Ryan_Gallagher: January 15, 2020, 1:39am
22yo male patient
CC: Visual disturbance
• patient experiences “visual snow” and “after images”
• this has been occurring for 2 yrs; a friend died at the time—emotional time; however, he doesn’t really associate
the emotional tumult with the visual change; he thinks he’s always had the vision issues, but one day he simply
recognized it, and it’s bothered him since; both eyes are equally affected
• visual snow; “it’s like there’s a screen in front of my vision with little dots oscillating between black and white;
there’s movement to it; dots are pulsing between black and white”
• after images: most of the time they’re positive, sometimes they’re negative; started out when he’d see something
bright in the darkness, it would linger; now he sees it in the daytime too; notices it when seeing a license plate on a
car—it’ll stay in mind for a few seconds; when he moves his eyes around, there’s a slight trail; makes night driving
difficult, especially if it’s raining
• after images more commonly appear when things are dark, then he sees a bright thing and it sticks around; also
happens throughout the day; saw sun reflect on pavement this morning, stuck around—first as the same bright
orange color, then as a negative imprint (greenish color)
• after images are more noticeable in the dark, and if he hasn’t slept well, and toward the end of the day
• has always had visual floaters
• doesn’t have visual problems with computer screens (works as a coder)
• wears glasses
Appearance & demeanor:
• average facial symmetry
• dark hair, darkish complexion; eyes not very bright; doesn’t tend to make direct eye contact
• quite unconcerned with appearance (hair is disheveled, clothes are loose and casual)
• polite and pleasant +5 yet aloof +5; gives thoughtful responses to questions, but doesn’t overshare or make small
talk; seems like he’s in his own world +7; sometimes taps fingers like he’s playing music (he’s a musician)
Lifestyle:
• works as a coder; is a musician, playing in several bands24/01/2024, 11:5922yo male with visual disturbance – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/22yo-male-with-visual-disturbance/835/print2/5
• not very perfectionistic, more go with the flow
• plays instruments and video games in spare time
Body morphology:
• slight frame, on the short and thin side
• tension throughout ribsides, R moreso than L
Temperature:
• tends towards neutral to cold
GI:
• no significant problems; feels like his metabolism is fast; has about 3 b/m’s a day; with stress, can get loose
Water metabolism:
• thirst: not much
• urination: feels like he might go frequently
• perspiration: doesn’t sweat much
• dizziness: once every 3 months gets dizzy spell; also gets slight lightheadedness if he hasn’t eaten in a while
HEENT:
• headaches; had them frequently until he got glasses 6 months ago; more rare now
• of note: he gave himself a headache recently because he worries about his cranial sutures and ended up pressing
on them too hard
• tinnitus from playing in bands and going to a lot of shows; R=L; L ear drum might be damaged
• nasal congestion—nasal passages feel “tight” much of the time
• ears are also prone to congestion and popping
Chest:
• chest pains come and go; intense for a split second; at the same time he first noticed the visual snow, he had chest
pressure for a week straight; feels it right on the sternum; about once a day now; lasts just a couple seconds; no
emotional component
• denies shortness of breath or wheezing
Skin & hair:
• skin is on the oily side24/01/2024, 11:5922yo male with visual disturbance – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/22yo-male-with-visual-disturbance/835/print3/5
• has little cyst inflamed lateral to R eye, which got inflamed after picking at it; the previous session, he had a cyst
by L eye/forehead
Mental/emotional:
• generalized depression; on SSRI; manifests with low energy, anhedonia
• can have anxious spells; looks at surroundings and if things don’t look right it puts him on edge • no complaints
with sleep
• energy has felt consistently low over the past couple yrs
Excess presentations:
SP: oily skin +5, no thirst, nasal congestion +3, worry
LI: thin frame +7, runs cool +2, fast metabolism +4, nasal congestion +3
ST: thin frame +7, oily skin +5, R ribside tension +7, fast metabolism +4, nasal congestion +3, fatigue +5
LU: R ribside tension +7, nasal congestion +3
HT:
BL: runs cool +2
SI: not concerned with appearance +8
KD: cysts
LR: prone to depression +4, runs cool +2, seems like he’s in his own world +7
SJ: pulsating vision +9, difficulty with night driving +5
GB: twitchy +2
PC: cerebral +6
Grossest thing in the room: visual disturbances, not caring about his appearance
Main treatment ideas:
+LU/L, +LR/R, +SJ/L?
I’ve only seen him twice over the span of a couple months, but he’s scheduled again in a couple weeks. I’ve done
both +LU/L and +LR/R, but neither affected any change in vision. Any thoughts?
A few things I need to clarify:
How do I understand the visual snow and after images, in the context of Saam? I’m unclear on whether it’s a Liver-
excess “buffer” or a Sanjiao-excess “over-exposure” or something else. Does he need shielding or clarity?
Under which excess would I place chest pain (lots of jingluo traverse chest)?24/01/2024, 11:5922yo male with visual disturbance – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/22yo-male-with-visual-disturbance/835/print4/5
Need to ask him further about:
The nature of his chronic nasal “tightness”—damp or dry?
His worry about his cranial sutures.
KristinWisgirda: January 15, 2020, 11:07pm
Hi Ryan, It’s been a while. Thanks for the case.
Ryan_Gallagher:
eyes not very bright
Not sure if this means some brightness or that you aren’t sure if they are bright or dull. Ask yourself- are his eyes
dull? For me, dullness has been harder to notice than brightness. So if eyes aren’t striking me as clearly bright, I
simply ask myself if they are dull. Since there are a mix of SJ and Liv excess signs, the eyes could tell you what is
more true for him.
You could add some other qualities to the Liver excess list:
Ryan_Gallagher:
doesn’t tend to make direct eye contact
Yes, this could also be an effort to shield when you are overexposed. But on the whole, he sounds more Liver
excess.
Ryan_Gallagher:
sometimes taps fingers like he’s playing music (he’s a musician)
This is not a very SJ excess kind of behavior. More evidence for “off in his own internal world”
Darkish complexion?- Possible Liver excess or SI excess.
Ryan_Gallagher:
quite unconcerned with appearance (hair is disheveled, clothes are loose and casual)
Could this possibly be a Liver excess, lost in his own world sign? I know it is classically SI excess not taking care
of oneself, but a Liver excess might not care what other people think or social norms. What sounds like a better
explanation to you?
Ryan_Gallagher:24/01/2024, 11:5922yo male with visual disturbance – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/22yo-male-with-visual-disturbance/835/print5/5
How do I understand the visual snow and after images, in the context of Saam? I’m unclear on whether it’s a
Liver-excess “buffer” or a Sanjiao-excess “over-exposure” or something else.
Is his light sensitive in general?
The descriptions of his visual disturbance are such a mix of light and dark. Since the visual disturbances aren’t
pointing to a clear diagnosis, I would treat what is clearer in his presentation.
The chest pain is interesting especially as it came on with the visual disturbances. So many channels go to/through
the chest…
Let us know what happens with the next treatment.
Ryan_Gallagher: January 16, 2020, 5:51pm
Thanks @KristinWisgirda for taking the time to look over this case. I’ll ask that question “Are his eyes dull?”
next time I see him.
Hope you’re staying warm!