Qiological Community

Wrong Channel treatment...or?

Hi gang, I’ve been treating a woman for severe bloating for a few months with mixed results. The last treatment however has me super confused. Her cc is severe bloating And water retention for a few years after getting off her anxiety medication. Her bloating is constant and she has a history of anorexia so she doesn’t want to make any dietary modifications. She’s 28 and works as a social media consultant though wants to transition to being a photographer. Here’s her sa’am presentation
Ht xs very fast heart rate (9) chatty (6) loving (7). Hot and sensitive to heat (7)
Bl xs - very fearful. Catastrophic thinking about her health. Anxiety (all 9)
Ki xs - History of eating disorder (self focused - 6) pain in back and headaches (6) young. Mixed hot and cold. Bloating (consolidation?) Painful cloth period (7)
Si xs - not beautiful
Sp xs - bloating (9) acne (6) Loose stools
Lu xs - Incomplete and urine Retention (9) full thenar eminence (6) doesn’t worry about money (7) dry skin (7)
Sj xs - self critical (7) light sensitivity (7)
Lv xs - dense tissue
Gb xs - assertive (7) struggles to sleep (7)

I’ve tried so many channels. Liv+ helps light sensitivity but not bloating. St+ helps bloating sometimes. Bl+ caused an aggravation of symptoms.

2 sessions ago I treated li+. Everything got a little better. But period was painful. Back pain and headaches. (Ha was on gb channel) back pain was bl channel and si joint. She also was having itching on her back. I supplemented si. She settled a little bit But the next day had hives and diarrhea. And then lots of loose stools back pain bloating. I cannot imagine treating this woman with ki+ but it does sound like she responded negatively to si+. I would love to do li+ But do I need to fix a possible mistreatment first?

A few questions . . . .

what is her general physique like? thin and wiry? excess spleen flesh?
why does she want to be a photographer - perhaps just have a free flowing convo about why that inspires her - I often find when I do that with no presumptions on my part - just a convo - and I stay open and present, something critical about her character emerges.
Bloating is a convexity - have you delved into impatience, frustration issues? Is she nerdy, bookish, intellectual (teasing out the GB-PC more)?
How is she on the rude/oblivious - polite spectrum?
have you queried her history a bit - surgeries, life history, major events, relationships (romantic, friends, family), traumas, illnesses?
Where is she on the indsutrious - couch potato spectrum?

This might be a perfect scenario for considering a drainage - i.e. you’ve tried several things and not much response. If you were to drain something, what is or are the one or two most prominent things in the room? You’ve got a few 9’s and 7’s there so some pretty extreme symptoms and signs - of

(I noticed Daniel replied after I wrote this out…so I have similar questions as Daniel with additions below…)

It can be confusing when we see some things get better and others get worse. I plan on posting a couple of interesting cases where treatment clearly helped one big complaint but aggravated another.

I don’t have.a clear picture of your patient. What is her morphology? Thin and dry?
Where is her water retention? Is it all abdominal or extremities?

Your list of excess characteristics is a bit too broad and does not fit within the Sa’am archetypal structure.

When I find a rapid heart rate, especially if it is thin (think fluid deficient) I am putting a little checkmark next to supplementing BL+. Although Toby’s teacher did not use the pulse and it is not part of this observational tradition for me it seems to hold some weight.

Eating disorder would not fall under KD excess, and I am not sure we can put it anywhere for Sa’am. But if we did put it someone it would show up as a SI excess as it is not loving self depending on the level of consciousness. Some people have an ED and think they are doing right for themselves and others there is some self hatred.
Pain and back and headaches is not KD excess, neither is bloating.
I have had many painful periods resolve without supplementing SI - so it is not a for sure KD excess sign. If there are palpable masses (i.e. oketsu) in the lower abdomen that is a KD excess sign in this tradition.

SP excess is more like damp/damp. Lazy. Heavy. Bored. Crave sugar. Those are characteristic of SP excess in Sa’am. Bloating can certainly show up with SP excess but I’ve had digestive bloating resolve with a LR+ supplementation. Acne could point to SP if it is wet and red. Loose stools can also be a damp/dry condition so not necessarily a SP excess.

How does the urine retention/incomplete show up? I am not sure how that would fit into a LU excess category. We think of LU excess as the proverbial banker.

When it gets confusing like this I need to step back and look at the forest as I find I can get lost in details. I ask myself am I sure I needled properly? I have found even one point that is off can make a treatment unsuccessful. I also re-evaluate a person as if I have never seen them.

