Understanding the difference between Sj/Liv PC/GB

Shanlarson: April 24, 2019, 3:26pm
Anxiety and OCD
I have a patient whose chief complaint is anxiety and OCD. She’s very thin, 20 years old and has the look of a
teenager still. Her tongue is red/purple. Her pulse is thin. She sweats easily. She has dry skin and weak nails. Her
periods are painful for which she craves warmth. She has cold hands and feet but feels warm in core. No digestive
issues but she is quite thirsty for cold drinks.
She says her main issue is that she will check something again and again if her anxiety is high. For example
making sure the door is locked at her home. She’ll get out of bed many times to check if it’s locked. Her anxiety
attacks present as shortness of breath and shaky. Herb-wise I know what I want to do but she wants to start with
just acupuncture.
She’s seems quiet, and gentle. My first thought was SJ XS and treat the liver. It seemed to me she needed to feel
more shielded/protected but I’m not 100% sure that was right. She seemed like she was very alert through the tx
although she looked more relaxed as she left. I’m wondering if I should have treated the opposite. By repeating and
repeating a behavior was that more her shielding herself, over controlling and therefore perhaps she needs more SJ.
After a Q&A in the GMP I felt a better about understanding the difference between Liv/SJ but sometimes it’s still
fuzzy to my head. Could this be a more GB situation?
I thought about treating HT to balance BL XS thus treating fear but with her red tongue and desire for cold
beverages I didn’t want to add heat.
I would love to hear any thoughts. Thx!

Raui: April 24, 2019, 5:26pm
GB has an outward aggression. Fighter/Boxer energy. They’re guarded with a sword ready to attack if I remember
the archetype from the class. SJ is more like outward awareness, like Toby has said before – a tea ceremony with all
its subtle attention to every little detail is very SJ . Shaoyang in general has an outward direction, I could see the
easy sweating as a manifestation of excess SJ energy. I might’ve gone with SJ excess for my first thought too.
Seems she has cold in some places and heat in others, SI if I remember correctly is appropriate for separation of
heat and cold type presentations. Considering this with the fact she also has a purple tongue indicating potential
blood stasis, there is also period pain, SI seems like a possibility here too. Though it sounds like there might also be
some blood deficiency in the dry skin and brittle nails.
I know 2 channels at once is not recommended for beginners so my thought is maybe do Lv again and alternate
with SI which makes me think Tao Hong Si Wu Tang. Another approach could be the Lv/Ht approach, Lv to take
the brunt off the heat of the heart. Dang Gui Si Ni Tang I think was the formula that Michael likened this combo to.24/01/2024, 11:53Understanding the difference between Sj/Liv PC/GB – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/understanding-the-difference-between-sj-liv-pc-gb/152/print2/22
Would love to know others opinions.

ngmatthews: October 4, 2021, 5:15pm
From your description I see both Blood Stasis and Blood deficiency. And clearly San Jiao excess type. As Toby
told us in Seattle, it is good to come up with 3-4 potential patterns that you think fit and do your best guess the first
time. I think I’d repeat Liver again because that can help with Blood deficiency. I’d recommend Small Intestine
because it is good for Blood stasis, due to its having both warming and cooling properties that move the Stuck
situation. Even though she does not display anger obviously, some deeper questioning could reveal a Gb pattern.
I’d definitely put PC on my list for her, as we know it is very helpful for insomnia, according to Toby. As for Ht
deficiency, this would be a colder person who lacks love for others. Def Ki type is more lacking in self-love and
can be a cooler person, since Ki is fire and water. Hope this helps.

Shanlarson: April 24, 2019, 5:55pm
Thanks for all the insights. I love hearing how other people are seeing it. SI wasn’t on my radar for this one but it
does make total sense. I look forward to seeing how this unfolds. It’s interesting to consider strengthening PC for
insomnia. I was more thinking strengthening GB because she has more a quiet subtle librarian energy to me.
I’m loving the SAAM acupuncture although I’m finding it peaks and valleys in my learning curve but when it’s the
right treatment it has reinforced in me how incredibly effective and strong acupuncture can be!

