Daniel: October 1, 2019, 7:34pm
I have a patient I need some input on.
39 year old lab technician.
Married.
Three teenage children.
about 5’11”. Thin. No extra body flesh at all.
Somewhat quite and reserved but not too much and also smiley and bright.
Main complaint:
“Lymphocytic Colitis” symptoms
. . . mucousy and watery diarrhea, intestinal cramping, bloating.
Lifelong issue but worse lately.
Was all better during all three pregnancies.
Also has episodes where her left cheek gets hot, she gets very woozy and spacey in her head and has occipital
pressure pain from ear to ear.
These episodes, 50% of the time are preceded by a sudden electrical shock sensation that runs through her body.
What is VERY interesting is that these two symptom complexes alternate perfectly like a seesaw. Literally!! When
digestion is good, the woozy-head hot-cheek episodes flare and when digestion is bad, the woozy-head hot-cheek
episodes die down.
What is also very interesting is that with BOTH sides of the seesaw . . . the colitis and the hot cheeks, she gets
quite thirsty and needs a water bottle with her.
Other signs and symptoms:
Very low blood pressure all her life.
a full week of premenstrual pms and breast tenderness
her ‘worst week’ symptomwise is often around ovulation.
She is thin, verging on boney but not quite boney
skin is neither dry nor oily
her thenar eminences are a little sunken
Lung 1-2 areas are a little sunken
So, I had been treating her with my pre-Sa’am approaches – about ten sessions over 3 months and her digestion had
improved quite remarkably – still had odd flareups but mostly really very normal digestion. But – these episodes of
hot left check, woozy head had not responded AT ALL – occuring pretty much 3 or 4 times a week and quite
bothersome.
Based on her thin body type and her empty thenar eminences and sunken Lu 1- 2 areas, I tried a Sa’Am Lung
supplementation last week. She got very very relaxed on the table. A week later, she reported a terrible week that
started almost right after the treatment with seesawing between intense colitis and intense hot cheeks!! Suggesting24/01/2024, 12:03Need Help with a Diarrhea – Hot Cheek Seesaw – Sa’am Clinical Questions – Qiological Community
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the Lung supplementation sent her in precisely the wrong direction!!! I realise her diarrhea is mucousy suggesting
damp on the inside but she just doesn’t have that body type at all and her thenars are sunken. Should I supplement
Stomach (dry that mucousy watery diarrhea? but what about the hot cheek and the thirst?). Should I move into the
GB-PC-SJ-Liv domain (certainly possible – although a little confusing in that regard). Should I try supplementing
Spleen (I know diarrhea is watery and mucousy but she has thirst, deficient flesh, not much flesh)?
KristinWisgirda: October 1, 2019, 8:03pm
How pretty/symmetrical is she?
What does her tongue look like?
Daniel: October 1, 2019, 8:14pm
I haven’t looked at her tongue – I can check next time.
the ‘pretty question’!!
hmm – well, she is certainly symmetrical -there is no asymmetry to her.
I would say – not hollywood drop dead gorgeous but certainly attractive
KristinWisgirda: October 1, 2019, 8:55pm
Daniel:
What is also very interesting is that with BOTH sides of the seesaw . . . the colitis and the hot cheeks, she gets
quite thirsty and needs a water bottle with her.
Her body is saying that she wants fluids.
Along with thin+dizzy (small boned even though she is tall???), and pretty with heat flushing and a case for SI+ is
coming together. That is my first thought.
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Daniel: October 2, 2019, 12:41pm
Hi Kristin. Thanks for your thinking about this case! Hmmm. Well, I don’t think I would call her small-boned, or
large-boned. She is just average boned. Her ‘skinniness’ is not about her bones, it is about her flesh. I have been
under the impression this type of body points to Large Intestine and Stomach? By “SI+”, do you mean “Small
Intestine Excess” or “Small Intestine Supplementation” (i.e. Kidney Excess).?
KristinWisgirda: October 2, 2019, 2:02pm
Skinniness is different than being small or thin boned for sure.
Do you know about thin+ small boned + dizzy being a special triad for SI+ (supplementing small intestine)? This
was a special gem from Toby’s teach. Being pretty adds more weight, for sure.
Daniel:
Should I supplement Stomach (dry that mucousy watery diarrhea? but what about the hot cheek and the
thirst?). Should I move into the GB-PC-SJ-Liv domain (certainly possible – although a little confusing in that
regard). Should I try supplementing Spleen (I know diarrhea is watery and mucousy but she has thirst, deficient
flesh, not much flesh)?
Using the tools of Case Study Format
likely will help you see your patient better. If you still need help, you can share the formatted case and we can look
at it together.
Daniel: October 2, 2019, 5:47pm
KristinWisgirda:
Do you know about thin+ small boned + dizzy being a special triad for SI+ (supplementing small intestine)?
This was a special gem from Toby’s teach
No – I never heard this
but it has me confused.
It would seem to me thin, small boned and dizzy would almost be a Kidney Deficiency situation, calling for
Kidney supplementation.
