philipsuger: September 1, 2020, 12:31am
Saw a patient today who Yesterday threw out his back picking up his phone from the floor. Patient is 35 yrs old,
several years ago hurt his back weight lifting, from then on he has had some back pain issues that responded well
to acupuncture. Patient is overweight and robust. Pain is primarily located on the R side around the junction
between the back and hip, pain is sharp 10/10. Pain radiates down the back of the leg to the knee. After the incident
happened he went to the ER and had an xray done, there no abnormalities. He was prescribed meds but hadn’t
taken them yet. He came in with a walker the pain was so bad.
I first treated him with a channel based treatment haven gotten really good results in the past with these types of
cases. After his time was up he got up and the pain was just as severe as before, though the slight pain on his left
that he had was gone. So I had him lie down again to try Sa’am, I figured this was the time for the SI channel to
shine. So I supplemented SI on the L. Afterwards he got up and everything was pretty much the same.
Needles were good, they could have been thicker but I had gotten good results with them before. Kind of surprised
that it didn’t help him. Any other ideas that could have led to a better treatment? BL channel?
Daniel: September 1, 2020, 11:08am
I’ve had similar experience. We have to remember that while SI is a major choice for severe pain, it is
fundamentally related to Blood. . . . . blood stasis . . . blood flow. So now you can add to your understanding of this
case that getting blood to move did nothing for this case. Given the level it is at (UB 25 level) and that it is on the
right, perhaps look into things like LU-ST and SP-LI. I have some pretty remarkable results for severe one sided
low back pain with using these two pairs.
What is his ribcage like? Thenar eminence? Relationship to resources? Knee pain? if he is overweight,
supplementing LI (dry him out) can be remarkable. Couch potato? Compulsively industrious? . . . .
KristinWisgirda: September 1, 2020, 6:22pm
It’s so hard not to deliver pain relief when a patient comes in with 10/10 pain. Ughh! Not a good feeling.
Ditto to Daniel’s post. While the intro puts some emphasis on using SI+ for pain, all of the other channels can be
equally effective for pain. SI+ works when dynamic movement is needed, ie for blood stasis or when there is
excess consolidation of Kidney. Looking back on the patient, did he have blood stasis signs or the symmetry and
concern for oneself of K excess?
Besides Daniel’s St/Lung, LI/SP ideas, the pain radiating down what sounds like the UB channel brings to mind
H/UB. I would be questioning about hot/cold tolerance, palpating the abdomen for soft/hard of the midline, if19/01/2024, 11:03SI channel didn’t meet expectations – Sa’am Clinical Questions – Qiological Community
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possible. I try to find a subject that the patient might lovingly gush over- such as kids, pets, hobbies- to see if there
are indications for H excess.
Palpating the back to pinpoint the worst part of the pain is really helpful so you can consider the channel pair that
correlates with the back shu at the same level.
michaelmax: September 17, 2020, 12:55am
Daniel:
Given the level it is at (UB 25 level) and that it is on the right, perhaps look into things like LU-ST and SP-LI.
I have some pretty remarkable results for severe one sided low back pain with using these two pairs.
Hi @philipsuger
Yes, often +SI will help for pain if there is blood stasis, and in my book pain usually involves some aspect of blood
stasis, but as Daniel points out the shu location of the pain can also give you a clue.
So UB25 is the back shu of the Lg Intestine. Since this person is overweight (damp inside) you can consider
tonifying the LI on the opposite side of the pain.
Have you had a chance to do a follow up with this guy?
cassiopeia: September 17, 2020, 1:13am
Daniel:
Given the level it is at (UB 25 level) and that it is on the right, perhaps look into things like LU-ST and SP-LI.
I have some pretty remarkable results for severe one sided low back pain with using these two pairs.
I understand the SP-LI pair for low back pain b/c of damp and also LI back shu, but what is the LU-ST reasoning?
There’s not a corresponding low back shu point… Is it b/c LU-ST can treat damp or dry related low back pain? Is it
because in this case, the back pain is on the R, giving weight to using LU+?
thanks for answering newbie questions19/01/2024, 11:03SI channel didn’t meet expectations – Sa’am Clinical Questions – Qiological Community
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philipsuger: September 22, 2020, 1:43am
He went to see another practitioner unfortunately. This was a good lesson though, really driving home that SI+ is
for blood stasis pn and not all types of pn.
michaelmax: September 22, 2020, 2:25am
Here’s one of the things I have discovered about using Saam @philipsuger.