This is not Sa’am but I find it is important to use SI+ properly around cycling women. I typically use it in the luteal phase close towards the period. In your case does she have palpable masses in the lower abdomen?

Is her age the main reason why?

Thank you so much Daniel and George for your responses. I realize this was a pretty pathetic write up. I realized in the 11th hour that I needed to powwow this case but didn’t have the time to do a proper write up…my apologies.
To answer your questions:
Patients has dense limbs with a very hard rounded “Convex” abdomen. Her skin is dry and she has mildly bright eyes. She wants to be a photographer mostly for the freedom that it would allow.
She is assertive and I have treated her with pc+ in the past but it didn’t seem to do much.
She is polite though not overly so.
She is married to her high school sweetheart. Her biggest health history is related to anxiety, anorexia, and her bloating. She is very close with her family and her dog and is constantly terrified that something will happen to him.
She seems more industrious than couch potato but has a ferocious sweet tooth.
Her urine feels incomplete and she has had a few good flushes after treatment and after her period. She notices the water retention in a swollen face, fingers, and belly.
Her bowels are loose and incomplete.
I guess I considered bowels and urine incompleteness with lung excess because of the holding on aspect and lack of downward movement.
Regarding needle technique - I’m always open to that possibility. I check my needle location and twist about 3 Times usually so I’m not sure what else I could do about it but continue to be vigilant.
I’m so hesitant to do kidney because she feels so consolidated to me already but maybe I’m not understanding consolidation properly. She’s on the table now - I decided to go with a kiiko style treatment this time.
She gave me more information about her response to si+ which was that everything felt like it flushed up. It was also right after her period (which was an unusually heavy painful period) so I’m thinking, as you May have suggested George that perhaps it was the wrong part of her cycle - maybe she did need more consolidation post bleed.
Si+ can be such a trickster for me. I realize now that it definitely wasn’t indicated for her - but in hearing pain, and itching, and clotty period, I immediately thought of it- I think it was a bit rash of a decision.
I do think she may be a good candidate for draining at some point…but as we are peeling away layers of excess (with herbs too) her deficiency is becoming more apparent. Perhaps once I build her up a bit more?

<This might be a perfect scenario for considering a drainage - i.e. you’ve tried several things and not much response.>

I highly disagree with this recommendation. Draining should absolutely be avoided when you are unsure of your diagnosis.

I’m so glad you caught that Toby! I don’t know what I was thinking. I was up at 4:00 am and did that at that time. I’ll be sure to be more clearly awake next time!

Could this possibly be a case where the SP is deficient and is holding onto all fluids? I have found the sweet tooth can be present in SP def cases, almost like the SP is craving some love.

How dry is the skin? In your opinion is the dry skin from LU or LI.

How industrious is she? Could she sit in a room with no stimulation? I ask because You mentioned she is a social media consultant, does she step away from her job or is she always on? Is she the type of person that sits in front of the TV with her phone or computer in her lap working?

Thanks Daniel and George for the thorough break downs, both were very helpful in viewing some of the S&S from a Sa’am pov.

Thank you So much for considering. She doesn’t seem overly industrious to me and she did benefit from +li in the past.
Her responses to the treatments have been as follows:
St+ mostly positive - helped bloating and swelling. One time gave her a headache And caused a rash
Li+ Mostly positive. Helped everything.
Though one time caused headache
Bl+ everything worse
Liv+ helped light sensitivity. No change in bloating
Si+ aggravated symptoms though not immediately
Pc+ - nothing much.
I do feel comfortable diagnosing her as lung excess and spleen excess. I Brought this case to the forum mostly Because I was surprised by her response to Si+ treatment and wondered if I had added liv+ or li+ if she would have responded more positively. Like was the negative reaction because the movement created By Si+ was going in the wrong direction (Upward) or the dampness didn’t have a way to drain…or is she really kidney excess? She certainly doesn’t seem to fit the bill of what I understand kidney excess to look like (also didn’t mention - no dry heels - Very mild varicosities in lower leg) I have had great experience using Ki+ for osteoporosis, or bone issues, or fertility. Maybe this is a case of self love deficiency but at this point I’m not convinced that it will help with this intense bloating. I’m curious now to hear about your experiences with ki+

Just because someone is assertive does indicate GB excess. Easy example is the assertive intellectual. You would want to see a convex energy and quick lack of thought response.

