Ryan_Gallagher: June 7, 2019, 2:42pm
44yo woman
Chief concern: Migraines + episodes of blindness
• was having regular migraines until about January; this transitioned to a few months of periodic episodes of
blindness in L eye that would last a few minutes; these blindness episodes have gone away and migraines have
returned recently
• migraines start with dizziness and progress to visual migraine of both eyes (with no blindness and no head pain)
• migraines used to feel like her brain was burning in her skull; no brain-burning these days, just a weird visual
distortion; lasts 10-20 minutes; feels normal afterward
• migraines seem stress-related, while episodes of blindness seemed related to posture (bending neck) and menses
(typically happened around period)
• history of whipash (MVA) and concussion (fall) last winter
The patient also reports:
Seasonal allergies: nasal congestion, PND, cough, itchy eyes, itchy ears
R sacral pain: life-long; improving recently with gentle chiro adjustments and a change in mattress
Dysmenorrhea: heavy periods, PMS, clotting; although, after a few acu treatments, her last period was easiest
she’s had
L breast lump: got a biopsy yesterday, will get results soon
Of note:
• Mom and dad (dad especially—very bad temper) were emotionally abusive with her, sometimes physical; life-
long self-esteem issues, which she links to her chronic back pain; feelings of shame, humiliation
• Temp: runs warm; likes it cold at night
• Digestion: good overall; has always tended toward constipation
• Thirst: rarely feels thirsty
• Urination & sweating are normal
• Dry skin (esp around lips—she’s been mouth-breathing at night due to allergies)
• Abdominal palpation: mild discomfort at epigastrium, otherwise no tenderness; tissue is very dense; sternocostal
angle is wide
Patient is exceedingly polite and reserved, yet pleasant. She sometimes softly says “thank you” a dozen times in the
short time I’m needling. She has bright eyes. Her posture is very contained—though she is overweight, she makes
herself very compact. When she sits in the waiting area, she’s not slouching on her phone, but sitting upright with
hands on lap. The tissue itself is compact, dense. She is articulate about her struggles that stem back to her parents’
treatment of her, and she is ardent in her desire to let go of harmful mental habits. Lastly, she had been having26/01/2024, 12:06Visual migraine case – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/visual-migraine-case/281/print2/4
anxiety about paying for a biopsy, which was affecting sleep. She found an affordable route recently, which
alleviated that particular anxiety. As for the lump itself, her doctor has made her feel confident that it’s benign.
ASSESSMENT
Sa’am considerations:
Body is LU-excess (or LR-excess, given its denseness)
Personality is a sure-fire SJ excess
Consider supplementing: +LR, +SI/+KD, +ST
I’m finding the SI/KD intriguing—she has a tendency toward consolidation of physique and of circulation (given
the dysmenorrhea/clotting and back pain), which suggest a need to supplement SI, and yet she has clear self-esteem
issues, suggesting a need to supplement KD. Perhaps she holds herself together so intently as a way of encouraging
KD consolidation (and thus self-esteem)?
Over the course of the few times I’ve seen her, I’ve alternated supplementing LR (to counter SJ, and for blindness,
visual migraine, and breast) and SI, along with one +ST for allergies. She always responds positively to the
treatments (closing eyes, relaxing), but it’s difficult to get her out of “polite mode” enough for me to understand
whether a given treatment is deeply “landing” for her. Since starting treatment, the blindness episodes have gone
away, but the migraines are back. Her period is smoother.
Oof, didn’t mean for this to be so long, but if you’ve made it this far, please let me know if you have any feedback!
michaelmax: June 9, 2019, 11:58pm
Ryan_Gallagher:
it’s difficult to get her out of “polite mode” enough for me to understand whether a given treatment is deeply
“landing” for her. Since starting treatment, the blindness episodes have gone away, but the migraines are back.
Her period is smoother.
Hi @Ryan_Gallagher
I think you have your answer here… she’s getting better. Always better to watch to see what changes. IN some
ways, what it is nice that patients settle or express they “went deep” really what we want is to see change to key
physical markers. And it seems like you are getting them.
As to her being polite. Hey, that is probably who she is. Keep working that liver along with the other channels out
outlined here.
KristinWisgirda: June 10, 2019, 5:38pm
26/01/2024, 12:06Visual migraine case – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/visual-migraine-case/281/print3/4
Thanks for the interesting case. It sounds like she is making good progress with your treatment.
From observing a few vision cases with Toby: blindness can point to Liver excess and seeing lights can point to SJ
excess. Do her visual migraines have a bright/dark aspect beyond the “weird visual distortion”? With her dense
body and super polite personality, sounds like she has a teeter tottering Liver/SJ situation.
I recently had a case of a very polite patient who was having trouble (and anxiety) seeing in dim light or in the
dark. Treating SJ+ really helped. Something to consider if the blindness becomes an issue again or if her migraines
have a dark aspect.
Knowing if her sacral pain is closer to UB27 versus UB28 will give you information if it is related to SI/K versus
potential UB/H, though it sounds like this symptom isn’t a priority.
Considering SI/K, she has many indications for using SI+ as treatment- dizziness, PMS, menstrual related
migraines, dysmenorrhea. Noting how symmetrical and careful with her appearance she is will help you weight the
Kidney excess versus the low self esteem SI excess.
Please let us know what happens.
Ryan_Gallagher: June 13, 2019, 10:44pm
Thanks for the feedback, @michaelmax and @KristinWisgirda
I saw this patient again yesterday and she had a great week. I’ll continue to alternate +LR and +SI. She mentioned
that when she was having migraines, they could be triggered by glinting afternoon light and they featured “bright
rainbow fractal distortions.” So, it makes sense to continue with +LR. But if the blindness episodes return, I’ll
consider +SJ.
Speaking of LR/SJ…I had a different patient yesterday who deals with nausea, reflux, anxiety, and depression. She
had been doing well with +LU treatments (which fits her constitution—thin with oily skin) and a Banxia Houpo
Tang modififcation. Then, last week, wanting to change it up, I did a +SI tx, since she was about to have her
period, and was having painful cramping. She returned today and said she had a difficult week, especially with
depression and reflux. +SI was likely the wrong choice.
In considering her depressive state, I looked to the SJ/LR polarity. She does not have bright eyes; in fact, they’re on
the dark side. Her reflux is not of the burning variety, just uncomfortable pressure. In the mornings, she’s been very
lethargic, depressed, and then too amped up in the second half of the day, with difficulty winding down at night.
I chose to +SJ to try to bring some brightness and outwardness into her system. It didn’t go well! She started
feeling agitated and dizzy. So, I pulled the needles and did a +LR tx on the same side. She felt much better after
that. So, it seems that she needed the cool, dense forest, not the bright desert. What was I missing? She’s a
vegetarian, with a thin physique and thin pulse, and it seems a blood xu component is something I overlooked.
Maybe I should have been leaning toward +LR because of that. And maybe that’s why she responded poorly to the
+SI tx last week—she doesn’t need blood movement, she needs blood building. I’m learning to be more cautious
with +SI.
I could’ve asked her more about her depression from the get-go: Was she feeling very exposed, very vulnerable to
external stimuli, and wanting to hide/escape/withdraw, or was she feeling like she was in a thick fog, cut off from
the world? I’ll ask next week, but I’d assume the former, given how she responded.26/01/2024, 12:06Visual migraine case – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/visual-migraine-case/281/print4/4