dcantor: April 8, 2019, 6:18pm
The case I intended to ask about at the last webinar got split up and a little mangled; here is the full case with
clarification:
The patient is a 65 yo male with the cc of severe hiccups followed by vomiting after he eats, multiple times a day
on most days, for the last 25 years. He also has a hx of Lu CA and had one lung removed, and has a Hep C dx
though based on his last scan his liver is in pretty good shape. He’s of average build, a little puffy in the abdomen,
quite dry skin, kind and easily communicative. Temp was described as normal/comfortable but prefers hot to cold
and his abdomen sometimes feels cold. Abdomen objectively feels cooler above umbilicus and warmer below.
BMs were, amazingly, described as normal, regular, and formed. Urination normal. Energy good though gets tired
more easily now with only one lung.
R Middle pulse is Empty/Qi Wild and a little slippery (this means Yin and Yang are separating in the Sp/ST, either
because Yin is not anchoring Yang or Yang is not stirring Yin, plus there’s some Dampness. Considered a very
serious pulse quality indicating immediate attention is needed to that area and that chaos is developing in the
physiology of those organs); slippery in OB/OO as well (= retained Damp pathogen). Tongue body is slender,
slightly pale but center is red with cracks, sticky white coating.
The first treatment was actually provided by a colleague of mine before she sent the patient on to me. She gave me
the basics of the case and asked what I would do from a Sa’am perspective and I explained how to supplement ST
on the left. She didn’t have anything remarkable to report, but primarily practices Japanese acupuncture and I
wasn’t sure how precise and strong her tx was. When I saw him and confirmed all the reasons I thought there was a
ST deficiency (severe hiccups, nausea and vomiting = ST Qi not descending, internal Damp signs including some
excess weight around the middle, slippery pulse, sticky white tongue coat, poor diet, and quite dry skin) I decided
to supplement ST again to be clear about his reaction, and bilaterally because the case is severe.
He did notably settle on the table, complexion evened out, face became peaceful, and he even fell asleep, all of
which I took as good signs. But two days later, he reported no change in the hiccups and vomiting.
I prescribed a modification of Wu Zhu Yu Tang, which has produced the first notable shift in his sx (tho as I said,
some benefit from Fu Zi Li Zhong Tang + Ban Xia Xie Xin Tang in the past) – he reported less severity and
frequency of hiccups and vomiting.
My main question is, based on the sxs and sns I’ve shared and the patient’s reaction, whether the best conclusion is
that ST supplementation was not addressing the root of his condition, and shouldn’t be repeated, or that his
condition is severe enough that the acupuncture was not able to impact it enough. I am confident in my technique,
point location and stimulation.
I am also curious if channel supplementation can sometimes be more effective when combined with another
appropriate channel, just as we use a guiding herb to obtain the therapeutic effect we want from another herb, and
similar to your statement that you can combine Pc or SI with BL or Lv if the person needs Pc or SI but has too
much heat (which I’ve done with success).26/01/2024, 12:31Severe Hiccups and Vomiting – Case Questions – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/severe-hiccups-and-vomiting-case-questions/59/print2/4
And, have you ever found certain Sa’am treatments to be more effective once someone has taken an appropriate
formula for some time, if the tx was not effective prior to taking the formula?
The other channels on my radar for this patient are Ht and Lv. Any other suggestions you have for channels or
approaches I should consider are appreciated. I did consider that I was misjudging Damp since he does have some
contradictory sns (such as the dry slender tongue body), but was concerned about the potential impact of
supplementing Sp since it has an ascending quality.
Tobydaly1: April 8, 2019, 8:37pm
dcantor:
My main question is, based on the sxs and sns I’ve shared and the patient’s reaction, whether the best
conclusion is that ST supplementation was not addressing the root of his condition, and shouldn’t be repeated,
or that his condition is severe enough that the acupuncture was not able to impact it enough. I am confident in
my technique, point location and stimulation.
It’s impossible to know this for sure, but I suspect there may be a deeper cause.
Blockquote
I am also curious if channel supplementation can sometimes be more effective when combined with another
appropriate channel, just as we use a guiding herb to obtain the therapeutic effect we want from another herb, and
similar to your statement that you can combine Pc or SI with BL or Lv if the person needs Pc or SI but has too
much heat (which I’ve done with success).
Blockquote
Yes, channels are frequently combined in the Saam system.
Blockquote
And, have you ever found certain Sa’am treatments to be more effective once someone has taken an appropriate
formula for some time, if the tx was not effective prior to taking the formula?
Blockquote
Definitely combining the Saam system with a well matched formula often yields good clinical results.
Blockquote26/01/2024, 12:31Severe Hiccups and Vomiting – Case Questions – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/severe-hiccups-and-vomiting-case-questions/59/print3/4
The other channels on my radar for this patient are Ht and Lv. Any other suggestions you have for channels or
approaches I should consider are appreciated. I did consider that I was misjudging Damp since he does have some
contradictory sns (such as the dry slender tongue body), but was concerned about the potential impact of
supplementing Sp since it has an ascending quality.
[/quote]
Ht and Liver are reasonable channels to consider supplementing for this case.
dcantor: April 9, 2019, 3:15am
Tobydaly1:
Yes, channels are frequently combined in the Saam system.
Got that. Up until now I have combined channels if I need to balance some aspect of one channel (adding BL if I
want to supplement SI but the patient is too hot) or if I feel that supplementing two channels will more fully
address the patient’s complaints than one alone. I’m asking if one channel can “guide” or somehow augment the
effect of another – such as Ht+ST guiding heat downward or into the middle jiao…or if that idea does not translate
to this system. Thanks.
Tobydaly1: April 10, 2019, 9:55pm
<I’m asking if one channel can “guide” or somehow augment the effect of another – such as Ht+ST guiding heat
downward or into the middle jiao…or if that idea does not translate to this system. Thanks.>
Definitely, but at this stage of learning I’m recommending students only use on channel per treatment.
ngmatthews: October 4, 2021, 5:15pm
I would not give up on your initial treatment until you have repeated it a couple of times. In a case this severe it
might just take some repetition.
michaelmax: April 26, 2019, 8:59pm
Yes, like with herbal Rx, we don’t immediately shift a formula. We give it some time to work.26/01/2024, 12:31Severe Hiccups and Vomiting – Case Questions – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/severe-hiccups-and-vomiting-case-questions/59/print4/4