Qiological Community

Too much LV+ = too much "movement"

I had my most extreme (negative) reaction to a Sa’am treatment today so thought I would write it up. I know where I went wrong (it is obvious), but thought it might be helpful to others. Would also love your thoughts for moving forward.

22 year old female, extremely thin, very pale skin, bright sparkly eyes, very polite, easy eye contact, soft voice. She expressed that she is very hard on herself - pushes herself very hard.

Chief complaint = diagnosis of POTS manifesting with nausea and dizziness all the time. Fatigued all the time. Somnolence. Nausea worse after she eats. Not much appetite. Postural dizziness.
Easy SOB, palpitations, and easy lightheadedness.
Light sensitivity - does not like full sun.
Periods = terrible cramps, slightly better with heat. “Blinding pain” first day. Dark old looking clots. 2-3 days of bleeding - typically moderate flow for 1-2 days and then light flow for 1-2 days. Generally 28 day cycles but past 3 months have been about 40 days. All symptoms worsen with period and stress.
Good sleep.
On and off constipation. Some weeks 1 BM / day and then others 3 BMs / week.
Always cold. First appt she wore two sweaters under winter coat (we live north of Chicago).
Acne and eczema - bubbly dry itchy on LI channel of both arms by wrists. Dermatagraphism - hives from touch. Skin issues don’t seem to be related to period. Acne best right before period.
Sweaty hands. No noticeable dry / damp rest of body.
T= reddish (not dark, not bright, but also not pink), pancake flat, slight quiver, full subs
P= deep, thin, floating cun both sides,
Abdominal palpation = tight rectus and tension above navel, pt noted that above navel and both R and L were painful on palpation.

First Sa’am tx =
R: LV+
L: HT+
Reaction: Pt noted that she has not been as cold. Nausea and dizziness not as severe. BMs were better for about 5 days. CD33 - still no period - fullness in lower abdomen but no pain.

Second tx:
R: LV+
L: SI+
Pt got period night of last tx - 33 day cycle. Not severe cramps, no nausea / vomiting. Dark clots - almost black blood. 4 days of bleeding - last two days were very light.
Pt noted that her itching worst at night - 8pm and later. Does not wake her up once she is asleep. Energy has improved - not as fatigued.
Hot flashes around period in Dec and Jan - worst around 8pm.
Pt noted that she has not been as cold (she wore only long sleeved shirt under coat).
Nausea and dizziness ok. Postural dizziness ok.
BMs somewhat better - 1x / day but small pebble stool / incomplete feeling.
Pt noted that during / after her period she feels depleted.

Third tx:
Bilateral LV+
I left her about 20 minutes. She was fine when I walked out of room - all felt ok. When I walked back in she was visibly agitated, said she felt nauseous and shaky and had to go to the bathroom.

I quickly pulled the needles and she ran to bathroom. When she came back I asked her if I could do something to try to help and she agreed and laid back on the table. I quickly put in SJ+ on R side.

She was shaky and told me that it felt like “things were moving too fast”, but she was happy because she had the first good BM in awhile.

I stayed in the room with her and kept asking her how she was feeling. She was visibly more settled, and her pulse seemed more even, but she said she still felt like things were moving too fast in her chest and lower abdomen.

I added PC+ on the L side and left the SJ+ on the R. After a few minutes I asked how she was and she reported better but still felt a little anxious.

I pulled the ®SJ+ and left the (L)PC+. Within a couple minutes she felt better so I left her with those for about 7 more minutes. She looked and said she felt very calm when I returned.

Clearly I went too hard on the LV, but I thought it was interesting that over-tonification resulted in a “things moving too fast” feeling. I would have thought that would happen with mis-treatment with SJ or GB but not LV. Any thoughts for how I should move forward with her?

Hi @janabricker thanks for sharing this with us.

Yes, your patient certainly sounds SJ excess along with some yang deficiency thus cold, blood stasis and a bit of LI excess as well. I have a few thoughts.

First, when starting out with a new patient I recommend only doing one side. Even for someone like this patient who clearly needs Liver tonification and is cold. It will be easier to track things if you just do one side as you’ve given the body one clear message on what you want it to do.

Since you’ve been doing bilateral treatments for her, it might not be that bilateral LV was too much, it might be that doing bilateral treatments is too much. You’re asking too much of the body too quickly.

As a friend of mine likes to say to drive the point home… “more is not gooder.”

It could be the “moving too fast” is that you’re asking the body to do too much too soon. Expecially as she is both blood deficient and yang deficient. Even though all the channels you’ve chosen seem to spot on in terms of what she needs. It’s asking the body to do too much, when it is in a depleted condition.

Slowing things down and using just one side for a while might be helpful.

Very interesting case. Thanks for sharing with us, and keep us posted on how she does going forward.

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Everything Michael said…I never double side a new patient…and I take time to explain the power of this system and ask for patience with “my learning about your body so I can best help you”. I find this especially needed if they are an experienced acupuncture patient.