michaelmax: April 24, 2019, 10:50pm
Raui:
I know 2 channels at once is not recommended for beginners so my thought is maybe do Lv again and alternate
with SI which makes me think Tao Hong Si Wu Tang. Another approach could be the Lv/Ht approach, Lv to
take the brunt off the heat of the heart. Dang Gui Si Ni Tang I think was the formula that Michael likened this
combo to.
HA! Spot on @Raui, in the beginning, especially for a patient like this it is best to only use one channel,
otherwise you will never really clarify your diagnosis.
Indeed there are aspects of blood stasis and +SI is a good solution for that. But I would first work the +LV more
first. I do not see the constant checking as a way to “creating shielding” that being said, it would be helpful to get a
better sense of her eyes. Kind of dull and inward, that is more Liver shielding, Bright with piercing express, that is
your SJ excess.24/01/2024, 11:53Understanding the difference between Sj/Liv PC/GB – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/understanding-the-difference-between-sj-liv-pc-gb/152/print3/22
Remember too that while sometimes miracles happen in one treatment, most miracles take some time to unfold. So
give it a treatment or two moving her in a specific direction before shifting unless your previous treatment was
clearly wrong. Like with herbs, it is helpful to stay the course a bit rather than constantly modify.
ngmatthews:
As Toby told us in Seattle, it is good to come up with 3-4 potential patterns that you think fit and do your best
guess the first time. I think I’d repeat Liver again because that can help with Blood deficiency.
I’m with @ngmatthews on this. Come up with 3 potential diagnosis, it helps to broaden the thinking and catch the
blind spots. And again, I’m wanting to bump her liver as well.
KristinWisgirda #6April 25, 2019, 11:38am
Shanlarson:
I’m wondering if I should have treated the opposite. By repeating and repeating a behavior was that more her
shielding herself, over controlling and therefore perhaps she needs more SJ.
Patients are self medicating all the time with their behaviors. It can be helpful to try to tease out the compensations
so that you can see the deeper core.
I have a super polite patient with piercing eyes whose chief complaint is alcoholism. His urge to drink immediately
lessened with Liver supplementation.
It sounds like calm intelligent Pericardium would ease that compulsive activity. Though Gb excess is framed as
aggression, to my mind a lesser version of that is reactivity, an inappropriate tendency to act. I wonder if this is
why Pericardium supplementation can be helpful with insomnia, even in the absence of anger and aggression. At
night, you need calm inwardness to sleep. Any kind of hyperactivity at that time- mental or otherwise-might be a
relative GB excess. I’ll check with Toby to see if this thinking is correct.
Let us know what happens!

Tobydaly1: April 25, 2019, 3:18pm
KristinWisgirda:
Though Gb excess is framed as aggression, to my mind a lesser version of that is reactivity, an inappropriate
tendency to act.
Definitely. GB excess is associated with quickly changing emotions – with the high likelihood of reacting to those
emotions.24/01/2024, 11:53Understanding the difference between Sj/Liv PC/GB – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/understanding-the-difference-between-sj-liv-pc-gb/152/print4/22

michaelmax: April 25, 2019, 6:45pm
Tobydaly1:
Definitely. GB excess is associated with quickly changing emotions – with the high likelihood of reacting to
those emotions.
So it is not just about “fighting or aggression” (although that can be the case) but more a mercurial shift in affect
along with reactivity.

Tobydaly1: April 25, 2019, 7:21pm
Yes, fighting is the end product of: some type of external stimuli -> emotional reaction-> biochemical changes ->
biochemical changes making unpleasant sensations on the body -> mental reactions to those sensations -> and if
those mental reactions get strong enough -> physical action.
People with GB excess rush quickly through these steps.

Shanlarson: April 25, 2019, 7:34pm
Well I have learned a lot in this thread. I have been feeling like there were more nuances to the GB/PC SJ/LIV
pathologies but wasn’t quite sure how to understand them. SJ having that “tea ceremony” aspect really helped and
the fast changing emotion of the GB tendency really makes sense.
I think my one question and it’s probably a skill I need to cultivate is understanding the change in the face. It seems
most in this thread think staying with Liver supplementation is a good tactic for the next treatment but the reason I
questioned this strategy to begin with is I didn’t see a change in the face and she seemed awake and wide eyed
through the treatment. I guess I will evaluate again next treatment but at least I have other options floating in my
head. Thank you!

KristinWisgirda: April 25, 2019, 7:40pm
Toby emphasizes the face change and overall settling as key indicators of appropriate treatment. If you felt like
your needles really connected and were properly stimulated, then trying a strategy besides Liver makes sense.
Supplementing Pericardium is my vote given the chief complaint.24/01/2024, 11:53Understanding the difference between Sj/Liv PC/GB – Sa’am Clinical Questions – Qiological Community
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Tobydaly1: April 28, 2019, 9:25pm
Definitely consider supplementing Pc in this case. Please let us know how it goes.