Is this based on your results of supplementing LI+ and ST+? Dry skin and industrious would not suggest SP excess.

I am confused trying to understand this person but she sounds like a very on edge worried individual. I wonder if her bloating can be impacted by many factors so that getting a reliable treatment report may be difficult.

You asked in your first post about treating for mistreatment. I don’t see that reason here as you’ve done so many treatments with unclear results. This feels to me she needs a walk in the PacNW rain forest as she is on edge. When you did that did it offer no calming effect? Also I’d play along the lines the the wet.dry for her in terms of ST+ or LI+ if you’ve only done it one time as that seemed to work. With the rashes/swelling/acne that may be where to go and see how it unfolds.

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HI,
Have you asked her if the bloating feels like water bloating or constraint of air?
If it feels watery (which is what it sounds like the ST+ or LI+ both sound like good ideas.
St+ will also help things move down and out - which also seems to be an issue with the urination.

It seems like she has a lot of water retention and SI strengthens the Tai yang - which is cold water and also directs it to the surface -which is not great for swelling.
It also is scattering and for a person with anorexia which points to a lack of love for self - damaging the self, that may not be what she needs. I see why you chose it but clinic clearly told you that was not what she needed.
I understand your concerns for not wanting to tonify Kid. THere is a case for it though - between the anorexia, not symmetrical, anxiety, pain on SI meridian. And it is possible to view all of the water collection as water that is not consolidated.
HOwever, I wouldn’t necessarily jump there first. I would still look elsewhere before you get to kidney - but do not take it off the table.

THis right here gives you a lot of information.
CLinic is our best teacher. Since Bl caused an aggravation of symptoms it tells you that Ht was needed. You said that she is hot however there still may be cold in her stomach. Does she crave ice cold water or does she prefer room temp or warmer beverages? She also has issues with the bladder and painful periods with could be caused by cold. Do you know if she craves a hot water bottle with her menstrual cramping? Are her feet cold?
It is possible that there is cold in her uterus even if she is hot.
I am treating a 50 year old woman now who is VERY hot and loud and angry but whose chronic knee pain on the Bl channel is responding beautifully to HT+. She craves the heating pad on her knee and going out in the cold makes it worse… I was so scared to do Ht+ for her but after Bl+ increased the SWELLING of the knee and did not help the pain I tried Ht and it is getting better.
So ask the questions - dig deeper about the cramping and other possible cold GI signs and touch her skin on her legs and feet and see if there is indeed some cold lurking around that may be causing the bloating.
And let us know what happens.

Thanks again for taking the time. For some reason I’m unable to login to the forum on my computer so I’m responding from my phone and am unable to reply directly.

Just for some perspective on the stubbornness of this case, this patient was originally put on miralax for this condition - and it took 8 weeks before she noticed any shift in her bowel pattern.
In response to George - this patient is super convex. She also has a loud voice and doesn’t seem to be much of a researcher.

I feel comfortable diagnosing her as lung and spleen excess because of her response to st+ and li+ which has been mostly positive. She is more industrious than a couch potato but honestly feels somewhere in between.

I do agree that her bloating is impacted by many factors.

I asked regarding mistreatment because she had a very negative response one day after the si+ treatment.

I’ve used st+ many times…and while it usually does help, the results are not always sustained (and she doesn’t always sink in). I’ve only treated once with li+ and everything got better for a few days (she did sink it but noted that it was a shorter rest than normal)

When I treated liv+ - she did sink in - it was calming for her - but there was no change in her bloating.

In response to Adina, her bloating is definitely water.

Your response about the direction of taiyang was so helpful! I associate this upward outward movement with taiyang herbs, but didn’t think about this in relationship to the si+. Thank you for that insight.
And yes, since writing this up (which was a humbling but fruitful endeavor) I have started to think about +ht. She seems overrun by water - as well as fear. I had been hesitant in the past because Of her super fast heart rate - and sensitivity to heat (she has no thirst) - but I’m definitely bumping this treatment up to the top trio.
Regarding her period - with all the treatment (and herbs too - which feels too complicated to weave in here at the moment) her period has moved from 36 days to 28 days. With the recent 28 day cycle has come more cramping and clotting). I definitely suspect interior cold and have been working my way slowly to a fu zi formula. Also regarding the cold - as we are progressing her thighs and feet have started to feel cold to her.
Thanks again for taking the time - and I will update you all.

yes, the super fast heart rate stands out… But remember, HT+ is also generally for someone whose overall functioning is ‘hypo’ - the bloating and swelling and water accumulation can certainly be a hypofunctioning issue (if that helps you feel ‘better’ about trying HT+). What is the temperature and tension of her substernal area like? The success of your ST+ and LI+ treatments may be missing that addition of HT+ to get the whole hypofunctioning of the water dynamic going. In the end, as you know, I am sure, the patient’s responses are the most definitive data . . . . and her responses to LI+, ST+ and UB+ seem to have been the most informative so far . . . . keep us posted - I’m fascinated to hear how HT+ goes!

