Qiological Community

Vertigo poss brought on by PC+? (help!)

I took Toby’s intro course last weekend and have dived right in, using Sa’am strategies. As with learning anything new, I’m running into complications already.

35yo F, CC vertigo

I’ve worked with her for about 10 months already. symptoms are generally controlled with Classical Pearls Serpent Pearls (Wu mei wan) - b/c she can’t stand the taste of herbs. Current s/s:

thin, fit build
eyes with shen but not “diamond eyes”
healthy complexion
skin not dry or oily
she is a therapist and clerks at quaker meeting, isn’t a loud extrovert but clearly has a calling to be in conversation with people.

vertigo, tinnitus, dizziness began suddenly June 2018.
In Jan 2018 she was in a car accident with concussion.
tinnitus constant - L ear
Dizziness - vertigo is a spectrum. triggers: rainy weather/changes (most clear trigger); associated with PMS phase, stress, computer work.
often will have dizziness upon waking, but vertigo is more rare (lately hasn’t happened). when it happens, feels HOT, sweaty, can have nausea with or without vomiting.
When vertigo present, needs to lay in a quiet dark room.
Recently, after a big road trip during which she lost her eyeglasses (she is very nearsighted), she’s had dizziness daily upon waking.

Anger, irritability (d/t recent life stress)
Poor sleep, wakes at 3am with busy mind
GI: she has a pattern of having a full BM, well formed, easy, complete in the morning, but if she goes for a run after that, then bowels get activated and she has to urgently stop in the woods to empty bowels - loose, mod-large amount. (if she doesn’t go for a run, this does not happen)

Appetite, thirst, urine normal. temp/sweat normal except during vertigo onset.
GYN: ~28d cycle, PMS sx milder with tx/herbs but present: irritability, breast tenderness. menses now mod bright red flow, no/mild pain.
MSK: neck pain along vertebrae
Abd: healthy soft overall, some pressure pain at ren 10, R st 25-26

I diagnosed as:

  1. GB excess: convex - upsurge sx vertigo; GB channel/ear involvement; insomnia; anger (not sure if this is the right kind of anger for GB? she’s not very aggressive, I think it’s more internalized anger); R PC+ seemed right b/c when having vertigo she needs quiet, dark, calm.
  2. SJ excess: heat in UW (heat during vertigo flare), eyes with shen, polite, considerate of others; ear/SJ channel involvement
  3. KD excess: symmetrical, fertile (2 kids, strong PMS symptoms)

She seemed to do well with the R PC+ points: neck looser, abdomen cleared, her coloring was good, she felt calm.

Later that day she emailed me to say she had a bad vertigo flare in the afternoon. It lasted 3h and went through her fairly typical progression.

I’d appreciate some input:

  1. does the GB excess seem correct?
  2. Do you think the PC+ tx induced a vertigo flare?
  3. What next?

thank you!
-Saam newbie, Fang Cai

Hi Fang,

Thanks for the case and welcome to the forum!
It doesn’t take long to get complicated situations.

While the GB channel is involved, the non-aggressive, unexpressed internalized anger sounds more like P+, maybe also SJ excess if it is directed toward herself . There are lots of discussions on this forum about anger and the GB/P axis. Though anger is presented under GB excess, it is in context of rapidly changing emotions. You want to see the volatility/reactivity and/or aggression along with the anger to diagnose GB excess.
Toby presents insomnia as likely GB excess because it is common but the reality is that any channel excess can be involved in insomnia.

On the table: Sometimes SJ excess will tell you that they are calm and play calm as part of their politeness. But you say her coloring was good and there were some positive physical changes, so it sounds like she settled on the table.

I’m really not sure. It sounds like she hadn’t had full on vertigo in a while and it happened soon after the treatment. But she seemed settled on the table. Hmmm. Were there any other potential triggers present for her that day? So far this isn’t so clear cut that I would want to GB+ at the next visit.

Fang, your case writing is great but please consider the case writing suggestions presented here:Case Study Format
It suggests 3 tools:
Grading the patient’s symptoms and qualities on a +1 to +10 scale.
Listing the 12 channels and assigning all aspects of a patient’s presentation to all of the channels they could possibly by related to.
Identifying the qualities/symptoms that are the grossest thing in the room.

Including these 3 pieces in your case presentation will help you and us better see your patient through Saam eyes.

From what you have written, SI+ would have been my first treatment for her. Dizziness is a windy condition. Windy conditions are often treated well by SI+. She has plenty of Kidney excess. Toby’s teacher taught that small boned+thin+dizzy means SI+. Extra points if she is pretty. We know she is thin and dizzy. Please let us know if she is small boned.

I hope this helps.

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Kristin,
thanks for the case format guidance. It looks super helpful. I will use it for future posts and will spend some time poking around this forum to learn its ways.

I’m rethinking the GB excess. she’s definitely not volatile, the anger is more like a frustration that lead to rumination and irritability.

