Legato: October 22, 2021, 8:24pm
Hi!
I’ve been treating a woman with spotting and some heavy bleeding postpartum. I had some unexpected reactions to
her last treatment, which I would love feedback on. Thanks in advance!+
Nancy
35 y.o. woman, 4 months postpartum (first child)
CC: Heavy postpartum period, spotting before and after period.
Her first period after giving birth was heavy and long, with some clots. The second period was less heavy and
shorter, but still with some clots, and she spotted a couple days before and a couple of days after. She then started
very lightly spotting again about 1 week later, for one day every 3 days or so. She has been spotting like that until
now, and her next period should come in 3-4 days. (She had spotting before and after her periods pre-pregnancy as
well.)
She has also been bruising easily on her legs, which look light brown.
Secondary complaints: Poor appetite, infrequent BM, and postpartum emotions
Poor appetite and quickly full. Not eating much. Her appetite had been normal, but dropped off when both of her
parents had medical emergencies on the same weekend a few weeks ago.
BM every 2nd day, well-formed, maybe slightly soft. (Shortly after giving birth, her stools varied between hard
and difficult to expel and too soft; this improved after her first treatment. See below.)
Emotions: She tries to display a very positive attitude, to sound calm about everything, but since the birth gets
weepy easily. Feels an empty sort of helplessness, and then gets angry with herself if something in her life is not as
it should be. Shortly after the birth, she had a really hard time getting back to sleep after feeding her baby, would
lay awake just kind of fluttering around in her head, wondering if she was doing everything right, feeling like she
had no floor under her feet; this is much better now, but she still doesn’t quite feel the floor is completely solid
under her feet.
Appearance and demeanor : average facial symmetry; neatly but casually dressed, warm and friendly +5; talks
quickly +7, very positive at least superficially, but since the birth can become easily emotional and weepy +7
(better than shortly after giving birth, but still happens.) Smart and knows it, likes to show it (but nice about it.)
Lifestyle: Very active and productive lifestyle even through the end of her pregnancy +7. Less active outside the
house now, spending a lot of time taking care of her baby (naturally). Lives with her husband with her parents, who
have both have medical emergencies recently, adding to her stress. Her husband is very focused on providing
materially for her and their child, and has investments and such. However, they are living with her parents until
they can find a nice place that they can afford.04/01/2024, 11:55Postpartum Bleeding – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/postpartum-bleeding/1659/print2/5
Body morphology and flesh quality: Tall, slim. Currently an outbreak of some kind on her skin right temple
region.
Skin Quality: currently having a skin outbreak on her right temple with pale-reddish spots with white spots of…
fluid? Pus? Crusties? Itchy
Body Temp: currently comfortably warm (had previously been slight tendency to cold, especially in her feet.)
Respiratory: OK
Sleep: sleeping deeply, but has to wake once nightly to feed daughter – then takes 20-60 minutes to fall back
asleep. Hasn’t slept through the night in 4 months, but could sleep well if she didn’t have to get up.
Urination: Good.
Other Body:
Bruising easily on legs in the last 2 weeks; the bruises look pale brown to me.
Lots of hair loss since giving birth.
Some orthostatic hypotension for 5-10 seconds. She has a history of getting dizzy anyway, regardless of
position, regardless of blood pressure – but that previous kind of dizziness seems better lately.
Tongue: small body +5, thin white fur with the slightest bit of damp right in the middle.
Abdomen: a chopstick, but above the navel, not below. An improving softness in the Ren4/6 region.
Excess Presentations:
Heart: warm friendly +5, talkative +7, talks quickly +7, burning sensation with skin outbreak
UB:
GB: skin outbreak on right-side temple; hard to get back to sleep at night, lack of calmness
P: intelligent
SJ: wants everything in order; angry more with herself than others when things aren’t in order; weepy
Liver: slightly superior feeling with her intellect
Lung: good resources from parents and husband
Stomach: thin body, wet outbreak on temple
LI: super productive constitutionally +8
Spleen:
Lu/St/Sp/LI: low appetite, BM every 2 days and slightly soft.
SI: Bleeding (lack of consolidation?); still not feeling like she’s quite got the floor back under her feet
K: Bruising on legs (or is this just a result of bleeding under the skin and lack of consolidation again?); dizziness04/01/2024, 11:55Postpartum Bleeding – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/postpartum-bleeding/1659/print3/5
The Grossest Thing(s) in the Room: poor appetite, anger with self when things aren’t in order, bleeding, skin
outbreak
Main treatment ideas: Liv+ on right, Pe+ on right or left, Lu+ on left, Kid+ on right
Other treatment ideas: SI+ (toggle with Kid+)
Treatment #1: Liver+ on right
Results: Two days of increased dizziness, which then completely disappeared for 2 weeks. Energy, emotions, sleep
significantly better. BM not too hard anymore; still infrequent and slightly soft. Her first postpartum menstruation
started about 5 days later, and was very strong (as described above.) Her hair loss worsened.
Treatment #2: TCM tx: PC6, Sp4, St36, Kid3 + moxa at Sp1, Liv1
Result: Period stopped shortly after treatment. When I saw her again, her mother had just had a medical incident,
and the patient herself was still pretty upset. She had no appetite, no energy, her sleep was worse. She had a
resurgence of chronic back pain in her lower right back. Her BM was better formed but still only every 2nd day.
