michaelmax: April 5, 2019, 1:20pm
You know that thing about you have to know how play scales and understand the rules of music before you can
play jazz? Or how good writers can break the rules because they know them?
It’s a tempting risk when working at the edge of what we know.
I’d like to see if I can salvage some understanding from this case–
68 year old man. Former fighter pilot in Vietnam. In good physical shape as he works out. January of 2017 started
getting sciatica on the left side. Mostly bothers him when walking his dogs or standing for about the amount of
time it takes to make a sandwich.
As I said, he’s fit. Works out regularly. Dresses neat as a pin. Very polite. Piercing blue eyes. (dang, a lot of clarity
comes from just writing this up)
During the interview he mentioned that he had been to a chiropractor years ago who did acupuncture for his bum
knee. Stuck a few pins in, it hurt like hell. He pulled the needles out and said “we’re done.”
Fighter pilots are like that.
His tongue is swollen with a thick greasy white yellow coating. He has diabetes and the 1000mg of Metformin he
takes a day gives him loose stools.
Pulses are slippery and fast
My diagnosis is GB excess and I want to tonify his PC on the opposite side. But in my mind I’m replaying his
experience with the chiro. And I’m timid to needle those jing wells on a first visit. So I take the “idea” of tonifying
the PC and draining the GB and work it with other points. (yep, crossing systems and perspectives… what could go
wrong?)
DX: internal dampness with fire in the GB channel
Treatment–
Right: PC6, GB38 (fire point, drain) GB21, LV8
Left: tonify LI11 and ST36 for the dampness in the middle burner
Treatment two–
Patient reports the sciatica is worse by a factor of two.
Pulses slippery, wiry fast and on the left overflowing
Tongue, the same
This time I think “dammit, just do what you set out to do.” So I tonify the PC on the right with Sa’am treatment
and do LI11 and ST36 on the left.26/01/2024, 12:43Mixed metaphors comparing apples and oranges – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/mixed-metaphors-comparing-apples-and-oranges/37/print2/7
I notice that his face is a flushed and can not remember if it was that way when he came in. And make a note to self
to start writing down how the complexion is during the interview. (I should have corrected this when I noticed his
face was flushed, but was was also unclear on his usual complexion)
At the end of the treatment his ears are red and hot. And I’m perplexed at how so much heat rose up to his head.
He decided not to return.
As I review this case, I think there are a couple of things.
1- Start paying close attention to the complexion before the treatment
2- In retrospect I was thinking GB excess, but I think he might have a San Jiao excess. And I should have gone for
liver which was cooler, not PC which added to the fire.
3- I’m wondering how to think about people like him… highly trained to be cool and collected under terrifying
conditions. What is the organ(s) that helps you to stay clear and focused when you constantly are under the threat
of dying? And could it be that the way highly trained military people present be different than how civilians
present?
Tobydaly1: April 6, 2019, 9:53pm
<1- Start paying close attention to the complexion before the treatment>
Yes! I can’t emphasize this enough. It is my most reliable and immediate ways to gauge the appropriateness of my
treatment.
<2- In retrospect I was thinking GB excess, but I think he might have a San Jiao excess. And I should have gone
for liver which was cooler, not PC which added to the fire.>
Sound clinical reasoning. My teacher had a lot of respect for the amount of heat just supplementing Liv 1 (??)
adds to the body.
<3- I’m wondering how to think about people like him… highly trained to be cool and collected under terrifying
conditions. What is the organ(s) that helps you to stay clear and focused when you constantly are under the threat
of dying?>
SJ, right?
<And could it be that the way highly trained military people present be different than how civilians present?>
My teacher said that if something is drilled in deeply enough to someone that they believe it with all their heart
then this belief is what you need to treat.
michaelmax: April 6, 2019, 10:52pm
26/01/2024, 12:43Mixed metaphors comparing apples and oranges – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/mixed-metaphors-comparing-apples-and-oranges/37/print3/7
Tobydaly1:
My teacher said that if something is drilled in deeply enough to someone that they believe it with all their heart
then this belief is what you need to treat.
Well @Tobydaly1 , I’ve only heard you say this about 50 times now. That if something has been deeply
conditioned into someone, then it is who they are in the moment. Treat them as such.
Sometimes I get into thinking (not sure where I picked it up) that there is a true self and a conditioned self and the
true self is the real one and to attend to that. Hummm… interesting narrative now that I stop to think about it.
michaelmax: April 6, 2019, 10:53pm
Tobydaly1:
Sound clinical reasoning. My teacher had a lot of respect for the amount of heat just supplementing Liv 1 (?
?) adds to the body.
To quote our friend Hazel from TUA… Elaborate!
I think of the LV as the cool, moist, mossy wood. Where’s the heat coming from? Is it the wood of wood which
then easily generates fire?
Tobydaly1: April 7, 2019, 11:06pm
Because it is part of the 4 point combo for supplementing Ht. He didn’t specifically explain why he singled out Liv
1 (??) for being the most heat generating.
michaelmax: April 8, 2019, 1:19am
Tobydaly1:
Because it is part of the 4 point combo for supplementing Ht. He didn’t specifically explain why he singled out
Liv 1 (??) for being the most heat generating.
Ahhh one of those tricky teachers that makes you think for yourself. 26/01/2024, 12:43Mixed metaphors comparing apples and oranges – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/mixed-metaphors-comparing-apples-and-oranges/37/print4/7
Tobydaly1: April 8, 2019, 8:24pm
Yes! Frustrating, huh?
