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Tea Stat!Tea Stat! Embedded File.https://www.youtube.com/watch?v=SYqfBaqF45U&t=3s1 teacher remarkKristin Wisgirda Seasons of darknessNewNov 30 | Edited1ReactNovember around here means only 9 hours of daylight- and not all of them are so bright.When this lack of light converges with dark seasons of people's lives, the Liver/SJ balance has to be considered. A couple of casesthat stand out.A woman presented with intense bilateral sacral pain that started when she bent over while doing her hair the day before. Shegoes on and on about what she felt the day before to the point that it is hard for me to determine what exactly she is experiencingnow. She also has her period which she reports is unusually clotted. She has reported seasonal aﬀect disorder in the past butwhen I ask about it she says that it hasn't kicked in yet and that overall she is much less depressed than usual. However having herperiod triggers rumination about a miscarriage that happened 3 months ago and hating her body. Her tissues are slightly dense,her eyes are +3 dull. SJ+ relieved pain on the table and she got up pain free. She was on day 3 of her period so I didn't want to useSI+.A 63 year old therapist, somatic experiencing practitioner, meditation teacher and overall serious meditator reports left shoulderpain on the LI channel that started out of the blue 2 days after her divorce was ﬁnalized. At ﬁrst she could barely move her armbut by the time she gets to my oﬃce she is able to abduct 90 degrees.Her left shoulder and chest have had episodes of pain throughout the years. In the past, Liver+ has given her some relief as part oftreatments for these episodes. She associates the area with a childhood episode of when her big brothers tried to drown her. Shehas very light and open ﬂesh +9 except the muscles over her scapula are dense and spasmed. She moves lightly but there issomething about that light movement that feels forced independent of her pain. She is very polite but it also feels like she has towork at it- it lacks real warmth. She usually has a slightly dark complexion but looks darker when she presents for treatment.When asked about her emotions she complains darkly about the divorce process. My sense is that her left arm is not integratedwith the rest of her body. When asked how integrated her left arm is with her body, she says that it is a relief to be asked thisquestion and that it feels like her left arm is on a separate table beside her. She loves talking about her felt sense. SJ+ relieved herpain on the table and improved her range of motion. She returned the next week having had no pain except a little pain returningin the last day when overdoing exercise. She also reports that she loves being divorced and has put the divorce process behindher. Sleep issues and a hard time regulating her temperature started 4 days after the SJ+ treatment..The muscles over the scapulawere still dense and sore - SI+ relieves this little bit of pain. She just texted me saying that she slept perfectly last night and hertemperature is regulating ﬁne now.Terri MatsonNewDec 1ReactKristin Wisgirda

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1 reply 1Reply@Kristin Wisgirda Very interesting and helpful case. I appreciated your description as practitioner the felt sense, "that her left arm is not integratedwith the rest of her body. When asked how integrated her left arm is with her body, she says that it is a relief to be asked thisquestion and that it feels like her left arm is on a separate table beside her" and the distinction and relationship to Liver excess.Very beautiful, thank you.Kristin Wisgirda A Saam Acupuncturist Goes Grocery ShoppingNewNov 29Reacthttps://www.youtube.com/watch?v=aN4JVTAlpcAThe Acupuncturist Goes Grocery ShoppingThe Acupuncturist Goes Grocery Shopping Embedded File.https://www.youtube.com/watch?v=aN4JVTAlpcA ReplyTerri MatsonNewNov 30ReactExcellent grocery store conversation!Adina KletzelSI in pregnancyNewNov 23ReactHI,I do not treat many pregnant women at all but a new client (female age 33) arrived 2 weeks pregnant and she wants to stay withme.She had two miscarriages at 6 weeks in the past year and she would like to try and make this pregnancy last.She has a cyst in her ovary and had irregular menstruation.I did Bl+ in the ﬁrst treatment because she is SO hot 10+, very loving 8+, and has panic attacks with a very fast heart rate. She didgreat with the treatment and feels much calmer, less hot, and her acne is no longer burning and itching.

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2 teacher remarks1 reply 11 more comment1Second treatment I did Liv+ because she is SJ excess and in order to build blood for the pregnancy.She is now at 6 weeks and so far so good.She is now VERY tired and wants to sleep all the time. Of course this is somewhat normal for the ﬁrst trimester but I waswondering if I can treat Kid+ in the next treatment even though she has a cyst in her ovary.I would have done SI+ but don't think it is a good idea because of the pregnancy and history of miscarriages.The question is can Kid+ with cysts in the ovaries actually aﬀect the pregnancy in a negative way?If I can't use Kid+ I thought maybe LU + would be good but up until before the Bl+ treatment she had reﬂux...Is there any Sa'am approach to treating women who are pregnant other than staying away from SI+. ST+, LI+, and sometimes Bl+I could use some treating pregnant women guidance here.Thanks! ReplyKristin Wisgirda  NewNov 28React<can Kid+ with cysts in the ovaries actually aﬀect the pregnancy in a negative way?> If the cyst is palpable and/or causing extremepain, then it has clinical weight for K excess but otherwise I don't give it much clinical weight.How SI excess is the patient? I do treat a fair number of pregnant women. K+ isn't helpful for ﬁrst trimester fatigue unless thepatient is actually SI excess- in my experience.I cautiously use ST+, LI+ and UB+ but have only used SI+ 38 weeks and later. With pregnancy, I am more likely to use othermethods and require a higher standard of clarity before using Saam. That said, I do still use Saam most of the time. ReplyDaniel SchulmanNewNov 30ReactTwo weeks ago, a woman on her expected delivery date who was being 'threatened' with inducement by the OBGYN's (eventhough she is actually a delivery room nurse!! and was asking not to be induced!) . . came to me for acu-inducement . . . . I did aST+ treatment and within hours, frequent contractions began and she delivered 36 hours later.Kristin Wisgirda wedding planningNewNov 22ReactA symmetrical 30 year old woman with a masters in theater came for panic attacks (tingling and numbness throughout her body)since moving to the area 6 months ago, buying a house and planning a wedding. She also complains of "manic thinking"- her mindjumping around every which way though she says she can complete one task before moving on to the next. Her movement ismore methodical than erratic.She is on the birth control pill but denies any pain or irregularity with her periods before being on the pill. Heels average with novaricosities.With SI+, she reported all of the tension in her body unwinding on the table. One week she reports no panic episodes- no need formedication- and the absence of the usual emotional reactivity (easy crying) she didn't report before, and only a little bit of the"manic thinking".With the overwhelming deluge of details she was needing to juggle, I thought about Liver+. Her eyes were bright +2, ﬂesh open+3,. +5 presence to the outside (at least in the oﬃce)- so I couldn't see a reason not to use Liver+. Soon after inserting Liver+, shestarted talking about wanting to be healthy for her wedding- not lose weight per se- but eat better and be her best for the

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1 teacher remark1 reply 1wedding. This talks sounded very suspicious to me, especially for it to come up soon after putting Liver+ in. I took out Liver andreplaced it with SJ+. She relaxed visibly on the table and reported the tension unwinding again.A week later she reported that she didn't realize how many invasive thoughts she was having until they were gone. ReplyJoanne TaitNewNov 22ReactWow, that's so interesting. Did you switch sides when you replaced it with SJ+? I may have jumped back to SI based on that. Didyou go to SJ because you felt her reaction was negative, in order to balance it out? Or because you had just done SI at the previousvisit? ReplyJanNewNov 22 1ReactThat is so interesting. Yes I have deﬁnitely made that mistake -- trying to use Liver + when a client is overwhelmed, even when theyare dull. I was treating the situation rather than the person. This is very helpful thank you!3 teacher remarksAdina KletzelComing lateNewNov 22ReactHI,I was thinking about how to break down the Saam qualities involved in coming late for treatment.GB excess- When one comes late they are pushing their will over the practitioners will. They decide that they have somethingmore important than respecting the schedule of the practitioner. They are pushing their will out and pushing the practitioners willdown.Liv excess -Just not aware of time. Does not notice. No intentional emotions involved, just not aware of timeKid excess - I am more important. My needs come ﬁrst. I have to give to myself ﬁrst and if I can't get there on time that is ﬁnebecause I need to take care of myself.SI excess - I am just falling apart and I just can't handle the pressure of getting there on time. I just can't deal with my life and I amjust going to have to get there late. I hate myself for it but I just can't handle life right now so I can't do better.Sp excess - I am so lazy and can't get myself going so I am just going to be late.I think those are the main ones. I am thinking that GB and Liv excess probably deﬁne most of the latecomers. I am also thinkingthat many of the latecomers have a bit of GB excess pushing their will over the other involved.It can also change. One of my chronic latecomer clients used to feel to me more like an SI excess latecomer but now it feels morelike GB excess. But maybe because I am resenting it more...What do others think about this breakdown and what have been your experiences?Thanks!Kristin Wisgirda  NewNov 22ReactHi Adina,Thanks for articulating your thoughts.

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3 replies 3Reply<GB excess- When one comes late they are pushing their will over the practitioners will. They decide that they have something moreimportant than respecting the schedule of the practitioner. They are pushing their will out and pushing the practitioners will down.> Thisdoesn't sound like an expression of pure GB to me. Yes-erratic, impulsive GB energy will side track movement to get to theappointment on time. "Pushing their will over the practitioner's will" sounds more like Kidney - I am important- along with UB - Icoldly don't respect other people.2 teacher remarks1 reply 1Adina KletzelSpider VeinsNewNov 15ReactHas anyone seen spider veins go down or even disappear after Saam treatments?Particularly using SI+?Anyone have successful case studies to share treating heavy painful spider veins?ReplyKristin Wisgirda NewNov 151ReactI remember Allyson Nevard saying that she had a case where spider veins were reduced by addressing the channel rather thanusing SI+.I have never noticed a reduction in spider veins with treatment but cosmetics haven't been a concern for patients presenting withthese.If a patient came in with "heavy painful spider veins", I would tell them that the heaviness and pain are likely to respond well butthat I am not sure that acupuncture can make the spider veins go away. This is based on my experience with pain and swellingaround larger varicosities. ReplyKristin Wisgirda NewNov 17 | EditedReact@Adina KletzelI am familiar with what you are talking about and have used blood letting techniques in the past in a limited way. In my limitedexperience bleeding the luo as part of a more complex intervention has been helpful for alleviating symptoms but onlytemporarily reduced the appearance of spider veins. I haven't used blood letting as a stand alone treatment so really can't speakto its eﬃcacy.After symptoms are relieved and systems are running smoothly, the persistence of spider veins isn't necessarily a problem in myview beyond showing a history or possible tendency to blood stasis. They can be like healed over cracks in the tongue which showthey there was signiﬁcant ﬂuid deﬁciency in the past that isn't necessarily a problem now.I don't have enough clinical experience to speak to what Saam can and can't treat compared to other approaches.What do others think?Adina Kletzel

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2 teacher remarks1 reply 13 more comments3Kristin Wisgirda Sensory OverwhelmNewNov 141ReactSensory overwhelm was a major complaint for a patient recently, along with neck and forearm pain. The world seem to be movingtoo fast for her. She mentioned bright car lights bothering her.LI+ helped all symptoms.I mention this case because it can be so easy to think sensory overwhelm comes from San Jiao excess too open to the outside. Thedislike of bright car lights could easily support this view. She also gives lots of details- however these details are muddled ratherthan bright and crisp.Asking more about her experience, this patient felt her reaction times were slow. Damp fog slowing her processing and reactionsmade the sensory information too much. ReplyDaniel SchulmanNewNov 14Reactoh wow!! that so totally makes sense. thank you for sharing Krista . . . so many nuanced ways to parse these things ReplyTuriyaNewNov 14ReactWere there aspects of her morphology suggesting SpExcess or dampness?Sharon ShermanAnyone practicing SA'AM in San Diego?Nov 6ReactLooking for a practitioner. A patient is moving from Philadelphia to San Diego CA.1 earlier comment 2 teacher remarksAdina KletzelSJ excess and HT excessNov 61ReactWould a combination of SJ excess and HT excess like to go out and be with people most of the time rather than be home in thequiet?Someone who is in tune to others feelings and notices details but always likes to be with people and busy doing things, likes togive to people, and has a lot of friends - can this be because of the Ht excess or does this description decrease the likelihood thatthis person has much of a SJ excess imbalance?The person I am talking about does not have strong SJ excess signs - most of her SJ excess is noticing people and their emotionsstrongly but otherwise she is more dull 5+, heavier energy 5+, denser ﬂesh 3+, dull eyes 0.The heavier energy though may be because in the past year she lost both her parents and a brother to cancer... So it is hard to seethe SJ/Liv imbalance clearly...I am trying to ﬂesh it out because after a SJ+ treatment she started having wrist joint pain - mostly on the LU meridian. I waswondering if I misdiagnosed the LIv excess and maybe what I thought was liv excess is more Ht excess attributes.

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1 reply 1 ReplyNaomi FrankNov 101React<When a patient talks about being oriented to other people and attuned to other's emotions in the absence of other demonstrations of SJouter awareness- I wonder more about Heart excess than SJ excess.>very helpful! I had not thought of it this way. I've certainly over dxd SJ excess, by placing too much weight on people saying theyare aware of others/are easily overstimulated by people.but I also ﬁnd the Ht/Bl dynamic quite perplexing when it is not very classic.ReplyAdina KletzelNewNov 27React@Kristin WisgirdaOn the same note with a little twist - It feels like there is some overlap between Liv excess dullness and Bl excess lack of passion.Both feel dull... I have client who is Bl excess - no ﬁre or outward expression of love but he is also SO dull. He is so ﬂat, slow, and Ithink he is inward focused - but his daughter's mess really bothers him and he needs everything to be orderly and in place.It got me thinking that maybe his dullness is Bl excess and the Liv/SJ imbalance is not so sharp.How do you fully diﬀerentiate between Bl excess lack of passion and Liv dullness?Thanks.Kristin WisgirdaKristin Wisgirda SJ+ helps light sensitivity and dry eyeNewNov 13ReactThis 77 year old patient has had severe dry eye, light sensitivity and general eye irritation for decades. Bilateral but always worseon the left. The patient has relentlessly searched for relief from every possible world renowned specialist , has tried countlessglasses, drops and gadgets and has seen me almost weekly for 17 years!Because she has stuck with me for soooo long, regardless of how much relief my treatments give or don't give her, she has givenme the opportunity to try, and retry, lots of diﬀerent approaches. What a gift for learning. She claims that her eyes feel better for afew hours after treatment regardless of what I do which makes me suspect our interactions have therapeutic beneﬁt for her.She is the edgiest of edge case for many reasons. She rarely settles with treatment but still has gotten beneﬁt from Saamtreatments for symptoms other than her eyes. A draining treatment was found by process of elimination and improved her eyesby 50%. This unlocked the door and Spleen+ started to give her some mild relief too, even though Spleen+ never helped her eyesbefore.I had used SJ+ and part SJ+ twice before. Once, many years ago, as part of a Kiiko Mastsumoto style treatment using SJ2/3- she hadan adverse reaction on the table. When I used a full Saam SJ+ in 2020, she was agitated for several days after the treatment. Undernormal circumstances these reactions are good reason to not repeat SJ+.But the body ecology is transformed when the key channel imbalance has been found and treated. In other cases I have seentreatments work that previously gave no beneﬁt. And I didn't have any other approach. So when I looked at her dull eyes againand again noticed her dull joyless inward orientation, and how her right eye was almost normal but how her LEFT eye was the areaof great suﬀering, I treated SJ+ on the right. (Her only SJ presentation is light and open ﬂesh +6) Miraculously she settled with thistreatment- she who rarely settles. And her left eye was signiﬁcantly better this past week with 2 symptom free days, which isunheard of! She did have 4 hours of mild agitation the day after the treatment so I didn't repeat SJ+ this week.

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3 teacher remarks1 reply 13 replies 3My takeaway is that when you have found a treatment that signiﬁcantly changes the chief complaint, it can be worthwhile to revisitthe treatments that might not have helped in the past. ReplyMarintha TewksburyNewNov 3 2Reactthis is such an interesting case! can you say what draining treatment shifted things so that Sp+ worked and then your SJ+treatments took hold?it reminds me of a case that i have been struggling with for years. this 79 year old woman has severe back pain, sciatica, andrelentless migraine headaches. the migraines appear nightly at 3am exactly. i have tried treating according to the resolutiontimes....... but that had no aﬀect. i have probably tried every channel over the years. she comes to see me every week regardless ofthe fact that nothing really changes. her back will stabilize for a while (although i suspect that is more from the bodywork & CSTthat i do than from the acupuncture) and i had one moment of success with her headaches by treating bilateral ST+. but i couldnot capitalize on that gain and her headaches returned. she is often free of the migraines when she is traveling. it doesn't seem tomatter if she is traveling for work or pleasure (i can't make heads or tails of that...... maybe she is more relaxed and energizedwhen away? we have been around and around with that without coming to a clear diagnostic idea). recently she fell and broke herhip while vacationing in Europe. she returned for hip surgery and the headaches returned as usual. so now i am treating the hip,the back pain that has of course worsened since she is walking with a walker, and the migraines. oy! she became VERY cold onceshe got home from the hospital. i treated Ht+ on the right and the migraines have disappeared and have stayed away for severalweeks now.it is so hard to know what leads to success in these cases. i have tried Ht+ once or twice in the time that we have worked together,but without any real success. these types of breakthroughs give me hope when working with other patients for whom not muchhelps (i seem to have quite of few of these folks.......). it is hard to get perspective when i have been working with someone foryears. i think in this case, i was able to see the UB excess so clearly because she got so cold. in standing back, i realized that shereally is not a very warm and fuzzy person. she will talk of her family and friends and i can tell there is love and connection there,but she never gushes. she is well versed in what are appropriate social responses and interactions and there is A LOT of KidneyExcess for her (she is a choreographer and performer). i think this got in the way of my ability to see her clearly.my only take away in all of this is that i need to be able to ﬁnd a way to step back and clearly SEE the patient. this can be so diﬃcultwhen i know the person well and there are muddy and meh responses to treatment.clinic is hard. ReplyMarintha TewksburyNewNov 3 2Reactthanks, Kristeni get it. it is not always helpful to get into the weeds with the some of these long term patients. how one treatment builds onanother is so speciﬁc to each individual. there is no play book in this medicine. i do think an edgy case like yours really helps toremind us to stay open to the possibility of all 12 channels and to really try a SEE our patients at each visit.bestMarintha TewksburySanta Monica, CA?NewOct 29Reactanyone practicing Sa'am in Santa Monica?

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1 teacher remarkMariaNausea after ST+NewOct 27ReactJust wanted to get your thoughts about what else maybe causing nausea. I have done ST+ 2x, P+, SI+, SP+, H+. Nothing has helpedmuch. Do you have other ideas? Patient is impatient, irritable, thin, dry skin, with good heels. He also seems to be SJ excess but heis not very polite, so I am not sure. His chief complaint is frozen R shoulder which has been improving with the treatments. Thankyou! ReplyKristin Wisgirda NewOct 281ReactTo me, nausea means that there is disruption in t+t (transformation and transportation) in the middle jiao though some patientswill experience it in the upper jiao too. It doesn't necessarily have any upward movement so Stomach+ and P+ aren't always theremedies, as your case is demonstrating. It is one of those symptoms that can be from just about anything- too much damp/dry,hot/cold, density/openness, stasis/movement.With treatment eﬀect is mixed (shoulder better, nausea worse), some piece of the puzzle is missing. Time for a fresh evaluation. ReplyJoanne TaitNewNov 221ReactI recently had a patient that experienced more nausea after a ST treatment, but then drank chamomile and lavendar tea whichshe said helped resolve it. She also said she felt like her whole st system was feeling calmer and better in general... but I was a bitbaﬄed by the response as well.Another case where I did P+ had more nausea afterward as well. She's post-Covid with tons of other things going on, but theprimary issue for her was not sleeping/settling at night and a sensation of buzzing so we did P+. (also some GB channel HAs) Shehad a very mixed response to it, but nausea was her primary complaint after that treatment. She's deﬁnitely more P than GB XS,so I think that was part of the problem... but I don't think I would've done GB+ to correct it since her response was a bit mixed. Shehasn't come back for another treatment yet. Alas, the continual learning of SAAM subtleties?Naomi FrankHeart excess people feeling alone and fearful (for example)NewOct 26ReactI run into this every so often: people who seem intrinically Heart excess in their appearance and behaviour (in GTITR terrotory),but who are going through a bumpy patch: perhaps feeling less inclined to socialize, or ﬁnding less comfort in the things theyusually enjoy, or feeling fearful/sad.This obviously gives them a mixed presentation. I ﬁnd it diﬃcult to evaluate whether we can used the H/B sytem to balance themout.I will of course look for a bigger gap elsewhere, but with strong morphology/personality pointing to Ht XS, it can feel like ignoringthe strongest signs and in the examples I'm thinking of, have led to "ho hum" treatments.... And yet cooling them down alsodoesn't seem like the best idea.I feel like I've asked a similar q in the past, so I'm sorry if this is repetitive, but it still perplexes me!

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5 teacher remarks7 more comments7 ReplyKristin Wisgirda NewOct 26ReactSorry that I don't have any enlightening clinic experience to share.When emotions are distressing, I try to suss out which primary channel quality is causing the suﬀering.Sometimes with Heart excess, longing for the other being is really painful when it is unfulﬁlled. If that is the case and externalcircumstances can't satisfy that voracious clinging, UB+ might be appropriate. For instance, maybe all the Heart excess person canfocus on is that she can't be with her beloved.If the longing isn't really the cause of suﬀering, then maybe Heart isn't so strongly excess or problematic. ReplyKristin Wisgirda NewOct 26 | Edited1ReactRight on schedule: Tonight a patient came in with this scenario- so Heart excess and despondent. Dull eyes and dense ﬂesh.Treated SJ+ and UB+ together. She had responded really well to UB+ before and severe hot ﬂashes were her second complaint.She settled super deeply and got oﬀ the table feeling like a new person. Being Heart excess, she thanked me profusely.After needling SJ+ ﬁrst, before UB+ was put in: she noted the left side of her body getting cold in a good way. This might beanother case of Liver excess aggravating the heat of Heart excess.Adina KletzelKnees buckle when runNewOct 24 | EditedReactHI,I am treating an 18 year old male whose main complaint is that his knees buckle when he runs or walk up the stairs and then hisback pushes out the other way to keep him up and he ends up with knee pain and back pain. THe weakness and pain are justwhen he is running or doing other physical activity and passes a few minutes after he stops. The pain and weakness include thewhole knee cap.He is supposed to go try out for an elite unit in the army in two days and he has to run as part of the testing to get in so he verymuch wants this to go away.It started a year ago during a time period when his uncle was sick with cancer, his grandmother was sick with cancer, and hisgrandfather just died of cancer. Subsequently both his uncle and his grandmother died so he lost three close relatives in 7months.His house was not functioning and he was depressed.He is now doing better but still gets sad and views that time period as traumatic.He often got sprained ankles over the years so there is some weakness in bone structure.Body morphologytall, 8+, broad, 7+ average weight 7+ line from sternum to umbilicus more tight 6+ ﬁrm thenar 6+LIfestyleﬁnished HS last year. drafting to army in a monthDigestion ﬁne, skin average, thirst averageSaam Chart

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2 teacher remarks2 replies 2Kid Symmetrical 7+ young, strong likes sport 7+ pain on knees 7+ runny nose w/w change of season 4+ nose bleeds with change ofseason constantly clicking his joints – feels a need to release them 6+SI Pushes himself to work out physically even when it hurts 7+ history of sprained and broken bones 5+Liv likes parties 7+ likes light 8+ does not notice details abt ppl has dark thoughts before go to sleep – abt death 6+ musclestighten up and have to release 7+ dense ﬂesh 6+ loses things easily 7+ heavy energy 7+St phlegm in throat and nose 5+ skinny and sweats a lot 6+ weak knees due to loss 8+LU phlegm in throat and nose inﬂated chest 6+ ﬁrm thenar 6+ has family support 6+GB hard time falling asleepBl knee pain is w/w winter 5+ not very passionate 4+GTITR - that he feels like he can't hold himself up at the moment his knees buckle, feels like he is going to fall downI did SJ+ and no change.I am thinking of doing LU+ since the knees started hurting and buckling during a time when he lost so many family members atonce - a form of resources...HE is also skinny and sweats a lot in the heat.He also strikes me as someone who needs to be inﬂated and not deﬂated.BUt his chest is broad and more full and he has a ﬁrmer thenar.I also thought maybe Ht+, since the pain is w/w winter and he is not passionate about anything right now and seems very ﬂat. Healso could use to ﬁll his heart back up with love after such a huge loss.Another idea is Kid + because his legs are not holding him up - he literally is about to fall when he runs. BUt... he is young andsymmetrical.Is there something else I should be seeing that I am not for the particular symptoms of knees buckling when running (afterloss/trauma in particular)?Thanks! ReplyKristin Wisgirda NewOct 24ReactMy notes on weak knees and Stomach excess is this:<weak knees which make them want to sit down(maybe slightly painful) esp after losing money or other resources (including friends) for a long time (not necessarily for a short term loss)and has to sit frequentlyThis sounds like a match except the morphology. But then you say: <He also strikes me as someone who needs to be inﬂated and notdeﬂated.> Are there any physical ﬁndings that back up this impression, such as soft voice or collapsed posture?The conditions that I think of when a patient presents a symptom that lacks ﬁrmness and strength are SI excess lack ofconsolidation, Spleen excess mushy dampness, SJ excess lack of density, P excess too down and in, ST excess deﬂation, maybeHeart excess lack of cold ﬁrmness.weak knees is a for sure indication for Lung+ if morphology is right>

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2 teacher remarks2 more comments 2Daniel Schulman36 Week Pregnant Rib PainNewOct 21ReactHi. I have a woman coming in later today, 36 weeks pregnant! fractured a rib and in pain. I have not seen her yet. Would youconsider Sa'Am too moving for someone at that stage of pregnancy . . . like SI+ for example . . all I know its on the left lowerribcage . . . . just curious what people think of the Sa'Am risk/safety in such a case . . . on the phone, I clariﬁed the pregnancy isperfectly healthy, she is young and otherwise healthy, its her ﬁrst pregnancy and she has never had any miscarriages. ReplyTerri MatsonNewOct 22ReactHi Daniel, I can't oﬀer any experience with Sa'am in third trimester, have done a few treatments on a patient in second trimester. Ido remember Toby mentioning using SI+ later in pregnancy, but I can't recall the details. Please let us know what you did and how it went. ReplyKristin Wisgirda  NewOct 22ReactHi Daniel,Toby gives strong caution for using SI+ in pregnancy, especially before 36 weeks, but doesn't say that it is contraindicated.As you are someone who is more experienced with Saam and have good ﬂuency with safe practice, SI+ can be on the table for thissituation if there are clear signs of Kidney excess. Of course, channel location and systemic channel gaps should be stronglyconsidered.As someone who treats a fair number of women with later stage pregnancies, I am on the lookout for Stomach excess because itis a common pattern in later pregnancies. It is easy to think physical trauma means treating the expected resulting blood stasiswith SI+. It is also helpful to be aware of other factors that slow the resolution of blood stasis. This can certainly include the qideﬁciency that comes with stomach excess.Please let us know what you decided to do, even if you decided not to treat with Saam. Thanks!Kristin Wisgirda Right sided headache caseNewOct 19 | EditedReactA 37 year old woman, elementary school teacherRight sided headaches: mostly UB channel but also GB/SJ sometimes. Likes pressure.History of headaches since 2014. Denies any signiﬁcant events at onset. Over the summer headaches became more frequent-every other day, often lasting more than 24 hours. Often start mid-morning. Notices she can be hungry or thirsty when they comeon.During headache: light/sound sensitive and sweet food averse, denies these symptoms at other times.Second complaint: TTC. No pregnancies. Not using any technology. Cycles 28-32 days. Exercise induced menstrual cramps only ifshe runs on cycle day 1 or the day before her period- can be severe. Denies other menstrual, pms or vaginal symptoms.+5 LI excess morphology; +1-2 small rib cage; grooming 8+ but no sexual vibe or glamor; symmetry 4+; +3 full red face and neck;eyes wander randomly as she talks and eye contact is below average; +2 eye dullness; runs warm +2 but is normal temperature tothe touch; pleasant with average presence/awareness; happy to talk about herself- no other subject comes up; loud voice 4+;thenars +3 full and ﬁrm; medial heels dry and lack varicosities; 3+ tight abdominal midline; pulse 58 bpm; ﬂesh neither open ordense

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2 teacher remarks1 reply 1Sips on water several times during interview. Often thirsty- not particular about temperature of ﬂuids.distance runner- often runs over 20 miles/weekWhat is your diagnosis and how would you treat?ReplyTerri MatsonNewOct 22 | EditedReact@Kristin Wisgirda Taking into consideration, the 5+ morphology in earth metal phase, industriousness, TTC (dry inside), thinking the biggest gapappears between LI excess and SP excess. 1. SP+ (left) even though slightly warming. 2. LR+ (left) 3. KD+ at some point seems necessary but diﬃcult to overlook the symmetry and grooming.Kristin WisgirdaTerri MatsonNewOct 231ReactGood Morning @Kristin WisgirdaMy thought process to diagnosis was laying out the excess gapsHT: channel painUB: channel pain, +3 tight midlineKD: +4 symmetry, +8 groom, menstrual cramps w exerciseSI: older TTC, low fertility, dry medial heels, no varicositiesPC: channel painGB: channel painLU: +3 thenars, +4 loud voice, full resources, RS painST: +1-2 small ribcage, dry inside, RS painSP:LI: +5 morphology, distance runnerLR: channel pain, +2 dull eyes, poor eye contactSJ: channel pain, +3 red face/neck, poor temp regulation, light-sound sensitive w HA, (wander eyes)keysHA ^ in summer *could be HT excess or SJ excessHA ^ hungry or thirsty (thinking < poor blood sugar regulation and/or dry interior) LI excessHA worse sweet food (possibly damp interior) LU ExcessThirsty (but liquid temp not important) thinking there was no ST ﬁreNot sure about poor eye contact (LR shielding) and/or wondering eyes (SJ open exterior)Possibly +4 loud voice was GB excess but was described as pleasant.Kristin Wisgirda

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2 replies 21 more comment1ReplyRegards to RS headache pain thought about LU excess qualities +3 thenars, and +4 loud voice, full resources, and supplementingST+ to support (down) and might further dry interior, and RS pain was not on either LU or ST channel but likely would have been tx3 or tx 4, if the head pain continued, and excited to see what worked for her. Thank you..1. Starting with SP+ based on largest gap, *possibly related to TTC2. LR+ seemed safer due the SJ Excess qualities listed above and considering light-sound sensitive w HA. Considered supplementing UB+ due to +3 red face/neck and pain worse in the summer, however her body temp did not test “hot”,supplementing UB+ early in treatment seemed drastic, and cold might possibly make pain worse.3. KD+ (some point in treatment) considered based on her second complaint TTC and the SI excess qualities present: low fertility, and olderconsidering fertility, dry medial heels, no varicosities. She does have several KD excess qualities with higher (++) +4 symmetry, +8 groom,menstrual cramps w exercise and happy to talk about herself. There is not a huge gap, however being ﬁrst complaint is pain, I can seethat SI+ might be the better choice.1 teacher remarkMelissa Rathbonetwitchy on the tableNewOct 18ReactWhen I see patient's body's twitch once they have the needles in and are resting on the table, I generally think of it as a sign ofsettling but I am curious if maybe Sa'am sees it diﬀerently?Just thought I'd ask, always looking to clarify my sense and observation of a patient's settling vs. not settling.Thanks! ReplyKristin Wisgirda NewOct 18ReactI haven't heard Toby mention that twitching is a sign of settling per se. Twitching can occur in the presence of settling signs such aschange in complexion and visual softening or opening.Hope that makes sense. ReplyMelissa RathboneNewOct 18ReactSo is it safe to say it's not a sign of not settling?Sounds like it's not considered a sign of either, but may come along with the other signs of settling, do I have that right?Thanks Kristen!Adina KletzelItchy after put in needlesNewOct 18ReactHI,

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2 teacher remarks1 reply 11 reply 11 more comment1I have an 18 year old client who gets very itchy around the needles after I put them in.I have never seen this before and am wondering what it is from. Has anyone else seen this?SOme background - her main complaint is dysmenorrhea.She is taking birth control for this.THis is her Saam breakdown:SJ feet are purple and always freezing, hands warm 10+ likes quiet and home 8+ does not like parties 7+ eyes sensitive to sun 7+poor temp regulation 7+Liv clumsy 7+LU lots of hiccoughing 8+ vag secretions, bloating and dry skin 7+ get full really quickly 8+ get carsick very easily 7+ has resources8+ teeth hurt with sinus infectionsKid so much pain with period 10+ symmetrical 9+SISP not involved in anything, likes to do nothing 7+LI skinny and dry skin 7+Ht hates the heat 7+ can feel very hot 7+I have done Liv+, ST+, and SI+SHe will get her period tomorrow so we will see how it is going.Meanwhile no change in Temp. of feet. Digestion is better though.THoughts?Thanks. ReplySharon ShermanNewOct 18ReactIs it an allergic reaction to alcohol swabbing? Or just a histamine response? ReplyKristin Wisgirda NewOct 18ReactDo the areas around the needles get red and and swollen?<Ht hates the heat 7+ can feel very hot 7+> Any more Heart excess signs, or Ub excess signs?Sharon ShermanPondering "The Doubles"NewOct 12 | EditedReactI've been thinking about the qualities of double channels.

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2 teacher remarks1 reply 1LI - Double Dry (cool) cool and drying (yang) Sp - Double damp (warm) smothered in warm cocoon of damp (yin)UB - Double cold water, throwing cold water on something (yang)Ht - Double Fire - as a yin channel, where is the yin here?So as a yin/yang relationship is the yin only in the manifestation of emanating outward love? In a substantive sense, it's hard tounderstand where the yin quality is????? ReplyKristin Wisgirda NewOct 12ReactJust a reminder that the temperatures of LI and Spleen are somewhat cool and warm respectively. These temperature qualitiesare deﬁnitely secondary to their drying and moistening qualities.The following ideas are a bit heady. I'm not really sure of their clinical utility but I'll share them anyway. The storage aspect of yin iswhat enables enough yang to accumulate to become hot.The sun emanates lots of heat and light into space- but space is cold and dark. Only when the yang energy of the sun is receivedby the yin earth can it accumulate enough to become warm.Heart is part of Shaoyin Fire which corresponds to the trigram Li- Fire or Clinging. This clinging quality has an object. Heart's yangﬁrst needs to accumulate enough to radiate from the depths of the body. The storage is necessary for the expression. Heart ﬁreseeks an object- the beloved and therefore can be perceived as warm.Compare Heart with GB qualities in Saam. The abundance yang of GB radiates out erratically in all directions but it doesn't warmbecause in its purest form it doesn't have an object.As for where the yang is in ice cold UB, the ﬂowing nature of water is what comes to mind.Thanks to Sharon Weizenbaum for the basic understanding of yin storage and the nature of yin/yang in relationship to the sunand earth.An idea that I am playing-not ready for prime time but something to ponder: what is going on at the center of the body- asevidenced by emotional expression and midline tension/temperature- might be diagnostically more important that the peripherywhen evaluating UB/Heart. This is probably most true when the emotions and midline have gross presentations. Too many peoplewith cold peripheries and pale faces have beneﬁtted from UB+. And hot people have beneﬁtted from H+. ReplySharon ShermanNewOct 12ReactThanksYup, all of the doubles made sense to me except the heart. So rather than focusing on the "hot temperature" and the outwardexpression which seem yang.... We are actually referencing the repository where things can grow and be engendered.Kristin Wisgirda the importance of determining morphologyNewOct 111ReactToby on morphology: "This is often the most straightforward and unambiguous info we get from patients."In case studies, practitioners are often wishy washy about their descriptions of patient morphology. In one case a patient wasdescribed as "average" but on further questioning we learned that the patient could lose 20-30 lbs! In this case I wonder of clinical

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1 teacher remark1 reply 1discernment was clouded by a reﬂexive unwillingness to be judgmental about body weight in a world that is otherwise toojudgmental about body weight. I understand that impulse but at the same time morphology is an important Saam diagnostic.I want to encourage everyone to frame morphology in terms of Earth and Metal-damp and dry- and not just use words likeaverage or ﬁt or athletic. When looking at the amount of ﬂesh, ask how much weight can this patient aﬀord to lose or gain and stilllook healthy? When someone is "average" ask both questions. If someone can aﬀord to gain 5lbs- they are dry on the inside. Ifsomeone can aﬀord to lose 5 lbs, they have some internal damp. The more we frame aspects of a patient's presentation in Saamterms, the better we get at practicing Saam.When presentations aren't gross you might note that a morphology is potentially mixed. For instance, a body with greasy skin +4that could lose no more than 5 lbs could be a described as Spleen excess>Stomach excess. An obese person with slightly dry skincould be described as Lung excess > or = Spleen excess. I use greater than or equal to here because the extreme damp on theinside by itself could be a reason to use LI+ and "sacriﬁce the skin" until the internal dampness is better under control.Since morphology includes size and shape we do want to note size and shape of ribcage too. This information is often missingfrom case studies. Getting in the habit of noting the ribcage will help you get in the habit of noticing the ribcage. You will get betterat judging size.All of this being said, morphology isn't the only determining factor of Earth Metal excesses. Other aspects of the presentationshould be used to determine where the gaps are.As well, morphology lets us know how carefully we need to be when considering drying and moistening strategies even if Earthand Metal gaps aren't the biggest. For instance, if we determine that a patient is really skinny with dry skin- clearly an LI excessmorphology- but also really UB excess with cold related symptoms, supplementing Heart might not be the best ﬁrst treatmentstrategy because double ﬁre is so drying.ReplyAdina KletzelNewOct 18React@Kristin WisgirdaAre you saying here that you have seen clinically that weight is an absolute determining factor in the damp/dry equation?Are there overweight people who may beneﬁt from LU + or SP+?And are there underweight people who may beneﬁt from LI+ or ST+?I believe the answer to those questions are yes and so I still try and understand how much weight does morphology get exactly?From your post it seems like a lot....Thanks!Kristin WisgirdaAdina KletzelHt excess or KId excess?NewOct 3 | Edited1ReactHI,I have an interesting case of a middle aged woman who loves so much the question is if it is more Ht excess or kid excess.She spent most of the session talking about her kids and that they are athletes and she just wants them to be happy. She has ahard time saying no to them and she just wants to give and give to them so that they will be happy. Her son hurt his ankle and shedid not sleep all night cuz she was scared it would aﬀect his performance on the court and then he won't be able to goprofessional and fulﬁll his dreams... She is so worried when one of them loses a game, worried that he will be upset and loseconﬁdence... Her wanting to always make them happy tires her out though cuz she can never give enough. She wants to pleasethem so much and is worried that they won't be happy enough with her.She is an executive at work and manages many people successfully. She says that everyone adores her at work and that she isassertive but loving at the same time.

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3 teacher remarks2 replies 2She seems to have self conﬁdence even with wanting to please people. She talks a lot in the treatment and has a strong outgoingpresence.When touching her body some of it is cool to the touch and some is warm. She says she is usually colder.Main complaint is lower energy, joint pain, pain on front part of lower legs - Liv, SP, St, and GB meridians, crying easily (father dieda couple of months ago), getting very emotional and easily unsettled about anything that happens in her kids lives.Ht just wants to give 8+ overly loving to her children 8+ has some burning pain on GB mer.6+ talks a lot 8+Bl feels colder 6+ certain areas of skin feel cold 6+Kid overly focused on her kids 8+ loves her kids so much 9+SI not very symmetrical 2+GB assertive at work 7+ (not so assertive with kids) energy pushes outward 7+ trouble sleeping 7+ not rooted 7+ Her energy takesup all the space in the room 8+ She has a strong big broad body 8+ she has always been the leader - in family and at work 8+SJ notices details around her 8+ picks up on emotions of ppl around her 8+ bright light energy 8+Liv likes the sun and light 8+LU overweight and dry skin 8+ phlegm in back of throat and dry skin 8+ puﬀed thenar 4+ inﬂated chest 7+ has resources 7+Her energy is so strong and full that I am exhausted after she leaves. She could just talk on and on - about herself and her kids.I started with St+ (with St 36) cuz she had so much phlegm in the back of her throat and morphologyI think she is more Kid excess but she does say that everyone loves her at work too and she is SO friendly and warm but she is alsocold so not sure about Ht excess.She is also such a strong presence so maybe more GB excess.I would love to hear what others think.Thanks! ReplyKristin Wisgirda NewOct 3ReactWhy can't she be both? The declaration that everyone loves her soundsmore Kidney excess than Heart excess. Let me tell you how great I am! Heart excess wants to talk about how much she loves andappreciates the people at work.Do you think she feels signiﬁcant love for those besides her family? What about the color of her complexion and the temp andsoftness of her midline.<Bl feels colder 6+ certain areas of skin feel cold 6+> A Kidney excess can add mixed hot and cold.<GB assertive at work 7+ (not so assertive with kids) energy pushes outward 7+ trouble sleeping 7+ not rooted 7+ Her energy takes up allthe space in the room 8+ She has a strong big broad body 8+ she has always been the leader - in family and at work 8+> Heart energypushes out. Kidney energy can be assertive and stand up for herself and want to be a leader. Make room for ME. Reactivity, erraticenergy, rapidly changing emotions have much more weight for GB for me. All of these other signs and symptoms can be fromsomething else. It is so easy to feel pushed around by a combo of Heart/Lung/Kidney. I mention this because I have made thismistake before.<Main complaint is lower energy, joint pain, pain on front part of lower legs - Liv, SP, St, and GB meridians, crying easily (father died acouple of months ago), getting very emotional and easily unsettled about anything that happens in her kids lives.> Taking into accountthe presentation of her problem areas will be helpful for you to ﬁgure out your next step.Let us know how it goes. Thanks!

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2 teacher remarks3 replies 3MariasadnessNewOct 1ReactJust wondering how you would think about sadness from a SA'Am perspective. Thx. ReplyPhilip SugerOct 2ReactVia Toby he said that LU or ST can be considered for sadness. One has to diﬀerentiate that relationship. ReplyKristin Wisgirda Oct 2 | Edited1ReactSadness, like anxiety and depression, is an umbrella term for states that can contain all kinds of qualities. It helps me to try toframe the patient's experience in terms of Saam qualities.While Lung and Stomach can be considered, you might also see other qualities of other channels such as dark inwardness,haunting memories, or cold disconnect.I am treating a woman who lost her father over the summer. Lung+ helped her in the early days when she was feeling empty. Italso ﬁt her morphology. However, UB+ was a more pivotal treatment for her. She obsessively longed for her father. UB+ helpedher step away from that relationship so that she could engage with life again. Before his death she had an obsessive love for himtoo. She is a ﬁrst grade teacher who loves her kids. She is thin and runs cold but has a warm soft midline and a pulse that isconsistently rapid.Alison Unterreiner, DACM, L.Ac.Complex pain syndrome caseNewSep 30ReactQuestion for teacherHi Kristin -Looking for guidance on an interesting case...Patient came to me with RSD - a complex pain syndrome I had to look up. It manifests typically after an injury or surgery asexcruciating pain that is not commensurate with the initial injury. This patient initially had it in her right arm, but recently had all ofher bottom teeth pulled because her gums and teeth were bad and the pain has now ﬁrmly lodged itself in her lower jaw. Thepain is 10/10, excruciating, a feeling of "hot coils" in her mouth, tongue is burning, diﬃculty eating and talking. She also has painpoints on her scalp on both the right and left side, primarily right side. She has a metallic taste in her mouth.Appearance and demeanor: neat and clean, demeanor is quiet probably due to the painLifestyle: not working much right now, but when she does work is a cleaning ladyBody morphology and ﬂesh quality: average body, stomach ﬂesh is puﬀy and slightly sagging +4, ﬂesh doughy +5Skin Quality: skin dry +7Kristin Wisgirda

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2 teacher remarksBody Temp: very cold hands and feet, diﬃculty maintaining temperature - easily hot or coldGI: Bowel movement daily, experience frequent gas and bloatingRespiratory: no issuesSleep: diﬃculty with sleep due to pain, wakes frequently at 3am and cannot fall back to sleepEmotions: the pain is very diﬃcult for her, she has been dealing with this for 6+ years and it's taking a tollUrination: painful urination, urgent urination, little urine comes outBody: no varicosities noted, medial heel - not sure (have to look at next visit), thenars - not sure (have to look at next visit), midlinesoft and warm with small cool spots noted around umbilicus, eyes more dull +3Excess presentations:Heart: abdominal midline soft and warm +4UB: hands and feet tend to be cold, painful urination, +7 (not sure if UB is whole body cold or just certain areas though....)GB: insomnia, +4 (but really no other signs of GB xs)P: slow movements, signs of stasis with the pain - +6SJ: noneLiver: Spirit is inward, but could be a result of the pain, +5Lung: dry skin, pain on ride side of head +7Stomach: pain along stomach channel, +9LI: dry skin, +4Spleen: soft body, weak teeth/gums - +9 (but no numbness!)SI: noneK: noneGoing through all of this, looks like LU+ would be tx, but not sure because of metallic taste in mouth...?Grossest thing in the room - this poor woman's quiet pain, her jaw wasn't moving much when talking because of the pain and shehad very slow movements in generalNo sa'am treatment was done, would love insights!!Kristin Wisgirda Sep 30ReactHi Alison, Thanks for the case.Is the pain that she experiences only on the right side? Forget about pain on palpation.If the pain is still in her right arm, which channels are aﬀected?What is her complexion like? Is her rib cage normal size or smaller/larger than average?What is her pulse rate? How good are her resources?<UB: hands and feet tend to be cold, painful urination, +7, (not sure if UB is whole body cold or just certain areas though.> UB is ice coldwater. So the cold signs that correspond with UB are full body cold or more severe local coldness. Sounds like she has mixed hotand cold- <diﬃculty maintaining temperature - easily hot or cold>When you jump into ice cold water it is common to want to pee freely. The urinary sign that points to UB excess is frequent, freeﬂowing clear urine. Urination that is painful and scanty is from something other than UB excess. If the urine is concentrated

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1 reply 1Replyand/or has any burning sensations it could be from heat.<a feeling of "hot coils" in her mouth, tongue is burning> What does these symptoms tell you? Which Saam channels do you think of?<Going through all of this, looks like LU+ would be tx, but not sure because of metallic taste in mouth...?> Given that her skin is +7 dryand that she has enough ﬂesh for you to write <stomach ﬂesh is puﬀy ... ﬂesh doughy +5>, what is her morphology if you have tochose between Lung, Stomach, Spleen and LI excesses?See what happens if you rework your channel analysis with the answers to my questions. Also, please look back at all of her majorSaam markers and put them in their place in the analysis. For instance, you forgot to put dull eyes +3 under Liver excess. Alsoremember that channel symptoms belong with the channel AND its counterbalancer.Please update us and we can take it from there. ReplyKristin Wisgirda Sep 30ReactThanks for responding.It is still important to know which channels are aﬀected in the pain areas and add those to your symptom analysis. So pleaseconsider the channels aﬀected in the arms. The LI channel also passes through the lower gums.I would want to know if the urine is concentrated and/or has burning sensations before saying that her painful urination is comingfrom heat and heart excess.Grading the burning/hot coil sensation in her mouth would be helpful, if they can be diﬀerentiated from the rest of the pain. Ifthey are 10/10, then noting that in your analysis will let you know how strong the case for Heart excess is. I don't see any reason for using thisstrategy. It is always better to treat the channel gaps that you see. I agree that her morphology is Lung excess. Because shestomach channel pain is a major complaint, it is important to look at the Lung/Stomach balance. Morphology alone doesn'tdetermine channel excess but it does have signiﬁcant clinical weight. Determining Earth/Metal morphology is really helpful for allcases because it tells you how much damp draining and drying you can do with a patient. As a case reader, it helps me see yourpatient better.If you take into consideration all of the signs and symptoms for Lung/St, your channel analysis looks like this:Lung: stomach channel pain, dry skin +7, puﬀy stomach +4, doughy ﬂesh +5Stomach: stomach channel pain, poor resources (?)The pain being on the right side of her head doesn't have much, if any, clinical weight for St/Lung because the pain she haselsewhere is bilateral. Right sided symptoms only have weight for BOTH Lung Stomach when they are only on the right side. Themore right side only symptoms, the more weight the right sidedness has.With strong pain we have to consider if SI+ is appropriate. I don't see any information on her age, her menses, kids, etc.It is also important to consider how the pain started besides the dental work.Kristin Wisgirda How full of yourself are you?NewSep 292ReactThis is my new favorite question when inquiring about the balance of K/SI.Pretty people with good grooming might not be that full of themselves.Old ladies wearing ancient, tattered sweatpants can be totally full of themselves.

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This question can be asked about the general presentation or about parts of the presentation. Is the good grooming a gloriﬁcationof self or is it a uniform that is the norm for work culture?Is over the top worry about a seemingly small symptom-like a minor rash- an aﬀront to the self that sees itself as perfect or arehealth issues triggers for existential fear or something else?Pretty people with good grooming who aren't full of themselves can still beneﬁt from SI+. Recently a pretty but very humble ladywas able to stop her anxiety medications after just one SI+ treatment.The gap between K/SI might not be signiﬁcant so you look for a gap elsewhere . Or they might actually need K+. See how the signsand symptoms stack up.2 teacher remarks1 reply 1Kristin Wisgirda muscle spasms, tightnessNewSep 29ReactIn the GMP we are taught that muscle spasms and tightness are a blood xu. A variation of Shao yao gan cao tang is often thetreatment of choice.Is it helpful to import that idea into Saam and treat these symptoms with Liv+?In my experience, the answer is no. Yes, Liver+ can help with muscle spasms and tightness but only in the presence of SJ excess.These symptoms are common in the clinic. I ﬁnd it helpful to zoom in to identify the channels involved and palpate the quality ofthe aﬀected tissues looking for dense/open, ﬂuidy/dry. Then I zoom out and look at the big picture. If there is overlap in the Venndiagram of diagnosing local and system, treatment is often straightforward. Here are a few clinical scenarios not involving Liver+and their successful treatments.A +8 loving lady with a 4+ warm soft midline with calf cramps since her trip sitting on the beach in Aruba: UB+A strident squealing unproductive cough in a +4 dull eyed, 6+ dense muscled woman who speaks at length about randomsubjects. There is no getting a word in edgewise and she would be uninterested in what I have to say anyway. : SJ+ She is also Lungexcess- ST+ helped 40% getting rid of phlegm that was initially there.A Lung excess woman with chronic neck tension, worse on the left side, post plastic surgery on her chin bag. Her whole neck feltlike a water bed- full of ﬂuid. LI+ gave great relief. SI+, SJ+, ST+ were the follow ups.A lady with LI excess morphology +3 and personality +5, with chronic neck tension. Muscles feel sinewy and dry. Sp+What are your experiences? ReplyAndy WegmanNewSep 30 | EditedReact50-something woman, bedraggled, general SP+ morphology with chronic R sided trap/scap/neck tension/tightness. Great stress atwork as MD oﬃce secretary and at home with diﬃcult relationship with daughter and her boyfriend, who live with patient and herhusband. Dull eyes +3, pain 4-7/10 with soft ﬂesh but more ropey in painful area, can't rest without watching shows on her phoneduring tx. We (eventually) identiﬁed dryness as an everpresent sign (skin, mouth, eyes to a lesser degree) employing a SP+ tx. Thislead to "the ﬁrst week I can remember where I didn't have any (r-sided trap, etc.) pain". ReplyAndy WegmanNewOct 3Reactre: SP morphology patient is obese, will occasionally speak about boredom and/or overwhelm while at work. Not much in the way of LI personality traits....more of 'grin and bear it' person while numbing out on tv and food in the midst of apretty shitty home situation over the past two years. This person has been coming to clinic for a few years, and has received a variety of treatments born of diﬀerent acu-approaches. We have used ST + tx in the recent past, but it wasn't until the SP+ tx that she observed substantial, lasting changes in R UQ pain.

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1 reply 12 replies 2Kristin Wisgirda visualizing the gaps reduxNewSep 28ReactOver the years a number of people have proposed organizing counterbalancers side by side, allowing signs and symptoms tostack up in a vertical orientation. Compared to listing signs and symptoms in a stream, this way allows you to see the gaps moreeasily.Sharon Sherman has kindly shared an elegant chart with plus signs as bullet points to remind us to grade the ﬁndings. Having thegrades align also allows you to easily see how much weight signs and symptoms have under each channel.PS: Sharon ﬁxed some glitches in the previous charts she provided. Thanks Sharon!DOCX | 587.2 KDOCXSAAM-Analysis-LandscapeDOCX | 587.1 KDOCXSAAM-AnalysisReplySharon ShermanNewSep 28ReactIf you previously downloaded, the ﬁle Kristin supplied, please delete it. It has some buggy code artifacts that make the columnsfreak out and lose formatting.ReplySharon ShermanNewSep 28ReactI am also providing a link for those of you that prefer Google docs. https://drive.google.com/drive/folders/1PrZ-nz2JHwifhTTq02SA5-8_IMvwdN_S?usp=sharing I am open to your feedback regarding helpfulness, formatting or any other brainstorming that helps us elevate our understanding.Kristin Wisgirda Saam 3 Class Registration OpenNewSep 221Reacthttps://whitepinecircle.org/saam-deconstructing-point-combos/It will be the broken up into 5 digestible 3 hour courses.

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MaeveAnxiety and frequent urinationNewSep 19ReactHi Kristin/all, appreciate any input to help me to see him more clearly.59 year old manChief complaint: AnxietyHe says he has had it since his twenties, can’t pinpoint what started it. Negative thoughts, frustration with himself and others,always swirling around in his head. Was on Prozac for about 20 years, until 2 years ago. Felt a lot less anxious on Prozac butwanted to get oﬀ it as he felt he felt ﬂat with no joy. Put on a lot of weight while on Prozac, has lost 7 stone (84lbs) since coming oﬀit 2 years ago. Felt okay for about a year but in the past year the anxiety has been creeping back in. Does not want to say muchabout his childhood but over the weeks is opening up a little bit. Today mentioned that his Dad was great man in theneighbourhood but quite neglectful to his own family, wouldn't elaborate.Secondary complaint: Frequent urination at night, wakes 2-3 times per night to urinate. No burning or discomfort, bladder not fullbut does need to go. GP diagnosed enlarged prostate and prescribed meds which he does not want to take.Appearance and demeanor: Symmetry -2, Clean but dressed in tatty clothes, no interest in his appearance +7. Eyes 0, face seemsto go between malar ﬂush and full red between visits. Is very shielded and diﬃcult to reach/get information from +8. Is a danceteacher but has no interest in talking about it, no “gushing” about anything +6Lifestyle: Lived abroad for many years and is now back living with his mother while he renovates a house he bought. He is singlewith no children. Teaches dance classes in the evenings, has no problem getting up in front of people but the day after feelsmentally exhausted.Spending time doing up his house during the day. Likes to swim in the sea, ﬁnd that it helps his anxiety and over-thinking for fewhours. Recently joined a gym.Body morphology and ﬂesh quality: Average frame, average weight, slight extra weight around the middle. Muscle tone is okay.Skin Quality: normalBody Temp: feels warm everywhere on palpation and cupping brings out a lot of heat. Says he hates the heat and much preferswinter/cold weather.GI: Says all normal.Respiratory: No issuesSleep: Poor, late bedtime because of work, ﬁnds it hard to unwind then. Also wakes to urinate.Emotions: Seems quite agitated and just wants to have acupuncture without engaging much.Body: No varicosities, medial heel not ﬂeshy, thenars puﬀy, middle Ren empty and warm.Tongue: normal size body, slightly red/purply, no coating, razor slice down part of the middle +5Excess Presentations:Heart: Hates heat, feels better after swimming in cold sea, warm on palpation, empty epigastrum, razor sliced tongueUB: frequent urination, cool demeanor (does not talk warmly about anything/anyone in his life), Heartrate ~60GB: Feels frustrated and cross about most things, says thoughts are “all over the place”P: Very slow and deliberate in his movements,SJ: self critical +6, prefer winter and being by himself, insomnia +4, ﬂesh open and light +5, malar ﬂush at timesLiver: Shielded and thoughts dull (today he spoke for about 5 minutes about his brother-in-law who said he would help him withhis house for a week (for no pay which he acknowledged was nice) but he has only given him 1 day. Stuck in thoughts from hispast, feeling slighted by people.Lung: Some extra weight around the middle +3, plump thenars +8, says doesn’t worry about resources, has enough.Stomach: none

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4 teacher remarksLI:Spleen:SI: No interest in grooming +7, negative self-thought +7, less than average symmetry +4, feels mentally exhausted??, frequenturination (lack of containment)?K: Razor slice on tongue +4, “stuck” in thoughts, can't move past things.The Grossest Thing(s) in the Room: Lack of grooming and shieldedness.In hindsight I probably should have avoided SJ/LIV for a while as its so unclear to me.Treatment 1: +PC leftLooked relaxed, felt relaxed but no sleep. Better for few days but then back to usual thought pattern.No change in urinationTreatment 2: +SJ leftVery unsure of SJ/Liv but felt he was so closed oﬀ and diﬃcult to reach. Again seemed and said was relaxed but no sleep. Travelledfor few days for family funeral and back to negative overthinking again, sleep very poor and exhausted from the week. No changein urination.Treatment 3: +LIVConsidered +SJ might be wrong treatment. Seemed relaxed on the table but no sleep. The next week no improvement withanxious thoughts but was more open with information and had joined the gym (had been putting this oﬀ), so some progress. Nochange in urinationTreatment 4: +SIEven though no obvious signs of Kid XS, he does seem “stuck” in his thought process so I wanted to try this before +Kid as he alsodoes not seem very physically depleted. No change in anything that week.Treatment 4: +BLFell into a deep sleep. Said he felt so relaxed. But by today no change in anxiety and urination possibly more frequent.Treatment 5: +KidUrinated right before treatment. When needles in said mind was very relaxed. After about 18 minutes he said he needed tourinate again, that he had needed to go since 5 minutes in but his mind felt so relaxed that he wanted to keep the needles in aslong as possible? This was today. Would you consider this a mis-treatment?Next treatment thoughts:Repeat +PC+ST....some signs of LU XS....inability to "digest" past experiences? Is that a reach when there aren't any physical symptoms of LUXS?With the ﬂushed face and hot physical symptoms, over-thinking, dislike of heat i'm slow to try +HT but wonder if it would help withhis love for others, urination, feeling some joy.Kristin Wisgirda  NewSep 20 | EditedReactHi Maeve,Thanks for sharing this complicated case.<bladder not full but does need to go.> What about the quality of his urination? Lots of clear ﬂuid? Or only going small amounts?Does his urine stop and start? Is the frequent urination only at night? Urinating full amounts frequently, especially if the urine isclear, is more of a UB excess sign. If the frequency is because his urination is incomplete, then it is not a Ub excess sign.

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4 replies 41 reply 1Reply<Negative thoughts, frustration with himself and others, always swirling around in his head.> Does his anxiety have any physicalsymptoms or is a phenomenon only up in his thoughts?<GB: Feels frustrated and cross about most things, says thoughts are “all over the place”> Frustration and irritation just means that hedoesn't like something. Thoughts all over the place means says hyperactivity in his head. For me, neither have strong weight forGB because they can be from other things. GB is erratic, reactive, quick to move out into space in any direction. Any of these signs?<P: Very slow and deliberate in his movements,> Can you put a number to his slow deliberate movements? Is his speech slow anddeliberate too?<Treatment 4: +SI Even though no obvious signs of Kid XS, he does seem “stuck” in his thought process> He does seem stuck but thereare many possible other channel excesses that create stuckness besides Kidney. SJ+ didn't help either. Could P excess be a sourceof his mental stuckness?<Treatment 1: +PC left Looked relaxed, felt relaxed but no sleep. Better for few days but then back to usual thought pattern.> On the tableP+ might look settling even if it is really only sedating so it might be hard to judge treatment eﬀect. How much conﬁdence do youhave in his reporting improvement after this treatment?<After about 18 minutes he said he needed to urinate again, that he had needed to go since 5 minutes in but his mind felt so relaxed thathe wanted to keep the needles in as long as possible? This was today. Would you consider this a mis-treatment?> It sounds like he settledwonderfully so deﬁnitely not a mistreatment. Maybe just bad timing with the ﬂuid regulation in relationship to the treatment? ReplyMaeveNewOct 26ReactJust a quick update. Unfortunately he has not been back since. He cancelled his next appt the night before and booked for theweek after and again cancelled that one about 10 minutes before! He had done this after his ﬁrst session too but I put it down to aone-oﬀ. I am putting this ﬁrmly in Liver XS column now though I asked him for an update by text, whether there was any change to anxiety or urination but he just replied that he doesn't haveavailability at the moment and may return at a later stage (GB XS?).I am kind of assuming +kid didn't help but who knows. I have seen new ads for his dance classes so I guess he must be doing okay.Kristin Wisgirda Eye Observation Class 10/15Sep 161ReactPlease join me for a class in eye observation live on Qiological on Saturday October 15 at 12pm EST. Putting this class togetherwith Toby really helped me understand what we are looking for when we evaluate for brightness and dullness according to Saamprinciples. Registering for the class includes a packet of over 50 pictures that have been graded by Toby for brightness anddullness. We won't get through all of the pictures but they will be a resource for you for further reﬁnement of your skills.I am especially happy with the pictures of dark eyes, both bright and dull, since dark eyes can be harder to evaluate.https://www.qiological.com/qiological-live-saam-eyes/For those of you have taken the eye class earlier this year, please know that this class has the same slides.For those who have taken the 12 Channels class, please know that most of the slides in this class are diﬀerent.If you can't make it live, the course will be oﬀered on demand. Lifetime access to the recording is included with live registrationand on demand.Terri MatsonNewSep 16ReactKristin Wisgirda

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1 more comment1ReplyI highly recommend this course with @Kristin Wisgirda. Learning how to discern eye brightness and use it as a diagnostic tool hasadded enormous beneﬁt seeing and embracing the channels in a new way. ReplyMariaNewSep 16ReactThanks Kristin for putting this class together. I have found that the eyes could be the deciding factor in evaluating SJ/LV excess, yeti ﬁnd it so hard to discern. I'm so looking forward to it.2 teacher remarks1 reply 12 replies 2Kristin Wisgirda Didn't make the teamNewSep 13ReactA long time patient came in this morning with news that has ripped her family apart, kept her from sleeping for a week, and givenher awful headaches. She also complained of exhausting non-stop repetitive thoughts and feeling warmer than usual. Her eyeswere dull +4.Her 14 year old daughter didn't make cut for the high school soccer team. This girl has been a soccer star in every other arena andhas 2 older sisters who are soccer stars. She told her mom that she didn't want to live.SJ+ had the patient sleeping on the table within minutes. The headache was gone when she woke up. Her eyes were bright again. Ihope that this mom will pass along her enhanced SJ powers to her daughter so they can see the way forward. ReplyPhilip SugerNewSep 13ReactWith SJ being the second warmest treatment we can perform why do you think she was warmer than usual? The dense heatexplanation?ReplyJanNewSep 13ReactFrom my understanding the dullness of the eyes points to Liver excess, also the inward focus of the mind (maybe). I would wonderabout the intensity of the non-stop repetitive thoughts and being slightly warmer might point to San Jiao excess. Also, that she hasbeen externally focused on her daughter, perhaps anxiously noting worrying details about her daughters behavior. Then I wonder,is her focus inward or outward? And is she too open or too dense? Is her thought pattern "dense" in that it is non-stop? Or is shenot protecting her own center and hyper aware of her daughter? I think of SJ as being able to breath air into something -- not toinﬂate but to act as a sigh or the warm breeze described by Toby. But a cool dense forest might be nice too. . . And that could helpher regroup to support her daughter rather than being caught up with the external concerns. In this case does a SJ+ help herbreak out of her dense pattern of thought? I'd love to hear your feedback Kristin as it seems that often a case could be made forboth poles.Kristin Wisgirda Tough Day at the ClinicNewSep 113React

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1 teacher remarkhttps://www.youtube.com/watch?v=KwVCBRGsHeATough Day at the ClinicTough Day at the Clinic Embedded File.https://www.youtube.com/watch?v=KwVCBRGsHeA ReplyKristin Wisgirda  NewSep 11 2ReactI notice my tough times in the clinic happen with certain patients, rather than on certain days. With many patients, I don't need toconsult their charts to keep their info straight. With particular patients, no matter how many times I consult their charts I manageto ﬂub up some part of the encounter. Some combination of losing my ground and checking out on my part. The treatment resultsare rarely good with these patients.A strong reminder of the importance of self cultivation.ReplyTerri MatsonNewSep 12 1ReactOy vey! I very much appreciate your sentiment @Kristin Wisgirda about self-cultivation. What a beautiful reminder and way to viewthose moments in the oﬃce, how self cultivation steadies our presence, so when the wind blows we remain unmoved.Kristin Wisgirda1 teacher remarkMariaUB67 Needle SensationNewSep 1 | EditedReactWhen I needle this point, most patients don't feel anything. It seems like this area is often callous. How important is it that thepatient gets needling sensation at UB67?Kristin Wisgirda  NewSep 23ReactAching and throbbing are common qi sensations with UB67. If the area is really calloused, I would needle under the callous to besure the needle hits the point.

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3 4 5 6   1 teacher remarkMariaAsymmetrical NarcissistNewSep 1ReactHow would you rate someone which is not symmetrical 3-4/10 but thinks highly of themselves and puts a lot of attention on theirmakeup and clothing. They typically don't have much varicose veins but also healthy heels. ReplyKristin Wisgirda Sep 11ReactWhat a person thinks about themselves deﬁnitely has clinical weight even if it objectively isn't true.It is a matter of grading piece of the puzzle and then seeing what the resulting balance between SI and K ends up being.If they are younger-say under 35- without any varicosities- then this is normal for me.Kristin Wisgirda The Invisible Gorilla Strikes AgainNewSep 1  2React83% of a group of experienced radiologists failed to notice the gorilla as they were doing a routine scan for lung nodules."The invisible gorilla strikes again: sustained inattentional blindness in expert observers"July 2013, Psychological Science 24(9)Focusing our attention on speciﬁc aspects of a patient's presentation can blind us to other very signiﬁcant problems, unless wemake a habit of softening our focus stepping to take in the whole picture.Zoom in. Zoom out.WEBP | 120.6 Kgorilla-radiology.jpg

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1 teacher remarkSharon ShermanNice examples: Losing Consolidation Kid-->SINewSep 1 | Edited1Reacthttps://www.youtube.com/watch?v=j5HE_pJmTMcSergi Cadenas. Dualitats. 2021Sergi Cadenas. Dualitats. 2021 Embedded File.https://www.youtube.com/watch?v=j5HE_pJmTMc ReplyKristin Wisgirda  NewSep 11ReactThe face shows the yin/ying separation of aging so well. Flesh pulling away from the bone. Flesh sinking leaving hollows. Skinsagging, wrinkling. An even complexion breaks down into splotches of red, pallor and varying shades of brown.Except lucky Marilyn ages into a bushy browed genius!5 teacher remarksKristin Wisgirda Saam 3NewAug 31ReactToby is considering oﬀering Saam 3- Deconstructing Point Combinations and Advanced Case Studies on the White Pine Circle. Thisclass includes some very useful clinical tools for those who have already taken the Saam 2- Draining and Bilateral Treatmentsclass. As well, Toby presents a number of his interesting cases using these strategies but also the advanced methods presented inSaam 2. Student cases are also discussed in depth as well.This class would be presented in 3 hour chunks with a dedicated forum. Much easier to take in info this way compared to theusual full weekend brain frying format.Please let us know if you are interested. Thanks!George MandlerNewAug 31React

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1 reply 11 reply 12 more comments 2ReplyPhilip SugerNewAug 8ReactCorrect only the follow up Q&A is available directly on the site. Not the same thing.ReplyGabriel SternNewAug 8Reactany word on if Toby is planning to do a Saam 3 in the six week format like he did for 1 &2?2 teacher remarks2 replies 21 reply 1Kristin Wisgirda September/October Advanced Case Study GroupNewJul 28 | EditedReactUpdate 8/7/22This group is full. Feel free to let me know if you are interested in participating in another group.We are forming a case study group for those who have taken both advanced classes- bilateral/draining and deconstructing pointcombos. Toby has graciously agreed to answer questions that come up during this session. A recent case study group generatedlots of conversation about Ren/Du supplementation that lead to an in-detail clariﬁcation of how to use these channels from Toby.This small group format will build your conﬁdence in using advanced methods.The group will be 5 people including me. 2 cases study write ups will be required of you. We will meet for 4 x 2 hour sessions. Thecost is $225. Calls will be recorded. We will meet for 4 Thursdays in a row starting September 29-October 20th from 11am EST to1pm EST.To register, contact me at kwisgirda@gmail.comIf you are interested but these dates and times don't work for you, email and let me know so we can ﬁnd a time that works for youin future groups. ReplyJanNewAug 1ReactHi Kristin, Do you know if Toby is planning to teach any advanced classes this fall or winter? Thank you, Jan ReplyJoanne TaitNewAug 4ReactWhere do we get information about using Ren and Du channels? Is that part of this group? I did the advanced class but it didn'tcover that as far as I remember. Does the deconstructing point pairs class cover those and if so how do I ﬁnd that? I feel like it wasoﬀered at some point, but I don't know where. Thanks, Joanne

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4 more comments4 ReplyJPEG | 69.3 KToby Meme ReplyTerri MatsonNewAug 30ReactAppreciate the humor, and the picture of your Toby Meme!3 teacher remarks1 reply 1Adina KletzelAttention to DetailNewAug 28ReactHI,I have seen in clients who otherwise seem aﬀected by their environment in an emotional sense and thereby seem Sj excess to notcare whether their physical environment in messy or neat.One client in particular is a social worker and is very empathic and feels what others feel. She also was very aﬀected by herparents constant arguing and screaming but she does not care if her personal space is messy or clean. On the one hand there isstrong external focus and on the other there is not. This seems to be a mixed picture but I wonder if there is any room to allow aSJ excess to not care about the physical environment while being overly sensitive to the emotional environment.Have you seen that combination and still supplemented Liv with good results?Her whole Liv/Sj breakdown is as follows:SJ Bright eyes 7+ arms loose ﬂesh 7+ attention to emotional detail 7+ blood def. 6+ bright light and noise give her migraines 8+less migraines in winter 7+ polite 7+ self critical 7+Liv does not mind mess 6+ body feels heavy 7+ legs dense ﬂesh 3+ ReplyKristin Wisgirda  NewAug 28ReactWhen patients are really aﬀected by other people, I consider Heart and SJ excesses. Both have an outward orientation and can bemoved too much by other people's business but for diﬀerent reasons which might be hard to tease apart. I have had patients whotalk about being very empathetic but who are not SJ excess but there are plenty of SJ excess empaths as well.People are such a mix of diﬀerent qualities. Anything is possible! It helps me to look at each piece for what it is.<does not care if her personal space is messy or clean> Is this because she doesn't see it or she doesn't have enough self care mojoto make a nice space for herself? Or she doesn't have the luxury to indulge in caring because she is too busy making ends meet?Daniel SchulmanNewAug 31ReactI had a patient recently who was incredibly sensitive to those around her . . . both in her work (as a psychologist) and in her homelife in relation to her mom, her siblings and her partner . . . . in the end, the treatment that 'changed her life' was Kidney

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3 replies 31 more comment1Replysupplementation! . . . . her self-love was weak to the point she was giving her attention out to everyone around her.1 teacher remark1 reply 1MariaLooking for Sa'am one in SF PennisulaNewAug 26ReactPatient lives near Brisbane, CA.Thank you! ReplyKristin Wisgirda  NewAug 26Reacthttp://www.marinthatewksbury.comMarintha Tewksbury is wonderful! Your patient is lucky to have access to her.4 teacher remarksAdina KletzelPhlegm as a pathological attempt to hoard waterNewAug 25ReactWe have discussed before that phlegm or even cysts can be the bodies way to hoard water when there is dryness from yindeﬁciency or heat.We all see patients with phlegm or dampness in any Jiao who are also dry - with either dry mouths, thirsty, dry bowels, skinny,cracks in the tongue....I know in Sa'am we have the option to both dry out and nourish water at the same time with St or LU but even in these cases Iwonder if drying out the phlegm is actually what we want to do. If the phlegm/damp is coming from the dryness don't we justwant to nourish water and that will also take care of the damp/phlegm in the body? Aren't there cases where drying even whenthere is damp can possibly make the problem worse?How do you approach phlegm/damp in dry people? Do you ever consider the fact that the dampness seems that it is coming fromdryness or does that not factor into your diagnosis at all?Kristin Wisgirda  NewAug 26React<If the phlegm/damp is coming from the dryness don't we just want to nourish water and that will also take care of the damp/phlegm inthe body?> Most often yes.<Aren't there cases where drying even when there is damp can possibly make the problem worse?> Absolutely yes.<Do you ever consider the fact that the dampness seems that it is coming from dryness or does that not factor into your diagnosisat all?> Moistening to expel phlegm is a common treatment strategy when dryness is present.For me, framing this situation as hoarding water isn't a helpful image. More helpful is something we see all the time in nature-puddling during drought. Most of the time we want to get the river ﬂowing again by adding ﬂuids. But there are rarecircumstances that the puddle is so putrid that you need to drain it out before adding more moisture to an extremely drycondition. I haven't used this treatment strategy yet but saw Toby use it in the case of the super thin super dry woman with the

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2 replies 23 replies 3Replynecrotic jaw. This patient was seen in a teaching setting. Toby used LI+ to try to save the teeth and jaw. He said that he wouldfollow up with supplementing ﬂuids.ReplyDaniel SchulmanNewAug 31ReactThis is such a great conversation . . . yes, this damp-dry question is for me, after now what? two years or more of diligent Sa'Ampractice, still one of the most challenging ones. These complex scenarios of mixed dry and damp and inside / outside questions . . .I feel like we could do a whole advanced class just on this . . . . one small thing I will share here is that often when the whole inside/ outside question is too hard to parse based on where the dryness and dampness are manifesting . . . I step back and considermy assessment at least within the domain of Lung-Stomach, Spleen-Large Intestine based more on the overall morphology /morphological type of the body in front of me . . . . things like chest size, thinness of legs, etc . . . .2 teacher remarks2 replies 22 more comments2Sharon ShermanSAAM Archetypes and Herbal FormulasNewAug 23 1ReactI thought it might be fun, since a lot of people here were also herbalists, to try and conceptualize historical formulas that embodySA'AM archetypes. Anyone game to play?ReplyKristin Wisgirda  NewAug 23ReactYou ﬁrst. Is there a particular formula or herb that inspired you to post? ReplyTerri MatsonNewAug 23 1ReactAnd, Er Chen Tang would be appropriate for Spleen Excess...Kristin Wisgirda Good GroomingNewAug 15ReactI heard a podcast where a woman described her grandmother's meticulous grooming. She wouldn't leave the house with chippednail polish. This grandmother, who was part of a marginalized social group, explained to her granddaughter that good groomingchanges the way the world interacts with you. A chipped nail could make the diﬀerence between getting a loan and not getting aloan.In a case study group, a practitioner presented a case of a woman with alopecia areata who was meticulous about her hair. Thethin hair that she had left was carefully swept over her bald spots and shellacked into place. Not a hair out of place. This patienthad an adverse reaction to SI+ and got beneﬁt from K+. There were other factors besides the grooming that lead the practitionerto ﬁrst believe that the balance tipped more to Kidney excess.When a patient presents with outstanding attention to appearance, you have to ask what the motive behind that is. Is it for sexualdisplay and/or gloriﬁcation of self or something else? It isn't something you can politely ask about either, so you have to putyourself in the patient's shoes and use your imagination.

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1 teacher remark1 reply 1Marintha TewksburyAustin, TX?NewAug 15ReactAnybody practice Sa'am in Austin, Tx?ReplyKristin Wisgirda Aug 15ReactThe wonderful Joanne Tait, who is also in the GMP, practices here: https://www.napaustin.org@Joanne Tait please let us know if you practice elsewhere in Austin. Thanks.Joanne Tait1 teacher remarkMelissa Rathbone3 needles?NewAug 11ReactI was doing a supplement S int treatment today on a patient and she experienced a lot of pain with Sint 2. We waited a bit to see ifit would calm down, but it didn't and after a few minutes she said it was too painful and she asked me to take it out - which I did.I continued with the rest of the treatment but she wouldn't agree to me re-inserting Sint 2.I left the other 3 needles in but I'm not sure if that was the correct choice?Can 3 out of 4 needles be a useful treatment?She wasn't agitated or upset by the treatment, she never fully falls asleep but she said her body deﬁnitely calmed down. She has alot of fear around needles to begin with so she's always a little anxious as the needles are going in. It didn't seem that she washaving an adverse response to the treatment but I'm concerned that a treatment with 3 needles will leave everything a bit oﬀ.What do you do in this scenario? I'm wondering if I should have taken the needles out and done my second choice of treatment?Thanks for your input! ReplyKristin Wisgirda NewAug 11ReactI would have ﬁrst backed the point up a minute amount while putting ﬁrm pressure on her ﬁnger. Often this is enough.If the needle is already out- sometimes a toe point might jump out- and the patient is not happy about a reinsertion, I let themknow that the treatment won't be as eﬀective without the point being reinserted. If I don't reinsert it, we will have to do a newtreatment. I've never had anybody chose the new treatment. With this patient refusing, I would have removed the needles andused another strategy. A 3 point treatment in an unknown quantity.I also play up that this a strong treatment and strong sensation is normal.I did have a case where the patient normally tolerated uncomfortable points but was getting agitated about sensation at a certainpoint. Adjusting it didn't help and she wasn't settling so I used another strategy.

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p y ReplyMelissa RathboneNewAug 11Reactok got it. thanks kristen5 teacher remarks5 replies 53 more comments3Sharon ShermanPlum Pit Qi in SA'AM Speak?NewAug 9 | EditedReactI know each case is individual in it's nuances, but does anyone have ideas on plum pit qi (sensation of something stuck in thethroat) from a SA'AM lens? Many thanksSharon ReplyKristin Wisgirda  NewAug 9ReactYou ﬁrst: What are the possible channel excesses that could explain plum pit qi?Like with most chief complaints, I most often look for an overlap between local presentation (channel/quality) and systemicexcesses.Recently, a patient of mine had a one Saam treatment miracle cure of plum pit qi she had had for years. I'll share that case whenwe have ﬂeshed this out more.Anyone else have experiences treating this with Saam? ReplySharon ShermanNewAug 9ReactChannels that go to the area Lung, Stomach, Heart, Liver, Small Intestine, Ren SA'AM excesses that overlap channel terrain that could explain the stuckness Lung (upward movement, interior dampness), Kidney (over consolidation, stuckness), Liver (heaviness, dullness)3 teacher remarksKristin Wisgirda On Demand Saam 3 Deconstructing Point Combos ClassNewAug 8ReactThis class, which includes Ren/Du as well as the deconstructed points is available on Qiological.com by special request.You have to contact Michael directly, either through the Write Us or chat button on qiological.com or emailmichael@qiological.comYou will need to provide Michael with proof that you took the ﬁrst Advanced Saam class (draining and bilateral treatments).

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3 replies 3ReplyKristin Wisgirda  NewJul 29ReactThere are so many nitty gritty details to go over with Saam. Ask away!On this subject Toby doesn't give us a hard and fast rule. He uses the term avoid deliberately, rather than saying never. He says hehas used K+ as a ﬁrst treatment on a few occasions.Some, but not all, patients need both K+ and SI+. In these cases, Toby tends to treat SI+ ﬁrst, but he didn't say that he always does.If there is more SI excess than K excess/blood stasis, then there is a case for treating K+ before SI+.I hope that helps. ReplyMariaNewJul 29ReactIt sounds like it would be OK to do K+ as a 2nd treatment, without ever doing SI+.1 teacher remarkKristin Wisgirda Can't Find The KeyNewJul 28 | EditedReactA practitioner asked me: <When we can't decode the lock, is there still beneﬁt in the treatments? What happens in the body whentreatments were perhaps performed at the wrong time or sequence?????>This is a good question for Toby.Before the pandemic, I treated a patient 6-7 times with little to no improvement in her symptoms. Because of the lack of improvement, I was surprised andnot exactly delighted when she recently called me to resume treatment for a violent cough she had had for 2 years. Chronic coughs can be so tricky! With 2Saam treatments the cough that nobody else could help was totally gone. Now we are making really good progress with the problems she came to me withinitially, because nobody else could helps those either. In those 2 years, this patient got laid oﬀ from a highly toxic job with a highly abusive boss.My point is that sometimes you don't know what kinds of seeds you are planting with your treatments. As well, timing can have a critical role.Toby says that 4 elements determine eﬀectiveness of the treatment. We are in control of only 2: diagnosis and treatment execution. We have no control overpatient constitution and strength of the pathology including external factors.I don't really know answer to the practitioner's question but have some ideas and experiences that guide my practice. I have seen chief complaints notimprove signiﬁcantly with Saam while other symptoms do improve. This tells me that treating the "lesser" gaps can still beneﬁt the patient even if the maingap hasn't been adequately treated.< What happens in the body when treatments were perhaps performed at the wrong time or sequence?>I suspect that timing and sequence are only harmful if the treatment is trying to correct a gap that isn't there, meaning that you are supplementing somethingthat doesn't need supplementing. I try to minimize incorrect treatments by really attending to settling and symptoms on the table. I'm still working at gettingbetter at noting the complexion and resting facial expressions before treatment so I have something to compare to when the needles are in. In my earlierdays of practicing Saam, I sometimes let patients ride treatments where there was no clear settling or beneﬁt on the table in hopes that beneﬁt from mydiagnosis would come later. Yikes! I deﬁnitely made a few patients worse. The patient's response to treatment has the highest clinical weight, alwaysoutweighing our ideas about the patient.JPEG | 196 K800wm

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1 reply 1ReplyNaomi FrankNewJul 30ReactI have also had questions in my mind about timing and sequence. Occasionally a treatment seems to unlock the previousltreatment (just like sometimes the patient suddenly feels Qi at the previous point needled once we have moved on to the nextpoint.)In terms of diagnosis, most of the time I ﬁnd it is with patients who present as well balanced and healthy that it's diﬃcult to ﬁndthe biggest gap.What about patients who are so sick, with many concurrent patterns and everything you do seems to have a mixed result?I won't write this one up as it's very complex, and the patient has decided she no longer wants me to use SAAM. We did see somebeneﬁts but they were always mixed. But she also is someone who has been severely ill for so long (lots of medical testing andspecialist visits but no clear answers)... I had really hope that SAAM could help me to help her but any gain also seemed to amplifysome other discomfort that is going on.I haven't done the advanced class yet and I wonder if people ﬁnd that these types of patients are the ones who needcombinations? But I'd also guess that they are the ones where you want to proceed the most cautiously.Thoughts?6 teacher remarksKristin Wisgirda Dull vs Calm vs Foggy/UninterestedNewJul 28 3ReactAn overweight 5+ physical therapist with very dense ﬂesh 9+ had severe chronic back pain and lots of pain elsewhere- all channelsare involved. She was talkative but would go on and on about dull subjects like she was lost in her own world. She was pleasantand able to answer my questions reasonably well. Treatment focusing on SJ+, SI+, LI+ really helped her back pain but didn't makeit go away completely.She stops treatment to get her knee replaced and returns for treatment 6 months later. Her replaced knee is still stiﬀ and swollendespite following all of the rehab rules and her old GB channel hip pain is worse. She still has some back pain and a variety ofother pains. Since the ﬁrst round of acupuncture she lost weight, her eyes are brighter and she seems more present in the room.But her personality is still blah and boring. GB+ improves everything! She has never felt better- including her back. I missed herdeliberate movements and intelligent consideration of my questions in the ﬁrst round of treatment. It took the GB channelinvolvement for me to really consider the P/GB balance.The dictionary deﬁnes dull by what it is lacking- brightness, vividness, sheen, excitement, interest, intensity. We need a moreprecise deﬁnition for Saam to distinguish Liver excess here.Calm/slow to react and foggy/bored could easily be perceived as dull.These qualities can be even harder to distinguish and weighted when they are combined with each other. They are also quieterqualities that are easily drowned out by louder, ﬂashier qualities so it helps to get in the habit for looking for them.How do we get better at seeing P excess and diﬀerentiating P qualities from Liver and Spleen when observing the patient's aﬀectas she interacts with us? Please share your thoughts and observations and I will share mine.Of course we can use signs and symptoms in other areas of the patient's being but when they don't make the channel gaps soobvious, how do you know is a blah personality is densely shielded, calm or just bored?ReplyMariaNewJul 28ReactThis is a great post and deﬁnitely a big area to explore. Thanks for bringing this up!<would go on and on about dull subjects > What are dull subjects?

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3 replies 31 reply 16 more comments6ReplyPhilip SugerNewJul 28ReactMaybe this can be addressed by asking about hobbies. If someone doesn't really have interests I would think that would beindicative of liver dullness. While if they do have hobbies and as you inquire about them they are focusing on minutia this may bePC excess. On top of that if such hobbies have any competitions you could ask if they participate in those revealing some GBaspects.1 teacher remark1 reply 1Gabriel SternGB vs LUNewJul 25ReactHi Kristin (or anyone else who wants to chime in)would you compare and contrast GB ex vs LU ex. chest morphology and breathing patterns for me. I've looked over my notes butthe descriptions i have are quite similar and I'm having trouble telling one from the other.Thanks,GabeReplyKristin Wisgirda  NewJul 26ReactThe size and shape of the chest wall relates to Lung/St. An inﬂated, barrel shaped chest is a Lung ﬁnding. A deﬂated, sunken chestwall is a Stomach ﬁnding.Overall chest wall morphology is not an expression of GB/P though local chest wall ﬁndings on the GB or P channel relate to GB/Pjust an any channel ﬁnding relates to itself and counterbalancer. Otherwise GB/P energies can express in posturing but this can beless clear cut. Does a collapsed posture have to do with excessive rooting, a lack of qi to hold the body up and hold qi or diﬃcultyholding yourself together? Is a chest projecting forward just a big physical ribcage or is it an expression of pushy Gb energy or is itlook at me Kidney swagger?Both GB excess and Lung excess can have shallow breathing. GB because the pushing out energy prevents air from coming in.Lung because the body is so eﬃcient at drawing resources in that it doesn't have to breath deeply and/or internal dampness istaking up space preventing deep breathing. While these dynamics help explain how these qualities contribute to SOB, GB andLung excess aren't the only qualities that contribute to SOB. Any of the 12 channels can contribute.You may remember the acute SOB case aggravate by a smokey environement from the advanced class. Toby supplementedLung+.P excess types might be deeper breathers because energy drawing in and down is strong.Kristin Wisgirda The Most Resourced Man in the WorldNewJul 20ReactThanks to Toby for sending this along.No need to waste anyone's time asking questions. Just treat.

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2 teacher remarks2 replies 2Naomi Frankone more for the list of weird H+ successesNewJul 201ReactI started writing this case up for input months ago and never had time to complete. Here's how I got there on my own.61 yr old female. She comes regularly for acu and it beneﬁts her pain and sleep.She also described heat that is better with movement, and this was something that my other treatments weren't touching. Itbuilds up durng the day and gets worse as soon as she sits down at end of the day. It aﬀects her at night too. The actual air orroom temperature doesn't seem to make much diﬀerence It was worse in the winter and better in hot weather because she cansweat and that brings moderate relief. Her skin is warm to the touch and P is rapid.Other obvious ﬁndings are lots of evidence of blood stasis (also hx of cancer). She is thin and strong. Pain points are Yin channelson knees (hurt after long walks) and trap pain esp at GB21. Her aﬀect is quite closed and it wasn't easy to get info. English issecond language which was also a factor and there are clear cultural inﬂuences that made it diﬃcult to determine GB/P dynamic.Anyway, I had tried SI+, SJ+, GB+ over the last 2-3 months interspersed with other styles of treatment. All had moderate results,with reduced heat for just a few hours. GB+ really helped her knees but no change in her traps...which I didn't understand.Last time I did H+, despite the hot weather and her rapid pulse, based on her (brief) answers about a sense of belonging tocommunity and her feeling better in hot weather. It was great and cleared the heat!Going forward I might try SP+ based on her physique and need to move (unless this has really reduced with H+ treatment, she diddescibe herself as lazy but the heat would keep her moving) and perhaps K+, as SI+ was the least eﬀective (no adverse results, butI'm not sure if she would report a cranky mood.)Any thoughts are welcome! ReplyKristin Wisgirda NewJul 20ReactThanks for the very curious case!Were there any other cold signs- aversion to cold drinks, cold tight midline, body pain worse with cold better with heat?What did she say about her sense of belonging to community?<Her aﬀect is quite closed and it wasn't easy to get info. English is second language which was also a factor and there are clear culturalinﬂuences that made it diﬃcult to determine GB/P dynamic.> Lots of my patients speak English as their second language. Whenlanguage skills aren't great or I am getting my information through a translator, the patients tend to have a less open aﬀect.Kristin Wisgirda Rectal/Vaginal Pain Patient continuedNewJul 19ReactSharon Sherman

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6 teacher remarks3 replies 38 more comments8Sharon Sherman and I want to let you in on the conversation that is spring up around her rectal/vaginal pain case. The rectal painis ﬁxed and stabbing and the vaginal pain is burning. So far UB+ once and SI+ twice haven't created any change in the chiefcomplaint. Sharon has been hesitant to use SJ+ even though there is Liver excess and the pain is on the liver trajectory.Sharon: <if we are trying to unlock the Chief complaint, how other than bringing illumination to the dullness, would SJ help therectal/vaginal burning pain?>Me: The location by itself is a strong indication to look at Liver/SJ. The liver channel goes to the genitals which are not so far away from the rectum. Duringyour presentation, SJ/Liver evaluation showed a clear gap. The ﬁxed nature of the pain gives more weight to Liver excess density. Liver excess is too muchblood that is dense and dull, that has no light in it. Sounds like a variety of blood stasis to me.Sharon: < This is a personal gem. "Liver excess is too much blood that is dense and dull, that has no light in it. Sounds like a variety of blood stasis to me."It takes the archetype of "dullness" and becomes a commentary on the correct physiology of blood.I think while the archetypes are a helpful starting place, to then reﬂect on dullness from a yin/yang perspective is super helpful. So I take your thinking to mean that it is a form of yin stasis. Blood is the yin ﬂuid but blood in its correct form is also imbued with qi that transforms it into a vital lifeforce.In this SAAM "crappy blood" presentation we bring light through san jiao to infuse the yin stasis with qi to transform and animate.What a beautiful idea!>Me: Going back to yin and yang is always helpful!Thanks to Sharon W for the explanation of yin/yang physiology of blood as an enriched ﬂuid that holds ﬁre and light. This understanding helps me so muchpracticing Saam. Whenever someone presents with blood pathology signs, I don't just think about K/SI but all of the other pathomechanisms that can createblood stasis and blood deﬁciency. The Saam concept of Liver density, darkness and dullness related to blood describes so much clinical reality.Technically, Sharon W's deﬁnition of crappy blood is a systemic presentation of blood stasis and xu.Your patient's chief complaint of ﬁxed stabbing pain is a localized blood block which is diﬀerent. We can look to the rest of the patient's presentation to tell uswhat methods of breaking up that localized block might be needed.Everyone: Please feel free to share your experiences with treating blood stasis beyond using SI+. ReplyPhilip SugerNewJul 20ReactI have a failure related to this which still haunts me even though it has been months. I had a patient who was the avatar of bloodstasis. Genetic issues on top of physical traumatic injury. He had horrible back pain that was persistent. I used +SI and he wassurprised about much he felt better and how he slept better. I decide to double down on +SI by using it on both sides. Resultswere not as dramatic, perhaps he was too deﬁcient to make that big of a push. Since I had used +SI twice I needed to change it up.I decided to use +LR because he had mentioned that he was ﬁne with several conversations going on but had diﬃculties sittingdown and writing thinking this related to excessive focus or overstimulation. That and I thought that liver would have an internalblood moving aspect to it as it does in a more TCM mindset. After the ﬁrst treatment he had his muscles seize up which he blamedon dehydration as it had happened before. The next treatment I thought the reaction was a ﬂuke and went with +LR again. Afterthat I had heard from his wife that again he had an episode where his muscles went in to spasm.So the lesson of the story is that no, +LR does not move blood in Saam, it consolidates and toniﬁes blood. Toby had mentioned tome that he sometimes uses +SJ for certain cases of menstrual pain. It would be good though to understand how +SI and +SJ diﬀerin their blood moving capabilities. ReplySharon ShermanNewJul 21ReactSo pain notched down 1 point after last SI tx. Then came back a day later. Today treated SJ+ (R) for female since she really can'tdistinguish either side being worse. Made sure my point location and needling were impeccable. SJ+, no change. Anyone have anyother ideas for burning pain in rectum and inside and outside of vagina? I have one more shot at this. Tx #1 - UB+ (R) Tx #2 - SI+ (L) Tx #3 - SI+ (R) Tx #4+ SJ+ (R)

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2 teacher remarks1 reply 11 reply 1Kristin Wisgirda Spiritual resources and Lung/StNewJul 191ReactAnother conversation from the case study group worth sharing.:This is regarding the patient with constant severe rectal vagina pain for 6 years. This pain has been recalcitrant to all conventionaltreatments.<Thinking about Lung+?She has mentioned lack of resources on a few occasions (she is a senior on a ﬁxed income). Might her heavily dispirited nature regarding her condition be seen as alack of resources? "Nothing Helps" Are resources beyond material? Are personal resources related to having hope, faith, optimism, loss of vitality?>A heavy dispirited nature and lack of optimism sound less like Stomach excess and more like Liver excess- no light or hope; maybe UB excess if it feels like acold disconnect.Loss of vitality could be Stomach excess but you would want to see other Stomach excess signs to support.Seeing all of these qualities as part of Stomach excess is a bit of a reach but at the same time it is possible that if you have more qi to work with, your outlookon life can improve.Typically, the more material the resource, the more weight for Lung. The less material the resource, the less clinical weight for Lung. Material resources caninclude people and the support they can provide.ReplyAdina KletzelNewJul 20React@Kristin Wisgirda @Sharon ShermanIn this case, where the lack of hope and feeling that nothing helps is coming from an outside experience - where she has tried allthe resources out there and none of those resources were able to help her. Does that have more weight to a material inﬂuence toher lack of hope?Some people have lack of hope from a heavy , depressive nature but it seems that her lack of hope is actually based on the factthat all of the outside resources that she tried to use did not yield results for her.Can we make that diﬀerentiation and give more weight to a St excess experience in this case?Sharon Sherman,Kristin WisgirdaReplyGabriel SternNewJul 20ReactIt may be apples and oranges, but i recently had a male patient with "levater ani (sic)" near crippling pain in the anus and pelvis,nothing had help over many years. he responded beautifully to SP+ then PER+, full resolution in 4 treatments. he was an obviousLI ex type. the GB stuﬀ was a bit more subtle. If it ﬁts maybe consider the other end of Tiayin with SP/LI dynamic.Kristin Wisgirda Dull reporting and repeating treatmentsNewJul 19ReactIn our current case study group, Sharon Sherman brings this really interesting inquiry. A patient with severe constant rectal and vaginal pain for the last 6years reports no change to her chief complaints after 2 treatments (UB+ and SI+). Sharon notes remarkable positive changes in her demeanor after thesecond visit. She is lighter and much more personable. Based on the these positive changes and despite no improvement in her chief complaint, Sharonchose to repeat the second treatment SI+.<If someone is dull and it *possibly* eﬀects their reporting how does that inﬂuence our decision making?> Unless the person is non verbal or child likedevelopmentally, they can give you enough of a gist that their symptom is improving signiﬁcantly or not. I trust the "no improvement" of even the dullestpatient who can make their own appointment. It gets a little more complicated interpreting when someone says a little improvement. I always make goodnotes at the ﬁrst visit of the better with/worse with factors so I can remind the patient of them in follow up visits.<While I have no way of experiencing her chief complaint ﬁndings, do my observations in a change in her aﬀect and demeanor get scrapped as an ineﬀective treatmententirely???>

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3 teacher remarks3 replies 32 replies 2The patient is coming to you to address their chief complaint. A positive change in demeanor is a positive ﬁnding and could certainly inﬂuence the eﬃcacy offuture treatments. But the absence of a change in the chief complaint is a message from the body that you have to look elsewhere to treat next. If the chiefcomplaint hasn't changed you haven't found the key to unlock that part of the puzzle. Toby recommends repeating treatments that create signiﬁcantimprovement in the chief complaint where that channel gap is still the grossest. This means that if the patient had a little improvement in the chief complaintalong with some improvements in other areas, it is still best practice to look for a gap in another channel pair.There might be some exceptions to this rule, say if a patient with long term sleep deprivation comes in with a chief complaint of fatigue. If the patient's fatigueis only a little better but your treatment has improved the sleep signiﬁcantly and initial channel gap that you treated is still gross, you could justify repeatingthe treatment because you know that the patient's energy level depends on consistent sleep.What do others think? Do you have any experiences where repeating an unsuccessful treatment at the next visit improved the chief complaint? Early onpracticing Saam, I made this mistake several times and it never worked.ReplyAdina KletzelNewJul 20 1React@Kristin WisgirdaI often ﬁnd that even repeating a treatment that worked often does not work on the second time. That is one of my biggestchallenges in practicing Sa'am - when something that worked so well the ﬁrst time does not work well the second and sometimeseven moves things back wards. I would really love some more guidance on how to predict when repeating a treatment thatworked is not going to bring good results.I don't usually ever repeat treatments twice in a row so I am referring to repeating treatment after having used other channels inbetween.Kristin Wisgirda ReplyNaomi FrankNewJul 20React<Toby recommends repeating treatments that create signiﬁcant improvement in the chief complaint where that channel gap is still thegrossest. This means that if the patient had a little improvement in the chief complaint along with some improvements in other areas, it isstill best practice to look for a gap in another channel pair.>This is a helpful reminder - I have deiniﬁtely made the mistake of repeating where it wasn't warranted. I've also had the experienceof patients seeming quite changed in their demeanour but not recognizing it and wondering how to assess that.To me the patients that love SAAM and come regularly also present some challenge becasue they are keen to repeat somethingthat gave them a profound shift and ﬁnding the next biggest gaps is much harder. This is especially so in my community clinicwhere I have 10-15 mins at most to chat with them - but if I use all of that time, then the next patient will have arrived by the time Iwant to go and check on them.1 teacher remarkMariaST+ with ST36 modiﬁcationNewJul 16ReactDo you mind explaining when this would be appropriate? I understand that modifying with ST36 is when there is more dampnesspresent, but does that mean more external dampness? It would be great if you could elaborate further. Thank you!Kristin Wisgirda  NewJul 16ReactFrom my notes: St36 can replace ST41 when

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Reply-the patient moves around lots and you are afraid of St41 being irritating. This must of happened somewhere in the history ofSaam, so it continues to be passed down.-if the appetite is poor- if you want to descend more. ST6 is more descending than St41-if there is more internal dampness.-when there is fatigue. Toby mentions this as an idea he imported from TCM but it makes sense that moving out excess damp willimprove energy.I think of +St36 as a hybrid LI/St treatment, helpful for when there is Lung and Spleen excesses. Hope this helps. ReplyPhilip SugerNewJul 18ReactIt is for when there is more internal dampness and not much dryness at the exterior.1 teacher remark1 reply 1Kristin Wisgirda August September Case Study GroupNewJul 6 | EditedReactDiscussing real life cases in a small group is a great opportunity to reﬁne your Saam skills.Myself and 2 other practitioners are coming together on the following dates.3 sessions of 2 hours each at 10am EST/7am PST:Friday August 12Friday September 9Thursday September 15The cost is $225. The Zoom calls will be recorded. Each participant will be required to present 2 cases.We just need 1 more practitioner to complete our group so please contact me ASAP to secure your place. If you can't make all 3dates, but can make 2 of the dates live to present 2 cases, you can still participate and will have access to all of the recordings.I love talking Saam in small groups so this will be fun! ReplyDaniel SchulmanNewJul 23ReactOK - I will jump in . . . where do I register? ReplyKristin Wisgirda NewJul 24ReactThis group is now ﬁlled.If you are interested in participating in a new group starting late September into October, please let me know. Also please let meknow if you have taken the advanced courses as I am hoping to form an advanced case study group.

