Qiological Community

Choosing channel over quality

A 60-year-old female massage therapist called for an appointment last week to treat intense L side sciatica pain she had been suffering 3 weeks without relief. She felt her sacrum was displaced as well. On her first visit, she was 9/10 in pain and activities of daily living. On her first visit, I could not get a clear picture of GB or BL line pain, so I chose to treat her SI+ R for pain and, if the pain remained, follow up with trigger point release of the three gluteus muscle and piriformis with electro stimulation. With the two, I was able to reduce pain by half and increase mobility.
Two factors that made it hard to decide are she talked both about how cold she was to the core and keeping her emotions very stuffed -yet feeling like they needed to break free. She also talked of the pain as a ball needing to burst open.

The second visit was the same, half SAAM, half ortho with electro. Again less pain and improved mobility. In this visit, she talked more about the pain being along the Bladder channel BL 54 to 58 and more about being very cold.

Third visit: 5 things were mentioned. 1) she mentioned other pain in her body that moves from place to place, 2) she described the pain always starting at BL 58 and moving up into the hip along the hamstring. 3) since using a hot water bottle on her lower abdomen, back, and BL 58, she was feeling warmer in general and no longer had to heat the bathroom like a sauna once a day to get warm 4) she also had recently acquired an aversion to wind 5) in the first visit, she stated that fear was her predominant emotion and that Joy had truly diminished in her life in the last year. Funny how you can ask the same questions every week and get different, better, more diagnostic information.

I had been reluctant to tonify BL because of how cold she was and feeling fear, but I was curious about the clear channel presentation. I muscle tested my hypothesis to use either HT or BL. It pointed to BL. I went for it BL + R. She immediately relaxed into the table as if melting. About 10 minutes in, she said she could feel the pain melting and felt like she had been in a very deep sleep with no awareness of time or place. After the treatment, as she moved about the room, her pain had left completely.

I remember Toby saying that a Wind-Cold Damp pathogen could be cleared using BL; this seems both logical and counterintuitive; I was also getting sidetracked thinking about her stuffed emotions and “sciatica”. I agree with having to quiet the mind to get a clear picture.

Hi Amy,

I’m not quite following, by noting BL+ are you saying you treated her Bladder Excess by supplementing Heart? When Toby was referring to Wind-Cold Damp he surely meant to address this excess condition via supplementing Heart, no?!

I’m new at this, so excuse my confusion.

Thanks for this case. It is interesting when a patient craves warmth but UB+ is what provides relief.

Besides the location of the pain, were there any other Saam signs suggesting H excess? For instance- rapid pulse, full red face, body warm to the touch, soft and/or warm middle Ren, loving personality?

I have never heard Toby talk about treating a wind-cold-damp condition with UB+. My notes talk about using UB+ for early stage coming down with something, where you would want to improve the function of Taiyang. This strategy isn’t in patients with and indisputable strong cold presentation or those who might not otherwise do well with ice cold UB.


Thank you for sharing the case today Amy.

I might consider GB+ supplementation here.

I have used BL+ supplementation on cold dry patients and it works well. Do not get hung up on one particular characteristic - look at the entire forest. As Kristin asked, I too am curious if there may been other HT excess signs that could have suggested BL+.

One thing I learned early on in Sa’am is to keep it simple. If we are doing other modalities it has been suggested to do those first before a Sa’am treatment. I tell my patients not to get any other work (Chiro, massage etc) for at least a couple of days after a Sa’am session as the unwinding can sometimes take 24-48 hours. Even though we can get quick results in Sa’am sometimes I find patience can be good for patients.

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Nomenclature. Yes it can be confusing. It sounds like she supplemented her Bladder channel so BL+.
And agreed I think there was a mix-up on the Wind-cold damp regarding Excess BL and supplementing HT+ it is so easy to do. I mixed up LU/ST for a while in the beginning.

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I am curious as to why you even thought to muscle test when the pain was on the BL channel - which could mean either Bl or Ht could work and she said she is so cold. I probably would have gone straight to Ht. What made you stop and even consider Bl?
ANd also have you found muscle testing to be a reliable indication of which channel to use? Do you use it often and has it given you clear and helpful information?

Great question. I chose to muscle test because I was unclear whether to chose channel or quality. I thought I’d let the body tell me.

