BridgesAOM: July 18, 2019, 4:37pm
Hi everyone!
I would love some insight on a vertigo case I’ve been treating since the beginning of April, where the most
puzzling thing is that she was making quite good progress until mid-June, when she suddenly started getting severe
attacks of vertigo following treatments. I went to the St. Louis class at the end of June, so while I had been using
some of the Sa’am points for this patient, I was using thin needles, superficially, and without strong stimulation, so
it was really more like a standard 4-point treatment we learned in school. I also wasn’t using Sa’am archetypes
until the class at the end of June.
This is a 58-year-old female who came to me complaining of vertigo attacks and anxiety for decades. It wasn’t
until I asked if there was a correlation with these complaints that she realized they do tend to come together. She
described growing up in a manipulative household with a difficult childhood, and has a very difficult time breaking
ruminating/worrying thought patterns and struggles with guilt. These attacks are completely debilitating and
draining, and are usually preceded by a humming in the ears, especially her left ear. She also recently noticed a
correlation with them happening more frequently and more severely around the full moon. She also reported brain
fog, and her vision is usually blurry with these attacks. After a few months, she decided to mention that her ears
had been lanced frequently as a child. She said that she sometimes swells when she eats too much salt, although
she doesn’t crave salt, and her body temperature feels well-regulated. During many treatments, she would bring up
how “done” she was with her old patterns and is ready to move on.
This patient was seeing another acupuncturist nearer her house, but reported not telling that practitioner about her
emotional issues because she didn’t want people in her hometown knowing about it, and repeatedly said she “felt
driven” to come to see me. I met her through an acupuncture/yoga class I co-led, and she initially made her
appointment with me, then cancelled with a long explanatory text saying that she was already seeing someone else
and it felt too much like cheating on her first practitioner. I wrote back saying that I understood, but if it were me I
would be glad of another practitioner’s insight. So she started coming to me and switched completely to my care.
It’s noteworthy that she does this a lot: makes a decision, worries about it, changes her mind, I ease her worry, and
she changes back. Her texts are always long, detailed, and often apologetic for being a “problem patient.”
By late May, she mentioned for the first time that she drinks Diet Pepsi daily (and had since college), but decided
to stop since she learned that aspartame is a neurotoxin. A week or so later, she also decided to stop caffeine
completely. As far as I know, she did quit both cold turkey (although every now and then she would report having
some caffeine). She reported her intermittent dizziness stopped after about 10 days off of the Diet Pepsi.
This patient made slow but significant progress over this time between April and mid-June, with generally more
energy and less severe attacks, although she would still get the attacks. At one point, she reported frustration and
anger that it kept happening.
Then, in mid-June about two hours after her appointment, she felt a swell of jittery energy from feet all the way up
through the rest of her body. She said this continued for a few hours until it crescendo-ed with seeing “waves of26/01/2024, 11:46Vertigo/anxiety case with severe reactions to any treatment – could it really be all detox? – Sa’am Clinical Questions – Qiological C…
https://forum.qiological.com/t/vertigo-anxiety-case-with-severe-reactions-to-any-treatment-could-it-really-be-all-detox/383/print2/7
energy” in her vision which suddenly left her body, nearly causing her to black out. After that, she was completely
drained of energy and unable to get up the next morning. She reported her energy started to come back that evening
and was able to move around by the next day. She did go to see a doctor, and everything looked normal.
Since then, she had continued to have these reactions to acupuncture treatments, although not as severely as that
first one. Any manipulation of her qi (even from the biomat I have in my office) seems to tank her energy and
cause an attack of vertigo. Her second crash came with sweating, frequent urination, and nausea, and a later attack
came with being “sick to stomach.” She describes the crashes as starting with a swell of energy that bursts out of
her, which is what drains her.
Since these reactions, this patient has been obsessively trying to figure out what is causing these reactions. She
utterly convinced herself that these are detox reactions, both from cleaning up her diet and from shedding lifelong
patterns, and she holds onto that strongly (although given a different convincing explanation, I am sure that she
will immediately switch to that one). Now she has stopped treatments altogether to give her body a break, although
she repeatedly says that she does not blame me at all, it’s just her body reacting in a weird way.
A few other clinical notes: She is generally thin, although is more hefty around the hips and her skin is dry,
especially near her knees. Her eyes are bright (although the skin underneath is dark) and she is intensely detail-
focused (it seems to me both on internal and external things, but a discussion on the differentiation of that might be
helpful). Her pulses are very deficient and sunken in all positions, and both third positions are hidden. (And I know
I felt her abdomen, but apparently I forgot to write it in the chart and now I can’t remember what I found.)