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2 teacher remarks1 reply 1MariaWhat happened?NewJul 14 | EditedReactThere are 2 cases from today that I am wondering what happened and what to do.Case 1: Severe endometriosis and endometrioma cyst, LBP. With this case, I did LI+ because of location of LBP that was describedto be from S2-L5. Patient was not terribly settled and had increased pain in her RLQ in her SP/ST area while on the table. Shecouldn't quite pinpoint the location. I was in quandary not sure if I should reverse the treatment or not because she said her LBPfeels better. Her skin is normal - not dry/not oily. She does have a soft morphology though not overweight by any means. I alsofeel that she needs LU+ because of R sided congestion and fatigue but I have hesitated because of her soft morphology. Underthese circumstances, would you go ahead and reverse the treatment right away or wait and see?Case 2: R shoulder impingement and pain. This patient was doing great with SAAM and within 4 treatment regained alot of hismobility to almost back to normal. Then the last treatment I did was UB+ because he told me that he is always hungry in themiddle of the night and is always complaining of running warmer than others. I saw the hunger as heat so I decided to do UB+. Hesettled really well and fell asleep (the ﬁrst time since starting treatment). He felt great the day of the treatment with increasedmobility to shoulder. The next 2 days, he lost all gains and now has trouble lifting his arm again with pain. I took it as an adversereaction and use H+ to increase function. He settled really well and fell asleep again. To me it is interesting that he settled reallywell both times and that he actually felt great for 1 day post the ﬁrst treatment. What do you think happened? ReplyKristin Wisgirda NewJul 15ReactCase 1: If the net result of her treatment was some improvement in her lbp, then the treatment reaction was mixed and notadverse. If this is the case there is no need to counterbalance.Case 2: This sounds like a mixed reaction to UB+ since he settled well and the treatment created some temporary improvement. This is not a for sure sign of heat for me.Mixed reactions mean that you didn't diagnose the biggest gap between channel pairs. Time to reevaluate. ReplyMariaNewJul 16React This is not a for sure sign of heat for me. > What comes to your mind?<This sounds like a mixed reaction to UB+ since he settled well and the treatment created some temporary improvement.> I was takenaback by the complete regression. We were at 80% improvement and now it is back to square one.Kristin Wisgirda Elbow Pain anf Numbness: Adina's Case Study Hour CaseNewJul 14React33 year old maleChief ComplaintLeft sided elbow falls asleep at night, causes pain in the elbow 8+, disturbs sleepNumb on SI meridian on ﬁfth ﬁnger 5+ and on palm of hand P/lung meridians. 5+Hurts on TW 10 and goes to TW meridian on ﬁnger 7+Elbow pain ﬁve months ago and it started falling asleep one month ago

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Feel also tingling in hand 5+; Also feel tingling when work out and lift weights 5+Elbow started hurting when he moved apartments2 year old child had to move kindergartens and was hard for the childArm falling asleep started right before wife gave birth and was so scared she would have post partum depression again – like hadafter last baby 8+Second complaint: Worry, Overthinks things, Can’t shut oﬀ his mindFeels unfocused, No patience, No calm, discontent, Hard to let go All 8+Appearance and DemeanorSkinny, average height 4+Darker shade of skin 5+A bit slumped over 6+, Body posture portrays that he is tired and worn out 6+Seems worried and weighed down 7+Grounded feeling to his energy 6+Eyes bright 3+Symmetrical 6+Dressed casual but neat and clean 6+LifestyleMarried with two children under age of 3; Had a new baby 6 weeks ago3 year old having a hard time accepting babyWorks in High Tech at pressured job, likes but is pressured, does not like the competition 5+Average resourcesSkin Quality: Upper arms rough and dry with raised red/purply dots 7+Skin on face a bit oily 3+, Rest of skin normalBody TempMore hot 4+Roasting hot at night 10+; Sleeps with AC on even in the winterhands and feet are freezing cold in winterDoes not like the winter – dark, rain, coldLoves the light and sun 6+GIAs soon as get up in morning have to go to bathroom for BMAlso when feel pressured need to go to bathroom – BM 7+BM is loose, no form 6+; Have always been that wayBloating after some foods 6+ Can’t have milk+Stomach hurts when empty 5Gums bleed and get infectedThirst : Not very thirstyRespiratoryGets sinusitis a couple of times a year – feel it all around eyes 7+, St/GBThroat hurts on and oﬀ 6+

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1 teacher remarkSleep: Light Sleeper 7+; w/w feeling pressured 6+EmotionsWorried, stressed 7+; Feels has no time for self ; Mind never shuts oﬀ 9+Notices details in environment 7+; Needs to have everything in place 7+Body PainsNeck hurts 5+stuck neck- once a week for past couple of years 7+, bw movementLower back hurts for past 12 years 6+, comes and goesEnergy level: up and down, When good at a 6+; Likes to exercise 7+, Feels good when release energySweatAlways sweats in underarm, even when coldBodyyeast in big toe nails and second and third toes on right footits numb, can’t feel top of toe- started on trip to Australiaﬂesh not too dense or looseGTITRHis seeming weighed down by pressure and worrySaam ChartBlHt very hot at night 9+ raised red dots on upper arms 8+ ? mind always active, never settles 8+GB says has no patience 6+PC slow and deliberate movements 5+ rooted 4+ would like to be more assertive 5+ does not like competition at work 6+GB says has no patience 6+ can have quick angry outbursts 4+ tingling near PC 8 3+Kid symmetrical 6+ numbness on SI meridian on hand 7+ pain by Kid back shuSI gives a lot to wife and kids 8+ not much time to give to himself 8+ numbness on SI meridian on hand 7+ pain by Kid back shualways sweats in underarm 8+SJ notices details 8+ needs order 8+ bright eyes 3+ heat above, cold below 4+ pain on SJ mer.Liv Pain on Sj meridian loves the sunshine and summer 7+STLU loose stools and dry skin 5+ bloating after certain foods 5+LI skinny with dry skin 6+ ReplyKristin Wisgirda  NewJul 14ReactThanks again Adina for presenting this great case.Adina treated him twice so far:Treatment 1: Liv+ relieved his elbow pain and made him feel calm for 2 days. No change in numbnessTreatment 2: SI+ and LI+ He settled well. We are awaiting a report of further results.

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2 replies 2ReplyJoanne TaitNewJul 14ReactThanks again for a great case. I wanted to add something unrelated to SA'AM that I've been recommending for so many patientswith chronic neck issues is to use a cervical pillow for sleeping. I know it's made a big diﬀerence for me and many of my patients,in case this is stemming from the neck, which seems quite possible. Look forward to hearing more about this case.Kristin Wisgirda Call for Cases: Case Study Hour July 14thNewJul 6ReactLooking forward to talking Saam Thursday July 14 at 1pm EST.If you would like to present a case and can be there live, please send it to me beforehand at kwisgirda@gmail.comif you have subjects you would like to discuss, let me know those as well.Registration is required if you would like to attend live. Here is the link:https://whitepineinstitute.instructure.com/courses/255/calendar_events/1388The recording will be posted on our site within 24 hours of the call.1 teacher remark1 reply 1Philip SugerMaking your patient susceptible to covid via SaamNewJul 2ReactI think I may have made my patient more prone to covid. A sweet 70 year old woman who is fully vaccinated and boostered hashad covid 3 times. This most recent time, it occurred after I had did +ST twice. Which she responded to fairly well, but perhaps itwas too much of a push in one direction. She also isn't immunocompromised or anything like that. This most recent instance ofcovid was the worst of the three. The previous two were largely asymptomatic while this one was much more manifest. I wonder ifbalancing the LU through Saam may have made it worse.After she recovered she was in Europe for 3 weeks. Her case is really complex but when I saw her today her chronic fatigue hasreturned. Feels winded going up stairs. Sensation of dyspnea. Sweating profusely, feels hot. No insomnia, no irritability. Drymouth. Says her skin is dry but not really.I wanted to do +BL but given her fatigue and frailty I went with +LU. Her temperature normalized but the sensation in the chestremained.I might write up her case in the future as it is very interesting. ReplyPhilip SugerNewJul 4ReactContacted her today and +LU provided temporary beneﬁt but symptoms came back the next day. I guess it wasn't the primaryimbalance at hand. I think I will do +BL next time but worried about her chronic fatigue. In Sa'am though there is also an issue ofexcess and deﬁciency therefore we have to trust the system and follow the symptoms.

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2 teacher remarks1 more comment1Daniel SchulmanWhen Robust Matters . . .NewJun 30ReactHi Kristin (and anyone else who feels they can contribute here) . . . would you be so kind as to list here the speciﬁc clinical decisionareas in Sa'Am where attention to the patient's robustness must be front-and-centre considered as part of the decision . . . i.e.where patient robustness directly informs a choice to do or not do something . . . . Thanks!!ReplyMariaNewJun 30ReactI hate to write and admit this because it is never fun to admit to adverse reactions but I feel I must report this as a public service tomy fellow SAAMers.I had a real scare with my post covid patient, the one I posted previously with the tinea like rash. It was suggested to try ST+. I wasreally hesitant because she just had a chest tube thoracostomy about 4 weeks ago to drain the ﬂuid in her lungs. My initial instinctwas not to do SAAM. But she recovered really well from the procedure and was feeling great. Her RUQ was still congested. She stillfelt dry on the outside. Her pulses felt strong. I decided to go ahead with ST+ against my better judgement.I stayed and watched closely. 5 minutes upon insertion, she felt that something was going on with her heart, like it was workingreally hard. Her pulse dropped to 33bpm (her norm is 55-60bpm). She felt faint. I immediately reverse treatment with LU+ andgave her lots of water. It took awhile but her pulse came back up to 45-48bpm. That was really scary!So this is the case where the patient's robustness must be front and center because it could go terribly wrong. ReplyKristin Wisgirda NewJul 1React@Daniel SchulmanRobustness is required for draining techniques.Robust patients will tend to more easily "metabolize" an inappropriate treatment more rapidly than an average or frail patient.You want to avoid using bilateral treatments or repeating single sided treatments back to back in frail or deﬁcient patients.Though robust patients are better candidates than frail for double sided treatments, the strength of their system can do lots withsingle sided treatments. Toby mentioned that he couldn't used double sided treatments that addressed damp with one of hisrobust patients because the man had to urgently pee during the middle of treatment even though he urinated just before thetreatment- damp was moving out too quickly.Avoid using UB+ when a patient is coming down with something and that patient has a less than average constitution and is notHeart excess.Can anyone think of anything else?Daniel SchulmanKristin Wisgirda OverturnedNewJun 29ReactA fertility patient came in for thaw cycle prep today. She is a well resourced surgeon, Stomach excess morphology 9+, dense ﬂesh5+, polite but not overly so. Today she complained about being obsessed with the Roe v Wade overturn. She wakes every day

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5 teacher remarks1 reply 11 reply 16 more comments6thinking about it with a pit in her stomach. She seemed happy to spend the whole treatment talking about this subject if allowed.Instead I treated her with SJ+ and she immediately sunk into the table.While treating her 3 years ago as she was trying to conceive her son, she was my poster woman for bright dark eyes. Her ﬂesh waslight and open. She received many Liver+ treatments and had an easy pregnancy. Postpartum Liver+ was treated once, as well asK+, Lung+. Then I didn't see her for 2 years.This is the second time in 2 months that I have treated SJ+. The ﬁrst time she was obsessing over the timing of her ivf cycle withher work schedule. Her eyes were magnetized to my calendar.This patient has now joined all of my other patients who are surgeons in presenting as Liver excess.I am not sure exactly what brought about the big change from SJ excess to Liver excess during the 2 years I didn't see her. Wecould speculate about being a mother in a challenging world. When she was ﬁrst treated she only beneﬁted from Liver+treatments. ReplyDaniel SchulmanNewJun 29ReactJust a thought, but I have found the entire COVID Zeitgeist (along with other 'issues' like racism/antiracism, Israel/Palestine, Trump,Gender Identity and now Abortion . . . the escalating/intensifying of polarisation in general is bringing out a lot of extremepsychology in people . . . and certainly one of them can be Liver Excess . . . . ReplyPhilip SugerNewJun 29 | EditedReactI am having some diﬃculty in fully understanding this case. I understand how the continuous talking about roe v wade indicatesthis lack of awareness of everything beyond this issue and that it isn't entirely socially appropriate while she is in on the table. Yetthis news is coming from the outside and sounds like it doesn't even aﬀect her in a direct sense as she is trying to get pregnant,not get an abortion. You would think that she would possibly need shielding from all the crazy things going on.Is this obsession an aspect of how it aﬀects her? As a woman, as being pro-choice, etc. You would think being a doctor you have tofocus greatly on your patients and as a mother you have to greatly focus on your children.Obviously you treatment result begs to diﬀer, so there must be something else going on.Perhaps +SJ could be a positive treatment for addicts who are obsessed with whatever it may be.

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2 teacher remarks1 reply 1MariaOsteogenesis Imperfecta (brittle bones)NewJun 28ReactNP: 46 y.o. female, teacher, 2 kids 15,12cc: LBP due to cracked vertebrae (transverse process of L5 on the left) - 8/10 pain every otherHx: Broke femur at 8 y.o. Dx'd with Osteogenesis Imperfecta. Mother, brother and son has same issue. Rods in both tibias, femurs,and hips. Harrington Rods in the spine and an almost 100% spinal fusion. Appendectomy 2 yrs ago, salpingectomy, and two C-SectionsK: attractive 6, ﬁrm heels 6, vv 2SI: one leg shorter (asymmetrical)H:UB:LV: hyper vigilant (due to husband's bipolar issues) , detail oriented, bright eyes 7SJ:GB: reactive emotionally 7P:LI: like to keep busySP: brittle bones 10, side job making cookies/cakes, recent root canal, skin not dry 5, big belly 4ST: skin not dry 5LU: big belly 4, big chest 4Considerations: LI+, SI+ LV+, P+Treatments thus far: LI+Question: I would like to consider SI+ due to all the surgeries. With her brittle bones, I am nervous that too much breaking apartmay be problematic. What are your thoughts? ReplyKristin Wisgirda NewJun 28 | EditedReactWhile brittle bones can be from SI excess, they can also be from Spleen and SJ excess which she has clear signs of. If the shortnessof one leg is from fracture, then this asymmetry has less weight for SI excess. The brittle bones aside, she looks more Kidneyexcess. So I wouldn't have a problem using SI+ at this point. K+ would deﬁnitely still be on the table for her treatment plan in thelong term.Please let us know how it goes.

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1 reply 1 ReplyMariaNewJun 30React@Kristin WisgirdaJust wanted to upload some photos of her heels and legs, just so I could get your take on them. When there is both SI or K excessand they seem equally weighted, which one do you usually do ﬁrst?Kristin WisgirdaJPEG | 1.7 M20220630_083850JPEG | 1.7 M20220630_0839102 teacher remarksKristin Wisgirda All over the place!NewJun 28ReactLast night a tax accountant presented with chronic cervical, thoracic and right upper extremity pain-many channels involved. Hispain had been well managed, even through tax season, with periodic treatments including SI+, LI+, H+, ST. Pain is worse with coldand damp. His morphology is Lung excess veering toward Spleen excess.His pain is recently aggravated. He is moving into bigger oﬃce space and is expanding his services by hiring more employees. Lastnight, I could feel a buzz in his system that was new. The stress of the move was obviously a big factor so I wanted to get a betterfeel for his experience of his current circumstances. Generally, he is cool calm and collected but not enough to clearly point to Pexcess. I asked him about decision making and he said he was slower than usual making decisions. His tone prevented me fromgiving this answer weight toward P excess. As we continued to talk about what was going on, he spontaneously said "I am all overthe place!" and I could so easily imagine him jumping from one task to another. I also asked him about irritability- he said he wasworking hard to keep it from breaking the surface.I had explored other channel pairs including SJ/Liver but his exclamation was really the grossest thing in the room. P+ gave himinstant relief on the table and he was much better by the end of the treatment.This interaction made me aware of which qualities of patient speech have more clinical weight. Spontaneous exclamations havemore weight than attempts to answer my questions. The former feel more alive than the later. While responses to my questionshave less clinical weight in general, those that feel more alive and more true to their experience have more weight. It is good tohave your sensors out for answers that come from a place of conditioning.This all might be obvious but it helps me to articulate my process.Joanne TaitNewJun 28React

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4 more comments 4ReplyThanks, Kristin. This is such a subtle but super helpful thing to keep in mind. I appreciate you sharing that with us. It's such a goodreminder that our patients aren't always being completely honest/or providing what we need, and to notice those cues when theycome up.ReplyDaniel SchulmanNewJun 28ReactExcellent! I so concur with you Kristin. I just love those moments the patient spontaneously blurts out something so pure, sorevealing, so not rehearsed or conditioned . . . its such a gift, an instant view into the depths of what is going on. To add to it, Ioften ﬁnd for patients who have intimate partners, such moments can ﬂash in some version of 'what my partner always says' . . . .I recently had a patient blurt out . . . 'my husband always says if we could have a house with no windows or lights, I'd be in heaven'.Bingo!2 teacher remarksPhilip SugerGrappling with Sa'amNewJun 27 | EditedReactThis post was administratively edited at 06/27/2022 7:28 PMThere are some core concepts within saam that I still ﬁnd myself grappling with. I was wondering if anyone has a good heuristic indealing with these.1. When should one move to another channel when they have gotten results? You supplement a channel and get good resultswhether it be signiﬁcant or mild. Now you have the choice of supplementing it again one more time consecutively or changing toanother channel. How do you make that decision? For example a person comes in with back pain 7/10 and by next treatment it is3/10. Do you just go for the same channel again to clear up the residual pain when it remains their CC and there isn't anything elsetoo signiﬁcant?2. More of an aside but if a patient is having right sided issues can you consider this both as a LU/ST issue or just LU. Same withthe left side is it just LR related or both LR/SJ?Kristin Wisgirda  NewJun 27ReactThanks for your questions.1. Toby has given us guidelines on when to repeat versus when to try something else.Avoid repeating a treatment with weaker patients. Even if they responded wonderfully to a treatment, they often cannot handlebeing pushed in the same direction twice by supplementing the same channel in back to back sessions. They need other parts ofthe circle supplemented before repeated the initial treatment.When someone returns reporting great symptom relief, it is important to evaluate if they still have the initial channel excess thatyou treated at the last visit. If UB+ helps lots with back pain but the patient no longer has a full ﬂushed face and is now muchcooler, then I would look for an imbalance between channels other than Ub and Heart. The persistence of a strong channel excesseven if the chief complaint is much better suggests that the patient will beneﬁt from a repeat.If symptom improvement is mild, then you most often need to look elsewhere.We have to be mindful of the strong human bias to repeat what has worked. Best practice is to do a thorough reevaluation at eachtreatment keeping in mind all 6 channel pairs.In my practice, I often don't repeat the same treatment. Most symptoms have multiple contributing factors.2. Having a right sided only issue gives some weight to Lung and Stomach. Having a left sided only issue gives some weight to Liverand San Jiao.Having multiple unilateral only issues or ﬁndings gives much more weight to Lung/St or Liver/SJ, depending on the side.

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2 replies 2Reply4 teacher remarksPhilip SugerWhat are the emotions of +SI and +BLJun 19ReactWhat are the positive psycho-emotional aspects that are fostered when supplementing SI and BL? We often discuss the outwardand self love involved in the second circuit related to the HT and KI respectively. Yet, those of the SI and BL aren't mentioned asmuch. Though when dealing with ego centrism and narcissism we do often bring up KI excess but without giving a speciﬁc termthat describes what is occurring during the emotional balancing process of using +SI. When it comes to the HT/BL dynamic thefear involved with BL excess is common knowledge but not so much the positive aspect of this fear.So I was trying to think of the best description for these concepts so as to better understand this system. The psycho-emotionalaspect with +SI seems relatively straightforward and would likely best be described as humility which is counterbalanced by theself-love of KI. I am less certain of what would be the best descriptor for +BL, though if I had to choose one I think wariness mightﬁt, counterbalanced by the outward love of +HT. The suspicion and mistrust of others that is necessary to a certain degree butwhen in excess becomes fear.What do you all think of this rationalization? ReplyKristin Wisgirda NewJun 19ReactFor me, Water and Shaoyin Fire on a psychoemotional level are about relationship of self to other.Humility is a great way to describe a virtue of SI on this level. Since SI is all about dynamic movement, I also see it as counteractingthe ﬁxed sense of self that K provides.The trigram associated with Shaoyin is Li. While Li is often translated as Fire it also can mean clinging. As Kidney clings to self,Heart clings to others.We have seen many cases studies where UB+ helped balance out too much hot love wrecking havoc on physiology. I wouldn't saythat it did so by bringing fear or wariness, though wariness can be a ﬂavor of what UB brings in certain cases. The way I describethe function of UB in this realm is conserving of a separate self. UB's cold separates self from others in a self preserving, not selfglorifying way. Fear and wariness fall under this umbrella.Ub is the capacity to go your own way and not be tied to others. The hot expansiveness of Heart is yang that will be dissipated ifnot controlled by the cold of UB. That uncontrolled heat can make the qi chaotic. Thrill seeking teens on a reckless joy ride needsome fear to sober them up into safer behavior.What do you think?Philip Suger NewJun 19 | EditedReactThat's a good point. I like that idea that +UB is conserving a separate self (diﬀerent from egotism) but I don't think that is the exactopposite of the HT. How about this instead: +UB counterbalances the outward compassion and love of the heart with therestrained indiﬀerence of cold water.

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3 replies 34 more comments 4ReplyBy hot love do you mean the erotic and all encompassing love at the beginning of a romantic relationship or is this more so theunbounded compassion for others?2 teacher remarks1 reply 1Mariapregnancy mask, liver marksNewJun 18ReactJust wondering how we would look at darkening of the skin such as pregnancy mask, liver marks, etc. through the lens of SAAM orTCM. Any success in treating these?ReplyKristin Wisgirda  NewJun 18ReactI have never treated chloasma or liver marks. I don't have anything in my Saam notes about brown skin marks.My Saam notes say for dark skin consider cold including Liver excess, blood stasis.It is yet another symptom where I would diagnose the bigger picture and then let it explain why the patient has these skinchanges. Deﬁnitely consider the channels they appear on.My notes from Mazin say that with chloasma he looks for qi stagnation, maybe blood xu, maybe Kidney xu. Not really that helpfuland not Saam so take with a big grain of salt.ReplyKristin Wisgirda  NewJun 24React@MariaI hope this helps:I asked Toby: Does brown skin discoloration- such as liver spots or chloasma- have any diagnostic signiﬁcance for a particularchannel besides the channel location of the spot? Blood stasis or just some qi and blood disharmony?He replied:Yes, mild correlation with blood stasis but stronger correlation to a channel if it follows its trajectory closely.MariaMelissa RathboneNot sure where to start! Case study - Anxiety and DepressionNewJun 17React44 year old womanCC: Anxiety and depression. Currently processing a lot of early childhood traumas in therapy (describes being an only child of"narcicisstic demanding, obsessive" mother, current relationship with mom- "relentless") and is feeling a lot of physical andemotional symptoms. Describes depression as dark, can feel scary and overwhelming, occasionally has some suicidal ideation.Running / exercise helps depression. felt best in her life when she was breastfeeding her son.Wakes with anxiety, doing a self -hypnosis app while lying down in her yard helps to calm her.

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Is aware that she presents as "very together, calm and friendly" but "on the inside she is frazzled and very anxious". Troublefocusing on one thing at a time, say she is "missing small details" in her work.Second CC: Dizziness. Had a seizure in 2020- was hospitalized for a week. Did lots of tests and seizure was attributed to extremestress. Did vestibular therapy, now has to be careful how she turns her head, how quickly she gets up from lying down. Noticesthat her hands have a tremorHas had episodes of "ataxia" - started in her 20's, episodes can last from 3 hours to 3 days. Can't feel her legs, loses sense of herbody in space, has to drag her feet to walk and has to use one arm to hold up the other. Extreme weakness in combo with areas ofnumbness. Rests in bed until episode passes.Appearance and Demeanor: Very polite - texted to apologize for possibly arriving late when her app said her eta was 4:57 and herappt was at 5:00. No make-up but neat and put together. Brought loose pants to wear at ﬁrst appt without me asking.Lifestyle: Graphic designer - currently working 2 jobs, money is tight. Mother of 1 child (7 yrs). Very busy but doesn't like having somuch going on at once. Says she directs a lot of anger inward at herself as opposed to out at the people involved. Says she "justwants to have space for herself"Body morphology / ﬂesh: Thin, narrow rib cage. Open muscles. Softness at calves - fog?Skin quality: uses moisturizer daily, eyes always dry - uses eye drops in am and pm. Some thinning of hair at mid forehead hairline.Appetite/digestion: No appetite. Describes feeling like her stomach is a "locked door" while pointing at her upper abdomen. Has tovape marijuana to activate her appetite. Vegan diet for past 4 years. Has regular bowel movements, no issues with constipation ordiarrhea.Body temp: runs cold, hands cold to my touch, feet normal temp.Sleep: Has to vape marijuana to fall asleep, has nightmares, gets up 2x a night to peeUrination: frequent. Has kidney stones.Thirst: always thirsty, prefers cool waterMenses: regular cycle until past 2 months, current cycle 30 days. Flow heavy on day 2, last 5 days.Has an ovarian cyst that gets quite painful week before period. Often gets a cold before her period starts. Low sex drive.No notable varicosities. Ribside tight on both sides. Heels reasonably full.Excess presentations:Ht - felt better when breastfeeding (?)UB- runs cold, fear re: her depressionGB - insomnia, "feels frazzled internally"- which she described by shaking her hands back and forth, hx of seizure?PC-St- no appetite +8 - trouble taking things in, money issuesLU- dry skinSp- fog, weakness of limbs /numbness+4Lint- dry eyes, thirst+5Sint- hx of suicidal ideation +5, "windy symptoms" - dizzy/tremors +6, low sex drive,Kid- kid stones, ovarian cystSJ- open ﬂesh, hard on herself +6, aware of details, very polite +6, eyes bright +3

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3 teacher remarksLiv- body temp cool +6, cold hands, dark depression +6GTITR: She's struggling emotionally and I want to help her with that but couldn't ﬁgure out where to start w/ Sa'am so I did non-Sa'am acupuncture. I have only seen her once.-She has signs of SINT excess but I hesitated to supplement Kid because of the ovarian cyst and kidney stones. Don't want to overconsolidate.-She also has a lot of SJ excess signs but also runs cool and I just didn't feel like I should add cool darkness to her.I'm thinking of starting maybe with a supplement LU (for her St excess) or maybe supplement Heart (for the cool temps and fear).Does supplementing heart help someone direct love towards themselves? With her thirst and dry eyes, would that be too drying?Was also thinking about supplementing PC.I'm open for all input!!Thanks!Kristin Wisgirda  NewJun 17ReactThanks for the case.With a complicated case it is great that you are holding oﬀ with Saam until you feel you know her better.It is not hard to get overwhelmed by a patient's suﬀering. Looking for the GTITR we really want to step back and see what Saamqualities really stand out to you. It helps me to identify the GTITR for the patient overall and the GTITR for the patient's chiefcomplaint.Besides frazzled with trouble focusing, can she identify any other felt experience with the anxiety? Is the bottom dropping out withfear? Does she feel erratic and out of control? Is there vibration or pain in any parts of her body? Watching body language whilepeople talk about their anxiety can provide clues. If a patient is having a hard time describing their felt experience, I will drawattention to their gestures- eg "I notice you putting your hand on your chest- what does it feel like in there?" or "it looks like youare holding your breath". I might ask what they feel in their torso/belly.How much of her frazzled feeling matches the erratic, quick to act, rapidly changing, short fused GB energy? Or is it anotherspecies of hyperactive qi?I see lots of energy moving outward- her politeness, consideration, the busyness.<She also has a lot of SJ excess signs but also runs cool and I just didn't feel like I should add cool darkness to her.> How cold is she? Andhow much of that cold comes from being so open? What is her complexion like- palor, darkness, any redness or easy ﬂushing?How bright are her eyes? Is the depression constant or does it come and go? How much of the depression comes fromoverwhelm? What about running/exercise makes her depression better? Is it the movement, the time for herself, the breathing???What is her relationship to light and darkness?<"windy symptoms" - dizzy/tremors +6, > These go under K excess as do reasonably full medial heels. I would frame the ovarian cystas premenstrual abdominal pain. If she doesn't currently have symptoms from Kidney stones we don't have symptoms to giveweight to.How does she interact with her mother? Does she feel family obligation to stay engaged and/or is there a clinging attachment toher mom that won't allow her to step back to have "space for herself"? A UB excess person would just coldly not engage with hermom.With her being thin with dry skin- her morphology is LI excess. How much fog does she have? Weakness of the 4 limbs meansSpleen is involved-we don't know LI or Sp excess. The numbness is a damp sign so we have to separate it from the weakness. LIexcess will also have low appetite. Sp+ and ST+ are both the primary consideration for low appetite.

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3 more comments3Reply<Does supplementing heart help someone direct love towards themselves?> Kidney+ is technically the treatment for supplementingself love but if someone is really cold and loveless, I feel that the love of humanity that H+ supplements can spill over to love ofone's own humanity, if not love for self.<With her thirst and dry eyes, would that be too drying?> She does sound dry overall so that is a consideration.Let us know what you ﬁnd and what happens.Thanks!ReplyMelissa RathboneNewJun 17ReactThanks Kristen!Let's see what I can ﬁll in...when she said she feels frazzled on the inside, she was waving her hands back and forth. I asked if she felt like her emotionsshifted quickly or felt "stormy" and she didn't have an emphatic yes or no. I don't see her as particularly GB excess, she didn'tseem to have any outward anger, frustration, nothing particularly convex in her symptoms and def not going through life"swinging a sword".In terms of the cold - it didn't seem to me like it was from being too open (she wasn't sensitive to drafts, isn't always adjusting thethermostat). She has some darkness under her eyes, no signs of ﬂushing or ruddiness. She is a bit sensitive to lights, maybe a 3+(said she's always the one to turn oﬀ an extra light but wasn't super emphatic about it). I'll ask further about what feels goodabout the running.The depression comes and goes - it's been coming up more recently as she's working on early childhood traumas, she said theEMDR treatments require going back to the incidents and that's diﬃcult.She's deﬁnitely engaged with her mom - has thought about moving away to get some distance (they both live in Brooklyn) but hermom calls her often through the day. She describes her mom as mentally ill, she's clearly trying to establish boundaries but is defnot coldly disengaged.She's def not cold and loveless - feels very close to her son and husband. she also mentioned that she is working on asking forwhat she needs in her relationship with her husband.Ok I still have some info to gather! Would you lean towards any particular treatment given what I've said so far?Philip SugerTrouble with a mixed presentationNewJun 16ReactFemale: 25CC: AcneI had treated this woman for long standing HAs that have now resolved. I had used another style of acupuncture but want toincorporate more Sa'am in my clinic so I switched to this style of treatment. Frequently has acne pop up on her face especially

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5 teacher remarksaround her period. Tend to be red, painful and under the skin sometimes pus ﬁlled. Recently began to appear on her back aroundthe bra strap on the BL channel.LU: Thin, not dry skinST: Large supportive familyLI: Schedules time for relaxation, likes to relax, large tongue and toothmarksSP: Body is thin, abdominus rectus muscles are tightHT: Often feels cold, wears a sweater in work when other people use fans, diﬃculty making friendsBL: Loves her family and dog, acne location, color, does not sweat easily, warm midlineSI: Symmetrical, youngKI: Late menarche 16, not sure if she wants children, low libido when in a relationship, angry at herself for being single, does notoften wear make upPC: Previously had Shao Yang HAGB: Calm demeanorSJ: Somewhat dense attitudeLR: Bothered by bright lights, some anxiety lurking underneath her surfaceSo today I did +BL given the location and color of her acne and also the lack of sweating though was hesitant due to her subjectivefeeling of cold. She did not have a negative reaction on the table and felt rested. In the future I want to do +KI but felt like it wasn'treally tied in as much with her CC.How does sweating play into saam? What does easily sweating and diﬃculty sweating associate with? Not sure if that lack ofsweating is best associated with +BL as adding cold/water could be seen as counterintuitive, but Toby did mention for examplethat at the beginning of an EPI +BL can be helpful suggesting there is more to +BL than just cold/water.After writing things out it seems like I should have gone with +KI but we will see how she reacts, seeing her in two weeks.Kristin Wisgirda  NewJun 16ReactThanks for the case.

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6 replies 61 reply 12 more comments2ReplyIn Saam, the presentation of the acne guides our diagnosis-pus=dampness, red=heat, purple=blood stasis, etc- but we pay specialattention to signs of dampness on the surface as dampness is often a major contributor. We also pay attention to the color andquality of the skin around it.Is her acne nodular (.5cm+) or more papular (.5cm or smaller)? If it is larger and painful and tending toward pus ﬁlled, it soundslike cystic acne. If so, then this is a sign of internal dampness.The convention in this group is to list signs and symptoms under the channel qualities that they point to, rather than thetreatment, but your system is clear. Grading signs and symptoms on a scale of 1-10 helps us see your patient better and mighthelp you evaluate the balance between channel pairs better too. In her case it would be good to know how symmetrical she is sowe can know how to weigh that compared to the signs of you listed under SI+. That the acne occurs premenstrually gives a littleweigh to Kidney excess blood stasis.It helps to know that Toby strongly avoids using K+ early on in treatment unless there is gross SI excess pathology. He explainsthat he doesn't like to consolidate pathology. I agree that SI excess isnt tied to her chief complaint. Sincethe gap between SI and K isn't clearly big, and the chief complaint is worse during the build up time of her menstrual cycle, I wouldavoid using K+ right now.<PC: Previously had Shao Yang HA> Symptoms that are resolved and aren't recurrent have little to no clinical weight in my practice.If she was having headaches on the shaoyang channels, then they would give weight to Liv/SJ/P/Gb because channel involvementpoints to both the channel and its counterbalancer.<BL: Loves her family> With Heart excess love for those outside of our family has more weight than love for those in our family line.Love for my people by itself is a pointer to Kidney excess. Love for her dog is a Heart quality since her dog is not part of her bloodline.<LI: Schedules time for relaxation, likes to relax, large tongue and toothmarks> We seldom give clinical weight to tongue ﬁndings inthis system.<What does easily sweating and diﬃculty sweating associate with?> On one level, lack of sweat is surface dryness and easy sweat issurface dampness but I like to look for possible explanations why there is easy or no sweat. Are they sweating because there is somuch heat pushing the sweat out or is the sweat leaking out because they are so unconsolidated or qi xu? Is there no sweatbecause heat has dried the ﬂuids up or cold has frozen the ﬂuids?<Toby did mention for example that at the beginning of an EPI +BL can be helpful suggesting there is more to +BL than just cold/water.>Using UB+ for an early stage EPI is a special circumstance, that has less to do with sweating/not sweating and more with thefeeling of coming down with something- in my opinion. While UB+ does add cold water, it also ﬁlls up the Ub channel andsupplements the function and improves circulation in the Tai Yang layer. There are some discussions of using UB+ in early stageEPI in this forum and the qiological forum.Let me know what you think.ReplyFang CaiNewJun 211ReactI second @Kristin Wisgirda's take on diﬀerentiating the acne by how the lesions look.A lesion on the skin with pus doesn't automatically mean external dampness, if the lesion is deep and, for example, takes a longtime to come to the surface. If the pus is hard to squeeze out, it's more internal damp. typically those lesions are also larger. Thesecases often don't have greasy skin, and in fact tend to have dry skin - check the rest of the body, not just the face.Vs. smaller lesions that come and go quickly, with pus that practically sits at the tippy top and comes out/oﬀ with light pressure -that's more external damp. Often these people have overall greasy skin.Kristin Wisgirda

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2 teacher remarks2 replies 2MariaHeel questionNewJun 14ReactThis is a young symmetrical man 30 y.o. with shoulder pain and leg pain complaints.I am curious how you would analyze this guy's heels. It seems like the heels are slightly deﬂated and slightly dry. Would you stillconsider SI+? What would be your thinking process?JPEG | 1.7 M20220614_163608 ReplyKristin Wisgirda  NewJun 15ReactThose are pretty withered heels, especially his left, especially for a 30 year old. The picture doesn't convey dryness to me but itmight be diﬀerent in real life. Looks like some very slight varicosities.His K3s look empty. K3 is not part of the medial heel reﬂex zone but it is part of the Kidney channel. When I see K3s that are thisempty I am cautious with SI+.Just from the heels and the K3s, he looks more SI excess. But you said he is symmetrical, so you have to ﬁgure out if there is a gapbetween K/SI.MariaStrategy help please!NewJun 14 | EditedReact79 y.o. womancc: Neck pain; sciatic pain; exhaustion/tiredness; back pain (from neck to hips); arthritis pain pretty much all over body; shortnessof breath from COPD. Numbness and neuropathy - hands, wrists, arms, neck, back, feet/toes, legs - head to toe pretty much.Unsteady on feet so doing PT for strength.Hx: Skin cancer; partial spinal fusion; carpel tunnel and synovectomy; both hips and both knees replaced; dislocated left shoulder.Aborted migraines and headaches from neck pain; dizziness and vertigo at times; dizziness with low BP as well as post Covid.UB:Hx: Soft midline, pulse: 95bpm, talks alot, feels warm all the timeLV: neck painSJ: bright eyes, alert, attentive to detail 7, tissue - lack density 7, neck pain

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2 teacher remarks2 replies 2LI: dry skin 7, dry jerky leg and arm muscles 7, severely dehydratedSP: numbness, big midsectionLU: Dry skin 7, big chest cavity 7, internal dampness: big abdomen 6, numbnessST: weak thenar 3, internal dryness: dry leg and arm muscles 7K: old age, dry heels 4, vertigo, dark bruising/stagnation, varicose 2, joint painSI: many surgeries, joint pain, not much varicose 2GB: moods erratic 7, SOB, strong voice, hip and upper trap painP: more calm as she ages, hip and upper trap painTreatments: LV+, SP+, SI+, UB+, LV+, K+, P+Response: Neck pain gone, muscles not as dry, overall improvementQuestion: 1.) Not sure how to tackle numbness given her internal dryness and dampness. This patient obviously has dampnessbut she was also extremely dry. I've attached some pictures of her skin and thenar. 2.) With weak thenars like that, I am nervous todo ST+. What would be the best strategy? 3.) When I did UB+, her leg started to get restless the ﬁrst time. I kept the treatment andshe did alright, it seems. The 2nd time I tried to do UB+ as her pulse was 95bpm and was complaining of heat, I noticed that whenI touched her arms, she had tremors and internal shaking after the needles were put in. This time I pulled and went with P+ andshe fell asleep. I can't ﬁgure out why UB+ would cause the tremors.JPEG | 1.6 Mthenar20220614_152434JPEG | 1.8 Mheel20220614_152508JPEG | 1.5 Mupper arm20220614_152446 ReplyKristin Wisgirda NewJun 15ReactThis lady obviously needs lots of help. So glad that you have already given her signiﬁcant relief.It sounds like her morphology is clearly Lung excess. The strong voice is a signiﬁcant Lung excess sign for me too. The thenars arepancake ﬂat- I would ask if she has had thumb or wrist injuries- but even if she hasn't her picture is more Lung excess to me.How does the neuropathy present besides numbness- tingling, temperature sensations/aversions, etc? Most of her body has a afrank lack of sensation? How deep is that numbness- skin level or does it extend into the tissues? With signiﬁcant numbness, thereis room to consider LI+. With her Lung excess picture I would consider using ST+.I'm not sure why she had that reaction to UB+. Either her heat/hyperactive talking is coming from somewhere besides Heartexcess or some other piece of the puzzle needs to be addressed before she can receive UB cold water.

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Shannon Larson Jun 14 This post was administratively deleted at 06/14/2022 3:22 PM2 teacher remarksAdina KletzelFrom SI excess to Kid Excess?NewJun 13ReactHI.I am treating a 53 year old woman who was an extreme SI excess as a child/young adult. She was sexually abused as a child andher father and older brother criticized her and put her down constantly to the point that she had zero self-conﬁdence and felt thatshe had no place on this world and that she was the most despicable person ever to have lived. She could not look anyone in theeyes and could not connect to anyone.Over years of therapy and work on herself she now has self-conﬁdence and feels that she has a place on this world and she cansee how she learned and grew from all of her suﬀering as a child.She can even come oﬀ as pushy and overly conﬁdent - giving the message that I know what is good for me and I am very good athelping many people (she is a therapist...).She does not come oﬀ as weak but underneath all of that I still see pain and damage and struggle. She cries easily and seems tobe begging for help underneath her strength and pushiness.I did a SI+ treatment a while back and it helped opened up her stuck lower abdomen and tight shoulders and she got her periodagain for the ﬁrst time in 6 months.The next time I did SI+ (cuz she really liked it the ﬁrst time) she did not have a good week - felt weaker and tired and someshoulder and throat pains came back.When I pressed to see if it was a full blown adverse reaction and asked if she felt scattered and un- centered she immediately saidno - she will never admit to be unbalanced emotionally. I did not counter with Kid+.This past week she came in saying she was so tired and weak because her mother is sick and she is very busy taking care of herand it is tiring her and weakening her.When I asked if she feels that she needs to be ﬁlled up because she is giving so much she said no - that she knows how to ﬁllherself up and takes time to give to herself...She does have issues with taking from others - because of her trauma as a child - she came to the conclusion that she needs totake care of herself and no one has anything to oﬀer her.The question is - even though the patient is resisting a treatment that will ﬁll her up and even though she puts up a very strongfront - is there room to tonify Kid?She comes from such a strong Kid deﬁcient back-ground and even though she turned that around it feels like she could use someKid+ but she is resistant to the idea that she needs that kind of help from the outside...I am sure that she does make time to give to herself and she has learned to ask for help from her husband and children but shealso seems like she had a kidney deﬁcient place deep inside that needs nourishing.However, she is saying that she doesn't....What do you think?Kristin Wisgirda  NewJun 13ReactHi Adina,Thanks for the case.

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2 replies 2ReplySometimes you need to step back from the history and the story and look at what is before you. I would give more weight to howyou perceive her now and how she reacted to the last SI+ treatment. If it was clearly an adverse reaction with no beneﬁt, you canconsider counterbalancing. If it is all too confusing, look for the biggest gap elsewhere.1 teacher remarkPhilip SugerA Blast From the PastNewJun 12 2ReactI have been looking at the historical texts related to Sa'am acupuncture and found some interesting information. Shortly after thetransmission of the Sa'am style there was a case study book compiled by a person supposedly named Zhi Shan (Chinesetranslation) called Zhi Shan Yi An or The Medical Records of Zhi Shan. He was the ﬁrst person to refer to thesupplementing point prescriptions as Zheng Ge or upright form and the draining point prescriptions as Sheng Ge orprevailing form. He had an interesting description of these point prescriptions that I wanted to share with you all. Below is a roughtranslation.The upright form is like the governance of a good king, the prevailing form is like the use of force by a skilled generalHopefully this analogy will provide insight into your clinical work.ReplyKristin Wisgirda NewJun 12ReactThanks Philip!A good king wants harmony and abundance in his land. Supplementing the correct channel will create that.Draining is only to be used when the usual methods aren't enough to close the gap between channel pairs. War is an exceptionalcircumstance and a skilled general will only use force when necessary.ReplyDaniel SchulmanNewJun 14ReactNice!

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1 teacher remark1 reply 12 more comments2Gabriel SternAnyone in portland ME?NewJun 9Reactold friend now living in Portland, Had some underlying chronic issues that were well managed. He got covid late April and it throwhis system for a loop. He reached out looking for a referral.Who do we have in the great white north? ReplyKristin Wisgirda Jun 13ReactSorry, I can't think of anyone near Portland. I put a post on the Qiological forum and will let you know if I hear back. ReplyGabriel SternNewJun 13ReactThank you.Kristin Wisgirda Can't take the heatNewJun 81ReactI've recently had a number of patients report sudden onset of symptoms that can be traced back to heat exposure. Theyresponded well to UB+.A man with back pain at the level of L3/4/5 that came on "out of the blue" while watching a lacrosse tournament.A woman with shoulder pain that started 2 days after an hour of gardening on a hot day. She tried to avoid the heat by gardeningin the evening.A woman with unstable ankles and sore feet after watching a soccer tournament.All 3 of them have Heart excess constitutions.With all 3 it would be easy to treat other channels. With the shoulder pain lady, I ﬁrst tried SI+ with no improvement. When theweather matches a strong channel excess, as in these cases, it does seem helpful to give it a good deal of clinical weight.

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5 teacher remarks3 replies 33 replies 34 more comments4JPEG | 6.7 KUnknownReplyDaniel SchulmanNewJun 8ReactInteresting! Weather aside, the soccer and lacrosse could have also , in a Heart Excess person, been very 'exciting' for some reason(close game, a child in the match, etc).I am wondering Kristin, did you ﬁnd in these cases the two signs of rapid pulse and warm soft substernal to match the cases or not. . . I have found of ALL of the many signs and symptoms in our Sa'Am world, the pulse rate and substernal tension / temperatureto be the most confusing and often contradictory in assessing the HT-UB polarity.ReplyShannon LarsonNewJun 141ReactI have had a very interesting case of a patient with jaw tension, SOB and a "feeling of energy exploding out of her head". The GTITRis her talking. It's very pathological. I am always running over because it's almost impossible to get her to stop. One of thetreatments that helped her the most so far was HT+. As I needled it her talking slowed down, quieted and she deeply settled. Itwas so noticeable. So needless to say incessant talking can come from many things. I think what has been a lesson for me with heris that her talking was always about her condition. What has worked and hasn't, who she has seen etc It wasn't about reaching outand communicating with me.5 teacher remarksMariaP+ adverse reactionsNewJun 7 | EditedReactWhen going through the discussions, there are many warnings about GB+. However my experience with P+ is equally problematic.Of course all the channels when diagnosed wrong are problematic. I am just thinking about P+ because of a new adverse reactionI have discovered that I thought I would share and would love to hear about other people's experience with it.The new adverse reaction I learned is unexplained weight gain, especially around the midline and the butt. I didn't catch theproblem right away because it wasn't on my radar. My patient complained about gaining weight and it has never been a problemfor her. She hasn't changed a thing. She was really upset by it as she couldn't control the weight no matter what she did; she justkept getting bigger. When it was ﬁrst mentioned, I thought it was a dampness. I did LI+, ST+, but she kept gaining weight. It wasonly after several attempts that I ﬁnally tried GB+. After one treatment, the weight gained stopped. I did another GB+ back to backbecause she was having foot problem that day on GB area and she has lost a few pounds after the 2nd treatment. This patienthad low testosterone previously, and somehow, I think P+ made it even lower, causing weight gain. I know I am not suppose tomix the two, but that is my reasoning for what happened.Other adverse reactions I've noticed with P+ are exacerbation of diverticulosis/itis, non-healing wounds, skin issues, mobilityissues. Some of these reactions were hard to ﬁgure out as they seem to be new conditions.What has been your experience?

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10 replies 10ReplyKristin Wisgirda NewJun 8ReactHi Maria,Thanks for sharing your clinical experience. Sounds like the patient might have received multiple P+ treatments.Pericardium's quality is rooted down and in. If in excess, it is easy to imagine it creating all kinds of issues of stagnation.I've had patients who are grossly overweight who did not get much out of drying treatments- LI+ and St+. These cases widened myperspective on other factors that can create accumulation of ﬂesh in the body- Liver density and K excess/blood stasis. It makessense that Pericardium can be added to that list.ReplyPhilip SugerNewJun 9 | EditedReactInteresting I was just thinking about what kind of issues PC excess would cause. I think we become so focused on GB excesssometimes we forget that PC excess also has certain issues. Toby mentioned the aspect of PC is inner calm, which makes you thinkhey that sounds like a good thing, but obviously too much of anything is bad, like the wealth aspect of LU excess.@Maria could you please describe the patient and explain why you thought of +GB?Maria2 teacher remarksMariaAmenorrheaNewJun 4React14 y.o.cc: no period after 2nd booster. period started at 11 y.o. and stopped on 7/14/2021 when she was 13y.o.K: young, ﬁrm heels, gets dolled up (curls her hair) 4SI: not attractive but face looks symmetrical 7, no varicose, no period (no fertility)LV: dense tissue 7, dull and hard to get info out of her 8,SJ: her mom says she is sensitive and talks easily at home 6GB: mood swings/gets mad easily 7P:LI:SP:ST:LU:I have done P+, SJ+, SI+ a couple of time. Still nothing though her moodiness is better. The last time I asked to see her face and Iwas really surprised to ﬁnd that she was not attractive. The mask hides so much. I am thinking that K+ would be more appropriatethan SI+. But I wonder since she is so young, would that be a problem? Any other ideas?

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4 replies 4ReplyPhilip SugerNewJun 5 | EditedReactYou could ask if she had any developmental issues in the womb and in early childhood, that would be another tally for +KI. Thoughyou are right to be cautious because the virus whether acquired through transmission or via a vaccine has a blood stagnatingeﬀect on the circulatory system. I tell my students all the time that we will likely be seeing an increase in gynecological issues in thenear future as a result. I recently committed a serious error in a patient with severe blood stagnation by doing +LR thinking that itwould help move the blood in the interior. Toby corrected me by saying that +LR has a blood tonifying nature that would actuallyexacerbate the stagnation. So unless the girl has signs of blood deﬁciency I would avoid +LR.Just joined the forum so I am not sure if I should be replying or not but hope this helps. ReplyKristin Wisgirda  NewJun 8React<she is not attractive. I hate to say that!> Because you are a nice person. Think of it more clinically. Not attractive= lack of K sexualenergyTending to avert eyes is more of a SJ excess quality. They are so open they need to protect. Liver excess people, if they notice you,will have no problem looking right at you because they are so well protected.<Seems somewhat dull/cold/not hyper (UB excess) but her mom says she is pretty talkative at home and with her friends.> Teens can behard to judge in the clinic. I would put weight in how mom sees her.If you have done SI+ a couple of times and her lack of attractiveness is the GTITR, K+ sounds like an option.Please let us know how she does.Jan WilsonPuzzling new clientNewJun 3ReactHi KristinI am feeling a bit stuck with a new client and would appreciate some help. I cannot seem to ﬁnd the biggest gap.52 year old female, full time prosecutor (sex crimes division).Tongue: is pale, crimped , dry white coatPulse: wiry, slippery at right guanChief complaint: left sided upper back and, neck pain, 10 years.Bw massage and muscle relaxers, Ww sitting and stressOther concern: Palpitations and discomfort in her chest which occur only when she lies down at night from upper stomachbloating (20 years). If she can burp she can fall asleep otherwise she needs Ambien. Has a recurring night mare about not beingable to ﬁnd her car in a city parking garage and darkness is descending. She wakes with numbness and tingling on the San Jiaomeridian of her left arm and into the middle ﬁnger.Body: Medium height, solidly build, a bit of a belly. Thick brown shoulder length hair with only a few grey. Runs warm with coldhands and feet, worse when nervous. Sweats easily. Oily skin when younger moisturizes now. Dressed professionally (notexpensive or showy) practical, comfortable shoes. No makeup or jewelry.Complexion is slightly sallow, no red. Slightly dark under her eyes.

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Muscle Tissues are strong, tight through the neck and shoulders. When palpating the calves, I expected them to be dense becausethey look so solid but they are open and soft, maybe a +1 to the dense side.Eyes are bright +4, Hard +3. She does not feel exposed in front of the court room.Life Stye: Married with a 16 year old daughter. Busy either at work or in the garden. Daughter describes her as a “pit bull”. 30-90minutes of exercise every day.HistoryBowels: slow motility, stools are dry, long and hard, better lately with magnesium. Goes every other day.Emotions : held in, her husband complains that he cannot “read” her emotions. She describes herself as “a just the facts” kind ofperson. She is not a story teller.She does not gush about her daughter and husband, more factual. She will answer any questions but I have to ask them very littleis volunteered.Heels are plumpThenars are averageUrination is frequent and clear. She is thirsty for room temp water and drinks speciﬁcally to hydrate her bowels.Abdomen is warm and ﬂeshy on the middling CV 15-8, empty at CV12, empty below the navel.GTITR: 20 years of sleep disruption dt stomach bloating, the darkness of her work.GB: will go after criminals in court without hesitation, and appears calm but reports feeling chaos inside, daughter describes heras “pit bull’PC well researched, chest eﬀected by bloatingLI strong body and very busy (not thin), dry stool, sl dry skinSPLU well resourced ,ST bloating laying when lying down, sallow complexion,KD thick hair, plump heelsSI no stagnant blood vessels*Special considerations for SI, painUB no gushing about anything, pain on UB channel,HT Body is warm (I can feel heat radiating from her), warm midlineSJ eyes are brite +4, and hard+3, numbness and tingling on left SJ meridian in the morningLV pain only on the left side, held in emotionallyFirst Treatment SI, right – Patient felt less pain on the table and fell asleep.Ideas going forward:PC+ ground the chaotic interior and pit bull exterior, location of discomfort at night from upper stomach bloating,? ST+ descends the bloating, but am concerned with the dry stool?LV+ pain on left side, nourish blood, bring cooling and moisture, balance sight SJ+eyesSpars defect (spondylolysis) at L5,S1 changed her life. Was a serious runner in her 20s- 40s until diagnosed with pars defect. Low back not currentlypainful.Heavy menses causing anemia and requiring iron infusions when she was younger. Last period July 2021. No peri menopausal symptoms.

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1 teacher remark?SP+ to bring moisture to interior and exterior? UB+ to address the back pain, moisten the stool and cool her down a bitThank you for the help ReplyKristin Wisgirda NewJun 6ReactHi Jan, Thanks for the case. Please translate a few descriptives into Saam language to help me see her better.<Complexion is slightly sallow, no red.> By sallow do you mean yellowish or is there a darkness to it. This description does make methink that there is no light in her complexion. Interesting that she is hot but there is no red.<solidly build> For Saam it helps to distinguish frame size from ﬂesh quantity and quality. Is she solid because she has ample ﬂeshor is it her frame that looks bigger and sturdier? How about the size of her ribcage? You said that she has an bit of a belly and isn'tthin. Does that mean that she has a little extra weight but not too much?<Muscle Tissues are strong, tight through the neck and shoulders.> Are they dense- more like a solid block or can you distinguishindividual muscles and strands of muscle? What channels are involved in her upper back and neck pain.How conﬁdent are you with eye brightness? Do you feel her gaze projects outward in a way that you know she is aware of herenvironment?<Abdomen is warm and ﬂeshy on the middling CV 15-8, > Is this area generally softer or harder besides being empty at Ren12?<LI strong body > The teaching about LI excess and strength is "thin strong arms". Toby doesn't talk about strength in general forLI- and there can be other channels involved with general physical strength- like Kidney, GB, Lung. LI double dry does makestissues more sturdy compared to Sp double damp soft mushiness.< LU well resourced, ST bloating laying when lying down, sallow complexion,>She also looks like a Lung excess morphologyBloating is more of an internal excess that is more likely to belong to Lung excess. Stomach excess is emptier inside in that it can'thold onto anything. There are no complexions associated with Lung and Stomach except dry skin and damp skin.<SJ eyes are brite +4, and hard+3, numbness and tingling on left SJ meridian in the morningLV pain only on the left side, held in emotionally>That her chief complaint is on the left and she has SJ channel pain- both of these ﬁndings point to both Liver and Sj excesses.<Has a recurring night mare about not being able to ﬁnd her car in a city parking garage and darkness is descending.> This sounds like asign of symptom that doesn't like too much darkness.For the chief complaint I am really interested in this SJ/Liver balance but it is unclear enough to me to want to avoid Liver+.For eyes3+ brightness isn't that bright if your scale is 1-10.<PC+ ground the chaotic interior and pit bull exterior, location of discomfort at night from upper stomach bloating,? ST+ descends the bloating, but am concerned with the dry stool>P+ and ST+ really sound the safest for me. With the palpitations relieved by burping - she clearly needs down. I wouldn't worryabout the dry stool and Stomach+. Toby says that he often ﬁnds treating morphology a reliable way of improving bowels. I am alsointerested in how her bowels respond to SI+.Please let us know what you think, what you do and how she responds. ReplyJan WilsonNewJun 9ReactThank you for your comments Kristen. I will see this client next week and will have an update.I am currently working my way through the 12 channels course and ﬁnding it VERY clarifying. Thank you for sharing yourunderstanding with us.

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 Reply3 teacher remarksAdina KletzelMixed Reaction to Liv+NewMay 31ReactHI,I have a challenging case that I could use another opinion on.I am treating a deaf and mute woman aged 44 who just ﬁnished chemo and radiation for breast cancer. She is taking hormonaltreatment and biological treatment now.All of my communication with her is through typing since she can't speak in a way that is understandable so I feel a bit limited inusing comfortable communication to diagnose.Her main complaint is pain in her bones and joints and exhaustion.I will ask my speciﬁc question and if you need me to write up the whole case then I will.I treated her last week with Liv+my reasons - in my questioning she answered that she is sensitive to her environment - she gets upset when things are out ofplace and needs order, she picks up on peoples emotions, she has Left rib side tension, her eyes are bright at a 4+, and her energyfelt open.She settled on the table and said she felt relaxed afterwards.A week later when I asked her how her week was she said that she felt relaxed for two days after the treatment, she has less painin her joints and bones, and she has less phlegm then she had before.BUT - she felt more depressed 3 days after the treatment - so depressed that she stopped taking her hormonal treatment.When I questioned further - since she had not mentioned the depression in my extensive questioning before the ﬁrst treatment,she said that she has been depressed for the last couple of months and she thinks its cuz of all she went through this year and cuzof the hormonal treatment. BUT the depression was REALLY strong three days after the treatment and she is still depressed.I tried to ask if the depression gets better with people/sunlight/action or with dark and quiet and she said sometimes this andsometimes that.SO - I understand that she had a mixed reaction to LIv + but if the stronger depression was caused by Liv + then I think I should doSJ+ tomorrow but I can't know FOR SURE that the stronger depression was a result of the Liv + and so I wanted to see what othersthought.BlHt lots of heat waves 8+ had many burning UTI’s in past 6+ very thirsty 6+Kid surgery a couple months ago , C-section surgery , polyp surgery back hurts 6+ bones hurt 7+ knees hurt 7+ symmetrical 7+SI crying a lot 7+, feels tired and not herselfLU ST always bloated 7+, mouth dry 7+ very thirsty 7+ gets nauseous 6+ has phlegm in chest 6+ST very tired 9+SJ likes order 8+ likes quiet 5+ doesn’t like strong sun 5+ open to envir 6+ bright eyes 4+ cancer in left breast energy seems light 5+Liv depressed 6+GB she is very irritable 7+ she is spontaneous 6+THanks!

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4 replies 4ReplyKristin Wisgirda NewMay 31ReactWith such clear improvements in some areas after Liv+, I would not use SJ+ tomorrow. We have seen depression be from manyother excesses besides Liver.From your write up, it looks like SI+ would be a good next step.Joanne TaitDystonia and Parkinson'sNewMay 30ReactHello and happy holiday,I am posting about a patient I saw for the ﬁrst time on Saturday. I'm seeing her again tomorrow, but realize it's a holiday and maynot get feedback before then.I would still love any ideas or input you all may have whenever you can give it. I tagged several folks who were on a previousParkinson's thread, plus George, just because :)My colleague just referred her to me in a community clinic setting, so my information is fairly limited, but here's what I've got sofar:75 year old female diagnosed with Parkinson's 6 years ago.Small stature, thin and is very contorted due to dystonia, she's in a wheelchair and has a caretaker with her to help move her andinterpret what she's saying which is diﬃcult to understand.She is curled up and contorted.Neck/head is contorted to the Left pretty severely at nearly 90 degrees. No pain, oddly enough.Right wrist contracture.Legs and ankles contracted, knees pull toward midlineVoice is diﬃcult to understand, high pitched and not clear, presumably d/t vocal cord contracture.LV: Flesh is soft and shiny, moderately dense, though diﬃcult to distinguish w/ dystonia - +4SJ: Eyes bright - +4Very polite and kind demeanor +6Loves the beach, going for her bday.K: Medial heels soft and in good shape considering her age - +5Has one childGrooming - seems quite good considering/she was probably quite pretty/symmetrical prior to dystonia and Parkinson's) +6SI: Mild tremor in hands and voice + 4Fang Cai,George Mandler,Adina Kletzel,Kristin Wisgirda,Daniel Schulman

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1 teacher remarkAsymmetrical - +9LU: Not dry, but moisturizes daily so unclear if her skin is dry.Thenars slightly withered and deﬂated, but she's 75 so not sure that's much to go on. +2ST: thin +5BMs normal (I think)Resources unknown (I will try and get more info)LI: muscle contracture -+7 (not sure this goes here?)SP: nothing of noteHT/BL: nothing stands out in either regard here; I didn't check her midline yet, will try and assess at our next visitP: nothing of note aside from her body moving down and inward +9; will look furtherGB: nothing of noteT: red, quiver, scant coat/cracks or geographic (couldn't see completely due to mouth aperture)P: thin wiry - R guan and L cun if I recall correctly, need to recheckGTITR - contracture1st treatmen LV+ - she fell asleep and rested well, caretaker said she seemed noticeably less tight afterward.Communication is quite challenging and time is limited in this setting, so that's all I've got so far.Other ideas: +SI, +SJ, SP+, +GB, (this makes me nervous, but am curious about it having an upward/straightening eﬀect), +K (thisalso makes me hesitate based on the other post and not wanting to consolidate her into the position she's currently in, butperhaps later if we can get her more upright...)

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1 reply 1ReplyKristin Wisgirda  NewMay 31ReactThanks for the case.With systemic contracture, I wonder about cold, dryness, blood xu, blood stasis and maybe hyperdensity.I am interested in why she likes the beach so much- the heat, the sun, people watching, etc.With shiny skin, I wonder if her skin is so dry that care takers use extra greasy stuﬀ.Is her voice quiet or loud?<+SI, +SJ, SP+, +GB, (this makes me nervous, but am curious about it having an upward/straightening eﬀect), +K>I like SI+.Sp+ if her skin is really dry and if you get a sense that she is interested in lots of things.I would hold oﬀ on SJ+, especially since she had a good reaction to Liv+ at least on the table. WIth the dystonia, can you feelstrands of her muscles are are they one solid block? With SJ excess muscle tightness even if the muscles feel hard, you can makeout striations.I would wait to get to know her a little better before doing GB+ or K+ but be open to the possibility.Please let us know what happens. Thanks!1 teacher remark1 reply 1Kristin Wisgirda Allergy SeasonNewMay 251ReactThis is my 4th allergy season working with Saam. In the early days of practicing Saam, I looked for Lung/Stomach imbalances andSpleen excess for congestion and Kidney excess for itching. Results were mixed. With more experience, it seems that correctingthe biggest overall channel imbalance seems to be most eﬀective. This year I have used Liver+, SJ+, K+ as often as Lung, Stomach,LI and SI, with better results overall. A couple of cases of UB+ as well.I can imagine that there could be scenarios where P+ and GB+ are called for.What are other people's experiences? ReplyDaniel SchulmanNewMay 25 | Edited1ReactYes! I have seen TW Excess and GB Excess patterns and their treatment ﬁgure very centrally in eﬀective treatment of seasonalallergies! I think often a very big part of seasonal allergies is some aspect of heat trapped in the head, or heat rising to the head . . .the heat component being more important than the 'phlegm' component. ReplyJoanne TaitNewMay 30ReactI love to think about allergies in new ways as sometimes the LU/ST toggling gets murky and doesn't always yield a great result. Ihave a patient who is constantly drippy, watery eyes and LI has worked well for her, but I'm really interested to try K+ as well sinceshe's got some SI XS signs too. Often we're working on other issues more primarily, but this is so helpful to consider for herallergies.

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3 teacher remarksMariaCovid RashNewMay 19React69 y.o. female patientCC: Caught covid 9 months ago and developed a red itchy rash. She felt itching and dryness all over.Other Sx: Low energy, hip pain, hair loss, weak nails.K: symmetrical 5, VV 3, ﬁrm heels, multiple bone fracturesSI: depressed but not suicidal,LI: very dry, dry lips, dry skin, dry hair, busy, thin bodySP: ascites (internal damp) 4SJ: receding gums, sensitive to criticism 8, hard on self 8LV: Eyes dull 4LU: thenar 4, dry skin, eyes, lips, R side congestion with ascitesST: widowH: talks alot, lips were burningUB: tend coldP: snarky but not physically aggressive, former lawyer, avoids confrontation and holds everything in.GB:Patient responded well to GB+, LV+, SP+, ST+ but nothing made much diﬀerence to diminish the rash. The itching is better, but therash persists. I am wondering about trying UB+ because her lips were burning from the dryness and the rash is red. What do youthink? Do you have any other suggestions?JPEG | 1.6 M20220329_095342Kristin Wisgirda  NewMay 20ReactHi Maria,Thanks for the case. Extra thanks for the picture!In Saam SI+ is the ﬁrst treatment to consider for itching and windy conditions. It is something to try as long as she has enoughKidney energy.

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2 replies 21 reply 12 more comments2Reply<K: symmetrical 5, VV 3, ﬁrm heels, multiple bone fractures> Multiple bone fractures is a strong sign for Spleen excess and onlysecondarily for SI excess. Too much Kidney won't create weak bones.SI+ would be my ﬁrst consideration.I see that the itching is all over but is the rash just on her belly or is it elsewhere? The lesions are well demarcated. In dermatologythat points to damp. (OK I'm importing from other systems). If the lesions are just on her belly, I would consider damp and use LI+.With the red rash, her being super dry- except the ascites, talkative and the burning lips- UB+ would be a consideration - except Idon't know if I wan't to put cold water on ascites. ReplyFang CaiNewJun 14Reacta little late to the party here but those lesions have the characteristic "leading border" look of fungal infection, tineacorporis/ringworm. has she been seen for this by a GP or dermatologist? Even an OTC fungal cream may handle it. Or, theDermatology-M Ti xuan ding then Ti xuan gao.Tinea is very stubborn so treat for at least a week beyond resolution of leading border activity.Adina KletzelCase - post cancer joint painNewMay 18 | EditedReactThis post was administratively edited at 05/19/2022 7:48 AM48 year old womanHad breast cancer two years agoDouble mastectomy and had ovaries taken out; RadiationNow on hormone pills for preventionMC: joint pain 8+Limbs heavy and weakPain with walking, Walks as if dragging limbsRest helps; Fingers get stuck – can’t open jointsSo tiredSC: depressedWent through so much, lost all womanly organs- Two years later and can barely moveAppearanceTall – very long legsArms and legs are skinnyTorso area a bit fuller but not fatDarker face that hold pain

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7 teacher remarksSymmetrical 5+Eyes bright 2+Arms and legs open 6+Back dense 6+Lower abdomen soft and mushy, sink in 6+Medial heel – thin and dry 4+Good grooming 6+GTITR: diﬃculty moving limbs. See the pain and stiﬀness of limbsHt aversion to heat hot ﬂashes palpitationsBl palpitationsGB poor sleep easily angeredPCLIV depressed darker faceSJ does not like bright light 6+ likes order 5+ trouble regulating tem.STLU Bloating after food phlegm in throat and dry skin fuller torso and thin arms and legsLISP hemarrhoidsKID pain in joints 8+ four surgeries in past two years 7+ symmetrical 5+ had period painsSI was sick a lot as a childMy QuestionsI often have trouble between SI and Kid in these types of cases.She has been through so much medically in the past two years. She has a weak constitution. She is so tired and weak and canbarely get her legs to walk (SI excess)On the other hand she also has had four surgeries in two years and her limbs are stiﬀ and heavy and she is in so much pain (Kidexcess).I always hear Toby’s voice in my head saying that he likes to tonify SI ﬁrst when it is mixed.But - is she strong enough for SI+? I am not sure… if she is not then her pain may increase…Also – would a strong aversion to damp heat and exhaustion weigh too strongly against a LU excess body morphology?Thank-youKristin Wisgirda  NewMay 19ReactThanks for another complicated case. (I compressed the info a bit to make it easier to scroll through.)

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16 replies 16ReplyI'm not seeing her well yet. How skinny are her limbs and how full is her torso? How dry is her skin, eyes and vagina? She is alsosweating lots and very thirsty. Would be good to see how dry she is.To touch, any notable temperature?Her limbs are heavy and weak and she has pain walking. Does she have pain moving her arms and hands?<Fingers get stuck – can’t open joints> Any or all ﬁngers? Do they stay stuck?<Palpitations – slow down every dayNeeds to cough to speed it back up>I don't know what you mean by slow down every day. What is her experience here? is she counting her pulse or does it just feelslow?Palpitations are just an uncomfortable feeling of your heart beating. I wouldn't assign them to H or UB. Rapid and slow pulses arethe indicators for those.<Arms and legs open 6+> Do you mean her ﬂesh or her posture?<SI was sick a lot as a child> If those sicknesses were enough to stunt her growth, then I would give weight to SI excess here.Otherwise I'm not so sure. Just because someone has had lots of medical problems doesn't mean SI for me either because somany other excesses could be the culprit.<But - is she strong enough for SI+?> When someone presents with weakness and tiredness, it is easy to consider SI excess but it ismore helpful to stay open to the big picture.Her sleep sounds not good even with the medication. For anyone with energy issues, improving sleep is an important ﬁrst step.Redoing your symptom analysis and grading symptoms will help.1 teacher remarkKristin Wisgirda 12 Channels Class recordingsNewMay 161ReactIf you didn't get a chance to attend the class, you can still access the recordings and get ceus if you complete the quiz/worksheetetc by 11/3/22.Register for the class here: https://whitepinecircle.org/12-channels-of-saam/Of course, you can ask questions about the class on this forum.I'll likely be running a revised version of the class in the fall/winter. It will be broken up into 3 pieces: a reﬁned version of theoriginal, a second class comparing and contrasting channel excesses, and the eye observation class. Embedded File.https://whitepinecircle.org/12-channels-of-saam/

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3 more comments3 ReplyAdina KletzelNewMay 16 2React@Kristin WisgirdaI highly recommend this class. Kristin broke down each channel into its primary and secondary qualities and helped us learn tofocus on the primary qualities while still considering the secondary qualities. Her explanations, examples, and visuals really helpedme develop my understanding of each channel which ultimately improved my diagnosing abilities in the clinic.Kristin Wisgirda ReplyNaomi FrankNewMay 16 1ReactEchoing Adina’s comment!! This class really helped me to develop my understanding of SAAM and identity some blind spots that Ihad as well as false assumptions I was making. At times I look back at things I did before and cringe…but I guess that is a part oflearning any medicine. I still go back to the notes and recordings at times3 teacher remarks2 replies 2MariaNot sure what happenedNewMay 14 | EditedReactI am confused as to what happened with this patient. Maybe you could help shed some light.I did a H+ treatment for this patient for her LBP. It seemed right at the time. She is pale, tend cold, pulse slow, ﬁrm mid section anddeﬁnitely not hyper. She came in a week later telling me that her back pain got worse after the treatment. This time, when Irechecked, her mid section was very soft and painful to palpate esp. at ren 9 area. She said that she had this pain around herumbilicus area for years and had forgotten about it as she doesn't palpate herself. Taking it for an adverse reaction, I reversed thetreatment and did UB+. She called 2 days later and told me that her back pain got even more painful and wanted to cancel allfuture treatments. I was surprised that she felt even worse after the reversal. What do you think happened? ReplyKristin Wisgirda NewMay 14ReactSorry that this case wasn't straight forward. There has to be some other channel excess that needs treatment.Did she clearly settle on the table or get some temporary pain relief on the table? Either of these would let you know that therewas some positive input- and that the overall reaction to H was mixed. If the reaction is mixed, you look to another channel pair totreat.If someone has back pain, it is often easy to ﬁnd some movement they can do to aggravate the pain on the table. This movementcan be rechecked once the needles have been in for a few minutes. If there is no beneﬁt, I most often remove needles and tryanother channel.Adina KletzelNewMay 15React@Kristin WisgirdaKristin Wisgirda

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4 teacher remarks5 replies 5Melissa RathboneHealing crisis?NewMay 13ReactHi there!I don't usually subscribe to the idea of "healing crisises" much but I have had a couple people who have had strong responsespost-treatments that seemed like they might have been an adverse reactions but then once that response cleared, were in a muchbetter place symptom-wise.I know I'm not giving you many speciﬁcs but is this something that you see? Do you see it more with certain types of people orcertain types of treatments? Curious to hear your take on this...Thanks! ReplyKristin Wisgirda NewMay 13ReactHi Melissa,I'm with you. I entertain the idea of healing crisis very reluctantly. Yet, sometimes they truly do happen. My deﬁnition: Anunwanted symptom that happens during or after a treatment in which all other signs point to the body moving toward health. Thepatient has a sense of well being or positive shift throughout. And the patient ends up overall better oﬀ after the symptomresolves. Usually, the unwanted symptom won't last very long.Toby gives the classic Saam example in every intro class: Griddle Man. The post stroke man who burned his hand on a griddlebecause he could not sense heat. After treating H+, that same hand became hypersensitive to heat. Toby assured him that thiswould resolve in a day or 2 (and crossed his ﬁngers). The heat sensitivity recalibrated back to normal just as Toby said.In Saam I see these odd reactions most often in the elderly and the frail. Maybe they don't metabolize treatments as easy . On thetable the patient settles beautifully and symptoms are relieved. The next day something uncomfortable gets stirred up or theyhave an aggravation of the original problem. Then in a day or two they feel much better overall.This phenomenon is another reason why you don't counterbalance a treatment if the response seems mixed. You onlycounterbalance ifToby has mentioned that the elderly can be odd responders as well as slower responders.Looking forward to hearing other's thoughts and experiences.Kristin Wisgirda  NewMay 16ReactI never forget that I am practicing medicine. We have to learn our medicine and we have to learn the unique terrain of our patients.<What's your take on damp getting in the way when choosing a treatment that focuses elsewhere?>I think that any quality that is signiﬁcant to the patient's pathology can prevent you from getting results with other strategies. I'veseen untreated blood stasis, Sj openness, H heat, GB excess, etc, get in the way of other treatments working. Toby talks aboutsome patients having a key treatment that they need before other treatments will work.

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1 more comment1ReplyToby does keep repeating that he like to address damp ﬁrst when it is signiﬁcant. As well, he likes to supplement SI before K whenboth are needed. These ideas do seem to work in the clinic, most of the time.1 teacher remark1 reply 1Kristin Wisgirda Small Study Group Anyone?NewMay 11 1ReactI would like to oﬀer another small study group in the summer, July- August.3 sessions of 2 hours each for 3 weeks in a row, with 3 participants + me.You will be required to present at least one case, with the option of presenting 2 cases. The cost will be $225.Please let me know if you are interested either here on the forum or direct to my email: kwisgirda@gmail.com If you havepreferences for days/times let me know that too- week days only please.I want to you all to have ﬁrst dibs before I oﬀer it to others.ReplyAdina KletzelNewMay 11React@Kristin WisgirdaHi Kristin, will these case studies include working with the more Advanced Saam material from Toby's second and third classes?Kristin Wisgirda ReplyMarintha TewksburyNewMay 17ReactI am interested!I would love to discus Advanced Sa'am techniques, but will happily stick to the basicsKristin Wisgirda Coming Down With SomethingNewMay 11 2ReactYesterday I had a ﬁrst hand experience with using UB+ for an early stage coming down with something.The worse symptom was extreme chills- a mountain of blankets and a heating pad didn't warm me. Also had signiﬁcant malaise,skin level pain on my back, mild sore throat and a dull headache covering many channels. No sweating. No heat signs except aslightly redder throat.UB+ immediately relieved my sore throat, warmed my body and was settling. About 1 hour after the treatment it was like a switchwas ﬂipped- the chills were gone and the malaise was much better. The headache was gone. This morning the sore throat cameback but my energy is improved enough to move concrete blocks around my yard.Toby has always emphasized that UB+ or part UB (LI1+, St36-) are the go-to treatments for early stage coming down withsomething if the patient is robust enough. If the patient is not so robust and cold is a major factor, he will use H+ or SJ+. If cold isnot a major factor, he will focus on the major symptom and constitution. My impression is that he ends up using UB+ whole orpart most of the time.

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1 teacher remarkHerbally the right formula for me would probably have been spicy warm ma huang tang to unblock my frozen exterior. If Tobydidn't share this teaching, my impulse would be to take the basic Saam principles and use a similar a warming method to unblockmy frozen exterior- probably H+ or SJ+. But instead a ﬂush of ice cold water from UB+ worked. How so we reconcile theseseemingly contradictory methods? What do they tell use about the qualities and functions of Saam UB and the nature of Taiyangcold water?Here are some very rough draft musings.The Taiyang surface is a boundary with the outside but it also has to be semi permeable. It has to breathe. Just as with all ofnature, the function of the Ub channel and the Taiyang surface depends on the right interaction of yin/yang, qi/blood, ying/wei.An image from Ed Neal has always fascinated me: The UB channel of the back as a "blood sweater". Intercostal arteries form thearteries of the back and the lower taiyang river. No major blood vessels traverse this area. Instead blood seeps into the backmuscles via numerous ﬁne vessels creating a marshy area that has lots of blood but not much qi- just as the classics say.A number of practitioners, including me, have successfully used UB+ on very cold patients. Many of these patients have been thinand very dry. In my experience they have also had some heat signs- like manic talking or intense burning sensations. It makessense that very dry patients lack the yin to perfuse all the way out to the surface. And not enough yin/blood/ﬂuids to hold the yangto warm that surface. UB water does moisten.Toby has often described UB+ as a ﬂush of ice cold water. I've always interpreted the ﬂush as a yang quality suggesting that UBisn't a block of ice but is instead cold moving water.A good ﬂow blood and ﬂuids is needed to ﬁll out that blood sweater. To me the cold of UB+ speaks to a certain amount ofconsolidation that needs to happen at the surface.For now I can't say that I deeply understand how UB+ helped me yesterday beyond saying that the ﬂush of cold water UB+improved the ﬂow and function through the Ub channel and the Taiyang surface.I don't have any of this wrapped up in a bow. Looking forward to hearing what others have to say. ReplyNaomi FrankNewMay 111Reactgreat post to reﬂect on, Kristin (and I'm glad you feel better! I would have been nervous to do that treatment on myself) I am quitemystiﬁed by this use of B+.I just wrote an update to an old post detailing a somewhat adverse response to B+ (it started the next day) .. but I think this mayhave been due to a needling error.I have not used B+ on many people. The most successful times have been with a long Covid patient who was very overheated andhad brain fog. B+ cooled him and LI+ dried him. Pretty textbook. I will have to look out for the cold and dry type that you mention.Adina KletzelNewMay 11  2React@Kristin WisgirdaThat is so interesting! I had the same experience yesterday! I felt like I was coming down with something, I started sneezing, gotheadachy, chilled, felt all tight in my back, tired.... and so I did partial UB+ and felt better immediately. The headache lingered onfor a while but I no longer felt like I was coming down with something. Pretty amazing!!I seem to remember Toby stressing that the partial UB treatment releases the Tai yang - that it is stuck (with wind cold) and it isnot so much that we are adding UB cold water but rather releasing the Tai Yang so the wind cold can get out.I thought that was why he stressed a partial UB toniﬁcation. I did not realize that he said that a whole UB+ treatment can also beused. When would you chose whole versus partial?I agree that UB is somewhat of a mystery. Just as it works to warm cold people I have also seen it have no aﬀect on VERY hotpeople...Kristin Wisgirda

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1 more comment 1ReplyPerhaps we need to explore more how the need for UB+ has more to do with what is going on on the surface of the body. That issomething we can start to look out for and report our ﬁndings..Kristin Wisgirda Case Study Hour 7/14 1pm ESTNewMay 9ReactHere is the link to register if you would like to attend live:https://whitepineinstitute.instructure.com/courses/255/calendar_events/1388Let me know the topics that interest you. Of course, feel free to write up any case you would like to share.1 teacher remarkFang CaiSeeking Saam-one in DenverNewMay 6ReactIs anyone in the Denver CO area who can take on a spinal pain case?ReplyKristin Wisgirda NewMay 11ReactJan Vanderlinden is in Boulder: https://blueheronhealth.net@Jan If you aren't available, can you recommend anyone in Denver?JanAdina KletzelSJ excess too open to envir.NewMay 1ReactI have been thinking a lot about how to isolate if someone is too open to the environment.One of the questions that I ask and look for is how much stimulation the patient can handle before they MUST have some quietand alone time in order to gain back their sense of peace and calm.I try to understand if they are more of the going out kind of people or the stay home and read a book kind of people. I also try toascertain how much they notice in their environment and how much they are oblivious to their surroundings.I was just thinking though that needing quiet and being overwhelmed by one's environment could also technically come from Stexcess lack of qi. If someone is really fatigued and has no energy then being in a stimulating environment can cause moreexhaustion and thereby cause them to want peace and quiet which is not related to SJ excess.The same can be true for a SI excess - they can feel so scattered and not pulled together and therefore an environment with noiseand too much action make them feel more scattered and they need quiet in order to regroup and pull themselves back together.THis also has nothing to do with SJ excess.How do we reconcile all of these other factors that may cause one to feel too open and vulnerable to their environment whichmay not be a sign of SJ excess?Questioning may not always reveal the diﬀerences between these channels. People aren't always aware why exactly they needmore quiet than stimulation.

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2 teacher remarks1 reply 1ReplyKristin Wisgirda NewMay 2ReactThis is why we need to develop our observation skills.Mental exercises exploring the possibilities of how each channel quality/direction might contribute to a certain experience ishelpful. And interesting!ReplyJanNewMay 2ReactI've been confused about the same thing myself. And looking at my notes from Kristin's class a few months ago I see that San Jiao:is not shielded or protected from the environment, is hyper aware and focused on the external environment and attentive tothose details. Their tissues are open and they have piercing eyes. But I'm not seeing that they are necessary bothered by it. Thatmay even be their delight. And I think practically everyone is overstimulated so that doesn't end up being very useful for me. Iguess I try to feel the energetics -- do they need to be grounded and rooted by Liver or opened up and lifted up by SJ. Andsometimes the question is -- do they need more help with San Jiao energy (and so a SJ tx) or do they need to step away from thatexternal focus (a Liver tx). So even a San Jiao type presentation might beneﬁt from an SJ tx. Has anyone else found this to be thecase? I think I'm talking about trying to understand the interplay between an individuals tendencies versus what is going on tocreate a pathological condition for them.Marianeuropathy caseNewApr 28 | EditedReact78 y.o. male - retired, former auto mechanic5'8 245lbs.cc: neuropathy of feet - tingling needle like sensation. sleep interrupted due to pain.SI excess: chapped heel 4, varicose veins 2, his feet look slightly purple 5, olderK excess: ﬁrm heels 5, symmetrical 4LV excess:SJ excess: Lack of density 6, bright eyes 5H excess:UB excess: Not hyper 5LI excess: Dry skin 8,SP excess: Not busy, Big belly 7, overweight 8, Watery eyes 8, numbness 8ST excess: Flat and ﬂaccid thenar 7, Watery Eyes 8,LU: Big Belly 7, Dry skin 8, overweight 8, numbness 8, chest 5GB excess:P excess: calm 7, rooted 7Medical Hx: Diabetes, HTN, Enlarged prostate

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5 teacher remarks3 replies 3Treatments tried: LI+, GB+ (he hurt his hip getting up oﬀ of my table during previous session), ST+. Rationale behind strategiestried: Toby says to consider dampness for neuropathy or hypertension.Questions:1.) Given his ﬂat thenar, I was hesitant to use ST+, but the rest of his proﬁle and morphology ﬁts LU excess. How much weight togive to the thenar?2.) Since his skin is so dry, I was hesitant to use LI+ but I know that dampness could prevent moisture from reaching the skin. I amwondering what your thought process would be and how you would approach a patient like this.Thanks! ReplyKristin Wisgirda NewApr 29ReactThanks for the case.<1.) Given his ﬂat thenar, I was hesitant to use ST+, but the rest of his proﬁle and morphology ﬁts LU excess. How much weight to give tothe thenar?.> Dry Skin 8+ and clear obesity are very strong signs for Lung excess. Even though his thenars are ﬂat and ﬂaccid 7+, Itend to give them less weight.Given that he has frank numbness along with the tingling, I would hesitate to moisten the surface with ST+. Frank numbness is asign of dampness. I would use other strategies before using the ST+ variation with ST36+ to replace ST41+.<SI excess: chapped heel 4, varicose veins 2, his feet look slightly purple 5, older> Purple color being a sign of blood stasis belongs to Kexcess. Varicosities being 2/10 is normal for a 78 year old but generally the presence of varicosities should be listed under Kexcess.For tingling/pins and needles, SI+ Toby's treatment of choice. Based on this patient's presentation, this is probably where I wouldhave started. The symptom is in the feet which are purple- there is blood stasis in the feet. Blood stasis only aggravates thedampness as well. Even though he is 78, there are enough good K excess signs for me to believe that SI+ can be used safely.<) Since his skin is so dry, I was hesitant to use LI+ but I know that dampness could prevent moisture from reaching the skin. I amwondering what your thought process would be and how you would approach a patient like this.> With signiﬁcant obesity along with asigniﬁcant sign of damp on/near the surface (numbness), we can "sacriﬁce" the skin at ﬁrst.<Toby says to consider dampness for neuropathy or hypertension.> While Toby has shared When a patient presents with a westerndiagnosis, I do my best to forget they have it and diagnose with our medicine. I have seen in my own cases and the cases of otherpractitioners, "neuropathy" improved with so many other strategies besides drying. What does the neuropathy and what they callhypertension feel like? How can we explain their experience through qualities and directionality we see in our Saam diagnosis?Please let us know what you do you and how he responds. Thanks! ReplyJanNewMay 2ReactSo blood stasis -- purple color -- and tingling are Kidney signs. Why are they not listed under for sure signs? One can see bloodstasis is Kidney only by inference.I can infer it by the fact that SI + states little or no signs of blood stasis, (but I don't really see that in my limited Sa'am practicehistory -- more often the opposite.) In fact I think SI excess might also appear as blood stasis as it also seems to be used often forpain. I believe that it's used for pain as it mobilizes the blood which is not being adequately moved by the qi. Or is there an implicitlack of blood and ﬂuids with SI excess? If so that would explain the lack of signs of blood stasis? Lots of questions. . .

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1 reply 15 more comments56 teacher remarks1 reply 19 more comments9Kristin Wisgirda Spleen+ Relieves Extreme FatigueNewApr 24ReactA 77 year old woman complains of "extreme fatigue" after a hike 2 weeks prior. She knows that a 2 hour hike is her limit this daysbut she got lost. The hike lasted 4 hours and includes lots of hills and mud. Now every time she sat down she fell asleep andreported not having any energy for her usual activities. In the oﬃce, she looked tired but was able to stay focused and alert. Thehike aggravated her low back and hip stiﬀness which presented as aching and stiﬀ movement when she got up from sitting- thisresolves quickly after moving around. Since moving really helps this symptom, not having energy to move was also making thismore prominent.Her morphology/skin is moderately Lung excess, her resources are good, her voice had no less qi than it usually does. Dry eyesand eye irritation are her other major complaints.K+ helped a little but maybe not more than I would expect another week of rest to help.At the next visit, I asked her more about her activity level- She walked a dog everyday for 1/2 hour. That week she had alsoattended a vigorous exercise class after which she felt good for a few hours and then crashed again. When she sits and doesn't fallasleep she gets very agitated. Not being able to stay in constant motion makes her anxious. She resents her body for notperforming.I treated SP+ and recommended that she do nothing for the next week. 4 days after the treatment, she reported that 2 days afterthe treatment it was as if a switch ﬂipped and she had her energy back. She had followed the instruction to do nothing and foundthis was less of a problem than usual.Toby teaches that K+ and Lung+ are treatments to consider for fatigue- if we know nothing else. This case shows how applying ourunderstanding of yin/yang to our patient's experience brings good results.Her dry eyes were somewhat better too. ReplyJanNewApr 25ReactThanks for the case Kirsten. I have a few questions. So "morphology/skin moderately Lung excess -- does that mean she's got anexpanded rib cage and dry skin? Also, you're saying that the tendency to always be busy is a LI excess and that is the reason forthe Spleen treatment? I think so but just conﬁrming/clarifying. Thanks! ReplyJanNewApr 25ReactThat's wonderful. thanks for the feedback Kristin!Melissa RathboneQuestion re: San Jiao / LiverNewApr 22React

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3 teacher remarksHi there!I can write this case up if need be but I have what I hope are a couple quick questions.I have a patient who has hemorrhoids, a varicose vein that runs along her perineum and dense ﬂesh. She has a fair amount ofdark veins along her legs and left sided hip pain. Her eyes are bright 2+ and she isn't particularly dull or shielded but also not thatswayed by her environment.Considering supplementing SJ for her but have a couple questions.Could hemorrhoids and varicose veins be seen as "full of blood" symptoms?Does supplementing SJ have a lifting quality?Does left sided pain tilt her presentation towards SJ excess in a way that would make supplementing SJ a clear mistake?I did Sint+ with her a couple weeks ago and she settled very well but the pain didn't shift and the hemorrhoid ﬂared up in the fewweeks since that session.Thanks Kristen! ReplyKristin Wisgirda NewApr 22 | EditedReact<Her eyes are bright 2+> How conﬁdent are you about the brightness? When eyes are are in the range of 2+ bright to 2+ dull, I don'tgive them very much weight.<she isn't particularly dull or shielded but also not that swayed by her environment.> I have had a number of Liver excess patients whoI wouldn't call shielded but who lacked brightness. They were perfectly nice and polite. I could reach them but all they gave backwas "blahness" that could be called dull. In short, they were boring.<"full of blood" symptoms> I wouldn't say that. Hemorrhoids and varicosities are too much blood in one place- blood stasis- butthere are many reasons why this could be. Toby describes Liver as being full of blood but hasn't ﬂeshed that out totally to mysatisfaction. My personal take is the followingPart of me wants to also include lack of blood deﬁciency signs for "full of blood" but Toby hasn't really deﬁned these for thissystem. When I look at other systems, there isn't such a clear overlap between Saam SJ excess and blood xu. For instance, SharonWeizenbaum includes poor night vision as a blood xu sign. This would be more of a pointer to Liver excess in Saam! Hence, I don'tﬁnd "full of blood" to be a good pointer for diagnosing Liver excess- dense dull shielded inward are way more helpful.<Does left sided pain tilt her presentation towards SJ excess in a way that would make supplementing SJ a clear mistake?> Left sidedness-if it is only left sided- gives weight to both Liver and SJ excesses. Because of a passage in the Nei Jing, Toby likes to emphasizesupplementing Liver for left sided issues, but in practice left sidedness has weight for both Liver and SJ excess- especially whenthere are multiple symptoms only on the left side. I have had a number of cases of Liver excesses where the symptoms stacked upon the left.Toby has mentioned that, in this system, LI+ tends to be really helpful for hemorrhoids. Hemorrhoids happen to be a problem formonastics who sit lots, so there is lots of clinical experience to back this up.In my practice, LI+ and Lung+ have been helpful in a number of cases of hemorrhoids.If the ﬂesh is signiﬁcantly dense and the Liver channel is aﬀected, given the other info on the Liv/SJ balance you have provided, Iwould consider using SJ+ if no other channel excesses stand out.Excess of blood is that there isn’t enough light in the blood so it becomes dull (not enlivened, overshielding, too dense and plodding) butnot necessarily stagnant in the Kidney excess way

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2 replies 21 reply 1ReplyMariaNewApr 23React@Kristin WisgirdaI too have a question about SJ/LVAre LV excess folks distant and non-engaging? Would you go as far to say they are unfriendly? I have a few patients where theirﬂesh is so dense but they are delightful people with hard to discern dark eyes.Kristin Wisgirda2 teacher remarks1 reply 1Gabriel SternSaam in NYC?NewApr 21ReactAnyone in NYC, preferably Manhattan?ReplyKristin Wisgirda  NewApr 21ReactI know there a quite a number of great practitioners practicing Saam in NYC. Here a couple:Melissa Rathbone melissarathbone.comSharon Yeung https://ﬁveseasonshealing.comEveryone else out there, please speak up.ReplyMelissa RathboneNewApr 22ReactHi Gabe,I still consider my self a Sa'am newbie (I've been working with it for about a year) but would be happy to see your patient!And thanks Kristen for the referral!MelissaMelissa RathboneSInt+ treatment after a knee replacementNewApr 20ReactHi!I'm seeing a patient today who had a knee replacement 4 weeks ago. He's responded well to Sint+ but I have already done thattreatment 2x.

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2 teacher remarks3 replies 3If there is still signiﬁcant bruising, is it ok to do repeat Sint+ for a 3rd time? The last time I saw him was 2 weeks ago.He's 60, strong, symmetrical +6, some dryness at heels, also lots of spider veins at heels.I know Toby says never to repeat a channel 3x but wondering if he makes exceptions post-surgery? ReplyKristin Wisgirda NewApr 20ReactI would hesitate to use SI+ a third time in a row. If he received other Saam treatments since the last SI + or in between the ﬁrst 2SI+, then it is less of a concern.SI+ is the treatment of choice post surgery but you still have to evaluate. There have been cases of adverse reactions to SI+ postsurgery.2 teacher remarks2 replies 2MariaInteresting photoNewApr 191ReactI saw this picture for a gua sha ad. I just had to share it here because It is such a great picture showing the contrast between dullvs. shiny eyes.JPEG | 644.3 KScreenshot_20220419-195931_C…ReplyKristin Wisgirda NewApr 20 | EditedReactThanks for the picture. The ﬁrst thing that popped out was the asymmetry.If you just look at her eyeballs, how bright is her left eye? What do other folks think of these eyes.ReplyLynda B. DanzigNewApr 21ReactHer right eye is 5+ dull, her left eye is 2+. It’s striking, there is such a diﬀerence between the two! great photo, thanks Maria!