Adina_Kletzel: April 10, 2019, 7:04pm
I had this idea of PC bringing down the GB heat that has risen up – because it counterbalances GB which I see as
something that causes heat to rise… now I see I may be mistaken. If tonifying PC makes heat rise then HOW does
it counterbalance GB???
KristinWisgirda: April 10, 2019, 9:44pm
Hi Adina,
The GB/P and SJ/Liver relationships are something I am still looking for clarity on too.
My understanding is that the GB/SJ are outward directed and the P/Liver are inward directed. Toby even mention
protruding vs sunken/collapsed if looking at posture. The GB is more expansive and the Sj is more focused. The P
is warm and intelligent, the Liver is cool and dense.
Even though it is warming, I’m surprised that treating the P caused such a dramatic reaction for Michael’s patient.
If he really needed cool moistening Liver tonification, I wonder if adding part of the double dry LI tonification
treatment was part of the aggravation.
It is fun trying to think through these cases.
George_Mandler: April 10, 2019, 10:13pm
Kristin I was wondering about Michael’s tonificaiton of yangming earth points even though he didn’t disperse the
fire points.
On a related note I have a patient on the table now that I started seeing in the fall. (when I first started tinkering
with Saam.) She was clearly a SJ excess type. Often she got Liver+. Now she is 15 weeks pregnant and I noticed a
feistiness I hadn’t seen before. I asked if she was getting angry and she shot out “Oh my god [my husband] says
‘where is my sweet Brenda’…since pregnancy I’ve been getting angry which isn’t me”. I am treating PC+…26/01/2024, 12:43Mixed metaphors comparing apples and oranges – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/mixed-metaphors-comparing-apples-and-oranges/37/print5/7
haunani: April 11, 2019, 8:34am
I’m looking forward to hearing how your treatments are going with the pregnant client. Using Saam during
pregnancy is one of my big questions and curiosities. I’m not treating a lot of people right now due to our location
but am eating the Saam podcasts and supporting materials like crazy. Please keep us posted.
michaelmax: April 11, 2019, 10:57am
George_Mandler:
Kristin I was wondering about Michael’s tonificaiton of yangming earth points even though he didn’t disperse
the fire points.
Hi @George_Mandler that’s a good question. There are times I want to give the patient’s system a nudge in a
particular direction, but don’t want to go “full in” with shutting the Ke Cycle aspect of the treatment.
This is not something that Toby teaches, it’s my own idea. Something I’m experimenting with really. So don’t take
it as gospel. It’s a way that I’m taking what Im learning here and seeing if it can be applied in other ways.
When first learning I would recommend against what I’m doing. It is much better to treat one channel and then
you can clearly the see the results of your intervention.
mferguso: April 13, 2019, 6:52pm
Its interesting to see Liver 1 showing up in three of the tonification protocols tonified in HE PC and sedated in SP.
Its warming quality also makes me think of how its often recommended in TCM cold in the liver channel shan dx.
If only I could really enjoy needling that point having done it on myself a couple times. That SP tonification is an
exceptionaly rough go in terms of pokey points.
michaelmax: April 14, 2019, 1:10am
@mferguso, I know what you mean as LV1 and SP1 are often points that yours truly have to needle for himself.
Not to mention any of jing-wells that my patients need.
I’ve discovered that if I don’t think about “oh I have to needle this painful and troublesome point” but instead feel
clear, confident and capable about needling it, and that it is is no big deal… then it usually turns out the patient is26/01/2024, 12:43Mixed metaphors comparing apples and oranges – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/mixed-metaphors-comparing-apples-and-oranges/37/print6/7
fine with it as well.
My perspective vastly influences the patient’s experience.
Try it out and see if your patients have a more comfortable experience when you yourself are more comfortable
with needling the jing-well.
dcantor: April 14, 2019, 10:07pm
@michaelmax I think this is really true. I used to do a lot of apologizing about the jing-wells and other painful
points, and that just made patients more uncomfortable with them. Now I just try to be clear and confident with the
treatments, help people breath with the points, and sometimes joke about them a little bit, and it’s been going much
better. It’s amazing the trust that patients afford to us as practitioners – it’s an honor to be in that position, and this
system has been a great reminder to be as clear and collected as possible when giving treatments.
lauramcgraw: April 16, 2019, 3:32pm
Most of my patients have no problem with a little discomfort once they feel the results. I have been needling LI 1
and BL67 on myself for bladder suppl, I am needle sensitive and something about it being the right treatment
seems different. I needled a patient yesterday with vertigo and she needs both suppl kidney and sm. int. I did
Kidney yesterday and she said to me … the points are really painful today… after 2 minutes I checked in on her
and she was getting a headache and didn’t feel right. I removed them and immediately did sm. intestine and those
point were not painful at all, she said they felt good when I put them in. And within 30 seconds she said, OH, that’s
different I feel really relaxed and my headache is going away. She also got that heavy eyelid look and a smile on
her face:)
michaelmax: April 17, 2019, 2:08am
The different between correct and incorrect treatment is so profound with this. Good on ya for catching that
problem and fixing it!
1 Like26/01/2024, 12:43Mixed metaphors comparing apples and oranges – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/mixed-metaphors-comparing-apples-and-oranges/37/print7/7
KristinWisgirda: April 17, 2019, 1:59pm
@dcantor Jokiness helps take the edge off the pokey points in my experience too.