Shanlarson: April 30, 2019, 1:55am
I saw this patient again today. Interestingly strengthening the Liv was NOT the right direction. She woke up the
next morning in a panic with her heart racing. She felt her symptoms got worse for about 3 days and then leveled
out. So today with some further discussion with her I found out she use to have night terrors as a kid. These anxiety
attacks started about then. The rest of her symptoms were the same. I strengthened PC which felt right based on the
discussion here and with this new info. She did settle more and fell asleep on the table. I also prescribed herbs but
asked her to wait a couple of days before starting so I can tease out what may be the herbs vs acupuncture. So we
will see.

KristinWisgirda: April 30, 2019, 12:41pm
@Shanlarson Thanks for the update. The panic episode the night after the Liver+ treatment is quite surprising. So
this is what can happen when a system that needs the warm calming intelligence of Pericardium gets too much cool
heavy dull energy of Liver. This situation is also making me ask what really needs to be balanced for deep
restorative sleep to happen? I’m sitting with it and not totally understanding it. Maybe more cases will help me
really get this dynamic.
Every case shared has been really helpful for me.

KristinWisgirda: April 30, 2019, 1:04pm
Tobydaly1:
Yes, fighting is the end product of: some type of external stimuli -> emotional reaction-> biochemical changes
-> biochemical changes making unpleasant sensations on the body -> mental reactions to those sensations ->
and if those mental reactions get strong enough -> physical action.
People with GB excess rush quickly through these steps.24/01/2024, 11:53Understanding the difference between Sj/Liv PC/GB – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/understanding-the-difference-between-sj-liv-pc-gb/152/print6/22
Calmly considerate Pericardium slows this process down at the level of emotional reaction. It sees the external
stimuli and discerns that the situation is safe. Abundant Liver might damp down the GB reactivity by shielding a
system from external stimuli but doesn’t provide the intelligent knowing that right now everything is OK.
I’m just talking it through. How does this sound?

Tobydaly1: April 30, 2019, 7:08pm
Yes, well articulated. Aren’t you supposed to be on vacation?

michaelmax: April 30, 2019, 7:28pm
KristinWisgirda:
Calmly considerate Pericardium slows this process down at the level of emotional reaction. It sees the external
stimuli and discerns that the situation is safe. Abundant Liver might damp down the GB reactivity by shielding
a system from external stimuli but doesn’t provide the intelligent knowing that right now everything is OK.
This is a helpful distinction of the inward jueyin influence. The PC brings the aspect of
fire/intelligence/communication. The LV brings the aspect of wood/cool/withdrawing/shielding.
They each they their place. And with this case in particular it shows how the different sides of the jueyin can bring
out very different resources for a patient.

Joanne_Tait: May 6, 2019, 4:33pm
This discussion has been very helpful for parsing out the differences between these systems for me, thanks to
everyone for their comments and insights. It made me think of a patient I had the other day who came in quite late,
so I didn’t have much time for the treatment. She said she had an anxiety attack on the way over, so I tonified
pericardium for her. She felt better and said it brought her back from the edge. At the time, I didn’t have as clear of
an understanding of pericardium, but this discussion helps me see how that system was most beneficial for her at
the time to slow down her level of emotional reactivity to everything. I am really enjoying working with this
system so much.

Ryan_Gallagher: May 6, 2019, 7:39pm

24/01/2024, 11:53Understanding the difference between Sj/Liv PC/GB – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/understanding-the-difference-between-sj-liv-pc-gb/152/print7/22
I’ve heard Toby say to be very cautious in supplementing GB. I’m wondering what might be some examples when
supplementing GB is warranted. We can, of course, do +GB to counterbalance a PC channel disturbance or in cases
of a deficient GB channel presentation. But what about other instances? PC is the librarian archetype. In what sorts
of cases would we want to coax the librarian’s energy outward and upward? Perhaps in cases of deep fatigue? Lack
of motivation? Alienation? What about repressed anger—how do we know when it’s skillful to draw that repressed
emotion outward? Any thoughts would be very helpful!

michaelmax: May 7, 2019, 4:04am
Good questions @Ryan_Gallagher, I would think that a +GB situation is where someone is just not coming
forward into parts of their life that they are sort of abdicating. Areas where you might need some decisive, outward
movement.
I’d be careful with deep fatigue. I suspect the key thing here is what is causing the fatigue. If it is a collapse of
energy inward then maybe.
Likewise…alienation… again I think we need to look at what has brought that about and what does it mean to the
patient.
We probably need the clinical data points of other practitioners here. I don’t have a lot of experience of +GB. The
first I did it the treatment really took my patient in a bad direction. The second time was a week ago, I got the
needles in and it felt wrong. Face flushed, pulse tightened.
Now some of that I suspect is normal when doing a +GB. But I don’t my patient was ready for the energy that
going to bring up. Really I’m a bit nervous about adding to the GB with this system.
Let’s see what other’s have to say.