Or I like Toby’s analogy “Do you eat all the food for the week on Monday?”

Another popped into my head “is it safer to drive home at 55mph or 110mph”

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Point taken George and Michael! I sometimes start with single side and sometimes start with bilateral treatment depending on how clear I am with the signs / symptoms. I have had many great experiences combining LV / HT and LV / SI when appropriate.

She did great with the first two treatments, but the third really threw her for a loop. It was her reaction that I found particularly interesting.

I will for sure go single sided for the next few.

Other ideas (in addition to LV, HT, and SI) were PC (palpitations, easy SOB, dizziness), SP (epigastric tension and hard, dry stool), and possibly ST (nausea). Thoughts about those?

Toby suggests not doing the same channel more than 2x in a row. The Liver supplementation was the third.

I am in both awe and confusion how a treatment can work so well one time and fail the next. Or I had a patient who is a scientist where I treated Liver+ 4 weeks ago and she loved it. “best treatment”. Yesterday I did a deep eye sensing and finally saw her blue eyes were dull, she also said she was emotionally down over the weekend. I treated SJ+ and she said she felt great and her eye twitching she has had for weeks was gone.
Our treatments options have a time and state dynamic dependence to them for sure.

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I also have definitely found timing to be important. Interesting that your patient had such positive responses to LV+ and SJ+. I have one patient with whom I sometimes use PC+ and others GB+ (often with other treatments in between) always with good results (so far anyway!).

I certainly agree. Just because a treatment worked well one week does not mean that it will work well again. While we should take note of what worked in the past we need to reevaluate at each treatment what is right for today.
I treated a patient with extreme vertigo episodes from water rising from the stomach to the upper body with St+ one week. She had a great week - no vertigo, great energy, less tinnitus, less brain fog…
Three weeks later when I put in St+ again she right away started to have chest pain and I had to take the needles out…
Why? It’s baffling but it must be that something shifted the last time I did St+ and it was no longer necessary. She continued to have some vertigo episodes after the St+ treatment but it was improving and so it must be that St+ was no longer a part of that picture.
How can we predict that? I don’t know. Toby probably can but the rest of us just need to try and be present with our patients and do our best. And most importantly we should enjoy learning and trying to master a very difficult but rewarding acupuncture system.

Something similar happened to me personally. Liver+ made me feel shaky and panicked. SJ+ quickly remedied. Too much cool dark density is scary. Imagine being lost and cold in the dark woods.
If yang is unable to root because it is deficient and too much yin encroaches, it can surge. Herbally gui zhi tang jia gui comes to mind where the addition of extra spicy warm sweet cinnamon twig is used to treat the upsurge.

I’m not clearly seeing this patient so can’t give feedback. A more fleshed out case study would help. I don’t see information about her medial heels, thenars, occupation, strength of voice, changable moods or very grounded, appearance of acne, etc. Is bubbly rash mean that the bubbles are fluid filled? Considering symptoms with all of the channels in mind would help stimulate your thinking. Palpitations and dizziness aren’t necessarily GB excess signs and could be so many other things. Nausea can be treated by so many things besides Stomach.

I share the others concerns about too many bilateral treatments. I understand the impulse to want to do more and the temptation when it has helped others in the past. However, it is a much riskier way of practicing and you lose clarity.
You ended up giving the patient 2 x 2 sided treatments that day! I would have left her with the SJ+ treatment since that is the antidote to too much Liver and not added the P+.
Reevaluation of the patient at each treatment is critical as well as close watching of the patient on the table.

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Hi Kristin - I very much appreciate your thoughts and agree completely that it was too much. I sat with her for 5-7 minutes with the SJ+ and there was no change so that was why I switched to PC+ (she was very ungrounded). Fortunately, PC+ worked for her.

I am extremely cautious with Sa’am and only use it when I feel like I clearly see the patient (about 50-60% of treatments). This was no exception.

This was a learning experience. Unfortunately, we always learn so much more from the things that go wrong than we do from the things that go right. Thanks again for your thoughts!

@janabricker
It takes loads of courage to present your mistakes publicly. Talking about mistakes serves the community in the best possible way. Thank you. My guess is that everyone on this forum has made one if not several big mistakes with Saam. Definitely me included.

I also applaud your curiosity to wonder why too much Liver lead to a “too fast” feeling. Your patient’s reaction shows us that not every Liver excess presents as a tree stump.

SJ+ has helped a number of my patients who present as “hyper” besides my own personal mistreatment experience.

I totally get the urge to make the patient better ASAP especially when I know I mistreated. Because mistreatment was a double dose of Liver, you would expect SJ+ to take longer to counterbalance.

Yes- in the moment. I’ve been duped by the sedation of P+ treatment before. In one case, the patient reported an unusually terrible week of headaches after. She seemed angelic on the table and I was very confident in my diagnosis at the time.

My many, many mistakes are big reasons why I try to promote safe practice.

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