Hello SAAMers! I’m Alexis and am a SAAM newbie here! I took the online beginners course a few months ago and am just starting to incorporate it more into my practice. Any advice is much appreciated
49 year old female
Chief complaint : Nausea +9, vomiting +8. Constant nausea for two months with vomiting daily for two weeks. The vomiting is not a lot in volume, will usually throw up in her mouth 2x a day and have to go spit it out.
Second complaint: Headaches +7 and Vertigo +6. Headaches usually accompany nausea. If she doesn’t have a headache notices nausea is better. Stronger headaches make nausea worse. Headaches are mainly behind the eyes and occur 3-4x a week. Light sensitive +5 when experiencing headaches, has to wear glasses throughout the day if she wakes up with a headache. Vertigo is ongoing for 3 years. Comes and goes. Has not had a strong episode in two months but will occasionally feel unstable when walking with intermittent episodes off dizziness. Has been working on vertigo with PT for 6 months.
Appearance and demeanor : average facial symmetry; casually dressed but put together, warm and friendly +4; polite +4, reserved +7 but has opened up more with each treatment. Definitely not an over talker. Difficult to get to know her from her words up until our 4th session together. Describes herself as an introvert +5, dull eyes +5
Lifestyle: Works from home as an online receptionist. Really enjoys her job. Recently divorced after a very unhealthy relationship. Has a lot of anxiety since the divorce. Is realizing she has spent a lot of her life taking care of others and not caring about herself. Doesn’t ever stick up for herself.
Body morphology and flesh quality: Large frame, overweight +9, dense body
Skin Quality: dry skin of fingers, joints, arms and legs +8 with itchiness +3, oily skin of face +5 especially around chin and mouth with mild acne +4. Is prone to getting hives, especially with stress.
Body Temp: Tends to get cold easily but also overheats easily. Any change in extreme temperature affects her. Sometimes gets cold hands and feet. Doesn’t sweat easily. Has to exert herself to really work a sweat
GI: Appetite comes/goes, difficult lately with more nausea. Has to force intake of food often. Tends to eat two meals a day. Daily BM.
Respiratory: Denies SOB aside from with anxiety. Reports an increase in phlegm production which comes up into her mouth. Positive for asthma that is allergy related.
Sleep: Sleep is interrupted, wakes frequently through the night.
Emotions: Experiences anxiety daily- manifests as shortness of breath +3, heart racing +5, upset stomach as if she has had way too much coffee +6. Panic attacks occur a couple of times a month, reports this as getting better. Depression comes and goes. When depression is bad will feel like she is stuck in a dark place +5 with negative self talk +5. Tends to neglect her own needs so that others can be cared for +7; lack of self assertiveness +8
Urination: Feels like urination is proportionate to the amount of water she drinks. Experiences thirst throughout the day and drinks plenty of water. No pain with urination, no frequency, no incontinence.
Other Body: very few varicosities; hysterectomy 8 years ago.
Tongue: pale, scalloped, patch of yellow fur in SP/ST area
Pulse: deep and thin on the left, slippery on the right
Heart: warm friendly +3
P: lack of self assertiveness +8, doesn’t get angry, or act on anger- tends more towards holding in and suppressing anger +7
SJ: light sensitive +5, self critical +5
Liver: dull eyes +4, introverted ?, when depressed feels stuck in a dark place ?, dense body
Lung: damp inside/dry outside with dry skin and overweight. inflated thenars
Spleen: overweight +9, damp inside/out with being overweight & greasy skin on face
SI: puts others needs before her own+7; mixed warm and cool?, low self esteem +6
The Grossest Thing(s) in the Room: overweight, oily face, dry skin, lack of assertiveness, introverted, taking care of others before herself, low self esteem
Main treatment ideas: LI, ST
1st treatment: LI on right
Helped reduce nausea and vomiting stopped for 3 days. Headaches slight decrease in intensity. During the 1st treatment I noticed how dry her arms and legs were and though to myself that I probably should have treated +ST instead.
2nd treatment: ST on right
Helped reduce nausea and vomiting stopped for 6 days. Still having headaches but not as much nausea.
3rd treatment: ST on right
Prescribed Sheng Jiang Xie Xin Tang during this visit. With herbs + SAAM tx vomiting has stopped completely and nausea is significantly reduced. Will only get nausea when she gets a headache which is still happening 3-4x a week but nausea is more mild. Has been having more of an appetite and able to eat things other than rice and broth.
4th treatment: SJ on right
Came in for this treatment and reported that headaches are still an issue but has not had an episode of vomiting or extreme nausea in over two weeks. Works on the computer all day which can make the headaches worse. During intake for this treatment we talked more about her depression as well as her being an introvert and I was drawn to LR excess so I treated SJ, although looking back on it I feel like the LR/SJ axis may be too close and I should have left it alone. She started to feel slightly agitated during the +SJ treatment and I spoke with her about removing the needles and putting in +LR but she asked me not to. She explained that her agitation was around starting to have feelings of anger come up which makes her slightly uncomfortable but she was wanting to explore it on the table. She had a strong emotional release and cried during this treatment, felt better by the end of the treatment.
Two days later she sent me a message saying- “I had more anger bubble to the surface after the last treatment. I understand where it’s coming from now and it’s much older than I had thought. I’ve been doing exercises to let go of some of it and also lots of journaling. The day after I saw you, I had a bad headache and nausea day but I took the day off and rested. The nausea is gone again and only a bit of headache remains.
Other treatment ideas: GB+, KD+
My biggest questions moving forward are:
Should I not have done SJ? If so, do I need to do +LR before moving on to another channel? Could SJ have brought anger up from its shaoyang connection to GB?
I am feeling inclined to do +GB seeing how she lacks assertiveness and has a lot of repressed anger but I’ve been cautious/scared of doing a +GB tx!
I already treated ST twice, should I avoid going back here? Is +LI something I should consider revisiting?
Any other ideas people have or advice to guide me through this case? I know there is probably a lot I missed or am not seeing/asking in regards to seeing things through the SAAM lens. This is one of the first patients I’ve dived into SAAM with and I’m still learning! Very open to any and all feedback and advice.