haunani: May 7, 2019, 6:30am
in response to @KristinWisgirda as well…(not sure how to highlight text yet)…This is making me really think of
so many conversations I have with moms with toddlers (I’m thinking of myself as well) who feel like they are
doing their best to keep it together. They are having a good day and then one little thing (a small spill, talking back,
not being on time) can set them off and they “lose it.” The bottled up yang energy gets released and it comes out
almost inappropriately for the situation at hand (although it could have been building for hours or days). Up until
now, I had been looking more at the warmth and cooling aspects of the HT and KI as ways to manage these
emotional releases but now I am completely looking at the inward/outward nature of these reactions as a jueyin
aspect. I know I need to take the person’s other symptoms, challenges, and body types into consideration but just
trying to understand the jueyin/shaoyang through this conversation has been so helpful.
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KristinWisgirda: May 7, 2019, 4:43pm
Ryan_Gallagher:
I’m wondering what might be some examples when supplementing GB is warranted.
I’ve GB+ once- for the patient in the Slow Healing Wound Post. Her chief complaint was fatigue. She wondered
why she is tired all of the time while she plays indentured servant to her clients and her husband who is a member
of the Burmese royal family and expects to be treated as such even though he lives in suburban Massachusetts. She
was clearly in need of some righteous standing her ground. After that treatment she noted that she was taking more
time to take care of her needs and not sitting through her husband’s political rants. Yay!
This patient clearly had not boundaries.
Ryan_Gallagher:
What about repressed anger—how do we know when it’s skillful to draw that repressed emotion outward?
If anger is already there, even if repressed or just in the form of thoughts, I would think of other ways of supporting
the patient before GB+. The presence of anger in any form means that there is GB energy present. Ask if this
patient really needs help brandishing the sword and has enough P energy to do it responsibly and safely.

Jeffrey: August 23, 2019, 4:11pm
thanks to ALL for these clinical insights and sussing this topic’s differentials out, very helpful info. now the real
test, If I can apply only apply your wisdom in the clinic
kind regards

dcvalley: September 22, 2019, 7:50pm
Regarding +GB, I have used this quite a few times in the last 6 months. Prior to Saam, I would have called it a wen
dan tang presentation. These are usually ladies, who by the end of treatment have initiated divorce proceedings.
Basically they are finding their courage. Most of my patients have only needed one treatment, in fact more
definitely seemed inappropriate. I won’t do the treatment if they are prone to acting out of anger. Simply
questioning helps settle that easily for me. It is probably the most profound of the saam interventions per my
current experience. Three of my patients, the first a social worker who had basically had a nervous breakdown. I
tried a few other interventions (sorry I don’t have my notes in front of me) per seam, they weren’t working so I
using pulse and palpation tonified kd. Then after a few weeks did the +GB treatment, with profound response. All
anxiety disappeared, her happy bubbly self returned, within two weeks she was able to return to work. I think we
repeated this pattern 4 times over 4 weeks. The second was a stay at home mom who is the frequent victim of24/01/2024, 11:53Understanding the difference between Sj/Liv PC/GB – Sa’am Clinical Questions – Qiological Community
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spousal abuse. I will spare the days of our lives details but intellectually she knew what do do, she had been
working with her therapist for years on plans contingencies etc. After her venting to me before a session this
seemed and appropriate intervention. She loved it, she felt “powerful” per her words. Over the next few weeks she
kicked her husband out and initiated divorce proceedings. No violence, just resolute action. We have done it
weekly for a few months. Though is it feeling less indicated. This led me to look for other people to use it for.
Another patient a recent widow I have treated for years, was in desperate straits, she was having profound gb pain.
She also could not get a handle on cleaning of the affairs of her late husbands estate, the property or really taking
care of herself. I tried the +gb and she felt immediate gb improvement and started to be able to organize her affairs.
We have done this 12+ times with every lengething time between tx’s, but he gb has stayed clear and she is finally
able to face going forward with her life. I also as an experiment did this with my wife, whose midwestern
politeness can sometimes be mistaken for meekness even by her husband. She did not like it, I noticed no increase
in aggressiveness,but definite more frankness and directness in her approach both at her work and at home. I did
not repeat it, this is an example of one off and done.
I am still working out what specific situations/signs/symptoms/pulse etc call for this. at the moment it is still
mostly intuitive, and as described above if I would have thought herbally about wen dan tang it comes right up into
consideration.

michaelmax: September 23, 2019, 4:51am
Spot on with the Wen Dan Tang @dcvalley. I like that Rx for people with a certain kind of anxiety and after
reading your thoughts it does resonate with me.
I’ve done +GB a few times. Like with your experience… it tends to be on women who are “too nice,” or not
stepping in their life and feeling overwhelmed.
I think the first person I did it on a while back did not do well. But I think that was because of a lot of inner anger
that she usually refuses to express. Just stirred her up too much. But for the other folks, yes… they often make
decisions and get on with things.