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1 teacher remark3 replies 3Kristin Wisgirda Good Grief!NewApr 19React"How is grief seen in Saam?" is a common question. Toby's answer is always that there is no particular association of grief in Saam.So what do you do when grief is the Grossest Thing In the Room?A discussion in the Graduate Mentorship Program included a couple of varieties of grief.One patient who couldn't get over her loss, who cried all of the time in a collapsing sort of way. I can imagine the patient as beinglike a limp rag.Another patient described being sad all of the time, but unable to cry, with a heavy chest and a lump in the throat.I can remember a patient who thought obsessively about the loss of her sister 5 years previously. She constantly broughtconversation back to her sister and had a hard time seeing anything else.Grief really is short hand for a wide variety of experiences that requires me to observe and question the patient to reallyunderstand the experience. Even from these brief descriptions, I'm pretty sure that I would want to treat each patient with adiﬀerent strategy than the others.My question is: How can you describe this patient's physical presentation of grief in terms of the directional, elemental, energeticlanguage that we use when we diagnose with Saam?Please share your thoughts and any other ﬂavors of grief that you have seen.JPEG | 5.7 KUnknown ReplyDaniel SchulmanNewApr 191ReactRecently , a long standing patient of mine (I have seen her for probably two decades, her daughter (whose son is named after me!),her sister . . . . she is now in her mid-60's . . . her husband of 45 years died a few months ago . . . she was in very deep grief . . .when she came in it was so clear - she has literally lost such a big part of herself, she was lost and she looked truly lost . . . . and ithad been making matters worse that most around her were 'trying' to get her to 'move on', to distract her, etc . . . when she reallyneeded more time to adjust, adapt and integrate . . . . . it occurred to me, all things considered . . . what she needed most now wasa consolidation of self-love to give her the fortitude to process the loss and become intimate with an entirely new orientation towho she was . . . . so I gave her a Ki+ treatment. The results were quite radical . . . she slept for days, felt much more grounded andwhen she returned to my clinic a week later, appeared to be an entirely diﬀerent person.

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2 teacher remarks2 replies 2TuriyaSI+ dynamic of treating wind conditionsNewApr 171ReactQuestion for teacherI'm having a hard time understanding the dynamic of how SI+ treats wind conditions( itching, muscle cramps, dizziness,etc). andhow it ﬁgures as a counter balance for Kiexcess which is about consolidations. ReplyKristin Wisgirda  NewApr 18ReactGood question.In my experience, SI+ works for windy conditions only in the presence of K excess overconsolidation or blood stasis.The windy quality is qi out of right relationship with blood/yin. Something is causing the qi not to be housed in the blood/yin.Blood stasis is just one of a number of possible mechanism for wind.It is also helpful to note where the windy quality is- which channels and locations.Hope that helps.Kristin Wisgirda The Price of Cat FoodNewApr 141ReactYesterday, a patient returned for a second visit. He got 3 weeks relief from his general body aches from his ﬁrst visit a month ago. Ididn't use Saam on him then because I just wasn't sure. His outﬁt was slovenly with his enlarged belly hanging out of a junky t shirtpaired with gaudy crocs and a bad haircut . He is cursorily polite but a little aggressive, with an air of cold entitlement. Not overtlyrude but rude non-the-less. His responses to questions were dull, self satisﬁed, over conﬁdent, and lacking curiosity. In his 40s,married, no kids, no varicosities, neutral temperature. Works as a night security guard. Disliked my inquiry into his lack of physicalactivity. He complained of muscle knots and tension but his ﬂesh felt lax and open.Yesterday, his aches were back with an emphasis his right shoulder. He went on and on about the price of cat food and his cat'seating habits- a subject he expounded upon at great length at the ﬁrst visit.He settled well with SJ+ and his shoulder felt much better. Now I will be less distracted by open ﬂesh in someone who is sootherwise Liver excess.Do you have any favorite Liver excess signs from your clinic? Other memorable stories from my clinic include-a woman who told me everything she ate for the past week including ingredients and cooking methods-the woman came back from Iceland but could only talk dully about how much she liked the bread there.

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3 teacher remarks1 reply 1JPEG | 2 MIMG_3137ReplyGeorge MandlerNewApr 141ReactKristin - Your headline caught my eye as yesterday I was saying to one of my cats - this 5.5oz can costs $4.50 it is more than a lot ofpeople can aﬀord for food. (it was grain free rabbit I accidentally bought). From my cat's expression I don't think she cared.On Monday I had my most profound SJ+ supplementation for someone I was not thinking LR excess on the ﬁrst two session. Thisis a 52yo woman who in 2018 was sideswiped in an MVA and got whiplash. She had 6 kids between the ages of 26-34. She has aheavy energy to her, overweight that it looks like water in her tissues. She is reserved but is quiet, polite and soft spoken. She runshot but not visible heat signs except several hot ﬂashes per week.She has been to PT, had a dozen (yes 12) cortisone shots, went to Chiro down the road who referred her to me. Pain is to the leftof C3 and palpating I can clearly feel a rotation in C3 also the muscles along the BL channel are knotted in the C4-C2 area on left.She said her head 'locks' several times per day where she has to move it a little to unsnap it.First Tx: I did not have a clear Sa'am picture - thought to do SI+ but not enough blood stagnation signs nor surgeries. Her scaleneson the right were extremely painful to touch. I did some local motor point to release the scalene. I did a Tung Tx afterwards Thescalenes were softer but it gave her a headache and no change to neck.Second Tx Monday: I thought OK let's go SI+ because of the accident even though it was not a huge jolt. No change when Ipalpated her neck. I then looked at her eyes and said to myself "wow they are withdrawn". OK she runs warm but I just feel sheneeds SJ+ to at least lighten her energy. I took out SI2/3 and replaced it with SJ3/2. Immediate release to the neck. I couldn't'believe it. The knot was gone. She even smiledThe lat couple of days I've been wondering if it held. She just came in and is on the table now. I can palpate much further and nowfeel that only GB20 and GB12 is tender with a slight tenderness on the left C3 process. She stated this is the ﬁrst time anything hasgiven her relief. And I know this is not conﬁrmation bias as she was clearly lighter on her feet and laughing a lot.Wow - so grateful for Sa'am - this is one of those memorable treatments where I think "it is incredible how the body can respondto 4 needles placed in precise locations".Today's treatment I supplemented GB+. The pain at GB20 and GB12 were gone immediately after needling GB44-. I had herpalpate to check and she was quite astounded. I did not feel SJ+ was warranted again as she was noticeably lighter and again,maybe conﬁrmation bias, I think her eyes were brighter. But GB+ makes much sense in terms location in the pain. Also her talkingabout the "locking up: of her neck made me think about opening up. And she seems like someone that could get walked on a bit. Imissed this the ﬁrst time as she is not very talkative.If I had better Sa'am radar the ﬁrst 2 treatments I could have seen the LR excess. And not so much a PC excess but perhaps morea GB deﬁciency.Adina KletzelNewApr 24ReactGeorge Mandler,Kristin Wisgirda

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6 more comments 6Reply@Kristin Wisgirda @George MandlerThese are great case example! Thank-you Kristin and George!I have a Liv excess patient who has the most typical Liver excess body I have seen so far. Her body is completely dense - there isnowhere that you can get in between her ﬂesh. It is all one thick and dense mass. Her walk is heavy and you can even here a clunkwith each step. Her eyes are also dull 8+.HEr energy is also heavy and feels weighed down.She comes in and puts her things on a small space in front of the water pitcher and clock instead of the basket right next to herchair. She leaves her phone on for the entire treatment and does not seem at all bothered by the noisy whatsapp pings and theintruding phone calls during the treatment. After treatment she often forgets to pay and usually leaves one of her belongingsbehind.Her shoulders are tight and constantly painful, she has tinnitus, and has chronic UTI's.THese symptoms are consistently helped by SJ+ but I need to repeat the treatment once every few weeks. I have played with theidea of double SJ or draining Liver but she is 74 and so I am very hesitant.MariaHeelsNewApr 12ReactHi KristenI took some pictures of heels because I wanted your opinion to the grading as to the ﬁrmness and dryness.Patient X: I took pictures of both heel because I've noticed on some patients, one heel looks better than the other. Actually thispatient, both heels look about the same.Patient Y: She has some serious varicose going on, but her heels seem hard to me.Both patients walk barefoot quite a bit. I would love to hear your thoughts about these.Thanks!MariaJPEG | 1.4 MJPEG | 1.5 MJPEG | 1.7 M

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4 teacher remarks4 replies 44 replies 4right heel of pt. x20220326_142013left heel of pt. x20220326_142003patient Y20220331_163621 ReplyKristin Wisgirda  NewApr 13ReactThanks for the pictures.Barefoot loving patients do make it harder to evaluate dryness. I try to get a feel for how often and under what conditions they arebarefoot and calibrate my ﬁndings from there. If it is too confusing then I accept that I don't know and try to base my diagnosis onother ﬁndings.My weighting of medial heels ﬁndings is just based on the range of heels I have seen. I hope Toby gives us more guidance withpictures.When the dryness creeps up the sides, like in these pictures, I deﬁnitely give some weight to SI excess.Patient X has varicosities 2-3. On both feet the posterior aspect of the heel is ﬂatter and less ﬂeshy. I wonder if there is a pocket ofﬂuid in the more anterior part of this area masquerading as ﬂesh. The wrinkles on the left look like they could be full of ﬂuidrather than being normal ﬂeshiness.Patient Y's legs and feet have lots going on. All those varicosities, a signiﬁcant sunken area above the callus. Looks like Y's legs andfeet have extra ﬂuid too. Is it the callus that feels hard to you? A hardened callus isn't plump ﬂesh that is characteristic of Kidneyexcess heels. ReplyLynda B. DanzigNewApr 21ReactThese pictures are great!im wondering about Patient Y and age. I remember your caution to using SI+ with elderly. Can you give some guidance with whenyou have used SI+ for folks over 70?Pt.Y has a light sheen to both legs more so on the L. I’m thinking it is from a superﬁcial ﬂuid accumulation ? Maybe just the photo?Also it looks like Ki2 area on L is blanched.MariaEasy bruisingNewApr 12ReactI have a case that I'd like some help with:74 y.o. male, still working as handy man.cc: L groin pain, hip pain and low back pain.Secondary complaint: easily bruised and thin skinPair Findings K excess: good symmetry, ﬁrm heels, varicose veinsSI excess: easy bruising? (I see this as a lack of consolidation but could there also be other reasons for bruising?)ST excess: ﬁnancial insecurity (still feels like he has to keep working)LU excess: dry skin 3, thenar 5, slight belly fat 1

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2 teacher remarksLV excess:SJ excess: bright eyes 8, engaging, perfectionist, hard on self, light tissue densityH excess: midline is slightly ﬁrmUB excess:GB excess:P excess: walks away from confrontations, keeps things inside.LI excess: dry skin 3, LBP (UB 25)SP excess: UB 25 pain, sweet cravings 8, former alcoholicFor the groin pain, hip pain, LBP, he responded rwell to LV+, LI+, SI+, GB+.I am now working on the bruising of his arms. He gets scraped or bruised easily just brushing up against something. The bruisingis all on his arms, (none on the legs. They seem to be mostly on SJ and LI channels. Is bruising easily a sign of SI excess? I includedpictures just in case they might be helpful.Thank you.JPEG | 1.7 MPicture of heels20220409_161348JPEG | 1.9 MLeft arm20220409_161330JPEG | 1.8 MRight Arm20220409_161320JPEG | 1.7 Mlower leg20220409_161359Kristin Wisgirda  NewApr 12ReactThanks for the case. Extra thanks for the pictures- they really do say a thousand words.With a case like this I would ﬁrst rule out medications and have him check with his doctor to rule out other conditions that aﬀectclotting.

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2 replies 2ReplyMost likely it is senile purpura, which is bleeding under the skin due to fragile vessels.While it is tempting to look at bleeding due to fragile vessels from a western point of view and conclude that in Saam it is a sign ofSI excess, it is more helpful for me to consider the other possible factors too.I ﬁnd Sharon W's teachings on the 3 causes of bleeding really helpful.Qi xuHeatBlood stasisFor the purposes of this case, based on your info, I can loosely translate these intoQi xu- SI and Stomach excessesHeat- SJ excessBlood stasis- Kidney excessBesides heat, SJ excess also has an aspect of too loose and open that could help explain easy bleeding.It looks like K/SI and SJ excesses are the strongest presentations.While it is always important to note channel location, in this case I think it can be at least partly explained by extensor forearmscoming into contact with more stuﬀ more often than other areas.For other cases there might be other possibilities too.Let us know what happens. Thanks.MariaFrozen ShoulderNewApr 8ReactI have a 44 y.o female patient with R frozen shoulder. We've been able to reduce the pain with SAAM but there has been noimprovement with ROM. She can't lift her arm up unassisted. There is no strength in the arm.K excess: Pretty, ﬁrm heels, self content, pain along SI/KSI excess: no varicose veins, pain along SISJ excess: bright eyes, muscles not dense, open personality, pain along LV/SJLV excess: not a perfectionist or detailed oriented now but professed to be when she was younger. pain along LV/SJSP excess: soft and mushy arms, not too many hobbies, pain along LI/SP, face looks oily.LI: dry 2 in arms/legs, pain along LI/SPST excess: ﬂat belly despite being overweight and mushy . Her stomach looks a bit like a deﬂated balloonLU excess; dry skin 2 in arms/legs, face looks oily, good energy,H:UB:I have treated SI, LI, LV.Thank you in advance for your input.

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1 reply 1ReplyIt is also interesting to think about the dynamics of H/Ub in someone with a combo of K and Liver excesses. Heart excess love forothers won't necessarily soften narcissism. Love for others isn't the same as open awareness of others.Melissa RathboneTreating painNewApr 6ReactI feel a little stuck when it comes to treating pain, esp if the ﬁrst couple of treatments don't seem to have much aﬀect. Presenting acase as an example, would love your input.64 yr womanCC1 - sensations of pinching, numbness, tingling, chills, itchy skin. come and go all over body, attributes them to ﬂare-ups postlyme diagnosis and treatment in summer 2020CC2 - pain along SJ / S Int channels, Right arm, injured in a fall Oct 2021Appearance/demeanor - friendly w/ some reserve, neatly dressed with some clear attention paid to style, eyes bright +4,inquisitive, moves above in her chair (she's petite and my chairs seem a little uncomfortable for her)Lifestyle - Newly retired librarian. Manages stress with Qi gong, exercise. Resources - moderate, some concern re: ﬁnances but hasa second home in CT, seems secure ﬁnancially. Husband having hip surgery the week she ﬁrst came to see me - alot of stressthereBody morphology - Some"fog",Petite with average weight. Pointed out bags under her eyes.Skin - moisturizes daily. gets some redness marks on skin with pressure (leans on arm - get a red welt at place of pressure, lastsfor an hour or so, doesn't feel particularly painful or hot). skin can be itchyBody temp - prefers it warm but not overly cold. No cold H /FtGI - had St upset at time of retirement (Pandemic hit right when she retired - big transitional time). No major GI issues now. canfeel bloated.Sleep - "situational" has been poor recently = stress, then sleeping on couch as husband recovers from surgery.Emotions - seems nervous but open to treatments. Describes a general feeling of being "unwell", foggy head.Body - some dark spider veins on lower legs, heels ﬁne - not particularly dry or withered, slightly tight at L ribside, thenars ﬁneExcess presentations:Ht:UB: runs slightly coldGB: occ insomnia, moves around alot

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7 teacher remarksPC: actually was a librarian but no real excess PC signsSJ: bright eyes, sensitive to surroundings (light, sounds), pain along SJ channel,Liv:Lu: Dry skin, fog, bags at eyes,St: some numbness, concern re: ﬁnances +2Lint: Keeps busy +3SP : fog, some numbnessSint: pains that move around body & come and go, pain along Sint channel, itchy skinKid: good self-care, heels ﬁne, some dark spider veins along lower legs, pain on Sint channelGTITR: nervous aﬀect, moving around alot, concern re: pain at arm not changing1st treatment: Sint + on L. Pinching pains reduced in frequency and severity, felt a "clearing" overall (she couldn't really describe itmore but said it was positive). R arm pain unchanged.2nd: Liver+ on L. very relaxed during treatment, felt a throb at R arm initially when needles were inserted but it went away duringtreatment. After reported feeling calmer and the continued reduction in pinching / lyme related symptoms. No relief with R armpain.Having treated the channel pairs associated with the arm pain (S Int, SJ) I'm not sure what to do. She strikes me as SJ excess so I'mhesitant to +SJ, esp since she relaxed with Liv. I am also hesitant to +Kid because of the itching and I don't want to consolidatepain.Not sure what to do next... thanks in advance for your input!! ReplyKristin Wisgirda  NewApr 6ReactThanks for your case.Does anything make her chief complaint better or worse? Anything interesting about events around her right arm injury?Something is going on on the surface.<GTITR: nervous aﬀect, moving around alot> Is the moving around a lot from a speciﬁc discomfort in your chair and/or is there anerratic GB excess quality to it? What is the quality of her movement and her speech?How dry is her skin? How much fog is there? What is her belly like- bloated, midline? Any special qualities in the tissues around herright arm injury?I am interested in the damp dry dynamic. With the numbness and fog there is room to dry.Melissa RathboneNewApr 6React<Does anything make her chief complaint better or worse? Anything interesting about events around her right arm injury?>Exercise makes her CC better and stress seems to make it worse. The arm pain (which seems to be shifting to her CC1) seems toremain the same. I'll ask more about the fall that caused the injury - she didn't oﬀer up a lot of details about it.I think the moving around is mostly due to my chair, her feet don't quite reach the ground if she sits all the way back and it lookslike it makes her uncomfortable. Her movement quality is pretty unremarkable otherwise, it's not hard for her to be still on thetable.

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1 reply 111 more comments11ReplyShe is quick to ask questions but the tone of her voice is moderate - she's not a loud talker, I don't get much sense of GB excessfrom her.Her skin is mildly dry - she does moisturize every day but that seems suﬃcient, it's not cracked or wrinkly. Fog is deﬁnitely present,there's a softness to her ﬂesh below the skin. She says she feels like she's carrying extra weight but she isn't overweight.Nothing remarkable about her midline but I will check again, I will also look more closely at her arm.I was thinking there might be room to dry as well but was unsure given that there is some dryness to her skin.Thanks Kristen!2 teacher remarksMarika ChandlerTonifying LU with cough and Nausea?NewApr 5ReactI have a patient, 36yo female who has a persistent cough following a recent cold. She has gotten these coughs for most her lifewhich linger for weeks. It feels like a tickle and keeps her up at night. Always worse when she lays down. There is some post nasaldrip contributing but otherwise she is not very phlegmy and not much mucus is coming out. In the past she always has a prettythick tongue coatbody type ST excess type 9+ she is VERY thin (without trying) and has an oily scalp, moist skinGB / PC- occasional diﬃculty sleeping but doesnt seem overly aggressive or overly inward (librarian) she is a go -getter type somaybe leans a little more towards GB+LU- persistent coughLI - 7+ very motivated, do-er, likes to work and has many projects goingHt- her personality is warmSJ- Sj excess 7+, polite, bright eyed, detail oriented but this doesnt call out too much to memore Kd excess then SI- well groomed, symetrical* She had heart surgery as a 2 year old and has a large scar following the edge of her left scapula. Not sure if this is signiﬁcant butthought I'd mention.Since our last treatment she is pregnant and is now feeling ﬁrst trimester nausea. So, even though tonifying LU seemed like a goodidea considering her body type and the cough I'm now concerned that it could increase the nausea.Would love your thoughts.Kristin Wisgirda  NewApr 6ReactThanks for your question.

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1 reply 1ReplyClinical experience makes T really rely on ST+ to relieve vomiting- for this reason is very hesitant to use Lung+ in a vomitingpatient. But nausea isn't the same as vomiting. Vomiting has a clear up motion. Nausea, by itself, is better described simply as adisruption of qi in the location it is found in.Tendency to vomiting or other uprising symptoms- like reﬂux with a sense of uprising- would make me want to avoid Lung+.Otherwise, I would strongly consider using it based on the information you provided. ReplyMarika ChandlerNewApr 6ReactThank you that is very clarifying! I hadn't thought about the diﬀerence in Nausea and vomiting in that way.Kristin Wisgirda 2 Day Live Internships with TobyNewApr 51Reacthttp://www.ﬂourishmedicine.com/about ReplyShannon Larson NewApr 11ReactNuts. If I wasn't going to Amherst this summer for the pulse course I would totally do this. Sigh. Can't do it all.Adina KletzelSI/Kid for Kid channel painNewApr 4ReactHI,I have a 49 year old male client who had pain on the Kid channel on the medial side of his ankle which the doctor has said isplantar fascitis.The pain is worse after he walks a lot and stands on it a lot. It started after taking a trip and doing a lot of walking.Since it is on the Kid meridian I am considering using SI or Kid but the choice is not fully clear to me.He is 49 but his hair is 70% grey - although it is a full head of hair.His face is quite wrinkled - especially around his eyes.He has a lot of joint pain which ﬂares up more after he does too much lifting or other types of exertion.He talks a lot and seems conﬁdent but not pompous or way too into himself.Symmetrical 5+. He would look more symmetrical to me if his face did not seem so old looking for a younger man.Well groomed, neat and clean.medial heel - ﬂeshy 8+ ( he is average weight)When his foot does not hurt him he runs 10 K twice a week. He does not love it but does it because he feels it is good for him.Other signiﬁcant information is that he had bells palsy twice - once when he was 6 years old and once as a teenager. I thought thatwas pretty extreme to have at such a young age. You can still see a little droop on the left side of his mouth. His whole demeanorand body energy seems a bit saggy and droopy - like it's not held up well.So even though I would usually go to SI+ for a middle aged man who seems pretty put together, there is something about thisman that seems older than he is - his look and his achy body that seems to fail him upon too much exertion.

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4 teacher remarks1 reply 12 replies 23 more comments3I would love to hear other's takes on this case and whether there is something here that I am not seeing.He is also SJ excess (did Liv + ﬁrst treatment and has some GB excess attributes).Saam ChartGB assertive decisive takes over/pushy outward energy pain on GB mer. does not sleep deeplyPCSJ bright eyes aware of details aware of envir lighter energyLivKid pain on Kid mer ﬂeshy heels seems sure of selfSI looks older than he is pain on Kid mer.Bl feels cold not loving, more stiﬀHtLI on skinnier side with dry skinThanks ReplyKristin Wisgirda  NewApr 4ReactThanks for the case. My tendency is to give weight to such impressions. However, some of the details you mentioned could be partiallyattributed to dryness- eg wrinkling.<he runs 10 K twice a week. He does not love it but does it because he feels it is good for him.> Does he seem to push himself beyondwhat is good for his body? If so, I give this kind of behavior some weight to SI excess lack of self love.Reading your case, I probably would let my clinical experience with similar cases guide me to K+. ReplyKristin Wisgirda  NewApr 4React<some of the details you mentioned could be partially attributed to dryness- eg wrinkling.>Drier skin wrinkles more easily than moist skin.I have 3 cases of people 40-50s who have good grooming, pretty good symmetry, who have PF from overworking their bodies inpursuit of "ﬁtness". One woman walked 8 miles while she was having pain, thinking that would "work it out". That is self abuse.Their PF responded really well to K+. They looked a little worn out for their age. What they don't have in common with your patientis their medial heels which were withered, unlike your patient's.Adina KletzelDoes Saam cover sinews, divergent, and Eight extra?NewApr 3ReactHI,

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2 teacher remarks1 reply 11 more comment1Gabriel Sternnon mirrored self treatmentNewApr 1ReactI ﬁnd it diﬃcult to needle my dominant side (right), and that only increase when there are already needle in my left hand. wouldsame sided sequential treatment be a reasonable work around in your option (eg. SI+ on the L +/-20 min retention, pull theneedles, then do HRT+ on the Left for another +/- 20 min)? ReplyKristin Wisgirda Apr 1ReactI'll have to ask Toby's opinion on this one. One after the other versus both at once.Jun Koo Youn, the author of The Practice of Saam, seems to practice this way regularly. However, his practice is not quite the sameas that of our lineage. ReplyGabriel SternNewApr 1Reactthanks for looking into it, ﬁgured Id do my due diligence before experimenting on myself.2 teacher remarks2 replies 2MariaBasic Question regarding toggling v. reversing treatmentsNewMar 26ReactI am uncertain about the diﬀerence between the toggling protocol v. counterbalancing an adverse reaction protocol. Can youplease clarify this for me? Thank you!!ReplyKristin Wisgirda NewMar 29ReactThanks for the question. What is your understanding of when to counterbalance an adverse reaction? What is your understandingof toggling?Alison Unterreiner, DACM, L.Ac.Extreme constipationNewMar 25ReactKristin Wisgirda

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6 teacher remarks3 replies 3Hiya -I have a case of extreme constipation I would love help with. The entire case study is very long and I'm not sure I should type it allout here, but I will give you the most important bits as I'd love any and all feedback.- Patient has CC of constipation - so bad, she will go 2-3weeks without a BM before having to manually remove feces herself. Hasbeen to ER with impaction multiple times. This is a long term issue, but has really become this problematic in the last 4 years.(Interestingly, when I asked if anything changed 4 years ago, she said nothing had, but later on in the intake, she said sheseparated from husband 4 years ago...so...)- Also has chronic pain - possible RA or ankylosying spondilytis - but basically has pain in all joints, bilaterally which is worse in theAM and with cold and better with movement.- Also has chronic sinus infections - up to 6x/year, yellow/green phlegmThe grossest thing in the room to me is something I sense, which I ﬁnd diﬃcult to explain, other than to say: I feel fear coming oﬀof her. Something happened in her past that involves physical and sexual abuse that she did not talk about further. She has PTSDfrom it. She is unable to sleep for more than 2-3 hours a night from the PTSD and pain.Her body type is round with a large, ﬂaccid, soft, cool to the touch abdomenSo knowing all of this, I've been trying to come up with a sa'am treatment for her, but I am conﬂicted:Constipation = SP xs = LI+, which is drying her out and it sounds like she is dryyyyy internally, so I don't know if this is a good idea.GTITR = Fear = UB xs, so we would add HT+, which is ﬁre/heat - I'm not sure with so much internal heat this is a good idea...?Trauma and chronic pain = SI xs = KID+, but is that to consolidating?Let me know if you need more information, but would love to hear thoughts.Thank you!Alison ReplyKristin Wisgirda NewMar 25ReactThanks for your question.We deﬁnitely need a full case. UB+, GB+, Lung+ and SI+ have been some of the really eﬀective treatments for my most severelyconstipated patients. Constipation is one of those many symptoms where just about any channel could be used.Knowing if she has the urge to have a bm would help. I also want to know if there is any numbness or reduced sensation in herperineum from trauma or any other reason.<Constipation = SP xs = LI+, which is drying her out> I don't understand this statement. Have you diagnosed Spleen excess and youare using LI+?GTITR = Fear = UB xs, so we would add HT+, which is ﬁre/heat - I'm not sure with so much internal heat this is a good idea...?>How do you know she is really dry internally- is it because the stools are really dry and hard? How do you know there is lots ofinternal heat?

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3 replies 35 more comments5ReplyMelissa RathboneNewMar 30 | EditedReactThank you for this example Kristen! I have a couple questions re: why you chose Lung+ with her<She only got uncomfortable on day 5/6 of not having a bm and would use a laxative. She reported that her stool was not dry andthat the laxative didn't create loose stools at all. She considered this normal for her and not a problem.>Is this what lead you to Lung+? It seems to me that the laxative not creating any looseness would point to internal dryness whichwould support Lung +.She had a St excess body morphology but good resources - would you say these 2 signsbalanced each other out?Did the grief for her mother also point you to LU+?Kristin WisgirdaKristin Wisgirda More Eye Pics from NaomiMar 25ReactI moved these from another post so everyone can ﬁnd them easily.Naomi requests your 2C.Thanks for sharing Naomi!JPEG | 1.6 M2A799FA8D5E04DDD9AD4EAFE…JPEG | 1.7 MC8CA8E5F78D449F287B4B3E6A…JPEG | 1.5 M42207EAB7DBB4CAF8209E15C5…JPEG | 1.9 M893B874703F04C9F9A268790DE…

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6 teacher remarks1 reply 114 more comments14JPEG | 1.6 ME7E4EB99942C4767B9283CC90…JPEG | 1.9 MBE0AC052FE26473F924DA1E7D… ReplySharon WeizenbaumNewMar 25React@Kristin Wisgirda Hi Kristin, I have a patient whose eyes are very striking and at the same time, confusing for me. He has beengoing through a very manic period and was hospitalized for mania. When he looks at me, it is with such intensity and he leans in. Ifeel invaded. At the same time, he is somewhat rude, disheveled, even smelly and his eyes have a striking wooden quality to me.Like dead wood. There is a convex angry quality as well. Last time I supplemented PC. I want to supplement SJ but am ﬁndingmyself doubting liver excess because his stare is invasive - which makes me think of SJ excess….though he thinks that Tich NatHahn's spirit is reincarnating through him, with other manifestations of spiritual gradiosity, he is not monk-like in his demeanor.Any thoughts? Thank you for your ongoing supply of wisdom.Kristin Wisgirda ReplySharon WeizenbaumNewMar 25ReactThank you!I would ask myself- how much is he actually aware of me and the present environment? How bright and clear is thatawareness?Very helpfulLiver and SJ for me are about qualities of awareness. P and Gb are about qualities of action.Also very helpful.I now feel that I can comfortably supplement SJ! He is unaware of others.1 earlier comment 3 teacher remarksAdina KletzelLI/Sp damp and dryMar 21ReactHI,I am running into challenge in the LI/SP channel pair.I see people with a lot of ﬂesh with dry symptoms and people with barely any ﬂesh with damp symptoms.In the Intro class Toby stressed that the amount of ﬂesh a person is a strong indication for damp versus dry.Is the amount of ﬂesh a person has a primary indication for LI or Sp? Is that one of the key things we should be looking at?I don't ﬁnd that always holds up in the clinic.I feel like a class just on successful case studies supplementing LI or SP and pointing out for sure damp and dry in the body wouldbe SO helpful....Naomi FrankMar 22React

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1 reply1 reply 1ReplyI am treating a very petite woman who ﬁrst came for grief and loss of appetite, then we turned our attention to hormonal acneand headaches.Over the last 6 months I’ve used Lu+, GB+, Lv+ (bad reaction - I posted about this), SJ + and eventually LInt +. She’s very responsivein general, but it took me ages to ﬁnd LInt for her because of her physiqueBesides the acne it was a sense of lethargy that was the big clue. At the begin this was quite bound up with the grief from hersister’s death but eventually I saw that it was a general trait.We might have a thread on this somewhere but I ﬁnd that questioning about GB excess and Sp excess are the most diﬃcult to get‘true’ answers. ReplyShannon Larson NewMar 282React@Adina KletzelI have found the LI/SP, ST/LU axis to sometimes be less straightforward. I always start with morphology but I have learned to keepan open mind.I have a patient I talked about in Toby's advance class who is super skinny. She struggles with extreme exhaustion and sometimesanxiety for 4 years.. She does have acne and when her forehead gets greasy she usually get super exhausted. She is also verythirsty and has dry eyes. You would think LU+ is screaming for attention. I tried it early on and it makes her feel awful. ST+ didn'tbalance it out either. Eventually I ﬁgured I would try LI+ and it is magical for her. It makes her feel like she has been given an IV.Her forehead clears up, She has energy, her eyes get LESS dry, she is LESS thirsty and she gets her appetite back. I have even done2 partial drains of SP on her at the full moon and it works even better. It's a head scratcher. All I can think is that there issomething damp and sticky that is keeping her from absorbing. I have obvious tried other things and will write this case upbecause it's been a great learning experience for me. All this to say there are so many layers with SAAM.Adina Kletzel9 earlier comments 5 teacher remarksKristin Wisgirda Lung 8Mar 14 | EditedReactHopefully many of you were able to attend the point location call on Qiological this weekend.Really all of the Saam point locations are the same as Deadman locations except Lung8 and Lung9. Toby ﬁnds Lung 8 distal to thestyloid process of the radius. Saam Lung9 is also slightly more distal than the Deadman location of Lung9 which is level with H7and the proximal border of the pisiform bone. I'm not sure if Toby's presentation made these diﬀerences clear.Naomi FrankMar 16ReactThanks for the tip about needles @Gabriel Foucreault-Boisclair. I @Kristin Wisgirda I could have sworn that in the intro class I remember Toby say that he starts more perpendicular and thenangles the needle once he feels Qi. But in this class he was saying the opposite. That left me confused because unless you arefeeling Qi right up near the surface, wouldn’t you needle a little bit away from the point if you are going in at an angle as he isdoing (but he did say that he inserts the needle right at the point)In any case, I ﬁnd that with certain patients I can feel Qi quite easily and in others I have to work quite hard. This is consistent withhow people are in general, but it does make me wonder how much my needling needs improvement!I would love to get a SAAM treatment from anyone other than myself!Gabriel Foucreault-Boisclair,Kristin Wisgirda

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1 replyReplyReplyNaomi FrankMar 17 | EditedReactAbsolutely yes, needling perpendicularly meant having to retract the needle to then angle it, so I do what you do.Besides this bit of confusion it was a super helpful class. Thanks for suggesting it. I’d love the videos to have been a bit closer upbut really it was great being able tp see them over and over and hear the discussion.1 earlier comment 2 teacher remarksMariaBasic QuestionMar 11 | EditedReactI have a really basic SAAM questions1.) Do we always needle the Right side for LV/SJ even for male patients (unless of course the problem is on the Right side, then wewould needle the opposite side)? This question also applies to the LU/ST pair as well.2.) I have a scenario where I am a bit confused. If someone gets angry but does not have the aggression to confront the otherperson face to face, and instead explodes at home by slamming doors and throwing things, this seems like it is P excess but thereis also pent up GB aggression as well.ReplyMariaMar 11React<If nothing contralateral: liver on right> Just to be sure, if there is nothing out of the ordinary, we needle LV+ on the Right for malepatients.ReplyKristin Wisgirda NewMar 12React@Maria YungIf a male patient has bilateral or left sided symptoms/gross ﬁndings and SJ excess, we needle Liver+ on the right.If a male patient has right sided symptoms/gross ﬁndings and SJ excess, we needle Liver+ on the left.MariaMariaRochester NY Anyone?Mar 11ReactAnyone practicing in Rocherster NY or nearby?

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Kristin Wisgirda Case Study Call Link DiﬃcultiesMar 11ReactThanks everyone for letting me know that you were having trouble ﬁnding the link to the calls. Emile on the WPC tech teamprovided some insight. His system log says that everyone who registered was sent 2 emails with the link to the call. He suspectsthat these emails are getting lost in inboxes or sent to spam folders.Unfortunately, there is no way to put the link in a centralized place on the WPC page or our page here. So we are going to have torely on the emails for now.If you have checked your spam, trash and inbox folders and are still having problems please do contact Emile atemile@whitepinecircle.orgHe is always really responsive and helpful. If folks keep having problems, we will ﬁnd a way to restructure the call logistics to makeit work.ReplyNaomi FrankMar 13ReactI did receive the email. But with most WPC events that I register for, I also receive a text message with the link, shortly before,which makes it easier to ﬁnd.When you are enrolled in both GMP and WPC, sometimes those emails come thick and fast and it’s hard to locate the right one.I wonder though if it might be our individual settings in Canvas. (When I’ve tried to customize these it is quite confusing)Kristin Wisgirda Kristin's Smoldering Heat CaseMar 10React58 year old womanChief Complaints: Severe Insomnia, Heat Intolerance and Hot ﬂashesOther complaintsBody Observations:Sleep disturbed by general heat punctuated by hot ﬂashes for past 3 years- most nights 2-3 hours sleep4-5 hours a night is decent sleep (happens 2x week when she crashes)Sleeps in cold environment- max AC + fan, cooling sheetsMedications for sleep: trazadone, magnesium, CBD, occasional THC helps sleep but makes groggyHot ﬂashes: sporadic during the day, become severe around 7pm at night, sweats can be drenchingExhaustion: saves energy for work and only the necessary house chores, no energy for socializing or other activities but does walk and gardenWhole body itching- with sun exposure or heat exposure (cooking) that leads to sweatingrelieved by ice water and cold showersEpigastric “sour” discomfort- feels hot; occurs if doesn’t eat homemade yogurt every 2-3 days, yogurt cools and soothes; can occur with diarrheaGYN: 1 child, partial hysterectomy 1992Lifestyle/behavior: Executive assistant, happily married, opinionated, expounding on her strong faith and philosophy lacks warmth; superﬁcially politebut hard to get a word in, I don’t feel like my questions are always answerednormal weight, dense ﬂesh 5+ with overlay of fog 4+skin- moist but moisturizes; acne scarring on face, acne managed by spironolactone; slightly warm to the touchComplexion- healthy glow, hard to evaluate additional redness because of dark skin; eyes neither clearly bright or dullMedial heels- minor varicosities 2/10, plump 2/10Thenars: full 6+, ﬁrm 5+; average rib cageGood Grooming 5+, stylish dresser, symmetry 4+, looks 10 years younger than age

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5 teacher remarksGTITR: Self assured and opinionated; I’m going to tell you how it is; under control and put together, on itOvertime more aware of a disconnectTX1-7: UB, SI, Liv, ST (+St36), P, UB, UB+ SITx 8: Presents with right sided back pain for 2 days, left upper eyelid stye (red and swollen); paraspinals dense 9+L SJ+Result: back pain- immediate relief, fully resolved in 24 hours3 weeks later reports few ﬂashes and slept undisturbed by heat, until previous week when had 3 nights in a row of disturbed sleepfollowed by nights of undisturbed sleepStill heat intolerant even though feet are freezing to the touch.Repeated SJ+ on rightOk response. Immediate increase in restful nights 7+ hours of sleep, gradual reduction of nights of <3 hours of sleep; most nights are still disturbed bystrong heat; not keeping track of hours/night because that puts too much focus on sleepLittle change in heat intolerance but some reduction of hot ﬂashes; energy gradually improving; Hot ﬂashes somewhat less, no longer having thepredictable after supper heatSour stomach- less often by still thereJPEG | 862.3 KEmbers_01Adina KletzelMar 14React@Kristin WisgirdaThis was a really great case. It added a whole new understanding of Liv excess and opened up the option of using SJ+ even whenthe patient is very hot. Thank-you so much for sharing!I am considering using SJ+ for one of my patients who has "smoldering heat" with main complaint being migraines.Liv excess symptomshard to reach - she is very friendly and social but when it comes to answering personal question she slips behind a wallcomes late to appointments all the time and barely apologizesarea on temples where gets headaches is very dense - it is like a feeling of rocks sticking out (may be SJ mer.)lower back area is dense as wellSJ excess symptomsKristin Wisgirda

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1 earlier reply9 more commentsReplynotices details - notices all changes in my home and clinicgeneral body more openeyes bright 4+polite (but seems forced)Absolutely LOVES the cold, cloudy, rainy weather (she is always hot). has more energy in cold weather. 9+She has mixed reactions to when I tonify Liv - sometimes has a great week with no headaches and sometimes has a lot ofheadaches that week.Is it risky to tonify SJ with the bright eyes and more open body?Does the dense area where she gets headaches (on SJ channel) carry clinical weight?Thank-you. ReplyAdina KletzelNewMar 29React@Kristin WisgirdaIn TCM intense muscle cramping is usually a sign of LIver blood deﬁciency but in Saam muscle cramping can also be caused byLiver excess density correct? If a muscle is so dense then the blood can't ﬂow through smoothly causing cramping.Muscle cramping could also be caused by Sj excess as well in that if the muscles are too loose and open then the blood is notﬁlling it out enough causing the muscles to be dry and stiﬀ.Muscle cramping would therefore not be a for sure sign of any channel deﬁciency in particular. Does this sound correct?Kristin WisgirdaReplyKristin Wisgirda NewMar 29React@Adina KletzelSounds good. Other factors can cause cramping too- cold, dryness, wind, local channel problem.Adina KletzelKristin Wisgirda Marintha's Case Study Hour CaseMar 10ReactKristin's comments/questions are in italics(So sorry that tech problems on WPC end prevented Marintha from attending the call. I have contacted the tech department.)The Chef That Can’t Eat

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51 year old professional chef under high stress running a large kitchen. She works 12 hour days that begin at 4 amChief complaint: 1) insomnia +9 waking 2 hrs after falling asleep, sometimes up for the rest of the night, sometimes falls backasleep and then wakes again every few hours, (What’s going on when she is bed)2) alternating diarrhea and constipation +8 with abdominal cramping +8; lifelong history of diarrhea with abdominal cramping +8.Recently she has been alternating between dry, hard stool with incomplete BM and diarrhea.3) alternating extreme depression w/ suicidal thoughts and anger & irritability +9Appearance demeanor: whole body is red, red face and skin of the arms and legs +7. (Full ﬂushed red, or mottled red?)Flesh is dense +7. Lots of hair +8. She projects a sense that nothing is going to make anything better. Selfcare does not comenaturally – taking herbs or any supplements regularly feels impossible, cannot set aside time for exercise or time for herself +8.Grooming is decent. Eyes are dull +2Lifestyle: Works 12 hour days that begin at 4am. She unhappy with work, but feels she cannot quit. She struggles raising herteenage daughter. There is lots of worry and rumination +8. She does not sound happy in her marriageBody morphology: 20 lbs overweight +7. Flesh is dense +8Temp: does not report running hot or cold, objectively no marked temperatureFluids: not thirsty, forgets to drinkGI: This woman has no appetite +9 and seems to eat very little (weight loss?)Skin: dry +7, varicosities +8Resp: noneSleep: insomnia +9 waking every 2 hours or up for most of the nightEmotions: volatile, alternating with deep suicidal depression +9 and anger and irritability +9. She never presents as angry oraggressive and does not display extreme emotions. She laughs at herself as if there is nothing to be done about her situationFull thenarsNothing of note- medial heels, symmetryGrossest Thing in the Room: apathy juxtaposed with extreme, unchanging sypmtomsExcess presentations:Ht: red face and bodyUB: none (cold disconnect, any love for anything? depression)GB: angry & irritable +9 alternating erratic emotions and digestion symptoms +9 (erratic in tx room or self reported)P: noneSJ noneLiv: dense ﬂesh +7, dull eyes +2, lots of hair +8, depressionLu: overweight with dry skin +7St: noneLI: dry skin +7 with some dry stool(?)Sp: tends to ruminate and worry +7 (unproductive inward focused dark thoughts more consistent Liver. ) Overweight +7 (is 20lbsoverweigt a 7+). Nothing in her life sounds interesting or fun (but she is working such long hours- not consistent with Sp excess)K varicosities +8SI: suicidal +9, diﬃculty taking care of selfTreatments:I have been treating her for months without much aﬀect. Point combinations I have tried have been P+, SI+, K+, LI+ none of thesetreatments has made signiﬁcant change

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1 teacher remark1 replyI treated with GB drain the other week and that was the most aﬀective – there has been no abdominal cramping and pain since,bowels are not exactly normal, but there is no pain. Sleep has been slightly better, still up at least once per nightI treated her with ST+ last night to try and stimulate her appetite and with the hope that the descending nature of ST+ would helpthe insomniaConsidering UB+.(do you really want to pour cold water on depression) I would love to use SJ+, but I am afraid that it brings in toomuch heat. I would also love to use Ht+ with Kid+, but Kid+ on it’s own did not do much and I am worried about the red face andusing Ht+ ReplyMarintha TewksburyMar 121ReactThank you all so much for spending time with my case on Thursday. I could not for the life of me ﬁnd the Zoom link for class! I stillcan't ﬁnd it actually, but that might be a function of my over-crowded inbox. I will check with Emile at White Pine to see if there issomething amiss.Further clarifying the nature of Liver excess was SO helpful. There were so many reason's why I wanted to supplement SJ in thecase, all of which you all mentioned. In my mind, because SJ is listed as the 2nd hottest treatment on the spectrum of bringing inheat or cold in Saam, I was very worried about creating too much heat in this client. I have several Liver excess clients who are veryhot and I have struggled to treat them because of this aspect. It was also very aﬃrming to hear that over-rumination can beattributed to Liver excess. I have been trying to see worry and obsessive thoughts in Spleen excess clients and I just don't see it.Like Kristen said, my Spleen excess clients are too content or too bored to get wrapped up in over worry! Being able to attributeconstant worry and rumination to Liver excess is super helpful.I wish you all could have been in the room with me when I decided to drain the GB in this patient! She came in that day redder andmore ﬂustered than I have ever seen her. Like many Liver excess people, she has described extreme emotional states with a ﬂataspect in the past. This day she was clearly shaken and said she had had an intense outburst of anger at work and had had toleave the building and go walk around the block so that, in her words, she "wouldn't hurt someone". She was SO angry and felt outof control. I realize that I chose to drain the GB because, while none of the previous treatments had huge impact, I think I had asense that they were helping some. Treating Liver excess people is really hard. It is hard to get information out of them. With her,everything is always meh and unchanging. You are correct, Kristen, when you say that she "had no vision". I don't think she noticesif something is better or if there is change unless it is very dramatic. Small changes are not noticed by her. I was actually satisﬁedto see an extreme emotion in her. It gave me something to work with! But I think that I need to be careful with the idea that youhave to hit a dull, Liver excess person hard in order to aﬀect change. You just have to ﬁnd the right treatment. I think that I waslucky in this case of draining GB that I did not push too hard.Also aﬃrming was to hear that depression can be seen as Liver excess. That dense, dull aspect really ﬁts with what I see inchronically depressed patients.You are right that supplementing UB would not be great for her. I think that I was considering it because she was SO red (herwhole body) that day, but pouring cold water on an already hidden and dull person does not make a lot of sense. Although I wasnot able to articulate it at the time, I think I intuitively felt that that treatment would not be right and so went with ST+ instead. Ihave not heard back from this client regarding the outcome of that treatment, but will post the results when I see her next.One thing that came up for me in this case review, was that idea of overworking and the nature of Liver excess and Large Intestineexcess. I see someone who is Liver excess as someone who "endures", endures long hours and too much work. LI excess, in mymind, is someone who might work too much in that they have too many projects and things they are doing at once. Does thatsound right?Lastly, I am realizing that I have a hard time rating how overweight someone is when there tissue is dense. This is something that Iam going to have to pay attention to as I write up future cases.Think you all for your attention and insight.I really hope to be there in person for the next case review!

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1 reply1 reply 1ReplyCan you parse out if it feels like rumination over speciﬁc topics redundantly or just fear? Is there an overarching theme to these thoughts? Do the thoughts relate to trying to control or feeling out of control? How does it aﬀect mood - Does it create irritability and volatile emotions? Is the worry speciﬁc to an issue, or do you move from topic to topic where these endless thoughts occupy a large portion of yourtime? Are there any self-management techniques that are helpful? ReplyAlison Unterreiner, DACM, L.Ac.NewMar 25React@Kristin Wisgirda Would this line of thinking be applicable to anxiety and depression as well? I have tons of patients with "anxiety","stress", and "depression" as chief complaints and I never really know how to think about this in terms of Sa'am, so I usually skipusing it in cases like that.Kristin Wisgirda1 teacher remarkAdina KletzelCan an organ or condition be GB excess?Feb 28ReactHI,I have been wondering if an organ or speciﬁc condition in the body can be GB excess while the person's personality is PC excess?I will give an example. I have a PC excess patient who does brain research, is always calm - does not even like when his wife raisesher voice or slams the door, he likes calm peaceful interactions, he is rooted, and thinks carefully before making decisions.However, he has an enlarged prostate that is pushing on his bladder. It is convex and puts pressure on his bladder so that whenhe changes positions, has some gas or a full bowel he must run quickly to the bathroom. I view this as an aggressive prostate. It istaking up more space than it should in the lower warmer and causes all the other organs to shrink back and not be able tofunction well because of the pushing out of the prostate.So can the state of the prostate be considered GB excess and warrant the use of PC+ to help push the prostate back into its placeor can we only apply these attributes to personality and not organs or conditions? ReplyKristin Wisgirda Feb 28ReactConvexity in the situation you describe is more likely due to damp or blood stasis.To me, it is quite a reach to call this GB excess. If you have success treating it in this way please let us know.Kristin Wisgirda Liver Excess Dark ComplexionNewFeb 27ReactToby conﬁrms that this woman's complexion is Liver excess dark.So glad to ﬁnally have pictures to go along with the description. To me it looks like there is a ﬁne dull blackness that isindependent of normal pigmentation.Toby agrees that her eyes are 5+ dull.

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4 teacher remarks2 replies 24 more comments4JPEG | 156.4 Kimage 3IMG_6492ReplyKristin Wisgirda  NewFeb 24ReactHi Shannon, Thanks for the pictures. The more the better, especially with dark eyes.Before I chime in about the others: Is it just me or does #2 look extra photoshopped? They are likely all touched up but #2 lookslike another android. ReplyShannon LarsonNewFeb 24 | EditedReactI see what you are saying. Here is another one of her. Her eyes to me look brighter here. When I see her on TV I'm always thinkingpossibly dull but not so much here.Now that I compare her with photo #1, Photo # 1 eyes look quite bright to me.JPEG | 122.4 KIMG_6670Naomi Frankanxiety from loneliness, 72 yr old MNewFeb 14 | Edited1ReactQuestion for teacherCC: anxiety, loneliness/disconnection and a feeling of lack of control in his life (no friends, no money) 2nd complaint: debilitating chronic pain and neuropathy in hands/lower legs:low back and hips esp L side. Sleeps in recliner in last 2 yrs because lying ﬂat is uncomfortable. Sleep is worsening and is often awake much of the nightnumbness and tingling in hands: can no longer write /type - further isolating him

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Appearance and demeanor: gentle person, anxious energy, but when he becomes more comfortable he will respond to jokes andhas a wry humour. Although in pain and highly anxious his mind is very clear. There is a heavy sadness and quiet helplessnessabout him. Lifestyle: unlucky with employment & money - e.g. bookstore he helped to design closed; worked many years in low pay jobs thathe disliked. Paciﬁst who was in US army for a short time before injury. Body morphology and ﬂesh quality: tall thin frame, lax upper body muscles , lower body stronger. Was very strong as a youngman. Skin Quality: skin soft 8+ and seems well hydrated but not oily,; except on feet where he has dry skin/callouses and some ingrowntoenails that look a bit funky (can't remember which channels) Body Temp: average, dislikes hot humid weather; wraps up well in winter. Sweats easily (w/ anxiety) everywhere except feet. GI: poor appetite, loose stools. Hx of colitis which ﬂared recently and causes urgent loose BM, usually passes quickly. (has notnoticed mucous in stool, asked him to check) Respiratory: sinus congestion; allergies spring/fall = PN drip, surgery after pneumothorax that followed pleurisy and pneumonia.He spent > 6 months in hospitalshx "lung surgery leaving scarred and weakened lungs" (will get further details on this) Sleep: only 2-3 hours at a time d/t pain & can't lie ﬂat, plus anxiety ﬂares at night Emotions: feeling of no control in his life, severe loneliness. Lives alone, few friends. Lives to see his grand-daughter but this isonly a few times a year (they are in same city, not sure how is his relationship with his son. There is likely a back story there.)Also pertinent: brought up in southern Bible belt, corporal punishment, bullying. Described need for self defense made him quickto get into ﬁghts as a teen/young man, made a conscious decision to "do no harm" and also determined to raise his childrenwithout fear of violence.Urination:Body: pale soft skin, thinning hair, few varicosties ; average symmetry, eyes bright 4+ (haven't seen him in person for some time sothis is something I will be evaluating more closely ). Tissue neither dense nor open. Tongue: (only one blurry photo sent in June at ﬁrst visit) = red with thick yellow coatingExcess Presentations: Heart: (craves connection) UB: fear of isolation +9, (very pale), disconnection, pain on UB GB: quick to ﬁght in his youth; (described a turning point where decided not to be like this) when older used physical strengthwhere necessary to defend himself, pain on GB P: restrained, described calmness in situations with hostile people in past, pain on GB SJ: bright eyes +4 (?must re-eval) , self critical +8 : writing brought him pleasure and had a few articles published, but nothing wasever to his satisfaction, feels he failed in this one ambition. R shoulder pain SJ.(childhood: would hide where couldn't be seen but gained comfort from seeing others) Liver: depression can feel like darkness; fear is worse at night(doesn't seem to try and exercise control over others) Lung: (sinus congestion) St: tall with sunken chest, skin moist, poor resources (including no social support) bad luck with money LI: severe R shoulder pain and weakness mostly LI (some SJ) Spleen: dislikes hot humid weather, funky toes SI: (lack of self-care - but this seems linked with low resources) K: (very focused on grand-daughter - but seems d/t loneliness)TGTIR: fearMain treatment idea: H+, Other treatment ideas: SJ+; GB+???Only SAAM tx to date: Lu+ on R (early December) almost pain free for most of week, felt "very stoned afterwards" rest of day, depression seemed worse the follwoing week (Iwondered if absence of pain ampliﬁed that, he wasn't sure) My questions:numbness in lower legs and feet, some sensation has come back with regular acu and he now sometimes has pain in dorsum of feet.How to tease out the balance between GB/P in terms of childhood history and later life. I'd guess he is P+ now but some of the sx that happen in a panicattack make me cautious (dizzy, pounding, "too fast", must sit down)Same for Lv/SJ - I think he's constitutionally SJXS but currently can make a case for Lv XS (will be able to check eyes on Wed 16th)

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7 teacher remarks1 reply 1I'm doing a home visit on Wed 16th. Have seen him weekly in clinic for months but not since December. Have spoken to him twiceat legth on the phone since to ﬂesh out some details.What else shold I look for besides where pain is showing up? And assessing eyes.TIA. I never usually do home visits but am feeling so deeply called to help this man. He's (like Toby's patient in recent Qiologicalclass) fearful that he will feel worse after treatment. Has usually wanted local needling as this helped in the past and he did slowlyimprove with this. I have written this up rather quickly (and he's leap frogged a more complex case that I've been wanting to sharefor input...) because of this home visit and would love anyone's input. ReplyKristin Wisgirda NewFeb 15ReactThanks for another very challenging case. What you have written makes me really want to use Lung+. Really interesting that hisreaction to Lung+ was mixed.Sounds like insomnia is at a crisis level.Anything else about the felt experience of his anxiety besides what you have mentioned? Any quality of his anxiety that isapparent to you? Is that the fear you mentioned?<How to tease out the balance between GB/P in terms of childhood history and later life.> I deﬁnitely give more weight to present time.Can you imagine him having a short fuse or acting erratically? Is his system more oppressed by too much down and in? Is there noGB quality springtime in his system?<heavy sadness and quiet helplessness > Does putting a number on these impressions help clarify?If history is dramatically Gb excess, I won't forget that. However, I wonder how much of his history was more using Gb for selfdefense in a brutal environment.<Same for Lv/SJ -> it helps me to recall the primary qualities and see if they are showing up in the room, in his chief complaint or inhow he portrays what is going on outside of the oﬃce. Is he unshielded and too open with me, with other people or in his mainsymptoms? Is he too dull, dense and inward with me, with other people or in his main symptom?< I'd guess he is P+ now but some of the sx that happen in a panic attack make me cautious (dizzy, pounding, "too fast", must sit down)>>In the recent post Adina's Case Study Hour Case, we discussed how ﬂustered people, panicy people can also be P excess and howGB+ can be quite calming when it is needed. I can explain panic symptoms in a P excess this way: yin and yang are separating frommuch oppressive yin P rooting without the healthy balancing of an integrated Gb yang. The yang that is present can end upﬂoating creating symptoms such as his. I my practice GB+ has been very eﬀective many times for treating dizziness, unsteadiness,and ﬂoating yang symptoms in P excess people.Check for a gray cast to his skin to see if that gives more weight to Ub excess. ReplyKristin Wisgirda NewFeb 16React<feeling of lack of control is awful for him. Besides P+, does that tell you anything?> Classically SJ excess types want to control but Icould see it stem out of Kidney excess wanting to make sure the world revolves around me or Gb excess lack of hesitation to actand react.<I've been wanting to ask, regarding disconnection I've always had the impression that a UB excess person separates themselves and hasa fear of getting too close. So this does not seem to ﬁt as his greatest fear is of being alone.> I think of all of the channel excesses beinga process of qualities and directions that leads to an end state. Sometimes we see the process and sometimes we see the endstate. UB excess is the process of being able to coldly contract away from others and the state of being coldly separate fromothers which includes lack of capacity to receive and feel love. How exactly these show up depends also where he is on thespectrum of Heart to Ub excess, as well as other channel excesses present.I can see that fear of being alone could be an awareness of an excess of this motion of UB contracting away from others. But italso could show up as a straight up of incapacity to love or feel love from others. It is possible to feel lonely and unloved in a roomfull of H excess people.

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1 reply 110 more comments 10 Reply4 teacher remarks9 more comments9Naomi FrankWhat do you think of these eyes?NewFeb 22ReactBefore I share my thoughts and questions… Some of my recent dark eyed patients. I’ve started photographing eyes because Ifound the eye class so very helpful. Live is better but there’s only so much time you can spend looking right at someone’s eyes!!JPEG | 2 M8A7A5A0B-D8B3-46C5-95BA-1C…JPEG | 1.5 M3E465E9A-46EA-4DAF-A5D3-A5A…JPEG | 2.8 M509CE191-D6CB-4BAE-B12A-16… ReplyKelly KaedingNewFeb 231ReactI'll give it a go. It's not so easy with the photo and the glare, and none of these eyes are extreme...1. 0 (scared?)2. dull +23. bright + 3 ReplyElaine NolanNewFeb 231ReactI'll also give it a go Naomi and thanks for posting them. Its diﬃcult for me but1. Bright 5+2. Dull 4+3. Most diﬃcult I thought they were bright but when I looked a larger scale I feel they're actually a little dull 2+Michelle GreenhoughConcussionNewFeb 22React

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1 teacher remark1 reply 1I have a new patient who has glaring classic signs of SJ excess but is coming in speciﬁcally for a recent concussion. From ourconversation it sounds as though Kidney excess is also high on her list. I have not seen this patient yet but had a long conversationwith her. She is 100lb overweight and has depression. In treating a recent concussion would you do anything diﬀerent than youwould for any other treatment? By this I mean are there speciﬁc protocols that one should follow or treatments to avoid with aconcussion? If her SJ is in extreme excess, is it conceivable that supplementing the liver would be a good ﬁrst choice in treating theconcussion? Thoughts?? ReplyKristin Wisgirda NewFeb 22ReactHi Michelle,SI+ to move blood stasis out of the physically traumatized tissue is the ﬁrst thought for post concussion symptoms. Of course youhave to evaluate the balance between SI and K- if SI excess is signiﬁcant then you need to avoid using SI+. If you are unsure aboutthat balance, it would be safer to treat the biggest gap that presents.It sounds like you have talked but not met in person. Before you consider using Liver+ on her, it would be good to get a better ideaof the nature and severity of her depression. You wouldn't want to add dark density to depression that is dark and dense.Feel free to write up her case if you would like more input.Kristin Wisgirda Challenges in Improving ObservationNewFeb 22ReactRecently, a number of cases have shown me that I am missing or misinterpreting observational ﬁndings more often than I wouldlike. Time to get back to basics.One area of interest is really trying to better develop the ability to recognize where certain features fall on the scales of 0-10.Sometimes if a feature doesn't stand out I might not note it at all. How dry is that skin? How open is that ﬂesh? How soft is thatmidline? By comparing patients to one another- especially those exemplify certain attributes, I am hoping to get more ﬂuent inthese qualities that we are looking for. Using the grading system is really helpful for comparing and contrasting.A memory researcher said that if you want to remember something important, you must write it down as soon as possible. If Idon't write an observation down, that observation can get muddled together with other impressions.By the way, the above mentioned memory researcher focuses on the relationship between memories and reality. In short, herresearch shows that people can easily be inﬂuenced to be convinced that they committed acts that required police interventionwhen that act never really happened! Here is an interview with her describing her ﬁndings.https://www.bbc.co.uk/programmes/m0014p73There are so many implications for our practice including how easily inﬂuenced patients are by us and how strongly they canidentify with stories that aren't based in reality.

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4 teacher remarks1 reply 1BBC Radio 4 - The Life Scientiﬁc, Julia Shaw on memories that aren't trueCan we trust our memories of events? Julia Shaw talks to Jim Al-Khalili.Source: https://www.bbc.co.uk/programmes/m0014p73 Embedded File.https://www.bbc.co.uk/programmes/m0014p73 ReplySharon ShermanNewFeb 23 1ReactSometimes I wonder if it might simplify things if the scale was ﬂattened a bit. Rather than a continuum that goes from 10-->0<--10with 21 possibilities for every channel pair, might it be easier to talk to 5-->0<--5 ? As far as any of these observations, I think just creating a mapping the scale of 21 levels of an attribute or lack of an attribute quitea daunting task.Adina KletzelNewFeb 24React@Kristin Wisgirda<Recently, a number of cases have shown me that I am missing or misinterpreting observational ﬁndings more often than I would like. >Can you give examples of what you are referring to? What observational ﬁndings are you misinterpreting?And what exactly are you trying to accomplish by grading the ﬁndings?Are you saying for example that if skin is a 9 in dryness then that would for sure push to prioritize a ST+ or a SP+ treatment?I would like to fully understand what you are saying but I could use some examples.Thanks.Kristin Wisgirda

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5 replies 5 Reply2 teacher remarks1 reply 1Adina KletzelLI+ before period?NewFeb 22ReactHI, if someone has scanty menstruation but otherwise has SP excess qualities is there any reason to be cautious tonifying LI acouple of days before the period? Can LI+ dry out the blood even more - given that it is a ﬂuid?Another LI question -I know that we have talked about being overly clingy as a possible Ht excess quality but can we consider that the sticky aspect ofbeing clingy may be related to SP excess?I have a client that is so mushy (that's what stands out to me).She is always complaining and needs so much support from others to keep her up. It feels like she has no inner strength to keepher ﬁrm and upright. It feels like her energy is sticky and wants to stick to mine and suck it up. The ﬂesh on her abdomen is alsodoughy and her skin is not dry.Her energy feels SP excess - lacking form and ﬁrmness.I was just wondering if others have related this sticky clinginess to Sp excess or see it as more of a Ht excess quality? ReplyKristin Wisgirda  NewFeb 22ReactThanks for your questions.<if someone has scanty menstruation but otherwise has SP excess qualities is there any reason to be cautious tonifying LI a couple of daysbefore the period?> I don't see a reason any cautions or contraindications for LI+ in this circumstance.Can you say for sure that the menses are scanty because the blood is dry? It helps to evaluate the symptom for just what it is- notmuch blood coming out and see how you can explain it with other parts of the presentation. For instance, dampness is a cause ofblood stasis. The clingy aspect of Heart excess comes from love of other people. The description of yourpatient sounds more like neediness and not loving toward others. Is there anything else in her presentation beside her mushinessthat could explain that energy vampire quality? Let us know what you ﬁnd when you treat her. Thanks!Kristin Wisgirda  NewFeb 23 | EditedReact<there is not enough separation of self to stand on her own feet and tap into her own energy. I see a Bl deﬁciency in this.> I don't seethat. Not being able to stand on your own feet is not a H/Ub issue. I would look more to the more "qi deﬁcient" excesses Stomachor SI (or even P). It is always good to look at each piece separately- neediness, the hard to stand on her own feet,the hot/cold, reaching out to others.<But what you are saying is that it could only be a true Bl def. if there is some HT excess love there?> Yes, if we are just looking at the islove of others vs separation of self and not looking at hot/cold. We can also consider how intensely that love of others manifests- aspectrum of a desire/ability to reach out and connect with others all the way to red hot love. Knowing "love of others" in all thedegrees is helpful.Maybe Spleen excess + Heart love of others + some qi deﬁcient factor creates this expression of mushy neediness that looks toothers in a more in more personal clingy way. In contrast, swapping out UB excess in this scenario, the person might still seek help

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5 teacher remarks1 reply 17 more comments7Melissa Rathbonesweet cravingsNewFeb 9ReactGiven that sweet cravings are a sign of Spleen excess, which is double damp, is it correct to think that if a patient reports strongsweet cravings, but doesn't seem a full Sp excess, that dampness is deﬁnitely a part of their presentation? And would sweetcravings point to internal dampness?Always trying to clarify! Thanks Kristen ReplyKristin Wisgirda NewFeb 9ReactClassically, sweet cravings are a sign of Spleen excess and this often pans out in the clinic.But, consider this from Su Wen Chapter 22: "When the liver is suﬀering from tension quickly eat something sweet to relax it."If there are no other pointers to Spleen excess and the sweet craving seems to only to come during times of tension, I lookelsewhere.So, no, sweet cravings are not a primary sign of Spleen excess for me.However, I have seen skinny people with LI channel problems and a collection of mild damp signs and symptoms including sweetcravings, respond well to LI+.As well, if it is a really dramatic sweet tooth, I would give it more clinic weight for Spleen excess, even if it is the only sign. ReplyMelissa RathboneNewFeb 9ReactThanks Kristen! So then sweet cravings don't necessarily mean the patient has some dampness in their presentation, is that right?Kristin Wisgirda Interviewing from the HeartNewFeb 9ReactFor those of you who didn't receive the announcement about Toby's talk this Saturday at Qiological, here is the link to register:https://www.qiological.com/interviewing-from-the-heart/If you can't make the noon EST, 9am PST start time, a recording will be available.A very timely subject, given the issues that came up with a recent exchange between Maria Y and I in the recent post "Making UpStories".How do we direct an exchange to get meaningful information and not be bogged down by too much information? How do weinvite patients to express themselves without getting into their business? How do we create an environment that allows patientsto feel safe enough to divulge their true nature?

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Qiological Live • Interviewing From the Heart • Toby Daly Embedded File.https://www.qiological.com/interviewing-from-the-heart/ ReplyNaomi FrankNewFeb 14ReactThis was a wonderful discussion - I was unable to attend live and listened to the recording yesterday.The patient who asked for assurance that things wouldn’t get worse was particularly resonant for me. Just wrote up a case ofsomeone in a similarly desperate (but quite diﬀerent) situation. Would welcome any input!2 teacher remarksAdina KletzelParkinsonsNewFeb 8ReactHI,Does Parkinsons have any intrinsic Saam imbalances or is it a completely individual diagnosis based on the patients own personalimbalances?Particularly, does the shaking of the hands tell us any for sure imbalance?I know that shaking can be seen as windy if Kid excess matches but shaking can also be seen as a kind of lack o f consolidation.My client's hand shakes even more when she is nervous so I see that as more of a lack of consolidation.My client was told however that the more exercise she does the slower the degeneration will be - that is based on the fact thatParkinsons slows down the brain and exercise keeps adds certain beneﬁcial movement to the system - so that would perhaps be astrike agains Kid+.Does anyone have any particular successes with slowing down the symptoms of Parkinsons through Saam? Any insights in generalrelated to treating Parkinsons disease?ThanksKristin Wisgirda  NewFeb 8ReactI don't have any clinical experience treating Parkinson's or tremors with Saam.

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1 reply 14 more comments4ReplyTremors are one of those things I would look to the rest of the picture to explain.<My client was told however that the more exercise she does the slower the degeneration will be .... so that would perhaps be a strikeagains Kid+.> I wouldn't give this information any clinical weight. ReplyDaniel SchulmanNewFeb 8ReactI have just been working with someone with a left hand tremor. post menopausal woman. I don't have my notes in front of me. Idid of course consider it to be wind - which in Chinese Medicine is a wood imbalance, correct? She does have quite bright eyes andis very polite in her interaction with me - and somewhat light in her body - so I did try a few Liv + treatments . . . it 'sort of kind ofhelped a bit' but not strikingly. I recall doing a few SI+ treatments - again, notes are not here but there must have been some signsof blood stasis but not much help (Oh now I remember, she actually has been having pain and numbness on the left pinky ﬁngerfor some time). She is quite 'symmetrical' and has had three kids - but interestingly her periods did not begin until age 16! Sobased on that and a sense she might be lacking self-love and has no history of painful periods, I wondered if she was Kidneydeﬁcient and three pregnancies had drained Kidney a LOT . . . so on our last treatment last week, I tried a Kidney+ treatment. Shefound the treatment to stand out as the one that was NOT relaxing and her foot jerked through the treatment!! I will check in withher next week and see what happened.3 teacher remarksMariaMaking up storiesNewFeb 7 | EditedReactThis is a continuation of a conversation that Kristin and I started in another thread. I wanted to start a new discussion herebecause it is really a new topic and I wanted to chew on it more.< Rather than making up a story about what happened, it will be more helpful to reevaluate what lead you to possibly misinterpretthe signs and symptoms that lead you to the faulty diagnosis and also inquire about what you might be missing.> I must admitthat when I received this response from Kristin, I got defensive. But after meditating on it some more, I have some insights andthoughts that I'd like to share and perhaps provoke further discussion.<Making up a story> I realized that this is what we do all the time. We are constantly making up stories about other people andourselves. In a way, we can't help but make up stories about others because what we know of them is really our own perception ofthem. We aren't mind readers and people are complex as many of us don't even really know ourselves. To add to that, Tobymentions that we can't really trust what our patients tell us (sorry if I got the quote wrong but the gist is that patients sometimessay what we want to hear or how they wish to portrait themselves). To that end, We are constantly projecting our own stories ofother people onto them as we relate to them.Let alone making up stories about other people, we ourselves are a product of our own story. As a cultivator, part of my personalpractice to see my true nature, to see what is really true beyond my personality, beyond my own story. We ourselves are just aproduct of experiences and our personality/ego is formed from how our mind manages and tells that story about our lifeexperiences.I think the reason why Toby really strongly suggests that we have a regular meditation practice and to do a short session ofmeditation after each patient session is so that we can return to our true nature and really go beyond the story of ourselves andour patients and see what is really there, without the story.From Toby's lecture slides:Critical Role of Self Cultivation “When the perfect man employs his mind, it is a mirror. It conducts nothing and anticipates nothing; it responds to (what is beforeit), but does not retain it. Thus he is able to deal successfully with all things, and injures none.” Zhuangzi (Legge 2015"In the absence of habitual reactions, our placid minds are free to pursue unencumbered skillful action."

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4 replies 41 more comment1 ReplyKristin Wisgirda  NewFeb 7ReactHi Maria,Thanks for your very thoughtful post.I have also been thinking about our exchange and wondering how to make my input more constructive. My mistakes included notfollowing the spirit of your initial observations nor inquiring into how to contribute to the conversation in a more productive way.Your post touches on the heart of Saam, the heart of practicing medicine and the heart of cultivating our truest selves.<We are constantly projecting our own stories of other people onto them as we relate to them. Let alone making up stories about otherpeople, we ourselves are a product of our own story.> A very sobering truth.<Toby mentions that we can't really trust what our patients tell us > So what can we trust? Here is how my notes have paraphrasedToby on the same subject:Never trust the patients' words. Their actions and expressions are more true than their self evaluation. Can you feel what the patient isdescribing? If not don’t believe it. Honing trust or not to trust- when you perceive a disconnect, note it and keep checking in with it.Where is the truth here?These are words that strongly guide my practice.<We ourselves are just a product of experiences and our personality/ego is formed from how our mind manages and tells that story aboutour life experiences.> Yes but we- and our patients- are also made of the elemental directional physical of the 5 phases and 6conformations.My working hypothesis is that the truth can be found by orienting - or trying to orient- to our felt sense of the primary directionalmovements of the 12 channels in ourselves and our patients. I suspect the seemingly magic knowing of Toby's teacher came fromdoing this. For me, giving more weight to patient's actions and presentation and less weight to their words, creates better clinicaloutcomes.But patient's live most of their lives outside of the clinic, so when the presentation isn't clear, inquiry can be helpful to get theﬂavor what is happening for the patient outside of clinic time. For inquiry, open ended questions with the least amount ofpresumption are most helpful to me. Then evaluating the quality of the answer- both for the level of heart-feltness on the patient'spart and for any directional qualities the expression of speech has. Clean questioning- as described in several Qiological podcasts-is really helpful here but sometimes I ask questions more directed to particular channel qualities.Recently, the P/GB dynamic needed ﬂeshing out for a patient, so I asked her "You seem like a very capable, can-do woman." At thispoint I felt her body respond with an expression of delight at that recognition- like a cat enjoying being pet- that supported mydiagnosis of Kidney excess. We both knew that this statement is true. There was also feeling of erectness and readiness for actionthat supported my GB excess hypothesis.I went on: "but appearances sometimes can be deceptive. I wonder if there is any aspect of your life where you feel you can'tassert yourself or speak up for yourself." Her response was entirely surprising- she, as a 70 year old woman, is having a chastelove aﬀair with her high school sweetheart who is married to another woman. Wow! If I had asked a more pointed question abouta particular aspect of her life, that revelation would likely never have come forward. I didn't sense any oppressive down and inmovement in her system while she talked candidly about this intimate subject. Rather a few more ﬂashes of GB excess poppedthrough. The P+ treatment she received improved her Gb channel neck pain and range of motion. (While she settled well with SI+,it didn't help her neck pain or dizziness). Her candor gave a point or 2 to SJ- I didn't perceive any shielding or dullness.What to do with her story and its interpersonal machinations- not so sure. It was the quality of her expression that was mostimportant. ReplyLynda B. DanzigNewFeb 7ReactThank you both for sharing, courageous vulnerability and sagely observations

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Kristin Wisgirda Advanced Class starts next weekNewFeb 3 | EditedReactToby will be teaching bilateral treatments and draining in the class that starts Thursday at 4pm EST. It will be 6 x 3 hour classes. Ifyou can't make it live, recordings will be available for 1 year. There will also be a forum to ask questions.https://whitepinecircle.org/saam-acupuncture-level-2/It is required that you have practiced Saam for 1 year before taking this class.Besides learning new skills, your Saam knowledge will be reﬁned by talking cases with Toby. Most of the time spent in class will bediscussing cases Toby's own and student case studies.Feel free to reach out if you have questions.Kristin Wisgirda counterbalancing adverse reaction to P+NewFeb 3 | EditedReactA conversation in another thread lead me to ask Toby this questionIf someone had an adverse reaction to P+ and their outer circumstances were violent, for instance if they lived with a volatile violent person, would you hesitatecounterbalancing with GB+?No. If they are truly GB deﬁcient then supplementing GB will allow them to act more appropriately even in a volatile situation.Toby always recommends using extra caution using GB+ when the patient's outer circumstances are volatile, so it is good to conﬁrm that counterbalancingwith GB+ is ok in these circumstances, ie there is clear P excess. This goes along with the notion that an adverse reaction to a treatment has the highestclinical weight. The body is telling you directly that is has a particular channel excess when it reacts negatively to you adding more of those excess qualities tothe system. So even if you are convinced that a patient is Gb excess, if they react negatively to P+, counterbalancing with GB+ is the appropriate next step.ReplyNaomi FrankNewFeb 5ReactThanks for checking, Kristin! This is good to know. The patient in question always feels very relaxed during needling, but a coupleof times has had strong reactions the next day (notably to SI+ and in this instance to a 4th P+). I will write up her case to get moreeyes on it as she is complicated. I did see your other response, thank you!1 teacher remarkShannon LarsonAbout the medial heel..NewFeb 2 | Edited1ReactI am wondering what weight a wrinkled medial heel has. Withered I understand means less ﬂesh which has the most weight forSIXS. Dry and cracked has some weight- depending on lifestyle but what about the heels that look like wrinkled skin like people getfrom being in water too long? Does that have weight?I am also wondering sometime, when you have time, no rush, could you possibly show a picture of a plump, a withered and anaverage medial heel next to each other just to see the contrast of what you and Toby are clocking as normal and the variationsaway from normal.Thanks!Kristin Wisgirda  NewFeb 22React

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ReplyI consider wrinkling to be a variety of withered. There isn't any ﬂeshiness to plump it out so the skin looks too loose.Yes- we need pictures of the range of heels, from extreme to extreme but also a normal heel. I will work on that.Adina KletzelCase full of mixed presentationsNewFeb 2ReactHI,The following is a challenging case full of mixed presentations.I could use a fresh eye.59 year old womanOverweight 6+Big body frame 5+Main complaint:Physically and sexually abused as a childWas a repressed memory until 5-6 years agoContinues to have ﬂashbacks and PTSD symptoms – crying, doesn’t want to be with people,Nervous, poor memory, not feeling presentSecond complaintHead accident 7 years ago – on DU channel in back of headAccident happened from rocking in a chair too fast, she “forgot that she was in the chair” and hit the corner of a book shelf. Herhead was thrown forward.Has trigeminal neuralgia on right side of face and head– split down the face through the center of the nosePain, tight locked jawPresentationHer train of thought is muﬄed, jumps topics, is not clear in her answers to questions,Gets disorientedEmotional, seems oﬀ…, sound a bit like a childLifestyleMarried with 2 children, loving supportive husbandWorks two hours a day with childrenBody morphologyDry skin 8+, dry mouth 8+Thenar on softer side

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4 teacher remarksBl cold wind increases pain 9+ cold wet hair increases pain 9+ very freq nightime urin.Ht likes to give and help 6+ hates the heat 8+Kid had two surgeries symmetrical 6+ feeling of something stuck in throat 6+SI disoriented, nut pulled tog. 7+Liv seems lost in her own world 7+ dull eyes 5+ gets lost a lot 7+ cries a lot 6+SJ anger at self seems like needs a shield from all of her trauma (says she has no protection from envir.) 7+ energy is lighter 4+LI constipation and dry skin 8+SP seems so slow and thick 8+LU overweight and dry skin 8+ says sees mucus in stool when does an enema 6+ nausea, reﬂux, hiccoughingGB restless sleep, seems so un rooted so emotional, no intellectual aspect 8+PC so hard for her to say no to othersShe needs SO much help and so many of the channels seem mixed.For example, I would love to tonify Liv and give her a shield from all of the trauma that she went through BUT her eyes are so dull,she seems like she is drowning in her own world, and she is sad and crying all of the time. She also said that she loves the brightlights but loves dim lights.I would love to calm her whole system down with PC because she is SO agitated and she tosses and turns all night but she can'tstand up to others and say no.I would like to tonify SI because of the pain, accident, and trauma but she is SO unconsolidated.She also seems so phlegmy in her mind and she seems like she is so full of damp but she says her skin is dry, she is constipatedand she drinks all night.I would like to tonify HT for the pain that is w/w cold but it si also w/w hot wind and she loves to drink ice cold water - but doesn'tbecause she was told it is not good for her.I did settle on St+ for the ﬁrst treatment and had to take out the needles early because her head face pain was acting up. She saidthat always happens when she gets nervous but that means she was nervous with St+.... I did not counterbalance at that point... Itdid not seem right.Any insights?Thanks. ReplyKristin Wisgirda  NewFeb 2ReactHi Adina,Thanks for the case. Trying to process and take into consideration so much info can be overwhelming. What happens if youreevaluate her through just the primary qualities? What happens if you take away the stories and other practitioners diagnoses?What happens if you put aside considering symptoms or qualities that you give less weight to?You use words like disoriented, not present, muﬄed, not clear. This description makes me question her trustworthiness of herreporting. What happens if you focus on your experience of her rather than what she says?I believe considering these questions will give you some clarity with her. Whatever happened in the past, is past.You can't shield her from that. If you look at her main complaint, she is not being overwhelmed from anything going on outside ofher. The suﬀering is coming from replaying of dark images and thoughts.<She also seems so phlegmy in her mind > Could this be dull density? The thickness you listed under Spleen- could that be dulldensity?

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1 reply 15 replies 5 ReplyKristin Wisgirda  NewFeb 3React<Do you recommend mostly just focusing on the primary qualities?> The primary qualities are the closest things that we have to forsure signs, though I wouldn't call them that. These are the qualities that I give most clinical weight to. Orienting to them oftenmakes the channel excesses pop out at you. You can then use them to help explain other signs and symptoms. The secondaryqualities can often be attributed to multiple channels so they have less weight for me. The secondary qualities that are stronglyassociated with a channel- for instance soft and warm midline for Heart- I give these more weight when they are moderate orextreme. I ﬁnd SJ+ very helpful for headaches when the picture is correct. A few weeks back, Ihad 2 patients with frontal headaches on the same day. One got relief from SJ+ and the other got relief from Liver+. You must havehad some adverse reactions in the past that make you cautious. Try to let those go.<You don' t think that providing a person a shield now from all of the trauma they went through in the past is helpful?> An experience istraumatic when the system can't process it. Signs and symptoms tell us us where the system is failing to process and operate. HerPTSD is experienced as repeated dark invasive thoughts and images. These alone point suggest some possible Liver excess. I seethese symptoms on the background of dullness (including her eyes), muddledness and lack of awareness of the outside, primaryLiver excess qualities. Her Liver excess presentation is strong for me.<She told me that she feels exposed and does not trust anyone to come near her. > Someone with such clouded awareness could easilybecome afraid of just about anything. Imagine walking through a dark forest at night, unable to see and lost. Probably scary. Yourunclear senses turn the sound of every squirrel rustling in the leaves into a bear or wolf. When a branch brushes your arm yourecoil, thinking it is a snake.I really don't see any clear indication of SJ excess.<Have you completely disregarded what patients tell you and just go by your sense and have seen that work well?> It isn't that I disregardwhat patients say. If it is muddled and unclear, I give it less clinical weight. WIth her feeling overexposed- I take that into accountbut keep an open mind about how that could come to be. The primary qualities help me do that.Let us know what you think and what happens.Thanks as always for sharing your cases.Kristin Wisgirda Eye Observation class reminderNewJan 29ReactI have had lots of fun comparing and contrasting eyes and faces while putting this class together. It is designed to be reallyinteractive with breakout rooms and plenty of opportunities to learn the language of how your individual system process thisparticular information. Fluency with this skill will quickly improve your ability to evaluate the balance between Liver and San Jiao.The class is this Thursday 1pm EST for 90 minutes.If you can't attend live, the recording will be available for 6 months.Here is the link to register: https://reg.gosignmeup.com/s_reg/reg_registration_maintenance.aspx?ek=0078-0004-e985baa9a07b4ac0930717e14c2b82ﬀPlease join me.

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JPEG | 787.1 KDF9AE12A-9626-430D-8726-93C…4 teacher remarks1 reply 1Adina KletzelStiﬀ and Tight Pain Liv/SJNewJan 24ReactHI,When diagnosing stiﬀ and tight pain involving a LIv/SJ imbalance I have been placing it in the SJ excess category too quickly.When I think of Liv toniﬁcation treating stiﬀ and tight pain I visualize thick warm blood entering the muscles and tendons andnourishing and softening the tightness thereby subduing the pain.THis image does not always play out in the clinic nor are the patients always SJ excess....It got me thinking to how Liv excess can cause stiﬀ and tight pain. The image that Kristin showed us of the tightly bound ﬁbers ofLiv excess made me realize that tightness can come from too much density and providing some loose and open SJ energy may beexactly what is needed to relieve the congested muscles and tendons.I had a client yesterday who came in down and depressed from the rainy cold weather with tight and stiﬀ pain on her inguinalarea - Liv channel and a tight sharp pain near her knee in between the St and GB channels. She said that a hot water bottle helpsthe pain. HT+ only provided limited relief but SJ+ completely opened the inguinal area, lowered the knee pain, and lifted her mood.If I had gone with the warm thick blood image I would have completely missed the mark.It is just hard to let go of the TCM approach that tight, hard muscles are a for sure sign of liver blood deﬁciency... ReplyKristin Wisgirda NewJan 24 | EditedReact<It is just hard to let go of the TCM approach that tight, hard muscles are a for sure sign of liver blood deﬁciency...> Yes. Through hardwon experience, I now know not to equate "stiﬀness" and "tightness" with anything in particular in Saam. Evaluating the quality ofthe tissue through palpation really helps, along with noting the channels. One patient complaining of a a stiﬀ tight neck hadtissues that felt like a water bed. LI+ really helped her.<When I think of Liv toniﬁcation treating stiﬀ and tight pain I visualize thick warm blood> Good to remember that Liver is cooling. I heatmy house with a wood stove. Whenever I pick up a piece of wood to put in the stove, I notice the wood is often cooler than theambient temperature even if it has been sitting in the warm house for days. The denser the wood the cooler it is, too. To me thatsuggests that Liver coolness is really a function of density.Kristin Wisgirda  NewJan 25React<For SJ excess - you would feel that they are light and open even though the patient says they are stiﬀ and tight?> Yes.<Are there any other very notable sensations upon palpation > I question if any of the basic qualities of the channel excessescorrelate with what my hands are feeling- damp/dry, dense/open, hot/cold, too consolidated/not consolidated enough,sunken/proud.

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4 replies 4ReplyKristin Wisgirda Adina's Case Study Hour CaseNewJan 21ReactI can't stop thinking about the colitis case Adina presented yesterday. So many aspects to ponder!First, the patient had a surprising response to P+. During the call, I called this a zebra case referring to the old adage "When youhear hoof beats, think of horses, not zebras." Calling it a a zebra case makes it seem exotic or edge, like something we reallycouldn't prepare for. On reﬂection, all of the information was there, but our understanding of how to interpret it was lacking.Contemplating Adina's case has given me ideas about how better to understand and diﬀerentiate the qualities of GB and P. Adinadescribed her patient as "not at all rooted" 8+, reacting emotionally 9+, having outbursts of anger (at least in the recent past) andhaving a tendency to feel angry but also liking research 7+. One of the grossest things in the room was the patient's constant needfor reassurance that presented with questions ad nauseam about the safety of treatment for her and her baby.The patient's rectal bleeding got worse with P+ and improved with GB+.Myself and other practitioners have had patients with surprising adverse reactions to P+. It is really common to see certainbehaviors as aggressive that may not be and to want to calm a patient in chaos down with P+. I have made this mistake a numberof times. We have to diﬀerentiate the chaos a patient may be experiencing from the patient's system actually having too mucherratic movement outward. The second scenario is GB excess; the ﬁrst scenario may just be more of a reﬂection of a system incrisis but not necessarily Gb excess crisis.This case has helped me reframe my understanding of P's relationship to rooting. My understanding of being rooted is calm,centered, placid, serene. Adina's case shows that a patient can be P excess and none of these things. Instead she displayed anexcess of the rooting motion with her constant question asking in attempt to get reassurance. This capacity to deliberately pulldown and in is an essential quality of P in contrast to the erratic expansive up and out in all directions of GB.The end product of this P rooting tendency doesn't have to be the calm, placid serenity of rootedness.This case really underscores the importance of reﬁning our ability to perceive the fundamental qualities of the channel excesses. Abig part of that is prioritizing the information we get through our senses including the quality of interactions.For example, the excessive repetitive questioning makes me wonder what is impairing her from making use of the information sheis receiving. Could it be dullness or cold disconnect?@Adina Kletzel I wonder if part of the tightness of patient's lower abdomen has a dense quality, even though you said her ﬂeshwas more open. Please let us know how the patient responded to SJ. Thanks again for presenting such an educational case. It hasbrought up so many pitfalls that I have experienced treating complex patients. It is wonderful to have a platform and a communityto work on these issues and deepen our understanding of Saam.And GB+ helping so much with a rectal bleeding case totally stokes my excitement about Saam!Best wishes for your patient.Adina KletzelJPEG | 28.2 KTE009771DOCX | 168.3 KDOCXadina's case

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6 teacher remarks3 replies 311 more comments 11ReplySharon ShermanNewJan 21ReactInteresting. It also makes me think about the yin resources "tangible resources" being there as far as information and questionsanswered BUT the inability to alchemize/root the info/material resources she is receiving into any meaningful treatment gains.Another way of looking at the success of the GB+ treatment might be the "fu call to action". The GB's ability to transform as a yangorgan/channel to facilitate and rectify the disconnect. Very cool!ReplyDaniel SchulmanNewJan 21ReactYes! Thank you so much Adina for such a fantastic case that really provoked us to think and Kristin for your fantastic insightsabove. This really truly challenges us to look deeper and deeper into the nature of these archetypes and never 'settle' for someassumed superﬁcial manifestations we expect of them. To deepen our connection to , understanding of and capacities to perceivethe channel archetypes in play. I have often found precisely these cases where the loud signal after multiple treatments (with noresponse to most treatments as I struggle 'intellectually' with a case) is a patient's clear adverse response to one of the treatments. . . the GIFT being that their body told me something very clear that is demanding my full attention because therein lies the key . . ..4 teacher remarks3 replies 3Kristin Wisgirda Two Maggie SmithsNewJan 14ReactWhat can we notice about these ladies? The light haired woman is the famous actress. The dark haired woman is a poet.WEBP | 186.5 K04041693-dab6-4707-b2d5-7903…WEBP | 361.2 Kimage.jpg ReplyTuriyaNewJan 14ReactSan Jiao eyes?

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7 teacher remarks1 reply 1Kristin Wisgirda Shy vs MeekNewJan 11ReactAnother Saam practitioner mentioned associating Pericardium excess with shyness. This didn't sound right to me. Thinking backto my conﬁrmed Pericardium excess patients, not many of them could be called shy. This left me with the task of articulating why.Shyness suggests social discomfort to me. The American Psychological Association deﬁnes it as the state of being worried, tense,and awkward in social situations. Toby has mentioned that introverted and shy people are likely to be SJ excess. It is easy tounderstand how someone unshielded would feel overexposed in the presence of others with the result being social discomfort.Another possibility: fearful and cold Ub excess could ﬁnd social situations awkward and worrying. Maybe Liver excess with justenough outer awareness to see the eﬀects of their cluelessness could ﬁnd social interactions awkward and tense.Pericardium's qualities of being able to pull in information from the outside, rootedness, slowness to react and deliberate actionwouldn't seem to contribute to shyness. On the contrary, many of my P excess patients have quite a bit of social grace that seemsto come from these P qualities.I wonder if the other practitioner was mashing up shyness with meekness which is more consistent with P excess qualities. Meek'sdeﬁnition includes being soft spoken, gentle, and easily imposed upon.What do you think? Any diﬀerent experiences or perspectives? ReplyGabriel SternNewJan 13ReactHi Kristin,I'm hopping you could clarify this a little further for me, I may just be getting stuck on the language.I can see where a SJ ex, could lean towards meekness, as not wanting to/ letting themselves grate against social conventions. orhow the fear from UB ex can lead to "grin and bear it".I thought the PER ex "rule following" had more to do with strict adherence to what they believe/ understand to be "right" withoutneeding to intervene and correct the others "Mistake". I cant see how that tracks with "easily imposed Upon"?thanks for the help,GabeAdina KletzelNewJan 25React@Kristin Wisgirda<Meek's deﬁnition includes being soft spoken, gentle, and easily imposed upon.>I think the 'easily imposed upon ' is the closest to PC excess meekness from this deﬁnition of meek. A PC excess will back downfrom the ﬁght and accept circumstances too easily in situations where a bit of pushback would be called for. It is not about anger itis about pushing back out into the world when circumstances are trying to push down and in.I have a 69 year old female client with GB meridian thigh and knee pain. A couple of months ago PC+ helped relieve this pain(amongst other channels). Last month her husband had a biking accident and got injured and also some of her friends have fallenill. These circumstances have caused her to lose her conﬁdence and feel that she and her husband are getting old and should selltheir house and move closer to their kids. Her GB mer. thigh and knee pain also started acting up again.Kristin Wisgirda

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1 reply 111 more comments11ReplyShe was quite agitated when she came in for treatment and her energy seemed all up and out and so I toniﬁed PC. The treatmentdid not help her pain and her state of mind got worse.I was pretty surprised but then took a step back and realized that my client's usual push back and ability to tackle her challengeswas missing. She was throwing in the towel and even though her husband's injuries were healing she no longer wanted to pushforward but rather allowed herself to submit to the premature belief that she and her husband are old and can't liveindependently anymore. That is a big leap from a vibrant and active 69 year old to an old and incapable 69 year old.Next treatment I toniﬁed GB. She got her ﬁght back and her pain went away.This was a great lesson - ﬁrst on the push back of GB excess and the meek acceptance of PC excess and second - how both achannel and its counterbalance can treat the same pain depending on the state of mind of the patient on that particular day.Nothing in Saam is a given.2 teacher remarks2 replies 2Adina KletzelLiv excess coldNewJan 111ReactIs it possible that someone can be cold only from being liver excess and not from Bl excess?A primary quality of BL excess is extreme cold but if someone has a mixed pattern for Bl/Htbut is clearly liver excess so can we say that the cold is attributed more to the liv excess than the Bl excess and that only SJ+ canwarm them up?OR in other words can Ht+ warm up liver excess cold?THanks ReplyKristin Wisgirda  NewJan 111React<Is it possible that someone can be cold only from being liver excess and not from Bl excess?> Yes. I can think of a case where thepatient started out Ub and Liver excess. Supplementing Heart warmed her up somewhat but didn't help her chief complaint ofhand joint pain. She remained cold and sensitive to cold. Repeating H+ didn't help her. SJ+ relieved her joint pain and warmed herup more.<can Ht+ warm up liver excess cold?> The above example tells me No for at least this case. If H+ worked for what I thought wasLiver coldness, I would probably rethink my diagnosis.This is still a really interesting question and stimulates inquiry into the diﬀerences between Ub and Liver cold and Heart and SJheat. Heart double ﬁre melts ice but isn't as eﬀective for Liver excess as SJ is. My theory is that the cold of Liver excess issecondary to the dull density. Counterbalancing that density requires the piercing and opening quality of SJ. The image coming tomind is of holes getting poked into a block of wood to let in the light and warmth.Gabriel SternNo SubjectNewJan 7ReactQuestion for teacherHi Kristin,

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1 teacher remarkYou and Toby have both stated that the presence of "heat above cold below" and visa versa are manifestations of the SJ/Livdynamic. that's pretty straight forward. I'm wondering if "cold extremities and warm core" and visa versa. is another manifestationof imbalance in the SJ/LIV axis, or if you track that to a diﬀerent Pair?Thanks,Gabe ReplyKristin Wisgirda  NewJan 7ReactHi Gabe,<"cold extremities and warm core" and visa versa. > I look at these as mixed hot and cold which could be attributed to a bunch ofdiﬀerent scenarios besides Sj/Liv. Combined hot and cold channel excesses such as UB and Sj or Heart and Liver or single channelexcesses that are a mix of hot and cold such as SI and K could create the mix. Conceivably other dynamics- such as damp, dry andqi stagnation- that aren't necessarily about heat/cold directly could aﬀect circulation creating mixed temperatures.Kristin Wisgirda Needling a Manic PatientNewJan 51ReactI mentioned this patient in the 12 Channel class. My experience needling her reinforces what I know to be best Saam practices notjust for her but for all patients.She is clearly GB excess- rapidly changing emotions, erratic behaviors and speech. She just got back on her medication for bipolarafter having run out of it. She has chest pain and shortness of breath. Sleep is poor and disturbed by jolts of energy in her chestand legs. She is nauseous and vomits every few days, especially worse with high emotions. No question needs P+.She is fearful of needles and starts crying at the thought of them. On the table when she knows the needles are about to go in shesquirms and starts sobbing and asking what she needs to do to make it better. The fact is that she is still so unstable that noamount of coordinated breathing is going to help and prolonging the process is not going to help. The thought of using thinnerneedles brieﬂy ﬂashes but I quickly dismiss it because I know that using thinner needles won't make the experience any better andcould reduce the input of P that she so desperately needs. I tell her that we are just going to get it over with. I remind myself aboutwhich direction the needles need to go in so that they are correct and just get them in.Unlike her ﬁrst P+ treatment, she immediately calms down and tells me that her chest feels lighter. This immediate calming isprogress. At her ﬁrst treatment with P+ she continued to cry for 10 minutes after the needles were in. The gap between P and GBis smaller now so the Gb is no longer ﬁghting back. She is also more comfortable with the qi sensations around the needlesbecause she knows they are normal and signs of the needles working. ReplyLynda B. DanzigNewJan 52ReactI had a teacher at NESA by the name of Dr. Tsay. He taught advanced needling and before introducing 2-5 inch needle insertiontechnique he said, “Have no mercy to have mercy”. I think of that many times when I am practicing conviction plus courage.This is a great illustration of minding the gaps.thank you!!Kristin Wisgirda Vacation TimeNewDec 23, 2021 1ReactHappy Holidays everyone!

