Qiological Community

Clinical Revelations on the SJ-Liver External-Internal Boundary

I had an interesting experience with the SJ-Liver pair this month. You know how we often discuss how the precise location of the ‘boundary’ between internal and external pertaining to the wet and dry characteristics of the Lung-Stomach pair is not straightforward? Sometimes, dry eyes or dry mouth (for example) can be dry on the outside and sometimes it can be dry on the inside, etc etc.

I have always assumed the same kind of ‘boundary’ is much more straightforward in the Liver-SJ pair; that focus on the inside (Liver Excess) really means focus on the interior concerns of the patient with no regard for the external environment and focus on the outside (SJ Excess) really means focus on the external environment. For example, one set of questions I often ask to shed light on this aspect is how attentive a patient is to the order and detail in their home and work environment (assuming that excessive concern and attention to this signifies a SJ Excess). Clinic recently showed me this may need to be fine tuned!

This month I had a patient who on her third session, I felt needed a Liver+ treatment. She returned the following week reporting that after that treatment, she became very focussed on longstanding disorder at home in her kitchen, her bathroom, her living room. She became very motivated and cleaned and ordered things she had allowed to become very disorderly over the months and years. She said this motivation and drive to do this was very clear and pronounced after the treatment. It got me thinking much more fluidly about where that SJ-Liver boundary between internal and external focus is to be located . . . . in her case, I am presuming that her most immediate personal domestic environment (her own bathroom, kitchen, living room) are, in fact, part of her domain of ‘internal focus’ and when I supplemented her Liver system, she became engaged with that immediate personal environment that I had mistakenly been assuming was always in the ‘external’, outwardly focussed domain of the San Jiao .


Thanks Daniel for the case and trying to make sense of a seemingly paradoxical reaction by reframing the boundaries.

What made you choose to supplement LR+ for her?

In terms of where the boundary lies, how was her reaction to the outside world?. Did she feel like she wanted to pull back from social situations or any less focus on other aspects of her life? (This is incredibly subjective and may also be difficult to flush out in this time of covid social separation)

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In discussion, it became apparent she is really hard on herself for days and months after any time she feels she made a mistake


This is a very interesting and important observation but also adds a bit of confusion to the SJ/Liv pair.
I have seen flutters of what you have observed but haven’t thought of it in this way.
I have a client who is very focused in on how she feels. She reports every sensation in her body with great detail. She is not specifically polite and even though I have given her extra time in her appointments and have moved around my schedule to accommodate her she does not express gratitude. She is sensitive to her environment though and does say that she allows too much of what others are feeling to affect her.
I do think that she is overly focused on herself but since she is SUCH a good reporter and gives me SO many details about how she is feeling I have tonified Liv and not SJ. Liv+ has never brought any sig results and the morning after one LIv+ treatment she got a headache.
Could it be that her focus on herself and her symptoms are not necessarily the SJ excess focus on details but rather the Liv excess of focusing inward?
This is such an important distinction. I would love some clarity on this subject.

Hi Adina . . . . when I read your description above - not knowing anything else of course about the case, I find I am very drawn to her being Liver Excess. BUT - as I understand it, above all else, a patient’s response to a treatment is the most powerful litmus test in our Sa’Am practice. When that response is clearly and powerfully either positive or negative, its definitely a ‘loudest thing’ in the room. And when that response is mushy, murky, neither here nor there - it really is saying that whole pair is just not that relevant (at this time!) to the case.

So, in your case, you have reported that Liver+ treatments yield very little response of any kind - at most, a headache on one occasion. This suggests that NEITHER Liver+ nor SJ+ treatments at this time are key to this case. In the case I reported, her response to that Liver+ treatment was clear and dramatic.

So perhaps her focus on self is more of a Kidney XS issue? Or lurking behind it maybe a UB deficiency? Or perhaps it is a derivative of inadequate resources (Lung deficiency)? Or if its all very analytical with a timidity, a PC XS? Or maybe there is just some other mechanism unrelated directly to this issue of focus on self that needs to be freed up first, is ‘gumming up the works’ before clarity will emerge on the focus on self feature of her presentation? So much nuance!! Anything can be anything.


Hi Adina,
Yes Yes to what Daniel stated. Also SJ excess is external focus. She has a very much internal focus. That is an important distinctions - it is not just about details - it is external details. I’ll bet her eyes are not bright and outward.

This can be confusing because we can say the meditating monk (and ultimate SJ excess) is focused inward, but there is an outward/greater awareness, and ultimate politeness which your patient does not display.

A supplement SJ+ after that LR+ treatment would have been appropriate depending on the time between sessions.

Consider all the channels and don’t get stuck on one characteristic. Soften your gaze in the treatment room and sink into possibilities. If the MC is more of a physical symptom maybe give more weight to Metal/Earth channels. Toby uses the spokes on a wheel analogy and that is the way I see it in my mind in the treatment room.

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Adina, I have a fibromyalgia patient so similar to this. She is an excellent reporter. And though she appears very sj excess to me (super hard on herself, light body density with malar flush) she responds negatively to liver+ as it makes her more internally focused (more focused on her pain body). She responds best to gb+ which I think helps her engage in a bigger way with the world around her and get her out of her mind.

This is really good advice and something that I am working on.
I am overly focused on details and its harder for me to see the big picture. I see a whole bunch of symptoms coming at me and get stuck on the details.
I am working on this (Liv + helps…) but if you have any specific advice on how to make more progress in this area I would love to hear.
This discussion has helped a whole lot.
I can see now that tonifying Liv + for her even though she does have some SJ excess characteristics was probably not the right treatment.
The grossest thing in the room is that she is obsessively focused on her own symptoms and it weighs her down and makes her heavy.
I think SJ+ may do her a lot of good.
Thanks to you and Daniel for helping me see this.

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If the response to a channel is neither here or there can you really say for sure that also the counterbalancer is not relevant at this time?
Is there no room for let’s say Liv + to have given no response but for SJ+ to still be able to help?

Hi Adina - its a great question which I don’t have a definitive answer for. It certainly seems to me that there is a kind of ‘physics’ to this system which would say if one of a pair yields minimal results, the other will too, and best to look elsewhere. But then again, there is mystery and ‘clinic is hard’ - certainly the case details you have posted point quite significantly to Liver XS and suggest SJ+ is worth a try. and then again, as I understand it, the patient’s response to treatment is data of the highest quality here - so one would expect a more adverse response to a Liver+ treatment than you got. I can only think of two possibilities - (1) look at the other pairs and ask yourself which one may be central or (2) try a SJ+ treatment and sit with the patient for 5 minutes and see what happens . . . . . two notes . . . (1) in my experience - it can be that ‘strong response’ to a treatment at one end of a pair can be more difficult to ‘notice’ than ‘strong response’ to a treatment at the other end of a pair . . . for example, with the PC-GB pair, I think a ‘strong’ Mike Tyson-ish response is (by definition) more in your face than a ‘strong’ librarian-ish response. . . … (2) I have certainly had patients who are just so bad at reporting, I have had to give up essentially on their reporting back skills - working with one now - she just cannot report back reliably or meaningfully at all - except for the ultimate report (‘I am much better’) - with her, I just really gave up on her reporting and did what I felt she needed - yesterday she came in and reported her symptoms are mostly gone and she was very happy - ‘phew’!

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