Kristin – can you help me understand via principles how this triad fits into a Kidney Excess – Small Intestine
Deficient scenario (thus calling for SI supplementation)?24/01/2024, 12:03Need Help with a Diarrhea – Hot Cheek Seesaw – Sa’am Clinical Questions – Qiological Community
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KristinWisgirda: October 2, 2019, 9:08pm
Daniel:
It would seem to me thin, small boned and dizzy would almost be a Kidney Deficiency situation, calling for
Kidney supplementation.
When I first heard of this, the small boned struck me as a SI excess sign.
BUT
KristinWisgirda:
This was a special gem from Toby’s teach.
Look out for this triumverate, because it is so clinically useful.
Dizziness, by itself, being a windy symptom, is an indication for considering SI+. My questioning was looking for
more K excess signs to support that.
I notice that many contributors to the forum don’t mention how symmetrical and/or into themselves their patients
are. With each patient, it is so helpful to make a habit of going through each of the 6 channel pairs and look for
potential signs for each of them. Cultivating close observation of patients with an openness to all 12 channels is the
foundation of Saam diagnosis.
Daniel: October 15, 2019, 3:31pm
So, this case I presented to Toby on the Case Discussion Call this past weekend – first case of the hour. She comes
in tomorrow and I will be seriously looking to confirm treating either Liver (SanJiao excess) or Drying out with
either Stomach (highly indicated by the adverse response to Lung) or Large Intestine. As discussed between Toby
and I. But I do feel conflicted . . . here is the basis of my conflict . . . . I understand, as Toby noted, that full facial
heat would be Heart Excess and only limited facial heat and in this case even more so being only on the Left –
would be San Jiao Excess . . . pointing to treating Liver. BUT she is cold all the time (and she improves when she
gets warm as with ovulation) and Liver is ‘cooling’ (that cool forest) – so I feel a tad apprehensive about it (but will
probably do it anyway). Then there is the drying of a Stomach or Large Intestine treatment – certainly indicated by
mucousy diarrhea (not to mention the adverse response to Lung supplementation) – BUT with both her diarrhea
AND her hot cheek, she gets very very thirsty and she is also thin so I am apprehensive about drying her out!!! I
guess . . . . Clinic is Hard!!! (p.s. Kristin – apologies, I called you Kirstin on the call with Toby!).
KristinWisgirda: October 15, 2019, 8:10pm
Daniel:24/01/2024, 12:03Need Help with a Diarrhea – Hot Cheek Seesaw – Sa’am Clinical Questions – Qiological Community
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she is also thin so I am apprehensive about drying her out!!!
I once saw Toby LI+ a patient who was so dry she looked like she was just leather and bones. Her teeth were
abscessed and gradually falling out as the result of radiation. LI+ was used as a rescue measure to save her teeth,
knowing that moistening treatments could be used later to counter any side effects.
Here is a case of mine, where SP+ worked a long lasting miracle for dry constipation in an overweight woman with
not very dry skin. Her bowels are perfect to this day , without having to treat Sp+ again.
A case of constipation and supplementing Spleen
It is easy to think of supplementing Spleen in patients with the classic LI excess morphology- dry inside and
out. A couple of patients have shown me that overweight patients can at times benefit from the moistening milk
of Mama Spleen- cautiously. One obese patient with severe dry mouth from Sjogren’s (causing rapid weight
loss) felt fluids return to her mouth during a Spleen+ treatment. Here’s another case: A 51 year old woman
moderately overweight and with mildly dry skin. She has a history …
As for the left side intense hot cheek: Heat above and cold below is classic SJ excess. The left sidedness is like a
message screaming- please consider Liv+!
Were you in one of the classes where Toby shared a case of a woman with muscular dystrophy, deeply icy cold legs
and lots of moles on the left side of her body? During the treatment of Liv+ her legs warmed up. Cool Liver
warming the body by increasing the density of blood.
Kristin, Kirstin, Crystal, Christine- they are all good
Daniel: October 15, 2019, 10:44pm
Hi Kristin – thank so much for these GREAT examples – they really speak to what we are working with and what I
am facing with this case. Thanks!
kellykd: December 14, 2019, 7:59pm
How about an update, Daniel? Did you do Liv+ or what? Inquiring minds want to know!
amyjenner: December 23, 2019, 11:43pm
i was wondering about the nature of the diarrhea…hot or cold?24/01/2024, 12:03Need Help with a Diarrhea – Hot Cheek Seesaw – Sa’am Clinical Questions – Qiological Community
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Daniel: January 6, 2020, 3:07am
kellykd:
How about an update, Daniel? Did you do Liv+ or what? Inquiring minds want to know!
SORRY I didn’t get back to you sooner!!! So here is what happened . . .I did a Liver supplementation treatment.
She returned a week later reporting 24 hours after the treatment of a strong intensification of her cheek flushing
and woozy head feeling. Then she got all better and her digestion remained excellent. But a few days later, she
developed a bad fever and chills and was still feverish when she cam back to see me. At that point, I reverted to
two Kiiko style treatments over two weeks. Her digestion remained excellent for a good 2-3 weeks and while she
did have her daily cheek flushing experience, it was always very brief (compared to many many hours a day). We
decided not to treat as she was mostly better and stable and she agreed to contact me if things deteriorated (and she
is very committed to the treatments and very communicative). I’ve not heard from her for two months now so I am
assuming things remained much better. Was it the Liver supplementation? I dunno?