Treatment #3 : another TCM tx: Yin Tang, PC6, Liv8, Kid7. She started taking Wen Jing Tang.
Result: Sensation of pressure and scratchy feeling in her chest with a non-productive cough since the last
treatment. Still no appetite, but back pain, sleep and energy better. BM still every 2nd day. Her period was due in
the next few days, but she had already started light spotting (she hadn’t been taking the Wen Jing Tang very often.)
Treatment #4: Lung+ on right (I don’t remember why I did it on the right – could be that I tried pressure at both
Lu9s, and the right side was more helpful to her symptoms.)
Immediate: As soon as I inserted Lu10-, she got super dizzy. I took out the needle and immediately needled
Stomach+ on the left, and the dizziness went away completely.
Result: Pressure and scratchy feeling in the chest went away. Period this time was not nearly so heavy and only
lasted 4-5 days. Then after a week, the spotting started again.
Nearly 3 weeks after this treatment, she developed some light nausea that came and went, better with eating.
However, she still had no appetite and was quickly full. BM still every 2nd day. The orthostatic hypotension and
bruising in the legs appeared around this time. This is when she starting talking about getting angry with herself
when things weren’t as she expected them to be. Liver+ was my first choice, but actually pressure at PC3 helped
her nausea and made her suddenly smile and start laughing, whereas pressure at Liv8 seemed not to help at all.
Treatment #5: Pericardium+ on right.
Immediate: Nausea went away, energy and mood were better.
Next day: a skin outbreak on her right temple is worse, with burning and itching; energy worse; pulse faster; a
light headache on forehead comes and goes. No nausea. Would you consider this as the wrong treatment? I really,
really hesitate to tonify GB on this patient! I was thinking of trying Lung+ on the left, or maybe just a good ole
TCM treatment.04/01/2024, 11:55Postpartum Bleeding – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/postpartum-bleeding/1659/print4/5
George_Mandler: October 23, 2021, 1:53pm
Hi Nancy
Thank you for your thorough case report. There is a lot to unpack here. I wonder if you are conflating other styles
into Saam. Stick with the basics laid out in the first course for your Saam diagnosis.
Legato:
This is when she starting talking about getting angry with herself when things weren’t as she expected them to
be. Liver+ was my first choice, but actually pressure at PC3 helped her nausea and made her suddenly smile
and start laughing, whereas pressure at Liv8 seemed not to help at all.
For the diagnosis I would stick with what is presented. She sounds SJ excess and over a month prior a supplement
LR+ treatment worked well for her. She also sounds PC excess with her strong intellect (you put that in LR but that
would be PC).
Although pressing points to determine between two channels may be valid and figured out after using this system
or a while I would be cautious as it is not within the framework taught in this beautiful tradition. Especially in the
beginning. (I am on 33 months, minus 10 weeks of covid shutdown, of basically 100% Saam treatments and
consider myself a beginner) For example here you pressed the water point on the liver channel and compare it to
the water point on the fire channel – how do you know what the other three points will do to balance it out? I
suggest seeing Saam within the whole of the 4 needles and use the basic archetypes of observation to make your
diagnosis. Mixing it with other styles is like talking Mandarin and German at the same time.
Legato:
Treatment #5: Pericardium+ on right.
Immediate: Nausea went away, energy and mood were better.
Next day: a skin outbreak on her right temple is worse, with burning and itching; energy worse; pulse faster; a
light headache on forehead comes and goes. No nausea. Would you consider this as the wrong treatment?
Interesting she felt better immediately then the next day not so good. Looking back on your TCM treatments it
seems she had some better and worse as well. Patients like this that have a lot going on and seem very effected by
many factors (i.e. her mother’s emergency then things declined for her). It can be hard to tease out what is
treatment and what is sort of typical imbalanced blowing in the wind. Not sure what pulse faster means in this case
– was her pulse normal before or slow or fast?
In reading through your case it seems she has a mix of PC excess and GB excess. The GB excess being the lack of
calmness if what you mean is changing emotions. Does she that quickly changing emotions or talk in starts/stops –
up and out energy. I would not be doing GB+ supplementation if that is even partially true.
Legato:
SI: Bleeding (lack of consolidation?); still not feeling like she’s quite got the floor back under her feet
K: Bruising on legs (or is this just a result of bleeding under the skin and lack of consolidation again?);
dizziness04/01/2024, 11:55Postpartum Bleeding – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/postpartum-bleeding/1659/print5/5
Bruising is not necessarily a KD excess sign. Yes we may supplement SI+ for dizziness, but in this case with the
bleeding I am thinking supplement KD+. You didn’t say anything about pain with the period or oketsu in the lower
abdomen. If she is still having bleeding I’d be giving her that consolidating energy of KD+. For the few postpartum
mamas that make it in supplementing KD+ is high on my list of options.
Adina_Kletzel: November 3, 2021, 9:20pm
George_Mandler:
I am thinking supplement KD+.
She also is very busy taking care of her newborn baby AND her parents so she may be giving out more energy than
she has. She also had worsening of symptoms after a weekend of taking care of her parents medical emergencies
and it sounds like she doesnt feel very consolidated emotionally. These all point to SI excess.