When it is right. It’s really right. When it’s wrong, people will be unforgiving. I know I lost some patients early in
the process of learning Saam because I not only did not get right, I got quite wrong.
Unlike other treatments where when you get it wrong it is not a such a big deal, because it just doesn’t do much.
When if you get the Saam wrong you’re doing something, and people get moved in a direction that is not helpful.
And they will not want to be subjected to that again.
Part of the way I knew that Saam had firepower, was by misusing it. Sorry to hear you lost that patient. It also fits
with my experience. Take it as learning and… Onward!!!
Daniel: September 24, 2020, 10:58am
cassiopeia:
what is the LU-ST reasoning?
Yes, being on the right is, in and of itself, as I understand it – a ‘gem’ that carries a lot of weight – so it immediately
puts Lu-ST in the ‘running’. Also, the pain goes to the knee and knee pain is a ST gem. In addition to that, and this
is my own thing, I’ll admit – its not ‘orthodox’ as i understand it – but its in my constellation of considerations just
outside of the ‘orthodoxy’ – what I would call ‘the adjacent pairs’ . . . so if the case calls for LI-Sp, I have in my
awareness ST-Lu as well; if the case calls for GB-PC, I have in my awareness TW-Liv as well; if the case calls for
Ht-UB, I have in my awareness Ki-SI as well. In part this originates with me and some channel patterns I was
seeing and investigating a LOT in my clinic in the years just before I started to do Sa’Am (there is a whole podcast
here on Qiological with Michael where I go into it in considerable detail).
KristinWisgirda: September 24, 2020, 12:31pm
Daniel:19/01/2024, 11:03SI channel didn’t meet expectations – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/si-channel-didnt-meet-expectations/1257/print4/10
knee pain is a ST gem.
Sorry, knee pain isn’t a gem. The gem for St excess, from the intro Powerpoint, is “weak knees (especially after
losing $) and has to sit frequently”. The need to sit is because of the weak knees.
Rightsidedness is a Lung excess gem. It is a St excess rock or gravel.
UB25 location points to LI/Sp. However, with low back pain I really like to poke around even when the patient
reports a fixed pain location. I have had cases where the pain is around UB25/26 but palpation at other levels yields
exquisitely tender points.Treatment based on the palpation points, for instance SI+ for Ub23 level pressure pain,
have yielded good results but there were always other pointers to pathology in that channel pair anyway. So I could
see the pain being at UB25 but then finding a markedly tender point at the level of UB21 and then treating St or
Lung.
amyodellwilson: September 24, 2020, 6:27pm
I had a very similar experience this week with a 52 year old female with “Sciatica Crisis” as she put it. Same
location UB 25-26 down the back of the R leg. She described it as a 10/10 searing hot knife pain that would drop
her to the floor into childs pose to get relief which I unfortunately witnessed within a minute of needling SI+ on the
L. I quickly pulled the needles as the pain intensified. She jumped off the table and went to the floor. My next
intention was to do the opposite as the training suggests until she stated, unsolicited, that she felt like everything in
her body was consolidated. I hit the pause, welcomed her back on the table to try another approach and changed
methods to release the Gluteus muscles and the piriformis as I learned in Ortho acupuncture. Starting on the R Glut
maximus, GB 30 gave relief, Piriformis trigger however intensified everything again. I pulled that needle and went
to the L Piriformis thinking treat the opposite side. It worked. Slowly the pain decreased she said her entire upper
body relaxed for the first time in weeks. She should still feel the burn on the back of her leg but it was diminishing.
I left the needle for about 15 minutes and never added another. She left at 0/10 which maintained for a few hours.
She returns tomorrow.
What is notable is that she is very thin, skin not particularly dry or wet, good stools, cracked heels, asymmetric
face, explosive and reactionary with anger but not physical, demands an intense level of perfection with only one
way to do things at work and from others, but home is messy. Does not feel like she has taken a deep breath in 18
years. Does not feel good about relationship with parents. Would prefer lying out on a hot beach, anger directed at
self, eyes are more dull, she came in talking a mile a minute and telling me so many details about her life beyond
the direct pain. Palpation of Sacrum found point tenderness at UB 25, 26 and just off the edge of the sacrum at this
area there were palpable lumps. When I withdrew this piriformis needle, red blood followed.
She is convinced this is tied to an unidentified emotional pattern. I am so glad I saw this post today. I have been
thinking about UB +L because she talks of hot burning pain and she is an RN and mom who gives and gives. I also
thought of the GB/ PC because of the glut release, but not much else fit. There seems to be alot of TE, but not the
eyes. Now thinking about LI/SP or ST/LU is the ticket.