The only thing I can think of is she was on day 2 of her cycle; she also went running that morning and had an urgent BM during the run (this had not happened in a few weeks). So maybe the lack of holding/stabilizing in the lower warmer was a trigger for the wind to rise up (?). Since she’s not had vertigo in a while, it’s easy for me to link the treatment with vertigo.

re: being small boned, it’s a new clinical concept that I need to pay attention to. Her bones match her thin frame; even though not disproportionately small, yes I’ll call her small boned.

I never would have thought this would be legit phrase for us to say. but yes, she gets the extra points!

So it sounds like SI+ would have been most helpful, if her current chief complaint is dizziness. I’m going to call her to come back in for a treatment next week. She did settle quite well on the table and felt good after the treatment. Do you think that doing R SI+ for the next tx would be correct? It doesn’t feel right to do GB+ to “correct” the last tx.

thanks so much for your help.

Sitting with your case longer, it doesn’t seem right to use GB+ next.

Based on small boned+thin+ dizzy with extra points for pretty, she is a great candidate for SI+.

My own curiosity, which needs to be run by Toby, is that if she really needs SI+ and you top off P+, perhaps the rooting of P+ further pushes on her overconsolidated K excess. Even though P doesn’t counterbalance SI+, there is a still too much down and in on a system that needs dynamic movement.

If a patient has an iffy reaction to a treatment, I make a note at the top of the chart in red so that it stays on my radar.

Clinical decision making based on beauty and grooming takes some getting used to. Here are some examples of my cases that were all guided by the look.
A usually well put together lady came in 2 weeks ago and her hair was all wrong. Time to do K+. There were other signs too but the hair was such a big pointer.
A handsome 85 year old man with UB 27 area pain: He had dyed his thick mane of hair sometime in the recent past. Sure he had 1-2 inches of roots but even so, the hair was the grossest thing in the room and reduced concerns about using SI+ in an 85 year old.
By contrast, a 16 year old girl with average symmetry had zero interest in grooming and clothes. K+ helped her sooo much with her neck pain and basketball related breathing problems.

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Kristin, thanks for offering so many gems here.

I’ll do that this week and report back!

I read in another thread the same gem from Toby’s teacher. It brings up the question of what “small boned” actually means. I typically think of KD excess types, those beautiful fertile people, as having strong bone structure: high cheekbones, strong wide jaw, not willowy. Their heads and rib cages look proportional to the rest of the body. Whereas KD xu types would have the thin jawline with a small head, often tiny ribcage (this is my experience with quite a few women with fertility issues). So how does “small boned”, get to be part of this KD excess gem?

You specifically mentioned this is in women. So… a small-boned, thin, pretty, dizzy woman calls to mind a fragile bird-like creature who is vulnerable. My feminist self hates thinking along this line, but is that like a patriarchal archetype of of a desirable woman, who, though not constitutionally strong and hearty like a typical KD excess type, is a maiden worth rescuing?

That might be going too far. I am just trying to understand the WHY of this pattern. Do you have a way of categorizing it or do you just take it as a gem?

So are saying that even though he was 85, the fact that he is handsome, has thick hair and cares enough to dye it, made you feel ok about using SI+?

Today I saw a 75yo woman who is quite pretty and normally very put-together. her main complaint is typically pain and terrible itching. I had analyzed her case ahead of time and was all ready to do SI+ on her. But today she had on no makeup, and was in despair over a friend’s death. She used the words “I’m a total fucking wreck,” which she’s never said about herself even though she suffers so much from her physical symptoms. I wasn’t sure about R SI+ anymore, but did it anyway. her cheeks got paler and she began to have anxiety in her abdomen. I removed them and did L KD+. cheeks got pink, anxiety settled, and she became much more positive. the shen returned and she even looked prettier by the end of the session. amazing lesson!

Not sure. It goes against my initial idea that K excess should have big bones. We just have to put the idea that small bones= SI excess. Also, the pretty part is optional which makes it less consistent with K excess. Just take the teaching as a gem.

Toby confirms that small bones thin and dizzy can apply to men too. I had a patient who got SI+ for this reason. He was also very handsome and into his looks. Sorry, I miswrote when mentioned women specifically. I just see so many women with the presentation, often with infertility too. With infertility they get SI+ and K+ toggled at some point. Remember that going to great ends to reproduce yourself is another K excess sign!

Yes. He was also totally into himself, like an actor on stage, which made the call even easier.

Thanks for sharing your SI/K case. What a great learning experience! Now you know to take changes in grooming seriously.

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Toby just gave his perspective on this situation. He words are in bold italics. My question is in brackets <>

<If the patient really needs SI+, could topping off a P that isn’t in need cause enough stagnation to aggravate her K excess enough to send her into vertigo?>

Possibly. Also the vertigo happened s/p a car accident so supplementing SI looks very good. Since it’s likely but not certain that supplementing Pc was inappropriate I’d recommend supplementing SI for the next treatment and then consider supplementing GB after that if the patient requires more treatment.