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I will be oﬀ the forum from now until the new year. Looking forward to seeing you questions and ideas when I get back.Wishing you all peace and health in the new year.1 teacher remark1 more comment1Kristin Wisgirda What about these eyes?NewDec 20, 2021ReactJPEG | 632.3 Kimage ReplyAdina KletzelNewDec 20, 2021React@Kristin WisgirdaHI,I think hers are bright 6+and his are bright 4-5+They both seem to be looking out at youKristin Wisgirda ReplyAlison Unterreiner, DACM, L.Ac.NewDec 20, 2021 1ReactHis eyes are brighter to me, actually. They are not light colored, but they are more "twinkly" and they are also piercing - I would say+7Hers are piercing but tired - I would say +5TuriyaWonderful response to Ki+ with 2needles at Ki3NewDec 15, 20212ReactI was experiencing some fatigue . I also experienced what I would describe as a sense of inner "disheveledness" and overwhelmwith circumstances of my life. I identiﬁed this as SI Excess . And I felt that Ki+ was the right treatment. Once all the needles were in

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1 teacher remarkI looked at the direction of Ki3 needled in the direction of Ki6 and 2 and wondered about the directionality that seemed to bypassKi4 and 5....so I added another needle. I settled very deeply and meditatively. The experience was so pleasant and nurturing that Ileft the needles in 40 minutes. This was probably the best acupuncture experience of my life. The following few days I felt a senseof solidity and consolidation and focus in an easy and unforced way. When I meditated in the mornings the symmetry of the sittingposture was just there and I felt upheld by life.JPEG | 57.9 K1-IMG_3741 ReplyKristin Wisgirda  NewDec 16, 20211ReactHi Turiya,Sounds like this experience gave you a good felt sense of SI and Kidney excesses that will help inform your evaluation of yourpatients.<inner "disheveledness"> I love this expression for SI excess. The disheveledness can be outer or inner or both.<Upheld by life> so lovely...When needling K3, Toby puts a ﬁnger on K2 to give the needle a target.Thank you so much for sharing.Kristin Wisgirda Liver+ dramatically relieves vomiting in pregnancyNewDec 15, 20212ReactThe patient is 28 years old and one of those challenging very well balanced people. The biggest gap in her is between K and SI- sheis Kidney excess. She came in worrying about not being able to conceive- she hadn't even tried yet- had one treatment with SI+and got pregnant that cycle. I don't give credit to SI+ because she is so well balanced. l'm not surprised she had no problemconceiving.At 7 weeks pregnant she reported constant nausea, strong gag reﬂex and vomiting 2-4 times a day. She could keep 1 meal down aday and denied any signs of dehydration. She was taking Diclegis every night before bed and during the day on her days oﬀ work.She is thin but not overly so. I am cautious about using drying treatments in pregnancy unless there is clear dampness, so I optednot to treat the symptom by using ST+.Her eyes are only slight bright and her ﬂesh is slightly more open rather than dense. She is a nurse practitioner with an on-the-ballpersonality and good awareness of the environment, so SJ excess was the only real other excess, besides Kidney, that I could see.In the week after Liver+ she vomited only twice and reported long stretches of time feeling "almost normal". She didn't stop takingDiclegis at night but stopped the daytime dose.Just a reminder that sometimes you don't need a downbearing treatment to help keeps things down. In my experience withnausea/vomiting in pregnancy, looking for the biggest gap gives the best results- (outside of Kidney excess)

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5 teacher remarks7 more comments7 ReplyAlison Unterreiner, DACM, L.Ac. NewDec 20, 2021ReactThank you for this reminder, Kristin! I just had a patient in early 3rd trimester with problems digesting food which caused vomitingon a daily basis. I tried ST+ on her because of the downward movement - very cautiously - and it did nothing. Thinking about herusing this information you just gave me, I can see how she could have easily been a bit more LIV excess and perhaps a SJ+treatment would have been better suited. Thank you for the reminder!! ReplyKristin Wisgirda NewDec 22, 2021ReactI saw this patient again this week after repeating Liv+. Even though she settled well with the second Liver+ and it relieved thenausea she had while on the table, this past week was not so good. She vomited once a day when she wasn't working and 6 timesa day when she was working. Nausea was back to her pretreatment levels. She denied concentrated urine and said that she wasable to keep enough food down on her days oﬀ that she wasn't losing weight.She is thin, her skin is dry, and her personality veers more towards LI excess. Sp+ settled her on the table and relieved her nauseato the point that she said she was delight to feel normal. Here's hoping the treatment eﬀect is enough to give her a good week.Kristin Wisgirda Eye Observation Tutorial February 3rdNewDec 14, 2021 | Edited2ReactAnnouncing 90 minute call devoted to eye observation on February 3rd 1pm EST, 10am PST.https://whitepinecircle.org/bright-dull-saam/We will be looking at over 50 photos of eyes and learning to discern between bright and dull. We will be covering tips and tricks tohelp you ﬁlter out the factors that skew your ability to evaluate the eyes correctly.Toby has graded these images with me so this class will help you calibrate you observation skills with his.If you can't make the class live, the recording will be available for 6 months.The images and Toby's grading will also be available for you to download.For those of you who are taking the 12 Channels class, please know that most of the subjects will be new.https://whitepinecircle.org/bright-dull-saam/ Embedded File.https://whitepinecircle.org/bright-dull-saam/

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2 teacher remarks1 reply 11 reply 1WEBP | 19 K71846917.jpgReplyShannon LarsonNewFeb 2ReactI wish I could do this live. I will watch the recordings. I am getting better a picking out eyes but still struggle with some. This womanis prime example. I am so glad you put up this pic. I see eyes like this and for reason the word that comes to mind is water. Theyfeel soft but I feel like she sees me. I can't tell if I think they are bright or dull. I recently did LIV+ on someone with eyes like this andshe didn't settle. Her openness of ﬂesh was medium. She was have body temperature regulating problems.ReplyLynda B. DanzigNewFeb 5ReactHi Kristin,thank you so much for your class on bright and dull, I loved it!i had recently visited the MFA in Boston. The exhibit was on American Quilts. I felt this artist captured bright and dullin hermasterful work.JPEG | 1.2 M5F170A3C-FFFF-4726-A60B-…JPEG | 2.5 M99A2B9EE-E82B-4788-ABE1-…JPEG | 1.7 MB42951A8-150B-40CA-B4CE-…Kristin Wisgirda Saam Panel on Practice PodcastNewDec 12, 20213ReactIt is worth checking out the latest episode of Qiological with Sharon Sherman, Jeri Steele and Charles Bishop. It came out on 12/7. Ido believe you need to be a subscriber to access it, otherwise you might be able to pay forAll of the participants shared thoughtful insights and experiences that we can all learn from.Jeri's GB+ case gone wrong was a great example of what settling doesn't look like. The patient felt wonderfully energized on thetable but then had a number of adverse reactions that took two P+ treatments to counterbalance. Settling, even with GB+, isn'tstimulating or activating any way. Toby says that the patient falling asleep or at least being deeply relaxed and calm are the bestsigns that the body need GB+.Though some practitioners use pulse and other methods, Toby teaches that complexion and settling are the most reliable ways ofevaluating treatment eﬀect on the table.This lead into a discussion of how our biases can cloud our clinical judgement. I've been guilty of this many times. It has neverended well when I have jumped to treat what I feel the patient "needs" without diagnosing the biggest gap between channel pairs.

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If you have two closely matched channel excesses- for instance Heart excess and Spleen excess- it CAN be helpful to ask whichqualities does the patient need on this particular day. The mistake is when you forget to look at whole picture. This can be a perilof focusing too much on the grossest thing in the room.Take a listen and let us know what you think.Adina KletzelCold Reaction to Ht+NewDec 07, 2021 | EditedReact40 year old female suﬀering from PTSD to an emergency surgery after her inner stitches opened up to a prior surgery forremoving a uterine growth.She is constantly scared something bad is going to happen, does not sleep well, tight feeling in throat and chest, does not want togo out and be with people.She is very loving 9+ and she feels safest when with husband and children. Family time makes her feel better. She used to lovealso going out with friends but now she just wants to stay home with husband and children.She does customer service and loves to help people. She has loving eyes.She feels cold and likes to eat and drink hot food.Even though she is so loving I did HT+ because she feels that she is not as loving as usual for her, she is cold, she is VERY scaredand traumatized and even said: I want to pour hot water through my body.She started shivering when I put in the points - but said that lying on the table and having acupuncture done brought her back to aplace of feeling out of control and being a patient in a medical emergency. I sat with her and we talked and she relaxed andstopped shivering so I kept the points in.When she came back the next week she reported that she was much calmer, feeling less traumatized, the tormenting fearthoughts went down a lot and she is feeling a lot better.HOWEVER since the treatment she is even colder -shivering at night and during the day , shivers in her spinal cord and legs andshe pees even more frequently...THis is quite a surprising reaction to HT+!She feels that the cold that is stuck inside of her from the trauma (she started shivering when her inner stitches opened) is tryingto come out. She also still has some fear (cold) which is working on leaving.Or - is it at all possible that since Bl excess is mixed for her since she is cold and fearful but is also a very loving person that Ht+helped but also caused a weird body temp reaction...That doesn't sound right but just trying to ﬁgure this out...I decided to do SI+ to help move the trauma and cold out. We will see what happens.Has anyone seen this kind of reaction to HT+ before?Could it be that she needed SI+ before Ht+ in order to move out the trauma ﬁrst and then warm up?I did not want to do 2 sides on the ﬁrst treatment otherwise maybe SI and HT together would have been better.She also needs LIv+ but I am concerned about the cool quality of liv+.I thought to do LIv and HT tog but am concerned about the cold reaction to HT+.I will include the Saam chart below so you can get a fuller picture.Saam chartBl cold 7+ fear 9+ pain on Bl mer. 6+ craves hot drinks 7+ trauma 7+ not as loving as usual 7+ freq urin. 8+Ht loving 7+ loves to give and help 9+GB gets angry 2 days a month (hormone related) 7+ night mares 7+ poor sleep 7+ not rooted 6+Kid 3 surgeries 8+ pain and tightness on Kid mer. Choking feeling in throat 7+ normal medial heel had mass in lower abdomen 8+symmetrical 7+SI pain and tightness on Kid mer.

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6 teacher remarks8 replies 81 reply 1SJ needs to be in control 10+ very aware of details around her 8+ neat and orderly 9+ polite 9+ has a strong intuition light energy7+ warm energy wants quiet and shield of house 8+ eyes bright 2+Liv lights candles to feel betterSt feels her body needs to be lifted up tiredLU bloated after food 7+ food stuck, doesn’t move down well 6+ dry on outside poor appetie 8+ ReplyKristin Wisgirda  NewDec 07, 2021React<is it at all possible that since Bl excess is mixed for her since she is cold and fearful but is also a very loving person that Ht+ helped butalso caused a weird body temp reaction..> Very simply- yes. Her presentation was mixed UB/H so treating H+ created a mixedreaction.<Could it be that she needed SI+ before Ht+ in order to move out the trauma ﬁrst and then warm up?> A mixed reaction to H+ meansthat there was a bigger gap between channels that needed to be addressed ﬁrst. K excess looks like a contender so it will beinteresting to see how she responds to SI+_.I wouldn't include trauma in the list for UB excess. Trauma is unprocessed experience. Symptoms resulting from trauma resultfrom where the processing didn't happen- that will be determined by channel imbalances so it is good to keep an open mind. Smart. Bilateral treatments can cause so much chaos. Single sided treatmentsare so much safer and will give you precious clear feedback.<Has anyone seen this kind of reaction to HT+ before?> I haven't. But I have seen UB+ warm people up for better or worse.ReplyNaomi FrankNewDec 15, 2021ReactThanks for sharing this interesting case @Adina Kletzel .@Kristin Wisgirda , I was searching for the thread where you described these unusual reactions to UB+ but I couldn't ﬁnd it. I knowit was way back. Can you link it when you get a chance or mention the subject line/date? Thanks!Adina Kletzel,Kristin WisgirdaMariaskin issuesNewDec 04, 2021ReactI would like some help for my patient with Eczema.50 y.o. patientcc: multiple joint pain, digestive issues, weight issuesK: well dressed 8+, symmetrical 8+, narcissistic 8+, varicose 5,SI: Dry heels 4+, prone to depression 3 (though I wonder if this is a narcissistic aspect of too much self concern than real self hate)SJ: Bright eyes 3+ (light colored eyes that engage but not too piercing),, controlling 6, hard on self 6, easily overwhelmed, hotﬂashes 7, cold feet 2LV: dense 5 (but not tightly packed. her physique looks like overweight mary lou retton/gymnast, eyes not piercing 3+GB: easily frustrated 8, convex (large protruding belly - convex shaped), dream disturbed sleep 5

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1 teacher remarkP: speaks calmly and deliberately 8 movement is normal.H: tend hotUB:LI: dry patches of eczema 4, stubborn 5SP: likes alcohol and sugar 8, overweight but not mushy with large belly 8, not overly productive 5, puﬀy face and eyes, easilyswollenLU: thenar 4, large belly 8, normal chest, dry eczema 4, dry skin 1-2 (mixed), dry eyesST:It seems like that her eczema ﬂared up after I did ST+ and LI+ treatments. After I did LI+, she had a ﬂare-up of eczema along LI, SIand SP meridians. Eczema in the ankle area (SP5) is a new spot for her. It was a mixed treatment because she felt less swollen andcan ﬁt in her clothing better.Any ideas how I could treat the skin condition?Thank you! ReplyKristin Wisgirda  NewDec 05, 2021ReactWhat was her skin like before the eczema ﬂare- dry or normal or moist?Besides dry what is the eczema like- itching, pale, red, weeping, bleeds when scratched???<LV: dense 5 (but not tightly packed. > I'm not sure what this means. Dense means compact.<Bright eyes 3+ (light colored eyes that engage but not too piercing),... (liver excess) eyes not piercing 3+> The way you present your eyeevaluation confuses me. Even if the eyes are 10+ piercing is there any outward projection? We will be viewing lots of eyes in the 12channels class this week.<GB: easily frustrated 8, convex (large protruding belly - convex shaped), dream disturbed sleep 5> None of these are GB excess for me.You haven't mentioned what her gi issues are.<It seems like that her eczema ﬂared up after I did ST+ and LI+ treatments. > Did both treatments clearly ﬂare the eczema? Even if itwas a mixed response, sounds like she didn't respond well to drying. It also sounds like she is fairly hot. Very hot people can easilybe overdried because heat is so drying.What other channels can be used to add moisture besides Spleen+?

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1 teacher remark1 reply 1Ruth RichardsMistreatment or partially eﬀective treatment?NewDec 02, 2021ReactQuestion for teacherI am not sure of the diﬀerence between a mistreatment and a partially eﬀective treatment. After treating a woman with LI+ forsevere hot ﬂashes, she settled well on the table and had relief for almost 24 hours. Then the hot ﬂashes came back even morefrequent and intense. If this is a mistreatment, how soon does a counterbalancing treatment need to be administered? ReplyKristin Wisgirda NewDec 02, 2021 | EditedReactHi Ruth,This sounds like a mixed result scenario. Instead of counterbalancing what you have done, looking for the biggest gap betweenthe other channel pairs is the right thing to do.A mixed treatment is when the is clear beneﬁt (settling on the table + signiﬁcant symptom relief) but also clear adverse eﬀects.Mistreatment is when there is litlle to no clear beneﬁt but very clear adverse reactions.Feel free to send along a case study.2 teacher remarksNaomi Frankamazing response to Liver +NewDec 01, 2021ReactJust wanted to share this from a couple of weeks ago. A patient who has had signiﬁcant mental health challenges requiringhospitalization, coming regularly for acu since. She will often fall asleep during session, but have intense vivid bad dreams. Ieventually tried SAAM on her. She's hyper-sensitive to stimulus and has very bright eyes so it was easy to choose Lv+.She had a big release during the treatment, starting with Liver 8 (3rd point) . During the treatment she said she slipped into thesame type of dream but that it didn't feel at all threatening. The change in her is still evident 10 days later.Now to ﬁgure where to go next. It'll be St + or GB+ based on my conversation with her. ReplyKristin Wisgirda NewDec 01, 2021 1ReactAwesome! Responses like that keep us going when the going gets tough in the clinic.Saam can create such dramatic shifts.MariaNewDec 03, 2021React

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1 reply 11 more comment1ReplyI am wondering since pt. has vivid bad dreams, a GB excess pattern, would one go forth with GB+ with caution or rule it out as amixed pattern?Naomi FrankFemale 39 - Cough, fertility, energy/weight gainNewNov 28, 2021ReactThis is a patient I have treated for some time and who is very drawn to SAAm. I set up an online appointment so I could go more indepth with questions than I can in my community clinic, where things can be fast paced. She is fascinated by the system and isalso a trained therapist, so I didn't have to 'disguise' my questions as we sometimes need to do! Some extra notes on that rightdown at the bottom.Female 39 - CC cough and low energy, also fertilityCC: cough and low energyAppearance and demeanour: very open, and friendly.Lifestyle: is a teacher of small children. Loves this work. Also trained as Gestalt (?) therapist and sees clients after school day.Body morphology and ﬂesh quality: large, ﬂeshy. Robust and curvy body but has also gained signiﬁcant weight in 2020 and hassome stress around this.Skin: moist, does not need moisturizer besides face and isolated areas (e.g. her elbows, recently) Body temp: typically warmer but this is less pronounced as she gets older. Noticing more alternating, e.g. rising heat with anxiety,can get cold more easily.Respiratory: chronic cough with sticky clear mucous sometimes easily expectorated, always audible. Mild asthma as a child. Lungsused to be suceptible to cold but this is less the case now. Can feel tightness in back of ribcge, triggered by anxiety.Sleep: goodEmotions: historically lots of ﬂuctuations, with her work in therapy in the last 15 years she feels more even keeled. Mom dies lastyear shortly after their reconcilitation, which caused signiﬁcant grief, also right after she had a miscarriage. See note re P+ eﬀect.GI: digestion unproblematic. Can get heartburn. Signiﬁcant weight gain 2020. Cravings for chocolate and bread.Urination: Menses/Reproductive: tendency to spotting; rarely has cramps, fresh red -dark ﬂow, regular. Miscarried at 7 weeks in October2020 and chemical pregnancy April 2021.Pain: R knee pain, mostly Sp/St channelsInjuries and surgeries: noneTGTITR: her generous and positive, grateful demeanour.Excess PresentationsLu: phlegmy cough +8 , wide ribcage and ample ﬁgure +8. Acumulates possessions; hard to let go +7 Feels well resourced , earnsgood income and pays at the high end of our sliding scale(but see note below)St: moist skin, "where does the money go"/slips through her ﬁngers +7 Sp: ﬂeshy body +8, enjoys being lazy +7, cravings +6 (used to be stronger)L Int: Ht: open and generous personality +8; P rapid, tends to warmth +6, warm soft midline (I had her palpate this so will check in clinic)UB:Kid: symmetrical +7, strong sense of self, likes to be in charge and centre of attention - see note below, grooming +5,

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5 teacher remarksSI: P: GB: naturally ﬂuctuating emotions/energy/engagement in life +8; can get irritable +6. Temporal h/a that she associates withfrustration/irritability (rating?) Lv:SJ: 'super feeler'= very permeable to other people's emotions +9, works hard to let go of thiswarm/cold alternating +6, hard on self re weight gain +7*NOTES:Re Kid XS/Ht XS: when she described her late mom, this was a very clearly Kid XS person. I asked in what ways she is similar to hermom. She said "I used to have a "predominant self-focus in thinking that I was the worst". To me a great reminder that K+narcissim is not a lways a healthy sense of self. I asked her what drew her to being a teacher - which she wanted since childhood -and there were many things: likes to be centre of attention, likes to be in charge & do things her own way. Alsoemotional/social/nurturing component, loves watching them learn skills (like reading) that will be with them for life.Re Lu/St presentation:Feels very well resourced, BUT described this as a recent feeling, could be that it is the result of therapy/internal work, becasueshe also strongly identiﬁed with money easily slipping away and having a run of bad luck (mostly expensive repairs on her newhouse). So mixed!SAAM Treatments:1. Lv+ on L (16 Oct) - noticed irritability in following week, not new but perhaps exacerbated2. P+ on R (23 Oct) - irritability totally cleared, particularly noticeable at work with students: "oceans of patience" in a way that feelstotally new. ReplyKristin Wisgirda  NewNov 29, 2021 | EditedReactThanks for the case Naomi.<She said "I used to have a "predominant self-focus in thinking that I was the worst". To me a great reminder that K+ narcissim is not always a healthy sense of self.> Thinking that you are the worst is not Kidney excess. Maybe SI lack of self love, SJ being hard onherself or even Liver excess inward and dark thoughts.<SJ: 'super feeler'= very permeable to other people's emotions +9, works hard to let go of thiswarm/cold alternating +6, hard on self re weight gain +7> These signs and symptoms can all be attributed to other channels as well.Her reaction to Liver+ conﬁrms. I wonder if the "super feeler" could be an element of Heart excess love for others- a kind ofclinging on to others emotionally. Warm cold alternating can be attributed to other channel excesses. Even if the irritabilityfollowing Liver+ wasn't dramatic, it was still part of a partially adverse reaction which makes me wonder if you missed some signsof Liver excess.How about her eyes- bright or dull? Flesh - dense or open?<Re Lu/St presentation: .... So mixed!> Worrying about money slipping through your ﬁngers is a normal response to having a newhouse needing repairs. It is just one of those circumstances where you end up writing big check after big check. I wouldn't give it ahuge amount of weight unless it was clearly causing symptoms like insomnia or anxiety.Looks like she needs help in Earth/Metal and also K/SI. What are your thoughts moving forward?Naomi FrankNewDec 01, 2021 | EditedReact@Kristin WisgirdaKristin Wisgirda

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7 more comments 7ReplyThinking that you are the worst is not Kidney excess. Maybe SI lack of self love, SJ being hard on herself or even Liver excess inward anddark thoughts.I have to put this into context better. She was telling me about her late mom who was quite self involved, as well as always welldressed and groomed. I asked her how she resembles her mom. We were speciﬁcally talking about a focus on self, and she wasreferring to feelings that she had years ago, has worked on in therapy and feels clear of. I think she was saying it was always allabout her (when she felt that way).She does not seem SI XS to me.Deﬁnitely more SJ excess than Liver. I'm not sure the irritability was a response to Lv+. I didn't listeyes (I still ﬁnd this hard to evaluate) but they are not dull, and she does really connect when I am talking to her. I'd say tissue ismore on the dense side though.However I had not really picked up on Kid XS either, except for wanting to have a child (I'm not giving that much weight, shedoesn't seem obsessed) and then the comments about why she was drawn to teaching. I can dig deeper when I see her next.Her Sp XS seems clear so I think I'd feel comfortable doing LI+.I'm uncertain about Lu/St. It's very mixed. I wonder if this is one of those combination situations, her Ht XS generosity leads tomore spending? She is well resourced but said that it's taken her time to feel that way (that she has enough). She works hard at 2jobs. She did say she feels she doesn't know where the money goes. Sounds like a lot on therapy and on her house.Adina KletzelPregnant, nauseous, and thinNewNov 24, 2021 | EditedReactThis post was administratively edited at 11/24/2021 4:47 PMAge 32A couple of weeks pregnant with second child.Main complaint: nausea 10+, weak 9+, body pains 7+,, a stuck feeling in her chest and throat along with heat 8+, no appetite 9+,pain and pressure in sinuses 8+, headache 8+, trouble taking deep breaths 8+Throat, mouth, and sinuses feel hot 7+Wants to cool it oﬀ with cold waterShe has a one and a half year old daughter and she found out that she is pregnant 2 weeks ago. A week after that she got sick withbad throat pain, weakness, and body pains.It went away after a few days but she was left with the main complaint symptoms listed above.In her ﬁrst pregnancy she was a bit nauseous but not barely as bad as now.She just stopped nursing her daughter now and her period returned 6 months after she gave birth. She feels that she neverregained her strength since she gave birth a year and a half ago.Body morphology: very thin 9+, pale sallow complexion 8+Lifestyle: mother, married to a loving husband, works part time from home in advertisingSkin: dry 7+, not much ﬂeshGI: BM usually normal, has diarrhea nowhistory of getting nauseous - esp in the carEyes: history of getting many styes in eyes – full of puss, needed 2 surgeries to drain themEmotions: very orderly, can’t take a mess, always cleaning up, has to do things a certain way, controlling, attention to detailsaround her 8+She needs to take care of daughter and home before she can let herself rest.Tendency to get angry and impatientRight now she is sad and dejected because of how sick she feels.

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3 teacher remarks2 replies 22 more comments2She cried a whole lot during the treatment.Sleep: trouble falling asleep, light sleeperTongue: greasy coating, ﬂat, more paleEyes: bright 2+Medial heel averageI would have liked to do St+ because of the nausea and all the congestion above (sinuses, throat, chest) but she is so thin and sheis pregnant so I did PC+ for the ﬁrst treatment (trouble taking deep breaths, so agitated and upset, it started with throat pain).Other top ideas are Liv+ and Kid+Liv + cuz she is Sj excess type and also both gave birth, nursed and had her period for the past year so tonifying blood should behelpful.Kid+ cuz she is taking care of her baby and husband and is not taking care of herself. And she never fully recuperated after lastbirth.BUT – I am not sure if those will address the nausea and the feeling of a lump in her throat and body pain and no appetite…I amhesitant to do ST+ cuz of how thin she is.Should I consider SP+? I am hesitant because her sinuses feel full and have pressure and I have never used it for nausea.Do you think I should try to go to Liv+ or Kid+ ﬁrst?Also – you said that you don’t use a greasy tongue coating as an indication of interior damp. I may have used ST+ if I gave credenceto her tongue coating. Are you saying to just ignore the tongue?Thanks for your input. ReplyKristin Wisgirda  NewNov 24, 2021React<Are you saying to just ignore the tongue?> I would ignore the tongue here.Is there any uprising with the nausea? She is able to eat even though she doesn't have an appetite?Is there any discharge with the sinuses?I would probably avoid Spleen+ until the heat is cooled down.I see more reason to use Liver+ than K+.(BTW- I edited the post by removing the spaces to make it shorter. Canvas adds too much space.) ReplyKristin Wisgirda  NewNov 25, 2021React<So you agree that ST+ is not a good ﬁt here?> I really would hesitate to use ST+ with signiﬁcant interior dryness and no upwardsigns.<And have you seen SP+ work to calm nausea in Skinny and dry people?> I haven't had the chance but I would consider it.<Would the clogged sinuses deter you from using SP?> If there was lots of discharge I would hesitate but there is no discharge.Sinus congestion is one of those symptoms that can be just about anything.<Would the tendency to get pussy styes in her eyes deter you from using Sp+?> If it was recent I would give it more weight.The heat was the big deterrent for SP+.

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1 teacher remarkToby WedgleSa'am practitioner in Pittsburgh?NewNov 22, 2021ReactAnybody know a Sa'amster out there? Thanks!! ReplyKristin Wisgirda NewNov 29, 2021ReactHi Toby,Sorry I can't think of anyone practicing in Pittsburgh. I put word out on the Qiological forum and will let you know if it gets aresponse.1 teacher remarkMariaCounter balanceNewNov 20, 2021 | EditedReactJust curious... if we went back and counter every treatment we have given, would the patient be back to where (s)he started?ReplyKristin Wisgirda  NewNov 23, 2021ReactMy guess is no. Patients' lives aren't a simple algebra equation. They experience other inputs which inﬂuence and interact withtheir systems.1 teacher remarkAdina KletzelWarming the bloodNewNov 16, 2021ReactHI,If Liv+ toniﬁes and cools the blood so does SJ+ warm the blood?Furthermore, can we say the SJ+ warms the Liver meridian?ReplyKristin Wisgirda  NewNov 16, 2021React<does SJ+ warm the blood?> My take is that it brings warmth by opening dense tissues so that light and warmth can penetrate. Areyou wondering if it has more aﬃnity for the blood than Heart+ because Liver is its counterbalancer? I wouldn't say so.<can we say the SJ+ warms the Liver meridian?> I don't see why not. SJ+ warms and it has an aﬃnity for the Liver and SJ channels.

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Sharon Sherman Nov 15, 2021This post was administratively deleted at 11/15/2021 11:29 AM2 teacher remarksAdina Kletzelwithered medial heelNewNov 14, 2021ReactHI,You have recently stressed that a withered versus a dry and cracked medial heel is a strong sign of SI excess.Would this heel be an example of a withered medial heel?If not can you post a picture of a withered medial heel so that I can understand the diﬀerence between withered and dry/cracked?THanks!JPEG | 1.3 Mevyatar heelKristin Wisgirda NewNov 14, 2021ReactWithered means there is less than normal ﬂesh. Dry means the skin is dry. It is helpful to look at them separately when evaluatingthe medial heel.This heel looks withered and dry.I made dry heels a secondary sign for SI excess because one can buﬀ and moisturize the dryness away for the most part. Witheredis a primary sign for SI excess because you can't cosmetically improve the ﬂeshiness unless you get fat implants there!Fleshy heel was made a secondary sign for Kidney excess because ﬂeshiness here can be on overﬂow from a grossly overweightbody and not a sign of K excess. A ﬂeshy heel in a normal or thin person would have more weight.

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2 replies 21 more comment1ReplyReplyTuriyaNewNov 14, 2021ReactI'd be curious and inquiring into his daily caﬀeine consumption.Kristin Wisgirda Anyone in Pasadena?NewNov 07, 2021ReactPlease let us know. Thanks!Kelly Kaeding12 Channels of Sa'amNewNov 04, 2021ReactHi KristinI couldn't get into the discussion forum for 12 Channels so I am writing here instead of emailing. Hope that is ok.I am excited for the class today. I have two questions.Is it possible to get a printable version of the handouts without the black background? If not today, maybe in the future?Can we go over point location with each channel??Looking forward to seeing you in a couple hours.KellyNicole SharkeyRecent sense of anxiety, feeling of dread in epigastric areaNewOct 26, 2021React65 Year old FemaleChief complaint: Anxiety and sense of dread in her upper abdomen which has come on over the last few monthsSecondary Complaint: A variety pain, including joint pain with cold weather, foot pain, lumbar pain, and 40 years of urinarystricture with incomplete voiding and burning urination.Appearance and demeanor:Body morphology full, clean but unkempt: nails are groomed but hair rarely is, very casual clothing occasionally with stains,although maintains a slight sense of style. VERY talkative – non-stop through treatment until treatment begins, but with a slightlynervous energy. Shares a lot of details about life but not always open about her emotions. Not warm or eﬀusive but very caring –often makes gifts for others, brings me or my daughter things she has made/grown.Kristin Wisgirda

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Lifestyle: Desk job, works very hard despite not liking company she works for. Looking forward to retirement. Very busy at homewith gardening, crafting projects. Rarely slows down, despite a lot of body pain.Body morphology and ﬂesh quality: Full, ﬂesh is soft in abdomen, sl dense in legsSkin quality: Slightly dry 1+Body Temperature: Warm. Keeps house at 59 degrees, rarely wears a coat, although professed to having more moments offeeling cold over the last few months.GI: Tendency towards reﬂux and dyspepsia. Diﬃculty losing weight. Feels better oﬀ of carbs/processed foods but hard to controlwhen depressed.Respiratory: Frequent post-nasal drip, occasional uncontrollable coughing. Springtime allergies – red itchy eyes, sneezing.Sleep: Diﬃculty falling (uses podcasts, warm baths) and lots of diﬃculty staying asleep (restlessness, pain, nocturia, etc.).Emotions: Normally has frequent bouts of depression where she has diﬃculty getting out of bed. In last three months, hasexperienced more of a sense of anxiety and not wanting to leave home which is unusual for her. Still experiences interest inprojects at home, but anxious about doing anything other than the projects that make her happy at home.History of abuse – ex-husband, childhood. Daughter passed away from cancer several years ago.Urination: Urinary stricture since in her mid-20’s after birth of ﬁrst child. Frequent burning and painful urination. Has urethradilated every 6 weeks to breakup scar tissue.Body:Excess Presentations:Heart: Constant talking (though she does become quiet during treatment), makes lots of gifts for others, often feels warm and hashot ﬂashes, diﬃcult urination, burning urination.UB: Sense of dread in upper abdomen, anxiety about leaving home and talking to others. New sense of occasionally feeling cold.Lumbar pain.GB: Very ﬁdgety. Very quick to get on and oﬀ the table.P:SJ: Hot ﬂashes? Red face, occasional LR channel knee painLiver: Slightly dense, unconcerned about appearance, occasional LR channel knee painStomach: Slightly ﬂat thenars, historical lack of resourcesLU: Springtime allergies, post-nasal drip, acid reﬂuxSpleen: Full morphology, sugar cravingsLI: very busy, active despite body painSI: Tendency towards depression, slightly unkepmt/disregard for hair/clothingKID: Four children, symmetrical 1+Sa’am Treatment History:LI + 4/21/21: Lumbar pain w/ pain at L4. (Improved with this treatment but not fully resolved).UB + 5/13/21: Sudden onset allergic rhinitis with red, itching eyes (gone after this tx)LI + 6/22/21: L shoulder pain on LI and SJ channels. Pain 50% improved.Medial heels: full but no xue luoThenars: Slightly ﬂat 1+Midline: Line of tension, esp at REN 14, which can be felt with deep palpation onlyRibside tension: Right side 4+, left side 3+Eyes: Bright 3+Face: Slightly redTongue: dusky, sl thick, sl dry white coat, Sublingual vein distention 4/5

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4 teacher remarks1 reply 1LR + 6/24/21 : L shoulder pain on LI and SJ channels Pain slightly improvedLI + 7/8/21: Pain in L shoulder on LI channel – Pain mostly gone.UB + 8/18/21: Burning itching feeling on top of right shoulder blade for last several months, burning urination. Not particularlyhelpful.LI + 9/1/21: Left shoulder pain, generalized joint pain. Somewhat helpfulUB + 9/16/21: Pulled muscle at UB 40, continued to have some burning urination. Pain in leg resolved after one treatment. Nochange to burning urination.Treatment Ideas: I am wondering if all of the UB + may have contributed to this new sense of dread which has developed over thelast few months. I am wondering if tonifying HT would be contraindicated considering the talking and heat. ReplyKristin Wisgirda  NewOct 27, 2021ReactHi Nicole,Thanks for the case.<Body morphology full> What is she full of- extra ﬂesh, air? It would be helpful to know. Grading the amount of extra ﬂesh/air/etcwould help us see your patient more clearly. If she has lots of extra ﬂesh, then the ﬂeshiness of her medial heel has less weight forKidney excess. I am interested in her K/SI balance so this would be good to know.Is her urine dark or is it associated with heat sensations? For burning to point to heat, I like to see other heat signs. Has anytreatment clearly helped the urinary symptoms? I wonder how much the burning urination varies in relationship to her lastdilation.<GB: Very ﬁdgety. Very quick to get on and oﬀ the table.?> When a patient is quick to jump oﬀ the table, I question how much settlingwas achieved with the treatment. Itcould have. All of your treatments of her have been cool, cooler and cold (LI/Liv/UB). She has some other cold (or dark) signs- jointpain worse with cold, prone to depression that makes it hard to get out of bed.Nicole SharkeyNewOct 27, 2021ReactHi @Kristin Wisgirda Thank you so much for your comments.<What is she full of- extra ﬂesh, air? > Do I understand this idea correctly, that being full of extra air would mean more light andpuﬀy ﬂesh, which is not dense, and being full of extra ﬂesh would be more dense? Would sagging ﬂesh be more of the airy varietyif it were loose and hanging oﬀ the bones? Would we also want to look at how much ﬂuid is in the ﬂesh by looking for any pittingedema or tautness to the skin? Would we want to evaluate this in one part of the body over the other? For example, would we lookat the abdomen for ﬂesh quality over legs which tend to be more muscular and dense?In her case the ﬂesh is slightly loose and puﬀy around the abdomen but is fairly balanced 30/30/30 ﬂesh, air ﬂuids. There is noextreme puﬃness and no particular taughtness. She is slightly more dense in the legs and there is more ﬂeshiness to the fullnessin the legs and ankles and no pitting edema. The ﬂeshiness in her ankles seems consistent with the rest of her body - no morethere than anywhere else.<Is her urine dark or is it associated with heat sensations? For burning to point to heat, I like to see other heat signs. Has any treatmentclearly helped the urinary symptoms? I wonder how much the burning urination varies in relationship to her last dilation.> Her urine isslightly dark and feels burning. UB + did help tremendously once with allergies and burning urination (I believe the ﬁrst time I didKristin Wisgirda

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5 replies 5Replyit on 5/13/21) but hasn't made a diﬀerence since. The burning is deﬁnitely worse after dilation, and retention becomes a biggerissue the longer it has been since dilation, though she can get burning any time.<When a patient is quick to jump oﬀ the table, I question how much settling was achieved with the treatment.> It seems to be consistentwith every treatment, even the few where she has fallen asleep (Sa'am and non Sa'am). But I would agree that in general, I don'tfeel that she is ever very settled.< Itcould have. All of your treatments of her have been cool, cooler and cold (LI/Liv/UB). She has some other cold (or dark) signs- joint painworse with cold, prone to depression that makes it hard to get out of bed.>Yes. To be honest when we started Sa'am treatments she hadn't had depression in a while and hadn't mentioned the joint pain soI really overlooked those cold signs. It is chronic but I also wonder if that has gotten worse because of the cold treatments I havebeen doing too, because she started mentioning that more frequently over the last month and a half.

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1 teacher remarkFang CaiLazy eyeNewOct 26, 2021React38yo female patient, very polite, neat dresser, with super bright eyes 9+.She is not sensitive to light. Just today I asked more about her vision since she wears thick glasses. She has trouble seeing in thedark; also if she doesn't wear glasses or contacts for a few hours, her L eye start gets "lazy", unfocused and she sees double.I would categorize lazy eye as dull eyes. Is this correct thinking?If so, then how do we think about someone whose natural state is dull eyes, but with glasses has super bright eyes?Is this a mixed case where I should just go to other channel pairs?FYI, I did LV+ on her once, she was reasonably settled but nothing spectacular. ReplyKristin Wisgirda NewOct 26, 2021ReactVision problems, such as double vision and blurring, that are not related to dark/light don't have weight for Liver or SJ. So lazy eyedoesn't equal dull eye.The brightness/dullness is related to the appearance of the eyes themselves. Bright eyes have a piercing gaze that is directedoutward. Dull eyes, lack that piercing quality and are more inwardly directed.Her Liver/SJ presentation is somewhat mixed in that she has super bright eyes but also trouble seeing in the dark. ReplyFang CaiNewOct 26, 2021Reactthank you wise one!Kristin Wisgirda Jan's CaseNewOct 25, 2021 | EditedReact54 year old femaleChief complaint - Heaviness and pain of the limbs due to Stage 3 Lipedema which includes ﬁbrosis of the connective tissue. Onset with puberty at 12years old. The condition runs in her family on her father’s side.Worse in hot damp weatherWorse standing up ﬁrst thing in the morning.The legs feel heavy.Leg pain moves around, is achy and feels “like a toothache”.Flesh is hanging on the Yin meridians of the arms and legs. Skin and ﬂesh are not attached. The texture is slippery and weak. Painful small bumps/lumpsappear closer to the bone. Pain is equal on both sides.

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Meridian ExcessesGBPCST – acid eﬄux +6LU – Thenars +7*reasons to use +ST +numbness right anterior thigh+7*reason to use +Lung= right sided pain under right ribsLISP Body type +10, phlegm nodulations +9, brain fog +7SJ sparkling eyes +7,LVUBHT Warm caring personality +7, Soft, warm midline +8 (although cooler at CV14-16), burning pain right Achilles +7SIKD Pain +8, Heels are plump +8, stagnant veins +6Treatments+ ST left3 +LV right+SI , leftNumbness on the right anterior thigh (ST meridian)Secondary complaint burning and tightness in her right Achilles tendon following a sprain in 2012, worse standing up the ﬁrst time in the morning. Thetendons of the knees are also tight.Physical attribute most prominent – very large body, what you would call obese, however she carries herself lightly!Mental Emotional attribute most prominent – Fiery, friendly personality with sparkling eyes (+7), however this genetic condition is exhausting her.Pulse is deep and forceful. Sometimes diﬃcult to ﬁnd.Tongue is Pale with a lavender hue, Swollen, slightly crimped, scalloped, thin white coat. Veins are stagnant lower down.Abdomen is soft and warm at the midline but cool from CV 14-16. Discomfort under right ribs.Body Temp Her body temperature is neutral. In hot weather she is hot and sweats profusely.Thirst,–not thirsty and likes her drinks chilled.Digestion/Appetite/Bowels (Bloating and acid reﬂux in the past – controlled with diet). Stools are formed, soft logs and are easy to pass, 2X a day usuallyin the morning.Urination – small amounts, no urge, not frequent.Aversion to wind –Sleep – interrupted by pain in the ﬂesh of the legs. Takes melatonin nightly (it’s a habit) 11:30-7:30. Wakes to urinate at 3:30-4 and falls back to sleepeasily.MensesMenopausal symptomsLigament pain in the legs, High Blood Pressure, acid reﬂux, brain fog, weight gain, irritability. Last period 8/2019 at 53 years old.History of a regular irregular period alternating between 28 and 35 days with cramping at ovulation and bloating before the ﬂow starts.Respiratory – allergies to dust and mold – chest gets tight and she experiences general fatigue.Energy/Exercise – Unable to exercise due to the leg pain. She is a massage therapist.Emotions – feels “meh”, “languishing”. Anxious about the progression of her condition and loosing mobility.Skin – dry +6 , Heels – no lines - some stagnate veins. Thenars – Plump and ﬁrm +7+LI both sidesOverall Client feels better since late treatment. Still feels heavy in the legs and pain at night and in the morning when she ﬁrst stands up. Urinating morefrequently and more volume, Brain fog is better. Numbness on right ST meridian bothering her today,Right leg feels better. Pain in the ﬂesh feels better. Her eyes are like laser beams todayFlesh pain continues to feel better. Right ankle is worse. She feels pain every time she stands up.

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2 teacher remarks+LI, right+SI, right+PC, right+LI, right+UB+LI, right +SI, leftClient texted a few days later to rave about this treatment- She reported sleeping well , had more urine output, less pain and feltlike she feels like she was “deﬂating”.+LI, right +SI, left*Note the patient is also taking herbs.Knee and ankle pain feel ‘ok’ today. Urination is not as satisfying as it had been. Pain in the legs has been waking her up at night Feels like a tooth ache.Urination is a good amount; sleep is better (less leg pain at night). Her body feels smaller but her actual weight is the same. Pain in the left knee is takingup mental space.Not sleeping well and feeling restless at nightSleep has been good. Her mood is improved, no brain fog, Ligaments of the ankles and knees feel tight but the pain level is improved. Heavy andachiness in the legs continues, also the numb ‘tooth ache” pain in the St meridian of the right thigh comes and goes.The weather is hot and she feels hot and sweaty, fatigued from the heat. Her ﬂesh although heavy feels less ﬁbrotic, less dense, less painful around thenodulations.Was on vacation and ate fried foods. Her legs feel heavy and sore, she is achy in her sleep, (her body is not hot and she is not a sweaty mess).Palpating the ﬂesh the skin and muscle feel more connected. There are less nodulations and they are less painful. Patient reports feeling less heavy,more upbeat and has more energy. She requests the same treatment again. I made a note to +liver but her eyes were not as brite today so I repeatedthe treatment.Kristin Wisgirda NewOct 25, 2021ReactJan wrote this case for a case study group but we didn't have time to discuss it fully.Lipedema is diﬀerent than lymphedema. I was unaware of it. It is fat build-up in buttocks, thighs, calves, and sometimes the upperarms. Diuretics, elevating your legs and support stockings do not help the aﬀected areas. There is typically no swelling in feet, orhands unless the patient has chronic venous insuﬃciency or lymphedema. Cause is unknown but tends to run in families. It isalmost exclusively in females and tends to show up around hormonal events like puberty, pregnancy and menopause.It sounds like the patient is making progress with Jan's treatments but here is some food for thought.- Do include the involved channels and counterbalancers. While this isn't helpful for the lower body pain where all channels couldbe included, it would help for achilles pain which is her second complaint and maybe her knee pain.-Don't include things that are well controlled with lifestyle. Unless she has to eat a really restricted diet to control her acid reﬂux,the acid reﬂux isn't a signiﬁcant part of her picture.-<reason to use +Lung= right sided pain under right ribs> Tension and pain under the right ribs is a ﬁnding for both Lung andStomach excesses. Toby says that there is a slight preference for wanting to use Lung+ but I think that is just lip service to theclassics.-<Heels are plump +8> FIY: This ﬁnding has less weight for Kidney excess when the patient is obese.@Janet Wilson Please let us know about her symmetry and grooming. On the call you mentioned she doesn't have children.Fleshing out the K/SI balance will give you a better idea about how often you can use SI+ and perhaps what her achilles tendonissue needs. Since you have already used SI+ a number of times, you should be on the lookout for SI excess signs especially sinceshe is on the other side of 7x7 years.- Like we mentioned on the call, she has lots of SJ excess signs- loose open ﬂesh, light movements, and super bright eyes (attimes).Jan Wilson

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1 reply 11 more comment 1ReplyDid UB+ give her any beneﬁt? With severe damp, I like to consider all the treatments that can address dampness- which includesH+. Though she seems more H excess on paper, with cooler weather coming and depending on the eﬀect of UB+, there maybe aplace for H+.Please let us know what you think and how she does with further treatment. Thank you. ReplyJan Wilson NewOct 26, 2021ReactThank you for your direction and clariﬁcations Kristin.Did UB+ give her any beneﬁt? With severe damp, I like to consider all the treatments that can address dampness- whichincludes H+. Though she seems more H excess on paper, with cooler weather coming and depending on the eﬀect of UB+,there maybe a place for H+.The UB channel was during a hot spell in the summer. Her Achilles tendon pain was burning and she felt hot. I wasn't thinkingabout the damp part of the UB channel, just the cold. Thank you for pointing that out. She settled during the treatment or I wouldhave taken the needles out. She went on holiday for a few weeks and I did not get clear feedback. I do think +HT might be nice forher. She lost her mother and brother both in the past 5 years. But I would deﬁnitely wait and see how the weather changes eﬀecther. On occasion she may get depleted in her work as a massage therapist 'giving and giving'. Would a +HT give her some love?Please let us know about her symmetry and grooming. On the call you mentioned she doesn't have children. Fleshing out theK/SI balance will give you a better idea about how often you can use SI+ and perhaps what her achilles tendon issue needs.Since you have already used SI+ a number of times, you should be on the lookout for SI excess signs especially since she is onthe other side of 7x7 years.Her symmetry is a 4.Her grooming is a 6. She wears some make up and makes an eﬀort. It isn't a pulled together look by any means.What do you mean by looking out for SI XS sighs on the other side of 7x7 years? I must have missed that clue.Thank you again.4 teacher remarksKristin Wisgirda Michelle PhillipsNewOct 19, 2021ReactWhat can you see that would inform a Saam diagnosis?JPEG | 4.5 KMV5BM2RiN2ZmNTktYWJjZS00…JPEG | 26.8 Kmichelle-phillips-51kk-allfamou…JPEG | 165.7 K9th+Annual+American+Human…

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3 replies 310 more comments10ReplyAlison Unterreiner, DACM, L.Ac.NewOct 19, 2021ReactSparkly eyes and red cheeks = SJ XSSymmetrical features = KID XS ReplyTerri MatsonNewOct 19, 2021ReactI agree with Sharon the ﬁrst photo (youngest) her eyes look more shielded and appears take on brightness as she ages. Theredoes appear to be some asymmetry in the eyes, which is most apparent in the third (oldest) photo.Adina KletzelCounterbalance questionNewOct 18, 2021ReactHI,I have what seems to be a complicated situation to ﬁgure out and can use some guidance.I have a 48 year old female client whose body morphology is more Sp excess. She is overweight and normal skin.She has more of a LI excess personality though - she works a lot and is quite busy with a big family, community commitments andbeing a dating and marriage coach.Her main complaint is stiﬀness in her neck and shoulder - BL and GB meridians.I have done BL+ on her in the past (she is also HT excess in personality) and it has helped her stiﬀness but has caused stomachdiscomfort - loose stools and discomfort under her ribs.She also has a strong dispersion thirst - drinks and pees and her mouth is dry.THree treatments ago I did LI+ for morphology and she got tired , irritable, constipated and had breakthrough bleeding in hercycle. She lives far and I did not see her for two weeks at which point these symptoms had resolved and I did SI+ which was reallygood for her.This past treatment she complained of being more tired than usual, not sleeping well, and the neck stiﬀness.I decided to do LU+ since the LI+ caused her to be constipated so I thought she could use some moistening inside, she was tired,her face looked worn, some of her pain was on the LU meridian, and she said her pain and stiﬀness come mostly when she hasoverexerted herself.She texted today that she feels really tired, her stiﬀness is worse, and she did not sleep well.I do not know if she settled because she lives far and I travel to her and she talks to me the whole treatment....I am going to give it one more day but the question is if I need to counterbalance with ST+ then can I counterbalance on theopposite side that I did LU+ on and then add Bl+ on the other side for the channel pain (and it has helped in the past)?I know it is not ideal but I only have one chance to try and ﬁx this and try to treat the stiﬀness. I will not be able to travel out to heragain for two weeks and she cannot come to me.I also know that ST+ and BL+ are not great channels to use together since one is drying and one is bringing in cold water.What would you suggest in this situation?This is the rest of her excess presentation just to give a fuller picture:Excess Presentations

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3 teacher remarks2 replies 21 more comment1SJ bright eyes 7 likes order 8 craves the forest 8 pain on SJ mer. 10 aware of people around her 9 needs to wear sunglasses in sun8 Has a light happy energy 6+Liv pain on SJ merHt talks a lot 9 pain on Bl mer 8 loves the water 9 very active 8 very loving 9 sternum to umbil. Soft and warm 7UB pain on Bl mer. 8 very freq urin.Kid had car accident 9 in terrible pain 10 fertile 8 had 5 c sections 7 pain on SI mer 10 ﬂeshy medial heel 8SI pain on SI mer 10 gives A lot to other ppl 8 is 48 no period crampsGB ? had GB stones 8 pain on GB merPC pain on GB mer..10 doesn’t get angry 7LI likes to be busy and do 8Sp overweight and normal skin 6St pain w/w tired and with overexertion 7LU inﬂated chest 6 ﬁrm thenar 5 damp inside and dry mouth 7Thanks ReplyKristin Wisgirda  NewOct 18, 2021ReactYour questioning her settling response makes knowing whether or not she needs counterbalancing a harder call. If you arereasonably sure that she settled but still had adverse reactions, then this is mixed response and you should look elsewhere.As for repeating UB+, looks like she had a mixed response to that treatment.Even if UB+ was a for sure good idea, mixing it with another untested treatment is really risky. If it backﬁres, you wouldn't knowhow to ﬁx it.I understand feeling pressure to want to relieve her suﬀering. In my experience, letting that pressure push you to try to do toomuch is never a good idea.What about looking elsewhere? She had a good response to SI+. Looks like she has signiﬁcant K excess that would beneﬁt fromanother SI+.Also looks like she is clearly SJ excess, so Liver+ might be an option. ReplyMariaNewNov 20, 2021ReactI did LI+ for morphology and she got tired , irritable, constipated and had breakthrough bleeding in her cycle. She lives far andI did not see her for two weeks at which point these symptoms had resolved and I did SI+ which was really good for her.This kind of situation is often a conundrum for me. When a patient clearly didn't do well after a treatment, but the symptoms selfresolved. Would it be best to do a counter or move on to a diﬀerent channel?Kristin Wisgirda Point LocationNewOct 13, 20211React

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5 teacher remarksThis conversation started in another thread. @George Mandler had the good idea to start a new thread. Below is the what wehave talked about so far, cut and pasted from the other thread.Kristin:Toby has mentioned that one of the reasons why we use big fat needles and why we thread them whenever possible is so that we don'tmiss the point! But even with this method we still have to double check our location. A great diagnosis is nothing without perfect pointlocation and needle technique.Yes- St41 and K10 are high on my list of needing extra care. Other points that need to special attention in my practice are the jing wellsand UB66, because I don't always get them right. With Gb41-42 the needle needs to touch both points."I have had a number of cases where adjusting the jing wells on UB+ made all of the diﬀerence. If you think stimulation of LI1 and UB67were light when you did UB+, consider doing it again threading the needles even a little bit to make sure the directional stimulation isadequate."George: Absolutely. If a treatment is not responding as I'd expect and I am conﬁdent in my diagnosis I meticulously re-check all 4points. They deﬁnitely have a feel that "I got the point" but I ﬁnd not just the jingwells but others often can have an eﬀect such asST41, ST43, KD10, SI3, GB41, TW3. I experience a required precision to the needling that has really opened my eyes to a "holy cow Icannot believe that slight change in depth/angle/location did that".I used to be a sloppier about my needling but now I check and double check each point which takes less than a minute with my2.5x readers!Yes BL66 I ﬁnd getting it right in the space under the knuckle is key.GB41-->42 I ﬁnd the space medial to the 5th metatarsal and needle there and getting under the tendon to GB42-GB42-->41 I ﬁnd GB41 then the space for GB42 over the tendon and needle GB42 under the tendon to GB41I ﬁnd people get an ache (sometimes strong and deep) on this (and that is my experience doing it myself) and ﬁnd it much lesspainful than Jing wells for sure.KD10 is one where I have caused discomfort as ﬁnding that space between the tendons can be challenging on some bodies. I tryto separate it and then needle as obliquely as I can but sometimes it pulls the needle. It may be the point I ﬁddle with the most toget right for this tendon reason.SI3 and SI2 I get right in that space next to the knuckles halfway between the dorsal and palmar sides. I ﬁnd SI3 is especiallyimportant to get right. This is similar to BL66 (SP3 , SP2 as well)Then there is SI5 and ﬁnding the space which is diﬀerent if with or against the channel.George MandlerKristin Wisgirda  NewOct 13, 2021 | Edited 2ReactC=nail root; E= matrix; F=nail bedThe tradition of Dr Wang Yu Ji taught me to ﬁnd jing well points in a depression. Most often that depression is not .1 cun lateraland proximal to the corner of the nail. Instead it seems like that depression is at the edge of the nail root. I end up needling whereJPEG | 15.5 K0D739543-3FC2-4001-8BA2-…

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4 replies 42 replies 23 more comments 3ReplyC and D are in the picture but more obliquely. There certainly is more qi and more meat to needle into than in the traditional .1cun from the corner of the nail location.ReplyMariaNewOct 14, 2021React<SI5 and ﬁnding the space which is diﬀerent if with or against the channel.> Can you please comment on this? Thx.Adina KletzelAny Practitioners in the Northern Jersey area?NewOct 12, 2021ReactHi Does anyone practice in the Northern Jersey area - Teaneck, Fairlawn, Ft, Lee??Thanks1 teacher remark1 reply 1Kristin Wisgirda Diﬃculty registering for Classes and Calls?NewOct 07, 2021ReactWhen I asked our tech guru Emile about your recent diﬃculties registering, he sent this response:"I'd say that a laptop or a desktop are deﬁnitely less likely to have issues. Mobile devices have a setting called "cross site tracking" which when disabled won'tallow them to access the registration page directly from Canvas (this can also happen if someone has cookies disabled on their laptop/desktop).What I'd suggest telling people if they come to you with issues is that there is always a If the form does not load properly, click here to open it in a new window.link on the Canvas calendar which will open the registration page in a new browser. As long as they remember they put the discount code in, they can registerthat way and shouldn't have the same issues."ReplyJoanne TaitNewOct 09, 2021ReactI have had to open new windows to register and that seems to work ﬁne. I'm wondering if the Oct 7th case discussion recordingwill be posted soon? I've been looking forward to it, sorry I couldn't make it to the live discussion.Adina KletzelCase: Shortness of breath and Panic attacksNewOct 06, 2021React30 year old femaleMC: diﬃculty taking in a deep breath 9+, stuckness and congestion in chest 9+, heat in chest 8+, pain on CV line 7+, stuckness inthroat – thick blob of phlegm that cant get out 9+, panic attacks that come with panic thoughts, nausea, dizziness, chills 9+, pain in

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upper back by LU back shu.Appearance and demeanor: bright eyes 5+, puﬀy cheeks with pimples, full around the middle 5+, dense ﬂesh 2+, dry skin 6+, drymouth and lips 6+, symmetrical 5+, polite and warm 7+She comes across as calm and pulled tog even though she is a mess inside.People come and tell her their problems, this is the ﬁrst time she is weaker and she needs to ask for help. She hates being weakand hates asking for help.Lifestyle: married, mom to a 3 year old, works in hi tech in a highly pressured job. She manages other people at her job. Successfulin work force. Has High pressured boss.Body TempShe is usually colder. Suﬀers from cold in winter.In current state – burning in chest and throat,, hot ﬂashes, redder cheeksHands and feet always colder than rest of bodyGI tends toward constipation – goes every 2-3 daysDuring panic attack will have loose BMBitter taste in mouthNo appetie right nowResp. dry cough with blob of phlegm stuck in throat 8+ Needs to yawn to try and get in oxygen 8+Menstruation cramps with period 7+Sleep: hard to fall asleep – esp cuz harder to breathe lying down 8+EmotionsShortness of breath started when got promotion and had more resp at workNurturing to others, giving to others, likes to be the strong one 7+Likes to be in control 7+Self critical 6Demands a lot from herself 6Hates feeling weak and asking for help 9+Currently exper. Panic, anxiety, fear,Tongue: thick coating, teethmarks, thin, red tipGetting a lot of cold sores in mouthBody: thick shiny hair, soft sensitive eyes, soft and warm line from sternum to umbilicus

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Fleshy medial heel, thenar – not full and not ﬂat, chest inﬂated 5+GTITR: Struggle to get a deep breath inGB trouble taking deep breaths 9+ trouble falling asleep 7+SJ controlling 8+ perfectionist 7+ bright eyes 7+ attention to details 7+ pain on Liv mer 7+ goes from cold to hot 7+ blood def. 8+red on cheeks 5+ self-critical 6+LU stuck phlegm and dry skin 7+ nauseous all of the time 8+ inﬂated chest 5+ pain by lung back shu 7+ trouble taking deepbreaths 9+ low appetie 7+St very tired 7+ constipation and pimples on face 6+ nauseous 7+ pain by lung back shu 7+Bl usually cold 7+ feels chills 6+Ht nurturing to others 6+ heat in chest and throat 8+ craving ice cold water 8+Kid period cramps 7+ ﬂeshy medial heel 6+ dizziness 5+ feels congestion in chest 9+ feels like something is stuck in throat 8+exper. A trauma as a child 7+SI always helping others 5+ feeling panicked and unraveled now 8+LI constipated and dry skin 6+ dry cough and dry skin 7+ dry mouth and throat 6+ always busy 6+Sp numbness in tips of ﬁngers 6+( ren and Du – hurts on CV line 8+)Treatments I did14/09/2021PC+(R)Only partial settling. Still trouble taking deep breaths.Heavy mood eased up a bit and had some more energy.chest and back still hurt. more appetite but still nauseous.Hot in chest. Still dizzy and have chills. Still have coughwith phlegm that wants to come out. Have heat waves.19/09/2021ST+(L)Good settling. Shortness of breath went down to a 4 froma 6 for two days. Then got nervous about echo-cardiogram so went back up to a 6. Back pain and chestpain much better for 2 days. Then chest pain moved toleft side. Less dizzy and less chills. More appetite. Morephlegm being released – not as stuck. Still dry mouth andthroat. Got lots of cold sores24/09/2021Liv+(R)Good settling. Shortness of breath got worse a day later(nervous about going back to work). Chest Pain less onsides and more in middle on CV line. Back pain a bit less.Chest very hot – want to pour ice water on it. Face alsored and hot. Got pimples. Heat waves much less. Way lessphlegm. Nausea and reﬂux better. Still feel numbness inﬁngers. Feel stuckness and heat in throat area. Heavinessin chest – cant open it enough.27/09/2021BL+(R) and Ht freshGood settling. Still felt heat in chest right after. Had panicattack that night and another 2 nights after that. Nauseaand chills came back, dizziness came back. Still heat inchest. CV line in chest still hurts. Still stuck feeling inthroat. Back pain went away for 3 days. Breathing stayedthe same and got worse 3 days later. Still has bitter tastein mouth. Got cold sore. Period came after 4 weeksinstead of after 3 weeks.04/10/2021ST+ with St 36 andadded CV 12Had trouble relaxing. Felt some chills during tipul. Feltpanic coming on afterwards – nausea and panic thoughts.Gave BXHPT and si ni san. SOB , mood, nausea, stucknessin throat all improving, still dizzy and still has pain on CVline in chest.Questions -

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7 teacher remarks1 reply 16 replies 65 more comments51. I would like to do SI+ for all of the stuckness and pain in chest. Do you think this is reasonable due to her giving nature and herfeeling so unravelled and panicked right now?2. Her reaction to Bl+ and ht fresh was very surprising. She had SO much burning heat in chest and throat and wanted cool waterso badly but it did not help and even seemed to make it worse. I complicated things by combining with HT fresh So I dont havevery clear feedback. It seems like it could be an adverse reaction and need Ht+ but I am hesitant cuz of the burning in the chestand she is a loving and nurturing person. Also her back pain went away for 3 days. But she is usually colder than hotter. I did notcounterbalance in the next treatment because of these hesitations but maybe I should. What do you think about that?3. St+ did not produce immediately good results and she did not settle well. I added herbs right after that because her situationwas so severe and she is improving. Again I do not know if the herbs helped or if somehow St+ kicked in and started helping later.Should I consider LU+ to maybe oxygenate her chest with Lu qi (is that even a thing in Saam?)?4. HEr chest pain is so directly on the CV meridian and her symptoms started when she got a promotion at work - she is expectedto be an eagle at work and maybe her pelican energy is weak and calling out for help. Do you think adding CV+ could be relevanthere?Thanks so much for your help! ReplyKristin Wisgirda  NewOct 06, 2021 | EditedReactHi Adina,Thanks for the case.<GTITR: Struggle to get a deep breath in> Yes, but the grossest thing about her chest area is the intense heat she is experiencingthere. Repeating ST+ with ST36 was too drying her because the heat is cooking the ﬂuids.This woman needs UB+ by itself. Along with the intense heat in the chest, thirst for ice water, warm soft midline. She sounds like aloving person too-does that sound right to you?Heart Fresh is a very warming treatment- really 3/4 of it is ﬁre. Adding Heart Fresh to UB+ also asked the body to do 2contradictory things which is seldom a good idea with combining channel treatments. Another downside of Heart Fresh is thatthere is no clear way to counterbalance it. Given her situation, the best you can do is give her the pure ice water she needs to ﬂushher chest. Given her poor response to the ﬁre and water combo of UB+ and HF- SI+ is not a good idea at the moment. Maybeconsider it after the heat is better under control with UB+.(For those of you who don't know about Heart Fresh and the eagle and pelican need to take Toby's advanced class part 2 to ﬁndout). Remember that these advanced techniques are for edge cases. I know it is tempting to use new tools but with Saam it isalmost always best to get the clear feedback from simple one sided treatments. ReplyKristin Wisgirda  NewOct 06, 2021ReactH excess was on the top of my diagnosis list when I ﬁrst read this case. Having a hard time breathing is enough reason to causemajor fear so I don't give fear much clinical weight for UB excess. I also know that sometimes constitutionally freezing people haveHeart excess signs that require UB+.UB+ before HF didn't improve symptoms but also didn't aggravate symptoms. How conﬁdent are you that she was or was notsettling with UB+ alone?Her response to UB+/HF is really getting in the way of me getting behind SI+ for the reasons stated above.It is clear that she had an adverse reaction to the last treatment -ST+ ST36. Not settling and having a panic attack soon aftertreatment is enough to say adversity and consider Lung+ next.Please let us know what you do and how she does. Thanks.

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2 teacher remarks3 replies 3Adina KletzelBreathing issues - LU versus StNewOct 05, 2021ReactHI,I am struggling to identify LU excess versus St excess when it comes to breathing issues.A Lung excess type would have a puﬀed out chest and diﬃculty taking a deep breath in because of all of the accumulation in thelUng.Is that correct? I ask because in the intro slides it only says that the chest is inﬂated and they have plenty of qi and resources. Itdoes not mention that they have diﬃculty taking deep breaths or shallow breathing.TOby has mentioned that LU+ treats breathing issues so I ﬁnd this to contradict the picture of the banker which suggests shallowbreathing.So unless there is a clear picture of LU excess or St excess which one would treat the diﬃculty taking deep breaths?I have a client 24 year old client who is skinny with skin more on the dry side, who has asthma attacks - with diﬃculty taking deepbreaths.Her thenars are a bit puﬀed out and her chest may be a bit inﬂated 2+. She does not have any digestive issues and she has lowenergy. Sometimes with asthma attacks her nose runs, her eyes tear, and she coughs but not always. Her asthma is w/w exposureto dust and mold.She does not strike me as a banker type but her body morphology points more to St excess between the two.So the question comes down to which channel treats diﬃculty taking deep breaths.(I know GB excess is also relevant in this question but she is not a GB excess type)ReplyKristin Wisgirda NewOct 05, 2021 | EditedReact<A Lung excess type would have a puﬀed out chest and diﬃculty taking a deep breath in because of all of the accumulation in the lUng.Is that correct?> Yes- that is the way I look at it.<So unless there is a clear picture of LU excess or St excess which one would treat the diﬃculty taking deep breaths?> I would lookelsewhere if the Lung/St dynamic isn't clear. So many other channel excesses can contribute. I have a patient on the table who hasSOB from chemo damaging her lungs. Her breathing has improved using LI+, SJ+, and GB+. While with cough, asthma and sob weoften look to Lung/St and GB/P balances really any of the 12 channel excesses can be involved.I wish it was more straightforward.Tal CarmelNose completely blockedNewOct 04, 2021 | EditedReactQuestion for teacher35yo. Man.CC: Since childhood, diﬃculty breathing. Unable to inhale air through his nose which feels completely blocked. B/w mechanicalexpansion of the nostrils. W/w lying down.

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SC1: In mornings, has transparent phlegm balls coming to his mouth from his throat. Spitting it out help clear his throat but has noeﬀect on the CC.SC2: Frequent allergy attacks during which he has clear copious rhinitis and itching, tearing eyes (the itching is at UB1). From timeto time, a more severe attack in which he has shortness of breath and needs to use an inhaler W/w: stress, exposure to dust.Appearance and demeanor: Good looking +7, symmetry +7, bald since 21yo., neatly but casually dressed +4, groomed +2, warmand friendly +8, grounded movements and behavior +9, intelligent +10, polite +6, listen attentively +10, opinionated +6, Sallowcomplexion +4, sensitivity to light +10, bright eyes +4 Lifestyle: Vegan for many years, m+3, teacher, entrepreneur of activities for social equality, occupied with many projects +8, likesto read +8, does not exercise regularly b/c his knees, back and neck become spastic and painful very easily +8, resources +3Body morphology and ﬂesh quality: Tall, lean and muscular, wide chest and shoulders +7. Very hard chest and belly muscles +8,good muscle tone in the 4 limbs.Skin Quality: dry skin mostly in hands and feet. Patches of red scaly dry skin under R-knee, ST channel (looks like Psoriasis to me). Some red pimples very small to large size, with a purulent head, in the head (GB,UB, DU) and back (UB). Often mouth sores: red concave with white head. Body Temp: Average, middle Ren unremarkable, normal thirst, normal sweat. GI: Very picky with foods: vegan mostly because food that originates from animals disgusts him. Soft stool +3. Dry lips.Respiratory: CC + SCSleep: sleeps well but not enough (takes care of the baby at night)Emotions: self awareness +3, feels under pressure +6Urination: normalBody: No varicosities, bulging convex area in L- GB channel : temple (1cm) and calf (1.5 cm). Tight muscles in neck, shoulders andback +7. W/w: stress, physical eﬀort. About 2 times a month, sharp stabbing pain under L- rib cage or in the chest. Eyes feel tired and heavy in the end of a day +7. Every 6 months has "an attack": his eyes' focus deteriorates, his ﬁeld of vision shrinks abruptly till he can't see at all in one or botheyes. Lasts about 30 minutes and resolves spontaneously with rest. About 16 years ago, a small retinal rupture in L eye due to an accidental blow in the face. It was treated with Laser therapy. Sincethen, black spots in vision. Medial heel dry skin not ﬂeshy +3, Thenar +4 Pulse: 60 bpm. Wiry and a little thin on R side. Weaker on the L side.Hara diagnosis: Normal temperature. Flat, very hard abdomen. Maybe a Hard Pi. Ri Kyo both sides. Maybe tightness under R-rib cage. He feels "uncomfortable" (not painful) when I palpate around the umbilicus. He's very ticklish in the abdomen. L Oketsu area feels hard. He says it is ticklish not painful, but even with his knees bent it's not possible to palpate deeply. Tongue: Lavender, pale sides, slightly red dots in UJ, cringed, thin white coating, some spittle bubbles on the tongue, cracks in LUarea, sublingual veins 4/10 GTITR: completely blocked nose, clear rhinitis, sensitivity to light, hard chest and belly musclesExcess Presentations: HT: warm and friendly, teacher, entrepreneur of activities for social equality, patches of red scaly dry skin, red pimples with a purulent head, red mouth sores, itching at UB1, pains along UB channels UB: clear copious rhinitis, tearing eyes, pimples on UB channel, itching at UB1, pains along UB channel GB: diﬃculty breathing, pimples on GB channel, bulging convex area in L- GB channel PC: grounded movements and behavior, intelligent, polite, listens attentively (I thought it shows a willingness to absorb things from the outside) opinionated (his opinions are based on logical reasoning) likes to read, pimples on GB channel, concave mouth sores, bulging convex area in L- GB channel SJ: sallow complexion, light sensitive +10, bright eyes, polite, spastic muscles, hard chest and

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3 teacher remarksbelly muscles, vegan + food that originates from animals disgusts him, stabbing pain under L- rib cage, attacks of diminished vision, black spots in visionLIV: good muscle tone in the 4 limbs, self awareness only +3 (is low self awareness a LIV excess?) LU: blocked nose, phlegm in throat, wide chest, patches of red scaly dry skin ST channel, mouth sores with pus ("white head"), soft stool +3, dry lips. ST: blocked nose, phlegm in throat, resources only +3, patches of red scaly dry skin ST channel, pimples with a purulent head, mouth sores with pus LI: occupied with many projects, lean with dry skin, dry lips. SP: pimples with a purulent head, mouth sores with pus, Soft stool KID: completely blocked nose (too consolidated), young, fertile, good looking, symmetry +7, stabbing pain under L- rib cage and in chest SI: itching eyes, bald since 21yo (is hair loss is a sign of lack of consolidation?) , groomed only +2, no varicosities, pains after exercising, not ﬂeshy with dry skin medial heelMy top 3 priorities were: +LIV(R), +LI (L), +SI(L)I didn't get any improvement in the CC so I tried the other channels. I did every channel except + SJ.The best results was from +SP(L). He felt an immediate relief and had a good week after. The next time he came I tried +SP(L) and his breathing became immediately harder, I took out the needles and did +LI(R), it didn'thelp. I tried +LI(L) twice (not in consecutive treatments) . 1st time it didn't help at all. 2nd time there was no improvement during thetreatment but he had a good 5 days after.He has a calm demeanor and looks settled all the time. I didn't see and he didn't feel any change in settling during a treatment. Idouble check my point location every time. His condition has improved gradually since he started the treatment (no pains, less spastic muscles, easier breathing, much lessallergy attacks even though he stopped taking antihistamine medications) but the CC hasn't resolved yet, and I feel that the pictureis still not clear to me.I need your advice. Thank you! ReplyKristin Wisgirda  NewOct 04, 2021ReactHi Tal,Since you tried everything except SJ+, please send along the order of the treatments and any notes on treatment reactions.How much conﬁdence do you have in his bright eyes? Is his muscle tone good or is there real density to his tissues? Dense tissuesare compact- it is hard to diﬀerentiate individual muscles.<lean and muscular, wide chest and shoulders +7. Very hard chest and belly muscles +8,> Is his leanness +7?Tal CarmelNewOct 08, 2021 | EditedReactHi Kristen,Sorry, it took me some time to understand I should tag you.I looked at him again, His eye aren't dull but neither they are bright. His back and abdomen muscles are very tight, maybe I misjudged it for density. I read your suggestion to check the density of the limbs, I'll check it next time he comes.Kristin Wisgirda

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By "lean" I meant that he is thin but not too thin, he doesn't have fat at all. In this meaning he is +7 I forgot to mention that I haven't done +KID as well as +SJ. I thought that his blocked nose is a kind of extreme consolidation.Tx history:+ST(L)Breathing was a little better. Chest discomfort. One day suﬀered from heartburn. Anotherday had numbness in L knee. Itching in the eyes (eyes not dry). Stopped taking theantihistamine.+HT(L) (complained he feltcold)Felt very tired after the treatment and also more tired than usual during the week. Fewdays after the treatment breathing at night was easier. A new big convex pimple with apurulent head on GB channel in the head. A visible swelling in L- side of the throat (GBchannel).+PC (R ) to treat the pimpleand the swelling2 days after the treatment suﬀered from a sore throat with copious phlegm clear to greenin colour. His nose was completely blocked. Didn't have allergy attacks at all.+SI (L)3 days after the treatment his breathing became easier. A day after the treatment suﬀered"an attack" in his eyes. Couldn't see at all in the R-eye for 20 minutes (previous times insuch attack couldn't see in both eyes)+LI(L)Breathing a little easier. Had allergy: eyes felt itchy and tired mostly in the evenings andhad clear rhinitis. Back stiﬀness+LIV (R)Immediate relief in breathing that lasted only few minutes. Breathing was a little easierduring the week. Numbness in L-foot, pain 5/10 in L-knee ST channel all week+ST(R)A day after the treatment chest compression with pains along the L-hand . The skin of Rknee Peeled oﬀ and now has new skin. Even though he was 2 weeks in the desert (dusty)his breathing was better for the whole time. A new pimple with a purulent head at ST30.When came to treatment had LBP that was b/w streaching+LIV (R), +SI (L)Felt worse, like his airways were constricted. When he blew his nose came out a bloodyphlegm with blood clots. During the week had a slight fever with frontal HA (his childrenhad the same symptoms). Played basketball and felt a severe pain in L-upper back abovethe lung. At night had sharp pain like a stab in L-lung.+LU (L)Some improvement in the upper back pain. Breathing was a little easier. R-eye itchy and amuscle in the lower R- eyelid is twitching constantlyTCM treatmentIn addition to the CC + SC2, pains 7/10 L side of neck GB channel after stretching uponwaking up. Dryness in hands, stabbing pain in L-lung+GB (R )Immediate relief in breathing. I noticed that I needled GB43 in he wrong direction. Aftercorrecting it, the nose was blocked again.2 days after the treatment no pains in the neck. 5 days after the treatment back pains UB20– UB25 both sides. His all family suﬀered from fever and vomiting. In addition pain in L-ear.R-under eyelid muscle twitching

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3 more comments 3ReplyTCM treantmentNo pains, easier breathing. Light sensitivity and R-under eyelid muscle twitching. Skindryness in both feet+SP (L)Immediate relief in breathing. Had to blow his nose, had blooded phlegm and succeeded tobreath much easier for 5 days. New pimples appear in the LB and head (UB, GB channels)+SP (L)Immediate regression in ability to breath. I took out the needles after 3 minutes and did+LI. No improvement during treatment.His breathing during the week was less good than last week but still better than usual.Scanty yellowish phlegm in throat. Muscle under R-eyelid twitches. Eyes dry and itchy. Redmouth sore, new red pimples with purulent head UB channel . Skin dryness+UB (L)Mouth sore healed, less pimples. No change in CC or SCNaomi FrankFull body hives, single mom former midwifeNewOct 03, 2021ReactPatient: Female 33 - outbreaks of full body hivesCC: full body hives Several episodes of full body hives in the last year. Dx as “chronic spontaneous hives”. Triggers seem to be stress, sun exposure.Appearance of hives has evolved with subsequent outbreaks: initially small and red, then huge red patches (triggered by sun), laterlarge with red border, white inside. Distribution can vary with each outbreak - upper/lower, limbs/torso/scalp. No pattern that wehave been able to discern.Appearance and demeanour: friendly, gentle demeanour. Appears tired and worried. There is a sadness to her.Lifestyle: worked as a midwife until recently (stopped d/t stress levels). Student and single mom to 6yr old. Says she feels sheneeds more exercise.Body morphology and ﬂesh quality: tall, slim, chest is ﬂat (I wouldn’t describe as sunken). Flat thenars.Skin: dry heels, otherwise skin seems moist (I have to conﬁrm this) Body temp: tends to cold, esp. extremities (can get numb and white)Respiratory: easily gets a sore throat if poor sleepSleep: better with quitting midwife job, but still feels like not as much as she needs (ideally 9 hours)Emotions: appears calm; reports can be irritable. Worried about her symptoms; prefers to “try to let my body work things out” andfeels that overly focusing on her symptoms can be detrimental; but does have concerns about possible auto-immune illness withongoing hives.GI: low appetite +8; recent weight gain despite this. Irregular and incomplete BM.Urination: about 3x per day. Little thirst. Menses/Reproductive: mild cramps with menses. Tender breasts premenstrually (recent).One pregnancy: easy until full term - baby breech. Vaginal delivery attempted, eventually born via C section. Patient holdsemotional trauma from this time as a result of treatment from ex-partner and OBs.Pain:Injuries and surgeries: C section in 2015 (see Reproductive)

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3 teacher remarksTongue: shows heat and dampness, St/Sp yin deﬁciencyTGTITR: hives!Excess PresentationsLu: St: ﬂat chest +8, thin body +7, ﬂat thenars +6; poor resources; (numbness in extremities) Sp:L Int: Ht: P rapid, with rash can feel hot/feverishUB: tends to cold; some fear about healthKid: symmetrical +6 SI: dry medial heels; P: moves deliberately, appears calm (perhaps this is her countering her GB tendencies) GB: hives can be raised, can be irritable, emotions can change quickly Lv: can dissociate when under stress, describes as feeling “numb or in a trance, things feel surreal”SJ: sensitivity to surroundings +6 (e.g. to sun +8), tissue is not dense, bright eyes +7; hot and cold +8; frustration with her bodySAAM Treatments:2. SI+ on R (17 Aug) - was calm and settled initially but towards end of tx reported feeling agitated. I removed needles at 15-20 minmark and countered with K+ on L. She said that she felt more settled. I explained that we had likely just brought her back to whereshe was when she came in. Patient was going away shortly after that for several weeks. In the ensuing weeks she had no big ﬂaresbut several small outbreaks here and there. A full body ﬂare up brought her back in end September2. SI+ on R (28 Sept). Emailed: I think the treatment was helpful. I felt relaxed and calm the rest of the day. I did get a headache at night,but when I woke up the next morning a lot of the current hives were fading, and I was much less itchy. I am having new spots come (as isalways the case these days).1. SI+ on R (11 August - this was another practitioner’s tx) - reported beneﬁt; rash subsided, but had a ﬂare (hives less itchy and raised) 4 days later that hadher in ER.Naomi FrankNewOct 03, 2021 | EditedReactI ﬁnally managed to post a case! I gather info in the course of short visits in a community clinic, I feel there are some details I needto check in about (e.g. skin).Mainly I'm posting because I see some SI excess in this patient. I followed the idea of moving Wind out before consolidating butgiven the mixed response from second treatment (cack in mid August) I would not be inclined to repeat unless it was again after along gap and with a ﬂare of the rash. She is coming in this Friday so I'm wondering about next steps:I see SJ excess but the tendency to dissociate has me feeling cautious. I also feel that the brightness of her eyes can ﬂuctuate -have only seen her 2 times in clinic so far.Based on her body alone, I'm drawn to try St+The rash is usually covering many channels, so I haven't found this useful in guiding the treatment. However it can change, somaybe I should pay more attention to this as a factor.I also see mixed presentations in P/GB and H/UB.

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1 teacher remarkTuriyaDark cool forestNewOct 03, 2021ReactI feel like I have been misunderstanding the dark, cool forest of Liver Excess. Toby was asked " If someone is sensitive to brightlights-would that point to Liver Excess? Would a SJ Excess person prefer lots of light? " Toby responded : " The opposite. The LiverExcess patient seeks out a lot of bright lights and stimulation to feel something through their shielding. A SJ excess is bright andwide open so they seek darkness and avoid stimulation." Now it seems to me that the Liver Excess actually presents as the darkcool forest. That's what they are. Make sense? ReplyKristin Wisgirda Oct 03, 2021React<Now it seems to me that the Liver Excess actually presents as the dark cool forest. That's what they are. Make sense?> Yes, the intropowerpoint summarizes the qualities of Liver as "the dark cool forest and inner contemplation". Your retelling of Toby'sexplanation is totally consistent with the rest of his teaching.Shannon LarsonLearned A SAAM Lesson TodayNewSep 30, 2021ReactI have a patient who came to see me after a traumatic incident where he had to save someone's life. Since then he was havingperception issues, tingling in his ﬁngers and pain in the right shoulder. He was most concerned about the perception issues. Hewould reach out to touch things and miss. He felt he had no strength in hands. He was also very very cold since the incident andhaving insomniaHe's a big strong guy. Works in law enforcement.Eye brightness -5 VERY dull eyesMoves slowly precisely - 8+Aggression/ emotional volatility 1+ He's very even and calmDense ﬂesh 8+Cold 8+SKin dryness 3+no digestive issues.GTITR- He's very withheld. Short with answers not in an aggressive way, just not open. And VERY Dull eyes.I have seen him in the past for Sciatica. HT+ helped him the most. For this recent problem of perception/ lack of strength issue Itreated him twice with HT+ and it made a huge diﬀerence. At the 3rd visit I didn't want to do HT a third time so I thought I wouldfocus on his shoulder pain. It was in both SJ15/ GB21 area. I decided to go with the GTITR the LIVXS and treated SJ+. He settledwell. He came in today, a week after the SJ+ tx, and told me that the night of acu he got terrible jaw and neck pain and was supertense on his SCM. It was so bad he went and got a temporary mouth guard. It continued to hurt all week and didn't ease oﬀ untilhe saw his Chiro yesterday. Taking in all this info I thought, well perhaps it's an adverse reaction considering it lasted so long andwas so strong. I decided even though he just seemed sooo LIVXS to do LIV+. At ﬁrst he seemed ﬁne. Calm. I left him with theneedles with the intension doing my 5 min check in. He called me back before the 5 minutes. He was pouring sweat and feelingreally uneasy. I quickly took out LIV+ and put in SJ+ opposite side and he settled. I was worried about him getting that awful Jaw

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3 teacher remarks4 replies 4tension again by repeating SJ+ but I clearly had to do it to counter the adverse reaction. I considered adding PC+ on the oppositeside for the Jaw tension. PC+ had been my second idea but I decided against it. He's very robust but his reaction was so strong Ididn't want to do too much. I also hadn't done PC+ yet. It was slightly murkier with his calm even temper and wanted to have it astand alone treatment before doing 2 channels at once. I told him if the jaw again got terrible post treatment I would come in onthe weekend and address it. We'll see what happens.I am kind of kicking myself. I feel like by now I should know better. He was so clearly LIV XS but it's hard not to second guessyourself when faced with such a strong side eﬀect. I guess my long story here is that I deepened my understanding and trust forwhen I see someone settle. If I had trusted that I would have gone onto PC+ today and not LIV+ and wouldn't have had theadverse treatment. It's never dull with SAAM. Always learning. ReplyKristin Wisgirda  NewSep 30, 2021ReactThanks for sharing the interesting case.Yes, you have to trust the settling.After a treatment, I try to note any details of how the patient responded.After the ﬁrst SJ+, besides the terrible pain , did anything else change for him? Some piece of the puzzle is missing for a Liverexcess to have that kind of episode after SJ+.<Moves slowly precisely - 8+Aggression/ emotional volatility 1+ He's very even and calm>This description doesn't ﬁt your next choice is P+. Being in law enforcement and having just saved someone's life, requires a goodamount of GB readiness for action. Many of my patients who are ﬁre ﬁghters or police people have a certain controlled way ofbehaving- polite, even, rule following- but you can sense the ability to spring into action at any moment, if not the potential foroutright volatility.Please update us as his case unfolds.Shannon LarsonNewOct 04, 2021React@Adina KletzelI agree with you Adina. Sometimes a PC XS person needs help calming back down.Following my last post:My patient contacted me 2 days after the second SJ+ treatment (the one I did because of his immediate adverse reaction on thetable to LIV+). He woke up in the middle of the night with a migraine and his throat felt so dry and hurt. In his words it felt "as ifsomeone had been choking him." He also felt super anxious. I brought him into clinic that day and did PC+. In my gut it felt likethat's what I had to do even though generally I believe he leans more PC XS. He really settledHe emailed me the next morning feeling WAY better.So this is an interesting case for me. My mistake had been because he had a strong negative eﬀect I didn't trust myself in theoriginally settling with SJ+. When I tried to correct that at the next treatment with LIV+ he had an obvious, immediate, adversereaction. I question though whether I should have gone back to SJ+ to correct it. I did so because the adverse reaction was soobvious and I know that's what we are suppose to do but my fears of going to SJ+ for a second time came true. He had a horriblemigraine and anxiety. I wonder what would have happened if I had just gone to PC+ which had been my second choice.@Kristin Wisgirda I am curious what you would have done in that situation. Luckily, with my patient, we had made a lot good ofheadway in the ﬁrst 2 treatments he trusted me.Kristin Wisgirda,Adina Kletzel

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1 reply 12 more comments 2ReplyStuﬀ to think about.3 teacher remarks4 replies 4Adina KletzelBrain tumor and blurry visionNewSep 30, 2021ReactHI,If someone has a brain tumor that is causing blurry vision and double vision so can that be viewed as a Liver excess sign? It isclearly an inability to have clear and bright vision but it is caused directly by a brain tumor. Her vision issues are her maincomplaint and is the GTITR.Other liver excess signs she can get down because of her situation 4+, her eyes are dull 3+, her clothes are mismatched 3+, messdoes not bother her 5+SJ excess: LOVES the forest 9+, polite 6+, trouble regulating body temp 6+, reddish cheeks 5+, ﬂesh more airy 3+ ReplyKristin Wisgirda  NewSep 30, 2021ReactWhen I asked Toby about vision issues and Liver/SJ, he said that only vision issues having the qualities of too much brightness ortoo much dark have weight for Liver/SJ. Blurriness and double vision don't have light/dark qualities unless the patient says thatthey do.Kristin Wisgirda Disregard Test Post NotiﬁcationNewSep 29, 2021ReactSorry!I didn't realize that you would be informed of some of my experiments.Kristin Wisgirda clinical weight of infertility in otherwise Kidney excess patientNewSep 27, 20213ReactIn the advanced Saam class this weekend, Toby presented a case of a 43 year old woman with recurrent miscarriages (4). She hadmany strong Kidney excess signs- looking young for her age, narcissistic, symmetrical, put oﬀ a sexual vibe, 6 pregnancies- and noSI excess signs except "infertility." Toby said that he would avoid using Kidney on her and that infertility didn't really have anyweight for SI excess in the presence of a strong Kidney excess diagnosis.This was my suspicion but it was helpful to hear it from him.Kristin Wisgirda Anybody in southeastern Michigan?NewSep 25, 2021React

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Please let me know. Thanks!1 teacher remark1 reply 1Kristin Wisgirda Deeply settled and then...NewSep 23, 20211ReactA couple of weeks ago a patient fell asleep during a GB+ treatment. A great sign! When she woke up at the end of the treatmenther heart was racing. She was a little worried about it but was otherwise very chill. Outwardly she always seems grounded becauseshe is a P excess, but the inward agitation she came in with was gone so I was happy with the treatment eﬀect. The racing heartwas lessening but still there when she was about to leave the oﬃce. I told her it was most likely temporary but to contact me if itpersisted.At the next visit, she reported that her stressful situations were much more manageable and her neck pain was almost gone.Each time a patient has a great response to treatment but an unusual symptom pops up, I gain a little more conﬁdence that theunusual symptom is just a temporary response to the system recalibrating.ReplyAdina KletzelNewSep 23, 2021React@Kristin WisgirdaHow much time do you give in order for it to remain in the realm of temporary and not fall into the realm of adverse reaction?I had a patient feel dizzy and unbalanced after a PC+ treatment for 4 days after the treatment. Other than the two othersymptoms that he came to be treated for improved. Four days doesnt seem so temporary unless it is....Kristin Wisgirda2 teacher remarks1 reply 1Kristin Wisgirda Class Registration is Open: The 12 channels of SaamNewSep 20, 2021Reacthttps://whitepinecircle.org/12-saam-channels/I am excited about this class! ReplyLijana ShestopalNewSep 22, 2021ReactHi Kristin-Will this be recorded and saved for use at our own time in case we can't make that speciﬁc time?Thanks!

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1 reply 1ReplySpenta KandawallaNewSep 30, 2021ReactQuestion for teacherHi Kristin,Do you think you'll teach the class again in 2022? I really would like to take it live and I'm not sure I can swing it this winter.Thanks!2 teacher remarks1 reply 1Naomi Frankoverly apologeticNewSep 20, 20211ReactHi Kristin and allI usually see the overly apologetic (apologizing for things that couldn't possibly be their fault, as well as tiny variations from howwe ask things to be) as SJ excess. For the person I have in mind it is TGTITR.Are there other ways I might see this? Perhaps UB if there is an element of fear; P if they are very rule bound?Would love to hear your throughts. ReplyKristin Wisgirda  NewSep 20, 2021 1ReactYou mentioned my top 3 pics for overly apologetic. One of my patients seemed to cowerevery time she said she was sorry whichwas way, way too often. Her body would retreat slightly as if to say don't hurt me.As with many signs and symptoms it is good to keep an open mind and not jump to conclusions. ReplyFang CaiNewOct 03, 2021Reacthow about SI excess if they feel they don't deserve to exist?Kristin Wisgirda Free Talk and Class PreviewNewSep 19, 2021 1ReactPlease join me on Thursday October 28th 12pm EST for a 1 hour talk that will be a preview of my upcoming class. This talk is freebut you must register.Here is a link that includes the code that allows you to get in free: https://whitepineinstitute.instructure.com/courses/255/calendar_events/1196I am working on being sure that a recording can be posted to our group.

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3 teacher remarks2 replies 21 reply 13 more comments3My longer class starts Thursday November 4, 11am-1pm EST. It will be 6 classes of 2 hours each. 6 Thursdays in a row skippingAmerican Thanksgiving 11/25.I will pass on the link to register when it is set up but wanted to be sure that you save the dates if interested.For all who shared their time preferences for my upcoming class- Thank You. Sorry I'm not able to do it on a Monday orWednesday. ReplyTuriyaNewSep 19, 2021ReactThanks! Love this time because it's 8-10am West Coast time....and I can segue into my treatment rooms. ReplyMichelle GreenhoughNewSep 19, 2021ReactThank you for the details Kristin. What will the cost be for the 6 weeks course?1 teacher remarkDaniel SchulmanBody Jerking During Descent Into SleepNewSep 18, 2021ReactYou know that experience when you are falling asleep and partially into your descent into sleep, your body jerks suddenly and youwake fully up? I have a patient who experiences that every night - well into her descent into sleep, her body jerks and it wakes herso much it takes a while to get to sleep again. Interestingly, on her very ﬁrst treatment this past week, she reported in the 20minutes, descending deeply into sleep and being awakened by that sudden body jerk - and going through that cycle repeatedlyduring the treatment. What channel system comes to mind to explain such a phenomenon?ReplyKristin Wisgirda  NewSep 19, 2021ReactI recently heard a theory that this jerk phenomenon originated in our ancestors who slept in trees. Those who were awakened byany sense of dropping had a higher survival rate. A fun theory even if that info isn't accurate or useful.Interesting that she experiences well past initially falling asleep. That makes me more curious about a lack of ability to store thespirit and want to supplement a yin channel. But with all sleep disorders, it is most often best to use the rest of the presentation tomake sense of why this happens to her. Please let us know what you ﬁnd. ReplyFang CaiNewSep 19, 2021ReactI had a patient who had this symptom. It wasn't the main thing needing treatment, but when I asked it about it a few treatments init had stopped. I thought of it as ungrounded/inability to rest/hyperactive. Her treatments included LV+, UB+, P+, SI+/K+

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1 more comment1 Reply2 teacher remarks1 reply 11 reply 1Adina KletzelKid + for traumaNewSep 17, 2021ReactHI,I was re-listening to the Clinical Case Discussion from Feb 2020 on Qiological. Esther presented a case of a 16 year old male withchronic back pain from numerous injuries including being jumped on at the pool, doing a physical educ activity which he did notfeel he could do, a car accident.... Esther did SI+ numerous times which brought some slow results in reduction of pain.Toby suggested the she do Kid+ as well because of the recurring traumas that this boy experienced.Can you talk more about that suggestion? If someone has been through numerous traumas that brought to a situation of pain isthat then a reason to do Kid+? Chronic pain itself is traumatic - as in migraines for example. Would that then suggest that Kid+should be used even with ﬂeshy medial heels and good symmetry and a person that takes care of their own needs?Thank-you ReplyKristin Wisgirda  NewSep 17, 2021ReactWhat dedication- relistening to the older material.<Toby suggested the she do Kid+ as well because of the recurring traumas that this boy experienced.> This is contradicts what Tobyusually recommends with history of multiple traumas- which is to look for signs of blood stasis and consider using SI+. I don'trecall the case but if Toby said something like that I would be all ears! That it is not in my notes suggests that I didn't interpret theexchange the way that you did. My best guess is that the patient has some signs of SI excess or there were mixed reactions to SI+.These would suggest that K+ could be used.<If someone has been through numerous traumas that brought to a situation of pain is that then a reason to do Kid+? > This is not myunderstanding of a reason to use K+.<Would that then suggest that Kid+ should be used even with ﬂeshy medial heels and good symmetry and a person that takes care of theirown needs?> Not for me. I would need signs of SI excess before using K+.ReplyFang CaiNewSep 19, 2021ReactI remember Toby talking about going to SI+ for trauma - both physical and emotion, to release. But when asked by someone in theclass, he said it's not a sure-thing, that sometimes if someone is too scattered or, for example, has bad self-image from abuse,then K+ is more appropriate.So as always, look at the patient in front of you.

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2 teacher remarks2 replies 2Toby WedgleShooting Pain?NewSep 15, 2021ReactHi all, I have a patient I've only seen once who had a work injury that created "lightning bolt" type pain through her legs, arms andback. There are lots of pins and needles-type pain, as well as numbness. I can see numbness as Sp or St excess (her pain is alsoworse with damp weather; she occasionally has hard stools), but thinking of lightning bolt/shooting pain seems diﬀerent to me.Without drawing up a whole case study, I treated +R Lv for her ﬁrst treatment because she has trouble regulating her temp, brighteyes, and a slightly light body morphology and she's extremely sensitive to touch and temperature. I'll let you all know how thatone went, but I'm curious to hear what you all would look to for these shooting pains.... Thanks! ReplyKristin Wisgirda NewSep 15, 2021ReactHi Toby,The only reference in my notes to anything like shooting pains is Toby suggesting that electrical sensations might behyperfunctioning, meaning possibly Heart excess. I personally would want to see solid Heart excess signs before entertaining thisidea.Sounds like many channels are involved which is probably why you are looking to pain quality for more clues. If one or 2 channelsare more aﬀected then do give them and their counterbalancers somce clinical weight.Toby's teacher treated pins and needles sensations as dampness. But we know that damp doesn't always need to be dried. Bloodstasis and cold and channel trajectory are all considerations. Blood stasis especially since there is a history of physical trauma.Let us know what you ﬁnd.3 teacher remarksSharon WeizenbaumGrossest thing in the room?NewSep 12, 2021ReactHi Kristin, a student in the GMP brought this up, "what is the grossest thing in the room, at least several patients have a strongpattern of ﬁghting with, or trying dominate their bodies."I wonder what this makes you think of in terms of Sa'am? How does it play into things when people who come in hating theirbodies?ThanksKristin Wisgirda NewSep 12, 2021ReactHi Sharon,Straightforward low self esteem makes me think SI excess. Addition that could contribute interact with the low self esteem:SJ excess anger directed at oneself that comes from too much bright focus on the outside,LI excess industrious lack of contentment (my idea), Ub cold, P excess rule following, GB aggression

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2 replies 22 replies 21 more comment 1ReplyOne patient comes to mind- she was such a slave driver to her body and really resented having a body- constantly overworking itto the point of exhaustion and injury. When she was younger she had a picture of a bathing suit clad super model taped inside hercupboard. Even though she is symmetrical with luxurious hair and meticulous grooming, her heels were withered and dry. Hertreatments included SP+, Liv+, and K. Her body hatred certainly isn't gone but she isn't quite so harsh on herself and we madeheadway with her injuries.Anybody have other experiences or ideas?ReplySharon WeizenbaumNewSep 12, 2021ReactThanks Kristin, That is very helpful. Yes, I am also interested in what other's have to say.MariaShielding attributesNewSep 03, 2021 | Edited1ReactI am having a hard time with a certain personality attribute. So far, I've noticed this only in my infertility patients.The women seem angry and not too friendly. They rarely smile. They answer questions only when asked and tend not to overlyelaborate. They seem very intense. A couple of these women also have lots of hot ﬂashes, and tend warm.It seems like their personalities are shielded and more Liver, but the hot ﬂashes throw me oﬀ.patient: 40 year oldcc: infertility,After a DNC post miscarriage 2018, she has had 4-5 surgeries including an additional DNC, stents to prevent adhesions fromgrowing, hysteroscopies. She developed Asherman's syndrome. Adhesions was removed and she was given estrace to thickenlining. Infertility postulated by RE to be caused by thin uterine lining. She had multiple hysteroscopys in 2018 - 2019, undergone 3failed IVF cycles - abnormal embryos, diminished egg quality. Recently, found out she has partial blocked tube R and total L tubeblockage.menstrual cycle: 28 days, dark red blood initially with clots, fatigue, breast tenderness (ST), headaches, hormonal cystic acne,mood swings.other complaints: migraines, seasonal asthma and allergies, acid reﬂuxSleep - poor. feels hot at night. sleep paralysis (she feels that she can't move body when she wakes - only during sleep), nocturnal bruxism.Thirst - Frequent, drinks a lot of water - preference for ICE, COLD WATER, very thirsty at night.Urination - scanty and dark 1st urine of dayDigestion - lactose intolerant, acid reﬂuxDiet - avoids dairy, shrimp (mild rash)BMs - regular, loose, looser around her cycleMood - Worry, Anxiety, bouts of depressionEnergy - Lowmorphology: heavy set, broad chest, big bones, slightly overweight with belly fat. thick legs, back and arms.skin: mixed: oily and dry skin, acne, eczema on face neck, scalp and chest,K: casually nice, , not deﬂated, old, infertility, uterine adhesion (no palpable mass), blocked fallopian tube, noticeable veins but notprotruding 4.SI: Depressed, dry chapped heels 7LU: fat belly, big chest, dry skin, inner damp - loose stool

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2 teacher remarks1 more comment1ST: deﬂated thenar 5, lack resources, weak kneesLI: strong arms (not thin), like to paint (only hobby)SP: sweet tooth, soft warm body, oily skin (some parts), cystic acne, only one hobby/Not productive, foggy headedLV: hard to reach 8 (not friendly/not talkative), doesn't say much, only answers when asked, but becomes more animated when wetalk about her, dense,SJ: runs hot (though no cold feet), very hard on self 8, says she likes order but not meticulous 5, controlling ?H: runs hot, soft midlineUB: cold/reserve personality, not hyperP: introvert, walks away from conﬂict (is this more control?), prefers to paint and be alone, sleep paralysis.GB: has build of a ﬁghter, feels like she has suppressed anger, asthma/sobI've treated P+ several times. She feels calmer and less anxious. Helped with headachesAny ideas to unblock her tubes? She is really upset about the latest ﬁndings. ReplyKristin Wisgirda  NewSep 05, 20211React<K: casually nice, , not deﬂated> Not sure what is not deﬂated and what casually nice refers to.<old, infertility, uterine adhesion (no palpable mass), blocked fallopian tube, > Infertility technically should go under SI excess. Insteadof mentioning adhesions and blocked tube here, a better indication of K excess is multiple surgeries as they are likely to causesome blood stasis. Other factors could contribute to tendency to form adhesions and the blocked tube. We want to use our Saamdiagnosis to explain why she has these problems.<P: introvert, walks away from conﬂict (is this more control?), prefers to paint and be alone, sleep paralysis.> Introversion seems to havemore to do with needing shielding or being overly shielded and socially awkward or some coldness. There is nothing about therooting inward of P that needs to be alone.<LI: strong arms (not thin), like to paint (only hobby)> For the exercise of listing symptoms under channel excesses to be useful, youshould only list qualities that apply to the channel excess. You want to see how much of a discrepancy there is betweencounterbalancers. Having strong arms and 1 hobby are not LI excess signs. If you left the LI line empty, you would be able to seelots of signs under Spleen excess and none under LI excess. Compared to the other channel pairs, the biggest imbalance is SP/LIbased on your write up. ReplyMariaNewSep 07, 2021React<needing shielding or being overly shielded> What is the best way to diﬀerentiate this? I have been asking patients how they feelabout public speaking. If they hate it, then it seems like that leans toward SJ excess.<socially awkward> Is this SJ excess?<or some coldness.> UB excess or LV excess?Thin strong arms is a LI excess but what happens if the arms are not thin?

