allyson_nevard: October 31, 2019, 7:15pm
1st day back in the office after a fabulous class and clinic in Portland with Toby. I came home to this case who I
would love to be able to help.
14yo boy, 5’2″, 69 pounds (up from 57), extremely tight, ticklish belly, sallow complexion with darker circles,
darker eyes, tacit +8
CC: cyclical spells of whole body pain, worst in back and neck and exhaustion. All +9. Usually these spells start in
November but they started in October this year. Can’t go to school, sleeps until 2-3pm each day. Has had periods of
sleeping 20 hours per day. June – October he is energetic, athletic and social with lots of friends and lots of
basketball playing.
b/w: lying down. no pain when he is lying down.
w/w: cold, rainy weather.
Shen is the other thing that stands out: he is very removed when he is in pain. He looks like he is in his own world,
+8. His parents say they often feel like “Hello, where did you go?” when they are talking to him. He dazes off. He
is quiet but polite. Answers with just a few words. Can manage a small smile when someone tries to joke with him.
Goes to a therapist for “medical PTSD” bc he has been sick and having every medical test out there since he was 4.
Hx: got a tick bit at age 4 and has had different severe medical problems since including Reflex Sympathetic
Dystrophy (Right leg stopped working for a year), cyclic vomiting syndrome (gone for a year now), migraines
(gone)
Other:
eczema – very rough, dry skin with flaking patches all over his body – no redness, no weeping. Very dry. scabs from
scratching so much.
very low immune system – his mom says if there is a virus out there, he’s catch it.
lots of allergies including peanuts, mold, grass, etc.
mom says he has a healthy appetite but is picky, ‘he likes what he likes”. seems to like meat. no sweet tooth.
deflated LU 10s.
knees feel weak after standing for a while and has to sit down. His mom was surprised to him say this but the said
definitely yes. I had asked if he had weakness in the knees.
normal thirst, sweating and body temp, including hands and feet.
tongue – maybe short, pale purple, moist thick, wtc, red at the very tip
LV excess, TW deficiency: dark eyes, dull, inward focus, symptoms worse in cold, rainy weather (could benefit
from some brightening up), with that sallow complexion and really tight, ticklish belly I cant say he seems like he
has plenty of blood. definitely thin and weak looking.25/01/2024, 11:2914yo skinny dry boy with exhaustion and body pain – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/14yo-skinny-dry-boy-with-exhaustion-and-body-pain/717/print2/3
LI excess, SP deficiency – extremely skinny, tight body with very dry, rough skin (but has that thick, moist wtc and
is worse in cold rain)
BL excess, HT deficiency – tight belly (but not cold), seems like hypo-function in that he sleeps so much. BL
channel pain in back and neck is the worst. Symptoms come on in colder months and go away during summer. This
was originally my 1st choice but the darker red tongue tip and the extreme dryness scared me off.
Some ST excess – deflated LU 10s and weak knees. definitely seems like a lack of qi resources although he is well
provided for by parents and has lots of friends who are good to him. Extremely dry skin doesn’t match with this at
all. Does ‘symptoms worse in rainy weather’ count towards external damp?
What does everyone think?
Thank you so much in advance.
Allyson
KristinWisgirda: October 31, 2019, 8:32pm
Hi Allyson,
Glad to have you in the Saam community! As a repeat GMPer, you already have the skills to write up a great case
with lots of helpful information. Just a little formatting for Saam will help you navigate this case better.
Case Study Format
Here is a proposal for case a case study format for our forum. I welcome any and all feedback. The goals are to
help you sharpen your Saam diagnostic skills, help your readers see your patient and stimulate conversation
that will helps us grow as Saam practitioners. When presented with the idea of a case study format/intake sheet,
this was Toby’s response: Great idea, basically the Saam diagnosis is interested in everything. I think the Shen
Kuo quote from the lecture is a good starting framew…
The following 2 tools are what your case is missing:
Going through all of the channels individually, rather than the pairs, with all of the graded symptoms will help
you see the balance of the channels better.
Identify the grossest aspects of the presentation. What really stands out to you?
If you already treated him with Saam, let us know what happened.
A 3rd tool that could help: ask yourself what channel qualities would you most want to supplement for this patient.
Do you really want to moisten via SP+, or move via SI+, or brighten via SJ+, or …?
If you still want more eyes and minds to look at what you have come up with, send it back and we will take it look.
Either way, let us know what happens. Thanks!
1 Like25/01/2024, 11:2914yo skinny dry boy with exhaustion and body pain – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/14yo-skinny-dry-boy-with-exhaustion-and-body-pain/717/print3/3