Qiological Community

Podcast 128 Sa'am Scholar - w/Andreas Bruch

Sa'am Clinical Insights
#1

(I couldn’t decide whether to post here or in the Qiological podcast category but it seemed logical to post in a Sa’am category.)

Michael’s beginners mind interview had my wheels turning and I am curious about your take. My thoughts:

  • Interesting that Andreas uses Sa’am on one side and then may do some other style on the other. I am incredibly apprehensive about mixing these treatments styles as I have seen good results go sideways when I did too much. I do mix channels and may do a partial Sa’am treatment on the opposite side to support the primary side. (Daniel I know you’ve shared about treating BL Shu points after Sa’am)

  • For channel issues Andreas gave an example of shoulder pain on SJ meridian. He immediately went to tonifying SJ+ whereas we take the archetype into consideration and possibly we may tonify the LR+ if it fits.

  • The idea of choosing a point based on the 3 characteristics of the point - (meridian, Wu Xing, Liu Qi) - is cool and I can see how possibly it can expand into some points to choose within what we have learned.

  • He seemed to be using Sa’am based on TCM pairs where he gave an example of treating back pain on extension with the LU channel. I recall a question over a year ago to Toby about the TCM pairing and he said he doesn’t use it in this system. When I first started Sa’am I was thinking of TCM pairing but have kept within the Sa’am pairings. Do others consider the TCM pairings and found consistent clinical usefulness? WWTD

Comparing the 2 Sa’am books I own I am grateful for how Toby has presented the archetypes in Sunin Doam’s Sa’am system. I find there is a gracefulness and a heart connecting approach in Toby’s teachings that is missing in other Sa’am methods I’ve explored.

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#2

Hi George. Yes, I was going to post after listening to that podcast. Thanks for getting the conversation going. I was surprised mostly to hear no mention of the counterbalancing pairs that form such a core of the Sa’Am ‘style’ Toby is teaching us. I am finding those pairs (and the insights and interpretations into our patients they open up) to have a precision power unrivalled in any other acupuncture system or approach I have worked with. They seem to facilitate a profound clinical elegance.

With the patient lying face-up, I have been a complete purist - with perhaps only three or four cases in the past 8 months where I have done two Sa’Am supplementations - one on the right, one on the left - all of my treatments have involved one side with one of the 12 possible supplementation treatments. But I must confess, I do often then do something very simple and focused on the back - just one or two needles - usually pertaining to the front treatment (the back shu or hua tuo jia ji often of the excess or deficiency identified and treated on the front) - and usually based on palpation.

I am so thankful - this system we are learning here seems to be so elegant, so powerful, so complete and such a remarkable clinical portal into our patients - I feel my only limitations are not the system but my skill and capacity to deploy it well.

#3

It is a comfort to be reminded that Toby didn’t just make this stuff up. :slight_smile:

Kudos to Michael for taking this approach which gave Andreas an opportunity to give us a fresh take. He couldn’t possibly explain the whole system within the hour format so omissions might have for simplicity sake and not necessarily a different approach to the system. He might have also chosen the simplest, easiest to understand case study instead of delving into the more complex relationship of the channel pairs. I’ll be interested to look at any English resources Andreas might produce.

I am taking the “3 characteristics” as an invitation to reflect on the nature of the points and maybe deepen my understanding of what is being added when we supplement. I am hesitant to break up the point combos and remember Toby’s instruction that the 4 point combo provide a clear directive in an inherently unstable system. The system is so powerful and my skill with it is basic at best. I fear muddying the waters even more. Yesterday I found out that SI+ made a very pretty, thin boned dizzy girl’s SI channel shoulder pain WORSE for 3 days. What did I miss? She also has bad dysmenorrhea. True she didn’t settle but she didn’t want to be in my office to start and she had such a hard time with the needles. And I had such a mental block to needling here again, never mind using K+ for her. So much to learn and observe both from the patients and my blocks to effective practice. I notice that I am not the most confident practitioner when I treat teenagers.

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#4

This gets powerfully reinforced in my clinical experience every day.

