Donley: July 5, 2019, 11:48pm
Hello everyone,
I have a patient coming in tomorrow morning in severe pain from an outbreak of shingles. That is all the
information I have have the moment. I’m not sure where the outbreak is or the underlying cause. I’m just
wondering at the moment as to a general Sa’am approach to a viral outbreak which runs along dermal lines which
may cross several channels. I’m thinking the best bet is to find the underlying cause (of course) and treat that. For
example, Lv fire should be treated with Sj tonification or Sp Dampness should be treated with Li tonification. The
only other general treatment I can think of maybe to bring in some UB coldness (if appropriate). Any thoughts?
Thanks!
KristinWisgirda: July 6, 2019, 11:53am
Sometimes channel, sometimes quality.
Let us know what you find.
sweiz: July 6, 2019, 1:26pm
Hi Donley,
I will be curious as to what you find today with this patient. I think it is hard to have ideas about treatment when all
we know is the WM disease name and the primary symptoms. I think meeting her/him will tell you and us so much
more. I do know that shingles will often be primarily on the GB channel so I think of PC on the opposite side of the
primary pain. I also think of Liver and Bladder to cool if it shows up as hot. But that is without knowing much
about her/him.
One thing I noticed in your post was your idea of treating liver fire with SJ. My understanding of liver excess is not
the same as the TCM idea of liver fire. I think treating SJ for liver fire could make it worse.
KristinWisgirda: July 6, 2019, 6:53pm
sweiz:26/01/2024, 11:55Shingles and Sa’Am? – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/shingles-and-saam/346/print2/10
I think treating SJ for liver fire could make it worse.
For sure! Adding the warm focused brightness of SJ to a TCM Liver fire situation could create an inferno for the
patient. Thanks, @sweiz, for catching this part of the opening post.
sweiz:
that shingles will often be primarily on the GB channel so I think of PC on the opposite side of the primary
pain.
Don’t forget the possibility to needing to supplement the GB+ if the patient is more Pericardium excess. Even
though culturally, it seems like most patients could use a boost of Pericardium virtues, reading cases on the forum
of poor and adverse responses to P+ treatment is a good reminder that it isn’t always appropriate or safe.
The fewer preconceived notions we have going into meeting a patient, the more we will be open to the reality the
patient presents to us.
sweiz: July 6, 2019, 8:07pm
“The fewer preconceived notions we have going into meeting a patient, the more we will be open to the reality the
patient presents to us.”
Of course, yet I’ve also seen Toby give a series of preliminary ideas to keep in mind around a single pathology. It
seems that he thought of this as useful, especially when the importance of a full evaluation is reiterated, as we have
done.
Donley: July 6, 2019, 8:37pm
Thank you @sweiz for the heads up about the SJ. That makes perfect sense. I, at times, still confuse myself with
Sa’Am!
KristinWisgirda:
The fewer preconceived notions we have going into meeting a patient, the more we will be open to the reality
the patient presents to us.
I always try to go into the treatment room with an “empty” mind, but I like to have a topographical map of the
situation.
UPDATE:
74-year-old Male. Yin pulses deficient. GB pulse very excess. Tounge: red, no coat.26/01/2024, 11:55Shingles and Sa’Am? – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/shingles-and-saam/346/print3/10
Pacemaker installed 2 years ago. Over 6’ tall, slightly overweight. Arms slightly dry. Overall he is a warm person.
He is an engineer and works in Canada so he has to cross the border every day for work. In addition to stress at
work, he is also dealing with stress at home with his partner because they are “two very different people”.
He has been dealing with the shingles outbreak for a month. Has seen multiple western docs with multiple
treatments with no improvement. I saw the patient this morning and Pc supplementation immediately started
raising its’ hand.
He reported to having a 6-hour cycle of intense burning pain building up starting at the left axilla then moving
down the arm to end near the left wrist (PC 6). The slow build-up would end with “the most intense arm on fire
pain” he has ever felt in his life for about 20 seconds. That pain would resolve by moving up back into the axilla
and would continue for another 20 seconds. Then he would have about 30 minutes of no pain before the cycle
would start again. He had one episode of the “explosion” of pain while driving and he reported, “It was all I could
do to pull over to the shoulder to wait out the pain.” I could feel heat radiating from the rash about two inches from
the skin.
