KristinWisgirda: December 31, 2019, 12:21pm
Treating myself recently taught me a bit about damp/dry exterior/interior.
Chief complaint:
hands are rough/dry (7+), red (3+), itchy (3+)
itchy forearms 4+ (Lung/LI channels(, itchy lower legs 7+ (yang channels mostly) and sometimes armpits. Gui
zhi ge ban ma huang tang kinda helps the itching but not wonderfully. Scratching in the night leads to bloody
excoriations on the arms and legs that are slow to heal (4+)
one firm red papule/zit on the chin after drinking milk; milk and rich foods reliably lead to acne
Skin/body: In the past Toby saw me as “dry on the inside and slightly dry on the outside”. Presentation at the time
of treatment.
mildly dry skin overall (3+), dry legs (5+)
thin skin (lots of veins visible underneath) with lots of sagging skin from a 60 lb weight loss 20+ years ago; thin
receding gums not improved by gum grafting 5+
body weight normal to slightly thin, normal muscle tone
fog- a soft cushion of fluid in the subcutaneous layer- only from the hips up. 3+
spider veins at ribs 5+; varicosities on legs 2+
sweat-normal
Temp: cold 7+; not particularly bothered by dampness unless it is cold
Menses: painful 4+, irregular (skipping periods alternating with short cycles) 7+
Treatment: Stomach+ no change. SI+ no change. These treatments were not settling.
Within a day or 2 of treating LI+, my hands were much smoother and softer, my excoriations were healing faster
and the itching was almost gone. Aha! So the fog acts like a layer of turbid water that blocks blood circulation to
the surface. The image is of oil and water not mixing.
LI+ is also always deeply settling for me, more so than any other treatment. This is interesting given that I am more
of a LI excess personality- never bored, always multiple fascinating projects going. Once before going to Tucson in
May, I treated SP+ which was deeply settling. Repeating Sp+ back then gave me pains in my teeth and jaw.
A few days after treating LI+, I tried H+ which didn’t improve my skin any further. Heart+ never even warms me
up that much. The positive result of that treatment was that I wrote long overdue letters to old friends, instead of
terse Christmas cards.29/01/2024, 12:16Damp dry interior exterior – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/damp-dry-interior-exterior/808/print2/7
Repeating LI+ again improved my skin another step and was settling as well with no over drying. I am more damp
than I appear to be. My sweet tooth was also calmed by LI+. The fog might be slightly less squishy but it is hard to
tell.
Yesterday, with some mild dryness on my hands, mild acne on the Stomach channel of my chest from holiday
overindulgence, and some anxiety themed around perceived lack of resources I treated Lung+ which helped the
anxiety but didn’t clearly change the skin. I was hoping that treating Lung+ might give me better insight into
whether LI+ improved my skin by drying the interior or the exterior. Is the fog interior or exterior dampness?
Relatively healthy people can be harder to treat, especially when there is a mix of damp and dry.
3 Likes
Psoriasis and tonify Bl
pattycakes: December 31, 2019, 2:19pm
KristinWisgirda:
Relatively healthy people can be harder to treat, especially when there is a mix of damp and dry.
I find that too. Not only are the signs/symptoms subtler, but it becomes harder to tell if the S/S are due to pathology
or from the patient attempting to balance themselves. It becomes easier to find S/S from each side of paired
channels. I find it easy to get lost in the details, and have been trying to find a way to keep the bigger picture in
mind.
For instance, with LI/SP – is someone LI+ inherently very active, or do they stay active because they really dislike
boredom? It’s kind of a chicken or the egg situation.
I’m curious as to why you ever tried LI+, I would have thought you are already more LI than SP, and seems
contraindicated by having dry skin.
Daniel: December 31, 2019, 3:25pm
Thanks so much for sharing this. I too have been finding that dry skin can be super challenging vis a vis “damp dry
interior exterior” differentiation . . . sometimes it is really exterior dryness and sometimes it is dampness lurking
just below the surface (still ‘exterior’) that is blocking moisturising of the surface! And sometimes it seems the
only way to figure it out is to experiment with treatments in the Lung-Stomach and Spleen-Large Intestine
domains.
KristinWisgirda #4December 31, 2019, 3:41pm29/01/2024, 12:16Damp dry interior exterior – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/damp-dry-interior-exterior/808/print3/7
pattycakes:
I’m curious as to why you ever tried LI+, I would have thought you are already more LI than SP, and seems
contraindicated by having dry skin.
At the May Tucson class, Toby suggested that I try LI+ for my thin receding gums, as it is firming to the tissues of
the oral cavity, namely teeth and gums. He was comfortable with this recommendation based on the presence of
fog, my recent experiences with supplementing SP+ twice, my dry presentation being on the milder side, and my
general good health.