KristinWisgirda: September 23, 2019, 3:18pm
Such wonderful results!
dcvalley:
We have done it weekly for a few months.
For those new to Saam, know that in general, it is not recommended to repeat the same treatment more than twice.
Toby says that he rarely repeats the same treatment 3 times in a row because there is a risk of creating imbalances.
However, he has one patient with very strong pathology where he breaks his own rule and treats St+ most often24/01/2024, 11:53Understanding the difference between Sj/Liv PC/GB – Sa’am Clinical Questions – Qiological Community
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because it just works better than any other strategy. Some students will know this patient from a case study
presented in class: Robert of copious phlegm +myasthenia gravis + awesome K excess consitution.

ngmatthews: October 4, 2021, 5:15pm
I agree with your experience Dr Valley, I have used the Gb+ in women who seemed overly controlled by their
husbands, but unwilling to stand up for themselves. It has never been too much. They seem to find that they can
more easily assert themselves appropriately, and are less anxious because of it. This type of anxiety is clearly
unexpressed anger, and it is healthier for it to be able to be expressed.
We often think of treating anxiety with approaches that we assume tend to calm the system, such as Lv+ and Pc+,
but here we are using an approach that seems like it might make the problem worse, but it works in the correct
patient because it lets the pressure out of the balloon. So Healthy.
I think in a way that this is the true function of a well-operating Gb. I remember from TCM it was said that Gb
controlled “will”. This seems to be that function. The Mike Tyson pattern is the overabundant overfunctioning
pattern. This is the healthy pattern of energy that comes in and must go back out. The circuit is complete.
I think it is more tricky in someone who is irritable with their anxiety. In this case, we are at risk of pushing that
irritability to be inappropriately expressed. That is a case where one’s judgement would come into play. And you
would learn the result.

KristinWisgirda: September 23, 2019, 6:42pm
dcvalley:
I am still working out what specific situations/signs/symptoms/pulse etc call for this. at the moment it is still
mostly intuitive,
It may feel that way but your post has many clues that you have used GB+ conscientiously. You are determining
that they aren’t
dcvalley:
prone to acting out of anger.
And have a need for “resolute action” and “finding their courage”.
Thanks again for the cases.
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f.nunnariTCM #29October 30, 2019, 2:50am
So Pc Xs patients would not exhibit any anger/frustration? What about of a more verbal kind? i picture them as
having a bit of a verbal sting, but would never think about using physical violence. They get upset with the
injustices of the world, or with people who they perceive as ignorant or perhaps for example animal rights
activists…?

KristinWisgirda: October 30, 2019, 1:31pm
The GB/P pair is about how one reacts to stimuli.The inward Jueyin + intelligent fire of P capacity processes
intellectually. The windy wood outward moving Shaoyang of GB is the capacity to act and move out into the
world. The action/reactivity of GB is on a continuum of asserting oneself outward- thoughts, then words, then
actions.The more aggressive one’s thoughts/words/actions the more GB energy there is behind them.
People with P excess can certainly be frustrated and perceive injustice but because they have a relative GB excess,
they are less likely to do anything about it.

George_Mandler: October 30, 2019, 2:38pm
KristinWisgirda:
People with P excess can certainly be frustrated and perceive injustice but because they have a relative GB
excess, they are less likely to do anything about it.
Do you mean bc they have a relative GB deficiency?
That lack of GB energy meaning a lack of voice, feel they cannot speak their mind etc. I had a great case 2 weeks
ago with an irritable and angry woman where GB supplementation totally relaxed her and made her incredibly
calm. Her entire family noticed how ‘relaxed’ mom was. I just need some moments to write it up.

