Jeffrey: September 10, 2019, 7:58pm
56 year old female
cc: am runny nose, scratchy throat, p.n.drip.,predominately dry coughing spasms/fits for 8 yrs.(sx. sl. productive).
face: symmetry,pretty, moist
body: dry skin on legs/moist on face (uses lotion and makeup). varicosities, cracked med. heel flesh, early menses,
painful, previous fibroids, multiple surgeries; neck from right side over use, thyroid cancer(previous), R patella
surgery, damp interior body type, well proportioned,Hidden/sticky phlegm and SOB from R cun pulse diag.
(objective), thenar eminence full ,resources
demeanor: Busy OB/GYN surgeon often on call, cares for elderly (Russian) parents, go getter, does things to prove
to herself she can do it, active, single, two grown daughters, direct, forceful, v smart
temp: feels cool-cold (subjective), warm to touch, hands warmer than feet objective
sleep: sleeps well, some dream disturbance, sleep deprived due to job
BM: 1x every other day(dry)
digestion: veggie, veg protein doesnt agree> some gas,bloat
she has exhausted every modern method and many traditional therapies.
No shortage of contrasting signs/symptoms; cracked heel/varicosities, damp body shape with dry cough/BM etc.
tx prospects; +P,+SI,+K,
I think I remember hearing somewhere; cold patient, warm to touch +SJ ?
tx: +P to open chest and bring 02, and to calm
patient said she felt more calm and noticed deeper breathing
got even a stronger sense of her int. cold after tx when she mentioned she was sl cool the last few min, room was
warm, she felt warm to touch. +H isn t off the table though concerned about other interior dryness.
+SI is a strong contender. Im just sure of order of approach:
warm the interior+H, or +SJ
*move qi n blood,(cough spasm), and Kxs S&S +SI
consolidate due to chronic +K
moisten +LU ??
???
thanks for any and all25/01/2024, 11:318 year old (wind cold) cough – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/8-year-old-wind-cold-cough/596/print2/7
KristinWisgirda: September 10, 2019, 10:02pm
Jeffrey:
dry skin on legs
Jeffrey:
damp interior body type
Jeffrey:
thenar eminence full ,resources
All together these give strong case for Lung excess. The descending action of St+ would be very appropriate for
her chief complaint of cough. The dry cough could easily be more upper respiratory, and therefor exterior- another
reason to consider ST+
Jeffrey:
warm the interior+H, or +SJ
I m not seeing strong indications for H+ or SJ+. The cold aspect of her picture seems so minor and likely would
resolve with regulating other channels.
Did you ask about the proximate cause of the cough? What kind of sick was she when it started?
Jeffrey: September 10, 2019, 10:06pm
aha I ve been focusing on interior because of the chronic nature of her cc.
she caught a cold in March 8 years ago in Mass.
KristinWisgirda: September 10, 2019, 10:35pm
Jeffrey:
I ve been focusing on interior because of the chronic nature of her cc.25/01/2024, 11:318 year old (wind cold) cough – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/8-year-old-wind-cold-cough/596/print3/7
Chronic isn t interior in Saam
Jeffrey: September 10, 2019, 10:41pm
aha, but the affected organ LU is, and from your suggestion,+ST, that gets to the root as it were, yes?
KristinWisgirda #6September 10, 2019, 10:48pm
I m less interested in the Lung organ being involved and more interested in the cough being a symptom of lack of
proper descent/upward counterflow in a patient with obvious dry exterior/damp interior + other Lung excess signs.
2 great reasons to St+.
Jeffrey: September 10, 2019, 10:53pm
that makes perfect sense. when i first saw her and knew her cc, i thought ” i need this to descend!” and wasnt quite
sure about the drying quality. thanks for weighing the anchor on that.
Jeffrey: September 14, 2019, 3:50pm
KristinWisgirda:
I m less interested in the Lung organ being involved and more interested in the cough being a symptom of lack
of proper descent/upward counterflow in a patient with obvious dry exterior/damp interior + other Lung excess
signs. 2 great reasons to St+.
does it therefore make sense to toggle between the descending function of +ST and the inward, calm oxygenating
function of +P? how much clinical weight should be put on dry stool 1x every other day and a dry cough?
Even though this person shows plenty of Kxs, she does run herself hard, and does have cracked skin on medial
heel, does +K make sense, and possibly toggling between +SI/+K? thanks
KristinWisgirda: September 16, 2019, 4:53pm
Jeffrey:25/01/2024, 11:318 year old (wind cold) cough – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/8-year-old-wind-cold-cough/596/print4/7
does it therefore make sense to toggle between the descending function of +ST and the inward, calm
oxygenating function of +P?
Her response to P+ and St+ if you try it will let you know.
Jeffrey:
how much clinical weight should be put on dry stool 1x every other day and a dry cough?
If treating her as a Lung excess type doesn t work, you can definitely reevaluate the moisture status of the interior.
Such mixed cases really make me like my case study format recommendation of making a list of all the channels
and plugging in signs and symptoms. Who knows- she could turn out to be a LI excess type hiding in a Lung
excess morphology especially since
Jeffrey:
does things to prove to herself she can do it,
Plugging in symptoms to the list of channels might make you take a second look at what is really going on. She is
pretty with a cracked medial heel- this should be inspiration to take a closer look at her for signs to refute/support
SI excess vs Kidney excess.
The grading of symptoms and the grossest thing(s) in the room will really help you make a heirarachy of
potential treatment strategies too.