My treatments:
Before the class, they were mostly focused on KI tonifying and general blood tonifying. I did a few treatments with
the Sa’am points for tonifying KI, but again, not with Sa’am needling technique. After the class in St. Louis, I
convinced her to come in for one more treatment to try the Sa’am method (this involved another indecisive back
and forth text conversation, wherein I told her I would respect her decision not to be treated, but that I learned
some new things I thought would be helpful). Since my focus on consolidation with KI treatments had seemed to
stop working (even with non-Sa’am needling, it’s not like other systems don’t work, too), I decided to diagnose her
as SJ excess and tonified her LR. I kept a careful monitoring of her during the treatment and she seemed to do well,
both from my observation and her reporting. She had been feeling a little dizzy coming in, and left with no
dizziness and feeling hopeful that this would work.
That evening, she texted saying that she had another crash of energy and vertigo attack half an hour after the
treatment. The following evening, she texted again to say that around noon that day, she suddenly felt amazing. All
of her strength and energy returned. She still wanted to hold off on treatments, since the whole ordeal was so
draining, but she wanted to let me know how much better she was feeling. That was about two weeks ago and I
haven’t heard how she’s doing since.
I know this is long, and I thank you all for your consideration and insight into this case. I could especially use some
insight on what I might be able to tell her is going on (at this point, detox seems very reasonable, but I have a
feeling she’s unsatisfied with that explanation – and to be honest, I am, too, although there’s no doubt that detox
from 30 years of drinking Diet Pepsi is a factor). Explaining to patients what could be happening in this mysterious
medicine is sometimes challenging, especially to people like this who just want a logical, confident Answer To
Everything. And of course, insight on anything I might have missed would be very helpful, if this patient ever
decides to come back in.26/01/2024, 11:46Vertigo/anxiety case with severe reactions to any treatment – could it really be all detox? – Sa’am Clinical Questions – Qiological C…
https://forum.qiological.com/t/vertigo-anxiety-case-with-severe-reactions-to-any-treatment-could-it-really-be-all-detox/383/print3/7
KristinWisgirda: July 18, 2019, 8:23pm
@BridgesAOM, I appreciate how much effort you have put into writing this case up. As well, how much concern
you have for your patient in doing so.
However, your long post doesn’t include enough information to see the patient in front of me. I hope to have a case
study template ready soon to make sure that cases contain all the relevant information in an easy to read format. In
the mean time, it would help to sit down with your notes on her make sense of her whole system from the Saam
perspective since you were using a Saam treatment when she had the reaction. Go through each of the channels and
note if she has any symptoms or qualities that could be related to the channel excesses. SJ excess is unlikely her
only diagnosis.
michaelmax: July 19, 2019, 4:01am
Hi @BridgesAOM
As @KristinWisgirda points out we need the details via the Saam lens.
From what you have written I would suspect that she is SJ excess and so your treating LV was spot on. And given
that she later felt really good, it is worth considering if she comes back.
I also think of ST for descending the qi, which it does quite strongly. Probably only need to do it once or twice, as
while she has the dry skin and that fits the ST pattern, sounds like overall she is thin. Does she also have lots of
hard luck stories by any chance?
As to “detox” I’m alway leery of that term. It gets thrown around a lot and no one really defines it. If there is truly
a “detox” going on then, then we should be able to to say what is the toxin, where is it being detoxed from, and
how is it being expelled from the body. Too often I think “detox” simply means “I feel like shit and I hope this
means I’m getting better somehow.
Mostly I see this kind of talk and thought process as kind of a SJ excess over focus on details and trying to create
some order out of chaos.
How’s her period? And how does she sleep?
Is there good deficiency or stagnation?
Thanks for sharing this and looking forward to hearing more if she comes back.
sweiz: July 19, 2019, 1:21pm
Hi Bridges (?)
Of course, we need to take this in the context of the whole, so given that, I also thought of applying GB
tonification. It was the incredible difficulty with decisions that made me think of this. Do you see other signs of P
excess?26/01/2024, 11:46Vertigo/anxiety case with severe reactions to any treatment – could it really be all detox? – Sa’am Clinical Questions – Qiological C…
https://forum.qiological.com/t/vertigo-anxiety-case-with-severe-reactions-to-any-treatment-could-it-really-be-all-detox/383/print4/7
michaelmax: July 19, 2019, 1:27pm
sweiz:
Do you see other signs of P excess?
