cassiopeia #1September 4, 2020, 3:08am
This patient is suffering so much; Thanks for taking time to read this and giving feedback!
79yo female
Chief complaint: pompholyx eczema on first on feet, then hands. History of dry/cracked heels, worsened in
autumn 2019, correlated with aftermath of a course of antibiotics for bronchitis. Started in feet, now affecting
hands.
Skin Appearance: see attached photos.
The brown discoloration is Dermatology-M Da Huang Gao.05/01/2024, 12:08Pompholyx eczema in 79yo – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/pompholyx-eczema-in-79yo/1267/print2/605/01/2024, 12:08Pompholyx eczema in 79yo – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/pompholyx-eczema-in-79yo/1267/print3/6
Bilateral soles of feet fissured, dry, with weeping of serous fluid. Use of Da Huang Gao and gauze covering, plus
tight socks and sensible shoes, allow her to be able to walk, otherwise very painful. Intense itch when removing
bandages, needs to scratch, which irritates the skin further.
Bilateral palms have the same fissuring, dryness, some weeping, itch, and pain. If doesn t use Da Huang Gao and
gauze, the fissuring and subsequent dryness pull on the palms so much that the fingers curl inward.
Different herbal iterations gave limited improvement: initially, formulas to treat damp heat and fire toxin healed
fissuring a lot, but also induced urgent diarrhea. I ve tried both powdered and vacuum-decoctions; the limitation
with herbs is always diarrhea. (even herbs that support spleen and gently clear damp)
She was making slow but positive progress until June, when danger of potential business closure really increased
stress. Since then, the fissuring and all pompholyx symptoms intensified. The inflamed area has spread to the
ankles, L>R: redness, swelling, pitting edema, warm to touch, and itchy red macular lesions up lower legs, worst
on SP line.
Appearance: small stature, thin physique with soft belly, thin arms and legs; fingers deformed by arthritis; bright
eyes 9+, symmetry 7+, grooming 10+; rosy cheeks 2+; warm soft midline 8+; dry cracked medial heels 10+; many
varicosities esp KD 3-6 area; LU10 deflated 1+; overall thin, dry skin 5+
Affect: Polite 9+, clear, witty, and direct communicator. Chatty 6+. Controlling 8+ ( fix me by next week
humorous and also commanding). Recently feels depressed, doesn t want to get out of bed, I have no vim and
vigor , what s the point of dieting? .05/01/2024, 12:08Pompholyx eczema in 79yo – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/pompholyx-eczema-in-79yo/1267/print4/6
Lifestyle: owns and runs high-end interior design firm that s been in business for 40 years, but now, like so many
businesses, is in danger of closing. Does not want to retire. Drives shiny red volvo SUV. Divorced and seems
content living alone. Has a son and grandkids whom she only visits with sometimes in the driveway now; she
doesn t seem too bothered by this. Rarely talks about her grandkids.
GI: eats reasonably but then snacks on chocolate and popcorn after dinner; reflux and stomach pain if overeats
(often does, out of boredom). With herbs, has loose stools urgent diarrhea. Without herbs, bm ~formed, but
sticky.
Thirst, temp, sweat, urine normal
Msk: arthritis in neck, hands, knees; often stiff, achy. R hand can be numb upon waking or with too much
computer work, attributes that to neck arthritis.
Sleep: long history of taking Benadryl most nights to help with sleep. Recently poor sleep d/t stress of business.
EMO: depression, what s the point? typically a firecracker, but now often doesn t want to get out of bed. Feels
manipulated by employees.
GYN: no history taken; has one child
Tongue: dusky, swollen, little/no white coat; midline crack lung area
Pulse: slippery
Saam Conformations (Excess unless noted)
LV:
SJ: bright eyes 9+, polite 9+, notices details, pink cheeks 2+, controlling 8+
HT: warm soft midline, talker 6+, lesions ht 8; erythema; skin needs moistening and cooling; neck pain
UB: not gaga about grandkids; lesions ht 8; neck pain
PC: concave lesions/fissures; lesions P8; Feels manipulated by employees.