Jeffrey: September 16, 2019, 5:09pm
thanks. my second treatment was ST+. I ll find out how that went and reevaluate.
KristinWisgirda:
She is pretty with a cracked medial heel- this should be inspiration to take a closer look at her for signs to
refute/support SI excess vs Kidney excess.
Re: Kxs, quite pretty7, lots of energy, pushes through to prove herself 7+, spider veins on feet 4, on legs 0, cracked
medial heel 6+, lots of jing, runs herself hard9+, decreased fertility (menapause), grooming is low, too busy all the
time 4,
could this cough be hypo/hyper ?
KristinWisgirda: September 16, 2019, 5:44pm
Somethings to take out of the SI/K equation :25/01/2024, 11:318 year old (wind cold) cough – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/8-year-old-wind-cold-cough/596/print5/7
Jeffrey:
runs herself hard9+,
Jeffrey:
pushes through to prove herself 7+,
Jeffrey:
lots of energy,
These aren t definitive signs.
Jeffrey:
decreased fertility (menapause)
This is a really weak sign because she is 56. Infertility at this age is normal so I would take it out of the equation.
However, early natural menopause or years of infertility treatments because of poor ovarian response would be SI
excess signs.
Jeffrey:
grooming is low,
She isn t into herself. This is a strong SI excess sign.
Jeffrey: September 16, 2019, 5:59pm
Thank you. Hopefully ST+ is on track, then the determination of K+/SI+ will possibly be more benefit.
Jeffrey: September 17, 2019, 4:00pm
No benefit from ST+ tx#2. patient did mention that she has felt calmer since first tx.P+.
Her feet and hands are now the same temp as the rest of her exterior(did have cold feet and and cool hands,have
not LV+). She remains cool on the inside. She has been on call and extremely busy over the last week >more
sleep deprived by she has the the jing/drive to do it. My office mate argues that my patient “is exceptionally
beautiful/striking, and DOES groom well. She thought more appropriate to SI+ to move the qi, and insisted that the
patient seems quite consolidated. As my office mate is likely more perceptive and been doing saam longer, I took25/01/2024, 11:318 year old (wind cold) cough – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/8-year-old-wind-cold-cough/596/print6/7
the clue and SI+:crossed_fingers:
she seemed to settle well and rested, face seemed to express a nice glow
KristinWisgirda: September 17, 2019, 5:43pm
So lucky to have an in-house Saam colleague to share impressions!
I m still not totally comfortable with evaluating patients on their beauty. Clinic time with Toby was really helpful
as he pointed out symmetry and good bones in patients I wouldn t consider beautiful . You do have to look
beyond personal preferences, cultural differences, etc.
Jeffrey: September 17, 2019, 7:33pm
absolutely, and real important to check not just your own personal preferences, but also local norms . ie; I was
born and grew up in New England, lived in the Bay Area and north for over 20 years. This is built in as being
normal to me. Having lived in the South for 15 years I identify the local norms even if I don t identify with them.
Ironically, this patient has lived in the north east for decades. There was something I identified with, yet there was
some contrast to local norms. Thus, i diagnosed her against local norms. I would say that there are some possible
cultural differences to be aware of in this example. Hopefully a good lesson learned.
KristinWisgirda: October 13, 2019, 11:01pm
Hi Jeffrey,
Thanks so much for presenting this case again on Zoom today. It resulted in a great and important discussion.
Please keep us updated on how it goes.
Jeffrey: October 15, 2019, 9:37pm
little bit of recap;
tx 1, P+ some feeling of relaxation and deeper breath, but did not affect CC. not as much GB xs as i thought.
tx 2, ST+, no benefit even though clearly LU xs
tx 3 SI+, next day symptoms were arrested by 4 hours, first time in 8 years, but didnt last
tx 4 SI/LI+, no benefit
tx 5 non Saam, Si Ma ( four horses) and ling gu, slight benefit to cough and am phlegm
tx 6 LV+, no benefit to CC though positive change in temperment and temperature
tx 6 SI+, again benefit in am mucous and cough that showed continous though slight improvement through the25/01/2024, 11:318 year old (wind cold) cough – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/8-year-old-wind-cold-cough/596/print7/7
week.
tx 7 H+, waiting for result this was a suggestion from Q&A
Jeffrey: October 29, 2019, 3:34pm
unfortunately we have had some scheduling issues, and it took a bit of time for this patient to respond to her H+
results.
She reported that it did warm her up in general, hands and feet too, though no change on cc.
Interesting that this patient appeared to be Lu xs in that she is a surgeon and therefore assumed plenty of finances.
As it turns out, she is caring for elderly parents and two children in high dollar colleges. That said, finances are an
issue! She is taking a short break from treatment, though wants to continue soon.
So as I had no result from previous ST+, its no wonder. She just may need LU+
KristinWisgirda: October 29, 2019, 4:08pm
Thanks for the update. Even though H+ didn t change her cough, warming her up might improve the treatment
effect of whatever you decide to do next.
With finances, I don t assume anything based on profession. I look at clothes and ask about lifestyle- vacation
homes, hobbies, etc to get an idea of their spending habits. It is also helpful to ask about attitude toward resources
too. Do they have any anxiety about money, eg getting worked up when they are balancing their checkbook or
doing their taxes?
Jeffrey: October 29, 2019, 6:26pm
KristinWisgirda:
Thanks for the update. Even though H+ didn t change her cough, warming her up might improve the treatment
effect of whatever you decide to do next.
likely so, possibly useful again later as cold is in her nature.
and with finances being an issue Lu+ looks all the better