Sometimes treatments need to be layered. Sort of like peeling things away. She seems to have a lot of layers so I would not discount the LR+ treatment.

What other cold signs? She has a rapid heart rate and is hot and sensitive to heat. Is it just her extremities? It is not part of this tradition but what is her tongue tell you?
And to this tradition as Adina’s questions - what is her midline like? Cold and hard?

With a “very fast heart rate”, hot, sleep issues if you do HT+ you definitely need to stay with her in the room and watch closely.

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Regarding cold symptoms - hardly any except lack of thirst and now thighs and feet cold. But lots of fear.

Her midline is warm but uncomfortable. Ren 15 is super uncomfortable and ren 12 is hard.

SI is moving blood. Swelling can be from stagnation and I have found that SI+ in combo w/ST+ and LI+ to work well for swelling.

This entire thread has me concerned that there is overthinking and a lack of grounded/focus.

And you are confident in her accurate reporting? It “got worse” doesn’t tell me what got worse, how long. What else changed.

How many times have you treated her and how often? I have definitely found the rule of no more than 2x in a row - things can go side ways if you do. So frequency also matters.
I am now seeing a picture where this woman has gotten at least a dozen treatments - her body may be a ping pong ball at this point. Sa’am is powerful and if we do too much it can make our results quite blurry. She may need a break from treatment and a restart later.

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I can appreciate your concern George. I appreciate that my write up has been confusing. I probably should have resisted the temptation to post anything without the time to write it up more clearly. It was one of those moments where she emailed me to say she hadn’t felt well - starting the day after si+ And I was basically wondering - should I have her come in immediately and treat her for free with ki+ or not. I decided to treat her for free but with a different style to try and recalibrate her - and it did.
In writing this post I wasn’t necessarily looking for anything more that “was this a mistreatment or not?” That was really my question…but I understand how it could have been misinterpreted

To answer your question, I never do the same channel more than 2 times in a row. I’ve seen her about 12 times. In that time her pulse has gone from 103 to 88bpm. And her period has gone from 36 days to 28 days. Those don’t feel like ping pong markers. Her anxiety has been unchanged. And her bloating (her chief complaint) has improved overall with a few back slides. I will consider if she needs a break from treatment - but in her words- this has been the only thing that has been able to restore her hope that she can get better

I have treated people way more than 12 times in a row and have seen slow miracles, really slow but improvement none-the-less. Toby stresses that most of our Saam treatments will be slow miracles. There are many people out there with weak constitutions and long standing problems and understand that healing for them is a long haul.
What may be an idea is taking a break from acupuncture and using herbs for a couple of weeks - to strengthen up the body some and then continue treatment. This also provides clear feedback as to what are the results of the herbs and what are the results of the acupuncture.

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From this thread the trajectory of this patient’s main issue did not feel like a slow improvement. I am glad to hear that Sarah has helped her quite a bit, but the way this was written up and the thread felt as if the treatment were pulling her patient in many directions. In addition herbs were being used which can absolutely change the appearance of a treatment. As you stated a break in the acupuncture can be helpful. Healing is a non-linear and when thinks are not moving then the body may need a break in the input.
From Sarah’s reply the way the thread was presented it may not have been indicative of what happened in the treatment room. But I still 100% stand by my statement given the course of discussion. When you are trying so many things and it is not working stepping back can be quite helpful. Sa’am is powerful and if we give a wrong treatment it can be hard to know if we are dong other things along with it.

In addition I am also not clear on the frequency of Sarah’s treatments. 1x/week, 2x/week, monthly. That also plays into consideration here.
I find with Sa’am I do not treat people every week for a while. I have not had that experience with other styles.

Agreed. Each practitioner will need to determine this threshold with every patient. Pausing treatment, letting things settle down, and then re-evaluating is a reasonable course of action.