Saam for musculoskeletal problems

Hi Catherine!

I use musculoskeletal needling in my clinic with the majority of my patients and have been practicing these techniques for nearly 25 years. I work on tight ashi points, sinew confluent areas, motor points and trigger points—generally releasing tissue constrictions first on the affected side.

I think of this as creating more “slack in the container,” or room for the subsequent Saam treatment to move, fill, warm, cool, or consolidate within the patient. After 10 to 15 minutes, I remove those needles and then treat the opposite side with the appropriate Saam treatment.

I’d also add that when working in the musculoskeletal realm, I don’t consider myself to be addressing the primary channels. This level of needling happens within the sinew channels. Interestingly, the jing-well points are the only points that connect to the sinew channels—a curious thing to ponder when selecting your Saam treatment.

If you have more questions, please ask!

@sharonsherman 

thanks for sharing your needling process.  I have always assumed that we need to needle the Saam points first and then treat the branch.  I like your concept of creating slack In The channels to allow the vital qi to more effectively move thru the primary channels.  

Do you find that once the branch treatments have been provided that some of the “data” you used to select a Saam channel changes?  I use alot of abdominal reflexes when treating.  I know I am doing the right thing when they release.  In this example, if the branch treatments changes the abdomen do you reevaluate your channel decision or stick with your initial impression. 

Thanks 

@sharonsherman

I’d also add that when working in the musculoskeletal realm, I don’t consider myself to be addressing the primary channels. This level of needling happens within the sinew channels.

I'm interested in this, can you further elaborate? I was wondering if you could treat the channel only without also working with the emotional aspect of the channel's energy. I love working with the psycho-emotional aspect of Saam but sometimes it confuses me when I'm thinking more in terms of pathway and affected channel because there is not always a clear correspondance between the two. When it's the case I tend to think really hard to try and find a connexion, and sometimes I treat the opposite channel (like Pericardium when it's a GB case) just in case. But if there is a way to work more specifically with the sinew channels using saam, I'd be into knowing more! Thank you for taking the time to answer me, and I hope my questions are ok!

@danielwaywellnesscenter-com 

Hi Daniel,

I treat musculoskeletal issues in a very direct, no-frills, meat-and-potatoes kind of way. My focus is to get the patient’s pain or restriction addressed—no glamour, no theatrics. I work to create space: releasing constriction or binding so the musculature can properly recruit, and smoothing out kinks in the fascia so we’re not ironing dysfunction deeper into the system.

My toolkit is simple—usually just one or two tools per treatment. Plastisol lids for gua sha, liniments, sliding cups, and needles are my go-tos. I don’t use much moxa—that’s just my style.

I spend a fair amount of time in conversation with patients, especially during the initial visits. Whether in my former practice or now in this newer one, I prioritize building strong relationships. That rapport gives me space to start making notes about where a patient may sit on the Saam 6 qi and Mind-path continuums. Over time, as I get to know them better, I can refine the constitutional picture.

From the moment someone walks in, I’m observing posture, awareness, complexion, the quality of the eyes, how outward or inward they are. I ask questions that help steer my thinking in one direction or another. On the table, I’m palpating broad reflex zones—I’m not a hara palpation person. I take the pulse, look at the tongue, check for cold or hot areas. And always—always—I come back to the patient’s chief complaint.

I usually have a couple of treatment ideas that I explore after addressing the musculature. Sometimes these are purely driven by the pain itself, especially if that’s their main reason for coming in—this aligns closely with the material Andreas presented on Saturday. Other times, if I can clearly see how the Six Qi influences are contributing to a deeper imbalance, I’ll use the archetypes Andreas is introducing this week as the root treatment.

That said, practicing medicine means embracing the reality that “there never is always.” With time, you build a higher batting average, but there are always surprises along the way.

@catherine-debard 

If you have a copy of the Deadman point book, take a look at the sinew channels. These can be thought of as your musculoskeletal “zones.” Andreas touches on this when mapping and overlaying the correct channel for Saam treatment. While he was speaking in Saam terms, I see it as viewing the sinew maps through a Saam overlay—one that offers you the most congruent treatment options.

As for finding a clear correspondence on the psycho-emotional level, I think this Saturday’s presentation will shed more light on that. What I will say, in response to your question, is that if you believe mind, body, and spirit are intertwined, then once you place a needle, the body receives the message and processes it, in its own way. Beyond skillful sleuthing, deduction, and commitment to the treatment plan, we actually don’t control exactly how the message is received and processed.

In our sleuthing and deduction, we need to consider the patient’s overall strength and readiness to receive treatment—and not get ourselves too tangled up in every possible facet of a perfect data match. Some data points will align beautifully; others won’t. We each embody layers and the co-mingling of the various undulations of our individual topographic map—our own unique waveform that makes us who we are.

So when you’re starting out, it’s often best to go for the “low-hanging fruit”—the more obvious patterns that bring positive results and build confidence. Sometimes you’ll miss the mark, and that’s okay—you simply adjust and refine in subsequent treatments. Nothing replaces time in the clinic for developing skill and capacity. Hang in there. Stay curious. The exploration itself will grow you in ways that are both delightful and deeply beneficial to your patients.

I agree to all what you guys have said before. Very wholistic perspective. 

• In terms of Saam (I think) with the point combinations we can also address problems along the sinew channels. There are no special 4 point combos for sinew channel problems. 
• By understanding Saam balancing meridians we can directly apply principles that are also found in Dr. Tan's Balance method: The Six Qi balancing model lays out the related meridian at least of the first mirroring of Balance method (I hope I am getting the terminology in English correct) to find a reference area for painful muscoskeletal problems. For example in Saam Gallbladder and Sanjio belong to Shao Yang. So logically like in the Balance system if you have pain at the ancle along the Gb channel right side you immediately can say it might be useful to look for a treatment area at Sanjiao meridian in the wirst area on the left side as an additional treatment option. One of my friends in Korea is specializing on muscoskeletal problems and is doing Saam. He is heavily using the principles laid out in the Balance method. When I discussed this with him it turned out in Korea most Oriental Medical Doctors never heard about Balance method (under this brand name) but are using it's principles in Korean medicine anyway. It's all in the classics. 
• We should also consider that there will be cases, where the pain symptomatically shows at a specific place but it is more the projection area for example of muscular trigger points. So the better treatment might be to select the related meridian of the trigger point than that of the actual pain area. 

Andreas

@bruechasiatische-medizin-com Wow, my mind is blown! I am using the balance method already and this has just opened a wide array of possibilities! thank you for this!

@catherine-debard 

You are welcome!! 😀