Upon visual examination, I saw a 3 inch round rash solid dark red directly over the heart. Also a rash from the
axilla to the wrist traveling along the Ht and Pc channels with two papules in the axilla. When I was checking his
pulses he reported a 3 of 10 of burning sensation along his entire arm.
I had in mind Pc supplementation with Ub supplementation (for the fire) in my back pocket.
I started the Pc supplementation on the right side because of the location of rash and very excessive Gb pulse. After
10 minutes he began to feel tingling along the rash. After 20 minutes I check the progress of rash to see if there
were any change. His dark rash was completely gone from wrist to axilla! He had a dark bruise on his elbow (from
an injection at the E.R.) that I had not seen before because it had blended in with the rash. No change in rash on
chest. Because of the drastic change of the rash, I decided to keep him going another 15 minutes. After those 15 the
rash on the chest had reduced to 2.5 inches and the rash “broke” into a much lighter red and spotty instead of solid.
GB pulse re-checked and was mostly calm, ever so slightly excess.
After treatment, he reported that the burning was gone and replaced with a tingling nerve pain. He has a follow-up
tomorrow morning.
The rash and heat dissipating completely within 20 minutes was spectacular. I’ll still keep UB Cold in my pocket
tomorrow.
haunani: July 7, 2019, 12:47pm
Wow! So inspiring to hear and I’m so excited for your patient as well. Keep us posted.
michaelmax: July 7, 2019, 2:54pm
Thanks for the update @Donley!26/01/2024, 11:55Shingles and Sa’Am? – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/shingles-and-saam/346/print4/10
Hummm… I guess this Chinese medicine really works
Good call on the PC to treat the overactive GB, and for noting the heat and redness over the HT and considering
UB. Spot on.
Also, this from your first entry:
Donley:
For example, Lv fire should be treated with Sj tonification
I know you’ve already caught this, but I want to remind you and everyone that it is very easy to mix Saam and
TCM together in our minds and make a muddle of things. Much of what we’ve already learned does fit in here,
most of it really. But there are a few things that are quite different. This is one of them, and I think this is worth
noting—
When we say “liver fire” in TCM, that gets translated into “gallbladder fire” in Saam. All those times we harp on
the liver about being stagnant or liver qi rising, or liver fire… all that is actually the expression of Yang Wood…not
Yin Wood.
In TCM the Yin organs are preferenced, and as in this case, ascribed actions that belong to the Yang aspect of a
particular element.
Once you recognize there are yin and yang expressions of a phase, it gets a lot clearer.
Keep us posted. This is a great case. Thank you for sharing it
Donley: July 8, 2019, 3:57am
michaelmax:
When we say “liver fire” in TCM, that gets translated into “gallbladder fire” in Saam. All those times we harp
on the liver about being stagnant or liver qi rising, or liver fire… all that is actually the expression of Yang
Wood…not Yin Wood.
@michaelmax, I was aggravated with myself after this was pointed out as the Gb/Lv dynamic was an “ahhh!”
moment when I first heard it.
UPDATE:
Patient came in this morning for a follow-up. When he came to the door he was very disappointed with the results.
He stated no change, but upon further questioning, he did report that the cycle went from 6 hours to 11 hours
before the intense 40 or so seconds of severe pain. The rash on the arm was still gone and the rash on his chest was
still spotty. It was somewhat darker that the end of yesterday’s treatment but not as bad as before the treatment
yesterday. I could feel heat radiating from his arm between 1 and 2 inches from the skin.26/01/2024, 11:55Shingles and Sa’Am? – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/shingles-and-saam/346/print5/10
This time I addressed the fire with UB supplementation on the opposite side of the pain. I did add LI 11 bilaterally
(I couldn’t help myself!) After 20 minutes I inserted the Hua-Tou Jia Ji points level with UB 14 & 15 for 10
minutes (this is where we found slight pain, redness, and a very small rash directly on UB 14 & 15 both).
