Qiological Community

What happened? Insomnia

I have a treatment that didn’t go last week, and thought maybe someone would have some insight:

I have a 37yo female patient who is a regular and initially came to me for IBS. She is tall, thin and fairly active. She has her own business doing some sort of service for wealthy/famous people her in Los Angeles, which is probably kind of high maintenance and where she has to hustle. She has described herself as having a lot of masculine energy, which I took to mean that she really has to push to get things done. She is also a single mother of a 10yo, and I see her as having a lot of chronic stress and uncertainty in her life. In general she is friendly, likeable and outgoing but can also be demanding. She sometimes yells for me from the treatment room, when she could press the call button.

After we dealt with her IBS symptoms over the last year, we’ve started working on her sleep. She has very poor sleep, routinely waking at 3-4am. She uses cannabis regularly, including to go back to sleep. She also often has neck tension.

When she came in this week, she really wanted help with her insomnia, so I used +Pc on the right side. After 15 minutes she called me back in, and wanted the needles taken out. She said she had been able to rest some, but then had become very restless. She found Pc9 to be very uncomfortable the whole time. I then offered to re-needle her, and did +Liv, thinking she needed some calm/cooling. After 5 minutes she called me back, and said she was too restless and wanted to get up. She didn’t seem unsatisfied, but I would consider this an unsuccessful treatment (we’ll see how her sleep is when she comes back, but I bet it doesn’t improve much, as it has been very stubborn).

So what went wrong? It really seemed to me like the pattern fit her presentation. Perhaps Pc9 was too painful (I’ve had this happen to me)? Maybe she had taken some sort of stimulant? Should I have used a colder channel like SI or UB? Did I miss something? Maybe I’m being too quick to judge?

The strangest thing was that my next patient came and immediately told me that she probably wouldn’t be able to rest on the table as she had slept poorly the night before and was very restless. This turned out to be true, she stayed on the table about 10 minutes. At the same time, another practitioner in my clinic had that happen with their patient. So maybe it was just some sort of external influence?

Is she by any chance very dry - as in LI excess? I have seen LI excess types to be very bossy and demanding but not in an aggressive GB way. LI excess could have issues sleeping because of their mind racing with all they need to do and accomplish. If this is indeed the case then tonifying Sp may help.

Yes, that is an idea, she has dry skin. I would bet she spends a lot of time thinking about what she has to do.

Are you positive that you needled all the points of P+ correctly? Lack of proper angle and stimulation can make a difference.

If she was able to rest with it the first part of the treatment, she probably would be able to rest for the whole time if P+ was the proper treatment.

Does she already have a good amount of Pericardium qualities? Just because someone is assertive doesn’t mean that P+ is the way to go. If both GB and P are relatively strong, you need to look at the other channel balances. Patients with strong Gb energy will often use it to protect when other systems are weak. I have relatively strong GB energies that come out when I am over tired or feeling like I lack resources. Treating Lung or Spleen works better than P for me, because lack of P is not my weaker spot.

Exploring the theme and character of her stressors- money, time, nourishment, overstimulation, overexposer?- can help you point you to which channel pair is more in need of balancing.

More detail about morphology can be helpful too-. Is she thin and sinewy or thin and flabby/soggy. Is her skin moist and resilient or is it dry and saggy?

How hot or cold is she really?

Since we are all Saam newbies here, I think going back and looking at the details of what happened will be a better learning experience than writing it off it as an external influence.

I’ve been working with the patient for probably about a year, and so I know her decently well. As I look into her situation and diagnosis, I can’t find anything else that really stands out in Saam terms. I said she was tall and thin, but in reality she is neither under nor overweight. She has a moderate, healthy build, her skin is mildly on the dry side and her musculature feel a little on the soft side. Because of this I wouldn’t think much of Lu/LI/St/Sp.