KristinWisgirda: October 30, 2019, 6:11pm
George_Mandler:
Do you mean bc they have a relative GB deficiency ?
George, thank you for catching all of my typos!24/01/2024, 11:53Understanding the difference between Sj/Liv PC/GB – Sa’am Clinical Questions – Qiological Community
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Daniel: October 31, 2019, 12:25am
George_Mandler:
where GB supplementation totally relaxed her and made her incredibly calm
I’ve seen this too. And it speaks better than just about any other example I can think of to the fundamental power of
getting to the centre of what is off balance with a patient. The fact that supplementing Gall Bladder and all of the
Tysonesque nature it invokes would make a patient deeply relaxed is such a remarkable statement.
1 Like

f.nunnariTCM: November 1, 2019, 3:29am
I currently have a patient with “irritable” bowel syndrome, as soon as she has an anxious thought, her bowel can
move 3-5 times within an hour, which makes her more anxious…she is very intellectual and articulate, she keeps
up with all modern research, particularly researching her condition, doctors/pharmaceuticals etc, which…creates
more anxiety. Her symptoms started shortly after her husband had a stroke, and now relies on her full time care,
she has days where she is very frustrated with her situation and angry with him…from my view, is it correct to say
she exhibits both gb and pc characteristics, or a more suppressive gb deficiency?

ngmatthews: October 4, 2021, 5:15pm
I would venture that she is a PC excess type, thus deficient Gb. Some GB supplementation might be very helpful,
along with other things as you go along.

f.nunnariTCM: November 1, 2019, 11:51pm
I was getting very clear feedback when I started doing Saam treatments for her, (she responded well to St+) but she
has since started low dose amitryptaline, and I am finding it hard to know what is the result of my treatment and
what is the result of the drug.
KristinWisgirda #37November 3, 2019, 11:41pm24/01/2024, 11:53Understanding the difference between Sj/Liv PC/GB – Sa’am Clinical Questions – Qiological Community
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Being intellectual and research oriented are clear signs of P excess.
How much GB excess she has depends on how much outward movement of qi/wood wind she is manifesting. The
degree of assertive expression and aggressive action determine the degree of Gb excess. Ask yourself how likely
she is to act verbally or otherwise on her frustration and anger.
I have patients who have strong P and strong GB- they cite research with sword in hand, ready to stab you if you
disagree.
Then there are P excess folks who are frustrated and angry impotent. They don’t know how to assert themselves or
protect themselves. Griping to you really doesn’t count.

f.nunnariTCM: November 4, 2019, 1:53am
Ok thank you Kristin, so may be best I leave these two organs alone for a while. I don’t think this is the sort of
anger she would act on but maybe needed to verbally express it to feel better, rather than hold on to any lingering
resentment towards her husband.

michaelmax: November 16, 2019, 1:30am
f.nunnariTCM:
Ok thank you Kristin, so may be best I leave these two organs alone for a while. I don’t think this is the sort of
anger she would act on but maybe needed to verbally express it to feel better, rather than hold on to any
lingering resentment towards her husband.
I @f.nunnariTCM, I would encourage you to keep noodling on this.
It sounds like there is a psycho-emotive element here for your patient and it is worth exploring, because if you can
help bring balance here, then she, her bowels and her husband will all benefit.
I’m with @KristinWisgirda that the PC excess is intellectual and loves to display their “smarts” by quoting
science.
Something else to attend to is this– does your patient’s anger go outward toward her husband (GB) or does it go
inward toward herself (san jiao)
I like this from @KristinWisgirda
KristinWisgirda:
I have patients who have strong P and strong GB- they cite research with sword in hand, ready to stab you if
you disagree.24/01/2024, 11:53Understanding the difference between Sj/Liv PC/GB – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/understanding-the-difference-between-sj-liv-pc-gb/152/print14/22
I think this is one expression of a high GB and PC, but the other express is informed inner wisdom and intelligence
guiding the sword of GB to create appropriate boundaries, and to get your point across with both intelligence and
an eye toward power dynamics.
Sometimes you need to tonify the GB to help people actually stand up and speak truth.

tim: November 29, 2019, 7:09am
When we have both the PC and the GB in excess – the researcher with sword in hand – there is no deficiency in this
pair.
t.nunnariTCM’s patient with IBS seems to have too much movement and a deficiency of self love…
“Her symptoms started shortly after her husband had a stroke, and now relies on her full time care, she has days
where she is very frustrated with her situation and angry with him…”
which are a SI excess.
Maybe a KD tonification treatment would be appropriate which would inadvertently help to calm & balance the
PC/GB pair by Water controlling Fire and Water nourishing the yin of Wood.

KristinWisgirda: November 29, 2019, 5:22pm
tim:
“Her symptoms started shortly after her husband had a stroke, and now relies on her full time care, she has
days where she is very frustrated with her situation and angry with him…”
which are a SI excess.
A diminished self love of a true SI excess wouldn’t get frustrated with needing to care for her sick husband. She
wouldn’t resent giving up her life and energy for someone else.

michaelmax: December 1, 2019, 1:03am
KristinWisgirda:
A diminished self love of a true SI excess wouldn’t get frustrated with needing to care for her sick husband.
She wouldn’t resent giving up her life and energy for someone else.24/01/2024, 11:53Understanding the difference between Sj/Liv PC/GB – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/understanding-the-difference-between-sj-liv-pc-gb/152/print15/22
HI @KristinWisgirda
I’m curious as to how you see this. Is it because the SI is the fu of the Heart which has nothing but love for others?