Before the treatment started, he reported pain at 7 of 10 and increasing quickly.
After treatment, he reported pain at a 2 of 10 & I could not feel any heat radiating.
I’m seeing him again tomorrow. Anyone see something I’m missing? This man is in a lot of pain in the form of a
burning sensation (the reason I had him come in on Sunday morning).
michaelmax: July 8, 2019, 4:23am
Hi @Donley, go easy on yourself. Most learning is a process of iteration. The first time we get the insight we
think we are brilliant. The second time we get it (after forgetting it, or just being buffeted by the chaos of clinic) we
think we are stupid. In truth… it’s neither. We are just learning medicine and learning to not be attached to feelings.
Great job on reeling him back in after “no change”
Often there is a change but the patient does not see it. Or discounts it.
My only suggestion is to not use extra points. I’ve found the Saam works best when super tight and targeted.
Adding other points can dilute the effect.
I’m curious, what did the patient make of the rash on the arm that so quickly disappeared?
Keep us posted. Great case!
1 Like26/01/2024, 11:55Shingles and Sa’Am? – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/shingles-and-saam/346/print6/10
Donley: July 8, 2019, 4:46am
michaelmax:
My only suggestion is to not use extra points. I’ve found the Saam works best when super tight and targeted.
Adding other points can dilute the effect.
Point taken
michaelmax:
I’m curious, what did the patient make of the rash on the arm that so quickly disappeared?
He was quite happy and very surprised! Like you and the tongues, I wish I had taken a before and after picture.
kyleguarneros: July 10, 2019, 5:08am
Sounds like you’re helping him to me! Thanks for sharing Donley!
kyleguarneros #13July 10, 2019, 5:37am
I’m also curious if there is a component of heat involved with PC supplementation?
Donley: July 10, 2019, 8:43pm
Update: I haven’t seen this patient again. He was scheduled for the next day, but he canceled. He was not
improving fast enough for his liking. He did report that a flair-up happened about an hour after the last treatment
then It was 12 hours before the next one. He was very thankful for my attempts, and I think I may see him again.
I’m curious to know from the more advanced practitioners their thoughts about actually draining the Ht channel in
this case. Per Toby’s and other’s advice, I have not drained using Sa’am. Is this a case to consider? Or in the future
consider UB supplementation from the start and possibly an additional two times to drive the fire out.26/01/2024, 11:55Shingles and Sa’Am? – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/shingles-and-saam/346/print7/10
Donley: July 10, 2019, 8:44pm
Hello @kyleguarneros. Thank you, and welcome!
KristinWisgirda: July 10, 2019, 9:20pm
Toby opens the Clinical Practicalities section of class by saying
“Completely avoid draining the Heart.
Completely avoid draining the Kidney.”
Donley: July 10, 2019, 9:54pm
Well, that answers that question!
Thank you @KristinWisgirda!
I’m only on day one lunch break in the St. Louis seminar. More tonight!
ngmatthews: October 4, 2021, 5:15pm
I will say that it is VERY difficult to deal with our patients’ unreasonable expectations of us. I always tell people
that I don’t do anesthesia, that I do healing, and healing takes time. I tell them that pain improves because health is
increased, and that we have to respect the time of the body. I tell them that for anesthesia they need a doctor. But
still they expect miracles. It can be so frustrating. I remember Toby saying he tells patients he “does slow
miracles”. I would also say that this patient’s very high expectations are another manifestation of his GB excess.
He sounds angry and irritated that you did not do the magic. These people are always difficult.
The other issue that is interesting in this case is that tonification of PC helped symptoms along the PC channel. We
think of that rash as an excess. And it is on the channel of deficiency. We again have to let go of some of our
thinking from conventional TCM and just try to be clear about exactly what we see.
Donley: July 11, 2019, 9:10pm
ngmatthews:26/01/2024, 11:55Shingles and Sa’Am? – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/shingles-and-saam/346/print8/10
The other issue that is interesting in this case is that tonification of PC helped symptoms along the PC channel.
We think of that rash as an excess. And it is on the channel of deficiency.
