Qiological Community

Some clarification

I just finished an online course with Toby a couple weekends ago and have been using it almost exclusively in my practice since (and loving it!)
I am still unclear on a few symptom groupings and was hoping for some clarification:
In general,
*what does prolapse indicate?

  • hemmoroids?
  • bleeding from fissures?
  • Bloating?
  • heartburn, acid reflux
  • neurological symptoms - (like a sparkler/burning feeling in the legs)
    *elevated heart rate with movement (excessive - this is a post covid symptom I am seeing)

Which way do you needle kidney 3 to tonify/sedate?

I realize that these may not be entirely cut and dry but I guess some ideas would be helpful - then I can add them into my whole picture.

Thank You!

Hi Erin,

Welcome to the forum! Sounds like you have jumped right into Saam. Glad to hear that you are loving it.

The only time that you needle K3 is when you are supplementing Kidney. In this case, you are sedating K3 by needling against the flow of the channel. To sedate K3, Toby puts his finger on K2 and directs the needle towards K2.

An excellent way to review the intro material and exercise Saam thinking is to look at the symptoms you mentioned and come up with your own ideas first. Where does your understanding of the 12 channel archetypes match up with your understanding of possible pathomechanism for these symptoms? Keep repeating the magic mantra Sometimes channel, sometimes quality.
Send along your ideas and I will be happy to compare notes with you.

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In general,
*what does prolapse indicate? I would think this could be spleen excess in SAAM- but in my original pre SAAM thinking I would have suspected Spleen xu

  • hemmoroids? my thoughts are maybe Ki +
  • bleeding from fissures? SI +
  • Bloating? Again I would have though Spleen xu before Saam but now maybe Spleen excess - treat the LI
  • heartburn, acid reflux - Lu excess? - Supplement the Stomach?
  • neurological symptoms - (like a sparkler/burning feeling in the legs) Is this blood stasis? in which case supplement SI
    *elevated heart rate with movement (excessive - this is a post covid symptom I am seeing)
    I am definitely confused with this one. I am not sure to treat this as blood stasis or blood xu (SI+ or Liv+) I tried treating this by tonifying the liver last week and the patient reported feeling very heavy in the chest and an overall sense of unease and heaviness. My concern with tonifying the SI in these patients is I don’t want to move too much in a deficient patient. They have very low energy as it is (ST excess)

Thank you for your help!

When analyzing symptoms in Saam, it helps to look at the elemental and directional aspects of that symptom: too fast/too slow, too hot/too cold, too up/too down, too full/too empty, too dry/too wet, too outward/too inward, too held together/too falling apart. Identifying these elements will bring you back to the channel archetypes. Acid reflux is too much up. Prolapse is too much down. Bloating is too full on the inside. Hemorrhoids are too much down but also a pooling of blood and fluids. (It is important to know if they are itching or bleeding) Heartburn is impairment of circulation in the chest. Sparkler/burning feelings in the legs is impairment of circulation in the legs. The burning sensation can be a red herring- it isn’t necessarily heat unless the area feels hot (subjectively or objectively) or looks red. Bleeding is blood coming out. Fissures are compromised exterior.

After looking at the quality of the symptom in isolation, you have to look at the overall environment of the patient that could create those symptoms. For prolapse, is excess internal damp pushing the organ down or is the patient a light SJ excess without the density of tissues to hold his/her organs up or is the patient just falling apart SI excess? Or all of the above?

It is also really important to identify what channels and organs are involved. Prolapse where? Neurological symptoms in which channels? Whichever channels you ID, you must consider that channel and its counterbalancer.

What channels do you come up with now?

I am not going to go through all of the symptoms because they have been discussed on the forum before. Using the search function at the top right of the page will bring up lots of information fast on symptoms and topics. The forum has been very active for well over a year now, so there are lots of great discussions and cases. Spoiler alert: all channels can be considered for neuropathy- you really have to look at the patient and the symptom to narrow down the possibilities.

I really recommend looking at the Case Study Format for tools for learning Saam and helping to see your patient better through Saam eyes. Please follow the principles if you decide to present a case on the forum.

I’m not seeing anything in this symptom that says blood xu or blood stasis with this symptom. The heart is beating too fast and it is worse with movement. There are lots of potential explanations here. You are really going to have to look at the overall condition of the patient to figure it out.

This sounds like a potential mis-treatment. Did you take out the needles and treat with the counterbalancer?

Good thinking.

Could ST excess potentially explain the symptom? Yes, Stomach excess is damp outside/dry inside. You can also look at the St/Lung pairing as how the body stores and lets go of resources. Lung excess has a great capacity for drawing in and storing resources, including qi. By contrast, Stomach excess has a hard time holding onto resources, including qi. If the patient looks really deflated and is having a hard time drawing in and storing qi, consider Stomach excess.


