Daniel: July 15, 2020, 4:39pm
Would Love some thoughts on this one . . . .
66 Year Old Female
Jovial, Rotundish, Laughing, Smiling, bright Appearance
Polite, Outward going, friendly
TW XS, HT XS
no children by choice
tubes tied at age 25
Main Complaint(s):
Right 4th Finger completely stiff (history of trigger fingers) – TW channel
Left Knee Pain – medial – Liver 8
Bilateral ‘Ischial Tuberosity’ Pain , sitting can be uncomfortable (interesting because she is literally always sitting
on the edge of her seat in life!) – UB channel
TW – Liv, UB – Ht
Medical:
Diabetes, Hypertension, Hypothyroid (all medicated)
Surgeries: Tonsillectomy, Breast Reduction, Hysterectomy (very heavy bleeding, 3 huge fibroids), Cataracts,
Bilateral Carpal Tunnel
BLOOD STASIS
Sleep: wakes frequently and by 2:45 or 3:45 is often up GB XS
Energy: very energetic, never still, always moving, doing things LI XS, Ht XS
Detail: House is super clean, super organised, likes things in their place, even her cookbooks are organised TW XS
Digestion: no issues at all
Moisture: no phlegm anywhere, no congestion anywhere, skin is moist and fine
NO DAMP/DRY issues except overweight
Finances: Quite overleveraged – at this age, 200K mortgage, and signed nieces mortgage, and she and husband
need to work but are out of work since COVID
ST XS
Air / Temperature: window open even in winter, always needs air movemennt, fan on in the winter, has a hand fan
in her purse, her nightmare would be a small stuffy room. This can be described as hot, but with her, I think its
much more about air movement.23/01/2024, 11:5566 Year Old Female Trigger Finger – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/66-year-old-female-trigger-finger/1157/print2/4
Could be HT XS but I often think the claustrophobia / air movement issue is more about movement to counter
stasis of some kind
Can’t settle, always on edge
yawns a LOT
frequent spasms at Left Gall Bladder 20 (although could be UB 10)
bakes a lot and loves to give it away SP XS, HT XS
loves high carb meals
very prepared for emergencies – flashlights in every room, batteries stocked, well stocked cupboards, etc UB XS?
First session: tried Left UB +. No response on table. Did Left Liver +
Second session: Left Liver + again
Left knee pain substantially better, Ischial tuberosity pain significantly better, no change in right TW finger
Third session: Left SI + . . . first time she got very relaxed on table and her edginess responded.
KristinWisgirda: July 15, 2020, 4:56pm
Thanks for the case.
It brings to mind a couple of my own cases.
The first is a woman with a similar history trigger finger progressing to severely limited hand mobility such that
she could hardly flex her 4 fingers. Her 4th finger was also very painful. I treated her with Sa’am a couple of times
with only short lived mild improvements Then Covid hit. I read an article about herbal soaks in JCM and
prescribed a soak for her. Within 2 weeks her hand mobility was normal and the pain was gone! I know you are not
an herbalist but I just had to share this case. Covid time was an opportunity to experiment with herbal soaks for
hand and foot problems and the result were all good.
I am curious about your patient. She is rotund but what is the tissue quality of her hand. My hand patient was also
rotund but had strangely slender and fine hands.
As well, when did the trigger finger start? After the carpal tunnel surgery?
How symmetrical is she? Given her response to SI+, I’m guessing some K excess signs like varicosities and
prettiness.
Did her hand respond to SI+ yet?
A minor notes: hoarding of emergency supplies can also be St excess as well as UB excess
It looks like the hand issue is a hypofunctioning in the midst of lots of hyper functioning. It interesting that your
patient didn’t respond to UB+. You could consider H+ moderated by Liv+ if you don’t think she can handle the
heat. I never did try H+ in my patient.
Your patient reminds me of the patient I wrote up in the Case Study Format thread on this form- search for it to see
the details. She is an overweight super loving baker with a sweet tooth. She ALWAYS brings me home baked
goodies or flowers lovingly presented. She gushes about her kids and grandkids constantly. The H excess is
combined with a LI excess kinds of busyness and dedication to getting stuff done. She is interested in everything
and has loads of hobbies she is passionate about. She has had 2 recalcitrant musculoskeletal issues that resolved
completely with one Sp+. One was a knee problem on the Sp/Liver channels. The other was bilateral heel pain- no23/01/2024, 11:5566 Year Old Female Trigger Finger – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/66-year-old-female-trigger-finger/1157/print3/4
channel relationship to Spleen at all. The personality trumps morphology with her but even the personality is a mix
of extreme motherliness and LI excess busyness.
Let us know what you do and what happens.
Daniel: July 16, 2020, 2:19am
Thanks so much for your thoughtful reply Kristin.
I am pretty sure her history with trigger fingers is longstanding and her bilateral carpal tunnel surgeries were quite
recent. I will confirm that next week.
Interesting, I never thought of contrasting her hand with her ‘rotund’ core – again, I will have a look next week, but
my sense is that her hands are certainly NOT slender or fine, but kind of moderately beefy.
She admitted something interesting to me today which every Sa’Am practitioner should add to their growing list of
cautionary notes: She told me she likes a room to be dim because she has become very self-conscious of her
midsection girth and weight and the dimness hides it while a bright room makes her feel revealed. It was a very
vulnerable admission which I am sure only came because I had earned the requisite trust, BUT whoa! big caveat
for us Sa’Am people . . . . in this case, the desire for a dim room potentially does not have to do with her SanJiao-
Liver axis (which is our standard go-to on this matter) and more to do with her self-consciousness regarding her
weight (which could be a Kidney – Self Love issue although I guess it could in some way also be a SanJiao – angry
with one’s self issue?).
Overall, I would certainly characterise her as a Heart Excess person. She is warm, generous, loving, active,
genuinely smiley. And given her intense surgical history, and the fibroids, I think blood stasis looms large. That
puts the Kidney-Small Intestine and Heart-Bladder domains up front for me. But there is the intense financial
challenge, her midsection largesse and her love of sticky carby meals that alert me to Spleen-Large Intestine and
Lung-Stomach. And then the funny thing, my first two treatments were Liver supplementation!! – I got taken in to
that by her bright, polite disposition, her knee and finger pointing to Liver-SanJiao channels and the initial attempt
at UB supplementation yielding no response on the table and the pressure in that clinical moment to move to plan
B!!! This third treatment with SI + really relaxed her (and she is so on edge she says she can never relax). Clinic is
hard.
Oh – and beyond all of that, one of her GROSSEST signs is her issue with air movement!!! She needs it – a fan in
her room in the winter!! A hand fan in her purse she deploys often in restaurants and coffee shops. I have noted this
kind of thing in the past with patients – and its not about heat, its about ‘stuffiness’, a kind of claustrophobia, a need
for movement in the air . . . . I often think it has to do with an intense internally static environment (Blood stasis or
dampness) that requires the body to seek relief through movement in the surrounding air and if the surrounding air
becomes too still, a panicky feeling comes over the patient. Does that make sense?
KristinWisgirda #4July 16, 2020, 11:49am
Daniel:23/01/2024, 11:5566 Year Old Female Trigger Finger – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/66-year-old-female-trigger-finger/1157/print4/4
one of her GROSSEST signs is her issue with air movement!!! S
People are endlessly interesting! Damp and stasis make sense. Claustrophobia makes me think of P/GB too.