If I understand correctly, @ngmatthews, you are saying that because the rash is excess it may have been more
correct to supplement the GB in this case? And because of this, it is interesting that doing the opposite (supplement
PC) drove the rase to improve? Or is it that you think the GB was indeed in excess which lead to pathology along
the PC channel in this case?
Looking back on this case. I chose to Supplement PC for two reasons which may or may not have been the correct
decision.
1.) GB pulse very excess so I chose to supplement PC and the pathology was along the PC channel. (may be
correct Sa’am move)
2.) Pathology was along the PC channel. (This I now know to be NOT the correct Sa’am course of action). And this
is why it is interesting that this treatment had some success.
Monday morning quarterbacking in here is so fun and educational!
Donley #20July 11, 2019, 9:12pm
@KristinWisgirda, I had a good laugh a few minutes into the very next session I watched from the St. Louis
stream when he had several people repeat, “Completely avoid draining the Heart & Kidney channels”!
KristinWisgirda: July 11, 2019, 9:55pm
Donley:
I chose to Supplement PC for two reasons which may or may not have been the correct decision.
1.) GB pulse very excess so I chose to supplement PC and the pathology was along the PC channel. (may be
correct Sa’am move)
2.) Pathology was along the PC channel. (This I now know to be NOT the correct Sa’am course of action).
P+ worked awesomely at the first visit. Choosing based on channel location IS a totally legit Saam move. Keeping
to pure Saam diagnostics, an excess GB pulse is less relevant than the channel location. Keep to Saam, the
explosive nature of the pain gives more clinical weight for diagnosing GB excess.
From what I see, you did a great job choosing really helpful treatments. The strength of this man’s pathology is the
most likely factor that kept this case from being a 2 treatment miracle cure.
Donley #22July 11, 2019, 10:27pm26/01/2024, 11:55Shingles and Sa’Am? – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/shingles-and-saam/346/print9/10
KristinWisgirda:
the explosive nature of the pain gives more clinical weight for diagnosing GB excess.
Wow. That statement is something! That opens my understanding of GB excess being “explosive”. It does not
necessarily just mean a person’s reaction to the world; It can also be the reaction of a specific condition. The
patient’s condition was acting like “Mike Tyson”. Heat building and building until it just “exploded”. Thinking
back, the patient even stated the pain exploding at the end of a cycle.
Man, this medicine. . .
ngmatthews: October 4, 2021, 5:15pm
No, I am saying that it would be counter-intuitive in TCM to tonify PC when the excess was on the PC meridian. I
think the GB was overabundant relative to PC. We know that an overabundant channel can produce pathology
along its own meridian or its counterbalancing one.
In Saam we don’t use pulses except to monitor shifts in the situation. so #1 is erroneous thinking.
In Saam as I said above, pathology on PC could have been due to either PC or GB.
Taking the course once or twice or more can be very helpful to get perfectly clear on these concepts.
Ryan_Gallagher: July 12, 2019, 3:15pm
KristinWisgirda:
Sometimes channel, sometimes quality.
I have a question about this principle: Do you take the person’s constitution into consideration when choosing
whether a channel problem is excess or deficient? Say the patient presents with a case of BL excess sciatica
(stabbing, fixed, cold pain, worse with pressure and better with warmth) AND they are a HT excess constitution
(very talkative, hot, loving, etc.). I would assume that if the BL excess sciatica is the grossest presentation, it
shouldn’t be a problem to supplement HT, even though they naturally exhibit abundant HT already. Right? What if
the sciatica remains the grossest concern, and yet it’s more murky whether it’s BL excess or BL deficiency—would
you take in the bigger picture at that time, and, since the person is HT excess, lean toward supplementing BL? I’m
just trying to gauge the degree to which we should be isolating a channel issue from the person’s constitution.
KristinWisgirda: July 12, 2019, 8:06pm
26/01/2024, 11:55Shingles and Sa’Am? – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/shingles-and-saam/346/print10/10
Ryan_Gallagher:
I’m just trying to gauge the degree to which we should be isolating a channel issue from the person’s
constitution.
Ryan_Gallagher:
Sometimes channel, sometimes quality.
Add to that: Sometimes clinic is hard.