I don’t think she is very hot or cold - she is talkative, active, uses cannabis and can be restless, but she always comes wearing a sweater and often complains of the AC in our office. She isn’t particularly fearful. She is a mother, and clearly cares about her child, but it has never seemed overbearing. So I don’t see her Ht/UB as imbalanced. Her ego seems balanced to me, in that she is neither egotistical and self absorbed, nor does she seem to have self-esteem issues. She does have mild PMS. So her Kid/SI seem balanced to me.

With regards to Liv/SJ: my impression was that she was very interested in the calming aspects of acupuncture, but when I asked her if she was inclined to vacation in the Redwood forests, she responded that she would much more prefer a sunny beach setting. My impression of her was that she gets acupuncture as a refuge from the stressors of her daily life, indicating some Liver weakness, but I could be wrong in this impression. I would say that she is quite socially aware and has attention to detail, but perhaps her SJ isn’t super strong. She is routinely late to our appointments, and might not have a lot of inner-concentration/ability to maintain focus. So maybe Liv/SJ are weaker.

With regards to Pc/GB: she definitely is extroverted and can change emotions quickly. I would describe her as a little more aggressive than the average person. I wouldn’t think of her as calmly considerate and slow to react. This combined with her insomnia made me fairly comfortable treating Pc.

The main stressors in her life are financial (being self employed with an irregular work load) and relationship (uncomfortable with increasing commitment to boyfriend).

Something is missing here.
The way you talk about her stress is phrased in such a way as to make it sound like your impression of her rather than something that you have heard directly from her. Have you heard directly if money and lack of resources are anxiety provoking from her? If so you might want to supplement the Lung to treat a Stomach excess.

We’ve had clear discussions about her financial and relationship stress, sorry if it wasn’t clear. Lu could be a possibility if her money worries are keeping her awake, thanks for that.

@pattycakes, I’d take this as jueyin is not the direction to go. So for the moment you can count that out.
Thin and with dryish skin and hustles for a living… Sounds a bit Lg Intestine excess to me. Maybe +SP

My hit is that she is a LI excess type. So Spleen might be good. I remember Kristin saying something about the sweet mama spleen energy, and perhaps that would be helpful for her.

Not sure I would go from stress to liver in this system. I know that for me, stress mounting is way more about resources in terms of juggling time/energy/commitments. I would much more appreciate the bright light to see my way through than cool mistiness. I had a similar experience not long ago except that PC did nothing and when I put in LIV she went into full anxiety. SJ fixed it. I saw her yesterday and did another SJ treatment for her anxiety and she said she felt really good. In hind sight, it made perfect sense to me, as she is someone who suffers with the overcast environment here. I just forgot about that when I tried liv.

Yeah, I’m still trying to get out of my TCM mindset.

Laura, I’m of the opinion now that she has a dry exterior (she complains of dry skin, and has a large crack in her heel on the left UB CH) but some damp internally (tissues are soft to palpation), and a history of diarrhea. This would suggest Lu excess, and she has cried in the treatment room a number of times, but she has financial issues. So we will see.

Does a patient’s cannabis use help us clinically? In my own experience, using cannabis has a very cool, dark forest kind of effect, so I would think that would indicated a SJ excess. However, most have ruled out LR/jue yin as being beneficial for this particular patient, and I would agree. It’s also worth considering that cannabis has different effects of different people, so maybe this isn’t very helpful for us on the surface. Perhaps if we ask a follow up question of what do you feel when you smoke cannabis, or what sort of effect are you seeking with cannabis use? Any thoughts?

I like the idea of a LU+ treatment if financial worries are keeping her up. I cant help but think she really is a TW excess person with the nervous energy, feeling cold, the desire for calming energy, attention to detail. Does she flush up easily with embarrassment? Does she have really sparkly eyes? Is she overly sensitive to bright light (maybe not if she suffers from dark, dreary days but its worth asking). I wonder if the LV+ treatment didn’t make her restless but wasn’t enough to calm her after the inappropriate PC+ treatment? Did you do the LV+ on the right side? It might be worth trying one more Right sided LV+ treatment on its own to see what happens.