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Treating parasites with Sa'am

Good afternoon, good folks

Does anyone have experience treating possible intestinal parasites with Sa’am? Patient is a middle-aged man, not corpulent to begin with, who’s lost 40 lbs over the past year while living in Central America. While not extreme, his appearance is now somewhat emaciated. He has no acute GI illness and no diagnosis, just the suspicion of parasites. I have him on herbs (a constitutional formula and Wu Mei Wan) and have treated him twice with acupuncture–see below.

Besides the weight loss, his complaints include chronic digestive issues (flatulence, sticky unformed stool 3x/day), pelvic floor pain, neck and shoulder tension/pain, potency and libido issues, cloudy/dribbling urination, sensitivity to cold (worse now that he has so little insulation), depression and anxiety, sleep trouble, dry irritated nasal congestion and fatigue. Weight loss is his clear CC.

Treatment #1: HT+ and SI+. I had been tempted to do SP+ but went with what tested better upon palpation. He settled well and reported feeling more ease in his body and less sensitivity to cold afterward.

Leading up to treatment #2, I convinced myself that i was doing him a disservice by not supplementing SP, given his emaciated condition–isn’t this what Toby’s teacher on him did that first treatment in India, after all? Upon palpation testing (acupressure at 3 out of the 4 points), the response was encouraging (patient reported the points felt “grounding”). I inserted SP+ on one side. Seemed to settle well enough that I left them in, afterward reported his mind was racing.

All may become clear with time, but at the moment I’m asking myself: a) Could LI+ have been needed first to clear up any dampness (sticky stools) even in someone this thin? And b) is SP+ contraindicated in someone with (possible) parasites the way tonifying herbs like renshen are? And c) are there any Sa’am rules of thumb about parasites and how to approach them, or do we just treat the patient according to the usual parameters and let any pathogens work themselves out?

Thanks in advance for any insights,
Jonathan

Hi Jonathan,

I was wondering, why did you supplement Heart and Small Intestine during the first treatment? Besides them being the exact opposites of each other in terms of ‘function’, didn’t you state the CC was weight loss? By supplementing SI & HT, not only do you make this patient hot and cold at the same time but you might also increase the GI symptoms because you move things even more. I am a little bit confused as to how you came up with your treatment idea.

From a strict Chinese medicine diagnostic perspective, this is an interesting mix of S&S. It almost looks like a case of Yin Fire a la Li Dong-Yuan to me; but I’m just speculating. In that case though, again from a traditional Chinese medicine perspective, supplementing the Spleen would be my first choice; especially if you feel that the weight loss is the most pressing issue.

Coming back to the SAAM system of diagnosis and the importance it places on psycho-emotional ‘makeup’ and coping strategies. You describe the patient as being depressed and anxious. How does that show up in his demeanor, behavior towards you etc. Also, regarding the diagnostic categories SAAM employs i.e. Hot/Cold, Dry/Wet, Going Out/Going In, which one is the most severe one, do you think?

Thanks for your thoughts. I chose HT because of the intense cold he was experiencing, and SI because of pain and blood stasis signs (which I forgot to mention in my initial post: dry skin and o ketsu / abdominal blood stasis sign). I also tested these treatments using acupressure and he responded well to both, and not well to my #1 idea which had been Spleen supplementation.

I believe you’ve gotten mixed up re: HT and SI. In terms of Sa’am thinking, HT is counterbalanced by UB, and SI by KD. As paired fire organs, on the other hand, HT and SI can be supplemented together, and Toby Daly has mentioned this combination for treating cold bi. (It was perhaps on the aggressive side for me to supplement both at the first treatment, and might have been more prudent to stick with one or the other at the beginning).

I know that KD is counterbalanced by SI in SAAM, that’s why I asked about your pairing because it’s not quite SAAM 101 :slightly_smiling_face: (I’m a beginner).

I see what you’re saying, I did indeed confuse SI with UB. So this is not a pair treatment per se, just two different and complementary channels.

Apart from the abdominal palpation, are there any other blood stasis signs?
This looks like a case of Hot Above/Cold Below to me.

Hi Jonathan,

Just throwing some ideas out there. Now I’ve been doing this for a couple of years I find the SP/LI, LU/ST axis way more complex than it first seems. When reading your intake my first thought was LU+. There seems to be some dryness - the emaciation and the dry nasal congestion but also the loose stool. I have noticed that LI and SP are so great when the presentation is obvious but when someone has a little mix of dry and damp I always go to ST/LU axis first.
As for "rules for treating parasites I haven’t heard Toby give any rule around that.

My 2 cents :slight_smile:

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Hello Jonathan
There is a lot going on here so I would not have started with two channels. By using 2 channels to start you do not know how 1 channel effects him. With your treatment the SI+ blunts the HT+ effect and vice versa.

