Alvaro: June 21, 2019, 3:47pm
Hi everyone,
I’m new to the forum. First off, thank you all so much for your generosity contributing your thoughts and ideas on
the forum. I have been reading them and learning as much as I can from your experiences. I would love your take
on this pain related case. I gave this friend a 30 min free consultation yesterday and here is the info I got:
38 year old male massage therapist with sacro-lumbar pain (from L4 down) radiates down to either foot at different
times, especially 4th toe but sometimes also 5th toe. Started off a month ago with very intense spasms in the low
back after waking with stiff lumbar muscles worse on R and inability to stand up straight. Positive straight leg raise
on both sides but worse on R side. Received a couple of massages with no change so he saw primary care provider
and got 6 day dose of methylprednisone (suspected bulging disc or herniation) and started wearing back brace. Pain
improved about 70%, but still has some pain from L4 down to sacrum and pain referral to and 4th and 5th toes
(alternates L and R). Seems worse when driving with foot dorsiflexed or when twisting, side bending, or arching
back. Occasionally feels pain into hips or glute max as well. Sitting longer than 30 mins hurts sacrum and/or glute
(alternates L and R).
Quality of pain overall is dull achy, comes and goes throughout the day. He is quite thin, chronic sinusitis since
childhood, dry eyes in the morning, normal to oily face but legs very dry from knee down. Tends towards cold feet.
Pulse is strong over all, thin (2-3/5) and wiry (or tight in shen hammer system) especially on left side. I asked about
stress/emotions and he says sometimes clenches jaw/grinds teeth at night, occasionally short tempered, and can get
hangry or light headed if skips a meal. Not vegetarian though. Digestion: good appetite but for last 3 months has
been tending towards loose BM once or twice a day. Before then used to be more dry BM.
As far as treatment ideas the obvious one for the chief complaint I think would be to supplement SI. However, I
feel drawn to start with supplementing Liver first given the thin pulse on the left, dry legs, dry eyes in morning, and
tendency towards getting hangry. Also hoping the cooling aspect of +Liv will help with the potential lingering
inflammation in the lumbo-sacral region. Not sure if the jaw clenching/teeth grinding is related to a lack of blood to
store the shen or if it’s a type of GB aggression.
As far as the back shu, the dermatome pattern seems to follow L5 which would be LI but it radiates mostly to 4th
toe which would be GB channel… Not sure how to sort through those two with Saam. It seems he used to be kind
of LI excess but in the last 3 months BM loose and has had chronic sinus congestion all life.
Any ideas or suggestions would be much appreciated
KristinWisgirda: June 24, 2019, 11:36am
Thanks for the case. I can see that you are sorting through the presentation with a Saam perspective and through
other systems as well. When using Saam to treat, it is most helpful to use Saam to diagnose. Otherwise outcomes
won’t be so good and you can potentially send patients for an uncomfortably wild ride with this powerful system.26/01/2024, 12:04Lumbar pain with radiculopathy – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/lumbar-pain-with-radiculopathy/315/print2/3
Alvaro:
As far as the back shu, the dermatome pattern seems to follow L5 which would be LI but it radiates mostly to
4th toe which would be GB channel…
Location of pain is really helpful when using Saam. If the lower limb pain is GB channel primarily, then you would
consider treating either GB or its counterbalancer P. If the back pain is primary, have the patient point to the center
of the pain. If they give you a larger area, you can palpate and ask where it is the most painful. Finding the
corresponding back shu level of the most painful spot, you can treat that channel system or its counterbalancer. So
if it is L4, LI or Spleen.
Alvaro:
However, I feel drawn to start with supplementing Liver first given the thin pulse on the left, dry legs, dry eyes
in morning, and tendency towards getting hangry. Also hoping the cooling aspect of +Liv will help with the
potential lingering inflammation in the lumbo-sacral region.
This isn’t Saam thinking. Pulse isn’t used in Saam. The dry eyes and dry legs mean outside dry and point to either
Lung excess or LI excess, not Liver excess. With the patient’s thin body, the morphology points to LI excess. It
sounds like his skin is a mixed picture of normal/oily face and dry legs. Asking about moisturizer can be helpful to
give you a better picture.
Alvaro:
As far as treatment ideas the obvious one for the chief complaint I think would be to supplement SI.
Could do but if the primary pain is at the level of L4 and the patient is “quite thin” with mostly dry skin, there is a
strong case for LI excess, in which case you would want to supplement Spleen. The GB signs of windy teeth
grinding and occasional short temper don’t sound strong. Determining if the toe pain is worse than the back pain
would be a guide. Definitely keep it on the list of potential treatment approaches.
Alvaro:
for last 3 months has been tending towards loose BM once or twice a day.
Alvaro:
It seems he used to be kind of LI excess but in the last 3 months BM loose and has had chronic sinus
congestion all life.
Clinically sinus congestion by itself, without discharge, just tells me that there is some kind of block in the sinuses.
It can be wet or dry or more qi stagnation.
The loose stool doesn’t rule out supplementing Spleen. Use the grossest aspects of the presentation to guide your
diagnosis and treatment.26/01/2024, 12:04Lumbar pain with radiculopathy – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/lumbar-pain-with-radiculopathy/315/print3/3
Let us know how it goes.
Alvaro: June 25, 2019, 1:06am
Thank you so much Kristin! That’s very helpful. If you don’t mind, could you please share what are the physical
characteristics of Liver deficiency in Saam? I’m having a hard time distinguishing those. Most of what I have read
in the forum and heard from the podcasts is more centered around mental-emotional characteristics. I can’t wait for
the recorded class from Seattle to become available online so I can continue learning
KristinWisgirda: June 25, 2019, 4:59pm
If getting the Saam basics sooner sounds good, the St Louis class will be live streamed this weekend and available
for viewing for 1 month after. A good number of the students attending this class have taken previous classes and
are active on the forum, so I anticipate some higher level discussions in this class along with the basic foundation.
Toby is teaching Saam such that you diagnose in terms of which channel is excess relative to its counterbalancer.
Since Liver and SJ are paired counterbalancers, we diagnose SJ excess and treat it by supplementing the Liver.
The basics of a SJ excess presentation are a combination of a yang channel/organ that has Shaoyang fire + fire in
the 5 phase designation. It manifests with piercingly bright outward focus. These patients will be very polite
because they are so aware of their environment. Being so open to their environment they can feel exposed and
vulnerable.
A Liver excess, in contrast, is like a dark cool forest. It is dense, inwardly focused and provides shielding. These
patients might seem rude because they are so inwardly focused and unaware of their environment.
So supplementing the Liver in Saam is going to provide a dense shielding to a bright, overexposed SJ excess.
Class will provide many more nuances.
Alvaro: June 25, 2019, 6:45pm
Thank you! I’m traveling this weekend but I will check with Michael if I can still watch the recorded class later
even though I didn’t attend the live stream