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Recalcitrant insomnia

This is a woman in her mid 60’s whom I’ve been seeing off and on for two years, with the last 9 months exclusively Sa’am treatments (about 15 Sa’am treatments altogether). We’ve helped with her chronic sinus congestion but haven’t been able to do much for her insomnia. I’ve used only basic unilateral supplementing treatments, because I haven’t been able to gain the confidence one would want in order to do a bilateral treatment or certainly to drain. It seems that most channels (and we’ve tried something like 10 out of the 12) help her for two or three nights, then back to her pattern of highly interrupted sleep.

Without giving the full case here, I’ll point out a few interesting bits. The most effective treatment was HT+, resulting in 7 consecutive nights of good sleep (amazing for her). The following visited I supplemented HT again, resulting in 3 good nights. I left HT alone after that, but several treatments later wondered if I hadn’t overshot the mark; I tested UB+ with acupressure and, getting a good response, needled it. That resulted in 2 good nights. So at this point it’s difficult to say she has either UB or HT excess.

Another interesting thing, several visits ago I thought “I haven’t tried PC+, what’s wrong with me!” and tried it. I’d describe her as slightly tipped towards PC excess on the PC-GB axis, so it never jumped out, but with the recalcitrant insomnia I thought, ‘worth a try.’ Her response wasn’t good sleep-wise, but she actually felt chattier than usual and more “charged up.” The following week I counterbalanced with GB+ which was a little better for her sleep (one very good night after treatment) and calmed her emotionally, as well as resolving some digestive issues she’d been having. Interesting.

I’m about out of ideas, having supplemented virtually everything with modest results or diminishing returns, and not being confident enough in a treatment direction to risk draining. Herbs–and I’ve tried a lot of formulas as well as some western tinctures and even a homeopathic or two–haven’t done much for her sleep either. I’m going back to double check drug side effects (she’s on a non-drowsy antihistamine and a bone density injection), but beyond that…How would you approach a case like this?

Addendum: back in August she had a possibly bad reaction to LR+. It wasn’t totally clear. She was on vacation and by the time she returned, congestion was pressing and we focused on that. So I may have glossed over an opportunity to ‘apologize to the system’ with SJ+. I’m thinking to try SJ+ at our next visit for this reason, even though she doesn’t seem at all LR excess. Then again, LR excess is one of my blind spots, being SJ excess learning myself.

Thanks in advance, everybody.

A couple corollary questions:

-have folks seen pharmaceuticals interfere heavily with their Sa’am work? She’s not on a ton of heavy duty stuff but it seems a possible factor. And she’s now started gapapentin for sleep and RLS.

-how do folks think of RLS in TEAM terms, overall? She has legs that actually jump and twitch, not just restless in the sense of wanting to move them. She also gets pins and needles in her feet. My thoughts were wind and blood stasis and I’ve moved her blood with SI+ and with herbs, but not much response. Have also supplemented blood with LR+ which as mentioned may have resulted in a malreaction.

A detailed case study write up would give your readers a better picture of your patient’s situation.

Not yet.

In classic Sa’am terms, wind is the diagnosis and SI+ and Liver+‘are the treatments to consider. Since these failed, I would see how other elements of her picture could explain the RLS, including blockages to circulation in her lower body, damp/dry, etc. I would also look for clues like channel location of the twitches, better or worse with environmental factors, etc.

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