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8 teacher remarksMariacontinuous spotting after H+NewSep 03, 2021ReactI did H+ on CD 2 and the patient had continuous spotting (now CD 9) and feeling warm with hot ﬂashes and nightsweats. Patient istrying to conceive. The treatment prior was K+ (during her luteal phase)I was reluctant to counterbalance with UB+ because of her hard midline, resting pulse of 42, cold abdomen and she has a colderpersonality, not excessively talkative. Instead I did LV+ on CD7 because of she was feeling overwhelmed and anxious, cold feet, hotﬂashes.Both treatments she was passed out. She is complaining that she is still having light spotting. Did H+ caused that?Patient is 45y.o. still trying to conceive.morphology: body builder with strong musclesK: older, ﬁrm heels 8, no vv 4, pretty 8, self oriented (only talks about fertility issues)SI: infertility, multiple mc ,P: researches her interest alotGB: strong physically and personality, convex (arched back)LV: Not too talkative. Only talks about her fertility issuesSJ: controlling about her fertility issues, hot ﬂashes, obsessing over her fertilityUB:H: hard midline, slow pulse, not hyperST:LU: easily bloated, big chest, good thenar, good resources, skin dry 3, soft bmLI: stubborn, strong armsSP: bloating, soft b/m, skin not too dry, busy but not too many hobbiesKristin Wisgirda  NewSep 05, 2021ReactHi Maria,Double ﬁre that wasn't needed could certainly cause spotting. The treatments with double qualities need to be used with extracaution: H double ﬁre, UB double cold, Spleen double damp and LI double dry.I wonder about the appropriateness of Liver for her. The body builders I have treated all have dense ﬂesh.<LV: Not too talkative. Only talks about her fertility issuesSJ: controlling about her fertility issues, hot ﬂashes, obsessing over her fertility>I am not seeing a real SJ excess picture. Does she have bright eyes, light ﬂesh, hyperawareness of the outside? Hot ﬂashes can befrom so many other situations. The controlling of SJ comes from being sharply hyperaware of the outside. Being controlling aboutyour fertility issues is likely a mix because the focus is at least partly inner and the intent is really about being hyperconcernedabout fertility a K excess sign.<K: older, ﬁrm heels 8, no vv 4, pretty 8, self oriented (only talks about fertility issues)> Being older with no vv are SI excess signs.<P: researches her interest alotGB: strong physically and personality, convex (arched back)>

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17 more comments17ReplyYes, GB tends to be strong but you can be strong without being pushy and aggressive.<LI: stubborn, strong armsSP: bloating, soft b/m, skin not too dry, busy but not too many hobbies> LI excess arms need to be thin.Skin not too dry sounds close to normal, not abnormally moist. Busy but not too many hobbies sounds normal not bored. Soft bmis not a strong Spleen sign by itself. ReplyMariaNewSep 05, 2021 | EditedReactThank you for your thoughts. Would you like me to edit my ordinal post to reﬂect the corrections?I'm unsure what i should do at this point. Reverse the LV+ or Reverse the H+. I thought that H+ was appropriate because herqualities matched those of UB excess. But as you've stated before, we must use actual patient experience as our guide. In thiscase, would the continuous spotting would be considered an adverse reaction? Would the correct strategy be to reverse the H+treatment right away?3 teacher remarksAlison Unterreiner, DACM, L.Ac.Diarrhea/Constipation questionNewSep 03, 2021ReactQuestion for teacherHello -I am having some diﬃculty with a case currently and whenever that happens, I tend to turn to Sa'am, because it can really turnthings around.I will not post the entire case study, but here is what you need to know:I have a patient seeing me for Chron's/IBS symptoms - they manifest as urgent, frequent bowel movements with some crampingpain before a BM. She will go 6-8x/day! She claims that the BMs are formed and that after the ﬁrst 3 - which are substantial - therest will be small bits. She does not see undigested food. She also says there is frequent rectal pain and bleeding.After her ﬁrst treatment, she had decreased BMs, but her 2nd and 3rd have exacerbated her symptoms. I did not treat with Sa'am,and was really just working on getting her T+T organs aligned.My Sa'am question here is this - would this be considered diarrhea as a result of the fact that it is frequent BMs or would this beconsidered more constipation as it's clear that she is not fully eliminating on the ﬁrst few goes and the texture is not loose? Andcan you remind me what channels we look at for diarrhea vs. constipation. I believe Toby said SP excess for constipation patients,right??Thank you in advance for your help. I know this is a topic we have discussed so much, but I am having a diﬃcult time discerningwhich this actually is!-alisonKristin Wisgirda  NewSep 05, 2021ReactHi Alison,<would this be considered diarrhea as a result of the fact that it is frequent BMs or would this be considered more constipation asit's clear that she is not fully eliminating on the ﬁrst few goes and the texture is not loose?> In these situations, labelling the

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4 replies 4Replycondition diarrhea or constipation isn't really helpful. It is better to look at the diﬀerent aspects of the symptoms. Frequent stools,possibly incomplete at ﬁrst, urgency, rectal pain, bleeding.<And can you remind me what channels we look at for diarrhea vs. constipation. I believe Toby said SP excess for constipationpatients, right??> I have used all 12 channels, except GB, for bowel issues. Toby does say that with bowel issues, morphology isoften more important than the consistency of the stools. I assume that is only when we are looking at the damp/dry dynamic. I'llask for clariﬁcation.3 teacher remarks18 more comments18Kristin Wisgirda Seeking Your InputNewSep 02, 2021ReactHere is a description of a class coming soon to WPC:The 12 Channels of SaamWhether you have been practicing Saam for several years or you have just taken Saam Level 1 with Toby Daly, this course is anopportunity to deepen your understanding of the 12 channels. Each channel will be explored byPlease let me know what kind of logistics work best for you. The class will be 12 hours total.Does 6 x 2 hour classes sound better than 4 x 3 hour classes?Are there days or times of day that work best? Weekends are oﬀ limits.Thanks for your input.Grounding in the essential directional qualities of each channel.Highlighting target areas, clinical gems, and scenarios requiring caution.Comparing and contrasting with the other 11 channels.Reﬁning your understanding of the unique diagnostics of Saam to sharpen your observation skills. You can’t see it if you don’t know what to look for.Visuals will be used whenever possible. ReplyMariaNewSep 02, 2021ReactSounds great Kristin. M-W mornings or evenings. ReplyMichelle GreenhoughNewSep 02, 2021ReactInterested! Ideal: Monday (anytime), Wednesday (mornings), Thursday (mid-day) . 4 session x 3 hours! I assume this will berecorded so we may re-watch?Adina KletzelLiv + for depressionNewSep 01, 2021 | EditedReactHI,I was re-listening to last years advanced case studies course and on day 2 morning Toby talks about a case of treating a may withbipolar with Liv+. He was a SJ excess type - bright eyes, self-conscious, a meditation teacher, ﬂushed cheeks, warm.... Toby used Liv+ three times and his client reported feeling much less anxious, less self destructive thoughts, more stable, and able to writepoetry again.

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2 teacher remarks2 replies 2This case leads me to take a new look at the concept of staying away from Liv + for patients who are depressed. I equatedepression with deep, dark and weighed down - more of a dark forest than a bright sun. I understand that the signs andsymptoms need to guide us to the treatment and Toby's client had a number of Sj excess signs but I would have put depressionunder Liv excess and that may have deterred me from using Liv + for him.Can you talk a little bit about your experiences with using Liv+ for depression and how you see depression as also being apotential SJ excess? ReplyKristin Wisgirda  NewSep 01, 2021ReactI have notes on the case that you are referring to. It was a case of bipolar where the GTITR was bright eyes. Toby shared it to makethe point that when a patient has an unstable condition, it is important to only use one channel treatment at a time and to treataccording to how the patient presents that day.Did Toby say that the patient was depressed at the time of treatment? My notes say that the class talked about using SJ+, H+ or LI+if the patient was depressed which suggests to me that this patient was not depressed at the time of treatment with Liv+.<Can you talk a little bit about your experiences with using Liv+ for depression and how you see depression as also being a potential SJexcess?> Depression, like anxiety, needs to be deﬁned in terms of the patient's experience before we talk about it. I haven't usedLiv+ for the classical depression symptoms of loss of joy and interest in activities because this states often go along with the darkheaviness you mention. Adding cool dark shielding is only going to make that worse.Since the term depression is used so loosely, I could see SJ excess tendency of self blame maybe being labeled as depression.1 teacher remarkMariaHow much can we aﬀect?NewAug 27, 2021ReactJust curious how much can we change a person's personal patterns, morphology, characteristic traits through SAAM?If a person is overweight, rather lazy and unmotivated, can we oﬀset those traits so that they become thin and highly productive? ReplyKristin Wisgirda  NewAug 29, 2021ReactIt is important for us to be open to the possibility of being able to relieve the patient's suﬀering. At the same time, we have to becautious about imposing our ideals on our patients.4 factors determine treatment outcomes: 2 we can control and 2 we can't. We can control out diagnosis and treatment method.We can't control patient constitution and the strength of the pathogen and outside inﬂuences that contribute to that condition.Nanie CarrilloHow do I access the last case study from August?NewAug 25, 2021ReactHi Kristin,I signed up for the monthly case studies but I was not able to join the live call this month. I am trying to ﬁgure out how to accessthe recording but I'm being sent in circles around White Pine. I can only ﬁnd the course listed in the dashboard and calendar etcbut I am not ﬁnding a link to the actual recording. Please help.

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2 teacher remarks1 reply 1Thank you,Nanie ReplyKristin Wisgirda  NewAug 25, 2021ReactHi Nanie,Sorry it hasn't been clear where to ﬁnd the call.You access it via this mentorship group's page. On this page go to the top of the left hand column to ﬁnd Home.On the Home page, look under the blue "Let's Get Clear With Saam" banner to ﬁnd the Case Study Sessions tab. Recordings of all 3sessions are available under that tab.Please let me know if you need any further help.Nice to see you. Hope all is well. ReplyNanie CarrilloNewAug 25, 2021ReactHi Kristin, Yes, that is the process I followed. When I get the the Case Study Sessions page I do see the 8/17 session listed (not theother two). That link it takes me to the calendar and the calendar link takes me to a registration page. It asked me to register but Ican't bc the registration is closed. I did register for the forum on the 17th but not for the call bc I know I would not be able toattend. I ﬁgured I would just listen to the recording. I'm wondering if I cannot access the recording bc I didn't register for the call.1 teacher remark2 replies 2Kristin Wisgirda Anyone in Seattle?NewAug 25, 2021ReactThanks!ReplyNicole SharkeyNewAug 25, 2021 | EditedReactHi @Kristin Wisgirda , I am in Seattle.3123 Fairview Ave E, Seattle, WA 98102-3051 Suite 302(P) 206-335-8017www.nicolesharkey.comKristin Wisgirda

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1 teacher remarkAdina KletzelITP with no current symptomsNewAug 25, 2021ReactHI,If someone has ITP (immune thrombocytopenia - they have low levels of platelets so don't clot as quickly and easily so get morebruising) but it is being controlled by having had the spleen removed and medication so do we still consider it a SI excesssymptom? She gets some purple bruising every so often on her skin but nothing more than that. On her ﬁrst visit she did not haveany purple spots on her skin at all so do I still need to treat it as a strong Si excess sign or is it not that signiﬁcant?ReplyKristin Wisgirda  NewAug 25, 2021ReactWestern diagnosed conditions have lower clinical weight than the diagnostics we use. ITP diagnosis is something I would givesome clinical weight and take into consideration if trying to decide whether or not to use SI+. I would give it less clinical weight ifdeciding to K+.MariaAnother imbalance or adverse reactionNewAug 24, 2021React80 y.o. womancc: history of uncontrolled hypertension - been on multiple meds but nothing worked long term, parietal headaches, insomniamorphology: The most noticeable feature on her is her protruding round belly. she has a hard time buttoning her shirt around herbelly. She also has kyphosis. She looks and has the energy of a much younger woman.H: She used to have low heat tolerance but that has improved. Friendly 7, Loving 7UB:K: Firm Heels 9, Young looking 9, Varicose 6 (spider clusters) new development, Self concerned (her way or the highway) 8,symmetrical 8SI: Old, no varicose on arms or legsGB: Quick to anger 8, Rebellious 8, Swelling of legs 6, Gb Headaches 8P: concave posture 7LI: Dry skin 6, stubborn 5SP: Sweet tooth 8, not busy/project oriented 6, some dental issues 5ST: thenar: sl. deﬂated 5LU: Large belly 9, dry skin 6, upward energy (HTN), good resources 6, good energy 7LV:SJ: Polite 7, emotionally sensitive 8, attention to detail 7, cold feet 5My assessment: (K excess, GB excess, LU excess)I did P+ on her because she was complaining of not sleeping well and had a H/A. She responded well with the tightness/swelling inher legs improved on the table and her H/A gone by end of treatment.Next day, she called and said that she had an episode of vertigo in the morning (which came and went) , medial knee pain (shehad a cortizone shot a few days before for lateral knee pain but now the medial knee pain is constant) and then a pounding

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3 teacher remarks1 reply 14 more comments4headache at night. She said that she slept well after the treatment (ﬁrst time in a while). She was worried that the treatment wasnot eﬀective for her because she hasn't had vertigo in years.I felt that P+ was the right treatment for her. I felt that her new symptoms were from her K excess.Question: 1.) Do you think this was an adverse reaction or new symptoms (if so, why did it come up so quickly)? 2.) How soon canwe do the next treatment?Thank you! ReplyKristin Wisgirda  NewAug 25, 20211ReactThanks for your case.Since her sleep improved the night after treatment, the reaction to P+ is more mixed rather than truly adverse. Given her picture Iwouldn't counterbalance with GB+.Putting swelling of legs under Gb excess is a mistake. Not everything that is convex and protruding is necessarily Gb excess.Swelling of legs is better described as an accumulation of ﬂuids in the lower body, not a convexity.HTN isn't always too much up so I wouldn't use it as a deﬁnitive sign of Lung excess. However, Toby says that his ﬁrst choices forHTN are LI+ and ST+ to dry damp and move down, if they match the patient picture. For this patient, the Lung and SP excess aresigniﬁcant. These would be safer places to go next than K excess given her age and lack of varicosities- even with the new spiderveins. Given her overall presentation, I would try ST+ ﬁrst- probably with ST36+ instead of ST41+.No reason not to treat her right away. ReplyMariaNewAug 25, 2021ReactI thought swelling is a Gb excess pattern but maybe it is for swelling in a more localized area like joints.

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1 teacher remark1 reply 11 more comment1Kristin Wisgirda Worth recheckingNewAug 24, 20211ReactToday, I supplemented P for a patient with SI joint pain. She settled more than she had with other visits and I left the room. Almostimmediately, I was struck with the impulse to go back in and check K10. Sure enough- it wasn't quite at the right angle. I ﬁxed itand the patient sighed deeply.With only 4 points, they all have to be right on. It is worth rechecking. ReplyMariaAug 24, 20211ReactCan you explain what correction you did with the angle? Thx! ReplyGeorge MandlerNewSep 10, 2021ReactYes yes yes. I do wonder often if a treatment doesn’t work that should work according to the Sa’am framework if improper pointlocation can be a cause. This past spring I knew I had to supplement PC+ for a patient for a tight chest and allergies. It workedgreat a year prior and she has a lot of GB excess signs. After I needled no change. I checked KD10 and angled it a bit diﬀerentlyand immediately her chest opened and she could breathe. The patient brought up that experience at her next treatment. It was areal eye opening lesson for me. I am extremely careful with my locations and use my 2.5 x readers often.Adina KletzelPoor response to a channel versus body morphologyNewAug 23, 2021ReactI have a client who is a 46 year old female with chronic migraines.She is skinny and is always very hot and very dry.She doesnt have any interior damp signs except that has 5 bowel movements every morning and they are on the softer side.Other than that her skin is dry, her lips are dry, and she is thirsty.Her thenars are more on the deﬂated side 2+He chest is not puﬀed out. It is on the ﬂatter side 2+.Sp + did not reduce her migraines and neither did Lu+. IT is hard to say if she had a negative reaction because she has migrainesevery week. Some weeks they are less frequent and less painful. Other weeks they are more frequent and more painful.I have done LU and SP a number of times and the last time I did each of them she had more frequent and more intense migrainesthat week. The very ﬁrst time I did Lu+ for her she had a week and half without a migraine. THat did not repeat the next time I didLU +.Is that enough to warrant trying St+ or is her body morphology stronger and I should just move away from SP, LU, and St and notrisk drying her out even more?

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6 teacher remarks4 replies 41 reply 17 more comments 7ReplyKristin Wisgirda  NewAug 23, 2021React<Is that enough to warrant trying St+> If she had an adverse reaction to Lung+, then use St+. If Lung+ didn't produce much resulteither way, look elsewhere. Sounds like there must be other factors besides the dryness.ReplyMariaNewAug 24, 2021ReactI don't know if this helps, but I have very dry skin on my legs and moderately dry skin elsewhere. At the least, I don't have any oilyskin. I have dry lips and sometimes they get very uncomfortably dry . I have normal BM but tend to be infrequent. On a whole, itseems like I would not be a good candidate for LI+. However, in my other post, I did SP+ and had adverse reaction. I actuallycounter with LI+ and did another LI+ several treatments later on myself. To my surprise, I ﬁnd that LI+ actually helped my skinbecome less dry and BM more regular. I had developed eczema (from my early SAAM experimentation on myself) and the LI+treatment helped that. I do have a history of dental issues and though I am industrious and hard working, I cherish doing nothingduring my down time.1 teacher remarkAdina KletzelWhen to repeat and go back to treatments that workNewAug 23, 2021ReactHI,I have been challenged by knowing when to repeat a treatment and how often I can go back to a treatment that has worked. Ihave had experiences where repeating a treatment for a second time that worked well did not bring good results and times that ithas. I also have had times where switching oﬀ between 2 or 3 treatments that helped was good and times that going back totreatments that worked did not help. Is there any guidance as to how to make these determinations?ReplyKristin Wisgirda  NewAug 23, 2021ReactHi Adina,The persistence of signs and symptoms that pointed to the channel excess in the ﬁrst place are an indicator of the state of thatchannel excess. You also have to evaluate the counterbalancer, because the most eﬀective treatments are those that correct thebiggest imbalance between channel pairs.Really it comes down to freshly evaluating the patient with each visit.Kristin Wisgirda Picture of Couple from Case Study HourAug 17, 2021ReactThanks to the Be Local magazine of the Farmington River Valley for this great picture.For those of you who weren't able to make the Case Study Hour today, let us know what you see in the faces of this couple.

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4 earlier comments 1 5 teacher remarks3 replies 32 replies 2JPEG | 2.7 MIMG_0360 ReplyNaomi FrankNewAug 18, 2021ReactOoh Can I play?my ﬁrst observation was that both are ‘good looking’ but have a slightly crooked smile that would challenge the Kidney excesspresentation. It’s a bit hard to be sure with a photo but since their heads are angled diﬀerently it seems real. Aside from that her eyes look brighter and his look dull. Although I question whether looking straight at the camera can aﬀect this(which I think we discussed before). I love this opportunity to hear what others see! ReplyNicole SharkeyNewAug 24, 2021ReactHer left eye seems larger than her right. It's hard to tell but perhaps his nose is also a bit asymmetrical? I also see her eyes as verybright and his as dull.Kristin Wisgirda Melissa's Case From Case Study HourAug 17, 2021Reactfemale 68 yrs.Chief complaint: Chronic depression. Started 11 years prior- panic attacks the month her menopause began (none since meds).Went on medication immediately in order to continue functioning at work (legal aid attorney, parent). Now wants to come oﬀLexapro - hates the side eﬀects (foggy head +8, clenching hands & jaw- bites tongue +6, severe headaches+7).“When I am under severe stress, as I am with both of my sisters' situationsSecondary complaint: tension at upper back UB / GB channels +8diﬃculty swallowing, like my throat is closing upan uncomfortable tightness in my chest, unable to breathe deeplyon the verge of tears.I often ﬁnd that I have little interest in doing things that I normally enjoy.My body and limbs feel heavy, and I am often subject to debilitating headaches. "

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1 earlier comment 3 teacher remarksAppearance and demeanor: Natural white hair, neatly dressed, light make-up, painted toes = +5, bright eyes +4, polite +6, goodreporter +8 friendly but some reserve; symmetry 4+(? Mask)Lifestyle:Body: Average build, some softness to ﬂesh+5, upper back hard, tense muscles +8Varicosities - spider veins yin aspect lower legsthenars - not remarkablemidline - warm, damp, slightly softmedial heels- some dryness, dark spider veinsribside - R & L - not remarkableSkin quality: moisturizes daily +6, sweats very easily +8Body Temp: runs warm +9GI: no complaints.Respiratory: reported some chest tightness on day of session, attributed to stressful day the day before, was able to breathe moredeeply after acupuncture.Sleep: Doesn’t sleep well +8. Takes gabapentin but leaves unpleasant grogginess; without gabapentin, unable to fall asleepbecause she has too much on her mindEmotions: Derives a lot of pleasure from caring for others +10, Very worried about coming oﬀ medication because she has to“hold it together” for everyone else. Many recent “shocks” over past 3 years – family deaths/illness, sister’s bad divorce, niece’sgender transition; Trouble feeling love towards herself +7 - actively working on it in therapy.Urination: no issuesGrossest thing in the room: How much she wants to / thinks it’s her responsibility to take care of everyone elseRetired legal aid lawyer, medium resourcesnow “taking over as matriarch of her big, very close Italian family” due to deaths of mother/sister 3 years ago; (sister had ALS, mother died suddenly 6weeks after sisters death from a “broken heart”), another sister now is hospitalized with ALS. Very important to her to be able to keep it together foreveryone else +10,what she does for fun - studies Italian and takes care of elderly neighbors. ReplyTerri MatsonNewAug 24, 2021React@Kristin Wisgirda < classical depression is often some combination of cold, darkness and lack of love of self- not a condition you want to pour ice cold wateror shield with cool darkness > Appreciate you mentioning (again and again,) the nature of how the conformations inﬂuence the direction of treatment, its sohelpful to Kristin.Kristin WisgirdaMelissa RathboneNewAug 25, 2021ReactUpdate re: caseI treated this patient the day after presenting her case. I was still feeling a little concerned about "pouring ice cold water" into herbut she was all for it. I literally asked her how she felt about me adding cold water into her system and she said great!This was my ﬁrst time doing a sa'am treatment so admittedly I was a bit nervous but she seemed to rest well when she was on thetable. When she got oﬀ the table she said she felt like she could breathe more deeply than she had in a very long time and that thetemp of my treatment room felt "refreshing". I run AC in the room in the summer but this was the ﬁrst time she commented on it.Kristin Wisgirda

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1 reply 13 more comments3ReplyFollowed up with her the next day thru email, never heard back from her.Saw her today (1 week later). She said she has reduced her medication (lexapro) by 1/2 and is feeling less foggy, more focused andless despondent. She attributes the positive results to a combination of acupuncture, talk therapy and less medication. She'shaving much less clenching in her hands and jaw (hasn't worn her mouth night guard and is ﬁne in the morning) and she says sheis continuing to breath more deeply and easily.Today I did a supplement Liver treatment and again she seemed to rest well on the table.I can't say I've seen the deep settling response yet and neither treatment seems miraculous :) but she seems to be going in a gooddirection and she and I are happy with that. Her goal is to come oﬀ her medication altogether and so far, so good. Thanks @KristinWisgirda and the group for all of your input!4 teacher remarks1 reply 12 replies 26 more comments 6Kristin Wisgirda Small study groups anyone?NewAug 05, 2021 | EditedReactI'm thinking of groups of 4 people (+me) meeting for 90 minutes once a week for 3 weeks in a row. I will present cases- your casesor mine- for brainstorming breakout rooms and discussion. Then there will be time for questions and discussion.If anyone is interested post here or contact me at kwisgirda@gmail.com Include preferences for days/times.The October study group is ﬁlled right now. If there is enough interest we can start another group.Thanks! ReplyGabriel Stern NewAug 06, 2021ReactI'd be interested. Wednesdays would be ideal for me, but i could make it work any time except tues and fri evenings.ReplyMelissa RathboneNewAug 08, 2021ReactHi Kristen! I'd be interested as well esp if we get started after this current Sa'am class wraps up. Mondays and Thursdays are bestfor me but could possibly block out some clinic time for a few weeks on Tues or Weds. Thanks!Adina KletzelLiv + caused hemarrhoidsNewAug 15, 2021ReactHI,I have a 43 year old female client with the following SJ/Liv breakdown:SJ excess: strongly feels emotions and moods of others 8+, self critical 8+, anger directed at self 7+, controlling 8+, focused onexternal details 7+, likes order and neatness 8+ bright eyes 1+, polite 5+, reddish cheeks 3+

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2 teacher remarks2 replies 2Liv Excess: often feels down and dark 7+, feels heavy 5+, dense ﬂesh 2+, feels pulled inward 5+, prefers sunlight to forest 6+,darker complexion 2+I did Liv+ because she felt like her environment was just getting to her. She felt irritated by her family members and that she wasfeeling everything around her too strongly. She was also feeling like she was being very hard on herself and was criticizing herselfall the time. She said she felt like she just needed to go and hide and be by herself for a while so she could just recollect herself.She settled on the table and her initial reaction to Liv+ was a strong sense of relief, like a dam had been unblocked, and that herenergy had been unblocked. She also felt less reactive to those around her - that others weren't annoying her as much. But shealso felt that for the ﬁrst two days she had trouble taking deep breaths and that her digestion got a bit more sluggish. She also gotbig and painful hemorrhoids and felt vaginal dryness and burning. On the third day after Liv + she woke up feeling dark and heavywith a lot of negative thoughts. She also felt that she had more frequent urination.A couple of questions:1. How could a treatment provide such a clear initial positive reaction and then turn sour?2. How could Liv+ cause vaginal dryness and more frequent urination?3. Is this a clear adverse reaction requiring SJ+ or could it be that Liv+ alone was too heavy for her but that Liv and SI would workﬁne? She does have some clear SJ excess attributes.4. Has anyone else seen LIv+ cause hemorrhoids?Thanks ReplyKristin Wisgirda  NewAug 15, 2021React<1. How could a treatment provide such a clear initial positive reaction and then turn sour?> You missed something in her picture. Withclosely matched channel pairs, it is most often best to look elsewhere.<2. How could Liv+ cause vaginal dryness and more frequent urination?> Liver+ adds cool dark density to the body. Such coolstagnation could deﬁnitely cause these symptoms.<3. Is this a clear adverse reaction requiring SJ+ or could it be that Liv+ alone was too heavy for her but that Liv and SI would work ﬁne?She does have some clear SJ excess attributes.> Maybe, but unlikely given the signiﬁcantly adverse aspects of her reaction. Instead ofgoing there, I would question your diagnosis and question your evaluation of SJ excess. Could you be misinterpreting?<4. Has anyone else seen LIv+ cause hemorrhoids?> No.3 teacher remarksMariaChest evaluationNewAug 13, 2021ReactHow do we evaluate the chest on women? Is it just the size of the breasts? How can we tell a sunken chest for ST Excess onwomen?Kristin Wisgirda  NewAug 15, 20211React

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2 replies 2Replyin Saam, breast size is not taken into consideration for diagnosis, unless the size is part of the patient's symptom picture, eg breastswelling.For evaluating Lung/St you look at the size of the ribcage independent of the breasts and if there are any sunken areas. Largebreasts can get in the way of evaluating ribcage size but so can loose clothing. I do look at the width of the shoulders since a widerribcage will make for broader shoulders. You can look at the patient's back as well.ReplyMariaNewAug 15, 2021 | EditedReactIt seems like it would be hard to detect sunken chest area on most women and a sunken chest could also be seen as concavity,right?1 teacher remark1 reply 15 more comments5Kristin Wisgirda Input Requested for Advanced Skills Study GroupNewAug 04, 2021 | EditedReact**Update 8/11: Sorry, we don't have room for any more attendees. We are keeping the group small for the ﬁrst get-together. Youcan still let me know if you are interested if we have another round.For those of you who have taken the Advanced Skills class at least once:Please let me know if you are interested in having a study group. I am thinking about a Zoom call 90 minutes to 2 hours long oncea month or every other month to review the teaching and share cases. Let me know any preferences for length, days, times of dayformat, etc.Toby has given me the go-ahead so we have his support.Feel free to respond to me privately at kwisgirda@gmail.com or via Canvas messaging if you would rather not respond directlyhere. ReplyShannon LarsonNewAug 04, 2021ReactYES!!! ReplyAdina KletzelNewAug 04, 2021ReactThis is So necessary. Thank-you SO SO much for taking the initiative and putting this together. I think zoom calls will be great andperhaps an advanced forum will also be helpful. I am deﬁnitely in.Gabriel Sterntongues and gallbladdersNewAug 11, 2021React

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2 teacher remarks1 reply 1From what I understand Saam does not rely much on pulse or tongue. That being said I have heard briefly that the tip of the tongue if red(and I image pointed/sharp) points to a +GB. From there is it appropriate to consider a retracted tip (where it tip looks more like a fork thata spear) being inline with +PER?I currently have a patient with this presentation. I’m not familiar with what a +per looks like, but I can easily see him and his symptoms as-GB.Most here seem very cautious about tonifying GB so I figured I’d clarify further before my patient is subjected to my understand.Along the same rabbit hole: most systems I’ve studied before view the tip of the tongue as an aspect of the heart. pointed/red=heart heat,retracted or pale=a heart deficiency or obstruction. From a conceptual stand point is there over lap between Saam’s understanding of GBand other paradigms relationships e.g. hrt & gb being “opposite clock”, or having a “shao yin /shao yang” dynamic?I know the second questions a bit heady, But anyone's insight would be apricated as I try to get this lens a bit clearer.Thanksif this sort of question is better suited to the 6 week super newby forum please let me know and I’ll post there in the future. ReplyKristin Wisgirda  NewAug 11, 2021ReactHello,You can post either places but the tongue question is probably better asked here because we haven't touched on that yet in theintro. Thanks for asking.Tongue ﬁndings are generally not considered in Saam. Exceptions that have some "rock" level clinical weight are-a red tipped tongue being a possible Gb excess sign; the tip must be markedly redder than the rest of the body-tortuous sublingual veins as a sign of blood stasis- "sliced" tongue looks like it has been freshly sliced with a razor blade indicated possible Taiyang ﬂuid deﬁciency- consider UB+ orSI+<is there over lap between Saam’s understanding of GB and other paradigms relationships e.g. hrt & gb being “opposite clock”, or havinga “shao yin /shao yang” dynamic> In Saam we don't consider those associations.ReplyGabriel SternNewAug 11, 2021Reactthanks Kristin,at the risk of beating a dead horse: if the tip is red we would consider looking harder at a +GB. is it then reasonable if the tip isnoticeably duller or retracted to more strongly consider +PER. would the inverse of an excess sign for one aspect point to anexcess in it counter balanced pair?or is this line of thinking a red herring from your perspective?

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2 teacher remarks1 reply 1Gabriel SternQuestion on weighting and evaluating signs and symptoms?NewAug 09, 2021ReactQuestion on weighting and evaluating signs and symptoms?Do you weight physical finding e.g. quality of thenar eminence, medial heal, abdominal mid-line. More heavily than reported finding e.g.quality of sleep, bowel moments, temperature tolerance?Are these physical findings “Make or break” for a diagnoses? Or just another data point?I saw a patient this morning that seemed very clearly like he needed ST+: Loose stool, belching, dry patches (that he calls excema) on LI& ST chan on the face, rib cage more stuck on right, abd more stuck and tender on right. Shallowish high in the chest breathing.(There were other thing that lead me to think Yang Ming / Stomach but those are from a different tradition)on physical exam his TE were soft and deflated. Is that finding enough to go back to the drawing board, or does the abundance of otherS/S overrule the initial diagnoses? ReplyKristin Wisgirda  NewAug 09, 2021 | EditedReactHi Gabe,Physical ﬁndings, in general, are another data point. However, for Earth and Metal, Toby does give more weight to physicalcharacteristics versus the psych-emotive.If you grade each data point on a scale (I use 1-10) and then line them up behind their corresponding channel excess, it is easier tosee the balance between channel pairs. If the TE are ﬂat and soft 10+, then I would look more carefully at the rest of the signs andsymptoms to be sure they really match Lung excess.With the TE and medial heels in particular, if their presentation is the only factor that contradicts the general presentation, then Igo with the general presentation. So if overall the patient is really Lung excess 8+but the TE are soft and ﬂat 8+, I will treat the Lungexcess with ST+. Of course- watching the patient very closely when needles are in. I have had a few cases where this strategydoesn't work and treating according to a strong TE presentation was what was needed.<Shallowish high in the chest breathing.> This kind of breathing can also be a GB excess sign. Belching can be too much up/notenough down- another potential GB excess sign too. Seems worth analyzing his P/Gb balance if you haven't already. ReplyGabriel SternNewAug 09, 2021Reactthanks Kristin,I ended up doing per+ as that seemed the next largest thing and wasn't sure if TE was data point or red ﬂag.Kristin Wisgirda Health Looks Like....NewAug 05, 2021 1ReactI heard the serenity prayer last night:

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4 teacher remarks1 reply 1"God grant me the serenity to accept the things I can't change, the courage to change the things I can and the wisdom to know thediﬀerence."Sounds like a wish for P and GB in balance. Not only are P and GB in balance but there is enough directional movement of each tocreate serenity. If they were both lacking in equal measure, the result would be lack of acceptance but also lack of assertiveengagement- an uneasy, ineﬀectual stalemate.RBG and Nelson Mandela are exemplars that come to mind. Who exempliﬁes this for you?This is my playful conjecture. What do other people think?What does the expression of other healthy well balanced channel pairs look like?ReplyAdina KletzelNewAug 05, 20211React@Kristin WisgirdaI have been thinking a lot about the healthy balance between GB and P lately. I have a client who seems to have mostly GB excessbut some paralyzing aspects of P excess as well and I have been wondering if that could realistically co-exist.He is a 45 year old married man with 4 children. He can get angry 7 + and works to breathe down the rising heat of anger andanswer calmly. He is assertive 6+, has trouble getting into a deep sleep 6+, he responds from emotion, not from intellect 8+At the same time he does not have the courage to change things. He is 46, went to school and got a professional degree, but hestill works as a helper for an old lady. He also bought a hot dog stand and has yet to get it going. He has lack of clarity and is stuckwhere he is and can't get himself to move forward in any way.On the one had this could be pure PC excess in that he does not have enough up and out energy to get himself moving andmaking changes that would move him forward in life and allow him to use his talents.On the other hand maybe this inability to change things is part of GB excess in that he is so ungrounded and unrooted that hecan't make a change because he is not standing on any stable ground.I have treated him with PC+ and it has been great in helping to control the anger but has not helped with his inability to make thechanges in his life that he needs to make in order to help move himself forward. I have also used SI+ to generate movement andrelieve stuckness. This also hasn't produced signiﬁcant results.Is there any chance that even with all of the GB excess symptoms that there is some deﬁcient PC there as well which needs someGB toniﬁcation. It seems extreme but I thought I would throw it out there and see how others analyze the duality of symptoms.Kristin WisgirdaKristin Wisgirda  NewAug 07, 2021ReactSince nobody is taking me up in this game, I will let you know how I am playing.Preliminary musings on the healthy expression of the H and UB balance:Heart double ﬁre's virtue is obviously love for others. UB ice cold water's virtue is ... maybe self preservation? Maybe combinedwith an ability to detachment for others and create a boundary for oneself? Not totally sure.Scenarios that clearly need the virtue of Saam UB cold and could be called issues of self preservation:-joyriding teenagers so lost in their fun that they are not paying attention to the road-a mother whose love for her sick child runs so hot that she could possible burn herself out-other lovers who are at risk losing themselves in the heat of their love-maybe the love allowing them to be inﬂuenced by theirbeloved in ways that aren't in alignment with themselves.Taking Harmen Mesker's Yi Jing trigram class, I became fascinated with the relationship of Saam UB qualities and the trigram forwater, Kan, 2 yin lines sandwiching a yang line in the middle. Kan is associate with Taiyang in the Saam system. UB in the Saamsystem is yang + Taiyang cold + water. Notes on Kan- ﬂowing water- from Harmen's class:What it is: deep, uncertain, danger, irrational, unrestrained by boundaries, ever ﬂowing

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2 teacher remarks1 reply 13 more comments3Adina KletzelFungus ﬁlled toe nailsNewAug 04, 2021ReactI have a client whose toe nails have been yellow and misshapen and ﬁlled with fungus for 30 years.He has other damp issues and so I have used LI+ 3 times already (not in a row).There has been no improvement in his toe nails.Has anyone had success treating fungus ﬁlled toe nails?If yes I would love to hear about it.Thanks! ReplyKristin Wisgirda NewAug 04, 2021ReactToenail fungus is notoriously hard to treat. Many factors contribute. Toenails are slow growingThe only cases I have seen successfully treated are relatively mild cases where the patients are meticulous about treating them by-keeping toenails dry- changing socks, thoroughly drying (with a blow dryer or sun exposure) after getting them wet-using topicals multiple times every day- whether OTC or herbal-and working on the systemic issues which allow the fungus to take hold in the ﬁrst place.Besides SP excess damp, I would look for issues impacting circulation to the lower body, local channel problems or systemic (cold,blood stasis, etc), and issues with integrity of the nails which could include SJ excess and maybe SI excess causing weak nails.I've never had anyone with moderate or severe fungus stay with treatments long enough to really reverse the situation. ReplyAdina KletzelNewAug 04, 2021ReactThis was very helpful. Thank-you.So from what you wrote the obvious issue with fungus is damp but Liver blood def. or blood stasis could also be causative factorsto the accumulation of damp in the toe nails?I just want to make sure I understood correctly.Kristin Wisgirda The aftermath of GB+ euphoriaNewAug 03, 2021 | Edited 1ReactA fellow practitioner just shared a case of using GB+ for a patient with anger that she was having a hard time expressing. Thepatient was also intellectualizing her situation lots so seemed to be more P excess.

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4 teacher remarks4 replies 43 more comments3The patient felt euphoric on the table- just wonderful! but not deeply settled. She then went home and started having panicattacks. It took 3 P+ treatments to get the panic to go away.This was the ﬁrst time this practitioner used GB+. I can understand how she was led astray- the patient felt great on the table!GB+ can be a very seductive energy- up and out feels powerful and alive. It is not unusual for a patient to experience the qualitieswe are adding while they are on the table. By the same token, P+ can make a patient look sedated. But we still have to ask- arethey settled?My experience with good GB+ treatments is that they look like the settling of other treatments. The patient melts into the table,the face softens/opens up, complexion evens out.With GB+, patients are more likely to report feeling unusual movement in their bodies. If I am unsure how much the patient issettling, I will ask them to feel how easy it is to take a deep breath. If the breathing is open and free (no restriction), and there isthe movement sensation but they seem like they are settled, then good. Before needling GB+, I have patients check in with a deepbreath so we have a baseline if needed.The other warning sign that GB+ might not have been a good choice is that the patient has lots going on in her life. Adding thethunderous stormy potential of GB to an already chaotic situation is most often not a good idea.The above practitioner also mentioned that she might have let her biases get in the way of clinical judgement. She wanted thepatient to be able to express. Personal bias can often lead to misdiagnosis and mistreatment. Practicing Saam can provide lots ofopportunities for personal growth if we reﬂect on what might have clouded our clinical judgement. I say this from lots ofexperience.Every mistake is a learning opportunity. ReplyDaniel SchulmanNewAug 03, 2021ReactExcellent - thanks so much for sharing! Indeed - I ﬁnd that terrain quite challenging - where there is some clear GB XS but it'srepressed or subdued to some signiﬁcant degree but there is also signiﬁcant intellect in the room . . . . to calm the GB XS even if itis being repressed / controlled or to help it be expressed is a big question . . . Once I had a patient I chose to help it express andshe came back the following week and asked . . . . "what did you do last week, I have been yelling at all my coworkers all week!?!?!?" ReplyKristin Wisgirda  NewAug 03, 2021ReactI just shared this case with Toby and he commented: "I feel some conﬁdence in the outcome when a patient falls asleep when I'msupplementing GB."Kelly KaedingSI5 needling adverse eﬀect.NewAug 02, 2021ReactHi Kristin and everyone.I recall someone talking about their patient having ulnar nerve pain after needling SI5 - this past early spring. I can’t recall if thisdiscussion was on this forum, during the 6 week Sa’am 101 class, the digital internship or a diﬀerent Sa’am class. Does anyonerecall who mentioned this and/or when/where? I recall that Toby just said he has never had this problem. I would like to follow upto see if he said anything else and I would like to know how their patient is doing. Did the pain eventually go away? What helped?I have used St+ lots and lots of time with no problem, but about a month ago since needling SI+ my patient has had ulnar nervepain - it even wakes her up. Besides the pain waking her up, her sleep has been much better, which was one of her maincomplaints! The point combo was correct, but I think I injured her ulnar nerve. She is a chiropractor, fyi, and very sensitive. She still

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1 teacher remark1 more comment1comes for acu but I have not been doing Sa’am recently. I was hoping that within a couple weeks it would be better, but it is not !Any suggestions?Thank you for any help or feedback.Kelly ReplyKristin Wisgirda  NewAug 02, 2021ReactHi Kelly,Like you, I do remember someone having the same problem. Nothing came up about that incident in quick searches of this forumand the Qiological forum.Before Saam, needling SI3 irritated a patient's ulnar nerve. It took about 1 month to recover fully.I don't have any other notes about this issue.Anybody else have experience irritating nerves? ReplyMariaNewAug 04, 2021ReactI am wondering if SAAM could ﬁx that nerve irritation from the treatment?MariaAdverse Reaction - Skin conditionNewJul 30, 2021 | EditedReactLearning SAAM is hard.40 y.o. TTCMorphology: Thin, but not dried out looking, her skin looks moist and a bit softMenstrual History: Light ﬂow, clots, no cramps, polyp removed, no nightsweats, no hot ﬂashes, loose b/m before period, frontalH/A before and during periodK; Pretty 8, ﬁrm heels8, young, self concerned 7SI: no varicose veins 9, low fertility, clots in menstrual bloodH: Talks alot/cheerful 8UB: Tend Cold 8, hard midline7, pulse - sl. slow 5GB:P: Rule follower6 , self described calm (I can see her both ways)LV: light menstrual ﬂowSJ: Cold feet 6, Open/not shielded 8, polite8 , light ﬂexible body/not dense 8

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5 teacher remarks2 replies 2SP: sweet tooth8, warm body to the touch6 , mixed skin type/skin looks damp and not too dry: damp outside? , damp inside -cystic acne?LI:LU:ST: thenar not full 5, small rib cage/chest 5, skin not too dry 6--SAAM TreatmentsH+ - seem to feel ﬁne after. Had a period, not much changed.She had a polyp removed - 1 month later. Had cramping before and after the procedure. That month, her period started 1 weekearly with dark old blood, very light ﬂow. She also had a large cystic acne on her cheek (ST channel). She had bad acne as a childbut hasn't had a breakout in awhile. She attributed it to the taken for the procedure. She is very self conscious about her skin.LU+R (she is thin, thenar not full, acne, skin not dry).She returned next day after treatment, complaining of L upper back pain (UB12-14 area), her throat feeling warm and dry, She feltbloated with low appetite and pressure at Ren 15.ST+ L (counter treatment) - back felt better, pressure at Ren 15 eased on table. (ST 41 was not deeply inserted because shecouldn't take the pain)following week: LI+ R - (she complained on new acne developing, her tongue was very greasy and thick). She settled and hertongue immediately improved on the table.Today (1 week later); Tongue coat is not thick anymore but clear with sticky quality. She developed a circular skin rash (size of adime) on her forehead (above YinTang). The rash starts out dry, then itchy, once scratched it becomes raised but not red with drypatches around it. She went to the dermatologist and they don't know what it is. She has also been feeling itchy and tingly all over.Though her acne is better after a facial, she says it still feels like there is "river" under it. I consider the skin rash a potentialadverse reaction - I did not do SAAM today.Question: During the course of self experimentation with SAAM and getting it wrong. I have done the above set of treatments onmyself over a course of time. I have developed the same unusual skin condition and considered it an adverse reaction to theSAAM treatments. This is why when she brought it up, I recognized the rash. I am wondering if you could explain the interaction ofthe treatments that could of cause this reaction and maybe recommend my next course of action. ReplyKristin Wisgirda  NewJul 31, 2021ReactHi Maria,Thanks for sharing this case.Is the unusual skin condition that you developed the dry rash that gets raised, or the itchy/tingling all over or a combo?I don't have strong conﬁdence in my understanding of what happened with your patient and can just give you guesses. It may alsobe a situation where something was missed in observation that would be a key to the case. A theory I have is that, in some cases, ifyou miss the key imbalance pushing the patient around with treatments they need less is just irritating and not helpful. I wonderabout SI+ for her especially since the acne started after the polyp removal- remember- just a guess.If the acne didn't improve with LI+- this is interesting- though if the facial was soon after the treatment, I would give LI+ credit forimproving the acne not the facial- especially since it was cystic.Under SI excess, you put varicose veins. This should go under K excess.In the future, please grade symptoms/aspects of presentation. This would help us see your patient better. As well, please providethe grossest thing in the room.

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1 reply 15 more comments5ReplyMariaNewAug 07, 2021ReactAs an update, this patient's skin has improved. Upon looking at her more, I noticed that she is more dense than I had thought. Herdensity is that her calves feel like one solid piece of ﬂesh. She does have softness on top of that density even though she is thin.She also has regular soft stool and doesn't like to drink water. She said that she had perfect skin until she moved to SF (cold anddamp). Whenever she leaves this area, her skin clears up. She recently developed some cavities. This makes me think that she maybe more SP excess than I originally noticed. This showed me that I had huge holes in my observation and questioning skills.Question: I know that SI+ is not recommended while on the period. But what about LI+? Would that potentially dry out themenstrual blood? This patient typically has a light ﬂow. I am cautious with internal drying on TTC patients, especially if they are notgrossly overweight.Are there other channels that may not be a good idea to do while they are on their ﬂow?1 teacher remarkDaniel SchulmanAnyone in or Anyone Know Anyone in Vancouver ?NewJul 28, 2021ReactDoes anyone know a Sa'am practitioner in Vancouver, Canada? A friend needs treatment! ReplyKristin Wisgirda NewJul 28, 2021ReactYour friend is lucky to live in Vancouver so he/she can be treated by Shannon Larson: https://www.vancouvertcm.com/contact ReplyDaniel Schulman NewJul 28, 2021Reactoh, sooo perfect . . . thank you so much Kristin!2 teacher remarksShannon LarsonConnection between conformations and elementsNewJul 27, 2021 | Edited1ReactI've been thinking about something when I do SAAM and I am still not sure I can articulate it but I'm going to try. I am curious ifothers see this too. Sometime I will do something that seems like maybe it was an adverse treatment but with carefulconsideration I determined it wasn't. For example I treated a very cold, extremely exhausted Covid long-hauler patient with HT+and she really settled on the table. It was one of her favourite treatments. She had way more energy for the next week but shehad terrible terrible anxiety. I then went to KID+ next and it resolved everything. I ﬁnd when I look at those situations if I thinkabout the conformation/element attached to the treatment I often had one of them right but the other wrong. It's just made mestart to look at the conformation and element separately and ask if I see qualities that support another treatment. For example if Idid Shao yin Fire (HT+) but it wasn't quite right but wasn't wrong I want to deeply look and see if there are qualities of KID+ (SHAOYIN water) that my patient needs or SJ+ (Shao yang FIRE) that I may have missed.Does that make sense to anyone?

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1 reply 1ReplyKristin Wisgirda  NewJul 27, 2021ReactHi Shannon,I will look back on patients with mixed reactions to see if this theory ﬁts.Thanks for sharing your observations.ReplyMariaNewJul 27, 2021ReactI have this same observation Shannon. When i review my thinking after noticing such a phenomenon, I found that I would nothave changed my treatment strategy. My working theory right now is that I am re-balancing the wheel. By ﬁxing one spoke,another spoke became noticeably unbalanced. Is this theory potentially right, I wonder?1 teacher remarkSpenta KandawallaUsing SI+ when there's self-harmNewJul 26, 2021ReactQuestion for teacherI have a patient who suﬀers from severe PTSD, anxiety and depression. She is currently on heavy medications for theseconditions. She has many thoughts of self-harm, and even though the meds help her anxiety and depression, the thoughts of self-harm generally remain. The meds make her extremely tired and lethargic. She sleeps at night for up to 12 hours and wakes groggyin the morning. She has trouble focusing at work. When they tried to reduce the med that makes her the most tired, herdepression and thoughts of self-harm increased dramatically and she increased her dose again. She also is often freezing cold.She had a very positive response to a 2 channel treatment that included HT+ and K+. She said it was one of the best treatmentswe'd done in a long time and she felt happy. However, she had a mixed, but more adverse than beneﬁcial, response when I didthat treatment a second time. When she returned with this news, I was too scared to do SI+ (given the intense thoughts of self-harm) or UB+ (she drove to the appointment with a heater on during the summer -- she's always very very cold). But based onother signs, I decided to use LI+ (moist/greasy skin, not a large person, but damp in the belly and a little puﬀy/damp overall,including her face; intense lethary and fogginess; poor digestion; poor appetite).She responded well to the treatment of LI+: she was really hungry the night of treatment (very rare) and didn't feel anxious aboutit (struggles with eating disorders). She then said, "that's the only thing I noticed other than being a little calmer in general andbeing able to wake up early this morning". Now to me, I'm like, wow, those are 3 huge things that couldn't happen before thetreatment. Her response makes me feel like she can't see the positive as clearly. It made me start to wonder if she does indeedneed SI+. If her problems have become so self-consuming that she can't look up and 1) allow for change, 2) see things beyondherself, or see what is going well. But, I'm really nervous to do SI+ on a patient with such serious self-harm issues. She usually doesspend time on her presentation (put together, painted nails, makeup, etc), her medial heels tend to be smooth and ﬁrm, slightlyﬂeshy, and I think she's fairly symmetrical, not beautiful, but symmetrical. I have one more treatment with her and then I won't seeher for a month, so I don't want to leave her in a bad place, but if SI+ would be helpful, I want to oﬀer that. Any thoughts?Thank you!Kristin Wisgirda NewJul 27, 2021ReactThere is no knowing for sure what happened with adverse reactions to bilateral treatments. Was the culprit one channel, theother, that particular combo, or the extra big push of a bilateral treatment being too much for the patient to handle? We just can'tknow for sure.With thoughts of self harm, using SI+ is deﬁnitely risky. I would treat elsewhere ﬁrst to rule out other possibilities, even if youdidn't have just one more treatment.

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2 more comments2ReplyIt would also be risky to use Liver+ or UB+, since Liver and UB excesses are the other common patterns of deep depression. Oneof my patients with suicidal ideation responded really well to SJ+. She had never actually tried to harm herself.<Her response makes me feel like she can't see the positive as clearly. It made me start to wonder if she does indeed need SI+.> Notseeing the positive sounds more dark and maybe cold- Liver excess and/or UB excess.<She usually does spend time on her presentation (put together, painted nails, makeup, etc), her medial heels tend to be smooth and ﬁrm,slightly ﬂeshy, and I think she's fairly symmetrical, not beautiful, but symmetrical.> These aspects can be taken into account especiallyif they remain clearly present. If she doesn't respond well to other strategies and you can keep in close contact with her, you canconsider using SI+. ReplySpenta Kandawalla NewJul 27, 20211ReactThank you for these thoughts Kristin. I've used SJ+ and HT+ on her, both with success. And that's a helpful reminder about notseeing the positive being LV Excess and not necessarily that she's just overly focused on herself.6 teacher remarksMariateasing out GB/P patternsNewJul 22, 2021ReactI am wondering if you have any tips for getting more clarity on this pair.I had a patient this morning with foot pain in GB40-43 area on both feet.He admitted to being annoyed at work by one of his coworkers. He says that he doesn't get upset easily. He sees himself as a calmperson. He would just keep the anger/frustration to himself. He would never lash out. He doesn't have SOB. He doesn't dream. Heis quite rooted and walks with a slump.He is a former alcoholic and has a large belly. I have treated ST+, SI+ in the past for him.Seems like P excess so I needled GB+. He looked ﬁne but didn't settle too well. When I check in on him, he was surﬁng his phonebut seemed relaxed. Af the end of the treatment, I noticed that he had pitted edema around his ankle and he said that the paindid not go away. I immediately counterbalance with P+ and he settled. The edema went away. The pain was gone at the end ofthat treatment.I realize I get fooled by this pair a lot. What tips do you have to tease out the pattern more?ReplyKristin Wisgirda  NewJul 23, 2021ReactHow settled are you if you are surﬁng your phone?You can't trust your patients' words. Patients often don't reveal all of their facets to you in the clinic- a big understatement!It helps to try to imagine the patient lashing out or aggressively using their body. If you easily can, then suspect GB excess.Toby he sometimes asks patients what their best friend or partner would say about them.MariaNewJul 23, 2021 | EditedReactCatching him on the phone should have been a huge ﬂag. Lesson learned!

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1 reply 19 more comments 9ReplyI ﬁnd with that since our culture frowns so much on aggression that most people would not admit to it. What I hear most often is"I just hold it in and walk away." I've heard this from both camps.1 teacher remark2 replies 21 more comment1Kristin Wisgirda Putting away old styles of practice (again)NewJul 22, 20212ReactBefore Saam, I practiced a style heavily based on testing points by palpating to relieve reﬂex areas before needling. When ﬁrstpracticing Saam, I would test 4 point combinations before needling by pressing as many of the 4 points as I could and getfeedback from the patient or palpatory referents. What helped with palpation didn't always produce great treatment results whenthe patient was oﬀ the table so I stopped.This week, I was confused about what to do with a patient. Testing the points ﬁrst called to me again. I held K7 and Lung8 withstrong directional push and intention- no improvement in his pain. I tested other channels the same way- no improvement. WhenI needled K+, my ﬁrst choice, his pain improved by 90% within seconds.Lesson learned- again. ReplyDaniel SchulmanNewJul 22, 20212Reactso much for MatSa'amoto! ReplyShannon LarsonNewJul 27, 2021ReactYou actually taught me that a while back Kristin! I found sometimes testing points was leading me astray. The one thing I still dosometimes do and I don't know if you would consider this a no-no is if I am between 2 ideas I will put pressure on the 2toniﬁcation points of a channel and just look at the patients expression and complexion not paying attention to whether asymptom improves or not. I will even ask my intuitive patients if one just feels more comforting/ calming to them. Sometimes theyhave an obvious settling with just pressure with one of my 2 choices. If it's not obvious I give it no weight.Adina KletzelSpider VeinsNewJul 22, 20211ReactSpider veins are usually viewed as a for sure sign of blood stasis thereby being a Kidney excess sign.Sharon describes spider veins as blood leaving the normal pathway of the vessels - a type of bleeding.This creates blood stasis.I am just wondering if blood leaving the normal pathway can also be seen as a lack of consolidation of the blood in its normalpathway - like a leakage? This then would point us toward a SI excess symptom.I am asking with a speciﬁc client in mind. She is a 45 year old woman who has extensive spider veins on her legs and feet, strongmigraines, symmetrical, thin and dry medial heels (covered in spider veins). I have toniﬁed quite a bit of SI for her with minimalresults. When I toniﬁed Kid she had a great week with no headaches and more energy.For her it seems like the focus of the spider veins may be more of a leakage of blood out of the blood vessels which then resultedin stasis but the main issue is the leakage.

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3 teacher remarks1 reply 13 more comments3Perhaps for the others the stasis is paramount and the leakage less so.Is this something that you have seen before and is my analysis on target? ReplyKristin Wisgirda  NewJul 22, 2021ReactHi Adina,Thanks for sharing your experience. Your analysis sounds spot on to me.My preference of treating SI+ before K+ in a mixed SI/K case often gives good results. But I had a similar case where I ﬁxated onextensive spider veins and treated SI+ more than once without good results when the patient really needed K+.Repeating a treatment that gave minimal results happens when we prioritize ideas over clinical reality. I am guilty of this too. Ifonly patients would respond as they are supposed to! ReplyFang CaiNewJul 22, 2021ReactI've had the same question, but regarding varicose veins - in my mind, both spider veins and varicose veins are categorized in theKD xs category. I treated someone with varicose veins 10+ with SI+ with unremarkable results. LU+ was much more useful.I just went back to the intro powerpoint and don't see any vein issue mentioned in KD xs category. Is the spider veins/varicoseveins presentation more of a rock then a gem? I don't remember how or when that became accepted as indication of KD xs.5 teacher remarksMariaSurprising Adverse Reaction to LV+NewJul 22, 2021ReactI did a LV+ treatment and patient came back reporting hot ﬂashes and anxiety. She did not have hot ﬂashes or anxiety at the timeof treatment. I am surprised because these symptoms are more San Jiao excess. Do you have an explanation for this?Thank you. ReplyDaniel Schulman NewJul 22, 20213ReactI had a patient with almost the same reaction recently!! Was going to post it here - will do tonight or tomorrow . . . the followingweek, based on the important principle that the body adversely reacting to treatment is a high level sign . . . I gave her a SJ+treatment and it complete rocked her world - opened up the whole right side of her body that had been 'dead' since a dual rightsided thyroid cancer, breast cancer of 11 years ago!Kristin Wisgirda NewJul 22, 20211ReactLooking back can you see the Liver excess signs that you were missing?I had this experience personally- Liver+ caused anxiety. SJ+ instantly relieved it and cured the insomnia I had been having. Inhindsight, I could see that my thinking was dull and too internally focused.

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2 replies 26 more comments 6ReplyHot ﬂashes are usually heat above, a classic SJ excess sign. But hot ﬂashes can come from so many dynamics besides SJ excess.They simply are an expression of yang out of right relationship- so many causes. If you add coolness to an already cool systemsuch that the warm yang isn't strong enough to integrate it, then yang can lose its home and ﬂoat up and out. The body needsenough yang to hold the yang it has in the right place.If you are already cool and dense, then the prospect of night in a forest is pretty scary.Sorry to get all herby on you: This pathodynamic is described when you add extra cinnamon to gui zhi tang. Adding more spicywarmth to an already spicy warm formula treats symptoms of surging upward, including anxiety and hot ﬂashes.2 teacher remarks2 replies 21 reply 1Daniel SchulmanBoth Ends of the Pair Manifesting with IntensityNewJul 21, 2021 | EditedReactIt ALWAYS fascinates me when a patient presents with very extreme expressions of both ends of a pair! This morning I had a 63year old male in . . . on the one hand, he has a wickedly intense sweet tooth . . . like, if there is a bowl of candy, of wine gums,jujubes, whatever anywhere near him, he will eat them ALL , with no control . . . AND his mouth is full of cavities and ﬁllings!! . . .BUT, on the other hand . . . he is a slim and trim, (NO inner or outer damp body type physique at all), highly active, industriousUniversity professor - always on the go (his wife complains that he never settles down). So he is both very strongly Spleen ExcessAND very strongly Large Intestine Excess. And the reason he is coming for treatment? He is a professional classical clarinetist . . .for them, embouchure is critical - the tension in their lips has to be highly exact and controllable for 5 or 6 hours a day! Suddenly,he has developed an ache and fatiguing in his lips after only an hour of playing that has severely restricted his performance andpractice endurance. And the lips so clearly are at that intersection of the Spleen Large Intestine Axis!ReplyKristin Wisgirda  NewJul 21, 2021ReactThe suspense is killing me... What did you do? The safe strategy is to avoid the closely matched pair altogether.Besides LI, channels around the lips are Liver, Stomach (and Du, Chong Ren).I have a similar patient- loves sweets, thin and industrious. The mushiness of the little bit of ﬂesh that he does have points to SPexcess. And he is diabetic. He has responded well to LI+ several times.ReplyDaniel SchulmanNewJul 21, 2021ReactNothing else remarkable in the wet-dry realm. What fascinates me in such cases (and I have had several - where both ends of thepair are presenting with intensity) is that it certainly validates in a diﬀerent way, the compelling nature of these pairs but alsospeaks to a scenario where rather then one end of a pair clearly signifying that particular axis is way oﬀ centre, what is revealed isa very intense struggle within this patient on this axis - between both ends of the spectrum. Then I have had other cases - one justrecently in fact where all the signs and symptoms point strongly to one end of the spectrum - yet when I treat it, the patient getsworse - then the following week, when I treat the opposite - they actually get a LOT better!!! So we have three scenarios here . . .and when I put it all together, I start to see the whole dynamic as a series of body responses and compensations and counter-compensations - . . . . . a very dynamic ecological situation.

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1 teacher remarkAdina KletzelSI 2 and Bl 66NewJul 21, 2021ReactDoes anyone have any tricks in needling to avoid causing SI 2 and Bl 66 to bleed?They often bleed when I needle them and I would like to do a better job needling so they don't bleed.Any suggestions? ReplyKristin Wisgirda Jul 21, 2021ReactI always look out for superﬁcial veins and avoid them. Some veins can be pushed out of the way easily- such as at SJ3 and SJ2.Bleeding a point is more draining so it isn't so much of a problem when you want to drain the point.1 teacher remarkKristin Wisgirda Master the Basics by Retaking the Intro ClassNewJul 20, 2021 | EditedReactDan Bensky once said that any class worth taking once is worth taking at least 3 times. This is so true for the Saam Intro.Practitioners that retake the class always report that it was worth their time, eﬀorts and money. Each time I take it, I come awaywith a deepened understanding that bears fruit in the clinic.Toby is oﬀering the Intro via White Pine Circle for 6 Thursdays in a row starting August 5. Classes will be 3 hours, from 4pm-7pmEST, 1pm-4pm PST. The class will include a private forum managed by Toby and myself. This 6 week format received rave reviewswhen introduced last winter. Spreading out the information in 3 hour portions is much more conducive to learning than thosemarathon weekend classes that can even exhaust those of us with the keenest attention.If you can't attend live, recordings will be posted within 24 hours after the live class. You will have until January 5th to complete thecourse for NCCAOM and California CEUs so you will have plenty of time to watch and listen.Here is the link to register: https://whitepinecircle.org/saam-acupuncture-level-1-with-toby-daly-2/Toby is also oﬀering a 1 hour talk "An Overview of Saam Acupuncture Theory" on Thursday July 29 at 4pm EST, 1pm PST. This isfree for WPC members and $15 for the general public.https://reg.gosignmeup.com/s_reg/reg_registration_maintenance.aspx?ek=0078-0004-4216d5d1266b4205962ca0f24c70bbadhttps://whitepinecircle.org/saam-acupuncture-level-1-with-toby-daly-2/ Embedded File.https://whitepinecircle.org/saam-acupuncture-level-1-with-toby-daly-2/ ReplyTerri MatsonNewJul 20, 2021ReactI eagerly signed up to repeat this Saam Intro class beginning August 5. Thank you Kristin!

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1 reply 1ReplySpenta KandawallaNewJul 21, 2021ReactI've taken the intro class twice and I'm so glad I did. I caught so many new details the second time around and it enhanced myunderstanding and practice of Saam signiﬁcantly.3 teacher remarks3 replies 3Kristin Wisgirda A Conversation about Adverse and Unclear ReactionsNewJul 20, 2021ReactThis is a back and forth was inspired by Adina's recently submitted case "Weird Sensation at Night"My questions are in quotes "..."Toby's responses are in bold italics"A patient has an adverse reaction but you don't ﬁnd out about it until the next treatment. You needle the counterbalancer and the patient settles but beneﬁtto symptoms is mild or unclear. When there is a poor response to one treatment and then we use the counterbalancer, are we just evening out the pair?"It seems like the body metabolizes incorrect treatments a little less eﬃciently, but yes you're basically back at the baseline dynamic between the pairs plus orminus all the food, experiences, etc the patient took in between the treatments. But, there is some beneﬁt because at least you've added something to the overallsystem."Do we need to do the counterbalancer a second time to shift the balance?"If you can't ﬁnd another channel that needs supplementing more than the counterbalancer."This scenario came up on my forum with Adina's "Weird Sensation at Night" post- poor response to SI+, followed by not great response to K+ severaltreatments later.With some cases, needling the counterbalancer after a poor response creates clear improvement."It's possible the body metabolized SI and Kid supplementing diﬀerently. Or something signiﬁcant happened during the time between treatments. Or the channelssupplemented between the SI and Kid treatments aﬀected the body's overall dynamic.ReplyAdina KletzelNewJul 20, 2021React@Kristin WisgirdaTHank-you so much for this clariﬁcation Kristin. This brings up a very important point that I was not aware of.THis is saying that a poor reaction to a treatment and a neutral reaction to its counterbalancer does not indicate the potentialeﬀectiveness of the counterbalancer since the ﬁrst treatment is just oﬀ--setting the negative eﬀects of the incorrect treatment.Treating the counterblalancer a second time may then bring more substantial beneﬁts. Is this correct?It's possible the body metabolized SI and Kid supplementing diﬀerently.What does that mean?Kristin WisgirdaAdina Kletzel NewJul 21, 20211React@Kristin WisgirdaI have another unclear reaction to a treatment which I thought I would bring up here since this is the topic of conversation.I will not post the whole case but rather describe the reaction.Kristin Wisgirda

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1 reply 1ReplyI am treating a 52 year old man who has a long history of polyps in his sinuses which creates both congestion and a runny nose.He had 5 surgeries to try and open his sinuses.... It is worse with the cold AC blowing on his sinuses. It can also be aggravated byintense heat.He also had his appendix burst when he was 19 and he has recently been diagnosed with Parkinsons disease.His main complaint is stiﬀness and tightness in his right shoulder (SI, GB, and SJ) meridians. His right shoulder gets tight and staysup (convex) and he has to work to get it back down. The middle of his arm is tight on the Lung meridian and he meets resistancewhen he works to open the ﬁngers on his hand. The tightest ﬁnger is the third ﬁnger.The ﬁrst 3 treatments that I did were ST+ (with St 36), SI, and Liv. Each treatment brought improvement to both the sinus issue andthe stiﬀness.THe last treatment that I did was PC+.The reasons I chose it were: convex issues (polyps, shoulder gets stuck in the upward position, appendix burst), assertive, PCmeridian -third ﬁnger most stuck and shakes the most, and has strange dreams.After the treatment his shoulder went down a number in rating the tightness (so go one number better), there was a slightimprovement in the tightness of his hand, and his right nostril unblocked (from congestion). The left nostril had unblocked afterSI+.HOWEVER after the treatment he felt unbalanced - unsteady on his feet, dizzy, and irritable. The irritability went away later thatday and the unsteadiness and dizziness improved the next morning but did not go away fully until 4 days later.He also usually has 3 bowel movements a day and for 3 days he went down to one bowel movement without a full release. After 3days it went back to normal.So.... this is quite a strange reaction for two reasons.1 - his main complaints improved2. PC is a rooting and balancing treatment and should not be causing unsteadiness and dizziness.I feel that if it was a true adverse reaction then the main complaints should have gotten worse. At the same time I amuncomfortable with his reaction and I am not sure how to understand it.I did not do GB+ when I saw him four days after the PC+ treatment. It did not seem appropriate to do GB+ for him.(Just to note - he is not an angry person - he actually talks with a smile on his face. He is grounded in his responses but can getirritated by his kids and is assertive. He also does not scream and yell).Is it possible that this is an example of GB resisting the treatment? That the GB put up a fuss when asked to stop pushing outward(convex symptoms) and cause the unsteadiness?I remember Toby mentioning that GB could sometimes resist treatment before it gives way.I would love to hear how you see this reaction and if I should be doing the counterbalancer.Thank-you so much!4 teacher remarksKristin Wisgirda ﬁndings level with vertebrae not associated with organsNewJul 20, 2021 | Edited1ReactRecently I asked Toby : Are there any Saam associations, besides UB/DU, for symptoms/ﬁndings level with vertebrae notassociated with zang fu? For instance, T6 T7 and T8."Toby responded:My teacher was very concerned about wind entering the body at UB 12. He said protect that area at all costs in cold windy conditions. No otherrecommendations for non-organ shu points.(It went unspoken but for any ﬁnding on the UB channel, H excess involvement should be considered too.)

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1 reply 11 reply 14 more comments4ReplyTerri MatsonNewJul 20, 2021React@Kristin WisgirdaThank you for this information, on another note about the UB channel.... I have been re-listening to Toby's lectures and a fewconversations and understanding that in treatment such (as low back pain we could include UB 25) , in addition to the appropriate4 channel (+supplementation). Can we use other UB correspondence points.. such as UB20 if we were choosing to supplementSpleen for example. I just want to clarify that I am understanding what Toby was saying was correct and appropriate. Thank you..Kristin Wisgirda ReplyTerri MatsonNewJul 20, 2021React@Kristin Wisgirda Thank you for the clariﬁcation, good grief not sure how I misunderstood that section of the recording. Thank you!Kristin Wisgirda2 teacher remarks1 reply 1Alison Unterreiner, DACM, L.Ac.2-sided treatmentsNewJul 19, 2021ReactQuestion for teacherHi @Kristin Wisgirda !I have 2 questions about a double treatment -First - do you have any tips or pointers that were helpful when you started to do double sided treatments? I recently did a doubleUB+ on a patient with a strange skin issue that causes her face, arms and neck to appear incredibly red and feel hot (GTITR) and itlooked as though her skin was getting less red in front of my eyes. I hardly believed it. I had done UB+ 1-sided before and did notget the same result. Would you suggest trying just 1 sided before moving to 2-sided treatment? When does a case warrant it?When do you use more than 1 channel?Side-note - if this is too advanced for this forum, I'll wait until you create an advanced space for these types of questions.Second - if it's ok to ask this here!....when doing a tx on 2 sides, do you do points on both sides bilaterally or do you needle 1 sideand then the other?Thank you,AlisonKristin Wisgirda ReplyKristin Wisgirda  NewJul 19, 2021ReactHi Alison,It isn't my place to teach bilateral treatments to a wider audience so I can't answer your questions here.You will ﬁnd answers to your questions in the power point notes to the advanced strategies class.

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2 replies 2ReplyAdina KletzelNewJul 20, 2021 1React@Kristin WisgirdaI also feel that an advanced forum is very necessary. We learned the bi lateral pairings and draining just about a year ago and it ishard to consolidate that learning without a place to ask questions and read others cases. I know it is not your responsibility tomake this forum I just thought I would express my opinion. THanks.Kristin Wisgirda4 teacher remarksMariaCase Study: meNewJul 18, 2021 | Edited1ReactQuestion for teacherI am perplexed by my self treatments.LU excess: Big belly6, ﬁrm TM8, Very dry skin8, dry lips8, dry eyes7, good Qi8, hypertensiveST excess: weak knees with ﬁnancial troubles, phlegm, hard phlegm nodules (ST, SI, LI meridians), small chestSP excess: hard phlegm nodules, congested and phlegmy, no thirst, feels nauseous drinking water. bad teeth 6, jowlsLI excess: No sweet cravings 8, industrious 8, thin, loose skin 7 (lift skin oﬀ ﬂesh), very dry skin, feels dry inside, stubborn, strongarms4Self Treatments:ST+ over a month or two ago and reacted well but over time started to have really dry lips and the skin about the lips becamereally dry. I also developed dry itchy skin in my arms and hands along the LI meridian.SP+ skin got less dry, ﬂesh is ﬁlling out, less loose skin, lips better, itchy dry skin in hands and arms better. However, day or twoafter treatment I have been extremely constipated (urge to go but can't) and developed UTI like symptoms. Now taking Ba ZhengTang.SI+ didn't help with constipation.My question is: It seems like I didn't respond 100% positively to SP+ but doing LI+ counter seems wrong because of my LI excesspatterns. I am thinking I should do ST+ next but I just want to understand the mechanisms of the treatments and what happened.It seems like I have a mixed pattern of dryness and dampness as many people do. i would really appreciate your thoughts!Kristin Wisgirda  NewJul 18, 20211ReactHi Maria,Thanks for sharing your experience.A couple of notes about your symptom analysis:Hypertensive doesn't tell us anything about any of the channel excesses. If you have a symptom that goes along with high bloodpressure, we can work on that.The phlegm could also be part of Lung excess depending on where it is. The nodules being along the St channel make that apossible Lung excess sign too, as well as Stomach excess.Loose skin is diﬀerent than dry skin. I wouldn't associate it with LI excess. Loose skin can be SJ excess lack of density, maybe evenSI excess lack of consolidation.

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1 reply 1ReplyConstipation and uti like symptoms 2 days after treatment are adverse events but mixed with improvements in your skin so wedon't need to jump to LI+. We have to look to the rest of your case to ﬁgure out the best match.Based on the nature of your current symptoms that resulted from double damp Spleen, the most promising theory is that yourbody didn't like the introduction of internal damp.<LI+ counter seems wrong because of my LI excess patterns.> While you have some LI excess qualities, a larger belly and ﬁrm thenar- Iam interpreting "TM" as thenar- point to Lung excess internal damp. You say you have phlegm too and I would want to know moreabout it.We would need a complete case to know if ST+ is the right next step. ReplyMaria NewJul 21, 20211ReactHere is the complete self analysis :)CC: 1.) Hard round nodules by the ear (ST7, GB2, SI19), jawline (ST5) throat (ST 9).2.) Newly developed eczema, dry itchy patches on hands, arms along LI meridian. Very dry lips and skin around the lips -seemsworse after ST+ treatment3.) gnawing discomfort in Ren 14 areaLU excess: Big belly 5, ﬁrm Thenar 8, Very dry skin8, dry lips8, dry eyes7, good Qi8, hypertensive, history of nasal congestionthough better after previous ST+. Frequent Phlegm buildup in throat.ST excess: weak knees with ﬁnancial troubles, hard phlegm nodules, small chestSP excess: hard phlegm nodules, congested and phlegmy, no thirst, nauseous drinking water - not lately. bad teeth 6, jowlsLI excess: No sweet cravings 8, industrious 8, thin, loose skin 7 (lift skin oﬀ ﬂesh), very dry skin, feels dry inside, stubborn, strongarms4H excess: soft midline, constant caregiverUB excess: Tend coldK excess: fertile, symmetrical, varicose 6, ﬁrm heels 5, self concerned, occ. vertigoSI excess:GB excess: fast changing emotions 5, physical/aggressive 6, vivid dreamsP excess:SJ excess: Controlling 8, hot ﬂashes, hard on self 8, ﬂesh not dense, polite, not shieldedLV excess:After SP+ self treatment:In addition to the adverse reactions mentioned previously, I got some tooth pain B sides yesterday as well as a couple of acnebreakout by LI 19 and mouth. Although the bowel movements and UTI issues are resolving.Question: Isn't Hypertension inﬂated upward full? The hypertension symptom is just chest pressure and tightness in upper back,sometimes left, sometimes right side.<Based on the nature of your current symptoms that resulted from double damp Spleen, the most promising theory is that yourbody didn't like the introduction of internal damp.> If this is the case, then there is some internal dampness and external dryness.Since we can't always treat ST+, does it make sense to toggle between SP+ and ST+ to prevent too much internal drying?Thank you for your thought!

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5 more comments53 teacher remarks1 reply 12 more comments2MariaInternal DrynessNewJul 16, 2021ReactI am having some trouble diagnosing internal dryness. Aside from the some of the usual presentations of constipation, thirst, drytongue coat, dry hard muscles/sinew, what are some other diagnostic signs to look for?Is it correct understanding that eyes, lips, breasts could be both inside or outside dampness/dryness. What about vaginal dryness? ReplyKristin Wisgirda  NewJul 17, 20211ReactLack of ﬂesh is considered a sign of internal dryness. Phlegm that is scanty and really thick or hard is dried out ﬂuid/phlegm. Asymptom that clearly is worse with dehydration and better from getting ﬂuids has a dry aspect.For the vagina, Toby says he leans more towards exterior but sometimes will bend it toward the interior. ReplyTuriyaNewJul 17, 2021ReactKristin. Is lack of ﬂesh a quality that that you palpate for? Does skinny automatically qualify for internal dryness?2 teacher remarksSpenta KandawallaPromoting Labor with SaamNewJul 16, 2021ReactQuestion for teacherHi all. Have folks tried promoting labor using Saam? I have a patient at 40 weeks and OB has wanted to induce since last week. Sheis very healthy, no sign of distress to her or baby. Thought about various Saam treatments today like ST+ (has lots of upwardmomentum - rising heartburn, nausea when she lies down, lots of swelling - damp inside/dry outside); also thought of SI+ for itsdynamic movement and to get the blood moving and counter the consolidation of the past 9 months. But then I got nervous anddid other things.Any insight or good stories to share?Thanks!Kristin Wisgirda  NewJul 16, 2021ReactSorry I don't have any experiences to share but am hoping that others will chime in.Last time I heard Toby speak on induction he said that he never had the opportunity to use SI+ but would consider it.There are many possible reasons for "delayed" labor, one being the OB deﬁnition of "delayed". I would treat what I see to givemom whatever directional resources she most needs to make the transition into labor.

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4 more comments4ReplyAs an aside, in my few years of Saam experience, swelling in pregnancy has often proved to be a sign of exterior damp andresponded to Lung+, even with mildly dry skin. Usually these ST excess moms are also exhausted, and have a deﬂatedpresentation. Treating these moms has helped me identify the St excess behind other non-pregnant patients with edema orsuperﬁcial puﬀy excess weight. ReplySpenta KandawallaNewJul 16, 2021ReactThank you, this is very helpful! I have such a hard time seeing swelling as external damp, but imagining my patient, I can deﬁnitelysee it. My only concern with her is that she does get nausea and indigestion (heartburn).3 teacher remarksKristin Wisgirda Views of SI5 Supplemented Needled by TobyNewJul 14, 2021 | Edited1ReactJPEG | 56.1 K4B85450E-6E6E-4B96-A098-CAE1…JPEG | 44.6 KB5A5BD0D-32A7-46C5-9FC6-732…ReplyKristin Wisgirda  NewJul 14, 2021ReactI added these to the "File" folder that you can access on our homepage.ReplyTuriyaNewJul 14, 2021ReactSo I have been needling this at a more oblique/transverse angle. Krisitin do you needle/supplement this point with the patientspalm facing down or up? Thank you.

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1 reply 12 more comments 2Kristin Wisgirda Self CultivationJul 12, 2021 | Edited 5ReactThe latest issue of the Journal of Chinese Medicine contains an article "Self Cultivation: The Clinical Meta-Skill" by Toby Daly. Asubject worth reading about and taking to heart as Toby writes:"Self-cultivation is any practice or training that results in the ability to observe base reality at a deeper, less reactive and morestable level."and"Self-cultivation provides not only the fuel in the form of wisdom, but also the motivation in the form of compassion to performclinical work at the highest level for decades."Deﬁnitely helpful when practicing Saam.1 teacher remark1 reply 1TuriyaSt+ and needling SI5NewJul 11, 2021ReactThis is a point location query. In threading the needle up the arm are we actually sort of on the yin aspect of the arm where it isﬂeshier? Hope what I am asking is clear. ReplyKristin Wisgirda  NewJul 12, 2021ReactHi Turiya,I needle SI5+ with the palm down toward SI7 which is between the anterior aspect of the ulna and the muscle. So yes that could beconsidered the ﬂeshier side.Hope that is clear.Nicole SharkeyUpper body pain w/ mixed presentationNewJul 11, 2021 | EditedReactHello!I am trying to work through this case from a Sa'am perspective. I feel like I see a number of contraindications to the treatments I'dlike to use and I'm not sure how to move forward. Thank you!49 Year-Old WomanChief complaint: Neck, shoulder, upper back pain and limited ROM following MVA 17 years ago.Pain is moving and varies: aching, heavy, throbbing, stabbing, with areas of decreased sensation. Extends into her hands. Worsewith cold, damp and windy weather, particularly sensitive to atmospheric pressure change. Pain and restriction come on suddenlywith changes in the environment.

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At worse pain is 9/10 and she is unable to raise her arms past shoulder height, to have dexterity in ﬁngers, and has trouble eatingdue to the inability to fully move tongue, and a feeling that upper GI tract is “stuck”.Responds well to acupuncture treatment and especially to gua sha. After a treatment may have several days (winter) or 1-2 weeks(summer) where can raise her arms above her head, has an appetite and can perform regular household chores and self-care.Pain worse with cold (idea of a bucket of cold water sounds terrible to her) but she often experiences a sensation of heat andsweating in upper thoracic/lower cervical vertebrae at night.Accident hx: Sideswipe left her with several broken cervical and thoracic vertebrae, torn rotator cuﬀ muscles.Appearance and demeanor: Unkempt. Diﬃculty washing and brushing hair d/t pn and restriction. On disability d/t injuries: lowincome, clothes are second hand.Engaged, social, active on social media.Talkative. Considerate, generous with what she has.Lifestyle: Lives with partner, partner’s father and friend in mobile home. When she is physically able, takes an active role inmaintaining her health – stretching, doing gentle exercises, walking her dog, canning and preparing food, photography. Does all ofthe cooking and cleaning in her household.Hx of child physical and sexual abuse, domestic abuse, cancerBody morphology and ﬂesh quality: Tall and thin, ﬂesh slightly sagging in abdomen (two births), ﬂesh is light, puﬀy on abdomen,fuller in lower body despite often not having an appetite and often eating very little. Puﬃness 4+Skin quality: Mostly Dry (2+) with areas of dampness – underarms, upper back (2+)Body Temperature: Warm to the touch, though feels cold easily. Area of heat on upper back/neck that can keep her awake atnight, but wears scarf, neck warmer constantly during the day in colder weather. Palms and feet often warm. Spent much ofrecent heatwave (100+ F) outside because air conditioning and fan on inside her home made her back and neck hurt.GI: Low appetite, varies with upper back and neck pain.Respiratory: Cigarette smoker, occasional allergies in springSleep: Interrupted by discomfort and painEmotions: Even keeled. Intentional eﬀort to remain positive, focus on what she has, maintain integrity.Urination: NABody:Excess Presentations:Heart: Talking excessively, Sensation of heat in upper backUB: Back and neck pain, decreased sensation along UB channel, (sensation of) hypofunction of tongue and upper GI tract smoothmuscles at time, pain worse with coldGB: tension and pain along GB channel of shoulders and armsP: Even-keeled emotionsSJ: Warm and light body, sensitive to temperature changes, left ribs tight (5+) Spends lots of time on social media and in personhelping others when she can.Liver: Slightly dull eyes, low energy into self-presentationStomach: Historically under-resourced ﬁnancially, right-side ribside tension (3+), areas of numbness, dampnessMedial heels: dry, thin, small xue luoThenars: Puﬀy but emptyMidline: tight, tender 4+Left ribs tight: 5+Right ribs tight: 3+Eyes: Light, dull 2+Area btw C6-T1 warm to the touch, area of redness at C7Multiple subluxations in cervical and thoracic spine. Often will self-correct during treatment and then come out again over the weekDecreased sensation along UB channel T7-T11 both sidesVery tight bands along SI, SJ and GB channels at tops of shoulder, SCM musclesTongue – dark red, occasionally geographic thick yellow coat, moderately distended sublingual veins

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2 teacher remarksLU: Puﬃness to body, dry skin, occasional cough with yellow phlegm (Smoker)Spleen: Somewhat ﬂeshy body even though doesn’t eat muchLI: Low appetite, tries to be busy when she is physically ableSI: dry medial heels, pain along SI channels, often fatigued, low-energy into self-presentation, hx of traumatic injuryKID: small xue luo at medial heels, lots of sha during gua sha despite having many treatmentsSa’am Treatment History:Before learning that I should not start with KID+, I started w/ a KID+ treatment (R). Did not help her pain that week, but it did giveher an immense amount of energy. She was able to complete a few projects and still talks about that treatment as being helpful.A few (non-Sa’am) treatments later she was experiencing some constipation and a sensation of restriction in her back at T11. I didLI + (R). During the treatment she was excited to tell me what she was feeling but otherwise rested with eyes closed. Afterwardsshe said “this treatment didn't just open the channels but the spaces between the channels," (she’s had lots of acupuncture and ispretty sensitive) "I feel great." However, this tx didn’t end up impacting the sluggish stools or improve her body pain, and she saidshe did feel a little achy for a few days afterwards.Treatment Ideas:SI+ for pain, blood stasis. Concern – it will make her tiredLU + for upper body areas of numbness, historical lack of resources, right ribside tension, problems with GI tract. Concern – dryskin and internal dampness as shown by abd and lower body puﬃness (and tongue?)ST+ for dry skin, puﬃness, low appetite, GI movement. Concern – it will exacerbate already weakened resources, possibly makeher tiredHT + - for hypofunction, hypo-sensation of UB channel, pain worse with cold. Concern- will make hot spot on her back worse,create more heatUB + - for hot spot on back. Concern – exacerbate rest of pain LR + for body heat at night? SJ channel pain in shoulders and arms. ReplyKristin Wisgirda  NewJul 12, 2021 | Edited1ReactThanks for the case Nicole. With such a mixed picture the safest path forward is to use another system but you can still considerher Saam diagnosis as you treat her.How about her symmetry and fertility history? Even though K+ was beneﬁcial, there is the possibility that she could still need SI+because of the pain and moderately distended sublinguals (low but some clinical weight). The mixed hot and cold picture alsopoints to the SI/K pair.What is the grossest thing in the room?<Spends lots of time on social media and in person helping others when she can.> Is this more from having a loving nature or beingmore controlling?<Liver: Slightly dull eyes, low energy into self-presentation> If low energy into self presentation means poor grooming or lack ofsense of self, I would put that more into SI excess. If it is more lack of concern for social norms then it is more Liver excess.A somewhat riskier option: Her UB/H picture is mixed but so related to her pain area that it can't be ignored. It leans much moretoward UB excess with her talking and the heat sensations being the only signs that suggest possible H excess. You could try H+and watch her like a hawk knowing that you can counterbalance with UB+ immediately if needed. I would have her check in withher pain/restricted mobility on the table before needling and expect pain relief/improved mobility and settling within 2-3 minutes.I would only do this if you trust her reporting skills. I would also make sure she really understands what settling should feel like. Itsounds like she enjoys treatment sensations to some extent so you might have to tease these out. As well, if she is a real talkerthen having her stop talking would be a sign of settling for me. If the treatment seems to be going well, I would then leave theroom and check back in with her after 5 minutes just to be sure.The Lung/St axis stands out less than SI/K and UB/H. Based on what you have written so far SI+ and H+ would be my choices.

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Adina KletzelWeird Sensation at nightNewJul 11, 2021 | EditedReactThis post was administratively edited at 07/11/2021 9:59 AM50 year old womanMC: At night starts to feel a really weird sensation starting from her bladder that shoots down to her toes and up through herarms to her ﬁngers. It is a weird uncomfortable feeling that is like ﬁngernails on a blackboard. It is just strange and terriblyuncomfortable.She wakes up from it and the only thing that helps is getting up and going to the bathroom.When she goes to the bathroom her bladder is really full.She empties it out and then the next time the bladder ﬁlls up again it happens again. This happens 3-5 times a night.She thinks it started during radiation from breast cancer.At that time she also started hormone therapy and got her second covid shotDuring the day the bladder can be full and this will not happen.In addition in the past week she has a feeling a warmth running over the surface of her bodyHer hands and face feel especially warmSC: feels a lot of stress; Gets nervous about things and gets all tight insideAppearance and demeanorThin, thin boned, sallow dark complexion, mole on St 1, dry lipsSymmetrical but looks washed out and tiredShe is uptight, anxious, stressed, gets annoyed easilyTalks a lot – tells a lot of details of her issuesAttention to detail; A bit strong and forceful in her outlookDoes feel a bit heavy. Not a light energyLikes things to be done a certain wayLifestyleWorks full time for a company; Feels a lot of work stressMarried with 4 children; All girls; Oldest is 24 and youngest is 18; Very involved in her girls emotional lives.Diagnosed with breast cancer last November: Had surgery, radiation and now taking hormone therapyBody morphology and ﬂesh quality: Skinny; Thin skin, not a lot of ﬂeshSkin is not dry except for skin on faceEmotionsGets angry but more from a place of being overwhelmed at all that she has to do; Has a short fuseCritical of self; Feels a bit heavier and down since ﬁnishing radiationNervous; Likes to be busy

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Feels still needs to be supported and coddled since having breast cancer but since treatment is over does not get it and she feelsmore downMeds: Takes meds for high blood pressure; Meds for hypothyroidGICan get very gassy if eat heavy foods or too late at night. Will also feel bloated.Has a bowel movement every day; Lactose intolerance - gets gasGets nauseous when stressed; High stress makes her vomitWhen found out had breast cancer could not eat for ﬁrst 3 weeks. Lost a lot of weight.Body Temp: Usually feel more cold; Hates being cold; Always keep a sweatshirt handyLately she is feeling more hotUrinationHave to pee soon after drinking waterAt night sometimes takes a couple of minutes for pee to start ﬂowing outBodySays is sensoryLights from police car bother; Wears sunglasses in sunHas a kidney stoneGet headaches if don’t drink enough or from stressShe has TMJ and grinds her teeth at nightShoulders and neck are very tight and stiﬀ. She feels them all of the time and are painful; She rates the pain at a 9Thenar eminence a bit ﬁrm 5+Tongue: Red tip; Sides pale; On the paler side; Small, short tng; Dip in kidney areaSaam Chart ExcessesHt warm sensation on surface of body 8+ sternum to umbilicus soft 5+Bl cold 7+ frequent urination 7+ has cold induced asthma 4+SJ attention to details 7+ sensitive to light and noise 7+ critical of self 7+Liv feels a bit heavy and down 4+GB red tip of tongue 5+ gets angry 6+ reactive 5+ irritated 6+ assertive 6+ gets headaches 5+St thin and normal skin 7+ Mole on St 1 will get asthma with too much physical exertion 4+Lu nauseous and vomits when stressed 7+ ﬁrm thenar eminence 4+ mole on St 1Kid fertile 5+SI age 50 feels like needs support 5+ medial heel is thin and dryTreatments so farPC+(R)Said felt that sensation when lying down during thetreatment cuz had to go to bathroom and felt that it startedgoing away. Felt calmer the rest of the day but night was thesame. Feel calmer. No change at night. Night of treatmentfelt a bit of a bearing down sensation in vagina for a coupleof hours. It passed.ST+ (R) with St36Felt heat in third ﬁnger during treatment. Mind racing wholetreatment but said for her was relaxed.

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3 teacher remarks Had one long stretch without having the sensation. Had itlater in the night than usual. Able to calm the sensationdown a bit by using her mind. Still calmer. Stomach better.Still have warm sensation on surface of body.Bl+(R)Seemed quite relaxed. Getting out of bed to get rid ofsensation less. Sometimes can ignore it and go back tosleep. Getting better. Heat on surface of body comes andgoes.SI+(R)Fell asleep for a minute. Lots of bubbly sounds in stomach.Feeling so hot at night. Did not sleep well at all. Sensationmay have been lighter but not less frequent. She is moreirritable. Eczema is bothering her -red and itchy. Shouldersare killing her -so tight and painful. She is very stressed.More hot inside body and less on surface.Liv+(R)Hard time settling. Did not feel a change in shouldersafterwards. NO change the next day. Night -ﬁrst sensationintense next ones more moderate. (starting her on chai hugui zhi tang and si ni san). First 2 days felt like eyes werereally heavy. Still waking up 3 times a night with sensationand need to go to the bathroom. Sometimes intensesometimes lighter. Shoulder went from a 10 to 8 and worseon left side. Still peeing a lot during the day. Felt calmer –not in a rage after tipul. Eczema a lot better – not as itchy.Drooling stopped. No more hot on surface.LI+(L)Said she was most relaxed during this treatment.. NOchange in sensations and neck is slightly looser. Got a coldsore on corner of mouth. Still really hot. Still freq urin.Kid +(R)Said felt sensation a bit during treatment. Got really into theguided imagery. First night – said sensations were lighter.The following nights still had the sensations.We don't seem to be making any lasting progress.I am thinking of going back to PC+; I am also thinking that maybe she needs SJ+Her emotions are a bit heavy at times and she is not a great reporter.Maybe she needs St+ again - but she is so thin and I already dried twice and it did not bring any sig. results.It is such an odd symptom. I would love some fresh eyes on the case.ThanksKristin Wisgirda  NewJul 11, 2021ReactHi Adina, Thanks for the case. I edited it by reducing spaces to reduce the need to scroll through. I don't want to change yourwords because that risks distorting what you have to say. Can you please consider reducing the number of words you use? Extrawords make for extra work both for you to type and for me wade through to get the information I am looking for. I appreciate anyeﬀorts you can make.For instance : <Shoulders and neck are very tight and stiﬀ. She feels them all of the time and are painful; She rates the pain at a 9>could be written with half the number of words as: Shoulders/neck: constantly very tight/stiﬀ, pain 9+

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3 replies 3ReplyDo we really need to know that she has all girls?Are the headaches only on the Gb channel? How hot/cold does her body feel to you?It sounds like body heat and shoulder got worse after SI+. How much did the weird sensation improve before SI+? Where did theeczema show up?K+ didn't have a great response. I also have to question when there is a poor response to one treatment and then we use thecounterbalancer, are we just evening out the pair? Do we need to do the counterbalancer a second time to shift the balance?Sometimes we get a clearly good response after using the counterbalancer as in my recent case in the post "Listen to YourPatients". Have to ask Toby about this.The reaction to Liver+ was the ﬁrst mention of drooling that I can see. What about that?Sounds like the reaction to Liv+ was also on the side of not great but potentially muddied by the addition of herbs. She is sensitiveto light but are her eyes bright? Is her ﬂesh dense or open, besides her not having much of it.What is the grossest thing in the room most recently?Did results start to go backwards after SI+ and Liv+ or I am reading this the wrong way?ReplyKristin Wisgirda  NewJul 20, 2021React@Adina KletzelI just posted a conversation with Toby inspired by your case. Please see "A Conversation about Adverse and Unclear Reactions".Adina Kletzel2 teacher remarksToby WedgleCase study: anxietyNewJul 09, 2021ReactI could use some help ﬁguring out how to help this patient's anxiety. So far, we've had some success with her other symptoms buther anxiety remains largely unchanged. Thanks so much for your help!DOCX | 16.5 KDOCXDA Saam CaseKristin Wisgirda  NewJul 09, 2021 | EditedReact

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1 reply 1ReplyHi Toby,Thank you so much for submitting your case. Extra thanks for laying it out so clearly.Have you palpated her midline and hypochondriac regions left and right? How symmetrical is she?Really good case analysis. Here are a couple of notes.Under UB excess, add general hypofunction/wheelchair bound which is really signiﬁcant for her.I wouldn't put congenital spine condition under K excess or SI excess.<Stomach: nausea +8, > While nausea is not always too much up, it is less likely from too much down. I would think Lung excessbefore Stomach excess. But nausea can be caused from so many other dynamics- it is good to keep an open mind. Low appetiteand easily full suggest Lung excess. Sounds like she needs more down than up. I know stool is loose but St+ would be safe as longas she isn't having frequent urgent stools. If you do use ST+, she sounds damp enough to opt for ST36+ to replace ST41+. Let meknow if you are unfamiliar with that substitution.What makes you lean more toward Lung+ besides the ﬂat thenars? Is she like a deﬂated balloon that needs to be inﬂated? Thetiredness could also be from damp and cold.The yellow ﬂaking says there is some damp mixing with heat on the surface.You could consider the mixed hot and cold under K excess as well as SI excess. The heat in the upper could also be attributed to aLung excess not allowing descent, rather than SJ excess.How about her ﬂesh quality- dense or light/open? Her cold aversion and anxiety worse with dark/cold, and those dull eyes 7+,point to Liver excess.What do you think about trying SJ+ and ST+, separately of course? H+ likely will need to be used again as well.Please let us know what you do and what happens. We appreciate it.ReplyKristin Wisgirda  NewJul 14, 2021React<anxiety's connection to cold and dark as a Liver excess> Anxiety can be from any of the 12 channel excesses. Toby says that he oftenends up supplementing yin channels. I personally had the experience of Liver+ causes a jumping out of my skin kind of anxietywhich might not seem consistent with adding the cool, dark density of Liver. SJ+ instantly relieved it.Perennial lung issues can be Lung or Stomach excesses or involve many other channels as well.<Could you explain how heat in the upper is attributed to Lu excess?> The heat can come from internal dampness blocking qi leadingto an accumulation of heat. Heat tends to rise to can present in the upper. Lung excess also has not enough down and out sophysiological qi can accumulate pathologically and will rise. Toby has gone though a few cases where Lung excess key toaddressing heat in the upper, including a case of hotf lashes.<What about the ﬂaky skin in the upper, could that be Lu excess too? Would you consider that a damp or a dry situation (it feels damp(moist and warm) but looks dry (ﬂaky, red, cracked)?> Her skin seems to be a mix of damp and dry. The cracking could be drycracking (looking just too dry) or damp in the exterior preventing the skin from healing in which case I would expect the cracks tohave a wet quality to them even if they aren't frankly oozing or crusted. Your initial presentation also mentioned rough skin whichoften can be a species of dry. Without seeing it, it is hard to know if it really is more damp or more dry but she sounds dampenough that using ST36+ instead of ST41+ to dry her out more seemed more appropriate. The abdomen is really helpful for getting informationabout a number of channel pairs:UB/H (midline between xiphoid and ren8 warm/cool soft/hardLiv/SJ (left hypochondriac)Lung/ST (right hypochondriac)K/SI (hard masses in the lower abdomen).Please let us know what you do and how it goes with this patient. Thank you.