Hi @sweiz usually it’s so easy to see the signs of GB excess. What are your thoughts on PC excess? I’m curious
to know what leads you toward +GB. I usually think of that if some is meek, but this patient does not seem meek to
me.
sweiz: July 19, 2019, 2:11pm
Hi Michael,
Of course, I am just suggesting PC excess as a possibility to explore. I know meek is a close cousin of fearful but
not the same. I’ve seen some people who seem afraid of a lot not respond to Ht+ or Ki+ and then, when I’ve treated
GB+, which I rarely do, there has been a huge positive response. This woman sounds very indecisive and fearful.
Then there is the negative response to liver and lack of anger too…I am only saying this is something to consider,
not recommending it.
KristinWisgirda: July 19, 2019, 3:37pm
michaelmax:
Too often I think “detox” simply means “I feel like shit and I hope this means I’m getting better somehow.
“Detox” is a place we and our patients can go when we don’t understand what is happening in terms of our own
medicine. What does the patient’s reaction to x stimulus tell us about her system in terms of Chinese medicine and
now in terms of Saam?
One very helpful aspect of learning Saam is that I understand better how some of my pre Saam acupuncture
treatments went wildly and sadly wrong. Here’s an example:
A frigidly cold elderly lady with a hollowed out face presented with debilitating low back pain radiating into her
left leg. She could barely walk. During treatments I had every heating unit in my office on her to keep her warm.
She was responding slowly but surely to treatments that included K7 and H3 along with back shu points. Then one
day I decided to try a different strategy, inspired by study with JJ Hadlock, that included K1 and Ub40. She called
me the next day reporting that she was back to square 1 with her pain levels and then never returned for further
treatment. My treatment goal was to get her Ub channel to communicate with her Kidney channel. I could feel
palpable changes in the flow of the channels while she was on the table. So why did that not serve her?26/01/2024, 11:46Vertigo/anxiety case with severe reactions to any treatment – could it really be all detox? – Sa’am Clinical Questions – Qiological C…
https://forum.qiological.com/t/vertigo-anxiety-case-with-severe-reactions-to-any-treatment-could-it-really-be-all-detox/383/print5/7
Her Saam diagnosis is clear UB and SI excess. Including K7 and H3 in her treatments was giving her a little K+
and H+ that was helping. The treatment that included UB40 (drained) and K1 was essentially UB+ and draining
her Kidney. Yikes!
All of our mishaps are potentially great learning opportunities. There are plenty of situations that didn’t go well
that I have yet to understand. Reflecting on what we observe directly and what we might know for sure about what
happened is an invitation for insight to come, even if it happens years later.
michaelmax: July 19, 2019, 8:20pm
So helpful @KristinWisgirda to be able to look at our failures of the past through the lens of Saam and see where
we might have gone wrong.
BridgesAOM: July 21, 2019, 6:09pm
Thanks for your replies, everyone! (And apologies for not responding sooner – we had family visiting this
weekend.)
Unfortunately, I don’t have much more to glean from the Sa’am lens, since I only treated her once since the class
and didn’t get a chance to ask more specific Sa’am-lensy questions. I’ll try to fill in what blanks I can, though.
michaelmax:
Does she also have lots of hard luck stories by any chance?
Not so much in terms of loss of finances or resources (at least, that she’s told me), but she does keep coming back
to her difficult childhood as the source of everything. But it also might be worthy to note that she’s quite private
and nervous about her story getting out there. As I said, she switched from her old acupuncturist to me because her
old one was in her hometown (even though she knows that we’re bound not to talk about our patients in a way that
identifies them). There were several important tidbits that she took a long time to reveal until she felt comfortable
opening up to me. She is very concerned with how other people view her. So if she does have any “hard of luck”
stories, I’m not sure she’d tell me unless she thought it was relevant.
She did initially report, however, that her R knee swells and gets painful, which obviously isn’t a direct correlation
with resource-woes, but could be an indication.
michaelmax:
Too often I think “detox” simply means “I feel like shit and I hope this means I’m getting better somehow.
That’s exactly how I feel about it. Not that detox isn’t a real thing, but it does get turned into a blanket term for “I
don’t know what else is going on” (kind of like fibromyalgia for “I don’t know why you hurt, but you do”).26/01/2024, 11:46Vertigo/anxiety case with severe reactions to any treatment – could it really be all detox? – Sa’am Clinical Questions – Qiological C…
https://forum.qiological.com/t/vertigo-anxiety-case-with-severe-reactions-to-any-treatment-could-it-really-be-all-detox/383/print6/7
michaelmax:
How’s her period? And how does she sleep?
Is there good deficiency or stagnation?
She’s post-menopausal and we didn’t get into her past period symptoms all that much, again because she exhibited
nervousness around her privacy and seemed to want to get through the questioning as fast as possible. I know as
her practitioner I should still ask anything I think I need to, but during the initial intake it seemed less important to
dig into those symptoms than others. If she comes in again, though, I’ll ask.