I think she was willing to get back on the table and try again because I told her right at the start that the protocol I
was trying was known to release pain, but it might not and we would know immediately, which we did. It is the
benefit and curse of SAAM.19/01/2024, 11:03SI channel didn’t meet expectations – Sa’am Clinical Questions – Qiological Community
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I graduated last September and starting trying SAAM last fall when I opened. During the COVID break I took
Toby’s class which really made a difference in understanding.
Daniel: September 24, 2020, 7:17pm
KristinWisgirda:
Rightsidedness is a Lung excess gem. It is a St excess rock or gravel.
Oh – that’s interesting!!! Because for the Liver / SanJiao pair as I understand it, Left sided issues can point to either
member of the pair. But for the Lung / Stomach pair, right sided issues ONLY points to the Lung end of the pair?
Have I got that correct Kristin?
and right! thanks for the correction – its not knee pain, its knee weakness, sitting frequently, loss of resources.
KristinWisgirda: September 24, 2020, 7:24pm
Thanks for the case @amyodellwilson. It sounds like an intense experience!
amyodellwilson:
Now thinking about LI/SP or ST/LU is the ticket.
I’m not so sure about that. Maybe I am reading your case incorrectly, but I am seeing a couple of elephants in the
room pointing in a different direction.
amyodellwilson:
UB +L because she talks of hot burning pain and she is an RN and mom who gives and gives.
The burning pain was going down the UB channel too.
amyodellwilson:
she came in talking a mile a minute and telling me so many details about her life
This intense monologuing appears to be a significant part of her presentation. Added to the above, it sounds like
she needed an ice cold bucket of water.
amyodellwilson:
she felt like everything in her body was consolidated19/01/2024, 11:03SI channel didn’t meet expectations – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/si-channel-didnt-meet-expectations/1257/print6/10
Oooh- she used one of our words. I might have been thrown by this too. K+ probably wouldn’t have been perfect
for her in the moment but keep it up there on your list for when she returns.
amyodellwilson:
I also thought of the GB/ PC because of the glut release,
How about her admitting to “explosive and reactionary with anger” and “does not feel like she has take a deep
breath in 18 years”. Unless she is super smart, it looks like the scale tips strongly to GB excess. Lumps off the edge
of the sacrum are also in GB channel territory.
Let us know what happens, please!
KristinWisgirda: September 24, 2020, 7:32pm
Hi Daniel,
Daniel:
Because for the Liver / SanJiao pair as I understand it, Left sided issues can point to either member of the pair.
But for the Lung / Stomach pair, right sided issues ONLY points to the Lung end of the pair?
I am making a distinction between gems and rocks here. Both gems and rocks have clinical weight. Lung excess
manifesting on the right and Liver excess manifesting on the left are clearly gems. Toby has expressed hesitation in
the counterbalancer excesses having the same sided manifestations being labelled gem status. The intro powerpoint
reflects that. It is still a really clinically useful idea that pans out in the clinic all the time, even if it is officially a
rock.
How we weight symptoms can make a big difference in our outcomes. I am making gem and rock technical terms
that reflect distinctions Toby thinks are important.
Daniel: September 24, 2020, 11:42pm
ah, ok, I did not realise that Lung and Liver had right and left sided gem status but the Stomach and San Jiao
partners were only rock status! Thanks for the clarification Kristin!!
Daniel #15September 24, 2020, 11:43pm19/01/2024, 11:03SI channel didn’t meet expectations – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/si-channel-didnt-meet-expectations/1257/print7/10
oh, and yes, I also find often when people just point to their low backs, it looks like they are pointing to UB 25 but
I’ve certainly had a few times where upon further examination, really UB 21 is the epicentre of the pain
cassiopeia: September 25, 2020, 1:48am
KristinWisgirda:
Lung excess manifesting on the right and Liver excess manifesting on the left are clearly gems.
Hi Kristin, I am looking at the powerpoint again and it says ST excess: pathology tends to manifest on the right
side of the body…
SJ excess: Pathology tends to manifest on the left side of the body.
So, consider treating R sided issues with LU+, L sided issues with LV+. Is that what you mean?
KristinWisgirda: September 25, 2020, 9:55am
Aha! Thanks @cassiopeia. Toby must have updated the Powerpoint for the last class in reconsideration of this
issue. Last year he hesitated to give the ST excess and Sj excess side manifestations gem status.