#5

I didnt realize there was a topic on this already so I made another topic in the podcast section. Since this is the earlier topic I will post it here:

So I just finished listening to the interview with Andrea’s and, having a keen interest in saam, found it an interesting take. So my question is to Michael or anyone else who may have tried some of the ideas in clinic. There was talk of say the LI being Metal - Dry and Yangming - Cool so when you have say a patient who presents damp and heat we could use LI. I thought that this was potentially a great aid for myself in the Taiyin/Yangming dynamics as sometimes I find it hard to feel confident in a saam diagnosis when, for example, the patient is definitely damp interiorly but doesnt present with any overtly moist or dry signs exteriorly. In these cases I tend to use other methods and while I usually get results from that I would like to feel more confident in this aspect of diagnosis with Saam because when I get a Saam diagnosis down correctly the results are brilliant.

Have I understood what Andreas was saying correctly or have I misunderstood something? Any feedback/insights would be greatly appreciated!

#6

This is no different from Toby’s teaching, except that we have to evaluate interior/exterior as well to be sure it is a good match and know that Stomach or some another channel isn’t more appropriate. Andreas might use this thinking too- hard to know from a 1 hour interview.

You can ask whether or not the patient could handle drying the exterior with LI+. Or if the patient needs the descending action of ST+. Or maybe the moving aspect of SI+ to resolve the dampness.
The more familiar you are with the profiles of each of the channels the more confident you will be to use them. Experience will further refine your understanding.
I hope this helps but I’m not sure if I have addressed your question.

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#7

Thanks @KristinWisgirda!

Yes I do remember Toby talking about this but it seemed that Andreas put more emphasis on this aspect of the pairings than I felt was put in the course where I felt the emphasis was on interior/exterior dry/damp for the Taiyin/Yangming dynamic. Like you said though, it’s hard to tell from a 1hr interview.

From the second part of your reply I feel like maybe I am putting emphasis on things or getting unnecessarily caught up on certain details with your comment re questioning whether they need some descending St or could handle the dry exterior of LI. Clinic is a different beast to theory and sometimes I find that people fit the body type perfectly but other times I find myself having reservations, particularly with the exterior characteristic. Often it is very clear on interior dry/damp but the exterior characteristic is more elusive/not as defined. I feel like I may have put too much emphasis on the patient fitting the body type too strictly at the cost of other aspects of the pairing dynamics. Its certainly given me something to think about.

Thanks again Kristin!

#8

Toby has also talked about being able to mix something else if you want to on the other side.

However, I’ve found that to really learn the system. Stick with one side. Stick with tonification. Stick with it until you can use the system enough so the system teaches you how to use it. Then mix it up if you like. But don’t mix other things in too soon, or you’ll rob yourself of the opportunity to experience the power of this method, and to tune your perception to using it.

Sometimes channel, sometimes…
Yes, we have options.

Sometimes I got with a yin/yang pairing like LV to treat to GB. It’s one of the options if I need to toggle away from using PC.
I think the key thing for me is this— what can I use from the library of what I know, to create some balance in the system? The Saam diagnostics are very helpful and often give us tremendous insight into our patients. The basic four needles are a powerful method. But… we can take the diagnostics, get a clear picture of our patient and then choose any way of applying needles in service of working the counterbalances. At least at this moment in time… this is my sense of things.

#9

I’ve been experimenting with these a bit. For example, if I want to really dry someone out, then LI1… the metal point on the yangming metal channel is “triple dry.” (yang, metal, yangming)
I’m seeing if one point like this might be helpful, but I’m still in the initial stages of experimentation so I don’t have much to say about it at the moment.

#10

This is something I am currently contemplating after hearing Andreas’ interview, yet struggle to make sense of how to use it clinically. In your example of LI1 which is triple dry and makes sense. Yet LI1 is tonified for Bladder supplementation to bring water into the system. Does this mean the points are pleomorphic where when used alone they an have a different effect than if used in conjunction with their corresponding antiquity points? Certainly this does seem true.