It’s worth it to note that while she is very detail-oriented, her intitial intake forms that she filled out are strikingly
sparse. She didn’t even note on the forms the date of her last period or how she’s post-menopausal.
Definitely lots of deficiency. These vertigo and anxiety attacks seem to have drained a lot out of her over the years.
She often looks tired, her pulses are sunken, and she’s complained of debilitating fatigue that takes days to recover
from (with these attacks throughout her life, not just since treatments). Her skin seems deflated overall, although
not especially pale (in fact, her facial coloring is a bit dark, especially under the eyes).
She had nothing to report about her sleep patterns when she came in, and I always double-check when someone
says their sleep is good by clarifying, “So it’s easy for you to fall asleep and stay asleep?” I see now, though, that
it’s time for followup questions on this if she comes in again.
If memory serves, she does have some varicosities on her legs, but small and non-palpable.
sweiz:
Of course, I am just suggesting PC excess as a possibility to explore. I know meek is a close cousin of fearful
but not the same. I’ve seen some people who seem afraid of a lot not respond to Ht+ or Ki+ and then, when
I’ve treated GB+, which I rarely do, there has been a huge positive response. This woman sounds very
indecisive and fearful. Then there is the negative response to liver and lack of anger too…I am only saying this
is something to consider, not recommending it.
This is an interesting thought. She definitely has fear, but as @michaelmax points out, not the meekness. She also
does have anger at her situation and just wants it to be done with, but the anger was never directed at me (and she
made sure I knew that multiple times). I do see that she has PC excess in that she tries to understand and think
before acting. She is definitely more of a diplomat than a general.
That story is super helpful, @KristinWisgirda, and I’ve been wondering what I might have missed to trigger these
reactions in this patient. Per your suggestion, I went over my class notes and came up with these additional
insights:
She would often come in with her R ear whooshing (which didn’t always mean an attack was imminent, but
attacks were always preceded by the whooshing), and the point that seemed to calm the whooshing the best was
SJ 17. So this also points me to a LR/SJ imbalance because of the channel involvement. And if LR excess is
often L-sided symptoms, does that mean that SJ is often more R-sided symptoms?
My notes about PC/GB breathing got me thinking – she never reported any complaints about breathing, but in
my memory she did tend to take deep breaths on the table, but in a very controlled way. In fact, her whole body26/01/2024, 11:46Vertigo/anxiety case with severe reactions to any treatment – could it really be all detox? – Sa’am Clinical Questions – Qiological C…
https://forum.qiological.com/t/vertigo-anxiety-case-with-severe-reactions-to-any-treatment-could-it-really-be-all-detox/383/print7/7
seemed tense even as she relaxed, like she was internally telling herself to relax because that’s what she’s
supposed to do when laying on the table. And when I would leave the room she would do this little physical
shift like preparing for the next part of the treatment which is the Relaxing Part of the Treatment. You know like
a runner in a race shifts their weight just before the signal to go? That kind of bodily shift. Also, her bodily
movements tend to be quick and jerky, yet deliberate.
SI/KI clues: The whole process that she started experiencing with the attacks after treatment seems like an
imbalance of the consolidation process. She felt this build-up of energy, then an outward burst, followed by a
crash. (OR is this more of a PC/GB thing, with the sudden outward burst of energy like thunder?). She does
struggle with lack of self-love and self-value from her manipulative and somewhat abusive childhood (could
this be more of a source of her ultra-politeness than actually having a SJ excess?). The only physical pain she
ever mentioned was the occasional swelling of her R knee.
I’m afraid that’s all I can come up with. I’ll look forward to seeing your case template – I think that’ll help with
questioning new patients, too, because it can be hard to remember how to cover all the bases of the new system
during that initial intake. And, in case she comes back, so I’m prepared with what questions I missed before.
Again, thank you so much, everyone! I really appreciate your thoughts and insights!
KristinWisgirda: July 22, 2019, 6:38pm
BridgesAOM:
Her skin seems deflated overall, although not especially pale (in fact, her facial coloring is a bit dark,
especially under the eyes).
This kind of physical observation is so helpful in Saam and helps us see where and how the patient is not
functioning well. Developing an eye for the physical qualities of the patient will help you come to a clear diagnosis
and path of treatment.
BridgesAOM:
And if LR excess is often L-sided symptoms, does that mean that SJ is often more R-sided symptoms?
No. Left sidedness is an indication for Liver excess or SJ excess. Right sidedness is an indication for Lung excess
or Stomach excess. Toby has refined that to say that if symptoms are all left sided, you are more likely to
supplement the Liver and if all right sided you are more likely to supplement the Lung.