I will downloaded the most up to date powerpoint from the intro class.
kellykd: September 25, 2020, 3:30pm
Yes, also have right side of body for Lung XS. I was in the last last Aug in NY.
I also have Never bored for Lung XS (As well as LI XS) and have been doubting that that is correct for a year.
KristinWisgirda: September 25, 2020, 11:23pm
kellykd:
I also have Never bored for Lung XS (As well as LI XS) and have been doubting that that is correct for a year.
Never bored is a LI excess quality in contrast the bored tendencies of Sp excess.
kellykd:19/01/2024, 11:03SI channel didn’t meet expectations – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/si-channel-didnt-meet-expectations/1257/print8/10
I was in the last last Aug in NY.
There have been some small changes regarding channel excess to the intro Powerpoint in subsequent classes. It
seems that it is now a gem that Stomach excess can tend to have manifestations on the right and SJ excess can have
manifestations on the left. We knew these were clinically relevant but how they rank on the scale of clinical weight
has gone up.
1 Like19/01/2024, 11:03SI channel didn’t meet expectations – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/si-channel-didnt-meet-expectations/1257/print9/10
amyodellwilson: October 14, 2020, 8:18pm
Return Visit -It was something
CC: R leg searing pain from BL 34 to BL 40.
S: there has been some improvement since Tuesday’s visit. Pain is now consolidated to just the upper hamstring.
The episodes of 10/10 come less frequently and with shorter duration. There has also been an improvement in
sleep. She smoked a THC blend on thursday night to cut the pain. The treatment from Tuesday lasted several hours
and reduced the intensity overall. She has been journaling, walking, meditating and “talking to the pain”
She describes the pain as a searing cutting hot knife, but does not get the sense that it is a” fire that would be put
out by water” it feels much more electrical.
O: She came into the office much calmer than first visit with mild pain 2/10. She was able to sit for 5 minutes and
just talk through the intake without urgency. Her body was in a relaxed posture and her voice was relaxed during
the intake. At first she asked many questions about my family until I stopped the conversation to direct it back to
her. Giving her the hour to focus on herself. She stated that her teen and home and her undergraduate students
made it impossible to ever focus on herself. Local palpation showed.GB 30 and piriformis tender but not as much
as Tuesday. Palpation of G. Minimus trigger points elicited the pain.
Assessment: SAAM GB excess, PC. Wind attacking BL channel. Qi stagnation in BL channel.
Plan: PC + L for root and local Glut/ piriformis needling.
As last time, the pain returned intensely with the 4 needles, though not as intense at first. She described it as
coming in waves, each one less. Within 5 minutes the pain increased to 10/10. Through the waves there was also
waves of intense crying. I removed the four needles, and went for the GL minimus release on the L side and the
piriformis release on the L. It was knocking down the pain, but spasms in her l calf began. She asked me to release
the piriformis on the R it felt good at first but then the waves of pain returned. I used vibration massage over the
back and up and down the Bladder channel just to distract and relax the body. I removed all but the piriformis
needle on the L. She said the pain was abating and asked to just lay for another 5 minutes. When she left she was
calm and said she had felt a shift as she had on Tuesday as well. The pain was present 5/10, but she was hopeful
and rebooked. She cancel her appointment, but sent me this ” Thank you for your help these last 2 visits. I am
doing better, believe it or not. I’m doing some serious brain/mind work and its helping. It was a pleasure to work
with you.” I’ve only been in practice a year, this was pretty intense.
Thank you for taking an interest in this case Kristin, it helped me have more confidence heading into the 2 nd visit.
KristinWisgirda: October 15, 2020, 1:20pm
amyodellwilson:
Return Visit -It was something
My system gets rattled just reading about trying to treat someone in that much pain. Yikes!19/01/2024, 11:03SI channel didn’t meet expectations – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/si-channel-didnt-meet-expectations/1257/print10/10
amyodellwilson:
At first she asked many questions about my family
amyodellwilson:
She stated that her teen and home and her undergraduate students made it impossible to ever focus on herself.
Given these, the location of the pain and a number of other factors mentioned in previous posts, I would have
gotten her on the table and treated UB+.
amyodellwilson:
As last time, the pain returned intensely with the 4 needles, though not as intense at first. She described it as
coming in waves, each one less. Within 5 minutes the pain increased to 10/10. Through the waves there was
also waves of intense crying.
Removing the needles and inserting UB+ would have been a reasonable plan here too.