KristinWisgirda: December 1, 2019, 4:41pm
The hallmark of SI excess are signs of lack of consolidation of self, lack of concern for self. If life presents a
situation that calls for caring for another, potentially at the expense of one’s own personal agenda, she is less likely
to be resentful
By contrast a Kidney excess is going to be all about Me, Me and Me.

brichardsonlac: January 30, 2020, 3:23pm
I had a great case 2 weeks ago with an irritable and angry woman where GB supplementation totally relaxed her
George, can you explain how you came to treat the GB in someone who presents with irritability and anger. I
would have thought to specifically stay away from GB+ in that presentation. Was there some other aspect that
guided you there?

f.nunnariTCM: January 30, 2020, 11:01pm
Gosh this may be a dumb question, I’ve been out of practice for 6 weeks! Can y’all help me understand how 2
sides of the same coin (in this case PC and GB) BOTH be in excess? for one to be in excess, shouldn’t the other be
deficient? If both are presenting excess then, maybe, both are underlying deficient?
Apologies if this has been covered…

Raui: January 31, 2020, 4:34am
What are your signs and symptoms that make you say they’re both excess?

KristinWisgirda: January 31, 2020, 1:34pm
brichardsonlac:
I had a great case 2 weeks ago with an irritable and angry woman where GB supplementation totally relaxed
her24/01/2024, 11:53Understanding the difference between Sj/Liv PC/GB – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/understanding-the-difference-between-sj-liv-pc-gb/152/print16/22
How did you decide to GB+ this woman?
f.nunnariTCM:
Can y’all help me understand how 2 sides of the same coin (in this case PC and GB) BOTH be in excess?
This is a really important piece to understand, so I am glad that you are asking.
On the forum, we sometimes casually use excess to mean that a patient is strong in a channel’s qualities in a
general way but not necessarily in relative to its counterbalancer. This might have muddied the waters for you. It
all comes down to excess relative to what.
f.nunnariTCM:
for one to be in excess, shouldn’t the other be deficient?
Yes! If a channel is excess relative to its counter balancer, the lack of equilibrium will create symptoms and
problems. So when we say that there is a Lung excess, the Lung qualities are strong than the relatively deficient
Stomach. Therefor, you gotta St+.
However, the relative excess/deficiency of a channel relative to its counterbalancer doesn’t tell you how strong it is
overall, or in relationship to the other 11 channels. A patient can be generally deficient in all 12 channels, but
stronger/weaker in one or more. Or a patient can be generally robust, but stronger or weaker in one or more.
f.nunnariTCM:
If both are presenting excess then, maybe, both are underlying deficient?
By “presenting excess”, I wonder if you mean that they are presenting with what seem like unhealthy expressions
of the channel qualities. If both member of the counterbalancing pair are equally matched in their unhealthy
expressions, it is not a good idea to supplement one of that pair. Better to look at other channel pairs for where
there is a clearer imbalance.
Hope this helps. If not, ask again.