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5 teacher remarks1 reply 14 replies 42 more comments2Mariaquestions questions questionsNewJul 09, 2021React1.) If a patient use to be volatile/aggressive in youth but has mellowed with age and is more calm, would that person still beconsider GB excess?2.) What about someone who has been aggressive and explosive in the past but has learned better anger management, howwould that be viewed?3.) How many of the patterns must be met before we can conﬁdently use a SAAM treatment? Some people meet the entirechecklist and that is easy to diagnose but others meet most but not all of the pattern check list. Just an example, I have manyobese patients who have dry skin, large belly, not too chesty, thenar is not too full or deﬂated, hypertensive, moderate resources.4.) What is the diﬀerentiation between someone that is easily bored and keeps himself entertain by doing diﬀerent projects andthat of a person that is industrious?ReplyKristin Wisgirda  NewJul 09, 2021ReactHi Maria,Thanks for sharing your questions and thinking about Saam.Regarding questions 1 and 2: We are treating patients and their tendencies as they present in the present and recent past. In thepost Listen to Your Patients, I mentioned that the patient, my uncle, has a history of GB excess but now presents as P excess. Iknow he has a diﬃcult home situation so I am waiting for more information before I use GB+ for him.If someone has aggressive tendencies but utilizes anger management successfully, this demonstrates the presence of both GBand P qualities. When channel pairs are equally matched, we look elsewhere to treat. Generally, we are looking to treat the biggestdiscrepancy between channel pairs. These last 2 sentences are also the answer to your question #3.Question 4 could be asking the diﬀerence between-Lung excesses who might have lots of hobbies and past-times that they dabble in because they have the resources and the don'thave too work too hard to get by.-LI excesses who are industrious because they are just sooo interested, never bored, creative, stubborn. These folks areproductive.- St excesses who have to hustle to get by because they just can't hold onto resources or get a break.Please let me know if any of this needs to be clariﬁed. Thanks! ReplyKristin Wisgirda  NewJul 09, 20211ReactHaving hobbies is not a quality of Spleen excess. Unless sitting on your couch passively watching a screen and complaining there isnothing of interest is considered a hobby.

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1 teacher remarkSpenta KandawallaCase Study: stormy emotionsNewJul 08, 2021ReactQuestion for teacherI'm attaching a new case study. I have treated this patient for years, but she is coming back again after over a year of being gonedue to the virus (didn't feels safe to come into clinic). Prior to lockdown, I was treating her with Saam treatments, but I'm writingthis case fresh because I was so new when I was treating her before.Thank you for any questions and insights!PDF | 67.7 KPDFCase Study_July2021_LCKristin Wisgirda  NewJul 12, 2021ReactThanks for the case.How symmetrical is she? Given the history of notable sublingual veins, I would want to see what they look like now especially given:<having a rib removed in childhood (multiple spinal surgeries in childhood)> This has to be listed under K excess. And has to beconsidered a possible cause for all of the discomfort around her ribcage.YES, we don't often use tongue diagnosis in Saam but Toby has said that tortuous sublinguals do have weight toward blood stasisas a kind of varicosity.<Feelings of depression and anxiety increase in the 2 weeks prior to her period.> While this is not deﬁnitive for blood stasis in Saam,blood stasis should be explored as a possibility for any condition worse premenstrually that is relieved by the onset of the period.<doesn’t care about appearance 8+> While poor grooming is classically SI excess, with strong Liver excess signs we can be open to itbeing Liver excess not caring about social norms. Could this be a possibility for her?<a body without a life> Sounds like she is in a very dark place and is cold toward other people, unable to feel the warmth aroundher. The Liver excess stands out to me- the dark moods, the dull eyes, <very dense, a lot of negative thinking, unmotivated,purposeless.> The darkness is such that the SJ excess signs she might have don't even come close to evening out the Liver/SJ pair.<She says she can’t really tell what she feels, it’s too inconsistent> Or is her awareness too dull? Or does she feel like her body tempchanges with the environment like a SJ excess? Could wearing sweats on a hot day could possibility the result of her being closedoﬀ from the outside?With her kind of darkness, I would also be on the look out for coldness too. <She has a very hard time believing her friends orpartners care for her, and often pushes people away.> This sounds like possible Ub excess.How stormy are her emotions before her period? Real aggressive GB excess stormy? Or just more changeable and dark and cold?<blames others> Though you put this under GB excess, this could be K excess self centeredness or UB excess lack of love forothers.

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ReplySJ+ is a good next step. SI+ should be explored as a possibility before using Kidney. H+ should be explored as a possibility too. Ifher behavior is really stormy, then P+ during the storm but if she saw the light and felt the warmth, she might not need to wieldthe GB excess sword.Please let us know what you think and what you do. Thank you.ReplySpenta KandawallaNewJul 16, 2021ReactThank you for all of these suggestions. I used SJ+ this past week. She settled well on the table and seemed a bit lighter after thetreatment. I like the idea of H+ for her as well.To the questions above:<How symmetrical is she?> Her torso is very asymmetrical given the situation with the spine. I think her face is pretty symmetricalbut I need to give it a better look and ask her to remove her mask.<While poor grooming is classically SI excess, with strong Liver excess signs we can be open to it being Liver excess not caringabout social norms. Could this be a possibility for her? > Yes, this is a strong possibility. I think she just doesn't care about muchwhen the depression is strong.<How stormy are her emotions before her period? Real aggressive GB excess stormy? Or just more changeable and dark and cold?> In the past when I've seen her, she can be aggressive -- lots of ﬁghting and blaming of others, in addition to dark and cold. I don'tthink the blaming of others is a self-centeredness. She doesn't have much self-worth. Even though she blames others, she alsodoesn't have a lot of self-love. Occasional suicidal ideation. In fact, I've treated her with KD+ in the past and it was good for her.I'll keep you posted. Thanks!3 teacher remarksSpenta KandawallaWarm LV Excess?NewJul 08, 2021ReactQuestion for teacherHi Kristin & all,Is it possible to have a LV Excess patient who is warm? I am ﬁnding patients with that heavy, dark, weighted depression, dull eyes,not very aware of their surroundings, but who run warm or hot. I want to do SJ+ because of all of the expressions of LV Excess butI worry about the warmth. Any thoughts on this?Thank you ReplyKristin Wisgirda  NewJul 08, 2021ReactHi Spenta,Nice to see you in ethics class.Yes, the mix of other qualities besides Liver excess can make a clearly Liver excess patient warm or hot. SJ+ is the second warmesttreatment after H+ so you do have to be careful if someone really runs hot. If heat is really a big element, then perhaps you treat with channel, besides Liver+, that is cooling before using SJ+.Spenta KandawallaNewJul 08, 2021ReactNice to see you too!

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1 reply 13 more comments3ReplyThanks for this. That's a good idea to cool them down ﬁrst with a diﬀerent channel. Another question with LV Excess -- I feel like Ihave patients who have that heavy, dark depression and dull eyes, but they tend to be polite. This always has me hesitate usingSJ+. I'm imagining I just need to weigh out the symptoms and compare, but if you have any thoughts on this, I'd appreciate it.2 teacher remarks3 more comments 3Kristin Wisgirda Listen to Your PatientsNewJul 07, 2021 | Edited2ReactTreated a 63 year old patient for 14 year long neck pain today. Pain between c6/c7 on the spine and 1 inch to the right. Startedafter a bad fall but worsened after several other traumas and was constantly aggravated working as an HVAC contractor incramped spaces.The ﬁrst SI+ treatment mostly restored mobility to his previously almost totally stuck neck but it only reduced pain by 20-30%.Because of his full beet red face, being easily overheated and channel location, UB+ was next- it reduced pain signiﬁcantly on thetable but over the next few days pain relief wasn't much better than after SI+. Over the week his neck stiﬀened up and was almostas bad as before SI+.The third visit: SI+ was used again- on the table it totally restored his mobility and reduced pain somewhat. His mobility remainedperfect over the week but pain was still constant.Because the pain was on the right side, I decided to look at the balance of Stomach and Lung. His morphology is very Lung excess:broad chest 4+, ﬂeshy plump thenars 7+, dry skin 3+, big belly and ﬂeshy overall 6+. He has COPD with a cough that produces clearphlegm in the morning. His breathing often sounds phlegmy from the chest level. His sinuses also drain in the morning. But hisvoice was so quiet I strained to hear him 7+. You can tell he is fatigued 4+. And he was talking about ﬁnancial problems withoutprovocation. Because morphology has more weight with Earth and Metal channels and the phlegmy breathing, I decided to treatST+. No change in the pain after a few minutes so I removed the needles and inserted Lung+. The pain was totally gone within 5minutes. At the end of the treatment his voice was clearly louder too.Really his voice was the grossest thing in the room. I should have listened better when he ﬁrst came in.ReplyDaniel SchulmanNewJul 07, 2021ReactGreat case - thanks for sharing!ReplyTerri MatsonNewJul 07, 2021ReactThank you Kristin for proceeding though the thought process and treatments and reminders. Super helpfulKristin Wisgirda Seeing the channel pair imbalancesNewMar 21, 2021 | Edited3ReactIf you give each aspect of the presentation 1 line, it is easy to see which channel excess takes up more space compared to it'scounterbalancer.

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3 replies 36 more comments6ReplyDo we view the moisture of night sweats diﬀerently than regular sweating?ANd is it correct to view lack of or very little sweating as dryness on the outside?1 teacher remarkAdina KletzelHeavy eyes for 2 days after Liv+NewJul 07, 20211ReactHI,If someone feels that their eyes are so heavy for 2 days after a Liv+ treatment would that constitute and adverse reaction?Her main complaint did not change after Liv+ but other symptoms got a little bit better. She did not settle deeply but she does notreally settle much on the table - she does not like to be still and do nothing.I had another client whose symptoms did improve after Liv+ but her was SO tired for 2 days after the treatment. Is that part of theheaviness of Liv+ or does that indicate that its not the right treatment?ReplyKristin Wisgirda  NewJul 07, 20211ReactLiver+ adds density and cool dark dullness so feeling any of these qualities can be expected after treatment. I wouldn't considereither scenario you mentioned above an adverse reaction.48 hours is often the amount of time patients will feel these qualities more strongly before they become fully integrated into theirsystems.1 teacher remarkDaniel SchulmanLovely Consolidation CaseNewJul 06, 20212ReactI won't write up the whole case here . . . just wanted to share a lovely result . . . a 73 year old male patient with a hugely complexmedical / surgical history I have been working with for months now - who has responded very well on so many things . . . recentlycame in asking if I could help with a longstanding issue of his . . . . waking in the morning with a loose feeling in his lower lip,uncontrolled drooling and 3-4 hours of very runny nose. Given his whole picture, I decided it was most likely to be an issue of lackof consolidation. So I did a Kidney+ treatment - and for 4 days, starting the very next morning, his lower lip felt fuller, he had notdrooling and no nasal discharge (ﬁrst time in years). This medicine never ceases to amaze and impress me.ReplyKristin Wisgirda  NewJul 06, 2021ReactLovely result and lovely that our medicine can do that. If he went to his regular doctor he probably would have been giventreatments to dry him out.Thanks for sharing.Adina KletzelNewJul 06, 2021React

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1 more comment1Reply@Daniel SchulmanHI Daniel, THanks for sharing this case. I probably would have gone straight for on LU+ or LI + to dry on the outside. What pushedyou to right away see the lack of consolidation over the wet on the outside?Daniel Schulman1 teacher remark1 reply 1Sharon WeizenbaumDirection of Ren and DuNewJul 06, 2021ReactQuestion for teacherHi Kristin and other experienced Sa'am-o-phils, @Kristin Wisgirda @Daniel Schulman @George MandlerI have not studied Ren and Du with Toby so I've not integrated in into my work with Sa'am. In his original article, he lists themthough in a chart. Du is listed as having the characteristic of upward movement and Ren is downward. I wonder if you couldelaborate on this a bit. Does this mean that, when you treat them, Sa'am considers that we are bringing in that movement? Withthe other pairs, for example Spleen; the characteristic is moisture and we bring that in with supplementing spleen.So, do you have any thoughts on this idea of upward and downward?thanksSharonGeorge Mandler,Kristin Wisgirda,Daniel Schulman ReplyKristin Wisgirda  NewJul 06, 2021ReactHi Sharon,Toby hasn't taught the Ren and the Du publicly so I am not comfortable commenting on this subject.I'm not positive but he might discuss Ren/Du in a new advanced class (part2) coming up on September 25 and 26th of this year.Registration isn't open on Qiological yet but should be soon. I'm sure at least 1 year of Saam practice will be a pre-req but I am notsure if the part 1 advanced class is a requirement. ReplySharon WeizenbaumNewJul 06, 2021ReactThanks Kristin, makes sense.Jeri SteeleA morning sickness patientNewJul 04, 2021 | EditedReactQuestion for teacherI had a patient last week who is 7 weeks pregnant with morning sickness. Her tongue was pale with dusky purple in the center andher sublingual veins were a little swollen. Abdominal ﬁndings were tight subcostals more on the left and a right Oketsu. One smallbut distinct area of cold was found on the left just below the stomach area. She was also very easily irritated. Her body type wasSP with damp inside and damp out with some excess sweating and a little over weight (a little more then the pregnancy). Herthenars were a little thin. She is a Nurse Practitioner and makes a good living but I don't know her well enough to understand how

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1 teacher remarkshe feels about resources. Heels looked great. Symmetry about 5/10 and eyes lower to medium brightness. Considering theabdominal ﬁndings and that the GTITR was her anger and irritability, I chose +PC to counterbalance excess GB. The next or maybethe ﬁrst obvious choice would have been ST but Toby says to try others ﬁrst before using ST in a pregnant patient. Other choicescould be +LI, +LIV but I would also hesitate with +LI since she is pregnant and pregnant women need a lot of ﬂuid in the womb.Maybe +LU would be a choice since her thenars were a little on the thin side. +LIV would have given her some cooling but herirritability also verged on being impolite and shielded so I wasn't too sure about that and she has a lot of heat so I am keeping +SJlower on the list. What has been your and others experience treating women for morning sickness in early pregnancy using SAAM?I'm curious to hear what you all have found. She wants to wait on making another appointment so she can see how this works andshe only came because a friend recommended it to her. She is not conﬁdent that acupuncture will help and was very close mindedabout it so I'm surprised she even came in the ﬁrst place. I give her a lot of credit for coming. I just sent her an email asking howshe did and hope I get an answer but she's away all weekend for the 4th holiday so I'll probably have to wait on that a bit. Lookingforward to some advice! Thanks :) ReplyKristin Wisgirda  NewJul 06, 2021ReactYes there are lots of cautions with pregnancy. Some are critical than others. The strongest caution is for SI+ so I am glad that youdidn't consider it give the patient's K excess signs.<Toby says to try others ﬁrst before using ST in a pregnant patient> This is not my understanding of Toby's teaching. If a patient isclearly Lung excess you can use St+ safely. You do want to be cautious about how often you use it.<Her body type was SP with damp inside and damp out with some excess sweating> Besides the sweating does she have moist skinwithout the need for moisturizer? While sweating alone can mean damp outside, sweating can be secondary to other conditionsand can be mixed with a dry exterior. I am just seeing how much of a case can be made for Lung excess.Just that she makes a good living means she has resources- put that in the Lung excess column. How she feels about resourcescould have weight but you take into account what you know.How does she experience the morning sickness? Does she vomit or have any gagging or reﬂux? These are signs that we morelikely want to descend but we don't always need to descend for reﬂux.Regarding Liver/SJ: She has less bright eyes but what about the density of her ﬂesh and her facial complexion- any palor orﬂushing?Does the quality of her irritability ﬁt GB excess? That is, can you imagine her lashing out physically or with words to any degree.We will see how she reacts to the treatment.It can help to use the case study format recommendation of going through all 12 channels and listing the relatedsymptoms/qualities. Grading more of the the symptoms/qualities would help us see your patient better too.Jeri SteeleNeedling videosNewJul 04, 2021ReactQuestion for teacherHi Kristin. I was able to view the BL66 video. Not sure what happened but it worked ﬁne today. I have a few questions about theneedling. I notice Toby stimulates the needle as he is advancing it. For some reason I thought I was supposed to advance only aftergetting the Qi. Can you clarify for me? Also it looks like the needle Toby used for GB41 was longer then the others or is it just theangle of the shots and how I was seeing them? What can I do to ease the pain from needling the Jing Wells and BL66? I noticed thepatient in the video really felt BL66 too but I have actually had two patients decide never to have acupuncture again because ofthe pain they experienced, one with a Jing Well (BL67) and the other with BL66. My BL67 patient actually fell apart emotionally onthe table and it took me over an hour to console her. I had to give her a full body Reiki treatment which helped tremendously butshe vowed never to use acupuncture again. I then oﬀered to treat her the next time with Reiki at no charge and she made anappointment but then canceled at the last minute. I felt just awful. If it weren't for the good results I keep getting with otherpatients I probably would have abandoned SAAM after that experience but instead I'd like to learn if there are any ways to easethe pain of those points. I went out and got some numbing gel that tattoo artists use but it doesn't really help and you have toleave it on for 20 minutes which just isn't very practical. I prep the point with massaging it and have tried stroking along thechannel after it's placed. These help a little but I'm still getting some folks who just seem to really react in a very strong way andwill then refuse to let me use SAAM on them again. I'm actually now using a smaller gauge needle for the Jing Wells and BL66 justbecause I need to get my own conﬁdence back up again even though I know this won't achieve as strong of a response as usingthe thicker gauge needle at these points! Really looking forward to your advice and clariﬁcations. Many thanks! Jeri

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3 teacher remarks1 reply 13 more comments3 ReplyKristin Wisgirda  NewJul 06, 2021 | EditedReactHi Jeri,Thanks for your questions.<For some reason I thought I was supposed to advance only after getting the Qi.> This is the way Toby has articulated his technique butit does look diﬀerent. I wonder if "getting the qi" is just really feeling hooked into the point.<the needle Toby used for GB41 was longer> You deﬁnitely want to use an 1.5" needle for Gb41/42. The exception in my practice is atiny patient (under 5 feet) with hammer toes- I use a 1" because the longer needle handle seems to get in the way.<the patient in the video really felt BL66> Needling UB66 seems to create a reﬂexive jump response along with the sensation. Onanother forum, there have been reports of paraplegics jumping when their numb limb is needled here. So I tell patient I expectthem to jump when UB66 is needled.<What can I do to ease the pain from needling the Jing Wells and BL66?> Pumping the points with your ﬁngernail for a long time willmake the needle feel like a relief. Also distract the patient with chit chat.<I have actually had two patients decide never to have acupuncture again because of the pain they experienced, one with a Jing Well(BL67) and the other with BL66. My BL67 patient actually fell apart emotionally on the table and it took me over an hour to console her.>Oh boy. That must have been a rough experience for everyone. Is it possible that you mis-diagnosed these patients? In anotherpost we were talking the experience of extreme needle sensitivity being possibly a function of wrong point selection because ofmisdiagnosis. Such an extreme reaction makes me curious if this happened to your patient (s). ReplyTuriyaNewJul 06, 2021 | EditedReactWith respect to UB66 ...one of my patients who has sung all her life and was dreading this point in particular will sing a sound (eeeeeeeeeeeeeeee) as I insert the needle. And she ﬁnds it much easier to receive the point. I'm trying to remember to suggest thisthis to other patients as well.

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3 teacher remarks3 more comments3TuriyaDescribing Saam to patientsNewJul 03, 2021ReactI've been struggling to come up with a description of Saam ...especially to provide my past patients of why I am employing thisdiﬀerent way of practicing than they have grown accustomed to ( ie Tan, Tung, Back Shu, Auricular, etc).Any feedback and criticism is welcomedSaam Acupuncture recognizes 12 possible patterns or archetypes that in a person may be apparent constitutionally, ongoing anddominant….or sometimes only appearing with certain illnesses and injuries.It was seen and developed by a wandering Korean Monk named Saam in whose meditation and spiritual life there arose the giftfor medicine and healing. Saam studied the classics of Chinese Medicine and out of this study and his own deep seeing giftsdeveloped the treatment patterns to address the 12 archetypes.Compared to many acupuncture systems the treatments themselves are simple 4 needle patterns. The eﬀect can be very powerfulsending what has been described as a shove or wave through the mind and physiology of the patient and touching a broad terrainof problems. ReplyKristin Wisgirda NewJul 04, 2021ReactExplaining that we are seeking to balance particular qualities with diagnosis and treatment resonates with most patients- or thosewho are seeking an explanation. Especially when you describing the channel qualities in their most basic form. I also like to frame channel excesses in terms of super-powers. We aren’t lessening the gifts and capacities of our patients. InsteadSaam adds other capacities and qualities that will help them use their gifts in a way that is more sustainable and creates lesssuﬀering. Not everyone needs or wants an explanation. ReplyTuriyaNewJul 06, 2021ReactKristin I can see the super-powers, gifts and capacities of some of the channel types more easily than some of the others. Forexample: LI Excess strong arms , bones, many interests and capabilites.....and the KiExcess symmetry and reproductive strengthsto populate the earthLOL.....and San Jiao's strong awareness of detail/surroundings.....But how about StExcess for example? SIExcess?Spenta KandawallaPostpartum Skin Rash & KD+?NewJun 30, 2021ReactQuestion for teacherI have a patient who gave birth 4.5 weeks ago. About 2.5 weeks ago she started developing what seems to be a Pruritic urticarialpapules and plaques of pregnancy (PUPPP) rash. I treated her with SI+ because she was having a lot of pain from tearing. At thetime the rash was only showing in the stretch marks (where it usually begins). I didn't know what it was, but ﬁgured SI+ might work

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3 teacher remarks4 more comments4nicely since it was itchy. She settled well with the treatment and her pain improved. The rash, however, spread. Not immediately,so it didn't seem like a negative impact of SI+, but it certainly didn't get better.She now has raised red, very itchy patches on her thighs (front and back, bilat) and smaller bumps on her arms and lower legs andtorso. I tried UB+ but she was agitated from the needles. I removed those and put in LV+. There was no way I was going to needleHT+ (she felt hot and the rash was really hot). She did really well with LV+; settled on the table and felt great after. The rash alsoimproved some. No longer raised, dried up, and much less red.It has ﬂared up again. I know I could do LV+ again, but my question is actually this. She clearly needs KD+. She literally said to me:"I feel like I can't make decisions about what I need for myself." She's exhausted. Her eyes, which are normally symmetrical, lookasymmetrical. It feels like her body is asking for KD+, but I'm scared to needle it with that large and active of a rash. I wondered ifher body needs this balance so much then things will fall into place and the body's functionality will help heal the rash. What doyou think?Thank you for any guidance. ReplyKristin Wisgirda  NewJun 30, 20211ReactHi Spenta,Based on what you have written, I would consider using K+. She clearly needs K+ and she is recently postpartum. In my clinic, K+has helped with itchy rashes in patients who are clearly SI excess.A whole case write up might present other possibilities. I would look at channel location and qualities- both of the skin andotherwise, especially damp and dry.Please let us know what you do and the outcomes. Thank you. ReplySpenta KandawallaNewJun 30, 2021ReactThank you so much. I will see how things present tomorrow and if SI excess still feels strong, I'll use K+. If it goes poorly or I'm stillconfused I will write up a bigger case. And no matter what I'll write about it goes. Thanks for the help Kristin!Alison Unterreiner, DACM, L.Ac.Continuous treatment with Sa'am guidanceNewJun 30, 2021ReactQuestion for teacherHi Kristin -I have fallen oﬀ with using Sa'am as consistently over the past few weeks and I realize that it's because once I establish a channelto tonify and it seems to work and an issue is resolved or mostly resolved, I'm not sure what to do next. I know that Toby does notsuggest needling a channel more than 2-3x in a row, so I tend to try and mix up what I needle, but I ﬁnd that the patient doesn'talways get the results they want and then they decide they don't like "the 4 needles" anymore or I see that I can get quicker resultswith TCM and I go back to "regular" acupuncture.Do you have any guidance or words of wisdom on continuing to utilize Sa'am in treatments over time with patients once an issueis resolved? Do you ﬁnd yourself moving between Sa'am and more TCM treatments?Thank you in advance for your help!Alison

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1 teacher remark1 reply 1 ReplyKristin Wisgirda  NewJun 30, 20211ReactIf an imbalance in the Saam channel pairs is not clear to me, I use other systems.Once a big change has been made or an issue is resolved, your treatment has clearly shifted the balance of the channel pairs. Anew Saam evaluation needs to be done if Saam is going to be used. Repeating a treatment when it isn't needed is a recipe foradverse reactions. You are correct to use another Saam treatment or a non Saam treatment.2 teacher remarks1 reply 1Lijana ShestopalRight sided pathologyNewJun 30, 2021ReactI got a little bit confused on the Right sided pathology vs Left sided pathology. So if the pathology is on the Left, we treat LV? But ifpathology is on the R side, that would mean LU, but is it LU excess and treat ST? Because if this was the thinking, then if pathologyis on the left, that would mean that LV is in excess so to treat SJ? So basically, what I am asking is, if the pathology is on the R (andLU states that is one of the LU excess signs), would you treat LU or ST because my understanding until this point was that if thepathology is on the R, that is LU excess and to go ahead and treat ST?Thank you! ReplyKristin Wisgirda  NewJun 30, 20211ReactHi Lijana,This is often an area of confusion, so I'm sure others will beneﬁt from your asking this question.Right sided pathologies are an indication for BOTH Lung and Stomach excesses.Left sided pathologies are an indication for BOTH Liver and SJ excesses.You use other aspects of the presentation to determine which of the pairs is more excess.Toby says that there is a slight preference for supplementing Liver when there are left sided pathologies and Lung for when thereare right sided pathologies. I think he mentions this in homage to the classics but practically this doesn't override other aspects ofthe presentation that point to a Lung Excess or Liver excess.When we are talking right sided pathology, for sidedness to have weight for Lung/St that pathology can only be on the right. Themore pathologies line up on the right, the more clinical weight there is to consider treating a Lung/St imbalance.Let me know if any of this is unclear.Fang CaiNewJul 14, 2021ReactHi @Kristin Wisgirda , I have this in the intro powerpoint notes:When SJ organ system is in excess:Kristin WisgirdaPathology tends to manifest on the left side of the body,along the San Jiao channel, and along the Liver channel trajectories

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1 reply 1ReplyWhen ST organ system is in excess:So my understanding has always been that L-sided pathologies can be one indicator of SJ excess, not BOTH SJ and LV excess. AndR-sided issues = ST xs, not both ST and LU xs. Do you have a diﬀerent read of those powerpoint slides?Pathology tends to manifest on the right side of the body,along the Stomach channel, and Lung channel trajectories4 teacher remarks1 reply 11 reply 16 more comments6Kristin Wisgirda what did you notice with the digital internship?NewJun 28, 2021ReactNice to see a number of you at the digital internship yesterday. I think it will be helpful to share what we saw Toby do that hemight not have articulated.Two things that I saw that I know are a regular part of his practice:Just after SI5 was inserted, he stroked the skin along the SI channel of the forearm with the ﬂow of the channel. I've seen him dothis with other points- giving a little extra push along the channel to emphasize the stimulation.Having the patient rest for 1 minute after the needles come out. Having the patient ease back into activity helps the patientintegrate the qualities added during the treatment.What else did you notice him do? ReplyTerri MatsonNewJun 28, 2021ReactThank you for pointing out those subtleties Kristin, i am excited to watch and listen to the recording again. It seems like listening acouple time to the recordings really helps me take in and untangle all that is happening in the moment. I've been re-listening to hisrecent 6 week class at White Pine, the notion of "principles" hit me over the head like a canon. Toby has talked about the Saamstyle and its inherent foundation resting on these principles, I didn't quite understand and it opened up a crack of light and couldglean a deeper understanding and not be looking, looking, looking... ReplyTuriyaNewJun 28, 2021ReactI thought that before treatment her face was a little pale....and made me think of LV+Spenta KandawallaKD+ and suicidalityNewJun 23, 20211ReactQuestion for teacherI was wondering, is suicidal ideation/ feeling suicidal enough to warrant a KD+ treatment?I've had two patients this week where that is the GTITR. One is on the table right now. The other did well with the treatment -- feltmuch calmer physically and emotionally. On both of them I could probably name 1-2 SI Excess signs besides that but it feels likemore of a reach. So, it made me ask the question. Thank you!

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2 teacher remarks2 replies 21 more comment1 ReplyKristin Wisgirda  NewJun 24, 2021 | Edited1ReactSuicidal ideation is enough to consider K+. Supporting SI excess signs help.I had a case of persistent suicidal thoughts that was well treated with SJ+. Though she had thinner heels, less than averagegrooming, K+ didn't help. With deep depression, H+ is also high on the list for consideration. ReplySpenta KandawallaNewJun 24, 20211ReactThanks Kristin!This is relieving and helpful to hear. I have noticed HT+ can be really helpful, especially because the energy is so low. Today HT+ ona patient who's on heavy anti-psychotics, which make her extremely fatigued, said she felt lighter and happier after HT+. That wasexciting!2 teacher remarksLijana ShestopalAbdominal LumpsNewJun 23, 2021ReactHello fellow Saam'ers!I have a case that I would like some clarity on. Pt is F, 40s, very active, always has a lot of things happening all at once. Very brighteyes, talks fast, very open. Thin arms and legs but abdomen feels loose and mushy. Pt noticed two lumps on her left side (oneright below ribcage, one close to umbilicus, all in one line), before that ﬁnding, she was very bloated and gassy which is undercontrol now. Had scans done, nothing found, dr said it is probably just gas. Pt feels cold most of the time,LOVES warmth, doesn'tsweat easily, dry skin, loose stools most of the time, anxiety is always on the higher end. Prone to dermatitis on the skin (comes onrandomly, itchy, red, burning sensation). I have done ST twice now, does not seem to make much diﬀerence (since the abdominalmasses I am assuming are damp and she has dry skin and a lot of resources), did not make much of a diﬀerence in the lumps(although sleep has been better). The loudest thing in the room is the very SJ excess but I am nervous of doing LV on her as shedoes like the warmth so much and didn't know if cooling her down would be a great choice. Also, since she is very busy all thetime, fast movements, I wanted to try SP but considering that her abdominal area is already exhibiting lumps, which I wouldconsider dampness, I am not sure if that would be a great idea. Any suggestions?Kristin Wisgirda NewJun 23, 2021ReactHello Lijana,Thanks for the case. To get more feedback, I would need to see your patient better. In this forum's instructions you will ﬁnd a linkfor the Case Study Format. It is also under the File tab on this site's home page. The process of using this format will help you andus see your patient better.It would help to know which channel(s) the lumps are on. Next to the navel sounds like Kidney, but if it is bigger could includeStomach. Other important information are the heels, varicosities, symmetry, thenars, abdominal midline hard/soft cold/hot. If a treatment didn't help the chief complaint in a clear way, thenit is a mistake to use it again at the next visit.

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2 replies 2Reply<lumps, which I would consider dampness,> It helps to remember this: Sometimes channel, sometimes quality.<The loudest thing in the room is the very SJ excess> And the lumps are on the left side. Hmmm.Looking forward to seeing the full case. Thanks!4 teacher remarks7 replies 7Nicole SharkeyQuestion about treating painNewJun 22, 2021ReactHello, I had a few questions come up while I was in clinic today and wanted to check in on them. When we are treating an injury with pain, am I correct in thinking that we are treating the channel that is In pain, rather than thechannel that houses the injury? Today I saw a patient with a rotator cuﬀ injury. I believe that the tear is on the small intestinechannel at SI 11, but the pain she is feeling is clearly down the LI channel, with some on SJ. In the patient above, I can see how a muscle tear could warrant the use of SI+ as it is a recent injury. At the same time, she is 63, abit disheveled -doesn’t take great care in dressing, has dry medial heels and has a tendency towards depression. If the channel iswarranted for the injury but there is a hx of depression and sx of KID xu, I assume I would want to avoid it?Thank you so much!Take care,NicoleReplyKristin Wisgirda  NewJun 22, 20211ReactGreat question.The channel location of the pain has clinical weight, along with that channel's counterbalancer.The channel of palpatory or observational ﬁndings has clinical weight, along with that channel's counterbalancer. If multiplechannels have pain, or in areas where channels cross over each other- eg the shoulder- I always palpate.<If the channel is warranted for the injury but there is a hx of depression and sx of KID xu, I assume I would want to avoid it> Maybe. Youmight also consider supplementing K+. Always consider the counterbalancer. A traumatic injury and signs of blood stasis haveweight for SI+ but you always have to evaluate the status of the Kidney like you have to be sure using SI+ would be safe.Kristin Wisgirda Buddhist Precepts ClassNewJun 21, 2021ReactIn conversations about how he would like to teach Saam, Toby often mentions his desire to spend more time conveying theimportance of cultivation.On July 8, he will be teaching a 2 hour class: Buddhist Precepts as the Basis for Professional Ethics

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2 teacher remarks1 reply 1Even though the teachings can apply to all professional ethics, this class is especially important for the Saam community as ourfoundation has a monastic tradition. My sense is that Toby will be at least partly drawing on the transmission that he receivedfrom his Saam teacher as well as by his study and practicing with other teachers.The class is 2 hours: 4pm-6pm EST. It is open to WPC members $30 and non-WPC members $40.https://reg.gosignmeup.com/s_reg/reg_registration_maintenance.aspx?ek=0078-0004-648e63334a2c4f97b34045b5b8cdf6dcHoping to see you all there. ReplyKristin Wisgirda  NewJun 29, 2021ReactI forgot to mention that this class satisﬁes the ethics requirement for NCCAOM recertiﬁcation and provides 2 CEUs/PDAsAs well, there will be an interactive component to the class including breakout rooms. ReplyMariaNewAug 05, 2021ReactDarn! I didn't see this in time. Is this class recorded?1 teacher remarkTuriyaVideo of Toby needling SI+NewJun 20, 20211ReactWhile trying to access the June10th Case Study Hour there was a brief passing image of a video of Toby needling SI+. I know Ididn't imagine this but have no idea as to how to access it. ReplyKristin Wisgirda  NewJun 21, 20211ReactThe videos of Toby needling are in part of the site separate from the case study videos.On the home page go to Files.Scroll down past the Case Study Format doc and you will see the videos. Enjoy!1 teacher remarkMariacontraindications for SAAMNewJun 19, 2021ReactJust wondering if there are situations when it is not appropriate to use SAAM, aside from not deﬁnitively identifying the pattern. Ihave a patient just two day out from the hospital, still feeling quite tired. Would it be OK to use SAAM on her?Kristin Wisgirda  NewJun 20, 2021React

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ReplyNot being to conﬁdently identify the pattern is the only reason why not to use Saam. Toby hasn't mentioned othercontraindications that I can recall.The perspective of another tradition transmitted via Dr Ed Neal is not to use acupuncture when the channels are empty becausethe patient is extremely malnourished. He recommends nutritional and herbal therapy ﬁrst in those cases. There are manyreasons to be very tired after hospitalization.1 teacher remark1 reply 11 more comment1Kristin Wisgirda Digital Internship with Toby 6/27NewJun 19, 2021 2ReactOn Sunday 6/27, you will get the opportunity to watch Toby in action in the clinic.This event is via Qiological. Register here: https://www.qiological.com/course/saam-digital-internship?mc_cid=1cf0974b7d&mc_eid=38b0c6d600It will deﬁnitely be worth your time.Saam Digital InternshipDiscussion of the critical observations skills required to assess how a treatment is unfolding in realtime.Source: https://www.qiological.com/course/saam-digital-internship Embedded File.https://www.qiological.com/course/saam-digital-internship?mc_cid=1cf0974b7d&mc_eid=38b0c6d600 ReplyMariaNewJun 19, 2021 | EditedReactThat's awesome!! Thanks for letting us know! ReplyMelissa RathboneNewJun 21, 2021ReactKristen,Do you know what time this will be held? I clicked on the link but it's just a form to sign up. Also do you know if it will be availablefor viewing afterwards if we do sign up but can't watch live? I know live is preferable but if it doesn't work out timing-wise I'd stilllove to see it.Thanks!

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2 teacher remarks2 replies 2MariaHeat waveNewJun 18, 2021ReactHi Kristin!Just wondering about the prudence of using H+ during a heat wave. Thanks in advance for your thoughts! ReplyKristin Wisgirda Jun 19, 20211ReactH+ can only be used very, very cautiously. I have used it for patients with air conditioner syndrome, where they clearly reportedfeeling the air conditioner was way, way too cold and then had symptoms like stiﬀ neck and sinus congestion.1 teacher remarkTuriyaClutter and SI ExcessNewJun 18, 2021ReactI've been wondering about clutter in one's enviroment as possibly being a reﬂection of a lack of consolidation.' ReplyKristin Wisgirda NewJun 19, 2021ReactSI excess is lack of consolidation of self not one's environment. If the person is falling apart in his/her person, then this couldexplain why he/she would have a hard time organizing his/her environment.I would look to other aspects of the patients presentation to explain why the patient has clutter.Adina KletzelLoss of identity without a jobNewJun 16, 2021ReactHII am treating a 42 year old woman who is going through chemotherapy for breast cancer.The tumor is on the GB meridian on the side of her right breast.Toby has said that it is good to explore what happened a year before the cancer arrived to understand possible imbalances thatarose.When I asked her what happened in her life a year before the cancer appeared she said that she left her job and took another jobthat ended up being terrible for her so she left that job too. Corona hit and she was out of work for over a year. She tried to go

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1 teacher remarkback to her ﬁrst job and they did not take her back. That made her doubt her self worth and her ability to perform well in the workplace.She also felt a lack of identity while out of work, did not feel good about herself and worried that she would never ﬁnd anotherjob. She was also stressed ﬁnancially.The day that she started at a new job that she liked she found out that she had breast cancer.Without necessarily going into the whole case I am wondering how others see this particular issue of hers.Here are the possibilities that I thought of:ExcessSt ﬁnancial worries 5+SI lack of self-worth 7+BL fear of not getting another job 6+Any other ideas? I am wondering if there is a more speciﬁc way of seeing lack of identity. ReplyKristin Wisgirda  NewJun 16, 2021ReactClassic lack of consolidated self is SI excess.Another possibility that might be related, beyond what you have mentioned: Excessive self criticism would be SJ excess.Marika ChandlerUnexpected side eﬀectsNewJun 14, 2021ReactThis is my ﬁrst “Saam gone wrong” case and of course it is with a highly sensitive, delicate patient that I very much want to help.Oy! It involves two channels as I have taken the advanced class but Kristen gave me permission to post it here,This patient is a 50 yr old female who is very kind, polite and sensitive. When she ﬁrst comes into the oﬃce she looks like a scaredbird, scattered and with slightly wild eyes. Her body is slightly damp and her skin feels and looks moist but she complains of a dryrash on her back. She is symmetrical (pretty) but has a large, very noticeable gap in front teeth.Background: She Found lumps in breast July 2020 (during pandemic)Double mastectomy, lymph nodes removed on both side, port on left side NOV 2020,Still undergoing chemotherapy - herceptin, she will take tamoxifen for the next ﬁve years.As a result of this diagnosis the patient experienced Extreme anxiety and “adjustment and dissociative disorder”. Severe insomniafor months. She already had a background and history of anxiety and insomnia but, the fear that came up as a result of thisdiagnosis sent her into a tailspin.When she tries to sleep she gets- Chills, shaking and then hot ﬂashes and sweats. When sleeping she will have a rush of adrenalineand twitch, this will wake her upFeels at times like body and mind are going haywire, diﬃculty settling. She is also a very light sleeper and her husband snores. Shewakes frequently at night to urinate.In past had panic attacks and didnt sleep for months. Insomnia oﬀ and on her whole life and worse since cancerRight now she is coming oﬀ of lexapro and gabapentin and she feels her body is detoxing.Gets disconnected from her feet, and feels ungrounded

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6 teacher remarksLife long constipationSome tingling in left hand , some fullness in left arm, Sp ch toe pain on left sideIn past, had Nose bleeds from dryness due to chemoMoisture is starting to come backTip of tongue feels sore, there is a small nodule on tongue tip and she has scallops.She lives in the same building that she grew up in (did not have a good relationship with parents) and she never really found afulﬁlling career path. She has been supported by her husband who she reports is “wonderful and very supportive”. Everything isbetter when she swims- it brings her a lot of joy. She is also very spiritual and is comforted by praying and meditating butsometimes struggles to make this a real part of her life.Treatments: The ﬁrst few treatments I gave her were not in the SAAM tradition and she responded well. She reported feeling “putback together” and more grounded. Her eyes also looked diﬀerent. Not so wild but still bright. She changed magnesiumsupplements a few weeks into working together and this spiked her anxiety and insomnia again. (She is very sensitive)After we had permission to do arm points from her surgeon I wanted to try Saam because I thought it would really help calm her. Ican see now that I made a few mistakes with this case.This is what I saw from a Saam perspective.When she tries to rest she gets chills, hot ﬂashes, and body shaking. - coupled with the insomnia - GB excessShe is VERY polite, temperature ﬂuctuates, belly overall is soft and warm but under the ribs especially right rib is very tight andhard, she seems very vulnerable and that she could use some shielding - SJ excessThe ﬁrst treatment I think I should have done PC right away but honestly I was scared to cause her pain and I thought the TonifyLiver treatment was indicated and easier to tolerate so I went with that. As I put in the Liver points in I thought “are her eyes dull?”And then I brushed it aside because I thought for sure they had been bright in the past and she had so many other Sj excess signs.After the points were in she said she felt a lot of “energy”, I checked in on her in 5 min and she said she was cold. I put a heat lampon her and thought about taking the points out and doing Tonify SJ but, I couldn’t see any LR exces signs so I thought. “Well, LR iscooling and she has had temperature changes during treatment before so let me add in Tonify PC on the other side.” To me sheclearly needed PC and it is ﬁre so I thought this would help balance. It did seem to help some and when she left she said she felt “alot of energy, like she had had coﬀee” . Later she wrote to me that her insomnia and anxiety was much much worse.The next time she came in she told me more information: her husband is addicted to day trading and doesnt want to do anythingelse. She cant get him to go out of the house with her unless its for one of her treatments. As she spoke I realized that her life feelslike a dark cave. She’s lonely, isolated, scared and feels she has lost her partner. She said she likes her apartment but not any ofher furniture that it is all uncomfortable. She likes things neat but she hates to clean. I started to see this depression and isolationand being trapped inside as Liver excess.Other important things are, a lack of self care: sometimes doesnt want to cook for herself or resists doing things she knows willmake her feel better. Urinates frequently especially at night. There seems to be a lot of longterm stagnation in her life. She hasnever really moved forward- moved out of her parents house or found her calling. She feels childlike in a way.** thank you for making it through this very long case. I look forward to any helpful thoughts and insights.

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 ReplyKristin Wisgirda  NewJun 14, 2021 | EditedReactHi Marika,Thanks for writing up the case. Please do the channel excess analysis- where you list all of the channels and assignsymptoms/qualities to the appropriate excesses. I see you did that for a few signs and symptoms but did not include Saam speciﬁcobservational ﬁndings, body type, skin, etc. Please rate the symptoms/qualities on a scale of 1-10+ with 10 being the mostextreme. This process will help you - and us- see the patient more clearly, especially aspects of her presentation that are mixed.When you have posted that here, we will take a look. Thanks! I know it is lots of work.<chills, hot ﬂashes, and body shaking. - coupled with the insomnia - GB excess> chills and hot ﬂashes are not related to GB. Whatchannel excesses have a mixed hot and cold presentation? It helps to review that basic Saam notes again and again and again.Marika ChandlerNewJun 15, 2021ReactThank you Kristin! Sorry for my disorganized presentation. I think this case rattled me a bit. Here is Take 2!Chief complaint: Severe insomnia- sometimes not sleeping more than a few hours for days on end. Severe anxiety anddisassociation. Shakes, tremors, hot ﬂashes and chills. These symptoms all go together and range from 5 to 9/10.HIstory: she has had these symptoms in the past but, is now heightened with cancer diagnosis and treatment.Appearance: neat but casual and not fussed over. No makeup. Symmetrical 7/10 but large gap in front teeth that is very noticeable8/10.Lifestyle: is a lawyer that doesnt work much or like her work, has struggled to ﬁnd her calling and path, never moved from buildingthat she grew up in. Leans heavily on husband who has become very distant and “lost to her”. He is currently obsessed with daytrading and doesnt want to do anything else. She seems very isolated 8/10. Has resources but is not ﬂashyBody: Slightly soft body, soft ﬂesh, hardness at midline and particularly underneath ribs, right ribs especially. Skin is moist but shehas had some dry rashes post chemo and some dryness in her nose which led to nose bleeds (this is better). No visible varicositiesBody temp: alternates wildly from hot to cold, hot ﬂashes especially at night but also during the day.GI: life long constipationSleep: history of insomnia and diﬃculty sleeping. Very bad this year with the cancer treatment. Will wake with rushes of energy(feels like adrenaline), she will also have chills shakes and tremors at night when trying to sleep.Emotions: Severe and debilitating anxiety and a sense of disassociation. Extremely sensitive (changing the type of magnesium shewas taking made her body feel haywire), childlike quality, apologetic.Urination: wakes at night to urinate, urinates frequently during the day 6/10GB Excess- extreme insomnia and sleep anxiety, shaking, tremors at night, body going haywire. 9/10Sj Excess- very polite 7/10, temperature ﬂuctuations 8/10, seems very vulnerable and in need of shielding 7/10, likes things neatand little things bother her 6/10, under the ribs is tight and hard 8/10, self critical and very spiritual 7/10, eyes can be bright 6/10KD excess - Had major surgeries in the past year could have som blood stagnation as a result (doesnt complain of pain,) doesmuch better with movement and swimming 8/10, seems to have a lot of stagnation in her personal life 8/10. She is symmetrical6/10SI excess- lack of self care (sometimes wants to take care of self and sometimes is just over it, doesnt want to feed herself) 6/10,seems to lack self love and self conﬁdence, childlike 7/10, large very noticeable gap in teeth 7/10.HT excess-nodule on tip of tongue and tongue tip can feel raw at times 5/10 anxiety? (Not sure if this is a HT excess)LR excess- home environment feels very cloistered and small, husband doesnt want to leave house, she feels isolated 8/10, shedoesnt like to do any house work or improve her home even though “all her furniture is uncomfortable”. Eyes can be dull 5/10

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3 replies 36 more comments6ReplyUB excess - fear about the future and about death, fear about the treatments she has gone through and needs to continue with8/10, frequent urination 7/10, tight midlineSP Excess: slight damp body type with moist skin 5/10, Sp channel foot pain on left 3/10LI: Constipation?PC: Has a librarian personality type, cant imagine her exploding with angerTreatment:Patient responded well to non-saam treatments.First Saam treatment I did : Tonify LR on Right- patient said she felt “a lot of energy” then she said she felt cold.I added Tonify PC on the left. Patient seemed more balanced after but contacted me the next day and said she hadn’t been able tosleep and that she was back to having severe anxiety. Her chief complaint was back to a 9/10** I gave her this treatment before I knew about the patient’s home life (the isolation and the husband that is not present andwont leave the house). I think she spends a lot of time at home with no other outlets except for swimming now.1 teacher remarkMelissa RathboneConfusion re: the Grossest thing in the roomNewJun 14, 20211ReactHi Kristin!As I am trying to assess my patients, I'm ﬁnding that I often get stuck at identifying the grossest thing in the room. Sometimes it'squite obvious but, in those cases where it's less so, I'm not sure what to go with... It seems like a key component for diagnosis andtreatment and yet also seems so open-ended in terms of deﬁnition that when it isn't obvious, I don't quite know what to do.Can the grossest thing in the room be the chief complaint even if that isn't visible? For example, insomnia or irregularmenstruation? Or is it usually something you see or sense from being in the room with the patient, separate from what they arereporting? I'm feeling at a loss when there doesn't seem to be anything particularly "Gross" in the room and it seems tooimportant to the Sa'am system to skip over that part of the analysis. How do you make that assessment?Thanks for your help!Kristin Wisgirda  NewJun 14, 20212ReactHi Melissa,This is a great question. The grossest thing in the room (GTITR) is so important for Saam practice.<Can the grossest thing in the room be the chief complaint even if that isn't visible?> Yes. Or something that is not a complaint buthaving a major impact on health, ie severe insomnia, prolonged bleeding, inability to swallow, etc.It can also be something that they aren't reporting. In this case it is often a quality- sooo pretty, such dense ﬂesh, sooo loving, suchdry skin, etc.The grossest thing can be pretty subtle in healthier patients with more balanced channel pairs. In these cases you might morestrongly consider the chief complaints and the qualities of the chief complaints since these are what is driving the patients to youroﬃce.

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ReplySometimes GTITR is a top 3 -5 list, either because they have so many gross things or not enough gross things.Really the question is what stands out to you.ReplyMelissa RathboneNewJun 14, 2021ReactThanks Kristin, that's very helpful! Really appreciate it.Kristin Wisgirda Bad teethNewJun 12, 20211ReactThe recent case study call brought up a question about tooth decay. So I asked Toby to be doubly sure.Adina wondered if tooth decay could be a sign of inner dampness and belong to either Lung excess or Sp excess. Myunderstanding was that the symptom of weak teeth is speciﬁc to Spleen excess theorizing that the kind of damp that rots the hardteeth has to be double damp.Toby agreed with my analysis and said "Yes and a little bit of heat with Sp excess."I had a 76 year old patient report that she had most of her teeth pulled as a teenager because of extensive tooth decay. She insiststhat she had good daily dental hygiene, rarely ate sweets and was not overweight as a child. I believe her. Her dentist told her thatit was stress related. She was a victim of molestation at an early age. So I asked Toby: Is it possible that tooth decay can have otheretiologies in Saam? (I can imagine SI and SJ excesses contributing to loosening of the teeth but not necessarily decay.)Here is his response:"These are a theoretical stretch but -Like you said, SI excess could loosen them. I think the relative deﬁciency of Kidney vitality and its relationship with bone could actually cause tooth decay.Stomach deﬁciency - under nourishing its channel trajectory could do it.Ht excess could "melt" the teeth, etcAgain, Sp excess is your far and away primary causative factor." ReplyAdina KletzelNewJun 14, 2021ReactThanks so much for this clariﬁcation!Adina KletzelCase: strong pain radiating down right legNewJun 10, 2021 | EditedReactThis post was administratively edited at 06/11/2021 9:53 AM66 year old maleMC: sharp, burning pain on Liver, GB, ST, and BL meridiansAnd LI back shu on lower back. Rates it at an 11Cannot stand up on the legWhen tried to put pressure on the leg the muscle starts to vibrateHe is stuck in bed

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Started 2 months ago - he bent down and felt a strong pain in his lower backMuscles went into spasm.That lasted for a month. Slowly go better.A week ago was in a restaurant. Sat in same chair for two hours and when got up back hurt.Now back does not hurt but it is radiating down his legsIt is a constant painSC: Bladder burns when urinate. Has been like that for 10 years; some blood in the urineAppearance and DemeanorThin, thin arms and legs but legs have some muscles to themWhite beard, soft spoken, polite 7+, eyes dull 2+, wears glassesDoes not express emotion, Appears calm but says that he is stressed insidefocusedToe nails are all yellow and misshapen from fungusLifestyle: Married with 4 grown children, Works in hi tech, Has resourcesLikes to ride his bike a lot,Rides 2-3 times a week; Likes movement and likes to be outside in natureBody morphology and ﬂesh quality: Skinny, Flesh is ﬁrm, not dry or moist, Flesh is not denseMedial heel – more dry 5+ thin (not ﬂeshy) 5+Bottom of feet, sides of feet, toes dry skin 7+Line from sternum to umbilicus soft, and bit warmInﬂated chest 3+Body tempDoesn’t hate the heat or cold; But heat bothers him moreGI: RegularUrination: Hot pee, Burning with urination, Some blood in urine, Prostate is enlargedHas some inhibited urinationEmotionsOptimistic; Holds emotions in, Stressed insideHas a good attention spanCares what others think of himWorks well under pressure; Likes to be busy; An achieverSocial but likes a small intimate group not a big crowd

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Brother died from cancer 6 months ago. Still holding that inside of him.AssertiveCan get angry but not strong bursting out angerSleep: Is a light sleeperSleeps and wakes up and has to read to fall back asleep; Many thoughts at night when wakes up; Ends up sleeping only about 5hours a nightSurgeriesAppendics takes out at 2 years old2 hernias 10 years agoTng: Lots of cracks all over and on sides; Purply; A bit red; Coating a bit peeledHt burning while peeing 8+ burning pain on thigh 8+ racing thoughts at night 7+ soft CV line 5+GB insomnia 8+ assertive 7+ gets angry 6+ some pain on GB mer. 5+Kid 2 surgeries loves movement 8+ symmetrical 7+ pain of brother dying inside 6+ fertile 7+ athletic 7+SI 67 medial heel thin 5+SJ notices details 5+ strong focus 6+ polite 7+ pain on Liv mer 10+ doesn’t like large crowds 7+ spasmy muscles 7+ very stressedinside 7+ more optimistic 6+LU has lots of energy 8+Bl very frq urin. 7+First treatment: Bl+ (L)Yesterday had no pain when lying down. Only had pain when got up to go to bathroom – then it hurts on Liv mer.. slept on rightside and woke up at 11:00 with pain that moved to St and GB meridians. That pain now burns all of the time strongly. Last nightfell into ﬁrst deep sleep that had in a while but got up 2 hours later from pain.Second Treatment: Liv +(L)Some pain on Liver meridian came back. Still can’t walk. Pain on GB and ST meridians got worse.There are 4 considerations for the next treatmentSI+ - for the intense pain, and other Kid excess signsPC+ for pain on GB meridian, he says he is assertive and gets angry sometimes but he seems more grounded and rooted to me.Although he also does not sleep well.St + for strong pain on ST meridian, dry skin, inhibited urination (that = damp)He is skinny though and his tongue is so cracked and a bit peeledSp+ strong pain on LI back shu and he is more of a LI excess body morphology and personalityBut the inhibited urination makes me hesitate to tonify Sp.Bl+ really brought good results and I should probably go back to it at some point but I am thinking to do SI and then PC beforegoing to BL+.

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8 teacher remarks3 replies 3I would love to hear what you think. ReplyKristin Wisgirda  NewJun 11, 2021 1ReactThanks for the case. (I edited the formatting to reduce the need for scrolling)Was the Liver+ treatment aggravating or just not helpful? It sounds like the pain changes so it is hard to tell. Since maybe Liver+wasn't a great treatment, it might help to look back at the SJ/Liver balance and see what is there.<SJ notices details 5+ strong focus 6+ polite 7+ pain on Liv mer 10+ doesn’t like large crowds 7+ spasmy muscles 7+ very stressed inside 7+more optimistic 6+> Some of these qualities I wouldn't weight to SJ excess- optimistic, doesn't like large crowds, spasmy muscle,stressed inside. I would want to be sure that the noticing detail and focusing is outward oriented. It would help to include that hisﬂesh isn't dense and then note for Liver excess that he has dull eyes.P/GB looks like a mixed picture and not the biggest imbalance. If pain is disturbing sleep, then I give insomnia less weight for Gbexcess.Stomach/Lung: Did you look at his thenars? The pain is on the right and the pain is on the St channel among others- so it is goodto look at the balance of this pair. He is a mixLung excess: inﬂated chest, good resources, good energy, dry skin (but skinny)Stomach excess: soft voice, skinny (but dry skin)I have used SP+ for inhibited urination before, so if it is true that inhibited urination= dampness, in my patient the dampness wasdue to dryness.His morphology sounds more like LI excess- dry skin and skinny.Is his tongue "sliced", appearing as if freshly sliced by a razor blade. if so, this ﬁnding points to Taiyang ﬂuid deﬁciency andsupports the use of UB+ or SI+ (and maybe Sp+).<Kid 2 surgeries loves movement 8+ symmetrical 7+ pain of brother dying inside 6+ fertile 7+ athletic 7+> Toby has mentioned that henotices that people who were athletic in high school tend to be Kidney excess but this is a rock level teaching. Being athletic couldalso be a GB excess move the body out into space. So I wouldn't weight athleticism only to Kidney excess. The pain of his brotherdying I wouldn't ascribe to Kidney excess, unless every time he thinks of it he feels a sensation on the K/Si channels or has sometrue physical pain. The association of emotional trauma and Kidney excess is really weak.My vote for the next treatment would be for SI+. The pain is a huge factor and he has enough Kidney excess signs to warrant it.If he is really skinny and dry, my #2 option would be SP+.Let is know what you think and what you do. ReplyKristin Wisgirda  NewJun 12, 2021ReactAny change with his urination after SI+?<SP pain on LI back shu 8 skinny and normal skin 6 pain on SP mer.> So his skin is normal, with easy sweat and not dry? How skinny ishe?Cloudy urine is for sure damp, inhibited urination maybe not so. Si ni san has helped cases of inhibited urination and that doesn'ttreat damp.A pocket of damp can be treated by moistening if the background is signiﬁcantly dry- like a turbid puddle where a river used to beﬂowing. Restore the ﬂuids and the turbidity goes away.My patient whose inhibited urination was helped by SP+ also had painful and somewhat dark urine + moderately dry skin, severedry eyes, dry mouth, neither hot nor cold and slightly overweight. She has a signiﬁcant colder personality so I didn't want to pourice water on her.I am not sure about SP+ for this fellow now.

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4 replies 46 more comments61 teacher remarkFang CaiGB vs P - clarity from patient's wordsNewJun 10, 2021ReactI was having trouble ﬁguring out a GB vs P excess dynamic today. I knew that was the pair needing treatment b/c of pain at UB14radiating to GB20.P excess: cerebral thinker, pain worse after verbal abuse by ex-husband in front of kids; body feels puny and unstable since caraccidentGB excess: tight chest/can't get deep breath, is able to stand up for herself in divorce proceedings (but ﬁnds it exhausting); despitepain, has a strong athletic body; UB14-GB20 pain feels inﬂamed with an up and out feelingI was already leaning toward doing P+ after hearing about the tight chest, then she said, "In ﬁght or ﬂight, I would ﬁght."30 sec after all 4 needles went in, her breathing opened and pain disappeared. amazing. ReplyKristin Wisgirda NewJun 10, 2021ReactAwesome! Even if she didn't just oﬀer up the clariﬁcation, her words must have been believable.Adina KletzelCase: Cough, Phlegm, chest painNewJun 09, 2021React45 year old femaleMC: coughing, phlegm in lungs, feel pain in lungs, and under heart, and in back by lung area – BL 13, when cough it hurts more. 7-8 years ago used to get pneumonia oftenSC: feeling a lot of stressAppearance and demeanorOverweight 6+ neatly dressed 7+ symmetrical 6+, didn’t stop talking 8+She came in a within 5 minutes I already knew that her marriage was terrible, she wants to divorce her husband, what she doesand how many kids she hasShe just kept on talking without stopping.LifestyleIs a therapist for 3 dimensional therapyHer husband is a very angry person who is constantly criticizing her and yelling at her and her kidsShe used to get angry back and get very upset and insulted and then she went for treatment and now she lets most of it go anddoes not take it to heart

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But she still has a very hard time and would like to divorce him but was advised by someone she respects not to…Intuitive 7+ connected to herself and her emotions 7+Is mostly a positive and loving person but has a hard time due to her marriageShe used to go out and release stress with her sister who she was VERY close to but her sister suddenly dies 2 years agoHer best friend also went through some kind of break down and does not talk to her anymoreHer sister-in-law is too busy to spend time with herShe feels she does not have the support and resources that she needs 7+Likes when house is neat 6+Body morphology and ﬂesh qualitySkin is regular 7+ ﬂesh on stomach is soft and ﬂabby 7+ ﬂesh is soft but not mushy on rest of body 7+ thenar eminence is ﬁrm 6+inﬂated chest 6+Would very much like to lose weight. Does not like that she is heavyShe says she does not eat much and can’t lose weightBody TempNot signiﬁcant either wayVery cold if AC too high. But otherwise not too hot or too coldGITrouble losing weightCraves sweetIF eats sweet then gets itchy eczemaTeethHas problems with teethJust did a root canal on top and bottom of left side of mouth. Still hurtsCough and phlegm started after that treatment – was frozen in fear from treatment and body was stiﬀ and tense for whole hourof dental work. Was in terrible pain for a couple of days after dental work.EmotionsAnger at husbandStressed from living with husbandSad, hopeless, frustratedFeels like has a lot of suﬀering in her lifeTalkative, easy to reach,Loves to singtold me everything about herself, barely let me speak and ask any questionswent way over the time and did not apologize.Kept asking me questions even after I said that I had another client coming

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Wanted to know exactly how much other acupuncture points would hurtWants to bring numbing cream for the acupuncture next timeWanted to know exactly what I saw on the pulse and tongueAsked me for coﬀee during the treatmentTongueThin, thick coating esp in LW,tip is redGB gets angry 7+ emotional 7+ assertive 8 very pushy 9+Ht talks a ton 7+ warm and friendly 8 likes ppl 7 loving 8 wants to connect to ppl 7SJ likes it neat 7 very easy to reach 8 strong intuition 7 left sided issues 7 concerned about details 7Liv not respectful of my boundaries 8+ (went way over time and did not stop talking when I said another client is coming in)SP weak teeth 8 loves sweet 7LU likes to sing 7 inﬂated chest 6+ damp on inside, neutral on outside 8+ weak teeth 8+ ﬁrm thenar eminence 6+ pain in lungs 7+pain by LU back shu 6+Kid cares about herself 9 ﬂeshy medial heel 8 holding onto a lot inside 8SI had fertility issues, needed help having her 3 kids 6+St trouble holding onto resources – people 7+ pain in lungs 7+ pain by lung back shu 6+First treatment: did ST+ (L)Reasoning:has phlegm in lungscoughingProblems with teethWet on inside and nothing sig on outsideLU 10 is ﬁrmChest is inﬂatedEven with her lack of people resources she still seemed inﬂatedShe was energetic, talkative, seemed very strong and connected to herself and her own resources.She settled on the table. At the very end of the treatment she said that her left hand and foot – where the needles were got numb.That went away when she moved it around after I took the needles out.The next day I texted to ﬁnd out how she is doing and she said that she feels terrible, her lungs are full of phlegm, it is hard for herto breathe, it hurts when she coughs, she can barely talk.I told her to go check with the doctor to see if she has pneumoniaBUT – is it possible that she needed LU + and this is an adverse reaction???

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2 teacher remarks3 replies 34 more comments 4WE know for sure that the treatment did NOT help but she seems quite far from a LU excess (Except for the lack of peopleresources) that maybe the treatment just did not help and her condition developed into pneumonia -which she is prone to getting.Is this a case where I should oﬀer her to come in and do LU+???In any case I don’t think she would even allow me to put the LU+ needles in but I still want to know what you think.Is it at all possible that her presentation could be a St excess and not a LU excess?Could it be that the lack of resources from the people around her overrides her whole physical presentation?Should I have done LI+ even though we were dealing with a respiratory issue?Should I call her back to do LI+?Thanks for your help.ReplyAdina KletzelNewJun 10, 2021React@Kristin WisgirdaThank-you so much for reviewing this case on the Saam Case review hour. It was very helpful! I will let you know if she comesback.Kristin WisgirdaReplyKristin Wisgirda  NewJun 10, 2021ReactToby took a look at the case and agreed with our interpretation. Here is the conversation. Toby is in bold italic. I am in bracket <><My thinking is that it was not a true adverse reaction- the patient stopped talking and settled somewhat during treatment.>Agreed.<I posit that the addition of dampness from ST+ was aggravating instead. Deﬁnitely wouldn't want to add more internal dampness to her. LI+seems the better choice- her skin is relatively moist when the rest of Tel Aviv is dry and then there is the weak teeth.>Deﬁnitely.<The other strong choice is using P+ for her aggressive display of emotional intensity.>Very reasonable.Adina KletzelGB excess client requested numbing ointment for acupuncture pointsNewJun 08, 2021ReactHI,I have a GB excess and Kid excess client who requested that I put numbing cream on the points before I insert the needle. She isvery concerned about the pain and says she is very sensitive to pain.

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4 teacher remarks1 reply 17 more comments 7Has anyone ever used numbing ointment before? Can I use it for her? Will it interfere with the eﬀectiveness of the treatment?Thanks ReplyKristin Wisgirda  NewJun 08, 2021ReactHi Adina,Sorry I can't be of help. I have no idea.Is there even a readily available numbing topical that works quickly? ReplyNaomi FrankNewJun 08, 2021ReactYears ago our paediatrician oﬀered a numbing cream to apply before vaccinations. Gave us a little sample pack. It was neveroﬀered again, I guess the pharma rep only brought it the once!Fang CaiVulvodyniaNewJun 06, 2021React42yo womanChief complaint: vulvodynia began 2004 unknown reason, perhaps post-yeast infection. Flareup ~Feb 2021, also no speciﬁcreason. Rx lyrica, Cymbalta, amitriptyline to help manage.Daily burning pain 3-8/10, best in morning, worse as day goes on; ww sitting; stress eg kid chaos, computer work. Worse duringluteal phase. Can be soothed by ice pack or warm bath.Pain at vulva, perineum, when bad has zappy burning go up sacrum/lumbar spine.Vulvar area is slightly red/inﬂamed. No discharge. Does not want to have sex d/t pain.Appearance and demeanor: gorgeous 10+ blonde with pristine sculpted short haircut, light tasteful makeup, neatly andfashionably dressed (but not designer/ﬂashy). Polite 7+, reserved/cool aﬀect 8+, good reporter 9+, analytical 3+, bright eyes 9+;light movements 6+; hard to assess facial coloring d/t makeup and mask.Lifestyle: self-conﬁdent 8+ yoga teacher with successful online following. Married, 2 kids, some stress around marriage andparenting; adequate ﬁnancial resources; one time, when went out to dinner and was surprised by prix ﬁxe price of $120àhadimmediate vulvodynia ﬂare (but after discussion we think this is more d/t lack of control rather than money issue). Discussions re:kids are more around stress/overtaxed than gushing/love.Body morphology: thin and lean but light tissues 4+, soft midline 4+; full medial heels 6+, thenars average, little/no varicosities,empty low abdomen 5+Skin: unremarkable.Temp: tends to cold esp hands/feet; n/s with heat during luteal phase; but vulvodynia feels hot.GI: history/tends to constipation, bm 3-4x/d, can be dry, incomplete. Reﬂux w mucous in throat bw reducing dairy and gluten.Appetite, thirst, urine average.Head: temple and occip pressure h/a 1-3x/wk.

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4 teacher remarksEyes: light sensitive 6+, poss med-induced aura w light ﬂashes, blurry vision. No ﬂoaters.GYN: 2 kids born via c-section, easy fertility, 1x post-partum uterine infection. Regular cycles light menses no pain, bright red ﬂow;PMS irritable, overwhelmed, 1-2x soaking n/s. Low libido 7+Sleep/EMO: light sleep, tends to anxiety/overwhelm, uses klonopin prn 1-4x/week. With anxiety feels energy going upward.Tongue: pink sl pale, sl swollen, thin white coatExcess presentations:HT: soft midline 4+; burning pain esp sacrum/UB chan 3-8+UB: reserved cool aﬀect 8+, tends to coldP: temple and occip h/a; analytical 3+GB: temple and occip h/a; energy goes upward w anxiety 1+SP: n/aLI: thin morphology, thin strong armsLU: lack of descending in bowels 3+, reﬂux/throat mucous 1+; energy goes upward w anxiety 1+ST: thin morphology, lack of resources (childcare, pain w seeing $120 dinner) 1+KD: symmetry 10+, grooming 8+, self-conﬁdent 8+, easy fertility, vulvar pain ww sitting 5+, ww luteal phase 5+SI: low libido 7+, lack of varicosities 4+, no dysmenorrhea 9+, empty low abdomen 5+LV: vulvodynia on LV channel 10+; hot/coldSJ: Polite 7+, good reporter 9+, bright eyes 9+, pays attention to dress/details 10+, light sensitive 6+; vulvodynia on LV channel 10+,light tissues 4+, light movements 6+, hot/coldMost standout aspects: cool and polite in expressing frustration with long-standing vulvar pain.Main treatment ideas: R LV+, R SI+, R P+, (HT+/UB+ toggle)Treatment 1: R LV+Settled well. At next week reported pain improvement: reduced intensity, onset later in day/a couple days not at all.Treatment 2: R SI+Settled well; unremarkable, pain went back to original baseline.Treatment 3: R LV+Waiting to see resultsMy questions:1. I was surprised SI+ didn’t do much for her. Since she has such light menses, and positive response to LV+, should I consider doing LV+ with SI+? Or, sinceSI+ didn’t do much, just set that aside for now?2. What do you think of UB+? I would like to do it for the burning pain, but her tendency to cold and cool demeanor give me pause.3. I’m having a hard time ﬁnding other treatment ideas. Any input appreciated. Thank you!

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8 more comments 8 ReplyKristin Wisgirda  NewJun 06, 2021ReactHi Fang,Thanks for your case. Though she says the onset of the vulvodynia had no clear cause, I would ask again what was happeningaround the time of onset.BTW: Toby considers the vaginal more exterior but not deﬁnitively exterior.Any vaginal dryness? I would add dry stool to her LI and ST excess lists. My leaning is to consider SP+ over Lung+ because there isa clearer imbalance in the LI/SP pair and I wouldn't want to dry out her exterior or give her more up energy.Unremarkable skin on a person with impeccable grooming certainly could be dry. Sometimes questioning a patient can be tricky. Iused to ask patients if they use moisturizer. Then I had a patient say No to moisturizer. When I asked her again later she said sheuses oil not moisturizer. Jeez! Now if they have pretty good skin, I tell them so and then ask for the secret. It helps to be a lady.:)Consider the path of the Gb primary channelSeems like she could be a little more Gb excess than P.Other primary channels that go to the genitals are the Liver and the Du. Toby teaches that primary channel trajectories haveweight in Saam. Even so, in challenging cases I sometimes like to see which secondary channels pass through the problem area. Inthis case SP sinew, K sinew, Liver sinew, Liver luo, (St sinew binds in the pelvic region above the genitals)Since SI+ didn't help, I wouldn't repeat it any time soon even though she settled. She is a mix of SI and K excesses. <Should Iconsider doing LV+ with SI+?> No, bilateral treatment with a channel that didn't make any change in her symptoms is not a goodidea. There are plenty of other options to consider ﬁrst.She has such a mix of UB and H excesses but <Most standout aspects: cool and polite in expressing frustration> Before doing H+ orUB+, I would reevaluate the P/Gb and SP/LI pairs.Please let us know what you think, what you do and how she responds. Thanks!Circles the genitals, runs along margin of pubic hair, enters deeply to emerge at bailiao/sacral foramina meeting Ub channel and Du1 ReplyFang CaiNewJun 06, 2021ReactThanks @Kristin Wisgirda that is SUPER helpful. I'll check in more on:-onset-skin care - I'm fairly sure she said no lotion but I'll check on oils : )-no vaginal dryness but will consider SP+ if it seems a general softening/acceptance is needed-P/GB dynamicand will report back. thanks!Kristin WisgirdaNaomi FrankSI/Kid toggle and mixed responseNewJun 05, 2021ReactI used SI+ a couple of times on a 65yr old Kidney excess patient complaining of tinnitus, chronic allergies/sinus congestion, andchronic headaches mostly GB/UB channels. She is the kind of person who will come in and say what's really bad and sometimesforget about the other complaint that improved. She's not super negative, just quite focused on her symptoms.

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2 teacher remarksThe SI+ were several weeks apart and the 1st time was with thin needles, but seemed to help, 2nd time the tinnitus diminished fora few days. Her morphology is quite Lung excess and allergies/sinus has responded well to St+, which was the most recenttreatment I had done.When she came in with allergies better and tinnitus worse, I tried SI+ a third time. She called me over and said she felt oﬀ andunsettled, so I removed and needled K+. She settled deeply and said the treatment felt good. But the correction might have been alittle past the 10minute mark, because I had been with another patient in the meantime.At her next visit after K+ (4 days later) she said she'd felt a bit oﬀ and not quite herself since the acu. She almost cancelled herappointment for her second vaccine but did go ahead - day 2 after acu. Headaches were the main problem, but allergies and andtinnitus were both present as well. Some of that could have been from the vaccine, but I wondered if the SI+ eﬀect had lingeredand caused the worse days.This seems to be a patient for whom I can "spin the wheel" a little bit but doesn't seem to make that much headway. This could bebecause of a stressful job (this is the same person I mentioned in my other post about real time response to P+), and partly theway she reports symptoms.Are there indications that lead you to the SI/Kid toggle? I still don't see any SI excess for her really, but I understand hypotheticallywhy you wouldn't want to keep doing SI+ even if doing other treatments in between. ReplyKristin Wisgirda  NewJun 06, 2021React Being 65 years old she is past 7x7 cycles. She also had an adverse reaction on the tablewhich was immediately relieved by K+.(1/2 dose of SI+) + (a full dose of K+) + the vaccine= lots for her body to metabolize. From what you have written, my takeawaywould be that her body is telling us that she was SI excess at the time of that treatment and that I am unsure about the restincluding whether or not the SI excess had been fully balanced out by K+.If you did SI+ 3 times in a row, without any other Saam treatments in between, just a reminder that this is risky and not typicallyrecommended.<Are there indications that lead you to the SI/Kid toggle?> It is a simple and as complex as SI and K excess signs that are relevantto the chief complaint.Naomi FrankNewJun 06, 2021 | EditedReactIf you did SI+ 3 times in a row, without any other Saam treatments in between, just a reminder that this is risky and not typicallyrecommended.This was not the case, but I did go through all my treatments and saw that 1 week between SI+ treatments was likely too close. I'dthought I was proceeding cautiously with everyone but looking back that probably would have been a good day to do anotherbalance treatment. She is quite excited about SAAM and the stronger eﬀects, and I think I went back to SI+ as the one that had hadthe most eﬀect, without thinking about the actual date. And in this context perhaps the counterbalancing just happened a fewminutes too late. It makes me think that what I've written up below could be a good practice to do with patients like this, to keeptrack of the eﬀects. (I ﬁnd my EHR charts can be quite cluttered) I guess it's also unusual that she comes 2x per week for such aconsistent stretch.My treatments were:3 April SI+ (0.20 needles) - good result but short lived6 April - Balance acu13 April SI+ #2 (with 0.35 needles) - good result -11 May - Balance acu

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1 teacher remarkNaomi Frankvery obvious response to P+ in real time!NewJun 05, 2021ReactI had kept P+ in my back pocket for a patient who was coming mainly for tinnitus and allergies but also gets very regularheadaches involving GB channel, and joked that she's known for 'boiling over' at work sometimes.She had come in jovial as usual, but frustrated about work as she has a big event coming up and everyone had been given a 'downday' which she felt was unproductive. After I placed the needles for P+ I chatted with her for a few minutes so I could keep an eyeon her. I haven't yet done this, as I usually have to get ready for the next patient ( I can observe from a distance as I move aroundthe space.) Almost immediately she said that it had been a really rough week at work due to grief - this was in fact why the downday was given. I could almost see her perspective changing as the exterior shell gave way to the interior recognition of thiscollective burden. She'd been struggling as well but her way is more to battle on. ReplyKristin Wisgirda NewJun 06, 2021 | EditedReactThanks for sharing your observations.<chatted with her for a few minutes so I could keep an eye on her. I haven't yet done this, as I usually have to get ready for the nextpatient> Practicing Saam safely for all of us newbies, I highly recommend keeping as close an eye as possible on patients, notnecessarily chatting with them but checking in to make sure they are settling. If I am not sure if a patient is settling, I often check inon them after 3 minutes, no more than 5 minutes.I just read your other post. Sounds like she is clearly Gb excess with lots of upper and out symptoms. I suspect the down and in ofP+ will help her. Please let us know.2 teacher remarksMariaShielding v. Being OpenNewJun 04, 2021ReactHi KristinI am getting a bit confused about shielding v. being open. For a patient who is constantly diverting the conversation away fromherself would be considered shielded, LV excess. However, I am confused because maybe she feels too vulnerable and too open,so she is actively engaging in self protection which would point to SJ excess. I would appreciate some clariﬁcation on this. Thankyou so much!! ReplyKristin Wisgirda NewJun 06, 2021ReactIf you are trying to determine if a behavior is true to an excess or a protective compensation, it is best to look at other aspects ofthe presentation.<diverting the conversation away from herself> A variety of excess can lead one to divert conversation away from oneself. SIexcess lack of interest in oneself, H excess love of others, Gb excess erratic attention. And yes- Liver excess doesn't share easilyand may not really be hearing your questions. And yes SJ excess can at times divert attention elsewhere to protect. Probablyothers too.

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2 replies 21 teacher remarkNaomi Frankassertiveness/reactivity: when and how?NewJun 03, 2021ReactThis q comes up for me as I lean into the P/GB dynamic.I think it's common that people are much less restrained with their families. So I imagine plenty of people who might expressanger or be more volatile/reactive in the safety of home but never do that out in the world. How do we interpret this?Interested in anyone's experience with this.ReplyKristin Wisgirda  NewJun 03, 2021  2ReactThat is a common mixed picture and really important to keep in mind when we treat this pair. This is why we have to try to gaugethe patient's capacity to be volatile outside of our clinics.Volatile at home: GB excessRestrained elsewhere: P excess.I had treated a patient with GB+ 2 or 3 times with good results for his back pain and sleep issues. His wife was also coming fortreatment and let me know that her husband was getting unusually irritable. Time to back oﬀ! He was not a great reporter so I amthankful his wife was coming in.1 teacher remarkGabriel Sternanyone in Austin, TXNewJun 03, 2021ReactHey there,wondering if any of you are in Austin. I have an old friend living there who has been ill for a while. I had a chance to see and treather when she was passing through town last week. She responded very well and is interested in continuing Saam style treatmentbut is unfamiliar with the acupuncturist in her area.please let me know if you're in Austin or if you know of anyone practicing Saam in that area.thanksGabe. ReplyKristin Wisgirda  NewJun 03, 2021ReactJoanne Tait has studied Saam and is also a GMPer.Practicing at a community clinic, the Neighborhood Acupuncture Project (512-473-8884), or private sessions from my home oﬃce.Joanne 512-230-8350

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ReplyGabriel SternNewJun 03, 2021Reactthank you. I'll pass it along4 teacher remarksMarika ChandlerAllergiesNewJun 02, 2021ReactHi! I am hoping that you can share some thoughts or insights about allergies. I know they can manifest diﬀerently for variouspeople but, i have a speciﬁc patient in mind.With allergies (to pollen, grass, trees etc.) she can get a clear runny nose, sneezing, itchy eyes, swollen eyes, hives (swollen), and adry tickly cough. To me this sounds like a lot of wind with some dampness (her body is slightly damp and skin seems moist).So, right there, I am thinking to supplement SI and LI. My reticence to do SI comes from the fact that she gets body pains thatmove from one part of her body to another (sometimes same local for a while) but, she feels that her body is not integrated, that itdoesnt work in unison. After supplementing PC and LR (she has incredible insomnia and very bright eyes) she has felt much moreintegrated. And grounded in her mind (her mind spins and spins on many things at once- she is great at multitasking until sheliterally falls apart)I did a supplement KD treatment on her (she is 5/5 symmetrical, slight dry heals and feels Un-integrated) she responded well, notamazing, some of her pain cleared and allergies did kick up after. I guess I’m looking for some reasons why I should or shouldn’tsupplement SI. I think its hard for me to hold the dichotomy of SI helping chaotic wind settle (when it’s quality is so moving). I’mconcerned that it will not help her to feel more integrated and settled. Plus there could be something else that I’m missing or notseeing.Thank you :)ReplyKristin Wisgirda NewJun 03, 2021 | EditedReactThanks for your case.Given her response to P+ and Liv+, the unintegrated feeling is multifaceted. Did K+ help her with this?<5/5 symmetrical> This is a strong sign of Kidney excess. Consider her age, grooming, fertility, blood stasis signs. Besides dry, areher heels plump or withered, any varicosities?When did the allergies kick up in relationship to the K+ treatment? If it was soon after, then you can consider her reaction to K+ asa mixed response.With nose and eye related allergy symptoms, it helps to closely consider the St/Lung pair. Determining whether thedampness/dryness is internal or external can be tricky. How about her thenars and resources? Have you asked about moisturizeruse? More often than not I end up treating ST+.UB/H can also be considered because of location.Marika ChandlerNewJun 03, 2021ReactThanks Kristin, I will give some more details. (The plus symbol is broken on my keyboard so unfortunately I cant use it right now)I made a typo: Symmetry is 5/10 (not 5/5). Her grooming is not excessive, it doesnt seem very important to her 5/10 and she doesnot seem interested in fertility or reproduction, she is 32, I dont see many if any broken vessels or signs of blood stasis/varicosities. The tonify K helped her with some of her SI ch arm pain but did not help her mind settle or body integrate as much asPC and LR treatments. The allergies ﬂared up about a week after and after traveling by plane so, perhaps unrelated. Her medialheals are just slightly dry, and normally ﬂeshy (not too ﬂesh, not emaciated).

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1 reply 14 more comments4ReplyNew info, her allergies are deﬁnitely worse with damp and rainy weather. Swelling of eyes, mucus in eyes and nose and ﬁllingsinuses are a BIG deal as well as feeling heavy and hard to accomplish things (normally she does a lot). I’d say she has thepersonality of an LI excess (likes to have a lot of projects and can do a lot at once) but the body of a SP excess. Itching is the otherbig deal with her allergies, itchy throat, inner ears and sometimes hives on the body.Her body temperature tends to run warm on the outside, and she tends to feel warm, as a kid people thought she had a fever allthe time but, she does not like to be cold. She likes warmth. (Confusing, and makes me unsure about doing either HT or UB). Whenshe gets cold she sweats. When she is warm she does not sweat. Her face is not red or ﬂushed.Her thenars are normal. Her resources seem OK but not over abundant. I get the sense that she is not too worried but, she justquit her job and needs to think about how long the resources will last. She has deﬁnitely worked hard most of her life. Her skin ismore moist then dry.Her eyes are very bright and shiny. She is very polite. She is a restaurant manager so she can handle many details at once andkeep her cool and calm. She is very pleasant, she doesnt seem controlling but she is good at managing.In general, the things that stand out the most are her lifelong insomnia (wakes frequently and only sleeps a few hours at a timebut, still has energy). Her racing mind and feeling of not being integrated. And her bright eyes.Today, she looked damp and heavy, she described feeling heavy and thick and slow. Lots of mucus so I did a supplement LItreatment, she settled very well.This is what I see most clearly: GB excess, SJ excess, and today SP excess.2 teacher remarks2 replies 2TuriyaKi Excess VaricositiesNewMay 30, 2021ReactI've been wondering if this includes the full range between actual varicose veins , darker noticeable veins below the surface andspider nevi. ReplyKristin Wisgirda NewMay 31, 2021ReactMy understanding includes this range. Medium blue veins seen through skin are not included. ReplyLynda B. Danzig NewJul 13, 2021ReactI have a client who’s varicose veins were a 9/10 and had them surgically repaired. Now she appears to be SI excess, no dryness, novericosity . I’m inclined to think you would treat based on your history intake, not what meets the eye in her case. T

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1 teacher remarkTuriyaKi Excess Lower Abdominal MassesNewMay 30, 2021ReactI have a 24 yr old patient , pretty, very balanced/symmetrical, nicely dressed and groomed. When I palpate her lower abdomen Idon't detect any masses but she does ﬁnd it mildly painful . In the past she was diagnosed with endometriosis and now isn'tmenstruating due to birth control. Would you consider the lower abdominal palpatory pain conﬁrmation for Ki Excess? I'mwondering if they can be too small to feel to my untrained hand.ReplyKristin Wisgirda  NewMay 31, 2021ReactThe closer the ﬁnding matches "hard masses in the lower abdomen" the more weight it has for K excess. Something that isn't amass in the lower abdomen and isn't hard either has little to no weight- it could be part of many other excess presentations. Thechannel the symptom presents and the quality of the tissues have weight too.A mass that is hard to detect via palpation has little to no weight either.Endometriosis is a really common surgical ﬁnding and doesn't have perfect correlation with painful menses. It is an incidentalﬁnding for women who have little to no pain.1 teacher remarkAdina KletzelPC excess following rules versus SJ excess needing orderNewMay 30, 2021ReactHII am trying to diﬀerentiate the PC excess needing to follow the rules and the SJ excess needing things to be in order and done in acertain way.Does anyone have insight into how to diﬀerentiate between the two? I have seen quite a few SJ excess who also must follow rulesbut they also have GB excess qualities - anger, reactive...so does following rules also apply to a SJ excess or does it point more toPC excess?ReplyKristin Wisgirda  NewMay 30, 2021React<SJ excess needing things to be in order and done in a certain way.> Toby says that he associates need for order with metal not with SJexcess. Sorry I don't have more information on that to share.SJ excess deﬁnitely likes to control.Humans are complicated and are made up of qualities of all 12 channels (+ ren/du). If someone needs to follow rules then theyhave P energy. If they also express anger easily and are quick to react then they have GB energy. Having qualities of one doesn'texclude the possibility they they have qualities of the counterbalancer.Maria9 weeks pregnant with twinsNewMay 29, 2021React

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5 teacher remarks3 replies 36 more comments6Patient is pregnant with twins. She is normally meticulous and together person. Today she comes in with hair disheveled, wearinga sweatshirt that has food stains on it. I almost didn't recognize her. She is 9 weeks pregnant and dealing with nausea and fatigue.Her chief complaint today is that she doesn't feel like herself and is depressed with no interest in food or entertainment. She isexhausted and has been irritable with her 2-year old son that she adores. This case ﬁts in well for SAAM.K: ﬁrm heels, good looking, youngSI: low fertility (needed IUI to get pregnant), Varicose 3 (not too many, but deﬁnitely some) , depressed (new), unkempt (new)H: warm and loving, not hyperfunctioning thoughUB: not feeling coldSJ: Normally SJ excess but not today: bright eyes (3, normally 7), polite 8, detailed oriented 7, externally aware 7,LV: dull eyes (occasionally LV excess)GB:P: rooted, rule followerLU: large belly, dry skinST:LI:SP: damp inside, sweet tooth, warm and softWith the above presentation, she is SI excess and I want to treat K+. Because she is pregnant, I just want to doublecheck there isno contraindication with K+ for her. Thank you!! ReplyKristin Wisgirda  NewMay 30, 2021ReactHow much is nausea an issue? Where does she experience the nausea? Has she vomited? How closely tied to her feeling wipedout is the nausea/vomiting?How old is she?<Varicose 3 (not too many, but deﬁnitely some)> If she is younger, then even a few varicosities have more weight for K excess.K+ wouldn't be my ﬁrst choice for <K: ﬁrm heels, good looking, young> even if she had somewhat of a hard time conceiving. ReplyMariaNewJun 03, 2021ReactNausea is pretty bad but she hasn't vomited. Not sure if she is feeling wiped due to nausea. I will ask her next time.she is 37 y.o. She is usually really bright eye and extremely polite.I am curious what other possible treatments could be considered.Alison Unterreiner, DACM, L.Ac.SI/KID for painNewMay 29, 2021React

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4 teacher remarks6 replies 6Question for teacherHi Kristin,I have a patient who has chronic pain as well as emotional and physical trauma. I can deﬁnitely make a case for SI excess withdiminished love for self, convulsions, pain from stasis, hot ﬂashes/night sweats. So I was looking to treat her using KID+, but I havein my notes to be careful of KID+ in cases of pain since it's so consolidating and you want to move. Can you advise on this issue?Would you just stay away from both channels in that case? I had considered doing SI+ to move for pain, but since she has so manySI excess signs, I thought I better ask you instead.Thank you!AlisonReplyKristin Wisgirda  NewMay 29, 2021ReactHi Alison,Thanks for your questions.<a case for SI excess with diminished love for self, convulsions, pain from stasis, hot ﬂashes/night sweats> I see a mix of Kidneyand Si excess symptoms here.SI excess: diminished self loveK excess: pain from stasisConvulsions can be thought of as windy and possibly treated with SI+.Hot ﬂashes and night sweats can be part of SI excess, K excess and a number of other presentations.Hope this helps. Feel free to ask for clariﬁcation.Lynda B. DanzigComplicated CaseNewMay 27, 2021 | EditedReactThis post was administratively edited at 05/27/2021 8:47 PM68 yr. old male, retired faculty at Berkley School of MusicChief complaint is Left sided sciatic numbing pain, radiates from SIJ thru glutes, pathway is hamstring (UB) and ITB (GB) top andbottom of foot with a focal point at the talus bone, site of an old injury. Pain is b/w walking, pressing and support, w/w getting upout of bed, laying down on Left, leaning over to tie shoe or while working on a stool. Onset March 2021.Secondary complaint 2007 osteoporosisDX in 2007 Osteoporosis currently eﬀecting L1, 2, 3, Left head of trochanter, started with high doses of calcium and vitamin D.Patient reports a steady decline in bone mass over the last 4 yrs. TX includes Reclast 1x/yr infusion, SE both thumbs joints becamearthritic, Right Styloid process bulged with bony mass. (SI 6 Yang Lao, Nourishing the Old), 2-3 days fever, headache and acheyfeet, R hand swells, L foot swells.2019 DX w/ hypercalcemia and hyperparathyroid, endocrinologist decreased supplements by 75 %.2018 Cardiologist discovered calciﬁcation in an artery, discontinued calcium supplements2006 Adnoma ( including a surgically induced injury; surgeon nicked Left vocal cord) removing Left thyroid and parathyroid. Thevocal cord injury resulted in LOV for 8 months. He worked with a specialist to gain the muscle memory and reclaim his voice. Hisvoice becomes hoarse after long conversations. The hospital stay involved a code blue due to plummeting BP, SE of medications,he was emotional as he described the event.

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HEENT:1-2 x/mth will get dizzy, tension headaches from temple to temple w/w working with chemicals and deadlines. He is alwaysappropriately masked when working with inhalants. Hx of blepheritis, dry, itchy eyes treats with medication and eyedrops, Left eyelooks bulging.Respiratory:HX of childhood asthma, use of steroidal based inhalers his whole life, congenital bony deformation of rib cage that is severelyconcave below the root of the breast, both sides, and severely convex sub/sternal plate. The concave ribs impacted thedevelopment of the lungs which make him prone to accumulations in the bottom portion of the lungs.5/2009 & 2017- DX w/ Mycobacterium Avian Complex/Infection, standard protocol for tx is 18 months of antibiotics, one of thethree meds caused suicidal tendencies and was remedied with Avalox, unfortunately there were SE which caused achilles tendoninjury (no rupture).Swallowing is inhibited and he cannot cough. There is a ﬂap in the (glut ?) fold in the throat where food/pills have accumulated andcauses him to aspirate if not very careful, b/w tiny sips of water and laying on Left side.GI:IBS, episodical every 4-6 weeks with frequent (4 -5 x/d) BM's, loose stools, sometimes with mucus, terrible cramping on Left lowerquadrant to rectum, may include the whole belt channel.Lactose intolerantHas an appetite, but is very limited with food choices, very strict diet. Has thirst, drinks 5-6 16 ﬂ. oz. h2o. Sometimes frequenturination, sometimes may not go for several hours.2003 & 2020 small, benign polyps removed from stomach, 2003 Proton pump inhibitor to tx GERD but decreased in 2017, MD wasconcerned with research indicating protonics linked to osteoporosis and dementia.1999 Gallbladder removed. Does removing an organ have any implications with Saam?Musculoskeletal:Recently DX w/ Right side bonespur in cervical spine, decreased mobility of neck, pain, overextending may cause dizziness, vertexheadache.After retirement in 2019, he reported having a stomach ache for 3 months. His PCP set up a CAT scan which proved no problemwith stomach but he had an allergic reaction to the dye and an Left sided inguinal femoral hernia was discovered, surgicalrepaired in 3/2020.Left 4th ﬁnger, sliced the tip oﬀ when working on machinery. Playing Bass guitar has helped nerve reparation but is quiet numb.Left LE excruciating leg cramps, screaming pain.Appearance and Demeanor: Neatly dressed, articulate, punctual, polite, carries his calendar and notes into every appointment 7+,animated, detailed.Completely bald, face has symmetry, pleasant looking, skin on his face looks hydrated 5+. He is fairly tall, lanky and shoulders andupper back appear to be slightly hunched 7+, long strong arms 5+.Lifestyle: Recently retired faculty at Berkley School of Music, plays bass, passionate about restoring old cars, metal working,happily married, no kids. Very disciplined 9+, maybe personality but also, due to his sensitivities and so many instances of overtreatment or side eﬀects or injuries with care, there is a sense of fear and trauma. He researches everything 8+.Body Temp: Even, Left foot colder than RightHara: No pain or pressure upon palpation, sternal notch ﬁrm, warm, intense pulse of abdominal aorta 8+ .Thenar Eminence: Left slightly ﬂat 4+, Right is wrinkled, more full than Left but squishyMedial Mallelous: Both sides thin, reddish purple spider veins, superﬁcial, skin is slightly dry and thin 3+I have not seen his tongue or taken pulses yet.Excess Presentation:Heart: Hypercalcemia, hyperparathyroid, talkative, but in a way that is about protecting himself/ fear based to avoid mistakes 7+,sciatic pain along UB m.