I am a new practitioner, graduated 2019 and practiced just 5 months before getting shut down. Reopened in June and have been really focused on understanding the SAAM system - classes, webinars, podcasts, reading. Along with all of that one of my mentors uses muscle testing which I am also learning. I like to compare what I get with muscle testing with what I come up with in SAAM intake. It is just another tool. I also use an Acugraph to scan the meridians. All are just diagnostic tools - most of the time they all agree. Sometimes they don’t seem too, but I think that is my lack of greater understanding. For months now I have puzzled over what I have heard Toby say - sometimes quality sometimes channel. What does that mean? In this case I took a chance to focus on the channel. It worked. I always let my patient know I am working with a hypothesis and their honest feedback of how they are feeling will help me determine if I chose correctly. If not I have a plan b and c.

In this case both muscle testing and the Acugraph showed a def BL which always makes me curious.

As far as tx. I have found if I stimulate the first point on the SAAM chart. For example if LU front Mu goes weak on muscle test and then I stimulate earth point on Spleen channel(Sp3) - first point to tonify LU. If it is right tx, when I re check LU it holds strong. It hasn’t been 100% but perhaps 90%, and I do not use it on every patient yet. It certainly gives me more tools as a new practitioner. I also scan every patient with the Acugraph. My patients like it because they can see and feel results. Still learning and figuring things out; sometimes I feel like a forensic scientist. The main thing is I get results - which I hope will be reproducible not just chance.

I do appreciate the question and opportunity for dialogue.


I’m new to this- working hard at it for 6 months. I puzzle over what I’ve heard. “ sometime channel sometimes quality”. In this particular case I thought this was perhaps what was meant. No there were no HT excess signs.

Below is a response from the patient that was emailed to me today. 5 days post treatment. I cleared the pain and she craves the heat and tonification of Heart. Perhaps supplement the heart would have been the better choice, or freeing the channel first was a good move.Will do HT+ at her next treatment.

Note we are having the coldest temps of our winter thus far this week. -10 today. 4 yesterday.

“My hip is doing well thanks. It was interesting, my pain level yesterday was really low! I went out for a short walk at the end of the day with my dog and I could feel the sharp wind going through the layers on my legs. A short while after coming in the house I started getting strong cramppy pains in my left calf so I put one of the body warmers right on it and it dissipated within minutes of the heat penetrating. They work really well on the body. Ive been putting the foot warmers on my bum and low back as well. Ive also been doing a few simple stretches to focus on balancing the hips and that’s making a difference as well as all of yours and vinnies techniques. And I started making the Ahh sound when I exhale when deep breathing which I believe is the sound for the heart meridian and that feels good too. Emotions are still all over the map some days and other days I feel as strong and balanced as could be. So overall I’m happy to say that I improving. Thanks Amy! You’ve really helped me through this with all of your work and sound advice. I am so grateful! “

See you next week

I can hear you real interest in trying to figure this one out. Quality includes quality of the symptom and quality of the patient. Your presentation includes qualities of the symptom but very little about qualities of the patient. I know you weren’t writing up a full on case study but no one can really comment on this situation unless we get a better picture of the patient.

Are you sure? I’ve noticed that I get the patients that most eager to communicate with me outside of office hours are the H excess and SJ excess. Loving H excess wants to connect. It sounds like she could be SJ excess too with her embrace of healing sounds and the details.

While you might find the muscle testing and acugraph info helpful, be open to the possibility that it might be distracting you from developing your Saam observation skills. Toby cautions against bringing in information from other diagnostic systems. There is so much to observe just with Saam. New practitioners often forget to check or fail to register all of the important Saam information because trying to remember it all can be overwhelming. Never mind that you have just getting into the swing of practicing in general.

Toby strongly suggests just doing Saam. Clear feedback from the previous treatment, for better or worse, has highest clinical weight in choosing your next treatment, increasing the likelihood that you will be able to put the patient on the right track. If you are using other treatment styles or even adding other points you are muddying the water.

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my own relationship to Sa’Am is that it is the most engaging challenge into the development of my own patient assessment skills I have ever experienced - and for this there are no words for the level of gratitude I have here. But it does demand a dedicated and exclusive level of focus and attention to it’s particular framework in order to benefit - in my experience.

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