George_Mandler: January 31, 2020, 9:19pm
brichardsonlac:
George, can you explain how you came to treat the GB in someone who presents with irritability and anger. I
would have thought to specifically stay away from GB+ in that presentation. Was there some other aspect that
guided you there?
I had treated this 43yo female previously about 4 times for back pain as the MC. She responded well to Saam
treatments. (HT+, SI+) Then her emotions of rage at her kids especially during her period became the primary24/01/2024, 11:53Understanding the difference between Sj/Liv PC/GB – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/understanding-the-difference-between-sj-liv-pc-gb/152/print17/22
focus. I asked her if she held and invisible sword and she said “Definitely”. I treated PC+ but it did not help. She
had terrible PMS and also became exhausted with ‘dark depression’ post period. (She also just finished
acupuncture school and is going through a divorce)
So there is some concave and convex in there. In addition she is Middle Eastern coming to the US in 2010 or so. I
asked her if she has a voice or was it always suppressed growing up. She immediately replied “Oh I have no
voice”, I asked “is that your anger?” and she said “Oh yes timid all my life”. It was clear she needed a GB+
treatment.
When I put in the 4th needle to disperse GB44 she burst out crying. Bawling. “What is happening to me?” I gave
her a box of tissues and told her not to hold back.
At the end of the treatment she looked different. Toby always suggests to look at the face but I have a difficult time
seeing the nuances at the start of treatment. But this was huge. She said “Wow I feel so calm”.
I still vividly remember her coming in the next week and telling me that was the best week she has had. “Everyone
is remarking how calm I am. I feel so different”.
The initial GB treatment had held up well until she traveled to a few weeks ago to Dubai for a HS reunion and took
Adderall which unhinged her. It stirred some old stuff up and she came in Wednesday telling me she was diagnosed
with borderline personality disorder by her psychiatrist. I treated GB+ again. She reported feeling a lot of
movement in chest (interesting as that is what PC+ can do) and felt calm. Today (Friday) she wrote: ” feel very
stable emotionally and calm, … I was feeling less timid at work yesterday! My back pain though started creeping
back again!! ”
The archetypes are good guidelines to start with and apply, but we cannot get caught up in the head. What is on the
surface may not be under the hood. I really am a better clinician when I heed Toby’s words to connect and listen
with the Heart. Then I find the answers aren’t cerebral but they move through me.
Wednesday I treated GB+ on a guy that looks concave and timid. He said he was lacking motivation to get
anything done. He was feeling irritable too. I emailed him to check in and he replied “Slightly more motivated, but
if anything, less irritable. Not angry. I feel reasonably relaxed and easygoing! Also less overwhelmed. ”
Interesting how giving a bit of a push helps balance other things out but not too far. Sort of like an adaptogen.

KristinWisgirda: February 1, 2020, 12:44pm
Thanks for describing these patients for us George. The first case is especially beautiful and poignant. Before
treatment with GB+, I wonder if you could imagine these patients acting assertively or rightfully wielding a sword.
Asking the first patient if she has a voice seemed like a helpful way to access her inner experience.
When a patient complains of anger or rage we have to wonder what that really means. It is helpful to observe the
qualities of the body and patient’s experience – what Sharon Weizenbaum calls the elemental physicaland what Ed
Neal describes as climate that affects the Heart’s meaning making.
The GB/P axis is one of outward push/drawing in. Convexity/concavity. This week Ed Neal’s class is a discussion
of emotional issues. He describes anger as a push back that happens when there is an obstacle to our expression or
thriving. A patient who is so convex almost anything can be perceived as oppressive pushing on her. Just as likely,
too much P excess could feel like a punch in the gut, a stifling concavity. Too much rule following and not enough24/01/2024, 11:53Understanding the difference between Sj/Liv PC/GB – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/understanding-the-difference-between-sj-liv-pc-gb/152/print18/22
mojo to let your own inner truth express and act could definitely create frustration that might build up into what
feels like rage.
This discussion makes me realize that calm and relaxation aren’t static states but rather states of harmony that
come about when the ability to draw in is balanced with the ability to push away. It is all just breathing.
Discussing this stuff only gets more and more interesting. Thanks for the conversation.

Daniel: February 1, 2020, 5:17pm
Kristin – these comments are very much in line with my evolving thinking about the pairs in Sa’Am – each of them
in essence reflects a particular kind of breathing dynamic and sometimes supplementing one works and sometimes
supplementing the other works. I see a lot of patients with quite literally, on evaluation, a more or less equal
number of signs and symptoms expressing each side of the pair (I had someone just last week with embodied signs
and symptoms on BOTH Lung AND Stomach channels!!). What this tells me is that that particular breathing
dynamic (in that case, the Lung-Stomach breath if you like) is compromised / challenged . . . and sometimes its not
so clear which of the two will benefit from supplementation (or maybe even something else entirely first!) . . . .
what I love about Sa’Am is we can try one and usually tell within minutes if its the right choice.
amyjenner #51February 2, 2020, 12:26pm
I have been noticing this as well -where it seems that both sides of the pair are struggling and would like some help
making sense of that. Does it help to think of them as both low and each in their own way having trouble doing
their jobs and therefore expressing symptoms? Would it make sense then to consider that you you might end up
doing some toggling in that case? I could imagine doing some toggling and then having some other pair become
the more obvious in need.

KristinWisgirda: February 2, 2020, 3:20pm
My understanding of Toby’s approach is that when a pair of counterbalancers seems to be evenly matched, it is best
to look elsewhere for treatment. This advice is typically easy to follow, as most patients have clear imbalances
elsewhere. A few treatments in other areas might then change the dynamic of the pair that at first seemed evenly
matched.
It is much riskier to jump into supplementing a channel in what seems to be an evenly counterbalanced pair.
It is harder when the main complaints seem to be really impacted by the evenly matched counterbalancers. In
particular cases of significant pain and plenty of blood stasis but the patient is falling apart at the same time, come
to mind.