Thank you so much for this immensely helpful information. I really appreciate you taking the time to answer my rookie questions! This is going to really help the way I look at and diagnose patients. As a side note, the patient who I tonified Liver and she felt really heavy, that was a second treatment to fix a first mis-diagnosis. I originally treated her with supplementing PC as she said she was really sensitive and I thought this would be a good first tx to calm nervous system. Immediately she felt spacey and unwell so I took out the needles and did liver to which she said at the time she felt much better. It wasn’t until later that she felt the heaviness. I had her come in the next day and I did lung+ and she said she felt much better, lighter in the chest. I am seeing her again this morning so I will see how it played out over the weekend, Oof, I have a lot of learning to do! Thanks again, I will be sure to keep reading this resource.

I can understand the impulse to look for another “calming” treatment when the first attempt goes south. However, an adverse response to a treatment is a clear indication- the strongest indication- that the patient needs the counterbalanced supplemented. In this case, you should have done GB+ instead of Liver+. Do keep GB+ in mind for the near future.
You will read in this forum that all of the 12 channels have been used successfully for anxiety so while P + is grounding, grounded isn’t always what a patient needs to feel less anxious and can be too much of a good thing.

I’m not positive if the heaviness of the chest after Liver+’was an adverse reaction. If the patient felt good overall and that symptom was relatively mild,
it could be the overly open patient getting used to sensations of being shielded. This usually balances out within 48 hours of a treatment. The bright SJ excess patient can also feel strangely dull after Liver +. If the chest heaviness was stronger and felt disruptive, it would be considered an adverse reaction indicating SJ+ as the right step to counterbalance
Given the stronger negative reaction to P+, GB+ would be more important to treat.

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Thanks @KristinWisgirda for this poignant and clear summary of Saam.
I’m making note of it here because it is a great reminder of what we are doing. It points to both the utter simplicity of the system and at the same time an invitation into the complexity.

Most of all (and this happens to me all the time) when I feel confused, coming back to the basics is very helpful. It helps me to drop my previous experience, which was helpful in a previous moment, but not in this one. And let’s me start afresh seeing my patient in “this moment.”

Yes!! As @KristinWisgirda points out, anything can mean anything. We have to make sense of our patient not so much in relation to our mental models (although those are at times helpful… except for when they are not) or some flowchart of signs and symptoms (like we learned in school), but rather look at anything going on with our patients in relation to what else is going on with them, and bring it back to the basic parameters Kirstin mentioned.

Sometimes it is so easy it feels like cheating. Sometimes it is so difficult that I feel like going out and getting productive work where I feel like I’m actually contributing to the world. But, mostly it is kind of fun to puzzle through and learn something new about medicine and how to apply the foundational influences of our medicine.

Keep at it!

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Hi Kristin. . . . can you elaborate on this point? Never thought of SJ Excess that way - lack of density of tissues.

From the intro powerpoint: When the liver is in excess, the body is cool (especially the upper part), dense and heavy.

In comparison: When the SJ is is excess, the body is warm and light.

Toby described SJ excess body as the yoga teacher body that is light and flexible.

Some of my understanding of prolapse comes from the herbal teachings of Dr Yu who says that prolapse relates to tendons and ligaments which is related to wood. He uses shao yao gan cao tang (peony root and licorice), which is sour and sweet, as basis of his prolapse formulas. Zhi shi can be added to regulate the contractility of these tissues.
I haven’t used this idea yet herbally or with Saam but it makes sense to me and I will keep it on my radar when a patient with prolapse shows up.

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Thanks so much for this Kristin - its amazing how one can forget one of those basics on the intro powerpoint so easily - an exercise in profound humility!! Can you elaborate on how you perceive a ‘light’ versus a ‘heavy’ body. How do we perceive ‘density’ in a body standing in front of us short of having them lean against us and feeling what that feels like. Have you amassed a set of visual, observational clues that plug you reliably into the state of density of the body standing or sitting in front of you?

Hi Daniel, You are obviously a hands on guy. You already know what dense versus light flesh feels like, independent of adipose. It is harder to differentiate structures in people with dense flesh. People with light bodies have much more space in their tissues.

Light bodied people move through space like dancers- light on their feet, aware of themselves in space. Dense bodied people plod and seem heavy, in a way that feels different than the grounding of P excess. Again all of this is independent of body weight.

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I often will look at person or just sit with them and ask myself… elf or gnome?




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I love that, definitely a keeper!
:heart: :orange_heart: :yellow_heart: :green_heart: :sweat_drops: :dizzy: :boom:

Just had a patient tell me about some woman who was in the parking lot of her business and tossing trash out of the window. One of her co-workers saw this and started yelling at her to pick up her garbage, she was ignored.

Then this guy comes along and asked about the commotion. She told him that his woman was throwing her garbage out into the parking lot. He just kind of nodded, ambled along…and got in the car with the woman who was tossing the trash and drove away.

They could both use some TB tonification! :rofl: :rofl: :rofl:

This was the most HELPFUL summary of all my 4 years of TCM College. Ha! It always in all ways comes back to yin and yang. Thank you for the depth of clarity in this post, even after this quote above. You really are a wonderful teacher.