Since then I have used LI+ a number of times, with some slight improvement in my gums but always a good
settling response from the treatment and general improvement in well being. This gave me confidence to try LI+
for the skin. At the time I was wondering if the general thinness and lack of tone could be firmed by LI+, as it firms
the teeth and gums. As well, I just had an acne breakout on my chin from drinking milk- so I knew that poor
processing of damp foods was part of my picture. The LI channel distribution of the itching/excoriated region on
my arm also supported LI+. In the back of my mind, the slow to heal nature of my skin also suggested some
dampness knowing that blood nourishing never really helped my skin much at all, having had a variety of
dermatitis conditions for decades.
Getting the positive responses of improved moisture! and much reduced itchiness, I reached out to Toby. His take
was that the LI+ counterbalanced the fog. I agreed. This helped refine my understanding of LI function of firming
in the presence of dampness.
It is also really interesting that my skin is always worse in the winter, which is a mix of damp and dry cold here in
Massachusetts. Damp and warm doesn’t bother my skin at all. But H+ and SI+ don’t help my skin in any obvious
way, though they could be supportive without me directly experiencing improvement. My conclusion, based on my
body’s response to treatment, is that I am more damp than cold. The damp locks in the cold for me, just as much as
it can lock in the heat for other people.
I probably can treat myself more often and see if the gums get better.
George_Mandler: December 31, 2019, 5:05pm
Willing to be vulnerable so we can all be better clinicians. 11+
This is great Kristin, thank you.
I have a stubborn dry constipation case with dry skin, but with considerable more fog than you. Thirsty a lot.
Tongue is moist. (is that inside or outside hmmm) ST+, SP+ have not helped. Treated LU+ one time too. I’ve
thought about going to LI+ but the dry skin and thirst caused me to shy away from it. However given what you’ve
kindly shared that is what I am doing next for sure.
KristinWisgirda:
In the past Toby saw me as “dry on the inside and slightly dry on the outside”.29/01/2024, 12:16Damp dry interior exterior – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/damp-dry-interior-exterior/808/print4/7
I remember in Amherst when Toby palpated your arm and said “fog”. At the time I equated it to interior damp and
it has stuck with me in my diagnosis.
But now you provided a different image of it blocking the surface.
KristinWisgirda:
I reached out to Toby. His take was that the LI+ counterbalanced the fog. I agreed.
What does the LI+ counterbalancing the fog mean? Do you see it that it dried up the fog which allowed the surface
to be moistened? I am still in somewhat of a fog on how to apply your experience to the SAAM lexicon as to how
it improved your skin.
KristinWisgirda:
Once before going to Tucson in May, I treated SP+ which was deeply settling. Repeating Sp+ back then gave
me pains in my teeth and jaw.
Do you recall how many days apart for the treatments? You only felt calm from the first treatment but no change,
correct?
Anything get worse afterwards in terms of skin? – is it possible you pushed SP+ too far and especially needed LI+
now.
KristinWisgirda:
Relatively healthy people can be harder to treat, especially when there is a mix of damp and dry.
And yes I much prefer unwell people with gross imbalances to walk in the door. I feel a high level of “I’ve got
this” confidence because their most deficient/excess channels are screaming. However as people get well then
clinic gets hard as I find it harder to get some sort of measurable results.
KristinWisgirda:
My sweet tooth was also calmed by LI+.
We can market LI+ treatments around the holidays – Holiday sweet tooth? We can fix that.
mgreenberg #6January 1, 2020, 6:16pm
Kristin,
Can you explain what you mean by “fog”?
Thanks29/01/2024, 12:16Damp dry interior exterior – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/damp-dry-interior-exterior/808/print5/7
KristinWisgirda: January 3, 2020, 6:15pm
@mgreenberg Fog is a soft, fluidy layer in the subcutaneous tissue. To evaluate the subcutaneous rest a relaxed
hand lightly on the skin. If there is fog, you will feel it floating on a cushion of fluid. It doesn’t feel like healthy fat.
Compare that to other patients who are dry and desiccated or to other qualities of subcutaneous tissue. It should
have a nice firm integrity. Fog is pretty common, even in thin patients. Sometimes it is quite dramatic.
George_Mandler:
I remember in Amherst when Toby palpated your arm and said “fog”. At the time I equated it to interior damp
and it has stuck with me in my diagnosis.
Toby’s take on fog is that it is not clearly interior/exterior.
I had one case where it was clearly exterior damp: A postpartum woman with a chief complaint of scanty breast
milk. She also had foggy edema AND dry skin. Treatment with Lung+ increased her breast milk, reduced her fog
and moistened her skin.
@George_Mandler Let us know how your self treatment goes. You seem like you could be one of those tricky,
mostly healthy patients.
George_Mandler:
What does the LI+ counterbalancing the fog mean? Do you see it that it dried up the fog which allowed the
surface to be moistened?