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1 teacher remarkhyper overgrowth of bone, Right SI 6, cervical bone spurUB: appropriate fears 4+GB: convex sternum9+, upper back5+, Left eye appeared to me to be slightly bulging relative to Right 4+, sciatic pain along GB m.8+, Left sided inguinal femoral hernia, abdominal discomfort which feels knotted, and appears bulging ( better with massaging andpressing in) occurs when leaning over or laying on ﬂoor and goes to sit up 8+.PC: polite but not overly warm or cool, punctual, reasons, researches, deliberate8+, very intelligent but not snobby, street smart,able to problem solve and observe 7+, sunken, convex 8+SJ: Left foot cool 3+, especially careful 9+, detail oriented 7+Liv: Predominence of symptoms Left sided 8+Lung: may get congested in lungs/damp on the inside but not at the time of treatmentSt: inner dryness of eyes 9+, sunken rib cage (GB 24) 9+, may be down on luck but is resourceful and has resources based on hiseﬀorts, skills and talents.LI: long, thin, strong arms3+, has projects but not overwhelmed or over juggling 3+, never bored or lazy 7+Sp: Patient has a lot of numbness6+,SI: mixed warm and cool,, not calloused but thin skin and slightly dry5+Ki: minor accumulation of masses in lower portion of body 5+, medial heel highly vascularized 7+GTIR complicated health history where less is more in treatmentThank you in advanced for any insight, observations and suggestions. I am inclined to supplement PC on R, Supplement LI on R tomanage the dampness that may be causing dampness, then toggle a little between KI and SI to rid the dizzy and then to build withkidney. I know the stomach excess is signiﬁcant but I am needing some help with prioritizing.HEIC | 1.5 MConvexity at GB 24A2AD0B6B-197E-43EC-BF4C-001…HEIC | 1.6 MC0687591-CD5D-4328-86C7-53E…HEIC | 1.2 MRight Medial HeelD74A5896-AE2F-4AFB-99B0-B9F…HEIC | 906.5 KLeft Medial heelDDA9CA06-723D-42BF-B61B-80…Kristin Wisgirda  NewMay 27, 2021 | EditedReactHi Lynda,Thanks for sharing your case. (I edited you case by cutting out the blank spots to make it easier for me to scroll through. Canvascreates too much space.)Are any of the sacral liao point areas involved in his pain- namely the SI or UB shu points?Interesting that he has left lower quadrant pain with his IBS attacks.

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Reply<Reclast 1x/yr infusion, SE both thumbs joints became arthritic, Right Styloid process bulged with bony mass. (SI 6 Yang Lao, Nourishingthe Old), 2-3 days fever, headache and achey feet, R hand swells, L foot swells.> Are any of these symptoms long term or just aroundthe time of yearly Reclast?<GTIR complicated health history where less is more in treatment> Saam is an observation based, real time medicine. If you can't pinin down to 1 gross thing, try for the top 3 stand out symptoms or qualities of his presentation. What really stands out to you abouthim now. What does "less is more in treatment" mean?Yes there is lots of history but don't get bogged down in it. I am having a hard time getting through the case because there is toomuch historical detail that could be streamlined to the essential.One piece of history that could be helpful is what was going on around the time of the onset of his chief complaint.<Does removing an organ have any implications with Saam?> I wouldn't give it much weight.<face has symmetry, pleasant looking,> How handsome is he- give it a number, please. This is really important in Saam fordetermining is K/SI balance. This is important because he has pain and symptoms that resulted from surgery. So we want to knowhow safe it is to use SI+ for him.With your channel excess analysis, it is really important to include the chief complaint channels and counterbalancers. Westernmedical diagnosis, things you can't see with your Saam technology- such as bone spurs, and normal things like a certain amountof fear aabout your health problems, have much less clinical weight so put those in paretheses so you give them lessconsideration. Here are some notes about the channel excesses as you present them.H excess relates to hyperfunction, not accumulation of substances such as bone or calcium in the blood. How talkative is he- nonstop would be 10+. If the midline under the sternum is warm, put that under H excess.UB excess: UB channel pain, fearful talk (appropriate fear); if the midline under the sternum is ﬁrm then put that UB excess.GB: The bony shape of the rib cage really belongs to St/Lung not P/GB. If he really sticks his ribcage out at you, then that kind ofconvexity can be considered GB excess. If instead he hold his body in a meek collapsed posture that is more P excess. Are youincluding the hernia because it is on the Gb channel or because it is a convexity? I wouldn't give it much weight as convexitybecause it is from a weakening of tissue not something forcefully poking out of his body.P: How polite he is belongs to SJ/Liver? How does he move? Is he rooted and grounded (P excess) or erratic and impulsive (Gbexcess)? He really sounds more P excess to me than GB excess from what you have written.I am having a hard time seeing the shape of his sternum though the hair. Is the part that sticks out really sticking out more thannormal or just in contrast to the sunken area? If it really is sunken in one area and puﬀed up protruding in another- then you havea mix of Stomach and Lung excess.Left sided predominant problems belong to SJ and Liver excess. How piercing or dull are his eyes? With details, is he outwardoriented or inward oriented?<minor accumulation of masses in lower portion of body 5+,> What are these? The more a mass is hard and in the lower abdomen,the more weight K excess has. Being in the lower body in general, doesn't say Kidney.His arms are thin and his body looks thin, so this internal dryness belongs to Stomach excess and LI excess. His feet are dry andhis face looks hydrated. How about the rest of his skin?<St: inner dryness of eyes 9+> Eye dryness isn't necessarily internal. If he has resources put that under Lung excess. Flat thenarsbelong to St excess.Has he had any broken bones? With osteoporosis, we look for signs of internal dampness since weak bones are a sign of Spleenexcess. The episodic mucus in his stools is a sign of internal dampness. Is his ﬂesh soft at all?I know you have already put in a huge amount of eﬀort writing up this complicated gentleman. Rewriting the channel excessanalysis taking the above notes into account will help you see the patient more clearly. Answer the questions I have asked andinclude those too.Let us know what you come up with.Thanks again.ReplyLynda B. DanzigNewMay 27, 2021ReactThank you Kristin, I will take this all into account and rewrite the case.

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Reply2 teacher remarks1 reply 1Kristin Wisgirda Light sensitivityNewMay 25, 20211ReactA patient with disabling dark depression also complained about daily headaches during which she was unable to tolerate screensbecause of light sensitivity. Her eyes were dull but her body was light and open. She tends to be controlling and insisted that she,not I, roll towels to properly support her neck. She was barely sleeping because of the invasive dark thoughts. She settled deeplywith SJ+ and reported that this was the ﬁrst time she had relaxed in weeks.Even though the depression was 7-8+/10, her light/open body, controlling nature and the light sensitivity deﬁnitely had me pausebefore using SJ+. When asked if she had a history of concussion she said 1 deﬁnite but that she has whiplash 9 times but wasn'tsure if she hit her head during those accidents.My ﬁrst thought with light sensitivity is always SJ excess. Liver+ has worked wonders for so many patients. However, in my limitedclinical experience where the light sensitivity is only during headaches is that Liver+ has rarely worked. Other practitioners haveused Liver+ in such cases with good results, in one case even when the patient didn't have many other SJ excess signs.In the recent advanced class, we discussed pathologies other than SJ excess light sensitivity contributing to light sensitivity. Postconcussion blood stasis can change the ability of the pupil to regulate dilation. Consider SI+. One of my most extreme cases oflight sensitivity was GB excess. The patient reported to feeling "attacked by light".ReplyAdina KletzelNewMay 27, 2021React@Kristin Wisgirda<Even though the depression was 7-8+/10, her light/open body, controlling nature and the light sensitivity deﬁnitely had me pause beforeusing SJ+.>A mixed SJ/Liv presentation is one I have seen so many times and one that I struggle with. The dull eyes, over focus on ones ownsneeds, and a bit of heavy emotional energy along with a light open body, very controlling, and needing order is a mix I see in quitea few of my patients.The need to control and need for order are usually so strong that I have opted for Liv+. Some times I see good results from LIv+but if I try to do it again a couple of weeks later I could see poor results from it.This tells me that they may need some Liv + but they may also need some SJ+ as well. Toby often says that when it is so mixed togo to another channel but sometimes that grossest thing in the room is the strong attention to details.If you have any more insights on this mix of Liv/SJ I would love to hear. It is a challenge for me.Kristin Wisgirda ReplyDaniel SchulmanNewMay 27, 20211ReactI had a patient not long ago who came for treatment as a 'post concussion' case . . . headaches , easily over stimulated, lightsensitivity, even seemed hard on himself , even seemed light on his feet . . . really seemed a major SJ XS case. I gave him a numberof LIV+ treatments - they all 'sort of helped' but nothing truly stellar . . . he kept coming over many months . . . I tried several otherstrategies . . . again with some sort of not too bad results . . . but nothing seemed to 'knock it out of the park'. Then one day, Ireevaluated his whole case . . . he was a student in performance arts - singing . . . he is VERY tapped out for resources, fatigued, . . .he was about to perform his big ﬁnal pre graduation performance and his voice sounded dry to me . . . also, realised he ALWAYShad a water bottle with him and was constantly sipping on it . . . so I gave him a LU+ treatment . . . and . . . it ROCKED his world!! Asdid a few more after that. I came to interpret his headaches as being centred around dehydration . . . since then, I have had a fewother cases of hyperstimulation sensitive, light sensitive cases with headaches who, after full analysis, ﬁt this dehydration-headache scenario . . . and in those cases, LU+ treatments have been game changers!! So . . . . you never know . . . . we always haveto investigate everything!

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4 teacher remarks2 replies 2Adina KletzelTwo large cold soresNewMay 23, 2021ReactHI,My patient came in with two large cold sores on the palette underneath the tongue.The were red with a bit white middle.red = heatbig white middle = damp? or does it mean toxic heat?I seem to have stuck in my head that a white middle is toxic heat but I am not sure I am correct about that.She said that she gets these cold sores when she is stressed.If we were only evaluation this one symptom could all of the following be considered?Bl+ for the heatSt + because the stomach opens to the mouth and so the cold sores may be showing pathology in the stomach. And if the whitemiddle = damp so St+ could also dry the damp and lower the heat that has risen up to the UW.Liv or PC for the anxiety that caused them.Of course a full Saam diagnosis would need to be done in order to choose the right imbalance but I am just looking to see if I amevaluating this speciﬁc symptom correctly.Thanks ReplyKristin Wisgirda NewMay 23, 2021ReactCould the white middle be dead skin? Or is pus? If it is pus, is the the mucosa of the mouth interior or exterior? Could be either.Yes, to your possibilities.<Liv or PC for the anxiety that caused them.> My thinking would phrase it that those Liver+ and P+ treat SJ excess and GB excesscausing heat in the upper.Could underneath the tongue be considered the root of the tongue? If so the following channels go there: H luo, UB sinew, Kprimary and K divergent, SJ sinew. The Spleen primary also spread over the lower surface of the tongue. Even though I mentionnon primary channels, please know that Toby emphasizes that only primary channel location should be considered for Saamdiagnosis.Fang CaiNewMay 26, 2021ReactHi Adina, I think the "big white middle" can further be diﬀerentiated:if big and puﬀy/kind of squishy-wet looking = damp-->further, if superﬁcial then consider exterior, if very rooted/deep thenconsider interior.if hard/nodular = phlegm nodulation or even kd overconsolidatedif kind of dry looking you could even interpret as dryness (eg caused by HT xs, or LU or LI xs) leading to phlegm congealing.

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1 reply 13 more comments3ReplySo I would ﬁnd it hard to say anything "for sure" based on 1-2 lesions.2 teacher remarks2 replies 2Adina KletzelUterine cramps morning after SI+ treatmentNewMay 23, 2021ReactHI,I am treating a 45 year old woman for monthly migraines the day after she gets her period. I did an SI+ treatment around 2 weeksbefore her period. She settled during the treatment. The morning after the treatment she got uterine cramps for a couple ofhours. They went away with some advil.She does not usually get cramps with her period. Would this be a negative reaction to the treatment or can it be seen as positivegiven that the treatment moved blood that otherwise may have been stuck in the uterus?She still got a migraine with her period that month. ReplyKristin Wisgirda  NewMay 23, 2021React<Would this be a negative reaction to the treatment or can it be seen as positive given that the treatment moved blood that otherwise mayhave been stuck in the uterus?> How do you know that the cramps are the result of moving stuck blood in the uterus? I wouldn'tmake that assumption.For judging the adversity/beneﬁt of a treatment, it can help to weigh the good, the bad and the neutralcramps- a new symptom that occurs soon after treatment- badsettling with treatment- goodno improvement in initial complaint or anything else- neutralIf you aren't great at evaluating the settling of this patient- for instance because she seems to settle no matter what you do andwhat the treatment outcome- then I would put less weight on settling being a good sign.1 teacher remarkMariadry heelsNewMay 20, 2021Reactquick question:I have a patient whose heels on the bottom are very dry, like someone who walks barefoot a lot. The sides of the heel are not. Justwondering if this is a sign of SI excess? BTW, this patient's heels are ﬁrm. Thank you.ReplyKristin Wisgirda  NewMay 20, 2021ReactThe area of evaluation is the medial heel, not the sole. So if medial side of the heel is not dry there is no indication of SI excess.

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ReplyMariaNewMay 20, 2021ReactGreat! Thank you for the clariﬁcation!MariaRegulating the cycleNewMay 19, 2021ReactA little help, please. Disrupted Ovulation. I did a SJ+ treatment 2 days post ovulation per BBT rise and ovulation kit. 2 days after the treatment, her BBT fell back down to pre-ovulatory temperatures with slippery creamy discharge. It seemed that the treatment might have interrupted the ovulation process and now she is not longer ovulating. Her temps have now stayed in the low 97.4+/- now 1 week post treatment. I wonder if it was a mistreatment and what I could do to restore her cycle. Case: 43 year old woman, ﬁrst seen 8/23/20 Chief complaint: TTC for 3 years. Had 4 MC since 2018, always terminating around 6 weeks. Last MC was 6/2020 with severe blood loss ending with anemia. No longer anemic. Low AMH, and didn’t want to go through ART Cycle was 24-26 days after mc but prior to that she ovulated around CD 14, but 12 day luteal. PMS: denies any symptoms, has occ. nightsweats and hot ﬂashes, moderate ﬂow, no crampsAppearance and demeanor: She is friendly +5; polite +5, animated talker+5 but doesn’t overtalk. All conversation is about her trying to get pregnant. She knows what she wants and is very determined. She seems in charge of her relationship and makes her husband come to acupuncture even though he hates needles. She dresses casually when she comes in. Lifestyle: She works out regularly. She works at an insurance agency and PT for her friend. Her job is moderately stressful. Body morphology and ﬂesh quality: She is a weight lifter so she is dense and ﬁt. Not overly muscular but looks strong. Skin Quality: not dry, not oily. Body Temp: normal. She reports cold feet and needs to wear socks. But feet are not cold to the touch. Pulse is around 50's GI: she reports a history of constipated but she goes mostly daily and not hard. Respiratory: no issuesSleep: no problem Emotions: self assertiveness +8 Urination: normal Body: very few varicosities 3+, heel is not cracked and ﬁrm Tongue: pink with moist coat. The Grossest Thing(s) in the Room: This changes from treatment to treatment. When I last saw her, her eyes seemed dulland tired 5H/UB: doesn't feel cold or hot. sometimes she gets hot ﬂashes but not always. pulse is 50's, she feels like she has cold feet butthey are not cold to the touch. her body doesn't feel hot or cold to the touch. midline is not too ﬁrm or soft. She is friendly but notoverly talkative.K/SI: She is pretty and symmetrical. She dresses casually and very minimal makeup. Varicose 3+, ﬁrm heels7, she is self concernedabout her fertility.GB/P: she has a slight arch to her back so when she lies down, her back doesn't touch the table. Her eyes are slightly protruding4+, she has strong features and brow bone 6+. she is a body builder so deﬁnitely more ﬁghter like than librarian.SJ/LV: Her body is dense. Her dark eyes sometimes can be dull, but other times, more bright. She seems shielded. She doesn'tshare much outside of her medical info. She never comments about the oﬃce, or doesn't seem too detail oriented.

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7 teacher remarks2 replies 2ST/LU: from time to time, her abdomen would be noticeably bloated but not always.3+ skin is not noticeably dry or oily. she doeshave allergies and was taking mucinex. before her period, her breasts would enlarge. thenar is moderately ﬁrm 5+SP/LI+: Not dry not oily. Strong powerful arms 8, stubborn 7, no sweet tooth 4+ ReplyKristin Wisgirda  NewMay 19, 2021ReactHi Maria,Thank you for your case. I wouldn't use BBT to diagnose mistreatment and counterbalance. Are there any otherindications for mistreatment? Any signs of the treatment beneﬁting her?With your channel analysis listing the channels separately would help you see her more clearly. It is especially important to gothrough the K/Si axis this way since she has an interesting mix.For instance:SJ excess: eyes sometimes brightLiver excess: eyes sometimes dull, shielded, dense body, (doesn't seem oriented to details outside of herself?)Other notes about your analysis:< self assertiveness +8> This gets the highest rating for her presentation but you didn't include it in the channel analysis. If she isassertive in a way where you can imagine her using her body, call that GB excess. If she is assertive because the world revolvesaround her and her concerns, call that K excess.<makes her husband come to acupuncture even though he hates needles> Sounds like a bully. Possibly some combo of Gb and Kexcesses.To be LI excess you need thin, strong arms. Strong arms aren't enough. You haven't mentioned that she is skinny.<GB/P: she has a slight arch to her back so when she lies down, her back doesn't touch the table.> If she has little to support under herlegs, a little lumbar arch is normal when supine. What are you seeing here that is relevant to GB/P?<before her period, her breasts would enlarge.>I wouldn't get ﬁxated on Lung/St for breasts. Other channels inﬂuence them.What else have you used for treatment?Let us know what happens.MariaNewMay 19, 2021 | EditedReactThis comment was administratively edited at 05/20/2021 10:41 AMThanks Kristin for your comments.Her arch is noticeable and she does have knee support when she lies ﬂat. When I did a P+ treatment, the arch relaxes and the gapbetween back and table disappears.I think K excess sounds more like her. You make it so clear when you explain it like this <If she is assertive because the worldrevolves around her and her concerns, call that K excess>I realized in writing up this case that I may not engage my patients enough in conversation to ﬂush out some of the subtleties,especially the ones that aren't forthcoming. In this patient's case, we always end up talking about her infertility and little else.You have helped me out with this patient's case previously and per your suggestions, I have done P+, ST+, SJ+ with great results. Itseems like I have patients that I am spot on with SAAM and get great results and others where I keep running into a pickle.

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3 replies 39 more comments9 Reply3 teacher remarks1 reply 12 more comments 2Julia RosenumbnessNewMay 18, 2021ReactOften times when patients speak of numbness, they seem to be referring to pins and needles, , or the heaviness that you can feelwhen your foot falls asleep, or "feeling not normal", not diminished sensation.What is the deﬁnition of numbness in Sa'am?Thanks! ReplyKristin Wisgirda NewMay 18, 2021ReactNumbness is the spectrum of veiling of sensations- from diminished sensation to complete lack of sensation. But Toby's teacherwould treat tingling, including pins and needles, as dampness as well. My takeaway is that the sensations on the way of your footfalling asleep - the tingling, pins and needles, the heaviness- and waking up can be included as part of numbness. Dampness is thenumber 1 consideration but you can consider the other pathologies that contribute to dampness- namely blood stasis and cold- ascontributing factors.I have seen case studies where numbness/paresthesias were treated as channel problems (aﬀected channel or counterbalancer)and not treated by drying damp, addressing blood stasis or cold. ReplyAdina Kletzel NewMay 23, 2021ReactWhat about the feeling of electrical currents running through a channel or certain area of body? Would that also fall undernumbness or does that sound more like blood stasis?6 teacher remarksFang CaiSP+ vs ST+ moistening qualitiesNewMay 17, 2021ReactI understand how to think about the diﬀerence between the internal-moistening properties of LU+ (lifting up, ﬁlling the body withqi, moistening especially in the lungs) vs SP+ (adding absorbency, warmly moistening with thick jing ye esp in the GI system). Isthere a way to think about the external-moistening qualities of SP+ vs ST+? Besides the obvious other s/s of one being damp andthe other dry internally, I've been trying to ﬁgure out the speciﬁcs of diﬀerentiating these treatments based on the externaldryness.Anyone have hypotheses or musing on this matter?Kristin Wisgirda  NewMay 18, 2021React

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7 replies 76 more comments 6Reply<diﬀerentiating these treatments based on the external dryness.> I don't know if there is a way to diﬀerentiate based on the quality ofthe external dryness. I use the internal and other qualities to determine.St+ dries the inside, (makes the inside more open), descendsSP+ moistens the inside, makes the body heavier, is slightly ascending, is mildly warming, (adds contentment)Both can improve appetite and help receiving from the outside in diﬀerent ways.ReplyFang CaiNewMay 18, 2021Reactok thanks. I'll hold that in my Saam brain bank.2 teacher remarks2 replies 2Adina KletzelPlantar FasciitisNewMay 14, 2021 | EditedReactHI,I have had a number of plantar fasciitis cases. Some are more obvious - on the Kid channel or Bl channel but others are on thebottom of the heel - on the sole of the foot. Does Saam consider this the Kid channel? If it is more lateral but also on the solewould this be considered closer to the Bl channel? Can anyone share any particular successes with treating plantar fasciitis ? ReplyKristin Wisgirda  NewMay 14, 2021ReactI had never heard of Durban before and had to look it up. Sorry, no experience.With sole problems, I mostly consider the K channel. If the symptom is only on the very edges or just at the MTPs of certain toes, Iconsider the corresponding channels. ReplyFang Cai NewJul 14, 2021ReactHi Adina!totally not Saam, but this long stretch is super helpful for chronic PF. I think of it as SI+ and UB+ and LV+ and SP+: lengthening andsoftening the connective tissues that are often dry/contracted in PF.https://www.youtube.com/watch?v=RRDC8erSNqwAdina Kletzel.30X15 needles for the wellsNewMay 13, 2021ReactHI

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9 teacher remarks2 replies 25 replies 510 more comments10Has anyone come across a good brand of 30X15 needles?I would like to move up to 30X15 from 25X15 for the wells but I ﬁnd that putting 30X30 into the wells is a bit cumbersome.I usually use DongBang which I really like but I did not see that they have 30X15.Thanks so much ReplyKristin Wisgirda  NewMay 13, 2021ReactI had been using Kingli .30x13mm but now use Dongbang .35x30mm so that the gauges of the all the needles in a treatment arethe same.ReplyFang CaiNewMay 18, 2021React@Adina Kletzel I have used a mix of 0.15 length needles for jingwells, and ﬁnd the Kingli 0.35mm to be a smoother insertion thanthe 0.25mm DBC Promax sports needles. But I hate all the packaging of Kingli.I recently ordered Acufast needles for the "regular" small-needle practitioners in my oﬃce. I tried a few and the insertion is butter-smooth; it feels sooo good. I would love to buy Acufast needles in a larger gauge. I've contacted them via their website to make therequest. Maybe if enough of us ask, they'll respond to demand.@Kristin Wisgirda can you start a movement?Here's a chart of their current sizes. https://acufastneedles.com/#size as you see, they do make 0.35mm but I can't ﬁnd anywhereto buy them.Here's their contact page https://acufastneedles.com/contact-us/Adina Kletzel,Kristin Wisgirda2 teacher remarksSpenta KandawallaPost treatment reactionsNewMay 12, 2021ReactQuestion for teacherHi all,How long after a treatment are we attributing negative reactions to the treatment? 24 hours? 48? 72?Thank youKristin Wisgirda  NewMay 13, 2021ReactGreat question. We have to take into account other potential causative factors but have suspicion about our treatment.

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ReplyThe closer to the treatment, the more likely it is a true adverse reaction requiring counterbalancing.How adverse the reaction determines how quickly the patient needs counterbalancing.Then there are mixed pictures. Remember Toby's case from the intro course- LBP/knee pain/diarrhea that improved with SI+/LI+,then the patient started having extreme anxiety which got worse with LI+. Toby did not counterbalance with SP+ because thepatient's chief complaints continued to improve so this was not a classic adverse reaction. Instead it was a case of unblanketingthe anxiety. He used Liv+ because of the patient's diamond eyes.I'll ask Toby for conﬁrmation because this is such an important subject for safe practice. ReplyKristin Wisgirda  NewMay 14, 20212ReactWhen I presented this question to Toby and told him my response he said:"Great question. There can be so many other contributing factors as we get further and further from the treatment."Kristin Wisgirda kleptothermsNewMay 09, 2021ReactThis was a fun Radiolab podcast episode all about the UB/H pair:https://www.wnycstudios.org/podcasts/radiolab/articles/kleptothermsThe strongest predictor of core body temperature, considering a myriad of factors (body condition, climatic, etc), is the diversity ofsocial connections. Not the number of friends you have but the diversity of groups you are connected to.Kleptotherms | Radiolab | WNYC StudiosWebreak the thermometer watch the mercury spill out as we discovertemperature is far stranger than it seems. Five stories that run the gamut from snakes to stars.Source: https://www.wnycstudios.org/podcasts/radiolab/articles/kleptotherms Embedded File.https://www.wnycstudios.org/podcasts/radiolab/articles/kleptothermsAdina KletzelSI+ during menstruationNewMay 09, 2021ReactIf someone is on the second day of their period and still bleeding relatively heavily should SI+ be avoided?

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2 teacher remarks2 replies 2I had a case today of a woman in a lot of pain and SI+ was called for but I thought it would aggravate/interfere with hermenstruation so I did not do it. Was that the right judgement call? ReplyKristin Wisgirda  NewMay 09, 2021ReactDay 1, lots of pain, relatively heavy bleeding- using SI+ has little risk.Day 2, with the same picture, is more of a judgement call.SI+ isn't the only choice for menstrual pain. I have used other channels successfully.Kristin Wisgirda Adina's Dizziness CaseNewMay 06, 2021 | Edited1ReactNancy; 74, femaleMC: dizzy episodesRoom spinsHas to lie down and close eyes.Nausea, vomiting weaknessAfter she is dizzy she goes from hot to coldSometimes just get lighter dizziness and light headednessTaking antihistamine pill helpsHappens twice a weekSC: constant shoulder and upper back painIts tight and hard and painfulOn SJ, SI, GB meridiansBody morphology and ﬂesh quality; Short stocky womanArms and legs and face are thin and strong; Small faceMiddle is full, stocky, and dense – a lot of weight in her middleStomach really puﬀed out; Middle of body is denseArms and legs are skinny but a little muscularLU 10 averageMedial heel not ﬂeshy and not very dryDull eyesVaricose veins all over her legsBrown spots all over arms, legs, and face

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LifestyleWidow, husband dies 15 years ago; Lives aloneShe was a power house; a teacher and caterer at same timeWorked all day from early morning until late at night and had plenty of energyShe was a strong, assertive, determined person who could get anything done that she wantedNow she is alone, retired, having many health issues and it is very hard for her.She wants to be busy all day every day.It is so hard for her to be limited at all.Husband made a lot of money. Was well resourced.DemeanorSays she is not easily angeredBut she strikes me as tough; criticizes; Expects perfectionCan get down and negative esp. when she is not feeling physically wellShe does not have a strong attention to details on outside but when put we do acupuncture she can tell me exactly where shefeels the qi moving and what is going on in her bodyGI: She has been constipated for the past couple of months; Stool in hard and drySometimes she has Mucus in her stoolGassy; Bloating after foodFrequent urinGet up numerous times at night to peeChronic UTI’s – hot burningTHirstDrinks room temp or hot. does not like coldDry mouth at night – drink a lot at night; Not so thirsty during daySkinDry skin, lots of wrinkles on her faceSkin on lower legs and arms is thin, dry, with lots of brown spots and varicose veinsUpper legs more thick and denseUnder her eyes she puﬀy – looks like pockets of waterSweat- Does not sweat a lot; But sweats when wake up in the morningPain: Pain in lower left abdomen on SP meridianGets pain on bottom of her foot – arch when her stomach hurtsHurts when I press on her lower back – kidney area and on Sp area in middle back

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Pain on both shoulders a scapula area of upper backAfter she eats hurts and burns under right rib and around the backHigh sugar but does not take insulin; Has been high latelyNot overly cold or hotHad a heart attack 4 years agoBody SignsCarotid artery 75% blocked; Eyes redTons of thick varicose veins all over legstinnitus in earsFeel heat in ears and feel that they are stuﬀed with water; Head feels foggyWhen press on SJ 17 she breaks out in a sweat, gets hot and needs to drinkInﬂated chest – has a turtle back – in Lung areaTngMore on pale side, a bit purply; Fluted not much coatingCracks on MW; Sides pale; TeethmarksAbdomenEpig very puﬀed outHurts by CV 14Strong oketsuRSTOn left side of lower abdomen feels a bit lumpy over LI areaWhen lying on Sromach, Lung area of upper back very puﬀed out – convexDoes that also indicate Lu excess?Excess PresentationsGB pain on GB mer. On shoulders 7+ can be sharp 6+ tinnitus 7+Liv dull eyes +8 not a lot of attention to outside details +7 pain on Liv mer after eat +7 poor night vision +7 dense middle of body+7 likes bright sunlight 7+ can feel down 5+SJ controlling 6+Kid varicose veins +8 pain +7 bottom of foot hurts +8 movement helps symptoms 9+ dizzy 8+SI elderly 7+LI interested in a million things +8 hurts on LI channel on back +7 pain on SP mer. On lower stomach 7+ constipated with dry stool7+SP hurts on LI channel on back +7 pain on SP mer. On lower stomach 7+ water accum. 7+ mucus in stool 6+Lu wet on inside and dry on outside +8 puﬀed out chest 7+

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6 teacher remarks3 replies 3Bl very frequent urination at night +9Grossest thing in room: thick dense middle of bodyTop ideas: SJ, ST, SI ReplyNaomi FrankNewMay 06, 2021React@Kristin one thing I was hoping to clarify: if the abdomen is puﬀy/full (they carry weight there) but the chest is average and wecan't say it's either full/sunken, does this become a sign of Stomach excess or still in Lung excess territory? TIAAdina KletzelNewMay 07, 2021 | EditedReactThis comment was administratively edited at 05/08/2021 11:25 AMI have been seeing this patient for a while.THese are the past 9 treatments that I did.THe treatments are helping but no permanent and lasting changes. Past 9 treatmentsSI + (L)End of treatment felt hot ﬂuid in earDizzy spell night after treatmentTired all weak (but also got covid shot)Helped constipation. Shoulders still very painfulNext week SJ+Sleeping. When put in needles left ear opened up and when took out said it closed again. Said shoulder feels better -weight wentoﬀ of it. Left shoulder and neck much better. Right shoulder started to hurt this week… ringing in left ear better. Less foggy andheavy head. No dizzy episode this week. Loose stools for 3 days after tipul and then dry stools again. UTI coming on again.Next week PC+Had dizzy spell on Friday morning after treatment. Took an antihistamine and helped it go away. Also had dizzy spell on Mondaymorning and took antihistamine and went away. Right side of body hurt a lot – including shoulders – esp by SI meridian. Did notget UTI and const much better. Body feels heavy and tiredNext week ST+Put in St+ and she had pain on arch of foot and also on LU areaSo took it out after 6 minutesNext time SJ+ on left sideFelt heat draining from earsRight shoulder did not hurt right after treatmentRight shoulder much better. Bowel better. No ringing in ears for 3 days. No dizziness this week. Dryer skin and mouth this week(but on drying dizzy formula)Next week did LU+LU 10 bled a lot . LU 9 got swollen.

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7 replies 7ReplySt felt better, less constipation, less gas, don’t feel burning on side of mouth, got dizzy twice from high sugar but not vertigo, justdizzy and passed quickly. Had pretty good energy.Next week St+(R) and CV 12 and CV 3Felt good after. Less ringing in and stuﬃness in ears. Has great energy. No dizzy just some lightheadedness that passed quickly, Blﬁne, const good for 3 days after treatment and then stools hard and dry again. Still getting up to pee 3 times at night. Shouldersbetter. Less clogged head a less ringing.Next week did KID +(R)Back still hurt. Had loose stools and 2 days of hot explosive watery diarrhea with a lot of mucus in it. Shoulders and back hurt.After diarrhea over back a drop better, lower tone ringing in ears, less getting up to pee at night. One small dizzy wave but notbad. Feel tired and weak after diarrheaNext week did SJ+(R)Felt s/t drain out of ears. Still heard ringing and back still hurt but shoulders a bit better. Shoulders pretty good, less ringing inears, St good, bowel good, but hurts over LI area on lower abdomen, getting up less at night to pee, but feels physically tired andout of it and when walking having trouble taking deep breaths

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1 teacher remarkAlison Unterreiner, DACM, L.Ac.LU/ST clariﬁcationNewMay 07, 20211ReactQuestion for teacherHi Kristin -I have in my notes under ST excess just "GERD" and I'm not sure if I meant that ST excess is for patients with GERD or if you woulduse ST+ for GERD patients. I believe that ST goes down energetically, while LU goes up energetically, so I would assume ST+ forGERD, not ST excess. Can you clarify for me, please?Thank you! ReplyKristin Wisgirda NewMay 08, 20213ReactAlways good to clarify. Stomach adds the quality of down, so Stomach excess can have too much down and Lung excess can havetoo much up. ST+ is a contender for treating GERD but it is helpful to look beyond the diagnosis to the patient's actual experienceto know how to diagnose and treat with Saam.diﬀerentiate rising up vs burning or other sensationsif no rising up sensations consider other channelsif clear rising up consider ST+if really on ﬁre consider UB+ (Toby case of patient eating too much spice with wild burning)1 teacher remarkMarika ChandlerPost mastectomyNewMay 06, 2021ReactHI! I have a new patient that I’ve seen a few times. She had a double mastectomy in Nov with several lymph nodes removed oneach side but more removed on the left side. I have a pretty clear idea of several Saam treatments that I would like to do for her(including PC) but, she is very nervous about having any points in her arms, hand or wrists for fear of lymphedema. I amwondering what you would do in this case? And have you treated on the arms of women who have had lymph nodes removed?Ultimately if she is not comfortable with anything on her arms then I will not do it. But, I have never encountered this situationbefore in clinic so I thought I’d reach out to this community to ask for other’s experiences.Thank you kindly for your sharing thoughts! ReplyKristin Wisgirda NewMay 06, 2021ReactIn these circumstance, I always have patients ask their doctor if they can have needles in their arms.Lynda B. Danzig NewJun 29, 2021ReactHi Marika,

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ReplyI have had this same issue. I have also been trained in oncology Massage Therapy and patients are educated about prevention oflymphedema. Avoiding any kind of piercing or puncturing is warned against on the limb or quadrant where lymph nodes whereremoved. It’s a good question to bring up here. I’d be interested to here what other practitioners do in this case. I believe this issuehas come up in the past.Thank you!Kelly Kaedingorganizational worksheetsNewMay 06, 2021ReactI mentioned that I would share some of the worksheet that I have build for myself, and here I am ﬁnally doing that. I wanted to beable to organize the information in a way that I could easily see the CC, 10 Questions and all of the signs, ﬁndings andobservations - and that they would be organized in a way that is more or less consistent from patient to patient.Generally with new patients this is pretty easy and the ﬁrst doc is my 4 page form where I cut and paste my intake from my onlineintake which uses the same formate - into a word doc. I format it into 2 columns, take out extraneous words/simplify and print.From there I use my highlighter to highlight the key symptoms - and also the information that I didn't get on the ﬁrst go round so Iremember to gather that. It usually takes me 2-3 sessions to gather ALL the info, but I get enough to make some decisions aboutthe ﬁrst few treatments. You will see that I have a lot of the key Sa'am questions, like Dream Environment in the 10 questionssection, but then there is a part on page 2 that is still in progress that has a list of questions like How do they enter? What do theydrive?page 3 is the XS presentations and page 4 is my synopsis of CC, Key Sx, diagnosis, Tx ideas etc + where I track the treatments andresults. Page 4 end up on top of the left side of my ﬁle, with the other pages underneath, while the right side is the chart notes.I have a couple versions, the second version is for patients that I have been seeing for a while. I print out one page for subjectivedata - CC and 10 Q - and the other page is for Signs/objective and I go through the patient's ﬁle to ﬁll in the forms so I can easilysee it all. I also print pages 3 and 4 from the longer doc.I hope this is helpful and if anyone has anything to add, or improves these, I am very open to seeing what you do with it!! I havefound this system to be so helpful for myself! I will also note, that my goal with these was not just Sa'am, but herbs and other-than-Sa'am acupuncture, too.DOCX | 23.8 KNew Patient Worksheet 4 pagesDOCX1 FOC intake 2020DOCX | 51.9 KPrint for return patients 2 pagesDOCX1 Sx + Signs AnalysisTerri MatsonNewMay 07, 2021ReactKelly Kaeding

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Reply@Kelly KaedingThank you for posting these worksheets Kelly, it really helps to see how practitioners organize their thought process.Naomi FrankCase study: Uterine Flooding (for forum or discussion group)NewMay 05, 20211ReactPatient: F 37 (VT)CC: Flooding/trickling. Continuous uterine ﬂooding, bright red with large clots. No pain. Sept-Dec 2020 and also March-April 2021. Bleeding stoppedrecently, light spotting occurring now.Appearance and demeanour: appears shielded. Usually serious/ﬂat aﬀect. Clothes are neat and clean. Moves slowly anddeliberately. Determined. Pale/sallow skin. Note: Dx with OCD which has been problematic in the past but mostly well managed now. Describes it as circular thoughts.Lifestyle: worked as a teaching assistant for years (low pay). Worked extremely hard 2017-19 to put herself through teachingschool , is still not permanently employed (is a supply teacher). Being a teacher is stressful during COVID (esp when bleedingheavily) Very drained at the end of that time. Had 3 infections (UTI, eye, bronchitis) all tx with antibiotics 2019.Body morphology and ﬂesh quality: Short, stocky., carries more weight around her belly and upper body, legs are muscular withdense tone, tissue on arms is less dense.Skin: dry especially feet Body temp: tends to warmth but can get cold feetRespiratory: typically need to blow nose in morning multiple times (better with herbs)Sleep: good, but chronic night sweats (better recently with herbs). Mostly upper body. Emotions: answered yes to irritability, butappears very steady, calm. GI: tends to constipation, often with sticky stools. Cravings when stressed and around menses. Appetite ﬂuctuates.Urination: OK now. Had chronic UTI 2019-20. Born with bladder issues, had frequent investigations/catheterizations until age 10. Menses/Reproductive: Regular with no issues until Jan 2020; when started to have very scanty dark ﬂow, skipped a few cycles,then ﬂooding started Sept-Dec 2020. Bleeding was unresponsive to medications (and birth control caused chest pain). Pain: oftenstiﬀ and achy in the mornings, better with some movement.Injuries and surgeries: born deaf in R ear, L ear hearing impaired. Surgery at age 6 for mild form of spina biﬁda. Frequent bladdercatheterizations as a child.Grossest Thing in the Room= excessive bleedingExcess PresentationsLu: belly/torso bigger 7, thenars full but deﬂated 6 St: not well resourced 8 Sp: cravings come and go 5, tends to warmth and sweats at night 7 L Int: ...hard working 7 Ht: P rapid *only when bleeding* 4, low back pain on UB channel 7 UB: colder feet 4, low back pain on UB channel 7Kid: passing big clots 8 SI: no pain with bleeding7 ; no varicosities 6 P: appears deliberate, logical, calm 7 GB: irritability (on intake) 3, recent symptom: stomach bloated but soft ?6 Lv: appears quite shielded 8, eyes dull 7, SJ: describes not enjoying online teaching/being in spotlight 5, heat above cold below 6, says yes to detail oriented (maybe theOCD) 7SAAM Treatments:1. +Kid on R. Settled in well, but didn’t notice any changes from that visit. (thin needles 16 April)Kristin Wisgirda

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8 teacher remarks2. +Lv on R (thick needles, 1 May) - her email 3 days later said:Some changes in symptoms from my appointment on Saturday:-digestion has slowed down, no bowel movements since Friday -less lower back pain -not feeling warm or overheating -sleep is normal-bloated stomach -light brownish to pink menstrual spotting on Sunday evening & Monday morning-increased appetite (from very little appetite the previous week)PDF | 63.6 KPDFNaomi F Case Hist- Uterine ﬂoo…Kristin Wisgirda  NewMay 08, 2021ReactHi Naomi,Was she bleeding when she received the Liv+? If so how much? Just trying to ﬁgure out if Liv+ improved anything except herappetite. It sounds like it caused more stagnation in the bowels and belly.What are the closest shu points to her low back pain?Was anything in particular happening for her when the heavy bleeding started?Here is my edit of your channel analysis. If unsure about a symptom or if the symptom isn't so prominent, I put it in parentheses.Lu: belly/torso bigger 7, dry skin; thenars full but deﬂated 6 St: not well resourced 8, thenars deﬂated Sp: (more weight in belly)L Int: ...hard working 7 (dry skin) Ht: low back pain on UB channel 7 ((P rapid *only when bleeding* 4,)UB:low back pain on UB channel 7, ( colder feet 4)Kid: (mixed hot and cold) SI: no pain with bleeding7 ; no varicosities 6 (mixed hot and cold) P: appears deliberate, logical, calm 7 GB: Lv: appears quite shielded 8, eyes dull 7, dense legs SJ: pale/sallow, heat above cold below 6 (describes not enjoying online teaching/being in spotlight 5; says yes to detail oriented(maybe the OCD) 7)Clots can be produced by normal clotting as the blood sits in the vagina before leaving the body, so is not a sign of K excess. If theclots are meaty tissue in quality, not jelly like as would be with normal clotting, then they can be K excess.Irritability can be so many other things besides GB excess. With Gb excess you want to see an outward expression of angerWith putting "yes to detail oriented" under SJ excess, how believable is it that she is oriented to details outside of herself? Iwouldn't put much weight into a patient saying that she is detail oriented as I want to see it in action. Clinic has plenty ofopportunities for patients to demonstrate this quality if they have it.

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4 replies 4ReplyThere can be so many causes of bleeding; In Saam terms, you can look at it as too much moving down (Stomach excess, P excess,),hypofunction (not holding)- (UB excess, SI excess, Stomach excess), heat pushing the blood out (H excess, SJ excess). I have alsoseen case studies where LI+ has helped with heavy bleeding during the period.Please answer my questions and we will look again. ReplyNaomi FrankNewMay 14, 2021 | EditedReactHi KristinThanks for taking a look. Here are my updates:<Was she bleeding when she received the Liv+? If so how much? Just trying to ﬁgure out if Liv+ improved anything except herappetite. It sounds like it caused more stagnation in the bowels and belly.> - Bleeding had already slowed down at the time of theLv+ treatment. She has ongoing constipation (sometimes sticky) but yes that seemed worse immediately after the treatment. Ispoke to her brieﬂy a couple of days afterwards and she described her belly as protruding, but soft and not uncomfortable topalpate and press fairly deeply. I have not done abdominal palpation in clinic - I realize this could be helpful in this case, it issomething I am just starting to learn about.<What are the closest shu points to her low back pain?> B23-25<Was anything in particular happening for her when the heavy bleeding started?>From my perspective it is worse with stress and pressure - back to school in September 2020. Being a supply teacher here meansyou can be rotated around various schools and classrooms as needed, and this was a very stressful time due to pandemic. She isnot particularly fearful about COVID but it's not an easy situation and sometimes there's extensive travel involved. She describedcoming home, eating and falling into bed in the afternoon. (Of course bleeding like that would feel exhausting.) In the second boutof bleeding, when the ﬂooding was more intermittent (in the ﬁrst round it was continuous) she has mentioned that the bleedingincreased again when she took a vigorous walk.To me it's also signiﬁcant that her menses had slowed right down to almost nothing at the end of this very depleting year (2019)when she had ﬁnished teaching school and had these 3 infections. They were then irregular for a while and start of ﬂoodingcorresponded with this output of energy.<Clots can be produced by normal clotting as the blood sits in the vagina before leaving the body, so is not a sign of K excess. Ifthe clots are meaty tissue in quality, not jelly like as would be with normal clotting, then they can be K excess.>TBH this is the ﬁrst time I've heard this diﬀerentiation between jelly/meaty tissue texture. I asked her if clots were more solid liketissue or more stringy/mucousy, and she said more solid and dark when bleeding is profuse, and mucousy and light when thebleeding is light.<Irritability can be so many other things besides GB excess. With Gb excess you want to see an outward expression of anger> Idon't see her as GB excess. For P excess I might say deliberate movements and way of talking. Even then, she doesn't really seemP excess to me either, although more P than GB for sure. I guess I am trying to ﬁnd whatever might go with a certain pair even if itdoesn't seem signiﬁcant, rather than ignore it entirely??<With putting "yes to detail oriented" under SJ excess, how believable is it that she is oriented to details outside of herself? Iwouldn't put much weight into a patient saying that she is detail oriented as I want to see it in action. Clinic has plenty ofopportunities for patients to demonstrate this quality if they have it.>This makes sense. During the SAAM class, this patient immediately came to mind as an example of Liver excess because shestrikes me as inward and shielded. There is something heavy and closed about her demeanour. I mentioned attention to detailwhen when I was asking her questions about her work and she gave quite an emphatic yes. That and my sense that she seemed tofeel exposed with online teaching (even though it is much easier for her to be home and close to the washroom) led me tochoosing Lv+. But, I have never had to remind her anything or redirect her in the clinic as I do with some patients - especially aswe've changed the setup and entry/exit procedures considerably since the pandemic. I don't know if that has weight in the SJexcess realm? Can you give exmaples of observing this dynamic at play in the clinic?I guess I should ask more about the OCD because it's aways possible she was referring to this (which she has described in the pastas repetitive circular thoughts that she can't control). This used to be her primary reason for coming to the clinic, over the years. Itseems to be a lot better managed now although she did mention in one visit in in Feb (not with me but I see the chart notes) that itwas present again.

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1 reply 19 more comments9Nicole SharkeyCase Study: Anxiety with abdominal pain - for forum or case discussion groupNewMay 05, 20211React51 Year old WomanChief complaint: Anxiety. Manifests as stomach ache and feeling of shame. Wakes daily with pounding heart, extreme stomachache and nausea, diﬃculty breathing deeply and the sense of shame that she is doing something wrong or letting someone down.Aggravated by: social groups, her family, and ﬁnding work/deciding on a career path. Improved by: doing yoga, cold-waterswimming, dancing, being in one-on-one connections with people she really trusts. Improved with antidepressants but doesn’t likeusing them because of weight gain, low sex-drive. Relaxation practices help her relax in the moment but don’t seem to help oncetriggered by a challenging situation. Feels “easily ungrounded.”Anxiety since childhood- triggered by catholic school and family dynamics.Has tried therapy, yoga, cold-water swimming, mindfulness meditation, low-dose LSD, ketamine, mushrooms, extensive bodywork, somatic therapy without relief. One week ago started Lexapro, 5mg/day.Secondary Complaint:Left-sided body pain: frozen-shoulder-like symptoms in left shoulder with stiﬀness and pain in UB/GB and SJ channels of neck andshoulder, radiating pain along SJ and SI channels of left arm and hand. Pain in GB and ST channels of left hip while standing orwith pressure.Long history of neck and shoulder pain after working as a ﬂorist with a table too high for her frame. Multiple surgeries for softtissue conditions – wrists for carpal tunnel, breast reduction surgery for back pain, foot pain from calcium deposits, multipletendon tears. Upper body pain worsens with stress.Appearance and demeanor: Comfortable clothes but with a sense of uniqueness. Average symmetry. Polite and friendly but witha hint of anxiety 7+ (Hesitates at the door to the clinic room, even when it is wide open. Mentions that she always worries that shedoesn’t ask enough about me at our visits. We are friends outside of clinic.) Talks a lot about her conditions. Whichever conditionshe comes in with seems all-consuming 9+: in each case she feels a great deal of anxiety about the condition, has seen multiplepractitioners about it, has multiple theories about it, and has spent a great deal of time on her own trying to solve it throughvarious movement/meditation and other practices. Often seems hopeless about the prognosis.Lifestyle: A yoga teacher teaching sparse number of classes online. Has taught less and less over the years due to various injuriesand physical complaints, along with social anxiety, anxiety about social media requirements for her job, and a dwindling sense ofself-esteem surrounding her ability to self-actualize through a career. Has completed many training programs for various pathsbut becomes too anxious to look for work in those areas. Spends a large amount of time on self care 8+. Lives with husband whoworks too hard at his job, feels guilt about husband’s stress and the fact that he must continue to support them. 6+Body morphology and ﬂesh quality: small frame, thin but with slightly puﬀy abdomen and slight softness/puﬀy quality to limbsdespite being thin. 4+Skin quality: nourished 3+.Body Temperature: Says she runs cold but tends to wear thin clothing. Body feels moderately warm to touch 2+GI: stomach ache constant with stress. Occasionally more frequent and/or looser BM with stress.Respiratory: NA

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Sleep: able to fall asleep easily but wakes in the morning with sense of shame and dread, stomach ache. Occasionally nightmares,waking in the night, unable to fall back asleep for 10-15 minutes.Emotions: Easily ﬂuctuate – easily overwhelmed by feelings of others 9+, lack of assertiveness in social situations 7+ Sadnessabout world aﬀairs 6+ Anxiety regarding career 8+ Feels unsupported by her social group, some doctors, family 7+. Strong senseof shame about her inability to feel conﬁdent in career and social situations 7+ but also critical of others regarding of the actionsof others, especially when they seem insensitive to her needs and feelings (7+).Urination: NABody:Excess Presentations:Heart: Extensive talking about emotions? Easily saddened by world tragedies, Compassionate listener 8+UB: Lots of anxiety in social situations, presenting herself out into the world 8+. Some UB channel neck pain.GB: Emotions ﬂuctuate, critical of those she feels are unsupportive. Pain and tension along GB channel on left. 7+P: extreme anxiety presenting herself to the world? standing up for herself in conﬂict 8+SJ: strong sense of shame about inability to hold career, easily overwhelmed when others are upset with her, politeness 7+. Left-sided body pain along SJ channel of arm, left ribside stuck and tight 5+. Eyes bright 5+Liver: Left-sided body pain. Overwhelming focus on her physical and emotional experience 8+Stomach: Thenar eminence deﬂated 5+, feels unsupported by others 4+, feels lack of conﬁdence starting a career? 7+Spleen: slight puﬃness to body and abdomen?SI: Lack of self-conﬁdence in self-actualizing? SI channel pain in left arm, shoulder 6+. Medial heel lack of ﬂesh and varicosities.KID: SI channel pain on left.Sa’am Treatment History:3/24/21 LR+ on right with .18 needles. The following week she reported big change with L shoulder and hip pain that week, thoughcouldn’t discern when it began. Had other body work which she has regularly and felt more responsive to other that work than atprevious sessions. Pain (which she had had for 6+ months) has continued to improve since then . She felt no change in emotions,stomach clenching or sleep/waking anxiety.After several treatments with other styles, on 4/29/21 did LR+ (right) a second time, with .25 needles. Following that treatment, shereported more nightmares when sleeping, and hot ﬂashes – waking up sweating, which she doesn’t normally experience. She alsoreported that she felt more anxiety this week, but she also didn’t feel the need to talk about it as much (has had severaltreatments in a row where she talked extensively about her feelings) and she felt like she was very aware that was simply anxietyshe was used to having, could name it and didn’t feel overwhelmed by it’s presence. Body pain in left shoulder continues toimprove, but left hip had a slight ﬂare. She also began a very low dose of Lexapro at the same time as her last treatment whichmay account for the reduced focus on her emotions.Treatment Ideas:P+ on right – for GB channel pain, easily ﬂuctuating emotionsfew to no varicosities, very slight dryness on left heel 1+thenars- empty 5+Midline: Tender 6+, slightly cool 1+, soft at REN 14, but full and hard REN 12-10 4+Ribside tension: tight and tender on left 5+, right side tension 2+. Whole abdomen slightly tender, puﬀy.Very tight along GB and SJ channels of neck and shouldersRecurrent pain in left shoulder, arm, hipEyes: open 5+, wet 5+, bright 5+, darting 5+Face: slightly puﬀy, healthy color

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3 teacher remarks1 reply 15 more comments 5ST+ on right – thenars, sense of being unsupportedK + on right –SI channel pain, lack of conﬁdence presenting self as a lack of KID energy?SJ+ on left – to counteract increased sense of anxiety, nightmares and hotﬂashes following last week's LR+ on right. ReplyKristin Wisgirda  NewMay 05, 20211ReactHi Nicole,Thanks for the case with all of the details. Please let us know where she feels her stomachache- include channels.Also, when exactly did she start the Lexapro, which can have side eﬀects of sleep disturbance and sweating? Did the nightmaresand hotﬂashes start immediately after the second Liv+ treatment? It would help to know if she really had an adverse reaction tothe second Liver+. If so it is a priority to counterbalance that.Analysis of symptoms can be especially tricky at ﬁrst, though it is rarely totally straightforward even with more experience. It isbest to put in parenthesis with ??? those elements that you aren't quite sure belong under certain channel excess or evenexcluding them. For instance <UB: Lots of anxiety in social situations, presenting herself out into the world 8+.> Is this fear of otherpeople (more UB excess) or a dislike of feeling exposed (SJ excess)?It also sounds like she has quite a narrative going on. It helps to distill it down whenever possible. Saam is also an observationbased medicine so we should prioritize physical easily observed ﬁndings. It is more important to look at what patients do thanwhat they say. Spending lots of time on self care points to a certain amount of K excess. An SI excess person isn't going to bothermuch if at all with so much self care. Improved by cold water swimming sounds like H excess, though I would put a ? because italso could be an attempt to dissociate with cold. Darting eyes is likely GB excess.<Heart: Extensive talking about emotions? ,> Excessive/incessant talking is often Heart excess. If talking about her own emotionsexcessively, that is too much internal or self focus- so Liver excess or K excess. With such a ﬁnding I wonder, can I reach her whenshe is excessively talking about her own emotions (if not then Liver excess) and/or does she feel the world revolves around her (ifso K excess)?Please answer the questions at the beginning of the post and we can take it from there.ReplyNaomi FrankNewMay 06, 2021ReactThis was a great case to hear @Nicole Sharkey especially as parsing out anxiety within SAAM really feels like something I need topractice! Thank youNicole SharkeyGeorge MandlerParosmia -NewMay 05, 2021ReactHi KirstinI'd love your thoughts on anosmia and parosmia as I have a case I don't feel I am making good headway on. Have you successfullytreated any post covid anosmia/parosmia cases with Sa'am? Toby is away and I am looking for some support for my patient.For olfactory issues the ST channel trajectory seems to ﬁt the best. (I watched a Tung class on Healthy Seminars that also looked atST channel points).I have a 32 yo female who had Covid in December. Developed anosmia which turned into parosmia mid-March.She is damp/damp, life long fatigue, cold always. craves sugar

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3 teacher remarksHer Sa'am diagnosis feels quite clear SP excess is strongly evident and mild KD excess (but really more SI deﬁciency), SJ excess. BLexcess in terms of fear of what is happening to her body and she is cold. (but does not line up with midline or her warmpersonality)I have treated her 4 times. She feels relaxed each time, settles in says "I feel relaxed/good" after a session. I have treated SI/LI+(oketsu cleared), ST+(sub 36), SI+ (oketsu cleared), double LI+She is craving less sugar which is one deﬁnite change and perhaps has more energy.It feels that damp and stagnation and the underlying issues, but we never get a change in smell sensations after a session. (I haveher smell lemon, lavendar before and after).I am thinking of supplementing HT+ next tx if it feels right - If she had anosmia then deﬁnitely, but now it is a putrid sense of smellso no longer a hypofunction more of an altered function.It may just take time and toggling the LI/ST(sub 36)- adding in other channels. - treating her 2x/week.If you have any thoughts I'd be grateful.Thank you.extremely purple/pale white coated swollen tongue.Right sided oketsu. Soft squishy midline,My channels to supplement at ﬁrst glance would would be LI+, SI+ ST+(sub 36), HT+ ReplyKristin Wisgirda NewMay 05, 2021ReactHi George,Thanks for the case.I've treated anosmia but not parosmia.Yes for anosmia, H+ would be my next choice, given the nature of the problem and rest of her presentation. Interesting that it tooka number of months to turn to parosmia. Makes me wonder if damp is generating heat to register putrid.Nothing else of note for the case? For the channels involved, I am also interested in Lung. Anything of note for thenars andresources, inﬂated/deﬂated presentation?Toby always talks about damp being more tenacious. He also talks about us being able to control diagnosis and treatment but notpatient constitution and intensity of pathology. If she is weaker with lots of damp, we can expect slower progress.On this cool rainy Massachusetts day, I would probably be ok using H+ on this patient from what you have told me. Withentrenched dampness, it can be helpful to dry it out and move it with a variety of treatment approaches.Let us know what you try and how it works.George MandlerNewMay 05, 2021ReactThanks for your reply Kristin. (wish we could quote here like on Qiological forum!)Did you successfully treat anosmia with Sa'am ? Sounds like you used HT+ thinking hypo function.Yes with that fatigue and ST channel trajectory I would wonder about LU+ too, but she is well resourced, has plump full thenarsand overweight. I can't imagine supplementing LU+ on her, but maybe she may need it 1x LU+ treatment. I have seen successdoing a 1x treatment on a patient that would mostly seem excess in that channel. (It is something I can only explain using theimage of the spokes on the bicycle tire)Yes deep damp pathology often seems so diﬃcult to get lasting change so it may take time to get a breakthrough. Toggling LI+/ST+(sub36),/ SI+. with HT+ maybe a LU+ in there as energy wise she has little resource.

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1 reply 13 more comments 3ReplyI wonder how many post covid anosmia cases have an underlying damp pathology. ??Thank you for your feedback and letting me muse.Kristin Wisgirda Moving HelpersNewMay 05, 20216ReactI've employed movers twice since learning Saam. All of them have been very thin younger men with no bulk in their muscles butvery impressive strength. And hard workers. LI excess signs. Getting a good look at their skin wasn't really appropriate so I couldn'tconﬁrm dryness. Being a mover isn't exactly a lucrative profession so I have to consider Stomach excess too and gave them a bigtip.I've had two home inspectors too. Both had very bright eyes. Both had a hard time wrapping it our time because of excessivepoliteness. The second inspector also slowed everything down to make sure that I could formulate questions and understand hisanswers- a combination of SJ excess politeness and P excess grounding. I can remember what it felt like to be with him- feet on theground and really attentive.Every interaction provides an opportunity to reﬂect on Saam.Adina KletzelCase Study Overwhelmed, angry, anxious, and painNewMay 03, 2021React47 Year old womanChief complaint: Overwhelmed, uptight, tense, anxious, crying easily, getting angry.Ever since she has gone back to full time teaching after teaching on zoom from home she is overwhelmed and not herself. She isalso planning a big weekend party for her son’s Bar Mitzvah this weekend. She is not sleeping well and is anxious and uptight.Second complaint: Pain under both breasts that also goes around to her back – like a circle that starts under her breasts. Herwhole upper back down until Bl 19. Its hard and tight and painful. On her shoulders its particularly painful on the SJ and GBmeridians.The pain is worse when its cold outside or when the AC is on. Better with warmth. It is also worse in times of stress.Appearance and demeanorA bit overweight, symmetrical, soft ﬂeshWide at the hips and thighsKind eyesEyes not bright and not particularly dullDressed casually, wore nice earrings and rings, nails done nicelyEasy to reach. Cried easily a couple of times during the intake.LifestyleMarried, a mother of 4. Youngest is 9 years old.

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A teacher of HS students. Has been teaching for over 20 years and likes it.Enjoyed teaching from home during corona.Is having a hard time transitioning back to full time teaching in school.Likes to be busy. Says she is usually optimistic and happy.Skin QualityNot dry.Body TempShe is more cold than hotGIFineHas some reﬂux issuesLikes to drink both cold and hot beveragesRespHaving some trouble taking in deep breaths latelySleepWaking up at 4:00 for the past 2 months. Can sometimes fall back asleep after an hour and sometimes not.EmotionsHas been getting angry latelyIrritable, uptight, stressed, anxietyLow energy, tiredSays lacks her usual happiness and excitementHer mom got ovarian cancer when she was 10. She was sick for many years and died when she was 20. She had her own ovariesremoved 8 years ago.She did not seem to be over focused on that trauma but it is a trauma none-the less.Body:Some light varicosities on thighs but not pronouncedMedial heel ﬂeshyThenar eminence – not sig.Line from sternum to umbilicus is more toward the soft and warm sideUpper back and shoulders hard, tight, and painfulHurts when press under right ribsPain on the liver, SJ, GB, and Bl meridians.

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2 teacher remarksTongueDeep crack down the middleLots of red dots on tipThin white coatingNarrow 4+Excess PresentationsGB getting angry 7+ reacting emotionally 7+ trouble sleeping 7+ pain on GB mer. 6+ trouble taking deep breaths 5+PC pain on GB mer. 7+SJ controlling 7+ likes the forest 6+ attention to details 5+Liv likes talking in front a crowd (is a teacher) 5+ pain on Liv and SJ mer. 6+Bl pain worse with cold 7+ hates the cold 7+ pain on Bl mer. 7+ feels that she lost her spark/joy/excitement feel weak/no energy 6+Ht pain on Bl mer. Reﬂux – hot ﬂuids rising up 6+Kid symmetrical 6+ ﬂeshy medial heel 6+ pain 6+ had surgery – ovaries removed 6+SP a bit overweight and skin not dry 5+ mole on LI mer. 5+St low energy 5+Grossest Thing in the roomCries so easilyMain ideas: PC, Liv, HtThe ﬁrst treatment I did was PC+ (R)To calm the anger, help her sleep, calm the rising GB energy and give her some grounding and rooting.For the second treatment I am debating between HT and LivFor Liv – she seems like she could use a shield and all of this anxiety came when she had to leave her house and go back toteaching at school which makes me feel that her shield was snatched away suddenly and she could use a shield to go back outthere to the world and deal with busy post corona life.But – she is a teacher and likes standing in front of crowds and teaching so that means that she already has a shield doesn’t it?Also – her pain is worse with cold -which makes me hesitate to use Liv+.Ht+ may be good because her pain is worse with cold and she says that she is missing her spark.But I thought HT+ may be too stimulating for someone who is overwhelmed and overstimulated with so many things to get done.It is also so hot outside here now and her pulse is on the faster side.I would love some input. Thanks.

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1 reply 1ReplyKristin Wisgirda  NewMay 04, 2021ReactHi Adina, Thanks for the case.Did P+ help her take deeper breaths or change her pain?<– she is a teacher and likes standing in front of crowds and teaching so that means that she already has a shield doesn’t it?> Liverexcess folks don't mind being on stage but there are probably other factors motivating her to teach for instance H excess love ofothers, Kidney excess liking to be onstage. Liver+ is cooling and she is already cold.SJ+ could be considered if she is caught up in her internal world. Even if you can reach her if she mostly talks about boring detailsin a way that goes nowhere, she could be more Liver excess. Double checking to see if her ﬂesh is dense.<Ht+ may be good because her pain is worse with cold and she says that she is missing her spark.> SJ+ is warm and would deﬁnitely addspark. It would be safer than H+ given <Line from sternum to umbilicus is more toward the soft and warm side>, faster pulse, hotweather.There is a big enough gap between K/SI to consider SI+. It can help anxiety and anger if they come from entitlement- too muchbelieving that you are the center of the world and world is not giving you your due. Extra points for Kidney excess if she is reallyfamily oriented in a clannish way- and the Bar Mitvah is an opportunity to celebrate HER son.Let us know what you think and what happens. Thanks!ReplyAlison Unterreiner, DACM, L.Ac.NewMay 05, 2021React@Kristin Wisgirda - Hiya, I was just reading through the case and was wondering if you could elaborate on the "clannish" aspect ofKidney excess. I've heard you mention this several times and never felt clear on the family oriented nature of this archetype. Iviewed Kidney excess as an overly sexualized, narcissistic type of person. Thank you!Kristin Wisgirda1 teacher remarkCameryn ElliottStroke Patient turns a cornerNewMay 03, 20211ReactI just wanted to share a really exciting development in a 34 year old stroke patient I have been seeing for a little over two months.She had a stroke a year ago, and since then has been non-verbal (though she can communicate by other means), partiallyparalyzed on her left side (very tight muscles won't/can't relax), with chronic constipation and amenorrhea. She also has a historyof seizures.After my second Sa'am course, I decided to switch from doing scalp acupuncture and some body points with e-stim, which I hadgotten lackluster results with, to Sa'am.So I chose +SI on the right side, just the 4 needles, and last week when I saw her, in that one week she had said her husbandsname (+ one other word), gotten her period, and had not needed Miralax all week!!! Her family was in tears.I should mention that it may not just be +SI, though I think that is a huge factor in this new shift, I also put her on a modiﬁed DangGui Shao Yao Wan two weeks prior to the Sa'am tx and she also has a new speech therapist. Either way this makes me so happy.ReplyKristin Wisgirda  NewMay 04, 2021ReactThanks for sharing the case Cameryn. Saam can deﬁnitely create big changes, so I wouldn't be surprised if it was a majorcontributor to her improvement.

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ReplyKelly KaedingNewMay 06, 2021ReactThat's awesome! I love SI+ (but don't worry, it's not my favorite, ha ha). I wonder how much it played a part in a fertility patientwho I've been seeing for over a year. The month she got pregnant I did SI+ right before ovulation. She has blood stasis... She isnow 9.5 weeks - the furthest she has gotten - and is good and nauseous (ha ha). There were a few other factors that I am surehelped, too.Kristin Wisgirda The virtues of the channel treatmentsNewMay 02, 2021  3ReactIn a previous post Spenta asked why you would want to add swampy damp to anyone by using Sp+.When learning Saam, we often focus on the signs and symptoms of channel excesses. But a channel excess only occurs when thatchannel's qualities predominate over its counterbalancer's. It is important to learn to understand the physiological functions andqualities of each channel. These are the virtues that we are adding to a system when we supplement a channel system.We can ﬁnd the fundamental qualities of the channels, as seen by Saam, in the intro powerpoint, when it describes the 12channels according to yin/yang, 5 phase, 6 conformation, and then a few words.For Spleen: Yin + Taiyin (damp) + Earth (damp)= Inner and Outer Dampness, BoredomToby has very intentionally used this language to stay true to the way the tradition was transmitted to him. The language canpresent challenges at times. Dampness and Boredom don't sound that beneﬁcial, but these are the virtues of Spleen. A double dryLI excess patient needs moisture and some zoning out to balance his system. It helps me to go back and forth between thecounterbalancer pairs, using the qualities of one to help me understand the qualities of the other.Studying the trigrams associated with the channels are another source of exploration. It was helpful for me to learn that thetrigram for Fire, associated with Shaoyin Heart and Kidney, is also called "Clinging". Consolidated Water/Fire of Kidney clings tooneself. Double Fire heart clings to others. This helped me understand the "fear" of UB. UB doesn't cling to others and doesn'thave love for others but has a capacity to go her own way. Yes, when UB doesn't have the counterbalancing of Heart Love UB, thatﬂowing one's own way without connection to others can be coldly isolating and fear producing= UB excess.Though he isn't oﬀering workshops now Yi Jing scholar Harmen Mesker is an Yi scholar. I am still chewing on info from hisworkshop on the trigrams. https://www.yjcn.nl/wp/As students, it is important that we are really careful in our explorations and keep checking in with the foundational Saammaterials because it is easy to go astray.

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3 teacher remarksSo, I recently received my new needles (more like toothpicks than my usual 0.20s...)Wanted to share the ﬁrst time I used them. Deﬁnitely got some instant feedback. Forgive me for not typing up the whole case. I'lljust share how I made the choices I did.F, 36CC: pelvic and lower abdominal pain esp at LLQ, heavy dark menstrual ﬂow with clots. Makes her want to curl up in the fetalposition. Was just dx with endo. Also has some R sided electric pain down Lv channel from inguinal crease to just above the knee.Previously had same pain on the L side but it got better with regular acu, which she has not had in the last 2-3 weeks.Medial heels soft, not plump. No varicosities/spider veins. Skin (overall) tends to moist although there is dryness around edge offoot which is much more pronounced on the UB channel but does show up a little bit on the inner heel. Toenails had old nailpolish but clothes are neat and clean, is casually dressed.Craves warmth and sunlight, lower body is colder, dense muscle tissue esp legs (less so on arms). Describes herself as notattentive to detail and more of an inward dreamer. Is polite and friendly. Eyes not particularly bright.With the grossest thing in the room being the pain, I was focusing on K/SI and Lv/SJ. Lv/SJ seemed very mixed so I went with SI+ onthe L.The immediately reaction was increased heart rate/anxiety and hands feeling a little clammy. So I removed needles right away andreplaced with K+ on L.Patient settled quickly and later reported feeling warmth/light in lower abdomen spreading to whole torso.I may write up the whole case properly (choosing between this one and another one) to get input on possible next steps, but fornow I'm just wondering, when there has been an adverse reaction like that, does the counterbalancing treatment just undo thedamage, or can I expect some positives to come out of it? ReplyKristin Wisgirda  NewMay 02, 2021ReactHi Naomi,Thanks for sharing your experience. Yay for big needles! They will bring you clearer responses which really help you learn Saamand learn your patient.<adverse reaction like that, does the counterbalancing treatment just undo the damage, or can I expect some positives to comeout of it?> An adverse reaction to a treatment is the body saying that you are pushing it in the wrong direction and it needs a pushin the opposite direction- ie the counterbalancer. If the original incorrect treatment was not left in for too long, then thecounterbalancing treatment most often creates a net beneﬁt to the patient. Even when I let an incorrect treatment go for the full20+ minutes and didn't know about adverse reactions until the next visit, treating the counterbalancer still create a net beneﬁt.If needle sensation is strong for a patient and the hands get clammy hands from the needles, I might wait an extra 30-60 secondsbefore letting other symptoms lead me to calling an adverse reaction. Sometimes they settle down.Naomi FrankNewMay 02, 2021 | EditedReact<If needle sensation is strong for a patient and the hands get clammy hands from the needles, I might wait an extra 30-60 secondsbefore letting other symptoms lead me to calling an adverse reaction.> This is good to know! She did mention the increased heartrate ﬁrst and the sweaty hands was something I noticed as I removed the needles. I will check in with her in a day or two and see what’s changed. But yes although my ﬁrst ‘proper’ SAAM treatment led to anadverse reaction I was grateful to see that instant feedback in action and be able to act on it!

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5 more comments5ReplyI was also grateful that the patient was very game and trusting. Part of this was that having tried this for a few weeks in clinic I’mcoming up with new ways to talk to patients about what might happen. This wouldn’t work for everyone, but what I said to her wasthat we have to see if your body accepts this treatment or message, because it can make sense on paper but your body is theultimate authority and knows what it needs. So she was not hesitant to tell me.2 teacher remarks2 replies 2Spenta KandawallaLV Excess and heatNewApr 29, 2021ReactQuestion for teacherI'm often ﬁnding that I'll have a patient who seems LV Excess -- dense body, shielding/brooding/not paying attention, but who alsorun warm to hot. Then I'm worried to supplement SJ+ because of the heat. Am I thinking about this wrong or have I missed thediagnosis? ReplyKristin Wisgirda  NewApr 29, 2021ReactYes, SJ+ is the second most warming treatment after H+, so you are correct to use caution with SJ+ in a hot Liver excess patient. Itis always a matter of looking for the biggest gap between channel pairs and consider the safety of your approach. ReplySpenta KandawallaNewApr 30, 2021ReactThank you. Could you consider pairing UB+ with SJ+ to cool it down?

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2 teacher remarks1 reply 1Spenta KandawallaAdding SP+NewApr 29, 2021 1ReactQuestion for teacherI gave a SP+ treatment today (dry skin, thin body, long thin powerful arms, and doing doing doing) and was wondering: if we seeSP excess as a kind of swampy damp, how would we talk about the moisture we're adding into a patient when we do SP+? Addinga swampy damp doesn't seem quite right :). Thanks for any insights!ReplyKristin Wisgirda NewApr 29, 20211ReactThanks for your question Spenta. The same question occurred to me. Who wants to be a bored, drooling, swampy puddle?The excesses of the channels are obviously pathological but we are made of all 12 channel qualities and need all of them to live.This got me musing on the virtues of the 12 channels and the following is an expression of my ideas- nothing Toby evermentioned- but helpful to me clinically.I have a certain amount of LI excess tendencies- interested in 100 things, always have multiple projects which can easily lead toexhaustion. When ﬁrst learning Saam, I found myself on a plane, sandwiched between 2 ﬂeshy men radiating contentment as theylook at the their devices playing games or watching videos (very polite Sj excess guys, I never felt squished), being served simplecalories by the ﬂight staﬀ. Held captive like a baby in a car seat- nothing to do but just be carried along by a force greater thanmyself. A rejuvenating dose of Spleen double damp! Contentment, a capacity to be fed and take in a necessary undiﬀerentiatedkind of nourishment. These are my thoughts but patients receiving SP+ have shared similar experiences.When diﬀerentiating UB ice cold water from Spleen damp, Toby has said that UB is more like pure water and Sp is thicker morenourishing yin body ﬂuids. I muse on UB as yang ﬂowing water.By the same token, who wants to be an aggressive GB excess bully? I frame the virtues of GB as assertiveness and uprightness.Let me know your thoughts on the virtues of the 12 channels and we can discuss.ReplySpenta KandawallaNewApr 30, 20211ReactThis is amazing. It's been my experience too that the right SP+ treatment oﬀers people more space to just be, instead of doing. Ilove the thought of contentment, a capacity to be fed and nourished. I'll think and share more and hope you will too aboutchannels and their virtues. Thank you!Nicole SharkeyUnsettled reaction where the opposite channel treatment doesn't seem to ﬁtNewApr 28, 2021ReactI had a 32 year old patient today who came in with Right side ST/LI channel lymph node swelling in the neck and throat followinghis 2nd Moderna vaccine. He also reported a swollen nodule inside his throat (not red, hot or irritated - just throat color) that wasirritating him when he swallowed. This patient has been coming to see me for anxiety, which he reported was much better thisweek. He has also complained about acne in the past.

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2 teacher remarks3 replies 3He is thin, but slightly puﬀy rather than dense, and his skin is very moist and slightly oily. He also sweats easily and with anxiety.Because of the location of the lymph node swelling and the moist skin, I decided to do an LI + treatment on the left. However,about 2 minutes into the treatment, he reported that he was suddenly feeling extremely anxious. I took the needles out and hisanxiety immediately subsided. However, I hesitated at doing the opposite treatment on the opposite side to counteract thetreatment, as he was complaining about both damp in the lymph nodes and had very damp skin. SP+ just didn't feel right.Because his anxiety had calmed I ended up doing a diﬀerent style of treatment instead.I'm wondering what was the best choice in this situation given his anxiety. Was it to do a SP+ treatment on the opposite sidedespite the moist skin and swellings? And in general, is the answer to an unsettling treatment always the opposite channelsupplementation, even if it deﬁes the patient's presentation?(In retrospect, a ST+ treatment might have been a better choice due to his thinner stature and the fact that the lymph nodes werealso on the ST channel. But I wasn't sure about the wisdom of switching from LI+ to ST+ in the same treatment either. Otherﬁndings besides thin body and damp skin (8/10) is a tension in left ribside (6/10). Midline is slightly tight (5/10), and pulse slightlyrapid. He is gentle and polite (7/10) but also assertive and clear about his feelings (he had no trouble telling me that he was feelinganxiety. Thenar eminences are soft and slightly puﬀy but not ﬁrm.)Thank you so much for your thoughts! ReplyKristin Wisgirda  NewApr 28, 2021 | EditedReactHi Nicole,Thanks for sharing your experience. Adverse reactions are never fun for anyone :( but they are the clearest indication directly fromthe body of the next right step which is to treat the counterbalancer, which would be SP+, even if sooo many other signs seem tocontraindicate that treatment. In another post, I just mentioned a move star handsome 50 year old man 9-10+ with signiﬁcantvaricosities 7+ who reacted adversely to SI+ but got signiﬁcant relief from his long time si/low back pain from K+.It is common for students to have a hard time counterbalancing a treatment they just convinced themselves was the correct one.Saam demands that we stay present to our patients and put the highest clinical weight on their reactions to treatment. Ourpatients' safety depends on it.Say you don't catch the adverse reaction on the table, but the patient comes back reporting to not really have felt good on thetable and either aggravation of the same symptoms or new symptoms that started very soon after the treatment and can't beattributed to anything else. The correct move is to treat the counterbalancer, even if the new symptom would - on paper- seem tobe aggravated by the qualities of the counterbalancing treatment.<ST+ treatment might have been a better choice> Your patient sounds more clearly Stomach excess: wet on the outside, dry onthe inside. Soft, not ﬁrm thenars support this. Stomach channel ﬁndings are equally attributed to Lung and Stomach excess. Lung+would dry his outside and moisten his inside.Mariavaccine or treatment?NewApr 26, 2021 | Edited1Reactpatient is 68 y.o. female, works as oﬃce manager/admin

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7 teacher remarksthin not dense 8very well groomed 9varicose 7heel not dry/ﬁrmrooted 8hunched over 8soft voice/ not easily stirred emotionally 8dry hair, wrinkled, dry skin 7face drawnstrong bones/teeth 8no sweet cravings 7cold feet 7soft middle 5eyes brightness 6denies being hot or coldfriendly and polite 8large belly 5thenar 5hx. of uterine prolapse, occ uti, arthritisI see her monthly:Treatments thus far in sequence: SI+, K+, LU+,LV+GB+,SP+She settled nicely each time and looks great after.I saw her this week after she called about developing swollen hot ankles on B legs. L side medial ankle is red, hot and swollen upto midcalf, L side lateral is swollen but less. R lateral ankle is swollen. she said that this developed over the week suddenly and hasnever had this before. I last saw her about 3 weeks ago. She had her 2nd vaccine shot a week before I saw her about 1 month ago.She noted that she had the same kind of reaction on her L arm when she had the ﬁrst vaccine. Aside from the swelling, there is noother complaints. I decided to use LI+R as it reverses my last treatment and I recall reading that Toby uses LI+ to remove toxicity.She settled well (but she always claims she settles and looks settled). The swelling seems to lessen on the table so I kept thetreatment.Question: since problem is on the SP and GB channels, I wonder if the treatment could have cause or contributed to this problem.Kristin Wisgirda  NewApr 26, 2021React

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1 reply 115 more comments15ReplyHi Maria,Thanks for your question.Sudden onset asymmetrical (even though bilateral) hot swelling does make me want to rule out blood clots. Assuming that she didthat:Since the timing of the onset of the hot swelling is important, please tell me if I got it correct:2nd vaccine: 1 month agoSP+ treatment: 3 weeks agoOnset of symptoms: 1 weeks agoIf the hot swelling started 2 weeks, or even 1 week, after the SP+ then I wouldn't attribute it to a true adverse reaction. The bigbelly 5+ makes me think wonder if ST+ would be a better match for her morphology so adding internal moisture might not havebeen the best choice.<Toby uses LI+ to remove toxicity.> LI+ treats toxicity that is speciﬁcally Spleen excess damp warmth that is taken to the extremecausing toxic symptoms such as rotting, putrefaction, pus, foul discharges. However in this situation LI+ might be a good matchbecause the symptoms are damp and warm and on the Spleen channel on at least one side, not because they are toxic.<She noted that she had the same kind of reaction on her L arm when she had the ﬁrst vaccine.> So her arm was swollen and hotaround the injection site soon after the ﬁrst vaccine? If so this was to-be-expected vaccine response. If the hot swelling was not atthe site of the injection, or if the onset of the hot swelling was also signiﬁcantly delayed after the vaccine then this is less likelyvaccine related.My patients like to blame to vaccine for all kinds of symptoms.ReplyMariaNewApr 26, 2021ReactThanks Kristin.I just think it odd that the problem is on the channels that I worked on, SP and GB. Many times I notice this. Patient will returnweeks later, complaining of issues that seem related to the treatment they received last. I wonder if using thinner needles coulddrag out the time it takes for adverse reactions to show up.for this patient, the large belly isn't really that prominent. When I did LU+, she settled super well and looked amazing after she wasdone. She got the lift that she much needed. Her face has been quite drawn and saggy.The patient's ﬁrst vaccine reaction showed up soon after injection.1 teacher remarkAdina KletzelChannel PathwaysNewApr 26, 2021Reacthi,When considering pathology along a certain channel pathway do we consider the interior pathway of the channel as much as theexterior pathway of the channel?For example if someone has acne on the throat - around St 9 area so are the stomach and lung channels given more weight thansay the Gb, Liver, and Heart channels who also pass through the St 9 area on their interior pathway?Thanks

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ReplyKristin Wisgirda  NewApr 26, 2021ReactWith acne being on the surface, I would give much more weight to the channels running on the surface than to those that run onthe interior.Just a reminder: In Saam secondary channels pathways (luo, sinew channel, divergents) do not have clinical weight whendetermining channels involved. We use the primary channels.8 teacher remarks2 replies 28 replies 83 more comments3TuriyaLI Morphology and LI Excess constant diarrheaNewApr 25, 2021ReactIn the recent 6 week class forum Toby spoke of constant diarrhea as being internal damp or LI excess. I'm wondering how doubledry holds the conditions for diarrhea.And I'm trying to visualize how thin and powerful arms are seen and viewed. I don't think this part of the LI morphology getsmentioned very often on any of the forums.Thanks Kristin! ReplyKristin Wisgirda NewApr 25, 2021ReactSp+ seems to increase the capacity of body to absorb ﬂuids, hence it can treat double dry LI excess. LI excess diarrhea could beseen as a kind of leakage- the body is unable to hold ﬂuids. Think of really parched soil in the rain- the water ﬁrst beads up androlls away in the dust.I have a friend with thin and powerful arms. His LI excess body type is such that he would have to go to extreme lengths to bulk uphis muscles. The LI excess body type has a hard time gaining weight. In the clinic, you might see manual laborers who are thindespite really demanding physical work. In contrast, I have a few oﬃce workers who never ever work out or do any physical laborbut yet have thick dense muscles. The density is a Liver excess quality but the bulk of the ﬂesh points says that the body hasenough Spleen qualities to grow substantial ﬂesh (even if they aren't really that Spleen excess). Spleen and LI excess morphologyis about quantity of ﬂesh. ReplyKristin Wisgirda  NewApr 26, 2021ReactA clearer diﬀerentiation of LI and Spleen ﬂesh (hopefully):LI excess is thin and hard. Dry makes things hard which creates strength. The thinness means ﬂesh and muscles will not be bulky.Spleen excess has abundant and soft ﬂesh. Soft makes the ﬂesh weaker.Kelly KaedingGB+ for insomnia?!?!!NewApr 24, 20211React

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5 teacher remarks2 replies 28 more comments8Hi everyone.One of my patients was experiencing headaches and jaw pain primarily on the GB channel, and also restless/achy along her outercalves on the GB channel, as well as insomnia, some reactivity with her kid, and ADD/scattered/hard to focus but can then hyperfocus. She does present with some signiﬁcant P XS characteristics as well, such as being a researcher type who can get paralyzedby indecision and said she could use Courage, so it wasn't clear cut, but I did P+ and her insomnia got worse. I was a little nervousto do GB+ but thought I'd better try it 2 weeks later when she returned and low and behold, here is what she said about the GB+tx when I checked in a couple days later:"Things are going better. I've been able to go to sleep pretty quickly and then sleep through the night. My jaw and shoulders are doing better, too, despite mysitting in front of a computer the last couple of days doing my taxes! Lateral calves aren't bothering me. I think my courage is better, but we'll have to put thatto the test later..."Without going into the whole case, I wanted to share this experience with all of you. Lots of reminders for me, of course, to look at the whole picture (shelooks much more like a librarian than a young Mike Tyson) and also to be open-minded and conﬁdent about the pattern that we see versus what the channelis known to do, like P+ for insomnia. In addition, I need to not jump on a word, like reactivity, and jump to GB XS - maybe some reactivity with one's children isactually an appropriate reaction at times?!Has anyone else had good luck this GB+ for a patient who was experiencing insomnia, or otherwise doing something unexpected.What Fun! ReplyKristin Wisgirda  NewApr 25, 20213ReactThanks, Kelly, for sharing your experience.Of all the gems in the intro for power point, insomnia being an indication for GB excess is one of the biggest red herrings.(Infertility indicating SI excess can also be misleading).Insomnia can respond to supplementing any of the 12 channels. Theoretically GB+ and SJ+ should be the least likely to be helpfulfor insomnia, but I have used them both successfully several times. Sleeping and waking are cyclical events involving down and infollowed by up and out. If your tendency is already too much down and in, sometimes you need the up and out to reestablish thehealthy cycling. SI+ can also help in insomnia cases. SI+ is like the good physical workout that then helps you to sleep better.<What Fun!> Oh yeah. It would be good to review such a case and look for other P excess signs that might have tipped you oﬀsooner. For instance, does her physical presence point more to P excess or GB excess? Are her movements slow and deliberateand rooted=P excess? Can you imagine her using her body in an assertive/aggressive way= GB excess? If you experience of herpoints more to P excess, then you might give less weight to her reports of reactivity. The lack of focus can be other things sodoesn't need to be GB excess.I made a mistake with GB/P with a patient with GB channel headaches. Her physical presence was more rooted (in hindsight) buther talking was all over place- rapid but also changing subjects frequently. She seemed on the edge stressed out and I couldimagine her lashing out in a reactive way. She was hot too and had UB channel hip pain so I ﬁrst treated UB+ which helped her hippain but not the headaches. Then I tried P+ - she had a week of horrible headaches. She also told me that during the P+ treatmentshe didn't feel right but couldn't bring herself to say anything (unusual for her). She refused to come back to me despite my pleasthat I could counterbalance the mistreatment and make it right. Yikes!She seemed settled on the table to me but that was because P+ is going to be slowing and rooting whether or not the patientneeds it. For her already P excess it was downright paralyzing. A cautionary tale. ReplyNaomi FrankNewApr 25, 2021React@Kristin Wisgirda I'm curious in this situation what terms you use to explain to the patient that you misjudged your dx and there isa way to counter the eﬀects of the treatment? Just like that?Kristin Wisgirda

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1 teacher remarkAlison Unterreiner, DACM, L.Ac.LI+ questionNewApr 23, 2021ReactQuestion for teacherI have a question about LI - in my notes, I have that LI "drains toxicity" - but I'm unclear on if it would that be an LI+ treatment or isit LI excess (so a SP+ treatment) that you would use to drain toxicity?I have a patient right now who is undergoing chemo and he is very dry, so I was considering a SP+ treatment on him, but if the LI+would drain toxicity...well I want to be sure I'm doing what's best.Thank you,Alison ReplyKristin Wisgirda  NewApr 23, 2021ReactHi Alison,Always a great idea to check and double check your notes!It is LI+ (not SP+) that can treat a speciﬁc kind of toxicity. This kind of toxicity is an extreme of Spleen excess damp warmth thatcreates rotten, putrid, pussy situations. LI+ is not appropriate for other kinds of toxicity unless they present in this extreme Spleenexcess way.Supporting patients subjected to other kinds of toxicity are best treated by strengthening their systems in a way their Saampresentation calls for.3 teacher remarks1 reply 1Kristin Wisgirda Body condition as a guide to wet/dry dynamicNewApr 21, 2021 2ReactReviewing notes from the observation class last weekend:Toby says that if thirst contradicts the body presentation, ie morphology and skin, go with the observation. This approach isconsistent with what I have observed of Toby's general approach: Physical signs with Earth and Metal generally have more weightthan symptoms. He really emphasizes body presentation over other signs and symptoms, especially when determining the wetdry dynamic. We recently talked about this in another post, mentioning that Toby uses body presentation as a strong indicator ofhow to treat bowel problems. For instance, hard dry constipation in a sweaty grossly overweight patient, his ﬁrst choice is LI+. Fordiarrhea in a thin dry patient, his ﬁrst choice is SP+.ReplyTuriyaNewApr 21, 2021 | EditedReactI've been wondering that if in determining damp/dry of the skin if actually seeing/palpating the mid back might not be the mostexact presentation. It is the most diﬃcult to reach with washing or moisturizers,Adina KletzelNewMay 05, 2021React

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1 reply 12 more comments 2Reply@Kristin WisgirdaI have a question on the wet/dry dynamic and determining what is interior and what is exterior. Someone who is clearly damp onthe inside and their skin is not strongly damp or dry but their muscles are hard, contracted, and tight and their mouth is dry sowhen tonifying St+ can the muscles be seen as the exterior? My intention would be to dry the interior and moisten some of thestiﬀness and hardness of the muscles with some ﬂuids. Is that too much of a stretch?Kristin Wisgirda3 teacher remarks4 replies 4Morgan GaskinFirst Sa'Am treatment!NewApr 20, 2021ReactI ﬁnally got some .25 needles and gave my ﬁrst "real" Sa'Am treatment yesterday! Not sure it was an amazing success but I'm glad Igot everything in order and have started using this great system.This was a very needle-sensitive patient. I didn't make a big deal about using diﬀerent needles or trying to get more sensation withthe needling, but she still seemed to notice the diﬀerence with a lot of hissing between the teeth and wincing. I ended upswitching to my usual thinner needles for the last two points.I went with supplementing Stomach for her, mainly because the grossest thing in the room to me is her very round, distendedabdomen and this is coupled with dry skin, so I wanted to bring her inner dryness and outer dampness. I can deﬁnitely see Lungexcess signs with her--shallow breathing, inﬂated thenars, plenty of external resources, things moving upwards in the body(hyperactivity in the head and some acid reﬂux). I thought Stomach a good place to start.I checked in with her twice and she seemed ﬁne. I don't think she ended up having a really deﬁnitive, strong reaction either way tothe treatment. I'm trying to think of questions I can ask her next Monday to see if any of her symptoms shifted during the weekthat I could link to this treatment. Overall not a raging success, but not a fail (so far) and I'm really excited to get started on thisjourney!ReplyKristin Wisgirda  NewApr 20, 2021 | EditedReactHi Morgan,Great that you are graduating to bigger needles over time. I know it can seem like a big deal. I remember having some angst whenI was doing the same. Patients will excuse all manner of needle sensations when they settle into the table and get good results. Ihave plenty of patients who make noise about needle sensation every single time but yet they keep coming back.Have you needled yourself with the thicker needles yet? It will help if you haven't. With thinner needles, it is hard toknow if this was a function of your diagnosis, your needle technique or needle thickness.As well, Toby has expressed concern about using diﬀerent gauges for the 4 points, likely because you are giving unevenstimulation to the 4 points. I had been using thinner gauge needles on jing wells because I liked the smaller handles and couldn'tﬁnd anything thicker than .30mm, but now am using .35mm to match the other points.Naomi FrankNewMay 05, 2021ReactI have not been able to needle myself since my 0.35s arrived. I placed one needle and bottled out.... eek. Will try again.I'm also realizing that my technique could use some work - I've had someone free hand Jing Wells on me and felt no pain (with thinneedles)

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2 replies 2ReplyAny tips are welcome!2 teacher remarksAdina KletzelGB stones - too consolidated?NewApr 19, 2021ReactHI,I have a couple of questions related to the same client.First - Are GB stones considered over consolidation?Or do we not consider them because we can't see them so we just work with what we can see?Second - someone who has black stool (also has GB stones), does this tell us anything in Saam diagnosis?Third - She has a very mixed kid/SI dynamic:Kid excess: is a prof. singer 7+ lots of varicose veins on medial heels, feet, and legs 7+ whole medial heel area looks purply anddark 7+Symmetrical 6+ stiﬀness on SI meridian on ﬁnger 7+SI excess: very dry, thin medial heels 7+ scared of other people's reactions toward her7+ low self-conﬁdence 6+ does not want tobe on stage even though she is a singer - does NOT enjoy being the center of attention 7+ Is 60 years old stiﬀness on SI meridianon ﬁnger 7+She is a very delicate person in body and mind. Gets easily insulted and scared of what other people will think of her if sheexpresses herself.She also thinks that her fear is her main issue.I already did a LIv+ treatment on her and next I would like to do Kid + for her before SI +. I think SI+ might be too much for herwithout Kid + but I know Toby says that he tried to do SI+ ﬁrst when both KId and SI are needed. I think there is a risk in doingeither one ﬁrst. What do you think?THanks!ReplyKristin Wisgirda  NewApr 19, 2021React<Are GB stones considered over consolidation? Or do we not consider them because we can't see them so we just work with what we cansee?> First question- no real weight, can be so many other things. Yes to the second question.<someone who has black stool (also has GB stones), does this tell us anything in Saam diagnosis?> Black stool says blood. This is a redﬂag sign that needs to be checked out by an MD. Nothing Saam speciﬁc.<does NOT enjoy being the center of attention 7+> This is likely SJ excess feeling overexposed.<lots of varicose veins on medial heels, feet, and legs 7+ whole medial heel area looks purply and dark 7+> This is a strong K excess signenough to give me conﬁdence that SI+ is a much better choice to use before K+.JohannaNewApr 24, 2021ReactHi,

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1 reply 1Replyit's so interesting to follow all the cases and thought processes.Regarding deciding btw SI+ versus K+ (and I completely understand this is not a full case write-up and other factors may well leadto another channel for treatment): I currently have a 83 yo male patient, very ﬁt for his age but also lots of spider veins aroundcracked heels. His main complaint is dribbling/frequency (physician attributes this to BPH, but patient is not convinced andattributes it to a badly applied catheter after a dehydration episode). My thinking is: given his age would it be ok to go straight forSI+? Rather go for K+ in the ﬁrst instance and only then to SI+?Thanks so much!Karim KarimHelp with a Sleep and Depression caseNewApr 18, 2021ReactHi all you great SAAMers!I just saw a patient on Wednesday past (18 April) and I would love some feed back and help. Please. I have attached a pdf with thecase to make it easier for me to work on it and hopefully for you to read and comment.I will write a shot bit, but more details are in the pdf.In short: 38 yr, MaleHe came to see me because he cannot sleep through the night. Falls asleep ﬁne but wakes up after a restful 5 hours and thencan't go back to sleep. Seems to wake up after the second sleep rested, but want to get a full night sleep, about 7 hours, all in arow. He is desperate to have this back. He does get angry about it and wonders "why is this happening to me?". He is also beendiagnosed with sleep apnea and sleeps with a machine.He is a big, tall man, and was dressed in dark sweat suit and slippers w/socks. Like he left home, getting oﬀ the sofa, and justdrove here. Didn't see his car.While questioning him, he brought out the fact that he is on antidepressants and been on several diﬀerent ones, this was d/t hebecame suicidal. This was about 1.5 years ago.He gained about 50 lbs, started about 5 years ago (forgot to ask why) and can't seem to get rid of it, but he didn't sound like hewas dong much about it.He also appeared slumped and concave chest, but didn't ﬁt the rest of him. Tall, large body (he said overweight), big belly, dry skin,Thirsty all the time, feels cold most of the time, but hot when he wakes up. Has very watery diarrhea and urinates lots, as he isthirsty, feels dry and drinks a lot.I didn't note down, but the Biggest thing in the room for me was seeing a big, tall man, feel so inward and inside himself.I wanted to move things in him, but after the intake, I was a little worried and concerned on what I should do. Because of theantidepressants and most of his issues started just before or after his depression started, I felt like I wanted to get him to lovehimself. But not sure if that was just me projecting.I will be seeing him again on Wednesday 21 April, and wondering if I should do the same treatment, or PC+. But I'm worried abouthis depression and him thinking too much.Help ...PDF

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2 teacher remarksPDF | 182.1 KMale 38 yrs case presentation h…Kristin Wisgirda  NewApr 19, 2021 | EditedReactThanks for the case Karim. I know it is lots of work to write out so much detail. Thank you for grading the symptoms.The way you have assigned symptoms could be misleading, so let’s take a look. I am listing your symptoms and interpretationsfollowed by my comments.Inward: P excess is rooted and deliberate, not assertive or aggressive. Liver excess is shielded and hard to reach, lost in an innerworld. Which sounds more right to you?Is his anger around not sleeping well really an up and out GB excess movement, or is it more frustration? Forget about his wordsand focus more about the energy behind the words. The more you can imagine him using his body in outward way, the more GBexcess he is.Why is this happening to me?: This doesn’t sound GB excess aggressive to me. Possibly Kidney excess self absorption. But it couldbe other things. Depends on how he is saying it.Wakes up hot, generally cold: This a mixed hot and cold presentation- SI excess or Kidney excess are considerations. Hot beingmore predominant belongs to H excess or SJ excess. Cold being more predominant belongs to UB or Liver excess. Any of theseexcesses are up for consideration.Depression: Consider UB excess, Liver excess, SJ excess, SP excess, ST excess (a kind of exhausted deﬂation).Vertigo: Toby teaches that you ﬁrst think about using SI+ (so K excess) but you want the rest of the presentation to support that. Inmy clinic I have used K+ more often than SI+.Not sure why you said dry inside and thirsty all the time is Lung excess. Lung excess is damp inside and dry outside. Thirst can beinternal dryness or a craving for UB water or because he is losing so much ﬂuid with the diarrhea.Constant diarrhea: How constant- if it is frequent this is a big problem. Could be internal damp, leakage (SI excess), too muchdown (St excess), could be cold or heat.Concave chest is Stomach excess but this is diﬀerent than being hunched over which can be P excess concavity or a lack of abilityto hold oneself up (possible SI excess)Constant urination: We need to know if it is complete or constant because it is only a small amount coming out at once. Not allfrequent urination is UB excess.Lack of self love- are you assuming this from his history of being suicidal or do you have other clues? Present suicidal thoughts orattempts have more weight than those in the past.Sweat suit and slippers: This could be SI excess lack of self love but it could also be Liver excess not caring about social normsMore information needed: facial symmetry, midline palpation, back shu levels of the low back pain; is being cold all the timeobjective or subjective, hypochondriac palpatory ﬁndings right and leftToby recommends avoiding K+ for the ﬁrst treatment, wanting to clean up other areas ﬁrst. K+ too early can consolidatepathology. To me, the SI/K imbalance in this patient doesn’t seem to be the biggest to me. Even if K+ improves his symptoms, Iwouldn’t repeat it for the second treatment.My recommendations for formatting cases and symptoms help guide you to your diagnosis. Please give them a try. Listing thechannels and placing corresponding aspects of the presentation next to them lets you see the signs and symptoms stack up ornot. Channel imbalances are more easily revealed. Doing it the other way around as you have done doesn’t give you that clarity.

