Qiological Community

Depression case and parsing SJ/Liv ambiguity

Hi there,
I have a patient who came back to see me after a bit of a pause. Some family revelations this summer and her own reflections on a spiritually abusive relationship in her religious community put her into a spiral that she’s had a hard time digging out of. I’m still new enough/shy enough about Sa’am that I would love some feedback on my analysis of her case. I’ve been using TCM-type treatments for her with some (time-limited) effect, and I’d like to have some of the sort of benefits that Sa’am could offer her – while minimizing any risks of potentially putting her into more of a spin than she’s already in.

She also has a bunch of signs that to me point at both Liv and SJ, so if anyone has feedback about that area, I’m interested!

Here’s my first stab at a Sa’am case study:

Chief complaint: Depression
Secondary complaints: digestive upset, UTI-like symptoms

Background: 40-ish woman, very active and productive in a religious community and as a healthcare practitioner. Significant weight gain over the past year. Normally a dancing ball of brightness, productivity, and loving connections.

Appearance and demeanor: Currently slightly overweight with drier skin. Average facial symmetry. Neatly but casually dressed. Strong voice. Much less extroverted currently than usual. 7+

Lifestyle: normally super productive and sacrifices her own time/energy to take on big projects for her community or to help others in difficulty. 5+ Currently retreating inside herself. 8+

Emotions and cognition: Currently crying intermittently throughout the day, often with sort of gasping, interrupted-swallow sort of cries, and sometimes with silent screams. 8+ Her main emotional state is sadness without anger or malice toward the people who have triggered her upset. 8+ She has been asking herself repeatedly “Why?!” she let herself be hurt. 6+ She is a very “good girl” not in a pollyanna sense but definitely in the sense of always trying to do – and to feel – what is “right.” 7+ She feels very hurt by one person she counted on for spiritual leadership, and the family revelations made her feel like she had had the rug pulled out from under her, like her roots were suddenly gone. She feels like she is in a deep dark forest and would desperately like to come out into the sunlight. 7+ She is afraid 6+ she won’t be able to find her way out. However, she has absolutely no suicidal ideation (religious or self-love? I think a bit of both.)
She can barely focus on work or conversations with others. She recently moved from one floor to the other in her community house in order to have more privacy while working through things. 7+

Respiratory: strong voice; no breathing issues. Chest had felt constrained last week, as if someone was sitting on it - this is now better. Thenar eminence: fairly plump. 5+

GI: Currently poor appetite 7+ (a sharp change from the previous year of inexhaustible appetite), a burning feeling in her esophagus 6+, and more burping than usual 6+, with distension in her abdomen, pain in her right ribside 5+, and soft stools without odor and with some urgency. 3+
The abdominal distension is worse with lying down on her stomach. Occasional pain currently in the area of St3.

Thirst and urination:
She is thirsty for cool water. 6+ She has enough saliva in her mouth but feels dry there.
Her urine is scant, with dripping, but no blood. 7+

Body temp:
Her toes are subjectively extremely cold and objectively fairly cold +7; her hands are only slightly cold. (Interestingly, historically she has had very warm feet with colder hands.) She has a feeling of water build-up in her legs, though it wasn’t visible to me. 3+

She’s not clear if her symptoms are better with movement, because she has so little motivation to get out of the house, other than for work. She is exhausted with difficulty sleeping more than a short while. 8+ She wakes often, thinking about things.

Other body: Blood pressure newly high since the emotional upset. Few varicosities. Recent hardening of the skin at Liv1 and Sp1 bilaterally. 3+

Tongue: narrow body, relatively long; she reports that she had a reddish body with scant coat, but when I saw it, it had a thin, slightly slippery, gray or slightly “dirty” fur. Not particularly dry.

Abdomen: epigastric discomfort/Pi with extremely empty feeling in epigastrium. I forgot to palpate specifically in a Sa’am way for tightness/looseness or warmth/cold, but nothing was outstanding to me.

Pulse: very slightly rapid (80 bpm) (And otherwise very tense and slippery)

Excess Presentations:
Lu: plump thenar eminence, strong voice, plenty of non-money resources. Lots of signs of Qi not descending through the St, which I am reading as Lung excess/St def: esophageal burning, burping, abdominal distension, pain at St3, high blood pressure. Also poor appetite. And lightly overweight with dry skin.
St: none (?)
Sp: soft stools; thickened skin at Sp1 (and Liv1).
Ht: previous history of helping others at some personal sacrifice
Kid: zero suicidal ideation despite a very difficult situation;
SI: little or no varicosities
UB: fear that she won’t find her way out of the “forest.”
SJ: warmth above, cold below; self-critical;
Liv: stuck in the deep dark forest and wanting to come out; super sad. Thickened skin at Liv1 (and Sp1).
PC: no anger, even at people who have hurt her.
GB: right side ribside pain

The Grossest Things in the Room: Sadness and devastating loss; cold feet with warm(er) hands, GI and urinary signs.

Main treatment ideas: St+ on right.
(Do others agree that all these digestive signs are more issues of St deficiency leading to Qi rebellion?)

Other treatment ideas: I’m stumped:
– I thought about PC to ground, but on the other hand she’s such a person for doing what’s right, and when she is angry, she tends to repress it or get very passive-aggressive about it.
– Thought about Liv for helping her shield, soothing her, and balancing the SJ excess sign of cold below, but this would be more of the dark forest that she wants out of. Thought about SJ to bring her out of the dark forest (and I wondered if this could also help with her urinary symptoms), but her cold feet make me think that would be unwise.

Previous treatments have been a combination of moving Qi (Master Tung Mu, Liv3) and grounding (Kid 3, Kid 1), with generally good results that last however only for a day or two.

Any thoughts or suggestions? I know there’s a lot of posts about SJ/Liv, and I’m OK with doing something else for now and seeing “what else might be revealed.”

Thanks in advance for any feedback!

Hi Nancy,

Thanks for the case.

With so many symptoms piling up behind Lung excess, St+ stands out as a safe bet.

Your analysis could be refined a bit. High blood pressure is not a for sure anything sign in Saam. Channel based findings, such as St3 pain and Sp1/Liv1 thickening, belong under their respective channels and counterbalancers. Right ribside pain points to the Lung/Stomach pair. If it is the GB channel then you could also say P/GB.
Burning in the epigastrium and thirst for cool can be seen as a heat signs that could go under H excess and the other excesses that include heat (SI, K, SJ- though it isn’t exactly heat above). The very empty epigastrium can also go under H excess as this area includes part of the H/UB diagnostic area of ren15 to ren 8. This area being soft and/or warm is a H excess sign. Next time you palpate, feel if this area is warm or cool. Sometimes out of control emotional expression needs a bucket of UB ice cold water to cool"them off- not sure if this is how she presents but some of her physical signs make me curious about this. H excess types can cling excessively to attachments and could use the cooling detachment of UB+.

Despite the warmth above and cold below, given the above she looks way more Liver excess right now. She sounds trapped in an internal hell- more shielding won’t help her get out of that. A finding like really bright eyes could change my mind about the Liver/SJ balance.

The P/GB balance isn’t so clear to me.

Let us know what happens. Thanks.

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