Qiological Community

Unresolved Bleeding

Hey everyone,
I haven’t been on here in a while, and I happy to be back. I have a lot of catching up to do!

I have a case I would like to share with you to see if anyone on here has any advise.

Female, 71 years old
Medical History
2018 Uterine cancer
One round of chemo. was successful. I was treating the patient during this time and she remained healthy.
2019 Hip replacement
Again I was treating the patient throughout. She recovered quickly and was able to take a 6 week trip to Europe 3 months after the surgery. The scar healed quickly.

Constitution

  • Pulse is forceful throughout the yang positions. Deficient in the Yin pulses. Can visibly see the radial pulse, can also see the pulse at the elbow (I’ve never seen this before with any other patient).

  • Patient has resources. Grew up wealthy. Retired from D.C. government job (husband as well). Husband now is a consultant with various companies dealing with aeronautics. They take a 6-week vacation to Europe every year. The list goes on.

  • Small frame 5". Not overweight at all (quite skinny).

  • Skin is not oily or very dry, but if I had to choose I would place in the dry category

  • Polite and very put together.

  • Very intelligent, but not in your face about it.

  • Stays busy with social events and volunteering.

The Current Concern
The patient began bleeding from the anus shortly after the hip replacement. There are no hemorrhoids. Her Western docs were not surprised and told her that it is a rare side effect to the chemo which occurred at the end of 2018.

  • The bleeding only occurs every three days or so. No swelling, itching, pain or discomfort of any kind. Was checked out and has no hemorrhoids.

  • Blood is bright red and only occurs in the morning after waking found upon wiping.

  • The patient denies any other health issues. (digestion great, B.M. great, sleep great, mood great, everything is great!)

  • The patient is currently going through a regimen of daily Hyperbaric Oxygen treatment with the local wound clinic (currently completed 15 of the 40).

  • She is on Evergreen’s GI Care (HMR) with Huang Lian Jie Du Tang added to clear some heat (This is new last week)

What I’ve Tried

  • I’ve been bad. Upon typing this up I have realized that I have not had my Sa’am hat on with this patient. I have tried things like supplementing the Sp (TCM Sp not holding blood). When that Didn’t work I thought of supplement the LI (connection with the anus). I was treating these two thinking Sa’am constitutions due to her small build and dry body. I tried ST once thinking to offset the Lu constitution.

  • I’ve also tried Master Tung and had no positive results.

  • This write-up has been helpful I think! Now I think I have missed the Sa’am mark. I now think my next step will be to Supplement UB to add some cold. I think I see heat everywhere. Being able to SEE the pulse on her wrists and elbows, but being deficient on the deep positions (I know pulse is not Sa’am, but I would think that would still indicate heat). Bleeding every few days (body trying to get rid of the internal heat). A side effect to chemo (I would think the chemo would be heat). Skin probably being dry.

Any thoughts?

Hi Donley,

Nice to hear from you. Thanks for this interesting case. It is an unusual symptom and will be fun to find out what works for her.

I’m not seeing any heat, besides your interpretation of the pulse which has low clinical weight in the Saam. You didn’t mention her body temp, subjective or objective, or note any hot sensations or redness. She doesn’t sound hyperactive. Is she a non-stop talker?

My understanding of causes of bleeding are

Heat- xu or shi
Blood stasis
Qi not holding
(trauma)

I don’t find it helpful to assume that western meds have certain qualities. Do we really know that her chemo is hot? Doing so often distracts you from the patient’s actual presentation which has so much more clinical weight and is a much more reliable guide to treatment. Side effects of medications are better at telling you how the body is not working well, rather than giving any solid information about the nature of the medication.

I suggest listing the 12 channels and asking yourself if she has any symptoms or qualities that are for sure Saam signs of those channel excesses.

I am curious about her K/SI axis. How symmetrical is she? Does she have any varicosities or dark aspects to her complexion? We know that she had cancer (K excess) and is a speedy recoverer (K excess) and is “very put together” (if that means appearance, then K excess). But she also is 71 years old (SI excess).

Not sure what this is about. Are there any scars or other local factors causing tissue tension in the region that could put pressure on the pulse?

Please let us know how it goes.

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I recently had a patient with ongoing uterine bleeding. She has lots of varicosities in both legs. I tonified SI and was pleasantly surprised when she returned the following week to say her bleeding had completely stopped the next day. Reminded me of Sharon’s spit ball technique to stop the kids nose bleed caused by blood stasis. Prior to Sa’am and the GMP, I don’t think I would’ve gone there, but it totally worked! Interested to hear how it goes.

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From my previous studies of Sa-am, I know that +SI stops bleeding and use it a lot successfully.

Hi @Lucy_Diskant-
Welcome to the forum!
With whom did you study Saam previously? Feel free to share you experiences here. We are all eager to learn.

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Dr. Tae Cheong Choo. I am aware that there are discrepancies in Sa-am and Sasang teaching. But +SI for bleeding definitely works.

Hi Lucy,
Does your previous training have you look for blood stasis or excess consolidation signs consistent with Kidney excess as indications to use SI+ to stop bleeding? The books I’ve read on Sa’am haven’t presented a strong easy to understand system like Toby’s teaching has so I am just curious how other teachers present the material since you obviously have found it effective.
My limited understanding of Sasang is that it a distinctly separate system than Sa’am. Does your training include both?

Thanks!

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HI Kristin, Toby’s approach is new to me, the way he starts with excess. Dr. Choo’s approach comes from deficiency and a combination of 6 qi and 5 elements. So than SI (Tai Yang is cold, fire is hot), is of warm nature and treats among other things anything related to blood (blood stasis is not mentioned), especially blood deficiency and Yin deficiency. I remember him saying that blood heat should no t be cooled with the cold Qi (UB) but with the warmth. The comparative chart in his manual compares Tai yin qi to Shao Yin qi . Shao yin is solid and hard. Tai yin is soft and delicate.

Hi Lucy- Thank you for theinsight and interesting examples. It sounds like there is much overlap in the approaches such as

along with some differences in emphasis

And some approaches that I would be interested in learning more about

I’ll be contacting Dr Choo to see if he has manuals for sale.

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