ (possible ST or LI XS)
dry Skin 6+. (possible LU or LI XS)
chatty. 8+ HT XS or (possible SP XS)
Feels warm 6+
Energy low 7+ (possibly STXS)
cracked heels4+ (SI XS)23/01/2024, 11:57Looking for insight with a Case – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/looking-for-insight-with-a-case/1132/print2/5
a week later:
Pain in lower left quadrant 7+ (KIDXS)
Because her chief complaint was Pain in the the arm in SJ area I originally did LIV+ on the left side.
That weekend her bloating became excessive. Her husband made her go to emergency because he thought it was
appendicitis or a kidney stone which she had in the past. They found nothing. She saw me again 4 days later. Her
arm felt a little improved but the bloating was now her chief complaint.
-Thinking possible it was an adverse reaction to LIV+on left or at minimum Liv+ wasn’t helpful, I did SJ + on
right.
I saw her 3 days later. The bloating had come down. During this time she also starting seeing a physio for her arm.
It was improving but still bothering her. I decided to take the contralateral indication into consideration with her
arm but still bloating was her main focus.
I decided to do LI+ on the left. She seemed calm and centred when I left. And I really was looking for anything
to show me she was not settling.
At the end of the treatment she said she felt more bloated and her arm hurt more. We both had some extra time so I
did SP+ on the right. It immediately made her feel better. The bloating came down and the arm hurt less.
She came to see me 4 days later. Her arm is a lot better but she feels that’s from physio’s work (who knows) Now
the bloating was considerably less and it was now this focused sharp pain in her left lower quadrant. She also was
feeling slightly more chilled. I was back and forth about what to do. I originally was thinking I would do SP+ on
the left again but because the bloating was now more a sharp pain in her left lower abd. She also had pain at oketsu
on left when palpated. I decided to do SI+ on right.
5 min into checking on her she said her body felt tense. I took the needles out and did KID+. The tension went
away. She said at the end of the KI+ treatment her mind was thinking about lots of things but not anxiously. More
lots thoughts just jumping around/ half dreaming but can’t remember what she was thinking about. From my
personal experience of this I call it “acupuncture dreaming”. Usually I don’t think it’s a bad thing, fingers
crossed… She felt cold at the end of the treatment.
In retrospect I’m not sure I should have considered the SI/KID dynamic because she was so in the middle with
symptoms. So I guess my question is LIV+ And LI+ both gave adverse effects. Would it have been wise to have
done SJ+ or SP+ another time seeing as I already knew she responded well to them even though the nature of the
chief complaint had changed? I had also considered LUXS and strengthening ST but with less epigastric bloating
and the pain being on the lower left it didn’t seem quite right. It sort of seems like I keep going for the complete
opposite of what she needs and then having to fix it. She is slowly getting better but geesh I would like not to have
to keep switching to the opposite treatment
KristinWisgirda: July 9, 2020, 2:18pm
Lesson learned: be careful when you ask the universe for something, like cases. She always delivers more than you
bargained for.
After all of that, what do we know for sure about this lady that will you treat her in the future?23/01/2024, 11:57Looking for insight with a Case – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/looking-for-insight-with-a-case/1132/print3/5
First, it would have been easier to look at the case if the symptom analysis was organized according to channel, so
we can see how symptoms pile up behind each channel system. If you did so, you probably would have stayed
away from treating LI+.
But it wouldn’t have kept you away from treating Liver. It sounds like the post Liv/SJ treatment reactions were not
immediate, and there were the outside factors of the new diet and the physio treatments. Looking at her again, are
there any Liver excess signs besides the SJ channel involvement and the possible negative reaction to Liver+ and
possible benefit of SJ+? I wonder if treating her SJ on the left would have made a more immediate impact on her
right sided pain, making it clearer whether or not the SJ+ was helpful.
For sure: LI+ bad reaction, SP+ good reaction
Unclear: Liv/SJ
Clearer, but not crystal clear: SI+ not good, K+ somewhat good
Shanlarson:
Pain in lower left quadrant 7+ (KIDXS)
There are other possibilities besides K excess, including all of the channels that go through that area and their
counterbalancers.
If I reorganize her symptoms according to channels, Heart excess pops out to me: chatty 8+, feels warm 6+
What does her epigastrium and midline feel like to touch? Even if she still complains of bloating, it might be softer
that you would think.
Shanlarson:
female. Ht XS
BTW: the teaching is that ladies tend to UB excess and men tend to be Heart excess. I look for corroboration.
As well, you mentioned that chatty could be SP excess. If she was perseverating in the damp sticky muck of her
mind, I might consider SP excess but not with chattiness.
Since you fully supplemented LI and Sp, they are back to their previous balance so there is very likely more room
to supplement Sp again. That she benefited from adding fluids with SP+ gives me even more curiosity if UB+
might be be a good match.
Tell us what happens and what you find when you take a fresh look at her next time. Thanks!
Shanlarson: July 9, 2020, 3:37pm
KristinWisgirda:
BTW: the teaching is that ladies tend to UB excess and men tend to be Heart excess23/01/2024, 11:57Looking for insight with a Case – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/looking-for-insight-with-a-case/1132/print4/5
Oh shoot. yes. That I know. I just did another Toby class. I’m so use to going right to writing what channel I’m
going to treat and have to slowdown in my head to make sure I’m writing what’s in XS. HT+ had crossed my mind
but her pulse was weak and definitely not rapid and by the third treatment she was more chilled. Her epigastrium
was soft though.
Sorry. I’m a little confused when you say the symptom was organized by channel. The arm pain was on the LI and
SJ channels of the arm. With most of the pain being around the elbow but yes I didn’t specify or really consider the
channels of the pain that developed on her lower abdomen which now I see could be SP/ ST/ Liver channels. That
gives more weight to SP+ Or SJ+ again. I just realized a big gap in my thinking. When it comes to the abdomen
with a non-musculoskeletal pain I don’t have the channel trajectory on my mind for some reason. It’s so hard to
present a case to write out all your mistakes for all to see but it is just so helpful!
So it sounds like you probably would have stayed with SJ+ and SP one more time and see where that went. Now
thinking about it I probably would too.
Thanks!
KristinWisgirda: July 9, 2020, 9:18pm
Shanlarson:
So it sounds like you probably would have stayed with SJ+ and SP one more time and see where that went.
I don’t know about SJ+ for the above mentioned reasons. From here, SP+ has more indications and a clearer
history of benefit.
Shanlarson:
I’m a little confused when you say the symptom was organized by channel.
It would look like this
LI excess: dry skin, LI channel pain, lax belly?
Sp excess: LI channel pain
SJ excess: Sj channel pain, bright eyes 6+, attention to detail S8+, self critical, warm
Liver excess: Sj channel pain
etc. for all of the channels, even listing the ones that don’t have any symptoms. This format makes it really easy to
see which channels are in play, rather than listing the symptoms and then the possible channels. I do this with
almost all of my new patients and do refer back to it.
2 Likes23/01/2024, 11:57Looking for insight with a Case – Sa’am Clinical Questions – Qiological Community
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