GB: lesions P8; sudden extreme itch when removes bandages
SP: soft abdomen, diarrhea, eats carbs out of boredom, swollen L ankle, L SP line most affected, pitting edema;
weepy lesions
LI: thin limbs, typically busy/productive, dry fissured skin; L SP line most affected
LU: well resourced; dry fissured skin
ST: thin limbs, swollen L ankle
KD: grooming 10+; volvo; still working at age 79; many varicosities; kd 1 area lesions
SI: Depressed. No vim and vigor. Dry cracked medial heels 10+; kd 1 area lesions
Saam treatments performed:
settled well, was v relaxed from most of these treatments
R SI+ neck pain improved05/01/2024, 12:08Pompholyx eczema in 79yo – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/pompholyx-eczema-in-79yo/1267/print5/6
R LI+ L ankle swelling and redness decreased by end of session
R UB+ L ankle less swollen
R KD+ ( I ve got no vim and vigor; what s the point of dieting? ) – calm, rosy face
Bi LI+ ankle swelling and redness reduced
Despite her positive calming response and clear reduction of ankle swelling while on the table, the eczema is
deteriorating.
The grossest thing in the room is the fissured skin, swollen red ankle with pitting edema.
I have no clarity on how to think about the damp/dry, interior/exterior issues.
Is this a clear Concave presentation? Does GB+ seem like a good idea?
Please send ideas and suggestions. Thank you!
KristinWisgirda: September 4, 2020, 12:04pm
Hi Fang,
Those are some serious fissures- poor lady!
My Saam miracle cure case of pompholyx was much more straightforward in terms of damp and dry. She had deep
fissures, bleeding, intense itching in her hands but no weeping. She also had an inflated chest, big voice and was
well resourced- ST+ was the ticket (along with UB+, P+).
This case is way more complicated.
cassiopeia:
Despite her positive calming response and clear reduction of ankle swelling while on the table, the eczema is
deteriorating.
It sounds like no Saam treatment has made a significant shift for her yet.
cassiopeia:
She was making slow but positive progress until June, when danger of potential business closure really
increased stress. Since then, the fissuring and all pompholyx symptoms intensified.
Since you have tried my top treatment choices for her without success, I would next focus on this part of her
presentation. I am most curious about Stomach excess. The weeping is a damp exterior, her thin body is a dry
interior. The pitting edema says fluid is accumulating from deficiency and could be seen as fluid on the surface.
The threat to her business is a loss of resources, as well as her resistance to retiring at 79 yo! Her belly is soft- with
Lung excess I would want to see an inflated belly.
cassiopeia:
Is this a clear Concave presentation? Does GB+ seem like a good idea?05/01/2024, 12:08Pompholyx eczema in 79yo – Bothersome Clinical Problems – Qiological Community
https://forum.qiological.com/t/pompholyx-eczema-in-79yo/1267/print6/6
From your analysis, it sounds like your impression of concave is from the fissures and feeling manipulated by
employees. With the weeping and edema mixed with dryness, I don t see the fissures as a caving in. The
emotional/relationship piece might be making you wonder if she needs the convexity of GB. Instead of concave,
both the physical and emotional aspects of her picture make me wonder if she is deflated. With St/Lung, I ask
myself if the patient is overinflated or deflated. This is my idea but I find it really helpful.
A Lung+ would bring the dryness of metal to firm her surface while lifting and plumping her up qi. A really
dramatic case of Lung+ doing just that can be found here: Slow Healing Wound Healed in 1 Treatment
It helped that the wound was on the Stomach channel but this woman s skin was soooo dry but puffy as well.
Please let us know what you think and what happens.
cassiopeia: September 5, 2020, 8:32pm
Hi Kristin, thanks for the helpful guidance, especially
KristinWisgirda:
With St/Lung, I ask myself if the patient is overinflated or deflated.
I m having a very hard time discerning ST/LU. the interior/exterior boundary seems so fluid. Last week I chose
incorrectly a couple times and luckily could fix the mistake. I ll apply this inflation perspective and see if that
helps provide more clarity.
That slow healing wound case offers great insight. I need to noodle on all that. Will report back after seeing my
patient again. thanks!