#11

But the Sa’Am system fundamentally employs mother-child and controlling relationships to achieve its effects - Nan Jing needling dynamics - to the very core. As I know we all know, to dry inside and outside, we support Large Intestine - but by (a) supporting its mother and (b) diminishing influences that are controlling it. The intention is drying, but the strategy is through concurrently enhancing and diminishing the pertinent dynamic relationships. Putting the indirect dynamic relationships into play, rather than just the direct hit. LI 1 just being ‘triple dry’ makes no use of relationship dynamics - its just an alleged direct quality of a point - presumably needling it directly to achieve the direct quality was NOT the chosen strategy by the Sa’Am developers for a good reason? Certainly, the unrivalled power I know I have observed with this system suggests the 5 phase dynamic relationship approach is just that , more powerful. I imagine in my mind its the difference between kicking a ball directly in a straight line versus putting a strong spin on it and kicking it in an edgy arc. A curve ball with a spin versus just a throw. It does make sense. If you just give a kid some money to buy some food, the result is not likely to be all that good. He’ll probably just go chips and pop. If you give his mother some money to buy and cook some food and feed her child AND you distract the over-domineering toxic uncle next door who is messing with the kid, the thriving of the child is likely to be much more impressive.

#12

4 points do 1 thing.

Thanks for the elegant analysis Daniel. I couldn’t decide which of Daniel’s lines to quote. I recommend reading Daniel’s post again.

Using all 4 points is a much more stable input than needling 1 or 2 of the points.

The stability and direction come from getting the whole dynamic working in the direction of supporting that dynamic/channel system.

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#13

Thank you for laying it out so clearly Daniel. I love the kid and food analogy with mother and uncle.

#14

Pleomorphic… Love learning new words. And yes… I suspect so. Just like an herb can have a “single” function, but when combined with another then the synergy creates something else. That is my working hypothesis.

#15

Agreed that the relationships involved all bring a dynamic and stable power to the issue at hand.

For me looking at the individual points as Andreas suggested is an inquiry for me into how I might extend my “Saam thinking” into other aspects of working with the five phases and six jing

#16

I too have been inspired by the suggestion of “triple qi” (so to speak) points. I’ve laid out the ones that fall into this category as follows.

Taiyang—Cold—Water=UB66
Yangming—Dry—Metal=LI1
Shaoyang—Ministerial Fire=SJ6
Taiyin—Damp—Earth=SP3
Shaoyin—Heat—Imperial Fire=HT8
Jueyin—Wind—Wood=LR1

Please let me know if I’ve made a mistake in working these out. I wanted to see what power they may have, so yesterday I needled two points as a test. I have a persistent spasm in my left shoulder region, could be SI channel, could be upper reaches of the UB channel. I don’t know what’s causing it but it’s been around for close to a year and part of me thinks it’s my body beginning to create a frozen shoulder (not Chinese medicine I know) because there’s some tight fascia pulling on the muscle/muscles that are in spasm. I’ve tried many things including Sa’am on myself to get some relief. At times I can get it to go away for a couple hours, a couple days, or a couple weeks. Anyway, yesterday I drained LR1 while supplementing SJ6, both on the right, and it took the spasm away for about 24 hours. Earlier this afternoon I supplemented HT8 and it went away for a couple of hours but it’s now back (wish I’d gotten more bang for my buck with that painful needle). I will continue playing with these points on myself and thinking about them, and what they can teach me about the Sa’am system and the nature of points. Appreciate the discussion so far along these lines.

#17

I too have chronic upper back issues. Here is what I have found to be most helpful…not an acupuncture suggestion but I often see that as an over use problem with too much sitting, computer, concentration on things in front of us…Tends to result in a postural problem causing over stretching in some areas, tightness in others. My most successful remedy is actually upper back posture exercises, and practice aligning the spine meaning focus on lifting Du 20 so the weight of the head is sitting over the spine rather that a chin forward that we slip into when not paying attention. https://www.youtube.com/results?search_query=back+intelligence+forward+head. This guy had some good ideas on the alignment and some stretches to help.
I often give this link to px for exercises https://www.nbcnews.com/better/health/5-exercises-will-strengthen-your-back-reduce-pain-ncna849911
Hope it helps

#18

Corrective exercise is definitely a favorite therapy of mine. A balanced diet of movement is as necessary as a balanced diet of food.
I like the NBC exercises. Recommendations from NBC will be more accessible and convincing for some patients.