<Do you have any thoughts on adverse events from similar situations?>

Supplementing GB is the most likely channel to cause seemingly adverse reactions on the table even if it is correct and supplementing Pc is most likely channel to cause settling reactions on the table even if it is incorrect.

(Even though this makes sense, this statement makes clinic seem that much harder.)

It’s possible that supplementing Pc was inappropriate and the settling in qualities of Pc covered the overt reaction up on the table.

So glad I asked! This casts light on a recent case at the next visit after using P+ (which had been a dramatic positive turning point treatment a couple weeks back), the patient reported some regression in her sciatic pain and that she was edgy during the previous week’s treatment but decided not to say anything. She just thought that the “special breathing” she does during treatments wasn’t working. She seemed pretty settled during the P+ treatment but at the end got off the table more quickly than she usually does. I thought that this was because she was feeling better. Wrong!
Now the patient knows to speak up if she isn’t going deep but I know where the responsibility really lands.

Thanks again for the case Fang.

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That answers a weird reaction I recently had with a patient with PC+. She has bad Irritability, moody, quick changing emotions before her period. I supplemented PC+ and she said it was worse the night of the tx . She was ready to break up with her partner. The next time I saw her I went to GB+ but she immediately didn’t like it. I took it out and moved to something else. But I’ve been very confused about it. She is very sweet, gentle and polite in clinic. She seems more PCXS but her description of her mood swings/ irritability seemed so extreme. I would be interested to hear how Toby would evaluate GB+ is right but the patient on the table is presenting with a seemingly adverse reaction.

Kristin, thanks for checking in with Toby. The answers are helpful but, as with any good answer, brings up more questions for me :face_with_monocle:

Whaaaaat? based on this, it seems possible that my patient settled well on the table b/c of the settling nature of PC, not bc it was the right treatment. (though her neck tension and some abdominal reflexes improved on the table).

May I ask what/how you instruct your patients in order to assess this? Do they all know that “going deep” is a necessary sign for the right treatment?

Back to dizzy lady. Her PC+ tx was on 7/16.

I saw her again on 7/22. She reports: after the 3h vertigo spell, she has had the typical post-vertigo sequelae: L ear tinnitus is very loud, with full stuffy feeling - this is decreasing daily. The day after vertigo had a bad h/a and was exhausted.

She made changes: stopped caffeine, sugar, stopped running in the mornings and is meditating instead. She also got new glasses with the correct Rx.

Daily morning dizziness has clearly improved. But it was hard to discern if this is due to the PC+ or the other changes she made.

I asked more about the anger. She said it had to do with moderating sensitive topics within the quaker forum, and she was confrontational in emails, which was very uncomfortable for her. It was hard to let go of the anger, which affected her sleep <-- I’m understanding this as more of the SJ control energy rather than aggressive GB energy - is that a reasonable analysis?

Closer observations: she’s thin in an athletic way. Small bones? not at the wrists and ribs. But her face and chin could belong on a smaller-boned body.
She’s quite pretty. I did R SI+. It felt good to her.

I got this email on evening of 7/23: “I feel quite a bit of relief today. Just wanted you to know.” woot!

So… now I just keep hammering double SI+ right? kidding. But her prettiness and small chin won’t be going away. If she still has some tinnitus or dizziness, would I repeat the SI+? I read somewhere else on the forum to not do the same treatment twice on the deficient/elderly. Assuming I should use my clinical judgement to look for the grossest thing in the room, but as always if there’s general guidance for next steps I’m all ears.

thanks!

Toby did say to consider supplementing GB based on the turn of events.
I came to Saam from practice heavily oriented to reducing palpatory referents during treatment. I still palpate pretty extensively but I no longer rely on improvements in the referents to evaluate treatment effect. Too many times referents improved on the table but overall treatment effect was meh. I wish it weren’t so. Evaluating “settling” is way harder, even without masked patients.

A Quaker being “confrontational” in her own eyes, may or may not be very confrontational at all. To me anger generally speaks to boundary issues in the P/GB realm more than SJ/Liver. But if the essence of the problem is that she is upset because she can’t control the situation and smooth everything over then Sj excess is better. Saam analysis really requires that you look beyond the patient’s words to see the real nature of the dynamic.

Yay!

This is correct. It doesn’t look like this rule applies to her so SI+ again isn’t off the table.

Assumption correct. Keep getting to know her through the filter of Saam.
Please let us know what happens. Thanks for all the efforts you put into your sharing and inquiry.

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Hi Kristin, I’m so happy you’re back!!! Thank you for the answers. They make sense.

More updates from her are that the daily morning dizziness is gone; no more vertigo episodes.

BUT the tinnitus continues to be bad and she has some hearing loss as a result. It’s on the left, constant, loud. Does Saam consider tinnitus in any particular way? I wonder if I should consider this a wind issue and use SI+, or if it’s a manifestation of “lack of shielding” and, given her SJ excess signs, use LV+ next.

May I ask for your input on that one?

so.much.to.learn. but so fun. and thank you so much.