The Sa’am system is one based on observation. So there is nothing I know of in this traditions that considers parasites. Treat how you see it based on the archetypes.

He is emaciated, with sticky stools and cloudy urine. Sounds like there could be a wet/dry dynamic going on as well, but you feel he is all dry. Is his skin very dry? What are his thenars like?

From what you shared I do not see a reason to supplement SI+. Low libido, dribbling urine, diarrhea. He does not sound like he needs dynamic movement energy. I assume he must have fleshy firm medial heel for you to have chosen to supplement SI+.

Could be a wet dry dynamic. I am coming back to the thenars - if they are deflated or even not clearly full and plump I would consider supplementing LU+.

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Thanks @Shanlarson and yes, it would seem that SP+ was indeed a mistake: I wasn’t completely sure from the initial mind-racing-while-on-the-table, but in the days since he has reported increased flatulence and a sharp downturn in spirits, among other worsening complaints. I’ll do LI+ ASAP to reverse the damage, then consider LU+ (which occurred to me as an option initially as well) at the following treatment. Also considering LR+ (I forgot to mention he has very bright, penetrating eyes).

Some thoughts . . . .

Its extremely important, even more so in the early stages of working with a patient, to keep focused on Sa’Am fundamentals and avoid clouding the issue with perspectives from other medical paradigms including modern biomedicine, other alternative medicine frameworks and even to some degree other frameworks from within the large umbrella of Chinese Medicine.

‘Parasites’ is one such complicating matter.

Last week, I had a new patient come in and say she wanted me to treat her for ‘hormonal issues’. I am very quick to reframe things with the patient. I have different ways of of speaking to different patients, it depends on what is appropriate . . . but for example, I told her that ‘hormonal issues’ gave me no information. That in my world, I need to know what she is experiencing, her symptoms, her experience, and what happens in her experience in response to things. People are so in their medical minds, it can be challenging . . . she then responded with more ‘theorizing’ about thyroid and toxicity and parasites . . . I just stay on course and force the clinical dialogue back to her ‘medical weather’ . . . hot, cold, damp, dry, in, out, up, down, etc etc.

You haven’t presented a full case here, but from what you have presented, it seems the BIG thing in the room is his rapid weight loss and emaciation. That of course is internal dryness. It could also be a physiological hyper issue (‘rapid’ weight loss) - which would contraindicate a HT supplementation. He was living in Central America - HOT climate! And of course, the two work together - HOT is DRYING and RAPIDLY so!. So, the two things I would promptly investigate and consider is cooling down the interior and moistening the interior. First, I would investigate those issues further from a Sa’Am perspective - methodically . . . what are thenar eminences like? What is skin like? Oily? Sweaty? Clammy? What is pulse rate? What is substernal like? Soft, Hard, Warm, Cool?

The number one Sa’Am treatment for cooling is UB+. Of course Sp+ can moistent - but if he is dry on the inside and moist on the outside, Lu+ is more appropriate. Liv + can also be cooling and moistening. Just based on (a) weeding out all the information above that is NOT Sa’Am - relevant and (b) considering the limited Sa’Am - relevant information . . . I would suspect treatments to consider include UB+, Lu+ and Liv +. With more Sa-Am intake data, I would rank these (and anything else that comes up).

And, while I appreciate fully the impulse to want to just get the patient all better quickly, I would almost never do a combination treatment on the first session - as George said, that really complicates the picture and gives you NO diagnostic value when they return the next week to report their response. It most often puts you in week 2 with the patient, confused and starting over.

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Makes sense, George. My thinking with SI+ was chronic pain, history of emotional trauma and blood stagnation signs, but I can see how this is a mixed KD/SI picture and so better to stick with other channel pairs, at least at first.

I’m not defending my choice to treat two channels on first treatment–I almost never do this and don’t plan on making a habit of it. But his response was positive that first treatment. The surprise was that SP+ on a dry and emaciated person (granted, the sticky stool pulls a different direction) got us into trouble. We’ll see how things go after LI+ today and then looking to LU+ or possibly LR+.

@Daniel, points taken, thank you. Agreed about getting people out of their medical heads. Here I was actually attempting to put biomedical considerations aside; it was Sa’am thinking that led me to HT+ (he was so cold, with a very tight abdominal midline, and also fearful) and to SP+ (very thin and losing weight). If I’d let myself think in non-Sa’am terms, I might have avoided SP+ for fear of tonifying a pathogen.

Anyway, clinic is hard! Grateful for thoughtful and experienced colleagues. And as always, just typing up the case (however incomplete) helps me see it more clearly.