I see LI+ as drying up the fog allowing circulation to the skin being improved. At first I was wondering if it was
increasing the absorptive capacity of the tissue- a thought influenced by Sharon’s idea of chalky herbs. But
increasing the absorptive capacity is a Spleen+ quality. The image that makes the most sense is of oil and water not
mixing. The damp fog presented a barrier of fluid that prevented normal blood and fluids from getting to the skin.
In regard to my Spleen treatments back in May, I just remember a deep sense of peace with the first SP+ and can’t
remember symptoms per se. Since then I have treated LI+ a whole bunch of times- at least once a month- always
feeling great afterward in some way. I don’t think 2x Sp+ created a relative LI deficit. Thinking about my case
more, I have other damp signs, like water retained in the stomach creating sloshing long after drinking and frequent
rhinitis of clear fluids, worse with cold. I also have other dry exterior signs- like nasal dryness with small amounts
of bleeding that lasts most of the winter.
George_Mandler:
Holiday sweet tooth? We can fix that.
I think we could develop a whole menu of holiday services. Need to increase your love for your mostly benign
family? H+. Need to be shielded from holiday overwhelm? Liv+. Need to process long stuck grief stirred up by the
holidays? Maybe ST+. Unable to see the light? SJ+. Feel free to add more to the list.
3 Likes29/01/2024, 12:16Damp dry interior exterior – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/damp-dry-interior-exterior/808/print6/7
Psoriasis and tonify Bl
Daniel: January 3, 2020, 7:07pm
KristinWisgirda:
I think we could develop a whole menu of holiday services. Need to increase your love for your mostly benign
family? H+. Need to be shielded from holiday overwhelm? Liv+. Need to process long stuck grief stirred up by
the holidays? Maybe ST+. Unable to see the light? SJ+. Feel free to add more to the list.
This is really Great! …
michaelmax: January 5, 2020, 6:08am
KristinWisgirda:
I think we could develop a whole menu of holiday services. Need to increase your love for your mostly benign
family? H+. Need to be shielded from holiday overwhelm? Liv+. Need to process long stuck grief stirred up by
the holidays? Maybe ST+. Unable to see the light? SJ+. Feel free to add more to the list.
Hummm… this system seems to cover a lot of clinical reality
Thanks for sharing this @KristinWisgirda. I remember Toby showing us your “fog” condition and it’s something
I think about a lot in clinic. That there can be quite dry skin, but there is a layer of “not interior, not exterior” fluid.
And as you’ve pointed it… it can be obstructive of the clear fluids and qi getting to the surface. But I usually
associate this “fluid layer” more something denser than the “fog.” So the fact that the +LI are settling and helpful
shows me that even this kind of “thin foggy fluid” can cause significant problems.
Now this is a stretch, but maybe something to consider. When I think of “not interior, not exterior” it makes me
thing of the Shaoyang and the way it gets talked about in the Shang Han Lun tradition as “half interior, half
exterior”… so maybe consider treating your Shaoyang.
I know you’ve got those diamond bright eyes (along with many classic signs of +LI). But since the SJ is considered
the pathway for fluids and yuan qi, maybe have a treatment of +SJ and see if that might improve the fluid
metabolism.
Indeed it is much easier to work the gross imbalances, much tricker when people are “healthier.” Makes us refine
our diagnosis and clinical eye.
KristinWisgirda: January 6, 2020, 6:55pm
29/01/2024, 12:16Damp dry interior exterior – Sa’am Clinical Insights – Qiological Community
https://forum.qiological.com/t/damp-dry-interior-exterior/808/print7/7
michaelmax:
But since the SJ is considered the pathway for fluids and yuan qi, maybe have a treatment of +SJ and see if that
might improve the fluid metabolism.
In Saam, SI+ and H+ are definite adjuncts for treating dampness. I remembered Toby stating that SJ+ “is only
slightly drying” but have a note that SJ+ can be considered in obesity with cold. With obesity, I wonder if SJ+ only
works if the density of Liver excess is present.
I did recently benefit from a SJ+ treatment. Needling Liv+ for insomnia caused anxiety. Counterbalancing with SJ+
calmed me right down and I slept like a baby. This was in the dark of November. It didn’t help my skin at all.
cassiopeia: September 17, 2020, 8:47pm
KristinWisgirda:
Toby’s take on fog is that it is not clearly interior/exterior.
I am so grateful to have read about Fog in this forum, it helped me feel more confident in using ST+ for a patient
this week. She complained of feeling puffy, which I otherwise may have thought of as more of an exterior damp
issue. Here is her email to me 2d after the ST+ treatment. I love her description of the crayon outline extending
from her whole body. like a child’s rendition of fog.
My feeling – so much less puffy. before I came in I’d felt like there was an extra inch of blah feeling extending
from all of my body (like an outline in crayon), it also felt a lot like the period puffiness I get or the pregnancy
feeling, plus a vague feeling of yuck in my abdomen and overall.
Today I was about 2.5 lbs lighter on scale in am and that feeling of the outline was gone and my skin was normal
(not puffy) with no yuck feeling in tummy or anywhere.