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28 29 30 31   2 teacher remarks2 more comments2DebraRe L or R side of bodyNewApr 18, 2021ReactWhen someone has pathologies on R side of body but they are not located on Lu or St channel, do we still consider using Lu or Stfor treatment? And similar for Lv/Sj? ReplyKristin Wisgirda Apr 18, 2021ReactYes. The right sided association with Lung/St is independent of channel location. Same for the left sided association with Liver/SJ. Itoften happens that the ﬁndings will also correlate with those channels in patients who have the corresponding constitutions. ReplyDebraNewApr 18, 2021ReactThank you3 teacher remarksNaomi Frankbright eyesNewApr 18, 2021ReactRe: bright eyesI ﬁnd this rating particularly diﬃcult with (most people's) eyes, and i have wondered if the colour can cause an unintended bias.When I picture what I think of as 'diamond' eyes they are usually light coloured...although now that I say that, my hound dog canhave a very intense gaze in his dark brown eyes when he thinks that he may earn a treat and is trying to ﬁgure out what to do toget it.So is it really as much about the way a person is looking at and relating to us as it is about the way their eyes look?I can picture a +10 very SJ excess person. I have seen them. I can also bring to mind patients with shielded/dull look in their eyes.I'm having trouble rating people who are in between. So, let's say one is writing up a case study where other symptoms bring us tothe Liv/SJ pair and the eyes are unremarkable, do you give an average rating, or just leave that sign out? TIA!Kristin Wisgirda NewApr 18, 2021 | EditedReactColor can deﬁnitely make a diﬀerence in my perception. It is harder to see the brightness of darker eyes and the dullness of lightcolored eyes. I am still learning and by no means a master.Toby says to ask if the eyes are piercing. This hint is most helpful to me.34 students have completed the assignment. Visit Topic Activity for details.Forum

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3 replies 32 more comments2Reply<the eyes are unremarkable, do you give an average rating, or just leave that sign out?> Please let us know that you have consideredthe eyes and that they are unremarkable or that you are unsure.Here are some eyes. What do you think?JPEG | 11.6 K78821500-A972-44FE-9B3F-…PNG | 40.3 KScreen Shot 2021-02-01 at 2…PNG | 28.8 KScreen Shot 2021-02-01 at 3…PNG | 31.5 KScreen Shot 2021-02-01 at 2…ReplyNaomi FrankNewApr 21, 2021React@Kristin Wisgirda the upper pairs both look bright to me, withy perhaps the dark eyes looking more intense. The third set of eyes (bottom left) looks the least bright to me. The ones at bottom right look average.How do you see them?I also think that makeup can aﬀect the way someone looks.Kristin WisgirdaJohannaSaAm and moxa? Or cupping?NewApr 17, 2021ReactQuestion for teacherHi,ﬁrst of all, it’s just wonderful that Toby’s class is continuing in this form – it’s great to have this ongoing support. Thanks so muchKristin :).I’m wondering whether it’s acceptable to add adjunct treatments like moxa (cupping, tuina when doing SaAm? With moxa I don’tmean warming needle moxa but for example moxa pole on the abdomen or lower back?Thanks so much!Johanna

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1 teacher remarkReplyKristin Wisgirda  NewApr 18, 2021ReactHi Johanna,Thank you for your important question.The patient's response to the clear directional push of a Saam treatment- for good, for ill or mixed- has the highest clinical weightfor determining how to next treat the patient. If you add other therapies, how will you know which part of the response came fromSaam or those other therapies? How can you be sure that those other therapies aren't interfering with you Saam treatment?I don't add any other therapies during or after a Saam treatment. I also tell my patients not to get other therapies, including herbsI prescribe, for at least 48 hours after a Saam treatment whenever possible so that we can clearly evaluate the eﬀect of the Saamtreatment.That being said, I sometimes use gua sha and cupping and channel palpation (which could be considered Tuina), before Saam. Iﬁnd these to be helpful diagnositically. Palpating gives me information about the channels that can integrated into Saamdiagnosis- channels involved, heat, cold, damp, dry, dense, too open, etc. As well, I am chatting with the patient the whole time,getting information about the patient's life and the aﬀected area that often doesn't come up in a sit down interview.I always evaluate changes in pain and range of motion after these therapies before using Saam.From what Toby has said and seeing him in the clinic, he doesn't use any of these techniques. I haven't seen him do any kind ofhands-on exam either.ReplyJohannaNewApr 19, 2021ReactHi Kristin,thank you so much for your response – it conﬁrms what I suspected (adjunct treatments during or after SaAm creating confusionabout results). I really like the idea of gua sha/cupping/channel palpation beforehand.One of the reasons I asked about moxa is that I use it a lot and I know that some of my clients will query why I’m not using it asthey really like it.Kristin Wisgirda1 teacher remarkDaniel SchulmanParadoxes, Compensations and Trust . . .NewApr 17, 2021 | EditedReactMaria and Kristin wrote: . . . . . <Findings on scans have little to no clinical weight for Saam.>That is interesting. Still makes me a bit nervous to consolidate lower abdomen if a scan shows a growth. Thanks so much!*********Sometimes, the body in its paradoxical wisdom, will counter a deﬁciency with a compensatory development . . . so she may in factbe at the core, Kidney 'unconsolidated' and her body has, in a compensatory response, consolidated by producing ﬁbroids. I'vehad patients with a LOT of head congestion who otherwise were very 'dry' (in a full Sa'Am sense of dryness) . . . when I did SP+treatments, their head congestion cleared up! One of my biggest lessons with Sa'Am and it has and continues to take time - its abiggie! - is to not be afraid, to just evaluate fully according to the system and then to trust . . .

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ReplyKristin Wisgirda  NewApr 18, 20211ReactThanks for starting a new post so people don't miss your response to an older post.<the body in its paradoxical wisdom, will counter a deﬁciency with a compensatory development . . . so she may in fact be at the core,Kidney 'unconsolidated' and her body has, in a compensatory response, consolidated by producing ﬁbroids.>"Unconsolidated" means yin and yang are separating. What was physiological when integrated, becomes pathological during thebreakdown. Yin can easily accumulate into masses when it is not integrated, yang can ﬂoat up and out when it is not integrated.Lack of consolidation is just one mechanism that can cause yin and yang to separate.Below is cut and paste from an older post. The quotes are from Daniel again.<On of my biggest lessons with Sa'Am and it has and continues to take time - its a biggie! - is to not be afraid, to just evaluate fullyaccording to the system and then to trust> "Evaluate fully according to the system" is worth as much emphasis as formatting allows.Evaluate the whole patient fully, don't just get ﬁxated on the symptom.Evaluate the symptom fully, possible nature(s), location, channels. For instance, don't get ﬁxated on congestion just beingdampness or if it is clearly damp, the kind of damp that needs LI+.Below is a quote from a post Daniel made on the Qiological forum:<In my experience, when the ‘congestion’ is ONLY in the sinuses, but not in the lungs at all - all very very upper body . . . I have almostnever found it to be a primary issue around getting rid of dampness . . . in my experience this is much more often - almost always an issueof phlegm getting trapped in the very upper reaches of the body for some reason (you’ve even conﬁrmed that by noting that when hismuscles relax, he drains).>This reﬂects my experience as well and is super useful clinically.Evaluate according to the system. That means Saam. The closer your evaluation stays to Saam, the better your Saam diagnosisand results. Importing ideas and understandings from other systems often clouds your Saam seeing.ReplyMariaNewApr 23, 2021ReactIt is ﬁnd it hard to just trust when things could go so wrong if our assessment is oﬀ. Not that we intentionally make the wrongassessment, because I am certain we all do our best in that endeavor, but it happens either because our understanding of thefoundations is not strong, or that our perception of the patient is oﬀ.Daniel SchulmanFavourite GB XS Insomnia Patient Expression Ever . . . .NewApr 16, 2021 3ReactNew patient today with main complaint - Insomnia . . . .Direct Quote: "If I don't get some sleep soon, I am going to kill someone!"Adina KletzelNewApr 19, 2021React@Daniel SchulmanDaniel Schulman

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ReplyThat is awesome!!! Gotta love when patients tell us EXACTLY what they need!!3 teacher remarks2 replies 21 reply 1Daniel SchulmanNewly Commented Upon Posts?NewApr 16, 2021ReactThis platform does not seem to move any post that has a new comment to the front of the line or ﬂag it in any way so that when Iget on here, I can see where new comments have been added - even to old posts and threads. Makes it very hard to keep up onnew comments unless one takes the time to go through all posts from top to bottom. Am I missing something or is this just theway it is with this platform?ReplyKristin Wisgirda NewApr 16, 2021 | EditedReactA yellow dot indicates a new comment on a post but the platform doesn't move a newly commented upon post to the top.If you are commenting on an old post and want your comment to be seen, I highly recommend starting a new post. Cut and pasteis easy.This platform does make one appreciate the Qiological forum platform.ReplyNaomi FrankNewApr 18, 2021Reactspeaking of this platform, I've been wondering if you are all manually putting in these <quotations> ? Or am I missing something inthe formatting?1 teacher remarkFang CaiLI+ for dry hard constipation?NewApr 15, 2021ReactAlong the same lines of “cold people needing UB+”, I’d like to learn about people with constipation who need LI+I’ve run across a few patients who have constipation of dry hard stools, alongside SP excess presentation: bloating, high appetiteesp for sweets, heavy fatigue, no motivation, foggy head, maybe a wart around SP9 or damp skin. I want to use LI+ on them, buthave never done so for fear of aggravating the dry hard constipation.I understand in theory that dampness could be blocking physiological ﬂuids in the LI and that drying damp could help with theconstipation, but I have never been brave enough to test the theory.Does anyone have experience/examples of using LI+ in such cases?

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2 more comments2ReplyDaniel SchulmanNewApr 16, 2021ReactIn my experience so far, two central considerations to put into this mix - together I use them to really direct me this way or that . . .. (1) the overall body type . . . . is their body type 'dry' - meaning are they skin, veins and bones with very little ﬂesh . . . . is theirbody type 'wet' - meaning do they have excessive rolls of ﬂesh . . . . (2) are they a 'couch potato' or are they super industriousalways active with many projects on the go? ReplyKristin Wisgirda  NewApr 16, 2021ReactOn the subject of stools, Toby has mentioned that he is more likely to morphology and skin moisture over stool quality. He gavethe example of dry hard stool in moist skin obese person- LI+ would be his ﬁrst choice, Stomach+ would be his second choice.I don't have any experience using LI+ for dry constipation in a double damp person or herbally using large doses of unprocessedbai zhu for dry constipation in any body type.2 teacher remarks1 reply 1TuriyaLeft sidedness and self treatment.NewApr 14, 2021ReactHistorically and presently I have left sided woundings or pain. As a teenage I tore a tendon in my wrist ( LI ch) . About 20 years agoI developed a largish lipoma on my left neck around LI18 which was surgically removed. . I have had a lifelong tendency to leftsided temporal headaches. A couple of times a year I get some pain in the left sacroiliac joint. In the last few weeks I havedeveloped deep pain in the left lateral knee/GBch . And 10 days ago I painfully cut my left thumb.So my question for my own self treatment is this: In my notes I have written to supplement Liver for left sided pain stuﬀ. Butwould it be appropriate to alternate and treat on the right side as well as on the left ?I tend to be TW Excess. ReplyKristin Wisgirda  NewApr 14, 20211ReactHi Turiya,<In my notes I have written to supplement Liver for left sided pain stuﬀ. But would it be appropriate to alternate and treat on the rightside as well as on the left ?> Liver should almost always be supplemented on the right, except when symptoms present on the rightin which case you would supplement Liver on the left.Symptoms only being on the left side gives weight primarily to SJ excess but also to Liver excess. So given your SJ excess, all of yourleft sided pains add weight to the SJ excess diagnosis.I am not entirely sure if this answers your question. Please let me know. Thanks! ReplyTuriyaNewApr 14, 2021ReactThanks Kristin. After all these months I should know this. I feel like my head got spun around a bit!

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2 teacher remarks1 reply 1Leisha LairdShock/ TraumaNewApr 14, 2021ReactHi Everyone,I just had the client we did the case on in March in class reach out. (59 year old woman with severe Insomnia and post oncologysurgery and radiation on her neck)Her husband died on Monday, suddenly, and she attempted to resuscitate him. She is coming in today to see me. I will stay opento what she presents with. She was calm and her polite self on the phone yet she described that she can't ﬁnd the word to explainhow she feels. The closest is trauma from attempting to reccessitate him while unable to compute what was happening.I want to hold space for her and do my best to diagnose at the same time (which is improving yet I am still very new). It may bequite clear when she comes in yet do you have suggestions on what to look out for or be mindful of with trauma/ shock?Thanks,Leisha ReplyKristin Wisgirda  NewApr 14, 2021 2ReactSo sorry to hear about your patient. Symptoms related to trauma and shock are most often related to where the system is mostout of balance so there is no set prescription. To quote Toby- "Trauma lives in the gaps"- the gaps being the biggest discrepancybetween channel pairs.If you aren't clear on your diagnosis for the patient, it is best to use other acupuncture tools. Of course, your attentive presencewill be a great support to her. ReplyLeisha LairdNewApr 20, 2021ReactI love that visual - Trauma lives in the gaps.That reminder has helped me this week, looking for the biggest gaps. Thanks KristinAlison Unterreiner, DACM, L.Ac.Sa'am and limb amputationsNewApr 14, 2021 1ReactQuestion for teacherHi Kristin -I was wondering how Aa'am works when you are treating someone with 1 or more amputations. I currently have a patient comingin for spinal stenosis who is a double amputee and cannot get out of his chair, therefore I really think Sa'am would be beneﬁcial(since there are so few points and he doesn't need to get on the table), but 1/2 of the 4 points would go in a limb he no longer has.Please let me know what you think!

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1 teacher remarkThank you,Alison ReplyKristin Wisgirda  NewApr 14, 20212ReactIf the patient is missing both lower limbs, I don't see how you can use any of the 4 point combinations. Splitting up the 4 points,you are changing the directional quality of the treatment in ways that are not studied through this system of Saam. I don't see anychoice but to use another system.4 teacher remarks1 reply 19 more comments9Adina KletzelSp+, 2 needles in wrong directionNewApr 14, 2021ReactHI,This is the ﬁrst time I have done this - for SP + I put Sp 1 and Liv 1 needles going in the direction of the channel instead of against. Ionly noticed when I took the needles out. I had turned them counter clockwise and left open the point when I took the needlesout. I have never done this before and I would like to know if you think the treatment had any aﬀect at all or the whole treatmentwent to waste?Also - could I have caused any harm to her? ReplyKristin Wisgirda  NewApr 14, 2021ReactLiv1 and Sp1 are needled with the channel (supplementing direction) is part of the SP draining treatment. So you ended up usingpoints to both supplement and drain SP in one treatment. Hard to know what a body is going to do with the mixed messages. ReplyFang CaiNewApr 15, 2021 1ReactHi Adina,How did the patient settle on the table?I've certainly done incorrect needle directions - some I suspect suﬀered from it, and some had a fantastic treatment. So... I'm justgathering more data; would you please let us know how the patient does in the coming days?Daniel SchulmanBone Metastasis and Sa'AmNewApr 12, 2021ReactI have a new patient coming in next week - elderly gentleman, with a history of prostate cancer who has bone metastasis - I thinkhe has been 'holding his own' for quite a few years, living a rigorously healthy lifestyle . . . . given the intense directionality ofSa'Am (and that I personally am into it now with about a year and a half of clinical experience), would you have any apprehensions(general or speciﬁc) about using Sa'Am with him - as opposed to a more 'harmonising' approach (I preceded Sa'Am which is all I donow - with 20 years of almost exclusively Kiiko style).

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1 teacher remark1 reply 1ReplyKristin Wisgirda  NewApr 13, 2021ReactHi Daniel, So nice to have you joining the conversation.I love your question. Knowing the great directional power of Saam, you are concerned about the safety of your patient. There areso many considerations to practice safely.While all patients need to be handled with care, that Daniel's gentleman is elderly with serious disease in an advanced stagemeans extra consideration. The wrong treatment could really send him spiraling in the wrong direction.The safest practice of Saam is a single sided treatment addressing the biggest discrepancy amongst the counterbalanced pairs. Ifcounterbalancers are closely matched in signs and symptoms, even if it seems most relevant to the patient's chief complaint, it isalways safer to look for a clearer discrepancy between counterbalancers elsewhere. If you can't see a clear discrepancy betweencounterbalancers that would be relevant to the patient's chief complaint, it is better to use another system of acupuncture. If I amunsure about a Saam presentation, I treat with another system.At the advanced class last weekend, Toby mentioned that the elderly's initial response to treatments can be "slow" and "weird" .For me that means harder to evaluate. He gave an example of a 75 year old woman with intense lbp which didn't change in thetreatment room. The next morning the pain was clearly worse but then was 50% better for the next 3 days. Expecting a slow anduneven response to treatment diminishes my conﬁdence that I can read the patient's response clearly in case trouble shooting isneeded.For the elderly, SI+ should be used with great caution. Pain alone isn't enough of a sign. You want to see clear Saam signs ofsubstantial blood stasis or Kidney overconsolidation. If you do use it successfully in the elderly, I wouldn't use it twice in a row. Thegeneral rule for patients in weakened states- and that includes those of advanced age- is that you don't use the same treatmenttwice anyway.Knowing you considerable Saam experience, what are your concerns Daniel?

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1 teacher remarkMariaP+ with low SJNewApr 09, 2021ReactHi Kristin,I was rereading another post that you commented on last year, where someone's patient said "I would NEVER want to get high ordrunk or lose control.”Your response was "P excess devotion to following rules could make one speak these words. Especially since she is low on SJ."Do you mind explaining what low on SJ would mean in this situation? I would think the opposite, that it would be someone whowas SJ excess never wanting to draw attention to themselves.Thank you. ReplyKristin Wisgirda NewApr 09, 20212ReactHi Maria,A quality of SJ excess is a desire to control others but also to be in control themselves. Often they know they are more aware ofthe external than other people are. That makes them want to be in control.3 teacher remarksAlison Unterreiner, DACM, L.Ac.Initial Visit Sa'am TXNewApr 08, 2021ReactHi again!So I just wanted to share this really cool experience!I had a patient last week who came in for her initial visit with a laundry list of complaints - sciatica, anxiety/depression,hypothyroid, sinus issues, allergies. I won't get into the whole case but she was very slow and deliberate, quiet, dull eyes, hair wasgreasy and unkempt, constipation and she complained of extremely extremely dry skin.I did a ST+ treatment on her, since it was just so obvious she was a LU excess, but I was super anxious since I knew if it wentsideways on the ﬁrst treatment, I'd likely never see her again. She was very tense on the table and I almost pulled the needlesbecause her tension was making me tense! But I just KNEW she needed ST+ so I kept it in. Her complexion looked good and I lether rest.Well I saw her this week and I swear, it's like she was a new person! Her eyes were brighter and her hair wasn't matted down toher head. She said she felt like she was detoxing for 3 days after the last treatment and that she deﬁnitely felt lighter and calmer. Iwas so pleased with the result!-alisonUnfortunately, I did not do another Sa'am treatment because it wasn't totally obvious what she needed on the 2nd visit *sadtrombone sound*DebraNewApr 08, 2021React

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7 replies 71 more comment1ReplyAlison, could you please explain your thinking on LU exc? I'm new and trying to understand. Thank you. I see:Liv exc = dull eyesPC exc =slow and deliberate, quietSI exc= Hair greasy and unkemptLU exc= sinus, allergies ReplyDebra NewApr 09, 2021ReactThank you both. More clariﬁcation helps.3 teacher remarksAlison Unterreiner, DACM, L.Ac.So many questions!NewApr 08, 20212ReactQuestion for teacherHi!Now that I'm using Sa'am more and more, I realize there are simple things I know Toby has gone over, but I can't recall.Firstly, when inserting needles, I know we are going from top to bottom, but how do we pull them?When looking at a case and trying to determine what to treat, I know that everyone is unique and people tend to have aspects ofeach channel, which can sometimes throw me oﬀ - for example, if someone seems to be very SI excess, but they have varicositiesis one that happens to me a lot - how do you suggest treating that? Do you move on to the next channel or do you toggle betweenthe 2 channels?Lastly, Toby has put the fear of god in me about using GB. I have a patient who is slow and deliberate and intellectual with atendency towards depression and anxiety that might do well with a little "up and out", but I'm too nervous! Please help me be okwith using this channel!Thank you!AlisonKristin Wisgirda  NewApr 09, 2021 2ReactHi Alison,<Firstly, when inserting needles, I know we are going from top to bottom, but how do we pull them?> Toby has mentionedremoving them the same way but also that needling order and removal are not a big deal. Closing the hole for supplementing thepoint and leaving the hole open for draining a point is more important when removing the needles.

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4 replies 4Reply<If someone seems to be very SI excess, but they have varicosities is one that happens to me a lot - how do you suggest treatingthat? Do you move on to the next channel or do you toggle between the 2 channels?> Every human being a mix of qualities fromall 12 channels. Practicing Saam you are looking for the grossest imbalance between the channel pairs as a primary guide fordiagnosis and treatment. I suggest using the tool of listing the signs and symptoms that belong to each channel excess. When lotsof signs and symptoms pile up behind a channel but very few behind its counterbalancer, you will be able to see the imbalance.Grading the symptoms helps too. If the varicosities are 10+ and the grossest thing in the room and the SI excess symptoms arefew and mild, you treat SI+. But you also have to consider the relevance of a ﬁnding to the chief complaint.<Lastly, Toby has put the fear of god in me about using GB. I have a patient who is slow and deliberate and intellectual with atendency towards depression and anxiety that might do well with a little "up and out", but I'm too nervous! Please help me be okwith using this channel!> You are wise to want to use GB+ with caution. Go through the case and analyze the balance of GB and Pexcess signs and symptoms. Even if the patient is clearly P excess, you do still need to ask if the patient has signiﬁcant personalturmoil going on. If so, you pass on the GB+ treatment and look to other channel imbalances.You don't want to unleash thethunder and storm when a situation is better approached with rooted and calm Pericardium qualities.Adina KletzelCase Study - Excruciating Shoulder, Scapula, and neck painNewApr 07, 2021 | EditedReactFemale age 47Chief complaintExcruciating left sided neck, shoulder, and scapula pain that radiates down her left arm.Pain is constant. On SJ, SI, GB, and PC meridians.Day after second vaccine had shooting pains in left arm. Went away after 10 hours.3 weeks later woke up feeling tightness in shoulder that developed into pain.Pain has been at a 12 for a month.In 2017 was in car accident. Damage to vertebrae T4 and T5Discs are bulging and herniated.Appearance and DemeanorOverweight 5, lost 15 kilo this year and is still dieting,very bright and piercing eyes 9, Warm and friendly 9, very talkative 9Her talking does not feel heavy, she is positive and warm and not self-centered.Symmetrical 7LifestyleShe is a dating and marriage coach. Mother of 5 biological children (youngest is 11) and one adopted daughter. Had 5 C-sections.She and her husband are also spiritual and religious leaders in their community.Walks and swims regularly. Loves to swim 9 - says its her happy placeLoves the forest 9 (wants to build a clinic in the forest, husband proposed to her in the forest…)Likes things to be orderly 8

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She is a doer, likes to be busy 7Good energy level 8Always wears sunglasses in the sunBody morphology and Flesh qualityFlesh not dense and not soft and droopy – somewhere in the middleBody TempLikes summer and winter. During the day not too hot or too coldGets freezing when she is tired, likes to be covered with lots of blankets – likes the weight and the warmthGets some hot ﬂashes at nightGIGB removed a number of years ago cuz was ﬁlled with stonesHad pains under both breasts that were somewhat relieved with a bowel movementNo longer has those painsStool on softer sideThirstySleep well but now harder to sleep with painEmotionsPositive attitudeLoving, warm, talkativeGives a lot to others but also takes care of herselfShe had a very rough month – had to move houses suddenly (did not want to move), in pain, grandfather died,Had Passover holiday where had to host a lot of people.Over past month felt anxious, nervous, and angry, says she is feeling better now – she moved and likes her new houseFeels the people around her 8, reads people and situationsLikes to be in control 7Says she does not get angry easily.She is not meek, she can assert herself but says does not react emotionally to situations.She is passionateMenstruationFirst 2 days very heavy 7No crampingFeel weak and get a headache 3-4 days before period, feel better once period comes

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Period lasts 7 days, only ﬁrst 2 days heavyTonguered and dry in MWSides palerThinnerThick purple veins underneathCracks on sidesBodyFrom sternum to umbilicus soft and warmStomach - ﬂesh – soft and a bit spongy 4Thenar eminence - not ﬁrm and not weakMedial heel – ﬂeshyPC meridian on arm tight and painful when pressedExcess PresentationsSJ very bright eyes 9 likes order 8 craves the forest 8 pain on SJ mer. 10 aware of people around her 9 needs to wear sunglasses insun 8Liv pain on SJ merHt talks a lot 9 pain on Bl mer 8 loves the water 9 very active 8 very loving 9 sternum to umbil. Soft and warm 7UB freezing when tired 8 pain on Bl mer. 8Kid had car accident 9 in terrible pain 10 fertile 8 had 5 c sections 7 pain on SI mer 10 ﬂeshy medial heel 8SI pain on SI mer 10 gives A lot to other ppl 8 symmetrical 7GB ? had GB stones 8 pain on GB mer was angry in past couple of weeks (at G-d) 8PC pain on GB mer..10 doesn’t get angry 7LI likes to be busy and do 8First treatment did Liv + (R)Did not settle deeply, still in pain during and after treatmentsaid felt cold after I put the needles in and she remained cold throughout the treatment (Is that a red ﬂag?)Said it was relaxingMain ideas: Bl, SI, PCTreating her again tomorrow.I am not sure if I should go straight to SI because of the extreme painOR maybe to Bl because the damaged vertebrae are on the Bl meridian and the pain may be connected to the second vaccine –maybe stuck in the tai yang.

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8 teacher remarks1 reply 11 reply 112 more comments12Or maybe PC because the pain radiates down the PC meridian and it is tight and stiﬀ to the touch.Thanks! ReplyKristin Wisgirda  NewApr 07, 2021ReactThanks for the case Adina.<felt cold after I put the needles in and she remained cold throughout the treatment (Is that a red ﬂag?)> Liver+ adds coolness tothe body so this reaction is not surprising or worrisome unless it is uncomfortable or unsettling for her.<SI pain on SI mer 10 gives A lot to other ppl 8 symmetrical 7> Symmetrical 7 belongs to K excess. Giving a lot to others isn't an SIexcess sign to my mind. Given other aspects of her presentation, this is more consistent wit Heart excess love of others. SI excessis more about not taking care of yourself. She has plenty of K excess signs to support the use of SI+.<OR maybe to Bl because the damaged vertebrae are on the Bl meridian and the pain may be connected to the second vaccine –maybe stuck in the tai yang.> None of these reasons that you list have much or any clinical weight for Saam. However, her Heartexcess presentation is strong enough to use UB+. If you had mentioned UB or H channels being aﬀected by the pain, Ub+ wouldbe my ﬁrst choice.Please let us know what happpens. Thank you. ReplyKristin Wisgirda  NewApr 08, 2021ReactSee her tomorrow if possible.She will have the night to process the treatment.She is in crisis right now which is enough to stir up GB a little but GB excess doesn’t sound like her chief imbalance. She is so clearly K excess, K+ would be very, very risky.MariaSI/KNewApr 07, 2021ReactHi Kristin,I gave my infertility patient with multiple ﬁbroids 2 SI+ treatments 2 weeks apart. She seemed to have settled well upon receivingthe treatments. She disappeared oﬀ my radar for about 2 months. She returned recently complaining of bad depression and"feeling like an old lady on the inside." She said she hasn't been feeling well for a couple of months now and has been verystressed with work and home life. Her husband has cancer and undergoing treatment. Upon checking her, I noted that her heelshave become extremely dry and deﬂated. She said that her period 2 months ago, she had bleeding for 10 days straight.So it seemed that it was a mistreatment that didn't get caught because the patient didn't return for a followup. My questions are:1.) do I give her a K+ treatment even though she has ﬁbroids? If so, could that potentially enlarge the ﬁbroids in the future?2.) what is your strategy about follow up with patients post SAAM?

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2 teacher remarks2 replies 2Thanks for your thoughts. ReplyKristin Wisgirda  NewApr 07, 20211React<So it seemed that it was a mistreatment that didn't get caught because the patient didn't return for a followup.> Sounds likely.The most weight for an adverse reaction is when the patient clearly doesn't settle and has side eﬀects. The reality is that I don'thave high conﬁdence in my ability to evaluating settling and positive face changes on the table. I suspect that many otherpractitioners are in the same boat, made worse in this tme of masks. For that reason, if someone returns having a bad week or theappearance of new suﬀerings, I highly suspect my treatment. But it isn't always an adverse reaction so you again have to watchthe response on the table.Your patient sounds like she has signs of SI excess but you should look at the balance of her whole system at this point.<1.) do I give her a K+ treatment even though she has ﬁbroids?> Do her ﬁbroids ﬁt the gold standard of Kidney excess, ie hardpalpable masses in her lower abdomen? If they are not palpable and hard, then they have little clinical to clinical weight for Kexcess. Findings on scans have little to no clinical weight for Saam. As well, masses can accumulate because of damp, yang xu, etc.Channels where they are located need to be considered too, if palpable.<2.) what is your strategy about follow up with patients post SAAM?> Always reevaluate. ReplyMariaNewApr 07, 2021React<Findings on scans have little to no clinical weight for Saam.> That is interesting. Still makes me a bit nervous to consolidate lowerabdomen if a scan shows a growth. Thanks so much!Spenta KandawallaCase continued from Saam Mentor ClassNewApr 05, 2021ReactQuestion for teacherHi Kristin,I'm responding to the questions you posed last week about my case and have updated the case again with my latest treatment...<is she symmetrical?>I have a harder time assessing this if it's subtle, but I would say, yes, she's symmetrical and always put together. She does wearvery bright clothes and I believe I heard Toby once say that could be a Liver excess. I had a hard time understanding that so if youcould give insight in general and on her clothes, I'd appreciate it.<I am really curious about Liver+ for her given my above comments and the left sided knee pain. Liver+ is my top suggestion. IfST+ did cause the acne outbreak, that would support LI+. I am not sure above UB+ given that she is generally cold. Her personalitysounds more like SJ excess rather than H excess. H+ is a contender as well because of the back pain and her running cold ingeneral.>(this is also in the attached updated case)

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3 teacher remarksSI+ caused the acne breakout. She had a good experience after ST+. It relieved her shoulder pain and when I saw her last week,the shoulder pain was still gone. It didn't touch neck/occiput pain and wandering back pain. Last week she came in withneck/occiput pain, medial left knee pain, low back pain, and her left foot seizing up in the arch and around LV 4 and ST 41, andhead pressure in her temples. A lot of wandering aches and pains (she's only 30). She also told me she's very detail oriented andwhen she misses things it raises her threat level for everything and she blames herself. So I treated LV+.She realxed on the table but not as deeply as when i treated ST+. Facial complexion seemed normal. Patient has dark skin soslightly hard to tell, but she didn't go pale or get blotchy and she didn't appear distressed. I also check in and re-check after a fewminutes and she was resting. But after treatment she said she felt the pain moving around and strange sensations, but was alsopleased with the experience.Results the next day: overall feeling good; said knee is "not feeling bad at all", has less "crunchiness" in low back, some tightness inthe upper part of her low back where the pain moved to during treatment, no alleviation of neck pain and her foot was still seizingup the night of the treatment.She runs warm body with cold hands and feet (worse feet). But she comes in often in a t-shirt (the bay area is notoriously weirdlycold) and her midline is soft and warm. I'm wondering about UB+ for her next treatment to try and get more targeted on thisneck/back pain. Or LI+ for damp body, diarrhea with stress and anxiety, mixed skin picture.Thank you for any insight.PDF | 88.1 KPDFCase Study_March2021_update…Kristin Wisgirda  NewApr 05, 2021ReactHi Spenta. Thanks for the update.<Treatment 1: SI+ on the Left • Results: no alleviation of body or head pain, but she didn’t have any menstrual crampsfor this cycle (was on Cd 1 when I treated her), she did bleed more; she also noted an acne breakout across her jawline aftertreatment that she described as sudden; body and head pain got worse over the week and had some ringing in ears – she thinksdue to stress>I am still curious about possible adverse reaction to SI+ now that you are clear that the acne happened after SI+ not ST+. Eventhough she has some Kidney excess signs, this kind of response is enough for me to use K+.<She does wear very bright clothes and I believe I heard Toby once say that could be a Liver excess. I had a hard timeunderstanding that so if you could give insight in general and on her clothes, I'd appreciate it.>Bright clothes bring to mind a couple of qualities. Liver excess folks are so dull so brightness and sparkle are welcome stimulationfor them. Kidney excess folks can wear ﬂashy clothes to draw attention to themselves. They love being noticed. Do you noticeeither of these vibes in a strong way?

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1 reply 13 more comments 3Reply<She runs warm body with cold hands and feet (worse feet). But she comes in often in a t-shirt (the bay area is notoriously weirdlycold) and her midline is soft and warm. I'm wondering about UB+ for her next treatment to try and get more targeted on thisneck/back pain. Or LI+ for damp body, diarrhea with stress and anxiety, mixed skin picture.> Given generalized back pain, UB+ andH+ are contenders. Now that you have determined that her body is more warm and her midline is warm and soft, UB+ might bethe better choice but her picture isn't text book H excess.The case for using LI+ given her chief complaints is less strong than UB+. The diarrhea only coming on with stress gives it lessweight for dampness. Her body morphology seems only a little damp. Her pain is not impacted by damp. The medial knee paincould be on the Spleen channel which does give weight to using LI+ if that is a prominent symptom for her.Her picture remains mixed. At this point, for me, K+ and UB+ are worth consideration for your next steps. Or repeating ST+.Please let us know what happens.ReplyMariaNewApr 07, 2021 | EditedReactQuestion for teacherHi Kristin,I am wondering if cystic acne could be a sign of GB+ since abcesses or non-healing wound could be due to P+.?Since the patient's pain could be along the GB, I am wondering whether this patient is convex or concave? Since GB is shaoyang, Iam curious if a mixed presentation of hot/cold a consideration for the GB channel? Another possible GB consideration is thatthere maybe anger issues < “puberty was really hard facing active bullying and racism”. > <she walks into clinic like her feet aren’t on the ground+4> -Seems SJ+, but could that be GB+, kind of a Mike Tyson walk? with breasts, I know it is consider a LU+, but I've noticed that sometimes it can be bigger and more swollen on the sides along the GB/Pchannel. Could that be a consideration too?I am trying to understand the qualities better as I consider these cases. Thank you so much.2 teacher remarksAdina KletzelIntake questionsNewApr 05, 2021ReactI though it would be super helpful if we could put together a master Sa'am intake questionere. THis would be an intake withspeciﬁc questions to bring out the channel imbalances. I have some questions that I use but I am sure that there are many moreout there that I have not thought of.Kristin - I am sure you have a lot of great intake questions. Can you share yours?And can others also share questions that they have found really bring out the excesses and deﬁciencies of each channel?Adina KletzelNewApr 05, 20211ReactA couple of the questions that I use:Do you crave warmth?WHen you are in a room by yourself, do you like to have the light on or prefer to keep it oﬀ?Do you prefer going out and being with people or staying home?

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2 replies 21 more comment 1ReplyDO you crave sweets?Can you rate your energy level from 0-10?Would you prefer going for a walk in an open ﬁeld in the bright sun or in a dark cool forest?Are you meticulous? Are you a perfectionist?ReplyKristin Wisgirda  NewApr 06, 2021React<You just ask conversational questions and that leads you to what is in excess?> For the most part yes. Conversational questionsdevelop rapport and the information ﬂows freely from there- both what the patient says and how they say it. Now and then, I dopepper in more pointed questions to clarify.I have a new patient on the table right now. She wasn't oﬀering me good information about the nature of her back pain.Hammering away at it wasn't going to help. Asking her the following questions, information about aggravating/amelioratingfactors and lifestyle came out naturally.What kind of work did you do before retirement? How do you like retirement? Any new hobbies since retiring?How do you know the patient who referred you?Kristin Wisgirda Practices For New Saam PractitionersNewApr 04, 20215ReactWhether or not you feel ready to treat with Saam, you can use these practices to improve your Saam observation skills and helpyou improve your ability to weight signs and symptoms. This will improve your ability to diagnose and treat.Get into the habit of observing and noting Saam diagnostic signs and symptoms. To avoid getting overwhelmed keep it simple.Maybe one day you will just make a point of looking at everyone’s heels, plump/withered, varicosities present or not. Even if youcan’t remember what means what just write what you see.An incomplete list of features to start noticing:eyes bright/dull morphology skin dry/moist ﬂesh dense/light aﬀect open/closed thenars: plump/withered ﬁrm/ﬂaccidheels: plump/withered, dry moist, varicosities yes or nomidline: soft/tense, warm/coldGrade your patient’s signs and symptoms, 1-10+: Mild symptoms that occur infrequently get a low grade: High intensitysymptoms that occur often get a high grade. There is a direct correlation between grade and clinical weight. Don’t get caught upwith a symptom they used to have.For qualities that you aren’t use to observing, this might seem hard at ﬁrst. Even if you have no idea, compare that quality in thepatient before and after the one in question. Comparing and contrasting patients’ qualities will help you quickly develop an eye forthe range of presentations. Often a patient will exemplify a quality and become your standard for measuring all bright eyes, forexample.Don’t forget the channels. Many students get captivated with Saam psychology and morphology and forget to consider thesymptomatic channels in their diagnosis. Remember, the presence of a symptom on a channel means that you should considerthat channel and its counterbalance.Don’t forget the chief complaint. Try to relate the channel imbalances you ﬁnd elsewhere to the patient's chief complaint. If apatient comes in with a laundry list, have them rate their suﬀerings so you can address what is most important to them.

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1 teacher remark2 more comments2 ReplyTerri MatsonNewApr 16, 2021ReactThese such helpful reminders to keep reorienting the diagnostic process toward. Had a follow up treatment with a patient and theroom that completely smelled of urine. It reminded me of that often simple (but sometimes not easy) task of locating the biggest(grossest) aspect in the room and how that plays into the treatment process. ReplyJohannaNewApr 18, 2021ReactThanks Kristin, I ﬁnd all the pointers how to transition in a gentle way from current practice to SaAm really helpful, especially thereminder of not forgetting the channels.1 teacher remarkAdina KletzelLiv + timingNewApr 04, 2021ReactQuestion for teacherI have a client who gets migraines before her periods. Her migraines are a 10 out of 10 and she often vomits incessantly andneeds to go to the emergency room for treatment.She is a SJ excess in that she has strong attention to details, is a perfectionist, self-critical, meticulous, and too much bright lightand hot sun can trigger a migraine. She is a very tense and uptight person who gets stressed easily and this directly inﬂuences hermigraines.Liv+ has not helped with her migraines. I was wondering if using Liv+ during the second half of her cycle (after ovulation) asopposed to the ﬁrst half of her cycle could inﬂuence the eﬀectiveness of LIv+ for her.Her migraines come at a time when the body needs a lot of movement - right before her period and LIv + increases the density ofthe blood so could it be that LIv+ for her will only be aﬀective at the time of the month when the body WANTS to increase thedensity of the blood - ie: right after the period but before the period when the blood needs to move smoothly Liv+ is too dense?I am basically asking - for someone whose main complaint is directly related to the menstrual cycle shouldn't we take the cycleinto account?And could LIv+ right before the period aggravate symptoms while after the period beneﬁt the symptoms? ReplyKristin Wisgirda  NewApr 04, 2021React<for someone whose main complaint is directly related to the menstrual cycle shouldn't we take the cycle into account?>Yes.<And could LIv+ right before the period aggravate symptoms while after the period beneﬁt the symptoms?> Maybe. I depends onthe case. Liv+ treated just before the period has helped improve the menstrual symptoms of many of my patients. In this case, yousaid Liv+ didn't help but I am not hearing that it aggravated the migraines.<Her migraines come at a time when the body needs a lot of movement - right before her period and LIv + increases the density ofthe blood so could it be that LIv+ for her will only be aﬀective at the time of the month when the body WANTS to increase thedensity of the blood - ie: right after the period but before the period when the blood needs to move smoothly Liv+ is too dense?>Whether or not this applies to her depends on her presentation.

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Naomi FrankPianist wants a babyNewApr 01, 2021 | Edited1ReactCase Study: Female, 33 - using scale 1-10Chief Complaint: TTC since September 2019. Dx with unexplained infertility.Has had 2 unsuccessful IUI (most recently Nov/2020). Reluctant to do IVF, prefers less clinical approach.Appearance and demeanour: precise, polite and punctual +6, more relaxed in her treatments as time goes on but quitecontained. Very dedicated/compliant patient +9Lifestyle: professional pianist. High achiever +8, likes to have a project. Well resourced +6Reﬂects that she misses the excitement of her work, but also that she has made positive changes for her health in that time(scheduled eating, cut out coﬀee, more regular sleep) Was noticeably energized and cheerful in the weeks when she had beenback in rehearsal.Body morphology and ﬂesh quality: Slim and petite +8, large breasts for her physique. Flesh is dense, toned +5. I noticesock/pants imprints on legs during acu +6. Tired eyes, headaches and neck tension are ways that she feels stress, especially on L,+6 (she rarely mentions these). Has an intensity in eyes = bright eyes? +6.Skin quality: uses moisturizer daily as habit (skin does not seem dry)Can get puﬀy eyes in am.Body Temp: reports running cold (skin doesn’t feel super cold to me) esp cold feet +6.Respiratory: goodSleep: generally good (but occasional nausea/anxiety +4 - see under GI)Emotions: frustration around not conceiving +7. Also because work situation is uncertain with COVID. Described ‘mild’ anxiety atintake, but it has come up a lot. Hx of panic attacks during her 20s. Anxiety has improved with acupuncture. Describes a“complicated childhood”. Is getting counselling.Headaches: gets a brief sharp vertex h/a in the evening, a few times a week, if working +5GI: tends to looser BM especially with emotional trigger +6. History of skipping meals during long rehearsal days. During pandemichas made eﬀort to eat mindfully.NOTE: has occasional nausea at night along with anxiety. She recalls having this in childhood, experienced it again approx March-Nov. 2020. Has not had it since starting acupuncture.Menses: regular 28-30 day cycle. Cramps before and day 1; sometimes doubled up +8.; clots. Ovulation can be delayed (accordingto BBT chart)Tongue: Distinctly swollen but doesn't look soft/ﬂaccid or large; deep central crack (possibly inner dryness) coating now usuallythin/normal (was thicker before herbs) .Health of partner: sperm count and quality ﬁne, nothing else known. He is supportive.EXCESS PRESENTATIONS:LU – well resourced +6, thenars large but soft (=average) +6, skin looks moist +5ST – some puﬃness under skin esp lower body +4 (not sure this belongs in St excess?)SP – sweet cravings but well managed +5L Int – thrives when busy and active +7, tenacious +8HT – desire for family , soft warm midline+5KD – above average symmetry, average grooming, very focused on fertility +8; cramps/clots with menses +8; smooth medial heels+5. Libido higher at ovulation.UB – tends to cold, but this is improving with acu/herbs. Feet still a bit cold +6SI – pain/tension L SI at times (sometimes at piano 4-5 hours day) +6,

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9 teacher remarksGB –P – calm controlled demeanour +4, - occasionally tearful when talking about fertilitySJ – in spotlight professionally, anger at self (fertility)+8, polite, tension always more on L, bright eyes +6LV – ﬂesh fairly dense: toned but not hard/muscular +5The Grossest Thing in the Room: anxiety around TTC not going as planned (is used to achieving what she sets out to do, althoughshe shows self awareness around this)TREATMENTS:- Dec-March have used mostly Dr Tan protocols with her, Plus herbs.Treatment Results:SAAM Treatments:1. March 23: SInt+Result: Felt lots of activity around midsection during treatment. Felt distinctly warmer as a result of this tx. (but note she wasalready starting to feel less cold recently). Says her partner commented on change in warmth.2. March 27: Liv+Result: not much eﬀect noticed from this treatment.3. April 2nd: Sp+Result: settled deeply and felt whole L side activated/buzzing after about 20 mins (she has had this response in other treatments,when I needled ear Sympathetic point)My questions:Has noticed more fertile cervical mucous. Episodes of nausea/anxiety/warmth at night have stopped (were happening since lockdown)cramps are reducingfeeling less chilledI expected +Liv to be more helpful than it was. I wondered afterwards if the (mixed) enjoyment of performing could indicate some liver excess - kind oflike Toby’s case with the person who wore glittering clothes?my next thought was to +Stomachalso wondered about +Kid, but she seems quite Kid excess.PDF | 54 KPDFPianist wants a baby - 33yr Fem…Naomi FrankNewApr 01, 2021ReactI will check the midline tomorrow! (working on remembering this)

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17 more comments17 Reply ReplyKristin Wisgirda  NewApr 02, 2021 | EditedReactThanks for the case Naomi.Rating the signs/symptoms really helps us see your patient. It tells us how much to weight that aspect f the presentation. Let usknow your scale- 1-5+ or 1-10+.<cold generally [but warmer recently]> This kind of statement is confusing to me. How cold/warm is she now, subjectively andobjectively?<hard on self, taking fertility struggles as a personal failure> sounds more like SJ excess People who love all eyes onthem are K excess. Liver excess doesn't mind being on stage because they have enough shielding.Other important info isdensity of ﬂeshskin quality- dry, normal, moist- you must ask about moisturizer use if skin if normal or moisthealth status of her partner- good enough for iui but what else?Make the requested changes above and I will take another look.Thanks.MariaSevere Constipation and bloating Case StudyNewApr 02, 2021 | EditedReact56 y.o. female patientc.c.: Patient had major bike crash coming down a steep hill in early October 2020. She had to be helicoptered out. No concussionbut suﬀered multiple fractures in R hip. No surgery required but had to be oﬀ hip. She had some moderate pain along R bikiniline. Her Hip has healed since and is able to exercise again and suﬀer no pain or discomfort. Her chief complain is severeconstipation and bloating. She doesn't have an appetite. She needs to manually move her clay like stool. She is thirsty.appearance: She wears shiny shoes and a black mask with a glittering heart. Her clothing is understated. She is slight petite butstrong. Her face is somewhat symmetrical but her gait and posture is very asymmetrical (she was like that prior to her accident).Her gait is rather heavy and stiﬀ. she is not overly groomed but not messy.Energy: weary, deﬂatedEyes: somewhat dullVoice: calm/somewhat monotoneTongue: dull pink with thin coat (didn't look too dry)UB/H: Pulse: average, midline - not exception, she denies being hot. She says she feels a little cold if anything +2.GB/P: sl. convexity?, not physical (she looks more librarian than mike t.), she seems more of a reasoner (she rationalizes why she isoverworked), she has soft features

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4 teacher remarksLV/SJ: She doesn't feel light. Her energy is more dense and heavy 5+. She is not aware of her surroundings 6+. She wears ﬂashyshoes and mask. She prefers a walk on the beach. Hard to reach? (She is friendly and will share info but she does seem shielded.)Dull Eyes 3+K/SI: No varicose 8+, History of depression and suicidal thoughts 6+, no symmetrical 6+, Groomed 4+, self absorbed 6+ (this feelsmore LV than K)ST/LU: Big belly 8+, breast (seemed large 7+ when I did ST+ but now 4+), skin not dry 5+, T.E.5+, resource 5+, Good Qi 5+SP/LI: Not bored 6+, Skin Moist 5+, strong arms 6+, No sweet toothI have worked on her for awhile. The best response she had was SP+. This helped move her bowels. Since then, I have messed upagain by giving her a ST+ treatment because she was still bloated and her skin looked dry. When I did that treatment, her belly wasbig, her breast looked prominent, her skin seemed dry, energy and TE was ﬁrm. She seemed to have settled well but 2 weeks later,she reports that her constipation is worse than ever. Her bowels are tarry and she can't evacuate . She is extremely bloated. I did aLU+ to reverse the last treatment, but she didn't settle. I took out the needles and did standard TCM treatment.My top 3 consideration: LVx, SIx, Px (but it would seem that these would aggravate her condition)Thank you in advance for your thoughts and comments. ReplyKristin Wisgirda  NewApr 02, 2021ReactThanks for the case. Rating symptoms on a scale of 1-10+ really helps me see the patient better. Add the rating whenever possible.<sl. convexity?> not sure what you meanDid the constipation start after the accident? Her bowels were normal before?<She needs to manually move her clay like stool.> Please be more speciﬁc. Her stool is clay like in consistency and/or color? Is itdry and crusted as well? Any urge to evacuate? Laxative use?What does she do for a living?Please separate the channel pairs to help us see where signs/symptoms stack up.This belongs to LI excess if they are thin.It sounds like her skin is variable in moisture. Have you asked about her moisturizer use?Double damp Spleen helped her constipation and drying her interior with Stomach made her constipation worse. That tells methat she needs ﬂuids on the interior. What are all of the channel treatments that provide ﬂuids to the interior?

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5 more comments5 ReplyMariaNewApr 02, 2021 | EditedReactsl. convexity?> I am wrong. She is more concave 2.Did the constipation start after the accident? Her bowels were normal before? Yes.<She needs to manually move her clay like stool.> Please be more speciﬁc. Her stool is clay like in consistency and/or color? Isit dry and crusted as well? Any urge to evacuate? Laxative use? Stool is dark brown. Modeling Clay like consistency. Used miralax-didn't help. No urgency at all but feel very stuck and bloatedWhat does she do for a living? She is an admin assistant for brokerage ﬁrm.It sounds like her skin is variable in moisture. Have you asked about her moisturizer use? She moisturizes. but she told me thatshe doesn't think her skin is dry. Please separate the channel pairs to help us see where signs/symptoms stack up.UB: Cold 2H:GB:P: Concave 2, not physical (she looks more librarian than mike t.), she seems more of a reasoner (she rationalizes why she isoverworked), she has soft features LV: Energy is more dense and heavy 5. She is not aware of her surroundings 6+. She wears ﬂashy shoes and mask. She prefers awalk on the beach. Hard to reach? (She is friendly and will share info but she does seem shielded 3.) Dull Eyes 3+self absorbed 6+ (this feels more LV than K)SJ: Body is light/ﬂex.K: fertility 7, ﬁrm heel 5SI: No varicose 8+, History of depression and suicidal thoughts 3+, no symmetrical 5+, Groomed 4+,LU: Big belly 8+, breast (seemed large 7+ when I did ST+ but now 4+), skin not dry 5+, T.E.5+, resource 5+, Good Qi 5+ST: deﬂated 3SP:LI: Not bored 6+, Skin Moist 5+, strong arms 6+, No sweet tooth, thin strong arms 6, strong bones 7 (no major skeletal damageafter accident)Double damp Spleen helped her constipation and drying her interior with Stomach made her constipation worse. That tellsme that she needs ﬂuids on the interior. What are all of the channel treatments that provide ﬂuids to the interior? SP, UB, LU,LV?Shannon LarsonEvaluation of "settling" when not obviousNewApr 01, 20212ReactI had a patient today who I have always found diﬃcult to read even before doing SAAM. She has seen me for years. Recently shecame in with the feeling of something stuck in her throat and burping. I have tried a few things that didn't really help. At the lasttreatment I settled on SJ+. She at ﬁrst settled but at the end of the treatment she felt it made her ears ache. She is the kind ofpatient who will never call me back during the treatment even if something is bothering her no matter how much I explain to herthis style. (She also has a history continuing to take herbs even if she doesn't feel good taking them ignoring my very clearinstructions to stop)

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3 teacher remarks2 replies 24 more comments4I noted that it that perhaps the ear ache was a sign of an adverse treatment and kept in contact. The SJ+ treatment actually helpedher throat and burping the most and for 3 days it went away completely. I also gave her herbs that she started a couple of daysafter the acupuncture so I feel pretty conﬁdent that the acupuncture did help. She came back after 3 weeks as the same issue hadreturned. I decided again to do SJ+ one more time as it really seemed to help. Once the table, after the needles were in, she saidshe felt energized and more clear. Sometimes I take more energized to be a sign of not settling but it being a SJ+ treatment Ithought about how it could bring clarity. She is also someone who can feel dull and what she calls "ﬂat" However when I checkedin at 5 min I had a mixed bag. The lump feeling in her throat was gone but she had a dull headache and felt things swirling andheavy in her chest. I wasn't sure what to do. The main symptom was better but I'm never happy about a headache. I checked in onher 5 minutes later and she said things had moved and she had no more headache so I left the needles in the full 20 min.Unfortunately at the end of the treatment she said the headache came back as a low grade headache but she decided not to callme back. The lump feeling in the throat was much better. I told her to keep an eye out for worsening symptoms and if she has anyI would bring her back ASAP.So I guess my question is should I have taken the improvement of the main complaint as a sign to stay with the treatment even ifthere are other things that didn't seem perfect? ReplyKristin Wisgirda NewApr 02, 20211React<So I guess my question is should I have taken the improvement of the main complaint as a sign to stay with the treatment even ifthere are other things that didn't seem perfect?>I would have done the same. With this hard to read patient and mixed results, the signiﬁcant improvement of the chief complaintis enough for me to stick with a treatment. The patient's experience of the last treatment giving 3 days of relief even with sometemporary side eﬀects supports that too.<a SJ+ treatment I thought about how it could bring clarity> This is deﬁnitely a consideration too. The qualities you are adding to apatient during a treatment shapes the experience. Ideally, there are clear signs that the patient feels really settled despite thechanges happening, but it doesn't always happen. New students, more on this soon.Thanks, Shannon, for showing new students how complicated evaluating treatment results can be. Please let us know how thissecond SJ+ impacted the patient longer term.ReplyDaniel SchulmanNewApr 16, 2021ReactWhat a great example of how complicated clinic can really be and how diﬃcult it can be to tease it all apart in real time right therein the clinic and make the decisions we have to make on the spot!

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Mariamistakes are the best teachersNewMar 30, 2021 | Edited 2ReactThis post was administratively edited at 03/31/2021 10:31 AMFirst of, I just want to thank Kristin so much for her counsel and her help getting me out of dire straits. I would highly recommendKristin's private session for anyone who is running afoul with Saam.I just wanted to share all my mistakes and experiences with folks here because I had to learn the really hard way how powerfulSaam is and it has the potential to cause grave harm to your patient if you make a mistake. Since the system is subtle and clinic ishard, mistakes are easy to make especially for those of us who are new. I will just list some of the serious problems that were caused by doing Saam wrong:-Elevated A1C-Elevated blood pressure-Tachycardia-Elevated Cancer Markers-Non healing wounds-Cyst formation-Severe Hemorrhoid-Prolapse-Amenorrhea-Severe Depression. suicidalEver since starting Saam, I would hear this statement, "I don't know why but all of a sudden I developed XXX. I never had thisbefore , or it was never this bad before. The doctors don't understand why it is happening....." When I hear that, I know what happened,I also just wanted to share some reﬂections with everyone. My mistakes have caused me a great deal of stress, anguish and pain. Ihave given a lot of thought as to what happened. What was going on with me that did Saam so poorly besides being new and alazy note taker (which are both pretty huge problems).1.) False sense of security. Acupuncture may not help but it can't hurt. Wrong. Not with Saam. The patient can land in ER.2.) Saam is easy. Wrong. Because it is subtle, it is hard to discern the diﬀerences.3.) Practitioner bias: We see what we want to see. It is easy to trick ourselves.4.) Patient bias: Patients want to relax and settle. They will tell you what you want to hear.5.) Practitioner motivation: Wanting to give the patient qualities they lack. i.e.: wanting them to lose weight, gain weight, be moreassertive, etc.6.) Not taking into account the entire health history of the patient and where former issues ﬁt in the saam picture.34 students have completed the assignment. Visit Topic Activity for details.

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2 teacher remarks4 more comments 47.) Focusing too much on certain qualities and not see the other qualities.8.) Weekly sessions. Since I see my patients frequently, I kept using saam on them. As their symptoms became less obvious, therewas a higher chance to make a mistake.Thank you for letting me share this. It is my sincere hope that others will learn from my mistakes and take extreme care whenpracticing Saam.ReplyKristin Wisgirda  NewMar 31, 2021 | Edited3ReactThanks for sharing your experience @Maria Yung. It takes lots of courage to talk about mistakes.You are totally not alone.Adverse events from Saam treatments are not uncommon. It is really important to know how to counterbalance an adversereaction. Sometimes it can be a challenge to know what is clearly an adverse event that requires counterbalancing and othersituations that require other kinds of righting of the wheel of the channels. This is a big and important area that I hope to startdiscussing on this forum soon.Because of the risks of treatment, it is also to start slowly and carefully with Saam. If you are unsure of your Saam diagnosis orrushed in the clinic, treat with another system you are more comfortable with. As well, write up a few case studies and presentthem here to test your Saam knowledge. Feel free to ask lots of questions here, the more basic the better.I have been guilty of many, if not all, of the mistakes that you have listed. Practitioner bias is a particularly insidious one that issimply unavoidable. It is impossible not to let our life experiences cloud our ability to observe, but the practice of medicine, andSaam in particular, asks us to see our patients with clear eyes and heart. We are also asked to see ourselves and our behaviorclearly too.MariaReplyShannon LarsonNewMar 31, 2021 2ReactI've been doing SAAM for over 2 years and in the beginning I really didn't give it the respect it deserved. I have deﬁnitely madesome of the mistakes you listed above. The learning curve has been steep. It's however my favourite style of acupuncture by far. Iam really looking forward to getting more into deciding if it was an adverse treatment or not. I've had patients who have settlednicely on the table and then the next day had some strange thing pop up. Thinking it's adverse reaction I've had them come in totreat the opposing channel only to ﬁnd them really not settling with that channel which has made me go to the next grossest thingin the room. It seems like the original treatment was such a shift that something else became glaring out of balance. I look forwardto exploring this more.Kristin Wisgirda When cold people need UB+NewMar 29, 2021 | Edited2ReactReported body temperature, even when it is one of the grossest things in the room, isn't always a reliable indicator of whichchannel to treat. Even with lots of corroborating signs, you still have to watch patient response to treatment.

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5 teacher remarks4 replies 43 memorable cases of cold women needing UB+:1 case of a hot man needing H+A woman in her 50s with anxiety. She reports to being freezing and requests the treatment room to be heated. Even with blankets, heat lamps, a tablewarmer she reports to being cold. Pale yellowish face, skeletal thin and dry overall- like human jerky. Chief complaints are anxiety and insomnia. Herbody is warm to the touch. Midline warm and tight. She is talking non-stop, crazy talk. The talk is the grossest thing in the room. When I ask if she coulduse a bucket of cold water over her heat the answer is yes! When UB+ is inserted, she immediately quiets. At the end of the treatment she says she usmuch warmer and comfortable.A woman in her 50s, general neck and back pain s/p MVA. Pale, thin body with notable layer of fog. A history of ﬁbromyalgia. Before treatment requeststhat the room be heated to 75 degrees, blankets, heat lamps and tablewarmer. All clothing is double or triple layered. Her body feels warm to the touch.Midline is warm but tight. Pulse 75 bpm. The grossest thing in the room is her incessant talking. She is also very SJ excess so I treat Liver+ ﬁrst whichrelieves her pain. During the treatment she starts to overheat. Her back pain gets a few points of relief from that treatment and she is sleeping better. Ather second treatment, the non-stop talking continues and I notice that the themes are loving and about connection. This gives me more conﬁdence touse UB+ which is deeply settling and relieves lots of her pain. I have treated her about 8 times now and repeated UB twice more and she reports to beingmuch more comfortably warm in general. She is still a talker!A woman in her 20s with general back pain which is better for warmth. She craves heat in general. Pale, thin soft body, warm to the touch. Vey soft, warmmidline. She has had leukemia for years and often hospitalized with one health crisis after another- infections, fevers, septicemia. Not as talkative as theprevious 2 patients but gushing with love and sincere gratitude. Midline soft and warm. UB+ made her more comfortable than any other treatment tried.60 years old. Right sided upper back/shoulder/arm pain with paresthesias in the SI/H channels. Notable Ub15 pain. Dislikes heat, hot to the touch, hotsoft midline. He mentions often that ice on his neck gives reliable relief. Chatty but self involved. Pulse low 50s/bpm- this deterred me from using UB+.He got some relief from ST+ and SI+, falling asleep quickly with those treatments. Hearing one more time that ice reliably relieves his pain, I treat withUB+. Immediately he feels aggravation at UB15 and is very unsettled. I counter with H+. He settles quickly and has a great week after. ReplyGeorge MandlerNewMar 30, 20211ReactThanks Kristin. The last case is a good one as pulse is such a good indicator. Curious do you have in your notes what his tonguewas like?i noticed on the Qiological forum and in classes that we as Chinese medicine practitioners seem to give more weight to thepatient's temperature than other signs and symptoms. Maybe it is the way we are taught that if it is cold to warm it up. This is acommon mistake in Sa'am diagnosis as you point out as we don't want to avoid supplementing BL+ just because the patient feelscold. It is sort of like not supplementing LI+ because they have dry skin even though they have other S/S that demonstrate SPexcess.I too have supplemented several thin, dry, freezing cold women with BL+. If their pulse is rapid (I use an oximeter) and they have ahyper like personality or other S/S that suggest HT excess then BL+ supplementation must be considered even if they say they arefreezing cold.. We need to take in the entire picture.Today I supplemented BL+ on a "freezing cold all the time" 58 year old woman with plantar fasciitis up her BL channel. Her ﬁrsthusband tragically died when she was 26 and her second husband died of pancreatic cancer when she was 38 and was left with 3young kids.. Those events I thought of as freezing cold water so I hesitated in the previous two treatments to consider BL+supplementation. However this woman is very loving and lovingly chatty Her pulse rate normal at 58bpm. She had a thick gray,extremely dry tongue coat. But her skin was appropriately moist and ﬂesh had a lot of fog, not what we would typically considerfor BL+ supplementation.Her midline was extremely soft and warm like her chatty personality Given tthat plus the dry tongue and channel location I felt thiswas enough to consider a BL+ supplementation. She quieted right down and had one of those "oh my god I never felt so relaxed"moments when I took the needles out. She said the foot was 75% better. I likely will not choose BL+ supplementation again in thenear future as there are other spokes to true.Kristin Wisgirda  NewMar 31, 20211React@George MandlerThe case of my male patient above: I'm not looking at tongues right now. Toby's teacher didn't take pulses and pulses aren't reallyused in Saam except for rate. But for this case, the slow pulse was the only pointer to H+, besides symptom location. Interesting:George Mandler

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5 more comments 5Replywhen I needle UB+, his pulse went up into the 60s but his reaction was still adverse. I still love my pulse oximeters and use themon almost every patient for quick check of the rate.I mentioned body types for my cold patients because you too have had thin dry cold female patients respond well to UB+. Itmakes sense that really dry people could need the water UB+ provides and that lack of physiological ﬂuids getting out to thesurface could make one feel cold.<Those events I thought of as freezing cold water> Practicing Saam gives us plenty of opportunities to question our biases andperspectives. How the patient reacts to the event is most often more important than the event itself.8 teacher remarksMelissa RathboneQuestion re: SJNewMar 29, 20211ReactHi Kristen!I'm feeling a little shy about my newbie questions, but I'm just going to go for it :) I saw on the case study format posted that"spiritual" was considered a quality SJ excess and I have a question.I had a new patient this week, a 24 year old male who studied philosophy in college and is coming in for bilateral wrist pain. WhenI asked him about his mood, he said "he was focusing too much on the evil". He further explained that he was thinking a lot aboutgood vs evil and life being a tragedy and very quickly he was talking about very broad concepts of light/dark, good/evil, buddhism,christianity and Islam. He doesn't strike me as having a true diminished love for self - more just caught up in big philosphicalconcepts. I was struck by how extreme and far reaching his thinking was and was not sure how to categorize it. It felt chaotic to meso I was thinking maybe S Int + , but then I saw that notation on the case study format and thought maybe this is more a case ofbeing "wide open". When considering the SInt + , does the chaotic, quickly moving around quality extend to someonesconversational manner?ReplyKristin Wisgirda  NewMar 30, 20211ReactHi Melissa,Thanks for your question. Newbie questions are a great opportunity to ﬂesh out the basics.My understanding of SJ excess spirituality is that it is a function to being wide open to the outer world. This openness makes ableto notice and experience more phenomena that could be ascribed to higher powers and connectivity. Not sure if your patient fallsmatches this picture.<caught up in big philosphical concepts> Sounds more intellectual rather than experiential.<It felt chaotic to me> Does the chaotic feeling you get match any of the channel excess qualities? For example:erratic and rapidly changing in emotional tone or aggressively argumentative (GB excess)unfocused and lost in an inner world, hard to reach (Liver excess)Other aspects of his presentation- other symptoms, how he speaks, how he moves, how he relates to you, etc.- might paint a fullerpicture that helps you understand where his thinking is coming from.My ﬁrst though is not SI excess with this. SI excess conversation is not self involved which he sounds like he might be. A SI excessperson will be falling apart, often exhausted and having a hard time holding themselves together.Let me know if this answers your questions.

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3 replies 312 more comments12ReplyMelissa RathboneNewMar 30, 2021ReactHi Kristen,Thanks for your response! The basics seem so clear until you try to actually apply them to people :)The distinctions you listed are very helpful. I think I am still puzzling out what the "chaotic" quality of S I excess looks like. Is thechaos more associated with the presentation of the symptoms (ie "wind" like symptoms, itching, rashes etc)?<SI excess conversation is not self involved, A SI excess person will be falling apart, often exhausted and having a hard timeholding themselves together > this is clarifying. He is pretty self involved - in a very detailed way (which points me to SJ)I was considering SInt + for him because he has injuries and pain along the SInt channel and also a fair number of other injuries inthe recent past, so I was thinking about trauma/accidents and associating that with Small Int.But there is also a lot in the SJ+ category for him and I think the "unprotected, wide open" characteristic of SJ does apply to him.Also his feet are cold and he has pain along the SJ channel as well. I'll keep thinking about it!I know this isn't a case study presentation so won't go on and on.... Really appreciate your help!Kristin Wisgirda Chronic elbow pain and not that much elseNewMar 21, 2021 | Edited1React50 year old woman with R lateral epicondyle pain for 1 year.Body: thin+3, slightly moist skin +2, soft ﬂesh +4; runs cooler +3; thin ribcage slightly sunken +1; thenars average, medial heel thinand not ﬂeshy +4; no varicositiesFace/appearance: pale face; diﬀuse pale papules on forehead, greasy forehead +2; average eyes (not bright or dull), averagesymmetry; tidy but comfy clothesAﬀect: pleasant and present, normally polite, soft voice +3, a ﬂuttery way of speaking as if easily ﬂustered but not aggressive orreactive; emotionally even, deniesGI/urinary: Normal except has a sweet tooth that she controls carefullyGyn: recent menopause-denies problems, 1 child, uneventful gyn historyEnergy/sleep: tired 3+, a new puppy is disturbing her sleep but sleeps well otherwiseAnalysis:ST excess: morphology/ribcage, tiredSpleen excess: sweet tooth??, elbow painLI excess: elbow pain, thin body?Liv excess: elbow pain, runs coolerSJ excess: elbow pain, pale, ﬂesh not denseUb excess: runs coolerSI excess: medial heel, 7x7 cycles completedPT and a steroid injection improved 95% but then pain returned despite doing exercises and ergonomics. She is an OT.pain on the LI/Sj channels, doesn't radiateupon waking: stiﬀ and painful for 1/2 hour; pain 5-6/10 when fully extending/ﬂexing elbow, opening jars/doors, doing hair; 3-4/10 during certain yogamoves but not worse oﬀ afterno history of trauma, gradual onset; suspects worse with increased computer use

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4 teacher remarks1 reply 16 more comments6Treatment #1: L Liv+ (ok settling)Treatment #2 (5 days later): L LI+ (deeper settling)Treatment #3 (3 weeks later, delay bc of covid exposure): L Lung+ (ok settling)Treatment #4 (1 week later): l LI+ (deeper settling)Result: morning pain/stiﬀness less intense and shorter duration, no pain the morning of the second treatment; pain with movement might be slighltybetter; repalpation of the elbow showed mild edema and marked lack of tone at LI11Result: Follow up 1 week later- no pain/stiﬀness in the morning, pain with movement is 3/10. Shovelling snow aggravated brieﬂy but bounced backquickly. Fell on outstretched right hand and has forearm pain but no aggravation of elbow.Follow up 3 weeks later- improvement in elbow is holding, slight forearm pain. 1 week ago cold sores appear on Left LI19 and on inside of right nostril-red slightly raised and lightly crustedResult: cold sores gone; no change in elbow but previous improvements are holdingResults: 1 week later elbow is pain free with movement/activities and in the morning.ReplyMariaNewMar 28, 2021 | EditedReactQuestion for teacherHi Kristin,Thank you for the case study.I wonder if the cold sore and the blister on the nose could be a development of LI+. I noticed that on one of my patients whodeveloped blisters on her nose and a hard ﬂat cyst along her SCM along SJ/ST junction. I thought it was due to my over drying herwith ST+ and LI+ treatments. It got better quickly after I did SP+. If you concur that maybe the problem, what would explain thatdevelopment? ReplyMariaNewMar 29, 2021 | EditedReactThx for your thoughts. In my patient's case, i thought it was the internal drying that caused the body to erupt just like a St×pattern. I took the problem to be more of an internal dryness imbalance.As you know, one of my concerns and observation is that once we pushed the body in a certain direction, that it seems to keepgoing in that direction which may aggravate underlying pre-existing issues in that paired axis. I will try to give some exampleswhen i sum up all my mistakes and failings in another post.

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1 earlier comment 7 teacher remarksKristin Wisgirda A helpful intake chartMar 21, 20212ReactFang Cai shared this chart with me. It has reminders of what you are looking for and places to note where you ﬁnd those qualities.I would add sections for the thenars, the medial heels, moles/birthmarks and varicosities.Thanks Fang!Intake1-10+morphologyThin/fatInﬂated/deﬂatedskin Dry thin Moist thickfaceColor(location):expressioneyesBright/dull light/dark dense/openOpen/closedloving cold calm darting ﬁxedsquinthair Thin/thick Groomed/unkemptMidline abdomen Cool/warm Hard/softLiv/SJ Open/closed GB/P Up and out/Down and In Body tempLocationWarm/HotCool/ColdBody movementsLight/heavy grounded/ungroundedStiﬀ/ﬂexibleFast/slowmethodical/erraticenergy Lively/weary Inﬂated/deﬂated postureConvex/concaveRigid/relaxedgrooming Clothes hair makeup Breathing/voiceSoft/loudsighingdistress/sob/wheezeVoice quality: bubbly, whiningRelatingOpen/hard to reachAggressive/meekWarm/coldBoredSelf absorbed/Interested in othersboredMariaNewMar 29, 2021ReactHi Kristin,

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Kristin Wisgirda AUTHOR TEACHER Oct 2 10 18am Exemplar of P qualities the ideal poison control center attendant Gathers information calmly and methodically Shares information in a step by step manner that is deliberate and easy to digest Reply Maria Edited Sep 29 9 10pm Last reply Sep 30 11 03am Thank you for the case study of the infertility couple It was so interesting 1 I find it hard to differentiate when someone crosses the line from being one channel to another as in this case where the woman is not symmetrical but still somewhat attractive Any thoughts 2 The man is given a SI 2 given the dullness of Liver But if we were evaluating K v SI he would be more Kidney based on his symmetry Wouldn t the dullness only be considered as a LV quality I am just confused by this If someone has H qualities and also LV qualities that combo wouldn t make the person a UB excess For some reason that doesn t seem right to me 3 I have a male patient coming in for fertility He is overall handsome with good symmetry hairline K 3 but he has these ears that stick out which makes him less attractive Would we then deduct a point and give him K 2 His heels are firm K 4 but dry SI 2 Does that give his heels an overall grade of K 2 I am having trouble evaluating qualities where there are some conflicting characteristics This patient is interesting in that he is not very masculine in his way of being He has a soft effeminate quality to him Would this be consider a SI quality Thanks in advance for your thoughts Reply 1 Reply 1 Maria Sep 22 7 17pm Thank you for the excellent analysis Love it I realize that I have a misconception that thin people are less dense I have to watch that

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He also struggled with his own mental health The transition to the prestigious St John s Prep in Danvers Mass on a partial scholarship was difficult His dad s old 2004 Infiniti stood out in the parking lot among all the shinier BMWs and Mercedes The academics daunted him Small struggles suddenly felt enormous He began losing his temper on the golf course He fell into a deep depression He thought about suicide When people meet him they can initially think it s sort of an act that it s sort of fake says Jay Pawlyk Tony P s high school English teacher Like no one is just this upbeat and nice Reply 6 Replies 6 Maria Sep 19 9 28pm Last reply Sep 20 9 07am How would you rate his eyes Reply 1 Reply 1 Maeve M Sep 6 4 53pm Last reply Sep 16 7 57pm Hi Kristin My sons friend 13 YO has just been diagnosed with XL Retinitis Pigmentosa an agressive type I have spoken with a TCM practitioner here who has trained with Andy Rosenfarb and will consider all options But on the Saam front i wondered if you have treated it and if you have any insights I have not treated people specifically for eye conditions before some have had improvements reduced blurriness pressure after Saam treatements for other conditions but with the symptoms of this condition my mind goes straight to LIV XS His presenting symptoms are a darkness in peripheral vision in daylight tunnel vision night blindness including in fading dim light I believe his central vision is almost perfect He has very dark brown eyes but I had never thought to look for dullness brightness so I will assess this soon I have known him since he was 1 years old and of all my sons friends I have always struggled to connect with him always felt he avoided eye contact i know this could be either too shielded or unshielded though I will be meeting him this weekend so I will be doing a full intake etc and will take some eye pics as well Will be looking at all other channels as well I just thought you or someone else on the forum may have treated this and have some insight Thanks Maeve

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Reply 11 Replies 11 Kristin Wisgirda AUTHOR TEACHER Sep 13 8 39pm Anyone practicing in LA Reply Kristin Wisgirda AUTHOR TEACHER Aug 29 9 46am Last reply Sep 11 12 21am I knew what was going to happen before it happened Sharon Sherman shared this vignette including lots of details about this person s presentation Can you guess what she saw that had her anticipating this behavior Include morphology eyes movement pattern and any other likely characteristics you can think of I was at an agility trial today I think I mentioned to you previously that it is like a big family reunion The Club that sponsors the event generally brings all kinds of crap food and baked goods to celebrate dogs and their handlers that hit big milestones in their competitive careers There is this man roaming around So I watch him hovering over this table of bakery cupcakes with airbrushed icing tops I hang back about 20 feet to witness his next move He quickly takes his large hand and with 4 sausage fingers scoops the icing off of multiple cupcakes and shovels the plump appendages dripping with Betty Croacker s finest in his mouth It was gross hysterical and soooo expected I LOVE SA AM Thanks Sharon Reply 1 Reply 1 Kristin Wisgirda AUTHOR TEACHER Edited Sep 9 2 20pm Schooled again by Lung Stomach A 74 year old woman complained of bilateral knee pain Sp Stomach channels along with right shoulder pain lung channel that only disturbs her sleep and is fine during the day She is resigned to getting knee replacements and would like to work on the shoulder

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SI gave partial relief for her shoulder for 2 days but really helped her knees She also complains of intermittent reflux and bloating Her morphology is significantly Lung excess inner damp 6 outer dry 3 even with moisturizer in the summer when it is typical for people s skin to be more moist Her thenars are thin and soft 3 St is inserted She does not settle She settled angelicly with the first treatment She starts to feel right shoulder pain which she had no trace of when she came in I removed ST and inserted Lung on the left She settled beautifully and has had pain free nights with her shoulder awaiting more feedback My mistake was missing how deflated she is She has a soft voice While her morphology is clearly Lung she doesn t have the qi of a real Lung excess Her deflation level is 2 3 Reply KG Kari Guillen Sep 7 3 41pm Anyone practicing in the St Paul Minneapolis area Had the chance to work with a lovely person passing through my hometown who would really like to follow up with acupuncture back home I think SAAM is a great fit for him Reply Kristin Wisgirda AUTHOR TEACHER Aug 28 8 11pm Hypo hyperfunction Toby often attributes hyperfunction to Heart and hypofunction to UB I don t makes these qualities primary for their respective channel organ systems because they can easily come from other systems Hypofunction could also be the result of damp excessive Pericardium rooting Liver dull inwardness Hyperfunction also could be from more extreme LI excess or Gall Bladder However the more extreme the hypo hyperfunctioning the more I consider UB H as contributing factors Toby has said if the patient is in a wheelchair supplement Heart A conversation with Sharon Sherman about this made me realize that hypo hyperfunctioning in how one relates to others definitely has more weight for UB H Being really warmly interested in and curious about other people is a strong Heart sign Being uninterested in others and unmotivated by social interactions is a UB quality To my mind hypo hyper social function covers the grey area between love and fear in a way that could be useful clinically I ve had to reframe patient behavior as love to see how it fits into the H Ub balance when maybe in the past I could easily have seen it as hyper social function What do you think How does this re languaging sit with you

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Reply Kristin Wisgirda AUTHOR TEACHER Aug 28 10 37am Heart Love vs Kidney Love This morning a patient presented with shortness of breath and tightness in her chest since having a cough 2 months ago It was aggravated this weekend as she was moving her daughter into a freshman college dorm She points to feeling a pressure around Ren15 She notices the SOB when she sits but not when moves around She spent the weekend crying whenever possible because she was losing her baby girl She gushes about her daughters and her dogs She sending her freshman daughter care packages daily for the first few weeks Her sleep was disturbed by worries over her daughter s boyfriend being in the path of a hurricane Midline was soft and warm 2 Overall warm to the touch 3 Hates air conditioning 6 Complexion flushed 1 Morphology is Lung excess extra flesh 5 mildly dry skin 2 but moisturizes Needling LI1 she felt something give in her chest Upon completing UB she settled quickly and could breath more deeply While there is a Kidney love at work here this patient s Heart love is so much stronger Kidney love by itself doesn t gush and is not this warm Kidney love does not include non family members as well Reply Deleted by Kristin Wisgirda Deleted Aug 24 3 15pm Naomi Frank Aug 18 6 19pm Last reply Aug 19 12 01pm I hope this is the right way to post a new question What do we think about these eyes This is a complex case that I ll try to find the time to write up I m a bit flummoxed by the Lv SJ dynamic 1692397181 442672 jpg https whitepineinstitute instructure com files 13624 download download_frd 1 verifier 29miKxuA6xNDcbpwhc1jbWjuV5rQEN10qwBVsb1t Reply 2 Replies 2

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Maria Edited Aug 17 8 57pm Last reply Aug 18 9 31am Hi Kristin I have a 16 y o male patient that has 2 swollen lymph nodes near the groin along the SP channel I did SI thus far I am considering LI but this patient is very athletic and thin not much fat at all Drinks water when thirsty B M normal His skin is Dry 1 Very taut abdominal muscles He has 1 acne What do you think Would it be ok to try LI Reply 1 Reply 1 Kristin Wisgirda AUTHOR TEACHER Aug 17 2 36pm Anybody in Wisconsin or northern Illinois Please let us know Thanks Reply Maria Edited Aug 15 10 07pm Last reply Aug 16 9 53am Hi Kristin 1 What do you think about using SJ for anemic patients Would it make the situation worse I know that using SAAM LV or SI are considered for building blood 2 How would you consider passive aggressive people These are generally women who are very pushy but yet can t imagine them getting into a cat fight Would they be more P or GB Thanks Reply 1 Reply 1 Kristin Wisgirda AUTHOR TEACHER Aug 16 9 29am Separation of Pure From the Impure

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Maria Aug 11 9 46pm Last reply Aug 12 4 50pm Hi Kristin I am having trouble differentiation people who are shielded v open Toby said SJ excess people feel too vulnerable and exposed already so they won t readily open up and discuss more but can LV excess folks also be too dense to talk much Some of my patients don t talk a whole lot Their muscle density is 5 which makes it hard to tell They have dark eyes which are hard to discern The problem is on the left side so I want to figure out the LV SJ axis better I know when they don t talk alot it could also be cold UB excess or SP excess Do you have a way to differentiate the LV SJ better based on conversation Reply 3 Replies 3 Kristin Wisgirda AUTHOR TEACHER Aug 2 3 10pm GB without needles https territrespicio com using your voice to tap your strength https territrespicio com using your voice to tap your strength Reply 2 Deleted by Jason Deleted Aug 26 11 05am Kristin Wisgirda AUTHOR TEACHER Jul 31 9 14am Summer Heat and Humidity This has been a particularly soupy summer in my neck of the woods I find my self considering LI more often for that reason

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However I am careful to ask patients about heat tolerance especially patients who spend lots of time outdoors or who work in hot conditions For these patients I am more cautious with using LI because of dehydration risk Reply Kristin Wisgirda AUTHOR TEACHER Jul 26 7 02pm Anyone in the DC area practicing Saam Thanks for letting us know Reply Kristin Wisgirda AUTHOR TEACHER Jul 25 1 22pm Relationships between channel qualities Putting together my upcoming class on comparing channels I ve organized the relationships into 5 categories excluding the foundational counterbalancer relationship The Same Compounding This mostly applies to the the Earth Metal channels For instance Lung exterior dryness LI exterior dryness will likely create extra dry skin and exterior Opposing Balancing but not full counterbalancing Stomach exterior damp LI exterior dryness will likely create an exterior with near normal moisture unless either Stomach or LI is dramatically excess Similar An example is Kidney consolidation and Liver density If we are looking at a discrete area these can be had to differentiate This category really asks us to look closely at how we understand the basic qualities of each channel Mixing For example Heart Double Fire and Spleen Double Damp easily create damp heat when in excess Pretty straightforward Enhancing Aggravating but not similar nor the same This category will have us looking at pathomechanisms of qi blood fluids heat and cold as they apply to Saam For instance Liver excess can aggravate damp dryness heat and cold conditions because of the way density and dullness can interplay with these qualities Most of our discussion will be around the Similar and Enhancing Aggravating categories I ll be sharing how clinic has taught be to discern between similar channels and treat certain mixed channel excess scenarios I m hoping everyone will share their clinical experience as well

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The other half of class will be observing video cases which will be a joy to discuss Each time Toby watches these cases with me I learn so much from seeing these subjects through his eyes I m excited to share these with you Here s the link to sign up for the class I hope you can join us https whitepinecircle org saam channel comparison and video diagnosis https whitepinecircle org saam channel comparison and video diagnosis Reply Naomi Frank Jul 17 3 19pm Last reply Jul 24 4 26pm Hello Kristin Wisgirda My q is regarding your August class WPC announcement says Thursdays but the dates given are Saturdays I m hoping Thurs becasue I work most Saturdays Also am I missing a place for the forum discussion or it is just very quiet It s hard to tell with this new format Reply 2 Replies 2 Maria Edited Jul 15 11 48pm Last reply Jul 21 8 14am Decisions decisions I have a patient who has post surgical complications after the removal of an acoustic neuroma tumor that was wrapped around the 8th cranial nerve on 5 9 2023 It was first diagnosed in 2021 and was being monitored The doctors just wanted to wait and watch but the patient insisted on getting it removed Since the surgery she has developed Mal De Debarquement syndrome walk off balance feels like she is on a boat R Face droop R eye can t shut causing dry eye She had a plug put in to help increase lacrimation She drools from R corner of mouth because of the droop She can t smile Deafness in R ear post surgery fatigue Pain and pressure along R GB5 7 1st treatment I did SI on her and she responded really well Her eyes became more leveled as the droop improved She was able to blow out of her mouth which she couldn t before She felt more energized 2nd treatment I did P She reported that the pressure pain along the side of her head felt better

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Since she responded so well to SI I am thinking I would like to repeat SI again some time in the future not right away as there are other channels that I need to work on first Since she has both K and SI signs I am trying to figure out how to decide the appropriateness of doing SI again What would you thinking process be K Strong heels 6 history of blood clot slight VV 2 strong sense of self 3 SI Unkempt in appearance 8 9 Asymmetrical because of the droop Does this count Separate question not related to the above Is thirst considered a symptom of external or internal dryness Reply 3 Replies 3 Kristin Wisgirda AUTHOR TEACHER Jul 15 2 46pm The powerpoint from this most recent Case Study Hour is available under the Case Study Hour tab under chats and handouts Enjoy Reply Kristin Wisgirda AUTHOR TEACHER Jul 13 5 58pm Every Male Patient A Video From Flourish Medicine Studios https www youtube com watch v PR_4tvXv3Qg Reply Terri Matson Jul 13 2 36pm Last reply Jul 13 2 43pm Thank you Kristin for today s Saam mentorship zoom call I had to jump off a few minutes early and wanted to thank you

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I appreciate the opportunity to review the videos you have prepared they are another valuable learning experience I look forward to your August class much appreciation Terri Reply 1 Reply 1 Kristin Wisgirda AUTHOR TEACHER Edited Jul 12 7 16pm Hot Stuff A recent case reminded me of how important it is to consider the influence of extreme environments A 78 year old woman presented with pain and tingling on her right lateral thigh and anterior lower leg after gardening in the heat for 4 days in a row Her face and neck were also full red 4 and covered with an slightly itchy rash that she attributed to the stress of a real estate transaction 1 week prior The rash was not getting better Her morphology is Lung excess 5 with the addition of fog 6 in her limbs Her qi presents as deflated 3 Her body was unusually warm to the touch 4 and midline was soft 2 Though I ve been treating her for 10 years she has never been particularly emotionally warm Her last treatment one month prior was GB which resolved dizziness she was having The leg pain was bad enough that she was limping and so was more distressing than her rash The pain was such that she felt her leg could easily give out on her We are always looking at Sometimes channel sometimes quality While the pain was on GB and Stomach channels the balance of those channels with their counterbalancers weren t clearly off balance Her heat exposure along with the full redness of the rash and other qualities pointed me to treat UB The persisting extreme environmental heat gave me more confidence in using this strategy Her pain was 50 better getting off the table and 75 better 1 week later And her rash was lighter getting off the table and completely resolved 1 week later With hot steamy weather I find myself using UB and LI more often and hesitating about using H and SP Reply Kristin Wisgirda AUTHOR TEACHER Jul 5 10 45am Making Bows and Forging Steel Descriptions of how the basic Saam qualities work in the world always pique my interest

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Reply 1 Reply 1 Kristin Wisgirda AUTHOR TEACHER Aug 17 2 36pm Anybody in Wisconsin or northern Illinois Please let us know Thanks Reply Maria Edited Aug 15 10 07pm Last reply Aug 16 9 53am Hi Kristin 1 What do you think about using SJ for anemic patients Would it make the situation worse I know that using SAAM LV or SI are considered for building blood 2 How would you consider passive aggressive people These are generally women who are very pushy but yet can t imagine them getting into a cat fight Would they be more P or GB Thanks Reply 1 Reply 1 Kristin Wisgirda AUTHOR TEACHER Aug 16 9 29am Separation of Pure From the Impure Toby presents this query What do you think The small intestine receives the food that has been digested by the spleen and stomach and further extracts absorbs and distributes it throughout the body all the while separating the pure from the turbid Huang Di Nei Jing Su Wen Chapter 8 Ni 1995 Why does the small intestine s ability to separate the pure from the turbid fit perfectly with Saam theory Reply

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college dorm She points to feeling a pressure around Ren15 She notices the SOB when she sits but not when moves around She spent the weekend crying whenever possible because she was losing her baby girl She gushes about her daughters and her dogs She sending her freshman daughter care packages daily for the first few weeks Her sleep was disturbed by worries over her daughter s boyfriend being in the path of a hurricane Midline was soft and warm 2 Overall warm to the touch 3 Hates air conditioning 6 Complexion flushed 1 Morphology is Lung excess extra flesh 5 mildly dry skin 2 but moisturizes Needling LI1 she felt something give in her chest Upon completing UB she settled quickly and could breath more deeply While there is a Kidney love at work here this patient s Heart love is so much stronger Kidney love by itself doesn t gush and is not this warm Kidney love does not include non family members as well Reply Deleted by Kristin Wisgirda Deleted Aug 24 3 15pm Naomi Frank Aug 18 6 19pm Last reply Aug 19 12 01pm I hope this is the right way to post a new question What do we think about these eyes This is a complex case that I ll try to find the time to write up I m a bit flummoxed by the Lv SJ dynamic 1692397181 442672 jpg https whitepineinstitute instructure com files 13624 download download_frd 1 verifier 29miKxuA6xNDcbpwhc1jbWjuV5rQEN10qwBVsb1t Reply 2 Replies 2 Maria Edited Aug 17 8 57pm Last reply Aug 18 9 31am Hi Kristin I have a 16 y o male patient that has 2 swollen lymph nodes near the groin along the SP channel I did SI thus far I am considering LI but this patient is very athletic and thin not much fat at all Drinks water when thirsty B M normal His skin is Dry 1 Very taut abdominal muscles He has 1 acne What do you think Would it be ok to try LI

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Reply KG Kari Guillen Sep 7 3 41pm Anyone practicing in the St Paul Minneapolis area Had the chance to work with a lovely person passing through my hometown who would really like to follow up with acupuncture back home I think SAAM is a great fit for him Reply Kristin Wisgirda AUTHOR TEACHER Aug 28 8 11pm Hypo hyperfunction Toby often attributes hyperfunction to Heart and hypofunction to UB I don t makes these qualities primary for their respective channel organ systems because they can easily come from other systems Hypofunction could also be the result of damp excessive Pericardium rooting Liver dull inwardness Hyperfunction also could be from more extreme LI excess or Gall Bladder However the more extreme the hypo hyperfunctioning the more I consider UB H as contributing factors Toby has said if the patient is in a wheelchair supplement Heart A conversation with Sharon Sherman about this made me realize that hypo hyperfunctioning in how one relates to others definitely has more weight for UB H Being really warmly interested in and curious about other people is a strong Heart sign Being uninterested in others and unmotivated by social interactions is a UB quality To my mind hypo hyper social function covers the grey area between love and fear in a way that could be useful clinically I ve had to reframe patient behavior as love to see how it fits into the H Ub balance when maybe in the past I could easily have seen it as hyper social function What do you think How does this re languaging sit with you Reply Kristin Wisgirda AUTHOR TEACHER Aug 28 10 37am Heart Love vs Kidney Love This morning a patient presented with shortness of breath and tightness in her chest since having a cough 2 months ago It was aggravated this weekend as she was moving her daughter into a freshman

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Reply Kristin Wisgirda AUTHOR TEACHER Aug 29 9 46am Last reply Sep 11 12 21am I knew what was going to happen before it happened Sharon Sherman shared this vignette including lots of details about this person s presentation Can you guess what she saw that had her anticipating this behavior Include morphology eyes movement pattern and any other likely characteristics you can think of I was at an agility trial today I think I mentioned to you previously that it is like a big family reunion The Club that sponsors the event generally brings all kinds of crap food and baked goods to celebrate dogs and their handlers that hit big milestones in their competitive careers There is this man roaming around So I watch him hovering over this table of bakery cupcakes with airbrushed icing tops I hang back about 20 feet to witness his next move He quickly takes his large hand and with 4 sausage fingers scoops the icing off of multiple cupcakes and shovels the plump appendages dripping with Betty Croacker s finest in his mouth It was gross hysterical and soooo expected I LOVE SA AM Thanks Sharon Reply 1 Reply 1 Kristin Wisgirda AUTHOR TEACHER Edited Sep 9 2 20pm Schooled again by Lung Stomach A 74 year old woman complained of bilateral knee pain Sp Stomach channels along with right shoulder pain lung channel that only disturbs her sleep and is fine during the day She is resigned to getting knee replacements and would like to work on the shoulder SI gave partial relief for her shoulder for 2 days but really helped her knees She also complains of intermittent reflux and bloating Her morphology is significantly Lung excess inner damp 6 outer dry 3 even with moisturizer in the summer when it is typical for people s skin to be more moist Her thenars are thin and soft 3 St is inserted She does not settle She settled angelicly with the first treatment She starts to feel right shoulder pain which she had no trace of when she came in I removed ST and inserted Lung on the left She settled beautifully and has had pain free nights with her shoulder awaiting more feedback My mistake was missing how deflated she is She has a soft voice While her morphology is clearly Lung she doesn t have the qi of a real Lung excess Her deflation level is 2 3

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Maria Sep 19 9 28pm Last reply Sep 20 9 07am How would you rate his eyes Reply 1 Reply 1 Maeve M Sep 6 4 53pm Last reply Sep 16 7 57pm Hi Kristin My sons friend 13 YO has just been diagnosed with XL Retinitis Pigmentosa an agressive type I have spoken with a TCM practitioner here who has trained with Andy Rosenfarb and will consider all options But on the Saam front i wondered if you have treated it and if you have any insights I have not treated people specifically for eye conditions before some have had improvements reduced blurriness pressure after Saam treatements for other conditions but with the symptoms of this condition my mind goes straight to LIV XS His presenting symptoms are a darkness in peripheral vision in daylight tunnel vision night blindness including in fading dim light I believe his central vision is almost perfect He has very dark brown eyes but I had never thought to look for dullness brightness so I will assess this soon I have known him since he was 1 years old and of all my sons friends I have always struggled to connect with him always felt he avoided eye contact i know this could be either too shielded or unshielded though I will be meeting him this weekend so I will be doing a full intake etc and will take some eye pics as well Will be looking at all other channels as well I just thought you or someone else on the forum may have treated this and have some insight Thanks Maeve Reply 11 Replies 11 Kristin Wisgirda AUTHOR TEACHER Sep 13 8 39pm Anyone practicing in LA

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What do you think He softly sings the Mister Rogers Neighborhood theme song even though there are no neighbors around He mounds red and white miso paste into a bowl douses it with rice vinegar soy sauce and honey and mixes it into a beige sludge to bathe two meaty filets He s never touched most of these ingredients before and is going mostly on feel When the food finishes cooking he exclaims It s a Christmas miracle even though it isn t It s just a quiet Tuesday He also struggled with his own mental health The transition to the prestigious St John s Prep in Danvers Mass on a partial scholarship was difficult His dad s old 2004 Infiniti stood out in the parking lot among all the shinier BMWs and Mercedes The academics daunted him Small struggles suddenly felt enormous He began losing his temper on the golf course He fell into a deep depression He thought about suicide When people meet him they can initially think it s sort of an act that it s sort of fake says Jay Pawlyk Tony P s high school English teacher Like no one is just this upbeat and nice Reply 6 Replies 6

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Reply 1 Maria Edited Sep 29 9 10pm Last reply Sep 30 11 03am Thank you for the case study of the infertility couple It was so interesting 1 I find it hard to differentiate when someone crosses the line from being one channel to another as in this case where the woman is not symmetrical but still somewhat attractive Any thoughts 2 The man is given a SI 2 given the dullness of Liver But if we were evaluating K v SI he would be more Kidney based on his symmetry Wouldn t the dullness only be considered as a LV quality I am just confused by this If someone has H qualities and also LV qualities that combo wouldn t make the person a UB excess For some reason that doesn t seem right to me 3 I have a male patient coming in for fertility He is overall handsome with good symmetry hairline K 3 but he has these ears that stick out which makes him less attractive Would we then deduct a point and give him K 2 His heels are firm K 4 but dry SI 2 Does that give his heels an overall grade of K 2 I am having trouble evaluating qualities where there are some conflicting characteristics This patient is interesting in that he is not very masculine in his way of being He has a soft effeminate quality to him Would this be consider a SI quality Thanks in advance for your thoughts Reply 1 Reply 1 Maria Sep 22 7 17pm Thank you for the excellent analysis Love it I realize that I have a misconception that thin people are less dense I have to watch that Reply Sharon Sherman Edited Sep 19 2 30pm Last reply Sep 22 7 39am ARTICLE IN WASHINGTON POST ABOUT A NEW INFLUENCER

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Search entries or author All Sort 70 Replies 50 Kristin Wisgirda AUTHOR TEACHER Jul 1 11 38am Edited Oct 2 10 18am General Forum Any aspects of Saam practice is up for consideration here The only exception is advanced topics which has it s own designated forum Ask questions Share experiences and insights Muse Wonder Replying to this header is how you post Replying to any post will keep the conversation going No question is too basic The basics of Saam are often more complex and nuanced than they appear at first glance and always worth reviewing If you present a case please ask specific questions about the case If the case needs more detailed attention consider presenting it a Case Study Hour or in a private mentorship session If you have taken all of the advanced Saam classes and would like to access to the advanced forum please contact me privately Kristin Reply Kristin Wisgirda AUTHOR TEACHER Oct 2 10 18am Exemplar of P qualities the ideal poison control center attendant Gathers information calmly and methodically Shares information in a step by step manner that is deliberate and easy to digest